OBJECTIVE(S):To describe the characteristics of moderate-to-severe chronic pain, and its association with daily functional decline among older individuals attending a large outpatient geriatric clinic in Hanoi, Vietnam. METHODS:A cross-sectional study was undertaken between November, 2019 and March, 2020. In-person structured interviews were conducted in 518 patients 60 years and older with chronic pain. Patient's self-reported pain was categorised into two levels of mild (0-3), moderate to severe (4-10) pain based on a 0-10 scale. RESULTS:The median age of the study sample was 69 years, women accounted for 74.1%. The knee-foot-leg region was the most common site of chronic pain in both groups (39.5% in mild pain vs. 45.1% in moderate-to-severe pain. Participants experiencing moderate-to-severe pain were more likely to describe their pain as dull (65.5%) or burning (11.3%) and to report pain occurring independently of specific activities (48.7%), compared to those with mild pain (53.9%, 1.2%, and 32.4%, respectively). In a multivariable adjusted model, dependency in activities of daily living (OR: 3.73, 95% CI: 1.82-7.68) and dependency in instrumental activities of daily living (OR: 9.41, 95% CI: 3.94-22.5) were significantly associated with moderate-to-severe pain. CONCLUSIONS:Moderate to severe chronic pain was reported in a high proportion of older Vietnamese outpatients and was associated with impaired daily functional impairment.

Acute prosthetic heart valve thrombosis (PHVT) is a severe complication affecting patients who have undergone heart valve replacement surgery. We present a case of acute recurrent PHVT associated with parasite-induced eosinophilia. A man in his early 50s with rheumatic heart disease underwent mechanical mitral valve replacement 5 years ago and received well-managed anticoagulation with regular follow-up visits. The patient developed a sudden onset of dyspnoea and was diagnosed with mechanical valve thrombosis, which was managed with thrombolysis. However, the valve became stuck again just a week after the initial episode while the patient was still in the hospital and was receiving anticoagulation within the target range. Concurrently, he experienced skin rashes and itching, prompting an investigation that revealed hypereosinophilia secondary to parasite infestation. The patient's valve functions well after thrombolysis and parasite infection treatment. The eosinophil counts were monitored to remain within the normal range.

BACKGROUND:Nurses' competencies are crucial in providing effective dementia care in healthcare settings for older people. Understanding nurses' current knowledge, attitudes and confidence in this area is essential for developing education programmes for healthcare professionals to improve patient care. The purpose of this study was to assess the knowledge, attitudes and confidence related to providing dementia care among nurses practicing in geriatric hospital wards and nursing homes in Hanoi, Vietnam. METHODS:A total of 269 out of 313 (response rate was 86%) full-time nurses working at six geriatric wards in hospitals and nursing homes in Hanoi were surveyed using three self-administered questionnaires: the Dementia Knowledge Assessment Scale (DKAS), Dementia Attitude Scale (DAS) and the Confidence in Dementia Scale (CODE). Multiple regression models were constructed to identify factors associated with dementia care knowledge, attitudes and confidence. RESULTS:The overall mean scores of nurse's knowledge, attitudes and confidence were 28.1 ± 8.0, 102.1 ± 13.4 and 28.3 ± 6.4, respectively. A positive correlation was reported between the knowledge and attitude scores and between the attitudes and confidence scores. Greater seniority (β: 0.29; 95% CI: 0.03-0.56) and having learned information through colleagues or experts (β: 3.02; 95% CI: 0.88-5.16) were associated with better dementia knowledge. A higher level of dementia training desirability was associated with increased knowledge (β: 0.74; 95% CI: 0.28-1.20) and favourable attitudes (β: 0.94; 95% CI: 0.15-1.74), whereas frequent exposure to dementia cases was associated with higher confidence (β: 3.56; 95% CI: 1.39-5.73) and more favourable attitudes (β: 3.96; 95% CI: 0.27-7.66). CONCLUSION:Our study highlights deficits in knowledge, low levels of social comfort in nurses' attitudes towards people with dementia and a lack of confidence in providing effective care among nurses practicing in healthcare settings for older adults in Hanoi, Vietnam. With the ageing of the population and with increasing numbers of persons living with dementia, our findings suggest the importance of improving the training of nurses to specifically address these deficits. IMPLICATIONS FOR PRACTICE:Multidisciplinary consultation meetings need to be encouraged in the healthcare workplace setting as well as ensuring the presence of qualified counsellors for care teams working with older adults in non-hospital settings. Training about non-cognitive symptoms of dementia and demonstrating effective verbal and non-verbal communication skills is critical and should be integrated into nurse's educational training.

