Pretreatment Assessment Research Articles

Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU).

The aim of this study was to systematically review the current evidence regarding the oncological and functional outcomes of salvage radical prostatectomy (sRP) for recurrent prostate cancer. A systematic review was conducted throughout September 2022 using the PubMed, Science Direct, Scopus, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. A total of 55 studies (3836 patients) met our eligibility criteria. The vast majority of men included had radiation therapy (including brachytherapy) as their first-line treatment (n = 3240, 84%). Other first-line treatments included HIFU (n = 338, 9%), electroporation (n = 59, 2%), proton beam therapy (n = 54, 1.5%), cryotherapy (n = 34, 1%), focal vascular targeted photodynamic therapy (n = 22, 0.6%), and transurethral ultrasound ablation (n = 19, 0.5%). Median preoperative PSA, at the time of recurrence, ranged from 1.5 to 14.4 ng/mL. The surgical approach was open in 2300 (60%) cases, robotic in 1465 (38%) cases, and laparoscopic in 71 (2%) cases. Since 2019, there has been a clear increase in robotic versus conventional surgery (1245 versus 525 cases, respectively). The median operative time and blood loss ranged from 80 to 297 min and 75 to 914 mL, respectively. Concomitant lymph node dissection was performed in 2587 cases (79%). The overall complication rate was 34%, with a majority of Clavien grade I or II complications. Clavien ≥ 3 complications ranged from 0 to 64%. Positive surgical margins were noted in 792 cases (32%). The median follow-up ranged from 4.6 to 94 months. Biochemical recurrence after sRP ranged from 8% to 51.5% at 12 months, from 0% to 66% at 22 months, and from 48% to 59% at 60 months. The specific and overall survival rates ranged from 13.4 to 98% and 62 to 100% at 5 years, respectively. Urinary continence was maintained in 52.1% of cases. sRP demonstrated acceptable oncological outcomes. These results, after sRP, are influenced by several factors, and above all by pre-treatment assessment, including imaging, with the development of mpMRI and metabolic imaging. Our results demonstrated that SRP can be considered a suitable treatment option for selected patients, but the level of evidence remains low.

Abstract 16734: Patterns of Inflammatory Activation in Cardiovascular Disease: Insights From the Randomized Colchicine PCI Trial

INTRODUCTION: Recent studies demonstrate that neutrophils accumulate in atherosclerotic lesions and that neutrophil counts correlate with disease severity. The randomized double-blind Colchicine-PCI study demonstrated that colchicine attenuated systemic inflammation (IL-6, CRP) after percutaneous coronary intervention compared with placebo. GOALS/AIMS: We characterized neutrophil activity in patients across a spectrum of cardiovascular phenotypes, including severity of coronary artery disease (CAD) and presentation of acute myocardial infarct (AMI). METHODS: The Colchicine-PCI biomarker sub-study enrolled 478 participants with pretreatment assessment of inflammatory biomarkers. White blood cell count and differential were performed using a hematology analyzer. Soluble markers of neutrophil activity, including neutrophil extracellular traps (NETs), and systemic inflammation were assessed using multiplex assays. Neutrophil surface markers of activity and neutrophil platelet aggregates were assessed using an Accuri C6 flow cytometer. RESULTS: We observed neutrophil concentration, adhesion, transmigration, and activation, as well as increased NETs complexes; but no difference in extent of neutrophil platelet aggregation or systemic inflammation in patients with versus without obstructive CAD. Conversely, in patients with versus without AMI, neutrophil markers of adhesion and transmigration did not differ, but systemic markers of inflammation and neutrophil activation were elevated. CONCLUSION: This single-site, prospective study is the largest neutrophil biorepository in patients with cardiovascular risk factors. Inflammatory activation, and particularly neutrophil profiles, differ in patients with obstructive CAD and in the setting of AMI.

Randomized Controlled Pilot Trial: Project Support Positive Parenting Module Following Sexual Abuse

Purpose: Support from a nonoffending caregiver can play a critical role in helping children recover from sexual abuse. However, many caregivers lack the skills to effectively support their child during the aftermath of a sexual abuse disclosure. This randomized controlled pilot trial examined a brief parenting intervention (Project Support Positive Parenting module) delivered by paraprofessionals to families waiting for intensive, trauma-focused therapy at a children's advocacy center. Methods: After a pretreatment assessment, 21 families were randomized to the intervention or a treatment-as-usual control group. Families also completed a posttreatment assessment. Results: Caregivers who received the Project Support module reported improved caregiver support and parenting self-efficacy, and their families were more likely to engage in trauma-focused therapy. Caregivers and service providers reported high levels of satisfaction with the program. Discussion: Although the results should be interpreted as preliminary, they offer promising evidence for brief parenting programs following a sexual abuse disclosure.

