Year Of Outpatient Treatment Research Articles

Impact of the COVID-19 pandemic on utilization and cost for care of pediatric and young adult ALL

ObjectiveAcute lymphoblastic leukemia (ALL) is the most common childhood malignancy and among the most common malignancies in young adults and requires a unique pattern of healthcare utilization including an acute/emergent presentation and an intensive initial 8 months of therapy followed by two years of outpatient treatment. The COVID-19 pandemic caused massive global disruptions in healthcare use and delivery. This report aims to examine the effects of the COVID-19 pandemic on the presentation, diagnosis and continued management of childhood and young adult ALL in regard to utilization and cost of care among commercially insured individuals in the United States.ResultsUtilizing a commercial insurance claims database, 529 pediatric and young adult patients were identified who were diagnosed with ALL between January 2016 and March 2021. New diagnoses were evaluated by era and demographics. Utilization was measured by COVID-related era as number of inpatient and outpatient encounters, inpatient days, and cumulative cost during the initial 8 months of therapy. None of these cost or utilization factors changed significantly during or shortly after the pandemic. These findings reinforce that the necessary care for pediatric and young adult ALL was unwavering despite the massive shifts in the healthcare system caused by the COVID-19 pandemic. This provides a valuable benchmark as we further examine the factors that influence the pandemic’s impact on health equity and access to care, especially in vulnerable pediatric and young adult populations. This is the first investigation of the effect of the COVID-19 pandemic on utilization and cost of care in pediatric and young adult cancer.

Inpatient and outpatient treatment by specialist infant nutrition centres in Argentina effectively reduced child malnourishment.

We evaluated the impact of inpatient and outpatient treatment provided by an infant nutrition foundation in Las Heras, Mendoza, Argentina and identified the factors that influenced nutritional recovery. This 2010-2018 retrospective study was based on 300 children up to 5 years of age with primary malnutrition, who were treated by an inpatient recovery centre, then an outpatient prevention centre. We analysed the children's height, weight, psychomotor development and living conditions when they were admitted, discharged and had received 1 year of outpatient treatment. There were full data on 241 children and just admission and discharge data for 59. The children's mean age on admission and weight were 14.8 ± 12.4 months and 6.9 ± 2.3kg and they stayed in hospital for a mean of 59.5 ± 49.7 days. We observed a significant increase in the weight-for-age, height-for-age and weight-for-height z-scores when all three time points were compared (p < 0.001). Psychomotor development improved considerably in all patients after treatment. The factors that negatively influenced nutritional recovery were higher age at admission, suboptimal breastfeeding practices, low birth weight, longer hospital stays, younger maternal age and overcrowded housing. Combining inpatient recovery and outpatient preventive treatment was effective for undernourished children in Argentina.

Modelling trajectories of change in psychopathology and well-being during eating disorder outpatient treatment

Objective: There are considerable differences in how eating disorder (ED) patients respond to treatment. This study aimed to identify change trajectories of mental health during treatment. Method: Longitudinal data of 442 patients was used with five time points during a year of outpatient treatment. ED psychopathology and well-being were used as primary measures. A series of latent growth mixture models were applied to model trajectories of change. Results: Three latent classes were found for ED psychopathology and well-being. For ED psychopathology, a high baseline severity and slow recovery class (55.9% of the patients), a high baseline severity followed by a substantial recovery class (19.9%) and a moderate baseline severity and no significant recovery class (24.2%) were found. For well-being, a low baseline followed by a slow growth class (44.6%), a low baseline and substantial growth class (9.5%) and a moderate and stable well-being class (45.9%) was found. General psychopathology, early symptom change, hope for recovery, intrinsic motivation and the ED type were predictive of class membership in either ED psychopathology or well-being. Conclusions: This study shows variability in ED psychopathology and well-being change trajectories, modelled in meaningful latent recovery classes. These results may have clinical implications, such as adjusting patients’ treatment based on change trajectories.

Hospitalizations and length of stay of cancer patients: A cohort study in the Brazilian Public Health System.

