Number Of Visits Research Articles

The Impact of Telehealth on Obstetrical Outcomes during the COVID-19 Pandemic.

Nationwide, obstetric clinics modified prenatal care to include telehealth visits in response to the COVID-19 pandemic, enabling the opportunity to investigate its impact on patient outcomes. We hypothesized that use of prenatal telehealth visits would increase the number of prenatal visits, decrease the frequency of urgent triage/emergency department (ED) visits, and improve perinatal outcomes. To determine the impact of telehealth on number of obstetric prenatal visits and urgent triage/ED visits amidst the COVID-19 pandemic. This is a retrospective cohort of patients from a federally qualified health center (FQHC) in central Texas. Patients with a singleton gestation who delivered after 32 weeks were included. Comparison groups were made between those patients who delivered between May 2020 to December 2020 (presumed modified prenatal visit schedule with in-person and telehealth) and those patients delivering between June 2019 to February 2020 (the traditional care model with in-person visits only). Multivariable linear and logistic regression models were used to estimate differences in the number of prenatal visits and unscheduled triage/ED visits. A total of 1654 patients were identified with 801 (48.4%) patients undergoing modified prenatal care and 853 (51.6%) patients receiving traditional care during the study period. No significant differences were seen in overall prenatal attendance or triage/ED presentations. However, when stratified by parity, multiparous patients undergoing modified prenatal care were less likely to experience an urgent triage/ED presentation (8.7% vs. 12.7%; odds ratio, 1.69; 95% confidence interval, 1.10-2.61). When compared to a traditional prenatal visitation cohort pre-pandemic, patients who received modified telehealth prenatal care during the COVID-19 pandemic had similar prenatal attendance and unscheduled emergency presentations. However, multiparous patients experienced a decreased rate of unscheduled emergency presentations. Supplementing prenatal care with telehealth may provide overall comparable prenatal care delivery.

Effects of Patient‐Initiated Brief Admissions on Psychiatric Care Consumption in Borderline Personality Disorder: ARegister‐Based Study

ABSTRACTPrevious studies have reported that patients with borderline personality disorder (BPD) often have negative experiences in psychiatric inpatient care. To address this issue, a novel intervention known as patient‐initiated brief admission (PIBA) has been developed. PIBA offers a constructive approach to crisis management in situations of heightened anxiety, as well as during instances of self‐harm and suicidal ideation. The intervention allows patients to directly contact the psychiatric ward to initiate a brief admission lasting 1–3 days. This easily accessible care option during a crisis has the potential to prevent harm to the patient and reduce the need for prolonged hospital stays. The aim of the present study is to investigate the effects of PIBA on psychiatric care consumption among patients diagnosed with BPD. This retrospective register‐based study includes data from both inpatient and outpatient care registries for patients diagnosed with BPD. Data were extracted from the National Board of Health and Welfare in Sweden. The study period encompasses 2013–2020, with the PIBA intervention occurring between 2016 and 2019. The sample included 107 patients in the PIBA group and 5659 matched controls. Data were analysed using a difference‐in‐differences (DiD) approach through ordinary least squares (OLS) regression and ordinal logistic regression. Throughout the 3‐year follow‐up, both groups exhibited a reduction in the number of days of utilisation of psychiatric inpatient care services. The DiD analysis indicated an additional decrease of 1.5 days at the 6‐month mark for the PIBA group (β = −1.436, SE = 1.531), expanding to 3 days fewer at the 12‐month follow‐up (β = −3.590, SE = 3.546), although not statistically significant. For outpatient care, the PIBA group displayed an increase in the number of visits, averaging to half a visit more every 6 months (β = 0.503, SE = 0.263) compared with the controls. Statistically significant differences were observed for two out of six measurements at the 12‐month (β = 0.960, SE = 0.456) and 18‐month follow‐up period (β = 0.436, SE = 0.219). The PIBA group had a statistically significant lower odds of experiencing extended lengths of inpatient care days after the index date than the controls (OR 0.56, 95% CI: 0.44–0.72). In conclusion, PIBA was associated with a significant reduction in the length of individual hospital stays, but not in the overall number of inpatient care days. PIBA may be linked to a shift from longer inpatient care utilisation to outpatient care utilisation. These findings suggest that PIBA may reduce the risk of prolonged hospitalisations for patients who have access to the intervention. Future research should explore the impact of PIBA on healthcare costs and cost‐effectiveness, both in relation to health care for the individual and cost‐effectiveness in relation to recovery and health.

