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BACKGROUND: In 2022-2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recommended for infants. We aimed to estimate the incidence of outpatient visits and antibiotic prescriptions in US children (≤17 years) from 2016-2019 for acute otitis media, pneumonia, and sinusitis associated with PCV15- and PCV20-additional (non-PCV13) serotypes to quantify PCV15/20 potential impacts. METHODS: We estimated the incidence of PCV15/20-additional serotype-attributable visits and antibiotic prescriptions as the product of all-cause incidence rates, derived from national health care surveys and MarketScan databases, and PCV15/20-additional serotype-attributable fractions. We estimated serotype-specific attributable fractions using modified vaccine-probe approaches incorporating incidence changes post-PCV13 and ratios of PCV13 versus PCV15/20 serotype frequencies, estimated through meta-analyses. RESULTS: Per 1000 children annually, PCV15-additional serotypes accounted for an estimated 2.7 (95% confidence interval, 1.8-3.9) visits and 2.4 (95% CI, 1.6-3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (95% CI, 11.2-20.4) visits and 13.2 (95% CI, 9.9-18.0) antibiotic prescriptions annually per 1000 children. PCV15/20-additional serotypes account for 0.4% (95% CI, 0.2%-0.6%) and 2.1% (95% CI, 1.5%-3.0%) of pediatric outpatient antibiotic use. CONCLUSIONS: Compared with PCV15-additional serotypes, PCV20-additional serotypes account for > 5 times the burden of visits and antibiotic prescriptions. Higher-valency PCVs, especially PCV20, may contribute to preventing pediatric pneumococcal respiratory infections and antibiotic use.

BACKGROUND: The fast-growing migrant population in Japan and globally poses challenges in mental healthcare, yet research addressing migrants mental health treatment engagement remains limited. OBJECTIVE: This study examined language proficiency, demographic and clinical characteristics as predictors of early treatment discontinuation among migrants. METHODS: Electronic health record data from 196 adult migrants, identified from 14 511 patients who received mental health outpatient treatment during 2016 and 2019 at three central hospitals in the Tokyo-Yokohama metropolitan region of Japan, were used. We conducted multivariable regression models to identify predictors of early discontinuation within 3 months. FINDINGS: The study cohort (65% women, age range: 18-90 years, from 29 countries or regions) included 23% non-Japanese speakers. Japanese and non-Japanese speakers had similar discontinuation rates (26% vs 22%). Multivariable models revealed younger age (OR=0.97; 95% CI: 0.95, 0.99; p=0.016) and those with a primary diagnosis other than a schizophrenia spectrum disorder (OR=3.99; 95% CI: 1.36, 11.77; p=0.012) or a neurotic, stress-related and somatoform disorder (OR=2.79; 95% CI: 1.14, 6.84; p=0.025) had higher odds of early discontinuation. These effects were more pronounced among the Japanese speakers with significant language-by-age and language-by-diagnoses interactions. CONCLUSION: Younger age and having a primary diagnosis other than a schizophrenia spectrum disorder or a neurotic, stress-related and somatoform disorder increased vulnerability for discontinuing mental health treatment early in Japanese-speaking migrants but not for migrants with limited Japanese proficiency. CLINICAL IMPLICATIONS: Understanding language needs within a context of mental health treatment should go beyond assumed or observed fluency. Unmet language needs might increase vulnerability for treatment disengagement among migrants. Targeted clinical efforts are crucial for enhancing early treatment engagement and informing health practices in Japan and countries with growing migrant populations.

BACKGROUND: Buprenorphine is an effective treatment for opioid use disorder (OUD); however, buprenorphine initiation can be complicated by withdrawal symptoms including precipitated withdrawal. There has been increasing interest in using low dose initiation (LDI) strategies to reduce this withdrawal risk. As there are limited data on withdrawal symptoms during LDI, we characterize withdrawal symptoms in people with daily fentanyl use who underwent initiation using these strategies as outpatients. METHODS: We conducted a retrospective chart review of patients with OUD using daily fentanyl who were prescribed 7-day or 4-day LDI at 2 substance use disorder treatment clinics in San Francisco. Two addiction medicine experts assessed extracted chart documentation for withdrawal severity and precipitated withdrawal, defined as acute worsening of withdrawal symptoms immediately after taking buprenorphine. A third expert adjudicated disagreements. Data were analyzed using descriptive statistics. RESULTS: There were 175 initiations in 126 patients. The mean age was 37 (SD 10 years). 71% were men, 26% women, and 2% non-binary. 21% identified as Black, 16% Latine, and 52% white. 60% were unstably housed and 75% had Medicaid insurance. Substance co-use included 74% who used amphetamines, 29% cocaine, 22% benzodiazepines, and 19% alcohol. Follow up was available for 118 (67%) initiations. There was deviation from protocol instructions in 22% of these initiations with follow up. 31% had any withdrawal, including 21% with mild symptoms, 8% moderate and 2% severe. Precipitated withdrawal occurred in 10 cases, or 8% of initiations with follow up. Of these, 7 had deviation from protocol instructions; thus, there were 3 cases with follow up (3%) in which precipitated withdrawal occurred without protocol deviation. CONCLUSIONS: Withdrawal was relatively common in our cohort but was mostly mild, and precipitated withdrawal was rare. Deviation from instructions, structural barriers, and varying fentanyl use characteristics may contribute to withdrawal. Clinicians should counsel patients who use fentanyl that mild withdrawal symptoms are likely during LDI, and there is still a low risk for precipitated withdrawal. Future studies should compare withdrawal across initiation types, seek ways to support patients in initiating buprenorphine, and qualitatively elicit patients withdrawal experiences.

BACKGROUNDCOVID-19 convalescent plasma (CCP) virus-specific antibody levels that translate into recipient posttransfusion antibody levels sufficient to prevent disease progression are not defined.METHODSThis secondary analysis correlated donor and recipient antibody levels to hospitalization risk among unvaccinated, seronegative CCP recipients within the outpatient, double-blind, randomized clinical trial that compared CCP to control plasma. The majority of COVID-19 CCP arm hospitalizations (15/17, 88%) occurred in this unvaccinated, seronegative subgroup. A functional cutoff to delineate recipient high versus low posttransfusion antibody levels was established by 2 methods: (i) analyzing virus neutralization-equivalent anti-Spike receptor-binding domain immunoglobulin G (anti-S-RBD IgG) responses in donors or (ii) receiver operating characteristic (ROC) curve analysis.RESULTSSARS-CoV-2 anti-S-RBD IgG antibody was volume diluted 21.3-fold into posttransfusion seronegative recipients from matched donor units. Virus-specific antibody delivered was approximately 1.2 mg. The high-antibody recipients transfused early (symptom onset within 5 days) had no hospitalizations. A CCP-recipient analysis for antibody thresholds correlated to reduced hospitalizations found a statistical significant association between early transfusion and high antibodies versus all other CCP recipients (or control plasma), with antibody cutoffs established by both methods-donor-based virus neutralization cutoffs in posttransfusion recipients (0/85 [0%] versus 15/276 [5.6%]; P = 0.03) or ROC-based cutoff (0/94 [0%] versus 15/267 [5.4%]; P = 0.01).CONCLUSIONIn unvaccinated, seronegative CCP recipients, early transfusion of plasma units in the upper 30% of study donors antibody levels reduced outpatient hospitalizations. High antibody level plasma units, given early, should be reserved for therapeutic use.TRIAL REGISTRATIONClinicalTrials.gov NCT04373460.FUNDINGDepartment of Defense (W911QY2090012); Defense Health Agency; Bloomberg Philanthropies; the State of Maryland; NIH (3R01AI152078-01S1, U24TR001609-S3, 1K23HL151826NIH); the Mental Wellness Foundation; the Moriah Fund; Octapharma; the Healthnetwork Foundation; the Shear Family Foundation; the NorthShore Research Institute; and the Rice Foundation.

