Group Visits Research Articles

Effects of medical and nursing group rounds combined with emotional nursing on quality of life and emotion in patients with malignant lymphoma.

To investigate the effects of medical and nursing visits in the same group combined with emotional care on the quality of life and emotions of patients with malignant lymphoma. One hundred sixty cases of malignant lymphoma patients admitted to our hospital from March 2020 to July 2022 were selected as retrospective study subjects and divided into 80 cases each in the control group and the observation group according to the different nursing methods. Among them, the control group implemented conventional emotional care, and the observation group implemented medical and nursing visits in the same group on the basis of the control group. The differences in quality of life, anxiety-related scores and sleep quality between the 2 groups of patients with malignant lymphoma before and after nursing were compared. After nursing, the mental vitality (P = .015), social interaction (P < .001), emotional restriction (P = .007), and mental status (P = .028) scores of patients in the observation group were higher than those in the control group. After nursing, the Self-Rating Anxiety Scale (P < .001) and Hamilton Anxiety Scale (P < .001) of malignant lymphoma patients in the observation group were significantly lower than those in the control group, and the sleep quality (P < .001), increased awakening (P < .001), sleep disturbance (P < .001), night terrors (P < .001) scores in the observation group were significantly lower than those in the control group. The combination of medical and nursing group checkups and emotional care can effectively improve the quality of life and sleep of patients with malignant lymphoma and reduce adverse emotions, which is beneficial to patient prognosis and clinical treatment. It has certain reference value for the care of patients with malignant lymphoma.

THU600 Coronary Calcium Scores In Medical Group Versus Individualized Dietitian-led Visits Group In An Inner-city Setting

Abstract Disclosure: T.C. Friedman: None. P. Duran: None. M.J. Budoff: None. M. Shaheen: None. Obesity is highly prevalent in the U.S., particularly among ethnic minority groups. The purpose was using a randomized trial of 12-months to evaluate if coronary artery calcium (CAC) scores will decline in the medical arm compared to the dietitian-led arm and the control arm. Adult patients were recruited from LAC-DHS and randomized to medical group visit (n=58), dietitian individual visit (n=18) and control (n=50) groups. We measured the total CAC score and left anterior descending [LAD] scores using cardiac computed tomography to quantify CAC. We analyzed data for the change from baseline in the CAC scores between groups using the Kruskal Wallis test. We categorized the total CAC scores into 0-100 (no/mild risk); 101-400 (moderate risk); and &amp;gt; 400 (severe risk) and the LAD score into 0-99 (no/mild risk); 100-300 (moderate risk); and &amp;gt;300 (severe risk) and compared the groups using chi square or fisher exact test. P-value &amp;lt;0.05 was statistically significant. No statistical difference was found between the study groups in the change of the total CAC score. The mean, median and IQR of the change in total CAC score were -26.4, 0.0,3.0 in the dietitian group; 21.6, 0.0, 10.0 in the medical group; 44.6, 3.0, 23.0 in the control group (p=0.10). At baseline and post-intervention, no significant differences were found between the study groups in the total CAC risk (p=0.22). The mean, median and inter-quartile range (IQR) of the change in LAD score were -23.6, 0.0, 2.0 in the dietitian group; 4.7, 0.0, 2.0 in the medical group; 12.5, 1.0, 9.8 in the control group (p=0.036). Significant improvements were found between the dietitian group and control group (p=0.039) and the medical group and control group (p=0.027). For LAD risk groups at baseline, 10%, 11.1% and 10.3% of the control, dietitian, and medical groups, respectively, had moderate risk; and 10.0%, 5.6%, and 1.7%, respectively, had severe risk (p=0.069). Post intervention, there was a reduction in the percent with moderate risk in the dietitian (-5.5%) and the medical (-1.7%) groups relative to control group (2.0%). For the severe risk, there was a reduction of 5.6% in the dietitian group, with no change in the medical group relative to 2% increase in the control group (p=0.013). Our study showed significant improvement in the LAD score and its risk groups in the dietitian group relative to the control and medical groups indicating that the dietitian intervention was able to attenuate the progression of atherosclerosis. The implications of our study is that lifestyle obesity interventions have the potential to reduce cardiovascular disease. Presentation: Thursday, June 15, 2023

Integrative medical group visits for patients with chronic pain: results of a pilot single-site hybrid implementation-effectiveness feasibility study.