The need for and prospects of developing a modern mobile laboratory complex for equipping sanitary and preventive organizations of the Russian Ministry of Defense

Presently, an increasing volume of laboratory tests performed by sanitary and preventive organizations of the Russian Ministry of Defense (centers of state sanitary and epidemiological supervision) are carried out directly in the field during various combat training activities and special tasks and the localization and elimination of epidemic foci of infectious diseases in organized military collectives. Thus, non-staff mobile sanitary-epidemiological groups are formed. However, the regular special military equipment—medical field laboratory—used to equip such groups, is outdated and does not provide the basic principles of their autonomous functioning (mobility, autonomy, multidisciplinarity, high manufacturability, zoning of workplaces, compliance with biological safety requirements). Hence, the need for and prospects of developing a new automotive laboratory complex for equipping sanitary and prophylactic organizations of the Russian Ministry of Defense are investigated. This study analyzes the experience of military sanitary-preventive organizations for the period 2011–2021. The tactical and technical characteristics of the staff laboratory of the medical field laboratory of the state sanitary and epidemiological supervision centers of the Russian Ministry of Defense are compared with available analogues, including those in the institutions of other ministries and departments. As the number of long visits of military sanitary specialists and preventive organizations significantly increases to the extent of providing temporary accommodation for military units to ensure the sanitary and epidemiological well-being of the personnel, the need for laboratory research in isolation from the network of stationary laboratories to objectify the activities of the state sanitary and epidemiological supervision and ensure the anti-epidemic protection of troops also significantly increases. Moreover, the drawbacks of the standard medical field laboratory and its analogues and hence their limited use in the interests of the Russian Ministry of Defense in existing configurations were identified. The obtained results enabled reasoning for the need for a new automotive laboratory complex for equipping sanitary and preventive organizations of the Russian Ministry of Defense considering the successful solutions in laboratory complexes of other ministries and departments.

Pesona Objek Wisata Sejarah di Kabupaten Sinjai

This study aims to determine the potential of historical attractions in Sinjai Regency, the development of historical tourism in Sinjai Regency 2008-2016, and the impact of historical tourism on the communities around the site, the government and tourists. The method used in the research and writing of this thesis is a historical research method, which includes: heuristics, source criticism, interpretation and historiography. The techniques used in data collection are observation, interview and literature study techniques. The results of this study indicate that Sinjai as a Level II Region in South Sulawesi has tourism potential that is not inferior to other regions. The Batupake Gojeng Archaeological Park, the Karampuang Indigenous Area, and the Balangnipa Fort are one of the historical tourist destinations offered by Sinjai Regency. Although the Tourism and Culture Office of Sinjai Regency was only established in 2017, activities in the tourism sector will continue to be carried out in previous years. The three historical attractions have their respective developments both in terms of facilities and infrastructure to the number of visitors. The contribution of each element in the development of the historical tourism sector in Sinjai Regency is something that needs to be improved. Based on the results of this study it can be concluded that the historical attractions in Sinjai Regency have an impact on the socio-cultural, educational and economic sectors for the local government and the people who live around the site.

Health Care Use for Eye Pain

National estimates regarding the frequency of presentations and patterns of care for eye pain are unknown. This information could guide research and clinical efforts to optimize outcomes. To estimate eye pain visits in the US in the outpatient and emergency department (ED) settings. This retrospective cross-sectional study of National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data (2008-2019) analyzed a population-based sample of visits to outpatient clinics and EDs. The sample consisted of patients presenting with eye pain. Data were analyzed from September 2023 to April 2024. Weighted sample data estimated outpatient and ED eye pain presentations including patient and clinician characteristics, diagnoses (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10]), and disposition. From 2008 through 2019, 4.6 million (95% CI, 3.9 million to 5.3 million) outpatient and 1.0 million (95% CI, 0.8 million to 1.1 million) ED eye pain visits occurred annually. Patients were predominantly women (63.2% [95% CI, 59.4%-67.0%]) and older than 60 years (46.6% [95% CI, 42.4%-51.0%]) in the outpatient setting. Patients presenting to the ED were more often men (51.8% [95% CI, 48.7%-55.0%]) and aged younger than 45 years (aged <15 years: 16.4% [95% CI, 13.9%-18.8%]; 15-24 years: 19.2% [95% CI, 16.6%-21.7%]; and 25-44 years: 35.6% [95% CI, 32.7%-38.5%]). In nearly half of outpatient eye pain visits, the major problem was classified as nonacute (2.0 million [95% CI, 1.6 million to 2.3 million]). Eye pain was the primary reason for the visit (RFV) in 42.0% (95% CI, 37.8%-46.2%) of outpatient visits and 66.9% (95% CI, 62.9%-70.9%) of ED eye pain visits. It was the only RFV in 18.3% (95% CI, 15.0%-21.7%) of outpatient and 32.7% (95% CI, 29.0%-36.4%) of ED eye pain encounters. Ophthalmologists evaluated the largest number of outpatient visits (45.3% [95% CI, 38.8%-51.7%). The primary diagnosis was non-vision threatening for most outpatient (78.5% [95% CI, 56.8%-100%]) and ED (69.9% [95% CI, 62.1%-77.7%]) visits when eye pain was the primary RFV. Additional follow-up was scheduled in 89.4% (95% CI, 86.2%-92.6%) of visits. More than 5 million eye pain visits occur annually; the largest percentage are outpatient with ophthalmologists. Most diagnoses were non-vision threatening in both the outpatient and ED setting and resulted in additional care. Expanding therapeutic approaches to treat the causes of eye pain may reduce the burden on the health care system and optimize outcomes.

