Physician Advice Research Articles

Seasonal differences in participation and time spent in physical activity in Russia: The Know Your Heart survey.

This study aimed to assess the levels and investigate socioeconomic, demographic, and health-related predictors of winter and summer physical activity (PA) in Russia using the data from the Know Your Heart population survey conducted in Novosibirsk and Arkhangelsk (2015-2018; n=5068; aged 35-69years). Employing a series of probit, Tobit, and the Cragg models, we separated the predictors of the probability of participating in leisure-time PA from the predictors of time spent in PA. Our study showed that financial constraints limited males' participation in winter PA (probability of participation decreased by 12 percentage points) and females' engagement in winter and summer PA (decrease in the number of hours of practicing PA by approximately 1h a week). Education, self-reported health, smoking, and cues to action had different impacts on both probability and time spent in PA in winter and summer. We also found significant gender differences in participation and time spent in PA across seasons. Older age, poor health, and smoking were greater obstacles to PA for males compared to females both in winter and summer. However, males were more likely to follow physician's advice to lose weight and take up physical exercise. Information campaigns that promote physical activities, including those that are free of charge, are needed to help limit barriers to PA for people with low socioeconomic status and individuals with little or no exercise experience. Also, making sports more accessible to citizens by providing free and low-cost sports facilities can increase their participation and time spent in PA, improving individual health and productivity.

Insights from a 10-year Australasian idiopathic hypersomnia patient data registry study.

Idiopathic hypersomnia (IH) is a disorder of central hypersomnolence that results in excessive daytime sleepiness in the absence of another identifying cause. Case studies from sleep clinic patients may not be a fair representation of the wider IH population. This study aims to better characterize patients diagnosed with IH in Australia and New Zealand using online patient-driven survey data. A retrospective analysis of 686 participants from the Hypersomnolence Australia Patient Data Registry diagnosed with either IH (n = 554), narcolepsy type 1 (NT1, n = 54) or narcolepsy type 2 (NT2, n = 78) between January 2013 and October 2022 was performed. Participants with IH reported additional sleep disorders such as OSA (16.4%) and restless legs syndrome (7.9%) and notable comorbidities included depression (46.2%) and anxiety (50%). There was a mean delay in diagnosis of 10 years in participants with IH, when compared to symptom onset. IH presents with unique but also overlapping symptomatology with NT2, with similar reporting of long daytime naps, unrefreshed sleep and automatic behavior. Modafinil was the most common medication (45.5%) used by participants with IH followed by dexamphetamine (44.2%). Most participants with IH reported receiving physician advice regarding positive lifestyle changes but recommend that newly diagnosed patients be given more advice about medication use. This study demonstrates a delay in IH diagnosis when compared to symptom onset and overlapping features of IH and NT2. It also highlights the heterogeneous presentation of IH and the value of large patient registries in future research.

Lifestyle, air pollution, and risk of multimorbidity in a prospective analysis of the UK Biobank cohort

BackgroundAlthough associations between chronic obstructive pulmonary disease (COPD) or ischaemic heart disease (IHD) and lifestyle factors or air pollution factors (referred as LAFs below) are well-established, it is unclear the influences of LAFs on the trajectory of IHD and COPD multimorbidity (referred as ICM below). Therefore, this study investigated the influences of LAFs on the trajectory of ICM from healthy to IHD or COPD, to ICM, and to all-cause death. MethodsA cohort of 339,213 participants from the UK Biobank aged 37–73 who were free of IHD and COPD were included. A multi-state model was used to analyse the influences of high-risk factors including current smoking or quitting due to illness or physician's advice, current excessive alcohol drinking, physical inactivity, unhealthy body shape, and excessive air pollution with particulates matter with an aerodynamic diameter ≤2.5 μm (PM2.5) on ICM trajectory. ResultsDuring a median follow-up of 13.74 years, 46,398 participants developed IHD or COPD (referred as IOC below), 3949 developed ICM, and 35,691 died from any cause. All five high-risk factors played crucial but different roles in these transitions. The hazard ratios (95 % confidence intervals) per one-factor increase were 1.29 (1.27–1.3), 1.38 (1.33–1.44), and 1.69 (1.56–1.84) for transitions from baseline to IOC, from IOC to ICM, and from baseline to ICM and 1.19 (1.17–1.21), 1.18 (1.15–1.21), and 1.12 (1.05–1.19) for mortality risk from baseline to all-cause death, from IOC to all-cause death, and from ICM to all-cause death, respectively. ConclusionsOur study revealed that LAFs have a stronger impact on morbidity outcomes than on morbidity outcomes. These findings provide evidence to develop strategies for managing the trajectory of ICM.

