Independent T-test Research Articles

Investigating communication barriers impacting postoperative decision regret in patients with pancreatic ductal adenocarcinoma.

698 Background: Patient communication barriers are associated with worse quality of care and clinical outcomes. However there are limited data exploring their impact on shared decision-making (SDM) in the preoperative setting, especially for pancreatic ductal adenocarcinoma (PDAC). This study investigates the impact of patient communication barriers on patient-physician communication surrounding the decision to pursue pancreatectomy. Methods: This cross-sectional study investigates the impact of communication barriers on the degree of decisional regret (DR) in patients with PDAC who have undergone curative-intent resection at least 6 months prior to study recruitment. Patients completed validated surveys assessing communication preferences, SDM participation, and DR. Health literacy was assessed by the BRIEF Health Literacy survey. Groups were stratified by presence or absence of DR, assessed by the Decisional Regret Scale (DRS). Characteristics and survey scores were compared by chi-square and independent t-test. Given significant findings, results of this interim analysis are reported below. Results: 45 patients met inclusion criteria and completed all questionnaires. 19 (42.2%) patients expressed regret about their decision to pursue surgery with 5 patients expressing moderate to severe regret (DRS ≥25). Baseline characteristics were similar between groups. There were no significant differences in neoadjuvant or adjuvant treatments, or operative characteristics. Both groups reported high participation in preoperative SDM (average score 34.47 ± 9.67 in DR group vs 36.08 ± 8.88, P=0.567). Despite similar levels of education between groups, those expressing regret had a lower level of health literacy (14.68 ± 4.10 vs 17.35 ± 2.07, P=0.016). Fewer patients also identified English as their primary language in the DR group (78.9% vs 100%, P=0.026). While most patients preferred an active role in the final decision making process, fewer patients in the DR group reported this happening in actuality (ƙ= 0.635 vs ƙ=0.934). Conclusions: Almost half of patients expressed some regret pursuing surgery for PDAC. Despite similar educational backgrounds, a higher proportion of those expressing regret did not identify English as their primary language and had lower health literacy. While there was high participation in SDM, there was greater discordance between preferred and actual roles in the final decision making process. This identifies an important disparity to address in future preoperative discussions.

Assessing impact of postoperative outcomes and quality of life on decisional regret after resection of pancreatic ductal adenocarcinoma.

699 Background: Surgery is potentially curative for patients with localized pancreatic ductal adenocarcinoma (PDAC). Given the high rate of complications, decline in quality of life (QoL) postoperatively, and high rates of recurrence, clear preoperative communication and expectation setting is critical. This study investigates clinical outcomes that affect postoperative decisional regret (DR) in patients with PDAC. Methods: This mixed-methods study investigates the impact of clinical outcomes and QoL on the degree of DR in patients with PDAC who have undergone curative-intent resection at least 6 months prior to study recruitment. Patients completed validated surveys assessing DR and QoL by the European Organization for Research and Treatment of Cancer (EORTC). Groups are stratified by presence or absence of DR, assessed by the Decisional Regret Scale (DRS). Characteristics and survey scores were compared by chi-square, independent t-test, and median test. Narrative responses were thematically analyzed. Given significant findings, results of this interim analysis are reported below. Results: 45 patients met inclusion criteria and completed all questionnaires. 19 (42.2%) patients expressed regret about their decision to pursue curative-intent surgery, with 5 patients expressing moderate to severe regret (DRS ≥ 25). There was no significant difference in median postoperative timing of survey completion between groups (56 months in DR group vs 34 months, P=0.465). Baseline characteristics, medical treatments, and operative approaches were similar. Both groups had similar recurrence rates at time of survey completion. While 30 and 90 day readmission rates were similar, a greater proportion of the DR group had 30 day complications (42.1% vs 15.4%, P=0.045). Those expressing regret reported poorer physical functional status (mean score 79.30 ± 18.84 vs 92.31 ± 10.27, P=0.011) and greater impact on social activities (mean score 67.54 ± 33.55 vs 84.67 ± 19.19, P=0.038). Thematic analysis of narrative responses revealed that a majority of patients expressed a strong desire to have a greater focus on potential QoL changes during preoperative discussions. Conclusions: Patients expressing postoperative DR experienced more 30 day complications, and still report lasting effects on their current physical status and social activities. This emphasizes the importance of thorough preoperative counseling on surgical risks and potential changes in postoperative QoL so that patients may make the best informed decision.

Female collegiate soccer players post anterior cruciate ligament reconstruction utilize aberrant movement strategies to achieve similar performance to uninjured players.

