Outpatient Environment Research Articles

Iub™ Sead™ - A Novel Intra Uterine Ball: Spherical Endometrial Ablation Device

<h3>Study Objective</h3> The aim of this study is to assess the safety and efficacy of the IUB SEAD™ (Intra Uterine Ball: Spherical Endometrial Ablation Device) introducing silver nitrate to the uterus in women suffering from abnormal uterine bleeding. We present results of 6 months follow up period post treatment. <h3>Design</h3> Open-label multicenter study to assess the safety and efficacy of the IUB SEAD™ device in premenopausal women with predictable menstrual cycles, who suffer from AUB. Women with HMB were enrolled who had an average pictorial blood loss assessment chart (PBAC) score ≥ 150 over for 3 months. <h3>Setting</h3> The study was performed in the outpatient clinics of 2 Bulgarian medical centres between September 2019 and December 2020. <h3>Patients or Participants</h3> 16 women with HMB (PBAC>150) at least 3 months before inclusion were enrolled. <h3>Interventions</h3> Eligible subjects who met all the inclusion/exclusion criteria were treated during the first 7 days following the cessation of menses. The SEAD™ device was inserted into the uterine cavity via vaginal approach. The device was left in the uterus for 30 (±5) minutes and then removed. <h3>Measurements and Main Results</h3> A total of 16 participants aged 37-50 (mean = 43) were enrolled with a mean baseline PBAC score of 424; 14 of 16 completed follow up requirements and were evaluable at 6 months. All procedures were completed successfully without device/procedure-related adverse events. At 6 months post-treatment the mean PBAC score was 95 with 55% of the overall cohort ≤75 and 72% ≤ 100 and a mean percentage of 83% reduction. The mean procedure related pain score was ≤2 (mild).* <h3>Conclusion</h3> The IUB SEAD™ device is safe and effective in treating HMB in an outpatient environment. Future studies with larger number of patients are planned. *Results may vary until presentation date.

Rebooting the ambulatory enterprise in a community medical group in Kentucky following the initial surge of COVID-19.

The novel coronavirus disease 2019 (COVID-19) pandemic has intensified globally since its origin in Wuhan, China in December 2019. Many medical groups across the United States have experienced extraordinary clinical and financial pressures due to COVID-19 as a result of a decline in elective inpatient and outpatient surgical procedures and most nonurgent elective physician visits. The current study reports how our medical group in a metropolitan community in Kentucky rebooted our ambulatory and inpatient services following the guidance of our state's phased reopening. Particular attention focused on the transition between the initial COVID-19 surge and post-COVID-19 surge and how our medical group responded to meet community needs. Ten strategies were incorporated in our medical group, including heightened communication; ambulatory telehealth; safe and clean outpatient environment; marketing; physician, other medical provider, and staff compensation; high quality patient experience; schedule optimization; rescheduling tactics; data management; and primary care versus specialty approaches. These methods are applicable to both the current rebooting stage as well as to a potential resurgence of COVID-19 in the future.

Safety and Cost Effectiveness of Outpatient Total Shoulder Arthroplasty: A Systematic Review.

