Outpatient Care Center Research Articles

Creating a Multidisciplinary Bioethics Ambassador Program at a Comprehensive Cancer Center.

The Ethics Committee at Memorial Sloan Kettering Cancer Center (MSK) developed a Bioethics Ambassador Program (BAP); a yearlong educational program to assist clinical and non-clinical staff develop the skills to identify and address common burgeoning ethical issues that can arise during the provision of care to patients with cancer. The goal was to provide greater awareness of the role and services of Ethics, particularly at the institution's geographically-diverse outpatient care centers and to better-instill a culture of preventative ethics. This article discusses the design and implementation of the first two years of the program and analyzes its strengths, weaknesses, and impact on MSK.

Retention processed placental membrane versus standard of care in treating diabetic foot ulcers.

Diabetic foot ulcers (DFUs) are a severe complication for diabetic patients, significantly impacting patient quality of life and healthcare system efficiency. Traditional standard of care (SOC) treatments are inadequate for many patients, necessitating the use of advanced wound care products, such as human placental membranes. We studied a real-world population of large, hard-to-heal and complicated wounds, otherwise under-studied in the wound care literature. To this end, we conducted a retrospective cohort analysis to compare the effectiveness of a human placental amnion/chorion membrane product using retention-based processing (RE-AC) and SOC in managing chronic DFUs. During the study period of September 2021 through April 2024, we collected retrospective observational data from electronic health records of 21 patients treated with RE-AC at three outpatient wound care centres. Additionally, 21 control SOC patients were matched from a wound registry using Coarsened Exact Matching. Patients were categorized into two cohorts based on whether they received RE-AC or SOC. Key metrics included wound size progression and wound closure. The analysis employed Bayesian regression and Hurdle Gamma Analysis of Covariance models. Despite their rather large size (average of 13.8 cm2), our results indicated that RE-AC achieved almost a 10% higher expected wound closure rate compared to SOC at 12 weeks (8.53% [credible interval: 5.60%-10.7%]). Further, for wounds that did not close, RE-AC resulted in a 93.6% (credible interval: 147.7%-41.6) improvement in expected Percent Area Reduction over the SOC group at 12 weeks. We noted that on average, SOC wounds stalled or grew larger. In terms of a risk ratio comparing the study group with SOC, we found a 52% benefit in the RE-AC group (RR = 1.52). The findings suggest that even with larger DFUs, R-AC is superior to SOC for wound closure and expected Percent Area Reduction by 12 weeks. This benefit likely leads to reduced treatment costs, optimized resource utilization and improved outcomes in the DFU patient population; ultimately resulting in improved patient care.

Improving Screening for Social Determinants of Health in an Outpatient Complex Care Clinic.

Families of children with medical complexity (CMC) may face challenges related to Social Determinants of Health (SDoH). Although standardized SDoH screening has been implemented in numerous medical settings, there has been limited study of screening among CMC. Our global aim is to improve access to institutional and community resources for families of CMC with identified needs. Here, we aimed to establish SDoH screening for families in our outpatient Complex Care Center and attain a screening rate of 80%. A multidisciplinary team in our clinic used quality improvement methods to implement and study an expanded SDoH screen, which included 3 questions specific to the needs of CMC (ie, emergency planning, social support, and medical equipment concerns). Interventions, informed and refined by 5 key drivers, were tested over a 12-month period. A statistical process control chart tracked key outcome and process measures over time. SDoH screening sustained a mean of 80% after implementation during the study period. Incorporating registration staff in screen distribution was our most impactful intervention. At least 1 SDoH concern was identified on 56% of screens; concerns specific to CMC and mental health were most frequently reported. A total of 309 responses to positive screens were reported in total. Successful implementation of an expanded, tailored SDoH screen revealed a multitude of social needs specific to families of CMC that otherwise may not have been recognized. Our team continues to develop and distribute resources to address identified needs.

