Number Of Emergency Room Visits Research Articles

The Role of Educational Programs in the Treatment of Bronchial Asthma in Schoolchildren of the Chechen Republic

Background. The main component of the treatment of bronchial asthma is to achieve complete control over the disease. The aim of the study is to examine the role of educational programs in the treatment of bronchial asthma in schoolchildren of the Chechen Republic.Methods. The educational programs included group and individual classes, which were conducted at the allergy school of the specialized Department of Allergology and Immunology of the E.P. Glinka Republican Children’s Clinical Hospital by an allergologist-immunologist. Educational meetings were held once a week for 2 months, their duration was 1–1.5 hours. Initially and every 3 months for one-year, bronchial asthma control was assessed based on the results of the Asthma Control Test (ACT), the number of emergency room visits, hospitalizations, attacks of shortness of breath stopped at home, missed days at school, the use of systemic glucocorticoids, indicators of pulmonary function test (PFT), the level of nitric oxide in exhaled air. The subjects were divided into two groups: group A —trained, group B — did not participate in educational programs. The subjects were represented by two age subgroups: group IA — 7–8 years old (n = 24), group IIA — 13–14 years old (n = 13). The control group consisted of 37 children who did not undergo allergy school training, who were observed on an outpatient basis by an allergist-immunologist: group IB — 7–8 years old (n = 23), group IIB — 13–14 years old (n = 14).Results. 3 months after the educational activities, the lack of control over bronchial asthma, according to the results of the ACT, was noted only in 10.8% (4) of patients, whereas in the comparison group — in 59.5% (22). The PFT study recorded an increase in the volume of forced exhalation in 1 second in children who attended allergy school (p < 0.05). A comparative analysis of the frequency of emergency room visits and hospitalizations revealed a decrease in the studied indicators in groups IA and IIA (p < 0.05). The number of missed days at school due to bronchial asthma was significantly lower in children after educational activities — 16.1% (6) and amounted to less than 14 days. Attacks of shortness of breath for 12 months occurred only in 18.9% (7) of patients and were stopped independently, their frequency ranged from 1 to 3, and the use of systemic glucocorticoids in arresting an attack was not recorded among children who attended allergy school.Conclusion. Thus, our study confirmed the high importance of educational programs in the treatment of bronchial asthma, which are an additional tool for achieving disease control and allow timely prevention of disease progression.

Heterogeneity in the health effects of PM2.5 sources across the major metropolitan cities, South Korea: Significance of region-specific management

Ambient PM2.5, well-known for its adverse impacts on human health, is a very heterogeneous pollutant. Its chemical composition and attributable sources vary by region, influenced by meteorological and geographical conditions as well as emission sources. However, administrative policies are currently focused on mass concentrations. However, not all PM2.5 sources provide equally toxic particles. Thus, those sources that should be the focus of controls has not been the priority. In the present study, we conducted source apportionment utilizing positive matrix factorization (PMF) and investigated the association of PM2.5 source contributions with emergency department visits (EDVs) in major megacities in South Korea. Overall, an interquartile range (IQR) increment in source contribution increased the number of emergency room visits. Industry and coal combustion sources, marked by heavy metals, were principally associated with the adverse health impacts. However, the sources showing significant associations with EDVs differed across the study area. In addition, we found that region-specific relationships between PM2.5 sources and morbidity were plausible, considering the existence of relevant sources such as industrial complexes and coal-fired power plants. The analysis of source contributions according to wind conditions also supported the source-morbidity relationships. These findings suggest that administrative policies for PM2.5 control should be established and implemented considering region-specific characteristics of the links between PM2.5 sources and health impacts to maximize the control's public health effects. Furthermore, the results of the present study indicate that PMF was an effective method for linking acute exposure to PM2.5 source types with health outcomes to prioritize its sources.

Polyfracture and Cranial Injuries Drive the Cost and Inpatient Burden of Zygoma Fractures.

Facial trauma makes up a significant number of emergency room visits, with morbidity costs in excess of 1 billion dollars each year. Few studies have evaluated the economic outcomes of management and inpatient burden of facial trauma, most focusing solely on the mandible and isolated midface fractures. The authors aim to evaluate characteristics associated with increased cost and length of hospitalization of zygoma fracture management. Cross-sectional study. Level 1-trauma academic medical center. Patients with zygoma fractures who presented to our institution from 2008 to 2021. Demographics, injury mechanisms, associated injuries, treatment information, and associated costs were collected. Univariate and multivariate analyses were performed to identify the patient and fracture characteristics associated with increased cost and length of hospitalization. Our 14-year experience identified 689 patients with zygoma fractures who presented from 2008 to 2021. Seventy percent were male, and 40% occurred in Caucasian patients. The mean cost, adjusted for inflation, was $21,799.34, and the mean length of hospitalization was 5.5 days. Four or more fractures, associated cranial or intracranial injuries, and length of stay were associated with significantly higher cost, and 4 or more fractures, associated cranial or intracranial injuries, and female gender were associated with significantly longer length of hospitalization. This study represents one of the largest comprehensive databases of zygoma fractures and one of the first to provide a descriptive cost and inpatient burden analysis. To improve outcomes and reduce hospital cost and inpatient burden, protocols should be implemented to address the factors that the authors identified as contributing to increased cost and length of hospitalization.

