Presurgical Patients Research Articles

Diagnosis and Treatment of Perioperative Anemia: A Society for Perioperative Assessment and Quality Improvement Collaborative Review.

Anemia is common in presurgical patients and is associated with poor clinical outcomes, even without erythrocyte transfusion. Structured preoperative programs for anemia management are associated with fewer blood transfusions, increased hemoglobin concentrations, and improved outcomes.

Patient and healthcare practitioner evaluation of patient-reported outcomes in bariatric surgery - a modified Delphi study.

Patient-reported outcomes are an important emerging metric increasingly utilised in clinical, research and registry settings. These outcomes, while vital, are underutilised and require refinement for the specific patient population of those undergoing bariatric surgery. This study aimed to investigate and compare how pre-surgical patients, post-surgical patients, and healthcare practitioners evaluate patient-reported outcomes of bariatric surgery to identify outcomes that are considered most important. A modified Delphi survey was distributed to patients pre- and post-surgery, and to a variety of healthcare practitioners involved in bariatric care. Across two rounds, participants were asked to rate a variety of physical and psychosocial outcomes of bariatric surgery from 0 (Not Important) to 10 (Extremely Important). Outcomes rated 8-10 by at least 70% of participants were considered highly important (prioritised). The highest-rated outcomes were compared between the three groups as well as between medical and allied health practitioner subgroups. 20 pre-surgical patients, 95 post-surgical patients, and 28 healthcare practitioners completed both rounds of the questionnaire. There were 58 outcomes prioritised, with 21 outcomes (out of 90, 23.3%) prioritised by all three groups, 13 (14.4%) by two groups, and 24 (26.7%) prioritised by a single group or subgroup. Unanimously prioritised outcomes included 'Co-morbidities', 'General Physical Health', 'Overall Quality of Life' and 'Overall Mental Health'. Discordant outcomes included 'Fear of Weight Regain', 'Suicidal Thoughts', 'Addictive Behaviours', and 'Experience of Stigma or Discrimination'. While there was considerable agreement between stakeholder groups on many outcomes, there remain several outcomes with discordant importance valuations that must be considered. In particular, healthcare practitioners prioritised 20 outcomes that were not prioritised by patients, emphasising the range of priorities across stakeholder groups. Future work will consider these priorities to ensure resulting measures encompass all important outcomes and are beneficial and valid for end users.

B - 10 Performance Validity Test Failure Base Rates among Presurgical Epilepsy Referrals

Abstract Objective Patients with epilepsy undergoing presurgical workup are generally considered a population without clear incentive to perform invalidly during neuropsychological evaluation. This study investigated the base rates of performance validity test (PVT) failure among a sample of presurgical epilepsy patients. Participants and. Methods Data were collected from 68 consecutive patients with epilepsy undergoing outpatient neuropsychological evaluation for surgical candidacy. The sample included 33 males/35 females, had a mean age of 36.29 (SD = 12.07), mean education of 12.51 (SD = 2.23), and was racially and ethnically diverse. All patients were administered a number of freestanding (Test of Memory Malingering [TOMM], Dot Counting Test [DCT], Coin-in-Hand [CIH]) and embedded (Rey Auditory Verbal Learning Test-Forced Choice [RAVLT-FC], Wechsler Memory Scale–3rd Edition Digit Span Reliable Digit Span [WMS-III DS RDS]) PVTs within a comprehensive neuropsychological assessment battery. Results Overall, 9% of the sample failed ≥2 PVTs, suggesting invalidity. An additional 22% failed 1 PVT. However, a large portion of the sample (69%) passed all freestanding and embedded PVTs. Among the freestanding PVTs, the failure rates were TOMM: 4%, DCT: 21%, and CIH: 3%. Failure rates on embedded PVTs were RAVLT-FC: 15% and WMS-III DS RDS: 3%. Conclusions Although there is not an expected incentive for suboptimal neuropsychological performance among presurgical epilepsy patients, results show a critical need for objective validity assessment to guard against inaccurate surgical prognostication from invalid test data for patients undergoing high-stakes presurgical evaluations. Given the high invalidity rate on some individual PVTs, further research is necessary to cross-validate established PVT cut-scores in epilepsy-specific populations.

