Target Group Of Patients Research Articles

Investigation of IDO1 and TDO2 expression in breast tumors by immunohistochemistry and real-time polymerase chain reaction methods

Although diagnostic and therapeutic advances have been made in the treatment of breast cancer, the challenge of effectively controlling tumor progression persists. The objective of this study was to determine the relationship between IDO1 and TDO2 expression in breast cancer by immunohistochemistry and real-time polymerase chain reaction, hormone receptor status, Ki67 proliferation index, molecular classification, metastasis, and to investigate whether IDO1 and TDO2 expression can be used in combination with targeted therapy or as a marker to increase treatment efficacy in selected cases. The study included 74 cases of breast cancer and 14 cases of normal breast tissue as controls. All cases were analyzed for IDO1 and TDO2 by both immunohistochemistry and real-time polymerase chain reaction. The immunohistochemical analysis revealed that IDO1 immunoreactivity was significantly higher in tumor tissue compared to normal breast tissue. A statistically significant correlation was observed between IDO1 immunoreactivity and histologic subtypes. Furthermore, IDO1 gene expression was correlated with IDO1 immunoreactivity. TDO2 immune reactivity did not differ between tumor and non-tumor tissues and no correlation was found between histological subtypes. There was no correlation between TDO2 immunoreactivity and gene expression. The significant increase in IDO1 levels in tumor tissue and high positivity in age, HER2 positive and triple negative cases compared to other cases suggest that IDO1 inhibitors may be suitable for the target patient group in treatment selection.

Early intervention for eating disorders.

Research on early intervention for eating disorders has started to gain traction and examples of this in practice are increasing. This review summarizes findings over the past 3 years, focusing on the clinical effectiveness of early intervention in practice and the barriers and facilitators to its implementation. Recent developments in early intervention for eating disorders can be divided into three broad themes: research that has examined the efficacy of early intervention pathways in practice, research that has informed understanding of the target patient groups of early intervention (via clinical staging models, e.g.), and research that has suggested new ways to progress early intervention, towards becoming a standard part of best practice care. Early intervention pathways have shown promising clinical outcomes and are viewed positively by patients, clinicians and other stakeholders. However, more robust trials of their efficacy, effectiveness and cost-effectiveness are needed. Additionally, barriers to early intervention have been identified (e.g. delayed help-seeking); research must now develop and evaluate strategies to address these. Finally, the early intervention models in practice are underpinned partly by clinical staging models for eating disorders, which require further development, especially for eating disorders other than anorexia nervosa.

Satisfaction-based patient classification: Improving the quality of healthcare services

ABSTRACT Patient satisfaction is crucial for evaluating healthcare quality. However, its potential as a patient classification strategy remains to be explored, leaving healthcare institutions without clear guidance in this regard. This study introduces a comprehensive approach for classifying health service patients based on their satisfaction levels with the aim of enhancing service quality and overall patient experience. The proposed model involved five key steps: questionnaire, data analysis, classification analysis, classification function, action and check. The analytical support for this approach was derived from factor analysis, k-means clustering, and multiple discrimination analysis. In this study, 288 valid responses were collected from medical and dental clinics in Brazil, which comprised a convenience sample. This approach identified four quality factors – interaction, physical environment, service outcome, and waiting time – and two patient groups based on satisfaction levels, highlighting service outcome and waiting time as pivotal factors in patient clustering. This study addressed the challenges of identifying target patient groups and classifying them to enhance satisfaction while maintaining the quality of healthcare services. Future studies could replicate this methodology by incorporating variables that capture client-specific organizational relationships. This will contribute to refining strategies for enhancing service quality and patient satisfaction in diverse healthcare settings.

