Maximum Score Research Articles

Ahmadsarifudin KONDISI FISIK DAN TEKNIK ATLET GULAT DI KABUPATEN BLORA TAHUN 2021

In a wrestling match, good physical and technical conditions are needed to achieve maximum performance. The purpose of this study was to determine the physical condition and technique of wrestling athletes in Blora Regency. The research method uses descriptive quantitative. The instruments used are pretest, and documentation. The subjects of this study were all members of the wrestling athlete club in Blora Regency. The data analysis technique used descriptive statistical techniques. Data analysis by collecting data, reducing data, and presenting data, and drawing data conclusions. The results showed that of the 10 male athletes who were in the good category, 40% were sufficient, 20% less, 30% less, and 10% less. Meanwhile, of the 4 female athletes who are in the good category, 25%, 50% enough and 25% less. From the results of the physical condition test above, the highest score is 553, the average value is 498. As for the female athletes, the maximum score is 529 with an average value of 505. Meanwhile, the results of the technical skill test assessment test obtained the following data from a total of 10 male athletes. test participants who entered the good category 20%, 30% enough, 10% very good. Meanwhile, for female athletes, data were obtained that included 25%, 25% less, and 50% less. so it can be concluded that the physical condition and technique of the Blora wrestling athletes are in the "enough" category. Suggestions for coaches and supervisors for the PGSI Regency Blora Regency are to add more training programs to improve the physical and technical conditions of players and look for young athletes to achieve maximum performance.

Assessment of diaper dermatitis using a novel electronic health record-embedded scale.

Quantify the evolution and severity of neonatal skin injury, specifically diaper skin compromise, by embedding a validated skin integrity evaluation into the electronic health record (EHR). Retrospective longitudinal cohort analysis of 747 patients stratified by gestation: 22-27, 28-31, 32-24, and 35-37 weeks, from birth to discharge. Primary outcomes were time to first perineal erythema, duration as percent days with erythema, and severity as maximum score. Data were analyzed using generalized linear models and multiple linear regression methods. Seventy percent had erythema and, of these, 34% had at least one high score with bleeding. Days with erythema ranged from 34-44% (p < 0.05). Days to first erythema were inversely correlated with gestational age. Risks for severe injury included short time to first erythema, 5 or more stools/day, infection, and Caucasian race/ethnicity. The EHR-based scale can be readily implemented to mitigate diaper skin compromise in premature infants.

OGC P25 Impact of minimally-invasive oesophagectomy on post-operative analgesia and surrogate outcomes

Abstract Background Minimally invasive oesophagectomy (MIO) via either two (MIO2) or three phases (MIO3) has been proposed to reduce post-operative pain and correspondingly improve patient recovery compared to open Ivor-lewis (ILO), Left thoracoabdominal oesophagectomy (LTA) or hybrid-ILO (lap abdomen, open thoracotomy). The primary aim of this study was to audit analgesia outcomes according to surgical approach via maximum daily pain score, daily and total post-operative opiate usage. Secondary outcomes included return of GI function, mobility, and rates of post-operative pneumonia, escalation in ward care or re-intubation due to respiratory failure. Methods Retrospective review of records from consecutive patients undergoing oesophagectomy at a single tertiary centre between January 2015 and December 2022. Post-operative analgesia consisted of thoracic epidural and patient controlled analgesia (PCA) for patients undergoing thoracotomy and PCA+/- paravertebral analgesia for those undergoing MIO. Patients remaining ventilated due to early post-operative complications were excluded from analysis. Opioid usage was converted to oral morphine equivalents for comparison. Patient mobility was prospectively recorded by a physiotherapist using the Manchester Mobility Score (MMS). Pneumonia was defined as either rising inflammatory makers or fever and any new respiratory symptom, oxygen requirement or pulmonary imaging changes. Results Of a total 328 eligible patients, 225 underwent open oesophagectomy, 80 MIO, and 23 hybrid-ILO. Pain scores were similar on post-operative day 0-5 across approaches. MIO was associated with a significantly lower median total opioid usage (MIO2-624mg, MIO3-720mg) compared to open (ILO-1608mg, LTA-1984mg ) and hybrid-ILO-1977mg (P&amp;lt;0.001). There was no significant difference in pneumonia, escalation or reintubation rates between the different approaches. MIO was associated with an earlier return of bowel function (P&amp;lt;0.001) and patients undergoing MIO achieved the maximum MMS score earlier than those undergoing thoracotomy (P&amp;lt;0.001). Conclusions Equivalent post-operative analgesia can be achieved between open and minimally invasive oesophagectomy when multimodal approaches including epidural anaesthesia are employed. MIO is however, associated with an approximately threefold reduction in opiate use with corresponding earlier return of gut function, and improved post-operative mobility compared to ILO, LTA or hybrid-ILO. Where feasible and can safely be employed, suitable patients may benefit from a minimally invasive oesophagectomy over open or hybrid approaches as part of an enhanced recovery pathway supported by a multidisciplinary team.

