Initial Assessment Research Articles

Validity and Reliability of the Turkish Version of the Post-Extubation Dysphagia Screening Tool

Background and Purpose:Patients who have been intubated ≥48 hours are at risk of dysphagia. Evaluation of swallowing before starting oral feeding after extubation is necessary to prevent aspiration and the problems caused by aspiration. The Post-Extubation Dysphagia Screening tool is a validated and reliable tool used to evaluate extubation-induced dysphagia. This study was conducted to evaluate the validity and reliability of the Post-Extubation Dysphagia Screening Tool for the Turkish population.Methods:The study had a methodological design and was carried out with 50 patients followed in the intensive care unit of a public hospital. The study was carried out in four stages: (1) language validity, (2) content validity, (3) establishing interrater reliability by agreement with two observers (intensive care nurse and intensivist), and (4) establishing sensitivity and specificity with the intensive care nurse and intensivist.Results:The overall content validity index was 0.91, indicating content validity. Interrater reliability was established (Cohen’s g = 0.93). The prevalence of post-extubation dysphagia was 42%, and the sensitivity of the Post-Extubation Dysphagia Screening Tool was 82% and the specificity was 64%.Implications for Practice:The Turkish version of the Post-Extubation Dysphagia Screening Tool exhibited good evidence of validity and reliability and was determined important as it can help nurses evaluate post-extubation dysphagia in intensive care patients. The use of this tool by a nurse reduces the risk of unsafe oral intake among patients after prolonged intubation. This tool allows accurate assessment of dysphagia and initiation of early and safe oral feeding in critical care patients.

Disentangling the Diagnoses of Psychotic Depression, Catatonia, Neurocognitive Disorders, and Delirium: A Multidisciplinary Approach

An ambiguous clinical presentation can create diagnostic uncertainty, leading to delays in effective interventions and increasing the likelihood of adverse clinical outcomes. Unfortunately, many psychiatric conditions share overlapping clinical symptoms. Psychotic depression, catatonia, neurocognitive disorders, and delirium are all examples of distinct clinical conditions with overlapping symptomatology, and all require decidedly different therapeutic interventions. While much literature is devoted to the diagnostic criteria and management of these clinical conditions, little is dedicated to the challenge of disentangling these diagnoses when faced with a complex clinical presentation.We present here a complicated psychiatric inpatient hospitalization of a 77-year-old male who exemplified this diagnostic challenge. He primarily presented with severely depressed mood and decreased functionality, remaining in bed for much of the day with little attention to basic hygiene and oral intake. While records from a recent outside hospitalization carried a historical diagnosis of catatonia, his moderate level of engagement with providers and somatic delusion of disseminated prostate cancer suggested an alternate diagnosis of psychotic depression. However, before a diagnostic conclusion could be reached, other clinical characteristics surfaced. Following a singular administration of olanzapine shortly after his initial assessment, he developed Lilliputian hallucinations, prominent parkinsonism, and significantly altered mentation.Neuroleptic sensitivity raised clinical suspicion for an underlying neurocognitive disorder such as dementia with Lewy bodies, and a consult was placed to the neuropsychology service. While dementia could not be fully ruled out, they did recommend additional workup to rule out herpes simplex encephalitis, autoimmune limbic encephalitis, and paraneoplastic syndromes. After his MRI imaging revealed moderate microvascular ischemic changes, a true multidisciplinary approach to care was taken, as neurology was consulted to also help narrow the differential. An EEG was unremarkable and a serum encephalitis panel was also unremarkable. Olanzapine was discontinued with significant improvement in parkinsonism and cognition; however, severe neurovegetative symptoms and somatic and nihilistic delusions persisted. While antipsychotics remained clinically indicated for a suspected depression with psychotic features, caution was taken due to established neuroleptic sensitivity, subtle catatonic features, and the related risks of neuroleptic malignant syndrome. Ultimately, low-dose quetiapine was initiated with some benefit; however, he continued to remain acutely depressed and withdrawn with prominent negativism. Trials with benzodiazepines for these catatonic features were also approached with caution to avoid potential risks of delirium.Over time, a multidisciplinary approach to psychopharmacologic interventions and medication trials led the team to a principal diagnosis of major depressive disorder with psychotic features and subtle catatonia. The abrupt changes observed early in the hospital course were determined to be related to olanzapine-induced anticholinergic delirium. With greater diagnostic certainty, the team was able to counsel the patient and family about the importance of pursuing electroconvulsive therapy (ECT). The patient's cardiovascular risk factors and known microvascular changes were considered in the determination of the appropriateness for ECT. After starting ECT, he was immediately noted to have objective improvement, and following his fifth treatment, he was deemed appropriate for discharge after exhibiting significant improvement in depression and functionality and reporting near-resolution of somatic delusions. He was able to complete ECT on an outpatient basis and follow-up visits note durable improvements in mood, functionality, and quality of life, continuing to enjoy an active lifestyle of socializing with family and playing tennis. We use this case to further explore the clinical challenges that stem from the symptomatic similarity between psychotic depression, catatonia, neurocognitive disorders, and delirium and discuss optimal therapeutic approaches when the presentation appears complex and equivocal.

