Factors In Clinical Decision-making Research Articles

Thyroid and cardiovascular diseases.

The thyroid gland is one of the major regulator organs of hemostasis in the human body, controlling the functioning of numerous systems. Thyroid hormones exert a modulating effect on the cardiovascular system in particular, ensuring optimal functioning within the normal range. Triiodothyronine (T3), as an active form of thyroid hormone, is mainly responsible for this effect via both genomic and nongenomic mechanisms. It has been reported that overt thyroid disorders are associated with a number of cardiovascular diseases and cardiac mortality. While hyperthyroidism appears to be related to atrial fibrillation and heart failure, the most pronounced cardiovascular complication of hypothyroidism seems to be atherosclerosis. Achieving euthyroidism is of great importance for restoring cardiovascular function. However, depending on the underlying health conditions, this may not be possible for all patients. Furthermore, there has been a growing focus on the role of subclinical thyroid dysfunctions and their impacts on the cardiovascular system in recent years. The pattern of cardiovascular abnormalities in subclinical thyroid disorders appears to parallel that of overt hypothyroidism, suggesting that even mild alterations in thyroid hormone levels may also have effects on the cardiovascular system. The management of subclinical thyroid disease remains controversial. Current evidence suggests that patient age and underlying cardiovascular diseases are major factors in clinical decision-making.

“Comprehensive Analysis of Factors Influencing Recurrence and Survival in Glioblastoma: Implications for Treatment Strategies”: A Single Center Study

Glioblastoma is a highly aggressive malignancy affecting the brain and central nervous system. It is the most common malignant primary brain tumor, yet its prognosis remains poor. Median survival typically ranges from around 13 months with standard treatment to up to 19.9 months in some recent clinical trials. Despite advances in treatment, the aggressive nature of glioblastoma continues to present significant challenges for improving patient outcomes. This study aimed to analyze various biological, radiological, and molecular factors associated with glioblastoma recurrence and to estimate survival outcomes. A total of 104 glioblastoma patients diagnosed between January 2017 and September 2022 were included. Patient demographics, treatment received, and molecular characteristics were obtained from the Electronic Patient Record (EPR). Tumor molecular characteristics were analyzed using the OnkoSight Advanced CNS NGS panel. Statistical analyses were performed to develop a prognostic model for glioblastoma recurrence and estimate survival rates. Among the patients, 65.4% had no recurrence, with a mean age of 63 years. No gender or BMI differences were observed, but ages <60 years were associated with recurrence. Radiological findings showed no significant differences in tumor size, necrosis, site, or focality. In multivariate analysis, the female gender, obesity, old age (>60 years), or bifocal tumors were associated with decreased glioblastoma recurrence. However, factors like tumor site, size, necrosis, MGMT promoter methylation, and EGFR alteration showed no significant association with recurrence. Median survival was 12 months, with older age significantly associated with shorter survival. Tumor sizes >4 cm showed shorter survival trends but not statistically significantly. Patients who lived longer experienced more tumor recurrence incidents. Standard or non-standard treatments were associated with longer median survival compared to no treatment. Our findings provide insights into factors influencing glioblastoma recurrence and survival. Age, gender, and tumor characteristics play pivotal roles in recurrence. Understanding these factors could aid in optimizing treatment strategies and improving patient outcomes. However, further multicentric investigations are needed to validate these findings. This study emphasizes the importance of considering biological and radiological factors in clinical decision-making for glioblastoma cases.

Health-related quality of life in surgically treated asymptomatic meningioma patients: A population-based matched cohort study.

Asymptomatic patients with meningiomas are increasingly detected, where management can be challenging in terms of surgery versus watchful waiting. Health-related quality of life (HRQoL) is an important factor in clinical decision-making, albeit not greatly studied in this patient group. The aim of this paper is to map the HRQoL among patients with surgically removed asymptomatic meningioma as compared to the general population. Patients with first-time surgically treated asymptomatic meningioma between 2007 and 2013 were identified. Patients were invited in 2017 to answer a survey regarding different aspects of quality of life, using EuroQoL (EQ)-5D-3L, perceived health, lifestyle, and occupancy. Data from electronic patient records was obtained. The patients were matched based on age and gender with data from the Stockholm Region Public Health Cohort database. There was no difference in EQ-5D-3L or visual analog scale between the patients and their matched controls. Patients and controls experienced ill health to the same extent, but patients felt to a greater extent that this impacted their way of life. In 36% of patients, preoperative occupation was not resumed, mostly due to cognitive symptoms. Additionally, the study suggested social detachment in this cohort, as significantly more patients were living alone and had less emotional support compared to controls. Although surgically treated patients with asymptomatic intracranial meningioma have similar overall HRQoL compared to the general population, surgery has an impact on return to work and cognitive function.

