Telephone Contact Research Articles

Fate of the distal aorta following root replacement in Marfan syndrome: a propensity score matched study.

The aortic root is the most frequent segment involved in Marfan syndrome. However, Marfan syndrome is a systemic hereditary connective tissue disorder, and knowledge regarding the outcomes of the native distal aorta after prophylactic aortic root surgery is limited. From April 2010 to December 2020, 226 patients with Marfan syndrome and 1,200 patients without Marfan syndrome who underwent Bentall procedures were included in this study. By propensity score matching, 134 patients were assigned to each group. Clinical manifestations and follow-up data were acquired from hospital records and telephone contact. The cumulative incidence of aortic events was estimated in Marfan and non-Marfan patients with death as a competing risk. Patients with and without Marfan syndrome had similar baseline characteristics after propensity score matching. Differences in the aortic root (62.25 ± 11.96 vs. 54.03 ± 13.76, P < .001) and ascending aorta (37.71 ± 9.86 vs. 48.16 ± 16.01, P < .001) remained after matching. No difference was observed in the frequency of aortic adverse events between the two groups (10.5% vs. 4.6%, P = 0.106). The cumulative incidence of aortic events was not different between Marfan and non-Marfan patients (15.03% ± 4.72% vs. 4.18% ± 2.06%, P = 0.147). Multivariate Cox regression indicated no significant impact of Marfan syndrome on distal aortic events (HR: 1.172, 95% CI: 0.263-5.230, P = 0.835). Descending and abdominal aortic diameter above normal at the initial procedure were associated with the risk of distal aortic events (HR: 20.735, P = .003, HR: 22.981, P = .002, respectively). New-onset events of the residual aorta in patients undergoing Bentall procedures between the Marfan and non-Marfan groups were not significantly different. Distal aortic diameter above normal at initial surgery was associated with a higher risk of adverse aortic events.

A multicomponent complex intervention for supportive follow-up of persons with chronic heart failure: a randomized controlled pilot study (the UTILE project)

BackgroundHeart failure (HF) is a progressive disease associated with a high burden of symptoms, high morbidity and mortality, and low quality of life (QoL). This study aimed to evaluate the feasibility and potential outcomes of a novel multicomponent complex intervention, to inform a future full-scale randomized controlled trial (RCT) in Switzerland.MethodsWe conducted a pilot RCT at a secondary care hospital for people with HF hospitalized due to decompensated HF or with a history of HF decompensation over the past 6 months. We randomized 1:1; usual care for the control (CG) and intervention group (IG) who received the intervention as well as usual care. Feasibility measures included patient recruitment rate, study nurse time, study attrition, the number and duration of consultations, intervention acceptability and intervention fidelity. Patient-reported outcomes included HF-specific self-care and HF-related health status (KCCQ-12) at 3 months follow-up. Clinical outcomes were all-cause mortality, hospitalization and days spent in hospital.ResultsWe recruited 60 persons with HF (age mean = 75.7 years, ± 8.9) over a 62-week period, requiring 1011 h of study nurse time. Recruitment rate was 46.15%; study attrition rate was 31.7%. Follow-up included 2.14 (mean, ± 0.97) visits per patient lasting a total of 166.96 min (mean, ± 72.55), and 3.1 (mean, ± 1.7) additional telephone contacts. Intervention acceptability was high. Mean intervention fidelity was 0.71. We found a 20-point difference in mean self-care management change from baseline to 3 months in favour of the IG (Cohens’ d = 0.59). Small effect sizes for KCCQ-12 variables; less IG participants worsened in health status compared to CG participants. Five deaths occurred (IG = 3, CG = 2). There were 13 (IG) and 18 (CG) all-cause hospital admissions; participants spent 8.90 (median, IQR = 9.70, IG) and 15.38 (median, IQR = 18.41, CG) days in hospital. A subsequent full-scale effectiveness trial would require 304 (for a mono-centric trial) and 751 participants (for a ten-centre trial) for HF-related QoL (effect size = 0.3; power = 0.80, alpha = 0.05).ConclusionWe found the intervention, research methods and outcomes were feasible and acceptable. We propose increasing intervention fidelity strategies for a full-scale trial.Trial registrationISRCTN10151805, retrospectively registered 04/10/2019.

The value of cardiac MRI in the risk stratification in patients with hypertrophic cardiomyopathy

