Care Outcomes Research Articles

Mortality and its predictors among patients with Guillain-Barré syndrome in the intensive care unit of a low-income country, Ethiopia: a multicenter retrospective cohort study.

Guillain-Barré syndrome (GBS) is a rare autoimmune disease that affects the peripheral nervous system. It is characterized by the destruction of nerves involved in movement. This condition can lead to transient pain, changes in temperature and touch sensations, muscle weakness, loss of sensation in the legs and/or arms, and difficulty swallowing or breathing. Published data on the outcomes of critical care for patients with GBS are extremely scarce in Africa, particularly Ethiopia. Therefore, this study aimed to assess mortality and its predictors among patients with GBS in the intensive care unit (ICU) of specialized hospitals in Ethiopia, a low-income country. This retrospective cohort study was conducted at the Tibebe Ghion Specialized Hospital and the Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar, Ethiopia, from 1 January 2019 to 30 December 2023. Data were collected in the medical record rooms. Cox regression analysis was performed to identify the predictors of mortality among GBS patients in the ICU. The crude and adjusted hazard ratios (AHRs) and 95% confidence intervals (CIs) were calculated using bivariable and multivariable Cox regression models. A p-value of <0.05 was considered statistically significant. Of 124 GBS patients admitted to the ICU, 120 were included in the final analysis. During the follow-up, there were 23 (19.17%) deaths. The overall incidence rate of death was 1.96 (95% CI: 1.30, 2.95) per 100 person-days of observation. Traditional medicine (AHR = 3.11, 95%: 1.12, 16.70), COVID-19 infection (AHR = 5.44, 95% CI: 1.45, 73.33), pre-ICU cardiac arrest (AHR = 6.44, 95% CI: 2.04, 84.50), and ICU readmission (AHR = 4.24, 95% CI: 1.03, 69.84) were identified as the independent predictors of mortality. The mortality rate among GBS patients admitted to the ICU was high. Traditional medicine, COVID-19 infection, pre-ICU cardiac arrest, and readmission to the ICU were the significant predictors of mortality. Conducting large-scale studies with a prospective design in the future would yield more robust evidence.

Intricate roles of estrogen and estrogen receptors in digestive system cancers: a systematic review.

Gender disparities are evident across different types of digestive system cancers, which are typically characterized by a lower incidence and mortality rate in females compared to males. This finding suggests a potential protective role of female steroid hormones, particularly estrogen, in the development of these cancers. Estrogen is a well-known sex hormone that not only regulates the reproductive system but also exerts diverse effects on non-reproductive organs mediated through interactions with estrogen receptors (ERs), including the classic (ERα and ERβ) and non-traditional ERs [G protein-coupled estrogen receptor (GPER)]. Recent advances have contributed to our comprehension of the mechanisms underlying ERs in digestive system cancers. In this comprehensive review we summarize the current understanding of the intricate roles played by estrogen and ERs in the major types of digestive system cancers, including hepatocellular, pancreatic, esophageal, gastric, and colorectal carcinoma. Furthermore, we discuss the potential molecular mechanisms underlying ERα, ERβ, and GPER effects, and propose perspectives on innovative therapies and preventive measures targeting the pathways regulated by estrogen and ERs. The roles of estrogen and ERs in digestive system cancers are complicated and depend on the cell type and tissue involved. Additionally, deciphering the intricate roles of estrogen, ERs, and the associated signaling pathways may guide the discovery of novel and tailored therapeutic and preventive strategies for digestive system cancers, eventually improving the care and clinical outcomes for the substantial number of individuals worldwide affected by these malignancies.

