6-month Period Research Articles

Reducing Unnecessary Laboratory Testing: A Quality Improvement Initiative at Wellstar Spalding Medical Center.

The healthcare industry is grappling with escalating expenses, partially attributed to the inefficient use of medical resources, particularly by ordering unnecessary laboratory tests. Such practices not only increase costs but also result in extended hospital stays, patient discomfort, and potential clinical complications such as iatrogenic anemia. Blood tests, although essential for guiding medical decisions, are associated with significant clinical and financial costs. This quality improvement project aimed to decrease unnecessary laboratory testing at Wellstar Spalding Medical Center, a community hospital with a newly established residency program. Our study team played a pivotal role in formulating an algorithm that outlined the indications for a complete blood count and basic or comprehensive metabolic profile. We then conducted standardized didactic sessions for resident physicians and faculty, educating them on the use of "add-on" laboratory values, providing electronic medical records training, and highlighting the compounding costs of these simple laboratory tests. We analyzed data during a 3-month period, both before and in the intervention phase, adjusting for the number of physician-patient interaction days to account for potential variations in patient census in the hospital. The number of complete blood count orders and basic/comprehensive metabolic profile orders underwent an absolute decrease in the postintervention period. When adjusted for the number of physician-patient interaction days, this decrease remained consistent, although not statistically significant. Our project has yielded clinically and administratively meaningful results. We have seen a measurable decrease in costs and the prevention of unnecessary laboratory testing. If it also can be shown that we have prevented iatrogenic anemia, our project could be seen as enhancing the patient experience and reducing hospital length of stay. We also have raised awareness about high-value care and instilled clinical awareness among residents regarding ordering daily blood tests contributing to an improvement in patient care.

Influence of the Nursing Assistant Role in Nurse Satisfaction, Efficiency, and Patient Satisfaction in the Postanesthesia Care Unit

PurposeIn response to nurse concerns of the need for additional support from unit nursing assistants (NA) at the bedside, we set a goal to improve RN satisfaction with the role of the NA in the postanesthesia care unit (PACU). DesignProspective pre/post design. MethodsUsing LEAN methodology, the NA role was expanded to encompass their full scope of practice at the bedside, and the responsibility of performing patient transport from the PACU was reallocated to a Centralized Transport Service over a 6-month period. FindingsThe total number of transports performed by NA decreased by approximately 20%. Time spent waiting for a Centralized Transporter decreased from an average of 56 to 11 minutes. RN satisfaction increased in the 3 areas explored, with a 12.5% increase in median overall satisfaction with the NA role. Our facility’s Hospital Consumer Assessment of Healthcare Providers and Systems scores also increased from previous months after this project, alluding to more effective care delivered to patients in the PACU. ConclusionsRealignment of roles can promote efficiency and throughput. Communication fosters teamwork and can improve staff satisfaction.

Botulinum toxin treatment of refractory vaginismus: a prospective study.

Vaginismus is a common sexual dysfunction. A few studies have indicated that botulinum neurotoxin type A (BoNTA) can help treat refractory vaginismus by alleviating muscle tension. However, such studies did not use standardized methodology and BoNTA dosage. The aim is to evaluate the efficacy of intravaginal BoNTA injection in treating refractory vaginismus. Also, we intended to assess the effectiveness and safety of modest doses, that is, 100 to 200 IU of submucosal BoNTA injections. A prospective study was conducted in an outpatient surgical center over 18 months. Twenty patients aged 29 to 49 years (mean, 30.9 years) with refractory vaginismus were enrolled. All patients had been sexually inactive at the time of treatment. All participants had received various treatments such as psychotherapy, vaginal dilatator therapy, muscle relaxants, and lubricants with no relief. A dose of 100 to 200 IU of BoNTA was injected submucosally in the lateral sides of the bulbospongiosus, pubococcygeus, and puborectalis muscle areas. The patients were followed over 4 months posttreatment. Nineteen patients (95%) achieved satisfactory intercourse by the end of the 4-month follow-up period. A repeat BoNTA injection was not required as there were no recurrences. None of the participants reported adverse effects. A small sample size and lack of a control group. Injecting submucosally modest BoNTA doses is an effective and safe treatment for refractory vaginismus. When conventional therapies fail, BoNTA can be used to lessen muscle contraction, alleviate pain, and facilitate dilator treatments. Our standardized protocol, which involves a careful submucosal injection technique, can minimize risks and make the procedure easy to perform for daily practice.

