Previous Visit Research Articles

Awareness of child oral health among parents and caregivers attending Pediatrics OPD at BPKIHS, Dharan

Introduction: Parents and caregivers are the key sources responsible for their children’s good health. They are the basic needs-provider and role models as well for their children to learn good oral habits early on. Thus, their awareness about the factors affecting child oral health is an essential component for the well-being of the child. Objectives: To assess awareness of child oral health among parents and caregivers attending Pediatrics OPD at BPKIHS, Dharan. Methodology: A cross-sectional questionnaire-based study was conducted among conveniently selected 400 parents and caregivers of six months-to-14-year-old children attending Pediatrics OPD, BPKIHS, Dharan. A single interviewer administered pre-tested standardized questionnaires to the participants. The questionnaires consisted of five domains: socio-demographic profile of the participants; child’s oral hygiene practices; child’s feeding and dietary habits; awareness of child’s first dental visit and presence of family dental problems; and child’s dental service utilization. Data were entered in MS excel 2007 and statistically analyzed using SPSS version 11.5. Data analysis included descriptive statistics. Results: Majority (90%) of the parents and caregivers were literate and 44.3% belonged to the lower-class socioeconomic status. 83.3% of the participants reported that their children took a sugary diet and 77.6% of them brushed once daily before breakfast. 91% of the respondents reported the age of the child’s first dental visit to be any age when there was a dental problem. The awareness of the presence of oral health problems in their child was seen in 29.5%, whereas 18% had made previous dental visits. Conclusion: Despite the fact that most parents and caregivers reported factors affecting their children's oral health, there was evidence of lack of awareness and, as a result, low utilization of dental services for their children.

A Randomized, Controlled Trial of Treat-and-Extend vs. Pro Re Nata Regimen for Neovascular Age-Related Macular Degeneration.

PurposeTo compare the efficacy and safety of conbercept using a treat-and-extend (T&E) regimen vs. a pro re nata (PRN) regimen in Chinese patients with neovascular age-related macular degeneration (nAMD).MethodsThis was a randomized, multicenter, non-inferiority study. After an initial loading phase of three consecutive monthly intravitreal injections of 0.5 mg Conbercept, the patients were treated to PRN or T&E regimen. The prespecified retreatment criteria was defined as a more than 5-letter decrease in BCVA from the previous visit or any evidence of new retinal hemorrhages, or the presence of any IRF and any SRF of more than 200 μm in height at the sub-foveal center. The primary outcome was the mean change in best-corrected visual acuity (BCVA) from baseline to 24 months, with a prespecified non-inferiority limit of −5 letters.ResultsFrom July 2016 through August 2018, 141 participants were allocated and treated (T&E, n = 69; PRN, n = 72). About one fifth of the overall participants were dropped out during the 12-month follow-up (28/141, 19.9%), and about one thirds of the overall participants were lost during the 24-month follow-up (51/141, 36%). At 2 years, mean BCVA letter improvement was + 4.0 in the T&E group vs. + 5.1 in the PRN group, and T&E regimen was not non-inferior to PRN regimen [difference, −1.169 letters; 95% confidence interval (CI): −6.864 ∼ 4.526]. Subgroup analyses also demonstrate the similar results in PCV patients, naive patients and no-naive patients. The mean decrease in central subfield thickness were 180 ± 165 μm in the T&E group and 247 ± 230 μm in the PRN group, respectively. The patients in the PRN group had required significantly fewer injections than those in the T&E group (12.4 vs. 14.6 injections, P = 0.041). The types and rates of adverse events were comparable in the two treatment groups.ConclusionThese findings suggest that the T&E regimen was not non-inferior to the PRN regimen in patients with nAMD in terms of BCVA outcomes through 24 months.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT02802657.

Comparison of Responsiveness of British Isles Lupus Assessment Group 2004 Index, Systemic Lupus Erythematosus Disease Activity Index 2000, and British Isles Lupus Assessment Group 2004 Systems Tally.

