Paired T-test Research Articles

Patient-caregiver dyad concordance of transition readiness assessment for adolescent with cancer: A network analysis.

The concordance of adolescents with cancer and caregivers was examined, and the core elements of transition readiness were identified. In this cross-sectional study, 196 adolescent-caregiver dyads completed the Chinese version of Self-Management and Transition to Adulthood with Rx = Treatment Questionnaire and its parent version between March 2023 and August 2023. Intraclass correlation coefficients, paired t-tests and network analysis were used for data analysis. Caregivers reported slightly lower scores for transition readiness than adolescents (3.28 vs. 3.32). Healthcare engagement and provider communication were core elements in transition readiness networks. At the dyad level, agreement between adolescents' and caregivers' transition readiness ranged from poor to fair (intraclass correlation coefficients 0.103-0.486), and a significant difference in structure was found between the two networks. Caregivers tended to underestimate adolescents' transition readiness. Attaining better concordance between adolescents and family caregivers is critical to aligning roles and responsibilities in the transition process. This study extends the evidence on the variation in adolescents' transition readiness, clarifying the complex associative relationships among the elements of transition readiness, which can be potential pathways for improving transition readiness. Second, this study is the first to assess transition readiness from a dyad's perspective. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness, suggesting that targeted dyadic interventions should be developed and implemented to improve patient-caregiver transition readiness concordance, facilitate effective communication and mutuality between patients and caregivers, and contribute to their collaboration during the transition of adolescents and optimization of outcomes. WHAT PROBLEM DID THE STUDY ADDRESS?: Increased long-term survival rates of survivors of paediatric cancer highlighted the significant need for care continuity. Transitional readiness is an important predictor of adolescent survivor's ability to adapt to a long-term survival period. Assessments of adolescents' transition readiness are limited and overlook the synergies between family caregivers and adolescents in the transition period. WHAT WERE THE MAIN FINDINGS?: The levels of agreement on rating transition readiness varied from poor to fair among adolescent-caregiver dyads, and caregivers tended to underestimate adolescents' transition readiness. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness. Targeted dyadic interventions should be developed and implemented to improve patient-caregiver's transition readiness concordance, and facilitate effective communication and mutuality between patients and caregivers. Study methods and results reported in adherence to the STROBE checklist. No patients or members of the public were involved in the study. The main findings introduce pathways for improving transition readiness, which can enhance healthcare transition among other medical populations.

Heart rate dynamics after pulmonary vein isolation: pulsed-field vs. radiofrequency ablation

Abstract Background The autonomic nervous system (ANS) plays a pivotal role in the onset and maintenance of atrial fibrillation (AF). During thermal ablation, the epicardial ganglionated plexi (GP) can inadvertently be affected, as indicated by a post-ablation increase in heart rate (HR), potentially impacting post-procedural outcomes. Pulsed-field ablation (PFA) offers a safer and potentially more effective alternative, as lesion transmurality is not inversely related to safety as in thermal ablation. However, PFA's tissue selectivity may limit its effectiveness in ablating potential AF triggers like GP. Purpose We aimed to assess the impact of PF and RF energy on GP ablation by examining HR changes following PVI procedures. Methods We examined consecutive paroxysmal AF patients undergoing PVI at a single center, using either a variable-loop circular PFA catheter, as part of the inspIRE trial, or a conventional point-by-point RF catheter (1:2 ratio). ECGs were collected before and after ablation at multiple time points, including 1-hour, 1-day, 1-month, and 3-month intervals, with a 24-hour Holter ECG at 3 months. Patients without obtainable sinus rhythm ECGs at these time points were excluded. We also gathered data on post-ablation antiarrhythmic drug and beta-blocker usage. Data are reported as mean±SD, and analysis employed Student’s t-tests, paired t-tests, chi-squared tests, and multiple linear regression analysis to identify influencing factors. Results A total of 105 patients were included (PF = 35, RF = 70). Baseline demographics were similar (Table A). In the RF group, HR significantly increased at all measured time-points. In contrast, this trend was not observed in the PF group (Figure A and B). Following the procedure, the RF cohort exhibited a significantly higher HR compared to PF (7.3±10.3 vs. 0.8±11 at 1-day, p=0.018), and this difference persisted after 3 months (8.5±10.1 vs. 0.9±9, p<0.001, Figure C). These findings remained consistent when HR was assessed using Holter ECG data (HR at 3 months: mean 72.1±8.8 vs 65.8±9.4, min 55.2 vs 48.9; p=0.002, p=0.001, Figure D). The use of RF energy was the only predictor of HR increase after the ablation procedure (β = 7.687, p < 0.001, Table B). Conclusion Our findings indicates that PFA does not increase resting HR as seen with thermal RF ablation, suggesting limited effect on ANS modulation. The role of adjunctive GP ablation during PVI procedures remains a topic of debate.While PFA shows promising improvement in lesion durability, current evidence does not conclusively establish its advantage over RF. This invites contemplation about whether the addition of GP ablation in RF procedures could be a contributing factor. The absence of HR acceleration may pose issues for patients with sick sinus syndrome or pure vagally mediated AF. Further research is essential to confirm these findings and their clinical implications.Central illustrationTables

Pengaruh Media Proses Pencernaan Berbantuan Augmented Reality Terhadap Hasil Belajar Siswa

