Telephone Contact Research Articles

Feasibility and Usability of a Mobile App-Based Interactive Care Plan for Migraine in a Community Neurology Practice: Development and Pilot Implementation Study.

Migraine is a common and major cause of disability, poor quality of life, and high health care use. Access to evidence-based migraine care is limited and projected to worsen. Novel mobile health app-based tools may effectively deliver migraine patient education to support self-management, facilitate remote monitoring and treatment, and improve access to care. The risk that such an intervention may increase the care team workload is a potential implementation barrier. This study aims to describe a novel electronic health record-integrated mobile app-based Migraine Interactive Care Plan (MICP) and evaluate its feasibility, usability, and impact on care teams in a community neurology practice. Consecutive enrollees between September 1, 2020, and February 16, 2022, were assessed in a single-arm observational study of usability, defined by 74.3% (127/171) completing ≥1 assigned task. Task response rates, rate and type of care team escalations, and patient-reported outcomes were summarized. Patients were prospectively recruited and randomly assigned to routine care with or without the MICP from September 1, 2020, to September 1, 2021. Feasibility was defined by equal to or fewer downstream face-to-face visits, telephone contacts, and electronic messages in the MICP cohort. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-square test was used for categorical variables for those with at least 3 months of follow-up. A total of 171 patients were enrolled, and of these, 127 (74.3%) patients completed ≥1 MICP-assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient-confirmed understanding of the educational materials ranged from 26.6% (45/169) to 56.2% (95/169). Initial mean headache days per week was 4.54 (SD 2.06) days and declined to 2.86 (SD 1.87) days at week 26. The percentage of patients reporting favorable satisfaction increased from a baseline of 35% (20/57) to 83% (15/18; response rate of 42/136, 30.9% to 28/68, 41%) over the first 6 months. A total of 121 patients with MICP were compared with 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (13/121, 10.7%) compared with controls (26/62, 42%; P<.001). We describe the successful implementation of an electronic health record-integrated mobile app-based care plan for migraine in a community neurology practice. We observed fewer downstream face-to-face visits without increasing telephone calls, medication refills, or electronic messages. Our findings suggest that the MICP has the potential to improve patient access without increasing care team workload and the need for patient input from diverse populations to improve and sustain patient engagement. Additional studies are needed to assess its impact in primary care.

Association of the presence of a COVID-19 infection at the time of birth and the rates of exclusive breastfeeding upon discharge in BFHI hospitals: a multicenter, prospective cohort study

BackgroundVery few studies have assessed the association between COVID-19 infection and the rates of exclusive breastfeeding (EBF) upon discharge following the first waves of the pandemic and after initiation of vaccination. The primary objective of this study is to compare the rates of EBF since birth upon discharge in mothers diagnosed with COVID-19 infection at the time of the delivery versus a group of non-infected mothers in maternity hospitals with Baby Friendly Hospital Initiative (BFHI) accreditation. The secondary objectives include determining the rates of any breastfeeding at three and six months of life in both groups, as well as determining the possible factors associated with EBF rates observed upon discharge.MethodsAn observational, Spanish multi-center hospital, prospective cohort study conducted from 1 to 2021 to 31 March 2022 and with follow-up during the first six months of life. Follow-up was performed via telephone contact with calls performed at three and six months. A multivariate logistic regression analysis model was used to identify the factors related to a lower probability of EBF upon discharge.Results308 mother-infant pairs participated in the study, 111 in the cohort of women with COVID infection and 197 in the comparison group. EBF upon discharge was 62.7% in the COVID group vs. 81.2% in the comparison group (p = 0.002); at three months; 52.4% vs. 57.0% (p = 0.33) were performing EBF, with the rates of EBF at six months being 43.0% vs. 39.3% (p = 0.45), respectively. Exposure to COVID-19 at delivery (AOR 5.28; 95% CI 2.01, 13.86), not practicing BF previously (AOR 36.3; 95% CI 7.02, 187.74), birth via Cesarean section (AOR 5.06; 95% CI 1.62, 15.79) and low birth weight of the newborn (AOR 1.01; 95% CI 1.01, 1.01) were associated with a greater risk of not performing EBF upon discharge.ConclusionsMothers with a mild or asymptomatic COVID-19 infection at the time of the delivery were less likely to have exclusively breastfed during their hospital stay than other mothers in these BFHI-accredited hospitals. However, there were no differences in breastfeeding rates between the groups at three and six months postpartum.