Female soccer athletes with a history of anterior cruciate ligament injury are more susceptible to secondary injuries and potentially worse sport performance. The purpose of this study was to determine if female soccer athletes post anterior cruciate ligament reconstruction demonstrate worse jump height and reactive strength index performance and lower involved limb hip, knee, and ankle joint power and absorption, and larger joint power and absorption asymmetries compared to matched uninjured athletes. Eleven Division I female soccer athletes post anterior cruciate ligament reconstruction (18.8±1.0years, 1.72±0.04m, 66.4±3.4kg) and twenty-two matched controls (19.2±1.0years, 1.72±0.05m, 65.8±5.0kg) completed three trials of a standard bilateral jump landing. Separate 2×2 (group, limb) mixed-model ANOVAs, independent t-tests, and Mann-Whitney U tests (α≤0.05) were used for analysis. Post-hoc t-tests with false discovery rate P-values were used on significant interactions. We found no differences between groups in jump height, reactive strength index, ankle power and absorption asymmetry, hip power and absorption asymmetry, and knee absorption asymmetry (P>0.05). Athletes post anterior cruciate ligament reconstruction had decreased knee power in their involved limb compared to their uninvolved limb (P<0.001). Regardless of limb, athletes post anterior cruciate ligament reconstruction absorbed more at the hip compared to controls (P=0.013). Female soccer athletes post anterior cruciate ligament reconstruction utilize aberrant strategies to achieve the same level of performance as their uninjured peers. Specifically, the athletes utilized a hip dominant strategy to achieve similar performance outcomes.

Outcome of radiation related esophageal stricture from endoscopic dilation.

387 Background: Esophageal strictures present a significant challenge, particularly in cases of radiation-induced strictures. Esophageal dilation is a commonly used intervention aimed at improving swallowing function and nutritional status. However, radiation-induced strictures are amongst the most refractory to dilation. Understanding the success and limitations of this procedure is crucial for optimizing patient outcomes in the cancer population. Methods: This was a single-center retrospective chart review of 736 patients who received radiation as well as an EGD between 2014 and 2024. Patients without a radiation-induced stricture that was dilated were excluded. All continuous data are summarized as medians with interquartile ranges (IQR). Independent t-test was used for comparison among different groups. Results: 192 were eligible for this study. Our population was mostly male (58%) with a median age of 66 (IQR 67-74). The leading cancer diagnosis were esophageal (37%), head and neck (30.2%), and lung (17.1%). Radiation targets were head and neck (50.5%), lung (45.3%), both (1.6%), or other (1.6%). Patients were receiving active chemotherapy in 9.9% of cases. Mortality by the end of the study period was 51%. The median radiation dose was 5040 cGy (IQR 5040-6600) in a median of 28 fractions (IQR 26-33). Common indications for dilation were dysphagia (91.1%), weight loss (21.9%), and tube feed dependency (17.2%). Strictures were most often dilated 2 to 4 times (39.6%) to a median dilation size of 14 mm (IQR 12-15). Of note, 18.2% of patients needed 8 or more dilations. Dilation was associated with weight gain in 46.4% of patients, PEG tube removal in 3.1%, both forms of improvement in 9.9%, and no change in 40.6%. Complications included perforation (3.6%), aspiration pneumonia (3.6%), chest pain (0.5%), and hospitalization (0.5%). No significant differences were found in maximum dilation size, number of dilations, initial luminal diameter of the stricture, and initial length of the stricture between those who had clinical improvement as compared to those who did not. Conclusions: Our study reported 59.4% clinical improvement from esophageal dilation for radiation-induced strictures with nearly 20% of patients needing 8 or more dilations. The stricture dilation parameters did not appear to affect the success rate. This is the largest known single study of esophageal dilation for radiation-induced strictures.

Factors Associated With Low Childbirth Self-Efficacy for Vaginal Birth in High-Risk Pregnant Women.

Low childbirth self-efficacy is a significant indicator of vaginal birth and is closely related to adverse perinatal outcomes. This study aimed to evaluate factors associated with low childbirth self-efficacy for vaginal birth in high-risk pregnant women. This descriptive study was conducted between July and December 2022 in Van, Turkey, with a total of 200 participants. Data collection instruments included a Socio-demographic Questionnaire and the Self-Efficacy Regarding Vaginal Birth (SEVB) scale. Independent t-test, chi-square test and multivariable binary logistic regression were employed for data analysis. The mean age of the participants was 27.74 ± 5.12 years, and the mean gestational age was 33.22 ± 4.28 weeks. Unplanned pregnancy status (p = 0.002), a history of caesarean section (p = 0.013), multiparity (p = 0.001), age (p < 0.01) and gestational age (p = 0.001) were associated with low childbirth self-efficacy for vaginal birth. In multivariate analysis, only age (B: 1111; 95% CI: 1038-1189; p = 0.002) and gestational age (B: 1120; 95% CI: 1034-1214; p = 0.004; and p = 0.005) were independently associated with low childbirth self-efficacy. Low childbirth self-efficacy for vaginal birth was associated with higher maternal age and gestational ages. Identifying high-risk pregnant women with low childbirth self-efficacy will improve the care process for women and their newborns.

Early Detection of Diabetic Peripheral Neuropathy in Diabetic Patients: A Cross-Sectional Study.

