Scheduled Visits Research Articles

Demographic and Clinical Characteristics Predicting Missed Clinic Visits among Patients Living with HIV on Antiretroviral Treatment in Kinshasa and Haut-Katanga Provinces of the Democratic Republic of Congo.

Patients living with HIV (PLHIV) often face challenges that contribute to missed clinical care which can impact their health outcomes. This retrospective quantitative study comprised 5338 adults living with HIV who received antiretroviral treatment (ART) for 12 months, from July 2018 to June 2019 in Kinshasa and Haut-Katanga provinces of the Democratic Republic of Congo. Descriptive statistics were computed to show the level of missed appointments for ART. Multivariable associations of clinical and sociodemographic factors with a tendency to miss scheduled visits after adjusting for the covariates were examined using multivariable logistic regression analysis. Six percent of PLHIV experienced at least one missed visit while 94% did not miss any visits. A small proportion (20%) of PLHIV had a viral load ≥1000 copies/mL. PLHIV receiving ART from urban clinics showed significantly higher odds of missed visits compared to those from rural areas (AOR = 4.18, 95% CI [1.84-9.511]; p < 0.0001). Similarly, patients from semi-rural/semi-urban clinics showed significantly higher odds of missed visits compared to those from rural areas. (AOR = 2.57, 95% CI [1.08-6.141]; p = 0.03). Additionally, older PLHIV (18-34 years old) demonstrated increased odds of missed visits (AOR= 1.71, 95% CI [1.0078-2.697]; p = 0.02) compared to those under 18 years old. The findings from this study strongly suggest that there is a significant association between certain demographic factors, such as age and rurality-urbanicity, and missed visits. The study findings have implications for policy and interventions targeting PLHIV at higher risk of missed visits.

Healthcare Providers' and Frontline Workers' Experiences of an Ebola Vaccine Trial in the Boende Health District of the Democratic Republic of the Congo.

This study explored the experiences of healthcare providers (HCPs) and frontline workers who were involved in an Ebola vaccine trial in the Democratic Republic of the Congo. The researchers interviewed a total of 99 participants (HCPs and frontline workers) living and working in the Boende health district during the period of the study, from February to March 2022. These individuals included a mix of trial participants and non-trial participants (staff of the trial, local health authorities, and head nurses of health centers). In-depth individual interviews, as well as focus group discussions (FGDs), were used to understand interviewees' experiences and perceptions. The data were analyzed to identify the main themes. The findings unveiled a multitude of positive experiences among interviewees/FGD participants. The commitment of the trial investigators to improve the study site and to equip the volunteers with necessary skills and knowledge greatly contributed to a positive trial experience. However, some interviewees felt that the reimbursement for time and travel expenses during their trial visits was insufficient in comparison with their expectations. Additionally, there were expressions of worry about the frequency of blood draws during scheduled trial visits. Our findings emphasize the critical importance of addressing and continuously considering the perspectives and concerns of trial participants before designing and implementing vaccine trials. By actively incorporating their inputs, researchers can mitigate concerns and tailor communication strategies, potentially enhancing the overall success and impact of the vaccine trial.

Disparities in Telehealth Uptake for Developmental-Behavioral Pediatric Assessments by Preferred Family Language: A Developmental Behavioral Pediatrics Research Network Study.

Owing to the coronavirus disease 2019 (COVID-19) pandemic, many developmental-behavioral pediatric (DBP) practices adopted telehealth for care delivery. However, telehealth access and use for families with a preferred language other than English (PLOE) is an equity concern. Therefore, our study objective is to compare rates of telehealth utilization and visit completion by preferred family language among patients seen for DBP assessments during the COVID-19 pandemic. We completed a descriptive chart review using electronic health record data at 4 academic DBP practices to examine visits for patients up to 5 years seen for new-patient appointments between April 2020 and April 2021. We compared rates of in-person and telehealth visits by preferred family language and visit outcome (completed or missed). A total of 3241 visits were scheduled between April 2020 and April 2021; 48.2% were for in-person and 51.8% for telehealth. Families reported the following languages: 90.5% English, 6.2% Spanish, and 3.3% other language. Missed visits accounted for 7.6% of scheduled visits. The relative percentage of in-person versus telehealth visits varied significantly by site (p < 0.001) and preferred family language (p < 0.001). English-speaking patients had 2.10 times the odds of being scheduled for telehealth compared with patients with PLOE, adjusting for site. Statistically significant differences were not found for visit outcome (completed or missed) by visit type (in-person or telehealth) (p = 0.79), including after accounting for PLOE status (p = 0.83). At the height of the pandemic, most English-speaking families were scheduled for new DBP evaluations by telehealth, but fewer families with PLOE were. Attention to language to ensure telehealth access equity is critical.

