Clinical Setting Research Articles

Vmax as an Index of right ventricular function in pulmonary hypertension

Abstract Background For assessing right ventricular function in pulmonary hypertension (PH), the optimal approach is through the use of load-independent parameters. While pressure-volume (PV) loops are not feasible in clinical settings, the maximum velocity of the contractile element under no load, known as Vmax, serves as an alternative measure that could be derived only from right-heart catheterization (RHC). Objectives To determine Vmax in patients undergoing RHC and to evaluate its correlation with echocardiographic parameters. Methods 15 PH patients scheduled for risk stratification were subjected to RHC and echocardiography. The contractile velocity element (VCE) was calculated as VCE = 1 / (28.8 x P) x dP/dt, with P representing RV pressure in mm Hg and dP/dt its first derivative in mmHg/s. The P vs. VCE plot displays a peak VCE value, leading into a linear slope (red line, figure 1A) with Vmax as the zero-pressure intercept. Vmax was compared with 6 different echocardiographic parameters of RV function. Results They were six females and 9 males aging 61±6 y. Mean PH was 37,6±10,1 mm Hg and Vmax averaged 2,1±0,9 length/s (range from 0,8 to 4,4 length/s). Figure 1B illustrates 3 patients with deteriorated, mildly reduced and normal VCE. When compared to Vmax, tricuspid peak systolic tissue Doppler velocity and TAPSE shown the best correlation while RV fractional area change demonstrated the worse correlation (figure 2). Conclusion Vmax, an indicator of right ventricular systolic function that does not depend on load, can be obtained through right heart catheterization. Both tissue Doppler peak systolic velocity and tricuspid annular plane systolic excursion (TAPSE) have demonstrated a strong correlation with Vmax.Invasive pressureECHO parameters

The potential of non-clinical guidance alongside e-mental Health to overcome non adherence

Abstract Background Mental health problems account worldwide for over an eighth of the global burden of disease and waiting lists nowadays are commonplace. E-Health has potential to reduce mental illness, whilst waiting for therapy or as a stand alone. A big problem with implementation of E-health in clinical practice is non adherence. Non-clinical guidance could make a difference as compared to the non guidance modus. Our research question is: what factors contribute to the potential of non-clinical guidance in overcoming non adherence for e-mental Health for patients with depressive, anxiety and stress symptoms? Methods We did a qualitative study in a Dutch general practice. The treatment consisted of several modules accompanied by non-clinical guidance by a healthcare assistant. Out of 190 invited patients, 31 patients participated. Eight weeks after being invited, 11 semi-structured interviews were conducted until data saturation. Thematic analysis was used with open, axial and selective coding. Results Three major themes emerged: 1) The patients were satisfied with the non-clinical guidance in almost all aspects: Negative comments arose from an urge for more contact or tailoring. 2) The form of the guidance (e.g. non-clinical; used interface) was subordinate to the amount and tailoring of it. 3) Adherence could further be improved through a more personal introduction, explaining the benefits of certain exercises and more time management. Conclusions The potential of non-clinical guidance in overcoming non adherence for e-mental Health can be improved by further tailoring and increasing the interactivity when needed. Further research is also needed, after the suggested improvements, whether the intervention is effective, compared to a therapist guided and a non guided version. This study needs to be repeated in other clinical settings. Key messages • Non-clinical guidance, alongside e-mental health has potential to help with non adherence, thereby decreasing the burden of waiting lists. • Non-clinical guidance was positively received by patients who received e-mental health, although further tailoring could make online treatment even a larger success.

The evaluation of an eHealth tool to prevent and alleviate migraine complaints in adults

Abstract Background Migraines attacks cause great suffering in individual patients. There is great unfulfilled potential to increase patients’ knowledge about various personal triggers and subsequent treatments. The objective of this study is to pilot test an e-Health tool that aims to increase migraine patients’ knowledge. It takes into account personal preferences and contributes to informed decision-making in choosing the appropriate method. Considering the shortage of primary care physicians and other health care providers, such an e-Health tool could be of great value. Methods lessmigraine.nl consists of a website with information plus an electronic decision aid. It was evaluated on its content, development process and effectiveness, and its contribution to the patients’ empowerment process. A first round of usability testing was done using semi-structured interviews and thematic analysis with 12 patients from a Dutch General Practice until data saturation. After minor improvements to the e-tool, in a first implementation step subsequently 85 patients used the e-tool. Results Patients’ expectations were exceeded in terms of the content of the e-Health tool, as all patients discovered new potential migraine triggers. Most patients found the tool effective in the sense that it provided enough information to decide on an appropriate treatment. The implementation was successful in the sense that all 85 participants completed the e-tool. Most important triggers were stress, sleeping problems, changes in weather and flickering or bright light. Conclusions The majority of the migraine patients were satisfied with the e-Health tool. It enlarged their knowledge of prevention and treatment options and therefore empowered them in their decision-making process and communication with their GP. Other aspects of implementation need to be studied. This study needs to be repeated in other clinical settings. Key messages • Migraines cause great suffering in individual patients: Considering the shortage of primary care physicians and other health care providers, an e-Health tool could be of great value. • The e-Health tool increases patients’ knowledge about migraine, including personal triggers and subsequent treatments.

