Nine-point Scale Research Articles

Development of a core outcome set for clinical trials targeting interventions aiming to improve adherence to appropriate polypharmacy in older people-an international consensus study.

Medication non-adherence is prevalent in older people taking polypharmacy. Several interventions have been employed to improve adherence in this population. However, inconsistencies in outcomes have impeded comparisons of findings. Accordingly, this work aimed to develop a core outcome set (COS) for use in trials aiming to improve adherence to appropriate polypharmacy in older people. A group of stakeholders, including academics, journal editors, healthcare professionals (HCPs) and public participants, evaluated 13 outcomes compiled from the literature in a Delphi study using a nine-point Likert scale ranging from 1 to 9, where higher scores (7-9) indicated critical importance and lower scores (1-3) unimportance. The resultant Delphi consensus list was discussed and voted on (yes: critical and no: unimportant) in two online nominal group technique (NGT) meetings. The NGT followed a five-stage approach: introduction, silent generation, round-robin, clarification and voting. An outcome was included if ≥80% of participants scored it critical and ≤ 15% scored it as unimportant. Of the 13 outcomes originally presented to participants, consensus was achieved to include six outcomes in the COS after the Delphi study (Round 1, n = 57; Round 2, n = 53; Round 3, n = 50, where 'n' represents participant numbers) and the NGT meetings (n = 10) comprising medication adherence across multiple medications, treatment burden, health-related quality of life (HRQoL), healthcare utilisation (HCU), adverse events and side effects (AEs and SEs) and cost-effectiveness. This COS should be used in intervention studies focusing on improving adherence to appropriate polypharmacy in older people. Future work should identify outcome measurement instruments to be used alongside the COS.

Development of Melon Wine Products and Repeated-Batch Fermentation

This study aimed to develop melon wine through fermentation technology in order to increase the value of melon. Two varieties of melon, Momo (orange pulp) and Kimoji (green pulp), were used for wine production. The effect of dilution of extracted melon juice by water at 1:0, 1:1 and 1:2 ratio and fermentation duration at 2, 3, 5 and 7 days were studied. It was found that green-pulp melon juice could be processed into wine product faster than orange-pulp melon juice. The optimal conditions were dilution ratio of extracted melon juice with water at 1:2 and fermented with commercial yeast Saccharomyces cerevisiae for 2 days. The melon wine received an average liking score of 7 on a nine-point scale indicating acceptable sensory quality. This study also attempted to increase wine fermentation efficiency and reduce the cost of inoculum preparation by performing repeated-batch fermentation. The repeated-batch fermentation using the culture broth as the inoculum for the following batch could be performed up to 4 cycles with high fermentation efficiency. This method not only reduces the inoculum preparation cost but also shorten the fermentation time. To improve the taste, the green melon wine was formulated by adding concentrated melon juice at wine to juice ratio of 2:1. The formulated green melon wine showed better taste and received higher average liking score of 7.3.

Emotional Responses to Music Are Diminished in Bilateral Cochlear Implant Users

Introduction: Emotional response to music, though a central facet of music listening, remains poorly understood. In this study, we investigate the emotional responses to music among bilateral cochlear implantees. Methods: Bilateral CI users and normal-hearing (NH) controls were recruited from a tertiary academic center and community hearing loss groups. Participants listened (via an online survey) to ten previously validated 15-s musical clips representing multiple genres and wide range of valence (happiness vs. sadness) and arousal (excitement vs. calm) and rated the musical clips on validated nine-point visual analog scales of valence and arousal. Results: In total, 25 bilateral CI users and 18 NH controls completed the study. Compared to NH controls, CI users demonstrated significantly increased error in valence identification (mean [SD] 1.75 [0.61] vs. 1.16 [0.29], p < 0.001) but equivalent arousal error. There were significant differences for 8 of 20 total ratings between NH and CI groups. Additionally, CI users demonstrated a significantly constricted range of arousal (4.69 [1.39] vs. 6.04 [1.33], p = 0.0025) but a preserved range of valence (4.99 [1.57] vs. 5.62 [1.13], p = 0.13). Implantees reported significantly lower music enjoyment (5.78 [3.57] vs. 8.57 [1.17], p = 0.0016) than NH controls, and enjoyment was significantly associated with both valence and arousal range. Conclusions: Bilateral CI users’ emotional response to music is significantly constricted compared to NH controls. Blunted appreciation of emotional content likely contributes to reduced music enjoyment among cochlear implantees and is a critical target for improvement.

