Outpatient Follow-up Research Articles

Abstract TP118: Early Outpatient Follow-up After Acute Ischemic Stroke Reduces 30-day and 90-day Inpatient Readmissions

Introduction: Despite advancements in the management of acute ischemic strokes, readmissions continue to impact both healthcare costs and patient outcomes. The objective of our study was to evaluate factors associated with 30- and 90-day readmissions after acute ischemic stroke including the impact of early transitional care outpatient follow-up by a centralized specialty stroke clinic. Methods: We retrospectively identified all acute ischemic stroke patients discharged from the largest healthcare system in the state of Georgia from October 1, 2022 to March 31, 2024; we excluded patients who were discharged to a long-term acute care or hospice facility. Baseline characteristics, inpatient metrics and post-discharge outpatient follow-up were assessed to identify factors associated with 30- and 90-day inpatient readmission. Results: Of 2191 acute ischemic stroke patients discharged during the study period, 177 (8.1%) and 304 (13.9%) had 30- and 90-day all cause readmissions to the healthcare system, respectively. Increasing age, Charlson Comorbidity Index score, and history of diabetes were independently associated with 30- and 90-day readmission; history of heart failure, obesity, and discharge to inpatient rehabilitation or skilled nursing facility (versus home) were also independently associated with 90-day readmission. Completion of a subspecialty stroke clinic follow-up within 30 days of discharge was associated with a lower likelihood of 30-day (OR 0.64, 95% CI 0.41-0.96; p=0.04) and 90-day readmission (OR 0.69, 95% CI 0.49-0.94; p=0.02). Conclusion: While acute ischemic stroke patients who are older, have comorbid conditions and disability are at an increased likelihood of 30- and 90-day readmission after acute ischemic stroke, our study found that early (<30 day) outpatient follow-up in a subspecialty stroke clinic was associated with a significant reduction in 30- and 90-day readmission. Efforts should be made to ensure early outpatient specialty stroke clinic follow-up for acute ischemic stroke patients after discharge.

Abstract TP144: Telemedicine Appointments early after Acute Ischemic Stroke may Reduce 30-day Emergency Department Visits

Introduction: Limiting the rate of unplanned emergency department (ED) revisits for patients with acute ischemic stroke is an important aspect of secondary stroke prevention. This is influenced by patients’ demographics, comorbidities, stroke severity, disposition destination, and may be impacted by early outpatient follow-up where stroke risk factors and etiology continue to be evaluated. Methods: We retrospectively identified all acute ischemic stroke patients discharged from an 11-hospital network, the largest healthcare system in the state of Georgia, from October 1, 2022 to March 31, 2024; we excluded patients who were discharged to a long-term acute care or hospice facility. Baseline characteristics, inpatient metrics and post-discharge outpatient follow-up were assessed to identify factors associated with ED visits within 30- and 90-days after discharge. Results: Of 2,191 patients, 143 (6.5%) had ED visits within 30 days and 296 (13.5%) within 90 days. The median age was 68 [IQR 57, 77]. History of heart failure (HF), atrial fibrillation (AF), chronic kidney disease and end stage renal disease each increased the likelihood of an ED re-visit within 30 and 90 days whereas diabetes mellitus increased the likelihood of an ED re-visit at 90 days only. In multiple logistic regression analyses, factors independently associated with 30-day ED visit was a history of HF (OR 1.57, 95% CI 1.07-2.28; p=0.02) and AF (OR 1.49, 95% CI 1.00-2.19; p=0.04); at 90 days, only an increased Charlson Comorbidity Index score was associated with ED visit (OR 1.09, 95% CI 1.02-1.16; p=0.01). There were 501 (23%) patients who completed an outpatient neurology clinic follow-up within 30 days of discharge, including 81 patients (4%) who completed a telemedicine outpatient visit; patients completing a telemedicine visit were less likely to have a 30-day ED visit than those who had an in-person visit (OR= 0.13, 95% CI 0.01-0.62; p=0.05). Conclusion: ED revisits after hospitalization for acute ischemic stroke are relatively common and associated with patients who have comorbid conditions including HF and AF. Our study suggests that telemedicine-based follow-ups were associated with lower rates of unplanned ED revisits within 30 days. Efforts to increase outpatient neurology clinic access through telemedicine may reduce ED visits after discharge for acute ischemic stroke patients.

