Clinical Severity Index Research Articles

Comparison of the early childhood oral health impact scale (ECOHIS-4D) and EuroQol-5D-Y for measuring oral health-related quality of life utility in children.

The psychometric properties of the Early Childhood Oral Health Impact Scale (ECOHIS-4D), an oral health-related quality-of-life tool for children, and EuroQol 5D-Young (EQ-5D-Y), a commonly used generic quality-of-life tool for children, were compared across a clinical severity index to determine which tool is better for measuring oral health-related quality of life in children. Delayed and filled surfaces score (dfs) was calculated for under six-year-old children at the recruitment and one year later. ECOHIS-4D and EQ-5D were filled out on both occasions. The following properties were examined: (i) Content validity by comparing mean utility values using the Wilcoxson Signed Rank Test and Bland Altman Test, (ii) Construct validity (ability to discriminate between groups of different clinical severity) by examining effect size between severity groups (iii) Responsiveness (for changes in health status) using floor and ceiling effect, standard response mean and linear regression (iv) Correlation between the utilities and dfs. Respectively, 287 and 189 children were examined at the baseline and follow-up. Mean utility estimates from the tools were significantly different. All items of EQ-5D-Y showed high ceiling effects compared to items of ECOHIS-4D. Only the utility scores of ECOHIS-4D showed a significant association with the dfs score (β=-0.003, 95%CI=-0.004 to -0.002) in the linear regression models. Utility values form ECOHIS-4D, but not EQ-5D-Y correlated with the dfs (spearman's r=-0.33, 95%CI -0.43 to -0.23). ECOHIS-4D performs better than EQ-5D-Y in assessing young children's oral health-related quality of life.

Value of Anterior Segment Ocular Coherence Tomography (AS-OCT) in Dryness Evaluation in Vitiligo

Abstract Background Vitiligo is an acquired depigmentation disorder of the skin and mucous membranes with an autoimmune proposed pathogenesis. The concurrence of vitiligo and ocular abnormalities has been investigated in different studies, some of which have focused on ocular surface and dry eye evaluation in vitiligo. Aim of the Work Our study aimed at evaluating the tear film changes in patients with vitiligo using clinical assessment, severity indices and AS-OCT, and comparing these findings with healthy matching controls. Patients and Methods A case control observational study that included 60 eyes (the right eye of 30 patients with vitiligo and the right eye of 30 healthy age and sex matched controls). For every patient full dermatological assessment was done and drug history taken. Every study subject was evaluated regarding their dry eye symptomatology using the (OSDI) score questionnaire, clinical effect of dry eye in various tests (Schirmer’s test, TBUT, CFS using Oxford scheme), and using the AS OCT in measuring tear film height. Results We found that vitiligo patients had a lower tear film height when compared with controls (but statistically insignificant). Patients with vitiligo were more symptomatic regarding their dry eye symptoms assessed by OSDI score, they had a shorter tear breakup time than the control group, and a higher CFS grade using Oxford scheme indicating tear film instability. Conclusion Our study revealed lower, but statistically insignificant TFH as compared to the control group. TBUT was shorter, CFS was more evident and Schirmer’s test (although did not reach statistical significance) was shorter in vitiligo patients which revealed a tendency for dry eye syndrome. Supporting these findings, the OSDI score was higher in vitiligo patients. These results indicated worse symptomatology of dry eye in vitiligo patients and lack of stability of their tear film. The findings were supported by multiple previous studies mentioned earlier.

Clinical characteristics and prognostic marker for hospitalization in children with influenza infection in an emergency setting

