Considerable Care Research Articles

TRNA-derived fragments (tRFs) as regulators of oncogenes and tumor suppressor genes in head and neck squamous cell carcinoma.

e18082 Background: Roughly 50,000 individuals are diagnosed with head and neck cancers in the United States yearly. Though risk factors and common therapeutic strategies are well-established, early detection of head and neck cancers remains challenging. One strategy for early detection is high-throughput analysis of both coding and noncoding RNA transcripts, which has become increasing implicated in cancer pathogenesis. One such noncoding transcript is tRNA-derived fragments (tRFs), which are the products of enzymatic cleavage of precursor tRNAs. Though tRFs have been suggested to play important roles in the regulation of mRNA translation (similar to other noncoding RNAs), their utility as cancer biomarkers is not well-known. Methods: In this study, we investigate tRFs for correlation to cancer prevalence with specific consideration of translational regulation of oncogenes (OG) and tumor suppressor genes (TSG). tRF read counts were obtained for 499 head and neck squamous cell carcinoma tumor tissue samples and 44 adjacent normal samples. Results: The read counts between both groups were compared to identify tRFs dysregulated in tumor samples, which may be pertinent biomarkers for diagnosis. Ten tRFs were found to be significantly dysregulated in cancer samples. These tRFs were further assessed for correlation to expression of OGs and TSGs using the COSMIC database. Due to the mRNA-degrading nature of tRFs, we analyzed tRF abundance for inverse correlation to gene expression. Four tRFs upregulated in tumor samples showed significant anticorrelation to select TSG expression (ATP2B3, CSMD3, LZTR1, NTHL1, PTPRC), and three tRFs downregulated in tumor samples showed anticorrelation to OG expression (A1CF, MPL, SALL4, TNC). Notably, LeuCAG 5’ tRF was associate with high binding affinity for the TSGs CSMD3 and LZTR1, supporting the likelihood of tRF-mediated degradation. Interestingly, this tRF was inversely correlated with patient survival length. LeuCAG 5’ was also of significantly lesser abundance in patients who experienced complete or partial remission following chemotherapy treatment, further indicating this tRFs’ clinical relevance in HNSCC, potentially as an oncogenic-related agent. Conclusions: Investigation into these tRFs may reveal their potential for use in early diagnosis. High abundance of this tRF may be indicative of oncogenesis. In exploring tRFs’ for their potential as biomarkers of cancer, they may prove useful in allowing earlier diagnosis. Moreover, studying tRFs may provide additional considerations for patient care and treatment.

Optimizing treatment of brain metastases in an era of novel systemic treatments: a single center consecutive series

BackgroundThe multidisciplinary management of patients with brain metastases consists of surgical resection, radiation treatment and systemic treatment. Tailoring and timing these treatment modalities is challenging. This study presents real-world data from consecutively treated patients and assesses the impact of all treatment strategies and their relation with survival. The aim is to provide new insights to improve multidisciplinary decisions towards individualized treatment strategies in patients with brain metastases.MethodsA retrospective consecutive cohort study was performed. Patients with brain metastases were included between June 2018 and May 2020. Brain metastases of small cell lung carcinoma were excluded. Overall survival was analyzed in multivariable models.Results676 patients were included in the study, 596 (88%) received radiotherapy, 41 (6%) awaited the effect of newly started or switched systemic treatment and 39 (6%) received best supportive care. Overall survival in the stereotactic radiotherapy group was 14 months (IQR 5–32) and 32 months (IQR 11–43) in patients who started or switched systemic treatment and initially did not receive radiotherapy. In patients with brain metastases without options for local or systemic treatment best supportive care was provided, these patients had an overall survival of 0 months (IQR 0–1). Options for systemic treatment, Karnofsky Performance Score ≥ 70 and breast cancer were prognostic for a longer overall survival, while progressive extracranial metastases and whole-brain-radiotherapy were prognostic for shorter overall survival.ConclusionsAssessing prognosis in light of systemic treatment options is crucial after the diagnosis of brain metastasis for the consideration of radiotherapy versus best supportive care.Graphical

EPS2.05 The challenge of living with cystic fibrosis - short form - challenges experienced by parents/caregivers of children with Cystic Fibrosis in Ireland: the Irish Comparative Outcomes study (ICOS)

Objectives: Caring for children with Cystic Fibrosis (CwCF) involves considerable informal care, posing significant burden on caregivers who are required to adapt rapidly to their role. This study evaluates caregiving burden of parents of CwCF recruited to the Irish Comparative Outcomes Study of CF (ICOS). Newborn CF Screening began in 2011.