Elementary school students are required to learn about the digestive system. Direct observation is challenging because the human digestive system is inside the body. The latest advance in technology that allows simultaneous 2D and 3D visualization is augmented reality. This investigating aims to discover how augmented reality-assisted media influences student learning outcomes, especially on material about the digestive system. This investigating uses an experimental design with quantitative methodology. A quasi-experimental investigating design was adopted. The investigating population was all fifth-grade students at SDN 6 Ngunut. The investigating sample was class V students. Multiple choice objective tests, as well as non-test instruments such as questionnaires, interviews, and documentation, were used in this investigating.The hypothesis test used a paired sample t-test, and the results showed that the count was 8.013, t-table dk = 30-1 = 29, and the significance level (????) = 0.05 was 1.660. Hypothesis test findings show that the t-hitung> t-table (8.013 > 1.660). The result is that H0 is rejected, and H1 is accepted. Thus, it can be said that using media related to the human digestive system, activated by augmented reality, significantly impacts student learning outcomes

Catheter ablation of atrial fibrillation shows pulmonary vein dependent effect on the signal-averaged P-wave morphology

Abstract Background and Aims Cryoballoon ablation of atrial fibrillation alters a significant amount of vital myocardium that contributes to its electrical activity. However, the impact of pulmonary vein isolation (PVI) on P-wave morphology is unclear. The aim of this investigation was to quantify whether the contribution of the left or right pulmonary veins (PVs) is greater using means of signal-averaged P-wave analysis. Methods Unfiltered high-resolution (2000 samples/second) ECGs were obtained for 5 minutes both pre- and post-isolation of the left and right PVs, with 12 standard and 10 additional leads (x01-x10). Additional lead positions were determined in prior studies for optimal detection of atrial electrical activity not captured by standard leads. Signal-averaged ECGs were computed and analyzed using bespoke software in Matlab. Statistical significance was assessed using a two-tailed paired t-test. A total of 69 participants were screened for the study. For the analysis, 64 participants with sinus rhythm in all ECG recordings were eligible. Results Significant postablation changes for various ECG parameters across different lead combinations were found (Table 1). On average, after ablation of the left pulmonary veins (LPVs), there was a reduction in P-wave terminal force (3.07±2.05 mV*ms vs. 2.84±1.88 mV*ms, p = 0.044), P-wave complexity (2.02±0.64 vs. 1.90±0.57, p = 0.047), and sample entropy (0.210±0.039 au vs. 0.197±0.031 au, p < 0.001), whereas P-wave duration (148.24 ms vs. 153.23 ms, p < 0.001) and PQ time (200.41 ms vs. 205.43 ms, p < 0.001) prolonged. However, after ablation of the right pulmonary veins (RPVs), sample entropy decreased (0.196±0.031 au vs. 0.190 ±0.027 au, p = 0.049) and amplitude increased (0.087±0.024 mV vs. 0.091±0.024 mV, p = 0.002). Conclusion PVI in atrial fibrillation has a significant effect on signal-averaged P-wave. These effects are more pronounced after ablation of the LPVs than the RPVs. Parameters such as PWTF, PWC and SaE demonstrate potential to assess the effect of catheter ablation and may serve as a potential indicator for a successful procedural outcome.

#2746 Long-term benefits in dRTA patients treated with Sibnayal®, a prolonged-release combination of potassium bicarbonate and citrate: 6-year results

Abstract Background and Aims Distal renal tubular acidosis (dRTA) is a rare disease, either inherited or acquired, characterized by an hyperchloremic metabolic acidosis leading to negative effects on growth, bone metabolism and kidney function, and hearing impairment. Sibnayal®, an oral twice-daily fixed and prolonged-release combination of potassium bicarbonate and potassium citrate3, is registered in the indication of dRTA, whatever the genetic or acquired form, in patients aged 1 year and older. Both efficacy and good tolerability profile of Sibnayal® versus alkali Standard of Care (SoC) were demonstrated in the short-term in children and adults dRTA patients (B21CS study1). B22CS study2 is the long-term follow-up study with safety profile as main objective and evaluation of the impact on the long-term complications as secondary or exploratory objectives. Method Thirty patients with genetic dRTA, previously enrolled in B21CS study, were followed-up for six years on average in a multicenter open-label extension trial (B22CS) to evaluate long-term impact of Sibnayal® on safety and efficacy on metabolic acidosis control, renal function, bone remodeling and growth. Tubular damages and kidney function were assessed by bicarbonatemia, kalemia, eGFR (CKiDU25 formula), nephrocalcinosis (paired-t-test) and urinary pH (UpH) (symmetry test). Bone remodeling was assessed with spine bone mineral density (BMD) Z-score (paired t-test, McNemar-test) from baseline to end of follow-up (EoF) and bone alkaline phosphatase (bALP) until M48. Growth was assessed by Z-score of height, weight, and body mass index (BMI) (paired t-test). Results Thirty patients (24 children, 6 adults), median age 10.6 (2-21) years, with inherited dRTA were included in B22CS study (mean study duration of 5.8 ± 1.3 years). Only 20% of patients reported at least one treatment related adverse event, mainly of gastro-intestinal type, which resolved without study treatment discontinuation. Bicarbonatemia was maintained stable in the normal range over the study duration (22.0 ± 3.2 mmol/L at baseline and 22.6 ± 2.5 mmol/L at EoF, p = NS). Kalemia was also maintained in the normal range (3.8 ± 0.5 mmol/L at baseline and 3.7 ± 0.4 mmol/L at EoF, p = NS). UpH was maintained between 7 and 8 in 70% of patients and when UpH was superior to 8 there was no impact on ACCP crystals presence (47% of patients at baseline versus 35.3% at EoF, p = NS). Nephrocalcinosis was reported in 89% of patients at baseline and in 93% at EoF (p = NS). Glomerular filtration rate remained stable all over the follow-up, eGFR was 105.2 ± 16.9 mL/min/1.73 m2 at baseline versus 103.9 ± 19.9 mL/min/1.73 m2 at EoF (p = NS). Bone metabolism was improved as spine BMD Z-score significantly increased from baseline (−1.1 ± 1.0) to EoF (−0.8 ± 0.9), p = 0.0053. In addition, 88% of patients had a spine BMD Z-score in the normal range (> -2SD) at EoF versus 71% of patients at baseline (p = NS). bALP Z-score was in normal range at baseline versus M48 (0.9 ± 2.22 at baseline vs 0.7 ± 1.3 at M48, p = NS). Growth was improved as Z-score for height significantly increased from baseline to EoF (p = 0.0323) while both Z-scores for weight and BMI were stable (p = NS). Conclusion These data confirm the long-term good tolerability profile and efficacy of Sibnayal® in the management of metabolic acidosis, in patients with dRTA. Sibnayal® showed a preventive effect on metabolic acidosis long-term complications in this population.

