Multidisciplinary Intervention Research Articles

Investigating the Alcohol Effects on the Response to Strenuous Exercise Training: Protocol for a Multidisciplinary Intervention Study in Young Healthy Adults-The BEER-HIIT Study.

High-intensity interval training (HIIT) is a time-efficient strategy to improve fitness and performance. Whereas the multiple and negative effects of high intake of alcohol have been widely studied, the effect of moderate alcohol doses after exercise is not clear, and it is currently under debate. For that, a total of 80 young healthy adults are studied and allocated into 5 groups, each including 16 participants. Four groups follow a HIIT program, while the fifth group is a control non-training group. The training groups will be randomized according to the characteristics of the ingested beverage (alcohol beer, beer 0.0%, sparkling water, or ethanol). The effects of HIIT on several aspects of physical performance and mental health in young healthy adults are evaluated, also the concomitant effect of daily and moderate alcohol consumption. The novelty of this study lies in the continuous measurement of the psychological parameters associated with carrying out a highly demanding training program in conjunction with alcohol consumption in moderate quantities, reflecting real-life conditions.

Impact of Multidisciplinary Prehabilitation Interventions on Postoperative Hospital Length of Stay and Functional Capacity in Patients Undergoing Resection of Colorectal Cancer: A Systematic Review and Meta-analysis

BACKGROUND: While surgery is commonly regarded as the primary curative treatment for colorectal cancer, it could potentially be associated with postoperative morbidity and mortality. OBJECTIVE: Determining the pooled effect of exercise and multidisciplinary prehabilitation interventions on postoperative hospital length of stay and functional capacity in patients undergoing resection of colorectal cancer. DATA SOURCES: A systematic search was conducted in MEDLINE (via PubMed) and Web of Science databases from inception to November 2022. STUDY SELECTION: The original systematic search retrieved 2,005 studies. After removal of duplicates and screening by title and abstract, 77 eligible full‐text documents were evaluated for the final inclusion in the meta‐analysis. A total of 12 randomized controlled trials (RCTs), 5 non-randomized controlled trials and 3 uncontrolled before‐and‐after studies were selected. MAIN OUTCOME MEASURES: Postoperative hospital length of stay (in days), and functional capacity (assessed with the peak of oxygen consumption [VO2 peak] and 6 minutes walking test [6MWT]). RESULTS: The meta‐analysis was conducted on a total of 20 studies (3805 participants). RCTs and non-randomized controlled trials showed significant reductions on postoperative hospital length of stay (d = -0.10, nearly 2 days) and significant increments of VO2 peak (d = 0.27) and 6MWT (d = 0.31). Regarding the before‐and‐after studies, the pooled effect of multidisciplinary prehabilitation interventions was positively significant on VO2 peak (d = 0.29) and 6MWT (d = 0.29). There was no risk of publication bias (Egger's test: p > 0.05), being as 0.71 (from 0 to 1) on average. LIMITATIONS: There was a high between-studies heterogeneity, and several outcomes did not have the required number of studies for a desirable statistical power. CONCLUSIONS: These findings suggest that multidisciplinary prehabilitation interventions might be effective at decreasing postoperative hospital length (nearly 2 days) of stay and improving functional capacity. STUDY REGISTRATION: PROSPERO registration number CRD42022373982.

Research Perspective on: Impact of Multidisciplinary Prehabilitation Interventions on Postoperative Hospital Length of Stay and Functional Capacity in Patients Undergoing Resection of Colorectal Cancer: A Systematic Review and Meta-Analysis.

Research Perspective on: Impact of Multidisciplinary Prehabilitation Interventions on Postoperative Hospital Length of Stay and Functional Capacity in Patients Undergoing Resection of Colorectal Cancer: A Systematic Review and Meta-Analysis.

P.136 Implementation of BC Children’s Hospital’s intraventricular hemorrhage of prematurity management pathway: a quality improvement analysis

Background: Early placement of a ventricular access device (VAD) may decrease the need for permanent CSF diversion and improve cognitive outcomes in premature infants with intraventricular hemorrhage. In 2019, BC Children’s Hospital implemented a multidisciplinary early intervention pathway for these infants. This study evaluated process and compliance measures related to protocol implementation. Methods: A retrospective quality improvement chart review of enrolled infants was performed. Select measures included time to neurosurgery consult and intervention, compliance with VAD tapping and ultrasound protocols, overall ultrasound resource use, and complications. Results: Sixteen patients were included. Median time to VAD insertion was 6 days (IQR 4-9.5), greater than the 3-day target. Transfer time from peripheral NICUs and access to OR time were found to be important reasons for delay. Patients received a median 92.2% (IQR 85.1-100%) of the ultrasounds required by protocol, with a median of 36.5 (IQR 29-43.25) ultrasounds per patient. VAD tapping was 88.8% (IQR 75.6-94.8%) compliant; most protocol deviations were indicated taps not performed due to technical difficulties. Conclusions: Compliance with the new protocol was satisfactory. Areas for improvement include continued education at peripheral NICU sites to minimize transfer delays, improved access to the OR, and maintenance of technical skills amongst our NICU partners.

