Scheduled Visits Research Articles

Repetitive temporal interference stimulation improves jump performance but not the postural stability in young healthy males: a randomized controlled trial

BackgroundTemporal interference (TI) stimulation, an innovative non-invasive brain stimulation technique, has the potential to activate neurons in deep brain regions. The objective of this study was to evaluate the effects of repetitive TI stimulation targeting the lower limb motor control area (i.e., the M1 leg area) on lower limb motor function in healthy individuals, which could provide evidence for further translational application of non-invasive deep brain stimulation.MethodsIn this randomized, double-blinded, parallel-controlled trial, 46 healthy male adults were randomly divided into the TI or sham group. The TI group received 2 mA (peak-to-peak) TI stimulation targeting the M1 leg area with a 20 Hz frequency difference (2 kHz and 2.02 kHz). Stimulation parameters of the sham group were consistent with those of the TI group but the current input lasted only 1 min (30 s ramp-up and ramp-down). Both groups received stimulation twice daily for five consecutive days. The vertical jump test (countermovement jump [CMJ], squat jump [SJ], and continuous jump [CJ]) and Y-balance test were performed before and after the total intervention session. Two-way repeated measures ANOVA (group × time) was performed to evaluate the effects of TI stimulation on lower limb motor function.ResultsForty participants completed all scheduled study visits. Two-way repeated measures ANOVA showed significant group × time interaction effects for CMJ height (F = 8.858, p = 0.005) and SJ height (F = 6.523, p = 0.015). The interaction effect of the average CJ height of the first 15 s was marginally significant (F = 3.550, p = 0.067). However, there was no significant interaction effect on the Y balance (p > 0.05). Further within-group comparisons showed a significant post-intervention increase in the height of the CMJ (p = 0.004), SJ (p = 0.010) and the average CJ height of the first 15 s (p = 0.004) in the TI group.ConclusionRepetitive TI stimulation targeting the lower limb motor control area effectively increased vertical jump height in healthy adult males but had no significant effect on dynamic postural stability.

Text vs Patient Portal Messaging to Improve Influenza Vaccination Coverage

Increasing influenza vaccination rates is a public health priority. One method recommended by the US Centers for Disease Control and Prevention and others is for health systems to send reminders nudging patients to be vaccinated. To evaluate and compare the effect of electronic health record (EHR)-based patient portal reminders vs text message reminders on influenza vaccination rates across a health system. This 3-arm randomized clinical trial was conducted from September 7, 2022, to April 30, 2023, among primary care patients within the University of California, Los Angeles (UCLA) health system. Arm 1 received standard of care. The health system sent monthly reminder messages to patients due for an influenza vaccine by portal (arm 2) or text (arm 3). Arm 2 had a 2 × 2 nested design, with fixed vs responsive monthly reminders and preappointment vs no preappointment reminders. Arm 3 had 1 × 2 design, with preappointment vs no preappointment reminders. Preappointment reminders for eligible patients were sent 24 and 48 hours before scheduled primary care visits. Fixed reminders (in October, November, and December) involved identical messages via portal or text. Responsive portal reminders involved a September message asking patients about their plans for vaccination, with a follow-up reminder if the response was affirmative but the patient was not yet vaccinated. The primary outcome was influenza vaccination by April 30, 2023, obtained from the UCLA EHR, including vaccination from pharmacies and other sources. A total of 262 085 patients (mean [SD] age, 45.1 [20.7] years; 237 404 [90.6%] adults; 24 681 [9.4%] children; 149 349 [57.0%] women) in 79 primary care practices were included (87 257 in arm 1, 87 478 in arm 2, and 87 350 in arm 3). At the entire primary care population level, none of the interventions improved influenza vaccination rates. All groups had rates of approximately 47%. There was no statistical or clinically significant improvement following portal vs text, preappointment reminders vs no preappointment reminders (portal and text reminders combined), or responsive vs fixed monthly portal reminders. At the population level, neither portal nor text reminders for influenza vaccination were effective. Given that vaccine hesitancy may be a major reason for the lack of impact of portal or text reminders, more intensive interventions by health systems are needed to raise influenza vaccination coverage levels. ClinicalTrials.gov Identifier: NCT05525494.

Factors influencing the oral health behaviour of Dutch adolescents with mild to borderline intellectual disabilities living in residential care: A qualitative study.

