Patients Research Articles

Postoperative outcomes among patients evaluated via telemedicine-based preoperative consultations for inguinal hernia care.

In an era where telehealth is gaining traction within healthcare systems, its integration into preoperative assessment protocols presents both challenges and opportunities. Preoperative assessments have an important role in determining the best plan of action for each patient. Recent studies have reported adequate operative outcomes after telemedicine preoperative consultations. This study examines telehealth's efficacy relative to traditional in-person evaluations in the context of preoperative consultations for inguinal hernia repairs and provides a deeper insight into how telemedicine might be utilized for pre-surgical assessments. We analyzed a prospectively maintained single-center database at a tertiary referral hospital with a dedicated hernia and abdominal wall reconstruction center for pre, intra and postoperative variables comparing patients that received telemedicine (phone or video) preoperative consultations versus in-person clinic visits only. Secondary analysis with propensity score matching was employed to adjust for possible confounders. 265 patients that underwent inguinal hernia repair were included, with 60 encounters being telemedicine only and the rest in-person. This analysis found no difference in rates of postoperative complications between the telemedicine and in-person groups. The telemedicine group required less preoperative encounters with their surgeon (P < 0.001). In the preoperative in-person group, 41% switched to virtual follow-ups, while in the virtual group, only 18% chose in-person follow-ups (P = 0.003). Based on our analysis, the use of telemedicine for preoperative assessments in inguinal hernia repairs as a feasible and safe choice for patients opting for this approach, potentially reshaping the preoperative paradigm in surgical practices.

Influencing factors of self-management ability among dry eye patients in west China.

To investigate the current situation and influencing factors of self-management ability in dry eye patients in west China. A total of 265 patients clinically diagnosed with dry eye received a convenience survey questionnaire at West China Hospital of Sichuan University. All participants completed the rating scale of health self-management skill for adults (AHSMSRS), Huaxi Emotional-Distress Index (HEI), e-health literacy scale (e-HEALS) and Brief Illness Perception Questionnaire (Brief-IPQ). A generalized linear model was employed to establish a multivariate linear model with demographic data, psychological state, e-HEALS, and illness perception as independent variables and health self-management skill score as the dependent variable. The mean score for health self-management skill was 165.58±15.79. Multivariate analysis revealed that advanced age, better illness perception and improved psychological state were associated with better health self-management ability among dry eye patients. Furthermore, the health self-management ability of patients with a disease duration less than 1y was found to be higher compared to those with a disease duration exceeding 1y. The health self-management ability of dry eye patients in west China is relatively high. Age, duration of disease, illness perception and psychological state are the influencing factors on the health self-management ability of dry eye patients.

Comparative evaluation of Food for Special Dietary Use (FSDU) and Food for Special Medical Purpose (FSMP) product regulatory framework in India, EU and US

Nutraceuticals are naturally occurring compounds that is used globally due to its varied health benefits that extends beyond to basic nutrition. Various types of compounds are included in the umbrella term of nutraceuticals, including vitamins, minerals, herbal extracts, and dietary supplements. For better understanding and defined use of specific nutraceuticals in specific conditions, nutraceuticals are classified into various types, including Foods for Special Medicinal Purpose (FSMP) and Foods for Special Dietary Use (FSDU). FSMP are foods or nutraceuticals that are formulated in such a way to meet specific nutritional needs for managing medical conditions. FSMPs are designed to complement medical treatments, aiding in recovery, and improving quality of life. FSDU are formulated to meet the nutritional needs of individuals with specific dietary requirements or restrictions. FSDU are essential for ensuring individuals receive adequate nutrition while adhering to dietary restrictions. The regulatory framework for FSDU and FSMP varies significantly between countries. Each country has its own set of laws and regulations governing the production, labelling, and distribution of these products. These regulations ensure that FSDUs and FSMPs meet specific safety, efficacy, and nutritional standards relevant to local health policies and consumer protection laws. The review aimed to compare the regulatory frameworks for FSMP and FSDU across India, the US, and the EU. It focused on understanding differences in regulatory requirements for these products in each jurisdiction. By analyzing these regulatory landscapes, the study sought to highlight variations that impact manufacturers, healthcare providers, and consumers in these regions.

