Independent Outcome Research Articles

PENERAPAN MODEL PEMBELAJARAN THINK TALK WRITE (TTW) UNTUK MENINGKATKAN HASIL BELAJAR SISWA PADA MATERI PENCEMARAN LINGKUNGAN DI KELAS X SMA NEGERI 1 SEKADAU

This research aims to determine the improvement in student learning outcomes by using the Think Talk Write (TTW) learning model on environmental pollution material at SMA Negeri 1 Sekadau. There are two variables in this research, namely the application of the Think Talk Write (TTW) learning model as the independent variable and student learning outcomes as the dependent variable. The method in this research is the classroom action research (PTK) method which consists of two cycles, each cycle through four stages, namely planning, action, observation and reflection. Data collection techniques are observation and measurement techniques, with data collection tools namely observation sheets and test questions. The research results showed that in cycle I the average value of student learning outcomes was 68.57 with classical completeness of 71.42% and the average value of cycle II was 77.85% with classical completeness of 92.85%, there was an increase in learning outcomes of 9.28%. The application of the Think Talk Write (TTW) learning model can improve the learning outcomes of class X students at SMA Negeri 1 Sekadau

Early unrestricted vs. partial weight bearing after uncemented total hip arthroplasty: a systematic review and meta-analysis.

The choice of postoperative weight bearing protocol after uncemented total hip arthroplasty (THA) remains controversial. The aim of this study was to assess the efficacy and safety of immediate unrestricted weight bearing (UWB) compared with partial weight bearing (PWB) in patients undergoing uncemented THA. Relevant articles were retrieved from electronic databases. Both randomized controlled trials (RCTs) and non-RCTs were included but analyzed separately. All functional and clinical outcomes with at least 2 independent study outcomes were meta-analyzed. A total of 17 studies were investigated. No adverse effect was found regarding micromotion of the femoral stem with immediate UWB following uncemented THA. There was also no correlation between immediate UWB and failure of ingrowth fixation and higher risks of femoral stem subsidence and surgical revision in RCTs. Harris hip score was better in patients with immediate UWB than those with PWB at 1 year post surgery, but the difference was not statistically significant. Immediate UWB did not have extra harm compared with PWB in patients undergoing uncemented THA. UWB was not superior to PWB. Considering the improvement of Harris score and the compliance of patients, UWB can be encouraged in THA rehabilitation.

Psychometric Properties of the Dutch Contextual Assessment of Social Skills (CASS): An Independent Observational Outcome Measure of Social Skills in Autistic Adolescents.

The goal of this study was to translate and adapt the original 9-item of the Contextual Assessment of Social Skills (CASS) to a Dutch version and assess its psychometric qualities. Autistic adolescents aged 12 to 18years (n = 99) took part in a randomized controlled trial. In this study, pre-intervention data were utilized. The original CASS was adapted to ensure cultural relevance and the content validity was assessed. Data was used to assess reliability and structural validity, using confirmatory factor analysis. 4-item were added to the CASS during the adaptation to better align with the objectives of the experimental intervention. The original 9-item had inter-item correlations between .01 and .70. The Cronbach's alpha for the original 4-item total score was moderate (α = .69), while for a 7-item total score, it was high (α = .86). This 7-item total score had a sufficient model fit (Comparative Fit Index = .90). This total score had a significant correlation with the Assertion subscale of the Social Skills Improvement System-Adolescent (SSIS-A) (r = 0.26, p < .01), and the Social Responsiveness Scale-2 (SRS-2) total score (r = -.21, p = .04) indicating sufficient convergent validity. The CASS total score was not correlated with the Repetitive and Restricted Behavior scale of the SRS-2 (r = -.08, p = .43), indicating sufficient divergent validity. The Dutch CASS can be considered a conceptually sound and reliable observational instrument for assessing social conversational skills in Dutch autistic youth. Further evaluation of its feasibility when implemented in practice, outside of clinical research, is needed.Trial registration: Dutch trail register NTR6255 (NL6117) 08/02/2017 https://www.trialregister.nl/trial/6117.