Toothbrushing, limiting intake frequency, and scheduled visits to an oral healthcare professional (OHP) are key for good oral health. We aimed to explore factors influencing these oral health behaviours in Dutch adolescents with mild to borderline intellectual disabilities (MBID) in residential care. Using a qualitative, descriptive approach, we conducted focus groups and interviews with 12 adolescents, 9 counsellors, and 6 OHPs. Thematic analysis mapped factors influencing adolescents' knowledge, attitude, planning, and execution of oral health behaviours to oral care stakeholders. Of nine identified influencing factors, three were pivotal: Structure (influencing toothbrushing and intake frequency), Anxiety (impeding dental visits), and Support (provided by counsellors). Counsellors should provide structured daily guidance on oral hygiene and diet for adolescents with MBID, while respecting the adolescents' autonomy. As intermediaries between adolescents and OHPs, counsellors are key in reducing dental anxiety. Counsellors need clear oral health policies within care facilities to address competing priorities.

Telehealth and Technology for Diabetes in Pregnancy Clinics: Staff Perspectives from South Auckland, New Zealand.

Providing care for patients with diabetes in pregnancy (DiP) provides unique challenges beyond those faced in standard antenatal care or diabetes outside of pregnancy. Teleclinics (use of telephone, email, or other technologies) as an alternative to in-person clinic appointments have become more widely used for care since the start of the COVID-19 pandemic. To understand how teleclinics might be improved for ongoing use, it is important to understand the experiences and perceptions of the clinicians involved in DiP care. Aim. To understand staff experiences of DiP teleclinics and gain their perspectives on if and how teleclinics and other technologies might be best used in the future. Methods. A qualitative study using semistructured interviews of healthcare providers in a large DiP service. Twenty staff members (midwifery, obstetrics, physician, dietician, and administration) were approached to participate. Fifteen staff across 5 specialties consented to be interviewed. Template analysis of interview transcripts was performed, with a focus on 3 themes: collaboration and working together are important for providing care for DiP, a need for flexibility in scheduling and the ability to individualise the way care is provided, and challenges to adapting to new technology. Results. Potential benefits of teleclinics were acknowledged, but respondents also viewed teleclinics as not suitable for all DiP patients due to different needs and risks. Challenges to using teleclinics include establishing good rapport and the current limited infrastructure and patient resources. Conclusion. Healthcare providers viewed teleclinics as a way of supporting rather than replacing current care. Maintaining flexibility in clinic scheduling to allow incorporation of teleclinics into patient's current schedule of visits ad hoc and providing extra technical and administrative support are important considerations for developing a teleclinic service.

Impact of Severe Winter Weather on Operations of a Radiation Oncology Department

IntroductionDuring winter of 2022, Western New York faced two major storms with blizzard conditions and record-breaking snowfall. The severe weather resulted in power outages, and travel bans. This study investigates the impact of these conditions on patient adherence to radiotherapy. Combining data from a large academic center and its satellite clinic, this single-center study is shedding light on the challenges faced by cancer care facilities during severe weather and proposing suggestions to prevent and mitigate harm done by severe weather. MethodsIn this study, data was collected using the MOSAIQ Record and Verify system (v. 2.81) to generate deidentified reports of scheduled and treated patients. The treatment adherence rate was calculated by dividing the number of patients treated by the total number of patients scheduled. Data was specifically collected for patients undergoing treatment on linear accelerators at a primary academic center and a satellite facility. The study focused on working days from November 1, 2022, to March 31, 2023, excluding weekends and holidays (as treatments are not routinely scheduled). Severe weather days were identified using advisories from the National Weather Service and local institution, including specific periods in November, December, and January. ResultsIn the study, 15,010 scheduled treatment visits were recorded across the academic center and the satellite clinic. The mean daily treatment adherence rate was 91.7%. Severe weather conditions led to a significant reduction in adherence, with rates dropping to 77.8%. Adherence rates during non-severe weather days were notably higher at 93.9%. Statistical analysis confirmed the substantial impact of severe weather on adherence (p<0.001). Severe weather had a more pronounced impact on the satellite clinic during periods of severe weather with absolute reduction in adherence rates of 21.9% vs. 15% in primary hospital). Moreover, adherence rates at the satellite clinic vs. primary hospital site was lower even under standard operating conditions (92.2% vs 94.0%, p<0.001). ConclusionAs a part of operational planning, it is important to be aware how severe weather can impact treatment adherence. The study findings underscore the importance of proactive measures to ensure patient access to healthcare services during adverse weather events and highlight the broader significance of incorporating Social Determinants of Health (SDOH) considerations into contingency planning for maintaining treatment continuity.

