Outpatient Population Research Articles

Area Deprivation Index as a proxy for socioeconomic status in outpatient orthopaedic surgery patients – A prospective registry cross sectional study

BackgroundWe aimed to determine if Area Deprivation Index (ADI) is associated with self-reported metrics socioeconomic status (SES), and to assess the relationship between ADI and preoperative score on common patient reported outcome scores (PROS). MethodsPatients presenting for outpatient orthopaedic surgery completed Patient-Reported Outcome Metric Information System (PROMIS) and joint-specific PROS. ADI was determined from geocoded home address. Sociodemographic data was collected from self-reported survey. Tests of association were used to describe the relationship between ADI and sociodemographic factors as well as the correlation between ADI and PROS. Extreme group analysis was used to examine which PROS may be subject to clinically meaningful variation. ResultsADI was associated with self-reported SES. ADI was correlated with score on all baseline PROS. Extreme group analysis showed that low SES was associated with clinically meaningful differences in some, but not all, PROS. ConclusionADI is associated with self-reported measures of SES in an orthopaedic outpatient surgical population. Lower SES correlates with worse function to a clinically significant degree for some PROS. SES should be considered in the context of preoperative symptom severity in outpatient orthopaedic surgery patients. ADI may be a useful adjunct to self-reported measures of SES for this purpose.

The impact of anal incontinence: psychosocial and sexual consequences and factors associated with QoL in a Norwegian outpatient population.

Anal incontinence (AI) is a distressing condition with grave impact on many aspects of life, including quality of life (QoL), social life and sexual activities. This study explored how AI and bowel symptoms impact QoL in a Norwegian population by (1) describing the psychosocial and sexual consequences of AI, and (2) investigating factors most often associated with AI-specific QoL. A cross-sectional study among patients with AI referred to hospital outpatient clinics was conducted. A Norwegian version of ICIQ-B was used to measure bowel control, bowel symptoms, sexual impact, and impact on QoL. A total of 208 persons with AI completed the questionnaire. The results demonstrated that these patients are overall embarrassed, make plans according to the bowels, ensure the presence of a nearby toilet, and many abstain from sexual activities. After adjusting for other variables included in a multivariable model, we found that having bowel accidents on one's mind had the greatest relative impact on QoL, followed by lower bowel control, using more medications to stop bowels, having more pain/soreness around the back passage, lower age, and more straining to open the bowels. AI has substantial consequences for the psychosocial function and sexual activities of persons with AI. This study indicates that worrying about potential faecal accidents and the social stigma associated with this have greater impact on QoL than actual bowel leakages. Future studies should therefore focus on the emotional burden, patient coping, and health education related to bowel function and AI.

Shorter observation times and smaller gauge needles in outpatient kidney biopsies.

Controversy exists as to the optimal observational time (OT) after outpatient percutaneous kidney biopsy. Further, there is some uncertainty about the benefit of smaller (18-gauge) vs. larger (16-gauge) biopsy needles. At our institution, we have been lowering the OT after outpatient kidney biopsies. Initially in 2015, we were monitoring for 6 hours and gradually began to decrease the OT over time. From 2020, we have adopted an OT of less than 4 hours. During this time period (in 2018), we also began using a smaller gauge needle (18 gauge). We reviewed all outpatient kidney biopsies performed by the nephrology division at our institution since 2015. There were 137 biopsies reviewed. 63 had OT of 4-6 hours, and 74 had OT <4 hours. There was a total of 4 significant complications (2.9%). Two complications, symptomatic retroperitoneal bleeds, were detected in less than 3 hours. The other 2 complications were seen at 9 hours (clot retention) and 72 hours (retroperitoneal bleed after anticoagulation restarted). 63% of the biopsies were done using 18-gauge needles with 1 complication in this group vs. 3 in the 16-gauge group. All cases had adequate tissue for interpretation based on the ability to make a kidney diagnosis. The number of glomeruli obtained in the 18-gauge group was 29 ± 13 glomeruli, and in the 16-gauge group was 25 ± 10, which did not differ between groups. In summary, in an outpatient population, all significant post-biopsy complications were evident either within the first 3 hours or after 9 hours, and this suggests the feasibility of using shorter than standard OT in outpatient kidney biopsies. Furthermore, an 18-gauge needle may lower the risk of complications and obtain adequate tissue.

Exploring the Relationship Between Psychological Constructs and Decision-Making Preferences in Psychiatric Outpatients.