To compare the responsiveness of the British Isles Lupus Assessment Group 2004 index (BILAG-2004) and the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) disease activity indices and to determine whether there was any added value in combining BILAG-2004, BILAG-2004 system tally (BST), or simplified BST (sBST) with SLEDAI-2K. This was a multicenter longitudinal study of SLE patients. Data were collected on BILAG-2004, SLEDAI-2K, and therapy on consecutive assessments in routine practice. The external responsiveness of the indices was assessed by determining the relationship between change in disease activity and change in therapy between 2 consecutive visits. Comparison of indices and their derivatives was performed by assessing the main effects of the indices using logistic regression. Receiver operating characteristic curves analysis was used to describe the performance of these indices individually and in various combinations, and comparisons of area under the curve were performed. There were 1,414 observations from 347 patients. Both BILAG-2004 and SLEDAI-2K maintained an independent relationship with change in therapy when compared. There was some improvement in responsiveness when continuous SLEDAI-2K variables (change in score and score of previous visit) were combined with BILAG-2004 system scores. Dichotomization of BILAG-2004 or SLEDAI-2K resulted in poorer performance. BST and sBST had similar responsiveness as the combination of SLEDAI-2K variables and BILAG-2004 system scores. There was little benefit in combining SLEDAI-2K with BST or sBST. The BILAG-2004 index had comparable responsiveness to SLEDAI-2K. There was some benefit in combining both indices. Dichotomization of BILAG-2004 and SLEDAI-2K leads to suboptimal performance. BST and sBST performed well on their own; sBST is recommended for its simplicity and clinical meaningfulness.

Evaluation of emergency department visits prior to an HIV diagnosis: Missed opportunities

ObjectiveThere is a high rate of occult infection and late diagnosis in HIV. Hospital emergency departments (ED) are an important point of health care. The present work aims to know the number of missed opportunities for HIV diagnosis occurring in the ED. MethodRetrospective multicenter cohort study that included all patients diagnosed with HIV infection in 2019 in 27 Spanish hospitals in 7 different autonomous communities. All ED consultation episodes in the 5 years prior to diagnosis were reviewed to find out the reason for consultation and whether this represented a missed opportunity for HIV diagnosis. ResultSeven hundred twenty-three patients were included, and 352 (48.7%, 95%CI: 45.1%–52.3%) had at least one ED visit during the 5 years prior to diagnosis (median 2, p25–p75: 1–4). One hundred and eighteen patients (16.3%, 95%CI: 13.8%–19.2%) had a missed diagnostic opportunity. The main consultations were drug use [145 (15%)], sexually transmitted infections [91 (9.4%)] and request for post-exposure HIV prophylaxis [39 (4%)]. One hundred and fifty-five (42.9%) of the 352 had less than 350 CD4/mm3 when the HIV diagnosis was established. In patients with previous ED visits, the mean time to diagnosis from this visit was 580 (SD 647) days. ConclusionsSixteen percent of patients diagnosed with HIV missed the opportunity to be diagnosed in the 5 years prior to diagnosis, highlighting the need to implement ED screening measures different from current ones to improve these outcomes.

Implementation of an Intervention Based on Nutritional Care Process to Improve Glycemic Parameters in a Type 2 Diabetes Comprehensive Care Program. The CAIPaDi Program