Visitors’ attraction and co-creation at World Expo – a qualitative study unveiling visitors’ delight and engagement with immersive technology

ABSTRACT Global business events like World Expo attract massive numbers of visitors to attend this event. The present study investigates internal and external factors that attracted visitors to attend World Expo – Dubai 2022 and uncovers the core elements of these factors which are important for the strategic & planning context too. To this end, the attendees of this Expo were interviewed using the in-depth interview technique. The results revealed that internal factors such as functional, mechanic, and human cues affect visitors’ perception, whereas external factors, which include technological, socio-cultural, political, economic, and environmental aspects, contribute to the collaborative process of shaping visitor experience. The results also demonstrate that strategic planning and marketing strategies align with the AIDA model and that technological integration can help attract more visitors to Business-Expo, thereby boosting local tourism. Taken together, our findings provide meaningful implications for marketers, stakeholders, and governments.

Sex differences in houselessness, injection drug use, and mental health conditions among people newly diagnosed with HIV in Manitoba, Canada from 2018 to 2021: a retrospective cohort study

Manitoba saw the highest number of new HIV diagnoses in the province's history in 2021 and is the only Canadian province not meeting any of the previous UNAIDS 90-90-90 targets. Our goal was to describe sex differences and syndemic conditions within an incident HIV cohort in Manitoba, and the HIV treatment initiation and undetectable viral load outcomes. This was a retrospective cohort study of all people 18 years and older newly diagnosed with HIV in Manitoba, Canada between January 1st, 2018 and December 31st, 2021. Data was collected as follows: before HIV diagnosis: chlamydia, gonorrhoea, syphilis, and/or hepatitis C antibodies. At the time of HIV diagnosis: age, sex, gender, race/ethnicity, sexual orientation. During follow-up: CD4 counts, viral load, HIV treatment, hospitalizations, and number of visits to HIV care. Main exposures evaluated: methamphetamine use, injection drug use, houselessness, and mental health conditions. Outcomes: started antiretroviral treatment and achieved an undetectable viral load. A descriptive statistical analysis was used. There were 404 new HIV diagnoses in Manitoba from 2018 to 2021; 44.8% were female, 55.2% male; 76.% self-identified as Indigenous, 13.4% white/European, 4.7% African/black; 86.6% cis-gender; 60.9% heterosexual, 13.4% gay, bisexual and men who have sex with men, and 1.7% lesbian. Injection drug use was reported by 71.8% and 43.5% of females and males respectively. Methamphetamine was the most frequently injected drug (62.4%). Amongst females, 81.8% experienced at least one of the following: houselessness (43.1%), mental health comorbidities (46.4%), and injection drug use (71.8%). Only 64.9% of all individuals had an undetectable viral load (61.1% females and 67.9% males), 56.5% among people experiencing houselessness, 59% among young people (≤29 years), and 60.1% among people who inject drugs. People newly diagnosed with HIV in Manitoba are disproportionately experiencing houselessness, mental illness, and injection drug use (mostly methamphetamine). This pattern is more pronounced for female individuals. These findings highlight the need for syndemic and gender-specific approaches, simultaneously addressing social and health conditions, to treat HIV. This work was supported by the Canadian Institutes of Health Research, The Manitoba Medical Service Foundation, The James Farley Memorial Fund and the Canada Research Chairs Program.

