Private Outpatient Clinic Research Articles

Patient Experience and Barriers to the Visual Field Test for Glaucoma.

There are significant mental, physical, and perceptual challenges in patients undergoing visual field testing, particularly in the elderly population with glaucoma. To quantitatively and qualitatively investigate patient experiences of undergoing visual field testing. This cross-sectional, mixed-methods study involves adult patients attending a private outpatient ophthalmology clinic in Brisbane, Australia. Participant experiences of visual field testing were assessed using a 100mm visual analog scale (VAS), followed by face-to-face semi-structured interviews. Outcome data comprised of VAS scores (1-100) and thematically analyzed verbatim notes. Of the 152 participants [M:F 79 (52.0%):73 (48.0%)], the age group with the highest proportion of participants was 71-80 years [n=56 (36.8%)], and most had a primary ocular diagnosis of glaucoma [n=107 (70.4%)]. The mean VAS score for visual field testing experience was 60.45 (SD=30.38). The mean VAS score of participants with glaucoma was significantly lower than that of participants without glaucoma [55.34 (31.13) vs. 72.67 (25.04); P <0.05]. Prevalent themes regarding participant experiences of visual field testing consisted of concentration difficulties, intra-test and peri-test anxiety, skepticism in the testing process, and physical discomfort. Age, sex, and mean visual field index did not influence participant experiences of visual field testing. Mental and physical barriers to visual field testing tolerability were identified in a predominantly elderly population with glaucoma. Our findings highlight the importance of addressing patient concerns and apprehensions regarding visual field testing and emphasize the value of patient-initiated breaks, particularly for individuals experiencing concentration difficulties and physical discomfort.

Neuronavigated Right Orbitofrontal 20 Hz Theta Burst Transcranial Magnetic Stimulation Augmentation for Obsessive-Compulsive Disorder with Comorbid Depression and Anxiety Disorders: An Open-Label Study.

Despite the availability of pharmacotherapy and psychotherapy for treating obsessive-compulsive disorder (OCD), alternative approaches need to be explored due to the high likelihood of treatment resistance. Neuronavigated 20 Hz theta burst stimulation (TBS-20 Hz), targeting the bilateral dorsolateral prefrontal cortex (DLPFC) augmented with the right orbitofrontal cortex (ROFC), was tested for treating OCD comorbid with depression and anxiety disorders. A retrospective chart review was performed on fourteen patients treated for moderate-to-severe OCD in a private outpatient clinic. Twelve patients had comorbid major depressive disorder (MDD), and thirteen patients had either generalized anxiety disorder (GAD) or panic disorder (PD). Patients completed the Y-BOCS-SR, BDI-II, and BAI rating scales weekly, which were used to measure the changes in OCD, depression, and anxiety symptoms, respectively. Neuronavigated TBS-20 Hz was sequentially applied to the right DLPFC (RDLPFC), left DLPFC (LDLPFC), and ROFC. A total of 64% (9/14) of patients achieved remission from OCD (Y-BOCS-SR ≤ 14) in an average of 6.1 weeks of treatment (SD = 4.0). A total of 58% (7/12) of patients remitted from MDD (BDI < 13) in an average of 4.1 weeks (SD = 2.8), and 62% (8/13) of patients remitted from GAD/PD (BAI < 8) in an average of 4.3 weeks (SD = 2.5). The neuronavigated TBS-20 Hz sequential stimulation of RDLPFC and LDLPFC, followed by ROFC, significantly reduced OCD, MDD, and GAD/PD symptoms. Randomized sham controls are warranted to validate these results.

Common Comorbidities in Patients with Remitting Seronegative and Symmetrical Synovitis with Pitting Edema (RS3PE).

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is considered a rare inflammatory rheumatologic disorder that is seen primarily in older adult men. Patients present with arthralgias of large joints accompanied by painful pitting edema of the hands and feet. Few studies have reported the prevalence of metabolic syndromes, including diabetes mellitus and hyperlipidemia in these patients. This case series reviewed 25 patients who were diagnosed as having RS3PE in a private outpatient clinic. Nearly half of the patients (48%) had diabetes mellitus, predominantly type 2, and more than half of the patients (60%) had hyperlipidemia. We believe that future case studies on RS3PE should include an assessment of various comorbidities that can be seen in patients with this autoinflammatory disorder. The increased availability of musculoskeletal ultrasound provides a potential area of study to differentiate this disorder from other inflammatory arthritis and improve reaching the correct diagnosis.