Knowledge and Perceptions of Self-Medication Among Bachelor of Medicine and Bachelor of Surgery (MBBS) Students: A Cross-Sectional, Questionnaire-Based Study.

Self-medication (SM) is a common practice worldwide, and the irrational use of drugs is a cause of concern. Self-medication has various forms, including taking medications without a physician's prescription, using a previous prescription for a similar condition, or using drugs obtainable at home without getting a physician's advice. The youth are highly influenced by the media and the internet, which promote SM behavior. To determine the knowledge and perceptions of SM in Bachelor of Medicine and Bachelor of Surgery (MBBS) students in all professional years, including interns in Acharya Shri Chander College of Medical Sciences (ASCOMS) and Hospital, Jammu. The present study was conducted at ASCOMS Hospital, Jammu. A total of 200 students of MBBS were included in the study. A self-structured questionnaire was used to assess the knowledge and awareness level. The collected data were recorded in a Microsoft Excel sheet (Microsoft Corp., Redmond, WA) and analyzed with the help of IBM SPSS Statistics software for Windows, version 21.0 (IBM Corp., Armonk, NY). The present study reveals that 60% of the subjects were males and 65% of the students practiced SM, which indicates that SM is highly prevalent amongst MBBS students. It was observed that minor illness and quick relief were the major reasons for SM. Further, headache, cold/cough, and fever were the major indications for SM, whereas antipyretics and analgesics were the most commonly used drugs for SM. Conclusion: The present study concluded that there was a high prevalence of SM practice among medical students, especially among females. However, the knowledge and perceptions of SM were not insufficient.

Effectiveness of smoking cessation interventions among adults: an overview of systematic reviews

BackgroundThis overview of reviews aims to identify evidence on the benefits (i.e. tobacco use abstinence and reduction in smoking frequency) and harms (i.e. possible adverse events/outcomes) of smoking cessation interventions among adults aged 18 years and older.MethodsWe searched Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Database of s of Reviews of Effects, the CADTH Health Technology Assessment Database and several other websites for grey literature. Searches were conducted on November 12, 2018, updated on September 24, 2020, with publication years 2008 to 2020. Two reviewers independently performed title-abstract and full-text screening considering pre-determined inclusion criteria. Data extraction and quality assessments were initially completed by two reviewers independently (i.e. 73% of included studies (n = 22)) using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR 2), and the remainder done by one reviewer and verified by another due to resources and feasibility. The application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) was performed by one independent reviewer and verified by another.ResultsA total of 22 Cochrane systematic reviews evaluating the impact of smoking cessation interventions on outcomes such as tobacco use abstinence, reduction in smoking frequency, quality of life and possible adverse events were included. Pharmaceutical (i.e. varenicline, cytisine, nicotine replacement therapy (NRT), bupropion) and behavioural interventions (i.e. physician advice, non-tailored print-based self-help materials, stage-based individual counselling, etc.) showed to have increased smoking cessation; whereas, data for mobile phone-based interventions including text messaging, hypnotherapy, acupuncture, continuous auricular stimulation, laser therapy, electrostimulation, acupressure, St John’s wort, S-adenosyl-L-methionine (SAMe), interactive voice response systems and other combination treatments were unclear. Considering harms related to smoking cessation interventions, small/mild harms (i.e. increased palpitations, chest pain, nausea, insomnia, headache) were observed following NRT, varenicline and cytisine use. There were no data on harms related to behavioural therapies (i.e. individual or group counselling self-help materials, internet interventions), combination therapies or other therapies (i.e. laser therapy, electrostimulation, acupressure, St John’s wort, SAMe).ConclusionResults suggest that pharmacological and behavioural interventions may help the general smoking population quit smoking with observed small/mild harms following NRT or varenicline. Consequently, evidence regarding ideal intervention strategies and the long-term impact of these interventions for preventing smoking was unclear.Systematic review registrationPROSPERO CRD42018099691

Risk of anti-TNF therapy on pregnancy, breastfeeding, live vaccines and related information in patients with inflammatory bowel disease: Real-world data from a nationwide study

