Baseline Values Research Articles

Assessing Adherence to the PRISMA-DTA Guideline in Diagnostic Test Accuracy Systematic Reviews: A Five-Year Follow-up Analysis.

We evaluated reporting of diagnostic test accuracy (DTA) systematic reviews using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-DTA and PRISMA-DTA for abstracts. We searched MEDLINE for recent DTA systematic reviews (September 2023-Mar 2024) to achieve a sample size of 100. Analyses evaluated adherence to PRISMA-DTA (and abstracts), on a per-item basis. Association of reporting with journal, country, impact factor (IF), index-test type, subspecialty area, use of supplemental material, PRISMA citation, word count, and PRISMA adoption was evaluated. Comparison to the baseline evaluation from 2019 was done. Protocol: https://doi.org/10.17605/OSF.IO/P25TE. Overall adherence (n = 100) was 78% (20.3/26.0 items, SD = 2.0) for PRISMA-DTA and 52% (5.7/11.0 items, SD = 1.6) for abstracts. Infrequently reported items (<33% of studies): eligibility criteria, definitions for data extraction, synthesis of results, and characteristics of the included studies. Infrequently reported items in abstracts were characteristics of the included studies, strengths and limitations, and funding. Reporting completeness for full text was minimally higher in studies in higher IF journals [20.7 vs 19.8 items; 95% confidence interval (95%CI) (0.09; 1.77)], as well as studies that cited PRISMA [21.1 vs 20.1 items; 95%CI (0.04; 1.95)], or used supplemental material (20.7 vs 19.2 items; 95%CI (0.63; 2.35)]. Variability in reporting was not associated with author country, journal, abstract word count limitations, PRISMA adoption, structured abstracts, study design, subspecialty, open-access status, or index test. No association with word counts was observed among full text or abstracts. Compared to the baseline evaluation, reporting was improved for full texts [71% to 78%; 95%CI (1.18; 2.26)] but not for abstracts [50% to 52%; 95%CI (-0.20; 0.60)]. Compared to the baseline evaluation published in 2019, we observed modest improved adherence to PRISMA-DTA and no improvement in PRISMA-DTA for abstracts reporting.

Long Term Outcome Among HCV-Infected People Who Use Drugs (PWUD) Successfully Treated for HCV Infection with Glecaprevir/Pibrentasvir (G/P)

BackgroundSeveral clinical trials, including the recently published GRAND PLAN study from Vancouver Infectious Diseases Center (VIDC), have demonstrated the efficacy of HCV therapy among active drug users, including those facing significant addiction-related and social challenges. In GRAND PLAN, we documented SVR12 in 108/117 (92.3%) individuals (108/111 (mITT) or 97.3% of those reaching the SVR12 timepoint) receiving an 8-week course of Glecaprevir/Pibrentasvir (G/P), with almost all using fentanyl and over half being unstably housed. Data on the maintenance of this favorable outcome in the long term in such a population with a significant risk of reinfection are limited. We hypothesized that the offer of ongoing multidisciplinary care (including addiction care) after SVR12 was achieved would reduce the likelihood of loss to follow up, HCV reinfection or death and consolidate the gains achieved by initial engagement in care to diagnose and treat HCV infection. MethodsThe inception cohort for this analysis was the 108 individuals achieving a cure of HCV infection within the GRAND PLAN study. All were offered the opportunity to continue to receive care at VIDC. This is a multidisciplinary model of care to address medical, mental health, social and addiction-related concerns on an ongoing basis. This included, if necessary, opiate agonist and safer supply therapy, usually provided by the pharmacy adjacent to our inner-city campus. Among those choosing to be retained in care, the endpoint of this analysis was loss to follow up, mortality and HCV reinfection and their correlates. Reinfection was ascertained by repeat HCV RNA testing every 6 months, more frequently if clinically indicated. ResultsOf the 108 individuals making up the inception cohort for this analysis, all chose to remain in care at VIDC. We note median age 47 (22-75) years, 28% female, 21.3% identifying as indigenous, the majority with mild fibrosis (90.8% F0-F2), slightly more than half with unstable housing. It is of note that we recorded a 20% decrease in fentanyl users among those who were cured compared to the baseline evaluation of the overall study cohort (73.5% vs 94.9%, p < 0.000001). Among the cured individuals, 104 (96.3%) remained alive, while 4 individuals died of opioid overdoses. Out of the 104 patients, 99 (95.2%) remained HCV-free, while 5 (4.8%) were re-infected. All five have recently initiated repeat HCV therapy at VIDC, 2 of whom are already documented to be cured. ConclusionAmong a population of vulnerable inner-city residents cured of HCV infection within a multidisciplinary program of care at VIDC, all accepted the offer to remain in long-term follow up, with a statistically significant reduction in fentanyl use over time. In the setting of an ongoing opioid crisis where 3 deaths/day are recorded in the neighborhood where the study population resides, we documented 4 deaths. Reinfections occurred at a very modest rate, with maintenance in care allowing prompt re-treatment, with a cure already being documented in 2/5 cases, with the other 3 individuals remaining on HCV therapy at VIDC.

