Urban Clinic Setting Research Articles

Developing a Maternal Identity: Theoretical, Developmental and Clinical Considerations

This paper considers maternal subjectivity and maternal identity development through our work in an urban clinical setting where women present for treatment during the perinatal period. Drawing on a rich tradition of psychoanalytic observational research and mother-infant communication research, which supported the relational turn, we aim to shift the lens from mothers as important to their baby’s development, to maternal experiences as essential. Likewise, noting that a mother cannot exist without a baby, real or imagined, we consider the role of a baby in a mother’s own development. Tracing roots of maternal subjectivity in psychoanalytic traditions, while also noting its absence, we hope to offer ways to formulate maternal identity that are clinically useful and grounded in research, and reflective of our contemporary positions. Case examples further illustrate the utility of narrative measures, including the Adult Attachment Interview, in clinical settings.

A Scoping Review of Nurse-Led Medical-Surgical Knowledge Translation Interventions to Improve In-Hospital Clinical Practice in the WHO Afro Region

The process of placing research knowledge into action and thereby ensuring its dissemination is very important in healthcare currently. Although nurse-led knowledge translation interventions have become an important focus in the high-income countries, the extent of such interventions in the World Health Organization (WHO) Afro Region is not well established. This scoping review aimed to map the evidence of nurse-led knowledge translation interventions in the countries in the WHO Afro Region using the Joanna Briggs Institute (JBI) Scoping Review Methodology. A systematic electronic search of articles was carried out in selected electronic data bases using various search engines. All 688 eligible identified articles were imported into the Systematic Reviews Web App (Beta) Rayyan. The selection process included title and abstract screening, and full text article screening. A Prisma flow diagram detailing the procedure was developed. The review process resulted in 21 selected articles. The results showed minimal publications between 2013 and 2019 with a sudden increase in 2020 (n = 5) and 2021 (n = 4). The Eastern WHO Afro Region contributed 48% of the studies, followed by the Western WHO Afro Region with 43%. Ten countries were selected through the process of screening according to where nurse-led medical-surgical knowledge translation interventions were found. Nigeria contributed 33%, followed by Uganda with 19%. The scoping review concluded that studies be appraised for their ability to promote evidence-based knowledge, skills and behaviour in both rural and urban clinical settings. More of these studies need to be conducted in the WHO Afro Region. More focused systematic reviews should be conducted to sum up the best available research on these specific questions, supported by findings by clinical setting, type of intervention, and outcomes.

Telemedicine visits requiring follow-up in-person visits at an urban academic family medicine centre.

With the onset of the COVID-19 pandemic, telemedicine was rapidly implemented in care settings globally. To understand what factors affect the successful completion of telemedicine visits in our urban, academic family medicine clinic setting, we analysed telemedicine visits carried out during the pandemic. We conducted a retrospective chart review of telemedicine visits from 2 clinical units within a family medicine centre. To investigate the association between incomplete visits and various factors (age, gender, presenting complaints, physician level of training [resident or staff] and patient-physician relational continuity), we performed a multivariable logistic regression on data from August 2020, February 2021, and May 2021. An incomplete visit is one that requires a follow-up in-person visit with a physician within 3 days. Of the 2,138 telemedicine patient visits we investigated, 9.6% were incomplete. Patients presenting with lumps and bumps (OR: 3.84, 95% CI: 1.44, 10.5), as well as those seen by resident physicians (OR: 1.77, 95% CI: 1.22, 2.56) had increased odds of incomplete visits. Telemedicine visits at the family medicine clinic (Site A) with registered patients had lower odds of incomplete visits (OR: 0.24, 95% CI: 0.15, 0.39) than those at the community clinic (Site B), which provides urgent/episodic care with no associated relational continuity between patients and physicians. In our urban clinical setting, only a small minority of telemedicine visits required an in-person follow-up visit. This information may be useful in guiding approaches to triaging patients to telemedicine or standard in-person care.

Knowledge and Behavior of Primary Care Physicians Regarding Utilization of Standardized Tools in Screening and Assessment of Anxiety, Depression, and Mood Disorders at a Large Integrated Health System.