BackgroundAnti-TNF are usually maintained during pregnancy in patients with inflammatory bowel disease (IBD) but safety is still a concern for them. AimsTo provide data on management of anti-TNF agents during pregnancy, safety of live vaccines (BCG-MMR-rotavirus) and breastfeeding in newborns and dedicated information delivered to IBD women. MethodsWe performed an observational study in 25 centers from 2016 to 2018. We administered questionnaires to women with IBD receiving anti-TNF during pregnancy with newborn follow-up ≥ one year. ResultsOf 153 patients, 52 % maintained anti-TNF during the third trimester. Anti-TNF was shortly resumed in 79 % (58/73) after delivery. The rate of breastfeeding was 44 % (68/153) without any complication; 38 % of the mothers denied to breastfeed based on physician's advice. 26 % (34/129) of the newborns received live vaccines before 6 months-old (BCG:30 %; MMR:63 %; Rotavirus:8 %) and only 3 complications occurred (local BCGitis=1, fever=2). Information concerning anti-TNF during pregnancy/post-partum was delivered to 92 % of the patients, mainly by a gastroenterologist (97 %) who discussed with the obstetrician or the paediatrician in only 48 % and 25 %. ConclusionIn IBD patients, maintaining anti-TNF during pregnancy and breastfeeding is safe. Accidental live vaccines before 6 months did not lead to significant adverse events. The communication about these questions remains to improve.

Assessing the prevalence and knowledge of anabolic steroid use in male athletes in Al Madina Al Munawara, Saudi Arabia.

To assess the prevalence of anabolic steroid use and the level of knowledge on anabolic steroids among the male athletes in Al Madina Al Munawara, Saudi Arabia. A cross-sectional study was conducted on male athletes randomly selected from the private athletic centers in Al Madina Al Munawara over 5 months. Data were collected from all participants using a self-administered anonymous questionnaire with 33 questions. The questionnaire covered the socio-demographic characteristics of the participants, and their knowledge, attitudes, and use of anabolic steroids. Of the 150 male athletes surveyed, 121 completed the questionnaire (response rate: 80.6%). Over half were aged between 18 and 23 years (56.2%) and were single (79.3%). Thirty-two percent reported using anabolic steroids, mainly to increase muscle mass, following coaches' advice (46.1%). Key sources included the internet (30.7%), coaches (30%), and friends (27.9%), and non-healthcare professionals. The top motivations were price, coach's/physician's advice, and availability. The perceived benefits included increased muscle mass, strength, and endurance, while the perceived adverse effects included kidney/liver damage and sexual problems. One-third of the male athletes surveyed used anabolic steroids, influenced by accessibility and social contact, rather than healthcare guidance. This highlights the need for greater awareness of the long-term health risks, ideally through education provided by sports medicine specialists.

A Perceptual and Interactive Integration Strategy Toward Telemedicine Healthcare Based on Electroluminescent Display and Triboelectric Sensing 3D Stacked Device

AbstractThe conventional medical assistive strategy for wearable devices involves sensing physiological signals and subsequent analysis while it lacks the capability for visual interaction and often necessitates the use of additional bulky devices for display. Herein, a perceptual and interaction strategy based on electroluminescent and triboelectric sensing 3D stacked wearable device (ETD) is proposed to address current issues. The ETD utilizes a bottom triboelectric sensor for tactile physiological information, which is processed and analyzed, ultimately triggering the selective illumination of the top electroluminescent array through external power circuitry. The ETD possesses the capability to generate a 100 V with 1.5 cm2 and stable visual interaction ability at 30 V drive voltage. Based on outstanding features of the ETD, two medical assistance scenarios are explored. I) The ETD captures physiological signals, such as pulse rate, respiratory rate, and special joint flexion, and in situ displays the corresponding physiological information, effectively assisting the patients/elders in self‐monitoring. II) A bidirectional interactive telemedicine assistive system utilizing ETDs is implemented, which not only gathers real‐time activity status from patients/elders but also realizes that remote physician assesses the safety status and the assessment results are wirelessly back‐communicated to the ETD, enabling real‐time interaction of the physician advice.

Abstract P422: Lifestyle Intervention Improved Blood Pressure and Cardiovascular Disease Biomarkers in Patients With Chronic Kidney Disease and Resistant Hypertension: Insights From the TRIUMPH Randomized Clinical Trial