Abstract Background Nursing home residents with atrial fibrillation are at high risk for ischemic stroke, but most are not treated with anticoagulants. This study compared the effectiveness and safety between oral anticoagulant (OAC) users and non-users. Methods We conducted a new-user retrospective cohort study by using Minimum Data Set 3.0 assessments linked with Medicare claims. The participants were Medicare fee-for-service beneficiaries with atrial fibrillation residing in US nursing homes between 2011 and 2016, aged ≥ 65 years. The primary outcomes were occurrence of an ischemic stroke or systemic embolism (effectiveness), occurrence of intracranial or extracranial bleeding (safety) and net clinical outcome (effectiveness or safety outcomes). Secondary outcomes included total mortality and a net clinical and mortality outcome. Cox proportional hazards and Fine and Grey models estimated multivariable adjusted hazard ratios (aHRs) and sub-distribution hazard ratios (sHRs). Results Outcome rates were low (effectiveness: OAC: 0.86; non-users: 1.73; safety: OAC: 2.26; non-users: 1.75 (per 100 person-years)). OAC use was associated with a lower rate of the effectiveness outcome (sHR: 0.69; 95% Confidence Interval (CI): 0.61–0.77), higher rates of the safety (sHR: 1.70; 95% CI: 1.58–1.84) and net clinical outcomes (sHR: 1.20; 95% CI: 1.13–1.28) lower rate of all-cause mortality outcome (sHR: 0.60; 95% CI: 0.59–0.61), and lower rate of the net clinical and mortality outcome (sHR: 0.60; 95% CI: 0.59–0.61). Warfarin users, but not DOAC users, had a higher rate of the net clinical outcome versus OAC non-users. Conclusions Our results support the benefits of treatment with OACs to prevent ischemic strokes and increase longevity, while highlighting the need to weigh apparent benefits against elevated risk for bleeding. Results were consistent with net favorability of DOACs versus warfarin.

Between 2010 and 2011, stakeholders implemented a multi-faceted community-based intervention in response to the escalating issue of uncontrolled hypertension in Hung Yen province, Vietnam. This initiative integrated expanded community health worker services, home blood pressure self-monitoring, and a unique "storytelling intervention" into routine clinical care. From the limited societal perspective, our study evaluates the cost-effectiveness of this intervention using a Markov model with a one-year cycle over a lifetime horizon. The analysis, based on a cohort of 671 patients, reveals a lifetime incremental cost of approximately VND 90.37 million (USD 3,930) per quality-adjusted life year (QALY) gained. With a willingness to pay at three times GDP (VND 259.2 million per QALY), the intervention proves cost-effective 80% of the time. This research underscores the potential of the community-based approach to effectively control hypertension, offering valuable insights into its broader implications for public health.

BackgroundWhile ventricular tachycardia (VT) occurring during hospitalization for an acute myocardial infarction (AMI) increases mortality risk, its relationship with 30-day post-discharge rehospitalization has not been examined.MethodsUsing data from the Worcester Heart Attack Study, we examined the association between early (during the first 48 hours of admission) and late (after 48 hours of admission) VT with 30-day post-discharge all-cause and CVD-related rehospitalization while analytically controlling for several demographic and clinical factors.ResultsThe study population consisted of 3,534 patients who were hospitalized with an AMI between 2005 and 2015 (average age 67.2 years; 40.7% women); VT occurred in 452 patients (13.7%), with the majority (81.2%) occurring within 48 hours of admission. The 30-day all-cause rehospitalization rate was 17.3%, with 70.9% of the hospitalizations related to CVD. The odds of rehospitalization were 1.63 times (95%CI=0.99-2.69) and 1.12 times (95%CI=0.83-1.51) higher for patients with AMI who developed late VT and early VT, respectively, compared to patients who did not develop VT. The risk of rehospitalization among patients with late VT was higher (OR=2.22, (95%CI=0.79-6.26) in those with ST-segment-elevation compared to those with non-ST-segment-elevation AMI (OR=1.45, (95%CI=0.81-2.57); early VT was not associated with rehospitalization in patients with either AMI subtype. There was no significant association between the occurrence of VT and CVD-related rehospitalization.ConclusionPatients who develop late VT may experience a higher risk of 30-day rehospitalization following hospital discharge for AMI, especially among those with ST-segment-elevation AMI. Larger studies are needed to confirm our findings.

