Probability Of Outcome Research Articles

More A’s and I get to stay? How grading influences employment outcomes for contingent faculty

ABSTRACT Research has shown that changes in job security cause changes in grading behavior for lecturer faculty, but the impact of grading practices on future workload assignments is unknown. In this paper we use a detailed dataset of lecturers at a large public university to test the theory that awarding higher grades improves the probability of positive employment outcomes in the future. Lecturers that award higher grades receive significantly higher workload hours, are more likely to have their entitlement met and to receive repeat course assignments in the future, and these effects are larger for lecturers on contracts with more uncertainty.

Abstract 153: First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke is Modified by Procedure Time: Proposal of a New Measure for Thrombectomy Procedures

Objective: To determine whether first pass effect (FPE) after mechanical thrombectomy (MT) for anterior circulation large vessel occlusion acute ischemic stroke (LVO-AIS) is modified by procedural time (PT). Methods: The Stroke Thrombectomy and Aneurysm Registry (STAR), a multi-center international dataset, was retrospectively analyzed for anterior circulation LVO-AIS treated by MT who achieved excellent reperfusion (TICI 2c/3). The primary outcome was good functional outcome as defined by a 90-day modified Rankin Scale (mRS) 0-2. The primary study exposure was first pass success (FPS, 1 pass vs ≥2 passes) and the secondary exposure was PT. Logistic regression models were fit-adjusted and marginal effects used to assess the interaction of PT (≤30 vs >30 minutes) and FPS, adjusting for potential confounders including time from last known well to start of MT. Results: A total of 1,310 patients had excellent reperfusion. These patients were divided into two cohorts based on PT: ≤30 minutes (777 patients, 59.3%) and > 30 minutes (533 patients, 40.7%). Good functional outcome was observed in 658 patients (50.2%). The interaction term between FPS and PT was significant (p=0.018). Individuals with FPS in ≤30 minutes had 11.5% higher adjusted predicted probability of good outcome compared with those who required ≥2 passes (58.2% vs. 46.7%, p=0.001). However, there was no significant difference in the adjusted predicted probability of good outcome based on FPS in individuals with PT >30 minutes (p=0.763). This relationship appeared identical in models with PT treated as a continuous variable. Conclusion: In a large, real-world, multi-national dataset, we find that FPE is importantly modified by PT. The added clinical benefit of FPE is lost in longer procedures (>30 minutes). These data argue for a new metric for MT procedures, namely, FPE 30 , that better represents the ideal of fast, complete reperfusion with a single pass of a thrombectomy device.

Cost-Effectiveness of Diffusion-Weighted Magnetic Resonance Imaging Versus Second-Look Surgery in Treating Cholesteatoma: A Modeling Study.

To evaluate whether canal wall-up (CWU) tympanomastoidectomy with diffusion-weighted magnetic resonance imaging (DW-MRI) is a cost-effective method of treating cholesteatoma compared with CWU with second-look surgery. Cost-effectiveness analysis was conducted using a Markov state transition model. The simulation model adhered to the Panel Recommendations on Cost-Effectiveness in Health and Medicine established by the US Public Health Service. One-way and Monte Carlo probability sensitivity analyses were conducted for validation. Tympanomastoidectomy with DW-MRI versus tympanomastoidectomy with second-look surgery. Effectiveness and health utility were measured using quality-adjusted life years (QALYs). Costs were derived from Medicare reimbursement using the perspective of the payer. Probabilities for outcomes and complications were taken from existing literature. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio. With base case analysis, the total cost was $15,069 when treated with CWU and second-look surgery versus $13,126 when treated with CWU and DW-MRI. The second-look treatment pathway yielded 17.05 QALYs, whereas the DW-MRI pathway yielded 16.91 QALYs in terms of health benefit accrued across the lifetime of the patient. The cost-effectiveness incremental cost-effectiveness ratio was $21,800/QALY. Using the conventional $50,000 willingness-to-pay threshold, second-look surgery was the more cost-effective approach 63.7% of the time by simulation. Both treatment pathways were found to be cost-effective, with second-look surgery incrementally cost-effective 63.7% of the time. Assumptions were validated by one-way and Monte Carlo probability sensitivity analysis. There is ample variation in treatment pathways regarding usage of DW-MRI and second-look surgery for cholesteatoma. To evaluate the cost-effectiveness of DW-MRI and second-look surgery approaches, accounting for health-related quality-of-life outcomes and costs for the duration of the patient lifetimes. To inform the discussion on the treatment for cholesteatoma given emergent noninvasive technologies.Level of Evidence: Level III.Indicate IRB or IACUC: Exempt.