A - 153 Differing Impacts of Divided Auditory and Visual Attention on Abstract Reasoning among Patients with Mild Traumatic Brain Injury.

Although not all mild traumatic brain injuries (mTBIs) lead to long-term effects, they can still have significant cognitive and emotional impacts. One of the common lasting symptoms of mTBI is attentional deficit, with divided attention being specifically negatively impacted by mTBIs. This study investigated the impacts of divided auditory attention and divided visual attention on executive functioning among patients with mTBI. Participants were 98 mTBI patients. Ethnicity was self-identified as 77.5% White, 6.3%, Asian, 2.7% Hispanic, and 13.5% Mixed/Other, gender was 68% women. Tests included the Neuropsychological Assessment Battery (NAB) Numbers & Letters Test to assess divided visual attention, Paced Auditory Serial Addition Task (PASAT) for divided auditory attention, and the Halstead Category Test (HCT) to assess the abstract reasoning domain of executive functioning as part of a full neuropsychological evaluation at a private outpatient clinic. Multiple linear regression was used to analyze the data. The overall model was statistically significant (F(3,94) = 3.23, p = 0.03, R2 = 0.09). Results indicated a significant positive relationship between abstract reasoning and auditory divided attention (β= 2.42, p = 0.03), but no significant relationship between abstract reasoning and visual divided attention (β= 1.5, p = 0.2). The findings of this study suggest that divided auditory and visual attention may impact the abstract reasoning and problem-solving domain of executive functioning differently among those who have sustained mild traumatic brain injury. Specifically, divided auditory attention may play a more significant role in abstract reasoning abilities than visual divided attention.

Metacognitive interpersonal therapy-eating disorders versus cognitive behavioral therapy for eating disorders for non-underweight adults with eating disorders: study protocol for a pilot pre-registered randomized controlled trial.

Eating disorders (ED) are serious disorders characterized by an alteration of eating habits and excessive concern about weight and body shapes (Fairburn, 2002), accompanied by significant impairment inequality of life, high mortality rates and serious organic consequences (Jenkins et al., 2011; Treasure et al., 2015; 2020). Although evidence-based psychological therapies for nonunderweight ED presentations such as cognitive behavioral therapy for eating disorders (CBT-ED) are widely available, there is substantial scope for improvements, particularly in terms of efficacy and adherence. One option is to develop interventions to address elements of pathology not fully addressed by existing empirical supported treatments, such as incorporating techniques aimed at addressing interpersonal problems and personality disorder features into existing treatment delivery. We adapted Metacognitive Interpersonal Therapy, a psychological intervention supported by evidence for treating personality disorders and integrated it with existing CBT techniques for eating disorders (MIT-ED). MIT-ED targets aspects of ED that are not included in the transdiagnostic CBT-E model such as poor metacognition, or maladaptive interpersonal schemas. This is a pre-registered (Protocol number: 0000781) pilot randomized clinical trial aimed at assessing acceptability and feasibility of MIT-ED and establishing preliminary evidence of effectiveness for future larger studies. Twenty patients (10 in each arm) will be randomized to 20 sessions of individual psychotherapy, either MIT-ED or CBTE. Repeated follow-ups will be collected up to 24 months. Participants are recruited at a private outpatient clinic for ED treatment. Acceptability will be assessed via session attendance, completion rates and preliminary outcomes. The primary outcome is ED pathology assessed with the Eating Disorder Examination Questionnaire-6. Other ED outcomes assessed will be eating disorder attitudes, clinical impairment and binge eating pathology. Secondary treatment outcomes are anxiety, depression, and global symptomatology. We will also assess emotional awareness, emotion regulation and therapeutic alliance. Based on previous studies of MIT for personality disorders we hypothesize that MIT-ED will be acceptable to patients, evidenced by high treatment adherence and retention. We hypothesize that MIT-ED will be associated with reductions in eating disorder pathology, at least equivalent to CBT-E. Results will be used to inform the study design, sampling, likely effect sizes and choice of outcome measures for future larger trials of MIT-ED in ED samples.