A Comparison of Employee Engagement: Pre- and Post-COVID-19

The COVID-19 pandemic has created major disruptions in the global economy and employee working patterns. Employee engagement is a key factor for organizational management in that it provides an organization with employee commitment to the goals of the organization. The research literature shows mixed results related to the effects of Covid-19 on employee engagement pre-and post-periods. As a result, the literature on employee engagement across different industries is inconclusive. This research study explores the effects of employee engagement pre- and post-COVID-19 and attempts to identify differences across industries. The researcher administered a 15-question survey to organizations on factors related to employee engagement across five industry categories—Health Care, Food Services, Consumer Retail, Manufacturing, and Professional Services.

Latent profile analysis of resilience and its influencing factors in patients with lung cancer undergoing chemotherapy

ObjectiveThis study aims to analyze the classification characteristics of resilience in patients with lung cancer undergoing chemotherapy using latent profile analysis and explore the influencing factors and their relationship with medical coping strategies. MethodsA questionnaire survey was conducted on 265 patients with lung cancer undergoing chemotherapy at a tertiary Grade-A hospital in Guangzhou from November 2023 to March 2024, using the General Information Questionnaire, Resilience Scale Specific to Cancer (RS-SC), Lung Cancer Chemotherapy Symptom Cluster Assessment Questionnaire, and Medical Coping Modes Questionnaire (MCMQ). Latent profile analysis was performed using Mplus 8.3 to identify resilience classifications, estimate influencing factors, and evaluate their impact on medical coping strategy selection. ResultsA total of 259 valid questionnaires were collected, with an effective response rate of 97.74%. Patients were categorized into three groups based on resilience levels: low-resilience group (20.46%), mid-resilience group (40.52%), and high-resilience group (38.97%). Multinomial logistic regression analysis revealed that education level, family per capita monthly income, and gastrointestinal and emotional symptom cluster scores were significant influencing factors for different resilience classifications (P < 0.05). Statistically significant differences were found in the scores for the confrontation and resignation dimensions of medical coping strategies across different latent profiles (P < 0.01). ConclusionsResilience in patients with lung cancer undergoing chemotherapy is heterogeneous, presenting in three distinct categories. Medical staff should provide tailored interventions based on the characteristics and influencing factors of each patient profile to enhance resilience and coping strategies.

Impacts of the COVID-19 pandemic on pediatric and adult patients with hemophilia.

The coronavirus disease 2019 (COVID-19)-associated mortality rate of hemophilia patients is similar to that of the general population, but the risk of hospitalization and bleeding is higher. However, the specific impact of this infection on hemophilia patients remains unknown. We aimed to investigate the impact of the pandemic on the infection susceptibility, symptoms, drug use, and social intercourse of patients with hemophilia. A survey was distributed to 265 patients with hemophilia (185 adults and 80 children) in the Fujian hemophilia therapeutic center (Fuzhou City, China) during the COVID-19 pandemic, and data were collected between January 2022 and January 2023. The impacts of SARS-CoV-2 infection on hemophilia symptoms, drug use, and social intercourse of these patients were investigated, and the association between the recovery time and disease conditions was explored in infected patients. During the pandemic, compared with adult patients, pediatric patients had significantly reduced social intercourse and outdoor activities because of the fear of contracting COVID-19 (85.0% vs. 66.5%). Bleeding events were also significantly fewer in children than in adults (61.2% vs. 81.1%). The SARS-CoV-2 infection rate was significantly higher in patients living in urban areas than in those living in rural areas (74.3% vs. 53.6%). The duration of symptomatic recovery from COVID-19 was not significantly associated with hemorrhage, type and classification of hemophilia, presence of inhibitors, complications, and vaccination status. Having COVID-19 infection did not significantly influence the symptoms and treatments in patients with hemophilia. Pediatric patients had significantly fewer bleeding events than adults.

Long head of biceps tendon autograft is effective in the management of large to massive rotator cuff tear: a systematic review.

