Outcome Monitoring Research Articles

Assessing personal recovery in individuals with severe mental illness: validation of the Dutch Brief INSPIRE-O.

Recovery is a key objective in mental health services for people with severe mental illness (SMI). In addition to clinical and functional recovery, personal recovery has gained increasing attention. The CHIME Framework identifies five personal recovery processes-Connectedness, Hope, Identity, Meaning, Empowerment-and is the theoretical foundation for the Brief INSPIRE, a validated Patient-Rated Experience Measure (PREM) to evaluate recovery support. Brief INSPIRE was modified to a five-item Patient-Rated Outcome Measure (PROM) assessing recovery, called Brief INSPIRE-Outcome (Brief INSPIRE-O). Subject of this study are the psychometric properties of the Brief INSPIRE-O. Data on validity and reliability gathered through annual routine outcome monitoring were collected for 861 individuals with SMI of Flexible Assertive Community Treatment teams and a follow-up measurement was available for 232 of these individuals. Test-retest reliability was evaluated in a separate subset of 30 individuals with SMI. The Brief INSPIRE-O shows good internal consistency (Cronbach's alpha 0.77), test-retest reliability, construct validity, sensitivity to change and no floor or ceiling effects. Furthermore, change in Brief INSPIRE-O was positively related to changes in quality of life and negatively to problems in clinical functioning and unmet careneed. Brief INSPIRE-O can be used for research and monitoring to better understand and improve processes of personal recovery in individuals with SMI.

The "magic" of looking at that score: A multilevel investigation of therapist review of client symptom measures and client clinical outcome.

Randomized controlled trials have shown that using client feedback obtained from routine outcome monitoring can lead to better clinical outcomes in psychotherapy. However, existing randomized controlled trial studies did not address the between-person and within-person effects of routine outcome monitoring simultaneously. To fill this critical gap, this study conducted a multilevel analysis to explore the effect of therapist utilization of client symptom outcome data in a naturalistic practice setting. Participants were 26 therapist trainees and their 456 clients who conducted 5,917 sessions in total. Clients completed the Outcome Questionnaire (OQ)-45.2 prior to every session, and we used de-identified data to code whether each OQ report was reviewed by the therapist before or after the session, or not reviewed by the therapist. Multilevel analysis showed that, within the same therapist-client dyad, sessions where the therapist reviewed the client's OQ score beforehand (rather than afterhand) showed significantly larger symptom improvement by the next session than sessions without such a review. Additionally, comparing clients within a therapist's caseload, a higher percentage of sessions where the therapist reviewed OQ scores before (rather than after) was associated with quicker symptom recovery for those clients. Finally, comparing therapists, those who reviewed client OQ scores more frequently before (rather than after) therapy sessions achieved faster client symptom recovery across all clients. Practical implications of the findings were discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Normative Values of Rhinology Questionnaires in Young Adults: A Tool to Identify Candidates for Rhinoplasty

Objective: Normative values of Rhinoplasty Outcome Evaluation (ROE) and Functional Rhinoplasty Outcome Inventory 17 (FROI-17) allow the monitoring of surgery outcomes. The objective of our study was to determine the reference norms of these disease-specific questionnaires in the age group that most often seeks rhinoplasty. Methods: The normative values of the ROE and FROI-17 questionnaires were calculated for 570 (459 women and 111 men) young adults at the mean age of 19.3 ± 1.3 years, range 18–25 years. Each participant underwent an ENT examination. All those who obtained a positive result were asked to complete two questionnaires: ROE and FROI-17. Results: The mean total ROE score was 13.4 ± 2.3, with a median of 13 and a range from 7 to 24. The mean overall FROI-17 score was 9.1 ± 13.3, with a median of 4 and a range from 4 to 72. For nasal symptoms, the mean was 4.0 ± 6.0, with a median of 1 and a range from 0 to 29. We observed a statistically significant difference between men and women only for the normative values of nasal symptoms (mean 4.0 ± 5.9 and median 2 (0–27) vs. mean 3.7 ± 6.5 and median 0 (0–29)). Additionally, there was a statistically significant correlation between the normative values of the ROE and FROI-17 scores (ρs = −0.413 for all participants, ρs = −0.314 for women, and ρs = −0.437 for men). Conclusions: The established normative values for the ROE and FROI-17 questionnaires among young, healthy individuals without nasal abnormalities can assist in the initial assessment of individuals seeking rhinoplasty. Deviations from these normative values in the ROE and FROI-17 questionnaires results may serve as indicators of potential concerns, such as body dysmorphic disorder (BDD).

