Visits For Group Research Articles

Racial and Ethnic Disparities in Pediatric Atopic Dermatitis.

Atopic dermatitis (AD) is one of the most common chronic childhood conditions. Disparities in treatment and access to care can result in poor disease control and decreased quality of life. The aim of this study was to determine whether race and ethnicity affect treatment and healthcare utilization for pediatric atopic dermatitis in central Florida. This study of 4008 children with AD compared healthcare utilization and management using the numbers of AD-related healthcare visits, prescriptions, testing, and subspecialty referrals. Multivariable models were used to compare racial and ethnic groups (Black, Hispanic, Asian, and Other) with the reference group of non-Hispanic White, while adjusting for common confounders. The mean number of urgent care visits for the Hispanic group was 1.61 times that of the non-Hispanic White group, and the mean number of emergency department visits was 3.71 (P < 0.001) times the reference group. Black or African American patients had a mean number of emergency department visits that was 1.52 times that of non-Hispanic White patients (P = 0.021). The mean count of primary care visits was lower among Hispanic patients and higher among Asian patients (P = 0.012). Visits to subspecialty clinics and hospitalizations did not differ significantly. There were no consistent patterns in differences of AD-related prescriptions, testing, or subspecialty referrals. This study indicates that racial and ethnic disparities exist in healthcare utilization in pediatric AD. The underlying factors contributing to these disparities need to be further studied and addressed to reach health equity within pediatric AD.

The impact of medical insurance and old-age security on the utilization of medical services by the older population with disabilities

ObjectiveIn this study, the impact of medical insurance and old-age security on the use of medical services by the older population with disabilities is analyzed. A reference for decision makers is provided to improve medical and old-age security policies and enhance the use of medical services by the older population.MethodsData were drawn from 3,737 older people with disabilities aged 65 years or above from the 2018 China Longitudinal Healthy Longevity Survey. A two-part model based on social ecological theory was used for both analysis and group prediction.ResultsIn terms of the use of outpatient medical services, old-age pension significantly increased the probability of outpatient visits for this population group (P < 0.05). Urban employee/resident medical insurance, the new rural cooperative medical insurance, and retirement pension significantly affected medical expenses. In terms of the use of inpatient medical services, the new rural cooperative medical insurance and retirement pension significantly influenced the choice of inpatient medical services; retirement pension increased inpatient medical expenditure (p < 0.01). The expected average probability of hospitalization, unconditional expected cost, and conditional expected cost for the older population with disabilities were 49.5%, RMB 6629.31, and RMB 3281.51, respectively. Both conditional and unconditional expected costs were significantly higher for older people with disabilities with the following attributes: male, married, no less than three chronic conditions, and unassisted daily care; costs were lower for older people with disabilities who are female, not married, had less than three chronic conditions, and had a spouse, child, or other caregiver.ConclusionMedical insurance and old-age security can significantly promote the utilization of medical services by the older population with disabilities. It is therefore recommended to focus on strengthening the support and health management of these people who are unattended to improve the effective use of health services and better meet their needs.

Comparative assessment of the clinical outcomes of clear aligners compared to fixed appliance in class II malocclusion.

This study compared clinical outcomes between aligners and fixed appliances in class II adolescent patients. Records of 31 aligners and 35 fixed class II patients, aged 13.5 ± 1.6years were compared. Class II elastics was the mechanism employed for correcting the malocclusion. DI scores were used to compare initial complexity, and the PAR index scores were used to compare the clinical outcomes. Data on demographics, treatment and finishing durations, number of visits and refinements,duration of class II correction, and changes in the IMPA were collected. The mean pre-, post-treatment, and overall reduction in PAR index scores between the groups were not significantly different (P > 0.05). The clear aligners group had significantly shorter treatment duration (20.0 ± 11.6 months) than the fixed group (27.4 ± 9.1 months) (P < 0.001). The number of visits for the aligners' group was significantly less (12.7 ± 6.2) than in the fixed group (17.8 ± 5.8) (P < 0.001). Duration for class II correction was significantly shorter for clear aligners (13.3 ± 10.0months) compared to the fixed group (17.4 ± 9.0 months) (P = 0.026). A smaller post-treatment change in IMPA (2 ± 6°) was detected in the aligners group compared to the fixed group (5 ± 6°) (P < 0.05). Treatment outcomes for aligners in class II adolescent patients were comparable to those achieved in fixed appliances. Shorter treatment and class II correction durations, fewer visits, and better control for the IMPA were noticed in the aligners' group. Treating class II adolescent patients with aligners seems promising and demands shorter treatment time and fewer visits.

