Prevalence Rate Of Patients Research Articles

Brazilian Dialysis Survey 2022.

The Brazilian Dialysis Survey (BDS) is an annual national survey about patients on chronic dialysis that contributes to health policies. To report the 2022 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire that included clinical and epidemiological aspects of patients on chronic dialysis, dialysis therapy data, and dialysis center characteristics. Overall, 28% (n = 243) of the centers answered the questionnaire. In July 2022, the estimated total number of patients on dialysis was 153,831. The estimated prevalence and incidence rates of patients per million population (pmp) were 758 and 214, respectively. Of the prevalent patients, 95.3% were on hemodialysis (HD, 4.6% of these on hemodiafiltration) and 4.7% on peritoneal dialysis (PD). Only 1.3% of patients were not vaccinated against COVID-19. The prevalence of anemia (Hb < 10g/dL) was 27% and hyperphosphatemia (P > 5.5mg/dL) reached 30%. The estimated overall crude annual mortality rate was 17.1%. The absolute number and prevalence rate of patients on chronic dialysis continue to increase. A growing number of patients were receiving hemodiafiltration. The mortality rate decreased, probably due to the end of COVID-19 pandemic. The conclusions were drawn in the context of relatively low voluntary participation, which imposed methodological limitations on our estimates.

Nationwide Real-World Data of Microsatellite Instability and/or Mismatch Repair Deficiency in Cancer: Prevalence and Testing Patterns.

Determination of microsatellite instability (MSI)/mismatch repair (MMR) status in cancer has several clinical implications. Our aim was to integrate MSI/MMR status from patients tested in Greece to assess the prevalence of MSI-high (MSI-H)/deficient MMR (dMMR) per tumor type, testing patterns over time and concordance between MSI and MMR status. We retrospectively recorded MSI/MMR testing data of patients with diverse tumor types performed in pathology and molecular diagnostics laboratories across Greece. Overall, 18 of 22 pathology and/or molecular diagnostics laboratories accepted our invitation to participate. In the 18 laboratories located across the country, 7916 tumor samples were evaluated for MSI/MMR status. MSI/MMR testing significantly increased in patients with colorectal cancer (CRC) and other tumor types overtime (p < 0.05). The highest prevalence was reported in endometrial cancer (47 of 225 patients, 20.9%). MSI-H/dMMR was observed in most tumor types, even in low proportions. Among 904 tumors assessed both for MSI and MMR status, 21 had discordant results (overall discordance rate, 2.3%). We reported MSI-H/dMMR prevalence rates in patients with diverse cancers, while demonstrating increasing referral patterns from medical oncologists in the country overtime. The anticipated high rate of concordance between MSI and MMR status in paired analysis was confirmed.

Prevalence of Comorbidity among the Patients with Angina in a Divisional City of Bangladesh

Bangladesh has experienced a significant increase in the presence of non-communicable chronic diseases and associated mortality and morbidity in the last few decades. Chest pain is a common complaint and reason for consultation among them. This study aimed to analyze the prevalence of comorbidity among patients with angina in a divisional city in Bangladesh. Method This Prospective cross-sectional study was conducted at the Department of Emergency, Delta Health Care, Chittagong Ltd and CSCR (pvt) Ltd, Chattogram, Bangladesh. The study duration was January’20 to June’22. A total of 420 patients presenting in the emergency department were enrolled in this study following the inclusive criteria. Data were collected using the predesigned semi-structured questionnaire. A consecutive sampling technique was used. Data were processed and analyzed by SPSS version 20.0. Unpaired t-tests and Chi-square tests were performed to observe the association between the study variables, where p&lt;0.05 was considered the level of significance with 95% CI. Verbal consent was taken before recruiting the study population. Ethical clearance of this study was taken from the Ethical Review Committee of Delta Health Care, Ctg. Ltd and CSCR Ltd, Chattogram. The information was kept confidential only to be used for the study purpose. Result In this study, most of the patients (123, 29.3%) belonged to the age group of 50-59 years, with a minimum of 35 years and a maximum of 90 years of age. The mean age was 57.18±11.57. most of the patients (222, 52.9%) were male and the rest were female with a male-to-female ratio of 1.1:1. 95 (31.6%) patients from the 50-59 years age group, followed by, 82 (27.2%) patients from the 60-69 years age group complained of chest pain among all the study subjects with male preponderance (169, 56.1%). In contrast, 37 (31.1%) patients from the 60-69 years age group did not experience chest pain, and female preponderance was seen in the patients who did not complain of chest pain. There was no significant association of chest pain with age distribution but with sex. The comorbid conditions were DM, HTN, IHD, CAD. Chest pain was present in 122 (40.5%) and absent in 53 (44.5%) diabetic patients, it was also present in 150 (49.8%) and absent in 59 (49.6%) patients with IHD. Chest pain was present in 94 (31.2%) and absent in 37 (31.1%) patients with CAD and present in 188 (62.5%) absent in 77 (64.7%) hypertensive patients as well. There was no significant association between the comorbidities and chest pain. There was no significant relation between blood pressure with chest pain. Conclusion This study concluded that the mentioned comorbid conditions (DM, HTN, IHD, CAD, dyslipidemia) did not show any significant prevalence rate in patients with angina. However, some patients had one or more such conditions along with chest pain which was not statistically significant.

