Care For Treatment Of Patients Research Articles

Characteristics of Quality Improvement Projects in Health Services: A Systematic Scoping Review.

Current QI reports within the literature frequently fail to provide enough information regarding interventions, and a significant number of publications do not mention the utilization of a guiding model or framework. The objective of this scoping review was to synthesize the characteristics of hospital-based QI interventions and assess their alignment with recommended quality goals. This scoping review followed the JBI methodology for scoping reviews to synthesize existing literature on hospital-based QI interventions and reporting using the PRISMA Extension for scoping reviews. Included studies involved a hospital-based QI intervention that was evaluated through the Development of the Quality Improvement Minimum Quality Criteria Set (QI-MQCS) framework, reporting on hospital users' (i.e., practitioners and patients) data. We searched Medline, CINAHL, Embase and PubMed databases for primary research published between 2015 and 2024. Grey literature was also examined. A narrative synthesis guided the integration of findings. From 1398 identified records, 70 relevant records were included. Results indicate a wide variation in QI frameworks and methods used by the included studies. The QI interventions most frequently assessed were organizational-focused (n = 59), followed by professional-related interventions (n = 41) and patient-care interventions (n = 24). There were multiple facilitators and barriers across organizational, professional, and patient care levels found in the included studies. Examples of facilitators were instrumental in driving successful QI initiatives included education, training, active leadership, and stakeholder engagement. Conversely, barriers such as time constraints, resource limitations, and resistance were highlighted. Existing QI publications lack sufficient detail to replicate interventions. Using a model or framework to guide the conduct of a QI-activity may support a more robustly designed and well-conducted project. The variation of reporting characteristics suggests that future research should focus on the development of a pragmatic tool for use by front-line clinicians to support consistent and rigorous conduct of QI projects.

Spiritual Care Interventions for Adult Patients in Intensive Care Units: A Scoping Review Protocol.

Caring for patients in intensive care units (ICUs) requires healthcare workers to recognize the importance of a spiritual care approach in these settings. Moving toward a holistic and patient-centered care model that incorporates spiritual care is essential for enhancing patients' healing process. The disease-centered approach of ICU and the perceived deficit of spiritual care highlight the need to add knowledge on integrating spiritual care interventions into daily ICU practices. The aim of this scoping review will be to develop a comprehensive overview of the characteristics of spiritual care interventions for adult patients in ICU according to JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The inclusion criteria will be informed by the types of participants, concept and context, and types of evidence sources. Quantitative, qualitative and mixed methods studies, editorials, opinion papers and gray literature will be included. Databases such as PubMed (National Library of Medicine), CINAHL, Academic Search Complete, Psychology and Behavioral Sciences Collection, APA PsycINFO, Cochrane Central Register of Controlled Trials (via EBSCOhost), Scopus and Web of Science Core Collection will be searched. No date limit will be set. Titles and abstracts that meet the inclusion criteria, full texts of eligible studies and reference lists of all selected sources will be screened by 2 independent reviewers. Data will be extracted using customized tools, presented in diagrammatic or tabular format and summarized in a final narrative synthesis report. This research represents the first effort to develop a comprehensive overview of the characteristics of spiritual care interventions exclusively targeting adult patients in ICU settings. The findings will offer a thorough review of these interventions, including their main attributes, providers, resources, associated outcomes and assessment tools. Consequently, this knowledge can enhance the spiritual dimension of patient-centered care in the ICU, thereby promoting a shift from the traditional biomedical model to a more holistic perspective and establishing a new standard in critical care.

Effectiveness of oral health care intervention for stroke patients following the introduction of Oral Health Assessment Tool.

