Low Risk Research Articles

Effectiveness of the implementation of the birth planning and complication prevention (P4K) program for pregnant women in supporting the optimization of the labor process in the Working Area of Poasia Health Center, Kendari City

Overview: Improving maternal health is crucial for achieving the Sustainable Development Goals (SDGs), specifically reducing the Maternal Mortality Ratio (MMR) to 70 per 100,000 live births by 2030. Indonesia faces significant challenges in maternal health, particularly in Southeast Sulawesi. This study aims to analyze the impact of Birth Planning and Complication Prevention (P4K) on labor outcomes in the Poasia Health Center's working area in Kendari City. It focuses on the relationship between P4K preparation and the smoothness of labor among pregnant women in this region. Body of Knowledge: Maternal health is directly linked to lower maternal mortality and reduced complications during childbirth. Programs like P4K help pregnant women prepare for safe deliveries by educating them on recognizing danger signs and managing potential complications. Previous research has shown that birth planning and early detection of complications lower labor risks. These findings emphasize the importance of education, accessible health services, and psychological support to improve maternal health outcomes. Methods: The study used a cross-sectional design with a total sample of 69 pregnant women from the Poasia Health Center's working area. Data were collected through questionnaires and observations, with statistical analysis using the Chi-square test to assess the relationship between P4K preparation and smooth labor. Total sampling was employed to ensure all eligible participants were included. Results: Results revealed a significant link between P4K preparation and smoother labor. Of the 69 women surveyed, 85.7% who prepared for P4K had smooth deliveries, while 50% of those who did not prepare experienced complications. The statistical analysis indicated a p-value of 0.041, confirming the positive impact of P4K. Recommendation: The study recommends enhancing education and accessibility of P4K services, particularly for women facing transportation or economic challenges. Additionally, improving psychological support and educating families on pregnancy danger signs can further reduce complications and improve maternal health in the Poasia Health Center area.

2483 Hyponatremia In elderly: a systematic review and Meta-analysis

Abstract Introduction Hyponatremia is the most common electrolyte imbalance caused by serum sodium level of less than 135 mmol/L, prevailing 15 and 30% among hospitalised patients. Methods PRISMA guidelines were followed for this study. Pubmed was searched with the search term: (hyponatremia) AND (treatment OR control OR management [MeSH]) AND (elderly [MeSH]) with filters, timeline: 2000 to 21/07/2023, free full text articles and human species. Data extraction was done using Covidence app and depicted in PRISMA Flow diagram. Quality assessment was done by Cochrane Risk of Bias version 1. Odd’s ratio with 95% confidence interval was calculated for dichotomous outcomes. Mantel–Haenszel statistical method along with random effects model was used. Cochrane Q test was employed and I2 index was computed. Forest and Funnel plots were plotted. The analysis was done by Cochrane Review Manager. Results Out of 3222 results, 9 studies were included with total 980 patients. Eight were of vaptans and 1 of empagliflozin. Three studies had low risk of bias and were included in meta-analysis. Mean age and BMI were 70.55(SD = 14.5) years and 24.73(SD = 3.95) kg/m2 respectively. Most frequently occuring aetiology, comorbidity and symptom were congestive heart failure, hypertension and fatigue/malaise respectively. Mean baseline serum sodium was 124.89 mmol/L and mean rise was 9.142 mmol/L. Meta-analysis showed that placebo was significantly associated with achieving normonatremia as compared to treatment group (OR = 2.5, 95%CI:1.54,4.04, p = 0.0002,I2 = 0%). The most frequent reported side effects were nausea, dry mouth, pyrexia and thirst. Side effects both mild/moderate (OR = 1.12, 95%CI:0.69,1.81, p = 0.65, I2 = 0%) and serious (OR = 1.51, 95%CI: 0.77,2.98, p = 0.23, I2 = 0%) showed no difference between treatment and placebo groups. Treatment was not associated with rapid risk of overcorrection (OR = 1.65, 95% CI:0.57,4.81, p = 0.36, I2 = 0%). None showed osmotic demyelination syndrome. Conclusion We conclude that vaptans and Empagliflozin, although safe, show limited efficacy in hyponatremia treatment. Reference 1. Zhang X, Li XY. Eur Geriatr Med. 2020;11(4):685–692.

Past and future in vitro and in vivo approaches toward circulating factors and biomarkers in idiopathic nephrotic syndrome.

Predicting the risks of progression to chronic kidney disease (CKD) stage 5 in idiopathic nephrotic syndrome (NS) and recurrence of the disease (rNS) following kidney transplantation (KT) is a key assessment to provide essential management information. NS has been categorized etiologically as genetic and immune-based. A genetic cause can be identified in ~ 30% of children with steroid-resistant NS (SRNS), a finding associated with a very low risk of rNS following KT. In immune-based NS, clinical overlap is observed among steroid-sensitive NS, secondary-resistant NS, and SRNS not associated with disease-causing genetic variants (non-monogenic SRNS). While ~ 50% of SRNS patients with noidentified monogenic disease respond to intensified immunosuppressive treatments, the ones that do notrespond to this therapy have a high risk of progression to CKD stage 5 and post-KT rNS. Secondary-resistant patients who progress to CKD stage 5 display the highest risk of post-KT rNS. The proposed shared underlying mechanism of the immune-based NS associated with post-KT rNS is based on a systemic circulating factor (CF) that affects glomerular permeability by inducing foot process effacement and focal segmental glomerulosclerosis. However, identifying patients without a detected genetic form who will recur post-KT is a major challenge. Extensive efforts, therefore, have been made to identify CFs and biomarkers potentially capable of predicting the risk of progression to CKD stage 5 and post-KT rNS. This review discusses the in vitro and in vivo approaches employed to date to identify and characterize potential CFs and CF-induced biomarkers of recurrent NS and offers an assessment of their potential to improve outcomes of KT in this patient population.

