Outpatient Group Research Articles

Silent Infections are not So Silent: The Emerging Role of Combined Infections, Inflammation, and Vitamin Levels in OCD.

Recent evidence highlights that different agents may trigger immune-mediated processes involved in the pathophysiology of different neuropsychiatric conditions. Given the limited information on obsessive-compulsive disorder (OCD), the present study aimed at assessing current/past infections and plasma levels of vitamin D, vitamin B12, folic acid, homocysteine and common peripheral inflammatory markers in a group of OCD outpatients. The sample included 217 adult outpatients with an OCD diagnosis according to the DSM-5 criteria. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to assess the clinical phenotype and symptom severity. Laboratory blood tests measured levels of vitamin D, vitamin B12, folic acid, homocysteine, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood count and antibodies titers for cytomegalovirus (CMV), Epstein Barr virus (EBV), Toxoplasma gondii and antistreptolysin titer. Sixty-one patients had a previous EBV infection, 46 were seropositive for CMV IgG, 24 showed positive antistreptolysin titer, 14 were seropositive for Toxoplasma gondii IgG, and four for CMV IgM. More than a half of patients showed vitamin D insufficiency. Compared to seronegative patients, patients with a past EBV infection displayed significantly higher scores on the Y-BOCS total score and compulsion subscale, and other symptoms. Vitamin D was negatively correlated with both the Y-BOCS total score and the subscales scores. Folic acid was negatively correlated with the Y-BOCS total and obsessions subscale score. The findings of our study show an association between Epstein-Barr infection and hypovitaminosis D and the overall severity and specific symptom patterns of OCD. The laboratory measures used in this study are useful, cheap and easy parameters that should be routinely assessed in patients with OCD. Further studies are needed to clarify their role in OCD pathophysiology and outcomes, as well as the potential therapeutic impact of vitamins and antibiotics/immunomodulatory agents in OCD and other psychiatric conditions.

Diabetes Health Supervision and Treatment Strategy Based on Data Management and Analysis on eKTANG Platform.

The management of diabetes-related risk factors could effectively reduce the occurrence of its complications, improve the quality of life of patients, and reduce the mortality of patients. Data analysis based on the eKTANG platform could greatly improve the efficiency of communication between patients and doctors, and strengthen the treatment and management of diabetes. We created eKTANG to monitor patient health effectively. The eKTANG health management system aims to extensively intervene in blood glucose monitoring, nutrition, exercise, medicine, and health education to enable diabetes patients to achieve optimal treatment results. Diabetes patients diagnosed by Henan University Medical School included through the eKTANG platform were randomly divided into three groups: member service package group, discharge/ outpatient follow-up group, and out-of-hospital care group. We conducted intensive out-ofhospital interventions for three groups of patients for three months to help patients formulate precise blood glucose control plans and conduct training. The traditional group was compared with the eKTANG platform group, and the physiological indicators and patient compliance of the four groups were observed 6 months later. In the eKTANG platform management group, the average blood glucose compliance rate increased significantly, and the percentage of average blood glucose in the range of 3.9-10.0 showed an upward trend. Fasting blood glucose and postprandial blood glucose showed a downward trend. At the same time, the number of patients per capita blood glucose monitoring showed a significant increase compared with the control group. The establishment of the eKTANG platform can improve the efficiency of patient's medical treatment, improve their lifestyles, reduce the incidence of patient complications, and build a virtuous circle gradually. This research has strengthened the health management and autonomy of diabetic patients and improved the efficiency of treatment. It is worthy of promotion.

The Value of the COVID-19 Yorkshire Rehabilitation Scale in the Assessment of Post-COVID among Residents of Long-Term Care Facilities.

The COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) is a patient-reported outcome measure designed to assess the long-term effects of COVID-19. The scale was validated and is commonly used in the general population. In this study, we assess the utility of the C19-YRS in evaluating the post-COVID burden among residents of long-term care facilities with a mean age of 79. C19-YRS and Barthel index evaluations were performed among 144 residents of long-term care facilities reporting new or worsened symptoms or functioning three months after convalescence from COVID-19. The C19-YRS-based screening showed that 70.9% of COVID-19 convalescents had ≥1 complaint three months after recovery. The highest C19-YRS-scored symptoms (indicating a higher burden) were breathlessness, fatigue, and cognitive and continence problems; however, symptomatology was very heterogeneous, revealing a high complexity of the disease in older persons. The mean total C19-YRS score was higher in hospitalized patients (n = 78) than in the outpatient group (n = 66) (p = 0.02). The functioning subscale of the C19-YRS strongly correlated with the Barthel index, with r = -0.8001 (p < 0.0001). A moderately strong correlation existed between retrospectively reported C19-YRS-based functioning and the Barthel index score reported before illness (r = 0.7783, p < 0.0001). The C19-YRS is instrumental in evaluating the consequences of COVID-19 among long-term-care residents. The assessment allows for a broad understanding of rehabilitation needs.

