Medical Outcomes Research Articles

Assessing the association between probable posttraumatic stress disorder symptoms and quality of life among emergency service workers using path analysis.

Emergency service workers have highly stressful occupations; the stressors encountered can contribute to the development of mental disorders such as depression, anxiety, and posttraumatic stress disorder (PTSD). The present study used a conceptual model and survey to identify variables influencing the association between probable PTSD and quality of life (QOL) in emergency service workers. PTSD was assessed using the Impact of Event Scale-Revised. QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey. Path analysis was used to determine whether stress-coping (Brief Coping Orientation to Problems Experienced [Brief COPE] scores), social support (Multidimensional Scale of Perceived Social Support [MSPSS] scores), and resilience (Connor-Davidson Resilience Scale scores) explain the association between probable PTSD and QOL among 220 emergency service workers in Japan. Impact of Event Scale-Revised scores were significantly positively associated with Brief COPE Active coping scores and significantly negatively associated with MSPSS scores. Brief COPE Active coping and MSPSS scores were significantly positively associated with Connor-Davidson Resilience Scale scores, which were in turn significantly positively associated with Medical Outcomes Study 36-Item Short-Form Health Survey scores. Active coping in response to stressful situations is important for maintaining good mental health among emergency service workers. Active coping and social support may strengthen resilience, and resilience may improve QOL. Screening for mental health and QOL should include simultaneous assessment of stress-coping, social support, and resilience. Although the findings of this cross-sectional study are important, it could not confirm a causal relationship between PTSD and QOL.

Impact of COVID-19 on the development of major mental disorders in patients visiting a university hospital: a retrospective observational study.

This study aimed to investigate the impact of coronavirus disease 2019 (COVID-19) on the development of major mental disorders in patients visiting a university hospital. The study participants were patients with COVID-19 (n=5,006) and those without COVID-19 (n=367,162) registered in the database of Keimyung University Dongsan Hospital and standardized with the Observational Medical Outcomes Partnership Common Data Model. Data on major mental disorders that developed in both groups over the 5-year follow-up period were extracted using the FeederNet computer program. A multivariate Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the incidence of major mental disorders. The incidences of dementia and sleep, anxiety, and depressive disorders were significantly higher in the COVID-19 group than in the control group. The incidence rates per 1,000 patient-years in the COVID-19 group vs. the control group were 12.71 vs. 3.76 for dementia, 17.42 vs. 7.91 for sleep disorders, 6.15 vs. 3.41 for anxiety disorders, and 8.30 vs. 5.78 for depressive disorders. There was no significant difference in the incidence of schizophrenia or bipolar disorder between the two groups. COVID-19 infection increased the risk of mental disorders in the following order: dementia (HR, 3.49; 95% CI, 2.45-4.98), sleep disorders (HR, 2.27; 95% CI, 1.76-2.91), anxiety disorders (HR, 1.90; 95% CI, 1.25-2.84), and depressive disorders (HR, 1.54; 95% CI, 1.09-2.15). This study showed that the major mental disorders associated with COVID-19 were dementia and sleep, anxiety, and depressive disorders.

Social support during re-entry period and long-term quality of life in breast cancer survivors: a 10-year longitudinal cohort study.

This study evaluated the association between social support during the re-entry period and long-term health-related quality of life (HRQoL) in breast cancer survivors using a longitudinal cohort study. This is a prospective cohort study with 275 breast cancer survivors who reported HRQoL at 5 and 10years after diagnosis. Social support for the re-entry period was measured 3years after diagnosis using the Medical Outcome Study Social Support Survey (MOS-SSS). HRQoL was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and Breast Cancer-Specific Module (BR-23). Multivariable linear regression analysis was performed to evaluate HRQoL at 5 and 10years after diagnosis by level of social support during the re-entry period. The mean (SD) of social support during re-entry period was 68.5. The low social support (LSS, score < 55) group during the re-entry period had a significantly lower HRQoL (mean difference = - 12.93) compared to moderate or high social support (MHSS, score ≥ 55) group. 5 and 10years after diagnosis, the LSS group continued to demonstrate lower HRQoL (5years: - 7.17; 10years: - 7.85) compared to the MHSS group. The LSS group were more likely to have lower role and social function scores, and higher fatigue, pain, and financial problems compared to the MHSS group at 10years after diagnosis. Breast cancer survivors who received lower social support during the re-entry period were more likely to experience poorer HRQoL in the long term than those who did not.