Outcomes of same-day discharge in bariatric surgery

BackgroundRestrictions during the COVID-19 pandemic influenced a shift to same-day discharge in bariatric surgery. Current studies show conflicting findings regarding morbidity and mortality. We aim to compare outcomes for same-day discharge versus admission after bariatric surgery.MethodsSubjects included patients who underwent primary laparoscopic or robotic-assisted sleeve gastrectomy or Roux-En-Y gastric bypass at an academic center. The inpatient group included patients discharged postoperative day one, and the outpatient group included patients discharged on the day of surgery. Primary outcomes included the number of emergency room visits, reoperations, IV fluid treatments, readmissions, and mortality within 30 days. Secondary outcomes were morbidity, including skin and soft tissue infection, pulmonary embolism, and acute kidney injury.Results1225 patients met the inclusion criteria. In the gastric sleeve group, 852 subjects were outpatients and 227 inpatients. In the gastric bypass group, 70 subjects were outpatients, and 40 were inpatients. The mean age was 44.63 (17.38–85.31) years, and the mean preoperative BMI was 46.07 ± 8.14 kg/m2. The subjects in the outpatient group had lower BMI with fewer comorbidities. The groups differed significantly in age, BMI, and presence of several chronic comorbidities. The inpatient and outpatient groups for each surgery type did not differ significantly regarding reoperations, IV fluid treatments, or 30-day mortality. The inpatient sleeve group demonstrated a significantly higher readmission percentage than the outpatient group (4.6% vs 2.1%; p = 0.02882). The inpatient bypass group showed significantly greater ER visits (21.7% vs 10%; p = 0.0108). The incidence of adverse events regarding the secondary outcomes was not statistically different.ConclusionSame-day discharge after bariatric surgery is a safe and reasonable option for patients with few comorbidities.

Decreased aggressive care at the end of life among advanced cancer patients in the Republic of Korea: a nationwide study from 2012 to 2018

BackgroundThis study aimed to investigate the trends of aggressive care at the end-of-life (EoL) for patients with advanced cancer in Korea and to identify factors affecting such care analyzing nationwide data between 2012 to 2018.MethodsThis was a population-based, retrospective nationwide study. We used administrative data from the National Health Insurance Service and the Korea Central Cancer Registry to analyze 125,350 patients aged 20 years and above who died within one year of a stage IV cancer diagnosis between 2012 and 2018.ResultsThe overall aggressiveness of EoL care decreased between 2012 and 2018. In patients’ last month of life, chemotherapy use (37.1% to 32.3%; p < 0.05), cardiopulmonary resuscitation (13.2% to 10.4%; p < 0.05), and intensive care unit admission (15.2% to 11.1%; p < 0.05) decreased during the study period, although no significant trend was noted in the number of emergency room visits. A steep increase was seen in inpatient hospice use in the last month of life (8.6% to 26.6%; p < 0.05), while downward trends were observed for hospice admission within three days prior to death (13.9% to 11%; p < 0.05). Patients were more likely to receive aggressive EoL care if they were younger, women, had treatment in tertiary hospitals, or had hematologic malignancies. In the subgroup analysis, the overall trend of aggressive EoL care decreased for all five major cancer types.ConclusionThe aggressiveness of EoL care in stage IV cancer patients showed an overall decrease during 2012–2018 in Korea.

The outcomes of treatment for homebound adults with complex medical conditions in a hospital-at-home unit in the southern district of Israel