What works for whom? Moderators in parental reflective functioning intervention

ABSTRACT The DUET program (a group intervention) aims to enhance parental reflective functioning (PRF). We examined whether pretreatment levels of key outcomes as well as individual parental and family-environment characteristics predicted improvement after intervention with the DUET program. One hundred forty-two parents (native Israelis; mean age = 34.84 years) of preschool children (n = 107; mean child age = 4.3 years; 53% female) were assessed before, after, and 6 months following the intervention. Results indicated significant associations between lower levels of key outcomes at the pretreatment assessment and greater improvement after treatment in PRF, child self-regulation, and child self-distraction strategies. Furthermore, two subgroups of families were uncovered based on individual parental and family-environment characteristics: low-distress and high-distress parents. Following intervention, the high-distress group showed greater improvement in parental sensitivity and child problem behavior, whereas the low-distress group reported greater improvement in locus of control. Clinical and future directions are discussed.

Soluble galectin-3 as a microenvironment-relevant immunoregulator with prognostic and predictive value in lung adenocarcinoma.

Despite the success of therapies in lung cancer, more studies of new biomarkers for patient selection are urgently needed. The present study aims to analyze the role of galectin-3 (GAL-3) in the lung tumor microenvironment (TME) using tumorspheres as a model and explore its potential role as a predictive and prognostic biomarker in non-small cell lung cancer patients. For in vitro studies, lung adenocarcinoma (LUAD) and lung squamous carcinoma (LUSC) primary cultures from early-stage patients and commercial cell lines were cultured, using tumorsphere-forming assays and adherent conditions for the control counterparts. We analyzed the pattern of secretion and expression of GAL-3 using reverse transcription-quantitative real-time PCR (RTqPCR), immunoblot, immunofluorescence, flow cytometry, and immunoassay analysis. Our results using three-dimensional (3D) models of lung tumor cells revealed that soluble GAL-3 (sGAL-3) is highly expressed and secreted. To more accurately mimic the TME, a co-culture of tumorspheres and fibroblasts was used, revealing that GAL-3 could be important as an immunomodulatory molecule expressed and secreted in the TME, modulating immunosuppression through regulatory T cells (TREGS ). In the translational phase, we confirmed that patients with high expression levels of GAL-3 had more TREGS , which suggests that tumors may be recruiting this population through GAL-3. Next, we evaluated levels of sGAL-3 before surgery in LUAD and LUSC patients, hypothesizing that sGAL-3 could be used as an independent prognostic biomarker for overall survival and relapse-free survival in early-stage LUAD patients. Additionally, levels of sGAL-3 at pretreatment and first response assessment from plasma to predict clinical outcomes in advanced LUAD and LUSC patients treated with first-line pembrolizumab were evaluated, further supporting that sGAL-3 has a high efficiency in predicting durable clinical response to pembrolizumab with an area under curve of 0.801 (P = 0.011). Moreover, high levels might predict decreased progression-free survival and OS to anti-PD-1 therapy, with sGAL-3 being a prognosis-independent biomarker for advanced LUAD.

Exploring Suspected Pathogenicity of SETD5 Gene and Assessing the Impact of Speech and Physical Therapy Interventions: A Case Study Analysis with a Goal Attainment Scale Approach

Global developmental delay (GDD) is a heterogeneous condition characterized by delays in reaching developmental milestones during early childhood. Recent advancements in genetic research have underlined the role of genetic mutations in contributing to various neurodevelopmental disorders, including developmental delays (DD). One particular gene of interest, SETD5, has been associated with a distinct manifestation of developmental delay. Case description Through a case study approach, this study investigates the suspected pathogenicity of SETD5 gene mutations in a child who is 2 years and 5 months old and assesses the effectiveness of speech therapy and physical therapy interventions in a child with these mutations using the Goal Attainment Scale (GAS). Comprehensive clinical and developmental assessments such as Magnetic Resonance Imaging, Diffusion- Weighted Imaging, Magnetic Resonance Angiography, Whole exome sequencing (WES), Copy number analysis, Speech therapy assessment, and Physical therapy assessment were performed. Pre-intervention assessments revealed significant speech and motor delays. Post-Intervention GAS Scores revealed that the child displayed an average change of 32.8 and 32 in the areas of speech therapy and physical therapy, respectively. These scores signify a positive shift in outcomes for the broader objectives within speech therapy and physical therapy. Conclusions The findings of this study suggest that early diagnosis and interventions offer the potential in addressing speech and motor challenges linked to SETD5-related developmental disorders, improving the quality of life for those affected and their families. Keywords: Developmental delay, Global Developmental Delay, SETD5 gene mutation, Genetic counseling, Neurodevelopmental disorders, Speech therapy, Physical therapy, Goal Attainment Scale