Abstract TP212: 2b or Not 2b? TICI 2b Reperfusion Score in Endovascular Thrombectomy for Acute Ischemic Stroke Carries a Poor Functional Outcome

Background: Endovascular thrombectomy (EVT) for treatment of acute ischemic stroke (AIS) in the proximal cerebrovasculature has, since its inception, become part of the standard of care when addressing AIS. Overall, one in six individuals treated has improved neurologic and functional outcomes. Reperfusion following thrombectomy in the anterior cerebral circulation has long been graded by the modified Thrombolysis in Cerebral Infarction (mTICI) scale-and the score of mTICI (2b, or, “partial filling of more than 50% of the affected vascular territory” is considered the benchmark for “good” outcomes in EVT. It remains unclear whether this score at time of reperfusion reliably predicts a sustained improvement in neurologic or functional outcome. Method: This is a retrospective review of all anterior AIS patients with large vessel occlusion (LVO) at Barrow Neurological Institute between 01/01/2018 and 12/31/2022 who underwent EVT with mTICI 2b or greater. The study was approved by the local IRB. Demographic data of patients between the ages of 18 and 95 who had AIS with LVO in the anterior Circle of Willis or its supplying vessels were collected. Other variables collected and analyzed include mTICI score, and modified Rankin Score (mRS) at discharge and 90 days. The TICI grade was obtained via digital cerebral angiography post EVT. Descriptive statistics was used to examine the differences of mRS scores at 90 days. Results: Of 81 cases reviewed, 52 (65%) had a TICI 2b score and their average mRS was 3.7, 20 (25%) had a TICI 2c and their average mRS was 3.6, and 4 (5%) had a TICI 3 with mRS 3 at discharge. At 90 days, the average mRS for TICI 2b patients was 3.2, for TICI 2c patients 2.9 and for TICI 3 patients 2.3. No difference in the rate of intracerebral hemorrhage (ICH) following reperfusion between the TICI 2 and 3 groups (17%). Conclusion: Our results demonstrated that patients with a mTICI of 2b had a higher mean mRS at discharge and minimal improvement of mRS at 90 days compared against patients with a mTICI of 2c or 3 (average change in score was -0.6, -0.7 and -1.3 in the TICI 2b, 2c and 3 groups respectively). Therefore, a reperfusion score of mTICI 2b may not be sufficient to indicate a high probability of a good functional outcome. With EVT, reaching a TICI 3 should be attempted.

Abstract TMP96: Clear Thrombectomy Score: An Index to Estimate Probability of Good Functional Outcome Following Endovascular Treatment in the Late Window for Anterior Circulation Occlusion

Background: Endovascular thrombectomy (EVT) has established efficacy across a wide range of patient age, radiological findings, and clinical features. However, EVT may be less effective in extreme scenarios (e.g., large established infarction in later treatment windows), where there are currently limited data. Methods: A heterogeneous, multinational observational cohort (CLEAR registry) of consecutive adult patients ≥18 years old who underwent EVT for acute occlusion (2014-2022) of the internal carotid or proximal middle cerebral (M1 or M2) arteries was queried (n=64 sites). A high-fidelity model for predicting good functional outcome at 90 days (return to pre-stroke modified Rankin Scale [mRS] or mRS 0-2 after EVT) was developed using a binary, multivariable logit model with adaptive double lasso adjustment, which was validated using 5-fold cross validation and 1000 bootstrap sampling for confidence intervals. Results: At the time of the analysis, we evaluated 2953 patients from the registry treated with EVT, of which 1855 (63%) had complete covariate data for inclusion. The median National Institutes of Health Stroke Scale (NIHSS) score was 15 (IQR 9-20), with 14.0% having a pre-stroke mRS >2, 8.3% having a NIHSS <6, and 17.8% having an Alberta Stroke Program Early Computed Tomography Scale (ASPECTS) score ≤6. A good functional outcome occurred in 813 (43.8%) patients. Independent predictors of the primary outcome, with points allocated toward the final score, included younger age, higher ASPECTS, lower NIHSS, and time from last known well to arterial puncture. The areas under the curve for derivation and validation cohorts were 0.72 (95% CI 0.70-0.75) and 0.74 (95% CI 0.71-0.80), respectively. Discussion: The CLEAR thrombectomy score provides a simple, validated means of predicting good functional outcome following late-window, anterior circulation thrombectomy using routinely acquired clinical and imaging data. External validation is warranted.