Background: The negative impact of COVID-19 pandemic on healthcare service utilization has been reported in several countries. In Gabon, data on the preparedness for future pandemic are lacking. The aim of the present study was to assess the trends of hospital attendance, malaria and self-medication prevalences as well as ITN use before and during Covid-19 first epidemic waves in a paediatric wards of a sentinel site for malaria surveillance, in Libreville, Gabon. Methods: This was a retrospective descriptive and hospital-based survey which was conducted at the Regional Hospital of Melen Estuaire (RHME). Census of files of patients below 18 years of age attending for fever management with a result of malaria biological diagnosis from January 2018 to December 2022 was conducted. Comparison of the prevalence of microscopic malaria, ITN use, self-medication and the fever duration prior the screening before and after year 2020 was performed using bivariate and multivariate analysis. Results: Overall, 14428 febrile participants were screened for malaria. A 15% increase in the number of febrile patients was observed between 2019 and 2020 while this rate was above 100% in 2021 and 2022. The frequency of self-medication significantly doubled in 2020 and 2021 compared to the pre-COVID-19 period (p < 0.01). Previous self-medication was more common during the COVID-19 period compared to the COVID-19 one (aOR = 2.15 [1.91–2.42]) (p < 0.01). Among the 7259 (51.2%) patients screened after 3 days of fever onset, self-anti-malarial treatment was reported for 17.5% of them in 2019 and for more than 30% of them from 2020: 33.3% in 2020, 35.0% in 2021 and 32.3% in 2022 (p < 0.01). The median of fever duration was significantly higher in the group of participants with a previous self-medication (p < 0.01). Positive blood smears frequency was higher in the COVID-19 period (35.6%; n = 3876/10868) compared to the pre-COVID-19 period (23.6%) (OR = 1.79[1.59–2.02], (p < 0.01). Conclusion: Malaria prevalence and care-seeking behaviours for fever management in children significantly changed during the COVID-19 epidemic phase and subsequent years in the main malaria sentinel surveillance site of Gabon. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) is defined as a transdiagnostic phenomenon that has well increased in the latest years, especially in the adolescent population. It has been associated with suicidality, alexithymia, emotion dysregulation, and psychosocial impairment, as well as family issues. The choice of level of care (i.e., hospitalization versus outpatient visit) depends on a number of factors that relate not only to suicidal risk but also to severity of individual's psychosocial functioning, the ability of family environment to support treatment choices and to contain child, as well as the need for ongoing monitoring of the young patient. A scarcity of studies has compared outpatients with inpatients, both of them engaging in NSSI. Methods: the current study aimed to further expand knowledge regarding features that characterize young self-harmers who receive different levels of care, with particular attention on psychopathological, family, and NSSI-related characteristics, as well as suicidality. The current research included 56 inpatients and 56 outpatients with NSSI, paired for gender, age, and psychiatric diagnosis. Instruments investigating psychopathology, emotion dysregulation, alexithymia, psychosocial functioning, and interactive family dynamics were administered. Descriptive statistics, parametric and non-parametric inferential statistics were applied. Results: study findings highlighted that inpatients engaging in NSSI reported lifetime suicidality, clinical level of externalizing and internalizing problems, more severe alexithymia, emotion dysregulation, and impaired psychosocial functioning compared to outpatients engaging in self-harming. Furthermore, when compared to outpatients' families, inpatients' families were more capable of adhering to rules and time of the family play situation (the Lausanne Trilogue Play procedure) and fixing interactive mistakes through activities. On the contrary, in the inpatient group, global performance, role implication, parental scaffolding, child's involvement and self regulation tend to decline, while parental conflicts tend to rise over the four part scenario of the family play. Conclusion: these findings confirmed a more severe global picture of young inpatients engaging in self-harming, suggesting that NSSI may be the expression of this larger psychopathological picture. In addition, the study highlighted the need for a multi-informant and multimethod clinical assessment, which should include evaluation of family context and co-parenting system, especially for hospitalized young patients engaging in self-harm. [ABSTRACT FROM AUTHOR]

Objective: An increasing demand for inpatient treatment for adolescents with anorexia nervosa (AN) during and after the Covid‐19 pandemic contrasts with limited capacity and long waiting times. The current pilot study evaluated an outpatient group therapy (GT) as early intervention for adolescents with AN prior to inpatient treatment. Methods: Seventeen female adolescents who participated at the GT (intervention group, INT) were compared to 16 adolescents without GT (treatment‐as‐usual, TAU). BMI, eating disorder psychopathology and motivation of change (MoC) were assessed at three timepoints. Results: Comparing pre‐ versus post‐ group participation, we identified a significant increase of MoC and a trend towards a decreased AN‐specific psychopathology. Comparing INT with TAU adolescents, we found a significant lower AN psychopathology at inpatient admission for the INT group and a trend for different BMI courses: While the BMI of the TAU group decreased during waiting time, the INT group did not show a decrease during GT resulting in a higher BMI at admission. Conclusions: Results of the current pilot study suggest positive effects of an early outpatient intervention in a group setting for adolescents with AN prior to inpatient treatment. Further research with larger sample sizes is necessary to validate the current pilot results. Highlights: Outpatient group therapy (GT) for adolescents with anorexia nervosa (AN) prior to inpatient treatment represents an early intervention and may improve the starting conditions of inpatient treatment.Motivation to change improves while participating in an outpatient GT prior to inpatient treatment for adolescents with AN.Adolescents with AN participating in GT show less weight loss from first outpatient contact to inpatient admission compared to TAU adolescents. [ABSTRACT FROM AUTHOR]

Introduction: Timing of induction of labor (IOL) at term has been investigated in multiple settings. In Denmark, the 'When to INDuce for OverWeight' (WINDOW) study compares IOL at 39 weeks of gestation vs expectant management in low‐risk women with obesity. However, knowledge on women's expectations of and experience with IOL is sparse. The aim of this study was to explore women's motivation to join the WINDOW study and their experience when randomized to IOL at 39 gestational weeks. Material and Methods: A qualitative interview study of 25 pregnant women with obesity randomized in the WINDOW study to IOL at 39 weeks of gestation was conducted. Participants were recruited from four hospitals in Central Denmark Region and were interviewed four to six weeks after giving birth. A thematic analysis was performed using a phenomenological approach. Results: The analysis resulted in three main themes, (1) Motivation for IOL, (2) The IOL process, and (3) IOL in recollection and in the future. Participants perceived inclusion into the WINDOW study as a "great opportunity," as they hoped to be randomized to IOL at 39 weeks of gestation. Their main motivation for participating was physical discomfort in late pregnancy and a wish for "knowing" the timing of the birth. BMI‐related risk factors were mentioned by few as a motivating factor. Some participants described the IOL process as a team effort between the couple and the midwives and were positive towards future IOL. Others associated the IOL process with prolonged labor or described the body as "reluctant" to respond to the induction regime. A desire to experience spontaneous onset of labor in a future pregnancy was mentioned. Conclusions: Physical discomfort and wanting to "control" the onset of labor were main motivations for women's decision to participate in the WINDOW study, hoping they would be allocated for IOL. Comprehensive information and being supported by midwives through the IOL process was crucial for a positive IOL experience. Some participants were positive towards a future IOL. Others speculated if their body was not ready for birth in 39 weeks of gestation and/or associated the IOL process with a challenging labor. [ABSTRACT FROM AUTHOR]

Telephone and video consultations have been used as telepharmacy modalities for a number of years, particularly during the COVID-19 pandemic where in-person services were limited. However, a widespread global literature review has yet to be completed on studies since June 2016 regarding the effectiveness of telephone and video consultations as telepharmacy models. The aim of this review was to summarise the synchronous telepharmacy models of care for adult outpatients since June 2016. The secondary aim was to report on the effect of these models on clinical, service, and user-perspectives and non-clinical outcomes compared to the standard model of care, as well as facilitators and barriers of the telepharmacy models. A PROSPERO registered systematic review was conducted using PubMed, CINAHL, and Embase in March 2023. Key search terms included pharmacy, telepharmacy, and outpatient; data extraction and narrative analysis were then performed and NHMRC level of evidence determined. From 2129 unique articles reviewed, 103 were eligible for inclusion. Synchronous telepharmacy services in an outpatient setting were delivered by telephone consultations and video consultations, with the majority being delivered by the telephone modality (87 %) and the remainder by video (13 %). Services primarily involved a pharmacist providing a single consultation with a patient. The purpose of this was either to provide counselling, obtain a best possible medication history, or to provide ongoing support as part of a clinical program, such as diabetes and blood pressure monitoring. Patients reported the quality of care received through telepharmacy consultations provided the same level of care or was superior to in-person services. Key facilitators for the success of telepharmacy services were access to training, technical assistance, digital literacy and availability of technology. Telephone and video telepharmacy services are being delivered across a range of outpatient clinical areas. More evidence is needed for video consultation services and how this modality may potentially provide further benefit for certain clinical tasks such as counselling and use of medication delivery devices. Overall, telepharmacy services enhance patient accessibility to healthcare and offer a convenient method of delivering high quality services. [ABSTRACT FROM AUTHOR]