BackgroundA model of hospital-at-home services called the Home Care Unit (“the unit”) has been implemented in the southern region of the Clalit Healthcare Services in Israel. The aim of the present study was to characterize this service model.MethodsA retrospective cross-over study. included homebound patients 65 years of age and above who were treated for at least one month in the framework of the unit, between 2013 and 2020. We compared the hospitalization rate, the number of hospital days, the number of emergency room visits, and the cost of hospitalization for the six-month period prior to admission to the unit, the period of treatment in the unit, and the six-month period following discharge from the unit.ResultsThe study included 623 patients with a mean age of 83.7 ± 9.2 years with a mean Mini-mental State Examination (MMSE) score of 12.0 ± 10.2, a mean Charlson Comorbidity Index (CCI) of 3.7 ± 2.2 and a Barthel Index score of 23.9 ± 25.1. The main indications for admission to the unit were various geriatric syndromes (56.7%), acute functional decline (21.2%), and heart failure (12%). 22.8% died during the treatment period and 63.4% were discharged to ongoing treatment by their family doctor after their condition stabilized. Compared to the six months prior to admission to the unit there was a significant decrease (per patient per month) in the treatment period in the number of days of hospitalization (2.84 ± 4.35 vs. 1.7 ± 3.8 days, p < 0.001) and in the cost of hospitalization (1606 ± 2170 vs. 1066 ± 2082 USD, p < 0.001).ConclusionsTreatment of homebound adults with a high disease burden in the setting of a hospital-at-home unit can significantly reduce the number of hospital days and the cost of hospitalization. This model of service for homebound patients with multiple medical problems maintained a high level of care while reducing costs. The results support the widespread adoption of this service in the community to enable the healthcare system to respond to the growing population of elderly patients with medical complexity.

Using Telemedicine to Care for Patients with Breast Cancer: A Natural Quasi-Experimental Study.

This investigation assessed the clinical characteristics of patients who received care through telemedicine and the clinical impact telemedicine service had on breast cancer patients in a low-income country. This natural experimental study assessed the impact of telemedicine service on cancer outcomes among breast cancer patients at Shaukat Khanum Memorial Trust (SKMT), Pakistan, between January 1st, 2018, to December 31st, 2022. The study group (hybrid group) consisted of patients that had both face-to-face and telemedicine appointments, and the control group (physical group) included patients with only face-to-face encounters. A total of 3,205 patients were included in the analysis. Among those included in the analysis, 3,188 (99.5 %) were females, and the mean age of the cohort was 48.10 ± 11.94 years. Statistically significant differences were observed between the two groups in age, demographic distribution, disease stage, average number of emergency room visits, mean length of stay in the Intensive care unit, and the final patient status (alive at the end of observation period). However, the binary logistic regression model (forward-LR) suggested that the final patient outcome was related to disease relapse, COVID-19 infection, and age. Telemedicine clinics, when conducted in parallel with physical clinics (hybrid setup), are safe and have a clinical impact similar to having just physical encounters among breast cancer patients in a low-income country.

Title: The Impact of Recent Vaso-Occlusive Crisis on Health-Related Quality of Life in Adults with Sickle Cell Disease

Introduction: Sickle cell disease (SCD) is characterized by vaso-occlusive crises (VOCs) and a progressive clinical course, often leading to end organ damage and mortality. Individuals living with SCD with recurrent VOCs experience daily life disruptions due to recurrent pain crises, debilitating chronic pain and fatigue, which substantially impair health-related quality of life (HRQoL). The impact of a recent VOC on HRQoL has not been quantified. We investigated HRQoL impacts in adults with SCD who experienced a recent VOC (&amp;lt; 1 week) in comparison to overall adults with SCD with recurrent VOCs. Methods: A mixed-methods study was conducted to quantify the HRQoL, work impacts, and perceived health inequalities of individuals with SCD with recurrent VOCs. The study consisted of qualitative interviews and an online longitudinal survey administered at 3 timepoints (month 0, 3, and 6) in the US, UK, France, Germany, and Italy. Patient advocacy groups used multi-channel outreach to invite participants, who were required to meet the eligibility criteria and provide consent. Key eligibility criteria included recurrent VOCs defined as ≥ 2 VOCs/year in each of the 2 years prior to enrollment requiring a medical facility interaction and administration of pain medication or red blood cell transfusion. The survey included multiple patient-reported outcome (PROs) measures: the Functional Assessment of Cancer Therapy - Bone Marrow Transplant (FACT-BMT) inclusive of the FACT-General (FACT-G), EuroQol- 5 Dimension 5-Level (EQ-5D-5L), 11-point pain numerical rating scale (NRS), Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me), and the Work Productivity and Activity Impairment (WPAI) questionnaire. In this post-hoc analysis study participants with a current or recent VOC (&amp;lt; 1 week ago) were identified based on ASCQ-Me responses (herein referred to as recent VOC). The HRQoL impact of a recent VOC was assessed by descriptively comparing PRO scores between those with a recent VOC and the overall population of adults with SCD with recurrent VOCs (herein referred to as overall population). Results: The survey was completed by 142 participants with SCD (≥ 18 years) with 139 providing time since last VOC living in the US (n=82) and UK, Germany, France, and Italy (n=57). Fifty-six (40.3%) reported a recent VOC and had a similar mean age (35.7 vs. 35.3 years) and hydroxyurea use in the past month (58.9% vs. 61.9%) compared with the overall population. A higher proportion of those with a recent VOC were unemployed or unable to work due to SCD (76.8% vs. 64.7%). The mean EQ-5D VAS (0-100 scale, 100=best health) among those with a recent VOC was 49.2 (SD: 14.2), which was 16.2% and 38.8% lower relative to the overall study population (58.7 [SD: 19.4]) and the US general population (80.4 [SD: 15.6]), respectively. The overall mean EQ-5D health utility US index score (0.59 [SD: 0.27]) was much lower than the US general population (0.85 [SD: 0.21]) and further reduced among those with a recent VOC by 0.11 (0.48 [SD: 0.25]). The FACT-G total mean score was 53.6 (SD: 14.3) (0-108 scale, 108=best HRQoL) among those with a recent VOC representing a clinically meaningful reduction compared with the overall population (62.5 [SD:18.1]); with all FACT-G domain scores negatively impacted by a recent VOC. Based on the WPAI, those employed with a recent VOC (n=15) reported a mean of 35.4% (SD: 35.8%) absenteeism and 62.5% (SD: 21.8%) presenteeism, which were higher than the overall study population (24.7% [SD: 27.1%] and 42.0% [SD: 27.8%)], respectively). In the past 12 months, those with a recent VOC had a greater mean number of emergency room visits (9.6 [SD: 12.6] vs 6.2 [SD: 8.8]), hospitalizations with overnight stays (6.0 [SD: 5.7] vs. 4.0 [SD: 4.5]), and days overnight in the hospital (21.8 days [SD: 32.9] vs. 14.7 [SD: 24.7]) compared to the overall population. Conclusions: Despite current treatments, nearly 40% of adults with SCD in the surveyed population experienced a recent VOC (&amp;lt; 1 week), which has significant negative impacts on HRQoL and functional status, including the ability to work. These results demonstrate the substantial humanistic burden of those living with SCD with recurrent VOCs and the additional impairment of a recent VOC. Novel treatments that reduce or eliminate VOCs may provide an opportunity to improve health inequalities, HRQoL, and address unmet needs in this patient population.

