Standard Practice Research Articles

Evaluating the feasibility and challenges of using passive solar systems for achieving thermal comfort in African countries: a review

PurposeThis review investigates the significance of passive solar systems and bioclimatic building designs in improving thermal comfort across various African regions. The study evaluates current papers and publications, focusing on best practice standards, scientific developments and the possibility of achieving maximum thermal comfort across varied temperature zones.Design/methodology/approachThis research utilised a systematic approach to analyse passive solar systems and African bioclimatic design. It involved a review of 175 documents sourced from the Web of Science (WOS) and Scopus databases, focusing on peer-reviewed publications from 1992 to 2023 as well as the Regulations and Standards for Thermal Comfort established in African countries.FindingsThe study shows how integrating passive solar systems into bioclimatic architecture greatly increases thermal comfort and lowers energy consumption in African buildings. Nevertheless, significant research gaps exist in using these systems in different African climates. Maintaining and modifying passive solar systems is essential to tackling the distinct environmental issues faced by the continent.Research limitations/implicationsWhile this review provides a thorough analysis, it acknowledges the complexity of local settings and construction practices, recognising potential limitations in the available literature. The implications include a call for further research and technological advancements to address these limitations and refine passive solar systems for optimal performance.Originality/valueThis study bridges knowledge gaps about how passive solar systems and bioclimatic design principles can be efficiently used across various African climates and areas. Furthermore, it incorporates recent advances and a thorough review procedure to ensure that findings are current and relevant.

Mental health staff’s experiences of implementing trauma-informed care in the NHS

Purpose The NHS long-term plan outlined that mental health services in the UK will be based on the trauma-informed approach in the next 10 years. Staff in leadership roles in those services will face a responsibility to lead the implementation of TIC; however, little is known about the experiences of these staff attempting to create change. Therefore, this study aims to gain an understanding of mental health staff (MHS)’s experiences in implementing trauma-informed care (TIC) in the NHS. Design/methodology/approach In total, 14 mental health staff (MHS), comprising ten psychologists and four multidisciplinary clinicians, were recruited through purposive and snowball sampling. Semi-structured individual interviews were conducted via Microsoft Teams to provide qualitative data. Interviews were transcribed verbatim and analysed using Braun and Clarke’s (2006) reflexive thematic analysis. Findings Five themes were found: 1) having a visionary outlook and high expectations for change, 2) professional growth and personal development, 3) affirmation of the role’s importance and impact, 4) psychological discomfort and 5) ways of coping. Participants strongly believed that TIC should be standard practice for all health-care staff, noting that implementing TIC led to their professional and personal growth. While they found satisfaction in influencing others to value TIC, they experienced negative emotions when their efforts were unsuccessful and used various strategies to overcome barriers and manage psychological discomfort. Originality/value To the best of the authors’ knowledge, this study is the first to explore the experiences of MHS implementing TIC in the NHS. Support recommendations for staff in the role are made and future research is identified.

Assessment of different genotyping markers and algorithms for distinguishing Plasmodium falciparum recrudescence from reinfection in Uganda

Abstract Antimalarial therapeutic efficacy studies are vital for monitoring drug efficacy in malaria-endemic regions. The WHO recommends genotyping polymorphic markers including msp-1, msp-2, and glurp for distinguishing recrudescences from reinfections. Recently, WHO proposed replacing glurp with microsatellites (Poly-α, PfPK2, TA1). However, suitable combinations with msp-1 and msp-2, as well as the performance of different algorithms for classifying recrudescence, have not been systematically assessed. This study investigated various microsatellites alongside msp-1 and msp-2 for molecular correction and compared different genotyping algorithms across three sites in Uganda. Microsatellites 313, Poly-α, and 383 exhibited the highest diversity, while PfPK2 and Poly-α revealed elevated multiplicity of infection (MOI) across all sites. The 3/3 match-counting algorithm classified significantly fewer recrudescences than both the ≥ 2/3 and Bayesian algorithms at probability cutoffs of ≥ 0.7 and ≥ 0.8 (P < 0.05). The msp-1/msp-2/2490 combination identified more recrudescences using the ≥ 2/3 and 3/3 algorithms in the artemether-lumefantrine (AL) treatment arm, while msp-1/msp-2/glurp combination classified more cases of recrudescence using the ≥ 2/3 in the dihydroartemisinin-piperaquine (DP) arm. Microsatellites PfPK2 and Poly-α, potentially sensitive to detecting minority clones, are promising replacements for glurp. Discrepancies in recrudescence classification between match-counting and Bayesian algorithms highlight the need for standardized PCR correction practices.