Eosinophil–Basophil/Lymphocyte (EB/LR) and Eosinophil–Basophil–Platelet/Lymphocyte (EBP/LR) Ratios Could Serve as Useful Additional Markers for Assessing the Severity of Wasp Allergic Reactions

Wasp venom allergy can trigger severe allergic reactions, and predicting these acute responses remains challenging. This study evaluates the utility of immune system indexes, particularly the eosinophil–basophil/lymphocyte (EB/LR) and eosinophil–basophil–platelet/lymphocyte (EBP/LR) ratios, in assessing the severity of allergic reactions in patients with wasp venom allergy. A total of 61 patients with confirmed wasp venom allergy were categorized according to the Mueller scale, which classifies the severity of allergic reactions. Blood samples were analyzed for total and specific IgE levels alongside a range of hematological and biochemical parameters. This study found significant differences in the EB/LR and EBP/LR indexes between patients with mild (Mueller I–II) and severe (Mueller III–IV) allergic reactions, with higher values indicating more severe responses. However, no significant differences were observed in other immune indexes, such as the platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and systemic inflammatory response index, as well as in additional blood parameters. These findings suggest that the EB/LR and EBP/LR ratios may serve as useful markers for predicting the severity of allergic reactions in patients with wasp venom allergy. This is the first study to establish such a link, although further research with larger cohorts is necessary to confirm these results and their potential application in clinical settings.

Rapid and sensitive detection of Mycobacterium tuberculosis using nested multi-enzyme isothermal rapid amplification in a single reaction.

In this study, we have successfully developed a method called nested multi-enzyme isothermal rapid amplification (nestMIRA) for the detection of Mycobacterium tuberculosis (Mtb). This method involves a two-step thermostatic amplification process in the same tube and can be read using fluorescence and lateral flow dipstick (LFD) assays. It is known to be rapid, specific, and highly sensitive. Our method has shown promising results in the detection of clinical specimens, and we believe that it can be a valuable tool for the rapid detection of Mtb in a clinical setting.

Classification of Vaginal Cleanliness Grades through Surface‐Enhanced Raman Spectral Analysis via The Deep‐Learning Variational Autoencoder–Long Short‐Term Memory Model

In this study, it is aimed to establish a novel method based on a deep‐learning‐guided surface‐enhanced Raman spectroscopy (SERS) technique to achieve rapid and accurate classification of vaginal cleanliness levels. We proposed a variational autoencoder (VAE) approach to enhance spectral quality, coupled with a deep learning algorithm long short‐term memory (LSTM) neural network to analyze SERS spectra produced by vaginal secretions. The performance of various machine learning (ML) algorithms is assessed using multiple evaluation metrics. Finally, the reliability of the optimal model is tested using blind test data (N = 10/group for each cleanliness level). The data quality of the SERS fingerprints of four types of vaginal secretions is significantly improved after VAE decoding and reconstruction. The signal‐to‐noise ratio of the generated spectra increased from the original 2.58–11.13. Among all algorithms, the VAE–LSTM algorithm demonstrates the best prediction ability and time efficiency. Additionally, blind test datasets yielded an overall accuracy of 85%. In this study, it is concluded that the deep‐learning‐guided SERS technique holds significant potential in rapidly distinguishing between different levels of vaginal cleanliness through human vaginal secretion samples. This contributes to the efficient diagnosis of vaginal cleanliness levels in clinical settings.