Risk factors for hospitalization and pneumonia development of pediatric patients with seasonal influenza during February-April 2023.

In China influenza remains a low activity for continuous 3 years due to COVID-19 controls. We here sought to study the clinical characteristics and risk factors of the influenza infection among children after the mandatory COVID-19 restrictions were lifted. We included 1,006 pediatric patients with influenza A virus (IAV) infection, enrolled in one tertiary hospital in Zhenjiang, Jiangsu Province, China, during February to April 2023. Patients were divided into the outpatient (n = 798) and inpatient (n = 208) groups, and their baseline characteristics were compared between two groups to conclude the risk factors for pediatric hospitalization. Separately, pediatric inpatients (n = 208) were further divided into the pneumonia and non-pneumonia groups with comparison of their clinical characteristics, including their laboratory test results and representative radiological features, to derive the key determinants for pneumonia development after hospitalization. Compared to outpatients, IAV-infected pediatric inpatients exhibited younger age, higher female: male ratio, more co-infection of influenza B virus (IBV) and hematological abnormality. Multivariate regression analysis determined the independent risk factors of hospitalization to be the clinical symptom of abdominal pain (OR = 2.63, [95% CI, 1.05-6.57], p = 0.039), co-infection of IBV (OR = 44.33, [95% CI, 25.10-78.30], p = 0.001), elevated levels of lymphocytes (OR = 2.24, [95% CI,1.65-3.05], p = 0.001) and c-reactive proteins (CRPs) (OR = 1.06, [95% CI, 1.03-1.08], p = 0.001) upon hospital admission. Furthermore, the cough symptom (OR = 17.39, [95% CI, 3.51-86.13], p = 0.001) and hospitalization length (OR = 1.36, [95% CI, 1.12-1.67], p = 0.002) were determined to be risk factors of pneumonia acquirement for pediatric inpatients. While the abdominal pain, viral co-infection and some hematological abnormality mainly contribute to hospitalization of pediatric patients with IAV infection, the length of hospital stay and clinical sign of coughing upon hospital admission constitute the key determinants for nosocomial pneumonia development.

Safety and feasibility of endoscopic sinus surgery as an office-based procedure

Background: The purpose of this study was to evaluate whether office-based endoscopic sinus surgery (ESS) is as safe as tradi- tional outpatient surgery and whether there are differences in the operation results, patient recovery data, or complication and revision surgery rates. Methods: The study involved 164 subjects and data was collected retrospectively from Seinäjoki Central Hospital patient records. The office-based group included 92 patients who had undergone ESS under local anaesthesia in an office-based setting between April 2014 and December 2017, and the outpatient group 72 patients who had done so in an outpatient setting between January 2010 and December 2014. Patients were divided into two groups based on presence (wNPs, n=57) or absence (sNPs, n=107) of nasal polyps. Results: We found statistically significant differences in intraoperative medication in terms of amounts of drugs administrated. Sick leave was on average 2.1 days longer in the outpatient sNPs group and 2.4 days longer in the outpatient wNPs group than in the respective office groups. There were no statistically significant differences between methods in terms of complications. Revision rates for sNPs were 5.6% and 13.9% for the office and outpatient groups, respectively, and for wNPs 4.8% and 19.4%, respectively. Conclusion: Office-based ESS with careful patient selection seems safe, effective, and well tolerated by patients. Office-based intervention may lead to shorter sick leave durations and can reduce the overall use of sedative drugs during the operation.

The Safety and Effectiveness of Telemedicine for Cancer-Related Colostomy Care in the Early Stage of Discharge: A Prospective, Randomized, Single-Center Study.

