Patient Attendance Research Articles

Primary care research on hypertension: A bibliometric analysis using machine-learning

Hypertension is one of the most important chronic diseases worldwide. Hypertension is a critical condition encountered frequently in daily life, forming a significant area of service in Primary Health Care (PHC), which healthcare professionals often confront. It serves as a precursor to many critical illnesses and can lead to fatalities if not addressed promptly. Our study underscores the importance of this critical issue by analyzing articles related to hypertension in the PHC research area from the Web of Science Core Collection using bibliometric methods and machine learning techniques, specifically topic analyses using the latent Dirichlet allocation method. The analysis was conducted using Python Scikit-learn, Gensim, and Wordcloud Libraries, the VosViewer program, and the Bibliometrix R Biblioshiny library. Our findings revealed a steady increase in publication output in hypertension-related research. Analysis shows that hypertension-related research in the PHC research area is clustered into 8 groups: (1) management of hypertension in PHC, risk factors, and complications; (2) psychiatric disorders and hypertension; (3) pediatric and pregnancy hypertension; (4) environmental factors and living conditions; (5) sex and age effects on hypertension; (6) COVID-19 and hypertension; (7) behavioral risk factors, quality of life, and awareness; and (8) current treatment methods and guidelines. Research on hypertension has focused intensively on kidney disease, obesity, pregnancy, cardiovascular risk, heart disease, calcium channel blockers, body mass index, amlodipine, mortality, risk factors, hyperlipidemia, depression, and resistant hypertension. This study represents the first and comprehensive bibliometric analysis of hypertension in the PHC research area. Annual publication volumes have steadily increased over the years. In recent years, topics such as social determinants, patient attendance, self-management, diabetes mellitus, COVID-19, telemedicine, type 2 diabetes, and noncommunicable diseases have garnered significant interest in the field of PHC services.

Comparison of vitamin D status in healthy Bangladeshi urban and rural individuals and their association with serum calcium and alkaline phosphatase: A pilot study.

Vitamin D insufficiency is a worldwide problem that is likely underestimated since physical symptoms may only be apparent in individuals with severe deficiencies. Previously, people in South Asian countries were thought to be vitamin D sufficient because of plentiful sunshine, but vitamin D insufficiency has also been reported in these countries. In a South Asian country like Bangladesh, people living in the rural and urban parts of the country can have considerable differences in their sun exposure, types of clothing worn, and levels of air pollution. This pilot study aimed to explore the vitamin D status (measured by serum 25[OH]D) of healthy urban and rural Bangladeshi people and to examine the association of serum 25(OH)D concentration with calcium and alkaline phosphatase concentrations. A total of 101 apparently healthy adult individuals, aged 20-58 years, were enrolled from both urban and rural areas. The participants were selected from students, staff and patient attendants from the outpatient department (OPD) of Bangabandhu Sheikh Mujib Medical University and Mirsarai Upazila Health Complex, Chittagong. The overall rate of vitamin D insufficiency was 39.6% and of vitamin D deficiency was 51.5%. However, it was observed that the proportion of vitamin D-deficient participants in urban areas (70.6%) was more than double that of participants living in rural areas (32%) and that serum 25(OH)D concentrations were higher in rural compared to urban participants with similar sunlight exposure times. However, participants aged 50 years or more showed similar concentrations of serum vitamin D levels irrespective of their habitat. This pilot study highlights the need for further larger-scale studies in Bangladesh to determine the reasons for the high rates of vitamin D inadequacy overall and the differences between rural and urban populations.

Prevalence and association analysis of obstructive sleep apnea in India: Results from BLESS cohort

