Course Of Care Research Articles

Dementia Associated Disorders, Driving Status and the Relationships between Communication, Anxiety and Objective Cognitive Testing

AbstractBackgroundDementia associated diseases (DAD) refers to a heterogeneous group of disorders that are clinically characterized by progressive cognitive impairment (CI) that ultimately adversely influences an individual’s ability to function independently. CI may reflect abnormalities across multiple cognitive domains to varying degrees and combinations across various cognitive domains (CD). Identifying treatment needs and discussing treatment options requires ongoing communication between patient and provider over the disease continuum; communication capacity may be compromised but underappreciated. Impaired verbal and episodic memory function in people with DAD (PwDAD) can adversely impact communication abilities. Maintaining an effective long‐term treatment plan requires consistent monitoring of both performance ability and patient perspective (patient reported outcomes, PRO) across a continuum of patient needs (health, safety, and QoL).MethodRetrospective review of information obtained in the course of routine care including driving status, Neuro QOL‐Anxiety Short‐Form (A‐SF); Neuro QOL‐Communication Short‐Form (C‐SF); validated multi‐domain computerized cognitive assessment battery (CAB). CAB Domain Score of Verbal Function (CAB‐V) and Memory Function (CAB‐M). CAB and PRO were completed without provider influence.Result530 PwDAD (62% female, average age 71.9 +/‐ 14.3 years) was used to compare patient driving status with A‐SF, C‐SF, NT‐V, NT‐M scores. T‐Tests assuming both equal and unequal variances comparing multiple PRO scores to driving status determined significance at (p<0.01). Statistically significant relationships were identified between driving status and: A‐SF, C‐SF, CAB‐V, and CAB‐M.ConclusionSelf‐reported anxiety and ability to communicate, objective impairment in verbal, and memory function are related to driving status in PwDAD. Appreciation of disease impact, whether perceived or performance ability, across a continuum should be incorporated in routine care and monitoring of dementia disorders to optimize care and outcome by identifying issues of concern that have both visible and invisible impact both patients and clinicians to design an effective plan of care to accommodate patient centric impairment and needs. Standardized methods of routine PRO collection concerning various aspects of real‐world health outside of a clinic encounter are important to building an effective holistic treatment plan.

Enhanced Insight into Factors Impacting Driving Ability Across Manual Dexterity, Satisfaction with Managing Daily Activities and Select Cognitive Domains in People with Dementia Associated Disease

AbstractBackgroundDementia associated diseases (DAD) refers to a group of disorders characterized by progressive cognitive impairment (CI) that adversely influences ability to function independently in real world activities. CI may reflect abnormalities across multiple cognitive domains (CD) to varying degrees. Successful completion of activities of daily living (ADL) is progressively impaired DAD. Symptom recognition by family and clinicians typically present following irreversible damage, highlighting a demand for effective methods of early DAD diagnosis and treatment. Neurocognitive screening tools combined with patient reported outcomes (PRO) might provide deeper insight into the patterns and progression of DAD. Comparison of PRO across Upper Extremity Function Score (UEF), Self‐Efficacy for Managing Daily Activities (SEMDA), and cognitive performance measures with driving status in PwDAD might enhance understanding of disability across a continuum and identify the medical necessity of transportation assistance for PwDAD.MethodRetrospective review of examiner independent information collected in the course of routine care of a population of PwDAD including demographics, driving status, UEF, SEMDA, executive function (NT‐EF), and motor function, reflecting time to move and accuracy, (NT‐MF) of a multi‐domain computerized cognitive test (CTB). T‐tests were utilized for analysis with significance (p<0.05).Result529 PwDAD (59% female, average age 74.4 +/‐ 8.8 years) provided the data collected to compare patient driving status with UEF, SEMDA, NT‐MF, NT‐EF scores. Statistically significant (p<0.01) relationships were identified between driving status and PRO score for all domains: UEF, SEMDA, NT‐MF, and NT‐EF.ConclusionActive driving status in PwDAD is associated with better scores on a self‐reported upper extremity ability profile, self‐efficacy for managing daily activities as well as better executive function and cognitively defined motor function planning. While effective collaboration across a cognitive network provides for driving, simultaneous monitoring of UEF and SEMDA in conjunction with both NT‐MF, and NT‐EF might provide enhanced insight into driving impairment along a continuum. Improved awareness of the multiple potential paths of impairment and real‐world impact can offer proactive opportunities for intervention as well as novel important endpoints to measure therapy efficacy.

Musculoskeletal and Psychological Rehabilitation.