Approximately 20% of adults in the United States experience chronic pain. Integrative Medical Group Visit (IMGV) offers an innovative approach to chronic pain management through training in mindfulness, nutrition, and other mind-body techniques combined with peer support. To date, there are no studies on IMGV implementation, despite its promise as a feasible non-pharmacological intervention for chronic pain management. In this study, we assessed the feasibility of implementing IMGV and assessing its effectiveness for chronic pain. Implementation Mapping was used to develop and evaluate implementation strategies for IMGV. Strategies included disseminating educational materials, conducting ongoing training, and conducting educational meetings. IMGV was delivered by three healthcare providers: an allopathic physician, registered yoga teacher, and naturopathic physician. The effectiveness of IMGV on patient health outcomes was assessed through qualitative interviews and a Patient-Reported Outcomes Scale (PROMIS-29). Provider perspectives of acceptability, appropriateness, and feasibility were assessed through periodic reflections (group interviews reflecting on the process of implementation) and field notes. Paired t-tests were used to assess changes between scores at baseline and post intervention. Qualitative data were coded by three experienced qualitative researchers using thematic content analysis. Of the initial 16 patients enrolled in research, 12 completed at least two sessions of the IMGV. Other than fatigue, there was no statistically significant difference between the pre- and post-scores. Patients reported high satisfaction with IMGV, noting the development of new skills for self-care and the supportive community of peers. Themes from patient interviews and periodic reflections included the feasibility of virtual delivery, patient perspectives on acceptability, provider perspectives of feasibility and acceptability, ease of recruitment, complexity of referral and scheduling process, balancing medical check-in with group engagement, and nursing staff availability. IMGV was feasible, acceptable, and effective from the perspectives of patients and providers. Although statistically significant differences were not observed for most PROMIS measures, qualitative results suggested that participants experienced increased social support and increased pain coping skills. Providers found implementation strategies effective, except for engaging nurses, due to staff being overwhelmed from the pandemic. Lessons learned from this pilot study can inform future research on implementation of IMGV.

Relationship Between Ante Natal Care As A Health Education Approach And Incidence Of Hypertension (Gestational Hypertension) Among Pregnant Women

This study aims to determine the relationship between antenatal care (ANC) education approach and the incidence of hypertension in pregnant women. This study used a descriptive method to understand the relationship between the ante natal care as a health education approach and the incidence of hypertension in pregnant women. Samples were randomly taken on pregnant women who visited Antenatal Care in Leuwiliang district with a correlation formula as a minimal calculation. Eighty-seven subjects were included, and blood pressure measurements were carried out following the SOP for blood pressure measurement with description analysis and analysis of the relationship between hypertension events with ANC visits and gestational age. The highest variable of antenatal care visits in incomplete visits was 66 pregnant women (66.0%). Pregnant women who have the most hypertension status were 55 pregnant women (55.0%). The most hypertension in the group was not at risk as much as 46%. The highest percentage were mothers whose antenatal care visits were incomplete and hypertension was 44%. The lowest percentage is mothers with complete antenatal care visits and normal hypertension which was 8%. There was an incidence of hypertension in the non-risk group and ANC visits and showed the presence of hypertension in the incomplete ANC visit group. Thus, educational approaches and efforts to increase awareness of pregnant women in ANC need to be improved

Treatment strategy for BVO-ME based on long-term outcomes correlating retinal structure by OCT image and visual acuity

BackgroundIntravitreal anti-vascular endothelial growth factor (VEGF) is a mainstream treatment for reducing ME secondary to BRVO (BVO-ME). Regrettably, most reports of intravitreal anti-VEGF for BVO-ME have disclosed only short-term outcomes. Here, we characterized long-term indicators for the visual prognosis of patients with BVO-ME, including the correlation between retinal structure by OCT and visual acuity.MethodsPatients with BVO-ME were retrospectively recruited based on clinical records in Kansai Medical University Hospital from June 2012 to March 2022. This study enrolled patients with vision loss who received intravitreal injection of anti-VEGF for BVO-ME. Inclusion criteria were that patients received intravitreal injection of anti-VEGF as their first treatment and were followed for at least 36 months. Exclusion criteria were those patients with ocular disease other than BRVO or who had been previously treated for BVO-ME. Patients were divided into two groups according to BCVA at the final visit: Group A (≥ 0.7) and Group B (< 0.7).ResultsForty-seven eyes from 45 patients were assessed. The mean follow-up period from initial to final visit was 64.38 ± 15.07 (range, 38–100) months. BCVA in Group A (n = 32) was significantly greater than in Group B (n = 15) at all timepoints. The ratio that the number of eyes which the EZ band and the foveal bulge were intact in Group A was higher than in Group B (p = 0.0004 and p = 0.0002, respectively). The ratio that the number of eyes which recurrence SRD was observed by the final visit in Group A was lower than in Group B (p = 0.0485).ConclusionsThe integrity of the EZ band and an intact foveal bulge were significant predictors for visual acuity. In contrast, recurrent SRD led to poor visual acuity in the long term, even if BCVA was good in the short term.