Commentary on "preoperative cardiology consultations for geriatric patients with hip fractures rarely provide additional recommendations and are associated with prolonged hospital stays and delayed surgery: a retrospective case control study".

This letter discusses the recent study by Vahabi et al., which examined the role of preoperative cardiology consultations in geriatric patients undergoing hip fracture surgery. While the study highlights the limited impact of these consultations on treatment modifications and the associated delays in surgical intervention, this letter suggests areas for further exploration. Specifically, it proposes extending outcome monitoring to include long-term cardiovascular events and incorporating cost-effectiveness analysis to better assess the value of preoperative consultations. Moreover, the letter advocates for the use of blinding in future studies to minimize selection bias and enhance the reliability of results.

P0510 Evaluation of organizational and healthcare provider level readiness in European Inflammatory Bowel Disease centres for outcome-based quality improvement

Abstract Background Inflammatory bowel disease (IBD) affects quality of life and increases healthcare costs. Measuring patient outcomes for continuous quality improvement (QI) can optimize care, but resource limitations, infrastructure challenges, and strategic misalignments hinder progress. We assessed the readiness for outcome-based QI in European IBD centres at both the organizational and professional levels. Methods We employed a mixed-methods design, starting with a survey with follow-up interviews of IBD-specialized gastroenterologists. Dutch centres were approached through the Initiative of Crohn’s and Colitis (ICC) organization and other European centres were recruited through the European Crohn’s and Colitis Organization (ECCO). Eligible centres had a multidisciplinary care model with at least one dedicated gastroenterologist, nurse, and surgeon. Participants completed a web-based survey covering team characteristics, outcome-based monitoring for QI, resources, and attitudes toward outcome-based QI. Quantitative data were analysed using descriptive statistics, and follow-up interviews are ongoing. Results Of the 42 IBD centres surveyed, 69% were in the Netherlands (Figure 1). After exclusions, 36 centres were analysed (Table 1), mostly non-academic hospitals (58%) with 500-800 beds. Monitoring practices varied, with 25% monitoring outcomes annually, 25% monitoring outcomes biannually, or 28% more frequently, while 22% did not monitor outcomes. Manual or hybrid EHR data extraction was common, with few using fully automated methods. Doctors (100%) and specialized nurses (96%) consistently engaged in data discussions. Non-academic centres involved more data managers (53%) and patients (65%) than academic hospitals. Doctors led discussions in most cases (82%), particularly in academic centres (91%), with significant nurse involvement (64%). Non-academic centres had diverse leadership, including data managers (47%) and occasional patient involvement (12%). Frequently monitored outcomes included medication use (71%), clinician-reported measures (61%), healthcare utilization data (57%) and patient-reported outcomes (50%). Most centres (68%) had implemented 2-3 QI initiatives in the past year, with 48% regularly assessing their effectiveness, and most respondents recognized the value of outcome monitoring for providers and patients. Conclusion Outcomes monitoring is seen as an approach for QI in IBD care, yet practices varied across centres. Academic centres monitor outcomes more frequently and rely on care professionals to lead discussions, whereas non-academic centres often rely on data managers. These differences highlight the need for standardization in monitoring practices and team roles to support consistent, outcome-based QI across Europe.

Efficacy of Ceftazidime-avibactam in treating Gram-negative infections: a systematic review and meta-analysis.

