Brief Intervention Research Articles

Streamlined Intraoperative Brain Tumor Classification and Molecular Subtyping in Stereotactic Biopsies Using Stimulated Raman Histology and Deep Learning.

Recent artificial intelligence algorithms aided intraoperative decision-making via stimulated Raman histology (SRH) during craniotomy. This study assesses deep learning algorithms for rapid intraoperative diagnosis from SRH images in small stereotactic-guided brain biopsies. It defines a minimum tissue sample size threshold to ensure diagnostic accuracy. A prospective single-center study examined 121 SRH images from 84 patients with unclear intracranial lesions undergoing stereotactic brain biopsy. Unprocessed, label-free samples were imaged using a portable fiber laser Raman scattering microscope. Three deep learning models were tested to (i) identify tumorous/nontumorous tissue as qualitative biopsy control; (ii) subclassify into high-grade glioma (central nervous system World Health Organization grade 4), diffuse low-grade glioma (central nervous system World Health Organization grades 2-3), metastases, lymphoma, or gliosis; and (iii) molecularly subtype IDH and 1p/19q statuses of adult-type diffuse gliomas. Model predictions were evaluated against frozen section analysis and final neuropathologic diagnoses. The first model identified tumorous/nontumorous tissue with 91.7% accuracy. Sample size on slides impacted accuracy in brain tumor subclassification (81.6%, κ = 0.72 frozen section; 73.9%, κ = 0.61 second model), with SRH images being smaller than hematoxylin and eosin images (4.1 ± 2.5 mm2 vs. 16.7 ± 8.2 mm2, P < 0.001). SRH images with more than 140 high-quality patches and a mean squeezed sample of 5.26 mm2 yielded 89.5% accuracy in subclassification and 93.9% in molecular subtyping of adult-type diffuse gliomas. Artificial intelligence-based SRH image analysis is non-inferior to frozen section analysis in detecting and subclassifying brain tumors during small stereotactic-guided biopsies once a critical squeezed sample size is reached. Beyond frozen section analysis, it enables valid molecular glioma subtyping, allowing faster treatment decisions in the future; however, refinement is needed for long-term application.

Update on the clinical applications of SGLTis: Insight to benefits beyond hypoglycemic and cardiorenal protection.

Sodium glucose cotransporter inhibitor (SGLTi) drugs have been widely used in clinical practice. In addition to their benefits in hyperglycemia, heart failure (HF), and kidney disease, their effects on obesity, metabolic dysfunction-associated steatotic liver disease (MASLD, formerly named nonalcoholic fatty liver disease [NAFLD]), polycystic ovarian syndrome (PCOS), abnormal lipid metabolism, hyperuricemia, obstructive sleep apnea syndrome (OSAS), anemia, and syndrome of inappropriate antidiuresis (SIAD, formerly named syndrome of inappropriate antidiuretic hormone [SIADH]) have been explored. In this review, we searched the data of clinical randomized controlled trials (RCTs) and meta-analyses of SGLTis in patients with diabetes from the PubMed library between January 1, 2020, and February 1, 2024. According to our review, certain SGLTis exhibit relatively superior clinical safety and effectiveness for treating the abovementioned diseases. Proper utilization of SGLTis in these patients can provide additional medication options for patients with different disease scenarios. However, studies of SGLTis in these diseases are relatively rare, with shortcomings such as small sample sizes and short intervention periods. Therefore, further large-scale, long-term, well-designed studies are needed to clarify the findings.

Parallel activation of helicopter and ground transportation after dispatcher identification of suspected anterior large vessel occlusion stroke in rural areas: a proof-of-concept case with modeling from the LESTOR trial

