MD Score Research Articles

Evaluating the Application of an EMS Clinical Judgment Theoretical Framework

ABSTRACT OBJECTIVES Clinical judgment (CJ) encompasses clinical reasoning (process of evaluating a problem) and clinical decision-making (choice made). A theoretical model to better define emergency medical services (EMS) CJ has been developed but its use has not been evaluated in EMS training and assessments. Our objective was to evaluate the performance of this EMS CJ model to assess clinical reasoning and decision-making in a simulated environment. METHODS In this evaluation, EMS clinician teams (2-3 members) were directed to care for a simulated older adult patient in their home following a fall. Simulations were video recorded, clinician team actions coded, and evaluated for whether proper CJ reasoning and decisions were made. We evaluated CJ in two ways: 1) EMS medical directors' (MD) determination of whether the CJ questions were addressed (MD score) and 2) objective rubric evaluation of CJ questions using the EMS CJ model focused on recognition of appropriate cues, performance of actions, and revaluation after action (rubric score). The CJ questions addressed in this simulation included: 1) Is the patient stable/unstable?, 2) Are interventions necessary before movement?, 3) How should the patient be transferred from the floor?, and 4) Does the cause of the fall require hospital evaluation? Descriptive statistics were calculated, and concordance between the two assessments was evaluated (mean, 95% CI). Percent concordance was calculated with a validity threshold set at 70%. RESULTS Four EMS MDs reviewed 20 videos addressing 80 clinical judgment decisions. Overall concordance between MD score and rubric score for CJ decisions was above the threshold at 88.1% (85.0, 91.2). Concordance between MD score and rubric score for each CJ decision was 92.0% (87.3, 96.7) for question 1, 79.9% (71.5, 88.3) for question 2, 95.0% (90.4, 99.6) for question 3, and 85.4% (79.5, 91.2) for question 4. CONCLUSION An objective evaluation of CJ decisions using a rubric derived from an EMS CJ theoretical framework demonstrated high concordance to subjective evaluations of CJ made by EMS MDs. This approach may allow for reproducible and objective CJ evaluations that could be used for competency assessment in EMS.

The protection motivation theory as an explanatory model for intention to use alcohol protective behavioral strategies related to the manner of drinking among young adults.

This study aimed to prospectively examine the explanatory value of the protection motivation theory (PMT) for the intention to use manner of drinking protective behavioral strategies (MD PBS) and to explore its invariance across genders. A targeted sampling procedure was used to recruit 339 young adults in the community (Mage = 21.1; SD = 2.21; female = 50.7%) who completed baseline and 2-month follow-up measures of the PMT constructs and intentions to use each of the five MD PBS. Regression analyses revealed that the coping appraisal components (response efficacy and self-efficacy) had greater explanatory power for the intention to use MD PBS than the threat appraisal components (perceived vulnerability and perceived severity). Perceived vulnerability to alcohol consequences was not prospectively associated with any specific behavioral intention or with the total MD PBS score. In contrast, perceived severity was prospectively associated with the intention to use three out of five PBS and the total MD score. Regression coefficients revealed gender invariance for all six models. Our findings suggest that interventions aimed at encouraging young adults to use alcohol MD PBS would be most effective if they included components that enhance self-efficacy in using these strategies and emphasize their perceived usefulness in reducing alcohol-related consequences.

A close look at the nutritional status and mediterranean diet adherence in patients with behcet’s syndrome

OBJECTIVE: This study aimed to investigate Behçet’s syndrome (BS) patients’ regarding anthropometric measurements, daily energy and nutrient intake, and the MD adherence of patients. METHODS: 100 consecutive patients with BS were prospectively enrolled in two rheumatology outpatient clinics. Mid Upper Arm circumference (MUAC), Triceps skinfold thickness (TST), Mid Upper Arm Muscle Circumference (MUAMC), and Mid Upper Arm Muscle Area (MUAMA) measurements of patients were compared with Turkish reference values. Participants’ daily energy and nutrient intake were categorized by the ‘MD Adherence Score.’ RESULTS: Thirty patients (30%) had only mucocutaneous involvement. According to reference values, 47%, 36%, 14%, and 27% of the participants had low percentile values (<50. percentile) for MUAC, TST, MUAMC, and MUAMA, respectively. Walnuts (35%), eggplant (35%), and tomatoes (13%) were reported as the most prominent foods for symptom exacerbations. The mean MD adherence score was 23.5±6.5 (male: 23.2±6.9; female: 24.2±5.9) points and the adherence status was average (60%) and poor (35%) in the majority of the patients. CONCLUSIONS: Food consumption is important regarding symptom occurrence and multidisciplinary management of BS. Some participants had poor adherence to the MD. Increased waist/hip ratio, BMI, and decreased TST and MUAMA may indicate body muscle mass and unhealthy eating patterns. Patients with BS need encouragement for healthy eating habits.

