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This study proposed multiple revised variable neighborhood search (VNS) approaches applying the greedy concept to solve a nurse scheduling problem (NSP). In this paper, we developed three greedy-neighbourhood-swapping mechanisms (greedy-2-exchange, greedy-3-exchange, and greedy-4-exchange) to conduct local searches based on one-, two-, or three-neighbourhood structures that accounted for constraints imposed by government and hospital regulations. The greedy-neighbourhood-swapping mechanisms were used to identify medical staff members with the highest soft-constraint (e.g. nurses' preferences) violation weights on a given day who then swapped their shifts with others. To validate the proposed VNS approaches, we also conducted a case study. Based on the testing instances, all of the proposed VNS approaches generated optimal or near-optimal solutions, and the differences between them were small. The optimal number of the neighbourhood structures was determined to be two, confirming that a larger number of neighbourhoods in a neighbourhood structure would not necessarily be associated with more easily escaping local optima. Furthermore, the resulting outcomes supported the conclusion that the proposed modified VNS approaches generated better schedules for the medical staff members of hospitals than the compared meta-heuristic algorithms. [ABSTRACT FROM AUTHOR]

Secretory carcinoma is a malignant salivary gland tumor, which typically presents as an indolent painless mass within the parotid gland. Involvement of the minor gland is reported but less common. Secretory carcinoma was often misclassified as other salivary gland mimics, particularly acinic cell carcinoma, prior to 2010. It was first recognized as a molecularly distinct salivary gland tumor harboring the same fusion gene as well as histologic and cytogenetic features seen in juvenile breast cancer. Secretory carcinoma is generally managed in the same way as other low-grade salivary gland neoplasms and has a favorable prognosis; however, high-grade transformation requiring aggressive therapeutic interventions have been documented. Recent studies of biologic agents targeting products of this fusion gene offer the promise of a novel therapeutic option for treatment of this malignancy. Due to the limited number of reported cases, the spectrum of clinical behavior, best practices for management, and long-term treatment outcomes for secretory carcinoma remain unclear. A long-standing secretory carcinoma involving minor salivary glands of the mucobuccal fold, which was detected years after it was first noted by the patient, is reported. This case brings to light the importance of a thorough clinical exam during dental visits and reviews diagnostic differentiation of this malignancy from other mimics and discusses decision making for its management. [ABSTRACT FROM AUTHOR]

Context: Contusion and soft tissue injuries are common in sports. Photobiomodultion, light and laser therapy, is an effective aid to increase healing rates and improve function after various injury mechanisms. However, it is unclear how well photobiomodulation improves function after a contusion soft tissue injury. This study aimed to determine the effects of a pulsed red and blue photobiomodulation light patch on muscle function following a human thigh contusion injury. Design: Single-blinded randomized control trial design. Methods: We enrolled 46 healthy participants. Participants completed 5 visits on consecutive days. On the first visit, participants completed a baseline isokinetic quadriceps strength testing protocol at 60°/s and 180°/s. On the second visit, participants were struck in the rectus femoris of the anterior thigh with a tennis ball from a serving machine. Immediately following, participants were treated for 30 minutes with an active or placebo photobiomodulation patch (CareWear light patch system, CareWear Corp). Following the treatment, participants completed the same isokinetic quadriceps strength testing protocol. Participants completed the treatment and isokinetic quadriceps strength test during the following daily visits. We normalized the data by calculating the percent change from baseline. We used a mixed model analysis of covariance, with sex as a covariate, to determine the difference between treatment groups throughout the acute recovery process. Results: We found the active photobiomodulation treatment significantly increased over the placebo group, quadriceps peak torque during the 180°/s test (P =.030), and average power during both the 60°/s (P =.041) and 180°/s (P ≤.001) assessments. The mean peak torque and average power of 180°/s, at day 4, exceeded the baseline levels by 8.9% and 16.8%, respectively. Conclusions: The red and blue photobiomodulation light patch improved muscle strength and power during the acute healing phase of a human thigh contusion injury model. [ABSTRACT FROM AUTHOR]

Background: This correlative study aimed to examine how the different primary care models (physicians in solo practice, physicians in collaborative practice, physicians and nurse practitioners in collaborative practice, after-hours clinics, community centers, or emergency rooms) were associated with their capability to offer timely access to their patients. The data collected from the primary care provider's perspective was to complete the New Brunswick Health Council results on patients' perspective. Methods: A convenience sample of 120 primary care providers (33 physicians in solo practice, 33 physicians in collaborative practice, 27 providers in collaborative practice with nurse practitioners, 2 providers working in after-hours clinics, and 10 providers in Emergency departments) responded to an online survey about their primary care models and accessibility. We used the Statistical Package for Social Sciences software to run correlations, independent t-tests and Fisher's exact tests to compare timely access to care between variable groups. Results: A positive correlation was observed between patient load (or the number of patients under a primary care provider's practice), age and years of experience. However, the patient load did not translate to more timely access to care. However, a statistically significant difference (p = 0.032) was observed when primary care providers kept appointment slots available for daily urgent requests. When a primary care provider booked all available appointment slots, only 85% of them could offer timely appointments (in 5 days or less), compared to 97% who could deliver it when appointment slots were left open in their daily schedule. The primary care model (solo vs. collaboration), the use of health technologies and the type of provider did not significantly influence timely access to care. In contrast, the primary care providers who reported teleworking (or working remotely) were less likely to offer timely access to care. Conclusion: Timely access to care is not always available to patients, even those with a primary care provider. Certain organizational practices may improve access to care and should be integrated into primary care in New Brunswick and elsewhere in Canada. [ABSTRACT FROM AUTHOR]

Background: Robotic-assisted technologies have been developed to increase surgical precision and reduce surgical variability in total knee arthroplasty (TKA). Several different robotic systems have been introduced in the last decade for TKA. The DePuy Synthes VELYS™ Robotic-Assisted Solution (VRAS) is an imageless system designed to eliminate the need for preoperative CT scans and is one of the latest entrants in the rapidly evolving field of robotic technology in TKA. This study compared the clinical and economic outcomes associated with VRAS and other robotic-assisted technologies for primary TKA. Methods: A retrospective cohort study using the Premier Healthcare Database included patients who underwent primary TKA with VRAS or other robotic-assisted technologies from January 1, 2022, to April 30, 2023. The primary outcome for the study was hospital follow-up visits (revisits) within 90 days post-TKA. Secondary outcomes included readmission and revision rates within 90 days post-TKA, operating room time, length of stay, discharge status and hospital costs. Cohorts were balanced using propensity score fine stratification, and generalized linear models were constructed to evaluate outcomes. Results: This study included 827 VRAS TKA patients and 16,428 TKA patients treated with other robotic-assisted technologies. The 90-day all-cause and knee-related revisit rates were significantly lower for VRAS than for other robotic-assisted technologies (all-cause 13.9% vs. 22.8% and knee-related 2.8% vs. 5.4%, respectively; p value < 0.01). The all-cause and knee-related 90-day readmission rates were also lower for VRAS, although the differences were not statistically significant. The 90-day revision rates were similar for VRAS and other robotic-assisted technologies (0.48% vs. 0.45%), as was the operating room time (138 vs. 137 min). The 90-day knee-related cost for the VRAS cohort was $15,048 compared to $16,867 for other robotic technologies. Conclusions: This database study demonstrated that early postoperative revisit rates and total cost of care are lower for VRAS than for all other robotic-assisted technologies for TKA, while operating room time and discharge status were similar. These are important findings in ever-evolving healthcare systems that are increasingly cost conscious and cognizant of principles associated with value-based care. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to explore predictors associated with reasons for visiting an oral healthcare professional (OHP) and satisfaction with OHPs in the Netherlands among the Indian migrants and the host population. Methods: A random sample was obtained for this cross-sectional questionnaire study. Variables were classified according to the Andersen Behavioural Model of Health Services Utilization. Multivariable binary logistic regression analysis was conducted to identify significant predictors for reasons for visiting an oral healthcare professional (OHP) (routine checkups and preventive care or visiting only for pain and/or treatment) and satisfaction with OHPs (satisfied or dissatisfied). Results: The sample consisted of 391 participants (Indian migrants = 147 and host population = 244). Indian migrants with higher internal locus of control (LoC) [OR = 7.73 (95% CI: 2.13;27.99)], more trust in OHPs [OR = 4.12 (95% CI:1.68;10.14)] and higher integration level [OR = 1.09 (95% CI:1.03;1.17)] had higher odds of visiting an OHP for routine checkups and preventive care. In the host population, having dental insurance [OR = 2.64 (95% CI:1.00;6.95)] was significantly associated with increased odds of visiting an OHP for routine checkups and preventive care. For satisfaction, Indians with low paid jobs [OR = 16.26 (95% CI:2.83;93.36)] and those with higher integration levels [OR = 1.29 (95% CI:1.16;1.42)] had higher odds of being satisfied with the Dutch OHPs. Among the host population, those with more trust in OHPs [OR = 2.86 (95% CI:1.19;6.88)] had higher odds of being satisfied. Conclusion: Our study emphasize that integration levels and trust emerged as two crucial factors, policy makers can leverage upon to improve access to care for Indian migrants. Clinical trial: N.A as this is a survey based cross sectional study. [ABSTRACT FROM AUTHOR]