Pattern of Compliance and Efficacy of Repetitive Transcranial Magnetic Stimulation Protocol for Treating Major Depressive Disorder Among Treatment Participants and Completers: A Report From Iran.

Since the introduction of the Food and Drug Administration (FDA)-approved repetitive transcranial magnetic stimulation (rTMS) intervention in 2008, a breakthrough has been made in treating major depressive disorder (MDD). However, many sessions of treatment and its cost make it inconvenient for those who seek treatment, especially in large cities as well as in developing countries. A total of 22 patients (out of initial 24 referrals) who met diagnostic and statistical manual of mental disorders, 4th edition (DSM IV) criteria for MDD were enrolled in the study. All subjects had to fail at least one prior treatment for depression. The patients received the FDA-approved protocol of high-frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex. Seventeen out of twenty-two cases showed significant improvements after two weeks of treatment. Only six patients continued their treatments for the next two to four weeks. We have replicated other studies showing that the use of rTMS is effective for many patients with MDD without major side effects and their improvements are measurable mostly after two weeks. Our data highlight the importance of the application of more convenient protocols that require fewer sessions on fewer days to help with compliance and outcome, particularly in large populated cities and countries, such as Iran going through economic hardship. Repetitive transcranial magnetic stimulation (rTMS) is effective for treating major depresion.Improvemens are measurable after 2 weeks of treating with rTMS.Compliance is a major factorto for completing rTMS protocols. Major depression is one of the most common psychiatric disorders leading to debilitating course causing significant burden for the society. Many cases with major depression are resistent to treatment as they try multiple interventions with no success. This condition is also called refractory depression. rTMS is a novel intervention introduced first almost two decades ago to treat refractory depression among some other psychiatric disorders. In this intervention pulses generated by magnetic stimulation over the brain leads to improvement is depression. As this treatment is safe with no pain and discomfort there have been much interest in the field to use it more frequently. rTMS is usually done over 15-30 sessions with its maximum effects appearing within the first two weeks of treatment. The number of sessions is a potential factor contributing to poor compliance in some cases especially those living in large metropolitan areas. In this paper we explored compliance and effect of treatment within the first two weeks among a group of patients in a private outpatient clinic of a large metropolitan area.

Service Utilization for Parent Management of Early Childhood Behavior Problems in a Private Outpatient Behavioral Clinic: The Impact of Out-of-Pocket Cost, Travel Distance, and Initial Treatment Progress.

Poorly-managed early childhood disruptive behavior disorders (DBDs) have costly psychological and societal burdens. While parent management training (PMT) is recommended to effectively manage DBDs, appointment adherence is poor. Past studies on influential factors of PMT appointment adherence focused on parental factors. Less well studied are social drivers relative to early treatment gains. This study investigated how financial and time cost relative to early gains influence PMT appointment adherence for early childhood DBDs in a clinic of a large behavioral health pediatric hospital from 2016 to 2018. Using information obtained from the clinic's data repository, claims records, public census and geospatial data, we assessed how owed unpaid charges, travel distance from home to clinic, and initial behavioral progress influences total and consistent attendance of appointments for commercially- and publicly-insured (Medicaid and Tricare) patients, controlling for demographic, service, and clinical differences. We further assessed how social deprivation interacted with unpaid charges to influence appointment adherence for commercially-insured patients. Commercially-insured patients had poorer appointment adherence with longer travel distances, or having unpaid charges and greater social deprivation; they also attended fewer total appointments with faster behavioral progress. Comparatively, publicly-insured patients were not affected by travel distance and had higher consistent attendance with faster behavioral progress. Longer travel distance and difficulty paying service costs while living in greater social deprivation are barriers to care for commercially-insured patients. Targeted intervention may be needed for this specific subgroup to attend and stay engaged in treatment.

Discriminative capacity of guideline recommendations in the assessment of patients with asymptomatic microhematuria.