Abstract TMP76: Outcomes in Large Mostly Intraventricular Hemorrhage: From the Clear III Trial Public Use Dataset

Introduction: Intraventricular hemorrhage (IVH), a common complication of intracerebral hemorrhage (ICH), can occur with little or no associated ICH (mostly IVH, mIVH). mIVH is reported to have better outcomes than IVH associated with substantial ICH. Few data exist describing outcomes from mIVH, especially more severe cases. Hypothesis: Using the CLEAR III public use dataset, outcomes from large mIVH can be described and may be useful to providers and families making decisions about goals of care. Methods: Large mIVH was defined as CLEAR III patients with ICH volume < 5 cc and IVH volume > 30 cc. A backward stepwise logistic regression model identified baseline predictors of 180 day modified Rankin score 0-3 (good outcome), and a post-estimation probability was calculated for each patient. Descriptive nonparametric statistics are provided, including medians with interquartile range (IQR). Patients were divided into prognostic tertiles based on probability of a good outcome with corresponding 180 day modified Rankin scores (mRS) are displayed via a Sankey diagram. Results: Overall, 72/500 (14.4%) of CLEAR III patients had large mIVH. Among these 72, median (IQR) age was 59.5 (51-68) years, 39% were female, median (IQR) GCS 8 (6.5-10), IVH volume 48 cc (39-67) and 180 day mRS 4 (2-6). Age and IVH volume were final model independent predictors of good outcome. Baseline median (IQR) values for Age and IVH volume in each prognostic tertile with 180 day mRS distributions are shown in the Figure. Good outcome was possible despite large mIVH, especially with younger age and smaller IVH volumes. Conclusion: Focusing on the CLEAR III subset of patients with large mIVH, a simple regression model identified prognostic tertiles which combined with a Sankey diagram provide easily interpretable outcome distributions that may facilitate clinical decision-making.

Teaching Medical Students to Communicate Risks Like Military Intelligence Analysts.

Communication about health often involves descriptions of risk: the probability or likelihood of an unfavorable outcome. Communicating risk helps individuals make choices about their own health by building understanding of potential outcomes and providing context for the importance of procedures, health interventions, and lifestyle choices. However, medical education in the United States does not provide future physicians with adequate statistical literacy to communicate risk effectively and rarely encourages them to practice communicating risk in pre-clinical years. Risk communication in military intelligence, a field with formalized risk language and training, offers a unique perspective into potential improvements for medical risk communication. With backgrounds in the military, public health, communication, surgery, and medical education, the authors offer the following recommendations to improve risk communication for medical students. (1) Encourage the use of numerical absolute risk when communicating among health practitioners to avoid varied interpretations of what different risk descriptors ("uncommon," "likely," or "low") might mean; (2) build efficient, teachable skills in use of patient-facing risk communication tools like comparative probabilities and visual aids; and (3) practice estimating risk through role-play of risk communication between medical students and standardized patients. By improving risk communication in medical education, future doctors will be better equipped to build trust through open communication and improve the health of the patients and the communities for whom they care.

Abstract 51: Impact of Cerebral Autoregulation on the Relationship Between Blood Pressure Variability and Functional Outcome Following Endovascular Thrombectomy

Background: Both increased blood pressure (BP) variability and impaired autoregulation have been linked to worse outcome after endovascular thrombectomy (EVT). This study examined the combined effect of these variables on the risk of poor outcome in patients with large-vessel occlusion (LVO) stroke. Methods: Autoregulation was continuously measured for up to 24 hours after EVT and quantified as a moving correlation coefficient between arterial BP and the near-infrared spectroscopy-derived cerebral oxygen saturation. Systolic BP variability was assessed using the standard deviation of the mean. Values were averaged for the entire recording period and dichotomized at the lowest tertile for both variables. Functional outcome was assessed using the modified Rankin scale (mRS) at 90 days and dichotomized into good (mRS 0-2) and poor outcome (mRS 3-6). Results: We included 195 patients (mean age 70 + 16, 45% female, mean NIHSS 14, mean monitoring time 15 + 7 hours). After adjusting for age, NIHSS, ASPECTS, and TICI score, patients with low BP variability and intact autoregulation were significantly more likely to achieve a good outcome than those with high BP variability and impaired autoregulation (OR 3.7, 95% CI 1.2-12.1, p=0.028, Figure 1A). We found an interaction between BP variability and autoregulation (p=0.067). Patients with high BP variability showed a gradual decrease in the probability of a good outcome with worsening autoregulation. However, for patients with low BPV, autoregulation had minimal impact. (Figure 1B). No significant correlation was seen between autoregulatory function and BP variability (r=0.07, p=0.33). Conclusions: For LVO stroke patients with high BP variability after EVT, worse 90-day functional outcome may be exacerbated by impaired autoregulation. These results suggest that autoregulatory status should be considered in the management of BP after EVT to identify high-risk patients and develop individualized treatment strategies.

Effectiveness of white tea-mediated silver nanoparticles as an intracanal irrigant against Enterococcus faecalis: An in vitro study.