BackgroundInfluenza is a main cause of illnesses during seasonal outbreaks. Identifying children with influenza who may need hospitalization may lead to better influenza outcomes.ObjectiveTo identify factors associated with the severity of influenza infection, specifically among children who were admitted to the hospital after being diagnosed with influenza at the emergency department.MethodsA retrospective cohort study was conducted among pediatric patients (age < 18 years) with a positive influenza rapid test who visited the emergency department at Srinagarind hospital between January2015-December2019. The dependent variable was hospital admission, while the independent variables included clinical parameters, laboratory results, and emergency severity index(ESI). The association between these variables and hospital admission was analyzed.ResultsThere were 542 cases of influenza included in the study. The mean age was 7.50 ± 4.52 years. Males accounted for 52.4% of the cases. A total of 190(35.05%) patients, needed hospitalization. Patients with pneumonia, those who required hospitalization or were admitted to the critical care unit, consistently exhibited an elevated absolute monocyte count and a reduced lymphocyte-to-monocyte ratio (LMR). Various factors contribute to an increased risk for hospitalization, including ESI level 1–2, co-morbidity in patients, age < 1 year old, and an LMR below 2.ConclusionsESI level 1–2 and co-morbidity in patients represent significant risk factors that contribute to higher hospitalization admissions. A LMR below 2 can be used as a prognostic marker for hospitalization in children with influenza infection.

Efficacy of apremilast in hyperkeratotic hand and foot dermatitis: results from a randomized observer-blinded comparative study.

Hyperkeratotic hand and foot dermatitis significantly affects quality of life. Some patients respond suboptimally to topical corticosteroids and have multiple recurrences. Our aim was to compare the efficacy and safety profile of apremilast and topical corticosteroid versus corticosteroid alone in hyperkeratotic hand and foot dermatitis. This randomized controlled study involved 77 patients treated for 3 months. GroupA (39 patients) received mometasone furoate 0.1% cream with oral apremilast 30 mg twice daily, and Group B (38 patients) received mometasone alone. They were assessed monthly using the Hand Eczema Clinical Severity Index (HECSI) and Visual Analogue Scale (VAS) scores for pruritus. Investigator Global Assessment (IGA) and Quality of Life in Hand Eczema Questionnaire (QOLHEQ) were conducted at the end of 3 months. The HECSI, VAS score, and QOLHEQ showed a significant decrease in both groups from baseline to the third month. Intergroup comparisons of HECSI failed to reach the significance level. When compared, patients receiving apremilast had significantly better improvement in the third month according to the Patient Global Assessment (PGA) and Investigator Global Assessment (IGA). They also had a smaller number of flares. Adding apremilast to topical corticosteroid leads to better patient and physician-perceived improvement and reduces the number of flares in hyperkeratotic hand eczema.

P691 Intestinal ultrasonography accuracy in the evaluation of patients with moderate to severe ulcerative colitis starting infliximab therapy

Abstract Background The diagnostic accuracy of detecting active ulcerative colitis (UC) by transabdominal intestinal ultrasonography (IUS) is well described. However, the value of repeated IUS measurements in tight monitoring during treatment remains to be established. The aim of the study is to evaluate the utility of IUS for monitoring biologic therapy in UC. Additionally, to establish the correlations between IUS findings and the endoscopic Mayo score (EMS), as well as clinical and biochemical severity indices. Methods In a prospective open-label study, individuals with moderate to severe ulcerative colitis who were initiating infliximab therapy were included, excluding those with proctitis. Patients were evaluated at baseline and after 3 months of biologics induction by means of clinical, biochemical, endoscopic mayo score, and IUS assessments. A Paired Wilcoxon analysis was conducted to compare data before and after therapy induction. The correlation between bowel wall thickness (BWT) and the endoscopic mayo score (EMS), C-reactive protein (CRP), calprotectin, and the Simple Clinical Colitis Activity Index (SCCAI) was analyzed across both visits. Results Thirty-two patients were enrolled and completed baseline evaluations and 21 completed follow-up assessments. The median age was 38 years (IQR 29-60), with 53% male, a median disease duration of 7 years (6-9), 41% having left-sided colitis, and 59% with pancolitis. All patients were treated with infliximab. No significant differences were observed at both time points in terms of BWT, EMS, CRP, and calprotectin (5.5 vs 4.4, p=0.2; 2 (2-3) vs 2 (1-3), p=0.4; 9.4 vs 9.6, p=0.4; 979 vs 394, p= 0.1, respectively). The only significant improvement was in terms of SCCAI (7 (4.8-8) vs 3 (1-5), p=0.009). BWT showed significant correlations with EMS (r= 0.43, p= 0.0015) (figure 1), CRP (r= 0.40, p= 0.007), and SCCAI (r= 0.28, p= 0.03), while no correlation was found with calprotectin (r= 0.19, p= 0.25). Conclusion Intestinal ultrasonography could serve as a substitute for lower endoscopy in evaluating disease activity.