This study aimed to evaluate the effectiveness of oral health assessment tools in facilitating oral health care interventions by dental care providers for acute stroke patients within 48 h of admission, following a reform of the nursing system. Data were gathered from a retrospective cohort study conducted at a stroke center, comparing 10 months before and after the implementation of the reformed system, with a 2-month interval. Parameters assessed included stroke type, severity measured using the National Institutes of Health Stroke Scale, stroke history, stroke-related factors, number of teeth, hospitalization cost and duration, occurrence of fever and pneumonia, stroke treatment, days from admission to dental intervention, and intervention frequency. Implementation of the new system significantly reduced the time before dental intervention (P < 0.001), increased the frequency of interventions (P < 0.001), and allowed for the management of more severe cases (P = 0.007). However, there was a slight increase in the occurrence of fevers and the days of fever (P = 0.039 and P = 0.015, respectively). Multiple regression analysis showed that fever days were positively correlated with stroke severity and the number of days from admission to dental intervention (P < 0.001 and P = 0.013, respectively). Even after propensity score matching adjusting for stroke severity, these associations persisted. Additional multiple regression analysis was performed after this, but fever days were positively correlated with stroke severity and sex (P < 0.001 and P = 0.008, respectively), as well as with the presence of other factors affecting the occurrence of fever. Although the frequency and duration of fevers increased slightly, this approach, incorporating oral health assessment tools, made it possible to provide early dental intervention, particularly for patients with severe strokes. Geriatr Gerontol Int 2024; ••: ••-••.

Perioperative real-life experiences and care needs of patients undergoing lung cancer ablation: A qualitative study

Objective To gain an in-depth understanding of the perioperative real experiences and care needs of patients undergoing lung cancer ablation, to make a reliable basis for the construction of care programs for perioperative complications of lung cancer ablation, and to further improve the quality of perioperative clinical care interventions for such patients. Methods Sixteen lung cancer patients undergoing lung cancer ablation who were hospitalized in the Department of Oncology of our hospital from April 2023 to October 2023 as well as six healthcare professionals of Shanghai Pulmonary Hospital were recruited by purposive sampling. Semi-structured interviews were conducted with the enrolled individuals by using a phenomenological approach, and the Colaizzi's 7-step analysis method was used to analyze, summarize and refine the themes of the interview data. Results A total of seven study themes were identified emotional reactions of ablation patients, financial stress, needs for information on treatment outcomes and health education during recovery, reassurance of living and care needs during hospitalization, concerns about the treatment of complications, correct and detailed preoperative assessment, and doctor-nurse collaboration for good management of patient complications. Conclusion In the clinical nursing of patients with lung cancer, we should construct standardized perioperative ablation nursing process as soon as possible, create diversified health guidance materials, strengthen the continuity of nursing after discharge, improve patients’ understanding of the disease, pay attention to their emotional changes, and provide more maintenance support, so as to reduce complications and improve the quality of life of patients with lung cancer ablation.

The future of medicine: an informed look into the "crystal ball"

This article explores potential future scenarios for the medical field based on current trends, technological advancements, and social dynamics. By examining advances in artificial intelligence, immersive technologies, genomics, and digital health infrastructure, the paper envisions a healthcare system poised for transformative change. The anticipated role of AI as a digital assistant in diagnostics, resource management, and personalized medicine is highlighted, alongside the implications for clinical workflows. Immersive technologies, such as VR and AR, promise enhancements in medical education, patient care, and therapeutic interventions. Advances in genomics and gene editing technologies such as CRISPR further open possibilities for personalized treatment regimens and potential cures for genetic diseases. However, these innovations introduce new ethical challenges around privacy, data security, and clinical accountability. The article also addresses the healthcare implications of climate change, aging populations, and global conflicts, urging preparedness and resilience within healthcare systems. Taken together, it emphasizes the need for a balanced approach to innovation, integrating ethical considerations to foster a future where medicine remains empathetic and human-centered, even as it becomes more data-driven and technologically complex.