Association between mortality and phone-line waiting time for non-urgent medical care: a Danish registry-based cohort study.

Telephone calls are often patients' first healthcare service contact, outcomes associated with waiting times are unknown. Examine the association between waiting time to answer for a medical helpline and 1- and 30-day mortality. Registry-based cohort study using phone calls data (January 2014 to December 2018) to the Capital Region of Denmark's medical helpline. The service refers to hospital assessment/treatment, dispatches ambulances, or suggests self-care guidance. Waiting time was grouped into the following time intervals in accordance with political service targets for waiting time in the Capital Region: <30 s, 0:30-2:59, 3-9:59, and ≥10 min. The association between time intervals and 1- and 30-day mortality per call was calculated using logistic regression with strata defined by age and sex. In total, 1 244 252 callers were included, phoning 3 956 243 times, and 78% of calls waited <10 min. Among callers, 30-day mortality was 1% (16 560 deaths). For calls by females aged 85-110 30-day mortality increased with longer waiting time, particularly within the first minute: 9.6% for waiting time <30 s, 10.8% between 30 s and 1 minute and 9.1% between 1 and 2 minutes. For calls by males aged 85-110 30-day mortality was 11.1%, 12.9% and 11.1%, respectively. Additionally, among calls with a Charlson score of 2 or higher, longer waiting times were likewise associated with increased mortality. For calls by females aged 85-110 30-day mortality was 11.6% for waiting time <30 s, 12.9% between 30 s and 1 minute and 11.2% between 1 and 2 minutes. For calls by males aged 85-110 30-day mortality was 12.7%, 14.1% and 12.6%, respectively. Fewer ambulances were dispatched with longer waiting times (4%/2%) with waiting times <30 s and >10 min. Longer waiting times for telephone contact to a medical helpline were associated with increased 1- and 30-day mortality within the first minute, especially among elderly or more comorbid callers.

A 12-Year Comparison of Alzheimer's Dementia Patients With Their Informants in Taiwan.

To update the characteristics of patients with Alzheimer's disease (AD) and their informants in Taiwan and compare them from 12 years ago. 1218 patients with AD and their informants were recruited from six hospitals in Taiwan. The uniform data set version 3.0 (UDS3, form A1-A3) were administered. Compared with the first registration from 2010-2012 (n = 691), the mean clinical dementia rating sum of boxes score was significantly lower, more patients living independently, and more informants not living together with the patients. A total of 11.2%, 4.1%, 12.8%, and 0.5% of the patients had a reported history of cognitive impairment in their mothers, fathers, siblings, and children, respectively. Compared with the data from 2010, patients have been diagnosed at a milder disease stage, and their informants used telephone contact more frequently instead of living with the patients. Family histories of cognitive impairment in patients with AD remain frequent.

Does online communication mitigate the association between a decrease in face-to-face communication and laughter during the COVID-19 pandemic? A cross-sectional study from JACSIS study

