Morbidity In Patients Research Articles

Prevention and treatment approaches of post-dural puncture headache in obstetric patients: A comprehensive review

Neuraxial anesthesia and analgesia are administered to many patients. The incidence of dural puncture is about 1%, with a higher occurrence in laboring women. Post dural puncture headache (PDPH) develops in 60%-80% of patients after dural puncture which is usually positional and sometimes is accompanied by neck stiffness, photophobia, nausea, or hearing symptoms. It can also drive-up healthcare costs by increasing the length of hospital stay for chronic headache and back pain. PDPH has the potential to cause significant morbidity in the obstetric patients which prolongs the hospital stay. Epidural blood patch (EBP) is considered the gold standard for the management of PDPH. Proper scheduling of analgesics and supporting the patient psychologically as she cares for her newborn is needed. If the intensity of headache is severe, additional agents may be considered. In this review, the different methods and therapeutic approaches for prevention and treatment of PDPH are comprehensively discussed.

Hypothyroidism in Metabolic Syndrome.

Metabolic syndrome (MetS) and hypothyroidism are well-established forerunners of atherogenic cardiovascular disease (CVD). It is possible that patients suffering from both these disease entities may have a compounded risk. This study aimed at determining the prevalence of hypothyroidism in MetS. This cross-sectional study was conducted from September 2017 to August 2018 in the department of medicine at a tertiary care hospital in Northern India. Ethical approval was obtained from the institutional ethical committee. The study subjects consisted of 157 patients with MetS, the diagnosis of which was based on the International Diabetes Federation criteria. After a detailed history and physical examination, relevant investigations including complete thyroid profile were done. The data were analyzed using appropriate statistical tests (P < 0.05). In our study, the age of subjects ranged between 14 and 92 years, with a mean ± standard deviation of 48.1 ± 17.01 years. There were more females than males with a male-to-female ratio of 1:1.3. The prevalence of hypothyroidism was 46.5%. Hypothyroidism was more common in females (58.9%) as compared to males (41.1%). Patients with hypothyroidism had significantly higher body weight and body mass index (BMI) in comparison to euthyroid patients. The rest of the anthropometric parameters were comparable. Waist circumference and BMI of overt hypothyroid patients were found to be higher as compared to subclinical hypothyroid patients. Total cholesterol and triglyceride were significantly higher (P = 0.001 and P < 0.001, respectively), while high-density lipoprotein levels were significantly lower in patients with hypothyroidism than the euthyroid group (P < 0.001). Hypothyroidism, especially subclinical hypothyroidism, is a common endocrine disorder in patients with MetS. As MetS and hypothyroidism are independent risk factors for CVD, hence there is a need for screening for hypothyroidism and the treatment of the same can be beneficial in reducing the cardiovascular morbidity and mortality in patients with MetS.

Early surgical outcome for Tetralogy Of Fallot In An African Setting; A Tanzanian experience using retrospective analysis of hospital data

BackgroundTetralogy of Fallot (TOF) is typically treated in infancy but often done late in many resource-limited countries, jeopardizing surgical outcomes. This study examined the early results of children undergoing primary complete TOF repair at the Jakaya Kikwete Cardiac Institute (JKCI) in Tanzania, an emerging cardiac center in Eastern Africa.MethodsA retrospective cohort study of children ≤ 18 years undergoing primary TOF complete repair between 2019 and 2021 was conducted. Patients with complex TOF and those with obvious genetic syndrome were excluded. Data on socio-demography, pre-and postoperative cardiac complications, Intensive Care Unit (ICU) and hospital stay, and in-hospital and 30-day mortality were analyzed. Logistic regressions were employed to find the factors for mortality, ICU, and hospital stays.ResultsThe I02 children underwent primary TOF complete repair were majority male (65.7%; n = 67), with a median age of 3.0 years (IQR: 2–6), ranging from 3 months to 17 years.Only 20 patients (19.6%) were below one year of age. Almost all (90%; n = 92) were underweight, with a mean BMI of 14.6 + 3.1 kg/m2 Haematocrits were high, with a median of 48.7 (IQR: 37.4–59.0). The median oxygen saturation was 81% (IQR:72–93). Over a third of patients (38.2%; n = 39) needed Trans annular patch (TAP) during surgery. The median ICU stay was 72 h (IQR:48–120), with ICU duration exceeding three days for most patients. The median hospital stay was 8.5 days (IQR:7–11), with 70 patients (68.2%)experiencing an extended hospital stay of > 7 days. Bacterial sepsis was more common than surgical site infection (5.6%; n = 6 vs. 0.9%;n = 1). No patient needed re-operation for the period of follow up. The in-hospital mortality rate was 5.9%, with no deaths occurring in children less than one year of age nor after discharge during the 30-day follow-up period. No statistically significant differences were observed in outcomes in relation to age, sex, levels of hematocrit and saturations, presence of medical illnesses, and placement of TAP.ConclusionTOF repairs in this African setting at a national cardiac referral hospital face challenges associated with patients’ older age and compromised nutritional status during the surgery. Perioperative mortality rates and morbidity for patients operated at an older age remain elevated. It’s important to address these issues to improve outcomes in these settings.