Evidence Base for Virtual Primary Care


 The aim of this report was to identify and organize evidence and summarize key findings on the clinical effectiveness, cost-effectiveness, patient and provider experiences and preferences, and equity considerations of virtual primary care. It includes 60 relevant reports, of which we summarized 6 systematic reviews (SRs) and organized 54 additional reports into annotated reference lists.
 This report was not a formal evidence synthesis, and no conclusions were formed about the value of virtual primary care. The literature was not critically appraised, and the quality of the evidence from the included reports is unknown.
 The evidence about the clinical effectiveness of virtual primary care summarized in this report comes from a limited number of studies identified by 3 SRs and was mainly focused on health care utilization outcomes versus patient health or clinical harms outcomes. The findings were mixed, but overall, in-person visits may be associated with lower rates of health care utilization (e.g., emergency department visits, hospitalizations) compared with virtual visits. Virtual consultations may be associated with improved patient engagement compared with in-person care for certain conditions or settings (e.g., opioid addictions) but not others (e.g., smoking cessation, postnatal care, other general settings).
 The evidence about the cost-effectiveness of virtual primary care summarized in this report comes from 3 studies identified by 1 SR. Virtual primary care compared with in-person care might be cost-effective for patients with asthma and patients who received cognitive behavioural therapy, but these analyses considered very limited outcomes.
 The evidence about patient and provider experiences and preferences associated with virtual primary care that is summarized in this report comes from 4 SRs. The SRs identified many perceived benefits and drawbacks of virtual primary care from both patient and provider perspectives, including those around access to care, effectiveness, experience and satisfaction, and financial impact and cost.
 The evidence about potential equity issues associated with virtual primary care summarized in this report comes from 2 SRs. Equity considerations, such as age, may affect individuals accessing and using primary care health services. For example, telephone consultations tended to be used by older individuals (aged ≥ 85 years), while internet-based consultations tended to be used by younger individuals.

Radiosensitivity of rhesus nonhuman primates: consideration of sex, supportive care, body weight, and age at time of exposure

ABSTRACT Background Animal models are vital for the development of radiation medical countermeasures for the prophylaxis or treatment of acute radiation syndrome and for the delayed effects of acute radiation exposure. Nonhuman primates (NHPs) play an important role in the regulatory approval of such agents by the United States Food and Drug Administration following the Animal Rule. Reliance on such animal models requires that such models are well characterized. Methods Data gathered from both male and female animals under the same conditions and gathered concurrently are limited; therefore, the authors compared and contrasted here the radiosensitivity of both male and female NHPs provided different levels of clinical support over a range of acute, total-body gamma irradiation, as well as the influence of age and body weight. Results Under matched experimental conditions, the authors observed only marginal, but clearly evident differences between acutely irradiated male and female NHPs relative to the measured response endpoints (rates of survival, blood cell changes, and cytokine fluctuations). These differences appeared to be accentuated by the level of exposure as well as by the nature of clinical support. Conclusion Additional studies with both sexes under various experimental conditions and different radiation qualities run concurrently are needed.

Hearing Loss Diagnosis and Management in Adults with Intellectual and Developmental Disabilities.

Hearing loss is a common concern in patients with intellectual and developmental disabilities (IDD), and early detection and intervention are crucial to prevent negative impacts on communication, cognition, socialization, safety, and mental health. Despite a lack of the literature specifically focused on hearing loss in adults with IDD, there is a substantial body of research demonstrating the prevalence of hearing loss in this population. This literature review examines the diagnosis and management of hearing loss in adult patients with IDD, with a focus on primary care considerations. Primary care providers must be aware of the unique needs and presentations of patients with IDD to ensure appropriate screening and treatment. This review highlights the importance of early detection and intervention, as well as the need for further research to guide clinical practice in this patient population.

People living with HIV who inject or have injected non-prescription drugs: Evidence of substantial differences in health inequalities and experiences of clinical care.

This study investigates differences in health and well-being associated with current, past or no injecting drug use (IDU) among people living with HIV (PLHIV) in Australia, identifying key health care considerations between injecting experiences. Data were extracted from the HIV Futures 9 study; a survey of PLHIV conducted in 2018-2019. Chi-square and analysis of variance analyses compared clinical and treatment characteristics, major physical and mental comorbidities, sexually transmitted infection diagnoses, and quality of life for those who reported current (last 12 months), past (12+ months ago) or no IDU. Current IDU (n = 106) was associated with higher rates of sexually transmitted infection testing and diagnoses, higher frequency of self-reported antiretroviral therapy non-adherence due to drug use and greater social quality of life than past (n = 126) or no IDU (n = 508; total N = 740). Past and current IDUs were associated with more mental illness diagnoses and self-reported concern about drug use. Past IDU was associated with more physical comorbidities, lower satisfaction with clinical care and greater difficulty in affording health care than current or no IDU. Past and current IDUs are associated with unique health concerns. However, past IDU appears to be related to greater dissatisfaction in navigating health care than individuals with current IDU experience. Higher social connection and the types of services being accessed by individuals who currently inject may play a role in shaping service satisfaction. Peer-based interventions to help support individuals in accessing services that are affirming of their needs is an ongoing priority.