Changes in healthcare policy have driven many hospital-based surgeries to the outpatient environment. Multiple studies have shown outpatient total shoulder arthroplasty (TSA) is a safe alternative to the inpatient setting. This systematic review evaluates patient selection, perioperative protocols, complications, costs, patient satisfaction, and clinical outcomes of outpatient TSA and compares these with their inpatient counterparts. The Emnbase, Medline, and CENTRAL databases were queried on April 30, 2020, for outpatient TSA studies, identifying 232 articles, with 21 meeting inclusion criteria. This involved 25,808 and 231,408 patients undergoing outpatient and inpatient TSA, respectively. Failed same-day discharge, readmissions, revision surgeries, cost, and complications among outpatient TSA were aggregated when raw numbers were available. Statistical significance for comparisons among outpatient and inpatient TSA within individual studies was alpha = 0.05. Ten studies evaluated same-day discharge rate, with 440 of 446 patients (98.7%) meeting the goals. Fourteen studies evaluated readmissions, revision surgeries, and complications, with readmissions in 238 of 6,133 patients (3.9%), revision surgeries in 32 of 1,484 patients (2.1%), and complications in 376 of 4,977 patients (7.6%). Readmission rates were similar between inpatients and outpatients, with only one study finding more readmissions after inpatient TSA. Complications were more common in inpatient TSA in five studies. Outpatient TSA demonstrated a charge reduction of $25,509 to $53,202 per patient, and patient satisfaction after outpatient TSA was "good to excellent" in more than 95% of patients. Patient selection for outpatient TSA used patient age, medical comorbidities, social support, living proximity to location of surgery, and lack of preoperative opioid use. Outpatient TSA in appropriately selected patients is a safe and cost-effective alternative to inpatient TSA. However, the literature is limited to national database or small retrospective studies. Large prospective, cohort studies are necessary to further assess differences in complication profiles between outpatient and inpatient TSA. Level IV; systematic review.

Characterising gait in paediatric neuromuscular disorders: an observational study of spatio-temporal gait in a clinical cohort

Aim Few studies have characterised the relationship between disease and gait function in children and young people with rare neuromuscular disorders (NMDs). This study aimed to describe the relationship between disease and gait in a large paediatric cohort from a neuromuscular outpatient clinic. Methods A prospective, cross-sectional study of gait in independently ambulant children and young people aged 4–21 years with a clinical or genetically confirmed NMD. Participants traversed an electronic walkway barefoot and in footwear at self-selected and fast pace. Analysis of disease included a typically developing (TD) reference group. Results A sample of 113 participants with NMD, mean age 9.5 years (SD 3.1), 28% female, grouped into nine diagnostic subgroups. Eighty percent reported limitations to functional mobility. Children with NMD walked slower, with a shorter and wider step compared to a TD reference group, with moderate to large effect sizes for each of these gait parameters indicative of the clinical significance of these gait deviations. Children with Duchenne muscular dystrophy (DMD) walked slowest with a markedly wide gait pattern. Footwear had little overall effect on gait in children with NMDs. All children could accelerate over short distances. Conclusions Gait, notably speed, step length, and width are clinically significant biomarkers of disease in paediatric NMDs, affording objective functional measures in clinical settings and research. Implications for rehabilitation Gait should be considered a functional biomarker of disease in children and young people with neuromuscular disorders (NMDs). Comparison of gait in a paediatric neuromuscular cohort indicates that children with Duchenne muscular dystrophy (DMD) walk slowest with a shorter step length and a wider step width which increases with age and disease progression. Measurement of gait speed is a simple, pragmatic tool to monitor disease progression in the outpatient clinical environment and relates to everyday function. In clinical research, gait can be measured as a functional outcome to demonstrate change from disease-modifying interventions and treatments in NMDs.

LB742 Predictors of post-discharge follow-up attendance among hospitalized dermatology patients

Background: The transition from the inpatient to outpatient environment is important for patient care. However, this transition has not been studied in the context of hospitalized dermatology patients. Objective: To determine significant predictors of follow-up attendance among patients seen by the inpatient dermatology teams at Zuckerberg San Francisco General Hospital (ZSFG) or UCSF Medical Center (UCSF) between March 2018 and February 2020 who were recommended for outpatient dermatology follow-up.