Impacts of a new diagnosis-related group point payment system on children's medical services in China: Length of stay and costs.

Paediatric healthcare is always highlighted in medical and health care system reform in China. Zhejiang Province established a new diagnosis-related group (DRG) point payment reform in 2020 to regulate provider behaviours and control medical costs. We conducted this study to evaluate impacts of the DRG point payment policy on provider behaviours and resource usage in children's medical services. Data from patients' discharge records from July 2019 to December 2020 in Children's Hospital, Zhejiang University School of Medicine were collected for analysis. We employed the interrupted time series approach to reveal the trend before and after the DRG point payment reform and the difference-in-differences analysis to estimate the independent outcome changes attributed to the reform. We found that the upward trend of length of stay slightly slowed, and the total costs began to decrease at the post-policy stage. Although independent effects of the reform were not presented among the whole sample, the length of stay and hospitalisation costs of moderate-hospital-stay paediatric patients, non-surgical patients, and infant patients were found to decrease rapidly after the reform. DRG point payments can changed the provider behaviours and eventually reduce healthcare resource usage in children's medical services.

Thrombolytic Therapy in Strokes: A Retrospective Clinical Data Analysis of 40 Patients in a 7-Year Period: The Experience of a Greek Internal Medicine Department

Stroke is one of the main causes of mortality and disability in developed countries. In acute ischemic stroke, the standard treatment is recombinant tissue plasminogen activator (rt-PA). The benefits of the treatment depend on the time of administration, the earlier it is administered, the greater its benefit. There are limited studies on the retrospective outcome of thrombolytic therapy in patients with acute ischemic stroke outside of clinical trials. The present retrospective study aimed to analyze the clinical data of 40 patients over 7 years who were hospitalized with acute ischemic stroke at the AHEPA University Hospital in Greece. From January 2013 to December 2020, 40 patients with acute ischemic stroke were admitted and treated. Computed tomography (CT) was performed at 24 h after thrombolytic treatment or earlier in case of neurological worsening. The hospital had 3 months follow-up at the stroke clinic and data consisting of the National Institute of Health Stroke Scale (NIHSS), functional outcome assessed by modified Rankin Scale (mRS) and mortality were reviewed in the medical records from the stroke clinic. The clinical outcome of functional independence defined by the modified Rankin Scale (mRS) ≤ 2 at 3 months was evaluated. Safety outcomes were in-hospital mortality, mortality at 3 months, and symptomatic intracerebral hemorrhage (sICH) defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria. The main finding of the present study, that there was an overall reduction in the NIHSS scale after thrombolysis, proves that the patients showed improvement after performing thrombolysis. Consequently, from the total of 40 thrombolysis performed at the clinic, it can be concluded that most patients had a good outcome.

Abstract 209: Incidence and outcome of perforations during medium‐vessel occlusion compared to large‐vessel occlusion thrombectomy

Introduction Vessel perforation during thrombectomy is a severe complication and is hypothesized to be more frequent during MeVO thrombectomy. The aim of this study was to compare the incidence and outcome of patients with perforation during MeVO and LVO thrombectomy and to report on the procedural steps that led to perforation. Methods In this multicenter retrospective cohort study, data of consecutive patients with vessel perforation during thrombectomy between January 01, 2015 and September 30, 2022 were collected. The primary outcomes were independent functional outcome (i.e. modified Rankin Scale 0‐2) and all‐cause mortality at 90 days. Binomial test, chi‐squared test and t‐test for unpaired samples were used for statistical analysis. Results During 25,769 thrombectomies (5,124 MeVO, 20,645 LVO) in 25 stroke centers, perforation occurred in 335 patients (1.3%; mean age 72 years, 62% female). Perforation occurred more often in MeVO thrombectomy (2.4%) than in LVO thrombectomy (1.0%, p &lt; 0.001). More MeVO than LVO patients with perforation achieved functional independence at three months (25.7% vs 10.9%; p=0.001). All‐cause mortality did not differ between groups (overall 51.6%). Navigation beyond the occlusion and retraction of stent‐retriever/aspiration catheter were the two most common procedural steps that led to perforation. Conclusion In our cohort, perforation was approximately twice as frequent in MeVO than in LVO thrombectomy. Efforts to optimize the procedure may focus on navigation beyond the occlusion site and retraction of stent‐retriever/aspiration catheter. Further research is necessary in order to identify thrombectomy candidates at high risk of intraprocedural perforation and to provide data on the effectiveness of endovascular countermeasures.