Investigating differences in young- and late-onset progressive supranuclear palsy.

The impact of age of onset on the presentation of progressive supranuclear palsy phenotypes is not well studied. We hypothesized that there is difference in presentation and phenotype between young- and late-onset PSP. Our aim was to compare phenotypes and rate of change in disability between young-onset PSP (YOPSP) and late-onset PSP (LOPSP). Retrospective data of patients seen in the Rossy PSP Centre from March 2014 to April 2022 with clinical diagnosis of PSP as per the MDS 2017 diagnostic criteria were examined. We used cut-off age of 65years to categorize the patients into YOPSP and LOPSP. We compared the prevalence of phenotypes, presenting symptoms, and MDS core criteria between the two groups. The severity of disease between the two groups was measured using PSP-RS. We found 107 patients with clinical diagnosis of PSP as per MDS criteria, a third were defined as YOPSP. PSP speech/language (SL) phenotype was more prevalent in YOPSP (18% vs 0%, p < 0.001). Aphasia was significantly higher in YOPSP (16% vs 1.4%, p = 0.03). The speech and language dysfunction (C1) core criteria were more prevalent in YOPSP (33.3% vs 12.2%, p = 0.05). Longitudinal analysis of PSP-RS showed worsening of bulbar total score at 6months in YOPSP (t (38) = 2.87; p = 0.05). Our study revealed that YOPSP are more likely to present with a speech and language variant. Our results highlight that age of onset may predict PSP phenotypes, which holds both clinical and prognostic importance.

Assessing the Mediterranean diet adherence during pregnancy: Practical considerations based on the associations with cardiometabolic risk.

The aim of the present study was to provide practical considerations for assessing MD adherence during pregnancy based on the association with cardiometabolic risk. Longitudinal study. A food frequency questionnaire was fulfilled by 152 pregnant women at the 16th gestational week (g.w.). We calculated the Mediterranean Food Pattern (MFP), the MD Scale (MDScale), the Short MD questionnaire (SMDQ), the MD Score (MedDietScore), and the MD scale for pregnant women (MDS-P). The cardiometabolic risk score consisted of pre-pregnancy body mass index, blood pressure, glucose, triglycerides, and high-density lipoprotein-cholesterol (at 16th and 34th g.w.). Multiple linear regression models showed that the MFP, the MedDietScore, and the SMDQ were associated with lower cardiometabolic risk at the 16th and 34th g.w. (β's: -0.193 to -0.415, all p<0.05); and the MDS-P at the 34th g.w. (β=-0.349, p<0.01). A comparison of these models with the J test showed that the MFP and the MedDietScore outperformed the SMDQ at the 16th g.w. (p's<0.05); while the MedDietScore outperformed the SMDQ, MFP, and MDS-P (p's<0.05) at the 34th g.w. Receiver-Operating-Characteristic-derived thresholds for the MFP, MedDietScore and MDS-P indices were 21, 30, and 6 points, respectively, to identify women with high cardiometabolic risk. The MFP and MedDietScore are recommended to assess MD adherence during pregnancy, as these showed the strongest associations with cardiometabolic risk. Our validated thresholds might assist in the detection of poor dietary patterns during pregnancy.

Adherence to the Mediterranean Diet in Relation to Gastric Cancer in Afghanistan.

BackgroundDespite the adherence to the Mediterranean dietary pattern (MD) being associated with a reduced risk of several cancers, there is no report about the highly prevalent diet-disease associations in Afghanistan, particularly about gastric cancer (GC).ObjectiveThe aim of this study was to investigate the association between MD and GC in Afghanistan.MethodsThis hospital-based case-control study was carried out on a total number of 270 subjects (90 cases and 180 controls) aged between 20 and 75 years. Using the convenience-sampling method, cases and controls were selected. Cases were patients with GC whose condition was pathologically confirmed. The controls were apparently healthy people who were matched with cases in terms of age (±5 years) and sex. Assessment of dietary intake was done using a pre-tested food frequency questionnaire, designed specifically for Afghanistan. Adherence to the MD pattern was done based on the scores suggested in earlier studies.ResultsOut of 270 studied subjects, 73% were men. We found that subjects in the highest tertile of MD score had 52% decreased odds of GC (OR: 0.48; 95% CI: 0.24–0.98, P-trend = 0.05) compared with those in the lowest tertile. After considering potential environmental factors, age, and sex, the observed association disappeared (OR: 0.43; 95% CI: 0.13–1.38, P-trend = 0.41). After further adjustment for BMI in the last model, we found that participants with the highest MD score were 83% less likely to have GC than those in the lowest tertile (OR: 0.17; 95% CI: 0.03–0.80, P-trend = 0.14).ConclusionWe found that greater adherence to MD might be associated with a lower odds of GC.