Use of opioids and opioid alternatives during general anesthesia: a pan-Canadian survey among anesthesiologists.

While there is limited patient-centred evidence (i.e., evidence that is important for patients and end-users) to inform the use of pharmacologic opioid minimization strategies (i.e., the use of opioid alternatives) for adult surgical patients requiring general anesthesia, such strategies are increasingly being adopted into practice. Our objectives were to describe anesthesiologists' beliefs regarding intraoperative opioid minimizing strategies use and utility, and to explore important clinical decision-making factors. We conducted a pan-Canadian web-based survey of anesthesiologists that was distributed using a modified Dillman technique. Our multidisciplinary team, including a patientpartners panel, participated in the process of domains and items generation, items reduction, formatting, and composition. Our sampling frames were members of the Canadian Anesthesiologists' Society and members of the Association des Anesthésiologistes du Québec. We used the newsletters of each organization to distribute our survey, which was available in English and French and housed on the LimeSurvey (LimeSurvey GmbH, Hamburg, Germany) platform. From our eligible sampling frame, 18% completed the survey (356 respondents out of 2,008 eligible participants). Most of the respondents believed that using opioid minimization strategies during general anesthesia could improve postoperative clinical outcomes, including pain control (84% agree or strongly agree, n = 344/409). Reported use of pharmacologic opioid minimization strategies was variable; however, most respondents believed that nonsteroidal anti-inflammatory drugs, acetaminophen, N-methyl-D-aspartate receptor antagonists (ketamine), α2-adrenoceptor agonists (dexmedetomidine), corticosteroids, and intravenous lidocaine improve prostoperative clinical outcomes. The primary factors guiding decision-making regarding the use of opioid minimization strategies were postoperative acute pain intensity, the impact of acute pain on functioning, patient well-being (i.e., quality of recovery) and patient satisfaction with care. A lack of evidence was the most important barrier limiting the use of opioid minimization strategies. In our survey of Canadian anesthesiologists, several opioid minimization strategies were believed to be effective complements to general anesthesia, although there was substantial variation in their reported use. Future randomized controlled trials and systematic reviews evaluating the effectiveness of opioid minimization strategies should prioritize patient-centred outcome measures assessment such as the quality of recovery or the impact ofacute pain on functioning.

Interdisciplinary Approaches by Polish Orthodontists, Periodontists, and Oral Surgeons to Soft Tissue Augmentation in Adult Patients: A Survey Study

This study evaluates the preferences of dentists regarding the interdisciplinary treatment of patients with gingival recession (GR) and a thin periodontal phenotype, based on their specialization. A cross-sectional study was conducted among Polish dentists, between May and October 2022, using an online survey. The dentists were first asked to provide details regarding their specialization and the length of their professional career. In the second part of the survey, they responded to questions about the preferred timing of a consultation and soft tissue augmentation in patients who planned to undertake orthodontic treatment (OT). Moreover, factors undermining the decision-making process regarding soft tissue augmentation and the methods used for the evaluation of periodontal tissues were assessed. In total, 554 dentists completed the survey, among whom 328 were orthodontists and 226 were periodontists/oral surgeons. A third of the surveyed periodontists/oral surgeons (33%) reported that they receive referrals from orthodontists prior to OT and 39% of orthodontists indicated that they refer patients for soft tissue augmentation before commencing OT. The majority of periodontists/oral surgeons (51%) and the most significant proportion of orthodontists (45%) agreed that the ideal timing of soft tissue augmentation is dependent on each specific case. Both groups of surveyed dentists considered “planned tooth movement” as the most important factor in clinical decision-making. Among the periodontists/oral surgeons, the most popular methods to assess periodontal tissues were: 3D radiological examination, the visual method, and gingival transparency with the use of a periodontal probe. On the other hand, the surveyed orthodontists preferred the visual method, followed by 2D radiological examination, and then by 3D radiological examination. The majority of surveyed periodontists/oral surgeons and orthodontists agreed that the ideal timing of soft tissue augmentation in patients undertaking orthodontic treatment should be decided on a case-by-case basis, with planned tooth movement being the determining factor.

