Recorded Rates of Trauma-Exposure in a Retrospective Epidemiologically Complete First-Episode Psychosis Cohort.

BACKGROUND: Trauma plays an important role in the development and maintenance of psychosis. However, it is still under-examined in daily clinical practice. The current study investigated the rates of recording of trauma-exposure in the clinical histories of a first-episode psychosis (FEP) cohort attending an early intervention psychosis service. METHODS: This study used a retrospective chart review methodology in a 6-year epidemiologically complete FEP cohort attending an early intervention psychosis service. The Trauma and Life Events Checklist was used to define the rate and types of trauma-exposure reported in clinical histories. The relationships were examined between recorded trauma-exposure and positive and negative symptoms, depression and duration of untreated psychosis at first assessment. RESULTS: Trauma-exposure was frequently recorded within clinical histories. Childhood trauma-exposure was recorded in 47.4% of the sample, which is lower than may be expected. No significant relationships between the recorded trauma-exposure and symptom measures were found. A significant relationship was found between interpersonal stressors and positive symptoms, and work-related stress and negative symptoms, highlighting the importance of proximal stressful life events. DISCUSSION: This study found that clinicians were frequently recording trauma-exposure in daily practice. However, it was unclear whether the recording of trauma-exposure highlighted led to systematic diagnosis, assessment or treatment of trauma for people with psychosis. The importance of treatment and service planning to include information about trauma-exposure is discussed.

Patterns and Characteristics of Diabetic Ketoacidosis in Children With Type I Diabetes in Saudi Arabia.

BACKGROUND: Type 1 diabetes mellitus (T1DM) in children, a significant public health concern, often leads to diabetic ketoacidosis (DKA). The prevalence of T1DM is increasing globally, with Saudi Arabia recording high rates of DKA at T1DM onset. This study aimed to evaluate the characteristics and risk factors of pediatric T1DM patients presenting with DKA in the emergency room in Saudi Arabia and quantify intensive care unit (ICU) admission incidences reflecting DKA severity. METHODS: This retrospective chart review, conducted at Medina Maternity and Children's Hospital, Saudi Arabia, analyzed data from 2017 to 2022. The study included children and adolescents under 18 presenting with DKA, using non-probability consecutive sampling. Patient medical records provided demographic, medical, and laboratory data, and the analysis employed SPSS for statistical assessment. RESULTS: The study enrolled 70 participants, predominantly female (n = 42, 60%) and Saudi nationals (n = 63, 90%). The average age at diabetes mellitus (DM) onset was 6.9 years, with a mean hospital stay of 3.31 days. About 18.57% (n = 13) were newly diagnosed with DM, and 81.43% (n = 57) were known cases of DM. Most participants (n = 59, 86.8%) had no comorbidities, while 7.4% (n = 5) had celiac disease. The recovery rate was high (n = 67, 95.7%), with 80% (n = 56) experiencing no complications. Notably, 44.3% (n = 31) were admitted to a ward, and 12.9% (n = 9) required ICU admission. Weight was found to be a significant predictor of ICU admission (OR = 1.26, 95% CI: 1.05 to 1.5; p = 0.011). CONCLUSIONS: This study highlights the importance of personalized insulin therapy and weight management in pediatric T1DM patients presenting with DKA. It suggests that early and effective management in emergency settings can significantly improve patient outcomes. The study also calls for further research into long-term management strategies and the impact of targeted educational programs.

A scoping review of the methodological approaches used in retrospective chart reviews to validate adverse event rates in administrative data.

