Rates Of Adequacy Research Articles

Correlation of cardiovascular disease with racial disparities in endometrial cancer outcomes.

5602 Background: Survival for Black women with endometrial cancer (EC) is shorter than that for non-Hispanic White (NHW) women, with a rate ratio for mortality of 1.98 per the American Cancer Society. Cardiovascular risk factors and disease are also more prevalent in Black women than NHW women. In women with breast cancer, Black patients received less optimal management of comorbidities and experienced increased cardiovascular disease (CVD)-related mortality as compared to White women. Similar to breast cancer, we hypothesize that CVD contributes to EC mortality disparities for Black women. Methods: In this retrospective cohort study, SEER and institutional data were utilized to investigate the contribution of CVD to outcomes for Black EC patients. The primary outcome was the contribution of cardiovascular mortality to the overall survival of Black patients. Secondary outcomes included identifying rates of new cardiovascular diagnoses, renal dysfunction, and adequacy of blood pressure control. The SEER cohort was defined using SEER*Stat 8.4.0.1. Uterine cancer patients were identified from the 2020 SEER Research Data. Survival by cause of death and proportion of deaths by cause of death were analyzed. Raw and adjusted hazard ratios for cardiovascular mortality were calculated. Next, institutional data was used to investigate survival, CVD diagnoses, renal dysfunction, and HTN in EC patients. Results: The SEER cohort contained 192,465 patients. Of these, 153,878 (80.8%) were White and 19,906 (10.3%) were Black. Black race was associated with decreased survival among patients who died of cardiovascular causes (HR 1.51, 95% CI 1.4 - 1.63, p < 2*10-16). When adjusted for age, stage, and histology, the hazard for decreased survival remained elevated for Black patients who died of cardiovascular causes (adjusted HR 1.65, 95% CI 1.52-1.77, p < 2*10-16). Our institutional cohort included 1491 patients, 1263 (84.7%) White and 151 (10.0%) Black. Black patients had a relative risk of death of 1.92 (95% CI 1.38 - 2.61) compared with White patients. Among patients with CVD, the hazard for death was 2.02 (95% CI 1.39 - 2.80). Black patients had significantly higher blood pressure, creatinine, and eGFR measurements. Conclusions: Racial outcome disparities in EC are multifactorial. CVD management will become increasingly important with the use of targeted therapies including lenvatinib and trastuzumab. Our study highlights an additional area of disparity and suggests possible interventions.

Comparative Diagnostic Performance of Different Techniques for Endoscopic Ultrasound-Guided Fine-Needle Biopsy of Solid Pancreatic Masses: A Network Meta-analysis.

There is limited evidence on the comparative diagnostic performance of tissue sampling techniques for endoscopic ultrasound (EUS)-guided fine-needle biopsy (FNB) of pancreatic masses. We performed a systematic review with network meta-analysis to compare these techniques. Rates of sample adequacy, blood contamination, and tissue integrity using FNB needles were evaluated. Direct and indirect comparisons were performed among slow-pull technique, "dry suction", "modified wet suction", or "no suction". Results were expressed as risk ratio (RR) and 95% confidence interval (CI). Overall, 9 RCTs (756 patients) were identified. On network meta-analysis, "no suction" technique was significantly inferior to the other techniques (RR 0.85, 95% CI 0.78-0.92 vs slow pull; RR 0.85, 0.78-0.92 vs "dry suction"; RR 0.83, 0.76-0.90 vs "modified wet suction") in terms of sample adequacy. Consequently, "modified wet suction" resulted as the best technique (SUCRA 0.90), with "no suction" showing poorer performance in terms of sample adequacy (SUCRA score 0.14). "Dry suction" was associated with significantly higher rates of blood contamination as compared to slow pull (RR 1.44, 1.15-1.80), whereas "no suction" led to less blood contamination of samples in comparison to other techniques (RR 0.71, 0.52-0.97 vs slow pull; RR 0.49, 0.36-0.66 vs "dry suction"; RR 0.57, 0.40-0.81 vs "modified wet suction"). "Modified wet suction" significantly outperformed "dry suction" in terms of tissue integrity of the sample (RR 1.36, 1.06-1.75). "Modified wet suction" seems to provide high rates of integrity and adequate samples, although with high blood contamination. "No suction" technique performs significantly worse than other sampling strategies.