Fuzapladib in a randomized controlled multicenter masked study in dogs with presumptive acute onset pancreatitis.

Currently, no specific treatment is available for acute onset pancreatitis (AP), and management relies on symptomatic and supportive standard of care (SOC). Fuzapladib is a novel leukocyte function-associated antigen type-1 (LFA-1) activation inhibitor, blocking activation and subsequent adhesion and migration of neutrophils, potentially decreasing the risk of pancreatitis progression and systemic inflammation. Evaluate the safety and clinical response of dogs with AP after 3 days of administration of fuzapladib. Sixty-one client-owned dogs with presumptive AP. Randomized, masked, and placebo controlled multicenter study. Sixty-one dogs with AP were included for safety assessment, whereas 35 evaluable cases (fuzapladib, n = 16; placebo, n = 19) were included for clinical evaluation. Clinical improvement was assessed based on the change in the modified clinical activity index (MCAI) score on Day 3 compared to Day 0. Secondary variables included canine acute pancreatitis clinical severity index (CAPCSI) scores and serum concentrations of canine pancreatic lipase immunoreactivity, cytokines, and C-reactive protein. Fuzapladib was well tolerated by all treated dogs. Mean change in MCAI scores was significantly higher in the fuzapladib-treated (-7.75) than the placebo group (-5.68; P = .02, 95% confidence interval [CI] for the difference, -4.33, -0.35), suggesting clinical improvement in fuzapladib-treated dogs. No significant difference was found in any of the secondary variables between groups. Administration of fuzapladib to dogs was safe, and a favorable response was detected in 2 clinical activity scores. Effects of fuzapladib on survival and duration of hospitalization were not studied.

Measuring the Unilateral Cleft Lip Nasal Deformity: Lateral Deviation of Subnasale Is a Clinical and Morphologic Index of Unrepaired Severity.

Objective measurement of pre-operative severity is important to optimize evidence-based practices given that the wide spectrum of presentation likely influences outcomes. The purpose of this study was to determine the correlation of objective measures of form with a subjective standard of cleft severity. 3D images were ranked according to severity of nasal deformity by 7 cleft surgeons so that the mean rank could be used as the severity standard. 45 patients with unilateral cleft lip and 5 normal control subjects. Each image was assessed using traditional anthropometric analysis, 3D landmark displacements, and shape-based analysis to produce 81 indices for each subject. The correlation of objective measurements with the clinical severity standard. Lateral deviation of subnasale from midline was the best predictor of severity (0.86). Other strongly-correlated anthropometric measurements included columellar angle, nostril width ratio, and lateral lip height ratio (0.72, 0.80, 0.79). Almost all shape-based measurements had tight correlation with the severity standard, however, dorsum deviation and point difference nasolabial symmetry were the most predictive (0.84, 0.82). Quantitative measures of severity transcend cleft type and can be used to grade clinical severity. Lateral deviation of subnasale was the best measure of severity and may be used as a surrogate of uncoupled premaxillary growth; it should be recorded as an index of pre-operative severity with every cleft lip repair. The correlation of other measures evaluated clarify treatment priorities and could potentially be used to grade outcomes.

Mapping the Path to Cognitive Balance: Applying the States of Mind Model and Network Analysis to Eating Disorder Patients.