Efficacy and Safety of Radiotherapy Plus Relugolix in Men With Localized or Advanced Prostate Cancer

Combination androgen deprivation therapy (ADT) with radiotherapy is commonly used for patients with localized and advanced prostate cancer. To assess the efficacy and safety of the oral gonadotropin-releasing hormone antagonist relugolix with radiotherapy for treating prostate cancer. This multicenter post hoc analysis of patients with localized and advanced prostate cancer receiving radiotherapy in 2 randomized clinical trials (a phase 2 trial of relugolix vs degarelix, and a subset of the phase 3 HERO trial of relugolix vs leuprolide acetate) included men who were receiving radiotherapy and short-term (24 weeks) ADT (n = 103) from 2014 to 2015 and men receiving radiotherapy and longer-term (48 weeks) ADT (n = 157) from 2017 to 2019. The data were analyzed in November 2022. Patients receiving short-term ADT received relugolix, 120 mg, orally once daily (320-mg loading dose) or degarelix, 80 mg, 4-week depot (240-mg loading dose) for 24 weeks with 12 weeks of follow-up. Patients receiving longer-term ADT received relugolix, 120 mg, orally once daily (360-mg loading dose) or leuprolide acetate injections every 12 weeks for 48 weeks, with up to 90 days of follow-up. Castration rate (testosterone level <50 ng/dL [to convert to nmol/L, multiply by 0.0347) at all scheduled visits between weeks 5 and 25 for patients receiving short-term ADT and weeks 5 and 49 for patients receiving longer-term ADT. Of 260 patients (38 Asian [14.6%], 23 Black or African American [8.8%], 21 Hispanic [8.1%], and 188 White [72.3%] individuals), 164 (63.1%) received relugolix. Relugolix achieved castration rates of 95% (95% CI, 87.1%-99.0%) and 97% (95% CI, 90.6%-99.0%) among patients receiving short-term and longer-term ADT, respectively. Twelve weeks post-short-term relugolix, 34 (52%) achieved testosterone levels to baseline or more than 280 ng/dL. Ninety days post longer-term ADT, mean (SD) testosterone levels were 310.5 (122.4) (106.7) ng/dL (relugolix; n = 15) vs 53.0 ng/dL (leuprolide acetate; n = 8) among the subset assessed for testosterone recovery. Castration resistance-free survival was not statistically different between the relugolix and leuprolide acetate cohorts (hazard ratio, 0.97; 95% CI, 0.35-2.72; P = .62). Adverse events grade 3 or greater for short-term or longer-term relugolix (headache, hypertension, and atrial fibrillation) were uncommon (less than 5%). The results of these 2 randomized clinical trials suggest that relugolix rapidly achieves sustained castration in patients with localized and advanced prostate cancer receiving radiotherapy. No new safety concerns were identified when relugolix was used with radiotherapy.

