Consent Form Research Articles

Quantifiable Bodies: The Influence of Biometric Technologies in Patient Consent

While research has been done to identify the potential implications of biometric technology on marginalized populations’ privacy and autonomy, this paper contributes to existing research by examining these technologies in healthcare settings. Drawing from insights across surveillance studies, rhetoric of health and medicine, and technical communication, we identify how one leading healthcare institution in New York City has employed rhetorics of efficiency, effectiveness, safety, and security regarding its biometric technology system. This employment of biometric technologies often contributes to patients’ marginalization and dismissal. As we explore, interrogating the language used by the healthcare institution to describe biometrics opens opportunities for us—surveillance studies scholars, patients, allies, students, and more—to ensure that innovations within the healthcare system promote equity, agency, and improved outcomes for all.

Abstract IA013: Increasing Diversity in Pediatric Cancer Clinical Trials: Challenges and Opportunities

Abstract Although childhood cancer is the leading cause of death by disease past infancy in the US, with 17,000 children younger than 21 years being diagnosed annually, survival has improved dramatically, and is now greater than 80% overall. Because of unequal access to services and adverse Social Determinants of Health (SDOH) affecting underserved populations, disparities in survival exist among minoritized youth with cancer. For example, Hispanic children have higher incidence of certain cancers and poorer survival rates than non-Hispanic White children. Minorities are severely under-represented in research. This means that cancer outcomes data are largely based on data from non-Hispanic White participants, and there is incomplete information to adequately assess treatment benefits for minorities. We showed that 53% of Latino parents declined research participation, compared to 20% of non-Hispanic White parents, in our institution. There are several barriers to informed consent for clinical trials. First, there are no mandates to ensure comprehension, and informed consent forms are complex, long, and difficult to understand. This leaves parents of children with cancer with an incomplete understanding of risks, procedures, randomization, alternative treatments, and the voluntary nature of clinical trial participation. Furthermore, pediatric cancer often requires urgent treatment, leaving little time for decision-making. We developed COMPRENDO (ChildhOod Malignancy Peer REsearch NavigatiOn), a peer-navigation intervention to improve research literacy and diversity in pediatric cancer clinical trials. In this intervention, trained peer-navigators, who have the lived experience of having a child diagnosed with cancer, provide in-hospital support. The goals of COMPRENDO are to improve parents’ informed consent experience and comprehension of informed consent for cancer treatment, to explain to parents terms to be discussed by the oncologist during the treatment conference, to introduce to parents concepts of clinical trials and research, and to facilitate and empower shared decision-making. In a pilot study at Rady Children’s Hospital-San Diego, this intervention showed a significant increase in comprehension of therapeutic trials, particularly in Hispanic and Spanish-speaking parents. The demographics of children with cancer enrolled in clinical trials should be comparable to the US population, and approaches to improve enrollment must also be tailored to specific settings. Structural barriers for participation of minorities should be considered during study and informed consent design and planning. Strategies to increase clinical trial enrollment of minority individuals include: Provider-level training on patient-provider communication, development of linguistically appropriate tools, and promotion of culturally aware staff. Key strategies at the patient-level include building trust; education and awareness of clinical trials; implementation of culture, language, and health literacy-concordant interventions; and initiatives to address adverse SDOH. Citation Format: Paula Aristizabal. Increasing Diversity in Pediatric Cancer Clinical Trials: Challenges and Opportunities [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pediatric Cancer Research; 2024 Sep 5-8; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl):Abstract nr IA013.

Enhancing educational experience through establishing a VR database in craniosynostosis: report from a single institute and systematic literature review.

Craniosynostosis is a type of skull deformity caused by premature ossification of cranial sutures in children. Given its variability and anatomical complexity, three-dimensional visualization is crucial for effective teaching and understanding. We developed a VR database with 3D models to depict these deformities and evaluated its impact on teaching efficiency, motivation, and memorability. We included all craniosynostosis cases with preoperative CT imaging treated at our institution from 2012 to 2022. Preoperative CT scans were imported into SpectoVR using a transfer function to visualize bony structures. Measurements, sub-segmentation, and anatomical teaching were performed in a fully immersive 3D VR experience using a headset. Teaching sessions were conducted in group settings where students and medical personnel explored and discussed the 3D models together, guided by a host. Participants' experiences were evaluated with a questionnaire assessing understanding, memorization, and motivation on a scale from 1 (poor) to 5 (outstanding). The questionnaire showed high satisfaction scores (mean 4.49 ± 0.25). Participants (n = 17) found the VR models comprehensible and navigable (mean 4.47 ± 0.62), with intuitive operation (mean 4.35 ± 0.79). Understanding pathology (mean 4.29 ± 0.77) and surgical procedures (mean 4.63 ± 0.5) was very satisfactory. The models improved anatomical visualization (mean 4.71 ± 0.47) and teaching effectiveness (mean 4.76 ± 0.56), with participants reporting enhanced comprehension and memorization, leading to an efficient learning process. Establishing a 3D VR database for teaching craniosynostosis shows advantages in understanding and memorization and increases motivation for the study process, thereby allowing for more efficient learning. Future applications in patient consent and teaching in other medical areas should be explored.

