Mean Number Of Days Research Articles

QLTI-11. TIMELINE FROM INITIAL MRI TO INTERVENTION IN NEWLY DIAGNOSED HIGH GRADE GLIOMA

Abstract OBJECTIVE Prompt treatment of high-grade glioma is crucial for prolonging life. In an attempt to identify factors that lead to delays in treatment, we evaluated the amount of time between initial MRI and treatment start date for our patients with newly diagnosed high grade glioma. METHODS This was a retrospective chart review study. Adults over the age of 18 years of age with newly diagnosed high grade glioma were included if they were seen by the neuro-oncology department at Loma Linda University Medical Center. Reviewed charts were dated from November 2020 to August 2022. We evaluated the amount of time between initial MRI and several important milestones in the diagnosis and treatment of high grade glioma, including resection; biopsy results; neuro-oncology consult; radiation-oncology consult; date that chemotherapy was ordered, received by the patient, and initiated; and radiation therapy start date. RESULTS Twenty-two patients with new diagnosis of high-grade glioma were identified. Six patients were excluded due to complicated treatment courses involving outside facilities. Sixteen patients were included in the study. Thirteen patients (81%) had a diagnosis of glioblastoma, 2 (12%) had a diagnosis of diffuse midline glioma, and 1 (6%) had a diagnosis of anaplastic astrocytoma. The mean number of days between initial MRI and chemotherapy start date was 88. Prolonged timelines were seen in all analyzed metrics. CONCLUSIONS There is a significant delay in chemotherapy initiation for patients with high grade glioma at our facility. We also provide a framework for other institutions to evaluate their system processes in order to improve care delivery.

Efficacy of polyherbal formulation along with standard care of treatment in early recovery of COVID-19 patients: a randomized placebo-controlled trial

BackgroundThe coronavirus disease-2019 (COVID-19) pandemic crisis has affected millions of people worldwide. The emergence of mutant strains one after the other, breakthrough infections post-vaccination and reinfection of the virus have made it difficult to fight the pandemic and bring an end to it. Naturally available compounds with an array of phytochemicals and potent antiviral properties can provide an alternate solution in improving innate immunity, early recovery and symptomatic cure from COVID-19.ObjectiveThe present study investigates the efficacy of a polyherbal formulation, NAOQ19, on the rate of recovery and clinical improvement among COVID-19-infected patients who were not on a ventilator or in intensive care unit.MethodsA randomized placebo-controlled study design was adopted for the study. The study enrolled 124 patients with 62 patients included in the NAOQ19 arm and other 62 patients enrolled in the placebo arm along with standard care of treatment. Key outcomes of the study included improvement from COVID-19 based on RT-PCR negative test tested on day 3, 5, 7 and 10, CRP inflammatory rate and drug safety. Data analysis included intention to treat approach. Significance was accepted with a two-sided p value < 0.05 for the outcome measures.ResultsThe results of the present study demonstrated higher proportion of patients recovering in NAOQ19 arm compared to placebo arm on day 3 (33.8% vs. 8%; p < 0.001). The mean number of days required to turn RT-PCR (Real-time reverse transcriptase-polymerase chain reaction) negative was also lower in NAOQ19 arm by a day compared to placebo arm (5.4 vs. 6.2; p = 0.022). Inflammatory marker CRP (C-reactive protein) significantly reduced in the NAOQ19 arm at exit compared to placebo arm (6.25 mg/L vs. 10.26 mg/L; p = 0.048). Liver function test and kidney function test profiles were within normal limits during exit demonstrating the drug safety.ConclusionNAOQ19 along with standard care of treatment demonstrated higher percentage of population recovering from COVID-19 in comparison with those who were on standard care of treatment.Trial registration: The trial was also registered in Clinical Trial Registry India with registration number CTRI/2021/10/037423.

Abstract 12912: Effect of Real-Time Ambulatory Electrocardiography on Time-to-Intervention