Nutritional Psychiatry: The Impact of Diet on Mental Health

Nutritional psychiatry is an emerging discipline exploring the intricate relationship between diet and mental health. This field emphasizes the role of dietary patterns, nutrients, and the gut-brain axis in influencing psychological well-being. Research highlights the benefits of specific nutrients, including omega-3 fatty acids, B vitamins, and magnesium, in alleviating symptoms of mood disorders such as depression and anxiety. The Mediterranean diet, rich in plant-based foods and healthy fats, is associated with improved mental health outcomes and reduced cognitive decline. Furthermore, the gut microbiome plays a pivotal role in the gut-brain axis, influencing mood and behavior through complex biochemical pathways. Clinical applications of nutritional psychiatry advocate personalized interventions, dietary assessments, and collaboration with registered dietitians. Despite significant advancements, broader policy reforms and interdisciplinary approaches are essential to integrate nutritional psychiatry into standard mental health care practices. This review underscores the transformative potential of diet as a therapeutic tool in mental health management and calls for continued research to solidify its role in psychiatric care. Keywords: Nutritional psychiatry, Mental health, Gut-brain axis, Mediterranean diet, Nutritional interventions.

Feasibility and Safety of bedside placement of tunneled dialysis catheters: A systematic review and meta-analysis of prevalence.

Tunneled dialysis catheters (TDCs) are typically the vascular access of choice for critically ill patients in need of urgent dialysis for prolonged periods of time. The standard of practice is to insert these catheters under fluoroscopic guidance to ensure proper catheter placement in the cavo-atrial junction or right atrium. However, there is increasing interest in bedside placement of TDCs without fluoroscopic guidance in patients deemed too critically ill to be transported to the fluoroscopy suite or operating room. Our aim was to systematically review the literature on bedside placement of TDCs and to calculate the pooled prevalence rates of technical success, favorable clinical outcomes, and overall complications. We searched PubMed and Google Scholar for articles on bedside insertion of TDCs without setting a specific timeframe. We stratified the articles based on the risk of publication bias. Data on technical success, favorable clinical outcomes and complications were collected. A total of 22 articles were included, comprising 1546 TDCs inserted at bedside. The technical success rate was found to be 97.2% [95% CI: 94.6 - 98.9%; I2 = 77.5%]; LFK index = -0.72 and favorable clinical outcome was reported in 97.6% [95% CI: 94.5-99.5%; I2 = 84.8%]; LFK index = -1.62. The pooled prevalence of complications was found to be 6.98% [95% CI: 3.12 - 12.1%; I2 = 87.8%]; LFK index = 0.95, most of which were mechanical in nature. Our findings suggest that bedside placement of TDCs is a technically feasible procedure with high favorable clinical outcomes and comparable complication rates to the conventional method of TDC insertion under fluoroscopic guidance. Several non-fluoroscopic techniques have also been suggested to confirm the proper positioning of the catheter in the right atrium. These findings may challenge the gold standard of utilizing fluoroscopic guidance for TDCs.

The impact of obtaining explicit informed consent for medical student participation in the pelvic examination underanesthesia: A qualitative interview study.

To examine patient, physician, and operating room (OR) staff perceptions at an academic institution following the introduction of an explicit, written consent form for medical student participation in the pelvic examination under anesthesia (EUA). The study was performed at one urban academic medical center between May 2021 and May 2023. Thirty-one individuals including patients, OR staff, and physicians were interviewed to better understand their perspectives regarding an initiative to explicitly consent patients for the student pelvic EUA. Northwestern University Institutional Review Board approval was obtained. Patients appreciated being asked to explicitly consent to or refuse the student pelvic EUA and having a dedicated consent form left them with a positive feeling about the hospital and their healthcare providers. OR staff and physicians agreed that the student pelvic EUA is necessary, and almost all supported an explicit consent form. Physicians did not find the additional consent form burdensome and noted only a modest decline in learning opportunities. Patients and healthcare providers agreed that requiring explicit written consent for the student pelvic EUA respected patient autonomy, improved healthcare quality, and caused minimal disruption to medical education. Our data support the use of an explicit written consent form as standard practice.