Valuing wildlife sightings at the species-wide and individual animal levels: an approach and application to bear viewing in Yellowstone National Park

ABSTRACT Wildlife viewing is a popular recreation activity in parks and protected areas around the world, yet information on the nonmarket value that visitors derive from viewing specific species, and how that value is affected by small-scale population changes, is lacking. We devised an approach to fill the gap. First, we applied the travel cost method to obtain the value of a wildlife viewing trip. Next, we estimated a value per animal sighting, which we aggregated by the number of visitors who experienced and valued a sighting. Finally, we incorporated the probability of viewing an animal to determine an individual animal’s contribution to sighting value, which varies by species type, visibility, and seasonality. We examined bear viewing in Yellowstone National Park. For grizzly and black bears, respectively, per-sighting values are $16 and $14, aggregate annual sighting values are $6.9 and $9.7 million, and annual per-bear viewing values are $46,000 and $15,000.

Cadmium soil contamination alters plant-pollinator interactions

Soil heavy metal contamination is often an unintended byproduct of historic land-use. This contamination can negatively impact resident plants and their interactions with other organisms. Plant fitness in contaminated landscapes depends not only on plant growth, but also on the maintenance of interactions with pollinators. Cadmium (Cd) is a heavy metal that is commonly found in agricultural, urban, and industrial ecosystems as a legacy of historic land-use. It is a prioritized pollutant in soils because of its wide distribution and strong biotoxicity. To understand how Cd influences plant growth and pollinator interactions, we grew sunflowers in media with three different Cd concentrations to represent the range of Cd contamination faced by sunflowers growing on land recovering from past land-use. We measured Cd contamination effects on sunflower morphology and pollinator foraging behavior, specifically the number of visits and visit duration. We then measured seed number and weight to determine if contamination directly or indirectly, as mediated by pollinators, altered plant fitness. Plant height was negatively correlated with Cd concentration, but contamination alone (in the absence of pollinators) did not affect sunflower reproduction. Bumble bees visited sunflowers grown in Exceeding Threshold Cd concentrations less often and for shorter time compared to visits to Below Threshold Cd sunflowers, but honey bees and sweat bees showed similar foraging behavior across Cd contamination treatment levels. Sunflower seed set was positively correlated with the total number of pollinator visits, and sunflowers grown in Exceeding Threshold Cd soil had marginally lower seed set compared to those grown in Below Threshold Cd soil. Our results suggest that at Exceeding Threshold Cd contamination levels plant-pollinator interactions are negatively affected with consequences for plant fitness.

Mental Wellness Self-Care in Singapore With mindline.sg: A Tutorial on the Development of a Digital Mental Health Platform for Behavior Change.

Singapore, like the rest of Asia, faces persistent challenges to mental health promotion, including stigma around unwellness and seeking treatment and a lack of trained mental health personnel. The COVID-19 pandemic, which created a surge in mental health care needs and simultaneously accelerated the adoption of digital health solutions, revealed a new opportunity to quickly scale innovative solutions in the region. In June 2020, the Singaporean government launched mindline.sg, an anonymous digital mental health resource website that has grown to include >500 curated local mental health resources, a clinically validated self-assessment tool for depression and anxiety, an artificial intelligence (AI) chatbot from Wysa designed to deliver digital therapeutic exercises, and a tailored version of the website for working adults called mindline at work. The goal of the platform is to empower Singapore residents to take charge of their own mental health and to be able to offer basic support to those around them through the ease and convenience of a barrier-free digital solution. Website use is measured through click-level data analytics captured via Google Analytics and custom application programming interfaces, which in turn drive a customized analytics infrastructure based on the open-source platforms Titanium Database and Metabase. Unique, nonbounced (users that do not immediately navigate away from the site), engaged, and return users are reported. In the 2 years following launch (July 1, 2020, through June 30, 2022), the website received >447,000 visitors (approximately 15% of the target population of 3 million), 62.02% (277,727/447,783) of whom explored the site or engaged with resources (referred to as nonbounced visitors); 10.54% (29,271/277,727) of those nonbounced visitors returned. The most popular features on the platform were the dialogue-based therapeutic exercises delivered by the chatbot and the self-assessment tool, which were used by 25.54% (67,626/264,758) and 11.69% (32,469/277,727) of nonbounced visitors. On mindline at work, the rates of nonbounced visitors who engaged extensively (ie, spent ≥40 seconds exploring resources) and who returned were 51.56% (22,474/43,588) and 13.43% (5,853/43,588) over a year, respectively, compared to 30.9% (42,829/138,626) and 9.97% (13,822/138,626), respectively, on the generic mindline.sg site in the same year. The site has achieved desired reach and has seen a strong growth rate in the number of visitors, which required substantial and sustained digital marketing campaigns and strategic outreach partnerships. The site was careful to preserve anonymity, limiting the detail of analytics. The good levels of overall adoption encourage us to believe that mild to moderate mental health conditions and the social factors that underly them are amenable to digital interventions. While mindline.sg was primarily used in Singapore, we believe that similar solutions with local customization are widely and globally applicable.