Influence of audiovisual distraction on the feeling of stress, analgesic sedation and patient satisfaction during electrophysiological ablation procedures on the heart

Abstract Background Distraction using audiovisual stimuli has mostly been researched in a paediatric population with the results showing an inhibiting effect on stress and anxiety as well as the subjective perception of pain. Purpose We designed a study to test if audiovisual distraction may reduce the level of sedatives and analgesics by reducing anxiety and stress during electrophysiological intervention (EP). Methods We conducted a clinical intervention pilot study that was carried out in a randomized controlled manner. Consecutive 70 patients undergoing EP with subsequent ablation were randomized 1:1 to control (CTL) or intervention group (AVD). In addition to standardized sedation, all patients in AVD group received audiovisual glasses. Feeling of fear and stress was assessed through blood pressure changes. The patient satisfaction was assessed with Client Satisfaction Questionnaire, ZUF-8. Numeric scale (NRS) was used to quantify the perceived pain during the procedure. The difference between the subjective estimated duration of the procedure and the actual duration of the procedure was compared. Results The study included predominantly male patients (58.6%) with a mean age of 56 years. Technical aptitude was well balanced between both groups with the majority of patients in both groups owning a smartphone or a tablet (86.1% vs 85.7% for CTL and AVD respectively, p=0.92), and majority of patients in both groups using a computer, laptop or tablet on a weekly basis (58% vs 57.1% for CTL and AVD group respectively, p=0.97). The baseline feelings of anxiety were well balanced within both groups (Figure 1). Our analysis revealed no significant difference between the mean blood pressure values of the CTL and AVD groups (systolic: 135 vs. 141 mmHg; p = 0.32; diastolic: 74 vs. 72 mmHg; p = 0.45). Patient satisfaction score was comparable in both groups (26.5 vs. 26.8 points, p = 0.36). Average response for perceived pain using NRS scale as well as perceived procedure duration was similar between the groups (Figure 2). AVD group required a lower dose of Midazolam than CTL group (0.005 mg/kg/h vs 0.007 mg/kg/h, p = 0.07). Majority of patients (31.4%) in AVD group stated: "The audiovisual glasses made me feel distracted at times." 10% of the AVD patients stated: "The audiovisual glasses made me feel completely distracted and more relaxed." Conclusion The use of audiovisual glasses has no influence on the patients’ feelings of anxiety and stress during EP. The use of audiovisual glasses can temporarily induce distraction during EP, while they do not seem to be sufficient in reducing pain intensity during ablation therapy. Patients undergoing EP do not seem to be the target patient group for AVD use.

Effects of extracorporeal CO2 removal on gas exchange and ventilator settings: a systematic review and meta-analysis

PurposeA systematic review and meta-analysis to evaluate the impact of extracorporeal carbon dioxide removal (ECCO2R) on gas exchange and respiratory settings in critically ill adults with respiratory failure.MethodsWe conducted a comprehensive database search, including observational studies and randomized controlled trials (RCTs) from January 2000 to March 2022, targeting adult ICU patients undergoing ECCO2R. Primary outcomes were changes in gas exchange and ventilator settings 24 h after ECCO2R initiation, estimated as mean of differences, or proportions for adverse events (AEs); with subgroup analyses for disease indication and technology. Across RCTs, we assessed mortality, length of stay, ventilation days, and AEs as mean differences or odds ratios.ResultsA total of 49 studies encompassing 1672 patients were included. ECCO2R was associated with a significant decrease in PaCO2, plateau pressure, and tidal volume and an increase in pH across all patient groups, at an overall 19% adverse event rate. In ARDS and lung transplant patients, the PaO2/FiO2 ratio increased significantly while ventilator settings were variable. “Higher extraction” systems reduced PaCO2 and respiratory rate more efficiently. The three available RCTs did not demonstrate an effect on mortality, but a significantly longer ICU and hospital stay associated with ECCO2R.ConclusionsECCO2R effectively reduces PaCO2 and acidosis allowing for less invasive ventilation. “Higher extraction” systems may be more efficient to achieve this goal. However, as RCTs have not shown a mortality benefit but increase AEs, ECCO2R’s effects on clinical outcome remain unclear. Future studies should target patient groups that may benefit from ECCO2R.PROSPERO Registration No: CRD 42020154110 (on January 24, 2021).Graphical abstract

Post-operative Patient Portal Messaging is Associated With Return to the Emergency Department After Lumbar Spine Surgery.

