Careful Assessment Research Articles

Transcultural adaptation and validation of Persian Version of Patient Assessment of Chronic Illness Care (PACIC-5As) Questionnaire in Iranian older patients with type 2 diabetes

BackgroundThe Patient Assessment of Chronic Illness Care (PACIC-5As) questionnaire has been designed to evaluate the healthcare experiences of individuals with chronic diseases such as diabetes. Older adults are at higher risk for diabetes and its associated complications. The aim of this study was transcultural adaptation and evaluation of the validity and reliability of the PACIC-5As questionnaire in older patients with diabetes residing in Qazvin City, Iran.MethodIn this validation study, we recruited 306 older patients with diabetes from Comprehensive Health Centers in Qazvin, Iran. The multi-stage cluster sampling technique was used to choose a representative sample. The PACIC-5As questionnaire was translated into Persian using the World Health Organization (WHO) standardized method. The validity (face, content, and construct) and reliability (Cronbach’s alpha) of the PACIC-5As were assessed. Data analysis was conducted using R software and the Lavaan package.ResultsThe mean age of the older patients was 69.99 ± 6.94 years old. Most older participants were female (n = 180, 58.82%) and married (n = 216, 70.59%). Regarding face validity, all items of PACIC-5As had impact scores greater than 1.5. In terms of content validity, all items had a content validity ratio > 0.49 and a content validity index > 0.79. The results of confirmatory factor analysis demonstrated that the model exhibited satisfactory fit across the expected five factors, including assess, advise, agree, assist, and arrange, for the 25 items of the PACIC-5As questionnaire. The Cronbach’s alpha coefficient for the PACIC-5As questionnaire was 0.805.ConclusionThis study indicates that the Persian version of the PACIC-5As questionnaire is valid and reliable for assessing healthcare experiences in older patients with diabetes. This means that the questionnaire can be effectively used in this population.

Emerging Trends in Pre-Anesthetic Assessment: A Systematic Review of Novel Approaches and Technologies

In order to understand the current evolution, this systematic review examines the advances in preanesthetic assessment. Although the paper demonstrates the potential to revolutionize patient care, it also recognizes its limitations. These include publication bias and search limitations. At the same time, the general exposure to advances in preoperative care, including but not limited to technology and patient-centered approaches, may be valuable to the research. The nature of survey research is complicated because studies vary in quality and are prone to bias. Nevertheless, studies should be conducted on a regular basis, and techniques for assessing preanesthetic should be improved. Furthermore, this improvement should take into account patient outcomes and their subsequent need for surgical safety. Although achievements in assessment systems have limitations, prospective developments aim to fill gaps, including deficiencies in current approaches. This fact is beneficial for both patients and healthcare providers, and underscores the importance of innovation and EBP practices for preanesthetic assessment and overall quality of perioperative care.

A Literature Review of Cutibacterium Acnes: From Skin Commensal to Pathogen in Shoulder Surgery.

Cutibacterium acnes, previously known as Propionibacterium acnes, is a gram-positive rod in the pilosebaceous glands and commonly implicated in acne vulgaris. Its role in prosthetic joint infections, particularly in shoulder surgeries, has recently gained attention due to its prevalence around the shoulder girdle. This review collates evidence on the pathogenic role of C. acnes in shoulder surgeries, discussing preventive measures, risk factors, clinical presentation, investigation, and treatment strategies. C. acnes infections are complex, often presenting with non-specific symptoms and delayed diagnoses. Risk factors include male sex, presence of hair, shoulder steroid injections, and previous shoulder surgeries. Investigations such as inflammatory markers, synovial fluid analysis, diagnostic arthroscopy, tissue cultures, and advanced molecular techniques like next-generation sequencing and multiplex polymerase chain reaction are explored for their effectiveness in detecting C. acnes. Treatment strategies range from prolonged antibiotics and antibiotic spacers to single-stage and two-stage revision surgeries. Studies indicate that single-stage revision may provide better outcomes compared to two-stage revision. Effective management of C. acnes infections requires careful assessment, relevant investigations, and tailored treatment approaches. This review emphasizes the need for further research to address intraoperative contamination and to develop more efficient diagnostic and treatment methods.

A Decade of Monitoring Primary Healthcare Experiences through the Lens of Inequality.