Background/Aim: Measures to control adverse events (AEs) in the use of oral multi-kinase inhibitors (OMI) are important for the continuation of treatment. Patients and Methods: In this study, oncology pharmacists monitored symptoms of patients receiving outpatient therapy with OMIs in real-time using a smartphone Web app for the early detection/early treatment of AEs. This feasibility study evaluated the effects of using the app in 10 patients compared with data from 10 patients who did not use the app. Results: In the app group, grade 3 AEs were reported in all patients on the day of their occurrence. In contrast, in the no-app group, it took 1-22 days for pharmacists to detect these AEs, among whom 2 patients needed emergency consultations and admissions due to grade 3 AEs. In the app group, 1 patient had an emergency consultation, without admission. The percentage of patients requiring 10 minutes or more for symptom checking during the interview before the physician's examination was significantly lower (p=0.001), and the frequency of telephone calls was also significantly lower (p=0.029) in the app group compared to the no app group. Conclusion: Using the Web app facilitates the early detection of AEs, contributing to reducing the need for emergency consultations and admissions, and minimizing the time pharmacists spend confirming symptoms with patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Importance Objective Design Setting Participants Main Outcomes and Measures Results Conclusions and Relevance The incidence of potentially inappropriate medication (PIM) prescribing among older adults is not as well studied as its prevalence. Estimates of factors associated with PIM incidence, such as patient age, sex, race‐ethnicity, medication subsidy support, and comorbidity, are also limited.To estimate the incidence of PIM prescribing in older adult outpatients, as well as the incidence and predictors for each PIM class, in a large outpatient electronic health records (EHR) cohort.Retrospective study of PIM prescribing among outpatients with encounters leading to prescription orders, 2015–2018, excluding prevalent cases.Outpatients receiving care from a multi‐site health system in western Pennsylvania.342,405 patients, contributing 893,754 person‐years of follow‐up.The incidence of PIM prescribing based on automated coding of 2019 Beers criteria. A multivariable Poisson regression model was estimated to assess the impact of age, sex, race‐ethnicity, comorbidity, and medication subsidy (PACE/PACENET) on PIM risk. For each PIM class, the association between predictors and time to PIM prescribing was evaluated using proportional hazard models.The incidence rate (IR) for 1 or more PIM was 193.5 per 1000 person‐years, led by short‐ and intermediate‐acting benzodiazepines (37.6), first‐generation antihistamines (32.8), and skeletal muscle relaxants (22.0). The incidence of PIM prescribing was 15% higher among white patients and 35% lower among males. High comorbidity (Charlson score ≥ 3) was associated with a 59% higher risk. Participation in the PACE/PACENET program, a medication subsidy program, was associated with an 83% increase in incidence. Each additional year of age was associated with a 1.2% reduction in incidence.This study establishes benchmarks for the incidence of PIM prescribing in outpatients and identifies important disparities in PIM risk, which vary by PIM class. [ABSTRACT FROM AUTHOR]

Background: The introduction of the Enterovirus A71 (EV-A71) vaccine in China in 2016 has led to a considerable decline in severe hand, foot, and mouth disease (HFMD) cases, with mild outpatient instances now representing the majority of HFMD cases in the country. Nevertheless, epidemiological investigations concerning mild outpatient cases remain scarce, resulting in inadequate descriptions of their clinical, etiological, and epidemiological characteristics. Our study aimed to analyze the clinical, etiological, and epidemiological characteristics of HFMD outpatients in Chengdu from 2019 to 2022 while identifying potential risk factors associated with the progression of outpatients requiring hospitalization. Methods: A retrospective study was conducted to summarize the clinical, etiological, and epidemiological characteristics of outpatient HFMD cases in Chengdu from 2019 to 2022. Risk factors associated with progression to hospitalization of HFMD outpatients were evaluated using binomial logistic regression analysis. Results: The study included 1,073 coxsackievirus A6 (CVA6), coxsackievirus A10 (CVA10), and coxsackievirus A16 (CVA16) HFMD nucleic acid test-positive outpatients. Among these, only 45 outpatients (4.19%) progressed to hospitalization. The median ages for CVA6, CVA10, and CVA16 infections were 25.23, 28.13, and 38.45 months, respectively (P < 0.001). CVA6 (76.51%, 821/1,073) has become the main serotype among outpatients in Chengdu, with the proportions from the second half of 2019 to 2022 being 45.59%, 95.17%, 77.67% and 80.71% respectively. EV-A71 cases even disappeared. Patients infected with CVA10 had a significantly higher likelihood of hospitalization (P < 0.05), while the presence of oral rash served as a protective factor (P < 0.05). Conclusions: Our study highlights the critical need for enhanced surveillance of multiple HFMD pathogens, predominantly caused by the prevalent serotype CVA6. Clinically, enhanced surveillance of CVA10 is imperative to mitigate the hospitalization rate associated with HFMD. [ABSTRACT FROM AUTHOR]

Introduction: Evidence on the association of biomarkers of host response to infection with COVID-19 clinical outcomes has focused mainly on hospitalized patients. We investigated the prognostic performance of 39 immune and endothelial activation markers measured early in the course of disease to predict the development of severe COVID-19 and hospitalization. Methods: We conducted a nested case-control study from a randomized clinical trial evaluating the efficacy of COVID-19 convalescent plasma in outpatients aged 50 years or older presenting with mild-to-moderate COVID-19. We selected participants who were hospitalized within 28 days (cases) and who were not (controls) to compare their biomarker levels in plasma samples collected at enrolment. Results: A total of 42 cases and 42 controls were included in this study. The levels of CRP, IL6, IP10, ferritin, IFNα, IL8, IL1RA, MCP1, and RANTES, determined within 7 days of symptoms onset, showed good individual prognostic performance for COVID-19 associated hospitalization by day 28. The biomarkers CRP, IL6, IP10, IL8, IL1RA, and suPAR showed good individual prognostic performance for severe COVID-19. CRP, IL6 and IP10 had the most robust association with both hospitalization and severe COVID-19, with CRP having the highest discriminatory capacity with hospitalization, and IL6 for severe COVID-19. Discussion: Our study shows good prognostic performance of CRP and IL6 for 28-day hospitalization in patients with mild-to-moderate COVID-19, in the absence of clinical criteria for admission upon enrolment. These findings confirm the value of these biomarkers at early stages of COVID-19 disease in the outpatient setting to support management decisions. [ABSTRACT FROM AUTHOR]

AbstractObjective: Early leaving in substance use disorder treatment may be the single largest variable undermining treatment success. Existing work on early leaving tends to explore either client factors, which include age, race, gender, and diagnoses, or treatment factors, which include the type of treatment activities offered, treatment experiences of clients and staff, treatment amenities, and environmental factors in the residential treatment program. However, existing work on both client factors and treatment factors provides mixed results on what contributes to early leaving. Further, there has been very little research in the private residential treatment setting. This study aims to explore the factors influencing early leaving in a private residential treatment setting. Methods: The study analyzed admission and treatment records from 247 consecutive clients at a private treatment facility in Southern California to identify factors related to shorter retention. The program employs a biopsychosocial approach and evidence-based practices to assist clients in recovery from substance use disorders and mental health conditions. We utilize a battery of client measures, including the Outcome Questionnaire 45.2, Trauma History Questionnaire, as well as demographic and psychiatric variables in our analyses. Results: Findings challenge previous research by showing that age and gender do not predict shorter retention, contrary to findings in the extant literature on public treatment centers. Instead, clients with higher symptoms of distress stay longer, as indicated by scores on the Outcome Questionnaire 45.2. Additionally, we find the majority of the cohort stayed in residential treatment for more than 30 days, with the average length of stay being 47.92 days, indicating that treatment completion of clients with severe symptomatology for an extended time in treatment (30 days or more) is achievable. Conclusions: The study underscores the importance of considering client symptomologies and severities in understanding and improving retention in substance use disorder treatment programs. This study highlights the potential impact of treatment services offered in private settings on client retention. [ABSTRACT FROM AUTHOR]

Background: The incidence of chronic disease is increasing worldwide which, in turn, increases the demand for healthcare services. To meet these demands, healthcare systems are adapting their services in order to reduce treatment costs and ensure coherence for patients with multiple diseases. One form of adaptation is shared outpatient consultations between internal medical specialties. However, little is known about how patients interact with multiple clinicians in shared consultations. Aim: This project aimed to explore how patients with diabetes and chronic kidney disease interact with multiple clinicians in a shared outpatient setting. Research Methods: We performed a qualitative ethnographic study, combining focused participant observations with informal field interviews. We included 17 participants, nine males and eight females with a mean age of 67.3 in the project. The data analysis was guided by Braun and Clarke's reflexive thematic analysis and Arthur Kleinman's theory of illness and disease. Results: We found one over‐arching theme: 'A consultation which encompassed both illness and disease' and four subthemes: (1) 'The medical focal point' pertained to the focus on physiological measurements in dialogue between patients and clinicians. (2) 'The possibility of negotiations' illustrated how decisions about dialysis and pharmacological treatment were based on negotiations. (3) 'Speaking different languages' displayed how patients used alternative illness‐based explanations whereas clinicians tended to use biomedical language. (4) 'Perceptions of everyday life' concerned what patients considered was best for them when managing their illness and everyday lives. Conclusion: Patients present information on how they balance life with physiological and psychosocial challenges. When clinicians employ a biomedical perspective, opportunities to gain information on patients' illness behaviours or cues to negotiate are missed. Patients prioritise functioning on a daily level over following treatment regimes. These findings are tenuous and require verification in similar studies in similar settings. Short Phrases: Shared Outpatient Clinic, Patient–clinician interactions. [ABSTRACT FROM AUTHOR]