B - 9 Implications of Cognitive Reserve (CR) in Pre-Surgical Epilepsy Patients: a Case Series

Abstract Objective Localization-related epilepsy is a chronic neurological condition for which neurosurgical interventions are effective. The pre-surgical evaluation process requires careful analysis of neuropsychological data to localize and lateralize areas of underlying neuropathology to guide surgical planning and post-operative prognostication. While it is well-described throughout the literature that global impairments may obscure patterns of discernable neurocognitive strengths and weaknesses, specifically in pre-surgical epilepsy evaluations, less is known about the impact of cognitive reserve (CR). CR, often described in the aging literature, refers to high levels of mental reserve acquired from educational, vocational and intellectual capacities, with the potential to guard against neurocognitive decline. Method Four right-handed patients (ages 24–44) with localization-related, medically-refractory epilepsy with left hemisphere onset (2 temporal and 2 extra temporal onset) underwent a comprehensive neuropsychological evaluation as part of a comprehensive pre-surgical workup. Results The CR conglomerate for these four patients (i.e., educational, vocational attainment and scores on premorbid cognitive metrics) fell in the Very High range. Three out of four patients did not evince the clinically-significant pattern of deficit (>1.5 SD lower than premorbid estimate) on verbally-mediated tasks often seen in right-handed individuals with left-sided seizure onset (i.e., diminished naming and verbal learning). Conclusion The reasons underlying the manifestation of definitively localizing or lateralizing neuropsychological profile differs from patient-to-patient (i.e., handedness, duration of epilepsy, structural lesion, language(s) spoken); however, CR should also be considered an important confound when interfacing with data of questionable clinical utility and prognostic value.

How Does Nerve Mechanical Interface Treatment Impact Pre-Surgical Carpal Tunnel Syndrome Patients? A Randomized Controlled Trial.

Carpal tunnel syndrome (CTS) presents a high burden on the healthcare system. However, no alternative treatments are provided during the waiting period. In addition, the incidence of severe patients with comorbidities is underestimated. The aim of this study was to determine whether nerve mechanical interface treatment improves the symptoms, function, and quality of life in pre-surgical CTS patients. A randomized controlled trial and intention-to-treat analysis were carried out. Forty-two patients with an electrodiagnosis of carpal tunnel syndrome, included on the surgery waiting list of a public healthcare system, were analyzed. The intervention group (n = 20) received a 45 min session/per week of instrument-assisted manual therapy (diacutaneous fibrolysis) for 3 weeks. The Boston Carpal Tunnel Questionnaire (BCTQ) was the primary outcome. The symptoms, mechanical threshold, grip strength, mechanosensitivity of the median nerve, quality of life, and patient satisfaction were included as secondary outcomes. The control group (n = 22) remained on the waiting list. The intervention seems to be beneficial for the BCTQ score (function and symptoms scale), pain, and mechanosensitivity after treatment, at the 3 and 6 months follow-up (p < 0.05). Kinesiophobia was improved at 6 months (p = 0.043; η2 = 0.10) and the mechanical threshold at the 3-month follow-up (p = 0.048; η2 = 0.10). No differences were identified for grip strength. At 6 months, the intervention group patients were satisfied (100%), as opposed to the controls, who felt that they had experienced a worsening of their condition (50.1%). Nerve mechanical interface treatment improved the symptoms, function, and quality of life in pre-surgical CTS patients. One hundred percent of the treated patients, characterized as moderate and severe CTS with associated comorbidities, were satisfied.

Utilizing connectome fingerprinting functional MRI models for motor activity prediction in presurgical planning: A feasibility study.

Presurgical planning prior to brain tumor resection is critical for the preservation of neurologic function post-operatively. Neurosurgeons increasingly use advanced brain mapping techniques pre- and intra-operatively to delineate brain regions which are "eloquent" and should be spared during resection. Functional MRI (fMRI) has emerged as a commonly used non-invasive modality for individual patient mapping of critical cortical regions such as motor, language, and visual cortices. To map motor function, patients are scanned using fMRI while they perform various motor tasks to identify brain networks critical for motor performance, but it may be difficult for some patients to perform tasks in the scanner due to pre-existing deficits. Connectome fingerprinting (CF) is a machine-learning approach that learns associations between resting-state functional networks of a brain region and the activations in the region for specific tasks; once a CF model is constructed, individualized predictions of task activation can be generated from resting-state data. Here we utilized CF to train models on high-quality data from 208 subjects in the Human Connectome Project (HCP) and used this to predict task activations in our cohort of healthy control subjects (n = 15) and presurgical patients (n = 16) using resting-state fMRI (rs-fMRI) data. The prediction quality was validated with task fMRI data in the healthy controls and patients. We found that the task predictions for motor areas are on par with actual task activations in most healthy subjects (model accuracy around 90%-100% of task stability) and some patients suggesting the CF models can be reliably substituted where task data is either not possible to collect or hard for subjects to perform. We were also able to make robust predictions in cases in which there were no task-related activations elicited. The findings demonstrate the utility of the CF approach for predicting activations in out-of-sample subjects, across sites and scanners, and in patient populations. This work supports the feasibility of the application of CF models to presurgical planning, while also revealing challenges to be addressed in future developments. PRACTITIONER POINTS: Precision motor network prediction using connectome fingerprinting. Carefully trained models' performance limited by stability of task-fMRI data. Successful cross-scanner predictions and motor network mapping in patients with tumor.

