Clinical Support Research Articles

Our Daughters-Ourselves: Evaluating the Impact of Paired Cervical Cancer Screening of Mothers with HPV Vaccination for Daughters to Improve HPV Vaccine Coverage in Bamako, Mali.

Cervical cancer (CC) is the second most common cancer in Western Africa, accounting for 12,000 cases and 6000 deaths annually. While vaccination against human papilloma virus (HPV) and CC screenings reduce the incidence and mortality of CC in many developed countries, 90% of CC deaths are in low-income countries. Lack of knowledge about the connection between HPV and CC, lack of access to vaccines and screenings, weak healthcare infrastructure, and stigma related to sexually transmitted diseases are among the factors that contribute to this disparity. Previously, we evaluated the knowledge of HPV and CC in Bamako, Mali, showing that knowledge of the link between HPV and CC was very low (less than 8% of participants) and that less than 3% of women were screened for CC. Subsequent implementation of a community-based education program and support for local clinics resulted in a five-fold increase in CC screening at the five participating clinics in 2015. In this study, we paired CC screenings of mothers with HPV vaccination of their daughters to target out-of-school (OOS) girls whom school-based vaccination campaigns would not reach. Our campaign resulted in a 10.7% increase in HPV vaccination.

Genetic diagnostic outcomes from a 10-year research programme in autism in Aotearoa New Zealand

ABSTRACT Autism is a relatively common neurodevelopmental difference with considerable phenotypic heterogeneity impacting cognitive, sensory, and social processing, and often co-occurs with other conditions. Therefore, there is not a one-size-fits-all clinical support pathway for autistic individuals following diagnosis. DNA sequencing technology has enabled the discovery of genes causative of, or associated with, autism. Unsurprisingly, genetic heterogeneity goes hand-in-hand with the phenotypic heterogeneity for this condition; with causative genetic variation ranging from single base pair changes to complex chromosomal rearrangements in more than 100 different genes. This study captures a snapshot (201 individuals) of the autistic population (both clinically referred and self-referred) in Aotearoa New Zealand and documents a decade’s research effort to refine diagnosis using a flexible and customised genome-wide sequencing approach. The diagnostic yield in this phenotypically disparate cohort was 12.9%, with an additional 15.9% of individuals harbouring ‘likely causal’ variants, providing the groundwork to tailor clinical, social, and educational care. Importantly, this study reveals the diagnostic utility of customised genetic screening for autism across a phenotypically diverse autistic population.

Implementation of a Secure Firearm Storage Program in Pediatric Primary Care

Increased secure firearm storage can reduce youth firearm injury and mortality, a leading cause of death for children and adolescents in the US. Despite the availability of evidence-based secure firearm storage programs and recommendations from the American Academy of Pediatrics, few pediatric clinicians report routinely implementing these programs. To compare the effectiveness of an electronic health record (EHR) documentation template (nudge) and the nudge plus facilitation (ie, clinic support to implement the program; nudge+) at promoting delivery of a brief evidence-based secure firearm storage program (SAFE Firearm) that includes counseling about secure firearm storage and free cable locks during all pediatric well visits. The Adolescent and Child Suicide Prevention in Routine Clinical Encounters (ASPIRE) unblinded parallel cluster randomized effectiveness-implementation trial was conducted from March 14, 2022, to March 20, 2023, to test the hypothesis that, relative to nudge, nudge+ would result in delivery of the firearm storage program to an additional 10% or more of the eligible population, and that this difference would be statistically significant. Thirty pediatric primary care clinics in 2 US health care systems (in Michigan and Colorado) were included, excluding clinics that were not the primary site for participating health care professionals and a subset selected at random due to resource limitations. All pediatric well visits at participating clinics for youth ages 5 to 17 years were analyzed. Clinics were randomly assigned in a 1:1 ratio to receive either the nudge or nudge+. Patient-level outcomes were modeled to estimate the primary outcome, reach, which is a visit-level binary indicator of whether the parent received both components of the firearm storage program (counseling and lock), as documented by the clinician in the EHR. Secondary outcomes explored individual program component delivery. A total of 47 307 well-child visits (median [IQR] age, 11.3 [8.1-14.4] years; 24 210 [51.2%] male and 23 091 [48.8%] female) among 46 597 children and 368 clinicians were eligible to receive the firearm storage program during the trial and were included in analyses. Using the intention-to-treat principle, a higher percentage of well-child visits received the firearm storage program in the nudge+ condition (49%; 95% CI, 37-61) compared to nudge (22%; 95% CI, 13-31). In this study, the EHR strategy combined with facilitation (nudge+) was more effective at increasing delivery of an evidence-based secure firearm storage program compared to nudge alone. ClinicalTrials.gov Identifier: NCT04844021.