Investigating the relationship between FRailty And Quality of LIfe in patients with heart faiLure and CKD (FRAIL study).

Patients with chronic kidney disease (CKD) or heart failure (HF) are disproportionally affected by frailty, an independent predictor of morbidity. The prevalence of frailty and its impact on quality of life (QoL) in a unique population of patients with both CKD and HF (CKD-HF) is unclear. The aim of this study was to investigate the association between frailty and QoL in patients with CKD-HF. Patients were identified from a tertiary care cardiorenal clinic. Eligible patients had CKD-HF with a stable estimated glomerular filtration rate of <60mL/min/1.732. Data were collected from each participant at one point in time using surveys delivered by study personnel between 14 July 2022 and 31 March 2023. Frailty was defined as Modified Frailty Phenotype (MFP) score ≥3. The Medical Outcomes Study 36-item Short Form Health Survey (SF-36) was used to assess QoL. Demographic data were retrospectively collected from electronic patient records. Demographics and QoL were compared between frail and non-frail cohorts using Pearson's R and Student's t-test (two-tailed, alpha-priori=0.05). One hundred five participants consented, and 103 completed the questionnaires in full. Amongst the 103 participants, 49.5% (n=51) were frail. Frailty was related to sex (P=0.021) and medication count (P=0.007), however not to other clinical measures, including estimated glomerular filtration rate (P=0.437) and ejection fraction (P=0.911). Frail patients reported poorer QoL across physical functioning (P<0.001), general health (P<0.001), bodily pain (P=0.004), social functioning (P<0.001), and energy levels (P<0.001), however not emotional wellbeing (P=0.058); 51.5% cited 'better quality of life' as their healthcare priority, over longer survival (23.3%) or avoiding hospital admissions (22.3%). This was consistent across frail and non-frail groups. A large proportion of CKD-HF patients are frail, regardless of disease severity, and more susceptible to significantly poorer QoL across physical and social domains. Improving QoL is the priority of patients across both frail and non-frail cohorts, further emphasizing the need for prompt recognition of frailty as well as possible intervention and prevention.

SPeC: A soft prompt-based calibration on performance variability of large language model in clinical notes summarization

Electronic health records (EHRs) store an extensive array of patient information, encompassing medical histories, diagnoses, treatments, and test outcomes. These records are crucial for enabling healthcare providers to make well-informed decisions regarding patient care. Summarizing clinical notes further assists healthcare professionals in pinpointing potential health risks and making better-informed decisions. This process contributes to reducing errors and enhancing patient outcomes by ensuring providers have access to the most pertinent and current patient data. Recent research has shown that incorporating instruction prompts with large language models (LLMs) substantially boosts the efficacy of summarization tasks. However, we show that this approach also leads to increased performance variance, resulting in significantly distinct summaries even when instruction prompts share similar meanings. To tackle this challenge, we introduce a model-agnostic Soft Prompt-BasedCalibration (SPeC) pipeline that employs soft prompts to lower variance while preserving the advantages of prompt-based summarization. Experimental findings on multiple clinical note tasks and LLMs indicate that our method not only bolsters performance but also effectively regulates variance across different LLMs, providing a more consistent and reliable approach to summarizing critical medical information.

Epilepsy care and outcome in low- and middle-income countries: A scoping review.

Epilepsy is a common neurological condition in low- and middle-income countries (LMICs). This study aims to systematically review, analyze, evaluate, and synthesize information on the current state of medical and surgical management and outcomes of epilepsy in LMICs. Systematic searches were conducted on MEDLINE, EMBASE, World Health Organization Global Index Medicus, African Journals Online, WOS, and Scopus, covering the period from the inception of the databases to August 18th, 2021, focusing on studies reporting management and outcomes of epilepsy in LMICs. A total of 2298 unique studies were identified, of which, 48 were included (38035 cases). The mean age was 20.1 ± 19.26 years with a male predominance in 60.92% of cases. The type of seizure commonly reported in most of the studies was absence seizures (n = 8302, 21.82%); partial focal seizure (n = 3891, 10.23%); and generalized tonic-clonic seizures (n = 3545, 9.32%) which were the next most common types of seizures. Mesiotemporal epilepsy was less frequently reported (n = 87, 0.22%). Electroencephalogram was commonly used (n = 2516, 6.61%), followed by computed tomography scan (n = 1028, 2.70%), magnetic resonance imaging (n = 638, 1.67%), and video telemetry (n = 484, 1.27%) in the care of patients with seizures. Primary epilepsy was recorded in 582 patients (1.53%) whereas secondary epilepsy was present in 333 patients (0.87%). Carbamazepine was the most used anti-epileptic drug (n = 2121, 5.57%). Surgical treatment was required for 465 (1.22%) patients. In LMICs, epilepsy is underreported. There is still a lack of adequate tools for the diagnosis of primary or secondary epilepsy as well as adequate access to medical management of those reported.