Experience of organizing BCG therapy for localized bladder cancer in outpatient cancer care centers

Experience of organizing BCG therapy for localized bladder cancer in outpatient cancer care centers

Usability And Feasibility of an in-Home Remote Exam Device in Children with Medical Complexity During the COVID-19 Pandemic.

Background: Children with medical complexity (CMC) account for high health care utilization. Telemedicine holds significant potential in CMC, as it allows a provider to engage with CMC in their home environment and can alleviate both financial and transportation burdens. Remote exam devices that enable the performance of a physical exam could expand the ability of providers to clinically assess CMC during a telemedicine visit. In this pilot study, our goal was to develop a process for integrating an in-home remote exam device into a complex care clinic during the COVID-19 pandemic and evaluate the usability and feasibility of this device. Methods: The remote exam device was distributed to caregivers of CMC cared for at a complex care outpatient center. Using deliberate practice framework, our onboarding process provided opportunities for caregivers and providers to learn how to utilize the device. Surveys examining usability and feasibility were administered to both caregivers and providers after each telemedicine encounter. Results: A total of 43 caregivers participated in the onboarding process, which included a total of 83 practice visits. The remote exam device was rated as having excellent usability by caregivers; however, providers rated the device as having lower usability. Feasibility was notable for technology issues contributing to 15% of encounters being cancelled or ending early. Conclusions: The remote exam device was successfully integrated into a complex care clinic. Data from this pilot study supports the usability and feasibility of deploying a remote exam device across a telemedicine platform in a busy and complex outpatient academic practice.

An Overview of the Management of Drug-Resistant Tuberculosis in Six French-Speaking African Countries from 2018 to 2022.

Drug-resistant tuberculosis (DR-TB) poses a significant public health challenge, particularly in resource-limited settings. The prevalence and management of DR-TB in African countries require comprehensive strategies to improve patient outcomes and control the spread of the disease. Aggregated routine data (from 2018 to 2022) on multidrug-resistant TB (MDR-TB) were collected from the National TB Programs (NTPs) from all six countries. The diagnostic capacity for MDR-TB was globally insufficient. The system for collecting and transporting samples was sometimes inoperative. A total of 2353 cases of MDR-TB were reported, with 86.4% receiving treatment. The gap between the expected number of MDR-TB cases and the number reported per country varied from 51.5% to 88.0%, depending on the year. Fifty-two extensively drug-resistant (XDR) TB cases received treatment regimens over five years, with variations across countries. All patients received free follow-up examinations, nutritional and financial support for travel expenses to the outpatient care and treatment centers. The MDR-TB treatment success rates for all regimens between 2018 and 2021 ranged from 44.4 to 90.9%, varying by country and year. The information system relied on primary tools, reporting tools, and digital solutions. Progress has been made in MDR-TB management; however, challenges persist, necessitating resources to enhance access to rapid molecular screening tests.

Increasing Provider Utilization of a Seizure Action Plan in the Outpatient Setting.

A seizure action plan (SAP) is a powerful tool that provides actionable information for caregivers during seizures. Guidelines have expressed the need for individualized SAPs. Our quality improvement team aimed to increase implementation of an SAP within a pediatric tertiary center, initially among epilepsy providers and expanded to all neurology providers. Process changes were implemented using Plan-Do-Study-Act cycles and data were evaluated monthly using control charts. The team focused on tracking patients who received SAPs and identified opportunities for improvement, including reminders within the electronic medical record, and standardizing clinic processes. A secondary analysis was performed to trend emergency department (ED) use among our patient population. The SAP utilization rate among epilepsy providers increased from a baseline of 39% to 78% by December 2019 and reached the goal of 85% by June 2020, with a further increase to 92% by February 2022 and maintained. The SAP utilization rate among general neurology providers increased from 43% in 2018 to 85% by July 2020, and further increased to 93% by February 2022 and maintained. ED visits of established patients with epilepsy decreased from a baseline of 10.2 per 1000 to 7.5 per 1000. Quality improvement methodologies increased the utilization of a standardized SAP within neurology outpatient care centers. The SAP is a simplified tool that allows patients and providers to navigate a complex health care system. The utility of an SAP may potentially extend to minimizing unnecessary ED visits.