The effects of Dapagliflozin in a real-world population of HFrEF patients with different hemodynamic profiles: worse is better

BackgroundSodium-Glucose Cotransporter-2 inhibitors (SGLT2i) represent a deep revolution of the therapeutic approach to heart failure (HF), preventing its insurgence but also improving the management of the disease and slowing its natural progression. To date, few studies have explored the effectiveness of SGLT2i and, in particular, Dapagliflozin in a real-world population. Therefore, in this observational prospective study, we evaluated Dapagliflozin's effectiveness in a real-world HF population categorized in the different hemodynamic profiles.MethodsFrom January 2022 to June 2023, we enrolled 240 patients with chronic HF and reduced ejection fraction (HFrEF) on optimal medical therapy, according to 2021 ESC guidelines, that added treatment with Dapagliflozin from the HF Clinics of 6 Italian University Hospitals. Clinical, biochemical, and echocardiographic parameters were collected before and after 6 months of Dapagliflozin introduction. Moreover, the HFrEF population was classified according to hemodynamic profiles (A: SV ≥ 35 ml/m2; E/e′ < 15; B: SV ≥ 35 ml/m2; E/e′ ≥ 15; C: SV < 35 ml/m2; E/e′ < 15; D: SV < 35 ml/m2; E/e′ ≥ 15). Then, we compared the Dapagliflozin population with two retrospective HF cohorts, hereinafter referred to as Guide Line 2012 (GL 2012) group and Guide Line 2016 (GL 2016) group, in accordance with the HF ESC guidelines in force at the time of patients enrolment. Precisely, we evaluated the changes to baseline in clinical, functional, biochemical, and echocardiographic parameters and compared them to the GL 2012 and GL 2016 groups.ResultsDapagliflozin population (67.18 ± 11.11 years) showed a significant improvement in the echocardiographic and functional parameters (left ventricular ejection fraction [LVEF], LV end-diastolic volume [LVEDV], LVEDV index, stroke volume index [SVi], left atrium volume index [LAVi], filling pressure [E/e′ ratio], tricuspid annular plane systolic excursion [TAPSE], tricuspid annular S′ velocity [RVs’], fractional area change [FAC], inferior vena cava [IVC diameter], pulmonary artery systolic pressure [sPAP], NYHA class, and quality of life) compared to baseline. In particular, TAPSE and right ventricle diameter (RVD1) ameliorate in congestive profiles (B and D); accordingly, the furosemide dose significantly decreased in these profiles. Comparing the three populations, the analysis of echocardiographic parameters (baseline vs follow-up) highlighted a significant decrease of sPAP in the Dapagliflozin population (p < 0.05), while no changes were recorded in the GL 2012 and GL 2016 population. Moreover, at the baseline evaluation, the GL 2012 and 2016 groups needed a higher significant dose of furosemide compared to Dapagliflozin group. Finally, Dapagliflozin patients had significantly fewer rehospitalizations (1.25%) compared with the other two groups (GL 2012 18.89%, p 0.0097; GL 2016 15.32%, p 0.0497).ConclusionsWe demonstrate that Dapagliflozin is rapidly effective in an HFrEF real-world population; furthermore, the more significant effect is recorded in HFrEF patients with a congestive profile (B and D), supporting the introduction of Dapagliflozin in patients with a congestive profile and a worse prognosis. In conclusion, our data suggest evaluating the patient's hemodynamic state beyond LVEF in HFrEF.

Assessing research culture and capacity amongst faculty at a North American chiropractic institution: an explanatory mixed methods study

BackgroundResearch enables a profession to establish its cultural authority, validate its professional roles and ensure ongoing improvement in the quality of its academic programming. Despite the clear importance of research, a mature research culture has eluded the chiropractic profession. A fostering institutional culture that enables, values, and supports research activity is essential to building research capacity. Our study aimed to collect information about the existing research capacity and culture at the Canadian Memorial Chiropractic College (CMCC) and explore the views, attitudes and experiences of faculty members regarding research.MethodsWe conducted a sequential explanatory mixed methods study with quantitative priority between April and July, 2023. Quantitative data were collected using the Research Capacity and Culture (RCC) tool. Survey results guided the qualitative data collected from four faculty focus groups with varying levels of research experience. Quantitative data were analyzed using descriptive statistics by domain and stratified by research education and workload. The qualitative data were thematically analyzed and then integrated with the quantitative results to provide deeper meaning to the results.ResultsThe faculty survey response rate was 42% (59/144). Attributes at the organization or department level were consistently rated as either moderate or high; however, research skills at an individual level were more variable and influenced by factors such as research workload and highest research-related academic qualification. Qualitative focus group data were categorized under four themes: institutional factors, resource allocation, career pathways and personal factors. Lower scores for survey items related to mentorship, research planning and ensuring faculty research career pathways, as well as the identified workload and time-related barriers (e.g., other work roles and desire for work/life balance) for engaging in research were supported by each of the four themes. Research motivators included keeping the brain stimulated, developing skills and increasing job satisfaction.ConclusionThe quantitative and qualitative information in this study provides a baseline evaluation for RCC and identifies key factors impacting RCC at the CMCC. This information is critical for planning, developing, implementing, and evaluating future interventions to enhance research capacity. Ultimately, these efforts are aimed at maturing the research culture of the chiropractic profession.