Assessing the FAIRness of Metabolic Bariatric Surgery Registries: a Comparative Analysis of Data Dictionaries from the UK, Germany, France, Netherlands, Norway, and Sweden.

This study is part of an initiative to improve the FAIRness (Findability, Accessibility, Interoperability, Reusability) of metabolic bariatric surgery (MBS) registries globally. It explores the extent to which European registry data can be manually integrated without first making them FAIR and assesses these registries' current level of FAIRness. The findings establish a baseline for evaluation and provide recommendations to enhance MBS data management practices. Data dictionaries from five national MBS registries in Germany, France, the Netherlands, the UK, and a combined registry for Scandinavia (Norway and Sweden) were evaluated regarding their ability to manually integrate registry datasets with one another. The FAIR Data Maturity Model from the Research Data Alliance (RDA) FAIR Data Maturity Model Working Group was used to assess the FAIRness of both metadata and data of the registries. The registries showed significant variability in variables and coding structures, with inconsistent numerical formats and without linkage to international standards such as SNOMED CT, LOINC, or NCIt, making data integration labor-intensive and assumption-heavy. Despite the presence of data dictionaries, all registries failed the FAIR assessment because machine-readable data was unavailable, and only human-readable metadata was available in the form of data dictionaries in a spreadsheet. Our study reveals significant inconsistencies in data structuring and a failure to comply with the FAIR Principles, which limit effective data analysis and comparison. This emphasizes the critical need for standardized data management practices. We recommend four next steps to improve the FAIRness of MBS registries: (1) annotate data elements using standardized terminology systems, (2) deposit registry-level metadata in a repository, (3) request globally unique and persistent identifiers for datasets, and (4) define access restrictions.

Global biogeography of N2-fixing microbes: nifH amplicon database and analytics workflow

Abstract. Marine dinitrogen (N2) fixation is a globally significant biogeochemical process carried out by a specialized group of prokaryotes (diazotrophs), yet our understanding of their ecology is constantly evolving. Although marine N2 fixation is often ascribed to cyanobacterial diazotrophs, indirect evidence suggests that non-cyanobacterial diazotrophs (NCDs) might also be important. One widely used approach for understanding diazotroph diversity and biogeography is polymerase chain reaction (PCR) amplification of a portion of the nifH gene, which encodes a structural component of the N2-fixing enzyme complex, nitrogenase. An array of bioinformatic tools exists to process nifH amplicon data; however, the lack of standardized practices has hindered cross-study comparisons. This has led to a missed opportunity to more thoroughly assess diazotroph diversity and biogeography, as well as their potential contributions to the marine N cycle. To address these knowledge gaps, a bioinformatic workflow was designed that standardizes the processing of nifH amplicon datasets originating from high-throughput sequencing (HTS). Multiple datasets are efficiently and consistently processed with a specialized DADA2 pipeline to identify amplicon sequence variants (ASVs). A series of customizable post-pipeline stages then detect and discard spurious nifH sequences and annotate the subsequent quality-filtered nifH ASVs using multiple reference databases and classification approaches. This newly developed workflow was used to reprocess nearly all publicly available nifH amplicon HTS datasets from marine studies and to generate a comprehensive nifH ASV database containing 9383 ASVs aggregated from 21 studies that represent the diazotrophic populations in the global ocean. For each sample, the database includes physical and chemical metadata obtained from the Simons Collaborative Marine Atlas Project (CMAP). Here we demonstrate the utility of this database for revealing global biogeographical patterns of prominent diazotroph groups and highlight the influence of sea surface temperature. The workflow and nifH ASV database provide a robust framework for studying marine N2 fixation and diazotrophic diversity captured by nifH amplicon HTS. Future datasets that target understudied ocean regions can be added easily, and users can tune parameters and studies included for their specific focus. The workflow and database are available, respectively, on GitHub (https://github.com/jdmagasin/nifH-ASV-workflow, last access: 21 January 2025; Morando et al., 2024c) and Figshare (https://doi.org/10.6084/m9.figshare.23795943.v2; Morando et al., 2024b).

