Working Group Research Articles

LOCATE-SM PROTOCOL: LOCATION ORIENTED CORTICAL AND SUB-CORTICAL ASSESSMENT FOR THERAPEUTIC EVALUATION- SENSORY-MOTOR TESTING IN AWAKE CRANIOTOMY

Abstract AIMS Awake craniotomy is a well-established surgical procedure to debulk intracranial tumours in eloquent areas (‘functional hubs’). Intraoperative mapping facilitates maximal safe debulking. Review of current sensory motor assessment tools highlighted the absence of a comprehensive ‘location to function’ protocol. We aimed to develop a new protocol that enables ‘location to function’ sensory-motor task selection in preparation for, and during, awake craniotomy. METHOD A literature review demonstrated multiple different intraoperative strategies exist for the preservation of sensory-motor function in awake craniotomy. Incorporating these with functional neuroanatomy, and consensus agreement in the Tessa Jowell Academy Physiotherapy Awake Craniotomy Working Group and the National Brain Mapping MDT, led to the development of testing strategies aligned with ‘location to function’ task selection. Testing strategies were peer-reviewed by three specialist Neuro-Oncology physiotherapists. RESULTS A protocol (LOCATE-SM) has been developed at Leeds to identify critical cortical and subcortical sensory-motor functions that are aligned with anatomo-functional models. Physiotherapists have used this to select individualised pre-, intra- and postoperative tests depending on tumour location and sensory-motor impairment. Additionally, this facilitates intraoperative mapping of eloquent functional regions that are variably located. Cases using LOCATE-SM are presented. CONCLUSION LOCATE-SM is a new awake sensory-motor testing protocol developed by specialised Neuro-Oncology physiotherapists at a Tessa Jowell Centre of Excellence (Leeds). Current cases demonstrate that it leads to greater consistency between physiotherapists and specificity in ‘location to function’ sensory-motor task selection. Future work will systematically analyse the outcomes (onco-functional balance) of using this protocol, and validation in other centres.

Improving the Utility of a Cancer Gene Mutation Panel for Multiple Myeloma Patients

Abstract Multiple myeloma is a plasma cell malignancy that accounts for 1-2% of all cancer diagnoses and 10-15% of hematopoietic neoplasms. Clonal rearrangement of the IG locus suggests a monoclonal model for pathogenesis. The presence of cytogenetic abnormalities in >90% of cases suggests transformation by chromosomal instability and rearrangement. Classification and consensus guidelines by The International Myeloma Working Group (IMWG) and others reflect this by categorizing myeloma based on ploidy, translocations, and chromosomal abnormalities. Interestingly, a portion of Emory’s test volume for cancer gene mutation profiling by second generation short-read sequencing is for multiple myeloma cases. This suggests our 75-gene myeloid neoplasm panel (MMP75) is being utilized for medical purposes that are not met by cytogenetic and microarray characterizations performed during the diagnostic workup of multiple myeloma. Inspired by this observation, this study investigates providers motivations for ordering MMP75 and assesses the adequacy of our current implementation for their stated purposes. Anecdotes from ordering physicians indicate interest in MMP75 results when informing prognosis, selecting treatments, and evaluating for treatment associated secondary neoplasms. A more formal survey is underway that will statistically capture how the results of MMP75 testing were ultimately used: to inform diagnosis, determine prognosis, guide treatment, explain progression, identify/rule-out secondary neoplasia, or no effect on management. We also explore the variants called by MMP75 when performed using bone marrow from patients who received a cytogenetic workup for multiple myeloma at some point. A retrospective analysis of the 5-year interval between Jan 2019 and Jan 2024 identified 156 cases meeting this criterion. The number of pathogenic variants per case ranged between 1 and 8, with mutations detected across 42 genes. The genes most frequently identified with pathogenic mutations were TP53 (22.4%), DNMT3A (19.2%), TET2 (14.7%), and ASXL1 (12.2%). All four have been associated with adverse outcomes in patients with multiple myeloma. Activating events in therapeutic targets included mutations in the RAS/RAF pathway (16.7%), JAK/STAT signaling (2.6%), and the kinase KIT (0.6%). While these findings support the use of MMP75 for detection of relevant mutations, the genetic variants identified are not unique to multiple myeloma. Mutations detected in DNMT3A, TET2, and ASXL1 are common in clonal hematopoiesis of indeterminant potential (CHIP) and myeloid neoplasms. Hotspot mutations in TP53 and activating events in the RAS/RAF pathway also occur in various hematologic malignancies. This test therefore detects events that occur in both the plasma cell compartment and other cells of origin. This encumbers distinguishing variants that inform on a patient’s multiple myeloma from events that suggest a secondary neoplasm. Future directions include determining whether the effect of plasma cell enrichment on a mutations variant allele frequency (VAF) in repeat testing can help distinguish true multiple myeloma variants from events in other cells.