Evaluation of an early-stage prototype polyurethane femoral head implant for hip arthroplasty

IntroductionThi study evalautes a new bone-preserving femoral head cover that mimics the articular cartilage of the femoral head. MethodsA specially developed polyurethane (PU) was evaluated in biocompatibility (cytotoxicity test) and mechanical response to tensile loading. In the cytotoxicity test, steam sterilized (SS) and ethylene oxide sterilized (EtO) PU samples were incubated separately in a cell culture medium. The seeded cell line MG-63 was then added to these sample-incubated cell culture mediums. One negative control group and one positive control group were also evaluated. The cells in each group were cultured for seven days before being quantified using the alamarBlue assay. In the mechanical test, the femoral head cover implants were separated into three groups of three samples. Each group represented a different implant insertion idea: direct insertion (uc sample) and another two insertion modes (is and ss samples) representing implants with enclosure mechanisms. The test consisted of distance-controlled cyclic tensile loadings followed by a failure test. ResultsThe cytotoxicity test results show no significant difference in fluorescence intensity between the negative control, the three SS groups, and one EtO group (P > 0.05). However, the other two EtO groups exhibit significantly lower fluorescence intensity compared with the negative control (P < 0.05). In the mechanical test, the is samples have the highest cyclic loading force at 559.50 ± 51.41 N, while the uc samples exhibit the highest force in the failure test at 632.16 ± 50.55 N. There are no significant differences (P > 0.05) among the uc, is, and ss groups in terms of stiffness. ConclusionThe cytotoxicity test and the mechanical experiment provide initial assessments of the proposed PU femoral head cover implant. The evaluation outcomes of this study could serve as a foundation for developing more functional design and testing methods, utilizing numerical simulations, and developing animal/clinical trials in the future.

Cultural applicability and desirability of ‘Broodles’: The first serious game intervention for siblings of children with disabilities

ObjectiveSerious games can serve as easily accessible interventions to support siblings of children with disabilities, who are at risk of developing mental health problems. The Dutch serious game ‘Broodles’ was developed for siblings aged 6–9 years. The current study aims to assess the cultural applicability, desirability, feasibility, and acceptability of ‘Broodles’ in Norway. MethodsNorwegian siblings (N = 16) aged 6–13 years and parents (N = 12) of children with intellectual disabilities assessed the game. Their feedback data from interviews and questionnaires were sorted using a model of engagement factors in serious games. ResultsAt pre-use, participants showed interest in the game, and after initial use the participants were overall positive about the format, content and objectives, including validation of emotions and recognition. The participants had suggestions for improved engagement and feasibility. ConclusionThe game was found to be culturally applicable, desirable and acceptable, although Norwegian translation is necessary for further evaluation. Recommendations to enhance engagement were provided, including suggestions to play the game with parents or in a group. InnovationThis initial assessment of the serious game Broodles in a non-Dutch setting shows promise for an innovative way of supporting siblings of children with disabilities.

Validated assessment of power plant components with flaws and defects operating under long-term creep and isothermal creep-fatigue loading

