Clinical Work Research Articles

A validated web-application (GFDC) for automatic classification of glaucomatous visual field defects using Hodapp-Parrish-Anderson criteria.

Subjectivity and ambiguity of visual field classification limits the accuracy and reliability of glaucoma diagnosis, prognostication, and management decisions. Standardised rules for classifying glaucomatous visual field defects exist, but these are labour-intensive and therefore impractical for day-to-day clinical work. Here a web-application, Glaucoma Field Defect Classifier (GFDC), for automatic application of Hodapp-Parrish-Anderson, is presented and validated in a cross-sectional study. GFDC exhibits perfect accuracy in classifying mild, moderate, and severe glaucomatous field defects. GFDC may thereby improve the accuracy and fairness of clinical decision-making in glaucoma. The application and its source code are freely hosted online for clinicians and researchers to use with glaucoma patients.

Lived Experiences of Parenting Transgender and Gender Nonconforming Youth: Implications for Clinical Social Work Practice

AbstractTransgender and gender non-conforming (TGNC) youth are the focus of media attention, policy and practice changes, and multidisciplinary research. Due to their disproportionate risk of self-harm, depression, and suicidality, family support of TGNC youth is a key focus. Despite growing community awareness, TGNC children, and their families, continue to navigate a complex myriad of challenges, including at an individual, family, community, and societal level. Parents are likely influenced by their child’s TGNC identity however little is known about how this parenting experience is perceived and navigated, with most research exploring the TGNC person’s perspective. Using qualitative photovoice methodology, this study explored the lived experience of raising a TGNC child from the parent perspective. Eight Australian parents of a TGNC young person aged between 10 and 18 years participated in an in-depth interview guided by their chosen photographs as the stimulus. Thematic analysis identified five key findings: 1. crossing the threshold: finding out and figuring it out; 2. changing and adapting; 3. same but different: attachment and family dynamic; 4. letting go and holding on; and 5. finding a path forward. Findings suggest complex psychosocial impacts on parenting. Recommendations include targeted support for parents that addresses grief, social isolation, career stress, and access to relevant information and services. Clinical social workers can play a vital role in supporting parents of TGNC children by providing trauma informed responses that recognise disenfranchised grief, acknowledge socioemotional impacts, and empower parents with appropriate resources to meet their needs, and those of their TGNC child.

Plasma Biomarkers for Hypertension-Mediated Organ Damage Detection: A Narrative Review

Hypertension (HT) is a disease that poses a serious threat to human health, mediating organ damage such as the cardiovascular (CV) system, kidneys, central nervous system (CNS), and retinae, ultimately increasing the risk of death due to damage to the entire vascular system. Thus, the widespread prevalence of hypertension brings enormous health problems and socioeconomic burdens worldwide. The goal of hypertension management is to prevent the risk of hypertension-mediated organ damage and excess mortality of cardiovascular diseases. To achieve this goal, hypertension guidelines recommend accurate monitoring of blood pressure and assessment of associated target organ damage. Early identification of organ damage mediated by hypertension is therefore crucial. Plasma biomarkers as a non-invasive test can help identify patients with organ damage mediated by hypertension who will benefit from antihypertensive treatment optimization and improved prognosis. In this review, we provide an overview of some currently available, under-researched, potential plasma biomarkers of organ damage mediated by hypertension, looking for biomarkers that can be detected by simple testing to identify hypertensive patients with organ damage, which is of great significance in clinical work. Natriuretic peptides (NPs) can be utilized as a traditional biomarker to detect hypertension-mediated organ damage, especially for heart failure. Nevertheless, we additionally may need to combine two or more plasma biomarkers to monitor organ damage in the early stages of hypertension.