Purpose: to investigate the effectiveness of a 4-week combined progressive program on functional abilities, disability status and quality of life (QoL) in COVID-19 recovered patients. Materials & Methods: 18 COVID-19 recovered patients performed a combined rehabilitation treatment accounting for 12 sessions, including both respiratory and motor training sessions. A careful monitoring of exercise intensity, duration and progression to tailor complexity evolution on patients' competencies was carried out. Patients were monitored with different functional scales and self-reported questionnaires before (T0) and after (T1) rehabilitation. Results: 6-Minutes Walk Test, Timed Up and Go Test and Short Physical Performance Battery significantly improved, while Physiological Cost Index presented a significant reduction after rehabilitation. Moreover, Barthel Index significantly improved and patients presented significantly increased upper and lower limbs strength at T1. Furthermore, mMRC Dyspnoea Scale presented a significant reduction after training. Finally, physical and psychological well-being scales improved according to Short-Form 36; while, self-reported questionnaires related to mood and depression showed no significant modification after rehabilitation. Conclusions: results evidenced the efficacy of the combined progressive intervention in COVID-19 recovered patients. The specific customization on patients' needs and the careful exercise monitoring promoted improvements on functional abilities and disability status, with positive impact on QoL. IMPLICATION FOR REHABILITATION: Post-acute COVID-19 patients could require an adequate respiratory and neuromotor rehabilitation plan. Rehabilitative intervention should include a combined progressive training program. A 4-week progressive combined intervention seems effective in COVID-19 recovered patients. The specific customization on patients' needs and the careful exercise monitoring promotes improvements on functional abilities and disability status and patients' quality of life. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify prognostic factors pertaining to neck pain from systematic reviews. Data sources: A search on PubMed, Scopus, and CINAHL was performed on June 27, 2024. Additional grey literature searches were performed. Review methods: We conducted an umbrella review and included systematic reviews reporting the prognostic factors associated with non-specific or trauma-related neck pain and cervical radiculopathy. Prognostic factors were sorted according to the outcome predicted, the direction of the predicted outcome (worse, better, inconsistent), and the grade of evidence (Oxford Center of Evidence). The predicted outcomes were regrouped into five categories: pain, disability, work-related outcomes, quality of life, and poor outcomes (as "recovery"). Risk of bias analysis was performed with the ROBIS tool. Results: We retrieved 884 citations from three databases, read 39 full texts, and included 16 studies that met all selection criteria. From these studies, we extracted 44 prognostic factors restricted to non-specific neck pain, 47 for trauma-related neck pain, and one for cervical radiculopathy. We observed that among the prognostic factors, most were associated with characteristics of the condition, cognitive-emotional factors, or socio-environmental and lifestyle factors. Conclusion: This study identified over 40 prognostic factors associated mainly with non-specific neck pain or trauma-related neck pain. We found that a majority were associated with worse outcomes and pertained to domains mainly involving cognitive-emotional factors, socio-environmental and lifestyle factors, and the characteristics of the condition to predict outcomes and potentially guide clinicians to tailor their interventions for people living with neck pain. [ABSTRACT FROM AUTHOR]

Purpose: To determine the current incidence and impact of chemotherapy-associated food aversions in a variety of cancer types. Methods: Cancer patients aged 18 years and older who received chemotherapy infusions at the outpatient chemotherapy unit of a university hospital between May 2022 and April 2023 were included in the study (n = 243). To monitor the occurrence of food aversions, participants were asked to complete a food preference questionnaire each time they visited the outpatient chemotherapy unit. Results: During the one-year survey period, one in four cancer patients receiving outpatient chemotherapy developed food aversions, and one in four of them complained of interference with daily life due to eating problems at the same time or later. The median time to the onset of food aversion was 46 (interquartile range 36–77) days after the start of chemotherapy. The incidence of food aversions was significantly higher in patients who were women, had a digestive, gynecologic, or breast cancer, and received more cytotoxic agents in chemotherapy. Patients who developed food aversions tended to lose more body weight than those who did not. Conclusion: Food aversions were still common among cancer patients undergoing chemotherapy. Even an aversion to a single food may have affected the patient’s nutritional status. Healthcare professionals should closely monitor the occurrence of food aversions, especially in the early days of chemotherapy induction, to detect an increasing risk of malnutrition. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Objective: Telepsychiatry consultations grew rapidly with increased total consultations and reduced face-to-face consultations following the pandemic-triggered expansion of Medicare Benefits Schedule (MBS) telehealth items. It was unclear how much telehealth expansion independently impacted overall and face-to-face consultation trends after accounting for lockdown severity. Methods: We extracted monthly MBS Item Reports for psychiatric consultations (January 2012–December 2023). The monthly average Stringency Index (SI) for Australia represented lockdown severity from January 2020 to December 2022. A dichotomous variable denoted telehealth expansion (March 2020 onward). We constructed consecutive multiple linear regression models for combined consultations and face-to-face consultations to include seasonality, trend, SI, and telehealth expansion. We compared model performance using information criteria. Results: Median monthly total consultations increased from 148,413 (Interquartile range, IQR: 138,219–153,709) pre-expansion (January 2012–February 2020) to 173,016 (IQR: 158,292–182,463) post-expansion (March 2020–December 2023). Contrarily, median monthly face-to-face consultations decreased from 143,726 (IQR: 135,812–150,153) to 99,272 (IQR: 87,513–107,778). Seasonality and trend were present in both time series. The time series regression model with expansion but excluding SI best explained all consultations, while both telehealth expansion and SI were significant in the best-fit model for face-to-face consultations. Conclusion: MBS telehealth expansion was associated with total and face-to-face consultations independent of lockdown severity changes. Policy changes allowing wider access to new telehealth services have possibly led to increased uptake of psychiatric care and addressed previously unmet needs. What is known about the topic? A large rise in telepsychiatry consultations with increased total consultations and reduced face-to-face consultations followed the pandemic-triggered expansion of Medicare Benefits Schedule telehealth items. What does this paper add? We demonstrated that after adjusting for pre-existing trends, seasonality, and COVID-related restrictions, telehealth expansion was associated positively with all consultations and negatively with face-to-face consultations at clinically significant levels. What are the implications for practitioners? Policy changes widening telepsychiatry services have possibly led to increased uptake of psychiatric care by addressing previously unmet needs. Hybrid face-to-face/telehealth care may become the new norm. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to identify predictors of poststroke spasticity (modified Ashworth Scale scores, ≥1) at 3–6 mos after stroke. Design: A 5-yr (2015–2020) retrospective cohort of patients who attended inpatient stroke rehabilitation in Southwestern Ontario, Canada, were included. Sociodemographic, clinical, stroke-related, rehabilitation-related, and outcome measure data were extracted from paper charts and electronic databases. Results: Of the 922 individuals attending inpatient stroke rehabilitation, 606 (55.8% males; mean age = 70.9 ± 14.2 yrs) returned for an outpatient visit. Most patients had a first ever (n = 518; 85.5%), ischemic (n = 470; 77.6%) stroke with hemiplegia (n = 449, 74.1%). A total of 20.3% (n = 122) of patients had developed poststroke spasticity by 4 mos after stroke. A binary logistic regression significantly predicted poststroke spasticity (χ2(6) = 111.696, P < 0.0001) with good model fit (χ2(8) = 12.181, P = 0.143). There were six significant poststroke spasticity predictors: hemorrhagic stroke (P = 0.049), younger age (P < 0.001), family history of stroke (P = 0.015), Functional Independence Measure admission score (P < 0.001), use of selective serotonin reuptake inhibitors (P = 0.044), and hemiplegia (P < 0.001). Conclusions: Patients should be monitored closely for poststroke spasticity after discharge from stroke rehabilitation and throughout the care continuum. [ABSTRACT FROM AUTHOR]