The mechanism of silent steam pop during radiofrequency catheter ablation: an ex-vivo porcine heart study

Abstract Background A steam pop (SP) during radiofrequency catheter ablation(RFCA) is usually assumed as an audible one and shows obvious changes of impedance, temperature or bipolar/unipolar potential of ablation catheter. Moreover, a SP generates a void which sometime penetrate the tissue and cardiac perforation. In clinical setting, we have sometimes experienced gas explosion from an ablating site detected only by intracardiac echography (ICE) without any sound or remarkable parameter changes, so called as a ‘silent’ SP (S-SP). However, the mechanism of this phenomenon is not yet to be clarified. Methods We performed RFCA of porcine ventricle using Tactiflex until a SP or 120s. In the first step, the output and the contact force (CF) of RFCA were fixed for 50W and 1g, 5g, 10g or 20g. Second, an ablation catheter was moved by every second with 50W. A SP was defined as suddenly gas explosion during RFCA detected by ICE and in case of non-audible SP by 2 persons standing 50cm away from ablation site, it was provided as a S-SP. Otherwise, we defined as audible one (A-SP). We analyzed the occurrence of S-SP and ablation parameters between S-SP and A-SP. Results In the first stage (n=24), 4 S-SPs and 17 A-SP were observed(S-SP; 3 in 1g and 1 in 20g, A-SP; 2 in 1g, 5 in 5g, 6 in 10g and 4 in 20g, p=0.0454). The ICE images of S-SP and A-SP seemed to be similar. S-SP significantly occurred in the setting of lower CF as compared with A-SP {3.0(2.25-16.5) vs. 8.0(5.0-21.5); p=0.0290}. There were no statistical differences concerning duration of RFCA, initial/final impedance, impedance drop, initial/maximum temperature. At the timing of SP, changes of potentials were relatively smaller in S-SP {bipolar: 0.975(0.565-6.410) vs. 5.700(3.680-8.915); p=0.0648, unipolar: 1.265(0.208-3.793) vs. 8.070(5.820-8.815); p=0.0003}. Voids formation after SPs were detected in 2(50%) of S-SP and 16(94%) of A-SP(p=0.0797). In the second beating stage (n=46), 14 S-SPs and 20 A-SPs were observed (Figure 1). Although there were no differences of average/maximum CF throughout RFCA, S-SP dominantly occurred when a catheter was pulling back against the tissue, or at the bottom of CF curve (Figure2). Whereas A-SP did when a catheter was pushing toward tissue, or at the end of ascending limb of CF curve. For ablated lesion, S-SP exhibited less void or smaller crack (Figure1). Conclusions S-SP was difficult to detect without ICE and occurred in the combined condition of high power (50W) and lower CF. For the setting of beating mode, just like clinical environment, S-SP was involved while an ablation catheter was moved away from the tissue. Although S-SP seemed to be safer than A-SP due to less or smaller voids, continuous RFCA after S-SP might involve a big void or perforation. Therefore, it might be better to use ICE for the detection of S-SP, especially for a site accompanied by unstable CF, like papillary muscles.Figure 1.Ablation parameters in a cathetFigure 2.The timing of steam pop

Efficacy and safety of Shexiang Baoxin pill in patients with ischemia with non-obstructive coronary arteries (LESS): a phase 4, multicenter, randomized, double-blind, placebo-controlled clinical trial

Abstract Background Patients with ischemia with non-obstructive coronary arteries (INOCA) present with ischemic signs and symptoms but no obstructive coronary artery disease (CAD) at coronary angiography. Shexiang Baoxin pill (MUSKARDIA) is effective in reducing angina frequency in patients with stable CAD. Purpose This phase 4 trial was conducted to evaluate the efficacy and safety of MUSKARDIA in INOCA patients. Methods This was a multicenter, randomized, double-blind, placebo-controlled clinical trial (NCT04897126). The enrolled patients with INOCA confirmed as eligible by leading PI were randomly assigned in a 1:1 ratio to receive MUSKARDIA or placebo (oral 4 pills 3 times a day) on the basis of conventional treatment until the end of follow-up. The primary endpoint was the angina-related outcomes based on the Seattle Angina Questionnaire (SAQ) score that assessed by same doctor at week 12. Results 236 INOCA patients were randomized (MUSKARDIA group, n = 117; placebo group, n=119). At week 12, patients in MUSKARDIA group showed higher SAQ scores compared with placebo group (all P<0.0001, Figure 1) indicating MUSKARDIA could significantly relieve symptoms of angina. According to the Canadian Cardiovascular Society (CCS) grading of angina pectoris, the severity of angina pectoris was significantly reduced in MUSKARDIA group compared with placebo group at week 12 (grade Ⅰ [91.09% vs 48.15%]; grade Ⅱ [8.91% vs 25.93%]; grade Ⅲ [0% vs 19.44%]; grade Ⅳ [0% vs 6.48%]; P<0.001). After 12 weeks of treatment with MUSKARDIA, numbers of weekly angina attacks were significantly reduced compared with placebo group (-2.60 vs -0.42; LSM difference: -2.18; P<0.0001). The percentage of patients who did not used nitroglycerin was noticeably higher in MUSKARDIA group than that in placebo group (84.16% vs 58.33%, P<0.001). The incidence of adverse events did not differ meaningfully between two groups. Conclusion MUSKARDIA was confirmed to be an effective, safe and well-tolerated treatment for INOCA patients in clinical settings.