The Use of Simulation in Communication Sciences and Disorders: A Follow-Up Survey.

This study investigates changes in the prevalence and practice of simulation in communication sciences and disorders (CSD) education. It is a follow-up to a 2015 survey on the same topic. Given the changes in program certification standards and the impact of the COVID-19 pandemic on clinical education programs across the United States, re-examination of simulation in CSD is warranted. An online questionnaire was developed to survey university programs accredited by the Council on Academic Accreditation of the American Speech-Language-Hearing Association. University program directors and clinical directors received recruitment e-mails using QuestionPro, an online survey platform. The recruitment e-mail contained the purpose of the study and a link to the online questionnaire along with instructions to forward the survey to the appropriate designee. The consent form was then embedded in the questionnaire. The results of this survey indicated changes in patterns and the use of simulation in clinical education for CSD. Results indicated an overall increase in the use of simulations, specifically in computer-based simulations. Distance simulation as a hybrid technology proved a major addition to clinical education programs during the COVID-19 pandemic. External and internal factors affecting the use of simulations in CSD were identified. The use of simulation to supplement clinical education in CSD has evolved in recent years. These changes are likely due in part to changes in certification standards in the profession, an increase in awareness and training, and reliance on distance simulation during the COVID-19 pandemic.

ANALYSIS OF STUNTING INCIDENTS IN TODDLER CHILDREN

Children who experience malnutrition, repeated infections, and inadequate psychosocial stimulation can result in impaired growth and development or stunting. There are still findings of cases of stunting in children under five, followed by the presence of malnourished children under five, where in 2023 there will be 243 stunting. There are many factors that cause stunting in the Puskesmas work area which causes problems in children, both health and growth and development. This research aims to determine the factors which is related to the incidence of stunting in children under five at the Megang Sakti Community Health Center, Musi Rawas Regency in 2024. The design of this research is quantitative research with a cross-sectional approach. The population in this study is the target group of children under five in 2023, totaling 32,561 respondents. The sample in this study consisted of 100 respondents. The sampling method uses purposive sampling technique, using the Slovin formula. Inclusion criteria are willingness to become a respondent by filling out a consent form. This research was carried out on March 10 - April 30 2024 at the Megang Hospital Health Center. Collecting primary data by interviews using questionnaires. Bivariate data analysis used the Chi-Square test and multivariate logistic regression. The results of the study showed that there was a relationship between maternal age (p value 0.02) and birth weight (p value 0.002) with the incidence of stunting in children under five at the Megang Sakti Community Health Center, Musi Rawas Regency. in 2024. The conclusion is that there is a relationship between age and birth weight with the incidence of stunting in children under five at the Megang Sakti Community Health Center, Musi Rawas Regency in 2024. The community health center should carry out continuous screening of children under five who are at risk of stunting and provide education on efforts to prevent stunting children, such as risk factors for stunting.

ANALYSIS OF BPJS PATIENT SATISFACTION WITH THE QUALITY OF HEALTH SERVICES IN 2024

Satisfaction is a response received, then compared with performance according to expectations. The performance of the health services received exceeds expectations, so the patient feels satisfied, conversely, if the performance they receive does not meet their expectations, it can be said that the consumer feels dissatisfied. This study aims to determine factors related to BPJS patient satisfaction with the quality of health services at the Muara Kulam Community Health Center in 2024. The design of this research is quantitative with a cross-sectional approach. The population of this study was BPJS patients who received treatment at the Muara Kulam Community Health Center in 2023, totaling 717 respondents. The sample in this study amounted to 88 people. The sampling method uses purposive sampling using the Slovin formula. Inclusion criteria are willing to be a respondent by filling out a consent form. This research was carried out on March 28 - April 28 2024. Data was collected using a questionnaire. Bivariate data analysis used the Chi-Square test. The research results show a tangibles (p value 0.005), responsiveness (p value 0.006) and empathy (p value 0.05) with BPJS patient satisfaction at the Muara Kulam Community Health Center in 2024. Conclusion: there is a relationship between tangibles, responsiveness and empathy with BPJS patient satisfaction in Muara Kulam Community Health Center in 2024. The Community Health Center should complete the facilities and infrastructure at the Community Health Center such as examination equipment