Clinical Pharmacogenomic MT-RNR1 Screening for Aminoglycoside-Induced Ototoxicity and the Post-Test Counseling Conundrum.

Aminoglycoside antibiotic exposure can result in ototoxicity and irreversible hearing loss among individuals that harbor the m.1555A>G variant in the mitochondrial 12S rRNA gene, MT-RNR1. Importantly, pre-emptive m.1555A>G screening has been shown to reduce the prevalence of pediatric aminoglycoside-induced ototoxicity; however, professional guidelines to support and guide post-test pharmacogenomic counseling in this context are not currently available. This Perspective highlights key issues with delivering MT-RNR1 results, including longitudinal familial care considerations and communicating m.1555A>G heteroplasmy.

Consensus recommendations for the assessment and treatment of perinatal obsessive–compulsive disorder (OCD): A Delphi study

The perinatal period is one of increased vulnerability to parents experiencing the onset of, or an increase of existing, obsessive–compulsive disorder (OCD) symptoms. Existing OCD and perinatal mental health best practice guidelines do not detail specific considerations relevant to OCD in the perinatal period (‘Perinatal OCD’). Perinatal OCD risks being undiagnosed or misdiagnosed, and subsequently untreated or mistreated, with potential negative impacts for individuals and families experiencing this problem, highlighting the importance of specific guidance. This study employed a modified Delphi survey methodology to establish recommended best practice for the assessment and treatment of perinatal OCD. A literature review identified 103 initial best practice recommendations, and participants suggested 18 further recommendations. These recommendations were rated for importance over three survey rounds by two expert panels, comprising of 15 professionals with clinical or research expertise in perinatal OCD and 14 consumers with lived experience of perinatal OCD. One-hundred and two statements were endorsed for inclusion in the final set of recommendations for clinical best practice with perinatal OCD. These recommendations inform practice across eight themes; psychoeducation, screening, assessment, differential diagnosis, case care considerations, treatment, partners & families, and culture & diversity. This novel study is the first to collate and outline a set of clinical best practice recommendations, developed using the consensus perspectives of both individuals with lived experience and professionals with relevant expertise, for supporting individuals with perinatal OCD and their families. Differences between panel perspectives, and directions for future research are also discussed.

BAUS oncology guidance for implementing streamlining in cancer MDT meetings: Selecting standards of care and operational considerations

It is widely recognised that multidisciplinary team meetings (MDTMs) are the cornerstone of cancer practice in the United Kingdom and many countries around the world. While MDTMs offer several key benefits to patients, healthcare professionals and cancer registration, data and audit services, in the United Kingdom they have over time become too large, onerous and ‘transactional’ often discussing cases that have a pre-determined management plan. In response to this growing problem, National Health Service (NHS) England and NHS Improvement produced an multidisciplinary team (MDT) streamlining document as a guide to encourage MDTM to consider a ‘Standard of Care’ (SoC) approach to conditions with a predictable agreed management plan based on national, regional cancer network or local cancer unit protocols. This would then enable more meaningful discussion of complex cases with in the MDT. This document did not gain much traction and had little impact on UK urological cancer MDTM. As a result, The British Association of Urological Surgeons (BAUS) was approached by the NHS Getting It Right First Time (GIRFT) Leads in 2021 to promote an SoC-based streamlining to urological cancer MDT working. Having consulted widely with colleagues, cancer networks and cancer delivery teams, the BAUS Section of Oncology sought views from its membership during a dedicated MDTM session in the Sections of Oncology Meeting, December 2021. From this extensive engagement with stakeholders, we have put together the following guidance for use as a framework to facilitate the agreement of local policies in the interests of supporting the needs of patients and MDTs. Level of evidence: level 5 (Expert opinions based on non-systematic reviews of results or mechanistic studies)

SP-0844 Radiobiology is an essential consideration in complete patient care

SP-0844 Radiobiology is an essential consideration in complete patient care

Carrying children, groceries, and water across varying terrain: Changes in gait and comfortable walking speed