Exploring the Challenges of Context in Accessing Mental Health Support in Rural New Zealand: A Case Study Approach.

This paper explores the complexities that impact access to mental health services in rural New Zealand. Historical, cultural, social and political factors will be examined against the philosophical positioning of Foucault and Fairclough. This research is a single-embedded case study design exploring participants' discourses in the context of a rural, bounded geographical area of New Zealand. The results show that mental health support that addresses people's actual needs rather than the needs that governments map against ever-changing policy is required and that an awareness of context within case study research is important. The process of case study design is described, including building upon a rationale for selecting the case, collecting data and conducting case analysis and interpretation. This study examines factors influencing the real-life rural context of accessing mental health support. This article demonstrates that case-study research can be valuable for navigating context complexity and developing nuanced understandings of complex phenomena. The paper highlights how the multifaceted case study context is more than mapping discourses against a rural backdrop. It is necessary to consider the power dynamics that shape experiences and their impact on service creation and its consequent delivery. Rather than services being created that are complex and not meeting people's needs, there is a need to listen to the people who have experienced mental health distress and provide services and support in locations other than clinical settings.

Validation of digital cardiovascular risk score (DiCAVA) in the United States All of Us dataset

Abstract Introduction The cardiovascular disease (CVD) risk score DiCAVA was developed in 2021 using UK Biobank data with the aim to be used for population health screening by deriving its predictions only from variables readily available to every individual, omitting difficult-to-obtain measurements such as blood pressure and invasive blood tests for metrics like cholesterol or HbA1c, which are commonly used in clinical CVD risk assessment tools. The original set of variables was reduced to 30 in the DiCAVA Lite score to further improve usability in a digital solution accessible to the general population, while maintaining its discrimination ability. Purpose Like many countries, the US has a large burden of CVD and would benefit from easily accessible screening tools. However, to ensure generalisability of the UK-developed score, it is necessary to evaluate its performance in a population where the score is intended to be used. Methods Data from a large real-world modern observational study in the US, All of Us, was used to evaluate discrimination and calibration metrics of the risk score. Participants with pre-existing CVD and without available electronic health records were excluded from the study. Variables from the All of Us dataset were matched to the original variables and any missing values were imputed using multiple imputation. Results 216,985 participants with a median follow-up time of 3.44 years were included in the study. The median age was 51 years and 63% of the population were female. Discrimination ability in the All of Us dataset (C-index 0.76) slightly surpassed the discrimination achieved at training with UK Biobank (C-index 0.73), and that of Framingham risk score calculated for the All of Us population (C-index 0.72), demonstrating the score’s usability in the US. The score showed very good discrimination in both males (C-index 0.74) and females (C-index 0.77), all ethnic groups and age groups, with the exception of the population over 65 years of age, where the C-index dropped to 0.65 as expected (similar to that observed in the UK Biobank). Calibration of the original model was assessed at 3 years and showed under-estimation of the predicted risk (calibration-in-the-large of 2.37%). Following re-calibration, the algorithm demonstrated excellent results with the average predicted 3-year risk showing 0.59% difference from the observed CVD rate (calibration plot in Figure). Conclusions Overall, the DiCAVA Lite score has shown very good discrimination in the US, showing its generalisability in different demographic populations. Its re-calibrated form is now validated for use in the US population and because of its ability to be utilised outside clinical settings, it can be deployed widely in the general population as an initial screening tool and potentially boost awareness of cardiovascular health in an effort to drive preventative care of CVD.Re-calibration of the DiCAVA Lite score

Predictors of Ischemic Stroke in a cohort of patients with Chagas Cardiomyopathy: the CLOT-Chagas study