Integration of Flash Glucose Monitoring During the Transition of Care From Inpatient to Outpatient Settings in Patients With Type 2 Diabetes

Background: The use of continuous glucose monitoring (CGM) technology in the outpatient setting has been associated with both improved patient satisfaction1 and increased glucose monitoring2. It remains to be seen, how well this technology can be integrated during the transition from hospital discharge to outpatient settings. Here, we aim to assess the feasibility of introducing the FreeStyle Libre during the transition of care from inpatient to the outpatient environment in patients with Type 2 diabetes (T2D). We will assess CGM use as measured by the numbers of days used and frequency of daily scans. Methods: During the time period April and September 2020, 20 patients with T2D being discharged on multiple daily injections admitted to North Shore University Hospital were enrolled in this study. Exclusion criteria were those with adhesive allergy, CKD 4/5 or on dialysis and pregnant women. Participants were trained on how to use the FreeStyle Libre with the LibreLink mobile application. All patients received 2 Libre sensors at the time of discharge, one that was placed in the hospital and the other to be placed after 14 days. 1 participant died prior to discharge. Analyses included descriptive statistics, specifically categorical variables using frequencies and percentages while continuous variables using mean and standard deviation. Results: Among who used the mobile application, 10 were men and 9 were women. Majority of patients were Black (n=11, 57.9%) with a mean age of 52 years (range 31–76). The mean duration of diabetes was 9.7 years (range: 0 to 22) and mean Hemoglobin A1c of 11.2% (range: 5.5–15.5). 10 out of 19 persons used CGM for more than 2 weeks, while the remaining 9 utilized the CGM for less than 2 weeks. Mean average daily scans were 5 times per day (range: 1–12) with majority of the persons (n=15, 78.9%) scanning more frequently (3 or more times per day). The average glucose ranged from 62 to 268 mg/dl and the mean active CGM time was 52.05% (range 0–98). Mean glycemic variability was 29.17% (range: 14.5–56.7). Technical issues with the CGM included poor adhesion or issues connecting to the mobile application. Conclusion: Our study found that the initiation of CGM during the transition from hospital discharge to the outpatient setting is feasible and a useful tool. A limitation of this study was the inability for all people to use the mobile application due to incompatible phones or operating systems.

P062 How do our patients feel about face-to-face review in rheumatology clinics since COVID-19? A single tertiary care centre experience

Background/Aims The COVID-19 pandemic has had a significant impact on the management of outpatients. During the first wave of the pandemic, and in common with other departments, almost all our patient consultations happened over the phone. As the rate of infection fell, we felt it was crucial that the patient voice was heard as we re-organised clinical areas and re-opened services. In view of this, we conducted an online survey to better understand patient concerns around visiting our hospital for appointments and how we can adapt the way we work to ensure patient safety and satisfaction. Methods Using our electronic patient record, we identified patients from the clinic lists of 2 adult rheumatology consultants over a 6-week period between June and August 2020. This timeframe was selected as it was towards the end of the UK nationwide shielding period and our department was returning to deliver an increasing proportion of outpatient care face-to-face. Included patients had to have been treated with an immunosuppressive drug and only those on monotherapy hydroxychloroquine, sulfasalazine or prednisolone under 5mg were excluded. We consented each patient via telephone before sending them an email link to an online anonymised survey. This included a combination of 9 multiple choice and white space questions. Results 65 patients were identified of which 16 were excluded as we were unable to contact them or they declined consent. 49 patients were sent the survey of which 31 responses were received. 21/31 (67%) of patients had been shielding. The survey revealed six themes of concern. These include: lack of social distancing in common hospital areas, lack of personal protective equipment compliance amongst staff, prolonged time spent in waiting rooms, lack of knowledge on new hospital policies, logistics of using public transport to come to the hospital, and the importance of retaining virtual consultations going forward. 55% of patients stated they would feel safe in returning to the hospital for face-to-face appointments over the next few months. Conclusion Important themes have emerged from this project that we have presented to our rheumatology multi-disciplinary team, Director of Innovation and Head of Patient Experience. This has reinforced adaptations in our hospital environment such as installing safe distance seating in waiting rooms and scheduled phlebotomy slots. Further, where possible we call patients before face-to-face appointments to inform them of our safety measures and try to schedule these patients for outside peak travel hours. We acknowledge that using an online survey may limit responses from older individuals or those with English as a second language. Despite this, our project has shown the importance of recognising the unique concerns of rheumatology patients and the value in using their opinions to create a “new normal” for our outpatient environment. Disclosure R. Amarnani: None. B. Goulden: None. J. Manson: None. V. Morris: None.