Clinical predictive value of the age, creatinine, and ejection fraction score in patients in acute type A aortic dissection after total arch replacement

The age, creatinine, and ejection fraction (ACEF) score has been accepted as a predictor of poor outcome in elective operations. This study aimed to investigate the predictive value of ACEF score in acute type A aortic dissection (AAAD) patients after total arch replacement. A total of 227 AAAD patients from July 2021 and June 2022 were enrolled and divided into Tertiles 1 (ACEF ≤ 0.73), Tertiles 2 (0.73 < ACEF ≤ 0.95), and Tertiles 3 (ACEF > 0.95). Using inverse probability processing weighting (IPTW) to balance the baseline characteristics and compare the outcomes. Cox logistic regression was used to further evaluate the survival prediction ability of ACEF score. The in-hospital mortality was 9.8%. After IPTW, in the baseline characteristics reached an equilibrium, a higher ACEF score before operation still associated with higher in-hospital mortality. After 1 year follow-up, 184 patients (90.6%) survival. Multivariable analysis revealed that ACEF score (adjusted hazard ratio 1.68; 95% confidence interval 1.34–4.91; p = 0.036) and binary ACEF score (adjusted HR 2.26; 95% CI 1.82–6.20; p < 0.001) was independently associated with 1-year survival. In addition, net reclassification improvement (NRI) and integrated differentiation improvement (IDI) verified that the ACEF score and binary ACEF score is an accurate predictive tool in clinical settings. In conclusions, ACEF score could be considered as a useful tool to risk stratification in patients with AAAD before operation in daily clinical work.

Artificial intelligence as a new answer to old challenges in maternal-fetal medicine and obstetrics.

Following the latest trends in the development of artificial intelligence (AI), the possibility of processing an immense amount of data has created a breakthrough in the medical field. Practitioners can now utilize AI tools to advance diagnostic protocols and improve patient care. The aim of this article is to present the importance and modalities of AI in maternal-fetal medicine and obstetrics and its usefulness in daily clinical work and decision-making process. A comprehensive literature review was performed by searching PubMed for articles published from inception up until August 2023, including the search terms "artificial intelligence in obstetrics", "maternal-fetal medicine", and "machine learning" combined through Boolean operators. In addition, references lists of identified articles were further reviewed for inclusion. According to recent research, AI has demonstrated remarkable potential in improving the accuracy and timeliness of diagnoses in maternal-fetal medicine and obstetrics, e.g., advancing perinatal ultrasound technique, monitoring fetal heart rate during labor, or predicting mode of delivery. The combination of AI and obstetric ultrasound can help optimize fetal ultrasound assessment by reducing examination time and improving diagnostic accuracy while reducing physician workload. The integration of AI in maternal-fetal medicine and obstetrics has the potential to significantly improve patient outcomes, enhance healthcare efficiency, and individualized care plans. As technology evolves, AI algorithms are likely to become even more sophisticated. However, the successful implementation of AI in maternal-fetal medicine and obstetrics needs to address challenges related to interpretability and reliability.

Prognostic impact of interstitial lung abnormalities in lung cancer: a systematic review and meta-analysis

BackgroundNewly identified as a radiological concept, interstitial lung abnormalities (ILA) is emerging as a prognostic factor for lung cancer. Yet, debates persist regarding the prognostic significance of ILA in lung cancer. Our inaugural meta-analysis aimed to investigate the correlation between ILA and lung cancer outcomes, offering additional insights for clinicians in predicting patient prognosis.MethodsArticles meeting the criteria were found through PubMed, the Cochrane Library, EMBASE, and Web of Science by February 29, 2024. The outcomes evaluated were the survival rates such as overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and cancer-specific survival (CSS).ResultsA total of 12 articles with 4416 patients were included in this meta-analysis. The pooled results showed that lung cancer patients with interstitial lung abnormalities had an inferior OS (n=11; HR=2.22; 95% CI=1.68-2.95; P&amp;lt;0.001; I2 = 72.0%; Ph&amp;lt;0.001), PFS (n=3; HR=1.59; 95% CI=1.08-2.32; P=0.017; I2 = 0%; Ph=0.772), and CSS (n=2; HR=4.00; 95% CI=1.94-8.25; P&amp;lt;0.001; I2 = 0%; Ph=0.594) than those without, however, the ILA was not significantly associated with the DFS (n=2; HR=2.07; 95% CI=0.94-7.02; P=0.066; I2 = 90.4%; Ph=0.001). Moreover, lung cancer patients with ILA were significantly correlated with male (OR=2.43; 95% CI=1.48-3.98; P&amp;lt;0.001), smoking history (OR=2.11; 95% CI=1.37-3.25; P&amp;lt;0.001), advanced age (OR=2.50; 95% CI=1.56-4.03; P&amp;lt;0.001), squamous carcinoma (OR=0.42; 95% CI=0.24-0.71; P=0.01), and EGFR mutation (OR=0.50; 95% CI=0.32-0.78; P=0.002). The correlation between ILA and race, stage, ALK, however, was not significant.ConclusionILA was a availability factors of prognosis in patients with lung cancers. These findings highlight the importance of early pulmonary fibrosis, namely ILA for prognosis in patients with lung cancer, and provide a partial rationale for future clinical work.

