Patients In Outpatient Clinic Research Articles

#535 Roxadustat as a treatment of anemia after kidney transplantation

Abstract Background and Aims Roxadustat is a recently approved hypoxia-inducible factor prolyl hydroxylase inhibitor that has demonstrated favourable safety and efficacy in the treatment of renal anaemia. The goal of this study is to analyse the effect of roxadustat on the level of hemoglobin in a group of patient with chronic kidney disease with or without kidney transplantation. Method This is a monocentric study conducted on the patients of Transplant-nephrology department and/or Transplant-nephrology out-patient clinic of University Hospital Martin, Slovakia who have been treated with roxadusat since August 1st, 2022. Results 33 patients were included in the study. The average follow up of treatment with roxadustat was 4.2 months. The following parameters were recorded at the baseline: age, gender, estimated glomerular filtration rate—eGFR (CKD-EPI), treatment with iron and level of iron in serum, level of C-reactive protein, level of hemoglobin, starting dose of Roxadustat. We discovered a significant improvement in the levels of hemoglobin after one month of roxadustat treatment (P < 0.0001) and another significant improvement in follow-up (P ‚0,0373). There was no significant difference in eGFR, CRP or iron levels during follow up, so hemoglobin levels were not affected by inflammation or kidney function. In the next step the group of patients was divided based on history of kidney transplantation. Again, we confirmed significant improvement in hemoglobin levels in kidney transplantation group in first month of treatment (P < 0.0001) as well as in follow up (P < 0.0001). There was a significant improvement in hemoglobin levels in the first month of roxadustat treatment in the group of patients who did not undergo kidney transplantation (P = 0.0261). However, there was no significant difference between hemoglobin levels in month 1 and follow up in this group. Conclusion Roxadustat—as a new treatment option of anaemia for patients with chronic kidney diseases. Our first analysis confirmed that roxadustat is very effective not only in patients with CKD, but also in patients with anaemia after kidney transplantation.

Prevalence of masked hypertension in attended versus unattended office blood pressure measurement.

There is a controversial debate regarding whether unattended blood pressure (BP) measurement should be regarded as the new gold standard of office BP measurement. Unattended BP measurement eliminates the white-coat effect and reduces external influences on the patient. On the other hand, it might underestimate real-life BP. The present study compares the prevalence of masked hypertension using attended versus unattended office BP measurements. We performed a cross-sectional study on 213 patients in a general practitioner's outpatient clinic and compared attended and unattended office BP with 24h-ambulatory BP monitoring (24h-ABPM). Masked hypertension was defined as pressure ≥135/85mmHg in daytime ABPM with office systolic BP<140/90mmHg. Median attended and unattended office BPs were 140/86 and 134/80mmHg with a median 24h-BP of 129/79mmHg and daytime ABP of 133/82mmHg. The number of patients with masked hypertension was 45/213 (21.2%) using unattended and 23/213 (10.8%) using attended office BP measurements (p<.0001). Bland-Altman analysis revealed a 7.4mmHg systolic and 6.2mmHg diastolic bias between the attended versus unattended office BP, and two systolic and -1.7mmHg diastolic biases between the unattended office BP and daytime ambulatory BP. In linear regression analysis, an unattended office BP of 134mmHg corresponded to 140mmHg in attended BP measurement. Using a cut-off of 135/85mmHg instead of 140/90mmHg in unattended office BP measurement, the rate of masked hypertension was 26/213 (12.2%). Thus, unattended office BP measurement results in a substantial increase in the prevalence of masked hypertension using the traditional definition of hypertension. The present findings suggest that it might be reasonable to use a definition of 135/85mmHg.

Disparities in Teleneurology Use in Medicaid Beneficiaries With Epilepsy by Practice Setting: Promoting Health Equity in Academic Centers.