Asymptomatic microhematuria (aMh) remains a diagnostic challenge in urological practice: while aMh is a risk factor of urothelial carcinoma (UC), prevalence of aMh is high. Guidelines were developed to permit risk stratification and reduce diagnostic workload. This study investigates the efficacy of several recommendations. Sixty hundred eight patients with newly diagnosed aMh without previous UC from an academic referral center (A; n = 320) and a private outpatient clinic (B; n = 288) were included. All patients underwent clinical workup including medical history, urine cytology, upper tract imaging and cystoscopy. Eleven former and current guidelines were applied to each patient individually; every patient was classified as either low risk (no further workup recommended) or high risk. Furthermore, a recently developed nomogram for hematuria assessment was included. The cohort comprised 142 females and 466 males (mean age 62 [range 18-92] years). Sixty-one patients (10.0%) were diagnosed with UC. Excluding the Swedish and recent NICE guideline generally advising against urologic workup, application of 9 other recommendations would have diagnosed all UCs and saved 1.6% to 16.1% of patients from workup. For the 2020 US guideline, solely applied to cohort B, 10.6% of patients were classified as low risk. The use of the nomogram would have saved 17.1% to 25% of patients from workup. Practical relevance of current guidelines is limited as they do not sufficiently identify patients not requiring clinical work up. Thus, guideline adherence may trigger overdiagnosis and even overtreatment. New ways of risk stratification are needed to improve aMh assessment.

How Registered Dietitian Nutritionists become and Practice as International Board Certified Lactation Consultants: Words of Advice and Calls to Action.

Breastfeeding is the normal way to feed human infants. While RDNs are called to support and promote breastfeeding, they receive little professional training in undergraduate programs. Additionally, there are relatively few RDNs who also hold a lactation credential. In order to explore how dietitians can pursue lactation training, 12 RDNs who were International Board Certified Lactation consultants were interviewed about their experiences pursing and using the IBCLC credential. Most RDNs pursued IBLCE pathway 1, had the CLC certification first, and pursued the IBCLC because they were exposed to lactation in their practice setting and had difficulty with breastfeeding a child. Many worked in private practice, outpatient clinics, and public health. Only 1 currently practiced inpatient care. Several RDNs mentioned that they were not able to practice inpatient lactation care because they were not RNs. Private practice and outpatient clinic RDN IBCLCs billed for services. Percent of time spent providing lactation care ranged from 10 - 90% of their practice time. Most of the private practice RDN IBCLCs had clients pay directly, however, billing insurance through a third party was also used. RDNs are s underrepresented in the field of lactation. Additionally, while RDN IBCLCs are prevalent in private practice, they face barriers to practicing inpatient lactation care. Lactation may provide RDNs with opportunities to bill for additional services and promote revenue generation as well. Calls for action include adding lactation to undergraduate education and promoting RDNs in inpatient lactation care.

Sedative use and incidence of falls and hip fractures among older adults in an outpatient geriatric clinic

Objective: To investigate the use of sedatives by older adults attending a private outpatient geriatric clinic in Belo Horizonte (MG), Brazil, and its association with falls and hip fractures. Methods: Using a longitudinal design, the prevalence of benzodiazepine and nonbenzodiazepine (“z-drugs”) intake by older adults was described and their association with the incidence of falls and fractures (30 days after the initial visit) was evaluated through logistic regression. Results: A total of 7821 older adults were included in the study, most of them women (72.50%), with a mean age of 77.5 years and a mean Clinical-Functional Vulnerability Index (IVCF-20) score of 16.5. The overall prevalence of sedative use (any sedative) was 6.19%, with 4.48% benzodiazepines and 1.98% z-drugs. The most widely used sedatives were clonazepam (29.04%), zolpidem (28.65%), and alprazolam (23.44%). Falls were reported for 182 patients (2.33%), with a higher incidence among users of any sedatives (4.34; p = 0.002; OR = 1.94, adjusted for sex, age, and IVCF-20) and benzodiazepines (5.14%; p &lt; 0.001; OR = 2.28) than among non-users (2.19%). Hip fractures occurred in 33 patients (0.42%), and again were more frequent among users of sedatives (1.03%; p = 0.032; OR = 2.57) and benzodiazepines (1.43%; p = 0.003; OR = 3.45) than among non-users (0.38%). Conclusions: The use of sedatives, especially benzodiazepines, is associated with an increased incidence of falls and hip fractures in older adults.