Increased prevalence of myopia in Swedish conscripts between 1975 and 1995 - associations with education and verbal ability.

The objective of this study is to examine the trends in the prevalence of myopia in Swedish young men over a 30-year period and identify potential risk factors for myopia development. This retrospective, cross-sectional study analysed testing results from three cohorts of Swedish military conscripts: 1975, 1985 and 1995. Myopia was defined as a spherical equivalent (SE) of ≤ -0.5 D and high myopia as SE ≤ -5 D. Myopia prevalence was analysed in combination with physical measures (height, weight and BMI), social measures (theoretical upper secondary school) and cognitive measures (4 different abilities). The results from the cognitive tests used a STANdard NINE scale (stanine or S9), a method of scaling test scores on a nine-point standard scale, with a mean of five and a standard deviation of two. The study included a total of 13 075 males aged 17 to 19 years. Adequate data on physical measures and vision were available for 95%-98% of participants. The proportion of individuals with myopia increased significantly from 22% to 29% between 1975 and 1995 (p < 0.001). High myopia increased from 1.9% to 3.3% (p < 0.001). Multivariate logistic regression indicated associations between myopia and year of testing (OR = 1.15), presence of theoretical upper secondary school (OR 1.71, compared to the absence of theoretical upper secondary school), verbal ability (OR 1.08 per stanine) and visuospatial perception (OR 1.05 per stanine). Over the 30-year period from 1975 to 1995, the prevalence of myopia among Swedish conscripts increased from 22% to 29%. A higher level of education and higher verbal and visuospatial ability were risk factors for myopia.

Identifying Key Performance Indicators for Health Management of Population, Family, and Schools in the Deputy of Health at Ahvaz Jundishapur University of Medical Sciences

Background: Reproductive, maternal, neonatal, and child health hold significant potential to enhance the health and quality of life for the current and future generations, thus they are considered the centerpiece of the Sustainable Development Goals (SDGs). Identifying Key Performance Indicators (KPIs) and utilizing them in monitoring health programs is crucial for resource management, service quality enhancement, and satisfaction. This study aimed to identify the KPIs for the health management of the population, family, and schools in the Deputy of Health at Ahvaz Jundishapur University of Medical Sciences. Methods: This study is an observational research utilizing the Delphi technique. The research population included 50 managers and staff from the health deputy and health networks. Participants were selected using purposive sampling. Initially, a review of literature and organizational documents was conducted to examine all programs related to the management of population, family, and school health, and indicators for each program were extracted separately. Subsequently, over three stages, the opinions and assessments of these individuals were collected and analyzed to reach a consensus on the KPIs. Two Likert scale questionnaires—a three-point scale (inappropriate, no opinion, appropriate) and a nine-point scale—were used to identify and confirm the KPIs. Data analysis was performed using frequency, percentage, and median. Results: In five health management programs targeting the population, family, and schools, 107 indicators were included the study. The highest number of indicators (over 35 %) in the first Delphi round pertained to maternal health programs. After completing the first round of Delphi, 76 indicators were identified as appropriate by 60 % or more of the participants and entered the second round of Delphi. All 8 indicators for the adolescent, youth, and school health programs advanced to the next round. However, 53.8 % of the indicators related to population and reproductive policies were selected for the subsequent round. Moreover, 8.4 % of the second round indicators (9 indicators) were reviewed in the third round for further experts’ comments, resulting in the approval of 4 key indicators related to the middle-aged and elderly health program as key indicators in this round. Conclusion: From the total indicators of population health, family, and school health management, 44 indicators were identified and confirmed as KPIs. The middle-aged and elderly health program had the most number of key indicators with 11 indicators, and the adolescent, youth, and school health programs had the fewest number with 6 indicators. Other programs key indicators were equal (9 key indicators for each program). The analysis and evaluation of these indicators by health managers and experts can facilitate effective planning and interventions to improve public health.