Healthcare utilization impacts of an eConsult program for headache at an academic medical center.

Interprofessional consultations ("eConsults") can reduce healthcare utilization. However, the impact of eConsults on healthcare utilization remains poorly characterized among patients with headache. We performed a retrospective, 1:1 matched cohort study comparing patients evaluated for headache via eConsult request or in-person referral at the Mount Sinai Health System in New York. Groups were matched on clinical and demographic characteristics. Our primary outcome was one or more outpatient headache-related encounters in 6 months following referral date. Secondary outcomes included one or more all-cause outpatient neurology and headache-related emergency department (ED) encounters during the same period. We used univariable and multivariable logistic regression to model associations between independent variables and outcomes. We identified 74 patients with headache eConsults who were matched to 74 patients with in-person referrals. Patients in the eConsult group were less likely to achieve the primary outcome (29.7% vs 62.2%, P < 0.0001) or have an all-cause outpatient neurology encounter (33.8% vs 79.7%, P < 0.0001) than patients in the comparison group. Both groups did not significantly differ by headache-related ED encounters. In multivariable analyses, patients in the eConsult group had significantly lower odds of having one or more headache-related or all-cause neurology encounters than patients in the comparison group (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1-0.6; OR 0.1, 95% CI 0.1-0.3, respectively). In comparison to in-person referrals, eConsult requests for headache were associated with reduced likelihood of outpatient neurology encounters in the short-term but not with differential use of headache-related ED encounters. Larger-scale, prospective studies should validate our findings and assess patient outcomes.

The Effect of Educational Technology on Learning Facilities on Learning Independence to Improve Learning Outcomes of Building Construction Engineering Students

Building engineering education is a discipline that continues to develop along with technological advances. Educational technology, especially the integration of technology in learning facilities, has become an essential aspect in improving the quality of learning at various levels. This study aims to investigate the effect of educational technology on learning facilities on the learning independence of building engineering students and its impact on improving learning outcomes, especially in building construction subjects. This study uses a survey method, with a causal technique. The research sample will consist of final-semester students of the building engineering study program registered at a leading higher education institution. Data will be collected through an instrument in the form of a questionnaire to measure the level of student learning independence, as well as an evaluation test of learning outcomes for building construction subjects. Data analysis will be carried out using descriptive statistical methods to describe student profiles and analyze differences between the experimental and control groups. Furthermore, inferential analysis such as the t-test will be used to identify the effect of educational technology on learning independence and student learning outcomes. It is hoped that this research will result in a deeper understanding of how the integration of educational technology in learning facilities can influence student learning independence in the context of engineering education. The findings from this study can provide guidance for educational institutions in designing more effective learning strategies through the use of educational technology. In addition, this research is also expected to contribute to academic literature related to technical education and the use of technology in learning.

Anorexia of aging: An international assessment of healthcare providers' knowledge and practice gaps.