Planning, Implementation, and Evaluation of a Postpartum Nurse Home Visit Service to Improve Health Equity

ObjectiveTo describe how a college of nursing and urban academic medical center partnered with the local health department to plan, implement, and evaluate a universal nurse home visit service to improve health equity in the postpartum period. DesignEvidence-based practice. Setting/Local ProblemWide health disparity in rates of maternal and infant morbidity and mortality in Chicago, Illinois. PatientsAll patients who gave birth at the medical center and lived in Chicago. Intervention/MeasurementsA nurse home visit was offered after birth to all eligible patients beginning in March 2020. We used data from a Web-based platform to determine key performance indicators for the program and examined patient demographics to determine equitable delivery of the service for all visits provided in 2022. ResultsThere were 1,488 patients eligible for a home visit and 714 who received a home visit. The average contact rate was 76%, the scheduling rate was 63%, the completion rate for scheduled visits was 76%, and the population reach was 48%. Sixty-eight percent of families visited were from high-economic-hardship zip code areas of the city. Eighty-one percent of visits resulted in at least one referral to meet a family’s need, and 98% of patients surveyed rated their visit as “very helpful.” ConclusionThe successful implementation of this public–private partnership was due in part to an organizational culture that supports health equity initiatives, the inclusion of system-wide stakeholders, having a process in place to monitor outcomes, and hiring a diverse team of nurses who prioritize respectful patient-centered care.

Medical Record Monitoring an Administration System

Abstract— A state-of-the-art software program called the Medical Record Monitoring and Administration System offers a consolidated platform for monitoring and managing medical data, hence streamlining the management of healthcare. Healthcare personnel can effectively handle patient data, keep track of medical histories, and guarantee regulatory compliance using this system. Medical records are kept accurate, current, and easily accessible thanks to the system’s sophisticated features, which also include safe data storage, automatic alarms, and real-time monitoring. This solution improves data management, lowers mistakes, improves patient care, and boosts operational efficiency by automating administrative activities. The Medical Record Monitoring and Administration System is a vital tool for healthcare businesses looking to increase the caliber and effectiveness of their services because of its user-friendly interface and strong security features. Keywords – Pregnancy care management, Monitoring of scheduled visits, Maternal health informatics.

Counselling with a focus on product and price transparency for over-the-counter headache medicines: A simulated patient study in community pharmacies in Munich, Germany.

In Germany, over-the-counter (OTC) medicines may only be dispensed by community pharmacies (CPs). German CPs must ensure 'adequate' counselling, including the cost of medicines. Along with information gathering and advice giving as classic aspects of counselling, the aim was also to investigate counselling indicators of product and price transparency. The cross-sectional study was based on the covert simulated patient (SP) methodology and was conducted in a random sample of CPs stratified by districts in the major German city of Munich. Each of the 178 selected CPs was visited once by one of five trained female students. They simulated a symptom-based sub-scenario 1 with a request for an OTC medicine for a headache and a sub-scenario 2 with standardised information regarding product and price transparency. The assessment, completed immediately postvisit by the SPs, included a total of 23 items. All 178 scheduled visits were completed successfully. The median counselling score with the classic items was 3.0 out of 12 points (interquartile range [IQR] 4.25) and when expanded by items for product and price transparency the score was 4.0 out of 14 points (IQR 4.00). A selection of medicines was offered unsolicited in 38.2% of the visits and in 5.6% of the visits voluntary price information was provided before the transaction. A request for a cheaper medicine led to a significant price reduction (Wilcoxon signed-rank test; p<0.001, r=0.869). Due to the below-average level of counselling, the regional chambers of pharmacists are recommended to initiate measures for improvement. There is also potential for optimisation with regard to product and price transparency as an important extension of the classic counselling aspects. It is therefore recommended that the government raise customers' awareness of the cost of medicines.