Ceftazidime-avibactam (CAZ-AVI) has emerged as a promising treatment option for Gram-negative infections, particularly those caused by CAZ-Non-Susceptible (NS) pathogens. This systematic review and meta-analysis aim to assess the efficacy and safety of CAZ-AVI in these challenging infections. We systematically queried EMBASE, Cochrane CENTRAL, and PubMed/Medline for studies published until September 15, 2024. Randomized Controlled Trials (RCTs) evaluating CAZ-AVI against Gram-negative infections were included. A meta-analysis was performed to calculate pooled odds ratios (OR) for both clinical and microbiological success. A total of 146 studies were identified through database searches, leading to the inclusion of 17 studies. Among the efficacy studies for Gram-negative pathogens, there was no significant difference in clinical success rates for CAZ-AVI compared to comparators (pooled OR: 0.90, p = 0.22), and a non-significant increase in microbiological success was observed (pooled OR: 1.20, p = 0.41). In contrast, for CAZ-NS pathogens, six studies reported no significant difference in clinical cure rates (pooled OR: 0.77, p = 0.24), while four studies indicated a non-significant increase in microbiological cure rates (pooled OR: 1.83, p < 0.02). This study suggests that CAZ-AVI is a viable option for treating Gram-negative infections, including CAZ-NS pathogens. While it has shown promising activity against these resistant pathogens, its clinical and microbiological success rates are comparable to other antibiotics in the overall analysis. However, CAZ-AVI may offer an advantage in managing resistant infections. These findings underscore the need to consider CAZ-AVI in treatment guidelines and emphasize the importance of antibiotic stewardship programs to optimize its use and prevent resistance. Ongoing monitoring of resistance patterns and patient outcomes is essential to ensure its long-term efficacy.

P0240 Cross-cultural adaptation and validation of the Crohn’s Anal Fistula – Quality of Life scale in Dutch patients with active perianal fistulizing Crohn’s disease

Abstract Background Perianal fistulizing Crohn’s disease (pCD) is associated with debilitating symptoms such as fecal incontinence and perianal pain, and can significantly impact a patient’s quality of life (QoL)1. The Crohn’s Anal Fistula Quality of Life (CAF-QoL) scale has recently been developed as the first disease-specific patient-reported outcome measure for patients with pCD2, but has yet to be validated in an independent cohort. Therefore, we aimed to adapt and validate the CAF-QoL scale in a Dutch cohort of patients with active pCD. Methods Patients with active pCD were retrieved from a prospective multicenter study performed in 41 Dutch (non-)academic hospitals between September 2022 and March 2023. Respondents of the CAF-QoL scale and other health-related QoL questionnaires (sIBDQ and EQ-5D-5L3,4) at baseline were included. After translation of the CAF-QoL scale to Dutch, patient representatives verified the questionnaire’s comprehensibility. Prospective validation comprised the assessment of construct validity, internal consistency, test-retest reliability and responsiveness. Item response theory (IRT) was used to investigate the discriminative power of individual CAF-QoL items and to test for differential item functioning (DIF), examining whether each item behaves equally across all respondents. Results Questionnaires were completed by 264 patients (response rate 64%; female 56%) (Table 1). The median pCD duration at inclusion was 3.0 years (IQR 1.0 – 8.0). Evaluation of construct validity found a moderate correlation between CAF-QoL and sIBDQ (r -0.61, p&amp;lt;0.01) and EQ-5D-5L (r -0.58 [utility] and r -0.42 [VAS], p&amp;lt;0.01) scores. Furthermore, the CAF-QoL scale demonstrated excellent internal consistency (Cronbach’s alpha 0.93), good stability (intraclass correlation coefficient 0.83) and responded well to improvement and worsening of pCD symptoms (p&amp;lt;0.01)(Table 2). Discrimination values revealed that most items (73%) possessed a moderate to high ability to predict poor QoL; items pertaining to the impact of pCD on daily life had the greatest predictive abilities. No clinically relevant DIF was found among patients of different ages, sexes or education levels. Conclusion In this prospective multicenter study, the CAF-QoL scale was validated as a robust tool to measure pCD-specific QoL among Dutch patients with active pCD. Therefore, this scale appears to be well suited for use in clinical practice. Further studies are required to establish a minimal clinically important difference for the CAF-QoL scale; this would determine the smallest change in test scores perceptible to the patient, enabling effective monitoring of treatment outcomes.