Introduction: Evidence is limited regarding the effect of lifestyle modification on health outcomes in patients with chronic kidney disease (CKD). Hypothesis: We hypothesized that lifestyle modification involving the DASH diet, exercise and weight loss would improve blood pressure (BP) and cardiovascular disease (CVD) biomarkers in CKD patients with resistant hypertension. Methods: The Treating Resistant Hypertension Using Lifestyle Modification to Promote Health (TRIUMPH) trial randomized patients with resistant hypertension to either a 16-week cardiac rehabilitation (CR) facility-based lifestyle modification program involving thrice weekly aerobic exercise and weekly classes on DASH diet and behavioral weight loss (C-LIFE) or to a standard education and physician advice (SEPA) control condition. We conducted a secondary analysis involving participants with CKD. CKD was defined as having eGFR <60 mL/min/1.73 m 2 or albuminuria at baseline. Primary outcome was mean change in clinic systolic BP. Secondary outcomes were mean changes in clinic diastolic BP, 24-hour ambulatory BP, and CVD biomarkers including baroreflex sensitivity (BRS), high-frequency heart rate variability, flow-mediated dilation, pulse wave velocity, and left ventricular mass index. Results: Ninety-seven (69%) of 140 TRIUMPH participants were considered to have CKD. Mean age was 62 years, 57% self-identified as Black race, 67% were male, and the majority (82%) had CKD stage 3. Participants with CKD randomized to C-LIFE achieved greater reduction in clinic SBP and greater improvement in BRS compared to SEPA. There were no differences between groups in ambulatory BP or other CVD biomarkers. Conclusions: A structured 16-week diet, exercise and weight management program conducted in a CR setting improved BP and resting BRS in resistant hypertension patients with CKD. Future studies are needed to confirm the beneficial effect of multi-component lifestyle modification on CVD biomarkers in CKD and to determine the persistence of benefit over time.

Physical activity promotion among pregnancy - the role of physician from the women's perspective.

The clear benefits of planned and supervised physical activity (PA) during pregnancy make it imperative that women are encouraged and educated about this activity. This study aimed to investigate how effectively physician promote physical activity and exercise among pregnant women. It also examines pro-health changes in selected health behaviours during pregnancy. This cross-sectional study recruited a total of 353 pregnant women in Wielkopolskie Voivodship in Poland. An anonymous survey (on-line or in-paper) was used to assess physical activity before and during pregnancy (with Pregnancy Physical Activity Questionnaire), physical activity self-efficacy, well-being (WHO-5 Well-Being Index), and guidance received from physicians on physical activity during pregnancy. Only 41% of women surveyed followed WHO recommendations for PA before pregnancy, and they were much more likely to discuss safety and the need to change the intensity or type of PA with their doctor or gynaecologist. Only 23% of women were asked about their PA before pregnancy and less than 40% were encouraged to be active during pregnancy. We observed a higher probability of poor well-being among pregnant women who were inactive before pregnancy (OR = 1.873, 95%CI 1.026 to 3.421, p = 0.041). Health professionals infrequently educate and motivate women to be physically active during pregnancy. Physician advice, as it is currently perceived by women, seems to be insufficient to help pregnant women meet the recommendations for PA during pregnancy.

Patient self-reported experience and satisfaction with golimumab and etanercept treatments for rheumatic diseases: A cohort study.

Golimumab and etanercept both exhibit good efficacy in treating rheumatic diseases, while the patient self-reported measurement of treatment improvement and injection experience lacks sufficient evidence. Hence, this study aimed to compare the satisfaction with disease improvement and injection experience and the level of injection site reactions (ISRs) between golimumab-treated and etanercept-treated patients with rheumatic diseases. A total of 312 patients with rheumatic diseases were serially enrolled. Among them, 158 patients received golimumab (golimumab group); the other 154 patients were treated with etanercept (etanercept group) according to the actual disease status, physician advice, and patient willingness. Satisfaction with disease improvement was assessed using the 7-point Likert scale; satisfaction with injection experience and level of ISRs were both determined by the 5-point Likert scale. Satisfaction degrees with global injection experience (P = .025), injection device (P = .008), injection frequency (P = .010), and injection convenience (P = .003) were superior in the golimumab group to the etanercept group, while satisfaction degrees with global disease improvement, symptom relief, and speed of action did not vary (all P > .050) between the 2 groups. Discomfort (P = .005), swelling (P < .001), pain (P = .028), and burning (P = .035) levels were lower in the golimumab group than in the etanercept group. In addition, among 56 patients with a history of tumor necrosis factor inhibitor treatment before golimumab, 40 (71.4%) patients preferred golimumab to other tumor necrosis factor inhibitor. After switching to golimumab treatment, the level of ISRs in most patients was reduced or comparable. Golimumab achieves a satisfying injection experience and relieves the level of ISRs over etanercept in patients with rheumatic diseases.

