Patient satisfaction and follow-up adherence to glaucoma case management clinic in China

AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.

Prevalence and clinical implications of polypharmacy and potentially inappropriate medication in elderly patients with heart failure: results of six months' follow-up

OBJECTIVES To investigate the prevalence of polypharmacy and potentially inappropriate medication(PIM)in elderly patients with heart failure(HF)and their impact on readmission and mortality.METHODS We conducted a study of 274 participants aged 60 years or older with HF.The prevalence of polypharmacy(defined as the use of five or more medications)was calculated,and the 2019 American Geriatrics Society Beers criteria were applied to access PIMs.Medications and PIMs were characterized at admission and discharge,and changes in prescriptions during hospitalization were compared.The impact of polypharmacy and PIM on readmission and mortality were investigated.RESULTS The median age of this study population was 68 years old.The median number of prescribed drugs was 7 at admission and 10 at discharge.At discharge,99.27%of all patients were taking five or more drugs.The incidence of composite endpoint and cardiovascular readmission increased with the number of polypharmacy within 6 months.The use of guideline-directed medical therapy reduced the incidence of composite endpoint events and cardiovascular readmission,while the use of noncardiovascular medications increased the composite endpoint events.The frequency of PIMs was 93.79%at discharge.The incidence of composite endpoint events increased with the number of PIMs.“PIMs in older adults with caution”increased cardiovascular readmission and“PIMs based on kidney function”increased cardiovascular mortality.Several comorbidities were associated with cardiovascular mortality or non-cardiovascular readmission.CONCLUSIONS Polypharmacy and PIM were highly prevalent in elderly patients with HF,and their use was associated with an increased risk of composite endpoint events,readmission and mortality.Non-cardiovascular medications,“PIMs in older adults with caution”,“PIMs based on kidney function”and several comorbidities were important factors associated with hospital readmission and mortality.Our findings highlight the importance of medication optimization in the management of HF in elderly patients.

Determinants of the Ophthalmological Follow-Up of Sickle Cell Patients at the National Center of Research and Care for Sickle Cell Patients in Lome-Togo

Objectives: To assess the factors influencing the ophthalmological follow-up of sickle cell patients in Togo. Materials and Methods: The national center of research and care for sickle cell patients (CNRSD) served as study setting. It was a descriptive and analytical study by interview over a three-month period from December 01, 2020 to March 02, 2021. Was included in the study, any patient with sickle cell disease genotype SS or SC, age ≥ 17 years, regularly followed at the CNRSD and having accepted the interview by a survey sheet. Excluded were patients with sickle cell trait genotype AS or AC or with a disability that prevented them from being interviewed. Results: Two hundred and fifty (250) patients with sickle cell disease were interviewed. The mean age was 29.1 years ± 11.12 years [17 years;67 years] and the sex ratio = 0.52. Nine patients over ten (9/10) attended at least secondary school. The jobless represented 25.60% of the total population followed respectively by students and laborers in 20.40% and 16% of cases. Twenty-four percent (24%) of patients were followed up in ophthalmology department. Statistically, there was no significant relationship between level of education (p = 0.4083), occupation (p = 0.6441) and knowledge of the ocular complications of sickle cell disease. Statistically, there was a significant relationship between knowledge of the ocular complications of sickle cell disease and compliance with ophthalmological follow-up (p = 0.0009). Conclusion: The knowledge of eye disorders related to sickle cell disease by patients with sickle cell disease improves their ophthalmological follow-up. Greater awareness on eye disorders related to sickle cell disease by medical staff towards patients with sickle cell disease would improve ophthalmological follow-up. .

Intensive follow-up vs conventional follow-up for patients with nonmetastatic colorectal cancer treated with curative intent:A metaanalysis