Education and cooking methods in the management of calcium and PTH serum levels in patients on hemodialysis: a randomized controlled study.

Chronic kidney disease associated mineral bone disorder (CKD-MBD) is one of the major causes of excess morbidity and mortality in hemodialysis patients. The purpose of this study was to investigate whether education about dietary intakes and specific food processing methods affect serum calcium and PTH concentrations in hemodialysis patients. Forty-seven hemodialysis patients were randomly divided into a control and an intervention group. All participants were on individualized phosphate binder therapy. Both groups received education on dietary intake by a trained dietitian. The intervention group received additional education on specific preparation methods of different foodstuffs and consumed two hospital meals prepared according to these methods during hemodialysis. Serum calcium and PTH levels, and vitamin D analog therapy dosage were periodicallymonitored during the 1-year study period. At the baseline of the study, there were no differences between control and intervention groups in serum calcium (p = 0.078), serum PTH (p = 0.670), and vitamin D analog therapy dosage (p = 0.184). At the end of the study, serum calcium was better regulated in the intervention group, resulting in a significant differencebetween thestudy groups (p = 0.013). This was also confirmed by serum PTH levels in the intervention group, which remained stable until the end of the study (p = 0.110). Additional education on specific food processing techniques mayresult in improved management of serum calcium and PTH levels, which could ultimately provide better control of secondary hyperparathyroidism in hemodialysis patients.

Development and Validation of Nosocomial Bacterial Infection Prediction Models for Patients With Systemic Lupus Erythematosus.

Hospital-acquired bacterial infections are associated with high morbidity and mortality rates in patients with systemic lupus erythematosus (SLE). This study aimed to develop and validate predictive models for the risk of hospital-acquired bacterial infections in patients with SLE. A historical cohort study was designed for development, and another bidirectional cohort study was used for external validation. The risk of bacterial infection was assessed upon admission and after 5 days of hospitalization. Predictor selection employed the least absolute shrinkage and selection operator (LASSO) techniques. Multiple imputations were used to handle missing data. Logistic regression models were applied, and the properties of discrimination, calibration, and decision curve analysis were evaluated. The development cohort comprised 1686 patients and 237 events (14.1%) from 3 tertiary hospitals. The external validation cohort included 531 patients and 84 infection outcomes (15.8%) from 10 hospital centers in Colombia (secondary and tertiary level). The models applied at admission and after 120 hours of stay exhibited good discrimination (AUC > 0.74). External validation demonstrated good performance among patients from the same tertiary institutions where the models were developed. However, geographic validation at other institutions has been suboptimal. Two predictive models for nosocomial bacterial infections in patients with SLE are presented. All infection prevention recommendations should be maximized in patients at moderate/high risk. Further validation studies in diverse contexts, as well as clinical impact trials, are necessary before potential applications in research and clinical care.

Neurofibromatosis type1 adult surveillance form for Austria.