Background: Mobile cardiac telemetry (MCT) and event monitors are ambulatory electrocardiography (AECG) monitors to aid in the detection/diagnosis of arrhythmias. They are unique in their real-time alerts to clinicians. This contrasts with Holter monitoring, which is continuous but where results are not available until after completion of the exam, uploading, and clinician over-read. There is limited data on relative benefit for time to electrophysiology procedure and interventions. Hypothesis: Does real-time monitoring of AECG reduce the time to cardiac implantable electronic device procedure, ablation procedure, or healthcare encounter when compared to AECG without real-time monitoring? Methods: This is a retrospective observational analysis of University of Utah Health patients who underwent AECG studies from 2010-2022. The study cohort was stratified by patients with an ambulatory ECG that provides real-time event notification (CEM and MCT; hereafter Non-holter) versus those that do not (Holter). The outcomes of interest were cardiac device implantation, ablation procedure, and ER/hospitalization within 12 months, analyzed based on time-to-event using log-rank tests. Results: We identified 50 patients in the Holter group and 137 for the Non-holter group. The groups had similar baseline characteristics in terms of age, gender, and co-morbidities. The mean number of days to device implant was 68.1 and 66.36, to ablation procedure was 77.68 and 67.77, and to ER/hospital visit was 61.12 and 55.38 in the Holter and Non-holter groups respectively (Figure). Conclusion: There was not a statistically significant difference between AECG monitoring in real-time (Non-holter) and those without (Holter), however, there was a trend toward decreased time to intervention in the Non-holter group for each of the three outcomes. Future, larger cohorts may provide adequate power to determine if real-time monitoring does reduce time to the studied interventions.

Harnessing technology and gamification to increase adult physical activity: a cluster randomized controlled trial of the Columbia Moves pilot

BackgroundThe use of health technologies and gamification to promote physical activity has increasingly been examined, representing an opportunistic method for harnessing social support inherent within existing social ties. However, these prior studies have yielded mixed findings and lacked long-term follow-up periods. Thus, a pilot cluster randomized controlled trial was conducted to gauge the feasibility and preliminary efficacy of a digital gamification-based physical activity promotion approach among teams of insufficiently active adults with existing social ties.MethodsTeams (N = 24; 116 total participants) were randomized to either a 12-week intervention (Fitbit, step goals, app, feedback; TECH) or the same program plus gamification (TECH + Gamification). Mixed effects models were used to compare group differences in treatment adherence, and changes in social support, steps, and moderate-to-vigorous physical activity at 12 weeks and 52 weeks from baseline, adjusted for sociodemographic characteristics and team size.ResultsTECH had a lower mean number of days of Fitbit self-monitoring versus TECH + Gamification during the intervention (adjusted difference: -.30; 95% CI, -.54 to -.07; P = .01). Post-intervention, TECH had 47% lower odds of self-monitoring 7 days per week versus TECH + Gamification (.53; 95% CI, .31 to .89; P = .02). No differences were observed between TECH + Gamification and TECH in increases in social support (0.04; 95% CI, -.21 to .29; P = .76), ActiGraph-measured daily steps (-425; 95% CI, -1065 to 215; P = .19), or moderate-to-vigorous physical activity minutes (-3.36; 95% CI, -8.62 to 1.91; P = .21) from baseline to 12 weeks or in the regression of these improvements by 1 year (Ps > .05). Although not significant in the adjusted models (Ps > .05), clinically meaningful differences in Fitbit-measured daily steps (TECH, 7041 ± 2520; TECH + Gamification, 7988 ± 2707) and active minutes (TECH, 29.90 ± 29.76; TECH + Gamification, 36.38 ± 29.83) were found during the intervention.ConclusionsA gamified physical activity intervention targeting teams of adults with existing social ties was feasible and facilitated favorable, clinically meaningful additive physical activity effects while in place but did not drive enhanced, long-term physical activity participation. Future investigations should explore optimal team dynamics and more direct ways of leveraging social support (training teams; gamifying social support).Trial registrationClinicaltrials.gov (NCT03509129, April 26, 2018).

Prior Daratumumab Exposure and It's Correlation to Parameters Related to Apheresis Prior to Hematopoietic Stem Cell Transplantation in Multiple Myeloma

A number of recent studies have brought to light the potential detrimental effect the biologic monoclonal antibody daratumumab, directed towards CD38, may have on the collection of stem cell collection for hematopoietic stem cell transplantation (HSCT). In our evaluation of this claim, we retrospectively reviewed multiple myeloma patients who underwent autologous HSCT at a major tertiary transplant center between 2017 and 2022. A total of 240 patients were identified which included 62 patients who received daratumumab prior to stem cell collection and 178 patients who had no prior daratumumab exposure. Basic demographic data was collected as well as radiation, chemotherapy, and smoking history. No significant differences were identified between the groups based on demographics, smoking, or radiation exposure. Parameters related to peripheral stem cell collection were identified and recorded. We found that in patients exposed to daratumumab prior to apheresis, the mean number of days of apheresis required to reach the target collection goal was statistically increased compared to control (1.42 days ± 0.07 vs 1.26 ± 0.03; p&amp;lt;0.05). Furthermore, medications used to increase peripheral stem cell collection yield were also increased. It was demonstrated that the mean number of doses of plerixafor and G-CSF analogs were increased in the daratumumab group vs the control (1.08 ± 0.12 vs 0.6 ± 0.05; p&amp;lt;0.001 and 5.98 ± 0.31 vs 5.17 ± 0.06; p &amp;lt;0.001 respectively). Total number of stem cells collected both as an absolute number and controlled for the number of days of apheresis were lower in the daratumumab group compared to the control (5.31x10^6 ± 0.31 vs 6.68x10^6 ± 0.20; p&amp;lt;0.05 and 4.16x10^6 ± 0.32 vs 5.84x10^6 ± 0.21; p &amp;lt; 0.001 respectively). These results suggest that pre-apheresis exposure to daratumumab has a detrimental effect on peripheral stem cell collection. These results have a significant implications for both long term patient care and healthcare system resource utilization. The clinical outcome implications of daratumumab are currently not well known and further study is needed to determine if alterations in stem cell collection protocols would result in improved stem cell collection yields for patients with pre-collection daratumumab exposure. All data is expressed as mean ± SEM

