Activity Levels In Patients Research Articles

Are Sleep Quality, Physical Activity Levels, and Fear of Movement of Obstructive Sleep Apnea Syndrome Patients Different From Healthy People During the Coronavirus Disease 2019 Pandemic?

The sleep quality and physical activity levels of patients with obstructive sleep apnea syndrome during the lockdown period have not yet been investigated. The aim of this study was to evaluate the sleep quality, physical activity level, and fear of movement in patients with obstructive sleep apnea syndrome and healthy individuals during the coronavirus disease 2019 pandemic. Patients with obstructive sleep apnea syndrome (n = 33) and healthy individuals (n = 30) were included in the study. Physical activity levels, sleep quality, and fear of movement were evaluated. The total physical activity amount of patients with obstructive sleep apnea syndrome and healthy individuals was lower than the acceptable levels. The obstructive sleep apnea syndrome group had significantly lower leisure-time physical activity (P = .006) and higher sitting time (P = .008) than the healthy individuals. Patients with obstructive sleep apnea syndrome had significantly more sleep disturbances, daytime dysfunction, and daytime sleepiness than healthy people (P < .001). Fear of movement was negatively correlated with the amount of vigorous (r = -0.395, P = .023) and leisure activities (r = -0.557, P = .001) in the obstructive sleep apnea syndrome group. During the coronavirus disease 2019 pandemic, patients with obstructive sleep apnea syndrome and healthy individuals had lower physical activity levels. Physical activity counseling is an important strategy for increasing the physical activity of patients with obstructive sleep apnea syndrome and healthy individuals during and after the coronavirus disease 2019 pandemic.

Mental well-being and patient activation during the first eight months of the COVID-19 pandemic in Denmark - a cohort study among 710 Danish adults with chronic conditions

BackgroundCOVID-19 has highlighted the importance of patient activation in managing chronic conditions and promoting resilience during times of crisis. Patient activation refers to an individual’s knowledge, skills, and confidence in managing their own health and healthcare. Previous research has shown that people with higher levels of patient activation are better prepared to navigate the challenges of chronic illness and are more likely to engage in healthy behaviors. However, the impact of patient activation on COVID-19-related concerns and mental well-being among people with chronic conditions during the pandemic remains unclear. This study aims to investigate the possible role of patient activation in shaping COVID-19-related concerns and to describe changes in mental well-being among Danish adults with one or more chronic conditions during the early months of the pandemic.MethodsDanish adults with chronic conditions (e.g. diabetes, coronary heart disease, obstructive pulmonary lung disease, cancer) who had participated in a municipal health education program prior to the COVID-19 outbreak were asked to participate in this prospective questionnaire study in May 2020 and November 2020. Sociodemographic (sex, age, living status, educational attainment, employment status) and disease-related information (diagnosis, one or more chronic conditions) along with the Patient Activation Measure were collected before the outbreak and were obtained from a clinical database used for monitoring and evaluation of municipal health education programs. In contrast, the two questionnaires collected six months apart consisted of single items related to concerns about COVID-19 and the WHO-5 well-being index.ResultsA total of 710 people with chronic conditions (mean age 60.9 years; 55.8% female) participated at both time points. In bivariate analyses, patient activation was associated with COVID-19-related concern and well-being. At follow-up, participants experienced a significant decrease in well-being. The decrease was associated with poorer well-being measured six months earlier, a greater perception that it had become more challenging to take care of one’s health due to the pandemic, and finally, feeling lonely. The association between patient activation and well-being ceased to be significant in the multivariate regression model.ConclusionsA considerable proportion of people with chronic conditions participating in this study have been mentally burdened during COVID-19. Although lower levels of patient activation were associated with greater COVID-19-related concerns, it did not have a significant impact on mental well-being over time.

Predilection of Patellofemoral Cartilage Lesions in Patients with Posterior Medial Meniscal Root Lesions.