Recommendations on visit duration and sample number requirements for an automated head chamber system.

Automated head chamber systems (AHCS; GreenFeed, C-Lock Inc., Rapid City, SD) increasingly are being used for measuring the gas flux of unrestrained cattle. There are a wide range of recommendations for what constitutes a "good" visit (i.e., duration) to an AHCS and how many visits are required for the AHCS to quantify gas fluxes accurately and precisely. Accordingly, the purpose of this experiment was to investigate the effects of visit duration thresholds and the subsequent effects of these thresholds on the number of visits needed to provide adequate estimates of carbon dioxide (CO2) and methane (CH4) emissions, and oxygen (O2) consumption by beef cattle. This analysis utilized data from three previously published experiments with grazing beef steers and one experiment with finishing beef steers, with 103 steers total. When comparing all available visits, there was excellent agreement [Lin's concordance correlation coefficient (CCC) ≥ 0.96] between visits ≥ 3min in duration and those ≥ 2min for the three gases in all four experiments. When data from all four experiments were pooled, there was excellent agreement between visits ≥ 3min and those ≥ 2min and ≥ 1min for all gases (CCC ≥ 0.96). These results suggest that estimates from visits ≥ 2min are like those from visits ≥ 3min. Next, we investigated if including visits ≥ 2min or ≥ 1min would increase the minimal number of visits required to provide excellent agreement with the "gold-standard" (mean of all visits ≥ 3min). For this, we used only one of the experiments and randomly selected visits per animal ranging from n = 5 to 60, in increments of 5. The sole experiment was used because all animals had more than 60 visits. We then assessed the agreement between the "gold-standard" (mean of all visits ≥ 3min [144 ± 55.01 visits per steer]) estimates of CO2, O2, and CH4. The minimum number of visits required to achieve excellent agreement (CCC ≥ 0.90) to the "gold-standard" estimate for all gases was 30 visits ≥ 3min in duration, or 40 visits ≥ 2min in duration. Visits ≥ 1min in duration did not achieve excellent agreement, even when 60 were used. Based on these results, we recommend excluding visits < 3min in duration with 30 minimum visit records per animal. However, if researchers choose to implement a 2-min visit duration threshold then 40 visit records are needed per animal.

Trends of Buprenorphine Prescribing for Opioid Dependence Before, and During the Early and Later Part of the COVID-19: A Study from a Large Publicly-Funded Opioid Agonist Treatment Services in India.

The COVID-19 pandemic has affected the availability and access to medications for opioid dependence (OD). We examined the monthly trends in new buprenorphine/naloxone (BNX) treatment episodes, number of clinical visits for BNX, BNX dispensed per person, and BNX prescription over 56-month, which included pre-pandemic, during early, and later part of pandemic (Jan 2017 - Aug 2022). Research data were collected from the pharmacy database of a large publicly funded treatment center in India. A flexible, low-threshold service was adopted in April 2020 in response to the lockdown implemented on 25 March 2020. Change Point analyses were performed to examine monthly trends visually and statistically. We used Autoregressive integrated moving averages to forecast trends from April to Aug 2020 and March to August 2022, using Jan 2017 to March 2020 and March 2020 to February 2022 as training datasets. 993 patients were started on BNX treatment, 40452 BNX clinic attendances were made, 1401393 BNX tablets were dispensed, and 6795 new patients with OD were registered. The observed data for clinic attendance for BNX was significantly lower than the projected estimates in April -Aug 2020; however, observed new treatment episodes and monthly BNX prescriptions were within the 95% projected estimates; BNX dispensed per person was significantly more than the projected estimate. In contrast, observed BNX prescription trends surpassed the upper limit of 95% CI in March-Aug 2022. A low-threshold and flexible treatment service could mitigate the unintended consequences of pandemic-induced restrictions.

Forest lookout tower visitor data in the Covid epidemic periods: what the numbers tell

The Covid epidemic between the spring of 2020 and the summer of 2021 showed that there is an increasing demand for various forms of forest-related tourism. Number of visitors in forests broke records in certain places: 32 million visitor days were registered in 2020 in Pilisi Parkerdő Ltd. alone. In this article we present data originated from the automatic visitor counters placed on certain forest lookout towers. Processing the data, we can get an insight of the number and distribution of hikers in each period. As a result of the research, forest managers can learn more about the popular tourist destination, furthermore, knowledge is gained about the motivations and needs of forest tourism participants. Based on this, public welfare investments that meet real demands can be planned in a cost-effective manner. Ideally, the results achieved can bring satisfaction to all actors involved in forest tourism. On the demand (visitor) side, targeted and needs-tailored developments increase the experience factor of the time spent in the forest. On the supply (forestry) side, knowing the motivations makes the performance of public welfare tasks more efficient, which ultimately contributes to the improvement of the sector's image.