Aims: Heart failure (HF) with reduced left ventricle ejection fraction (LVEF) is an entity with poor prognosis characterized by decompensations. Bioelectrical impedance analysis (BIA) is used to assess volume overload (VO) and may be useful to identify apparently stable HF outpatients at risk of decompensation. The aim of this study is to analyse whether VO assessed by BIA is associated with worsening heart failure (WHF) in stable outpatients with HF and reduced LVEF (HFrEF). Methods and results: This is a prospective single‐centre observational study. Consecutive stable HF outpatients with LVEF below 40% underwent BIA, transthoracic echocardiography, blood sampling, and physical examination and were followed up for 3 months. VO was defined as the difference between the measured weight and the dry weight assessed by BIA. Demographic, clinical, anthropometric, echocardiographic, and analytical parameters were recorded. The primary endpoint was WHF, defined by visits to the emergency department for HF or hospitalization for HF. A total of 100 patients were included. The median VO was 0.5 L (interquartile range 0–1.6 L). Eleven patients met the primary endpoint. Univariate binary logistic regression analysis showed that left ventricle filling pressures assessed by E/e′, N‐terminal pro B‐type natriuretic peptide, inferior vena cava dilatation (≥21 mm), signs of congestion, and VO were associated with the primary endpoint. Binary logistic regression multivariate analysis showed that VO was the only independent predictor for the primary endpoint (adjusted OR 2.7; 95% CI 1.30–5.63, P = 0.008). Multivariate Cox regression analysis also showed an adjusted hazard ratio (HR) for VO of 2.03; 95% CI 1.37–3.02, P < 0.001. Receiver‐operating characteristic curve analysis showed an area under the curve for VO of 0.88 (95% CI 0.79–0.97, P < 0.001) with an optimal cut‐off of 1.2 L. Conclusions: VO assessed by BIA is independently associated with WHF in stable outpatients with HFrEF at 3 months. [ABSTRACT FROM AUTHOR]

Mental health is an important segment in preserving overall health and represents a significant public health issue. In modern times, mental health disorders have risen, often requiring complex pharmacotherapy and chronic monitoring. The aim of this research was to determine the prevalence and clinical significance of potential psychotropic drug interactions in outpatient settings and compare the differences in potential drug–drug interaction (pDDIs) exposure with age. The psychotropic drugs included antipsychotics—N05A, anxiolytics—N05B, hypnotics and sedatives—N05C, and antidepressants—N06A. This retrospective study analyzed prescribed pharmacotherapy in 492 outpatients who were treated with at least one psychotropic drug. We determined 1.64 prescribed psychotropic drugs per patient and 2.2 pDDIs that involved psychotropic drugs. In total, 2285 pDDIs were recorded, of which almost half (47.6%) were pDDIs with psychotropic drugs. More prescribed psychotropic drugs were found in patients younger than 65 years, and equal exposure to pDDIs of psychotropic drugs (p = 0.5077) was found in both age groups. The most commonly identified psychotropics involved in pDDIs were benzodiazepines, promazine, and zolpidem. The results indicate that psychotropic drug interactions represent important drug-related problems for primary health care. The widespread use of psychotropic drugs and the determined clinical significance of their interactions require pharmacist interventions which can reduce the prevalence of pDDIs and increase patient safety. [ABSTRACT FROM AUTHOR]

Abstract Aims Heart failure (HF) with reduced left ventricle ejection fraction (LVEF) is an entity with poor prognosis characterized by decompensations. Bioelectrical impedance analysis (BIA) is used to assess volume overload (VO) and may be useful to identify apparently stable HF outpatients at risk of decompensation. The aim of this study is to analyse whether VO assessed by BIA is associated with worsening heart failure (WHF) in stable outpatients with HF and reduced LVEF (HFrEF). Methods and results This is a prospective single‐centre observational study. Consecutive stable HF outpatients with LVEF below 40% underwent BIA, transthoracic echocardiography, blood sampling, and physical examination and were followed up for 3 months. VO was defined as the difference between the measured weight and the dry weight assessed by BIA. Demographic, clinical, anthropometric, echocardiographic, and analytical parameters were recorded. The primary endpoint was WHF, defined by visits to the emergency department for HF or hospitalization for HF. A total of 100 patients were included. The median VO was 0.5 L (interquartile range 0–1.6 L). Eleven patients met the primary endpoint. Univariate binary logistic regression analysis showed that left ventricle filling pressures assessed by E/e′, N‐terminal pro B‐type natriuretic peptide, inferior vena cava dilatation (≥21 mm), signs of congestion, and VO were associated with the primary endpoint. Binary logistic regression multivariate analysis showed that VO was the only independent predictor for the primary endpoint (adjusted OR 2.7; 95% CI 1.30–5.63, P = 0.008). Multivariate Cox regression analysis also showed an adjusted hazard ratio (HR) for VO of 2.03; 95% CI 1.37–3.02, P

BACKGROUND: Simultaneous urine testing for albumin (UAlb) and serum creatinine (SCr), that is, dual testing, is an accepted quality measure in the management of diabetes. As chronic kidney disease (CKD) is defined by both UAlb and SCr testing, this approach could be more widely adopted in kidney care. OBJECTIVE: We assessed time trends and facility-level variation in the performance of outpatient dual testing in the integrated Veterans Health Administration (VHA) system. DESIGN, SUBJECTS AND MAIN MEASURES: This retrospective cohort study included patients with any inpatient or outpatient visit to the VHA system during the period 2009-2018. Dual testing was defined as UAlb and SCr testing in the outpatient setting within a calendar year. We assessed time trends in dual testing by demographics, comorbidities, high-risk (eg, diabetes) specialty care and facilities. A generalised linear mixed-effects model was applied to explore individual and facility-level predictors of receiving dual testing. KEY RESULTS: We analysed data from approximately 6.9 million veterans per year. Dual testing increased, on average, from 17.4% to 21.2%, but varied substantially among VHA centres (0.3%-43.7% in 2018). Dual testing was strongly associated with diabetes (OR 10.4, 95% CI 10.3 to 10.5, p

BACKGROUND: Up to one third of survivors of AKI that required dialysis (AKI-D) during hospitalization remain dialysis dependent at hospital discharge. Of these, 20%-60%, depending on the clinical setting, eventually recover enough kidney function to stop dialysis, and the remainder progress to ESKD. METHODS: To describe the challenges facing those still receiving dialysis on discharge, the AKINow Committee conducted a group discussion comprising 59 participants, including physicians, advanced practitioners, nurses, pharmacists, and patients. The discussion was framed by a patient who described gaps in care delivery at different transition points and miscommunication between care team members and the patient. RESULTS: Group discussions collected patient perspectives of ( 1 ) being often scared and uncertain about what is happening to and around them and ( 2 ) the importance of effective and timely communication, a comfortable physical setting, and attentive and caring health care providers for a quality health care experience. Provider perspectives included ( 1 ) the recognition of the lack of evidence-based practices and quality indicators, the significant variability in current care models, and the uncertain reimbursement incentives focused on kidney recovery and ( 2 ) the urgency to address communication barriers among hospital providers and outpatient facilities. CONCLUSIONS: The workgroup identified key areas for future research and policy change to ( 1 ) improve communication among hospital providers, dialysis units, and patients/care partners; ( 2 ) develop tools for risk classification, subphenotyping, and augmented clinical decision support; ( 3 ) improve education to providers, staff, and patients/care partners; ( 4 ) identify best practices to improve relevant outcomes; ( 5 ) validate quality indicators; and ( 6 ) assess the effect of social determinants of health on outcomes. We urge all stakeholders involved in the process of AKI-D care to align goals and work together to fill knowledge gaps and optimize the care to this highly vulnerable patient population.

BackgroundFacility HIV self-testing (HIVST) in outpatient departments can dramatically increase testing among adult outpatients. However, it is still unclear why populations opt out of facility HIVST and reasons for opt outing. Using data from a parent facility HIVST trial, we sought to understand individual characteristics associated with opting out of facility HIVST and reported reasons for not testing.MethodsExit surveys were conducted with outpatients aged ≥15 years at 5 facilities in Central and Southern Malawi randomized to the facility HIVST arm of the parent trial. Outpatients were eligible for our substudy if they were offered HIVST and eligible for HIV testing (ie, never previously tested HIV positive and tested ≥12 months ago or never tested). Summary statistics and multivariate regression models were used.ResultsSeven hundred seventy-one outpatients were included in the substudy. Two hundred sixty-three (34%) opted out of HIVST. Urban residency (adjusted risk ratios [aRR] 3.48; 95% CI: 1.56 to 7.76) and self-reported poor health (aRR 1.86; 95% CI: 1.27 to 2.72) were associated with an increased risk of opting out. Male participants had a 69% higher risk of opting out (aRR 1.69; 95% CI: 1.14 to 2.51), with risk being 38% lower among working male participants. Primary reasons for not testing were feeling unprepared to test (49·4%) and perceived low risk of HIV infection (30·4%)-only 2.6% believed that HIVST instructions were unclear, and 1.7% were concerned about privacy.ConclusionWorking, risky sexual behavior, rural residence, and good self-rated health were positively associated with opting out of HIVST among outpatients. Strategies to address internalized barriers, such as preparedness to test and perceived need to test, should be incorporated into facility HIVST interventions.