BackgroundDespite having the largest population in the world with 1.4 billion inhabitants, there is only scarce data on the prevalence of OSA from India. Research questionThis study aimed to find the prevalence of Obstructive Sleep Apnea (OSA) using Polysomnography (PSG) and current scoring rules (AASM 2012) in population and investigate OSA associations for cardiovascular and metabolic comorbidities. Study designand Methods: Participants were randomly selected among the accompanying attendants of patients admitted to a hospital in Bhopal, India and underwent level I PSG. Anthropometric measurements, blood investigations were taken. The primary outcome was prevalence of OSA, assessed by the Apnoea-Hypopnoea Index (AHI). ResultsLevel I PSG was performed on 1015 adult participants from December 2019 to February 2023; after excluding 57 participants with sleep time <240 min, 958 participants (age range 18–80 years) were finally included in this study. Median (IQR) age was 40.0 years (31.0, 49.0) while median (IQR) BMI was 23.5 (20.7, 26.8) Kg/m2. Prevalence (95 % CI) of moderate-to-severe OSA (AHI ≥15) and severe OSA (AHI≥30) was 30.5 % (28–34 %) and 10.1 % (8.3–12), respectively. The upper quartile of the AHI (Q4 ≥17) was independently associated with the presence of Diabetes Mellitus [OR 2.14 (95 % CI 1.07–4.44)], Hypertension [OR1.98 (95 % CI 1.20–3.28)] and Metabolic Syndrome [OR 2.36 (95 % CI 1.37–4.09)] compared to the first quartile AHI. InterpretationOSA prevalence was found to be significantly higher than previously estimated in Indian population. Association of OSA with diabetes, hypertension, and metabolic syndrome was observed.

Patients' Nonattendance in Outpatient Specialist Consultations: A National Cohort Analysis of a Health System.

Analyzing patients' nonattendance at medical appointments helps address an issue impacting the management and sustainability of health systems globally, providing valuable insights for healthcare managers. This study aims to identify factors at both patient and health system levels that contribute to understanding missed appointments. The analysis was conducted using data from secondary care consultations within the Brazilian Unified Health System between April 2018 and March 2020. Primary care includes general medical consultations, while secondary care involves specialized services provided by doctors with advanced expertise. We examined demographic factors (age, sex, race/color, socioeconomic level) and health system practices (waiting time, hospitalization, distance to service, medical specialty, and severity of clinical condition) to assess their impact on patient attendance. A weighted analysis and receiver operating characteristic (ROC) analysis were applied to determine the relative risk of nonattendance. Of 5,003,159 consultations, 435,523 (8.7%) were missed. Nonattendance was highest among patients facing long distances to the service (13.3%, [RRR] 1.227), younger age (16-30 years: 11.8%, [RRR] 1.041), and waiting times (>30: 10.9%, [RRR] 1.738). Socially vulnerable patients were more likely to miss appointments (9.6%, [RRR] 1.055) compared to less vulnerable groups (8.6%). Practice-level factors had a slightly greater impact on nonattendance (ROC: 0.621) than patient-level factors (ROC: 0.5674). The overall predictive model achieved a C statistic of 0.6228, resulting in a fair predictive ability. However, the model showed only modest prediction of no-shows, indicating the need for more detailed data to improve accuracy. Gauging which group suffers the highest risk of nonattendance was a secondary goal of this analysis. Young, socially vulnerable patients with long commutes and extended waiting times are at higher risk of nonattendance. Effective management of these risk factors and targeted preventive actions are essential to reduce absenteeism and improve health system efficiency.

Identification of Risk Factors Associated with Early Discontinuation of Physical Therapy Following Shoulder Surgery.

Postoperative physical therapy (POPT) is a critical aspect of patient recovery following orthopedic shoulder surgery. Despite the importance of POPT, some patients do not complete their course of physical therapy, which can affect postoperative recovery and outcomes. This study aimed to identify risk factors that influence patient adherence and attendance of POPT. Patients >90 days postop from elective shoulder surgery were retrospectively recruited for this study from an urban, academic tertiary medical center. Patient charts were reviewed for demographic factors with eligible patients being contacted via telephone call to answer a questionnaire concerning their use of POPT. Inadequate levels of POPT were defined as stopping formal physical therapy earlier than the physical therapist recommended. Final analysis cohorts were compared using Fisher's Exact Test and Wilcoxon Rank Sum Test. A total of 104 patients were included in the final analysis with 84 completing POPT and 20 reporting having stopped therapy early. Patient medical history including elevated BMI (mean significance difference 3.8, [0.018 to 7.6 95% CI]) p=0.026)), being a smoker (p=0.027), having diabetes (p<0.001), and having Medicaid as their primary insurance (p=0.008) were significantly associated with stopping physical therapy earlier than recommended by the physical therapist (Table I). Demographic factors such as requiring additional assistance to get to medical appointments (p=0.012) and living farther away from a physical therapy center (p=0.007) were also substantially associated with a greater risk of stopping physical therapy earlier than recommended by the physical therapist (Table II). Elevated BMI, tobacco use, diabetes, Medicaid enrollment status, requiring additional assistance to get to PT appointments, and living farther away from their physical therapy center are risk factors associated with patients stopping PT after elective shoulder surgery earlier than recommended by a physical therapist. Knowledge of these patient-specific risk factors should be considered by orthopedic surgeons and physical therapists when tailoring a POPT protocol.