Antibiotic prescriptions for child sinusitis varied between specialties after Finnish guidelines were updated in 2018.

We evaluated antibiotic prescriptions issued for Finnish children with acute sinusitis by a nationwide private outpatient clinic network from 2014-2020. Data were compared before and after updated guidelines in 2018. The study comprised data on 45 296 children aged 2-17 years with acute sinusitis, namely diagnoses, ages, dates, the doctor's specialty and any antibiotics. We measured compliance with the updated 2018 Finnish guidelines, which recommended amoxicillin or amoxicillin-clavulanic acid for children under 12 years old, with doxycycline as an alternative for 12 years plus. There were 6621-7585 visits per year for acute sinusitis in 2014-2019 and 2954 in 2020. Antibiotics were prescribed for 37.9%-41.6% of patients during the study years. Amoxicillin, including penicillin, accounted for 35.9% of prescriptions, followed by amoxicillin-clavulanic acid (26.9%). Macrolides accounted for 20.6% and, encouragingly, decreased by 38% from 2014-2019. Doxycycline accounted for 5.3%. Paediatricians, general practitioners (GPs) and ear, nose and throat specialists followed the guidelines in 75.1%, 73.8% and 66.7% of cases, respectively. GPs prescribed antibiotics more often than other physicians. Antibiotics were prescribed for about 40% of acute sinusitis visits by Finnish children from 2014-2019. Specialities differed with regard to prescribing rates and whether they followed the guidelines.

Real-world depression, anxiety and safety outcomes of intramuscular ketamine treatment: a retrospective descriptive cohort study

BackgroundKetamine has emerged as a promising pharmacotherapy for depression and other mental illnesses, and the intramuscular (IM) administration of ketamine is now offered at many North American outpatient psychiatric clinics. However, a characterization of the outpatient population receiving IM ketamine treatment and an evaluation of the real-world depression, anxiety, and safety outcomes of long-term psychiatric IM ketamine treatment has not been reported. This study aimed to evaluate the clinical characteristics, treatment patterns, clinical outcomes, and adverse events of patients receiving IM ketamine treatment.MethodsPatient data from the electronic health records of a private outpatient psychiatric clinic network in the United States were collected and analyzed retrospectively. Adults with any psychiatric diagnosis who received ketamine treatment only by IM administration from January 2018 to June 2021 were included. A total of 452 patients were included in the cohort.ResultsPatients receiving IM ketamine treatment had a mean of 2.8 (SD 1.4) psychiatric diagnoses. 420 (93%) patients had a diagnosis of major depressive disorder, 243 (54%) patients had a diagnosis of generalized anxiety disorder, and 126 (28%) patients had a diagnosis of post-traumatic stress disorder. Patients received a median of 4 (range 1–48) IM ketamine treatments. Median depression scores (PHQ-9) improved 38% from 16.0 (IQR 11.3–21.8) at baseline to 10.0 (IQR 6.0–15.0) at last treatment (p < .001). Median anxiety scores (GAD-7) improved 50% from 14.0 (IQR 8.0–17.0) at baseline to 7.0 (IQR 4.3–11.8) at last treatment (p < .001). With maintenance ketamine treatments, average improvements in depression (PHQ-9) and anxiety (GAD-7) scores of at least 4.7 and 4.9 points were maintained for over 7 months. An adverse event occurred during 59 of 2532 treatments (2.3%).ConclusionsIM ketamine is being utilized to treat psychiatric outpatients with multiple mental illnesses not limited to depression. Average depression and anxiety levels significantly improve throughout IM ketamine treatment and do not regress to baseline during patients’ maintenance treatment phase. Prospective studies are recommended to confirm the long-term effectiveness and safety of IM ketamine.