Effect of Perioperative Physical Activity on Skeletal Muscle Loss 6 Months After Esophageal Cancer Surgery.

Sarcopenia contributes to a poor prognosis in patients with esophageal cancer; thus, any clinical support that prevents loss of skeletal muscle mass preoperatively and postoperatively should be actively investigated. This study aimed to evaluate physical activity during the perioperative period and its impact on postoperative skeletal muscle mass. Sixty-two patients who underwent esophagostomy at the Hamamatsu University School of Medicine between 2019 and 2023 were evaluated. The physical activity (measured by the step count) of patients scheduled for esophagectomy was assessed preoperatively using a fitness tracker. The percentage change in skeletal muscle mass index (SMI) was calculated preoperatively and 6 months postoperatively. Factors associated with decreased SMI 6 months after esophagectomy were analyzed using multivariate analysis. The median decrease in SMI was -6.2%. Multivariate analysis revealed that factors associated with the reduction of SMI were age >69 years [odds ratio (OR)=7.21, 95% confidence interval (CI)=1.36-38.19, p=0.020], preoperative step count <7,800 steps/day (OR=5.17, 95% CI=1.38-19.33, p=0.015), and postoperative step count <2,400 steps/day (OR=3.55, 95% CI=1.01-12.45, p=0.048). A low perioperative step count and older age were significant risk factors for skeletal muscle loss in patients with esophageal cancer undergoing surgery. For patients with a low number of steps in the perioperative period or for older patients, interventions to increase the number of steps may prevent skeletal muscle loss.

The History of US Menstrual Health, School Nurses, and the Future of Menstrual Health Equity.

In the United States, adolescents suffer from inadequate menstrual health, meaning that adolescents are unprepared for menarche, lack the practical resources they need to comfortably and confidently manage menstruation, and receive inadequate health education and care for menstrual pain and disorders. In this article, we provide a historical analysis of the role of school nurses in addressing menstruation from the early 20th century up to the present day. We contextualize the current realities of school nursing and menstrual health education and clinical support. We argue that the decentralized US school system, a cultural aversion to open discussion about menstruation, and the outsized influence of commercial menstrual product manufacturers have hampered the ability of school nurses to deliver menstrual health education along with menstrual health support. Finally, we discuss implications for today's schooling experiences as well as recommendations for how to support school nurses in aligning our national approach to menstrual health toward the public health perspective of menstrual equity. (Am J Public Health. 2024;114(9):903-908. https://doi.org/10.2105/AJPH.2024.307705).

Extracting lung cancer staging descriptors from pathology reports: A generative language model approach

BackgroundIn oncology, electronic health records contain textual key information for the diagnosis, staging, and treatment planning of patients with cancer. However, text data processing requires a lot of time and effort, which limits the utilization of these data. Recent advances in natural language processing (NLP) technology, including large language models, can be applied to cancer research. Particularly, extracting the information required for the pathological stage from surgical pathology reports can be utilized to update cancer staging according to the latest cancer staging guidelines. ObjectivesThis study has two main objectives. The first objective is to evaluate the performance of extracting information from text-based surgical pathology reports and determining pathological stages based on the extracted information using fine-tuned generative language models (GLMs) for patients with lung cancer. The second objective is to determine the feasibility of utilizing relatively small GLMs for information extraction in a resource-constrained computing environment. MethodsLung cancer surgical pathology reports were collected from the Common Data Model database of Seoul National University Bundang Hospital (SNUBH), a tertiary hospital in Korea. We selected 42 descriptors necessary for tumor-node (TN) classification based on these reports and created a gold standard with validation by two clinical experts. The pathology reports and gold standard were used to generate prompt-response pairs for training and evaluating GLMs which then were used to extract information required for staging from pathology reports. ResultsWe evaluated the information extraction performance of six trained models as well as their performance in TN classification using the extracted information. The Deductive Mistral-7B model, which was pre-trained with the deductive dataset, showed the best performance overall, with an exact match ratio of 92.24% in the information extraction problem and an accuracy of 0.9876 (predicting T and N classification concurrently) in classification. ConclusionThis study demonstrated that training GLMs with deductive datasets can improve information extraction performance, and GLMs with a relatively small number of parameters at approximately seven billion can achieve high performance in this problem. The proposed GLM-based information extraction method is expected to be useful in clinical decision-making support, lung cancer staging and research.