Background: In eating disorders (EDs), cognitive-behavioral therapy (CBT) represents one of the first-line treatment options albeit with sub-optimal results. The assessment of cognitive balance through an index measuring increased adaptive thinking and reduced maladaptive thinking, the desired outcomes, and the ultimate goal of CBT treatments warrants attention. The states of mind model (SOM) provides a framework through which a cognitive balance index can be defined. The current cross-sectional controlled study tested the clinical utility of the SOM model in a sample of ED outpatients. Methods: ED outpatients (n = 199) were assessed at baseline with the attitudes and beliefs scale-2 (ABS-2) for rational beliefs (RBs) and irrational beliefs (IBs), from which a SOM ratio score index (RBs/(RBs + IBs)) was calculated, the eating disorder inventory-3 (EDI-3) for ED symptoms and ED-related psychopathological features, the psychological well-being scales (PWB) for positive psychological functioning. A matched control sample (n = 95) was also assessed with the ABS-2. Results: ED patients exhibited significantly lower SOM and RB scores compared to controls. Network analysis results highlighted the centrality of the SOM-cognitive balance index, PWB-self-acceptance, and EDI-3-general psychological maladjustment, as well as the importance of the influence that cognitive balance and general psychological maladjustment exert on each other. Conclusions: The findings support the clinical utility of the SOM ratio applied to cognitions in EDs. This demonstrates its ability to differentiate such patients from controls and in capturing worse ED-related general psychopathology as well as compromised aspects of psychological well-being, in particular self-acceptance and environmental mastery. It thus might be considered in CBT treatment of EDs a potential cognitive clinimetric and clinical index of ED severity indicating key difficulties in counteracting maladaptive thinking with adaptive thinking.

Artesunate alleviates psoriasis-like dermatitis by reducing interleukin-23 expression in tumor necrosis factor-alpha-induced HaCaT cells.

Artesunate (ART), an antimalarial drug with a multifunctional immunomodulatory effect, reduces psoriasis disease. ART can alleviate psoriasis-like dermatitis in mice but has no effect on proinflammatory cytokines in the blood. Thus, we hypothesized that the skin might be the target tissue of ART during the treatment of psoriasis. The interleukin (IL)-23/IL-17 axis has a key role in the pathogenesis of psoriasis. However, whether and how ART manipulates the IL-23 signal during psoriasis is unknown. This study found that IL-23 is highly expressed in the epidermis of psoriasis lesions and positively correlated with histological neutrophil infiltration and clinical psoriasis area and severity index (PASI)scores. Furthermore, ART inhibits the migration and cell cycle, as well as tumor necrosis factor-alpha (TNF-α)-induced IL-23 expression in HaCaT cells in a dose-dependent manner, probably through interference with the nuclear factor kappa B (NF-κB) signalling pathway. Animal experiments in imiquimod (IMQ)-induced psoriasis-like mice model also suggested that ART dose-dependently reduces IL-23 in the epidermis and ameliorates neutrophil infiltration. These findings thus provide further molecular evidence supporting ART as a promising drug for psoriasis in clinic.

Atherosclerosis Associated With COVID-19: Acute, Tends to Severely Involve Peripheral Arteries, and May be Reversible.

Arterial stiffness was reported with corona virus disease 2019 (COVID-19). We studied atherosclerosis in COVID-19 directly through duplex ultrasound measurements and their relation to co-morbidities, clinical and laboratory severity markers, and serum interleukin (IL) 6 and 17. Serum IL 6 and 17, average carotid intima-media thickness (cIMT), diameter and peak systolic velocities (PSV) of tibial, ulnar, radial arteries, and ankle brachial index (ABI) were measured in 44 COVID-19 patients and 44 healthy controls. Serum IL6, IL17, PSV, and cIMT were higher while diameter was lower (P ≤ .01) in cases. Clinical severity index correlated positively with age, co-morbidities, ferritin, IL6, IL17, cIMT, and PSV (P ≤ .04) and negatively with diameter and ABI (P = .04). Patients with severe lymphopenia had higher PSV, IL6, and IL17 and lower diameter (P < .00001). Ferritin positively correlated with PSV and negatively with diameter and ABI (P ≤ .01). Those who received an IL6 inhibitor (tocilizumab) showed lower PSV and higher diameter (P ≤ .01). In multiple regression analysis, IL17 and (age, co-morbidities) were related to (PSV, diameter) and cIMT (P ≤ .001, ≤0.02), respectively. COVID-19 may be associated with subclinical acute and may be reversible atherosclerosis severely involving peripheral arteries.

