Rank Test Research Articles

A Pilot Study on the Collection of Adverse Event Data from the Patient Using an Electronic Platform in a Cancer Clinical Trial Unit.

Accurate and robust adverse event (AE) data collection is crucial in cancer clinical trials to ensure participant safety. Frameworks have been developed to facilitate the collection of AE data and now the traditional workflows are facing renewal to include patient-reported data, improving completeness of AE data. We explored one of these workflows in a cancer clinical trial unit. The study was a single-site study conducted at a tertiary hospital located in Australia. Patients consenting to a clinical trial were eligible for inclusion in this study. Participants used an electronic platform-My Health My Way (MHMW)-to report their symptomatic data weekly for 24 weeks. A symptom list was included within the platform, along with a free text field. Data reported via the platform was compared with data recorded in the patient's medical chart. Time taken to compile data from each source was recorded, along with missing data points. Agreement between patient-reported data and data recorded in the medical notes was assessed using Kappa and Gwet's AC1; time taken to compile data and missing data points were assessed using a Wilcoxon signed rank test. Low agreement was found between patient- and clinician-reported data (-0.482 and -0.159 by Kappa and Gwet's AC1 respectively). Only 127 (30%) of the total 428 AEs were reported by both MHMW and medical notes. Patients reported higher rates of symptoms from the symptom list, while clinicians reported higher rates of symptoms outside of the symptom list. Time taken to compile the data from MHMW was significantly less than that taken to review medical notes (2.19min versus 5.73min respectively; P < 0.001). There were significantly less missing data points from the MHMW data compared with the medical notes (1.4 versus 7.8; P<0.001). This study confirms previous reports that patient- and clinician-reported adverse event data show low agreement. This study also shows that clinical trial sites could significantly reduce the work performed by research staff in the collection of adverse event data by implementing an electronic, patient-reported platform.

Notetaking Instruction for Prospective EFL Teachers: Effects on Notetaking Skills and Perceptions

Notetaking is a vital skill at the university level since students are responsible for their learning and notetaking is their primary method of recording and storing information. However, students may struggle with simultaneously following the lesson and taking notes, which requires systematic training. This study will contribute to the literature by focusing on the outcomes of providing prospective English as a foreign language (EFL) teachers with notetaking instruction. It is also aimed to investigate prospective EFL teachers’ perceptions of notetaking and notetaking instruction. Participants of the study were 39 prospective EFL teachers (junior ELT department students) enrolled in a Listening and Notetaking course. A mixed method approach was employed in the study, in which both qualitative and quantitative data were collected through text analysis of participants’ notes and semi-structured interviews (n = 10). Quantitative data were analysed through paired samples t-test, chi square test, and Wilcoxon signed rank test. Qualitative data were analysed through content analysis. The findings revealed that providing learners with notetaking instruction is beneficial in many aspects including recording more information units, having better organization, and deciding what is important. Students’ perceptions of notetaking were found to be mostly positive. They consider it a useful strategy for following lectures better and for overall academic success.

Effect of home based tele pilates on pelvic girdle pain and lumbo pelvic stability among pregnant women – A randomized controlled trial

