Ambulatory Patient Research Articles

Predicting deterioration in dengue using a low cost wearable for continuous clinical monitoring

Close vital signs monitoring is crucial for the clinical management of patients with dengue. We investigated performance of a non-invasive wearable utilising photoplethysmography (PPG), to provide real-time risk prediction in hospitalised individuals. We performed a prospective observational clinical study in Vietnam between January 2020 and October 2022: 153 patients were included in analyses, providing 1353 h of PPG data. Using a multi-modal transformer approach, 10-min PPG waveform segments and basic clinical data (age, sex, clinical features on admission) were used as features to continuously forecast clinical state 2 h ahead. Prediction of low-risk states (17,939/80,843; 22.1%), defined by NEWS2 and mSOFA < 6, was associated with an area under the precision-recall curve of 0.67 and an area under the receiver operator curve of 0.83. Implementation of such interventions could provide cost-effective triage and clinical care in dengue, offering opportunities for safe ambulatory patient management.

Diagnosis and management of diverticular disease in primary care.

Each year, more than 1 million ambulatory patient visits occur for diverticular disease, with nearly 75% of these patients seen in outpatient clinics. Although diverticulitis historically had been considered a disease of the older adult, it has become increasingly prevalent among the younger population. Likewise, in the past, antibiotics were considered first-line treatment for uncomplicated diverticulitis (Hinchey classification 0 and Ia); however, two large clinical trials compared treatment with antibiotics versus without antibiotics in uncomplicated cases of the disease and found no significant difference in patient outcomes. Based on these findings, first-line management now constitutes clear-liquid diet along with bowel rest for resolution of symptoms in these patients. Proper management with lifestyle modifications can help prevent complications and improve outcomes for patients with this condition; patient education is therefore critical.

The number of patient scheduled hours resulting in a 40-hour work week by physician specialty and setting: a cross-sectional study using electronic health record event log data.

To quantify how many patient scheduled hours would result in a 40-h work week (PSH40) for ambulatory physicians and to determine how PSH40 varies by specialty and practice type. We calculated PSH40 for 186188 ambulatory physicians across 395 organizations from November 2021 through April 2022 stratified by specialty. Median PSH40 for the sample was 33.2 h (IQR: 28.7-36.5). PSH40 was lowest in infectious disease (26.2, IQR: 21.6-31.1), geriatrics (27.2, IQR: 21.5-32.0) and hematology (28.6, IQR: 23.6-32.6) and highest in plastic surgery (35.7, IQR: 32.8-37.7), pain medicine (35.8, IQR: 32.6-37.9) and sports medicine (36.0, IQR: 33.3-38.1). Health system leaders and physicians will benefit from data driven and transparent discussions about work hour expectations. The PSH40 measure can also be used to quantify the impact of variations in the clinical care environment on the in-person ambulatory patient care time available to physicians. PSH40 is a novel measure that can be generated from vendor-derived metrics and used by operational leaders to inform work expectations. It can also support research into the impact of changes in the care environment on physicians' workload and capacity.

Using Clinical-based Discharge Criteria to Discharge Patients After Endoscopy Procedures Under Drug-induced Intravenous Sedation in the Outpatient Care Unit: An Observational Study