Adolescents with first-episode psychosis and clinical high risk in the Province of Ferrara: an audit on the implementation of a specialised early intervention program

Objective The first-episode psychosis (FEP) and clinical high-risk (CHR) team within the child and adolescent mental health (CAMH) service receives referrals by psychiatric units, CAMH service, schools, and general practitioners. This audit evaluated the implementation of the FEP-CHR team in Ferrara, Italy. Methods The FEP-CHR team provides standardised assessment and up to 2-year individualised treatment including pharmacological prescription, cognitive-behavioral psychotherapy, and vocational activities. Data regarding access and pathways to care, assessment, and outcome of all patients admitted to this service from January 2019 to June 2023 were analysed. Descriptive statistics were reported and discussed. Results The service admitted 29 patients (19 FEP, 10 CHR), mostly females. FEP referrals primarily came from families via general practitioners, while half of CHR patients were already receiving CAMH care. One in three in the total sample had psychiatric hospitalisation during treatment. At discharge, most transitioned to usual or specialised mental health care and five patients achieved full recovery. Conclusions The audit revealed a lower-than-expected incidence rate, a sub-optimal adherence to the standardised assessment, and a need for improved outcome monitoring. It promoted quality improvement initiatives including professional training to improve psychiatric differential diagnosis, drug prescribing, and transition to adult psychiatric services.

Cervical cancer stage distribution and survival outcomes in Africa: a systematic review and meta-analysis.

Cervical cancer is a leading cause of cancer-related deaths among women, with a disproportionate burden in sub-Saharan Africa. Understanding the cervical cancer stage and outcomes is crucial for developing effective interventions and reducing its burden. We aimed to undertake a systematic review and meta-analysis of cervical cancer stage distribution and survival outcomes in Africa. We searched MEDLINE, Embase, PubMed, Cochrane Library, Clarivate Analytics Web of Science, and the World Health Organization African Index Medicus database for publications in all languages from the inception of databases to July 2021. A total of 144 studies published between 1978 and 2021 from 33 African countries were included, encompassing 55,747 patients. We revealed that 53.3% (95% CI 50.9 to 55.6) of cervical cancer cases in Africa were diagnosed at late stages (stage III-IV). This proportion varied significantly across countries and regions, ranging from 7.7% to 86.3%. The study also highlighted disparities by Human Development Index (HDI) grouping, with low HDI countries exhibiting higher proportions of late-stage diagnoses (56.0%, 95% CI 51.6 to 60.4) compared with medium (51.2%, 95% CI 47.5 to 54.9) and high (50.7%, 95% CI 47.0 to 54.5) HDI countries. Notably, there was no stage migration observed over time (p = .53). The median overall survival was 24.0 months (interquartile range, 19.2-39.4). These stage and outcomes data highlight the need for expanding cervical cancer screening and treatment and are crucial for policymakers to develop evidence-based strategies aimed at accelerating the elimination of cervical cancer in Africa. Additionally, standardized data collection and reporting are needed to facilitate better monitoring of cervical cancer outcomes across countries.

Remote Monitoring And Population Health Collaboration For Improving Heart Failure Outcomes

Remote Monitoring And Population Health Collaboration For Improving Heart Failure Outcomes

Changes in Recovery Capital Among Patients Receiving Buprenorphine Treatment for Opioid Use Disorder in a Telehealth Setting.