Health care is not exempt from harboring social inequalities, including in those countries with a universal public system. The objective was to ascertain whether the population's assessment of primary care (PC) changed between 2006 and 2016, the decade that included the economic crisis of 2008, and also if it exhibited patterns of social inequality in Barcelona (Spain). This was a cross-sectional study using Barcelona Health Surveys 2006 and 2016. Samples (4027 and 3082 respectively) comprised residents in Barcelona, over 15 years old. Primary Care (PC) index. age, social class, and birthplace. Analyses included means and percentiles of PC index, and Somers' D test to compare the distribution of the groups. Comparing 2016 with 2006, the distribution of the PC index remained in women (median of 73.3) and improved in men (from 70 to 73.3). By social class, the pattern of inequality observed in 2006 in men with perceived poor health status disappeared in 2016. Inequalities according to birthplace persisted in women, regardless of perceived health status, but disappeared in men. In the 10 years between which the global economic crisis occurred, the assessment of PC did not worsen, and it did improve for men, but the study points to the need for more focus on people born abroad.

Minimizing the Risk of Diagnostic Errors in Acute Care for Older Adults: An Interdisciplinary Patient Safety Challenge.

Modern healthcare systems are increasingly organized according to diagnosis-specific clinical pathways and treatment protocols. At the same time, the number of patients with complex problems and needs that do not fit the single-diagnosis approach is rising, contributing to a high prevalence of diagnostic errors. In this article, we focus on the risk of diagnostic errors arising from missed or incomplete diagnosis and assessment of older adult patients' care needs in the first hours of acute hospitalizations in EDs. This focus is important for improving patient safety, as clinical decisions made in EDs impact patient safety in the subsequent steps of the process, thereby potentially causing new risks to arise. Based on our discussion of clinical decision-making and diagnostic errors in the acute care context, we propose a more comprehensive interdisciplinary approach to improvements in patient safety that integrates organizational and clinical research and examines where, when, how, and why risks to patient safety arise in and across different clinical-organizational contexts.

Identification of Pain through Actigraphy-Recorded Patient Movement: A Comprehensive Review.

Chronic pain affects over 50 million people in the United States, particularly older adults, making effective assessment and treatment essential in primary care. Actigraphy, which monitors and records limb movement to estimate wakefulness and sleep, has emerged as a valuable tool for assessing pain by providing insights into activity patterns. This review highlights the non-invasive, cost-effective nature of actigraphy in pain monitoring, along with its ability to offer continuous, detailed data on patient movement. However, actigraphy's reliance on physical activity as a proxy for pain, and its inability to directly measure pain intensity, limit its applicability to certain pain types, such as neuropathic pain. Further research is needed to overcome these limitations and to improve the effectiveness of actigraphy in diverse clinical settings.

The (dis)continuing of antithrombotic drugs and its implications for occurrence of adverse cardiovascular and bleeding events in cancer patients during end of life

Background and ObjectivesFor patients receiving end-of-life care, adjusting polypharmacy and deprescription of potentially harmful medicines are important impactors on quality-of-life. Antithrombotic therapies (ATT) are used by 30-50% of patients with cancer, rising to 80% in older cancer patients, and are often continued until a quality-of-life-impacting bleeding event, or a patient is physically unable to take oral medication. We aimed to describe the use of ATT and occurrence of clinical outcomes in patients with cancer during end-of-life care. ApproachLinked health and administrative data in SAIL were used to identify end-of-life cancer patients diagnosed in Wales, focusing on cancer types with an estimated 1-year survival time. Survival analysis was used to describe current ATT usage and to investigate the associations between ATT usage and major cardiovascular and bleeding events. Results21,880 individuals were diagnosed with the pre-defined cancer types between January 2013 and December 2019, 5,660 (26%) of these were taking ATT at diagnosis. During the study period 1670 (30%) were discontinued. Median survival time of patients taking ATT at diagnosis was 169 (IQR 158-180) days, while median time to deprescription was 206 (IQR 190-224) days. Among ATT-users diagnosis, 460 (8%) and 900 (16%) experienced a major bleed or a cardiovascular event, respectively, within 1 year following diagnosis, compared to 1100 (7%) and 1930 (12%) among those who were not prescribed ATT at diagnosis. Conclusions and ImplicationsOur research highlights the need for careful assessment and management of ATT in the interest of improving quality-of-life for patients with cancer during end-of-life care.

Elderly Cruelty: What is the Role of the Caregiver?