Strengthening Understanding of Customer Services and Practical Instructions for Hospital Financial Management

Increasing competition in the health industry at the national level makes the hospital management always tidy up in improving the quality of service to patients and improving the quality of medical infrastructure facilities according to the standard HNAC (Hospital National Accreditation Committee). Armed with the success of the value chain strategy concept training agenda at Elizabeth Semarang Hospital on May 16, 2018, I submitted the same training proposal to the Miriam Pratama Clinic, Kudus. The underlying factor is the urgency of the MIRIAM Pratama Clinic to raise the level of its business to become an C accredited hospital so that it can continue to survive and from the results of their communication with one of my relatives in Kudus who has heard me conduct training on the topic of value chain strategy at Elizabeth Hospital Semarang. So then I made a communication with the MIRIAM Pratama Clinic to get approval for the implementation of the training activities on March 18, 2019. Seeing the urgency of increasing the status of this business level, then I added aspects of financial management with the basis of considerations to raise the level of business and build a system of value chain strategies from Swayne, et.al. (2006) a large cash flow is needed. And this will be fulfilled with the right budgeting model. Finally, the activity was successfully carried out on March 18, 2019 with a very good response from participants who asked about how to regulate social and business motives in managing clinical businesses in the midst of a lack of cash flow and a budgeting model that does not have to be a month to month approach from Berger (2008). So the short answer is to raise the level of business, business motives should be a priority because improving the quality of services will require large costs and to fulfill them is not necessary with a month to month budgeting approach from Berger (2008) but can be from budget flexibility according to the clinical work calendar. In the mentoring activities on April 18, 2019 there were more positive results from the training activities on March 18, 2019 namely the more enthusiastic doctors, nurses and non-nursing staff working and more positive testimonials from key patients, mothers giving birth and their families. This has had a positive impact on status of the clinic as a C accreditation.

Duration and severity of COVID-19 symptoms among primary healthcare workers: A cross-sectional survey.

This study aims to investigate the epidemiological characteristics of COVID-19 infection among healthcare workers, including the severity, duration of infection, post-infection symptoms and related influencing factors. A self-administered questionnaire was utilized to assess the post-infection status of primary healthcare workers in Jiangsu Province. The questionnaire collected information on demographic characteristics, lifestyle habits, post-infection clinical manifestations, work environment and recovery time of the respondents. Customized outcome events were selected as dependent variables and logistic regression models were employed to analyse the risk factors. Phi-coefficient was used to describe the relationship between post-infection symptoms. The analysis revealed that several factors, such as female, older age, obesity, previous medical history, exposure to high-risk environments and stress, were associated with a higher likelihood of experiencing more severe outcomes. On the other hand, vaccination and regular exercise were found to contribute to an earlier resolution of the infection. Among the post-infection symptoms, cough, malaise and muscle aches were the most frequently reported. Overall, there was a weak association among symptoms persisting beyond 14 days, with only cough and malaise, malaise and dizziness and headache showing a stronger correlation. The study findings indicate that the overall severity of the first wave of infection, following the complete lifting of restrictions in China, was low. The impact on primary healthcare workers was limited, and the post-infection symptoms exhibited similarity to those observed in other countries. It is important to highlight that these conclusions are specifically relevant to the population infected with the Omicron variant. This study helps to grasp the impacts of the first wave of COVID-19 infections on healthcare workers in China after the national lockdown was lifted. Primary healthcare workers in Jiangsu Province, including doctors, nurses, pharmacists and other personnel from primary healthcare units such as community health service centres and health centres.