Classification of Pneumonia, Tuberculosis and Covid-19 from Chest X-Ray Images Using Convolution Neural Network Model

Accurate and timely diagnosis of respiratory ailments like pneumonia, tuberculosis (TB), and COVID-19 is pivotal for effective patient care and public health interventions. Deep learning algorithms have emerged as potent tools in medical image classification, offering promise for automated diagnosis and screening. This study presents a deep learning-based approach for categorizing chest X-ray images into three classes: pneumonia, tuberculosis, and COVID-19. Utilizing convolutional neural networks (CNNs) as the primary architecture, owing to their ability to automatically extract relevant features from raw image data. The proposed model is trained on a sizable dataset of chest X-ray images annotated with ground truth labels for pneumonia, TB, and COVID-19. Extensive experiments are conducted to evaluate the model&amp;#39;s performance in terms of classification accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC-ROC). Furthermore, we compare the performance of our deep learning model with traditional machine learning approaches and assess its generalization ability on an independent test set. Our findings demonstrate that the proposed deep learning model achieves high accuracy in classifying chest X-ray images of pneumonia, TB, and COVID-19, outperforming traditional methods and showing potential for clinical deployment as a screening tool, especially in resource-limited settings.

The Necessity of Palliative Care Interventions in Emergency Departments: A Literature Review.

Palliative care, a beacon of relief and comfort, ensures the best quality of life for patients nearing death, a patient population that often presents to emergency departments, by providing interventions to promote comfort and support final wishes. The purpose of this literature review was to examine the outcomes of palliative care interventions for adult patients with chronic illnesses who have died in emergency departments. The literature review was conducted in CINAHL, PubMed, SCOPUS, OVID, and APA Psych using the keywords "palliative," "emergency department," "adult," and "chronic disease." The search was limited to English language publications with no date limits and performed according to Preferred Reporting Items for Systematic reviews and Meta-Analysis statement standards. The search yielded 531 articles, with 226 duplicates excluded. After a review, only 16 articles met the inclusion criteria. Common interventions included implementing screening tools, enhancing communication skills, providing end-of-life care education, and health record alerts for palliative care criteria. This review highlights how critical palliative care interventions are needed in emergency departments. The inevitability of seriously ill patients presenting to emergency departments underscores the urgency and importance of palliative care interventions, leading to increased comfort and decreasing distressing symptoms experienced by dying patients.

Knowledge, Attitude and Practice of Artificial Intelligence Among Healthcare Professionals at a Tertiary Care Teaching Hospital in South Gujarat.

Background Artificial intelligence (AI) is rapidly evolving within healthcare, promising improvements in patient care, diagnostic accuracy, and therapeutic interventions. As AI technology becomes more integrated into clinical workflows, understanding healthcare professionals' (HCPs) knowledge, attitudes, and practices concerning AI is crucial, particularly in diverse healthcare environments like South Gujarat. This study evaluates HCPs' understanding, perception, and application of AI at a tertiary care teaching hospital in this region. Methods This observational, cross-sectional study utilized a non-validated, structured questionnaire based on the Knowledge, Attitude, and Practice (KAP) framework. A convenient sampling technique was employed to recruit 290 HCPs, including consultant doctors, medical faculty, residents, and interns. Data were collected electronically via Google Forms and analyzed using descriptive statistics. Results Most participants (176; 60.7%) were junior residents, with notable representation from departments like Pharmacology and Community Medicine. Regarding AI knowledge, 80 (27.6%) of participants reported full awareness, while 182 (62.8%) were partially aware. AI subtype knowledge varied, with 84 (28.9%) identifying "Self-awareness" and 50 (17.2%) "Limited Memory." Internet sources were the predominant information source for 171 (58.9%) of participants. Notably, 192 (66.2%) recognized AI's role in saving time and enhancing accuracy, although some expressed concerns about its lack of empathy and ethical implications. Conclusions The findings highlight substantial awareness but varying depths of understanding of AI among HCPs, who are interested in further AI education. Increased educational programs on AI's ethical and practical aspects may enhance AI integration into clinical practice, aiding responsible adoption in healthcare settings.

Safety and Effectiveness of a 4-Week Diet on Low-Carb Ready-to-Eat Ketogenic Products as Preoperative Care Treatment in Patients Scheduled for Metabolic and Bariatric Surgery.