A prospective intervention study to identify drug-related emergency department visits comparing a standard care group and a pharmaceutical care group.

Adverse drug reactions impose a major burden. Those adverse drug reactions might lead to hospitalization but are often not correctly identified in the emergency department (ED). Clinical pharmacists, although not routinely implemented, can help identify adverse drug reactions. The primary objective was to examine the drug association of ED visits in a pharmaceutical group with a clinical pharmacist integrated in the ED team compared with a standard group without additional support. This prospective intervention study was performed in the ED of a tertiary care university hospital in Leipzig, Germany. Patients who were ≥50 years old were included. From 1 March 2020 to May 31, 2020 patients were enrolled in the standard group. From 1 March 2021 to 31 May 2021, the pharmaceutical group was enrolled. The clinical pharmacist supported the ED team with patient´s detailed medication history and medication analysis. In both groups, patients were evaluated whether their ED visit was drug-related. The number of identified drug-related ED presentations were compared between the two groups. Interventions performed on adverse drug reaction management, causative drugs and patient characteristics were evaluated. A total of 798 patients were enrolled in the standard group and 827 patients in the pharmaceutical group. Patients whose ED visit was drug-related had a median age of 77 years [(Q25-Q75) 63.5-83.5] and took 7 [(Q25-Q75) 5-8] drugs in standard group. In the pharmaceutical group median age was 78 years [(Q25-Q75) 66-83] and number of drugs taken was 9 [(Q25-Q75) 5.25-11]. 31 (3.9%) drug-related ED visits were identified in the standard group compared to 104 (12.6%) in the pharmaceutical group (OR 3.56; 95% CI 2.35-5.38). An intervention on the patient's pharmacotherapy was performed in 16 drug-related ED visits in standard group compared to 77 in the pharmaceutical group. In this study the implementation of a clinical pharmacist was associated with improved identification of drug-related ED visits. Discontinuations of causal medications and dose reductions were significantly higher in the pharmaceutical group compared to the standard care group.

Impact of Initiation of Insulin Therapy on Serum Prolactin and Cortisol Levels in Type 2 Diabetic Male Patients

Background Type 2 Diabetes Mellitus is a common metabolic disease characterized by a decline in insulin sensitivity and relative insulin insufficiency-induced hyperglycemia. In type 2 diabetic patients who have failed to achieve target glycemic control goals on oral anti-diabetic drug therapy, Initiating insulin therapy significantly improved overall glycemic control. Objective To assess Impact of Initiation of Insulin Therapy on Serum Prolactin and Cortisol levels In Type 2 Diabetic Male Patients. Subjects and Methods It was conducted on thirty (30) male patients who were diagnosed to have type 2 diabetes attending diabetes clinic at Ain- Shams University Hospital from 1 Jan. to 1 July 2018. Their ages range from 40 to 60 years old. Results On studying the Correlation between cortisol and prolactin with other laboratory findings showed that: There were no significant correlations between cortisol a.m. and prolactin with FBS, 2HPPBG and HbA1C (P &amp;gt; 0.05) in the first and third visits in group I. And no significant correlations between cortisol a.m. and prolactin with FBS and 2HPPBG (P &amp;gt; 0.05) in the second visit in group I. But there was a significant positive correlation between cortisol with FBS (P = 0.028) and HbA1C (P = 0.033) in group II. And a significant positive correlation between cortisol with FBS (P = 0.034) and 2HPPBG (P = 0.041) in group III. There was a highly significant positive correlation between cortisol and FBS (P = 0.001) in group III. And there was a highly significant positive correlation between prolactin with 2HPPBG (P = 0.008) in group II. Conclusion We conclude from this study that initiation of insulin therapy in poorly controlled diabetic patients achieves a highly significant reduction in blood glucose level. Also, insulin therapy in diabetic patients has impact on other hormones regulating blood glucose level as it reduces serum prolactin and cortisol levels. Also we conclude that prolactin is a diabetogenic hormone.