Functional impairment of chronic migraine with medication overuse: Secondary analysis from the Medication Overuse Treatment Strategy (MOTS) trial.

Chronic migraine exerts substantial negative impacts on daily functioning. Efforts to manage impaired functioning may result in medication overuse, which contributes to the worsening profile and chronification of migraine. The Migraine Functional Impact Questionnaire (MFIQ) is a recently developed measure assessing the impact of migraine on physical, social, and emotional function. The objective of this analysis was to assess changes in MFIQ scores following initiation or modification of migraine preventive medication and determine if changes in function are associated with changes in other aspects of migraine burden, such as headache frequency, headache intensity, and symptoms of anxiety and depression. This is a secondary analysis of data from the Medication Overuse Treatment Strategy (MOTS) trial, a prospective pragmatic clinical trial that investigated two treatment strategies for those with chronic migraine and medication overuse. Data from both treatment arms were pooled and analyzed using a pre-post design. Prior to and 12 weeks following initiation or modification of migraine preventive medication, participants completed a series of questionnaires that captured migraine characteristics, medication use, migraine-related physical impairment (MFIQ), anxiety (Generalized Anxiety Disorder-7), and depression (Patient Health Questionnaire 9 [PHQ-9]) symptoms. Changes from baseline in all measures were assessed using the paired t-test. Relationships between changes in MFIQ scores and other measures were assessed using linear regression. Multivariable modeling was performed to determine which additional variables contributed to the change in MFIQ beyond that already explained by an individual variable. Model terms were selected by using elastic net regularization. Only those participants who completed the baseline and 12-week MFIQ were included in this analysis. Of the 537 patients, 88.2% were female, and the average age was 45 years (standard deviation 13). The mean frequency of days with moderate-to-severe headache improved 39.2% from 13.5 per 30 days at baseline to 8.1 per 30 days at week 12. The mean MFIQ Usual Activities Global score improved by 15.0 points (on a 100-point scale). All five domains (Usual Activities Global, Usual Activities, Social Function, Emotional Function, Physical Function) of the MFIQ improved by a mean of at least 13.0 points. Changes in PHQ-9 score, followed by changes in headache frequency, had the strongest associations with change in all domains of the MFIQ. The negative impact of chronic migraine with medication overuse on physical, social, and emotional functioning substantially lessened following initiation or modification of migraine preventive medication. Improved functioning, as measured by the MFIQ, was most strongly associated with reductions in depression scores and headache frequency, highlighting the importance of recognizing and monitoring changes in depressive symptoms, in addition to headache frequency and functional impairment, when evaluating response to preventive medications.

The Impact of a One-Day Workshop on Good Psychiatric Management for Adolescent (GPM-A) Borderline PersonalityDisorder.

Despite evidence validating the diagnosis of borderline personality disorder (BPD) in youth, specifically showing persistence of BPD symptoms and morbidity similar to adults, there is reluctance to diagnose this in teens. Further, there is a belief among many trainees and academic child and adolescent psychiatrists (CAPs) that only specialty programs are effective, leading to treatment delays. This study charts the impact of a full-day workshop offered to an entire academic CAP department. A Good Psychiatric Management for Adolescent (GPM-A) Borderline Personality Disorder in-person workshop was offered to department members. Participants were asked to complete a pre-survey, an immediate post-training survey, and a survey at 6months post-training. Utilizing a Qualtrics questionnaire, both linear mixed-effect models and paired t-tests were used to estimate the immediate and sustained effects of the training. Thirty-two participants completed the workshop, with 31 answering the pre-survey, 27 the post-training survey, and 23 the 6-month follow-up survey. Immediately after the training and 6months later, participants demonstrated statistically significant (p < .05) improvements in willingness to disclose the diagnosis of BPD, a reduced negative attitude around BPD, and an enhanced sense of confidence in addressing the needs of adolescents with BPD. GPM-A training can make a positive impact on groups of clinicians who work with youth who meet criteria for BPD, specifically reducing stigma, encouraging trainees and faculty members to make the diagnosis more readily, and helping them feelmore competent inaddressing the treatment needs of adolescents with BPD.