114 Prime Time of Life: A multimodal physical activity and health education programme for middle-aged and older adults

Abstract Prime Time of Life is inclusive of people living with clinical conditions and differing fitness and functional abilities. Health screening was conducted preprogramme, and specific clinical exercise advice and support was provided to participants by Dr Diane Cooper, Clinical Exercise Physiologist. Participants completed two 60-minute multimodal (cardiovascular fitness, strength, balance, flexibility) exercise classes per week and were also encouraged to complete additional classes in their purpose built on-demand exercise library. In all 60-minute exercise classes the exercise instructor demonstrated three different options for each exercise to cater for participants who were working at beginner, intermediate and advanced levels of fitness. Participants appreciated the adaptations and progressions that were available for all exercises as it enabled them to work to their ownability and progress and monitor progress throughout the programme. Each week a 20-minute health education workshop relevant to participants was delivered online via Zoom. The workshop was recorded, edited, and uploaded to YouTube to view on-demand. The link for each video was shared with participants weekly via email to support on-demand learning in addition to any other relevant supporting material such as a training diary. The Prime Time of Life programme increased participants upper and lower body strength, aerobic fitness and perceptions of physical and mental health (see chapter 3). This was in addition to increased confidence and feelings of positivity around the participants’ own management of healthy functional ageing (see chapter 3). Participants commented that they really enjoyed the Prime Time of Life programme. It increased their awareness on the importance of multimodal exercise for healthy ageing and that they felt empowered to continue training and improve their health in the long term. Following on from this successful programme a full train the trainer programme has been developed and piloted with 9 Local Sports Partnerships, 20 participants with further plans for upscaling.

517. INTERNATIONAL CONSENSUS AND CLINICAL CARE ALGORITHM FOR THE DIAGNOSIS AND TREATMENT OF ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY

Abstract Background Anastomotic leak (AL) is a common and severe complication after esophagectomy. Guidelines for the management of AL are lacking due to limited evidence, in which case consensus can provide a sound base for guiding clinical practice. This study aimed to develop a consensus-based guideline and clinical algorithm on the diagnosis and treatment of AL after esophagectomy. Methods A three-stage modified Delphi study was performed. Stage 1 comprised a scoping systematic review to find available evidence and formulate statements. Methodological quality was assessed using the Newcastle-Ottawa scale. Stage 2 comprised a two-round Delphi survey, globally distributed to surgeons and gastro-enterologists experienced in diagnosing and treating AL. During stage 3, clinical recommendations were formulated by an international expert panel, based on the Delphi consensus and a strength was assigned following GRADE principals. A clinical care algorithm was developed based on these recommendations. This study was performed in collaboration with the ISDE Guidelines Committee. Results A total of 5.843 articles were screened, and 118 included to formulate Delphi statements. The Delphi survey was completed by 106 participants in the first round and 136 in the second. Consensus was achieved on 13 statements on diagnosis and 21 statements on treatment of AL. During the guideline development stage, 12 diagnostic recommendations were formulated covering screening, clinical signs, biochemical tests, and imaging for the diagnosis of AL. 15 recommendations were formulated regarding treatment strategies of AL and indications and techniques for supportive care, drainage and defect closure. A clinical care algorithm on diagnosis and treatment of AL was designed. Conclusion This study developed clinical recommendations based on consensus and available evidence, and designed a clinical care algorithm for the diagnosis and treatment of AL after esophagectomy. The developed recommendations and clinical care algorithm, may provide clinical support and aid standardized decision-making in clinical practice and potentially improve patient outcomes.