Neurofibromatosis type1 (NF1) is arare autosomal dominant tumor predisposition syndrome with abirth prevalence of approximately 1in 2000-3000 individuals. Management of both benign and malignant tumors arising in individuals with NF1 is demanding and tumors may be difficult to treat. Both standardized and individual surveillance programs are therefore highly important to prevent morbidity and mortality in patients with NF1. The guidelines for the clinical management of NF1 recently proposed by the European Reference Network for Genetic Tumor Risk Syndromes provide the cornerstone of the present surveillance form and were discussed through three rounds of voting and afinal consensus meeting involving experts from five Austrian and one German clinical NF1 centers for adults and one patient organization representative. Subsequently, 31items within 4categories were integrated into the proposed surveillance form for Austria. All recommendations, unless otherwise specified, pertain to primarily asymptomatic patients in routine follow-up. At healthcare transition from pediatric to adult surveillance or the initial visit in adulthood, we suggest athorough clinical, laboratory and radiological examination to obtain abaseline for future diagnostics. To comply with the general screening recommendations in Austria, we suggest extending the frequency of clinical visits from annual to biennial at 50years of age. In cases of clinical dynamics, early follow-up is recommended to facilitate early detection of potential complications. Particular emphasis should be placed on preventive patient education.

EASIX (endothelial activation and stress index) predicts mortality in patients with coronary artery disease.

Coronary interventions reduce morbidity and mortality in patients with acute coronary syndrome. However, the risk of mortality for patients with coronary artery disease (CAD) additionally depends on their systemic endothelial health status. The 'Endothelial Activation and Stress Index' (EASIX) predicts endothelial complications and survival in diverse clinical settings. We hypothesized that EASIX may predict mortality in patients with CAD. In 1283 patients undergoing coronary catheterization (CC) and having a diagnosis of CAD, EASIX was measured within 52days (range -1year to -14days) before CC and correlated with overall survival. In an independent validation cohort of 1934 patients, EASIXval was measured within 174days (+ 28days to + 11years) after CC. EASIX predicted the risk of mortality after CC (per log2: hazard ratio (HR) 1.29, 95% confidence interval: [1.18-1.41], p < 0.001) in multivariable Cox regression analyses adjusting for age, sex, a high-grade coronary stenosis ≥ 90%, left ventricular ejection fraction, arterial hypertension and diabetes. In the independent cohort, EASIX correlated with EASIXval with rho = 0.7. The long-term predictive value of EASIXval was confirmed (per log2: HR 1.53, [1.42-1.64], p < 0.001) and could be validated by integrated Brier score and concordance index. Pre-established cut-offs (0.88-2.32) associated with increased mortality (cut-off 0.88: HR training: 1.63; HR validation: 1.67, p < 0.0001 and cut-off 2.32: HR training: 3.57; HR validation: 4.65, p < 0.0001). We validated EASIX as a potential biomarker to predict death of CAD patients, irrespective of the timing eitherbefore or after catheterization.

ThP4.9 - The role of preoperative nutritional assessment in postoperative outcomes of hepato-pancreato-biliary patients: A bicenter prospective observational study

Abstract Aims Preoperative nutritional status of patients who undergo surgery due to hepato-pancreato-biliary (HPB) cancer has been considered as a prognostic factor of their postoperative course. The aim of the present study was to investigate the association of preoperative nutritional assessment with the postoperative morbidity and mortality in such patients. Methods Patients undergoing surgery due to HPB cancer from March 2022 until March 2023 at two university surgical departments were included in the present study. Patients’ demographics and postoperative parameters, such as complications’ severity according to Clavien-Dindo classification and mortality, along with malignancy stage were reported. Preoperative nutritional assessment was conducted according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Controlling Nutritional Status (CONUT) score. The present study was registered in ClinicalTrials.gov (NCT05795374). Results The present study included 66 patients with a mean age of 63 ± 12 years old. The high risk of malnutrition according to the GLIM criteria was associated with major (Clavien-Dindo≥3) postoperative complications (74% vs 32%, p=0.026) and increased 30-day mortality (80% vs 23%, p=0.021). Moreover, malnutrition according to the CONUT tool was correlated to increased 30-day mortality (66% vs 45%, p=0.016). Conclusions Preoperative malnutrition seems to be associated with higher rates of postoperative mortality and major morbidity in patients undergoing surgery due to HPB cancer.