Medications for the treatment of opioid use disorder (MOUD) such as buprenorphine are the most effective treatment available for OUD; yet, beyond drug testing results and retention in care, systematically measured clinical outcomes have proven elusive. There is growing interest in integrating systematic monitoring of patient-reported outcomes and measurement-based care as strategies to improve patients' success in treatment. We analyzed changes in recovery capital assessed via the Brief Assessment of Recovery Capital (BARC-10) from baseline to 30-120 days post-intake among patients initiating buprenorphine treatment from May to October 2023 at Ophelia, a telehealth MOUD provider, who were retained for ≥90 days. Differences in baseline characteristics were assessed between patients with and without high "remission-predictive" baseline scores (≥47) using chi-squared and t-tests. Changes in scores from baseline to follow-up were assessed using paired t-tests. In all, 791 patients initiated treatment during the study period, 742 (93.8%) of whom had a baseline BARC-10 score, 542 (73.0%) of whom were retained in treatment for ≥90 days, and 477 of whom (88.0%) had a follow-up BARC-10 score and represent the analysis sample. Older patients, those not requiring buprenorphine induction, and those not using heroin or fentanyl at intake were more likely to have remission-predictive baseline BARC-10 scores (P < .05). Patients with remission-predictive baseline scores (n = 257) had a mean increase of 1.4 (SD = 5.9) from 52.7 (SD = 4.1) (P < .001), and 234 (91%) sustained remission-predictive scores throughout the assessment period. Patients without remission-predictive baseline scores (n = 220) had a mean increase of 9.2 (SD = 8.2) from 38.4 (SD = 6.6) (P < .001), and 129 (59.0%) achieved a remission-predictive score at follow-up. Most patients had increased or sustained already high levels of recovery capital, an established predictor of sustained remission. Further research is required to better understand variability across patients and how it may relate to long-term outcomes.

Cohort profile: Multicenter Networks for Ideal Outcomes of Rare Pediatric Endocrine and Metabolic Diseases in Korea (OUTSPREAD study).

Rare endocrine diseases are complex conditions that require lifelong specialized care due to their chronic nature and associated long-term complications. In Korea, a lack of nationwide data on clinical practice and outcomes has limited progress in patient care. Therefore, the Multicenter Networks for Ideal Outcomes of Pediatric Rare Endocrine and Metabolic Disease (OUTSPREAD) study was initiated. This study involves 30 centers across Korea. The study aims to improve the long-term prognosis of Korean patients with rare endocrine diseases by collecting comprehensive clinical data, biospecimens, and patient-reported outcomes to identify complications and unmet needs in patient care. Patients with childhood-onset pituitary, adrenal, or gonadal disorders, such as craniopharyngioma, congenital adrenal hyperplasia (CAH), and Turner syndrome were prioritized. The planned enrollment is 1,300 patients during the first study phase (2022-2024). Clinical, biochemical, and imaging data from diagnosis, treatment, and follow-up during 1980-2023 were retrospectively reviewed. For patients who agreed to participate in the prospective cohort, clinical data and biospecimens will be prospectively collected to discover ideal biomarkers that predict the effectiveness of disease control measures and prognosis. Patient-reported outcomes, including quality of life and depression scales, will be evaluated to assess psychosocial outcomes. Additionally, a substudy on CAH patients will develop a steroid hormone profiling method using liquid chromatography-tandem mass spectrometry to improve diagnosis and monitoring of treatment outcomes. This study will address unmet clinical needs by discovering ideal biomarkers, introducing evidence-based treatment guidelines, and ultimately improving long-term outcomes in the areas of rare endocrine and metabolic diseases.

Breast Implant Surgery: The Importance of Informed Health Care Decisions and Outcome Monitoring.

Breast implant surgery is a popular, globally performed, and frequently requested cosmetic and reconstructive surgical procedure. Breast implant surgery can cause implant-associated systemic symptoms and types of implant-associated cancers, so it is vital to monitor patient outcomes. Most patients who undergo breast implant surgery do not experience health problems. However, patients who do experience health problems as a result of breast implant surgery form a unique patient population. When plastic and aesthetic surgeons, nurses, and other healthcare providers are knowledgeable and experienced in recognizing and treating patients with health problems related to breast implant surgery, the health outcomes of this patient population improve. This article aims to promote informed decision-making and increase patient safety by providing information about the health problems associated with breast implant surgery. This article also highlights recent safety announcements and updates from the United States Food and Drug Administration (FDA). Ensuring the safety of patients undergoing breast implant surgery is a responsibility shared by plastic and aesthetic surgeons, nurses, and other healthcare providers; the general medical community; breast implant manufacturers; and the FDA. These entities must collaborate and coordinate as a united group to accomplish this important goal. The nursing profession can contribute to these collaborative efforts by serving as professional liaisons to these entities and advocating for continued collaborative efforts to increase the safety of patients who have undergone breast implant surgery.