Before metabolic and bariatric surgery (MBS), moderate weight loss and liver left lateral section (LLLS) volume reduction are desirable. Low-carb ketogenic diet-induced weight loss before MBS has been shown to have beneficial effects on the reduction in body weight (BW) and LLLS. However, the nutritional protocol of low-carb ketogenic diet may be hard to keep for prolonged periods due to the lack of sweet taste. Furthermore, transitioning to a low-carb ketogenic diet can cause people to crave foods that are restricted in the ketogenic diet, such as cookies, bread, pasta, and bagels. Therefore, many ready-to-eat low-carb ketogenic products (RLCKP) that mimic carbohydrate-rich foods despite a low-carb composition have been provided to make it easier for the patients to adopt a low-carb lifestyle. To date, there are no studies describing the dietary protocol for efficient and safe use of pre-operative RLCKP in terms of weight and LLLS volume reduction in patients with obesity scheduled for MBS. Therefore, the aim of this study was to assess the safety and effectiveness of a 4-week diet using RLCKP in reducing BW and LLLS volume in patients with obesity scheduled for MBS. Patients with obesity (n = 42) with a mean body mass index (BMI) of 42.4 ± 9.2 kg/m2 scheduled for MBS underwent a 4-week preoperative RLCKP diet intervention. Their weight, LLLS volume, and biochemical and metabolic parameters were measured before and after the diet. Patient compliance was assessed by the presence of ketonuria and weight loss. Qualitative methods (5-point Likert questionnaire) were used to measure diet acceptability and side effects. All patients completed the study. We observed highly significant decreases in BW (-6.5%, p < 0.001), and LLLS volume (-22.3%, p < 0.001) and an amelioration of patient clinical status. All patients showed a high frequency of acceptability and compliance in following the diet. No adverse side effects were reported. Based on our findings, we were able to support the hypothesis that a 4-week preoperative RLCKP diet is safe and effective in reducing BW, and LLLS volume in patients with obesity scheduled for MBS.

Facilitators to implementing preventive health interventions for adolescents in the emergency department: A multicenter qualitative analysis.

Adolescents frequently use the emergency department (ED) to meet their health care needs, and many use the ED as their primary source of care. The ED is therefore well situated to provide preventive health care to large numbers of adolescents. The objective of this multicenter qualitative analysis was to identify factors that influence the implementation of preventive health care interventions for adolescent patients in the ED. We conducted semistructured interviews with ED health care providers (HCPs) from five academic pediatric EDs in distinct geographic regions. We developed an interview guide to explore HCP attitudes and beliefs related to implementing preventive health interventions in the ED. Interviews were recorded, transcribed, and coded by three investigators. The Consolidated Framework for Implementation Research (CFIR) was used as a guide to code and analyze interview data. We collaboratively generated themes that represent factors that are perceived to facilitate the implementation of preventive health interventions for adolescent patients in the ED setting. We conducted 38 interviews (18 pediatric emergency medicine attendings/fellows, 11 registered nurses, five nurse practitioners, or and four physician assistants). We generated 10 themes across the five CFIR domains: innovation characteristics (designing interventions to promote adolescent engagement), inner setting (integrating interventions into ED workflow and scope, minimizing provider burden), outer setting (involving the community, aligning with departmental and institutional missions), individuals (identifying champions), and implementation process (involving key stakeholders early, having patience, and targeting all patients to reduce stigma). Factors facilitating implementation of preventive health interventions for adolescent patients in the ED encompassed multiple CFIR domains, elucidating how the delivery of preventive health interventions for this patient population in the ED requires considering numerous factors comprehensively. These data suggest methods to enhance and facilitate implementation of preventive health interventions for adolescents in the ED.