Patient safety is a key quality issue for health systems. Healthcare acquired adverse events (AEs) compromise safety and quality; therefore, their reporting and monitoring is a patient safety priority. Although administrative datasets are potentially efficient tools for monitoring rates of AEs, concerns remain over the accuracy of their data. Chart review validation studies are required to explore the potential of administrative data to inform research and health policy. This review aims to present an overview of the methodological approaches and strategies used to validate rates of AEs in administrative data through chart review. This review was conducted in line with the Joanna Briggs Institute methodological framework for scoping reviews. Through database searches, 1054 sources were identified, imported into Covidence, and screened against the inclusion criteria. Articles that validated rates of AEs in administrative data through chart review were included. Data were extracted, exported to Microsoft Excel, arranged into a charting table, and presented in a tabular and descriptive format. Fifty-six studies were included. Most sources reported on surgical AEs; however, other medical specialties were also explored. Chart reviews were used in all studies; however, few agreed on terminology for the study design. Various methodological approaches and sampling strategies were used. Some studies used the Global Trigger Tool, a two-stage chart review method, whilst others used alternative single-, two-stage, or unclear approaches. The sources used samples of flagged charts (n = 24), flagged and random charts (n = 11), and random charts (n = 21). Most studies reported poor or moderate accuracy of AE rates. Some studies reported good accuracy of AE recording which highlights the potential of using administrative data for research purposes. This review highlights the potential for administrative data to provide information on AE rates and improve patient safety and healthcare quality. Nonetheless, further work is warranted to ensure that administrative data are accurate. The variation of methodological approaches taken, and sampling techniques used demonstrate a lack of consensus on best practice; therefore, further clarity and consensus are necessary to develop a more systematic approach to chart reviewing.

Hospital-Acquired Acute Kidney Injury in Non-Critical Medical Patients in a Developing Country Tertiary Hospital: Incidence and Predictors.

Background: Acute kidney injury (AKI) is a frequent complication in critical patients, leading to a worse prognosis. Although its consequences are worse among critical patients, AKI is also associated with less favorable outcomes in non-critical patients. Therefore, understanding the magnitude of the problem in these patients is crucial, yet there is a scarcity of evidence in non-critical settings, especially in resource limited countries. Hence, the study aimed at determining the incidence and predictors of hospital acquired acute kidney injury (HAAKI) in non-critical medical patients who were admitted at a large tertiary hospital in Ethiopia. Methods: A retrospective chart review study was conducted from September 25, 2022 to January 20, 2023 among 232 hospitalized non-critical medical patients admitted to St. Paul's Hospital Millennium Medical College between January 2020 and January 2022. The incidence of HAAKI was estimated using incidence density per total person day (PD) observation of the study participants. To identify predictors of HAAKI, a log binomial regression model was fitted at a p value of ≤0.05. The magnitude of association was measured using adjusted relative risk (ARR) with its 95% CI. Results: During the median follow-up duration of 11 days (IQR, 6-19 days), the incidence of HAAKI was estimated to be 6.0 per 100 PD (95% CI = 5.5 to 7.2). Significant predictors of HAAKI were found to be having type 2 diabetes mellitus (ARR = 2.36, 95% CI = 1.03, 5.39, p-value=0.042), and taking vancomycin (ARR = 3.04, 95% CI = 1.38, 6.72, p-value=0.006) and proton pump inhibitors (ARR = 3.80, 95% CI = 1.34,10.82, p-value=0.012). Conclusion: HAAKI is a common complication in hospitalized non-critical medical patients, and is associated with a common medical condition and commonly prescribed medications. Therefore, it is important to remain vigilant in the prevention and timely identification of these cases and to establish a system of rational prescribing habits.

Unraveling a history of overlap: A phenotypic comparison of RBCK1-related disease and glycogen storage disease type IV.