Taming Anxiety Before Surgery: Video Education Reduces Pre-Operation Patient Anxiety

Pre-operative anxiety is normal, but can have a negative impact on the patient's health. Therefore, it is necessary to educate patients who will undergo surgery to reduce their anxiety levels. Providing education through videos has proven effective in reducing anxiety, this is because video media allows the delivery of more interesting and interactive information. The purpose of this community service activity is to determine the effect of video education on the anxiety of pre-surgical patients at Lavalette hospital Malang City. This community service program consists of two stages, namely socialization to families of surgical patients and training in the application of nursing interventions, anxiety reduction education in preoperative patients. The effectiveness of the program is evaluated by pre-test and post-test methods. The result of this community service activity is that video education has proven effective in reducing anxiety of pre-operative patients. It can be concluded that video education is an effective way to reduce anxiety in pre-operative patients and needs to be widely applied in hospitals.

Understanding the Mechanosensitivity of the Median Nerve in Pre-Surgical Carpal Tunnel Syndrome Patients: A Correlational Study

(1) Background: Neurodynamic tests are recommended for the diagnosis of entrapment neuropathies such as carpal tunnel syndrome (CTS). However, their association with clinical variables in severe patients or patients with associated comorbidities is poorly documented. This study aims to analyze the association between the mechanosensitivity of the median nerve and symptoms, function and psycho-social variables in moderate and severe carpal tunnel syndrome patients with comorbidities; (2) Methods: Correlational study. In total, 42 pre-surgical patients (24 females; 59.1 ± 12.7 years) included in the Spanish Public Healthcare System with an electrodiagnostic of CTS were selected. Sociodemographic variables and clinical features (symptoms, function, sensitivity and quality of life evaluated with the 36-item Short Form Survey (SF-36) and the Medical Outcomes Study Sleep Scale (MOS-sleep) were recorded. Upper Limb Neurodynamic Test 1 was used to evaluate neural mechanosensitivity; (3) Results: The 81% had a severe CTS and 78.6% had some comorbidity. The average time from the first medical visit to the surgeon’s visit was 365.5 days. Median nerve mechanosensitivity correlated weakly with the SF-36 subscale, General Health, (Spearman’s rho = 0.367) and MOS sleep scale, Awaken Short of Breath or with headache dimension (Spearman’s rho = −0.353) and moderately with SF-36 subscale, Social Functioning (Spearman’s rho = 0.553); (4) Conclusions: No associations were observed for median nerve mechanosensitivity, except for quality of life and sleep. Both social determinants and clinical variables should be considered when examining and treating these patients.

Association of Cognitive Reserve and Preoperative Cognitive Function in Patients with Adult Moyamoya Disease: A Preliminary Study.

Many patients with moyamoya disease (MMD) exhibit cognitive decline; however, the link between cognitive reserve (CR) and cognitive function in those who have not undergone revascularization remains unexplored. We aimed to evaluate preoperative cognitive impairment in such patients and to explore the relationship between CR, measured using the Cognitive Reserve Index questionnaire (CRIq), and cognitive abilities across different domains, determined using neuropsychological tests. Demographic, clinical, CRIq, and neuropsychological assessment data were gathered from patients with MMD who underwent preoperative cognitive functional assessments at our center during 2021-2023. These patients were categorized according to their Montreal Cognitive Assessment score. Multivariable linear regression was performed to analyze the association between CRIq score and cognitive performance, both globally and in specific domains. In the MMD cohort of 53 patients, 49% (n = 26) of the patients exhibited a decrease in overall cognitive performance. Individuals with cognitive dysfunction had significantly lower composite CRIq scores than those with intact cognition. Although no association between overall cognitive ability and CR was observed, independent associations emerged between CR and specific cognitive functions - language (β = 0.56, p = 0.002), verbal memory (β = 0.45, p = 0.001), and executive function (β = 0.35, p = 0.03). This preliminary study revealed that expressive language, verbal memory, and executive function are linked to CR in presurgical patients with MMD, highlighting the role of CR in predicting cognitive outcomes. Further research is warranted to elucidate the combined effects of CR and other risk factors on the cognitive function of patients with MMD.