Abstract Objectives Personalized and evidenced-based nutritional interventions are needed to overcome the burden of type 2 diabetes (T2D) epidemic. The aim of this study was to describe the implementation and impact on glycemic control of an intervention based on Nutritional Care Process Terminology (NCPT) within a T2D comprehensive care program in Mexicans. Methods This is a single-arm study of a 2-years follow-up. We evaluated 258 individuals of the CAIPaDi program across six visits. The program seeks to achieve metabolic goals and provide self-efficacy to recently T2D-diagnosed patients. The customized nutritional intervention was implemented for all participants based on an NCPT model. The intervention was implemented by two dietitians, following the NCPT program. Each participant engaged in a 30-minutes session each visit. The main outcome is the achievement of treatment goals defined by the National Committee for Quality Assurance criteria (NCQA). Results The program was effective to reduce the prevalence of subjects with poor glycemic control from 85% to 57% (P < .0001) after 2 years. Nutritional diagnoses were grouped into the three main domains, 1) ingestion, 2) clinical, and 3) Behavioral/Environmental. At baseline, the most prevalent diagnostic was behavioral diagnostics (44%), followed by ingestion (39%), and clinical (17%). The majority of individuals with behavioral diagnostics migrated to ingestion, whereas individuals with ingestion diagnoses at baseline migrated to the non-diagnostic at the final visit. At the end of the follow-up, the most frequent diagnostic was ingestion (45%), with 29% of the subjects with good glycemic control, contrasting with 79% of the non-diagnostic individuals (p = .0001). Subjects in the category the non-diagnostic nutritional in one previous visit, were 89% more likely to reach a good glycemic control in the last visit (HR 1.89; 95CI% 1.17–3.05) even after adjusting by confounders: age, sex, body fat, years of onset and HbA1c at baseline. Conclusions An intervention based on NCPT can help provide individualized nutritional interventions and prioritize clinical attention to improve the effectiveness of a T2D comprehensive care program. Funding Sources Consejo Nacional de Ciencia y Tecnología project 214,718.

Smoking cessation counseling in patients with active malignancy.

e18655 Background: Tobacco smoking increases risk of multiple malignancies, most notably lung cancer, and is a leading cause of premature morbidity and mortality. Tobacco cessation counseling is effective in assisting patients to quit smoking and improving health outcomes, but over one third of smokers report receiving no counseling by healthcare providers. In this study, we investigated rates of tobacco cessation education at ambulatory visits among patients with active malignancy. Methods: We identified ambulatory visits among current smokers with a diagnosis of malignancy using the National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of ambulatory visits in the US, from 2008 to 2018. We first determined weighted rates of documented smoking cessation counseling. We next evaluated sociodemographic characteristics, provider and visit type, and chronic conditions as determinants of counseling in this population using logistic regression. Results: We identified 2,437 total visits during the study period, representing an estimated 48.9 million such visits in the US. In this cohort, smoking cessation counseling was provided at 14.2% (95% confidence interval [CI] 12.1-16.7%) of visits. Patients were significantly less likely to receive counseling with older age (adjusted OR 0.97 per year of age; 95% CI 0.96-0.98) and less likely in surgical (OR 0.49; 95% CI 0.32-0.75) or medical subspecialties (OR 0.60; 95% CI 0.36-0.99) compared to primary care visits. Sex, race, year of visit, insurance type, and previous visit to the same provider were not significantly related to receipt of counseling. Patients with concomitant COPD were substantially more likely to receive counseling (OR 3.50; 95% CI 2.21-5.53), with 28.4% (95% CI 21.5-36.4%) of such visits including tobacco cessation education. Conclusions: Tobacco smoking is a modifiable risk factor associated with multiple malignancies and substantial non-neoplastic morbidity and mortality. Nonetheless, smokers with current malignancy receive smoking cessation counseling at only about one in seven outpatient visits, with lower frequency with advanced age and at subspecialty visits. As more effective treatments improve survival for cancer patients, further work is needed to improve tobacco cessation efforts that could improve survival and quality of life.[Table: see text]

Intelligent Transportation System

Abstract: People have experienced frequent communication and information exchange in recent years as a result of the proliferation of mobile devices. For example, when people go on vacations, it is common for each person to bring a smart phone with them to get information about nearby attractions. When a user visits a location, the application will provide useful information based on the user's current location preferences and previous visits to locations and their traffic signs. This new feature of map will learn your preferences and will display traffic signs in the area this system would display all traffic signs in and around the city including No Parking, Give Way, Speed Breakers ,Zebra Crossings ,Signals ,Tunnels, Sharp Curves, Speed ,No Overtaking Zones, Accidents Ponds, and Cycle Lanes. The use of popularity based filtering allows users to see all of the traffic signs in the area. Keywords: Traffic signs, Intelligent Transportation

Factors associated with weight loss in people with overweight or obesity living with type 2 diabetes mellitus: Insights from the global DISCOVER study.