Therapists’ prototypes of common mental disorders – An empirical identification

BackgroundAlthough earlier studies concluded that clinicians' prototypes of patients with mental disorders can influence diagnostic decisions, it remains unclear how presumably more or less prototypical features were identified in these studies. Therefore, the aim of the current study was to empirically identify therapists’ prototypes of major depression, generalized anxiety disorder, borderline personality disorder, and bipolar disorder. MethodPsychotherapists (N = 69) filled out an online survey and answered questions on the most common thoughts, feelings, behaviors, appearance, life circumstances, age, and gender of a typical person with each disorder. Additionally, they rated the DSM-5 criteria according to how much they think about each criterion when picturing a typical person with the respective disorder. ResultsThe most frequently mentioned features are reported and associations between features are visualized by means of network analyses. Besides some exceptions, therapists’ responses were mostly in line with the DSM-5 criteria and prevalence rates in patients with each disorder. LimitationsThe main limitation is the fact that categorization of therapists’ responses into features depended on subjective decisions. Despite efforts to make this process as objective as possible, replication could lead to slightly different results. ConclusionTherapists' prototypes might be helpful to make diagnostic decisions in typical situations but could lead to incorrectly diagnosing or overlooking a disorder in less typical situations. The results of the current study should inform further research on the influence of prototypes on diagnostic decisions. Additionally, the current findings should be used to increase therapists’ awareness of prototypes of different mental disorders and the importance of accurate diagnosis.

Enthesitis indices identify different patients with this characteristic in axial and peripheral spondyloarthritis and also in psoriatic arthritis: ASAS-PerSpA data

BackgroundIn axial spondyloarthritis (axSpA), peripheral SpA (pSpA) and psoriatic arthritis (PsA), enthesitis is a hallmark clinical feature that can be assessed by the SPARCC index, LEI, MASES and MEI. These indices evaluate different locations, which may identify different numbers of patients with enthesitis among SpA subtypes. Thus, the aim of this study was to evaluate whether the proportion of patients with at least one enthesitis across these three most prevalent SpA subtypes differs according to the index used and to evaluate the level of agreement among indices in detecting patients with enthesitis.MethodsA total of 4185 patients (2719 axSpA, 433 pSpA and 1033 PsA) from the international and cross-sectional ASAS-PerSpA study were included. The proportion of patients with enthesitis identified by the indices was evaluated across the three diseases. Pairwise agreement between indices was computed using Cohen’s kappa.ResultsThe prevalence rates of patients with at least one enthesitis according to the MEI, MASES, SPARCC index and LEI were 17.2%, 13.5%, 10.7%, and 8.3%, respectively. In axSpA, the indices that identified the most patients with enthesitis were the MEI and MASES (98.7% and 82.4%, respectively); in pSpA and PsA, the indices that identified the most patients with enthesitis were the MEI and SPARCC index (MEI: 100% and SPARCC: 84.6%; MEI: 97.3% and SPARCC: 77%, respectively). In the total population, the MASES vs. MEI showed the strongest agreement (absolute agreement 96.3%; kappa: 0.86); similar results were obtained in axSpA patients (97.3%; 0.90). In pSpA and PsA patients, the SPARCC vs. MEI (97.2%; 0.90 and 95.4%; 0.83, respectively) showed the strongest agreement.ConclusionsThese results suggest that the prevalence of patients with enthesitis across SpA subtypes differs depending on the disease and the index used. The MEI and MASES appeared best for assessing enthesis in SpA and axSpA, while the MEI and SPARCC index appeared best for assessing enthesitis in pSpA and PsA.

Brazilian Dialysis Survey 2021.