Determinants of COVID-19 Mortality in Patients With Cancer From a Community Oncology Practice in Brazil.

PURPOSEThe COVID-19 pandemic remains a public health emergency of global concern. Determinants of mortality in the general population are now clear, but specific data on patients with cancer remain limited, particularly in Latin America.MATERIALS AND METHODSA longitudinal multicenter cohort study of patients with cancer and confirmed COVID-19 from Oncoclínicas community oncology practice in Brazil was conducted. The primary end point was all-cause mortality after isolation of the SARS-CoV-2 by Real-Time Polymerase Chain Reaction (RT-PCR) in patients initially diagnosed in an outpatient environment. We performed univariate and multivariable logistic regression analysis and recursive partitioning modeling to define the baseline clinical determinants of death in the overall population.RESULTSFrom March 29 to July 4, 2020, 198 patients with COVID-19 were prospectively registered in the database, of which 167 (84%) had solid tumors and 31 (16%) had hematologic malignancies. Most patients were on active systemic therapy or radiotherapy (77%), largely for advanced or metastatic disease (64%). The overall mortality rate was 16.7% (95% CI, 11.9 to 22.7). In univariate models, factors associated with death after COVID-19 diagnosis were age ≥ 60 years, current or former smoking, coexisting comorbidities, respiratory tract cancer, and management in a noncurative setting (P < .05). In multivariable logistic regression and recursive partitioning modeling, only age, smoking history, and noncurative disease setting remained significant determinants of mortality, ranging from 1% in cancer survivors under surveillance or (neo)adjuvant therapy to 60% in elderly smokers with advanced or metastatic disease.CONCLUSIONMortality after COVID-19 in patients with cancer is influenced by prognostic factors that also affect outcomes of the general population. Fragile patients and smokers are entitled to active preventive measures to reduce the risk of SARS-CoV-2 infection and close monitoring in the case of exposure or COVID-19-related symptoms.

Professional practice in caring for maternal grief in the face of stillbirth in two countries.

to understand professional care for maternal grief in the puerperium of stillbirth. a clinical-qualitative study with all the women who had stillbirths living in Maringá (Brazil) and participating in the Center d'Études et de Recherche in Family Intervention at the University of Quebec in Outaouais in Gatineau (Canada). Semi-structured interviews were carried out and the relevant aspects were categorized into themes. the identified categories were: Assistance received in the puerperium with a focus on grief: hospital and outpatient environment, and Professional support in coping with maternal grief after fetal loss: with contact and memories, without contact and without memories and impossibilities of contact with the baby. considerations: the need for a multidisciplinary support and monitoring network for women who experienced fetal loss was evident. From this study, a routine of care for grief can be implemented in Brazil based on experiences in Canada.

Implementation of the FL-REACH Caregiver Intervention: Translation in an Outpatient Memory Disorders Clinic

The REACH II intervention is the gold-standard in dementia caregiver interventions. The FL-REACH translation is a novel adaptation offered in both English and Spanish to an outpatient memory disorder clinic at an urban, Southeastern healthcare system. This pre-post feasibility trial involves 6 sessions (4 in person at the clinic and 2 by phone) with the identified caregiver and any other family who wish to attend, which may also include the person living with dementia. The program is focused on early stage post-diagnosis, and is structured around building rapport, empowering families to build support networks, and teaching skills and knowledge-based material. Twenty four of the 60-participant target sample have consented to participate in this ongoing study. Change on the Preparedness for Caregiving Scale is significant (t=3.03, p=.001, Cohen’s d=2.49). Means for the Zarit Burden 12-item scale went from 24.5 to 13.17 (t=-6.65, p=.03, Cohen’s d=3.53). Access by care recipients to dangerous objects decreased (67% to 14%). Confidence in ability to use behavioral strategies in caregiving increased from 8% at baseline to 72% at study completion. Satisfaction surveys indicate high satisfaction with all elements of the intervention. These outcomes are consistent with existing data regarding utility of the REACH framework and reflect feasibility of delivering an adapted program model in an outpatient clinic environment. A future randomized controlled trial should examine whether early intervention and training reduces utilization of emergency care over time and improves quality of life for families.