Objective: The objective of this study is to identify studies on the prevalence of abuse in the elderly and to estimate the profile of the caregiver of the elderly and the possible reasons that lead them to present a relationship of mistreatment towards the elderly. Theoretical Framework: Population aging is a global phenomenon that has led to an increase in the demand for long-term care for the elderly. In this context, the role of the caregiver, whether formal or informal, becomes crucial for the well-being of this population. Method: Systematic review of population-based studies in electronic databases (PubMed and LILACS), covering the last 15 years. Population-based studies were included and studies without a defined methodological definition were excluded. Results and Discussion: Thirty-eight articles were found, but only 13 articles were selected. The prevalence studies found coefficients of mistreatment, with physical abuse between 1.2% and 18%. The overload of daily primary care and the lack of careful assessment and subsequent appropriate treatment of the caregiver appear to be related to this relationship of mistreatment. Research Implications: The research may influence the formulation and implementation of public policies aimed at protecting the elderly from abuse. This includes the creation of training programs for caregivers and the strengthening of legislation that protects the elderly. Originality/Value: Although there are several studies on mistreatment of the elderly, the originality of this research lies in its specific approach to the role of caregivers, both formal and informal, in the occurrence or prevention of such mistreatment.

EP503 - A retrospective assessment of quantitative futility in emergency laparotomy using pre-operative frailty as the predictor

Abstract Background Recent literature has proposed that emergency laparotomy in the frail population may be qualitatively futile leading to negative desired morbidity and missed opportunities for palliation. The aim of this study was to appraises the futility of emergency laparotomies within a 3 month period based on the predictor of pre-operative frailty with in a large district general hospital. Method Retrospective analysis of all patients undergoing emergency laparotomy in a 3 month time period in the Dumfries Royal Infirmary. Futility was defined as all-cause mortality within 3 days of emergency laparotomy and frailty based on the characteristics set out by the Rockwood frailty score. A assessment of surgical futility in emergency laparotomy was carried out based on the pre-operative frailty. Conclusions Increased frailty demonstrates an increase in futile emergency laparotomies. It is therefore recommended that a multidisciplinary team approach with careful assessment and consent should be made prior to any surgical intervention on this patient cohort.

The experience sampling methodology as a digital clinical tool for more person-centered mental health care: an implementation research agenda.

This position paper by the international IMMERSE consortium reviews the evidence of a digital mental health solution based on Experience Sampling Methodology (ESM) for advancing person-centered mental health care and outlines a research agenda for implementing innovative digital mental health tools into routine clinical practice. ESM is a structured diary technique recording real-time self-report data about the current mental state using a mobile application. We will review how ESM may contribute to (1) service user engagement and empowerment, (2) self-management and recovery, (3) goal direction in clinical assessment and management of care, and (4) shared decision-making. However, despite the evidence demonstrating the value of ESM-based approaches in enhancing person-centered mental health care, it is hardly integrated into clinical practice. Therefore, we propose a global research agenda for implementing ESM in routine mental health care addressing six key challenges: (1) the motivation and ability of service users to adhere to the ESM monitoring, reporting and feedback, (2) the motivation and competence of clinicians in routine healthcare delivery settings to integrate ESM in the workflow, (3) the technical requirements and (4) governance requirements for integrating these data in the clinical workflow, (5) the financial and competence related resources related to IT-infrastructure and clinician time, and (6) implementation studies that build the evidence-base. While focused on ESM, the research agenda holds broader implications for implementing digital innovations in mental health. This paper calls for a shift in focus from developing new digital interventions to overcoming implementation barriers, essential for achieving a true transformation toward person-centered care in mental health.

Fluid management in the septic peri-operative patient.

This review provides insight into recent clinical studies involving septic peri-operative patients and highlights gaps in understanding fluid management. The aim is to enhance the understanding of safe fluid resuscitation to optimize peri-operative outcomes and reduce complications. Recent research shows adverse surgical and clinical outcomes with both under- and over-hydration of peri-operative patients. The kinetic of intravenous fluids varies significantly during surgery, general anaesthesia, and sepsis with damage to endothelial glycocalyx (EG), which increases vascular permeability and interstitial oedema. Among clinical anaesthesia, neuraxial anaesthesia and sevoflurane have less effect on EG. Hypervolemia and the speed and volume of fluid infusion are also linked to EG shedding. Despite improvement in the antisepsis strategies, peri-operative sepsis is not uncommon. Fluid resuscitation is the cornerstone of sepsis management. However, overzealous fluid resuscitation is associated with increased mortality in patients with sepsis and septic shock. Personalized fluid resuscitation based on a careful assessment of intravascular volume status, dynamic haemodynamic variables and fluid tolerance appears to be a safe approach. Balanced solutions (BS) are preferred over 0.9% saline in patients with sepsis and septic shock due to a potential reduction in mortality, when exclusive BS are used and/or large volume of fluids are required for fluid resuscitation. Peri-operative goal-directed fluid therapy (GDFT) using dynamic haemodynamic variables remains an area of interest in reducing postoperative complications and can be considered for sepsis management (Supplementary Digital Content). Optimization of peri-operative fluid management is crucial for improving surgical outcomes and reducing postoperative complications in patients with sepsis. Individualized and GDFT using BS is the preferred approach for fluid resuscitation in septic peri-operative patients. Future research should evaluate the interaction between clinical anaesthesia and EG, its implications on fluid resuscitation, and the impact of GDFT in septic peri-operative patients.