Enhancing Patient Counselling in Community Pharmacy Setting: Strategies, Challenges, and Best Practices Points : A Review

Patient counselling is their fore an interaction between care provider and patient during which the patient is provided with information about the health condition, medications etc. Patient counselling as a component of pharmaceutical care delivery can provide the launching pad for increased recognition of the role of pharmacist as care giver. Patient counselling is a vital component of community pharmacy practice, influencing medication adherence, health outcomes, and patient satisfaction. However, pharmacists face numerous challenges in providing effective counselling. This presentation aims to explore strategies, challenges, and best practices for enhancing patient counselling in community pharmacy settings, ultimately improving patient care and health outcomes. A comprehensive review of literature and expert opinions identified key strategies, challenges, and best practices for patient counselling. These include effective communication skills, patient- centered care, medication therapy management, technology integration, and inter-professional collaboration. Enhancing patient counselling in community pharmacy settings requires a multifaceted approach. By adopting effective strategies, addressing challenges, and implementing best practices, pharmacists can improve patient outcomes, satisfaction, and adherence to medication regimens.

Graphene: future prospects for biomedical engineering applications

Graphene is one of the allotropic forms of Carbon. It is typically presented as a thin, almost transparent, and very lightweight sheet, despite its remarkable mechanical strength. Recent studies have demonstrated that graphene has significant potential for application in the medical industry, not only due to its mechanical resistance and lightness, which suggest its use in prosthetics and bionic limbs, but also because of its excellent electrical conductivity, indicating its potential in medical measurement equipment. Moreover, graphene's biocompatibility and resistance to corrosion make it an ideal material for long-term medical implants. It has been explored in the development of biosensors, enabling real-time monitoring of biological signals such as heart rate and brain activity. For instance, graphene-based sensors could be implanted to detect subtle electrical changes in neurons, which might be particularly useful in neuroprosthetics or for individuals with spinal cord injuries. Graphene's flexibility also paves the way for the creation of flexible electronic devices that could be worn on the skin or integrated into clothing for continuous health monitoring. These innovations could revolutionize personalized medicine by offering more accurate, accessible, and non-invasive diagnostic tools. As research continues to advance, graphene holds the promise of transforming biomedical engineering with cutting-edge applications that could improve patient care and treatment outcomes.

Setting national nursing research priorities in Qatar: A Delphi survey.

To establish consensus on the priorities of nursing research in Qatar regarding nursing administration, nursing practice and nursing education for the years 2023-2033. Classic Delphi format over three phases. The first phase involved a qualitative round where participants identified 10 research priorities. In phase two, the collected sentences were analysed and grouped into themes. Participants were then requested to rate these sentences based on their perceived importance. During phase three, participants received their individual responses, the consolidated group response from the second round, and were given the opportunity to agree or disagree with the group ranking. The panel of experts consisted of 32 participants who agreed to participate in all three rounds. They included a mixture of nursing academics, clinical managers and nursing directors from public sectors and nursing schools in Qatar. The experts reached a consensus on the research priorities for Qatar. These prioritized topics focused on improving patient care outcomes, enhancing workforce development, strengthening nursing leadership, integrating technology to improve nursing and nursing education and promoting evidence-based practice. This research emphasizes the importance of progress in nursing to meet healthcare demands. Findings showed the need of future research to focus on improving nursing workforce and well-being, leadership styles and technology, and evidence-based practice and technology in nursing education. The impact of identifying nursing research priorities in Qatar will improve healthcare practices, fostering a culture of evidence-based care. These advancements will motivate nurses to engage more actively in research, thereby enhancing overall healthcare outcomes. Not applicable.

Validity of dietary intake methods in cancer cachexia.

Accurate assessment of dietary intake, especially energy and protein intake, is crucial for optimizing nutritional care and outcomes in patients with cancer. Validation of dietary assessment methods is necessary to ensure accuracy, but the validity of these methods in patients with cancer, and especially in those with cancer cachexia, is uncertain. Validating nutritional intake is complex because of the variety of dietary methods, lack of a gold standard method, and diverse validation measures. Here, we review the literature on validations of dietary intake methods in patients with cancer, including those with cachexia, and highlight the gap between current validation efforts and the need for accurate dietary assessment methods in this population. We analyzed eight studies involving 1479 patients with cancer to evaluate the accuracy and reliability of 24-hour recalls, food records, and food frequency questionnaires in estimating energy and protein intake. We discuss validation methods, including comparison with biomarkers, indirect calorimetry, and relative validation of dietary intake methods. Few have validated dietary intake methods against objective markers in patients with cancer. While food records and 24-hour recalls show potential accuracy for energy and protein intake, this may be compromised in hypermetabolic patients. Additionally, under- and overreporting of intake may be less frequent, and the reliability of urinary nitrogen as a protein intake marker in patients with cachexia needs further investigation. Accurate dietary assessment is important for enhancing nutritional care outcomes in cachexia trials, requiring validation at multiple time points throughout the cancer trajectory.