Laughter has a protective effect on human health. The spread of coronavirus disease 2019 (COVID-19) has changed opportunities for face-to-face communication and might decrease opportunities for laughter. This cross-sectional study aimed to investigate whether the decrease in face-to-face communication during the COVID-19 pandemic is associated with a decrease in laughter. Additionally, we investigated whether an increase in online communication mitigates this association. Data from the “Japan COVID-19 and Society Internet Survey (JACSIS),” conducted between August and September 2020, were used. Participants aged 15–79 years were included in this study. The outcome was a decrease in laughter before the onset of the COVID-19 pandemic. The explanatory variables were decreased face-to-face communication with friends and increased online communication (text message, telephone, and video contact). Causal mediation analysis was used to calculate prevalence ratios (PRs) and 95 % confidence intervals (CIs) of the controlled direct effects of increased online communication. Furthermore, the proportions eliminated (PEs) by an increase in online communication were calculated. Among the 25,482 participants, 40.4 % had decreased face-to-face communication and 21.4 % had a decreased frequency of laughter. After adjusting for confounders, a decrease in face-to-face communication was significantly associated with a decrease in laughter (PR = 1.62, 95 %CI = 1.55–1.70). PEs for decrease in laughter were 27.2 % (95 %CI = –2.0 to 56.4) for text-based communication, 36.1 % (95 %CI = 12.3–59.8) for telephone-based communication, and 28.6 % (95 %CI = 0.6–56.6) for video-based communication. Although a decrease in face-to-face communication was associated with a decrease in laughter during the COVID-19 pandemic, online communication, particularly telephone-based communication, mitigated this association.

Twelve-year outcomes of watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 years and older: a randomised controlled trial

Inguinal hernia belongs to the most common surgical pathology worldwide. Approximately, one third is asymptomatic. The value of watchful waiting (WW) in patients with asymptomatic or mildly symptomatic inguinal hernia has been established in a few randomised controlled trials (RCTs). The aim of this study was to assess long-term outcomes of a RCT comparing WW and elective surgery. In the original study, men aged ≥50 years with an asymptomatic or mildly symptomatic inguinal hernia were randomly assigned to WW or elective repair. In the present study, the primary outcome was the 12-year crossover rate to surgery, secondary outcomes were time-to-crossover, patient regret, pain, quality of life and incarceration. Dutch Trial Registry: NTR629. Out of 496 originally analysed patients, 488 (98.4%) were evaluable for chart review (WW: n=258, surgery: n=230), and 200 (41.0%) for telephone contact (WW: n=106, surgery: n=94) between November 2021 and March 2022 with a median 12 years follow-up (IQR 9-14). After 12 years, the estimated cumulative crossover rate to surgery was 64.2%, which was higher in mildly symptomatic than in asymptomatic patients (71.7% versus 60.4%, HR 1.451, 95% CI: 1.064-1.979). Time-to-crossover was longer in asymptomatic patients (50% after 6.0 years versus 2.0 years, p=0.019). Patient regret was higher in the WW group (37.7 versus 18.0%, p=0.002), as well as pain/discomfort (p=0.031). Quality of life did not differ (p=0.737). In the WW group, incarceration occurred in 10/255 patients (3.9%). During 12-year follow-up, most WW patients crossed over to surgery, significantly earlier with mildly symptomatic hernia. Considering the relatively low incarceration rate, WW might still be an option in asymptomatic patients with a clear preference and being well-informed about pros and cons. The initial trial was funded by the Netherlands Organisation for Health Research and Development (ZonMW). This long-term study did not receive funding.

Use of primary health care services and mortality in older patients with type 2 diabetes with or without comorbidities

Objective This study aimed to examine primary health care (PHC) service utilization and mortality in older patients with type 2 diabetes (T2D) with or without comorbidities. Design and setting A cohort study in PHC in the city of Vantaa, Finland. Follow-up period was set between the years 2011 and 2018. Subjects PHC patients aged 60 years or more with a T2D were included. Main outcome measures Service utilization was defined as the number of face-to-face appointments and telephone contacts between a patient and general practitioner (GP) or nurse. The presence of comorbidities was defined using the Charlson Comorbidity Index (CCI). Mortality was assessed using hazard ratio (HR) and standardized mortality ratio (SMR). Results In total, 11,020 patients were included and followed for 71,596 person years. Mean age of the women and men in the beginning of follow-up were 71 and 69 years, respectively. The patients in the study cohort had a mean of eight appointments per person year to the GPs or nurses. Patients with T2D with comorbidities had more appointments than patients with T2D without comorbidities (incidence rate ratio (IRR) 1.44 [95% CI 1.39–1.49]). Increase in the number of all appointments reduced mortality in patients with T2D with and without comorbidities. Between patients with T2D with comorbidities and patients with T2D without comorbidities, the age and sex adjusted HR for death was 1.50 (95% CI 1.39–1.62). The SMR was higher in patients with T2D with comorbidities (1.83 [95% CI 1.74–1.92]) than in patients with T2D without comorbidities (0.91 [95% CI 0.86–0.96]). Conclusions In older patients with T2D, the presence of comorbidities was associated with increased use of PHC services and increased mortality. Increase in the number of appointments was associated with reduced mortality in patients with T2D with or without comorbidities. Key Points In older patients with T2D, it has not been studied whether and to what extend multimorbidity affects use of PHC services and mortality. The presence of comorbidities according to the Charlson Comorbidity Index (CCI) was associated with increased use of PHC services. The number of appointments to GPs or nurses was associated with reduced mortality in patients with T2D with or without comorbidities according to the CCI.