Impact of Intensified Outpatient Follow-up on Rehospitalization after Transcatheter Aortic Valve Implantation: Results from the HOSPITAVI Trial

Impact of Intensified Outpatient Follow-up on Rehospitalization after Transcatheter Aortic Valve Implantation: Results from the HOSPITAVI Trial

Abstract TP154: Optimizing Stroke Care: A Pilot Study on Secured Clinic Slots for Timely Follow-Up

Introduction: The initial 1-3 months following a Transient Ischemic Attack (TIA) or acute stroke are critical for patient management and recovery. Timely follow-up care is recommended to reduce the risk of recurrent stroke and address ongoing health issues. Prolonged hospital stays can hinder prompt outpatient follow-up. We present a pilot model of secured slots for urgent stroke referrals and follow-up for TIA and acute stroke patients. Methods: A three-year pilot study was conducted within the Geisinger Medical Center Vascular Neurology and Stroke Clinic from October 2021 to June 2024. Dedicated 3:00 PM time slots were established for urgent referrals and follow-ups of patients with TIA and acute stroke from the Emergency Department(ED). Three neurology physicians shared these slots. The study evaluated slot utilization, including time from discharge to clinic visit, 90-day unplanned stroke readmission rates, and the percentage of inappropriate slot use. An integrated assessment was performed to determine the program's impact on clinic workflow and patient outcomes. Result: An initial review of the first 200 patients revealed the following utilization of secured slots: 21.5% for urgent referrals, 22% for ED follow-ups, 20.5% at provider discretion, 15% allocated by triage team decision, and 18.5% for routine follow-ups. No-shows and scheduling errors accounted for 2.5% of the slots. For urgent referrals and ED follow-ups, there were no unplanned hospital admissions within 90 days. The time to clinic visits after ED discharge ranged from 1 to 21 days (mean 6.9 days), compared to the national average of 2-8 weeks. Many patients underwent partial stroke workups in the ED or hospital. Outpatient testing such as TTE, and ambulatory rhythm monitoring were coordinated to reduce hospital stays. Limitations included challenges in scheduling appointments within 24-72 hours due to provider availability, weekends, and patient scheduling conflicts. Conclusion: Secured stroke clinic slots provide a timely opportunity for high-risk patients to receive immediate follow-up care after ED visits for stroke or TIA. This model significantly reduces hospital costs and improves patient readmission rates, and burden of prolonged hospital stays, without compromising care. Future studies are encouraged to focus on streamlining referrals, reducing scheduling errors, and integrating this model with other stroke-related services, such as rehabilitation to further enhance overall patient care.

Left Ventricular Outflow Tract Obstruction (LVOTO) Causing Syncope in Hypertrophic Cardiomyopathy (HCM): A Case Report

Background: Hypertrophic cardiomyopathy (HCM) is one of the most common inherited cardiovascular diseases. HCM can sometimes result in dynamic obstruction of the left ventricular outflow (LVOT) tract that can subsequently compromise adequate cardiac output. The symptoms of left ventricular outflow tract obstruction (LVOTO) can range from mild symptoms of impaired cardiac output to sudden cardiac death (SCD) in extreme cases. Case Description: A 68-year-old female with comorbidities including obesity, obstructive sleep apnea (OSA), and hyperlipidemia but no prior diagnosis of HCM or known family history of HCM, presented after a witnessed syncope and subsequent head injury, who had an extensive evaluation of the etiology of her syncope. Transthoracic echocardiogram (TTE) revealed presence of HCM with evidence of dynamic LVOTO. The patient underwent a transesophageal echocardiogram (TEE) which showed hypertrophy of LVOT in the septal area causing moderate increase in LVOT mean gradient. The patient was started on medical management with diltiazem that was not tolerated because of bradycardia. The patient had a stable clinical course without any hemodynamic events and was discharged home with outpatient Cardiology follow-up. The patient was also advised to get a referral for a cardiac magnetic resonance (CMR) for further evaluation of HCM and the potential for dynamic LVOTO. Conclusions: HCM can cause dynamic LVOTO that can lead to symptoms including fatigue, chest pain, presyncope, and syncope. Extreme cases of LVOTO can lead to SCD. Medical management is imperative in HCM with symptoms of LVOTO. In extreme cases risk stratification for implantable cardioverter defibrillator (ICD) implantation is indicated to prevent SCD