Reference intervals for knee functions specific to outpatients with knee osteoarthritis: a cross-sectional study

BackgroundReference values (RVs) for knee function tests have been reported in perioperative patients with knee osteoarthritis (KOA); however, such values for practical use in outpatient setting has yet to be determined. Therefore, we aimed to establish the reference intervals (RIs) for outpatients with mild to moderate KOA.MethodsThis cross-sectional study enrolled 202 outpatients with KOA from 8 Japanese orthopedic clinics and measured knee extensor/flexor muscle strength (MS) and knee extension/flexion range of motion (ROM). We used multiple regression analysis to evaluate the sources of variation, including sex, age, body mass index, Kellgren–Lawrence (K-L) classification, bilateral KOA, and exercise habits. Magnitude of between-subgroup differences is expressed as standard deviation ratio (SDR) based on a three-level nested analysis of variance, with SDR ≥ 0.4 as the threshold for requiring RIs specific for subgroups. RIs were calculated parametrically using two-parameter Box-Cox formula if Gaussian transformation of RVs was successful, otherwise calculated nonparametrically.ResultsPartitioning was required by sex for extensor and flexor MS (SDR = 0.65, 0.57, respectively) and by K-L classification for flexion ROM (SDR = 0.54). RIs were determined parametrically for extensor MS as 0.27–2.09 (male) and 0.27–1.54 (female) Nm/kg and for flexor MS 0.18–1.20 (male) and 0.13–0.79 (female) Nm/kg. On the other hand, RIs for extension and flexion ROM were determined nonparametrically due to discrete nature of their RVs. The RIs determined for extension ROM were -15°–0° and for flexion ROM were 105°–150° (for K-L grade I/II) and 95°–140° (for K-L grade III/IV).ConclusionsThe ranges of RIs determined specifically for patients with mild to moderate KOA were in-between those of age-matched healthy controls and pre-surgical KOA patients, both of which we had reported for use in physiotherapeutic management of KOA patients undergone total knee arthroplasty. The newly derived RIs will provide an objective benchmark for physiotherapy targeting outpatients with mild to moderate KOA.

Herbal treatments used by patients before surgery: A literature review example

Aim: Herbs, which hold significant historical significance in medicine and have been utilized for centuries to manage and prevent illnesses, interact with medications. This interaction extends to anesthetics and drugs administered during surgical procedures. Identifying these herbal remedies and discontinuing their use at appropriate intervals is crucial. This study aimed to identify publications examining the utilization of herbal medicine by presurgical patients through the PubMed database.Method: Literature published between 2000 and 2023 was scrutinized using the keywords "herbal medicine, presurgical patients" in the PubMed database for this study.Results: Among the studies, 56.2% constituted research articles and were thus included in the study. Those conducted within the last decade accounted for 22.2% of our sample. The majority of the studies were conducted in the United States (44.4%). The most frequently used herbs among the publications included in the sample were Echinacea (Echinacea) (n=5), Ginseng (Panax), Ginkgo biloba (n=3), Perforate St John's-wort (n=3), and Garlic (Allium sativum) (n=3).Conclusions: Insights into preoperative herbal use are pivotal. It is well-established that herbs interact with anesthetic medications. The findings of this review indicate a paucity of literature on this subject globally. Therefore, there is a demand for more rigorous, experimental studies to raise awareness among healthcare professionals.

Patient sex and race are associated with differences in coronal plane alignment classification in native arthritic knees.