Effectiveness of Jena DM® Herbal Formulation as Complementary Therapy to Conventional Oral Hypoglycemic Agents in Type-2 Diabetes Mellitus: A Quasi-experimental Study.

There is vast preclinical evidence that indicates that extracts from several Artemisia plant species have significant antidiabetic benefits. However, clinical evidence is limited to this effect. We sought to evaluate the effectiveness ofJena DM® (anArtemisia annua-based poly-herbal formulation) on glycemic control (Hb A1C) and insulin metabolism (HOMA), when administered as a complementary therapy in type-2 diabetes mellitus (T2DM). This study was supported by a research grant (JRD005) from Jena Herbals (U) Ltd, which is a local herbal medicines manufacturing facility in Uganda. We conducted a 12-week quasi-experimental study, involving 118 patients under routine follow-up at a diabetes and endocrinology clinic. Random assignment to either conventional or experimental study groups was done using a random number generator (Microsoft Excel version 16.0). Participant sociodemographic and clinical data as well as whole blood samples (3-5 mL) were obtained at scheduled clinic visits. Medication adherence was assessed using the Hill-Bone Scale, and adverse drug events (ADEs) using the Naranjo causality and the National Institute of Allergy and Infectious Diseases, Division of AIDS (DAIDS) scales. Group differences in glycemic control (HbA1C), fasting serum insulin (FSI) indices (% HOMA2-B, HOMA-IR), and other cardiometabolic parameters were assessed using independent samples t-test, and Pearson chi-square statistical tests were used. A p-value <0.05 was considered statistically significant. Ethical approvals were obtained before the study commencement. 12-week daily complementary therapy withJena DM® showed no significant effect on Hb A1C reduction (0.1 (95% CI: -0.56, 0.80) %;p=0.798); however, we observed a significant reduction in total body weight (2.0 (95% CI: 0.73, 3.28) kg;p=0.002). The overall frequency of self-reported ADEs including dizziness was significantly higher among patients that usedJena DM® (p=0.001).Epigastric pain was the most severe ADE necessitating clinical management. There was no significant difference in the homeostatic model assessment for insulin resistance (HOMA2-IR) between study groups. In contrast to a few studies that previously showed significanthypoglycemic effects ofArtemisia-basedextracts, this study did not show a statistically significant reduction on HbA1C during a 12-week complementary use ofJena DM® in patients withT2DM. Based on the findings of this study, future research should evaluate the long-term effects ofJena DM® on body weight, overall insulin metabolism, and the subsequent effect on glycemic control in T2DM.

Efficacy and safety of sovleplenib (HMPL-523) in adult patients with chronic primary immune thrombocytopenia in China (ESLIM-01): a randomised, double-blind, placebo-controlled, phase 3 study