Conceptions and Historicity of Clinical Social Work in Latin America: A Contemporary Overview

Conceptions and Historicity of Clinical Social Work in Latin America: A Contemporary Overview

Chinese expert consensus on the surgical treatment of neuropathic pain by the spinal cord dorsal root entry zone

In order to promote the standardization of the treatment of neuropathic pain by spinal dorsal root entry surgery, alleviate the pain of certain specific neuropathic pain patients, and improve their quality of life and survival, experts with experience in neuropathic pain and spinal dorsal root entry surgery were organized by Functional Neurosurgery Group of the Neurosurgery Branch of the Chinese Medical Association and Functional Neurosurgery Expert Committee of Chinese Congress of Neurological Surgeons to write this consensus. Based on a systematic review and summary of literature and clinical evidence at home and abroad, this consensus discusses the diagnosis and drug treatment of neuropathic pain, clinical application of, spinal dorsal root entry surgery the selection of patients receiving surgery of dorsal root entry zone, preoperative examination, surgical procedures, postoperative management, and the prevention and management of postoperative complications, and forms 12 recommended recommendations, providing reference and guidance for clinical work on the treatment of neuropathic pain through spinal dorsal root entry surgery.

Quality of life and its related-influencing factors in patients with cervical cancer based on the scale QLICP-CE(V2.0)

BackgroundQuality of life research can guide clinical workers to adopt more targeted treatment and intervention measures, so as to achieve the purpose of improving patients’ quality of life. The objective of this study was to evaluate health-related quality of life in Chinese patients with cervical cancer and to explore its influencing factors.MethodsA total of 186 patients with cervical cancer were investigated by using the QLICP-CE (V2.0) scale (Quality of Life Instruments for Cancer Patients-Cervical Cancer) developed by our group in China. The data were analyzed by t-test, one-way ANOVA, univariate analysis, and multivariate linear regression.ResultsThe total score of quality of life scale for cervical cancer patients was (62.58 ± 12.69), Univariate analysis of objective clinical indexes showed that creatinine concentration was a negative influence factor in the psychological domain, potassium ion concentration was a negative influence factor in the common symptoms and side effect domain, erythrocyte content was a positive influence factor physical domain and common general domain. Multiple linear regression results suggested that clinical staging was the influencing factor of common symptom and side effect domain, common general module and total score of scale. Marital status has different degrees of influence on the psychological, social, and common general domains. The level of education also influenced scores in the social domain.ConclusionThe total score of quality of life in patients with cervical cancer who received active treatment was acceptable. Marital status, clinical staging, and educational level are the factors that affect the quality of life of patients with cervical cancer. At the same time, potassium ion concentration, red blood cell count and creatinine concentration also have important effects on quality of life in patients with cervical cancer. Therefore, it is very important to give personalized treatment and nursing to patients based on various factors.

Understanding delays in chronic limb-threatening ischaemia care: Application of the theoretical domains framework to identify factors affecting primary care clinicians' referral behaviours.

Patients in the community with suspected Chronic limb-threatening ischaemia (CLTI) should be urgently referred to vascular services for investigation and management. The Theoretical Domains Framework (TDF) allows identification of influences on health professional behaviour in order to inform future interventions. Here, the TDF is used to explore primary care clinicians' behaviours with regards to recognition and referral of CLTI. Semi-structured interviews were conducted with 20 podiatrists, nurses and general practitioners in primary care. Directed content analysis was performed according to the framework method. Utterances were coded to TDF domains, and belief statements were defined by grouping similar utterances. Relevance of domains was confirmed according to belief frequency, presence of conflicting beliefs and the content of the beliefs indicating relevance. Nine TDF domains were identified as relevant to primary care clinicians: Knowledge, Environmental context and resources, Memory, Decision and attention processes, Beliefs about capabilities, Skills, Emotions, Reinforcement and Behavioural regulation. Relationships across domains were identified, including how primary care clinician confidence and working in a highly pressurized environment can affect behaviour. We have identified key barriers and enablers to timely recognition and referral behaviour. These beliefs identify targets for theory-driven behaviour change interventions to reduce delays in CLTI pathways.