INTRODUCTION:Chronic kidney disease (CKD) is a severe, progressive condition with a significant economic burden. We performed a systematic review to assess the cost-effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors in treating CKD. METHODS:A comprehensive search was conducted across PubMed, Embase, Web of Science, Scopus, INAHTA, NHS EED, and relevant websites. Two reviewers independently screened titles and abstracts, extracted data, and assessed study quality using CHEERS 2022 and Phillips's checklist. RESULTS:Thirteen model-based cost-utility studies met the inclusion criteria, evaluating Empagliflozin (n = 3), Canagliflozin (n = 3), and Dapagliflozin (n = 8). Empagliflozin or Dapagliflozin plus standard care (SoC) was cost-effective compared to SoC alone in CKD patients, regardless of type 2 diabetes (T2D) status. In CKD patients with T2D, SGLT2 inhibitors combined with SoC were cost-saving in high-income countries under health system perspective whereas Dapagliflozin was not cost-effective compared to Canagliflozin. No study met all criteria of the CHEERS 2022 checklist, and most did not fully satisfy Phillips's checklist for economic models. CONCLUSION:Adding SGLT2 inhibitors to SoC is cost-saving for treating CKD with T2D and cost-effective for CKD patients with or without T2D. REGISTRATION:The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023469005.

Background: The COVID-19 pandemic has revealed significant challenges in disease forecasting and in developing a publichealth response, emphasizing the need to manage missing data from various sources in making accurate forecasts. Objective: We aimed to show how handling missing data can affect estimates of the COVID-19 incidence rate (CIR) indifferent pandemic situations. Methods: This study used data from the COVID-19/SARS-CoV-2 surveillance system at the National Institute of Hygieneand Epidemiology, Vietnam. We separated the available data set into 3 distinct periods: zero COVID-19, transition, and newnormal. We randomly removed 5% to 30% of data that were missing completely at random, with a break of 5% at each timepoint in the variable daily caseload of COVID-19. We selected 7 analytical methods to assess the effects of handling missingdata and calculated statistical and epidemiological indices to measure the effectiveness of each method. Results: Our study examined missing data imputation performance across 3 study time periods: zero COVID-19 (n=3149),transition (n=1290), and new normal (n=9288). Imputation analyses showed that K-nearest neighbor (KNN) had the lowestmean absolute percentage change (APC) in CIR across the range (5% to 30%) of missing data. For instance, with 15%missing data, KNN resulted in 10.6%, 10.6%, and 9.7% average bias across the zero COVID-19, transition, and new normalperiods, compared to 39.9%, 51.9%, and 289.7% with the maximum likelihood method. The autoregressive integrated movingaverage model showed the greatest mean APC in the mean number of confirmed cases of COVID-19 during each COVID-19containment cycle (CCC) when we imputed the missing data in the zero COVID-19 period, rising from 226.3% at the 5%missing level to 6955.7% at the 30% missing level. Imputing missing data with median imputation methods had the lowest biasin the average number of confirmed cases in each CCC at all levels of missing data. In detail, in the 20% missing scenario,while median imputation had an average bias of 16.3% for confirmed cases in each CCC, which was lower than the KNNfigure, maximum likelihood imputation showed a bias on average of 92.4% for confirmed cases in each CCC, which was thehighest figure. During the new normal period in the 25% and 30% missing data scenarios, KNN imputation had average biasesfor CIR and confirmed cases in each CCC ranging from 21% to 32% for both, while maximum likelihood and moving averageimputation showed biases on average above 250% for both CIR and confirmed cases in each CCC. Conclusions: Our study emphasizes the importance of understanding that the specific imputation method used by investiga-tors should be tailored to the specific epidemiological context and data collection environment to ensure reliable estimates ofthe CIR.