Minimizing patient burden in outcome monitoring: The case for abbreviated versions of PHQ-9, GAD-7 and WSAS.

The Improving Access to Psychological Therapies (IAPT) program uses the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the Work and Social Adjustment Scale (WSAS) as part of their unique outcome monitoring system. To reduce patient burden, this study explored whether abbreviated versions of these questionnaires can be used to derive relevant outcome statistics with minimal loss of information. Using two samples (training; n = 1530, validation; n = 766), we examined whether existing short-forms, PHQ-4 and GAD-R3, would provide enough information to calculate relevant outcomes with near perfect agreement with the outcomes based on the original scales. We also examined 1) whether additional items would further improve the agreement between the abbreviated and original scales, and 2) alternative short-forms based on the sample-derived item information curves. The latter was also used to derive an abbreviated version of WSAS. The abbreviated version derived from the item information curves provided the closest match with the original scales. A 5-item version of PHQ, a 4-item version of GAD, and a 3-item version of WSAS were correlated 0.95 with their original counterpart. Agreement as expressed by Cohen's kappa also suggested near perfect agreement for the outcomes (reliable) recovery rate and reliable improvement rate (>0.80). The outcome point estimates also matched very well (<2 % difference). Results were replicated in the validation sample. The derived abbreviated versions can be used for the purpose of routine outcome monitoring with minimal loss of information and reduce patient burden with nearly 50 %.

Digital phenotypes and digital biomarkers for health and diseases: a systematic review of machine learning approaches utilizing passive non-invasive signals collected via wearable devices and smartphones

Passive non-invasive sensing signals from wearable devices and smartphones are typically collected continuously without user input. This passive and continuous data collection makes these signals suitable for moment-by-moment monitoring of health-related outcomes, disease diagnosis, and prediction modeling. A growing number of studies have utilized machine learning (ML) approaches to predict and analyze health indicators and diseases using passive non-invasive signals collected via wearable devices and smartphones. This systematic review identified peer-reviewed journal articles utilizing ML approaches for digital phenotyping and measuring digital biomarkers to analyze, screen, identify, and/or predict health-related outcomes using passive non-invasive signals collected from wearable devices or smartphones. PubMed, PubMed with Mesh, Web of Science, Scopus, and IEEE Xplore were searched for peer-reviewed journal articles published up to June 2024, identifying 66 papers. We reviewed the study populations used for data collection, data acquisition details, signal types, data preparation steps, ML approaches used, digital phenotypes and digital biomarkers, and health outcomes and diseases predicted using these ML techniques. Our findings highlight the promising potential for objective tracking of health outcomes and diseases using passive non-invasive signals collected from wearable devices and smartphones with ML approaches for characterization and prediction of a range of health outcomes and diseases, such as stress, seizure, fatigue, depression, and Parkinson’s disease. Future studies should focus on improving the quality of collected data, addressing missing data challenges, providing better documentation on study participants, and sharing the source code of the implemented methods and algorithms, along with their datasets and methods, for reproducibility purposes.