Assessment of drug therapy problems in pediatric patients using Cipolle/Morley/strand classification: A hospital based study

Drug plays an important role in treating diseases and improving health. However, inappropriate drug use can lead to the occurrence of drug-Therapy problems (DTPs). According to Cipolle/Morley/Strand classification DTPs are any undesirable event experienced by the patient that involves or is suspected to involve drug therapy and that actually or potentially interferes with a desired patient outcome. The purpose of this study was to assess the drug therapy problems in a pediatric ward of Srinivas institute of medical science and research centre and to identify associated factors for drug therapy problems. A retrospective observational study was carried out to assess drug therapy problems (DTPs) in paediatric patients using Cipolle/Morley/Strand classification from January to June 2024. Ethical approval was obtained, and informed consent was signed by each study participant's parent before the commencement of the study. All paediatric out patients and patients admitted to the paediatric ward during the study period were included in the study. Data were collected through medical record reviews of patients and using semi structured questionnaire. Data was analysed using Microsoft Excel. The participants mean age was 2.32 years. Among 150 patients, 116 (77.33%) of them had at least one drug therapy problem per patient which indicates that the prevalence of the drug therapy problem was substantially high. On the other hand, Adverse drug reaction was the least 4 (3.38%) drug therapy problem. Hence to ensure optimum care in paediatric patients, a targeted approach is essential. Thus, the present study concluded that pharmacists can be helpful in the identification of the drug therapy problems, their causes and the risk factors involved and thus lead to a better health care outcome.

Innovative and best models of palliative and end-of-life care - with focus on rural and remote communities.

The review aims to synthesize the most recent innovative models of palliative care being delivered in rural and remote locations. Worldwide, as the ageing population grows, more people will require palliative care. However, equal availability of high-quality palliative care services remains a significant challenge, particularly in rural and remote communities. Innovative models of palliative care have been developed to address the projected need of people in rural and remote areas. Models that leverage the use of digital healthcare (such as telecare and Artificial Intelligence), the non-specialized palliative care workforce (such as GPs, pharmacists, and family carers), and community driven approaches have demonstrated success in achieving positive palliative care outcomes, such as reduced physical and emotional distress, and family carers feeling more supported. There is a need to support people to remain within their rural and remote communities towards the end-of-life (EOL). While some models of care have been identified to help with this, there continues to be significant difficulties in access to health and social care in rural and remote areas. It is important we build on this research to understand more broadly the models of support for those living in remote and rural communities at the EOL.

Challenges in Beta Cell Replacement for Type 1 Diabetes.

Type 1 diabetes (T1D) presents a significant global health challenge, characterized by immune-mediated destruction of pancreatic beta-cells. Achieving therapeutic goals such as prevention of immune destruction, preservation of beta-cell mass, and automated insulin delivery remains complex due to the disease's heterogeneity. This review explores the advancements and challenges in beta-cell replacement therapies, including pancreas and islet cell transplantation, stem cell-derived β-cell generation, and biotechnological innovations. Pancreas transplantation, especially simultaneous pancreas and kidney transplantation (SPK), has evolved significantly, offering insulin independence and improved quality of life despite surgical and immunological complications. Allogeneic islet transplantation, though less invasive, faces challenges such as donor scarcity, immunosuppressive therapy, and variable long-term success. Innovations in stem cell therapy, particularly using human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs), promise an unlimited source of β-cells. However, translating these advances into clinical applications involves overcoming technical, biological, and ethical hurdles. Strategies such as immunomodulation, encapsulation, and genetic engineering are critical to enhancing the viability and integration of transplanted cells. This review provides a comprehensive overview of the scientific intricacies and potential of β-cell replacement therapies, emphasizing the need for continued research to address the remaining challenges and improve diabetes care outcomes.