Introduction. Pelvic girdle pain is one of the common musculoskeletal problems in pregnancy, resulting from hormonal variations and biomechanical alterations in the muscles that support lumbo-pelvic stability. The Pilates method, which includes mind-body approaches and focuses on core strength, provides relief from pelvic pain. In recent years, tele-rehabilitation has emerged as one of the most popular solutions in clinical practice. Aim. To find out the effect of home-based Tele Pilates on pelvic girdle pain and lumbo-pelvic stability among pregnant women. Materials and methods. A randomized controlled trial was conducted in Sri Ramachandra Hospital, Chennai, from January 2023 to June 2023. Pregnant women with pelvic girdle pain from 20-30 weeks of gestation were screened and randomly divided into a Pilates exercise group (n = 19) and a control group (n = 19). Subjects in the Pilates group followed the exercise thrice a week for eight weeks. Subjects in the control group followed standardized antenatal exercises and education. The outcome measures used were Visual Analogue Scale (VAS) for pain level, Pelvic Girdle Questionnaire (PGQ) for functional disability, and Pressure Biofeedback for lumbo-pelvic stability. Mann-Whitney test, Wilcoxon signed rank test, and ‘t’ test were performed to examine the pain score, Pelvic Girdle Questionnaire, and the lumbo-pelvic stability. Results. Baseline parameters are similar and comparable. (p &lt; 0.05). Between-group analysis revealed that the experimental group showed improvement in the pain and disability with a significant difference (p ≤ 0.001). Both groups showed significant improvement in lumbo-pelvic stability in the within-group analysis (p &lt; 0.001). Conclusion. Home-based tele Pilates (HTPE) can be recommended as an effective and safe method for decreasing pain levels and improving lumbo-pelvic stability among pregnant women with pelvic girdle pain.

Effectiveness of biopsychosocial approach for subacute neck pain among geriatrics

Background: The geriatric Population faces common health challenges such as Frailty and neck Pain, which increases the risk for adverse ADL. It leads to a greater level of disability &amp; Headache risk, lower physical functioning and reduced quality of life. A Biopsychosocial Approach centred on activities, emphasizing the enhancement of Biological factors, Psychological factors and Social functional performance to achieve the goals of the Biopsychosocial Approach. This involves intensifying exercise training by leveraging the environment, conducting thorough task analysis, providing feedback and consistently repeating training sessions. Objective: To determine the effects of the Biopsychosocial Approach on Subacute Neck Pain in the geriatric population, focusing on pain, neck-specific disability and work status. Methods: 64 samples were randomly allocated into two groups. The experimental group received the Biopsychosocial Approach, which integrated biological, psychological and social aspects activity-centred, emphasizing repeated training sessions over 8 weeks. The control group underwent Conservative Management 3 days/week for the same duration. Pre and post-test assessments were conducted using the PCS, NDI and AQoL-8D. Results: The significant improvements in the experimental group compared to the control group were demonstrated by the Wilcoxon Signed Rank Test and Mann-Whitney Rank scores (p &lt; 0.001). Specifically, participants in the experimental group experienced reduced neck pain, enhanced neck function, and improved quality outcomes. The results suggest that the Biopsychosocial Approach effectively addressed the multifaceted nature of pain. Conclusion: The study provides compelling evidence supporting Biopsychosocial in reducing neck pain and improving overall quality of life among geriatric populations.

Effectiveness of joint mobilization on heel fat pad syndrome among obese patient in geriatric population

Objective. To determine the effect of joint mobilization on Heel Fat Pad Syndrome among obese geriatrics. Methods. The randomized controlled study was performed at the Saveetha Physiotherapy OPD, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India. 202 samples aged above 60 years were collected based on the criterion for inclusion and exclusion. Interventions. The experimental Group (101Subjects) was treated with Ultrasound and Joint Mobilization. The Control Group (101 Subjects) was treated with Ultrasound and conventional Exercises. The lifestyle and Balance Assessment used the Foot Function Index and Berg balance scale. A numeric Pain Rating Scale was used to measure Pain. Results. The Wilcoxon Signed Rank Test revealed a significant difference (p &lt; 0.001) in the experimental Group between the pre-test and post-test values of NPRS, FFI, and BBS. Similarly, the Control Group showed a significant difference (p &lt; 0.001) in the pre-test and post-test values of NPRS, FFI, and BBS. The comparison of post-test scores between the Experimental Group and the Control Group also showed a significant difference (p &lt; 0.001), indicating significant improvements in the experimental group. As a result, the effects of Joint Mobilization on Heel Pad Syndrome minimize the symptoms of heel fat pad syndrome, Improve Foot Function and balance and reduce pain. Conclusion. The study provided evidence that ultrasound and joint mobilization used in this study show a significant reduction in pain and balance with non-specific heel pain.