A biochemical feedback signal for hypothermia treatment for neonatal hypoxic-ischemic encephalopathy: focusing on central nervous system proteins in biofluids.

Hypothermia has been widely used to treat moderate to severe neonatal hypoxic-ischemic encephalopathy (HIE), yet evaluating the effects of hypothermia relies on clinical neurology, neuroimaging, amplitude-integrated electroencephalography, and follow-up data on patient outcomes. Biomarkers of brain injury have been considered for estimating the effects of hypothermia. Proteins specific to the central nervous system (CNS) are components of nervous tissue, and once the CNS is damaged, these proteins are released into biofluids (cerebrospinal fluid, blood, urine, tears, saliva), and they can be used as markers of brain damage. Clinical reports have shown that CNS-specific marker proteins (CNSPs) were early expressed in biofluids after brain damage and formed unique biochemical profiles. As a result, these markers may serve as an indicator for screening brain injury in infants, monitoring disease progression, identifying damage region of brain, and assessing the efficacy of neuroprotective measures. In clinical work, we have found that there are few reports on using CNSPs as biological signals in hypothermia for neonatal HIE. The aim of this article is to review the classification, origin, biochemical composition, and physiological function of CNSPs with changes in their expression levels after hypothermia for neonatal HIE. Hopefully, this review will improve the awareness of CNSPs among pediatricians, and encourage future studies exploring the mechanisms behind the effects of hypothermia on these CNSPs, in order to reduce the adverse outcome of neonatal HIE.

Reflecting on Reflection in Clinical Social Work: Unsettling a Key Social Work Strategy

Abstract This study calls into question some of assumptions within social work education and practice regarding the transformational potential of reflection-on-practice. Participants (n = 34) in this simulation-based study each engaged in two clinically focused simulations, each followed by an interview which included observing segments of their video-recorded simulations. The objectives of this study are to make some sense of the misalignments between participants’ post-simulation reflections of their practice behaviours, and the practice behaviours observed by the research team, and later by participants themselves. Findings illustrate that: (i) how clients and the session are understood in the moment can be different than how they are understood post-client engagement; (ii) reflections of practice behaviours can be tied to how individuals want to be, which are not necessarily aligned with how they are in the moment; and (iii) reflections are intertwined with awareness of oneself. These results identify some of the limitations of individualised reflective activities, and demonstrate the powerful potential of collective reflection on recordings of simulations to challenge memory distortions, retrospective biases and to promote greater accountability to ourselves as social workers, and to those we work with.

Guidelines and recommendations for cross-linguistic aphasia assessment: a review of 10 years of comprehensive aphasia test adaptations