Predictors of ongoing attendance at an Australian publicly funded specialist obesity service.

There is a demand for publicly funded specialist obesity services in Australia. A range of factors can impact on patient attendance which can result in poorer health outcomes. To identify patient factors that predict ongoing in-person attendance following initial medical assessment at the Canberra Obesity Management Service. Data were collated from two retrospective reviews (July 2016-June 2017 and July 2018-June 2019). Predictive modeling was used to determine the likelihood of ongoing attendance. A total of 396 patients were identified. Mean age was 45.4years (SD 13.1), mean weight was 139.5kg (SD 27.8) and mean Body Mass Index was 49.87kg/m2 (SD 8.7). Demographics and anthropometrics were not predictive of ongoing attendance. Patients with a higher comorbidity burden were more likely to continue attending (p<0.001). Patients with obstructive sleep apnea (OSA) were 4.9 times more likely to continue attending (p<0.001). Hypertension was more common among patients who continued attending (p=0.005); however, this relationship was no longer significant when using a multi-adjusted model. Comorbid depression and/or anxiety diagnoses were not predictive of ongoing attendance although the p-value for anxiety severity classification approached significance. Findings are consistent with existing evidence linking OSA and attendance at specialist obesity services. Hypertension was predictive of ongoing attendance and warrants further research. Determining if anxiety is a true barrier to attendance at specialist obesity services may have implications in terms of optimizing diagnosis and treatment prior to referral or in the early stages of obesity management.

Patient Experiences With Group Teletherapy for the Treatment of Mental Illness: A Qualitative Study.

The authors sought to understand patient experiences with group teletherapy to inform improvements in service delivery. From December 2022 to October 2023, semistructured interviews were conducted with 20 adults with depression or bipolar disorder who had received outpatient group teletherapy in the past 2 years. A rapid thematic analysis was conducted by using a matrix to identify patterns and synthesize data. A logic model from the patients' perspective was developed by extracting common themes related to elements of effective group teletherapy. Telehealth allowed for more empowered engagement in group teletherapy and enabled better access and longitudinal attendance for many patients, compared with in-person group therapy. However, many patients reported a reduced sense of emotional intimacy and connectedness with telehealth, and some reported that technology challenges and distractions contributed to feelings of disconnection. Patients were divided in their modality preferences, but many expressed an interest in receiving at least some of their group therapy sessions by telehealth. Although group teletherapy has the potential to meet patients' needs and preferences, more work is needed to improve the quality of the experience for patients.

Feasibility of a Community-Based Aquatic and Peer Support Intervention for People With Musculoskeletal Disorders Delivered via a Cross-Sector Partnership-A Service Evaluation.

Worldwide, the unmet rehabilitation needs of adults with musculoskeletal disorders are high. Aquatic exercise is clinically effective in managing musculoskeletal disorders, but access to rehabilitative services is limited. To determine the feasibility of a community-based aquatic exercise and peer support intervention for patients with musculoskeletal disorders delivered via a multisector partnership between an NHS physiotherapy service, a leisure operator and a social enterprise that creates personalised exercise programmes delivered through an application on a tablet computer. Cost-sharing was implemented after an initial complimentary session. A mixed method service evaluation was undertaken. Patient demographics, attendance, and patient-reported outcomes were summarised using descriptive statistics. Semi-structured interviews and an online survey were employed to explore patient acceptability of the intervention. Thirty four patients accessed the intervention during the 6-month pilot. Over half were from minority ethnic groups and nearly two thirds were in the bottom three deciles relating to low income. Patients exercised in a group of up to eight, supported by NHS rehabilitation professionals and volunteers. Provision of post-session refreshments encouraged connectivity between patients. Weekly attendance at the programme was high. Patient-reported outcome measures showed favourable changes in pain intensity and function following the intervention. Qualitative data suggest that the intervention was acceptable to patients. Implementation of a community-based aquatic exercise and peer support intervention for people with musculoskeletal disorders via a cross-sector partnership involving the NHS appears feasible and acceptable to patients. Further research is needed to assess the impact on musculoskeletal health and health inequalities.

