Telephone Contact Research Articles

Clinical Profile and Outcome of COVID Positive Hematology Patients during the COVID-19 Pandemic - an Analytical Cross Sectional Study from a Tertiary Care Centre in India

Introduction:The COVID-19 pandemic is a global public health challenge that has affected more than 30 million people and taken more than 4 lakh lives in India. The first and second COVID waves have greatly impacted the lives of a vast majority and vaccination of the masses remains a struggle. Although SARS -CoV-2 infections in patients with hematological diseases are expected to have an adverse outcomes, only limited reports are available from India. Hence, our study aims to identify the outcome in terms of severity and mortality in this group and the risk factors involved in developing severe COVID-19 and death.Methodology:This is a cross sectional analytical study done in a tertiary care hospital in Southern India for a period of 11 months. All hematological patients irrespective of age, who were infected with SARS-CoV-2 during the first wave (June -December 2020) and second wave (March - June 2021) were consecutively enrolled for the study after IRB approval. The patients were then categorized as neoplastic (acute and chronic leukemia, lymphoma, myeloma, MPN and MDS ) and non-neoplastic (ITP, aplastic anemia, hemolytic anemia, MGUS and TTP ) diseases. The clinical data was collected retrospectively from the electronic medical records and by direct telephonic contact. Patients were categorized as having mild (spO2 > 94 % symptomatic /asymptomatic), moderate (spO2 90 - 94 %) and severe (spO2 < 90 %) disease based on their severity of infection, each category of patients received appropriate clinical management. Treatment details, mortality and other outcomes were recorded for 30 days. The continuous variables were represented as mean (± SD)/median (IQR) and categorical variables as frequency and percentage. The association of the outcome variable with selected variables were calculated using Chi-square tests and kaplan meier survival analysis. The data sets were analyzed (SPSS version 21) and a p value of < 0.05 was considered statistically significant.Results:The study was conducted with 70 patients (n=70). Demographic details of patients are summarized in Table 1.Seventeen (24.3%) out of 49 (70%) hospitalized patients required ICU care. There were 13 (18.6%)deaths. in the patients who survived, prolonged antigen positivity of COVID on testing after 21 days was seen in 9 patients (16.1%). In 35 patients (50%)hematological treatment was restarted with a mean delay of 9.2 +/- 10.72 days. Predictors of severity of the disease is summarized in Table 2. Age more than 50 years (P=0.002)(Figure 1a), severe COVID (P=<0.001) and D dimer value of >2 times normal (P=0.047) were associated with a 30-day mortality. Additionally, patients on active treatment for hematological disease were at greater risk of severe COVID (P=0.012). There was no significant difference in severity (P=0.197) or mortality (P=0.556)in patients with neoplastic vs. non-neoplastic disordersConclusion:COVID-19 patients with malignant and non-malignant hematological diseases showed an increased mortality. Age > 50 years and high D dimer values (>2N) were identified as predictors of mortality. Active treatment for haematological disease predisposed to severe disease.The study needs to be validated further on a larger cohort of patients . Preventive strategies including vaccination is warranted in patients with hematological disorders. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Effect of BMI on Prolonged Abstinence after Smoking Cessation Treatment: A Retrospective Cohort Study.

Despite the well-documented relationship between weight gain and poorer cessation outcomes among smokers, the role of the former (baseline) weight in smoking cessation is insufficiently investigated. We hypothesized that patients with higher baseline body mass index( BMI) have a worse prognosis in tobacco cessation. This retrospective clinical cohort study aimed to investigate the role of the baseline BMI on abstinence over 12 months after participation in smoking cessation treatment conducted in a middle-income country (n = 664). Data from a 6-week smoking cessation protocol performed in a Psychosocial Care Unit (CAPS) were used. The protocol included four medical consultations and six Cognitive-Behavioral Therapy (CBT) group sessions. Initially, 1,213 participants were evaluated for the study, but only the participants whose telephone contact was successful were included in the outcome analyses. The attrition rate was 45.3%. Continuous and categorical (normal, overweight, and obesity) BMI values were computed. Survival regression models were used to test the associations between BMI and the 12-month abstinence outcome. Self-report 4-week abstinence at the end of treatment was also investigated using logistic regression models. Baseline BMI had no significant effect on both short (4-week-point abstinence) and long (12-month prolonged abstinence) treatment outcomes. The possible influence of the baseline BMI on smoking cessation outcomes, especially considering prolonged abstinence, was not corroborated by our results. Regardless of our results, the detrimental health outcomes due to the combination of obesity/overweight and smoking justify that these subgroups of individuals be continuously targeted for adequate smoking prevention and treatment.

