General Clinical Practice Research Articles

Primary otomycosis: Assessment of risk factors and identification of fungal agents – A tertiary care hospital experience

Background: Primary otomycosis is one of the common conditions seen in general clinical practices. Although non-fatal, inappropriate management of this condition may lead to serious complications. Aims and Objectives: A cross-sectional study was conducted in our tertiary care hospital to determine the fungal agents in primary otomycosis and its associated risk factors. Materials and Methods: A total of 62 consecutive patients of more than 18 years of age with clinical diagnosis of otomycosis were included in this study. Samples were collected and processed and the fungal isolate was identified. The predisposing factors, fungal isolate, and demographical profile of the patients were analyzed. Results: About 61.29% were males and 38.71% were females. Majority of the patients were in the age group of 18–30 years (62.90%). The most common associated risk factor was habitual self-cleaning (50%), followed by oil instillation (30.65%). Itching (75.81%) was the most common symptom followed by ear discharge (45.16%). About 79.03% of our fungal isolates were Aspergillus species, Aspergillus niger being the most common (58.06 %). About 12.90% of our isolates were Candida species. About 63.27% of Aspergillus isolates was associated with habitual self-cleaning and 62.50% of Candida isolates was isolated with the instillation of oil. About 66.67% of Penicillium species and 100% of Rhizopus species are associated with inappropriate use of topical antibiotics. Conclusion: Health education of the community along with knowledge of common fungal agents causing otomycosis and its associated risk factor will help in reducing the incidence of otomycosis, which along with proper management will prevent further complications.

Minimally Invasive Endoscopic Interventions in the Treatment for Traumatic Intracranial Hematomas

Traumatic brain injuries are a global problem, with more than 50 million people suffering from brain injuries every year. A frequent consequence of severe traumatic brain injury is intracranial hematoma (ICH), causing mortality, disability, post-traumatic epilepsy. ICH has different clinical manifestations and physical characteristics. Standard treatment for ICH includes conservative monitoring for small volume hematomas or surgical evacuation of the hematoma. Craniotomy is often used to remove hematomas, because acute and subacute hematomas contain clots, and drainage of the hematoma cavity alone is not enough. In chronic hematomas, drainage through a hole is usually used, but this is effective only if the hematoma is represented by one cavity and its contents are completely liquid, which is not always the case. Thus, widely used techniques do not always meet modern requirements for effectiveness and low invasiveness of surgical treatment.The review considers endoscopic methods of surgical treatment for all variants of traumatic ICH; 31 publications have been found on this topic, mentioning 602 interventions. Differences in patient selection criteria make it difficult to compare the methods and outcomes. From the technical point of view, the procedures were also very diverse. The article analyzes the main features of different authors’ methods.None of the authors comes to the conclusion about outcome worsening after endoscopic intervention. With regard to acute and subacute hematomas, there are currently no reliable statistical data, but the results obtained can generally be assessed as positive.In acute and subacute hematomas, endoscopic intervention is perceived by the authors not as providing more opportunities, but only as a less invasive replacement for conventional craniotomy. In chronic hematomas, endoscopic intervention is considered to have more opportunities and advantages over the standard treatment.At present, the widespread use of endoscopic minimally invasive methods of surgical treatment for traumatic hematomas is hampered mainly by the lack of clear criteria for selecting patients and well-established methods of intervention. More high-quality research is needed to determine the role of these methods in general clinical practice.

Self-evaluation of Sexual History Taking Skills Among Medical Students in Southern Thailand

Objective: Sexual health is an important issue in a holistic approach in general clinical practice. Inappropriate sexual history taking could lead to improper clinical management. This study aimed to examine perceptions of practice, attitudes toward sexual history taking and their associated factors among final year medical students in southern Thailand. Materials and Methods: This cross-sectional survey was conducted between September and October 2022, using a self-reported questionnaire via Google forms. The self-reported questionnaire consisted of questions related to the practice and attitude toward sexual history taking (α = 0.90 and 0.71, respectively), as well as perceptions of the undergraduate medical training on taking a sexual history (α = 0.91). Descriptive data analysis and multiple logistic regression was conducted by using Program R. Results: Of 91 participants, most were male and Buddhist (54.9% and 87.9%). In general, most medical students rated their proficiency in sexual history taking skills as fair-to-good across all aspects. The majority showed a positive attitude toward sexual history taking (68.1%) and reported that contraception was the main reason that they usually have such discussions with female patients (36.3%), while the prevention of sexual transmitted diseases (STDs) was the most common issue during annual examinations, and when with patients with suspected STDs (27.5% and 49.5%). Male medical students and those who perceived good-to-very good knowledge and well-to very well-trained skills of sexual history taking were significantly associated with more regular sexual history taking. [adjusted OR (95%CI) = 4.51(1.19-17.11) and 5.3 (1.51-18.65), respectively] Moreover, students with a good attitude toward sexual history taking were significantly associated with a perceived good-to-very-good training in both history taking and communication skills. Conclusion: Most medical students exhibited a positive attitude toward sexual history taking, and they stated that birth control and STDs symptoms were typically the primary subjects they discussed with patients in general. There was a significant association between being male, a perception of good knowledge and well-trained skills, and a more consistent practice of sexual history taking. Additionally, medical students who displayed a good attitude towards taking sexual history significantly showed a perception that they had received sufficient training in both the areas of history taking and communication skills.