Abstract Introduction a high risk of embolic events characterizes Chronic Chagas Cardiomyopathy (CCC) due to the presence of structural alterations of the left ventricle, the high incidence of arrhythmias, and intrinsic coagulation disorders. Despite its relevance, there is limited information on factors associated with this type of embolic event in patients with CCC, with most studies designed as case-control studies. This study aimed to prospectively analyze independently associated factors with this population's Ischemic Stroke (IS). Materials and Methods A prospective study was conducted between 2019 and 2023 at a cardiovascular center's Heart Failure and Heart Transplant Clinic. Adult patients diagnosed with CCC were included, recording sociodemographic, clinical, and echocardiographic variables as potential predictors of IS. Patients were followed up for 18 months via telephone for outcome assessment. Multivariate logistic regression models were used to identify factors potentially associated with IS during follow-up. Results A total of 232 patients diagnosed with CCC were included (males: 54.9%; median age: 67 years), the majority of whom were receiving anticoagulant therapy (n=144; 62.1%), with DOACs being the most frequently prescribed type of anticoagulants (51%). During follow-up, 16 patients (6.9%) developed an IS. There was a trend towards a lower incidence of IS in patients treated with direct oral anticoagulants (6.8%) compared to those receiving Warfarin (11.5%); however, this difference was not statistically significant (p=0.584). In the multivariate regression analysis including all potential predictors of IS, only the presence of a ventricular aneurysm (RR 5.64; 95% CI 1.61-19.70, p=0.007) and the score obtained when applying the Pfeiffer cognitive impairment questionnaire (RR 0.56; 95% CI 0.42-0.75, p<0.001) were significantly associated with the outcome of IS, even after adjusting for age, sex, NYHA functional class, ejection fraction, and anticoagulant therapy. The model composed of ventricular aneurysms and the Pfeiffer questionnaire score showed adequate performance in predicting IS during follow-up (AUC 0.79). Conclusions and Discussion: The incidence of IS in this population was higher than reported in the literature for both CCC patients and those with heart failure from other etiologies. The finding of an association between the presence of ventricular aneurysms and IS has been previously reported; however, the association between the Pfeiffer cognitive test and the development of IS represents a novel observation that deserves validation in future studies for its applicability in the clinical setting.

Adverse event profile of albumin-bound paclitaxel: a real-world pharmacovigilance analysis

BackgroundAbraxane plays a crucial role in the treatment of various types of cancer, despite the considerable attention it has garnered for its adverse drug events (ADEs). Nevertheless, there is currently a significant lack of comprehensive real-world pharmacovigilance studies on the ADEs associated with Abraxane.MethodsWe conducted a retrospective analysis of ADEs associated with Abraxane using data mining from the FAERS database, analyzing data from 2005 to 2023. In a real-world setting, we quantified and visualized the signals of these ADEs using four pharmacovigilance algorithms.ResultsThe FAERS database identified a total of 10,230 adverse event reports associated with Abraxane. The study revealed that Abraxane-related adverse drug events involved 27 system organ classes (SOC), with the strongest signals associated with the lymphatic and hematological systems and hepatobiliary disorders. Additionally, we identified 70 significant Preferred Terms (PT) signals, which included some critical adverse events not highlighted in the product labeling, such as cystoid macular edema. Further analysis of the timing of adverse reactions showed a median onset time of 41 days. Most adverse events (AEs) occurred within the first month of using Abraxane (43.5%), although some were still possible 1 year after treatment (3.5%). Gender-specific analysis indicated that high-risk AEs differed between females (nausea, vomiting, and erythema) and males (febrile neutropenia, disseminated intravascular coagulation, and upper gastrointestinal bleeding).ConclusionThe examined results provide crucial recommendations for optimizing the administration of Abraxane, enhancing its effectiveness, and mitigating potential adverse effects. This knowledge will substantially facilitate the implementation of the substance in clinical settings.

Facilitators and Barriers to Implementation of Perineal Techniques: A Scoping Review Applying the Consolidated Framework for Implementation Research.

To summarise the barriers and facilitators to the clinical implementation of perineal techniques and to provide evidence-based insights for decision-making based on existing research. A scoping review. Nine electronic databases (PubMed, Cochrane Library, Embase, CINAHL, ProQuest, CNKI, WanFang, VIP and SinoMed) were systematically searched on 4 February 2024. This study followed Joanna Briggs Institute's scoping review methodology. The barriers and facilitators identified in the included studies were mapped to the domains of the Consolidated Framework for Implementation Research (CFIR): intervention characteristics, outer setting, inner setting, characteristics of individuals and process. A total of 18 studies were finally included and analysed. The most frequently identified facilitator was theoretical education for midwives (inner setting). Common barriers included: lack of time to implement perineal techniques (intervention characteristics); labour pain and women's stress due to insufficient understanding of the birthing process, as well as women's reluctance to receive the perineal techniques (outer setting); risk factors for OASIS (inner setting); insufficient theoretical education for midwives and inadequate prenatal education for pregnant women (inner setting) and concerns about potential medical disputes among performers (characteristics of individuals). Many of the factors influencing the implementation of perineal techniques identified in this review are modifiable. Developing implementation strategies based on these factors can promote the successful implementation of these perineal techniques in clinical settings. This scoping review could serve as a reference framework for health authorities in developing strategies to promote the use of perineal techniques in clinical practice. Existing research has primarily focused on the outer setting, inner setting and characteristics of individuals implementing perineal techniques. Therefore, there is a need for more high-quality studies focusing on intervention characteristics and the implementation process. This study followed the PRISMA extension for scoping reviews. Not applicable.