S46 EUS-Guided Through the Needle Biopsy vs Fine Needle Aspiration for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

Introduction: Endoscopic Ultrasound guided fine needle aspiration (EUS-FNA) has been widely used to collect samples from pancreatic cystic lesions (PCLs) for cytology and fluid analysis. However, EUS guided FNA has relatively lower sensitivity in discriminating the types of lesions as well as detection of malignancy. Recent studies have investigated the EUS guided through the needle biopsy (EUS-TTNB) as an alternative method for sample collections in PCLs. We conducted a systemic review and meta-analysis on the studies that compared EUS-FNA and EUS-TTNB for adequate sampling and diagnostic accuracy in patients with PCLs. Methods: We performed a comprehensive search of the databases: PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception through May 10th, 2022. We considered randomized controlled trials, cohort studies, and case-control studies. We excluded abstracts, animal studies, case reports, reviews, editorials, and letters to editors. The primary outcome was sample adequacy which is defined as the presence of enough sample for histopathological evaluation. The secondary outcome was sample accuracy which is defined as the ability to have a definite diagnosis. The random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). A p value < 0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index. Results: Nine observational studies involving 520 patients were included in the meta-analysis. The rate of sample adequacy was significantly higher in the EUS-TTNB group compared to the EUS-FNA group (RR 1.64, 95% CI 1.19-2.26, p =0.003, I2 = 95%) (Figure 1A). Only four studies compared the accuracy rate between the EUS-TTNB method and the EUS-FNA group. The diagnostic accuracy was significantly higher in the EUS-TTNB group compared to the EUS-FNA group (RR 2.03, 95% CI 1.13-3.65, p = 0.02, I2 = 87%) (Figure 1B). Conclusion: Our meta-analysis demonstrated that the rates of both sample adequacy and accuracy were higher in the EUS-TTNB group compared to the EUS-FNA group. EUS-TTNB should be considered where applicable clinically for improving the diagnostic yield in patients undergoing evaluation of PCLs. Further randomized controlled trials are needed to confirm our findings.Figure 1.: a) sample adequacy rate b) diagnostic accuracy rate

Why do aspirations matter for empowerment?: Discrepancies between the A-WEAI domains and aspirations of ethnic minority women in Vietnam

Empowerment programs for women have been key development initiatives toward achieving gender equality. Projects, models, and measurement tend to focus on resources and agency as core to empowerment. Missing from most models and research is women’s own aspirations, or what they value for their futures, that affect how women use their resources and agency to achieve wellbeing. Aspirations are central to a sense of a good life and are necessary to strengthen among poor communities, but they are often overlooked among women, particularly those who are not pursuing formal schooling and who work in informal labor. This paper examines how aspirations matter for women in poverty who are working in informal sectors (agriculture and tourism) in Vietnam. It argues that without examining women’s aspirations for themselves, their family, and community, development projects may miss achieving their outcomes because they are not valued by women. Using data from the abbreviated version of the Women’s Empowerment in Agriculture Index (A-WEAI), and qualitative interview data from women and men from minority ethnic groups in Vietnam, we show that women and men achieve similar rates of adequacy in their access to resources and decision-making as measured by the A-WEAI, and that women’s aspirations for themselves and their community emphasized other valued outcomes from projects aimed at economic empowerment.

"Wet Heparin" and "Wet Saline" EUS-Guided Liver Biopsy Techniques Both Provide High Rates of Specimen Adequacy for Benign Parenchymal Liver Disease.