Effectiveness of Ali Satia Graha massage therapy method on increasing range of motion and reducing knee pain in pre-elderly

This study aims to test the effectiveness of the Ali Satia Graha massage therapy method on increasing Range Of Motion (ROM) and reducing knee pain in pre-elderly. This study is a pre-experimental study using a One Group Pretest-Posttest research design. The population in this study was pre-elderly patients with knee injuries at the Ali Satia Graha Method Sports Injury Massage Therapy Service at Plaza UNY. The study used incidental sampling with a sample size of 17 people. The data collected were: (1) The scale of Range Of Motion (ROM) of the knee joint was measured using a goniometer. (2) The scale of knee joint pain was measured using the Numeric Rating Scale (NRS). The data analysis technique used a quantitative descriptive analysis and hypothesis testing using the Wilcoxon Signed Rank Test with a significance level of 5%. The results of the study showed that: (1) massage therapy could reduce knee joint flexion motion pain with an effectiveness of 54.9%. (2) Massage therapy could reduce knee joint extension motion pain with an effectiveness of 56.1%. (3) Massage therapy could increase the Range Of Motion (ROM) of knee joint flexion with an effectiveness of 10.2%. (4) Massage therapy could increase the Range Of Motion (ROM) of knee joint extension with an effectiveness of 48.8%. It can be concluded that the massage therapy applied in the Ali Satia Graha Method Sports Injury Massage Therapy Service was effective in increasing ROM and reducing knee joint pain in pre-elderly.

Predictors of wound healing after surgical deroofing in Hidradenitis Suppurativa.

Surgical deroofing is an essential part of ongoing management of Hidradenitis Suppurativa, including persistent lesions non-responsive to medical therapy. The variables associated with delayed wound healing after surgical deroofing are contradictory within the literature due to the inclusion of heterogeneous surgical intervention methods. We aimed to assess the predictors of time to wound healing after surgical deroofing in HS. Patients who underwent in-office surgical deroofing between 2020 and 2024 at a single tertiary HS referral centre were included in analysis. Demographic, disease and blood variables were collected as per standard of care. Statistical analysis was performed using univariate correlation, with multiple regression performed to explore the interactions between variables and identify variables predictive of time to wound healing. A total of 270 individuals were included in the analysis. The median time to wound healing was 9.6 weeks with a range from 4 to 22 weeks. Kaplan-Meier curves demonstrated significant differences with the log rank test when comparing biologic use versus no use, normal versus abnormal CRP and normal versus abnormal haemoglobin. Cox regression analysis identified biologic use with a significant hazard ratio compared to no biologic therapy (HR = 2.512, p < 0.0001) along with baseline CRP (HR = 0.968, p < 0.0001) and baseline haemoglobin (HR = 1.052, p < 0.001). Time to wound healing after in-office deroofing can be decreased with prior biologic therapy and markers of systemic inflammation in blood are also significantly associated with delays in healing. This correlates well with the existing literature promoting concurrent medical and surgical therapy to improve patient outcomes in HS.

KECEMASAN PADA PASIEN DENGAN LUKA KAKI DIABETIK

The prevalence of diabetes continues to increase from year to year in 2021. There were 90 million cases and 5.5% are predicted to have diabetic foot ulcers, and it is predicted that it will increase by 68% in 2045 with 152 million patients. This study was conducted to determine whether there was a relationship between duration of diabetes and age on the level of anxiety in patients with diabetic foot ulcers at the Kitamura clinic in Pontianak. This type of research is descriptive analytic with a cross sectional approach. The sample used in this study were 60 respondents with diabetic foot ulcers who received treatment at the Kitamura Pancasila Pontianak Clinic, the instruments used in this study were the Anxiety Inventory (S-AI) Form questionnaire to measure anxiety levels and observation sheets for respondent demographic data. The results of the Spearman Ranks test obtained with the results of significance (2-tailed) or p value = 0.005 there is a relationship between the length of time suffering from DM with anxiety levels in diabetic foot ulcers patients and there is no relationship between age and anxiety levels in diabetic foot ulcers patients with p-value 0.064. Conclusion, there was no relationship between age and anxiety level and there was a relationship between duration of DM and anxiety level in patients with DM.