Background: The continuum of maternal health care ensures consistency in the delivery of care from pregnancy to the postnatal period. It recommends a minimum of 4 antenatal visits, skilled birth attendance, and 42 days of postnatal care. This approach helps reduce maternal deaths. The aim of this study was to estimate the proportion of women who had completed the different stages of the continuum of maternal health care (four antenatal visits, given birth under the care of qualified personnel, and received postnatal care within 42 days of delivery). Methods: This was a cross-sectional analytical study conducted in the five communes of Conakry, using a two-stage cluster sampling for data collection. Results were described using medians and percentages. The proportions of women in the continuum of care, and at the different stages of this continuum, have been weighted. Multivariate logistic regression was used to identify the factors associated with non-completion of the different stages of the maternal health care continuum among the women included in this study. Results: We found that 26.9% of women had completed all stages of the maternal health care continuum, while 73.1% had not. While 56.7% received four antenatal visits, only 29.5% delivered under the care of a qualified healthcare professional. Key factors associated with discontinuity were not attending school (AOR 1.825: 1.594-2.089), unemployment (AOR 4.588: 3.983-5.285), having two or more living children (AOR 1.890: 1.016-1.296), and not receiving a free Long-Lasting Insecticidal Net at the first Antenatal Care. Conclusion: Maternal care discontinuity is a major issue in Guinea. The country's Health Development Plan had set an expected level for maternal care which has not been met as of 2022. The completeness of care is influenced by various factors, including individual socio-demographic characteristics and factors related to the organization, availability, and quality of health services. To reduce maternal and child mortality rates, it is essential to improve interpersonal communication during antenatal care, ensure the availability of quality health services, and conduct a national study on maternal health service quality and maternal satisfaction. This will help establish a proper continuum of care for mothers and children. [ABSTRACT FROM AUTHOR]

Background: Fall risk and incidence increase with age, creating significant physical and mental burden for the individual and their care provider. Lift assistive devices are used in multiple healthcare facilities, but are generally not portable nor self-operational, limiting their use outside of medical supervision. The RaymexTM lift is a novel lift assistance device within a rollator to address these limitations. We aim to gather user-centered feedback on the RaymexTM lift, set up instructions, safety protocols to improve feasibility and usability, and explore the potential usability as a fall recovery or prevention device. Methods: Four older adults, two informal caregivers and 16 formal caregivers (clinicians and continuing care assistants) participated in a focus group. Participants provided feedback on the RaymexTM lift after viewing a demonstration and using the device. Qualitative and quantitative data were analysized using thematic and descriptive analysis respectively. Results: Participants highlighted three major themes: (1) Design features requiring improvement, (2) Positive feedback and suggestions to optimize the RaymexTM lift and (3) Pricing vs. social utility. Participants suggested widening the seat, changing the braking button layout, and lowering the device weight to improve usability. Participants believed the main device feature was fall recovery and had implications for social utility by reducing the need for ambulance visits to the home. Price point led to a concern on affordability for older adults. Conclusion: The feedback gained will advance the development of the RaymexTM lift and may highlight cost-effective design choices for other developers creating related aging assistive technologies. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of the PerioRisk prognostic tool in implementing the effect of motivational interviewing (MI) on psychological outcomes and supragingival plaque control. Materials and Methods: Participants underwent MI immediately after their first periodontal visit. According to a parallel‐arm, randomized study design, MI was performed with (RISK group) or without (CTR group) information on PerioRisk level and treatment goals based on PerioRisk output. Psychological outcomes were assessed using the Positive Affect Negative Affect Scale (PANAS) and Protection Motivation Theory (PMT). Plaque index (PI) was re‐evaluated after 8–12 weeks. Results: Significant improvements in PMT overall score and PI were observed in CTR and RISK groups, without inter‐group difference in PANAS and PMT overall scores and PI. A sub‐analysis showed that the overall PMT scores recorded immediately after MI in both CTR and RISK groups for subjects with no tooth loss due to periodontitis were higher than those recorded before MI in subjects with tooth loss due to periodontitis. Conclusions: At first periodontal visit, MI (implemented with without PerioRisk) has tangible effects on psychological outcomes and supragingival plaque control and seems to anticipate the awareness that is commonly generated by periodontitis‐related tooth loss (ClinicalTrials.gov protocol registration ID: NCT05078411). [ABSTRACT FROM AUTHOR]

The association between depression and ambulatory care utilization is unclear. The authors sought to determine the association between untreated depression and ambulatory care utilization, including the extent to which care is fragmented, or spread across providers. The authors conducted a longitudinal study using data from the nationwide REasons for Geographic and Racial Differences in Stroke study linked to Medicare fee-for-service claims (N = 1412). They categorized participants into three study groups, based on self-reported depressive symptoms (Center for Epidemiological Studies Depression Scale score ≥ 4) and a medication inventory for antidepressants: Symptomatic Untreated (SU), Symptomatic Treated (ST), and Asymptomatic Treated (AT). The authors used descriptive statistics to characterize ambulatory care patterns by study group. They determined the association between the study group and fragmentation score (with high fragmentation defined as a reversed Bice–Boxerman Index ≥ 0.85) using multivariable logistic regression. All groups had similar numbers of primary care visits, but the SU group had the fewest specialist visits. The SU group had the lowest proportion of participants who received care from a psychiatrist (3.4% vs. 10.7% for ST and 11.9% for AT, pairwise P-values < 0.001). The SU group was the least likely to have highly fragmented care (adjusted odds ratio 0.68; 95% confidence interval 0.48, 0.95, compared with the ST group). These results suggest that older adults with untreated depression are not engaged in excess care-seeking behaviors. Rather, the results suggest undertreatment of depression in primary care and underutilization of psychiatric care. [ABSTRACT FROM AUTHOR]

We evaluated the effects of behavioral skills training on improving participant implementation of functional communication training with multiple schedules when working with a confederate. Behavioral skills training produced mastery‐level responding for all six participants who required training, providing the first empirically supported training for this functional communication training approach. Next, we assessed durability during training challenges with (a) procedural changes to the original protocol, (b) a novel confederate with different discriminative stimuli and reinforcers, and (c) relapsed confederate destructive behavior. Training effects degraded at least once for all participants and in 62% of training challenges, although continuing to expose the participant to the challenging situations or providing postsession booster training resolved the degradation in most cases. We discuss these findings in relation to their clinical implications and directions for future research. [ABSTRACT FROM AUTHOR]

Background: This study aims to assess the effectiveness of a structured audio-visual educational session for people on asthma symptoms management during a general practitioner visit. Methods: We conducted this single-centre intervention study in a general practice clinic in Queensland, Australia. There were 78 intervention and 78 control participants in this study. We followed 1:1 randomisation to allocate study intervention between two groups of participants with asthma. The intervention group received an audio-visual demonstration of asthma, its symptoms, triggers, and how to use inhalers correctly, along with the standard asthma management by a physician on enrolment. The control group received only the standard asthma management by a physician. We assessed the 'Asthma Control Test' score on enrolment and after 90 days and compared the changes across the groups. Results: Participants were, on average, 28 years old (range: 6–60, 60% women). The intervention group showed a 1.9-unit increment, and the control group showed a −0.5-unit increment in 'Asthma Control Test' score from baseline to endline. The difference of differences between the intervention and control groups was 2.4 units (P = 0.016) after adjusting for potential confounders. In age-stratified analysis, the children (6–17 years) showed a significant difference (mean difference of 2.5 between intervention and control groups) in their asthma control score. Conclusions: Structured educational sessions involving audio-visual media along with standard management for people with asthma during general practice visits would be effective for better asthma control. However, a further multi-centre study with a larger sample is needed to see its efficacy. The effectiveness of an asthma educational adjunct to standard management during a general practice visit is not well studied. A recent study in a Queensland general practice clinic examined the impact of a structured audio-visual educational session on asthma management and showed a significant improvement in Asthma Control Test scores in the intervention group compared to controls. This suggests the potential efficacy of such interventions in enhancing asthma control during general practice visits, although further multi-centre studies are necessary for conclusive evidence. [ABSTRACT FROM AUTHOR]