Flower-visiting lizards as key ecological actors for an endemic and critically endangered plant in the Canary Islands

Oceanic islands are places where biological assemblages are relatively simple, as compared to the mainland. On islands, however, pollinator assemblages may to be composed of a taxonomically disparate group of organisms (e.g. insects, lizards, and birds), some of them with opportunistic nectar-feeding behaviour. Here we investigated some components of pollination effectiveness of Lotus maculatus (Fabaceae), an endangered Canary Islands endemic. In a flower exclusion experiment, we bagged flowers and compared their subsequent fruit and seed set to that of control flowers. Number of interactions with vertebrate and invertebrate flower visitors was counted and it was recorded whether interactions were legitimate (potentially pollinating) or non-legitimate (nectar robbing). Additionally, we estimated pollen loads on lizards and looked for any relationship between reproductive success of individual plants and number of visits made by the top three flower-visiting species (in terms of both frequency of occurrence at censuses and number of floral visits). Bagged flowers fruited less and with fewer seeds than control flowers. The only observed flower-visiting vertebrate was the Tenerife lizard Gallotia galloti, whose interactions were always legitimate and with around a half of captured individuals carrying pollen grains. The most frequent flower-visiting insect was the honeybee Apis mellifera followed by the solitary bee Lasioglossum arctifrons. The honeybee, however, was only a nectar robber, and the solitary bee was not an effective pollinator, but rather a pollen gatherer. Fruit set by individual plants was positively related only to frequency of visits by the lizard. Thus, the lizard seems to play a key role in the conservation management of L. maculatus.

Adherence, health care utilization, and costs between long-acting injectable and oral antipsychotic medications in South Carolina Medicaid beneficiaries with schizophrenia.

Schizophrenia and schizoaffective disorder require long-term antipsychotic treatment with antipsychotic medications, but poor medication adherence can lead to increased health care utilization and costs. Long-acting injectable antipsychotics (LAIs) offer potential therapeutic advantages in that they require less frequent dosing and improved medication adherence. South Carolina has the highest adoption of LAIs among US states, making it an ideal population for comparing the effectiveness of LAIs vs oral antipsychotics (OAPs) in treating schizophrenia or schizoaffective disorder. To evaluate the effect of LAIs compared with OAPs on medication adherence, health care resource utilization, and costs among South Carolina Medicaid beneficiaries with schizophrenia or schizoaffective disorder. South Carolina Medicaid beneficiaries with at least 1 claim for an LAI or OAP between January 1, 2015, and December 31, 2018, aged 18 to 65, with at least 2 claims with diagnoses of schizophrenia or schizoaffective disorder were included. Propensity scores (PSs) were calculated using logistic regression adjusting for confounders and predictors of the outcome. We estimated the "average treatment effect on the treated" by employing PS-weighted t-tests and chi-square tests. A total of 3,531 patients met the inclusion criteria, with 1,537 (44.5%) treated with LAIs and 1,994 (56.5%) treated with OAPs. In PS-weighted analyses, the LAI cohort had a greater proportion of days covered than the OAP cohort with a 365-day fixed denominator (69% vs 64%; P < 0.0001), higher medication possession ratio with a variable denominator while on therapy (85% vs 80%; P < 0.0001), and higher persistence (82% vs 64%; P < 0.0001). The average number of inpatient visits and emergency department visits did not significantly differ between cohorts (0.28 hospitalizations, P = 0.90; 3.68 vs 2.96 emergency department visits, P = 0.19). The number of outpatient visits, including visits for medication administration, were greater in the LAI cohort (23.1 [SD 24.2]) vs OAP (16.9 [SD 21.2]; P < 0.0001); however, including the costs for medication administration visits, outpatient costs (per member) were approximately $2,500 lower in the LAI cohort (P < 0.0001). The number of pharmacy visits was greater in the OAP cohort (LAI 21.0 [SD 17.0] vs OAP 23.0 [SD 15.0]; P = 0.006). All-cause total costs were greater in the LAI cohort ($26,025 [SD $29,909]) vs the OAP cohort ($17,291 [SD $25,261]; P < 0.0001) and were driven by the difference in pharmaceutical costs (LAI $15,273 [SD $16,183] vs OAP $4,696 [SD $10,371]; P < 0.0001). Among South Carolina Medicaid beneficiaries, treatment with LAIs for schizophrenia or schizoaffective disorder was associated with greater medication adherence rates. Patients using LAIs had higher drug costs and total costs, but lower outpatient and total nondrug costs compared with those using OAPs.

