Patient-related Characteristics Research Articles

Patient-related characteristics or local tradition: what predicts the admission to a locked ward or the use of coercive measures in psychiatric inpatient treatment?

Prior research shows that locked doors and coercive measures are not only applied due to safety concerns, but also due to the specific local tradition of an institution. We examined the association of the use of coercive measures and the admission to a locked ward with person-related characteristics compared to the admission to a specific clinic. In this 15-year, naturalistic observational study, we examined 230,684 admissions to 14 German psychiatric inpatient clinics from Jan 1, 1998, to Dec 31, 2012. To analyze the degree to which admission to a locked ward and coercive measures (received vs. not received) were connected with person- and clinic-specific factors, two-step logistic regression analyses were applied. 27% of the variance of the admission to a locked ward were explained by person-related characteristics (Nagelkerke r2 = 0.269). By adding the clinic the person was admitted to, the explained variance increased by 15% (Nagelkerke r2 = 0.418). 36% of the variance of the use of coercive measures were explained by person-related characteristics (Nagelkerke r2 = 0.364). By adding the clinic the person was admitted to, the explained variance increased by 4% (Nagelkerke r2 = 0.400). The local tradition of a psychiatric clinic seems to play a more prominent role for the decision to admit a person to a locked ward than for the decision to use coercive measures. Clinicians should be made aware of the connection of local traditions with clinical pathways in acute psychiatry to avoid unnecessary admissions to locked wards.

IMMUNOLOGICAL REACTIVITY AND REACTIVE RESPONSE OF PERIPHERAL BLOOD NEUTROPHILIC GRANULOCYTES IN PATIENTS WITH COVID-19 DEPENDING ON THEIR BLOOD GROUP

At the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, a potential link between ABO blood type and susceptibility to the disease was reported. The evidence supporting this link is strengthening as the volume and quality of research expand. Recently, interest has shifted from merely examining susceptibility to exploring the severity of the disease and the immune response characteristics of patients in relation to their blood groups. Objective: to investigate the immunological reactivity and reactive response of peripheral blood neutrophilic granulocytes in patients with COVID-19 patients based on their blood group. Materials and methods. This prospective study included 198 patients with COVID-19-associated pneumonia of mild, moderate, and severe degrees. The cohort comprised 50.51% (100) men and 49.49% (98) women, with an average age of 54.18 ± 7.25 years (range: 18 to 80 years). The distribution of blood groups according to the ABO system was as follows: 0 (I) - 37.37% (74 patients), A (II) - 37.37% (74 patients), B (III) - 18.18% (36 patients), and AB (IV) - 7.07% (14 patients). The immunological reactivity and reactive response of neutrophilic granulocytes were assessed through the analysis of 14 integral leukocyte indices, including the leukocyte shift index, the ratio of the absolute number of leukocytes to the erythrocyte sedimentation rate (ESR), the lymphocyte-granulocyte index, the lymphocyte index, the index of immunological resistance, and reactivity, among others. Results. In moderate and severe coronavirus infection, the indices of cellular and total immune reactivity and resistance are significantly lower compared to mild coronavirus infection: 1.35-3.08 times (p≤0.042-0.001) for resistance, 2.02-3.87 times (p<0.001) for reactivity, respectively, showing the highest activity among them in the owners of blood group 0 (I), with significantly lower values for A (Ⅱ), B (Ⅲ) and AB (Ⅳ) group variants by 3.94-19.10%. Whereas, with increasing severity of the disease, the reactive response of neutrophilic granulocytes, on the contrary, increases significantly compared to the mild degree: in moderate disease by 43.79-87.62% (p≤0.018-0.005), in severe disease by 1.62-2.11 times (p≤0.012-0.001), with the highest average value in AB (Ⅳ) blood group owners – by 46.69-68.44% (p≤0.017-0.005). Conclusions. The highest index of immunological reactivity is observed in individuals with blood group AB (IV) experiencing a mild clinical course of the disease. Conversely, the lowest index of immunological reactivity is found in patients with blood group A (II) who have a moderate clinical course. Additionally, the reactive response of neutrophilic granulocytes significantly increases in patients with a severe clinical course, with the highest average value recorded in those with blood group AB (IV).

Reporting of late-onset immune-related adverse events with immune checkpoint inhibitors in VigiBase.