Factors Associated with Poor Glycemic Control: A Real World Data from a Private Outpatient Clinic of South Punjab, Pakistan

Factors Associated with Poor Glycemic Control: A Real World Data from a Private Outpatient Clinic of South Punjab, Pakistan

Misoprostol for cervical preparation before IUCD insertion in patient with no previous vaginal birth

Background: Intrauterine devices (IUD) are extensively used as reversible contraceptives. Copper &amp; Levonorgestrel releasing IUD (LNG (are safe, cost-effective over the long term, and just as effective in relation to others with tubal sterilization. Aim of study: To investigate the effect of oral misoprostol on facilitating intrauterine device (IUD) placement in patients with a history of cesarean sections (Cs). Method: It was a randomized clinical trial (RCT) study carried out on 98 women eligible for IUCD inclusion in the private outpatient clinic (obstetrics and gynecology) in search of contraception in the cities of Mosul and Erbil. This study ran from February 2020 to July 2021. All participants who requested an IUD had already had one or more cesarean sections and had never given birth vaginally. Participants were randomized into two equal groups; the first group was given misoprostol orally and the second group was given placebo 3 h before insertion of the IUD. Result: In this clinical trial study, the mean age of the cases was (29 year) and for control group was (34.1year). The (ARR) is (0.2449), which reflects how much misoprostol lessens the risk of difficulties in IUD insertion. Women with cervical misoprostol preparation were found to have much higher abdominal cramps than those with placebo, with P value 0.0135. Inserting the IUD was a lot easier in the misoprostol group than in the placebo group, with P value of 0.0018 (&lt;0.05) very significant. A higher incidence of complications like vaginal bleeding was also observed in the misoprostol group, with P value 0.0381 and the efficacy of the use misoprostol in the study group was (26%). Conclusion: Our study found that a pill of misoprostol was administered orally before the insertion of an IUD in women who had not had a vaginal birth facilitated the insertion process

Impact of Dialectical Behavior Therapy Prolonged Exposure protocol on trauma-related symptoms in Egyptian women with Borderline Personality Disorder

IntroductionAlthough around 50% of individuals with borderline personality disorder (BPD) suffer from trauma-related disorders, literature lacks a specific treatment for these serious co-occurring problems. Dialectical Behavior Therapy Prolonged Exposure (DBT PE) is a recent protocol developed by Melanie Harned, integrating (PE) into standard (DBT). The protocol has showed promising results in treating comorbid PTSD in BPD patients. The current study, however, was the first trial to apply DBT PE protocol in Egypt.ObjectivesTo investigate the efficacy of (DBT PE) protocol in reducing trauma-related symptoms (psychological trauma symptoms and trauma-related cognitions) among Egyptian women with BPD.MethodsSixteen women diagnosed with BPD and trauma-related symptoms, were recruited from “DBT clinic”, a private outpatient clinic in Alexandria, Egypt and randomly divided into equivalent (Therapeutic &amp; Control) groups. The therapeutic group received DBT PE protocol while the control group received Treatment as usual (TAU). Participants were assessed pre and post-intervention using: The short version of the Borderline Symptom list, The Trauma Symptom Checklist-40, and The Posttraumatic Cognitions Inventory. The therapeutic group started treatment with standard comprehensive DBT concurrently with DBT PE protocol (14 individual sessions, 120 minutes/ week), according to readiness criteria suggested by the treatment developer.ResultsPatients who received DBT PE protocol showed significantly lower degrees of psychological trauma symptoms and trauma-related cognitions compared to patients in control group.ConclusionsDespite being applied for the first time in Egypt, DBT PE protocol proved to be an effective intervention in reducing trauma-related symptoms in a sample of Egyptian BPD patients without any need to modify the original protocol.DisclosureNo significant relationships.

