Reduction of missed appointments at an urban primary care clinic: a randomised controlled study

<p>Abstract</p> <p>Background</p> <p>Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments.</p> <p>Methods</p> <p>We conducted a randomised controlled study in an urban primary care clinic at the Geneva University Hospitals serving a majority of vulnerable patients. All patients booked in a primary care or HIV clinic at the Geneva University Hospitals were sent a reminder 48 hrs prior to their appointment according to the following sequential intervention: 1. Phone call (fixed or mobile) reminder; 2. If no phone response: a Short Message Service (SMS) reminder; 3. If no available mobile phone number: a postal reminder. The rate of missed appointment, the cost of the intervention, and the profile of patients missing their appointment were recorded.</p> <p>Results</p> <p>2123 patients were included: 1052 in the intervention group, 1071 in the control group. Only 61.7% patients had a mobile phone recorded at the clinic. The sequential intervention significantly reduced the rate of missed appointments: 11.4% (n = 122) in the control group and 7.8% (n = 82) in the intervention group (p < 0.005), and allowed to reallocate 28% of cancelled appointments. It also proved to be cost effective in providing a total net benefit of 1846. - EUR/3 months. A satisfaction survey conducted with 241 patients showed that 93% of them were not bothered by the reminders and 78% considered them to be useful. By multivariate analysis, the following characteristics were significant predictors of missed appointments: younger age (OR per additional decade 0.82; CI 0.71-0.94), male gender (OR 1.72; CI 1.18-2.50), follow-up appointment >1year (OR 2.2; CI: 1.15-4.2), substance abuse (2.09, CI 1.21-3.61), and being an asylum seeker (OR 2.73: CI 1.22-6.09).</p> <p>Conclusion</p> <p>A practical reminder system can significantly increase patient attendance at medical outpatient clinics. An intervention focused on specific patient characteristics could further increase the effectiveness of appointment reminders.</p

Loureirin B, an essential component of Sanguis Draxonis, inhibits Kv1.3 channel and suppresses cytokine release from Jurkat T cells

Sanguis draxonis (SD), also known as “Dragon’s Blood”, is a traditional herb medicine that has been used to treat a variety of complications with unknown mechanisms. Recent studies show that SD displays immunosuppressive activities and improves symptoms of type I diabetes in animal models. However, the mechanisms underlying SD’s immunosuppressive actions are not completely understood. The voltage-gated Kv1.3 channel plays a critical role in the pathogenesis of autoimmune diseases by regulating the functions of both T cells and B cells. Here we investigated the effect of SD and one of its active components loureirin B (LrB) on Kv1.3. Both SD and LrB inhibited Kv1.3-mediated currents, produced a membrane depolarization, and reduced Ca(2+) influx in Jurkat T cells. In addition, application of LrB inhibited phytohemagglutinin (PHA)-induced IL-2 release from activated Jurkat T cells. Furthermore, point mutations in the selective filter region significantly reduced the inhibitory effect of LrB on Kv1.3. The results of these experiments provide evidence that LrB is a channel blocker of Kv1.3 by interacting with amino acid residues in its selective filter region. Direct inhibition of Kv1.3 in T cells by SD and LrB might be the cellular and molecular basis of SD-mediated immunosuppression

Scanning Nanobeam Diffraction and Energy Dispersive Spectroscopy Characterization of a Model Mn-Promoted Co/Al2O3Nanosphere Catalyst for Fischer-Tropsch Synthesis

Manganese oxide is an effective promoter for enhancing the activity and selectivity of cobalt-based Fischer-Tropsch synthesis (FTS) catalysts. Previous studies suggest that Co atoms located at the Co-MnO perimeter adsorb CO more strongly and undergo C-O bond cleavage more readily than CO adsorbed on Co sites, which leads to improved C5+ selectivity. Thus, direct characterization of the formation and structure of the active interface between Co nanoparticles and MnO is essential for a full understanding of the FTS promotion effect. Scanning transmission electron microscopic (STEM) methods are well-suited for direct characterization of nanoscale features through imaging, energy dispersive spectroscopy (EDS) elemental mapping, and spatially resolved electron diffraction, a technique known as scanning nanobeam diffraction. However, these techniques require that the catalytic nanoparticles are non-overlapping and well-defined, which is not typical for nanoparticles on porous metal oxide FTS supports. In the present study, we addressed these challenges by synthesizing catalysts composed of cobalt dispersed on nonporous alumina nanospheres (Co/ANS), which yielded isolated nanoparticles that are amenable to elemental and phase mapping by STEM-EDS and scanning nanobeam diffraction. Then, manganese oxide-promoted Co/ANS (Mn-Co/ANS) was characterized using these two techniques, which provided direct evidence for the transformation of a Co-Mn oxide spinel present in the as-prepared catalyst into closely associated Co3O4 and MnO2 nanoparticles in the passivated catalyst after its use for FTS