Sovleplenib, a novel spleen tyrosine kinase (SYK) inhibitor, showed promising safety and activity in patients with primary immune thrombocytopenia in a phase 1b/2 trial. We aimed to evaluate the efficacy and safety of sovleplenib in patients with chronic primary immune thrombocytopenia. This randomised, double-blind, placebo-controlled, phase 3 trial (ESLIM-01) was done in 34 clinical centres in China. Eligible patients, aged 18-75 years, had chronic primary immune thrombocytopenia, an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, and received one or more previous treatments. Patients were randomly assigned (2:1) to receive oral sovleplenib or placebo, 300 mg once daily, for 24 weeks. Randomisation was stratified by baseline platelet counts, previous splenectomy, and concomitant treatment for anti-immune thrombocytopenia at baseline. The primary endpoint was durable response rate (proportion of patients with a platelet count of ≥50 × 109/L on at least four of six scheduled visits between weeks 14 and 24, not affected by rescue treatment) assessed by intention-to-treat. The trial is registered with ClinicalTrials.gov, NCT05029635, and the extension, open-label phase is ongoing. Between Sept 29, 2021, and Dec 31, 2022, 188 patients were randomly assigned to receive sovleplenib (n=126) or placebo (n=62). 124 (66%) were female, 64 (34%) were male, and all were of Asian ethnicity. Median previous lines of immune thrombocytopenia therapy were 4·0, and 134 (71%) of 188 patients had received previous thrombopoietin or thrombopoietin receptor agonist. The primary endpoint was met; durable response rate was 48% (61/126) with sovleplenib compared with zero with placebo (difference 48% [95% CI 40-57]; p<0·0001). The median time to response was 8 days with sovleplenib compared with 30 days with placebo. 125 (99%) of 126 patients in the sovleplenib group and 53 (85%) of 62 in the placebo group reported treatment-emergent adverse events (TEAEs), and most events were mild or moderate. Frequent TEAEs of grade 3 or higher for sovleplenib versus placebo were platelet count decreased (7% [9/126] vs 10% [6/62]), neutrophil count decreased (3% [4/126] vs 0% [0/62]), and hypertension (3% [4/126] vs 0% [0/62]). Incidences of serious TEAEs were 21% (26/126) in the sovleplenib group and 18% (11/62) in the placebo group. There were no deaths in the study. Sovleplenib showed a clinically meaningful sustained platelet response in patients with chronic primary immune thrombocytopenia, with a tolerable safety profile and improvement in quality of life. Sovleplenib could be a potential treatment option for patients with immune thrombocytopenia who received one or more previous therapy. HUTCHMED and Science and Technology Commission of Shanghai Municipality.

Implementation of a Pharmacist-Driven Contraception Service at a Safety-Net Health-System.

Background: Access to safe, effective, and appropriate contraception significantly reduces the rates of unintended pregnancies; however, this preventative care is not always easily accessible. There is a high patient demand for contraception visits that is often delayed or unmet due to lack of access to traditional providers. Pharmacists are highly accessible and can help manage this high demand, yet clinical pharmacists as providers of contraception services remains a gap in published literature. Objective: Develop and implement a pharmacist-led contraception service at a safety-net health-system. Methods: A comprehensive pharmacist-led clinical contraception service was created to improve patient access. To support this project, a collaborative practice agreement (CPA) was developed and enhancements were built into an electronic medical record. The CPA allowed the pharmacist to complete contraception-related interventions such as ordering urine pregnancy tests, prescribing hormonal and emergency contraceptives, and manage adverse effects. The piloting pharmacist was available at the Narcotics Treatment Program (NTP) clinic one half-day each week for scheduled and same-day visits. Results: Within the initial five half-day clinic sessions at NTP, the pharmacist had written seven prescriptions, including three for emergency contraceptives. Of all patients seen for this service at NTP, only one had been using a method of contraception consistently prior to their visit. Conclusion: The interventions that were able to be made by the pharmacist highlighted the need for improved access to contraceptives. Pharmacist-managed services in sexual and reproductive health can help fill this gap. Patients also self-reported ease of access as a benefit to this service.

The Impact of Telehealth on Obstetrical Outcomes during the COVID-19 Pandemic.

Nationwide, obstetric clinics modified prenatal care to include telehealth visits in response to the COVID-19 pandemic, enabling the opportunity to investigate its impact on patient outcomes. We hypothesized that use of prenatal telehealth visits would increase the number of prenatal visits, decrease the frequency of urgent triage/emergency department (ED) visits, and improve perinatal outcomes. To determine the impact of telehealth on number of obstetric prenatal visits and urgent triage/ED visits amidst the COVID-19 pandemic. This is a retrospective cohort of patients from a federally qualified health center (FQHC) in central Texas. Patients with a singleton gestation who delivered after 32 weeks were included. Comparison groups were made between those patients who delivered between May 2020 to December 2020 (presumed modified prenatal visit schedule with in-person and telehealth) and those patients delivering between June 2019 to February 2020 (the traditional care model with in-person visits only). Multivariable linear and logistic regression models were used to estimate differences in the number of prenatal visits and unscheduled triage/ED visits. A total of 1654 patients were identified with 801 (48.4%) patients undergoing modified prenatal care and 853 (51.6%) patients receiving traditional care during the study period. No significant differences were seen in overall prenatal attendance or triage/ED presentations. However, when stratified by parity, multiparous patients undergoing modified prenatal care were less likely to experience an urgent triage/ED presentation (8.7% vs. 12.7%; odds ratio, 1.69; 95% confidence interval, 1.10-2.61). When compared to a traditional prenatal visitation cohort pre-pandemic, patients who received modified telehealth prenatal care during the COVID-19 pandemic had similar prenatal attendance and unscheduled emergency presentations. However, multiparous patients experienced a decreased rate of unscheduled emergency presentations. Supplementing prenatal care with telehealth may provide overall comparable prenatal care delivery.