Standardized screening, objective evaluation, and management of behavioral health conditions are major challenges in primary care. The Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Mood Disorder Questionnaire (MDQ) provide standardized screening and symptom management tools for generalized anxiety disorder (GAD), major depressive disorder (MDD), and Mood Disorders (MD), respectively. This study explores family physicians' knowledge, attitudes, and practices regarding the utilization of GAD-7, PHQ-9, and MDQ in outpatient primary care offices. The study method was a cross-sectional electronic and paper survey utilizing a self-administered questionnaire that assessed primary care physicians' demographics, knowledge, attitudes, and practices in rural and urban outpatient clinical settings regarding GAD-7, PHQ-9, and MDQ. Statistical software SAS 9.4 was used for descriptive and Chi-Square statistics. Out of 320 total participants,145 responded (45.3%). Responding family physicians demonstrated a high level of familiarity with the GAD-7 (97.9%), PHQ-9 (97.9%), and MDQ (81.3%) assessment tools. However, the reported utilization rates were relatively lower than knowledge, with 62.7%, 73.1%, and 31.9% extremely likely or likely to utilize the GAD-7, PHQ-9, and MDQ as screening and monitoring tools, respectively. Less than a quarter of the total respondents use the objective score for the future management of GAD, with significantly more residents utilizing the score for GAD-7 compared to attendings (P < .05). There was no statistical significance difference between residents and attendings for the objective evaluation of Major Depressive Disorder (P = .26) and Mood Disorders (P = .05). Despite being knowledgeable of the utility of GAD-7, PHQ-9, and MDQ, the primary care physicians in a large integrated health system in Central Pennsylvania and Northern Maryland report inconsistent utilization in their practice. Further studies are needed to determine the underlying factors contributing to the suboptimal usage of these screening tools and ways to increase it.

Panton-Valentine Leukocidin-Positive CC398 MRSA in Urban Clinical Settings, the Netherlands.

We report detection of Panton-Valentine leukocidin-positive clonal complex 398 human-origin methicillin-resistant Staphylococcus aureus L2 in the Netherlands. This hypervirulent lineage originated in the Asia-Pacific Region and could become community-acquired in Europe after recurrent travel-related introductions. Genomic surveillance enables early detection to guide control measures and help limit pathogen spread in urban settings.

ROLE OF FAMILY MEDICINE IN CANCER PATIENT CARE: A REVIEW

According to one definition, Family Medicine is a specialty that provides the provision of ongoing, comprehensive medical treatment to patients within the setting of their families and communities. Acute and chronic care, identification of family and social needs, long-term support, epidemiologic awareness, and treatment of unexplained illness are all included in continuing whole-patient care. This review aimed to summarize the updated evidence considering the role of Family Medicine in the care and management of cancer patients. PubMed, Web of Science, Science Direct, EBSCO, SCOPUS, Wiley, and Cochrane Library were searched. Study articles were screened by title and abstract then a full-text assessment was implemented. Family Physician (FP) plays a crucial part in providing care for a patient with cancer. There have been many different roles for doctors identified, and these responsibilities differ greatly depending on whether the practice takes place in an urban or rural clinical setting. Alongside surgical, medical, and radiation oncology specialists, FPs commonly provide care for patients with breast and gastrointestinal cancer. They also work with gynecologic, hematologic, and paediatric cancer patient populations. The management of treatment-related physical and psychosocial side effects, the provision of follow-up care for cancer survivors, and palliative medicine are examples of typical tasks and responsibilities. In addition, the FP support clinical trials, research focused on genetics, and high-risk population cancers.