Assessment of knowledge, attitude and practices of self-medication among the geriatric population of the Wardha district in central India: A cross-sectional study

Background The incidence of self-medication varies greatly for each country. It is a widely used method across advanced and developing nations worldwide. Self-medication is taking pharmaceuticals without seeking physician advice for a diagnosis or treatment. This study will evaluate geriatrics’ knowledge, attitudes, and practices regarding self-medication. The objectives of the current study are to examine the practice of self-medication and assess the knowledge and attitude toward the same in the senior population, as well as the socio-demographic aspects influencing its usage and the reasons for its use. We also aim to test the correlation between demographic issues and self-medication. Methods A cross-sectional study will be conducted in the rural community area of the Wardha district. A survey will be used to evaluate the entire sample of geriatric age groups to determine the socio-demographic characteristics and associated risk factors for practicing self-medication. A semi-structured, pre-validated questionnaire Self-Medication Scale (SMS) will be used to understand the participants’ practice and attitudes regarding self-medication. The frequency and percentages of descriptive statistics will be determined. The correlation among variables will be discovered using the Chi-Square Test. Tables, graphs, and charts will present the data analysed. Study implications The present study will help formulate guidelines on medicine access and reinforce them with strong policy implementation mechanisms. The study will also help provide medical insurance or free consultations for populations in need.

Following Physician's Advice in Late Life: The Roles of Health Beliefs and Health Status.

This study aims to explore the influence of health-related locus of control beliefs such as belief in the role of health professionals in influencing patient health, cognitive functioning, and multimorbidity on adherence to physician's recommendations among older adults. A cross-sectional study involving older adults (N=684, age range = 71-100 years) living in Clearwater, Florida, reported their adherence to physician's recommendations, cognitive functioning, physical health, and health-related locus of control beliefs. Ordered Logistic regression was used. Older adults who believed that health professionals influence health and a person is likely to recover from illness because other people take good care of him/her had higher adherence to physician's recommendations. Older adults who believed that their own action affects their health had lower odds of reporting adherence by 27%. Additionally, those with cognitive impairment had lower odds of reporting adherence by 38%. Functional limitations, multimorbidity, and self-image of health were not associated with adherence. This is one of the first studies to consider the influence of locus of control beliefs on adherence of physician's recommendations among community dwelling older adults. With the exception of one item "My good health is largely a matter of good fortune", generally individuals with external locus of control had higher adherence. Our findings also underscore the policy and clinical significance of different health-related beliefs held by older adults.

Ibrutinib in Combination with Revlimid/Dexamethasone (Rd) in Relapsed/Refractory Multiple Myeloma (AFT-15)

Introduction: Preclinical studies have suggested synergism between lenalidomide (LEN) and ibrutinib (IBR) in multiple myeloma (MM). Both downregulate IRF4, a master transcriptional factor that regulates myeloma cell survival. Single agent oral IBR combined with dexamethasone proved well tolerated and active in advanced, steroid refractory relapsed MM as part of a large Phase1/2 study in 60 patients, with durable stabilization and minimal response seen in most evaluable patients (Richardson PG et al, BJH 2018). LEN is considered a standard of care in newly diagnosed MM, as maintenance and in relapsed disease, and a backbone of oral therapy in the MM treatment paradigm (Laubach JP et al, Leukemia 2016). Methods: We therefore conducted a 3+3 phase I trial to determine the maximum tolerated dose (MTD) of IBR in combination with LEN + dexamethasone (DEX) in patients with relapsed/refractory (RR) MM who had at least 2 prior lines of therapy. Three dose levels (DL) were planned. Cycle length was 28 days. IBR was administered orally daily at 560mg on DL1-2 and 840mg on DL3, LEN orally days 1-21 at 15mg on DL1 and 25mg on DL2-3, and DEX orally days 1, 8, 15, and 22 at 40 mg if age &amp;lt; 75 or 20 mg if ≥75 for DL1-3. Patients with GFR ≥ 30 and &amp;lt; 60 were treated according to manufacturer's instructions with lenalidomide dosed at 10mg/d. Dose limiting toxicities (DLT) included grade 4 thrombocytopenia; grade 4 neutropenia lasting more than 5 days or febrile neutropenia; grade 4 nausea, vomiting or diarrhea; grade 3 thrombocytopenia with bleeding or platelet transfusion; grade 3-4 hyperglycemia or thrombotic/embolic event, treatment delays ≥ 21 days for toxicity; and treatment related death. Due to changes in standard of care during the study, eligibility was modified to allow the enrollment of patients with RRMM who had at least 1 prior line of therapy. Response was assessed using IMWG/Uniform Criteria. Results: Fourteen patients (DL1-6 pts; DL2-3 pts; DL3-5 pts) registered to the study from March 2019 to May 2023, prior to its closure due to slow accrual. One patient on DL3 cancelled participation prior to start of treatment due to disease progression (PD). The remaining 13 patients are included in summary of toxicities and response but 2 patients on DL3 are excluded from determination of MTD due to discontinuing cycle 1 treatment due to COVID and receiving 280 mg/day of IBR instead of assigned 840 mg/day dose during cycle 1, respectfully. Twelve patients were evaluable for response. The median number of prior lines of therapy was 3 (range: 2-9), reflecting a heavily pretreated relapsed and refractory population. One of the 6 patient on DL1 developed a DLT, grade 3 non-viral hepatitis. None of the 3 patients on DL2 or the 2 patients on DL3 had a DLT. One patient on DL1 remains on treatment with stable disease for 42+ cycles. The median number of cycles administered was 3 (range: 1-42+). Severe toxicities reported included grade 3 lymphocytopenia (3), anemia (2), alanine aminotransferase increase (1), aspartate aminotransferase increase (1), blood bilirubin increase (1), hypocalcemia (1), hypokalemia (1) hypophosphatemia (1), febrile neutropenia (1), chronic kidney disease (1), non-viral hepatitis (1), soft tissue infection (1), and fatigue (1); grade 4 lymphocytopenia (1), and grade 5 sepsis (1). End of treatment reasons included: PD (7), toxicity (2), death [soft tissue infection that turned into sepsis considered to be likely related to DEX] (1), and concomitant conditions (2). Stable disease (SD) or better was achieved in 10 of 12 evaluable patients (83%), including one patient who achieved disease control for over 3.5 years. One patient (8%) on DL3 had a complete response (CR) but stopped treatment after 2 cycles due to reversible toxicity and comorbid conditions, based upon physician advice and patient choice. Conclusions: The combination of lenalidomide with Ibrutinib as an all-oral approach in RR MM proved feasible and generally tolerable, with the majority of discontinuation seen in this Phase I study due to disease progression. No COVID related - mortality was seen. SD or better was achieved in 83% of patients, including one CR. Potential future directions include combination approaches with next generation IMids such as pomalidomide, as well as other orally bioavailable novel agents with potent immune activating properties, such as CelMoDs. Support: AFT; Pharmacyclics; Clinicaltrials.gov Identifier: NCT03702725