Analysis of Immunization and Immunization Coverage in Children’s Outpatient Clinics of Any Type (Public or Private): Cross-Sectional Study

Background. Worldwide private health care system plays significant role in promoting immunization programs for the children population. The role of private medical facilities in Russia in combating children vaccination issues has not been previously studied.Objective. The aim of the study is to study immunization and immunization coverage in children population according to the national immunization schedule (NIS) in outpatient clinics of different forms of property.Methods. The study of medical documentation of children in private (n = 1) and public (n = 2) facilities in Moscow and Moscow region was performed. Immunization (complete vaccination course in those who should be vaccinated by age) and immunization coverage (at least one dose of vaccine by those who have to be vaccinated) were estimated against the NIS schemes according to the data from preventive vaccination cards (form 063/y) and from preventive vaccination lists (form 112/y).Results. The study includes 313 cards of children from private outpatient clinic and 305 — from public outpatient clinic. Immunization and immunization coverage of children against tuberculosis were similar in these facilities: 293 (94%) and 294 (96%) (p = 0.114), respectively, as well as immunization coverage against hepatitis B — in 282 (90%) and 269 (88%) (p = 0.448). Rates of immunization and immunization coverage against the remaining NIS infections were higher in the private clinic. Maximum differences were noted in immunization (178 (57%) in private and 19 (6%) in public facilities; p &lt; 0.001) and immunization coverage (238 (76%) and 52 (17%), respectively; p &lt; 0.001) against pneumococcal disease. Immunization coverage of children for epidemic indications was also higher in private clinic: the largest differences were in immunization against hemophilic and meningococcal infections.Conclusion. Children followed up in private outpatient clinic have higher immunization and immunization coverage rates against most of the NIS infections.

Weight-Bearing Computed Tomography of the Foot and Ankle in the Pediatric Population.

Newer cone-beam computed tomography (CT) technology has grown in popularity for evaluation of foot and ankle pathology in the weight-bearing (WB) position. Many studies have demonstrated its benefits within the adult population, but there is a paucity of its use within the pediatric literature. The purpose of this study was to describe the indications and clinical findings of WBCT within a pediatric population. A retrospective cohort of 68 patients (86 extremities) who underwent WBCT for a variety of conditions were compared with 48 patients (59 extremities) who underwent traditional supine nonweight-bearing (NWB) CTs. Clinical indications, demographic data, radiation doses, and cost were obtained from the medical record. WBCTs were obtained in a private outpatient orthopaedic clinic, and the conventional NWBCTs were obtained within a hospital-based system. The most common indications for obtaining a WBCT and NWBCT in our study were fracture, tarsal coalition, and Lisfranc injury. The average WBCT radiation dose was 0.63 mGy for patients <100 lbs and 1.1 mGy for patients >100 lbs undergoing WBCT. For NWBCTs, the average radiation dose was 7.92 mGy for patients <100 lbs and 10.37 mGy for patients greater than 100 lbs. There was a significant reduction in radiation dose for all patients who underwent WBCT (P<0.0001 vs. 0.002). The average reimbursement for NWBCTs was $505 for unilateral studies and $1451 for bilateral studies. The average reimbursement for the WBCTs was $345 for unilateral studies and $635 for bilateral studies. WBCT offers a new modality for studying complex foot and ankle pathoanatomy in the pediatric population at a reduced radiation exposure and reduced cost. Level III-a retrospective comparative study.

Compliance of Appointment, Antidiabetic Treatment, and Diet in Type 2 Diabetes Mellitus Patients at Private Diabetes Clinic

Context: India is an epicenter of type 2 diabetes mellitus (T2DM) in the entire world. Compliance is essential for chronic diseases treatment and has a significant impact on health and health care costs. The current study was planned to assess compliance to the appointment, treatment, and diet in T2DM patients at a private diabetic clinic in Rajkot city. Aims: The aim was to assess compliance to physician’s appointment, antidiabetic treatment, and diet among T2DM patients attending private diabetic clinic at Rajkot city. Settings and Design: This was an interview-based, prospective study done at a private diabetes clinic. Methods and Material: T2DM patients (>18 years) of either gender who were on antidiabetic treatment (at least 3 months before enrollment) at a private outpatient diabetic clinic during 2019 were included after ethical approval and obtaining informed consent. Juvenile diabetes, gestational diabetes, and noncompliant T2DM patients were excluded. Statistical Analysis Used: The χ2 test was used for the statistical association of sociodemographic and disease variables with compliance using GraphPad version 7 (p value <0.05 was considered significant). Results: Of 370 enrolled patients, 21 patients were lost to follow-up (noncompliant). From 349 T2DM patients, the majority of patients were in the middle age-group (60%, 41–60 years), preobese and obese (69.99%), and with comorbidity (42.7%). Compliance to appointment, treatment, and diet was observed above 85% in this study. Old age (>60 years) was significantly associated with poor appointment compliance, and comorbidity is significantly associated with the poor appointment, treatment, and diet compliance. An increasing number of comorbidities were significantly associated with poor appointment compliance. Conclusions: A higher compliance to appointment, treatment, and diet was achieved.