An extensive database of frequently used heat-resistant steels 1 %Cr, 9–10 %Cr and 12 %Cr steels at application-typical temperatures was evaluated using the Nikbin-Smith-Webster model. Influencing factors, such as the initial plasticization and the specimen thickness, were investigated in the evaluation of the fracture mechanics material characteristic values. A thickness influencing factor fB for crack initiation is proposed, which improves the crack initiation estimation using the NSW model and reduces its over-conservatism notably. It could be shown that the crack initiation and especially the crack growth under creep loading can be described with sufficient accuracy by the modification of the NSW model. The limitation in the application of the C*-parameter could also be shown and explained by the Two-Criteria-Diagram (2CD). It should be applied to crack geometries with predominant crack tip damage. The 2CD is shown as preferred method for a more precise, material-related understanding and assessment of the crack initiation process.Based on the recalculation of fracture mechanics tests on CT und DENT specimens, the analytical approaches for the description of crack initiation and growth under creep and isothermal creep-fatigue loading could be validated in the long-term range by comparison with the experimental results up to 100,000 h.Finally, the transferability of these approaches from CT und DENT specimens to large components was investigated by calculating cracked components under practical creep and isothermal creep fatigue loading using these methods. It has been shown that the load level and the duration of holding time are decisive for the crack initiation and the crack growth under isothermal creep-fatigue loading. In the case of high stress and shorter holding times, the damage is predominantly influenced by fatigue. With lower stress and longer holding times, creep plays a more important role.

A Comprehensive Review of Bulldozers in Modern Construction

This study investigates the contemporary landscape of bulldozer technologies and trends in the year 2023, aiming to provide a comprehensive overview of the advancements shaping the construction and earthmoving industry. This research meticulously analyses industry reports, manufacturer data, and emerging technologies, delving into key areas. Firstly, the study explores the integration of cutting-edge technologies into bulldozer design, with a focus on GPS-guided systems for precise grading, telematics for remote monitoring, and automation features contributing to enhanced operational efficiency. Secondly, environmental considerations are examined, emphasizing efforts to make bulldozers more sustainable. This involves an assessment of initiatives to reduce emissions, improve fuel efficiency, and the exploration of alternative power sources, such as electric or hybrid systems. The study also investigates advancements in safety and operator-centric features, including ergonomic cab designs, improved visibility, and the incorporation of safety technologies aimed at reducing accidents and enhancing overall job site safety. Data analytics and telematics play a crucial role in this research, with a focus on their utilization for performance optimization, predictive maintenance, and efficient fleet management. Additionally, the study touches upon the influence of global market trends, economic factors, and regulatory changes on the adoption and development of bulldozer technologies. This includes an examination of how regional demands for infrastructure projects and urbanization impact the design and utilization of bulldozers in different parts of the world. In conclusion, this study aims to contribute valuable insights into the current state of bulldozer technologies, offering a foundation for understanding the industry's trajectory and potential areas for future research and development.

Statistical and machine learning analysis for the application of microbially induced carbonate precipitation as a physical barrier to control seawater intrusion

Seawater intrusion in coastal aquifers is a significant problem that can be addressed through the construction of subsurface dams or physical cut-off barriers. An alternative method is the use of microbially induced carbonate precipitation (MICP) to reduce the hydraulic conductivity of the porous medium and create a physical barrier. However, the effectiveness of this method depends on various factors, and the scientific literature presents conflicting results, making it challenging to generalise the findings. To overcome this challenge, a statistical and machine learning (ML) approach is employed to infer the causes for the reduction in hydraulic conductivity and identify the optimum MICP parameters for preventing seawater intrusion. The study involves data curation, exploratory analysis, and the development of various models to fit the input data (k-Nearest Neighbours – kNN, Support Vector Regression – SVR, Random Forests – RF, Gradient Boosting – XgBoost, Linear model with interaction terms, Ensemble learning algorithms with weighted averages – EnL-WA and stacking – EnL-Stack). The models performed reasonably well in the region where permeability reduction is sensitive to carbonate increase capturing the permeability reduction profile with respect to cementation level while demonstrating that they can be used in initial assessments of the specific conditions (e.g., soil properties). The best performing algorithms were the EnL-Stack and RF followed by XgBoost and SVR. The MICP method is effective in reducing hydraulic conductivity provided that the various biochemical parameters are optimised. Critical biochemical parameters for successful MICP formulations are the bacterial optical density, the urease activity, calcium chloride concentration and flow rate as well as the interaction terms across the properties of the porous media and the biochemical parameters. The models were used to identify the optimum MICP formulation for various porous media properties and the maximum permeability reduction profiles across cementation levels have been derived.