BACKGROUND The frequency and content of follow-up strategies remain controversial for colorectal cancer(CRC),and scheduled follow-ups have limited value.AIM To compare intensive and conventional follow-up strategies for the prognosis of non-metastatic CRC treated with curative intent using a meta-analysis.METHODS PubMed,Embase,and the Cochrane Library databases were systematically searched for potentially eligible randomized controlled trials(RCTs)from inception until April 2023.The Cochrane risk of bias was used to assess the methodological quality of the included studies.The hazard ratio,relative risk,and 95%confidence interval were used to calculate survival and categorical data,and pooled analyses were performed using the random-effects model.Additional exploratory analyses were performed for sensitivity,subgroups,and publication bias.RESULTS Eighteen RCTs involving 8533 patients with CRC were selected for the final analysis.Intensive follow-up may be superior to conventional follow-up in improving overall survival,but this difference was not statistically significant.Moreover,intensive follow-up was associated with an increased incidence of salvage surgery compared to conventional follow-up.In addition,there was no significant difference in the risk of recurrence between intensive and conventional follow-up strategies,whereas intensive follow-up was associated with a reduced risk of interval recurrence compared to conventional follow-up.Finally,the effects of intensive and conventional follow-up strategies differed when stratified by tumor location and follow-up duration.CONCLUSION Intensive follow-up may have a beneficial effect on the overall survival of patients with non-metastatic CRC treated with curative intent.

Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen,China

BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.

Association of cardiometabolic multimorbidity with all-cause and cardiovascular disease mortality among Chinese hypertensive patients

BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.

Refining safety considerations for intradialytic blood flow restriction exercise. Commentary on “Concerns on the application of blood-flow restriction resistance exercise and thrombosis risk in hemodialysis patients”

I read with great interest the article“Concerns on the application of blood flow restriction resistance exercise and thrombosis risk in hemodialysis patients”by Correa et al.1 The study presents complementary data from a previous randomized controlled trial,2 exploring the application of intradialytic blood flow restriction exercise for hemodialysis patients.

Depression and anxiety among cancer patients visiting a tertiary care cancer hospital

BACKGROUND Cancer patients frequently experience psychological problems related to reactions to cancer diagnosis,cancer type and stage,treatment effects,recurrence,fear of end-of-life,survivorship,and financial burden.Depression and anxiety are both psychological and physiological disturbances among cancer patients.AIM To assess the prevalence of depression and anxiety among cancer patients attending a tertiary care cancer hospital.METHODS A cross-sectional study was conducted at Bhaktapur Cancer Hospital in Kathmandu Valley among 220 cancer patients aged from 18 years to 70 years.Ethical approval was taken from the Institutional Review Committee of CiST College.Convenient sampling was used to interview patients with the standardized Patient-Health Questionnaire(PHQ-9)for Depression and Hospital Anxiety and Depression sub-scale(HADS-A)for anxiety.Epi-Data was used for data entry and transferred to SPSS Version 25 for analysis.RESULTS The study revealed that of 220 patients,most of the respondents belonged to the age group 51-60 years.More than half 131(59.6%)of the respondents were female,most of them had depression,and one-third had anxiety.Among the respondents,124(56.4%)had mild depression,70(31.8%)had moderate depression,and 3(1.3%)had severe depression;79(35.9%)had mild anxiety,64(29.1%)had moderate anxiety,and 4(1.8%)had severe anxiety.CONCLUSION Most respondents were depressed and one-third had anxiety.More than half and nearly one-third had mild and moderate depression,respectively,and nearly one-third had mild and moderate anxiety,which is higher than other studies.

Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial

The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.

Effects of an Omaha System-based follow-up regimen on self-care and quality of life in gastrointestinal surgery patients

BACKGROUND Currently,a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery patients.AIM To investigate the effect of follow-up protocol based on the Omaha System on self-care ability and quality of life of gastrointestinal surgery patients.METHODS A total of 128 patients with inflammatory bowel disease in gastrointestinal surgery in gastrointestinal surgery from March 2019 to August 2021 were divided into A(n=64)and B(n=64)groups according to different nursing methods.The group A received a follow-up program Omaha System-based intervention of the group B,whereas the group B received the routine nursing intervention.Medical Coping Modes Questionnaire,Crohn’s and Colitis Knowledge Score(CCKNOW),inflammatory bowel disease questionnaire(IBDQ),Exercise of Self-nursing Agency Scale(ESCA),The Modified Mayo Endoscopic Score,and Beliefs about Medicine Questionnaire(BMQ)were compared between the two groups.RESULTS Following the intervention,the group A were facing score significantly increased than group B,while the avoidance and yield scores dropped below of group B(all P<0.05);in group A,the level of health knowledge,personal care abilities,self-perception,self-awareness score and ESCA total score were more outstanding than group B(all P<0.05);in group A the frequency of defecation,hematochezia,endoscopic performance,the total evaluation score by physicians and the disease activity were lower than group B(all P<0.05);in the group A,the total scores of knowledge in general,diet,drug,and complication and CCKNOW were higher than group B(all P<0.05);in group A,the necessity of taking medicine,score of medicine concern and over-all score of BMQ were more significant than group B(all P<0.05);at last in the group A,the scores of systemic and intestinal symptoms,social and emotional function,and IBDQ in the group A were higher than group B(all P<0.05).CONCLUSION For gastrointestinal surgery patients,the Omaha System-based sequel protocol can improve disease awareness and intervention compliance,help them to face the disease positively,reduce disease activity,and improve patients’self-nursing ability and quality of life.