OGBN O02 Ergonomics in laparoscopic cholecystectomy. Do we need to change our practice to look after ourselves?

Abstract Background Up to 80% of surgeons report musculoskeletal problems which significantly affect their personal and professional lives. The cost of back pain alone in the NHS costs £400 million per year (for all staff), and surveyed surgeons report 40% have sustained an injury at work. Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures but the musculoskeletal impact of this procedure on surgeons is unknown, though anecdotally it is likely to be high. Methods We observed the positions held by surgeons undertaking laparoscopic cholecystectomy and measured them against the Rapid Entire Body Assessment (REBA) score, which is widely used to assess the risk of an activity causing musculoskeletal injury. The higher the score, the less ergonomic the posture and the higher the risk of long term harm. Photographs were taken of the operating surgeon with consent (excluding views of the patient) and then measured against the score to assess the risk. Operations were graded to give an average risk score which represents the need for a change of process to safeguard staff. Results Eight laparoscopic cholecystectomies, undertaken by 6 different surgeons were analysed. Scores for trunk posture were generally low but score for upper limb position were higher. The mean and median REBA scores were both 4 and the maximum score during one operation was 6. Conclusions The scores measured in this small study were very consistent and suggest that the practice of laparoscopic cholecystectomy as currently practised has a medium risk of causing operator harm; practice change is recommended to safeguard staff. Further research is needed with larger sample sizes as well as different arms for techniques such as position changes or robotic surgery, while observing outcomes for patients and time taken.

A Study to assess knowledge regarding Janani Suraksha Yojana among Antenatal mothers in selected rural area

Janani Suraksha Yojana, under the overall umbrella of National Rural Health Mission (NRHM), has been proposed by a way of modifying the National Maternity Benefit Scheme (NMBS). To assess knowledge regarding JSY among antenatal mothers in selected area. To find out an association between knowledge regarding JSY among antenatal mothers with selected demographic variables. Method: Descriptive design was used for the study. 100 antenatal mothers were selected as sample for study by using simple random sampling technique. The data was collected by using structured knowledge questionnaires to assess the knowledge. For the assessment of the level of knowledge regarding basic concepts of JSY among antenatal mothers who attend antenatal visit at selected PHC score was divided in to three groups poor (0-2 score), average (3-4 score) and good (5-6 score). The assessment of level of level of knowledge regarding basic concepts of JSY among antenatal mothers showed that, 5% of mothers had poor knowledge, 64% had average knowledge and 31% had good knowledge level. The average knowledge score was 4.04 with standard deviation of 1.00. The minimum score was 0 with the maximum score 6. The assessment of level of knowledge regarding of Janani Suraksha Yojana among antenatal mothers showed that, 1% of mothers had poor knowledge, 85% had average knowledge and 14% had good knowledge level. The average knowledge mean score was 14-98 with standard deviation of 1.87. The minimum score was 8 with the maximum score 20. Conclusion There was significant association of these demographic variables with the level of knowledge.