Simple Summary: This study investigates the survival outcomes and palliative care needs of patients with muscle-invasive bladder cancer (MIBC) who are not eligible for curative treatment. Analyzing a cohort of 142 patients, this research reveals a median overall survival of 10.6 months and a median cancer-specific survival of 11.9 months. Worse outcomes were associated with advanced disease stage and hydronephrosis. Notably, patients excluded from curative treatment solely due to advanced age had a relatively better prognosis compared to those with severe comorbidities. This study underlines the significant burden on this patient population, highlighting frequent emergency department visits and the need for palliative interventions. These findings emphasize the critical unmet need for tailored therapeutic approaches in patients with MIBC who cannot undergo curative treatment. Objective: To assess the survival outcomes of patients diagnosed with muscle-invasive bladder cancer (MIBC) who are not candidates for curative treatment and to identify the factors influencing these outcomes. Methods: We conducted an analysis of patients diagnosed with MIBC who were either unable or unwilling to undergo curative therapy. We evaluated overall survival (OS) and cancer-specific survival (CSS) and examined their associations with various clinical variables. Additionally, we assessed emergency department visits and palliative procedures. Results: The study included 142 patients with a median age of 79.4 years and a Charlson Comorbidity Index of 9.8. At diagnosis, 59.2% of the patients had localized disease, 23.2% had metastatic disease, and 49.3% presented with hydronephrosis. Curative treatment was excluded due to comorbidities in 40.1% of cases and advanced disease stage in 36.6%. The 1-year and 2-year OS rates were 42.8% and 23.6%, respectively, with a median survival of 10.6 months. The 1-year and 2-year CSS rates were 49.6% and 30.2%, respectively, with a median survival of 11.9 months. Worse survival outcomes were associated with advanced disease stage and the presence of hydronephrosis. Patients excluded from curative treatment solely due to age had a relatively better prognosis. On average, patients visited the emergency department three times: 19% underwent palliative transurethral resection of the bladder tumor, 14.8% received radiotherapy to control hematuria, and nephrostomy tubes were placed in 26.1% of cases. Conclusions: Patients with MIBC who are unable or unwilling to undergo curative treatment have a median overall survival of less than one year, with worse outcomes observed in those with advanced disease stage and hydronephrosis. [ABSTRACT FROM AUTHOR]

Low birth weight (LBW) is a global health issue. We conducted a cross-sectional study to assess factors associated with LBW at Georgetown Public Hospital Corporation (GPHC). We used data from all women who delivered a single live baby as of 28 weeks of gestational age from July to September 2022. 1,304 mothers and their respective live-born babies were included. Logistic regression was used to identify LBW-associated factors at p <.05. The prevalence of LBW was 13.3 percent (95 percent IC: [11.6–15.3]). Women who were primigravida (AOR: 2.18, 95 percent CI = [1.40–3.38]), smoked during pregnancy (AOR: 3.41, 95 percent CI: [1.05–11.03]), had fewer than eight antenatal care visits (AOR: 2.43, 95 percent CI = [1.54–3.83]) were significantly associated with LBW. Similarly, those who had gestational hypertension (AOR: 2.30, 95 percent CI = [1.36–3.80]), urinary tract infections during pregnancy (AOR: 2.91, 95 percent CI = [1.22–2.97]), and gave birth before 37 weeks of gestational age (AOR: 22.65, 95 percent CI = [14.32–35.83]) were more likely to have their babies born with LBW. These findings are crucial for guiding health policies to improve prenatal care access, provide smoking cessation programs, control gestational hypertension, and prioritize early detection and treatment of urinary tract infections, ultimately aiming to reduce preterm births and LBW at GPHC. [ABSTRACT FROM AUTHOR]

Objectives: This retrospective cohort study aims to understand the effectiveness of the Singular Therapeutic Project (STP) implemented in a Child Psychosocial Care Center in preventing recurrence of self-harm and suicide attempt (SA), by comparing the group of patients who adhered to the STP with the group that did not adhere completely. Method: Data were collected from the medical records of adolescents with self-harm or SA during the period from 2015 to 2019. The primary outcomes analyzed were recurrence of SA, self-harm, and hospitalization; and the secondary outcomes analyzed were demographics, diagnosis, number of appointments, and negative life events. Results: A total of 228 adolescents were included. After multivariate analysis, social service consultations decreased risk in 94.6% (HR.054, 95% CI:.004–.681) of the cases, but risk was increased by 23 times if there was an episode of self-harm among family members and/or friends (HR 23.641, 95% CI: 1.394–400.8). Additionally, in terms of SA, adherence to family interventions reduced the risk by 66.2% (HR.338, 95% CI:.125–.913). Victims of prejudice, racism, homophobia, transphobia presented a 3.7-fold increased risk (HR 3.766, 95% CI: 1.058–13.401). Conclusion: The STP interventions were effective in reducing the recurrence of self-harm and SAs in adolescents. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of risk factors for suboptimal oral health in people with learning disabilities • To recognise the importance of education and training for healthcare professionals and carers to support oral health for people with learning disabilities • To read about interventions that can be used to support access to dental care for people with learning disabilities. People with learning disabilities have poorer oral health compared with the general population. Risk factors for suboptimal oral health in this group include diet, reliance on others for oral care and barriers to accessing dental care. This article discusses these risk factors and considers the importance of education and training for carers and healthcare professionals, including dentists and dental students, to enhance oral health in people with learning disabilities. The author uses a fictional case study to illustrate some of the challenges experienced by people with learning disabilities in accessing oral care and how the use of interventions such as desensitisation programmes, as well as reasonable adjustments, can help address these challenges. [ABSTRACT FROM AUTHOR]

Background: Hearing loss is prevalent and consequential but under‐diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient‐reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown. Methods: We use 5 years of electronic medical record (EMR) data (2017–2022) for a sample of 13,776 older primary care patients. We identify the first (index) AWV indication of hearing concerns and existing and subsequent hearing loss EMR diagnoses (visit diagnoses or problem list diagnoses) and audiology referrals. For a 20% random sample of AWV notes (n = 474) we compared hearing loss EMR diagnoses to documentation of (1) hearing concerns, (2) hearing loss/aid use, and (3) referrals for hearing care. Results: Of 3845 (27.9%) older adults who identified hearing concerns (mean age 79.1 years, 57% female, 75% white) 24% had an existing hearing diagnosis recorded. Among 474 patients with AWV clinical notes reviewed, 90 (19%) had an existing hearing loss diagnosis. Clinicians were more likely to document hearing concerns or hearing loss/aid use for those with (vs. without) an existing EMR diagnosis (50.6% vs. 35.9%, p = 0.01; 68.9% vs. 37.5%, p < 0.001, respectively). EMR diagnoses of hearing loss were recorded for no more than 40% of those with indicated hearing concerns. Among those without prior diagnosis 38 (9.9%) received a hearing care referral within 1 month. Subgroup analysis suggest greater likelihood of documenting hearing concerns for patients age 80+ (OR:1.51, 95% confidence interval [CI]: 1.03, 2.19) and decreased likelihood of documenting known hearing loss among patients with more chronic conditions (OR: 0.49, 95% CI: 0.27, 0.9), with no differences observed by race. Conclusion: Documentation of hearing loss in EMR and AWV clinical notes is limited among older adults with subjective hearing concerns. Systematic support and incorporation of hearing into EMR and clinical notes may increase hearing loss visibility by care teams. [ABSTRACT FROM AUTHOR]