There has been an exponential growth in the use of telemedicine services to provide clinical care. However, the safety and effectiveness of telemedicine in cancer-related colostomy care during the early stages of discharge remain unclear. This study aimed to support that the safety and effectiveness of telemedicine in cancer-related colostomy care were not inferior to those of outpatient care. This was a prospective randomized noninferiority study. A total of 76 consecutive patients who underwent cancer-related colostomy stoma were enrolled and randomly divided into a telemedicine group or an outpatient group with an equal allocation ratio (1:1). The outpatient group was provided in-person interview mode colostomy care, whereas the telemedicine group was provided video interview mode colostomy care. The stoma-related complications, self-care ability, and quality of life reflected the safety and effectiveness of colostomy care in the early stages of discharge. The incidence of stoma-related complications within two weeks and one month after discharge was not significantly different between the two groups (p 2-weeks = 0.772 and p 1-month = 0.760). The mean NCI-CTCAE score for stoma-related complications was less than level 2. The ESCA and C-COH-QOL-OQ scores were not significantly different between the telemedicine and outpatient groups at two weeks and one month after discharge (all p > 0.05). The results revealed that the safety and effectiveness of telemedicine for cancer-related colostomies in the early stages of discharge were not inferior to those of outpatient care alone.

Incidence of heart failure with preserved ejection fraction (HFpEF) in COPD patients during acute exacerbation in Ain Shams University Hospitals

Abstract Background Cardiovascular comorbidities are frequent in chronic obstructive pulmonary disease (COPD) and are associated with a worse prognosis, and the presence of COPD has a negative impact on cardiovascular disease and heart failure The available estimates of the prevalence of diastolic dysfunction vary widely, probably due to different diagnostic approaches and small sample sizes. Aim Perspective analytical comparison of ECHO findings (done or will be done) within a 3-month interval of acute exacerbations. Outcomes Previous or prospective comparison of EF with current findings at the examination station or grade of diastolic dysfunction, Left atrial dimension, E/A, E/e′ ratios, and slope findings among the 3-month follow-up period perceptively (incidence) in the following two groups, namely Group A: the patient group with prior EHCO findings showing no heart failure with preserved ejection fraction (HFpEF) before enrollment but develop HFpEF during acute exacerbations. Group B: the patient group with ECHO findings of HFpEF following acute exacerbations within 3 months or thereafter. Patients and methods Patients with confirmed COPD by spirometry were evaluated by echocardiography initially as baseline and 3 months after for the assessment of diastolic dysfunction grades. Those patients are divided into two groups as inpatients and outpatients. Results An observational cross-sectional study including 36 COPD diagnosed patients: 33 males and 3 females with a mean age of (58.5 ± 7.7 years). The patients were divided into 17 inpatients and 19 outpatients. These patients were divided according to COPD severity into groups A, B, and C (outpatient group) and D (inpatient group) as 7, 9, 3, and 17 patients, respectively. Comparisons between baseline echocardiographic findings and after 3 months’ follow-up were processed. There were significant increases of tricuspid regurgitation (TR) and diastolic dysfunction in COPD group D compared with the other group at baseline and in the same group after a 3-month follow-up and significant correlation with COPD grade D cases and high-grade diastolic dysfunction. There were significant decrease of TR and decrease of diastolic dysfunction grades after a 3-month follow-up of acute exacerbations compared with baseline. It was found that spirometry parameters were nonstatistically different at baseline concerning the existing diverse diastolic dysfunction. However, only a significant negativecorrelation was found between baseline left atrial dimension and forced expiratory volume in first second/percentage of forced vital capacity. Conclusion COPD severity influences the HFpEF with tendency to increase diastolic dysfunction and TR, which could be improved with COPD management. Assessment of left ventricular diastolic dysfunction is pivotal.

Cost Analysis of Outpatient Colectomy in a Tertiary Center: A Projected Medico-Economic Evaluation

Aim of the study: Short stay processes are incentives to unburden chronically stressed healthcare systems. The aim of this study is to analyze financial implications of day admission (DAS) and outpatient strategies for colon resections in a prospective payment system (PPS) using Diagnosis Related Group (DRG) coding. Methods: Consecutive patients undergoing left and right colonic resections between January 1, 2019 and December 31, 2020 were included. Medico-economic evaluations of the virtual outpatient and day admission surgery groups based on predefined criteria were compared to the identical group of patients who underwent surgery in the actual traditional inpatient setting. In a second step, postoperative complications of the virtual outpatient group were assessed. Cost-revenue analysis was performed using a micro-costing approach including direct medical costs. Results: Overall (N = 257), 97 (37.7%) colectomies would have been potentially eligible for an outpatient strategy. The global costs of the actual inpatient strategy totaled USD 3 634 392 with a global revenue of USD 3 571 069, corresponding to a cost coverage rate of 98%. The result of the virtual DAS strategy would have been a net loss of USD 15 800 (coverage rate of 99%) due to 4 low length of stay outliers triggering a reimbursement reduction and preventing a positive net result of USD 16 208. The pilot reference outpatient case’s revenue and cost amounted to respectively USD 7479 and USD 6911 (cost coverage of 108%). Conclusion: From both any given hospital and healthcare system point of view, elective outpatient colectomy for selected patients is the most cost-saving option. However, in a prospective payment system implemented to avoid bad incentives, the latter can unintentionally disadvantage best performing hospitals and impede widespread adoption of high-value strategies.