The probability of a positive outcome of root canal therapy is substantially higher if the infection is eradicated successfully before the obturation of the root canal system. Irrigation is an essential aspect of root canal debridement, as it enables more thorough cleaning than is possible with root canal instrumentation alone. To overcome the side effects of chemical irrigants, there has been a search for herbal medicines as substitutes. The aim of the present study was to explore the antimicrobial efficacy of white tea-mediated silver nanoparticles (AgNPs) formulated as an intracanal irrigant against Enterococcus faecalis, and to compare it with the efficacy of chlorhexidine and sodium hypochlorite irrigants. The experimental groups were as follows: group I - white tea-mediated AgNPs; group II - 2% chlorhexidine; and group III - 2.5% sodium hypochlorite. The characterization of AgNPs was performed using ultraviolet-visible (UV-Vis) spectroscopy and transmission electron microscopy (TEM) analysis. Enterococcus faecalis was inoculated onto Mueller-Hinton agar plates. The disks impregnated with irrigants were placed on the inoculated plates and incubated aerobically at 37°C for 24 h. Then, the growth inhibition zones were measured. Statistical analysis was performed using the one-way analysis of variance (ANOVA) and the post hoc tests. A concentration of 50 μL of white tea-mediated AgNPs exhibited the greatest zone of inhibition (32 ±2 mm), followed by 2% chlorhexidine (25 ±1 mm) and 2.5% sodium hypochlorite (23 ±3 mm). White tea-mediated AgNPs showed promising results in the elimination of E. faecalis, being superior to chlorhexidine and sodium hypochlorite irrigants.

Quantum Theory in Finite Dimension Cannot Explain Every General Process with Finite Memory

Arguably, the largest class of stochastic processes generated by means of a finite memory consists of those that are sequences of observations produced by sequential measurements in a suitable generalized probabilistic theory (GPT). These are constructed from a finite-dimensional memory evolving under a set of possible linear maps, and with probabilities of outcomes determined by linear functions of the memory state. Examples of such models are given by classical hidden Markov processes, where the memory state is a probability distribution, and at each step it evolves according to a non-negative matrix, and hidden quantum Markov processes, where the memory is a finite-dimensional quantum system, and at each step it evolves according to a completely positive map. Here we show that the set of processes admitting a finite-dimensional explanation do not need to be explainable in terms of either classical probability or quantum mechanics. To wit, we exhibit families of processes that have a finite-dimensional explanation, defined manifestly by the dynamics of an explicitly given GPT, but that do not admit a quantum, and therefore not even classical, explanation in finite dimension. Furthermore, we present a family of quantum processes on qubits and qutrits that do not admit a classical finite-dimensional realization, which includes examples introduced earlier by Fox, Rubin, Dharmadikari and Nadkarni as functions of infinite-dimensional Markov chains, and lower bound the size of the memory of a classical model realizing a noisy version of the qubit processes.

Abstract 145: Anticoagulation-Related Intracerebral Hemorrhage and Time to Reversal Treatment After Intracerebral Hemorrhage in the United States

Background: Anticoagulation-associated intracerebral hemorrhage (AC-ICH) often results in death. Specific reversal agents are available, but it is not clear whether there is a time-dependent treatment effect. We characterized patients with AC-ICH and investigated the relationship between time to treatment and outcome. Methods: We analyzed data from 9492 AC-ICH patients who presented within 24 hours of onset across 465 hospitals reporting any anticoagulation reversal treatment in GWTG-Stroke from 2015 to 2021. For patients with available door-to-treatment (DTT) times, outcomes were analyzed using logistic regression models adjusted for demographic, history, baseline, and hospital characteristics. A spline plot for mortality was generated for DTT and in-patient mortality from the adjusted predicted outcome probability. Results: Among 9492 patients admitted within 24h of AC-ICH, the median age was 77 years, 45% female, and NIHSS median 11. 79% (7469) received reversal treatment and 21% (2143) did not. Among reversal patients, pretreatment AC was warfarin in 62.2% and a direct oral anticoagulant in 37.8%. For 5224 patients with documented times, median onset to treatment time was 232 (IQR 142-185) minutes and DTT was 82 (58-117) mins, with DTT ≤60m for 27.7%. DTT ≤60 minutes was associated with lower odds of mortality than a DTT of >61-180 minutes (aOR 0.83 [95% CI: 0.69-1.00]). Factors associated with DTT ≤ 60 minutes include white non-Hispanic race, higher blood pressure, lower NIHSS, and a larger hospital size. Spline plotting showed a steep mortality increase with longer DTT in the first 30-minutes post-arrival (Figure). Conclusion: In US hospitals participating in GWTG-Stroke reporting reversal therapy, most patients with AC-ICH received reversal agents. Earlier administration was associated with improved survival. These findings support intensive efforts to accelerate evaluation and treatment for patients with this devastating form of stroke.