Although it has long been believed that stress has a detrimental effect on health and the risk of disease, little research has been done on the precise mechanisms by which this happens. The literature produced by past workers suggests many possibly intersecting mechanistic pathways that might be useful for future fundamental and clinical study. Exercise has been thoroughly researched as a non-pharmacologic strategy to increase bone mass. Many evidence-based treatment recommendations for patients suffering from osteoporosis-related fractures, potential courses of care, and rehabilitation concur that multidisciplinary therapy would be the most beneficial. Older and recent articles about musculoskeletal and psychological rehabilitation in the management of osteoporosis published in prominent and reputed journals are reviewed. Important and interesting information from some of the cross-references is also included. Opinions and impressions from the experience of treating osteoporosis are added while describing various aspects of psychological and physical rehabilitation. The recent evidence, reviewed here, also indicates the possibility of cross-effects between osteoporosis and psychological issues. A multi-factorial and personalised strategy should be explored for improved outcomes in patients under psychological stress, particularly those at increased risk of osteoporosis development. Reviewing current publications, the objectives of rehabilitation are evolving based on the disease's stage. For example, during the initial stage of a vertebral body collapse, the patient is treated with bracing, physical therapy, education, local and systemic analgesics, and a brief period of bed rest. The need to mobilise the patient carefully and safely along with a mix of medical care, dietary supplements, rehabilitation, and instructions to facilitate daily living activities, are endorsed to manage post-fracture osteoporosis. This chapter is not to make treatment advice, but rather to outline potential connections between psychological stress and low bone density and to emphasise potential multi-system consequences of pharmaceutical therapies. The goal is to enhance activities of daily living, which will increase safety, minimise falls, and maintain bone mass. Osteoporosis and fragility fractures can be prevented and managed with regular medical check-ups, daily exercise and yoga, a healthy diet, fall prevention measures,recreational groupactivities, supportive medications, control ofcomorbidities, use of assistivedevices, and customised rehabilitation programmes.

Clonal Hematopoiesis and Inflammation in the Vasculature (CHIVE), a Prospective, Longitudinal Clonal Hematopoiesis Cohort and Biorepository

Introduction Clonal hematopoiesis (CH), the expansion of a clonal population of hematopoietic cells, is an age-associated phenomenon leading to increased risk of both hematologic malignancy and non-malignant organ dysfunction. There have been significant advances in our understanding of the underlying pathophysiology of CH in recent years. However, additional studies are needed to better understand clinical trajectories and optimal care of patients with CH. To address this gap, the prospective, longitudinal CHIVE (Clonal Hematopoiesis and Inflammation in the VasculaturE) registry and biorepository was created to support multidisciplinary CH clinics. Methods Adults without active hematological malignancy who were clinically identified to have CH or who were at risk for CH were sequentially enrolled utilizing a multidisciplinary referral approach between October 2020 to April 2023 at Vanderbilt University Medical Center (VUMC). Research samples were procured at the time of routine clinical blood draws or bone marrow biopsies and stored in a newly established biorepository, equipped to store DNA, plasma, and viably cryopreserved cells to enable a spectrum of downstream applications. Specimens were sequenced on a highly cost efficient (~$6/sample) targeted next generation sequencing capture panel that identified mutations residing in the 24 most frequently mutated CHIP genes.The VUMC CH clinic, which serves as a referral pool, were included in Arm A of CHIVE (n=57). We also sought out a population at risk for CH which included patients over 18 years of age with a history of solid tumor, cardiovascular disease, renal disease, rheumatologic disease, or diabetes, who were included in Arm B (n=122). Patients from Arm A or B were included in the CH-positive (CH+) group if they met criteria for CH on the research assay at any time during their enrollment in the study. All other genotyped patients who were not found to have CH by the research assay, regardless of their clinical CH status at study enrollment, were included in the CH-negative (CH-) group.Anthropometric data and clinical assessments, including laboratories and cardiovascular studies obtained in the course of routine clinical care were extracted from the electronic health record, and recorded and maintained in the CHIVE database. Results 261 patients were approached for consent to enroll in CHIVE and 179 were ultimately enrolled. More than one half (54%) of all participants had a CH mutation (CH+) and of those, 49.5% were female. Median age of CH+ patients was 71.9 (IQR 64.0-77.5). DNMT3A (n=44) and TET2 (n=39) were the most commonly mutated genes, while variant allele fractions (VAF) ranged from 2.1 - 79.8% (Figure 1). 246 samples were serial samples collected from 89 patients at regular intervals. Significantly more CH+ patients had a diagnosis of coronary artery disease compared to CH- patients (55.7% vs 32.9%, p=0.004). CH+ patients also had increased rates of hypertension and heart failure compared to the CH- group (p<0.001, 0.035, respectively). Laboratory evaluation showed CH+ patients to have a lower median white blood cell count, hemoglobin, and platelets, and elevated blood urea nitrogen values compared to CH- patients, differences that did not meet statistical significance. 8.2% of the CH+ patients progressed to frank hematologic malignancy over the course of the 2.5-year study (Table 1). Eight of the 97 CH+ and 2 of the 82 CH- patients died over the course of the study period resulting in a trend toward decreased survival in CH+ patients (p=0.112). Conclusions We demonstrate the feasibility of a prospective, observational study of CH patients utilizing a robust referral network to support both clinical care and translational research. A well-genotyped and phenotyped cohort of CH patients will be critical to future translational research efforts and clinical trials - a key function of our study design. Early clinical findings from our cohort recapitulate large scale retrospective datasets where CH patients are at an increased risk of development of hematologic malignancy, end organ damage, and all-cause mortality. Scaling this resource in collaboration with other centers is underway and will ultimately enable the development of clinical guidelines and treatment strategies for this increasingly recognized patient population.