Endoscopic ultrasound-guided liver biopsy (EUS-LB) has emerged as a viable mean to obtain core tissue, but the optimal tools and techniques are still an area of active investigation. (1) To compare tissue adequacy using "wet saline" (WS) vs. "wet heparin" (WH) technique (2) To compare post-procedure pain between EUS-LB and percutaneous liver biopsy (PLB). Retrospective review of consecutive patients who underwent EUS-LB and PLB for benign parenchymal liver disease between May 2017 to October 2019 at a single tertiary veterans affairs medical center. About 257 biopsies from 217 patients were included. Among the 102 EUS-LB specimens, 53 were obtained using WS technique and 49 were obtained using WH technique. Specimen adequacy was similar in both groups. Median Aggregate Specimen Length (ASL) and length of longest piece did not differ significantly between WS and WH groups. Clots were present more frequently in the WS group. Among patients who underwent EUS-LB of both right and left liver lobes, an adequate biopsy was obtained in 85% of patients in the WS group and 96% of patients in the WH group. The percentage of patients experiencing immediate post-procedure pain was higher with PLB compared to EUS-LB, but these results were not statistically significant. Both WS and WH EUS-LB techniques can offer high rates of specimen adequacy with low rates of pain and other post-procedure complications.

Publicly-Funded Services Providing Sexual, Reproductive, and Maternal Healthcare to Immigrant Women in the United States: A Systematic Review.

Sexual, reproductive, and maternal health (SRMH) care in the US is highly politicized, with restrictions that impede immigrant women's health. This review describes SRMH outcomes among immigrant women accessing publicly-funded services. We examined articles published from December 2007 to August 2020 in PubMed, PsycINFO, and Web of Science databases, following PRISMA guidelines. Included articles (n = 9) consisted of predominantly Latina immigrant samples. The majority included a subsample of women classified as vulnerable due to low income, low educational attainment, and/or documentation status. Our search strategy included a range of SRMH outcomes; however, the majority of articles focused on prenatal care (PNC). Over half of the articles revealed that underserved immigrant women with access to Medicaid/CHIP during expansion had higher rates of PNC adequacy compared to those without access. There is a need for more research on the impact of publicly-funded services other than Medicaid on outcomes beyond PNC.

Evaluation of prenatal care according to indicators for the Prenatal and Birth Humanization Program

Abstract Objectives: to evaluate prenatal care provided to low-risk pregnant women users of the Sistema Único de Saúde (SUS) (Public Health System) in the city of Joinville, SC. Methods: this is a cross-sectional observational study carried out from March 2018 to February 2019, through interview and analysis of the Pregnant Card of puerperal over 18 years old, from Joinville, who underwent prenatal care at SUS, excluding recent given up puerperal. Prenatal care was evaluated according to the recommended criteria by the Prenatal and Birth Humanization Program. Results: 683 mothers were interviewed. The criteria with the highest levels of adequacy were accessibility (99.6%), early initiation on prenatal care (92.7%) and 6 or more consultations (87.1%) and the criteria with the lowest rates of adequacy were the set of guidelines (17.7%) and the third and first trimester exams (42.5% and 63.5% respectively). Conclusion: it is concluded that the prenatal care provided by SUS in the city of Joinville, despite the almost universal accessibility, the early onset and the prevalence of puerperal women with more than 6 consultations, showed a sharp decline in the analysis of the recommended indicators.

The Epidemiology of Depressive Disorders and Service Use in China: Findings from the China Mental Health Survey