To date, evidence on late-onset immune-related adverse events (irAEs) with immune checkpoint inhibitors (ICIs) is limited to a small number of clinical cases. This study aimed to identify drug- and patient-related characteristics potentially associated with the reporting of late-onset irAEs with ICIs in VigiBase, the WHO global database of individual case safety reports (ICSRs). Observational study comparing deduplicated ICSRs with ICIs reporting late-onset irAEs (occurred >90 days after ICI discontinuation) versus ICSRs with ICIs not reporting late-onset irAEs, collected in VigiBase from 2011 to December 31, 2022. Logistic regression was used to model the relationship between drug-related and patient-related characteristics of ICSRs and the reporting of late-onset irAEs. Significance was determined for variables with the lower bound of the 95% CI of the reporting OR (ROR) higher than 1 and a p value <0.05. The study population consisted of 6006 ICSRs with ICI-related irAEs (4574, 76.2%, originated from Europe; 3900, 64.9%, involved males; median patient age was 67 years, IQR 59-74 years). Of these, 344 (5.7%) ICSRs reported a total of 388 late-onset irAEs, among which the most frequent were thyroiditis (n=45), pneumonitis (n=37), interstitial lung disease (n=25), hepatitis (n=23) and vitiligo (n=19). Median time to onset since ICI discontinuation was 167 days (IQR 115-294 days), with negligible proportion (3.2%) of co-reported antineoplastic agents during the discontinuation period. Logistic regression models showed disproportionate reporting of late-onset irAEs with ICI combination therapy (ROR 2.33, 95% CI 1.19 to 4.57), reporting of multiple irAEs (ROR 3.96, 95% CI 2.85 to 5.52), reporting of cutaneous irAEs (ROR 1.83, 95% CI 1.24 to 2.71), and melanoma (ROR 1.47, 95% CI 1.04 to 2.06). This global pharmacovigilance study provides the largest case series of late-onset irAEs with ICIs to date and identifies characteristics of ICSRs associated with disproportionate reporting. Dedicated prospective observational studies focused on long-term sequelae, quality of life and survival of patients developing late-onset irAEs with ICIs should be planned to confirm whether these reporting characteristics are predictors of actual occurrence. Furthermore, translational research should be encouraged to clarify the molecular mechanisms underlying late-onset irAE development.

Variation in Lymph Node Assessment After Pancreatic Cancer Resection: Patient, Surgeon, Pathologist, or Hospital?

BackgroundWe sought to define individual contributions at the patient, surgeon, pathologist, and hospital levels on lymph node assessment after pancreatic cancer resection. MethodsSEER-Medicare beneficiaries who underwent pancreatic cancer resection were identified. Multi-level multivariable regression was performed to assess the proportion of variance explained by patient, surgeon, pathologist, and hospitals on lymph node assessment (≥12 versus <12). Results2,872 patients underwent pancreaticoduodenectomy by 646 distinct surgeons and 1,063 distinct pathologists across 308 hospitals. Patient-related characteristics contributed the most to the variance in adequate lymph node assessment (71.0%). After accounting for all explanatory variables in the full model, 5.5% of the residual provider-level variation was attributed to the pathologist, 35.2% to the surgeon, and 59.3% to the hospital. ConclusionsPatient-to-patient variation was the greatest underlying contributor to variations in adequate lymph node assessment related to pancreatic cancer surgery. Variation among hospitals was greater than among surgeons or pathologists.

Patient and practice characteristics related to patient’s consent for health data exchange

Abstract Background Sharing patient health data electronically between healthcare providers can prevent medical errors and improve patient safety. In the Netherlands, exchange of health information is facilitated on a national level and is only allowed with patient consent. Consequently, it is important to know which factors are related to this patient consent. Methods Routine electronic health records data from up to 10% of Dutch general practices (sourced from the Nivel Primary Care Database) were utilized, covering the period from 2016 to 2020. We examined whether patient consent for health data exchange varied depending on patient and practice characteristics, which are expected to have a relationship with granting consent for health data exchange. Therefore, multilevel analysis was performed. Results The percentage of patients granting consent ranged between 40%-50% in the period 2016 to 2019, while this was 97% in 2020, due to the governmental corona opt-in regulation. Significant disparities were observed across several of the included patient and practice characteristics in relation to patient consent for all the years examined. In most years, patient consent provision varied by gender, age, socioeconomic position, location, and healthcare use. Practice characteristics showed notable differences in patient consent across information systems, patient volumes, and practice types over all years examined. Conclusions We observed significant variations in patient consent for health data exchange, both among the included patient (need) and practice characteristics. These differences may stem from unequal exposure to opportunities to grant consent, differences in risk of inadequate communication between healthcare providers, levels of health literacy, and practice resources. These factors should be taken into account by policymakers when further implementing and upscaling the national health data exchange system. Key messages • Variations in patient consent for health data exchange were observed among different patient groups and general practices. • Variations in patient consent for health data exchange may stem from unequal exposure to opportunities to grant consent, levels of health literacy, and practice resources, among other factors.