Validation of the JH-SEFAC Questionnaire on Knowledge on Insulin Management by Patients with Diabetes in Community Pharmacies

To review and validate a questionnaire on knowledge of injectable insulin management (JH-SEFAC) by patients with diabetes for use in community pharmacies. Study design: cross-sectional observational in Spanish community pharmacies during the first half of 2023. Inclusion criteria: patients with diabetes, of legal age, on insulin treatment. Questionnaire design: a nominal group of community pharmacists reviewed and piloted the initial questionnaire to determine its feasibility. It was approved by the CEIC of Aragón (PI22/375). Content validation: by a multidisciplinary group of experts in diabetes, using an ad hoc evaluation questionnaire of 10 questions (Likert scale of 1-5). Reliability: by means of the internal consistency index (Cronbach's alpha) and the intraclass correlation coefficient (ICC). Reproducibility (test/retest): the results of the questionnaire administered twice 2-3 weeks apart to the group of patients were compared. Pharmacists members of the SEFAC Diabetes Working Group collaborated. Sample: calculated in 127 subjects (95% CI and precision of 10%). 20 community pharmacies from 13 autonomous communities included 131 patients. The expert assessment was 4.52 out of 5 (90.4%). The Keiser-Meyer-Olkin test was 0.626 and Bartlett's test was significant (p<0.001). The Cronbach's alpha of the global questionnaire was 0.804 and the ICC was 0.902. The mean score of the questionnaire was 15.98 out of 31 points. The JH-SEFAC questionnaire was validated to evaluate the management of insulin injectables, providing community pharmacists with a valuable tool for therapeutic education.

A Quantitative LC-MS/MS Method for Xylazine and Metabolites in Urine

Abstract The prevalence of xylazine in fatal overdoses is on the rise across the United States, as reported by the Center for Disease Control and Prevention (CDC). Xylazine, a nonopioid sedative commonly used to adulterate illicitly manufactured fentanyl (IMF), poses severe health risks, including soft tissue wounds and increased overdose potential. Originally emerging in the eastern United States, its presence became widespread in Philadelphia overdose cases by 2019. Recently, there has been a notable increase in xylazine infiltrating the drug supply on the West Coast, as evidenced by a surveillance program in San Francisco in June and July 2023. Existing literature quantifying xylazine concentrations in human urine faces limitations due to the high variability in the drug supply regionally and temporally, hindering generalizability to West Coast patients. To address this gap, we developed and validated a quantitative LC-MS/MS method following Scientific Working Group for Forensic Toxicology (SWGTOX) guidelines to establish baseline urine concentrations in West Coast patients. The primary objective of this study was to develop a quantitative method for analyzing xylazine and two metabolites in the urine of exposed patients to establish expected concentrations. Chromatographic separation utilized a Shimadzu Prominence LC-20 series liquid chromatography system and a Phenomenex C-18 2.3µm 100 Å 50x3mm Kinetex column. Data acquisition employed a Sciex Triple Quad 4500. Mobile phases included Honeywell Water LC-MS grade and Honeywell Acetonitrile LC-MS grade. Xylazine and metabolites were detected using multiple reaction monitoring with the following transitions: xylazine 221.1/164.1 and 221.1/90.0,4-hydroxy-xylazine 237.1/137.1 and 231.1/136.1,2,6-dimethylaniline 121.9/105.1 and 121.9/77.0. Validation followed SWGTOX guidelines, and de-identified urine samples (n = 46) from the San Francisco Opiate Treatment Outpatient Program were analyzed.The method was linear from 1 to 10,000 ng/ml, established through triplicate analyses over five days, with an R2 value of 0.9972. The lower limit of quantification for xylazine was determined to be 1 ng/ml, with a coefficient of variation (CV) of 10.01% across 20 samples. Intra-day and inter-day precision was assessed using three different spiked pools representing low, medium, and high values, yielding CV values of 8.71%,7.45%, and 5.99%, respectively for inter-day precision. The intra-day CV ranged from 0.14% to 11.86%,0.82%to 5.37%, and 0.92% to 7.05% over the course of five days. In patients, the concentration of xylazine ranged from 4 to 3,789 ng/ml, with only one patient sample showing the presence of the metabolite 4-hydroxy-xylazine, while there was no detection of 2,6-dimethylaniline in this sample set. The LC-MS/MS method, validated according to SWGTOX guidelines, is suitable for quantifying xylazine in urine samples. This study, the largest on West Coast patients to date, provides essential baseline information for local clinicians dealing with the health implications of xylazine exposure, expanding knowledge beyond the East Coast-focused literature.