Background: In China, depressive disorders have been estimated to be the second leading cause of years lived with disability (YLDs). However, nationally representative epidemiological data for depressive disorders, in particular depressed adults’ mental health services use, are still unavailable in China. The present study is a part of the Chinese National Mental Health Survey (CMHS), 2012–15, which reported the prevalence, treatment, and associated disability of depressive disorders in the Chinese general population. Methods: The CMHS recruited a representative sample of 28140 Chinese residents (≥ 18 years) by using multistage proportional-to-population-size sampling method. Trained investigators interviewed participants with the Composite International Diagnostic Interview 3.0 to ascertain the presence of lifetime and 12-month depressive disorders according to DSM-IV criteria, including major depressive disorder (MDD), dysthymic disorder (DD), and depressive disorder not otherwise specified (DD-NOS). Participants with 12-month depressive disorders were asked whether they ever received any 12-month treatment for their emotional problems and the specific types of treatment providers. The Quick Inventory of Depressive Symptomatology and Sheehan Disability Scale (SDS) were used to evaluate the severity of and role impairments associated with 12-month depressive symptoms. Findings: The weighted lifetime and 12-month prevalence rates of any depressive disorder were 6.8% (95%CI: 5.8-7.8%) and 3.6% (95%CI: 3.0-4.2%), respectively; the corresponding figures were 3.4% (95%CI: 2.0-3.9%) and 2.1% (95%CI: 1.8-2.4%) for MDD, 1.4% (95%CI: 1.1-1.7%) and 1.0% (95%CI: 0.8-1.3%) for DD, and 3.2% (95%CI: 2.6-3.9%) and 1.4% (95%CI: 1.1-1.7%) for DD-NOS. Overall, 77.2% of persons with 12-month depressive disorders had role impairment of any SDS domain: 82.2% for MDD, 81.5% for DD, and 64.6% for DD-NOS. Depressed participants reported an average of 41.0 days out of role in the past year due to depression; the corresponding figures were 49.7 days for MDD, 54.9 days for DD, and 12.2 days for DD-NOS. In total, 88.9% of individuals with 12-month depressive disorders had clinically significant depressive symptoms: 93.7% for MDD, 91.7% for DD, and 77.5% for DD-NOS. MDD and DD had similar proportions of “severe” or “very severe” depressive symptoms (43.0% and 42.1%), which were higher than DD-NOS (13.9%). 9.5% of participants with 12-month depressive disorders were treated in any treatment sector: 3.6% in the specialty mental health (SMH), 1.5% in the general medical (GM), 0.3% in the human services (HS), and 3.3% in the complementary-alternative medical (CAM) sector. Respondents with MDD and DYS had the highest proportion of seeking treatment in SMH sector (4.7% and 3.0%) while those with DD-NOS had the highest proportion of seeking treatment in CAM sector (most treatments were Traditional Chinese Medicine) (3.3%). Only 0.5% of participants with depressive disorders were treated adequately. Rates of treatment adequacy of MDD and DYS in SMH sector were 9.2% and 2.4%, respectively. Both rates in GM sector were 0%. Interpretation: Compared to western countries, our data show a relatively low prevalence of depressive disorders in China. Nevertheless, their associated role impairments, symptom severities, and disabilities are severe. Importantly, the treatment rates are rather low, let alone adequate treatment. Nationwide programs aiming at removing barriers in availability, accessibility, and acceptability to mental healthcare are needed in China. Funding: The study was funded by the Special Research Project for Non-profit Public Service of the Chinese Ministry of Health (grant number 201202022), the National Twelfth Five-Year Plan for Science and Technology Support of the Chinese Ministry of Science and Technology (grant numbers 2012BAI01B01 & 2015BAI13B00) and the National Key R&D Program of China (grant numbers 2017YFC0907800, 2017YFC0907801). Declaration of Interests: The authors have no conflicts of interest to declare Ethical Approval: The study protocol of CMHS was approved by the Ethics Committee of the Sixth Hospital of Peking University (No.: IMH-IRB-2013-13-1).

Assessment of antibiotic prescriptions in pediatric care units in a regional university hospital

ObjectivesThe main objective was to assess the relevance of antibiotic prescriptions in the pediatric wards of a regional university hospital in France. Secondary objectives were to assess adequacy of the dose, administration frequency, administration route, treatment duration, adaptation to bacteriological results, and treatment reevaluation. Patients and methodsWe assessed antibiotic prescriptions in pediatric settings. We included all patients under 18 years of age hospitalized in a pediatric ward who received a computerized prescription for antibiotic treatment between June 1st and June 30th, 2018; 163 clinical cases for 157 patients were analyzed. Patients hospitalized in neonatology, pediatric intensive care unit, and onco-hematology wards were excluded. ResultsThe rate of relevance was 71%. The rates of adequacy for the other criteria were 60% for the dose, 99% for the administration frequency, 98% for the administration route, 72% for treatment duration, 98% for treatment adaptation to microbiological results, and 100% for treatment revaluation. All criteria combined, the overall rate of adequacy was 28%. ConclusionsEffort should be made regarding doses and treatment durations. Areas for improvement have been suggested to the wards: standardized prescription protocols, pediatric prescription guide, training of residents, setting up of the operational team in pediatric wards and a second clinical evaluation.