The Role and Scope of Practice of Veterinary Social Workers in Animal Shelters

Animal shelters play a pivotal role in protecting pets in crisis and bringing families together. This paper adds to the work of Hoy-Gerlach and colleagues which outlined a three-tier framework for developing and training veterinary social workers (VSWs) to serve in animal shelters. Our research questions sought to explore the VSWs’ self-identified role (RQ1), and how VSWs self-identify their scope of practice (RQ2). Through these exploratory questions, our research aimed to advance knowledge about the state of VSWs in the animal-shelter setting. Methods: Using a purposive sampling strategy, an anonymous community practice survey (CPS) was emailed to VSWs working in animal shelters. Inclusion criteria included being over the age of 18, being currently employed in an animal shelter, and cognitive fluency in English. The survey yielded 25 responses with 14 included in the data analysis. Findings: The VSWs identified their role as supporting multiple groups, including clients and their practice community (i.e., colleagues). While most of their time was devoted to individuals from the community, they also supported the mental wellbeing of their team. Their work ranged from case management and psychoeducation to crisis intervention and suicide risk assessment. As there are no standards of practice for VSWs, each respondent used unique language to explain their role and scope of practice. Conclusions: The CPS was helpful in illuminating developing trends within the field, though a larger sample size is needed to gain a more nuanced understanding of self-identified needs of VSWs practicing in animal shelters and other related spaces.

Translating measurement into practice with PHQ-9 calculator: an open tool to assess depression levels in the Brazilian population.

We aim to create a web-based calculator for assessing depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9), utilizing IRT-based standardized scores, to improve measurement precision, standardization, and practical application in clinical practice. This study developed a web-based calculator using a graded response IRT model for assessing depressive symptoms with the PHQ-9, using data from the Brazilian National Health Survey 2019 (n = 90,846, aged 15 to 107 years old, 52.8% female). The tool calculates latent depressive symptoms and converts them into T-scores, with stratification by sex and age groups. The application respects patient confidentiality by deleting sensitive information postcalculation. Estimated models resulted in a mean sample size of 3244.5 participants in each group (SD: 1066). The calculator can be accessed at https://mheg.shinyapps.io/phq9-score. The development of an IRT-based web calculator for the PHQ-9 represents an advancement in depressive symptoms' assessment, offering precision and potential clinical utility. By standardizing scores into a common metric, this tool facilitates the interpretation of depressive symptoms and comparison across different instruments. The study's scope is limited to the Brazilian population and external validity for other contexts is warranted. Future studies should evaluate the clinical validity and the threshold of the tool for predicting real life problems.

Impact of Locum Tenens Providers on Delivery of Pediatric Surgical Care.

We sought to understand the impact of locum tenens surgeons on pediatric surgical care delivery. We conducted a cross-sectional survey of Children's Hospital Association pediatric surgical practices. Anonymous electronic surveys were used to investigate locum tenens utilization, primary reason for use, limitations on clinical activities, and variations in practice standards or quality. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between practice characteristics and locum tenens use. Of 172 practices, 71% (n=122) completed the survey. Median hospital size was 203 beds (interquartile range=130-350). Median number of surgeons per practice was 5 (interquartile range=3-8). Thirty-seven practices (30%) employed locum tenens at primary (n=27) or satellite (n=12) sites. Locum tenens utilization was higher in suburban (odds ratio [OR]=3.78, P=0.006) and rural (OR=4.96, P=0.041) locations and lower at sites with a level 4 neonatal intensive care unit (OR=0.35, P=0.035). Most (51%) used locum tenens ≥ 1 time monthly but < 1 time weekly and for ongoing or interim coverage (87%). In total, 14% of practices reported clinical restrictions for locum tenens surgeons, including limitations on extracorporeal membrane oxygenation, neonatal index cases, and operative trauma. Most (76%) practices using locum tenens reported variations in practice standards or quality; all were perceived as negative (57%) or neutral (43%). Locum tenens providers are utilized most commonly in suburban and rural sites and hospitals without the highest level of neonatal intensive care. While locum tenens surgeons may help maintain access to pediatric surgical care where gaps exist, there may be a need to improve the quality and reliability of care rendered.