1646. Optimizing Antibiotic Durations of Therapy in Pediatric Community-acquired Pneumonia

Abstract Background Several recent high-quality studies have shown similar efficacy for a shorter, 5-day duration of antibiotics instead of the prior standard, 10 days, in pediatric community-acquired pneumonia (CAP). Despite high-quality literature support, implementing short courses into routine clinical practice remains challenging. This study aimed to assess the impact on the duration of antibiotics for CAP of a pilot clinical pharmacist discharge antibiotic prescription review and departmental education supporting short-course antibiotics for CAP. Methods This was a single-center retrospective cohort study for patients admitted with an order for any antimicrobial for CAP. Patients were excluded if they were admitted to the pediatric intensive care unit or transferred during their course of care. The pre-intervention period was from June 2021 to June 2022, and the postintervention group was from August to October 2022. A one-time education session was hosted with the Pediatric Hospital Medicine department summarizing the literature supporting short courses. Statistical analysis included ANOVA, Fisher’s Exact, and Mann-Whitney U test as appropriate. Results One hundred twenty-four patients were included, 85 in the pre-intervention and 39 in the post-intervention groups. The median age was two years old in both groups (p=0.2). No differences were present in the median length of stay, penicillin-allergy status, or vaccination status. Patients had a positive viral test 56% and 59%, respectively (p=0.8). Discharge attendings did differ and impact the total length of therapy (p< 0.001). Overall median antibiotic duration for CAP decreased from 8 to 5 days (p< 0.01). Inpatient median durations remained the same at 2 days (p=0.5), while outpatient durations fell from 6 to 4 days (p< 0.01). Patients that received over seven days for CAP decreased from 62% to 10% (p< 0.01). Treatment failure at 30 days occurred in 2 and 8% (p=0.16), respectively. Conclusion A pilot discharge prescription review by clinical pharmacists and education supporting short courses for CAP effectively reduced the duration of antibiotic therapy. Consideration should be given to discharge antibiotic prescription reviews when adopting short courses for common pediatric infections. Disclosures Shubho Sarkar, MD, Abbott Laboratories: Stocks/Bonds|Abbvie INC: Stocks/Bonds|Bristol-Myers Squibb: Stocks/Bonds|CVS Health Corp: Stocks/Bonds|Johnson & Johnson: Stocks/Bonds

«Digesting Crohn's Disease»: The Journey of Young Adults since Diagnosis.

Crohn's disease affects 2.5 million people in Europe (more than 100,000 people in France) and often occurs between the ages of 15 and 30, a period marked by self-construction. However, few studies have focused on the experience of the diagnosis during this sensitive developmental stage. This study aimed to qualitatively explore the experience of Crohn's disease in young adults since their diagnosis. Fifteen young adults (18-35 years) diagnosed with Crohn's disease participated in a semi-directive interview. Narrative data were subjected to a thematic analysis, and thirty percent of the interviews were double-coded. The results revealed an evolution of four main themes since diagnosis: (1) course of care, (2) illness perceptions, (3) disease management and (4) self-perception. For most participants, the onset of the disease was difficult, marked by severe symptoms requiring hospitalization, numerous medical examinations and sometimes several consultations before diagnosis. This journey was more difficult when it was associated with negative relations with the medical staff, who were sometimes perceived as unsupportive. Thus, some people described this diagnostic period as an "ordeal", while others experienced it as a "relief" from their suffering. The announcement of the diagnosis was often a "shock", an "upheaval" or a "downfall", followed by phases of denial associated with a desire to maintain a "normal life" and not to be defined by the disease. Despite a difficult start, most participants grew from their experience with CD, with a sense of a personal development that was made possible by self-regulation processes that enabled them to draw on their own experience and resources to adjust to their illness. By highlighting positive possibilities for evolution, this study suggests the importance of supporting the psychological resources of young adults by proposing, at an early stage, psychological support or therapies focused on acceptance and engagement.

What is bad news in fertility care? A qualitative analysis of staff and patients' accounts of bad and challenging news in fertility care.