#2910 Renal toxicities in oncology at a secondary level hospital within the first 6 months of outpatient consultation establishment

Abstract Background and Aims In recent years the discovery of targeted therapies in oncology have been a revolution with spectacular results for patients with advanced neoplasia and metastasis. Representing a more precise approach to interfering with tumorigenesis, these therapies exhibit superior tolerability profile in terms of toxicity and have significantly improved overall survival (1). Numerous studies have demonstrated the increased risk of cancer patients developing acute renal failure and progressing to chronic kidney disease, both contributing to higher mortality. The use of these novel drugs, alongside traditional chemotherapy, coupled with the extended survival of patients with neoplasms has led to a rise in kidney pathologies (2.3). Addressing the need to provide a comprehensive and optimized treatment to this group of patients, the field of Onconephrology has emerged. Its primary objective is to assist in the diagnosis and management of kidney diseases associated with the underlying oncological condition and/or oncotherapeutics. While well-established Onconephrology Clinics predominantly operate in tertiary hospitals worldwide, acknowledging the growing significance of this field, we established an Onconephrology outpatient consultation at our secondary level hospital. In this study, we aim to delineate the incidence of renal toxicities secondary to oncotherapeutics within the first six months of initiating our Onconephrology outpatient consultation. Method Forty-six patients were retrospectively included, and an analysis of oncological and renal variables was conducted to determine the incidence of renal toxicities. Results Out of the forty-six patients evaluated, 12 exhibited renal toxicity secondary to oncotherapeutics, with a mean age of 73.3 years. The most frequent malignancy was lung cancer (n = 6), followed by gastrointestinal tract cancer (n = 2). Most patients presented with metastatic disease (n = 9), and their malignant disease was either in remission (n = 4) or stable (n = 5). Reasons for referral included acute kidney injury (n = 7), acute kidney injury over chronic kidney disease (n = 3), proteinuria (n = 1), and electrolyte abnormalities (n = 1). The diagnoses included acute immune-mediated tubulointerstitial nephritis secondary to checkpoint inhibitors (n = 5), cisplatin renal toxicity (n = 3), acute tubular necrosis secondary to tyrosine kinase inhibitors (n = 2), hypomagnesemia induced by EGFR inhibitor (n = 1), and nephrotic syndrome related to anti-VEGF. Following multidisciplinary intervention, most patients experienced recovery of kidney function (n = 9), while some progressed to chronic kidney disease (n = 2), and other maintained electrolyte imbalances (n = 1). Conclusion This study describes 12 patients with renal toxicities secondary to oncotherapeutics over a 6-month period at a secondary hospital. Most patients exhibited recovery of kidney function, emphasizing the positive outcomes achievable through multidisciplinary care, particularly in the context of the Onconephrology outpatient consultation, even in institutions with limited resources.

What is the volume, quality and characteristics of evidence relating to the effectiveness and cost-effectiveness of multi-disciplinary occupational health interventions aiming to improve work-related outcomes for employed adults? An evidence and gap map of systematic reviews.

What is the volume, quality and characteristics of evidence relating to the effectiveness and cost-effectiveness of multi-disciplinary occupational health interventions aiming to improve work-related outcomes for employed adults? An evidence and gap map of systematic reviews.

Efficacy of occupational rehabilitation in return to work for back pain: A systematic literature review.

Currently, there is no standard procedure for a return to work (RTW) rehabilitation program used by practitioners. The aim is to investigate the efficacy of occupational rehabilitation programs for workers with back pain. Two independent reviewers screened abstracts and full-text articles in a systematic literature search in three databases conducted in 2023. Subsequently, they extracted data according to the PRISMA Statement. Among the 4,010 articles retrieved, 20 met the inclusion criteria. Data from accepted studies were abstracted into tables relating to the RTW, improvement of pain intensity, quality of life (QOL), and degree of disability in persons with back pain. The risk of bias was assessed using the (SIGN)-criteria. Significant improvements in RTW were shown by a workplace intervention with a physical approach and a multidisciplinary intervention but with a wide range of effect sizes. Five studies showed significant improvements in pain intensity and QOL, six studies observed significant improvements in disability. The studies that stated positive effects on work-related data differed between intervention programs and traditional care. A combination of activity, maintenance therapy, stretching, and manual therapy showed promising results in improving RTW. In addition, the relationship and mediation between employer/workplace and employee seems to be an important aspect of RTW. However, pain intensity, disability, and QOL were enhanced with interventions that included a high proportion of physical activity. However, the intervention programs differed widely, leading to the assumption that the treatment effect of the intervention programs is not established, yet.