PurposeTo verify the feasibility of clinical-based discharge (CBD) criteria and to find out the reasons for the delayed discharge of outpatients after endoscopy procedures under drug-induced intravenous sedation. DesignA prospectively observational study conducted at a tertiary endoscopy center. MethodsMedical records were collected from outpatients admitted for endoscopy procedures under drug-induced intravenous sedation from June 1, 2021 to December 30, 2021. Patients were scheduled to discharge at least 30 minutes based on the time-based discharge (TBD) method. Postanesthetic discharge scoring system in the outpatient post-anesthesia care unit (PACU) recorded the time of patients discharged home on the CBD criteria. Postoperative complications were recorded in the PACU and within 24 hours after discharge. Multivariate analysis was applied to identify the factors relating to late discharges. Findings10,597 patients were safely and successfully discharged home, and we were informed of no serious emergency or accidental readmissions to the hospital. The mean CBD time (21.77 ± 11.35 minutes) was compared with the TBD time (30 minutes) and actual TBD discharge time (61.56 ± 4.93 minutes), which were statistically significant, without changes in the patient's vital signs (P < .01). Primarily, further univariate and multivariate analyses showed that abdominal pain and fatigue were key factors accountable for delay in PACU discharge (P < .05). ConclusionsThe study concluded that in patients undergoing ambulatory endoscopy procedures with drug-induced intravenous sedation, discharge times based on physiological scoring systems can efficiently and safely guide ambulatory patient discharge as compared to the traditional TBD method. Postoperative fatigue and pain were the main factors affecting patients discharge associated with a relatively long PACU length of stay.

A calculation of capitation-based payment standardto chronic disease cases in primary care settings

BackgroundOutpatient medical care payment play a pivotal role in the reform of medical insurance payment methods. With ongoing reforms in China, a variety of payment strategies, including capitation and the ambulatory patient groups (APG) point method, are being progressively implemented. ObjectiveThis study aims to identify appropriate capitation calculation methods for chronic diseases in Beijing and to provide recommendations for implementing capitation payments reforms in the city. MethodsWe focused on four prevalent chronic diseases—hypertension, diabetes, coronary heart disease, and stroke—and analyzed basic medical data and public health funding in Beijing's districts C and H as case studies. This research was aimed at developing a capitation calculation method tailored to these locales, determining payment standards for major chronic diseases in primary care clinics, and thus supporting the advancement of capitation reform for outpatient chronic diseases. ResultsUsing medical insurance data and public health funding data from 2017 to 2019, a top-down allocation was employed to determine the capitation payment standards in district H: 4,693.11 Yuan for hypertension, 6,597.70 Yuan for diabetes, 5,644.46 Yuan for coronary heart disease, and 6,437.78 Yuan for stroke. A bottom-up costing approach was used in district C, resulting in payment standards of 4,884.18 Yuan for hypertension, 5,960.63 Yuan for diabetes, 3,733.93 Yuan for coronary heart disease, and 3,886.66 Yuan for stroke. ConclusionThe outpatient costs associated with different chronic disease populations vary considerably. In view of maintaining equity in medical insurance and the fairness of capitation fees, it is imperative to apply risk adjustments to the benchmark capitation fee. Personalized services should be tailored to the diverse types and severities of chronic diseases. It is also crucial to provide customized basic medical and public health services to various chronic disease patients as part of the capitation payment reform for outpatient services. Additionally, enhancing the capabilities of community health services in managing chronic diseases, improving contracting percentages, and establishing effective incentive and evaluation mechanisms for general practitioners are essential for equitable distribution of surplus from capitation payments.

Improving ambulatory patient access through strategic reorganisation and implementation of innovative ambulatory care best practices

John Muir Health, a large health system in northern California, struggled with a complex practice management structure that lacked role clarity and core positions, making it difficult to bring about positive change within the ambulatory setting. As part of a broader, strategic partnership to improve operations and deliver healthcare, health system leaders partnered with Optum Advisory to reorganise the practice management structure and optimise primary care patient access. Across its duration, the partnership improved access within primary care while reducing the administrative burden on providers through care team redesign, and with a new structure, physicians received administrative clarity and practice managers have leaders providing support for access, project management and innovation. These changes led to greater innovation and efficiency, resulting in higher satisfaction for patients, providers and staff. Optimising access and productivity, John Muir Health primary care practices have decreased the amount of time it takes for patients to get into the practice, increasing the overall number of patients they have been able to see. In addition, centralised prescription refills have allowed patients to receive their medications quicker while enabling physicians to concentrate on direct patient care. The overall result has been less administrative burden for providers and staff, allowing for more top-of-licence work and time with patients.

Palliative Care Needs of Patients with Musculoskeletal Malignancies.