Effectiveness of an Educational Booklet for the Management of Patients with Chronic Low Back Pain

Introduction: The aim of the present study was to assess the effectiveness of provision of an educational booklet for the management of patients with chronic low back pain. Material and Methods: A Randomized controlled clinical trial was conducted from January 2018 to June 2018 among 80 patients attending at Physical Medicine and Rehabilitation outpatient department of the Shaheed Suhrawardy Medical College and Hospital after obtaining requisite consent from the patients. 80 Patients were divided into two groups (Group A and Group B). Group A contains Patients educational booklet group + exercises + analgesics (Case group). Group B contains Physicians advice only group + exercises + analgesics (control group). Data were collected through interviewing and examining of the patients. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the effectiveness of provision of an educational booklet for the management of patients with chronic low back pain. The study was approved by the institutional ethical committee. Results: In a pool of 80 patients, the range of age was 18-55 years in case group and control group. There was no significant difference found in age between case and control group (p value is 0.383). Among the patients of case group 28 (70.0%) were male and 12 (30.0%) were female. Among the patients of control group 17 (42.5%) were male and 23 (57.5%) were female. Visual analogue score (VAS) score of group A patient was 5.4±1.0 and group B was 5.7±1.1 (p=0.143). At the first follow up the mean VAS score of group A was 4.5±1.0 and group B was 4.8±0.9 (p=0.111). At the second follow up the mean VAS score of group A was 3.1±0.9 and group B was 3.5±0.8 (p=0.077). And at the final (third) follow up the mean VAS score of group A was1.9±0.8 and group B was 2.4±0.6 (p=0.002). Conclusion: There was significant improvement of pain of case group than control group. At the end of study we can tell that, educational booklet is effective for the management of patients with chronic low back pain. Medicine Today 2023 Vol.35(2): 87-90

Abstract 15722: Developing a Patient-Centered Roadmap to Reduce Maternal Morbidity/Mortality for Individuals With Congenital Heart Disease