Abstract 243: Out-of-hospital Cardiac Arrest in the Outpatient Clinical Environment

Background: Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death in the US, affecting over 400,000 annually. Although outcomes have improved, rates of return of spontaneous circulation (ROSC) and survival are lower from OHCA than from in-hospital cardiac arrest. Clinical emergencies, including OHCA, in outpatient clinical settings are often first attended by rapid response teams (RRT), but the causes and outcomes from OHCA in these environments has not been characterized. An understanding of this population is critical both for RRT quality improvement and resource allocation. Objectives: We aimed to describe OHCA that occurred in outpatient clinical environments. We hypothesized that OHCA in ambulatory settings would be uncommon and would be concentrated in a limited number of higher-risk outpatient areas. Methods: Retrospective analysis of all RRT calls for non-hospitalized adult outpatients occurring between 2012- 2020 at the Hospital of the University of Pennsylvania. Results: There were 7336 RRT calls;25 were for OHCA. Information was available for 24 of these. Mean age was 64 +/- 16.7 y, and 38% were female. Initial rhythm was pulseless electrical activity in 79%, ventricular fibrillation in 13%, asystole in 4%, and was not recorded in 4%. CPR was initiated in all cases prior to the arrival of the RRT. ROSC was obtained in 84%, extracorporeal membrane oxygenation (ECMO) was initiated in 8%, and 8% did not survive. ROSC was obtained within 5 min in 58% of cases. Of those that attained ROSC, 75% survived to discharge, 80% with good neurological status (CPC 1-2). Most events (54%) were judged to be iatrogenic. Of these, 54% were due to anaphylaxis, 15% were during cardiac stress testing, and 31% were peri-procedural. The most common causes of anaphylaxis were chemotherapeutics and radiographic contrast agents. Conclusions: OHCA events are uncommon in the outpatient clinical setting and are frequently iatrogenic. These events are associated with high rates of ROSC and neurologically intact survival. Iatrogenic OHCA occurred during a limited number of clinical settings, including outpatient procedural, , infusion, and stress test locations.. This finding suggests the need to focus resuscitation training in these specific environments.

Lipectomia bucal: relato de complicação cirúrgica mediata

O coxim adiposo bucal é descrito como um tecido gorduroso localizado na face e a sua remoção é conhecida como lipectomia bucal ou bichectomia, podendo ser indicada com finalidade estética e funcional. Esse trabalho tem como objetivo relatar um caso de complicação mediata após a lipectomia bucal. Paciente, 33 anos, sexo feminino, buscou tratamento por apresentar morsicatio bilateral. Foi realizada cirurgia de lipectomia bucal e após três horas do fim do procedimento, a paciente relatou edema na face desproporcional e unilateral direito, com presença de dor leve e latejante, havendo evidente formação de hematoma periorbitário e equimose no olho direito. A paciente necessitou de nova intervenção para explorar a ferida, necessitando de drenagem do hematoma, seguida de manobras de compressão e cauterização com bisturi elétrico monopolar. Diante da estabilização do sangramento, a paciente foi orientada a fazer uso de antibiótico, bem como controlar a dor com analgésicos e crioterapia, sendo monitorada diariamente até que a regressão do edema fosse evidente. O hematoma regrediu com 30 dias, não havendo prejuízo funcional e estético. A cirurgia de lipectomia bucal deve ser realizada por um profissional qualificado com experiência em ambiente ambulatorial e hospitalar, com capacidade de intervir precocemente nas possíveis intercorrências, minimizando a possibilidade de evolução para complicações mais significativas.