Could persistent organic pollutants affect future generations of sea turtles by maternal transfer? First results for Caretta caretta nests along the North-Western coast of Italy

Since 2013, loggerhead sea turtle (Caretta caretta, Linnaeus 1758) nesting has been observed further north along the Italian coast, reaching the Tuscan coast (NW Mediterranean Sea). The four nesting events that occurred in Tuscany in the summer of 2019 spurred the scientific community to monitor these occurrences more carefully, following them from egg deposition to hatching. This provided an opportunity to collect samples for conducting multidisciplinary investigations, including the toxicological investigations of the biological material collected from the four nests. The aim of this study was to conduct an initial assessment of persistent organic pollutants in the eggs laid in Tuscany, aiming to establish a baseline on this topic for subsequent nesting events that have occurred until today. Organochlorine compounds (OCs), specifically polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT) and its metabolites, and hexachlorobenzene (HCB), were analyzed and detected in unhatched eggs, embryos, and chorio-allantoic membranes (CAMs). OCs were detected in all samples, with PCBs &amp;gt; DDTs ≫ HCB. A significant spatial variation in pollutant levels and profiles among sea turtle nesting locations was found. Embryos showed higher levels of contamination than egg contents regardless of the developmental stages. Depth of the laying chamber and egg mass were not significant factors in OC bioaccumulation. For the first time in the Mediterranean Sea, this study assessed the role of CAM in the transfer of contaminants to the embryo. Overall, the OC levels found were lower compared to the results from other studies conducted worldwide on loggerhead sea turtle biological material. This was the first assessment of nest biological material for the North-Western coast of Italy.

Malnutrition as a prognostic factor for 2-year mortality in hospitalized patients in Norway: A matched cohort study.

Risk of malnutrition and malnutrition have been previously associated with increased risk of mortality. It remains unclear, however, whether the severity of malnutrition differentiates in association with all-cause mortality. The aim was to assess the association between being at risk of malnutrition or being diagnosed with malnutrition according to the diagnostic assessment of the Global Leadership Initiative on Malnutrition (GLIM) with all-cause mortality during a 2-year follow-up in hospitalized patients. A matched cohort study was conducted in hospitalized patients (excluding cancer, intensive care, and transmissible infections) at a university hospital in Bergen, Norway. All patients underwent nutrition screening with the Nutritional Risk Screening 2002 and a further nutrition assessment using the GLIM criteria. All-cause mortality was estimated from the Norwegian death registry after 2 years, and risk factors were calculated by Cox regression analysis. Among 326 patients included, 55 patients died within 2 years (17% mortality rate). Risk of malnutrition was associated with increased all-cause mortality, which disappeared after adjustment for age and sex. Malnutrition was associated with an increased risk of all-cause mortality at 2 years also after adjustment for age and sex and, additionally, for further comorbidities (hazard ratio = 2.50; 95% CI, 1.41-4.42). When analyzed separately only severe malnutrition was associated with mortality (hazard ratio = 2.73; 95% CI, 1.44-5.15). The findings highlight a strong association between inpatients with severe malnutrition, defined by the GLIM criteria, and an increased risk of all-cause mortality within a 2-year follow-up.

Blunt mechanism chest wall injury: initial patient assessment and acute care priorities.

Blunt mechanism chest wall injury (CWI) is commonly seen in the emergency department (ED), since it is present in around 15% of trauma patients. The thoracic cage protects the heart, lungs and trachea, thereby supporting respiration and circulation, so injury to the thorax can induce potentially life-threatening complications. Systematic care pathways have been shown to improve outcomes for patients presenting with blunt mechanism CWI, but care is not consistent across the UK. Emergency nurses have a crucial role in assessing and treating patients who present to the ED with blunt mechanism CWI. This article discusses the initial assessment and acute care priorities for this patient group. It also presents a prognostic model for predicting the probability of in-hospital complications following blunt mechanism CWI.

From 3D Point Cloud to an Intelligent Model Set for Cultural Heritage Conservation

Cultural heritage conservation demands interdisciplinary and complex documentation and analysis while facing increasing pressure to adopt sustainable and productive practices. This paper bridges these gaps by proposing a methodology and a set of requirements for Building Information Modeling (BIM) models aligned with European directives for sustainability and productivity in the Architecture, Engineering, and Construction (AEC) sector. Leveraging 3D scanning and intelligent models, we establish information needs specific to conservation, encompassing material properties, historical data, and decay analysis. Interoperability, compatibility with advanced analytical tools, and open-source formats are emphasized for seamless data integration and accessibility. We further introduce two use cases for BIM-enabled heritage conservation, illustrating the application of our proposed methodology in real-world scenarios. These cases exemplify how BIM models cater to the specific needs of cultural heritage sites, from their initial condition assessment to ongoing preservation efforts. Through these examples, we demonstrate the adaptability of BIM technology in capturing and managing the complex information associated with heritage conservation, including structural details, material characteristics, and historical significance. Our work highlights the potential of BIM to revolutionize heritage conservation practices, offering a digital backbone for documentation, analysis, and management that aligns with sustainability and productivity goals.