Background: Individuals with congenital heart disease (CHD) face higher rates of pregnancy-related complications and interventions, however, few studies have assessed ways to improve outcomes. Goal: Improve reproductive care and reduce maternal morbidity and mortality for pregnant individuals with CHD. Methods: We formed a diverse consortium of CHD patients, providers, and advocates to identify knowledge deficits. Survey responses were solicited through social media and professional and advocacy networks. Results: As of 6/2/23, respondents included 815 (11% male, 88% female) patients from 48 states DC, and 216 providers (19% male, 81% female). Providers included 90 (42%) midwives, 59 (28%) adult congenital cardiologists, and 41 (19%) maternal-fetal medicine specialists. Most patient respondents are CHD patients (n=781, 96%) with complex CHD anatomy (n=606, 81%) between the ages of 30 and 44 (52%) with 72% reporting an annual household income over $75,000. Some patients reported they had received contraception counseling (n=262); counseling was provided by a physician (n=149, 57%), registered nurse (n=37, 14%), or parent (n=36, 14%). Of 189 CHD patients, the top reasons cited for not pursuing a pregnancy included not being ready (n=80, 42%), concerns about their heart condition (n=78, 41%), and physician advice due to potential complications (n=59, 31%). More than half of the patient respondents (n=231, 51%) reported a pregnancy, and 147 (64%) reported their pregnancy caused stress and anxiety. Cost and provider education are top priorities for improving care for pregnant individuals with CHD for respondents with household incomes under $49,000 per year while access to specialized heart care and obstetrics are top priorities for those with incomes over $50,000 (see Figure 1). Conclusions: CHD patients and providers are eager to provide their experiences relating to pregnancy and patient-centered research is an important tool to bridge the knowledge gap.

Attitudes towards deprescribing in geriatric psychiatry: A survey among older psychiatric outpatients.

Understanding the patient perspective is a significant part of the deprescribing process. This study aimed to explore the attitudes of older patients with psychiatric disorders towards deprescribing. A total of 72 of psychiatric outpatients (68% women; median age 76 years) completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Patients used a median of eight medications (interquartile range 6-12), with 88%, 49% and 24% using antidepressants, antipsychotics and anxiolytics, respectively. Fifty-one percent of patients reported an intrinsic desire to stop one of their medications, while 92% would be willing to stop one on their physician's advice. Seventy-five percent of patients would be worried about missing out on future benefits following deprescribing and 37% had previous bad deprescribing experiences. Use of ≥8 regular medications was associated with more concerns about stopping medication and greater perceived burden of using medication, while use of antipsychotics was not associated with any differences in rPATD factor scores. It is crucial for health care professionals to be aware of patients' specific concerns and past experiences to promote a patient-centred deprescribing approach that takes into account the needs and preferences of older patients with psychiatric disorders.

Trial of a Patient-Directed eHealth Program to Ameliorate Perinatal Depression: The MomMoodBooster2 Practical Effectiveness Study

ABSTRACT Perinatal depression and postpartum depression represent a significant burden for those who experience them and are associated with preterm birth, low birth weight, postpartum hospitalization, diminished mother-child relationships, offspring developmental delay, and other important markers of health and well-being. Perinatal depression, in particular, is underidentified and thus undertreated. This study was designed to assess the MMB eHealth program (MomMoodBooster2 [MMB2]), which is targeted toward perinatal depression, with an aim to assess the effectiveness of the smartphone version of this tool. Primary outcomes were targeted toward analyzing the extent to which MMB2 relieved the severity of anxiety and depression symptoms in general (using both perinatal and postpartum tools); secondary outcomes focused on usage trends along with ratings of usability and helpfulness. Participants were recruited from the Perinatal Depression Program (PDP) in the NorthShore University HealthSystem. Eligibility criteria included pregnant women and women less than a year postpartum, age older than 18 years, no active suicidal ideation, access to internet, and English language proficiency. REDCap (Vanderbilt University Nashville, Tenn) was used for onboarding and randomization. Final analyses included 191 patients randomized into 2 groups, one with MMB2 and the PDP protocol and one with only PDP. After program completion, 93% of patients completed an associated posttest. Primary screenings were not significantly different between groups, and baseline characteristics were likewise consistent. Controlling for perinatal status, posttests showed a significant decrease in depression severity, anxiety, stress, and automatic thoughts (P ≤ 0.001), as well as an increase in behavioral activation and self-efficacy. Further analysis showed that the MMB2 group showed greater decreases from baseline to posttest in both stress (P = 0.019) and depression severity (P = 0.003). No other significant effects were found when comparing the 2 groups. Usage of MMB2 varied, but generally showed that patients visited the program shortly after receiving the first invitation and then periodically on multiple distinct days between their first and last visit to their health care provider (mean [SD] visits, 49.4 [30.2] distinct days). Perinatal tools were used by 41% of participants, and 43% used postpartum tools, with 10% using both tools because of being pregnant at initial recruitment but delivering over the course of the study. The program included text messages for the first 12 weeks, and impact of these was not directly assessed. Of ratings provided, 96% rated the program as “somewhat” to “extremely” easy to use, and 83% of participants rated it as “somewhat” to “extremely” helpful. Many participants in both groups reported using other management strategies such as medication, therapy sessions, and physician advice, but use of these interventions did not differ between groups. These results indicate that MMB2 is effective at reducing anxiety and depression severity, as well as improving self-efficacy. Clinically, this eHealth tool may be an appropriate way to subsidize care for women where in-person options are limited or other options are unavailable. It could also be used to augment in-person options for management of depressive symptoms. Further research should focus on larger and more diverse populations, to understand if the findings are generalizable beyond this small population. In addition, the sustainability and adoption strategies should be optimized to allow this program to be as far reaching as possible. More research could also examine long-term follow-up and durability of the effects of this treatment.