The Brazilian Dialysis Survey (BDS) is an important source of national data about people on chronic dialysis that contributes to the formulation of health policies regarding kidney failure. To report the 2021 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire covering clinical and epidemiological aspects of patients in chronic dialysis, data on dialysis therapy, characteristics of dialysis centers, and the impact of the COVID-19 pandemic of 2021. Thirty percent (n = 252) of the centers answered the questionnaire. In July 2021, the estimated total number of patients on dialysis was 148,363. The estimated prevalence and incidence rates of patients per million population (pmp) were 696 and 224, respectively. Of the prevalent patients, 94.2% were on hemodialysis (HD) (1.8% of these on hemodiafiltration), and 5.8% on peritoneal dialysis (PD); 21% were on the transplant waiting list. The incidence rate of confirmed COVID-19 between January and July 2021 was 1,236/10,000 dialysis patients, and the case-fatality rate reached 25.5%. Up to July 2021, 88.6% of patients had received at least one dose of the anti-SARS-CoV-2 vaccine. The estimated overall and COVID-19 crude annual mortality rates were 22.3% and 5.3%, respectively. The absolute number and the prevalence rate of patients on chronic dialysis continue to increase. Most dialysis patients were vaccinated against COVID-19 during the year. The COVID-19 pandemic was associated to the overall mortality rate.

Prevalence and Clinical Characteristics of Patients with Moderate-to-Severe Asthma in Japan Using a JMDC Claims Database

Introduction: Although the prevalence and burden of asthma are continuously increasing, there is a lack of evidence on the landscape of moderate-to-severe asthma in Japan. Here, we report the prevalence of moderate-to-severe asthma and describe patient’s demographics and clinical characteristics from 2010 to 2019 using the JMDC claims database. Methods: Patients (≥12 years) from the JMDC database with ≥2 asthma diagnoses in 2 different months in each index year were stratified as moderate-to-severe asthma based on the definition of asthma prevention and management guideline (Japanese Guidelines for Asthma, JGL) or Global Initiative for Asthma (GINA). Primary objective: 10-year trend (2010–2019) in the prevalence of moderate-to-severe asthma. Secondary objective: Demographics and clinical characteristics of patients from 2010 to 2019. Results: Of 7,493,027 patients from the JMDC database, 38,089 and 133,557 were included in JGL and GINA cohorts, respectively, by 2019. Both cohorts presented an increasing trend in the prevalence rate of moderate-to-severe asthma from 2010 to 2019, irrespective of age groups. Demographics and clinical characteristics were consistent across the cohorts in each calendar year. Majority of patients were in the age group of 18–60 years in both JGL (86.6%) and GINA (84.2%) cohorts. Allergic rhinitis was the most frequent comorbidity and anaphylaxis the least frequent comorbidity reported in both the cohorts. Conclusions: In Japan, the prevalence rate of patients with moderate-to-severe asthma, as per JGL or GINA in the JMDC database, increased from 2010 to 2019. The demographics and clinical characteristics were similar in both cohorts over the assessment duration.

Inflammation-activated C/EBPβ mediates high-fat diet-induced depression-like behaviors in mice.

Depression, one of the most common causes of disability, has a high prevalence rate in patients with metabolic syndrome. Type 2 diabetes patients are at an increased risk for depression. However, the molecular mechanism coupling diabetes to depressive disorder remains largely unknown. Here we found that the neuroinflammation, associated with high-fat diet (HFD)-induced diabetes and obesity, activated the transcription factor CCAAT/enhancer binding protein β (C/EBPβ) in hippocampal neurons. This factor repressed brain-derived neurotrophic factor (BDNF) expression and caused depression-like behaviors in male mice. Besides, the loss of C/EBPβ expression in C/EBPβ heterozygous knockout male mice attenuated HFD-induced depression-like behaviors, whereas Thy1-C/EBPβ transgenic male mice (overexpressing C/EBPβ) showed depressive behaviors after a short-term HFD. Furthermore, HFD impaired synaptic plasticity and decreased surface expression of glutamate receptors in the hippocampus of wild-type (WT) mice, but not in C/EBPβ heterozygous knockout mice. Remarkably, the anti-inflammatory drug aspirin strongly alleviated HFD-elicited depression-like behaviors in neuronal C/EBPβ transgenic mice. Finally, the genetic delivery of BDNF or the pharmacological activation of the BDNF/TrkB signaling pathway by 7,8-dihydroxyflavone reversed anhedonia in a series of behavioral tests on HFD-fed C/EBPβ transgenic mice. Therefore, our findings aim to demonstrate that the inflammation-activated neuronal C/EBPβ promotes HFD-induced depression by diminishing BDNF expression.