The aim of this systematic review is to review the functional, clinical and radiological outcomes of patients undergoing large to massive rotator cuff repair with long head of biceps tendon (LHBT) autograft, as well as compare these to standard arthroscopic cuff repair. A review of the online Medline database was conducted on 20 October 2022 according to PRISMA guidelines and registered prospectively on the PROSPERO database. Clinical studies assessing patients with large to massive rotator cuff tears undergoing LHBT autograft repair were included. All studies reported on functional outcomes, range of movement (ROM) and radiological re-tear rates. The Methodological Index for Non-Randomised Studies (MINORS) tool was used to appraise all studies. The search strategy identified ten studies for inclusion including a total of 594 patients. Five studies were comparable (346 patients), assessing LHBT autograft repair against arthroscopic rotator cuff repair without autograft. A variety of techniques of LHBT autograft were used across all studies, including bridging and augmentation styles. Radiographic comparison showed lower re-tear rates in the LHBT autograft group with two studies demonstrating statistically significant results. Pain scores, functional outcomes and ROM were significantly improved post-operatively in all studies for LHBT autograft patients, with no significant difference when compared to standard arthroscopic repair. LHBT autograft looks to significantly improve functional scoring and range of motion in patients with large to massive rotator cuff tears. When compared to standard arthroscopic cuff repair, LHBT autograft appears to significantly reduce the re-tear rate. Further randomised studies are needed to assess the efficacy of this technique.

SP5.3 - Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: Time to change the traditional practice

Abstract Background To evaluate comparative outcomes of outpatient versus inpatient treatment and antibiotics versus no antibiotics approach in the treatment of uncomplicated (Hinchey 1a) acute diverticulitis. The protocol of this review was registered in PROSPERO (CRD42023488826). Methods A systematic online search was conducted using electronic databases. Comparative studies of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey 1a) acute diverticulitis were included. The primary outcome was diverticulitis recurrence. Emergency surgical resection, elective surgical resection, development of complicated diverticulitis, mortality rate, and length of hospital (LOS) were the other evaluated secondary outcomes. Results The literature search identified 14 studies (n=3,875) comparing NABX (n=2,008) versus ABX (n=1,867). The NABX group showed a lower disease recurrence rate and shorter LOS compared with the ABX group (P=0.01) and (P=0.004). No significant difference was observed in emergency resections (P=0.33), elective resections (P=0.73), development of complicated diverticulitis (P=0.65), hospital re-admissions (P=0.65) and 30-day mortality rate (P=0.91). Twelve studies (n=2,286) compared OP (n=1,021) versus IP (n=1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P=0.10), emergency surgical resection (P=0.40), elective resection (P=0.30), diverticulitis recurrence (P=0.22), and mortality (P=0.61). Conclusion Compared with the use of ABX, the NABX approach seems to provide similar clinical outcomes and shorter LOS. Moreover, OP treatment of Hinchey 1a acute diverticulitis is comparable with IP management and presumably leads to cost savings in depleted healthcare systems

WP5.15 - A review of emergency general surgery (EGS) admissions via the direct access pathway (DAP) in a district general hospital in United Kingdom

Abstract Aims Emergency surgical presentations require urgent attention by surgeons to ensure appropriate treatment, However, increased waiting time in A&amp;E often leads to delayed diagnosis and subsequently delayed management. A direct access pathway (DAP) to Surgical Emergency Assessment Unit (SEAU) helps minimize these delays and subsequently improve patient outcome. Methods A retrospective observational study of Emergency General Surgery (EGS) admissions from May 2023 to December 2023 was performed. Structured DAP referral proforma was implemented for patients to be directly referred to SEAU from A&amp;E triage. Factors taken into consideration were - initial presentation, source of referral, time of initial assessment and patient outcome. Results A total of 265 patients were channeled through DAP referrals during the study period, of which 96.6% were appropriate referrals. The main source of the referral the A&amp;E (52.4%), while the UTC-GP and GP constituted the remaining (47.6%). The most common clinical presentations were abdominal pain (32.4%), followed by subcutaneous abscess (17.3%). The median watiting time for initial assessment by the surgical team was 60 minutes. In terms of outcomes - 15 % patients were admitted, 14.7% were discharged after intervention, 35.8 % were discharged without intervention and 28.6% were planned to return for investigations or interventions. Conclusion The DAP for EGS admissions has enabled surgical emergencies to be addressed more promptly, and thus seen to have improved patient outcome as a result of avoiding unnecessary steps and delays before being reviewed by the surgical team through A&amp;E pathway.