Effects of retinoic acid on immunity and inflammation in patients with &lt;i&gt;Psoriasis vulgaris&lt;/i&gt;

Purpose: To investigate the effect of retinoic acid on immune and inflammatory factors in patients with psoriasis vulgaris, and its underlying mechanism of action.Methods: A total of 20 P. vulgaris (PV) patients from Dongtai People's Hospital were divided into two groups, with 10 patients receiving retinoic acid and 10 receiving calcipotriol. The patients' clinical parameters, psoriasis area and severity index were evaluated after one month of treatment. Enzymelinked immunosorbent assay (ELISA) was used to measure the concentrations of interleukin-10 and interleukin-17 in the patients' peripheral blood, while the proportion of T helper immune cells that expressed IL-17a and regulatory T immune cells were determined via flow sorting. Expressions of Notch1 in psoriatic lesions and CD4+T cells were determined by quantitative real time-polymerase chain reaction (qRT-PCR).Results: Retinoic acid significantly reduced psoriasis area and severity index. Furthermore, retinoic acid decreased the concentration of IL-17, increased the concentration of IL-10, lowered the percentage of Th17 cells, but elevated the percentage of Treg immune cells (p &lt; 0.05). Expression of Notch1 in skin lesions and CD4+T cells was lower in the retinoic acid group than in the calcipotriol group (p &lt; 0.05).Conclusion: Expression of Notch1 is decreased in skin tissue lesions of PV patients receiving oral retinoic acid treatment. Thus, retinoic acid influences Th17/Treg immune balance by regulating Notch1 signaling pathway in PV patients, and therefore can potentially be developed for the treatment of psoriasis.

A Study of the Clinical Profile and Respiratory Index of Severity in Children (RISC) Score in Infants Admitted With Acute Respiratory Infections at a Tertiary Care Hospital.

Background Pneumonia is a major infectious cause of mortality in young children worldwide. The Respiratory Index of Severity in Children (RISC) score was designed with the intent to provide an objective mean to quantify the severity of lower respiratory tract infection in young children based on their risk of mortality. Knowledge about the clinical profile of acute respiratory infections and the scoring system predicting the risk of mortality helps in modifying treatment strategies. This study was undertaken at a resource-limited, tertiary-care public hospital in southern India with the objectives of describing the clinical profile of infants admitted with acute respiratory infections and determining the association of the RISC score with mortality. Method This was a retrospective observational study conducted over six months. Case records of infants admitted with acute respiratory infections were reviewed. The socio-demographic and clinical details of each case were recorded. The RISC score was calculated using clinical parameters which included the history of refusal of feeds, oxygen saturation lower than 90%, chest in-drawing, wheezing, and low weight-for-age. The maximum score was six. Descriptive data was represented using mean, standard deviation, and percentage or proportion. The association between any two categorical variables was analyzed using the chi-square test. The differences between any two continuous variables were analyzed using the independent sample t-test. A p-value of < 0.05 was considered statistically significant. Results A total of 75 infants were admitted with a diagnosis of acute respiratory infection during the study period. Of these, 68 were included in the study. The mean age of infants was 6.69 ± 3.96 months; 58.8% were male, 41 (60%) were exclusively breastfed, and 51 (75%) were up-to-date immunized. Twenty (29.4%) infants had a history of exposure to indoor smoke. The majority (67.6%) had pneumonia. Nine (13.2%) were mechanically ventilated. The mean duration of hospital stay was 8.16 ± 5.45 days. Sixty-three (92.64%) infants recovered and there were five deaths. The presence of less than 90% oxygen saturation (p-value=0.004), a diagnosis of severe pneumonia (p-value <0.001), and the need for mechanical ventilation (p-value <0.001) were significantly associated with mortality. A statistically significant (p-value=0.001) association was observed between the RISC score and mortality. Conclusions Addressable factors like the absence of exclusive breastfeeding, partial-immunization status, exposure to indoor smoke, and malnutrition were observed in infants with acute respiratory infections, which reinforces the importance of protective and preventive strategies for the control of pneumonia. The RISC score was observed to be beneficial in predicting mortality in an infant with acute respiratory infection. Triaging and early identification of infants at risk of mortality using this score could be very helpful in initiating timely treatment to reduce mortality, especially in resource-limited settings.