Tissue Adequacy and Safety of Percutaneous Transthoracic Needle Biopsy for Molecular Analysis in Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis

ObjectiveWe conducted a systematic review and meta-analysis of the tissue adequacy and complication rates of percutaneous transthoracic needle biopsy (PTNB) for molecular analysis in patients with non-small cell lung cancer (NSCLC).Materials and MethodsWe performed a literature search of the OVID-MEDLINE and Embase databases to identify original studies on the tissue adequacy and complication rates of PTNB for molecular analysis in patients with NSCLC published between January 2005 and January 2020. Inverse variance and random-effects models were used to evaluate and acquire meta-analytic estimates of the outcomes. To explore heterogeneity across the studies, univariable and multivariable meta-regression analyses were performed.ResultsA total of 21 studies with 2232 biopsies (initial biopsy, 8 studies; rebiopsy after therapy, 13 studies) were included. The pooled rates of tissue adequacy and complications were 89.3% (95% confidence interval [CI]: 85.6%–92.6%; I2 = 0.81) and 17.3% (95% CI: 12.1%–23.1%; I2 = 0.89), respectively. These rates were 93.5% and 22.2% for the initial biopsies and 86.2% and 16.8% for the rebiopsies, respectively. Severe complications, including pneumothorax requiring chest tube placement and massive hemoptysis, occurred in 0.7% of the cases (95% CI: 0%–2.2%; I2 = 0.67). Multivariable meta-regression analysis showed that the tissue adequacy rate was not significantly lower in studies on rebiopsies (p = 0.058). The complication rate was significantly higher in studies that preferentially included older adults (p = 0.001).ConclusionPTNB demonstrated an average tissue adequacy rate of 89.3% for molecular analysis in patients with NSCLC, with a complication rate of 17.3%. PTNB is a generally safe and effective diagnostic procedure for obtaining tissue samples for molecular analysis in NSCLC. Rebiopsy may be performed actively with an acceptable risk of complications if clinically required.

S3122 Factors Associated With Inadequate Colonoscopy Bowel Prep: Not the Patient but the Endoscopist, and the Role of Volume of Colonic Irrigation (VOCI)

INTRODUCTION: Colonoscopies with inadequate bowel preparation (BP) decrease the detection of adenomas and lead to earlier repeat follow up exams. There is no data on the impact of the endoscopists’ effort to achieve an adequate exam through water lavage and the endoscopists’ adequate BP rate. METHODS: This is a single center institutionally approved prospective study of eight endoscopists performing colonoscopy from 07/2017-03/2020. All endoscopists trained in the use of the Boston Bowel Prep Score (BBPS). We measured the volume of colonic irrigation (VOCI), defined as water infused in and fluid suctioned out for each colonoscopy. Data collection included patient demographics, factors associated with inadequate BP (BMI, constipation, tricyclic antidepressant and opiate medication use, diabetes), and colonoscopy findings (BBPS, VOCI in and out, polyp number, pathology). Only screening, surveillance and FIT positive cases were included. Inadequate BP was defined as a BBPS score of < 2 in any segment. We calculated the modified adenoma detection rate (mADR) defined as the proportion of screening or surveillance exams for which one adenoma was identified, as well as the modified adenomas per colonoscopy (mAPC) for each endoscopist. Comparisons between means were made using T-tests and ANOVA, with comparisons between proportions were made using Chi square. Coefficients of determination were calculated for linear correlations. RESULTS: Eight endoscopists performed 1223 colonoscopies (Table 1). Rates of adequate BP varied from 71.3% to 96.3%. There was no difference in VOCI in or out between high vs low adequate BP rate endoscopists (Table 2). There was no difference in VOCI in between high vs low mAPC endoscopists, but there was a statistically significant higher mean VOCI out (P = 0.035), although the volume was small (42 mL). mADR significantly differed among endoscopists but correlated with mAPC (R2 = 0.915). Rates of adequate BP did not correlate with mADR (R2 = 0.283). CONCLUSION: Despite standardized BP and prep scoring as well as equal distribution of inadequate BP patient factors, the rates of adequate BP still varied by 25% among endoscopists and was not affected by VOCI. These findings require further study but suggest that differences in rates of BP adequacy may have more to do with endoscopist factors than previously recognized, and may not correlate with other markers of endoscopist performance like mADR.Table 1.: Patient Demographics and Risk Factors for Inadequate Colon BP by EndoscopistTable 2.: VOCI, BBPS, mAPC, and mADR Rates by EndoscopistFigure 1.: Scatter Plot of Adequate Bowel Prep Percent by modified ADR.