ANALYSIS OF INFANT MORTALITY IN THE WORKING AREA OF NORTH MUSI RAWAS REGENCY IN 2024

Infant deaths are caused by the top three causes of death, namely LBW, asphyxia and infection. Meanwhile, the highest cause of other neonatal deaths was caused by intrapulmonary complications such as respiratory and cardiovascular disorders. This research aims to determine the picture of infant mortality in the working area of ​​North Musi Rawas Regency in 2024. The design of this research is quantitative with a case control approach. The population in this study were all mothers who gave birth in North Musi Rawas Regency in January 2023. The sample in this study was 99 people, with sampling using case and control 3:1. Namely cases as many as 33 respondents and controls as many as 66 respondents, with the inclusion criteria being willing to become respondents by filling out a consent form, and parents of toddlers. This research was carried out on March 30 - April 29 2024. Primary data was collected by interviews using questionnaires. Bivariate data analysis used the Chi-Square test. The results of the study showed that there was a relationship between birth attendant (p value 0.01), place of delivery (p value 0.002), birth weight (p value 0.006), ANC visits (p value 0.00), and comorbidities (p value 0, 00) with the incidence of infant deaths in the working area of ​​North Musi Rawas Regency in 2024. The most dominant factor in the incidence of infant deaths in the working area of ​​North Musi Rawas Regency in 2024, namely birth weight (p value 0.004) (OR 0.261). The conclusion is that there is a relationship between birth attendants, place of delivery, birth weight, ANC visits and comorbidities. The Health Service should coordinate with the Community Health Center to carry out scheduled posyandu activities.

A–Z of prescribing for children

This series focuses on aspects of prescribing for neonates, children and young people, from A–Z. Aspects of pharmacokinetics will be considered, alongside legal considerations, consent and medications in schools

Antibiotic sensitivity pattern among diabetic patients admitted with urinary tract infection.

Objective: To determine the frequency of types of bacterial pathogens involved in urinary tract infections and antibiotic sensitivity patterns among diabetic patients in the medical units of Khyber Teaching Hospital Peshawar. Study Design: Cross-sectional study. Setting: Department of Medicine, Khyber Teaching Hospital, Peshawar. Period: November 9, 2022 until May 8, 2023. Methods: The study was conducted after the approval of the hospital's ethical committee and the written informed consent of patients. Data was entered and analyzed using SPSS. Patients aged 16 to 80 years of both genders admitted to medical units with diabetes and diagnosed with urinary tract infection were enrolled using a non-probability consecutive sampling technique. Results: In our study, a total of 184 patients were enrolled, with a mean age of 52.08±18.4 years. There were 42.4% male and 57.6% female patients. The most common organism isolated was E. coli in 37% of patients, followed by Klebsiella in 23.9% of patients, Pseudomonas in 6.3%, Enterococcus in 12%, and Proteus mirabilis in 10.9% of patients. The most sensitive drug was Fosfomycin in 89.1% of patients, followed by nitrofurantoin in 81.5%, imipenem in 77.1%, amikacin in 73.3%, Piperacillin/tazobactam in 69%, gentamycin in 67.9%, Trimethoprim-sulfamethoxazole in 66.8%, Amoxicillin-clavulanic acid in 59.7%, ciprofloxacin in 54.3%, ceftriaxone in 51%, and cefixime in 46.1% of patients. Conclusion: E. coli is the most common organism isolated in urinary tract infection in diabetics and Fosfomycin is the most sensitive drug for treatment.