Endovascular Treatment of Traumatic Vascular Injuries in the Head and Neck Region.

Background and Objectives: Traumatic vascular injuries of the head and neck pose significant treatment challenges due to the complex anatomy, diverse clinical presentation, and mostly emergent nature. Endovascular treatment increasingly complements traditional surgical approaches. This study aimed to report our 10-year experience in treating traumatic vascular injuries of the head and neck with endovascular therapy and to determine the effectiveness of endovascular treatment. Materials and Methods: A retrospective analysis of 21 patients treated for head and neck vascular injuries between May 2011 and April 2021 was performed. Patients' medical histories, clinical presentations, imaging findings, treatment materials, and clinical outcomes were reviewed. Treatments included stenting, coil embolization, and other endovascular techniques focused on hemostasis and preservation of the parent vessel. Results: The most common injuries involved the internal maxillary artery branches (n = 11), followed by the common or internal carotid artery (n = 6), vertebral artery (n = 3), and others. Endovascular treatment achieved successful hemostasis in all but one case. In five of six carotid artery injuries and two of three vertebral artery injuries, we achieved successful hemostasis while preserving the parent vessel using covered and bare stents, respectively. Conclusions: Endovascular therapy might be a useful treatment modality for traumatic vascular injuries in the head and neck region, offering efficacy, safety, and a minimally invasive approach.

Abstract TP244: Racial and Ethnic Differences in Risk Factors and Outcomes in Young Patients With Intracerebral Hemorrhage

Racial and ethnic disparities in risk factors and outcomes for young patients with ischemic stroke (AIS) are well described. Less is known about disparities in risk and outcomes for young patients presenting with intracerebral hemorrhage (ICH), which is associated with higher short-term and long-term mortality. As such, it is important to review disparities in its evaluation and management. In this study, we aimed to evaluate racial and ethnic differences in risk factors and outcomes for young patients with ICH. Methods: We identified patients aged 18-45 from our inpatient stroke registry who presented to our comprehensive stroke center with non-traumatic ICH from 10/2016 to 11/2019, with exclusion of patients with primary subarachnoid hemorrhage. We abstracted baseline characteristics and compared ICH risk and outcomes amongst different racial groups and ethnicities through examination of sociodemographic and medical risk factors and outcomes using independent samples t-test for continuous outcomes, and chi-squared test for categorical outcomes. All tests were two-tailed and the error rate was set at 5%. Results: Among 430 patients who met inclusion criteria, 22.3% were non-Hispanic White (NHW), 31.6% Non-Hispanic Black(NHB), 28.6% Hispanic (HIS), 4.9% Asian, and 5.1% other. There were significant differences in insured status, with 50.4% of HIS having insurance compared to 67.6% of NHB and 68.8% of NHW patients. NHB and HIS patients were more likely to be single (55.1% and 44.7%), compared to NHW (32.3%) and Asian (38.1%) patients. Black patients had the highest likelihood of living alone (20.6%; p=0.07), while Hispanic patients were more likely not to not have a primary care provider (64.2%; p=0.02). NHB patients were more likely to have prior hypertension (72%), and diastolic dysfunction (27.2%) compared to NHW (53.1%, 13.5%), and HIS (50.4%, 11.4%) patients). No significant differences in overall discharge disposition or mRS was noted when comparing racial and ethnic groups. Conclusion: Although we did not find significant differences in measured outcomes, our study demonstrates underlying sociodemographic and clinical risk factors which may underlie racial and ethnic disparities in long-term outcomes for patients with ICH.