KardiaMobile 6L versus 12-lead ECG: Effects on clinic utilization time.

We aimed to study whether KardiaMobile 6L 30-second capture technology could shorten ECG collection time compared to standard 12L ECG without compromising data usability. A single-center, non-randomized trial was performed on patients presenting for follow-up visits to the electrophysiology (EP)clinic. Providers in the KardiaMobile 6L group were allowed to request a standard 12L if the 6L was deemed insufficient for clinical care. Room utilization times, defined as the time from medical assistant room entry to exit, were compared for each group. There were 100 patients in the study, with 50 in each arm. Average room utilization time for the 12L group and 6L groups were 10.33 ± 2.2and 7.27 ± 1.93 min, respectively (p < .001). In 8 (16%) visits for the 6L group, an additional 12L was requested. For EP follow-up visits, clinic utilization time was significantly reduced with the KardiaMobile 6L compared to the 12L ECG with infrequent need for an additional 12L.

Novel Internet Support for Neck-Specific Rehabilitation Improves Work-Related Outcomes to the Same Extent as Extensive Visits to a Physiotherapy Clinic in Individuals with Chronic Whiplash-Associated Disorders: A Prospective Randomised Study

PurposeTo address the current lack of information about work-related factors for individuals with whiplash-associated disorders (WAD) we investigated the effectiveness of 3 months of neck-specific rehabilitation with internet support in combination with four physiotherapy visits (NSEIT) compared to the same exercises performed twice a week (24 times) at a physiotherapy clinic (NSE).MethodsThis is a prospective, multicentre, randomised controlled trial regarding secondary outcomes of work-related factors in 140 individuals with chronic moderate/severe WAD with 3- and 15-month follow-up.ResultsThere were no group differences between NSE and NSEIT in the Work Ability Scale or work subscales of the Neck Disability Index, Whiplash Disability Questionnaire or Fear Avoidance Beliefs Questionnaire (FABQ-work). Both groups improved in all work-related outcome measures, except for FABQ-work after the 3-month intervention and results were maintained at the 15-month follow-up. Conclusions: Despite fewer physiotherapy visits for the NSEIT group, there were no group differences between NSEIT and NSE, with improvements in most work-related measures maintained at the 15-month follow-up. The results of the present study are promising for those with remaining work ability problems after a whiplash injury.Protocol registered before data collection started: clinicaltrials.gov NCT03022812.

(299) The Modulating Effects of Follicle Stimulating Hormone and Clomid on Men with Azoospermia or Oligozoospermia Taking Human Chorionic Gonadotropin