The Association between a Recorded Diagnosis of Obesity and Clinically Significant Weight Loss in the Primary Care Setting: A Nationwide Registry

Introduction: Overweight and obesity (OW/OB) are underdiagnosed. The primary aim was to assess whether a diagnosis of OW/OB recorded by a primary care physician (PCP) is associated with clinically significant weight loss, compared to a missed diagnosis. The secondary aim was to investigate the association between OW/OB diagnosis and patient attendance at dietary consultations. Methods: This retrospective, observational cohort study was conducted using a nationwide healthcare database. The study included a random sample of 200,000 adults with BMI ≥25 kg/m2, recorded on a primary care visit, between 2014 and 2020. Patients with prior diagnosis of OW/OB or obesity-related complications were excluded. The independent variable was OW/OB diagnosis recorded by the PCP immediately after BMI measurement. The outcome variable was ≥5% weight loss at a second weight measurement within 9–15 months. Multivariate regression analysis was applied. Results: Of the 200,000 people with OW/OB, 36,033 (18.0%) had a diagnosis of OW/OB, and 37,368 (18.7%) had a second body weight measurement, of which 7,635 (20.4%) lost ≥5% of their baseline body weight. The prescription rate of anti-obesity medication was 1.2% and did not differ between patients who achieved weight loss and those who did not. Those with a recorded diagnosis were 2.6 times more likely to visit a dietitian (odds ratio [OR] 2.57, 95% confidence interval [CI]: 2.56–2.64) and 2.5 times more likely to achieve weight loss (OR 2.53, 95% CI: 2.46–2.60). After adjusting for multiple confounders, including attendance at dietary consultation, people who received OW/OB diagnosis were 32% more likely to achieve weight loss (OR 1.32, 95% CI: 1.28–1.36, p < 0.001) compared to people with missed diagnosis. Conclusions: Recording a diagnosis of obesity among relatively healthy people is associated with clinically significant weight loss at 1-year follow-up, independent of attendance at dietary consultation. Early obesity diagnosis is a significant opportunity to promote weight loss in the primary care setting and may affect weight trajectory.

Transforming Breast Cancer Care and Clinical Outcomes: Local Experience in Yanbu Industrial City, Saudi Arabia

ObjectiveThis study aimed to enhance outcomes for women undergoing breast cancer screening in a low utilization setting by implementing structured improvement cycles. MethodsImprovement cycles were conducted using the Plan-Do-Study-Act (PDSA) methodology. Three cycles were implemented: (1) dedicating a specific day for breast screening and increasing appointment slots; (2) establishing a breast screening clinic with same-day registration; and (3) introducing a breast surgery clinic to expedite biopsy procedures for BI-RADS-4 category cases. ResultsFollowing each improvement cycle, dramatic increases in patient attendance were observed. In 2021, there was a 67.5% rise compared to the previous year, and a 72% increase in 2022 compared to 2021 figures. Patient characteristics revealed that 60% of attendees were new patients, with 53% of cancer and precancerous cases observed in women below 50 years old. Before the third cycle, the estimated diagnosis turnaround time (TAT) showed that only 23% of patients had their biopsy completed within 5 working days. However, after the third cycle (n = 131), 63.5% of biopsies were done within five working days. ConclusionStructured improvement cycles guided by the PDSA methodology effectively enhanced breast cancer screening outcomes. These cycles led to increased patient attendance, expedited biopsy procedures, and improved access to timely diagnosis. The findings highlight the importance of systematic approaches in optimizing breast cancer screening and improving patient care.

COVID-19 Pandemic-Induced Changes in Hospital-Based Pattern of Skin Diseases in Gharbia Governorate, Egypt