The safety and efficacy of unicompartmental knee arthroplasty in outpatient surgical centers: A systematic review and meta-analysis.

Unicompartmental knee arthroplasty (UKA) is an effective treatment method for knee osteoarthritis. With the development and implementation of enhanced recovery after surgery, UKA is now increasingly performed in outpatient surgical centers. However, there is ongoing debate regarding the safety and effectiveness of performing UKA in outpatient settings. The search was performed to retrieve randomized controlled trials and cohort studies on outpatient UKA from PubMed, Cochrane Library, EMbase, CNKI, and WanFangData databases. The search was conducted from the inception of the databases until August 31, 2023. After independent screening, data extraction, and risk of bias evaluation by two researchers, meta-analysis was performed using RevMan 5.4 software. A total of eight studies involving 18,411 patients were included. The results showed that the postoperative transfusion rate in the outpatient group was lower than that in the inpatient group [OR = 0.36, 95%CI (0.24, 0.54), p < 0.00001], and the difference was statistically significant. However, there was no significant difference between the two groups in terms of readmission rate, reoperation rate, surgical site infection, and periprosthetic fracture. The differences were not statistically significant. Compared to the traditional inpatient route, the blood transfusion rate for single-condyle replacement in the outpatient operation center is lower, and there is no significant difference in readmission rate, reoperation rate, surgical site infection, and periprosthesis fracture. The outpatient approach to UKA is safe, feasible, and highly satisfactory for patients. However, the results have certain limitations, and a rigorous preoperative complication risk assessment can minimize the risk of UKA in outpatient surgery centers. PROSPERO number CRD42023405373.

STUDY OF RISK FACTORS FOR CARDIOVASCULAR DISEASES AND CENTRAL HEMODYNAMICS IN SENIOR STUDENTS

HighlightsThe article examines the prevalence of risk factors for cardiovascular diseases (CVD) and the state of central hemodynamics (CHD) in senior students. Aim. To study the risk factors for CHD and CVD in senior students with the aim of early detection of arterial hypertension (AH) and the implementation of therapeutic and prophylactic measures.Methods. The study involved 223 senior students of medical universities in Moscow aged 20-27 years (the mean age was 22.8±0.17 years). The following cardiovascular risk factors were assessed for each student: age, gender, smoking, physical activity, genetic predispositions; body mass index. The indicators of CHD were studied by volumetric compression oscillometry using a portable automated software-hardware complex for non-invasive research of central hemodynamics (“SHCNIR CHD vco-“Globus” device).Results. The presence of CVD risk factors in senior students was revealed in 52.5% of cases; more than two risk factors were found in 19.3% of cases; 1st degree arterial hypertension (AH) in 11.2% of cases; “white coat hypertension” in 10.8% of cases; genetic predisposition to CVD in 30.0% of cases; overweight in 17.0% of cases; obesity in 5.4% of cases; low physical activity in 23.8% of cases; smoking in 16.1% of cases. An altered CHD profile was found in 62.1% of students. An increase in total peripheral vascular resistance at normal blood pressure levels was noted in 31.8% of cases. Indicators of total peripheral vascular resistance, mean blood pressure, systolic and diastolic blood pressure were significantly higher in the group of students with CHD risk factors.Conclusion. Outpatient follow-up groups should include students with established risk factors for cardiovascular diseases, diagnosed AH, and with altered indicators of CHD. Preventive examinations should include a simple method for studying hemodynamics – compression oscillometry.

The sense of loneliness and meaning in life in post-COVID convalescents-a preliminary study.