Factors Associated with Thyroid Disorders and Iodine Adequacy in Pregnant Saudi Women.

Little is known about iodine adequacy and gestational thyroid disorders (GTDs) in Saudi Arabia. This study measured the rates of GTDs and iodine adequacy in 810 healthy Saudi women. Concentrations of serum thyroid hormones and 24-h urine iodine (24-h UIC), and GTDs were diagnosed according to the American Thyroid Association guidelines. Dietary and socioeconomic data to determine factors associated with GTDs and iodine insufficiency were collected. GTDs were detected in 265 women (32.7%) as follows: subclinical (SCH; 20.2%) and overt (OH; 5.8%) hypothyroidism, isolated hypothyroxinemia (ISH; 4.7%) and hyperthyroidism (2%). The SCH (109.2μg/L; IQR: 77.2-149.7), OH (95.3μg/L; IQR: 74.3-130.5) and ISH (107.3μg/L; IQR: 65.5-133.1) groups had median 24-h UIC below the WHO recommended limit, whereas the euthyroid (191.4μg/L; IQR: 170.03-219.8) and hyperthyroid (159.5μg/L; IQR: 152.9-238.3) groups were iodine sufficient. Numbers of pregnancies, less education, not consuming iodized salt and not using iodine supplements increased risk of hypothyroidism and ISH. Contrariwise, interval ≥ 3years from last pregnancy and higher 24-h UIC decreased odds of hypothyroidism and ISH. Moreover, dairy products and egg consumption were markedly lower in all GTD groups. Dairy products and seafood consumption correlated independently with 24-h UIC of the study participants, whereas consuming yogurt, eggs, redfish and shellfish protected against GTDs. In conclusion, GTDs appear to be prevalent in pregnant Saudi women and the hypothyroid and hypothyroxinemia groups had iodine insufficiency. However, consuming iodized salt, iodine supplements, dairy products, seafoods and eggs may protect against GTDs.

Avaliação da adequação no uso da paramentação cirúrgica

Objetivo: Analisar a adequação da paramentação cirúrgica pelos profissionais de saúde que prestam assistência em um centro cirúrgico deum hospital de ensino no Nordeste do Brasil. Método: Estudo transversal, descritivo, quantitativo e de natureza observacional. A amostra foi compostade 100 profissionais de saúde. Resultados: Os itens de maior adequação foram: no momento da colocação do propé e das luvas (100%), seguidoda circulação da roupa privativa e do momento de colocação do gorro (99%). Obtiveram-se menores taxas de adequação no uso dos óculos (5%) equanto ao local de guarda da máscara (8%). As inadequações relacionadas à máscara cirúrgica ocorreram pela não troca mediante sujidade ou umidadee em cirurgias com duração maior de duas horas aproximadamente (23%). Conclusão: Apesar de a maioria (18 dos 20) dos itens estar com boastaxas de adequação, outros apresentaram taxas consideradas medianas e baixas. As categorias profissionais que apresentaram maiores inadequaçõesforam anestesistas (35%), enfermeiros (27%) e técnicos de enfermagem (22%). Esses percentuais necessitam ser melhorados, a fim de oferecer aospacientes cirúrgicos uma assistência mais segura.