MO692: A Four-Year Analysis on Home Dialysis at the North Bristol NHS Trust—What to Do Next?

Abstract BACKGROUND AND AIMS Home dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), has been associated with improved patient autonomy, quality of life and overall cost effectiveness (Weinhandl et al. Propensity matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol. 2010; 21: 499–506). The 2021 Get It Right First Time (GIRFT) Renal report revealed that home dialysis patients were at a lower risk of contracting and dying of coronavirus disease 2019 (COVID-19), compared to those who received in-center hemodialysis (ICHD) (2). Despite these advantages, uptake of home dialysis is still lower than that of ICHD. The aim of our study was to analyse the numbers and reasons for home dialysis withdrawal at the North Bristol NHS Trust between 2018 and 2021. METHOD All patients on PD and HHD between 2018 and 2021 were included. Analysis of the episodes that led to home dialysis cessation was carried out. As some patients required withdrawal more than once during the 4-year period, each episode of dropout was considered separately. The prevalence rate of patients on home dialysis was calculated. RESULTS The total number of patients on home dialysis increased from 74 in 2018 to 98 in 2021. The male: female ratio of patients was 3:2 with an average age of 58.3. The number of patients on PD increased from 58 at the end of 2018 to 82 in 2021. The number of patients on HHD remained stable over the years, with an average of 16. The prevalence rate of home dialysis was 17.1% at the end of 2021. Figure 1 shows the total number of patients who started and dropped out of home dialysis every year. The number of patients initiating PD was 58 in 2018, 55 in 2019, 37 in 2020 and 59 in 2021. The number of dropouts was 57 in 2018, 41 in 2019, 29 in 2020 and 43 in 2021. The dip in number of patients initiated on PD in 2020 can be attributed to the start of the COVID-19 pandemic, when elective procedures were temporarily withheld. On the other hand, a lower number dropped out during 2020. This may be explained by the emphasis given to self-isolation rules and persistence with home dialysis during the outbreak. The overall increase in PD uptake in 2021 may be explained by the establishment of a new specialist clinic that promotes the uptake of home dialysis. The initiation of a new peer support service group in 2021 may also have contributed. The number of patients initiating and withdrawing from HHD followed the same pattern, with a significant dip in 2020. Figure 2 demonstrates the reasons for withdrawal from PD over the study period. The most prevalent reasons were PD-related infections and transplantation. The observed figures for transplantation reflect the continuous efforts involved in the maintenance of a successful transplant programme. The figure also shows that termination of PD due to failure was highest in 2021. The authors postulate that this surge might be due to the previous year's low PD dropout rate. The leading reason for stopping HHD was transplantation. Other reasons included recovery of renal function and switching to conservative management. Death led to one dropout/year in 2018–20, but none in 2021. CONCLUSION Around 17% of the NBT’s total dialysis population is currently on home dialysis. The commonest reasons for termination of home dialysis were transplantation and PD-related infections. The GIRFT report recommends that all adult renal units in the UK should reach a minimum prevalence rate of 20% of their dialysis population on home dialysis by the end of 2024 (Lipkin et al. Renal medicine: Get It Right First Time (GIRFT) Programme National Specialty Report. March 2021. NHS England and NHS Improvement). Whereas our statistic falls slightly short of this, we aim to reach this target through various strategies. These include continued audit, home dialysis campaign, continued psychological services and a reduction in waiting time for PD catheter insertion.

Pseudomonas aeruginosa ve Pyoverdinler: Apiterapi Uygulamalarında Gizli bir Tehdit

Pseudomonas aeruginosa, a Gram-negative rod-shape bacterium, is one of the most common pathogens in nosocomial infections and this pathogenic species draws attention with its high prevalence rate in patients with septicemia. Pyoverdines are fluorescent siderophore produced by some Pseudomonas species such as P. aeruginosa and Pseudomonas fluorescens. These siderophores support biofilm production in these microorganisms and also plays a role as a virulence factor. In this study, anti-Pseudomonas activity of 10 different honey samples was evaluated by agar well diffusion (AWD) method. In addition, minimum inhibition concentration (MIC) and minimum bactericidal concentration (MBC) values of these honey samples were determined via microbroth dilution method. The obtained results showed that only oak honey and chestnut honey have negligible scale low anti-Pseudomonas activity. In addition, it was observed that other honey samples did not have an inhibitory effect against these pathogens. Finally, the promoting property of pyoverdine siderophore production of these honey samples was evaluated and it was concluded that all honey samples stimulated pyoverdin production at a concentration ½ w/v.