Efektivitas Penggunaan Media Pembelajaran Edpuzzle Berbasis Video Terhadap Hasil Belajar Peserta Didik pada Materi Suhu dan Pemuaian

After Covid 19, computer-based distance learning was opened, but based on a preliminary study in one of the Public High Schools in the Kuningan Regency area, it obtained 710 out of a maximum score of 1600 (low category). The research method uses a quasi experiment with a Pretest-Posttest Control Group Design approach. This research was conducted in January - February 2023 at Public High School. The research population was all class XI IPA of SMA Negeri, consisting of 6 classes with 213 students. The research sample was taken using a random cluster sampling technique as many as 2 classes out of 6 classes, namely class XI IPA 1 as the intervention group and Class XI IPA 2 as the control group. Data analysis techniques used the Chi Square test, Fisher's test, and T-test. The results of the calculation of the hypothesis test using the paired sample t-test with a significance level (α = 0.05) obtained tcount&gt;t_table, namely 3,495&gt;2,030. it can be concluded that there are differences in the effect of using video-based Edpuzzle learning media on student learning outcomes at Public High School.

Smart Buildings: Water Leakage Detection Using TinyML.

The escalating global water usage and the increasing strain on major cities due to water shortages highlights the critical need for efficient water management practices. In water-stressed regions worldwide, significant water wastage is primarily attributed to leakages, inefficient use, and aging infrastructure. Undetected water leakages in buildings' pipelines contribute to the water waste problem. To address this issue, an effective water leak detection method is required. In this paper, we explore the application of edge computing in smart buildings to enhance water management. By integrating sensors and embedded Machine Learning models, known as TinyML, smart water management systems can collect real-time data, analyze it, and make accurate decisions for efficient water utilization. The transition to TinyML enables faster and more cost-effective local decision-making, reducing the dependence on centralized entities. In this work, we propose a solution that can be adapted for effective leakage detection in real-world scenarios with minimum human intervention using TinyML. We follow an approach that is similar to a typical machine learning lifecycle in production, spanning stages including data collection, training, hyperparameter tuning, offline evaluation and model optimization for on-device resource efficiency before deployment. In this work, we considered an existing water leakage acoustic dataset for polyvinyl chloride pipelines. To prepare the acoustic data for analysis, we performed preprocessing to transform it into scalograms. We devised a water leak detection method by applying transfer learning to five distinct Convolutional Neural Network (CNN) variants, which are namely EfficientNet, ResNet, AlexNet, MobileNet V1, and MobileNet V2. The CNN models were found to be able to detect leakages where a maximum testing accuracy, recall, precision, and F1 score of 97.45%, 98.57%, 96.70%, and 97.63%, respectively, were observed using the EfficientNet model. To enable seamless deployment on the Arduino Nano 33 BLE edge device, the EfficientNet model is compressed using quantization resulting in a low inference time of 1932 ms, a peak RAM usage of 255.3 kilobytes, and a flash usage requirement of merely 48.7 kilobytes.

Development and prospective validation of postoperative pain prediction from preoperative EHR data using attention-based set embeddings

Preoperative knowledge of expected postoperative pain can help guide perioperative pain management and focus interventions on patients with the greatest risk of acute pain. However, current methods for predicting postoperative pain require patient and clinician input or laborious manual chart review and often do not achieve sufficient performance. We use routinely collected electronic health record data from a multicenter dataset of 234,274 adult non-cardiac surgical patients to develop a machine learning method which predicts maximum pain scores on the day of surgery and four subsequent days and validate this method in a prospective cohort. Our method, POPS, is fully automated and relies only on data available prior to surgery, allowing application in all patients scheduled for or considering surgery. Here we report that POPS achieves state-of-the-art performance and outperforms clinician predictions on all postoperative days when predicting maximum pain on the 0–10 NRS in prospective validation, though with degraded calibration. POPS is interpretable, identifying comorbidities that significantly contribute to postoperative pain based on patient-specific context, which can assist clinicians in mitigating cases of acute pain.

Understanding Variation in Health Care Quality Experiences of Three Stakeholders: Patients and Kin, Professionals, and Hospitals