SP5.2 - Reducing Elective Colorectal Surgical Site Infections with Change of Gloves and Instruments Prior to Abdominal Closure; A Multicycle Audit

Abstract Aims Surgical site infections (SSI) carry a significant impact on patient morbidity, length of stay and antibiotic resistance. Our local colorectal unit has made several interventions over many years with no significant nor sustained improvement in the rate of SSI. The ChEETAh trial (Lancet, 2022) demonstrated a reduction in the rate of 30-day SSI by 13% with routine change of gloves and instruments (COGI) prior to abdominal closure. We aim to reduce our rate of SSI through implementation of COGI prior to abdominal closure; involving whole scrub team change of gloves and use of sterile instruments. Methods Adults undergoing elective colorectal surgery with an abdominal wound greater than 5cm were eligible for this study. Diagnosis of SSI was made based on at least one clinical indicator of infection or at least one symptom of SSI with data collection over 3 cycles spanning 11 months using clinical notes, imaging and microbiology results. The primary outcome was the diagnosis of a SSI involving the skin, subcutaneous, muscle or fascial layer up to 30 days post-operatively. Results The baseline SSI rate prior to intervention was audited at 29%. After implementation of COGI the rate fell to 23%. Further reinforcement of COGI and team education has demonstrated a further decrease in SSI to 15%. This has been sustained across a 6-month period post intervention. Conclusions Change of gloves and instruments is an effective, reliable and sustainable method to reduce the rate of surgical site infection in elective colorectal abdominal surgery.

EP465 - Transfusion Associated Circulatory Overload (TACO) Audit - A prospective analysis of adherence to standards ensuring safe transfusions

Abstract Aims TACO is defined as acute or worsening respiratory compromise during or up to 12 hours of transfusion, with additional features including cardiovascular system changes not explained by the patient’s underlying medical condition. In the UK, TACO remains a major cause of Morbidity in surgical post operative patients. The aim of this audit was to assess whether the current trust transfusion practices are synchronous with the NICE guidelines and SHOT recommendations. Methods We reviewed 27 incidences of transfusion during the whole month in acute general surgical ward. Patient’s notes, trust intranet and EPMA were used for data collection. The adherence to Ng24 as well as latest SHOT recommendations was checked. Following standards were taken into account: A formal pre-transfusion risk assessment for transfusion-associated circulatory overload (TACO) should be undertaken for all patients receiving blood transfusion and mitigating actions taken. (Serious hazards of transfusion SHOT recommendation) Patients who develop respiratory distress during or up to 24 hours following transfusion where transfusion is suspected to be the cause must be reported to SHOT. A structured incident review should be undertaken for every case of TACO. Weight-adjusted red cell dosing should be used. (NICE Guidelines Ng24) Result TACO assessment checklist was only completed for 15% of transfusions (compared to 35% nationally) while mitigation actions were only considered for 4% of patients. There appeared discordance among junior doctors regarding TACO Management. Conclusions Interventions like teaching sessions, information leaflets and posters, presentation for induction pack and liaison with Transfusion practitioner team to modify transfusion pathway significantly reduced inconsistencies regarding safe transfusions and immensely improved patient management.

Characteristics of Patients with Spontaneous Coronary Artery Dissection Presenting with Sudden Cardiac Arrest in the United States and the Potential Role of Implantable Cardioverter Defibrillator Therapy.

Spontaneous coronary artery dissection (SCAD) is a disease entity that often occurs in young, healthy women and can cause life-threatening ventricular arrhythmias and sudden cardiac arrest. However, the characteristics and outcomes of SCAD with cardiac arrest are not well characterized. This study investigated the baseline characteristics of SCAD patients with cardiac arrest using the National Inpatient Sample (NIS) database between 2016 and 2020. In addition, we also sought to determine the potential impact that implantable cardioverter defibrillator (ICD) therapy had on morbidity and mortality in SCAD patients presenting with cardiac arrest. Our findings showed that the SCAD with cardiac arrest population had significantly higher comorbidities, including cardiac arrhythmias, congestive heart failure, pulmonary circulation disorders, liver diseases, solid tumors, coagulopathy, fluid disorders, chronic kidney disease (CKD), anemia secondary to deficiency, psychosis, neurological disorders, carotid artery disease, atrial fibrillation, ventricular arrhythmias (ventricular tachycardia (VT), ventricular fibrillation (VF)), and acute myocardial infarction (AMI), compared to the SCAD without cardiac arrest population. Likewise, for SCAD patients who did not have an ICD in place, we found increasing age, fluid and electrolyte disorders, uncomplicated diabetes, neurological disorders, peripheral vascular disease, pulmonary circulatory disorders, cardiac arrhythmias, and congestive heart failure to be associated with greater mortality. SCAD patients with certain comorbidities (e.g., pulmonary diseases, liver diseases, cancers, coagulopathy, and CKD) who presented with AMI or congestive heart failure should be monitored closely for ventricular arrhythmias as they have a higher chance of progressing to cardiac arrest. ICD therapy can be considered for these patients, but data on the success of this treatment option are limited, and more research needs to be performed to determine whether the benefits of this outweigh the risks.