Pneumothorax Identified by a Remote Physician Using Paramedic-obtained Tele-ultrasound: Case Report.

The use of telemedicine and ultrasound is emerging and novel in the field of community paramedicine. However, there is a paucity of data supporting its use and even less evidence that shows a morbidity and mortality benefit. This case highlights a unique way to diagnose a common medical emergency, which can lead to a good outcome. We describe the use of lung point-of-care ultrasound by a trained community paramedic that led to the identification of a pneumothorax in an 86-year-old male at a scheduled home visit. The images were interpreted over telehealth in real-time by an emergency physician, and the patient was transported to the emergency department where the diagnosis was confirmed by chest radiography. He underwent chest tube placement and was discharged five days later after returning to his baseline. Despite minimal data to support or refute the use of paramedic tele-ultrasound, this case highlights a unique opportunity to expand the use of telemedicine and ultrasound in community paramedicine to improve patient outcomes.

Effect of 2 Years of Monthly Calcifediol Administration in Postmenopausal Women with Vitamin D Insufficiency.

We assessed the long-term (24 months) efficacy and safety of monthly calcifediol (0.266 mg) in the correction and maintenance of total 25(OH)D levels in postmenopausal women with basal values <30 ng/mL. We initially enrolled 45 consecutive patients during the period September 2019-September 2020. After an initial visit, patients were instructed to return at 3, 6, 9, 12 and 24 months for measuring serum total 25(OH)D, ionised calcium, creatinine and isoenzyme of alkaline phosphatase (bALP). Here, we report only the per-protocol analysis, because the COVID-19 pandemic precluded adherence to the scheduled visits for some patients. The patients' mean age was 62.4 ± 9.0 years. Mean basal 25(OH)D levels were 20.5 ± 5.3 ng/mL. There was a continuous increase of mean 25(OH)D values (p for trend < 0.001). However, mean values at month 24 (36.7 ± 15.9) were not significantly different in respect to values at month 12 (41.2 ± 11.18). At 24 months, only 1 out 19 patients had a value <20 ng/mL. There was a significant decrease with time of mean values of bALP (p < 0.0216), with no significant changes between 12 and 24 months. No significant changes were observed as far as ionised calcium or creatinine were concerned. The long-term administration of calcifediol maintains stable and sustained 25(OH)D concentrations, with no safety concerns.

Loop diuretic discontinuation in chronic heart failure patients: A retrospective study

Introduction and ObjectivesThe use of loop diuretics is central in managing congestion in heart failure (HF), but their impact on prognosis remains unclear. In euvolemic patients, dose reduction is recommended, but there is no recommendation on their discontinuation. This study aims to assess the impact of loop diuretic discontinuation on the prognosis of outpatients with HF with reduced ejection fraction. MethodsThis retrospective cohort study collected data from medical records of patients followed in an outpatient HF clinic at a university hospital center. Patients were included if they had been on loop diuretics and these were discontinued. Demographic, clinical and laboratory data were collected, and number and type of congestive events during the one-year period after discontinuation were recorded. ResultsAmong 265 patients on loop diuretics, almost half (129) discontinued them at some point. Patients had optimized medical therapy, low median age, low New York Heart Association class, low B-type natriuretic peptide values, normal blood pressure, controlled heart rate and kidney function within normal limits. Among 122 patients with one year of follow-up, 18 (14.8%) had a congestive event. Fifteen events (83.3%) were low-dose diuretic reinitiation at a scheduled visit. There were only three worsening heart failure events (2.5%) during the one-year period. A significant improvement in kidney function from discontinuation to the one-year follow-up appointment was also observed. ConclusionsIn our cohort, loop diuretic discontinuation was possible and safe in a large proportion of patients. The results should be interpreted with caution and cannot be extrapolated to a broader population of HF patients.