The present study aims to compare the presence and severity of patellofemoral osteoarthritis between patients with root lesions and non-root lesions. A total of 102 patients were included in this study (51 root lesions and 51 non-root lesions). The root lesion cohort was matched to a non-root lesion cohort based on sex, body mass index, and age at the time of surgery. Radiographic evaluation with modified Outerbridge scoring of MRI of the knee was performed to determine the severity of degeneration of the knee joint preoperatively. Mann-Whitney and Independent t tests were used to compare the groups. The root lesion group had statistically greater Outerbridge patella scores (M = 2.45 ± 1.12) and trochlear scores (M = 2.27 ± 1.37) than the non-root lesion patients (M = 1.78 ± 1.30, P = 0.006, and M = 1.55 ± 1.40, P = 0.010, respectively). When using a new scale for grading patellofemoral arthritis, the root lesion group had statistically greater scores (M = 8.33 ± 3.38) than the non-root lesion patients (M = 5.67 ± 3.07) (P < 0.001). Patients with root lesions have a greater degree of patellofemoral cartilage lesions than patients without root lesions. The presence of cartilage lesions preoperatively in root lesion patients has presented the question of whether repair is worthwhile or if one should delay surgery until arthroplasty is indicated. Future research should be carried out on outcomes of root repair surgery in patients with patellofemoral cartilage lesions, in addition to considering the patient's age, activity level, and other risk factors.

Pamiparib in combination with tislelizumab in patients with advanced solid tumours: results from the dose-expansion stage of a multicentre, open-label, phase I trial

BackgroundThe aim of this study was to investigate the antitumour activity, safety, and tolerability of pamiparib plus tislelizumab in patients with previously treated advanced solid tumours.MethodsIn this study, patients were enrolled into eight arms by tumour type. All received pamiparib 40 mg orally twice daily plus tislelizumab 200 mg intravenously every 3 weeks. The primary endpoint was objective response rate (ORR), assessed by the investigator per Response Evaluation Criteria in Solid Tumours v1.1. Secondary endpoints included duration of response (DoR), safety, and tolerability.ResultsOverall, 180 patients were enrolled. In the overall population, the ORR was 20.0% (range: 0–47.4 across study arms), with median DoR of 17.1 months (95% confidence interval [CI]: 6.2, not estimable [NE]). The highest ORR was observed in the triple-negative breast cancer (TNBC) arm (patients with BRCA1/2 mutations and/or homologous recombination deficiency) (ORR: 47.4%; median DoR: 17.1 months [95% CI: 3.0, NE]). Treatment-emergent adverse events (TEAEs) of ≥Grade 3 occurred in 61.7% of patients. Serious TEAEs occurred in 50.0% of patients.ConclusionsPamiparib plus tislelizumab showed a variable level of antitumour activity in patients with advanced solid tumours, with the highest ORR in TNBC and was associated with a manageable safety profile.Clinical trial registrationClinicalTrial.gov: NCT02660034.

Examining the effects of physician burnout on pain management for patients with advanced lung cancer.

Physician burnout is generally associated with worse clinical outcomes. The purpose of this study is to examine the effects of physician burnout on the quality of physicians' pain assessment and opioid prescribing for patients with advanced lung cancer. Moreover, we test whether these relationships are moderated by patient-level factors, such as patient race and activation level, that have a demonstrated impact on clinical encounters. We conducted a secondary analysis of data from a multisite randomized field experiment. From 2012 to 2016, 96 primary care physicians and oncologists who treated solid tumors were recruited from hospitals and medical sites in three small metropolitan and rural areas in the USA. Physicians saw two unannounced standardized patients who presented with advanced lung cancer. Standardized patients varied across race (Black or White) and activation level (activated, typical). Visits were audio recorded and transcribed. Pain management was evaluated by the quality of pain assessment and opioid prescribing during these visits. Mixed-effects linear regression and generalized mixed-effects modeling showed that higher levels of burnout were associated with a greater likelihood of prescribing an opioid and prescribing stronger opioid doses for patients. These effects were not moderated by patient race or activation level. Findings from this work inform our understanding of physician-level factors that impact clinical decision-making in the context of cancer pain management. Specifically, this study identifies the role of physician burnout on the quality of prescribing for patients with advanced lung cancer.