Characterizing patients reporting unchanged or worsened mental health symptoms after completing a partial hospital program: A mixed-methods study.

Research is needed to better understand and characterize individuals who do not benefit from evidence-based psychiatric services or whose symptoms worsen following treatment. This study aimed to compare clinical severity at admission, treatment outcomes, treatment beliefs, and satisfaction with care among patients (N = 5,129) with perceived improved, unchanged, or worsened mental health at discharge from a partial hospital program. Chi-square tests, one-way analyses of variances (ANOVAs), analyses of covariances (ANCOVAs), and qualitative analyses were used to probe study aims. Patients perceiving overall unchanged or worsened mental health at discharge did not appear more clinically severe at admission compared to patients perceiving overall improved mental health at discharge; however, they did report more negative beliefs about treatment, poorer outcomes across specific clinical severity indices, and poorer patient satisfaction at discharge. Patients most frequently attributed their unchanged or worsened mental health to engaging with difficult emotions for the first time, being a poor fit for an otherwise helpful program, and/or needing more time to apply new skills. Findings suggest that patients who do not perceive benefit from evidence-based acute psychiatric care may not be more clinically severe at admission, yet they may enter care with more negative treatment perceptions and report poorer outcomes on specific psychiatric indices at discharge compared to those perceiving treatment benefit. Efforts are needed to improve treatment for patients who do not benefit from psychiatric services; yet, for some, unchanged or worsened mental health in the short term may represent a step along the trajectory to long-term recovery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Risk factors for prolonged viral RNA shedding in patients with COVID-19; a nested case-control study.

The coronavirus disease 2019 (COVID-19) pandemic continues to have a global impact. The behavior and viral course of severe acute respiratory syndrome coronavirus (SARS-CoV-2) remains unpredictable. We aimed to investigate the prediction factors associated with prolonged viral shedding in COVID-19 patients. This is a retrospective, nested, case-control study with 155 confirmed COVID-19 infected patients divided into two groups based on nucleic acid conversion time (NCT), a prolonged group (viral RNA shedding >14 days, n = 31) and a non-prolonged group (n = 124). The mean age of participants was 57.16 years, and 54.8% were male. Inpatient numbers were 67.7% across both groups. No statistically significant differences between the two groups were observed in terms of clinical manifestation, comorbidities, computer tomography, severity index, antiviral treatment, and vaccination. However, C-reactive protein and D-dimer levels were significantly higher in the prolonged group (p = 0.01; p = 0.01). Using conditional logistic regression analysis, D-dimer and bacterial co-infection were found to be independent factors associated with the prolonged NCT (OR: 1.001, 95% CI: 1.000-1.001, p = 0.043; OR: 12.479, 95% CI: 2.701-57.654, p = 0.001 respectively). We evaluated the diagnostic value of the conditional logistic regression model by using receiver operating characteristic curve analysis. The area under the curve was 0.7 (95% Cl: 0.574-0.802; p < 0.001). Our study design included controlling confounders. We showed a clear result associating predicting factors with prolonged NCT of SARS-CoV-2. D-dimer level and bacterial co-infection were considered as independent predictors of prolonged NCT.

Continued Validation of the RBD Symptom Severity Scale (RBDSSS) in Participants of the North American Prodromal Synucleinopathy (NAPS) Consortium (P6-13.004)

Continued Validation of the RBD Symptom Severity Scale (RBDSSS) in Participants of the North American Prodromal Synucleinopathy (NAPS) Consortium (P6-13.004)

Thrombectomy versus tPA in Basilar Artery Occlusion Stroke (P7-5.012)