Accuracy of the Quebec Pre-Hospital Triage Scale (EQTPT) in Predicting the Need for Trauma Team Activation: A Retrospective Administrative Data Study

Background: Trauma team activation at a Level 1 trauma centre In Quebec, Canada, is primarily at the emergency department’s staff discretion. Trauma teams may be activated prehospital, based on information provided by field paramedics or in the emergency department based on the patient’s condition on arrival. In this study, we examined over and undertriage rates based on present trauma team activation criteria. We also examined if trauma team activation, for those patients solely meeting pre-hospital major trauma criteria, would result in significant overactivation of the trauma team. Methods: This is a single-centre retrospective medical record review. Primary ambulance transport reports from May 15, 2018 to December 31, 2020, were screened to identify patients aged ≥16 years who met pre-hospital trauma triage criteria to bypass community hospitals to arrive directly at the Level 1 trauma centre. We examined pre-hospital triage criteria, trauma team involvement, Injury Severity Scores (ISS) and final disposition. Patients were evaluated for over and undertriage and rates were compared to the rates assuming all patients were to have a trauma team activation. We considered patients overtriaged if they had a full trauma team activation but had an ISS &lt;12 and were discharged from the emergency department. Undertriage was defined as any patient with an ISS ³12 and did not have a trauma team activation. Results: Of the 371 patients who met study inclusion criteria, 123 (33.3%) did not meet trauma team activation criteria, while 214 (57.7%) had a trauma team activation. Of these, 49 patients (13.2%) were undertriaged and 31 patients (8.4%) were overtriaged and 25.8% of the major trauma patients (ISS ³ 12) were undertriaged. A trauma team activation for all meeting field triage criteria increased overtriage to 25.3% and brought undertriage rates to 0%, with statistically significant differences based on the Wilcoxon signed ranks test (p&lt;0.05). Conclusions: In this study, undertriage rates were well above 5%. Trauma team activation, based on local field trauma triage criteria adapted from the CDC-ACSCOT field triage criteria, eliminates undertriage and keeps overtriage rates below 35%. This research suggests that field triage criteria accurately predict major trauma and the need for the involvement of the trauma team and that the condition of the trauma patient in the pre-hospital setting is accurately predicting the need for advanced trauma care

ADL ACTIVITY OF DAILY LIVING DAN KUALITAS HIDUP PASIEN PASCA STROKE ISKEMIK

Ischemic stroke, also referred to as non-hemorrhagic stroke, results in the death of brain tissue due to impaired blood flow, primarily caused by blockages in the cerebral or cervical arteries and, less commonly, in the cerebral veins. This condition profoundly affects various aspects of an individual's life, including physical, emotional, psychological, cognitive, and social well-being. Following a stroke, many individuals experience reduced independence and mobility, which significantly detracts from their quality of life. Often, they face self-care deficits and require assistance to gradually regain the ability to perform activities of daily living (ADL) independently. This study aims to elucidate the strong relationship between ADL independence and the quality of life of post-ischemic stroke patients at Abdul Aziz Hospital in Singkawang City. Employing an analytic observational design with a cross-sectional approach, the research involved a sample of 60 respondents selected from the Neurology Polyclinic at RSUD dr. Abdul Aziz through purposive sampling. Data analysis was conducted using the Spearman Rank test with a 95% confidence level. The results indicate a significant relationship between ADL independence and the quality of life of these patients, as demonstrated by a p-value of 0.000 (p &lt; α) and a correlation strength of 0.514, categorized as moderate (0.40 – 0.599). These findings highlight that the level of independence in activities of daily living is intrinsically linked to the quality of life for post-ischemic stroke patients.