Development and feasibility of a sex- and gender-sensitive primary care intervention for patients with chronic non-cancer pain receiving long-term opioid therapy (GESCO): a study protocol

BackgroundChronic non-cancer pain (CNCP) is a common condition worldwide. The disease burden is influenced not only by pain itself, but also by psychiatric co-morbidities, which aggravate symptoms, generally negatively influence therapies, and may thereby lead to frustration, resignation, or withdrawal. A growing body of evidence suggests that sex and gender aspects influence CNCP management as the experience of pain, the emotions associated with it, and the expression of pain may differ between women and men. In addition, doctor-patient communication is known to be influenced by gender stereotypes. Despite there being evidence on such differences, current guidelines do not consider sex- and gender-sensitive approaches. In order to examine how to adequately address the diversity of the experience and processing of pain in patients of differing sex and gender, the GESCO study aims at developing and pilot testing a sex- and gender-sensitive intervention for patients with CNCP receiving long-term opioid therapy (LTOT) in primary care.MethodsThe development process is designed in accordance with the first two phases of the UK Medical Research Council. Phase I will iteratively explore, develop, and pilot the intervention’s modules using literature searches, interviews, and workshops involving stakeholders and experts. Phase II will pilot-test the novel intervention in a sample of 40 patients with CNCP under LTOT from ten general practices using an effectiveness-implementation hybrid design including a mixed-methods process evaluation focusing on implementation strategy criteria and a single-arm, pre-post comparison to determine preliminary effects in preparation for a larger effectiveness trial. The intervention will combine in-person educational sessions for general practitioners and tools to be used in patient care.DiscussionThe intervention aims to improve CNCP management in primary care by empowering practitioners to reflect on their attitudes towards pain and stereotypes. Besides sex and gender aspects, awareness of other factors that might affect the care process, such as age, social conditions, or culture, is also promoted. The intention is to develop a comprehensive care concept for CNCP that considers aspects relevant for sex- and gender-sensitive care which are transferrable to other health care fields as well.Trial registrationGerman Clinical Trial Register DRKS00029980.

Health-related quality of life (HRQoL) loss associated with self-perceived anxiety/depression in seropositive rheumatoid arthritis

ObjectiveTo analyze the HRQoL loss associated with self-perceived anxiety/depression in patients with seropositive rheumatoid arthritis (RA).MethodThis secondary data analysis is based on a registry-based retrospective follow-up study of patients with seropositive RA treated between August 2014 and January 2023 in ARTMEDICA, Colombia. HRQoL loss and self-perceived anxiety/depression were defined as outcomes. Disease activity (DAS-28) and other patient data were also gathered. Statistical analyses were performed using the ordinal logistic and generalized linear regression models.ResultsA total of 3579 patients with a mean follow-up of 2.9 (SD 2.4) years, 85.6% women with a median age at diagnosis of 48.1 (IQR 37.8–57.5) years, and a median of 6.5 (IQR 1.9–14.7) years living with RA were included. At program admission, the median DAS-28 score was 2.8 (IQR 2.1–4.2), and 6.6% of patients reported extreme anxiety/depression. The average HRQoL loss was 3.4 months per year lived with seropositive AR. Among patients with no pain or discomfort, moderate and extreme anxiety/depression were associated with mean HRQoL losses of 2.2 (95% CI − 2.3 to − 2.2) and 4.1 (95% CI − 4.3 to − 3.8) months. In patients with extreme pain/discomfort, these estimations were 0.8 (95% CI − 0.9 to − 0.7) and 1.9 (95% CI − 2.1 to − 1.7) months, respectively.ConclusionOur study adds to the available body of evidence by clarifying the differential impact of anxiety/depression on HRQoL, depending on the severity of pain. These findings highlight the importance of strengthening mental health care and psychological well-being interventions for patients with RA, regardless of pain or disease activity.Key Points• The average HRQoL loss was 3.4 months per year lived with seropositive AR.• Pain/discomfort rather than disease activity explained the severity of anxiety/depression as well as its associated HRQoL loss.• For patients with extreme pain/discomfort and anxiety/depression, the average HRQoL loss was 8.1 months per year lived with the disease compared to 0.4 months for patients without those impacts.