Integrating the Age-Friendly Health Systems Movement in Veterans Health Administration: National Advance Care Planning via Group Visits and the 4Ms Framework.

Integrating the Age-Friendly Health Systems Movement in Veterans Health Administration: National Advance Care Planning via Group Visits and the 4Ms Framework.

Diversification of Processed Tempe Products to Increase Sales Turnover and Local Wisdom Value in Thematic Tourism

Kampung Sanan is one of the creative villages in Malang Raya, with various soybeanbased product innovations. Covid-19 has impacted the amount of tourists who come to visit, making production and sales turnover decrease. Before the pandemic, 4-5 groups visited Sanan Village in a week, or approximately 18-20 visitors in one month. This condition declined due to the PPKM enforced in Malang Raya and the prohibition on receiving large group visits, limiting it to only individuals and a maximum of 5 people per week. This condition encourages the tempe artisans of Kampung Sanan to be persistent in diversifying. The creation of various innovations by these artisans is to improve the people’s economy. Kampung Sanan always holds the Tempe Sanan Culinary Festival every year by displaying superior products, so it must always strive for new products that are uniquely attractive but still refer to the characteristic of Kampung Sanan, namely tempe processing. This article aims to describe the various product diversifications carried out by the residents of Kampung Sanan to increase sales turnover and strengthen local wisdom values. The method used is descriptive qualitative with data collection techniques through interviews, observations, and documentation of the activities of the residents of Kampung Sanan. The result shows a lot of innovative products, including the latest one, processing soybean waste into silky pudding, crackers, or macaroni. Residents are also currently trying to process tempe characters in various shapes and models, which are not found elsewhere.&#x0D; Keywords: diversification, tempe processing, sales turnover, local wisdom value

Telehealth vs In-Person Shared Medical Appointments for an Intensive Therapeutic Lifestyle Change Program for Patients With Type 2 Diabetes and Prediabetes

In response to Covid-19, the Lifestyle Medicine Clinic at Midland Health elected to utilize telehealth to engage remotely with patients to deliver a 12-week intensive therapeutic lifestyle change (ITLC) program for patients with type 2 diabetes and prediabetes. This program utilized a shared medical appointment (SMA) group visit model. Beginning in May/2020, the program was offered again in-person; however, the telehealth option remained. This study is a retrospective chart review, aimed at comparing pre- and post-program changes in body weight, HbA1c, fasting lipid profile, systolic pressure, and diastolic blood pressure between in-person vs telehealth SMA formats. This study found no statistical difference in ITLC program health outcomes between telehealth vs in-person shared medical groups. At the end of ITLC Programs between both groups, an average weight loss of 9.66 pounds and 1% reduction was noted in ptHbA1C. Total cholesterol reduced by 7.1 mg/dL, and LDL by 15.19 mg/dL. The blood pressure readings showed a reduction in systolic blood pressure of 13.4 mmHg and diastolic blood pressure of 4.14 mmHg. Our results indicated that this novel telehealth delivery model could be equally successful in delivering an intensive therapeutic lifestyle program (ITLC) using an SMA approach to prevent, treat and often put chronic diseases in remission.

Work Intensity of Postoperative Care Following Implantation of Presbyopia-Correcting versus Monofocal Intraocular Lenses.

