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Objectives To examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization. Methods Retrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories of Medicare spending on: hospital services, physician services, post-acute care services, and other services. Generalized estimating equations (GEE) with a log link gamma distribution and first order autoregressive, correlation matrix was used to estimate cost ratios (CR) of population segments, and GEE with a logit link binomial distribution was applied to estimate odds ratios (OR) of healthcare use. Results Participants in the major complex chronic illness segment who were also pre-frail or frail had higher total costs and utilization compared to the healthy segment. The CR for total Medicare spending was 3.05 (95% CI, 2.48–3.75). Similarly, this group had higher odds of being classified in the high-cost category 5.86 (95% CI, 3.35–10.25), nursing home care utilization 11.32 (95% CI, 3.88–33.02), hospitalizations 4.12 (95% CI, 2.88–5.90) and emergency room admissions 4.24 (95% CI, 3.04–5.91). Discussion Our findings highlight that frailty assessment is an important consideration when identifying high-need and high-cost patients.

Sweden as many other countries uses video consultation to increase patients’ access to primary healthcare services particularly during the COVID-19 pandemic. Working in digital care settings and using new technologies, in this case video consultations, require learning new skills and adoption to new workflow. The aim of this study is to explore nurses’ experience of using video consultation in a digital care setting and its impact on their workflow and communication. Fifteen semi-structured interviews were carried out with registered nurses recruited from a private digital healthcare provider. Interviews were recorded, transcribed, and analysed using an abductive approach. Nurses’ workflow was modeled, and several categories and subcategories were identified: nurses’ workflow (efficiency, flexibility, and information accessibility); communication (interaction with patients and interprofessional communication); user experience (change and development of the platform, challenges, and combining digital and physical care). Even though providing online care has its limitations, the nurses were positive towards using video consultations.

Background: Most biomedical research has focused on sampling COVID-19 patients presenting to hospital with advanced disease, with less focus on the asymptomatic or paucisymptomatic. We established a bioresource with serial sampling of health care workers (HCWs) designed to obtain samples before and during mainly mild disease, with follow-up sampling to evaluate the quality and duration of immune memory. Methods: We conducted a prospective study on HCWs from three hospital sites in London, initially at a single centre (recruited just prior to first peak community transmission in London), but then extended to multiple sites 3 weeks later (recruitment still ongoing, target n=1,000). Asymptomatic participants attending work complete a health questionnaire, and provide a nasal swab (for SARS-CoV-2 RNA by RT-PCR tests) and blood samples (mononuclear cells, serum, plasma, RNA and DNA are biobanked) at 16 weekly study visits, and at 6 and 12 months. Results: Preliminary baseline results for the first 731 HCWs (400 single-centre, 331 multicentre extension) are presented. Mean age was 38±11 years; 67% are female, 31% nurses, 20% doctors, and 19% work in intensive care units. COVID-19-associated risk factors were: 37% black, Asian or minority ethnicities; 18% smokers; 13% obesity; 11% asthma; 7% hypertension and 2% diabetes mellitus. At baseline, 41% reported symptoms in the preceding 2 weeks. Preliminary test results from the initial cohort (n=400) are available: PCR at baseline for SARS-CoV-2 was positive in 28 of 396 (7.1%, 95% CI 4.9-10.0%) and 15 of 385 (3.9%, 2.4-6.3%) had circulating IgG antibodies. Conclusions: This COVID-19 bioresource established just before the peak of infections in the UK will provide longitudinal assessments of incident infection and immune responses in HCWs through the natural time course of disease and convalescence. The samples and data from this bioresource are available to academic collaborators by application https://covid-consortium.com/application-for-samples/.