Readmission Rates After Acute Respiratory Distress Syndrome in Children

An increasing number of children survive after acute respiratory distress syndrome (ARDS). The long-term morbidity affecting these survivors, including the burden of hospital readmission and key factors associated with readmission, is unknown. To determine 1-year readmission rates among survivors of pediatric ARDS and to investigate the associations of 3 key index hospitalization factors (presence or development of a complex chronic condition, receipt of a tracheostomy, and hospital length of stay [LOS]) with readmission. This retrospective cohort study used data from the commercial or Medicaid IBM MarketScan databases between 2013 and 2017, with follow-up data through 2018. Participants included hospitalized children (aged ≥28 days to <18 years) who received mechanical ventilation and had algorithm-identified ARDS. Data analysis was completed from March 2022 to March 2023. Complex chronic conditions (none, nonrespiratory, and respiratory), receipt of tracheostomy, and index hospital LOS. The primary outcome was 1-year, all-cause hospital readmission. Univariable and multivariable Cox proportional hazard models were created to test the association of key hospitalization factors with readmission. One-year readmission occurred in 3748 of 13 505 children (median [IQR] age, 4 [0-14] years; 7869 boys [58.3%]) with mechanically ventilated ARDS who survived to hospital discharge. In survival analysis, the probability of 1-year readmission was 30.0% (95% CI, 29.0%-30.8%). One-half of readmissions occurred within 61 days of discharge (95% CI, 56-67 days). Both respiratory (adjusted hazard ratio [aHR], 2.69; 95% CI, 2.42-2.98) and nonrespiratory (aHR, 1.86; 95% CI, 1.71-2.03) complex chronic conditions were associated with 1-year readmission. Placement of a new tracheostomy (aHR, 1.98; 95% CI, 1.69-2.33) and LOS 14 days or longer (aHR, 1.87; 95% CI, 1.62-2.16) were associated with readmission. After exclusion of children with chronic conditions, LOS 14 days or longer continued to be associated with readmission (aHR, 1.92; 95% CI, 1.49-2.47). In this retrospective cohort study of children with ARDS who survived to discharge, important factors associated with readmission included the presence or development of chronic medical conditions during the index admission, tracheostomy placement during index admission, and index hospitalization of 14 days or longer. Future studies should evaluate whether postdischarge interventions (eg, telephonic contact, follow-up clinics, and home health care) may help reduce the readmission burden.

Analysis of Tools Supporting the Formation of Relations in an Educational-and-economic Network