RBCK1-related disease is a rare, multisystemic disorder for which our current understanding of the natural history is limited. A number of individuals initially carried clinical diagnoses of glycogen storage disease IV (GSD IV), but were later found to harbor RBCK1 pathogenic variants, demonstrating challenges of correctly diagnosing RBCK1-related disease. This study carried out a phenotypic comparison between RBCK1-related disease and GSD IV to identify features that clinically differentiate these diagnoses. Literature review and retrospective chart review identified 25 individuals with RBCK1-related disease and 36 with the neuromuscular subtype of GSD IV. Clinical features were evaluated to assess for statistically significant differences between the conditions. At a system level, any cardiac, autoinflammation, immunodeficiency, growth, or dermatologic involvement were suggestive of RBCK1, whereas any respiratory involvement suggested GSD IV. Several features warrant further exploration as predictors of RBCK1, such as generalized weakness, heart transplant, and recurrent infections, among others. Distinguishing RBCK1-related disease will facilitate correct diagnoses and pave the way for accurately identifying affected individuals, as well as for developing management recommendations, treatment, and an enhanced understanding of the natural history. This knowledge may also inform which individuals thought to have GSD IV should undergo reevaluation for RBCK1.

Patterns of use of advanced wound matrices in the Veterans Administration clinics.

Chronic wounds are a common and costly health issue affecting millions of individuals in the United States, particularly those with underlying conditions such as diabetes, venous insufficiency, and peripheral artery disease. When standard treatments fail, advanced wound care therapies, such as skin substitutes, are often applied. However, the clinical effectiveness, indications, and comparative benefits of these therapies have not been well established. In this study, we report on the usage of both acellular and cellular, single and bilayer, natural and synthetic, dermal, and epidermal skin substitutes in a VA hospital system. We performed a retrospective chart review to understand the ordering and usage patterns of advanced wound therapies for patients with chronic wounds at the VA Northern California Health Care System. We examined types of products being recommended, categories of users recommending the products, indications for orders, and rate of repeated orders. Neuropathic, venous, or pressure ulcers were the main indications for using advanced wound matrices. Only 15.6% of patients for whom the matrices were ordered had supporting laboratory tests. Exactly 34.3% of the ordered matrices were not applied. And the use of wound matrices resulted in increased costs per patient visit of $1018-$3450. Our study sheds light on the usage patterns of these therapies in a VA healthcare facility and highlights the need for more robust evidence-based studies to determine the true benefits, efficacy, and cost-effectiveness of these innovative treatment options.

Increased healthcare utilization in the year before multiple sclerosis diagnosis.

BACKGROUND: Studies have suggested possible multiple sclerosis (MS) prodrome with non-routine healthcare utilization as an indicator. The objective of this project was to compare utilization in the four years (years -1, -2, -3, -4) before clinically definite diagnosis and examine demographic associations. METHODS: i2B2 database search at the Medical College of Wisconsin Comprehensive MS center yielded 613 patients between 07/01/2018 and 07/01/2022. Patients with established MS diagnosis, MS mimicker diagnoses, and pediatric-onset MS were excluded; 108 met the criteria for adult patients ≥ 18 years of age newly diagnosed with clinically definite MS after manual chart review. Utilization score for each of the four years before diagnosis was calculated; demographic variables were also collected. Adjusted repeated measures mixed model and Pearson correlation analysis were performed; P value was set at <0.05 for statistical significance. RESULTS: Utilization was greatest for year -1 compared to years -2, -3, and -4 after demographics adjustment (p < 0.001). Utilization was greater (p < 0.05) for older age and unmarried, patients. CONCLUSIONS: Utilization increased a year before formal MS diagnosis, suggestive of prodromal presentation.

Effect of Korean Medicine Treatment on Patients with Postherpetic Neuralgia: A Retrospective Chart Review.