Background Multiple chronic conditions (MCCs) are common in patients hospitalized with acute myocardial infarction (AMI). We examined the association of 12 MCCs with the risk of a 30-day hospital readmission and/or dying within one year among those discharged from the hospital after an AMI. We also examined the five most prevalent pairs of chronic conditions in this population and their association with the principal study endpoints. Methods The study population consisted of 3,294 adults hospitalized with a confirmed AMI at the three major medical centers in central Massachusetts on an approximate biennial basis between 2005 and 2015. Patients were categorized as ≤1, 2-3, and ≥4 chronic conditions. Results The median age of the study population was 67.9 years, 41.6% were women, and 15% had ≤1, 32% had 2-3, and 53% had ≥4 chronic conditions. Patients with ≥4 conditions tended to be older, had a longer hospital stay, and received fewer cardiac interventional procedures. There was an increased risk for being rehospitalized during the subsequent 30 days according to the presence of MCCs, with the highest risk for those with ≥4 conditions. There was an increased, but attenuated, risk for dying during the next year according to the presence of MCCs. Individuals with diabetes/hypertension and those with heart failure/chronic kidney disease were at particularly high risk for developing the principal study outcomes. Conclusion Development of guidelines that include complex patients, particularly those with MCCs and those at high risk for adverse short/medium term outcomes, remain needed to inform best treatment practices.

Better understanding of the quality of life among nursing home residents with dementia is important for developing interventions. The objectives of this cross-sectional study were to examine factors associated with poor health-related quality of life in older people with dementia living in nursing homes in Hanoi, Vietnam. In-person interviews were conducted with 140 adults who were 60 years and older with dementia, and information about their quality of life was obtained using the Quality of Life in Alzheimer’s Disease (QOL-AD) scale. The sociodemographic and clinical factors associated with poor health-related quality of life (lowest quartile) were assessed through the results of physical tests, interviews with nursing home staff, and review of medical records. The average age of the study sample was 78.3 years, 65% were women, and their average QOL-AD total score was 27.3 (SD = 4.4). Malnutrition, total dependence in activities of daily living, and urinary incontinence were associated with poor quality of life after controlling for multiple potentially confounding factors. Our findings show that Vietnamese nursing home residents with dementia have a moderate total quality of life score, and interventions based on comprehensive geriatric assessment remain needed to modify risk factors related to poor health-related quality of life.

Cardiovascular disease (CVD) is the leading cause of death among all non-communicable diseases (NCDs) in Vietnam. The objectives of the present study were to analyse contemporary gaps in CVD control studies, which were published in Vietnam between 2013 and 2017. A systematic literature review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Research articles written in English or Vietnamese, published between 2013 and 2017, and focused on the four main WHO themes of CVD control were identified. Among 11,385 Vietnamese-based CVD studies published during this period, only 119 studies (1.0%) were relevant to public health CVD control outcomes, and only 17 of 20 CVD indicators were addressed in these studies. Most studies were published in Vietnamese journals (73.9%), focused on disease and intermediate risk factors (73.9%), were cross-sectional (84.8%) and hospital-based (54.6%). We observed a lack of studies, many of which suffered design and analysis limitations, focused on several WHO themes for effective CVD control. Future Vietnamese-based CVD control studies should focus on the WHO-recommended themes and health indicators in broader community settings to provide better data to inform effective public health policies to control CVD.