Blood pressure measurement knowledge and counselling among hospital pharmacists - an interventional study

BackgroundPharmacists occupy a vantage position to educate patients with hypertension on self-monitoring of blood pressure (BP). An update on their knowledge and counselling on BP measurement is needful to ascertain proper information dissemination to patients.MethodsAn interventional study was carried out for a six-month period among consecutively sampled pharmacists working at a tertiary healthcare facility, using a semi-structured questionnaire for data collection. Sequel to preintervention assessment of pharmacists’ knowledge and counselling on BP measurement, an educational intervention comprising didactic lecture, case studies, demonstrations, and interactive question and answer sessions was carried out to address the gaps observed. Knowledge and counselling were then reassessed one-month postintervention to find out the impact of the intervention. Data was summarized with descriptive and inferential statistics with significance level set at p < 0.05.ResultsOne hundred and forty-four pharmacists completed the study. Preintervention knowledge and counselling on BP measurement among the pharmacists was poor. Median scores of pharmacists’ knowledge on BP measurement increased significantly from 13.00 preintervention to 25.00 postintervention (p < 0.001); while their counselling on BP measurement also increased significantly from 1.00 preintervention to 12.00 postintervention (p < 0.001). The knowledge category of the pharmacists’ improved as majority who were categorized as having either “poor” (67, 46.5%) or “fair” (68, 47.2%) knowledge preintervention advanced to “excellent” (99, 68.7%) knowledge postintervention. Similarly, the pharmacists’ counselling category was upgraded from the majority categorized as poor (141, 97.9%) preintervention to excellent (87, 60.4%) postintervention. Prior to the educational intervention, only 62 (43.1%) pharmacists knew that BP measurement had to be carried out in both arms for a first-time patient. Also, when asked the question “What BP reading will be recorded for a patient whose BP readings when taken thrice were 149/82 mmHg, 141/78 mmHg, and 139/78 mmHg?” only 38 (26.4%) provided the right answer. Similarly, majority of the pharmacists (51, 35.4%) could only state one out of five precautions during blood pressure measurement. In this study, pharmacists’ gender, additional educational qualification, and work experience did not significantly influence their knowledge and counselling on BP measurement.ConclusionsThe educational intervention significantly improved pharmacists’ knowledge and counselling on BP measurement.

Using a combined working memory – Semantic feature analysis approach to treat anomia in aphasia: A Pilot Study

IntroductionThe purpose of the study was to pilot a working memory (WM) – and modified Semantic Feature Analysis (SFA) approach to treat word finding deficits in a group of people with aphasia (PwA). Two research questions were posed: 1. Will the group of PwA be able to complete the WM tasks used in the approach? 2. Will the approach improve naming performance in PwA? MethodThree individuals with mild – moderate aphasia participated in this singlesubject multiple baseline treatment design. Pre-treatment assessments of language, and pre- to post-treatment assessments of WM abilities were carried out. The treatment protocol incorporated WM and linguistic tasks in order to improve naming accuracy across two treatment lists. Probes were carried out prior to treatment on each list, and at one-month following completion of treatment. Two outcome measures were obtained: Percent accuracy in completing the WM steps, and treatment effect sizes (Beeson & Robey, 2006). Additionally, modified t-tests (Crawford & Garthwaite, 2012; Crawford & Howell, 1998), were calculated in which post-treatment WM measures were compared against neurotypical control groups to detect any improvements in WM functions. ResultsAll three participants completed the WM steps with a high degree of accuracy. A range of small to large ESs were obtained for all three participants across the two treated lists, while no meaningful ESs were obtained for the control (untreated) list. All three participants demonstrated improved scores across most of the WM measures with significant improvements noted on certain WM assessments. ConclusionsThe findings revealed that the WM – SFA approach can be used successfully in individuals with mild – moderate aphasia. The proposed approach holds promise as feasible intervention designed to remediate anomia in PwA.

Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients

Although most ovarian masses in children and adolescents are benign, many are managed with oophorectomy, which may be unnecessary and can have lifelong negative effects on health. To evaluate the ability of a consensus-based preoperative risk stratification algorithm to discriminate between benign and malignant ovarian pathology and decrease unnecessary oophorectomies. Pre/post interventional study of a risk stratification algorithm in patients aged 6 to 21 years undergoing surgery for an ovarian mass in an inpatient setting in 11 children's hospitals in the United States between August 2018 and January 2021, with 1-year follow-up. Implementation of a consensus-based, preoperative risk stratification algorithm with 6 months of preintervention assessment, 6 months of intervention adoption, and 18 months of intervention. The intervention adoption cohort was excluded from statistical comparisons. Unnecessary oophorectomies, defined as oophorectomy for a benign ovarian neoplasm based on final pathology or mass resolution. A total of 519 patients with a median age of 15.1 (IQR, 13.0-16.8) years were included in 3 phases: 96 in the preintervention phase (median age, 15.4 [IQR, 13.4-17.2] years; 11.5% non-Hispanic Black; 68.8% non-Hispanic White); 105 in the adoption phase; and 318 in the intervention phase (median age, 15.0 [IQR, 12.9-16.6)] years; 13.8% non-Hispanic Black; 53.5% non-Hispanic White). Benign disease was present in 93 (96.9%) in the preintervention cohort and 298 (93.7%) in the intervention cohort. The percentage of unnecessary oophorectomies decreased from 16.1% (15/93) preintervention to 8.4% (25/298) during the intervention (absolute reduction, 7.7% [95% CI, 0.4%-15.9%]; P = .03). Algorithm test performance for identifying benign lesions in the intervention cohort resulted in a sensitivity of 91.6% (95% CI, 88.5%-94.8%), a specificity of 90.0% (95% CI, 76.9%-100%), a positive predictive value of 99.3% (95% CI, 98.3%-100%), and a negative predictive value of 41.9% (95% CI, 27.1%-56.6%). The proportion of misclassification in the intervention phase (malignant disease treated with ovary-sparing surgery) was 0.7%. Algorithm adherence during the intervention phase was 95.0%, with fidelity of 81.8%. Unnecessary oophorectomies decreased with use of a preoperative risk stratification algorithm to identify lesions with a high likelihood of benign pathology that are appropriate for ovary-sparing surgery. Adoption of this algorithm might prevent unnecessary oophorectomy during adolescence and its lifelong consequences. Further studies are needed to determine barriers to algorithm adherence.

Refractive errors in infants with retinopathy of prematurity treated using laser or anti-vascular endothelial growth factor monotherapy

Background: Infants treated for retinopathy of prematurity (ROP) could develop visually significant refractive errors. In this study, we report pre-treatment refractive errors in premature infants with treatment-requiring ROP treated using laser or anti-VEGF monotherapy and compare the components of post-treatment refractive error values between the two treatment groups at different follow-up timepoints.&#x0D; Methods: In this retrospective cohort study, we analyzed 360 eyes of 181 premature infants with treatment-requiring ROP who were referred to Farabi Eye Hospital, Tehran, Iran between March 2020 and April 2021. Of the 360 eyes, 195 received laser monotherapy (laser treatment group) and 165 received an intravitreal anti-VEGF injection (anti-VEGF therapy group). All included eyes underwent pre- and post-treatment cycloplegic refraction. Cycloplegia was induced for each infant by instilling a mixed eye drop containing 1% tropicamide, 2.5% phenylephrine, and 0.5% tetracaine (in equal volumes) in each eye three times at five-minute intervals. Cycloplegic refraction was performed 30 minutes after the third instillation.&#x0D; Results: The mean (standard deviation [SD]) gestational age (GA) and birth weight (BW) of the infants were 29.0 (2.0) weeks and 1241.0 (403.0) g, respectively. The male-to-female ratio in the entire study cohort was 107 (59.1%) / 74 (40.9%), whereas the ratios in the anti-VEGF therapy group and laser treatment group were 47 (56.6%) / 36 (43.4%) and 60 (61.2%) / 38 (38.8%), respectively. The pre-treatment assessment revealed that 218 (60.6%) eyes were hyperopic, 112 (31.1%) were myopic, and 30 (8.3%) were emmetropic. In the anti-VEGF therapy group, 87 (52.7%) eyes were hyperopic, 63 (38.2%) were myopic, and 15 (9.1%) were emmetropic. In the laser treatment group, 131 (67.2%) eyes were hyperopic, 49 (25.1%) were myopic, and 15 (7.7%) were emmetropic. The mean (SD) spherical refractive error and spherical equivalent of refractive error (SEQ) at the 1-week, 1-month, and &gt; 6-month post-treatment follow-up timepoints; the mean cylindrical refractive error at the 3-month post-treatment timepoint; and the mean SEQ at the time of ROP regression were significantly different between the treatment groups (all P &lt; 0.05). The rate of anisometropia increased significantly from 3.4% at baseline to 9.2% at the 6-month post-treatment follow-up timepoint (P &lt; 0.05).&#x0D; Conclusions: In this study, the most common pre-treatment refractive status of all included eyes with treatment-requiring ROP and eyes in each treatment group was hyperopia, followed by myopia and emmetropia. At the more than 6-month post-treatment follow-up, cycloplegic refraction revealed that the laser-treated eyes were significantly more hyperopic than the anti-VEGF-treated eyes, a finding similar to the pre-treatment refraction results. Further studies of same cohort with a longer follow-up period and a control group are needed to determine the real-world effect of each treatment modality on the refractive statuses of children treated for ROP.