The COVID-19 epidemic has provided opportunity to study the impact of a well-defined severe illness on the development of a depressive episode and the associated sense of loneliness and lack of meaning in life. The aim of the study was to assess the occurrence of a reactive depressive episode, the severity of depression, a sense of loneliness and meaning in life in subjects who approximately a year earlier than the date of the study had suffered from a pulmonary form of SARS-CoV-2 infection with radiologically documented interstitial lesions of the lungs, requiring and not requiring hospitalization compared to people who did not develop the disease as a result of infection with that virus. The study included 63 subjects hospitalized for pulmonary lesions, 67 not hospitalized and 60 healthy controls. The severity of depressive symptoms was measured using a Polish-language standardized version of the Beck Depression Inventory, a sense of loneliness using the De Jong Gierveld Loneliness Scale, and a sense of meaning in life using the Life Attitude Profile-Revised. The frequency of depression and its severity were found to be the highest in hospitalized patients compared to those treated at home and healthy people. A significant difference in the frequency of depression and its severity between outpatients and healthy people was also observed. The feeling of loneliness turned out to be greatest in the group of hospitalized people. Also, the severity of loneliness was found to be higher in the outpatient compared to the control group. The sense of meaning in life reached its lowest level among hospitalized patients, was moderately reduced in the outpatient group, and typical of the Polish population in the control group. Both pulmonary SARS-CoV-2 infection and hospitalization have been shown to be a risk factor for depression, increased feeling of loneliness and a reduced sense of meaning in life. The effect of trauma and the presence of depression can be the explanation for the increased sense of loneliness after the illness and the partial breakdown of the lifeline manifested by a decrease in the sense of meaning in life.

Predictors of reduced incremental shuttle walk test performance in patients with long post-COVID-19.

One of the common limitations after COVID-19 pneumonia is the decrease in exercise capacity. The identification of the factors affecting exercise capacity and the assessment of patients at risk are important for determining treatment strategy. This study was conducted to determine the predictors of decreased exercise capacity in long post-COVID-19 patients. We investigated the association of exercise capacity as measured by the incremental shuttle walk test (ISWT) with age, sex, spirometric variables, respiratory and peripheral muscle strength, quality of life, fatigue, hospital anxiety depression scale, chest X-ray involvement, and hospitalization. The patients were divided into three groups: outpatients, inpatients, and ICU patients. Regression analysis was used to determine which parameters were significant predictors of exercise capacity. Of the 181 patients included in the study, 56 (31%) were female. The mean ISWT in percentage of predicted values (ISWT%pred) was 43.20% in the whole sample, whereas that was 52.89%, 43.71%, and 32.21% in the outpatient, inpatient, and ICU patient groups, respectively. Linear regression analysis showed that predictors of decreased ISWT%pred were sex (b = 8.089; p = 0.002), mMRC scale score (b = -7.004; p ≤ 0.001), FVC%pred (b = 0.151; p = 0.003), and handgrip strength (b = 0.261; p = 0.030). In long post-COVID-19 patients, sex, perception of dyspnea, restrictive pattern in respiratory function, and decrease in peripheral muscle strength are predictors of reduced exercise capacity that persists three months after COVID-19. In this context, we suggest that pulmonary rehabilitation might be an important therapy for patients after COVID-19.

Immediate-use strategy is as safe and effective as delayed-use strategy following percutaneous endoscopic gastrostomy tube placement: A retrospective cohort study.

Percutaneous endoscopic gastrostomy (PEG) tube placement is the most common enteral access for long-term feeding. The aim of our study is to assess the feasibility and safety of immediate PEG tube use after initial placement. We conducted a single-center retrospective cohort study between August 2006 and August 2016. Prior to August 2011, tube feedings were delayed for ≥4 h after initial PEG placement, compared with immediate use (<1 h) after August 2011. Primary outcomes were complication rates within 30 days of placement. Secondary outcomes were impact of morbidity, mortality, length of stay, and need for repeat PEG placement. Our study included 1296 patients during the 10-year period, of which 704 underwent delayed use and 592 underwent immediate use (744 inpatient and 552 outpatient). There were no significant differences between the delayed-use and immediate-use PEG with regard to complications (3.4% vs 4.4%; P = 0.76). Subgroup analysis also reflected no significant differences in complications between inpatient and outpatient groups. For inpatients, there were no substantial differences in inpatient mortality (3.9% vs 3.3%; P = 0.70), mortality within 30 days of discharge (13.8% vs 13.1%; P = 0.15), readmissions (38.2% vs 34.3%; P = 0.23), repeat PEG placement (0.7% vs 1.5%; P = 0.46), and length of stay (13.3 vs 13.9 days; P = 0.99). Patients who received immediate enteral nutrition after PEG tube placement did not have any increased complications, morbidity, or mortality; and it is just as safe when compared with patients who received delayed feeding.