Symptoms of depression, anxiety and stress in women with chronic pelvic pain attended at a private hospital in São Luís, Maranhão: a cross-sectional study

ABSTRACT The study aimed to evaluate the relation between depression, anxiety stress symptoms, duration and pain intensity in women with chronic pelvic pain (CPP). This study consisted of a sample of women diagnosed with CPP from April 2021 to August 2023, including women aged 18 years or older who agreed in writing to participate in the study with the Free Informed Consent Form, who could understand the study’s objectives and participate. Women between 31 and 37 years old, married or in a stable relationship, with a higher education degree predominated. Were observed outside the normal range scale 58.8 percent of depression, 66.7 percent of anxiety and 59.8 percent of stress. The level of alteration most often observed in patients was extremely severe in 24 percent of with depression and 33.3 percent of anxiety, and the level was mild in 19.6 percent of stress symptoms. No statistical association was found between duration of pain and emotional states of anxiety, depression or stress. Regarding pain intensity levels, there was no significant association with the presence or absence of symptoms of depression outside the normal range or its levels. It’s was significantly associated with the presence or absence of anxiety symptoms outside the normal range (p = .003) and with their levels (p = .005). Also significantly associated with the presence or absence of stress symptoms outside the normal range (p = .007), as was its levels (p = .023). The symptoms of depression, anxiety and stress occur frequently in women with CPP and that the intensity of pain experienced is significantly associated with the presence of stress and anxiety but not with depression.

Ethnobotanical diversity, phytochemical screening and biological evaluation of selected medicinal mushrooms species

The current study was aimed to investigate the ethno-pharmacology, diversity, biological potentials of different mushrooms species from District Swabi, Pakistan. Ethno-pharmacological data was collected from 73 respondents based on interview, group discussion and field visits. Quantitative analysis such as informant consent factor (ICF), Use value (UV), Relative Frequency of Citation (RFC) were done. Morphological identification of mushrooms, extract preparation, phytochemical screening and statistical analysis of data was conducted. Phytochemical analysis of six mushroom species revealed that saponins, alkaloids, glycosides, flavonoids and phenols were present in six selected mushrooms, while tannin and steroids (−) present in Agaricus arvensis. In Morchella conica only steroids (−) was absent, Qunion (−) in Polyporus tuberaster, Pleurotus ostreatus and Omphalotus olearius were found absent. Moisture contents (10.17 ± 1.27) and crude fats (5.26 ± 1.50) present in Omphalotus olearius. Highest content of crude fibers (26.57 ± 0.86) and carbohydrates (62.18 ± 0.73) were found in Pleurotus ostreatus. Highest ash contents (12.62 ± 0.46) were reported in Polyporus tuberaster. The respondents’ consensus factor values ranged from 1.66 to 61.74 in which highest ICF value was 61.74 while the lowest was 1.66. The high RFC was recorded forAgaricus (0.67) while lowest RFC was observed in Clitocybe frondasa (0.05). The results of analgesic activity were compared to the diclofenac (Standard drug). The extracts of aqueous and methanolic extract were most active at the level of (400 mg/kg). As antipyretic agents, methanolic and aqueous extracts of Agaricus species were analyzed for anti-inflammatory activity compare to diclofenac (Standard drug) where the aqueous (200 mg/kg) and methanolic (400 mg/kg) were found to be very active. Finally, mushrooms with high (ICF and UV) were further investigated for phytochemicals and pharmacological analysis which revealed significant biological potentials. This provides basic ground information which can be used to explore novel mushroom-based medicines for the treatment of various diseases. The commercial cultivation of mushrooms represents a promising opportunity to leverage their diverse health benefits and nutritional properties. By prioritizing research and cultivation methods while educating the public, the potential of mushrooms as vital components of both nutrition and medicine can be significantly realized, impacting health outcomes and contributing to sustainable agricultural practices.

Practices of Informed Written Consent for Elective Urological Procedures at a Tertiary Care Hospital in Sudan.