Development, validation, and reliability testing of the standard treatment workflow checklist

Background: Standard Treatment Workflows (STWs) are systematically developed documents designed to enhance clinical care and patient outcomes. Validating these workflows is essential for their adoption across diverse clinical settings. This study aimed to develop and validate a checklist for evaluating STWs. Methods: The study was conducted in three phases. Initially, items were generated through a comprehensive literature review and expert consultations, followed by pre-testing (N=50). In the second phase, content validation (N=43) was performed using the Content Validity Index (CVI) and Content Validity Ratio (CVR) to assess the relevancy and essentiality of each item. Item-level (I-CVI) and scale-level (S-CVI) indexes were calculated. Items were accepted, modified, or rejected based on these scores. In the third phase, pilot testing (N=30) assessed the checklist's reliability and calculated Cronbach's alpha. Results: The final checklist comprised 33 close-ended and one open-ended items. Each item was deemed relevant and essential, with I-CVIs ranging from 0.96 to 1.00 and S-CVI/UA and S-CVI/Ave values of 0.83 and 0.99, respectively. CVR values ranged from 0.85 to 1.00, with an average CVR of 0.97. Reliability testing yielded Cronbach’s alpha values of 0.863 and 0.961 for the two parts of the checklist. Conclusions: The developed checklist is valid and reliable, with satisfactory CVI, CVR, and Cronbach’s alpha values. It can be used as a standard tool for assessing STW validation and effectively capturing essential aspects of STW evaluation.

Artificial intelligence governance framework for healthcare.

Recent advancements in the field of Artificial Intelligence (AI) provide promising applications of this technology with the aim of solving complex healthcare challenges. These include optimizing operational efficiencies, supporting clinical administrative functions, and improving care outcomes. Numerous AI models are validated in research settings but few make their way into useful applications due to challenges associated with implementation and adoption. In this article, we describe some of these challenges, along with the need for a facilitating entity to safely translate AI systems into practical use. The authors propose a new AI governance framework to enable healthcare organizations with a mechanism to implement and adopt AI systems.

Protocolizing social prescribing in mental health and addiction services: barriers and opportunities

Abstract Issue Social Prescribing (SP) is a structured approach where health professionals recommend community activities to enhance well-being. Starting in Catalonia in 2012, it expanded to the entire primary care network by 2016. By 2023, 23,338 patients received SP, showing a 2.3-fold increase from 2022. Two-thirds experienced improvement in mental well-being. Now, efforts focus on applying SP to mental health and addiction services (MHAS), where SP can be used for restoring health and well-being. Description A literature review was conducted and a working group was initiated with MHAS professionals was initiated to exchange experiences and identify needs and best practices. This was done in preparation for designing a pilot experience, which will include a qualitative study through focus groups to validate the action plan and determine barriers and facilitators in MHAS. The groups will be segmented into MHAS users and frontline professionals. Results The results of the review process and the working group sessions demonstrated that SP can be useful and beneficial for the health MHAS users. However, barriers and opportunities were identified. The main barriers detected include: the need for strong support during referrals to community activities; increased awareness of addiction among activity providers to reduce stigmatization; define inclusion and exclusion criteria; determining monitoring and evaluation tools; and mapping and updating community assets. Regarding opportunities, the following were highligthed: the interest of MHAS professionals in promoting and implementing a SP program in this area; the existence of organizations already conducting community activities focused MHAS users; and political prioritization of this issue. Lessons The implementation of a SP program protocol in MHAS is considered beneficial. It is necessary to analyse barriers to effectively address them and to identify opportunities to leverage them. Key messages • Social Prescribing has significantly enhanced mental health outcomes in Primary Care, which can imply a potential improvement in well-being of mental health and addiction services users. • Implementing Social Prescribing in mental health and addiction services offers promising integrated care opportunities, requiring barriers resolution and maximizing existing prospects.