Abstract WMP10: Carotid Floating Thrombus; Medical Management and Outcomes

Background: Carotid free-floating-thrombus(CFT)is a rare cause of stroke describing an intraluminal thrombus that is loosely associated with the arterial wall and manifesting as a filling defect fully surrounded by contrast. Unfortunately, there is no clear consensus among experts on the ideal treatment for CFT. Methods: Retrospective analysis of acute ischemic stroke(AIS)patients diagnosed with internal carotid CFT on CTA between January2015-March2023.We aimed to compare two treatment regimens: antiplatelet(APT) and anticoagulation(ACT) in the treatment of CFT. APT regimens included the use of dual or single APT (aspirin, clopidogrel and ticagrelor) and ACT regimens included the use of direct oral anticoagulants, warfarin, heparin or low molecular weight heparin+/-aspirin. Patients that underwent thrombectomy were excluded. Results: During study time there were 8252 AIS patients, of which 137(1.6%) patients were diagnosed with CFT. Sixty-six patients were included in our analysis. Patients assigned to APT were older (60.4years + 12.8;p&lt;0.01) (Table 1) .Other demographic variables were similar between groups. Complete CFT resolution by repeat imaging was comparable between groups at 30 days (58.8vs31.6%;p=0.1) and at latest follow-up (70.8vs50%;p=0.1) on ACT vs APT, respectively. There were similar rates of any ICH (13.5vs27.6%;p=0.5), PH1/2, independence at discharge and similar hospital length of stay between APT and ACT groups, respectively ( Table 1 ). Patients assigned to APT were more likely to be discharged on their assigned treatment compared to those assigned to ACT (86.5vs55.2%;p&lt;0.001).The rate of recurrent AIS was comparable among APT and ACT at 30 days (0vs3.4%;p=0.1,respectively).Sensitivity analysis comparing DAPT to exclusive ACT lead to similar results. Conclusion: Our study showed comparable efficacy and safety outcomes in CFT patients who were exclusively managed with APT vs ACT. Larger prospective studies are needed.

Outcomes of Unicompartmental Knee Arthroplasty in Patients Receiving Long-Term Anticoagulation Therapy: A Propensity-Matched Cohort Study

BackgroundAlthough total knee arthroplasty has been considered the gold-standard treatment for severe osteoarthritis of the knee, unicompartmental knee arthroplasty (UKA) has become an increasingly favorable alternative for single-compartment osteoarthritis of the knee. Few studies have examined potential high-risk populations undergoing this procedure. The purpose of this study was to investigate the outcomes of UKA in patients receiving long-term anticoagulation therapy. MethodsIn this study, a large administrative database was queried to identify patients undergoing UKA between 2009 and 2019, who were then divided into a cohort receiving long-term anticoagulation and a control cohort. Propensity scores were utilized to match these patients. Multivariable logistic regression was utilized to compare 90-day and 2-year complication rates between cohorts. ResultsPatients who were on long-term anticoagulation had significantly increased odds of extended length of stay, surgical site infection, wound complication, transfusion, deep vein thrombosis, pulmonary embolism, and readmission at 90-day follow-up. The long-term anticoagulation cohort also experienced significantly higher odds of periprosthetic joint infection and mechanical complications at 2-year follow-up; however, odds of conversion to total knee arthroplasty were not increased. ConclusionsThis study demonstrated that long-term anticoagulation use was associated with poorer medical and surgical outcomes at both 90 days and 2 years postoperatively in patients undergoing UKA, even after rigorous adjustment for confounders.

Abstract TP103: Association Between Neighborhood-Level Disadvantage and Patient-Reported Mental Health Outcomes in Intracerebral Hemorrhage Survivors

Introduction: The influence of social determinants of health (SDH) is well-documented across a range of medical conditions and health outcomes. Less clear is the impact of SDH on patient-reported outcomes, particularly mental health outcomes, in intracerebral hemorrhage (ICH). This study examines the association between the Area Deprivation Index (ADI), a measure of neighborhood-level disadvantage, and self-reported health outcomes in ICH survivors. Methods: This investigation is nested within the REDUCE clinical trial, an ongoing, randomized trial comparing standard-of-care to spironolactone-containing hypertension regimens in ICH survivors. Participants complete the PROMIS Global Health survey at baseline. Global Mental Health (GMH) and Global Physical Health (GPH) scores are standardized to t-scores (GMH 21.2-67.6; GPH 16.2-67.7) around a reference population mean (50 ± 10). ADI uses elements of income, education, employment, and housing quality to assign a composite score (1-100), with a higher score signifying greater disadvantage. Patients were grouped into tertiles based on ADI. GMH and GPH scores were analyzed against the reference mean via a one-sample t-test and across tertiles with a one-way ANOVA. Bivariable linear regression examined ADI as a continuous variable. Multivariable models adjusted for sex, age, race, ethnicity, ICH to baseline interval, and baseline mRS. Results: Fifty patients were included in the analysis. Those in the third, most disadvantaged, tertile had significantly lower GMH scores (39.5 ± 8.17) than the reference population (p&lt;0.001), the first tertile (54.10 ± 10.20, p&lt;0.001), and the second tertile (50.4 ± 8.90, p=0.003). In multivariable analysis, these differences remained significant (T3 vs. T1, B= -18.31, p&lt;0.001; T3 vs. T2, B= -14.67, p&lt;0.001). Further, ADI as a continuous variable was significantly associated with GMH scores in bivariable (B= -0.22, p&lt;0.001) and multivariable analysis (B= -0.23, p=0.005). No significant relationship was found between ADI and GPH. Conclusions: Higher ADI is associated with worse patient-reported mental health outcomes after ICH. Neighborhood disadvantage, and its constituting factors, should be considered in reporting post-ICH patient care and outcomes.