Patient activation in adults attending appointments in general practice: a cross-sectional study

BackgroundPatient activation refers to patients’ knowledge, confidence, skills, ability, beliefs, and willingness to manage their health and healthcare. Patient activation is an essential component of self-management and identifying patient activation levels will identify people at risk for health decline at an earlier stage. We aimed to explore patient activation in among adults attending general practice by (1) investigating differences in patient activation according to characteristics and markers of health-related behaviour; (2) examining the associations of quality of life and satisfaction with health with patient activation; and (3) comparing patient activation between persons with or without type 2 diabetes (T2D) and with or without elevated T2D risk.MethodsWe performed a cross-sectional study and recruited 1,173 adult patients from four Norwegian general practices between May to December 2019. The participants completed a questionnaire containing sociodemographic and clinical variables, the Patient Activation Measure (PAM-13), the quality of life and satisfaction with health items from the WHO Quality of Life-BREF, three questions about exercise (regularity, intensity and exercise time), the Finnish Diabetes Risk Score (FINDRISC) and Body Mass Index. We tested differences between groups and associations using Chi-squared tests, Fisher’s exact tests, t-tests, one-way ANOVAs and Spearman’s rho tests.ResultsThe sample’s mean PAM-13 score was 69.8 (0–100) (SD 14.8). In the total population, we found that participants reporting higher patient activation scores also reported more favourable health-related behaviours (exercise and healthy eating). We found positive correlations between the PAM-13 scores and, respectively, the quality of life score and the satisfaction with health score. We found no differences in patient activation between people with or without T2D and those with or without elevated T2D risk.ConclusionsWe found that higher patient activation was associated with favourable health-related behaviours, a better quality of life and better satisfaction with health among adults attending four general practices in Norway. Assessing patient activation has the potential to help general practitioners identify patients who might benefit from closer follow-up in advance of negative health outcomes.

Characterising the Effect of a Two-Armed Diet Intervention on Physical Activity Levels in Patients With Coronary Heart Disease

Characterising the Effect of a Two-Armed Diet Intervention on Physical Activity Levels in Patients With Coronary Heart Disease

Participation of quetiapine in oxidative stress and inflammation status in the treatment of drug overdose

Quetiapine (QT) belongs to the second generation of antipsychotics. It is mostly used to treat depression, bipolar disorder, and schizophrenia. During biotransformation via myeloperoxidase (MPO) QT is oxidized to quinoneimine and a reactive radical, which may contribute to the development of oxidative stress during intoxication. The coexisting inflammation may also significantly contribute to the disturbances in the course of QT poisoning. In this study, twenty-one patients poisoned with quetiapine were examined. The study aimed to assess the correlation between blood QT concentration and selected oxidative stress as well as inflammation biomarkers, such as MPO and C-reactive protein (CRP) levels in the serum of poisoned patients. The obtained results were related to the values of the control group consisting of 21 healthy people, untreated and not poisoned with the drug. In patients with a toxic QT concentration in the blood (3.15 ± 2.11 μg/mL), the activity of MPO and CRP serum level were significantly higher in comparison to the control group. The mean level of CRP in the study group was 76.74 mg/L, while in the control group only 1.86 mg/L. The increase in MPO activity and CRP blood level in patients after QT overdose may confirm the hypothesis of oxidative disorders arising during its biotransformation and concomitant inflammation. Statistically significant relationships between selected biomarkers and blood QT concentration, the patient's clinical condition and the type of therapy were demonstrated.

Status and factors associated with patient activation and its relationship with HIV clinic outcomes among Yi minority people living with HIV in Liangshan, China: a cross-sectional study.