Changes in blood pressure measurement prevalence among United States adults with hypertension before and during the COVID-19 pandemic

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic disrupted health care, with particularly profound effects on persons with chronic conditions like hypertension. ObjectivesIn this study, we examined changes in the prevalence of blood pressure (BP) measurements by a healthcare professional among adults aged ≥ 18 years with hypertension before and during the COVID-19 pandemic in the United States (US). MethodsThis study utilized the National Health Interview Survey data from April to December of the 2019 and 2021 modules of the survey. A total of 15,855 participants were included in the analytic sample. The prevalence of BP measurements taken by a health professional was calculated and the association between survey year and BP measurements was evaluated using adjusted and unadjusted logistic regression models. ResultsOverall, the prevalence of BP measurements by a health professional among US adults with hypertension decreased from 95.9 % in the pre-pandemic period to 94.7 % in the pandemic period. Adults with hypertension were less likely (OR: 0.76, 95 % CI: 0.63–0.91) to report having had a BP measurement taken by a health professional during the pandemic compared to before the pandemic. ConclusionSelf-measured BP monitoring with clinical support could ensure continuous and improved care of individuals with hypertension, especially when circumstances could interrupt healthcare access.

Experiences, barriers and perspectives of midwifery educators, mentors and students implementing the updated emergency obstetric and newborn care-enhanced pre-service midwifery curriculum in Kenya: a nested qualitative study

IntroductionTo achieve quality midwifery education, understanding the experiences of midwifery educators and students in implementing a competency-based pre-service curriculum is critical. This study explored the experiences of and barriers to implementing a pre-service curriculum updated with emergency obstetric and newborn care (EmONC) skills by midwifery educators, students and mentors in Kenya.MethodsThis was a nested qualitative study within the cluster randomised controlled trial investigating the effectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in 20 colleges in Kenya. Following the pre-service midwifery curriculum EmONC update, capacity strengthening of educators through training (in both study arms) and additional mentoring of intervention-arm educators was undertaken. Focus group discussions were used to explore the experiences of and barriers to implementing the EmONC-enhanced curriculum by 20 educators and eight mentors. Debrief/feedback sessions with 6–9 students from each of the 20 colleges were conducted and field notes were taken. Data were analysed thematically using Braun and Clarke’s six step criteria.ResultsThemes identified related to experiences were: (i) relevancy of updated EmONC-enhanced curriculum to improve practice, (ii) training and mentoring valued as continuous professional development opportunities for midwifery educators, (iii) effective teaching and learning strategies acquired – peer teaching (teacher-teacher and student-student), simulation/scenario teaching and effective feedback techniques for effective learning and, (iv) effective collaborations between school/academic institution and hospital/clinical staff promoted effective training/learning. Barriers identified were (i) midwifery faculty shortage and heavy workload vs. high student population, (ii) infrastructure gaps in simulation teaching – inadequate space for simulation and lack of equipment inventory audits for replenishment (iii) inadequate clinical support for students due to inadequate clinical sites for experience, ineffective supervision and mentoring support, lack/shortage of clinical mentors and untrained hospital/clinical staff in EmONC and (iv) limited resources to support effective learning.ConclusionFindings reveal an overwhelmed midwifery faculty and an urgent demand for students support in clinical settings to acquire EmONC competencies for enhanced practice. For quality midwifery education, adequate resources and regulatory/policy directives are needed in midwifery faculty staffing and development. A continuous professional development specific for educators is needed for effective student teaching and learning of a competency-based pre-service curriculum.

Impact of COVID-19 on recorded blood pressure screening and hypertension management in England: an analysis of monthly changes in the quality and outcomes framework indicators in OpenSAFELY

BackgroundThe COVID-19 pandemic disrupted cardiovascular disease management in primary care in England.ObjectiveTo describe the impact of the pandemic on blood pressure screening and hypertension management based on a national quality...

Parenting pain away: Quasi-experimental study of an eHealth learning platform to evaluate acceptability, feasibility, and utilisation of parent-led pain management.

To evaluate the impact of an eHealth educational resource about infant procedural pain management, given during the prenatal period, on feasibility, acceptability, knowledge, self-efficacy, and involvement. Routine health care requires newborns to have painful procedures (e.g., intramuscular injection). The impacts of untreated pain in neonates are widely recognised but adoption of effective procedural pain management strategies in clinical practice varies. There is clear evidence supporting the effectiveness of parent-led pain management during procedures (e.g., skin-to-skin care) and reputable resources to raise awareness among parents are warranted. Our team co-created Parenting Pain Away, a website to equip parents with evidence to assist with managing the pain of procedures and empower them to be involved. A quasi-experimental evaluation using a pre/post intervention design with low-risk expectant parents. Of the 41 participants, before intervention exposure participants were familiar or had used skin-to-skin care (n = 33), breastfeeding (n = 30) and sucrose (n = 13) as pain management. Most participants (n = 38) desired more information on how to be involved. Providing access to Parenting Pain Away during pregnancy was supported and participants ranked the website above average using the System Usability Scale. Parenting Pain Away did not have a statistically significant influence on outcomes. Participants reported variation in clinical support with parent-led pain management. A multifaceted approach is recommended to maintain infant procedural pain management. Equipping parents with knowledge related to infant pain management using an eHealth approach satisfied their information desires. The study findings are important considerations for perinatal care providers, policy makers, and families to finally achieve adequate procedural pain management. This study used the STROBE checklist, adhering to EQUATOR guidelines. A stakeholder group (expectant parents, parents, perinatal researchers, clinicians, and administrators) was created to inform the study design and intervention.