Diabetic Peripheral Neuropathy (DPN) is a chronic complication in Type 2 Diabetes Mellitus (T2DM) patients and is characterized by paresthesia, pain, and hypoesthesia of the extremities. The Diabetic Neuropathy Symptom-Score (DNS) is a quick, inexpensive, and easy-to-perform tool to detect DPN in clinical practice. Biochemical markers like Nitric Oxide (NO) and Vascular Endothelial Growth Factor (VEGF) play a role in the early detection of DPN. This study aims to investigate the relationship between risk factors and these biomarkers. So, it is expected to improve the prevention and treatment of diabetic neuropathy more effectively. A cross-sectional method was used for this study. The sample size was 85 patients with T2DM who visited several primary healthcare in Medan, selected by consecutive sampling method based on eligibility criteria. Data collected included DNS, assessment of NO, VEGF, Glycated Hemoglobin (HbA1c), plasma blood glucose (PBG), and lipid profile. The collected data were analyzed using an independent T-test. The results showed that most T2DM patients, namely 73 people (85.9%), experienced DPN. From the bivariate analysis results, the risk factors associated with the prevalence of DPN in T2DM patients were found to be increased levels of total cholesterol, HbA1c, NO, and VEGF (p < 0.05). Meanwhile, blood pressure, fasting BGL, HDL-C, LDL-C, and triglycerides were not related to the occurrence of DPN in this study (p> 0.05). DNS can be used as a quick and easy initial screening tool implemented in clinical practice for screening DPN. Diabetic patients with DPN tend to have lower NO and increased VEGF; besides, NO levels are also associated with the progression of DPN. Furthermore, education, blood sugar control, and physical exercise, especially leg exercises, can prevent progressive DPN.

Symmetries of the vertical ground reaction force, contact time and area, and center of pressure during gait in female patients 3weeks post-total hip arthroplasty.

Few studies have assessed vertical ground reaction force, contact time, contact area, and center of pressure during gait in the early phase post-total hip arthroplasty. This study aimed to investigate whether these parameters are more pronounced in participants post-total hip arthroplasty compared to healthy controls. We included 22 female participants who underwent total hip arthroplasty (age, 68.9±7.2years; body mass index, 22.9±2.6kg/m2) and 11 healthy female controls (age, 50.3±7.8years; body mass index, 19.4±1.7kg/m2) as controls. Vertical ground reaction force, contact time, contact area, and center of pressure during gait were measured using a force plate. Comparisons between the affected, unaffected, and control legs were conducted using one-way analysis of variance or the Kruskal-Wallis test, with additional comparisons using independent t-tests or the Mann-Whitney U test. The first peak force was lower, the time to the first peak force and heel contact time were longer, and the contact area at the second peak force was significantly larger in the affected leg than in the unaffected leg or the right leg of the controls. These parameters were significantly more asymmetrical in the total hip arthroplasty cohort compared to the controls, with significant differences in the starting position and center of pressure length. The loading timing, magnitude, and form of plantar contact during gait were more asymmetrical in the total hip arthroplasty cohort than in healthy females. Early-phase rehabilitation post-total hip arthroplasty should address these asymmetries.

Exploring factors influencing body acceptance in women with breast cancer: A cross-sectional study.

Body acceptance in women with breast cancer is a crucial factor related to their physical, psychological health, and quality of life. However, research on the factors influencing body acceptance in this population is lacking. This study aims to identify these factors to provide insights for developing tailored interventions. We conducted a cross-sectional study with 258 participants via an online survey in September 2023. Variables measured included general and disease-related characteristics, self-esteem, resilience, social support, objectified body consciousness, and body acceptance. We analyzed the data using descriptive statistics, frequency analysis, independent t-test, one-way ANOVA, Scheffé's test, Pearson's correlation coefficient, and hierarchical regression analysis. Among participants' characteristics, we identified age, religion, menstruation status, elapsed period after diagnosis, cancer stage at diagnosis, and current treatment as factors influencing body acceptance. Additionally, higher resilience (β=0.35, p<.001), increased social support (β=0.13, p=.037), and lower objectified body consciousness (β=-0.31, p<.001) positively influenced body acceptance. Collectively, these variables accounted for 78.9% of variance in body acceptance. This study offers valuable insights into the factors affecting body acceptance in women with breast cancer. The findings highlight the need for tailored interventions that enhance resilience, foster social support, and address objectified body consciousness. Future research should validate these findings across diverse populations and refine personalized care strategies in clinical practice.

Comparing outcomes for early and late drainage of malignant ascites.

842 Background: Malignant ascites (MA) is a common sequela of peritoneal carcinomatosis resulting in significant morbidity and poses substantial management challenges for clinicians. Large volume paracentesis remains the gold standard treatment. The impact of time to drainage of MA is poorly studied. The purpose of this study was to compare clinical outcomes of hospitalized patients with MA that had drainage performed within 48 hours of admission and after 48 hours of admission. Methods: The NIS was queried between the years 2016 and 2020 to identify all adult patients hospitalized with malignant ascites (ICD-10 code R18.0) and had a drainage procedure performed (ICD-10 Procedure code 0W9Gx). These patients were then stratified into an early cohort (&lt;48 hours after admission) and late cohort (&gt;48 hours after admission). Baseline characteristics and clinical outcomes were collected and analyzed using chi squared tests, independent sample t-tests, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). Adjusted Odds ratios (aOR) are presented with 95% Confidence intervals (CI). Results: A total of 129,040 patients were analyzed, with 89,905 (69.7%) hospitalizations in the early cohort and 39,135 (30.3%) in the late cohort. Baseline characteristics were similar between the groups, with no significant differences in age (63.8 vs 63.6, p = .06) or gender distribution (63.6% vs 63.1%, p = .09). However, patients in the early paracentesis group exhibited a lower CCI (9.8 vs 10.2, p&lt;.001). Notably, early paracentesis was associated with significantly improved outcomes, including lower mortality (aOR 0.67, 95% CI 0.64–0.69), reduced incidence of sepsis (aOR 0.67, 95% CI 0.65–0.69), decreased need for transfusions (aOR 0.69, 95% CI 0.66–0.71), lower rates of mechanical ventilation (aOR 0.44, 95% CI 0.42–0.47) and vasopressor use (aOR 0.79, 95% CI 0.73–0.87). Conclusions: Early paracentesis in patients with malignant ascites was found to be associated with significantly improved clinical outcomes, independent of comorbidity burden. These findings underscore the importance of timely intervention to mitigate complications and enhance quality of life. Late ParacentesisN=39,135 EarlyN=89,905 p-value Age (years) 63.6 ± 13.1 63.8 ± 13.0 .06 Gender (% female) 24665 (63.1%) 57120 (63.6%) .09 CCI 10.2 ± 3.1 9.8 ± 3.2 &lt;.001 Mortality 5720 (14.6%) 9030 (10.0%)aOR .67 (.64 - .69) &lt;.001 Sepsis 7675 (19.6%) 12525 (13.9%)aOR .67 (.65 - .69) &lt;.001 Transfusion 5275 (13.5%) 8605 (9.6%)aOR .69 (.66 - .71) &lt;.001 Ventilation 2130 (5.4%) 2190 (2.4%)aOR .44 (.42 - .47) &lt;.001 Vasopressor 770 (2.0%) 1385 (1.5%)aOR .79 (.73 - .87) &lt;.001