Development of an innovative clinical pharmacy service in a urology surgical unit: a new initiative from Qatar.

To provide an insight into the role of a clinical pharmacy initiative in a surgical urology unit through evaluating the nature, significance, associated medications, and acceptance rate of pharmacist interventions. A cross-sectional study was carried out at the Ambulatory Care Center (ACC), Doha, Qatar. Data related to clinical pharmacist interventions and associated rationale were classified according to the nature of the intervention using an adapted classification system. The assessment of the severity followed the National Patient Safety Agency (NPSA) Risk Matrix. Linear regression, Kruskal-Wallis, and post-hoc analyses were performed to determine the association between patient-related and medication-related characteristics on pharmacist interventions. A total of 3284 interventions (on 1486 patients) were analysed. Most patients (n = 1105; 74.4%) had 1-2 interventions. Age and gender showed a positive linear correlation with the number of interventions per patient (p < 0.01). Majority of interventions were related to pharmacological strategy (n = 1858; 56.6%) and quantity of drug (n = 821; 25%). Additional drug therapy (n = 748; 22.78%) was the most common subcategory followed by optimum dose/frequency (n = 691; 21.04%) and discontinuation of medications (n = 352, 10.72%). Anti-infectives were the most identified drug category (n = 798, 55.1%). Most interventions (59.4%) were of moderate significance; patients with moderate interventions were found to be older compared to patients with minor interventions (p = 0.032). Prescribers' acceptance rate was high (>90%), with a notable increase of 6.6% from 2021 to 2023. This study showed that the clinical pharmacy service in the urology surgical field was a fruitful initiative. The clinical pharmacist's role has expanded to include not only therapeutic optimisation while ensuring medication safety across the continuum of perioperative care but also the identification and management of untreated health problems. The dynamic and complexity of the urology patient population challenge clinical pharmacists; however, the practice concepts remain the same as in any other clinical setting.

Nutritional Deficiencies, Vitamin D Levels, and other Risk Factors in Pediatric Tuberculosis Patients

Background: Tuberculosis (TB) is a major world health challenge affecting more than 9 million people every year of which more than 1 million are children. It presents non-specific symptoms and for this reason has been described as a silent epidemic, especially in the diagnosis of childhood TB, especially in bacteriological confirmation. Understanding the risk factors of TB in children is therefore important. Objectives: to describe socio-economic, environmental, and health related characteristics of childhood TB patients in Nowshera, Pakistan, and their risk factors in order to propose public health interventions. Study design: A Cross-Sectional-Study Place and duration of study : This research study is proposed to be conducted in Nowshera Medical College / Nowshera Medical College / Qazi Hussain Ahmed Medical Complex situated in Nowshera, Khyber Pakhtunkhwa province of Pakistan over a period of eight months starting from the first of 03 March 2022 to 03 December 2022 Materials and Methods: A cross-sectional study was carried out at the DOTS-center of Nowshera Medical College / Qazi Hussain Ahmed Medical Complex Nowshera from 1st March to 31st October 2022 and comprised of 130 patients. In this study, Convenience sampling (Non probability) was used. The data was collected by a structured questionnaire and analyzed by statistical package for the social sciences (SPSS version 24). Quantitative data were described by measures of central tendencies; mean and standard deviation and qualitative data were described by frequencies and percentages. Chi-square test was used to test the relationship between variables where the level of statistical significant was set at P ≤ 0. 05. Results: Participants included mainly the study population of children aged 0-15 years, and the gender was equally split throughout boy 50% and girls 50%. A large percentage (69. 2%) were from low income earners’ homes, and 66. 9% of the respondents were from rural areas. Subjects’ Body Mass Index (BMI) varied from less than 18 to more than 25. Of special interest, 43. 8% of the children with TB had not been administered BCG vaccination. The source of infection, that is, contact with an adult TB patient, was reported in 43. 8% while the rest were in the 56. 2 % who had no such history. Conclusion: childhood TB in the population under study is significantly related with some factors namely; direct contact with TB patients, low economic status, crowded housing, poor ventilation and malnutrition

Cardiac (tele)rehabilitation in routine clinical practice for patients with coronary artery disease: protocol of the REHAB + trial.