To estimate real-world change in weight over 3 years and the factors influencing it in participants who are overweight and live with type 2 diabetes. DISCOVER is a multinational prospective observational study that enrolled participants with type 2 diabetes between December 2014 and June 2016 at the time of initiation of a second-line glucose-lowering medication (GLM). Demographic, anthropometric, and quality-of-life data were collected at baseline, and after 6, 12, 24 and 36 months of follow-up. Using a hierarchical, repeated-measures linear regression model, we examined factors associated with weight change over time. Of 10 675 participants with type 2 diabetes who were overweight/obese (mean age 57.1 ± 11.1 years, 46% women), 21% lost ≥5% weight over 3 years, which was associated with modestly improved physical and mental health. Advancing age, female sex, and higher baseline weight were associated with weight loss. Most importantly, the type of GLM prescribed at previous visit had the strongest impact on weight change over time independent of participant factors, with use of a sodium-glucose cotransporter-2 inhibitor or glucagon-like peptide-1 receptor agonist associated with 1.0% weight loss versus a 0.6% weight gain with sulphonylureas, thiazolidinediones, meglitinides or insulin. In this large contemporary prospective study, approximately one in five participants with early-stage type 2 diabetes and overweight/obesity lost ≥5% weight over 3 years. The type of GLM has the most impact on weight loss over time, highlighting the need for a careful selection of agents that takes baseline weight into consideration.

The influence of smoking on oral health and patient evaluation of tobacco cessation help from dentists working in the dental college of Bareilly city

Introduction: Dentists play a key role in assisting patients in quitting smoking. Dentists’ competence in smoking cessation as part of regular patient treatment is studied in this research. Methodology: Two hundred twenty-six patients were selected from the Institute of Dental Sciences Bareilly’s smoke cessation center to complete in-person cross-sectional research about previous dental visits Patients’ smoking patterns, as well as their smoking cessation experience from their dentists, and willingness for dentists to apply smoking cessation recommendations were all covered in the survey. Results: Overall, 38 percent of the subjects were current smokers, 8% were former smokers, and 68% had tried to stop smoking before. Former/non-smokers had significantly greater plaque index, gingival index, and probing depth levels than smokers (p0.05). The dentists’ approach to cessation conversations, on the other hand, was limited to a list of the negative consequences. Only 32% of patients were told about the negative impacts of tobacco, and only a third were encouraged to quit. Conclusions: Smoking causes dental health issues. Dentists in Bareilly City may inquire about their patients’ smoking habits, but they are less likely to provide actual assistance in quitting.

Predictors of blood glucose change and microvascular complications of type 2 diabetes mellitus patients in Felege Hiwot and Debre Markos referral hospital, North West Ethiopia

BackgroundMicrovascular complications lead to disability, dependency, and accelerated morbidity and mortality. This study aimed to identify predictors of blood glucose change and time to microvascular complications among patients with type 2 diabetes.MethodsA retrospective cohort study was conducted among type 2 diabetes mellitus patients enrolled between December 2014 and December 2015 at Felege Hiwot and Debre Markos Referral Hospital. A total of 318 T2DM patients were included in the study. Joint modelling of longitudinal and survival analysis was employed to identify predictors of Blood Glucose Change and Microvascular Complications in Type 2 Diabetes Mellitus Patients.ResultsThe prevalence of microvascular complications in Type 2 diabetes patients was 26.3%, 95%confidence interval(CI):(21.5, 31.1). Of which, half of the patients developed a microvascular complication after 30 months from the onset of the follow-up. The significant predictors of developing microvascular complication were positive proteinurea (adjusted hazard ratio (AHR) = 1.418, 95%CI: 1.080, 1.861), Serum creatinine (AHR = 3.704, 95%CI: 1.992, 6.887), Weight (AHR = 1.058, 95%CI: 1.023, 1.094), and log fasting blood glucose(log(FBS))(AHR = 1.013, 95%CI: 1.010, 1.015). The predictors of fasting blood glucose progression were higher baseline FBS(est(estimate) = 0.002,95%CI:0.0018, 0.0022), Systolic blood pressure (SBP) (est = 0.003, 95%CI: 0.002, 0.004), diastolic blood pressure (DBP) (est = 0.002, 95%CI: 0.0002, 0.004), and age (est = 0.003, 95%CI: 0.001, 0.004).ConclusionThe progression of the fasting blood glucose level for rural patients was faster than for urban patients. Patients having higher baseline FBS, previous hypertension history, higher SBP, higher DBP, older age, and fewer visits to the hospital have a relatively more progressive change in blood sugar levels. Patients having higher triglyceride levels, positive proteinuria, higher fasting blood sugar, higher weight, and a lesser number of hospital visits have a higher risk of developing a complication. In response to this finding, an aggressive intervention that targets to prevent microvascular complications is required.