Anorexia of aging is a common geriatric syndrome that includes loss of appetite and/or reduced food intake, with associated undernutrition, unintended weight loss, sarcopenia, functional decline, loss of independence and other adverse health outcomes. Anorexia of aging can have multiple and severe consequences and is often overlooked by healthcare professionals (HCPs). Even more concerningly, clinicians commonly accept anorexia of aging as an inevitable part of 'normal' aging. The aim of this assessment was to identify current gaps in professional knowledge and practice in identifying and managing older persons with anorexia. Results may guide educational programmes to fill the gaps identified and therefore improve patient outcomes. This international assessment was conducted using a mixed-methods approach, including focus group interviews with subject matter experts and an electronic survey of practicing HCPs. The assessment was led by the Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD) and was supported by in-country collaborating organizations. A quantitative survey of 26 multiple-choice questions was completed by physicians, dietitians and other HCPs (n=1545). Most HCPs (56.8%) recognize a consistent definition of anorexia of aging as a loss of appetite and/or low food intake. Cognitive changes/dementia (91%) and dysphagia (87%) are seen as the biggest risk factors. Most respondents were confident to give nutritional (62%) and physical activity (59.4%) recommendations and engaged caregivers such as family members in supporting older adults with anorexia (80.6%). Most clinicians assessed appetite at each visit (66.7%), although weight is not measured at every visit (41.5%). Apart from the Mini-Nutritional Assessment Short Form (39%), other tools to screen for appetite loss are not frequently used or no tools are used at all (29.4%). A high number of respondents (38.7%) believe that anorexia is a normal part of aging. Results show that treatment is focused on swallowing disorders (78%), dentition issues (76%) and increasing oral intake (fortified foods [75%] and oral nutritional supplements [74%]). Nevertheless, the lack of high-quality evidence is perceived as a barrier to optimal treatment (49.2%). Findings from this international assessment highlight the challenges in the care of older adults with or at risk for anorexia of aging. Identifying professional practice gaps between individual HCPs and team-based gaps can provide a basis for healthcare education that is addressed at root causes, targeted to specific audiences and developed to improve individual and team practices that contribute to improving patient outcomes.

A joint survival model for estimating the association between viral load outcome and survival time to death among HIV/AIDS patients attending health care and treatment centers in Tanzania

BackgroundGlobally, HIV/AIDS is one of the diseases that have a huge burden in terms of cost and health of individuals; and Sub-Sahara Africa is the highly affected region by the pandemic. Tanzania is among the countries that have a higher prevalence of HIV/AIDS-related mortality. This study aimed at using the joint survival model to estimate the association between viral load outcome and survival outcome to death adjusting for age, sex, adherence, and visit date.MethodsSecondary data from a retrospective cohort of HIV patients attending health care and treatment centers were used to analyze the association between the longitudinal viral load and time-to-death outcomes. The three-step analysis was based on the individual mixed effects linear model and the Cox proportional hazards models to estimate the significance of the independent outcomes, and the joint survival model as a final model. The joint model was used to estimate the factors affecting the average change in log viral load over time and the risk factors for the survival time of HIV patients. The exposures for both models were ART adherence status, age, male, and visit date whereas the outcome for the LMM was log viral load and the outcome for the Cox PH model was time-to-death in years.ResultsThe joint survival model results revealed that a 10-year increase in age was associated with a 37% increased risk of death (HR = 1.369, 95% CI: 1.253–1.844), and being male was associated with a 49% higher risk of death (HR = 1.489, 95% CI: 1.202–1.844) compared to females. The results also provided evidence of an association between the longitudinal log viral load and the survival time to death ) whereby a unit increase in the log viral load was associated with a 26% increase in the risk of death (HR = 1.262, 95% CI: 1.226–1.301).ConclusionThe joint survival model analysis provided valuable insights into the associations between time to death and log viral load with adherence to ART, age, visit date, and sex of the patients. This implies that viral load suppression, as well as sex and age-specific interventions, are necessary for reducing HIV/AIDS-related deaths.