Incident heart failure: comparing management and outcome in primary care and hospital settings in Western Sweden 2008-2017

Abstract Background Heart failure (HF) is a major problem in primary care (PC) and hospital care (HC). HF patients managed in these two settings may differ in their demography, comorbidities, treatment and outcomes. Aim We aimed to compare the patient management in PC and HC in the Västra Götaland Region (VGR) in Sweden. Methods The VEGA database is an administrative database includes all patients living in VGR. Patients with a first principal or contributory diagnosis of HF (I50) ≥18 years old between 2008 and 2017 were included. One-year mortality was used as the outcome. Results In total, 62,229 new-onset HF cases were included, with 18,722 identified only in PC and 16,651 in HC. HF patients in PC were older (80.7±10.9 vs 76.1±13.6), more women (57.1% vs 44.9%), with more hypertension, musculoskeletal and mental disorders, but less myocardial infarction. Guideline directed medical therapy was more frequently used in HC despite similar medication before HF diagnosis. Patients in HC had almost 4 times higher all-cause 1-year mortality [3.92 (3.77 - 4.08), p&amp;lt;0.0001] compared with PC after adjustment for age and sex. Over 10-year period, despite decreasing mortality in both settings, hazard ratios for HC vs. PC were significantly increased for all patients (p for interaction 0.0004), which was more marked in female and for 70-80 years old patients. Conclusion Over a 10-year period, not withstanding decreasing mortality in HF patients in both PC and HC settings, differences remain between these two HF populations not only demographic profile and medications but also outcomes.

Implementation of Medical Hospitalist Care at a Korean Tertiary Hospital: A Retrospective Cross-Sectional Study.

Background/Objectives: In March 2018, a tertiary teaching hospital launched a medical hospitalist team. This study presents the clinical characteristics and outcomes of medical hospitalist care and reveals the relationship between them. Methods: This study included 4003 patients first admitted to the hospitalist team via emergency room and then discharged from the hospitalist team between March 2018 and November 2022. The patients were admitted either to the teaching admitter hospitalist team or the hospitalist-led acute medical unit (AMU). Afterward, the patients were either discharged, if possible, within a few days or transferred to ward hospitalists if assigned wards for hospitalist care were available. Results: The patients' mean Charlson Comorbidity Index score was 3.5 and the mean National Early Warning Score was 3.4. Of the admissions, 44.2% of the patients were admitted to the AMU, and 26.8% received an early consultation with a subspecialist. Each hospitalist managed 12.8 patients per month on average. The patients' mean LOS was 14.52 days, 10.5% of patients died during hospitalization, and 13.0% of patients had unscheduled readmission within 1 month. The patients' mean total cost per hospital stay was 572,836 won per day. Admission to the AMU was associated with a lower total cost per hospital stay, but the relationships with mortality, readmission, and LOS were not significant. Conclusions: The study reports on the outcomes of implementing a medical hospitalist care system that combines short-term admission wards with integrated care models to manage complex cases. These findings provide insights into optimizing hospitalist systems for improved patient outcomes.

Supplemental Material for Neonatal Care and Developmental Outcomes Following Preterm Birth: A Systematic Review and Meta-Analysis

Supplemental Material for Neonatal Care and Developmental Outcomes Following Preterm Birth: A Systematic Review and Meta-Analysis