1266. Effects of Rapid Initiation of Antiretroviral Therapy in an Urban Clinic Setting

Abstract Background Rapid initiation of antiretroviral therapy (ART), i.e. within 72 hours of diagnosis, in people living with HIV (PLWH) has shown improved viral suppression, medication adherence, and retention in care, compared to deferral until initial labs have resulted. More real-world experience with rapid ART programs is needed, however, particularly among clinics in resource-limited settings that serve a complex and largely uninsured or underinsured population, such as the HIV clinic at SUNY Downstate Medical Center. In 2017, the clinic implemented rapid ART in select PLWH. Methods This was a single-center retrospective chart review of patients seen at our HIV clinic between January 2015 and June 2021. Patients were included if they were ART-naïve or off ART for &amp;gt; 3 months. Exclusion criteria included baseline undetectable viral load (VL) and perinatal HIV infection. Patients were assigned to standard or rapid start groups based on time from intake to initiation of ART. The primary outcome was proportion of patients with VL &amp;lt; 50 copies/mL at week 52. Secondary outcomes were proportion of patients with VL &amp;lt; 200 copies/mL, retention in care, and mean weight change from baseline, all at week 52; time from intake to ART; and time to viral suppression. Results As shown in Table 1, of the 190 patients that were included, 133 were rapid start while 77 were standard start. 103 patients had baseline resistance data; only 1 had integrase stand inhibitor resistance. Median time to ART was 0 days and 2.5 weeks in the rapid and standard groups, respectively. The most common initial regimen was BIC/FTC/TAF in both groups (49.6%, 31.2%). As described in Tables 2 and 3, 62.1% and 73.7% of patients had VL &amp;lt; 50 and &amp;lt; 200 copies/mL at week 52, respectively. Nearly 73% of patients remained in care at week 52, with similar rates between groups. Time from ART to viral suppression was similar between groups. Conclusion Rapid ART was well-tolerated but resulted in similar viral suppression and retention in care at week 52 compared to standard ART. However, rapid ART resulted in quicker viral suppression, although further evaluation of the clinical impact of this finding is needed. This study highlights the need for a multifaceted approach to engaging patients with HIV throughout the care continuum to ensure retention in care. Disclosures All Authors: No reported disclosures.

Smartphone Ownership and Interest in Mobile Health Technologies for Self-care Among Patients With Chronic Heart Failure: Cross-sectional Survey Study

BackgroundHeart failure (HF) is a highly prevalent chronic condition that places a substantial burden on patients, families, and health care systems worldwide. Recent advances in mobile health (mHealth) technologies offer great opportunities for supporting many aspects of HF self-care. There is a need to better understand patients’ adoption of and interest in using mHealth for self-monitoring and management of HF symptoms.ObjectiveThe purpose of this study is to assess smartphone ownership and patient attitudes toward using mHealth technologies for HF self-care in a predominantly minority population in an urban clinical setting.MethodsWe conducted a cross-sectional survey of adult outpatients (aged ≥18 years) at an academic outpatient HF clinic in the Midwest. The survey comprised 34 questions assessing patient demographics, ownership of smartphones and other mHealth devices, frequently used smartphone features, use of mHealth apps, and interest in using mHealth technologies for vital sign and HF symptom self-monitoring and management.ResultsA total of 144 patients were approached, of which 100 (69.4%) participated in the study (63/100, 63% women). The participants had a mean age of 61.3 (SD 12.25) years and were predominantly Black or African American (61/100, 61%) and Hispanic or Latino (18/100, 18%). Almost all participants (93/100, 93%) owned a cell phone. The share of patients who owned a smartphone was 68% (68/100). Racial and ethnic minorities that identified as Black or African American or Hispanic or Latino reported higher smartphone ownership rates compared with White patients with HF (45/61, 74% Black or African American and 11/18, 61% Hispanic or Latino vs 9/17, 53% White). There was a moderate and statistically significant association between smartphone ownership and age (Cramér V [ΦC]=0.35; P<.001), education (ΦC=0.29; P=.001), and employment status (ΦC=0.3; P=.01). The most common smartphone features used by the participants were SMS text messaging (51/68, 75%), internet browsing (43/68, 63%), and mobile apps (41/68, 60%). The use of mHealth apps and wearable activity trackers (eg, Fitbits) for self-monitoring of HF-related parameters was low (15/68, 22% and 15/100, 15%, respectively). The most popular HF-related self-care measures participants would like to monitor using mHealth technologies were physical activity (46/68, 68%), blood pressure (44/68, 65%), and medication use (40/68, 59%).ConclusionsMost patients with HF have smartphones and are interested in using commercial mHealth apps and connected health devices to self-monitor their condition. Thus, there is a great opportunity to capitalize on the high smartphone ownership among racial and ethnic minority patients to increase reach and enhance HF self-management through mHealth interventions.