Objective: To explore the value of cardiac magnetic resonance imaging (CMR) in the risk stratification of hypertrophic cardiomyopathy (HCM). Methods: HCM patients who underwent CMR examination in Fuwai Hospital between March 2012 and May 2013 were retrospectively enrolled. Baseline clinical and CMR data were collected and patient follow-up was performed using telephone contact and medical record. The primary composite endpoint was sudden cardiac death (SCD) or and equivalent event. The secondary composite endpoint was all-cause death and heart transplant. Patients were divided into SCD and non-SCD groups. Cox regression was used to explore risk factors of adverse events. Receiver operating characteristic (ROC) curve analysis was used to assess the performance and the optimal cut-off of late gadolinium enhancement percentage (LGE%) for the prediction of endpoints. Kaplan-Meier and log-rank tests were used to compare survival differences between groups. Results: A total of 442 patients were enrolled. Mean age was (48.5±12.4) years and 143(32.4%) were female. At (7.6±2.5) years of follow-up, 30 (6.8%) patients met the primary endpoint including 23 SCD and 7 SCD equivalent events, and 36 (8.1%) patients met the secondary endpoint including 33 all-cause death and 3 heart transplant. In multivariate Cox regression, syncope(HR=4.531, 95%CI 2.033-10.099, P<0.001), LGE% (HR=1.075, 95%CI 1.032-1.120, P=0.001) and left ventricular ejection fraction (LVEF) (HR=0.956, 95%CI 0.923-0.991, P=0.013) were independent risk factors for primary endpoint; Age (HR=1.032, 95%CI 1.001-1.064, P=0.046), atrial fibrillation (HR=2.977, 95%CI 1.446-6.131, P=0.003),LGE% (HR=1.075, 95%CI 1.035-1.116, P<0.001) and LVEF (HR=0.968, 95%CI 0.937-1.000, P=0.047) were independent risk factors for secondary endpoint. ROC curve showed the optimal LGE% cut-offs were 5.1% and 5.8% for the prediction of primary and secondary endpoint, respectively. Patients were further divided into LGE%=0, 0<LGE%<5%, 5%≤LGE%<15% and LGE%≥15% groups. There were significant survival differences between these 4 groups whether for primary endpoint or secondary endpoint (all P<0.001) and the accumulated incidence of primary endpoint was 1.2% (2/161), 2.2% (2/89), 10.5% (16/152) and 25.0% (10/40), respectively. Conclusion: LGE is an independent risk factor for SCD events as well as all-cause death and heart transplant. LGE is of important value in the risk stratification in patients with HCM.

P-524 Fertility and subsequent pregnancy outcomes among women with tubal ectopic pregnancy treated with methotrexate

Abstract Study question What are the future fertility prospects and subsequent pregnancy outcomes among women with tubal ectopic pregnancy treated with methotrexate? Summary answer Pregnancy post-ectopic pregnancy occurred in 53% of women within 12 months following methotrexate treatment. Among those who became pregnant, ectopic pregnancy recurrence occurred in 16.8%. What is known already Concerns regarding ectopic pregnancy recurrence and future fertility predominate when counselling women about management options for tubal ectopic pregnancy treatment. Current UK National Institute for Health and Care Excellence guidance is based on low quality evidence and estimate long-term ectopic pregnancy recurrence rate of ∼18.5%. Further, they state that there are no differences in rates of subsequent pregnancy or ectopic pregnancy recurrence between ectopic pregnancy management methods. However, 30% of women managed with methotrexate experience treatment failure and require rescue surgery and subsequent pregnancy outcomes in this group are poorly understood. Study design, size, duration The data for this study were derived from a UK multicentre RCT of methotrexate and gefitinib versus methotrexate and placebo for treatment of ultrasound diagnosed definite or probable tubal ectopic pregnancy with pre-treatment hCG ≥1000 IU/L and ≤5000 IU/L (GEM3). The trial found adding gefitinib to methotrexate was not superior to placebo. This analysis reports trial participant follow-up data at 12-months examining post-treatment fertility, subsequent pregnancy outcomes and participant characteristics associated with ectopic pregnancy recurrence. Participants/materials, setting, methods Trial participants of GEM3 (as described above). Participants were contacted to provide follow-up data 12 months after randomisation to treatment. Where telephone contact was unsuccessful, electronic health records were reviewed to collect pregnancy outcome data. Post-treatment fertility and pregnancy outcomes were summarised using descriptive statistics and compared between groups using a chi-squared test, p&amp;lt;.05 signified statistical significance. Main results and the role of chance Pregnancy follow-up data was obtained for 283/327 trial participants. (167 participants were successfully contacted by telephone; the electronic health records were reviewed for 116 participants). 52.7% (149/283) of the trial participants became pregnant in the 12-month follow-up period. There was no difference in subsequent pregnancy rates between ‘methotrexate only’ and ‘methotrexate and rescue surgery’ groups. The surgical approach (salpingectomy vs salpingotomy) did not affect subsequent pregnancy rates. Among women who had a pregnancy in the follow-up period, a live birth was recorded in 65% of women (n = 93/142, n = 7 missing), any pregnancy loss (miscarriage, ectopic pregnancy, stillbirth, termination of pregnancy or molar pregnancy) was recorded in 43% of women (n = 59/137, n = 12 missing). Recurrent ectopic pregnancy was reported in 16.8% of women (n = 22/131, n = 18 missing). There was no difference in rates of live birth, pregnancy loss or recurrent ectopic pregnancy between methotrexate only and methotrexate and surgery groups or between type of surgical management groups (salpingectomy vs salpingotomy). Limitations, reasons for caution This study only reports on a 12-month follow-up period and this should be considered when interpreting comparatively low post-treatment pregnancy rates. We did not record which couples were trying-to-conceive post treatment and were therefore unable to stratify results by this variable or report subfertility rates. Wider implications of the findings This prospective dataset strengthens current understanding of the likelihood of ectopic pregnancy recurrence. Furthermore, it provides reassurance that women with tubal ectopic pregnancy managed with methotrexate requiring rescue surgery have similar post-treatment fertility and pregnancy outcomes to those successfully treated with methotrexate. Trial registration number ISRCTN67795930

Efficacy of remote consultation between hospital cardiologists and primary care in cardiovascular disease management: the "Cardiologia in linea" project in Trentino, Italy