ABSTRACT Background Standardised aphasia assessment tools may not always be available in a variety of languages, posing challenges for speech and language therapists to adequately assess and diagnose aphasia in speakers of those languages. In 2013, Working Group 2 (WG2) Aphasia Assessment & Outcomes, part of the Collaboration of Aphasia Trialists network, was formed with the purpose of developing reliable and valid aphasia assessment tools and their cross-linguistic adaptations. Over the past decade, WG2 has undertaken important adaptation projects, including the cross-linguistic adaptation of the Comprehensive Aphasia Test (CAT; Swinburn et al., 2004). Aims This review aims to achieve three objectives: (a) describe the adaptation procedure of the CAT within WG2, (b) summarise common guidelines and recommendations for future adaptations, and (c) provide concrete solutions for specific cross-linguistic and cross-cultural challenges encountered during the adaptation and validation procedures of the CAT. Methods Between 2013 and 2023, WG2 employed a committee approach and fully adapted the CAT into Catalan, Croatian, Dutch, French, Hungarian, Norwegian, Spanish, and Turkish. Further adaptations are in progress for Arabic (Moroccan), Basque, Cantonese Chinese, German, Greek, Icelandic, Lithuanian, Serbian, Slovenian and Swedish. The review comprehensively addresses the linguistic/cultural adaptation and validation procedure for the three components of the battery: the Cognitive screening, the Language battery and the Aphasia Impact Questionnaire. Critical outcomes and some best practice recommendations from psychometric norming and piloting are also discussed. Outcomes and results This review builds upon prior work (Fyndanis et al., 2017) and serves as a practical guide for researchers and clinicians undertaking cross-linguistic adaptations of the CAT, with specific conclusions and recommendations drawn from WG2’s adaptations in 19 languages with diverse typological properties. Building on the work exemplified in this paper, future initiatives can direct their efforts towards adapting the CAT for PWA from different linguistic backgrounds for whom validated assessment instruments may be unavailable. This can be achieved through rigorous systematic adaptation procedures for the establishment of comparable language versions of this tool, valuable for various clinical applications. Such endeavours have the potential to provide access to valuable shared datasets for their use across international aphasia trials, and for comparable clinical work within the aphasiology community.

Abstract PO3-09-07: When We Tri(al): Reaching, Motivating, &amp; Effectively Engaging Black Women In Breast Cancer Clinical Trial Research

Abstract According to the American Cancer Society, Black women in the United States are 41% more likely to die from breast cancer than non-Hispanic white women. A systematic review of participation in clinical trials found that Black patients comprised less than 4% of all patients enrolled in clinical trials for emerging immune-based cancer treatments. The physiology of Black women has not been a significant consideration in clinical trial research. Clinical trial education, recruiting, and participation are not commensurate with the burden of disease. TOUCH, The Black Breast Cancer Alliance (TOUCHBBCA) launched the When We Tri(al) Movement (WWT) in January 2022 with robust multi-media support and nationwide community event activations to educate and empower Black women with culturally-agile messaging from the trusted voices of Black Breast Cancer survivor/thrivers. WWT provides an innovative and engaging learning platform that clearly depicts how clinical trials work, explains standard of care, dispels historical myths, establishes trust, and empowers self-advocacy. To date, whenwetrial.org has garnered over 108,000 visits and sent nearly 11,000 Black women to clinical trial portals. One-third of unique website visitors have gone into clinical trial search portals. Over a sixteen day period in late June and early July of 2023, TOUCHBBCA conducted research among Black women who joined the When We Tri(al) movement using a pre-experimental, retrospective pre-then-post test (RPTP) survey design to assess growth in knowledge and behavior change among Black women exposed to the Movement. This survey received 113 respondents who self-identified as Black and assigned female at birth. Following exposure to WWT, 34.5% of respondents reported an increase in their understanding of how breast cancer clinical trials work, 31.9% reported an increase in their understanding of standard of care in breast cancer clinical trials, and 40.7% reported an increased understanding of why clinical trials are important for Black women. 32.7% of survey respondents were more likely to consider participating in a clinical trial after interacting with the WWT movement. After interacting with the movement, 31% of respondents took active steps to participate in a clinical trial—specified as searching for clinical trials in a portal, asking about clinical trial options, talking to a doctor about clinical trials, etc. Another 17.7% of respondents reported supporting a loved one in taking steps to participate in a clinical trial only after interacting with WWT. The majority of respondents reported first hearing about WWT through social media (59.2%), followed by “Other” (the majority of write-in responses named Google or a friend) (19.5%). Respondents reported that the most convincing WWT messages were delivered via social media (26.6%) and in-person conversations (20.4%). Not only is When We Tri(al) educating and equipping Black women with critical clinical trial knowledge, but the movement is driving significant behavior change by Black women around clinical trial participation. Citation Format: Ricki Fairley, Emily Powers, Hayley Brown. When We Tri(al): Reaching, Motivating, &amp; Effectively Engaging Black Women In Breast Cancer Clinical Trial Research [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-09-07.