Impact of integration of transferable skills into education and training on employability of women in Kenya: case for CAPYEI

Purpose This study evaluated a programme, CAP Youth Empowerment Institute (CAPYEI) that uses Basic Employability Skills Training (BEST) model to contribute the evidence and generate lessons on the type of skills needed to enhance women economic empowerment. The purpose of the study is to generate evidence of what works in women skill acquisition and employability in Kenya. Design/methodology/approach This study adopted a mixed research design incorporating both quantitative and qualitative approaches to conduct an impact evaluation of the CAP YEI training programme on the employability and entrepreneurship of women and girls in Kenya. The design allows for the consideration of two groups: treatment and control groups thus allowing for a clear comparison of outcomes between those who received the training (treatment group) and those who did not (control group). Project evaluation data were collected from both primary and secondary sources. Given that the study was conducted post evaluation, it did not have baseline survey data, therefore an ex post baseline evaluation using a retrospective approach was computed. In the absence of a true baseline, the questionnaire was tailored to allow beneficiary recall. A key design consideration of impact evaluation study was the identification of a valid control group that could generate a suitable counterfactual outcome. Findings The results indicate positive self-evaluation on most of the selected soft skills. For instance, over 80% of both the beneficiaries and non-beneficiaries indicated that they possessed communication, teamwork, interpersonal, decision-making, prioritization, assertiveness and negotiation skills, whereas 58 % and 63 % of the beneficiaries and non-beneficiaries, respectively, indicating that they possessed information and communication technology (ICT) skills. Results indicate that skills development improves chances of employment among the target group and especially women. The results indicate that addressing gender inequality requires targeted interventions. The targeted interventions could be aimed at ensuring that women and girls are empowered to compete favourable with men and boys in the labour market. Research limitations/implications This study was an evaluative study of the impact of an intervention in a single case study. This means while the findings of the study are relevant to policy and practice, they cannot be generalized to a broader populace. The absence of base-line data rendered the use of comparative data impossible. Data generated through self-reported assessment of intervention impacts are prone to responder biases, which may raise questions about the validity of the findings. Practical implications This study recommends integration of transferable skills training in teaching and training institutions to enhance competitiveness, employability and entrepreneurship chances of the graduates in the labour market. The study is significant in informing policy direction in Kenya. Originality/value This study evaluated a model of integrating transferable skills into a young women training programme and evaluated its impacts with a view of documenting what works for women employability. This case is a unique one in the country specific context.

Acute effects of motor imagery interventions and physical exercise on tongue strength and pain in healthy adults: a randomized, crossover trial

BackgroundMotor imagery (MI) has increasingly been used in physiotherapy. Oral rehabilitation may be a potential application area for MI. The aim of this study is to investigate the acute effects of orofacial and tongue muscle strengthening exercises in the form of physical exercise and motor imagery on pain and tongue strength in healthy adults.Thirty asymptomatic adults were included in this trial. MI skills were evaluated using the Movement Imagery Questionnaire-Revised and the mental chronometer. The pain and strength were assessed using an algometer and a tongue pressure device. Following the baseline evaluations, three interventions: physical exercise, kinesthetic motor imagery, and visual motor imagery, were applied randomly on different days. Pain and tongue strength were re-evaluated immediately after the interventions.ResultsThe physical exercise program did not significantly improve pain and tongue strength (p > 0.05). Following the kinesthetic MI training, a significant increase was detected (p = 0.016, d = 0.51) in the left masseter muscle pain threshold. Visual MI training resulted in improvements in anterior tongue strength (p = 0.002, d = 0.66) and left masseter muscle pain (p = 0.024, d = 0.40).ConclusionsThe present study suggests that different motor imagery strategies may have different effects on tongue muscle strength and pain threshold in healthy adults.

Safety outcomes and immunological correlates in a prospective clinical trial of immune checkpoint therapy plus debulking surgery for patients with metastatic renal cell carcinoma.

Surgical removal of primary tumors was shown to reverse tumor-mediated immune suppression in pre-clinical models with metastatic disease. However, how cytoreductive surgery in the metastatic setting modulates the immune responses in patients, especially in the context of immune checkpoint therapy (ICT)-containing treatments is not understood. Here, we report the first prospective, non-comparative clinical trial to evaluate the feasibility, clinical benefits, and immunologic changes of combining three different ICT-containing strategies with cytoreductive surgery or biopsy for patients with metastatic clear cell renal cell carcinoma (mccRCC). Based upon baseline evaluation and surgical eligibility after 6 weeks of ICT treatment, 43 patients on this trial proceeded with cytoreductive surgery, while 36 patients who had medical comorbidities preventing surgery or did not have a lesion amenable for surgical resection underwent post-ICT biopsy as specified in the clinical trial protocol, and 25 patients who discontinued study participation due to progressive disease or toxicities or withdrawal of consent did not receive either procedure (total N=104). Our data demonstrated that, in the subgroup of patients receiving the combination of ICT with cytoreductive surgery or biopsy, no additional ICT- or procedure-related toxicities were observed as compared to historical data. The median OS (overall survival) was 54.7 months for patients who received ICT-containing regimens plus cytoreductive surgery (n=43). Immune-monitoring studies with co-detection by indexing (CODEX) identified distinct tumor spatial conformation of cellular subsets as a novel and improved predictor of response to ICT. Importantly, single-cell RNA-sequencing (sc-RNA-seq) data demonstrated that surgical removal of the tumor increased antigen-presenting dendritic cell population with a concurrent reduction in KDM6B-expressing immune-suppressive myeloid cells in the peripheral blood. Together, this study highlighted the feasibility of combining ICT with cytoreductive surgery in a metastatic setting and demonstrated the potential enhancement of immune responses following ICT plus cytoreductive surgery in patients with metastatic disease.