Purpose: The purpose of this study was to evaluate associations between demographics and Coronal Plane Alignment of the Knee (CPAK) classification in pre-surgical TKA patients. Methods: This is a retrospective study of 1167 patients with knee osteoarthritis who underwent TKA. CPAK categories I-IX were determined by arithmetic mechanical hip-knee-ankle angle and joint line obliquity measurements from pre-operative bone length radiographs. Patient age, sex, body mass index (BMI) and race were collected. Chi-square test of independence and adjusted Pearson's residuals evaluated associations between CPAK classification and demographics. Results: There was a significant association between CPAK phenotypes I-IX and patient sex (X2 = 5.8, p < 0.01). A positive association was found between both men and CPAK phenotype I, and women and CPAK phenotype VII. A positive association was found between African American patients and CPAK phenotype III and a negative association was found between African American patients and CPAK phenotype I (X2 =14.8, p-value = 0.01). There was no association between age and BMI with CPAK phenotypes (n.s.). Conclusion: These results indicate that there are unidentified sex and race differences that exist in the CPAK classification of native arthritic knees. Patient characteristics play a significant role in determining patient knee phenotypes. Further research should investigate whether these characteristics warrant inclusion in pre-operative preparations, aiming to enhance the personalization of arthroplasty procedures.

EMG-projected MEG high-resolution source imaging of human motor execution: Brain-muscle coupling above movement frequencies.

Magnetoencephalography (MEG) is a non-invasive functional imaging technique for pre-surgical mapping. However, movement-related MEG functional mapping of primary motor cortex (M1) has been challenging in presurgical patients with brain lesions and sensorimotor dysfunction due to the large numbers of trials needed to obtain adequate signal to noise. Moreover, it is not fully understood how effective the brain communication is with the muscles at frequencies above the movement frequency and its harmonics. We developed a novel Electromyography (EMG)-projected MEG source imaging technique for localizing early-stage (-100 to 0 ms) M1 activity during ~l min recordings of left and right self-paced finger movements (~1 Hz). High-resolution MEG source images were obtained by projecting M1 activity towards the skin EMG signal without trial averaging. We studied delta (1-4 Hz), theta (4-7 Hz), alpha (8-12 Hz), beta (15-30 Hz), gamma (30-90 Hz), and upper-gamma (60-90 Hz) bands in 13 healthy participants (26 datasets) and three presurgical patients with sensorimotor dysfunction. In healthy participants, EMG-projected MEG accurately localized M1 with high accuracy in delta (100.0%), theta (100.0%), and beta (76.9%) bands, but not alpha (34.6%) or gamma/upper-gamma (0.0%) bands. Except for delta, all other frequency bands were above the movement frequency and its harmonics. In three presurgical patients, M1 activity in the affected hemisphere was also accurately localized, despite highly irregular EMG movement patterns in one patient. Altogether, our EMG-projected MEG imaging approach is highly accurate and feasible for M1 mapping in presurgical patients. The results also provide insight into movement-related brain-muscle coupling above the movement frequency and its harmonics.

MRI evidence for material-specific encoding deficits and mesial-temporal alterations in presurgical frontal lobe epilepsy patients.

Neuroimaging studies reveal frontal lobe (FL) contributions to memory encoding. Accordingly, memory impairments are documented in frontal lobe epilepsy (FLE). Still, little is known about the structural or functional correlates of such impairments. Particularly, material specificity of functional changes in cerebral activity during memory encoding in FLE is unclear. We compared 24 FLE patients (15 right-sided) undergoing presurgical evaluation with 30 healthy controls on a memory fMRI-paradigm of learning scenes, faces, and words followed by an out-of-scanner recognition task as well as regarding their mesial temporal lobe (mTL) volumes. We also addressed effects of FLE lateralization and performance level (normal vs. low). FLE patients had poorer memory performance and larger left hippocampal volumes than controls. Volume increase seemed, however, irrelevant or even dysfunctional for memory performance. Further, functional changes in FLE patients were right-sided for scenes and faces and bilateral for words. In detail, during face encoding, FLE patients had, regardless of their performance level, decreased mTL activation, while during scene and word encoding only low performing FLE patients had decreased mTL along with decreased FL activation. Intact verbal memory performance was associated with higher right frontal activation in FLE patients but not in controls. Pharmacoresistant FLE has a distinct functional and structural impact on the mTL. Effects vary with the encoded material and patients' performance levels. Thus, in addition to the direct effect of the FL, memory impairment in FLE is presumably to a large part due to functional mTL changes triggered by disrupted FL networks. Frontal lobe epilepsy (FLE) patients may suffer from memory impairment. Therefore, we asked patients to perform a memory task while their brain was scanned by MRI in order to investigate possible changes in brain activation during learning. FLE patients showed changes in brain activation during learning and also structural changes in the mesial temporal lobe, which is a brain region especially relevant for learning but not the origin of the seizures in FLE. We conclude that FLE leads to widespread changes that contribute to FLE patients' memory impairment.