<h3>Objective:</h3> To evaluate the effectiveness of thrombectomy compared to medical management for patients with a basilar artery occlusion (BAO). <h3>Background:</h3> The effectiveness of thrombectomy to treat a BAO stroke has only recently been established. The BAOCHE trial and ATTENTION trial reported improvement in functional outcomes in Chinese patients with BAO treated with thrombectomy as compared to conventional medical management. These findings warrant validation in other populations before any definitive conclusions can be drawn about the effectiveness of thrombectomy for BAO. <h3>Design/Methods:</h3> Using the National Emergency Department Sample Database (NEDS), we retrospectively queried patients with a BAO between 2006–2019 in the United States. Patients were stratified into groups reflecting treatment with intravenous tissue plasminogen activator (tPA) alone, thrombectomy alone, or both tPA and thrombectomy. Multivariable logistic regression was performed to evaluate likelihood of death and length of hospital stay within all treatment groups. <h3>Results:</h3> Of the 2,998,237 stroke patients identified, 17,346 had a BAO, of whom 1,508 were treated only with thrombectomy, 1,697 were treated with tPA only, and 704 were treated with both thrombectomy and tPA. Patients treated with either dual therapy (OR: 2.88, 95% CI: 1.34–6.17) or thrombectomy-only (OR:1.95, 95% CI:1.64–2.33) had a higher death risk than those treated with tPA-only. Compared to patients treated with tPA-only, patients treated with dual therapy (b=4.02, 95% CI: 1.08–6.96) or thrombectomy-only (b=3.25, 95% CI: 2.60–3.90) had longer hospital stays. There was no difference in length of stay between those treated with dual therapy or thrombectomy-only. <h3>Conclusions:</h3> The present analysis did not find any associated mortality or length of stay benefits in patients treated with thrombectmoy compared to those treated with tPA. However, the nonrandomized allocation of treatment groups and lack of clinical severity indices limit the findings of this population-based analysis. <b>Disclosure:</b> Karan Patel has nothing to disclose. Mr. Taneja has nothing to disclose. Mr. Diaz has nothing to disclose. Mr. Mohamed has nothing to disclose. Mr. Batchu has nothing to disclose. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Focus group participant with Alexion. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AstraZeneca.

Clinical outcomes, MRI evaluation and predictive factors of indirect decompression with lateral transpsoas approach for lumbar interbody fusion: a multicenter experience.

Evaluating the effects of indirect decompression obtained through lateral lumbar interbody fusion (LLIF) by clinical improvements and radiological parameters on MRI scans. Identifying predictors of better decompression and clinical outcome. From 2016 to 2019, patients who underwent single- or double-level indirect decompression LLIF were consecutively reviewed. Radiological signs of indirect decompression were evaluated in preoperative and follow-up MRI studies and were subsequently correlated to clinical data, expressed as axial/radicular pain (VAS back/leg), index of disability (Oswestry Disability Index) and clinical severity of lumbar stenosis (Swiss Spinal Stenosis Questionnaire). 72 patients were enrolled. The mean follow-up was 24 months. Differences in vertebral canal area (p < 0.001), height of the foramina (p < 0.001), thickness of the yellow ligament (p = 0.001) and anterior height of the interbody space (p = 0.02) were observed. Older age (p = 0.042), presence of spondylolisthesis (p = 0.042), presence of intra-articular facet effusion (p = 0.003) and posterior height of the implanted cage (p = 0.020) positively affected the increase of the canal area. Change in root canal area (p < 0.001), height of the implanted cage (p = 0.020) and younger age (p = 0.035) were predictive factors of root pain relief, while increased vertebral canal area (p = 0.020) and height of the interbody fusion cage (p = 0.023) positively affected the severity of clinical stenosis. LLIF indirect decompression showed both clinical and radiological improvements. Presence and degree of spondylolisthesis, presence of intra-articular facet effusion, age of the patient and height of the cage were predictive factors of major clinical improvements.