Conservative fluid resuscitation protocol does not reduce the incidence of reoperation for bleeding after emergency CABG

Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG.Trial registration: www.clinicaltrials.gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic.clinicaltrials.gov/ct2/show/NCT04533698

Outcome of the novel description of arterial position changes after major liver resections: retrospective study.

After major liver resections, anatomical shifts due to liver parenchymal hypertrophy and organ displacement can happen. The aim of this study was to evaluate the impact of these anatomical changes on the main abdominal arteries (coeliac trunk and superior mesenteric artery) and on patient outcomes. All patients who underwent major liver resections (between January 2010 and July 2021) and who underwent preoperative and postoperative arterial-phase contrast-enhanced abdominal CT imaging were studied. Observed arterial position changes were classified into three groups: no position changes; class I position changes (vessel displacement with or without kinking with a vessel angle greater than 105°); and class II position changes (kinking less than or equal to 105°). The Mann-Whitney test and the Kruskal-Wallis test were used to compare continuous variables and the chi-squared test and Fisher's exact test were used to compare categorical variables. Univariable and multivariable logistic regression analyses were used to identify the risk factors for morbidity and mortality. A total of 265 patients (149 men and median age of 59 years) were enrolled. Arterial position changes were detected in a total of 145 patients (54.7%) (99 patients (37%) with class I position changes and 46 patients (18%) with class II position changes) and were observed more often after extended resection and right-sided resection (P < 0.001). Major complications were seen in 94 patients (35%) and the rate of mortality was 15% (40 patients died). Post-hepatectomy liver failure (P = 0.030), major complications (P < 0.001), and mortality (P = 0.004) occurred more frequently in patients with class II position changes. In multivariable analysis, arterial position change was an independent risk factor for post-hepatectomy liver failure (OR 2.86 (95% c.i. 1.06 to 7.72); P = 0.038), major complications (OR 2.10 (95% c.i. 1.12 to 3.93); P = 0.020), and mortality (OR 2.39 (95% c.i. 1.03 to 5.56); P = 0.042). Arterial position changes post-hepatectomy are observed in the majority of patients and are significantly related to postoperative morbidities and mortality.

Emergency Medicaid enrollment after traumatic injury predicts long-term health care utilization.

Injured patients have high rates of uninsurance, which is associated with worse outcomes. Insurance linkage programs that connect patients to Medicaid coverage can prevent catastrophic costs for patients. Less is known about the long-term impact of insurance enrollment. We examined health care utilization for previously uninsured patients, hypothesizing that newly insured patients postinjury would use health care more than those remaining uninsured. We linked institutional trauma registry data to the electronic medical record to identify injured patients aged 18 to 64 years from 2017 to 2021. Patients admitted without insurance and then retroactively insured (RI) during hospitalization were compared with patients with preestablished Medicaid (Medicaid insured [MI]) and those remaining uninsured. We compared demographic and injury characteristics and future health care utilization, including hospitalizations, emergency department (ED) visits, and clinic visits, among groups at 30 days and 12 months postinjury. Patient-reported outcomes (PROs) 6 months after injury were compared by group for a subset of patients participating in an ongoing study of long-term PROs. We compared 494 RI patients with 1,706 MI and 148 uninsured patients. Retroactively insured patients were younger, more likely to have penetrating injuries, and longer hospitalization than other groups. There was a significant increase in ED and clinic visits and hospital admissions at 30 days and 12 months between RI and uninsured patients (p < 0.001). Using multivariable logistic regression, RI was associated with higher future ED utilization, hospital admissions, and specialist visits at 30 days and 12 months compared with uninsured patients. Of the 265 patients with 6-month PROs, Medicaid coverage was not associated with any significant difference in physical function or anxiety. Patients enrolled in insurance postinjury are more likely to use health care in the future than patients without insurance, but the downstream effects are less clear. Health insurance is a necessary step but not independently sufficient to optimize care and improve health outcomes. Prognostic and Epidemiological; Level IV.

Domestic and Family Violence Screening and Response: A Prospective, Cross-Sectional, Mixed Methods Survey in Private Mental Health Clients.