THE ROLE OF DIGITAL LITERACY OF PRE-SERVICE AND IN-SERVICE EFL INSTRUCTORS IN POST PANDEMIC COVID-19

There is a need to pay more attention to the incorporation of digital technologies in teaching English as a Foreign Language (EFL) due to the increased importance of digital technology and digital literacy highlighted by the COVID-19 pandemic. The digital proficiency of teachers is crucial for effective teaching and learning in the 21st century, especially in the context of foreign language education [1]. In this context, this study investigates the role of digital literacy of pre-service and in-service EFL instructors post-pandemic. Participants are N:165 EFL pre-service and in-service instructors. The current study has a quantitative design, the data tool is the Digital Literacy Questionnaire for Language Teachers. The data is analyzed via the Mann-Whitney U test, Wilcoxon Signed Rank Test, descriptive analysis for one of the questionnaire items and content documentation for the last open-ended question for of the questionnaire. The findings of the study indicate that there are significant differences between Pre-service and In-service EFL Instructors for some of the items. Besides, as the findings suggest lack of skills and knowledge of teachers, lack of training, lack of budget, and lack of interest of teachers are among the factors affecting the use of digital technologies for foreign language teaching. The findings undeniably confirm the vital importance of digital literacy in teaching English as a Foreign Language (EFL) in the digital age, highlighting the need for teachers to actively acquire and employ it. Therefore, it is essential for EFL teachers to include digital literacy in their teaching methods by making use of a range of digital technologies, including Web 2 tools that provide several capabilities. The results also indicate the necessity of teacher training programs focused on enhancing the digital literacy skills of English as a Foreign Language (EFL) instructors.

Effectiveness of Video Education in Preventing Electric Smoking Behavior in Students

Electronic cigarettes have experienced very rapid development, recently many people have been seen using electronic cigarettes, In Indonesia, as many as 2.1 million who use electronic cigarettes are students. Control of electronic cigarettes is carried out by providing education to change the knowledge and attitudes of adolescents. In the digital era, innovation is possible in delivering messages for prevention through audiovisual media such as short videos. This study aims to determine the effectiveness of video media on knowledge, attitudes and actions of electronic smoking behavior in adolescents at SMK Istiqomah Muhammadiyah 4 Samarinda. This study was conducted using an Experimental research method with a pre and post design approach. This study involved two research groups, namely the experimental group and the control group. Data were obtained using a questionnaire on knowledge, attitudes and actions of electronic smoking. The research sample was 234 students. The sampling technique that will be used in this study is Simple Random Sampling. Statistical Wilcoxon Signed Rank Test. The results of the study were that after education using video there was an increase in knowledge of 5 points and attitudes of 2 points. The results of the statistical test showed that there was an effect of video education on knowledge and attitudes with a P Value of 0.000. The conclusion of this study is that video education about the dangers of electronic cigarettes can increase knowledge and attitudes towards preventing electronic smoking behavior.

Financial Performance of Banking in Indonesia: A Comparison Before and During the Covid-19 Pandemic

This research aims to examine the financial performance of the banking sector in Indonesia both before and during the pandemic. In the course of this investigation, financial performance was evaluated using several factors namely Loan to deposit ratio (LDR), non-performing loan (NPL), return on assets (ROA), as well as operating expenses and operating income (BOPO). Furthermore, the data used comprised information on the banking financial conditions before (2018-2019) and during the pandemic-affected periods (2020-2021). Purposive sampling was used for sample selection and the analytical methodology adopted comprised the Wilcoxon signed rank test and paired samples t-test analysis. It is also crucial to establish that the present research utilized statistical computations conducted via the Statistical Package for the Social Sciences (SPSS) application, with a significance level of 5%. The obtained results showed that no significant difference was identified between LDR and BOPO both before and during the pandemic. However, a substantial difference was identified between NPL and ROA over the two examined periods.