Sarcopenia diagnosis in patients receiving hemodialysis: Agreement among different consensuses.

There are many consensuses to diagnose sarcopenia, and their agreement in patients receiving hemodialysis (HD) is not clear. We described the sarcopenia prevalence in patients receiving HD using different consensuses and analyzed their level of agreement. Sixty-seven patients (43 men, 55 ± 14.6 years) were evaluated for appendicular skeletal muscle mass using dual-energy x-ray absorptiometry and muscle strength using handgrip strength. Patients were classified according to different sarcopenia consensuses (European Working Group on Sarcopenia in Older People [EWGSOP], Revised EWGSOP [EWGSOP2], Foundation for the National Institutes of Health Project [FNIH], and Asian Working Group for Sarcopenia 2019 [AWGS2]). Kappa analysis identified the level of agreement. The prevalence of sarcopenia ranged from 1.5% to 11.9% depending on the sarcopenia consensus. The agreement between the different consensuses ranged from poor to almost perfect. FNIH and EWGSOP showed the lowest agreement (κ = 0.20; 95% CI, -0.14 to 0.54; P < 0.05), whereas EWGSOP2 and AWGS2 had the largest κ = 0.90 (95% CI, 0.71 to 1.00; P < 0.001). When stratified by age (≥60 years), the sarcopenia prevalence was higher in the older group (27% vs 2%; P = 0.004). In addition, male participants seemed to be more prone to sarcopenia compared with female counterparts, but this difference was not statistically confirmed (16% vs 4%; P = 0.242). The sarcopenia consensuses showed from poor to almost perfect agreement, which varied the sarcopenia prevalence rates in patients receiving HD. EWGSOP2 and AWGS2 showed the largest agreement.

Electroencephalogram (EEG) Features of Post-Stroke Seizure Patients in the Department of Neurology, Dr. Soetomo General Hospital Surabaya

Backgrounds: Seizures are one of the most common and hazardous neurological complications of stroke. Post-stroke seizures were classified as early onset seizure and late onset seizure, depending on seizure onset after stroke. Stroke is one of the most common risk factors for seizures and epilepsy, especially in older patients, accounting for 39-45% of all seizure incidents. Knowledge of various risk factors and capability to perform supporting examinations such as EEG are essential to do with the aim of early detection, improving the prevention and treatment of post-stroke seizures so that it is expected to reduce the prevalence and mortality rate of post-stroke seizures. Objectives: This study aims to determine the electroencephalogram (EEG) features found in post-stroke seizure patients in the Department of Neurology, Dr. Soetomo Surabaya Hospital Methods: This study is a descriptive observational study using secondary data obtained from the medical records of patients with post-stroke seizures at the Department of Neurology, Dr. Soetomo Surabaya Hospital within the time period of January 2017 ? December 2019. Results: In this research, we evaluated seizure characteristics in 230 patients who had ischemic and hemorrhagic stroke. 116 patients were male (50.4%) while 114 patients were female (49.6%). The highest age range found in the study sample was > 19-60 years. In addition, this study revealed that 58.7% of seizures were focal seizures and 39.1% were generalized seizures, the remaining 2.2% were unknown seizures. Focal seizures become bilateral tonic clonic seizures are the most common type of focal seizures while generalized tonic clonic seizures are the most common type of generalized seizures seen. 80% of patients with focal seizures have impaired awareness during seizures. Seizures occurred in 148 ischemic stroke patients (64.3%) and 82 hemorrhagic stroke patients (35.7%). 97 Patients with ischemic stroke had thrombus etiology (65. 5%) and 32 had an embolic etiology (21.6 %), while patients with hemorrhagic stroke had the most dominant etiology, namely ICH as many as 53 patients (64.6%). lesions were cortical (47.8%) and 91 patients had lesions located subcortical (39.6%). The majority of patients experienced early onset seizures (55.2%) and the majority of patients had EEG recordings 7 - < 14 days and 3 - < 7 days after seizure manifestations (29.1%). EEG results showed abnormal features in 78.7% patients. Slow activity EEG is the most visible EEG picture with Continuous Slow Activity (CSA) as the most dominant pattern, while in epileptiform EEG the sharp/spike wave image is the most common pattern. In the EEG special pattern, the most common picture is asymmetry decreased background rhythm accompanied by CSA. Conclusion: This hospital-based study showed that post-stroke seizures were associated with young and middle aged (>19-60 years), male gender, ischemic stroke, thrombus type, cortical location, and comorbid hypertension, with a high prevalence rate in patients with hypertension. Based on this study, our data showed that patients with post-stroke seizures after stroke were more likely to have impaired awareness during the seizure. The most EEG features found in this study are continuous slow activity waves. In this study, post stroke seizures occurred more commonly after ischemic stroke, middle aged, and when stroke occurred in the cortical region