Development of An Intelligent Learning Evaluation System Based on Big Data

The increasing need for effective learning evaluation in higher education is driving the development of big data-based systems to provide comprehensive insights. This research aims at developing an Intelligent Learning Evaluation System (ILES) to support team teaching and monitor the effectiveness of the learning process through pre-tests, post-tests and periodic evaluations. The system was developed using the Agile methodology, including iterative stages of requirements gathering, design, development, testing and implementation. Codeigniter is used for backend development, PostgreSQL as database. This system enables dynamic monitoring and evaluation of teaching performance and student learning outcomes. The finding showed that the Real-time data visualization and user-friendly dashboards improve decision making for faculty and administrators. Testing shows increased engagement and actionable insights for performance improvement. ILES demonstrates the potential of big data in higher education by enabling data-based decision making and driving continuous improvement in teaching and learning. Future research will explore integration with broader institutional systems and its scalability

Enhancing educational frameworks through innovative approaches and technologies

The article focuses on studying strategies and methods to improve educational systems, introducing the latest technologies and updating curricula to assess their effectiveness. The research methodology was based on a synergistic approach focused on understanding educational systems as complex dynamic systems, the interaction of elements generating new properties and phenomena. Research has demonstrated that the improvement of educational systems necessitates a comprehensive approach that encompasses the study of strategies and methods for enhancing education, the implementation of the latest technologies, the updating of curricula, and the practical assessment of these changes. Analysing educational systems in Europe, the USA, and other countries worldwide has revealed many approaches to teaching and educating the younger generation. The principal challenges confronting contemporary educational systems include suboptimal educational quality, inadequate accessibility for all social segments, tardiness in integrating the latest technologies, and the necessity for continuous curriculum updates. The proposed strategies and methods for enhancing educational systems entail active implementation of innovations, the application of modern technologies in the educational process, and continuous curriculum updates that consider labour market needs and the demands of contemporary society. Evaluating the efficacy of the proposed alterations to the educational system represents a pivotal phase in their implementation. The systematic monitoring of outcomes and data analysis will facilitate the timely identification of issues and the implementation of adjustments to education development strategies.

Frontal White Matter Changes and Craving Recovery in Inpatients With Heroin Use Disorder

Amidst an unprecedented opioid epidemic, identifying neurobiological correlates of change with medication-assisted treatment of heroin use disorder is imperative. White matter impairments in individuals with heroin use disorder (HUD) have been associated with drug craving, a reliable predictor of treatment outcomes; however, little is known about structural connectivity changes with inpatient treatment and abstinence in individuals with HUD. To assess white matter microstructure and associations with drug craving changes with inpatient treatment in individuals with HUD (effects of time and rescan compared with controls). This cohort study conducted from December 2020 to September 2022 included individuals recruited from urban inpatient treatment facilities treating HUD and surrounding communities in New York City. Participants with HUD were receiving medication-assisted treatment. Data were analyzed from October 2022 to March 2023. Between scans, inpatient individuals with HUD continued treatment and related clinical interventions. Control participants were scanned at similar time intervals. Changes in white matter diffusion metrics (fractional anisotropy and mean, axial, and radial diffusivities) assessed voxelwise with general linear models in addition to baseline and cue-induced drug craving, and other clinical outcome variables (mood, sleep, affect, perceived stress, and therapy attendance). Thirty-four individuals with HUD (mean [SD] age, 40.5 [11.0] years; 9 women [36%]; 3 Black [9%], 17 White [50%], 14 other race or ethnicity [41%]) and 25 control (mean [SD] age, 42.1 [9.0]; 7 women [21%]; 8 Black [32%], 10 White [40%], 7 other race or ethnicity [28%]) were included. Main voxelwise findings showed HUD-specific white matter microstructure changes (1 - P > .949), including increased fractional anisotropy and decreased mean and radial diffusivities, encompassing mostly frontal major callosal, projection, and association tracts. The increased fractional anisotropy (r = -0.72, P < .001, slope SE = 9.0 × 10-4) and decreased mean diffusivity (r = 0.69, P < .001, slope SE = 1.25 × 10-6) and/or radial diffusivity (r = 0.67, P < .001, slope SE = 1.16 × 10-6) in the genu and body of the corpus callosum and left anterior corona radiata in individuals with HUD correlated with a reduction in baseline craving (voxelwise 1 - P > .949). No other white matter correlations with outcome variables reached significance. This cohort study of inpatients with HUD on medication-assisted treatment found whole-brain normalization of structural connectivity in frontal white matter pathways implicated in emotional regulation and top-down executive control. Observed associations with decreases in baseline craving further support the possibility of recovery, highlighting the relevance of these white matter markers to a major symptom of addiction, with implications for clinical outcome monitoring.