The effect of DNA-V model intervention on learning behaviors and stress in Chinese adolescents: A randomized controlled trial

ObjectiveThe Discoverer Noticer Advisor-Value (DNA-V) model is an adaption of Acceptance and Commitment Therapy, which focuses on adolescent development and value-led behavioral change. However, few studies have validated the effectiveness of this model in adolescents in learning environments. This study thus aimed to examine the effectiveness of a Chinese version of the DNA-V model in a Chinese middle school student population. Additionally, we sought to determine whether online or face-to-face versions of the model were more effective. MethodsOne-hundred and thirty-six middle school students were randomly divided into a face-to-face DNA-V group (n = 40), an Internet DNA-V (iDNA-V) group (n = 50), and a traditional group (control, n = 46). The intervention was administered with a 45-min psychology course once a week for six weeks. The three groups were assessed on three core variables of academic learning motivation, strategies, and confidence, as well as stress at three time points (pre-intervention, post-intervention, and at a two-month follow-up). ResultsRepeated-measures ANOVA showed that the Group × Time Point interaction was significant for learning motivation (F(4,266) = 2.746, p = 0.029, ηp2 = 0.04) and stress (F(4,266) = 3.681, p = 0.006,ηp2 = 0.05). Learning motivation scores showed no between-group differences at any of the three time points, but the iDNA-V group showed significant improvement at the two-month follow-up and the traditional group showed significant gains at post-intervention that were maintained until the follow-up test. The DNA-V group exhibited lower stress scores at follow-up than at the pre-intervention assessment (p = 0.002) and post-intervention assessment (p = 0.005), with significantly lower stress follow-up scores than those of the iDNA-V (p = 0.024) and control (p = 0.023) groups. ConclusionThese results suggest that different intervention formats of DNA-V can be used as an alternative to traditional adolescent school psychology programs. It is important to consider how to emotionally support students when designing and developing internet-based DNA-V intervention programs to increase the effectiveness of this program for stress intervention.

Functional Outcomes and Toxicities Associated with SBRT to Bone Metastases Involving the Joint Space

Metastatic spread to bone is a common occurrence in advanced malignancies. Stereotactic Body Radiation Therapy (SBRT) is increasingly used for management of bone metastases in both the palliative and oligometastatic settings, especially for radioresistant histologies. Historically, therapeutic radiation to joints has been avoided whenever possible to minimize toxicities such as joint fibrosis and stiffness. Very little data exists to guide the treatment of bone metastases involving or adjacent to the joint space using SBRT. The purpose of this study is to report functional outcomes and toxicities associated with SBRT to metastatic bone lesions involving the joint space. Patients with solid tumor bone metastases involving the joints of long bones who were treated with SBRT (≥500 cGy/fraction; BED10 ≥37.5) who had ≥30 days follow up were identified from our institutional electronic health record using an IRB approved protocol. Pre-treatment and post-treatment pain assessments and toxicities were collected and scored retrospectively. Toxicities were categorized as acute (≤30 days post treatment) or late (>30 days post-treatment). Weidentified 40 evaluable patients with 54 lesions treated with SBRT. Lesions treated included those involving the hip (29/54, 54%), shoulder (11/54, 20%), elbow (8/54, 14%), and knee (6/54, 11%). The most common patient histology treated was renal cell carcinoma (13/40, 33%), followed by prostate adenocarcinoma (7/40, 18%), non-small cell lung cancer (4/40, 10%), and breast cancer (4/40, 10%). The remainder (12/40) had other histologies. Median follow up time was 7.7 months (range = 1.3-55.0). Median prescribed dose was 650 cGy/fraction (range = 500-1300 cGy) and most lesions received 4000 cGy in 5 fractions (18/54, 33%). At >30 days, of the 42 sites where pain was reported pre-treatment, 30/42 (71%) had complete or partial pain relief, while 10/42 (24%) experienced no pain relief during available follow up. Patients reported worsening pain after SBRT in 2/54 (3.7%) of treated lesions. Seven of 54 (14.0%) treated lesions led to complaints of joint stiffness requiring physical therapy. A minority of patients developed insufficiency fractures or treatment failures after SBRT requiring surgery (4/54, 7.4%). Three of 54 patients (5.6%) developed symptomatic radiation myositis confirmed on imaging. Toour knowledge, this is the first study to report functional and toxicity outcomes of SBRT to lesions involving the joints of long bones. While SBRT appears to have acceptable toxicities at the doses reported in this analysis, further study is warranted to identify pre-treatment factors predictive of toxicity. Limitations of the study include its small sample size, retrospective nature, and single institution design. Future studies will focus on dosimetric and clinical factors associated with toxicities which may allow for more personalized treatments and assist with informed consent.