Investigating survival outcomes in patients with early- vs late-onset colorectal cancer with liver metastases.

282 Background: Approximately 50% of patients with colorectal cancer develop liver metastases (CRLM). The incidence of early onset colorectal cancer (EOCRC), defined as &lt;50 years of age at time of diagnosis, is increasing. In this study, we aim to explore the prognosis of early vs late onset colorectal cancer patients with CRLM who receive curative-intent treatment. Methods: A retrospective study was conducted to assess clinical outcomes in patients with CRLM presenting with EOCRC compared to those with late onset colorectal cancer (LOCRC). All patients underwent surgical resection and/or ablation between 2009 and 2024 at a tertiary care center. Groups were defined by patient age at the time of diagnosis of the primary tumor &lt; 50 years versus ≥ 50 years. Demographics, tumor characteristics, and treatment modalities were compared between groups using Chi-square, independent samples t-test, and median test. Survival outcomes were assessed using Kaplan-Meier. Results: 342 patients met inclusion criteria. There were 85 (24.9%) EOCRC patients, with a median age at diagnosis of 44 years versus 63 years in the LOCRC group. EOCRC patients had fewer major medical comorbidities. EOCRC patients had a smaller proportion of right-sided (15.9% vs 29.6%, P=0.049) tumors. Rates of synchronous metastases (74.1% in EOCRC vs 72.4%, P=0.781), median size (28cm in EOCRC vs 25cm, P=0.421) median number of metastases (2 in EOCRC vs 2, P=0.385), and initial CEA levels (339.18 + 1276.48 ng/ml vs 328.87 + 2520.59 ng/ml, P=0.482) were similar between groups. However, EOCRC patients had higher rates of node-positive disease (75.6% vs 58.8%, P=0.010) and Fong Clinical Risk Scores 3-5 (57.0% vs 39.7%, P=0.009). Both groups underwent similar operative management with no differences in morbidity, but more EOCRC patients received neoadjuvant therapy (82.4% vs 66.1%, P=0.017). There were no significant differences in RAS/RAF (37.6% in EOCRC vs 34.2%, P=0.669) or TP53 (25.9% vs 34.6%, P=0.98) mutational status or microsatellite instability (stable in 74.1% in EOCRC vs 69.3%, P=0.523). Both intra- (46.5% in EOCRC vs 50.6%, P=0.535) and extra-hepatic (47.7% in EOCRC vs 38.1%, P=0.129) recurrences occurred at similar rates, with no significant differences in post-recurrence treatments received. Patients with CRLM and EOCRC had significantly worse overall survival, with a median time of 80 months versus 116 months (P=0.042). Conclusions: Despite similar clinical, pathologic, and genetic features, fewer medical comorbidities, and receiving similar medical and surgical treatments, EOCRC patients had worse median overall survival than LOCRC patients. High risk Fong Clinical Risk Scores were more common in the EOCRC group, who also received neoadjuvant therapy at higher rates. Additional research is needed to understand the differences in survival.

Exploring the link between liver cirrhosis and liver metastasis in colorectal cancer.