Analysis of collaborative work among university students in the province of Cusco, Peru

This study aims to analyze and describe the various forms of collaborative work that teachers and university students in the province of Cusco accomplish together using the descriptive methodology. All professionals must know their area of work as well as lead in all work environments. The participation was anonymous and voluntary. The participating students are from the first cycle to the third cycle of the different professional careers between males and females from the rural and urban areas of the province of Cusco, Peru. The findings indicate that university teachers play an effective and significant pedagogical role in designing the collaborative work model that assigns group work in their respective classrooms with the various careers they supervise. Additionally, the findings show that the teacher fulfils the social role of motivating students by performing as a tutor in the classroom. Therefore, it has a positive and significant effect among university students. This has implied that the formation of working groups in university students generates student leaders and demonstrates broad knowledge in communication and information technologies which will generate many expectations in their professional training.

&lt;span&gt;&lt;strong&gt;Diverse groupings in teaching English-speaking skills&lt;/strong&gt;&lt;/span&gt;

This study aims to investigate the effects of diverse groupings on learners' English-speaking skills. Accordingly, diverse groupings as an intervention procedure were implemented over an English-speaking course. This course lasted 15 weeks and 48 EFL students from a university in Vietnam enrolled in the course. On the completion of the course, quantitative data were collected via a questionnaire surveying the involved students' evaluations of the effects of the intervention procedure. Meanwhile, participants' reflections on the course recorded in audio files served as qualitative data for the study. The obtained results from both quantitative and qualitative data reveal that participants highly valued the course because it facilitated their English speaking skills as well as cognitive and social skills. These positive effects were derived from practicing English speaking with various partners. In addition, qualitative data recorded their perspectives on different preferences for partners in group work. These patterns include partners’ English proficiency levels, sex, partnership selection, and working duration. On these results, pedagogical implications are addressed. Further expanded research in this regard within Vietnam and beyond is also suggested to overcome the present study’s limitations.

Group work and translanguaging as coping strategies for content learning in English-medium higher education contexts

Abstract English as a medium of instruction (EMI) has been increasingly used in Higher Education institutions in countries where English is spoken as a second or foreign language (ESL/EFL). Research over the last decade has predominantly focused on EMI implementation, perceptions, and attitudes of stakeholders towards EMI as well as the challenges experienced by both teachers and students. However, little research, thus far, has focused on the coping strategies used by students to overcome challenges and manage their EMI study. The present study duly aims to fill this gap and contribute to the advancement of EMI research and pedagogy in this under-researched area. The study particularly attempts to explore group work and translanguaging as coping strategies that students employ to overcome content learning challenges and succeed in their EMI study. The study adopted a qualitative methodology and semi-structured interviews were used as the main method of data collection. Twenty participants voluntarily took part in the study. The data were analysed thematically and inductively. Results showed that students utilised several coping strategies to overcome EMI learning challenges and described these strategies as being helpful for them to understand EMI subject content. The pedagogical implications are discussed.