Retrospective study. To explore the association between patients undergoing lumbar spine surgery who message their care team via an electronic patient portal (EPP) post-operatively and emergency department (ED) visits within 90 days of surgery. Secure patient messaging through electronic patient portals has grown over recent years. Despite its frequent utilization by patients to engage with their care team, its association with clinical outcomes remains unknown in spine surgery. This study was approved by our Institutional Review Board. Inclusion criteria were adults who underwent single-stage lumbar spine surgery between January 2016-June 2023. Patients with incomplete information, multi-stage surgeries, and those who died within 90 days of surgery were excluded. Patient sociodemographic, surgical, hospital readmission, and patient-provider engagement data were collected. A total of 13,135 patients were included. A total of 1,711 patients (13%) had a post-operative ED visit, and 4,791 patients (36%) used the patient portal to send a message after surgery. Sending a post-operative patient message after undergoing lumbar spine surgery was associated with an increased likelihood of having an ED visit that does not lead to readmission (1.29 (1.10-1.53), P = 0.002). Patients with high school degrees were more likely to have an ED visit without readmission (1.33 (1.08-1.65), P = 0.008). Patients at a higher risk of presenting to the ED post-operatively should be identified and may benefit from additional counseling and access to the care team virtually to limit unnecessary healthcare utilization. Focusing on patients who reach out via EPP messaging post-operatively may be a good target patient group to address first. Future research is needed to investigate the possible health literacy and other socioeconomic barriers affecting these patients so that appropriate, more cost-effective resources can be utilized to avoid clinically unnecessary and costly ED visits.

The value of artificial intelligence for the treatment of mechanically ventilated intensive care unit patients: An early health technology assessment

PurposeThe health and economic consequences of artificial intelligence (AI) systems for mechanically ventilated intensive care unit patients often remain unstudied. Early health technology assessments (HTA) can examine the potential impact of AI systems by using available data and simulations. Therefore, we developed a generic health-economic model suitable for early HTA of AI systems for mechanically ventilated patients. Materials and methodsOur generic health-economic model simulates mechanically ventilated patients from their hospitalisation until their death. The model simulates two scenarios, care as usual and care with the AI system, and compares these scenarios to estimate their cost-effectiveness. ResultsThe generic health-economic model we developed is suitable for estimating the cost-effectiveness of various AI systems. By varying input parameters and assumptions, the model can examine the cost-effectiveness of AI systems across a wide range of different clinical settings. ConclusionsUsing the proposed generic health-economic model, investors and innovators can easily assess whether implementing a certain AI system is likely to be cost-effective before an exact clinical impact is determined. The results of the early HTA can aid investors and innovators in deployment of AI systems by supporting development decisions, informing value-based pricing, clinical trial design, and selection of target patient groups.

Covid-19: Course and prognosis in patients with severe clinical form

Our aim is to identify factors of unfavorable prognostic significance in hospitalized patients with severe COVID-19, an analysis of clinical and demographic characteristics and routine laboratory tests was performed. For the following period: March - July 2023, 25 patients with severe COVID-19 needing intensive care and treatment were hospitalized in Military Medical Academy Sofia (Bulgaria). The diagnosis has been confirmed by RT-PCR analysis for SARS-CoV-2 detection. According to the prognosis, the target group of patients were divided into two groups - discharger and deceased. The average age of the analyzed cohort was 77.6 years. The most commonly reported clinical symptoms include fever, cough, shortness of breath, and neurological symptoms. We found that all patients with severe COVID-19 were comorbid and elderly. The average hospital stay in intensive care is 11.9 days. Nearly half of the cases had fatal outcome (12/25). Among the factors associated with the clinical severity of COVID-19 and mortality are advanced age, presence of chronic concomitant diseases, development of pneumonia and/or neurological complications, as well as deviations in some laboratory parameters.