Telemedicine enables patients to receive better care via the simplification of procedures while allowing for a significant reduction of in-office appointments and emergency room visits. The "Cardiologia in linea" project started with the objective of strengthening communications between cardiologists and primary care, particularly with general practitioners. Between January 2017 and October 2022, by means of a facilitated telephonic and digital contact between territorial professionals and the cardiologist, the project provided in most cases immediate answers to cardiology queries, which were logged. A total of 2066 telephonic or digital consultations have been recorded, originating from 316 general practitioners in the Trento province (Italy). The mean age of patients was 76.4 years, 53% were male. After consultation, an immediate response was provided in 1989 (96%) of cases. A total of 1112 (54%) cardiology visits were avoided. After the consultation, a cardiologic visit was suggested in 29 cases (1%), and the emergency system was activated in 20 cases (1%). Overall, most questions concerned direct oral anticoagulant prescriptions (537 cases, 31%) and anti-hypertensive treatment (241 cases, 14%). The "Cardiologia in linea" project demonstrated a low-cost improvement in the patient assistance workflow, in the communication between hospital cardiology and primary care, while reducing the number of emergency room accesses. The project successfully shows the feasibility of a real-time dialogue between the general practitioner and the hospital cardiologist.

An Appraisal of Participant Observation Methodology

Abstract All different sciences are defined in a specific way. It is not enough to define anthropology as a science that has studied human beings at all times and all places. It is the methodology of anthropology that is unique and increasingly appreciated by other fields. With the spread of COVID-19, as displacement became a problem, for the researcher and for those s/he had to be with, this methodology was temporarily put into question: social media or simply telephone contacts to gather data was used. The collection of articles in this issue reconfirms that it is through participant observation that the researcher can diligently and exhaustively study a topic or shine new light upon well-studied topics. Our topics are varied this time, some papers are from different fields, our methodology remains the same.

Skills of undergraduate dental students in performing atraumatic restorative treatment one year survival rate of this restoration.

Objective: To assess the skills of the undergraduate dental students in performing Atraumatic Restorative Treatment and the one year survival of this restoration. Study Design: Cross sectional study. Setting: Department of Community Dentistry, Multan Medical &amp; Dental College, Multan. Period: Sept 2021 to Aug 2022. Material &amp; Methods: Through convenient purposive sampling selected 2nd year dental students were assigned to collect the extracted teeth to perform ART according to the given guidelines using Glass Ionomer Cement. The research supervisor assessed the characteristics of the filling and keeping in view the status of the restoration it has given Alfa, Bravo or Charlie score. The students who scored Alfa were then allowed to perform ART on patients in Out Patient Department. The demographics of the patients along with caries assessment (Class I, II &amp; III) were recorded. Patients were kept on telephonic contact and were recalled after 1 year to evaluate the survival rate. Results: A total 100 ART restorations were done on extracted teeth. Around 76 fillings were found to be perfect while 24 fillings were associated with any one or two defects. Later 100 patients were included having any of the 3 classes of caries. Mean age of the patients was 32 years. The success rate of ART restorations at 12 months was found to be 89% with highest success rate of 62% was reported in Class I ART restorations. Conclusion: Extraordinary high survivals rates of Atraumatic Restorative Treatment found in this study represented the reliability of this method as an affordable preventive and curative treatment for dental caries particularly in developing countries.

The Main Strategies of Restaurant Revenue Management and its Applicability in the F&amp;B Department

Over the past years, Revenue Management has been used in various sectors, starting in the airlines, passing through the hotel and restaurant sectors, with a focus on the creation and maximization of revenue. In this sense, Restaurant Revenue Management becomes a useful tool for incomes, making establishments more competitive and contributing to business growth and sustainability in catering and restaurants context. The main objective of this study is to research the development and application of Restaurant Revenue Management, through the study of its systems and strategies, to understand how restaurant and catering establishments can optimize revenue through the creation and implementation of RRM systems. This research begins with a literature review where we aim to understand the principles and characteristics of Restaurant Revenue Management as a whole, to know the RRM strategies and how to apply them in the hospitality and catering sector. The methodology chosen was quantitative, where questionnaires were prepared and distributed to hotels and restaurants in Portugal. The results demonstrate that major part of the respondents is not familiar with the concept of Restaurant Revenue Management. Most respondents believe that the application of the RRM concept is important for the company's results and for those who are familiar with the concept, they consider that it allows the ideal customer to be defined based on their characteristics and enables decisions to be taken based on knowledge, creating a structure of fixed and variable costs. Purpose: Thus, the general and specific research objectives inherent to the study are: To assess how Restaurant Revenue Management is applied in Portugal in the restaurant and hotel contexts. To recognize what are its characteristics and practices. To understand how Restaurant Revenue Management influences revenues. To realize the advantages and disadvantages identified by the application of restaurant revenue management. Methodology: This research focuses on a quantitative methodology, using the questionnaire as a data collection tool. A deductive research approach was used in the scientific research process. The technical procedure used in the investigation phase was bibliographic research, having been collected information in several scientific articles and books on the subject. On a first moment, the collection of relevant documents for the research was made. The script was validated by six academic professionals and five professionals from the sector. After validation, an online questionnaire was conducted using the Google Forms platform. To achieve the maximum possible number of answers, the distribution channel used, to collect the results, was the e-mail. An initial telephone contact was made to confirm availability to answer the questionnaire. After this contact, the questionnaire was sent via e-mail. The questionnaires were conducted in Portuguese, as the study was only intended for entities located in Portugal. During the investigation, 880 questionnaires were sent out and 131 responses were received all completed, in a period between June and August. The instrument used to analyze and process the data collected was Excel. Results: The concept of Restaurant Revenue Management generally is not known among F&amp;B departments, as demonstrated in the answers collected during the distribution of the questionnaire, in which 58.8% do not know the concept and only 41.2% of the respondents are familiar with the subject. Those who know and apply the concept of RRM consider the application of the concept and its respective impact important and crucial for the business. In the answers to the questionnaire about 57.4% consider its application important, while 24.1% considers it very important and 14.8% extremely important. Only 3.7% states that the RRM is not very important. Of the 131 respondents, only 41.2% are familiar with the concept of Restaurant Revenue Management, making a total of 54 responses. Originality: This is original research with the authors perspective constructed based in arguments from other research work to back up the investigation.