Summary As quality of care increasingly becomes a strategic topic for hospitals, understanding variation between stakeholders’ experiences is essential. A framework can be used by managers, researchers, and policy makers to account for these variations and set priorities to ensure an environment of trust among all stakeholders — including patients and kin. To measure perceptions of quality from a multidimensional view, researchers at the Leuven Institute for Healthcare Policy established four objectives. The first was to explore whether patients and kin (collectively), and professionals experience quality as a multidimensional concept. The second was to examine the between-stakeholder variation across health care quality experiences of patients/kin and professionals. The third was to examine between-hospital variation in health care quality experiences among the 19 hospitals studied. The fourth was to set quality priorities for hospital management and policy makers based on multistakeholder and multicenter data. To collect information, researchers used the Flanders Quality Model (FlaQuM)-Quickscan tool, which is a two-part instrument that measures quality from a multidimensional view. It includes a series of statements on health care quality for patients and kin (part 1) and a corresponding series of statements on health care quality for professionals (part 2), each consisting of 15 quality domains and three global ratings; all respondents were required to address both parts 1 and 2. To explore whether quality is experienced as a multidimensional concept, intraindividual variation was examined by analyzing stakeholders’ differences between minimum and maximum scores on the instrument domains. Between-stakeholder variation was examined by evaluating differences in mean scores of the two stakeholder groups on the quality domains using unpaired t-tests. Between-hospital variation was examined by evaluating differences in hospitals’ mean scores on the quality domains using one-way analysis of variance (ANOVA). In total, 14,977 respondents (6,590 patients/kin and 8,387 professionals) completed the FlaQuM-Quickscan during the study period between May 2021 and June 2022. Respondents used a Likert scale, where 0 is full disagreement with the statement and 10 is full agreement. Analyses revealed important intraindividual variation in experiences of respondents across quality domains. Researchers also observed that patients/kin scored all domains (in parts 1 and 2) significantly higher than professionals, except for the Equity domain in part 2. Significant between-hospital variation in the mean scores was observed for all domains. Of note, by combining the correlation of the overall quality scores with the quality domains, the difference in mean scores on domains, and the variation between hospitals’ mean scores, priorities can be identified. Overall, researchers found that patients/kin and professionals do experience quality as a multidimensional concept. The multidimensional priorities identified based on the FlaQuM-Quickscan results indicate the need for future multifaceted quality strategies at the meso and macro levels that can have an impact at the patient care level. Hospital management and policy makers need to support the integration between executive/management-level and frontline-level initiatives.

Long-term effects of surgically corrected menstrual outflow obstruction: A case-control study.

To enhance evidence-based knowledge on long-term sequalae in patients with surgically corrected obstructing Müllerian anomalies. This long-term case-control study included patients with menstrual outflow obstruction due to congenital anomalies of the uterus or vagina, who were at least 18 years old, and for whom 2 years had elapsed since the first surgery at the start of this study. The control group consisted of women without current gynecological problems. Patients underwent a surgical correction at the Radboud University Medical Center Nijmegen between 1980 and 2013. Of 78 patients approached, 38 (49%) were included in this study. The control group consisted of 54 females. The main outcome measures were pain and health state. The following questionnaires were used: Visual Analogue Scale pain scores, European Quality of Life-5 Dimensions questionnaire (EQ-5D-3L) and the adapted Endometriosis Health Profile questionnaire (EHP-30). Patients had higher actual and maximum abdominal pain scores compared with controls (11 vs 0 [P = 0.007] and 48 vs 21 [P = 0.035], respectively). Based on the EQ-5D-3L scores, patients had more pain and discomfort (P = 0.005), more mood problems (P = 0.023), and a poorer subjective health state (P = 0.002) and self-rated health state (P = 0.031). Based on the EHP-30, patients had a significant poorer self-rated health state on four out of five subscales. In this study, following surgically corrected menstrual obstruction, patients had statistically significant higher abdominal pain scores and a poorer self-rated health state compared with controls.

Multi-Criteria Evaluation Model of Management for Weaned Piglets and Its Relations with Farm Performance and Veterinary Medicine Consumption.