Effect of early electroconvulsive therapy on length of stay in patients with bipolar, depressive and psychotic disorders.

There is limited literature examining the effect of early electroconvulsive therapy(ECT) on the length of stay(LOS), especially for psychotic disorders. This study aimed to evaluate the association between early ECT and LOS in three main groups of patients with bipolar, depressive and primary psychotic disorders. A retrospective descriptive analysis of 464 patients who received inpatient ECT from May 2017 to March 2021 in a large tertiary psychiatric institution was conducted. Early ECT was defined as ECT done before the mean number of days from admission to initiation of ECT by diagnosis. The main outcome measure was LOS, which was examined by diagnosis between the early and late ECT groups, using a linear regression model with adjustment factors chosen based on univariate analysis. A strong, significant association was found between early ECT and a shorter LOS (β -28.3, 95% CI -33.6 to -23.0, p<0.001), even after accounting for adjustment factors. This association was consistent in all three diagnosis groups: bipolar disorders (β -14.5, 95% CI -20.1 to -9.0, p<0.001), major depressive disorder (β -18.2, 95% CI -27.1 to -9.3, p<0.001) and psychotic disorders (β -39.0, 95% CI -46.8 to -31.2, p<0.001). There was no significant difference in the 30-day readmission rates between the early and late ECT groups trans-diagnostically. Early ECT is strongly associated with a shorter LOS across a range of diagnostic indications including major depressive disorder, bipolar disorder and schizophrenia. ECT can be considered earlier in treatment-decision algorithms and may offer a reduction in LOS.

Pharmacist-led intervention on potentially inappropriate prescription in patients with polypharmacy: PHARM-PC clinical trial protocol

ObjectivePolypharmacy and potentially inappropriate medications (that is, those associated with an unfavorable risk-benefit ratio) are common concerns in the context of elderly patients treated in primary care as they may increase the risk of morbidity and mortality, as well as healthcare costs. Several studies have assessed the impact of pharmacist-led systematic reviews with respect to prescription appropriateness, health outcomes and/or costs. However, no cluster-randomized controlled trial has been identified that provides an overall assessment of these variables. The objective is to determine the effectiveness of a pharmacist-led systematic medication review in reducing the mean number and proportion of patients on potentially inappropriate medications (primary goal); as well as in decreasing morbidity and mortality and the cost of medications and the use of healthcare resources (secondary goals). MethodAn open-label, cluster-randomized controlled trial will be conducted; where primary care physicians will be randomized either to receive (intervention group) or not to receive pharmacist recommendations to withdraw potentially inappropriate medications detected through the combined use of explicit and implicit criteria (control group). Primary endpoints will be the proportion of patients on potentially inappropriate medications and the mean number of such medications per patient. Secondary endpoints will be healthcare resources used, the proportion of patients who die and the mean number of days survived, as well as the cost of medications and cost of healthcare resources used. ConclusionsIn line with similar reports and based on our stud's design, we hope to obtain statistically significant reductions in the use of potentially inappropriate medications and in medication costs overall. We do not however expect to obtain significant reductions in morbimortality or the cost of health resources employed.