Enhancing Interpretability in Medical Image Classification by Integrating Formal Concept Analysis with Convolutional Neural Networks.

In this study, we present a novel approach to enhancing the interpretability of medical image classification by integrating formal concept analysis (FCA) with convolutional neural networks (CNNs). While CNNs are increasingly applied in medical diagnoses, understanding their decision-making remains a challenge. Although visualization techniques like saliency maps offer insights into CNNs' decision-making for individual images, they do not explicitly establish a relationship between the high-level features learned by CNNs and the class labels across entire dataset. To bridge this gap, we leverage the FCA framework as an image classification model, presenting a novel method for understanding the relationship between abstract features and class labels in medical imaging. Building on our previous work, which applied this method to the MNIST handwritten image dataset and demonstrated that the performance is comparable to CNNs, we extend our approach and evaluation to histopathological image datasets, including Warwick-QU and BreakHIS. Our results show that the FCA-based classifier offers comparable accuracy to deep neural classifiers while providing transparency into the classification process, an important factor in clinical decision-making.

Clinical and systems of care factors contributing to individual patient decision-making for early mobilization post-stroke

IntroductionMany stroke guidelines recommend against starting intensive out-of-bed activity (mobilization) within 24 h post-stroke. Few guidelines address care after the first 24–48 h, and little information is provided about how early mobilization decisions should be tailored to patients. We aimed to identify clinical and systems of care factors contributing to individual patient decision-making for early mobilization post-stroke.MethodsExpert stroke clinicians were recruited to participate in an interactive one-on-one session that included an introductory semi-structured interview followed by an assisted data exploration session using an early mobilization data visualization tool.ResultsThirty expert stroke clinicians with a median (interquartile range) 14 (10–25) years of experience were included. Stroke type and severity, and medical stability were identified as important clinical decision-making factors by the majority of expert stroke clinicians. Inadequate staffing and equipment were frequently indicated as barriers to early mobilization. The perceived characteristics of early mobilization responders were mild or moderate stroke severity, ischemic stroke, partial anterior circulation stroke, younger age, and one or fewer comorbidities. Perceived characteristics of early mobilization non-responders included severe stroke severity, hemorrhagic stroke, total anterior circulation stroke, older age, those with persistent vessel occlusion or high-grade stenosis, hemodynamic instability, multimorbidity and an altered state of consciousness. Some characteristics led to uncertainty amongst interviewees e.g., early mobilization decision-making were moderate stroke severity, older patients, and those with lacunar circulation infarcts.DiscussionWe gained unique, in-depth insights into patient and systems of care factors that contribute to individual patient decision-making related to early mobilization post-stroke. The identified areas would benefit from further empirical research to develop structured decision support for clinicians.

Value of Proximal Femur Geometry in Predicting Occult Hip Fracture.

Background and Objectives: Patients with occult hip fractures are a difficult subgroup to treat. MRI is the gold standard for diagnosing occult proximal femur fractures but is costly and may not be readily available in an emergency setting. The purpose of this study was to determine whether changes in the proximal femur geometry can predict the likelihood of an occult hip fracture in patients presenting with hip pain following a ground-level fall. Material and Methods: Patients admitted to the hospital with a clinical suspicion of a hip fracture but initial negative radiographs over a seven-year period were included. All patients were additionally investigated with an MRI scan, and retrospectively, six radiologic parameters were obtained on plain radiographs: The cortical thickness index (CTI), the canal to calcar ratio (CCR), the canal flare index (CFI), the morphological cortical index (MCI), the canal bone ratio (CBR) and the canal bone aria ratio (CBAR). Subsequently the result of the plain radiographic indices of the patients with a negative MRI (Group A, no occult fracture) were compared to those with a positive MRI (Group B, occult fracture). Results: A total of 78 patients (59 female, 19 male) could be included in the study. The mean age was 82 years. The univariate analyses revealed a poor predictive ability of all radiological parameters with AUC values ranging from 0.515 (CBR) to 0.626 (CTI), whereas a multivariate prognostic model demonstrated improved prognosis (AUC = 0.761) for the CTI (p = 0.024), CBAR (p = 0.074) and CRR (p = 0.081) as the most promising predictive radiological parameters. Conclusions: Single radiologic indices obtained from conventional X-rays of the proximal femur have a weak predictive value in detecting occult fractures of the hip and cannot be used as clinical decision-making factors.