The power of the adult attachment interview in predicting subsequent psychopathology: a tribute to Mary Main

ABSTRACT Mary Main’s conceptualization and operationalization of attachment states of mind through the Adult Attachment Interview (AAI) represent seminal contributions to the attachment field. The AAI is a semi-structured clinical interview used to assess attachment states of mind that is widely used in research and clinical settings. Unresolved state of mind regarding loss or trauma has been linked to concurrent internalizing symptoms. The current study explored the associations between unresolved classification and later depression and anxiety, above and beyond trauma history and symptoms. Participants (n = 70) were parents (98.6% female, 67.1% Black/African-American) from a follow-up of a randomized clinical trial of a parenting program for families referred to child welfare services. Parents completed the AAI, Childhood Trauma Questionnaire, and the Psychiatric Diagnostic Screening Questionnaire at timepoint 1 (T1) and the Brief Symptom Inventory approximately 12 years later, at timepoint 2 (T2). Hierarchical regressions revealed that unresolved state of mind significantly predicted depression at T2, and marginally predicted anxiety at T2, above and beyond childhood trauma, post-traumatic stress symptoms, and early internalizing symptoms. These results suggest that unresolved states of mind are clinically significant and provide unique information about later internalizing symptoms in adults with a history of trauma or loss.

Fully automated artificial intelligence-based cine cardiac magnetic resonance image quantification

Abstract Background Analyzing cine cardiac magnetic resonance (CMR) images is a task that demands substantial experience and time, and it is subject to both inter- and intra-observer variability. Existing automated tools in the clinics for image analysis often necessitate substantial editing to enable accurate quantification. Objective To tackle this issue, in this study, we developed and validated a fully automated artificial intelligence (AI)-based system for the analysis of cine CMR images, aiming to address these challenges. Method In this study, 1,038 patients with CMR images were enrolled. Out of these, 350 CMR images, along with corresponding segmentations for the left ventricle myocardium (LVM) and the left- and right ventricles (LV and RV, respectively), sourced from open access data from 5 centers and databases (with different cardiac diseases), were utilized for model development. The remaining images from two local registries were used to evaluate the model. A 2D U-Net network with deep supervision, enhanced with various image augmentation techniques, was developed for automatic segmentation. The developed model was subsequently utilized to segment the test dataset of 4D (3D+time) short-axis cine CMR images. End-diastolic volumes (EDV) and end-systolic volumes (ESV) were automatically detected from these segmentations and evaluated against the ground truth calculations performed by two experienced physicians using commercially validated software. Results In the test set, Dice scores of 0.84, 0.90, and 0.93 were achieved for the RV, LV, and LVM, respectively. The mean percentage error for EDV was 0.6% for LV and -6.32% for RV. Regarding ESV, the mean percentage error was 2.95% for LV and -6.32% for RV. A -6.95% error was achieved for LV mass calculation. The stroke volumes for LV and RV were calculated with a mean percent error of -2.52% and -8.43%, respectively. We achieved a mean percent error of -3.22% for LV and -1.64% for RV ejection fraction. Conclusion The fully automated AI-based quantitative analysis of cine cardiac MR images developed in this study demonstrated high agreement with the ground truth across large datasets, including those from external centers. This method can significantly reduce the time required for image analysis and enhance the accuracy and consistency of cardiac quantitative assessments in clinical settings.

Closing the Gap: Implementing Gender-Sensitive Care to Address Healthcare Disparities