2526 Web-based compassion interventions for family caregivers’ mental well-being

Abstract Introduction The ageing population has increased the demand for family caregivers, who often suffer from psychological distress, especially compassion fatigue. This systematic review and meta-analysis evaluate the effectiveness of web-based compassion interventions in improving the mental well-being of family caregivers. Methods MEDLINE, Embase, PsycINFO, Web of Science, Cochrane Library, and Proquest were searched from database inception until manuscript submission date. Eligible studies included family caregivers participating in web-based compassionate interventions with reported mental wellness indicators, such as self-compassion. Two independent researchers conducted a literature review, extracted data, and assessed the quality of each study using the Risk of Bias 2 tool. Random effects meta-analysis was performed to pool the data, followed by subgroup analyses, sensitivity analyses and Egger’s tests. Results Out of 1095 studies evaluated, eight randomised controlled trials (encompassing 1978 participants) were included, with 75% exhibiting low risk of bias and high-quality evidence. Meta-analysis results indicated positive effects of web-based compassion interventions on family caregivers’ self-compassion (SMD = 0.33, 95% CI 0.08 to 0.58, P = 0.009) and mindfulness (SMD = 0.46, 95% CI 0.03 to 0.90, P = 0.04). These interventions also demonstrated a positive impact on reducing stress (SMD: -0.32, 95% CI -0.59 to −0.04, P = 0.02) and anxiety (SMD: -0.28, 95% CI -0.47 to −0.09, P = 0.003). Subgroup analyses highlighted superior self-compassion outcomes for caregivers supporting individuals with mental illness and cancer compared to those caring for individuals with Alzheimer’s disease. Interventions lasting ≥8 weeks were the most common and effective. Conclusions Web-based compassion interventions benefit family caregivers by enhancing self-compassion, mindfulness, and reducing anxiety and stress. More well-designed studies are suggested for future clinical applications.

Effectiveness and Safety in Patients with Non-Valvular Atrial Fibrillation Who Switched from Warfarin to Direct Oral Anticoagulants in Medicare Population.

Atrial fibrillation (AF), a common heart rhythm abnormality, is linked to a higher risk of stroke. Traditionally, warfarin has been the primary anticoagulation treatment for reducing the stroke risk. The new standard of treatment by direct oral anticoagulants (DOACs) offers greater benefits including improved efficacy and fewer adverse effects with reduced monitoring. This study aims to evaluate the risk of stroke/systemic embolism (SE) and major bleeding (MB) among patients with AF who switched from warfarin to DOACs. This study utilized Medicare data to conduct a retrospective analysis of patients withnon-valvular atrial fibrillation (NVAF) who switched from warfarin to DOACs between January 1, 2012, and December 31, 2019. Patients with NVAF aged 65 and older who switched from warfarin and had continuous health plan enrollment were included. Descriptive statistics, propensity score matching (PSM), and Cox proportional hazard (PH) models were utilized to compare the outcomes and assess risks of SE and MB across the DOAC cohorts. Among 1,843,495 patients with NVAF on warfarin, 171,700 switched to DOACs within 90days of discontinuation (apixaban: 90,850; rivaroxaban: 67,698; dabigatran: 12,900). The mean follow-up period across DOAC cohorts ranged from 552 to 628days. After PSM, apixaban showed significantly lower rates of stroke/SE compared to dabigatran (2.99% vs. 3.98%, p<0.0001) and rivaroxaban (3.08% vs. 3.80%, p<0.0001). MB rates were also lower with apixaban versus dabigatran (4.29% vs. 5.57%, p<0.0001) and rivaroxaban (4.07% vs. 6.35%, p<0.0001). Cox PH models confirmed these findings, with apixaban demonstrating lower risks of stroke/SE [hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.72-0.96 vs. dabigatran; HR 0.91, 95% CI 0.85-0.96 vs. rivaroxaban] and MB (HR 0.79, 95% CI 0.71-0.89 vs. dabigatran; HR 0.68, 95% CI 0.65-0.72 vs. rivaroxaban). The risk of stroke/SE and MB varies significantly among patients with NVAF switching from warfarin to different DOACs, with apixaban presenting the lowest risk compared to dabigatran and rivaroxaban.