Streptococcus Salivarius K12 Probiotic in Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis syndrome

Background and Objectives: Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) is the most common syndrome in children. This complication is characterized by the sudden onset of fever, aphthous stomatitis, pharyngitis, and cervical adenitis, as well as less common signs, such as headache, rash, and changes in the digestive system. This study aimed to investigate the effectiveness of the probiotic Streptococcus Salivarius K12 in patients with PFAPA. Materials and Methods: This randomized clinical trial included PFAPA patients divided into intervention and control groups. The intervention group, along with the conventional treatments, received Lactogum containing Probiotic Streptococcus Salivarius K12 for four months. The control group, however, received conventional treatments, including acetaminophen and non-steroidal anti-inflammatory drugs (prednisolone), along with a placebo. Results: This study investigated 40 PFAPA patients. The mean ages of the patients in the control and intervention groups were 6.94±2.21 and 5.71±2.59 years, respectively. The highest fever temperature of the children in the control and intervention groups upon admission to the clinic were 38.88±0.53ºC and 39.96±0.85ºC, respectively. According to the results, in the first month, the mean number of days suffering from fever was fewer in the intervention group, compared to the control group. Moreover, the mean number of pharyngitis days in the first and second months was fewer in the intervention group than that in the control group. In the fourth month, the disease symptom percentages were reduced in the intervention group, compared to the control group. Conclusion: The results show that the use of probiotics (Streptococcus Salivarius K12) can be effective in reducing the consumption of corticosteroids and minimizing the complications caused by conventional treatments.

Aluminium Application and Rhizobia Inoculation Effects on Growth, Yield and Nutrients Uptake of Three Kenyan Soy Bean Genotypes

Soy bean (Glycine max L.) grains are important legume crops commonly grown in Kenya. Soy bean genotypes are grown in western Kenyan soils that are highly saturated with aluminium ions. Aluminium toxicity mainly limits crop production. Many soy bean genotypes do not tolerate high acidity in soils. Aluminium stress have effects on root growth, which limits plant growth and development. Inoculation of plants with Rhizobia can restore nitrogen under acid affected soils to produce competitive crop yields. There is little information on response of soy bean genotypes grown in Western Kenya to aluminium toxicity under rhizobium inoculation. This study was designed to determine the effect of aluminium application and Rhizobia inoculation on growth, yield and nutrients uptake of soy bean genotypes. Eight treatments of Al (AlCl3.6H2O) levels and Rhizobia were imposed. Randomized Complete Block Design with three replicates was used. Parameters determined included; number of branches, days to 50% flowering, pod clearance, number of pods, days to harvest maturity and nitrogen, phosphorus and potassium contents. Tukey’s HSD test at 5% level was used to separate treatment means. Mean of branches for NAMSOI was significantly higher compared to mean branches for GAZZELLE and TGX at treatment 4 (T4) on 61 DAT, respectively. Mean number of days to 50% flowering of NAMSOI was significantly higher than that of GAZZELLE and TGX genotypes, respectively at T3.There was a statistically significant interaction between the effects of treatments and genotypes on NPK concentrations in plants. These findings show that Bradyrhizobium japonicum inoculation alleviates Al effects to a level that is significant to improve soy bean yield. Therefore, genotypes GAZELLE and NAMSOI under Rhizobia inoculation were identified to be more tolerant to Al-stress, hence are recommended for growing in Al prone soils. It provides the best conditions in improving soy bean production under Al stress prone soils.

Evaluation of audit and feedback to family physicians on prescribing of opioid analgesics to opioid-naïve patients: A pragmatic randomized delay trial

BackgroundExposure to opioid analgesics have historically raised concern for a risk of developing opioid use disorder. Prescriber audit-and-feedback interventions may reduce opioid prescribing, but some studies have shown detrimental effects for current users. We examined the effectiveness of an audit and feedback intervention, named Portrait, to reduce initiation of opioid analgesics among opioid-naïve patients experiencing pain. MethodsREDONNA was a single-blinded, two-arm (Early vs Delayed mailing) randomized trial of a portrait for eligible family physicians (FPs) in British Columbia (BC), Canada. The primary outcome was the change in the number of initiations of opioid analgesic prescriptions written by FPs for acute/chronic pain management. We compared outcomes for a 6-month window before vs. after each mailed intervention, using differences in percent differences (DPD) with 95% confidence intervals (CI) and odds ratios (OR) from logistic regressions adjusted for clustering of patients by FP. ResultsIn the Early (n = 2260) and Delayed (n = 2156) groups, opioid initiations per month were the same in the Before (2.10 Early; 2.06 Delayed) and After (1.94 Early; 1.95 Delayed) windows. The DPD was −2.1% (CI: −4.4% to 0.3%), and ORs were: 0.98 (CI: 0.96 to 1.01) for any opioid, 0.97 (CI: 0.94 to 1.01) for codeine (62% of initiations), and 1.0 (CI: 0.97 to 1.07) for tramadol (25% of initiations). There were no differences in mean quantity of tablets, mean milligrams of morphine equivalents (MME), or mean number of days. ConclusionPortrait had no impact on FPs' rates of prescribing opioid analgesics to opioid-naïve patients experiencing pain. Trial registrationThe study was registered prospectively on 30 March 2020 at the ISRCTN Register (https://www.isrctn.com/ISRCTN34246811).