Clinical experiences with robotic computed tomography-guided interventions: A comparison with manual technique

Background: Image-guided biopsies have become standard practice; however, challenges such as multiple punctures and re-attempts can complicate procedures. The introduction of robotic guidance systems, such as MAXIO offers a potential solution for improving planning and navigation. This study evaluated the efficacy of the MAXIO needle-guiding robotic device in computed tomography (CT)-guided interventions compared with conventional manual techniques. Aims and Objectives: This study aimed to evaluate the performance of the MAXIO robotic system for CT-guided biopsies at the Barnard Institute of Radiology and compare it with the conventional manual technique. Materials and Methods: A total of sixty patients who underwent CT-guided biopsies were retrospectively divided into two groups: Group A (manual procedure) and Group B (robot-assisted procedure). The MAXIO device was utilized in combination with a Siemens 32-slice CT scanner for robot-assisted biopsies. Key parameters analyzed between the two groups included the volume CT dose index, dose-length product (DLP), target location, target depth, target size, distance from the entry point, needle angulation, procedural time, number of punctures, complications, and re-biopsy rates. Results: Significant differences were found between the two groups in the number of punctures (p = 0.002), DLP (p = 0.0001), and degree of needle angulation (p = 0.0002), with the robotic technique demonstrating a better performance. Although the procedural time was reduced in the robotic group, this difference was not statistically significant (p = 0.104). Other assessed parameters, such as complications and rebiopsy rates, showed no significant differences. Conclusion: Robotic-assisted CT-guided procedures using the MAXIO system showed improved diagnostic accuracy and safety, with reductions in radiation dose, needle manipulations, and punctures, compared to conventional manual techniques.

Advances in cellular therapies for children and young adults with solid tumors.

Adoptive immunotherapy brings hope to children and young adults diagnosed with high-risk solid tumors. Cellular (cell) therapies such as chimeric antigen receptor (CAR) T cell, CAR natural killer (NK) cell, and T cell receptor (TCR) T cell therapy are potential avenues of targeted therapy with limited long-term toxicities. However, development of cell therapies for solid tumors is in its nascent stages. Here, we will review the current clinical experience, barriers to efficacy, and strategies to improve clinical response and patient access. Cell therapies are shown to be generally safe and well tolerated. Strategies to optimize antitumor activity have now moved into early-phase trials. The immunosuppressive tumor microenvironment remains a major barrier to efficacy, and efforts are underway to gain better understanding. This will inform future treatment strategies to enhance the antitumor activity of cell therapies. Clinical experiences to date provide important insights on how to leverage cell therapies against solid tumors. Key factors in advancing the field include a better understanding of immune cell biology, tumor cell behavior, and the tumor microenvironment. Lastly, improving access to novel cell therapies remains an important consideration in the conduct of clinical trials and for future implementation into standard practice.

Advances in the Pathogenesis, Diagnosis, Treatment, and Prognosis of Marginal Zone Lymphoma.

The management of marginal zone lymphoma (MZL), an indolent B-cell non-Hodgkin lymphoma, requires a personalized and adaptive approach due to its clinical and prognostic heterogeneity. We believe treatment should emphasize a balanced strategy considering the subtype, disease burden, symptoms, and actionable genetic or environmental factors, such as infections or autoimmune diseases. For asymptomatic patients with low tumor burden or disseminated disease, a watch-and-wait approach remains appropriate, given MZL's indolent nature and the risks of overtreatment. Conversely, for symptomatic or high-burden cases, early intervention with chemoimmunotherapy is recommended for effective disease control. Surgery remains essential for both diagnosis and the treatment of localized disease. Incorporating molecular profiling and prognostic models, such as MZL-IPI and POD24, is crucial for decision-making and risk stratification. Testing for infectious agents like Helicobacter pylori or Hepatitis C virus should be standard practice, as eradication therapy offers a targeted, less toxic, and effective option in select patients. With ongoing advancements in understanding dysregulated signaling pathways and the tumor microenvironment, we anticipate novel targeted therapies and combination regimens will further improve outcomes. We advocate for molecular testing at diagnosis to identify actionable biomarkers, particularly for patients with refractory or relapsed disease. Finally, MZL management requires vigilant follow-up with adjustments based on evolving disease features. Treatment decisions should integrate patient preferences, clinical context, and the latest evidence to maximize survival while preserving quality of life.