Cardiac rehabilitation programs face the challenge of suboptimal participation, despite being a level Ia recommendation. Cardiac telerehabilitation, with its potential to engage patients who might otherwise not show interest, necessitates the adaption of existing center-based cardiac rehabilitation programs to facilitate rehabilitation at home. REHAB + is a mobile cardiac telerehabilitation program cocreated with patients and rehabilitation centers, aiming to future-proof cardiac rehabilitation and improve accessibility. The REHAB + application enables users to remotely communicate with their coach, receive on-demand feedback on health goal progression, and reduces the need for frequent in-person meetings at the cardiac rehabilitation center. The REHAB + study seeks to compare patient-related outcomes and characteristics of patients between those offered the option to participate in cardiac telerehabilitation and those attending center-based cardiac rehabilitation over a twelve-month period. The REHAB + study is a multicenter, prospective, matched controlled, observational study that includes (N)STEMI patients eligible for cardiac rehabilitation. We aim to enroll 300 participants for cardiac telerehabilitation and 600 for center-based cardiac rehabilitation. Participants opting for cardiac telerehabilitation (REHAB+) will be matched with center-based cardiac rehabilitation participants. Additionally, characteristics of patients unwilling to participate in either center-based rehabilitation or telerehabilitation but are willing to share their demographics will be collected. The primary endpoint is quality of life measured with the SF-36 questionnaire at three and twelve months, with patient-related characteristics driving intervention choice as the most important secondary endpoint. Secondary endpoints include physical activity, modifiable risk factors, and digital health experience. The trial is registered at clinicaltrials.gov with registration number NCT05207072. The REHAB + trial is unique by offering patients freedom to choose between cardiac telerehabilitation and center-based rehabilitation. The integration of digital components into cardiac rehabilitation has the potential to complement behavioral change strategies for specific patient groups. Offering patients the option of cardiac telerehabilitation next to center-based rehabilitation could enhance overall cardiac rehabilitation participation rates.

Previous Cesarean Section Delivery Increases the Risk for Seroma Development in Abdominoplasty Patients: Our Experience With 746 Patients.

Complications after body-contouring surgery are a field of great interest. Recognition of patient-related characteristics contributing to a greater risk for complication is of the utmost importance in improving the quality of care and safety profile of aesthetic procedures. Previous history of cesarean section (CS) and its impact on adverse events after abdominoplasty has yet to be investigated and defined. Our objective was to evaluate the effect of previous cesarean section on the risk for adverse events in abdominoplasty. The medical records of 746 eligible patients were reviewed, and relevant information was extracted. Stratification of patients based on a previous history of CS was followed by statistical analysis of differences between the groups. Relevant regression models were implemented to further understand the data. Seven hundred forty-six patients were included in the study, of which 308 (43.1%) had history of CS delivery. The group did not differ in baseline demographic and surgical details, except for a greater hemoglobin level in the non-CS patients (P = .007). Analysis of complication rates revealed a statistically significant increase in the risk for seroma development in the group of patients with a history of CS delivery (P = .031), which correlated to a 65% increase in the risk for complications (odds ratio = 1.65, 95% CI 1.07-2.56). A medical history of CS increases the risk for seroma development in the postoperative period following abdominoplasty. Several potential pathogenic mechanisms exist, and further prospective research is needed to further characterize the association.

Investigating Patient Use and Experience of Online Appointment Booking in Primary Care: Mixed Methods Study.