Development and Initial Assessment of an Emotional Support Provision Training Intervention for Interpersonal Support Providers in the Context of Chronic Illness

ABSTRACT This study reports on the development and pilot testing of an emotional support provision training intervention for interpersonal support providers to those with chronic illnesses. Using findings from a needs assessment in combination with existing theory and research, we created a training framework consisting of verbal person-centered message design, empathic listening, and communicated perspective-taking. Then, we recruited 282 individuals to participate in a pre-training questionnaire, the online training module, a post-training questionnaire, and a two-week post-training questionnaire. Outcome variables included emotional support knowledge, efficacy, and intentions, as well as general support efficacy, response efficacy, and quality. Repeated measures MANCOVA revealed significant increases from T1 to T2 for all variables of interest. These increases were sustained at T3 for emotional support knowledge and efficacy, and support provision response efficacy. Participants rated the training favorably and provided helpful suggestions for improvement. This study answers the call for more theoretically-grounded support interventions that not only assess theory in real-world settings, but also help people better their supportive communication skills.

A pilot study on the efficacy of a seaweed mud application in the treatment of cellulite.

Cellulite represents a common multi-factorial condition that affects nearly all women and is now recognized as a clinical condition associated with systemic factors and negative psychological effects. Several noninvasive and minimally invasive treatments were developed during the last few years, but limited evidence supports many of them due to lack of evidence, insufficient participants, and potential adverse effects. This study aimed to evaluate the efficacy of a seaweed mud application in improving both the structure and function of tissues affected by cellulite. Sixty women with cellulite underwent 4-week applications of seaweed mud on the buttocks and thighs. The following assessments were performed at baseline and after the last treatment: photographic, clinical, and anthropometric evaluation; tests for elasticity and hydration; ultrasonography of cellulite nodules; and cellulite biopsies in the trochanteric region. Patient satisfaction was assessed using a 5-point Likert-scale questionnaire. The treatment resulted in a significant improvement in the severity of cellulite severity between the initial assessment and the 4-week follow-up, with enhanced structure, elasticity, and hydration of the affected tissues. Microscopic analysis of the cellulite biopsies revealed a significant restoration of dermal organization with induced collagen synthesis and reduced inflammation, edema, and lipid deposition following the 4-week seaweed mud applications. Additionally, the treatment led to a remarkable improvement in comfort and satisfaction as well as a reduction in body circumferences. The cosmetic application of seaweed mud has proven to be a safe, non-invasive treatment for improving the tissue alterations characteristic of cellulite.

Developing a capacity-building intervention for healthcare workers to improve communication skills and awareness of hard of hearing and D/deaf patients: results from a participatory action research study

BackgroundHealthcare workers (HCWs) are commonly not prepared to properly communicate with D/deaf and hard of hearing (HoH) patients. The resulting communication challenges reinforce the existing barriers to accessing and benefiting from quality of care in these populations. In response, this study aimed to develop and evaluate a capacity-building intervention for HCWs to raise their awareness of D/deaf and HoH individuals’ experiences in healthcare and improve their capacity to communicate with these populations.MethodsThis study featured a participatory action research design using qualitative and quantitative methods. The intervention was developed and tested through 4 iterative phases. Reactions (i.e., satisfaction and perception of the intervention content, quality, appropriateness and usefulness) were assessed quantitatively and qualitatively after the intervention, whereas perceived knowledge and self-efficacy in communicating with D/deaf and HoH patients and organizational payoffs (use frequency of basic rules and tools improving communication) were quantitatively assessed before, after and 6-month post-intervention.ResultsMain qualitative and quantitative findings showed that the final version of the intervention reached high levels of satisfaction among participants. Next, perceived knowledge and self-efficacy scores obtained after receiving the intervention and 6 months later were significantly higher than those yielded in the initial assessment, although both scores significantly decreased at 6 months (compared to the scores obtained just after the intervention). Finally, findings showed no significant changes in organizational payoffs after receiving the intervention. Echoing these results, main qualitative findings documented that after receiving the intervention, participants felt more confident yet not more equipped to communicate with D/deaf and HoH patients.ConclusionsFindings suggest that the capacity-building intervention is a promising means to sustainably increase HCWs’ perceived knowledge and self-efficacy on how communicating with D/deaf and HoH patients, although complementary approaches and follow-up intervention reminders may be necessary to enable practice changes in the working environment.