Abstract Background Women still face a higher mortality rate after a heart attack compared to men, and the reasons remain unknown. The project HeartGap aims to investigate the disparity between evidence-based guidelines and the integration of Gender-Sensitive Care (GSC+) in clinical settings. By exploring healthcare providers’ attitudes and knowledge on GSC+, the project seeks to develop holistic recommendations for its effective implementation. Methods The project HeartGap employs a mixed-methods approach, including a scoping review, qualitative focus group interviews, and quantitative surveys. The focus of this abstract will be on the qualitative survey. From June 13, 2023, to April 26, 2024, a total of 18 focus group interviews were conducted in 9 hospitals of varying sizes and levels of care in Germany. These interviews involved separate groups of 3-8 nurses or physicians to explore attitudes, knowledge including the european guidelines for cardiology and current implementation of GSC+ into clinical practice. Facilitating factors and barriers were also discussed and in which fields measures should be applied. The results were evaluated using a qualitative content analysis. Results The interviews revealed discrepancies in healthcare providers’ awareness of GSC+ and identified both facilitating and hindering factors in its implementation. Facilitating factors included increased awareness, more evidence by considering gsc+ in research, university and professional education, support from hospital leadership and politics. Barriers included a lack of time and knowledge, other priorities and vague content on GSC+ in medical and nursing guidelines. Conclusions Gender-sensitive care is crucial for personalized healthcare, yet its implementation remains inconsistent in clinical practice. Targeted strategies are necessary to enhance awareness, knowledge, and guidelines and policy support for GSC+. The Identified recommendations for action are transferable throughout Europe. Key messages • Gender-sensitive care is pivotal for addressing healthcare disparities but faces implementation challenges. • Comprehensive strategies, including awareness, teaching and policy support, are indispensable for integrating gender-sensitive care into clinical practice.

Assessing the practicality of a novel heart failure therapeutic score (QUAD Score) for drug optimisation in heart failure with a reduced ejection fraction

Abstract Introduction The 4 pillars of drug treatment for heart failure with a reduced ejection fraction (HFrEF) [Angiotensin-converting enzyme inhibitors (ACEi)/Angiotensin receptor–neprilysin inhibitors (ARNi), β-blockers (BB), Mineralocorticoid receptor antagonists (MRA), and Sodium-glucose cotransporter 2 inhibitors (SGLT2i)], are recommended by international HF guidelines to improve patient outcomes. Treatment inertia remains a challenge with non-prescription or sub-optimal dosing of these therapies. We developed a pragmatic HFrEF treatment score (QUAD score) (Figure 1) to prompt initiation and/or titration of sub-optimally dosed foundational therapies. Patients are categorized as poor (<8), good (8-14), and excellent (15-24) based on the dose and number of foundational drugs prescribed. This study aims to assess the practical utility of the QUAD score and its influence on treatment optimization. Methods Unwarned prescribing HCPs were approached consecutively in person, within clinical settings. Participants were told the questions were part of a research project and they provided verbal consent. Responses were anonymous and no patients were involved; therefore, verbal consent was considered proportionate and reasonable. HCPs were given an information sheet describing the QUAD score (Figure 1). They were then presented with 3 hypothetical clinical scenarios of haemodynamically stable and uncomplicated HFrEF patients with uncalculated poor, good and excellent QUAD scores. They were asked to calculate the QUAD score and if they proposed any changes to treatment. Time was recorded using a stopwatch and proposed changes were recorded. They were then invited to answer a series of follow-on questions. Results Between September 2023 and February 2024, there were 70 respondents. 71% (50) were doctors and 29% (20) allied HCPs. 83% (58) placed patients in the correct treatment grade in at least one scenario. 62.9% (44) did so for all three scenarios (Figure 2) with numerically more HCPs compared to doctors (80% vs 56% p=0.06).The median (IQR) time in seconds required to calculate the QUAD score for clinical scenarios 1,2 and 3 was 158 (100-234), 86 (54-122) and 83 (53-119) respectively. In response to the calculated QUAD score, 94.3% (66), recommended drug treatment optimisations. On a 5-point Likert scale (1 -poor, 5- excellent), 77.1% of participants rated the QUAD score ≥3 for ease of use, and 88.6% rated ≥3 as an incentive for treatment optimization. Conclusion We demonstrated the rapid clinical usability of the QUAD Score in a cohort of unselected prescribing HCPs, with a decremental calculation time with each presented clinical scenario. HCPs were also motivated to achieve further HF drug therapy optimization based on the calculated score. We conclude that the QUAD Score as a HFrEF drug therapy score may have a role in addressing treatment inertia however, it needs validation against clinically relevant outcomes in a larger cohort of HFrEF patients.