Psychological burden in patients with sellar masses under conservative and surgical management

The aim of this study was to investigate the level of distress and the quality of life of operated and non-operated patients with pituitary tumors. Patients who presented to a neurosurgical center and two endocrinological services for outpatient follow-up after surgical treatment, as well as those under medical therapy or radiological follow-up without treatment, were invited to participate in the study. Sociodemographic, health-related quality of life and clinical data were assessed. Psychosocial factors were measured using the Distress Thermometer (DT), the Hospital Anxiety and Depression Scale (HADS), the Short Form (SF-36), and the Sino-nasal outcome test (SNOT). Thirty-two postoperative patients and thirty conservatively managed patients (n = 21 under medical treatment, n = 9 watch and wait), mean age 53, SD 19; 56% female participated in the study. Prolactinomas (35%) and non-functioning pituitary adenomas (21%) were the most common findings. There were no significant differences between conservative and operative groups in mean DT score (4.7 (SD 2.45) vs. 4.9 (SD 3.0), p = 0.61), HADS anxiety score (6.4 (SD 3.9) vs. 6.0 (SD 4.3), p = 0.76) or depression score (5.7 (SD 4.8) vs. 4.6 (SD 3.6), p = 0.50). For patients with ACTH-producing adenomas, the mean anxiety score was significantly higher (10.3 (SD 1.9) vs. 5.9 (SD 4.0), p = 0.03). The SNOT score correlated significantly with the DT, HADS-A, and HADS-D scores and therefore was associated with higher psychological distress. The level of self-reported distress in patients with sellar processes was not associated with a specific treatment strategy. ACTH-producing adenomas and manifest nasal symptoms were associated with higher psychological distress.

P-155. Challenges with Artemether and Lumefantrine in the Management of Uncomplicated Malaria Infection

Abstract Background Annually there are approximately 1,500 cases of imported malaria in the UK, with the majority being falciparum infection in African diaspora visiting friends and relatives (VFR). The management of uncomplicated falciparum infection usually entails a treatment course of artemether and lumefantrine. However, this medication can pose challenges to prescribers and patients alike due to the dosing schedule and administration requirements. We assessed the management of uncomplicated falciparum malarial infection in the emergency department and designed a tailored treatment package for patients being managed in an outpatient setting in order to improve medication compliance and clinical outcome for this cohort. Compliance Aid for Artemether/Lumafantrine - Patient Information Leaflet Customised patient information leaflet to be completed by prescriber and given to patient to improve medication adherence Methods A retrospective audit was conducted at a hospital in London from December 2021 to January 2023. The management of uncomplicated falciparum malarial infections and the adequacy of existing clinical pathways were assessed using electronic patient records.. Patients that presented to the emergency department, diagnosed with uncomplicated falciparum infection and discharged home with oral treatment with subsequent outpatient clinic follow-up were included Results A total of 17 patients were included in the audit. 41% (7/17) patients were identified as experiencing issues with medication including confusion regarding when to take tablets, not taking medication with food and not completing the course due to symptom resolution. 3 patients consequently required further course of Riamet and 1 person required admission to hospital due to rising parasitaemia as a result of not taking artemether and lumefantrine correctly. As a result of these findings, a customised patient information leaflet and artemether and lumefantrine prepacks were created and made available in the emergency room. Conclusion This study demonstrates the challenges posed by artemether and lumefantrine for prescribers and patients. Patients with falciparum infection are at risk of rapid deterioration and therefore clear instructions on when and how to take the medication are needed. Follow-up is essential in this cohort and medication compliance issues should be considered in persistent/rising parasitaemia or ongoing symptoms. Disclosures All Authors: No reported disclosures