What do fertility staff and patients think is bad news in fertility care? Staff and patients agree bad news is any news that makes patients less likely to achieve parenthood spontaneously or access and do successful treatment, but their appraisals of how bad the news is are differently influenced by specific news features and the context of its delivery. Bad news is common in fertility care, but staff feel unprepared to share it and four in 10 patients react to it with unanticipated emotional or physical reactions. Research has paid much attention to how bad news should be shared, but considerably less to what news is perceived as bad, despite the fact this may dictate elements of its delivery. Two cross-sectional, online, mixed-method surveys (active 7 January-16 July 2022) were distributed to fertility staff and patients across the UK and Europe. Staff inclusion criteria were being a healthcare professional working in fertility care and having experience of sharing bad news at least once a month. Patients' inclusion criteria were being adults and having had a conversation in which staff shared or explained bad news concerning their fertility care within the last 2 months. Surveys were created in English using Qualtrics, reviewed by patients and healthcare professionals, and distributed via social media, Prolific, fertility organizations, and scientific societies. Patients were asked, regarding the last time bad news were shared with them, 'What was the bad news?' and 'What other news would you consider bad news in fertility care?'. Staff were asked to 'List the three most challenging topics of bad news you share with your patients'. Staff and patient data were separately thematically analysed to produce basic codes, organized into sub-themes and themes. Themes emerging from patients' and staff data were compared and synthesized into meta themes. Three hundred thirty-four staff accessed the survey, 286 consented, and 217 completed (65% completion rate). Three hundred forty-four patients accessed the survey, 304 consented, and 222 completed (64% completion rate). Eighty-five percent of participants were women, 62% resided in Europe, and 59% were in private care. Average staff age was 45.2 (SD = 12.0), 44% were embryologists or lab technicians, 40% were clinicians (doctors, consultants, or physicians), and 8% nurses or midwifes. Average patient age was 32.2 (SD = 6.4) and 54% had children. Staff answers originated 100 codes, 19 sub-themes and six themes. Patients' answers produced 196 codes, 34 sub-themes, and 7 themes. Staff and patient themes were integrated into three meta-themes reflecting main topics of bad news. These were Diagnosis and negative treatment events and outcomes, Inability to do (more) treatment, and Care and patient factors disrupting communication. Staff and patients agreed that some news features (uncertain, disruptive, definitive) made news more challenging but disagreed in relation to other features (e.g. unexpected/expected). Patient factors made bad news more challenging to staff (e.g. difficult emotions) and care factors made bad news more challenging to patients (e.g. disorganized care). Participants were self-selected, and most were women from private European clinics. Questions differed for staff and patients, focused on subjective perceptions of news, and did not measure news impact. The badness of fertility news is not only a product of the extent to which the news compromises parenthood goals but also of its features (timing, nature, number) and the context in which the news is delivered. Guidance on sharing bad news in fertility care needs to go beyond easing the process for patients to also consider staff experiences. Guidance may need to be tailored to news features and context. Cardiff University funded the research. S.G., J.B., O'.H., and A.D. report funding from the Higher Education Funding Council for Wales and the European Society for Human Reproduction and Embryology (ESHRE) to develop fertiShare: a sharing bad news eLearning course for fertility care. fertiShare will be distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence (CC BY-NC-SA 4.0). No other conflicts are reported in relation to this work. N/A.

Cognitive Remediation in Bipolar (CRiB2): study protocol for a randomised controlled trial assessing efficacy and mechanisms of cognitive remediation therapy compared to treatment as usual

BackgroundA substantial proportion of people with bipolar disorder (BD) experience persistent cognitive difficulties associated with impairments in psychosocial functioning and a poorer disorder course. Emerging evidence suggests that cognitive remediation (CR), a psychological intervention with established efficacy in people with schizophrenia, can also benefit people with BD. Following a proof-of-concept trial showing that CR is feasible and potentially beneficial for people with BD, we are conducting an adequately powered trial in euthymic people with BD to 1) determine whether an individual, therapist-supported, computerised CR can reduce cognitive difficulties and improve functional outcomes; and 2) explore how CR exerts its effects.MethodsCRiB2 is a two-arm, assessor-blind, multi-site, randomised controlled trial (RCT) comparing CR to treatment-as-usual (TAU). Participants are people with a diagnosis of BD, aged between 18 and 65, with no neurological or current substance use disorder, and currently euthymic. 250 participants will be recruited through primary, secondary, tertiary care, and the community. Participants will be block-randomised (1:1 ratio, stratified by site) to continue with their usual care (TAU) or receive a 12-week course of therapy and usual care (CR + TAU). The intervention comprises one-on-one CR sessions with a therapist supplemented with independent cognitive training for 30–40 h in total. Outcomes will be assessed at 13- and 25-weeks post-randomisation. Efficacy will be examined by intention-to-treat analyses estimating between-group differences in primary (i.e., psychosocial functioning at week 25 measured with the Functional Assessment Short Test) and secondary outcomes (i.e., measures of cognition, mood, patient-defined goals, and quality of life). Global cognition, metacognitive skills, affect fluctuation, and salivary cortisol levels will be evaluated as putative mechanisms of CR through mediation models.DiscussionThis study will provide a robust evaluation of efficacy of CR in people with BD and examine the putative mechanisms by which this therapy works. The findings will contribute to determining the clinical utility of CR and potential mechanisms of action.Trial registrationCognitive Remediation in Bipolar 2 (CRiB2): ISRCTN registry: https://www.isrctn.com/ISRCTN10362331. Registered 04 May 2022. Overall trial status: Ongoing; Recruitment status: Recruiting.

Effects of a death education based on narrative pedagogy in a palliative care course among Chinese nursing students.