#2408 Effect of low and very low protein diet with ketoanalogue on progression of CKD, quality of life and KAP in India: an interim analysis

Abstract Background and Aims Recent studies have established lack of advantages of Very Low Protein (VLP) with Ketoanalogues in CKD progression against to the KIDGO guidelines [1]. No systematic study is available in India to examine effect of Low protein (LP) and VLP with Ketoanalogue towards CKD prevention even though there were diverse in dietary habits. Further, effect of counseling on QoL, KAP and CKD outcomes have also not been examined. Present study intended to examine effect of dietary intervention on CKD progression, QoL, and KAP. Method This ongoing prospective randomized controlled trial was initiated since December 2022. A total of 198 patients of CKD 3 to 5 (ND) of age 18 to 60 years were completed one year. Enrolled subjects were screened from Nephrology OPD for CKD diagnosis and counselling was done for dietary intake. Their basic demographic profile socio- economic status, dietary habits, physical activity and biochemical details are being recorded through which e-GFR is calculated by CKD-EPI formula at baseline. All were randomised into 3 groups- Normal protein (0.8-1.0 gm/kg/day), low protein (0.6 gm/kg/day) and very low protein supplemented with Ketoanalogues (0.3 gm/kg/day) as a method of dietary intervention. Their dietary nutrient analysis (calories, protein, sodium, potassium, and phosphorus) was done by Diet Cal version 10.0 software using a 4-day dietary record. Dietary nutrients, nutritional status (BMI, BP, pallor, MUAC and handgrip) and all other parameters were measured at baseline, at 6th and 12th month. All patients underwent dietary intervention with home-based Personalised supervision (PS) diet. Dietary re-enforcement and counselling for clinical as well as diet-related patient concerns were done by exclusive renal dietician with weekly telephone calls. KAP and QoL were also recorded at baseline and after 6 months. The parameters were analysed by using the paired t-tests and one-way ANOVA to assess Effect of PS. Results A total 198 subjects were completed one year study. The detail demography has depicted in Table 1. Among them 79% were literate and 58.6%, 34.5%, and 6.8% were Non vegetarian, vegetarians and ovo-vegetarian respectively. Of total, there were CKD 3 (NP-30, LP- 28 and VLP-33), CKD 4 (LP-31 and VLP-32) and CKD 5 (LP-16 and VLP- 27) respectively. At baseline, all three stages have low protein intake (CKD3-36.0 g, CKD 4-34.1 g and CKD 5-31.6 g) against the standard (36.6-43.3 g) in 61 kg as mean weight. Further, in normal, low and very low groups there were 36.1 g, 35.5 g and 31.0 g protein intake respectively. Intake of sodium was high and potassium was low, which has been reversed after 1 year. (p = .000). Further, there were significant improvement in most of nutritional and biochemical parameters. However, total dietary intake and calories increased but couldn't reach to the recommendations in non-dialysis patients. (Table 1) As shown in Fig. 1, the e-GFR has increases in all groups, whereas in VLP group it has decreases non- significantly at one year. Physical component score (PCS) as QoL has improved from 2389.1 ± 415.2 to 3527.2 ± 657.5 (p = .000) whereas, Mental component score (MCS) has decreased. After counselling, all the components of KAP have been improved significantly. Conclusion Interim analysis showed that at sixth month there was slowing in progression of CKD manifested by increase in e-GFR among NP, LP and VLP with Ketoanalogue group, whereas at one year, there were non- significant reduction in VLP group. After dietary counselling, both KAP and PCS have been improved significantly.

COVID-19 and male fertility: short- and long-term impacts of asymptomatic vs. symptomatic infection on male reproductive potential

BackgroundStudies exploring the effect of COVID-19 on male reproductive system suggest a detrimental association, however with conflicting results. The aim of this study was to assess the association between COVID-19 infection and male reproductive potential including hormone profiles and semen parameters.MethodsThis prospective cohort study included 48 patients with confirmed COVID-19 infection. Patients were subdivided into an asymptomatic group (n = 30) and a group with COVID-19 symptoms (n = 18). Serum hormone levels including testosterone, LH, FSH and estradiol were collected during active infection (baseline, time 0), and at 3 and 6 months following COVID-19 infection. Semen samples (basic semen analysis and oxidation reduction potential) were examined at 3 and 6 months following infection. Student and paired-t tests were used to compare continuous variables between the study groups and across the studied time intervals, respectively. Multivariate binary logistic regression analysis was performed to explore predictors for COVID-19 symptoms during active infection.ResultsPatients with COVID-19 symptoms were significantly older (p = 0.02) and had significantly lower serum testosterone levels (p = 0.01) and significantly higher LH: testosterone ratio (p = 0.01) than asymptomatic patients. Multivariate analysis revealed older age (OR = 1.18, p = 0.03) and lower serum testosterone level (OR = 0.8, p = 0.03) as independent predictors of symptomatic COVID-19 infection. Significant increase in testosterone (p &amp;lt; 0.001 for both) and decrease in LH (p = 0.02, p = 0.007) and LH: testosterone (p = 0.02, p = 0.005) levels were observed at 3 and 6 months in patients with COVID-19 symptoms. Asymptomatic patients demonstrated significant increase in testosterone (p = 0.02) and decrease in LH: testosterone (p = 0.04) levels only at 3 months following COVID-19 infection. No significant differences were observed between the two study groups with regards to the semen analysis results obtained at 3 or 6 months following COVID-19 infection.ConclusionSignificantly lower testosterone values are associated with worse disease severity among men with COVID-19 infection. This association appears to be temporary as a significant increase in testosterone levels are witnessed as early as 3 months following recovery. No significant detrimental effect for COVID-19 infection on testicular sperm production is found in this patient population.