Screening of Fabry disease in patients with chronic kidney disease in Japan.

BackgroundFabry disease (FD), an X-linked lysosomal storage disorder caused by a deficiency in alfa-galactosidase A (α-Gal A) activity due to mutations in the GLA gene, has a prevalence of 0–1.69% in patients undergoing haemodialysis; however, its prevalence in patients with chronic kidney disease (CKD) Stages 1–5 is unknown.MethodsSerum α-Gal A activity analysis and direct sequencing of GLA were used to screen for FD in 2122 male patients with CKD, including 1703 patients with CKD Stage 5D and 419 with CKD Stages 1–5. The correlation between serum α-Gal A activity and confounding factors in patients with CKD Stages 1–5 was evaluated.ResultsFD prevalence rates in patients with CKD Stage 5D and CKD Stages 1–5 were 0.06% (1/1703) and 0.48% (2/419), respectively. A patient with CKD Stage 5D exhibited a novel GLA mutation, p.Met208Arg, whereas two patients with CKD Stages 1–5 had c.370delG and p.Met296Ile. p. Met208Arg caused moderate structural changes in the molecular surface region near the substituted amino acid residue but did not affect the catalytic residues Asp170 and Asp231 in α-Gal A. Serum α-Gal A activity in patients with CKD Stages 1–5 was inversely correlated with age (P < 0.0001) but directly correlated with estimated glomerular filtration rate (P < 0.0001).ConclusionsFD prevalence was much higher in male patients with CKD Stages 1–5 than in those with CKD Stage 5D. FD screening in patients with CKD Stages 1–5 may improve patient survival, decreasing the number of patients with CKD Stage 5D.

Variation in restraint use between hospitals: a multilevel analysis of multicentre prevalence measurements in Switzerland and Austria

BackgroundIn restraint use in the somatic acute-care hospital setting, routine and institutional culture seem to play an important role. This implies that similar patient situations would be managed with restraints in one hospital, while in another hospital the situation would be managed without restraints. This practice variation appears to be ethically and legally questionable. The influence of organisation-specific factors such as the availability of guidelines is discussed. However, the relevance of such factors at the hospital level has been rarely investigated to date. Therefore, the aims of this study were a) to determine how much variance in restraint use can be explained on the hospital level (hospital general effect) and b) to examine the impact of organisational factors on restraint use (specific contextual effects).MethodsA secondary data analysis of cross-sectional multicentre data was performed. Data were collected during three quality measurements (2016–2018) in acute-care hospitals in Switzerland and Austria. Hospitalised patients from different medical specialties aged 18+ with informed consent were included. Descriptive analysis and multilevel logistic regression analysis were performed.ResultsThe study included 29,477 patients from a total of 140 hospitals. The 30-day prevalence rate of patients with at least one restraint was 8.7% (n = 2577). The availability of guidelines regarding restraint use and refresher courses for nursing staff were associated with less restraint use (odds ratios = 0.60 and 0.75). By adding the hospital as a random effect, the explained variance of the model increased from 24 to 55%.ConclusionsThe use of restraints varies widely between hospitals, even considering patient characteristics. The identification of situations in which restraints were used out of routine or institutional culture appears to be an important approach in restraint reduction. Investments in appropriate structures and employee knowledge can facilitate providing restraint-free care as much as possible.