Management of anesthesia in elderly patients, special considerations and challenges

Introduction: Anesthesia management in elderly patients presents distinct challenges due to physiological changes related to aging. Comorbidities, physical frailty and increased risk of postoperative complications are important aspects to be considered. Methods: Systematic reviews of the literature and analyzes of clinical and experimental studies that addressed the management of anesthesia in elderly patients were carried out. Articles published in English, Spanish and Portuguese were selected. The keywords used were "anesthesia in the elderly", "preoperative assessment", "anesthetic techniques", "intraoperative monitoring", "postoperative pain control" and "prevention of complications". Results: Comprehensive and individualized preoperative assessment was identified as crucial for identifying and treating comorbidities and physical frailty in elderly patients. The choice of the appropriate anesthetic technique depends on the type of surgery and the patient's clinical conditions. Careful monitoring during anesthesia, including blood pressure, heart rate, oxygenation and capnography, is essential to detect and intervene early on hemodynamic and respiratory changes. Postoperative pain control in the elderly requires an individualized approach, with appropriate use of analgesics and regional blocks. Complication prevention strategies, such as optimizing hydration, glycemic control, early mobilization and appropriate use of medications, are essential to reduce the risk of delirium, infection and cognitive dysfunction. Conclusion: Anesthesia management in elderly patients requires an individualized and comprehensive approach, taking into account physiological changes related to aging and associated comorbidities. Careful preoperative assessment, appropriate choice of anesthetic technique, strict intraoperative monitoring, postoperative pain control and prevention of complications are essential to ensure a safe perioperative period and successful recovery in the elderly. Keywords: anesthesia in the elderly, preoperative assessment, anesthetic techniques, intraoperative monitoring, postoperative pain control, prevention of complications.

Psychometrics of the modified family-centered care assessment short version for childhood obesity

BackgroundIncorporating principles of family-centered care into pediatric weight management interventions can improve the effectiveness and quality of treatment and reduce attrition rates. To assess the family-centeredness of interventions, reliable, valid, and easy-to-administer scales are needed. The purpose of the study was to develop a shortened version of the modified Family Centered Care Assessment (mFCCA) and assess its psychometric properties.MethodsThe mFCCA, a scale to assess the family-centeredness of interventions for childhood obesity, was administered to families following the Connect for Health randomized control trial evaluating the effectiveness of a primary care-based pediatric weight management intervention. We iteratively removed items from the mFCCA and used Rasch modeling to examine the reliability and validity of the shortened scale.ResultsWe included data from 318 parents and the exploratory factor analysis showed the presence of a single factor. The results of the Rasch modeling demonstrated acceptable internal consistency of the scale (0.7) and strong validity as evidenced by the overall model fit and range of item difficulty. Following the psychometric analyses, we reduced the number of items from 24 to 8 items.ConclusionThe mFCCA short version demonstrates good psychometrics and can be used to evaluate the family-centeredness of childhood obesity interventions with reduced participant burden, thereby improving outcomes for children with obesity.Trial registrationClinicaltrials.gov NCT02124460 registered on April 24, 2014.

Emerging occupational risks in green jobs: a review.

Green jobs are to be understood as those jobs directly associated with specific sustainability issues and activities related to the efficiency, quality and innovation of goods and services offered, from an eco-sustainability perspective. The objective of the research was to fill knowledge gaps of new and emerging environmental and occupational risks related to sustainable activities and to understand the impact these might have on workers' psychological and physical well-being. A selection of several scientific articles and a critical analysis of the selected articles was carried out from the perspective of defining the concept of "emerging occupational risks in green jobs," using different keywords in the title or abstract as search criteria. Emerging occupational risks, most prevalent in the green sector are those determined by the rapid introduction of new technologies, new materials, new processes and work organizations. In order to be able to improve prevention and protection at work, it is necessary to act on a more careful and adequate risk assessment, the definition of new professional figures expert in green issues, the expansion of research and development of scientific knowledge, and the improvement of ergonomic aspects. Int J Occup Med Environ Health. 2024;37(3):244-56.