Abstract Introduction Depression of spermatogenesis is a significant concern for hypogonadal patients on testosterone therapy. Human chorionic gonadotropin (hCG) is commonly prescribed in these men to prevent testicular atrophy and to maintain some degree of spermatogenesis. Furthermore, hCG dosages are significantly increased when a pregnancy is desired. Historically, we have concomitantly used Clomid to stimulate FSH and testosterone production since both are needed for optimal spermatogenesis. However, with the availability of compounded FSH, we have introduced its usage instead of Clomid to evaluate if it yields superior quantitative sperm production. Objective To investigate which medication pairings yields the greatest improvement in hormone and semen parameters over time. Methods Including men with azoospermia or oligozoospermia who were prescribed hCG, we noted whether the men were additionally taking FSH or Clomid. The patient population of men in the hCG + FSH group had 32, and the hCG + Clomid group totaled 14. Baseline laboratory values were documented for testosterone and total sperm count for each patient prior to being prescribed their combined medications, followed by subsequent values for these variables in the months following this prescription. ANOVAs were employed using SPSS to analyze the change in the two assessed metrics across follow up visits. Results By analyzing increase in testosterone over time, the hCG + FSH cohort experienced the greatest improvement after four follow up visits (600.89 ng/dL after four visits, 150.22 (ng/dL)/visit), outperforming the hCG + Clomid group (505.63 ng/dL after four visits, 126.41 (ng/dL)/visit). The ANOVAs across the subsequent visits for each treatment group are as follows: hCG + FSH: f-ratio = 3.226, p-value = 0.0137; hCG + Clomid: f-ratio = 1.456, p-value = 0.219. Regarding total sperm count, the hCG + FSH group surpassed the HCG + Clomid group across the follow-up visits as well: hCG + FSH: 41.47 million after three follow-up visits; hCG + Clomid: 26.20 million after three follow-up visits. The ANOVAs across the subsequent visits for each treatment group are: hCG + FSH: f-ratio = 3.015, p-value = 0.0339; hCG + Clomid: f-ratio = 1.485, p-value = 0.234. Conclusions Those taking hCG with FSH experienced a greater improvement in both testosterone and total sperm counts compared to men on hCG and Clomid. It would seem that the use of FSH gives a more rapidly successful outcome for hypogonadal patients, since its combination with hCG acts directly to stimulate spermatogenesis, within the testes rather than requiring, as with Clomid, secondary stimulation through the pituitary gland's secretion of LH and FSH. With the relatively recent introduction of FSH as compounded biologics and its reduction in cost compared to brand FSH, the use of this trophic hormone can now be more widely used. Moreover, these data suggest that hCG with FSH results in a more rapid improvement in both spermatogenesis and serum testosterone than historically alternative therapies. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Larry Lipshultz: AbbVie (Consultant) American Medical Systems/Boston Scientific (Speaker) Aytu BioScience (Consultant) Contraline, Inc. (Consultant) Endo Pharmaceuticals (Consultant/Speaker) Inherent Biosciences (Advisor) Lipocine (Consultant).

Post-discharge follow-up of patients with spine trauma in the National Spinal Cord Injury Registry of Iran during the COVID-19 pandemic: Challenges and lessons learned

PurposeThe purpose of the National Spinal Cord Injury Registry of Iran (NSCIR-IR) is to create an infrastructure to assess the quality of care for spine trauma and in this study, we aim to investigate whether the NSCIR-IR successfully provides necessary post-discharge follow-up data for these patients. MethodsAn observational prospective study was conducted from April 11, 2021 to April 22, 2022 in 8 centers enrolled in NSCIR-IR, respectively Arak, Rasht, Urmia, Shahroud, Yazd, Kashan, Tabriz, and Tehran. Patients were classified into 3 groups based on their need for care resources, respectively: (1) non-spinal cord injury (SCI) patients without surgery (group 1), (2) non-SCI patients with surgery (group 2), and (3) SCI patients (group 3). The assessment tool was a self-designed questionnaire to evaluate the care quality in 3 phases: pre-hospital, in-hospital, and post-hospital. The data from the first 2 phases were collected through the registry. The post-hospital data were collected by conducting follow-up assessments. Telephone follow-ups were conducted for groups 1 and 2 (non-SCI patients), while group 3 (SCI patients) had a face-to-face visit. This study took place during the COVID-19 pandemic. Data on age and time interval from injury to follow-up were expressed as mean ± standard deviation (SD) and response rate and follow-up loss as a percentage. ResultsAltogether 1538 telephone follow-up records related to 1292 patients were registered in the NSCIR-IR. Of the total calls, 918 (71.05%) were related to successful follow-ups, but 38 cases died and thus were excluded from data analysis. In the end, post-hospital data from 880 patients alive were gathered. The success rate of follow-ups by telephone for groups 1 and 2 was 73.38% and 67.05% respectively, compared to 66.67% by face-to-face visits for group 3, which was very hard during the COVID-19 pandemic. The data completion rate after discharge ranged from 48% – 100%, 22% – 100% and 29% – 100% for groups 1 – 3. ConclusionsTo improve patient accessibility, NSCIR-IR should take measures during data gathering to increase the accuracy of registered contact information. Regarding the loss to follow-ups of SCI patients, NSCIR-IR should find strategies for remote assessment or motivate them to participate in follow-ups through, for example, providing transportation facilities or financial support.