The transformative impact of the mediterranean diet and physical activity on Alzheimer’s disease

Alzheimer's Disease (AD) is a neurodegenerative condition that affects millions of people worldwide, being responsible for most cases of dementia. This disease, characterized by progressive cognitive decline, significantly impacts the quality of life of patients and their families. Amid the search for effective treatments, non-pharmacological interventions, such as the Mediterranean diet and physical activity, emerge as promising approaches for the prevention and management of Alzheimer's. Mediterranean Diet: Nutrition for Brain Health: The Mediterranean diet, which originates from countries such as Greece, Italy, and Spain, is recognized for its balanced dietary pattern, consisting of foods rich in neuroprotective nutrients. Among its main components are fruits, vegetables, whole grains, olive oil, fish, nuts, and red wine in moderation. These foods provide antioxidants, omega-3 fatty acids, vitamins, and polyphenols, which are essential for fighting oxidative stress and inflammation in the brain. Scientific research shows that adherence to the Mediterranean diet is associated with a lower risk of developing Alzheimer's and other neurodegenerative diseases. individuals who strictly follow this dietary pattern are 40% less likely to develop dementia compared to those who consume Western diets, rich in saturated fats and refined sugars The antioxidant role of the diet is critical for brain health, as it reduces damage caused by free radicals. Omega-3 fatty acids, present in fatty fish such as salmon and tuna, are known to promote synaptic plasticity and communication between neurons. In addition, olive oil, rich in anti-inflammatory compounds, helps protect nerve cells against inflammatory processes that contribute to the progression of AD. Physical Activity: Movement and Neuroprotection: Regular physical exercise is an equally effective intervention in combating brain degeneration. Exercise, especially aerobics, promotes neurogenesis in the hippocampus, a region responsible for memory and learning, showed that regular exercise increases hippocampal volume in older adults, slowing cognitive decline. Longitudinal studies, such as the one indicate that physical activity improves executive functions, memory, and attention in older adults with mild cognitive impairment. In addition, exercise reduces metabolic risk factors, such as obesity, hypertension, and diabetes, which are directly associated with the progression of AD. Point out that up to a third of Alzheimer's cases could be avoided through interventions aimed at reducing these factors.

Examining the associations between social support and postpartum depression symptoms among adolescent mothers in Nairobi, Kenya.

Globally, adolescent mothers are at increased risk for postpartum depression (PPD). In Kenya, 15% of adolescent girls become mothers before the age of 18. While social support can buffer a mother's risk of PPD, there are gaps in knowledge as to whether-and which types-of social support are protective for adolescent mothers in Kenya. Understanding the associations between support and postpartum depression symptoms among adolescent mothers can inform mental health interventions. Cross-sectional data of adolescent mothers ≤ 1 year postpartum (aged 14-19 years old) in an informal settlement in Nairobi, Kenya (N = 193) were used in analyses. Participants with scores ≥ 10 on the Patient Health Questionnaire-9 were classified as having postpartum depressive symptoms. To fully examine the different ways that social support might matter for adolescent mothers, we examined several domains of social support: child's father support during pregnancy, parental support during pregnancy, parental support of girl's education, membership in a social club, having a good female friend and having a supportive female adult one can turn to for help. We used bivariate and adjusted modified Poisson regression with robust standard errors to examine the associations between support measures and depressive symptoms, controlling for relevant covariates. One-quarter of participants experienced postpartum depressive symptoms (24.9%). Adolescent mothers who reported their mothers or their fathers as being very supportive of girls' education had a lower risk of depressive symptoms (ARR 0.35, 95% CI 0.20-0.61; ARR:0.34, 95% CI 0.13-0.90, respectively) than those whose mothers or fathers were less supportive. Adolescent mothers who had a good female friend to confide in had decreased risk of depressive symptoms (ARR 0.61; 95% CI 0.37-0.99). Having a mother or father being very supportive of girls' education and having a good female friend reduced risk of depressive symptoms. With the unique challenges of early childbearing and high adolescent birth rates in Kenya, interventions which increase parental and peer support during pregnancy and the postpartum period could improve adolescent mothers' mental health.

Sex differences in the associations of water, coffee and tea consumption with cardiovascular diseases: a prospective cohort study

BackgroundWater, coffee and tea are the primary sources of daily hydration. However, the sex-specific relationship between these beverages and cardiovascular disease (CVD) among remains unclear.MethodsIn total, 210,239 men and 251,383 women from the UK Biobank were included. The consumption of water, coffee and tea were self-reported. CVDs, including coronary heart disease (CHD), stroke and heart failure (HF) were followed till March 1st, 2023. Sex-specific Cox models were utilized to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations.ResultsDuring a median follow-up of 8.7 years, 11,098 (2.40%) participants developed new-onset HF, 33,426 (7.24%) participants developed new-onset CHD, and 9,706 (2.10%) participants developed new-onset stroke. After adjustments, higher water consumption was generally associated with reduced risk of CVDs among both men and women. In contrast, heavy coffee consumption (particularly ≥6 cups/day) was associated with a greater risk of HF [1.16 (1.03–1.31) in men vs. 1.25 (1.12–1.40) in women], a greater risk of CHD [1.27 (1.18–1.36) in men vs. 1.21 (1.14–1.29) in women] and a greater risk of stroke [1.13 (0.99–1.29) in men vs. 1.20 (1.03–1.31) in women]. Similarly, heavy tea consumption was associated with an increased risk of HF (men: HR 1.19 [1.08–1.31]; women: HR 1.12 [1.02–1.23]) and CHD (men: HR 1.12 [1.05–1.18]; women: HR 1.18 [1.12–1.24]).ConclusionOur study revealed that water consumption was associated with a lower risk of CVDs, with a lower risk of CVDs, while heavy coffee or tea consumption was linked to a higher risk. Notably, coffee and tea consumption partially attenuated the protective association of water intake with CVDs. Furthermore, significant sex differences were observed in the associations between coffee or tea consumption and CHD incidence.