BackgroundWhen stroke patients with suspected anterior large vessel occlusion (aLVO) happen to live in rural areas, two main options exist for prehospital transport: (i) the drip-and-ship (DnS) strategy, which ensures rapid access to intravenous thrombolysis (IVT) at the nearest primary stroke center but requires time-consuming interhospital transfer for endovascular thrombectomy (EVT) because the latter is only available at comprehensive stroke centers (CSC); and (ii) the mothership (MS) strategy, which entails direct transport to a CSC and allows for faster access to EVT but carries the risk of IVT being delayed or even the time window being missed completely. The use of a helicopter might shorten the transport time to the CSC in rural areas. However, if the aLVO stroke is only recognized by the emergency service on site, the helicopter must be requested in addition, which extends the prehospital time and partially negates the time advantage. We hypothesized that parallel activation of ground and helicopter transportation in case of aLVO suspicion by the dispatcher (aLVO-guided dispatch strategy) could shorten the prehospital time in rural areas and enable faster treatment with IVT and EVT.MethodsAs a proof-of-concept, we report a case from the LESTOR trial where the dispatcher suspected an aLVO stroke during the emergency call and dispatched EMS and HEMS in parallel. Based on this case, we compare the provided aLVO-guided dispatch strategy to the DnS and MS strategies regarding the times to IVT and EVT using a highly realistic modeling approach.ResultsWith the aLVO-guided dispatch strategy, the patient received IVT and EVT faster than with the DnS or MS strategies. IVT was administered 6 min faster than in the DnS strategy and 22 min faster than in the MS strategy, and EVT was started 47 min earlier than in the DnS strategy and 22 min earlier than in the MS strategy.ConclusionIn rural areas, parallel activation of ground and helicopter emergency services following dispatcher identification of stroke patients with suspected aLVO could provide rapid access to both IVT and EVT, thereby overcoming the limitations of the DnS and MS strategies.

P-068 Fertility education improves knowledge and semen quality: an open-label randomized controlled trial on 382 healthy Japanese men

Abstract Study question Does fertility education improve semen quality in healthy men? Summary answer Healthy men who received online video-based education had significantly improved fertility knowledge and semen quality. What is known already Modifiable lifestyle and environmental factors can affect semen quality, but men generally have limited knowledge about fertility and are not aware of the impact of these factors on their reproductive health. Prior research indicates that fertility education increases fertility awareness, but whether this effect extends to modifications in lifestyle and thus to semen quality remains unexplored. Study design, size, duration Participants (N = 382) were randomised into two groups. The intervention group (IG) watched a five-minute online video series about healthy lifestyles and fertility risks (e.g., sedentary time, smoking, high temperature) every four months, a total of three times. At the same time points, the control group (CG) received a general health web article. Assessments of fertility knowledge, health behaviour, and semen quality were assessed before the intervention (T1) and one year later (T2) for both groups. Participants/materials, setting, methods Participants were male employees recruited during annual health check-ups at six workplaces in Japan. Those aged 20-39 years who planned to have children in the future participated. The primary short-term outcome was semen quality, measured by sperm concentration, sperm count, sperm motility, and DNA fragmentation index (DFI). Secondary outcomes were Cardiff Fertility Knowledge Scale (CFKS) scores and health behaviours (e.g., reduced sedentary time). All analyses were conducted on an intention-to-treat basis. Main results and the role of chance Of the 382 participants, 208 (55%) completed the T2 survey: 53% (99/188) in the IG and 56% (109/193) in the CG. T1 characteristics, fertility knowledge, health behaviours, and semen quality were well balanced between groups. Generalised estimating equation models showed a significant gain in fertility knowledge from T1 to T2 in both groups: +13.2 points on CFKS (95% confidence interval [CI]: 9.7 to 16.7) in the IG and +4.7 (1.3 to 8.1) in the CG, with a significant interaction between group and time (P&amp;lt;0.001). Total motile sperm count showed a significant interaction between group and time (P=0.046), with a significant improvement over time in the IG (+58.1 [15.2 to 101.1] million/ejaculate) but no change in the CG (-2.6 [-43.8 to 38.6]). DFI showed a marginally significant interaction (P=0.064) and an improvement over time in the IG (-0.72 [-1.54 to 0.10]) compared with the CG (+0.35 [-0.43 to 1.13]). The other semen indicators and health behaviours showed a favourable trend in the IG, but the interactions between group and time did not reach statistical significance. Limitations, reasons for caution Difficulties in recruiting participants and high attrition led to a small sample size, which may limit the statistical power to detect a significant link between knowledge gain and improved sperm quality via altered health behaviours. Volunteer bias towards men more interested in fertility may limit the generalisability of the findings. Wider implications of the findings Low-cost short video interventions could improve semen quality at the population level. As a future direction, the preventive effects of fertility education on infertility and the causal pathway should be explored in larger studies. Trial registration number UMIN000045389

Effect of nurse-Led psychosocial intervention on body image distress and treatment compliance among patients undergoing treatment of cancer: A randomized controlled trial.