Clinical Subtypes of Neutrophilic Asthma: A Cluster Analysis From Australasian Severe Asthma Network

Clinical heterogeneity may exist within asthma subtypes defined by inflammatory markers. However, the heterogeneity of neutrophilic asthma (NA) remains largely unexplored. To explore potential clusters and the stability of NA. Participants with NA from the Australasian Severe Asthma Network underwent a multidimensional assessment. They were then asked to participate in a 12-month longitudinal cohort study. We explored potential clusters using a hierarchical cluster analysis and validated the differential future risk of asthma exacerbations in the identified clusters. A decision tree analysis was developed to predict cluster assignments. Finally, the stability of prespecified clusters was examined within 1 month. Three clusters were identified in 149 patients with NA. Cluster 1 (n= 99; 66.4%) was characterized by female-predominant nonsmokers with well-controlled NA, cluster 2 (n= 16; 10.7%) by individuals with comorbid anxiety/depressive symptoms with poorly controlled NA, and cluster 3 by older male smokers with late-onset NA. Cluster 2 had a greater proportion of participants with severe exacerbations (P= .005), hospitalization (P= .010), and unscheduled visits (P= .013) and a higher number of emergency room visits (P= .039) than that of the other two clusters. The decision tree assigned 92.6% of participants correctly. Most participants (87.5%; n= 7) in cluster 2 had a stable NA phenotype, whereas participants of clusters 1 and 3 had variable phenotypes. We identified three clinical clusters of NA, in which cluster 2 represents an uncontrolled and stable NA subtype with an elevated risk of exacerbations. These findings have clinical implications for the management of NA.

Social Determinants of Health and Associations With Outcomes in Pediatric Patients With Brain Tumors.

Social determinants of health (SDOH) are nonmedical factors that affect health outcomes. Limited investigation has been completed on the potential association of these factors to adverse outcomes in pediatric populations. In this study, the authors aimed to analyze the effects of SDOH disparities and their relationship with outcomes after brain tumor resection or biopsy in children. The authors retrospectively reviewed the records of their center's pediatric patients with brain tumor. Black race, public insurance, median household income, and distance to hospital were the investigated SDOH factors. Univariate analysis was completed between number of SDOH factors and patient demographics. Multivariate linear regression models were created to identify coassociated determinants and outcomes. A total of 272 patients were identified and included in the final analysis. Among these patients, 81 (29.8%) had no SDOH disparities, 103 (37.9%) had 1, 71 (26.1%) had 2, and 17 (6.2%) had 3. An increased number of SDOH disparities was associated with increased percentage of missed appointments ( P = .002) and emergency room visits ( P = .004). Univariate analysis demonstrated increased missed appointments ( P = .01), number of postoperative imaging ( P = .005), and number of emergency room visits ( P = .003). In multivariate analysis, decreased median household income was independently associated with increased length of hospital stay ( P = .02). The SDOH disparities are prevalent and impactful in this vulnerable population. This study demonstrates the need for a shift in research focus toward identifying the full extent of the impact of these factors on postoperative outcomes in pediatric patients with brain tumor.