This study aimed to elucidate the relationships among health locus of control, psychological reactance, attitudes toward psychiatric treatment, and patient decision-making preferences within a psychiatric outpatient population. A total of 200 consecutive psychiatric outpatients from a community mental health center in Tenerife, Spain, were approached for participation between September 2023 and March 2024. Of these, 151 patients consented to participate in this cross-sectional study. Participants were selected based on their willingness to participate and were provided with informed consent forms. Data were collected using the Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) and the Control Preferences Scale (CPS). The PHBQPT evaluates health beliefs impacting adherence to psychiatric treatment, while the CPS assesses the preferred level of involvement in medical decision-making. Sociodemographic data were also collected to contextualize the findings. Significant correlations were found between patients' control preferences and their attitudes towards medication, compliance with psychiatric advice, and perceptions of treatment control. A collaborative control preference was notably associated with positive attitudes toward medication and trust in the psychiatrist. These findings suggest that tailored treatment approaches prioritizing patient involvement could enhance adherence and outcomes. The study underscores the importance of considering psychological constructs in psychiatric care to foster a holistic, patient-centered approach. Recognizing and integrating patients' control preferences, attitudes towards medication, and psychological reactance can improve the therapeutic relationship and treatment adherence. Future research should explore longitudinal and interventional studies to further understand the impact of aligning treatment approaches with patient preferences and psychological profiles.

Ecological momentary assessment and cue-elicited drug craving as primary endpoints: study protocol for a randomized, double-blind, placebo-controlled clinical trial testing the efficacy of a GLP-1 receptor agonist in opioid use disorder

BackgroundDespite continuing advancements in treatments for opioid use disorder (OUD), continued high rates of relapse indicate the need for more effective approaches, including novel pharmacological interventions. Glucagon-like peptide 1 receptor agonists (GLP-1RA) provide a promising avenue as a non-opioid medication for the treatment of OUD. Whereas GLP-1RAs have shown promise as a treatment for alcohol and nicotine use disorders, to date, no controlled clinical trials have been conducted to determine if a GLP-1RA can reduce craving in individuals with OUD. The purpose of the current protocol was to evaluate the potential for a GLP-1RA, liraglutide, to safely and effectively reduce craving in an OUD population in residential treatment.MethodThis preliminary study was a randomized, double-blinded, placebo-controlled clinical trial designed to test the safety and efficacy of the GLP-1RA, liraglutide, in 40 participants in residential treatment for OUD. Along with taking a range of safety measures, efficacy for cue-induced craving was evaluated prior to (Day 1) and following (Day 19) treatment using a Visual Analogue Scale (VAS) in response to a cue reactivity task during functional near-infrared spectroscopy (fNIRS) and for craving. Efficacy of treatment for ambient craving was assessed using Ecological Momentary Assessment (EMA) prior to (Study Day 1), across (Study Days 2–19), and following (Study Days 20–21) residential treatment.DiscussionThis manuscript describes a protocol to collect clinical data on the safety and efficacy of a GLP-1RA, liraglutide, during residential treatment of persons with OUD, laying the groundwork for further evaluation in a larger, outpatient OUD population. Improved understanding of innovative, non-opioid based treatments for OUD will have the potential to inform community-based interventions and health policy, assist physicians and health care professionals in the treatment of persons with OUD, and to support individuals with OUD in their effort to live a healthy life. Trial registration: ClinicalTrials.gov: NCT04199728. Registered 16 December 2019, https://clinicaltrials.gov/study/NCT04199728?term=NCT04199728.Protocol Version10 May 2023

Long-COVID olfactory dysfunction: allele E4 of apolipoprotein E as a possible protective factor.

Olfactory dysfunction (OD) represents a frequent manifestation of the coronavirus disease 2019 (COVID-19). Apolipoprotein E (APOE) is a protein that interacts with the angiotensin-converting enzyme receptor, essential for viral entry into the cell. Previous publications have suggested a possible role of APOE in COVID-19 severity. As far as we know, no publications found significant associations between this disease's severity, OD, and APOE polymorphisms (E2, E3, and E4). To analyze the epidemiology of OD and its relationship with APOE polymorphisms in a cohort of Long-COVID patients. We conducted a prospective cohort study with patients followed in a post-COVID neurological outpatient clinic, with OD being defined as a subjective reduction of olfactory function after infection, and persistent OD being defined when the complaint lasted more than 3 months after the COVID-19 infection resolution. This cross-sectional study is part of a large research with previously reported data focusing on the cognitive performance of our sample. The final sample comprised 221 patients, among whom 186 collected blood samples for APOE genotyping. The persistent OD group was younger and had a lower hospitalization rate during the acute phase of the disease (p < 0.001). Furthermore, the APOE variant E4 allele frequency was lower in this group (p = 0.035). This study evaluated OD in an outpatient population with COVID-19. In the current literature on this disease, anosmia is associated with better clinical outcomes and the E4 allele is associated with worse outcomes. Our study provides new information to these correlations, suggesting APOE E4 as a protective factor for OD.