Background: Individuals with Alzheimer's disease and related dementias (ADRD) often face high acute care clinical utilization and costs with unclear benefits in survival or quality of life. The emergency department (ED) is frequently the site of pivotal decisions in these acute care episodes. This study uses national Medicare data to explore this population's ED utilization. Methods: Retrospective cohort study of persons aged ≥66 years enrolled in traditional Medicare with a Chronic Condition Warehouse diagnosis of dementia. Primary 1‐year outcome measures included ED visits with and without hospitalization, ED visits per 100 days alive, and health‐care costs. A multivariate random effects regression model (clustered by county of residence), adjusted for sociodemographics and comorbidities, examined how place of care on January 1, 2018, was associated with subsequent ED utilization. Results: In 2018, 2,680,006 ADRD traditional Medicare patients (mean age 82.9, 64.2% female, 9.4% Black, 6.2% Hispanic) experienced a total of 3,234,767 ED visits. Over half (52.2%) of the cohort experienced one ED visit, 15.5% experienced three or more, and 37.1% of ED visits resulted in hospitalization. Compared with ADRD patients residing at home without services, the marginal difference in ED visits per 100 days alive varied by location of care. Highest differences were observed for those with hospitalizations (0.48 visits per 100 days alive, 95% confidence interval [CI] 0.47–0.49), skilled nursing facility (rehab/skilled nursing facility [SNF]) stays (0.27, 95% CI 0.27–0.28), home health stays (0.25, 95% CI 0.25–0.26), or observation stays (0.82, 95% CI 0.77–0.87). Similar patterns were observed with ED use without hospitalization and health‐care costs. Conclusions: Persons with ADRD frequently use the ED—particularly those with recent hospitalizations, rehab/SNF stays, or home health use—and may benefit from targeted interventions during or before the ED encounters to reduce avoidable utilization and ensure goal‐concordant care. [ABSTRACT FROM AUTHOR]

Short sleep duration, poor sleep quality, and irregular timing of sleep are prevalent sleep troubles for children, but fully assessing children's sleep environments and effectively promoting children's overall sleep health is nearly impossible during brief clinical encounters. This commentary on a case suggests strategies for navigating this problem with a patient- and family-centered approach that prioritizes identifying family sleep-related beliefs, values, and goals and maintaining flexibility when offering evidence-based recommendations to improve children's sleep. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Preventive health care for children comprises routine well-child visits and immunizations. Women with physical, sensory, or intellectual or developmental disabilities tend to experience more barriers to preventive health care; yet it is unknown whether such barriers are observed among their young children. METHODS: This population-based study in Ontario, Canada included children born between 2012 and 2019 whose mothers had a physical (n = 74 084), sensory (n = 26 532), or intellectual or developmental (n = 1391) disability, multiple disabilities (n = 5774), or no disability (n = 723 442). Primary outcomes were receipt of the recommended number of well-child visits and routine immunizations in the first 2 years. Secondary outcomes included receipt of the enhanced 18-month developmental assessment and any developmental screen. Relative risks (aRR) were generated using modified Poisson regression and adjusted for maternal sociodemographics and mental health and child sex. RESULTS: Compared with children of mothers without disabilities, those whose mothers had intellectual or developmental disabilities were less likely to receive the recommended number of well-child visits (56.3% vs 63.2%; aRR 0.92, 95% confidence interval [CI] 0.88-0.97), routine immunizations (43.8% vs 53.7%; aRR 0.88, 95% CI 0.83-0.94), enhanced 18-month developmental assessment (52.3% vs 60.8%; aRR 0.92, 95% CI 0.88-0.97), or any developmental screen (54.9% vs 62.5%; aRR 0.94, 95% CI 0.90-0.99). Other disability groups did not experience such disparities. CONCLUSIONS: There is a need to develop resources to improve access to preventive health care for young children of women with intellectual or developmental disabilities. [ABSTRACT FROM AUTHOR]

Background: Timely initiation of breastfeeding is crucial for positive health outcomes for babies and mothers. Understanding the factors influencing timely initiation of breastfeeding is vital for reducing child morbidities and mortalities in Mauritania. This study, therefore, assessed the prevalence of early initiation of breastfeeding and its associated factors among women in Mauritania, providing significant insights for improving maternal and child health in the country. Methods: We performed a secondary analysis of the 2019–2021 Mauritania Demographic and Health Survey data. A weighted sample of 4,114 mother-child pairs was included in the study. We used percentage to present the prevalence of early initiation of breastfeeding. A four-modelled multilevel binary logistic regression was used to examine the factors associated with early initiation of breastfeeding. The regression results were presented using adjusted odds ratio (aOR) with their respective 95% confidence interval (CI). Stata software version 17.0 was used to perform all the analyses. Results: The prevalence of early initiation of breastfeeding was 57.3% (95% CI 54.5, 60.00). Birth order was associated with early initiation of breastfeeding with the highest odds among those in the fourth birth order (aOR 1.61; 95% CI 1.08, 2.39). Mothers who practiced skin-to-skin contact were more likely to initiate breastfeeding early than those who did not (aOR 1.46; 95% CI 1.14, 1.87). There were regional disparities in the early initiation of breastfeeding. The odds of timely initiation of breastfeeding was lower among women who were delivered by caesarean section (aOR 0.22; 95%CI 0.14, 0.36), those who were working (aOR 0.57; 95% CI 0.45, 0.73), those who had four or more antenatal care visits (aOR 0.67; 95%CI 0.47, 0.94)], and those in the richest wealth quintile (aOR 0.61; 95% CI 0.38, 0.98) compared to those who had normal delivery, those who were not working, those who had zero antenatal care visits, and those in the poorest wealth quintile households, respectively. Conclusion: Our study found a relatively low prevalence of early initiation of breastfeeding among women in Mauritania. Factor such as birth order, region of residence, mother and newborn skin-to-skin contact after birth, antenatal care visits, caesarean delivery, employment status, and wealth index were associated with early initiation of breastfeeding. Improving optimal breastfeeding practices, such as early initiation of breastfeeding in Mauritania, should be given adequate attention. There is a need for interventions such as baby-friendly facilities, providing an enabling environment for mothers to breastfeed their newborns early. Addressing regional health access disparities is important to improve early initiation of breastfeeding and other maternal, newborn, and child health interventions. [ABSTRACT FROM AUTHOR]

Aim: To explore patients' process of living with chronic liver disease while continuing regular healthcare visits for hepatocellular carcinoma surveillance. Methods: Semistructured interviews and participant observations were conducted in this qualitative constructivist grounded theory study. The participants included 11 patients undergoing regular hepatocellular carcinoma surveillance every 1–6 months for 2–30 years. Data were analyzed using coding, memo‐writing, theoretical sampling, and constant comparison. Results: The participants incorporated regular healthcare visits into their living cycle. The cycle's core comprised two categories ("inferring my liver condition" and "desiring status quo"). The cycle underwent a transition described by three phases ("seeking ways to live with my chronic liver disease," "being overwhelmed by living with my chronic liver disease," and "reconstructing my life to live with my chronic liver disease"). This transition involved adjusting to living with chronic liver disease while continuing regular healthcare visits. The relative importance of the cycle's core progressively shifted from "inferring my liver condition" to "desiring status quo." Conclusions: This study revealed the transition phases of patients' living cycles in adjusting to living with chronic liver disease while continuing regular healthcare visits. Understanding the different phases in which patients are and the psychological impact of healthcare visits can help them look forward to recuperative actions. Furthermore, patients who have a sense of ownership experience loneliness because of regular healthcare visits. A support system including nurses as part of regular hepatocellular carcinoma surveillance should be established to help ease patients' sense of loneliness by utilizing their sense of ownership. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Our study aimed to assess the efficacy and durability of holmium laser enucleation of the prostate (HoLEP) in managing acute urinary retention (AUR), neurogenic chronic urinary retention (NCUR), and non-neurogenic chronic urinary retention (NNCUR). We also sought to compare outcomes in patients with preoperative urinary retention (UR) to those without. METHODS: We conducted a retrospective analysis using prospectively gathered data from men who underwent HoLEP at our institution between October 2017 and July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure, median urinary volume drained, or median postvoid residual urine volume (PVR) before catheterization or HoLEP. Chronic urinary retention (CUR) was defined as PVR >300 mL in males able to void; and initial catheter drainage >1000 mL in males unable to void, in the absence of pain. NCUR and NNCUR were differentiated based on the presence of any significant illness or injury with a neurologic impact on the bladder. All patients had postoperative followup visits at one, three, six, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS), quality of life (QoL) assessment, maximum urinary flow rate (Qmax), PVR, and catheter-free status. RESULTS: Three hundred sixty-eight males who underwent HoLEP were included in our study. The UR group consisted of 189 patients (70 AUR, 42 NCUR, and 77 NNCUR), and the lower urinary tract symptoms (LUTS) group was comprised of 179 individuals. There were no statistically significant differences between the NCUR and NNCUR subgroups regarding demographics and outcomes. At 12 months postoperative, the AUR group had a higher catheter-free rate than the CUR group (p=0.04), and other outcome variables were comparable between the two cohorts. The UR group had a significantly lower QoL score at one month (p=0.01) and a significantly lower IPSS score at one and 12 months (p=0.034 and p=0.018, respectively) than the LUTS cohort. During all followup visits, the UR group had a significantly higher PVR than the LUTS cohort. The successful first trial of void (TOV) rate for the UR and LUTS groups was 81% and 83.2%, respectively. At 12 months postoperative, the catheter-free rate for the UR and LUTS cohorts was 96.3% and 99.4%, respectively. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) has been shown to be feasible and safe. In order to improve uptake of this ambulatory model in Canada, we aimed to update our experience of SDD after RARP and identify reasons for SDD pathway non-initiation and failure in a universal healthcare system. METHODS: A review of our prospectively collected database of patients undergoing RARP at a Canadian tertiary academic center from May 2021 to May 2023 was conducted. Binary logistic regression analysis determined predictors SDD pathway non-initiation and failure. RESULTS: We identified 387 patients, of which 198 were initiated on the SDD pathway. Of those initiated, 104 (52.5%) were successfully discharged home on the same day. Patients who travelled distances greater than 100 km, or who had non-CPAP (continuous positive airway pressure)-compliant obstructive sleep apnea were significantly less likely to be initiated on the SDD pathway (both p<0.05). Patients who were scheduled to be the second case or later had an estimated blood loss ≥300 mL, or had a postoperative abdominal drain, were predictive of failing SDD after initiation (all p<0.05). There were similar rates of readmissions, unscheduled office visits, and emergency department presentations, when compared to the traditional inpatient model (all p>0.05). CONCLUSIONS: SDD after RARP in a Canadian healthcare system remains feasible and safe for selected patients. Predictors of failed SDD identified in this study inform the development of future ambulatory protocols and highlight areas of need in infrastructure to increase uptake of these outpatient pathways. [ABSTRACT FROM AUTHOR]