Attitudes and practices of open data, preprinting, and peer-review-A cross sectional study on Croatian scientists.

Attitudes towards open peer review, open data and use of preprints influence scientists' engagement with those practices. Yet there is a lack of validated questionnaires that measure these attitudes. The goal of our study was to construct and validate such a questionnaire and use it to assess attitudes of Croatian scientists. We first developed a 21-item questionnaire called Attitudes towards Open data sharing, preprinting, and peer-review (ATOPP), which had a reliable four-factor structure, and measured attitudes towards open data, preprint servers, open peer-review and open peer-review in small scientific communities. We then used the ATOPP to explore attitudes of Croatian scientists (n = 541) towards these topics, and to assess the association of their attitudes with their open science practices and demographic information. Overall, Croatian scientists' attitudes towards these topics were generally neutral, with a median (Md) score of 3.3 out of max 5 on the scale score. We also found no gender (P = 0.995) or field differences (P = 0.523) in their attitudes. However, attitudes of scientist who previously engaged in open peer-review or preprinting were higher than of scientists that did not (Md 3.5 vs. 3.3, P<0.001, and Md 3.6 vs 3.3, P<0.001, respectively). Further research is needed to determine optimal ways of increasing scientists' attitudes and their open science practices.

A quality analysis of the YouTube video content on meniscus repair surgery

Objectives:The Internet, especially YouTube, is an important and growing source of medical information. The content of this information is poorly evaluated. The objective of this study was to analyze the quality of YouTube video content on meniscus repair. The hypothesis was that this source of information is not relevant for patients.Methods:A YouTube search was carried out using the keywords "meniscus repair". Videos had to have had more than 10,000 views to be included. The videos were analyzed by two evaluators. Various features of the videos were recorded (number of views, date of publication, "likes", "don’t likes", number of comments, source, type of content and the origin of the video). The quality of the video content was analyzed by two validated information system scores: the JAMA benchmark score (0 to 4) and the Modified DISCERN score (0 to 5). A specific meniscus repair score (MRSS scored out of 22) was developed for this study, in the same way that a specific score has been developed for other similar studies (anterior cruciate ligament, spine, etc.).Results:Forty-four (44) videos were included in the study. The average number of views per video was 180,100 (± 222,000) for a total number of views of 7,924,095. The majority of the videos were from North America (90.9%). In most cases, the source (uploader) that published the video was a doctor (59.1%). A manufacturer, an institution and a non-medical source were the other sources. The content actually contained information on meniscus repair in only 50% of the cases. The mean scores for the JAMA benchmark, MD score and MRSS were 1.6/4± 0.75, 1.2/5 ± 1.02 and 4.5/22 (± 4.01) respectively. No correlation was found between the number of views and the quality of the videos. The quality of videos from medical sources was not superior to those from other sources.Conclusion:The content of YouTube videos on meniscus repair is of very low quality. Physicians should inform patients and, more importantly, contribute to the improvement of these contents.

A comparative study to assess the cognitive and moral development of school age children among joint versus nuclear family in selected rural area of Bijapur district

The fundamental unit of any society is the family. The family is usually the major source of the basic necessities of life and health, love and tenderness, adequate food, clean water, a place and time for rest, clothing and sanitation. Family is one of the major factors which influence the children development.A comparative study was done to assess the cognitive and moral development of school age children among joint versus nuclear family in selected rural area of Bijapur district. The objectives of the study were 1. To assess the level of cognitive development among school age children belongs to joint and nuclear family as measured by structured questionnaire. 2. To assess the level of moral development among school age children belongs to joint and nuclear family as measured by structured questionnaire. 3. To compare the level of cognitive development among school age children belongs to joint and nuclear family. 4. To compare the level of moral development among school age children belongs to joint and nuclear family. 5. To find out the association between cognitive and moral development of children belongs to joint and nuclear family with selected demographic variables. Null hypothesis: There is no significant difference in the cognitive and moral development among school age children of joint and nuclear family.Non probability convenient sampling technique was used to obtain a sample from children belongs to the joint and nuclear family. Structured questionnaire was used to assess cognitive and moral development of children.Majority of them 68% from joint family and 76% from nuclear family had excellent level of cognitive development.Study findings also reveals that most of children belongs to joint and nuclear family (76% &amp; 78% respectively) exhibit excellent level of moral development.Z test was used for comparison of cognitive and moral development of school age children among joint and nuclear family. Finding shown that (CD score -1.39 &amp; MD score -0.25) there is significance difference in joint and nuclear family in cognitive and moral development aspect.The present study finding shows that there is influence of the family on cognitive and moral development of school age children.