Dissatisfaction with one's physique is the most common issue among cancer patients, and it is correlated with stress, anxiety, and hopelessness. The current study aimed to assess how the Nurse-Led short psychosocial intervention affected cancer patients' body image distress and treatment compliance. 67 patients above 18 years of age and undergoing cancer treatment were enrolled in the study through complete enumeration sampling. The individuals were divided into experimental and control groups using simple randomization. A nurse-led brief psychosocial intervention program was implemented for 15 days for the experimental group while the control group was on standard treatment. The intervention's effects were measured on the 15th day using a structured body image distress scale and self-structured treatment compliance scale. The consolidated norms of reporting trials (CONSORT) statement was used to perform the study. Utilizing SPSS, descriptive and inferential statistics were performed to analyze the data. Post-intervention on the 15th day of the program revealed a reduction in Body image distress (Mean, SD and P value; 2.73, 1.72 (experimental), 4.90 ± 2.23 (control) and <0.001). The program also resulted in improved treatment compliance (Mean, SD and P value; 3.66, 2.23 and (experimental) and 5.83, 1.62; and <0.001). According to the study's findings, nurses are essential to the care of cancer patients. Nurse-led intervention can be an effective strategy to address these psychological issues and concerns.

The Growing Role of Telerehabilitation and Teleassessment in the Management of Movement Disorders in Rare Neurological Diseases: A Scoping Review.

Background: People with rare neurological diseases (RNDs) often experience symptoms related to movement disorders, requiring a multidisciplinary approach, including rehabilitation. Telemedicine applied to rehabilitation and symptom monitoring may be suitable to ensure treatment consistency and personalized intervention. The objective of this scoping review aimed to emphasize the potential role of telerehabilitation and teleassessment in managing movement disorders within RNDs. By providing a systematic overview of the available literature, we sought to highlight potential interventions, outcomes, and critical issues. Methods: A literature search was conducted on PubMed, Google Scholar, IEEE, and Scopus up to March 2024. Two inclusion criteria were followed: (1) papers focusing on telerehabilitation and teleassessment and (2) papers dealing with movement disorders in RNDs. Results: Eighteen papers fulfilled the inclusion criteria. The main interventions were home-based software and training programs, exergames, wearable sensors, smartphone applications, virtual reality and digital music players for telerehabilitation; wearable sensors, mobile applications, and patient home video for teleassessment. Key findings revealed positive outcomes in gait, balance, limb disability, and in remote monitoring. Limitations include small sample sizes, short intervention durations, and the lack of standardized protocols. Conclusion: This review highlighted the potential of telerehabilitation and teleassessment in addressing movement disorders within RNDs. Data indicate that these modalities may play a major role in supporting conventional programs. Addressing limitations through multicenter studies, longer-term follow-ups, and standardized protocols is essential. These measures are essential for improving remote rehabilitation and assessment, contributing to an improved quality of life for people with RNDs.

STEM Career Choices for K–12 Students and the Influencing Factors—A Comparison of Students in Different Support Programs

AbstractThe evidence regarding the effectiveness of STEM support programs for K–12 students to spark their interest in the STEM field is mixed. The goals and contents of support programs vary and mostly cover short intervention periods. So far, not many studies exist that cover different learning characteristics of students in long-term STEM support programs. Against this backdrop, the present paper engages in intra- and intergroup comparisons, characterizing groups of students interested in STEM who participated in three long-term STEM support programs and a control group. The sample contained a total of N = 1170 students. For this purpose, the study was divided into a description of the samples, an analysis of the factors influencing career choice decisions, and an analysis of the interest profiles of students in support programs based on a circumplex model comparing STEM and non-STEM students. The results of this study indicate that female students in different support programs tend to fall into the Ideas domain on Prediger’s axis, and male students in support programs are located close to male students in the control group. Overall, the results align with the state of research, suggesting that support programs should be offered regularly, integrated into school curriculums, and linked with STEM universities and mentoring. This study indicates that future research in the context of STEM support programs could verify the effects on students’ vocational interests with longitudinal analyses.

A single-site feasibility randomised controlled trial comparing 'my hypo compass' short pyscho-educational intervention with standard care alone in individuals with type 1 diabetes and impaired awareness of hypoglycaemia.