Evidence regarding Korean medicine treatment (KMT) for neuropathic pain is lacking. We aimed to identify the effects of integrative KMT in patients with postherpetic neuralgia (PHN). We retrospectively analyzed the electronic medical records of patients with PHN who received KMT at Kyung Hee University Korean Medicine Hospital between August 2021 and July 2022. We evaluated the effects of KMT-comprising acupuncture, pharmacopuncture, herbal medicine, cupping, and moxibustion-on pain intensity using the numerical rating scale (NRS), Short-Form McGill Pain Questionnaire (SF-MPQ), Hospital Anxiety and Depression Scale-Anxiety (HADS-A), Hospital Anxiety and Depression Scale-Depression (HADS-D), Daily Sleep Interference Scale (DSIS), Fatigue Severity Scale (FSS), and EuroQol-5D. Among 53 patients with PHN, 13 were included. The NRS score for worst pain over 1 week decreased from 6.54 ± 0.64 at baseline to 3.85 ± 0.63 at 8 weeks (41% reduction, p < 0.01), while that for average pain over 1 week decreased from 4.93 ± 0.67 at baseline to 3.08 ± 0.46 at 8 weeks (37% reduction, p < 0.01). From baseline to 8 weeks, there were significant reductions in the SF-MPQ, HADS-A, FSS, and EuroQol-5D scores. No adverse events were reported after KMT. Therefore, KMT may be an effective treatment option for patients with PHN.

Patient outcomes associated with subcutaneous C1INH prophylaxis for hereditary angioedema: a retrospective analysis.

BACKGROUND: Real-world data on subcutaneous C1INH (C1INH[SC]) usage and patient-level impacts on hereditary angioedema (HAE)-related outcomes and quality of life (QoL) are both lacking and challenging to generate using conventional study methodologies. Using a hybrid study design involving patient interviews supplemented by retrospective medical chart data review, we conducted a real-world assessment of the impact of C1INH(SC) prophylaxis on HAE attack patterns, QoL, and on-demand medication use. METHODS: The study was conducted at seven US sites and included 36 adults with HAE who had been treated with C1INH(SC) long-term prophylaxis following ≥ 12 months of on-demand management only. Patients underwent 30-min interviews, facilitated and analyzed by a trained qualitative research specialist. Medical records were reviewed for 12 months before (pre-index) and after (post-index) initiation of C1INH(SC). Using interview data with descriptive terms converted to numerical values, we compared pre- versus post-index attack frequency, severity, and rescue medication usage. RESULTS: Mean (SD) annualized attack frequency per patient decreased 82.0%, from 38.8 (38.8) attacks/year pre-index to 7.0 (15.3) attacks/year (P < 0.001); the median number of attacks decreased by 97.0% (30 pre-index to 1 post-index). For 20 patients, the annualized attack rate after starting C1INH(SC) prophylaxis was ≤ 1 attack/year; 12 of these patients reported 0 attacks. Mean (SD) attack severity (scale: 0 = none/mild to 4 = very severe) decreased from 2.3 (0.7) pre-index to 0.9 (0.9) post-index (P < 0.001). Mean/median rescue medication use decreased by 77.2%/96.3%. Improved QoL was narratively described for many domains. CONCLUSIONS: These real-world findings indicate that long-term prophylaxis with C1INH(SC) markedly improves important factors that contribute to the goal of achieving total disease control and normalization of patients' lives, including fewer and less severe attacks, less rescue medication usage, and improved QoL.

The effects of untreated reflux on the incidence of dysphagia, oral aversion, and feeding difficulty in the NICU population.

OBJECTIVES: To determine whether late-preterm and full-term neonates in the neonatal intensive care unit (NICU) with diagnosed gastroesophageal reflux (GERD) have an increased incidence of feeding difficulties, dysphagia, and oral aversion. To determine the incidence of reflux medication use in late-preterm and full-term neonates in the NICU. METHODS: Neonates greater than 34 weeks gestational age (GA) diagnosed with reflux, who were hospitalized for at least five days, were included in the study. Neonates with anatomical anomalies that interfere with feeding are excluded. The control group included neonates greater than 34 weeks GA not diagnosed with reflux. The key outcome variables were subjective ease of feeding, oral aversion, and placement on nasogastric (NG), orogastric (OG), or requirement of total parenteral nutrition (TPN). Statistical analysis was performed using chi-squared and t-test to compare incidence of feeding difficulties between the groups. A p-value <0.05 was considered significant. RESULTS: In neonates with a diagnosis of reflux, 42.02% had feeding difficulties (66 patients). In the control group, 30.49% of neonates had feeding difficulties (218 patients). Feeding difficulties in neonates with reflux was 11.55% higher than in the control group (p = 0.001). CONCLUSION: Late-preterm and full-term neonates diagnosed with reflux have a higher incidence of feeding difficulties than those who did not have reflux. Only 0.86% of neonates diagnosed with reflux were treated with anti-reflux medications at this large tertiary care children's hospital.