Prediction of heat waves over Pakistan using support vector machine algorithm in the context of climate change

Many efficient forecasting models have been found to fail or show low skill due to the changes in the predictor–predictand relationship with the changes in global climate. An attempt has been taken to develop a climate change resilient heatwave prediction model using machine learning (ML) algorithms known as Support Vector Machines (SVM), random forest and artificial neural network. The National Centres for Environmental Prediction/National Centre for Atmospheric Research reanalysis data of ocean-atmospheric variables were used as the predictors of ML models for forecasting the number of heatwave days (HWDs) in the summer of Pakistan. An SVM based recursive feature elimination method was used to select the skilful predictors. The ML models were developed by considering a moving window of 29 years with a time step of 5 years to incorporate the changes in the relation of HWDs with its predictors due to climate change. The result showed changes in the relationship of HWDs with all the ocean-atmospheric variables considered in this study as probable predictors, which indicates the necessity of forward-rolling approach proposed in this study for the development of climate change resilient forecasting model. The relative performance of ML showed the higher capability of SVM to predict HWDs with an %NRMSE of 36, R2 of 0.87, md score of 0.76 and an rSD of 0.88 during the validation period. The result revealed the potential of SVM model to be used for reliable forecasting of heatwaves in the context of climate change.

High variability of food and nutrient intake exists across the Mediterranean Dietary Pattern-A systematic review.

A Mediterranean style dietary pattern (MDP) is considered beneficial for health. The MD Score (MDS) definition has evolved, resulting in considerable variability in the foods and nutrients associated with MDS adherence. We systematically investigated food and nutrient composition of the MD between studies, countries, and methods of classifying the MDS. We searched Embase for MD systematic reviews and selected observational studies reporting intakes of foods, macronutrients, or micronutrients by categories of MDS adherence. The percentage differences in food and nutrient intakes between categories of high and low adherence to the MDS were calculated for each study. A total of 369 full‐text primary papers were reviewed from the included systematic reviews and 74 papers selected (66 adults, 8 children). We found considerable differences in MDS definitions and scoring criteria. Between‐study variation in food intake between high‐ and low‐adherence MDS adherence categories ranged from a mean of −23% for meat, to 119% for fruit, and 278% for fish. Greater variability was evident in non‐Mediterranean than Mediterranean regions. We conclude that few studies report food and nutrient intakes across the range of the MDP in adults and even fewer in children. The considerable variability in the foods and nutrients reported makes comparison of results from studies and translation into dietary guidelines difficult. We recommend that future publications of MD studies include full details of the range of food and nutrient intakes across the distribution of MD adherence in order to facilitate translation into health policy and practice.

The prognostic value of a Methylome-based Malignancy Density Scoring System to predict recurrence risk in early-stage Lung Adenocarcinoma.

Current NCCN guidelines do not recommend the use of adjuvant chemotherapy for stage IA lung adenocarcinoma patients with R0 surgery. However, 25% to 40% of patients with stage IA disease experience recurrence. Stratifying patients according to the recurrence risk may tailor adjuvant therapy and surveillance imaging for those with a higher risk. However, prognostic markers are often identified by comparing high-risk and low-risk cases which might introduce bias due to the widespread interpatient heterogeneity. Here, we developed a scoring system quantifying the degree of field cancerization in adjacent normal tissues and revealed its association with disease-free survival (DFS).Methods: We recruited a cohort of 44 patients with resected stage IA lung adenocarcinoma who did not receive adjuvant therapy. Both tumor and adjacent normal tissues were obtained from each patient and subjected to capture-based targeted genomic and epigenomic profiling. A novel methylome-based scoring system namely malignancy density ratio (MD ratio) was developed based on 39 patients by comparing tumor and corresponding adjacent normal tissues of each patient. A MD score was then obtained by Wald statistics. The correlations of MD ratio, MD score, and genomic features with clinical outcome were investigated.Results: Patients with a high-risk MD ratio showed a significantly shorter postsurgical DFS compared with those with a low-risk MD ratio (HR=4.47, P=0.01). The MD ratio was not associated with T stage (P=1), tumor cell fraction (P=0.748) nor inflammatory status (p=0.548). Patients with a high-risk MD score also demonstrated an inferior DFS (HR=4.69, P=0.039). In addition, multivariate analysis revealed EGFR 19 del (HR=5.39, P=0.012) and MD score (HR= 7.90, P=0.01) were independent prognostic markers.Conclusion: The novel methylome-based scoring system, developed by comparing the signatures between tumor and corresponding adjacent normal tissues of individual patients, largely minimizes the bias of interpatient heterogeneity and reveals a robust prognostic value in patients with resected lung adenocarcinoma.