Medicaid beneficiaries in many American academic medical centers can receive care in a separate facility than those not covered by Medicaid. We aimed to identify possible disparities in care by evaluating the association between facility type (integrated faculty practice or Medicaid-only outpatient clinic) and telehealth utilization in people with epilepsy. We performed retrospective analyses using structured data from the Mount Sinai Health System electronic medical record data from January 2003 to August 2021. We identified people of all ages with epilepsy who were followed by an epileptologist after January 3, 2018, using a validated ICD-9-CM/10-CM coded case definition. We evaluated associations between practice setting and telehealth utilization, an outcome measure that captures the evolving delivery of neurologic care in a post-coronavirus disease 2019 era, using multivariable logistic regression. We identified 4,586 people with epilepsy seen by an epileptologist, including Medicaid beneficiaries in the Medicaid outpatient clinic (N = 387), Medicaid beneficiaries in the faculty practice after integration (N = 723), and non-Medicaid beneficiaries (N = 3,476). Patients not insured by Medicaid were significantly older (average age 40 years vs 29 in persons seen in Medicaid-only outpatient clinic and 28.5 in persons insured with Medicaid seen in faculty practice [p < 0.0001]). Medicaid beneficiaries were more likely to have drug-resistant epilepsy (DRE), with 51.94% of people seen in Medicaid-only outpatient clinic, 41.63% of Medicaid beneficiaries seen in faculty practice, and 37.2% of non-Medicaid beneficiaries having DRE (p < 0.0001). Medicaid outpatient clinic patients were less likely to have telehealth visits (phone or video); 81.65% of patients in the Medicaid outpatient clinic having no telehealth visits vs 71.78% of Medicaid beneficiaries in the faculty practice and 70.89% of non-Medicaid beneficiaries (p < 0.0001). In an adjusted logistic regression analysis, Medicaid beneficiaries had lower odds (0.61; 95% CI 0.46-0.81) of using teleneurology compared with all patients seen in faculty practice (p = 0.0005). Compared with the Medicaid-only outpatient clinic, we found higher telehealth utilization in the integrated faculty practice with no difference by insurance status (Medicaid vs other). Integrated care may be associated with better health care delivery in people with epilepsy; thus, future research should examine its impact on other epilepsy-related outcomes.

Implementation of a Suicide Risk Screening Clinical Pathway in a Children's Hospital: A Feasibility Study.

Youth suicide is a pressing global concern. Prior research has developed evidence-driven clinical pathways to screen and identify suicide risk among pediatric patients in outpatient clinics, emergency departments (ED) and inpatient hospital units. However, the feasibility of implementing these pathways remains to be established. Here, we share the results of a hospital-wide "youth suicide risk screening pathway" implementation trial at an urban academic pediatric hospital to address this gap. A 3-tier "youth suicide risk screening pathway" using The Ask Suicide-Screening Questions (ASQ) was implemented for patients aged 10 to 26 years who received care at an urban academic pediatric hospital's emergency department or inpatient units. We retrospectively reviewed implementation outcomes of this pathway from January 1 to August 31, 2019. The feasibility of this implementation was measured by assessing the pathway's degree of execution, fidelity, resource utilization, and acceptability. Of 4108 eligible patient encounters, 3424 (83%) completed the screen. Forty-eight (1%) screened acute positive, 263 (8%) screened nonacute positive and 3113 (91%) screened negative. Patients reporting positive suicide risk were more likely to be older and female, although more males required specialty mental health evaluations. Pathway fidelity was 83% among all positive screens and 94% among acute positive screens. The clinical pathway implementation required 16 hours of provider training time and was associated with slightly longer length of stay for inpatients that screened positive (4 vs 3 days). Sixty-five percent of nurses and 78% of social work providers surveyed supported participation in this effort. It is feasible to implement a youth suicide risk screening pathway without overburdening the system at an urban academic pediatric hospital.

Obstetrics and gynecology patients' perceptions about bedside teaching at a Saudi teaching hospital.