Sicherstellung der hausärztlichen Versorgung in Deutschland – Befunde einer quantitativen Befragung von Allgemeinmediziner*innen

ZusammenfassungHintergrundAngesichts der Gefahr einer Verknappung niedergelassener Allgemeinmediziner*innen stellt sich die Frage, welche Konzepte wirksame Beiträge leisten können, um eine drohende Mangelversorgung abzuwenden. Bis dato fehlt es an Studien, die beleuchten, wie Hausärzt*innen aus ihrer beruflichen Erfahrung zu verschiedenen Ansätzen zur langfristigen Sicherstellung der Primärversorgung stehen.Ziel der ArbeitZiel der Studie war es, Positionen, Haltungen und Erfahrungswerte von Hausärzt*innen mit Blick auf eine Sicherstellung der allgemeinmedizinischen Breitenversorgung zu ermitteln.MethodenIm Zuge einer Online-Befragung wurden zwischen Februar und Juni 2023 insgesamt 4176 Hausärzt*innen befragt. Über die deskriptive Analyse hinaus erfolgte zur Ermittlung von signifikanten Unterschieden zwischen 2 Gruppen ein t‑Test bei unabhängigen Stichproben.Ergebnisse42 % beobachten im Umfeld einen merklichen Schwund allgemeinärztlicher Praxen. 53 % bescheinigen der Hausarztmedizin eine sinkende Attraktivität für den ärztlichen Nachwuchs, was 3 Problembereichen zugeordnet wird: 1) Stellung der hausärztlichen Versorgung im Gesundheitswesen, 2) Voraussetzungen in Aus- und Weiterbildung, 3) Arbeitsbedingungen. Zur Sicherung der Hausarztmedizin sprechen sich die Befragten v. a. für folgende Ansatzpunkte aus: Einrichtung eines Primärarztsystems (85 %), vermehrte Förderung von Interesse und Berührungspunkten in Aus- und Weiterbildung (80 %), Stärkung multiprofessioneller ambulanter Versorgungszentren (64 %), Restrukturierung von Curricula (56 %) und Zulassungskriterien zum Medizinstudium (50 %), Reform der allgemeinmedizinischen Weiterbildung (53 %).DiskussionHausärzt*innen haben eigene Vorschläge und Präferenzen, die Expertisen und Sachverständige ergänzen. Bei der Planung, Implementierung und Evaluation von Maßnahmen zur Stabilisierung der hausärztlichen Versorgung sollten Allgemeinmediziner*innen konsequenter als bislang involviert werden.

Assessing placental membrane treatment efficiency in diabetic foot ulcers: Processing for retention versus lamination.

Diabetic foot ulcers are a severe complication in diabetic patients, significantly impact healthcare systems and patient quality of life, often leading to hospitalization and amputation. Traditional Standard of Care (SOC) treatments are inadequate for many patients, necessitating advanced wound care products (AWCPs) like human placental membranes. This study conducts a retrospective analysis to compare the effectiveness of two human placental membrane products, retention-processed amnion chorion (RE-AC) and lamination-processed amnion chorion (L-AC) in managing chronic diabetic foot ulcers (DFUs). The study collected retrospective observational data from electronic health records (EHRs) of patients treated for DFU at three outpatient wound care centers. Patients were categorized into two cohorts based on the treatment received. Key metrics included wound size progression and the number of product applications. The analysis employed Bayesian estimation, utilizing an analysis of covariance model with a Hurdle Gamma likelihood. We found that RE-AC achieved a marginally higher expected Percent Area Reduction (xPAR) in DFUs compared to L-AC at 12 weeks (67.3% vs. 52.6%). RE-AC also required fewer applications, suggesting greater efficiency in general wound closure. Probability of full wound closure was similar in both groups (0.738 vs 0.740 in RE-AC and L-AC, respectively). The findings suggest that while L-AC might be slightly more effective in complete ulcer healing, RE-AC offers overall better treatment efficiency, especially in reducing the frequency of applications. This efficiency can lead to improved patient comfort, reduced treatment costs, and optimized resource utilization in healthcare settings.