A community-based peer-facilitated psychological and social support model to improve retention in care among Cameroonian adolescents perinatally infected with human immunodeficiency virus: A randomized controlled trial

BackgroundPsychological and social support for adolescents living with HIV remains undocumented and unaddressed in Central Africa. This study aimed at assessing effectiveness of a peer-facilitated community-based support model in improving retention in care among adolescents living with HIV and attending care in Chantal Biya Foundation, Yaounde, Cameroon. Materials and methodsWe conducted an analysis of adolescents aged 10–19 years old, perinatally infected with HIV, on follow-up in the Day Care Unit of a reference hospital in Yaounde, Cameroon, and enrolled in the IAS-CIPHER-2021/1214-ATE-SMAVI, a individually randomized controlled trial. While the control arm only received routine care in the health facility, the intervention arm, in addition, was assigned to an HIV association for sustained support model, including support groups, leisure workshops and home visits. Structured questionnaires, including validated French versions of mental health scales, were quarterly administered to the study participants in both study arms by trained healthcare providers. The main outcome was maintaining retention in care beyond the first 15-month period of the study start. Kaplan-Meier and Cox regression models were fitted to assess association between intervention and outcome. Hazard Ratio (HR) across categories of exposure variables were compared using Wald's test. p-value <0.05 was considered significant. ResultsIn total, 305 adolescents were recruited in the study at a median age of 15.2 years old, including 162 (53.1 %) females and 153 individuals in the intervention arm. Mental health troubles were prevalent: severe depression (26.9 %), high or very high anxiety (28.9 %), and low self-esteem (84.9 %). Noteworthy, all of the baseline characteristics were balanced irrelevant to the study arm. Probability of maintaining good retention in care beyond the first 15-month period of study start remained higher in the intervention arm (82.0 % [95 %CI: 73.7 %-88.4 %]) versus the control arm (71.0 % [95 %CI: 63.2 %-78.1 %]), [cHR (95 %CI): 2.0 (1.1–3.3), p=0.044]. ConclusionsCapacity should be built in terms of implementing community-based peer-facilitated support groups in local organizations providing care to adolescents living with HIV.

Effects of storage of cookies containing xylitol or sucrose on their fluorescent, antioxidative and browning properties

The aim of this study was to examine the effects of xylitol as a sucrose alternative in cookies on the formation of free fluorescent compounds and browning associated with the Maillard reaction and on antioxidative potential during storage. The fluorescent measurements of ethanolic extracts of cookies and spectrophotometric assessments of melanoidins extracts of cookies support the thesis that xylitol, being a polyol like sugars, participates in the Maillard reaction. Melanoidins extracted from sucrose-containing cookies were characterized by higher values of browning index (25.93–72.53 OD/100 g) than melanoidins from cookies with xylitol (20.21–44.97 OD/100 g), probably due to structural differences of sucrose and xylitol. Extracts of melanoidins, which had a higher browning index, had a higher ability to scavenge DPPH• and ABTS•+ radicals in ethanolic extracts of cookies. Cookies containing xylitol kept their antioxidant potential until 6 months of storage, while after 3 months of storage, sucrose addition significantly (p < 0.05) accelerated the storage time-related reduction of scavenging DPPH• and ABTS•+ radicals in ethanolic extracts of cookies. The use of xylitol in cookies instead of sucrose is more beneficial because it results in the formation of lower amounts of advanced glycation end products (AGEs) and in a lower decrease of browning index and losses of antioxidative potential during baking and storage for the 12-month period.