Pathways to Psychiatry Care among Children with Mental Health Problems

Many children with mental health problems in Egypt, as in many other countries, do not receive the help they need. Investigating the pathways of care is crucial for the early detection and treatment of these children. This study examined referral patterns and the duration of untreated psychiatric illness of 350 children attending two urban clinical settings in Egypt. Diagnoses were made using the Kiddie Schedule for Affective Disorder and Schizophrenia for School-aged children present and lifetime (K-SADS-PL), Child behavior checklist (CBCL,) and the Stanford-Binet Intelligence Scale. For 46.3%, the most distressing symptom was behavioral problems. A delay in seeking psychiatric help was found. positive family history, and lower socioeconomic class were associated with delays in psychiatric consultation. For 39.7% of patients, the first contact was with a psychiatrist. Most children were referred by relatives. Awareness programs are needed to increase knowledge about and to decrease the duration of untreated illness.

Prognostic Indicators in Patients with Intracerebral Hematoma in an urban clinical setting of a resource limited Country

Context and Objective: Hemorrhagic Cerebrovascular Accidents represent 10 to 15% of all strokes and are often related to the spontaneous rupture of small vessels weakened by chronic arterial hypertension or amyloid angiopathy. The aim of this work was to study the prognostic determinants of intracerebral haematomas at the neurology department of Conakry University Hospital.&#x0D; Patients and Method: This was a retrospective analytical study conducted on all patients who were hospitalized with intracerebral hematoma over the 24-month period. Only the records of patients in whom intracerebral hematoma was confirmed by brain imaging were included in this study. Logistic regression (uni-variate and multi-variate) identified prognostic determinants of intracerebral hematoma at p &lt; 0.05. The data were entered using Epi Info software version 7.1.4.0 then analysed using STATA / SE software version 11.2.&#x0D; Results: This study found 21% of cases of intracerebral hematomas during the study period, with a male predominance of 60% and a sex ratio of 1.50. The study was conducted in the presence of a male patient. Hypertension was the cause found in 89.52% of patients; followed by arteriovenous malformations in 6.67% of patients, 2.86% of cases of amyloid angiopathy and 0.95% of unknown cause. Nevertheless, we still recorded 20% of deaths during hospitalization.&#x0D; Conclusion: Previous quality of life and co-morbidities also modify the prognosis and should be taken into account in the prediction of disability and future quality of life of patients with intracerebral haematoma.

Past-futures in experimental care: breast cancer and HIV medicine

Cambrosio et al. (2018. “Extending Experimentation: Oncology’s Fading Boundary Between Research and Care.” New Genetics and Society 37 (3): 207–226) argue that “experimental care” in contemporary oncology involves the rapid merging of patient research and care, and invite further study into developments across other health conditions. We present a 2018–2019 study of experimental breast cancer care in an urban clinical setting in the light of two other studies in the same hospital group: in the same cancer service (2013–14) and, prompted by these earlier findings, an interview study in HIV services (2014–15). We found that patients and staff anticipated better outcomes by treating sub-types of breast cancer but they also hoped for a better one-size-fits-all approach, akin to the antiretroviral treatments introduced for HIV and explored in our interview study. We conclude that the promise of targeted treatment for sub-types of disease – variously described as experimental care, personalised, precision, stratified and sub-group medicine – is accompanied by hopes for a single, standard, effective approach.

High HIV-1 Virological Failure and Drug Resistance among Adult Patients Receiving First-Line ART for At least 12 Months at a Decentralized Urban HIV Clinic Setting in Senegal before the Test-and-Treat.