Improving Wound Healing and Infection Control in Long-term Care with Bacterial Fluorescence Imaging.

High bacterial burden stalls wound healing and can quickly progress to infection and sepsis in complex, older-adult patients in long-term care (LTC) or skilled nursing facilities (SNFs). To investigate the outcomes of point-of-care fluorescence (FL) imaging (MolecuLight i:X) of bacterial loads, which are frequently asymptomatic, to inform customized wound treatment plans for patients in LTC/SNFs. In this retrospective pre/postinterventional cohort study, the authors compared the healing and infection-associated outcomes of 167 pressure injuries from 100 Medicare beneficiaries before and after implementation of FL imaging. Most patient demographics and wound characteristics did not differ significantly between the standard-of-care (SOC; n = 71 wounds) and FL (n = 96 wounds) cohorts. Significantly more wounds (+71.0%) healed by 12 weeks in the FL cohort (38.5%) versus the SoC cohort (22.5%). Wounds in the FL cohort also healed 27.7% faster (-4.8 weeks), on average, and were 1.4 times more likely to heal per Kaplan-Meier survival analysis (hazard ratio = 1.40; 95% CI, 0.90-2.12). Infection-related complications decreased by 75.3% in the FL cohort, and a significant shift from largely systemic to topical antibiotic prescribing was evidenced. Fluorescence-imaging-guided management of wounds significantly improved healing and infection outcomes in highly complex and multimorbid patients in LTC/SNFs. Proactive bacterial infection management via local treatments was enabled by earlier, objective detection. These reported outcome improvements are comparable to randomized controlled trials and cohort studies from less compromised, selectively controlled outpatient populations. Fluorescence imaging supports proactive monitoring and management of planktonic and biofilm-encased bacteria, improving patient care in a complex, real-world setting.

The association between malnutrition risk and revised Edmonton Symptom Assessment System (ESAS-r) scores in an adult outpatient oncology population: a cross-sectional study

BackgroundCancer-associated malnutrition is associated with worse symptom severity, functional status, quality of life, and overall survival. Malnutrition in cancer patients is often under-recognized and undertreated, emphasizing the need for standardized pathways for nutritional management in this population. The objectives of this study were to (1) investigate the relationship between malnutrition risk and self-reported symptom severity scores in an adult oncology outpatient population and (2) to identify whether a secondary screening tool for malnutrition risk (abPG-SGA) should be recommended for patients with a specific ESAS-r cut-off score or group of ESAS-r cut-off scores.MethodsA single-institution retrospective cross-sectional study was conducted. Malnutrition risk was measured using the Abridged Patient-Generated Subjective Global Assessment (abPG-SGA). Cancer symptom severity was measured using the Revised Edmonton Symptom Assessment System (ESAS-r). In accordance with standard institutional practice, patients completed both tools at first consult at the cancer centre. Adult patients who completed the ESAS-r and abPG-SGA on the same day between February 2017 and January 2020 were included. Spearman’s correlation, Mann Whitney U tests, receiver operating characteristic curves, and binary logistic regression models were used for statistical analyses.Results2071 oncology outpatients met inclusion criteria (mean age 65.7), of which 33.6% were identified to be at risk for malnutrition. For all ESAS-r parameters (pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and wellbeing), patients at risk for malnutrition had significantly higher scores (P < 0.001). All ESAS-r parameters were positively correlated with abPG-SGA score (P < 0.01). The ESAS-r parameters that best predicted malnutrition risk status were total ESAS-r score, lack of appetite, tiredness, and wellbeing (area under the curve = 0.824, 0.812, 0.764, 0.761 respectively). Lack of appetite score ≥ 1 demonstrated a sensitivity of 77.4% and specificity of 77.0%. Combining lack of appetite score ≥ 1 with total ESAS score > 14 yielded a sensitivity of 87.9% and specificity of 62.8%.ConclusionMalnutrition risk as measured by the abPG-SGA and symptom severity scores as measured by the ESAS-r are positively and significantly correlated. Given the widespread use of the ESAS-r in cancer care, utilizing specific ESAS-r cut-offs to trigger malnutrition screening could be a viable way to identify cancer patients at risk for malnutrition.