Tourist Behavior and Awareness in Airline Voluntary Carbon Offset Programs: A Portuguese Perspective

This study examines the attitudes and behaviors of Portuguese air travelers towards voluntary carbon offset (VCO) programs, with a focus on understanding the motivations and awareness levels that drive offsetting behaviors. An online survey conducted between February 28 and April 30, 2023, gathered responses from 534 Portuguese residents who had traveled by air in the 12-month period prior to completion of the survey The findings reveal that while the decision to participate in VCO programs is primarily driven by a fundamental environmental ethos among offsetters, tourists exhibit limited understanding of these programs and heightened concern about affordability. Notably, the study uncovers a significant cognitive dissociation among tourists, where they often overlook or fail to acknowledge VCO offers. The findings highlight the challenge of integrating sustainability into the leisure tourism experience. This suggests that future research must account for these psychological hurdles when conducting sustainability experiments. Moreover, for sustainability initiatives to be truly effective, they must first address these cognitive barriers and reshape how environmental responsibility is perceived during leisure travel.

The Development of Socially Directed Attention: A Functional Magnetic Resonance Imaging Study in Infant Monkeys.

Socially guided visual attention, such as gaze following and joint attention, represents the building block of higher-level social cognition in primates, although their neurodevelopmental processes are still poorly understood. Atypical development of these social skills has served as early marker of autism spectrum disorder and Williams syndrome. In this study, we trace the developmental trajectories of four neural networks underlying visual and attentional social engagement in the translational rhesus monkey model. Resting-state fMRI (rs-fMRI) data and gaze following skills were collected in infant rhesus macaques from birth through 6 months of age. Developmental trajectories from subjects with both resting-state fMRI and eye-tracking data were used to explore brain-behavior relationships. Our findings indicate robust increases in functional connectivity (FC) between primary visual areas (primary visual cortex [V1] - extrastriate area 3 [V3] and V3 - middle temporal area [MT], MT and anterior superior temporal sulcus area [AST], as well as between anterior temporal area [TE]) and amygdala (AMY) as infants mature. Significant FC decreases were found in more rostral areas of the pathways, such as between temporal area occipital part - TE in the ventral object pathway, V3 - lateral intraparietal (LIP) of the dorsal visual attention pathway and V3 - temporo-parietal area of the ventral attention pathway. No changes in FC were found between cortical areas LIP-FEF and temporo-parietal area - Area 12 of the dorsal and ventral attention pathways or between Anterior Superior Temporal sulcus area (AST)-AMY and AMY-insula. Developmental trajectory of gaze following revealed a period of dynamic changes with gradual increases from 1 to 2 months, followed by slight decreases from 3 to 6 months. Exploratory association findings across the 6-month period showed that infants with higher gaze following had lower FC between primary visual areas V1-V3, but higher FC in the dorsal attention areas V3-LIP, both in the right hemisphere. Together, the first 6 months of life in rhesus macaques represent a critical period for the emergence of gaze following skills associated with maturational changes in FC of socially guided attention pathways.

Mood, Activity, and Instability in Bipolar Disorder and Unipolar Disorder-An Exploratory Post Hoc Study Using Digital Data.

Mood, activity, and instability in symptomatology hold significant roles in bipolar disorder (BD) and unipolar disorder (UD). The objectives were to examine disparities in these symptoms among patients with BD and UD. Data from two studies including patients with BD and UD, respectively, were combined for exploratory analyses. Patients provided daily smartphone-based evaluations of mood and activity/energy for a 6-month period. A total of 47 patients with BD and 59 patients with UD were included in the analyses. The dataset contains more than 13,000 patient-reported evaluations of mood and activity. Daily mood and activity instability measures were calculated using the root squared successive difference method. In linear mixed effect regression models adjusted for age, sex, and work status, there were statistically significant lower levels of activity in patients with BD as compared with patients with UD overall, during euthymic states and during depressive states (B: -0.61, 95% CI: -0.98; -0.24, p = 0.001). There were no statistically significant differences in mood instability and activity instability between patients with BD and patients with UD overall, during euthymic states and during depressive states, when accounting for multiple testing (p > 0.012). Analyses were exploratory and post hoc. Findings should be interpreted with caution. The sample size was modest. Patients with BD presented with lower level of activity as compared with patients with UD. There were no differences in mood and activity instability between these groups. Future studies including larger sample sizes should investigate differences between BD and UD. ClinicalTrials.gov identifier: NCT03033420.