Bedside teaching (BST) is a crucial component of medical education. It entails the interaction of students with patients in outpatient clinics and inpatient wards under the supervision of their tutors in order to improve the clinical skills of the students and, ultimately, patient outcomes. This teaching relies heavily on patients' willingness and cooperation. The aim of this study was to assess the perception of Obstetrics and Gynecology (OB/GYN) patients regarding the presence and participation of medical students in BST. A cross-sectional survey was conducted among OB/GYN patients at the outpatient clinics and inpatient wards at King Fahd Hospital of the University (KFHU) in Al-Khobar from January 1 to April 30, 2023. Data were collected online through the Google Drive survey tool using a validated and pilot tested questionnaire. Data were analyzed utilizing SPSS version 26.0. Chi-squared test was employed to test for association between two categorical variables. Multiple logistic regression model was used to determine variables associated with positive attitudes. A total of 507 patients completed online questionnaire. A highly positive patients' attitude was observed toward the presence and participation of medical students during BST with a mean score of 81.8 ± 10.4. The acceptance rates were higher for female students compared to male students (91.9% vs 61.7%) and for senior doctors compared to junior doctors (89.9% vs 58.9%). Patients who came to the outpatient clinics were also more likely to accept students' presence than those who went to hospital wards. Age, marital status, and previous clinic visits were positively associated with the acceptance level of the presence and involvement of medical students in BST without a significant difference. In general, patients had a good perception of medical students' engagement in their care and that the gender of the medical students/doctors and clinical setting could affect this perception. Raising patients' awareness of their valuable role in male medical students' and doctors' education should be raised, as this will increase their acceptance during BST.

Two-Center Comparison of Viral Hepatitis A, B, C Seroprevalence among the 18-25 Age Group

Objective: Viral hepatitis is inflammation of the liver due to a viral infection that affects millions of people worldwide, causing thousands of deaths due to acute-chronic infection, liver cancer and cirrhosis. This study is aimed to compare datas of the seroprevalence of markers for viral hepatitis A, B, C among 18-25 age group outpatient clinic patients and healthcare workers between the two University Hospitals from east and west zone of Turkey. Material and Methods: The data of a total of 562 patients and healthcare workers, aged between 18 and 25, who applied to the outpatient clinic at Sütçü İmam University Faculty of Medicine and Onsekiz Mart University Faculty of Medicine Hospital between 01.01.2022 and 01.07.2022, were retrospectively examined. The presence of serological markers against HAV, HBV, HCV and HIV was tested with the ELISA method. Results: Anti-HAV IgG positivity was 25.5% and 40.3% for Çanakkale and Kahramanmaraş, respectively. Anti-HAV seropositivity rate in Kahramanmaraş was statistically significantly higher than in Çanakkale (P&amp;lt;0.001). Anti-HBs positivity was found to be 74.5% and 75.4% for Çanakkale and Kahramanmaraş, which were similar to each other bulundu (P=0.458). HBsAg positivity was detected as 1.5% in Çanakkale and 0.8% in Kahramanmaraş. There was no significant difference between the two cities (P = 0.810). Anti-HCV was found to be positive in one (0.5%) patient in Çanakkale and in four (1.1%) patients in Kahramanmaraş. Anti-HCV positivity was higher in Kahramanmaraş and anti-HIV positivity was higher in Çanakkale (P=.03, P&amp;lt;0.001). It was detected that anti-HBs positivity (80.7%) was higher in HCWs and anti-HAV IgG positivity was higher in non-HCWs (38.4%) (P=.042, P=0.013). There was no significant difference between the 2 groups in terms of anti-HCV and anti-HIV positivity. Conclusion: Due to the low anti-HAV seropositivity rates in the 18-25 age group, this makes this group more risky in terms of HAV infection. Especially due to the anti-HAV positivity in Çanakkale is low compared to Kahramanmaraş, it is recommended to support vaccination in this region. Since health care workers are at risk of having and transmitting hepatitis, it was found to be appropriate getting prevention measures by screening against vaccine-preventable diseases.