Weaned piglets, being immature, demand careful handling to mitigate post-weaning stress in order to avoid immunosuppression and the use of antimicrobials to palliate the effects of disease outbreaks due to poor management. The objective of this work is to design a quick scan calculator or multi-criteria evaluation model of management for weaned piglets, founded on 10 critical indices covering post-weaning management aspects based on hygienic measures and management of facilities and animals. These include pre-weaning handling, batch management, biosecurity, water management, feed management, health program, stockmen training, temperature, ventilation, and floor conditions and density to relate handling and hygiene practices with farm performance and the consumption of veterinary medication. Each index carries a maximum score of ten, with evaluations derived from different management factors that make up each index (from three to eight factors were evaluated per index). Their cumulative score reflects the degree of adequacy of on-farm management. Therefore, a perfectly managed farm would achieve 100 points. The calculator underwent testing on 23 intensive farms with a total population of close to 16,000 sows and more than 400,000 weaned piglets, revealing the highest mean scores in floor conditions and density (8.03 out of 10) and pre-weaning handling and health programs (6.87 and 6.28, respectively). Conversely, the lowest scores corresponded to temperature, ventilation, water management, and stockmen training (4.08, 4.32, 4.81, and 4.93, respectively). The assessed farms averaged a global score of 56.12 out of 100 (from 37.65 to 76.76). The calculator's global score correlated with key post-weaning productivity and piglet health indicators, such as the feed conversion ratio, mortality rate, and piglet production cost, with r values of -0.442, -0.437, and -0.435, respectively (p < 0.05). Additionally, it negatively correlated with medication costs per piglet (r = -0.414; p < 0.05) and positively with annual farm productivity (r = 0.592; p < 0.01). To enhance management, hygiene, and prevention, farms should prioritize addressing indices with the lowest scores, thereby reducing medication consumption and enhancing productivity and health outcomes. Additionally, this quick scan calculator can be used for benchmarking purposes.

Quality of Life After Obstetric Fistula Among Women in Developed Countries

This research aimed to evaluate the correlation between the experience of obstetric fistula and quality of life. Extensive research exists explaining obstetric fistula and the associated effects among women in underdeveloped countries; however, there is a lack of research pertaining to women who have experienced this condition in developed countries. We surveyed women who experienced obstetric fistula in developed countries. Participants were identified by their association with a social media support group for women affected by obstetric fistula (n= 68). Participants completed the Ferrans &amp; Powers Quality of Life Index to provide data relating to their perceived quality of life after experiencing obstetric fistula. An overall score calculated from four subscales determined total quality of life scores. Each scale evaluated the participants’ perception of their satisfaction and the importance of particular items and assigned a score from 0-30 based on participant response. Quality of life scores ranged from 4.27 to 29.58, with an average score of 19.4. The results revealed a significant correlation between obstetric fistula and diminished quality of life. The subscale with the lowest scores was the Health and Functioning subscale with a minimum score of 1.12 and maximum score of 29.54.

Assessment of Internet Available Patient Information on Chronic Pancreatitis Using the Ensuring Quality Information for Patients Tool: A Systematic Search and Evaluation

Introduction: Chronic pancreatitis (CP) is a relevant chronic medical problem whereby delayed presentation and poor patient understanding can cause adverse effects. Quality of patient information available on the internet about CP is not known. Methods: A systematic review of the information about CP available online using the search term “chronic pancreatitis” in using the search engine Google has been conducted. The quality of the top 100 websites returned from this search term was analysed using the validated Ensuring Quality Information for Patients (EQIP) tool (maximum score 36). Additional items were included in the website analysis specific to CP. Results: In total, 45 websites were eligible for analysis. The median EQIP score of the websites was 16 (interquartile range 12–19.5). The majority of websites originated from the USA and the United Kingdom with 31 and 11 websites, respectively. Provision of additional information was inconsistent, with most websites covering information regarding aetiology and advocating alcohol and tobacco cessation, but only few reporting on more complex issues. Conclusion: Internet available information about CP is of limited quality. There is an immediate need for high quality, patient targeted, and informative literature accessible on the internet about this topic.

Implementation of a Cooperative Learning Model of Group Investigation Type to Increase Student Activity and Understanding of Tayyibah Hauqalah Sentence Material

This research aims to implement a group investigation type cooperative learning model to increase student activity and the level of student understanding of the tayyibah hauqalah sentence material. This research method uses the type of Classroom Action Research (PTK). The PTK model used refers to Kurt Lewin, which has a spiral shape from cycle I to cycle II. Each cycle consists of planning, action, observation, and reflection. Data collection techniques in this research used observation, interviews, documentation and tests. The data analysis technique in this research uses descriptive statistical analysis techniques to analyze quantitative data.&#x0D; The results of this research show that 1) there is an increase in student activity, as evidenced by the results of observations of student learning activity in cycle I which shows that the score obtained is 80 out of a maximum score of 92, or if the final score of student activity obtained is 90% of maximum score. Furthermore, in cycle II there was also an increase in student learning activity, as evidenced by the results of observations of student learning activity, which obtained a score of 86 out of a maximum score of 92, or if the final score of student activity was obtained as a percentage, it was 93% of the maximum score. 2) there was an increase in the level of students' understanding of the tayyibah hauqalah sentence material in cycle I as evidenced by students getting an average class score of 80.0 and the percentage of learning completion that reached the KKM was 76% or 23 students. Furthermore, in cycle II there was also an increase in the level of students' understanding of the tayyibah hauqalah sentence material as evidenced by students getting an average class score of 88.5 and the percentage of learning completion that reached the KKM was 93% or as many as 28 students.