Outcome of Preoperative Oral Steroids on Patients With Sinonasal Polyposis

Background and Objectives: This study aimed to evaluate whether preoperative oral prednisolone improves the intraoperative parameters and postoperative outcomes over a 3-month period in patients of sinonasal polyposis who undergo functional endoscopic sinus surgery.Methods: In a triple-blind, randomized controlled study, 43 patients diagnosed with sinonasal polyposis in the Department of ENT, AIIMS, Jodhpur, were enrolled. After obtaining institutional ethics clearance and registering the clinical trial, randomization was conducted to assign participants into experimental and control groups. Preoperatively, patients were assessed using the clinical severity score (Sino-nasal Outcome Test; SNOT-22), radiological severity score (Lund-Mackay score), and endoscopic severity scores (discharge-inflammation-polyp [DIP] score and Lund-Kennedy score). Intraoperative assessment was done using the Perioperative Sinus Endoscopy (POSE) score, the duration of surgery, intraoperative blood loss, and visual analog scale for visual field during surgery and for the ease of disease removal. Postoperatively, at 3 months all the preoperative parameters were reassessed, and, using independent t-test, comparison was made between the two groups.Results: Twenty-one patients were included in the experimental group (48%), and 22 in the control group (51%). Although the mean duration of surgery in the experimental group was shorter than in the control group, the difference was not statistically significant. Similarly, although the postoperative SNOT-22 score was lower in the experimental group compared to the control group, there was no statistically significant difference in outcomes between the two groups across any of the parameters assessed.Conclusion: Although the role of oral steroids has been established in the treatment of sinonasal polyposis, our study did not find any significant difference between the group that received oral steroids prior to surgery and the group that received placebo.

Online alcohol deliveries: age verification processes of online alcohol delivery companies in Auckland, New Zealand

aim: This study aims to document the age verification processes for online alcohol deliveries in Auckland, New Zealand, with a focus on rapid alcohol delivery (delivery within 2 hours of ordering). methods: Alcohol orders from Auckland online alcohol delivery companies were placed by a researcher under 25 years of age over a 2-month period in 2023. Procedures were recorded around speed of delivery and age verification processes. results: In total, 33 (73%) of the 45 online alcohol orders did not require age verification at delivery. This comprises 22 (49% of the total) deliveries left unattended at the door and 11 (24%) in-person deliveries that did not request age verification. The average speed of delivery for rapid alcohol delivery companies was 29.5 minutes and the standard deviation 9.5 minutes. conclusion: It is common for online alcohol deliveries in Auckland to be left unattended on delivery or delivered without requesting identification. This has implications for increasing alcohol-related harm, including supply to minors. Additional regulation addressing alcohol delivery is needed in New Zealand.

Arcobacter species isolated from human stool samples, animal products, ready-to-eat salad mixes, and ambient water: prevalence, antimicrobial susceptibility, and virulence gene profiles

IntroductionArcobacter species are emerging foodborne pathogens increasingly associated with human illness worldwide. They are commonly found in the gastrointestinal tracts of animals and are frequently isolated from various food sources, including raw meat, poultry, and seafood. The aim of this study is to investigate the antimicrobial resistance patterns of Arcobacter spp. isolated from human stool samples, animal products, ready-to-eat salad mixes, and ambient water, assess the presence of resistance genes, and explore their potential implications for public health.MethodsIn this study, a total of 683 samples were collected from the Shahrekord area over a 12-month period. Samples were obtained from human stool, chicken meat, raw cow milk, RTE salad mixes, and environmental water sources. Two different methods were used to detect Arcobacter, depending on the sample type: bacteriological isolation and identification, and molecular identification. After identification, antimicrobial susceptibility testing was conducted. Polymerase chain reaction (PCR) was used to identify ten putative Arcobacter virulence and resistance genes.FindingsThe results revealed that Arcobacter spp. were present in 26.06% (178 out of 683) of the tested samples, with varying isolation rates across different sample types. A. butzleri being the most commonly isolated species across all sample types, while A. cryaerophilus was restricted to RTE salads, surface waters, and chicken meat. Notably, A. skirrowii was only isolated from chicken meat and environmental water. The differences of Arcobacter spp. in prevalence between the sample types were statistically significant (p < 0.05), and no significant seasonal variation was found across the sampling periods (p > 0.05). PCR analysis for ten putative virulence genes indicated that the cadF gene was present in all Arcobacter isolates. Similarly, 83.33% of the tested strains harbored the ciaB gene, while other genes were less frequently detected. Regarding resistance genes, tet(O) (7.69%) was the most identified gene, followed by blaOXA-61 (4.37%).ConclusionIn conclusion, this study highlights the alarming prevalence of antimicrobial resistance in Arcobacter spp. Monitoring Arcobacter spp. resistance can be achieved through surveillance, risk assessments, antibiotic stewardship in agriculture, public education, research collaborations, rapid diagnostics, and harmonized policies, all aimed at reducing contamination and safeguarding public health effectively.