Analysis of factors affecting ultrasound examination time: A quantitative study.

Numerous studies have focused on reducing patient absences and effectively scheduling exams. However, very few studies have analyzed the factors influencing examination time and predicted examination time. To investigate the factors affecting ultrasound examination visit length and provide a reference for interventions to optimize ultrasound appointments. This cross-sectional study was conducted at a fertility clinic in China. Ultrasound examination time and clinical characteristics were obtained from the electronic records. Univariate and multivariate analyses used 33,432 patients who attended our clinic center between August 1 and October 30, 2018. A quantile regression model was constructed to examine associations between ultrasound examination time and statistically significant variables in the univariate analysis. Of the 33,432 patients included in this study, 29,085 (87%) were female and 4,347 (13%) were male. Their mean examination time was 6 ± 3 minutes. The doctor's title and gender, equipment, and patient's age, examination site, gender, and origin were all statistically significant. Physical examination and outpatient clinic patients had shorter examination times than inpatients. Female physicians had longer examination times than male physicians. Examination time was positively correlated with thyroid, breast, liver, gallbladder, spleen, pancreas, kidney, heart, vascular, adrenal, gynecological, early pregnancy, nuchal translucency, prostate, scrotum, and mid-to-late pregnancy fetal sites. Moreover, NT and mid-to-late pregnancy fetal sites showed a clear and continuous positive trend with increasing examination time. The length of the ultrasound examination was correlated with the examination site, physician title, physician gender, patient age, patient gender, patient origin, and instrumentation. The reliability of inspection time predicted by variables such as the physicians' title, sex, sites examined, and the number of sites examined was higher when they were longer.

THE INFLUENCE OF PERCEIVED HOSPITAL SERVICE QUALITY ON PATIENTS' HEALTH-RELATED QUALITY OF LIFE AND REVISIT INTENTION

Improved hospital service quality is anticipated to enhance the Health-Related Quality of Life (HRQL) for patients with heart and internal medicine diseases. This cross-sectional study at Persahabatan General Hospital (RSUP Persahabatan) explores the influence of perceived hospital service quality on HRQL and revisit intentions among 120 cardiology and internal medicine outpatient clinic patients. Findings reveal no direct impact on HRQL and revisit intention, but a significant influence on patient satisfaction and trust. Patient satisfaction acts as a crucial mediator between service quality perception and HRQL and revisit intention, emphasizing the need for enhanced procedural ease and healthcare staff training at RSUP Persahabatan.

Hepatitis delta virus infection in Turkey: A meta-analysis of prevalence

ObjectivesHepatitis delta virus (HDV) infection has been granted orphan disease status by the US Food and Drug Administration and the European Medicines Agency owing to its rarity and relatively limited research and treatment options. Turkey is considered an endemic country for the virus. We aimed to provide a current and updated country- and region-specific HDV infection prevalence. MethodsIn this meta-analysis, we searched databases, including MEDLINE, PUBMED, EMBASE, and UlakBim (Turkish Medical Index) published between January 1, 2006, and December 31, 2022. We included blood donor studies, outpatient clinic studies that comprised patients without cirrhosis, and inpatient clinical studies that comprised patients with cirrhosis. Turkey was divided into three regions: West, Central, and East Turkey. ResultsAfter a systematic assessment, 41 studies were included. Using a random-effects model, the estimated HDV prevalence among hepatitis B surface antigen–positive blood donors, outpatient clinic, and inpatient clinic patients were 3.37% (confidence interval [CI] 1.99-6.11), 5.05% (CI 4.00-6.23), and 29.06% (CI 10.45-51.79), respectively. The HDV prevalence among outpatient clinic patients in Western, Central, and Eastern regions were 3.38% (CI 2.47-4.44), 2.15% (CI 1.37-3.09), and 9.81% (CI 6.61-13.55), respectively. ConclusionsEast Turkey continues to have a high burden of HDV. Public health efforts, such as screening, should be targeted accordingly.