Abstract 4118122: Effect of Beta Blockers on Exercise Capacity, Diastolic Function, and Quality of Life in Patients with Heart Failure with Preserved Ejection Fraction

Introduction: In recent landmark HFpEF trials, 75-80% of patients are taking beta blockers (BB) without clear evidence of clinical or symptomatic benefit. Patients with HFpEF commonly have comorbidities that have been classically managed with BB (AF, CAD, HTN), though the utility of this medication class for these conditions is being reconsidered. It remains unclear what impact BB use, in patients with HFpEF, has on exercise capacity, diastolic function, and quality of life. Hypothesis: We hypothesized that BB use is associated with worse exercise capacity, diastolic function, and quality of life in HFpEF patients. Methods: This retrospective cohort study was completed using deidentified patient data from the INDIE-HFpEF and RELAX clinical trials (two trials of HFpEF patients). Patients were divided into two groups based on BB use at trial enrollment. The primary outcomes were exercise capacity, diastolic function, and quality of life at baseline evaluation. A multivariate logistic regression model was used to assess for statistically significant differences after controlling for potentially confounding variables including age, sex, BMI, AF, prior MI, COPD, DM, HTN, serum creatinine, and NYHA functional class. Results: A total of 320 patients were included in this analysis, with 230 on BB (72%). Baseline demographics are shown in Table 1. Patients studied were older (68 years old), white (90%), obese (average BMI 34 kg/m 2 ) individuals with an average LVEF of 61%. Outcomes and multivariate linear regression results are shown in Table 2. After controlling for potential confounding variables, there were no differences in baseline exercise capacity [peak VO2 (mL/kg/min): 12.1 vs 13.2, P=0.233], diastolic function [average E/e’: 14 vs 12, P=0.125; LAVI (mL/m 2 ): 42 vs 37, P = 0.665; peak TR velocity (m/s): 2.8 vs 2.7, P = 0.165; PASP (mmHg): 41 vs 36, P = 0.357], quality of life [KCCQ: 54 vs 58, P = 0.206; MLHFQ 43 vs 46, P = 0.762], or NT-proBNP (633 vs 342; pg/mL, P = 0.208) in HFpEF patients on BB compared to those not on BB. Conclusion: There was no association with BB use and worse exercise capacity, diastolic function, or quality of life in HFpEF patients. This may be due to heterogenous treatment effects, with differing impact of BB based upon the underlying pathophysiology of unique HFpEF phenotypes. To definitively determine the impact of BB use in patients with HFpEF, both on clinical outcomes and symptoms, randomized controlled trials are necessary.

Abstract 4124182: Depression Symptomatology as Predictor of Incident Major Vascular Outcomes: Results from the Hispanic Community Health Study/Study of Latinos

Background: Cardiovascular disease (CVD) has consistently been associated with higher depression symptoms and disorders. Conversely, fewer studies have shown that depression predicts risk of incident CVD and mortality. Objective: To examine the association of depression symptoms with incident major adverse cardiovascular events (MACE) among Hispanics/Latinos living in US. Methods: MACE-free Hispanic Community Health Study/Study of Latinos participants who underwent baseline evaluation between 2008-2011 (n=15,180) were included. MACE was defined as the composite of incident stroke, myocardial infarction (MI), or decompensated heart failure (HF), adjudicated using standard criteria up to year 2019. Depression symptoms were assessed at baseline with a 10-item Center for Epidemiological Studies Depression Scale (CES-D 10, range 0-30 points, 5 points increments), with clinically significant depression defined as CES-D 10 ≥10 points. The incident rate ratio (IRR) of MACE across CES-D 10 scores was determined using Poisson regression models, adjusting for baseline sociodemographic characteristics and Framingham Risk Scores. Analyses were weighted for complex survey design and non-response. Results: The mean age (95% CI) was 40.4 (39.9-40.9) years, and the mean CES-D 10 score was 8.4, 95%CI (7.2-9.5) for those with MACE vs 6.9, 95%CI (6.7-7.0) for individuals without MACE (p&lt;0.05). Clinically significant depression symptoms were present in 29% of the population. There were 321 total MACE outcomes that occurred between baseline and year 2019, with 120 MACE occurrences in individuals with CES-D 10 ≥10 points. In the fully adjusted model, increasing CES-D 10 was associated with higher incidence of MACE (for all: IRR 1.22, 95% CI (1.10-1.36); for those with CES-D 10 scores ≥10: IRR 1.62, 95% CI (1.21-2.17). Additionally, participants with CES-D 10 scores ≥10 were 1.4 times more likely to develop MACE compared to those with CES-D 10 scores &lt;10 (HR 1.41, 95% CI=1.13-1.83, Figure). Among MACE sub-components, incident HF was twice as high in the population with CES-D 10 ≥10 points versus those with CES-D 10 &lt;10 points (HR 2.36, 95% CI (1.58-3.51)). Conclusion: The findings of this cohort study indicate that depression symptomatology is associated with incident overall MACE and HF, and that clinically significant depression symptoms further increased risk for MACE and HF, making early treatment of depression a possible target for decreasing CVD incidence.

Weight loss in patients with severe obesity after bariatric surgery-the potential role of the chrono-nutrition, chronotype and the circadian misalignment: A study protocol of the ChronoWise prospective cohort.