(082) Erectile Dysfunction: Tool to Break Men's Sexual Stigma

Abstract Introduction Statistics reveal that a significant number of men, particularly those over the age of 30 and 50, experience some form of erectile dysfunction (ED). Shockingly, 8 out of 10 men suffering from ED do not take any proactive measures to treat or prevent it. This rise in ED cases has been closely linked to the increasing rates of obesity, diabetes, and cardiovascular diseases, with hypertension also being a contributing factor. As of 2017, nearly half of all adults in the US (47%, or 116 million) had hypertension. Unfortunately, many men choose to conceal or remain silent about their struggles with ED, primarily due to the social stigma that surrounds this issue. Objective Our goal is to break the stigma surrounding men’s sexual health, transform men's attitudes towards their intimate well-being, and encourage them to proactively prioritize it. We aim to encourage men to pay more attention to their sexual health and empower them to lead long, fulfilling intimate lives while also seeking timely medical assistance when needed. Methods We have developed a mobile application for iOS that allows men anonymously to discreetly monitor, maintain, and enhance their sexual health. The application offers the following features: 1. Physical and relaxation exercises, alongside a sexual activity tracker, enabling users to record details about sexual encounters, masturbation, and erection quality. For instance, the tracker revealed that men reported engaging in masturbation 40% more frequently than participating in sexual activities. Additionally, 17.8% of users experienced incomplete erections during intercourse, while a significant 71% of men were affected by varying degrees of erectile dysfunction (ED). 2. Educational content: Articles categorized into topics such as sexual education, diseases, sexual education for children and teenagers, gender identity, and more. 3. Regular "Check-up" feature helps users keep track of recommended tests based on their age, providing reminders for scheduled doctor's visits. It is important to note that the application doesn't replace a visit to a doctor. In June 2023, a user survey was conducted to assess the impact of the application on men's health, and 57 male participants were recruited from the app's user base, voluntarily participating in the study. Results The findings revealed that the majority of participants reported positive changes in their sexual health after using the application. 1. 75% reported a general improvement in their sexual health. These positive changes encompassed various aspects of sexual well-being, such as erectile function, libido, orgasm intensity, and overall satisfaction. 2. 42% reported an improvement in the quality of their erections. 3. 23% experienced more intense orgasms. 4. 25% reported an increase in their libido. 5. 42% became more aware of their sexual health. Conclusions The survey findings suggest that the app may have contributed to improvements in various aspects of sexual well-being, including erection quality, orgasm intensity, libido, and sexual health awareness. The results highlight the potential value of the application as a tool for men seeking to monitor, enhance, and unlock the full potential of their sexual health. Disclosure No.

How Safe Are Biological Agents in Pediatric Rheumatology?

Biologic therapy has changed the prognosis of patients with rheumatologic disease. Despite all benefits of the biological agents, adverse events may occur due to their long-term use. The aim of this study is to analyze the adverse events observed in pediatric patients who received biological treatment. This retrospective observational cohort study was conducted between January 2010 and January 2022. File records of 139 patients used biological agents for rheumatologic diseases in a pediatric rheumatology clinic were evaluated. Diagnosis, received treatment, the rationale for stopping treatment, requirement of tuberculosis prophylaxis, presence of an adverse event, and results were recorded. The most used biological therapy was etanercept (41.7%). Anakinra, adalimumab, canakinumab were used in 30.9%, 27.3%, 23.7% of patients, and the others in less than 10%. Totally 491 adverse events (97.9/100 patient-years) were encountered during the duration of biological treatment. The most often adverse event was recurrent upper respiratory tract infection in the patients (31.9/100 patient-years). Elevated aminotransferase levels (10.4/100 patient-years), abdominal pain (7/100 patient-years), and headache (5.2/100 patient-years) were among the other common side effects. Isoniazid (INH) prophylaxis was needed before biological treatment in 20.9% of the patients. Tuberculosis developed in none of the patients followed-up for latent tuberculosis, however, it developed in a patient while receiving etanercept due to noncompliance with his scheduled outpatient visits during etanercept treatment. The most commonly used biological treatments were TNFi and IL-antagonists, and the majority of side effects were infections and laboratory abnormalities. Although the rate of serious adverse events is quite low, close follow-up of patients receiving biological therapy is very important.

Human umbilical cord mesenchymal stem cell therapy for renal dysfunction in Alport syndrome: protocol for an open-label, single-arm trial in China

IntroductionAlport syndrome (AS) is one of the most common fatal hereditary renal diseases in human, with a high risk of progressing to end-stage renal disease without effective treatments. Mesenchymal stem...

Impact of social determinants of health on follow-up adherence, testing completion, and outcomes among pediatric glaucoma patients at a tertiary care center

PurposeTo identify patient characteristics associated with visit attendance, treatment outcomes, and optical coherence tomography (OCT) testing in pediatric glaucoma patients at an urban tertiary care center. MethodsThe records of patients with childhood glaucoma seen from 2015 to 2021 were reviewed. Primary outcomes were the proportion of scheduled visits completed, visual acuity and intraocular pressure (IOP) at most recent follow-up, and rates of OCT testing. Social determinants of health evaluated included race and ethnicity, distance of residence from clinic, insurance carrier type and residence within Baltimore City County, the latter two serving as proxies for socioeconomic status. ResultsA total of 99 patients met inclusion criteria: 61% were male; 47%, white (non-Hispanic); 25%, black (non-Hispanic); 11%, Hispanic/Latino; and 7% Asian/Pacific Islander. Mean distance from clinic was 45.3 miles. Mean visit completion rate was 90.4%; there was no statistically significant variation in visit completion rates by patient characteristics. IOP outcomes did not vary across patient groups, but visual acuity outcomes in affected eyes were significantly worse among Baltimore City County residents compared with non-residents. Only 22% of the cohort received ≥1 OCT per year, and patients living 0-29.9 miles from clinic had significantly lower odds of reaching the threshold than more distant patients. Patients with state-based insurance had significantly lower odds of being ≥50th percentile for rate of OCTs received compared to patients with commercial insurance. ConclusionsIn children with glaucoma, residence within Baltimore City County was associated with significantly worse visual acuity outcomes, and close proximity to clinic was an independent predictor of lower rates of OCT testing, despite similar visit attendance rates and IOP outcomes across all groups.