#1350 Finerenone in real-life clinical practice: first results from a pilot study

Abstract Background and Aims Finerenone is a new drug for the treatment of patients with albuminuric diabetic kidney disease (DKD) that has protective cardiorenal effects, with hyperkalemia being a possible side effect. Our pilot study aimed to obtain real-life clinical data in patients with DKD treated with finerenone. Method So far, we have included 16 patients receiving finerenone due to albuminuric DKD (urine albumin/creatinine ratio - UACR &amp;gt; 3 g/mol in two random urine samples taken at least one week apart) (Fig. 1). Nine patients (56.3%) were prescribed 20 mg. Seven patients (43.7%) received 10 mg daily. The dose was then adjusted at follow-up visits according to guidelines. Arterial stiffness measurements were performed non-invasively (Sphygmocor Atcor Medical®, Australia). A 28-zone lung ultrasound (LUS) was performed, and the sum of B-lines was recorded (VscanTM GE HealthCare Technologies Inc.®). Bioimpedance was measured with BCM®, Fresenius Medical Care. SPSS version 29 was used for statistical analysis. Results 10 patients (62.5%) were male. The most common comorbidities were arterial hypertension (n=15, 93.8%), hyperlipidemia (n=15, 93.8%) and ischemic heart disease (n=4, 25%). Baseline data are shown in Table 1. Paired samples T-test showed a slight increase in serum potassium after introducing finerenone, without clinically significant hyperkalemia or renal damage. UACR decreased, but the difference was insignificant (Table 2). Patients had no change in prescribed medications during this time, and no side effects of finerenone were noted. Conclusion Finerenone has the potential to lower UACR with little risk of hyperkalemia or acute kidney injury. The effects of the drug on lung extracellular water, body composition and arterial stiffness will be prospectively investigated in our research.

The impact of simulation-based training on medical students' whole blood transfusion abilities.

Whole blood transfusion has been found to increase the likelihood of patient survival within both military and civilian medicine contexts. However, no whole blood transfusion training curriculum currently exists within undergraduate or graduate medical education in the United States. The purpose of our study was to: (1) determine the impact of simulation-based training on medical students' abilities to conduct whole blood transfusions; and (2) determine the impact of simulation-based training on medical students' confidence in conducting whole blood transfusions. We assessed 157 third-year military medical students' ability to conduct whole blood transfusion before and after Operation Gunpowder, a 2-day high-fidelity prolonged casualty care simulation. We conducted a paired samples t-test to compare the students' pre- and post-simulation performance scores as well as self-reported confidence and stress ratings. There was a significant difference in students' scores at the beginning of the course (M = 20.469, SD 6.40675) compared to their scores at the end of the course (M = 30.361, SD = 2.10053); t(155) = -18.833, p < .001. The effect size for this analysis (d = 6.56) was large. There was a significant difference (p < .001) between the pre- and post-ratings for all self-reported confidence and stress survey items. Our results suggest that simulation-based training is an effective means of training medical students to conduct whole blood transfusiontraining in a limited resource simulated environment where blood inventories may be limited.

#1306 Online medical education advances physicians’ understanding of the clinical benefits of SGLT 2 inhibition in chronic kidney disease management

Abstract Background and Aims Patients with chronic kidney disease (CKD) have a substantially impaired cardio-renal health prognosis and a reduced life expectancy. Several recent cardio-renal outcomes trials have demonstrated the clinical benefits conveyed by Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors with respect to improved cardiovascular (CV) risk and reduced decline in kidney function. The goal of this online medical education activity was for learners to be better able to detect CKD early in clinical practice and integrate reno-protective therapies, such as SGLT2 inhibitors, into their management of suitable patients with CKD. Method Five nephrology experts participated in a 30-min online video program with synchronized slides and written transcript. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed knowledge/competence, 1 question rated on a Likert-type scale assessed confidence. A paired samples t-test was conducted on overall average number of correct responses and for confidence rating, a McNemar's test was conducted at the question level (5% significance level). Cohen's d with correction for paired samples estimated the effect size of the education on number of correct responses. Data collection from 28 December 2022 to 1 March 2023. Results Conclusion Participation of PCP in an online video expert program improved their understanding of the close association between metabolic, renal, and cardiovascular diseases, the latest results of CKD outcome trials with SGLT2 inhibition in CKD management, as well as their competence in the practical use of these reno-protective medications in suitable patients with CKD.

#1235 Comparative effect on bone remodeling and inflammation biomarkers of citrate dialysate and bicarbonate dialysate in HDF-OL patients