Despite the potential effectiveness of bariatric surgery in promoting weight loss, a considerable proportion of patients still face the challenge of achieving optimal post-surgery outcomes. The timing of eating, in addition to the content of what is eaten, as well as chronotype and social jetlag (a marker of circadian misalignment), have been implicated in weight regulation. However, the current understanding of these chrono-related behaviours in individuals undergoing bariatric surgery is still scarce. Thus, this study aims to evaluate the role of chrono-nutrition, chronotype, and circadian misalignment in the weight-loss trajectory among individuals living with severe obesity who underwent bariatric surgery. The ChronoWise project is a prospective single-centre cohort study designed to follow patients experiencing bariatric surgery at the Santo António Local Health Unit (ULSSA), Porto, Portugal. Participants will be recruited and evaluated at pre-surgery and followed-up over 3 and 6 months after surgery. The baseline evaluation will be conducted face-to-face during the hospital stay and by telephone or video call on the subsequent evaluations, following standard procedures. Data collection includes sociodemographics, food intake, chrono-nutrition behaviours, sleep time behaviour, sleep quality, screen time, physical activity and exercise behaviours, anthropometric measurements, and biochemical parameters. The 'Munich Chronotype Questionnaire' will be used to assess chronotype and social jet lag. Chrono-nutrition dimensions will be measured by the 'Chrononutrition Profile-Questionnaire' in all evaluations. Weight and height will be self-reported and retrieved from medical registries. trajectories of weight-loss will be obtained. This study will add important evidence on the role of chrono-nutrition, chronotype and social jetlag profile in weight-loss outcomes after bariatric surgery. Identifying novel approaches to change the paradigm of post-surgical weight management towards a tailored treatment aligned with circadian rhythm may be useful to strengthen the existing treatments and improve patients' response to bariatric surgery.

Gene-eral survey to describe genomic education needs in hospital pharmacy departments in the West Midlands and Oxford

Abstract Introduction Genomic medicine is a rapidly developing field and a priority for the NHS to ensure it is embedded into Medicine Service Alliance is that the NHS staff have understanding and confidence to utilise genomics safely and effectively. Pharmacy professionals, as experts in medicines, will lead the implementation and delivery of pharmacogenomics and wider genomic medicine services across all healthcare sectors1. Aim To understand current levels of genomic education across NHS Trust Pharmacy Departments in the Central and South region, and preferences for types of future learning. Methods A MS Forms survey was distributed across the Pharmacy Departments of five NHS Trusts, emailed to all local pharmacy staff via the Education and Training lead pharmacists; all pharmacy staff were eligible to participate, and total numbers of staff were not available. The survey was based on a previously published national survey2, but reduced in content to allow completion within 5 minutes; content was agreed between the genomics specialist pharmacy team at C&amp;S. Ethics approval was not sought as this baseline evaluation formed part of a planned service improvement. Results One hundred and twenty-nine respondents participated in the survey, including pharmacists (62%), pharmacy technicians (29%) and assistant technical officers (5%). Seventy-one out of 127 respondents (56%) had more than 10 years of experience since qualified. Given a scale of ’very low-low-medium -high-very high’, the majority of the 127 respondents (63%) considered their knowledge about Genomic Medicine to be medium or high, and no responder considered themselves to have a very high level of knowledge about Genomic Medicine. Most participants saw the relevance of Genomic Medicine to their professions, particularly in areas like personalised medicine and 82% expressed an interest in learning more about Genomic Medicine and 15% answered ’Maybe’; the cohort had a preference for in-person meetings and seminars (32%), followed by on-line meetings (27%). Discussion / Conclusion Respondents saw the relevance of Genomic Medicine to their professions, and showed a mixture of enthusiasm, curiosity, and uncertainty about Genomic Medicine, with no respondent feeling they had a very high level of knowledge of Genomic Medicine. Most pharmacy staff in the 5 departments surveyed have an interest in furthering their knowledge of Genomic Medicine, with a marked preference for in-person meetings and seminars. Respondents recognised the potential benefits such as personalized medicine, improved treatment outcomes and reduced trial-and-error approaches in medication selection, with expectations that Genomic Medicine will improve patient care and outcomes, reducing adverse events and informing treatment decisions Limitations to this study include an inability to judge response rate due to lack of denominator data, however relatively similar numbers were obtained from each Department, with a good mix of respondent roles. An in-person training event with hybrid online options is being planned as a result of this work.

Clinical performance of a simulated abbreviated liver magnetic resonance imaging in combination with contrast-enhanced computed tomography for the baseline evaluation of the liver in patients with colorectal cancer

Clinical performance of a simulated abbreviated liver magnetic resonance imaging in combination with contrast-enhanced computed tomography for the baseline evaluation of the liver in patients with colorectal cancer

Clinical progression of Parkinson's disease in the early 21st century: Insights from the accelerating medicine partnership (AMP-PD) data