Dance Culture in Screen and Stage Discourse

The purpose of the article is to conduct a comprehensive analysis and determine the specifics of the director's means of adapting choreographic art in the screen plane. Research methodology. In the development of the topic, an interdisciplinary approach was used, based on the application of such general scientific methods as: a system of theoretical methods – induction, deduction, complex art analysis, synthesis. This enabled the author to study the factual material of choreographic numbers on stage and screen. The method of generalisation and systematisation was used in order to argue the originality of screen direction in the presentation of choreographic art. The use of analytical and systematic methods was effective and useful for researching the art history aspect of the given problem. The scientific novelty of the article is the delineation by the researcher of the vectors of mutual influence and mutual enrichment of choreographic and audiovisual arts in the modernisation of visual and expressive means of directorial skill in the screen and stage plane; in revealing the peculiarities of the director's activity in the presentation of choreographic works in screen productions, which became the subject of a special study for the first time; in the identification of creative dominants in the production of screen works in which choreographic experience is adapted. Conclusions. It is substantiated that screen direction not only popularises, but also with the help of audiovisual means opens up new opportunities for showing works of choreographic art (in particular, folk dance), the work of choreographers, choreographers, choreographic groups, and individual performers.

Translanguaging in content assessment: voices, experiences and practices of EMI university students

Abstract While translanguaging has gained significant traction as a theory of language that holds implications for educational settings with students from various language backgrounds, its viability in content assessment remains an unresolved issue. Students in English-medium instruction (EMI) programs at a private university in Türkiye participated in content exams that did not impose any language constraints, and follow-up interviews were conducted to probe into the participants’ language-related EMI experiences and the factors that affected their language use in their responses. Student reports showed that L1 was used by instructors to explain complex concepts or when students’ comprehension was challenged. Students used both English and L1 materials for studying, and in group and individual work, a mix of English and L1 was common, driven by the aim of cognitive efficiency and overcoming language barriers. In the content exams, both monolingual and translingual practices were employed by the participants, and their language use was mainly associated with relative proficiency in L2, encoding-retrieval match, and compartmentalization of languages. The study demonstrates that students encounter challenges in L2 comprehension and production in lessons and exams and that offering language flexibility in content exams may serve as a temporary accommodation that allows fuller expression of content knowledge, particularly in time-constrained exams.

The Clinical Genome Resource (ClinGen): Advancing genomic knowledge through global curation.

The Clinical Genome Resource (ClinGen) is a National Institutes of Health-funded program founded 10 years ago that defines the clinical relevance of genes and variants for medical and research use. ClinGen working groups develop standards for data sharing and curating genomic knowledge. Expert panels, with >2500 active members from 67 countries, curate the validity of monogenic disease relationships, pathogenicity of genetic variation, dosage sensitivity of genes, and actionability of gene-disease interventions using ClinGen standards, infrastructure, and curation interfaces. Results are available on clinicalgenome.org and classified variants are also submitted to ClinVar, a publicly available database hosted by the National Institutes of Health. As of January 2024, over 2700 genes have been curated (2420 gene-disease relationships for validity, 1557 genes for dosage sensitivity, and 447 gene-condition pairs for actionability), and 5161 unique variants have been classified for pathogenicity. New efforts are underway in somatic cancer, complex disease and pharmacogenomics, and a systematic approach to addressing justice, equity, diversity, and inclusion. ClinGen's knowledge can be used to build evidence-based genetic testing panels, interpret copy-number variation, resolve discrepancies in variant classification, guide disclosure of genomic findings to patients, and assess new predictive algorithms. To get involved in ClinGen activities go to https://www.clinicalgenome.org/start.

Lower risk of the deterioration of muscle mass and function in oral active vitamin D users among Incident peritoneal dialysis patients: a 12-month follow-up cohort study