Association of Sleep Traits With Venous Thromboembolism: Prospective Cohort and Mendelian Randomization Studies.

Previous research indicates an association between sleep traits and venous thromboembolism (VTE) risk, though causal relationships remain uncertain. This study evaluated combined and independent associations between sleep traits and VTE risk using UK Biobank data and explored the causal associations between sleep traits and VTE through two-sample Mendelian randomization (MR) analyses. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the associations between the healthy sleep score, as well as individual sleep traits (including sleep duration, insomnia, daytime sleepiness, snoring, and chronotype), and VTE risk were calculated using Cox proportional hazards regression models. Additionally, the two-sample MR analyses used the inverse-variance weighted method to determine odds ratios (ORs) and 95% CIs for causal associations. In the cohort analysis, 314 077 VTE-free participants were followed for a median of 12.3 years, during which 7176 VTE cases occurred. In comparison to those with a sleep score of 0-1, participants with a score of 5 were associated with a 30% lower risk of VTE (HR: 0.70; 95% CI: 0.61-0.80). A U-shaped association was noted between sleep duration and VTE risk. Both short (≤ 6 h) and long (≥ 9 h) sleep durations increased VTE risk. Excessive daytime sleepiness, snoring, and evening chronotype also elevated VTE risk. MR analyses supported a causal relationship for short sleep duration (OR: 1.24; 95% CI: 1.04-1.47) with VTE risk, while other sleep traits showed no causal association. These findings underscore the importance of optimal sleep in reducing VTE risk.

Bilateral carotid body tumor management: tips, tricks, strategies, and problems

Purpose of review Carotid body tumors (CBTs) are rare neuroendocrine tumors with an annual incidence of 1 : 30 000. Bilateral carotid body tumors (BCBTs) account for 3–5% of all CBTs and are more frequently linked to familial syndromes and potential malignancy. BCBT management is still not universally standardized and depends on multiple factors, including patient's age, risk of malignancy, location, growth rate, size, and related Shamblin and Mehanna classifications. Recent findings Options of treatment include active surveillance, external beam radiation, and surgery. Surgery is the first-choice treatment, but it may not always be performed especially in elderly patients. Simultaneous BCBT resection is not suggested due to high intra-operative and postoperative risks. The decision to operate on the larger or smaller tumor first is still debated. Whenever feasible, treatment of the larger tumor first to reduce the tumor burden should be preferred but with higher risks of neurovascular injury. Conversely, starting with the smaller tumor first offers a lower risk at initial surgery but may complicate the management of the larger tumor later. Summary Surgery for BCBTs, whenever feasible, remains the most indicated treatment but poses a significant risk of neurovascular complications. Resection of the larger, often more symptomatic, and potentially problematic or malignant tumor, reduces the overall disease burden and mitigates risks of rapid progression but involves a higher immediate complication hazard. Multidisciplinary evaluation is essential for balancing surgical risks and long-term outcomes, prioritizing neurovascular preservation and reducing morbidity.

Prevalence and impact of Internet Gaming Disorder: A population-based study

Internet Gaming Disorder (IGD) has emerged as a significant public health concern, yet not enough is known about its prevalence among the general population as well as its relationship to well-being, mental health, specifically depression and anxiety, and gaming genres. This study aimed to address these questions. The research was conducted on a representative sample of the Croatian general population including 4,994 participants, aged between 15 and 64 years (M = 40.75, SD = 15.49). The Ten-Item Internet Gaming Disorder Test, Mental Health Inventory-5, Personal Well-being Index, Gaming time and Game Genres Preferences were used. The prevalence of the IGD in the general population of Croatia, aged 15-64 years, was estimated at 0.48%, 95% CI [0.30%, 1%], and among video game players (N = 1,239) at 1.63%, 95% CI [1.11%, 3%]. The highest prevalence was observed among young males. IGD showed the strongest relationship with depression, and weaker relationships with anxiety and well-being. Among the individual criteria, negative consequences for significant relationships, deception and escape had the strongest, while tolerance, loss of control and withdrawal had the weakest relationship to depression, anxiety and well-being, in a relative sense. Sports games and casual games players had lower risk for IGD, while other genres did not differ in their risk for IGD. Online and offline games did not differ in their risk for IGD. This study has shown that IGD has a relatively low prevalence among the general population and video game players, and that not all IGD criteria are equally relevant. Future longitudinal studies and studies on clinical samples are needed.

Prevalence and Determinants of Sarcopenia Among Older Adults in India: Insights From the Longitudinal Aging Study in India.