#2933 Quality of care in patients after kidney transplantation with or without telemedicine

Abstract Background and Aims Patients after transplantation require special attention to avoid complications. This includes trained medical doctors but also adherent patients and the integration of other health provider. eHealth products have the potential to improve medical care further. Therefore, we established a telemedicine module in addition to the standard care, which is ongoing since 2019. Patients receive a smartphone app to provide vital signs, confirm the intake of medication and have access to their laboratory values, current medication plan and a medication alert. A telemedicine team values the incoming data and acts if needed (www.maccs-projekt.de). In this study, we want to evaluate how satisfied patients are with telemedicine compared to patients receiving standard care only. Method This is a monocentric and prospective cross-sectional study including a set of questionnaires. We have a positive decision of ethics committee at our center. The study started 2020 and is still ongoing. We ask patients with appointments at our center for participation. If a signed consent is available, patients receive a set of questionnaires. We choose the ZAPA (https://www.kbv.de/media/sp/ZAP_Fragebogen_Englisch.pdf) and ZUF-8 (https://gfqg.de/forschung/assessment/zuf-8), both validated questionnaires, to evaluate the quality of care. Results Demographic data: To date 247 patients participate, 156 (63.2%) with additional telemedicine and 91 (36.8%) as control (68% male). Median age is 57 years (±13.59 years). The youngest participant in the study is 21 years old, and the oldest is 85 years old, resulting in an age range of 64 years. In this population, the data indicate the following primary causes for transplantation: IgA Nephropathy (18.1%), ADPKD/Polycystic Kidney Disease (16.5%), unknown aetiology (8.6%), Chronic Glomerulonephritis (6.6%), and Focal Segmental Glomerulosclerosis (4.1%). Collectively, these conditions account for 53.9% of the underlying diseases leading to transplantation in this cohort. All patients are kidney recipients, 24 patients (9.7%) received a second kidney transplant, while only three patients (1.2%) received three kidneys. Nine patients (3.6%) had a mono pancreas transplantation, three patients (1.2%) received two pancreas and one patient (4%) had three pancreas transplantations. Two patients (8%) received a liver transplantation. The median after kidney transplantation is eleven years (± 9.4 years). The maximum of a functioning kidney is currently 39 years. Questionnaires: The ZAP evaluates the satisfaction of patients with their outpatient care centers. The questionnaire has five categories measuring various aspects of medical care (scale 0 to 100 points, higher values indicate greater satisfaction). The results are shown in Table 1. In average 94.7 to 96.8% of patients participated on this test. The questionnaire ZUF-8 evaluates the satisfaction of patients with the current care (every kind of care can be estimated). ZUF-8 includes eight questions and has a range of eight to 32 points. Higher sums indicate better satisfaction. The telemedicine group had a mean of 28.6 points (±3.2 points) and the control group a mean of 28.8 points (±3.4 points). Conclusion All over, patients are highly satisfied with the standard care after transplantation at our center. Patients with access to telemedicine seem to benefit from help regarding organization of their treatment plan. The data indicate trend to better doctor-patient interaction and cooperation of the doctor to support patients, although testing for significance could not rule out the null hypothesis. As the trial is still ongoing, we plan further evaluations with more participants.

Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre

BackgroundTo analyse the nature of medical or technical emergency issues of ambulatory peritoneal dialysis (PD) patients calling a nurse-provided emergency PD support service of a reference centre that is provided all year in the after-hours.MethodsWe retrospectively analysed patients’ chief complaint, urgency, resolution of and association to current PD treatment and modality directed to an on-call nurse-provided PD support service from 2015–2021 based on routinely collected health data. Calls were systematically categorized being technical/procedural-, medical-, material-related or type of correspondence. Call urgency was categorized to have “immediate consequence”, inquiry was eligible for “processing next working day” or whether there was “no need for further action”. Call outcomes were classified according to whether patients were able to initiate, resume or finalize their treatments or whether additional interventions were required. Unexpected adverse events such as patients’ acute hospitalization or need for nurses’ home visits were evaluated and quantified.ResultsIn total 753 calls were documented. Most calls were made around 7:30 a.m. (5:00–9:00; median, 25-75th CI) and 6:30 p.m. (5:00–8:15). 645 calls were assigned to continuous ambulatory- (CAPD) or automated PD (APD). Of those, 430 calls (66.7%) had an “immediate consequence”. Of those 77% (N = 331) were technical/procedural-, 12.8% (N = 55) medical- and 6.3% (N = 27) material related issues. 4% (N = 17) were categorized as other correspondence.Issues disrupting the course of PD were identified in 413 cases. In 77.5% (N = 320) patients were able to initiate, resume or finalize their treatment after phone consultation. Last-bag exchange was used in 6.1% enabling continued therapy in 83.6%.In 35 cases a nurse visit at patients’ home or patients' visit to the practice at the earliest possible date were required, while hospitalization was required in seven medical category cases (5.4% and 1.09% of total assessed calls, respectively).ConclusionThe on-call PD-nurse provides patient support for acute and imminent issues enabling them to successfully initiate, resume or finalize their prescribed treatment. Nurses triage of acute conditions facilitated rapid diagnostics and therapy. Maintaining quality PD homecare, the provision of trained personnel is indispensable. The information gathered in this study may therefore be used as a foundation to tailor educational programs for nephrology nurses and doctors to further develop their competencies in PD.

The barriers and facilitators to nursing care for patients with permanent colostomy in outpatient centers: A qualitative study.

Ostomy care nurses are responsible for the management of patients with colostomy from the time of diagnosis. Currently, most ostomy care services are provided in outpatient ostomy care centers in order to reduce patients' hospital stay and reduce hospitalization-related costs. Many different factors can affect colostomy nursing care provision in these centers. Identification of these factors can facilitate quality care provision. This descriptive qualitative study was conducted in 2020-2021 to explore the barriers and facilitators to nursing care for patients with permanent colostomy in Tehran and Qom ostomy centers. Participants were twelve nurses with ostomy care licenses, two adult patients with permanent colostomy for at least two years, and one family caregiver of a patient with permanent colostomy purposefully selected from outpatient ostomy care centers in Iran. Data were collected via fifteen in-depth semi-structured interviews and were analyzed using Graneheim and Lundman's conventional content analysis. The barriers and facilitators to nursing care for patients with permanent colostomy in outpatient centers came into three main categories, namely specialized capabilities of colostomy care, care continuity, and caring status in the family. These findings imply that not only nurses, but also patients, family caregivers, and referral systems can influence nursing care provision to permanent colostomy. Effective management of these factors can improve the quality of ostomy nursing care.

Self-report versus clinical ratings using the SWAP-200 in the assessment of personality disorders