To compare the work intensity of postoperative care following implantation of presbyopia-correcting intraocular lenses (IOLs) to that of standard monofocal IOLs. This open-label, multicenter, comparative study retrospectively reviewed the case records of cataract surgery patients who underwent bilateral implantation of either presbyopia-correcting IOLs (presby-IOL group; N=177) or standard monofocal IOLs (monofocal group; N=177). Outcome measures included the total time the patient spent in the office, number of visits, mean duration of visits, and the number of procedures and diagnostic tests during the first postoperative year. Outcome measures were compared between the first 90 days and days 91-365 after surgery. Mean (±SD) time spent in the office during the first postoperative year was 5:50 ± 3:35 hours (H:MM) over 6.6 ± 2.9 visits in the presby-IOL group, compared to 3:38 ± 1:36 hours over 4.9 ± 1.6 visits in the monofocal IOL group (p <0.001). During the first 90 days, a presby-IOL patient spent 40 minutes longer in the office than a monofocal IOL patient (3:39 ± 1:38 hours vs 2.59 ± 1:13 hours) (p <0.001). During days 91-365, time in the office was 1:32 hours longer (p <0.001), and the mean visit duration was 8 minutes longer for the presby-IOL patients (p=0.002) than those with monofocal IOL. In addition, the presby-IOL patients underwent more procedures and diagnostic tests (p ≤0.001) as compared with standard monofocal cataract surgery patients. Patients implanted with presbyopia-correcting IOLs require significantly more clinic time, diagnostic testing, and procedures postoperatively as compared with standard monofocal cataract surgery patients.

Original surgical technique for the treatment of patellofemoral instability after failure of conservative treatment

IntroductionAcute patellar dislocation is a common but serious injury that can significantly impact a patient's functional prognosis. The objective of this retrospective study is to evaluate the clinical outcomes of arthroscopic medial patellofemoral ligament (MPFL) reconstruction and plication of the medial patellar retinaculum using suture anchors in adolescent patients with first-time acute patellar dislocation (APD) and MPFL insertion injury. HypothesisTightening repair of the medial retinaculum complex can result in favorable clinical and functional outcomes in this patient population. Materials and methodsA total of 84 adolescent patients with first-time APD and with an average age of 15.5 years (10-22) were included in the study. Of these patients, 61 (7 male and 54 female) underwent arthroscopic suture anchor plication for medial patellar retinaculum, while the other 23 were successfully treated non-operatively. Radiographic outcomes, including the congruence angle (CA), lateral patellofemoral angle (LPA), and patellar tilt angle (PTA), were evaluated preoperatively and at the last follow-up visit in the surgical group. Functional outcomes were assessed using the Lille Patello-Femoral Score, Lysholm Score, and Kujala Score at the same time points. In addition, the surgical and non-operative treatment success groups were compared in terms of both radiographic and functional outcomes. ResultsMean follow-up was 40.9 months (24–60). Fifty-nine knees showed excellent or good results postoperatively, 2 patients had a recurrent patellar subluxation. The Lille Patello-Femoral Score was 96.9±4.7 at the last follow-up. The subjective Lysholm Score and Kujala Score improved significantly, from 58.6 to 91.9 and from 60.4 to 88.9, respectively. The radiographic CA, LPA and PTA improved significantly, from 19.8±2.1° to –6.7±1.7°, from –7.4±2.2° to 5.7±1.8° and from 23.8±2.9° to 12.3±2.3°, respectively. There was no statistically significant difference in functional and radiographic assessments between the success with non-operative treatment group and the surgery group. ConclusionThe results of this study suggest that arthroscopic MPFL insertion reconstruction and plication using suture anchors, which is less invasive and improves patella stability, can lead to favorable clinical and functional outcomes in adolescent patients with first-time acute patellar dislocation and insertion injury. This treatment approach should be considered as a viable option for this patient population. Level of evidenceIV; monocentric retrospective descriptive study.

A randomized controlled trial for evaluating an occupational therapy self management intervention in adults with type 2 diabetes

This study evaluated the efficacy of the Occupational Therapy Diabetes Self-Management intervention (OTDSM) to enhance glycemic stability and self-management skills in people with diabetes type-2. Based on this single-blind randomized trial, 30 subjects with diabetes type-2 were assigned to two groups of intervention and control. The intervention group received a 10-week program, consisting of four group visits and six individualized sessions. The control group received an individual session and three weekly phone calls. The primary study outcome, blood hemoglobin A1C, was measured before and three months after the study. The secondary outcome was assessed in terms of the participants’ self-management behaviors, self-efficacy, diabetes distress, depressive symptoms, and performance and satisfaction with daily activities. These outcomes were evaluated three times: before, one month into, and three months after the study. The study findings demonstrated significant differences between the two groups in the hemoglobin A1C levels, self-management behaviors, self-efficacy, and performance and satisfaction with daily routines after the intervention (P < 0.05). No significant differences existed between the groups for the extent of diabetes distress and depressive symptoms. Inclusion of occupational therapy protocol into the plan of care for people with diabetes can improve health outcomes by promoting their routine participation in self-management activities.