Frequency of Subclinical Hypothyroidism Among Pregnant Women: A Retrospective Chart Review.

Background Subclinical hypothyroidism is a common endocrine disorder during pregnancy, associated with adverse maternal and fetal outcomes. This study aimed to evaluate the frequency of subclinical hypothyroidism among pregnant women who presented to our hospital between 2020 and 2022. Methods A retrospective chart review was conducted on 589 pregnant women using convenience sampling. Only women who underwent thyroid function testing and had no known thyroid disease were included. Data on age, weight status, history of miscarriage, history of infertility, menstrual cycle regularity, thyroid function, and symptoms of thyroid diseases were collected. Descriptive statistics were used to analyze the data. Results The mean age of the participants was 24.8 ± 3.7 years. Among the participants, 270 (45.9%) had a normal weight, 199 (33.8%) were overweight, and 120 (20.4%) were obese. A history of miscarriage was reported by 69 women (11.7%) while 37 women (6.3%) had a history of infertility. The menstrual cycle was regular in 499 women (84.7%) and irregular in 90 women (15.3%). The results showed that 517 (87.7%) women were euthyroid, 47 (7.9%) had hypothyroidism, and 25 (4.2%) had hyperthyroidism. Of the 47 patients with hypothyroidism, 32 (68.08%) had subclinical hypothyroidism and 15 (31.91%) had overt hypothyroidism. Conclusion This study highlights the frequency of subclinical hypothyroidism among pregnant women. The findings underscore the importance of thyroid function testing during pregnancy.

A multicenter chart review of patient characteristics, treatment, and outcomes in hereditary angioedema: unmet need for more effective long-term prophylaxis.

BACKGROUND: Hereditary angioedema (HAE) is a rare disease characterized by unpredictable, recurring subcutaneous or submucosal swelling. Without effective therapy, HAE can negatively impact patients' quality of life. Management of HAE includes on-demand treatment of attacks and short- and long-term prophylaxis (LTP) to prevent attacks. Newer therapies may be more tolerable and effective in managing HAE; however, therapies such as androgens are still widely used in some countries owing to their relative ease of access and adequate disease control for some patients. This study evaluated the characteristics, treatment patterns, clinical outcomes, and healthcare resource utilization of a multinational cohort of patients with HAE, with a focus on understanding reasons for recommending or discontinuing available therapies. METHODS: A retrospective chart review was conducted at 12 centers in six countries and included data from patients with HAE type 1 or 2 who were ≥ 12 years of age at their first clinical visit. The relationship between LTP use and attack rates was evaluated using a multivariable Poisson regression model. Data were collected between March 2018 and July 2019. RESULTS: Data from 225 patients were collected (62.7% female, 86.2% White, 90.2% type 1); 64.4% of patients had their first HAE-related visit to the center prior to or during 2014. Treatment patterns varied between countries. Overall, 85.8% of patients were prescribed on-demand treatment and 53.8% were prescribed LTP, most commonly the androgen danazol (53.7% of patients who used LTP). Plasma-derived C1 inhibitor (Cinryze®) was used by 29.8% of patients for LTP. Patients who received LTP had a significantly lower rate of HAE attacks than patients who did not receive any LTP (incidence rate ratio (95% confidence interval) 0.90 (0.84-0.96)). Androgens were the most commonly discontinued therapy (51.3%), with low tolerability cited as the most frequent reason for discontinuation (50.0%). CONCLUSIONS: Overall, findings from this study support the use of LTP in the prevention of HAE attacks; a lower rate of attacks was observed with LTP compared with no LTP. However, the type of LTP used varied between countries, with tolerability and accessibility to specific treatments playing important roles in management decision-making.