Morbidity and Postoperative Mortality of Colorectal Tumors

Colorectal cancer, by its frequency and severity, represents a serious public health problem worldwide. In Morocco, the incidence of colorectal cancer is constantly increasing. Post-operative morbidity and mortality is an event whose evaluation and analysis are necessary to improve surgical results and optimize patient care. Thus, knowledge of the causes and risk factors of morbidity and mortality will contribute not only to a better evaluation of patients candidates for colorectal surgery, but also to reveal new avenues of research to improve the post-operative prognosis of these patients. The objective of this retrospective work is to carry out an epidemiological study of the morbidity and mortality of patients admitted during the postoperative period of colorectal surgery to the surgical intensive care unit of the Ibn Rochd University Hospital in Casablanca; as well as the search for potential predictive factors associated with it.

WP5.9 - Emergency laparotomies in the elderly: a patient perspective

Abstract Aims Emergency laparotomy is known to convey worse morbidity and mortality for elderly patients. Despite a growing elderly population, there is a limited understanding of the patient experience in emergency laparotomy. This study aims to assess patient satisfaction following emergency laparotomy. Methods Patients were identified from the National Emergency Laparotomy Audit (NELA) database, who were aged 80 and above, and underwent surgery between: January 2020 and August 2023 at Torbay Hospital. Of the patients who survived to discharge, a telephone-based interview was undertaken in January 2024. Exclusion criteria included: confusion, severe illness and relook laparotomy. Data were collected on functional status and satisfaction with the procedure. Patients were also asked what they wished they known prior to the operation. Post-operative outcomes were assessed in a separate study. Results 132 cases were undertaken in this period. 72 cases met inclusion criteria. We achieved a 61% response rate. 59% of respondents were living independently post operatively and 61% had no functional decline. 93% of respondents were happy to have had the operation and if given the opportunity again would still have had the procedure. Patients were overall very happy with the information offered prior to the procedure, 7% felt they had no alternative option. One patient was not satisfied with the follow up received. Conclusions Although emergency laparotomy in the elderly is high risk, our data demonstrate excellent patient satisfaction. This study provides a better understanding of what is important to patients; this should be considered in the consent process and communication.

Association of in vitro fertilization with severe maternal morbidity in low-risk patients without comorbidities

To determine whether an association exists between in vitro fertility (IVF) and severe maternal morbidity among low-risk pregnant patients. Retrospective cohort study SUBJECTS: Low-risk pregnant patients who delivered between 1/2019 and 12/2022. Low-risk was defined as having an Obstetric Comorbidity Index (OB-CMI) score of 0. IVF MAIN OUTCOME MEASURES: The primary outcome (dependent variable) was any severe maternal morbidity. The secondary outcome was the need for a cesarean delivery. A modified Poisson regression with robust error variance was used to model the probability of severe maternal morbidity as a function of IVF. Risk ratios (RR) and their associated 95% confidence intervals (CI) were computed. An alpha value of 0.05 was considered statistically significant. A total of 39,668 pregnancies were included for analysis, and 454 (1.1%) were conceived by IVF. The overall severe maternal morbidity rate was 2.4% (n=949), with the most common indicator being blood transfusion. Overall cesarean delivery rate was 18.8% (n=7,459). On modified Poisson regression, IVF-conceived pregnancies were associated with 2.56 times the risk of severe maternal morbidity (95% CI 1.73 - 3.79) and 1.54 times the risk of having a cesarean delivery (95% CI, 1.37-1.74) compared to non-IVF pregnancies. IVF is associated with higher rates of severe maternal morbidity, primarily the need for a blood transfusion, and cesarean delivery in low-risk pregnancies without major comorbidities. Recognizing this association allows healthcare providers to implement proactive measures for better monitoring and tailored postpartum care.