Objective This study aimed to assess informed consent practices in elective urological surgeries at a tertiary care facility. Materials and methods A retrospective cross-sectional survey was carried out between March 1, 2023and April 1, 2023, at the Department of Urology, Omdurman Military Hospital, Sudan. We included all patients who had undergone elective urological procedures under local, spinal, or general anesthesia. The medical records were accessed to analyze the consent forms' standards. A total of 42 consent forms were included and analyzed. We use the General Medical Council's (GMC) Guidance on Professional Standards and Ethics for Doctors: Decision Making and Consent, and the Royal College of Surgeons (RCS) of England's Consent: Supported Decision-Makingas the standard for our study. The GMC and the RCS of England have provided comprehensive and standardized guidelines for obtaining informed written consent, including indications, benefits, risks involved, and alternatives in addition to demographics, patient details, responsible consultant, diagnosis, and title of the surgery, intended benefits, probable risks, type of anesthesia, consenting doctor's name, designation, and signature, and the patient's signature and name. Results A total of 42 consent forms were included. The diagnosis and the intended surgical procedure were mentioned in all consents. The potential benefits and risks were discussed in 36 (85.7%) and 18 (42.9%) cases, respectively. The type of anesthesia was discussed in 39 (92.9%) of cases. The likely result of not having the procedure and the alternative treatment: Recorded completion rates of 10 (23.8%) and 12 (28.6%), respectively. Patient demographics were completely documented in 41 (97.6%) forms. Senior doctors were only involved in 14 (33.3%) of the consents. Details of the consenting doctor, including name, title, and signature, were present in 30 cases (71.4%), and the date of signing the consent was documented in 38 cases (90.5%). The completeness of the consent form correlated with the level of the doctor obtaining it, with consultants achieving the highest completion rates (100%), followed by registrars (66.7%) and medical officers (35.7%). Conclusion The current practices of informed consent were found to be substandard. Handwritten consent forms do not adhere to the recommended guidelines for informed consent in elective urological procedures. It is preferable to utilize a pre-designed consent form, allowing for personalized additions based on the patient's specifics. Our recommendation is to organize an educational session for junior doctors to emphasize proper consent procedures, and deepen their knowledge of common urological elective procedures, and associated risks. This approach promotes adherence to best clinical practices and minimizes the risk of legal challenges.

Do we consent to change? An evaluation of oral and maxillofacial outpatient department dentoalveolar consent forms

Obtaining informed consent before performing any dentoalveolar procedure is a professional, ethical, and legal obligation. Prior to this work, in this oral and maxillofacial department, no standardised consent process existed for dentoalveolar procedures. A targeted literature review established localised gold standards for dentoalveolar procedures, and retrospective data from 56 dentoalveolar consent forms over a four-week period assessed baseline compliance with these standards. Data analysis identified that risks of dry socket and trismus were documented in only 7% of cases, and maxillary tuberosity fracture was never documented. Thirty-three per cent of lower third molar cases did not include consent for inferior alveolar nerve injury. Findings were discussed in a departmental audit meeting, and a root cause analysis identified memory failure, repetition fatigue, and varying clinician knowledge and experience, as key drivers. The evidence base and localised gold standards were discussed. A standardised, bilingual, triple-copy dentoalveolar consent form was developed, including predefined indications, additional procedures, and risks, in a tick-box format. This form was presented to the Department of Patient Safety and Quality and gained local approval. Cases completed with the new form will now be evaluated against the localised gold standards, with a mixed-methods feedback survey investigating staff and patient opinions. Local processes for obtaining and documenting valid consent for dentoalveolar treatment were found to be inconsistent and frequently inadequate. Fifteen localised gold standards were set, and a new standardised consent form developed, which will be evaluated for effectiveness and acceptability.

296. CLINICAL T1B-SM2-3N0M0 ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Background With advancements in endoscopic techniques, safer and more reliable endoscopic resection of submucosal invasive lesions has become feasible. The evaluation of treatment outcomes for superficial esophageal carcinoma has typically been predicated on the depth of pathological diagnosis; however, there have been limited studies based on preoperative diagnosis. Given that treatment decisions in clinical practice are primarily guided by preoperative diagnosis, there is a heightened emphasis on studies grounded in preoperative assessments. This study aims to analyze the accuracy of preoperative diagnosis of T1b-SM2-3 N0M0, evaluate the accuracy of treatment selection and depth diagnosis, and assess long-term outcomes based on these determinations. Methods Thirty-eight patients diagnosed with T1b-SM2-3 N0M0 between April 2010 and December 2020 were included in the study. Depth diagnosis was determined through endoscopic evaluation utilizing white light, NBI, NBI magnification plus EUS, with lymph node metastasis diagnosis performed via CT imaging. Treatment decisions were made following patient consent, and long-term prognosis was assessed for each treatment modality. Results Initial treatment involved ESD in 14 patients, with an additional 5 patients undergoing additional treatment (ESD + AD) based on histological evaluation (surgery: 1, CRT: 4). Surgery or neoadjuvant chemotherapy (NAC) followed by surgery was performed in 15 patients, with CRT administered in 7. Among the 22 patients who did not receive NAC and whose histologic depth was evaluable, the accuracy rate of depth diagnosis was 64%, primarily attributable to overdiagnosis. In the 14 patients who underwent ESD excluding piecemeal resection, the negative rate of vertical margins was 93%. Five-year overall survival rates were as follows: ESD: 64.8%, ESD+AD: 75%, surgery: 86.2%, and CRT: 45.7%, with no statistically significant differences observed. The majority of deaths (83%) were attributed to other diseases or cancers, with only 2 deaths attributed to the primary disease. Conclusion ESD or surgery emerged as the preferred treatment modalities in the majority of cases, with relatively favorable long-term prognoses. Treatment decisions were influenced by comorbidities and other factors, potentially impacting long-term outcomes.