Optimizing Response Rates to Examine Health IT Maturity and Nurse Practitioner Care Environments in US Nursing Homes: Mixed Mode Survey Recruitment Protocol.

Survey-driven research is a reliable method for large-scale data collection. Investigators incorporating mixed-mode survey designs report benefits for survey research including greater engagement, improved survey access, and higher response rate. Mix-mode survey designs combine 2 or more modes for data collection including web, phone, face-to-face, and mail. Types of mixed-mode survey designs include simultaneous (ie, concurrent), sequential, delayed concurrent, and adaptive. This paper describes a research protocol using mixed-mode survey designs to explore health IT (HIT) maturity and care environments reported by administrators and nurse practitioners (NPs), respectively, in US nursing homes (NHs). The aim of this study is to describe a research protocol using mixed-mode survey designs in research using 2 survey tools to explore HIT maturity and NP care environments in US NHs. We are conducting a national survey of 1400 NH administrators and NPs. Two data sets (ie, Care Compare and IQVIA) were used to identify eligible facilities at random. The protocol incorporates 2 surveys to explore how HIT maturity (survey 1 collected by administrators) impacts care environments where NPs work (survey 2 collected by NPs). Higher HIT maturity collected by administrators indicates greater IT capabilities, use, and integration in resident care, clinical support, and administrative activities. The NP care environment survey measures relationships, independent practice, resource availability, and visibility. The research team conducted 3 iterative focus groups, including 14 clinicians (NP and NH experts) and recruiters from 2 national survey teams experienced with these populations to achieve consensus on which mixed-mode designs to use. During focus groups we identified the pros and cons of using mixed-mode designs in these settings. We determined that 2 mixed-mode designs with regular follow-up calls (Delayed Concurrent Mode and Sequential Mode) is effective for recruiting NH administrators while a concurrent mixed-mode design is best to recruit NPs. Participant recruitment for the project began in June 2023. As of April 22, 2024, a total of 98 HIT maturity surveys and 81 NP surveys have been returned. Recruitment of NH administrators and NPs is anticipated through July 2025. About 71% of the HIT maturity surveys have been submitted using the electronic link and 23% were submitted after a QR code was sent to the administrator. Approximately 95% of the NP surveys were returned with electronic survey links. Pros of mixed-mode designs for NH research identified by the team were that delayed concurrent, concurrent, and sequential mixed-mode methods of delivering surveys to potential participants save on recruitment time compared to single mode delivery methods. One disadvantage of single-mode strategies is decreased versatility and adaptability to different organizational capabilities (eg, access to email and firewalls), which could reduce response rates. DERR1-10.2196/56170.

ApoLink: Terhubung Langsung dengan Apoteker untuk Mendapatkan Layanan Kesehatan Terbaik

The development of the digital era and technological advances have had a significant impact on various aspects of human life, including in the health sector. Information systems have become an important tool in presenting information effectively and efficiently. In this case, advances in the internet and telemedicine have changed the way health services are provided to the public. This research aims to develop an application called Apolink that connects directly with pharmacists, thus providing optimal health services. The research method used is qualitative with an emphasis on literature studies, interviews, and direct observation at the pharmacy. The research process includes analysis of system requirements based on drug data, customer data, sales data, and health consultations. In the analysis conducted, it was revealed that telemedicine services, such as consultations with doctors remotely, ordering medicines, and up-to-date health information, have many advantages. Telemedicine services can save time for doctors and patients, increase the accessibility of health services, and overcome geographic barriers. In addition, telemedicine can also reduce costs, improve medication adherence, and provide better clinical support. Based on this needs analysis, the Apolink application is developed with features that can meet user needs.