Health-Related Quality of Life Across the Spectrum of Pulmonary Hypertension

BackgroundHealth related quality of life (HRQOL) is frequently impaired in pulmonary arterial hypertension (PAH). However, little is known about HRQOL in other forms of pulmonary hypertension (PH). Research QuestionDoes HRQOL vary across groups of the World Symposium on Pulmonary Hypertension (WSPH) classification system? Study Design and MethodsThis cross-sectional study included PH patients from PVDOMICS (Pulmonary Vascular Disease Phenomics). HRQOL was assessed using emPHasis-10 (e-10), Medical Outcomes Survey Short Form-36 (SF-36; physical component (PCS) and mental component (MCS)), and Minnesota Living with Heart Failure Questionnaire (MLHF). Pearson’s correlations between HRQOL and demographic, physiologic, and imaging characteristics within each WSPH group were tested. Multivariable linear regressions compared HRQOL across WSPH groups adjusting for demographics, disease prevalence, functional class, and hemodynamics. Cox proportional hazard models were used to assess associations between HRQOL and survival across WSPH groups. ResultsAmong 691 PH patients, HRQOL correlated with functional class and six-minute walk distance but not hemodynamics. HRQOL was severely depressed across WSPH groups for all measures except the SF-36 MCS. When compared to Group 1, Group 2 subjects had significantly worse HRQOL (e-10: 29 vs 24, p=0.001, PCS: 32.9 ± 8 vs 38.4 ± 10, p<0.0001, MLHF: 50 vs 38, p=0.003). Group 3 subjects similarly had worse e-10 (31 vs 24, p<0.0001) and PCS scores (33.3 ± 9 vs 38.4 ± 10, p<0.0001) compared to Group 1, which persisted in multivariable models (p<0.05). HRQOL was associated in adjusted models with survival across Groups 1, 2, and 3. InterpretationHRQOL is depressed in PH and particularly in Groups 2 and 3 despite less severe hemodynamics. HRQOL is associated with functional capacity, but hemodynamic disease severity poorly estimates the impact of PH on patient’s lives. Further studies are needed to better identify predictors and treatments to improve HRQOL across the spectrum of pulmonary hypertension.

Associations Between Family-Assessed Quality-of-Dying-and-Death Latent Classes and Bereavement Outcomes for Family Surrogates of ICU Decedents.

To examine associations between family surrogates' bereavement outcomes and four previously determined quality of dying and death (QODD) latent classes (high, moderate, poor-to-uncertain, and worst). Prospective, longitudinal, observational study. Medical ICUs at two academically affiliated medical centers in Taiwan. Three hundred nine family surrogates responsible for decision-making for critically ill patients at high risk of death (Acute Physiology and Chronic Health Evaluation II scores > 20) from a disease. None. Participants were assessed by the depression and anxiety subscales of the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, 11 items of the Prolonged Grief Disorder (PGD) scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey at 1, 3, 6, 13, 18, and 24 months post-loss. We simultaneously examined associations of four QODD latent classes with physical and mental health-related quality of life (HRQOL) and symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and PGD assessed over 24 bereavement months using multivariate hierarchical linear modeling. Surrogates' distinct QODD latent classes assessed at 1-month post-loss were significantly associated with bereavement outcomes, except for physical HRQOL and PGD symptoms. Significantly more depressive symptoms and worse mental HRQOL (β [95% CI]) were reported by bereaved surrogates in the moderate (1.958 [1.144-2.772], -2.245 [-3.961 to -0.529]), poor-to-uncertain (2.224 [1.438-3.010], -7.026 [-8.683 to -5.369]), and worst (2.081 [1.215-2.964], -4.268 [-6.096 to -2.440]) QODD classes than those in the high QODD class. Bereaved surrogates in the moderate (2.095 [1.392-2.798]) and poor-to-uncertain (0.801 [0.123-1.480]) QODD classes reported more anxiety symptoms, whereas those in the poor-to-uncertain QODD class suffered more PTSD symptoms (2.889 [1.005-4.774]) than those in the high QODD class. The four distinct QODD latent classes were significantly associated with ICU family surrogates' bereavement outcomes, suggesting targets to improve end-of-life care quality in ICUs.