Ocorrência de Cryptosporidium spp. em bezerros de rebanhos leiteiros do norte de Antioquia, Colômbia

ABSTRACT Cryptosporidium spp. are important enteropathogen protozoan parasites that infect humans and other animals throughout the world. Cryptosporidiosis in cattle industry leads to considerable economic losses due to diarrhea, dehydration, growth retardation, weight loss, and possibly death, however, data on the occurrence ofCryptosporidiumspp. in cattle in Colombia are limited. Therefore, this study aimed to investigate the occurrence and possible factors associated to the excretion of Cryptosporidium spp. oocyst in pre-weaned calves from dairy farms in Northern Antioquia, Colombia. In addition, Sheather’s sugar floatation (SSF), and Modified Ziehl-Neelsen staining (MZN) methods were compared. A total of 41 fecal samples were collected from calves between 1 and 92 days of age of which 23 were positive (56.1%). Crossbreed calves were nine times less susceptible than purebred dairy cattle to excretion of Cryptosporidium spp. oocysts (OR=0.10). MZN was the best technique for the detection of oocysts in fecal samples, however, the mean number of days to detect cryptosporidial oocysts was lower for the SSF method. Cryptosporidium is widespread among calves under 2 months of age in dairy herds of Northern Antioquia, although further investigations considering a greater number of farms and animals are necessary.

Treatment patterns, survival, and healthcare utilisation and costs in patients with locally advanced and metastatic bladder cancer in Denmark 2015–2020

Background Treatment patterns in locally advanced and metastatic urothelial bladder cancer (La/mUBC) is changing, but little is known about current treatment patterns, survival, and costs of these patients. Our aim was to describe treatment patterns, survival, and healthcare utilisation/costs in Danish La/mUBC patients in a routine clinical care setting. Methods Registry-based nationwide cohort study including all bladder cancer patients aged 18 years or older with a La/mUBC tumour in the pathology register and a concomitant bladder cancer diagnosis in the Danish National Patient Registry in the period 2015–2020. We categorised the patients according to (1) La/mUBC at time of first bladder cancer diagnosis (de novo La/mUBC) and (2) non-invasive or localised muscle-invasive bladder cancer at time of diagnosis which had progressed to La/mUBC. All patients were included at date of pathology-confirmed La/mUBC. Follow-up ended 30 September 2022. Results We identified 1278 patients (69% men) with La/mUBC and no other previous cancer. Of these, 212 (17%) had de novo La/mUBC, while 1066 (83%) had progressed to La/mUBC. Median age was 72 years. Patients were followed for a median of 13.0 months (interquartile range 4.7;32.0). During follow-up, 651 (51%) patients started first-line treatment, of these, 285 progressed to second-line treatment, and 112 also started third-line treatment. Median survival was 13.0 months from La/mUBC diagnosis, 12.1 months from start of first-line treatment, 9.8 months from start of second-line treatment, and 8.6 months from start of third-line treatment. The mean number of days admitted to hospital was 3.47, 3.97, and 4.07 per month following initiation of first-line, second-line, and third-line treatment, respectively. Conclusion Patients with La/mUBC have a poor prognosis, and in routine clinical care only around half of the patients received systemic anti-cancer treatment suggesting an unmet need for novel treatments. The overall costs only increased slightly from first to third-line treatment.

Utility of Office Hysteroscopy in Diagnosing Retained Products of Conception After Early Pregnancy Loss After In Vitro Fertilization.