Prognostic Factor Risk Groups for Clinical Stage I Seminoma: An Individual Patient Data Analysis by the European Association of Urology Testicular Cancer Guidelines Panel and Guidelines Office

BackgroundThe relapse rate in patients with clinical stage I (CSI) seminomatous germ cell tumor of the testis (SGCTT) who were undergoing surveillance after radical orchidectomy is 4–30%, depending on tumor size and rete testis invasion (RTI). However, the level of evidence supporting the use of both risk factors in clinical decision-making is low. ObjectiveWe aimed to identify the most important prognostic factors for relapse in CSI SGCTT patients. Design, setting, and participantsIndividual patient data for 1016 CSI SGCTT patients diagnosed between 1994 and 2019 with normal postorchidectomy serum tumor marker levels and undergoing surveillance were collected from nine institutions. Outcome measurements and statistical analysisMultivariable Cox proportional hazard regression models were fit to identify the most important prognostic factors. The primary endpoint was the time to first relapse by imaging and/or markers. Relapse probabilities were estimated by the Kaplan-Meier method. Results and limitationsAfter a median follow-up of 7.7 yr, 149 (14.7%) patients had relapsed. Categorical tumor size (≤2, >2–5, and >5 cm), presence of RTI, and lymphovascular invasion were used to form three risk groups: low (56.4%), intermediate (41.3%), and high (2.3%) risks with 5-yr cumulative relapse probabilities of 8%, 20%, and 44%, respectively. The model outperformed the currently used model with tumor size ≤4 versus >4 cm and presence of RTI (Harrell’s C index 0.65 vs 0.61). The low- and intermediate-risk groups were validated successfully in an independent cohort of 285 patients. ConclusionsThe risk of relapse after radical orchidectomy in CSI SGCTT patients under surveillance is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse. Patient summaryThe risk of relapse after radical orchidectomy in patients with clinical stage I seminomatous germ cell tumor of the testis is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse.

Nonextraction Orthodontic Treatment of Severely Impacted Maxillary Canines through Transalveolar Transplantation in a 10-Year-Old Patient: A Case Report with a 6-Year Follow-Up Period

Objective: This case report describes the interdisciplinary treatment of a 10-year-old girl with asymmetric Class III malocclusion, severe maxillary crowding, and bilaterally impacted maxillary canines. Clinical considerations: The clinical decision-making factors regarding treatment alternatives and the final treatment plan are discussed. A two-phase nonextraction therapy was implemented to relieve severe crowding, eliminate the maxillary canine impactions, and compensate for skeletal Class III malocclusion. The first treatment phase involved aligning the left canine through conventional orthodontic traction, while the more deeply horizontally impacted right canine was corrected through transalveolar transplantation. In the second phase, the Class III dental relationship was corrected through mandibular molar retraction. The effective use of various temporary skeletal anchorage devices such as modified c-palatal plates and mini-implants was illustrated. Conclusions: At the end of the treatment, esthetic dental alignment was achieved, along with improved facial balance. The transplanted maxillary right canine showed good health and a favorable long-term prognosis over six years after the procedure.

Impact of comorbidities on outcomes in patients with advanced head and neck cancer undergoing immunotherapy.

To explore the impact of pre-existing comorbidities on immunotherapy response, overall and progression-free survival, and immune-related adverse events (irAEs) of patients with advanced head and neck cancer (HNC) treated with immunotherapy. Ninety-three patients treated with immunotherapy were identified and stratified into comorbidity absent or present (CCI < 1 and CCI ≥ 1, respectively) cohorts, and clinical outcomes were compared between these two groups. Patients with no comorbidities had longer overall survival (aHR = 2.74, 95% CI [1.18, 6.40], p = 0.02) and progression-free survival (aHR = 2.07, 95% CI [1.03, 4.16], p = 0.04) and a higher tumor response rate (32% in CCI < 1 vs. 14% in CC ≥ 1, p = 0.05). Risk for irAEs was higher in the comorbidity absent group (p = 0.05). Comorbidity should be considered as a significant prognostic factor in clinical decision-making for patients with advanced HNC undergoing immunotherapy.