The Satisfaction With Care of Patients With Schizophrenia in Taiwan: A Cross-Sectional Survey of Patient-Centered Care Domains

Pharmacological interventions combined with nonpharmacological treatments such as patient-centered care (PCC)-related activities are widely used to enhance outcomes in patients with schizophrenia. However, few studies have examined and identified the PCC factors essential to achieving better outcomes in patients with schizophrenia. This study was designed to identify the Picker-Institute-identified PCC domains associated with satisfaction and to determine which of these domains are most important in the context of schizophrenia care. Data were collected using patient surveys in outpatient settings and record reviews at two hospitals in northern Taiwan between November and December 2016. PCC data were collected in five domains: (a) support of patient autonomy; (b) goal setting; (c) collaboration and integration of healthcare services; (d) information, education, and communication; and (e) emotional support. The outcome measure was patient satisfaction. The study controlled for demographic factors, including age, gender, education, occupation, marriage, and urbanization level in the respondent's area of residence. Clinical characteristics included the Clinical Global Impressions severity and improvement index scores, previous admission, previous emergency department visit, and readmission within 1 year. Methods were adopted to prevent common method variance bias. Multivariable linear regression with stepwise selection and the generalized estimating equation were used to analyze the data. After controlling for confounding factors, the generalized estimating equation model found only three PCC factors significantly associated with patient satisfaction, which differed slightly from the results of the multivariable linear regression. These three factors are as follows, in order of importance: information, education, and communication (parameter = 0.65 [0.37, 0.92], p < .001); emotional support (parameter = 0.52 [0.22, 0.81], p < .001); and goal setting (parameter = 0.31 [0.10, 0.51], p = .004). The three critical PCC-related factors were evaluated in terms of enhancing patient satisfaction in patients with schizophrenia. Practicable strategies related to these three factors should also be developed for implementation in clinical settings.

Mild-to-moderate severity of psoriasis may be assessed remotely based on photographs and self-reported extent of skin involvement

Remote monitoring was used to assess and manage skin diseases. To investigate to what extent smartphone photographs along with a self-reported body region (BR) score can be used to evaluate psoriasis severity. Psoriasis severity was assessed in the clinic using the psoriasis area and severity index and the physician's global assessment. On the same day, the patients took a photograph of a representative lesion from 4 BR (head/neck, upper limbs, trunk, and lower limbs) and completed a questionnaire about BR score. The photographs were rated by 5 dermatologists. Intraclass correlation coefficients with 95% CIs were calculated. Overall, 32 were included, of which 6% had almost clear, 69% had mild, and 25% had moderate psoriasis. Perfect agreement between the self-reported and the doctors' BR score was observed for 59%, and near-perfect agreement (deviation of maximum 1 score) was 92%. The intraclass correlation coefficient between clinical and photographic psoriasis area and severity index was 0.78 (95% CI, 0.55-0.90), and for physician's global assessment, perfect agreement was 53%. The agreement between psoriasis severity assessed clinically and by photographs was good in a study setting. This gives the opportunity to remotely assess psoriasis severity by combining photographs with self-reported BR scores.

Mussel adhesive protein treatment delivered by microneedling for sensitive skin: A clinical study.

Mussel adhesive protein (MAP) is extracted from the mycelial glands of marine mussels. It has anti-inflammatory properties and may relieve skin itching and other symptoms. Based on the anti-inflammatory effect of MAP, this study was designed to treat sensitive skin (SS) using MAP delivered by skin microneedling. Twenty-three Chinese female patients with SS were enrolled. Treatments were delivered three times at one-month intervals. Symptom improvement and recurrence rates, treatment safety, and patient satisfaction levels were evaluated. After one course of treatment, 20 patients had a Symptom Score Reducing Index (SSRI) of >20%, with an effectiveness rate of 87%. At the end of treatment, all patients had an SSRI of >20%, and the effectiveness rate was 100%. Dryness, tightness, desquamation, flushing, burning, itching, and tingling improved. After treatment, the Clinical Erythema Assessment and Lesion Severity Index of Facial Telangiectasia scores were significantly decreased. Clinical photographs following treatment revealed improved erythema reaction and decreased capillary density. During treatment, the patients experienced mild pain and erythema and swelling reaction without exudation. Complications, such as pigmentation changes or scarring, were absent. Additionally, there were no cases of recurrence, and patient satisfaction levels were high. MAP combined with microneedling can help treat SS, showing satisfactory safety outcomes and high patient satisfaction.