The hospitalizations are part of cancer care and has been studied by researchers worldwide. A better understanding about their associated factors may help to achieve improvements on this area. The aims of this study were to investigate the association between demographic and clinical characteristics and hospitalizations, as well as between these characteristics and the length of stay (LOS), within the first year of outpatient treatment, for the most incident cancers in the Brazilian population. In this cohort study, we investigated 417,477 patients aged 19 years or more, who started outpatient cancer treatment, from 2010-2014, for breast, prostate, colorectal, cervix, lung and stomach cancers. The outcomes evaluated were: i) Hospitalizations within the first year of outpatient cancer treatment; and ii) LOS of the hospitalized patients. It was performed a binary logistic regression to evaluate the association between the explanatory variables and the hospitalizations and a negative binomial regression to evaluate their influence on the length of hospital stay. The hospitalizations occurred for 34% of patients, with a median of LOS of 6 days (IQR: 2-15). Female patients were 16% less likely to be hospitalized (OR: 0.84; 95% CI: 0.82-0.86), with lower average of LOS (AR: 0.98; 95% CI: 0.97-0.99), each additional year of age reduced in 2% the hospitalization odds (OR: 0.98; 95% CI: 0.98-0.99) and in 1% the average of LOS (AR: 0.99; 95% CI: 0.98-0.99), patients from South region had twice more chances of hospitalization than from North region (OR: 2.01; 95% CI: 1.93-2.10) and patients with colorectal cancer had greater probability of hospitalization (OR: 4.42; 95% CI: 4.27-4.48), with the highest average of LOS (AR: 1.37; 95% CI: 1.35-1.40). In view of our results, we consider that the government must expand the policies with potential to reduce the number of hospitalizations.

CARDIOVASCULAR COMPLICATIONS RISK AND VASCULAR AGE DYNAMICS IN LONG-TERM TREATMENT OF ARTERIAL HYPERTENSION

Aim. To evaluate the possibility for the novel scores implementation in everyday management by perindopril/amlodipine in arterial hypertension patients of high and very high risk. Material and methods . Totally, 30 patients included, with AH of high and very high risk (12 males, 18 females) at the age 57,7±9,3 y.o., who, after the in-patient management of non-controlled AH by fixed combination of perindopril/amlodipine doses 10/5, 5/10, 10/10 mg, respectively, were treated and followed up for the next 2 years (with additional control in 1 year). During this period there was control of BP dynamics, intervisit variability of SBP/DBP, adherence to treatment, some of hemodynamics values (by EchoCG), lipids, creatinin and glucose of blood. Based on the proposed new expert systems (ASCORE scale, “vascular age” assessment scale) a clinician evaluated the dynamics of individual risk of cardiovascular complications and the “vascular age”. Results . The outpatients had stage III AH, of those grade 2 AH was diagnosed in 26,7%, and grade3 in 73,3%. In one year of treatment by perindopril/amlodipine in office visit the level of SBP/DBP was 162,8±7,7/91,5±2,4 mmHg; adherence to treatment — 63,4%. During the second year patients adhered to clinicians recommendation, with the target BP levels achieved (adherence 83,4%). There was significant decrease of intervisit variability of SBP (with the baseline 11,6±1,4 mmHg at in-patient and to 4,3±0,2 mmHg in 2 years of outpatient treatment; p<0,001).Lipid spectrum values and glucose decreased significantly. Probability of 5-year risk of cardiovascular complications (CVC) decreased from 16,1±1,1% (in-patient) to 9,2±2,0% (p<0,01) and 4,4±0,7% (p<0,01) in 1 and 2 years, respectively. The “vascular age” during admittance was 14,4 years higher than real (passport), and in 2 years the values of passport age and VS overlapped (p<0,01). Conclusion . In real-practice circumstances we tested new European expert systems: 5-year risk score for cardiovascular events, and assessment of “vascular age” by SCORE, which demonstrated the probability of CVC risk decline and confirmed the concept of “vascular age” decrease under influence of effective antihypertension therapy. The fixed combination of perindopril/amlodipine, used during two years, showed clinical effectiveness in former non-controlled patients with AH, decreased the intervisit variability of BP, decreased individual risk of CVC and increased adherence to treatment.

Avaliação econômica da doença pulmonar obstrutiva crônica e de suas agudizações: aplicação na América Latina

A doença pulmonar obstrutiva crônica tem elevada prevalência em todo o mundo. Estima-se que entre 7% e 10% da população adulta seja afetada. No Brasil, a bronquite crônica tem uma prevalência de 12,7% na população de mais de 40 anos. Os estudos econômicos têm grande relevância em doenças de alta prevalência. A maioria dos estudos relacionados aos custos da doença pulmonar obstrutiva crônica provém de bases de dados nacionais de saúde. Poucos estudos avaliaram os custos sanitários diretos da doença. A partir destes, conclui-se que um paciente portador de doença pulmonar obstrutiva crônica gera um custo direto anual de 1.200 a 1.800 dólares. O custo correlaciona-se com a gravidade da doença: os pacientes graves geram um custo duas vezes maior que os menos graves, e por isso é vital o diagnóstico precoce. A estratégia mais custo-efetiva é a detecção precoce da doença, associada a campanhas contra o tabagismo. Em estágios avançados da doença, a hospitalização é responsável pelos custos mais elevados. Neste caso, o tratamento correto das agudizações é crucial como estratégia custo-efetiva. O custo médio de uma internação no Brasil é de 2.761 reais, o que representa quase o valor do tratamento ambulatorial por um ano. A antibioticoterapia é responsável por pequena parte do custo total da agudização. O uso de antibióticos mais eficazes pode ser uma estratégia custo-efetiva por reduzir a taxa de fracasso de tratamento. A análise econômica deve permitir a identificação e aplicação de estratégias custo-efetivas para o tratamento da doença.