Developing a manual clinical trials screening process in a diverse southern gynecologic oncology practice in the Deep South.

e23209 Background: At this time, there is no standard clinical trial screening process or definition that has been adopted within Gynecologic Oncology. In our low resource, highly diverse Gynecologic Oncology patient population, we sought to create an equitable, adaptable, manual screening process that better reflected our patient population. Our objective is to describe our clinical trial screening process and our success in improving trial enrollment and a matched trial portfolio. Methods: An IRB-approved, QI project was implemented in July 2022 to evaluate trial access for Gyn Onc patients. First, screenable events were defined as: the start of one’s first scheduled visit, bi-monthly tumor boards, weekly pre-op meetings, and by keeping track of on a shared Epic list. Potential patients were those with a screenable event: new patients or diagnoses, regimen changes, progressions, and recurrences. Events were categorized into screen positive or screened no trial available. Screen positives were further categorized as screen fail, screen positive, enrollment failure, or enrolled. Data about patients was collected via weekly research team meetings. Monthly meetings occurred to review progress. This data was compared to trials available, number of patients with trail available, and those that enrolled. Reasons for enrollment fails were tracked to improve access and anticipate barriers. Results: Overall demographic data of patients was collected. The average age of participants was 60.67 years (SD = 13.45), and the average distance to a treatment center was 59.27 miles (SD = 137.43). Other demographics are presented in Table 1. For each month, the percentages of “screen no trial available (SNTA)” events and patients who screened positive and did enroll on trial were recorded. Over time, SNTA rates stayed stable, but enrollment increased. Patient preference accounted for 32.8% of enrollment fails (n = 42), pre-existing symptoms/conditions accounted for 23.4% (n = 30), and distance/location accounted for 21.1% (n = 27). During a time of high employee turnover in the summer months of 2023, there was a rise in enrollment fails due to staffing (n = 6, 4.7%). Conclusions: Through a collaborative quality initiative, we describe an effective process of clearly defining and tracking our patient population and ‘screenable events’ for which all patients are screened and offered trial participation if eligible. We show that we improved understanding of the patient population, built a clinical trial portfolio better matched to population served, exceeded national averages for enrolling patients on trials, and are moving toward improved number eligible over time. [Table: see text]

An ancillary care policy in a vaccine trial conducted in a resource-constrained setting: evaluation and policy recommendations

IntroductionClear guidelines to implement ancillary care (AC) in clinical trials conducted in resource-constrained settings are lacking. Here, we evaluate an AC policy developed for a vaccine trial in the Democratic...

Health-related quality of life (HRQoL) outcomes from the randomized, double-blind phase 3 KEYNOTE-671 study of perioperative pembrolizumab for early-stage non-small-cell lung cancer (NSCLC).