The Impact of the COVID-19 Pandemic on Antimicrobial Resistance and Management of Bloodstream Infections.

The pressure of the COVID-19 pandemic on healthcare systems led to limited roles of infectious diseases services, increased rates of irrational use of antimicrobials, and incidence of infections by multidrug-resistant microorganisms. The aim of the present study is to evaluate the incidence of antimicrobial resistance and the management of bloodstream infections before and during the COVID-19 pandemic at the University General Hospital of Alexandroupolis (Greece). This is a retrospective study conducted from January 2018 to December 2022. Data were collected from the University Microbiology Laboratory per semester regarding the isolated strains of Gram-positive and -negative bacteria in blood cultures and respiratory samples in hospitalized patients in medical and surgical wards and in the intensive care unit (ICU). Additionally, bloodstream infections with requested infectious disease consultations were reported (n = 400), determining whether these were carried out via telephone contact or at the patient's bedside. Demographic data, comorbidities, focus of infection, antimicrobial regimen, duration of treatment, length of hospitalization, and clinical outcome were analyzed. A total of 4569 strains of Gram-positive and -negative bacteria were isolated. An increasing trend was reported compared to the pre-pandemic period in the incidence of resistant Gram-negative bacteria, particularly in ICUs. Prior antimicrobial use and the rate of hospital-acquired infections were increased significantly during the pandemic. In the pre-pandemic period 2018-2019, a total of 246 infectious disease consultations were carried out, while during the period 2020-2022, the number was 154, with the percentage of telephone consultations 15% and 76%, respectively. Detection of the source of infection and timely administration of appropriate antimicrobial agents were more frequently recorded before the pandemic, and 28-day mortality was significantly reduced in cases with bedside consultations. The empowering of infectious disease surveillance programs and committees, rational use of antimicrobials agents, and bedside infectious disease consultations are vital in order to reduce the impact of infections caused by multidrug-resistant strains.

P340 REMOTE MONITORING IN HEART FAILURE: EFFECTIVE TOOL TO REDUCE HOSPITALIZATIONS AND MORTALITY

Abstract Introduction The prevalence of heart failure in the general population in the idustrialized countries is estimated to be around 2%, a prevalence that increases with age until it reaches 10% at 70 aa of age. The disease is burdened by a high mortality rate and high expense related mainly to repeated hospitalizations. Patients with low ejection fraction heart failure are often implanted with devices, which have the ability to be monitored remotely. The Ministry of Health‘s 2017 annual report on hospitalization activity shows dramatic data: 60% of patients with heart failure are re–hospitalized within one year of discharge and in 14% of cases even within one month of discharge with an annual mortality rate of 18%. The aim of our study is to investigate whether remote monitoring allows improving the outcome of patients with heart failure in terms of reduction of hospitalizations and reduction of all–cause mortality. Materials and Methods In the year 2021, 241 patients with heart failure and reduced ejection fraction, implanted with devices of mean age 73 yr (+/– 11 yr) were remotely monitored in our center; Other population data: see Table 1. On the occasion of transmissions presenting with alarm events, our operational flow chart provides: first telephone contact and possible subsequent outpatient follow–up within 24 h working hours. Results During the year 2021, all–cause mortality in our population was 10.7% (26 patients), while re–hospitalizations were 70 (28.8%). As a result of alarms reported to remote monitoring, 83 patients were contacted whose therapy was changed or device reprogrammed. The causes of alarms were in order: reduced thoracic impedance, arrhythmic events, and reduced biventricular pacing rate. Conclusions The use of remote monitoring in heart failure patients and device wearers allows early and timely diagnosis of clinical changes that anticipate heart failure exacerbation and active intervention by modifying the clinical course, often avoiding hospitalization, with a significant social and economic impact. Thanks to the operational organization of our center, the management of remote monitoring has allowed a low rate of hospitalization and low mortality year compared with literature data.