Effects of a lifestyle intervention programme after 1 year of follow-up among South Asians at high risk of type 2 diabetes: a cluster randomised controlled trial

IntroductionSouth Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults...

Impact of NHS 111 Online on the NHS 111 telephone service and urgent care system: a mixed-methods study

BackgroundThe NHS emergency and urgent care system is under pressure as demand for services increases each year. NHS 111 is a telephone triage service designed to provide advice and signposting to appropriate services for people with urgent health-care problems. A new service, NHS 111 Online, has been introduced across England as a digital alternative that can be accessed using a website or a smartphone application. The effects and usefulness of this service are unknown.ObjectivesTo explore the impact of NHS 111 Online on the related telephone service and urgent care system activity and the experiences of people who use those services.Design and methodsA mixed-methods design of five related work packages comprising an evidence review; a quantitative before-and-after time series analysis of changes in call activity (18/38 sites); a descriptive comparison of telephone and online services with qualitative survey (telephone,n = 795; online,n = 3728) and interview (32 participants) studies of service users; a qualitative interview study (16 participants) of staff; and a cost–consequences analysis.ResultsThe online service had little impact on the number of triaged calls to the NHS 111 telephone service. For every 1000 online contacts, triaged telephone calls increased by 1.3% (1.013, 95% confidence interval 0.996 to 1.029;p = 0.127). Recommendations to attend emergency and urgent care services increased between 6.7% and 4.2%. NHS 111 Online users were less satisfied than users of the telephone service (50% vs. 71%;p &lt; 0.001), and less likely to recommend to others (57% vs. 69%;p &lt; 0.001) and to report full compliance with the advice given (67.5% vs. 88%;p &lt; 0.001). Online users were less likely to report contacting emergency services and more likely to report not making any contact with a health service (31% vs. 16%;p &lt; 0.001) within 7 days of contact. Thirty-five per cent of online users reported that they did not want to use the telephone service, whereas others preferred its convenience and speed. NHS 111 telephone staff reported no discernible increase or decrease in their workload during the first year of operation of NHS 111 Online. If online and telephone services operate in parallel, then the annual costs will be higher unless ≥ 38% of telephone contacts move to online contacts.ConclusionsThere is some evidence that the new service has the potential to create new demand. The service has expanded significantly, so it is important to find ways of promoting the right balance in numbers of people who use the online service instead of the telephone service if it is to be effective. There is a clear need and preference by some people for an online service. Better information about when to use this service and improvements to questioning may encourage more uptake.LimitationsThe lack of control arm means that impact could have been an effect of other factors. This work took place during the early implementation phase, so findings may change as the service expands.Future workFurther development of the online triage process to make it more ‘user friendly’ and to enable users to trust the advice given online could improve use and increase satisfaction. Better understanding of the characteristics of the telephone and online populations could help identify who is most likely to benefit and could improve information about when to use the service.Trial registrationCurrent Controlled Trials ISRCTN51801112.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 9, No. 21. See the NIHR Journals Library website for further project information.

Long-term prognostic value of computed tomography-based attenuation correction on thallium-201 myocardial perfusion imaging: A cohort study.

BackgroundMyocardial perfusion imaging (MPI) is a well-established diagnostic tool to evaluate coronary artery disease (CAD) and also an effective prognostic tool for patients with CAD. However, few studies investigated the prognostic value of attenuation correction (AC) in MPI, and the results were controversial.ObjectivesTo investigate the prognostic value of computed tomography (CT)-based AC thallium-201 (Tl-201) MPI.MethodsA total of 108 consecutive patients who underwent Tl-201 MPI and received coronary angiography within 90 days were included. Medical records were reviewed and missing information was completed after telephone contact. The prognostic value was evaluated by Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards model.ResultsAfter a mean follow-up of 7.72 ± 3.72 years, 27 patients had died, 41 had been readmitted for cardiovascular (CV)-related events and 44 had reached the composite of death plus CV-related re-admission. Kaplan-Meier curves for all-cause mortality for SSS with a cutoff value of 13 for AC and 16 for non-AC (NAC) images showed a significant difference between the two curves for both AC and NAC images (p = 0.011 for AC and p = 0.021 for NAC). In the multivariable model, SSS and SRS showed similar independent predictive values in predicting all-cause mortality and composite of all-cause mortality plus CV-related re-admission, in both AC and NAC images. Subgroup analysis implicated that AC MPI possibly provided better risk stratification in obese patients.ConclusionCT-based AC and NAC MPI showed similar value and were the only significant predictors for the composite of mortality and CV events.