Concordance analysis between practice and algorithm recommendations for cardiac screening in a cohort of high-risk lymphoma survivors.

498 Background: Cardiovascular disease (CVD) is a leading cause of mortality among cancer survivors, with the risk peaking five or more years post-diagnosis. Among survivors, lymphoma patients receiving cardio-toxic therapies such as anthracyclines and mediastinal radiation exhibit an elevated risk for CVD-related complications and mortality. To address this concern, we have implemented lymphoma survivorship care algorithms that outline recommended cardiovascular health monitoring for these patients. Methods: In 2021, 387 patients were seen in the Lymphoma Survivorship clinic. Of these, 53 were previously treated with both an anthracycline and thoracic radiation. We conducted a review of cardiac screening tests and visits for this high-risk group, with the aim of evaluating the concordance between their survivorship care and the algorithm recommendations. Specifically, we assessed the frequency and type of cardiac screening received by these patients at risk for cardiac late effects from treatment, and the prevalence of cardiac abnormalities in the cohort. Results: The mean age of the patients at their most recent survivorship appointment was 53 years, while the median time since the last radiation therapy was 11.67 years. Of the patients studied, 84.9% had a post-treatment cardiology consultation, with 69.8% receiving cardiology services at MD Anderson. An echocardiogram (ECHO) was available for 90.5% of patients, with no abnormal left ventricular ejection fraction (LVEF) reported. The average number of cardiology visits was 3.08 per patient, and the average time between the most recent ECHO and the latest survivorship appointment was 1.26 years. A lipid profile was performed for 98% of the cohort, typically during their survivorship appointment or a subsequent cardiology visit. Body Mass Index (BMI) and blood pressure were assessed in all patients, with an average BMI of 29 and hypertension reported in 28% of cases. Conclusions: We identified a high level of concordance in survivorship care and our algorithm’s recommendations for a cohort of lymphoma survivors with a high risk of cardiovascular late effects post-treatment. We conclude the algorithm was beneficial in guiding care in this patient population. Collaboration with cardiology services is crucial for identifying and monitoring high-risk survivors, updating cardiology care guidelines, and continuously monitoring long-term cardiovascular outcomes.

Costs and Resource Utilization of People with Stable Heart Failure and Insomnia: Evidence from a Randomized Trial of Cognitive Behavioral Therapy for Insomnia

ABSTRACT Objectives Nearly half of patients with chronic heart failure (HF) report insomnia symptoms. The purpose of this study was to examine the impact of CBT-I versus HF self-management on healthcare costs and resource utilization among patients with stable chronic HF who participated in a clinical trial of the effects of CBT-I compared to HF self-management education (attention control) over 1 year. Methods We measured resource utilization as self-reported (medical record review) physician office visits, emergency department visits, and inpatient admissions at 3-month intervals for 1 year after enrollment. Costs were estimated by applying price weights to visits and adding self-reported out-of-pocket and indirect costs. Univariate comparisons were made of resource utilization and costs between CBT-I and the HF self-management group. A generalized linear model (GLM) was used to model costs, controlling for covariates. Results The sample included 150 patients [79 CBT-I; 71 self-management (M age = 62 + 13 years)]. The CBT-I group had 4.2 inpatient hospitalizations vs 4.6 for the self-management group (p = .40). There were 13.1 outpatient visits, in the CBT-I compared with 15.4 outpatient visits (p-value range 0.39–0.81) for the self-management group. Total costs were not significantly different in univariate or ($7,813 CBT-I vs. $7,538 self-management), p = .96) or multivariable analyses. Conclusions Among patients with both HF and insomnia, CBT-I and HF self-management were associated with similar resource utilization and total costs. Additional research is needed to estimate the value of CBT-I relative to usual care and other treatments for insomnia in patients with HF.