Anthropometrical measurements and maternal visceral fat during first half of pregnancy: a cross-sectional survey

BackgroundDetermining anthropometric measures that indicate different fat deposits can be useful to predict metabolic risk and set specific treatment goals, reducing negative consequences for maternal and fetal health. In cases where pre-gestational weight measure and subsequent body mass index (BMI) values cannot be determined, other anthropometric measurements may be ideal for measuring the nutritional status of pregnant women, especially in low- and middle-income countries. This study aims to identify which anthropometric measurements correlate better with the maternal fat deposits measured by ultrasound.MethodsA cross-sectional study was conducted with pregnant women from the city of Porto Alegre (city), capital of Rio Grande do Sul (state), southern Brazil, from October 2016 until January 2018. Anthropometrical variables (weight, height, mid-upper arm circumference [MUAC], circumferences of calf and neck and triceps skinfolds [TSF] and subscapular skinfolds [SBSF]), and ultrasound variables (visceral adipose tissue [VAT] and total adipose tissue [TAT]) were collected. To verify the correlation of anthropometric and ultrasound measurements, a non-adjusted and adjusted Spearman correlation was used. The study was approved by the ethics committees.ResultsThe age median of the 149 pregnant women was 25 years [21–31], pre-pregnancy BMI was 26.22 kg/m² [22.16–31.21] and gestational age was 16.2 weeks [13.05–18.10]. The best measurements correlated with VAT and TAT were MUAC and SBSF, both of which showed a higher correlation than pre-pregnancy BMI.ConclusionsIt is possible to provide a practical and reliable estimate of VAT and TAT from the anthropometric evaluation (MUAC or SBSF) that is low cost, efficient and replicable in an outpatient clinic environment, especially in low- and middle-income countries.

ORAL HEALTH ADEQUACY IN PATIENTS WITH BLACKFAN-DIAMOND ANEMIA

Blackfan-Diamond anemia is a rare congenital disease and there are possible treatments: Hematopoietic stem cell transplantation, steroids, and platelets and red blood cells transfusion. A 25-year-old male diagnosed with Blackfan-Diamond anemia, with insulin-dependent diabetes, developed medullary failure and underwent supportive treatment with monthly red blood cells transfusions. As a result of the multiple transfusions, he presented iron overload. At the oral physical examination, there were caries lesions on all teeth, generalized biofilm accumulation and presence of root remains. Considering the patient’s systemic conditions and the severity of oral health, it was decided to perform multiple exodontia in an operating room. For that, pre, trans, and post-procedure platelet transfusion was required, as well as other maneuvers for local hemostasis. Root remains or teeth with extensive coronary destruction were extracted. There were no intercurrences and, after the patient’s recovery, the treatment was continued in an outpatient environment. Blackfan-Diamond anemia is a rare congenital disease and there are possible treatments: Hematopoietic stem cell transplantation, steroids, and platelets and red blood cells transfusion. A 25-year-old male diagnosed with Blackfan-Diamond anemia, with insulin-dependent diabetes, developed medullary failure and underwent supportive treatment with monthly red blood cells transfusions. As a result of the multiple transfusions, he presented iron overload. At the oral physical examination, there were caries lesions on all teeth, generalized biofilm accumulation and presence of root remains. Considering the patient’s systemic conditions and the severity of oral health, it was decided to perform multiple exodontia in an operating room. For that, pre, trans, and post-procedure platelet transfusion was required, as well as other maneuvers for local hemostasis. Root remains or teeth with extensive coronary destruction were extracted. There were no intercurrences and, after the patient’s recovery, the treatment was continued in an outpatient environment.