To evaluate the utility of office hysteroscopy in diagnosing and treating retained products of conception in patients with infertility who experience early pregnancy loss (EPL) after in vitro fertilization (IVF). We evaluated a retrospective cohort of 597 pregnancies that ended in EPL in patients aged 18-45 years who conceived through fresh or frozen embryo transfer at an academic fertility practice between January 2016 and December 2021. All patients underwent office hysteroscopy after expectant, medical, or surgical management of the EPL. The primary outcome was presence of retained products of conception at the time of office hysteroscopy. Secondary outcomes included incidence of vaginal bleeding, presence of intrauterine adhesions, treatment for retained products of conception, and duration of time from EPL diagnosis to resolution. Log-binomial regression and Poisson regression were performed, adjusting for potential confounders including oocyte age, patient age, body mass index, prior EPL count, number of prior dilation and curettage procedures, leiomyomas, uterine anomalies, and vaginal bleeding. Of the 597 EPLs included, 129 patients (21.6%) had retained products of conception diagnosed at the time of office hysteroscopy. The majority of individuals with EPL were managed surgically (n=427, 71.5%), in lieu of expectant management (n=140, 23.5%) or medical management (n=30, 5.0%). The presence of retained products of conception was significantly associated with vaginal bleeding (relative risk [RR] 1.72, 95% CI 1.34-2.21). Of the 41 patients with normal pelvic ultrasonogram results before office hysteroscopy, 10 (24.4%) had retained products of conception detected at the time of office hysteroscopy. When stratified by EPL management method, retained products of conception were significantly more likely to be present in individuals with EPL who were managed medically (adjusted RR 2.66, 95% CI 1.90-3.73) when compared with those managed surgically. Intrauterine adhesions were significantly less likely to be detected in individuals with EPL who underwent expectant management when compared with those managed surgically (RR 0.14, 95% CI 0.04-0.44). Of the 127 individuals with EPL who were diagnosed with retained products of conception at the time of office hysteroscopy, 30 (23.6%) had retained products of conception dislodged during the office hysteroscopy, 34 (26.8%) chose expectant or medical management, and 63 (49.6%) chose surgical management. The mean number of days from EPL diagnosis to resolution of pregnancy was significantly higher in patients who elected for expectant management (31 days; RR 1.18, 95% CI 1.02-1.37) or medical management (41 days; RR 1.54, 95% CI 1.25-1.90) when compared with surgical management (27 days). In patients with EPL after IVF, office hysteroscopy detected retained products of conception in 24.4% of those with normal pelvic ultrasonogram results. Due to the efficacy of office hysteroscopy in diagnosing and treating retained products of conception, these data support considering office hysteroscopy as an adjunct to ultrasonography in patients with infertility who experience EPL after IVF.

Multi-disciplinary management of type 1 and 2 skin tears using a silver-based hydrofiber dressing.

Skin tear is a common problem encountered in the emergency department. If it is not properly managed, it can lead to wound infection, skin necrosis and a need for further surgical intervention and skin grafting. Current management is to cleanse the wound, replace the thin skin tear followed by coverage with a dressing that is inducive for wound healing. Several dressings have been suggested for the coverage of these wounds. But, up to now, there has been no mention of the use of a silver-based hydrofiber dressing in the management of this condition. The objective of this study was to explore the use of a silver-based hydrofiber dressing for the management of paper-thin skin tears. We retrospectively reviewed all patients with Type 1 or 2 skin tears that had undergone management using a silver-based hydrofiber dressing between October 2019 and October 2020. Demographic data and medical history was obtained by retrospective chart review. Data that was collected included: age, sex, comorbid illnesses, defect location, defect size, complications, number of times the silver-based hydrofiber dressing was replaced and the number of days required to achieve complete wound healing. A total of 65 patients were included in the study. There were 42 males and 23 females. There were 28 patients whose age was greater then 85 years old, of which 14 patients were over 90 years old. The mean number of outpatient visits was 2. The mean defect size was 33 cm2 (range 1 cm × 1 cm to 18 × 10 cm). The mean number of days required for total wound healing was 13 days (range 7-21). We did not encounter any patients that required further surgical debridement or split-thickness skin grafting. The use of a silver-based hydrofiber dressing was well tolerated by the elderly population as it provided an easy, efficient, economical and effective form of management of skin tears. We suggest that a silver-based hydrofiber dressing can be used as a first-line treatment method for type 1 and 2 skin tears.

307 An audit of dual antiplatelet prescribing after minor ischaemic stroke

Abstract Background The American Heart Association make class 1A recommendation for dual antiplatelet therapy for secondary prevention in patients with minor ischemic stroke (National Institutes of Health Stroke Scale score ≤ 3) or high risk TIA on the basis of evidence from randomised controlled trials, such as POINT and CHANCE, which have demonstrated a lower rate of subsequent stroke compared with single antiplatelet therapy. A number of clinical factors have been shown to influence effectiveness, including time from symptom onset to initiation of dual antiplatelet therapy. We aim to evaluate the rate of dual antiplatelet prescribing in this cohort and whether the rationale not to prescribe was clearly documented. Methods We reviewed the electronic records of all stroke patients aged 18 and above, admitted to University Hospital Galway within June 1st to September 29th 2022. Patients who either had a minor ischaemic stroke with a clearly documented NIHSS score of ≤3 were included in the analysis. These records were then assessed for the rate of dual antiplatelet prescribing versus single antiplatelet prescribing and if the rationale was documented. Results Of 29 patients admitted with minor ischaemic stroke, 8 were commenced on dual antiplatelet therapy. The mean number of days from symptom onset to presentation was 1.92 for those who were prescribed DAPT and 2.42 for those who were prescribed SAPT. Of those prescribed SAPT, the rationale for not commencing DAPT was documented. Rationale included delay to presentation (&amp;gt;72 hours) and atrial fibrillation. Conclusion 48.3% (n = 14) DAPT was either prescribed or a documented rationale for SAPT was provided. Our findings are consistent with DAPT prescribing patterns in other studies [1].