Objectives This study examined formal and informal healthcare use (HCU) in community women with disordered eating, and associations of HCU with mental health-related quality of life (MHRQoL), psychological distress, mental health literacy (MHL) and eating disorder (ED) symptoms over time.Hypothesis We hypothesised that HCU would lead to improvement in ED symptom severity, MHRQoL, MHL and psychological distress.Design, setting, participants Data were from years 2, 4 and 9 of a longitudinal cohort of 443 community women (mean age 30.6, SE 0.4 years) with a range of ED symptoms, randomly recruited from the Australian Capital Territory electoral role or via convenience sampling from tertiary education centres. Data were collected using posted/emailed self-report questionnaires; inclusion criteria were completion of the HCU questionnaire at time point of 2 years (baseline for this study). HCU was measured using a multiple-choice question on help seeking for an eating problem. To test the effect of HCU over time on MHRQoL (Short Form-12 score), psychological distress (Kessler Psychological Distress Scale score), ED symptom severity (Eating Disorder Examination Questionnaire score) and ED–MHL, linear or logistic mixed-effects regression analyses were used.Results 20% of participants sought ED-specific help at baseline; more than half of participants sought help that was not evidence based. HCU at baseline was significantly associated with improved MHRQoL and ED symptom severity and decreased psychological distress over time (Cohen’s d all >0.3, ie, small). HCU was not significantly associated with MHL over time. The predictive ability of the fitted models ranged from 32.18% to 42.42% for psychological distress and MHL treatment, respectively.Conclusions Formal and informal HCU were associated with small improvements in ED symptoms, MHRQoL and psychological distress but not with improved MHL. Informal services in ED management should be investigated further along with efforts to improve ED–MHL.

Background: Epilepsy is one of the most prevalent neurologic disorders in all ages. Epilepsy surgery is widely prescribed for patients with refractory epilepsy, and can control seizure episodes. Controlling seizures is associated with decrease in mortality in these patients. This study aimed to evaluate the prevalence of sudden unexpected death in epilepsy (SUDEP) in patients with refractory epilepsy underwent epilepsy surgery. Methods: This was a descriptive epidemiologic study on patients with uncontrolled epilepsy underwent epilepsy surgery in Kashani hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, during the years 2007-2017. They were under long term video electroencephalogram (video EEG) monitoring for presurgical evaluation in Kashani hospital epilepsy center. Patient's records were given from hospital archives, and evaluated for demographic and epilepsy data. Then, telephone call was made to assess the presence of mortality in patients and its causes, and the frequency of mortality and sudden unexpected death was calculated. Findings: In this study, 324 patients with refractory epilepsy, who underwent epilepsy surgery, with mean age of 29.2 ± 9.8 years were evaluated; 59.3% of them were men. The total incidence of mortality was 2.3% (3 cases), and none of them were sudden unexpected death. There was significant and non-significant association between incidence of mortality with gender and age, respectively. The causes of death were tumor recurrence (2 cases) and intracranial hemorrhage during the surgery (1 case). Conclusion: The frequency of sudden unexpected death among the epilepsy patients underwent epilepsy surgery in Iran is lower than other countries.

ObjectiveTo compare two strategies, interprofessional teams versus fast track streaming, for orthopedic patients with limb injuries or back pain, the most frequent orthopedic complaints in an emergency department.MethodsAn observational before-and-after study at an adult emergency department from May 2012 to Nov 2015. Patients who arrived on weekdays from 8 am to 9 pm and presented limb injury or back pain during one year of each process were included, so that 11,573 orthopedic presentations were included in the fast track period and 10,978 in the teamwork period. Similarly, another 11,020 and 10,760 arrivals presenting the six most frequent non-orthopedic complaints were included in the respective periods, altogether 44,331 arrivals. The outcome measures were the time to physician (TTP) and length of stay (LOS). The LOS was adjusted for predictors, including imaging times, by using linear regression analysis.ResultsThe overall median TTP was shorter in the teamwork period, 76.3 min versus 121.0 min in the fast track period (-44.7 min, 95% confidence interval (CI): -47.3 to -42.6). The crude median LOS for orthopedic presentations was also shorter in the teamwork period, 217.0 min versus 230.0 min (-13.0 min, 95% CI: -18.0 to -8.0), and the adjusted LOS was 22.8 min shorter (95% CI: -26.9 to -18.7). For non-orthopedic presentations, the crude median LOS did not differ significantly between the periods (2.0 min, 95% CI: -3.0 to 7.0). However, the adjusted LOS was shorter in the teamwork period (-20.1 min, 95% CI: -24.6 to -15.7).ConclusionsThe median TTP and LOS for orthopedic presentations were shorter in the teamwork period. For non-orthopedic presentations, the TTP and adjusted LOS were also shorter in the teamwork period. Therefore, interprofessional teamwork may be an alternative approach to improve the patient flow in emergency departments.