Development of a clinical pathway for bariatric surgery as an integral part of a comprehensive treatment for adolescents with severe obesity in the Netherlands.

Introduction In the Netherlands, bariatric surgery in adolescents is currently only allowed in the context of scientific research. Besides this, there was no clinical pathway for bariatric surgery in adolescents. In this paper, the development of a comprehensive clinical pathway for bariatric surgery in adolescents with severe obesity in the is described. Methods The clinical pathway for bariatric surgery in adolescents consists of an eligibility assessment as well as comprehensive peri- and postoperative care. Regarding the eligibility assessment, the adolescents need to be identified by their attending pediatricians and afterwards be evaluated by specialized pediatric obesity units. If the provided treatment is considered to be insufficiently effective, the adolescent will anonymously be evaluated by a national board. This is an additional diligence procedure specifically established for bariatric surgery in adolescents. The national board consists of independent experts regarding adolescent bariatric surgery, and evaluates whether the adolescents meet the criteria defined by the national professional associations. The final step is an assessment by a multidisciplinary team for adolescent bariatric surgery. The various disciplines (pediatrician, bariatric surgeon, psychologist, dietician) evaluate whether an adolescent is eligible for bariatric surgery. In this decision-making process, it is crucial to assess whether the adolescent is expected to adhere to postoperative behavioral changes and follow-up. When an adolescent is deemed eligible for bariatric surgery, he or she will receive preoperative counselling by a bariatric surgeon to decide on the type of bariatric procedure (Roux-en-Y gastric bypass or sleeve gastrectomy). Postoperative care consists of intensive guidance by the multidisciplinary team for adolescent bariatric surgery. In this guidance, several regular appointments are included and additional care will be provided based on the needs of the adolescent and his or her family. Furthermore, the multidisciplinary lifestyle intervention, in which the adolescents participated before bariatric surgery, continues in coordination with the multidisciplinary team for adolescent bariatric surgery, and this ensures long-term counselling and follow-up. Conclusion The implementation of bariatric surgery as an integral part of a comprehensive treatment for adolescents with severe obesity requires the development of a clinical pathway with a variety of disciplines.

Evaluating Weight Loss Efficacy in Obesity Treatment with Allurion's Ingestible Gastric Balloon: A Retrospective Study Utilizing the Scale App Health Tracker.

Obesity represents a growing public health concern, affecting more than 15% of the global adult population and involving a multi-billion market that comprises nutritional, surgical, psychological, and multidisciplinary interventions. The objective of this retrospective study was to evaluate the short-term efficacy and body weight measurements associated with differing levels of physical activity following the use of Allurion's ingestible gastric balloon that was designed to increase feelings of fullness and decrease food consumption, being naturally eliminated after approximately 16 weeks. This study involved 571 individuals who qualified for the intervention for being older than 20 years with a body mass index (BMI) of 27 kg/m2 or more. Utilizing the Scale App Health Tracker and Allurion's smartwatch, this study was able to track vital signs and physical activity in real time. The participants had an average initial BMI of 34.1 kg/m2 and a median age of 41 years. Notable outcomes were observed in both study groups, "Less Active" and "More Active", which were classified by achieving less or more than a median number of 8000 daily steps. Specifically, body fat percentage saw a reduction from 33.1 ± 9.4 to 28.3 ± 10.2 in the less active group and from 32.2 to 27.5 in the more active group, with both groups achieving statistical significance (p < 0.001). Additionally, there was a significant reduction in average weight, dropping from 98.2 ± 22.8 kg to 84.6 ± 19.3 kg in the less active group and from 97.7 ± 21.0 kg to 82.1 ± 22.9 kg in the more active group (both p < 0.001). Interestingly, those in the more active group also experienced a significant increase in lean mass compared to their less active counterparts (p = 0.045), although no substantial differences in weight loss, BMI reduction, and total body fat decrease were observed between the two groups. This investigation confirms the hypothesis that Allurion's ingestible gastric balloon significantly reduces weight in the short term and enhances several physical health metrics, demonstrating effectiveness as an autonomous method for challenging weight management, regardless of the level of daily physical activity.