301 Background: Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer mortality in the world. Although it is now associated with improved outcomes due to advancements in treatment modalities, CRC continues to be the most common source of liver metastasis. Previous studies have shown cirrhotic livers to be at reduced risk of metastatic disease. Our study aims to investigate the association between colorectal cancer and liver metastasis in the presence of concomitant liver cirrhosis. Methods: The National Inpatient Sample (NIS) was queried to identify all hospitalizations with colorectal cancer utilizing ICD-10 codes C18.x, C19.x, and C20.x from 2016 to 2020 and were further classified based on the presence or absence of cirrhosis. Demographic and clinical data were analyzed using chi-squared tests, independent sample t-tests, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). The primary outcome studied was liver metastasis. Secondary outcomes were hepatic encephalopathy, portal hypertension, and spontaneous bacterial peritonitis. Statistical significance is indicated by a p-value less than 0.05. Results: A total of 255,599 hospitalizations with colorectal cancer were identified. Out of these, 5,370 (2.1%) had liver cirrhosis and 250,229 (97.9%) did not. Hospitalizations with CRC and concomitant cirrhosis had higher comorbidities as per the Charlson Comorbidity Index (10.5 vs 8.1, p-value&lt;0.001) and higher mortality rates (8.5% vs 4.2%, p-value&lt;0.001). Higher rates of liver metastasis (26.5 vs 23.4, p &lt;0.001) and portal hypertension (26.1% vs 0.3%, p&lt;0.001) were observed in the cirrhosis subgroup. This subgroup also has a significantly higher risk of SBP (2.8% vs 0.2%, p &lt;0.001). Conclusions: This is a large retrospective study analyzing the impact of cirrhosis on liver metastasis in patients with colorectal cancer. Patients with concomitant cirrhosis consistently have increased liver metastasis and worse outcomes. The results of this study imply that diligent CRC screening is of utmost importance in patients with cirrhosis. Patients with CRC and coexisting cirrhosis would benefit from routine surveillance such as carcinoembryonic antigen (CEA) screening or CT scans to allow early detection of liver metastases which could potentially improve outcomes. Colorectal Cancer Patients No Cirrhosis (N=250,229) Cirrhosis (N=5,370) p-value Age (in years) 65.79 ± 13.8 65.04 ± 10.9 &lt;.001 Sex (Female) 47.3% 36.8% &lt;.001 Charlson Comorbidity Index 8.1 ± 3.6 10.5 ± 3.7 &lt;.001 Mortality 4.2% 8.5% &lt;.001 Length of Stay 6.6 ± 7.2 7.4 ± 7.2 &lt;.001 Liver Metastasis 23.4% 26.5% &lt;.001 Hepatic Encephalopathy 0.0% 0.2% &lt;.001 Portal hypertension 0.3% 26.1% &lt;.001 Spontaneous Bacterial Peritonitis (SBP) 0.2% 2.8% &lt;.001

Prevalence and determinants of lower urinary tract symptoms in pregnant women.

The management of lower urinary tract symptoms (LUTS) is crucial for providing quality pregnancy care. This study aims to determine the prevalence and predictors of LUTS in pregnant women. This cross-sectional study was conducted between November 2023 and February 2024 with a total of 1703 pregnant women who attended routine pregnancy care at four state hospital obstetrics outpatient clinics. Data were collected using a pregnant woman information form and the "Bristol Female Lower Urinary Tract Symptoms-Short Form (BFLUTS-SF)". Descriptive statistics, the independent sample t-test, analysis of variance (ANOVA) test, Tukey or Tamhane's T2 post-hoc tests, and multiple linear regression (Stepwise) analysis were carried out. All analyses were conducted with a 95% confidence interval and a significance level of p<0.05. The prevalence of LUTS among pregnant women was found to be 99.2%. High prevalence rates were obtained for storage symptoms, voiding symptoms, and urinary incontinence symptoms (respectively, 99.2%, 48.8%, and 61.2%). Multiple linear regression analysis indicated that previous pregnancy stress urinary incontinence (SUI), history of curettage and urinary tract infection (UTI), absence of episiotomy, presence of SUI in the mother and/or sister, smoking, being employed, and being in the third trimester are significant predictors of LUTS during pregnancy (p<0.05). The findings of this study indicate that LUTS is commonly in pregnant women. For quality pregnancy care, it is recommended to organize community-based, repeated educational programs and counseling services aimed at preventing and reducing LUTS in women.

Impact of race on end-of-life care among patients with esophageal cancer.

337 Background: Esophageal cancer is an aggressive malignancy with rising incidence globally. Patients with advanced esophageal cancer suffer from a heavy burden of a wide array of symptoms including dysphagia and cachexia/anorexia, necessitating the need for focused symptom management and palliative care. Studies focused on other cancer types have shown that Black patients are more likely to receive aggressive care at end-of-life (EOL) and suffer from a decline in quality of life. We sought to investigate racial differences in EOL care among patients with advanced esophageal cancer in the US. Methods: The National Inpatient Sample (NIS) was queried to identify all hospitalizations with esophageal cancer utilizing ICD-10 codes C15x from 2016 to 2020. Hospitalizations of White and Black patients with documented inpatient mortality events were then extracted. Demographic and clinical data were analyzed using chi squared tests, independent sample t-tests, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). Adjusted Odds ratios (aOR) are presented with 95% Confidence intervals (CI). Results: A total of 15,130 patients with esophageal cancer were included, of which 13,345 (88.2%) were White and 1785 (11.8%) were Black. Hospitalizations with White patients recorded higher age, more males, and higher comorbidities per CCI. Hospitalizations with Black patients had longer lengths of stay on average, higher total hospital charges, and significantly less likely to have a Do Not Resuscitate (DNR) code status (aOR 0.81, 0.74-0.9 95% CI). Rates of inpatient palliative care consultation at EOL were significantly lower among Black patients (aOR=0.53, 0.48-0.58 95% CI). Black patients were more likely to receive aggressive intervention at EOL demonstrated by rates of blood transfusion (aOR 1.9, 1.6-2.1 95% CI), mechanical ventilation (aOR 1.7, 1.5-1.8 95% CI), and vasopressor usage (aOR 1.4, 1.2-1.6 95% CI). Conclusions: We present a large retrospective analysis demonstrating significant racial disparities in EOL care amongst hospitalized patients with esophageal cancer. Black patients had longer lengths of stay, lower rates of palliative care consultation and DNR code status, and higher rates of aggressive interventions at EOL. These findings may have implications for improving health care decision making for EOL care amongst minority patients with esophageal cancer. WhiteN=13345 BlackN=1785 p-value Age (in years) 68.24±10.67 65.12±10.36 &lt;.001 CCI 9.4±3.3 8.6±3.9 &lt;.001 Mean length of stay (days) 7.5±11.3 10.4±22.8 &lt;.001 Total Cost (In thousands of dollars) 108.6±231.0 141.9±388.5 &lt;.001 Palliative Adjusted OR 60.9% 45.1% .53 (.48 - .58) &lt;.001 DNR Adjusted OR 63.8% 58.0% .81 (.74 - .90) &lt;.001 Blood transfusion Adjusted OR 13.0% 23.0% 1.9 (1.6-2.1) &lt;.001 Mechanical ventilation Adjusted OR 31.4% 45.9% 1.7 (1.5-1.8) &lt;.001 Vasopressor Adjusted OR 7.8% 10.6% 1.4 (1.2-1.6) &lt;.001