Integrated neighborhood teams in the chronic care project 'Leuven Cares' (Zorgzaam Leuven)

In the city of Leuven, ‘integrated neighborhood teams’, as the smallest building blocks of primary care networks, work together facilitated by ‘Leuven Cares’ and driven by population health management and clinical guidelines for the most common chronic diseases.
 Primary caregivers from different professional backgrounds and working in the same neighborhood cooperate to provide structured and coordinated care.
 The targeted patient groups are their shared most vulnerable population with complex needs.
 In 2018 Leuven Cares started founding neighborhood teams. Via a bottom up approach, primary care providers were stimulated to unite in neighborhood oriented networks. Frameworks and local actions for integrated care are elaborated by the neighborhood teams, who act on the level of the neighborhood, while individual teams at patient level do apply them. To start with, risk stratification based on queries in the electronic records helps the teams to indicate what population(s) to focus most on. Than agreements are made for disease management in patients with chronic diseases and care protocols for patients with increased care needs. Stratification helps to see parallelism and complementarity in existing interventions and actions. It also points out where gaps exist that are not covered with usual care. Proactive care, profound coordination of care for complex needs, care planning, empowerment of patients to control their own care process are items that are focused on in the local teams.
 More specific, those frameworks make sure that every patient has access to a care plan that is spoken trough and clear. Items of this care plan are medical follow up and coordination of care, medication coordination, healthy lifestyle, mental wellbeing, prevention etc…
 An individual care plan structures the fragmented care and supports communication between the individual caregivers. An even more important goal of this plan is the possibility for the individual patient to take control over his own care process. For people who are not capable to coordinate their own care, support can be given by the local network. One team member, with a specific focus takes on a coaching role in care coordination This team member can supervise the individual care process for those who cannot do it alone, or can even take over coordination if needed.
 General team processes are supported by the team coach, acting as an operational manager, who assists the team in focusing on the long-term vision, in the implementation of the framework, in gathering data of what happens in the local actions etc.
 
 This results in eight multidisciplinary primary care teams that are progressively engaged to provide integrated care to their shared, most vulnerable population. In these teams up to 60% of the primary caregivers are involved to support the needs of 4000 included patients (October 2022).
 Leuven has been our testing ground to develop these co-acting teams. The overall population of this city is already very divers. On the other hand, our model is not tested for smaller less divers cities, and more rural neighborhoods.
 Next steps are to find out whether our model is implacable for other environments. 
 
 
 
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Implementation of point-of-care HbA1C instruments into community pharmacies: Initial development of a pathway for robust community testing.

Point-of-care (POC) analysers in community settings can provide opportunistic and regular HbA1c monitoring. Community pharmacies in NHS Scotland are utilised by populations at greatest risk of type two diabetes (T2D). This study describes initial development of an HbA1c pathway using a POC analyser in community pharmacies. The Abbott Afinion analyser was compared in (i) NHS Tayside's Blood Sciences Service and (ii) community pharmacies from four Scottish Health Boards. A side by side comparison with standard operating procedures for HbA1c quantification using 80 T2D patient venous samples. The machine was implemented into 11 community pharmacies and 144 samples obtained from patients for comparison to their recent laboratory HbA1c. Four focus groups examined themes around the intervention and an exit questionnaire was administered. Laboratory assessment verified the efficacy of the POC test machine. The value for level 1 quality control was 44mmol/mol and the mean during testing 42.7mmol/mol. The greatest percent coefficient of variation (cv) was within-run for both levels of quality control material, at a value of 1.63% and 1.62%, respectively. The analyser performed robustly within the pharmacy assessment, with a mean difference of 1.68 and a standard deviation of 0.71 (CV 0.423). Patients with T2D reported positive experiences of using a pharmacy. The focus groups identified an appreciation of the convenience of pharmacies and of the longitudinal relationships with pharmacy staff. POC HbA1c analysers can be successfully established in community pharmacies. The target patient group responded positively to the opportunity to use a pharmacy service.