Construction of Rural Left-Behind Children’s Mental Health Mobile Information System Based on the Internet of Things

Left-behind children, as a special phenomenon group stationed in rural areas, lack parents’ education and care for a long time and shoulder the burden of life early. Moreover, in rural areas with relatively closed information, their communication with their parents only relies on short-term telephone contact. If things go on like this, it may lead to mental health problems in children. In recent years, the group of left-behind children began to get the attention of the society. The social people want to help the left-behind children mainly through the information provided by the school, which cannot actually understand the real situation of the left-behind children, and the help to the left-behind children is only a drop in the bucket. Therefore, it is necessary to use the internet as a convenient and fast platform to build a mobile information system for the mental health of rural left-behind children, input the mental health of left-behind children, and pay attention to and track the left-behind children. This paper mainly studies the construction of the rural left-behind children’s mental health mobile information system based on the Internet of Things. This paper expounds the related concepts of the Internet of Things, which has a good connection effect on the construction of the left-behind children’s mental health mobile information system. Then, it analyzes the functional requirements of the rural left-behind children’s mental health mobile information system, in terms of design, the C/S model is used, the database in the data server is designed to analyze the mental health information management needs of left-behind children, and the data model is established by defining the key domains in the system. This paper also collects and sorts out the left-behind children’s mental health data through data mining technology, studies the factors affecting the left-behind children’s mental health, and clarifies the necessity of constructing the rural left-behind children’s mental health mobile information system and focuses on the observation objects. The results show that the evaluation factors of left-behind children’s mental health are significantly higher than those of non-left-behind children, and their mental health needs attention because left-behind children lack the care of their parents for a long time. The mental health status of left-behind children aged 7–12 is the most worrying, which is significantly different from other age groups in obsessive-compulsive disorder, interpersonal sensitivity, anxiety, hostility, paranoia, and mental illness. It may be because left-behind children aged 7–12 are in the development stage, they are not as ignorant as left-behind children aged 1–6, and they are not as mature as left-behind children aged 13–17.

Survey on the Evasion Factors of a Psychology School Clinic

The Psychology School Clinic enables the practice of internships inwhich students apply their theoretical knowledge in procedures madeavailable free of charge by the university to the community. Through thecharacterization of the reasons for evasion of cases dismissed in 2019, it isproposed to identify the causes of the psychological services offered and,therefore, to outline possible parameters for discussion and adjustment forthe given procedure. A descriptive survey of information collected fromclosed records was carried out.We surveyed 422 medical records that wereclosed in 2019, of which made it possible to identify the factors, namely:waiting time for care, telephone contact difficulties and the specificity ofemotional demand. These results allowed for a better understanding of theserved clientele and, therefore, it was possible to consider new strategiesin an attempt to reduce the evasion rate of the service, as greater visibilityof the device, reaching a larger population, as well as the propagation ofgood results. We emphasize the importance of the constant production ofstudies like this one, aiming, through the availability of data, to maintainthe teaching process and improve service to the public.

The individual approach to management of patients with atrial fibrillation and its influence on patient adherence to anticoagulant therapy