Food insecurity (FI) is associated with poor health outcomes in children, and studies have shown higher FI among children with diabetes mellitus. This study assessed provider (N = 22, 35.5% response rate) and parent/guardian (N = 207, 14.6% response rate) perspectives toward FI screening in a pediatric diabetes program. Among 22 providers, most "rarely" (54.5%) or "never" (27.3%) screened for FI although all felt that screening was at least "slightly important." Barriers included lack of time (63.6%), not remembering to screen (59.1%), lack of knowledge about how to address positive screens (45.5%), and being unsure how to screen (40.9%). Among 186 parent/guardians, only 24.1% had been asked about FI at a pediatric medical appointment, but only 8.6% disliked the idea of being asked by a medical provider at endocrinology visits. To be effective and sustainable, FI screening must fit within the visit flow, and providers need education on how to address positive screens. [ABSTRACT FROM AUTHOR]

More than 20 years that have elapsed since the inaugural American College of Medical Toxicology Spring Conference in 2002. During this time, the now ACMT Annual Scientific Meeting has grown in many ways, as demonstrated by the increase in attendance and abstract submissions, and diversification of educational offerings, and partners. Most importantly, the scientific rigor and presentation of new knowledge has continued to mature, and the conference is now firmly rooted in the annual educational schedule for medical toxicologists. In anticipation of the upcoming 2025 ASM, we reflect upon the evolution and growth of ACMT's research and educational agendas, and the Annual Scientific Meeting itself. [ABSTRACT FROM AUTHOR]

Objective: This research aimed to evaluate the impact of grading and zoning nursing management on traumatic brain injury (TBI) patients' emergency treatment outcomes. Methods: This randomized controlled trial included 200 TBI patients. They were treated with a conventional care (control group, n = 100) and a novel grading and zoning approach (study group, n = 100), respectively. This innovative model organized care into levels based on urgency and complexity, facilitating targeted medical response and resource allocation. Key metrics compared included demographic profiles, consultation efficiency (time metrics and emergency treatment rates), physiological parameters (HR, RR, MAP, SpO2, RBS), and patient outcomes (hospital and ICU stays, complication rates, and emergency outcomes). Results: The study group demonstrated significantly improved consultation efficiency, with reduced times for physician visits, examinations, emergency stays, and specialist referrals (all p < 0.001), alongside a higher emergency treatment rate (93% vs. 79%, p = 0.004), notably better physiological stability, improved HR, RR, MAP, SpO2 and RBS (p < 0.001), shorter hospital and ICU stays, fewer complications, and superior emergency outcomes. Conclusion: Grading and zoning nursing management substantially enhances TBI patients' emergency care efficiency and clinical outcomes, suggesting a viable model for improving emergency treatment protocols. [ABSTRACT FROM AUTHOR]

Objectives: Smoking is an important modifiable risk factor in all vascular diseases and verbal advice from providers has been shown to increase rates of tobacco cessation. We sought to identify factors that will improve tobacco cessation and recall of receiving verbal cessation advice in vascular surgery patients at a single institution. Methods: The study is a retrospective cohort study. Patients seen in outpatient vascular surgery clinic who triggered a tobacco Best Practice Advisory (BPA) during their office visits over a 10-month period were contacted post-clinic and administered surveys detailing smoking status, cessation advice recall, and validated scales for nicotine dependence and willingness to quit smoking. This BPA is a "hard stop" that requires providers to document actions taken. Charts were reviewed for tobacco cessation documentation. Nine-digit zip-codes identified the area deprivation index, a measure of socioeconomic status. Univariate analysis was used to identify factors associated with cessation and advice recall. Results: One hundred out of 318 (31.4%) patients responded to the survey. Epic Slicer Dicer found 97 BPA responses. To dismiss the BPA, 89 providers (91.8%) selected "advised tobacco cessation" and "Unable to Advise" otherwise. Of the 318 patients, 115 (36.1%) had cessation intervention documented in their provider notes and 151 (47.5%) received written tobacco cessation advice. Of survey respondents, 70 recalled receiving verbal advice, 27 recalled receiving written advice, 28 reported receiving offers of medication/therapy for cessation. 55 patients reported having tobacco cessation plans, and among those 17 reported having quit tobacco. Recall of receiving written advice (P <.001) and recall of receiving medication/therapy (P =.008) were associated with recall of receiving verbal cessation advice. Conclusions: Providing patients with tobacco cessation medication/therapy and written tobacco cessation education during office visits is associated with increased patients' recall of tobacco cessation advice. Vascular surgeons should continue to provide directed tobacco cessation advice. [ABSTRACT FROM AUTHOR]

Purpose: Telemedicine has been essential during the coronavirus disease 2019 (COVID-19) pandemic. In March 2020, pharmacist-led chronic disease state management services at our family care centers and primary care clinics were converted to telemedicine. This study aimed to determine the impact of expanding telemedicine services on appointment adherence, clinical outcomes, and financial reimbursement. Methods: This was a single-center, retrospective, quasi-experimental study of the impact of expanding telemedicine services on adult patients with diabetes, hypertension, and/or hyperlipidemia. The study included patients scheduled with a pharmacist at a hospital-based (HB) or physician-based (PB) clinic. The primary outcome was the difference in the mean no-show rate. The secondary outcomes were differences in mean change in HbA1c, LDL, blood pressure, and reimbursement. Mean differences between pre- and post-telemedicine groups of each clinic were measured for all outcomes. Results: The mean difference (SE) in the no-show rate in the HB clinic was -12.09% (4.862; P =.014), compared to 2.88% (3.656; P =.431) in the PB clinic. The mean difference (SE) in the change in HbA1c in the HB clinic was.00% (.338; P =.992), compared to.01% (.239; P =.945) in the PB clinic. The mean difference (SE) in reimbursement in the HB clinic was $1.93 (4.209; P =.647), compared to $20.46 (3.210; P <.0001) in the PB clinic. Conclusion: Expansion of pharmacy telemedicine services provided evidence for improved appointment adherence in the HB clinic and increased reimbursement in the PB clinic. No change in healthcare outcomes was observed. [ABSTRACT FROM AUTHOR]