P-1423. Barriers to Care: Improving Outpatient Follow-Up for Patients on Long-Term Oral Antimicrobial Therapies

Abstract Background Best practice for patients on COpAT (Complex Outpatient Antimicrobial Therapy) includes close follow-up once discharged from the hospital. However, some patients discharged with COpAT do not receive monitoring for complications, increasing their risk for re-admission. There is limited analysis regarding patient-specific social determinants of health (SDOH) that may contribute to a reduced follow-up rate. We aimed to determine the percentage of patients discharged on long-term oral antibiotics who received recommended outpatient Infectious Disease (ID) support and potential barriers to follow-up for quality improvement.Table 1:Outcomes associated with social determinants of healthSelected social determinants of health associated with specified monitoring and outcomes. Bolded values are considered statistically significant. Methods In this single-center cohort, patients discharged between 1/1/2021 and 12/31/2022, on ≥ 2 weeks of oral antibiotics, age > 18 years, with inpatient ID consult, and with recommendations for follow-up in the University of Utah ID Clinic were examined. SDOH included distance from the medical center, age, race/ethnicity, employment status, substance use, homelessness, and history of bipolar disorder/psychoses. We assessed patient outcomes of treatment failure or lost to follow-up within 90 days post-discharge. We also evaluated the time to appointment, lab monitoring, and number of adverse drug events (ADEs) after discharge. Results One hundred ninety-seven patients met the inclusion criteria for the cohort. Median times to suggested lab monitoring and ID appointment were 13 and 21 days post-discharge respectively. 71% completed lab monitoring within 90 days of discharge. After 90 days, 19% of patients were lost to follow up and 20% had experienced treatment failure. Those younger than 55, unemployed, or experiencing substance use were more often lost to follow-up. Individuals with substance use or age < 55 had a longer time to lab monitoring. Patients with a history of substance use had fewer ADEs (Table 1). Conclusion SDOH that contribute to patient outcomes include a history of substance use and unemployment, suggesting an area of clinical quality improvement. Additionally, those younger than 55 were more often lost to follow-up. Further examination of follow-up protocol for these patients is important to improve patient outcomes. Disclosures Russell J. Benefield, PharmD, BCPS-AQ ID, Paratek Pharmaceuticals: Grant/Research Support Laura Certain, MD, PhD, Zimmer Biomet: Advisor/Consultant

Impact of a virtual cardiology programme for postdischarge patients with cardiovascular disease: a matched cohort analysis

IntroductionTelemedicine programmes have shown promise in reducing hospital readmissions, but varied RPM strategies and study populations have contributed to mixed results. Here, we evaluate a standardised virtual care programme in...

Corticosteroids in severe alcohol-associated hepatitis? Not so fast: A systematic review of randomized controlled trials.

Severe alcohol-associated hepatitis (AH) is rising in incidence with a high mortality burden. While corticosteroids are recommended for eligible patients with severe AH, no guidance exists for the timing of steroid initiation, tapering regimens, and surveillance of adverse events. We aim to systematically review these variables and provide evidence-based recommendations for the inpatient and outpatient management of severe AH. We performed a literature search from inception to 5/30/2024 to include clinical trials published in full form and assessed the quality of evidence using the Cochrane Risk of Bias tool. Data were collected on the timing of initiation, rate, and complications following steroid therapy, and taper regimens in the setting of severe AH. Of 28 studies that fulfilled our inclusion criteria, median time from admission to steroid initiation was 6.5 days. The most common steroid dosing regimen was prednisolone 40mg daily for 28 days. Twenty-five studies containing 3,196 subjects reported adverse events, with exactly 50% in the steroid arm and the other half in the comparison arm. Infections, gastrointestinal bleeds, and renal impairment were the most frequently reported adverse events. Most infections occurred within the first month of the study. A two-week steroid taper was the most frequently reported regimen. We recommend taking up to a week to systematically and thoroughly evaluate patients before initiating steroids, and vigilant monitoring in the first month of treatment. We also recommend the lowest possible steroid exposure with a two-week steroid taper and close outpatient follow-up.