Abstract Background and Aims Hemodialysis (HD) treatment increases the inflammatory state of chronic kidney disease (CKD), which is associated with dysregulation of mineral bone metabolism. Reduced inflammation and increased bone formation have been described in Hemodiafiltration (HDF) compared with conventional HD. On the other hand, HD and OL-HDF using citrate-enriched dialysate are known to be safe and anti-inflammatory. However, the effects of post-dilution OL-HDF with citrate dialysate compared to bicarbonate dialysate on biomarkers of bone formation and resorption have not been studied. We aimed to compare the effect of bone remodeling markers and inflammation of different dialysates (citrate vs bicarbonate) in post dilution OL- HDF treatment. Method A total of 33 patients on conventional HD with bicarbonate citrate were included. At month 1, 18 patients, who did not require individualized adjustment of the dialysate composition such as potassium, were changed to HD with citrate dialysate and 15 patients remained with bicarbonate dialysate. By the second month, however, all patients were on OL-HDF with no change in buffer dialysate. Pre-dialysis blood samples were taken in both treatment groups at baseline (prior to the initiation of citrate dialysate in 18 patients), and at the first, second and fifth months after the introduction of citrate. Measurements of mineral homeostasis (calcium, phosphate, magnesium, parathyroid hormone, intact parathyroid hormone), inflammation (interleukin-6, β2-microglobulin, C-reactive protein) and bone remodeling markers (carboxy-terminal crosslinked telopeptide of type 1 collagen (CTX), as a biomarker of bone resorption and procollagen type 1 N-terminal pro-peptide (P1NP), as a biomarker of bone formation) were performed. All samples were collected before a mid-week dialysis session. Mineral homeostasis measurements were also performed before and after HD at the first and second month of the switch to citrate dialysate. Normally distributed data were presented as mean (standard deviation, SD) and median (interquartile range). Intra-subjects comparisons were analyzed using paired sample t-test or Wilcoxon signed-rank test. Comparisons between groups were analyzed using Mann-Whitney U test. Statistical analyses were performed using the SPSS (version 15.0, Chicago, IL, USA). p-value &amp;lt; 0.05. Results Overall, 75.7% (n = 25) of the subjects were male, the median age was 69 years (SD: 12) and 39.3% suffered diabetes (n = 13). Patients on citrate and bicarbonate dialysates were comparable for age, sex, comorbidities, months on dialysis and anemia control. Baseline mineral, bone remodeling and inflammation markers before HD, were also comparable in both groups. Only patients on bicarbonate dialysate had higher β2-microglobulin levels at baseline. Changes in serum levels of mineral, bone remodeling and inflammatory biomarkers at 5 months compared to baseline for both groups are shown in Table 1. After 5 months of follow-up, a 22% trend-reduction (p = 0.08) in P1NP as bone formation biomarker was observed in patients on citrate dialysate compared to those on bicarbonate dialysate. In addition, the fold change observed in CTX as parameter of bone resorption was attenuated in the citrate dialysate group (11% vs 116% in the bicarbonate dialysate group, p &amp;lt; 0.001). β2-microglobulin levels decreased significantly in both groups at 5 months but It is explained by the known effect of OL-HDF treatment on the inflammatory state of dialysis patients. Conclusion In patients on OL-HDF treatment the use of the citrate as dialysate may provide a benefit in bone remodeling by reducing bone resorption and trend to balance the bone formation/resorption. However, our results are in line with previous studies, where caution should be adopted in patients with very high parathyroid hormone levels, as this may be enhanced by reduced mineral turnover.

#1067 The impact of hemodialysis (HD) versus hemodiafiltration (HDF) on the effect of intradialytic exercise: a multicentre cohort study

Abstract Background and Aims Diminished physical function in HD patients is a critical issue, necessitating strategic approaches to enhance the efficacy of exercise therapy. The differential impacts of HD and HDF on solute clearance, albumin loss, uremic conditions, and malnutrition could influence the success of exercise interventions. Presently, empirical evidence for this is lacking. This investigation explores how HD and HDF modalities influence the efficacy of exercise therapy administered during dialysis sessions. Method This study encompassed intradialytic resistance exercises, involving 414 patients with end-stage renal disease across 10 centers. Participants were voluntarily enlisted in an exercise regimen during their dialysis sessions. The intradialytic regimen comprised stretching and four types of resistance exercises utilizing elastic tubes, conducted thrice weekly over six months. Parameters such as 10-meter walking speed, knee extensor muscle strength, serum albumin levels (Alb), normalized protein catabolic rate (nPCR), and Creatinine Generation Rate (%CGR) were assessed pre-and post-intervention. Statistical analysis included propensity score matching to adjust for baseline characteristics, segregating patients into HD and HDF cohorts. Changes in the aforementioned indicators before and after intervention (Δ) were calculated. Analytical methods included paired t-tests for within-group comparisons and independent t-tests for between-group comparisons of Δ values. A 5% risk threshold was established for statistical significance. Ethical clearance was obtained from the Seirei Christopher University Ethics Committee. Results A propensity score matching yielded 70 matched pairs. There were no significant differences in baseline subject characteristics after propensity score matching. Within-group analyses in the HD group revealed significant improvements in 10-meter walking speed (1.42 ± 0.41→1.60 ± 0.46 m/s, p = 0.000), knee extensor strength (44.3 ± 14.7→49.6 ± 13.8%, p = 0.000), and a reduction in Kt/V (1.69 ± 0.32→1.64 ± 0.32, p = 0.006) after six months. The HDF group significantly enhanced 10-meter walking speed (1.54 ± 0.40→1.72 ± 0.40, p = 0.000), knee extensor muscle strength (51.7 ± 17.1→57.4 ± 17.7%, p = 0.000), nPCR (0.88 ± 0.15→0.94 ± 0.18, p = 0.009), and %CGR (106.3 ± 23.2→112.9 ± 25.2, p = 0.002) (pre to post value, respectively). There are no significant differences in other variables between pre- and post-values in each group. Comparative analysis between groups demonstrated a significantly lower ΔAlb (HD 0.04 ± 0.24 HDF −0.05 ± 0.27, p = 0.045)and a higher 7, p =0(HD 1.47 ± 18.2 HDF 6.65 ± 17.2, p = 0.004)in the HDF group compared to the HD group. Conclusion The study demonstrated a notable HDF group improvement in %CGR, an indicator of muscle mass, despite a decrease in albumin levels. This suggests that albumin loss due to HDF minimally affects the augmentation of physical function. The findings suggest integrating exercise therapy with HDF may positively influence protein consumption and muscle mass enhancement.