Patient activation is determined by an individual's knowledge, skills and confidence in managing his/her health. It is vital for people living with HIV (PLWH) to enhance their self-management skills and health outcomes, especially those from low- and middle-income regions, since they are at higher risk of worse health outcomes. However, literature from those regions is limited, especially in China. This study aimed to explore the status and factors associated with patient activation among Yi minority PLWH in Liangshan, China and to determine whether patient activation is associated with HIV clinic outcomes. This cross-sectional study included 403 Yi minority people living with HIV in Liangshan between September and October 2021. All participants completed an anonymous survey measuring sociodemographic characteristics, HIV-related information, patient activation and illness perception. Multivariate linear regression and multivariate binary logistic regression were used to explore factors associated with patient activation and the association between patient activation and HIV outcomes, respectively. The Patient Activation Measure (PAM) score was low (mean = 29.8, standard deviation = 4.1). Participants with negative illness perception, low income, and self-rated antiretroviral therapy (ART) effect based on self-perception were most likely to have a lower PAM score (β = -0.3, -0.2, -0.1, respectively; all p < 0.05); those with having disease knowledge learning experiences and an HIV-positive spouse were more likely to have a higher PAM score (β = 0.2, 0.2, respectively; both p < 0.001). A higher PAM score (AOR=1.08, 95% CI: 1.02, 1.14) was associated with viral suppression, mediated by gender (AOR=2.25, 95% CI: 1.38, 3.69). Low patient activation level among Yi minority PLWH impacts HIV care. Our findings indicate patient activation is associated with viral suppression for minority PLWH in low- and middle-income settings, suggesting that tailored interventions enhancing patient activation may improve viral suppression.

#4416 MAINTAINING PHYSICAL ACTIVITY IN PATIENTS THROUGH INTRADIALYTIC VIRTUAL REALITY EXERCISE INTERVENTION: THE REVID STUDY

Abstract Background and Aims People suffering from Chronic kidney disease (CKD) have lower levels of physical activity than their healthy counterparts. The lower level of physical activity is associated with impaired physical function in people undertaking hemodialysis. The COVID-19 pandemic has worsened the physical activity level of this cohort. Intradialysis exercise programs have a positive impact on many functional variables, but despite these proven benefits exercise interventions are scarce in clinical practice. Our group is implementing strategies to increase clinical applicability of exercise programs. Virtual reality (VR) intradialysis programs improve function of patients. The main aim of this study was to analyze the impact of an intradialytic non-immersive VR exercise program on physical activity level of people undertaking hemodialysis treatment. Methods A randomized trial (the REVID study) included two groups of patients, exercising at different times during the dialysis session for up to 12 months. The present study includes participants from the REVID study who, once the study finished, continued exercising at their preferred time during the hemodialysis treatment, with the only support of the health professionals at the HD unit. Adherence to the exercise program was measured as a percentage (number of sessions attended divided by the number of sessions offered). The physical activity level was evaluated using the Human Activity Profile (HAP) questionnaire. The HAP scale is self-administered and a list of 94 daily activities; the maximal activity score (MAS) and adjusted activity score (AAS) were calculated in this evaluation. Depending on the outcome of the HAP, patients were classified as having physical activity levels that were “impaired” (&amp;lt;53 points), “moderately active” (53–74 points), or “active” (&amp;gt;74 points). These patients had been exercising The intradialytic exercise consisted of a non-immersive VR game called ‘Treasure Hunt’ in which the participant try to catch targets and avoid obstacles by moving their lower limbs (hip flexion, abduction and adduction, and knee flexion and extension). The difficulty level of the game was graduated according to the characteristics of each player and the patients were allowed to change their legs during the game at their convenience. The impact of the program on physical activity level was analyzed with a non-parametric test for paired simples (p&amp;lt;0.05). Results This study included 11 participants, mean age 71.6 (13.9) years, 9 males, median dialysis vintage 18 months (10 to 50 interquartile range), and Charlson index 6.3 (2.2). The AAS at the baseline of the REVID study was 66 (58-72 interquartile range). The median time that participants exercised in the REVID study was 12 months (6 to 18 months interquartile range). After 3 months of the present study, when they exercised at any time during dialysis, they maintained their physical activity level, from a median AAS of 69 (interquartile range 52-71), to a Median of 70 (interquartile range 41-74). The changes were non-significant. The mean adherence to the exercise sessions was 54.6 (11.7)%. Conclusion This study suggests that an intradialysis virtual reality exercise program maintains the physical activity level of elderly patients undertaking HD. Most of the participants in this long-term intervention were male and moderately active. Future interventions should include an ‘exercise champion’ professional in the units to recruit women and les conditioned participants, and to achive higher adherence rates.