Most domestic and family violence (DFV) research has focused on establishing prevalence and screening rates in public health and community samples. This study sought to address a gap in the literature by evaluating DFV screening and response practices in a private mental healthcare inpatient service and determining if clients of the service had unmet DFV needs. A prospective, convenience sample, mixed methods, cross-sectional survey of adult inpatient mental health consumers was employed. Sixty-two participants completed the Royal Melbourne Hospital Patient Family Violence Survey. Quantitative Likert-type and categorical responses were collated and analysed descriptively (count and percentage). Free-text responses were analysed using qualitative description within a content analysis framework. Sixty-five percent of participants had been screened for at least one DFV issue, on at least one occasion, with 35% not being screened, to their recall. Twenty-three percent reported disclosing DFV concerns, 82% felt very supported by the clinician's response to their disclosure, and 86% were provided with information they found helpful. Unmet needs were identified in 13% of participants, who had wanted to disclose DFV concerns but not feel comfortable to do so. No unscreened respondents disclosed DFV concerns, highlighting the need to uphold best practice guidelines for direct enquiry. Most disclosing clients were positive about the support they received. Indicated areas for improvement were screening rates, active follow-up, increasing psychology support levels and safety planning.

Construction and verification of a risk prediction model for cognitive frailty in older patients with chronic obstructive pulmonary disease and diabetes mellitus.

We explored risk factors for cognitive frailty in older patients with chronic obstructive pulmonary disease (COPD) and diabetes mellitus to develop and verify a risk prediction model for cognitive frailty. This was a cross-sectional study. Convenience sampling was used to randomly select 378 patients hospitalized between February 2022 and December 2023. We allocated 265 patients who visited between February 2022 and February 2023 to a modeling group to analyze risk factors for cognitive frailty and create a logistic regression model for risk prediction. Another 113 patients who visited between March 2023 and December 2023 were included in a validation group for model verification. The cognitive frailty incidence in the 265 patients was 35.09% (93/265). Regression analysis showed that age >80 years (odds ratio [OR] = 4.576), regular exercise (OR = 0.390, polypharmacy (OR = 3.074), depression (OR = 2.395) duration of COPD combined with diabetes (OR = 1.902), Family APGAR index score (OR = 0.428), and chronic pain (OR = 2.156) were factors influencing the occurrence of cognitive frailty in older patients with COPD accompanied by diabetes. The constructed risk prediction model for cognitive frailty in older patients with COPD and diabetes showed good predictive value, aiding in the clinical identification of high-risk patients and facilitating timely intervention and guidance.

Abstract MP07: Efficacy and safety of aprocitentan in patients with resistant hypertension and elevated NT-proBNP

Background and Objectives: The endothelin ETA/ETB receptor antagonist aprocitentan (APRO) decreased blood pressure (BP) in patients with confirmed resistant hypertension (RHT) in the PRECISION study. 19.6% of the overall population (143 subjects) had a reported history of Heart Failure (HF). It is well known that in subjects with RHT, HF is often underdiagnosed. In PRECISION, NT-proBNP (a marker of HF) was measured. Here we report the efficacy and safety of APRO in patients with increased NT-proBNP. Methods: 730 patients with RHT were switched to a standardized fixed-dose combination of amlodipine/valsartan/hydrochlorothiazide from their existing anti-hypertensive and diuretic medication and then randomized to APRO (12.5 mg or 25 mg) or placebo in PRECISION. This analysis considers subjects with baseline blood levels of NT-proBNP &gt;125 pg/mL. Change in BP, incident cases of edema/fluid retention and change in body weight were assessed. Descriptive statistics are presented. Results: 236 enrolled subjects (32.3%) had NT-proBNP levels from 125–1125 pg/mL. At Week 4, APRO 12.5 mg decreased trough sitting systolic BP (SiSBP) by mean (SD) 14.2 (16.7) mm/Hg, APRO 25 mg by 15.8 (13.5) mm/Hg and placebo by 9.9 (18.0) mm/Hg, confirming that the effect was greater for APRO than placebo with no apparent difference between 12.5 and 25 mg, as observed in the overall population enrolled in PRECISION. The effect was maintained with APRO 25 mg at Week 36 with a decrease of 18.4 (15.2) mm/Hg versus baseline. Adverse events of edema/fluid retention were reported with an incidence of 13.4%, 25.7% and 1.2% in the 12.5 mg, 25 mg and placebo group, respectively, at Week 4. During the SB part up to 36 weeks edema/fluid retention was reported by 26.1% of subjects with 25 mg. Body weight change at Week 4 was +0.5, +0.7 and -0.2 Kg with 12.5 mg, 25mg and placebo, respectively. This weight increase was reversible: a subsequent decrease resulted in a difference versus baseline of 0.4 kg at Week 36. NT-proBNP ratio vs baseline (geometric mean) was 0.94, 0.86 and 0.78 with 12.5 mg, 25 mg and placebo, respectively, at Week 4. There was no increase over time, the ratio vs baseline was still below 1 (0.91) at Week 36. Conclusion: Aprocitentan is effective in patients with RHT and elevated NT-proBNP. Edema and fluid retention are more common in this sub-group compared with the overall population included in PRECISION, but it is not linked to significant weight gain or increase of NT-proBNP.