Concordance between 8-1-1 HealthLink BC Emergency iDoctor-in-assistance (HEiDi) virtual physician advice and subsequent health service utilization for callers to a nurse-managed provincial health information telephone service

BackgroundBritish Columbia 8–1-1 callers who are advised by a nurse to seek urgent medical care can be referred to virtual physicians (VPs) for supplemental assessment and advice. Prior research indicates callers’ subsequent health service use may diverge from VP advice. We sought to 1) estimate concordance between VP advice and subsequent health service use, and 2) identify factors associated with concordance to understand potential drivers of discordant cases.MethodsWe linked relevant provincial administrative databases to obtain inpatient, outpatient, and emergency service use by callers. We developed operational definitions of concordance collaboratively with researcher, patient, VP, and management perspectives. We used Kaplan–Meier curves to describe health service use post-VP consultation and Cox regression to estimate the association of caller factors (rurality, demography, attachment to primary care) and call factors (reason, triage level, time of day) with concordance as hazard ratios.ResultsWe analyzed 17,188 calls from November 16, 2020 to April 30, 2021. Callers advised to attend an emergency department (ED) immediately were the most concordant (73%) while concordance was lowest for those advised to seek Family Physician (FP) care either immediately (41%) or within 7 days (47%). Callers unattached to FPs were less likely to schedule an FP visit (hazard ratio = 0.76 [95%CI: 0.68–0.85]). Rural callers were less likely to attend an ED within 48 h when advised to go immediately (0.53 [95%CI:0.46–0.61]) compared to urban callers. Rural callers advised to see an FP, either immediately (1.28 [95%CI:1.01–1.62]) or within 7 days (1.23 [95%CI: 1.11–1.37]), were more likely to do so than urban callers.InterpretationConcordance between VP advice and subsequent caller health service use varies substantially by category of advice and caller rurality. Concordance with advice to “Go to ED” is high overall but to access primary care is below 50%, suggesting potential issues with timely access to FP care. Future research from a patient/caller centered perspective may reveal additional barriers and facilitators to concordance.

Predicting Readmission of Cardiovascular Patients Admitted to the CCU using Data Mining Techniques

Background: Cardiovascular (CV) diseases account for a large number of readmissions. Objective: Using data mining techniques, we aimed to predict the readmission of CV patients to Coronary Care Units of 4 public hospitals in Shiraz, Iran, within 30 days after discharge. Methods: To identify the variables affecting the readmission of CV patients in the present cross-sectional study, a comprehensive review of previous studies and the consensus of specialists and sub-specialists were used. The obtained variables were based on 264 readmitted and non-readmitted patients. Readmission was modeled with predictive algorithms with an accuracy of &gt;70% using the IBM SPSS Modeler 18.0 software. Cross-Industry Standard Process for Data Mining (CRISP-DM) methodology provided a structured approach to planning the project. Results: Overall, 47 influential variables were included. The Support Vector Machine (SVM), Chi-square Automatic Interaction Detection (CHIAD), artificial neural network, C5.0, K-Nearest Neighbour, logistic regression, Classification and Regression (C&amp;R) tree, and Quest algorithms with an accuracy of 98.60%, 89.60%, 89.90%, 88.00%, 85.90%, 79.90%, 78.60%, and 74.40%, respectively, were selected. The SVM algorithm was the best model for predicting readmission. According to this algorithm, the factors affecting readmission were age, arrhythmia, hypertension, chest pain, type of admission, cardiac or non-cardiac comorbidities, ejection fraction, undergoing coronary angiography, fluid and electrolyte disorders, and hospitalization 6-9 months before the current admission. Conclusion: According to the influential variables, it is suggested to educate patients, especially the older ones, about following physician advice and also to teach medical staff about up-to-date options to reduce readmissions.