Natural History of Chronic Subdural Hematoma following Middle Meningeal Artery Embolization: A Retrospective Analysis

The efficacy of middle meningeal artery (MMA) embolization in the management of chronic subdural hematoma (cSDH) has been increasingly supported by recent randomized controlled trials. However, long-term data on the natural history of cSDH post-treatment remain limited. This study aims to evaluate the natural history and outcomes of cSDH over a 12-month period following MMA embolization. We conducted a retrospective analysis of 61 MMA embolization for the treatment of cSDH in 49 consecutive patients at a single institution between October 2019 and December 2022. Patients underwent MMA embolization as the primary treatment of cSDH, concurrently with surgical evacuation, or after initial surgical evacuation and subsequent recurrence. Clinical data, including patient demographics, hematoma maximal thickness, midline shift size, procedural details, and outcomes, were collected and analyzed. The primary outcomes assessed were time to resolution of hematoma maximal thickness, midline shift reduction and clinical improvement. Secondary outcomes included occurrence of complications, recurrence rate and the characteristics of the group of patients who needed surgical rescue. Tables and Kaplan-Meier curves were created, broken down by the percentage of reduction in current hematoma maximal thickness. Results for the primary, concurrent and recurrent groups were compared. The mean age of included patients was 73 ± 10.8 years. Among them, 33 patients (67.3%) reported a history of previous trauma, with falls being the main mechanism of injury (65.3%). The majority of patients (77.5%) were male. The most frequent neurological symptom was headache (61.2%). The mean hematoma thickness and midline shift were 15.9±7.1 and 5.6±2.6 mm, respectively. There was a significant improvement in clinical symptoms within 1 month following middle meningeal artery embolization. Kaplan-Meier curves were generated for resolution of hematoma size and midline shift. At one month post procedure, only 25% of patients had at least a 25% reduction in hematoma size. However, by three months, 75% had a decrease in hematoma size by 50%. 85% of patients had complete resolution of hematoma by 7 months and all patients had resolution of hematoma by 12 months. Four patients underwent surgical rescue hematoma evacuation and the mean timeframe between the embolization and the surgical rescue was 2 weeks. Hematoma size and midline shift resolved faster for patients who underwent concurrent or rescue surgical evacuation of the hematoma in addition to embolization. No difference in results between the liquid embolics n-BCA and Onyx-18 was found. This study demonstrated a favorable resolution of subdural hematoma within 7 months in 85% of patients and in all patients by 12 months. By 3 months, 50% of patients had a decrease in hematoma size by 50% or more. A complete resolution of midline shift within 7 months, and a significant improvement in clinical symptoms within 1 month following middle meningeal artery embolization. Hematoma size and midline shift resolved faster for patients who underwent embolization for recurrent hematoma or concurrent surgical evacuation of the hematoma in addition to embolization.

An evaluation of a multidisciplinary care planning tool for people with intellectual disabilities and behaviours of concern.