Abstract P438: Is aprocitentan also sympatholytic in patients with resistant hypertension?

Background: Aprocitentan is an endothelin ET A /ET B receptor antagonist (ERA) approved for the treatment of hypertension not adequately controlled on other drugs. Resistant hypertension is associated with sympathetic activation. The insufficient blood pressure (BP) lowering of many patients at night (non-dipping) and an often-increased heart rate are signs of sympathetic activation. Because ET A and ET B receptors participate in adrenaline and noradrenaline release and dual ERAs have been shown to decrease catecholamines, we hypothesized that aprocitentan might, among the various effects of dual blockade, behave as a sympathetic inhibitor. To assess this hypothesis, we investigated the effect of aprocitentan on nighttime BP and heart rate, both influenced by the sympathetic system. Methods: In the PRECISION study, where enrolled subjects were still hypertensive despite being on a standard fixed-dose background combination therapy composed of amlodipine, valsartan and hydrochlorothiazide, 730 patients were randomized to receive aprocitentan 12.5 mg, 25 mg or placebo for the first 4 weeks (double-blind placebo-controlled phase). 24-hour ambulatory BP monitoring (ABPM) was recorded in all randomized patients at baseline and Week 4. Results: At baseline, 60% of patients were non-dippers at night . Among those, 25%, 39% and 37% were reverted to dippers in the placebo, aprocitentan 12.5 and 25 mg groups, respectively, at Week 4. Accordingly, aprocitentan 12.5 mg and 25 mg decreased nighttime BP by -8.1 and -11 mmHg, respectively, vs -2.6 mmHg on placebo at Week 4. This reduction in nighttime BP by aprocitentan was larger than the reduction in daytime BP (-6.2 and -7.8 mmHg decrease at 12.5 and 25 mg, respectively, vs -2.3 mmHg on placebo). At baseline, mean heart rate, measured by office BP measurement at trough, was 74 beats/min. At Week 4, aprocitentan 12.5 mg and 25 mg, despite the respective 15.3 and 15.5 mmHg reduction of office BP from baseline, did not increase heart rate (-3.3 and -2.6 beats/min at 12.5 and 25 mg, respectively, versus -2.7 beats/min on placebo). Conclusion: We conclude that, by blocking ET A and ET B receptors, aprocitentan may have downstream sympatholytic effects, which may help its efficacy on nighttime BP – a prognostic factor for CV events in hypertension – and allow marked BP lowering without any reactive tachycardia.

Abstract 28: A major effect of aprocitentan on albuminuria in patients with resistant hypertension