This review aims to assess the literature regarding current treatment options for the palliative care of patients with advanced musculoskeletal malignancies whether primary or metastatic. The inclusion of specialized palliative care physicians, in conjunction with surgeons, medical oncologists, radiation oncologists, interventional radiologists, and mental health professionals, results in better control of end-of-life symptoms in both children and adults with terminal musculoskeletal malignancies. The palliative care of patients with musculoskeletal malignancies requires a multi-disciplinary team and benefits from specialized palliative care physicians. The unique impacts of musculoskeletal malignancies on ambulation and independence creates additional mental and physical burdens on patients and care-takers alike. Palliative care should focus on preserving ambulatory function and patient independence, in addition to managing chronic pain and other end-of-life symptoms common to these malignancies.

#805 Successful application of DALI for extracorporeal hemocorrection in a patient with LDL cholesterol serum levels (case study)

Abstract Background and Aims Plasma lipoidosis type 4 (PLD4) is a rare hereditary disease characterized by disorders of fat metabolism in the body. PLD4 occurs rare in the general population. The exact frequency of occurrence is unknown, as it depends on hereditary factors in a particular population. The relevance of the disease lies in its rarity and potential association with various complications. Patients with PLD4 have decreased levels of low-density cholesterol (LDL) and increased levels of triglycerides in the blood, which can lead to the development of atherosclerosis and other cardiovascular diseases. Plasma lipoidosis type 4 requires further researches for better understanding of its epidemiology, mechanisms of development and possible treatment strategies. In this case, we describe the case of a patient with type 4 plasmatic lipoidosis who was treated with the DALI (Direct Adsorption of Lipoproteins) technique. Anticoagulation is initiated with heparin and maintained by ACT. This technique is accompanied by decreasing the level of LDL and Lp (a) without decreasing the level of HDL and fibrinogen. The pore sizes of the polyacrylamide bed are small enough to avoid the removal of red blood cells and platelets. Activation of leukocytes and complement is minimal and clinically insignificant. Depending on the initial level of lipidemia during this procedure, it is possible to select the appropriate adsorber (DALI-500, -750, -1000). Methods of extracorporeal correction of lipid metabolism disorders should be widely introduced into healthcare practice. It should be noted that during DALI apheresis, the fibrinogen level does not decrease so sharply and is not accompanied by changes in erythrocyte aggregation. (Richter W. O., 2003). Aim of study The purpose of our study was to evaluate the effectiveness of using DALI (Direct Adsorption of Lipoproteins) in a patient with type 4 plasmatic lipoidosis. Method Patient N., 67 years old, diagnosed with IHD. Angina pectoris FC 2. Plasma lipoidosis type 4, hyperbetalipoproteinemia by autosomal dominant type of inheritance. Cysts of both kidneys. In 1997, diagnosed with: plasma lipoidosis type 4, hyperbetalipoproteinemia by an autosomal dominant type of inheritance. The plasmapheresis sessions were recommended against the increased lipid metabolism indexes. The patient regularly receives antilipidemic therapy and plasmapheresis sessions up to 2 times a year. The patient is admitted with complaints of fatigue and general weakness. According to the patient's ambulatory card, discharge summaries: CREA - 147 µmol/l, UREA – 6.3 mmol/l. GFR – 34 ml/min/1.73 m2. Total bilirubin - 9 µmol/l, direct bilirubin - 3 µmol/l. Considering the severity of the condition and the activity of the main diagnosis, a procedure with the DALI technique was started. During the hospitalization period, 3 procedures were performed, the whole of them were tolerated satisfactorily. The general condition is of moderate severity. Consciousness is clear. Hemodynamics is stable. Urination is free and painless. Diuresis is adequate. Results Hemodynamics: when connected - blood pressure – 120/82 mm Hg, heart rate – 61 beats/min. When disconnected, the patient's condition is the same, hemodynamics - blood pressure – 119/59 mm Hg, heart rate – 65 beats / min. Conclusion The usage of the apheresis method with the DALI system can effectively reduce the level of low-density lipoprotein (LDL) and Lp (a), while maintaining the content of high-density lipoprotein (HDL) and fibrinogen at a constant level. This reduction in LDL concentrations has the potential to reduce patients' risk of developing cardiovascular disease and the mortality from it.