Sarcopenia, characterized by declining muscle mass and function, is a growing concern among India's aging population. This study investigates sarcopenia's prevalence and determinants using the nationally representative LASI dataset. This analysis included 26,780 community-dwelling adults aged 60 and above, with informed consent obtained from all participants. Sarcopenia was defined using the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Demographic, socioeconomic, health, and geriatric factors, including age, sex, living arrangements, economic status, comorbidities, and geriatric syndromes, were examined. Multinomial logistic regression was used to analyze associations with sarcopenia and severe sarcopenia, and results were expressed as relative risk ratios (RRR) with 95% confidence intervals (CI). The prevalence of sarcopenia was 43.6% (n = 11,665), and 19.4% (n = 5202) had severe sarcopenia. Sociodemographic factors significantly associated with sarcopenia and severe sarcopenia included being widowed (RRR: 1.24, 95% CI: 1.12-1.37 for sarcopenia; RRR: 1.82, 95% CI: 1.64-2.03 for severe sarcopenia) or divorced (RRR: 1.68, 95% CI: 1.12-2.54 for severe sarcopenia). Additionally, a higher BMI and higher education level were associated with a lower risk of sarcopenia. Among comorbidities, joint and bone diseases were linked to both sarcopenia (RRR: 1.21, 95% CI: 1.07-1.35) and severe sarcopenia (RRR: 1.4, 95% CI: 1.23-1.58), while hypertension (RRR: 1.22, 95% CI: 1.1-1.36), chronic lung disease (RRR: 1.22, 95% CI: 1.02-1.44), and cerebrovascular accident (RRR: 1.5, 95% CI: 1.09-2.08) were specifically associated with severe sarcopenia. Geriatric syndromes such as tooth loss, impaired vision and hearing, history of falls, and depression were significantly associated with increased risk of sarcopenia. This study reveals significant associations between sarcopenia and various sociodemographic factors, comorbidities, and geriatric syndromes in older adults in India, suggesting potential areas for targeted intervention. However, further longitudinal studies are needed to validate these findings and clarify the causal relationships of the observed associations.

Lipid Levels and Lung Cancer Risk: Findings from the Taiwan National Data Systems from 2012 to 2018

BackgroundLipids are known to be involved in carcinogenesis, but the associations between lipid profiles and different lung cancer histological classifications remain unknown.MethodsIndividuals who participated in national adult health surveillance from 2012 to 2018 were included. For patients who developed lung cancer during follow-up, a 1:2 control group of nonlung cancer participants was selected after matching. Multivariate conditional logistic regression was used to explore the associations between lipid profiles, different lung cancer histological classifications and epidermal growth factor receptor mutation statuses. Subgroup, sensitivity, and dose‒response analyses were also performed.ResultsA total of 4,704,853 participants (30,337 lung cancer participants and 4,674,516 nonlung cancer participants) were included. In both the main and sensitivity analyses, the associations remained constant between lower high-density lipoprotein (HDL) cholesterol levels and a higher risk of lung cancer (main analysis: odds ratio: 1.13 [1.08–1.18]) and squamous cell carcinoma (1.29 [1.16–1.43]). Hypertriglyceridemia was associated with a lower risk of adenocarcinoma (0.90 [0.84–0.96]) and a higher risk of small cell lung cancer (1.31 [1.11–1.55]). Hypercholesterolemia was associated with a lower risk of squamous cell carcinoma (0.84 [0.76–0.94]). In the subgroup analysis, lower HDL cholesterol levels were associated with greater risk across most subgroups. HDL cholesterol levels also demonstrated a dose‒response association with the development of lung cancer.ConclusionsThe distinct associations between specific lipid profiles and lung cancer subtypes suggest that lipid metabolism may play different mechanistic roles in lung cancer development.

Influence of Recipient Insurance on the Outcome of Simultaneous Pancreas and Kidney Transplantation.

Simultaneous pancreas-kidney (SPK) transplantation is an established treatment for insulin-requiring diabetics with advanced chronic or end-stage kidney disease. Outcomes of SPK transplantation may vary according to socioeconomic factors such as funding sources. The aim of this study was to assess the association between insurance payer of transplant recipients and outcomes of SPK transplantation in the United States. All adult primary SPK transplants performed in the United States between January 1, 1988, and December 31, 2017 were included, using data from the national Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients database. A total of 19,849 adult SPK transplant recipients were included in the study, after excluding patients who had insurance sources other than Medicaid, Medicare, or private; dual insurance; or were lost at 90-day follow-up. Post-transplant outcomes were analyzed in terms of allograft and recipient survival. Recipients with private insurance had significantly lower risks of late kidney graft loss (hazard ratio [HR], 0.74), late pancreas graft loss (HR, 0.77), and late death (HR, 0.73) compared with those with Medicaid. Recipients with Medicare had a higher risk of late death (HR, 1.05). Private insurance recipients had better 10-year and 15-year kidney, pancreas, and patient graft survival rates across most racial/ethnic groups. Recipient insurance status significantly influenced long-term outcomes after SPK transplantation. Transplant programs should consider publicly sponsored insurance status as a marker of poorer post-transplant survival to implement changes in both pre- and post-transplant strategies.