Background and Objectives: Micro- and macroalbuminuria measured by urinary albumin-to-creatinine ratio (UACR) (30–300 mg/g and &gt;300 mg/g, respectively), and high normal UACR (10–30 mg/g) are associated with higher risk of mortality, CV disease and CKD progression in patients with hypertension, diabetes, decreased renal function, or even the general population and reduction can lower these risks. The endothelin ETA/ETB receptor antagonist aprocitentan reduced albuminuria in patients with confirmed resistant hypertension (RHT). In the PRECISION trial, in addition to standard background therapy including valsartan, aprocitentan 12.5 mg reduced UACR by 30% compared to placebo (LS Geom Mean [95 CL] 0.70 [0.61, 0.80], p&lt;0.0001) and 25 mg by 34% (0.66 [0.58,0.75], p&lt;0.0001) at the end of double-blind part 1 (4 weeks) in the overall population. In this analysis, we evaluated the effect of aprocitentan on UACR at both doses according to the baseline (BL) albuminuria (30–300 mg/g and &gt;300 mg/g). Methods: 730 patients with RHT on a standardized fixed-dose combination of amlodipine/ valsartan/hydrochlorothiazide were randomized to aprocitentan (12.5 mg or 25 mg) or placebo. Of these, 174 and 90 had BL microalbuminuria or macroalbuminuria, respectively. Changes from BL in UACR and office systolic blood pressure measured at trough (SBP, the primary endpoint in PRECISION) after 4 weeks of double-blind treatment. Results: In subjects with microalbuminuria, aprocitentan reduced UACR by 43% in the 12.5 mg group (0.57 [0.42, 0.78], p=0.0005) and by 45% in the 25 mg group (0.55 [0.40,0.77], p=0.0004) compared to placebo. In subjects with macroalbuminuria, aprocitentan reduced UACR by 48% with 12.5 mg (0.52 [0.37, 0.75], p=0.0006) and by 61% with 25 mg (0.39 [0.27,0.57], p&lt;0.0001) compared to placebo. In contrast, placebo did not have any noticeable effect on albuminuria in any group. The effect of aprocitentan in lowering blood pressure, measured at trough, was independent of the level of albuminuria at baseline. After 4 weeks, 53.3% and 60% of patients achieved a decrease of ≥10 mmHg from baseline with 12.5 mg aprocitentan, respectively in the microalbuminuria and macroalbuminuria groups, compared to 64% with aprocitentan 25 mg (both cohorts) and 48% and 29% in the placebo group. Conclusion: Aprocitentan produced a major decrease of albuminuria regardless of baseline level in patients with RHT. These findings suggest substantial clinical benefit of aprocitentan in CKD patients.

The 2023 outbreak of viral conjunctivitis: Clinical features and treatment patterns from five states in India

Background: In July 2023, an outbreak of viral conjunctivitis swept across India. A knowledge of clinical features and outcome of treatment helps in the management of future outbreaks. Aim: The aim of this study was to report the clinical presentation, treatment, and outcome in patients affected during the outbreak of viral conjunctivitis. Setting and Design: This was a multicentric retrospective case series. Materials and Methods: This study reviewed the medical records of all consecutive patients diagnosed with viral conjunctivitis between July 1, 2023, and August 10, 2023, in five centers across India. Results: Of the 793 patients, 525 (66.2%) were male and 268 (33.8%) were female, with a mean age of 34.1 ± 19.0 years. The mean symptom duration was 2.6 ± 2.1 days with bilateral disease in 591 (74.5%) patients. The common ocular signs were conjunctival congestion (793, 100%), lid edema (479, 60.4%), follicles (607, 76.5%), and conjunctival hemorrhages (339, 42.7%). Artificial tears were used in 730 (92.1%) patients, antibiotic eye drops in 661 (83.4%) patients, and steroid eye drops in 428 (54.0%). The time to resolution was the least in patients who had been treated with only artificial tears (4.61 ± 2.24 days) and was maximum in patients who had been treated with topical steroids (6.5 ± 2.51 days), and the difference was significant (P &lt; 0.001). Conclusion: The presence of conjunctival hemorrhages indicated acute hemorrhagic conjunctivitis. Although many patients were treated with topical antibiotics, it was unnecessary, as the shortest resolution time was found in patients who had been received supportive therapy with artificial tear eye drops and not topical antibiotics or steroids.

Exploring the Intersection of E-commerce and Healthcare: A Visual Analysis of Research Trends.