Online appointment booking is a commonly used tool in several industries. There is limited evidence about the benefits and challenges of using online appointment booking in health care settings. Potential benefits include convenience and the ability to track appointments, although some groups of patients may find it harder to engage with online appointment booking. We sought to understand how patients in England used and experienced online appointment booking. This study aims to describe and compare the characteristics of patients in relation to their use of online appointment booking in general practice and investigate patients' views regarding online appointment booking arrangements. This was a mixed methods study set in English general practice comprising a retrospective analysis of the General Practice Patient Survey (GPPS) and semistructured interviews with patients. Data used in the retrospective analysis comprised responses to the 2018 and 2019 GPPS analyzed using mixed-effects logistic regression. Semistructured interviews with purposively sampled patients from 11 general practices in England explored experiences of and views on online appointment booking. Framework analysis was used to allow for comparison with the findings of the retrospective analysis. The retrospective analysis included 1,327,693 GPPS responders (2018-2019 combined). We conducted 43 interviews with patients with a variety of experiences and awareness of online appointment booking; of these 43 patients, 6 (14%) were from ethnic minority groups. In the retrospective analysis, more patients were aware that online appointment booking was available (581,224/1,288,341, 45.11%) than had experience using it (203,184/1,301,694, 15.61%). There were deprivation gradients for awareness and use and a substantial decline in both awareness and use in patients aged >75 years. For interview participants, age and life stage were factors influencing experiences and perceptions, working patients valued convenience, and older patients preferred to use the telephone. Patients with long-term conditions were more aware of (odds ratio [OR] 1.43, 95% CI 1.41-1.44) and more likely to use (OR 1.65, 95% CI 1.63-1.67) online appointment booking. Interview participants with long-term conditions described online appointment booking as useful for routine nonurgent appointments. Patients in deprived areas were clustered in practices with low awareness and use of online appointment booking among GPPS respondents (OR for use 0.65, 95% CI 0.64-0.67). Other key findings included the influence of the availability of appointments online and differences in the registration process for accessing online booking. Whether and how patients engage with online appointment booking is influenced by the practice with which they are registered, whether they live with long-term conditions, and their deprivation status. These factors should be considered in designing and implementing online appointment booking and have implications for patient engagement with the wider range of online services offered in general practice.

Impact of Dental Prostheses on Occlusal Function in Edentulous Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Dental prostheses can improve oral health and have an impact on occlusal function in edentulous patients. For instance, implant-supported dentures are thought to improve masticatory efficiency and biting power; these more modern instruments have demonstrated to offer greater patient satisfaction than traditional complete dentures. Patient-related characteristics such as age, sex, and associated illnesses or comorbid conditions may influence treatment success. Even though total tooth loss is declining globally, edentulism is still frequent, especially in older persons. Modern prosthetics have a major positive impact on oral health overall and occlusal function. Enhancing patient well-being and optimizing treatment outcomes require an understanding of and attention to patient-specific requirements.

Increased incidence of traumatic spinal injury in patients aged 65 years and older in the Netherlands

PurposeThe global population is ageing rapidly. As a result, an increasing number of older patients with traumatic spine injuries are seen in hospitals worldwide. However, it is unknown how the incidence of traumatic spinal injury has developed over the past decade. Therefore, this study aimed to determine the incidence and characteristics of traumatic spinal injury in patients aged under and above 65 years.MethodsDuring three time periods: 2009–2010, 2014–2015 and 2019–2020, all adult patients with traumatic spinal injury in the Netherlands were identified from the Dutch National Trauma Registry. Patient-related characteristics and 1-year mortality were collected from a subgroup of patients treated at a level-1 trauma centre, and patients aged ≥ 65 years were compared to patients aged < 65 years.ResultsIn the Dutch National Trauma Registry 25,737 patients with traumatic spinal injury were identified. The incidence of spine injury in patients > 65 years was 49.5/100,000/yr in 2009–2010, 68.8 in 2014–2015 and 65.9 in 2019–2020. The percentage of patients ≥ 65 years increased from 37% in 2009–2010, to 43% in 2014–2015, and to 47% in 2019–2020. In the subgroup of 1054 patients treated in a level-1 trauma centre, a similar increasing incidence was seen in patients aged ≥ 65 years. In these patients low energy falls were the most common trauma mechanism and the cervical spine was the most commonly injured region. Moreover, patients ≥ 65 years had significantly higher 1-year mortality compared with patients aged < 65 years, 22.7% versus 9.2%.ConclusionThe incidence of traumatic spinal injury in older patients in the Netherlands has increased over the last 12 years. Almost half of the patients with traumatic spinal injury are currently aged ≥ 65 years. The increasing incidence and the high 1-year mortality highlight the need to modify existing treatment protocols for these patients.

Can machine learning predict the accuracy of preoperative planning for total hip arthroplasty, basing on patient-related factors? An explorative investigation on Supervised machine learning classification models.