INTENSITAS PENGGUNAAN MEDIA SOSIAL DAN PERSEPSI REMAJA TENTANG CITRA TUBUH IDEAL

The intensity of social media (Instagram) usage is how long and how often someone accesses it. The duration of accessing Instagram often triggers perceptions about ideal body image in society. The purpose of this study to analyze the effect of the intensity of Instagram social media usage on adolescents' perceptions about ideal body image at SMA Negeri 4 Purwokerto. The research method used is a non-experimental quantitative research type with a cross-sectional approach. The sample consisted of 124 students. The research instruments included a questionnaire that measured the intensity of Instagram usage using a scale adapted from previous researchers and the perception of ideal body image using the Multidimensional Body Self-Relations Questionnaire (MBSRQ) measuring instrument. The test results using SPSS version 25, the characteristics of the respondents were mostly female (72.6%), the intensity of Instagram usage and adolescents' perceptions about body image were in the moderate category, 73.4% and 60.5%, respectively. The results of the Spearman rank test showed a p value of 0.004 (&lt;0.05) so that H1 was accepted and H2 was rejected. Thus, there is an influence between the intensity of Instagram use and ideal body image with a significance value of 0.004 &lt;0.05, so it can be concluded that the two variables are correlated with a correlation coefficient value of 0.259, which means that the level of relationship between the two variables is in a very weak relationship.

Measuring palatability of pet food products: Sensory components, evaluations, challenges, and opportunities.

The pet food industry is a growing business launching a variety of new products in the market. The acceptability or preference of pet food samples has traditionally been measured using either one-bowl or two-bowl tests. Academic researchers and professionals in the pet food industry have explored other methods, including the cognitive palatability assessment protocols and the ranking test, to evaluate more than two samples. A variety of approaches and perspectives were also utilized to predict palatability and key sensory attributes of pet foods, including descriptive sensory analysis by human-trained panelists and pet food caregivers' perceptions of pet food. This review article examined a range of testing methods for evaluating the palatability of pet foods, specifically targeting products for dogs and/or cats. It outlined the advantages and disadvantages of each method. Additionally, the review provided in-depth insights into the key sensory attributes of pet foods and the methodologies for assessing palatability. It also explored pets' behavioral responses and facial expressions in relation to different pet foods. Furthermore, this review discussed current challenges and future opportunities in pet food development, including the use of instrumental analyses and artificial intelligence-based approaches.

Efektivitas Layanan Informasi dengan Pendekatan Cooperative Learning Model Jigsaw untuk Membentuk Sikap Anti Cyberbullying Siswa

This research is motivated by the phenomenon where there are still students who send harsh words through conversations on social media, humiliate friends by editing and spreading their personal photos on social media, so it can be said that students don’t have anti-cyberbullying attitudes. As a student, an anti-cyberbullying attitude should be possessed, in order to help create a safe and comfortable learning atmosphere where all students feel valued and protected. Therefore, information services with jigsaw-type cooperative learning approach are needed to shape students' anti-cyberbullying attitudes. This type of research uses quantitative approach with a pre-experimental method of one group pretest and posttest design. The subjects of this study amounted to 30 students of class XI SMAN 1 Lubuk Basung. Subjects selection using purposive sampling technique. The data collection technique used an anti-cyberbullying attitude scale, the data were analyzed using the Wilcoxon signed rank test. The results showed that information services with a jigsaw-type cooperative learning approach were effective for forming anti-cyberbullying attitudes in students, where after being given the treatment, students' anti-cyberbullying attitudes increased significantly. This can be seen from the results of hypothesis testing, the Asymp.Sig (2-tailed) result of anti-cyberbullying attitudes in students is 0.000, in other words, the probability is below 0.05 (0.000 ≤ 0.05), meaning that H0 is rejected and Ha is accepted. Based on these results, it is concluded that information services with a jigsaw-type cooperative learning approach are effective for forming anti-cyberbullying attitudes in students.