Underrepresentation of Black Men in Physician Assistant and Associate Training

The underrepresentation of Black men in the health care workforce, particularly among physician assistants and associates (PAs), represents a missed opportunity to alleviate shortages of health care professionals and enhance workforce diversity. Increasing the number of Black men in the training pipeline could significantly benefit education, patient care, and overall health outcomes. To analyze patterns from 2013 to 2021 among Black men applying to and matriculating into PA programs and compare these figures with the age-specific US population of Black men. This cohort study assessed deidentified application and matriculation data from the Central Application Service for Physician Assistants (CASPA) for PA training programs in the US, alongside US Census data. CASPA applicants reporting race and gender identities as Black male were included. Data were obtained March 10, 2023, from the 2012-2013 to the 2020-2021 application cycles; data were analyzed from June 2023 to May 2024. Black male applicants and matriculation. Patterns and proportion of Black male applicants and matriculants to PA programs relative to total rates and expected numbers. From 2013 to 2021, PA programs grew 64.3%, with an increase in applicants from 19 761 to 30 196 and matriculants from 6192 to 11 115. Despite this growth, the representation of Black men among applicants (from 435 to 732) and matriculants (from 73 to 156) remained stagnant, averaging 2.2% and 1.2%, respectively, significantly lower than their 8.7% (3 920 231 individuals aged 20-29 years) representation in the US Census. In 2021, the matriculation rate for Black men (156 of 732 [21.3%]) was notably lower than the matriculation rate for all applicants (11 115 of 30 196 [36.8%]). Based on the expected proportion of Black men in the PA applicant age range, there should have been 2641 applicants (actual: 732) and 972 matriculants (actual: 156) across 308 PA programs in 2021; these numbers indicate that, per program, approximately 9 applicants would have to have been evaluated and 3 matriculated to achieve parity, in contrast to the mean of 2 applicants and 1 matriculant per 2 programs. In this cohort study of PA applicants and matriculants, Black men remained substantially underrepresented despite overall growth of PA training programs. The low representation among matriculants was due in part to the low numbers of applicants but also to substantially lower matriculation success. This persistent underrepresentation highlights systemic barriers and underscores the need for targeted interventions to achieve a more representative health care workforce. To achieve equitable admissions, each PA program should aim to evaluate 9 Black male applicants and matriculate 3 Black men annually.

KardioNet Digital - a structured care model involving digital tools for intersectoral communication and a patient-focused strategy for treatment of heart failure

Abstract Introduction Inefficiencies and discontinuities in care at the interfaces within Germany's healthcare system, especially between acute and outpatient care, present significant challenges in managing patients with heart failure (HF). The management complexity of HF has increased with the advent of new digital tools, though patient acceptance of these tools remains contentious. The prevention of loss of diagnostic and therapeutic information for this complex disease is crucial for cross-sectoral communication (hospital - office-based cardiologist - general practitioner) and quality of care. Purpose Our goal was to examine the impact of digital app-supported coordination of HF management across different healthcare providers from hospital discharge to the ambulatory sector and to assess patients' acceptance of a structured care program. A patient-focused digital strategy, supported by a Heart Failure Nurse (HFN), aimed to facilitate structured follow-up and patient empowerment, focusing on patient-reported outcomes and experiences (refer to Table 1). Results Out of 401 patients screened during their hospital stay for HF, only 57 (14.9% male, 12.6% female) participated in the KardioNet Digital (KND) program. NYHA classifications were I (3.5%), II (49.1%), III (40.4%), and IV (7.1%); Diagnoses included CMP (26, 45.6%), CAD (19, 33.3%), valvular HF (8, 14.0%), and others (4, 7.0%). The mean age was 55.03 years, with a notable difference in participation based on age (≥70 years: 9.5% male, 33.3% female; &amp;lt;70 years: 90.5% male, 66.7% female). Age was a significant determinant of program participation. Patients who regularly used the app benefited from several features: A total of 35 alerts (17 patients) were triggered for reasons such as bodyweight increase (2kg or more) and device-induced alerts (i.e. false shock delivery, 3x slow-VT, Syncope), leading the HFN to contact the patients. This early intervention prevented rehospitalization due to decompensation of heart failure in 11 patients (64.7%) and addressed device-related alarms for organizing an emergency hospital visit by HFN. Despite substantial incentives, such as support from an HFN and expedited appointments with specialists for follow-up therapy, refusal rates were high (refer to Table 2). Conclusion A structured, digitally supported cross-sectoral care model for heart failure patients can potentially improve care coordination and outcomes. However, the success of such programs critically depends on patient willingness and the seamless integration into existing healthcare structures. Despite valuable incentives, we observed low acceptance of the program. Even among motivated participants (14.1%), there is a significant need for substantial support and education on digital literacy for the widespread implementation of digital tools in real-world settings for the treatment of heart failure.Workflow of structured digital supportReasons for Declining Participation