Data in terms of how active vitamin D supplementation affects muscle mass and function in end-stage renal disease (ESRD) patients has led to inconclusive results. The main goal of this research was to examine the association of active vitamin D supplementation and risk of the deterioration of muscle mass and function among ESRD patients on peritoneal dialysis (PD). Eligible ESRD patients on PD were prospectively included, and followed up at 3-month intervals in the tertiary care center. Based on the medications during the 12-month follow-up period, the patients were divided into two groups (vitamin D users and non-users). The deterioration of muscle mass and function was identified utilizing the criteria set by the Asian Working Group on Sarcopenia in 2019 (AWGS 2019). Primary outcome was defined as the deterioration of muscle mass and function at the end of the 12-month follow-up. The absolute diffecence and 95% confidence interval (CI) of the incidence of deterioration between vitamin D users and non-users was estimated. The association of vitamin D supplementation with risk of the deterioration of muscle mass and function during the 12-month follow-up period, was examined by employing multivariate logistic regression models. A total of 229 incident PD patients (6 of whom were lost in follow-up) were included. During the entire study period, 54.7% (122/223) of the remaining patients were considered users of oral active vitamin D. The incidence of deterioration in muscle mass and function was 30.5% (68/223) throughout the entire follow-up. In this regard, the rate was 23.0% (28/122) that received oral active vitamin D, while it was 39.6% (40/101) in the group that did not receive it, with an absolute diffecence of -16.6% (95% CI − 4.5, − 28.7) and an estimated relative risk (RR) of 0.784 (95% CI 0.651–0.943). After adjustment for potential confounding factors in logistic regression model, vitamin D users group was still associated with decreased risk of the deterioration of muscle mass and function (OR 0.330, 95% CI 0.159–0.683, P = 0.003). In secondary analysis, the relationship between oral active vitamin D and the deterioration of muscle mass and function remained consistent (≤ 0.25 µg per day vs. non-users; OR 0.300, 95% CI 0.131–0.688, P = 0.004); however, no significant relationship was identified in patients receiving a mean daily dose of > 0.25 µg compared with non-users (OR 0.389, 95% CI 0.146–1.034, P = 0.058). These results indicate that active vitamin D supplementation was significantly associated with a decreased risk of the deterioration of muscle mass and function in incident PD patients with ESRD. However, the amount and type of vitamin D used and the duration of the intervention warrant further randomized controlled trials to confirm the possibility that such medication improves sarcopenia in ESRD patients.

Consensus statement on non-cancer-related risk factors for development of secondary lymphedema.

Non-cancer-related risk factors for secondary lymphedema were defined across four categories: co-morbidity, social determinants of health, behavioral factors, and environmental effectors. Based on rapid reviews of the literature and presentations at the ACS/LANA Lymphedema Summit, this working group categorized these risk factors according to the strength of evidence. Consensus agreement on level of evidence was achieved through one face-to-face working session and three follow-up virtual meetings. Findings elucidate strong evidence for co-morbidities, such as cardio/metabolic and vascular factors contributing to the risk for lymphedema. Evidence is low-to-moderate for social and behavioral factors and is lacking for environmental factors. Panel recommendations suggest a tailored approach to prospective surveillance when monitoring for secondary lymphedema that includes social determinants of health considering the growing awareness and evidence of these factors' influence on cancer and cancer-related morbidity.

&lt;span&gt;Enhancing student's mathematical competency in learning the graph and properties of the sine function by Google Sheets app on smartphone&lt;/span&gt;

This study explores the integration of the Google Sheets app on smartphones to enhance students' mathematical competency in understanding the graph and properties of the sine function. The paper was an exploratory study involving 32 11th-grade students. The teaching intervention was structured into four phases: familiarizing with the Google Sheets app, creating the sine function value table, sketching the function graph, and analyzing the graph to deduce the sine function's properties. Data were collected through worksheets and audio -video recordings of group work, focusing on manifestations of mathematical competencies. The findings indicate that students completed the tasks and demonstrated significant competencies in mathematical reasoning and using digital tools. Students were able to identify and solve mathematical problems, utilize Google Sheets effectively, and use logical reasoning to enhance their understanding of the sine function. The study concludes that integrating Google Sheets into mathematics education not only aids in visualizing and comprehending mathematical concepts but also promotes interactive and collaborative learning environments, ultimately fostering a deeper understanding and proficiency in mathematics.

Temporomandibular disorders: INfORM/IADR key points for good clinical practice based on standard of care

ABSTRACT Objective To present a list of key points for good Temporomandibular Disorders (TMDs) clinical practice on behalf of the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) group of the International Association for Dental, Oral and Craniofacial Research (IADR). Methods An open working group discussion was held at the IADR General Session in New Orleans (March 2024), where members of the INfORM group finalized the proposal of a list of 10 key points. Results The key points covered knowledge on the etiology, diagnosis, and treatment. They represent a summary of the current standard of care for management of TMD patients. They are in line with the current need to assist general dental practitioners advance their understanding and prevent inappropriate treatment. Conclusions The key points can be viewed as a guiding template for other national and international associations to prepare guidelines and recommendations on management of TMDs adapted to the different cultural, social, educational, and healthcare requirements.

The association between changes in muscle mass and function and mortality in individuals receiving peritoneal dialysis.