BackgroundCarrying items of substantial weight and value in one’s arms while traversing challenging terrain is a common task that requires considerable care. Carrying valuable (e.g., child) or variable (e.g., water) items, compared to stable ones (e.g., groceries) demands increased coordination, and is likely to lead to slower comfortable walking speed (CWS) and altered gait mechanics, especially on difficult terrain. Research questionHow are gait parameters altered by carrying items of substantial weight and varying value and dynamics across more and less demanding terrain? MethodsIn two experiments, participants carried their child, an equally weighted sack of groceries, or an open bucket of water in the same manner across level floor and across uneven stairs of varying heights with gaps between them. Kinematics were assessed for both terrains; kinetics were measured for one step up and one step down on stairs. ResultsMixed models ANOVAs with repeated measures revealed that CWS on uneven stairs was approximately 65 % of CWS for level floor, regardless of the item carried. Step-to-step coefficients of variation for step length and CWS were also greater. Water was carried most slowly, with shorter steps on level floor and reduced accelerations on uneven stairs. CWS with children and groceries did not differ. SignificanceCarrying items of weight and worth with varying dynamics across more and less challenging terrain illustrates the ecological complexity of walking. Terrain requiring greater flexibility, strength, and coordination reduced CWS substantially, a complexity-speed tradeoff. More variable, difficult to control items altered CWS and other gait patterns regardless of terrain difficulty, suggesting terrain and item dynamics contributed independently to gait adjustments. More valuable items were not carried more slowly than less valuable ones. Carrying tasks deserve greater attention in research and clinical assessment.

Enhancing Expert Panel Discussions in Pediatric Palliative Care: Innovative Scenario Development and Summarization With ChatGPT-4.

This study presents a novel approach to enhance expert panel discussions in a medical conference through the use of ChatGPT-4 (Generative Pre-trained Transformer version 4), a recently launched powerful artificial intelligence (AI) language model. We report on ChatGPT-4's ability to optimize and summarize the medical conference panel recommendations of thefirst Pan-Arab Pediatric Palliative Critical Care Hybrid Conference, held in Riyadh, Saudi Arabia.ChatGPT-4 was incorporated into the discussions in two sequential phases: first, scenarios were optimized by the AI model to stimulate in-depth conversations; second, the model identified, summarized, and contrasted key themes from the panel and audience discussions. The results suggest that ChatGPT-4 effectively facilitated complex do-not-resuscitate (DNR) conflict resolution by summarizing key themes such as effective communication, collaboration, patient and family-centered care, trust, and ethical considerations. The inclusion of ChatGPT-4 in pediatric palliative care panel discussions demonstrated potential benefits for enhancing critical thinking among medical professionals. Further research is warranted to validate and broaden these insights across various settings and cultures.

Patient Care Considerations During General Anesthesia Administration.

AORN JournalVolume 117, Issue 5 p. P10-P10 Did You Know? Patient Care Considerations During General Anesthesia Administration First published: 27 April 2023 https://doi.org/10.1002/aorn.13926Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume117, Issue5Special Focus Issue: Infection PreventionMay 2023Pages P10-P10 RelatedInformation

Estimating Fluor Emission Spectra Using Digital Image Analysis Compared to Spectrophotometer Measurements.

This paper describes a practical method for obtaining the spectra of lights emitted by a fluor in a liquid scintillator (LS) using a digital camera. The emission wavelength results obtained using a digital image were compared with those obtained using a fluorescence spectrophotometer. For general users, conventional spectrophotometers are expensive and difficult to access. Moreover, their experimental measurement setup and processes are highly complicated, and they require considerable care in handling. To overcome these limitations, a feasibility study was performed to obtain the emission spectrum through image analysis. Specifically, the emission spectrum of a fluor dissolved in a liquid scintillator was obtained using digital image analysis. An image processing method was employed to convert the light irradiated during camera exposure into wavelengths. Hue (H) and wavelength (W) are closely related. Thus, we obtained an H-W response curve in the 400~450 nm wavelength region, using a light-emitting diode. Another relevant advantage of the method described in this study is its non-invasiveness in sealed LS samples. Our results showed that this method has the potential to accurately investigate the emission wavelengths of fluor within acceptable uncertainties. We envision the use of this method to perform experiments in chemistry and physics laboratories in the future.

Intraoperative mydriasis in left ventricular assist device patients. Do eyes never lie?

We report two cases of transient intraoperative mydriasis in left ventricular assist device (LVAD) patients with no profound underlining neurological pathology. Both cases concern females on LVAD for more than 30 months, due to dilated cardiomyopathy, as a bridge to transplant. A possible pathophysiology mechanism is suggested. As LVAD patients' life expectancy increases, more and more physiological alterations due to laminar flow will be revealed and must be taken into consideration for the better care of this patient group.