Death education has been confirmed to be an effective method to enhance nursing students' attitudes and coping abilities toward death. However, integrated Narrative Pedagogy into the death education to explore educational effectiveness is still limited. The study aimed to evaluate the effects of a death education based on Narrative Pedagogy in a palliative care course on the attitude toward death, coping with death, and attitude toward caring for the dying among undergraduate nursing students in China. The study was designed as a pre-post intervention study with a quasi-experimental design. All the participants received 6 class hours of death education which was designed in a palliative care course. The death education includes preparation, presentation, discussion, reflection, and practice of the narrative materials. Death Attitude Profile-Revised (DAP-R), Coping with Death Scale (CDS), and Frommelt Attitude Toward Care of the Dying-Form B (FATCOD-Form B) were used to measure outcomes. Sixty undergraduate nursing students who consented. There were statistically significant increases in the mean score of neutral acceptance and approach acceptance in the DAP-R, CDS, and FATCOD-Form B before and after the intervention. This death education integrated Narrative Pedagogy which indicated to improve attitude toward death, competence to cope with death, and attitude toward the care of dying patients. The findings assist teachers in understanding the importance and urgency of death education, as well as providing a favorable approach to death education. However, the long-term effectiveness still needs to study in further.

Developing a Mobile Learning Virtual Nursing Diagnosis (VND) Media for Medical Surgical Nursing Course

Link of Video Abstract: https://youtu.be/4zHCrIC1IGE Background: The development of innovative and technology-aligned learning media is a necessary solution for nursing students. Students require access to interactive, practical, and easily accessible learning resources. An application that can facilitate students' learning in nursing diagnosis for surgical nursing, such as Virtual Nursing Diagnosis (VND), is needed. This study focuses on the development of the VND application specifically designed for the Surgical Nursing Care course. Patients and methods: The research is a Research and Development (R&D) study involving 253 nursing students from Aceh Health Polytechnic. A needs analysis was conducted to identify the difficulties faced by students in applying nursing diagnoses to topics related to surgical nursing, particularly the cardiovascular system. Based on the findings of the needs analysis, it was discovered that students face difficulties in determining nursing problems. Therefore, the VND application was developed with features such as assessment forms, assessment tools, disease pathology, and nursing diagnoses. Additionally, the application is equipped with competency tests on interesting nursing cases that are user-friendly for students. Results: The research results indicate that the VND application has received positive feedback from 253 students who have used it in real classroom environments. The application is user-friendly, efficient in performing nursing diagnoses, and provides available nursing case questions. VND application provides an interactive, innovative, and effective learning tool for understanding nursing diagnoses while enhancing accessibility and flexibility through mobile-based learning. The application equips students with the necessary skills to apply nursing diagnoses in real-world surgical medical practice. Conclusion: the VND application significantly contributes to the development of nursing education. It not only improves understanding of nursing diagnoses but also provides an engaging and interactive learning experience. It is hoped that the use of the VND application in surgical nursing education can be an effective and innovative solution to enhance competency in applying nursing diagnoses in clinical practice.

Mixed analysis of the satisfaction survey of the Primary Health Care course of the Institute of Health for Well-being

Describing the perception towards the online course on Primary Health Care (PHC) of the Institute of Health for Well-being (INSABI) will allow to establish improvement actions. Describe the factors that contribute to satisfaction with the PHC course offered online by INSABI. 620 records of the Health Education System for Well-being were studied. Satisfaction was determined using a Likert-type questionnaire with three dimensions: virtual environment, cognitive area, and measurement of learning. A deductive analysis of the open opinions was carried out. 70% of the health personnel approved the course in less than a week, with an initial score of 5.41 ±1.9 points and final score of 7.8 ± 1.2. More than 65% had scores above the average in the three dimensions. Satisfaction with the virtual environment was 15.57 ± 3.4 points, and 15.73 ± 3.3 with the cognitive dimension. Age and gender were associated with dissatisfaction with the virtual environment and in the cognitive dimension, age was associated with dissatisfaction; 27.7% expressed negative comments, 28.5% related to course extension; 15.5% about the didactic techniques, 10.9% about the speakers and 10.4% about the final exam. The course generates significant learning, 62.4% of the students have a positive or neutral opinion. However, 27.8% expressed dissatisfaction, the majority related to the extension of the course.

Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study.

To identify trajectories of depressive symptoms in older breast cancer survivors and demographic, psychosocial, physical health, and cancer-related predictors of these trajectories. Recently diagnosed nonmetastatic breast cancer survivors (n= 272), ages 60-98 years, were evaluated for depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D; scores ≥16 suggestive of clinically significant depressive symptoms). CES-D scores were analyzed in growth-mixture models to determine depression trajectories from baseline (post-surgery, pre-systemic therapy) through 3-year annual follow-up. Multivariable, multinomial logistic regression was used to identify baseline predictors of depression trajectories. Survivors had three distinct trajectories: stable (84.6%), emerging depressive symptoms (10.3%), and recovery from high depressive symptoms at baseline that improved slowly over time (5.1%). Compared to stable survivors, those in the emerging (OR = 1.16; 95% CI = 1.08-1.23) or recovery (OR = 1.26; 95% CI = 1.15-1.38) groups reported greater baseline anxiety. Greater baseline deficit accumulation (frailty composite measure) was associated with emerging depressive symptoms (OR = 3.71; 95% CI = 1.90-7.26). Less social support at baseline (OR = 0.38; 95% CI = 0.15-0.99), but greater improvement in emotional (F= 4.13; p= 0.0006) and tangible (F= 2.86; p= 0.01) social support over time, was associated with recovery from depressive symptoms. Fifteen percent of older breast cancer survivors experienced emerging or recovery depressive symptom trajectories. Baseline anxiety, deficit accumulation, and lower social support were associated with worse outcomes. Our results emphasize the importance of depression screening throughout the course of cancer care to facilitate early intervention. Factors associated with depressive symptoms, including lower levels of social support proximal to diagnosis, could serve as intervention levers.