Enhancing a low-cost, minimally invasive screening test for dihydropyrimidine dehydrogenase mutations linked to 5-fluorouracil sensitivity by integrating computational mutation predictions.

226 Background: 5-Fluorouracil (5-FU), a common chemotherapy for solid tumors, is metabolized primarily by dihydropyrimidine dehydrogenase (DPD), encoded by the DPYD gene. With &gt; 200 known variants, individuals with nonfunctional DPYD alleles exhibit impaired 5-FU metabolism and are at risk of severe toxicity. Approximately 35% of the population has partial DPD deficiency, and 0.2% completely lack enzymatic activity. Despite this, DPYD genotyping is not standard practice. This study evaluates the use of non-invasive saliva samples for DPYD genotyping and combines AI-based molecular prediction modeling to search for novel variants within DPYD coding region. Saliva samples were collected from fifty-six healthy individuals and from gastrointestinal (GI) cancer patients including a family cohort of nineteen individuals and three unrelated patients undergoing chemotherapy. Methods: gDNA was sequenced for nine DPYD variants reported to reduced or abrogate DPD activity: c.1905+1G &gt; A, c.1679T &gt; G, c.2846A &gt; T, c.1129-5923C &gt; G, c.1236G &gt; A, c.299_302delTCAT, c.703C &gt; T, c.2983G &gt; T, and c.557A &gt; G. cBioPortal was utilized to search the TCGA database for studies involving colon cancer patients with novel DPYD mutations exhibiting a total FIS score of at least 2 or identified through 3D modeling of DPD using PyMol based on their proximity to or the presence of polar contacts within the active site. Putative pathogenic mutations were analyzed using AlphaMissense and ChimeraX to assign a RSMD score, assessing their potential negative impact on DPD function. Results: Computational studies identified three mutations in DPYD from TCGA colon cancer patients with an unknown impact on DPD and a FIS greater than 4 (c.198G &gt; C/T, c.2161G &gt; A, c.2185G &gt; A), suggesting potential disruption of its function. Four mutations (c.424T &gt; G, c.427T &gt; G, c.2460G &gt; C, c.2909C &gt; A) were identified through protein modeling using PyMol, but only two had a FIS greater than 2. Of these seven identified mutations, four (c.198G &gt; C/T, c.2161G &gt; A, c.2185G &gt; A, c.2909C &gt; A) also scored highly using AlphaMissense and ChimeraX. In silico prediction models from VarSome listed c.2185G &gt; A as Pathogenic Moderate and c.2909C &gt; A as Pathogenic Very Strong. Sequencing of saliva samples indicated mutations c.1129-5923C &gt; G and c.1236G &gt; A were present in four and three volunteers, respectively, and c.1905+1G &gt; A in one case. Mutations identified in GI cancer patients were c.1129-5923C &gt; G and c.1236G &gt; A. Conclusions: By combining computational modeling with the analysis of naturally occurring mutations in colon cancer patients, we have successfully identified potentially pathogenic mutations in the DPYD gene. This information can enhance existing clinical diagnostic tests, providing a more comprehensive assessment of DPYD mutations, including novel variants.

Implementation of Cystic Fibrosis Responsibility, Independence, Self-Care, Education Program Enhances Cystic Fibrosis Knowledge in Limited Resource Country: Results From a Randomized Controlled Trial.