Glaucoma severity and intraocular pressure reduction after cataract surgery in eyes with medically controlled glaucoma.

To investigate the relationship between glaucoma severity and intraocular pressure (IOP) reduction after cataract surgery in patients with medically controlled primary open-angle glaucoma (POAG).Retrospective case series.This study included glaucoma suspects (GS) and POAG patients who underwent cataract surgery and continued to use the same glaucoma medications during the postoperative period of 4 months. The main outcomes were percent and absolute IOP changes calculated using the preoperative IOP and the postoperative IOP at 3 months. Preoperative glaucoma medications, preoperative IOP, demographic information, biometric parameters and variables for glaucoma severity were evaluated as potential predictors of IOP change.The average IOP reduction was 3.3 ± 2.4 mmHg (20.0%) and 2.2 ± 2.5 mmHg (13.1%) from the preoperative mean of 16.0 ± 2.9 mmHg and 15.2 ± 3.3 mmHg in the GS and POAG groups, respectively. Preoperative IOP, preoperative IOP/anterior chamber depth (preoperative IOP/ACD [PD ratio]) and preoperative IOP/retinal nerve fiber layer (RNFL) thickness (preoperative IOP/RNFL [PNFL ratio]) and preoperative IOP score x MD score x number of glaucoma medications (glaucoma index) predicted absolute IOP change in the POAG group, whereas preoperative IOP, PD ratio, PNFL ratio, and axial length (AL) did in the GS group. Preoperative IOP, PD ratio, and PNFL ratio predicted %IOP change in the POAG group, whereas only AL did in the GS group.In medically controlled POAG eyes, structural or functional parameters for glaucoma severity did not independently predict IOP change following phacoemulsification. However, novel severity indices obtained by addition of preoperative IOP and/or glaucoma medications to the structural or functional parameter predicted IOP changes.

327 A Novel Emergency Department-Based Telemedicine Program: How Do Older Patients Fare?

Popular wisdom suggests telemedicine care may be less readily by older patients and providers may have concerns about the use of novel communication technology in the evaluation of older adults. We describe patient characteristics, diagnosis, ED management, likelihood to return to the ED for unplanned care, and patient satisfaction among older patients being evaluated by telemedicine as part of their ED care as compared to a younger group of patients receiving the same type of evaluation. We analyzed a retrospective cohort of all adult patients who presented to the ED of our large, urban, academic medical center and who agreed to be seen by our telemedicine ED Express Care service between July 15, 2016 and May 31, 2017. In this program, patients who have a low acuity complaint receive a screening medical exam by an Advanced Practice Provider. They are then offered the opportunity to be seen by a doctor remotely via video rather than in person. Participation is voluntary. Patients 60 and older were compared to patients 21-59 years old by sex, ED length-of-stay, x-ray order, and diagnosis. Return to the ED within 72 hours was compared between older and younger groups, as was the change in treatment plan and need for hospitalization on return. Patient satisfaction as measured by Press Ganey (PG) was compared between older and younger patients. 1052 patients were seen in the telemedicine Express Care service at our main hospital site between July 15, 2016 and May 31, 2017. Average age was 45; 49% of patients were female. Patients 60 and older comprised 24% of the total. In this group, the average age was 72; the oldest patients were 99 years old. Younger patients ranged in age from 21 to 59 with average age of 37. Older patients were more likely to be female and were slightly less ill than younger patients. Older patients were more likely to be evaluated for wound check or suture removal and less likely to have a diagnosis of infectious illness or acute traumatic injury. X-rays were ordered less often for older patients, and older patients had shorter median ED length-of-stay. There were no significant differences by age group in 72 hour returns or likelihood to have a change in treatment plan on return. No patient required admission after return within 72 hours (Table 1). PG scores across 4 indicators (MD courtesy, MD listening, MD informed regarding treatment, MD took time to listen, and overall MD score) did not differ significantly between older and younger groups. One-quarter of patients seen at our novel ED-based telemedicine ED Express Care program at NewYork-Presbyterian/Weill Cornell Medicine were 60 or older. These patients received expedited care and did not have a higher rate of 72 hour return visits or change in treatment plan on return than younger patients. Older adults were as satisfied with telemedicine evaluation as the younger cohort. Our experience at NYP/Weill Cornell suggests that clinical pathways involving telehealth technology can be safely implemented and, once implemented, can be effective and readily by older adults.