The association of the perioperative neutrophil-to-lymphocyte ratio with wound healing in patients with Wagner grade 3 and 4 diabetic foot ulcers after tibial cortex transverse transport surgery: a prospective observational cohort study

BackgroundDiabetic foot ulcers (DFUs) are severe complications of diabetes, involving multiple etiological factors including neuropathy, vascular insufficiency, and impaired wound healing. The global burden of DFUs is substantial, with significant morbidity and high management costs. Recent advancements have introduced the tibial cortex transverse transport (TTT) technique, which has shown promising results in the management of severe DFUs by promoting angiogenesis and immunomodulation.MethodsThis prospective cohort study enrolled patients with Wagner grade 3 and 4 DFUs, treated using the TTT technique from May 2022 to September 2023 at MianYang Central Hospital. The study assessed the influence of TTT on the perioperative neutrophil-to-lymphocyte ratio (NLR), an established biomarker of systemic inflammation, and its correlation with wound healing outcomes.ResultsA total of 82 patients were enrolled, with 66 completing the study. The survival analysis revealed that patients with a lower preoperative NLR experienced significantly faster wound healing compared with a high NLR (log rank test P&amp;lt; 0.05; hazard ratio (HR) = 0.46; 95% CI: 0.26–0.83). The optimal NLR cutoff values (4.25) were established to predict wound healing times for DFUs. The median NLR was significantly different before TTT surgery, 3 days after TTT surgery, and 1 month after TTT surgery (P&amp;lt;0.05).ConclusionThe TTT technique significantly influences the perioperative NLR and is associated with improved wound healing in DFU patients. The perioperative NLR serves as an effective predictive biomarker for wound healing outcomes, highlighting the significance of interventions targeting NLR values in perioperative management strategies and postoperative monitoring protocols for the treatment of diabetic foot ulcers (DFUs) in clinical practice.

Long-term survival after coronary artery bypass grafting comparing bilateral versus single internal mammary artery in a women cohort

Abstract Introduction Although neutral results from the ART randomized controlled trial, observational studies have been supporting better survival after bilateral internal mammary artery (BIMA) vs single internal mammary artery (SIMA) coronary artery bypass grafting (CABG). However, for some specific subgroups, like women patients, more doubts remain about BIMA benefits. Aim To compare long-term survival and early results in women after SIMA vs BIMA. Methods Longitudinal, retrospective, single-center study including consecutive women with at least 2 left-coronary system (LCS) vessel disease who underwent primary isolated CABG with at least 1 internal mammary artery (IMA) conduit and a minimum of 2 conduits targeting the LCS, between 2004-2014. Emergent or salvage surgeries, on-pump beating-heart, BIMA in which 1 IMA targeted the right coronary artery territory were excluded. The primary outcome was all-causes mortality (checked on February 2023). Time-to-event outcomes were studied using Kaplan-Meier Curves, Log-Rank test and multivariable Cox Regression. Median follow-up was 11 years, maximum of 19 years. Results From 539 women selected for this study, BIMA CABG was performed in 30%. SIMA patient’s were older (mean age 68.95±8.39 vs 62.75±9.82 years, p&amp;lt;0.001), but the prevalence of cardiovascular risk factors were similar between groups (arterial hypertension, p=0.693; dyslipidemia, p=0.111; diabetes mellitus, p=0.462 and obesity, p=0.109). Peripheral artery disease (p=0.707), left ventricular dysfunction (p=0.727), cerebrovascular disease (p=0.730), active smoking habits (p=0.05) and chronic obstrutive pulmonary disease (p=0.537) were also similar. Severe chronic kidney disease (27% vs 14%, p&amp;lt;0.001) and Canadian Coronary Society - grade IV (74% vs 63%, p=0.011) were more frequent in SIMA group. In the univariable survival analysis, SIMA had worse survival results than BIMA (Log Rank test p&amp;lt;0.01). At 5-, 10- and 15- years of follow-up, cumulative survival for SIMA vs BIMA were 88% vs 90%, 68% vs 75%, 42% vs 58%, respectively. However, the multivariable Cox regression showed that BIMA was not associated with long-term survival (HR [95%CI]: 1.09 [0.75-1.59], p=0.6). Most of post-operative outcomes were similar between groups, with the exception of atrial fibrilation (25% vs 16%, p=0.031) and time to discharge (median days [min-max]: 7 [4-128] vs 7 [4-59]) that were higher in SIMA. No differences were found in immediate reexploration of thorax (sternal infection – 0.3% SIMA vs 1.2% BIMA, p=0.219; bleeding- 1.6% SIMA vs 0.6% BIMA, p=0.681). Redo CABG occurred in 1 SIMA and 1 BIMA women, at 41 and 84 months of follow-up, respectively. Conclusion In this study, revascularization with BIMA seems to be safe in women and provides similar results than SIMA. More studies in women are needed to establish the better approach for this specific subgroup.