Factors Related to Adherence to Therapy in Patients Using Oral Anticoagulants in Outpatient Follow-Up

Introduction: Factors related to therapy adherence can influence the complexity of care for patients using anticoagulants. Objective: To identify the factors related to patient adherence to oral anticoagulant treatment in outpatient follow-up. Materials and Methods: This is a descriptive, cross-sectional study with a quantitative approach, conducted at the oral anticoagulation outpatient clinic of a cardiology reference hospital in northern and northeastern Brazil. A questionnaire with sociodemographic and clinical variables and an instrument measuring treatment adherence were employed. The data was analyzed using the Statistical Package for the Social Sciences and the Chi-squared and Fisher’s exact statistical tests. All the statistical tests applied a significance level of 5 %. Results: 202 patients were screened, 66.3 % of whom were classified as adherent. Patients with a clinical referral for valve replacement, a treatment time longer than five years, and an international normalized ratio (INR) value outside the therapeutic target showed greater adherence to treatment. In addition, having a sedentary lifestyle and the use of antiarrhythmic medication were significantly associated with adherence. Variables such as sex, income, occupation, level of education, and the presence of complications were not significantly associated with treatment adherence. Conclusion: This study’s findings highlight that adherence to treatment with anticoagulants hinges more on clinical factors and health behavior than on sociodemographic characteristics. Although traditionally studied, these are not necessarily reliable predictors of adherence. The essential factor seems to be more closely related to health education and medical and family support, which emphasizes the need for individualized support for these patients, with a focus on awareness and regular clinical follow-up.

N33 Construction and Application of a Digital Management Platform for the Whole Course of Inflammatory Bowel Disease Patients Based on Action Research

Abstract Background Utilize digital technology to construct a digital platform-based comprehensive management model for Inflammatory Bowel Disease (IBD) patients, and design and develop a digital management platform for IBD patients to achieve efficient, convenient, and intelligent IBD management. Methods From October 2021 to December 2022, under the guidance of action research methodology and based on the chronic disease care model, a digital platform-based management model for the entire course of Inflammatory Bowel Disease (IBD) patients was constructed through a spiral cycle process of "diagnosis, planning, implementation, evaluation, and reflection." Leveraging digital technology and using the online hospital as a vehicle, a comprehensive management platform for IBD patients throughout the entire course of their disease was designed and developed. A total of 83 IBD patients were selected and divided into a control group of 42 cases and an intervention group of 41 cases. The control group received outpatient follow-up plus standard treatment, while the intervention group received outpatient follow-up, standard treatment, and a digital comprehensive course management model. Each group was followed up for 3 and 6 months to observe the patients' fecal calprotectin levels, Inflammatory Bowel Disease Short Health Status (IBDSHS), and patient satisfaction. Results After two rounds of action research, a comprehensive management model for IBD patients throughout the entire course of their disease has been established, comprising three major elements: a digital platform, patients, and a healthcare management team. This platform offers services such as doctor-patient interaction, health consultation, self-management support, health data upload, access to laboratory test reports, and informational support. The intervention group showed lower fecal calprotectin levels at both 3 and 6 months compared to the control group; improvements in all dimensions of the brief health status were significantly greater in the intervention group, and satisfaction was higher in the intervention group than in the control group. Conclusion This study employs action research methods, integrating the practical aspects of IBD clinical diagnosis and care in China, the characteristics of IBD, patient needs, and medical staff requirements, to construct a digital platform-based management model for the entire course of IBD patients. This model not only aligns with the trend of innovative development in China's medical services but also establishes a closed-loop management model centered on IBD patients throughout the entire course of the disease, serving as a tool for the comprehensive management of IBD patients.