P-99. Comparative Analysis of False Positive Results in Low and High Risk U.S. Populations: New Access HIV Ag/Ab combo Assay vs. Abbott ARCHITECT HIV Ag/Ab Combo Assay

Abstract Background The fully automated 4th gen HIV Ag/Ab combo assay by Beckman Coulter, Inc. on the DxI 9000 Access Immunoassay analyzer allows for separate reporting of HIV-1 p24 Ag and HIV-1/HIV-2 Ab results, with a time to first result of ̴30 minutes and a sample volume of 60µL. To evaluate its performance, a U.S. multisite study was conducted to compare the Access HIV Ag/Ab combo assay with the ARCHITECT HIV Ag/Ab Combo assay. False positive rates were assessed in low and high risk U.S. populations with unknown HIV status by comparing the new Access HIV Ag/Ab combo assay with the ARCHITECT HIV Ag/Ab Combo assay.1 Footnotes Methods The evaluation tested 6,981 low risk and 799 high risk samples (adult, pregnant, pediatric) at 3 clinical trial sites. Following the CDC recommended algorithm, samples that initially tested reactive were subjected to duplicate testing, if repeatedly reactive, were further confirmed using the HIV 1/2 differentiation assay (Geenius HIV-1/2 Supplemental Assay, Bio-Rad), and the HIV-1 RNA PCR Assay (Aptima HIV-1 Quantitative Dx Assay, Hologic, Inc).2 Results The Access HIV Ag/Ab combo assay showed a lower incidence of false positive results (n=25) in the low risk group with a specificity of 99.6% (n=6981; 95% CI: 99.5-99.8%) compared to the ARCHITECT HIV Ag/Ab Combo assay (n=87) with a specificity of 98.8% (n=6981; 95% CI: 98.5-99.0%). Similarly, in the high risk group, the Access HIV Ag/Ab combo assay yielded fewer false positive results (n=1) with a specificity of 99.9% (n=799; 95% CI: 99.3-100.0%) than the ARCHITECT HIV Ag/Ab Combo assay (n=11) with a specificity of 98.6% (n=799; 95% CI: 97.6-99.2%). Conclusion Falsely reactive HIV test results can have significant consequences for patients and healthcare providers. Selecting an appropriate HIV assay with high sensitivity and specificity is essential. This study provides evidence that the Access HIV Ag/Ab combo assay is an attractive alternative to the ARCHITECT HIV Ag/Ab Combo assay with fewer false positive results, suggesting improved accuracy in identifying HIV infections in both low and high risk U.S. populations. Disclosures Fred S. Apple, PhD, Mindray: Advisor/Consultant|Werfen: Advisor/Consultant Robert H. Christenson, PhD, DABCC, FADLM, FACC, Beckman Coulter: Advisor/Consultant|Beckman Coulter: Grant/Research Support|Beckman Coulter: Honoraria|Becton Dickinson: Advisor/Consultant|Becton Dickinson: Grant/Research Support|Becton Dickinson: Honoraria|QuidelOrtho: Advisor/Consultant|QuidelOrtho: Grant/Research Support|QuidelOrtho: Honoraria|Roche Diagnostics: Advisor/Consultant|Roche Diagnostics: Board Member|Roche Diagnostics: Grant/Research Support|Roche Diagnostics: Honoraria|Siemens Healthineers: Advisor/Consultant|Siemens Healthineers: Board Member|Siemens Healthineers: Grant/Research Support|Siemens Healthineers: Honoraria

P-1589. Characterization of Blood Culture Ordering Practices at a Single Veterans Affair Medical Center

Abstract Background Blood culture (BCx) is the gold standard for definitive diagnosis of bacteremia and fungemia, but there is limited guidance for ordering practices. Unnecessary BCx increases the risk of false positives which can lead to increased length of stay, antibiotic use (AU), and additional testing. Diagnostic stewardship aims to optimize the use of diagnostic tests to improve patient management and outcomes. This study aimed to describe the current practice of BCx ordering at a single facility and identify areas for intervention. Methods This was a retrospective review of BCx ordered from 11/01/23 to 12/31/23. BCx were excluded if there was no encounter 5 days before or 2 days after BCx collection or initial BCx were drawn at another facility. Labs, vitals, BCx order date/time, ordering provider, location and results, AU and antibiotic indication were extracted from the Corporate Data Warehouse. Indications for BCx and endovascular infection risk were determined via chart review. Appropriateness of BCx was determined by an algorithm denoting low, intermediate, or high risk of bacteremia associated with an infectious disease state (Figure 1). Intermediate and high risk were deemed appropriate. Endpoints were analyzed with descriptive statistics. Results 243 BCx were evaluated and 215 were analyzed. 156/215 (73%) were ordered in the Emergency Department (ED) (Table 1). 113/215 (53%) of BCx were appropriate with the most common indications including sepsis, intra-abdominal infection, and severe community acquired pneumonia (CAP) (Table 2). The rate of appropriateness was similar across clinical departments (Figure 2). For inappropriate BCx, 41 had no suspected infection documented, and CAP, cellulitis, and cystitis were the most documented indications (Table 2). 17/215 (8%) of BCx were positive, 6/102 in low risk, and 11/113 in intermediate/high risk group. 4/6 in the low risk were identified as contaminants. Conclusion This study found ∼50% of BCx were ordered unnecessarily, and there was both low positivity rate and false positives in this group reflecting current literature. Similar BCx ordering practices were identified across services. These findings highlight the need for intervention system wide to promote strong diagnostic stewardship and appropriate BCx ordering practices. Disclosures All Authors: No reported disclosures

Cardiologic follow-up of patients treated with trastuzumab in an European university referral centre: do we follow the guidelines?