Appropriate Use Criteria for Osteoporotic Compression Fractures.

Appropriate Use Criteria for Osteoporotic Compression Fractures.

Emotional Responses to Various Digital Puppet Designs in Children’s Environmental Storytelling Sessions

ABSTRACT This quasi-experimental study explored how different digital puppet character designs affect the emotional experiences of 5- to 6-year-olds during environmental storytelling sessions. The research focused on two emotional dimensions: pleasure and arousal. Thirty kindergarten students participated, interacting with five distinct digital puppet designs over five consecutive days. Each 10-minute session featured a unique story with a consistent environmental theme to maintain engagement. Children’s emotional responses were measured using the Self-Assessment Manikin (SAM) questionnaire, which rates pleasure and arousal on a nine-point scale. Data were analyzed using ANOVA tests. Results showed positive mean scores for both pleasure and arousal across all puppet designs. No significant differences were found in emotional responses across designs, except for Wayang Kulit, which elicited significantly higher pleasure levels. These findings suggest that children respond positively to a variety of digital puppet designs when properly tailored to their preferences, highlighting the effectiveness of digital puppetry in environmental storytelling. This study emphasizes the potential of diverse digital puppet characters to engage young learners emotionally in educational content, particularly on environmental issues.

Identifying Research Priorities for Cognition in CKD: A Delphi Study.

Cognition is a research priority for people living with chronic kidney disease (CKD), but identification of critical research questions is lacking. This study aimed to determine which cognition-related research questions are most important to CKD stakeholders. A modified Delphi technique with 3 survey rounds was used. The study sample included 3 panels (People with lived CKD experience, Researchers, and Clinicians) recruited through international patient and kidney research networks, kidney societies, and snowball sampling with email invitations. Survey rounds were distributed electronically through REDCap. In Round 1 (October 2021-May 2022), respondents contributed three important research questions regarding cognition in CKD (free text). After deduplication and qualitative synthesis, respondents ranked the importance of these questions on a nine-point Likert scale in Round 2 (Feb-April 2023). Questions with mean and median ratings of >7 by at least two respondent panels or rated critically important by the 'lived experience' panel were re-ranked in Round 3 ( Aug-Sept 2023) and assessed for consensus to identify the final list of priority research questions. Respondents (n=152) identified 125 and 44 discrete questions after Rounds 1 and 2, respectively. The final shortlist included 27 questions in 8 categories. The most critical research question identified was "What factors prevent cognitive impairment in people receiving dialysis?" Overall, respondents prioritized questions focusing on prevention and treatment of cognitive impairment. Scores between the panels were significantly different for 16 questions. Those with lived CKD experience prioritized quality of life, researchers emphasized developing interventions to mitigate cognitive impairment, and clinicians prioritized the effect of CKD treatment on cognitive impairment. Through an established consensus methodology involving key stakeholder groups, we identified 27 critical research questions about cognition in CKD. These questions should guide future study design and outcome selection.

Spontaneous motor tempo modulates the effect of music tempo on arousal levels

Music tempo affects listeners’ mental state, especially arousal levels. However, several studies have demonstrated that the effect of music tempo on arousal while listening to music can be modulated by individual differences, such as the pace of mental activity, that is, spontaneous motor tempo (SMT). Thus, SMT is a candidate factor that affects the relationship between music tempo and arousal. Here, we conducted a psychological experiment to investigate how SMT modulates the effect of music tempo on listeners’ arousal levels. First, the participants were required to tap their finger at their preferred tempo to identify the SMT of each participant. Next, the participants listened to music and then rated their arousal levels on a nine-point scale. A linear mixed model analysis revealed a significant effect of the interaction between music tempo and preferred tapping tempo on arousal levels. This finding indicates that SMT modulated the effect of music tempo on arousal levels while listening to music; the faster the SMT of a listener, the greater the impact of music tempo on arousal levels.

Poorer objective but not subjective driving performance in drivers vulnerable to sleep loss effects during extended wake.