The Mediterranean diet and risk of colorectal cancer in the UK Women’s Cohort Study

Evidence from epidemiological studies investigating associations between adherence to the Mediterranean diet and colorectal cancer is inconsistent. The aim of this study is to assess in the UK Women's Cohort Study whether adherence to the Mediterranean dietary pattern is associated with reduced incidence of cancers of the colon and rectum. A total of 35 372 women were followed for a median of 17.4 years. A 10-component score indicating adherence to the Mediterranean diet was generated for each cohort participant, using a 217-item food frequency questionnaire. The Mediterranean diet score ranged from 0 for minimal adherence to 10 for maximal adherence. Cox proportional hazards regression was used to provide adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for colon and rectal cancer risk. A total of 465 incident colorectal cancer cases were documented. In the multivariable adjusted model, the test for trend was positive (HR = 0.88, 95% CI: 0.78 to 0.99; Ptrend = 0.03) for a 2-point increment in the Mediterranean diet score. For rectal cancer, a 2-point increment in the Mediterranean diet score resulted in an HR (95% CI) of 0.69 (0.56 to 0.86), whereas a 62% linear reduced risk (HR 0.38; 95% CI: 0.20 to 0.74; Ptrend < 0.001) was observed for women within the highest vs the lowest category of the MD score. Estimates for an association with colon cancer were weak (Ptrend = 0.41). Findings suggest that women adhering to a Mediterranean dietary pattern may have a lower risk of colorectal cancer, especially rectal cancer.

Adherence to Mediterranean diet in relation to bone mineral density and risk of fracture: a systematic review and meta-analysis of observational studies.

We aimed to systematically review available data on the association between adherence to MD and BMD as well as risk of fractures and to summarize this information through a meta-analysis. Previous studies in the field of adherence to MD in relation to BMD and risk of fracture were selected through searching PubMed, Scopus, ISI Web of Science and Google Scholar databases prior to June, 2016 using Mesh and non-Mesh relevant keywords. In the meta-analysis of four effect sizes, obtained from three studies, we found that adherence to MD was associated with a 21% reduced risk of hip fracture (overall RR 0.79; 95% CIs 0.72-0.87). Adherence to MD was positively associated with lumber spine's (mean difference of BMD comparing highest and lowest categories of MD score 0.12; 95% CI 0.06-0.19g/cm2), femoral neck (0.10; 0.06-0.15g/cm2) and total hip (0.11; 0.09-0.14g/cm2) BMD. Meta-regression of included observational studies revealed a significant inverse linear association between Mediterranean diet score and risk of hip fracture, such that one unit increase in the score of Mediterranean diet was associated with a reduction in the risk of hip fracture (RR 0.95, 95% CI 0.92-0.98 p=0.01). Adherence to MD was associated with a reduced risk of fracture as well as with a higher mean BMD.