BACKGROUND: Palliative care has the potential to address significant unmet needs in people with Parkinsons disease and related disorders, but models that rely on in-person specialty palliative care teams have limited scalability. AIM: To describe patient and care partner experiences with a novel, community-based palliative care intervention for Parkinsons disease. DESIGN: Qualitative study embedded in a randomized clinical trial to document participant experiences with a novel palliative care intervention (community neurologist training and remote team-based specialist palliative care). Transcripts were coded and thematically analyzed through a combination of team-based inductive and deductive coding. SETTING/PARTICIPANTS: Twenty-eight patients and 33 care partners purposively sampled from participants in a randomized clinical trial of a palliative care intervention for Parkinsons disease and related disorders conducted at nine sites. RESULTS: Benefits of the intervention included management of a wider range of non-motor symptoms, facilitation of conversations about the future, greater engagement with the health care team, and increased referrals to resources. Participants identified areas of improvement, including uptake of palliative care training by community neurologists, additional prognostic counseling, and clarity and timeliness of communication with the multidisciplinary team. CONCLUSIONS: Clinicians caring for people with Parkinsons disease and related disorders should screen for non-motor symptoms, provide regular prognostic counseling, and refer to specialty palliative care services earlier in the course of illness. Future interventions should be designed to promote uptake of palliative care training by community neurologists and further optimize referral to and coordination with in-person or remote specialty palliative teams.

OBJECTIVE: To investigate the feasibility of pre- and post-encounter patient-reported outcome (PRO) measure collection within an outpatient integrative health and medicine (IHM) clinic and to characterize factors associated with successful completion. METHODS: We conducted a retrospective review of 27,464 outpatient IHM encounters including 9,520 chiropractic; 8,237 acupuncture; 5,847 massage; 2,345 IHM consultation; and 1,515 osteopathic manipulation treatment encounters at four clinics offering IHM over 18 months. Patients were asked to complete paper questionnaires rating pain, anxiety, and stress from 0-10 immediately pre- and post-encounter. Generalized linear mixed effect regression models were used to examine the relationship between demographic, clinical, and operational covariates and completing (1) pre-encounter and (2) paired (i.e., pre and post) PROs. RESULTS: Patients (N = 5587, mean age 49 years, 74% white, 77% female) generally presented for musculoskeletal conditions (81.7%), with a chief complaint of pain (55.1%). 21,852 (79.6%) encounters were among patients who completed pre-encounter PROs; 11,709/21,852 (53.6%) completed subsequent post-encounter PROs. Odds of PRO completion were more impacted by provider, operational, and clinical-level factors than patient factors. Covariates associated with increased odds of pre-encounter PRO completion included being female, having additional IHM encounters, and having a pain or anxiety complaint. Covariates associated with increased odds of paired PRO completion included being aged 31-40 vs. 51-60 years and having additional IHM encounters. CONCLUSION: Implementing a paper-based PRO collection system in outpatient IHM is feasible; however, collecting post-encounter PROs was challenging. Future endeavors should leverage the electronic health record and patient portals to optimize PRO collection and engage patients and clinical providers.

OBJECTIVE: To describe the characteristics of patients who received outpatient therapy services through an infant bridge program using telehealth mode of service delivery and to identify if attendance rates vary by mode of service delivery. We hypothesized that telehealth visits will increase attendance rates. DESIGN: Retrospective, cross-sectional study. SETTING: UCSF Benioff Childrens Hospital outpatient infant bridge program. PARTICIPANTS: Eighty infants with a history of NICU admission and scheduled for a therapy appointment between June 1, 2019 and December 31, 2020 were included in the study. Participants had an average(SD) gestational age of 34.63(4.41) weeks and length of stay was 43.55(56.03) weeks. The majority were English-speaking (96.3%), White (37.5%), and had commercial insurance (72.5%). MAIN OUTCOME MEASURE: Descriptive analyses were conducted across the entire group along with service delivery model subgroup analysis. Logistic regression was performed to assess patient characteristics associated with attendance and if service delivery model influences attendance. RESULTS: In the analysis of 596 scheduled visits, there were more completed telehealth sessions than for in-person sessions (90.0% versus 84.1%, p = .011). For in-person sessions, infants (N = 40) with lower birth gestational ages (p = .009), longer length of stay (p = .041), and Medi-Cal insurance (p = .006) were more likely to have ≥2 missed appointments. For the telehealth sessions, infants (N = 40) who had longer length of stay (p = .040) were more likely to have ≥2 missed appointments. There is a higher likelihood of ≥2 missed appointments for patients with a longer length of stay (OR = 1.02, 95% CI [1.01, 1.03]) and for in-person service delivery when compared to telehealth (OR = 6.25, 95% CI [1.37, 28.57]). CONCLUSIONS: Telehealth was associated with higher likelihood of attendance, revealing that telehealth has the potential to increase access to early therapy services for certain populations. Future studies with larger sample sizes to determine which populations benefit from telehealth is recommended.

ObjectivesImproved understanding of the stability and consistency of symptom clusters across time, symptom dimensions and cancer diagnoses will lead to refinements in symptom assessments and management, and provide direction for mechanistic studies. Study purposes were to describe the occurrence, severity and distress of 38 symptoms; evaluate the stability and consistency of symptom clusters across a cycle of chemotherapy, three symptom dimensions and four distinct cancer types; and identify common and distinct symptom clusters.MethodsOncology outpatients (n=1329) completed the Memorial Symptom Assessment Scale prior to their next cycle of chemotherapy (T1), 1 week after chemotherapy (T2) and 2 weeks after chemotherapy (T3). Symptom clusters were identified using exploratory factor analysis using unweighted least squares. GEOMIN rotated factor loadings with absolute values ≥0.40 were considered meaningful. Clusters were stable if they were identified across each time point and/or dimension. Clusters were consistent if the same two or three symptoms with the highest factor loadings were identified across each time point and/or dimension.ResultsPatients reported 13.9 (±7.2) symptoms at T1, 14.0 (±7.0) at T2 and 12.2 (±6.8) at T3. Psychological, weight gain, gastrointestinal and respiratory clusters were stable across time and dimensions. Only the psychological, weight gain and respiratory clusters were consistent across time and dimensions.ConclusionGiven the stability of the psychological, weight gain and gastrointestinal clusters across cancer diagnoses, symptoms within these clusters need to be routinely assessed. However, respiratory and hormonal clusters are unique to specific cancer types and the symptoms within these clusters are variable.

The REST-IT study found the addition of zolpidem-controlled release (CR) provided a significant reduction in observer-rated measurement of suicidal ideation (the Columbia Suicide Severity Rating Scale) in 103 depressed outpatients with insomnia and suicidal ideation, but without significant change in a self-report measure of suicidal ideation (the Scale for Suicide Ideation). This secondary analysis of the REST-IT data examined the suicide item of another observer-rated scale, the Hamilton Rating Scale for Depression (HRSD), further clarifying the impact of insomnia-focused treatment on suicidal ideation. This analysis established a significant advantage for zolpidem-CR compared with placebo on the HRSD suicide item.

BACKGROUND: Limited research has studied the influence of social determinants of health (SDoH) on the receipt, disease risk, and subsequent effectiveness of neutralizing monoclonal antibodies (nMAbs) for outpatient treatment of COVID-19. OBJECTIVE: To examine the influence of SDoH variables on receiving nMAb treatments and the risk of a poor COVID-19 outcome, as well as nMAb treatment effectiveness across SDoH subgroups. DESIGN: Retrospective observational study utilizing electronic health record data from four health systems. SDoH variables analyzed included race, ethnicity, insurance, marital status, Area Deprivation Index, and population density. PARTICIPANTS: COVID-19 patients who met at least one emergency use authorization criterion for nMAb treatment. MAIN MEASURE: We used binary logistic regression to examine the influence of SDoH variables on receiving nMAb treatments and risk of a poor outcome from COVID-19 and marginal structural models to study treatment effectiveness. RESULTS: The study population included 25,241 (15.1%) nMAb-treated and 141,942 (84.9%) non-treated patients. Black or African American patients were less likely to receive treatment than white non-Hispanic patients (adjusted odds ratio (OR) = 0.86; 95% CI = 0.82-0.91). Patients who were on Medicaid, divorced or widowed, living in rural areas, or living in areas with the highest Area Deprivation Index (most vulnerable) had lower odds of receiving nMAb treatment, but a higher risk of a poor outcome. For example, compared to patients on private insurance, Medicaid patients had 0.89 (95% CI = 0.84-0.93) times the odds of receiving nMAb treatment, but 1.18 (95% CI = 1.13-1.24) times the odds of a poor COVID-19 outcome. Age, comorbidities, and COVID-19 vaccination status had a stronger influence on risk of a poor outcome than SDoH variables. nMAb treatment benefited all SDoH subgroups with lower rates of 14-day hospitalization and 30-day mortality. CONCLUSION: Disparities existed in receiving nMAbs within SDoH subgroups despite the benefit of treatment across subgroups.