BackgroundParkinson's disease (PD) therapeutic strategies have evolved since levodopa introduction in mid 1900s. To understand their impact and research gaps, this study delineated the clinical progression of PD in recent years. MethodsUsing Accelerating Medicine Partnership-PD (AMP-PD) data harmonized from seven biomarker discovery studies (2010–2020), we extracted: overall [Schwab and England (S&E), PD Questionnaire (PDQ-39)]; motor [Movement Disorders Society Unified PD Rating Scale (MDS-UPDRS)-II and -III and Hoehn & Yahr (HY)]; and non-motor [MDS-UPDRS-I, University of Pennsylvania Smell Identification Test (UPSIT), Montreal Cognitive Assessment (MoCA), and Epworth Sleepiness Scale (ESS)] scores. Age at diagnosis was set as 0 years, and data were tracked for 15 subsequent years. ResultsAmong 3001 PD cases identified to be suitable for this study, 2838 are white, 1843 are males, with a mean age at diagnosis was 60.2 ± 10.3 years. At baseline evaluation, the disease duration was 9.9 ± 6.0 years overall, 1915 within 0–5, 541 with 6–10, 254 within 11–15, and 163 greater than 15 years. Participants largely reported independence (S&E, 5y: 86.6 ± 12.3; 10y: 78.9 ± 19.3; 15y: 78.5 ± 17.0) and good quality of life (PDQ-39, 5y: 15.5 ± 12.3; 10y: 22.1 ± 15.8; 15y: 24.3 ± 14.4). Motor scores displayed a linear progression, whereas non-motor scores plateaued ∼10–15 years. Younger onset age and female correlated with slower progression. ConclusionsTwenty-first century PD patients remain largely independent in the first decade of disease at tertiary subspecialty care and research centers. There are data gaps for those who are non-whites or longer PD duration, and sensible metrics that can gauge non-motor progression when PD is beyond 10 years.

Implementation and Baseline Evaluation of an Evidence-Based Group Antenatal Care Program in Two Nigerian States.

Northern Nigeria has had historically low antenatal care (ANC) utilization rates with poor health outcomes. Previous studies have shown that group antenatal care (gANC) improves ANC behavior and pregnancy outcomes. The gANC has been adopted in Kaduna and Kano States, Nigeria. This paper presents baseline findings from the implementation of the gANC program in Kaduna and Kano States, Nigeria, based on data collected from 1269 and 1200 pregnant women, respectively, from March to April 2024. Analyses of sociodemographic and pregnancy behavior data were performed. Participants were mostly between the age of 19 and 31 years, married or living with a partner, with over 50% having their own businesses. Over 62% and 34% had completed secondary- or higher-level education, with 60% and 80% living in urban areas in Kaduna and Kano States, respectively. In Kano State, >60% of the women had their last delivery at home, with 41.6% not assisted by a skilled birth attendant. In Kaduna, >63% delivered in the hospital and >50% had skilled attendance during labor. Almost half had not used contraceptives previously. This study has provided baseline evaluation data for the implementation of gANC in two states in Nigeria. Subsequent longitudinal data will examine the impact of gANC utilization on perinatal outcomes and contraceptive behavior to inform the scaling of the program in the country.

Immunophenotyping myelodysplastic neoplasms: the role of flow cytometry in the molecular classification era.

The unique heterogenous landscape of myelodysplastic syndromes/neoplasms (MDS) has resulted in continuous redefinition of disease sub-entities, in view of the novel translational research data that have clarified several areas of the pathogenesis and the progression of the disease. The new international classifications (WHO 2022, ICC 2022) have incorporated genomic data defining phenotypical alterations, that guide clinical management of specific patient subgroups. On the other hand, for over a decade, multiparameter flow cytometry (MFC) has proven its value as a complementary diagnostic tool for these diseases and although it has never been established as a mandatory test for the baseline evaluation of MDS patients in international guidelines, it is almost universally adopted in everyday clinical practice for the assessment of suspected cytopenias through simplified scoring systems or elaborate analytical strategies for the detection of immunophenotypical dysplastic features in every hematopoietic cell lineage in the bone marrow (BM). In this review, we explore the clinically meaningful interplay of MFC data and genetic profiles of MDS patients, to reveal the currently existing and the potential future role of each methodology for routine clinical practice, and the benefit of the patients. We reviewed the existing knowledge and recent advances in the field and discuss how an integrated approach could lead to patient re-stratification and guide personalized management.

Does HFpEF represent a risk factor and a marker of cardiotoxicity in patients undergoing cancer treatment?

Abstract Background The prevalence of heart failure with preserved ejection fraction (HFpEF) increases with the aging of our population and shares risk factors with cancer. Furthermore, HFpEF conveys a worse prognosis if it remains unrecognized and untreated. However, it is not considered as a surrogate marker in the baseline risk stratificatoin of patients that will undergo potentially cardiotoxic cancer treatments. Moreover, the definition of cardiotoxicity focuses mainly on systolic dysfunction, based on left ventricular ejection fraction and global longitudinal strain changes. Data on the prevalence of new-onset HFpEF during cancer treatment are limited. Purpose We evaluated the prevalence of HFpEF in cancer patients followed in our cardio-oncology clinic, with new cancer therapy-related cardiovascular toxicity (CTR-CVT) events in patients with known HFpEF prior to cancer therapy. We also assessed the prevalence of patients diagnosed with HFpEF while undergoing cancer therapy. Methods A total of 630 cancer patients referred for either baseline evaluation, on-treatment surveillance, long-term follow-up or new complaints suspect for cardiovascular disease were included in this real-world observational study, with a mean follow-up duration of 507 days. They underwent comprehensive workup in accordance with the ESC guidelines, including clinical assessment, electrocardiogram, echocardiography and biomarker testing. Results From the total population, 36 (5.7%) were diagnosed with HFpEF prior to cancer treatment initiation. Among these, 18 (50%) developed CTR-CVT during follow-up, mainly heart failure events (cancer-therapy related cardiac dysfunction or HFpEF decompensation). Independent of baseline characteristics, 233 patients (37.0%) developed a heart failure event during or after cancer treatment. Of these, 92 patients (14.6% of the total population, 39.5% of all HF events on treatment) developed a HFpEF event during or after cancer treatment. Of these HFpEF events, 42 patients (45.7%) were known with pre-existing cardiovascular disease, of whom only 14 (15.2%) with pre-existing HFpEF. In 50 patients (54.3%) the HFpEF diagnosis was made de novo during (or after) cancer treatment. Patients developing HFpEF were mostly female (n=54, 58.7%) and relatively young (mean age 62.0 years). Most HFpEF events occurred in breast cancer patients (n=32, 34.7%), prostate cancer patients (n=13, 14.1%) and multiple myeloma patients (n=9, 9.8%). Conclusions HFpEF is frequently overlooked, but conveys a high risk of developing CTR-CVT and should therefore be taken into account in the baseline risk stratification. Furthermore, HFpEF is responsible for an important morbidity burden during or after cancer cardiotoxic treatments, even in patients without prior diagnosis of HFpEF at baseline evaluation. Further studies are needed to evaluate if this population may benefit from specific management and treatment strategies in order to improve prognosis.Prevalence of HFpEF in cancer patients