Multidisciplinary care planning for people with intellectual disabilities who engage in behaviours of concern (BoC) is challenging and complex. Effective collaborative understanding and action planning across all stakeholders is essential. Cornwall's Adult Community Learning Disability Team developed a care planning tool (Connect Behaviour) using contemporary evidence and best practice. Connect Behaviour is designed to facilitate care planning by collaborative and enhanced shared understanding and is also available as an interactive web-based tool. To evaluate Connect behaviour using stakeholders' experiences. Family members, care providers, advocates, social workers and professionals who had attended meetings guided by the Connect Behaviour care planning tool in a 3-month period were interviewed about their experiences of those meetings. This was interpreted using inductive thematic analysis. Of 71 individuals identified as meeting this criterion of inclusion 61 were contactable and 27 consented to participation. These participants consisted of 17 health professionals, two parents, two social workers, three advocates, two positive behaviour support advisors within care providers, and one manager of a local care provider. The thematic analysis of participant views of connect behaviour generated five superordinate themes of 'pragmatic', 'enabling', 'validation of effort', 'perceived lack of flexibility' and 'areas for development'. Further inquiry of themes highlighted subthemes of Connect Behaviour being 'sensible', 'practical', 'collaborative', 'holistic' and 'action'. Conversely, some perceived a lack of flexibility in the care planning tool. Future areas for development were also identified in the data. Changes were recommended to increase the tool accessibility for people with intellectual disabilities, support stakeholders understanding of the tool, and consider utility for other clinical scenarios. The evaluation established general feedback to continue to use the Connect Behaviour as a care planning tool. The benefits of Connect Behaviour in comparison to other care planning frameworks needs to be understood.

The Development and Clinical Impact of an Innovative Palliative Care Lever Tool for Individuals With Idiopathic Pulmonary Fibrosis: A Quality Improvement Project.

Palliative care (PC) is underutilized in the idiopathic pulmonary fibrosis (IPF) patient population, particularly in outpatient settings, despite high symptom burden and complex care needs. There is no clinician consensus for the most effective method of integrating PC into routine medical visits for this patient population, despite acknowledgement of its benefits. The purpose of this quality improvement (QI) project was to pilot an adapted nurse practitioner-led standardized PC lever tool for IPF in an outpatient clinic and evaluate the secondary PC referral rates during the implementation period. The lever tool was implemented over a 3-month period. De-identified patient health information from the health system's electronic medical record system was used to compare referrals to PC prior to and during the implementation of the lever tool. The established workflow for the nurse practitioner-led implementation of the tool was feasible. There were increased PC referrals and increased PC encounters during the QI period, however the results were not statistically significant. The findings of this QI project add to the limited existing literature evaluating PC referral methods for individuals with IPF in an outpatient setting. Further, the development process and workflow utilized confirms the feasibility of employing the nursing workforce to support the care needs of the IPF patient population.

Confirmatory Factor Analysis of the Hyperacusis Impact Questionnaire, Sound Sensitivity Symptoms Questionnaire, and Screening for Anxiety and Depression in Tinnitus, Including Preliminary Analyses of the Parent Versions for Use with Children.

We previously reported the results of exploratory factor analysis (EFA) of the Hyperacusis Impact Questionnaire (HIQ), the Sound Sensitivity Symptoms Questionnaire (SSSD), and the Screening for Anxiety and Depression in Tinnitus (SAD-T). Confirmatory factor analysis (CFA) is necessary to confirm the latent constructs determined using EFA. CFA should use different samples but with similar characteristics to those used for EFA. The aim was to use CFA to confirm latent constructs derived using EFA of the HIQ, SSSQ, and SAD-T. We further evaluated the psychometric properties of parent versions of these questionnaires (indicated by -P), which are intended for use with children. This was a retrospective cross-sectional study. Data for 323 consecutive adults and 49 children who attended a Tinnitus and Hyperacusis Therapy Clinic in the United Kingdom within a 6-month period were included. Data were collected retrospectively from the records of patients held at the Audiology Department. CFA with the weighted least-squares mean and variance-adjusted estimator was applied to assess the previously proposed factor structures of the HIQ, SSSQ, and SAD-T. The internal consistency of the scales was assessed via Cronbach's α (α). The items of the HIQ, SSSQ, and SAD-T were tested for measurement invariance regarding age and gender using the multiple indicator multiple cause (MIMIC) model. All questionnaires showed good to excellent internal consistency, with α = 0.93 for the HIQ, 0.87 for the SSSQ, and 0.91 for the SAD-T. The parent versions showed acceptable to good internal consistency, with α = 0.88 for the HIQ-P, 0.71 for the SSSQ-P, and 0.86 for the SAD-T-P. CFA showed that the HIQ, SSSQ, and SAD-T were all one-factor questionnaires and the factors generally were similar to those obtained for the EFA. The MIMIC model showed that all three questionnaires can be considered as measurement invariant, with scores similar across genders and ages. The HIQ, SSSQ, and SAD-T are internally consistent one-factor questionnaires that can be used in clinical and research settings to assess the impact of hyperacusis, the severity of sound sensitivity symptoms, and to screen for anxiety and depression symptoms. Future studies should further explore the psychometric properties of the parent versions of the HIQ, SSSQ, and SAD-T.