Background:The feasibility of antiretroviral therapy (ART) monitoring remains problematic in decentralized HIV clinic settings of sub-Saharan Africa. We assessed the rates and correlates of HIV-1 virological failure (VF) and drug resistance (DR) in 2 pre-test-and-treat urban clinic settings of Senegal.Methods:Consenting HIV-1-infected adults (⩾18 years) receiving first-line ART for ⩾12 months were cross-sectionally enrolled between January and March 2015, at the referral outpatient treatment center of Dakar (n = 151) and decentralized regional hospital of Saint-Louis (n = 127). In the 12 months preceding plasma specimens’ collection patients at Saint-Louis had no viral load (VL) testing. Significant predictors of VF (VL ⩾ 1000 copies/ml) and DR (clinically relevant mutations) were determined using binomial logistic regression in R software.Results:Of the 278 adults on EFV-/NVP-based regimens, 32 (11.5% [95%CI: 8.0-15.9]) experienced VF. Failing and non-failing patients had comparable median time [interquartile] on ART (69.5 [23.0-89.5] vs 64.0 [34.0-99.0] months; P = .46, Mann–Whitney U-test). Of the 27 viraemic isolates successfully genotyped, 20 (74.1%) carried DR mutations; most frequent were M184VI (55.6%), K103N (37.1%), thymidine analog mutations (29.6%), Y181CY (22.2%). The pattern of mutations did not always correspond to the ongoing treatment. The adjusted odds of VF was significantly associated with the decentralized clinic site (P < .001) and CD4 < 350 cells/mm3 (P < .006). Strong correlates of DR also included Saint-Louis (P < .009), CD4 < 350 cells/mm3 (P <. 001), and nevirapine-based therapies (comparator: efavirenz-based therapies; P < .027). In stratification analyses by site, higher rate of VF at Saint-Louis (20.5% [95%CI: 13.8-28.5] vs 4.0% [95%CI: 1.5-8.5] in Dakar) was associated with nevirapine-based therapies (OR = 3.34 [1.07-11.75], P = .038), self-reported missing doses (OR = 3.30 [1.13-10.24], P = .029), and medical appointments (OR = 2.91 [1.05-8.47], P = .039) in the last 1 and 12 months(s), respectively. The higher rate of DR at Saint-Louis (12.9% [95%CI: 7.6-20.1] vs 2.7% [95%CI: 0.7-6.7] in Dakar) was associated with nevirapine-based therapies (OR = 5.13 [1.12-37.35], P = .035).Conclusion:At decentralized urban settings, there is need for enhanced virological monitoring and adherence support. HIV programs in Senegal should intensify early HIV diagnosis for effective test-and-treat. These interventions, in addition to the superiority of efavirenz-based therapies provide a favorable framework for transitioning to the recommended potent drug dolutegravir, thereby ensuring its long-term use.

Sociodemographic determinants in Alzheimer’s disease - A retrospective study

Introduction: Alzheimer’s disease (AD) is a common cognitive function disorder commonly reported in old ages. Our aim was to understand the sociodemographic factors associated with AD. Material and Methods:In a retrospective study, we screened database at our private memory clinic to include the adult patients > 45 years of age who were screened with Montreal Cognitive Assessment (MoCA) test for AD. MoCA score of diagnosis of AD. Results:In 2412 patients included in analysis, 91.9% patients were diagnosed with AD. Overall mean age of the participants was 53.5±6.8 years and 63.2% were males. Among sociodemographic factors, compared to patients without AD, those with AD were younger (p=0.006), females (plesser occurrence of AD (p=0.001). No difference by dietary pattern was evident (p=0.976). Conclusion:In an urban memory clinic setting, AD is observed in young and female patients who have lower level of education and are involved in unskilled occupation. Greater number of family members also predisposes to AD. These findings need further confirmation in a prospective and long duration follow up. Keywords:Alzheimer’s disease, Sociodemographic, Cognitive dysfunction, India, Memory.

Infertility knowledge and treatment beliefs among African American women in an urban community

BackgroundTo assess infertility knowledge and treatment beliefs among African American women in an urban community in Atlanta, Georgia.MethodsThis was a cross sectional study at a safety net hospital. A convenience sample of a total of 158 women receiving outpatient obstetrical or gynecologic care from March–April 2017 were recruited. Infertility knowledge and treatment beliefs were assessed using a previously applied and field-tested survey from the International Fertility Decision Making Study.ResultsThe mean infertility knowledge score was 38.15% for total subjects. Those with a higher level of education (p < 0.0001) and those with paid employment (p = 0.01) had a significantly higher level of infertility knowledge. Those who had a history of infertility therapy were significantly more likely to agree with negative treatment beliefs (p = 0.01). There was no significant difference in infertility knowledge or treatment beliefs based on age, sexuality, parity or being pregnant at the time of survey completion.ConclusionsAfrican American women in our urban clinic setting seem to have a limited level of knowledge pertaining to infertility. Further research is needed to understand how differences in knowledge and beliefs translate into infertility care decision-making and future childbearing.