Understanding factors influencing primary treatment with intradetrusor onabotulinumtoxinA versus augmentation cystoplasty in patients with spina bifida.

Surgical interventions in the urologic management of children with neurogenic bladder secondary to spina bifida aim to preserve upper tract function, prevent urinary tract infections, and optimize quality of life. However, since the introduction of intravesical onabotulinumtoxinA (Botox) in the management of these patients, the indications for choosing Botox over augmentation cystoplasty (AC) remain undefined. The objective of this study was to determine which factors lead patients to undergo Botox versus AC as a primary surgical treatment after failing medical management. We retrospectively reviewed the records of pediatric patients with myelomeningocele undergoing either primary Botox or primary AC at our institution between 2013 and 2018. We recorded demographic and clinical information. We identified 10 important clinical decision-making factors: bladder trabeculation, vesicoureteral reflux, or hydronephrosis on imaging; end-filling pressure (EFP) ≥40 cm H2O, detrusor overactivity, detrusor-sphincter dyssynergia, or reduced capacity on urodynamic studies; physician-perceived bladder hostility; and patient/family desire for continence and independence. The presence of these factors was compared between patients undergoing either primary Botox or primary AC. We identified 14 and 50 myelomeningocele patients who underwent primary AC and primary Botox, respectively. We found no significant differences in age, sex, race, or history of reconstructive surgery (antegrade continence enema or catheterizable channel). For the 10 decision-making factors, desire for independence/continence (p = <0.001) and reduced capacity (p = 0.002) were significantly associated with AC, while trabeculation (p = 0.006), EFP ≥40 cm H2O (p = 0.029), rising slope (p = 0.019), and physician-perceived hostility (p = 0.012) were significantly more common with Botox. At our institution, quality of life measures prompted AC over objective urodynamic or imaging findings before attempting Botox. These findings support a shared decision-making approach when considering surgical intervention for neurogenic bladder secondary to myelomeningocele.

Clinical Indicators to Determine the Timing of Surgery for Adhesive Small Bowel Obstruction.

Decompression of the intestine with a long tube or nasogastric tube is the first-choice treatment for adhesive small bowel obstruction (ASBO). Scheduling surgery while weighing the risks of surgery against conservative care is a crucial factor in clinical decision-making. Whenever feasible, unnecessary surgeries should be avoided, and it is essential to provide clinical markers for this. This study aimed to obtain evidence regarding the optimal timing of ASBO and when conservative treatment options are not successful. The data of patients diagnosed with ASBO and receiving long tube insertion for more than 7days were reviewed. We investigated transit ileal drainage volume and recurrence. The primary outcomes were the change in the drainage volume from the long tube over time and the percentage of patients who required surgery. We evaluated some cutoff values to determine the indication for surgery based on the insertion duration and volume of long tube drainage. Ninety-nine patients were enrolled in this study. Fifty-one patients showed improvement with conservative treatment, whereas 48 ultimately required surgery. When a daily drainage volume of ≥500mL was considered an indication for surgery, 13-37 cases (25%-72%) would be judged unnecessary within 6days of long tube insertion, while 5 cases (9.8%) would be judged unnecessary on day 7. Unnecessary surgical interventions for ASBO might be avoided by assessing the drainage volume on day 7 after inserting a long tube.

European Association of Urology (EAU) Testicular Cancer Guidelines Panel: A new prognostic factor risk group classification for patients with clinical stage 1 seminoma in active surveillance.