Understanding the Past to Preserve the Future: Genomic Insights Into the Conservation Management of a Critically Endangered Waterbird.

To ensure the success of genetic rescue, we must minimise the potential negative effects of outbreeding depression that may arise from selecting source populations. The difficulty in assessing the likelihood of outbreeding depression has hindered its consideration in endangered species conservation. However, genomic research offers feasible indications. Here, we conduct conservation genomic analyses on the East Asian (EA) population and the relict Western/Central Asian (WCA) population of the critically endangered Siberian crane (Leucogeranus leucogeranus). We aim to assess genetic rescue's potential advantages and disadvantages between the two populations. Our analysis shows genomic evidence of limited genetic differentiation between them. The persistent decline in population size due to historical climatic oscillations leads to a decrease in genetic diversity and an increase in inbreeding. The WCA population has excessive deleterious homozygous mutations than the EA population, suggesting suffering from inbreeding depression resulting from less effective purifying selection. Forward simulations support the increase in genetic load due to elevated levels of inbreeding compromises fitness during population collapse. We strongly recommend an urgent genetic rescue for the WCA population through population supplementation from the EA population. However, the continuous monitoring of fitness outcomes is required through captive breeding. This work provides useful insights into the genetic management of a critically endangered species and emphasises the importance of evaluating the likelihood of outbreeding depression through genomic approaches.

Visual Outcome after Cataract Surgery in a Tertiary Eye Hospital in Southern Region of Bangladesh

Background: Vision is a very important sense for human life which is directly related with education, performance of work and quality of life. Worldwide cataract is considered one of the leading causes of blindness and visual impairment. Cataract surgery is one of the most commonly performed procedures in ophthalmology. Cataract extraction with intraocular lens (IOL) implantation is the only surgical approach available mostly in developing countries. Objective: This study aimed to evaluate the visual outcome who have had their cataract surgery in a tertiary level eye hospital. Method: Prospective interventional study was conducted from 1st January 2019 to 31st December 2019 at Sheikh Fazilatunnesa Mujib Eye Hospital &amp; Training Institute (SFMEHTI), Gopalganj. It was a hospital based study of consecutive cataract-operated patients who had age-related cataract with vision 6/24 or less before surgery. For surgery all the patients were evaluated including their relevant investigations with trained ophthalmologist and allowed as fit for surgery. Total 8776 patients who admitted in this hospital and fulfill the eligibility criteria were included in this study. Patients in age of 40 - 80 years were included in the study. The most common procedure was phacoemulsification (PE) with posterior chamber intraocular lens (PCIOL) 4704 (53.6%) followed by small incision cataract surgery (SICS) with posterior chamber intraocular lens (PCIOL) implantation, operated in4072 (46.4%) eyes. Most of the surgery was done by well-trained ophthalmologists; whereas few surgeries were done by young ophthalmologists under the supervision of senior ophthalmologist. Result: Among 8776 patients operated, the most common group was 40-60 years (65.5%). The mean age of the patients was 60.47 years. Male patients were more (52.8%). In post cataract surgery patients, 5967 (68%) eyes had presenting vision &gt;6/18. Visual acuity (VA) &lt;6/60 was found in 176 (2%) eyes. In 8600 (98%) eyes visual acuity (VA) was improved after best correction. Poor visual outcome was significantly associated with the patients who were in older age, gender female, literacy, hearing impairment and SICS&amp; PE surgery techniques. Conclusion: This study observed that good visual acuity can achieved in cataract surgery. More attention should be given towards monitoring of cataract surgical outcomes and correction of refractive error after surgery. It is also important to meet the WHO standard of visual outcome after cataract surgery. Central Medical College Journal Vol 8 No 1 January 2024 Page: 7-11