Enhancing COVID-19 Knowledge among Nursing Students: A Quantitative Study of a Digital Serious Game Intervention

Background: This study aimed to evaluate the effectiveness of a digital serious game intervention about COVID-19 on pre-registration nursing student knowledge. Method: This study included 282 nursing students from a university in Northern Ireland, with 210 students providing comparable pre-test and post-test results. The ‘serious game’ aimed to debunk common COVID-19 myths and provide accurate information about the virus. Participants completed a 25-item questionnaire before and after engaging with the game, which included true/false items based on the World Health Organisation’s list of top COVID-19 myths. The data were analysed using paired t-tests to assess knowledge changes, and scores were calculated as percentages of correct answers. Results: A statistically significant improvement in COVID-19 knowledge was demonstrated among first-year nursing students who engaged with the serious game. The post-test scores (M = 92.68, SD = 13.59) were notably higher than the pre-test scores (M = 82.64, SD = 13.26), with a p-value less than 0.001. Conclusion: This research suggests that integrating serious games into undergraduate nursing education can effectively enhance COVID-19 knowledge. This approach is aligned with the evolving trend of employing technology and gamification in healthcare education.

Mediterranean Diet Combined with Regular Aerobic Exercise and Hemp Protein Supplementation Modulates Plasma Circulating Amino Acids and Improves the Health Status of Overweight Individuals

Plant protein is considered a sustainable health-promoting strategy to prevent metabolic syndrome. Lifestyle changes (including dietary patterns and exercise) have been demonstrated to exert an effect on human health by modulating the biochemical status in humans. The objective of this study was to assess whether supplementation with hemp protein within a Mediterranean diet context together with exercise could help to ameliorate the metabolic statuses of patients prone to developing metabolic syndrome. For this study, 23 patients followed with Mediterranean diet and engaged in aerobic exercise according to the WHO’s recommendations, while also being supplemented with hemp protein, for 12 weeks. A comparison of anthropometric, biochemical, and mineral data as well as amino acid values was made between the start and the end of the study, with the subjects acting as their own control group. Statistical analyses included a paired t-test, Wilcoxon paired test, Pearson correlation coefficient, and Sparse Partial Least Squares Discriminant Analysis to evaluate significant differences and correlations among parameters. There were statistically significant changes in total cholesterol, HDL-C (+52.3%), LDL-C (−54.0%), and TAG levels (−49.8%), but not in glucose plasma levels. Following the intervention, plasma concentrations of some amino acids, including α-aminoadipic acid, phosphoethanolamine, and 1-metylhistidine, increased, whereas those of asparagine and alanine declined. Different correlations between amino acids and the other parameters evaluated were reported and discussed. A Mediterranean diet combined with regular aerobic exercise, together with protein supplementation, can highly improve the metabolic parameters and anthropometric parameters of subjects with obesity and impaired glucose levels, ameliorating their health status and likely delaying the development of metabolic syndrome.

#1651 Urinary oxygen partial pressure: closely associated with hourly urine output induced by furosemide in patients with acute renal injury

Abstract Background and Aims Urine oxygen level, an indicator of kidney medullar oxygenation, is promising for predicting the onset of acute kidney injury (AKI). Furosemide, a commonly used diuretic in ICU, significantly increases urine output and is believed to change kidney medullar oxygenation. We monitored the longitudinal change of urinary oxygen partial pressure during bolus or pump administration of furosemide, aiming to describe the reaction pattern in an AKI-susceptible patient population. Method The prospective observational pilot study included seven adult patients in the ICU because of cardiac surgery or sepsis. We monitored the continuous urinary oxygen partial pressure for 8-24 hours through a device placed between the urinary catheter and collecting bag during furosemide administration, recorded hourly urine output simultaneously from a urine bag, and followed the patients in the hospital for the onset and development of AKI. Results We recruited three female patients and four male patients with an average age of 54 years and a medium of 5 days in ICU with an AKIN stage I of AKI during their hospital stay. None of them developed more severe stage AKI or required any kidney replacement therapy. We found a reverse correlation pattern between hourly urine output and urinary oxygen partial pressure. Specifically, the urine oxygen level dropped during urine volume increase caused by furosemide bolus administration and abolished by furosemide administration through a pump with more stable urine output. The paired t-test showed a significant increase in average urine oxygen level (mean difference = 21.2 mmHg, p = 0.044) recorded during the “high hourly urine output” period compared to the “low hourly urine period”. Conclusion We first found a drop in urinary oxygen partial pressure during the high urine output period elicited by bolus furosemide administration. It shed light on the confounding factors in AKI predicating during possible furosemide administration.