The Divergence between Self- and Preceptor-Assessments of Student Performance during Advanced Pharmacy Practice Experiences.

(1) Objectives: A divergence in self- and preceptor-evaluations of clinical skills has been noted during Advanced Pharmacy Practice Experiences (APPEs). The goal of this study was to determine the domains of overestimation of clinical skills by students during their APPE rotations. (2) Methods: Preceptor-assigned grades for APPE rotations from 2017-2022 were analyzed to identify instances of letter grade B or lower. The self- and preceptor-evaluations of APPE rotation were compared to determine the domains of divergence in evaluation between students and preceptors. (3) Results: Between 2017 and 2022, 305 student APPE rotations were graded as B or lower (~14%) by the preceptors. A statistically significant difference was noted between self- and preceptor-assigned letter grades across all practice settings including ambulatory patient care, community pharmacy, general medicine patient care, hospital/health system pharmacy, and special population patient care APPE rotations. In addition, examining the self- and preceptor evaluation rubric for these rotations revealed a statistically significant overestimation of clinical skills by students in all 9 domains of APPE evaluation. Finally, the divergence in the rating of clinical skills between student- and preceptor evaluation was found to be highest in the domains of planning and follow-up of patient care, disease knowledge, and communication with patients. (4) Conclusions: Students who fail to exhibit exemplary practice readiness during APPEs tend to overestimate their clinical skills in all domains of APPE evaluation. The results from our study support the need for additional avenues to assist in the identification of deficits in student learning before APPEs to increase their self-awareness (metacognition).

Development and Validation of a Discharge Assessment Scale for Outpatients Undergoing Sedative Anesthesia in the Ambulatory Postanesthesia Care Unit: A Comprehensive Delphi Study

PurposeThe purpose of this study was to develop a discharge assessment scale tailored for outpatients undergoing sedative anesthesia treatment in the ambulatory postanesthesia care unit and validate its agreement with the Post-Anesthetic Discharge Scoring System. DesignThe Delphi method. MethodsA Delphi survey was conducted with 30 experts focusing on the evaluation of outpatient discharges following treatment under ambulatory anesthesia. Subsequently, a cross-sectional observational study employing convenience sampling selected 2,579 outpatients who had undergone painless ambulatory gastrointestinal endoscopy at a tertiary hospital to analyze the level of agreement with the Post-Anesthesia Discharge Scoring System. FindingsThe study conducted three rounds of expert consultations to create the ambulatory discharge assessment scale. Twenty-five experts from 12 provinces and municipalities in our country were interviewed. The discharge assessment form encompassed five aspects: consciousness level, vital signs, directional stability, mobility, and adverse reactions. According to the scale, if the total score exceeded 9 points, with none of the items scoring 0 points, the ambulatory patient could be discharged from the hospital with the accompaniment of family members. Patients assessed using this newly constructed scale were able to leave the hospital earlier compared to those assessed using the comparative scale. No significant differences were observed in vital signs at the time of discharge or the occurrence of adverse events within 24 hours after the procedure. ConclusionsThis assessment tool for discharging ambulatory patients after the ambulatory anesthesia from the postanesthesia outpatient care unit can be considered a valuable addition to formalize the discharge process in outpatient services.