BackgroundThe success of Total Hip Arthroplasty (THA) is influenced by preoperative planning, with traditional 2D approaches displaying varied reliability as well. The present study investigates the use of Supervised Machine Learning (SML) models with patient-related features to improve accuracy. MethodsPreoperative and perioperative data, as well as planning and final implant information, were obtained from 800 consecutive cementless primary THA, which was performed uniformly by a specialized surgical team. Six Supervised Machine Learning models were trained and validated using patient characteristics and implant data: Logistic Regression (LR), Linear Discriminant Analysis (LDA), K-Nearest Neighbors (KNN), Decision Tree (CART), Gaussian Naive Bayes (GN), and Support Vector Classifier (SVC). The models' ability to predict planning reliability and leg length disparity was evaluated. ResultsKNN performed better on the cup model (97.9 %), femur model (96.7 %), and femur size (99.2 %). SVM emerged as the model with the highest accuracy for cup size (60.4 %) and head size (62.1 %). CART had the best accuracy (99 %) when determining leg length discrepancy. ConclusionThe study demonstrates the utility of Supervised Machine Learning models, specifically KNN, in predicting the accuracy of preoperative planning in THA. The accuracy of these models, which are driven by patient-related characteristics, provides useful information for optimizing patients’ selection and improving surgical outcome.

요양병원 환자안전사고 분석

This study aimed to analyze the frequency, severity, and associated factors of patient safety incidents in long-term care hospitals in Korea, utilizing patient safety statistics. The objective was to provide foundational data for the development of system improvement strategies aimed at reducing the risk of harm occurrence in the future. From 2018 to 2022, a total of 10,117 patient safety incidents occurring in long-term care hospitals were analyzed. Cross-tabulation using chi-square tests was conducted to examine differences in the severity of patient safety incidents based on hospital-related characteristics and patient-related characteristics. Additionally, binary logistic regression analysis was performed to identify factors influencing the occurrence of harm in patient safety incidents. The risk of harm occurrence was approximately 1.2 times higher in hospitals with fewer than 200 beds and about 1.4 times higher in hospitals with 200-500 beds compared to those with over 500 beds. Furthermore, compared to medication errors, the risk of harm occurrence was approximately 74.8 times higher for injuries, 24.9 times higher for suicide·self-harm incidents, 10.7 times higher for meal-related incidents, and 7.6 times higher for falls. Given that long-term care hospitals with fewer than 200 beds are in a legal gray area and have a higher risk of harm occurrence in patient safety incidents, legislation for patient safety management is necessary. Additionally, since injuries pose a significantly higher risk of harm occurrence compared to medication errors, it is imperative to accurately identify the causes of injuries in long-term care hospitals and devise prevention measures.

Impact of Obesity on Hepatic Drug Clearance: What are the Influential Variables?

Drug clearance in obese subjects varies widely among different drugs and across subjects with different severity of obesity. This study investigates correlations between plasma clearance (CLp) and drug- and patient-related characteristics in obese subjects, and evaluates the systematic accuracy of common weight-based dosing methods. A physiologically-based pharmacokinetic (PBPK) modeling approach that uses recent information on obesity-related changes in physiology was used to simulate CLp for a normal-weight subject (body mass index [BMI] = 20) and subjects with various severities of obesity (BMI 25–60) for hypothetical hepatically cleared drugs with a wide range of properties. Influential variables for CLp change were investigated. For each drug and obese subject, the exponent that yields perfect allometric scaling of CLp from normal-weight subjects was assessed. Among all variables, BMI and relative changes in enzyme activity resulting from obesity proved highly correlated with obesity-related CLp changes. Drugs bound to α1-acid glycoprotein (AAG) had lower CLp changes compared to drugs bound to human serum albumin (HSA). Lower extraction ratios (ER) corresponded to higher CLp changes compared to higher ER. The allometric exponent for perfect scaling ranged from -3.84 to 3.34 illustrating that none of the scaling methods performed well in all situations. While all three dosing methods are generally systematically accurate for drugs with unchanged or up to 50% increased enzyme activity in subjects with a BMI below 30 kg/m2, in any of the other cases, information on the different drug properties and severity of obesity is required to select an appropriate dosing method for individuals with obesity.Graphical

Patient-related Factors Associated with Potentially Unnecessary Transfers for Pediatric Patients with Asthma: A Retrospective Cohort Study.