Evaluación de la simulación de alta fidelidad con actores en cuidados paliativos y estudiantes de Enfermería: un estudio de método mixto

ObjectiveThe most effective training methods are experiential, including those focused on experiences and emotions. Clinical simulation, especially high-fidelity simulation, is one of the most effective methodologies for the acquisition of competencies in care like palliative care. The simulation with actors can train future healthcare science professionals in technical, intellectual, or interpersonal skills. The objective is to evaluate high-fidelity simulation with actors as a tool in palliative care training for nursing students. MethodOver three years, the study was conducted in the Faculty of Nursing of Murcia with nursing students. A mixed methods study with sequential explanatory design in three moments was conducted: 1)Quasi-experimental study in a single group (n=12) before and after attending the palliative care course with clinical simulation with actors to assess the communication skills (CICAA scale). 2)Qualitative study with phenomenological perspective after clinical simulation (174 reflective students’ narratives). 3)Cross-sectional observational study, one year later, to assess the transfer of knowledge and skills to the clinical practice (71 students). ResultsStudents who interacted with actors in clinical simulation improved their communication skills and the ability to establish an effective helping relationship with both end-of-life patients and their families. The students perceived the clinical simulation as an innovative learning methodology that is useful to encourage reflection and transfer of learning during their clinical internship. ConclusionsStandardization of the use of active learning methodologies is recommended for a better acquisition of transversal skills such as communication skills in palliative care.

A study on measure of resilience and impact of demanding clinical training on young medical professional's burnout in a tertiary care hospital, Andhra Pradesh

BACKGROUND: The psychological state of medical students gaining concern on the part of medical institutions in several countries. Numerous studies are being conducted to study stress, burnout, and depression in medical students in India and globally. However, little is known about medical student resilience, particularly in India. The objectives of this study were to study the resilience, self-perceptions of stress coping skills, and burnout among medical students in clinical training in a tertiary care health center, to study factors associated with resilience among medical students in clinical training in a tertiary care health center and to study the relationship between resilience and self-perceptions of stress coping skills and symptoms of burnout. MATERIALS AND METHODS: This cross-sectional study was conducted in a tertiary healthcare hospital in district Guntur, Andhra Pradesh from November 2020 to December 2020, among 186 adult male and female medical students, aged more than 20 years, enrolled in the regular degree course and part of patient care or at least last three months. Participants were randomly selected and a structured questionnaire with Connor Davidson Resilience Scale 10 was used for interviewing. Descriptive and inferential statistics were conducted to measure associations between outcome and explanatory variables. We used multiple linear regression to examine the association between dependent and independent variables. A P value less than. 05 was considered significant. RESULTS: In the present study, 109 (58.0%) were females. The mean age of the study participants was 25.4 years (standard deviation 2.78). The mean score resilience score of the study participants using Connor Davidson Resilience Scale 10 was 25.1 (standard deviation 7.97). Of the total 44 (23.7%) of the study, participants reported the presence of burnout. A significant positive correlation was between resilience and self-perceptions of stress-coping skills with a Pearson Correlation coefficient of 0.393. Among the study participants, the mean resilience score was higher among those not having any symptoms of burnout. In the hierarchical stepwise multiple linear regression analysis, male gender (P value = .014), financial independence (P value = .044), and absence of burnout symptoms (P value = .004) were significantly associated with higher resilience scores. Psychiatric medicine usage was significantly associated with a lower resilience score with P < .05. CONCLUSION: Our study samples had higher resilience and lower burnout prevalence compared to the West. The stressful clinical event experienced by medical students demands training and innovative strategies to foster communication and teamwork skills among medical teams.

Interdisciplinary implementation of a synoptic reporting template for melanoma nodal surveillance ultrasound.

