Psychiatrist-led treatment of hepatitis C (HCV) at an opioid agonist treatment (OAT) clinic in Stockholm - enhancing the HCV treatment care cascade

Introduction

People who inject drugs (PWID) and opioid agonist treatment (OAT) patients have an increased hepatitis C (HCV) prevalence. Studies among these populations show promising HCV treatment results, which is essential to reach the WHO goal of eliminating HCV as a major public health threat by 2030.

Objectives

To introduce psychiatrist-led HCV treatment at an OAT clinic and to investigate HCV treatment results, i.e. sustained virological response at 12 weeks post treatment (SVR12) and numbers of reinfections.

Methods

Prima Maria OAT clinic in Stockholm, provides OAT for 450 patients. The majority have a history of injection drug use. Baseline HCV prevalence (January 2018) was retrospectively investigated through medical charts. In January 2018, psychiatrist-led HCV treatment (with consultation support from infectious diseases specialists) was introduced at the clinic. Prospective treatment results, numbers of reinfections and incidence rates between January 2018 and April 2021 were further investigated.

Results

Baseline data (n=418), showed that 46% were not tested for HCV. Of those tested (n=225), 64% had a chronic HCV infection. By January 2021, 104 HCV treatments were initiated. 97/97 (100%) were HCV RNA negative at end-of-treatment. 78/88 (89%) reached SVR12. Overall, 2 reinfections were noted after SVR12 corresponding to a reinfection rate of 3.5/100 PY. Numbers of HCV treatment did not decrease during the COVID-19 pandemic.

Conclusions

To enhance the HCV treatment cascade, targeted HCV diagnosis efforts are needed. Bringing HCV treatment to OAT clinics enhance the HCV care cascade. HCV treatment education for psychiatrists/addiction specialists makes HCV treatment more sustainable, as specifically noted during the COVID-19 pandemic.

Disclosure

This study was partly funded by Gilead Nordic Fellowship 2020. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the poster/manuscript.

Care pathways for patients with bipolar disorders at Psychiatry Clinic Affektiva, Gothenburg: Identifying and solving issues for a more efficient and safe care

Introduction

The Psychiatry Clinic Affektiva has developed a care pathway for patients with bipolar disorder (BD). It consists of one outpatient clinic and two inpatient wards. Clinical observations suggest that patients with BD benefit from treatment in a dedicated unit with tailored care programs and that better outcomes are achieved in terms of reduced average length of stay and safer transitions to outpatient care for this group.

Aims

The aim is to improve the care of bipolar patients by increasing bed-availability and overall continuity in the care pathway and monitoring core aspects in the management of outpatients in order to reduce admissions and to facilitate standardized treatment and collaboration between in- and outpatients unit.

Method

We developed a structure to monitor and measure specific outcomes such as readmission within 28 days, relapse within 12 months and the use of lithium in this group. We also developed a standardized care protocol in order to improve the safety and the equality.

Results

At this stage our preliminary results from our efforts are promising but further monitoring is needed to confirm our hypothesis. More data will be collected during 2017.

Conclusions

Affektiva Psychiatry Clinic has developed a model for continuously monitoring several essential aspects in the care of patients with BD and providing a specific care program.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A 1-year clinical report of a one-piece implant abutment

PURPOSE

Solid one-piece standard and conical abutments, which do not involve the external implant hex when seated, have been designed. The present clinical study represents a 1-year follow-up of the use of these abutments for anchorage of implant-supported fixed prostheses for oral rehabilitation of 36 completely and eight partially edentulous patients.

MATERIALS AND METHODS

After 1 year of loading, the implant-supported dentures were removed, and the seating of the 214 one-piece abutments was inspected clinically and radiographically.

RESULTS

After 1 year of loading, no loose abutments were observed. One complication was reported; it involved fracture of two abutment screws within the same fixed denture. Prosthesis mobility and gold screw loosening accompanied this complication. Ninety-one percent of the patients exhibited healthy gingiva, and 9% showed erythema/edema. No periimplantitis was identified.

CONCLUSION

The results of this study--healthy marginal tissue, a mean bone loss of 0.3+/-0.6 mm, and no abutment retightening 1 year after loading--support the use of the one-piece abutment design in implant-supported screw-retained restorations.

The use of a conical fixture design for fixed partial prostheses. A preliminary report

A specially designed, TiO2-blasted titanium fixture, partially conical and microthreaded, the Astra Tech Fixture ST, was used for rehabilitation of partial edentulism in the posterior mandible. Superior to the mandibular canal 25 fixtures were placed in 10 patients. Fixed metal-ceramic bridges were then performed. After 1-year follow-up, all bridges were found to be clinically stable. The implant survival rate was 100% and the mean marginal bone resorption was 0.05 +/- 0.11 mm.

Extraoral or intraoral approach in the oblique sliding osteotomy of the mandibular rami? Clinical experience and results

The clinical results of oblique sliding (subcondylar) osteotomy of the mandibular rami performed by the extraoral or intraoral approach were compared. The patient material comprised 40 patients with mandibular prognathism. Twenty patients were operated upon using the extraoral approach and 20 patients were operated on using the intraoral approach. All patients had intermaxillary fixation for 7 weeks. The patients in both groups were followed up for 18 months. The experience of the operations was that the intraoral approach gave a shorter operation time than the extraoral approach. The extraoral approach, however, gave better visibility in the operation field and greater possibilities of manipulating the proximal fragment into an optimal position. In the follow-up evaluation, there were no significant differences between the two surgical techniques with regard to dental relapse, post-operative occlusion and mandibular function.

Intraoral or extraoral approach in oblique sliding osteotomy of the mandibular ramus. A cephalometric study

Positional changes of the mandible after oblique sliding osteotomy of the mandibular rami were investigated by means of cephalometric analysis. The patient material comprised 40 patients. Twenty patients were operated upon using an extraoral approach and 20 were operated on using an intraoral approach. The patients were followed up with lateral cephalograms for 18 months after operation. In both groups, a posterior rotation of the mandible took place during the fixation period. This rotation gave a further retro-displacement of gnathion and a shortening of posterior facial height. The incidence of patients with considerable posterior rotation of the mandible was higher in the intraoral than in the extraoral group. The difference between the means of the changes in the mandibular plane angle (dEO = 4.9 degrees, dIO = 6.3 degrees) of the groups was, however, not statistically significant. Nor was there any significant difference in relapse between the two groups after release of the fixation.