8012 Background: Neoadjuvant pembrolizumab + cisplatin-based chemotherapy (neoadj pembro + chemo), resection, and adjuvant (adj) pembro (pembro arm; n=397) significantly improved EFS, OS, pCR, and mPR and had an expected safety profile versus neoadj placebo (pbo) + chemo, resection, and adj pbo (pbo arm; n=400) in patients (pts) with resectable stage II, IIIA, or IIIB (N2) NSCLC. We present prespecified pt-reported outcome (PRO) endpoints from KEYNOTE-671. Methods: Pts completed EORTC QLQ-C30 and QLQ-LC13 questionnaires at baseline (BL), the last scheduled presurgery visit, adj cycles 1-4, 7, 10, and 13, and each post treatment visit. A constrained longitudinal data analysis model was used to estimate least squares mean (LSM) score changes from BL to neoadj wk 11 and adj wk 10 (latest time of ≥60% completion and ≥80% compliance) in QLQ-C30 global health status (GHS)/QoL, physical functioning (PF), role functioning (RF), and dyspnea and QLC-LC13 cough and chest pain in all treated pts who completed ≥1 PRO assessment. Data are from interim analysis 2 (10 Jul 2023 cutoff). Results: Across arms, questionnaire completion was ≥87% at neoadj wk 11 and ≥62% at adj wk 10; compliance was ≥87% and ≥92%, respectively. There were no differences in LSM change from BL in the neoadj or adj phase for any PRO score (Table). Conclusions: Adding perioperative pembro maintained HRQoL in both the neoadj and adj settings versus neoadj chemo and surgery alone in pts with resectable early-stage NSCLC. Together with the significant efficacy improvements and absence of new safety signals, HRQoL data support the perioperative pembro regimen as a new standard of care. Clinical trial information: NCT03425643 . [Table: see text]

Clinical and Demographic Characteristics of Patient-Initiated Encounters Before the 6-Week Postpartum Visit.

To identify characteristics associated with a higher likelihood of patient-initiated encounters with a health care professional before the scheduled 6-week postpartum visit. We performed a retrospective cohort study of postpartum persons who received prenatal care and delivered at a single academic level IV maternity care center in 2019. We determined associations between maternal sociodemographic and obstetric characteristics and the likelihood of patient-initiated early postpartum encounters with χ2 tests for categorical variables and Wilcoxon rank sum tests for continuous and ordinal variables. A total of 796 patients were included in our analysis, and 324 (40.7%) initiated an early postpartum encounter. Significantly more postpartum persons who initiated early postpartum encounters were primiparous persons (54.3%) than multiparous (33.8%) persons (P < .001). Postpartum persons who desired breastfeeding or who had prolonged maternal hospitalization, episiotomy, or cesarean or operative vaginal delivery were also significantly more likely to initiate early postpartum encounters (all P≤.002). Of postpartum persons who initiated early encounters, 44 (13.6%) initiated in-person visits, 138 (42.6%) initiated telephone or patient portal communication, and 142 (43.8%) initiated encounters of both types. Specifically, 39.2% of postpartum persons initiated at least one early postpartum encounter for lactation support, and nearly half of early postpartum encounters occurred during the first week after hospital discharge. Early postpartum encounters were more common among primiparas and postpartum persons who were breastfeeding or had prolonged hospitalization, episiotomy, cesarean delivery, or operative vaginal delivery. Future studies should focus on the development of evidence-based guidelines for recommending early postpartum visits.

The role of self-examination in the early diagnosis of breast cancer: routine or real opportunities?

Approximately 90% of breast tumors are detected by women themselves, but about 50% of them already have significant sizes and metastases in the lymph nodes at the time of detection. Breast self-examination is an effective means of detecting cancer in its early stages, especially among women who regularly perform it. The objective: to determine the level of awareness of Ukrainian women about the role of breast self-examination in the early diagnosis of breast cancer.Materials and methods. In order to realize the set goal, a voluntary internet survey of 508 women aged 18 to 65 was conducted in the period from December 20, 2022 to April 20, 2023, based on a previously prepared questionnaire. The previously compiled questionnaire contained 27 questions, which are divided into 6 sections.The surveyed women are divided into two groups by profession:I group – 206 women with medical education;II group – 302 women without medical education.During the survey female respondents independently made a decision to refuse to answer certain questions, which was later taken into account during the statistical processing of the obtained results.Results. During the survey, almost all the women of the studied groups stated that they were aware of the high incidence of breast cancer among Ukrainian women, the extreme difficulty of treatment and the fatal consequences of its late diagnosis. However, 132 (64.08%) female respondents of the 1st group and 243 (80.46%) female respondents of the 2nd group were confident in the impossibility of contracting breast cancer (p&lt;0.05). Thus, women who voluntarily participated in the survey are from the category of the most active and informed, but with unfounded confidence in their absolute safety regarding breast cancer.Conclusions. As the research shows, the vast majority of women consider themselves to be sufficiently informed about breast cancer, however, existing unfounded confidence in the impossibility of getting the disease reduces their cancer bias, which is significantly higher among women of non-medical professions. Social networks and the Internet remain the main source of information about breast cancer and methods of self-monitoring of the condition of the mammary glands. The majority of women are aware of the presence of risk factors for precancerous diseases and breast cancer, however, most of them have delayed the debut of self-examination of the mammary glands, perform it irregularly and do not follow the rules of its conduct, which significantly reduces its diagnostic and prognostic value. Trusted family doctors do not conduct an annual clinical examination of the mammary glands during scheduled visits of women, which significantly reduces the effectiveness of screening programs in women of all age groups. From our point of view, self-examination, as part of breast cancer screening, does not play a leading role in the diagnosis of this disease, but instills in women an urgent need to constantly worry about their health.