Importance of the psychological nursing approach in pre-surgical adult patients

Introduction: Psychological preparation in the patient is very important before the surgical intervention regardless of the diagnosis and procedure to be performed, in this way it helps to reduce the degree of anxiety, fear and anguish presented before, during and after surgery. Providing the necessary information that the patient should know is important to clarify all types of doubts and concerns regarding the condition they present; It is necessary to inform the benefits and risks that surgical treatment entails, as well as to remain calm so as not to inhibit the administration of medication such as analgesics. Objective: Determine the importance of the psychological approach by nursing staff in pre-surgical adult patients to reduce anxiety and fear as well as reduce complications in the operating room. Methodology: A review of scientific articles from the databases PubMed, Scielo, Google Scholar was carried out, where the years of publication were considered to be from 5 years ago, in order to know the psychological preparation before surgery. Results: It was identified that psychological preparation is the fundamental phase to reduce anxiety before a surgical intervention, it helps to remain calm throughout the procedure, reducing complications and favoring the patient's prompt recovery. Conclusions: Psychological preparation towards the patient is of great importance to reduce fear, anxiety, worry, fear and stress, it must be done in a way that allows quality care to be provided with a more humanized treatment.

Abstract C028: Using novel multiomic plasma profiling from liquid biopsies to identify potential signatures for disease diagnostics in late-stage non-small cell lung cancer (NSCLC) in Trinidad and Tobago

Abstract Lung cancer is the leading cause of cancer-associated deaths in North America, with the vast majority being non-small cell lung cancer (NSCLC) with a five-year survival rate of only 24%. Non-invasive discovery of biomarkers associated with early-diagnosis of NSCLC can enable precision oncology efforts using liquid biopsy-based multiomic profiling of plasma cell-free DNA. Although tissue biopsies are currently the gold standard for tumor profiling, this method presents many limitations since these are invasive, risky, and sometimes hard to obtain as well as only giving a limited tumor profile. Blood-based, biomarker directed liquid biopsies provide a less-invasive, more robust approach to interrogate both tumor- and non-tumor-derived signals. Liquid biopsies can delineate complex tumoral genomic and proteomic profiles throughout tumor evolution and are increasingly used for cancer diagnostics that enables a precision oncology approach. We intend to examine 30 stage III-IV NSCLC pre-surgical patients and collect plasma samples. Cell-free DNA (cfDNA) will be extracted from plasma, and next-generation sequencing (NGS) performed as well as comparative traditional diagnostics. Through the analysis of tumor-specific alterations used as biomarkers, including single nucleotide variants (SNVs), insertions, deletions, copy number variations (CNVs), and methylation alterations we intend to identify tumor-derived DNA—ctDNA, among the total pool of cfDNA. Analysis of cancer genotyping for diagnostic purposes will also be compared to accuracy of traditional, imaging and tissue-based techniques. Using liquid biopsies offer opportunities to improve the surveillance of cancer patients during treatment and would supplement current diagnosis and tumor profiling strategies previously not readily available in Trinidad and Tobago. There are a vast number of advantages to use molecular biomarkers like liquid biopsies in diagnosis and tumor profiling as well as to monitor cancer patients, providing early information regarding disease evolution and treatment efficacy, and reorient treatment strategies rapidly, thereby improving clinical oncology outcomes. With the development of both experimental protocols and computational methods dedicated to liquid biopsy, the implementation of multi-omics strategies into the clinical workflow, especially in an under-performing clinical diagnostic system, will benefit the clinical management of cancers including decision-making guidance and patient outcome improvement in the underserved communities of Trinidad and Tobago. Citation Format: Samuel M. West, Nicole Ramlachan. Using novel multiomic plasma profiling from liquid biopsies to identify potential signatures for disease diagnostics in late-stage non-small cell lung cancer (NSCLC) in Trinidad and Tobago [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C028.

Outcomes of a first point of contact speech language therapy clinic for patients requiring vocal cord check pre and post thyroid/parathyroid surgery.

Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions. The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey. Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events. The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services. What is already known Assessment of laryngeal function via flexible nasoendoscopy is recommended best practice for patients pre and postthyroid/parathyroid surgery, as recurrent laryngeal nerve injury is a low incidence (<10%), yet well-recognised risk of these surgeries. Traditionally, general surgeons refer presurgical patients to ear, nose and throat (ENT) for vocal cord check (VCC) assessment. However, with access to specialist outpatient services under increasing pressure, there is growing support for utilisation of other health professionals, such as speech-language therapists working in first point of contact (FPOCC) models, to assist with the administration of pre- and postsurgical assessments of such low-risk populations. What this study adds This work expands on the emerging body of evidence for speech language therapy (SLT) led FPOCC models within ENT outpatient services, providing clinical and service outcomes to support the safety of a new model designed to administer VCCs for patients pre and post thyroid/parathyroid surgery. Adopting a similar model to a prior published SLT-led FPOCC model, the trained SLT completes the pre- and postsurgical VCC including flexible nasoendoscopy and videostroboscopy, with images and clinical information then presented to ENT for diagnosis and management planning. This study also provides the first data on consumer perceptions of this type of service model. Clinical implications of this study Data on 100 consecutive presurgical patients revealed positive service findings, supporting the safety of this model. Nature and incidence of clinical findings pre and post surgery were consistent with previously published studies using traditional models of care (i.e., ENT completing the flexible nasendoscopy). Consumer perception was positive. This model enables delivery of pre-and postsurgical assessments for patients receiving thyroid/parathyroid surgery, consistent with best practice care, and reduces burden on ENT services. In total 163 ENT appointments were avoided with this model, with positive implications for ENT waitlist management.

31 Item and Associative Visual Memory in Presurgical Temporal Lobe Epilepsy Patients

Objective:Patients with temporal lobe epilepsy (TLE) commonly show memory deficits on neuropsychological tests. The BVMT-R is a widely used test of visual learning and memory that involves accurately reproducing an array of figures in the correct special location. The present study examined performance processes of visual memory in presurgical patients with TLE, including item (i.e., accuracy) and associative memory (i.e., location), which have been shown to be dissociable in studies of visual memory in other neurologic populations.Participants and Methods:Participants included nine patients with left TLE (67% female; 67% left-handed; mean age = 46.15 years, range = 24-55; mean education = 14.8 years, range = 9-18) and six patients with right TLE (17% female; 33% left-handed; mean age = 57.64 years, range = 22-62; mean education = 15.52 years, range 11-18). Mean duration of epilepsy was 19 years. Participants had an average of two failed anti-seizure medications prior to surgery. TLE groups were compared to 22 healthy controls (36% female; 14% left-handed; mean age = 33.68 years, range = 2253; mean education = 17.66 years, range = 1620). All participants completed comprehensive neuropsychological testing at a large Northeastern medical center. The BVMT-R was scored using standard and novel scoring paradigms. All data were retrospectively reviewed from archival datasets.Results:MANCOVA results indicated a significant multivariate main effect for group membership and standard BVMT-R scoring after controlling for level of education, Wilks’ A = 0.59, F(4, 64) = 4.91, p = .002. The multivariate partial eta squared (np2) of .58 indicated a strong relationship between group membership and both immediate and delayed recall, with the control group performing better overall. The TLE groups did not perform significantly different from each other. A significant multivariate main effect for group and novel BVMT-R scoring was found (also controlling for education), Wilks’ A = 0.42, F(8, 58) = 3.97, p = .001. Overall, the control group demonstrated better item learning with no significant difference between TLE groups observed. Both the control (M = (16.5, SD = 2.04) and left TLE (M = 12.33, SD = 4.03) showed stronger associative learning compared to the right TLE group (M = 10.2, SD = 4.27). For item and location delayed recall, controls (M = 4.82, SD = 1.62) had more accurate recall compared to left TLE (M = 1.56, SD = 2.04) with a trend toward better performance compared to the right TLE patients (M = 2.6, SD = 1.82); the TLE groups performed similarly. No difference was observed for associative delayed recall between the three groups.Conclusions:Patients with right TLE showed worse associative learning compared to left TLE, while performance was generally comparable to their right TLE counterparts on other novel BVMT-R scoring paradigms. Unsurprisingly, patients with TLE performed worse on BVMT-R using standard scoring procedures, though no lateralizing effect was observed. While these findings suggest that associative visual learning weakness may be characteristic of right TLE, findings should be interpreted cautiously the given small sample size and demographic considerations (i.e., uneven gender distribution, lack of data on ethnicity/race).