Abstract Background Introduction: The COVID-19 pandemic, declared by the World Health Organization in 2020, prompted numerous restrictions and changes in healthcare practices globally. In Egypt, measures such as curfews, the closure of public places, and the suspension of schools and universities were implemented. These changes had significant implications for healthcare delivery, including dermatology services. Aim of the Work This study aimed to investigate the effect of the COVID-19 pandemic on the pattern of skin diseases in Egypt. Patients and Methods Data from 20,509 patients (14,353 in the pre-COVID year and 6,156 during the COVID year) were analyzed at Samanod Hospital, Gharbia Governorate, Egypt. Information on date, age, sex, and diagnoses was collected from dermatology clinic registry files for both pandemic and pre-pandemic years. Results A substantial decrease in patient attendance at dermatology clinics was observed during the COVID-19 pandemic, with numbers dropping by over 50%. Age and sex distribution of patients were also influenced, with teenagers and adults showing an increase in attendance, while younger children presented less frequently. Although female patients remained predominant during the pandemic, the female-to-male ratio slightly favored males. All disease groups and subgroups demonstrated a decline in patient numbers during the pandemic compared to the pre-COVID year. Infections increased relative to hypersensitivity, with bacterial and fungal infections remaining the most common subgroups. COVID-19-related dermatoses did not significantly increase, except for herpes zoster, which showed a relative increase. Some dermatoses demonstrated significant relative increases during the pandemic, including impetigo, furunculosis, warts, abscesses, and herpes zoster, while others showed declines, such as acne, candidiasis, tinea capitis, urticaria, herpes simplex, pityriasis alba, pityriasis rosea, tinea corporis, xerosis, and chilblains. Conclusion The COVID-19 pandemic had a substantial impact on the pattern of skin diseases in Egypt, affecting patient demographics and disease prevalence. Infection-related dermatoses remained prevalent, with bacterial and fungal infections being the most common subgroups. Although minimal changes were observed in some diseases, especially COVID-related dermatoses, the overall pattern of dermatoses was preserved compared to the previous year. This study underscores the need for healthcare systems to adapt to changing disease patterns during pandemics, ensuring adequate medications, supplies, and medical team training to provide effective care. Further community-based studies are necessary to validate the findings and address potential disparities between hospital-based and community-based disease prevalence.

Projected Annual Lecanemab Treatment Eligibility in an Irish Regional Specialist Memory Clinic.

The advent of Disease Modifying Therapies (DMTs) for the treatment of Alzheimer's Disease (AD) has the potential to transform the lives of those with early AD. Timely identification of eligible patients is needed to ensure treatments are delivered during a narrow window of therapeutic opportunity. Appropriate clinical service design will hinge on improved understanding of future demands, thus there is a pressing need to investigate patient eligibility in real world clinical cohorts. The primary aim of this study is to assess the eligibility by appropriate use criteria (AUC) for lecanemab therapy in a real-world, undifferentiated clinical patient cohort attending a Regional Specialist Memory Clinic (RSMC), with the secondary aims of determining the proportion of patients with biomarker positive Alzheimer's Disease (AD) who would be eligible for lecanemab therapy by AUC. Clinical trial eligibility criteria were also applied to both groups and discrepancies that exist between eligibility rates explored. A retrospective cohort study of all new patients attending a RSMC from 1st January 2022 to 31st December 2022 was conducted. Data collected included demographic details, outcomes of diagnostic assessments and comorbidities. MRI images, where indicated, were reviewed. Amyloid positivity was defined as either Amyloid and Tau positive (A+T+) or Amyloid positive with a positive P-Tau/Ab42 ratio on cerebrospinal fluid (CSF) testing. Appropriate use criteria (AUC) and clinical trial criteria for lecanemab were applied. Proportion of eligible patients was calculated. Eleven (5.9%) of 188 new patient attenders were eligible (average age 66.7years [SD 8.9], 63.6% female) by AUC, with 26.2% of patients with biomarker positive Alzheimer's Disease eligible for lecanemab therapy. The most common reason for exclusion was a lack of biomarker confirmation of AD pathology followed by cognitive ineligibility (based on defined cognitive testing cut-offs) at the time of referral and/or initial assessment. Only 40.4% of patients had CSF testing for AD biomarkers while almost 20% of the patients with biomarker positive AD were excluded due to lack of a screening MRI in the previous 12months. In this study, the potential eligibility rate by AUC of the entire patient cohort (5.9%) was limited by the small proportion of patients who had CSF testing for AD biomarkers. So while disease-modification with Lecanemab is a welcome therapeutic advance, although only a small proportion of people currently attending specialist services will be eligible. Successful delivery of DMTs will require significant resource allocation and optimisation of referral pathways to facilitate early identification of potentially eligible patients.

Association Between Cancer Screening Patterns and Carer Literacy in Individuals With Cognitive Decline: An Observational Study.