Cilostazol May Improve Outcomes Even in Patients with Aneurysmal Subarachnoid Hemorrhage Aged 75 Years and Older: Multicenter Cohort Study and Propensity Score–Matched Analyses

The opportunities to treat elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) are increasing globally, but the outcome remains poor. This study seeks to investigate treatment-related factors that can modify functional outcomes in patients with aSAH aged ≥75 years. A total of 202 patients with aSAH aged ≥75 years prospectively enrolled in 9 primary stroke centers from 2013 to 2021 were retrospectively analyzed. Clinical variables including treatments for hydrocephalus, angiographic vasospasm, and delayed cerebral ischemia were compared between patients with good (modified Rankin Scale [mRS] score 0-2) and poor (mRS score 3-6) outcomes at 90 days from onset, followed by multivariate analyses to find independent outcome determinants. A modifiable treatment-related variable was evaluated after propensity score matching with adjustments for age, sex, pre-onset mRS score, aSAH severity, and treatment modality. More than half of patients showed World Federation of Neurological Societies grades IV-V on admission. Univariate analyses showed that advanced age, worse pre-onset mRS score, more severe neurologic status on admission, higher modified Fisher grade on admission computed tomography scans, and acute and chronic hydrocephalus were associated with poor outcomes. In contrast, administration of a phosphodiesterase type III inhibitor, cilostazol, was associated with good outcomes in both univariate (P= 0.036) and multivariate analyses (adjusted odds ratio, 0.305; 95% confidence interval, 0.097-0.955; P= 0.042). Propensity score matching analyses showed that patients treated with cilostazol had better outcomes (P= 0.016) with fewer incidences of delayed cerebral infarction (P= 0.008). Even in patients with aSAH aged ≥75 years, cilostazol administration may lead to better outcomes by suppressing the development of delayed cerebral infarction.

Effect of the SAVI Learning Model on Arabic Writing Skills

Arabic language education in schools intends to improve students' ability to communicate globally and understand in both oral and written aspects. Language skills consist of four aspects namely, listening, speaking, reading, and writing skills. This research was conducted at MTs Arrukhshatul 'Ulum West Bandung with quantitative research. This research method uses a survey method with correlation analysis to see the relationship between the independent variable, namely student learning independence, and the dependent variable, namely student learning outcomes, using the Somatic, Auditory, Visual, and Intellectual (SAVI) learning model on Arabic writing material. This study aims to evaluate and measure the impact and how much significant influence is produced by the use of the SAVI learning model on the Arabic writing skills of 8th grade students at MTs Arrukhshatul 'Ulum West Bandung. This study has a very strong relationship between learning independence and student learning outcomes, or, in other words, student learning independence has a very strong effect on student learning outcomes, with a correlation coefficient value of 0.914. In addition, learning independence has an influence of 83.4% on student learning outcomes and the other 16.6% is influenced by factors outside student learning independence with the regression equation model Y = 19.012 + 0.727X

Safety governance during COVID-19 pandemic and beyond: a benchmarking inquiry of multiple countries

PurposeThis study aims to examine the role of safety governance in ensuring public–private interface ecosystems in response to the COVID-19 pandemic. It aims to highlight the role of safety governance in the complex interfaces of pandemic response mechanisms. The analysis is conducted at the national level, considering safety governance issues in terms of test, confirmed cases, fatality rates, vaccination rate, medical capabilities, Information and communications technology capability, Hofstede’s cultural index (individualism and power distance scores), public safety, personal privacy and national health capabilities.Design/methodology/approachUsing multigovernance theory and technology, organization and environment theory, the authors present a research model that defines four independent factors and country level performance outcomes and conducted analysis of variance tests.FindingsResearch findings suggest that countries are classified by diverse groups using multiple criteria (e.g. country size, Hofstede’s cultural indexes, ICT capabilities and Governance index). Countries indicate differences in their policy approaches according to their private and public ecosystems. COVID-19 response performance indicators are substantially different.Research limitations/implicationsThis study provides the relevance of the multigovernance theory. The empirical results suggest that effective crisis governance is characterized by vertically integrated organizational hierarchies with horizontally connected communication channels that seek maximum voluntary participation and a high level of motivation of informed societal members as a whole. Crisis events occur occasionally, and livelihood routines demonstrate incredible human agility. Gaining insight of the findings from this article may be useful to respond to future crisis events.Originality/valueThis significant study highlights the political and social factors that define response patterns of different countries regarding COVID-19 response mechanisms. With the wide vaccination administration, the COVID-19 landscape shows differences in these countries. This study is rare in providing research framework using Hofstede cultural value and examines with actual data provided by each national government, World Health Organization and credible information sources.