The clinical practice of palliative sedation in patients dying from COVID-19: a retrospective chart review.

BACKGROUND: Clinical experts experienced challenges in the practice of palliative sedation (PS) during the COVID-19 pandemic. Rapid deterioration in patients' situation was observed while the indications for starting PS seemed to differ compared to other terminal patients. It is unclear to which extent clinical trajectories of PS differ for these COVID patients compared to regular clinical practice of PS. OBJECTIVES: To describe the clinical practice of PS in patients with COVID versus non-COVID patients. METHODS: A retrospective analysis of data from a Dutch tertiary medical centre was performed. Charts of adult patients who died with PS during hospitalisation between March '20 and January '21 were included. RESULTS: During the study period, 73 patients received PS and of those 25 (34%) had a COVID infection. Refractory dyspnoea was reported as primary indication for starting PS in 84% of patients with COVID compared to 33% in the other group (p < 0.001). Median duration of PS was significantly shorter in the COVID group (5.8 vs. 17.1 h, p < 0.01). No differences were found for starting dosages, but median hourly dose of midazolam was higher in the COVID group (4.2 mg/hr vs. 2.4 mg/hr, p < 0.001). Time interval between start PS and first medication adjustments seemed to be shorter in COVID patients (1.5 vs. 2.9 h, p = 0.08). CONCLUSION: PS in COVID patients is characterized by rapid clinical deterioration in all phases of the trajectory. What is manifested by earlier dose adjustments and higher hourly doses of midazolam. Timely evaluation of efficacy is recommended in those patients.

Frequency and types of emotional dysregulation in referrals to child and adolescent mental health services.

INTRODUCTION: Emotional dysregulation (ED) is a transdiagnostic phenomenon that has received increased attention, because of its potential ability to explain the development and maintenance of various psychiatric disorders. The identification of ED may serve as a potential target for both preventive and treatment interventions, however, the frequency of transdiagnostic ED among children and adolescents has not previously been evaluated. Our aim was to evaluate the frequency and types of ED in accepted and rejected referrals to the Child and Adolescent Mental Health Center (CAMHC), Mental Health Services, Copenhagen, Denmark, regardless of psychiatric status and across diagnoses. We aimed to evaluate how often ED would be a leading cause in seeking professional help, and whether children with ED not directly reflecting symptoms of known psychopathology would have higher rejection rates than children with more distinct symptoms of psychopathology. Finally, we assessed associations between sex and age with various types of ED. METHODS: We examined ED in a retrospective chart review of referrals of children and adolescents aged 3-17 years to the CAMHC between August 1st, 2020, and August 1st, 2021. We ranked problems described in the referral as primary, secondary, and tertiary depending on severity. Further, we examined group differences in the frequency of ED in accepted versus rejected referrals, as well as group differences in types of ED in age and sex distributions, and diagnoses occurring with specific types of ED. RESULTS: ED was present in 62.3% of the 999 referrals and was assessed as the primary issue in twice as many rejected referrals (11.4%) compared to accepted referrals (5.7%). Boys were significantly more often described with externalizing and internalizing behavior (55.5% vs. 31.6%; 35.1% vs. 26.5%) as well as incongruent affect (10.0% vs. 4.7%), whereas girls were more often described with depressed mood (47.5% vs. 38.0%) and self-harm (23.8% vs. 9.4%). The frequency of different types of ED varied with age. CONCLUSION: The present study is the first to evaluate the frequency of ED in children and adolescents referred to mental health services. The study offers insights into the high frequency of ED and the associations between ED and subsequent diagnoses, which may prove to be a method of early identification of risk of psychopathology. Our findings suggest that ED may rightly be considered a transdiagnostic factor, independent of specific psychiatric disorders, and that an ED-centered as opposed to diagnosis-specific approach to assessment, prevention, and treatment could target transversal symptoms of psychopathology in a more holistic manner.