Healthcare resource utilization (HCRU) and costs among adult patients with lung cancer with broad panel genomic testing and clinically relevant or non-clinically relevant genomic variants.

e18889 Background: Lung cancer is the second most common cancer diagnosed in the United States. An estimated 236,740 new cases of lung cancer were diagnosed in 2022. Use of genomic testing to drive treatment decisions can lead to improvements in patient survival. However, the HCRU and costs of genomic testing are just being understood and little is known about the impact of the clinical relevance of those genomic findings. Methods: This retrospective analysis utilized administrative claims and enrollment information with linked genomic sequencing results from Optum’s de-identified Market Clarity Data and Clinicogenomics Database. Adult lung cancer patients newly diagnosed between 01 January 2016 – 30 June 2021 with evidence of treatment and genomic sequencing results post diagnosis were eligible for the study. Patients were required to have at least 6 months of continuous enrollment prior to and after their diagnosis date, unless death occurred, and were followed until death, disenrollment, or study end. Cohorts were created based on presence of clinically relevant variants with an FDA-approved treatment for lung cancer. Unadjusted all-cause HCRU and costs during follow-up were reported as per-patient per-month (PPPM). Results: This study identified 2,190 patients, of which 999 (45.6%) had clinically relevant variants. Age, insurance type, and geographic region did not appear to differ substantially between groups, though those with clinically relevant variants were more likely to be female (57.4% vs. 46.0%). During follow-up, the average number of PPPM ambulatory visits was similar between groups (5.89 vs. 5.58, p = 0.08), but the average number of emergency room visits (0.29 vs. 0.23, p &lt; 0.01) and inpatient stays (0.12 vs. 0.11, p = 0.03) were higher among those with clinically relevant variants. Additionally, those with clinically relevant variants had higher average PPPM all-cause medical costs ($20,948 vs. $19,097; p = 0.02) and pharmacy costs ($3,073 vs. $2,083, p = 0.02). Conclusions: Average PPPM emergency room visits, inpatient stays, medical costs and pharmacy costs were higher among lung cancer patients with clinically relevant variants compared to those with non-clinically relevant variants. Future research should evaluate HCRU and costs attributable to targeted therapy. [Table: see text]

Trends of using immune checkpoint inhibitors near end of life in limited resources setting: Experience of single cancer center in the MENA region.

6566 Background: Immune checkpoint inhibitors (ICIs) are standard of care nowadays in the treatment of many solid tumors as single agent or in combination. Recent literature suggested increased use of ICI near end of life; our aim was to find the characteristics of the patients who received ICI 30 days or less before their death. Methods: Data of patients with advanced solid tumors who have (ICI) therapy and died with disease were retrospectively retrieved. Patients were categorized into those dying within 30 days of the last dose of ICI and those receiving the last dose of ICI more than 30 days before death. Variables of potential interest were compared between the two groups by the Chi-square and independent sample t-tests as appropriate. Results: A total of 411 patients were included in this analysis; 135 (33%) received the last dose of ICI within 30 days of death and 276 (67%) received their last dose more than 30 days before death. Major cancer types included: lung (n=214; 52%), kidney (n=61; 15%), melanoma (n=44; 11%), head and neck (n=41; 10%), and others (n=14; 3%). Patients’ characteristics: median age = 58, majority were males (310; 75%), 105 (26%) had ECOG PS ≥3, and 147 (36%) had brain metastasis. Patients who received the last dose of ICI within 30 days of death had more frequent ICU admissions (50 (37%) vs. 60 (22%), p=0.001, and were less likely to die under the care of the hospice care service (22 patients (16%) vs. 84 (31%), p=0.001. In addition, patients who received the last dose of ICI within 30 days of death were more likely to have a full code status (89 (66%) vs. 147 (53%), p=0.015, and have received a lower number of doses of ICI treatments (mean number of doses: 4.2 vs. 6.5 doses, p=0.001). We did not observe any significant difference between the two groups regarding type of cancer, age, gender, ECOG PS, presence of brain metastasis, number of hospital admissions, dying inside hospital, and number of emergency room visits. Conclusions: Immune checkpoint inhibitors may be overused near end of life which leads to minimal clinical benefits, less likelihood of dying under hospice care, and utilization of ICU resources.