Independent Impact of Eat, Sleep, Console Assessment on Neonatal Opioid Withdrawal Syndrome.

Compared with the Finnegan Neonatal Abstinence Scoring System (FNASS), the Eat, Sleep, Console (ESC) approach reduces pharmacotherapy and length of stay (LOS) for neonatal opioid withdrawal syndrome (NOWS) infants. The independent outcome contribution of ESC is unknown as the approach combines ESC assessment with additional management changes. Our objective was to evaluate ESC assessment's independent impact on outcomes compared with FNASS. We conducted a retrospective cohort study of in utero opioid-exposed infants ≥35 weeks gestation managed with FNASS versus ESC. Outcomes included pharmacotherapy initiation, LOS, length of pharmacotherapy, and emergency department visit/readmissions. Among 151 FNASS and 100 ESC managed infants, pharmacotherapy initiation (P = .47), LOS for all infants (P = .49), and LOS for pharmacologically treated infants (P = .68) were similar. Length of pharmacotherapy did not differ (P = .84). Emergency department evaluation/NOWS readmission was equally rare (P = .65). Using equivalent models of care, comparison of ESC and FNASS assessment tools showed no difference in NOWS outcomes.

The Effect of Blended Learning with Edmodo-Assisted Scientific Approach on Independence and Science Learning Outcomes

The Effect of Blended Learning with Edmodo-Assisted Scientific Approach on Independence and Science Learning Outcomes

Clinical outcome and outcome prediction of octogenarians with acute basilar artery occlusion and endovascular stroke treatment compared to younger patients.

Octogenarians are underrepresented in recently published studies that showed the benefit of endovascular stroke treatment (EST) for patients with acute basilar artery occlusion (BAO). We aimed to compare the clinical outcome of octogenarians with BAO and EST compared to younger patients (YPs) and identify independent outcome predictors. This is a retrospective, single-center analysis of patients treated for BAO with EST from January 2013 until June 2021 in a tertiary stroke center. Octogenarians (80-89 years) were compared to YPs. A study endpoint was a favorable clinical outcome as per the modified Rankin Scale (mRS 0-3), 90 days after stroke onset. The study groups were compared using univariate analysis, and a multivariable logistic regression analysis was performed to define independent predictors for favorable and unfavorable (mRS 5-6) clinical outcomes. In this study cohort, 74/191 (38.7%) octogenarians had a higher pre-stroke mRS [median, interquartile range (IQR): 2, 1-3 octogenarians vs. 0, 0-1 YP, p < 0.001] and a comparable National Institutes of Health Stroke Scale (NIHSS) before EST (median, IQR: 21, 10-38 vs. 20, 8-35 in YP, p = 0.487). They showed a comparable rate of favorable outcome (mRS 0-3, 90 days, 23.0 vs. 25.6% in YP, p = 0.725), but were less often functionally independent (mRS 0-2: 10.8% in octogenarians vs. 23.0% in YP, p = 0.049). The rate of unfavorable clinical outcome was comparable (mRS 5-6, n = 40, 54.1% in octogenarians vs. n = 64, 54.7% in YP, p = 0.831). A baseline NIHSS was an independent predictor for clinical outcome in YPs [e.g., for unfavorable clinical outcome: odds ratio (OR) 1.061, confidence interval (CI) 1.027-1.098, p = 0.005] and for favorable clinical outcome in octogenarians. Pre-stroke mRS predicted favorable outcomes in octogenarians (OR 0.54, CI 0.30-0.90, p = 0.0291), while age predicted unfavorable outcomes in YPs (OR 1.045, CI 1.011-1.086, p = 0.0137). Octogenarians with acute BAO eligible for EST are as likely to achieve a favorable outcome as YPs, and the rate of death or severe disability is comparable. The admission NIHSS is an independent predictor for favorable and unfavorable outcomes in YP and for favorable outcomes in octogenarians. In this study cohort, pre-stroke mRS predicted favorable outcomes in octogenarians while age predicted an unfavorable outcome in YPs.