The analysis of the literature shows that cooperation, in particular the maintenance long-term, enhanced and stable relations between education and business is very difficult. Supported by scientific research, source literature presents a beneficial effect of the transfer of knowledge on the improvement of innovation, competitiveness and organizational conditions in enterprises, public institutions as well as other organizations. The activities developed in the educational-and-economic network analyzed herein include e.g. engaging in particular medium-sized and big enterprises in the exchange and updating of knowledge about competencies on the labour market which are necessary on job positions at which graduates of technical schools are employed. The main objective of the paper is to develop a process of cooperation between education and business institutions, in particular with respect to strengthening relations in an education-and-business network in which the activity can improve knowledge sharing. An indirect objective in its development is the analysis of the effectiveness of the application of tools stimulating companies to cooperate and exchange knowledge within the network. The studied were based on data from 2017-2020 collected from a sample of 352 companies. The analysis was also carried out in the context of the frequency of e-mail and telephone contacts as well as direct contacts understood as individual meetings most often held at a given employer’s facility. Kaiser-Mayer-Olkin criterion and Bartlett sphericity test were used for analysis of relationships between individual variables. Factor analysis (KMO and Cattell's criterion) and Pearson's correlation were used to study the effectiveness of the application of tools supporting the companies’ activity in the network. The analyses show that the biggest impact on forming relations is linked to participation in discussion panels. It is worth pointing out that the activity is organized for the purposes of exchanging knowledge and experience of experts who usually represent medium-sized and big employers, especially in the area of HR. As a result of the studies, a process path was proposed for the purposes of establishing, developing and maintaining long-term relations with big and medium-sized enterprises in the network of entities cooperating in the field of education and business.

Should Caregivers Also Be Included in Multicomponent Physical-Exercise-Based Interventions for People with a Neurocognitive Disorder? The Caregivers' Perspective.

Informal caregivers of people with neurocognitive disorders (NCDs) may play a decisive role in guaranteeing partners' participation in community-based physical exercise interventions. However, little is still known about their perspective on being involved in such programs that are specifically designed for their partners. This study aimed to explore the views of caregivers of people with NCDs about taking part in a multicomponent physical exercise intervention with their partners and to explore the perceived impact of this program on those caregivers who enrolled in it. An exploratory qualitative study was conducted with 20 caregivers (67.5 ± 13.94 years; seven female) from the "Body & Brain" project. Ten took part in the physical exercise sessions (active-participating caregivers), and the others did not (social-participating caregivers). Data retrieved from semi-structured interviews were analyzed following a thematic analysis approach. Regardless of their participation level, all caregivers reported their inclusion to be important in enhancing their partners' initiation and engagement in the sessions; also, they all identified personal gains. Active-participating caregivers reported exercise-related benefits on general health, enjoyment, and social connectedness. Social-participating caregivers considered this intervention an opportunity for respite and appreciated being involved only occasionally (i.e., occasional gatherings or telephone contacts). The findings support the inclusion of caregivers in physical exercise interventions designed for partners with NCDs, considering their decisive role in the partners' adherence and engagement and due to the perceived gains. Future community-based interventions designed for people with NCDs should consider giving caregivers the opportunity to choose whether they want or not to be actively involved in the exercise sessions. Further studies with larger samples are needed to verify these results, comparing caregivers' point of view at baseline and post-intervention.

A sentinel surveillance of adverse events and breakthrough infections following COVID-19 precautionary dose among south Indian healthcare workers

Background: Adverse events following immunization (AEFI) is defined as any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the usage of the vaccine. Break-through infections are referred to as antigen or SARS-CoV-2 RNA positivity of respiratory specimens more than 14 days after receiving all recommended doses. Aim: The study was conducted to identify adverse events and break-through infections following the precautionary dose of the COVID-19 vaccine among healthcare workers. Methodology: The study was designed as a cohort event monitoring; all healthcare professionals who received COVID-19 precautionary dose from the study site were included in the study. The study population was actively followed for any adverse event following immunization (AEFI) through telephonic contact (within 30 days of post-vaccination). Reported adverse events were carefully scrutinized and evaluated by the AEFI investigation team of the study site. Results: Out of 1232 vaccine beneficiaries, a total of 359 (29.14%) individuals were reported with 385 AEFIs. Of which 138 (38.44%) individuals were laboratory-confirmed (RTPCR positive) breakthrough cases. Less severity and low morbidity were observed among all the breakthrough cases. According to the WHO’s new causality assessment algorithm, 183 (47.53%) events were vaccine product-related and 202 (52.46%) were co-incidental events. Conclusion: There was a prevailing outbreak of COVID-19 infection in the study site, which resulted in many breakthrough infections soon after immunization. Initially, all breakthrough infections were misleading as vaccine-related events, where this study helped to break the concerns among the study population.