I Ação Comunitária de Cirurgia Oral Menor de Odontologia da UFPI – Relato de Experiência

Este trabalho é um relato de experiência obtido através da vivência de acadêmicos de Odontologia e especialistas de Cirurgia e Traumatologia Bucomaxilofacial da Universidade Federal do Piauí (UFPI). As experiências adquiridas e relatadas neste trabalho foram alcançadas a partir do projeto de extensão vinculado a CPPEX/UFPI denominado de Mutirão de Cirurgia Oral Menor (Terceiros Molares e Dentes Supranumerários inclusos). Esta atividade tem como objetivo atender a grande demanda de pacientes com necessidades cirúrgicas em ambiente ambulatorial de dentição inclusa. Acredita-se que ao relatar essas experiências podemos contribuir para uma atualização e treinamento de práticas cirúrgicas tidas como complexa, visto que situações semelhantes são poucas trabalhadas durante a grade curricular no curso, por não fazerem parte das diretrizes curriculares da graduação. Dessa forma, a instituição leva à comunidade os saberes desenvolvidos em seus espaços e presta auxílio à população, seja por meio de atendimento gratuito, clínica-escola, orientação, entre outros. Assim como as comunidades retribuem compartilhando os conhecimentos que é detentora e atuando em prol da defesa da educação. O projeto contou com a participação de 18 integrantes, sendo: 1 professor coordenador e 3 professores para monitoramento, 4 alunos da graduação e 10 alunos da especialização, todos estes sendo voluntários.

Observational study of ocular surface squamous neoplasia: Risk factors, diagnosis, management and outcomes at a tertiary eye hospital in South Africa

BackgroundOcular surface squamous neoplasia (OSSN) is the most common ocular surface tumour. Diagnosis and management have traditionally been by excision biopsy. Recently there has been success with the use of topical chemo or immunotherapy, which has resulted in a move from invasive diagnosis by histology to an array of non-invasive diagnostic tests.MethodsThis observational study aims to describe the characteristics of patients with OSSN at St John Eye Hospital in Johannesburg, South Africa. Non-invasive diagnostic tests (impression cytology, anterior segment-OCT, methylene blue staining) will be compared to the gold standard, histology. Treatment success, recurrence and adverse events will be documented between three treatment options that include: surgical excision, topical 5-Fluorouracil (5FU) chemotherapy, and topical 5FU with retinoic acid therapy.DiscussionThere is a trend to the use of less invasive diagnosis and management for OSSN. Minimally invasive diagnostic tests include cytology, anterior-segment OCT and methylene blue staining. The study will compare these to the gold standard histology, thereby providing evidence for their use in clinical practice. Interferon alpha 2b is commonly used as immunotherapy for OSSN. The cost of this medication is prohibitive to its adoption in a developing country. We therefore decided to use 5FU as the chemotherapeutic agent of choice in this study. The success, adverse events and recurrence rates with this agent may provide additional evidence for its use in the management of OSSN. Overall, if diagnosis and management can be implemented with good success in the outpatient environment, care can be improved for this condition in a developing country.