Abstract Background The key points in the treatment of patients with atrial fibrillation (AF) with the ABC (Atrial Fibrillation Better Care) pathway are the prevention of stroke and increasing patient adherence to therapy. The basis for increasing adherence to therapy is regular communication between medical staff and the patients. Purpose To assess the effect of telephone contact (TC) frequency on patient adherence to anticoagulant therapy (ACT). Methods A prospective, non-interventional observational study was carried out, during which 84 patients with non-valvular AF were observed remotely after being discharged from the hospital. Patient education was provided in the hospital, which included an explanation of the importance of ACT. The observation period was 12 months. All enrolled patients were 18 years of age or older; AF was documented before enrolment on the basis of objective electrocardiographic evaluation; all patients had indications for taking anticoagulants (AC) for stroke prevention. Adherence to therapy was assessed using the Morisky-Green test. Results The patients were randomized into 2 groups: group 1 – TC monthly, group 2 – TC every 6 months. In the first group, 85.7% of patients received the non–vitamin K antagonist oral anticoagulants (NOAC), and 14.3% received warfarin; in the 2nd group, 92.9% of patients received NOAC, and 7.1% received warfarin. The mean score of the adherence to therapy according to the Morisky-Green test was initially 3.3±0.8 in group 1, and 3.3±0.7 in group 2, p=0.78. After 12 months: in group 1, 14.6% of patients refused to take AC; and in group 2, 25.0% did the same. The mean value score of the adherence to therapy in group 1 underwent a statistically insignificant change over time (from 3.3±0.8 to 3.1±1.5, p=0.48). In group 2, after 12 months, the mean score of adherence to therapy saw a significant decrease from 3.3±0.7 to 2.7±1.6, p=0.03. Both in group 1 and in group 2, the decrease in the mean score of adherence to therapy occurred mainly due to patients with an initially insufficient level of adherence. Conclusions The results of our study confirm the need for individual strategy for managing patients through the ABC pathway. In most cases, face-to-face or telephone contact with medical staff once every six months is sufficient for patients who are initially adherent to therapy, after receiving an introductory briefing. Patients with insufficient level of adherence require more frequent contact. Funding Acknowledgement Type of funding sources: None.

Novel computed-tomography derived prognostic markers in patients undergoing TAVI with a self-expanding valve

Abstract Introduction Transcatheter aortic valve implantation is the treatment of choice in a consistently expanding group of patients with severe aortic valve stenosis. Tricuspid and mitral annular dilatation with consequent valvular regurgitation are associated with adverse outcome. Computed tomography angiography (CTA) is routinely performed for preprocedural evaluation of vascular access and prosthesis sizing. Purpose To evaluate the impact of mitral and tricuspid annular dimensions in preprocedural CTA on prognosis of patients undergoing TAVI with a self-expanding valve. Methods CTAs of consecutive patients undergoing TAVI in a single high-volume center between 2016 and 2019 were retrospectively evaluated. Maximal septolateral tricuspid annular diameters (TAD) and mitral annular diameters (MAD) were obtained and measured from properly angulated three dimensional CTA datasets. Moreover, maximal pulmonary artery diameter perpendicular to the long axis was measured in every patient. Patients were followed up by clinical visits or telephone contacts. As clinical events were defined all-cause mortality, stroke and heart failure hospitalization. Results In total 123 patients were included in the study. The mean follow-up duration was 875±383 days and 21 clinical events were recorded. There was a moderate but statistical significant correlation between TAD and both pulmonary artery diameter (r=0.39, p&amp;lt;0.001) and pulmonary artery systolic pressure by echocardiography (r=0.23, p=0.015). In univariate logistic regression analysis pulmonary artery diameter and TAD were both associated with heart failure hospitalization (p=0.03 and 0.02 respectively). In addition, MAD was associated with total events (OR: 0.43, 95% CI 0.19–0.99, p=0.048). The relationship of MAD with events remained significant after adjustment for sex, age and tricuspid annular dimensions (OR: 0.28, 95% CI 0.1–0.79, p=0.02). Conclusions TAD and MAD were associated with heart failure rehospitalization and clinical events respectively in patients undergoing TAVI with a self-expanding valve. Further larger prospective studies are warranted to evaluate the prognostic value of these CTA markers. Funding Acknowledgement Type of funding sources: None.

Patient perspectives on digital patient reported outcomes in routine care of inflammatory bowel disease

BackgroundDigital patient reported outcomes are used increasingly in daily care and treatment of inflammatory bowel disease. Their purpose includes increased focus on patient wellbeing, reduction in avoidable follow-up consultations and increased patient self-management. However, implementation issues occur and studies indicate patients may have concerns, particularly regarding having fewer face-to-face consultations. This study aims to explore patients’ perspectives of use and non-use of digital patient reported outcomes and to understand the mechanisms underpinning patient reluctance to engage with this health technology.ResultsSixteen patients with inflammatory bowel disease at a regional hospital in Denmark were interviewed about their experiences of, and perspectives on, digital patient reported outcomes. A certain level of eHealth literacy was found to be a fundamental condition for use, while other factors were barriers or facilitators for use of digital PROs. Patients’ main concerns were about potential consequences for their care and relationship with the clinic. Most patients in stable remission were satisfied with the hospital being a “life-line” if their symptoms worsened, and perceived digital patient reported outcomes to be an efficient tool to establish that “life-line”. Patients with severe symptoms and a high degree of emotional distress related to their disease valued the potential for digital patient reported outcomes to increase their clinicians’ focus on mental health and extra-intestinal symptoms.ConclusionThis study found that if patients had sufficient digital literacy, they perceived digital patient reported outcomes to be a useful replacement for face-to-face consultations. However, they were concerned about digital patient reported outcomes’ effect on the patient–clinician relationship and its ability to detect worsening of symptoms. These concerns may be mitigated by good patient–clinician relationships, and the option for patients to maintain direct telephone contact with their gastroenterology specialist.