Data in terms of how dynamic changes of muscle mass and function affect mortality in end-stage kidney disease (ESKD) patients undergoing dialysis have led to inconclusive results. The main goal of this research was to determine the association between dynamic deterioration of muscle mass and function and all-cause mortality in ESKD patient on continuous ambulatory peritoneal dialysis (CAPD). Eligible ESKD patients on CAPD were prospectively included, and followed up at 3-month intervals in the tertiary care center for 2 years. Dynamic deterioration of muscle mass and function during a 12-month follow-up period before patients enrolled was the exposure of interest. The deterioration of muscle mass and function was identified utilizing the criteria set by the Asian Working Group on Sarcopenia in 2019 (AWGS 2019). Primary outcome was defined as the all-cause mortality during the next 2-year follow-up period. Kaplan-Meier analysis with log-rank test was used to compare overall survival between groups. Association of dynamic deterioration of muscle mass and function with all-cause mortality was examined by employing Cox proportional hazards models. A sensitivity analysis was also conducted to examine whether the potential association was modified. A total of 217 eligible patients on CAPD were included. The prevalence of dynamic deterioration of muscle mass and function was 42.9% (93/217), of which that evolving to sarcopenia (nonsevere sarcopenia or severe sarcopenia) from nonsarcopenia was 24.9% (54/217) and that evolving to severe sarcopenia from nonsevere sarcopenia was 18.0% (39/217). A total of 35.0% (76/217) participants died during the 2-year follow-up period, of which the group with deterioration of muscle mass and function was 50.5% (47/93), and the group without deterioration was 23.4% (29/124), with an absolute difference of 27.1% (95%CI 14.5%-39.7%). Kaplan-Meier survival curve revealed that the participants with dynamic deterioration of muscle mass and function had a worse survival rate than those without deterioration (log-rank test, χ2 = 17.46, p < 0.001). After adjustment for potential confounding factors, the dynamic deterioration of muscle mass and function was still significantly associated with increased risk of all-cause mortality (hazard ratio [HR] = 2.40, 95%CI 1.44-4.00, p = 0.001). In sensitivity analysis, the relationship between dynamic deterioration of muscle mass and function (nonsarcopenia to sarcopenia vs without deterioration) and all-cause mortality was consistent (HR = 4.01, 95%CI 2.22-7.22, p < 0.001). Nevertheless, no significant relationship was found in participants who evolved to severe sarcopenia from nonsevere sarcopenia (HR = 1.41, 95%CI 0.72-2.74, p = 0.313). This research demonstrated a significant association between dynamic deterioration of muscle mass and function and higher risk of mortality in ESKD patients on CAPD, and we recommend individualized lifestyle intervention that may be implemented to intervene in the progression of their muscle mass and function across the health care spectrum.

Oral Frailty as a Risk Factor for Malnutrition and Sarcopenia in Patients on Hemodialysis: A Prospective Cohort Study.

Oral frailty is a concept that encompasses various aspects of impaired oral function in elderly people, leading to reduced food intake and less dietary diversity, which can result in sarcopenia and physical frailty. However, there have been no studies on the relationship between oral frailty and malnutrition, sarcopenia, and physical frailty in patients on hemodialysis (HD). This prospective observational cohort study assessed the oral status of patients on HD. The patients were divided into an oral frailty group and non-oral frailty group using the Oral Frailty Index-8. Malnutrition was assessed using the Geriatric Nutritional Risk Index (GNRI), the Nutritional Risk Index for Japanese Hemodialysis Patients (NRI-JH), and the Short-Form Mini-Nutritional Assessment (MNA-SF). Sarcopenia was assessed using the Asian Working Group for Sarcopenia 2019's criteria. Physical frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria. One year later, the changes in nutritional status, sarcopenia, and physical frailty risk categories were compared between the oral frailty and non-oral frailty groups. The study enrolled 201 patients (non-oral frailty group, 123; oral frailty group, 78). After 1 year, the oral frailty group had a significantly higher proportion of patients with worsening nutrition status (GNRI, p = 0.0011; NRI-JH, p = 0.0019; MNA-SF, p < 0.001) and sarcopenia (p = 0.0024). There was no significant between-group difference in the proportion of patients in a worse risk category for physical frailty after 1 year. Oral frailty predicts future malnutrition and the progression of sarcopenia in HD patients. In particular, our results strongly suggested that oral frailty was a strong determinant of worsening malnutrition and sarcopenia in HD patients aged ≥65 years.