Probiotic and prebiotic interventions in eating disorders: Anarrative review.

The review aimed to summarise and discuss findings focused on therapeutic probiotic and prebiotic interventions in eating disorders (ED). Using PubMed/MEDLINE, Cochrane Library, and Web of Science all published studies were retrieved until February 2023, following PRISMA guidelines. From the 111 initial studies, 5 met the inclusion criteria for this review. All studies included in this narrative review were focused on anorexia nervosa (AN). Three longitudinal, randomised, controlled trials aimed to evaluate interventions with probiotics (Lactobacillus reuteri, yoghurt with Lactobacillus, and Streptococcus) in children and adolescents. These studies primarily emphasised medical outcomes and anthropometric measures following the administration of probiotics. However, the findings yielded mixed results in terms of short-term weight gain or alterations in specific immunological parameters. With a lower level of evidence, supplementation with synbiotics (probiotic+prebiotic) has been associated with improvements in microbiota diversity and attenuation of inflammatory responses. Research on probiotics and prebiotics in ED is limited, primarily focussing on anorexia nervosa (AN). Their use in AN regarding medical and anthropometric outcomes needs further confirmation and future research should be warranted to assess their impact on psychological and ED symptomatology, where there is a notable gap in the existing literature.

Magnitude and Predictors of Dietary Diversity among HIV-Infected Adults on Antiretroviral Therapy: The Case of North-Western, Ghana.

Though people living with HIV/AIDS require a good combination of antiretroviral therapy and healthy dietary habits for a quality life and positive medical outcomes, little is, however, known regarding the dietary practices of HIV-positive patients who receive antiretroviral therapy (ART) in the Lawra Municipality. This study assessed the magnitude and factors associated with dietary diversity among HIV-positive patients on antiretroviral therapy (ART). This study was a facility-based cross-sectional study of 269 study participants recruited using a systematic random sampling technique. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with their dietary diversity. This study shows that only 36 (13.4%) of the sample consumed a diversified diet with a mean dietary diversity score of 3.7 ± 0.99. Starchy staple foods (96.7%) and flesh food (92.9%) were the most consumed foods. Being a nonfarmer employee (AOR = 10.76, 95% CI = 1.03-112.35), not taking cotrimoxazole prophylaxis (AOR = 3.76, 95% CI = 1.02-14.37) and adults of age 18-27 years (AOR = 5.95, 95% CI = 1.18-30.07) were significant predictors of high dietary diversity. This study revealed that dietary diversity was a significant nutritional problem among HIV-positive adults in Lawra Municipal Hospital. Starchy staple foods and flesh food were the most consumed foods, while organ meats, dairy products, and eggs were eaten less. Having a secured salary paid job, not taking cotrimoxazole prophylaxis, and being a young adult were strong predictors of a high dietary diversity score. Therefore, efforts should be made to strengthen and improve the economic status and to educate these vulnerable groups on the need to adhere to cotrimoxazole prophylaxis uptake.