Pre-implementation planning for a sepsis intervention in a large learning health system: a qualitative study

BackgroundSepsis survivors experience high morbidity and mortality. Though recommended best practices have been established to address the transition and early post hospital needs and promote recovery for sepsis survivors, few patients receive recommended post-sepsis care. Our team developed the Sepsis Transition and Recovery (STAR) program, a multicomponent transition intervention that leverages virtually-connected nurses to coordinate the application of evidence-based recommendations for post-sepsis care with additional clinical support from hospitalist and primary care physicians. In this paper, we present findings from a qualitative pre-implementation study, guided by the Consolidated Framework for Implementation Research (CFIR), of factors to inform successful STAR implementation at a large learning health system prior to effectiveness testing as part of a Type I Hybrid trial.MethodsWe conducted semi-structured qualitative interviews (n = 16) with 8 administrative leaders and 8 clinicians. Interviews were transcribed and analyzed in ATLAS.ti using a combination deductive/inductive strategy based on CFIR domains and constructs and the Constant Comparison Method.ResultsSix facilitators and five implementation barriers were identified spanning all five CFIR domains (Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals and Process). Facilitators of STAR included alignment with health system goals, fostering stakeholder engagement, sharing STAR outcomes data, good communication between STAR navigators and patient care teams/PCPs, clinician promotion of STAR with patients, and good rapport and effective communication between STAR navigators and patients, caregivers, and family members. Barriers of STAR included competing demands for staff time and resources, insufficient communication and education of STAR’s value and effectiveness, underlying informational and technology gaps among patients, lack of patient access to community resources, and patient distrust of the program and/or health care.ConclusionsCFIR proved to be a robust framework for examining facilitators and barriers for pre-implementation planning of post-sepsis care programs within diverse hospital and community settings in a large LHS. Conducting a structured pre-implementation evaluation helps researchers design with implementation in mind prior to effectiveness studies and should be considered a key component of Type I hybrid trials when feasible.Trial registrationClinicaltrials.gov, NCT04495946. Registered August 3, 2020.

Pro bono in the real World: A comprehensive review of the literature and recommendations for meaningful engagement

Background and PurposeThe APA’s Ethical Principles for Psychologists explicitly addresses and humbly encourages pro bono work: “psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage.” Yet, there is ambiguity surrounding the specifics, including frequency, time commitment, eligible services, and fair selection process to determine who will receive services. Materials and Methods: This manuscript provides the results of a comprehensive literature review on pro bono work. Initially focused on psychological assessment (e.g., neuropsychological, psychoeducational), the literature search expanded to therapy, community-based practice, and fee/paid assessment studies due to the dearth of literature. The purpose of the review to explore pro bono services in order to better understand in the future how services impact a child’s access to education, family engagement, and school relationships. Results: Two primary and secondary searches were completed. The primary search investigated the involvement of the family system when working with children and adolescents. The secondary search looked at the effectiveness of psychological, neuropsychological, and psychoeducational assessments to bolster results and provide additional recommendations and future directions. Discussion: The paper also features detailed recommendations based on the search results for how clinicians can engage meaningfully in pro bono work in their current practice along four main themes: community clinic, crisis, equity, and family support. Conclusion: Finally, future directions will address the substantial gaps in the literature on this subject.

Enhancing Healthcare Informatics: Integrating Category Theory Reasoning into OMOP-CDM Ontology Model.

The task of managing diverse electronic health records requires the consolidation of data from different sources to facilitate clinical research and decision-making support, with the emergence of the Observational Medical Outcomes Partnership - Common Data Model (OMOP-CDM) as a standard relational database schema for structuring health records from different sources. Working with ontologies is strongly associated with reasoners. Implementing them over expansive and intricate Ontologies can pose computational challenges, potentially resulting in slow performance. In this paper, we propose the implementation of a new reasoner based on categorical logic over a translation of OMOP-CDM into an ontology model. This enables enhancements to the efficiency and scalability of implementing such models.

Mandibular dose-volume predicts time-to-osteoradionecrosis in an actuarial normal-tissue complication probability (NTCP) model: External validation of right-censored clinico-dosimetric and competing risk application across international multi-institutional observational cohorts and online graphical user interface clinical support tool assessment.