T59 - Initial Validation and Characterization of a Measure to Assess Attitudes Toward Medications for Opioid Use Disorder for Outpatient Populations

T59 - Initial Validation and Characterization of a Measure to Assess Attitudes Toward Medications for Opioid Use Disorder for Outpatient Populations

Accounting for differences between serum and plasma: An indirect approach to derive reference intervals for total protein, albumin, and globulin

BackgroundObservable quantitative variations exist between plasma and serum in routine protein measurements, often not reflected in standard reference intervals. In this study, we describe an indirect approach for estimating a combined reference interval (RI) (i.e., serum and plasma), for commonly ordered protein measurands: total protein, albumin, and globulin. MethodsWe applied an indirect reference interval estimation for protein measurements in serum and plasma using data from July 2018 to February 2024. The data were divided into three Epochs based on a period of plasma separator tube shortage during the COVID-19 pandemic. Bootstrap resampling was used to calculate RIs and corresponding 95% confidence intervals for each month. ResultsOur results demonstrate notable changes in RI limits for total protein, albumin, and globulin between Epochs, reflecting the influence of changing sample matrix. A combined RI was identified for all components and verified using plasma and serum samples from 20 healthy individuals and retrospective analysis of flagging rates on our outpatient population using new and historical RIs. ConclusionThe study demonstrates notable differences in the RIs for total protein, albumin, and globulin when container type changes. In addition, the results demonstrate the effectiveness of big data analytics in deriving RIs and highlights the necessity of continuous RI assessment and adjustment based on the patient population and acceptable specimen types.

Pengaruh Short Waiting Time, Interpersonal Communication, Environment, dan Service Quality Terhadap Tingkat Kepuasan Pasien di Poli Gigi RSUD Kanjuruhan, Kabupaten Malang, Jawa Timur

This study aims to determine the effect of the variable SHORT WAITING TIME, INTERPERSONAL CUMMUNICATION, SERVICE QUALITY , Service quality on patient satisfaction at RSUD Kanjuruhan’s Dental Clinic. The model of this research was tested on a population of outpatients who had received treatment using a purposive sampling technique and obtained a sample size of 389 people in the period 15 November 2023 – 15 February 2024. Data collection was carried out online via a Google Form questionnaire using a Likert scale of 1 -5. The analysis method uses the SEM-PLS (Structural Equation Modelling based on Partial Least Square) technique using the SmartPLS 4.0 application. The results of this study show that: (1) there is a significant positive effect between short waiting time and patient satisfaction at RSUD Kanjuruhan’s Dental Clinic, (2) there is a significant positive effect between interpersonal communication and patient satisfaction at RSUD Kanjuruhan’s Dental Clinic Poly, (3) there is the influence is not positive and not significant effect between environmentand patient satisfaction at RSUD Kanjuruhan’s Dental Clinic, (4) there is a significant positive effect between service quality and patient satisfaction at RSUD Kanjuruhan’s Dental Clinic

Investigation Into Potentially Inappropriate Prescribing Patterns of Loop Diuretics in a Nationally Representative Outpatient Population.

Loop diuretic therapy effectively treats edema related to heart failure, chronic kidney disease, and liver impairment; however, evidence supporting other indications is lacking. For indications such as hypertension or dependent edema or treatment of adverse events associated with other medications, the benefits likely do not outweigh the risks, putting patients at an unacceptably high risk of poor outcomes. What is the proportion of loop diuretic prescribing that occurs in the absence of a diagnosis of heart failure, chronic kidney disease, liver impairment, or other evidence-based indications? This was a national, retrospective, cross-sectional investigation conducted using the National Ambulatory Care Survey from 2013 to 2016. Outpatient visits for patients aged 18 years or older prescribed with loop diuretics were included. The primary end point was the frequency of potentially inappropriate loop diuretic prescribing. The secondary end point was a multivariable regression model that identified predictors of potentially inappropriate loop diuretic utilization. This analysis identified 5261 outpatient visits conducted during the study period in which loop diuretics were prescribed. Of these, 3648 visits (65.8% of weighted visits) were of patients without a history of heart failure, chronic kidney disease, or liver impairment. Positive predictors included age older than 65 years (odds ratio [OR] 1.71; 95% confidence interval [CI] 1.38-2.13), concomitant calcium channel blocker (OR 1.42; 95% CI, 1.09-1.84), sodium-containing medication use (OR 2.78; 95% CI, 1.23-6.25), and office visit with a cardiology specialist (OR 2.84; 95% CI, 2.31-3.50). This analysis identified that loop diuretics are prescribed in the absence of evidence-based indications more frequently than they are prescribed for them. This prescribing pattern creates a unique opportunity for clinicians to optimize patient care. Further study of the outcomes associated with this prescribing pattern is warranted.