The relationship between self- and informant reports of personality using psychometric instruments is constantly the focus of attention for researchers in the field of clinical assessment in psychology. The research shows weak agreement between clinicians and patients’ assessments of personality disorders (PDs). The current study aimed at the convergence of measurement of PDs using the Shedler-Westen Assessment Procedure (SWAP-200), the self-report Character Styles Questionnaire-R (CSQ-R) and Borderline Personality Inventory (BPI). Paper-pencil questionnaires were administered to 102 inpatients (88.2% female, aged 18-64, M = 38.4) in a voivodeship hospital and outpatient health care centre. The SWAP-200 allowed us to gather expert (clinician) personality ratings basing on the intensive contact with patients. Results show that only a few SWAP-200 PD scales showed low positive correlations with corresponding self-reported PD scales from the CSQ-R. With the canonical correlation analysis, we identified two functions (borderline and internalising) that described similarities between the SWAP-200 and CSQ-R. SWAP-200 Obsessive-Compulsive PD correlated negatively with BPI scales. Consistent with previous studies, the self-report and the clinical assessment were only marginally convergent. Furthermore, OCPD stands out from other disorders in that it correlates positively with health indicators and negatively with some of the other personality disorders. The highest agreement was observed in the description of Borderline PD.

Screening of Individuals with Type 2 Diabetes on Anti-Diabetic Agents for Probable Hypoglycaemia Using the Stanford Hypoglycemia Questionnaire (SHQ) in Outpatient Settings: A Cross-Sectional Study from Outpatient Diabetes Care Centres in North India.

The study was aimed at identifying the incidence of unreported probable hypoglycaemia in individuals with type 2 diabetes (T2DM) on anti-diabetic medications, using the screening Stanford Hypoglycemia Questionnaire (SHQ) in real-world situations. It was a multicentre cross-sectional study on consecutive individuals attending 10 diabetes care centres in Lucknow, Uttar Pradesh, India. The inclusion criteria were as follows: known individuals with T2DM, literate, age greater than or equal to 18 years, on at least one anti-diabetic agent for more than a month and not engaged in regular self-monitoring of blood glucose (SMBG). This study was conducted from August 2017 to April 2018, involving 1198 participants. The mean age of the individuals enrolled was 53.45 years (±10.83), with males comprising 55.3% of the population. It was found that 63.6% of patients were on sulphonylurea (SU), 14.5% were on pioglitazone, 92.2% on metformin, 62.3% on Dipeptidyl peptidase (DPP4i) and 12.8% on Sodium-glucose cotransporter (SGLT2i). The mean SHQ score was 1.81 (±1.59). Probable hypoglycaemia was mild in 57.59%, moderate in 14.69% and severe in 1.41%. Those with diabetic neuropathy (P = <0.001), retinopathy (P = <0.001) and nephropathy (P = <0.001) had significantly higher SHQ scores. Insulin or SU use was associated with a significantly higher SHQ score. Concomitant statin use was associated with a lower incidence of mild, moderate and severe hypoglycaemia (P = 0.01). On multivariate analysis, we found that age, sex, systolic blood pressure (SBP), insulin use and fasting blood sugar were the most important factors associated with an increased risk of hypoglycaemia with an R2 cut-off of 0.7. SHQ was discovered to be a simple and cost-effective screening tool for outpatient detection of hypoglycaemia in an Indian setting, and it can add value to management.

Hospital transformation into regional health care

Hospitals in Germany are under enormous pressure. Legal reforms and shortages of nurses and doctors are forcing hospitals to review inpatient services to assess whether they can be provided on an outpatient basis. Legislation is now promoting such transformation processes through changes in hospital planning and financ-ing. Hospitals, thus, have become attractive partners and designers of regional integrated care solutions.&#x0D; OptiMedis is currently supporting various hospitals in the planning and conceptualization of regional, inte-grated health care with more centralized inpatient services and increased outpatient care options Smaller hospitals, which are no longer needed for inpatient care after the centralization of inpatient services, can be transitioned towards regional outpatient care. Here, outpatient practices, rehabilitative facilities, therapists, CHN, social workers, case and care managers, among others, can then work together intersectorally under one roof. There are already some concepts and German words describing this: Intersectoral Health Center, Primary Care Center, and Extended Outpatient Care. It is important to determine what needs exist in each region.&#x0D; This presentation will describe the different concepts pertaining to the transformation of smaller hospitals into regional outpatient intersectoral health care centers and discuss the implications for further development of integrated healthcare in Germany.