Patients’ preferences for systemic treatment of atopic dermatitis: safety and efficacy count the most

Background The advent of biologics and janus kinase inhibitors has revolutionized treatment of atopic dermatitis (AD). Objective To investigate preferences of patients with AD for attributes of currently approved systemic treatments and assess influencing factors. Methods An online discrete choice experiment was conducted in patients with AD throughout Germany to analyze preferences for outcome (probability of (almost) clear skin at week 16, probability of significant itch improvement, time to onset of itch relief and type of side effects) and process attributes (application method and frequency of laboratory tests). Results Participants (n = 182, 75.3% female) considered side effects (Relative Importance Score (RIS): 31.2), (almost) clear skin (RIS: 24.2) and probability of itch improvement (RIS: 16.0) most important. Application method (RIS: 14.4), time to onset of itch relief (RIS: 7.4) and frequency of laboratory tests (RIS: 6.8) were less relevant. Preferences were significantly influenced by sex, age, psychiatric comorbidity, current therapy and health-related quality of life according to multivariate regression analysis. Conclusions Participants attached great importance to safety and symptom control. However, preferences were also dependent on individual characteristics, underscoring the importance of personal counseling. Conjoined with medical considerations, patients’ preferences have fundamental impact on shared decisions for treatment of AD.

Bounds for selection bias using outcome probabilities

Abstract Objectives Determining the causal relationship between exposure and outcome is the goal of many observational studies. However, the selection of subjects into the study population, either voluntary or involuntary, may result in estimates that suffer from selection bias. To assess the robustness of the estimates as well as the magnitude of the bias, bounds for the bias can be calculated. Previous bounds for selection bias often require the specification of unknown relative risks, which might be difficult to provide. Here, alternative bounds based on observed data and unknown outcome probabilities are proposed. These unknown probabilities may be easier to specify than unknown relative risks. Methods I derive alternative bounds from the definitions of the causal estimands using the potential outcomes framework, under specific assumptions. The bounds are expressed using observed data and unobserved outcome probabilities. The bounds are compared to previously reported bounds in a simulation study. Furthermore, a study of perinatal risk factors for type 1 diabetes is provided as a motivating example. Results I show that the proposed bounds are often informative when the exposure and outcome are sufficiently common, especially for the risk difference in the total population. It is also noted that the proposed bounds can be uninformative when the exposure and outcome are rare. Furthermore, it is noted that previously proposed assumption-free bounds are special cases of the new bounds when the sensitivity parameters are set to their most conservative values. Conclusions Depending on the data generating process and causal estimand of interest, the proposed bounds can be tighter or wider than the reference bounds. Importantly, in cases with sufficiently common outcome and exposure, the proposed bounds are often informative, especially for the risk difference in the total population. It is also noted that, in some cases, the new bounds can be wider than the reference bounds. However, the proposed bounds based on unobserved probabilities may in some cases be easier to specify than the reference bounds based on unknown relative risks.

Investigation on wave-induced responses of heterogeneous seabed around a buried pipeline based on nonstationary random field model

The instability of the seabed poses a threat to the structural integrity and functionality of submarine pipelines. This numerical study investigates wave-induced responses in a heterogeneous seabed around a buried pipeline, considering spatial variability in soil properties through nonstationary random field models. Three scenarios of spatial variability for soil parameters changing with depth are simulated using both stationary and nonstationary random field models via the Karhunen-Loève expansion method. The discrete random fields are validated in terms of correlation structures and statistical characteristics. The stochastic finite element method, incorporating random fields and a poroelastic seabed model through a LiveLink code, is employed to examine probabilistic outcomes of dynamic soil responses and liquefaction zone distributions within a probabilistic framework. Contrastive analyses are conducted for seabed models with different random field scenarios, in addition to deterministic analyses. The results of the stochastic analysis show that the increasing trend of soil strength with depth has significant effects on the seabed responses and transient liquefaction characteristics around a pipeline.

Who shows the Unlikelihood Effect – and why?

Recent work shows that people judge an outcome as less likely when they learn the probabilities of all single pathways that lead to that outcome, a phenomenon termed the Unlikelihood Effect. The initial explanation for this effect is that the low pathway probabilities trigger thoughts that deem the outcome unlikely. We tested the alternative explanation that the effect results from people’s erroneous interpretation and processing of the probability information provided in the paradigm. By reanalyzing the original experiments, we discovered that the Unlikelihood Effect had been substantially driven by a small subset of people who give extremely low likelihood judgments. We conducted six preregistered experiments, showing that these people are unaware of the total outcome probability and do formally incorrect calculations with the given probabilities. Controlling for these factors statistically and experimentally reduced the proportion of people giving extremely low likelihood judgments, reducing and sometimes eliminating the Unlikelihood Effect. Our results confirm that the Unlikelihood Effect is overall a robust empirical phenomenon, but suggest that the effect results at least to some degree from a few people’s difficulties with encoding, understanding, and integrating probabilities. Our findings align with current research on other psychological effects, showing that empirical effects can be caused by participants engaging in qualitatively different mental processes.