Abstract Introduction The 2022 Clinical Practical Guidelines of the European Society of Cardiology recommend a close follow-up by imaging techniques in patients on trastuzumab therapy, with at least 4-5 echocardiograms by year, even though it has been reported a low incidence of cardiotoxicity in previous registries. However, the degree of application of these recommendations in various clinical settings is unknown. Our aim was to investigate the "real-life" management of the cardiological follow-up of patients treated with trastuzumab in a European referral university hospital, with special focus on the profile of this population, the imaging tests performed and the incidence of cardiotoxicity. Methods All patients treated with trastuzumab at a Spanish reference university hospital during 2022 were included. Medical records were reviewed between March and September 2023. We analyzed risk factors for cardiotoxicity according to definitions by guidelines, the imaging techniques performed and cardiotoxicity events. Results Of a total of 176 patients treated, 6 were excluded because they were participating in clinical trials, thus 170 patients were included in the study (97% female, mean age 57 +/- 12 years). The most frecuent tumor was breast cancer (95,3%) followed by gastric (3,5%) and head and neck cancers (1,2%). Cardiotoxicity risk was low, moderate, high and very high in 21,8%, 49,4%, 15,9% and 12,9% of patients. Along treatment time of 13 [10-16] months (median [p25-75]), a total of 429 imaging techniques were performed (1,7 [0,9-2,8] per patient-year): 276 echocardiograms (64%) -of wich 146 were advanced echocardiograms (3D echo or speckle tracking imaging)- and 153 radionuclid ventriculographies (36%). The median number of imaging techniques by year was similar among patients with low, moderate or high/very high risk: 1,2 [0,6-2,2], 1,8 [1,0-2,6] and 2,0 [0,7-3,0], p=0,18. Ventricular dysfunction (ejection fraction &amp;lt; 50%) in follow-up was observed in 3,5% of patients, and it was significantly more frequent in those with very high risk of cardiotoxicity (0% low risk, 2,4% moderate risk, 0% high risk and 18,2% very high risk, p=0,001). Moreover, 0,6% patients needed hospital admission for heart failure, all of them with very high risk (4,5% of this group, p=0,08 versus other groups). Other clinical data, complementary tests and follow-up are shown in the table. Conclusions The majority of patients treated with trastuzumab in a tertiary center in our setting have a low or intermediate risk of cardiotoxicity. After a median follow-up of 13 months, a median of 1,7 [0,9-2,8] imaging tests/year were performed, with no significant differences by risk group. The most frequently performed cardiac imaging technique was echocardiography, but more than one third of the tests were radionuclid ventriculography. The incidence of ventricular dysfunction and hospital admission for heart failure were significantly higher in the very high risk group.

Integration of Apolipoprotein B into the SCORE2 Framework: Implications for Cardiovascular Risk Prediction.

To evaluate whether integrating Apolipoprotein B (ApoB) into the SCORE2 cardiovascular risk prediction framework improves its predictive accuracy and clinical applicability within the UK Biobank population. A 10-year prospective cohort study was conducted with 448,303 UK Biobank participants eligible for SCORE2 calculation. Three approaches were employed: (1) threshold analysis to determine the optimal ApoB cutoff for cardiovascular disease (CVD) risk prediction using Youden's Index, (2) assessment of the synergistic effect of SCORE2 and ApoB through concordant and discordant classifications, and (3) recalibration of the SCORE2 model by incorporating ApoB as an additional predictor. Each 0.2 g/L increase in ApoB was associated with an increased subdistribution hazard for CVD events (SHR: 1.13; 95% CI: 1.11-1.14, p < 0.001), accounting for non-cardiovascular death as a competing risk. Threshold analysis identified an optimal ApoB cutoff at 1.18 g/L; however, it demonstrated limited discriminatory performance (area under the curve 0.54), with low sensitivity (32.4%) and moderate specificity (74.4%). Individuals with both low ApoB (<1.18 g/L) and low SCORE2 risk (<5%) had a lower CVD incidence rate (232.51 per 100,000 person-years) compared to those identified as low risk by SCORE2 alone (253.69 per 100,000 person-years). Integration of ApoB into the SCORE2 model did not significantly improve the model discrimination, calibration and net reclassification improvement. ApoB exhibited a dose-response relationship with cardiovascular risk but had limited standalone predictive utility within the UK Biobank population. However, combining ApoB with SCORE2 thresholds improved the identification of low-risk individuals, suggesting a complementary role for ApoB in refining cardiovascular risk stratification.

P-884. A Scenario-Based Survey of Clinician Recommendations for Follow-up Blood Cultures in Patients with Varying Risk of Persistent Gram-Negative Bacteremia