Impact of multivessel versus single-vessel disease on the association between low diastolic blood pressure and mortality after acute myocardial infarction with revascularization.

Previous studies demonstrated a J-shaped relationship between low diastolic blood pressure (DBP) and adverse clinical outcomes in patients with acute myocardial infarction (AMI) that was sensitive to revascularization. Hypothesized herein, was that this relationship differs between patients with multivessel disease (MVD) and those with single-vessel disease due to differing degrees of myocardial ischemic burden. Among 9,983 AMI patients from the Korea Acute Myocardial Infarction Registry database who underwent percutaneous coronary intervention and were followed up for a median duration of 3.2 years, average on-treatment DBP was calculated at admission, discharge, and every scheduled visit and divided into these parameters: < 70 mmHg, 70-74 mmHg, 75-79 mmHg, and ≥ 80 mmHg. The relationship between average on-treatment DBP and clinical outcomes including all-cause death, cardiovascular (CV) death, non-CV death, and hospitalization for heart failure was analyzed using the Cox regression models adjusted for clinical covariates. In patients with MVD, all-cause death (hazard ratio [HR]: 1.47; 95% confidence interval [CI]: 1.06-2.04, p = 0.012) and CV death (HR: 1.59; 95% CI: 1.02-2.46, p = 0.027) were significantly increased in patients with a DBP < 70 mmHg, showing a J-shaped relationship. However, these findings were not significant for single-vessel disease. On a sensitivity analysis excluding subjects with a baseline SBP < 120 mmHg, an increased risk of a low DBP < 70 mmHg remained in MVD. The J-shaped relationship between low DBP and adverse clinical outcomes in AMI patients who underwent revascularization persisted in MVD, which has a high ischemic burden. These high-risk patients require cautious treatment.

Patterns of engagement in care during clients' first 12 months after HIV treatment initiation in South Africa: A retrospective cohort analysis using routinely collected data.

Retention on antiretroviral therapy (ART) during the early treatment period is one of the most serious challenges facing HIV programs, but the timing and patterns of early disengagement from care remain poorly understood. We describe patterns of engagement in HIV care during the first year after treatment initiation. We analysed retrospective datasets of routinely collected electronic medical register (EMR) data for ≥18-year-old clients who initiated ART at public sector clinics in South Africa after 01/01/2018 and had ≥14 months of potential follow-up. Using scheduled visit dates, we characterized engagement in care as continuous (no treatment interruption), cyclical (at least one visit >28 days late with a return visit observed) or disengaged (visit not attended and no evidence of return). We report 6- and 12-month patterns of retention in care and viral suppression. Among 35,830 participants (65% female, median age 33), in months 0-6, 59% were continuously in care, 14% had engaged cyclically, 11% had transferred to another facility, 1% had died, and 16% had disengaged from care at the initiating facility. Among disengagers in the first 6 months, 58% did not return after their initiation visit. By 12 months after initiation, the overall proportion disengaged was 23%, 45% were classified as continuously engaged in months 7-12, and only 38% of the cohort had maintained continuous engagement at both the 6- and 12-month endpoints. Participants who were cyclically engaged in months 0-6 were nearly twice as likely to disengage in months 7-12 as were continuous engagers in months 0-6 (relative risk 1.76, 95% CI:1.61-1.91) and were more likely to have an unsuppressed viral load by 12 months on ART (RR = 1.28; 95% CI1.13-1.44). The needs of continuous and cyclical engagers and those disengaging at different timepoints may vary and require different interventions or models of care.