Automatic Controlled Pressure Sensor to Prevent Pressure Ulcer Obtained For Prolonged Hospitalization

The prototype model presented in this paper proposes a solution for evaluating and preventing pressure ulcers in long-lasting bedridden patients. The system integrates various sensors capable of monitoring critical factors such as pressure, temperature, and moisture. These sensors are embedded within the prototype bed, allowing for the collection of real-time data concerning the patient's condition and identification of potential risk factors associated with pressure ulcer development. The bed is equipped with switches that facilitate the monitoring of the patient's mobility and activities. These switches can detect movements, providing valuable information on changes in posture, frequency of turning, and overall activity level. Through data analysis, the system can assess the probability of pressure ulcer occurrence, taking into account factors such as prolonged pressure on specific areas, excessive moisture levels, or extreme temperatures. This prototype model shows significant promise in preventing pressure ulcers among long-lasting bedridden patients. Continuous monitoring of the patient's physiological parameters and activity levels enables healthcare providers to receive timely alerts and intervene appropriately to mitigate the risk of pressure ulcers. Additionally, the system can generate informative reports and offer valuable insights into the patient's condition, assisting healthcare professionals in making informed decisions regarding patient care and preventive measures. Overall, this prototype model provides a comprehensive approach to evaluating and preventing pressure ulcers in long-lasting bedridden patients. By leveraging sensor technology and real-time data analysis, it has the potential to improve patient outcomes, enhance the quality of care, and reduce the incidence of pressure ulcers in this vulnerable population.

Feasibility and preliminary effectiveness of virtual reality as a patient education tool for people with cancer undergoing immunotherapy: a protocol for a randomised controlled pilot study in a regional setting

IntroductionPatient education is a critical component of healthcare delivery. However, medical information and knowledge are complex and can be difficult for patients and families to comprehend when delivered verbally. The...

PLASMA PLASMINOGEN ACTIVATOR INHIBITOR 1 ASSOCIATES WITH HYPERTENSION IN PROSTATE CANCER

Objective: The aim was to determine the activity of serum PAI 1 in men with prostate cancer and its relationship with hypertension characteristics. Design and method: 39 men (median age 63.8 [52.7; 70.5]) with prostate cancer were enrolled. Serum PAI 1 activity levels were determined using a modified colorimetric method of plasminogen activator determination. We examined the association of plasma PAI 1 with incident hypertension by multivariate logistic regression, adjusting for age, obesity, lipids, fasting glucose, kidney function, inflammation, and follow-up years. Results: Arterial hypertension was detected in 26 (66.7 %) patients with prostate adenocarcinoma. The median PAI 1 activity level in patients with prostate cancer was 77.95 [64.72; 92.12] U/mL, in the control group – 64.54 [52.35;85.45] U/mL (p&lt; 0.05). The PAI 1 activity level correlated with diastolic blood pressure (R = 0.69, p &lt; 0.001), duration of prostate adenocarcinoma (R = 0.42, p &lt; 0.001), and testosterone level (R = 0.60, p &lt; 0.001). Higher level of log-transformed PAI 1 was associated with 1.29-fold increased risk of hypertension [odds ratio (OR) (95% confidence interval): 1.29 (1.09–1.53)]. Conclusions: Men with prostate cancer are characterized by increased levels of PAI 1 associated with hypertension. More research is needed to establish a relationship between PAI 1 and hypertension in men with prostate cancer.

Anticancer Effects of Alpha-lipoic Acid on A172 and U373 Human Glioblastoma Cells

The high mortality rate of Glioblastoma multiforme (GBM) patients is partly due to the invasive behavior of the tumor cells. Given the increased resistance to conventional therapies of invasive cells after surgical operations, current treatments are ineffective. Therefore, understanding the mechanisms of GBM cell invasion is critical for the development of successful therapeutic approaches. Natural small molecules and metabolites are widely used as chemotherapeutic and adjuvant agents in cancer treatments because they have strong anticancer properties and minimal side effects. Alpha-lipoic acid (ALA) is an antioxidant that has been found to reduce the level of ROS and increase GPx activity in cancer patients. In this study, we analyzed the in-vitro cytotoxic potential and apoptotic effect in A172 and U373 cells in the presence of various concentrations (7.8-500 µM) of ALA. We also investigated scratch assay in both cell lines. The ALA inhibited cell viability of A172 and U373 cells at 48h. In addition, Bax mRNA expression was significantly increased in response to ALA for A172 cells. Furthermore, the BCL-2 level was decreased in A172 cells with ALA after 48h. Caspase 3 and 9 mRNA expressions were increased in ALA treated U373 cell line. In summary, we found that ALA inhibits cell growth and causes apoptosis in A172 and U373 glioblastoma cells.

Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges.

Proximal humeral fractures (PHFs) are a common type of fracture, particularly in older adults, accounting for approximately 5-6% of all fractures. This article provides a comprehensive review of PHFs, focusing on epidemiology, injury mechanism, clinical and radiographic assessment, classification systems, and treatment options. The incidence of PHFs varies across regions, with rates ranging from 45.7 to 60.1 per 100,000 person-years. Females are more susceptible to PHFs than males, and the incidence is highest in women over the age of 85. The injury mechanism of PHFs is typically bimodal, with high-energy injuries predominant in younger individuals and low-energy injuries in the elderly. Clinical assessment of PHFs involves obtaining a thorough history, physical examination, and evaluation of associated injuries, particularly neurovascular injuries. Radiographic imaging helps assess fracture displacement and plan for treatment. The Neer classification system is the most commonly used classification for PHFs, although other systems, such as AO/OTA, Codman-Hertel, and Resch classifications, also exist. The choice of treatment depends on factors such as patient age, activity level, fracture pattern, and surgeon expertise. Nonoperative management is typically preferred for elderly patients with minimal displacement, while operative fixation is considered for more complex fractures. Nonoperative treatment involves sling immobilization followed by physiotherapy, with good outcomes reported for certain fracture patterns. Operative management options include closed reduction and percutaneous pinning (CRPP), open reduction and internal fixation (ORIF), or arthroplasty. CRPP is suitable for specific fracture patterns, but the quality of reduction is crucial for favorable outcomes. ORIF is used when CRPP is not feasible, and various surgical approaches are available, each with its advantages and potential complications. PHFs are a significant clinical challenge due to their prevalence and complexity. Treatment decisions should be patient centered based on patient factors and fracture severity.

Phase I/IIa clinical trial of a small molecule EBNA1 inhibitor, VK-2019, in patients with Epstein Barr virus–positive nasopharyngeal cancer with pharmacokinetic and pharmacodynamic correlative studies.

6035 Background: Epstein-Barr Virus (EBV) is associated with a diverse collection of malignancies, including nasopharyngeal carcinoma (NPC). One viral-encoded protein, EBNA1, is consistently expressed in all known EBV-associated malignancies and is critical for the replication and maintenance of the EBV genome in latently infected cells. VK-2019 is a first-in-class, orally bioavailable EBNA1 inhibitor that blocks latent replication and proliferation in preclinical studies. Methods: We conducted a Phase I/IIa clinical trial of VK-2019 as a single therapeutic agent in patients with advanced (recurrent or metastatic) NPC. An accelerated titration design allowed dose escalation to proceed rapidly from 60 mg/day to 1800 mg/day. Blood samples for detailed pharmacokinetic analyses were collected after the first and multiple doses. In addition, tumor biopsies were collected from 2 patients at the 1800 mg/day dose level at baseline and during treatment and analyzed for EBV copy number and viral and cellular gene expression. Results: A total of 22 advanced NPC patients were enrolled. VK-2019 was well tolerated with mostly grade 1-3 adverse events being reported. VK-2019 is rapidly absorbed with a biphasic distribution and a terminal T1/2 of ~12h after single or multiple doses. Cmax and AUC increases with dose escalation through 920 mg with large variability at 1800mg. Accumulation has been observed with multiple doses up to 460mg. Based on preclinical efficacy models, target exposures are at or above expected activity levels for patients at least on the 920 mg daily dose and above. A partial response ( &gt; 30% decrease in tumor size) was observed for one patient. Preliminary results from biopsies from 2 patients show decreases in EBV copy number and viral gene expression (LMP2 and gp150). We also observed decreases in EBER-positive cells in one patient. Conclusions: In this study, VK-2019 was well tolerated, exhibiting an excellent safety profile and exposure above in vitro efficacy. An MTD has not been yet established. Preliminary results indicate a decrease in EBV copy number and viral gene expression in latently infected tumor cells in some patients. Alternate dose schedules are justified to determine the clinical efficacy of an EBNA1 inhibitor in patients with advanced NPC. Funded by NCI, R01-CA235633 and Cullinan Oncology. Clinical trial information: NCT04925544 .