대형육류한식당 관계마케팅의 수요 결정요인 분석연구: 외식관여도를 중심으로

The purpose of this study is to identify the factors that consumers consider important when choosing and visiting large scale Korean BBQ in Seoul and the metropolitan area, in order to activate offline restaurants that primarily conduct face-to-face business after the COVID-19 pandemic. The study analyzed the relationship marketing factors and visit demand determinants between high/low involvement groups according to dinning involvement, using truncated Poisson(TP) and truncated negative binomial(TNB) models in LIMDEP 8.0. The study found that the pricing policy factor among the relationship marketing factors for maintaining continuous relationships with customers had a positive effect on the number of visits to large scale Korean BBQ at a significance level of 1%. In addition, it was found that income had a positive effect on the number of visits for the high involvement group, while for the low involvement group, being male, married and younger had a positive effect on the number of visits.

Effects of Changing Veterinary Handling Techniques on Canine Behaviour and Physiology Part 1: Physiological Measurements.

Signs of distress in dogs are often normalized during routine veterinary care, creating an animal welfare concern. We sought to test whether targeted interventions during veterinary visits affect physiological indicators of stress in dogs. Some 28 dogs were examined within four visits across 8 weeks. All dogs received the same care during the first visit and were then randomized into control and intervention groups for visits 2-4. In the intervention group, 14 dogs underwent procedures designed to reduce stress and to enlist their collaboration during examination. The 14 dogs in the control group received routine care. At each visit, heart rate (HR), serum cortisol (CORT), neutrophil lymphocyte ratio (NLR), and creatine kinase (CK) were measured. A composite stress index based on the summed standardized scores for these markers was constructed. No differences in HR, NLR, and CK parameters between groups were found, and both groups had a decrease in CORT by visit four. However, the intervention group showed a greater overall decrease in CORT between the first and fourth visit than the control group (p < 0.04). The composite stress index differed between the first and fourth visits for the intervention group, but not for the control group (Intervention p = 0.03; Control p= 0.288). There was a tendency for the composite stress index to worsen at visit four vs. visit one for the control group. The findings suggest that dogs that participated in adaptive, collaborative exams and procedures designed to minimize fear had a greater reduction in stress over time compared to those receiving standard care.

A comparative evaluation of presurgical infant orthopedics of modified Grayson’s technique with clear aligners incorporating a nasal elevator in patients with unilateral cleft lip and palate

To assess the differences between 2 methods of presurgical infant orthopedics: the modified Grayson's technique and a new technique using clear aligners in patients with complete unilateral cleft lip and palate. For this prospective comparative cohort study, 30 patients were divided into 2 groups: group A (modified Grayson technique) and group B (clear aligner trays), with 15 patients each. Scanned cast measurements were taken before and after treatment and evaluated using an appropriate 3-dimensional software assessing treatment changes in the alveolus (eg, reduction of width between major and minor segment, angulation change of each respective segment [intragroup and intergroup, respectively]). This was supplemented with standardized anterioposterior, Worms-eye view, and profile photographs assessing changes in columellar angle, nostril width, height, nasolabial angle, and soft-tissue cleft gap. Furthermore, the number of visits for each patient group was also tabulated and assessed. The differences were compared using the independent t test and Mann-Whitney U test for the respective parameters. Groups A and B showed similar posttreatment changes, with no overt significant differences. However, there was a statistically significant difference in the number of visits (P<0.05), with group B having much lower visits to the center than group A. The posttreatment values matched previously established growth reference values. The analysis of photographic measurements showed improved nasal asymmetry in both groups without any significant difference. Because there was no difference in the treatment results between the 2 methods and a reduction in the number of required patient visits, presurgical infant orthopedics via clear aligners could pave the way for a more patient-efficient approach.

Immediate versus Delayed Attachment Incorporation Impact on Prosthetic Aftercare among Mandibular Implant-Supported Overdenture Wearers.