Sleepiness-related errors are a leading cause of driving accidents, requiring drivers to effectively monitor sleepiness levels. However, there are inter-individual differences in driving performance after sleep loss, with some showing poor driving performance while others show minimal impairment. This research explored if there are differences in self-reported sleepiness and driving performance in healthy drivers who exhibited vulnerability or resistance to objective driving impairment following extended wakefulness. Thirty-two adults (female = 18, mean age = 33.0 ± 14.6 years) completed five × 60-min simulated drives across 29-hr of extended wakefulness. Subjective sleepiness (Karolinska Sleepiness Scale) and subjective driving performance ratings (nine-point Likert scale) were assessed at 10-min intervals while driving. Cluster analysis using simulator steering deviation and crash data categorised participants as vulnerable (n = 16) or resistant (n = 16) to driving impairments following extended wakefulness. No differences in self-ratings between the vulnerable and resistant groups were observed except during the last drive (25 hr awake), where the vulnerable group reported higher sleepiness (p = 0.008) and worse driving performance (p = 0.001) than the resistant group. For each 1-point increase on the Karolinska Sleepiness Scale and subjective driving scales, the vulnerable group showed about threefold greater steering impairment relative to resistant drivers. Although self-reported sleepiness and driving performance were correlated with objective driving performance, vulnerable drivers reported similar sleepiness and driving performance as resistant drivers. Thus, self-reported sleepiness and driving performance are not reliably sensitive to sleep loss effects on objective driving performance, which may impact the vulnerable driver's decisions to continue driving and delay engagement in countermeasures to reduce crash risk (e.g. napping), warranting further research.

Types of perception of work-life balance among MZ generation nurses: A Q methodology approach

Background &amp; Aims: Research on the types of work-life balance perceptions among MZ generation nurses is essential for improving collaboration and communication within organizations. The study aimed to identify the types of role perceptions regarding work-life balance (WLB) among MZ generation nurses. Materials &amp; Methods: The Q methodology was applied, selecting 36 Q samples from a population of 190, which were extracted from literature and in-depth clinical interviews with preceptors, new nurses, and nursing managers. The P sample consisted of 40 MZ generation nurses who had experience as preceptors regarding work-life balance. The Q samples were classified into a quasi-normal distribution frame and measured on a nine-point scale. Data were analyzed using the PQ Method program. Results: Q factor analysis of the subjective perceptions of MZ generation nurses regarding WLB revealed four types: 'Organizational-Culture-Oriented,' 'Personal-Goal-Oriented,' 'Organizational-Culture-Dissatisfied,' and 'Emotional -Stability-Oriented.' These four types explained 54.1% of the total variance. Conclusion: The findings suggest that MZ generation nurses prioritize mental satisfaction and quality of life over economic compensation. Therefore, organizations can improve job satisfaction and organizational commitment among nurses by providing multidimensional support that reflects their diverse needs.

Types of caregiving perceptions of family caregivers of elderly nursing home residents during the COVID-19 pandemic in Korea

BackgroundThis exploratory study applied Q methodology to identify the types of family caregivers of older adults in nursing homes during the COVID-19 pandemic based on their perceptions of the caregiving role and explore each type’s characteristics.MethodsQ statements were derived from in-depth interviews and a review of prior research. Q sorting was conducted using 39 P samples on a nine-point scale to determine Q distributions according to the degree of subjective agreeableness for each statement. In-depth interviews were conducted to determine why the subjects rated statements on either extreme.ResultsFour types of family caregivers were identified as a result of an analysis using the PC QUANAL program: caregiving-positive type (type I), caregiving-ambivalent type (type II), nursing home dependent type (type III), and caregiving conflict burnout type (type IV).ConclusionThe study results can help develop interventions and strategies based on perceptions of caregiving and their associated characteristics to provide psychological support to family members of older adult care home residents during the COVID-19 pandemic. Accordingly, the following measures are recommended: continuous follow-up research on specific measures facilitating communication between nursing home staff and family caregivers in the event of a pandemic; development of tools for measuring burnout risk among family caregivers and practical interventions for those at high risk; efforts to improve the image of older adult care homes and change the conventional perceptions of caregiving.