Delays in Diagnosis and Treatment of Appendicitis in Females [ID: 1375790

INTRODUCTION: Sex disparities in a perioperative emergency warrant investigation to improve equitable patient care. We investigated whether differences exist in care of appendicitis across patient sex. METHODS: We performed a retrospective cohort study of patients with appendicitis between 2011 and 2020 at an inner-city academic hospital. We collected demographic data and time records of key milestones in clinic care. We used chi-square, paired t test, ANOVA, and Cox proportional hazard analyses to examine differences between sex and other factors. RESULTS: A total of 385 patients were included, 182 (47.3%) females and 203 (52.7%) males. Patients were similar across sex, age, race, reason for visit, and number of emergency room visits. The time to admission for females was longer as compared to males (t(304)=–2.82, P&lt;.05). Cox proportional hazard analysis predicting time to admission based on sex while controlling for age and race showed that females have a longer time to admission (HR 0.73 [95% CI 0.58–0.92]), youngest patients (&lt;15 years) were admitted faster than older-aged patients (HR 2.13 [95% CI 1.45–3.13]), and as compared with Black patients, White patients were admitted faster (HR 1.56 [95% CI 1.06–2.29]). CONCLUSION: Reproductive-aged females had significantly longer times to admission than male peers with the same indication, and White patients were admitted more expeditiously than Black patients. There was a trend of slower surgical consult and admission for females with gynecological disorders. This study suggests that sex biases exist within our system. This highlights that an active effort must be taken to rule out differentials that are not sex based.

Impact of pharmaceutical teleconsultation on glycemic control of people with type 2 diabetes mellitus in a public pharmacy in Brazil: A randomized clinical trial protocol (TelePharmaceutical Care Diabetes Trial) – TPCDT

Telepharmacy is a fundamental tool to ensure glycemic control in patients who don’t access health services. The objective of this protocol is to report the procedures of a randomized clinical trial that will evaluate the impact and economic evaluation of a pharmaceutical teleconsultation service for patients using dapagliflozin, recently incorporated by the Brazilian public health system for the treatment of type 2 diabetes (T2D). Patients aged 65 years or older, with T2D, and who withdraw dapagliflozin in a public pharmacy located in southern Brazil will be recruited. They will be electronically randomized with allocation for intervention or control group. The intervention will be conducted out through three teleconsultations, one per month, with a pharmacist. The main outcomes will be glycemic control (hemoglobin A1c) and treatment adherence. Secondary outcomes will include lipid profile, blood pressure, and body mass index, number of hospital admissions, number of emergency room visits, number of medical consultations performed, number of problems related to pharmacotherapy identified and resolved, cost related to service and quality of life. The economic evaluation will be carried out using time-driven activity-based costing. Through this research, we will be able to identify whether pharmaceutical teleconsultation services can complement face-to-face consultations to improve health outcomes in T2D patients on dapagliflozin. The study was registered in Clinical Trials (NCT05380596).

Healthcare utilization among pre-frail and frail Puerto Ricans.

Frailty is associated with adverse health outcomes and greater healthcare utilization. Less is known about the relationship between frailty and healthcare utilization in Puerto Rico, where high rates of chronic conditions and limited healthcare may put this group at a higher likelihood of using healthcare resources. This study examined the association between pre-frailty and frailty with healthcare utilization at baseline and 4-year follow-up among a cohort of community dwelling Puerto Ricans living on the island. We examined data from 3,040 Puerto Ricans (mean age 70.6 years) from The Puerto Rican Elderly: Health Conditions (PREHCO) study between 2002-2003 and 2006-2007. We used a modified version of the Fried criteria defined as 3 or more of the following: shrinking, weakness, poor energy, slowness, and low physical activity. Pre-frailty was defined as 1-2 components. The number of emergency room visits, hospital stays, and doctor visits within the last year were self-reported. Zero-inflated negative binomial regression models were used for ER visits and hospital stays. Negative binomial models were used for doctor visits. Pre-frailty was associated with a higher rate of doctor visits with a rate ratio of 1.11 (95% CI = 1.01-1.22) at baseline. Frailty was associated with a higher rate of ER visits (1.48, 95% CI = 1.13-1.95), hospital stays (1.69, 95% CI = 1.08-2.65), and doctor visits (1.24, 95% CI = 1.10-1.39) at baseline. Pre-frailty and frailty were not associated with any healthcare outcomes at follow-up. Pre-frailty and frailty are associated with an increased rate of healthcare services cross-sectionally among Puerto Rican adults, which may cause additional burdens on the already pressured healthcare infrastructure on the island.

Relationship Between Patient-Centered Primary Care Provider Communication and Emergency Room Visits in the Medicaid Population in North Carolina, United States.