Russian registry of Surgical OutcomeS — RuSOS: study protocol

INTRODUCTION: Identification of risk factors that cause a high probability of an unfavorable outcome in the postoperative period is an urgent problem. The creation of national databases (registries) makes it possible to cover a certain patient population by identifying its risk predictors. Existing registries differ in the criteria for inclusion in the study, in the characteristics of the populations studied, and there is often no common view on the classification of postoperative outcomes. OBJECTIVE: Creation of a Russian national calculator for the risk of postoperative complications and mortality. MATERIALS AND METHODS: Two-level observational retrospective-prospective study. Setting: National multicenter study of surgical inpatients. Patients: Adult patients undergoing elective and emergency surgery. Types of interventions: obstetrics, gynecology, mammary gland, urology, endocrine surgery, maxillofacial surgery, orthopedics, traumatology, abdominal surgery, liver and biliary tract, thoracic surgery, vascular surgery, neurosurgery, cardiac surgery, other areas. RESULTS: The design was registered in the ClinicalTrials.gov database, the study was organized by the Federation of Anesthesiologists and Reanimatologists of Russia. Primary (30-day mortality, 30-day complications) and secondary (hospital mortality, hospital complications, length of stay in ICU, length of hospital stay, multiple organ failure (2 or more points on the SOFA scale), 90-day mortality, 90-day complications, post intensive care syndrome, readmission, 1-year mortality) outcomes; six primary and twelve secondary target points; criteria for inclusion, non-inclusion, exclusion. The required sample size and statistical analysis are described. The planned sample size to ensure the required power of the study is determined to be 60,800 observations for elective surgery and 20,000 observations for emergency surgery. The planned duration of the study is 2024–2028. CONCLUSIONS: The study has important scientific and medical-social significance; a Russian national calculator for the risk of postoperative complications and mortality will be developed. In the future, the developed calculator can become the basis for making medical decisions.

Home care for COVID-19 positive cases: suitability of the residential setting and ability of cases to adhere to the required preventive measures

IntroductionWith the upsurge of COVID-19 cases, Lebanese hospitals were overburdened and hospital care was prioritized for COVID-19 patients with the highest probability of poor outcomes. This paper aimed to assess the suitability of residential settings for home isolation and to explore the patient’s ability to adhere to the required precautions measures.MethodsAll COVID-19 cases reported between February, 21 and the end of June 2020 and who had mild or moderate symptoms, were contacted via phone calls by a healthcare professional to fill out a standardized questionnaire developed to assess the suitability of the residential setting for home care. Inpatient cases were required, before their discharge from the hospitals, to sign consent related to their adherence to the mandatory precautionary measures. They were also asked to complete, on daily basis, the symptoms monitoring log form. A referral system to health facilities was established to manage cases with worsening health status. A collaborative framework to address violations of home isolation rules was also put in place.ResultsOf the 600 cases assessed, 44.7% of them were isolated in a living building apartment (67.2%) with one entrance (85.5%) including four to eight rooms (71%). Around one-quarter of patients have children (< 5 years) and 75% of them were living with elderly people. Most of the patients confirmed the availability of a well-ventilated single room (96.2%) and a separate bathroom (80.17%). As for infrastructure, more than 90% of patients confirmed the availability of drinking and tank water, heating facilities, electricity, and safe trash elimination. Similarly, more than 90% of them had access to personal hygiene items, disinfectants, and personal protective equipment. The bulk of homes care were rated as easily reachable. As for awareness and ability to self-serving, 94.5% of patients were knowledgeable about the required preventive measures, able to serve themselves and to adhere to the isolation requirements as well. Only 51.8% of them had access to psychological support.ConclusionProper assessment of the residential setting for home care of COVID-19 cases combined with close monitoring of the adherence of patients to the required precaution measures are highly needed for limiting the spread of infection within the household and the community.

Early prognosis prediction in acute myeloid and acute lymphoid leukemia patients using cell-free DNA concentration ratios.