Research on the Integration and Development Path of Innovation and Entrepreneurship Education and Mental Health Education in Universities Empowered by the Metaverse

Abstract This paper establishes an integrated education model using hierarchical analysis to divide raw data into a number of sample data based on the magnitude of similarity of data attributes. The centroids of the mental health education model were added to the set, and then the set was updated and looped sequentially. Profile coefficients were used to evaluate the clustering results. The evaluation criteria were precision, which is the degree of accuracy in dividing data categories. The maximum value of the assignment profile of mental health education is 96.04, and the maximum score of mental health education popularization excellence is 71.7. It shows that the integrated education model can optimize the content of mental health education, strengthen the integration of innovative entrepreneurship education and mental health education, and achieve the development of the cultivation path of mental and physical health entrepreneurs.

Pengaruh Model Teams Games Tournament (TGT) terhadap Motivasi Belajar Matematika Berdasarkan Gender Siswa Sekolah Dasar

The background of this research is that students are less motivated in learning and do not understand mathematical concepts. The problem in this research is limited to the lack of student motivation in the mathematics learning process and the Teams Games Tournament (TGT) type cooperative learning model is rarely applied in the mathematics learning process. The aim of this research is to determine the effect of the Teams Games Tournament (TGT) model on elementary school students' motivation to learn mathematics based on gender. The research method used in this research is quantitative methods. This type of research uses a quasi-experimental method (Quasy Experiment). The research was carried out at SDN 091482 Kasindir, Jorlang Hataran District, Simalungun Regency from September 4 to September 9 2023 in the odd semester of the 2023/2024 academic year. Based on the results of descriptive analysis data obtained from the students' learning motivation progress scores that were tested, in the male initial questionnaire, the average questionnaire score was 38.67, the standard deviation was 1,231, the maximum score was 41, and the minimum score was 36. Initial questionnaire women obtained an average score from the questionnaire results of 39.92, a standard deviation of 1,256, a max score of 43, and a minimum score of 38. Meanwhile, in the final questionnaire for men, the average score of the questionnaire results was 39.83, the standard deviation was 1,337, the The maximum value is 42, and the minimum value is 38. And in the final questionnaire for women, the average value of the questionnaire results was 40.54, the standard deviation was 1,330, the maximum value was 42, and the minimum value was 38. Based on the results of this research, the author put forward suggestions namely, 1). Students are expected to always be active and pay attention to the teacher's explanations during the learning process. 2). For all teachers, they must always innovate and be able to adapt to be able to use various learning methods so that students do not get bored easily in the learning process.

The use of virtual reality during extra-amniotic balloon insertion for pain and anxiety relief—a randomized controlled trial