ASO Author Reflections: Are Common Risk Calculators Able to Predict Morbidity and Mortality Outcomes for Patients with Primary Retroperitoneal Sarcoma? A Multicentric Retrospective Analysis.

ASO Author Reflections: Are Common Risk Calculators Able to Predict Morbidity and Mortality Outcomes for Patients with Primary Retroperitoneal Sarcoma? A Multicentric Retrospective Analysis.

FP2.2 - Does preoperative nutritional assessment correlate with postoperative outcomes of patients undergoing surgery due to colorectal cancer? A bicenter prospective observational study

Abstract Aims Preoperative nutritional status has been investigated as a risk factor for postoperative complications in patients undergoing surgery due to colorectal surgery. The aim of the present study was to investigate the predictive role of preoperative nutritional assessment in terms of morbidity and mortality in such patients. Methods Patients undergoing surgery due to colorectal cancer from March 2022 until March 2023 at two university surgical departments were included in the present study. Patients’ demographics and postoperative parameters, such as complications’ severity according to Clavien-Dindo classification and mortality, along with malignancy stage were reported. Preoperative nutritional assessment was conducted according to the Patient-Generated Subjective Global Assessment (PG-SGA) tool and the Geriatric Nutritional Risk Index (GNRI) tool. The present study was registered in ClinicalTrials.gov (NCT05795374). Results The present study included 159 patients with a mean age of 69 ± 12 years old. Severe malnutrition according to the PG-SGA tool was associated with advanced disease stage (66% vs 59%, p=0.006). In addition, the high risk of malnutrition according to the GNRI tool was correlated to major (Clavien-Dindo≥3) postoperative complications (19% vs 15%, p=0.026) and increased 30-day mortality (34% vs 9%, p=0.026). Conclusions Postoperative morbidity and mortality of patients undergoing surgery due to colorectal cancer seem to be associated with preoperative nutritional stratification, especially with the high malnutrition risk.

The relationship between the technical performance score (TPS) and outcomes and its discriminative ability in congenital heart surgery.

Various scoring systems have been used to predict mortality and morbidity after congenital heart surgery. While the ideal system is still controversial, the technical performance score (TPS) has recently gained popularity. In this study, was investigated the effect of the TPS in predicting mortality and morbidity in pediatric patients who underwent congenital heart surgery in our clinic. Patients aged < 18 years who underwent congenital heart surgery between 2020 and 2023, were retrospectively analyzed. The patients' TPS categorizations were assigned according to their echocardiographic results at discharge and whether they required reintervention. The primary endpoints of the study were mortality (death within 30 days postoperatively) and morbidity. The secondary endpoint was a comparison of the effectiveness of TPS with that of the widely used Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score. Included in this study were 1075 patients. The median patient age was 3 months (interquartile range, 1-5 months). The mortality and morbidity rates were 11% and 24%, respectively. Of the patients, 60% were categorized as TPS I (optimal), 25% as TPS 2 (adequate, minimal residual defect), and 15% as TPS 3 (inadequate, hemodynamically significant residual defect). Being categorized as TPS 3 was associated with mortality, prolonged ICU stay, and major adverse events. The predictive power of TPS for mortality and morbidity was an area under the receiver operating characteristic curve (AUC) of 0.810 (95% CI: 0.79-0.839, P < .001) and 0.78 (95% CI: 0.76-0.80, P < .001), respectively. These values were similar to those of the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score (0.81 vs 0.83 and 0.78 vs 0.80 for mortality and morbidity, respectively). In patients with highly heterogeneous congenital heart disease, the use of intraoperative TPS may be helpful in predicting mortality and morbidity.

Perceived barriers and opportunities for the introduction of post-discharge malaria chemoprevention (PDMC) in five sub-Saharan countries: a qualitative survey amongst malaria key stakeholders

BackgroundPost-discharge malaria chemoprevention (PDMC) is an intervention aimed at reducing morbidity and mortality in patients hospitalized with severe anaemia, with its effectiveness established in several clinical trials. The aim of this study was to better understand factors that would influence the scale up of this intervention, and to identify preferences for two delivery mechanisms, facility-based or community-based.MethodsForty-six qualitative individual interviews were conducted in five sub-Saharan countries amongst malaria key opinion leaders and national decision makers. Findings were analysed following a thematic inductive approach.ResultsHalf of participants were familiar with PDMC, with a satisfactory understanding of the intervention. Although PDMC was perceived as beneficial by most respondents, there was some unclarity on the target population. Both delivery approaches were perceived as valuable and potentially complementary. From an adoption perspective, relevant evidence generation, favorable policy environment, and committed funding were identified as key elements for the scale up of PDMC.ConclusionsThe findings suggest that although PDMC was perceived as a relevant tool to prevent malaria, further clarification was needed in terms of the relevant patient population, delivery mechanisms, and more evidence should be generated from implementation research to ensure policy adoption and funding.