4 Characterizing Cognitive Profiles and Postoperative Cognitive Risk in Older Adults Presenting for Elective Surgery

Objective:Older adults represent 50% of surgical patients and are disproportionately at risk of poor cognitive outcomes after surgery including delirium, accelerated cognitive decline, and dementia. Delirium alone is estimated to occur in up to 50% of older adults postoperatively, while research indicates it is preventable in 30-40% of cases. Individuals with pre-existing cognitive impairments or neurodegenerative diseases are at the highest risk of such outcomes, but (1) cognitive diagnoses are grossly underrepresented in patients' medical records, and (2) routine preoperative cognitive clearance remains rare. The purpose of this presentation is to demonstrate the extent and nature of cognitive vulnerability in older adults preparing for elective surgery within a tertiary care hospital. A case series is also reviewed to illustrate varying surgical outcomes with and without consideration of preoperative cognitive risk.Participants and Methods:This presentation incorporated IRB-approved and data honest broker management to assess diagnoses and cognitive profiles of adults age 65 and older electing surgery with anesthesia between January 2018 and December 2019. Data were assessed across two phases of the Perioperative Cognitive Anesthesia Network (PeCAN) program within the University of Florida and UF Health. First, data from the preoperative anesthesia clinic were reviewed for the percentage of patients with cognitive difficulties within the patient problem list. Second, based on neuropsychological domains, the cognitive profiles of patients assessed by neuropsychologists within the preoperative anesthesia clinic were divided into primary attention, primary memory, or combined memory attention. From these patients, the presenter highlight cases to demonstrate how individuals with cognitive difficulties can be provided care by a multidisciplinary team to mitigate the presence of postoperative complications.Results:Of 14,794 older adults entering the tertiary care medical center for surgical procedures, 4% (n=591) of the sample had ICD cognitive or neurodegenerative codes in the record. When a comprehensive neurobehavioral assessments were conducted on 1,363 of these presurgical patients, 70% had confirmed cognitive deficits on neuropsychological testing. These deficits included primary attention and executive deficits (12%), primary memory impairment (27%), or both attention and memory impairment (31%). Cases from these patients are reviewed and highlight how preoperative cognitive risk status can inform conservative perioperative practices including opioid-sparing analgesia, depth of anesthesia monitoring, and postoperative inpatient geriatric medicine consultation.Conclusions:Medical records listed cognitive diagnoses in 4% of hospital preoperative medical records, yet neuropsychological assessment of a subset of cases revealed a markedly higher rate of impairment. Patients with preoperative cognitive assessment show cognitive symptoms consistent with known neurological disorders of aging including Alzheimer's disease and cerebrovascular disease. Appreciation of pre-existing neurocognitive disorders can alter perioperative practices to prevent or reduce the risk of delirium and other postoperative neurocognitive changes. These data and cases reviewed will highlight how neuropsychology can be involved in perioperative care and champion perioperative interventions for perioperative "rescues".

Frequency and importance of herbal use among presurgical patients: A prospective cohort study

Aim: Herbal medicine has been used by humankind since ancient times. However, its popularity has increased in the last 20-30 years. In addition to the production, presentation and marketing of herbal medicines, their effects on the body are also very complex. Uncertainty about the effects of these drugs on the body has increased the importance of pre-anesthetic evaluation. To determine the frequency of herbal drug use in patients presenting for preoperative evaluation and to highlight its importance in anesthetic practice.Method: It was designed as a prospective study with observational-analytical character. Patients over 12 years of age presenting to the Anesthesia Outpatient Clinic of our hospital for pre-anesthetic assessment were interviewed about their use of herbal medicines for 2 months. Patients who used herbal medicines were asked about the medicines they used.Results: A total of 2712 patients were evaluated. Of the patients attending the outpatient clinic, 2367 were over 12 years of age. The use of herbal drugs was found to be 1.18% (n=28). Among the patients who used herbal medicines, 53.6% were female and the mean age was 52.18±15.87 years. The most commonly used herbal medicines were black cumin, green tea, ginger, turmeric, cinnamon, and olive leaf.Conclusions: The use of herbal medicines may be much higher than detected in patients presenting for pre-anesthetic examination. As the effects of herbal products are very uncertain, they may interact with anesthetic drugs. They can prolong bleeding time, increase blood pressure and cause heart problems. For these reasons, they should be closely questioned in the pre-anesthetic examination and discontinued before surgery.