P438 DIABETES MELLITUS AND HEART FAILURE: A DANGEROUS ASSOCIATION

Abstract Introduction Diabetes mellitus is a frequent co–morbidity in heart failure patients reaching a prevalence of about 35% and patients with diabetes mellitus are twice as likely as non–diabetics to develop heart failure. The presence of diabetes is associated with higher rates of cardiovascular morbidity and mortality. In recent years, the introduction of remote monitoring systems has allowed for more careful management of them, although there are no large studies demonstrating their effectiveness in terms of improving prognosis. The aim of our study was to evaluate the prognosis of patients with diabetes mellitus and heart failure undergoing remote monitoring. Methods All patients undergoing device implantation for heart failure in our Center were recruited into the study, and the incidence of events (new hospitalizations or hospitalizations) during the period from January 1, 2021 to December 31, 2021 was assessed. Patients were monitored, and direct telephone contact or contact with one of the family members was made for all of them. Data on clinical characteristics and drug therapy were recorded. Results A total of 240 patients (73±11 years, 81% male) of whom 74 were diabetic (73±11 years, 87% male) and 166 were nondiabetic (73±10 years, p=0.82, 80% male, p= 0.198) were enrolled in the study. The two groups had no statistically significant differences in terms of clinical characteristics (such as ejection fraction, NYHA class, presence of anemia, rate of wide QRS, or rate of defibrillator implantation) except for a higher incidence of coronary artery disease in diabetic patients (70%) and multivessel coronary disease (67%) than in non–diabetic patients (57% coronary artery disease p= 0.05, and 46% multivessel disease p= 0.02). There were no significant differences in terms of drugs with the exception of higher use of statins in the group of diabetic patients (84%) compared to non–diabetics (64%, p= 0.002). Diabetic patients had almost 4 times higher mortality rates than non–diabetic patients (22% and 6% respectively, p&amp;lt; 0.0001). Differently, hospitalization rates were not significantly different among diabetic patients (24%) compared with nondiabetic patients (28%, p= 0.58). Conclusions The association of diabetes mellitus and heart failure represents a dangerous combination associated with an increased incidence of death. Therefore, clinical monitoring strategies and intensity of drug therapy should be particularly implemented in diabetic patients.

Nasogastric tube feeding under physical restraint: comprehensive audit and case series across in-patient mental health units in England.

To identify the clinical characteristics of patients receiving nasogastric tube (NGT) feeding under physical restraint. Clinicians participated via professional networks and subsequent telephone contact. In addition to completing a survey, participants were invited to submit up to ten case studies. The survey response rate from in-patient units was 100% and 143 case studies were submitted. An estimated 622 patients received NGT feeding under restraint in England in 2020-2021. The most common diagnosis was anorexia nervosa (68.5-75.7%), with depression, anxiety and autism spectrum disorder the most frequent comorbidities. Patients receiving the intervention ranged from 11 to 60 years in age (mean 19.02 years). There was wide variation in duration of use, from once to daily for 312 weeks (mode 1 week; mean 29.1 weeks, s.d. = 50.8 weeks). NGT feeding under restraint is not uncommon in England, with variation in implementation. Further research is needed to understand how the high comorbidity and complexity contribute to initiation and termination of the intervention.

Survey of Neonatal Resuscitation Practices in Metropolitan and Nonmetropolitan Nontertiary Birthing Units in New South Wales and Australian Capital Territory

Objective To describe the neonatal training experience of birth attendants in New South Wales (NSW) and Australian Capital Territory (ACT) and explore the variations in respiratory management and equipment use at birth. Methods We contacted 119 nontertiary units in NSW/ACT by a written survey followed by telephone contact. A set questionnaire was offered, asking for details of the availability and skill levels of staff at neonatal resuscitation, and of the equipment available at all births. Results Staff from 103 out of 119 units (87%) participated in the study. Resuscitation at all metropolitan units was supported by qualified pediatricians whereas midwives provided neonatal resuscitation as the first responder in a nonmetropolitan unit, with support from a general medical practitioner. Twenty-two percent of nontertiary units relied on external agencies or online support for neonatal resuscitation training. Three quarters of the units used a T-piece resuscitator as the primary device to provide positive pressure ventilation, 65.3% of nonmetropolitan units had blenders available, and 19% of units administered some oxygen at initiation of resuscitation. Thirty-eight percent units responded having no prior knowledge of the pressure relief valve setting. Conclusion Equipment and availability of trained personnel for neonatal resuscitation in nontertiary birthing units across NSW and ACT vary widely. The resources to provide training and education are variable.

Comparison of Safety and Effectiveness of Bivalirudin Between Diabetic and Nondiabetic Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