THE MODEL OF CHOOSING A CRM SYSTEM IN THE MANAGEMENT OF BUSINESS ROCESSES OF SMALL BUSINESSES

The article presents a model for choosing a CRM system for small and medium-sized enterprises (SMEs), which allows for effective business processes of interaction with clients. The authors came to the conclusion that in modern conditions, digitalization of SME activities is becoming one of the pressing issues.Active digitalization of business accelerates the process of transition of the economy to digital. The digital economy is based on information and communication technologies (ICT). Information technologies in the modern economy are used for the purpose of fast, high-quality and effective computer processing of information resources, their transmission over any distance in the shortest possible time. The authors argue that government support for business digitalization cannot and should not be the only stimulating factor for SMEs. In addition to external conditions, there are also internal motivating factors - these are the capabilities of the business environment. The authors of the article substantiate the idea that CRM systems allow optimizing the process of financial and economic interaction between a company and a buyer. Using the hierarchy analysis method, the key parameters for choosing a CRM system were determined. The final indicator of the CRM system selection allows choosing the optimal CRM system for the enterprise from alternative ones. The indicator is calculated based on the second-level indicators: the functionality of the CRM system, the program interface, the tariff scale.Each of these indicators is disclosed through the indicators of the 3rd level. The weights of the indicators of all levels were determined by experts through a pairwise comparison of the elements of each level on a nine-point scale. The criteria and their weight values proposed by the authors will allow SME sector entities to choose the optimal program depending on the requests and capabilities of the enterprise.

OD44 Consolidated Health Economic Evaluation Reporting Standards For Interventions That Use Artificial Intelligence (CHEERS-AI)

IntroductionProgress and innovation in artificial intelligence (AI)-based healthcare interventions continue to develop rapidly. However, there are limitations in the published health economic evaluations (HEEs) of AI interventions, including limited reporting on characteristics and development of algorithms. We developed an extension to the existing Consolidated Health Economic Evaluation Reporting Standards (CHEERS) to improve consistency, transparency, and reliability of the reporting of HEEs of AI interventions.MethodsThe Delphi method was used, following a prespecified study protocol. A steering group with expert oversight was formed to guide the development process. A long list of potential items was defined based on two recent systematic reviews of HEEs of AI-based interventions. The steering group identified and invited 119 experts to the three-stage survey. Participants were asked to score each item on a nine-point Likert scale, and they were also able to provide free-text comments. The final checklist was piloted on a random sample of nine HEEs of AI-based interventions.ResultsThree stages of the Delphi survey were completed by 58, 42, and 31 multidisciplinary respondents, respectively, including HTA specialists, health economists, AI experts, and patient representatives. The CHEERS-AI extension includes 18 AI-specific reporting items. Ten are entirely new items, including considerations about user autonomy, validation of the AI component, and AI-specific uncertainty. In addition, elaborations on eight existing CHEERS items were added to emphasize important AI-specific nuances. Some participants highlighted that CHEERS-AI can provide key benefits; for example, it could clarify the misconception that the predictive algorithms supporting AI-driven healthcare interventions are available for use without cost.ConclusionsCHEERS-AI can aid in improved reporting quality for researchers, editors, and reviewers conducting or assessing HEEs of AI interventions.

Development and Validation of Quality Indicators for Pulmonary Arterial Hypertension Management in Japan: A Modified Delphi Consensus Study.

Quality indicators (QIs) are used to standardize care and improve outcomes in patients with pulmonary arterial hypertension (PAH). It is important that QIs are validated within specific healthcare contexts. Therefore, this study aimed to validate QIs for PAH management in Japan using a modified Delphi consensus method. QI candidates were identified from published European QIs and clinical practice guidelines. An expert panel of 11 PAH specialists from diverse Japanese institutions anonymously rated the 36 initial QI candidates in two rounds using a nine-point appropriateness scale. In the first round, 35 QIs received a median score of ≥7 points. A panel discussion was held between rounds to address the single low-scored QI, biomarker modifications, and invasive examinations, resulting in 36 modified QIs. In the second round, all modified QIs received median scores of ≥7 points and were judged to be valid as the final Japanese set of QIs. The findings of this study validated a set of QIs for PAH management tailored to the Japanese healthcare context. These QIs can be used to standardize care, identify areas for improvement, and ultimately enhance outcomes for Japanese patients with PAH.