Automated extraction of post-stroke functional outcomes from unstructured electronic health records.

Population level tracking of post-stroke functional outcomes is critical to guide interventions that reduce the burden of stroke-related disability. However, functional outcomes are often missing or documented in unstructured notes. We developed a natural language processing (NLP) model that reads electronic health records (EHR) notes to automatically determine the modified Rankin Scale (mRS). We included consecutive patients (⩾18 years) with acute stroke admitted to our center (2015-2024). mRS scores were obtained from the Get With the Guidelines registry and clinical notes (if documented), and used as the gold standard to compare against NLP-generated scores. We used text-based features from notes, along with age, sex, discharge status, and outpatient follow-up to train a logistic regression for prediction of good (0-2) versus poor (3-6) mRS, and a linear regression for the full range of mRS scores. The models were trained for prediction of mRS at hospital discharge and post-discharge. The models were externally validated in a dataset of patients with brain injuries from a different healthcare center. We included 5307 patients, 5006 in train and test and 301 in validation; average age was 69 (SD 15) and 65 (SD 17) years, respectively; 47% female. The logistic regression achieved an area under the receiver operating curve (AUROC) of 0.94 [CI 0.93-0.95] (test) and 0.94 [0.91-0.96] (validation), and the linear model a root mean squared error (RMSE) of 0.91 [0.87-0.94] (test) and 1.17 [1.06-1.28] (validation). The NLP-based model is suitable for use in large-scale phenotyping of stroke functional outcomes and population health research.

Incidental Findings on Computed Tomography in Children With Blunt Abdominal Trauma.

Nontraumatic, incidental findings on computed tomography (CT) may be discovered after blunt abdominal trauma in children; however, the rate and importance of these findings are not well known. The objective of this study was to determine the prevalence and types of incidental CT findings among injured children undergoing abdominal/pelvic CT. This was a planned secondary analysis of a multicenter prospective cohort study of children (<18 years) who underwent abdominal/pelvic CT after blunt trauma. We abstracted radiology reports for nontraumatic findings. We assessed and classified findings by their clinical urgency. Of 7,581 children enrolled, 2,500 (33%) underwent abdominal/pelvic CT. The mean patient age was 10.1±4.8 years, and 1,446 (58%) were boys. A total of 988 (39.5%, 95% CI 37.6 to 41.5%) children had 1,552 incidental findings with a mean patient age of 10.6±4.8 years, of whom 59% were boys. Fifty-five (3.5%) incidental findings were considered to need immediate evaluation/treatment, and 84 (5.4%) were considered to require outpatient follow-up within 4 weeks. Most incidental findings, however, were considered less urgent regarding follow-up: 552 (36%) were routine, 574 (37%) were considered to have a potential need, and 287 (18%) did not need follow-up. Forty percent of children undergoing CT scanning after abdominal trauma have incidental findings, few of which are clinically important and require timely follow-up. CT scans should be obtained only when necessary, and clinicians must be prepared to address incidental findings and ensure proper management.

Diabetes mellitus and obesity: risk optimization before surgical interventions

The prevalence of obesity has increased significantly in recent years and is acausal risk factor for the development of type2 diabetes. Moreover, chronic degenerative joint diseases are also triggered by obesity. Both obesity-related secondary diseases-type2 diabetes and chronic degenerative joint disease-can be prevented or at least delayed by lifestyle intervention aimed at weight reduction. The progression of these diseases can also be favourably influenced by radical weight loss. Diets with areduction in carbohydrates-aso-called "low-carb" or ketogenic diet-appear to be superior to alow-fat diet. If joint replacement surgery is necessary, preoperative and perioperative interdisciplinary care by ateam of experienced therapists from the fields of orthopaedics and obesity/type2 diabetes is required. The Düsseldorf TeDia model in the network of Catholic hospitals in Düsseldorf takes these requirements into account by providing interdisciplinary care for such patients at the orthopaedic centre at St. Vinzenz Hospital Düsseldorf and the West German Diabetes and Health Centre (WDGZ). Patients with pronounced obesity or diabetes mellitus are presented preoperatively at the WDGZ on an outpatient basis, and weight reduction therapy or optimization of the diabetic metabolic situation is initiated. If joint problems persist despite weight reduction or pronounced degenerative changes that require surgery, the WDGZ provides inpatient diabetology care in the orthopaedic clinic with the option of further outpatient follow-up care.