Time-to-Treatment in Chronic Myelomonocytic Leukemia - a Novel Prediction Model

IntroductionFor chronic myelomonocytic leukemia (CMML) several scores exist which prognosticate overall survival (OS) based on different clinical and genetic parameters. The time-to-treatment (TTT) among CMML patients is highly variable, and a predictive model to specifically estimate TTT in CMML has not been described so far. The aims of this single-center retrospective study were (a) to test and validate established myelodysplastic syndrome (MDS)-specific and CMML-specific prognostic scores in our patient cohort, (b) to evaluate which baseline factors were relevant to the time point of treatment initiation with either hydroxyurea or azacitidine, and (c) to propose a prediction model for TTT in CMML.MethodsThis retrospective analysis was based on the data of 55 unselected, consecutive CMML patients diagnosed and/or treated at our tertiary center between 2004 and 2015. We applied the following published prognostic models to our CMML cohort, using both OS and TTT as endpoints: the MD Anderson Prognostic Score (MDAPS), the modified MDAPS (MDAPS M1), the CMML-specific Prognostic Scoring System (CPSS), the Mayo Prognostic Model, the Düsseldorf Score, the International Prognostic Scoring System (IPSS), and the Revised International Prognostic Scoring System (IPSS-R).ResultsAccording to the CMML-specific MDAPS, 27% of our patients were classified as "higher-risk" (23% intermediate-2, 4% high-risk) (Figure 1). At the time of data analysis, 38% and 24% of patients had received azacitidine and hydroxyurea as first-line treatment. A total of 40 (73%) patients had died at the time point of data analysis. The median time of follow-up was 24.8 months (range 1.7-74.8 months).All applied MDS-specific (Düsseldorf Score, IPSS, IPSS-R) and CMML-specific (MDAPS, MDAPS M1, CPSS, Mayo Prognostic Model) prediction scores were able to significantly discriminate patient cohorts with different OS probabilities. The following variables were associated with a shorter TTT in the univariate analysis: the presence of immature myeloid cells in the peripheral blood, white blood cell count ≥14.5 G/L, platelet count <55 G/L, absolute neutrophil count ≥6 G/L, absolute lymphocyte count ≥2.3 G/L, absolute monocyte count ≥2.8 G/L, serum lactate dehydrogenase ≥223 G/L, peripheral blood blasts >0%, bone marrow blast percentage ≥7.5%, red blood cell transfusion-dependence, palpable spleen and/or symptomatic splenomegaly, and the presence of B-symptoms at the time of initial diagnosis. In multivariate analysis, the following factors remained independently associated with TTT: lactate dehydrogenase (HR 5.428; p = 0.008), bone marrow blast count (HR 4.570; p = 0.001), and platelet count (HR 2.660; p = 0.027).These three clinical parameters were included in the TTT prediction model and CMML patients were stratified into three subgroups: low-risk, intermediate-risk and high-risk. Median TTT was not reached for low-risk patients, 16.5 months for intermediate-risk patients, and almost immediate treatment initiation (0.6 months) was observed in the high-risk group (Figure 2).ConclusionsWe validated seven existing MDS-specific and CMML-specific prognostic scores in 55 CMML patients treated at the center in Salzburg. We were able to demonstrate that lactate dehydrogenase, bone marrow blast percentage and platelet count at initial diagnosis were the most relevant parameters for predicting time to treatment initiation in our CMML cohort. Based on these three parameters, we propose the first TTT prediction score for treatment-naïve CMML patients. Clinical implications of this score include the identification of CMML patients for early investigational trials, as well as the tailoring of individual follow-up intervals. [Display omitted] [Display omitted] DisclosuresHuemer:Roche: Other: Travel funding; Merck: Other: Travel funding. Egle:Gilead: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Other: travel support; Celgene: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Other: travel support. Greil:Pfizer: Honoraria, Research Funding; Boehringer-Ingelheim: Honoraria; Eisai: Honoraria; Celgene: Consultancy, Honoraria, Research Funding; Amgen: Honoraria, Research Funding; Mundipharma: Honoraria, Research Funding; Merck: Honoraria; Janssen-Cilag: Honoraria; Genentech: Honoraria, Research Funding; Novartis: Honoraria; AstraZeneca: Honoraria; Roche: Honoraria, Research Funding; Sanofi Aventis: Honoraria; GSK: Research Funding; Ratiopharm: Research Funding; Cephalon: Consultancy, Honoraria, Research Funding; Bristol-Myers-Squibb: Consultancy, Honoraria. Pleyer:Celgene: Consultancy, Honoraria; Bristol-Myers-Squibb: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; AOP Orphan Pharmaceuticals: Honoraria.

Comparison of Three Visual Field Tests in Children: Frequency Doubling Test, 24-2 and 30-2 SITA Perimetry

ABSTRACTBackground: To investigate the reliability of FDT and 24-2 and 30-2 Humphrey perimetry in children. Methods: We retrospectively reviewed the records corresponding to 274 eyes of children aged 6–12 years, who underwent FDT and 30-2 and 24-2 Humphrey visual field testing from January 2011 through March 2013. Each test group was divided into two subgroups: a normal visual acuity subgroup (> 0.8 Snellen, group 1) and a low visual acuity subgroup (≤0.8 Snellen, group 2). Reliability indexes such as fixation losses, test duration, and the number and rate of false-positive errors were analyzed. Results: In both subgroups, test duration was shortest for 24-2 perimetry (group 1: p < 0.0001; group 2: p < 0.0001). FDT was associated with lower rates of fixation loss, false positive errors, and false negative errors than 30-2 perimetry. However, the fixation loss rate of FDT was only significantly lower under the subgroup analysis. The normal visual acuity subgroup had a higher MD score on FDT vs. 30-2 perimetry (P = 0.028). However, the PSD was similar for all tests. Conclusion: This reliability study showed that FDT perimetry is superior to 30-2 SITA perimetry. There was no significant difference in the reliability indexes for FDT and 24-2 SITA perimetry; thus, when considering test duration and reliability, 24-2 SITA perimetry appears to be the optimal choice in pediatric patients.

Assessment of Depression, Anxiety, and Quality of Life in Singaporean Patients With Glaucoma.