Optimization of Gelatin Gummy Properties Influenced by Black Garlic Vinegar and Honey Using D-Optimal Mixture Design

Black garlic is a valuable and versatile food product derived from the fermentation of fresh garlic. Black garlic possesses stronger antibacterial properties and contains antioxidants at levels twice as high as those found in regular garlic. The fermentation of black garlic into vinegar enhances its beneficial properties, including antimicrobial and antidiabetic effects. Currently, the market prospects for functional gummy candies are highly promising. This study aimed to optimize the formulation of functional gelatin gummy incorporating black garlic vinegar, gelatin and honey using a D-optimal mixture design. Product analysis included physicochemical, textural, and sensory properties of the gummies, evaluation of consumer acceptance and purchase intention. The optimal formulation for black garlic vinegar with honey gummies involved 10% black garlic vinegar, 17.06% gelatin, and 27.94% honey. Three experiments were conducted under practical conditions, yielding an average pH of 3.51 ± 0.02, hardness of 18.21 × 10³ g force, and gumminess of 16.44 × 10³ g force. The sensory descriptive analysis provided the following ratings: appearance (7.30 ± 0.84), black garlic vinegar aroma (6.10 ± 1.39), honey aroma (6.54 ± 1.27), honey taste (7.24 ± 1.13), overall taste (7.18 ± 1.04), aftertaste (7.24 ± 1.19), and overall liking (7.26 ± 0.94). The final product received hedonic scores ranging from 6 to 7 for all attributes on a nine-point scale (n=70). Notably, 98% of consumers found the product acceptable, and 78% expressed an intention to purchase it. This indicates the successful development of a gelatin gummy product that effectively incorporates black garlic vinegar while maintaining a pleasant taste, making it appealing to a wide consumer base.

Proximate Analysis of Multi-grain Pizza Base

The ill effects of junk foods are widely known, as it is acknowledged that their regular consumption may cause irreparable damage to the body. The role of millet-rich foods in offering protection against diabetes and heart disease is well established, which has led to an interest in increasing nutrients in developed pizza bases. The present research has been conducted to develop a nutritionally rich "millet-based pizza base "using whole wheat flour, Kodo millet, buckwheat flour, and brown rice flour. The developed pizza base is noted to have advantages over a normal base made from refined wheat flour. Sensory evaluation by a panel of 25 members using a nine-point scale showed that T3 was the most preferred among the samples, suggesting its potential as a standardized pizza base. Nutrient analysis revealed protein content ranging from 7.13% to 9.5%, fat from 1.59% to 1.75%, fiber from 0.798% to 0.913%, moisture from 36.12% to 37.08%, and ash from 0.91% to 0.98%. Overall, the study concluded that these value-added pizza bases offer superior nutritional benefits compared to conventional options.

The Evaluation of Mini-Clinical Evaluation Exercise (Mini-CEX) for Assessing Neurology Cases Among Postgraduate Medicine Students.

Background Traditional assessments in postgraduate medical training tend to emphasize cognitive skills while often neglecting the psychomotor and affective domains. The mini-clinical evaluation exercise (mini-CEX) addresses these limitations by evaluating clinical, communication, and humanistic skills with immediate feedback. This study aimed to evaluate the acceptability and feasibility of the mini-CEX in assessing neurology cases among postgraduate internal medicine students at a medical college in North India. Methods Between March and July 2024, 10 postgraduate medicine students and 14 faculty members participated in the study. Each student completed at least four mini-CEX sessions, during which performance across seven core skills was rated using a nine-point scale. Immediate feedback was provided by faculty following each session. Both student and faculty feedback were collected to assess the acceptability and feasibility of the mini-CEX. Descriptive statistics were used to evaluate these factors, while paired t-tests were applied to measure improvements in student performance. Results A total of 63 mini-CEX sessions were conducted, with an average observation time of 18.77 minutes and an average feedback time of 10.08 minutes. Significant improvements in clinical skills were observed among second-year (P = 0.04) and third-year(P = 0.01) residents, with second-year residents also showing gains in humanistic skills (P = 0.03). Student feedback was largely positive, with nine out of 10 (90%) participants expressing satisfaction and eight out of 10 (80%) recommending the continued use of the tool. Faculty feedback indicated that 10 of 14 (71.4%) supported its continued useand eight of 14 (57%) found it better than traditional assessment methods. Conclusions The mini-CEX is a feasible and acceptable formative assessment tool for neurology cases, effectively enhancing clinical and communication skills. Despite concerns regarding subjectivity, the mini-CEX shows promise for wider implementation in postgraduate, and potentially undergraduate, medical training.