Assessing Utilisation and Expenditure on Long-Acting Insulin Analogues in Kenya; Findings and Implications for the Future

Prevalence rates for patients with diabetes mellitus are rising across countries including sub-Saharan African countries, which will continue. As a result, there are an increasing number of patients with insulin-dependent diabetes across sub-Saharan Africa including Kenya. Growing prevalence rates are increasing the costs of treating patients with diabetes enhanced by associated complications. These include both microvascular and macrovascular complications, with hypoglycaemia and generally poor control of diabetes contributing to the burden. Long-acting insulin analogues were developed to reduce rates of hypoglycaemia associated with insulin usage, including nocturnal hypoglycaemia, and improve adherence through improving patient convenience. As a result, they are now included in the Kenyan Essential Medicines List. However, long-acting insulin analogues are typically considerably more expensive than standard insulins limiting their use in practice, especially in countries such as Kenya with concerns with affordability even for standard insulins such as Mixtard®. Consequently, a need to ascertain current utilisation and expenditure patterns for the different insulins including long-acting insulin analogues across Kenya starting with leading referral hospitals. Research in Kenyatta National Hospital (KNH) showed growing use of insulin glargine reaching up to 3.4 to 3.6% of total insulin utilisation in 2019 and 2020. However, prescribing was limited by considerably higher prices (3.4 fold higher) than standard insulins on a defined daily dose basis. Considerably higher prices resulted in no utilisation of long-acting insulin analogues in another leading referral hospital in Kenya. Overall, appreciably lowering the prices of long-acting insulin analogues through instigating local production and other activities should increase their use benefiting patients and the healthcare system in Kenya and wider. These are considerations for the future.

T53. NEUROPHYSIOLOGICAL AND BEHAVIORAL EFFECTS OF THE STIMULATION OF NICOTINIC RECEPTORS AND NON-INVASIVE BRAIN STIMULATION IN PATIENTS WITH SCHIZOPHRENIA: STUDY DESIGN AND METHODOLOGY OF A RANDOMIZED CONTROLLED TRIAL

BackgroundTobacco dependence is the most common substance use disorder in schizophrenia patients. Research suggests that prevalence rates for patients with schizophrenia are 40 to 80 percent. It is believed that these patients smoke to improve cognitive deficits. This assumption is supported by several neurophysiological and behavioral studies. The aim of the current study is to assess the physiological fundamentals and the behavioral effects of smoking in patients with schizophrenia.MethodsThe present randomized double-blind and controlled study is ongoing and focusses on enhancing cognitive functioning in schizophrenia patients. Nicotinic receptors of participating patients are stimulated by the substance varenicline. The resulting changes are assessed by non-invasive brain stimulation (NIBS) and cognitive performance tests. Additionally, anodal transcranial direct current stimulation (a-tDCS) is applied for inducing plasticity to examine the interaction between tobacco consumption and brain stimulation. The treatment consists of twice daily 1 mg of varenicline (or placebo) and 20-minute a-tDCS (or sham tDCS) over a period of five days. Sixty patients with schizophrenia will be recruited for this pilot study.ResultsThis is a double-blind study. Therefore no results can be shown so far. To this date 18 patients have been recruited (female = 6). There haven’t been major side effects and patients are tolerating the interventions well.DiscussionDuring the conference we will present the concept and design of the combined “varenicline x tDCS” trial for the treatment of cognitive deficits in schizophrenia.

The prevalence of obstructive sleep apnea in mild cognitive impairment: a systematic review

BackgroundPrevious studies have shown that obstructive sleep apnea (OSA) is associated with a higher risk of cognitive impairment or dementia in the elderly, leading to deleterious health effects and decreasing quality of life. This systematic review aims to determine the prevalence of OSA in patients with mild cognitive impairment (MCI) and examine whether an association between OSA and MCI exists.MethodsWe searched Medline, PubMed, Embase, Cochrane Central, Cochrane Database of Systematic Reviews, PsychINFO, Scopus, the Web of Science, ClinicalTrials.gov and the International Clinical Trials Registry Platform for published and unpublished studies. We included studies in adults with a diagnosis of MCI that reported on the prevalence of OSA. Two independent reviewers performed the abstract and full-text screening, data extraction and the study quality critical appraisal.ResultsFive studies were included in the systematic review. Overall, OSA prevalence rates in patients with MCI varied between 11 and 71% and were influenced by OSA diagnostic methods and patient recruitment locations (community or clinic based). Among studies using the following OSA diagnostic measures– self-report, Home Sleep Apnea Testing, Berlin Questionnaire and polysomnography– the OSA prevalence rates in MCI were 11, 27, 59 and 71%, respectively. In a community-based sample, the prevalence of OSA in patients with and without MCI was 27 and 26%, respectively.ConclusionsBased on limited evidence, the prevalence of OSA in patients with MCI is 27% and varies based upon OSA diagnostic methods and patient recruitment locations. Our findings provide an important framework for future studies to prospectively investigate the association between OSA and MCI among larger community-based cohorts and implement a standardized approach to diagnose OSA in memory clinics.PROSPERO registrationCRD42018096577.