Impact of Telehealth on Medication Adherence in Chronic Gastrointestinal Diseases.

BackgroundWith the COVID-19 pandemic, the demand and availability of telehealth in outpatient care has had exponential growth. Although use of telehealth has been studied and validated for various medical specialties, relatively few studies have looked at its role in gastroenterology.AimTo assess effectiveness of telehealth medicine in gastroenterology by comparing medication adherence rate for patients seen with telehealth and traditional in-person appointment for various gastrointestinal conditions.MethodsRetrospective chart review of patients seen in outpatient gastroenterology clinic was performed to identify patients who were given prescription to fill either through telehealth or in-person appointment. By using provincial pharmacy database, we determined the prescription fill rate.ResultsA total of 206 patients were identified who were provided new prescriptions or prescription renewal at their gastroenterology clinic visit. One hundred and three patients were seen through in-person visit during pre-pandemic period, and 103 patients were seen through telehealth appointment during COVID-19 pandemic. The mean age of patients was 49.2 years (55% female). On average, patients had 4.7 previous visits with their gastroenterologists before their visit. IBD management was the most common reason for visits (37.9% and 46.6% in telehealth and in-person groups, respectively). Prescription fill rate for patients seen through telehealth was 92.2% compared to 81.6% for the in-person group (OR: 2.69, 95% CI: 1.12–6.45; P = 0.023).ConclusionsMedication adherence rate for telehealth visits was higher than for in-patient visits. These findings suggest that telehealth can be an effective method of care delivery, especially for patients with chronic gastrointestinal conditions like IBD.

Assessment of risk factors for readmission in COPD patients at tertiary care centre RMCH Bareilly

COPD is currently one of the top 3 causes of death in the world with high morbidity and mortality. Various studies showed if symptoms of COPD patients are not well controlled then chances of admission & readmission has been increased. To find reasons for readmission in such patients this study was conducted. Between January 2020 and December 2021, we prospectively evaluated all the patients who were readmitted for acute exacerbation of COPD at tertiary care hospital RMCH Bareilly. Total 119 patients were enrolled in our study. Among 119 patients 25(21.0%) patients were readmitted for acute exacerbation of COPD. Patients discharged on LTOT among them 16(64.0%) were readmitted. Sputum culture among readmitted patients showed pseudomonal growth in 10(40.0%) as important risk factor. Common Comorbidities observed as diabetes mellitus 8(32.0%), hypertension 6(24%) of readmitted patients. Duration of hospital stay on previous visit of more than 6 days was observed in 12(48.0%) of readmitted patients. Average duration of hospital stays was 7+/-3 days. We found that there are multiple factors contribute to the risk of readmission in COPD patients. Risks can be minimised by ensuring regular follow up and proper adherence to the treatment, proper nutrition and pulmonary rehabilitation.

Factors Affecting Nonurgent Pediatric Emergency Department Visits and Parental Emergency Overestimation.