Knowledge management practices and organizational commitment among employees of line-agencies in Sulu

The study investigated the organizational commitment and knowledge management practices of line-agency employees in Sulu, Philippines during the Fiscal Year 2023. Quota sampling (n=200) was carried out to sample the participants. Descriptive-comparative analysis was conducted to analyze the organizational commitment and knowledge management competence of the employees. Findings of the study revealed that employees are highly competent in various aspects of knowledge management, including knowledge acquisition, sharing, creation, codification, and retention. For organizational commitment, the employees demonstrated a high level of commitment to their organization, work, profession, and group work. Further analysis indicated that some demographic profiles (i.e., age, appointment status, length of service, and educational attainment) mediated the knowledge management competence of the employees. Similarly, some profiles (i.e., appointment status, length of service, and educational attainment) mediated their organizational commitment. Linear correlation revealed that the commitment and knowledge management competence were highly but not significantly correlated. Organizations should continue to invest in training and development programs to sustain and further improve these competencies. This study observed the importance of continuous investment in employee development, personalized management practices, and integrated organizational strategies to optimize both knowledge management and employee commitment.

The development of a tool for the assessment of oral health program in a pediatric cancer unit

Abstract Background Oral diseases and associated illnesses interfere with cancer treatment, increase morbidity, prolong hospital stay, and increase costs. Oral care of children with cancer is essential to prevent oral diseases and decrease its symptoms. Standardized oral health and hygiene (OHH) practices must be a priority and incorporated as a routine cancer care quality. To improve OHH, baseline information of practices, processes and institutional support are necessary. Here, we report the steps we followed to develop a tool for evaluating OHH practices, support, and resources available in a pediatric cancer unit. Methods We conformed a working group (WG) integrated by healthcare professionals in pediatric, infectious diseases, oncology, and dentistry acquainted with the care of children with cancer. The steps proposed by the WG included: (1) literature review of published surveys in OHH; (2) interviews with practicing healthcare providers regarding OHH in pediatrics; (3) identification, adoption and adaptation of the Hand Hygiene Self-assessment framework (HHSAF), a survey model based on the multimodal improvement strategy (MMIS); (4) building of OHH tool; (5) validation test of OHH tool; and (6) pilot testing in recruited pediatric hematology and oncology centers. Google form version 0.8. Microsoft office excel 2021 (18.0) was used to build the OHH survey and obtain the WG member responses. The final draft of the survey was approved by WG members. We will evaluate survey validity in the pilot test among members of the PRINCIPAL network, a community of pediatric infectious disease experts and preventionists of Latin America. Results We found few reports on OHH practices in children cancer surveys. The WG met virtually and monthly from March to December 2023 to build the OHH survey. Our final survey version was organized following the model of the HHSAF and integrated into five main sections. These sections had items (Q) that requested answers regarding OHH practices and resources and institutional support (6Q); training and education of patients, families, and healthcare providers (6Q); evaluation and feedback of OHH processes in pediatric oncology unit and OHH practices of patients (6Q); reminders of OHH practices in the workplace (3Q); and hospital leadership support (2Q). The survey was made up of multiple choice and Likert scale questions. Each of the answers had a weight, and if all the items were present, the total was 400 points. Based on the total points obtained, we categorized the quality of the OHH practices of the pediatric oncology unit in inadequate (0-100); basic (101-200), intermediate (201-300), advanced (&amp;gt;300). The survey tool must be answered by an assigned team of the pediatric oncology unit oral health including a family member representative, and it could take less than 15 minutes to complete. Conclusion We developed a 21-item OHH practices survey following the WHO recommendations to use a MMIS model. We found that our newly developed tool was comprehensive and potentially helpful to assess OHH practices and identify success factors in best practices in OHH in pediatric oncology units. Our next step is pilot testing to evaluate our survey tool validity and reliability.