Exploring society‐to‐cells resilience among community members: A multidisciplinary study in outpatient clinics with diverse participant demographics

AbstractAimThis study explores and understands community members' resilience in outpatient clinics, considering various dimensions and types of resilience.DesignA cross‐sectional study.MethodsThis study was conducted in Saudi outpatient clinics from September to December 2023 and included 384 individuals chosen through systematic random sampling. Various tools were used, such as Social Cohesion and Trust Scale, Community Resilience Assessment Tool, Community Assessment of Psychic Experiences, Environmental Resilience Assessment, Economic Resilience Index, Connor‐Davidson Resilience Scale, Brief Resilience Scale, Resilience Scale for Adults and Healthcare Resilience Index.ResultsParticipants displayed a robust overall resilience level, as indicated by Total Connor–Davidson Resilience Scale score of 63.0 ± 9.0. Additionally, they demonstrated commendable levels of resilience in Total Brief Resilience Scale (56.04 ± 8.6), Resilience Scale for Adults (82.5 ± 7.2) and Healthcare Resilience Index (45.8 ± 5.5). These findings offer significant insights into psychological and emotional well‐being of the study population, highlighting their adaptive capacities and coping mechanisms across various life domains.ConclusionThis study provides valuable insights into the multidimensional nature of resilience in outpatient settings. The cross‐sectional design sets the groundwork for future longitudinal investigations, highlighting the need for a holistic approach to understanding and promoting resilience.ImpactThis study holds immediate implications for participants and their communities. It underscores the adaptive capacities and coping mechanisms prevalent in the outpatient population by revealing commendable resilience levels. This insight enhances individuals' psychological and emotional well‐being, contributing positively to the overall resilience and communal strength. Additionally, this study sheds light on how resilience among community members in Saudi Arabia relates to international advanced nursing communities, providing insight into their work.Patient or Public ContributionPatients who have received outpatient services in the past 6 months were purposively chosen to ensure a diverse representation across age, gender and socio‐economic backgrounds in this study.

Facial emotion recognition in children of parents with a mental illness

ObjectiveFacial emotion recognition (FER) is a fundamental social skill essential for adaptive social behaviors, emotional development, and overall well-being. FER impairments have been linked to various mental disorders, making it a critical transdiagnostic mechanism influencing the development and trajectory of mental disorders. FER has also been found to play a role in the transgenerational transmission of mental disorders, with the majority of research suggesting FER impairments in children of parents with a mental illness (COPMI). Previous research primarily concentrated on COPMI of parents with internalizing disorders, which does not cover the full spectrum of outpatient mental health service populations. Furthermore, research focuses on varying components of FER by using different assessment paradigms, making it challenging to compare study results. To address these gaps, we comprehensively investigated FER abilities in COPMI using multiple tasks varying in task characteristics.MethodsWe included 189 children, 77 COPMI and 112 children of parents without a diagnosed mental illness (COPWMI), aged 6 to 16 years. We assessed FER using three tasks with varying task demands: an emotional Go/NoGo task, a morphing task, and a task presenting short video sequences depicting different emotions. We fitted separate two-level hierarchical Bayesian models (to account for sibling pairs in our sample) for reaction times and accuracy rates for each task. Good model fit was assured by comparing models using varying priors.ResultsContrary to our expectations, our results revealed no general FER deficit in COPMI compared to COPWMI. The Bayesian models fitted for accuracy in the morphing task and Go/NoGo task yielded small yet significant effects. However, Bayes factors fitted for the models suggested that these effects could be due to random variations or noise in the data.ConclusionsOur study does not support FER impairments as a general feature of COPMI. Instead, individual factors, such as the type of parental disorder and the timing of its onset, may play a crucial role in influencing FER development. Future research should consider these factors, taking into account the diverse landscape of parental mental disorders.