Türkiye'de Cerrahi Alanına Yönelik Hasta Şikayetleri: Dijital Platformdaki Yorumların Analizi

Aim: The purpose of the research is to examine patient complaints made on the internet site "sikayetvar" regarding the field of surgery in Turkey. The study also aims to identify common themes in patient complaints about the surgery department, better define the patient population making complaints, and systematically examine the reasons for complaints.&#x0D; Materials and Methods: In the research designed as a retrospective, the complaints made to the complaintvar.com website were examined using the content analysis method, which is one of the qualitative research methods. In the research, 359 posts on the internet about the general surgery department in Turkey, made on the complaintvar.com site, between January 1, 2023 and November 1, 2023, were examined. Complaints made; They are classified according to gender, whether they are public or private hospitals, whether they are inpatients, outpatients or emergency patients, type of surgical procedure, whether only surgical intervention is performed, whether they are related to other departments, the number of views of the complaint and the subject of the complaint.&#x0D; Results: In the study, 335 (93.3%) of the complaints were related to the procedures performed in general surgery. It was observed that they received a response to 74 (20.6%) of the complaints. It was observed that the complaints from all outpatient clinic patients were significantly higher than the complaints from ward, surgery and endoscopy patients (p

NUMBER OF OPERATIVE ACTIONS AND REFERRALS TO GYNECOLOGY CASES AT MALINGPING HOSPITAL 2020-2022

Almost every woman has experienced a gynecological condition in her life. Access to quality and adequate health services for women is one of the Indonesian government's national programs. The main aim of this study is to assess the number of procedures and referrals for gynecological cases at the Malingping Regional General Hospital (RSUD) from 2020 to 2022. This research is a retrospective descriptive study. The target population includes all gynecology patients in outpatient clinics. In contrast, the accessible population is all gynecology patients undergoing outpatient treatment at Malingping District Hospital during that period. Research shows that ovarian tumors dominate with 45% of a total of 140 cases, with various treatments such as surgery and referral, especially in cases of suspected malignancy. Malingping District General Hospital faces significant obstacles in patient referral, particularly in cancer cases involving long travel and long waiting times, which have the potential to worsen patient morbidity and mortality. Challenges such as limited anatomical pathology facilities, distance to referral hospitals, and the uneven distribution of specialist doctors underscore the need to improve infrastructure, services, and health policies to ensure better access for regional patients. Cases with gynecological problems can be managed observationally, medically, and operatively. Correct diagnosis is essential for successful treatment. Hospitals must have a unified system, human resources, facilities, and infrastructure to support this. The current problem at Malingping Regional Hospital is supporting examinations, the availability of which depends on the hospital's spending capacity.

The neurosurgical outpatient clinic: comparison between accesses in public and private activities

BackgroundNeurosurgical clinic assesses presence and extent of pathologies of central and peripheral nervous system or disorders affecting the spine, to identify most effective treatment and possible recourse to surgery. The aim of the study is to evaluate the appropriateness of request for a neurosurgical consult both in private and in public outpatient clinics.Materials and methodsWe collected and analyzed all the reports of outpatient visits of public and private clinic over a period between January and December 2018.ResultsThere were 0.62% real urgent visits in the public sector and 1.19% in the private sector (p = 0.05). Peripheral pathologies represented 12.53% and 6.21% of pathologies evaluated in public and private sector respectively (p < 0.00001). In addition, 15.76% of visits in public lead to surgery, while they represented 11.45% in private (p = 0.0003).ConclusionsNo study is available comparing accesses of patients in neurosurgical outpatient clinics. In public clinic, visits are booked as urgent on the prescription of the general practitioner: in reality, only 5% of these visits were really confirmed as urgent by the specialist. Peripheral pathologies are more frequent in public clinic, while cranial pathologies are more frequent in private one. Patients with cranial pathologies prefer to choose their surgeon by accessing private clinic.