Effectiveness of E-learning on clinical application of dental injection anatomy via simulation manikins.

E-learning is frequently integrated into dental education, yet little is known on the effectiveness of e-learning in both instilling foundational knowledge and facilitating translation of newly acquired knowledge and skill into clinical application. The objective of this study was to investigate the impact of learning modality on acquisition of knowledge and translation to clinical skill using objective feedback from oral anesthesia manikins and subjects' self-reported confidence scores. This mixed-method study involved first year dental students (n=52) who volunteered to participate in a learning intervention, simulation exercise, and survey in 2022. Students were randomly assigned to lecture (n=26) or e-learning (n=26) cohorts and then participated in the intervention, postintervention assessment, and a simulation to evaluate correct approaches for each dental block and attempts to success. All subjects scored significantly higher on post-intervention assessment compared to pre-intervention assessment (8.2vs. 5.9; p<0.0001) with no significant differences between intervention groups when comparing preintervention and postintervention scores. Furthermore, there were no significant differences between the two cohorts when comparing abilities to correctly approach each dental block or attempts to success. Finally, all students reported a significant increase in confidence in most categories following intervention and simulation, with no significant differences between lecture and e-learning cohorts. Our findings suggest students learning via e-learning are equally capable as those learning via lecture at demonstrating newly acquired knowledge and skill in both assessments and clinical simulations. Results support incorporating supplemental e-learning and oral anesthesia manikin exercises for students learning the anatomy of dental injections.

Effectiveness of Sensory Integration and Conventional Therapy on Impaired Kinesthesia in Peripheral Neuropathy

Background: Peripheral neuropathy is a result of damage to the nerves located outside of the brain and spinal cord. Over all prevalence in India varies from 5 - 2400 per 10,000 populations. Diabetic neuropathy is the most common type. Kinesthesia is the ability to sense the motion of a joint or limb. It is primarily influenced by muscle spindles and secondarily influenced by skin receptors and joint receptors. Objectives: To determine the effectiveness of sensory integration on kinesthesia in peripheral neuropathy and to compare the effect of sensory integration with conventional therapy on kinesthesia in peripheral neuropathy. Materials And Methods: This was an experimental study conducted on 68 subjects in which Group A received conventional therapy (control) and another group received sensory integration along with conventional therapy (experimental). Simple Random Sampling technique was used. Pre intervention assessment was done and treatment was given for 6 weeks. Post intervention assessment was done with help of outcome measures. Statistical analysis was done using students t test. Results: Among the 68 subjects, Group B which received sensory integration along with conventional therapy showed extremely significant improvement in impaired kinesthesia. In the Weber two point discrimination test, the post intervention comparison (8.6 with group A and 5.98 with group B) showed that group was extremely significant in improving joint position sense. In joint position sense for plantar flexion and dorsiflexion, Group B showed extremely proximate results to range which was asked and the range which was performed by the subjects. Conclusion: Sensory integration therapy was found to be significantly effective on impaired kinesthesia in peripheral neuropathy.

İnsan Aktivite Modeli Temelli Ergoterapi Müdahalesinin Aile İçi Şiddet Yaşayan Kadınlarda Etkinliği

Purpose: Experiences of violence negatively affect women's independence and daily activities. The aim of this study was to investigate the effectiveness of the "Model of Human Occupation (MOHO)"-based occupational therapy intervention on the occupational competence and occupational participation of women affected by domestic violence and living in a women's shelter. Materials and Methods: The MOHO-based occupational therapy program, which includes 10 intervention areas, was applied to 13 women in two women’s shelters. Four-week (16 sessions) individual and group training and environmental interventions were provided. Participants' occupational competence was assessed with the “Occupational Self-Assessment” and occupational participation with the “Model of Human Occupation Screening Tool”. Assessments were conducted before the intervention, after the intervention, and at the 3-month follow-up. Results: Statistically significant differences were found in occupational competence (p=0.002) and occupational participation (p=0.004) between pre-intervention and 3-month follow-up assessments. Improvements were noted in all domains (OSA-competence, and volution, habituation, communication-interaction, process skills, and environment parameters of MOHOST) (p0.05). Discussion: MOHO-based occupational therapy interventions delivered in women's shelters could have a positive impact on the occupational competence and occupational participation of women experiencing violence.

Acceptability and Feasibility of a Socially Enhanced, Self-Guided, Positive Emotion Regulation Intervention for Caregivers of Individuals With Dementia: Pilot Intervention Study.