A virtual frame – how does forensic psychotherapy work remotely?

Psychotherapy has been practised via remote technology since the mid-1990s and has grown in mainstream popularity; yet, it remains controversial, particularly for psychoanalytically informed treatment, and limited research in this area has been published. However, COVID-19 provoked a necessary transition to online working across the psychotherapy profession, including clinicians providing psychoanalytic treatment to a unique forensic outpatient group remotely for the first time. This qualitative research study sought insights from this sample via grounded theory interviews and analysis to inform hypothetical future practice of remote psychotherapy via videoconferencing to forensic populations with limited access to treatment. This generated a substantive theory about how forensic psychotherapy works remotely: In the context of a forced transition to remote working, forensic psychotherapists make attempts to substitute for real by establishing an alternative frame; noticing how differently contact is mediated; adapting technique; and evaluating suitability for remote treatment. An implication of these findings may be that developing a new Virtual Frame for forensic psychotherapy, supported by specialist training and supervision, could increase its reach within settings that provide sufficient containment for the work. Further research is encouraged to support this undertaking and consider which patients, and/or clinicians, might work effectively this way.

The prevalence of HPV among 164,137 women in China exhibited some unique epidemiological characteristics

ObjectiveThe persistence of HPV infection is a significant etiological factor in the development of cervical cancer. The present study investigated the prevalence and genotype distribution of human papillomavirus (HPV) in a cohort of 164,137 unvaccinated women from Wenzhou, aiming to provide guidance for clinics in the cervical cancer screening and HPV vaccination strategies.MethodsThe present retrospective study included a total of 164,137 women, comprising 118,484 outpatients and 45,653 healthy female subjects recruited from 2015 to 2020. Cervical exfoliated cells were collected from these participants for subsequent DNA extraction. The extracted DNA samples were underwent analysis using a fluorescence in situ hybridization method, encompassing the detection of 27 HPV genotypes.ResultsThe overall prevalence of HPV was 17.35%; this corresponded to a prevalence of 19.10% in the outpatient group and 12.82% in the healthy female group. Among the outpatient group, the five most prevalent HPV genotypes were identified as HPV 52, 58, 16, 53, and 61. In the healthy female group, the five most common HPV genotypes were found to be HPV 52, 53, 58, 61, and 81. Additionally, it was estimated that the highest rate of HPV infection occurred among individuals aged between 10 and 19 years old (44.65%) and those aged between 60 and 69 years old (27.35%).ConclusionsThe prevalence of HPV in this region is substantial; therefore, it is imperative to implement scientifically sound and rational clinical interventions such as vaccination. Routine cervical screening should be performed to prevent the development of cervical intraepithelial neoplasia resulting from persistent infection with high-risk HPV, particularly in women with gynecological diseases and those over 60 years old.

Performance of the High-STEACS Early Rule-Out Pathway for High Sensitivity Cardiac Troponin T at 30-days in a US population

Abstract Background The High-STEACS Early Rule-Out Pathway for High Sensitivity Cardiac Troponin T (hs-cTnT) is an algorithm designed to rule-out myocardial infarction (MI) in ED patients with symptoms concerning for acute coronary syndrome (ACS). High-STEACS was validated in the United Kingdom but has yet to be evaluated in the US. Purpose The objective of this secondary analysis of the STOP-CP (High Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) United States (US) multicenter study is to determine the performance of the High-STEACS hs-cTnT Pathway in a multisite US cohort. Methods Patients (≥ 21 years old) presenting to the (ED) with symptoms suggestive of ACS were enrolled (1/25/2017-9/6/2018) at 8 US medical centers. Participants with 0- and 1-hour hs-cTnT measures were stratified into outpatient and admission dispositions using the established High-STEACS hs-cTnT cut-points. Cardiac death or MI and major adverse cardiovascular events (MACE; a composite of cardiac death, MI, and coronary revascularization) at 30-days were adjudicated. Negative and positive predictive values (NPV and PPV) and negative and positive likelihood ratios (-LR and +LR) for the High-STEACS pathway were calculated for each outcome with 95% confidence intervals. Results Overall, 1430 patients were studied. 54.2% (775/1430) were male with a mean age of 57.6 ± 12.8 years. At 30-days, 12.8% (183/1430) of patients experienced cardiac death or MI and 14.2% (203/1430) had MACE. High-STEACS classified 59.9% (857/1430) to the outpatient disposition and 40.1% (573/1430) to admission. Among patients stratified to the outpatient group, 1.9% (16/857) experienced cardiac death or MI and 3.4% (29/857) had MACE at 30-days. The NPV and -LR for High-STEACS were 98.1% (95%CI 97.0-98.9) and 0.13 (95%CI 0.08-0.21) for 30-day cardiac death or MI and 96.6% (95%CI 95.2-97.7) and 0.21 (95%CI 0.15-0.30) for 30-day MACE. For patients stratified to admission, 29.1% (167/573) had 30-day cardiac death or MI and 30.4% (174/573) had MACE. This yielded a PPV and +LR for 30-day cardiac death or MI of 29.1% (95%CI 25.5-33.1) and 2.8 (95%CI 2.6-3.1) and 30.4% (95%CI 26.6-34.3) and 2.6 (95%CI 2.4-2.9) for 30-day MACE. Conclusions The High-STEACS hs-cTnT Pathway stratified nearly 60% of patients to an outpatient disposition, but these patients had high rates of 30-day cardiac events. These findings suggest that providers should be cautious before using this pathway among US patients with possible ACS.