Background: Many infectious diseases are diagnosed in emergency departments (ED) and patients are prescribed antimicrobial therapy. Results from cultures typically take a few days to become finalized. Following up on these results is necessary when medication changes are indicated due to results that show bacteria are resistant to the prescribed antibiotics. Involving pharmacists in assessing the culture and sensitivity results, and making interventions when needed, is an innovative way to ensure that patients receive appropriate antimicrobial therapy based on the culture and sensitivity data. This study analyzed the impact of pharmacist involvement in the ED's post-discharge positive culture review process on ED re-visits and hospitalizations. Methods : This single-center, pre- and post-implementation study examined the impact of pharmacist involvement in the post-ED visit culture review process on ED re-visits and hospitalizations. Positive microbiological results included documented growth from urine, skin and soft tissue, throat, blood, or stool cultures. Patients included in the study were of 18 years of age or older and had a positive culture result post ED-discharge. Patients were excluded from the study if they were admitted to the hospital or transferred to another facility. The primary outcomes included ED re-visits within 7 days and hospital readmissions within 30 days for the same condition. The secondary outcomes were percentage of pharmacist interventions accepted and types of pharmacist interventions implemented. Results : A total of 141 patients were included in the study, with 65 in the pre-implementation group and 76 in the post-implementation group. The primary outcome of ED re-visits within 7 days for the same condition occurred in 11 (17%) patients in the pre-implementation group and 5 (7%) patients in the post-implementation group (P =.0454). The primary outcome of hospitalizations within 30 days for the same condition occurred in 5 (8%) patients in the pre-implementation group and 1 (1%) patient in the post-implementation group (P =.0137). Seventeen (94%) out of the 18 pharmacist interventions were accepted and implemented. The intervention types implemented were to recommend to: change antibiotic (35%), not initiate antibiotic (24%), initiate antibiotic (24%), and continue antibiotic (18%). Conclusion : Pharmacist involvement in the ED post-discharge positive culture review process showed a decrease in ED re-visits and hospitalizations for the same condition. [ABSTRACT FROM AUTHOR]

Purpose: Maternity leave is a critical employee benefit that allows mothers to recover from the stress of pregnancy and childbirth and bond with their new baby. We aimed to examine the association between the extension of a maternity leave policy and maternal use of mental health services and prescription drugs in a universal public healthcare system. Methods: This study uses administrative medical records from 18,000 randomly selected women who gave birth three months before and after an extension of the maternity leave policy. More specifically, mothers who gave birth after January 1st 2001, were entitled to 50 weeks of paid maternity leave, while mothers who gave birth before that date were entitled to only 26 weeks of paid maternity leave. Medical records were analyzed over a seven-year period (i.e., from October 1998 to March 2006). We examined the number and costs of mothers' medical visits for mental health care in the five years following delivery, as well as maternal use of prescribed medication for mental health problems. Results: We found that mothers with extended maternity leave had − 0.12 (95%CI=-0.21; -0.02) fewer medical visits than mothers without a more generous maternity leave and that the cost of mental health services was Can$5 less expensive per women. These differences were found specifically during the extended maternity leave period. Conclusions: The extra time away from work may help mothers to balance new family dynamics which may result in less demand on the healthcare system. [ABSTRACT FROM AUTHOR]

Although it is clear that people experience physiological arousal in anticipation of news-focused medical consultations, our knowledge of people's experiences during and throughout these consultations is scarce. We examine interbeat interval responses (IBI) of patients and doctors during real-life medical consultations to understand how the experiences of both parties change throughout these encounters and whether they differ from each other. We also examine how the type of news delivered affects responses. We measured the IBI responses of patients and their oncologists throughout 102 consultations in which providers delivered news (classified as good, bad, or status quo) to patients about a recent computerized tomography scan. We observed two distinct phases of consultations: an initial "news" delivery phase and a subsequent "information" phase. During the news phase, on average, patients' IBI responses rapidly increased–indicating less autonomic arousal over time – whereas doctors' responses did not change over time. In contrast, throughout the information phase, on average, both patients' and doctors' responses remained steady. During the information phase, responses differed based on news type: on average, status quo consultations involved an increase in autonomic arousal, whereas good and bad news consultations involved no changes. Lastly, we observed significant variability in patients' responses during both phases. In sum, on average, patients (but not doctors) experience decreases in autonomic arousal while news is being delivered, suggesting that anticipatory distress regarding these consultations wanes quickly. However, our results also indicate that patients' experiences vary from one another, and future research should focus on factors explaining this variability. [ABSTRACT FROM AUTHOR]

Objective Studies have suggested an association between prenatal care (PNC) and preterm birth (PTB). We evaluated trends in PTB and association of PNC and PTB. Study Design This was a retrospective cohort study of singleton, viable nonanomalous deliveries from 1991 to 2018. PNC utilization was defined by World Health Organization using number of visits: adequate (≥8), suboptimal (5–7), and inadequate (<5). Primary outcome was PTB. Tests of trend were used to assess changes in PTB over time. Baseline characteristics and outcomes were compared. Logistic regression estimated the association of PNC and PTB. We evaluated for effect modification by year of birth. Results Of 92,294 patients, 14,057 (15%) had PTB. Inadequate and suboptimal PNC were associated with higher odds of PTB compared to adequate PNC (adjusted odds ratios = [aOR 6.21], 95% confidence interval [CI]: 5.84–6.60; aOR = 3.57, 95% CI: 3.36–3.79). Inadequate PNC was associated with higher odds of PTB over time (effect modification p < 0.0001). Inadequate PNC was associated with 5.4 times higher odds of PTB in 1998, 7.0 times in 2008, and 9.1 times in 2018. Conclusion Despite an increase in adequate PNC, there was a rise in PTB associated with inadequate and suboptimal PNC. PNC utilization was a stronger risk factor in recent years with higher PTB in patients who attended more than five PNC visits. Key Points PNC utilization is associated with the risk of PTB. Despite an increase in PNC utilization, PTB rates have increased. There is an even stronger association between PNC utilization and PTB over time. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the relationship between women's healthcare autonomy and the utilization of maternal healthcare services (MHS), including antenatal care services, the services of health professionals at the birth of a child, and facility-based delivery. This was a cross-sectional study. This study utilized data from the 2015 Afghanistan Demographic and Health Survey (AFDHS 2015), which included women aged 15–49 years who had given live birth within the five years before the survey. Multilevel logistic regression was used to estimate the adjusted odd ratios (AOR) for each outcome variable. Among respondents, 16.49% made at least four ANC visits, 52.57% of childbirth were assisted by a skilled birth attendant (SBA), and 45.60% of children were born in health facilities. Women with high healthcare autonomy, compared to medium and low, were more likely to use ANC (AOR 1.45; 95% CI = 1.26–1.67), SBA (AOR 1.15; 95% CI 1.02–1.29), and FBD (AOR 1.12; 95% CI 1.04–1.20). The association between women's healthcare autonomy and the use of maternal healthcare services (MHS) was positively and significantly moderated by household wealth and women's access to media. Women's higher healthcare autonomy was significantly and positively associated with MHS in Afghanistan. Policy and programs that encourage women's empowerment and awareness of the importance of MHS utilization should be initiated. [ABSTRACT FROM AUTHOR]

Objective: In the United States, adult dental benefits are optional in the state‐managed, public insurance program, Medicaid. States also have the option to adapt their Medicaid program via waivers which pair healthy behaviour incentives (HBI) with cost‐sharing. These waivers have proven ineffective, but the empirical evidence has ignored differences between states. This study aims to evaluate the impact of four state's HBI Medicaid waiver on dental visits among low‐income adult population subject to incentives and cost‐sharing requirements by the HBI waiver. Methods: Analysing biannual data from the Behavioural Risk Factor Surveillance System's Oral Health module (2008–2018) with a Difference‐in‐Differences design, this study estimated the effect of a Healthy Behaviour Incentive waiver on the probability of visiting the dentist in the past year. The three states that implemented an HBI Waiver (Indiana, Michigan and Wisconsin) were analysed separately. Secondary outcomes included being uninsured and having all teeth extracted. Matrix Completion methods accounted for dynamic treatment and tested for non‐common trends. Inference was based on randomization inference tests. Results: Only in Michigan was an HBI waiver consistently associated with a significant increase in the probability of a dental visit (Est. = 5.6%‐points, p =.01). There was little convincing evidence that HBI waivers were associated with being uninsured or having all teeth extracted. Conclusions: Between 2010 and 2019, many states have implemented an HBI waiver, each with a different approach to incentivizing dental visits. These implementation differences may explain the heterogeneous effects by state. More work is needed to evaluate how Medicaid waivers impact health outcomes in low‐income populations. [ABSTRACT FROM AUTHOR]