410 Background: Between 4%- 30% of patients with clinical stage 1 (CS I) seminoma testis (ST) in active surveillance (AS) relapse depending on pathological risk factors tumor size (TS) and rete testis invasion (RTI). The level of evidence supporting these pathological risk factors in clinical decision-making is low due to heterogeneous study design and reporting and the difficulty to analyze patient subgroups according to combination of these factors. The objectives of the present study were to identify the most important pathological prognostic factors predicting relapse in CS I seminoma patients with normal post-orchidectomy serum tumor marker (STM) levels in AS and to construct risk-groups for guiding treatment decision-making and follow-up. Methods: Individual patient data from 1016 CS I-ST patients diagnosed between February 1994 and January 2019 in AS were collected from 9 institutions. Central pathology review was not routinely performed in all institutions; therefore, pagetoid and stromal RTI were not differentiated explicitly in most cases. Assessing patient age, pre-orchidectomy STM b-human chorionic gonadotropin and lactate dehydrogenase, pathological TS, RTI, lympho-vascular invasion (LVI), multi-focality, and GCNIS, multivariable Cox proportional hazards regression models were fit to identify the most important prognostic factors for the time to first relapse by imaging and/or markers (primary endpoint). Probabilities of relapse were estimated using Kaplan-Meier curves. Results: After median follow-up of 7.7 years, 149 (14.7%) patients relapsed, 104 identified by imaging alone, 44 by imaging with elevated STMs and 1 by elevated STMs alone. Excluding 18 patients with unknown LVI from the multivariable analyses, TS (≤ 2 cm, between 2 and 5 cm, &gt; 5 cm), presence of RTI and presence of LVI were used to form three risk groups: very low, low and high-risk (Table). Five-years probability of relapse varied from 8% in the very low risk-group to 44% in the high risk-group. The new model outperformed the current model with TS &lt; 4cm vs ≥ 4 and RTI (Harrell's C index 0.65 vs 0.61) and identifies a subgroup of patients with a higher risk of relapse. Conclusions: The new risk-group stratification for CS I -ST patients in AS outperforms the histopathological model based on TS and RTI. It will serve to better inform patients on the risk of relapse during follow-up after orchidectomy but requires an independent validation. [Table: see text]

Real Check RIO: A Real-World Analysis of Nivolumab in First Line Metastatic Melanoma Assessing Efficacy, Safety and Predictive Factors.

We performed a retrospective study on 51 metastatic melanoma patients treated with Nivolumab in first line, at the Regional Institute of Oncology (RIO) Iasi, Romania between April 2017 and December 2019. We studied the efficacy and safety of anti-PD-1 immune checkpoint inhibitor therapy on a treatment-naive population. After a median follow-up of 36 months, the median progression free survival (PFS) was 26 months (95% CI, 15-36) and the median overall survival (OS) was 31 months (95% CI, 20.1-41.8). At 12 months after the initiation of immunotherapy, the percentage of patients alive was 70%, and at 24 months 62.5%. The most common adverse events observed were dermatological (23.5%) and grade ≥3 was identified in 4 (6.8%) patients. Multivariate analysis indicated that the presence of liver metastases (HR 4.42; 95% CI: 1.88-10.4, p = 0.001) and a neutrophils/lymphocytes ratio (NLR) were associated with poor survival (HR 3.21; 95% CI: 1.04-9.87, p = 0.04). Although retrospective data on a small group of patients were analyzed, we can conclude that our results in RIO are similar to those described in clinical trials and other real-world studies. Our study highlights the potential usefulness of liver metastases and NLR as novel predictive factors in clinical decision-making.

Predictors of one year pressure injury outcomes in hospitalized spinal cord injured veterans with one stage 3 or 4 pressure injury

Objective The purpose of this study is to investigate predictors of pressure injury (PrI) outcomes at one year after discharge for Veterans with spinal cord injury (SCI) hospitalized with a Stage 3 or 4 PrI. Design/Setting/Participants This is a retrospective medical record review from one VA Health Care System SCI unit. Participants were Veterans with traumatic or non-traumatic SCI admitted with one Stage 3 or 4 pelvic PrI treated medically (e.g. without flap surgery). Logistic models were used to select the significant predictors of PrI healing outcomes. Outcome Measure One year after discharge wound outcomes (healed vs non-healed) for Veterans with SCI hospitalized with a Stage 3 or 4 PrI. Results A total of 62 hospitalizations were included for analyses resulting in 33 healed and 29 non-healed PrIs. Three significant predictors of non-healed PrI outcomes included use of pressure mapping during hospitalization, greater PrI depth, and usage of alginate dressings. Two significant predictors of healed PrI outcomes included the use of animal-based tissue and hydrocolloid dressings. Area under curve of this logistic regression model was 79.98%. Conclusion The clinical decision of having a patient pressure mapped predicts that the PrI may not heal at one year of discharge. Pressure mapping protocol correlated with another variable that could not serve as a predictor by itself, including using powered pressure relief techniques. The three PrI treatment predictors may represent characteristics of the PrI itself, rather than the efficacy of the product. Further investigation on these clinical decision-making factors is warranted to ensure efficient and cost-effective treatment strategies for individuals with SCI hospitalized with PrIs.