35 Background: As nodal surveillance is increasingly used for sentinel lymph node positive (SLN+) melanoma following the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II), availability of high-quality nodal surveillance ultrasonography (U/S) has become a critical need. Based on MSLT-II, U/S criteria concerning for nodal recurrence should be evaluated to determine indication for lymph node (LN) biopsy. We previously demonstrated low utilization of MSLT-II criteria for reporting nodal U/S at our tertiary cancer center, diminishing the clinical utility of these reports. Working in an interdisciplinary team of surgeons and radiologists, we aimed to implement and evaluate a synoptic reporting template for melanoma nodal ultrasound at our institution. Methods: Patients undergoing melanoma nodal surveillance at a tertiary cancer center from July 2017 to June 2023 who received at least one nodal U/S were identified retrospectively. Reporting language from each U/S was analyzed for number of MSLT-II criteria reported and presence of clinically actionable recommendations for the referring surgical team (e.g. normal LN appearance or abnormal LN with recommendation for biopsy or observation). The synoptic report was designed collaboratively by a group of radiologists and surgical oncologists to include MSLT-II U/S criteria and thresholds for biopsy versus continued surveillance, with the institutional U/S dictation template revised accordingly. Dissemination to clinical teams was conducted and utilization was monitored in the course of clinical care. Following implementation of the synoptic template in January 2023, post-implementation adherence and outcomes were reviewed. Descriptive statistics and bivariate analysis were performed. Results: 337 nodal U/S studies were performed on 94 SLN+ melanoma patients, with a median of 2.5 U/S per patient (range 1 to 12). Forty-two U/S (12.5%) were performed in the post-implementation period and eligible for synoptic reporting; of these, 32 (76.0%) were reported with the synoptic template. The mean number of MSLT-II criteria reported was greater post-implementation (Pre 0.5 ± 0.8 vs Post 2.5 ± 1.0, p<0.001). Abnormal findings were reported in 73 U/S (21.7%), with a significant increase in the proportion of clinically actionable recommendations for abnormal findings reported in the Post versus Pre group (93.0% vs 64.0%, p=0.037). Conclusions: Following the implementation of a collaboratively designed synoptic reporting template for melanoma nodal U/S, reports were much more likely to have MSLT-II criteria reported in addition to an actionable recommendation. There was notable improvement when ultrasounds had abnormal findings, when the application of these reporting criteria is most crucial. Further iterative improvement to increase adherence to the synoptic report and dissemination to other cancer centers is ongoing.

Assessment of high fidelity simulation with actors in palliative care in nursing students: a mixed methods study

ObjectiveThe most effective training methods are experiential, including those focused on experiences and emotions. Clinical simulation, especially high-fidelity simulation, is one of the most effective methodologies for the acquisition of competencies in care like palliative care. The simulation with actors can train future healthcare science professionals: in technical, intellectual, or interpersonal skills. The objective is to evaluate high-fidelity simulation with actors as a tool in palliative care training for nursing students. MethodOver three years, the study was conducted in a Faculty of Nursing of the south of Spain with nursing students. A mixed methods study with sequential explanatory design in three moments was conducted: (1) Quasi-experimental study in a single group (n = 12) before and after attending the palliative care course with Clinical Simulation with actors to assess the communication skills (CICAA scale), (2) Qualitative study with phenomenological perspective after Clinical Simulation (174 reflective students’ narratives), (3) Cross-sectional observational study, one year later, to assess the transfer of knowledge and skills to the clinical practice (71 students). ResultsStudents who interacted with actors in Clinical Simulation improved their communication skills and the ability to establish an effective helping relationship with both end-of-life patients and their families. The students perceived the Clinical Simulation as an innovative learning methodology that is useful to encourage reflection and transfer of learning during their clinical internship. ConclusionsStandardization of the use of active learning methodologies is recommended for a better acquisition of transversal skills such as communication skills in palliative care.

The Real-Life Impact of mFOLFIRI-Based Chemotherapies on Elderly Patients-Should We Let It or Leave It?

The oncologic treatment of elderly patients is going on with a lack of evidence due to their underrepresentation in clinical trials. Many data suggest that certain groups of elderly patients, like their younger counterparts, may benefit from the systemic treatment of their metastatic colorectal tumors (mCRC). We performed retrospective data analysis to investigate the clinical course of care and clinical outcomes of 515 patients who received first-line mFOLFIRI-based chemotherapy for mCRC between 1 January 2013 and 31 December 2018 at the Institute of Oncotherapy of the University of Pécs, focusing on a comparison of patients over and under 70 years of age, defined as the cut-off value. 28.7% of the 515 patients were 70 years old and older (median age 73.5 years). Compared to the data of the elderly patients, the younger group (median age 61.1 years) had a performance status that was significantly better (average ECOG 1.07 vs. 0.83, p < 0.0001), and significantly more patients received molecularly targeted agents (MTA) (21.6% vs. 51.8%, p < 0.0001); nevertheless, mPFS (241 vs. 285 days, p = 0.3960) and mOS (610 vs. 698 days, p = 0.6305) results did not differ significantly. Considering the 1y PFS OR and the 2ys OS OR values (0.94 [95%CI 0.63-1.41] and 0.72 [95%CI 0.47-1.09], respectively), only a non-significant trend was observed in OS favouring the younger population. Additional analysis of our data proved that the survival in patients over 70 years was positively affected by the addition of MTAs to the doublet chemotherapies, and the reasonable modifications/reductions in dose intensity and the addition of local interventions had similar positive effects as observed in the younger patients' group. Age stratification of mCRC patients is not professionally justified. Patients over 70 years of age with good performance status and controlled co-morbidities benefit from systemic therapy, its modifications and local treatment to the same extent as younger patients. With the increasing incidence of age-related cancers due to the rising average lifespan, prospective randomised clinical trials are needed to determine the real value of systemic therapy in the elderly and the rational, objective methods of patient selection.