Adherence to the Atrial Fibrillation Better Care (ABC) pathway and outcomes in patients with chronic kidney disease: A report from the APHRS-AF registry

Abstract Background The Atrial Fibrillation Better Care (ABC) pathway is based on three pillars: "A" avoid stroke with oral anticoagulation, "B" better symptoms control, and "C" optimization of cardiovascular risk factors and lifestyles. This integrated approach has been associated with improved outcomes in atrial fibrillation (AF) patients, but few data are available in patients with chronic kidney disease (CKD). Purpose To investigate the correlation between chronic kidney disease, adherence to the ABC pathway, and the occurrence of adverse events in patients with AF enrolled in the Asian-Pacific Heart Rhythm Society-AF Registry. Methods Logistic regression was used to investigate factors associated with CKD, warfarin use and rhythm control strategies. Cox regression analysis adjusted for age≥75 years, paroxysmal AF, CHA2DS2VASc≥2, chronic obstructive pulmonary disease, cancer, and ABC adherence was used to calculate Hazard Ratios (HRs) and 95% Confidence Interval (CI) for the risk of primary outcomes in patients with CKD (eGFR &amp;lt;60 ml/min/1.73m2). Sensitivity analyses were performed in moderate (eGFR 59-30) and severe CKD (eGFR&amp;lt;30). Interaction analysis investigated the effect of ABC pathway based on presence or absence of CKD. Primary outcomes were the risks of all-cause death, major cardiovascular events (MACE: Cardiovascular death, acute coronary syndromes, thromboembolic events, and acute heart failure) and major bleeding. Results We included 2 578 AF patients without CKD (age 66.5±11.3 years, 32.5% females) and 1 047 AF patients with CKD (75.3±10.3 years, 40.8% females). Lower ABC pathway full adherence was observed in CKD patients (42.1% vs 29.5%, p&amp;lt;0.001), primarily due to low adherence to "A" and "C" criteria. Logistic regressions confirmed the lower likelihood of anticoagulation (Odds Ratio (OR) 0.61, 95%CI 0.44-0.83), a higher use of warfarin (OR 1.50, 95%CI 1.23-1.83) and lower use of rhythm control strategies (OR 0.79, 95%CI 0.66-0.94) in CKD patients. After one-year follow up, patients with CKD had a higher incidence of all-cause death (1.6% vs 7.2%, p&amp;lt;0.001) and MACE (3.4% vs 8.1%, p,0.001) compared to those without CKD. On Cox multivariable analysis (Figure 1, Panel A-D), CKD and ABC adherence were independently associated with the risk of all-cause death (HR 2.54, 95%CI 1.69-3.80 and HR 0.57, 95%CI 0.35-0.93, respectively) and MACE (HR 1.58, 95%CI 1.14-2.20 and HR 0.66, 95%CI 0.46-0.95, respectively). The risk of primary outcomes was the highest in those with severe CKD. No association was found with the risk of major bleeding. The interaction analysis confirmed that the beneficial effect of ABC pathway adherence on death (p int= 658) and MACE (p int= 0.568) was irrespective of CKD. Conclusion AF patients with CKD have low ABC pathway adherence and high risk of all-cause death and MACE. Efforts to improve the ABC pathway adherence in AF patients with CKD are needed to improve their long-term clinical outcomes.Figure 1.Cox regression analyses

Critical care admissions and outcomes in pregnant and postpartum women: a systematic review.