Understanding the factors causing nonurgent visits to the pediatric emergency departments (PED) is essential for developing effective interventions. Sociodemographic factors might have a direct effect, or they might be associated with other potential causal factors such as access, perceived severity, and convenience. Therefore, we aimed to evaluate the factors that might have an effect on nonurgent PED visits and parental overestimation of emergency severity. Data of a total of 974 patients who have been administered to the PED of a district state hospital were collected with a cross-sectional, self-administered survey. Level 5 was accepted as nonurgent cases according to the Pediatric Canadian Triage and Acuity Scale. Parents' assessment of their child's emergency status was assessed along with the age and sex of the child, the number of children, presence of a chronic illness, presence of fever, admission time, parental age, education status and occupation, transportation method, and living distance to emergency department. Sixty-eight percent of visits were nonurgent. Among these visits, 51.6% were perceived as urgent, and 11.5% as extremely urgent by the parents. We identified that infancy age group (P = 0.001), father's unemployment status (P = 0.038), presence of a chronic disease (P = 0.020), and a previous visit to the PED in the last week (P = 0.008) are associated with urgent visits. Having a fever (P = 0.002), younger mother (P = 0.046) and father age (P = 0.007), mother not having an income (P = 0.034), and father's lower level of education (P = 0.036) increased the likelihood of overestimating the emergency severity. Nonurgent visits constitute most of the PED admissions. Several factors were found to be associated with nonurgent visits either by causing a direct effect or by indirectly impacting the perceived severity. Health literacy-based interventions targeting common symptoms like fever and especially younger parent groups might be beneficial in lowering the patient burden of PEDs.

Non-Private Health Insurance Plans and Delayed Access to a Specialty Pediatric Concussion Clinic

Background:Delayed access to specialty concussion clinic results in a 5.5 times greater risk of protracted recovery and higher costs to the healthcare system. Previous research highlighting health equity disparities has shown that being female, of minoritized status, or having non-private health insurance doubles the risk of delayed access to specialty concussion clinic.Purpose:The purpose of this project was to better characterize those with non-private insurance receiving care at a specialty concussion clinic and examine factors potentially contributing to delayed access to specialty care.Methods:Medical records of 231 patients with non-private insurance were reviewed. Patients were divided into two categories (Equivocal, Unequivocal) based on handbook language requiring PCP referral. Equivocal were insurance plans with ambiguous language requiring PCP referral. Unequivocal were insurance plans with a specific statement requiring a referral. Access to clinic was defined as early (0-7 days) or delayed (8-20 days). Descriptive stats were run to determine the number of males/females, providers previously seen, and if previously seen in the Emergency Room (ER). A one-way analysis of variance (ANOVA) was run along with Tukey post hoc to determine if there were any significant differences between number of previous providers seen and previous ER visit in the average number of days to specialty care.Results:Most patients, 97% (n=224) were in the equivocal category. The equivocal category was mostly male (n=145, 64.7%) and of minoritized status (n=177, 79%) with over 35% (n=80) being delayed to clinic (M=6.8 days, SD=4.7). The majority of those in the equivocal category (n=157, 67.9%) saw at least one previous provider, 53% being evaluated first in an ER (n=119). Those with a previous provider visit took longer to seek specialty care (F(2,230) = 3.54, p = 0.03). Those seeing two previous providers (M=9.4 days) on average took more days to get to initial specialty care compared to seeing one previous provider (M=6.8 days) or going straight to clinic (M=6.2 days).Conclusion:Patients with a non-private health insurance plan experience delayed access to specialty concussion care. Those with equivocal insurance plan language were delayed to clinic, seen by multiple providers, and first evaluated in the Emergency Room. Non-private insurance is often financially subsidized, yet the equivocal language in these policies could be a detriment contributing to overall increases in health care costs and quality of care for those who have sustained a concussion.