Repeated laparoscopy is at complication after gynaecological endoscopic operations

The objective. To analyze the results of repeated laparoscopy for patients of gynecological type with suspicion of intra-abdominal postoperative complications. Materials and methods. 42 patients (middle age - 46±11,3 years) with postoperative abdominal complications after surgical treatment of different gynecological diseases needed repeated operations took part in the research. Depending on the method of the repeated interference patients are up-diffused into 2 groups: basic (n=20) are women for the correction of postoperative complications laparoscopy only; control (n=22) are women in which for the correction of postoperative complications during diagnostic laparoscopy there were the proposed testimonies to relaparotomy. In 8 patients of the control group relaparotomy is executed at once. A complex inspection was conducted on all patients with the application of clinical, instrumental, and laboratory methods of research. Groups were homogeneous in age and by the structure of operations, executed on the organs of the small pelvis, and statistically comparative. Results. During research, the analyzed results of repeated laparoscopy of 34 patients of gynecological type are suspicion of intra-abdominal postoperative complications. For all patients of the basic group (47,6%) laparoscopy appeared the unique and eventual method of treatment of postoperative complications, in 7 women repeated реlaparoscopy was used from 2 to 4 times, and in 13 laparoscopies it was conducted singly. In the group control (52,3%) 10 patients during diagnostic laparoscopy were exposure to testimony to relaparotomy, 4 patients of the possibility of an operating brigade and laparoscopic technique allowed to execute some elements of operation and complete mini-laparotomy access, and 8 patients relaparotomy is executed at once. Peritonitis and intra-abdominal bleeding predominate in the structure of early abdominal complications. Application of videolaparoscopic method allowed in 28,6% patients with the poured out peritonitis successfully to liquidate the developed complication, remove his source and conduct санацію of abdominal region. Laparoscopic hemostasis is successfully executed in 7 patients. By comparison to standard, the use of videoendoscopic method allowed to improve the indexes of diagnostic value: to increase the level of sensitiveness in 1,07 times, in 1,39 times of specificity and in 1,11 times of exactness of diagnostics. Conclusion. On the whole in an early postoperative period concerning the suspected complications it is executed 47 реlaparoscopy, that is explained by the leadthrough of programmable sanation of abdominal region by application of dynamic laparoscopy for control of motion of intra-abdominal complication. On the basis of analysis of the investigated material we are offer general testimonies and contra-indications to the leadthrough of реlaparoscopy in an early postoperative period with the purpose of diagnostics and treatment of postoperative complications. Substantiating each of points, we followed the real possibilities of method in general clinical practice, which in the row of cases act after the efficiency of relaparotomy.

Is Capitate Shift Reliable as a Single Indicator for Failure of Non-operative Management in Distal Radius Fractures?

Background Distal radius fractures (DRFs) are the most commonly treated fracture; however, their treatment remains controversial. There is significant variation in the rate of surgical intervention related to a lack of consensus regarding the displacement threshold for surgery. Although studies have advocated that carpal malalignment is the most important radiographic parameter for surgical correction, it is rarely considered in general clinical practice and remains poorly studied. Recently, capitate shift was identified as the most useful measure of carpal malalignment, and a capitate shift threshold of -5.98 mm was proposed to indicate surgical intervention. This study aimed to investigate if this threshold is associated with the failure of non-operatively managed DRFs and should be used as a threshold for primary surgical intervention. Methodology A retrospective analysis was performed of all adult patients who underwent closed manipulation and cast immobilisation for DRFs in a UK district general hospital between September 2021 and February 2022. Capitate shift was measured on initial post-casting radiographs using the validated capitate-to-axis-of-radius distance (CARD) by a junior surgeon. The outcome measure was the failure of conservative management, which was defined as the need for repeat intervention (i.e., cast reapplication or surgical fixation) following closed reduction and cast immobilisation. Results A total of 64 patients with 65 DRFs (16 (25%) male, 49 (75%) female) were included in the study. The mean age was 66.6 years (SD = 17.9, 95% CI = 62.2 to 70.9). The mean capitate shift was -1.51 mm (SD = 5.05, 95% CI = -0.28 to -2.73) in all cases (n = 65). The failure rate of DRFs with an 'unacceptable' capitate shift (i.e., equal or less than -5.98 mm) compared to those with an 'acceptable' capitate shift (i.e., greater than -5.98 mm) was 16.7% versus 3.8% (p = 0.09). Conclusions The study concluded that there was no significant association between a capitate shift threshold of -5.98 mm and failure of non-operatively managed DRFs. Given the ease of use and reliability of capitate shift, we advocate for multicentre large cohort studies to identify a threshold for surgical intervention and establish its association with functional outcomes.