To synthesise evidence for the incidence of intensive care unit (ICU) admission, characteristics and mortality of pregnant and postpartum women with a focus on differences between high-income countries (HICs) and low-middle-income countries (LMICs) and report changes in reported findings since the last review by Pollock et al. (2010). We searched Ovid Medline, EMBASE, and CINAHL (2010-2023), following best practice guidelines for abstract screening for large-evidence systematic reviews. Patient and study characteristics of extracted studies were analysed descriptively. Multivariable meta-regression analysis, employing mixed-effects models, was conducted for assessing ICU admission and mortality. Studies reviewed by Pollock et al. were included to perform an overall analysis, including each study period and geographic region in a model. Seventy-one eligible studies reported data on 111,601 women admitted to ICU, with 41,291,168 deliveries reported in 65 studies. Fifty-six studies were retrospective. Case definitions, admission criteria, and causes of mortality reported were heterogeneous. The pooled ICU admission rate was 1.6% (95% confidence interval [CI] 1.28-1.99; I2 = 99.8%), 0.4% (95% CI 0.32-0.48, I2 = 99.9%) in HICs versus 2.8% (95% CI 0.65-6.4, I2 = 99.9%) in LMICs (p < 0.0001). The pooled ICU mortality rate among 140,780 admissions reported in 63 studies was 6.5% (95% CI 5.2-7.9; I2 = 98.7%), with mortality in HICs 1.4% (95% CI 0.8-2.1, I2 = 98.04%) lower than LMICs 12.4% (95% CI 8.1-17.5, I2 = 98.9%) (p < 0.0001). Multivariable meta-regression analysis found a significant association between the ICU admission rates (p = 0.0001) and mortality (p = 0.0003) with geographic region (HIC vs LMIC). Compared to the earlier study of Pollock et al. in 2010, there was an increase in reported studies (71 vs 40 in Pollock et al. study) and reported admissions (111,601 vs 7887 Pollock et al. study), particularly from LMICs'. Mortality for critically ill peripartum women is substantial and the gap in reported ICU admissions and mortality for critically ill peripartum women between HIC and LMICs remains unacceptably high. The reports are often small and heterogeneous using many case definitions. Reporting standards focusing on critical care processes and outcomes and large multinational prospective studies are necessary to better understand and mitigate maternal and child health challenges as sustainable development goals in LMICs and HICs.

Assesing health needs of women with breast cancer in a Regula Hospital Dispensary in Crete, Greece

Abstract Background Understanding the health needs of women with breast cancer is essential for tailor-made care. Socio-economic factors impact care access and outcomes. Previous research has indicated variations in healthcare experiences based on factors such as education level, employment status, and income. However, specific insights into the health needs of women with breast cancer in Crete, Greece, remain limited. Purpose The current study aimed at assessing the health needs of women with breast cancer. Methods A total of 161 women were surveyed between June 2023 and December 2023 in a regular Hospital Dispensary at a General Hospital in Heraklion, Greece. Results The majority were married (46%) and had an average of 2 children. 16% were graduates of secondary education and 42 % graduates of higher education, 33% retired and 19% full-time employees. Most participants (45%) reported a family income between 10,001 to 20,000 €, 29% under 10000 € and 26 % between 20001 to 30000 €. The majority had received additional medical treatment (75%), with surgery being the most common (30.6%). Other treatment included radiation therapy (28%), chemotherapy (23%), and hormone therapy (18%). Prevalence of comorbidities was high, with hypertension (97%), coronary heart disease (92%), cholesterol issues (43.5%), arrhythmias (82%), thyroid disease (81%), diabetes mellitus (79.5%), and bleeding disorders (43.5%) being reported. Smoking was also prevalent among participants (79.5%). Conclusions This study highlights the complex health needs of women with breast cancer in Crete region, Greece and emphasizes the prevalence of comorbidities and the importance of tailored support services and comprehensive care approaches for this population. Key messages • Considering socio-economic factors is critical in healthcare planning and intervention strategies. • Emphasizing the importance of tailored support services and comprehensive care approaches for this population.