Electrical bioimpedance measurement and near-infrared spectroscopy in pediatric postoperative neurocritical care: a prospective observational study.

To investigate the clinical significance of the disturbance coefficient (DC) and regional cerebral oxygen saturation (rSO2) as obtained through the use of electrical bioimpedance and near-infrared spectroscopy (NIRS) in pediatric neurocritical care. We enrolled 45 pediatric patients as the injury group and 70 healthy children as the control group. DC was derived from impedance analysis of 0.1 mA-50 kHz current via temporal electrodes. rSO2 was the percentage of oxyhemoglobin measured from reflected NIR light on the forehead. DC and rSO2 were obtained at 6, 12, 24, 48 and 72 h after surgery for the injury group and during the health screening clinic visit for the control group. We compared DC and rSO2 between the groups, their changes over time within the injury group and their correlation with intracranial pressure (ICP), cerebral perfusion pressure (CPP), Glasgow coma scale (GCS) score, Glasgow outcome scale (GOS) score, and their ability to diagnose postoperative cerebral edema and predict poor prognosis. DC and rSO2 were significantly lower in the injury group than in the control group. In the injury group, ICP increased over the monitoring period, while DC, CPP and rSO2 decreased. DC was negatively correlated with ICP and positively correlated with GCS score and GOS score. Additionally, lower DC values were observed in patients with signs of cerebral edema, with a DC value of 86.5 or below suggesting the presence of brain edema in patients aged 6-16 years. On the other hand, rSO2 was positively correlated with CPP, GCS score, and GOS score, with a value of 64.4% or below indicating a poor prognosis. Decreased CPP is an independent risk factor for decreased rSO2. DC and rSO2 monitoring based on electrical bioimpedance and near-infrared spectroscopy not only reflect the degree of brain edema and oxygenation, but also reflect the severity of the disease and predict the prognosis of the patients. This approach offers a real-time, bedside, and accurate method for assessing brain function and detecting postoperative cerebral edema and poor prognosis.

643-P: Engagement of Young Adults with Type 1 Diabetes (T1D) in a Virtual Young Adult Diabetes Clinic as a Component of Transition from Pediatric to Adult Diabetes Care

Objectives: Young adults with Type 1 Diabetes (T1D) face unique challenges with engaging in care as they transition from the pediatric to the adult setting. The Young Adult Diabetes Clinic (YADC) is a multidisciplinary clinic that includes a group clinic, combining endocrinology, diabetes education, and behavioral health. Due to the COVID-19 pandemic, the need for a virtual YADC group clinic arose. We sought to understand how this virtual setting could impact engagement as compared with the in-person model. Methods: We conducted a retrospective cohort study comparing in-person to virtual engagement, characterized by three central measures: rates of scheduled group visits after referral, rates of attended group visits after scheduling, and rates of follow-up after attending a group visit. A z-test was used to compare proportions of no-shows and lost-to-follow-ups between the in-person and virtual attendees. Results: Two hundred and seventy-one patients were referred to the YADC between December 2017 and December 2022. Out of those, 149 (54%) scheduled a group visit. Subsequently, 112 scheduled patients attended a group visit. Sixty-one (54%) attended a virtual group visit, compared to 51 (46%) in-person. Out of these attendees, 45 (62%) in-person attendees followed-up subsequently with a member of the care team, and 28 (38%) virtual attendees. No-show rates were significantly higher in the virtual population at 35% vs. 4% in-person (P=.002). Lost-to-follow-up rate was 27% in the virtual population and 12% in-person, (P=.07). Conclusions: Young adults with T1D face significant barriers to engagement that virtual medicine may help overcome. This data illustrates the continued challenges with engaging young adults in the virtual setting, and need for further understanding of what other factors may influence follow-up in this patient population. Disclosure T.H.Pandharpurkar: None. R.D.Tweet: None. J.J.Park: None. T.Heyerman: None. K.O'neil: None. I.Guttmann-bauman: None. F.Joarder: None.