Predictors of One Year Pressure Injury Outcomes in Hospitalized Spinal Cord Injured Veterans

<h3>Research Objectives</h3> To investigate predictors of wound outcomes at 1 year of discharge of Veterans with spinal cord injury (SCI) hospitalized with one stage 3 or 4 pelvic pressure injury (PI). <h3>Design</h3> Retrospective medical record review between 1/1/2013-12/31/2018. <h3>Setting</h3> VA North Texas HealthCare System SCI unit. <h3>Participants</h3> Veterans with SCI admitted with one stage 3 or 4 pelvic PI. Traumatic and atraumatic SCI patients treated medically without flap surgery were included. <h3>Interventions</h3> Wound care. <h3>Main Outcome Measures</h3> Wound status at one year of discharge. A logistic model was built to select the significant predictors of wound healing outcomes. The area under the curve (AUC) was calculated using the leave-one-out cross validation method. P< 0.05 was considered statistically significant. <h3>Results</h3> A total of 62 hospitalizations were included for analyses: 33 healed, and 29 non-healed wounds. Three significant predictors of non-healed wound outcomes include: pressure mapping protocol during hospitalization, wound depth, and usage of alginates dressings. Two significant predictors of healed wound outcomes include: animal-based tissue and hydrocolloid dressings. The AUC of this logistic regression model is 79.98%. <h3>Conclusions</h3> The five wound outcome predictors are the depth of the wound, and clinical decision-making factors regarding seating and wound treatments. Pressure mapping protocol correlated with other variables that could not serve as a predictor by themselves including higher neurological level of injury and lack of manual pressure relief techniques. The clinical decision having a patient pressure mapped predicts that the wound may not heal at one year of discharge. The three wound treatment product predictors may represent characteristics of the wound. Further investigation on these clinical decision-making factors is warranted in utilizing treatment and healthcare recourses for SCI individuals hospitalized with PI. <h3>Author(s) Disclosures</h3> N/A.

Splenic embolisation practices within the UK: a national survey

•There is wide variability in the selection and technique of splenic embolisation. •There is a lack of clear evidence and guidelines on the use of splenic embolisation. •Urgent investment in the provision of 24/7 IR services is still required. AIM To review UK splenic embolisation (SE) practices for traumatic injury. MATERIALS AND METHODS An online survey approved by the British Society of Interventional Radiology (BSIR) Audit and Registry Committee was distributed to BSIR members between 15/11/2021–29/11/2021. Data obtained included the interventional radiology (IR) trauma service response, service design, institutional treatment pathways, and key clinical decision-making factors. Descriptive statistics were carried using Microsoft Excel. RESULTS A total of 62 responses, of which 61.29% (n=38) worked at a major trauma centre (MTC); 70.97% (n=44) had an interventional radiologist on-call 24/7; 77.42% (n=48) had no direct involvement with the trauma team until an eligible case was identified with only 19.35% (n=12) being part of the acute receiving trauma team; 88.71% (n=55) did not have a standard imaging pathway for conservatively managed splenic injury in their institution. In terms of the proportion of respondents considering embolisation based on severity of splenic injury, 51% (n=32) would embolise grade 5 injuries, 66% (n=41) for grade 4, 54% (n=34) for grade 3, and 12.9% (n=8) for grade 2. CONCLUSION Wide variability exists in the SE practice and decision-making within the UK IR community. A UK consensus on management of traumatic splenic injuries is required; however, an improved evidence base is essential to support these guidelines. To review UK splenic embolisation (SE) practices for traumatic injury. An online survey approved by the British Society of Interventional Radiology (BSIR) Audit and Registry Committee was distributed to BSIR members between 15/11/2021–29/11/2021. Data obtained included the interventional radiology (IR) trauma service response, service design, institutional treatment pathways, and key clinical decision-making factors. Descriptive statistics were carried using Microsoft Excel. A total of 62 responses, of which 61.29% (n=38) worked at a major trauma centre (MTC); 70.97% (n=44) had an interventional radiologist on-call 24/7; 77.42% (n=48) had no direct involvement with the trauma team until an eligible case was identified with only 19.35% (n=12) being part of the acute receiving trauma team; 88.71% (n=55) did not have a standard imaging pathway for conservatively managed splenic injury in their institution. In terms of the proportion of respondents considering embolisation based on severity of splenic injury, 51% (n=32) would embolise grade 5 injuries, 66% (n=41) for grade 4, 54% (n=34) for grade 3, and 12.9% (n=8) for grade 2. Wide variability exists in the SE practice and decision-making within the UK IR community. A UK consensus on management of traumatic splenic injuries is required; however, an improved evidence base is essential to support these guidelines.