Background: Recurrent thrombotic events remain significantly high in spite of the currently recommended dual antiplatelet (DAPT) and conventional antithrombotic heparin (± GPI/ glycoprotein IIb/IIIa inhibitor) in diabetic ACS patients after PCI compared with non-diabetic even this drug eluting stent (DES) era. Therefore, more potent antithrombotic therapies are warranted for this group of high-risk patients.Comparison of safety and efficacy of newer anticoagulant bivalirudin between diabetic and non-diabetic ACS patients undergoing PCI using bivalirudin versus heparin (± GPI) is less well defined in Bangladeshi population. Objective: To determine and compare the incidence of 30-day major adverse cardiac events (MACEs), stent thrombosis and hemorrhagic complications between diabetic and non-diabetic ACS patients undergoing PCI. Impact of antithrombotic strategy (bivalirudin vs. heparin ± GPI) on the 30- day post PCI clinical outcome was also evaluated and compared between diabetic and non-diabetic subgroup. Methods: In this randomized controlled study, 500 ACS patients aged 18-75 years (200diabetic and 300 non-diabetics) who underwent PCI from November 2018 to October 2019 at the department of cardiology, BSMMU, were randomly assigned, in an open-label fashion to treatment with bivalirudin alone, heparin alone, or heparin plus eptifibatide (GPI) in a 1:1:1 ratio. Among them, 200 patients received Bivalirudin with a loading dose of 0.75 mg/kg, followed by an infusion of 1.75 mg/kg/h for up to 4 hours, 153 patients received UFH with a bolus of 70-100 U/kg (targeted ACT: 200-250 s) and 147 patients got heparin plus eptifibatide as 60 IU/kg heparin along with 180 μg/kg eptifibatide i.v. boluses, followed by a 2 μg /kg /min eptifibatide infusion for 18 hr consistent with current guidelines.Other pre- and post-procedural medications got under current guidelines. Both diabetic and non-diabetic subjects were subdivided into bivalirudin and control group (heparin ± GPI). In diabetic cohort, 100 patients were in bivalirudin and 100 patients were in control group. Among non -diabetic patients, 100 were in bivalirudin and 200 were in control group. The outcome measures were 30-day hemorrhagic complications, stent thrombosis, and MACCEs [death, MI, target lesion revascularization (TLR), and stroke] according to diabetic status. The diabetic and non-diabetic subgroup was also analyzed for the same outcome measure according to antithrombotic strategy. Peri and post PCI clinical follow-up comprised checking office visits and telephone contacts. Results: According to diabetic status, net adverse clinical events (NACEs) were significantly higher in diabetic in comparison to non-diabetic (diabetic vs. non-diabetic, 15% vs. 7.6 %, P=0.008) and was associated with higher incidence of MACCEs (10.5% vs. 4.0%, P=0.004), cardiac death (4 % vs. 1 %, P=0.02) and BARC 2,3,5 grade bleeding events (9% vs. 4 %, P=0.02). In diabetic cohort, incidence of 30-day NACEs was significantly lower in bivalirudin than control group(bivalirudin vs. UFH ± GPI, 6 % vs. 24 %, P=0.004) and was associated with lower incidence of MACCEs (2% vs. 8.5%, P=0.03) and bleeding events (3 % vs. 15 %, P=0.003) whereas incidence of stent thrombosis (2 % vs. 3%, P =0.651) was comparable between the bivalirudin and control groups. There was a significant advantage in favor of bivalirudin treatment among insulin-treated patients with regard to cardiac death at 30-day (bivalirudin vs. control group, 0% vs. 16.6%, p = 0.03) compared with non-insulin treat diabetic patients. However, subgroup analysis of the nondiabetic patients showed that there was no significant difference in the incidence of 30-Day NACEs (4% vs. 9.5%, P=0.09) according anticoagulant status. Multivariate analysis showed that bivalirudin (HR: 0. 202, 95% CI: 0.078 – 0.519, P=0.009) was independent protective factor of 30-day NACEs for diabetic patients. Conclusion: Bivalirudin monotherapy is safer and more efficacious for diabetic ACS patients compared with non-diabetic ACS patients undergoing PCI. J Dhaka Med Coll. 2022; 31(1) : 126-136

Long-Term Safety Analysis of the ChAdOx1-nCoV-19 Corona Virus Vaccine: Results from a Prospective Observational Study in Priority Vaccinated Groups in North India.

Various vaccines for protection against COVID-19 were provided emergency approval in late 2020 to early 2021. There is a scarcity of long-term safety data for many of these. The main aim of this study is to provide the one-year safety results of the ChAdOx1-nCoV-19/AZD1222 vaccine and determine the risk factors of adverse events of special interest (AESIs) and persistent AESIs. This was a prospective observational study conducted from February 2021 to April 2022 in a tertiary hospital in North India and its two associated centers. Health care workers, other frontline workers, and the elderly vaccinated with the ChAdOx1-nCoV-19 vaccine constituted the study population. Individuals were contacted telephonically at pre-decided intervals for one year and health issues of significant concern were recorded. Atypical adverse events developing after a booster dose of the COVID-19 vaccine were assessed. Regression analysis was conducted to determine risk factors of AESI occurrence and determinants of AESIs persisting for at least one month at the time of final telephonic contact. Of 1650 individuals enrolled, 1520 could be assessed at one-year post-vaccination. COVID-19 occurred in 44.1% of participants. Dengue occurred in 8% of participants. The majority of the AESIs belonged to the MedDRA® SOC of musculoskeletal disorders (3.7% of 1520). Arthropathy (knee joint involvement) was the most common individual AESI (1.7%). Endocrinal disorders such as thyroid abnormalities and metabolic disorders such as newly diagnosed diabetes developed in 0.4% and 0.3% of individuals, respectively. Regression analysis showed females, individuals with a pre-vaccination history of COVID-19, diabetes, hypothyroidism, and arthropathy had 1.78-, 1.55-, 1.82-, 2.47- and 3.9-times higher odds of AESI development. Females and individuals with hypothyroidism were at 1.66- and 2.23-times higher risk of persistent AESIs. Individuals receiving the vaccine after COVID-19 were at 2.85- and 1.94 times higher risk of persistent AESIs compared, respectively, to individuals with no history of COVID-19 and individuals developing COVID-19 after the vaccine. Among participants receiving a booster dose of the COVID-19 vaccine (n = 185), 9.7% developed atypical adverse events of which urticaria and new-onset arthropathy were common. Nearly half of the ChAdOx1-nCoV-19 vaccine recipients developed COVID-19 over one year. Vigilance is warranted for AESIs such as musculoskeletal disorders. Females, individuals with hypothyroidism, diabetes, and pre-vaccination history of COVID-19 are at higher risk of adverse events. Vaccines received after natural SARS-CoV-2 infection may increase the risk of persistence of adverse events. Sex and endocrinal differences and timing of the COVID-19 vaccine with respect to natural infection should be explored as determinants of AESIs in the future. Pathogenetic mechanisms of vaccine-related adverse events should be investigated along with comparisons with an unvaccinated arm to delineate the overall safety profile of COVID-19 vaccines.