Introduction: Cardiovascular disease (CVD) is rising in prevalence in India with economic development and the adoption of a Western lifestyle. Hypothesis: The increase in incidence and prevalence of CVD is possibly due to a rise in the incidence of risk factors like diabetes mellitus (DM), hypertension, hyperlipidemia, lack of physical activity and obesity, among various other causes. Aims: 1. To estimate the prevalence of DM in the community of Calcutta schoolteachers 2. To examine the relationship between the prevalence of DM and CVD risk as assessed by the different traditional CVD risk factors (age, sex, hypertension, current smoking, DM, and hyperlipidemia). Methods: We recruited 4,150 schoolteachers from 400 schools in Calcutta, India between June, and August 2019 with approval of the Tufts IRB and the local Ethics Committee. Participants were asked questions about their different risk factors to ascertain their cardiovascular risk by the ASCVD risk calculator. Baseline values (total cholesterol 170 mg/dL, HDL-C 50 mg/dL, no DM) were used when a participant’s glycemic status or lipid profile was not available. Based on the risk score, participants were stratified as mild (<5%), moderate (5-10%), or high (>10%) risk for developing ASCVD. A total of 240 participants were randomly selected from a stratified sample of the participants for evaluation for diabetes using HbA1c. DM was diagnosed when the Hb A1 C was 6.5% or more. Results: The mean age of the participants was 44 years, and 41% were male. Out of a total of 4,150 participants, 85.7% (3,558) were in the low-risk for CVD category, 9.0% (374) were moderate-risk, and 5.3% (218) were high-risk. Among the 240 screened for DM, 17.1% (41) were found to have the condition, and 41.3% (99) were pre-diabetic. There was no significant difference in prevalence of DM between men and women in the overall study population and in the mild risk group. However, more women in the medium risk group and more men in the high-risk group were found to be diabetic (p value <0.001 in both). Some participants were reclassified based on their new diagnosis of DM. Conclusions: The prevalence of DM was high among Calcutta schoolteachers, which contributes to being at increased risk for ASCVD. Most participants were unaware of their DM or cardiovascular risk, highlighting the need for increased testing and awareness. The estimates from this study may be used to understand the community burden of DM and cardiovascular risk.

Introduction Brain cancer is the leading cause of cancer-related deaths in children and the majority of childhood brain tumors are diagnosed without determination of their underlying etiology. Little is known about risk factors for childhood brain tumors in Vietnam. The objective of this case-control study was to identify maternal and perinatal factors associated with brain tumors occurring in young Vietnamese children and adolescents. Methods We conducted a hospital-based case-control study at Viet Duc University Hospital in Hanoi, Vietnam. Cases consisted of children with brain tumors aged 0-14 years old admitted to the hospital from January 2020 to July 2022 while the controls were age and sex-matched hospitalized children diagnosed with head trauma. Perinatal characteristics were abstracted from hospital medical records and maternal medical, behavioral, and sociodemographic factors were collected through in-person interviews. Conditional logistic regression models were used to examine maternal and perinatal factors associated with childhood brain tumors. Results The study sample included 220 children (110 cases and 110 controls) whose average age was 8.9 years and 41.8% were girls. Children born to mothers aged greater than 30 years at the time of the child’s birth had a higher risk of childhood brain tumors compared to those born to mothers aged from 18 to 30 years old (OR = 2.55; 95% CI: 1.13-5.75). Additionally low maternal body mass index prior to the current pregnancy of <18.5 kg/m2 significantly increased the odds of having a child with a brain tumor in relation to normal maternal body mass index from 18.5-22.9 kg/m2 (OR = 3.19; 95% CI: 1.36 - 7.50). Conclusion Advanced maternal age and being markedly underweight were associated with an increased odds of having a child with a brain tumor. A population-based study with larger sample size is needed to confirm and extend the present findings.

Asthma morbidity disproportionately impacts children from low-income and racial/ethnic minority communities. School-supervised asthma therapy improves asthma outcomes for up to 15 months for underrepresented minority children, but little is known about whether these benefits are sustained over time. We examined the frequency of emergency department (ED) visits and hospital admissions for 83 children enrolled in Asthma Link, a school nurse-supervised asthma therapy program serving predominantly underrepresented minority children. We compared outcomes between the year preceding enrollment and years one-four post-enrollment. Compared with the year prior to enrollment, asthma-related ED visits decreased by 67.9% at one year, 59.5% at two years, 70.2% at three years, and 50% at four years post-enrollment (all p-values< 0.005). There were also significant declines in mean numbers of total ED visits, asthma-related hospital admissions, and total hospital admissions. Our results indicate that school nurse-supervised asthma therapy could potentially mitigate racial/ethnic and socioeconomic inequities in childhood asthma.