Effect of a Patient Portal Reminder Message After No-Show on Appointment Reattendance in Ophthalmology: A Randomized Clinical Trial

PurposeTo assess the efficacy of electronic health record (EHR) messaging for re-engaging patients with ophthalmology care after a missed appointment. DesignProspective, randomized clinical trial. MethodsThe study setting was an academic ophthalmology department. The patient population comprised return patients age 18 years or older with an appointment “no show,” or missed appointment. Over two phases of recruitment, 362 patients with an active patient portal in the EHR were selected consecutively each business day. Patients were randomized using a web-based tool to receive a reminder to reschedule via a standard mailed letter only (control) or the mailed letter plus an electronic message through the electronic record within one business day of the missed appointment (intervention). Reengagement with eye care was defined as attendance of a rescheduled appointment within 30 days of the no-show visit. Patient charts were reviewed for demographic and clinical data. ResultsThe average age of recruited patients was 59.9 years, just under half of the sample was male (42.5%, 154/362), and most patients were White (56.9%, 206/362) or Black (36.2%, 131/362). Patients were most commonly recruited from the retina service (39.2%, 142/362) followed by the glaucoma service (29.3%, 106/362). Many patients in this study had previous no-show appointments, with an average no-show rate of 18.8% out of all scheduled visits across our health system. In total, 22.2% (42/189) of patients in the intervention group attended a follow-up appointment within 30 days of their no-show visit compared to 11.6% (20/173) of the control group (OR, 2.186; 95% CI, 1.225-3.898; p=0.008). When including only the 74 patients in the intervention group who read the intervention message in the patient portal, 28.4% (21/74) attended a follow-up compared to 11.6% (20/173) of the control group (p=0.001). ConclusionsEHR-based reminder messages sent within a business day of a missed appointment may promote re-engagement in ophthalmology care after appointment no-show.

Remote visits to address loneliness for people living with dementia in care homes: A descriptive qualitative study of visitors' perceptions.

To assess visitors' perceptions of the benefits and challenges related to engaging in a remote visit intervention, which was designed to address the loneliness of people living with moderate to severe dementia in care homes. A qualitative descriptive study. Twenty-four people living with dementia in care homes in Canada and their family and friends (i.e., remote visitors) took part in facilitated remote visits in 2021. Each person living with dementia received scheduled visits for 30-60 min per week for 6 weeks. Participants chose to complete one longer visit, or multiple shorter visits, per week. Twenty remote visitors participated in semi-structured interviews after six weeks to discuss their perspectives on the effectiveness, benefits and challenges of the program in relation to addressing experiences of loneliness of the person living with dementia. Conventional content analysis was used to analyze the data. We describe three themes and several sub-themes. Themes support the use of remote visits to enhance, rather than replace, in-person visits; the benefits of remote visits for the person living with dementia and their remote visitors; and the conditions that lead to a successful remote visit. Remote visitors reported that facilitated visits had positive effects for both visitors and people living with dementia with respect to loneliness, communication, relationships, and social connection. Clinicians can consider the factors that contributed to positive experiences of remote visits. The factors include individualized, facilitated visits that were flexible, and the use of reliable technology in a supportive, distraction-free environment. Loneliness and social isolation are growing health concerns. When experienced by people living with dementia residing in long-term care homes, loneliness and social isolation can result in lower levels of quality of life and well-being, and higher levels of anxiety and responsive behaviours. Remote visitors perceived that facilitated remote visits have the potential to address loneliness and improve quality of life for people living with dementia and also offer social support to remote visitors. The findings can impact clinician practice by guiding the use of remote visits in care homes, and inform future intervention research to evaluate the effectiveness of remote visits for people living with dementia and their remote visitors. This manuscript adheres to the relevant EQUATOR guidelines (the Consolidated criteria for reporting qualitative research or COREQ). No patient or public contribution.

"How are you?" Perspectives From Patients and Health Care Providers of Text Messaging to Support Rheumatoid Arthritis Care: A Thematic Analysis.