Exploration of the pulse pileup effects in a clinical CdTe-based photon-counting computed tomography.

High tube current generates a high flux of x-rays to photon counting detectors (PCDs) that can potentially result in the piling up of pulses formed by concurrent photons, which can cause count loss and energy resolution degradation. To evaluate the performance of clinical photon-counting CT (PCCT) systems in high flux, potentially influenced by pulse pileup effects, in terms of task-generic image quality metrics. A clinical phantom was scanned on a commercial PCCT scanner (NAEOTOM Alpha, Siemens) at 120kV under fourteen different tube current levels (40-1000mA) with a rotation time of 0.25 s and a pitch of 1. The dose levels corresponded to CTDIvol (32cm phantom) of 0.79-19.8mGy. CT sinograms were reconstructed using QIR-off mode (noniterative reconstruction algorithm), Br44 kernel, and a voxel size of . imQuest, an open-source MATLAB-based software package was used to calculate noise power spectrum (NPS), task transfer function (TTF), contrast-to-noise ratio (CNR), and CT number according to AAPM Task Group 233 metrology. The 50% cut-off frequency of TTF (f50 ) remained mostly constant across all higher tube currents for all inserts, namely polyethylene, bone, air, and acrylic. Using the lowest two data points (40 and 80mA), the expected relationship between noise magnitude and tube current was determined to be noise mA-0.47 . The measured noise magnitude were up to 11.1% higher than the expected value at the highest tube current. The average frequency of NPS (fav ) decreased from 0.32 to 0.29mm-1 as tube current increased from 40 to 1000mA. No considerable effects were observed in CT number measurement of any insert; however, CT numbers for air and bone changed almost monotonically as tube current increased. Absolute CNR increased monotonically for all inserts; however, the difference between measured and expected CNRs were approximately -6% to 12% across all tube currents. Increasing tube currents did not affect the spatial resolution, but slightly affected the CT number and noise measurements of the clinical PCCT system. However, the effects were only considerable at clinically irrelevant tube currents used on a small 20-cm phantom. In general clinical practices, automatic exposure control techniques are used to decrease the variation of flux on the detector, which alleviates the chances of detector saturation due to high count rates. The observed effects could be due to pulse pileup, signal-dependent filtration of the system, or nonlinearities in the reconstruction algorithm. In conclusion, either the deadtime of the detector used in the photon-counting CT system is shorter such that count losses due to pulse pileup are negligible, or pulse pileup has inconsiderable effects on the image quality of clinical photon-counting CT systems in routine clinical practice due to possible corrections applied on the system.

HEALTH CARE TECHNOLOGIES IN CREATING OPTIMAL WORKING CONDITIONS IN HIGHER EDUCATION INSTITUTIONS

Neck-shoulder syndrome is a real problem in general clinical practice, manifested by pain, reflex myotonic symptoms in the cervical spine and upper limbs. The goal of our research was a comprehensive study of the clinical and instrumental aspects of the neck-shoulder syndrome for the development of a preventive program and rehabilitation tactics. Materials and methods. We examined 103 people aged 18 to 50 years with clinical manifestations of reflex syndromes of cervical osteochondrosis in the form of cervicocranial pains, who underwent outpatient examination on the basis of National University «Yuri Kondratyuk Poltava Polytechnic» and the Skalyansky Clinic. Among them, 84 (78.64%) patients were women, 22 (21.36%) were men. The duration of having the neck-shoulder syndrome was from 1 to 10 years. The analysis of the obtained data revealed a mixed (musculovascular) mechanism of cervicocranial pain, which is a clinical manifestation of reflex syndromes of cervical osteochondrosis in young people. In this regard, it is advisable to include anti-inflammatory drugs (xefokam, denebol, olfen, nimesil, sigan, etc.), muscle relaxants (midokalm, sirdalud), vascular and venotonics (L-lysine escinat, troxevasin, actovegin) in the complex treatment of this category of patients , nicotinic acid preparations, etc.), vegetotropic drugs, as well as drugs that reduce irritative-paroxysmal phenomena and affect the pain syndrome (gabantine, lamotrine), antidepressants (amitriptyline, fluoxetine, etc.), physiotherapeutic methods and physical therapy. Conclusions. Modern diagnostics and a rational approach to treatment will further lead to early rehabilitation of patients and increase the working capacity of young patients with cervicocranial pain on the background of osteochondrosis of the cervical spine.