Background: Substantial effort is dedicated to finding the most favorable parameters that will ensure low aftercare demands among edentulous patients wearing mandibular implant supported overdentures (MISODs). The purpose of this retrospective cohort study was to compare prosthetic aftercare between MISOD patients with a simultaneous (group A) vs. a three-week settling in period (group B) prior to attachment incorporation. Methods: Forty-five patients enrolled in this study. Two implants per patient were placed using a two-stage implant insertion protocol. Second-stage surgery was performed after three months. All patients received ball attachments using the direct (chairside) incorporation method. Twenty-two patients received their dentures with simultaneous attachment activation and the rest—twenty-three patients—after a three-week settling in period. Patients’ files were scanned for aftercare visits. Outcome parameters included sore spot relief, attachment incorporation, and denture repair. Additionally, gingival index measurements were compared. Confounding factors included age, gender, and implant dimensions. Results: The mean follow-up for the entire cohort was 84 ± 21 months, and the range 39–120 months. The mean number of visits for group A vs. B respectively: pressure sores relieve (3.63 ± 0.84 vs. 3.71 ± 0.61, p = 0.581), liner exchange due to loss of retention (2.09 ± 1.03 vs. 2.31 ± 1.04 p = 0.487), and gingival index (1.3 ± 0.3 vs. 1.03 ± 0.2, p = 0.653) exhibited no statistically significant differences between the tested groups. No statistically significant differences between the groups were also noted for the denture repair aftercare treatments (p = 0.318) and the independent variables including age, gender, and implant length. Conclusions: Prosthetic aftercare in MISOD wearers is similar whether a simultaneous or a three-week settling in period for attachment incorporation is applied.

Drowning prevention counselling by paediatricians to educate caregivers on water safety.

Drowning is the leading cause of unintentional injury death for children 1-4 years of age in the USA. Texas, a southeastern state, is disproportionately burdened by paediatric drowning. The aim of this project was to increase drowning prevention counselling provided during well-child visits to families with children aged 0-10 years. We developed and implemented a water safety counselling programme for paediatricians to impart to families during well child, urgent care and ED visits for 0-10year age group. Physicians completed and self-reported demographic, pre- and post-intervention, counselling rate and project evaluation surveys, while caregivers completed post-intervention surveys only. Both physicians and caregivers were surveyed on evidence-based drowning prevention strategies (four-sided fencing of pools, touch supervision, life jackets and swim/cardio-pulmonary resuscitation classes). Thirty-three physicians and 1934 caregivers participated in the project. Physicians demonstrated statistically significant improvement in discussing drowning prevention with patients (3.5 vs. 4 on Likert scale; P=0.002) in 2018 versus 2019. The counselling frequency in primary care settings increased from 54% to 70% from year 1 to 2. 100% of physicians correctly identified the best drowning prevention strategy and 80.6% of caregivers reported learning new water safety information in 2019 versus 68.8% in 2018 (P value < 0.001). This water safety education programme demonstrated increased drowning prevention counselling during well-child visits. The counselling was effective as demonstrated by increased caregiver acquisition of new water safety information. Paediatricians had adequate drowning prevention knowledge; an efficient counselling strategy helped them impart this knowledge to their patients.

Role of ultrathin skin graft in early healing of diabetic foot ulcers: a randomized controlled trial in comparison with conventional methods.

Diabetic foot ulcers (DFUs) are a global burden on health care systems. Despite the availability of various treatment modalities, many DFUs do not heal. Nonhealing wounds can lead to various complications, which add to significant morbidity in terms of the degree of moisture retained in the dressing, pain, foul order, and restriction of daily activities. A different treatment modality that can promote the wound healing process earlier (and is cost-effective, easy to use, and readily available) may be necessary to consider. The purpose of the current study was to demonstrate the efficacy of ultrathin skin grafting (UTSG) in the early healing of DFUs in terms of cost-effectiveness, reduced total number of hospital visits, and final wound outcome (ie, limb salvage rate). A randomized controlled trial was conducted in which 52 patients were treated with either UTSG (test group) or conventional dressing (control group). Both groups were compared by time to healing, number of hospital visits, cost, and final outcome of the wound. By the end of the 12-week study period, 84.61% of wounds managed with UTSG healed completely, whereas only 53.84% of wounds managed with conventional methods achieved complete healing. The test group achieved a more than 50% wound size reduction within 6 weeks after grafting. There were fewer hospital visits for the test group, indicating this grafting technique was more cost-effective than the control group. As demonstrated in this study, UTSG appears to be beneficial in achieving faster healing of DFUs and improving the final outcome of the wound.