Dietitians' perceptions of employment models used in Australian residential aged care facilities.

The qualitative study aimed to explore dietitians' perceptions of employment status and engagement models with residential aged care facilities (RACF) and the impact on work activities and resident care. Dietitians currently working in RACF were recruited through convenience and snowball sampling, including contacting a list of dietitians who had previously consented to be contacted for research. A semi-structured interview guide was developed by the research team, pilot-tested and then used in each individual interview. Data were analysed using constant comparison and reflexive thematic analysis. Thirty-one dietitians (n = 29 female; median age, 39 years) with a range of experience working in different employment status and engagement models in RACF participated in an interview. Five themes were identified: (1) Being an employee allows for better integration and utilisation in the RACF, (2) Contract work creates a scarcity of time, (3) Ad hoc work does not meaningfully address nutrition challenges and may not be good for resident care, (4) Regularly scheduled visits support positive outcomes for residents and (5) Acknowledging many different employment models. Characteristics of engagement models likely affect dietitian work job satisfaction, individual resident care and food service in RACF. Regular dietetic engagement in RACFs is required to support resident-centred evidence-based dietetic practice and to improve residents' nutrition care. There is an opportunity for policy mandates to assist RACFs in regularly engaging a dietitian to ensure all residents have access to timely, high-quality nutrition care.

Factors associated with engagement in HIV care for young people living with perinatally acquired HIV in England: An exploratory observational cohort study.

Identifying which young people living with perinatally acquired HIV (PHIV) are less likely to engage in care is crucial to allow targeted interventions to support them to attend clinic. We adapted an existing Engagement in Care (EIC) algorithm for adults with HIV in England, for use in young people. We applied it to data from young people with PHIV in the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort. The algorithm predicts the timing of the next scheduled clinic visit, within 1-6 months of current visit, based on routine clinical data. Follow-up was 12-months from AALPHI baseline interview. Each person-month was classified as engaged in care or not. Logistic regression models (allowing for clustered data) were used to explore baseline characteristics associated with being engaged in care, adjusting for a priori variables (time from interview, sex, age, ethnicity, country of birth). Potential characteristics were across 7 domains: sociodemographic; risk behaviour practices; mental health; cognition; clinic setting; HIV management and experience; and HIV clinical markers. Of 316 young people, 187(59%) were female, 271(86%) of black ethnicity and 184(58%) born abroad. At baseline, median [IQR] age was 17[15-18] years, and 202(69%) had viral load ≤50 copies/ml(c/mL). 87% of 3,585 person-months were classified as engaged in care. Characteristics independently associated with poorer odds of being engaged in care were: Asian/mixed/other ethnicity, vs. black ethnicity (OR 0.44, 95% CI 0.25, 0.78, p = 0.02); ever self-harmed, vs. not (OR 0.55, 95% CI 0.32, 0.95, p = 0.03); on antiretroviral therapy (ART) and self-assessed bad/not so good adherence (OR 0.46, 95% CI 0.25, 0.84) or not on ART (OR 0.64, 95% CI 0.64, 1.21) vs. on ART and good/excellent adherence (p = 0.04)); baseline VL>50c/mL, vs VL≤50c/mL (OR 0.47, 95% CI 0.30, 0.75, p = 0.002). These characteristics can help identify individuals requiring enhanced support to maintain service engagement.