ASSESSMENT OF KNOWLEDGE, ATTITUDE, AND PRACTICE REGARDING HYPOTHYROIDISM AMONG INFERTILE WOMEN WITH HYPOTHYROIDISM

Objective: The study was designed to assess the knowledge, attitude, and practice (KAP) of hypothyroidism among infertile women with hypothyroidism.&#x0D; Methods: A cross-sectional analysis was performed in an outpatient environment of infertility centers. We used a validated questionnaire to assess hypothyroidism KAP. Using frequency counts (n) and percentages (%), discrete data were summarized. The Chi-square/Fisher test was used between groups to compare.&#x0D; Results: The mean age of participants was found to be 32±5.77 years. It was found that 72% of the subjects had poor knowledge, 44% were extremely concerned, and 81% were practicing with a moderate level of precaution. Among the consequences of hypothyroidism, 68% of the study subjects most properly-recognized menstrual disturbance, followed by 66%, 51%, and 48% of study subject properly-recognized weight gain, fatigue, and muscle aches/pain as a clinical manifestation of hypothyroidism. Most patients (98%) adhered to their medications. Nearly half of the study patients (45%) did not avoid cabbage, cauliflower, or soya.&#x0D; Conclusion: Our study highlighted the significance of investing appropriate time to provide patients with a comprehensive education to bridge the gaps in patient care. The findings also indicated that it be better for the understanding of the patients if health-care providers could provide patients with data sheets explaining the disease or having some pictorial/pamphlets about the disease’s reality and myths.

Parental experiences and genetic counsellor roles in Pierre Robin sequence.

Pierre Robin sequence (PRS) is a craniofacial abnormality comprising micrognathia, glossoptosis and airway obstruction, which can impair the newborn's feeding and breathing. While there has been much research around the cause of PRS and most appropriate methods of care, understanding the psychosocial aspects of a PRS diagnosis from the parents' perspective is lacking. The aim of this study is to understand parental experiences of having a child diagnosed with PRS, as well as the role of genetic counselling in PRS. Fourteen semi-structured interviews were conducted with parents of children diagnosed with isolated PRS between 2 and 5years prior. From these 14 interviews, eleven transcripts were analysed to find common themes and experiences. The diagnosis was confusing and overwhelming for participants during emotionally sensitive periods and little was understood about the cause of their child's PRS. Those participants who did recall experiences with genetic services reported that they were minimal and uninformative. According to participant recollection, genetic counselling was rarely offered, despite there being a potential for this service in PRS. Genetic counselling would be a valuable source of information and support for parents both at the time of antenatal diagnosis, and potentially 6 to 12months later in the outpatient environment when these children are all routinely reviewed by their clinical care team.

Reducing Revenue Loss and Patient Financial Toxicity with a Pharmacy-Managed Pre-Certification and Denials Management Program

In an era of soaring drug prices, payers have developed complex strategies to manage costs and ensure clinically appropriate prescribing in the outpatient environment.1–3 Some of the most frequentl...

Neonatal Management During the Coronavirus Disease (COVID-19) Outbreak: The Chinese Experience.

Novel coronavirus infection is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was named COVID-19 by the World Health Organization on January 7, 2020. In early December 2019, a number of pneumonia cases of unknown origin emerged in Wuhan, Hubei province, China. (1)(2) The disease then spread rapidly throughout China and has now become a global pandemic. As of March 23, 2020, more than 340,000 cases have been reported in more than 150 countries. Because the disease is primarily an airborne respiratory infection and is documented to have a strong human-to-human transmission, the pediatric and neonatal populations are vulnerable to this disease. However, the incidence and clinical presentations of pediatric COVID-19 infections are varied and differ from those found in adult patients. The atypical clinical presentations and 2 potential modes of transmission in neonates (ie, maternal-fetal or maternal-neonatal) have led to diagnostic and management challenges. In this perspective, we would like to share some published information from Chinese pediatric and neonatal societies about their approach to handling the 2019-2020 COVID-19 outbreak in China. Since the COVID-19 outbreak in December 2019, more than 81,000 confirmed cases have been reported in China (as of March 23, 2020). Most of these cases occurred between late January and early February 2020. The diagnosis of COVID-19 is based on the epidemiologic history of contact with an infected person, typical clinical features such as fever and respiratory distress, and a positive real-time polymerase chain reaction to the SARS-CoV-2 RNA test. The nucleic test is considered the gold standard for confirmation. As of February 8, 2020, 731 confirmed pediatric cases were reported in China, mainly from Wuhan city. (3) Relative to the total number of cases (n=34,664) reported in China, on February 8, 2020, the pediatric COVID-19 population accounted for 2.1% …