Patients with rheumatoid arthritis (RA) may need to access rheumatology care between scheduled visits. WelTel is a virtual care platform that supports secure two-way text-messaging between patients and their health care team. The objective of the present study was to explore perspectives and experiences of health care providers (HCPs) and patients related to the use of WelTel as an adjunct to routine care. Seventy patients with RA were enrolled in a six-month WelTel pilot project launched in September 2021. Patients received monthly "How are you?" text message check-ins and could message their health care team during clinic hours to request health advice. The current project is a qualitative study of the WelTel pilot. A subgroup of pilot participants was purposively sampled and invited to participate in interviews. A thematic analysis of transcripts was conducted using a deductive approach leveraging quality of care domains. Thirteen patients (62% female, mean age 62 years, 10 White) completed interviews. Patients' views suggested that text messaging with the rheumatology team supported high-quality care across multiple quality domains including patient-centeredness, timeliness, efficiency, safety, effectiveness, equity, and appropriateness. Seven HCPs (57.1% female, one pharmacist and six rheumatologists) completed interviews. HCPs' perspectives varied based on their experience with the WelTel platform. Additional themes reported by HCPs included perceived increased workload and burnout. Patients with RA perceived text-based messaging as supporting high-quality care. The impact of increased communications on HCP burnout and workload requires consideration, and future studies should evaluate the effect of texting on patient outcomes.

Multilevel approaches to address disparities in lung cancer screening: a study protocol

BackgroundLow-dose computed tomography (lung cancer screening) can reduce lung cancer-specific mortality by 20–24%. Based on this evidence, the United States Preventive Services Task Force recommends annual lung cancer screening for asymptomatic high-risk individuals. Despite this recommendation, utilization is low (3–20%). Lung cancer screening may be particularly beneficial for African American patients because they are more likely to have advanced disease, lower survival, and lower screening rates compared to White individuals. Evidence points to multilevel approaches that simultaneously address multiple determinants to increase screening rates and decrease lung cancer burden in minoritized populations. This study will test the effects of provider- and patient-level strategies for promoting equitable lung cancer screening utilization.MethodsGuided by the Health Disparities Research Framework and the Practical, Robust Implementation and Sustainability Model, we will conduct a quasi-experimental study with four primary care clinics within a large health system (MedStar Health). Individuals eligible for lung cancer screening, defined as 50–80 years old, ≥ 20 pack-years, currently smoking, or quit < 15 years, no history of lung cancer, who have an appointment scheduled with their provider, and who are non-adherent to screening will be identified via the EHR, contacted, and enrolled (N = 184 for implementation clinics, N = 184 for comparison clinics; total N = 368). Provider participants will include those practicing at the partner clinics (N = 26). To increase provider-prompted discussions about lung screening, an electronic health record (EHR) clinician reminder will be sent to providers prior to scheduled visits with the screening-eligible participants. To increase patient-level knowledge and patient activation about screening, an inreach specialist will conduct a pre-visit phone-based educational session with participants. Patient participants will be assessed at baseline and 1-week post-visit to measure provider-patient discussion, screening intentions, and knowledge. Screening referrals and screening completion rates will be assessed via the EHR at 6 months. We will use mixed methods and multilevel assessments of patients and providers to evaluate the implementation outcomes (adoption, feasibility, acceptability, and fidelity).DiscussionThe study will inform future work designed to measure the independent and overlapping contributions of the multilevel implementation strategies to advance equity in lung screening rates.Trial registrationClinicalTrials.gov, NCT04675476. Registered December 19, 2020.

No-Show Rates in an Academic Otolaryngology Practice Before and During the COVID-19 Pandemic.

Our objectives were to determine the no-show and nonattendance rate for an outpatient academic otolaryngology practice, to identify patient and systemic factors associated with nonattendance, and to evaluate the impact that the COVID-19 pandemic had on the rate of nonattendance. This is a retrospective review of the Epic practice management and billing reports from all scheduled outpatient visits at a multi-physician, academic, general, and sub-specialty otolaryngology practice from January 2019 to December 2021. Over three years, 121,347 clinic visits were scheduled in the otolaryngology practice. The overall nonattendance rate was 18.3%. A statistically significant increase in nonattendance was noted during the COVID-19 pandemic (16.8% vs. 19.8%, p < 0.001). The rate of nonattendance in patients of younger age (under 18 years) (p <0.001), female gender (p=0.03), afternoon appointments (p=0.04), and extended time between the day of scheduling and the day of appointment (p <0.001) increased. Head and neck clinics were found to have the lowest nonattendance rates, while pediatric otolaryngology clinics had the highest (12.6% vs. 21.3%). On multivariate regression, younger age (p < 0.001), female gender (p=0.01), afternoon appointments (p< 0.001), and online self-scheduling (p< 0.001) were significantly associated with nonattendance. Both patient and appointment-related factors were found to impact rates of nonattendance in this academic otolaryngology practice. In this study, young age, female gender, afternoon appointments, and online self-scheduling were associated with increased nonattendance. In addition, the COVID-19 pandemic significantly impacted no-show rates across all otolaryngologic subspecialties.