CF R.I.S.E is a program that helps people with Cystic Fibrosis (pwCF) transition from pediatric to adult care. In 2022, we adapted it to CF S.O.B.E in Turkish during a training session. This project aims to present the results of the CF S.O.B.E program. This study included 81 pwCF aged 16-25, divided into two groups: the standard CF S.O.B.E. group (n = 39) and the modified group (n = 42). The standard group received face-to-face education. Both groups participated in online training sessions and received written materials. The knowledge levels were evaluated with Knowledge Assessment Questionnaires (KAQ). The standard group showed higher post-training scores in "Lung Health and Airway Clearance" and "Equipment Maintenance and Infection Control" (p = 0.014 and 0.002). Modified group showed improvements in all KAQs except "Lung Health and Airway Clearance", "CF-related Liver Disease," "Pancreatic Insufficiency and Nutrition," and "Male Sexual Health." Regarding Pancreatic Insufficiency & Nutrition and CF-related Diabetes, individuals with these conditions demonstrated higher pretest scores than those without these conditions (p = 0.01 and 0.002, respectively). Both groups and their parents reported high satisfaction, and healthcare providers endorsed the program's effectiveness. Our study demonstrated the CF S.O.B.E program's success in enhancing knowledge, disease management skills, and self-confidence among pwCF. While the modified CF S.O.B.E program may be suitable for resource-limited centers, the priority should be to implement the standard program due to its superior outcomes in self-confidence and disease management. This study lays the foundation for incorporating CF S.O.B.E as a standard practice and evaluating its long-term clinical impact.

Leading the way: How leading Chinese institutions drive MDT excellence in hepatocellular carcinoma.

563 Background: HCC MDTs involve specialists collaborating on patient cases to create personalized treatment plans. Implementing MDTs can be challenging in countries with limited resources and high disease burdens. In China, there were 368,000 new liver cancer cases in 2022 representative of 40% of global cases. Therefore, evaluating MDT practices at leading hospitals in China may offer valuable insights that could help improve HCC MDT practices worldwide. Methods: This study selected hospitals with distinct MDT models: one for all new patients and one for complex cases. Hospitals handling over 1,000 HCC cases annually were chosen. Desk research and virtual interviews with MDT members from three leading Chinese hospitals—The First Affiliated Hospital of USTC, The First Affiliated Hospital of SYSU, and Tongji Hospital—were conducted to analyze their MDTs and determine key best practices. Results: We identified 6 key best practice in HCC MDTs at these leading Chinese hospitals. 1) Quality Control on MDT process: Leading hospitals ensure the MDT’s efficient execution and effective outcomes. E.g., USTC established a quality control team to audit the MDT process. 2) Real-World Evidence: Leading hospitals prioritize the construction of real-world databases linked to MDT-care to inform impact on outcomes. E.g., SYSU's preliminary data shows impact of MDT care on survival rates (From 2006 to 2010, 5,627 patients who underwent radical liver cancer resection with MDT care saw their five-year survival rate reach 60%, a notable improvement over historical averages) 3) Comprehensive Teams: These hospitals typically have robust teams, involving around 10 specialties. E.g., Tongji Hospital’s MDTs involve ~10 specialties for holistic care. 4) Patient Journey Coverage: MDTs manage patients from diagnosis to rehabilitation, providing a holistic approach to patient management. 5) Guideline-based treatment decisions: They follow latest guidelines coupled with access to approved therapies to make treatment decisions 6) Training: Young physicians are invited to actively participate in MDT consultations (e.g., through case preparation and presentation, etc.). Conclusions: Evaluation of MDT practices at leading China institutes highlights key best practices that could be adopted to enhance care quality for patients with HCC. The ongoing efforts and successes of these institutions provide a model for broader adoption and standardization of MDT practices across the country.

The Effect of Watching Animation-Assisted Information Video on Fear and Anxiety in Children Before an Endoscopy Procedure: A Randomized Controlled Study.

The purpose of this study was to evaluate the impact of children watching a video about their upcoming procedure on reducing anxiety and fear before endoscopy. This randomized controlled trial included 46 children aged between 6 and 12years who underwent endoscopy in the pediatric gastroenterology unit of a hospital in the Black Sea Region of Turkey. Children were randomly assigned to the experimental group or the control group. Children in the experimental group (n=22) watched video about their procedure, whereas children in the control group (n=24) received a verbal explanation about the procedure in line with standard clinical practice. The children's pre-procedure fear levels were evaluated using the Children's Fear Scale, and anxiety levels were evaluated using the Children's Anxiety Meter-State measure. Parents and observers also completed the fear and anxiety level measures. Data were analyzed via SPSS version 25.0. A statistically significant difference was found between the fear and anxiety scores of the children in the experimental and control groups before and after watching the video, according to the evaluations of children, mothers, and nurses. We conclude that providing children with information about the endoscopy procedure beforehand can alleviate their associated fears and anxieties. This concern is equally important for older clients as well and suggested to be adapted to be age-appropriate for any population.