Meibomian Gland Dysfunction Associated with Bortezomib in a Multiple Myeloma Patient

Purpose: This study reports a case of meibomian gland dysfunction associated with bortezomib, which is a treatment of choice for multiple myeloma.Case summary: A 59‐year‐old female patient presented to our hospital with a complaint of dryness that had worsened for 2 months and eye discharges that were difficult to remove even after washing her face. The patient had been diagnosed with multiple myeloma 5 months prior and had undergone four cycles of bortezomib therapy. Slit‐lamp microscopy revealed a number of pouting of the meibomian gland (MG) orifices in both eyes. Meibography revealed that more than one‐third and less than twothirds of the total MG area of both upper lids were lost and more than two‐thirds of the total MG area of both lower lids were lost. No clinically significant improvements were noted at 8 months despite thorough eyelid hygiene therapy, including warm compresses, topical antibiotics, steroids, and artificial tears. However, when the patient revisited our clinic 2 months after completing bortezomib treatment, the subjective symptoms had improved and all of the pouting of MG orifices had disappeared. There was no significant difference in the MG dropout area for either eye compared with the observations from a previous visit during bortezomib treatment.Conclusions: Clinicians should be aware that MG dysfunction may occur or worsen in patients receiving bortezomib treatment and should consider this when establishing a treatment plan for meibomian dysfunction or when educating patients.

Telemedicine Service for Keratoconus Monitoring: Patient Satisfaction and Prospects for Further Expansion.

Introduction: During the COVID-19 pandemic, keratoconus patient care moved from in-person clinics to virtual care. We surveyed patient satisfaction with the new virtual clinic model. Methods: We assessed the views of keratoconus patients enrolled in the novel virtual service between June 1 and July 31, 2020, in individual structured telephone interviews using Likert questions. Results: Of the 88 patients enrolled, the opinions of 69 patients could be evaluated (78.4%). Compared with previous in-person visits, mean waiting times for diagnostic examinations dropped from 43 (±32) min to 4 (±3) min (p < 0.001). The majority of patients (68; 99%) were satisfied or very satisfied with the overall service irrespective of the communication channel (telephone or video). A majority also indicated a desire to continue attending the virtual keratoconus clinic after the pandemic and supported the idea of decentralized sites for future diagnostic measurements. Discussion: A novel virtual service to monitor keratoconus progression was well received and was associated with shorter waiting times. There was a strong interest on the part of patients to further develop the virtual keratoconus clinic. Conclusions: This study demonstrates that keratoconus patients managed very well the conversion from in-person to virtual care. A solid majority of keratoconus patients also supported further expansion of the virtual consultations to a completely decentralized telemedicine model.

Levels of Anxiety and Fear Related to Non-Surgical Root Canal Treatment Performed by Endodontic Residents and Endodontists

ObjectivesDespite advances in endodontic treatment procedures, root canal treatment is still associated with anxiety and fear. This may cause care avoidance and subsequent oral complications due to untreated endodontic infections. Anxiety and fear levels in response to non-surgical root canal treatment performed by endodontic residents and endodontists were analyzed.MethodsA descriptive, cross-sectional survey was conducted among patients visiting the endodontic clinics at the University Dental Hospital. The questions addressed the participant's demographics, previous root canal treatment visits, clinician's level of training, and post-treatment experience.ResultsDemographics play a role in anxiety and dental fear in root canal treatment. Men scored significantly lower in the high-anxiety category than women, and patients treated by endodontic residents expressed lower levels of anxiety. Post-treatment experience of an endodontist or endodontic resident was a significant factor in reducing dental fear and anxiety.ConclusionThe level of anxiety and fear related to root canal experience of endodontists or endodontic residents is very low. Most of the patients expressed willingness to undergo further root canal treatment to save a tooth.

Are Patients Satisfied with Healthcare Services in Hospitals? Which Dimensions Influence it?