PULSE PRESSURE DYNAMICS: UNRAVELING THE IMPACT ON TARGET ORGAN DAMAGE, INDEPENDENT OF MEAN ARTERIAL PRESSURE

Objective: As individuals age, pulse pressure (PP) naturally increases due to arteriosclerosis and diffuse vascular stiffening. In the absence of an identifiable cause, a wide PP signals target organ damage (TOD) and adverse clinical outcomes. While hypertension is endemic in South Asia, there is paucity of data regarding determinants of PP and relationship with TOD in this region. We therefore aimed to explore the determinants of PP in an ambulatory patient population. Design and method: We analysed electronic medical records of subjects (n=8,362, 64% females 64%) attending a Medicine outpatient Department (OPD) at Shalamar Hospital, a tertiary care hospital, in Lahore, Pakistan during the period September 1st, 2021 to September 30th, 2023. Haemodynamic data included single measure of systolic and diastolic BP and heart rate. HTN was defined according to ESH and ACC guidelines. History of CVD included ishaemic heart disease and stroke. Relationshp between variables was analysed using univariate and multivariate analysis. Pp was analysed both as a continuous and categorical variable (&gt;50, mm Hg). Results: Of the 8,362 subjects attending the OPD, 62% and 100% had a diagnosis of HTN as per ESH and ACC guidelines, respectively. PP&gt;50, mm Hg was present in 56% and 45% of HTN as defined by ESH and ACC respectively. PP&gt;50, mm Hg was associated with age (OR=2.7), female gender (OR=1.46), chronic kidney disease (CKD, OR= 3.6), CVD (OR=1.47) and diabetes mellitus (DM, OR=1.54). In a stepwise regression model, age, gender, heart rate, DM, CKD and CVD were associated with PP, independent of mean arterial pressure (R2=0.45, p&lt;0.0001). Conclusions: To the best of our knowledge, this is the first large study, exploring the determinants of PP in Pakistan. While the study is retrospective, using single office BP measurements, it highlights the importance of PP as an independent predictor of TOD. Prospective studies are the need of the hour to elucidate the pathophysiology and outcome of high PP in this population.

Telemedicine Usability and Satisfaction among Pediatric Rheumatology Patients and their Caregivers during COVID-19 Pandemic.

The 2019 coronavirus disease pandemic opened an opportunity to explore the role of telemedicine in pediatric rheumatology clinic as well as patient satisfaction with virtual visits. To determine the usability and satisfaction rate of telemedicine among pediatric rheumatology patients and their caregivers. A cross-sectional online survey was conducted among patients and caregivers consulting via telemedicine at a pediatric rheumatology clinic of University of the Philippines - Philippine General Hospital (UP - PGH), a tertiary government hospital. Collected data included socio-demographics and the validated Telehealth Usability Questionnaire (TUQ). There were 39 (55.7%) patients and 31 (44.3%) primary caregivers included in the study. Across all usability factors, the response of primary caregivers did not significantly differ from those of patients. The average scores across all questions for both patients and primary caregivers were 5.96±1.19 and 6.04±1.34, respectively. This showed a high level of agreement that they were highly satisfied with telemedicine experience. Among the different usability factors, questions related to usefulness obtained the highest mean score for both patients (6.11±1.17) and primary caregivers (6.12±1.38). While the lowest mean score was observed on questions related to reliability, 5.65±1.33 for patients and 5.89±1.31 for primary caregivers. Pediatric rheumatology patients as well as their caregivers are generally highly satisfied with telemedicine during this time of pandemic. With high patient and caregiver satisfaction, telemedicine could be an option for ambulatory patient care even after pandemic.

Decentralizing referral prioritization to general practitioners at the primary care level: A qualitative case study based on the Grounded Theory.

Patient referral prioritizations is an essential process in coordinating healthcare delivery, since it organizes the waiting lists according to priorities and availability of resources. This study aims to highlight the consequences of decentralizing ambulatory patient referrals to general practitioners that work as family physicians in primary care clinics. A qualitative case study was carried out in the municipality of Rio de Janeiro. The ten health regions of Rio de Janeiro were visited during fieldwork, totalizing 35 hours of semi-structured interviews and approximately 70 hours of analysis based on the Grounded Theory. The findings of this study show that the obstacles to adequate referrals are beyond the management of vacancies, ranging from the standardization of prioritization criteria to ensuring the proper employment of referral protocols in diverse locations assisted by overloaded health workers with different backgrounds and perceptions. Efforts in decentralizing patient referral to primary care still face the growing dilemmas and challenges of expanding the coverage of health services while putting pressure on risk assessment, as well as sustaining the autonomy of physicians' work while respecting the eligibility when ordering waiting lists. A major strength of this work is on the method to organize and aggregate qualitative data using visual representations. Limitations concerning the reach of fieldwork in vulnerable and hardly accessible areas were overcame using snowball sampling techniques, making more participants accessible.