Differences in management of telemedicine alerts on weekdays and public holidays: Results from the OptiLink heart failure trial

Background In the OptiLink heart failure study, timely and appropriate reactions to telemedicine alerts improved clinical outcomes in heart failure patients. This analysis investigates the relation between the weekday of alert transmission and the subsequent patient contact. Methods In patients enrolled in the intervention arm of the OptiLink heart failure study (n = 505, age 66.1 ± 10.1, 77.2% male, left-ventricular ejection fraction 26.7% ± 6.1%), fluid index threshold crossing alerts were analysed according to the weekday of the transmission. Transmissions on Mondays–Thursdays were categorized as TD1, Fridays–Sundays as well as public holidays as TD2. Results Of 1365 transmitted alerts, 867 (63.5%) were categorized as TD1 and 498 (36.5%) as TD2. Same day telephone contacts were more frequent in TD1 (46.2%) than in TD2 (18.3%; p < 0.001). Accordingly, the median time to contact was significantly longer in TD2 compared with TD1 (2(1–3) vs 0(0–1) days; p < 0.001). Rates of no telephone contact were no different between the groups (12.1% vs 12.4%; p = 0.866). Although signs of worsening heart failure were prevalent in 32.4% in TD1 versus 32.1% in TD2 (p = 0.996), initiation of a pharmacological intervention occurred more likely in TD1 compared with TD2 (27.9% vs 22.9%; p = 0.041). No differences existed concerning hospitalization for heart failure within 30 days after alert transmission (3.9% vs 3.4%; p = 0.636). Conclusion Alert transmissions during weekends and public holidays were less likely associated with timely patient contacts and initiation of pharmacological interventions than during the week. Telemedical centres providing 24/7 remote monitoring service and specific education programmes for physicians might help to optimize patient care.

Effect of COVID-19 lockdown on bovine economy in Uttar Pradesh

A study was conducted among 570 farmers spread across 57 districts (out of 75) of Uttar Pradesh from 10 April to 10 May 2020 by telephonic contact using the pre-structured interview schedule to assess the impact of CoVID 19 lockdown on the investment and profitability of major bovines of the state namely cattle and buffalo each with 460 data points. Different indicators for research variables namely investment pattern and profitability were measured by asking direct questions to the randomly selected 10 farmers from each district during the lockdown period and their experiences during last year (2019). The collected data were subjected for descriptive analysis - average, percentage, rank, standard deviation (SD) and coefficient of variation (CV), and also to the paired t-test to see the significance of difference, if any. Findings of the study showed that all the investments indicators like feed and fodder price, treatment cost, animal handling charges and total cost of milk production of cattle and buffalo enhanced significantly during the lockdown. The magnitude varied as per the nature of the cost components. The price variation was observed across the sample respondents and district. Similarly, for profitability indicators, there was reduction in the magnitude of milk sale (13-15%), selling price of milk (4-5%) and B:C ratio (5.2 -7.3%) significantly owing to lockdown. The perceptions of KVK experts from across the selected districts were also analyzed. During this period, KVKs of the state also disseminated various advisories, instructions, crop and enterprise-specific recommendations.

Feasibility of remote home monitoring with a T-shirt wearable device in post-recovery COVID-19 patients.

Feasibility of remote home monitoring with a T-shirt wearable device in post-recovery COVID-19 patients.

Transcorporal septal dissection using the balloon technique in complete uterine septums, pre- and postoperative results. A follow up from 2007 to 2020

ObjectiveThe aim of the study is to show the pre- and postoperative results of transcorporal septal dissection using the balloon technique in complete uterine septums, which is a rare pathology. Study designIt is a retrospective analysis. In this study 21 patients with a complete uterine septum were included. All patient underwent the transcorporal septal dissection using the balloon technique. Data analysis was based on patient history, surgical reports and telephone contact with the patients and supervising gynecologists. Results73% patients with a current desire to become pregnant managed to do so and 75% of them were able to give birth on time. One patient was pregnant at the time of the analysis. In 17 patients the results of the control hysteroscopy were available. In eight patients (47%) a normal cavity was found. In nine cases (53%) a residual septum of 1–2 cm was found, so that an operative hysteroscopy with a residual septum dissection was performed. The operative time was average 30.6 min in the group without laparoscopy and 56.8 min in the group with laparoscopy. ConclusionThe transcorporal septum dissection using the balloon technique is a safe method with a good fertility outcome and requires an experienced surgeon.