Health staff perceptions of patient safety and associated factors in hospitals in Vietnam.

Patient safety is a global challenge of preventing and mitigating medical errors which might harm patients during their course of treatment and care. This study was employed to contribute to the existing literature aimed to assess patient safety culture among health staff and to determine predictors of health staff perceptions of patient safety in hospitals in Vietnam. A cross-sectional study was conducted in three hospitals of Vietnam with a total of 763 participants. This study used the Hospital Patient Safety Scale developed by the American Health and Quality Research Organization. In general, 8 of 12 patient safety dimensions in two hospital; and 10 of 12 dimensions in a third hospital had average scores of 60% and above positive responses. The communication openness and organizational learning dimensions were found to be significant different when comparing hospitals. Regarding sample characteristics, department (subclinical department) and health staff positions (nurses/technicians, pharmacists) were significant predictors in the total model including three hospitals (R2 = 0.07). This study reported that communication openness and organization learning are two aspects that need to be improved they are strongly related to patient safety culture and to knowledge exchange among health staff. It has been suggested that hospitals should deliver patient safety training courses and establish a supportive learning environment to improve these challenges.

Firearm injuries treated at trauma centers in the United States.

While firearm injuries and deaths continue to be a major public health problem, the number of nonfatal firearm injuries and the characteristics of patients are not well-known. The American College of Surgeons Committee on Trauma leveraged an existing data system to collect additional data on fatal and nonfatal firearm injuries presenting to trauma centers. This report provides an overview of this initiative and highlights the challenges associated with capturing actionable data on firearm-injured patients. A total of 128 trauma centers that are part of the American College of Surgeons Trauma Quality Improvement Program collected data on individuals of any age arriving alive between March 1, 2021, and February 28, 2022, with a firearm injury. In addition to the standard data collected for Trauma Quality Improvement Program, abstractors also extracted additional data specific to this study. We linked data from the Distressed Community Index to patient records using zip code of residence. A total of 17,395 patients were included, with mean (SD) age of 30.2 (13.5) years, 82.5% were male, and the majority were Black and non-Hispanic. The mean proportion of variables with missing data varied among trauma centers, with a mean of 20.7% missing data. Injuries occurred most commonly in homes (31.2%) or on the street (26.6%); 70.4% of injuries were due to assaults. Nearly one third of patients were discharged from the emergency department, 25.9% were admitted directly to the operating room, and 10.9% were admitted to the intensive care unit; 5.9% died in the emergency department, and 10.3% died overall during their course of care. Nearly two thirds of patients lived in the two highest distressed categories of communities; only 7.5% lived in the least distressed quintile. Using trauma center data can be a valuable tool to improve our knowledge of firearm injuries if clinical practices and documentation of patient risks and circumstances are standardized. Prognostic and Epidemiological; Level III.

Orofacial Migraine and Other Idiopathic Non-Dental Facial Pain Syndromes: A Clinical Survey of a Social Orofacial Patient Group.

Background: Orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes mainly characterized by painful attacks localized in facial and oral structures. According to the International Classification of Orofacial Pain (ICOP), the last three groups (non-dental facial pain, NDFP) are cranial neuralgias, facial pain syndromes resembling primary headache syndromes, and idiopathic orofacial pain. These are often clinical challenges because the symptoms may be similar or common among different disorders. The diagnostic efforts often induce a complex diagnostic algorithm and lead to several imaging studies or specialized tests, which are not always necessary. The aim of this study was to describe the encountered difficulties by these patients during the diagnostic-therapeutic course. Methods: This study was based on the responses to a survey questionnaire, administered to an Italian Facebook Orofacial Patient Group, searching for pain characteristics and diagnostic-therapeutic care courses. The questionnaire was filled out by patients affected by orofacial pain, who were 18 years and older, using a free online tool available on tablets, smartphones, and computers. Results: The sample was composed of 320 subjects (244F/76M), subdivided by age range (18-35 ys: 17.2%; 36-55 ys: 55.0%; >55 ys 27.8%). Most of the patients were affected by OFP for more than 3 years The sample presented one OFP diagnosis in 60% of cases, more than one in 36.2% of cases, and 3.8% not classified. Trigeminal neuralgia is more represented, followed by cluster headaches and migraines. About 70% had no pain remission, showing persisting background pain (VAS median = 7); autonomic cranial signs during a pain attack ranged between 45 and 65%. About 70% of the subjects consulted at least two different specialists. Almost all received drug treatment, about 25% received four to nine drug treatments, 40% remained unsatisfied, and almost 50% received no pharmacological treatment, together with drug therapy. Conclusion: To the authors' knowledge, this is the first study on an OFP population not selected by a third-level specialized center. The authors believe this represents a realistic perspective of what orofacial pain subjects suffer during their diagnostic-therapeutic course and the medical approach often results in unsatisfactory outcomes.