Abstract Background Studies examining the impact of follow-up blood cultures (FUBCs) in patients with gram-negative bacteremia (GNB) have shown mixed results. In practice, FUBCs are variably obtained. Understanding practice variation and motivation for ordering FUBCs is important to determine how providers stratify patients at high risk for persistent GNB.Figure 1:Global distribution of survey respondents (n=864). Methods We surveyed clinicians (physicians, pharmacists, clinical microbiologists, physician assistants, nurses, medical trainees) globally between 2/21/24-4/9/2024 to understand when they would obtain FUBCs in patients with GNB using 10 hypothetical patient scenarios. Scenarios were generated by varying age, clinical status after 48 h of antibiotics, and risk of persistent GNB based on our published AIMS scoring tool (Antibiotics, Infection source, Medical conditions, Serratia). The survey contained 4 low-risk cases (AIMS 0-1), 3 intermediate-risk cases (AIMS 2-3), and 3 high-risk cases (AIMS 4-6). This anonymous web-based survey was distributed through listservs, email, and social media.Table 1:Demographic characteristics of survey respondents (n=864). Results In total, 864 respondents from 50 different countries and 6 continents (Figure 1) opened the survey and provided 791 recommendations on FUBC ordering (791/864; 91.5%). Respondent demographics are described in Table 1. Most respondents were physicians (86.5%) specializing in infectious diseases (79.7%) who were within 10 years of training completion (52.3%); a plurality managed least 6-10 cases of GNB/month (22.7%). FUBCs were frequently recommended, with &amp;gt;40% of respondents recommending FUBCs in 7/10 scenarios. Fair inter-respondent agreement was seen across all scenarios (Fleiss kappa 0.27), with notable agreement for cases with high AIMS scores (Fleiss kappa 0.24) (Figure 2). Patient age and clinical status after antibiotic administration were not associated with FUBC recommendations. Survey results of FUBC recommendations by individual case scenario (1-10) stratified by low, intermediate, and high risk AIMS scores. Bar graphs represent percentage of recommendations in favor (yes) or not in favor (No) of FUBCs in patients with GNB. Conclusion In this survey study, clinicians risk stratified hypothetical patients with GNB when assessing the need for FUBC. There was fair agreement among clinicians that high risk patients should get FUBCs. Future studies should focus on variables which prompt FUBC ordering in low-risk patients, an area of disagreement among responders, and ideally in the form of randomized clinical trial. Disclosures Joshua T. Thaden, MD, PhD, National Institutes of Health K08 AI171183 (Thaden): Grant/Research Support Vance G. Fowler, MD, MHS, Affinergy: Advisor/Consultant|ArcBio: Stocks/Bonds (Private Company)|Armata: Advisor/Consultant|Astra Zeneca: Advisor/Consultant|Astra Zeneca: Grant/Research Support|Basilea: Advisor/Consultant|Basilea: Grant/Research Support|ContraFect: Advisor/Consultant|ContraFect: Grant/Research Support|Debiopharm: Advisor/Consultant|Destiny: Advisor/Consultant|EDE: Grant/Research Support|Genentech: Advisor/Consultant|Genentech: Grant/Research Support|GSK: Advisor/Consultant|Janssen: Advisor/Consultant|Karius: Grant/Research Support|MedImmune: Grant/Research Support|Merck: Grant/Research Support|sepsis diagnostics: Patent pending|UptoDate: Royalties|Valanbuio: Stocks/Bonds (Private Company)|Valanbuio: Stocks/Bonds (Private Company) Sonali Advani, MBBS, MPH, FIDSA, Biomerieux: Advisor/Consultant|GSK: Advisor/Consultant|Locus Biosciences: Advisor/Consultant|Sysmex America: Advisor/Consultant Stacey Maskarinec, MD, PHD, National Institutes of Health K23 HL159275 (Maskarinec): Grant/Research Support

P-110. Promoting Optimal Treatment for Community-Acquired Pneumonia in the Emergency Room: a Before-After Study of a Novel Care Pathway

Abstract Background Community-acquired pneumonia (CAP) in young children is mainly caused by viral pathogens; for this reason, Infectious Disease Society of America guidelines explicitly state that antibiotic treatment of non-severe CAP in this population is not obligatory. However, the vast majority of non-severe pediatric CAP episodes diagnosed in North America prompt antibiotic prescription anyway. Methods A before-after prospective study was done in a Canadian emergency department (ED) enrolling children aged 6+ months without comorbidities diagnosed with CAP and managed as outpatients. In the before (control) phase, participants were managed as per routine care. In the after (intervention) phase, participants were managed using a novel care pathway. This care pathway used imaging results, a point-of-care C-reactive protein (POC CRP) assay, and other already-available data (eg. O2 saturation, respiratory rate, age) to categorize participants as ‘appreciable risk’ or ‘low risk.’ Those at ‘appreciable risk’ were given a prescription for antibiotics, whereas those at ‘low risk’ were simply discharged home. The next day, caregivers of ‘low-risk’ participants were informed of results of nasopharyngeal viral/atypical pathogen testing. Follow-up was done at day 2-5, 14-21, and 30. Results There were 84 participants recruited in the control phase (Mar-Nov 2022) and 78 in the intervention phase (Nov 2022-Mar 2024). Control phase participants had a median age of 2.8 y (IQR 2.1 – 4.4y) and 13% had normal chest imaging, whereas intervention phase participants had a median age of 3.7 y (IQR 1.9 – 6 y) and 5.1% had normal chest imaging. All 84 of the participants in the control phase were prescribed antibiotics at ED discharge, as compared to only 51% of those in the intervention phase (49% less, 95%CI 38-60% less, p&amp;lt; 0.001). There were no significant differences in clinical cure at day 2-5, re-presentation to the ED, later hospitalization, or caregiver satisfaction with the care plan. Conclusion A simple novel care pathway incorporating POC CRP testing as well as other available data facilitated a very clinically important decrease in antibiotic prescribing without compromising clinical outcomes. This care pathway should be evaluated in the context of a multicentre randomized trial. Disclosures Jeffrey Pernica, MD, MSc, FRCPC, DTMH, MedImmune: Grant/Research Support|Merck: Grant/Research Support Dominik Mertz, MD, MSc, KCI Inc. USA: Grant/Research Support