Integrated models for concurrent disorders from a Public Mental Health lens: a Systematic Review

Abstract Concurrent disorders (COD), historically defined by the World Health Organization as the simultaneous presence of a psychoactive substance use disorder and another psychiatric disorder within the same individual, pose a significant challenge to public mental health. In today’s global landscape of mental health services, the prevalence of COD is on the rise, underscoring the need for an integrated approach to management. This review aims to provide an overview of existing global models and the evaluation approaches. This systematic review examined research evidence in PubMed, Scopus and Web of Science up to 2023 regarding integrated management systems for COD. Following PRISMA guidelines, we included articles describing specific models and evaluating the effectiveness of integrated versus non-integrated approaches. Quality assessment was conducted using the appropriate scales. Out of 7700 screened articles, 18 were included, all of fair or good quality. A diverse array of patient care models, programs, and interventions addressing comorbidities between mental health and substance use disorders emerged. The majority of studies focused on clinical outcomes, particularly alcohol and drug dependence, with global mental health consequences also under examination. Psychodiagnostics and social outcomes were also considered in a significant portion of the research, shedding light on health services utilization patterns. The integrated model for concurrent disorders in psychiatry stands as an effective approach, yet its implementation encounters challenges. This study showcases successful integration examples, providing valuable insights for policymakers and healthcare professionals to enhance existing models or develop new ones, particularly within European healthcare reforms like Italy’s restructuring of primary care, where they could serve as a criterion for the setting and organization of community houses. Key messages • COD, involving both substance use and psychiatric disorders, present a significant challenge to public mental health. Rising prevalence underscores the need for integrated management approaches. • Insights from successful integration examples offer valuable guidance for healthcare professionals and policymakers, particularly within healthcare reforms like Italy’s restructuring of primary care.

Effectiveness of spiritual care interventions among patients in the intensive care unit: A systematic review and meta-analysis.

Spiritual care interventions can be an important source of emotional support for patients in the intensive care unit (ICU). However, there is wide variation in the literature and no quantitative assessment to synthesize the results of these studies. To examine the effectiveness of spiritual care interventions on disease-related physiological parameter and treatment outcomes and psychosocial well-being outcomes among patients in the ICU. A comprehensive search was conducted across 11 databases from inception to 27 May 2024. Studies involving the implementation of spiritual care interventions for patients in the ICU were included. Cochrane's bias risk tool and JBI Critical Appraisal Checklist were used to examine the methodological quality of included studies. Review Manager 5.3 was used to conduct meta-analyses. A total of 18 studies were included. Meta-analysis showed that spiritual care interventions could significantly reduce mean arterial pressure (MAP) (MD: -12.12, 95% CI: [-23.68, -0.56], p = .04), length of stay in the ICU (MD: -5.49, 95% CI: [-8.99, -2.00], p = .002), and improved consciousness (MD: 3.91, 95% CI: [1.42, 6.39], p = .002), anxiety (SMD: -1.78, 95% CI: [-3.06, -0.50], p = .006), spiritual well-being (SMD: 1.57, 95% CI: [0.05, 3.08], p = .04) and comfort (MD: 15.53, 95% CI: [10.81, 20.25], p < .01) among patients in the ICU, but had no significant effects on heart rate (HR), respiratory rate (RR), pulse rate (PR), blood pressure (BP), oxygen saturation (SpO2), duration of ventilator use and pain. Spiritual care interventions could reduce MAP and length of stay in the ICU; improve consciousness, anxiety, spiritual well-being and comfort among patients in the ICU; and are still inconclusive for HR, RR, PR, BP, SpO2, duration of ventilator use and pain. Urgent efforts are needed to better integrate spiritual care interventions into clinical care to enhance patient well-being. Spiritual care interventions could improve well-being of patients in the ICU.

The Determinants of Mental Illness Self-Management for Patients With Schizophrenia and Type 2 Diabetes: A Self-Determination Theory Approach.