Abstract PO1-19-05: COGNITION/-GUIDE – Implementation of Precision Oncology in Early High-Risk Breast Cancer

Abstract Background: The concept of precision oncology is nowadays increasingly implemented into clinical practice but is predominantly restricted to the metastatic setting limiting the benefits to prolongation of progression-free-survival (PFS). Implementation of precision oncology at an earlier disease stage with less tumor burden, heterogeneity and a higher capacity of tumor lesions to inform on the molecular tumor landscape holds the promise to impact cure rates. Methods: The prospective COGNITION/-GUIDE precision oncology platform encompasses the COGNITION diagnostic multi-omics biomarker screening platform (NCT05906407) linked to the multi-arm phase II COGNITION-GUIDE umbrella trial (NCT05332561). Based on a two-step consenting procedure, patients with early breast cancer (eBC) and poor response towards standard-of-care (SOC) neoadjuvant chemotherapy (NACT) are first enrolled into the COGNITION diagnostic platform. Residual bulk tumors are subjected to whole-genome- (WGS)/whole exome- (WES) and RNA-sequencing to enable streamlined detection of a rigorous biomarker-framework for subsequent genomics-guided arm allocation. Pilot analyses revealed that 78% (81/104) of high-risk tumors (TNBC or HER2+ BC with non-pCR or HR+/HER2- BC with non-pCR and CPS-EG score ≥ 3, or ypN+ and CPS-EG score ≥ 2) can be successfully sequenced and discussed within an interdisciplinary molecular tumor board. In 67% (70/104) eligible biomarker-profiles could be identified for potential biomarker-guided therapeutic intervention. In a second step, having completed all standard-of-care neoadjuvant and post-neoadjuvant treatments (except endocrine therapy, which can be administered simultaneously to the experimental therapy), patients can be enrolled into one of 6 biomarker-based arms in the COGNITION-GUIDE phase II trial (atezolizumab, inavolisib, ipatasertib, olaparib, sacituzumab govitecan or trastuzumab/pertuzumab). Primary end point is invasive disease-free survival (IDFS) at 4 years after surgery in the whole study population. Secondary endpoints are overall survival (OS), IDFS in each treatment arm, distant disease-free survival (DDFS) and patient-reported outcomes (PROs). Enrollment in COGNITION-GUIDE started in Q2/2023 and 240 patients will be enrolled in 5 German sites until Q2/2027. A comprehensive biomarker discovery program is integrated on longitudinal tumor tissue and liquid biopsies for exploratory analyses. Further clinical work and accrual will be reported at the meeting. Conclusion: The theranostic COGNITION/-GUIDE platform moves the concept of precision oncology to a potentially curative but still high-risk stage of eBC following SOC NACT. Hence, this novel application in the field of precision oncology harbours the prospect to increase cure rates. Citation Format: Verena Thewes, Luise Strassl, Marc Zapatka, Mario Hlevnjak, Constantin Pixberg, Christian Maurer, Katharina Smetanay, Carlo Fremd, Laura Michel, Sabine Heublein, Celina V. Wagner, Jan-Philip Suppelna, Lars Buschhorn, Albrecht Stenzinger, Renate Haidinger, Eva Schumacher-Wulf, Sibylle Loibl, Pauline Wimberger, Jens-Uwe Blohmer, Peter A. Fasching, Wolfgang Janni, Richard F. Schlenk, Peter Lichter, Andreas Schneeweiss. COGNITION/-GUIDE – Implementation of Precision Oncology in Early High-Risk Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-19-05.

Signs and symptoms of serious illness in adults with acute abdominal pain presenting to ambulatory care: a systematic review.