Social factors that promote resilience in adolescents with depression: a systematic review

Abstract Background A socially protective environment matters. Social factors can protect against the development of depression among adolescents in community samples. There is however scant knowledge about their buffering role on the impact of depressive symptoms in adolescents in a clinical setting. Understanding these factors can help explaining why some children function well despite of their depression symptoms. In this review, we aimed to identify which social protective factors mitigate impairment from depression in adolescents. Methods We included peer-reviewed, cross-sectional and longitudinal studies using the following search strategy: Social protective factors AND depression or depression symptoms AND adolescents AND daily impairment, yielding 1737 hits. Included studies focused on social protective factors in relation to a depression diagnosis or depression symptoms severity, in adolescents age 11-24. Preliminary results We found 6 studies that examined the relationship between social protective factors and impairment or severity of depression symptoms in adolescents with a clinical depression or elevated symptoms. In these studies, higher rates of parental attachment, parental monitoring and school belonging moderated the relation between depression symptoms and daily impairment. Higher rates of family support and peer belonging were associated with the low depressed mood group. The rest of the studies tested the association of social protective factors on the development of depression symptoms in non-clinical populations. Conclusions There are limited studies on the buffering role of social protective factors in adolescents with clinical depression. Next, we will focus on non-clinical, longitudinal studies to explore which social protective factors moderate the development of depression over time. We aim to identify social factors that can mitigate the development of depression in community samples and are potentially important for clinical settings. Key messages • There is a scarcity of studies that explored the relation between social protective factors in adolescents with elevated depression symptoms or depression diagnosis. • The role of social protective factors that moderate the development of adolescent depression symptoms over time should be prioritized in the development of intervention programs.

Implementing the Design of Experiments (DoE) Concept into the Development of Mucoadhesive Tablets Containing Orange Peel Extract as a Potential Concept for the Treatment of Oral Infections

This study explores for the first time the impact of chitosan (CS) with varying molecular weights (MW), orange peel extract concentration, and hydroxypropyl methylcellulose (HPMC) content on the formulation of buccal tablets for treating oral infections. Utilizing a statistical design of experiments (DoE), nine different formulations were evaluated for mechanical properties, dissolution behavior, mucoadhesion, and biological activity. A formulation with high CS MW, 60% orange peel extract, and 8% HPMC, emerged as the optimal formulation, demonstrating superior tabletability, compressibility, and compactibility. Dissolution studies indicated that hesperidin release followed the Higuchi model, with higher extract content enhancing this phenomenon. Mucoadhesion improved with increased HPMC and CS concentrations, although higher extract content reduced bioadhesion. Biological assays showed that higher extract levels boosted antioxidant activity, while CS primarily contributed to anti-inflammatory effects. The optimized formulation exhibited broad antimicrobial activity against key oral pathogens, surpassing the effectiveness of the individual components. Principal component analysis (PCA) further confirmed the significant influence of extract content on tablet properties. These findings suggest that the optimized tablet formulation holds promise for effective buccal delivery in the treatment of oral infections, warranting further investigation in clinical settings.

Guideline-directed medical therapy patterns in heart failure with reduced ejection fraction: the OPTIMA-HF registry

Abstract Background/Introduction European guidelines strongly recommend an optimized pharmacological treatment in patients with heart failure with reduced ejection fraction (HFrEF) with a fast introduction of the four-pillars. Purpose Aim of the Optimization of Therapy in the Italian Management of Heart Failure [OpTIMa-HF] Registry was to collect data on HF patients to describe the current Italian population of HF patients with a specific focus on HFrEF treatment adherence and prescription rates, according to the most recent European Guidelines. Methods OPTIMA-HF is an observational, cross-sectional, multicenter, real-life study conducted in two different clinical settings: HF outpatients’ clinics of Italian University Hospitals and territorial Italian Cardiology outpatients’ services, that enrolled patients with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, mineralocorticoid receptor antagonist (MRA) and sodium glucose co-transporter II inhibitor (SGLT2i). Patient-level factors associated with medication use were examined. Results Overall, 1390 patients from 29 ambulatory cardiology practices and university hospitals were included. Mean age was 69.5 ± 11.9 years, 24% were female, and median EF was 33 (28-37). Among enrolled patients, 72.2% were prescribed ARNI, 17.1% ACEI/ARB, 95% beta-blocker, 75.5% MRA and 63% SGLT2i therapy (Figure 1). Despite high prescription rates for each single class, a still not sufficient number of patients was on treatment with all four pillars, in particular 40.4% considering the presence ARNI and 6.2%. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (31.7%), ARNI (16%), and beta-blocker (33.3%), whereas a higher proportion were receiving target doses of MRA therapy (38%), and all were receiving target dose for SGLT2i. Among patients eligible for all classes of medication, only 1.1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, MRA and SGLT2i. Prescription rates did not significantly differ between the type of center (University Hospital vs. territorial Cardiology outpatients’ services). As regards patients not on treatment with any of the four pillars, a small but still present amount of patients had no contraindications to these drugs (Figure 1). Conclusions In this contemporary outpatient HFrEF Italian registry, significant high prescription rates of the four-pillars were observed, however therapy combination rate is still not sufficient and drugs' titration need to be implemented to receive the greatest benefits from an optimized treatment. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.