Adherence to cancer screening for patients with Li-Fraumeni syndrome: A report on our experience at Fred Hutchinson Cancer Center.

e22553 Background: Li-Fraumeni syndrome (LFS) is a high-risk cancer predisposition syndrome where patients are at risk of developing multiple primary cancers, synchronous, and metachronous cancers in their lifetimes. Patients with LFS often serve as their own advocates to request and receive appropriate cancer screening as few clinicians have experience in caring for them and few clinics are adequately staffed to provide complex cancer screening coordination. Methods: Fred Hutchinson Cancer Center (Fred Hutch) is a large academic cancer care center associated with the University of Washington. In July 2020, Fred Hutch's clinical cancer genetic service launched a high-risk surveillance clinic for patients with hereditary cancer syndromes requiring services from multiple specialties. Our clinic has since helped patients with LFS receive coordinated cancer screening. Here we report on adherence to the Toronto protocol by reviewing patient demographic, cancer history and family history, and genetic records. Furthermore, we report on the number of visits, types of screening, and cancer diagnoses patients with LFS received since enrolling in the high-risk clinic. Results: A total of 112 patients with LFS were seen in the high-risk surveillance clinic between July 2020 and December 2023. Of these patients’ paths reviewed so far, 73 patients established with the clinic and received blood work and/or MRI imaging scans, and 42 were seen in at least one follow up visit. 2 patients with LFS were diagnosed with one or more new cancer diagnosis since enrollment, both have completed treatment, and both are without evidence of disease as of February 2024. Conclusions: The high-risk surveillance clinic was promptly utilized by patients with LFS for coordination of their complex cancer screening needs and to guide their next steps when triaging symptoms and concerns. While the clinic addresses a gap in cancer screening coordination, patients with LFS need wrap around care close to where they live which is difficult to accomplish in the Pacific Northwest.

Impact of immune checkpoint inhibitor-based combination therapy on palliative care utilization for patients with metastatic renal cell carcinoma.

e24086 Background: Palliative care (PC) is a vital tool in the treatment of patients with metastatic cancer, yet its role in metastatic renal cell cancer (mRCC) is poorly defined. These individuals are increasingly treated with immune checkpoint inhibitor-based combination therapies (ICT). While this approach confers a survival advantage, it comes with additional toxicity that may necessitate PC. Yet, little is known about how ICT impacts PC use for mRCC patients. Here we present real-world data from a single center with an embedded PC provider that evaluates the effect of ICT on PC utilization in mRCC and identifies predictors of PC use for these patients in the modern treatment era. Methods: A retrospective sample of patients who received systemic treatment for mRCC at the Jonsson Comprehensive Cancer Center from 2013 to 2023 was studied. With institutional approval, the electronic health record was queried for patient and disease characteristics. PC referral, engagement, and number of visits were compared between patients who did and did not receive ICT as first-line treatment using Pearson’s chi-squared and two-sample T tests. Predictors of PC utilization were identified using multivariable logistic modeling. Results: 146 patients were included. Mean age at mRCC diagnosis was 62.6 (SD 13.1) and 69.2% were male. The diverse patient sample was 6.4% non-Hispanic Black, 16.4% Hispanic, and 11.4% Asian. The majority (78.8%) had clear cell pathology and 20.5% had sarcomatoid features. More than 50% had more than 3 metastatic sites. More patients received ICT (45.2%) than tyrosine kinase inhibitor monotherapy (39.0%) or other single agents (15.7%). Patients travelled 53.2 (SD 98.0) miles for clinic visits. Overall, 48.6% had a PC referral and 43.8% completed a visit. Of the 46.6% of patients who died, 64.7% had a PC referral and 60.3% had a PC visit. There were no statistically significant differences in PC referral (55% vs. 44%, p = 0.19), PC engagement (50% vs. 39%, p = 0.17), or PC visits (mean 4.6 vs. 3.1, p = 0.19) for patients who received ICT compared to other treatments. Controlling for other variables, statistically significant predictors of PC referral were number of metastatic sites (OR 1.57, p = 0.01), distance from clinic (OR 0.99, p = 0.04), and presence of sarcomatoid features (OR 2.85, p = 0.02). Statistically significant predictors of PC engagement included number of metastatic sites (OR 1.61, p = 0.01). Conclusions: Using single institution real-world data, we found that PC referrals and engagement were driven by disease burden and adverse pathology, but not by treatment regimen. Patients receiving first-line ICT did not demonstrate increased need for PC, while patients who lived farther from clinic were slightly less likely to receive a PC referral. Further study of the role and timing of PC in the modern mRCC treatment era are warranted.