Sickness presenteeism, job burnout, social support and health-related productivity loss among nurses in the Chinese nurses' health cohort study (TARGET): A cross-sectional survey

BackgroundSickness presenteeism has potential negative impacts on job burnout and health-related productivity loss among clinical nurses, whereas social support has been identified as a potential mitigating factor for such impacts. However, there is limited evidence regarding the relationships and mechanisms between sickness presenteeism, job burnout, social support, and health-related productivity loss. ObjectiveTo explore the role of job burnout and social support in the association between sickness presenteeism and health-related productivity loss among female nurses. DesignA cross-sectional study. Setting(s)105 hospitals conveniently selected from 36 cities in 15 provinces in China. Participants50,653 registered female nurses. MethodsThis study utilizes the cross-sectional data from the baseline survey of the Chinese Nurses' Health Cohort Study (Towards A Revolution in GETting nurses' health ticked, TARGET), conducted from December 2020 to 21st February 2024. Variables were measured using the Sickness Presenteeism Questionnaire, Stanford Presenteeism Scale, Maslach Burnout Inventory, and Perceived Social Support Scale. Data analyses were performed using independent sample t-tests, Pearson correlation analysis, one-way analysis of variance, multivariate linear regression analysis, and the Process 4.0 macro plug-in method. ResultsA total of 42,843 valid questionnaires were collected with an 85 % response rate. The incidence of sickness presenteeism among female nurses was 62 %. Sickness presenteeism was positively correlated with job burnout and health-related productivity loss, and job burnout was also positively correlated with health-related productivity loss. Conversely, social support was negatively associated with sickness presenteeism, job burnout and health-related productivity loss. The findings showed that the association between sickness presenteeism and health-related productivity loss was partially mediated by job burnout. Moreover, the direct and indirect effects within the mediation model were moderated by social support. When levels of social support were high, the impact of sickness presenteeism on job burnout and health-related productivity loss was weaker, as was the impact of job burnout on health-related productivity loss. ConclusionsHospital administrators and nurses themselves can mitigate the adverse effects of sickness presenteeism on health-related productivity loss by alleviating job burnout and increasing levels of social support. By addressing these significant challenges, they can more effectively manage the consequences of sickness presenteeism and job burnout among nurses. RegistrationThe protocol of TARGET was registered in the China Clinical Trial Registry (ChiCTR2100043202). Tweetable abstractThe study based on TARGET analyzes the mechanisms between sickness presenteeism and health-related productivity loss.

Impact of inpatient palliative care consultation on end-of-life care among patients with esophageal cancer.

502 Background: Esophageal cancer is an aggressive malignancy with a high global prevalence. Patients often suffer from various debilitating symptoms like dysphagia and cachexia, particularly with more advanced stage disease. Most patients continue to receive aggressive interventions until terminal stages of disease without timely initiation of formal palliative care (PC). We sought to investigate the impact of formal inpatient palliative care consultation on end-of-life (EOL) care among patients with esophageal cancer. Methods: The National Inpatient Sample (NIS) was queried to identify all hospitalizations with esophageal cancer utilizing ICD-10 codes C15.x from 2016 to 2020. Hospitalizations with documented inpatient mortality events were extracted and stratified based on reception of PC consultation (ICD-10 code Z51.5). Demographic and clinical data were analyzed using chi-squared tests and independent sample t-tests. A threshold of p-value less than 0.05 was set to determine statistical significance. Results: A total of 17,745 patients with esophageal cancer were included, of which 10,370 (58.4%) received PC consultation. Patients that received PC consultation at EOL were more likely to have higher comorbidities per CCI. No significant difference between age and sex was observed between the two cohorts. Patients who received PC consultations at EOL had higher rates of Do Not Resuscitate (DNR) code status (78.1% vs 43.2%, p &lt;0.001) and lower rates of aggressive interventions such as chemotherapy (0.9% vs 1.6%, p&lt;.001), blood transfusions (12.3% vs 18%, p&lt;.001), and mechanical ventilation (28.5% vs 41%, p&lt;0.001). No significant difference was observed in the rates of vasopressor use between the two groups (p=0.83). Hospitalizations with PC consultations were associated with significantly lower total hospitalization cost ($97,879 vs $146,128, p&lt;.001). Conclusions: Inpatient PC consultations among patients with esophageal cancer were associated with lower rates of aggressive interventions and higher rates of DNR code status in addition to significantly lower total hospitalization costs. These findings underscore the importance of inpatient PC consultation at the EOL in helping minimize aggressive interpretation and facilitate a greater focus on comfort and quality of life. No PalliativeN=7375 PalliativeN=10370 p-value Age (in years) 67.58 ± 10.9 67.58 ± 10.9 .98 CCI 9.1 ± 3.5 9.4 ± 3.3 &lt;.001 Mean length of stay (days) 8.9 ± 14.9 7.5 ± 11.3 &lt;.001 Total Charges 146128 ± 321830 97879 ± 195868 &lt;.001 DNR 3170 (43.2%) 8100 (78.1%) &lt;.001 Blood transfusion 1320 (18.0%) 1280 (12.3%) &lt;.001 Mechanical ventilation 3015 (41.0%) 2960 (28.5%) &lt;.001 Vasopressor 585 (8.0%) 835 (8.1%) 0.83 Chemotherapy 115 (1.6%) 95 (0.9%) &lt;.001