The incidence rates of dementia, mild cognitive impairment, and cancer increase with age, posing challenges to affected individuals and their families. However, there are currently no clear cancer screening guidelines for individuals with cognitive impairment. This study analyzed the impact of carer health literacy on screening behaviors in this population. We conducted a postal follow-up survey, associated with the National Center for Geriatrics and Gerontology-Life STORIES of People with Dementia, that targeted primary carers to assess their reports regarding patient attendance at regular cancer screenings recommended by the Japanese Ministry of Health, Labor and Welfare, over the preceding 2 years. Screening rates were compared between the memory clinic cohort and the national average, and the influence of carer health literacy level on screening was analyzed. Among the 826 total individuals analyzed, the memory clinic cohort exhibited lower breast cancer screening rates, at 11% among female patients aged 65-74 years versus the national average of 32%. Higher health literacy among carers was significantly associated with increased screening. For female patients, carers with high levels of communicative health literacy were more likely to ensure that patients attended screenings for gastric (adjusted odds ratio [AOR], 1.77; 95% confidence interval [CI], 1.03-3.04), colorectal (AOR, 1.70, 95% CI 1.08-2.70), and breast cancers (AOR, 3.08; 95% CI, 1.40-6.76). Among the male patients, high communicative health literacy was associated with increased lung cancer screening attendance (AOR, 1.82; 95% CI, 1.11-2.99). Our research highlights a notable gap in cancer screening attendance between individuals with cognitive impairment and the general population, potentially arising from the intricate nature of screening procedures and the extensive burden on carers. More informed decisions and increased screening rates can be achieved through patient-centric communication strategies that accommodate the cognitive abilities of patients, ensuring the comprehensibility and accessibility of health-related information.

Factors Associated With Physical Therapy Attendance Rate and Self-Discharge in People With Chronic Pain

OBJECTIVE: To identify factors associated with physical therapy (PT) attendance and self-discharge in patients with chronic pain. DESIGN: Retrospective chart review with survey. METHODS: Organizational reports were screened for patients with chronic pain. A retrospective review of the electronic medical record was performed, and a survey invitation was sent to the evaluating therapist. Poisson regression analyzed factors related to attendance, while logistic regression analyzed factors related to self-discharge. RESULTS: The 200 patients had attendance and self-discharge rates of 73% and 55%, respectively. Attendance rates were lower in patients whose therapists reported higher comfort levels with treating chronic pain and slightly higher in patients with a longer duration of care. Odds of self-discharge were higher if the patient had a higher no-show rate or was seen by a therapist reporting higher comfort levels with treating chronic pain but were lower if more PT visits were completed. CONCLUSION: In this study, attendance rates and self-discharge were related to several patient- and therapist-driven factors. Therapists should identify each patient’s potential facilitators and/or barriers to attending PT and prepare them for self-management of their condition upon discharge. JOSPT Open 2024;2(4):332-339. Epub 7 August 2024. doi:10.2519/josptopen.2024.1136

Preventing Emergency Department Visits: Success Of A Community Dementia Care Model

Abstract Background Advanced dementia care in the community is an extremely complex task. NICE guidelines 2021 suggested that a gap in care was evident bridging between clinic attendance and end of life care. Secondary to a required need- a new advanced dementia care model was created in 2021.This was co-developed by an ANP with a specialist interest in gerontology, an integrated care team for older persons (ICPOP) consultant and palliative care in the community. Joint governance remains to this day. My aim is to review unexpected emergency department (ED) attendances of patients accepted to this pathway. Methods Patient records were reviewed of all cases accepted for review and managed under this model of care, time frame Jan 2023- May-2024. All patients &amp;gt; 65. Outcomes of management interventions were assessed. Those found to have an ED attendance during their time engaging with this model of care had closer review of their notes to assess reason why. Results 81 patients. Of which 75% were female. Average age – 89. Of these 48% died at home and are 37% still alive. Of the 81 patients only 5 (6%) had ED attendances. Of these 5 patients - 3 had unexpected traumatic falls- 2 resulting in hip fracture and 1 in humeral fracture. 2 were admitted with worsening delirium. Conclusion The advanced dementia care model has proved very successful in preventing ED attendances prior to direct end of life care engagement. Of those who were admitted – fractures appropriately warrant admission and the remaining 2 cases, had families who were resistant to accepting overall aims of treatment. This interdisciplinary model of care saves bed days. Expanding this care model further to ensure appropriate management of complex dementia cases is maintained in the community would further reduce hospital overcrowding and grant many patient and family wishes.