Frailty and associated outcomes in patients with transthyretin cardiac amyloidosis

Abstract Introduction Despite older age at diagnosis, the prevalence and clinical impact of frailty, an age-related geriatric syndrome, in patients with transthyretin cardiac amyloidosis (ATTR-CA) is poorly described. Purpose To determine: (1) the prevalence of frailty in ATTR amyloidosis patients; (2) the clinical frailty phenotype in ATTR amyloidosis (3) the independent and incremental prognostic value of frailty. Methods All consecutive patients diagnosed with ATTR-CA who underwent frailty assessment at two high-volume tertiary care centres from September 2019 to April 2023 were included in the study. Functional assessment was performed with the Rockwood Clinical Frailty Scale (CFS), an established frailty screening tool that stratifies patients on a nine-point scale ranging from 1 (very well) to 9 (terminally ill) providing a useful measure of physiological reserve. Frailty was defined as CFS &amp;gt;4. Functional status was further categorized as follows: 'non-frail' (CFS 1-3), ‘mild’ frailty (CFS 4-5), and 'moderate-to-severe' frailty (CFS 6-9). Logistic regression analysis was used to identify factors associated with CFS 6-9. Cox regression analysis was used to determine the independent and incremental prognostic value of frailty. Results The study comprised 880 patients with ATTR-CA (719 [81.7%] with wt-ATTR-CA, 85 [9.7%] with p.(V142I) hATTR-CA and 76 [8.6%] with a non-p.(V142I) hATTR-CA. Overall, 43.0% (N=378) were considered ‘non-frail’ (CFS 1-3). Prevalence of ‘mild’ frailty (CFS 4-5) was 41.4% (N=364), while prevalence of 'moderate-to-severe' frailty (CFS 6-9) was 15.7% (N=138). Frail patients were older, more symptomatic and with advanced disease stage as assessed with the National Amyloidosis Centre (NAC) staging system. At logistic regression analysis, age, female gender, non-p.(V142I) variants and NAC stage were associated with 'moderate-to-severe' frailty. Over a median 22 months, 16.8% died, with mortality rising with higher CFS levels. At Cox multivariable analysis, CFS was strongly associated with mortality (CFS 4-5 vs 1-3: Hazard Ratio [HR] 2.821, 95% C.I. 1.724-4.613; CFS 6-9 vs 1-3: HR 6.179, 95% C.I. 3.694-10.335, overall p-value&amp;lt;0.001), along with NAC stage and age. The addition of CFS to the NAC staging system significantly improved the goodness-of-fit of the model (X2: 73.26, p&amp;lt;0.00001), and significantly improved the discriminatory ability of the NAC alone (Figure, Harrell’s C statistics: 0.78, 95% C.I. [0.72-0.83] vs 0.69, 95% C.I. [0.64-0.75], p&amp;lt;0.0001). CONCLUSION Frailty is highly prevalent in patients with ATTR-CA, with up to 57% of patients living with some degree of frailty. Older age, female gender, non-p.(V142I) hATTR-CA variants and advanced disease stage were independently associated with moderate to severe frailty. Frailty was independently associated with all-cause mortality after adjusting for known predictors and increased the global predictivity of the NAC Score.Survival by Frailty Status and NAC

International expert guidance for defining and monitoring small bowel strictures in Crohn's disease on intestinal ultrasound: a consensus statement

International expert guidance for defining and monitoring small bowel strictures in Crohn's disease on intestinal ultrasound: a consensus statement