Sarkome: Neue Kombinationstherapie mit günstigerem Nebenwirkungsprofil

Purpose: While cytotoxic chemotherapy is the standard first-line treatment for patients with metastatic soft-tissue sarcoma (STS), clinical outcomes remain suboptimal. Our prior study showed lurbinectedin plus doxorubicin is well tolerated with promising clinical activity in STS. We designed this phase 1b trial to optimize dosing as the basis for a randomized trial in leiomyosarcoma and to further explore the safety profile and efficacy signal. Patients and methods: Patients had advanced/metastatic STS and no prior anthracycline/lurbinectedin/trabectedin. Escalation followed a 3 + 3 design with 3-week cycles: lurbinectedin (3.2 mg/m2 day 1) and two doxorubicin levels (DL1, 25 mg/m2 day 1; DL2, 25 mg/m2 days 1 and 8). The primary objectives were to identify the maximum tolerated dose and recommended dose for subsequent randomized trials. Results: Ten patients were enrolled in a 6-month period. The most common treatment-emergent adverse events were grade (G) 2 fatigue and nausea, and G2 cytopenias with no febrile neutropenia events. There were two dose-limiting toxicities (DLTs) at DL2 [day 8 (G2 alanine aminotransferase [ALT]/aspartate aminotransferase increase, G3 neutropenia)], and one DLT in DL1 (G3 ALT increase). These were reversible and all patients continued the study. DL1 was chosen for further study. At the time of data cutoff, the estimated median progression-free survival is 16.5 months [95% confidence interval (CI), 6.0-ND]. The objective response rate was 60% (6/10 confirmed partial responses).

Left Atrial Wall Thickness Measured by a Machine Learning Method Predicts AF Recurrence After Pulmonary Vein Isolation.

Left atrial (LA) remodeling plays a significant role in the progression of atrial fibrillation (AF). Although LA wall thickness (LAWT) has emerged as an indicator of structural remodeling, its impact on AF outcomes remains unclear. We aimed to determine the association between LAWT and AF recurrence after pulmonary vein isolation (PVI), as well as to evaluate the relationship between LAWT and LA fibrosis. Single-center registry of patients enrolled for radiofrequency PVI from 2016 to 2018. In all cases, a pre-ablation CT was performed within less than 48 h. Mean LAWT was retrospectively measured by a semi-automated machine learning method (ADAS 3D). A subgroup of patients also underwent pre-ablation cardiac MRI. The primary endpoint was time to AF recurrence after a 3-month blanking period. A total of 439 patients (mean age 61 ± 12 years, 62% male, 78% with paroxysmal AF) were included. The mean LAWT was 1.4 ± 0.2 mm (0.9-1.9 mm). During a median follow-up of 5.8 (IQR: 4.9-6.6) years, 238 patients (54%) had an AF relapse. After adjusting for 8 clinical and imaging potential confounders, LAWT remained an independent predictor of time-to-recurrence (aHR: 4.25 [95% CI: 1.65-10.95], p = 0.003). AF recurrence rates were 11%, 15%, and 21%/year across terciles of increasing LAWT (log-rank p < 0.001). Additionally, the AF recurrence rate increased across the spectrum of LA structural remodeling, ranging from 8% (normal LAWT and LAVI) to 30%/year (LAWT and LAVI both increased). In the 62 patients who also underwent pre-ablation MRI, a moderate relationship between LAWT and fibrosis (assessed by late-gadolinium enhancement) was found (Spearman R 0.468; p < 0.001). Mean LAWT, easily assessed by commercially available machine learning software, is an independent predictor of time to AF recurrence after PVI in the long term. Whether patients with increased LAWT should receive tailored therapy deserves further investigation.

Effect of multidisciplinary medical nutrition therapy on the nutrition status of patients receiving peritoneal dialysis: A randomized controlled trial.