145-LB: Consistent Care of Teens and Young Adults with Diabetes during the COVID-19 Pandemic

The transition period from pediatric to adult care is associated with worsening glycemic control and poor attendance with adult providers, which has only been complicated by the COVID-19 pandemic. Diabetes transition clinics and model programs may improve outcomes, but they remain few in number and underutilized. The aim of our cross-sectional, retrospective study was to compare diabetes control in our diabetes transition clinic (DTC) patients versus those who remained in pediatric endocrine care (non-DTC) over a 5 year period. A random sample of 82 patients ages 16 to 25 years seen in clinic from 9/11/2017 to 9/10/2022 were included. Each patient had at least one visit before and after 3/11/2020, when COVID-19 was declared a global pandemic. Those who attended DTC were similar to the non-DTC group except for insurance status (Table). The DTC group had a mean HbA1c of 8.8% vs. 9.0% (p=0.80) and a mean of 4.1 vs. 3.8 visits (p=0.69); whereas, the non-DTC group had a mean HbA1c of 10% vs. 9.6% (p=0.27) and a mean of 5.2 vs. 4.2 visits (p=0.19) before versus after 3/11/2020. Telehealth visits consisted of 15.7% of the visits in the DTC group versus 13.3% in the non-DTC group after 3/11/2020 (p=0.56). Despite the challenges of the COVID-19 pandemic, patients who moved to DTC during this time maintained glycemic control and continued to attend clinic visits consistently similar to those who remained in pediatric endocrine care. Disclosure D. S. Hsia: None. R. A. Beyl: None. R. Rumsey: None. Funding National Institute of General Medical Sciences (U54GM104940)

The effect of dapagliflozin therapy on ventricular repolarization parameters in electrocardiography in patients with diabetic cardiovascular disease

BackgroundDapagliflozin is an agent that has both antihyperglycemic effects and is significantly associated with a lower risk of cardiovascular events in patients with diabetes mellitus (DM). However, there is insufficient data and information about the effect of dapagliflozin on electrocardiographic (ECG) parameters. AimThe effects of dapagliflozin on ventricular repolarization parameters have not been fully elucidated yet. This study aimed to investigate whether dapagliflozin has a positive effect on ventricular repolarization heterogeneity parameters in patients with type 2 DM. MethodWe retrospectively enrolled 140 patients with a known diagnosis of type 2 DM who were newly prescribed dapagliflozin in addition to standard anti-diabetic therapy. The patients were divided into two groups according to whether they had cardiovascular disease (CVD). The effect of dapagliflozin treatment on ventricular repolarization parameters (frontal plane QRST angle, Tp-e interval, Tp-e/QTc, QTc, and QTc dispersion) was investigated, patient groups were compared before and after treatment. ResultsAmong 140 patients, 70 (50 %) had CVD and 70 (50 %) did not have CVD. Dapagliflozin treatment resulted in significant reductions in ventricular repolarization parameters over the study period in the CVD group with diabetes. Mean fQRST angle, Tp-e interval, Tp-e/QTc, QTc, and QTc dispersion were significantly lower than baseline values at 6-month follow-up visits in the CVD group (61.61 ± 9.22° vs 52.55 ± 8.31°, 74.45 ± 16.06 msec vs 63.27 ± 13.99 msec, 0.19 ± 0.03 vs 0.16 ± 0.03, 384.12 ± 47.93 msec vs 356.15 ± 43.31 mesc, 55.28 ± 5.50 msec vs 48.08 ± 6.48 msec for all pairwise comparisons p < 0.001). ConclusionSimilar antihyperglycemic effects were found with dapagliflozin treatment in patients with and without CVD. However, significant reductions in ventricular repolarization parameters were observed only in patients with CVD.

Feasibility and efficacy of implementing group visits for women’s health conditions: a systematic review

BackgroundShared medical appointments, also known as group visits, are a feasible and well-accepted approach for women receiving antenatal care, yet the feasibility and efficacy of this approach for female-specific reproductive conditions is uncertain.ObjectiveThe aim of this systematic review was to (a) determine the feasibility of group visits in adults with any female-specific reproductive condition, and (b) identify whether delivering group care for these conditions impacts clinical outcomes.MethodSix databases and two clinical trials registries were searched from inception through to 26 January 2022 for original research examining group medical visits or group consultation interventions for adults with female reproductive conditions or pathologic conditions specific to the female reproductive system.ResultsThe search yielded 2584 studies, of which four met the inclusion criteria. Included studies sampled women with breast cancer, chronic pelvic pain, polycystic ovary syndrome and gynaecological cancers. Studies reported high levels of patient satisfaction, with participants indicating their expectations had been met or exceeded. The impact of group visits on clinical outcomes was inconclusive however.Discussion/conclusionsThe studies in this review indicate delivery of female-specific healthcare via a group model maybe feasible and well-accepted. The review provides a solid basis for proposing larger and longer studies on group visits for female reproductive conditions.Trial registrationThe review protocol was registered with PROSPERO (CRD42020196995).