Clinical outcomes of children with acute asthma managed with intravenous magnesium sulphate outside intensive care setting.

Asthma in children constitutes a well-known respiratory condition with significant mortality. In poorly controlled asthma, multiple adjunct therapies including magnesium sulphate (MgSO4), are recommended to decrease the likelihood of intubation; however, limited evidence exists to support their routine usage in day-to-day situations. Aim of this study is to determine the outcomes of pediatric patients treated with magnesium sulphate during exacerbations of asthma admitted at a tertiary care unit. A retrospective study was conducted at The Aga Khan University Hospital, Karachi, Pakistan from January 2019 to December 2021. Patients aged 6 years to 15 years presented with acute asthma through Emergency Room (ER) having clinical respiratory score (CRS) more than five, admitted in high-dependency unit (HDU) were included in the study. Patients who were started on magnesium sulfate within 24 hours of admission were categorized in magnesium sulfate (MS) group. Patients receiving all standard acute asthma treatment but were not started on magnesium therapy within 24 hours of admission were categorized in the non-magnesium sulfate (non-MS) group. Different outcome variables were compared between the groups. A total of 110 patients with asthma were enrolled. Fifty-four patients were categorized into MS group while 56 were included in non-MS group. Fewer patients were transferred from HDU to pediatric intensive care unit (PICU) (24.07%) in MS group compared to non-MS group (42.85%), (p=0.02). In MS group, the mean number of days spent on oxygen in HDU were 2.38±0.81, while non-MS group spent more days (3.10±0.84 (p<0.01). This study demonstrates that for pediatric patients with severe asthma exacerbations, administration of IV MgSO4 (within 24 hours) is beneficial and results in fewer admissions to PICU and reduces the mean number of days spent on oxygen therapy.

ICGA combined with EP monitoring in microclipping of cerebral aneurysms.

Cerebral aneurysm is one of the common cerebrovascular diseases in neurosurgery, and rupture of cerebral aneurysm is the most important cause of spontaneous subarachnoid hemorrhage. How to precisely clip the aneurysm has been a topic worth discussing, so the authors explore the value of ICGA combined with electrophysiological monitoring in the microclipping of cerebral aneurysms. Using the method of retrospective analysis of cases, 661 patients with cerebral aneurysms admitted to the Department of Neurosurgery, Zhongnan Hospital of Wuhan University, from 2021.8 to 2022.10 were studied, 390 patients with aneurysm clipping were included, and patients with Hunt-Hess classification ≥ 4 were excluded, and whether to use ICGA combined with EP in microclipping of the ruptured and unruptured aneurysm in pterional approach was investigated at the time of discharge, respectively. The MRS and total hospital days were compared to investigate the value of ICGA combined with EP in the microclipping of cerebral aneurysms. All 390 patients enrolled in the group had successful aneurysm clipping, 178 patients were screened for ruptured aneurysm pterional approach and 120 patients for unruptured aneurysm pterional approach access; the MRS at discharge was significantly lower in the ICGA combined with EP group than in the no-EP group for ruptured aneurysm pterional approach microclipping (p < 0.001), and the mean number of days in hospital was significantly lower (p < 0.01). Patients in the ICGA combined with EP group in microclipping of unruptured aneurysms with pterional approach also had significantly lower MRS at discharge compared with patients in the ICGA alone group (p < 0.001), with no statistically significant difference in the mean number of days in hospital (p = 0.09). In open cerebral aneurysm microclipping, ICGA combined with EP monitoring for both ruptured and unruptured aneurysms can effectively reduce the false-negative rate of ICGA, significantly reduce the incidence of postoperative neurological deficits, and shorten the total hospital stay to some extent. ICGA combined with EP monitoring may be an effective means to reduce the rate of false clipping of the penetrating vessels and to avoid stenosis or occlusion of the aneurysm-carrying artery and is worth promoting in microclipping of cerebral aneurysms except for Hunt-Hess ≥ 4.