Prevalence of Hypothyroidism in Children with Transfusion Dependent Thalassemia Patient Attending in A Tertiary Care Hospital of Bangladesh

Background: Blood transfusions and iron chelation are standard treatments for β-thalassemia major and Hb E-Beta-Thalassemia. However, repeated transfusions raise body iron levels, leading to secondary hemosiderosis and complications in the heart, endocrine system, and liver. Thyroid dysfunction results from gland infiltration, chronic hypoxia, free radical damage, and iron overload. This study aimed to find out the prevalence of hypothyroidism in transfusion-dependent thalassemic children attending Bangladesh Shishu Hospital &amp; Institute. Methods: A descriptive cross-sectional study was conducted at the Thalassemia Centre, Department of Hematology and Oncology, Bangladesh Shishu Hospital &amp; Institute, from December 2019 to November 2020. The study included 140 children with thalassemia, aged 5 to 16 years, who were receiving blood transfusions. Data were collected using a structured questionnaire with participant consent. Statistical analysis was performed using SPSS version 23.0. Results: In this study, hypothyroidism was observed in 26.2% of patients, with 23.5% having subclinical and 2.9% overt hypothyroidism. In most of the patients (n=85), aged 11-16 years, 58.3% had normal thyroid function, 36.5% had subclinical, and 4.7% had overt hypothyroidism, which was statistically significant (p&lt;0.05). Of the 91 patients with hemoglobin levels below 11.5 g/dL, 85.7% had normal thyroid function, 13.2% had subclinical hypothyroidism, and 1.1% had overt hypothyroidism, also significant (p&lt;0.05). In the group with ferritin levels of 1200-2000 ng/mL, 78.1% had normal thyroid function, 18.8% had subclinical hypothyroidism, and 3.1% had overt hypothyroidism, which was not statistically significant (p&gt;0.05). Conclusion: Subclinical hypothyroidism is commonly seen in thalassemia patients aged 5 to 16 years who undergo regular blood transfusions. Regular physical exams and thyroid function assessments are crucial to detect overt hypothyroidism early. Timely hormone replacement can

Effectiveness of Personalised Phone Calls and Short Message Service Reminders in Improving Patient Attendance at a Radiology Department.

Patients missing scheduled hospital appointments posesignificant challenges, including resource waste and delayed patient care. This study evaluated the effectiveness of personalised reminder systems (phone calls andshortmessageservice (SMS)) in improving patient attendance rates at a radiology department. The study was conducted at a hospital facility in Saudi Arabia. The intervention involved reminding 493 patients of their radiology appointments using their preferred method (phone call or SMS). Demographic, clinical, and other factors were considered in analysing the impact of these reminders on appointment attendance. Attendance rates before the intervention were further compared with attendance rates after the intervention to assess the effectiveness of the studied strategies. Patient reminders affected overall patient attendance, with a 5% improvement compared to the attendance rates before the intervention. Phone call reminders were found to be more effective than SMS, particularly among older patients (41-60 years). The attendance rate for patients receiving phone call reminders ranged from 35% to 85%, whereas those receiving SMS reminders had a 15-65% attendance range. The study indicated marital status and distance as key factors associated with attendance. Chi-square analysis also highlighted significant differences in attendance rates before and after the intervention, particularly among female patients, single and divorced individuals, and those with at least secondary education. Patients living more than 35 km from the hospital and those referred from other hospitals were more likely to miss appointments, irrespective of the intervention. Personalised phone call reminders seem to be more effective than SMS in reducing missed appointments, especially among older patients. This study highlighted the importance of considering patient demographics and preferences in designing reminder systems to enhance healthcare appointment adherence.

Modern Approaches to the Diagnosis o Food Allergy in Children: Oral Food Challenges (Review)