The HypoCOMPaSS multi-centre trial achieved improvement in hypoglycaemia awareness and 20-fold reduction in severe hypoglycaemia (SH) in a cohort with long-standing type 1 diabetes (T1D). All participants received 'my hypo compass' (MHC) brief structured psycho-educational intervention in addition to optimisation of insulin delivery/glucose monitoring. In this 24-week, prospective, single-centre feasibility RCT, we piloted MHC as a sole intervention in comparison to standard clinical care alone (CON). Participants with T1D and impaired hypoglycaemia awareness (IAH) (Clarke score ≥4) were recruited. MHC comprised a group/individual 1-2 h face-to-face session followed by a telephone call and second face-to-face session at 4 weeks. Outcome measures at 24 weeks were compared with baseline. Fifty-two individuals provided consent for screening with 39 fulfilling eligibility criteria. Fifteen withdrew before any study intervention. Twenty-four adults with (mean ± SD) T1D duration 41.0 ± 15.1 years commenced/completed the study (100% visit attendance); 12 randomised to MHC and 12 to CON. All had IAH at baseline and at 24 weeks. Annualised SH rate following MHC was 3.8 ± 19.0 (24 weeks) versus 12.6 ± 3.5 (Baseline) and in CON group 2.0 ± 19.0 (24 weeks) versus 4.6 ± 11.5 (Baseline). 'Immediate Action' for and 'Worry' about hyperglycaemia measured by the Hyperglycaemia Avoidance Scale appeared lower following MHC. Participants attended all study visits and reflected positively on the MHC intervention. Feasibility of MHC implementation without additional intervention has been demonstrated. MHC education was associated with positive changes in attitudes and behaviours with the potential to reduce SH risk. MHC provides a validated, simple, well-received programme to fulfil the educational component within RCTs targeting problematic hypoglycaemia and as part of holistic clinical care.

Unveiling compositional images of specific proteins in individual cells by LA-ICP-MS: Labelling with ruthenium red and metal nanoclusters

BackgroundRecent biological studies have demonstrated that changes can occur in the cellular genome and proteome due to variations in cell volume. Therefore, it is imperative to take cell volume into account when analyzing a target protein. This consideration becomes especially critical in experimental models involving cells subjected to different treatments. Failure to consider cell volume could obscure the studied biological phenomena or lead to erroneous conclusions. However, quantitative imaging of proteins within cells by LA-ICP-MS is limited by the lack of methods that provide the protein concentration (protein mass over cell volume) rather than just protein mass within individual cells. ResultsThe combination of a metal tagged immunoprobe with ruthenium red (RR) labelling enables the simultaneous analysis of a specific protein and the cell volume in each cell analyzed by LA-ICP-(Q)MS. The results indicate that the CYP1B1 concentration exhibits a quasi–normally distribution in control ARPE-19 cells, whereas AAPH–treated cells reveal the presence of two distinct cell groups, responding and non–responding cells to an in vitro induced oxidative stress. The labelling of the membrane with RR and the measurement of Ru mass in each cell by LA-ICP-MS offers higher precision compared to manually delimitation of the cell perimeter and eliminates the risk of biased information, which can be prone to inter–observer variability. The proposed procedure is fast and minimizes errors in cell area assignment and offers the possibility to carry out a faster data treatment approach if just relative volumes are compared, which can be advantageous for specific applications. Significance and noveltyThis work presents an innovative strategy to directly study the distribution and concentration of proteins within individual cells by LA-ICP-MS. This method employs ruthenium red as a cell volume marker and Au nanoclusters (AuNCs) tagged immunoprobes to label the protein of interest. Furthermore, the proposed labelling strategy enables rapid data processing, allowing for the calculation of relative concentrations and thus facilitating the comparison across large datasets. As a proof–of–concept, the concentration of the CYP1B1 protein was quantified in ARPE-19 cells under both control and oxidative stress conditions.

Analysis during chest compressions in out-of-hospital cardiac arrest patients, a cross/sectional study: The DEFI 2022 study