Making needle procedures comfortable for autistic children: Caregiver perspectives

BackgroundAutistic children are at greater risk for having difficulty undergoing needle procedures and poor management of their needle pain and fear. While there are general clinical practice guidelines (CPGs) available for managing pediatric needle pain and fear, it is unclear whether these strategies are appropriate for autistic children and their caregivers. MethodThe objective of this study was to explore caregiver perspectives on what is needed for needle procedures to be comfortable and CPGs to be appropriate for them and their autistic child. Twenty Canadian caregivers of autistic children were interviewed, including open-ended questions and ratings of how helpful CPG strategies would be for autistic children. ResultsUsing reflexive thematic analysis, four themes were identified: 1) autistic children’s sense of autonomy is important; 2) external factors impact autistic children’s comfort (e.g., environment, familiarity, healthcare providers); 3) caregivers play a key role by preparing themselves and others before needle procedures and 4) it is essential to tailor CPG strategies to children’s needs. ConclusionsFindings indicate that a child and family-centered approach is imperative to making needle procedures comfortable for autistic children. Practical recommendations for healthcare providers and caregivers are provided.

Qualitative exploration of the visual function impairments and impacts on vision-dependent activities of daily living in Retinitis Pigmentosa and Leber Congenital Amaurosis: content validation of the ViSIO-PRO and ViSIO-ObsRO measures

BackgroundRetinitis Pigmentosa (RP) and Leber Congenital Amaurosis (LCA) are rare inherited retinal degenerative disorders. The associated visual impairments have significant impacts on patients’ vision-dependent activities of daily living (ADL), mobility, and distal health-related quality of life (HRQoL). To adequately capture patient and caregiver perspectives in clinical trials, patient and observer-reported outcome instruments must demonstrate sufficient evidence of content validity in the target population. This study aimed to explore the patient experience of RP/LCA and assess the content validity of the Visual Symptom and Impact Outcomes PRO (ViSIO-PRO) and ObsRO (ViSIO-ObsRO) instruments in RP/LCA.MethodsA total of 66 qualitative, combined concept elicitation (CE) and cognitive debriefing (CD) interviews were conducted (33 adults, 10 adolescents, 8 children and 15 caregivers of children) in the US, France, Germany, and Canada. Patients had a clinical and genetic diagnosis of RP/LCA from a range of genotypes. CE results were used to further inform the development of a conceptual model and CD interviews assessed the relevance and understanding of the 44-item ViSIO-PRO and 26-item ViSIO-ObsRO instruments. Interviews were conducted across two iterative rounds to allow item modifications.ResultsFindings were consistent across RP/LCA genotypes. Night blindness, reduced peripheral vision, vision in very bright lighting and light/dark adaptation were the most frequently reported visual function symptoms impacting vision-dependent ADL and mobility. Impacts on distal HRQoL domains were also reported. The ViSIO-PRO and ObsRO items were well understood by participants and relevant across genotypes. The instructions, 7-day recall period and response scales were well understood and endorsed. Participant and expert clinician feedback supported modifications to item wording, the addition of six new ViSIO-PRO items and one new ViSIO-ObsRO item, and the removal of one ViSIO-PRO item due to lack of relevance.ConclusionsFindings support the content validity of the ViSIO-PRO and ViSIO-ObsRO instruments for use across RP/LCA genotypes. Ongoing research to evaluate the psychometric validity of the instruments will support future use of the instruments as efficacy endpoints in clinical trials and in general clinical practice to track disease severity and impact of disease on functioning.

Experience in a Standardized Algorithm for Surgical Treatment of Patients with Mandibular Fractures

Background. In recent decades, new surgical technologies for the treatment of patients with mandibular fractures have been introduced into clinical practice. However, the incidence of complications still remains high, practically not differing from the values 30 years ago. According to the Russian Dental Association, the incidence of complications is 1519%. Probably, the introduction of rules governing the use of new methods of treatment can change the current situation for general clinical practice. Aims to evaluate the effectiveness of the algorithm for the surgical treatment of patients with mandibular fractures, developed on the basis of clinical observations and biomechanical studies, based on significant clinical material. Methods. A retrospective study over a 3-year period of medical records of inpatients with mandibular fractures and their complications was carried out, in the surgical treatment of which, in the conditions of the basic clinic, the surgical algorithm developed by the authors was used. Results. Case histories of 442 patients who met the search criteria were examined. In terms of the composition of the patients included in the study group, it reflects a typical picture for this type of injury, which is typical for domestic clinical practice. The incidence of postoperative complications was 4.1% (of which accompanied by a prolongation of treatment 2% of cases). Conclusion. The results of this work showed that the real percentage of complications in patients with injuries of the lower jaw can be significantly reduced due to strict compliance with the requirements of the algorithm, which was shown by a retrospective analysis of medical records of inpatients over a three-year period, reflecting the results of treatment of a significant number of patients. The data obtained can serve as the basis for appropriate multicenter clinical trials.