Spinal cord and brain corticospinal tract lesions are associated with motor progression in tumefactive multiple sclerosis.

BACKGROUND: Spinal cord lesions have been associated with progressive disease in individuals with typical relapsing remitting MS (RRMS). OBJECTIVE: In the current study, we aimed to determine if progressive disease is associated with spinal cord lesions in those with tumefactive multiple sclerosis (MS). METHODS: Retrospective chart review of individuals presenting to Mayo Clinic with tumefactive MS with spinal cord MRIs available (n=159). Clinical data were extracted by chart review. Brain and spinal cord MRIs were reviewed to characterize the tumefactive demyelinating lesion(s) and assess the burden of spinal cord disease. RESULTS: A total of 69 (43%) had spinal cord lesions. Progressive demyelinating disease was documented in 13 (8%); the majority (11/13) with secondary progressive disease. The method of progression was myelopathic in 8/13 (62%), cognitive in 3/13 (23%), motor from a supratentorial lesion in 2/13 (16%). EDSS at last follow-up was higher in those with progression than those without (median 6.0 (2.0-10.0) vs. 2.5 (0-10.0), p = < 0.001). Progressive demyelinating disease occurred in a minority. CONCLUSIONS: Patients with progression typically experienced progressive motor impairment, and this occurred exclusively in individuals with lesions in the corticospinal tracts of the brain and/or the spinal cord.

The Data Error Criteria (DEC) for retrospective studies: development and preliminary application.

Retrospective chart review (RCR) studies rely on the collection and analysis of documented clinical data, a process that can be prone to errors. The aim of this study was to develop a defined set of criteria to evaluate RCR datasets for potential data errors. The Data Error Criteria (DEC) were developed by identifying data coding and data entry errors via literature review and then classifying them based on error types. Three components comprise the DEC: general errors, numerical-specific errors, and categorical variable-specific errors. Two reviewers independently applied these criteria via a manual review process to an existing de-identified database. A total of 10,168 errors were identified out of a total of 28,656 data points. The total number of errors included redundancies as certain errors may be included in multiple categories. These included 2515 general errors, 39 numerical-specific errors, and 7614 categorical variable-specific errors. Input-related categorical variable-specific errors occurred most frequently, followed by errors secondary to blank cells. Inter-rater agreement was near perfect for all categories. Identifying errors outlined in the DEC can be crucial for the data analysis stage as they can lead to inaccurate calculations and delay study timelines. The DEC offers a framework to evaluate datasets while reducing time and efforts needed to create high-quality RCR-related databases.

Prognostic factors in major depressive disorder: comparing responders and non-responders to Repetitive Transcranial Magnetic Stimulation (rTMS), a naturalistic retrospective chart review.

AIM: Repetitive transcranial magnetic stimulation (rTMS) is widely utilized as an effective treatment for major depressive disorder (MDD) with varying response rates. Factors associated with better treatment outcome remain scarce. This naturalistic retrospective chart review hopes to shed light on easily obtainable and measurable predictive factors for patients referred to rTMS. METHODS: Protocol parameters, medication, rated scales, rTMS protocols, and treatment outcomes were reviewed for 196 patients with MDD who received rTMS at Saint Boniface Hospital between 2013 and 2019. Logistic regression and marginal effects were used to assess the different predictor variables for response (50% reduction or more on the Hamilton Depression Rating Scale (Ham-D)) and remission (Ham-D of ≤7 by the last session). RESULTS: HamD at 10 sessions was predictive of remission, and Sheehan Disability Scale (SDS) at 10 sessions was predictive of response to rTMS. Ham-D, SDS, and Beck Anxiety Inventory were predictive of remission and response by Beck Anxiety Inventory 20 sessions. High frequency rTMS had a similar response and remission rate to low frequency, but higher response rate to intermittent Theta Burst Stimulation with no difference in remission rate. Positive predictive factors of response were lower age and bupropion use. Negative predictive factors were antipsychotics, anticonvulsants, or benzodiazepine use. For remission, antipsychotics or anticonvulsants use were negative predictors; bupropion use and higher resting motor threshold were positive predictors. Severity of depression as measured by baseline HamD was not associated with different probabilities of treatment success.