Prediction of the burden and characteristics of coronary plaques by cardiorespiratory fitness

Abstract Background Cardiorespiratory fitness (CRF) and coronary plaque burden are both important predictors of mortality. Although mortality of coronary heart disease (CHD) is reduced, prevalence remains high and there is a need to improve early detection and preventive measures. How CRF relates to coronary plaque burden and composition in the general population is largely unknown. Purpose The aim was to study the relationship between CRF and the total coronary plaque burden, including subgroups of coronary plaques, in subjects without known CHD. Methods A random sample of participants from a large population-based echocardiographic reference range study aged 55-70 at baseline was included. Coronary plaque burden was assessed, on average, 4.0 years after the baseline evaluation using coronary computed tomography angiography (CCTA). The burden and characteristics of the coronary plaques were evaluated using a validated, commercially available, semi-automatic software that assessed all coronary territories including the left main, left anterior descending, circumflex, and right arteries. Coronary plaques were classified as dense calcified plaques, plaques with necrotic core, fibrous, and fibrous-fatty plaques. Baseline measures included cardiovascular risk factor assessment and measurement of peak oxygen consumption (VO2peak) assessed by treadmill cardiopulmonary exercise testing. Linear regression models were used to assess the impact of VO2peak on coronary plaque burden. In Model 1, we adjusted for sex and age, while Model 2 also included adjustments for non-HDL cholesterol, HbA1c, systolic blood pressure, smoking status, and body mass index. Results Of 845 invited to undergo CCTA, 707 (51% females) underwent CT scanning. Of these, 699 scans had acceptable quality for further analyses. Table 1 shows baseline characteristics and Table 2 shows the associations of VO2peak with coronary plaque burden. In the fully adjusted Model 2, there was a significant negative association of VO2peak with total plaque burden (β -0.18, R2 15%, p&amp;lt;0.001), while the association was not significant in Model 1 (p=0.54). Similarly, higher VO2peak significantly predicted a lower burden of dense calcified plaques, plaques with necrotic core, and fibrofatty plaques in both models (R2 3-17%, p≤0.01). The results were consistent whether the coronary plaques were evaluated across the entire coronary arteries (down to a diameter of 1.5 mm) or solely in the proximal segments. However, the predictive power of the models was relatively low with R2 of maximum 17%. Conclusion In a population without known CHD, CRF explained a modest part of the variation in coronary plaque burden. Considering CRF in risk prediction may enhance coronary artery disease prevention beyond traditional risk factors.

Incidence and risk factors for development of left ventricular hypertrophy in Fabry disease

Abstract Background Left ventricular hypertrophy (LVH) is the principal cardiac manifestation of Fabry disease (FD). This study aimed to determine the incidence and predictors of LVH development in a contemporary cohort of patients with FD and no LVH at baseline evaluation. Methods Consecutively referred adult (age ≥16 years) patients with FD were enrolled into an observational cohort study. Patients were prospectively followed in a specialist cardiomyopathy centre and the primary endpoint was the first detection of LVH (left ventricular mass index (LVMi) ≥115 g/m2 in men and ≥95 g/m2 in women). Results From a cohort of 393 patients, 214 (age 35.8 ±13.8 years; 61 [29%] males) had no LVH at first evaluation. During a median follow-up of 9.4 years (interquartile range [IQR] 4.7-12.7), 55 patients (24.6%) developed LVH. The estimated incidence of LVH was 11.3% (95% confidence interval [CI] 6.5-16.1) at 5 years, 29.1% (95%CI 21.5-36.7) at 10 years, and 45.0% (95%CI 33.8-62.4) at 15 years of follow-up. On multivariable analysis, independent predictors for LVH development were age (hazard ratio [HR] 1.04 [95%CI 1.02-1.06] per 1 year increase, p-value &amp;lt;0.001), male sex (HR 2.90 [95%CI 1.66-5.09], p-value &amp;lt;0.001), and an abnormal ECG (HR 3.10 [95%CI 1.72-5.57], p-value &amp;lt;0.001). The annual rate of change in LVMi was +2.77 (IQR 1.45-4.62) g/m2/year in males and +1.38 (IQR 0.09-2.85) g/m2/year in females (p-value &amp;lt;0.001). Conclusions Approximately one quarter of FD patients developed LVH during follow-up. Age, male sex, and ECG abnormalities were associated with a higher risk of developing LVH in patients with FD.Central Illustration