GP education posts for research.

Almost every patient and every healthcare condition are seen within primary care, but research is not yet embedded in general practice in the same way it is in secondary care. There is no well-defined pathway for a career combining research delivery and active clinical general practice. In Wessex, we set out to design a career pathway for the clinically active GP that could sustain research involvement throughout their working lifetime and underpin research activity in primary care. A lead for education on research was established, in 2021, to approach relevant organisations for funding, accreditation, and design of educational posts for research delivery in primary care. Health Education England is currently looking to fund additional placements prior to completion of GP training. NIHR CRN Wessex also identified funding for posts after completion of training. The authors worked with the Southampton GP Education Unit who applied for and achieved the first national recognition of 15-month research placements to count towards completion of GP vocational training. A GP career pathway was designed starting with these posts and followed by GP Research fellow posts, which provide ongoing sessional research work at any stage of a clinical GP career. National recognition for education on research has been achieved and a career pathway for GPs to train in and then work in research has been established. This will help embed research expertise and interest within primary care. This should increase research delivery and hence a cycle of increased research funding for further similar posts.

An adjusted Asia-Pacific colorectal screening score system to predict advanced colorectal neoplasia in asymptomatic Chinese patients

PurposeThe Asia-Pacific Colorectal Screening (APCS) score and its derivatives have been used to predict advanced colorectal neoplasia (ACN). However, it remains unknown whether they apply to the current Chinese population in general clinical practice. Therefore, we aimed to update the APCS score system by applying data from two independent asymptomatic populations to predict the risk of ACN in China.MethodsWe developed an adjusted APCS (A-APCS) score by using the data of asymptomatic Chinese patients undergoing colonoscopies from January 2014 to December 2018. Furthermore, we validated this system in another cohort of 812 patients who underwent screening colonoscopy between January and December 2021. The discriminative calibration ability of the A-APCS and APCS scores was comparatively evaluated.ResultsUnivariate and multivariate logistic regression were applied to assess the risk factors for ACN, and an adjusted scoring system of 0 to 6.5 points was schemed according to the results. Utilizing the developed score, 20.2%, 41.2%, and 38.6% of patients in the validation cohort were classified as average, moderate, and high risk, respectively. The corresponding ACN incidence rates were 1.2%, 6.0%, and 11.1%, respectively. In addition, the A-APCS score (c-statistics: 0.68 for the derivation and 0.80 for the validation cohort) showed better discriminative power than using predictors of APCS alone.ConclusionsThe A-APCS score may be simple and useful in clinical applications for predicting ACN risk in China.

BT07 Creation of a skin lesion image pipeline: key steps in developing a mobile application with DICOM® fields and metadata

Abstract A key issue facing artificial intelligence (AI) for dermatology is the lack of standardization around capture, transfer and storage of skin images and clinical data. To assist systematic capture of clinical data, we developed a nationally agreed proposed minimum dataset, based on Digital Imaging and Communications in Medicine (DICOM®) standards. Subsequently, we collaborated with an established image management system (IMS) supplier, Waba [supported by grants from our local National Health Service (NHS) innovation department], to incorporate these fields into a dermatology-specific mobile application (app), facilitating real-time capture and data transfer. We describe our steps in developing this app. The app integrates with the national Patient Administration System (SCI Store), allowing retrieval of real-time patient demographics linked to hospital or Community Health Index number. Each care episode captures a standardized dataset, including lesion views, clinical information and consent level. On episode completion, datasets are securely transferred to the IMS via WiFi or GPRS signal, following a fully auditable pathway. The IMS is a web-based app developed on a Microsoft Structured Query Language server, which allows authenticated users to access our trust’s centralized repository of nonradiological images. Adherence to industry-standard data storage format, patient safety reporting and specific access rights ensure compliance with Caldicott recommendations and data protection standards. For AI research, we are exploring conversion of datasets into DICOM format. Close collaboration between software developers and end users, including clinical photography, dermatology and general practice, was essential for app design. We worked on design architecture through fortnightly technical meetings, scheduled to progress development in months 1–8. Installation and functionality testing was performed in months 9 and 10, followed by comprehensive user testing in months 10–12. Live app test-of-change rollout was performed in months 13–16, with continued usability refinement during this period. To develop a standardized minimum dataset, we conducted a consensus exercise with the British Association of Dermatology AI working group. Based on DICOM standards, a comprehensive international standard for medical imaging, this could improve the quality, availability and interoperability of data for AI development. In summary, we have developed an app to standardize the capture, transmission and storage of skin lesion images and associated metadata. By collaborating with an industry partner with NHS experience, iterative user-led design and national engagement for standard-setting, we believe this is a useful step toward a national UK skin database for training and validating AI systems. Future work is planned to evaluate the output of this data pipeline.