Mobile Critical Care Recovery Program for Survivors of Acute Respiratory Failure

Over 50% of Acute Respiratory Failure (ARF) survivors experience cognitive, physical, and psychological impairments that negatively impact their quality of life (QOL). To evaluate the efficacy of a post-intensive care unit (ICU) program, the Mobile Critical Care Recovery Program (m-CCRP) consisting of a nurse care coordinator supported by an interdisciplinary team, in improving the QOL of ARF survivors. This randomized clinical trial with concealed outcome assessments among ARF survivors was conducted from March 1, 2017, to April 30, 2022, with a 12-month follow-up. Patients were admitted to the ICU services of 4 Indiana hospitals (1 community, 1 county, 2 academic), affiliated with the Indiana University School of Medicine. A 12-month nurse-led collaborative care intervention (m-CCRP) supported by an interdisciplinary group of clinicians (2 intensivists, 1 geriatrician, 1 ICU nurse, and 1 neuropsychologist) was compared with a telephone-based control. The intervention comprised longitudinal symptom monitoring coupled with nurse-delivered care protocols targeting cognition, physical function, personal care, mobility, sleep disturbances, pain, depression, anxiety, agitation or aggression, delusions or hallucinations, stress and physical health, legal and financial needs, and medication adherence. The primary outcome was QOL as measured by the 36-item Medical Outcomes Study Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS), with scores on each component ranging from 0-100, and higher scores indicating better health status. In an intention-to-treat analysis among 466 ARF survivors (mean [SD] age, 56.1 [14.4] years; 250 [53.6%] female; 233 assigned to each group), the m-CCRP intervention for 12 months did not significantly improve the QOL compared with the control group (estimated difference in change from baseline between m-CCRP and control group: 1.61 [95% CI, -1.06 to 4.29] for SF-36 PCS; -2.50 [95% CI, -5.29 to 0.30] for SF-36 MCS. Compared with the control group, the rates of hospitalization were higher in the m-CCRP group (117 [50.2%] vs 95 [40.8%]; P = .04), whereas the 12-month mortality rates were not statistically significantly lower (24 [10.3%] vs 38 [16.3%]; P = .05). Findings from this randomized clinical trial indicated that a nurse-led 12-month comprehensive interdisciplinary care intervention did not significantly improve the QOL of ARF survivors after ICU hospitalization. These results suggest that further research is needed to identify specific patient groups who could benefit from tailored post-ICU interventions. ClinicalTrials.gov Identifier: NCT03053245.

Ultrasound had high accuracy in measuring hip joint capsule thickness

BackgroundThe hip joint capsule is an essential component of hip joint function and stability, and its thickness is closely associated with certain medical conditions, surgical outcomes, and rehabilitation treatments. Currently, in clinical practice, hip joint capsule thickness is predominantly measured using magnetic resonance imaging (MRI), with limited utilization of ultrasound examinations for this purpose.MethodsWe retrospectively evaluated patients who visited our Sports Medicine Department between February 2017 and March 2023 and underwent both hip joint MRI and ultrasound imaging on the same side. All patients had undergone preoperative hip joint MRI and ultrasound examinations, with the time gap between the two examinations not exceeding three months. Measurements of hip joint capsule thickness were taken on both MRI and ultrasound images for the same patients to analyze their consistency. Additionally, we measured the alpha angle, lateral center-edge angle, acetabular anteversion angle, and femoral anteversion angle of the patients’ hip joints and analyzed their correlation with hip joint capsule thickness measure by ultrasound.ResultsA total of 307 patients were included in this study, with hip joint capsule thickness measured by MRI and ultrasound being 5.0 ± 1.2 mm and 5.0 ± 1.5 mm, respectively. The Bland-Altman analysis demonstrates good agreement or consistency. The paired t-test resulted in a p-value of 0.708, indicating no significant statistical difference between the two methods. The correlation analysis between acetabular anteversion angle and ultrasound-measured capsule thickness yielded a p-value of 0.043, indicating acetabular anteversion angle and capsular thickness may have negative correlation.ConclusionsThe measurements of joint capsule thickness obtained through ultrasound and MRI showed good consistency, suggesting that ultrasound can be used in clinical practice as a replacement for MRI in measuring hip joint capsule thickness. There was a significant correlation between acetabular anteversion angle and hip joint capsule thickness, indicating potential for further research in this area.

Medical clowns improve sleep and shorten hospitalization duration in hospitalized children