BACKGROUND:Vietnam is experiencing an increasing prevalence of hypertension in its adult population. In addition to medical therapy, modifying adverse lifestyle practices is important for effective blood pressure control. There are limited data on unhealthy lifestyle practices in patients with chronic diseases, however, particularly among hypertensive patients living in rural Vietnam. Our study objectives were to examine the prevalence of unhealthy lifestyle practices and associated factors among rural Vietnamese adults with uncontrolled hypertension. METHODS:Data from the baseline survey of a cluster randomized trial among hypertensive Vietnamese adults (2017-2022) were utilized. Information on unhealthy lifestyle practices including smoking, excessive alcohol consumption, physical inactivity, and inadequate fruit and vegetable intake was collected from study participants. The primary study outcome was having ≥2 unhealthy lifestyle practices. A multivariable logistic regression model was used to examine factors associated with the primary study outcome. RESULTS:The mean age of the 671 patients was 67 years and 45.0% were men. Nearly three out of every four participants had one or fewer unhealthy practices, 24.0% had two, and 3.3% had three or all four unhealthy lifestyle practices. Men, individuals who did unpaid work or were unemployed, and individuals with hypertension level III were more likely to have ≥2 unhealthy lifestyle practices, whereas individuals with higher education were less likely to have ≥2 unhealthy lifestyle practices compared with respective comparison groups. CONCLUSIONS:We observed a high prevalence of unhealthy lifestyle practices among rural Vietnamese patients with uncontrolled hypertension. Several demographic factors were associated with a greater number of unhealthy lifestyle practices. Newer interventions and educational programs encouraging lifestyle modification practices are needed to control hypertension among adults living in rural settings of Vietnam.

Background Approximately 20% of adults in Vietnam have hypertension, and management of this chronic condition remains challenging. This study aimed to assess the effectiveness of a multicomponent intervention in reducing blood pressure (BP) in adults with uncontrolled hypertension. Methods This cluster randomised controlled trial was conducted in sixteen communities (8 intervention and 8 comparison) in a rural setting in Vietnam (2017 - 2022). Consenting adults (aged >= 18 years) with uncontrolled hypertension were enrolled. Sixteen communities were equally randomised to an intervention or comparison group strati fi ed by district. Consenting adults were assigned to study groups by community. The comparison arm received training sessions about hypertension prevention and management for health workers, and patient education materials. The intervention arm received training sessions about hypertension prevention and management for health workers, and patient education materials and three enhancement components including a storytelling intervention, home BP self -monitoring, and expanded community health worker services. The primary outcome was the difference in changes in patient ' s levels of systolic BP between the study groups over a 12 -month follow-up period. Patients and outcome assessors were masked. Findings A total of 671 patients (340: intervention, 331: comparison) were enrolled in the trial. The mean age was 66 years and 45% were men. At the 12 -month follow-up, the mean systolic BP declined by 18.4 mmHg in the intervention group and 3.7 mmHg in the comparison group (differential decline of 14.7 mmHg [95% CI: 11.8 - 17.6]). The intervention group also achieved better BP control and medication adherence than the comparison group. There were no serious adverse events related to study participation. Interpretation The results of this trial demonstrate that a multicomponent intervention can effectively reduce elevated BP in individuals with uncontrolled hypertension in Vietnam. Trial registration: This trial was registered at ClinicalTrials.gov, NCT03590691. Funding National Heart, Lung, and Blood Institute. Health 2024;48: Published https://doi.org/10. 1016/j.lanwpc.2024. 101123 Copyright (c) 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: Oral anticoagulants (OACs) are effective in reducing the risk of cardioembolic stroke due to atrial fibrillation. While most nursing home residents with atrial fibrillation qualify for anticoagulation based on clinical guidelines, the net clinical benefits of OACs may diminish as residents approach the end of life.Methods: We conducted a cross-sectional study of 30,503 US nursing home residents with atrial fibrillation (based on Minimum Data Set 3.0 and Medicare Part A records) who used OACs in the year before enrolling in hospice care during 2012-2016. Whether residents discontinued OACs before hospice enrollment was determined using Part D claims and date of hospice enrollment. Modified Poisson models estimated adjusted prevalence ratios (aPR).Results: Almost half (45.7%) of residents who had recent OAC use discontinued prior to hospice enrollment. Residents who were underweight (aPR: 1.02; 95% confidence interval [CI]: 1.01-1.03), those with high bleeding risk (aPR: 1.04, 95% CI: 1.03-1.05), and those with moderate or severe cognitive impairment (aPR: 1.02, 95% CI: 1.02-1.03) had a higher prevalence of OAC discontinuation before entering hospice. Residents with venous thromboembolism (aPR: 0.94, 95% CI: 0.93-0.96), statin users (aPR: 0.88, 95% CI: 0.87-0.89), and those on polypharmacy (=10 medications, aPR: 0.72; 95% CI: 0.71-0.73) were less likely to discontinue OACs before enrollment in hospice.Conclusion: Anticoagulants are often discontinued among older nursing home residents with atrial fibrillation before hospice enrollment; it is not clear that these decisions are driven solely by net clinical benefit considerations. Further research is needed on comparative outcomes to inform resident-centered decisions regarding OAC use in older adults entering hospice.