Meta-analysis of the effect of entropy-assisted general anesthesia on the quality of postoperative recovery.

To evaluate the effect of the quality of postoperative anesthetic resuscitation in patients with entropy index monitoring assisted general anesthesia versus standard clinical practice. The randomized controlled trials on the application of entropy index monitoring in general anesthesia were searched in PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang, VIP, and other databases by computer. The data were collected from inception to January 2022. Two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria and used Cochrane's risk-of-bias assessment criteria to evaluate the quality of the literature. The evaluation indicators included respiratory recovery time, extubation time, consciousness recovery time, emergence agitation, postoperative nausea and vomiting (PONV), and intraoperative awareness. The RevMan 5.4.1 software was used for the meta-analysis of the data. A total of 860 patients from 10 eligible randomized controlled trials were included in this study. The results showed that compared with the control group, the respiratory recovery time (MD = -3.37, 95% CI: -5.09 to -1.85, P < .0001), extubation time (MD = -4.57, 95% CI: -6.08 to -3.95, P < .00001), and consciousness recovery time (MD = -4.95, 95% CI: -7.21 to -2.70, P < .00001) in the entropy index group were significantly shortened. The incidence of emergence agitation in the entropy index group (RR = 0.23, 95% CI: 0.11-0.47, P < .0001) decreased significantly. The incidence of PONV (RR = 0.46, 95% CI: 0.27-0.79, P = .004) was significantly reduced. However, the incidence of intraoperative awareness (RR = 0.33, 95% CI: 0.04-3.16, P = .34) wasn't significantly different. The application of the entropy index can improve the recovery quality of patients under general anesthesia, not only shortening the postoperative recovery time but also reducing the occurrence of agitation and PONV. It does not affect the incidence of intraoperative awareness.

O-190 Establishment of non-invasive prediction models for diagnosis of the subtypes and tissue composition of uterine leiomyomas by machine learning using MRI data

Abstract Study question We investigated whether machine learning models using MRI data can predict the subtypes and tissue composition of uterine leiomyomas. Summary answer Our machine learning models using MRI data were able to predict the subtypes and tissue composition of uterine leiomyomas with high accuracy. What is known already Recently, somatic mutations in the Mediator complex subunit 12 (MED12) gene were found to be a biomarker of uterine leiomyomas, which is detected in about 70% of uterine leiomyomas. Uterine leiomyomas are classified into two subtypes with or without the MED12 mutation. These subtypes differ in the ratio of smooth muscle cells and fibroblasts and in the amount of collagen fibers. In addition, sensitivities to female hormones differ between smooth muscle cells and fibroblasts. Thus, the effect of therapeutic drugs (GnRH analogs and selective progesterone receptor modulators) may differ depending on the subtypes and tissue composition of uterine leiomyomas. Study design, size, duration We analyzed 90 uterine leiomyoma nodules (MED12 mutation-positive and negative = 62 and 28) obtained from 51 women who underwent surgery at our hospital between 2020 and 2022. Seventy-one uterine leiomyomas (MED12 mutation-positive and negative = 49 and 22) were assigned to the primary dataset to establish the prediction models. Nineteen uterine leiomyomas (MED12 mutation-positive and negative = 13 and 6) were assigned to the test dataset to validate the prediction model utility. Participants/materials, setting, methods For each leiomyoma, the tumor signal intensity was quantified by five MRI sequences (T2WI, ADC, T1map, T2*BOLD, MTC) for evaluating the collagen amount. After surgery, genotyping of MED12 was examined and Trichrome staining was performed to quantify the collagen amount. Using these results, we established the prediction models based on machine learning by applying support vector classification and logistic regression for subtype prediction, and support vector regression and Ridge regression for tissue composition prediction. Main results and the role of chance The signal intensity of all five MRI sequences differed significantly between the subtypes. The cross-validation within the primary dataset showed that support vector classification and logistic regression models using five MRI sequences and MED12 genotyping data were highly predictive of the subtypes (AUC: 0.984 and 0.995, respectively). The validation using the test dataset showed that both models were able to predict the subtypes for all uterine leiomyomas (AUC: 1.000, both). This result showed higher accuracy than each MRI sequence’s cut-off value alone. On the other hand, four MRI sequence values (other than ADC) showed a significant correlation with the collagen amount. However, to improve accuracy, we added the ADC data and the result of the subtype predicted by the preceding models to the predictors for the collagen amount. Support vector regression and Ridge regression models using five MRI sequences and Trichrome staining data were shown to be highly predictive of the collagen amount in cross-validation within the primary dataset (R2: 0.570 and 0.525, respectively) and in validation using the test dataset (R2: 0.648 and 0.675, respectively). Moreover, the prediction models using only T2WI and ADC, which are taken in general clinical practice, were as accurate as using five MRI sequences. Limitations, reasons for caution In this study, we used limited data by using one specific MRI machine in a single center to establish the prediction models. We have not verified that similar results would be obtained under different conditions. Therefore, further training and evaluation in larger cohorts are required for clinical use. Wider implications of the findings The prediction models established in this study may be useful in clinical support such as predicting the effect of drug therapy and selecting therapeutic drugs, such as GnRH analogs and selective progesterone receptor modulators. Their utilities will be confirmed by validation using our prediction models in studies involving drug therapy. Trial registration number not applicable