Digesting danger: A two-decade study exploring the association between food processing and colon cancer.

87 Background: Dietary patterns play a significant role in cancer prevention and progression, yet the specific association of food processing with colon cancer remains largely under-investigated. The NOVA classification system categorizes foods by their level of processing, providing a unique way to examine this relationship. Colon cancer remains a leading global health concern, and emerging evidence points to diet as potential contributors. This study explores associations between NOVA-classified foods and colon cancer, offering new insights into the role of food processing in cancer development. Methods: Survey data from the NHANES database (from 1999 to 2018) was probed for demographic and clinically relevant data, and day one food journals were converted into NOVA classifications. Participants aged 20 and older were included for analysis, including those with and without colon cancer (n=339 and 47615, respectively). Independent two-sample t-tests were conducted to compare the mean proportion of daily energy consumption of various NOVA food categories between the two groups, and a Benjamini-Hochberg correction was applied to adjust for multiple comparisons at p&lt;0.05. Sensitivity analyses were performed using total grams and percent total caloric intake as inputs. Subgroup analyses were conducted via a logistic regression model including BMI, age, ethnicity, gender, education, country of birth, and military service. Results: Individuals with colon cancer had higher intake of ham and salted meats (NOVA 3, adjusted p=0.028) compared to those without cancer. Conversely, individuals without cancer consumed more legumes (NOVA 1, adjusted p=0.028), oils (NOVA 2, adjusted p=0.023), and “other processed foods” that did not fall into a specific processed food category (NOVA 3, adjusted p=0.038). Subgroups analyses revealed a greater association with colon cancer for age greater than 50 and non-hispanic White ethnicity. Conclusions: To our knowledge, this is the only study at this scale that evaluates colon cancer prevalence in the context of dietary behaviors stratified by level of industrial processing. The significant associations between ham and salted meats consumption, age greater than 50, and non-Hispanic White ethnicity with increased cancer prevalence highlight the impact of dietary and demographic patterns on colorectal carcinogenesis. Additional studies are needed to confirm these hypotheses in the prospective setting.

Marginal Fit and Fracture Resistance of Vertical Versus Horizontal Margins in Monolithic Zirconia Crowns.

The use of vertical margin design in all-ceramic restoration has generated inquiries regarding its clinical efficacy under diverse dynamic oral conditions. This research aims to assess the marginal fit and fracture resistance of monolithic zirconia crowns featuring vertical margin design as opposed to those with conventional horizontal margin design. Two metal dies were employed to generate replicated resin dies mimicking mandibular first molar preparation. The metal dies were precision-engineered with two margin designs: vertical margin design presenting a shoulderless configuration (Featheredge) and horizontal margin design (Radial Shoulder). Forty zirconia crowns were produced on the replicated resin dies using two varieties of monolithic zirconia, with twenty crowns in each category: pre-shaded and multilayered zirconia. Both sets were further subdivided into two groups based on the finish line configuration utilized (n = 10). The vertical marginal gap of the zirconia crowns was gauged before and after thermocycling (5-55oC/5000 cycles), followed by loading the crowns until fracture occurred. Statistical analysis was performed using one-way analysis of variance (ANOVA), accompanied by Bonferroni's post hoc test and independent t-test for pairwise comparisons. The Shoulder subgroup of BruxZir exhibited the highest mean marginal gap value (120.06 ± 10.15 µ), while the Featheredge subgroup of BruxZir displayed the lowest value (49.72 ± 6.53 µ). Among the BruxZir group, the Featheredge subgroup showcased the highest mean fracture resistance value (4251.57 ± 279.90 N), whereas the Shoulder subgroup recorded the lowest value (1721.60 ± 225.16 N). Monolithic zirconia crowns with vertical margin design (Featheredge) demonstrated statistically enhanced performance compared to conventional horizontal margin design, as evidenced by lower marginal gap values and increased fracture resistance tolerance.

Factors Influencing Knowledge and Attitudes towards Second-Hand Smoking Exposure Among University Students: An Exploratory Study.