This study based on self-determination theory aimed to assess the relationship between motivation, competence in diabetes management and perceived autonomy support respectively and mental illness self-management; furthermore, the authors intended to explore the determinants of mental illness self-management for patients with schizophrenia and diabetes. This was a cross-sectional study. One hundred ten participants were recruited at the psychiatric hospital and assessed with the Illness Management and Recovery Scale, the Treatment Self-Regulation Questionnaire, the Perceived Competence Scale for Diabetes and the Health-Care Climate Questionnaire. Patients with lower educational levels, who were admitted to the chronic ward, were unemployed, had lower motivation in illness management, lower competence in diabetes management and perceived lower autonomy support all had lower mental illness self-management. Competence in diabetes management, employment status, autonomy support, educational levels and living alone were the determinants of mental illness self-management. Recovery from schizophrenia and comorbid diabetes is an enduring and complicated process requiring support from healthcare providers. Health professionals should assess the levels of illness self-management and provide integrated care interventions for patients with schizophrenia and diabetes, helping them manage both conditions. The illness management programme could apply to patients with schizophrenia and diabetes and address patients' characteristics such as low levels of education, living alone and being unemployed while additionally promoting motivation and competence, and providing supporting autonomy. The STROBE checklist was followed. Patients with schizophrenia and diabetes were recruited for this study and voluntarily completed the questionnaire.

Trauma Scores Show Limited Utility for Predicting In-Flight Deterioration in Air Medical Patients

ObjectiveThe aim of this study was to determine the utility of the Triage Revised Trauma Score (TRTS), Glasgow Coma Scale/Age/systolic Pressure (GAP) score, and Shock Index (SI) in predicting in-flight hypotension and the need for critical care interventions in air medical trauma patients. MethodsA retrospective review of 3,582 air medical trauma cases from a 3-year period in Queensland was conducted. An initial TRTS, GAP score, and SI were calculated for each patient, and the lowest in-flight mean arterial pressure and systolic blood pressure were determined. The institution of in-flight critical care interventions was also recorded, including fluid resuscitation, vasopressors, and surgical procedures. The utility of the TRTS, GAP score, and SI for predicting in-flight hypotension was then examined using receiver operating characteristic curves. ResultsAll 3 approaches showed minor predictive value, with the GAP score performing slightly better than TRTS and SI for predicting in-flight interventions. The GAP score had a receiver operating characteristic area under the curve of 0.76 compared with 0.74 for the TRTS and SI. ConclusionNo score demonstrated sufficient predictive ability for deterioration in transit to be used clinically.

A-226 Validation of Calculated Glycerol Corrected Triglycerides

Abstract Background Patients with elevated free glycerol can have falsely elevated triglyceride concentrations known as pseudohypertriglyceridemia. Most clinical laboratory triglycerides methods measure the concentration of glycerol released following the enzymatic hydrolysis of triglycerides to quantitate triglycerides. Thus, increased free glycerol can lead to falsely increased triglyceride concentration. Identifying and measuring the interference is necessary to effectively manage patient care interventions. A glycerol-corrected triglyceride assay was discontinued from Roche Diagnostics in 2021. We created a process to determine glycerol-corrected triglycerides by measuring glycerol directly using an assay from Randox Laboratories. Methods Glycerol (Randox Laboratories) and nonglycerol-blanked triglycerides (Roche Diagnostics) were measured in serum using the Roche Cobas c501. Stability (n=10) and expected values (n=206) were determined using serum from healthy volunteers. Linearity (n=5) and precision (5 replicates on 2 runs over 5 days) were determined using residual clinical serum spiked with exogenous glycerol as necessary to span the analytical measuring range. Glycerol corrected triglyceride concentrations were calculated by subtracting glycerol (mmol/L) from triglyceride (mmol/L) and converting to mg/dL (x88.59). Samples previously measured using the Triglyceride/Glycerol Blanked Reagent (n=53, Roche Diagnostics) were used to assess accuracy. (Figure 1) Results Glycerol measures were stable 3 days refrigerated and 30 days frozen. Precision coefficient of variation was 1.0% within run and 7.1% within lab. Expected values were 10 - 109 mcmol/L, and the method was linear between 2 - 3,971 mcmol/L. The average bias between methods was 11.0% with slope of 1.02 and R2&amp;gt;0.97 (Figure 1). Conclusions Glycerol can be accurately measured using the Randox method and the result can be used to generate an accurate glycerol-corrected triglyceride concentration.

Influence of Hospice Palliative Care on Medical Service Usage in Prolonged Mechanical Ventilation Cases: A Nationwide Cohort Study.