Severe Acute Malnutrition among Children in Bale Zone Southeast Ethiopia: Treatment Outcome and its Determinant Factors

To assess the treatment outcomes of severe acute malnutrition (SAM) and its associated factors in children aged 6-59months in Bale zone, Southeast Ethiopia. A multi-institutionally-based, retrospective cross-sectional study design was conducted, based on records from September 11, 2014 to September 11, 2017. Simple random sampling was used to select the records. A pretested extraction format was used to collect information from the logbook and patient records. Treatment outcome was dichotomized into recovery and censored. Bivariate and multivariable logistic regression analyses were used to analyze the data. Odds ratios with 95% CIs were calculated to determine the association between each independent variable and treatment outcome. A total of 763 records were completed and reviewed. Of these, 711 (93.2%) were recovered from SAM. Provision of deworming treatment (aOR=6.5; 95% CI: 2.8-15.1), education given to the mother/caregiver (aOR=8.8; 95% CI: 4.2-18.4), age range 6-24months (aOR=0.37; 95% CI: 0.17-0.81), presence of anemia (aOR=0.33; 95% CI: 0.14-0.78), and use of nasogastric (NG) tube (aOR=0.42; 95% CI: (0.21-0.85) were associated with recovery from SAM. Recovery rate of SAM children in this study was in line with international standards. Deworming, maternal education status, child's age, anemia, and NG tube use were associated with recovery. Attention should be given to deworming all children, disease control, and prevention of anemia and other comorbidities.

Sensory functions and their relation to balance metrics: a secondary analysis of the LIMBIC-CENC multicenter cohort.

Among patients with traumatic brain injury (TBI), balance problems often persist alongside hearing and vision impairments that lead to poorer outcomes of functional independence. As such, the ability to regain premorbid independent gait may be dictated by the level of sensory acuity or processing decrements that are shown following TBI assessment. This study explores the relationships between standardized sensory acuity and processing outcomes to postural balance and gait speed. Secondary analysis was performed on the Long-Term Impact of Military- Relevant Brain Injury Consortium Chronic Effects of Neurotrauma Consortium LIMBIC (CENC) data set. Separate regression analyses were carried out for each of the balance assessments (via Computerized Dynamic Posturography, CDP) and walking speed. TBI frequency was significantly related to the majority of single CDP outcomes (i.e., Conditions 2-6), while various sensory processing outcomes had task-specific influences. Hearing impairments and auditory processing decrements presented with lower CDP scores (CDP Conditions 3,5,6, and 1-3 respectively), whereas greater visual processing scores were associated with better CDP scores for Conditions 2,5, and 6. In sum, patients with TBI had similar scores on static balance tests compared to non-TBI, but when the balance task got more difficult patients with TBI scored worse on the balance tests. Additionally, stronger associations with sensory processing than sensory acuity measures may indicate that patients with TBI have increased fall risk.