Transformative practice and its interactional challenges in COVID-19 telephone contact tracing in Flanders.

This article focuses on transformative interactional practice in COVID-19 contact tracing telephone calls in Flanders (Belgium). It is based on a large corpus of recorded telephone conversations conducted by COVID-19 contact tracers with index patients in the period mid-2020 to mid-2022. The calls were conducted through government-contracted commercial call centers. For nearly 2 years and applied country-wide, this was the most prominent strategy in Belgium for breaking transmission chains. COVID-19 telephone contact tracing with infected patients counts as transformative professional work in two ways. First, in addition to the registration of recent contacts in a relevant time window, the work is oriented to awareness-raising about how patients and their co-dwellers can and should adjust their behavior by attending actively to critical aspects of the pandemic during an individual period of (potential) infection. This is the terrain of advice, interdictions and recommendations about quarantine, isolation, personal hygiene, etc. In addition, the focus on interactional attention indexes patients' affect and emotions (e.g., anxiety, worry, or anger) in a period of health uncertainty and social isolation. The transformative work thus depends on successfully established rapport and empathetic, responsive behavior. Our analysis of the recorded conversational sequences focuses on the complexities of client-sensitive and responsive transformative sequences and highlights the constraints and affordances which surround the interactional task of 'instructional awareness raising' which is central to telephone contact tracing. Specifically, we detail the following dimensions of transformative sequences: (i) how do contact tracers deal with the knowledge status of clients, (ii) their use of upgrading/downgrading formulations, (iii) the use of humor and other mitigating strategies, and (iv) how contact tracers attend to interactional displays of affect and emotion. In a final section, we tie together our observations about the communication of particularized advice in a context of general measures through the twin notions of categorization/particularization-work. The findings in this paper are limited to the first step in the chain of contact tracing, i.e., telephone calls with tested and infected citizens.

Statistical analysis plan for a randomized controlled trial examining pedometer-based walking intervention in patients with heart failure with reduced ejection fraction: the WATCHFUL trial

BackgroundPhysical activity is an effective management strategy for heart failure with reduced ejection fraction, but patients’ compliance is challenging. Walking is a suitable form of physical activity due to its convenience and sustainability, and it can potentially improve functional capacity in heart failure patients.ObjectivesThe WATCHFUL trial aims to determine whether a pedometer-based walking intervention combined with face-to-face sessions and regular telephone contact improves functional capacity in heart failure patients.MethodsThe WATCHFUL trial is a 6-month multicenter, parallel-group, randomized, controlled, superiority trial with a 6-month follow-up. A total of 202 patients were recruited for the trial. The primary analysis will evaluate the change in distance walked during the 6-min walk test from baseline to 6 months based on the intention-to-treat population; the analysis will be performed using a linear mixed-effect model adjusted for baseline values. Missing data will be imputed using multiple imputations, and the impact of missing data will be assessed using a sensitivity analysis. Adverse events are monitored and recorded throughout the trial period.DiscussionThe trial has been designed as a pragmatic trial with a scalable intervention that could be easily translated into routine clinical care. The trial has been affected by the COVID-19 pandemic, which slowed patients’ recruitment and impacted their physical activity patterns.ConclusionsThe present publication provides details of the planned statistical analyses for the WATCHFUL trial to reduce the risks of reporting bias and erroneous data-driven results.Trial registrationClinicalTrials.gov (identifier: NCT03041610, registered: 3/2/2017).

Coordinators in the return-to-work process: Mapping their work models.