A-24 An Evaluation of Anxiety, Depression, and Neuropsychological Performance before and during the COVID-19 Pandemic

Abstract Objective High levels of depression and anxiety have been consistently linked to performance on neuropsychological evaluations. In this regard, recent evidence of increased emotional distress due to COVID-19 may exacerbate impairment typically demonstrated on evaluations. The current study examined differences in the severity of depression and anxiety ratings reported before and during COVID-19, and the relationship between mood and cognitive functioning before and during COVID-19. Method 75 adults seeking neuropsychological assessment services from a private outpatient clinic in January 2020 and 2021 were included in the study. Depression, anxiety, and cognitive functioning were measured using the BDI-II, BAI, RDS, FAS, and Trailmaking test. T-tests were conducted to examine mood and cognitive differences between groups. Correlations were used to assess the relationship between mood and cognitive functioning. Results T-tests revealed no significant differences between groups for anxiety, depression, performance validity, verbal fluency, and Trailmaking tests. No significant relationship was observed between reported mood level and cognitive functioning before and during COVID-19. A significant correlation was observed between age and anxiety, which showed that older adults reported less anxiety. All statistical findings will be reported fully in the poster. Conclusions No significant change in emotional distress was found between pre- and during COVID-19 groups. The absence of measurable change may also suggest measures commonly employed should be reviewed and possibly modified to better capture the distress experienced by patients during the pandemic.

Predictors of health activation for patients with chronic kidney disease undergoing hemodialysis

Introduction: the quality of self-care in patients with chronic kidney disease (CKD) is important to improve quality of life, increase survival and reduce complications. Self-care can be evaluated by measuring the health activation of these patients. Objectives: evaluating the health activation of patients with CKD undergoing hemodialysis (HD) compared to a normative group (health self-reported subjects), and to identify the social, demographic and clinical determinants that are associated with the health activation. Method: cross-sectional, analytical, descriptive and quantitative study approved by the local ethics committee and conducted in a public and a private outpatient hemodialysis clinic. Participants were patients with CKD on HD (focal group) and subjects on a normative group. All of them answered the questionnaire of sociodemographic and clinical characterization and the instrument "Patient Activation Measure" (PAM13). For scores comparisons were used the Mann-Whitney test. Regarding the evaluation of the linear effect of the variables of profile on PAM13, multiple linear regression was used, including the evaluation of the two groups and only for patients with CKD. Results: the study included in each group. Regarding the characteristics of the CKD patients, there was a predominance of males (59%), incomplete high school or less (68%). Most of them too was from a private administration clinic (53%) and reported having already presented some type of complication stemming from CKD (57%). Regarding the evaluation of activation, the activation scores did not differ between the two groups (median of 56.4 in CKD patients and 56.4 in normative group, p &gt; 0.05) and the activation scores of both groups corresponded to activation level 3 with 34.5% of prevalence (p &gt; 0.05). When the two groups were analyzed together, schooling (Bi = 5.38; p= 0.002), practice physical activity (Bi = 4.2; p= 0.019) and the number of people who co-reside (Bi = -2.22; p= 0.001) influenced the activation score. In the CKD patients, independently, the variables that influenced the activation score were gender (Bi = -4.69; p = 0.050); schooling (Bi = 6.55; p = 0.008); type of clinic of origin (Bi = -5.48; p = 0.02) and the presence of complications related to CKD (Bi = -5.25; p = 0.026). Conclusion: activation scores did not differ between the patients with CKD on HD and the health subjects. Schooling, practice physical activity and number of people residing with the individual were predictors of health activation in both groups. For the CKD patients group, the variables that influenced positively the activation was schooling; and that influenced negatively was the gender, type of clinic of origin and the presence of complications related to CKD.