Evolution of HBV Viral Load during Clinical and Biological Follow-Up of Chronic Hepatitis B Patients at the Saint Camille Hospital in Ouagadougou

Hepatitis B virus (HBV) infection is a major public health problem worldwide. The aim of this study was to document the dynamics of HBV viral load during the follow-up of chronic hepatitis B patients at the Saint Camille Hospital in Ouagadougou (HOSCO) from 2017 to 2021. This descriptive retrospective study was carried out in the Hepato-Gastro-Enterology Department of HOSCO and focused on patients who were undergoing treatment for chronic viral hepatitis B. A total of 260 cases of chronic hepatitis B were included in the study. The most affected age group was 21 to 30 years, accounting for 48.08% of the cases. Lifestyle factors included alcohol consumption (3.08%) and tobacco use (2.69%). Major risk factors for transmission included lack of vaccination (98.46%), family history of HBV infection (68.00%) and engagement in high-risk activities (28.00%). Patients requiring treatment were prescribed Tenofovir 300 mg tablets. FibroScan® showed the presence of stage F3-F4 fibrosis (2.14%) and S3 steatosis (13.33%). After one year of follow-up, 6.92% of patients achieved an undetectable viral load with normalized transaminase levels. The majority of other patients had a detectable viral load but below 20,000 IU/mL. The prevalence of viral hepatitis B remains significant worldwide. Although effective and well-monitored treatment can lead to undetectable viremia, prevention remains the most effective strategy for successful management of this disease.

Loss to Specialized Cardiology Follow-Up in Adults Living with Congenital Heart Disease

Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a successful transition.This is critical too,as patients lost to specialised care are more likely to experience mor-bidity and premature mortality.Aims:To understand the prevalence and reasons for loss to follow-up(LTF)at a large Australian Adult Congenital Heart Disease(ACHD)centre.Methods:Patients with moderate or highly complex CHD and gaps in care of>3 years(defined as LTF)were identified from a comprehensive ACHD data-base.Structured telephone interviews examined current care and barriers to clinic attendance.Results:Overall,407(22%)of ACHD patients(n=1842)were LTF.The mean age at LTF was 31(SD 11.5)years and 54%were male;311(76%)were uncontactable.Compared to adults seen regularly,lost patients were younger,with a greater socio-economic disadvantage,and had less complex CHD(p<0.05 for all).We interviewed 59 patients(14%).The top 3 responses for care absences were“feeling well”(61%),losing track of time(36%),and not needing fol-low-up care(25%).Conclusions:A large proportion of the ACHD population becomes lost to specialised cardiac care,even after a successful transition.This Australian study reports younger age,moderate complexity defects,and socio-economic disadvantage as predictive of loss to follow-up.This study highlights the need for novel approaches to patient-centered service delivery even beyond the age of transition and resources to maintain patient engagement within the ACHD service.

Focusing on the tetra-partite synapse in Parkinson’s disease research using human patient-derived neurons

Parkinson’s disease(PD)was first described as a neurological disease by Dr.James Parkinson in 1817 as a“shaking palsy”.Since that time,much more is known about the pathophysiology of PD yet the disease is still uncurable.The hallmark of the disease is often considered Lewy body neural inclusions in the substantia nigra pars compacta and other brain areas,although not all patients have these inclusions.The patients exhibit massive neuronal cell loss in the substantia nigra pars compacta,which is associated with the motor symptoms of tremor,bradykinesia,rigidity,and postural instability.PD is the second most common neurodegenerative disease after Alzheimer’s disease with a prevalence of around 1%of individuals over the age of 60.

Molecular Characterization of Coxsackievirus B1 Strains Isolated from Patients with Hand Foot and Mouth Disease in Yunnan,Southwest China

Coxsackievirus(CV)B belongs to the species Enterovirus B,genus Enterovirus of the family Picornaviridae.Enterovirus B(EV-B)includes 63 serotypes:CVB1-6;CVA9;echoviruses E1-7,9,11-21,24-27,and 29-33;EV-B69,EV-B 73-75,EV-B77-88,EV-B 93,EV-B 97-101,EV-B 106-107.