Development and Evaluation of eHealth Services Regarding Accessibility: Scoping Literature Review.

Accessibility is acknowledged as a key to inclusion in the Convention of Rights for People with Disabilities. An inaccessible design can result in exclusion from eHealth and cause disability among people who have impairments. This scoping literature review aimed to investigate how eHealth services have been developed and evaluated regarding accessibility for people with impairments. In line with Arksey and O'Malley's framework for scoping studies and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a search in 4 databases (PubMed, Scopus, IEEE, and Web of Science) in October 2020 and an update of the search in June 2022. The search strategy was structured according to the PICO model as follows: Population/Problem, digital accessibility for users with impairment; Intervention, health care delivered by any digital solution; Comparison, not applicable; Outcome, use of and adherence to (1) Web Content Accessibility Guidelines (WCAG), (2) other accessibility guidelines, and (3) other means, for designing or evaluating accessibility in eHealth services. A Boolean search was conducted by combining terms related to accessibility and eHealth. All authors participated in screening abstracts according to the eligibility criteria. Each publication, containing a potentially relevant abstract, was read (full text) and assessed for eligibility by 2 authors independently and pairwise. Publications deemed eligible were read by all authors and discussed for consensus. A total of 8643 publications were identified. After abstract screening, 131 publications remained for full-text reading. Of those, 116 publications were excluded as they did not meet the eligibility criteria. Fifteen publications involving studies of 12 eHealth services were included in the study. Of the 15 publications, 2 provided a definition of accessibility, 5 provided an explanation of accessibility, and 8 did not provide any explanation. Five publications used the WCAG to evaluate accessibility when developing eHealth services. One publication used International Organization for Standardization (ISO) 29138, ISO 2941, and ISO/International Electrotechnical Commission (IEC) 30071-1 standards together with the Spanish Association for Standardization (UNE) 139803 standard. Eleven publications used other means to address accessibility, including text-level grading; literature review about accessibility; user tests, focus groups, interviews, and design workshops with target groups of patients, relatives, and health care professionals; and comparative analysis of existing technical solutions to provide information about useful requirements. Although a clear definition of accessibility can enhance operationalization and thus measurability when evaluating accessibility in eHealth services, accessibility was insufficiently defined in most of the included studies. Further, accessibility guidelines and standards were used to a very limited extent in the development and evaluation of eHealth services. Guidelines for developing complex interventions that include guidance for accessibility are motivated to ensure that accessibility will be considered systematically in eHealth services.

Barriers to Inter-Organisational Collaboration in the Preoperative Management of Patients with Osteoarthritis of the Hip or Knee.

Integrated clinical pathways should provide the best and most efficient treatment. As no study on barriers to inter-organisational collaboration has investigated the barriers to unimplemented integrated clinical care in a country with less efficiently organised health system, the study aimed to identify these barriers in the preoperative management of patients with hip or knee osteoarthritis in Slovenia. A cross-sectional study was conducted using multiple methods, including a quantitative survey with participants involved in target patient groups, and in-depth interviews with involved key actors at micro, meso and macro levels in Slovenia. Respondents predominantly expressed a lack of inter-organisational collaboration. The exposed barriers are individualistic culture, the level of development of the health system, financing, administration, and regulatory frame at the macro level, shortage of staff at the meso level, and the lack of technological standards, trust, communication, and perception of pressures at the micro level. In addition to the barriers identified in previous studies, our study shows that individualistic culture and the level of development of the health system at the macro level, manifested as a pressure on health professionals and other actors at the micro level, are important barriers to inter-organisational collaboration.