PCR247 Relation of Patient Activation to Medication Adherence in Low-Literacy Older Adults with Chronic Health Conditions

Patient engagement may depend on patient activation and is one of the primary areas of focus in health economics and outcomes research. Data suggest demographic factors and health literacy impact patient activation to varying degrees. The primary purpose of this study was to explore the relation of patient activation to medication adherence in adults 40 years of age or older with chronic health conditions and low health literacy. Secondary objectives were to determine if demographic factors including age, education, gender, and race/ethnicity were related in this group to level of patient activation.

Osseointegration reduces aseptic loosening of primary distal femoral implants in pediatric and adolescent osteosarcoma patients: a retrospective clinical and radiographic study.

The challenge of distal femoral replacement (DFR) longevity remains a priority for orthopaedic oncologists as the overall survival and activity level of young patients with osteosarcoma continues to improve. This study hypothesized that increased extracortical osseointegration at the bone-implant shoulder (i.e., where the metal implant shaft abuts the femur) will improve stress transfer adjacent to the implant, as evidenced by reduced cortical bone loss, radiolucent line progression and implant failure in young patients (< 20 years) following DFR surgery. Twenty-nine patients of mean age 13.09 ± 0.56years received a primary DFR. The clinical outcome of 11 CPS®, 10 GMRS®, 5 Stanmore® and 3 Repiphysis® implants was evaluated over a mean follow-up period of 4.25 ± 0.55years. The osseous response to a bone-implant shoulder composed of either a hydroxyapatite-coated grooved ingrowth collar (Stanmore®), a porous metal coating (GMRS®) or a polished metal surface (Repiphysis®) was quantified radiographically. All (100.0%) of the Stanmore® implants, 90.0% of GMRS®, 81.8% of CPS® and 33.3% of the Repiphysis® implants survived. Significantly increased extracortical bone and osseointegration were measured adjacent to the Stanmore® bone-implantshoulder when compared with the GMRS® and Repiphysis® implants (p < 0.0001 in both cases). Significantly decreased cortical loss was identified in the Stanmore® group (p = 0.005, GMRS® and p < 0.0001, Repiphysis®) and at 3 years, the progression of radiolucent lines adjacent to the intramedullarly stemwas reduced when compared with the GMRS® and Repiphysis® implants (p = 0.012 and 0.026, respectively). Implants designed to augment osseointegration at the bone-implant shoulder may be critical in reducing short- (≤ 2years) to mid- (≤ 5years) term aseptic loosening in this vulnerable DFR patient group. Further longer-term studies are required to confirm these preliminary findings.

Early detection of fluid retention with a multisensory algorithm in chronic heart failure patients