A cross-sectional survey of ocular problems after COVID-19 infection among healthcare workers at a teaching hospital.

The COVID-19 pandemic was caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV2). The impact of the pandemic is becoming more apparent now on various tissues and body organs. Limited knowledge is present about the characteristics, duration, and long-term sequelae of ocular problems post-COVID-19 infection. The purpose of the present study was to evaluate and analyze the ocular problems occurring in healthcare workers after COVID-19 infection. This was a cross-sectional survey study conducted in the Department of Ophthalmology, Patna Medical College and Hospital, Patna. The participants were healthcare workers who were exposed to COVID-19 infection ≥6 months back. A questionnaire was prepared. Responses were evaluated and analyzed. Patient consent and institutional committee permission were taken as per norms. A total of 210 healthcare workers who were infected with COVID-19 >6 months back responded with complete answers. The maximum number of respondents was between the ages of 31 and 60 (73.3%). The pre-covid ocular problems were present in 25% of the participants, especially in those having chronic diseases (such as diabetes, hypertension, or both). Post-ocular problems were faced by 60% of the participants, which was significant (P < 0.01). Dry eye, itching, and foreign body sensations were present in 60% of those facing ocular problems (P < 0.01). Ocular surface manifestations were more common. A knowledge, understanding, and awareness about ocular problems and their long-term sequelae in post-COVID-19-infected patients will help in early diagnosis and better management of such patients.

Robotic techniques in endometriosis: six steps for excision of rectovaginal nodules – the butterfly method

To present a standardized and reproducible approach for the surgical excision of deep endometriosis in the rectovaginal septum, represented by #ENZIAN A. Surgical video article. A tertiary referral center. The case of a patient with an isolated endometriotic nodule in the rectovaginal septum was used to illustrate the surgical technique, also referred to as the butterfly method. An Intuitive Xi DaVinci system was used at the tertiary referral center, IFEMEndo in Bordeaux, France. Patient consent was obtained. Step-by-step approach for the excision of endometriosis in the rectovaginal septum. This educational film presents a systematic approach dividing the surgical procedure into following six steps: We used the metaphor of the butterfly because it comprehensively and pictorially reflects the resection line of the endometriotic nodule in the rectovaginal septum. Surgical management of rectovaginal endometriosis can be challenging and requires as much as possible the preservation of autonomic nerves. A systematic approach enables the endoscopists to perform a safe and complete removal of the lesion.

470. INTENSIVE EARLY SURVEILLANCE FOLLOWING ESOPHAGECTOMY IDENTIFIES DISTINCT PATTERNS OF RECURRENCE

Abstract Background There remains a lack of consensus about the protocol for follow-up following esophagectomy. Some centers will utilize a purely radiological approach to follow-up, while others will include routine endoscopy and blood markers. Furthermore, the frequency of follow-up is debated, though many centers will follow-up every 3 months due to the high recurrence rate in the first year. We follow patients every 3 months for the first year, every 6 months for the next year, then yearly to 5 years, solely with CT scans unless symptoms indicate endoscopy. We sought to examine our recurrence rate and survival using this follow-up protocol. Methods We reviewed our prospectively collected database for recurrence following esophagectomy in patients operated from March 2018 to May 2022. Consenting patients &amp;gt;18 years of age who underwent esophagectomy were included. Demographics including age, sex, and BMI, tumor factors including pathologic stage, tumor regression grade, and neoadjuvant therapy and post-recurrence treatment data were collected. Results We identified 190 patients who underwent esophagectomy and 69 patients had a recurrence. Patients with recurrence were younger (61.3 +/- 10.2 vs 66.4 +/- 10.1, p=0.001), were more likely pT3 (59.4% vs 36.4%, p=0.013) and have a tumor regression grade of 3 (27.5% vs 7.4%, p=0.002). There was no difference between patients with R1 resections vs R0 (5.8% vs 6.6%, p=0.824). Most recurrences were identified on CT scan (95.8%). For patients who recurred within 3 months, the mean time from operation to death was 9.11 months. Patients who recurred between 3-6mo, 6-9mo, and 9-12mo died at 17.1mo, 15.7mo, and 17.5mo following surgery, respectively. Patients who recurred in the next year died around 40 months from surgery. Conclusion As with other reports in the literature, recurrence is highest in the first year after esophagectomy. Patients recurring in the first 3 months had a short survival following esophagectomy and may represent missed micrometastatic disease at staging. Interestingly, patients who recurred between 3-12 months all had a similar time to death from the date of operation, suggesting lead-time bias for those detected at 3-6months. Early and later recurrence appear to have distinct biological behaviours. With improved and tailored adjuvant therapies, earlier detection may yet be beneficial and will require further study.