Architectural and communications barriers to access to primary health care in Brazil: an analysis based on the first national census of primary health care centers, 2012.

to analyze the results of the National Census of Primary Health Care Centers with regard to architectural and communication barriers in Primary Health Care throughout Brazil. this was a cross-sectional study based on data from the first National Census of Primary Health Care Centers conducted between May and October 2012. the Northern region had the lowest rates of adequacy; although the Southeast region had the best rates when compared to the country's other regions, they were nevertheless unsatisfactory, since for many items adequacy was still below 50%; the items relating to accessibility by people with disabilities (5.7 to 34.2%) and/or the illiterate (0.1 to 27.4%) had very low scores. the majority of services evaluated had architectural and communication barriers, hindering access to health services by disabled, illiterate or elderly people; the importance of allocating resources to reduce iniquities and improve access is stressed.

Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys.

To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.

Safety and Efficacy of Transjugular Liver Biopsy in Patients with Left Lobe–Only Liver Transplants

PurposeTo evaluate efficacy and safety of transjugular liver biopsy (TJLB) via the left hepatic vein in patients with left lobe–only liver transplants (LLOTs). Materials and MethodsRetrospective review revealed 43 TJLBs performed in 26 patients with LLOTs (mean age 51.3 y; range, 18–73 y) between January 2009 and June 2016 at a single institution. A comparison group of 44 randomly selected TJLBs performed in 37 orthotopic whole liver transplant (OWLT) recipients (mean age 57.6 y; range, 35–74 y) during the same time period was evaluated. Patient demographics, type and age of transplant, technical success, adequacy of samples, number of portal tracts obtained, pathologic diagnosis, and complication rate were reviewed. ResultsTechnical success was achieved in 98% (42/43) of LLOT procedures. TJLB failed in 1 patient with LLOT, in whom no patent hepatic veins were identified. Technical success was achieved in 100% (44/44) in the OWLT group. Mean (SD) number of needle passes was 4.12 (1.25) in the LLOT group vs 3.95 (1.28) in the OWLT group (P = .54). Mean (SD) specimen length was 1.16 (0.75) cm in the LLOT group vs 1.19 (0.58) cm in the OWLT group (P = .78). Mean (SD) number of portal tracts obtained in the LLOT group was 10.7 (5.26) vs 12.3 (4.68) in the OWLT group (P = .17). No major complications were observed in either group. ConclusionsTJLB in adult patients with LLOTs appears safe and feasible, with favorable rates of technical success and adequacy of sampling.

Transnasal Endoscopy in Unsedated Children With Eosinophilic Esophagitis Using Virtual Reality Video Goggles

Evaluation and treatment of children with eosinophilic esophagitis (EoE) requires serial endoscopic, visual, and histologic assessment by sedated esophagogastroduodenoscopy (EGD). Unsedated transnasal endoscopy (TNE) was reported to be successful in a pilot study of children. We evaluated video goggle and virtual reality-based unsedated TNE in children with EoE, collecting data on rates of completion, adverse events, and adequacy of visual and histologic findings. We performed a retrospective study of 190 children and young adults (age, 3-22 y) who underwent video goggle or virtual reality-based unsedated TNE from January 2015 through February 2018. We analyzed data on patient demographics, procedure completion, endoscope type, adverse events, visual and histologic findings, estimated costs, and duration in the facility. Esophageal biopsies from the first 173 subjects who underwent TNE were compared with those from previous EGD evaluations. During 300 attempts, 294 TNEs were performed (98% rate of success). Fifty-four patients (age, 6-18 y) underwent multiple TNEs for dietary or medical management of EoE. There were no significant adverse events. Visual and histologic findings were adequate for assessment of EoE. TNE reduced costs by 53.4% compared with EGD (TNE $4393.00 vs EGD $9444.33). TNE was used increasingly from 2015 through 2017, comprising 31.8% of endoscopies performed for EoE. The total time spent in the clinic (front desk check-in to check-out) in 2018 was 71 minutes. In a retrospective study of 190 children and young adults (age, 3-22 y) who underwent video goggle or virtual reality-based unsedated TNE, TNE was safe and effective and reduced costs of EoE monitoring. Advantages of TNE include reduced risk and cost associated with anesthesia as well as decreased in-office time, which is of particular relevance for patients with EoE, who require serial EGDs.