Medicaid, a joint federal-state program, finances health care for eligible low-income individuals and families in the United States. Medicaid patients use disproportionately more emergency room (ER) services than other patients in the United States. Inadequate provider communication during primary care visits might be one reason for this well-documented phenomenon. The goal of the study was to examine how patient-centered provider communication related to ER use by Medicaid patients in North Carolina. A 2015 state-wide cross-sectional telephone survey of NC adult Medicaid patients (n = 2652) was based on the CAHPS methodology. Predictors were 4 patient-centered provider communication characteristics assessed by patients. The outcome was the number of ER visits during 6 months prior to the survey. We used negative binomial regression to examine the relationship. Effective patient-centered provider communication index was associated with 19% fewer ER visits (P < .05). Provider's respect for patients had the biggest impact on the number of visits (37% fewer ER visits, P < .001). Easy to understand provider explanations were associated with 18% fewer ER visits (P < .05). Longer (>1 year) patient continuity with the current primary care provider was associated with 36% to 38% fewer ER visits (P < .001). Health care quality improvement should focus on training providers how to show respect, give easily understood explanations, and maintain good interpersonal relationships with patients. Relevant agencies should emphasize training and accreditation with a specific emphasis on communication of providers delivering care to Medicaid patients.

Risk of Periodontitis in Patients with Gastroesophageal Reflux Disease: A Nationwide Retrospective Cohort Study.

Gastroesophageal reflux disease (GERD) is the most common digestive clinical problem worldwide that affects approximately 20% of the adult populations in Western countries. Poor oral hygiene has been reported to be associated with GERD as an atypical clinical complication. However, evidence showing the relationship between GERD and the risk of periodontitis is less clear. The present study aimed to use a retrospective cohort study design to further clarify the association between GERD and the subsequent risk of periodontitis. The risk of periodontitis in patients with GERD was investigated by analyzing epidemiological data from the Taiwan National Health Insurance Research Database from 2008 to 2018. We selected 20,125 participants with a minimum age of 40 years in the GERD group and 1:1 propensity-matched these with non-GERD individuals by sex, age, and comorbidities. The incidence of periodontitis was determined at the end of 2018. A Cox proportional hazards regression model was used to evaluate the risk of periodontitis in patients with GERD. The overall incidence rate of the periodontitis risk was 1.38-fold higher (30.0 vs. 21.7/1000 person years, adjusted hazard ratio (aHR) = 1.36, 95% confidence interval (CI) = 1.28-1.45) in patients with GERD than in those without GERD. After stratified analyses for sex, age, and comorbidity, patients with GERD had a higher risk of periodontitis for age (aHR = 1.31, 95% CI = 1.20-1.42 for 40-54 years and aHR = 1.42, 95% CI =1.28-1.57 for 55-69 years), sex (aHR = 1.40, 95% CI = 1.28-1.54 for men and aHR = 1.33, 95% CI = 1.23-1.45 for women), and presence (aHR = 1.36, 95% CI = 1.27-1.45) and absence (aHR = 1.40, 95% CI = 1.21-1.62) of comorbidity than those without GERD. Among the GERD cohort, the risk for periodontitis was increased with an increasing number of emergency room visits (≥ 1 vs. &lt;1, aHR = 5.19, 95% CI = 2.16-12.5). Our results revealed that patients with GERD have a higher risk of periodontitis development than those without GERD. Clinicians should pay more attention to identifying and managing periodontitis in patients with GERD.

Using Wet Bulb Globe Temperature and Physiological Equivalent Temperature as Predicative Models of Medical Stress in a Marathon: Analysis of 30 Years of Data From the Twin Cities Marathon.

: Assess the relationships between wet bulb globe temperature (WBGT) and physiologic equivalent temperature (PET) at the start of a northern latitude marathon and their associations with medical stress and transfers to the emergency room (ER) when the race environment is unexpectedly warm, and participants are not acclimatized. : Retrospective review. : Twin Cities Marathon from 1990 to 2019. : Runners competing in the Twin Cities Marathon. : Start WBGT (prospectively collected) and PET (retrospectively calculated). : Marathon race starters and finishers and race day medical data (eg, medical stress, number of medical encounters, and number of ER visits). : The mean WBGT was 7.4°C (range -1.7°C to 22.2°C), and the meant PET was 5.2°C (range -16.7°C to 25.9°C). PET was not determined to be a significant predictor of medical stress (P = 0.71); however, a significant quadratic association between WBGT and medical stress was found (P = 0.006). WBGT (P = 0.002), but not PET (P = 0.07), was a significant predictor of the number of ER visits. Start WBGT was a better predictor of medical stress and ER visits than PET at the Twin Cities Marathon over a 30-year period. The start WBGT may be a better tool to predict race day environment medical safety.