Existing studies on osteoradionecrosis of the jaw (ORNJ) have primarily used cross-sectional data, assessing risk factors at a single time point. Determining the time-to-event profile of ORNJ has important implications to monitor oral health in head and neck cancer (HNC) long-term survivors. Demographic, clinical and dosimetric data were retrospectively obtained for a clinical observational cohort of 1129 patients with HNC treated with radiotherapy (RT) at The University of Texas MD Anderson Cancer Center. ORNJ was diagnosed in 198 patients (18%). A multivariable logistic regression analysis with forward stepwise variable selection identified significant predictors for ORNJ. These predictors were then used to train a Weibull Accelerated Failure Time (AFT) model, which was externally validated using an independent cohort of 265 patients (92 ORNJ cases and 173 controls) treated at Guy's and St. Thomas' Hospitals. Our model identified that each unit increase in D25% is significantly associated with a 12% shorter time to ORNJ (Adjusted Time Ratio [ATR] 0·88, p<0·005); pre-RT dental extractions was associated to a 27% faster (ATR 0·73, p=0·13) onset of ORNJ; male patients experienced a 38% shorter time to ORNJ (ATR 0·62, p = 0·11). The model demonstrated strong internal calibration (integrated Brier score of 0·133, D-calibration p-value 0.998) and optimal discrimination at 72 months (Harrell's C-index of 0·72). The model also showed good generalization to the independent cohort, despite a slight drop in performance. This study is the first to demonstrate a direct relationship between radiation dose and the time to ORNJ onset, providing a novel characterization of the impact of delivered dose not only on the probability of a late effect (ORNJ), but the conditional risk during survivorship. This work was supported by various funding sources including NIH, NIDCR, NCI, NAPT, NASA, BCM, Affirmed Pharma, CRUK, KWF Dutch Cancer Society, NWO ZonMw, and the Apache Corporation.

Randomized Clinical Trial of ICECaP (Individualized Coordination and Empowerment for Care Partners of Persons with Dementia): Primary Mental Health and Burden Outcomes.

Efficacy of the Individualized Coordination and Empowerment for Care Partners of Persons with Dementia (ICECaP), an intervention that involves one-on-one individualized support from a dementia care coordinator for a dementia care partner, compared to an active control group. At least once monthly contact is made from a dementia care coordinator to the dementia care partner by telephone, video conferencing, email, or in-person support at clinical visits for the person with dementia. In this pilot randomized unblinded control trial of ICECaP, n=61 (n=90 randomized) care partners completed 12-months of the ICECaP intervention and n=69 (n=92 randomized) care partners received routine clinical support (controls) in an outpatient memory care clinic at an academic medical center, from which the participants were recruited (ClinicalTrials.gov: NCT04495686, funded by Department of Defense and Virginia Department for Aging and Rehabilitative Services). Early termination endpoints (death and higher level of care) and trial drop out were comparable across groups. Primary efficacy outcomes were evaluated by comparing changes in care partner mental health, burden, and quality of life from baseline to 12-months between ICECaP and controls. Linear-mixed ANCOVA revealed no significant group differences in longitudinal changes on measures of caregiving burden, care partner depression, anxiety, quality of life, or reactions to the behavioral symptoms of the person with dementia. Hypothesized reasons for lack of initial efficacy on primary 12-month outcomes are discussed.

Provision of oral medicine in Scottish oral and maxillofacial surgery units: where are we and where are we going?

Introduction Oral medicine (OM) care occupies a significant quantity of oral and maxillofacial surgery (OMFS) outpatient clinical time. This survey aims to examine the current provision of OM care in OMFS units and explore opinions on how to improve the delivery of OM services across Scotland.Method An anonymous online questionnaire was distributed to all (33) OMFS consultants in Scotland. A range of questions were asked, covering place of work, formal OM training, proportion of time spent delivering OM clinical care, referral practices and support for a managed clinical network (MCN) in Scotland.Results A total of 18 (55%) OMFS consultants completed the survey. The majority of respondents (72%) worked in a university teaching hospital (UTH) setting. While none of the respondents were on the OM specialist register, most (72%) had received formal training in OM during their OMFS specialty training. Time dedicated to OM in outpatient clinics varied between less than 20% and 20-40% of clinical time. The majority of respondents (50%) referred 1-2 patients per month to OM. Most OMFS consultants (72%) felt that local OM services should be expanded and 78% would support the inclusion of OM specialists as part of the OMFS outpatient clinic team.Conclusion This study highlights the significant contribution to OM care within OMFS units in Scotland and emphasises the need for close collaboration between specialties. There is support for OM specialists to form part of the OMFS clinical team in UTHs or district general hospitals. Additionally, there is widespread support for the development of a MCN model of OM care in Scotland.