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Leiden University Medical Center Background Hospitalizations for decompensated heart failure are a marker for poor prognosis and pose a burden on patients and resources. The mainstay in preventing these hospitalizations is early detection of fluid retention and timely pharmacological intervention. The multisensory cardiac implantable electronic device (CIED) based HeartLogic™ algorithm can alert in case of upcoming congestion. The cumulative HeartLogic™ index is based on the following sensors: heart sounds, thoracic impedance, respiratory rate, night heart rate and patient activity levels. The current analysis investigates the performance of the HeartLogicTM algorithm in a real-world ambulant heart failure population. Methods All consecutive heart failure patients with a CIED and an activated HeartLogic™ algorithm were included for analysis. Patients were followed from 01-01-2018 until 01-09-2022 according to the heart failure care path (figure 1). HeartLogic™ automatically generated an alert if the index surpassed the preset threshold of 16. An alert was either true positive (≥2 signs/symptoms of fluid retention on top of the alert) or false positive (≤1 signs/symptoms). Without an alert a patient was true negative (≤1 signs/symptoms) or false negative (≥2 signs/symptoms). A logistic regression model with linear mixed models was used. Furthermore, patients with ≥2 true positive alerts and ≤1 false positive alerts per year were compared to patients without alerts to identify characteristics of patients who benefit most from the HeartLogic™ algorithm supported management. Results Data of 138 patients were included, median age was 69 [60 – 77], 78% was male and 50% had an ischemic etiology of heart failure. Majority of the patients had a CRT-D (n=90, 65%) and the remaining 48 patients had an ICD (35%). Total follow-up entailed of 297 patient years, median follow-up was 26 months [14 – 36]. During follow-up, 231 alerts were observed. After exclusion of 14 alerts (incomplete clinical information), 217 alerts were available for analysis. Majority of these alerts were true positive for fluid retention(n=161, 74%). Of interest, 21 of these alerts (13%) were not primarily heart failure related, but prompted clinical action (e.g. pneumonia or anemia). The remaining 59 (26%) alerts were deemed false positive. The sensitivity to detect impending fluid retention was 86%, the specificity 88%. The positive predictive value was 73% and the negative predictive value was 94%. Patients with HeartLogicTM alerts had a significantly higher baseline NT-Pro BNP, when compared to patients without alerts, p&amp;lt;0.05 (Figure 2). No differential response was observed based on age, gender or BMI. Conclusions In a real world heart failure population the HeartLogic™ algorithm supported care path adequately detects impending fluid retention. Patients who benefited most had higher levels of NT-Pro BNP at baseline.

Expert opinion on optimal programming strategy to increase AV synchrony in different profiles of patients implanted with leadless ventricular pacemaker

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic Background Recently published real-world data showed that Micra leadless pacemaker implanted in the right ventricle can provide atrioventricular (AV) synchronous pacing by accelerometer-based mechanically sensing atrial contractions in patients with a high pacing burden (1). Routinely performed programming optimization of several novel parameters (particularly concerning the A3 and A4 windows) is key to improving AV synchrony (AVS). Purpose This project aims to define optimal programming recommendations for defined patient profiles. Methods An Experts Panel (ExpP), made up of 11 electrophysiologists from high-volume centers (37±17 Micra AV procedures/year) contributing to the Medtronic Micra AV prospective Post Approval Registry (PAR), was assembled to share their opinion about the optimal programming strategy to improve AVS in patients with: 1) slow sinus rhythm and high degree AV block, 2) fast sinus rhythm and high degree AV block, 3) intermittent AV-block. The following steps were followed: - Data from Micra AV PAR database were retrospectively analyzed and shared with ExpP. - An online survey was completed by the ExpP to evaluate their current programming strategy, based on PAR data. - After a face-to-face meeting to discuss the survey results, a second survey round was completed to reach consensus on the optimal programming strategy. Agreement was considered reached when &amp;gt;75% of responders did not disagree. Results Specific detailed programming recommendations have been developed for the three different patient profiles (Figure 1). Most importantly, it was agreed that Auto A3 Threshold and tracking check should be turned off in all patients, AV conduction mode switch should be turned off in all patients with high degree AVB, and the lower rate should be programmed in general to 50bpm. In addition, the following general recommendations were agreed on by the ExpP: - A pre-implant echocardiogram with a particular focus on diastolic function should always be performed to identify patients who may benefit from Micra AV implantation. - Micra AV auto-setup should always be performed at implant. - Before discharge, basic adjustments based on results of the Manual Atrial. Mechanical (MAM) test, patient activity level, and age should be performed. - At each follow-up visit, fine-tuning programming based on patient feedback, device data (in particular %AM-VP) and performance of a MAM Test. Conclusions An ExpP of Micra AV implanters agreed on general recommendations for Micra AV patients’ management before implant and during follow-up. Specific programming recommendations for patients with slow sinus rhythm and high degree AV block, fast sinus rhythm and high degree AV block, and intermittent AV block have been developed. A validation phase will show if the application of these indications in clinical practice may improve AVS.