AimsDuring out-of-hospital cardiac arrest (OHCA), an automatic external defibrillator (AED) analyzes the cardiac rhythm every two minutes; however, 80% of refibrillations occur within the first minute post-shock. We have implemented an algorithm for Analyzing cardiac rhythm While performing chest Compression (AWC). When AWC detects a shockable rhythm, it shortens the time between analyses to one minute. We investigated the effect of AWC on cardiopulmonary resuscitation quality. MethodIn this cross-sectional study, we compared patients treated in 2022 with AWC, to a historical cohort from 2017. Inclusion criteria were OHCA patients with a shockable rhythm at the first analysis. Primary endpoint was the chest compression fraction (CCF). Secondary endpoints were cardiac rhythm evolution and survival, including survival analysis of non-prespecified subgroups. ResultsIn 2017 and 2022, 355 and 377 OHCAs met the inclusion criteria, from which we analyzed the 285 first consecutive cases in each cohort. CCF increased in 2022 compared to 2017 (77% [72–80] vs 72% [67–76]; P < 0.001) and VF recurrences were shocked more promptly (53 s [32–69] vs 117 s [90–132]). Survival did not differ between 2017 and 2022 (adjusted hazard-ratio 0.96 [95% CI, 0.78–1.18]), but was higher in 2022 within the sub-group of OHCAs that occurred in a public place and within a short time from call to AED switch-on (adjusted hazard ratio 0.85[0.76–0.96]). ConclusionsOHCA patients treated with AWC had higher CCF, shorter time spent in ventricular fibrillation, but no survival difference, except for OHCA that occurred in public places with short intervention time.

The effect of an online acceptance and commitment intervention on the meaning-making process in cancer patients following hematopoietic cell transplantation: study protocol for a randomized controlled trial enhanced with single-case experimental design

BackgroundHematopoietic cell transplantation (HCT) is a highly invasive and life-threatening treatment for hematological neoplasms and some types of cancer that can challenge the patient’s meaning structures. Restoring meaning (i.e., building more flexible and significant explanations of the disease and treatment burden) can be aided by strengthening psychological flexibility by means of an Acceptance and Commitment Therapy (ACT) intervention. Thus, this trial aims to examine the effect of the ACT intervention on the meaning-making process and the underlying mechanisms of change in patients following HCT compared to a minimally enhanced usual care (mEUC) control group. The trial will be enhanced with a single-case experimental design (SCED), where ACT interventions will be compared between individuals with various pre-intervention intervals.MethodsIn total, 192 patients who qualify for the first autologous or allogeneic HCT will be recruited for a two-armed parallel randomized controlled trial comparing an online self-help 14-day ACT training to education sessions (recommendations following HCT). In both conditions, participants will receive once a day a short survey and intervention proposal (about 5–10 min a day) in the outpatient period. Double-blinded assessment will be conducted at baseline, during the intervention, immediately, 1 month, and 3 months after the intervention. In addition, 6–9 participants will be invited to SCED and randomly assigned to pre-intervention measurement length (1–3 weeks) before completing ACT intervention, followed by 7-day observations at the 2nd and 3rd post-intervention measure. The primary outcome is meaning-related distress. Secondary outcomes include psychological flexibility, meaning-making coping, meanings made, and well-being as well as global and situational meaning.DiscussionThis trial represents the first study that integrates the ACT and meaning-making frameworks to reduce meaning-related distress, stimulate the meaning-making process, and enhance the well-being of HCT recipients. Testing of an intervention to address existential concerns unique to patients undergoing HCT will be reinforced by a statistically rigorous idiographic approach to see what works for whom and when. Since access to interventions in the HCT population is limited, the web-based ACT self-help program could potentially fill this gap.Trial registrationClinicalTrials.gov ID: NCT06266182. Registered on February 20, 2024.

Speed and Accuracy Training Affects Young Children’s Cognitive Control

ABSTRACT Young children tend to rely on reactive cognitive control (e.g. strongly slow down after an error), even when task accuracy would benefit from proactive cognitive control (taking a slower task approach up front). We investigated if giving young primary school children opportunities to repeatedly experience tasks where success rates depend on balancing speed and accuracy by using proactive and reactive cognitive control promotes their selective use of proactive cognitive control strategies. Participants were children from the German-speaking part of Switzerland (N = 105; mean age 7.5 yrs). They were allocated to a “training with feedback,” “training without feedback,” or control condition. They completed a pre- and posttest (Hearts and Flower task), separated by six computerized training tasks over three weeks. We analyzed time-by-condition effects on reaction time, rate-correct, and post-error slowing. In line with our hypotheses, both training groups outperformed the control group on reaction time and rate-correct in the incongruent block. Contrary to expectation, feedback did not enhance the intervention effect and the training group without feedback additionally outperformed control participants on rate-correct in the mixed block and improved their post-error slowing. Thus, our short intervention triggered accelerated development of proactive control in a cognitive conflict task requiring accuracy-speed trade-offs. This shows that during the developmental period in which children are assumed ready for developing proactive cognitive control strategies, repeated experiences over a short time-period can lead to acute improvements. More research is needed to check for long-term benefits and generalizability beyond our sample and the tasks employed.