Abstract PO1-03-01: Barriers, facilitators, and challenges for the implementation of a hybrid multidisciplinary lifestyle intervention

Abstract Background. Breast cancer is the leading cause of cancer-related death and disability among young women in Mexico. The physical and psychological symptoms they experience affect their quality of life, physical functioning, and psychological well-being. To address this, the National Cancer Institute in Mexico City developed a program called "Joven &amp; Fuerte" that provides services for young women with breast cancer. Due to the COVID-19 pandemic, the program has migrated to virtual attention and now offers hybrid attention to meet the needs of these patients. The research group developed the "Joven, Fuerte &amp; Saludable" intervention, which is a hybrid (face-to-face and virtual) multidisciplinary lifestyle intervention that includes nutrition, rehabilitation, psychological support, mindfulness intervention, and lifestyle education for early disease young women undergoing oncology treatments. This study aims to evaluate the barriers and facilitators for implementing this lifestyle intervention. Methodology. The study involved young women with early breast cancer enrolled in the "Joven &amp; Fuerte" program in 2022. They were invited to participate in a study to evaluate the barriers, facilitators, and challenges of a hybrid multidisciplinary lifestyle intervention during the first months since the diagnosis (3 months). The intervention included face-to-face consultations for anthropometric and biochemical assessments, interdisciplinary team evaluations, and virtual support through WhatsApp and Zoom. Educational materials such as printed or digital healthy lifestyle guides and educational videos were available on a private Facebook and YouTube group. Follow-up sessions were conducted via phone, video, or on-site visits. To evaluate lifestyle habits and quality of life status, distress, anxiety, and depression validated questionnaires were used. The CFIR and RE-AIM questionnaires were used to identify the barriers and facilitators among the program staff and patients while adopting the intervention. Results. The study found that patients were satisfied with the intervention and educational materials, but there were some barriers for implementation. One of the main barriers was the patients' geographical location, as 62.5% of patients were foreign and lived far from the hospital. Additionally, patients only sometimes used the educational materials due to forgetfulness, lack of time, not having internet access, or low digital literacy. Patients also had difficulty recognizing the impact of a "healthy lifestyle" and prioritized other consultations before the program schedule. Institutional barriers included a lack of human resources, which led to a loss in follow-up and patient motivation due to waiting-list periods. Undergraduate and postgraduate training students were introduced to support the multidisciplinary team in overcoming this challenge. Despite these obstacles, patients reported feeling supported by the multidisciplinary team and experienced benefits such as reduced stress and anxiety and better management of treatment side effects upon completing program activities. An important institutional success was achieved by reducing service waiting times from three months to just 1-2 weeks for all services. Conclusions. Cultural behavior and emotional distress at diagnosis and during the first 3 months of intervention are the major challenges for patients. A hybrid educational intervention seems convenient to make follow-up more practical and accessible. Patients feel motivated because they are in touch with their clinicians and receive fast resolutions to their concerns. Many talented and enthusiastic human resources are needed to implement these interventions, but it is possible for a Latin American public hospital, considering the essential benefits for the patients. Citation Format: Daniela Martinez-Palacios, Marlid Cruz-Ramos, Fernanda Sarahi Fajardo-Espinoza, Yanira Elvira Rodriguez-Fonseca, Alicia Gonzalez-Perez, Aline Barranco-Cortés, Dana Aline Pérez-Camargo, Alejandro Mohar, Cynthia Mayté Villarreal Garza. Barriers, facilitators, and challenges for the implementation of a hybrid multidisciplinary lifestyle intervention [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-03-01.

Abstract PO1-02-12: Nutritional guidance effect on anthropometric and inflammatory parameters in young women with breast cancer