Facial Mimicry and Doctor-Patient Satisfaction: The Feasibility of Artificial Empathy in a Clinical Video Data.

Good nonverbal communication between doctor and patient is essential for achieving a successful and therapeutic doctor-patient relationship. Increasing evidence has shown that nonverbal communication mimicry, particularly facial mimicry, where one mirrors another's facial expressions, is linked to empathy and emotion recognition. Empathy is also the key driver of patient satisfaction. This study explores how facial expressions and facial mimicry influence doctor-patient satisfaction during a clinical encounter. We used a facial emotion recognition-based artificial empathy model to analyze 315 recorded clinical video data of doctors and patients in a dermatology outpatient clinic. The results show a significant negative correlation between patients' emotions of sadness and neutral and doctor satisfaction, but no correlation between the duration of doctors mimicking patient emotions and patient satisfaction. These findings provide valuable insights into the future design of systems that can further enhance clinician awareness to maintain communication skills in the search for better doctor-patient satisfaction.

Ensuring Continuity of Care: Effective Strategies for the Post-hospitalization Transition of Psychiatric Patients in a Family Medicine Outpatient Clinic.

In healthcare, continuity of care is a crucial element, especially for patients in the field of psychiatry who have recently been discharged from a hospital. The shift from inpatient to outpatient care poses challenges for patients and healthcare providers, including openness to treatment, competing priorities, financial insecurity, concerns and dilemmas faced by patients regarding their post-hospitalization life after improvements in symptoms, lack of social support, poor patient-doctor relationships, lack of insight, and stigma associated with mental illness. Therefore, it is vital to employ effective strategies to ensure patients receive the required care and support during this transition. This review delves into the significance of continuity of care for psychiatric patients post-hospitalization, effective strategies for the transition, and the challenges and barriers to implementation from the perspective of a family medicine practice. To analyze physicians' role in managing psychiatric patients post-hospitalization, we developed a comprehensive search strategy. This involved extracting relevant data, updates, guidelines, and recommendations. Our search spanned various online repositories, such as PubMed and Google Scholar, specifically focusing on US-based guidelines aligned with our objectives. The search was conducted using medical subject headings (MeSH) and combinations of "OR," "AND," and "WITH." We crafted keywords to optimize our search strategy, including psychiatric illness, post-hospitalization, follow-up, follow-up care, primary care follow-up, and guidelines. Exploring online repositories yielded 132 articles, and we identified some guidelines that addressed our objectives. We established inclusion and exclusion criteria for our review and reviewed 21 papers. Post-hospitalization follow-up is a critical facet of psychiatric care, aligning with guidelines from the American Psychiatric Association and other relevant sources. Emphasizing continuity of care ensures a smooth transition from inpatient to outpatient settings, sustaining therapeutic momentum and minimizing the risk of relapse. This comprehensive approach involves careful medication management, regular mental health assessments, education on condition-specific coping strategies, and coordinated care between healthcare providers. It includes conducting risk assessments, safety planning, building social support and community integration, prompt post-hospitalization follow-up, and tailored treatment plans. Together, these measures enhance overall wellness for recently discharged patients. This holistic strategy tackles pressing short-term needs while facilitating long-term stability, promoting resilience and successful community reintegration, reducing readmission likelihood, and ultimately supporting sustained recovery.

Primary Open-Angle Glaucoma Patients in the Ophthalmology Outpatient Clinic Dr. Soetomo General Academic Hospital, Surabaya, in 2013–2015