Cost effectiveness of innovative anti-cancer drugs and reimbursement decisions in China

ObjectivesBecoming the bottleneck of patient access to new drugs, the reimbursement coverage process in China started to engage health economic evaluations. This study aimed to quantify the potential impacts of cost-effectiveness profiles on reimbursement coverage in China. MethodsCost and effectiveness measures of both reimbursable and non-reimbursable indications of newly covered anti-cancer drugs from 2017 to 2021 were collected from the literature since official documents were not accessible. The measures included incremental costs-effectiveness ratios (ICERs), incremental quality-adjusted life years (QALYs), incremental costs, acquisition costs, population sizes of target patient groups, availability of overall survival evidence in clinical trials, the language of literature, country of origin of the drug, and the year of initial coverage. Logistic regressions were used to examine the impacts of cost and effectiveness measures. ResultsSeventy-four anti-cancer drugs were newly covered from 2017 to 2021. We identified 64 and eight ICERs of reimbursable and non-reimbursable indications of the newly covered anti-cancer drugs. Of note, nine reimbursable indications of the newly covered anti-cancer drugs did not have corresponding literature evidence. The regression results suggested that ICER was not associated with reimbursement coverage. By contrast, incremental QALYs and patient population size by cancer type were positively associated with coverage, while acquisition costs were negatively associated with coverage. ConclusionsClinical benefits, acquisition costs, and the disease burden of the target population associated with new anti-cancer drugs are likely important considerations of reimbursement decisions in China. However, the importance of value-based pricing should be reinforced and investigated in the future when official documents become accessible. Public interest summaryAccess to new health technologies through reimbursement is critical to the public. Since 2017, Chinese healthcare and health insurance agencies have adopted health technology appraisals to expedite reimbursement decisions of new drugs, among which anti-cancer drugs accounted for the greatest proportion. The appraisals largely relied on health economic evaluations. In the current study, we quantified the potential impacts of cost-effectiveness profiles on the reimbursement of new anti-cancer drugs in China. We did not identify any significant association between reimbursement and incremental cost-effectiveness ratio, the latter of which is the primary measure of drug economic profiles. On the upside, incremental quality-adjusted life years (QALYs) were positively associated with reimbursement coverage, whereas acquisition costs had a negative association. To secure patient access to high-value anti-cancer drugs via reimbursement in China, it is vital to reinforce the consideration of cost-effectiveness evidence.

Protocol for a multicenter study on effectiveness and economics of the Back At work After Surgery (BAAS): a clinical pathway for knee arthroplasty

BackgroundOptimizing return to work (RTW) after knee arthroplasty (KA) is becoming increasingly important due to a growing incidence of KA and poor RTW outcomes after KA. We developed the Back At work After Surgery (BAAS) clinical pathway for optimized RTW after KA. Since the effectiveness and cost analysis of the BAAS clinical pathway are still unknown, analysis on effectiveness and costs of BAAS is imperative.MethodThis protocol paper has been written in line with the standards of Standard Protocol Items: Recommendations for Interventional Trails. To assess the effectiveness and cost-effectiveness for RTW, we will perform a multicenter prospective cohort study with patients who decided to receive a total KA (TKA) or an unicompartmental KA (UKA). To evaluate the effectiveness of BAAS regarding RTW, a comparison to usual care will be made using individual patient data on RTW from prospectively performed cohort studies in the Netherlands.DiscussionOne of the strengths of this study is that the feasibility for the BAAS clinical pathway was tested at first hand. Also, we will use validated questionnaires and functional tests to assess the patient’s recovery using robust outcomes. Moreover, the intervention was performed in two hospitals serving the targeted patient group and to reduce selection bias and improve generalizability. The limitations of this study protocol are that the lead author has an active role as a medical case manager (MCM) in one of the hospitals. Additionally, we will use the data from other prospective Dutch cohort studies to compare our findings regarding RTW to usual care. Since we will not perform an RCT, we will use propensity analysis to reduce the bias due to possible differences between these cohorts.Trail RegistrationThis study was retrospectively registered at clinicaltrails.gov (https://clinicaltrials.gov/ct2/show/NCT05690347, date of first registration: 19–01-2023).