Механизмы внедрения технологий искусственного интеллекта в здравоохранение: новые этические вызовы

Currently, systems based on artificial intelligence (AI) are finding increasing application in medicine. Acting as assistants of both the attending physician and managing physician, they can be a good help in solving a number of problems in modern healthcare, such as staff shortage, professional burnout and, in some cases, insufficient staff qualification. However, this leads to increased requirements for reliability of such systems. Introduction of a new advanced technology raises a number of ethical issues and problems, the solution of which is necessary to gain trust of people and reduce distrust associated with the use of AI technologies. It seems that if ethical standards determine and set the progressive development of artificial intelligence, this will lead to the maximum benefit from the use of this technology in healthcare. The paper examines the ethical aspects of transition of software into the category of medical devices. At the same time, legal and organizational mechanisms for solving ethical problems at both the international and domestic levels are provided. The activities of both public and government organizations in this field are considered. The need to obtain the permission of ethical committees for conducting clinical trials and ensuring informed consent of patients is emphasized. It also highlights the importance of integrating medical data into structured datasets that can be registered as databases. This will contribute to improved quality of medical research and practice.

Prospective cohort study identifying risk factors for sports injuries in adolescent athletes: the Healthy Injury-Free Adolescent Athletes (HIFAA) study

A high incidence of injuries has been reported in young athletes. Several factors have been associated with athletes’ sports injuries. However, scientific evidence is lacking, particularly for adolescent athletes. Hence,...

P225 RISK FACTORS FOR CEREBROVASCULAR DISEASE IN WOMEN ADMITTED TO THE INTERNAL MEDICINE SERVICE OF THE EMERGENCY DEPARTMENT OF THE CENTRAL HOSPITAL IN SAN CRISTOBAL (TACHIRA, VENEZUELA)

Background and objective: Cerebrovascular disease is a leading cause of mortality and disability worldwide. Research has focused on determining the risk factors for cerebrovascular disease independent of gender; however, it has been important to differentiate between men and women due to the variety of causes that occur in the latter. Therefore, the aim was to determine the risk factors for cerebrovascular disease in women admitted to the internal medicine service of the Central Hospital of San Cristóbal (Táchira, Venezuela). Methods: A case-control study was performed. Cases were female patients diagnosed with acute cerebrovascular disease (24 to 72 hours after symptom onset). Controls were hospitalized or community-based female subjects without pathologies associated with cardiovascular disorders. The case-control ratio was 1:2, of equal age or ± 5 years. All participants signed the informed consent form and completed the data collection form. Odds ratios (OR) were calculated, with 95% confidence intervals. Results: In the period between February 2 to July 15, 2020, 111 female participants entered the study, 37 cases (26 with ischemic cerebrovascular disease and 11 with hemorrhagic cerebrovascular disease) and 74 controls. Of the risk factors studied: arterial hypertension, diabetes mellitus, dyslipidemia, physical inactivity, smoking, alcohol consumption, overweight, obesity, atrial fibrillation, use of oral contraceptives, use of hormone replacement therapy, autoimmune diseases, only association was found between atrial fibrillation (OR 9.1736, 95% CI 3.3638-25.0173), autoimmune diseases (OR 9.1736, 95% CI 3.3638-5.0173) and ischemic cerebrovascular disease. No association was found with any risk factor and hemorrhagic cerebrovascular disease. Conclusions: The risk factors for cerebrovascular disease in the female population are modifiable and treatable, being pertinent to determine their presence and carry out the necessary actions to reduce morbimortality in this population group.