Acute abdominal pain is a common complaint, caused by a variety of conditions, ranging from acutely life-threatening to benign and self-limiting with symptom overlap complicating diagnosis. Signs and symptoms may be valuable when assessing a patient to guide clinical work. Summarising evidence on the accuracy of signs and symptoms for diagnosing serious illness in adults with acute abdominal pain in an ambulatory care setting. We performed a systematic review, searching for prospective diagnostic accuracy studies who included adults presenting with acute abdominal pain to an ambulatory care setting. Six databases and guideline registers were searched, using a comprehensive search strategy. We assessed the risk of bias, calculated descriptive statistics and measures of diagnostic accuracy. Results were pooled when at least four studies were available. Out of 18,923 unique studies, 16 studies with moderate to high-risk bias were included. Fourteen clinical features met our criteria, including systolic blood pressure <100 mmHg (LR +7.01), shock index >0.85, uterine cervical motion tenderness (LR +5.62 and LR- 8.60) and a self-assessment questionnaire score >70 (LR +12.20) or <25 (LR- 0.19). Clinical diagnosis made by the clinician had the best rule-in ability (LR +24.6). We identified 14 signs and symptoms that can influence the likelihood of a serious illness, including pain characteristics, systemic signs, gynaecological signs and clinician's overall assessment. The risk of bias was moderate to high, leading to uncertainty, preventing us from making firm conclusions. This highlights the need for better research in this setting.

Using the i-PARIHS theoretical framework to develop evidence implementation strategies for central venous catheter maintenance: a multi-site quality improvement project.

Evidence-based nursing practice can reduce complications associated with central venous catheters (CVCs). In this project, the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was considered an ideal theoretical instrument to identify facilitators and barriers to implementing evidence-based practice. The project was conducted in pediatric intensive care units in six Chinese tertiary children's hospitals. Twenty-two audit criteria were obtained from best practice recommendations, and a baseline audit was conducted to assess current practice against best practice. Next, the i-PARIHS framework was used to identify facilitators and barriers to best practice and develop improvement strategies. A follow-up audit was then conducted to measure changes in compliance with best practices. Facilitators and barriers were identified at the innovation, recipient, and context levels. A comprehensive CVC maintenance strategy was then developed to apply the best evidence to nurses' clinical work. Of the 22 audit criteria, 17 showed significant improvement compared with the baseline audit. The i-PARIHS framework is an effective tool for developing targeted, evidence-based improvement strategies and applying these to the clinical setting. The quality of the nurses' clinical practice improved during CVC maintenance. However, there is no certainty that these positive results can be maintained, and long-term data are needed to verify this. http://links.lww.com/IJEBH/A185.

Transition status and influencing factors of newly graduated nurses: A descriptive survey design

AimsTo assess the transition status of newly graduated nurses in China and identify its influencing factors. BackgroundNewly graduated nurses are the indispensable part of nursing human resource. The successful transition of into clinical work is crucial for their future career development. However, the transition status of new nurses in China remains inadequately explored. DesignA descriptive survey design was employed in this study. MethodsFrom October 2022 to January 2023, 1261 newly graduated nurses were surveyed online with the Transition Status Scale for Newly Graduated Nurses. Description statistical analysis was adopted to evaluate the transition status of new nurses. Independent-samples t-test, Analysis of Variance and Multiple Regression Analysis was used to explore the influencing factors of the transition status. ResultsThe total mean score of Transition Status Scale for Newly Graduated Nurses was 4.00 (SD=0.61). Competence for nursing work (Mean=4.20; SD=0.57) was rated the highest among the five dimensions of the scale, while the dimension of balance between work and life (Mean=3.65; SD=0.89) was rated the lowest. Mentored by senior nurses, night shift, attribute of working hospital, educational background, interned in the same department, tertiary general hospital, reasons for choosing nursing and working time can affect the transition status of new nurses, accounting for 17.9% of the variance in transition status (R²= 0.179, P＜0.001). ConclusionThe transition status of newly graduated nurses in China is at a relatively high level, especially in the dimension of competence for nursing work. However, newly graduated nurses are in a relatively poor status of work-life balance. Nurse educators and managers need to pay more attention to the transitional training of highly educated nursing talents and the optimization of clinical transition training programs to prevent talent loss. Experienced tutors should be allocated to provide guidance for newly graduated nurses.