Exploring disease interrelationships in older inpatients: a single-centre, retrospective study.

Comorbidity is a common phenomenon in the older population; it causes a heavy burden on societies and individuals. However, the relevant evidence, especially in the southwestern region of China, is insufficient. We aimed to examine current comorbidity characteristics as well as correlations among diseases in individuals aged >60 years. Retrospective study. We included records of 2,995 inpatients treated at the Gerontological Department of Sichuan Geriatric Hospital from January 2018 to February 2022. The patients were divided into groups according to sex and age. Diseases were categorised based on the International Classification of Diseases and their Chinese names. We calculated the age-adjusted Charlson Comorbidity Index (ACCI), categorised diseases using the China Health and Retirement Longitudinal Study questionnaire, and visualised comorbidity using web graphs and the Apriori algorithm. The ACCI was generally high, and it increased with age. There were significant differences in the frequency of all diseases across age groups, especially in individuals aged ≥90 years. The most common comorbid diseases were liver diseases, stomach or other digestive diseases, and hypertension. Strong correlations between the most common digestive diseases and hypertension were observed. Our findings provide insights into the current situation regarding comorbidity and the correlations among diseases in the older population. We expect our findings to inform future research directions as well as policies regarding general clinical practice and public health, especially for medical consortiums.

The use of a short course of Ulipristal Acetate for acute abnormal uterine bleeding in women without uterine fibroids.

Ulipristal Acetate (UPA) is a synthetic selective progesterone receptor modulator. It is used as emergency contraception and to reduce pain and blood loss in women of reproductive age with uterine fibroids. The first mechanism of action is myometrial apoptosis, the second is on the hypo-thalamic-pituitary-ovarian axis and the third action, is an anti-proliferative effect on the endometrium. Mainly based on the latter two, UPA is increasingly used off-label in women with abnormal uterine bleeding (AUB) without fibroids. The aim of this paper is to find evidence for a short course of UPA to treat acute AUB without fibroids, performing a systematic review as well as scrutinising literature data on the pharmacokinetics and on short term bleeding control in women with fibroids. A systematic electronic literature review was performed in February 2022. Inclusion criteria were UPA administered to women without myomas in a setting of acute uterine bleeding. Further criteria included papers describing early bleeding control using UPA, deemed independent of the presence of fibroids, with specific attention to the median time to amenorrhoea. The main outcome measured was the bleeding control within 10 days. One case report was identified. The data on symptomatic women with fibroids using 5 mg or 10 mg daily revealed bleeding control was reported within 10 days in 81% and 89% respectively, with amenorrhoea in 57% and in 78% respectively. A short-term administration may prove effective in abnormal uterine bleeding irrespective of the presence of uterine fibroids. However, more randomised controlled trials are needed and should be performed before implementation in general clinical practice. A short course of Ulipristal acetate as promising treatment for acute uterine bleeding without fibroids.

Current use of the National Surgical Quality Improvement Program surgical risk calculator in academic surgery: a mixed-methods study.