Financial concerns of people enrolled in the CAFÉ cancer financial navigation trial.

172 Background: CAFÉ is a three-arm randomized controlled trial testing whether financial navigation for people with cancer improves quality of life and financial distress compared to enhanced usual care at two integrated health systems (Kaiser Permanente Washington, KPWA; and Kaiser Permanente Northwest, KPNW). Our current objective was to describe financial concerns reported by a subset of participants enrolled and receiving financial navigation in the trial. Methods: We descriptively summarized the financial concerns in participants randomized to receive financial navigation between August 2021 and May 2022 (Total n = 135; KPWA = 75 and KPNW = 60). Participants received either one or three proactive outreach with financial concerns assessment plus any participant-initiated assessment. Navigators followed up with personalized liaison and warm handoff to resources and coordinated with oncology care team and organizational partners about participant cost concerns. We used the study’s bespoke REDCap database, including participant sociodemographic and clinical characteristics and discrete notes entered by CAFE financial navigators. During financial concerns assessments, CAFE navigators recorded the type of each concern: planning and budgeting; care decision-making; or acute financial needs; resource referrals provided; and time to concern resolution. Results: The sample was 36% male; mean age 61 years; and 62% married or living with a partner. Self-reported race/ethnicity was 9% Black, 15% other, and 76% White; 6% reported Hispanic/Latino ethnicity. 43% reported less than four-year college education. Cancer types were 38% breast; 16% prostate; 6% colorectal; 4% lung; and 36% other types. 5% had Medicaid and 44% Medicare. 58% reported &lt; $75,000 total family income in 2021. 16% were enrolled in the KP medical financial assistance (MFA) program. Navigators documented 179 assessments. Number of concerns/participant ranged from zero to 5 (mean = 1.3 concerns/participant). Participants reported a financial concern at 61% of assessments. The most common concern was planning/budgeting (68%), followed by acute financial needs (28%) and care decision-making (3%). Mean time-to-resolution was 22 days (planning/budgeting); 27 days (acute needs) and 33 days (clinical decision-making). The most common resource referrals included the KP MFA (77 times); coordination with KP member services (73 times) (e.g., for cost estimates), community resource navigators (35 times) and nurse navigators (25), and patient financial services (i.e. billing, 10). Conclusions: Proactive assessment by oncology financial navigators identifies financial concerns related to planning for cancer care expenses and acute financial needs. Concerns related to financial hardship as a factor in clinical decision-making were rare. Resource referrals varied by concern type, with time-to-resolution ranging from 22-33 days. Clinical trial information: NCT05018000.

Failure of Regenerative Endodontic Procedures: Case Analysis and Subsequent Treatment Options

IntroductionRegenerative endodontic procedures (REPs) are considered effective treatments for immature necrotic permanent teeth, with favorable outcomes. However, failed cases require subsequent treatment. This study aimed to review and analyze failed cases after REPs and suggest a treatment algorithm to aid clinical decision-making. MethodsA total of 111 REP cases were selected that were conducted between 2015 and 2020. Clinical outcomes were assessed based on clinical and radiographic evaluations. The criteria for failure included persistence of clinical signs or symptoms and/or periapical radiolucency showing persistent apical periodontitis. Cases requiring any treatment intervention, including extraction, were also considered failures. ResultsSixteen cases were included as failures. The etiology of pulpal disease was stratified into dental trauma (56%), dens evaginatus (25%), and dental caries (12.5%), with the remaining one case having an undocumented cause. The primary reasons for treatment failure were persistent infection (81.3%) and root resorption (18.7%). The identification time of failure varied, with 6 cases (37.5%) detected in less than 6 months and 10 cases (62.5%) later than 6 months after REPs. Sixteen failed cases received 5 different interventions: second REPs, apexification, conventional root canal treatment, surgical approach, and extraction. ConclusionsInterventions for failed REPs are challenging. Consideration of the treatability of the tooth, accessibility to the canal, and the presence of an apical seat might be key factors in clinical decision-making to obtain a successful outcome.