Development of two outpatient interdisciplinary group modules in the treatment of patients with pain and risk of chronification

An early treatment of patients who suffer from pain and show risk factors for chronification is meaningful as these patients can benefit from an early interdisciplinary multimodal pain treatment (IMST). In view of the insufficient treatment, two outpatient treatment modules for the secondary prevention of pain chronification are developed within the framework of PAIN2020: the educative and accompanying IMST (E‑IMST and B‑IMST). The developmental process of both IMSTs is presented. In this context two target groups of patients were defined for which 1session (E‑IMST) or 10intervention appointments (B‑IMST) were planned, depending on the chronification, impairment and complexity of the disorder. The conception was carried out in five steps: development of the objectives, development of the main contents, workshop on the content and conceptional design (contents, mediation, exercises), preparation of atime schedule and processing of the results (manual, presentations, worksheets, handbook). The B‑IMST was initially developed from which the contents for the E‑IMST were subsequently extracted. Additionally, aconcept for testing the feasibility and aworking model for apilot study were developed. The objectives for both forms of IMST are improvement of the understanding of pain and contributing factors, the increase of the experience of control and self-efficacy and the increase in self-responsibility with respect to strategies to reduce pain. Differences between the two treatment modules arise from the needs and framework conditions. Medical, physiotherapeutic and psychotherapeutic contents and schedules were organized for both IMST modules. The B‑IMST consists of five modules each with two sessions as group interventions (biopsychosocial model, activation planning, regulation of needs, sleep and medication, routine transfer). The 3‑h E‑IMST group intervention mainly intends to mediate knowledge on pain and the biopsychosocial pain model. Theoretical and practical interventions, empirical knowledge and experience-oriented methods are employed. There are now two interdisciplinary structured manuals for the secondary preventive treatment of patients with recurrent pain and arisk profile for chronification. These approaches must now prove themselves with respect to feasibility and effectiveness.

Prognostic Models of Primary Sclerosing Cholangitis

Aim: to study the significance of prognostic scales in a target group of patients with primary sclerosing cholangitis (PSC) living in the Chelyabinsk region.Materials and methods. The study included 21 patients with a confirmed diagnosis of primary sclerosing cholangitis (PSC) and a disease duration of at least two years. The primary endpoint studied was death. The MELD, Mayo Risk Score, Amsterdam-Oxford PSC Score, PREsTo score, and UK-PSC Score scales were calculated based on the medical records. Statistical processing was carried out using the SPSS Statistics v.22 application.Results. A retrospective assessment of the risk of mortality using the MELD, Mayo Risk Score and Amsterdam-Oxford PSC Score did not reveal a statistically significant difference between deceased and surviving patients. The UK-PSC Score scale showed the highest predictive value (p = 0.046).Conclusion. The new predictive model UK-PSC Score showed advantages in predicting death in PSC patients compared to other scales.

Consultation with target patient groups: User (Readability) testing/bridging procedure Regulatory experience with Agency for medicinal products and medical devices of Bosnia and Herzegovina (ALMBiH)

Consultation with target patient groups: User (Readability) testing/bridging procedure Regulatory experience with Agency for medicinal products and medical devices of Bosnia and Herzegovina (ALMBiH)

Collateral Effect of the Coronavirus Disease 2019 Pandemic on Emergency Department Visits in Korea.

Background and Objectives: The ongoing coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis that has had a serious impact on emergency department (ED) utilization trends. The aim of this study was to investigate the collateral effects of the COVID-19 pandemic on ED utilization trends by patients with mild and severe conditions as well as on 7-day fatality rates. Materials and Methods: We analyzed entries in the Korean National Health Insurance claims database between 1 January 2018 and 31 December 2020. Six target patient groups were identified using the main diagnosis codes in the 10th revision of the International Classification of Diseases. Numbers of patients visiting the ED, their age, regional differences, 7-day fatality rate, and rate of emergency procedures were compared between 2018 and 2019 as the control period and 2020, when the COVID-19 pandemic was in full force. Results: During the 2020 COVID-19 pandemic, the number of patients who visited the ED with low-acuity diseases and severe acute respiratory infection diseases sharply decreased to -46.22% and -56.05%, respectively. However, the 7-day fatality rate after ED visits for low-acuity diseases and severe acute respiratory infection diseases increased to 0.04% (p < 0.01), and 1.65% (p < 0.01), respectively, in 2020 compared to that in the control period. Conclusions: During the 2020 COVID-19 pandemic, ED utilization impacted and 7-day fatality rate after ED visit increased. Health authorities and health care providers must strive to ensure prompt delivery of optimal care in EDs for patients with severe or serious symptoms and time-dependent diseases, even during the ongoing COVID-19 or potential future pandemics.