Abstract Background Young women with breast cancer (YWBC) debut with more aggressive and advanced diseases; it may be related to chronic inflammation caused by the tumor. However, in Latin America, breast cancer is also related to malnutrition conditions such as obesity. Malnutrition is commonly associated with physiological adaptations to stress and inflammation resulting in muscle catabolism and loss of functionality, which may affect oncology outcomes. Our research group had previously reported that YWBCs in Mexico are overweight or obese at diagnosis. Although they received educational support, this malnutrition prevalence continues or increases during the follow-up. A limitation of this previous study is that we only have data such as weight and height and miss other anthropometric parameters to measure the metabolic impact of weight gain. Body composition assessment is valuable for measuring malnutrition, obesity, and sarcopenia. The body composition assessment with Bioimpedance analysis (BIA) provides valuable parameters such as phase angle (PhA), which correlates with nutritional status, disease prognosis, inflammation, cell health, and metabolic activity. BC patients with a PhA &amp;gt;5.6 show a better survival rate. Another accessible tool to evaluate systemic inflammation is the neutrophil-lymphocyte ratio (NLR). Higher NLR (&amp;gt;2.12) is associated with worse disease-free and overall survival. This pilot study aims to measure the importance of PhA and NLR in YWBC with early breast cancer at diagnosis and at 12 months to evaluate the effects of personal nutritional guidance on these parameters. Methods Patients included in the “Joven &amp; Fuerte (J&amp;F) navigator program” of the National Institute of Cancerology (INCan) from 2021 to 2022 were invited to participate in this observational study. To evaluate the efficacy of personal nutritional guidance in anthropometric and NLR parameters, basal and 12-month BIA and anthropometric measures such as the Waist-Hip index were assessed, and NLR was obtained from the patient's records. Results Eleven early breast patients agreed to participate in the pilot intervention. The median age of the participants was 37 years. The majority had local advanced disease (54.5%), regarding molecular subtype luminal was the more frequent subtype (45.5%), followed by HER2 (36.4%), triple-negative (18.2%). According to BMI at diagnosis, 18.2% had normal-weight, 63.6% were overweight, and 18.2% had obesity. At follow-up, 9.1% had normal-weight, 63.6% were overweight, and 27.3% had obesity. A significant change in body composition parameters was observed, the percentage of patients with excess adipose tissue increased from 54.5% at baseline to 81.1%. All patients exhibited cardiovascular risk, as indicated by a Waist-Hip ratio greater than 0.80, and maintained a PhA (5.2 at baseline, 5.5 final) associated with overall survival risk. No significant changes were observed in the NLR ratio (2.14 baseline, 2.34 final), maintaining the related risk for this parameter. Conclusions This pilot analysis suggests that a nutritional intervention based only in nutritional guidance and support seems inefficient in impacting nutritional or inflammatory parameters. A multidisciplinary intervention involving multidisciplinary healthcare teams, including rehabilitation, and psychology, may be required to achieve therapeutic effectiveness in this population. Further studies with larger sample sizes are necessary to confirm these findings and determine the most effective strategies to improve the nutritional status, cardiovascular health, and clinical outcomes of YWBC. Anthropometric and inflammatory parameters a The values presented as median and interquartile range, Wilcoxon. b The values presented as mean and standard deviation, paired t-test. Citation Format: Aline Barranco-Cortés, Fernanda Sarahi Fajardo-Espinoza, Ana Lorena Espadas-Vargas, Dana Aline Pérez-Camargo, Sara Aileen Cabrera-Nieto, Marlid Cruz-Ramos, Alejandro Mohar, Lucero Itzel Labra Alvarado, Cynthia Mayté Villarreal Garza. Nutritional guidance effect on anthropometric and inflammatory parameters in young women with breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-02-12.

Abstract PO1-11-10: Use of a standardized tool for the evaluation and treatment of cancer related cognitive impairment (chemo-brain) among breast cancer patients

Abstract There is a steep linear increase in patients surviving a cancer diagnosis. Clinical solutions that address the high prevalence of cancer-related treatment effects (CRTE) are urgently needed. A stark example of this need is the dearth of screening and treatment programs for cancer related cognitive impairment (CRCI) (colloquially called “chemo-brain”). Up to 75% of cancer patients report neurocognitive changes that leave patients unable to cope with the expectations of employers, colleagues, families, and friends. The prevalence of neurological disorders is 275% higher among adult cancer patients, when compared to an adult cancer-free population. For many adolescent and young adult cancer patients, the onset of CRCI occurs during "cognitive prime time"; a time when individuals are pursuing education, careers, and raising families. To address a gap in CRTE we have implemented a virtual multi-disciplinary intervention to measure and treat CRCI. Our CRCI intervention follows National Comprehensive Cancer Network and American Society of Clinical Oncology (ASCO) guidelines for CRCI. These guidelines indicate a multi-disciplinary approach with emphasis on increasing physical activity levels, cognitive-behavioral therapy, memory adaptive training, mood management, and sleep optimization. Our approach also follows recent ASCO guidelines for nutrition counseling. Our CRCI program utilizes medical oncologists, physician assistants, mental health therapists, registered dietitians, and occupational therapists. A nationally validated patient reported outcome (PRO) measurement, analysis, and reporting platform informs clinical treatment pathways, monitors patient progress, guides clinical decision making, and improves patient/provider communication. Using health status measures for CRCI, and following American Cancer Society and ASCO guidelines, patients are risk-stratified into three personalized cancer survivor care pathways: 1) low-complexity patients; 2) medium-complexity patients; and 3) high-complexity patients. Low-complexity patients baseline PROs score in the normal range, medium-complexity patients are those who score below the norm (moderate to large effect size difference from normal), and high-complexity patients are those who score well below the norm (greater than larger effect size difference from normal). Low-complexity patients are enrolled into a self-management and continuation of care program. Medium-complexity patients are enrolled into a shared care program. High-complexity patients are enrolled into an acute care program. All three clinical pathways include continued risk-factor vital-sign surveillance. Nearly 100% (99%) of patients who enroll in our primary cancer survivor care program complete our PRO baseline (N=80). From a convenient sample of breast cancer patients (N=42), provisional results of patient-specific segmentation analyses reveal a nearly perfect bell-shaped curve, with 51% of the population classified within the definition of medium-complexity and even split of outliers (high-complexity 24% and low-complexity 24%). Additionally, of all patients in our primary cancer survivor care program who completed at least three measurement time points for health status measures of cognitive impartment (N=38), 92% had a positive experience, 71% had a clinically significant improvement in cognitive health, 21% had a no change in cognitive status, and only 8% had a decline in cognitive health. If these data, and PRO implementation approach hold true, this program could be scaled to national and international cancer survivor population suffering from CRCI. Citation Format: John Librett, Mark Kosinski, Gregory Litton. Use of a standardized tool for the evaluation and treatment of cancer related cognitive impairment (chemo-brain) among breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-11-10.