Fostering Learning from Errors—Computer-Based Adaptivity at the Transition Between Problem Solving and Explicit Instruction

When learners acquire new content by working on a problem-solving task prior to explicit instruction, their attempts to solve the problem usually represent only partial steps on the way to the target concept. Both, theoretical assumptions on conceptual change as well as empirical findings on effective instructional formats with incorrect solutions, suggest that it is beneficial to address incorrect student solutions in a (subsequent) instruction phase by comparing incorrect and correct solutions. There is initial evidence that learning is most successful when learner compare the correct solution to an incorrect solution that reflects the learners’ conceptual understanding from the problem-solving phase. In the present study, we investigated in a highly controlled experimental design the relevance of this fit between the learners’ individual solution type from the problem-solving phase and the incorrect solution type in the instruction phase for learning success. In a computer-based learning environment, sixth graders worked on a problem-solving task to compare fractions. In the subsequent instruction phase, students in three conditions were given 1) an adaptive comparison, 2) a contra-adaptive comparison, 3) only the correct solution. Overall, there were no differences across conditions regarding the learning success. Further exploratory analyses revealed that only learners with an intermediate prior knowledge benefited from the adaptivity. This finding can be interpreted as indicator that our short intervention only induces conceptual change when basic knowledge is already available.

Teaching nursing students’ clinical judgment using situational awareness and principles of combat training

BackgroundNursing faculty are challenged with preparing nursing students to use clinical judgment and decision-making. These skills are best learned in clinical practice. Immersing students in patient care allows them to deepen their understanding of concepts learned in class while working with patients and families. InnovationReviewing a timeline used for situational awareness in military training, a Nursing Preventable Event timeline was developed that aligns with the nursing process and clinical judgment model. Like soldiers, nurses must be hyper-alert, always assessing, questioning, and looking for indicators of acute patient changes that need quick interventions. ImplicationsThe timeline can be used in class, clinical post-conference, lab, and simulation to introduce situational awareness early in the program to help students recognize, interpret, and respond to cues to make timely decisions and improve outcomes. ConclusionLearning situational awareness early will develop clinical judgment and critical thinking skills to connect didactic learning to clinical experiences, anticipate patient situations that may unfold, and be prepared to intervene quickly.

Feasibility and potential effectiveness of nurse-led video-coaching interventions for childhood, adolescent, and young adult cancer survivors: the REVIVER study

BackgroundChildhood, adolescent, and young adult (CAYA) cancer survivors, at risk for late effects, including cancer-related fatigue, cardiovascular issues, and psychosocial challenges, may benefit from interventions stimulating behaviour adjustments. Three nurse-led eHealth interventions (REVIVER) delivered via video calls and elaborating on person-centred care, cognitive behaviour therapy and/or motivational interviewing were developed. These interventions target: 1) fatigue management, 2) healthier lifestyle behaviours, and 3) self-efficacy and self-management. This study aimed to assess the feasibility and potential effectiveness of the REVIVER interventions for CAYA cancer survivors and healthcare professionals.MethodsIn a single-group mixed methods design, CAYA cancer survivors aged 16–54, more than five years post-treatment, were enrolled. Feasibility, assessed via Bowen's outcomes for feasibility studies, included acceptability, practicality, integration and implementation, demand and adherence. Qualitative data from semi-structured interviews and a focus group interview with survivors and healthcare professionals supplemented the evaluation. Paired sample t-tests assessed changes in self-reported quality of life, fatigue, lifestyle, self-management, and self-efficacy at baseline (T0), post-intervention (T1), and 6-month follow-up (T2).ResultsThe interventions and video consults were generally acceptable, practical, and successfully integrated and implemented. Success factors included the nurse consultant (i.e., communication, approach, and attitude) and the personalised approach. Barriers included sustainability concerns, technical issues, and short intervention duration. Regarding demand, 71.4%, 65.4%, and 100% of eligible CAYA cancer survivors engaged in the fatigue (N = 15), lifestyle (N = 17) and empowerment (N = 3) intervention, respectively, with 5, 5 and 2 participants interviewed, correspondingly. Low interest (demand) in the empowerment intervention (N = 3) and dropout rates of one-third for both fatigue and empowerment interventions were noted (adherence). Improvements in quality of life, fatigue (fatigue intervention), lifestyle (lifestyle intervention), self-efficacy, and self-management were evident among survivors who completed the fatigue and lifestyle interventions, with medium and large effect sizes observed immediately after the intervention and six months post-intervention.ConclusionsOur study demonstrates the feasibility of nurse-led video coaching (REVIVER interventions) despite lower demand for the empowerment intervention and lower adherence to the fatigue and empowerment interventions. The medium and high effect sizes found for those who completed the interventions hold potential clinical significance for future studies investigating the effectiveness of the REVIVER interventions.