225-LB: Demographic and Clinical Comparisons of South Asians with Type 2 Diabetes vs. Caucasians and African Americans in an Urban Clinical Setting

Background: The incidence of type 2 diabetes (T2D) is rising worldwide. South Asians are at higher risk, nearly 2-4 times greater than white Europeans, and tend to develop T2D at an earlier age and lower BMI. Prior studies have shown a potential advantage of incretin-based therapies in South Asians. The purpose of this study is to compare baseline characteristics of South Asians with T2D with those of other ethnic groups and to determine whether South Asians have a better glycemic response to incretin-based therapies in an urban United States diabetes center. Methods: Retrospective chart review of patients with T2D at the University of Maryland Center for Diabetes and Endocrinology from 2010-16 was performed. Adult patients (ages 18-85) with T2DM were included. A total of 43 South Asians (India, Bangladesh, Pakistan, Sri Lanka) and 182 non-South Asians (further subclassified into black or Non-Hispanic white) were enrolled. Data on age of T2DM diagnosis, family history, BMI, diabetic medications, exercise, blood pressure, and presence of micro- or macrovascular complications were collected. Baseline characteristics were compared and tested for statistical significance by Chi-square test and student t-tests. Results: South Asians were diagnosed with T2D at a lower BMI (29 vs. 34; p&amp;lt;0.0001) compared to their non-south Asian counterparts. In the South Asian group, there was a trend towards lower age at diagnosis, higher incidence of CAD and nephropathy compared to non- South Asians. No differences in hemoglobin A1c between South Asians vs. non-South Asians were noted at 3-month follow-up after initiation of incretin-based therapy. Conclusion: South Asians are more likely to have T2D at a lower BMI than black or Non-Hispanic white patients in an urban United States setting. No significant difference in T2DM complications was noted among ethnic groups, and incretin-based therapies did not have a significant effect on in South Asians vs. non-South Asians. Disclosure A. Ahmed: None. W. Rahman: None. K.M. Munir: None.

Barriers to treatment of chronic hepatitis C with direct acting antivirals in an urban clinic

Introduction and aimDirect-acting antiviral (DAA) agents are highly effective for treatment of chronic hepatitis C virus (HCV) yet access to treatment remains a serious challenge. The aim of this study was to identify barriers to treatment initiation with DAA-containing regimens in an urban clinic setting. Materials and methodsA retrospective cohort of all chronic HCV patients seen in an urban academic practice in Jacksonville, FL, USA from 1/2014 to 1/2017 was analyzed. Baseline characteristics were recorded and a review of medical records was performed to identify barriers to treatment initiation and overall success rates. ResultsTwo-hundred and forty patients with chronic HCV were analyzed. Fifty-six percent of patients were African-American and 63% were insured through Medicaid/county programs or uninsured. Sixty-nine percent had barriers to initiating antiviral therapy categorized as psychosocial (n=112), provider (n=26), medical (n=20), and insurance-related factors (n=7). The most commonly encountered psychosocial barriers included failure to keep appointments (79/240, 33%), active substance abuse (18/240, 8%), and failure to obtain laboratory testing (11/240, 5%). Overall, only 27% of patients evaluated were initiated on DAA-containing regimens with 18% reaching SVR12 within the 36-month study period. ConclusionIn conclusion, only 27% of patients who presented to an urban academic practice with chronic HCV received DAA-containing regimens over a 36-month period. Psychosocial issues were the major barriers to antiviral therapy. These findings illustrate the need for an integrated approach that addresses psychosocial factors as well as comorbidities and adherence to care in order to increase rates of HCV treatment in at risk patients.