Background: The STRONG-HF trial demonstrated substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized heart failure patients who were randomized to intensive guideline-directed medical therapy (GDMT) optimization compared to usual care. Whether an intensive GDMT optimization program would be cost-effective for patients with heart failure with reduced ejection fraction (HFrEF) is unknown. Methods: Using a 2-state Markov model we evaluated the effect of an intensive GDMT optimization program on hospitalized patients with HFrEF. Two population models were created to simulate this intervention, a "Clinical Trial" model, based off the participants in the STRONG-HF trial and a "Real-World" model, based off the Get With The Guidelines-HF Registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive triple therapy GDMT optimization program comprised of cardiologists, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both populations models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a United States healthcare sector perspective with a lifetime time horizon. Optimal quadruple GDMT use was also modeled. Results: An intensive GDMT optimization program was extremely cost-effective with incremental cost-effectiveness ratios

PurposeEvaluate for perturbed signaling pathways associated with subgroups of patients with low versus high levels of state anxiety. These pathways were compared to the pathways identified across eight network pharmacology studies of the anxiolytic effect(s) of a variety of compounds.MethodsAdult outpatients had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding four weeks; and were scheduled to receive at least two additional cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct anxiety profiles based on Spielberger State Anxiety Inventory scores that were obtained six times over two cycles of chemotherapy. Blood samples were processed using RNA sequencing (i.e., RNA-seq sample, n = 244) and microarray (i.e., microarray sample; n = 256) technologies. Pathway perturbations were assessed using pathway impact analysis. Fisher's combined probability method was used to combine test results using a false discovery rate of 0.01.ResultsIn the RNA-seq sample, 62.3% and 37.7% of the patients were in the low- and high-anxiety classes, respectively. In the microarray sample, 61.3% and 38.7% were in the low and high-anxiety classes, respectively. Forty-one perturbed signaling pathways were identified. Eight of these pathways were common to those identified in the network pharmacology studies.ConclusionsFindings increase our knowledge of the molecular mechanisms that underlie anxiety in patients receiving chemotherapy. This study provides initial insights into how anxiety in patients with cancer may share common mechanisms with anxiety in patients with other clinical conditions.

Abstract Background Patient satisfaction is a crucial indicator of healthcare quality, influencing outcomes and providing insights for improvement. This study aims to assess patient satisfaction levels, and associated factors, and identify areas for enhancement at Remera Rukoma District Hospital (RRDH) in Rwanda, where such data was previously lacking. Methods A cross-sectional study using a mixed approach of data collection was conducted, involving 384 participants (164 inpatients, 220 outpatients). Quantitative surveys and qualitative interviews were employed. Patient satisfaction was categorized as Very Satisfied (> 70%), Satisfied (50–69.9%), or Not Satisfied (≤ 49.9%). Data analysis included descriptive statistics, bivariate logistic regression, and thematic analysis of qualitative data. Results The study comprised 37.8% male and 62.2% female participants. Overall, 52.6% were highly satisfied, 29% satisfied, and 18% not satisfied. Among outpatients, 35.9% were dissatisfied with cashier services, and 46.9% with pharmacy wait times. Inpatients showed 74.4% satisfaction with the admission process, but 69.5% reported delayed test result feedback. Educational level significantly influenced satisfaction, with uneducated participants showing lower odds of satisfaction compared to university-educated ones (cOR = 0.409, 95% CI: 0.186–0.897, p = 0.026). Qualitative findings highlighted issues with wait times, communication, and service consistency. Conclusions While overall satisfaction at RRDH was positive, the study identified areas needing improvement, particularly in communication, wait times, and service delays. Education level was significantly associated with satisfaction level. Addressing these factors, beyond operational efficiency, may significantly impact patient satisfaction. Enhancing communication, managing expectations, and optimizing service delivery are crucial for maintaining satisfaction and improving service quality.

Abstract Background People with severe mental illness (SMI) face not only impaired mental health, but also a greater risk of physical comorbidities and a shorter life expectancy compared to the general population. A poor lifestyle plays a substantial role in this disparity. Combined Lifestyle Interventions targeting multiple lifestyle behaviors can improve mental and physical health, and quality of life. However, there is currently no appropriate structural support for people with SMI in outpatient care in the Netherlands. The Combined Lifestyle Intervention for Outpatients with SMI (GOAL!) is developed to address this gap. This study examines the (cost-)effectiveness and implementation of GOAL!. Methods In a type 1 hybrid quasi-experimental study with a mixed-method matched design, GOAL! participants (N = 50) are compared to people receiving care as usual (N = 50). The GOAL! program includes group and individual sessions, given by allied health professionals, over a period of two years. The first year starts with a 3-month intensive course on physical activity and nutrition, followed by 9 months of aftercare covering various lifestyle topics tailored to the group’s needs. There is close collaboration with local stakeholders to facilitate transfer to the community setting. The second year focuses on maintaining established activities in one’s daily living environment. Our primary outcome will be the change in physical activity, comparing GOAL! participants to those receiving care as usual. Secondary outcomes are changes in other lifestyle behaviors, physical health, mental well-being, and healthcare and societal costs. Additionally, achieving lifestyle-related goals, adverse effects, and barriers and facilitators to implementation are examined. Measurements are obtained at start (T0), and after 3 (T1), 12 (T2) and 24 months (T3). Discussion This study investigates the effects of GOAL! on lifestyle behaviors, health outcomes, implementation factors and cost-effectiveness after two years, aiming to offer valuable insights into the effectiveness and implementation outcomes of lifestyle interventions for outpatients with SMI. Trial registration : ClinicalTrials.gov (Identifier: NCT05600205). Prospectively registered on October 26, 2022.

Abstract Background The Covid-19 pandemic led to a rapid increase in the use of virtual consultations across healthcare. Post-pandemic, this use is expected to continue alongside the resumption of traditional face-to-face clinics. At present, research exploring when to use different consultation formats for palliative care patients is limited. Aim To understand the benefits and limitations of a blended approach to outpatient palliative care services, to provide recommendations for future care. Methods A mixed-methods study. Component 1: an online survey of UK palliative care physicians. Component 2: a qualitative interview study exploring patients’ and caregivers’ experiences of different consultation formats. Findings from both components were integrated, and recommendations for clinical practice identified. Results We received 48 survey responses and conducted 8 qualitative interviews. Survey respondents reported that face-to-face consultations were appropriate/necessary for physical examinations (n = 48) and first consultations (n = 39). Video consultations were considered appropriate for monitoring stable symptoms (n = 37), and at the patient’s request (n = 42). Patients and caregivers felt face-to-face consultations aided communication. A blended approach increased flexibility and reduced travel burden. Conclusions A blended outpatient palliative care service was viewed positively by physicians, patients and caregivers. We identified 13 clinical practice recommendations for the use of different consultation formats.

Abstract Background Sarcopenia is a geriatric disease characterized by loss of muscle mass and strength. Although combined exercise and nutrition intervention are known to be effective for sarcopenia, clinical trials involving outpatients with sarcopenia in primary care are scarce. We describe a protocol for a trial to examine the effects of a 12-week combined exercise and nutrition intervention in Korean older adults with possible sarcopenia in community-based primary care. Methods This multicenter, randomized, controlled trial will include 94 community-dwelling older outpatients aged 65–85 years with possible sarcopenia (47 participants in the intervention and control groups each). Resistance exercises, which incorporate concentric and eccentric exercises, will consist of an introductory phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; contraction exercises), an expanded phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; eccentric exercises), and a maintenance phase (6 weeks: once-weekly supervised exercise sessions and twice-weekly home exercises; power/eccentric exercises). Nutritional supplementation will be provided according to the nutritional status of the participants using a Mini-Nutritional Assessment. Participants will be assessed at baseline, 12 and 24 weeks, and the primary outcome will be the 5-times chair stand test results. Discussion To the best of our knowledge, this will be the first clinical trial to evaluate the efficacy of a combined exercise and nutritional supplementation intervention in older outpatients with possible sarcopenia in community-based primary care clinics. These findings will provide new insights to clinicians regarding the long-term usability for doctors and outpatients with possible sarcopenia in community-based primary care. Trial registration This trial was prospectively registered at ClinicalTrials.gov on September 16, 2023 (registration number: NCT06049914).