Quality measures of virtual care in ambulatory healthcare environments: a scoping review

ObjectivesDelivery of virtual care increased throughout the COVID-19 pandemic and persisted after physical distancing measures ended. However, little is known about how to measure the quality of virtual care, as...

Smart Warming: Lab VIEW- Powered Patient Mattress for Ultimate Comfort

Exposure to cold temperatures is, often, a neglected problem in ICUs, CT, AND MRI scans it may cause several discomforts such as shivering, lung diseases, and artifacts in scan reports, etc., one of the leading influences of the overall sensation of cold discomfort is the cooling of the back. This study aimed to evaluate the effect of a heated ambulance mattress- prototype on body temperatures and thermal comfort in an experimental study. The endotherm patient warming mattress and ambulatory patient mattress are the preexisting projects. The Inditherm mattress is designed for use by all patients undergoing anesthesia who may be at risk of inadvertent pre-operative hypothermia, and for any patients who require warming in pre-operative, intra-operative, and postoperative settings the ambulatory mattress is generally a warming mattress. The main disadvantage is that these two technologies are not automated the operator has to set all parameters. In this project, we are designing a mattress that liberates heat depending on room temperature. The Lab VIEW controls on and off of the system it compares the room temperature with the present value and produces a suitable result. The main advantage is the project is fully automated and warms the patient only at the required time.

ECMOve: A Mobilization Device for Extracorporeal Membrane Oxygenation Patients.

Extracorporeal membrane oxygenation (ECMO) is a temporary lifesaving treatment for critically ill patients with severe respiratory or cardiac failure. Studies demonstrated the feasibility of in-hospital mobilizing during and after ECMO treatment preventing neuromuscular weakness and impaired physical functioning. Despite more compact mobile ECMO devices, implementation of ambulatory ECMO remains labor-intensive, complex, and challenging. It requires a large multidisciplinary team to carry equipment, monitor and physically support the patient, and to provide a back-up wheelchair in case of fatigue. Moreover, there is no adequate solution to ensure the stability of the patient's cannula and circuit management during ambulation. We developed a system contributing to improvement and innovation of current ambulatory ECMO patient programs. Our modular cart-in-cart system carries necessary ECMO equipment, features an extendable walking frame, and contains a folding seat for patient transport. An adjustable shoulder brace with lockable tubing-connectors enables safe fixation of the blood tubing. ECMOve provides safety, support, and accessibility while performing ambulatory ECMO for both patient and caregiver. Prototype evaluation in a simulated intensive care unit showed feasibility of our design, but needs to be evaluated in clinical care.

Policy Evaluation of the Reform of Ambulatory Patient Groups Based on Access, Quality, and Cost of the Iron Triangle Value Chain in China

Objective. As part of the efforts to build a practical, effective, and diversified medical insurance payment method, it is crucial for China to deepen the reform of ambulatory patient groups (APGs). This study was aimed to explore the mechanism and effect of this policy from three dimensions, including medical expenses, medical insurance funds, and medical services. Methods. In 2020, China’s pilot reform of APG was initiated in Jinhua City, Zhejiang Province. Descriptive statistics, correlation analysis, and OLS regression analysis were utilized to evaluate the effect of the APG reform in Jinhua. Results. The implementation of the reform can contribute significantly to establishing a comprehensive medical service governance mechanism of classified settlement and coordinated promotion. It also plays a critical role in safeguarding people’s lives and health by promoting the high-level development of medical insurance systems and public hospitals, optimizing the quality of medical services, and improving the efficiency of medical insurance funds. Conclusion. Through the lens of policy evaluation, our findings can provide useful experience for the implementation of the outpatient medical insurance payment method in developing countries.