Malnutrition is a prevalent complication in patients undergoing peritoneal dialysis (PD). This study established a multidisciplinary team for medical nutrition therapy (MNT) to investigate the impact of this approach on enhancing the nutrition, anemic, and microinflammatory status of patients receiving PD. This randomized controlled trial study involved 81 patients undergoing PD (n = 41 in the intervention group, n = 40 in the control group). The intervention group received comprehensive MNT management, whereas the control group received standard nutrition care. The intervention spanned a 6-month period. Various nutrition parameters, markers of anemia, and microinflammatory indexes were assessed before the intervention, at 3 months, and at 6 months postintervention. Repeated-measures analysis of variance and the nonparametric Scheirer-Ray-Hare test were used for within-group and between-group comparisons. There were no statistically significant differences between the groups in terms of age, sex, duration of dialysis, primary disease, or baseline prenutrition inflammation data. At 6 months postintervention, the intervention group exhibited higher levels of serum albumin, blood calcium, serum iron, hemoglobin, total iron-binding capacity, body mass index, midarm circumference, triceps skinfold thickness, handgrip strength, and daily energy and protein intake compared with the control group (P < 0.05). Additionally, the intervention group demonstrated lower levels of subjective nutrition assessment value, C-reactive protein, and neutrophil-to-lymphocyte ratio than the control group (P < 0.05), with no statistically significant differences in other markers after interventions. Multidisciplinary MNT can ameliorate the nutrition status of patients receiving PD, decrease the incidence of malnutrition, and improve anemia and microinflammatory outcomes.

Inpatient Test Utilization and Test Volume Benchmarking: A Q-Probes Study.

Test-ordering practices vary widely between and within health care organizations, and methods used to benchmark test utilization data are unstandardized. To develop and apply standardized methodology to compare inpatient test utilization data submitted by laboratories enrolled in a College of American Pathologists Q-Probes study. Participating laboratories provided inpatient test volumes for 50 designated analytes and total inpatient days for 2019 or a recent 12-month period. Test utilization patterns were characterized by studying test volumes standardized per 1000 inpatient days. Test volume variability used the standardized median absolute deviation; standardized test volumes were evaluated by calculating comparative ranges for each analyte. Standardized test volumes falling outside their respective comparative ranges are referred to as outliers in this study. Volume data were tested for association with stewardship practices and institutional demographics. Methodology using standardized test volume data identified test groups that are commonly used in the inpatient setting and efficiently identified volume outliers. High test volume outliers included creatine kinase myocardial band, free prostate-specific antigen, myoglobin, serotonin release assay, and hepatitis B serologies; no low-volume outliers were observed. Among 33 participants, 13 (39%) had no test volume outliers, while 5 (15%) showed multiple tests (13-34) with comparatively high volumes. No statistically significant relationships were found between stewardship practices and test-ordering patterns. Our approach can be used to measure inpatient test volume data across organizations and for identifying test volumes falling outside of the standardized comparative ranges that may require interventions to change test utilization practices.

Evaluation of alternative vaccination routes against paratuberculosis in goats

Paratuberculosis is a chronic granulomatous enteritis, caused by Mycobacterium avium subspecies paratuberculosis (Map), that affects ruminants worldwide. Vaccination has been considered the most cost-effective method for the control of this disease in infected dairy herds. However, currently available vaccines do not provide complete protection and interfere with the diagnosis of both paratuberculosis and bovine tuberculosis, limiting its use. Because of that, efforts are being made for the development of new vaccines. The primary objective of this study was to evaluate the efficacy of two whole-cell inactivated experimental vaccines against paratuberculosis in goats, administered through the oral (OV) and intradermal (IDV) routes, and compare them with that of the commercial subcutaneous vaccine Gudair® (SCV). Over an 11-month period, the effect of vaccination and a subsequent Map challenge on the specific peripheral immune responses and Map-DNA fecal shedding were recorded. At the end of the experiment, tissue bacterial load and lesion severity were assessed. The experimental vaccines did not induce specific humoral immune responses and only elicited mild and delayed cellular immune responses. Although the OV reduced lesion severity, neither this vaccine nor the IDV prototype was able to reduce fecal shedding or tissue bacterial load. Moreover, although the SCV did not confer sterile immunity, it outperformed both experimental vaccines in all these parameters.