External validation of the M-CARS score for mortality risk in coronary intensive care units

Abstract Background The M-CARS (Mayo-CICU Admission Risk Score) score was recently developed and validated for coronary intensive care units (CICU) for the estimation of mortality risk at admission. Most existing scores were developed and validated for general intensive care unit patients with a distinct profile, and need a myriad of both clinical and laboratory data from the first 24 hours after admission and constant updates. The M-CARS is based on only 7 data points collected at admission: the presence of cardiac arrest, respiratory failure and/or any type of shock, the Branden score, blood urea nitrogen &amp;gt; 23mg/dL, anion gap &amp;gt; 14 and red blood cell distribution width (RDW) &amp;gt; 14.3. The scale varies from zero to 10 points and three risk categories were described: low (0 to 2 points), intermediate (from 2 to 4), and high (&amp;gt;4 points). Purpose To provide external validation of the M-CARS score. Methods Retrospective cohort of patients admitted to two CICUs in the same academic hospital. One is linked to the emergency ward and mainly admits acute cardiac care patients. The second one is linked to the cardiology clinical and surgical wards, the outpatient care center, and the interventional and surgical suites. Demographic, clinical, and laboratory data were collected during admission to obtain the M-CARS score. Our primary endpoint was death within 30 days of admission to CICU. Readmissions for the same time interval were also evaluated. Statistical analysis used parametric and non-parametric tests as needed to describe the data and for comparison between groups. P-value &amp;lt; 5% was established as significant. Results A total of 408 consecutive patients were included: 60% men, 81% white and the median age was 64 years. The mean stay duration was 6±6 days. The total mortality at 30 days was 9.8% (40 patients), with no age (62.4±14,6years - alive vs 66.4 ± 17.0years - dead; p=0.10), gender (p=0.31), and CICU location (10.9%- CICU linked to the emergency ward vs 8.3% - CICU linked to cardiology wards; p=0.38) differences. The M-CARS score was obtained in 363 patients, and the lack of blood chloride levels needed for anion gap calculation was the reason for the 45 patients not being included in this analysis. Within this group, 38 (10.5%) patients died. The M-CARS score was significantly higher in the group of patients who died within 30 days (4.4±2.6 vs 2.0±1,6; p&amp;lt;0.0001). Considering the risk categories, mortality was significantly distinct between all mortality risk categories (Low = 3.4%, Intermediate = 10.2%, and High =40.5%; p&amp;lt;0.0001, and P&amp;lt;0.0001 for all Bonferroni post-tests). Readmissions with 30 days had similar M-CARS score (P=0.64).CONCLUSIONS: The M-CARS score was adequate in identifying the mortality risk category in CICUs from outside the country it was developed. It could not predict readmissions. It may be incorporated into the admission proceedings and be used to guide medical care and instruct relatives about the risks of the patient.

Organizational models of cancer patient routing at the regional level

The main objective of the oncology patient routing system in the region is to ensure the accessibility and quality of outpatient oncology care. According to the regulatory documents of the Ministry of Health of Russia, the key role in the routing system is assigned to outpatient cancer care centers. We analyzed the regulatory requirements for the operation of the centers and proposed algorithms for their integration in the regions. Based on the developed algorithms, routing modeling and a rank assessment of the models were performed with a subsequent risk assessment and rationale for organizational measures to mitigate the risks.

Association Between Personality Traits and Functional Limitations in Older Adults with Affective Disorders: A Cross Sectional Study

ABSTRACT Objectives Personality traits and affective disorders are both related to functional limitations. It is unknown whether personality traits have an additional effect on functioning in older adults with affective disorders. We studied the association between personality traits and functioning within this group. Methods We performed a cross-sectional study of 180 older patients referred to outpatient specialized geriatric mental health care centers with a depressive, anxiety and/or somatic symptom disorder according to DSM-criteria. We studied the association between the Big Five personality traits and functional limitations assessed with the WHO-DAS II, adjusting for potential confounders, including the severity of various affective disorders. Results The 180 patients (57.1% female, mean age 69.2 years) had an average WHO-DAS II score of 31.3 (SD 15.1). Lower scores on Conscientiousness were associated with more overall functional limitations (p = .001), particularly limitations in self-care (p = .001) and household activities (p = .001). Lower Extraversion scores were associated with more limitations in getting along with others (p = .001). Conclusions Personality traits are related to functional limitations independent of the severity of affective disorders in older adults. Clinical implications Personality traits may be used as predictive factors for functioning in older adults with affective disorders.