CMR characterisation of patients with heart failure and left bundle branch block

Abstract Introduction Cardiac magnetic resonance (CMR) is recommended internationally for tissue characterisation, volumetric assessment and assessment of prior myocardial infarction (1). Patients with left bundle branch block (LBBB) form a significant sub-group of individuals, however, there is limited data available to accurate determine whether LBBB is associated with any CMR-definable phenotypes. Aim We aimed to identify the distinctive cardiac magnetic resonance (CMR) features of patients with left bundle branch block (LBBB) and heart failure with reduced ejection fraction (HFrEF) of presumed non-ischaemic aetiology. Methods Participants from the MATCH (MyocArdial Tissue CHaracteristics in patients with heart failure according to glycaemic status) registry were prospectively enrolled. Exclusion criteria included: LVEF &amp;gt;40% at initial evaluation, established diagnosis of coronary artery disease, known presence of structural heart disease, suspected myocarditis, congenital heart disease and significantly impaired renal function. Following identification of HF, guideline-directed medical therapy was initiated based on the decision of the treating physician. LV recovery was defined as achieving ≥10% absolute improvement to a level of 40% or greater of LVEF from baseline evaluation upon the date of CMR quantification. Electrocardiograms were analysed to establish the presence or absence of LBBB. Results A total of 391 patients were recruited including 115 (29.4%) presenting with LBBB. Compared to controls, LBBB patients exhibited larger left ventricles and smaller right ventricles, but no differences were observed with respect to LVEF (35.8±12 vs. 38± 12 %, p=0.105) or right ventricular ejection fraction (RVEF). The prevalence of ischaemic scar (18.3% vs 21%, p=0.54), non-ischaemic fibrosis (25.2% vs 32.6%, p=0.15) and inducible ischaemia (6.1% vs. 7.6%, p=0.6) was comparable in patients with LBBB and those without. The overall rate of LV recovery was not significantly different between LBBB and non-LBBB patients (27.8% vs. 33%, p=0.32) from their baseline evaluation to the time of CMR assessment (70 [42 - 128] days). In the multivariate logistic regression, reduced LVEF remained an independent predictor of LV non-recovery in patients with LBBB, even after adjusting for gender and QRS duration (OR 0.93, 95%CI 0.87 – 0.99, p=0.03). In contrast, this association was not observed among patients without LBBB, whereas ischaemic scar was the primary predictor of LV non-recovery (OR 4.31, 95%CI 1.85 – 10.04, p=0.0007). Conclusion In this study patients presenting with a combination of HFrEF and LBBB had a larger LV cavity and smaller RV cavity than those without LBBB. However, there were no differences in the prevalence of ischaemic scar, non-ischaemic scar of inducible ischaemia according to the presence of absence of LBBB. Rates of LV recovery were similar between LBBB and non-LBBB patients.Clinical CMR ParametersSegmental Distributions

Phenotype progression in pediatric RASopathy-associated hypertrophic cardiomyopathy

Abstract Background RASopathy syndromes represent the second most common cause of hypertrophic cardiomyopathy (HCM) in children. RASopathy associated HCM (Ras-HCM) has been shown to differ both in cardiac phenotype and long-term outcomes from sarcomeric HCM. However, there is a lack of knowledge from large cohort studies of how the cardiac phenotype of Ras-HCM changes over time. Aim To describe cardiac phenotype changes over time in children with Ras-HCM Methods Retrospective data from 148 patients diagnosed with Ras-HCM aged &amp;lt;18 years with ³2 follow-up visits were included. Clinical and echocardiographic data were collected at baseline assessment, 1, 2, and 5 years of follow up. Separate analyses were performed for patients who survived, versus patients who died or had a heart transplant (censoring events). Results One-hundred-and-two (68.9%) patients with Noonan syndrome, 25 (16.9%) with Noonan-syndrome with multiple lentigines, 10 (6.8%) with Costello syndrome, 9 (6.1%) with cardio-facio-cutaneous syndrome and 2 (1.4%) patients with Noonan-like syndrome with a median age of diagnosis 0.16 years (0.01-0.89) were seen at a median baseline age of 1.41 years (0.37-5.71) and followed up for a median of 12.1 years (4.8-17.4). During follow up, 18 patients (12.2%) died at a median age of 1.8 years (0.5-8.7) and 17 (12.5%) had a left ventricular myectomy, at a median age of 7.0 years (3.1-12.7). At baseline evaluation, patients who died compared to those who survived had a lower median age [0.4 years (0.1-0.8) versus 2.3 years (0.5-7.6), p&amp;lt;0.001], a higher proportion of them had a NYHA class&amp;gt;I (54.5% vs 15.1%, p&amp;lt;0.001), a higher maximal left ventricular wall thickness (MLVWT) z-score [13.4 (7.5) vs 9.6 (6.2), p=0.04], a higher proportion of left ventricular outflow tract obstruction (LVOTO) [64.7% vs 43.8%, p=0.087] and a higher proportion of biventricular hypertrophy [75% vs 49.2%, p=0.045]. For survivors, the MLVWT z-score improved over follow up [+9.6(6.2) at baseline vs. +7.9(5.5) at 5 years, p=0.072], and the proportion of patients with LVOTO (43.8% at baseline vs. 27.9% at 5 years, p=0.019) and biventricular hypertrophy (49.2% at baseline vs. 35.5% at 5 years, p=0.012) decreased over follow up. Conclusion While at baseline evaluation Ras-HCM has a high burden of symptoms, biventricular hypertrophy and LVOTO for patients who die or have a heart transplant, we have demonstrated that for survivors, over follow up, the phenotype becomes milder.Table 1