S1172 Early Palliative Care Referral May Improve End of Life Care in End-Stage Liver Disease Patients. A Retrospective Analysis From a Non-Transplant Center

Introduction: Patients with End Stage Liver Disease (ESLD) who are not transplant candidates often have a trajectory of rapid decline and death similar to patients with stage IV cancer. Palliative care (PC) services have been shown to be underutilized for such patients. Most studies examining the role of PC in ESLD have been done at transplant centers. Thus, determining the utilization and benefit of PC at a non-transplant tertiary center may help establish a standard of care in the management of transplant-ineligible patients with ESLD. Methods: We conducted a retrospective analysis of adult patients with ESLD admitted to Rochester Regional Health (RRH) system hospitals from 2012 to 2021. Patients were divided into groups based on presence (Group 1) or absence (Group 2) of PC involvement. Baseline characteristics were recorded. Impact of PC was assessed by comparing number of hospitalizations before and after PC referral, comparing code status changes, health care proxy (HCP) assignments, and requirement of repeated paracentesis. Results: 576 patients were analyzed of which 237 received a PC consult (Group 1) and 339 did not (Group 2). Baseline characteristics were comparable in both groups (Table). Mortality rate was significantly higher in group 1 than group 2 (83.1 vs 46.4%, p < 0.01). Changes in code status were higher in group 1 than in group 2 (77.6% vs 29.2%, p < 0.001). 59.9% in group I had comfort care code status and 67.8% in group 2 had full code. Patients in group 1 were more likely to have an HCP assigned (63.7% vs 37.5%, p < 0.001). Aspira catheter use (5.9% vs 0.9%, p < 0.001) and hospitalizations for frequent paracentesis (30.8% vs 16.8%, p < 0.001) were both more frequent in group 1. Mean number of emergency room visits or hospitalizations before the first PC consult was 15.6 and mean number of admissions after PC consult was 3.4 (P< 0.001). Conclusion: Our study shows that PC referral in patients with ESLD is associated with a higher rate of code status changes, HCP assignments and reduced hospitalizations. Patients receiving a PC referral were more likely to have a comfort care status while patients without a PC referral were more likely to be full code. Mortality rates at our non-transplant center were higher in patients with palliative care referral than those without. It suggests that patients did not receive a PC referral unless their disease severity was significant, however all patients with ESLD may benefit from early PC referral. Table 1. - Baseline characteristics and outcomes Variable PC involved (237) PC not involved (339) P-value Age (years) 64.61 64.07 0.58 Sex (% male) 57.40% 55.20% 0.59 Hepatocellular carcinoma 11 (4.6%) 12/339 (3.5%) 0.38 Transplant referral done 41 (17.3%) 72/339 (21.2%) 0.29 Mortality 196 (83.1%) 157 (46.4%) < 0.0001 Aspira catheter 14 (5.9%) 3 (0.9%) < 0.001 Frequent paracentesis 73 (30.8%) 57 (16.8%) < 0.001 TIPS procedure 8 (3.4%) 24 (7.1%) 0.06 Code status changes 184 (77.6%) 99 (29.2%) < 0.001 Full code 44 (18.6%) 230 (67.8%) < 0.001 Comfort care 142 (59.9%) 70 (20.6%) < 0.001 HCP assignments 151 (63.7%) 127 (37.5%) < 0.001

Long-Term Observational Outcomes after Total Correction of Congenital Heart Disease in Korean Patients with Down Syndrome: A National Cohort Study.

Background: In the present study, the population prevalence and postoperative morbidity and mortality in Down syndrome patients who underwent total correction for congenital heart disease were investigated using data from a large national cohort. Methods: Retrospective administrative data from 2,395,966 participants born between 2008 and 2012 were acquired from the National Investigation of Birth Cohort in Korea. Among Down syndrome patients, 58.3% had congenital heart disease and 32.3% underwent total correction. Propensity score matching (maximum 1:1) and stabilized inverse probability treatment weighting (IPTW) were performed for each group (153 Down syndrome patients and 4482 non-Down syndrome patients). Results: T late mortality rate was significantly higher in the Down syndrome group than in the non-Down syndrome group (8.1% vs. 3.8%). No differences were observed in postoperative heart failure and arrhythmias, but pulmonary hypertension was significantly greater in the Down syndrome group than in the non-Down syndrome group (26.9% vs. 7.0%). The length of hospitalization was longer in the Down syndrome group than in the non-Down syndrome group (14 days vs. 11 days; interquartile range (IQR): 10–25 vs. 6–19; p < 0.0001). After total correction, readmission frequency for any reason was minimally but statistically significantly higher in the Down syndrome group compared to the non-Down syndrome group (5 times vs. 5 times; IQR: 3–8 vs. 4–9; p < 0.0001). However, the number of emergency room visits was minimally but significantly lower in the Down syndrome group compared to the non-Down syndrome group (2 visits vs. 2 visits (IQR): 2–7 vs. 1–4; p = 0.016). Conclusions: Down syndrome patients with congenital heart disease undergoing total correction showed pulmonary hypertension after surgery, longer length of hospitalization, frequent hospitalization after surgery, and a higher rate of late mortality.