Prioritizing emergency department antibiotic stewardship interventions for skin and soft tissue infections using judgment analysis.

Skin and soft tissue infections (SSTIs) account for over 2.8 million annual emergency department (ED) visits and often result in suboptimal antibiotic therapy. The objective of this study was to evaluate a set of interventions in minimizing inappropriate prescription of antibiotics for presumed SSTIs in the ED. Case vignette survey. A national sample of emergency medicine (EM) physicians. Each vignette described a clinical scenario of a presumed SSTI (cellulitis or abscess) and included a unique combination of zero to five interventions (outpatient follow-up, inappropriate antibiotic request flag, thermal imaging for cellulitis or rapid wound MRSA PCR for abscess, patient education/shared decision-making, and clinical decision support). Out of 64 possible vignettes, we asked participants to respond to eight vignettes. Following each vignette, we asked participants if they would prescribe an antibiotic in their everyday practice (yes/no). We built adjusted hierarchical logistic regression models to estimate the probability of prescribing an antibiotic for each intervention and vignette. Surveys were completed by 113 EM physicians. The thermal imaging, rapid wound MRSA PCR, and patient education/shared decision-making interventions showed the largest decrease (15-20%) in antibiotic prescribing probability. Vignettes with a combination of both a diagnostic intervention (thermal imaging or rapid wound MRSA PCR) and a patient education/shared decision-making intervention had the lowest prescribing probabilities. We recommend future research focuses on the development and integration of novel diagnostic tools to identify true infection and incorporate shared decision-making to improve diagnosis and management of SSTIs.

Managing medical care for victims with thermal burn injuries caused by emergency accidents in megacity settings

Relevance. In emergency settings, medical care for thermal burn injuries remains a crucial problem of disaster medicine. In industrially advanced countries with ongoing urbanization, burns represent a most frequent and severe type of injuries requiring emergency medical care. The study objective is to analyze the efficiency of emergency medical care provided in Moscow over the 6 year’s timespan (2018 to 2023) to victims of emergency accidents presented with thermal burns.Methodology and methods. The study relies on the data obtained from the Disaster Medicine of Moscow automated analytical information system with a focus on the victims of emergency accidents presented with burns throughout the past 6 years (2018 to 2023). The platform is managed by the Moscow Territorial Scientific and Practical Center for Disaster Medicine (CEMP) and the N.V. Sklifosovsky Research Institute of Emergency Medicine.Results and discussion. Over the past 6 years (2018 to 2023), the emergency accidends affected 1989 victims presented with thermal burns, including 438 (22.0 %) declared dead at the scene prior to the arrival of CEMP medical and specialized emergency response teams. 1,216 patients (61.1 %) were evacuated to referral centers at multidisciplinary hospitals, 315 patients (15.9 %) travelled to medical hospitals by passing-by vehicles to apply for medical help independently, and 20patients (1 %) were referred for outpatient follow-up. Overall, 597 patients were admitted to burn injury department at the N.V.Sklifosovsky Research Institute. Those included 33.1 % in extremely severe and severe condition, with 1.7 % requiring tracheal intubation and respiratory ventilation support.Conclusion. At pre-hospital stage, deployment of the medivac ICU teams is the most promising strategy to ensure high quality medical care. Given the high incidence of multiple injuries (up to 49.6 %) in emergency accidents, sophisticated medical care shall be provided by a multidisciplinary team of reconstructive burn surgeons, ICU staff specializing in inhalation injuries, and medical professionals.