Asthma is a common chronic medical condition among children and the most common diagnosis associated with interfacility transports for pediatric patients. As many as 40% of pediatric transfers may be unnecessary, resulting in potential delays in care and unnecessary costs. Our objective was to identify the patient-related factors associated with potentially unnecessary transfers for pediatric patients with asthma. We used patient care data from the California Department of Health Care Access and Information patient discharge and emergency department (ED) datasets to capture ED visits where a pediatric patient (age 2-17years) presented with asthma and was transferred to another ED or acute care hospital. The outcome of interest was a potentially unnecessary transfer, defined as a visit where length of stay after transfer was <24 hours and no advanced services were used, such as respiratory therapy or critical care. Patient-related characteristics were extracted, including age, gender, race/ethnicity, primary language, insurance status, and clinical characteristics. First, we used descriptive statistics to compare necessary vs unnecessary transfers. Second, we used generalized estimating equations accounting for clustering by ED to estimate odds ratios (OR) and identify factors associated with potentially unnecessary transfers. A total of 4,233 pediatric ED patients were transferred with a diagnosis of asthma, including 461 (11%) transfers that met criteria as potentially unnecessary. Median age was 12years (interquartile range 7-15), and 46% were female. Factors associated with increased odds of potentially unnecessary transfer while controlling for key factors included younger age (eg, 2-5years, OR 2.0, 95% confidence interval [CI] 1.4-2.9), male gender (OR 1.4, 95% CI 1.1-1.7), and Hispanic ethnicity (OR 1.6, 95% CI 1.2-2.1), while multiple hospitalizations for asthma per year was associated with decreased odds (OR 0.2, 95% CI 0.1-0.4). Several patient-related factors were associated with increased or decreased odds of potentially unnecessary transfers among pediatric patients presenting to the ED with asthma. These factors can be considered in future work to better understand, predict, and reduce unnecessary transfers and their negative consequences.

Predictors of long-term mortality in older patients with hip fractures managed by hemiarthroplasty: a 10-year study based on a population registry in Saxony, Germany.

Mortality of patients with a femoral neck fracture is high, especially within the first year after surgery, but also remains elevated thereafter. The aim of this study was to identify factors potentially associated with long-term mortality in patients homogeneously treated with hemiarthroplasty for femoral neck fracture. This retrospective cohort study was performed at a single level 1 national trauma center at the university hospital of Leipzig (Saxony, Germany). The study time-window was January 1, 2010 to December 31, 2020. Primary outcome measure was mortality depending on individual patient-related characteristics and perioperative risk factors. Inclusion criteria was a low-energy femoral neck fracture (Garden I-IV) in geriatric patients 60 years of age or older that were primarily treated with bipolar hemiarthroplasty. Date of death or actual residence of patients alive was obtained from the population register of the eastern German state of Saxony, Germany. The outcome was tested using the log-rank test and plotted using Kaplan-Meier curves. Unadjusted and adjusted for other risk factors such as sex and age, hazard ratios were calculated using Cox proportional hazards models and presented with 95% confidence intervals (CI). The 458 included patients had a median age of 83 (IQR 77-89) years, 346 (75%) were female and 113 (25%) male patients. Mortality rates after 30 days, 1, 5 and 10 years were 13%, 25%, 60% and 80%, respectively. Multivariate regression analysis revealed age (HR = 1.1; p < 0.001), male gender (HR = 1.6; p < 0.001), ASA-Score 3-4 vs. 1-2 (HR = 1.3; p < 0.001), dementia (HR = 1.9; p < 0.001) and a history of malignancy (HR = 1.6; p = 0.002) as independent predictors for a higher long-term mortality risk. Perioperative factors such as preoperative waiting time, early surgical complications, or experience of the surgeon were not associated with a higher overall mortality. In the present study based on data from the population registry from Saxony, Germany the 10-year mortality of older patients above 60 years of age managed with hemiarthroplasty for femoral neck fracture was 80%. Independent risk factors for increased long-term mortality were higher patient age, male gender, severe comorbidity, a history of cancer and in particular dementia. Perioperative factors did not affect long-term mortality.

Adipokine (adiponectin-rs1501299) Gene Variant and Patient Characteristics in Relation to Metabolic-associated Fatty Liver Disease