Immunosuppressive adherence after kidney transplantation in adult patients treated at an outpatient clinic: a better practice implementation project.

To evaluate the compliance of the practice with the evidence-based criteria in relation to interventions developed to improve the immunosuppressive adherence of adults in postkidney transplantation. A best practice implementation project, based on the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in health practice, was conducted. A baseline and a follow-up audit were conducted in a kidney transplant clinic, including a sample of kidney transplant patients with a maximum of 30 days postoperatively, and health professionals working in the post-transplant period. The basic audit revealed that the parameters related to the professionals' knowledge did not reach adequate compliance; the involvement of patients in strategies to overcome barriers that interfere with nonadherence; guidelines for specific therapeutic regimens for patients and the prescription of immunosuppressants according to the patient's routine. To solve the identified weaknesses, training strategies were implemented with the professionals, follow-up by telephone contact with the patients and the elaboration and distribution of an educational booklet with guidance on the use of immunosuppressants, leading to an increase from 50 to 87.5% of conformity in the evaluated service. The evidence implementation project provided improvements in clinical practice behaviors. It demonstrated that there are strategies that facilitate the implementation of evidence regarding the promotion of interventions to improve immunosuppressive adherence. Additional audits are still needed to improve and assess the quality of interventions promoted by professionals regarding drug adherence in the post-transplant period, as well as to verify the behavior of patients, ensuring that the project will be maintained and supported.

P-97 COLOMBIAN EXPERIENCE IN THE MANAGEMENT OF PATIENTS WITH SARS-CoV-2 INFECTION AND LIVER TRANSPLANTATION

IntroductionMany authors have highlighted the management and outcomes of liver transplant patients with SARS -CoV2, however, there is a reduced experience identified with Hispanic or Latino patients [1]. We would like to share our experience with liver transplantation and SARS-CoV-2 infection (Real-time PCR identification) during 2020.ObjectivesDescribe the main infectious complications identified in patients with SARS-CoV2 and liver transplantation.Identify mortality rate among this group of patients and answer to therapies provided during their stay at the Hospital.Compare the mortality rate with other studies without Latin patients or with a reduced presence of them.MethodsThis is an observational descriptive study carried out from May to August 2020Results14 Hispanic patients were admitted to our institution (mean age 64 years; range: 57-76). Nine patients required hospitalization, and four patients were admitted to the intensive care unit (ICU). The most frequent risk factors were a history of arterial hypertension (n=8) and chronic kidney disease (n=6). The immunosuppression of these patients was based on antimetabolites (n = 9), calcineurin (n = 8), prednisolone (n = 4) and everolimus (n = 3). The onset of symptoms was six days approximately.All ICU patients receiving mechanical ventilation and renal replacement therapy for stage 3 acute renal failures. However, bacteremia caused by E. Coli, Citrobacter spp., and Staphylococcus aureus was present in three patients, an outcome that was not identified in the study population. The mortality rate was 28.5%. The mortality rate was higher than Webb et al 1 (18%) and other studies where rates were reported from 12% to 18%, and where the white population was predominant.The therapy provided in our institution was focused on tapering the immunosuppressive therapy attached with the use of dexamethasone. This treatment was given to six patients [4].ConclusionOur rate of mortality was higher compared with other similar studies. However, further future studies should include outcomes in the Hispanic population due to the social factors in addition to genetic factors that could be involved in higher mortality in ICU. Also, taking into account the increase in the number of cases, the follow-up of patients with liver diseases by telephone contact with transplant centers should be considered.Uncited references[2,3,5]

Influence of SARS-CoV-2 Virus Infection on the Course of Psoriasis during Treatment with Biological Drugs.