A multi-population-based genomic analysis uncovers unique haplotype variants and crucial mutant genes in SARS-CoV-2

BackgroundCOVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Rigorous detection and treatment strategies against SARS-CoV-2 have become very challenging due to continuous evolutions to the viral genome. Therefore, careful genomic analysis is sorely needed to understand transmission, the cellular mechanism of pathogenicity, and the development of vaccines or drugs. ObjectiveIn this study, we intended to identify SARS-CoV-2 genome variants that may help understand the cellular and molecular foundation of coronavirus infections required to develop effective intervention strategies. MethodsSARS-CoV-2 genome sequences were downloaded from an open-source public database, processed, and analyzed for variants in target detection sites and genes. ResultsWe have identified six unique variants, G---AAC, T---AAC---T, AAC---T, AAC--------T, C----------T, and C--------C, at the nucleocapsid region and eleven major hotspot mutant genes: nsp3, surface glycoprotein, nucleocapsid phosphoprotein, ORF8, nsp6, nsp2, nsp4, helicase, membrane glycoprotein, 3′-5′ exonuclease, and 2′-O-ribose methyltransferases. In addition, we have identified eleven major mutant genes that may have a crucial role in SARS-CoV-2 pathogenesis. ConclusionStudying haplotype variants and 11 major mutant genes to understand the mechanism of action of fatal pathogenicity and inter-individual variations in immune responses is inevitable for managing target patient groups with identified variants and developing effective anti-viral drugs and vaccines.

Implementing pharmacist‐led deprescribing in the haemodialysis unit: a quality use of medicine activity in the Queensland hospital setting

AbstractBackgroundPolypharmacy in haemodialysis patients can not only manifest as the continued prescribing of unnecessary medications but also has the potential to increase medication‐related hospital admissions, morbidity, and mortality. A validated deprescribing algorithm has recently been developed, specifically targeted at dialysis patients. This paper audits the experience of implementing this algorithm in Australian dialysis settings.AimThe aim of this paper was to evaluate the usefulness and applicability of the pharmacist‐led Toronto deprescribing tool in Australian haemodialysis settings.MethodThe pharmacist‐led deprescribing algorithm was implemented across two metropolitan sites and one rural site. The audit focused on five medications that could potentially be deprescribed in the target patient group (diuretics, alpha blockers, statins, proton pump inhibitors [PPIs], and quinine). Between 1 and 12 months later, a reaudit was conducted, with patients followed up to confirm if medications remained deprescribed.ResultsTwo hundred and eleven patients across three sites were reviewed. Application of the algorithm resulted in 168 medications deemed appropriate to deprescribe. Of these 168 medications, 56 (33%) were initially deprescribed, with 50 medications (30%) remaining deprescribed on reaudit. The deprescribing rates varied between the three different services, with initial deprescribing rates ranging from 18% to 61%. After follow‐up, deprescribing changes across target medications were fairly static, with only a small number of patients restarting either their diuretic or PPI.ConclusionThe pharmacist‐led deprescribing algorithm resulted in substantial deprescribing across the three sites. Deprescribing rates varied between the sites due to differences in the team model that the pharmacist worked within and the method of the rollout. Further studies should draw on aspects such as finding enablers to overcome prescriber and patient concerns about deprescribing and the aspects of which team models lead to higher rates of successful deprescribing.