Intervention by medical clowns was proven to have a positive effect in reducing stress and anxiety, increasing cooperation and improving the child's experience prior to a medical procedure and during the various stages of hospitalization. Sleep has long been known to be essential for recovery from injury and sickness, improving immune functions, and there is an emerging understanding of the restorative role quality sleep has on health and diseases. Hospitalized children are more exposed to sleep disorders and sleep deprivation due to the hospitalized environment, anxiety, and illness. Different behavioral interventions to promote sleep were previously studied in hospitalized children, some showing potential benefits. In this study, we sought to examine the ability of medical clowns to positively impact the child's sleep during hospitalization. The study is an observational matching (case–control) interventional study which took place at the department of pediatrics in Carmel Medical Center. Forty-two hospitalized children ages 2–17 were included in two equal groups of intervention or control. Children in the control group were recruited based on a method of matching the chief complaint plus the medical diagnosis and age of the children in the intervention group in a 1:1 matching. The children's sleep parameters were objectively evaluated for two consecutive nights using an Actigraph device and subjectively by parent's questionnaire. Additional factors such as hospital length of stay and demographics were also monitored. The study group had an encounter with a medical clown (15–30 min) before bedtime on either the first or the second night, and the control group was not exposed to a medical clown at all. We then compared the data from both groups using unpaired t-tests. Hospitalized children exposed to a medical clown prior to bedtime (n = 21) and children not exposed to a medical clown (n = 21) were comparable in age and clinical characteristics. The study group had a significantly delayed wake-up time compared to the control group (06:59 ± 46 min vs. 07:26 ± 42 min, p < 0.05) (mean difference of 27 min). Night's duration (from bedtime to wake-up) was significantly longer in the study versus the control group (570 ± 76 vs. 500 ± 66.1 min, p < 0.05), a total mean increase of 70 min, and sleep efficiency were significantly increased (92.3 ± 4.6% vs. 87.9 ± 8.7%, p < 0.05). Within the clown group, when comparing nights with and without exposure to a medical clown, total sleep time was prolonged by a mean of 54 min on the night of the intervention (518 ± 74 min vs. 464 ± 59 min, p < 0.01), and the total wake time during the night were reduced (52 ± 27 min vs. 77 ± 61 min, P < 0.05), mean difference of 25 min), mainly by reduction of wake period after sleep onset (WASO) (42 ± 25 min vs. 66 ± 58 min, p < 0.05), mean difference of 24 min). Regarding general medical outcomes, hospital stay was significantly shorter in the clown group vs. control (104 ± 42 h vs. 128 ± 42 h, p < 0.05), a mean reduction of 23 h—nearly an entire day. An encounter with a medical clown before bedtime in hospitalized children positively affects sleep parameters, which may be of great importance for healing in general. The clown intervention was also shown to shorten the hospital stay. Larger scale studies are warranted to establish these findings.

53. The Effect of Pre-Admission Energy Balance on Short-Term Medical Outcomes: Findings From the Study of Refeeding to Optimize Inpatient Gains (STRONG)

53. The Effect of Pre-Admission Energy Balance on Short-Term Medical Outcomes: Findings From the Study of Refeeding to Optimize Inpatient Gains (STRONG)

A comparative patient-level prediction study in OMOP CDM: applicative potential and insights from synthetic data

The emergence of collaborations, which standardize and combine multiple clinical databases across different regions, provide a wealthy source of data, which is fundamental for clinical prediction models, such as patient-level predictions. With the aid of such large data pools, researchers are able to develop clinical prediction models for improved disease classification, risk assessment, and beyond. To fully utilize this potential, Machine Learning (ML) methods are commonly required to process these large amounts of data on disease-specific patient cohorts. As a consequence, the Observational Health Data Sciences and Informatics (OHDSI) collaborative develops a framework to facilitate the application of ML models for these standardized patient datasets by using the Observational Medical Outcomes Partnership (OMOP) common data model (CDM). In this study, we compare the feasibility of current web-based OHDSI approaches, namely ATLAS and “Patient-level Prediction” (PLP), against a native solution (R based) to conduct such ML-based patient-level prediction analyses in OMOP. This will enable potential users to select the most suitable approach for their investigation. Each of the applied ML solutions was individually utilized to solve the same patient-level prediction task. Both approaches went through an exemplary benchmarking analysis to assess the weaknesses and strengths of the PLP R-Package. In this work, the performance of this package was subsequently compared versus the commonly used native R-package called Machine Learning in R 3 (mlr3), and its sub-packages. The approaches were evaluated on performance, execution time, and ease of model implementation. The results show that the PLP package has shorter execution times, which indicates great scalability, as well as intuitive code implementation, and numerous possibilities for visualization. However, limitations in comparison to native packages were depicted in the implementation of specific ML classifiers (e.g., Lasso), which may result in a decreased performance for real-world prediction problems. The findings here contribute to the overall effort of developing ML-based prediction models on a clinical scale and provide a snapshot for future studies that explicitly aim to develop patient-level prediction models in OMOP CDM.