Non-Pharmacological Strategies for Managing Sarcopenia in Chronic Diseases.

This article focuses on a range of non-pharmacological strategies for managing sarcopenia in chronic diseases, including exercise, dietary supplements, traditional Chinese exercise, intestinal microecology, and rehabilitation therapies for individuals with limited limb movement. By analyzing multiple studies, the article aims to summarize the available evidence to manage sarcopenia in individuals with chronic diseases. The results strongly emphasize the role of resistance training in addressing chronic diseases and secondary sarcopenia. Maintaining the appropriate frequency and intensity of resistance training can help prevent muscle atrophy and effectively reduce inflammation. Although aerobic exercise has limited ability to improve skeletal muscle mass, it does have some positive effects on physical function. Building upon this, the article explores the potential benefits of combined training approaches, highlighting their helpfulness for overall quality of life. Additionally, the article also highlights the importance of dietary supplements in combating muscle atrophy in chronic diseases. It focuses on the importance of protein intake, supplements rich in essential amino acids and omega-3, as well as sufficient vitamin D to prevent muscle atrophy. Combining exercise with dietary supplements appears to be an effective strategy for preventing sarcopenia, although the optimal dosage and type of supplement remain unclear. Furthermore, the article explores the potential benefits of intestinal microecology in sarcopenia. Probiotics, prebiotics, and bacterial products are suggested as new treatment options for sarcopenia. Additionally, emerging therapies such as whole body vibration training, blood flow restriction, and electrical stimulation show promise in treating sarcopenia with limited limb movement. Overall, this article provides valuable insights into non-pharmacological strategies for managing sarcopenia in individuals with chronic diseases. It emphasizes the importance of a holistic and integrated approach that incorporates exercise, nutrition, and multidisciplinary interventions, which have the potential to promote health in the elderly population. Future research should prioritize high-quality randomized controlled trials and utilize wearable devices, smartphone applications, and other advanced surveillance methods to investigate the most effective intervention strategies for sarcopenia associated with different chronic diseases.

Prevalence of childhood obesity in Spain and its relation with socioeconomic status and health behaviors: Population-based cross-sectional study

ObjectivesThis study aims to assess the current state of childhood overweight and obesity in Spain, and its relationship with socioeconomic status and health-related behaviors. MethodsPopulation-based cross-sectional observational study, based on the 2017 National Health Survey in minors in Spain. This study included all children surveyed who were aged 1–14 years. Childhood obesity was estimated from the z-score of the body mass index. ResultsThe study included 4882 children aged 1–14 years (mean 7.5). The prevalence of obesity was 18.6% (95% confidence interval [CI] 18.5–18.7), while 13.5% (95% CI 13.4–13.6) were overweight. These figures represent over a million children in Spain who are obese and nearly 750,000 who are overweight. A north–south geographic gradient was apparent, with higher prevalence of unhealthy body weight in southern Spain. Factors associated with childhood obesity were low socioeconomic status, poor diet and sedentarism, among others. ConclusionsChildhood overweight in Spain is strongly associated with socioeconomic status and other factors such as diet and sedentarism. Multidisciplinary public health interventions are needed to reduce this serious health problem in children.