Psychological Assessment for Gender-Affirming Care in Transgender and Nonbinary Youth: The Companionship Model.

This article introduces The Companionship Model as a template for conducting ethical and affirming assessment sessions for transgender and nonbinary youths (TNBY) and their guardians. The Companionship Model emphasizes proactive clinical companionship as TNBY and their guardians navigate access to gender-affirming care. The model offers specific action steps for establishing a therapeutic alliance and centers TNBY and their guardians' access to resources based on the informed consent/assent process. In this article, we provide sample session questions and illustrative clinical examples.

Integrating Fitness Training in Oncologic Care: Lessons Learned from a Large Telemedicine Trial

ObjectiveTo provide insights from patients and clinicians regarding the benefits and barriers of the introduction of a telerehabilitation fitness program into the oncologic care of people with late-stage cancer. DesignThis study is a qualitative assessment of the COllaborative Care to Preserve PErformance in Cancer trial, which involved the insertion of a telerehabilitation fitness program into the oncologic care of patients with late-stage cancer. SettingA large midwestern medical center. ParticipantsThirty-one patients who matched the overall demographics of the study participants as well as 3 oncologists, 2 physical therapist fitness care managers (FCMs), nurse pain care manager, and 2 supervisory physicians involved in the study. InterventionsFive hundred sixteen patients with late-stage (IIIC or IV) cancer were randomly assigned to 1 of 3 arms: a control group that received usual oncologic care and 2 intervention groups. The members of the latter continued with their usual care but also received either 6 months of a fitness program, with or without the addition of pain management assistance. All components were delivered via telemedicine with the fitness program consisting of progressive resistance and walking components. Main Outcome MeasuresPerceived benefits and shortcomings of the intervention were obtained via written narratives from the patients and as well as through interviews with the oncologists, FCMs, nurse pain care manager, and supervisory physicians involved in the study. ResultsThematic analysis revealed 87% (27/31) of the participants found the program helpful. Regular contact with someone who understood their situation, helped improve their function, and encouraged active engagement in their care was perceived as particularly beneficial. The FCMs who worked remotely with participants to coordinate their exercise programs agreed that regular interactions with the patient facilitated engagement, education, and meaningful goal setting. The oncologists were supportive of the intervention but had concerns about patient suitability. The supervisory physicians noted a number of institutional barriers such as oncology workflows and the need for better sharing of information across disciplines. ConclusionsA fitness program delivered via telemedicine was perceived as beneficial by the patients, the FCMs, and the supervising physicians. Success hinged on the quality of the interaction between patients and the FCMs. Institutional barriers to implementation seem similar to those encountered by many new programs that need to be inserted into the workflows of busy clinics and practices.

An all-sky catalogue of stellar reddening values

Context. When observing astronomical objects, we have to deal with extinction (i.e. the absorption and scattering of the emitted radiation by dust and gas between the source and the observer). Interstellar extinction depends on the location of the object and the wavelength. The different extinction laws describing these effects are difficult to estimate for a small sample of stars. Aims. Many sophisticated and automatic methods have recently been developed for estimating astrophysical parameters (age and metallicity, for example) depending on the reddening, which is normally treated as a free parameter within the corresponding estimations. However, many reddening values for stars have been published over the last few decades, most of which include observations in the ultraviolet, which are essential for a good estimation but are essentially no longer taken into account. Methods. We searched the literature through the end of 2022 for published independent reddening values of stellar objects based on various methods that exclude estimates from reddening maps. In addition, we present new reddening estimates based on the classical photometric indices in the Geneva, Johnson, and Strömgren-Crawford systems. These are based on well-established and reliable calibrations. Results. After a careful identification procedure and quality assessment of the data, we calculated the mean reddening values of 157 631 individual available measurements for 97 826 objects. We compared our results with the ones from recent automatic pipeline values, including those from the Gaia consortium. In addition, we chose star cluster members to compare their mean values with estimates for the corresponding aggregates. Within the different references, we find several statistically significant offsets and trends and discuss possible explanations for them. Conclusions. Our new catalogue can serve as a starting point for calibrating and testing automatic tools such as isochrone and spectral energy distribution fitting. Our sample covers the whole sky, including the Galactic field, star clusters, and Magellanic Clouds, and so can be used for a variety of astrophysical studies.