Highlights: POAG is a common type of glaucoma. POAG patients were predominantly &gt;60 years old, with males being more dominant than females. Abstract Introduction: Primary open-angle glaucoma (POAG) is a progressive, chronic optic neuropathy characterized by distinct optic nerve atrophy and impairment of the visual field. The purpose of this study was to describe the characteristics of primary open-angle glaucoma patients in the ophthalmology outpatient clinic of Dr. Soetomo General Academic Hospital, Surabaya, in 2013–2015. Methods: This was a descriptive-retrospective study. Samples were patients with a primary open-angle glaucoma (POAG) diagnosis in the ophthalmology outpatient clinic at Dr. Soetomo General Academic Hospital, Surabaya, in 2013–2015. Results: There were 88 samples of POAG patients in the ophthalmology outpatient clinic at Dr. Soetomo General Academic Hospital, Surabaya, in 2013–2015. POAG was dominated in the age group 60–69 years old, with a percentage of 37.50%. Males were more dominant than females, with a percentage of 55.70%. Many POAG patients were unemployed, with a percentage of 56.82%. Most patients with POAG did not have a history of hypertension or diabetes mellitus, with a percentage of 73.86%. Patients who had a history of hypertension were 11.36%, those with diabetes mellitus were 9.09%, and those who had a history of both hypertension and diabetes mellitus were 5.68%. Conclusion: POAG was a higher risk in older adults, with males being more dominant than females. Most patients did not have a history of either hypertension or diabetes mellitus.

The effectiveness of continuity of care in patients with inflammatory bowel disease: a systematic review

AimTo investigate the effectiveness of continuity of care in patients with inflammatory bowel disease.BackgroundThe prevalence of inflammatory bowel disease(IBD) is increasing by years, especially in China. Moreover, IBD is prolonged and difficult to heal, which seriously impairs the quality of life of patients. Some studies have identified that continuity of care could contribute to the improvement of the quality of life, but the results remains inconclusive in patients with IBD.MethodsPRISMA guidelines was the outline of this study. Review Manager Software (version 5.3) was used to carry out the data analysis. Outcome assessments included quality of life (QoL), remission rates, number of outpatient clinic visits, and medication adherence.ResultsUltimately, 12 studies involving 2415 patients were brought into this meta-analysis. The results indicated there was no significant difference for continuity of care to improve the QoL in intervention group (SMD = 0.02, 95% CI: -0.08, 0.12). Besides, the remission rates of disease had no difference with those patients in the two groups (OR = 1.07, 95% CI: 0.72, 1.60). However, continued care could contribute to the number of outpatient clinic visits (MD = -0.84, 95% CI: -1.19, -0.49) and patients’ adherence to medication significantly (OR = 2.40, 95% CI: 1.16, 4.95).ConclusionsIBD patients could benefited from continuity of care with reducing their number of clinic visits and improving medication adherence. Nonetheless, there was no evidence of continuity of care contribute to QoL and remission of disease for these patients.

Gradual improvement in functioning and mental distress during long-term outpatient SUD treatment – A prospective pre-post study

BackgroundGlobally, outpatient programs for substance use disorder (SUD) treatment have gained prominence. To assess the broader clinical implications of this trend we investigated shifts in functioning experienced by outpatients undergoing treatment. MethodsWe describe the clinical characteristics of a cohort of 93 SUD patients in a Norwegian outpatient treatment clinic. Using paired-samples t-tests, we examined changes in perceived functioning, mental distress, and other clinically relevant outcome variables in a 5-month time interval during the treatment course. ResultsWe obtained follow-up data for 67 (72%) of the included patients, with no significant difference in patient-related factors between those who completed the treatment course and those who were not assessed at follow-up. Perceived functioning increased significantly from study inclusion (Time 0) (mean 19.8, standard deviation ± 8.8) to its conclusion (Time 1) (24.3, ±9.3; t (66) = 4.5, (95% CI: 2.5–6.5, p < 0.001). We also identified significant improvement in most other measured variables, including mental distress, self-reported sleep quality, restlessness, and obsessive thinking. Substance use–related variables showed a modest, non-significant improvement at T1. ConclusionDuring a 5-month course of outpatient treatment, patients’ subjective experience of functioning improved significantly. Those with the lowest functioning levels at T0 improved the most. Structured monitoring may be a valuable clinical tool for personalizing intervention, enhancing treatment outcomes, and supporting the clinical decision-making process.