The responsibilities of being a primary caregiver for a loved one with dementia can produce significant stress for the caregiver, leading to deleterious outcomes for the caregiver's physical and psychological health. Hence, researchers are developing eHealth interventions to provide support for caregivers. Members of our research team previously developed and tested a positive emotion regulation intervention that we delivered through videoconferencing, in which caregiver participants would meet one-on-one with a trained facilitator. Although proven effective, such delivery methods have limited scalability because they require significant resources in terms of cost and direct contact hours. This study aimed to conduct a pilot test of a socially enhanced, self-guided version of the positive emotion regulation intervention, Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF). Studies have shown that social presence or the perception of others in a virtual space is associated with enhanced learning and user satisfaction. Hence, the intervention leverages various social features (eg, discussion boards, podcasts, videos, user profiles, and social notifications) to foster a sense of social presence among participants and study team members. Usability, usefulness, feasibility, and acceptability data were collected from a pilot test in which participants (N=15) were given full access to the SAGE LEAF intervention over 6 weeks and completed preintervention and postintervention assessments (10/15, 67%). Preliminary outcome measures were also collected, with an understanding that no conclusions about efficacy could be made, because our pilot study did not have a control group and was not sufficiently powered. The results suggest that SAGE LEAF is feasible, with participants viewing an average of 72% (SD 42%) of the total available intervention web pages. In addition, acceptability was found to be good, as demonstrated by participants' willingness to recommend the SAGE LEAF program to a friend or other caregiver. Applying Pearson correlational analyses, we found moderate, positive correlation between social presence scores and participants' willingness to recommend the program to others (r9=0.672; P=.03). We also found positive correlation between social presence scores and participants' perceptions about the overall usefulness of the intervention (r9=0.773; P=.009). This suggests that participants' sense of social presence may be important for the feasibility and acceptability of the program. In this pilot study, the SAGE LEAF intervention demonstrates potential for broad dissemination for dementia caregivers. We aim to incorporate participant feedback about how the social features may be improved in future iterations to enhance usability and to further bolster a sense of social connection among participants and study staff members. Next steps include partnering with dementia clinics and other caregiver-serving organizations across the United States to conduct a randomized controlled trial to evaluate the effectiveness of the intervention.

Prediction of Treatment Outcome in Major Depressive Disorder Using Ensemble of Hybrid Transfer Learning and Long Short-Term Memory Based on EEG Signal

Major Depressive Disorder (MDD) is a widespread global mental disease. The Effectiveness of Selective Serotonin Reuptake Inhibitors (SSRIs) antidepressants prescribed for MDD patients is limited and pre-treatment assessment of treatment outcome is a vital task. In this study, a hybrid model based on Transfer Learning (TL) of powerful pre-trained deep Convolutional Neural Networks (CNNs) empowered with bidirectional Long Short-term Memory (BLSTM) cells and attention mechanism were developed to classify Responders (R) and Non-Responders (NR) to SSRI antidepressants, using raw data images of pre-treatment EEG signal obtained from 30 MDD patients. TL-LSTM-Attention models based on VGG16, Xception, and Densenet121 models were created for the classification of R/NR. Results show that the highest performance of hybrid TL-LSTM-Attention models was achieved by VGG16-LSTM-Attention with an accuracy of 98.21%, sensitivity of 96.22%, and specificity of 99.67%. An Ensemble model based on weighted majority voting among hybrid models is constructed to surpass the performance of each single hybrid model. Our proposed ensemble model gained accuracy, sensitivity, and specificity of 98.84%, 97.80%, and 99.60%, respectively. Hence, the proposed model which is an ensemble of TL-LSTM-Attention models fed by raw data images of EEG signal leads to high confidence in the prediction of antidepressants treatment outcome.

Infection prevention and vaccination in the rheumatic diseases.

Patients with chronic inflammatory rheumatisms (CIR) have a higher risk of infections compared to healthy subjects. Viral and bacterial pneumonia are the most frequent infections observed in CIR with targeted disease modifying anti-rheumatic drugs (DMARDs). Moreover, drugs used to treat CIR (especially biologic and synthetic targeted DMARDs) increase the risk of infection and expose CIR patients to opportunistic infections such as tuberculosis reactivation. To limit the risk of infection, the risk-benefit ratio should be evaluated for each patient based on their characteristics and comorbidities. To prevent infections, an initial pre-treatment work-up must be performed, especially before the initiation of conventional synthetic DMARDs or biological and synthetic targeted DMARDs. This pre-treatment assessment includes the case history, laboratory and radiology findings as well. The physician must make sure a patient's vaccinations are up-to-date. The vaccines recommended for patients with CIR being treated with conventional synthetic DMARDs, bDMARDs, tsDMARDs and/or steroids should be given. Patient education is also very important. During workshops, they learn how to manage their drug treatments in at-risk situations and learn which symptoms require treatment discontinuation.

Nurses' knowledge on assessment and management of cancer therapy-associated oral mucositis.