Numerous studies have demonstrated that hospice palliative care interventions for cancer patients can reduce health care utilzation. In Taiwan, 20-25% of patients who require mechanical ventilation are using prolonged mechanical ventilation (PMV); however, only a limited number of studies have addressed the effectiveness of hospice palliative care for these patients. This study investigated the impact of hospice palliative care utilization on medical utilization among subjects using PMV. By using the health insurance database of a nationwide population-based study, we identified subjects who had been on mechanical ventilation for > 21 d, were age ≥18 y between 2009 and 2017, and had received hospice palliative care. The control group was formed through 1:1 matching by using propensity scoring after excluding patients who had participated in palliative care for <15 d or for >181 d. Furthermore, we used a conditional logistic regression analysis to investigate the incidence of ICU admission, emergency department presentation, and cardiopulmonary resuscitation within 14 d before death. A total of 186,533 new subjects receiving PMV age ≥ 18 y were admitted between 2009 and 2017. In addition, the number of subjects receiving palliative care increased annually, rising from 0.6% in 2009 to 41.33% in 2017. The emergency department visits (odds ratio [OR] 0.68, 95% CI 0.63-0.74), ICU admission (OR 0.59, 95% CI 0.53-0.66), cardiopulmonary resuscitation (OR 0.40, 95% CI 0.35-0.46), and total hospitalization cost ($1,319.91 ± $1,821.66 versus $1,544.37 ± $2,309.27 [$USD], P < .001) were significant lower in the palliative care group. Subjects undergoing PMV while receiving hospice palliative care experienced significant reductions in total hospitalization costs, ICU admissions, cardiopulmonary resuscitation, and medical expenses within 14 d before death.

A traffic light approach for treatment and supportive care stratification in lung cancer.

Comprehensive supportive care interventions for patients with lung cancer are being investigated in a range of ways, including: early palliative care, prehabilitation and rehabilitation. We review recent literature on supportive care and propose a traffic light system to individualise comprehensive supportive care. Green for those very likely to receive anti-cancer treatment, red for those very unlikely to receive anti-cancer treatment and orange where the chance of accessing treatment is uncertain. Comprehensive supportive care can be individualised based on the group a particular patient is in. Lung cancer outcomes are improving with the availability of increasingly efficacious treatments; however, treatment rates for advanced disease remain low. In this review, we discuss how person-centred outcomes could be improved, how outcomes can be prognosticated and how the 'host' can be staged as well as the cancer. Recent data suggests that early comprehensive supportive care improves quality of life, reduces time spent in hospital and may affect survival. Comprehensive supportive care is likely to improve quality of life in patients with advanced lung cancer. Further work is needed to see if it can improve treatment rates and survival.

Effectiveness and Feasibility of Home-Based Palliative Care Interventions for Geriatric Oncology Patients: A Systematic Review Using Narrative Synthesis.

Due to an urgent need to develop palliative care services for geriatric patients with advanced cancer, an overview of available information regarding home-based palliative care interventions would be valuable. To summarize current literature for interventions targeted to homebound, older patients with incurable cancer, and investigate whether these patients can be benefited from home-based palliative care and achieve improved outcomes. A search strategy consisting of terms related to home care, palliation, oncology, and geriatrics was employed. A protocol following PRISMA guidelines was prospectively uploaded at PROSPERO (ID = CRD42023404675). Pubmed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Epistemonikos.org databases were searched from inception until the present day. Eligibility criteria were selected based on the research question, the population of interest, and the research design. The Risk of Bias Assessment Tool version 2 (RoB-2) was used to appraise study quality. A total of 10 articles including 871 patients (out of 1236 titles and 141 fully-reviewed texts) were selected. Four studies assessed exercise interventions, two evaluated multi-component home-care models, two focused on supervision services, and two had nutrition and activity components. Eight studies reported improved outcomes in either specified or mixed cancer geriatric populations. There is a scarcity of clinical trials regarding home-based palliative care for geriatric oncology patients, resulting in poor information and a lack of evidence. At-home interventions seem feasible and have a positive effect on pain management and functional status, but more high-quality studies are required.