Effect of Selective Laser Trabeculoplasty on the Fellow Eye.

Aim: Determine if selective laser trabeculoplasty (SLT) affects the fellow eye's intraocular pressure (IOP). Materials and methods: A retrospective review of 76 pairs of eyes from 76 adult glaucoma patients who underwent SLT in one eye with at least 2 months between treatments were evaluated for IOP and medication reduction in the untreated fellow eye. Success was defined as ≥20% IOP reduction or ≥1 medication reduction without any additional IOP lowering procedures or medication. The primary outcome measures were success, IOP, and medication reduction in the untreated fellow eye at 6 months. Results: At 6 months after SLT treatment, 48.7% (38/76) treated eyes and 36.8% (28/76) untreated fellow eyes met success criteria. IOP reduction in the treated eye was 2.6 ± 5.8 (14.1%; p < 0.002) and 0.8 ± 4.3 (5.1%, p = 0.122) in the fellow eye. The fellow eye was significantly more likely to meet success criteria if the treated eye was successful [odds ratio (OR): 6.00, 95% confidence interval (CI) (2.11-17.06), p < 0.002]. Conclusion: After a unilateral treatment with SLT, over one-third of the fellow eyes experienced either ≥20% IOP reduction or medication reduction. Additionally, fellow eyes were six times as likely to meet success criteria if this was observed in the treated eye. These findings may support the proposed biochemical mechanism for the therapeutic action of SLT. Clinical significance: The implication for clinicians is that SLT treatment in one eye may allow the fellow eye to benefit and provide a prediction on the fellow eye's response without subjecting both eyes to the rare but present complications of SLT. How to cite this article: Hirabayashi M, Mellencamp E, Duong S, et al. Effect of Selective Laser Trabeculoplasty on the Fellow Eye. J Curr Glaucoma Pract 2023;17(4):175-177.

Factors Associated With Emergency Department Visits Among Patients Receiving Publicly-Funded Homecare Services: A Retrospective Chart Review From Southern Taiwan Regional Hospital.

BACKGROUND: The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments. However, scientific evidence regarding the association between home-based healthcare services and emergency department uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for emergency department visits among patients receiving publicly-funded homecare services. METHODS: The personal demographic and medical information, caregiver characteristics, and behaviours related to homecare services and emergency department visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated homecare services in a regional hospital in southern Taiwan between January 1, 2020, and December 31, 2020, were collected. After screening the potential predictor variables using the preliminary univariate analyses, the multivariate logistic regression with best subset selection approach was conducted to identify best combination of determinants to predict unplanned emergency department utilizations. RESULTS: Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio (OR)=1.33, 95% CI=1.05 to 1.70), male caregiver (OR=0.18, 95% CI=0.05 to 0.66), duration of introducing homecare services (OR=0.97, 95% CI=0.95 to 1.00), working experience of dedicated nurses (OR=0.89, 95% CI=0.79 to 0.99) and number of emergency department utilizations within previous past year before enrollment (OR=1.54, 95% CI=1.14 to 2.10) as significant determinants for unplanned emergency department visits. CONCLUSIONS: The present evidence may help government agencies propose supportive policies to improve access to integrated homecare resources and promote appropriate care recommendations to reduce unplanned or nonurgent emergency department visits among patients receiving homecare services.