A young patient with Trousseau syndrome presenting with multiple arterial emboli

Trousseau syndrome is characterized by thromboembolism induced by malignancy[1]and typically affects middle-aged to elderly patients.[2-4]When faced with a young patient suffering from cerebral infarction and diffuse arterial emboli,there is some controversy regarding whether to consider it a concurrent malignancy triggering Trousseau syndrome or to adhere to TOAST(Trial of Org 10172 in Acute Stroke Treatment)for common causes.[5,6]In this case study,we aimed to report a young patient with Trousseau syndrome presenting with multiple arterial emboli.

Evaluation of disease burden and symptom scores in patients with acute atrial fi brillation in the emergency department

Atrial fibrillation(AF)is a major public health problem and poses a substantial economic burden on healthcare systems worldwide.[1-4]The emergency department(ED)serves as the first point of contact with the healthcare system and plays a key role in the management of patients with AF,which accounts for 3%-10%of all hospital admissions.[5]Treatment plans are often discussed and initiated at the ED.

Hemoperfusion and continuous veno-venous hemodiafiltration for eliminating chlorfenapyr in poisoning patients

Chlorfenapyr is a liposoluble insecticide belonging to the pyrrole family.Chlorfenapyr is activated when the N-ethoxymethyl side chain breaks,forming a toxic metabolite,which uncouples oxidative phosphorylation in the mitochondria,inhibits the production of adenosine triphosphate (ATP),and leads to the death of cells and targe organisms.[1] Symptoms of chlorfenapyr poisoning in patients are mild and atypical in the early stage,especially in patients receiving low dose exposure;however,such cases are rare and may be ignored by physicians,often leading to delayed treatment.[2,3].

Optimal timing of invasive intervention for high-risk non-ST-segment-elevation myocardial infarction patients

OBJECTIVE To compare the immediate,early,and delayed percutaneous coronary intervention(PCI)strategies in non-ST-segment-elevation myocardial infarction(NSTEMI)patients with high-risk.METHODS Medical records of patients treated at the Daping Hospital,Third Military Medical University,Chongqing,China between 2011 and 2021 were retrospectively reviewed.Only patients with complete available information were included.All patients assigned into three groups based on the timing of PCI including immediate(<2 h),early(2–24 h)and delayed(≥24 h)intervention.Multivariable Cox hazards regression and simpler nonlinear models were performed.RESULTS A total of 657 patients were included in the study.The median follow-up length was 3.29(interquartile range:1.45–4.85)years.Early PCI strategy improved the major adverse cardiac event(MACE)outcome compared to the immediate or delayed PCI strategy.Early PCI,diabetes mellitus,and left main or/and left anterior descending or/and left circumflex stenosis or/and right coronary artery≥99%were predictors for MACE outcome.The optimal timing range for PCI to reduce MACE risk is 3–14 h post-admission.For high-risk NSTEMI patients,early PCI reduced primary clinical outcomes compared to immediate or delayed PCI,and the optimal timing range was 3–14 h post-admission.Delayed PCI was superior for NSTEMI with chronic kidney injury.CONCLUSIONS Delayed invasive strategy was helpful to reduce the incidence of MACE for high-risk NSTEMI with chronic kidney injury.An immediate PCI strategy might increase the rate of MACE.

The association between C-reactive protein to albumin ratio and 6-month neurological outcome in patients with in-hospital cardiac arrest

The global incidence rates of in-hospital cardiac arrest(IHCA)range from1.2 to 9.0 per1,000 hospitalized patients,as per the National Cardiac Arrest Database.[1] While IHCAs tend to exhibit superior 30-day survival rates relative to out-of-hospital cardiac arrests (OHCA) due to situational advantages,such as immediate access to medical personnel and treatments.

Risk factors for early death in severe non-brain- injured trauma patients

Severe trauma is one of the main causes of premature death,posing a significant challenge to public health systems.[1]At present,there is a lack of universally accepted guidelines for rapid detection of life-threatening severe trauma,[2]and the accuracy of existing prognostic models in predicting early death is limited.[3,4]Severe non-brain-injured trauma(SNT)patients account for approximately 70%of all trauma-related deaths.Moreover,there is a lack of studies on early death in SNT patients.[5]This study aims to identify risk factors associated with early death(≤72 h post-admission)in SNT patients.