Assessing acceptance of AI nurses for outpatients with chronic diseases: From nurses’ perspective

The primary objective of this article is to investigate and forecast nurses’ attitudes toward using AI nurses for outpatients with chronic diseases. AI technology is used in hospitals in a disease-centric manner. However, it is desired by healthcare regulators to be used in an individual-centric and holistic manner. The research model was developed based on the Unified Theory of Accepting and Using Technology. In determining the causes and consequences of the attitudes, actions, ideas, and beliefs of the nurses, the screening technique of causal comparison was used. Research data was collected from registered nurses who work in research hospitals and use intelligent health technologies for inpatients. Based on 494 responses, this study conducted a dual-phase assessment using Partial Least Squares Structural Equation Modeling as well as the creation of an AI method known as deep learning (artificial neural network). According to the results, nurses are convinced that AI is a suitable tool for their nursing tasks and increases their efficiency and productivity. It has been determined that nurses have intentions to use AI nurses for outpatients with chronic diseases. However, nurses have concerns about the reliability of ambulatory patient data. The policies and strategies of regulators will affect the acceptance of AI technology, not only for nurses but for all healthcare professionals and patients.

Novel Insights in Venous Thromboembolism Risk Assessment Methods in Ambulatory Cancer Patients: From the Guidelines to Clinical Practice.

Many cancer patients will experience venous thromboembolism (VTE) at some stage, with the highest rate in the initial period following diagnosis. Novel cancer therapies may further enhance the risk. VTE in a cancer setting is associated with poor prognostic, a decreased quality of life, and high healthcare costs. If thromboprophylaxis in hospitalized cancer patients and perioperative settings is widely accepted in clinical practice and supported by the guidelines, it is not the same situation in ambulatory cancer patient settings. The guidelines do not recommend primary thromboprophylaxis, except in high-risk cases. However, nowadays, risk stratification is still challenging, although many tools have been developed. The Khrorana score remains the most used method, but it has many limits. This narrative review aims to present the current relevant knowledge of VTE risk assessment in ambulatory cancer patients, starting from the guideline recommendations and continuing with the specific risk assessment methods and machine learning models approaches. Biomarkers, genetic, and clinical features were tested alone or in groups. Old and new models used in VTE risk assessment are exposed, underlining their clinical utility. Imaging and biomolecular approaches to VTE screening of outpatients with cancer are also presented, which could help clinical decisions.

Effect of nusinersen treatment on quality of life and motor function in adult patients with spinal muscular atrophy

The aim of this study was to assess the effect of 4 loading doses of nusinersen on motor function and quality of life (QoL) in adult patients with spinal muscular atrophy (SMA). Twenty-one adult patients with genetically confirmed SMA who were treated with 4 loading doses of nusinersen were included in this study. All patients were evaluated with the Medical Research Council (MRC) scale, the Hammersmith Functional Motor Scale Expanded (HFMSE), and the Short Form Survey-36 (SF-36) at baseline (V1) and before the first nusinersen maintenance treatment, which was at the 15th month of treatment (V2). The SF-36 score was compared between the patients and 35 age-matched healthy controls. Of the twenty-one patients with a median age of 36 years, 10 were nonambulatory, and 11 were ambulatory. The physical component score and the mental component score of the SF-36 were significantly lower in the SMA patient group at baseline than in the healthy group. The median HFMSE scores significantly improved at V2 in both ambulatory and nonambulatory SMA patients (p < 0.05). The median MRC score significantly increased at V2 in the ambulatory SMA patient group (p = 0.04) but not in the nonambulatory SMA patient group (p = 0.19). There was a significant improvement in physical QoL in all the SMA patients at V2 (p = 0.02), but there was no significant improvement in mental QoL (p = 0.15). The loading nusinersen treatment significantly improved motor function scores, muscle strength, and physical QoL.