Dental treatments under sedation-analgesia in patients who are unable to collaborate: a prospective observational study.

Excessive fear of dental procedures leads to disruptive behavior during dental examinations and treatments. Dental examinations and treatments of these patients usually require additional techniques, such as sedation. The most commonly used techniques are inhalation of nitrous oxide, infusion of propofol with fentanyl, and premedication and infusion of midazolam. A prospective observational epidemiological study was conducted on patients who required sedoanalgesia techniques for dental exploration and procedures. The reasons for the inability of patients to cooperate (excessive fear or intellectual disability), age, sex, weight, systemic pathology, oral pathology, treatment performed, time of intervention, anesthetic technique performed, and occurrence of complications were recorded. In total, 218 patients were studied. Sixty-five patients came for fear of dental treatment and 153 for presenting with a diagnosis of intellectual disability and not collaborating in the treatment with local anesthesia. The average age of all patients was 30.54 ± 17.30 years. The most frequent oral pathologies found in patients with excessive fear were tartar (6.8%) and wisdom teeth (6.4%), followed by missing teeth (5%). In patients with disabilities, a combination of tartar and cavities appeared most frequently (41.3%), followed by cavities (15.6%). The most frequently used sedoanalgesia technique was the infusion of propofol with fentanyl in both groups of patients, followed by nitrous oxide. The combination of propofol and fentanyl was the most frequently used alternative in patients who were unable to collaborate because of intellectual disability or carry out longer or more complex treatments. Inhaled nitrous oxide and midazolam were the sedative techniques of choice for simpler oral treatments, such as tartrectomies, shallow obturations, and shorter interventions, or in younger patients.

Educating and empowering health care teams who present to the hospital to recognize and intervene on cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) in patients on bispecific t-cell engager therapy (BiTEs): A quality improvement study.

e23212 Background: Treatment of oncologic disease with Bispecific T-Cell Engager antibodies (BiTEs) are an emerging novel immunotherapy with demonstrated efficacy in multiple hematologic malignancies. Notable side effects of BiTE therapy include cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which can be life-threatening and must be rapidly identified. We aim to fill knowledge gaps surrounding CRS and ICANS for medical providers, particularly considering increased use of BiTE therapy. We hope that educating providers will allow faster recognition and treatment and will improve patient outcomes. Methods: Our study focused on the impact of educational presentations on awareness and identification of CRS/ICANS. Our intervention targeted the residents and attendings in the emergency department and the nurses, advanced practice providers, and hospitalists in the bone marrow transplant (BMT) unit at Stony Brook University Hospital. Anonymous surveys consisting of 9 multiple choice questions were conducted to assess baseline foundational knowledge of CRS/ICANS. QI consisted of a 15-minute educational presentation for both groups. The same surveys were repeated following the presentations to assess improvement in overall knowledge of CRS/ICANS. A two tailed independent T test was used to calculate significance. Results: The average pre-survey score for the emergency department (N = 37) was 39%. The average presurvey score for the BMT department (N = 13) was 45%. Significant improvements in scores after intervention were shown in both the emergency department (39% vs 66%, p = 0.0001) and the BMT department (45% vs 68%, p = 0.0006). Conclusions: Education among emergency department and hospitalist providers is essential in improving management of CRS and ICANS in patients treated with BiTEs. This quality improvement initiative confirmed a knowledge gap in CRS and ICANS amongst our healthcare teams. By providing educational resources to both departments, there was a significant improvement in this gap. Future directions for continued improvement in the detection and management of CRS/ICANS include patient medication identification cards, a central repository of treatment protocols, algorithms, and toxicities associated with BiTEs, and expanding our educational curriculum which are all currently under development at Stony Brook University Hospital.