Background and objectives: Biological treatment is an important and effective therapy for psoriasis. During the COVID-19 pandemic, it remains unclear whether this type of therapy affects the course of SARS-CoV-2 infection. The aim of the study was to observe patients with psoriasis undergoing biological or other systemic treatment in relation to the impact of SARS-CoV-2 infection on the course of psoriasis and the COVID-19 disease itself. Materials and methods: A one-year observational study included 57 patients with diagnosed psoriasis who qualified for biological treatment and a group of 68 similar patients who were administered a different systemic treatment. Patients were analyzed monthly for psoriasis (including Psoriasis Area Severity Index (PASI) assessment) and constantly for SARS-CoV-2 infection (telephone contact). Cases of COVID-19 were confirmed by Polymerase Chain Reaction (PCR) at the study center. Results: SARS-CoV-2 infection was confirmed by a positive Real Time Polymerase Chain Reaction (RT-PCR) test in eight patients (14.0%) with psoriasis on biological therapy. None of the cases in this group required hospitalization for COVID-19. Similar data were obtained in the control group. Specifically, 11 (16%) patients were confirmed to be infected with SARS-CoV-2. These results were statistically comparable (p > 0.05). In the group of patients undergoing biological treatment, six (75%) of eight patients developed an exacerbation of psoriasis during SARS-CoV-2 infection, and similar results were noted in the control group, with eight (72%) patients experiencing an exacerbation of psoriasis. Conclusions: Patients with psoriasis who were administered biological treatment or other systemic therapy may experience a mild course of SARS-CoV-2 infection but might also experience a temporary exacerbation of skin lesions.

A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study.

BackgroundAccording to the United Nations, it is estimated that by 2050, the number of people aged 80 years and older will have increased by 3 times. Increased longevity is often accompanied by structural and functional changes that occur throughout an individual’s lifespan. These changes are often aggravated by chronic comorbidities, adopted behaviors or lifestyles, and environmental exposure, among other factors. Some of the related outcomes are loss of muscle strength, decreased balance control, and mobility impairments, which are strongly associated with the occurrence of falls in the elderly. Despite the continued undervaluation of the importance of knowledge on fall prevention among the elderly population by primary care health professionals, several evidence-based (single or multifaceted) fall prevention programs such as the Otago Exercise Program (OEP) have demonstrated a significant reduction in the risk of falls and fall-related injuries in the elderly within community settings. Recent studies have strived to integrate technology into physical exercise programs, which is effective for adherence and overcoming barriers to exercise, as well as improving physical functioning.ObjectiveThis study aims to assess the impact of the OEP on the functionality of home-dwelling elderly using a common technological platform. Particularly, the impact on muscle strength, balance, mobility, risk of falling, the perception of fear of falling, and the perception of the elderly regarding the ease of use of technology are being examined in this study.MethodsA quasi-experimental study (before and after; single group) will be conducted with male and female participants aged 65 years or older living at home in the district of Porto. Participants will be recruited through the network COLABORAR, with a minimum of 30 participants meeting the study inclusion and exclusion criteria. All participants will sign informed consent forms. The data collection instrument consists of sociodemographic and clinical variables (self-reported), functional evaluation variables, and environmental risk variables. The data collection tool integrates primary and secondary outcome variables. The primary outcome is gait (timed-up and go test; normal step). The secondary outcome variables are lower limb strength and muscle resistance (30-second chair stand test), balance (4-stage balance test), frequency of falls, functional capacity (Lawton and Brody - Portuguese version), fear of falling (Falls Efficacy Scale International - Portuguese version), usability of the technology (System Usability Scale - Portuguese version), and environmental risk variables (home fall prevention checklist for older adults). Technological solutions, such as the FallSensing Home application and Kallisto wearable device, will be used, which will allow the detection and prevention of falls. The intervention is characterized by conducting the OEP through a common technological platform 3 times a week for 8 weeks. Throughout these weeks, the participants will be followed up in person or by telephone contact by the rehabilitation nurse. Considering the COVID-19 outbreak, all guidelines from the National Health Service will be followed. The project was funded by InnoStars, in collaboration with the Local EIT Health Regional Innovation Scheme Hub of the University of Porto.ResultsThis study was approved on October 9, 2020 by the Ethics Committee of Escola Superior de Enfermagem do Porto (ESEP). The recruitment process was meant to start in October, but due to the COVID-19 pandemic, it was suspended. We expect to restart the study by the beginning of the third quarter of 2021.ConclusionsThe findings of this study protocol will contribute to the design and development of future robust studies for technological tests in a clinical context.Trial RegistrationISRCTN 15895163; https://www.isrctn.com/ISRCTN15895163International Registered Report Identifier (IRRID)PRR1-10.2196/25781

Long-term outcome of female dogs treated for intramural ectopic ureters with cystoscopic-guided laser ablation.