Background: Induction of labor with extra-amniotic balloon (EAB) catheter is a procedure commonly associated with maternal discomfort, pain, and anxiety. Objective(s): We aimed to investigate the distractive effect of virtual reality (VR) technology on pain and anxiety- in pregnant patients who undergo Induction of labor with EAB.Study design: In this randomized controlled trial, pregnant patients intended for Induction of labor with EAB at term, for various obstetric indications, were recruited and randomized in a 1:1 ratio into two groups. Patients in the VR group were exposed to a VR technology clip (using SootheVR All-In-One VR care system for pain and anxiety) during the entire EAB insertion while patients in the control group received the institutional standard care for EAB insertion. Pain scores expressed by Visual Analog Scale (VAS) and maternal hemodynamic parameters, were obtained before, during, and after EAB insertion. Anxiety was evaluated by the validated State-Trait Anxiety Inventory Scale (STAI-S) before and after the procedure. Maternal satisfaction from the VR technology was also recorded. The primary outcome was the change in VAS score before and during EAB insertion. Among the secondary outcomes was the change in Anxiety levels before and after EAB insertion. The study was powered to detect a 25% decrease in the primary outcome.Results: A total of 132 pregnant patients were recruited (66 in each group). There were no differences between groups in terms of age, BMI, gestational age at enrollment, indication for Induction of labor, and pre-procedural VAS score and anxiety levels. The change in VAS score (maximal VAS score during the procedure subtract the initial VAS score before the procedure, i.e the primary outcome) was significantly lower in the VR group compared to the control group (2.78±3.0 vs 4.09±2.99, p=0.01). In addition, the VR group benefited a higher rate of anxiety relief expressed by the difference between pre-procedure and post-procedure STAI score, (-6.46 ± 9.6 vs -2.01 ± 9.11, P=0.007). Patients in the VR group reported an overall very high (94%) satisfaction score.Conclusions: In this randomized controlled trial, we demonstrated that the use of VR technology in patients undergoing Induction of labor with EAB was associated with lower VAS scores during the procedure and significant anxiety reduction compared to patients who received standard care. There was also a very high satisfaction rate from the use of VR technology.

Effect of implantable cardioverter-defibrillator in non-ischaemic systolic heart failure according to the Heart Failure Collaboratory Medical Therapy Score: extended follow-up of the DANISH trial

Abstract Background The Heart Failure Collaboratory (HFC) has developed a medical therapy score which integrates types and doses of guideline-directed pharmacotherapies in patients with systolic heart failure, providing a measure of treatment quality. In clinical trials, this score may help determine the additive effect of new treatments. In the Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators (ICDs) in Patients with Non-ischaemic Systolic Heart Failure on Mortality (DANISH) trial, ICD implantation did not provide an overall survival benefit in patients with non-ischaemic systolic heart failure. Purpose Adding four years of additional follow-up to the DANISH trial, we examined the effect of ICD implantation according to baseline modified HFC (mHFC) medical therapy score. Methods In the DANISH trial, 1,116 patients with non-ischaemic systolic heart failure were randomised to receive an ICD (N = 556) or usual clinical care (N = 560, control group). The primary outcome was death from any cause. In the mHFC score, patients were assigned a score for each drug class of the original cornerstones of systolic heart failure treatment (renin-angiotensin-system inhibitor, beta-blocker, and mineralocorticoid receptor antagonist). The maximum score was 100%, corresponding to optimal medical therapy with all three types of medication (=&amp;gt;50% of target dose). Results The median mHFC score at baseline was 67% (25th-75th percentile, 67%-100%; range, 17%-100%). During a median follow-up of 9.5 years, the ICD group did not have significantly lower all-cause mortality compared with the control group (hazard ratio [HR] 0.89 [95% CI, 0.74-1.08]). The results were independent of the mHFC score at baseline (mHFC score = &amp;lt; median: HR 0.91 [95% CI, 0.70-1.19]; mHFC score &amp;gt; median: HR 0.87 [95% CI, 0.66-1.14]; P for interaction, 0.94). Similarly, ICD implantation did not reduce the rate of cardiovascular death overall (HR 0.87 [95% CI, 0.70-1.09]), and this association was not modified by the mHFC score (mHFC score = &amp;lt; median: HR 0.90 [95% CI, 0.65-1.24]; mHFC score &amp;gt; median: HR 0.84 [95% CI, 0.61-1.15]; P for interaction, 0.89). The ICD group had a significantly lower rate of sudden cardiovascular death in the overall population (HR, 0.60 [95% CI, 0.40-0.92]), and this association was not modified by the mHFC score (mHFC score = &amp;lt; median: HR 0.72 [95% CI, 0.40-1.29]; mHFC score &amp;gt; median: HR 0.53 [95% CI, 0.28-0.99]; P for interaction, 0.59). See Figure for results. Conclusions In this extended follow-up study of the DANISH trial, ICD implantation did not provide an overall survival benefit in patients with non-ischaemic systolic heart failure regardless of baseline medical heart failure therapy, assessed by the mHFC score.Modified HFC score in the DANISH trial

Association between empathy levels in physicians and patient satisfaction scores in a cardiovascular clinic