Disparity Between Perceived and Actual Opioid Prescriptions by Orthopaedic Surgeons After Total Joint Arthroplasty.

Healthcare institutions have sought to standardize opioid prescribing after elective total joint arthroplasty. The purpose of this study was (1) to compare opioid prescriptions at discharge with perceived opioid prescribing patterns and (2) to determine the relationship between preoperative adjunctive treatments and opioids prescribed at discharge. All surgeons who performed total joint arthroplasty of the shoulder, hip, or knee from January 1, 2021, to October 4, 2023, at a single academic institution were included. Surgeons completed a survey assessing perceived opioid prescriptions at discharge and perioperative pain protocols. Actual prescriptions were captured using our institutional opioid database. All opioid prescriptions were converted to morphine milligram equivalents (MMEs). Orthopaedic surgeons prescribed on average 594.2 MMEs more than they perceived as their postoperative protocol. They prescribed an additional 60.9 MMEs for every 10 MMEs that they perceived they were prescribing. Patients receiving liposomal bupivacaine were prescribed on average 597 fewer MMEs and had fewer opioid prescriptions (P < 0.001). Genicular nerve blocks and cryoneurolysis were associated with fewer prescribed MMEs (P < 0.001). Orthopaedic surgeons prescribe substantially more opioids than intended. This study underscores the need for standardized opioid prescribing practices and the potential of adjunctive treatments in reducing opioid prescribing.

Current status of physicians’ perception of HCC conversion/downstaging therapy: A nationwide survey in China.

585 Background: Conversion or downstaging therapy for intermediate and advanced unresectable hepatocellular carcinoma (HCC) has emerged as a significant exploring area of clinical practice and research in recent years. Nonetheless, there exists considerable variability in both the selection criteria for patients undergoing conversion therapy and the regimens selected for conversion across different regions and medical institutions. The present study aims to elucidate the current clinical application of conversion therapy in China, as well as to identify the considerations that physicians take into account when selecting eligible patients for conversion therapy and determining the appropriate conversion modality. Methods: Physicians meeting predefined inclusion criteria were invited to complete an online questionnaire from January to July, 2024. The collected data were subsequently pooled and analyzed descriptively. Results: A total of 120 valid questionnaires were retrieved, mainly form surgical (69.2%, n=83) and interventional (30.8%, n=37) departments. Generally, the study showed that approximately 51% of stage Ib-IIIa patients will be selected for the treatment goal of conversion or downstaging, and the overall successful rate as meeting criteria for surgical resection after treatment was 36%. Three primary factors were prioritized by physicians for determination of conversion therapy: the type of portal vein tumor thrombus (PVTT) (97%, 116/120), the future liver volume (90%, 108/120), and Child-Pugh classification (90%,108/120). In the specific physician group who selected the following attributes, patients classified as Child-Pugh A (82%, 89/108) or Child-Pugh B7 (66%, 71/108), those with tumor diameter exceeding 5 cm (92%, 98/106) and Eastern Cooperative Oncology Group (ECOG) performance score of 0 to 1 (89%, 76/85) were most frequently selected for conversion therapy. Additionally, study showed that patients presenting with Vp1-2 (72%, 83/116) and Vp3 (71%, 82/116) could also be considered for conversion therapy. Currently, the prevalent treatment approach of conversion therapy involves a combination of local and systemic therapies, which is utilized in approximately 73% of cases. Among systemic treatment methodologies, the combination of Lenvatinib and immunotherapy is the most widely adopted by physicians. Besides, higher ORR was the foremost consideration for 83% (99/120) of physicians, followed by rapid response (68%, 82/120), adherence to guidelines and consensus (63%, 76/120), and lower tumor progression rate (58%, 70/120). Conclusions: This study elucidates the current status of conversion therapy for HCC in China. The findings underscore the necessity for optimizing conversion modalities and advancing standardized practices in the application of conversion therapy.