Abstract Background Childhood trauma history has frequently been linked to eating disorders (EDs); nevertheless, the scientific literature calls for extending knowledge regarding mediators between EDs and childhood trauma. This study explored whether ED symptoms and early maladaptive schemas were more severe in ED patients with severe childhood trauma than in ED patients with no/mild childhood trauma and whether early maladaptive schemas mediated the relationship between childhood trauma and ED symptom severity. Methods Data were extracted from the Regional Centre for Eating Disorders registry at the University Hospital of Verona. The extracted data included self-reported data, including the Eating Disorder Inventory-3 score, Young Schema Questionnaire score, Childhood Experience and Experience of Care and Abuse Questionnaire score, and sociodemographic and clinical information on the ED outpatients seeking care. A mediation analysis using the structural equation modeling procedure was conducted. Results Forty-two outpatients, 31% of whom exhibited severe childhood trauma, satisfied the criteria for registry data extraction. The severity of ED symptoms, as well as the early maladaptive schemas’ scores for emotional deprivation, defectiveness, failure, vulnerability, insufficient self-control, and negativity, were greater in ED outpatients with severe childhood trauma. Furthermore, early maladaptive schemas related to defectiveness, failure, and negativity had a mediating role in the relationship between severe childhood trauma and ED symptom severity. Conclusions This exploratory study provides preliminary evidence about the importance of early maladaptive schemas in the relationship between trauma history and ED psychopathology. In addition, ED symptoms may represent a dysfunctional attempt to avoid unpleasant emotions associated with schema activation. The results support the need to consider early maladaptive schemas in the treatment of traumatized patients with ED symptoms. Study limitations, research and clinical implications are discussed.

Abstract We analyzed data from positively tested COVID-19 outpatients to describe self-medication with OTC drugs and use of other remedies against symptoms of SARS-CoV-2 infection. We specifically considered their type and frequency, as well as associations with patient characteristics, and reasons for use. Data were collected between May 1, 2020 and February 22, 2021 with two questionnaires in an observational cohort study with PCR-confirmed SARS-CoV-2-positive adult outpatients in the district of Western Pomerania in Germany. 523 out of 710 outpatients (74%; 340 women and 183 men) reported using drugs and other remedies to relieve COVID-19-symptoms. Overall, participants reported utilization of 1282 finished dosage products or remedies, including 213 different ingredients. In the population of 710 outpatients, utilization of ibuprofen (26%), acetaminophen (21%), metamizole (14%), and acetylsalicylic acid (10%) was most commonly reported. Phytopharmaceuticals, herbal and animal products as well as vitamins and minerals were also frequently reported. Among the 523 participants who used drugs and other remedies, most commonly mentioned reasons for use were headache (40%), other kinds of pain (e.g. myalgia; 37%), fever (24%) and cough (16%). Our analysis showed that a majority of the participants tried to alleviate COVID-19-symptoms using drugs and other remedies. Especially analgesic and antipyretic agents, followed by herbal medicines, were used very frequently. Trial registration: German Register for Clinical Studies DRKS00021672, first registration on December 1st, 2020.

Abstract Constipation is a prevalent gastrointestinal disorder that affects people globally, decreasing their quality of life and life expectancy. Individuals with schizophrenia often suffer from constipation, which could be a result of the illness itself or the side effects of psychotropic medications. However, little research has been conducted on factors contributing to constipation in individuals with schizophrenia. To address this issue, we conducted a survey using self‐administered questionnaires and medical records to identify factors associated with constipation in psychiatric outpatients. This study included 399 patients with schizophrenia, resulting in a high prevalence of constipation (43.4%). The analysis suggested that female gender, the doses of antiparkinsonian medications, and benzodiazepine sleeping pills may be associated with constipation.

Background: Patient satisfaction is a crucial indicator of healthcare quality, influencing outcomes and providing insights for improvement. This study aims to assess patient satisfaction levels, and associated factors, and identify areas for enhancement at Remera Rukoma District Hospital (RRDH) in Rwanda, where such data was previously lacking. Methods: A cross-sectional study using a mixed approach of data collection was conducted, involving 384 participants (164 inpatients, 220 outpatients). Quantitative surveys and qualitative interviews were employed. Patient satisfaction was categorized as Very Satisfied (> 70%), Satisfied (50–69.9%), or Not Satisfied (≤ 49.9%). Data analysis included descriptive statistics, bivariate logistic regression, and thematic analysis of qualitative data. Results: The study comprised 37.8% male and 62.2% female participants. Overall, 52.6% were highly satisfied, 29% satisfied, and 18% not satisfied. Among outpatients, 35.9% were dissatisfied with cashier services, and 46.9% with pharmacy wait times. Inpatients showed 74.4% satisfaction with the admission process, but 69.5% reported delayed test result feedback. Educational level significantly influenced satisfaction, with uneducated participants showing lower odds of satisfaction compared to university-educated ones (cOR = 0.409, 95% CI: 0.186–0.897, p = 0.026). Qualitative findings highlighted issues with wait times, communication, and service consistency. Conclusions: While overall satisfaction at RRDH was positive, the study identified areas needing improvement, particularly in communication, wait times, and service delays. Education level was significantly associated with satisfaction level. Addressing these factors, beyond operational efficiency, may significantly impact patient satisfaction. Enhancing communication, managing expectations, and optimizing service delivery are crucial for maintaining satisfaction and improving service quality. [ABSTRACT FROM AUTHOR]

Background: The Covid-19 pandemic led to a rapid increase in the use of virtual consultations across healthcare. Post-pandemic, this use is expected to continue alongside the resumption of traditional face-to-face clinics. At present, research exploring when to use different consultation formats for palliative care patients is limited. Aim: To understand the benefits and limitations of a blended approach to outpatient palliative care services, to provide recommendations for future care. Methods: A mixed-methods study. Component 1: an online survey of UK palliative care physicians. Component 2: a qualitative interview study exploring patients' and caregivers' experiences of different consultation formats. Findings from both components were integrated, and recommendations for clinical practice identified. Results: We received 48 survey responses and conducted 8 qualitative interviews. Survey respondents reported that face-to-face consultations were appropriate/necessary for physical examinations (n = 48) and first consultations (n = 39). Video consultations were considered appropriate for monitoring stable symptoms (n = 37), and at the patient's request (n = 42). Patients and caregivers felt face-to-face consultations aided communication. A blended approach increased flexibility and reduced travel burden. Conclusions: A blended outpatient palliative care service was viewed positively by physicians, patients and caregivers. We identified 13 clinical practice recommendations for the use of different consultation formats. [ABSTRACT FROM AUTHOR]

Background Outpatient parenteral antimicrobial therapy (OPAT) can deliver extended parenteral treatment of fungal infections in an ambulatory setting, whilst minimizing treatment burden and cost. The extended dosing interval of rezafungin may potentiate the benefits of OPAT. Methods This retrospective cohort study includes all adult patients who received echinocandin therapy in a large OPAT programme between 2012 and 2022. Patient characteristics, treatment and outcomes were studied. Data were analysed to determine the effects of replacing daily dosing with weekly dosing of echinocandin. Results Across the study period, 11% (44/386) of all patients in our Health Service treated with ≥7 days of echinocandin were managed via OPAT. All were Candida and related 'yeast-like' species infections. Nakaseomyces glabrata (20/41; 49%) was the most common pathogen, fungaemia the most common presentation (17/41; 41%) and azole resistance the most frequent indication for echinocandin use (21/41; 51%). In total, 633 days of echinocandin were administered as OPAT. Thirteen patients (13/41; 32%) received concurrent parenteral antibacterials. Treatment success was achieved in 30/41 (73%) patients. If daily echinocandin dosing was replaced with weekly dosing, a potential 52% (633 to 326) reduction in the total number of treatments (for any therapy) delivered by the OPAT team is possible. The ongoing need for daily antibacterial administration mitigated the benefit in some of this cohort. Conclusions Echinocandin therapy can be safely delivered via OPAT with outcomes equivalent to bed-based care. The extended dosing interval of rezafungin will allow for a substantial reduction in the number of treatments required across the patient cohort. [ABSTRACT FROM AUTHOR]

The safety of casirivimab + imdevimab (CAS + IMD) (anti-severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] monoclonal antibodies [mAbs]) in pediatric outpatients with coronavirus disease 2019 (COVID-19) was evaluated in a randomized phase 1/2/3 trial. Consistent with adults, CAS + IMD was generally well tolerated with low drug-induced immunogenicity rates. The findings support the development of next-generation anti-SARS-CoV-2 mAbs for at-risk pediatric patients. [ABSTRACT FROM AUTHOR]