Remote nutrition care during the first wave of COVID-19 pandemic: Did it impact nutrition therapy goals?

Nutrition societies recommended remote hospital nutrition care during the coronavirus disease 2019 (COVID-19) pandemic. However, the pandemic's impact on nutrition care quality is unknown. We aimed to evaluate the association between remote nutrition care during the first COVID-19 wave and the time to start and achieve the nutrition therapy (NT) goals of critically ill patients. A cohort study was conducted in an intensive care unit (ICU) that assisted patients with COVID-19 between May 2020 and April 2021. The remote nutrition care lasted approximately 6 months, and dietitians prescribed the nutrition care based on medical records and daily telephone contact with nurses who were in direct contact with patients. Data were retrospectively collected, patients were grouped according to the nutrition care delivered (remote or in person), and we compared the time to start NT and achieve the nutrition goals. One hundred fifty-eight patients (61.5 ± 14.8 years, 57% male) were evaluated, and 54.4% received remote nutrition care. The median time to start NT was 1 (1-3) day and to achieve the nutrition goals was 4 (3-6) days for both groups. The percentage of energy and protein prescribed on day 7 of the ICU stay concerning the requirements did not differ between patients with remote and patients with in-person nutrition care [95.5% ± 20.4% × 92.1% ± 26.4% (energy) and 92.9% ± 21.9% × 86.9% ± 29.2% (protein); P > 0.05 for both analyses]. Remote nutrition care in patients critically ill with COVID-19 did not impact the time to start and achieve the NT goals.

Intermediate-Dose Versus Low-Dose Low-Molecular-Weight Heparin in Pregnant and Post-Partum Women with a History of Venous Thromboembolism (Highlow Study): An Open-Label, Multicentre, Randomised, Controlled Trial

ABSTRACT Venous thromboembolism (VTE) in pregnancy is a major cause of maternal morbidity and mortality, but its prevention, medical thromboprophylaxis, can cause bleeding complications. Without thromboprophylaxis, up to 10% of women with a history of VTE are at risk of pregnancy-related recurrence. For those women with a history of VTE who are not on long-term anticoagulation medication, guidelines recommend subcutaneous low-molecular-weight heparin (LMWH) in all women in the postpartum stage. For those with moderate or high risk of recurrent VTE, antepartum thromboprophylaxis is recommended. In both cases, the optimal dose of heparin is unknown, and professional societies do not provide clear specific guidance often recommending multiple different dosing approaches without clear evidence to guide recommendations. The aim of this study was to assess the efficacy and safety of low- versus intermediate-dose LMWH in pregnant women with a history of VTE. This was an open-label, randomized controlled study conducted at 70 hospitals in the Netherlands, France, Belgium, Norway, Demark, Canada, the United States, and Russia. Included were adult pregnant women with a history of objectively confirmed VTE, either unprovoked or provoked by hormonal or minor risk factors, and a gestational age ≤14 weeks. Excluded were women with previous VTE related to a major risk factor, indication for therapeutic-dose anticoagulants, or contraindication to LMWH. Eligible women were randomly assigned to receive either weight-adjusted intermediate-dose heparin or fixed, low-dose heparin. Participants self-administered their allocated dose of heparin once daily and participated in in-person or telephone contacts 2 weeks after randomization; at 20 and 30 weeks of gestation; and 1 week, 6 weeks, and 3 months postpartum. The primary efficacy outcome was symptomatic VTE, and the primary safety outcome was major bleeding. A total of 1110 women were included in the analysis—555 were randomized to the intermediate-dose group and 555 to the low-dose group. Approximately 81% of women had a history of VTE related to hormone use, pregnancy, or the postpartum period. From randomization to 6 weeks postpartum, VTE occurred in 2% of women in the intermediate-dose group and 3% in the low-dose group (relative risk, 0.69; 95% confidence interval, 0.32–1.47; P = 0.33). Antepartum VTE occurred in 1% of women in each treatment group; postpartum VTE occurred in 1% in the intermediate-dose group and 2% in the low-dose group. These findings remained consistent up to 3 months postpartum. From randomization to 6 weeks postpartum, major bleeding occurred in 4% of women in the intermediate-dose group and 4% in the low-dose group (relative risk, 1.16; 95% confidence interval, 0.65–2.09; p = 0.63). Antepartum major bleeding occurred in &lt;1% of women in each treatment group. Early postpartum bleeding occurred in 4% in the intermediate-dose group and 3% in the low-dose group. Last postpartum bleeding occurred in &lt;1% in the intermediate-dose group and none in the low-dose group. In comparing weight-adjusted, intermediate-dose LMWH with fixed, low-dose LMWH, the risk of VTE was similar in pregnant women with a history of VTE in the antepartum and postpartum periods. Moreover, no differences were observed in the occurrence of major bleeding between the 2 treatment groups. These findings provide evidence-based guidance that low-dose heparin is appropriate for preventing pregnancy-related recurrent VTE.