185 Improving Care and Outcomes with One-Stop Haematuria Clinic

Abstract Aim To compare the outcomes of pre and post implementation of a Faster Diagnostic Standard (FDS) at 28 and 62 days before and after implementation of the One-Stop Haematuria Clinic in James Paget University Hospital. Method The data for the retrospective audit was collected from the Somerset cancer registry and Ullyses. All patients referred on 2 week-wait haematuria pathways were included from July 2020-October 2020 (pre-implementation of the one-stop clinic, n = 132) and from September 2021 – January 2022 (post-implementation of the one-stop clinic, n = 269). The data points were 2 week-wait, referral to flexible cystoscopy, imaging, 28-day and 62-day targets. The data was analysed using unpaired T-test. Results Following implantation of the one-stop clinic, the mean number of days for referral to flexible cystoscopy reduced from 27 to 19 (p&amp;lt;0.0001) and referral to imaging reduced from 27 to 19 (p&amp;lt;0.0001). The mean number of days to reach 28-day target decreased from 47 to 31 (p&amp;lt;0.0001). Days from referral to TURBT (Transurethral Resection of Bladder Tumour) decreased from 61 to 57 (p = 0.60). The patients meeting the 62-day target of TURBT as FDT increased from 66% to 83% (p = 0.35). Conclusions The introduction to one-stop haematuria clinic led to shorter time from referral to flexible cystoscopy, imaging and diagnosis. However, time from referral to TURBT was similar. A greater percentage of patients met the 62-day target of TURBT as FDT. Therefore, one stop haematuria clinics provide a more efficient diagnostic pathway for this group of patients.

Transcutaneous electrical diaphragmatic stimulation in mechanically ventilated patients: a randomised study

BackgroundFew specific methods are available to reduce the risk of diaphragmatic dysfunction for patients under mechanical ventilation. The number of studies involving transcutaneous electrical stimulation of the diaphragm (TEDS) is increasing but none report results for diaphragmatic measurements, and they lack power. We hypothesised that the use of TEDS would decrease diaphragmatic dysfunction and improve respiratory muscle strength in patients in ICU.MethodsWe conducted a controlled trial to assess the impact of daily active electrical stimulation versus sham stimulation on the prevention of diaphragm dysfunction during the weaning process from mechanical ventilation. The evaluation was based on ultrasound measurements of diaphragm thickening fraction during spontaneous breathing trials. We also measured maximal inspiratory muscle pressure (MIP), peak cough flow (PEF) and extubation failure.ResultsSixty-six patients were included and randomised using a 1:1 ratio. The mean number of days of mechanical ventilation was 10 ± 6.8. Diaphragm thickening fraction was > 30% at the SBT for 67% of participants in the TEDS group and 54% of the Sham group (OR1.55, 95% CI 0.47–5.1; p = 0.47). MIP and PEF were similar in the TEDS and Sham groups (respectively 35.5 ± 11.9 vs 29.7 ± 11.7 cmH20; p = 0.469 and 83.2 ± 39.5 vs. 75.3 ± 34.08 L/min; p = 0.83). Rate of extubation failure was not different between groups.ConclusionTEDS did not prevent diaphragm dysfunction or improve inspiratory muscle strength in mechanically ventilated patients.Trial registration: Prospectively registered on the 20th November 2019 on ClinicalTrials.gov Identifier NCT04171024.

1030 Impact of COVID-19 on Operative Timing for Plastic Surgery Hand Trauma in a Plastic Surgery Tertiary Referral Centre

Abstract Aim To evaluate the impact of COVID-19 on operative timing for hand trauma in a plastic surgery tertiary referral centre. Method Data was collected retrospectively on 80 patients who underwent surgical management for closed hand fractures, digital nerve injuries, and tendon injuries. Forty patients were in the pre-covid group (Jan-Mar 2019) and 40 in the post-covid group (Jan-Mar 2022). Outcome measures:Mean number of days between decision to operate and operation (operative delay time)Adherence to the operative timing requirements, as set by the British Society for Surgery of the Hand (BSSH) Results There was a statistically significant difference in operative delay time between the pre-covid group and the post-covid pre-vaccine group for hand fractures (2.5 vs 3.9, P = 0.0503), tendon injuries (1.4 vs 2.2, p = 0.016), and overall (1.9 vs 3.3, p = 0.0024). There was no significant difference between the 2 groups for nerve injuries (3.8 vs 1.8, p = 0.3062). In the post-covid group, BSSH operative timing requirements were met for a lower proportion of patients than the pre-covid group for hand fracture fixations (85% vs 100%), nerve repairs (87% vs 100%) tendon repairs (85% vs 100%). Overall, there was a statistically significant difference between the 2 groups (85% vs 100%, p = 0.0214). Operative delays were documented as being related to COVID-19 in 100% of patients who did not meet BSSH operative timing requirements. Conclusions COVID-19 has had a significant impact on operative timing for plastic surgery hand trauma. Further studies are needed to evaluate the usefulness of various interventions in the recovery of services following the COVID-19 global pandemic.