In recent decades, many countries have implemented return-to-work coordinators to combat high rates of sickness absence and insufficient collaboration in the return-to-work process. The coordinators should improve communication and collaboration between stakeholders in the return-to-work process for people on sickness absence. How they perform their daily work remains unexplored, and we know little about to what extent they collaborate and perform other work tasks to support people on sickness absence. This study examines which work models return-to-work coordinators use in primary healthcare, psychiatry and orthopaedics in Sweden. A questionnaire was sent to all 82 coordinators in one region (89% response rate) with questions about the selection of patients, individual patient support, healthcare collaboration, and external collaboration. Random forest classification analysis was used to identify the models. Three work models were identified. In model A, coordinators were more likely to select certain groups of patients, spend more time in telephone than in face-to-face meetings, and collaborate fairly much. In Model B there was less patient selection and much collaboration and face-to-face meetings. Model C involved little patient selection, much telephone contact and very little collaboration. Model A was more common in primary healthcare, model C in orthopaedics, while model B was distributed equally between primary healthcare and psychiatry. The work models correspond differently to the coordinator's assignments of supporting patients and collaborating with healthcare and other stakeholders. The differences lie in how much they actively select patients, how much they collaborate, and with whom. Their different distribution across clinical contexts indicates that organisational demands influence how work models evolve in practice.

Oral antibiotics and mechanical bowel preparation for colorectal surgery: A prospective observational study of surgical site infection and microbial analysis

PurposeSurgical site infections (SSIs) are common in colorectal surgery. Mechanical bowel preparation (MBP) in conjunction with oral antibiotics (OABs) have been shown to reduce SSI rates. It however is still unclear which OABs to use, and how this can be implemented in practice.MethodsThis is a prospective observational study carried out in Swansea Bay University Health Board during 2019–2021, evaluating the introduction of OABs in a stepwise manner on the incidence of SSI in major colorectal surgery. A control group having MBP only was compared to two OAB groups: one group had MBP plus metronidazole only and the second MBP plus metronidazole and neomycin. A 30-day follow-up after surgery was ascertained via chart review and telephone contact. Logistic regression was performed to estimate the relation between OAB use and SSI, with adjustment for confounding. In a subset of patients, faecal samples were analysed through 16S rRNA amplicon sequencing before and after OAB treatment, depicting the impact of the gut microbiome.ResultsIn total 160 patients were analysed: 46 patients had MBP only, whilst 76 patients had MBP plus metronidazole only and 38 patients had MBP with metronidazole/neomycin. The SSI rate in the entire cohort was 33.8%, whilst the adjusted ORs for the single- and dual-OAB groups were 0.76 (95% CI: 0.17–1.81) and 0.50 (95% CI: 0.17–1.52). The microbial analysis demonstrated that the relative abundance for many bacterial genera was changed before and after OAB treatment, but no link with SSI development could be shown.ConclusionsIntroduction of OABs in conjunction with MBP in colorectal surgery is feasible, and may potentially lead to lower rates of SSI, as well as altering the community structure of the faecal microbiome. More research is needed, especially considering different OABs and mechanistic studies of the gut microbiome in the context of colorectal surgery.

USING THE CAPABILITY, OPPORTUNITY, AND MOTIVATION MODEL OF BEHAVIOUR (COM-B) TO IMPLEMENT A PATHWAY TO REDUCE 30-DAY ELECTIVE EMERGENCY ADMISSIONS

AbstractIntroduction30-day emergency readmission is an indicator of treatment related complication once discharged, resulting in readmission. A board-approved quality improvement pathway was introduced to reduce elective re-admissions.MethodThe pathway involved telephone and email contact details provision to patients for any non-life threatening medical assistance, allowing for initial nurse led management of all issues. A new clinic room available 7 days, and same day ultrasound scanning for DVT studies were introduced. A capability, opportunity and behavior model of change was implemented.Readmission rates before and six months after implementation were collected from Model Hospital. A database used to document patient communications was interrogated for patient outcomes.ResultsPrior to implementation, readmission rates following elective primary total knee replacement (TKR) at the 1st business quarter of 2021 (April – June 2021), was 8.7%, (benchmark 3.8%). Following implementation, readmission rates decreased to 4.1% (October – December 2021). 54% of patients making contact were managed with telephone advice. 15% of patients required face-to-face clinic. 32% of those required a same day scan to exclude DVT (1/4).20 out of 684 TKRs performed following protocol introduction were re-admitted within 30 days. Readmissions were 41% surgical, 29% medical. 52% were unaware of the newly implemented protocol. Further improvements have been made to the protocol based on these findings.Implementation of a suitable pathway can significantly reduce re-admission rates in our center and could be used to reduce readmission rates in other national elective treatment centers.