Benefits of Telemonitoring of Pulmonary Function-3-Month Follow-Up of Home Electronic Spirometry in Patients with Duchenne Muscular Dystrophy.

Background: In patients with Duchenne Muscular Dystrophy (DMD), the respiratory system determines the quality and length of life; therefore, the search for easy and safe everyday monitoring of the pulmonary function is currently extremely important, particularly in the COVID-19 pandemic. The aim of the study was to evaluate the influence of a three-month home electronic spirometry (e-spirometry) monitoring of the pulmonary function and strength of respiratory muscles as well as the patients’ benefits from this telemetric program. Methods: Twenty-one boys with DMD (aged 7–22; non-ambulatory-11) received a remote electronic spirometer for home use with a special application dedicated for patients and connected with a doctor platform. Control of the hospital spirometry (forced vital capacity-FVC, forced expiratory volume in 1 second-FEV1, peak expiratory flow-PEF) and respiratory muscle strength (maximal inspiratory-MIP and expiratory pressures-MEP) before and after the three-month monitoring were performed as well telemonitoring benefit survey. Results: A total of 1403 measurements were performed; 15 of the participants were able to achieve correct attempts. There were no differences between the hospital and the home spirometry results as well as between respiratory muscle strength during v1 vs. v2 visits for the whole study group (all parameters p > 0.05); the six participants achieved increased value of FVC during the study period. There was a positive correlation between ΔFVC and the number of assessments during the home spirometry (r = 0.7, p < 0.001). Differences between FVC and MIPcmH2O (r = 0.58; p = 0.01), MEPcmH2O (r = 0.75; p < 0.001) was revealed. The mean general satisfaction rating of the telemonitoring was 4.46/5 (SD 0.66) after one month and 4.91/5 (SD 0.28) after three months. The most reported benefit of the home monitoring was the improvement in breathing (38% of participants after one month, 52% after three months of telemonitoring). Forgetting about the procedures was the most common reason for irregular measurements; the participants reported also increased motivation but less time to perform tests. Conclusions: The study indicates high compliance of the home telemonitoring results with the examination in the hospital. Benefits from home spirometry were visible for all participants; the most important benefit was breathing improvement. The remote home spirometry is usable for everyday monitoring of the pulmonary function in DMD patients as well can be also treated as respiratory muscle training.

The Impact of Axial Eye Growth on Foveal Avascular Zone Measurements in Children.

SIGNIFICANCEFoveal avascular zone (FAZ) area is a frequently used biomarker in diseases impacting the retinal vasculature in pediatric populations. Variation in axial length between individuals results in differences in lateral image scale, which affect the accuracy of FAZ area measurements. Accordingly, changes in axial length over time within individual children would affect estimates of FAZ area change.PURPOSEThis study aimed to quantify how changes in axial length over time affect estimates of FAZ area change using optical coherence tomography angiography (OCT-A) images.METHODSTwenty pediatric participants (<18 years old) and 40 adult participants were imaged on Optovue's Avanti system (Fremont, CA) and had axial length measurements acquired at two time points. The FAZ was segmented twice using the OCT-A image at each time point. Foveal avascular zone area was estimated at both time points using the assumed/fixed axial length of the OCT-A device (unscaled) and using the participant's axial length (scaled). Changes in FAZ area over time were compared between the pediatric and adult groups using both unscaled and scaled data.RESULTSThe average ± standard deviation follow-up time was 3.35 ± 1.66 years for the pediatric group and 2.90 ± 1.65 years for the adult group. Using unscaled data, FAZ area seemed to decrease between visits in the pediatric group (P = .004), whereas the FAZ area increased between visits in the adult group (P = .003). When correctly scaled data were used, the FAZ area still increased between visits for the adult group (P < .001), although the FAZ area no longer showed a significant change between visits for the pediatric group (P = .37). When comparing the normalized FAZ area change across visits between unscaled and scaled data, a significant difference was found between the adult and pediatric groups (P < .001).CONCLUSIONSScaled data should be used when measuring FAZ area in pediatric populations, especially in longitudinal studies.