Machine Learning-Based Cardiovascular Disease Detection and Intelligent Healthcare Workflow Automation

Cardiovascular diseases (CVDs) are a major cause of death worldwide, emphasizing the importance of better early detection methods. This study introduces a machine learning model to detect CVDs by analyzing vital sign information. The model, which was trained using a cardiovascular dataset, utilizes three algorithms: Support Vector Machine (SVM), Naïve Bayes, and Decision Tree. It assesses the health status of patients by predicting vital sign values, allowing healthcare providers to receive timely alerts. Following the Cross-Industry Standard Process for Data Mining (CRISP-DM) methodology, a proof-of-concept web application was created with object-oriented design principles and implemented using Python. This application predicts the likelihood of CVD and streamlines the scheduling of doctor appointments, promoting quick medical intervention. Our findings reveal that the Decision Tree classifier performed the best in accurately identifying patients who are at risk based on abnormalities in vital signs. This method can potentially enhance early detection of CVDs and improve the timing of medical care.

RTMS of the Cerebellum Using an Accelerated Stimulation Protocol Improved Gait in Parkinson’s Disease

Background Repetitive transcranial magnetic stimulation (rTMS) is a nonpharmacological and noninvasive brain stimulation technique that has been proven to be effective in Parkinson’s disease (PD). The combination of rTMS and treadmill training improved gait function in PD greater than treadmill training alone. Objective The aim of our study was to evaluate the combination of a novel high-intensity, short intervention rTMS treatment and a multimodal treatment protocol including of physiotherapy, occupational therapy and language therapy, the so-called Parkinson’s Disease Multimodal Complex Treatment (PD-MCT), to improve motor function. Methods In this randomized double-blind sham-controlled trial rTMS with 48 Hz or sham was applied over the cerebellum 3 times a day for 5 consecutive days. Patients were assessed at baseline (V0), after 5 days of treatment (V1), and 4 weeks later (V2). The primary clinical outcome measure was the motor sum-score of the Unified PD Rating Scale (UPDRSIII), secondary clinical outcomes were quantitative motor tasks. Results A total of 36 PD patients were randomly allocated either to rTMS (n = 20) or sham (n = 16), both combined with PD-MCT. rTMS improved the UDPRSIII score comparing baseline and V1 in the treatment group by −8.2 points (P = .004). The 8MW and dynamic posturography remained unchanged in both groups after intervention. Conclusion. Compressing weeks of canonical rTMS protocols into 5 days was effective and well tolerated. rTMS may serve as an add-on therapy for augmenting the multimodal complex treatment of motor symptoms, but seems to be ineffective to treat postural instability.

Brief intervention for chronic liver disease patients with alcohol use disorder in a hepatology outpatient unit: Effects and limitations.

It is not uncommon to encounter outpatients in the hepatology department with harmful alcohol habits. When treating such chronic liver disease (CLD) patients, an adequate intervention method for harm reduction of alcohol use, such as brief intervention (BI) or BI and nalmefene, should be considered. This study aimed to elucidate the clinical effectiveness of BI for CLD patients affected by harmful alcohol use. From June 2021 to 2023, 123 Japanese CLD outpatients (hepatitis B virus:hepatitis C virus:alcoholic liver disease:others=32:18:42:31) with an Alcohol Use Disorders Identification Test (AUDIT) score of ≥8 at the initial interview and a repeat interview with AUDIT 9months later were enrolled. Clinical features related to patient behavior following the initial AUDIT interview were retrospectively evaluated, and compared between patients without and with BI treatment. For the non-BI and BI groups, baseline AUDIT score (median 10 [interquartile range (IQR) 9-13] vs. 12 [IQR 10-17], p=0.016) and relative change in AUDIT score (median 0 [IQR -3 to 2] vs. -3 [IQR -7 to 0], p<0.01) showed significant differences, whereas there was no significant difference between the groups for AUDIT score at the time of the second interview (p=0.156). Following BI, significant improvements were observed for items 1, 2, 3, 4, 5, 8, and 10 of AUDIT (each p<0.05). Patients with an alcohol use disorder as well as those with alcohol dependency who received BI showed a significant decline in AUDIT score, although the score of the follow-up AUDIT indicated continued alcohol use disorder. In addition to BI, medication with nalmefene should be considered, based on individual factors.