How is primary care access changing? A retrospective, repeated cross-sectional study of patient-initiated demand at general practices in England using a modern access model, 2019–2022

ObjectivesTo explore trends in patient-initiated requests for general practice services and the association between patient characteristics including demographics, preferences for care and clinical needs and modes of patient contact (online...

An Overview of Strategies for Re-Engagement of Patients with Loss to Follow-Up Therapy for Arv ODHIV

This study aims to determine the strategy of re-engaging Loss patients to follow up ARV therapy for people with HIV/AIDS. The method used in this research is qualitative with a case study approach. The results of this research were obtained through analysis using deductive analytic which focuses on tracing and mentoring strategies, barriers, and partnerships. follow-up HIV/AIDS ARV therapy, namely a patient-centered approach (client-centered approach) with the tracing method via telephone contact, physical tracing/home visit and virtual tracing, Barriers to re-engagement of patients who stop or are absent from ARV HIV/AIDS care , that is. patient contact numbers are not available, patients do not have a permanent residence, partnerships between NGOs and service personnel have been going well, this is evidenced by the existence of an MOU between PEKA NGOs and Health Services/PKM&#x0D; &#x0D; Keywords: Re-Engagement, Loss to Follow-Up, HIV, Strategy

Results of the nursing care standardization program in cardiac electrophysiology patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients undergoing surgery in the electrophysiology unit pass through the hands of several nurses from different hospital units throughout the care process. Multiple studies show the importance of interprofessional communication in improving patient health outcomes. In our hospital we have standardized protocols for each procedure. In addition, it is convenient to have the relevant information available in a more visual and accessible way in order to enhance the agility of care. Purpose To design a summary table of the procedures performed in the electrophysiology unit with the most important points on nursing care. Methods A descriptive analysis of the nursing care of patients undergoing surgery in the cardiac electrophysiology unit was performed. For this purpose, meetings were held between the electrophysiology, the intensive care unit, the cardiology day hospital and the resuscitation unit nursing teams to standardize protocols between services. The needs of each service were detected and the most important nursing care notes were included in the table. Results A table was drawn up with a total of 8 surgical procedures performed in electrophysiology. For each of them, 3 parts of the care process were identified: pre-operative, intraoperative and post-procedure care. Each of the parts had subdivisions (Picture 1 and 2). In addition, important contact telephone numbers were added. Once the table was done and validated, it was shared through the hospital intranet and hung in a poster in all hospital units where a cardiac patient may be attended. Conclusions The electrophysiology patient care table improved communication between professionals of the different services where the patient is attended and it also helped standardize protocols to reduce peri-surgery risks and improve morbidity and mortality, since it could prevent complications. Therefore, it guarantees the continuity of nursing care.Poster TS EF Procedure

Kontakt telefoniczny tymczasowo aresztowanego z obrońcą oraz osobą najbliższą

The article discusses the issue of telephone contact of a person remanded in custody with his or her defence counsel and a significant other, which is essentially regulated by Article 217c of the Executive Penal Code. This provision was amended several times in recent years, which entailed significant changes for the status of these persons as well. This evolution, however, is aligned with the jurisprudence of the Constitutional Court, which through its rulings of 2014 and 2022 had a significant impact on the shape of Article 217c of the Executive Penal Code and somewhat differentiated the status of the defence counsel and the significant other in the context of telephone contact with a person remanded in custody. The aspect of the European law is also relevant because, through its jurisprudence, it co-shapes Polish legislation and gives it a certain framework. Therefore, considering the discussed issues, a question of what determines the shape of Article 217c of the Executive Penal Code and to what extent should be raised.