Aims To determine the effectiveness of a mobile application (app) in improving the quality of bowel preparation for colonoscopy.Method An endoscopist-blinded randomised controlled trial enrolled patients who were undergoing a colonoscopy on the same day of bowel preparation. The intervention used a Vietnamese mobile app that provides instructions on bowel preparation while patients in the comparison group received conventional instructions. Outcomes included the Boston Bowel Preparation Scale (BBPS) to assess the quality of bowel preparation and the polyp detection rate (PDR) and adenoma detection rate (ADR).Results The study recruited 515 patients (256 in the intervention group). The median age was 42 years, 50.9% were females, 69.1% high school graduates and higher, and 45.2% from urban area. Patients in the intervention group had higher adherence to instructions (60.9% vs 52.4%, p=0.05) and longer length of taking laxatives (mean difference 0.17 hours, 95% CI 0.06 to 0.27). The intervention did not reduce the risk of poor bowel cleansing (total BBPS<6) in both overall (7.4% vs 7.7%; risk ratio 0.96, 95% CI 0.53 to 1.76) and subgroup analysis. PDR and ADR were similar between the two groups.Conclusions The mobile app providing instructions on proper bowel preparation improved the practice during bowel preparation but did not improve the quality of bowel cleansing or PDR.

Objectives:We developed a questionnaire-based risk-scoring system to identify children at risk for rheumatic heart disease (RHD) in rural India. The resulting predictive model was validated in Nepal, in a population with a similar demographic profile to rural India.Methods:The study involved 8646 students (mean age 13.0 years, 46% boys) from 20 middle and high schools in the West Midnapore district of India. The survey asked questions about the presence of different signs and symptoms of RHD. Students with possible RHD who experienced sore throat and joint pain were offered an echocardiogram to screen for RHD. Their findings were compared with randomly selected students without these symptoms. The data were analyzed to develop a predictive model for identifying RHD.Results:Based on our univariate analyses, seven variables were used for building a predictive model. A four-variable model (joint pain plus sore throat, female sex, shortness of breath, and palpitations) best predicted the risk of RHD with a C-statistic of 0.854. A six-point scoring system developed from the model was validated among similarly aged children in Nepal.Conclusions:A simple questionnaire-based predictive instrument could identify children at higher risk for this disease in low-income countries where RHD remains prevalent. Echocardiography could then be used in these high-risk children to detect RHD in its early stages. This may support a strategy for more effective secondary prophylaxis of RHD.

Objective To describe the prevalence of blood pressure (BP) screening according to the 2017 American Academy of Pediatrics (AAP) guidelines and differences according to social vulnerability indicators. Study design We extracted electronic health record data from January 1, 2018, through December 31, 2018, from the largest healthcare system in Central Massachusetts. Outpatient visits for children aged 3-17 years without a prior hypertension diagnosis were included. Adherence was defined by the American Academy of Pediatrics guideline (>= 1 BP screening for children with a body mass index [BMI] of <95th percentile) and at every encounter for children with a BMI of >= 95th percentile). Independent variables included social vulnerability indicators at the patient level (insurance type, language, Child Opportunity Index, race/ethnicity) and clinic level (location, Medicaid population). Covariates included child's age, sex, and BMI status, and clinic specialty, patient panel size, and number of healthcare providers. We used direct estimation to calculate prevalence estimates and multivariable mixed effects logistic regression to determine the odds of receiving guideline-adherent BP screening. Results Our sample comprised 19 695 children (median age, 11 years; 48% female) from 7 pediatric and 20 family medicine clinics. The prevalence of guideline-adherent BP screening was 89%. In our adjustedmodel, children with a BMI of >= 95th percentile, with public insurance, and who were patients at clinics with larger Medicaid populations and larger patient panels had a lower odds of receiving guideline-adherent BP screening. Conclusions Despite overall high adherence to BP screening guidelines, patient- and clinic-level disparities were identified.