Longitudinal Muscle Biopsies Reveal Inter- and Intra-Subject Variability in Cancer Cachexia: Paving the Way for Biopsy-Guided Tailored Treatment.

In the rapidly evolving landscape of cancer cachexia research, the development and refinement of diagnostic and predictive biomarkers constitute an ongoing challenge. This study aims to introduce longitudinal muscle biopsies as a potential framework for disease monitoring and treatment. The initial feasibility and safety assessment was performed for healthy mice and rats that received two consecutive muscle biopsies. The assessment was performed by utilizing three different tools. Subsequently, the protocol was also applied in leiomyosarcoma tumor-bearing rats. Longitudinal muscle biopsies proved to be a safe and feasible technique, especially in rat models. The application of this protocol to tumor-bearing rats further affirmed its tolerability and feasibility, while microscopic evaluation of the biopsies demonstrated varying levels of muscle atrophy with or without leukocyte infiltration. In this tumor model, sequential muscle biopsies confirmed the variability of the cancer cachexia evolution among subjects and at different time-points. Despite the abundance of promising cancer cachexia data during the past decade, the full potential of muscle biopsies is not being leveraged. Sequential muscle biopsies throughout the disease course represent a feasible and safe tool that can be utilized to guide precision treatment and monitor the response in cancer cachexia research.

Quality of Life in Alcohol Use Disorder: Exploration of Predictive Factors in a Cross-Sectional Study

Alcohol use disorder (AUD) is a chronic and relapsing biopsychosocial condition that leads to various medical, psychological, social, economic, and personal issues. This study evaluated how sociodemographic characteristics, clinical variables, impulsivity dimensions, and cognitive functions were associated with quality of life (QoL) among patients seeking treatment for AUD. Furthermore, the study investigated the predictors of QoL among patients seeking treatment for AUD based on attention, cognitive instability, motor impulsiveness, perseverance, and self-control dimensions of trait impulsivity. This study also investigated the potential mediating effect of anxiety and alcohol use severity in this relationship. After an initial assessment, the participants underwent comprehensive evaluations, including sociodemographic data, clinical history, and QoL domains. The evaluations also covered AUD severity, impulsivity dimensions, cognitive functions, craving intensity, depression, anxiety, and self-efficacy. Multiple linear regression analyses were employed to identify associations between independent variables and QoL. The attention dimension of impulsivity and anxiety symptoms significantly predicted physical health domain of QoL. The self-control dimension and severity of alcohol use disorder predicted psychological domain of QoL. The indirect effect of attention dimension on physical health was significant [effect = −1.082, 95% CI (−2.008, −0.3598)]. The significance of impulsivity in influencing QoL for individuals with AUD has profound clinical implications. These findings underscore the importance of addressing anxiety and impulsivity in managing AUD, given their considerable impact, particularly on QoL, ultimately shaping treatment outcomes.

Exploration of Preliminary Objective Triage by Menopause Score and CA 125 Result Prior to Accelerating Fast-Track Booking for Suspected Ovarian Cancer-A Role for the Pathway Navigator?