Cough related to swallowing in asthma patients.

BackgroundOccurrence of cough during swallowing is common among asthma patients, but has not been investigated in detail.ObjectiveWe conducted an observational study to determine the prevalence of swallowing-related cough (SRC) and its characteristics in asthma patients.MethodsAsthma patients attending our outpatient department between May 2005 and April 2007 were interviewed to investigate if they had ever experienced SRC, as well as postnasal drip or heartburn and cough related to these conditions.ResultsAmong 417 patients who completed the questionnaire, 121 patients (29.0%) had experienced SRC. Spicy and sour foods were the most frequent tussigenic foods, causing cough in 76.0% and 53.7% of the 121 patients, respectively. In patients without SRC, the prevalence rates of postnasal drip and postnasal drip-induced cough were 35.8% (106 of 296) and 7.8% (23 of 296), respectively. The corresponding prevalence rates in patients with SRC were 50.4% (61 of 121) and 37.2% (45 of 121), which were both significantly higher than in patients without cough (p = 0.006 and p < 0.001 respectively). In patients without SRC, the prevalence rates of heartburn and heartburn-induced cough were 22.2% (66 of 296) and 2.4% (7 of 296), respectively. The corresponding prevalence rates in patients with SRC were 45.5% (55 of 121) and 16.5% (20 of 121), with both being significantly higher than in patients without cough (p = 0.002 and p < 0.001, respectively).ConclusionSRC was frequent in asthma patients, and was closely related to postnasal drip and heartburn. Irritable larynx is one of the possible underlying mechanisms of SRC. This study was registered with the University Hospital Medical Information Network clinical trials registry (registration number: UMIN000017426).

Current approaches to neurosurgical treatment for drug-resistant focal epilepsy in adults

The review is dedicated to the problems of current neurosurgical treatment for drug-resistant epilepsy in the adult population of Russia and foreign countries. The literature published in the period 2010–2017 was sought in Russian and foreign databases. This review included 58 only full-text publications. The search results have shown that despite advances in neurosurgery for drug-resistant epilepsy and the development of new surgical procedures, the problem of this disease has not yet been fully resolved today. This is evidenced by fairly high global prevalence rates in patients with postoperative epilepsy resistant to antiepileptic therapy. The literature analysis has revealed that the mean prevalence of postoperative epilepsy is 69%. This indicator may vary according to the type of an epileptogenic structural lesion and its location in the brain. However, despite the rapid development of epilepsy surgery, currently there is still a low surgical activity in the treatment of patients with drugresistant epilepsy. Of importance is also the presence of postoperative complications, including various infectious complications and neurological deficit. Taking into account the high rate of postoperative epilepsy, it is concluded that it is appropriate to develop postoperative rehabilitation methods for patients with drug-resistant epilepsy.

Measures of Drug Prescribing at Care Transitions in an Internal Medicine Unit.

Care transitions represent a common source of drug errors and confusions. The purpose of our prospective observational study was to assess the prevalence of medication discrepancies at care transitions, along with potentially inappropriate medications and potential drug-drug interactions, in an internal medicine unit of an Italian hospital. Adverse drug reactions that occurred in the 30-day period after the discharge from the hospital were included. A related-samples McNemar test was performed for evaluating the effects of hospitalization on the above-mentioned measures of drug prescribing. Medication discrepancies were frequent both on admission (93.4% [95%CI 0.8749, 0.9713]) and at discharge (78.7% [95%CI 0.7035, 0.8558]), with a significant difference between transition times (-14.7% [95%CI -21.82%, -7.69%]; P<.001)]. A high potentially inappropriate medication use prevalence was revealed without differences between care transitions. Potential drug-drug interactions were more frequent at admission to the hospital, with a significant difference of 8.2% in the distribution of patients with potential drug-drug interactions between care transitions. None of the adverse drug reactions recorded on follow-up was related to unintentional discrepancies, and the prevalence rate of patients with potentially inappropriate medication-related adverse drug reactions ranged between 4.9% and 6.9%, and the prevalence rate of patients with drug-drug interaction-related adverse drug reactions was 4.1% of patients. This study is important to raise awareness of the potential dangers medication discrepancies, potentially inappropriate medications, and potential drug-drug interactions could have on older adults. Clinicians and clinical pharmacologists must collaborate to improve patient care and minimize drug-related clinical outcomes.