Psychological Treatment for Major Depressive Disorder: Effectiveness of Cognitive Behavioural Therapy

Major depression, as a recurring and disabling disorder, can have a negative effect on the psychological and physical well-being of patients. Various psychological and medical interventions are generally used for patients with major depressive disorders. Patients suffering from major depressive disorders (MDD) may be subjected to medication only or medication may be used concurrently with psychological interventions. Psychological interventions like cognitive behavioural therapy (CBT) uses behavioural and cognitive principles to treat patients suffering from MDD, by helping them to identify, understand and analyse how the interaction of their thoughts, moods and behaviours triggers and aggravates depression. CBT has been beneficial in treating patients suffering from comorbidity of MDD with other disorders. While there is empirical and theoretical evidence supporting the use of CBT under various treatment settings and patient characteristics, research findings indicate varying rates of adequacy of the treatment. Further investigation of potential prescriptive risk factors associated with MDD in different contexts can help to predict more unbiased and consistent responses to different CBT techniques. This will make a valuable contribution to improving the use of CBT techniques for patients with different depressive characteristics and across different treatment settings and modes of delivery.

USE ASSESSMENT AND COST ANALYSIS OF PARENTERAL NUTRITION FOR ADULTS IN A PUBLIC HOSPITAL

The Parenteral Nutrition (PN) is a high-alert medication, with high-cost, indicated for patients in which oral or enteral nutrition is not possible, is insufficient or contraindicated. There are two PN systems currently available, the custom system, prepared in hospital pharmacies or outsourced to specialized clinics, and the standardized compartmentalized bag system. Currently, it is fundamental that the application of financial resources in health be performed efficiently, considering effectiveness, safety and economy. The aim of this study was to evaluate the effectiveness of industrialized NP in the supply of energy and to perform a pharmacoeconomic analysis of cost minimization comparing standardized and custom bags. For this, was determined the total energy expenditure of patient and then determined the adequacy of the prescriptions of PN. For cost analysis was used the values of the standardized bags used for the patient in relation with the hypothetical cost if the same formulation were custom manipulated. 28 patients and 296 PN prescriptions were identified in the study period. The rates of adequacy to the energy expenditure were 39.3% on the 1st day, 34.6% on the 2nd day, 44.65% on the remaining days of treatment, and 33.33% on the last day. As for the analysis cost, the cost of standardized bags was lower in relation to manipulated bags (p <0.05). It was therefore verified that this was a high level of the inadequacy of the prescriptions of industrialized PN bags and that the same is more cost effective for the hospital in question.

Treatment adequacy for social anxiety disorder in primary care patients.

ObjectivesThere is a gap between clinical practice guidelines for social anxiety disorder and clinical practice that needs to be addressed to ensure the delivery of evidence-based treatments. The objectives of this study were: 1) to describe mental health service utilization in a cohort of primary care patients with social anxiety disorder; 2) to examine treatment adequacy for pharmacotherapy and psychotherapy according to indicators based on clinical practice guidelines; and 3) to explore correlates of treatment adequacy.MethodThe “Dialogue” project (Quebec, Canada) is a large study conducted in 67 primary care clinics. After a mental health screening in primary care (n = 14 833), participants with anxiety or depressive symptoms took part in a telephone/web structured interview on mental health symptoms and service utilization (n = 1956). This study included 289 participants meeting DSM-IV criteria for social anxiety disorder.ResultsOverall, 86.2% of participants reported consulting for mental health reasons over the past 12 months. Only 23.6% of our sample reported the detection of social anxiety disorder by a healthcare professional in the past 12 months. Approximately 2 in 5 respondents with social anxiety disorder reported receiving pharmacotherapy or psychotherapy meeting our treatment adequacy indicators. Antidepressant medication was the most common treatment. Logistic regression models showed that the detection of major depression (OR = 4.651; 95% CI: 2.559–8.453) or other anxiety disorder(s) (OR = 2.957; 95% CI: 1.555–5.625) were associated with receiving any adequate treatment, but the detection of social anxiety disorder itself was not (OR = 1.420; 95% CI: 0.696–2.899).ConclusionLow rates of detection and treatment adequacy based on our indicators demonstrate that efforts must be made to ensure the quality of care for individuals with social anxiety disorder in primary care.