Red blood cell distribution width for the prediction of outcomes after cardiac arrest

The red blood cell distribution width (RDW) is a routinely available blood marker that measures the variation of the size/volume of red blood cells. The aim of our study was to investigate the prognostic value of RDW in cardiac arrest patients and to assess whether RDW improves the prognostic value of three cardiac arrest-specific risk scores. Consecutive adult cardiac arrest patients admitted to the ICU of a Swiss university hospital were included. The primary outcome was poor neurological outcome at hospital discharge assessed by Cerebral Performance Category. Of 702 patients admitted to the ICU after cardiac arrest, 400 patients (57.0%) survived, of which 323 (80.8%) had a good neurological outcome. Higher mean RDW values showed an independent association with poor neurological outcomes at hospital discharge (adjusted OR 1.27, 95% CI 1.14 to 1.41; p < 0.001). Adding the maximum RDW value to the OHCA- CAHP- and PROLOGUE cardiac arrest scores improved prognostic performance. Within this cohort of cardiac arrest patients, RDW was an independent outcome predictor and slightly improved three cardiac arrest-specific risk scores. RDW may therefore support clinical decision-making.

P11.56.A MODIFIED FRAILTY INDEX (MFI) AS A SURVIVAL AND FUNCTIONAL OUTCOME PREDICTOR IN OLDER PATIENTS UNDERGOING SURGERY FOR BRAIN METASTASES

Abstract BACKGROUND Surgical decision making in older patients with brain metastases (BM) is challenging. Frailty and comorbidities are often thought to limit therapeutic options as well as functional and survival outcomes. MATERIAL AND METHODS 139 consecutive patients undergoing surgery 2017-2021 for BM were analyzed retrospectively. Cut-off for age was ≥60 yrs. in accordance with the graded prognostic assessment (GPA) index. Frailty was investigated using the mFI index, a compound measure assessing comorbidities and the patients’ functional health status. RESULTS Median age was 69.0 (IQR: 63.0-74.5) yrs. 55.4% had multiple metastases. We recorded 9.4% major (CTCAE III-V) surgical and 10.1% medical complications. 7.9% of patients had major new focal neurological deficits ≥30 days. Median overall survival (mOS) was 7.8 (IQR: 5.0-10.6) months. Frailer patients lived shorter (mOS for “least-frail”/mFl 0: 13.6 [IQR: 8.6-18.6], “moderately frail”/mFl 1-2: 9.0 [IQR: 4.9-13.0] and “frailest”/mFl ≥3: 2.7 [IQR: 0.9-4.5] months; p&amp;lt;0.001). Multivariate analysis with all parameters correlating significantly with mOS in the univariate analysis (mFI, higher preop. KPS, younger age [&amp;lt;69 yrs.], female sex) revealed a higher preop. KPS to be the only independent significant survival predictor (70 vs. 80-100; HR 2.1, p&amp;lt;0.001). Frailer patients had poorer functional outcomes (patients w/ postop. KPS ≤70 vs. 80-100; mFI 0: 9/36 [25.0%], mFI 1-2: 20/65 [30.8%], mFI ≥3: 25/38 [65.8%]; p&amp;lt;0.001). Multivariate analysis with all parameters correlating significantly with better functional outcome in the univariate analysis (mFI, higher preop. KPS, younger age, female sex and single metastasis) showed that a higher preop. KPS was the strongest prognostic parameter (RR 17.2, p&amp;lt;0.001). The mFI was not an independent outcome predictor. In a ROC analysis the preoperative KPS proved a much better predictor of functional outcome than the mFI (AUC 92 vs. 71%; sensitivity/specificity optimum 80 vs. 2, resp.). mFI was not a predictor of complications (p=NS). CONCLUSION The mFI proved a strong survival and functional outcome predictor in older patients. However, this effect was no longer seen in multivariate analyses when the KPS was included as a covariate. This may suggest that surgical outcomes depend on the patients’ presurgical functional health status rather than comorbidities. The presence of comorbidities (if well treated) should therefore not deter from BM surgery in older patients.