Thromboprophylaxis in oesophageal cancer patients—a study protocol for a randomised, controlled trial (TOP-RCT)

BackgroundThe purpose of the study is to examine if prolonged thromboprophylaxis decreases the risk of thrombosis after intended curative surgery for oesophageal cancer.Study results are expected to inform a guideline for thromboprophylaxis after oesophageal cancer surgery. The perspective is to reduce morbidity and mortality in this critically ill patient group.Thrombosis is the second-most common cause of cancer death after the cancer itself. The risk of thrombosis depends on the cancer type, and upper gastrointestinal cancers are considered high risk. This risk is further increased when patients undergo surgery. However, only few studies have investigated the peri- and postoperative coagulation profile in oesophageal cancer patients. Due to this lack of knowledge, prophylaxis is currently restricted to 5000 IU (international units) low-molecular weight heparin daily from surgery until discharge from hospital (approximately 10 days), whereas patients with gastric cancer receive 30 days of treatment.The present study examines whether a 30-day treatment is superior and safe, compared with the current standard treatment.MethodsThe study is a randomised controlled trial. Inclusion is ongoing, and we aim to include 100 patients. Blood samples are drawn before and after surgery, and the coagulation is extensively examined. The primary endpoint is the difference in plasma levels of prothrombin fragment 1 + 2 (F1 + 2) 30 days after surgery between the intervention and the standard group. Furthermore, patients are examined with ultrasound to screen for asymptomatic venous thrombotic events (VTE).Secondary endpoints are incidence of bleeding, symptomatic and asymptomatic VTE and mortality 30 days 1 one year after surgery.DiscussionThe study will provide valuable information on the perioperative coagulation profile and VTE risk of oesophageal cancer patients. The study seeks to aid in optimising the postoperative thromboprophylaxis, and the perspective is to reduce morbidity and mortality in this at-risk patient population.Trials registrationThe trial was prospectively registered at the EU Clinical Trials Register with ID 2021–001335-24 on 30 June 2021 and at ClinicalTrials.gov with study identifier NCT05067153.

Risk factors and mortality associated with venous thromboembolism in the elderly US population with chronic lymphocytic leukemia

BackgroundVenous thromboembolism (VTE) causes morbidity and mortality in cancer patients. The association of VTE with known risk factors in chronic lymphocytic leukemia (CLL) is not known. ObjectiveTo examine risk factors and mortality associated with VTE in White, Black, and Asian CLL patients. MethodsThe United States SEER-Medicare database (2000–2015) was used for CLL patients ≥ 65 years. Logistic regression was used to examine VTE risk factors and Cox proportional regression was used to evaluate the effect of VTE on mortality in White, Black, and Asian CLL patients. ResultsAmong 34,075 CLL patients, VTE was diagnosed in 11.6 % of 31,395 White, 14.6 % of 2062 Black and 6.3 % of 618 Asian patients. Risk of having VTE was, ORa = 1.2 (95 % CI, 1.0–1.4) for Black patients and ORa = 0.5 (95 % CI, 0.4–0.7) for Asian patients compared to White patients. Anemia and heart failure were associated with VTE in all three racial cohorts and were the only risk factors in Asian patients. Other risk factors in White patients were the same as in the overall population, including hypertension, obesity, COPD, kidney disease, diabetes, hyperlipidemia, myocardial infarction, and chemotherapy. In Black patients, other risk factors were hypertension, and chemotherapy. Mortality was slightly higher with VTE in the overall population and in White patients. ConclusionThere was difference in VTE risk factors in White, Black, and Asian patients. VTE was marginally associated with mortality in CLL patients. Our findings may help to identify patients at higher risk of VTE in racially diverse CLL populations.