Navigating Unprofessional Behavior.

AORN JournalVolume 117, Issue 5 p. 312-314 Speaking Up: Voices From the OR Navigating Unprofessional Behavior Georgia Dinndorf-Hogenson PhD, RN, CNOR, Corresponding Author Georgia Dinndorf-Hogenson PhD, RN, CNOR Associate Professor [email protected] Corresponding Author Information: Georgia Dinndorf-Hogenson, PhD, RN, CNOR, Associate Professor, College of St. Benedict/St. John’s University, Office: Main Building 459, 37 South College Avenue, St. Joseph, MN 56374, Contact telephone: 320-363-5162. Contact e-mail: [email protected]Search for more papers by this author Georgia Dinndorf-Hogenson PhD, RN, CNOR, Corresponding Author Georgia Dinndorf-Hogenson PhD, RN, CNOR Associate Professor [email protected] Corresponding Author Information: Georgia Dinndorf-Hogenson, PhD, RN, CNOR, Associate Professor, College of St. Benedict/St. John’s University, Office: Main Building 459, 37 South College Avenue, St. Joseph, MN 56374, Contact telephone: 320-363-5162. Contact e-mail: [email protected]Search for more papers by this author First published: 27 April 2023 https://doi.org/10.1002/aorn.13916Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume117, Issue5Special Focus Issue: Infection PreventionMay 2023Pages 312-314 RelatedInformation

Evaluating the Quality of Delivery Service from the Customer's Point of View Using the Importance-Performance Matrix

Purpose: Delivery services are widely used in all aspects of purchasing, but the positive and negative effects they generate for the customer influence his behavior towards repeating this method of purchase. The study aims to find out the extent of customer satisfaction with the delivery services provided to them in the city of Baghdad. Theoretical framework: Delivery services of all kinds (delivery of food, household items, or any other materials) by direct telephone contact or using social media are among the modern services in Iraq, as this service has entered on a large scale after 2010, which requires preparation Studies and Research In order to improve these services, relevant previous research and studies have been objectively collected and reviewed to understand recent trends reached by the literature. Design/Methodology/Approach: The analytical descriptive approach was used, and data was collected through a two-part questionnaire. The first part included the quality of delivery services provided, while the second part (performance) included customer satisfaction with the services provided. The study sample consisted of 260 beneficiaries who use delivery services continuously in the city of Baghdad. The obtained data were analyzed using SPSS software and through an analytical approach based on significance performance analysis (IPA). Findings: The results of the research determined the extent of customer satisfaction with delivery services through 5 characteristics of service quality and customer satisfaction with the services provided, as the results showed that delivery services in the city of Baghdad have not yet reached a high performance. This requires the departments that provide that service to pay more attention and focus on achieving the highest points in the first and second quarters of the matrix (management focus) (keeping up with the good work). Research, practical and social implications: Research, practical and social implications: The modernity of delivery services in the Iraqi environment is a fertile field for providing more research and studies because this contributes greatly to increasing people’s awareness and understanding of this type of important service and at the same time contributes to raising the efficiency of operating companies and offices. for this type of service. Originality / Value: Delivery services are a new concept in Iraq, and there is no literature at the level of Iraq to assess the quality of this service and the extent of customer satisfaction with this service through the use of the importance-performance matrix. As a result, the purpose of this paper is to make up for this void.

P015 Rheumatology advice lines: how to manage rising demand and limited capacity?

Abstract Background/Aims Advice lines services (ALS) are a key aspect of providing coordinated patient care in rheumatology. Demand for rapid access to specialist advice increased during the pandemic due to the disruption of routine outpatient services but it is not clear whether this demand is sustained. We aimed to investigate the changes in demand for ALS, how this varied pre/during COVID-19 and audit the effect upon response times. We also aimed to assess the impact of introducing an email advice service on demand. Methods We audited the number of advice line contacts of a single rheumatology department, serving a population of 500,000 people. The telephone adviceline is provided as an answer machine with an email advice service set up in April 2020. The outcome of each contact is recorded as a) advice only b) action required (e.g., prescription, blood test, GP letter) or c) required appointment (monitor/nurse/medical). We audited response times using the RCN guidelines of a two-day response1 as the gold standard. Results Demand for advice had been increasing pre-COVID with an average of 368 calls/month (1/1/19-1/7/19) to 420/month (1/7/19-31/12/19). Sixty percent were advice only calls but 27% required additional action. Response times met the audit standard in 97% of cases pre-COVID. During the first two months of COVID demand for advice services doubled, however demand continued to rise although outcomes were similar (Table 1). As the number of contacts increased the proportion of telephone contacts responded to within the audit standard fell. Numbers of email contacts were variable, but response times exceeded the audit standard. Conclusion This audit demonstrates the demand of adviceline services has continued to increase throughout the pandemic and beyond, impacting the ability of services to respond within a timely manner. Ongoing QI work is assessing mechanisms to manage increased demand (using healthcare support workers to triage calls) and investigating reasons for accessing ALS to ensure appropriate advice is available. Disclosure S. Hider: None. A. Brownfield: None. R. Doe: None. S. Dutta: None. S. Ryan: None.