The role of e-commercein healthcare is one of the key research areas emerging from the broader digital transformation of health services and consumer interactions. This study presents the bibliometric analysis of literature on e-commerce in healthcare based on publications from1993 to 2024 in Scopus. In particular, this analysis shows trends in the publication record that have been constantly growing, with prominent increases during the COVID-19 pandemic, now hardwiring the fact that digital technologies are key in promoting global health. The study surveys the thematic evolution of key technologies such as artificial intelligence (AI), which is transforming predictive healthcare analytics; blockchain, which is enhancing security in health data transactions; and telemedicine, which is revolutionizing remote patient care, alongside other emerging technologies that are reshaping global healthcare systems. The research also showcases global collaboration patterns, underlining the international dimensions of scholarly contributions to the area under review. These insights provide a foundation for understanding the current state of e-commerce in healthcare and suggest future directions for research and policy development in this fast-evolving field.

The disaggregation of the oswestry disability index in patients undergoing lumbar surgery for degenerative lumbar spondylolisthesis

BACKGROUND CONTEXTThe Oswestry Disability Index (ODI), is a widely used patient-reported outcome measure (PROM) for assessing functional status in individuals with lumbar spine pathology. The ODI is used by surgeons to determine the initial status and monitor progress after surgery. Compiled ODI data enables comparisons between different surgical techniques. Degenerative lumbar spondylolisthesis (DLS) often causes symptoms such as back pain and neurogenic claudication affecting quality of life and activities of daily living captured by the ODI. Despite extensive studies on ODI changes after spinal surgery, little is known about the characteristics and changes in the different ODI subsections. PURPOSETo analyze the baseline characteristics and changes in total ODI and ODI subsections 2 years after elective lumbar surgery. STUDY DESIGNRetrospective analysis on patients prospectively enrolled who underwent spinal surgery for degenerative lumbar spondylolisthesis from 2016 to 2018. The ODI was assessed preoperatively and 2 years postoperatively. PATIENT SAMPLEA total of 265 patients were included in the study, 60% were female. The mean age of the patients was 67±8 years, and the mean BMI was 30±6 kg/m2. OUTCOME MEASURESThe analysis considered the differences in ODI scores before and after surgery, as well as the changes in all ODI subsections 2 years after elective lumbar surgery for DLS. METHODSThe analysis evaluated differences in ODI scores and variations in different subsections. Patients without an ODI follow-up at 2 years were excluded from the study. The study utilized the Wilcoxon Signed Rank Test for all prepost paired samples. The Wilcoxon rank sum test was used for sex and procedure comparisons for overall ODI and ODI subsection analysis. Univariate linear regression was applied for overall and subsection specific ODI outcomes with age and BMI as independent variables, respectively. The statistical significance level was set at p<.05. RESULTSImprovement in ODI was observed in 242 patients (91%). The highest baseline disability values were found for the questions regarding pain intensity (3.4±1.3), lifting (3.2±1.9), and standing (3.4±1.3). The lowest preoperative functional limitations were observed in sleeping (1.6±1.3), personal care (1.6±1.4), traveling (1.6±1.2) and sitting (1.5±1.4). At the 2-year follow-up, there was significant improvement in all questions and the overall ODI (all p<.001). The ODI subsections that showed the greatest absolute improvements were changing degree of pain (−2.6), with 89% of patients experiencing improvement, standing (−2.4) with 87% of patients experiencing improvement, and pain intensity (−2.1) with 81% of patients experiencing improvement. The subsections with the least improvement were personal care (−0.6), sitting (−0.7), and sleeping (−0.9). The study found that female patients had a significantly higher preoperative disability in various subsections but showed greater improvement in total ODI compared to male patients (p=.001). Additionally, improvement in sitting (p<.001), traveling (p<.001), social life (p<.001) and sleeping (p=.018) were significantly higher in female patients. Older patients showed significantly less improvement in sitting (p=.005) and sleeping (p=.002). A higher BMI was significantly associated with less improvement in changing degree of pain (p=.025) and higher baseline disability in various subsections. Patients who underwent decompression and fusion had significantly higher baseline disability in several subsections compared to those who underwent decompression alone. There was no significant difference between decompression alone and decompression with fusion in terms of overall improvement in the ODI and improvement in the subsections. CONCLUSIONThese results offer a more comprehensive understanding of ODI and its changes across different subsections. This insight is invaluable for improving preoperative education and effectively managing patient expectations regarding potential postsurgery disability in specific areas.