Clinical implications for the association of psoriasis and multiple sclerosis: an observational study

BackgroundMultiple sclerosis (MS) and psoriasis (PsO) are distinct chronic autoimmune conditions with varying impacts on patients' lives. While the co-occurrence of MS and PsO has been reported, the underlying pathogenic link remains unclear. This study aimed to investigate the prevalence of PsO in a MS outpatient clinic population and explore the potential interplay between these conditions.Methods316 MS patients who had at least one visit at our MS center in the last year, were selected from our outpatient MS Clinic electronic database and were e-mailed in August 2023 and inquired about a previous diagnosis of PsO. Demographic and MS history data were retrospectively gathered for two groups: MS patients without and with PsO. Information about MS phenotype, Expanded Disability Status Scale (EDSS) score at the diagnosis and at last follow-up, disease modifying therapy (DMT) were collected retrospectively from our MS data set. PsO diagnosis was confirmed by an experienced dermatologist and severity was assessed with the Psoriasis Area and Severity Index (PASI).ResultsAmong 253 respondents, 5.85% reported a PsO diagnosis that was confirmed after the dermatological evaluation Among patients with psoriasis 66.67% had progressive course of MS (p = 0.032) and the onset of PsO typically occurred after MS diagnosis. 9 out 15 patients had a PASI score of 0 and 6 are currently undergoing treatment with an anti-CD20 therapy. Notably, a subset of our patients were on anti-CD20 therapy and did not experience a worsening of dermatological symptoms.Discussion and conclusionThe prevalence of PsO in our outpatient MS population aligns with previous studies. Treatment approaches should be tailored to individual patient needs, emphasizing collaboration between neurologists and dermatologists. Medications like dimethyl fumarate, effective in both conditions, could be considered. The data from our study also suggest that anti-CD20 therapy may be a viable option for some patients with concurrent MS and mild PsO, without a significant worsening of dermatological symptoms. Further research is needed to elucidate the complex relationship between MS and PsO and to develop more effective therapeutic strategies for patients with both conditions.

Diabetes and frailty in the elderly: a cross-sectional study of an outpatient population

Screening for frailty syndrome, a marker of mortality risk, dependence, and institutionalization, is currently recommended in primary care to prevent its consequences effectively. Elderly diabetic individuals represent a significant and growing proportion of general practitioners' patient population, but their frailty status compared to the non-diabetic population is poorly understood. To study the relationship between diabetes and frailty in individuals aged 75 and older in general medicine. A total of 309 patients were included, among them 64 were diabetic patients, with a male/female ratio of 0.72. The proportion of frail elderly people was comparable between diabetics (24%) and non-diabetics (27.6%), as was the mean Fried score (1.78 vs. 1.56; not significant). Subgroup analysis revealed a significant difference in the risk of frailty, which was multiplied by 2.14 in diabetics without complications compared with non-diabetics, [95% CI=2.03 to 2.25, p<2e(-16)]. Larger-scale studies at multiple outpatient sites should be conducted in general medicine among subjects aged over 75. Frailty management should be continued and carried out in patients whether they are diabetic or not.

Micro-elimination of chronic hepatitis C virus in mental health settings: A prospective multicentre pragmatic trial.

Hepatitis C virus (HCV) prevalence is high in the mental health population. We sought to evaluate testing and treatment uptake for HCV following the implementation of a universal nurse led study in inpatient and outpatient mental health populations. From January 2018 to December 2020, we screened mental health inpatients (n = 322) and community mental health patients (n = 615) for HCV with either specialist hepatology nurses or mental health nurses (mental health nurse). 75.5% (464/615) of community patients and 100% (322/322) of inpatients consented to screening, with an HCV antibody-positive prevalence of 12.7% (59/464) in community patients and 19.6% (63/322) in inpatients. RNA detectable prevalence was 4.0% (22/464) and 7.5% (24/322), respectively. Community patients who were screened by specialist hepatology nurses were more likely to consent to screening (94.4% vs. 45.7%, p < 0.001) but had lower proportion of HCV antibody (10.5% vs. 20.3%, p < 0.001) and RNA detectable (4.0% vs. 7.5%, p = 0.018) when compared to mental health nurse screening. Engagement with treatment was 27.0% of community mental health patients and 45.8% of mental health inpatients undergoing treatment. All patients undergoing treatment and underwent sustained viral response (SVR) testing achieved SVR. Universal screening of HCV using a nurse-led model has high rates of success in mental health patients with high proportions undergoing screening, with no reduction in the rates of SVR achieved with DAA therapy compared to the general population. Further work is needed to bridge the gap between identification of HCV and treatment among mental health patients.