Background: Cell-free DNA (cfDNA) is a promising biomarker for disease prediction in many cancers, including acute leukemia (acute myeloid leukemia [AML] and acute lymphoblastic leukemia [ALL]). This study investigated the role of cfDNA in predicting relapse or unfavorable outcomes in acute leukemia patients upon initial diagnosis. Methods: Paired peripheral blood samples of 25 patients with ALL and AML were compared at baseline and induction/follow-up and clinically correlated with clinicopathological and outcome variables according to the risk category. cfDNA was isolated using commercial cfDNA extraction kits. The probability of poor outcomes in high-risk groups and a cut-off value for risk stratification minimal residual disease (MRD) positivity and outcome prediction were derived. Results: Twenty-five patients diagnosed with AML and ALL were risk-stratified based on NCI risk stratification, and of these 25 patients, 4 patients were of standard risk (SR) and 1 patient was of intermediate risk (IR), while a majority of patients (80%) were of high risk (HR). Of these, four HR patients passed away. The ratio of cfDNA reduction at baseline and the end of induction was a strong predictor of poor outcomes in high-risk patients, regardless of the MRD status. A cfDNA ratio score of 2.6 or higher at diagnosis/remission predicted poor outcomes, with higher accuracy than conventional MRD detection by flow cytometry. Conclusion: A higher cfDNA ratio at diagnosis/remission or at baseline predicts poor outcomes in acute leukemia patients. This pilot study suggests that cfDNA ratio scoring may be a useful tool for predicting prognosis in acute leukemia patients, regardless of the MRD status.

Predictors of Death in Comorbid Patients with Thrombotic Complications: a Single-Center Retrospective Cross- Sectional Study

INTRODUCTION. Despite the improvements and success in the management of thrombosis, the prognosis of thrombotic complications in comorbid patients remains extremely unfavorable. Understanding this problem suggests that it is rational to pay more attention to the prevention of thrombosis in order to avoid thrombotic complications in the first place, and there is an urgent need to improve the ability to predict the development of complications and, most importantly, death. Therefore, some inexpensive, but effective methods of risk assessment need to be developed and integrated in clinical practice. AIM OF STUDY. To assess which laboratory markers can be associated with higher probability of fatal outcome in patients with thrombotic complications. MATERIAL AND METHODS. The retrospective cross-sectional study included 283 patients who were admitted to the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2021. Minimum age was 21 years, maximum age was 96 years, median age – 68 (59,0; 76,5) years. 161 (56,9 %) patients were males, 122 (43,1 %) – females. Group I included 226 patients with thrombotic complications; Group II included 57 (20,1 %) patients who died during hospitalization. The patients were diagnosed with the following thrombotic complications: pulmonary embolism (PE) was diagnosed in 28 (9.9 %), acute coronary syndrome with ST segment elevation in 38 (13.4 %), arterial thrombosis in 84 (29.7 %), venous thrombosis in 54 (19.1 %), thrombophlebitis in 22 (7.8 %), and systemic thromboembolism in 7 (2.5 %) patients. RESULTS. It was established that the decrease in the estimated glomerular filtration to the levels of stage 3 (and lower) chronic kidney disease (AUC — 0,881, sensitivity — 86.92 %, specificity — 85.71 %), hemoglobin level — to less than 120 g/L (AUC — 0,690, sensitivity — 77,21 %, specificity — 55,1 %), as well as hypoalbuminemia (AUC — 0,905, sensitivity — 78,89 %, specificity — 91,18 %) statistically significantly increased the likelihood of death by 19 (OR 19.276, 95 % CI [7,792–47.687], p &lt; 0.001), 4 (OR 4.158, 95 % CI [2.177–7.939], p &lt; 0.001), and 30 (OR 30,000, 95 % CI [9.93–90,610], p &lt; 0.001) times, respectively. The statistical analysis using the univariate logistic regression model revealed that such diseases as coronary artery disease (OR 8,6, 95 % CI [2,6–28,466], p &lt; 0.001), chronic heart failure (CHF) (OR 13,714, 95 % CI [4,784–39,313], p &lt; 0.001), atrial fibrillation (OR 3,455, 95 % CI [1,830–6,525], p &lt; 0.001), type 2 diabetes (OR 2.5, 95 % CI [1,286–4,858[, p = 0.007), postinfarction cardiosclerosis (OR 3,734, 95 % CI [1,953–7,142], p &lt; 0.001), and previous stroke (OR 3,319, 95 % CI [1,519–6,490], p = 0.002) made an independent contribution to death prediction. During the study, we calculated the patients’ serum albumin-to-creatinine ratio (sACR). ROC analysis revealed a cut-off point for sACR to be 0.33 g/mmol as having the best predictive ability of death (AUC — 0.920, 84.3 % sensitivity, 85.29 % specificity). It was established that sACR less than 0.33 g/mmol increased the probability of death by 26 times (OR 26.3806, 95 % CI [9.4573.57], p &lt; 0.001). CONCLUSION. Serum albumin-to-creatinine content ratio can be used as a predictor of fatal outcome in comorbid patients with thrombotic complications.