Peroral Endoscopic Myotomy: What Nurses Need to Know to Provide Preeminent Perioperative Care.

This article aims to explore details of research, evidence, and key concepts intended for nurses and other healthcare clinicians surrounding the paradigm shift in therapeutic endoscopy relating to the third-space endoscopic procedure, peroral endoscopic myotomy. Although many medical publications detail the procedure, there are no specific guidelines for nurses to reference when caring for the patient undergoing peroral endoscopic myotomy. With scant published resources available to direct nurses distinctly in the delivery of exceptional care to patients undergoing peroral endoscopic myotomy, there is an identified need for collated information to be accessible to all nurses providing perioperative teaching and care. As peroral endoscopic myotomy continues to transpire as a mainstream or preferred standard treatment for patients who suffer from achalasia, relevant education remains to be fully understood and assessed in the nursing arena. By examining nursing considerations for patient care, indications, techniques, and advancements regarding this ever-emergent breakthrough, readers will discover guidance in comprehensive care encompassing patients undergoing the peroral endoscopic myotomy procedure.

Racial disparity in breast cancer survivorship: themes from a series of four national healthcare provider live virtual forums.

Significant disparity exists in the diagnosis, treatment, and survivorship outcomes among Black breast cancer (BC) survivors. Black BC survivors have more significant survivorship issues and a greater burden of illness than White counterparts. Barriers to rehabilitation exist for all BC survivors but are magnified in Black BC survivors. The purpose of this qualitative research was to document patient, clinician, and researchers' perceptions surrounding contributing factors, lived experiences, and potential solutions to racial disparity in BC survivorship. A narrative approach was utilized to identify themes from a series of four virtual healthcare provider forums that explored lived personal and professional experiences, issues, and potential solutions surrounding racial disparity in BC survivorship. Forums included perspectives of patients, healthcare providers, researchers, and stakeholders in the BC field. An independent thematic analysis was performed by the investigators, all of whom have emic perspectives with respect to race and/or BC. Three main themes were identified related to racial disparity in BC survivorship: (1) societal and cultural contributing factors, (2) contribution of healthcare providers and systems, and (3) models of care and research considerations. The findings provide compelling documentation of lived personal and professional experiences of racial disparity in BC survivorship. Potential solutions exist and must be enacted immediately to ensure equitable survivorship outcomes for Black individuals following a BC diagnosis. Increased awareness related to racial disparity in BC survivorship among survivors, healthcare providers, and researchers will contribute to health equity and improved outcomes for Black individuals.

Primary Care Considerations for Elderly U.S. Veterans of World War II and the Korean War: A Narrative Review.

Many of the United States' more than 18 million veterans obtain healthcare through the Department of Veterans Affairs' (VA) Veterans Health Administration system; however, recent legislative changes have expanded veterans' access to non-VA care in their communities, particularly for those who do not live near VA medical centers. Veterans are seen by physicians in outpatient practice across the United States and are admitted to non-VA hospitals; this is particularly salient for older veterans, who may require a more frequent and high level of care. We present a review of characteristics of U.S. veterans from two conflicts: World War II (WWII) and the Korean War. While non-VA clinicians are well equipped to provide care for patients of all different ages, veterans of armed conflicts have a unique constellation of exposures and cultural considerations that must be accounted for when providing them care. In this review, we describe characteristics of the generations of American veterans who served in WWII and the Korean War conflicts in a brief historical context. We then note conflict-specific exposures and potential long-term sequelae to watch for during physical examinations and to monitor thereafter, age-specific health and emotional concerns, and best practices for providing care to this cohort of veterans.

Digeorge syndrome, schizophrenia, intellectual disability and borderline personality disorder: A case report

Background DiGeorge syndrome (DGS) is a rare genetic illness characterised by the abnormal development of the pharyngeal pouch system. It is known to have a high association with intellectual disability and psychiatric disorders. Purpose This case report details a unique 22-year journey of a 49-year-old female with an established diagnosis Intellectual disability, Schizophrenia and Borderline Personality Disorder associated with DGS. This report demonstrates the challenges faced for a patient with 22q11.2DS in the 3 intersecting domains of physical, psychiatric and psychological illness. Results The report draws attention to the limitations in follow up care, risk management and discharge settings in the face of the treatment refractory nature of her underlying health conditions. Conclusions The case highlights the lack of specific treatment guidelines and psychosocial supports for the neuropsychiatric phenotypes associated with 22q11.2DS. More research is needed to inform guidelines and considerations of care for the`-se patients.