Severe Rheumatic Heart Disease in an Urban Adult Patient Population

Aim: To identify the ethnicity and age of patient groups with severe Rheumatic Heart Disease (RHD) presenting to an urban public adult hospital or clinic setting in South East Queensland (MetroSouth) and whether valvular interventions (valve replacement, repair or valvotomy) have been performed. Method: Patients with severe RHD were identified by retrospectively searching the hospital Echocardiography data management system from the period 2007–2018. RHD severity was based on cardiologist interpretation. Patients were grouped according to Indigenous status and country of birth. Results: A total 538 patients with RHD were identified, 43% (n = 229) had severe valvular disease. In the Indigenous Australian group, 38% (n = 21) of patients had severe RHD (mean age 49 yrs) and 43% of these patients had undergone valvular interventions. Forty one percent (n = 87) of Australian-born Non-Indigenous patients had severe RHD (mean age 66 yrs) and 76% had received valvular interventions. In the New Zealand and Pacific Islander group, 51% (n = 52) of RHD patients had severe disease (mean age 49yrs) and 79% had undergone valvular procedures. In contrast, the Asian born group had severe RHD in 34% (n = 23) of cases (mean age 52 yrs) and 83% had undergone interventions. Conclusion: Severe RHD was identified in all ethnic groups at similar rates. All ethnic groups had high rates of valvular interventions except the Indigenous Australian group which has a lower rate. Our results may reflect the nature of healthcare services provided and migration patterns.

Rheumatic Heart Disease in an Urban Adult Patient Population - Overseas Migrants the Largest Patient Group

Aim: Current registry data suggest a low prevalence of Rheumatic Heart Disease (RHD) in metropolitan South East Queensland (SE Qld). We aim to identify patients with RHD, as determined by echocardiography in an urban public adult hospital or clinic setting. Method: RHD patients were identified by retrospectively searching the MetroSouth health services (SE Qld) echocardiography data management system from the period 2007–2018 for the key word ‘rheumatic’. Patients were grouped according to Indigenous status and country of birth. Results: 538 patients with RHD were identified. RHD patients were more likely to be female (68% vs 32%). There were 55 (10%) Indigenous Australian patients with a mean age of 46 yrs (range 15–74). There were 211 (39%) Australian-born Non-Indigenous patients with a mean age of 65 yrs (range 15–92). There were 272 (51%) overseas-born RHD patients. The NZ and Pacific Islander patients group had 102 patients (19% total RHD patients) and mean age 52 yrs (range 18–85). Asian and European regions each comprised 13% (n = 68) and 12% (n = 65) of total patients, with Asian-born patients younger on average (mean 56 yrs) than European-born (mean 72 yrs). Conclusion: RHD in the SE Qld urban adult public healthcare setting is not an infrequent finding. The majority of RHD patients identified were overseas migrants with the largest group from New Zealand and the Pacific Islands. In regions with relatively high overseas migrant populations from the Pacific and Asian regions, rates of RHD may increase.

Effect of Immediate Loop Electrode Excisional Procedure for High-Grade Cervical Cytology in an Urban Academic Clinic Setting.

The aim of the study was to determine whether treating all patients older than 25 years with high-grade squamous intraepithelial lesion (HSIL) Paps with immediate loop electrode excisional procedure (LEEP) improves rates of receiving indicated treatment and evaluating whether this practice results in overtreatment (defined by excisional pathology less than cervical intraepithelial neoplasia 2). This was a retrospective cohort study at an urban, Medicaid-based clinic, which evaluated women older than 25 years with HSIL Pap results seen from June 2011 to December 2016. In June 2013, the clinic practice was restructured and management of HSIL Pap results in patients older than 25 years was standardized to immediate LEEP procedure, without intermediate colposcopic examination. Our primary outcome is the number of women who received LEEPs before and after this clinical practice change. The secondary outcome evaluated the number of women who received overtreatment. The χ test with a p value of 0.05 as significant was used to compare the results between groups. Twenty-three (82%) of the 28 women treated before clinical practice change received indicated treatment, with 19 receiving LEEPs. Twenty-four (96%) of the 25 women treated after the clinical practice change received indicated LEEPs (p = .11). Seven (37%) of the 19 women in the initial group had LEEP pathology results less than CIN 2, whereas only 4 (17%) of the 24 women in the immediate LEEP group had results less than CIN 2 (p = .13). Implementation of a standardized management of HSIL Pap with immediate LEEP did not statistically increase the amount of patients who received indicated LEEPs; however, implementation of this practice did not result in overtreatment.

Quality Improvement Project: Improving intake forms to make them more readable for patients in an urban clinic setting

Quality Improvement Project: Improving intake forms to make them more readable for patients in an urban clinic setting