Applying the Multimodal Improvement Strategy framework to understand current gaps in the use of antibiograms in hospitals caring for children with cancer in the Eastern Mediterranean and African regions

Abstract Background Empiric use of antibiotics in sick children guided by local antimicrobial susceptibilities (AMS) increases initial therapy effectiveness. Antibiograms (ABG) are cumulative AMS based on results of isolates susceptible to antimicrobial agents routinely tested in an institution over a specific time period. Although ABG use can enhance healthcare quality, for optimum quality healthcare the World Health Organization (WHO) recommends the use of frameworks such as the multimodal improvement strategy (MMIS). We used the MMIS framework to analyze the literature and understand gaps in using ABG in low- and middle-income countries (LMIC). The 5 WHO MMIS components are: system change, training and education, monitoring and feedback, reminders and communication, and a culture of safety, summarized as “build it, teach it, check it, sell it, and live it”. By combining elements of a scoping methodology with the MMIS framework, we reviewed the literature surrounding ABG and report the results here. Methods We assembled a 24-member working group (WG) interested in improving infection care and prevention (ICP) in their institutions in the Eastern Mediterranean and African regions. The WG members (physicians, pharmacists, and microbiologists) met virtually twice monthly from March to October 2023. We searched PubMed using essential keywords such as antibiogram, antibiotic, antimicrobial, antibacterial, isolate, and sensitivity test, and supporting keywords such as misuse, resistance, adherence, guideline, susceptibility, development, improvement, stewardship, low-income, middle-income and LMIC. Any identified additional papers were screened for relevance. We grouped the literature according to the five components of the MMIS framework focusing on information on the ABG tool, training in ABG, the outcomes of its use, promotion of its use, and elevation of its importance institutionally. The WG members reviewed literature assigned to each of the five MMIS components, and presented oral reports of main points, gaps, and how to fill the gaps according to a rubric encompassing relevance assessment, methodological evaluation, content evaluation and recommendations. Results We identified 66 publications with authors originating from Africa (n=23, 34.8%), the Americas (n=29, 43.9%), Asia (n=13, 19.7%), Europe (n=12, 18.2%) and Oceania (n=2, 3%). The publications fell into MMIS-Build (n=16, 24.2%), MMIS-Teach (n=16, 24.2%), MMIS-Check (n=14, 21.2%), MMIS-Sell (n=10, 15.2%), and MMIS-Live (n=10, 15.2%). WG members reviewed their assigned papers, discussed them in virtual meetings, and identified 20 papers as strongly relevant. According to the WG members, the literature reviews and discussion improved their ABG knowledge and perception of the utility of evaluation and education applied to ABG. The multidisciplinary WG composition and the MMIS allowed ABG perspectives of new solutions and ideas. Although using a complex framework as MMIS applied to a scarce literature of ABG was challenging, it promoted a deeper understanding of topics and enhanced group cohesion and communication. Conclusion We found a gap in the literature of ABG, especially in LMIC, and it was not often recommended. A lower number of publications within MMIS-Live and MMIS-Sell indicated suboptimal emphasis in sustaining this practice in healthcare. Using the MMIS framework focused discussions of WG members, improved ABG knowledge and clarified the utility of educational interventions.

MUC17 is a potential new prognostic biomarker and promotes pancreatic cancer progression in obstructive jaundice.

Our working group has previously shown that bile acids (BAs) accelerate carcinogenic processes in pancreatic cancer (PC) in which mucin 4 (MUC4) expression has a central role. However, the role of other mucins in PC are less clear, especially in bile-induced cancer progression. The study aim was to investigate expression of MUC17 in BAs- or human serum-treated pancreatic ductal adenocarcinoma (PDAC) cell lines and use different assays with RNA silencing/overexpression to study the role of MUC17 in cancer progression. Protein expression of MUC17 was evaluated in 55 human pancreatic samples by immunohistochemistry, and Kaplan-Meier survival analysis was used to compare survival curves. Expression of MUC17 increased in PDAC patients, especially in obstructive jaundice (OJ) and the elevated MUC17 expression associated with poorer overall survival (10.66±1.99 vs. 15.05±2.03 months; Log rank: 0.0497). Treatment of Capan-1 and AsPC-1 cells with BAs or with human serum obtained from PDAC + OJ patients enhanced the expression of MUC17, as well as the proliferative potential of the cells, whereas knockdown of MUC17 alone or in combination with MUC4 decreased BAs-induced carcinogenic processes. Our results demonstrated that MUC17 has a central role in bile-induced PC progression, and in addition to MUC4, this isoform also can be used as a novel prognostic biomarker.