The 28-days-to-diagnosis pathway is the current expected standard of care for women with symptoms of ovarian cancer in the UK. However, the anticipated conversion rate of symptoms to cancer is only 3%, and use of the pathway is increasing. A rapid triage at the moment of receipt of the referral might allow resources to be allocated more appropriately. In secondary care, multidisciplinary teams (MDTs) use the risk of malignancy index (RMI) score, (multiply menopausal status pre = 1 or post = 3 × ultrasound score = 0 - 3 × the CA 125 level), using a score of >200, to triage urgency and management in possible ovarian cancer cases. The most powerful determinant of the RMI score variables is CA 125 level, an objective number. Could a simple modification of the RMI score retain a high sensitivity for cancer whilst improving specificity and, consequently, decrease the morbidity of false-positive classification? To test this hypothesis, a retrospective evaluation of an ovarian two-week-wait telephone clinic of one consultant gynaecological oncologist was undertaken. Enquiry re menopause status was scored as one for pre- and three for postmenopausal or uncertain. CA 125 levels of >67 u/mL for premenopausal and >23 u/mL for postmenopausal women were used to precipitate urgent cross-sectional imaging requests and MDT opinions. These CA 125 cut thresholds were calculated using an assumption that the RMI imaging score, regardless of whether the result was available, could be three. We contemplate that women who did not exceed a provisional RMI score of >200 might be informed they are extremely unlikely to have cancer, removed from the malignancy tracker and appropriate follow-up arranged. One hundred and forty consecutive cases were analysed; 43% were deemed premenopausal and 57% postmenopausal. Twenty of the women had cancer, eighteen (90%) of whom had an RMI > 200. One hundred and twenty were benign, and only twenty-three (19%) classified as urgent cases in need of accelerated referral to imaging. In contrast, CA 125 > 35 u/mL, whilst retaining the sensitivity of 90%, misclassified 36 (30%) of the benign cases. It is possible that a telephone triage via a questionnaire determining menopausal status and the CA 125 result could offer a sensitivity for cancer of 90% and urgent expert review of under 20% of benign cases. This rapid initial telephone assessment could be presented by a trained pathway navigator, physician associate or nurse specialist. Substantial savings in NHS cancer services resources, anxieties all around and reduced patient morbidity may occur as a result.

(208) Enhancing Opportunities for Sexuality Assessment During Initial Mental Health Assessments: Barriers and Enablers for Psychiatric Registrars

Abstract Introduction Assessments of sexuality and sexual wellbeing is recommended as “best practice” in psychiatric assessments, however, education opportunities on sexuality and sexual wellbeing do not feature prominently in the training curriculum of psychiatric trainees in Australia. Objective To explore the training experiences of psychiatric trainees and identify barriers and enablers to enhance human sexuality assessments within mental health assessments. Methods Qualitative inquiry was adopted to allow for exploration of the issues. Semi-structured interviews of psychiatric trainees based at a metropolitan hospital and health service were conducted and analysed with a thematic analysis approach. Results Seven emergent themes were identified: barriers and enablers, skills and competence, inadequate training within the psychiatry training program, the belief that human sexuality is important to psychiatry, and training needs. Conclusions Psychiatric trainees believe that human sexuality and sexual wellbeing are an important part of mental health assessments. Despite this belief, participants reported a lack of direct training in sexual history taking, treatment of sexual issues, and sexual wellbeing, leading to an overall lack of confidence in assessing patients’ sexuality within mental health assessments. Psychiatrists of all levels of training require specific, regular education regarding human sexuality to ensure sound knowledge and consistent patient care. Disclosure No.

A qualitative exploration of ambulance clinician behaviour and decision making to identify factors influencing on-scene times for suspected stroke patients in North East England.

Ambulance clinician assessment of suspected stroke patients aims to provide rapid access to specialist care, however regional and national data show increasing pre-hospital times. This study explored paramedic views about factors contributing to on-scene time (OST) for suspected stroke patients, with a view to identifying opportunities for future interventions, to reduce OST. Views of paramedics from one regional service on factors influencing OST were explored using a qualitative approach. Semi-structured interviews with volunteers were recorded, transcribed and analysed using thematic analysis. Interviews were conducted with 13 paramedics between August and November 2021. Five interlinked themes were identified and described a range of factors influencing OST: 'Initial assessment and sources of information' describes how clinicians make assessments based on initial presentation, influenced by pre-arrival information from ambulance control and family members / bystanders at the scene, and how this influences OST.'Suitability for treatment and interventions' describes how paramedics consider actions such as the face, arms, speech test, cannulation, electrocardiograms and neurological assessments while recognising that pre-hospital interventions for suspected stroke are limited.'The environment' describes the influence of incident setting on OST, including the overall process needed to transport the patient to appropriate care.'Hospital interactions' describes how interactions with hospital staff influenced paramedic actions and OST.'Changing practice' describes the influence of experience and interaction with hospital staff leading to changes in paramedic practice over time. This study provides insight into how UK paramedics spend time on scene with stroke patients. Multiple factors influencing OST were identified which signpost opportunities for interventions designed to reduce OST. Standardising on-scene assessments for stroke patients, refining communication processes between ambulance services and hospital stroke services and increasing availability of stroke continuing professional development for paramedics were all identified as potential targets for improving OST.

Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement.

Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.