Deprescribing psychotropic drugs in a geriatric psychiatry outpatient clinic

Objective: To describe the psychotropic drug deprescription process in older patients of a geriatric psychiatry outpatient clinic. Methods: We conducted a quasi-experimental study of people aged ≥ 60 years who were treated at Hospital São Lucas’ Geriatric Psychiatry Outpatient Clinic, which is affiliated with Pontifícia Universidade Católica do Rio Grande do Sul, Brazil. Data on 150 older people were collected from March 2021 to August 2022 and were evaluated by the pharmacists. The inclusion criteria were age ≥ 60 years, being a patient of the hospital’s Geriatric Psychiatry Outpatient Clinic, use of at least one psychotropic drug, and agreeing to participate in the study. Those unable to report their medications and those who only came to the first appointment were excluded. Results: Overall, deprescription of at least one psychotropic drug was indicated in 61.3% (n = 92) of the participants, and it was effectively implemented in 68.5% (n = 63) of this group. Deprescribing, which was more frequent in the youngest age group (60–69 years) (p = 0.049), was indicated for 37.4% (n = 136) of psychotropic drugs, 67.6% (n = 92) of which were effectively deprescribed. The main classes indicated for deprescription were hypnotics and sedatives (90.0%; n = 18) and anxiolytics (73.3%; n = 11). Conclusions: At least 1 psychotropic drug was indicated for deprescription in the majority of the patients, and in most cases it was effectively implemented. One-third of the prescribed psychotropic drugs were indicated for deprescription, and more than half were successfully deprescribed.

Psychosocial Care in the Intensive Care Unit

The improvement of intensive care treatment options leads to an increasing number of patients being treated in this setting. For the majority of those affected and their relatives, this treatment is associated with tremendous stress, but also subsequent physical, psychological and cognitive impairments, the post-intensive care syndrome. The aim of psychosocial support in the intensive care unit is to stabilise and minimise the acute stress. This is done through care services oriented towards trauma therapy interventions and emergency psychology. Equally central are the needs of the patient's relatives and ways to stabilise and relieve them. The third pillar of psychosocial work in the intensive care unit is the support of the treatment team. Finally, an outlook is given for the specialised aftercare of these complex patients in PICS outpatient clinics.

Clinical characteristics of carriers of pathogenic LDLR and АРОВ mutations

Aim. To analyze the clinical characteristics of carriers of pathogenic LDLR and АРОВ mutations, as well as the prognostic value of Dutch Lipid Clinic Network Score (DLCNS) as applied to carriage of АРОВ or LDLR.Material and methods. The study included 1233 outpatient lipid clinic patients. Biomaterial samples from 421 patients with the hereditary dyslipidemia were studied using Next Generation Sequencing (NGS) to identify carriage of familial hypercholesterolemia (FH)-associated genes (LDLR, АРОВ, PCSK9, LDLRAP1), as well as polymorphism of the APOE gene. Statistical processing was performed using descriptive statistics methods.Results. According to the data obtained, the most significant predictors of pathogenic LDLR mutations are the levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), family history of coronary artery disease (CAD), and previous coronary artery bypass grafting. The level of LDL-C, family history of cerebrovascular accident or CAD, and arcus senilis were more significant for verifying the carriage of pathogenic АРОВ mutations. Using screening potential carriers of FH using the DLCN or Simon-Broome diagnostic criteria, the probability of FH may be underestimated due to the discrepancy between the scale criteria and the prognostic contribution of clinical or anamnestic data. These scales do not take into account the estrogen status of potential female carriers of FH.Conclusion. Thus, diagnostic criteria for identifying potential FH vary among different patient groups. Their diagnostic significance depends on sex, and in women, on reproductive status. Only part of DLCN and Simon-Broome criteria can be applied to assess the FH likelihood, and to a greater extent for carriage of LDLR, but not АРОВ.