Effect of pharmacotherapy on the immune response in patients with COVID-19

Background. The effect of pharmacotherapy used to treat patients with the new coronavirus infection COVID-19 on immune parameters after treatment has not been sufficiently studied.&#x0D; Aim. To study the effectiveness of pharmacotherapy and evaluate its impact on the immune response in patients with COVID-19.&#x0D; Material and methods. The subjects of the study were 98 patients with COVID-19 aged from 32 to 68 years who were treated at the Penza Regional Clinical Center for Specialized Types of Medical Care from November 2022 to March 2023. The average age of the patients was 5018 years. Computed tomography revealed pneumonia in all patients (CT1CT4). The outpatient observation group included patients with COVID-19 (n=32), who were characterized by a mild course of the disease, 36 patients with moderate severity of COVID-19, and 30 patients with severe and extremely severe disease. Patients with mild COVID-19 received molnupiravir as antiviral therapy, patients with moderate COVID-19 received favipiravir, and patients with severe and extremely severe COVID-19 received remdesivir. After treatment, 72 patients were examined on an outpatient basis 34 weeks after discharge from the hospital. In the blood of patients before and after treatment, the populations of T- and B-lymphocytes, the functional activity of T-lymphocytes, cytokine indicators tumor necrosis factor , interleukins-4, -10 and -18, interferon in cell supernatants were studied. Statistical analysis of the groups was carried out according to Wilcoxon, differences were considered significantly significant at p 0.05.&#x0D; Results. In the observation group (98 patients), in patients with mild disease (32 patients), recovery occurred in 31 (96.8%) people. With a moderate course of the disease, a favorable outcome with clinical and laboratory improvement was noted in 33 (91.7%) patients out of 36, and with a severe course of COVID-19 in 7 (23.4%) patients out of 30, 5 (16.6%) patients died, in 18 (60.0%) people after the 10th day of therapy complications from the cardiovascular system in the form of heart attacks and strokes were noted. After treatment in patients with COVID-19, the immune system showed an increase in the relative number of lymphocytes (p=0.034171), indicators of cytotoxic CD3+CD8+ T cells (p=0.001090), spontaneous synthesis of interferon (p=0.003246), induced production of interleukin-18 (p=0.003278), decrease in the absolute number of leukocytes (p=0.004319) and induced synthesis of interleukin-10 (p=0.042439).&#x0D; Conclusion. Regardless of the type of antiviral therapy administered, a high recovery rate was recorded in patients with mild and moderate disease compared with severe and extremely severe disease.

Reduction in Feeding Problems and Impact on Family Following a 12-Week Interdisciplinary Group Feeding Intervention for Children With Feeding Problems and Their Caregivers

Caregivers and their children with clinical levels of feeding problems participated in Picnic Group, an outpatient interdisciplinary family group treatment program for children with feeding disorders and their caregivers at a large regional pediatric hospital. The manualized treatment is based on an interdisciplinary systematic approach that draws from sensory integration, communication, and cognitive behavioral strategies (e.g., classical conditioning, systematic desensitization, communication of automatic thoughts) to increase pleasurable interactions with food over a 12-week period and includes caregiver and child intervention components. Escape extinction techniques such as nonremoval of the spoon were not used in treatment. Caregivers completed measures focused on their children’s feeding behaviors and family strain at baseline and at the end of the 12-week intervention. Wilcoxon signed-rank tests compared measures between baseline and the end of treatment. Results indicated that at the 12th week, caregivers generally reported one less feeding problem, fewer specific types of eating and mealtime problematic behaviors, and decreased impact of feeding problems on the family. Children were able to work up a hierarchy of food interactions with more foods per group session than at the first session. Caregivers of children with a developmental diagnosis showed the most decrease in caregiver strain. Outpatient interdisciplinary group treatment can decrease feeding problems and caregiver strain in families with children with feeding disorders.