The relationship between health-related quality of life and weight loss.

This is a report of health-related quality of life (HRQOL) changes in obese patients completing at least 1 year of outpatient treatment in a weight reduction program combining phentermine-fenfluramine and dietary counseling. Participants were 141 women (87.6%) and 20 men (12.4%) who had an average body mass index at intake of 41.1 kg/m(2) (SD = 7.0, range = 29.5 to 67.0 kg/m(2)) and an average age of 44.9 years (SD = 9.3, range = 23 to 65 years). HRQOL was assessed at intake and at 1-year follow-up using the Impact of Weight on Quality of Life (IWQOL)-Lite questionnaire. The relationship between HRQOL changes and weight loss was examined using Pearson correlations. Clinically meaningful change in HRQOL was defined as a 1.96 SEM reduction in IWQOL-Lite total score. On average, participants lost 20.2 kg or 17.6% of their weight over the 1-year period. Of the participants, 15.5% lost <10% of their weight, 24.2% lost 10% to 14.9%, 23.6% lost 15% to 19.9%, and 36.6% lost 20% or more. All five IWQOL-Lite scales and total score showed statistically significant improvement over the 1-year period. Changes in IWQOL-Lite scores from intake to 1 year showed statistically significant correlations with percentage of weight loss for all subscales and total score. Subscale correlations with weight loss ranged from 0.166 (Public Distress) to 0.396 (Physical Function) and was 0.370 for the total score. Forty-four percent of participants losing <10% met the criterion of clinically meaningful change, compared with 51.3% losing 10% to 14.9%, 55.3% losing 15% to 19.95%, and 76.3% losing >20%. For total score and for three of the five IWQOL-Lite scales (Physical Function, Self-Esteem, and Sexual Life), the relationship between weight loss and clinically meaningful change was linear and was significant at p < 0.05. Physical Function and Self-Esteem were most strongly affected by weight loss. HRQOL changes, as measured by an obesity-specific instrument (IWQOL-Lite), are strongly related to weight reduction.

Early intervention, social functioning and psychotic relapse of patients with recent-onset schizophrenic disorders

Social functioning and psychotic relapse were examined retrospectively in an early intervention programme in 133 young patients (mean ± SD age 20.3 ± 2.3 years) with recent-onset schizophrenia and related disorders. The programme included a combination of (1) pharmacotherapy; (2) psychoeducation of patients and parents; (3) individualized disease, medication and stress management; (4) support in finding structural activities; (5) establishment of parent groups; and (6) provision of continuity of care for both patients and parents. After 1 year of outpatient treatment, 89 patients (67%) who were inactive at admission had structured activities. However, 29 patients (21.8%) suffered a psychotic relapse of which 13.5% were severe and 8.3% mild. A severe relapse was, in most cases, followed by readmission. The length of time between the first contact with psychiatric services and admission to the treatment programme was associated with negative symptoms at the end of the treatment periods. Early psychosocial intervention combined with antipsychotic medication appears to improve social functioning and to reduce the relapse rate in recent-onset schizophrenia.

Impact of Treatment on God Image and Personal Adjustment, and Correlations of God Image to Personal Adjustment and Object Relations Development

This study examined the effectiveness of a religiously-based, object relations oriented psychotherapy treatment program. Effectiveness was measured by changes in personal adjustment and God image for a group of religious patients. An inpatient sample (N = 99), with the predominant diagnosis of major depression, was followed over the course of inpatient treatment and a year of outpatient treatment following hospitalization. Measures were administered at admission and discharge (N = 99), six months after discharge (n = 67), and 12 months after discharge (n = 30). The correlation of God image to object relations development was also examined. Inpatient treatment was found to have a significant positive impact on personal adjustment and God image. Improvement was maintained over the course of outpatient treatment but no significant further improvement was noted. Significant correlations were found among the measures at all four time points. Implications of these findings and suggestions for future research are discussed.

Starting Insulin Therapy in Children With Newly Diagnosed Diabetes: An Outpatient Approach

<i>Sir</i>.—I was delighted to see the clinical commentary by Dr Schneider regarding his experience with eight years of outpatient treatment of children with newly diagnosed diabetes who are not in need of hospital care.¹This approach was taught to me 20 years ago by the late David W. Smith, who early recognized that he could no better estimate a dose of intermediate-acting insulin after a week of chasing glucose with regular insulin in the hospital than if he had simply used a rule of thumb at the time of diagnosis. I remain convinced of the tremendous advantage of complete outpatient management as proposed by Dr Schneider.^2,3However, some youngsters do not have the family resources to respond appropriately to this approach; in such cases, hospitalization may be necessary to sort out the psychosocial situation and assure responsibility for the child. I have also found it necessary to