To report the complications and long-term outcome of female dogs with intramural ectopic ureter(s) (iEU) undergoing cystoscopic-guided laser ablation (CLA) and determine the effect of post-CLA neutering on urinary continence. Retrospective clinical study. Thirty-four client-owned dogs. Medical records of female dogs that had iEU-CLA were reviewed. A 10-point continence score was assigned before, immediately after, and at a minimum of 12 months postprocedure via owner telephone contact. Neutering status prior to and postprocedure was recorded. Continence scores increased in all dogs after CLA (p < .0001, mean duration of follow-up: 63.9 ± 5.7months) with an increase of the median score from 2 (preprocedure) to 10 (postprocedure). A urethral tear occurred in 2/34 dogs immediately after the procedure, successfully managed conservatively. Mild hematuria was present in 2/34, lasting less than 48 h. Postoperative urinary tract infections were documented in 6/34 dogs. Two dogs died of urinary-related issues at 1 and 5 months after CLA. Complete and near-complete urinary continence (scores 9 and 10/10) was achieved in 26/32 dogs including 3 dogs requiring medical (2) or surgical interventions (1). Post-CLA neutering did not affect continence scores (p=.44). A large proportion of dogs regained and maintained full continence after CLA alone. Subsequent medical or surgical therapy allowed further improvements when needed. Post-CLA neutering did not negatively impact urinary continence score. The beneficial effect of iEU-CLA in female dogs is long standing and not affected by postprocedural neutering.

Does motivational interviewing reduce health services use and mortality in heart failure patients? A secondary analysis of the MOTIVATE-HF trial

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Center of Excellence for Nursing Scholarship, Rome, Italy Background. Health services use and mortality are high among patients with heart failure (HF). The MOTIVATE-HF was a randomized controlled trial in which we demonstrated that Motivational Interviewing (MI) can effectively improve HF patient self-care (primary outcome). However, it is still unclear if MI can reduce health services use and mortality. Purpose. To test the efficacy of MI in reducing health services use (emergency services and hospitalizations), and all-cause mortality in HF patients. Methods. The MOTIVATE-HF was a multicenter parallel trial (1:1:1) with randomization of patient and informal caregiver dyads across three arms: Arm 1, MI administered to patients; Arm 2, MI administered to patients and caregivers; Arm 3, standard of care. Participants were enrolled from three Italian HF specialty centers. Patients were included only if they had HF in NYHA functional class II-IV and excluded if they had a recent coronary event, lived in a residential setting, or had severe cognitive impairment. Informal caregivers were nominated by the patients as the person mainly responsible for their care. The intervention consisted of one face-to-face MI session followed by 3 telephone contacts within 2 months from enrollment. Follow-up and reassessment occurred after 3-, 6-, 9- and 12-months post-randomization. A longitudinal generalized mixed model and a Cox proportional-hazard model were fitted to compare rates of health care services use and mortality among the three study arms during follow-ups. Results. The sample of 510 HF patients (median age 74 years; IQR 65-82; 58% male) was distributed as follows: Arm 1, n = 155; Arm 2, n = 177; and Arm 3, n = 178. Within the 12 months" period, 25 patients (16.1%) in Arm 1, 30 patients (17%) in Arm 2, and 20 patients (11.2%) in Arm 3 used health services at least once (p = 0.25) without significant differences at any follow up. Regarding all-cause mortality, at 3 months, 3 patients (1.9%) in Arm 1, 1 patient (0.6%) in Arm 2, and 9 patients (5.1%) in Arm 3 had died (p = 0.02). At 6 months, 5 patients (3.2%) in Arm 1, 1 patient (1.7%) in Arm 2 and 12 patients (6.7%) in Arm 3 had died (p = 0.05). No significant group differences were observed at 9 or 12 months. Mortality was lower in Arm 2 compared to Arm 3 in the first 3 months (HR = 0.112, 95% CI: 0.014–0.882, p = 0.038), whereas no difference was detected in the following months (p = 0.699). Mortality was also lower in Arm 1 compared to Arm 3 in the first 3 months, but this reduction did not reach statistical significance (HR = 0.383, 95% CI:0.104–1.414, p = 0.155). Conclusions. This analysis indicates that MI was not effective in reducing health services use in our sample, but it was effective in reducing all-cause mortality, at least in the short-term period. MI could be an inexpensive intervention to reduce HF mortality but further studies are needed to see if more frequent MI interventions could produce greater sustained reduction in health services use and mortality.