Pragmatic clinic-based investigation of echocardiogram parameters in asymptomatic patients with type 2 diabetes in routine clinical practice and its association with suggestive coronary artery disease: a pilot study

BackgroundPatients with diabetes mellitus (DM) have cardiovascular diseases (CVD) as a major cause of mortality and morbidity. The primary purpose of this study was to assess the echocardiographic parameters that showed alterations in patients with type 2 diabetes mellitus(T2DM) with suggestive coronary artery disease (CAD) determined by electrocardiography and the secondary was to assess the relationship of these alterations with established cardiovascular risk factors.MethodsThis cross-sectional, observational pilot study included 152 consecutive patients with T2DM who attended a tertiary DM outpatient care center. All patients underwent clinical examination and history, anthropometric measurements, demographic survey, determination of the Framingham global risk score, laboratory evaluation, basal electrocardiogram, echocardiogram, and measurement of carotid intima-media thickness (CIMT).ResultsFrom the overall sample, 134 (88.1%) patients underwent an electrocardiogram. They were divided into two groups: patients with electrocardiograms suggestive of CAD (n = 11 [8.2%]) and those with normal or non-ischemic alterations on electrocardiogram (n = 123 [91.79%]). In the hierarchical multivariable logistic model examining all selected independent factors that entered into the model, sex, high triglycerides levels, and presence of diabetic retinopathy were associated with CAD in the final model. No echocardiographic parameters were significant in multivariate analysis. The level of serum triglycerides (threshold) related to an increased risk of CAD was ≥ 184.5 mg/dl (AUC = 0.70, 95% IC [0.51–0.890]; p = 0.026.ConclusionOur pilot study demonstrated that no echocardiogram parameters could predict or determine CAD. The combination of CIMT and Framingham risk score is ideal to determine risk factors in asymptomatic patients with T2DM. Patients with diabetic retinopathy and hypertriglyceridemia need further investigation for CAD. Further prospective studies with larger sample sizes are needed to confirm our results.

How can primary care be secured in the long term? – a qualitative study from the perspective of general practitioners in Germany

BackgroundSecuring primary care is an important issue for health policy. Given a threatened shortage of GPs in Germany, there are discussions about what actions to take to guarantee primary care.ObjectivesThe aim was to obtain opinions of German GPs towards (a) the status quo and development of primary care, (b) favoured actions to secure it and (c) assessment of the actions taken.MethodsIn 2021 and 2022, 96 semi-structured interviews (criterion sampling) amongst GPs were conducted in all German federal states (41 face-to-face, 32 by telephone, 23 via telecommunication application). The data was analysed according to qualitative content analysis. Additionally, a short questionnaire recorded the problem of GP shortage.ResultsMany interviewees fear a veritable shortage of GPs in the future. They identify structural problems linked to the health care system. The interviewees suggested creating a primary care physician system or upgrading the GP position. They proposed greater support of interests about general practice in education and training, a restructuring of curricula and admissions criteria in higher medical education and reforming GP training. Building up multi-professional outpatient care centres and strengthening task shifting are valuable. The interviewees have observed progress in ensuring primary care but see a need for further action.ConclusionThe study has shown that GPs, from their perspective and experience, make specific suggestions to ensure primary care in the long term. Consequently, it is advisable to consider their points of view when planning, implementing and adjusting steps to strengthen primary care.