Objectives: Expanding HIV testing beyond specialized services has been a key strategic approach to eliminating the transmission of HIV. In recent years, dental settings have been identified as offering an opportunity for delivering point of care HIV testing (POCT) interventions. Intervention components and implementation strategies have varied across studies and there is uncertainty about the prevalence of undiagnosed HIV in the dental patient population. Therefore, this systematic review aimed to synthesize the HIV testing outcomes of intervention studies, identify the core components of POCT interventions implemented in dental settings; and understand the barriers and facilitators to intervention implementation. Methods: A mixed‐methods systematic review was undertaken. Two authors reviewed abstracts and full papers for inclusion and appraised the studies using the Mixed Methods Appraisal Tool. A convergent integrated mixed methods study design underpinned the synthesis. Outcomes were presented using descriptive statistics. Intervention components were mapped to the Template for Intervention Description and Replication (TIDieR) checklist. Barriers and facilitators were described using a narrative thematic analysis. Results: POCT was offered to 22 146 dental patients, 62.5% accepted POCT. Intervention studies that reported higher uptake of testing utilized a dedicated dental or researcher staff member to provide testing, integrated testing and provided results within the routine dental appointment and adopted a provider‐initiated universal approach to offering testing. Six themes emerged that were pertinent to the barriers and facilitators to HIV testing in dental setting. Conclusions: POCT uptake in dental settings was comparable with other non‐specialized health settings. Key to the operationalization of the intervention were perceptions about its value and relevance to the dental patient population, attitudes toward the intervention, logistical barriers to its implementation, the risk of HIV testing stigma to the patient‐practitioner relationship and maximising the fit of the intervention within the constraints of the dental setting. [ABSTRACT FROM AUTHOR]

Vicarious stigma shows how indirect stigmatizing experiences can lead people living with HIV (PLWH) to feel discriminated against. We enrolled 350 PLWH, who were administered a 17-item questionnaire to investigate a subjective experience of stigma experienced in the hospital care setting. We found that at least once 215 PLWH (61.4%) did not want the HIV exemption indicated on the prescription for a specialist medical visit, 232 PLWH (66.3%) never used their HIV-related exemption to make a specialist medical visit, 230 PLWH (65.7%) avoided undergoing a medical assessment outside the infectious disease clinics and 241 patients (68.9%) felt unwelcome during a specialist medical visit. Moreover, 241 patients (61.1%) had heard at least once stories of health workers who did not want to touch PLWH, 213 patients (60.9%) had heard stories at least once of PLWH who had been mistreated by hospital staff, 180 patients (51.4%) had at least once heard stories about PLWH being refused treatment and services and 257 patients (73.4%) had at least once heard stories about health workers talking publicly about PLWH. This is a little explored area, especially regarding the vicarious stigma faced by PLWH. Our findings indicate the importance of combating HIV-related stigma for the wellbeing of PLWH. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate potential predictors of no-shows and late cancellations in an outpatient clinic within a large healthcare system serving vulnerable communities. Methods: Demographic data and appointment status were recorded for 537 consecutive patients scheduled for neuropsychological evaluation in an outpatient psychiatry clinic. Patients include 220 males and 317 females with an average formal education of 11.01 years (SD = 3.87) and age of 55.64 years (SD = 16.20). Results: The overall rate of no-shows or late cancellations was 20%. Of the 106 patients who no-showed/late cancelled, 41% rescheduled, and of those, 23% missed or late cancelled their second appointment. No-shows and late cancellations were associated with historical/prior no-show rate, while race/ethnicity and activation of MyChart had slight impacts. Conclusions: These data suggest that prior no-show rates and MyChart access may be targets for interventions to improve show rates. This is important for the patients' gaining access to care as well as minimizing financial strains for the system and increasing wait times/delays to care for other patients. [ABSTRACT FROM AUTHOR]

Annual wellness visits (AWVs) guide appropriate patient care through lifestyle modifications, medication intervention, or social assistance. We launched a quality improvement program to target Medicare beneficiaries as part of an Accountable Care Organization (ACO). Key stakeholders collectively implemented a process consisting of two cohorts: AWVs completed with the support of the pharmacy team or directly by providers. A standardized workflow for the pharmacy cohort involved the clinical pharmacists and pharmacy extenders, allowing a layered learning experience. The AWV completion rate was optimized with the interventions of the pharmacy team. [ABSTRACT FROM AUTHOR]

Background/Objectives: Regular follow-up treatment is important for the management of diabetes and to reduce the risk of complications. In this study, we aimed to evaluate the proportion of adult diabetic patients who miss appointments, in addition to the potential correlation between personal characteristics, personality, and the context of family structure and characteristics and missed appointments by adult patients with type 2 diabetes. Methods: This study was a cross-sectional descriptive study. The data were gathered through self-administered questionnaires and the patient medical records of 106 individuals who received healthcare services at the Khon Kaen Province primary care unit. Data were gathered from 1 November 2023 to 28 December 2023. Adjusted odds ratios (aORs) and Chi-Square statistics were used to evaluate the relationships with multivariate analyses via multinomial logistic regression and the Kruskal–Wallis test. Results: The majority of patients in the sample, 39.62%, regularly missed appointments. There was a significant association between occasionally missed appointments and middle adulthood (p-value 0.013) and regular exercise (p-value 0.025). A moderate level of the agreeableness personality trait showed a significant association with missed appointments (p-value 0.042). Conclusions: It is important to have a comprehensive understanding of the patient's personality and family characteristics to effectively plan their healthcare and provide optimal support for diabetes treatment. [ABSTRACT FROM AUTHOR]

Texas Medicaid improved infant well-child visit rates by participating in a national learning collaborative. The two-year program encouraged creativity and innovation in care for Medicaid recipients through partnerships with managed care organizations (MCOs). The MCO projects discovered valuable practices in member outreach and were disseminated in shared learning experiences. At the completion of the learning collaborative, Texas Medicaid surveyed the MCO participants to assess the impact of their projects on Medicaid beneficiaries in Texas as well as the quality improvement project format. Collectively, the MCOs raised the infant well-child visit rate year-over-year. All of the partner MCOs stated they plan to continue focused work on improving infant well-child visit rates after the learning collaborative. [ABSTRACT FROM AUTHOR]

Background: Oral health is a critical component of overall well-being. However, students with disabilities (SWDs) face unique challenges in maintaining oral hygiene and accessing dental care. This study aims to explore oral health behaviours, dental care utilisation, and barriers to accessing dental care among SWDs in Al-Ahsa, Saudi Arabia, from the perspectives of their parents. Methods: A descriptive cross-sectional study was conducted among parents of SWDs in Al-Ahsa, Saudi Arabia. Data were collected using a validated questionnaire covering oral health behaviours, dental care utilisation, and barriers to care. The sample size was determined based on the SWDs population in the region. Data were analysed using descriptive and analytical statistics, with significant associations identified at p < 0.05. Results: Findings revealed that 45.7% of SWDs brushed irregularly, with only 16.8% brushing twice a day or more. Dental flossing was reported by just 4.3% of SWDs. Emergency-based dental visits were common (51.9%), and 29.5% of SWDs had never visited a dentist. Significant associations were found between maternal education and tooth brushing frequency (p = 0.004) and between parental education and the frequency of dental visits (p = 0.035). The most reported barriers included fear of treatment (47.1%), difficulty finding willing dentists (45.5%), and long wait times for appointments (44.7%). Conclusions: The study emphasises the pressing need for targeted interventions to improve oral hygiene practices and enhance accessibility to dental services for SWDs. [ABSTRACT FROM AUTHOR]

Background: Depression in type 2 diabetes mellitus (T2DM) impacts glycemic control and complications. This study examines the influence of depression on compliance with recommended annual diabetes assessments in patients within the Local Healthcare Authority of Romagna. From a clinical health psychology perspective, understanding how depression influences patients' engagement in managing their conditions is crucial. This insight can help improve healthcare services by ensuring they address mental health needs and thereby enhance treatment effectiveness and overall patient outcomes. Methods: This retrospective cohort study included residents of Romagna with incident T2DM from 2015 to 2017, followed from 1 January 2018 to 31 December 2022. Depression was identified via hospital discharge records or antidepressant prescriptions. Adherence to diabetes care guidelines was measured using the Guideline Composite Indicator (GCI). Results: The study included 13,285 patients, with a mean age of 61.1 years. Prevalence of post-diabetes depression increased from 3.0% in 2018 to 8.9% in 2022. Initial analyses showed higher GCI rates among patients with depression. However, propensity-score adjustment revealed that by 2021–2022, patients with pre-diabetes depression had 5% lower compliance rates (p-value ≤ 0.05). Older adults with depression had reduced adherence, while younger adults with post-diabetes depression had higher adherence rates. Conclusions: Depression significantly affects adherence to diabetes care guidelines in T2DM patients, particularly among older adults. Integrated care models addressing both diabetes and depression are crucial for improving health outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: The previous literature has identified increased work-related stress among healthcare workers (HCWs) during the COVID-19 pandemic. This study analyzes work-related perceived stress experienced by therapists during the COVID-19 pandemic in Germany to identify potential for supporting this crucial group of HCWs in future health crises. Methods: Survey data on stress, measured through the Perceived Stress Scale 4, among HCWs (therapists n = 612, nurses n = 501, and doctors n = 461) were analyzed using descriptive statistics, and data from four semi-structured interviews and seven focus group discussions with therapists were analyzed using thematic content analysis. Data were collected from March to September 2022. Results: Therapists reported similar stress levels to other HCWs, with the reporting of perceived stress differing between work contexts. Eight stressors were identified through the thematic analysis: (1) concerns about maintaining the quality of care, (2) uncertainty about the future, (3) workload, (4) interactions with colleagues and patients, (5) PPE, (6) the risk of infection, (7) insufficient information flow, and (8) the lack of public and political recognition. Conclusions: This study emphasizes the distinct challenges that therapists experienced during the COVID-19 pandemic. By identifying the factors that contributed to the stress experienced, the study can inform targeted support strategies which can enhance therapists' work, ultimately contributing to sustaining essential healthcare services during public health crises. [ABSTRACT FROM AUTHOR]