Objectives: To determine the patient satisfaction with health care services provided in hospitals, disregard of whether private or public Methodology: A cross-sectional online survey was conducted from January to October 2020 who had utilized health services from private or public hospitals. A questionnaire was used for assessing the satisfaction in various dimensions; Likert scales were used for quantifying the level of satisfaction. A formal approval of ERC from the parent institution and informed consent was sought. The sample size was 384 keeping the expected satisfaction at 50%; non-probability sampling was done. Multiple variables were used to assess patient satisfaction. They were grouped into four thematic areas, and a mean score was given to each. Results: The mean age of participants was 25.19 ± 6.99. More than half of the participants (59.9%) visited a private hospital compared to only 27% visiting a government hospital. Overall, 257 (88.9%) participants were satisfied with their previous visit. The satisfaction levels varied with various dimensions; with quality of doctor 73.2%; the environment and basic facilities 76.8%; the process of seeking care - 57.4%; and with medicine and diagnostic facilities 67.4%. Conclusion: Three-quarters of the study population were satisfied with their last hospital visit. The perceived quality of doctors, the ambiance and hospitals' general facilities make a difference in patients' satisfaction. The follow-up visits and compliance with the treatment are influenced by how satisfied one is with the last visit.

Predictors of laminitis development in a cohort of nonlaminitic ponies.

Quantifying risk factors for laminitis development requires improvement. To identify the most useful physical examination, metabolic and management factors to predict laminitis development in client-owned, nonlaminitic ponies. Prospective cohort study. Physical examination, metabolic and management data were collected from a pony cohort 6 monthly for up to 4years. Ponies were monitored for the development of laminitis. Metabolic data included basal plasma concentrations of ACTH ([ACTH]), adiponectin ([adiponectin]), triglycerides and glucose. Serum insulin concentrations ([insulin]) were measured in the unfasted basal state ([insulin]T0) and 60minutes ([insulin]T60) after administration of corn syrup (0.3ml/kg). Separate multivariable Cox proportional-hazards models were developed for physical, management/signalment and metabolic data and later combined into two final models. Low-, medium- and high-laminitis risk categories were defined based on basal or T60 [insulin]. Overall, 374 ponies (age 5-32years) and 891 pony-years were included in the main analysis. Laminitis incidence (95% confidence interval (CI)) was 4.8 (3.5-6.5) cases/100 pony-years. Laminitis development was associated with numerous univariable factors. Significant (P<.05) factors retained in the final multivariable models included [insulin]T0, [insulin]T60, [adiponectin] and divergent hoof growth. [ACTH] was not independently associated with laminitis. Based on [Insulin]T0, low- (<21.6 µIU/ml), medium- (21.6-45.2 µIU/ml) and high-risk (>45.2µIU/ml) categories encompassed 70, 20 and 10% of the population and had estimated 4-year laminitis incidences (95%CI) of 6 (2-9)%, 22 (10-33)% and 69 (48-82)% respectively. Based on [Insulin]T60 the low- (<53.4µIU/ml), medium- (53.4-153µIU/ml) and high-risk (≥153µIU/ml) categories comprised 60, 30 and 10% of the population and had estimated 4-year laminitis incidences (95%CI) of 3 (0-6)%, 20 (10-29)% and 73 (52-84)% respectively. Results may not apply to different insulin assays, geographical regions, breeds or management types. [Insulin]T0 or [insulin]T60 best quantify the risk of future laminitis development in nonlaminitic ponies.

Improving Road Segmentation in Challenging Domains Using Similar Place Priors

Road segmentation in challenging domains, such as night, snow or rain, is a difficult task. Most current approaches boost performance using fine-tuning, domain adaptation, style transfer, or by referencing previously acquired imagery. These approaches share one or more of three significant limitations: a reliance on large amounts of annotated training data that can be costly to obtain, both anticipation of and training data from the type of environmental conditions expected at inference time, and/or imagery captured from a previous visit to the location. In this research, we remove these restrictions by improving road segmentation based on <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">similar</i> places. We use Visual Place Recognition (VPR) to find <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">similar but geographically distinct</i> places, and fuse segmentations for query images and these similar place priors using a Bayesian approach and novel segmentation quality metric. Ablation studies show the need to re-evaluate notions of VPR utility for this task. We demonstrate the system achieving state-of-the-art road segmentation performance across multiple challenging condition scenarios including night time and snow, without requiring any prior training or previous access to the same geographical locations. Furthermore, we show that this method is network agnostic, improves multiple baseline techniques and is competitive against methods specialised for road prediction.