Concomitant prednisone may alleviate methotrexate side-effects in rheumatoid arthritis patients

ObjectivesTo evaluate whether addition of low-moderate dose prednisone to methotrexate (MTX) treatment can alleviate common MTX side-effects in rheumatoid arthritis (RA) patients.MethodsWe performed a post-hoc analysis of the CAMERA-II trial which randomized (1:1) 236 early DMARD and prednisone naive RA patients to treatment with MTX + prednisone 10 mg daily, or MTX monotherapy during two years. MTX dose was increased using a treat-to-target approach. We used Generalized Estimating Equations to model the occurrence of common MTX side-effects and of any adverse event over time, controlling for disease activity and MTX dose over time and other possible predictors of adverse events. To assess whether a possible effect was prednisone-specific, we performed the same analysis in the U-ACT-EARLY trial, in which the addition of tocilizumab (TCZ) to MTX was compared to MTX monotherapy in a comparable setting.ResultsMTX side-effects were reported at 5.9% of visits in the prednisone-MTX group, compared to 11.2% in the MTX monotherapy group. After controlling for MTX dose and disease activity over time, treatment duration, age, sex, and baseline transaminase levels, addition of prednisone significantly decreased the occurrence of MTX side-effects (OR: 0.54, CI: 0.38–0.77, p = 0.001). Specifically, the occurrence of nausea (OR 0.46, CI: 0.26–0.83, p = 0.009)) and elevated ALT/AST (OR 0.29, CI: 0.17–0.49, p < 0.001) was decreased. There was a trend towards fewer overall adverse events in the prednisone-MTX arm (OR: 0.89, CI: 0.72–1.11, p = 0.30). No difference in MTX side-effects was found between TCZ-MTX and MTX monotherapy in U-ACT-EARLY (OR 1.05, CI: 0.61–1.80, p = 0.87).ConclusionAddition of 10 mg prednisone daily to MTX treatment in RA patients may ameliorate MTX side-effects, specifically nausea and elevated ALT/AST.

The effect of childhood social isolation on behavioral cognition in Chinese middle-aged and older adults: The moderating effect of family support

IntroductionThis study aimed to analyze the association of childhood social isolation and behavioral cognition, and moderating effect of family support in middle-aged and older adults. MethodsThe study samples were from the China Health and Retirement Longitudinal Study (CHARLS) of 2014 and 2018. The dependent variable was behavioral cognitive ability, measured by episodic memory and mental state; The independent variable was childhood social isolation, and the moderating variable was family support. The baseline OLS regression model was used to explore the correlation among independent variables, dependent variables and moderating variables, the least square regression model was used to analyze the moderating effect of family support, and the replacement model and the method of replacing characteristic variables were used for the robustness test. Hierarchical regression heterogeneity analysis was performed to further verify the results of the moderating effect. ResultsIn this study, 3459 samples were selected for analysis. OLS baseline regression results showed that the deepening of childhood social isolation was significantly correlated with the decline of behavioral cognitive ability in middle-aged and elderly people (β=-0.9664, t = 0.0893). After adding all covariates, we found that childhood social isolation was significantly negatively correlated with behavioral cognitive ability in middle-aged and elderly people (β=-0.4118, t = 0.0785). Among the moderating variables of family support, we found that there is a moderating effect on female guardians' efforts of caring in early parental support (β=0.0948, t = 0.0320) and the frequency of children's visits in late children support (β=0.0073, t = 0.0036). Finally, through the heterogeneity test, we found that there were differences in the relationship between childhood social isolation and behavioral cognitive ability among middle-aged and elderly people of different ages, genders and places of residence. Moreover, there are significant differences in the moderating effect of female guardian's effort of caring and the frequency of children's visits in heterogeneous groups. ConclusionsThe greater the degree of childhood social isolation experienced by middle-aged and elderly people, the worse their behavioral cognitive ability. Female guardian's effort of caring and the frequency of children's visits have a moderating effect to suppress this negative effect.