The diagnosis of food allergies significantly impacts the lives of patients and their families, restricting diets and social activities. A misdiagnosis can lead to severe allergic reactions, making accurate diagnosis crucial. Immunoglobulin E (IgE)-mediated food allergies are diagnosed using skin tests or serum-specific IgE levels. However, for most allergens, the only reliable method for confirming the diagnosis remains the oral food challenge (OFC). Objective — elucidation of the importance of oral provocation tests in the diagnosis of food allergy and their relevance for the future treatment of food allergy. Materials and methods. A search for information on OFC was conducted in scientometric databases such as Web of Science, Scopus, Google Scholar, ScienceDirect and PubMed using the following keywords: «food allergy», «oral food challenge», «children». After reviewing the publications, professional sources that met the query criteria and were published between 2017 and 2024 were selected for the review. Results and discussion. OFCs help determine allergen sensitivity and reaction severity, which is useful for further management. They also have therapeutic value, reducing anxiety related to food allergies and improving quality of life. Psychological aspects play an important role in food allergies, as the fear of severe reactions often exceeds actual risks.One limitation of OFCs is the need for substantial resources and specialized knowledge, available only in specialized medical centers. This leads to long waiting lists and delays in food introduction, increasing the risk of developing allergies. Additionally, OFCs are often conducted in controlled environments, which may not reflect real-world accidental exposures.OFC results can include false positives, false negatives, and inconclusive outcomes. They are also time-consuming and may affect school or work attendance for patients and caregivers. It is essential to standar­dize doses for each food according to portion sizes and patient age. Conclusions. The frequency of food allergies is currently increasing in Ukraine, highlighting the need for allergists to master the technique and implement oral food challenges in general allergy practice to establish food allergies in children.

The Effect of COVID-19 on Lung Cancer Screening.

Background During the COVID-19 pandemic, many hospitals suspended non-essential medical procedures to reduce transmission and prioritize personal protective equipment (PPE) for COVID-19 patients. Hospitals that continued these procedures faced uncertainty about patient attendance. Multiple factors could explain a decline in patient attendance during the pandemic, including patients' reluctance to risk COVID-19 exposure in the hospital or their own illness requiring self-isolation. This study aimed to compare attendance rates of lung cancer screenings (LCS) before and during the pandemic. Unlike previous studies conducted on this research topic, the current study documents that the John B. Amos Cancer Center continued LCS throughout the pandemic.The alternative hypothesis was that there would be a decrease in the percentage of LCS performed during the pandemic period due to fear of nosocomial transmission. Materials and methods Data for 2,582 scheduled LCS were retrospectively analyzed on Microsoft Excel 2022(Microsoft Corporation, Redmond, Washington) from 2018 to 2021. For analysis purposes, 2018 and 2019 were considered pre-COVID years, while 2020 and 2021 were considered COVID years. The average percentage attended was calculated for each year and the standard deviation of that year's percentage. The percentage of patients seen each month was averaged during pre-COVID and COVID years. The p-value was calculated by comparing the average attendance percentage for each month in the pre-COVID and COVID years. A p-value <0.05 was considered significant. Results From 2018 to 2021, over 300 more people were scheduled during the COVID years. Although the percentage seen remained consistent throughout the years, there was an increase in both patients scheduled and seen. The results revealed an insignificant difference in LCS attendance between pre-COVID and COVID years, confirming the importance of their continuation. Conclusion The alternative hypothesis was rejected due to no significant difference in attendance percentage between the pre-COVID and COVID years. Further direction of this study may include monitoring the trend of LCS attendance during post-pandemic years as the transmission rates continue to change.

Enhancing Emergency Department Management: A Data-Driven Approach to Detect and Predict Surge Persistence.

The prediction of patient attendance in emergency departments (ED) is crucial for effective healthcare planning and resource allocation. This paper proposes an early warning system that can detect emerging trends in ED attendance, offering timely alerts for proactive operational planning. Over 13 years of historical ED attendance data (from January 2010 till December 2022) with 1,700,887 data points were used to develop and validate: (1) a Seasonal Autoregressive Integrated Moving Average with eXogenous factors (SARIMAX) forecasting model; (2) an Exponentially Weighted Moving Average (EWMA) surge prediction model, and (3) a trend persistence prediction model. Drift detection was achieved with the EWMA control chart, and the slopes of a kernel-regressed ED attendance curve were used to train various machine learning (ML) models to predict trend persistence. The EWMA control chart effectively detected significant COVID-19 events in Singapore. The surge prediction model generated preemptive signals on changes in the trends of ED attendance over the COVID-19 pandemic period from January 2020 until December 2022. The persistence of novel trends was further estimated using the trend persistence model, with a mean absolute error of 7.54 (95% CI: 6.77-8.79) days. This study advanced emergency healthcare management by introducing a proactive surge detection framework, which is vital for bolstering the preparedness and agility of emergency departments amid unforeseen health crises.