To determine the prevalence and risk factors for anxiety disorder and depression among glaucoma patients in Singapore, and to assess the relationship between quality of life (QOL) and depression/anxiety. In this cross-sectional study, glaucoma patients aged 21 and above with a known diagnosis of primary open-angle glaucoma or primary angle-closure glaucoma were recruited from a tertiary care hospital. Patients with other types of glaucoma, and coexisting ocular or psychiatric disorders were excluded.Ophthalmic examination was carried out on all participants, which included best-corrected visual acuity (BCVA), intraocular pressure (IOP), gonioscopy, standard automated perimetry, and optic disc evaluation. Sociodemographic information and treatment histories were also collected.The Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Visual Function Questionnaire (VFQ25) were administered to evaluate for depression, anxiety, and impact on QOL, respectively. A total of 100 patients were included in this study. The mean age was 67.1±12.0 years (range, 24 to 90 y). The frequency of depression and anxiety among our patients was 30% and 64%, respectively. The mean HAM-D score was 4.37±4.17 (range, 0 to 17), whereas the mean HAM-A score was 2.38±2.80 (range, 0 to 13). The mean VFQ25 score was 78.8±16.0 (range, 42.4 to 97.0). The poorest subscale on the VFQ25 was driving, with a mean score of 42.4±42.6 (range, 0.0 to 100.0).We did not find any significant difference between the presence of depression/anxiety between patients with primary open-angle glaucoma (P=0.263) and primary angle-closure glaucoma (P=0.830). Risk factors for depression included: female sex (P=0.020), higher logMAR BCVA in the worse eye (P=0.004), higher cup-disc ratio (P=0.016), lower MD in the better and worse eye (P=0.022 and 0.001, respectively), and lower mean VFQ25 score (P<0.001). Risk factors for anxiety included: lower MD in the worse eye (P=0.004) and lower mean VFQ25 score (P=0.004). There was also no significant association between the use of topical β-blockers/carbonic anhydrase inhibitors with depression (P=0.793) or anxiety (P=0.282). There is a relatively high prevalence of depression (30%) and anxiety disorders (64%) among glaucoma patients in Singapore. Female glaucoma patients are more likely to suffer from depression. Other risk factors for depression include higher cup-disc ratio, higher logMAR BCVA, lower MD, and a lower mean VFQ25 score. Risk factors for anxiety disorder include lower MD and lower mean VFQ25 score. Ophthalmologists could consider use of the VFQ25 as an assessment for impairments in QOL in a glaucoma patient. If a glaucoma patient is at high risk of depression or anxiety disorder, a multidisciplinary management approach involving ophthalmology and psychiatry may be required.

Abstract 13938: Relationships Between ‘Mediterranean’ and ‘Western’ Dietary Patterns and Biomarkers Associated With Increased Cardiovascular Risk in Patients With Stable Coronary Heart Disease in the Global STABILITY Trial

Introduction: In the STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial greater adherence to a Mediterranean dietary pattern (MD) was associated with major cardiovascular (CV) events (MACE) but there was no association between a ‘Western Diet Score’ (WDS) and MACE. The lowest mortality and MACE was in patients with a MD score (MDS) ≥15. Hypothesis: Low adherence to a MD may be associated with higher plasma levels of biomarkers known to predict adverse CV events. Methods: At baseline, 15,482 (97.8%) trial participants completed a lifestyle questionnaire. MDS was calculated for increasing consumption of whole grains, fruits, vegetables, legumes, fish, and alcohol, and for less meat. WDS was calculated for increasing consumption of refined grains, sweets and desserts, sugared drinks, and deep-fried foods. In 15,287 of these participants hs C-reactive protein (hs-CRP), hs troponin T (hs-TnT), N-terminal B type natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), cystatin-C, growth differentiation factor-15 (GDF-15) and lipoprotein-associated phospho-lipase A 2 (Lp-PLA 2 ) were measured from stored plasma samples taken at baseline. The ratios of the geometric mean level of each biomarker by diet group are reported adjusted for age, gender, darapladib treatment, geographic region, markers of disease severity, and CV risk factors including body mass index, diabetes, hypertension, and low and high-density lipoprotein cholesterol. Results: Lower MDS (13-14/ ≥15 and ≤12/ ≥15 respectively) was associated with higher hs-CRP 1.12 (95%CI 1.05; 1.19), 1.18 (1.11; 1.25), cystatin-C 1.01 (1.00; 1.02), 1.03 (1.01; 1.04), GDF-15 1.05 (1.02; 1.07), 1.06 (1.04; 1.09) and LpPLA2 1.02 (1.01; 1.04), 1.04 (1.02; 1.06) after adjusting for all co-variables (p&lt;0.01 for all). IL-6, hs-TnT and NT-proBNP were not independently associated with MDS. WDS was not independently associated with higher plasma levels of any biomarkers. Conclusions: MD may be associated with lower CV risk in part by effects on inflammatory activity and pathways of cellular function independent of plasma lipids. Greater consumption of food in the WDS was not associated with adverse CV events or with biomarkers known to be associated with risk.