Extracorporeal Methods of Hemocorrection in Patients with Abdominal Sepsis

BACKGROUND. Theoretical data convincingly support the use of extracorporeal hemocorrection (ECHC) methods in the treatment of sepsis. However, a large number of researchers have still not been able to convincingly prove the advantage of ECHC methods; there is no unanimity of opinion. We tried to analyze our own experience in using ECHC methods in the treatment of abdominal sepsis over the past 3 years. AIM OF STUDY. To analyze the use of ECHC methods in the early stages of treatment of abdominal sepsis, to determine whether their use had an advantage for survival. STUDY DESIGN. Prospective cohort. DESCRIPTION OF THE METHOD. In 50 cases (group 1), ECHC was performed early after surgery. The median time from admission to the intensive care unit after surgery to the start of ECHC was 25.3 (17.7; 36.5) hours. When determining the ECHC modality, we were guided by the individual approach and clinical experience of the ECHC specialist. Apheresis methods alone were performed in 8 % of patients (4/50), a combination of apheresis methods and renal replacement therapy was performed in 40 % (20/50), renal replacement therapy (RRT) methods were performed in 98 % (46/50), plasmapheresis/plasma exchange/selective plasma filtration were performed in 30 % (15/50), selective hemosorption of cytokines was performed in 4 % (2/50), selective hemosorption lipopolysaccharides was performed in 24 % (12/50). We analyzed outcomes, assessments of the severity of functional disorders and sepsis-associated organ dysfunction according to the APACHE scales II and SOFA and their dynamics, probabilities of outcomes depending on the scores on the indices (logistic regression); life times, cumulative survival rate (Kaplan-Meier method). SAMPLE CHARACTERISTICS. There were 113 patients after emergency laparotomy due to widespread peritonitis, abdominal sepsis, aged from 23 to 90 years. 67 men, 46 women. In 50 cases of observation (group 1), ECHC was performed in the early stages ; in 63 cases, methods of active hemocorrection were not used (group 2). In group 1 there were 35 patients with septic shock and 15 patients with stable hemodynamics (subgroup 1/shock and subgroup 1/sepsis). In group 2 there were 20 patients with shock and 43 with stable hemodynamics (subgroup 2/shock and subgroup 2/sepsis). RESEARCH RESULTS ECHC. Methods allowed survival of patients with more severe APACHE scores II and SOFA: in survivors in subgroup 1/shock Me 29 (24; 31) versus 23 (14; 26) in the subgroup 2/shock and 8 (4; 10) versus 4 (2; 6) points, p=0.048 and p = 0.010; with stable hemodynamics in survivors in subgroup 1/sepsis Me 20 (17; 22) versus 15 (11; 19) in subgroup 2/sepsis, p=0.016. ECHC changed the survival threshold in favor of more severe patients from 29 to 33 points; reduced the likelihood of an unfavorable outcome 1.2-fold for each point on the APACHE scale II and 1,276 times over the entire range of estimates; prolonged survival time in hemodynamically unstable patients at a significance level of p = 0.083, shifting the first quartile of survival from 1 to 12 days, the median from 12 to 20, the third quartile from 27 to 45 days. When performing ECHC, the cumulative survival rate was higher throughout the entire hospital observation period: 0.886 (95 % CI 0.780–0.939) in 2 days versus 0.700 (95 % CI 0.499–0.802); 0.800 (95 % CI 0.667–0.868) in 10 days versus 0.545 (95 % CI 0.325–0.658); 0.653 (95 % CI 0.494–0.734) in 14 days versus 0.416 (95 % CI 1.185–0.533). Overall mortality from all causes was 35.4 % (40/113), 67.3 (37/55) with shock, 5.2 % (3/58) with stable hemodynamics. The maximum risk of an unfavorable outcome occurred in the early stages: 30 % (12/40) of all deaths occurred in the first 4 days after surgery, 20 % (8/40) in the first 24 hours. In shock patients, 10-day mortality was lower when performing ECHC: 20.0 % (7/35) versus 45.0 % (9/20), p = 0.050, 1st stage. Fisher’s test, P = 0.38 insufficient. Hospital mortality in the shock subgroups was equal, all the advantages of ECHC achieved in the early stages were lost; although in most late outcomes the peritonitis was relieved; which was confirmed during the section. CONCLUSIONS. The power of the study was sufficient to identify statistically significant advantages of extracorporeal hemocorrection in the treatment of abdominal sepsis based on APACHE index estimates II and SOFA. For the Kaplan–Meier method, differences were obtained for shock patients at a significance level of 0.083; the number of observations must be doubled to detect statistically significant differences. The final results of hospital mortality require additional in-depth analysis, since in the later stages many deaths were not associated with abdominal sepsis and occurred with already resolved peritonitis. It is necessary to understand to what extent they were associated with experienced sepsis, and to what extent with comorbid pathology; whether there was an association with methods of extracorporeal hemocorrection.