Anatomic total shoulder arthroplasty with a nonspherical humeral head and inlay glenoid: 90-day complication profile in the inpatient versus outpatient setting.

Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a successful bone-preserving treatment for glenohumeral arthritis. This study aimed to describe the 90-day complication profile of TSA with this prosthesis and compare major and minor complication and readmission rates between inpatient- and outpatient-procedure patients. A retrospective review was performed of a consecutive cohort of patients undergoing TSA with a nonspherical humeral head and inlay glenoid in the inpatient and outpatient settings by a single surgeon between 2017 and 2022. Age, sex, body mass index, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and 90-day complication and readmission rates were compared between inpatient and outpatient groups. One hundred eighteen TSAs in 111 patients were identified. Mean age was 64.9 years (range, 39-90) and 65% of patients were male. Ninety-four (80%) and 24 (20%) patients underwent outpatient and inpatient procedures, respectively. Four complications (3.4%) were recorded: axillary nerve stretch injury, isolated ipsilateral arm deep venous thrombosis (DVT), ipsilateral arm DVT with pulmonary embolism requiring readmission, and gastrointestinal bleed requiring readmission. There were no reoperations or other complications. Outpatients were younger with lower ASA and CCI scores than inpatients; however, there was no difference in complications (1/24 vs. 3/94, P=1.00) or readmissions (1/24 vs. 1/94, P=0.37) between these two groups. TSA with a nonspherical humeral head and inlay glenoid can be performed safely in both inpatient and outpatient settings. Rates of early complications and readmissions were low with no difference according to surgical setting. Level of evidence: IV.

Outpatient versus inpatient delivery of intensive chemotherapy for patients with hematological neoplasms: A 5-year experience from a tertiary center.

7 Background: There has been a shift towards the utilization of outpatient delivery of intensive chemotherapy due to potential improvements in quality of life measures and resource utilization. Herein, we aim to report the findings of a five-year quality improvement project comparing the outcomes and healthcare costs of outpatient and inpatient delivery of post-induction intensive chemotherapy amongst patients with hematological neoplasms. Methods: Using Plan-Do-Study-Act (PDSA) methodology, a multidisciplinary team was established to determine appropriate strategies for delivering outpatient intensive chemotherapy and improving healthcare resource utilization. Records of patients receiving inpatient chemotherapy from 2016-2017 were retrospectively reviewed. Process mapping was utilized to design interventions to facilitate the outpatient delivery of chemotherapy. The interventions included the initiation of an outpatient chemotherapy clinic, creating clinical pathways for chemotherapy protocols, developing educational materials for patients and healthcare staff, and facilitating access to emergency care services. During 2018-2022, patients were prospectively identified and enrolled to receive outpatient chemotherapy. Results: 288 patients were enrolled with 70 (24.3%) receiving inpatient chemotherapy and 218 (75.7%) receiving outpatient chemotherapy. The median age for the inpatient and outpatient chemotherapy groups was 34 and 38, respectively [P = 0.027]. Patients enrolled in this project had diagnoses of acute leukemia (53.2%), Hodgkin’s lymphoma 16.3%, and non-Hodgkin’s lymphoma (30.6%). Febrile neutropenia was observed in 64.3% of patients receiving inpatient chemotherapy and in 27.5% of patients receiving outpatient chemotherapy [P &lt; 0.001]. Death during the course of the chemotherapy regimens was seen in 4% of patients receiving inpatient chemotherapy compared to 0.5% of outpatient chemotherapy patients [P = 0.003]. Outpatient chemotherapy resulted in a 53.4% reduction in total bed days occupied. The estimated total cost saving due to this intervention during the years of 2018-2022 was $2.88 million USD. Conclusions: Outpatient delivery of intensive chemotherapy for hematological malignancies is an effective approach which results in comparable safety outcomes and significant improvements in cost-effectiveness and resource utilization.