مقدمه: آنزیم‌های بتالاکتامازی یکی از مهم‌ترین عوامل در به وجود آوردن مقاومت آنتی‌بیوتیکی در میان باکتری‌های گرم منفی می‌باشند. این مطالعه به منظور تعیین الگوی حساسیت آنتی‌بیوتیکی و بررسی فراوانی ژن‌های بتالاکتامازی Ampc در ایزوله‌های بالینی کلبسیلا پنومونیه صورت پذیرفت. روش‌ها: 100 ایزوله‌ی كلبسیلا پنومونیه از نمونه‌های بالینی مختلف بیمارستان ولیعصر اراک جمع‌آوری شدند و توسط آزمایش‌های بیوشیمیایی استاندارد تعیین هویت شدند. الگوی حساسیت آنتی‌بیوتیکی با استفاده از روش دیسک دیفیوژن مطابق با دستورالعمل‌های CLSI (Clinical and Laboratory Standards Institute) تعیین گردید. ژن‌های پلاسمیدی AmpC با استفاده از روش PCR در ایزوله‌‌ها شناسایی شدند. یافته‌ها: بیشترین مقاومت آنتی‌بیوتیکی مربوط به آنتی‌بیوتیک‌های ریفامپین و اریترومایسین بود (90 درصد)، در حالی که کمترین مقاومت آنتی‌بیوتیکی مربوط به آنتی‌بیوتیک‌های ایمی‌پنم (8 درصد) و کلیستین (صفر درصد) بود. از 100 ایزوله‌ی کلبسیلا پنومونیه 19 ایزوله (19 درصد) دارای ژن‌های بتالاکتامازی AmpC بودند. 7 ایزوله (7 درصد) دارای ژن‌های خانواده‌ی MOX، 8 ایزوله (8 درصد) دارای ژن‌های خانواده‌ی CIT، سه ایزوله (3 درصد) دارای ژن‌های خانواده‌ی DHA و یک ایزوله (1 درصد) نیز دارای ژن‌های خانواده‌ی EBC بودند در حالی که ژن‌های خانواده‌ی ACC و FOX در هیچ کدام از ایزوله‌ها یافت نگردید. نتیجه‌گیری: این مطالعه اولین گزارش از وجود بتالاکتامازهای AmpC از دسته‌ی MOX در کلبسیلا پنومونیه در ایران بوده است. شیوع بالای ایزوله‌های تولیدکننده‌ی بتالاکتامازهای AmpC در بیمارستان مرکزی اراک، مقاومت آنتی‌بیوتیکی را تبدیل به نگرانی بزرگی کرده است. از این رو باید در سیاست‌های تجویز آنتی‌بیوتیکی و کنترل عفونت‌ها تجدید نظر حاصل گردد.

Background: Patient`s illness perception is formed base on patient`s beliefs and perceived information about their condition and it may influence the individual’s mental health and how the patient deal with the medical condition. The aim of this study was to determine the relationship between illness perception and symptom severity in patients with irritable bowel syndrome (IBS). Methods: In a cross-sectional study, 160 consecutive IBS patients, referred to the gastrointestinal and psychosomatic clinics at khorshid hospital in Isfahan, were selected. The patients completed illness perception questionnaires and the IBS Symptom Severity Scoring System (IBS-SSS). Data was analyzed by pearson correlation and multi variant regression models. Finding: A relationship between illness perception and symptom severity in patients with IBS was observed (R = 0.546, P = 0.001). The results showed that 39% of variation in symptom severity is predicted by variation in illness perception components (R = 0.63, R Squer = 0.39). Rregression model showed that only the identity and emotion components of illness perception can predict symptom severity variation (P = 0.04). However, there is no relationship between other subscales of illness perception and symptom severity. Conclusion: This study showed that there is a relationship between illness perception and symptom severity. So the interventions based on illness perception is proposed for managing symptom severity in IBS. Keywords: Illness perception, Symptom severity, Irritable bowel syndrome, Psychological factors.

Lichen planus (LP) is a chronic inflammatory disorder that most often affects middle-aged adults. LP can involve the skin or mucous membranes including the oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. It has different variants based on the morphology of the lesions and the site of involvement. The literature suggests that certain presentations of the disease such as esophageal or ophthalmological involvement are underdiagnosed. The burden of the disease is higher in some variants including hypertrophic LP and erosive oral LP, which may have a more chronic pattern. LP can significantly affect the quality of life of patients as well. Drugs or contact allergens can cause lichenoid reactions as the main differential diagnosis of LP. LP is a T-cell mediated immunologic disease but the responsible antigen remains unidentified. In this paper, we review the history, epidemiology, and clinical subtypes of LP. We also review the histopathologic aspects of the disease, differential diagnoses, immunopathogenesis, and the clinical and genetic correlations.