This study aims to quantitatively assess use of the NSQIP surgical risk calculator (NSRC) in contemporary surgical practice and to identify barriers to use and potential interventions that might increase use. We performed a cross-sectional study of surgeons at seven institutions. The primary outcomes were self-reported application of the calculator in general clinical practice and specific clinical scenarios as well as reported barriers to use. In our sample of 99 surgeons (49.7% response rate), 73.7% reported use of the NSRC in the past month. Approximately half (51.9%) of respondents reported infrequent NSRC use (<20% of preoperative discussions), while 14.3% used it in ≥40% of preoperative assessments. Reported use was higher in nonelective cases (30.2% vs 11.1%) and in patients who were ≥65 years old (37.1% vs 13.0%), functionally dependent (41.2% vs 6.6%), or with surrogate consent (39.9% vs 20.4%). NSRC use was not associated with training status or years in practice. Respondents identified a lack of influence on the decision to pursue surgery as well as concerns regarding the calculator's accuracy as barriers to use. Surgeons suggested improving integration to workflow and better education as strategies to increase NSRC use. Many surgeons reported use of the NSRC, but few used it frequently. Surgeons reported more frequent use in nonelective cases and frail patients, suggesting the calculator is of greater utility for high-risk patients. Surgeons raised concerns about perceived accuracy and suggested additional education as well as integration of the calculator into the electronic health record.

Cancer research in vulnerable populations: A call for collaboration and sustainability from MENATC countries.

e13649 Background: Cancer is a major burden across the Middle East and North Africa including Turkey and Cyprus (MENATC). Many MENATC countries experience acute and chronic emergencies, including COVID-19 pandemic, disasters, political instability, fragility, as well as chronic conflict that result in cumulative vulnerability to the region. This study examines the current level and the potential for cancer research among vulnerable populations in the MENATC, including its challenges, and gaps. Furthermore, it tries to ascertain cancer practitioners’ views on what defines vulnerability in the MENATC. Methods: Recurrent expert-driven meetings were held to conceptualize the study approach and highlight the barriers to conducting clinical cancer research among vulnerable populations in the MENATC. A self-administered online survey questionnaire was circulated to over 500 cancer practitioners in twenty-three MENATC countries. The survey covered: Demographic and general information, Clinical practice, Research capacity, Vulnerable populations, and logistics. Results: Half of the respondents considered clinical research in vulnerable cancer patients a key concern, while 24.5% did not. Out of the total respondents, 21.8% had worked on research that explicitly included vulnerable populations. About 60% of respondents reported seeing vulnerable populations during their daily practice. Lack of funding (60%), lack of protected time (42%), and lack of research training (35%) were the top three main reasons for research scarcity and major research challenges. Over half of the respondents agreed that recent wars/conflicts worsened the conditions for vulnerable populations. The top five ranked vulnerability groups were geriatric, terminally ill, mental health-related, chronically ill, and socioeconomically deprived patients, while the lower five ranked groups were LGBTQ+ community, veterans, divorced individuals or widowed women, prisoners, and ethnic minorities patients. Conclusions: This is the first study in the MENATC region to look at the status of and potential for research among vulnerable populations. The study highlights the challenges faced by cancer practitioners in the MENATC in research, especially among vulnerable populations. We believe that these limitations in research will negatively impact the outcomes for vulnerable communities in the region. Lack of research funding and training of cancer practitioners in the MENATC are major factors negatively affecting cancer outcomes which could lead to health improvement failure. Geopolitical, economic, and cultural differences clearly define the most vulnerable populations in cancer research. Addressing cancer disparities in the MENATC is a complex and pressing issue. By working together and providing the necessary resources, we can improve cancer research outcomes for the most vulnerable populations in the region.

Survival outcomes among patients with multiple myeloma in the era of novel agents: exploratory assessment using an electronic medical record database in Japan.

Despite recent advances in the range of therapies available for the treatment of multiple myeloma (MM), there are limited data surrounding survival outcomes and baseline characteristics influencing survival in general clinical practice in Japan. The aim of this study was to use electronic medical records (EMRs) to examine overall survival (OS) and prognostic factors in Japanese patients with MM. We extracted EMRs in the Real World Data (RWD) database of patients with a confirmed diagnosis of MM and treatment history with bortezomib, thalidomide, and/or lenalidomide. OS and prognostic factors for OS were analyzed using a univariate analysis and decision tree model. Of the 6509 patients in the database with a diagnosis of MM, 1565 were eligible. Patients had a median (range) age of 72 (23-92) years, a median OS of 53.5 months, and a 5-year OS rate of 45.6%. In alignment with previous studies, International Staging System stage and age were prognostic of OS. In addition, platelet and erythrocyte counts, chloride, total protein, C-reactive protein, and lactate dehydrogenase levels were identified as important prognostic factors for OS and were used to pilot a simple prognostic tool. In conclusion, we found that the survival outcomes extracted from EMRs in the RWD of Japanese patients with MM aligned with a previous retrospective study from Japan. Baseline laboratory parameters prognostic for OS were explored with additional factors to International Staging System and age identified. These might be used to optimize treatment selection, although further investigation using additional data sources is required.