Background/Objectives: Operating room (OR) efficiency is a critical factor in healthcare delivery, influenced by various components including surgical duration, room turnover, staff availability, and equipment preparation. Optimizing surgical start times through systematic strategies such as computational algorithms can significantly enhance OR utilization and management. This study aimed to improve OR efficiency by effectively managing and optimizing surgical start times using a computational algorithm designed to allocate resources more efficiently. Methods: A comparative analysis was conducted over two six-month periods from January to June 2023 and January to June 2024, with an improvement phase implemented between July and December 2023. Results: These measures encompassed training surgical personnel, strengthening the medical team, revising work procedures and hospital regulations, and the integration of a computational algorithm to better schedule and manage surgical interventions. Following the implementation of these comprehensive measures, enhanced management of surgical start times was observed. A statistically significant increase in surgical interventions between 8 and 10 a.m. was noted for the entire OR, rising from 28.65% to 32.13%. While OR occupancy between 8 and 12 a.m. increased from 63.91% to 73.30%, this difference was not statistically significant. However, a notable improvement in average occupancy between 9 and 11 a.m. was observed, rising from 87.53% to 98.07%. Conclusions: The introduction of computational algorithms significantly improved operating room efficiency, particularly in managing surgical start times. Additionally, team coordination improved as a result of more structured scheduling processes. The results indicate that effective management of surgical start times, especially when enhanced by computational algorithms, can positively impact OR utilization, particularly within specific time blocks. [ABSTRACT FROM AUTHOR]

PURPOSE: To establish thresholds in the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference, physical function, fatigue, and depression scores on the basis of their association with subsequent use of the emergency department (ED) or urgent care by people diagnosed with cancer. METHODS: Retrospective data from 952 people seen at Henry Ford Cancer and insured through the Health Alliance Plan were analyzed using generalized linear mixed-effects models. The log odds of ED or urgent care use during 14 or 30 days after each patient-reported outcome (PRO) assessment were related to PRO scores, while adjusting for comorbidity, sociodemographic, and tumor characteristics. RESULTS: Pain interference and physical function were associated with subsequent ED or urgent care visits, but fatigue and depression were not, and the results for 14- and 30-day visits were similar. Thresholds anchored in the likelihood of these visits differed according to cancer stage. For people with advanced cancer, a pain interference score of 60 or higher (odds ratio [OR] 3.75, [95% CI, 1.53 to 7.87]) and a physical function score lower than 40 (OR 2.94, [95% CI, 1.22 to 7.06]) produced the largest ORs with narrowest CIs for 30-day visits. For people with nonadvanced cancer, the thresholds of 65 for pain interference (OR 2.64, [95% CI, 1.40 to 5.01]) and 35 for physical function (OR 1.87, [95% CI, 1.01 to 3.45]) produced largest ORs with narrowest CIs for 30-day visits. CONCLUSION: These anchor-based thresholds in PROMIS scores can inform clinicians' actions with the goal of preventing ED or urgent care visits. PROMIS pain interference and physical function were related to emergency room or urgent care use. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has posed unprecedented pressure to health care systems, and interrupted health care delivery and access including HIV care in the United States' Deep South, which endures a double epidemic of HIV and COVID-19. Ryan White programs cover HIV care services for over half of PLWH in the Deep South. Given the important role of Ryan White programs, examining the visitation changes to Ryan White facilities during the pandemic offers insights into the impact of the pandemic on HIV healthcare utilization. Objectives: Analyze the geographic distribution of HIV facility visitors at the county level before and during the pandemic in the nine US states of Deep South (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas) to reveal the geographic and racial disparity in visitation disruption caused by the pandemic. Methods: We first extracted mobile device-based visitation data for Ryan White HIV facilities in the Deep South during 2019 and 2020. To quantify the disruption in visitations during 2020, we calculated the visitation reduction rate (VRR) for each county, using 2019 data as the baseline. Next, we conducted a spatial analysis of the VRR values to uncover geographical disparities in visitation interruptions. To investigate racial disparities, we performed spatial regression analyses with VRR as the dependent variable, and the percentages of Black, Hispanic, and Asian populations as the independent variables. In this analysis, we controlled for potential confounders. Results: Geographic disparities in visitation reduction were observed, with all nine Deep South states experiencing significant drops. Georgia experienced the highest visitation loss (VRR = -0.58), followed by Texas (-0.47), Alabama (0.47), and Tennessee (-0.46), while South Carolina had the smallest reductions (-0.11). All the regression models consistently revealed racial disparities in visitation interruption. That is, counties with a higher proportion of Black population tended to have higher RW facility visitation reductions. Conclusions: Our analysis revealed distinct geographic disparities in visitation interruptions at Ryan White HIV facilities in the Deep South during the COVID-19 pandemic in 2020. Furthermore, we found that the Black/African American population experienced a greater disruption at the county level in the Deep South during this period. [ABSTRACT FROM AUTHOR]

Introduction: Readmission is an important indicator of poor post-discharge management for psychiatric patients. This study explores the factors influencing psychiatric patient readmission, with a focus on post-discharge follow-up visits. Materials & Methods: This retrospective cohort study analyzed the clinical records of psychiatric inpatients over an eight-year period up to 2019. The relationship between various clinical factors during hospitalization (e.g., length of stay, diagnosis, treatment adherence) and post-discharge follow-up leading to readmission was assessed using Kaplan-Meier survival analysis, Log-rank test, and Cox regression analysis. Results: The study revealed a 23% readmission rate. Gender, education, length of hospital stay, number of previous hospitalizations, and restraint during hospitalization showed significant associations with post-discharge visits (P < 0.05). Gender, place of hospitalization, and type of discharge were related to the timing of the first post-discharge visit (P < 0.05). Scheduling follow-up visits at discharge was significantly associated with post-discharge follow-up (p = 0.001). Conclusion: To reduce or delay readmissions, the study recommends increasing post-discharge visits, minimizing treating psychiatrists, scheduling outpatient follow-up upon discharge, providing psycho-education at discharge (particularly for women and individuals with higher education), addressing patients who leave against medical advice, and conducting telephone follow-up for high-risk patients. [ABSTRACT FROM AUTHOR]

Women living with HIV/AIDS (WLHA) encounter numerous challenges, such as stigma and gender disparities, that hinder their access to care, especially in patriarchal societies like Vietnam. We developed a hybrid intervention with online and offline (in-person) components to empower WLHA in Vietnam. The intervention was pilot tested with 91 WLHA in Hanoi. During baseline and 4-month, study investigators delivered two in-person sessions, one Zoom session, and 15 weeks of Zalo (social media platform) discussions to enhance positive coping strategies, treatment utilization and adherence, and engagement of support from family and peers. The participants continued their Zalo discussions from 4-month to 6-month without investigators' involvement. Intervention outcomes, including active coping and perceived barriers to care, were evaluated at baseline, 4-, and 6-month surveys. Mixed-effects regression models showed that the participants' active coping significantly increased from baseline (50.5 ± 9.4) to 4-month (53.8 ± 6.2; p = 0.0001), although there was a slight decrease at 6-month (52.8 ± 7.2), the change from 4-month to 6-month was not significantly significant (p = 0.3256). There was a significant reduction in participants' perceived barriers to care, from 19.8 ± 5.2 at baseline to 17.4 ± 5.2 at 4-month (p < 0.0001), which remained stable at 17.8 ± 4.3 at 6-month (p < 0.0001 compared to baseline). This intervention presents a promising model to empower WLHA in Vietnam and potentially in similar global contexts. Future interventions could benefit from leveraging natural peer leaders and adopting a more person-centered approach to meet WLHA's varying needs. [ABSTRACT FROM AUTHOR]