BackgroundSeveral genetic and metabolic variables, most notably the variation in the adipokine gene rs1501298, have been linked to metabolic-associated fatty liver disease etiopathogenesis (MAFLD). Liver biopsy, the gold standard for diagnosing MAFLD, is an invasive procedure; therefore, alternative diagnostic methods are required. Consequently, the integration of these metabolic variables with some of the patients’ characteristics may facilitate the development of non-invasive diagnostic methods that aid in the early detection of MAFLD, identification of at-risk individuals, and planning of management strategies. MethodsThis study included 224 Egyptians (107 healthy individuals and 117 MAFLD patients). Age, sex, BMI, clinical and laboratory characteristics, and rs1501299 adipokine gene polymorphisms were examined. The Rs1501299 variant, insulin resistance, hypertension, obesity, blood pressure, lipid profile, hemoglobin A1C level, and hepatic fibrosis predictors were evaluated for MAFLD risk. The feasibility and effectiveness of developing non-invasive MAFLD diagnostic models will be investigated. ResultsThe +276G/T (rs1501299) polymorphism (GG vs GT/TT) was linked with MAFLD (OR: 0.43, CI: 0.26-0.69, p=0.002). The GG variants had lower MAFLD rates than those of the GT and TT variants. In addition to altered lipid profiles, patients with MAFLD showed increased gamma-glutamyl transferase levels (GGT: 56 IU/L vs. 36 IU/L). Genetic diversity also affects the accuracy of hepatic fibrosis and steatosis prediction. Hepatic fibrosis and steatosis predictors had ROC AUCs of 0.529%, 0.846%, and 0.700–0.825%, respectively. We examined a diagnostic model based on these variables, and demonstrated its effectiveness. ConclusionThe Adipokine variant rs1501299 increased the risk of MAFLD. Identifying and genotyping this variation and other metabolic variables allows for a non-invasive diagnostic model for early MAFLD diagnosis and identification of those at risk. This study illuminates the prevention and management of MAFLD. Further research with more participants is needed to verify these models and to prove their MAFLD diagnostic efficacy.

Direct adjusted comparison of expressed emotion towards patients with schizophrenia between halfway houses and family settings

IntroductionRates of high expressed emotion (EE) towards patients with schizophrenia have only indirectly been compared between families and community residential facilities, since studies including patients in both settings are unfortunately lacking. High EE rates in staff-patient studies are typically lower than in families, with negligible rates of high emotional overinvolvement (EOI). However, indirect comparisons can suffer from many biases.ObjectivesThis study directly compared patients with schizophrenia living in halfway houses or with their families on the EE of their caregivers, adjusting for patient- and caregiver-related confounders.MethodsWe included 40 inpatients with schizophrenia living in halfway houses and 40 outpatients living with their families and recorded the EE of the caring staff (N=22 nurses) or parents (N=56), respectively, through Five Minutes Speech Sample interviews. Each nurse rated 1-12 inpatients and each inpatient was rated by 2-5 nurses, totaling 155 nurse ratings. Each outpatient was rated by one or both parents. Due to the multilevel structure of EE ratings, generalized linear mixed models were fitted. We first adjusted only for differences in patient-related confounders between groups and then added basic caregiver-related demographics.ResultsCompared to outpatients, inpatients were older (p=0.001), less well educated (p=0.002), had a longer disease duration (p=0.047), more hospitalizations (p=0.012), lower severity of psychotic (p=0.027) and, specifically, negative symptoms (p=0.015), and lower perceived criticism (p=0.001). Nurses were younger (p&lt;0.001) and better educated (p=0.001) than parents. After adjusting for patient-related confounders only, EOI was significantly higher in parents (p=0.027) while criticism did not significantly differ between groups. However, after also adjusting for caregiver demographics (age, gender and education), criticism was significantly higher in nurses (p=0.027) while differences in EOI became non-significant.ConclusionsDifferences in EE, when directly compared between parents and professional caregivers, may be explained by differences in patient-related characteristics, caregiver demographics as well as other caregiver characteristics to be investigated in future studies.Disclosure of InterestNone Declared

Management and outcome of patients with chronic myeloid leukemia in blast phase in the tyrosine kinase inhibitor era – analysis of the European LeukemiaNet Blast Phase Registry

Blast phase (BP) of chronic myeloid leukemia (CML) still represents an unmet clinical need with a dismal prognosis. Due to the rarity of the condition and the heterogeneity of the biology and clinical presentation, prospective trials and concise treatment recommendations are lacking. Here we present the analysis of the European LeukemiaNet Blast Phase Registry, an international collection of the clinical presentation, treatment and outcome of blast phases which had been diagnosed in CML patients after 2015. Data reveal the expected heterogeneity of the entity, lacking a clear treatment standard. Outcomes remain dismal, with a median overall survival of 23.8 months (median follow up 27.8 months). Allogeneic stem cell transplantation (alloSCT) increases the rate of deep molecular responses. De novo BP and BP evolving from a previous CML do show slightly different features, suggesting a different biology between the two entities. Data show that outside clinical trials and in a real-world setting treatment of blast phase is individualized according to disease- and patient-related characteristics, with the aim of blast clearance prior to allogeneic stem cell transplantation. AlloSCT should be offered to all patients eligible for this procedure.