Despite extensive global research on second-hand smoking (SHS) exposure, there is a noticeable lack of studies focusing on the knowledge and attitudes of university students in Bangladesh. This cross-sectional study aimed to address this gap by assessing the levels of knowledge and attitudes towards SHS exposure among university students in Bangladesh. Utilizing a convenience sampling technique, data were collected from 383 university students, encompassing socio-demographic information, as well as knowledge and attitude-related inquiries. Statistical analyses were conducted using SPSS software, including independent t-tests and analysis of variance (ANOVA) and multiple linear regression. The findings revealed that participants exhibited a moderate level of knowledge and attitude towards SHS exposure. Multiple linear regression identified age, gender, mother's education, and self-rated health status as significant predictors of knowledge, explaining 12.9% of its variance (R2 = 0.129, F = 6.117, P < .001). Furthermore, age, gender, and living with parents emerged as significant predictors of attitude, explaining 14.7% of its variance (R2 = 0.147, F = 7.165, P < .001). The study highlights the need for interventions aimed at enhancing awareness and fostering positive attitudes towards SHS exposure among university students in Bangladesh. It is recommended that university authorities organize seminars and implement health education initiatives targeting vulnerable populations to address the findings and promote a smoke-free environment on campus.

A Comparative Study on the Relationship Between Placental Weight and Neonatal Outcomes Among Anaemic Mothers and Non-Anaemic Mothers in Selected Hospital, Rajnandgaon, Chhattisgarh

Abstract: Maternal anemia is a common pregnancy complication that may impact placental function and fetal development. This study aims to compare placental weight and neonatal outcomes among anemic and non-anemic mothers to determine the potential effects of maternal anemia on fetal growth and neonatal health. A comparative cross-sectional study was conducted among 200 mothers (100 anemic, 100 non-anemic) who delivered at term in a tertiary care hospital. Placental weight, neonatal birth weight, Apgar scores, and neonatal complications were recorded. Statistical analysis, including independent t-tests, chisquare tests, and Pearson correlation, was performed to examine differences between the two groups. The average placental weight was slightly lower in anemic mothers (495 ± 55 g) compared to non-anemic mothers (510 ± 50 g), though not statistically significant (p = 0.16). Neonates of anemic mothers had significantly lower birth weights (2600 ± 500 g vs. 2700 ± 450 g, p = 0.03) and lower Apgar scores at 1 minute (7.4 vs. 8.2, p = 0.02) and 5 minutes (8.3 vs. 9.0, p = 0.01). Neonatal complications, including respiratory distress and NICU admissions, were more frequent among the anemic group, but the difference was not statistically significant (p = 0.08). A moderate positive correlation was found between placental weight and neonatal birth weight (r = 0.45 for anemic, r = 0.52 for non-anemic).Maternal anemia is associated with lower neonatal birth weight and reduced Apgar scores, indicating possible fetal distress. Although placental weight differences were not statistically significant, the findings highlight the importance of managing maternal anemia to improve neonatal health outcomes. Further studies with larger samples are recommended to confirm these findings and explore additional contributing factors

The impact of bleaching using 15% carbamide peroxide on surface properties of CAD-CAM composite structures

This study aims to evaluate the effects of the home bleaching method on the surface microhardness and surface roughness of both polished and unpolished CAD-CAM resin composite materials. A polymer-infiltrated ceramic network (PICN) block, Enamic (VE), along with four resin composite blocks (RCB) (Grandio [GN], Lava™ Ultimate [LV], BRILLIANT Crios [B], and Cerasmart [CS]), were prepared to dimensions of 14 mm × 12 mm × 2 mm and were categorized into unpolished and polished groups (n = 4). Microhardness measurements were conducted using a Vickers microhardness tester (300 gf load for 20 s) at various time points: before home bleaching, after home bleaching with 15% Opalescence for 8 h and for 56 h, 24 h after bleaching, and one month after bleaching. Surface topography was examined using a stylus contact profilometer (n = 4) and a scanning electron microscope (n = 3) at ×40 k magnification. Control specimens from each group were also measured. Data were analyzed using one-way ANOVA, Tukey’s post hoc test, two-way ANOVA and an independent t-test. The polished samples demonstrated a decrease in hardness after 8 h of bleaching, with the most significant reduction observed in VE, followed by GN, LV, CS, and BR. Significant differences were noted between all materials except for CS and LV. After 56 h, VE exhibited the greatest decrease in hardness, followed by GN, LV, BR, and CS, with significant differences between all materials except BR and CS. In the unpolished group, VE showed the highest reduction in hardness after 8 h of bleaching, followed by LV, GN, BR, and CS. After 56 h, the order was VE, LV, GN, CS, and BR, with significant differences observed between all materials except BR and CS. Similar trends in hardness reduction were observed at 24 h and 1 month post-bleaching. Additionally, hardness was significantly reduced after polishing for all materials. Overall, the reduction in hardness was significantly influenced by the type of material, the time, and the interaction between these factors (p < 0.05). Home bleaching using 15% carbamide peroxide significantly decreased microhardness. This effect was more pronounced in unpolished groups and with prolonged exposure. Further studies are recommended to determine the suitable concentration and duration of 15% carbamide peroxide application to ensure its use is safe for CAD-CAM materials.