Patterns of acute chest pain at two tertiary centres in Accra, Ghana.

To assess the clinical presentation and evaluation of acute life-threatening chest pain in Accra, Ghana. This was a cross-sectional study at the emergency departments of two leading tertiary hospitals in Accra. The study was conducted at the Korle-Bu Teaching Hospital and the 37 Military Hospital in Accra. The study participants comprised adult patients aged 18 years and above who presented with acute chest pain at the emergency departments between April and June 2018. Acute coronary syndrome is the leading life-threatening cause of chest pain with poor pre- and in-hospital care. 232 patients with chest pain were enrolled as respondents aged 18 to 94 years. The prevalence of life-threatening conditions causing chest pain was 31.9% of those who presented with acute chest pain. These included acute coronary syndrome (82.4%), pulmonary embolism (14.9%), and acute chest syndrome (2.7%). A few (6.6%) with life-threatening conditions such as acute coronary syndrome were transported by ambulances, and 44.3% reported to the facility within 2 to 9 days after the onset of chest pain. None of the patients with pulmonary embolism and acute chest syndrome had computer tomography pulmonary angiogram (CTPA) and echocardiogram done, respectively. Our study found that life-threatening conditions amongst patients presenting with acute chest pains are common; however, there is a need to improve pre-hospital care and in-hospital assessment of these cases. The study was partly funded by the Medtronic Foundation.

Point of care ultrasound and shock: The value in bedside diagnosis and hemodynamic assessment in undifferentiated shock patients

Point of care ultrasound (POCUS) was introduced as a tool for critical care assessment in the 1990s and has since grown to be a tool for quantitative and qualitative data. Adopted initially by the emergency medicine community, it has recently been integrated into medical education for numerous specialties. It remains a valuable adjunct in the initial evaluation of patients as a widely available portable resource and provides real-time imaging. In patients who present in undifferentiated shock, visualization of the heart and lungs using POCUS can help delineate the cause of the clinical decompensation. Cardiac evaluation can look for right and left ventricular dysfunction, estimate left ventricle ejection fraction, evaluate for cardiac tamponade, and detect new wall motion abnormalities. Assessment of the lungs can add additional insight into underlying pathology. In patients who suffer cardiac arrest, POCUS can help identify any potentially reversible causes. It can also be used for hemodynamic assessment to aid in the resuscitation of patients with shock by evaluating of the inferior vena cava, hepatic, and renal veins. Here we provide a resource to describe not only the numerous benefits of POCUS in assessing and monitoring critically ill patients, but also the imaging findings of life-threatening diagnoses.

Atezolizumab Plus Bevacizumab Treatment for Unresectable Hepatocellular Carcinoma: Real-life Experience from a Single Tertiary Centre in Spain and ALBI Score as a Survival Prognostic Factor.

Atezolizumab/bevacizumab (atez/bev) has been established as first-line systemic treatment for hepatocellular carcinoma (HCC). However, concerns regarding safety and efficacy have been raised, and no biomarkers to predict response have yet been identified. We aimed to evaluate the real-life experience of atez/bev in a Spanish tertiary hospital and identify factors associated with overall survival (OS). A prospective study of consecutive patients with HCC treated with atez/bev was conducted from December 2020 to December 2022. Efficacy was assessed through OS and progression-free survival (PFS), whereas safety was evaluated based on adverse events (AE). Twenty-three patients were included; 91% were males with a mean of 70 years. Thirteen patients were classified as having BCLC-C. The median treatment duration was 126 days (range=567). Median OS was 381 days (95%CI=205-557) with a cumulative probability of death of 13%, 30%, and 49% at 3, 6 and 12-month follow-up, respectively. The only factor associated with OS was the ALBI score (HR=5.03; 95%CI=1.3-19.1), which showed an AUROC of 0.906 (95%CI=0.78-1.00) for the risk of death at 18 months follow up. Median PFS was 141 days (95%CI=110-172). Twenty (86.9%) patients experienced AE, which in nine (39.1%) cases led to the definitive discontinuation of the treatment, four of them (17.4%) due to an AE grade 5. The initial experience with atez/bev at our center demonstrated poorer outcomes compared to the original trial (IMbrave150). A careful assessment of the ALBI score may serve as a crucial factor in the selection of systemic treatment for patients with HCC.