#811 Effect of GLP-1 receptor agonists on the weight, urea distribution volume and blood pressure of hemodialysis (HD) patients

Abstract Background and Aims Glucagon-like-peptide-1 receptor agonists (GLP-1) drugs are a class of medications commonly used to treat type-2 diabetes. Diabetes is prevalent in almost 60% of the end stage kidney disease (ESKD) patients and an increasing number of dialysis patients use GLP-1 drugs. It is important to note that GLP-1 drugs may have additional benefits such as weight loss and potential cardiovascular benefits. However, little is known about the effects of these drugs in dialysis patients. We analysed the changes in body weight and blood pressure in hemodialysis (HD) patients who start using these drugs. We also analysed whether there are changes in patients’ urea distribution volume, a proxy of lean body mass, to understand whether these medications affect muscle mass. Method We retrospectively evaluated 236 ESKD patients who were prescribed GLP-1 drugs as part of routine clinical care in October of 2023 at clinics in a large dialysis organization. All patients received dialysis for at least 60 days before and after they started using the medication. We looked at the changes in the average post dialysis weight, urea distribution volume, and pre dialysis systolic blood pressure (pre-SBP) between the 60 days before using GLP-1 drugs (pre-GLP1 period) and 60 days after initiating the drug (post-GLP1 phase). For each metric, we performed a paired t-test to evaluate the changes between pre-GLP1 and post-GLP1. Results The average post dialysis weight pre-GLP1 was 103.98 kg and the average post dialysis weight post-GLP1 was 102.02 kg (difference: −1.96 kg, 95% CI :1.37 to 4.27, p-value &amp;lt;0.001). The average urea distribution volume was 36.0 L pre-GLP1, and 35.6 L post-GLP1 (difference: −0.47 L, 95% CI: −0.99 to 3.56, p-value=0.07). The mean pre-SBP was 147.83 mmHg pre-GLP1 and 149.67 mmHg post-GLP1 (difference: 1.85 mmHg, 95% CI: −5.49 to 24.93, p=0.29). Conclusion Our analysis showed a significant decrease in the average post dialysis weight of HD patients using GLP-1 drugs. While the decline in patients' urea distribution volume, which can be considered as a proxy for lean tissue mass, was not statistically significant, it may be clinically meaningful. We do not see a significant change in pre-SBP. Reductions in weight may suggest reduction in fat and muscle mass but can also be due to “regression to the mean” phenomena as patients who were on these medications tended to be larger. Further studies are necessary to evaluate this association.

#1149 Long-COVID in hemodialysis patients: a matched case-control prospective study

Abstract Background and Aims Long-COVID is defined as persistent symptoms after COVID-19 infection. It has been reported that up to 40% of COVID-19 survivors experience long-COVID (O'Mahoney et al. The Lancet, 2023). We aim to determine if hemodialysis (HD) patients experience long-COVID. Method HD patients diagnosed with COVID-19 via RT-PCR test were enrolled from January to April 2022 from 4 clinics in New York City. COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) was administered at baseline (i.e., as soon as possible after diagnosis), and 1 and 6 months after baseline. C19-YRS measures symptoms such as dyspnea, fatigue, decreased cognition, etc. before and after COVID-19 infection. Pre-COVID symptom severity at baseline was used as the comparator when determining differences between pre- and post-COVID periods. Controls were also enrolled as symptoms resembling long-COVID symptoms are prevalent in HD patients who did not have COVID-19 (e.g., fatigue, lowered quality of life, cognitive impairment). Controls were matched to case patients by age (&amp;lt;50 years, 50-70 years, &amp;gt;70 years), vintage (&amp;lt;1 year, 1-5 years, &amp;gt;5 years), sex, and race. In control patients, a modified C19-YRS that excluded questions specifically around COVID-19 infection was administered at the time of enrollment, and 1 and 6 months thereafter. Symptom severity is graded from 0-10 (10 being the worst) and global health score is reported with 10 being the best. Patient demographic and clinical data were obtained from medical records. Paired t-tests tests were used to examine differences in symptom severity pre- and post-COVID-19 infection in case patients. Unpaired t-tests or Chi-squared tests were used to examine differences at each time point in cases and controls. Linear and generalized mixed models were used to examine the effect of time on continuous and discrete long-COVID symptom severity, respectively. Results We studied 30 patients, 15 cases and 15 controls. There were no significant differences between the two groups in age, vintage, sex, race, ethnicity, diabetes, or hypertension (Table 1a). Baseline C19-YRS was administered 43 ± 24 days (range 9-108) after COVID-19 diagnosis. Five patients were hospitalized because of COVID-19 infection. C19-YRS results are shown in Table 1b. Compared to the pre-COVID period, case patients experienced significantly increased dyspnea at baseline; anxiety, depression, and dyspnea at 1 month; fatigue and dyspnea at 6 months. Further, fatigue and ability to perform personal care worsened in case patients from baseline to 6 months. Compared to the cases, controls had significantly higher global health scores at 1 month and a lower prevalence of dyspnea at rest and fatigue at 6 months. Conclusion Following COVID-19 infection, patients report worsening long-COVID symptoms compared to (a) the pre-COVID period and (b) matched controls, specifically fatigue, dyspnea at rest, and decreased perceived health. Further studies are warranted to investigate the long-term consequences of long-COVID in HD patients.

Integration of DigiLeaP (Digital Learning Packet) Offline Application as a Learning Resource and Its Effect to Students’ Engagement

Many applications are being discovered that can help or ruin students' education. Many students engage in different types of applications that enable them to improve their school performance. The main goal of this study is to determine the effectiveness and impact of DigiLeaP Offline Application to the academic engagement of students in Noveleta Senior High School. Eighty-one (81) learners from Noveleta Senior High School in Grade 11 served as the study's respondents and were chosen using total population sampling. This study utilized the one-group pretest-posttest quasi-experimental design. This study revealed that the integration of DigiLeap application has a significant impact on students’ learning engagement. Their engagement level prior to the implementation is in the good category but after the implementation, it raised to a higher level of engagement – affective, behavioral, and cognitive dimensions. The positive gained differences which indicated improved results were supported by the results of the Paired T-Test that yielded a significant difference between the pre-test and post-test scores of the students. Nonetheless, using DigiLeap can help children develop critical thinking, problem-solving, and information processing skills.