An exploratory randomized clinical trial on negative pressure wound therapy for lower limb full-thickness skin grafts of dermatosurgical patients.

Full-thickness skin graft (FTSG) reconstructions of lower limbs are especially prone to wound complications. Negative pressure wound therapy (NPWT) enhances wound healing, but no broad evidence exists if it promotes graft take of lower leg FTSGs. In this investigator-initiated, prospective, randomised and controlled trial, 20 patients with ambulatory FTSG reconstruction for lower limb skin cancers were randomised for postoperative treatment with either NPWT, or conventional dressings. As outcomes, adherence of the skin graft 1 week postoperatively, any wound complications within 3 months, including ≥3 weeks delayed wound healing, and the number of additional postoperative visits were compared. In both groups, grafts adhered equally well (p = 0.47); 80% of NPWT-treated and 100% of control group grafts adhered >90%. There was no significant difference in the number of postoperative complications/delayed wound healing (p = 0.65); 70% of patients in the NPWT and 50% in the control group developed a wound complication. Both groups had an equal number of patients with at least three additional control visits (p = 1.0). The study was discontinued after 20 patients were recruited, as no benefit from NPWT was seen. To conclude, the study showed no benefit from NPWT for lower limb FTSGs.

Cancer screening and first-time visits to oncology services during and after COVID-19 pandemic in Uruguay.

e23016 Background: On March 13, 2020, Uruguay confirmed the first cases of COVID-19 and the same day the government declared a Public Health Emergency that was extended until April 4, 2022. The measures implemented to mitigate the transmission included, among others, postponing screening studies and in-person consultations. Added to these measures was the fear of going to health centers and the consequences of the economic crisis, with the increasing difficulties in traveling and facing the co-payments necessary to access health services. This study aims to evaluate the impact of the COVID-19 pandemic on cancer screening and first time- visits to oncology services during the public health emergency and following its lifting. Methods: We compare the number of PAP test, mammograms and fecal immunochemical test (FIT) reported by the same comprehensive health providers during 3 periods: pre-pandemic (2018-2019), public health emergency period (March 13, 2020- April 4, 2022) and post-public health emergency (April 5 2022-June 30,2023). Cancer screening data was obtained from the screening registry of the Honorary Commission to Fight Cancer (CHLCC) and first oncology visits from the Oncology Electronic Health Record (HCEO). Health providers that report PAP, mammograms, and FIT cover around 90%, 30%, and 40% of health system users, respectively, and those that use HCEO, 40%. Results: After two years of COVID-19 public health emergency, the number of reported PAP smears test, mammography and fecal occult blood test, decreased by 26%, 46% and 33% respectively (Table 1). The reduction was greater during the first months of the pandemic and during the peak of the first wave (April-June 2021: PAP -50%, mammography -58%, occult blood test: -70%). Likewise, the number of first-time visits to oncology services decreased by 37%, reaching a 56% decline during the first wave. As shown in Table 1, these declines continued after the health emergency was lifted. Conclusions: Our results show an important decline of cancer screening and first-time visits to oncology services during the pandemic in Uruguay. After emergency was lifted, reported PAP test showed a partial recovery but mammography, occult fecal blood test and first-time visits to oncology services remain well below pre-pandemic levels. [Table: see text]

A learning-based granular variable neighborhood search for a multi-period election logistics problem with time-dependent profits

Planning the election campaign for leaders of a political party is a complex problem. The party representatives, running mates, and campaign managers have to design an efficient routing and scheduling plan to visit multiple locations while respecting time and budget constraints. Given the limited time of election campaigns in most countries, every minute should be used effectively, and there is very little room for error. In this paper, we formalize this problem as the multiple Roaming Salesman Problem (mRSP), a new variant of the recently introduced Roaming Salesman Problem (RSP), where a predefined number of political representatives visit a set of cities during a planning horizon to maximize collected rewards, subject to budget and time constraints. Cities can be visited more than once and associated rewards are time-dependent (increasing over time) according to the day of the visit and the recency of previous visits. We develop a compact Mixed Integer Linear Programming (MILP) formulation complemented with effective valid inequalities. Since commercial solvers can obtain optimal solutions only for small-sized instances, we develop a Learning-based Granular Variable Neighborhood Search and demonstrate its capability of providing high-quality solutions in short CPU times on real-world instances. The adaptive nature of our algorithm refers to its ability to dynamically adjust the neighborhood structure based on the progress of the search. Our algorithm generates the best-known results for many instances.