Efficacy of ursodeoxycholic acid in reducing the necessity of cholecystectomy due to pre-existing and subsequently formed gallstones in patients who underwent laparoscopic sleeve gastrectomy

BackgroundIn this study, we aimed to investigate whether ursodeoxycholic acid (UDCA) would reduce the necessity of cholecystectomy in patients diagnosed with asymptomatic gallstones after laparoscopic sleeve gastrectomy (LSG) and in patients diagnosed with asymptomatic gallstones before LSG.MethodsBetween July 2020 and November 2022, at least 2-year follow-ups of patients who underwent LSG for obesity were retrospectively analyzed. Patients with pre-existing asymptomatic gallstones during preoperative evaluation, those with UDCA treatment (group 1), and observation group (group 2). Patients with newly formed gallstones in postoperative outpatient clinic follow-up, those with UDCA treatment (group A), and those without UDCA treatment (group B).ResultsA total of 425 patients included. At the end of the first year, patients who had newly formed gallstones after LSG had a higher total weight loss percentages (TWL%) (39.8 ± 6.1) compared to those who did not develop gallstones (37.9 ± 7.4), which were statistically significant (p = 0.004). Among patients who developed gallstones postoperatively, UDCA treatment was associated with a significantly lower cholecystectomy rate in patients with newly formed gallstones postoperatively (p = 0.025), while no significant difference was shown in patients with preoperative gallstones (p = 0.631).ConclusionUDCA is a promising option for reducing the need for cholecystectomy in patients with post-LSG gallstones, but it appears ineffective for pre-existing gallstones.

Remote monitoring for patients with cardiac implantable electronic devices and heart failure

The digitalization in healthcare facilitates continuous monitoring of relevant medical parameters through internal and external sensors. For patients with heart failure and cardiac implantable electronic devices (CIEDs), telemedicine has the potential to improve patient care and reduce use of healthcare resources. Remote monitoring shortens the response time to aclinical event, reduces inappropriate shocks, and increases patient satisfaction. Despite some limitations, remote monitoring therefore represents avaluable addition to regular outpatient follow-up care.

Profiles of physician follow-up care, correlates and outcomes among patients affected by an incident mental disorder

ObjectivesThis study identified profiles of outpatient physician follow-up care and other practice features, mostly after detection of incident mental disorders (MD), and associated these profiles with patient characteristics and subsequent adverse outcomes.MethodsA cohort of 170,957 patients age 12 + with a new or recurrent MD detected in 2019-20 was investigated based on data from the Quebec Integrated Chronic Disease Surveillance System. Latent class analysis was performed to identify follow-up care profiles, mostly within one year of MD detection. Bivariate analyses tested associations between profiles and patient characteristics; logistic regressions examined relationships between profiles and adverse outcomes after one year.ResultsFive profiles were identified: Profiles 2 and 5 (64%) offered low mental health (MH) outpatient follow-up care, while the others dispensed higher MH follow-up care. Profiles differed in patient characteristics and related outcomes. Labelled “Follow-up care by usual psychiatrist”, Profile 1 (1% of sample) included younger patients with the most health and social issues. Profile 2 (50%), “Low MH follow-up care but high prior consultations for physical reasons”, mostly integrated older patients with chronic physical illnesses. Profile 3 (11%), “Follow-up care by general practitioners (GP) and psychiatrists”, referred to physicians other than the usual ones (e.g., walk-in practice) and encompassed patients with severe MD conditions. Profile 4 (23%), “High follow-up care by usual GP and prior consultations for physical reasons”, showed the typical characteristics of patients treated in primary care (more common MD, women, less materially and socially deprived). Profile 5 (15%), “Low MH follow-up care and prior consultations for physical reasons”, integrated more younger men, materially deprived patients, and with substance-related disorders (SRD) or co-occurring MD-SRD. More Profile 1 and 3 patients lived in university regions – those of Profile 4 were the least numerous in such regions. More Profile 5 patients lived in metropolitan and rural areas. Risk of death was higher in Profiles 5, 2, 3, and risk of frequent ED use and hospitalization higher in Profiles 1, 3, and 5 – patients with severe health and social issues.ConclusionThe study confirmed the need to improve prompt, adequate and continuous follow-up care for patients with incident MD.