Intravenous drug users in Iceland: Use of emergency departments, hospital admissions and mortality

Drug abuse is a significant contributor to premature disease and mortality. Drug users are less likely to attend traditional Primary Health Care and more likely to present to Emergency Departments with their problems. Drug users often present late for treatment and find difficult ot engage and follow through treatment in standard models of health services. The study is retrospective. 108 intravenous drug users were identified upon admission to one of three intpatient addiction treatment centres in Iceland in the years 2012-2013. Case notes for the two years leading to admission were examined. The study group had significantyl more contacts with Emergency Departments than a matched sample from the community (p<0.001). Mean number of visits for the study group per year was 4.8 (median 3.5) and 43% had four or more visits in a year. Majority of visits were for pshychiatric symptoms with a third considered serious. The two main medical reasons were infections from injecting and accidents/violence. There was no significant difference in study parameters between those who mainly use methylphenidate vs other substances. Mortality rate for the study group compared to the general population of same age was 26.4 (CI 16.7-41.5, (p<0.01)). Intravenous drug users are a vulnerable group with high level of psychiatric and medical problems and high mortality. It is important that this group has good access to evicence based addiction treatment, but also to medical and psychiatric services that are adapted to their needs.

The Effect of Care Provided at Home by Public Health Nurse on Control of Type II Diabetes Mellitus.

AIMThe aim of the study was to examine the effect of home care provided for patients with type II diabetes by public health nurse on HbA1c, and to investigate the opinions of these patients regarding diabetes.METHODThe quantitative aspect of the study consisted of a pre and posttest with the control group; the qualitative aspect consisted of a semi-structured interviewing technique. The sample size was 48 patients receiving treatment within the clinic of hospital during 11th–30th April 2016. Because some patients were excluded from the study, the research was completed with a sample size of 20 for the experiment and 20 for the control group. The following forms were used during data: Pre and post measurement and qualitative interview forms. A total of seven home visits were conducted for the experiment group and two home visits for the control group, during 2nd May to 27th October, 2016.RESULTSHbA1c decreased by 0.75% in the experiment group (p<0.05). It was found that faulty usage of insulin was treated; all patients developed the habit of tracking blood glucose. Blood glucose of three patients continued to remain at high levels, and most of the patients failed to develop healthy eating habits and regular exercising.CONCLUSIONAccording to these results, it is advised that long-term interventions be planned with the contributions of other experts.

The effect of Hyaluronic Acid as an Adjunct after Scaling and Root Planning in the Treatment of Chronic Periodontitis

The aim of this study is to evaluate the effect of the subgingival application of 0.8% hyaluronic acid (HA)gel as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. Twenty patientswith chronic periodontitis were recruited to participate in a study and divided to Group 1 (G1) treated with8% hyaluronic acid gel as an adjunctive to scaling and root planning (HARP) and Group 2 (G 2) treated withscaling and root planning only. Plaque index (PL.I) Gingival index (G.I) and bleeding on probing (B.O.P)were evaluated pretreatment (baseline) (1st visits), one week (2nd visits), and 4 weeks (3rd visit) posttreatment. Subgingival plaque sample were taken for microbiologic analysis at baseline and 4 weeks posttreatment. Intragroup comparison result between visits for Group 1showed that there was highly significantdifferent for BOP, CFU, and no significant different for PLI and GI between 2nd and 3rd visit. For G 2, therewas highly significant different for GI and significant for PLI and BOP, and non-significant different CFU,between 2nd and 3rd visit. Intergroup comparison for clinical parameter and bacteriological result betweenvisits Showed that there was highly significant different in1st visit for PLI, BOP and CFU in 3 rd visit. Itcan be conclude that the local application of hyaluronic acid gel (0.8%) in conjunction with scaling androot planning have a beneficial effect on clinical periodontal parameter and may prevent recolonization ofperiodontal pathogens in patients with chronic periodontitis