This study aimed to explore baseline nursing knowledge on assessment and management of patients at risk for developing cancer therapy-associated oral mucositis (OM) at a tertiary hospital in Ghana. A descriptive generic qualitative study design was conducted. The study population were nurses who cared for patients diagnosed with cancer. Participants were recruited using a purposive non-probability sampling technique. Data were obtained through face-to-face interviews using semi-structured interview guide. Data collection and analysis were done concurrently. The study found that nurses had knowledge on the pre-treatment assessment of clients undergoing cancer treatment; however, they had insufficient knowledge on the standardized tool for the assessment of OM. They also lack a definitive approach to prevent and treat OM. Nurses provided general education on cancer treatment but paid little attention to the education on the possible side effect that includes OM. Additionally, insufficient knowledge level of nurses on cancer treatment-associated mucositis and lack of structured protocol for OM coupled with unavailable tools for assessing the oral mucosa were also identified as militating against the management of OM. Findings from this study will guide policy that will improve the care that clients who are at risk of oral mucositis receive.

Predictive factors and clinical efficacy of Chinese medicine Shengji ointment in the treatment of diabetic foot ulcers in the elderly: a prospective study.

Objective: This study aims to investigate the predictive factors and efficacy of traditional Chinese medicine Shengji Ointment in the treatment of diabetic foot ulcers in the elderly population, with the intent of formulating an effective predictive model for deep diabetic foot ulcer healing. The importance of this research lies in its provision of new perspectives and tools for addressing the severe health impact of diabetic foot ulcers in the elderly population, considering the complexity and diversity of its treatment methods. Methods: The study includes 180 elderly patients with Wagner grade 3-4 diabetic foot ulcers that involve the tendon or fascia. The dependent variable is the initiation time of granulation tissue development. Independent variables encompass demographic information, a treatment strategy including Shengji Ointment, pre-treatment trauma assessment data, routine blood count, and biochemical index test results. Lasso regression is employed for variable selection, and Cox regression is utilized for the construction of a prediction model. A nomogram is generated to authenticate the model. Results: The Chinese Medicine treatment approach, ulcer location, creatinine levels, BMI, and haemoglobin levels are identified as independent predictors of granulation tissue development in diabetic foot ulcers. The combined treatment of Chinese herbal Shengji ointment and bromelain positively influenced granulation tissue development. The location of plantar ulcers, impaired renal functionality, obesity, and anaemia are established as independent risk factors that might influence the speed and probability of ulcer healing. The area under the time-dependent ROC curve fluctuates between 0.7 and 0.8, demonstrating substantial discrimination and calibration of the model. Conclusion: The study ascertains that a combined treatment strategy incorporating Shengji Ointment demonstrates greater effectiveness than the use of cleansing gel debridement alone in facilitating the healing of Wagner grade 3 or higher diabetic foot ulcers. Furthermore, the predictive model developed in this research serves as a valuable tool in evaluating the efficacy of Chinese Medicine treatments like Shengji Ointment for diabetic foot ulcers in the elderly. It aids clinicians in effectively assessing and adjusting treatment strategies, thereby proving its significant application value in clinical practice. Clinical Trial Registration: (https://www.chictr.org.cn/hvshowproject.html?id=73862&v=1.5&u_atoken=b403af53-d3b9-41ae-a7e2-db5498609b0c&u_asession=01tNh69p235bMUO4CmHIXcv8Hxirl5-557Duue9QB5lGfl3mf8IvPlcs2kN2zC30voX0KNBwm7Lovlpxjd_P_q4JsKWYrT3W_NKPr8w6oU7K_AyPrQhedMUWBMR2-ZDL_KO0uwDPR9XlF566xraDvT9mBkFo3NEHBv0PZUm6pbxQU&u_asig=05Kd_Q8fjv-24MVbZpOS9ef3xuCCN-tSVH5eUoJKgNLM7E0-n0zMpW6xLq9gh9aUhkKEEA15rdDoCydncF99APBwVSaTPgEG_V_B1iT4wimdCTxV_4ZVbTlDewxyQtE4YgU4-Oza7KPi94RJ64Utel0yZfqg3Tlm-bVxFNOY-zXFP9JS7q8ZD7Xtz2Ly-b0kmuyAKRFSVJkkdwVUnyHAIJzSYJ6SfhFl0WMTCCasZ7zV2I2qfyrp5m-SELPVeREKgX_6yRmLu26qT8kGfcS-Yaeu3h9VXwMyh6PgyDIVSG1W-7D_Sko5YQtpDbs3uvezYkZcUUY4o9-zDPaoYelmMDs8u7I4TPvtCXaPp44YUJcQ9bHr-_RmKA5V8nji3daArhmWspDxyAEEo4kbsryBKb9Q&u_aref=NNH1nHSUCE6pNvCilV%2F1MD0aERs%3D), identifier (ChiCTR2000039327).