Collaborative model of care between orthopaedics and allied healthcare professionals (CONNACT) in knee osteoarthritis: Effectiveness-implementation hybrid randomized controlled trial of a community-based, multidisciplinary, stratified intervention

ObjectiveTo compare the clinical and cost effectiveness of the Collaborative Model of Care between Orthopaedics and Allied Healthcare Professionals (CONNACT), a community-based, stratified, multidisciplinary intervention consisting of exercise, education, psychological and nutrition delivered through a chronic care model to usual hospital care in adults with knee osteoarthritis (OA). MethodsPragmatic, parallel-arm, single-blinded superiority RCT trial. Community-dwelling, ambulant adults with knee OA (Kellgren-Lawrence grade > 1; Knee Injury and OA Outcome Score (KOOS4) ≤ 75) were enrolled. Primary outcome was KOOS4 at 12-months; secondary outcomes included: quality of life, physical performance measures, symptom satisfaction, psychological outcomes, dietary habits, and global perceived effect. Intention-to-treat analysis using generalized linear model (GLM) and regression modelling were conducted. Economic evaluation through a societal approach was embedded. Results110 participants (55 control, 55 intervention) were randomized. No between-group difference found for the primary outcome (MD [95%CI]: -1.86 [-9.11. 5.38]), although both groups demonstrated within-group improvement over 12-months. Among the secondary outcomes, the CONNACT group demonstrated superior dietary change (12 months) and physical performance measures (3 months), and global perceived effect (6 months). While there was no between-group difference in total cost, significant productivity gains (reduced indirect cost) were seen in the CONNACT group. ConclusionCONNACT was not superior to usual care at 1 year. Further efforts are needed to understand the underlying contextual and implementation factors in order to further improve and refine such community-based, stratified care models moving forward. Trial RegistrationClinicaltrials.gov Identifier: NCT03809975. Registered January 18 2019. https://clinicaltrials.gov/ct2/show/NCT03809975

Intensive Multidisciplinary Feeding Day Programs in the United States: A Report Regarding the Treatment Landscape

Intensive multidisciplinary intervention is increasingly recognized as the standard of care for children with complex feeding problems. Much, however, remains unknown about this treatment model. This current qualitative, prospective study sought to identify intensive multidisciplinary day hospital programs operating in the US, describe the treatment approach, and summarize current capacity.

Sternotomic resection of an anterior mediastinal cystic teratoma with pericardial fistula

Background: Mediastinal teratomas are rare tumors and the majority of them are mature teratomas, benign lesions characterized by slow growth and low malignant potential. Signs and symptoms are infrequent; hence the diagnosis is often incidental. Complicated cases are rare and are traditionally treated with elective surgery. Our case report presents a patient with a teratoma complicated by pericardial fistulization requiring emergency surgery: the only case described in the literature. Case presentation: A 36-year-old male with no relevant medical history reported acute thoracic pain. Chest CT scan shows a mediastinal mass (compatible with cystic teratoma) compressing the superior vena cava, the heart, and pericardial involvement. The patient was first subjected to pericardiocentesis and then an en-bloc resection of the mediastinal lesion was performed via sternotomy. Discussion and conclusion: Mediastinal lesions require an accurate differential diagnosis, despite the diagnosis often being incidental in the absence of clinical symptoms. Conversely, if symptomatic, complicated cases can lead to life-threatening situations, where the exeresis of such lesions might require urgent, complex, and multidisciplinary surgical intervention.

Care home staff interventions to optimise pain assessment and management in people with advanced dementia in long-term care settings: a systematic review