INDEPENDENT EFFECT OF SGLT2I ON DIASTOLIC FUNCTION IN HFREF POPULATION

Abstract Background Scientific literature reinforces the role of diastolic dysfunction in patients with heart failure with reduced ejection fraction (HFrEF) as an independent prognostic indicator of all–cause mortality. In this context, E/e’ ratio plays a central role in diastolic dysfunction assessments and diagnosis. Despite the introduction of several novel medical therapies for HFrEF that led to improvement in mortality and HF hospitalization, the effect of the combined treatment with Sacubitril/Valsartan (SV) and Sodium Glucose Transporter 2 inhibitors (SGLT2i) on E/e’ ratio has not been addressed yet. Aim We aimed to evaluate the effect of SV alone vs SV+SGLT2i on E/e’ ratio in a real–life population of HFrEF outpatients. Methods This is an observational monocentric study including patients treated with either SV alone or with SV+SGLT2i from 2018 to 2023. E/e’ ratio was measured at baseline, at 6 and 12 months. Results 178 HFrEF patients (mean age 69 years±11, left ventricular ejection fraction (LVEF) 31±6%) in optimal medical therapy were enrolled. 121 of them received SV and 58 received SV+SGLT2i. Baseline E/e’ ratio was similar in the two groups (median value 11,2 [IQR 8;16] in SV group and 10,9 [IQR 8;16] in SV+SGLT2i group, p=0.45). At follow up, only SV+SGLT2i group showed a significative decrease in E/e’ ratio after therapy initiation while SV group showed a E/e’ ratio similar to baseline (E/e’ ratio median value 8,5 [IQR 7;12] vs 11,8 [IQR 8;15] respectively, p=0.035). Moreover, after 12 months most patients receiving SV+SGLT2i didn‘t required diuretic administration compared to those treated with only SV (43% vs 16% respectively; p=0,0002). Conclusions Among patients with HFrEF, treatment with SGLT2i+SV was associated with a significative reduction of E/e’ ratio and of diuretic administration. This result might suggest a favorable independent effect of SGLT2i on diastolic function and myocytes relaxation and might provide new evidence on the positive results observed on hard endpoints.

QTNet: Predicting Drug-Induced QT Prolongation With Artificial Intelligence–Enabled Electrocardiograms

BackgroundPrediction of drug-induced long QT syndrome (diLQTS) is of critical importance given its association with torsades de pointes. There is no reliable method for the outpatient prediction of diLQTS. ObjectivesThis study sought to evaluate the use of a convolutional neural network (CNN) applied to electrocardiograms (ECGs) to predict diLQTS in an outpatient population. MethodsWe identified all adult outpatients newly prescribed a QT-prolonging medication between January 1, 2003, and March 31, 2022, who had a 12-lead sinus ECG in the preceding 6 months. Using risk factor data and the ECG signal as inputs, the CNN QTNet was implemented in TensorFlow to predict diLQTS. ResultsModels were evaluated in a held-out test dataset of 44,386 patients (57% female) with a median age of 62 years. Compared with 3 other models relying on risk factors or ECG signal or baseline QTc alone, QTNet achieved the best (P < 0.001) performance with a mean area under the curve of 0.802 (95% CI: 0.786-0.818). In a survival analysis, QTNet also had the highest inverse probability of censorship–weighted area under the receiver-operating characteristic curve at day 2 (0.875; 95% CI: 0.848-0.904) and up to 6 months. In a subgroup analysis, QTNet performed best among males and patients ≤50 years or with baseline QTc <450 ms. In an external validation cohort of solely suburban outpatient practices, QTNet similarly maintained the highest predictive performance. ConclusionsAn ECG-based CNN can accurately predict diLQTS in the outpatient setting while maintaining its predictive performance over time. In the outpatient setting, our model could identify higher-risk individuals who would benefit from closer monitoring.

Incidence estimation of intolerance, malabsorption and bacterial overgrowth in the outpatient population

Incidence estimation of intolerance, malabsorption and bacterial overgrowth in the outpatient population