Prevalence of Malaria Infection in Pregnant Women Attending Antenatal Clinics in Southern Senegal.

Despite marked progress in Senegal, three regions in the southeast part continue to have a high burden of malaria, but there have been no recent studies assessing the prevalence of malaria associated with pregnancy. This study aimed to determine the prevalence of malaria infection in pregnant women attending antenatal clinics in Senegal. During the malaria transmission season of 2019, pregnant women attending 11 health care facilities for a scheduled visit and those presenting unwell with signs of malaria were invited to participate in a malaria screening study. A finger prick blood sample was taken for malaria diagnosis by rapid diagnosis test (RDT) and polymerase chain reaction (PCR). A total of 877 pregnant women were enrolled, 787 for a scheduled antenatal consultation and 90 for an unscheduled consultation with signs of malaria. The prevalence of Plasmodium falciparum among the first group was 48% by PCR and 20% by RDT, and that among the second group was 86% by PCR and 83% by RDT. RDT sensitivity in capturing asymptomatic, PCR-positive infections was 9.2% but ranged from 83% to 94% among febrile women. The prevalence of infection by PCR in women who reported having received at least three doses of sulfadoxine pyrimethamine (SP) was 41.9% compared with 58.9% in women who reported they had not received any SP doses (prevalence ratio adjusted for gravidity and gestational age, 0.54; 95% CI, 0.41-0.73). The burden of P. falciparum infections remains high among pregnant women, the majority of which are not captured by RDT. More effective measures to prevent malaria infection in pregnancy are needed.

Pregnancy assistance for foreign women in Trentino Region (Northern Italy): retrospective cohort epidemiological study.

to identify any differences between Italian and foreign women in the access to prenatal care, including the number and appropriate scheduling of visits, the execution of diagnostic, blood, and microbiological tests and the use of specific healthcare services. retrospective cohort epidemiological study, based on the monitoring of current information flows. data extrapolated from the Birth Attendance Certificate information flow of the Autonomous Province of Trento (Northern Italy) between 2012 and 2016. A total of 23,165 women with data regarding citizenship were included in the analysis. outcome variables used to assess appropriateness of antenatal care were medically assisted procreation techniques, use of invasive prenatal diagnosis, gestational age at the first appointment, total number of appointments and ultrasounds during pregnancy, blood and microbiological tests taken, and participation in antenatal classes. data indicates a significant difference in the use of chorionic villus sampling, testing for Cytomegalovirus, and vaginal-rectal swab for the detection of group B streptococcus, which are lower in the foreign population. Furthermore, there is a statistically significant difference in the gestational age at which the first appointment is attended, in the total number of visits, and in the number of ultrasounds performed during pregnancy as well as in participation in antenatal classes. this study reveals significant differences in access and use of pregnancy assistance between foreign and Italian women. There are also differences in terms of social determinants of health, with a concentration of unemployment and low education in the foreign population. It is therefore necessary to identify the factors that can potentially create health inequalities, considering the socioeconomic determinants and the specific needs of migrant women.

Comprehensive modelling of prostate cancer progression: integrating continuous and binary biomarkers with event time data and missing covariates

Longitudinal studies involve recording observations at scheduled visits or time points for individuals until a predetermined event, like reaching satisfactory tumor shrinkage in cancer studies. Furthermore, dropout in longitudinal studies leads to incomplete data, which significantly increases the risk of bias. An amended joint shared-random effects model (SREM) is proposed for mixed continuous and binary longitudinal measurements and a time-to-event (TTE) outcome, incorporating missing covariates. In the proposed model, a conditional model is applied for the mixed continuous and binary longitudinal outcomes; a mixed effect model is considered for the continuous longitudinal outcome. For the binary longitudinal outcome, given the continuous longitudinal outcome, a logistic mixed effect model is considered. These models share common random effects with the model for the event time outcome. The model formulation is based on Bayesian statistical thinking via Markov Chain Monte Carlo (MCMC). The proposed joint modelling is applied to contribute to the understanding of the progression of prostate cancer (PCa) by considering a generalized linear mixed effects model for time-varying covariates that incorporate ignorable missingness. The association between prostate-specific antigen (PSA) with alkaline phosphatase (ALP) and tumor status has been studied with mixed conclusions.