Abstract Introduction As a person’s dementia symptoms worsen, they become increasingly frail and dependent on others for support,[1] which often necessitates moving into long-term care (LTC). Pain is often poorly recognised and undertreated in people with advanced dementia.[2] Aim To identify and evaluate the effectiveness of care home staff interventions involving pain assessment and management in people with advanced dementia in LTC settings. Methods This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022355487). Nine databases (Medline, Scopus, The Cochrane Library, EMBASE, Web of Science, International Pharmaceutical Abstracts, PsycINFO, CINAHL, World Health Organisation International Clinical Trials Registry Platform) were searched. The search strategy was developed in Medline and adapted as appropriate for the other databases; it comprised the following search terms: ‘dementia’, ‘Alzheimer’s disease’, ‘pain assessment’, ‘pain management’, ‘pain intervention’, ‘care home’, and ‘nursing home’. The selection of studies was limited to randomised controlled trials (RCTs) in which ≥50% of participants had advanced (moderate-severe) dementia and published in English. Electronic databases were searched from date of inception to May 2023. Two reviewers independently assessed potentially relevant articles for inclusion, completed data extraction and assessed risk of bias using the Cochrane Risk of Bias (RoB) 2.0 tool. A third reviewer was consulted when consensus could not be reached. A narrative analysis was undertaken due to the heterogeneity of outcome measures. Results In total, 3504 articles were identified, with 998 records remaining after duplicate removal. This left 2456 studies for title/abstract screening, and 22 full-text studies were assessed for eligibility; five studies met the inclusion criteria. A total of 1363 participants (mean age 83-88 years) and 123 care homes were included in the studies. The studies reported that these interventions were shown to be effective compared to control groups: the Pain recognition and Treatment (PRT) protocol in China, regular use of the PACSLAC pain assessment tool in Canada, the use of a Comprehensive Observational Pain Management Protocol in Hong Kong, the COSMOS intervention in Norway, and the STA OP stepwise multidisciplinary intervention in the Netherlands. Primary outcomes concerning pain scores measured by PACSLAC (n=2 studies), PAINAD (n=2 studies), and MOBID-2 (n=1 study) showed a statistically significant decrease. Secondary outcomes measured included several clinical outcomes associated with pain, depression, presence of neuropsychiatric symptoms and nursing staff stress. Four of the included studies were judged to be at ‘some concerns of bias’ according to RoB 2.0, due to unclear information in two or more domains (randomisation process, deviations from intended interventions, and measurement of the outcomes); one study was judged as having a ‘low risk of bias’. Conclusion The use of pain assessment tools decreased pain scores in people with advanced dementia in LTC. A limitation of this review is the exclusion of non-English language studies. Further, the clinical and methodological heterogeneity of included studies made a quantitative comparison difficult, thus, the findings are based on narrative analysis.

Comparative analysis of different therapeutic approaches in the management of protein-energy malnutrition: Case reports from a clinical setting.

Severe protein-energy malnutrition (PEM) presents a significant clinical challenge, often compounded by comorbidities such as type 2 diabetes. This case report aims to elucidate the intricacies of managing severe PEM in conjunction with type 2 diabetes, emphasizing the importance of personalized interventions and multidisciplinary collaboration in achieving optimal outcomes. By addressing the unique challenges this complex clinical scenario poses, this report contributes valuable insights to the medical literature and guides clinicians in effectively managing similar cases. The patient, pseudonymously identified as Emma Thompson, underwent a comprehensive diagnostic evaluation to assess her symptoms' severity and underlying causes. This included a thorough physical examination, laboratory testing, imaging studies, and collaboration with specialists to formulate a tailored treatment plan. Interventions were meticulously administered, with dosages, strengths, and durations adjusted based on ongoing assessments and patient response. Implementing multidisciplinary therapeutic interventions significantly improved the patient's nutritional status, glycemic control, and overall well-being. Objective measures such as BMI, serum albumin levels, and physical functioning showed marked improvement throughout treatment. Patient-reported outcomes indicated enhanced quality of life, reduced fatigue, and increased energy levels, underscoring the comprehensive success of the integrated therapeutic approach. This case report highlights the efficacy of a holistic, patient-centered approach in managing severe PEM and comorbid type 2 diabetes. Optimal outcomes were achieved by addressing the complex interplay of medical conditions through tailored interventions and multidisciplinary collaboration. The lessons from this case underscore the importance of individualized care, ongoing assessment, and long-term follow-up in enhancing patient well-being and guiding future clinical practice.

Cardiac resternotomy after cardiac surgery in kids: CRACK the chest.

Emergent resuscitation of postoperative paediatric cardiac surgical patients requires specialised skills and multidisciplinary teamwork. Bedside resternotomy is a rare but life-saving procedure and few studies focus on ways to prepare providers and improve performance. We created a multidisciplinary educational intervention that addressed teamwork and technical skills. We aimed to evaluate the efficiency of the intervention to decrease time to perform critical tasks and improve caregiver comfort. A simulation-based, in situ resternotomy educational intervention was implemented. Pre-intervention data were collected. Educational aids were used weekly during day and night nursing huddles over a three-month period. All ICU charge nurses had separate educational sessions with study personnel and were required to demonstrate competency in all the critical tasks. Post-intervention simulations were performed after intervention and at 6 months and post-intervention surveys were performed. A total of 186 providers participated in the intervention. There was a decrease in time to obtain defibrillator, setup resternotomy equipment and internal defibrillator paddles and deliver sedation and fluid (all p < 0.05). Time to escort family from the room and obtain blood was significantly decreased after intervention (p < 0.05). There was no difference in time to first dose of epinephrine, defibrillator pads on the patient, or time to call the cardiovascular surgeon or blood bank. Providers reported increased comfort in identifying equipment needed for resternotomy (p < 0.01) and setting up the internal defibrillator paddles (p < 0.01). Implementation of a novel educational intervention increased provider comfort and decreased time to perform critical tasks in an emergent resternotomy scenario.