Abstract Introduction A good doctor-patient relationship is crucial to medical practice. A fundamental element that drives this relationship is the empathy of the treating physician, which has also been validated as a predictor of clinical competence and patient results. Purpose We conducted an original study to correlate empathy values of our physicians and patient satisfaction surveys. In this subanalysis, we evaluated whether age, sex or time since qualifying as specialist had an impact on empathy values. Methods In our originaly study we sought to correlate the empathy values of our physicians in our cardiovascular clinic with the results of outpatient satisfaction surveys, measured with HCAPS, using a linear regression model. The Jefferson Empathy scale is a self reported 20 question survey, answered through a 1-7 Likert scale, with a maximum score of 140 points. It is further subclassified into 3 categories: "Perspective", "Care with compassion" and "Stepping into patient's shoes". The HCAPS survey is a patient satisfaction query, with 5 items that inquire as to the patient's perception of being treated with respect by the physician, the interest shown in their problems, the time dedicated to the consult, and the quality of the explanation of their chief concern and treatment options. It is anwered through a Likert scale from "Totally diasgree" to "Totally agree". There is also a final question that asks for a global impression. Results 65 doctors answered the Empathy survey, 30.8% of them women. Mean age was 48.8 years, and over half were under 50 years old. 81% had been practicing for over 5 years. 61671 HCAPS surveys were analyzed, corresponding to those 65 practitioners. Mean Empathy score was 120.7 (DS 11.1). We found that patients perceived greater respectful treatment (p=0.03) and had their treatment options better explained to them (p=0.02) by physicians with higher levels of empathy. The other HCAPS queries had a positive, though non statistically significant, relationship with Empathy scores. Doctors with higher scores in the subcategory "stepping into patient's shoes" had a significant increase in patient's perception of the interest shown in their concerns (p=0.01). There were no differences in physicians' empathy levels according to their age, gender, or time since qualifying as a specialist. Discussion These results validate empathy as a key skill in the doctor-patient relationship, and show that high levels of this personality attribute lead to better patient satisfaction results. Our results differ from other published work in that we found no difference in empathy levels according to gender or practice time, whereas most previous literature found that women and longer practice time were positively associated with empathy levels.

Abstract 13906: Electrocardiographic Correlates of Cardiac MRI Findings in Women With MINOCA

Introduction: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is identified in 6-15% of patients with MI and disproportionately affects women. Cardiac magnetic resonance (CMR) imaging is important to identify the cause of MINOCA but is restricted by its technical complexity and limited accessibility. The electrocardiogram (ECG), a simple, readily available tool, may predict features associated with abnormal CMR. Methods: Women with a diagnosis of MI and &lt;50% angiographic stenosis in all epicardial vessels were enrolled in the Women’s Heart Attack Research Program (HARP), a prospective, multicenter, observational study. Participants had CMR at a median of 6 days from MI (n=116). A CMR core laboratory interpreted images while blinded to clinical data and ECGs. Abnormal CMR findings included late gadolinium enhancement (LGE) or myocardial edema. The patient’s presenting ECG was analyzed. ECGs with ≥2 uninterpretable leads or with bundle branch block were excluded. ECGs were assessed for T-wave inversions (TWI), pathologic Q waves (QW), fractionated QRS (fQRS), and ST segment depression or elevation. The DETERMINE score is 2x the number of leads (#) with QW + # fQRS + # TWI, excluding leads V1 and aVR (maximum score 40). Results: (Figure, Table): Among 112 women with MINOCA, CMR abnormality was more likely in women with DETERMINE score ≥3 vs &lt;3 (86% vs 65%, p = 0.01). DETERMINE score ≥3 was associated with abnormal CMR on logistic regression (OR 3.4, p = 0.01). Patients with any TWI were more likely to have abnormal CMR than those with no TWI (84% vs 64%, p = 0.02), and were more likely to have LGE on CMR (61% vs 34%, p = 0.005). In those with a DETERMINE score of 0, CMR was abnormal in 62% vs 78% with DETERMINE score ≥1 (p=0.09), and LGE was present in 28% vs 54%, p = 0.01. Conclusion: ECG abnormalities were associated with abnormal CMR among women with MINOCA. The ECG may provide risk stratification for CMR, but the absence of QW, fQRS and TWI does not preclude CMR abnormality.