Single spot albumin to creatinine ratio as an independent predictor of 12 years follow-up mortality in acute coronary syndromes without ST-segment elevation

Abstract Background To the best of our knowledge there is no evidence of the association between microalbuminuria, measured as single spot urine albumin to creatinine ratio (ACR), with very long-term mortality in patients with non-ST segment Elevation Acute Coronary Syndromes. Aim To evaluate the association between admission ACR and very long-term all-cause mortality in an unselected cohort of non-ST-segment elevation acute coronary syndromes patients. Methods A prospective cohort study was conducted, including patients with non-ST-segment elevation acute coronary syndromes admitted in the Intensive Care Unit. The ACR was determined in spontaneous urine samples during the first 24 hours after admission and analyzed by immunoturbidimetry. The primary endpoint was all-cause mortality during the follow-up. Actuarial survival curves were compared by log rank test and a logistical Cox regression analysis was performed to identify variables independently associated with mortality in the follow-up. Statistics were calculated using the IBM Statistics program SPSS version 26. Results 600 patients were analyzed. The overall average ACR value was 7 mg/gr (95% CI 4-26). 76% had normoalbuminuria (ACR 0-30 mg/gr), 22% had microalbuminuria (ACR 30-300 mg/gr), and 1.5% had macroalbuminuria (ACR &amp;gt; 300 mg/gr). The median and interquartile range of follow-up was 12 years (95% IC 11-14). The average ACR among those who met the primary endpoint was 59.15 mg/gr (95% CI 52-66) and among the survivors, 27.66 mg/gr (95 % CI 63-77), p &amp;gt; 0,003. ACR terciles were defined by 33th and 66th percentiles: tercile 1: patients with ACR of 0 to 4 mg/gr, tercile 2: ACR from 4 to 17 mg/g and tercile 3 values greater than 17mg/gr. Strong associations were observed between ACR with age, hypertension, stroke and history of COPD, previous use of angiotensin II converter/blocking enzyme inhibitors, systolic blood pressure at admission, ST segment deviation, left ventricle ejection fraction and elevation of serum Troponin T and CPK MB. All cause-mortality during the follow-up was 14% (CI 95% 11-17). Elevation of ACR was significantly associated with long term mortality risk: log rank test chi square: 133.936, p = 0.0001. By multivariate Cox regression analysis adjusted by age, gender, diabetes, hypertension, serum creatinine, troponin T elevation, ST segment deviation, previous AMI, prior use of aspirin, statins and percutaneous coronary intervention after hospitalization, the ACR was independently associated with a 12-year follow-up mortality: OR 13 (95% IC 5-35; p &amp;lt; 0.0001). Conclusion Single spot urine ACR at admission is a strong predictor of 12-year follow-up mortality in an unselected cohort of patients with non-ST-segment elevation acute coronary syndromes.Baselines characteristics of cohortsMultivariable COX regression analysis

Fastidious adherence to 0/1-hour high-sensitivity troponin T testing reduces emergency department length of stay in patients presenting with suspected acute coronary syndromes

Abstract Background High-sensitivity cardiac troponins (hs-cTn) are key clinical biomarkers in patients presenting with suspected acute coronary syndromes (ACS) to Emergency Departments (EDs). They have facilitated rapid 0h/1h troponin testing protocols, leading to safe, effective, and efficient triage of patients. However, early distinction of myocardial infarction (MI), which has a reported frequency of less than 10% in most cohorts, from the apparently stable hs-cTn elevations of chronic myocardial injury (CMI) remains a challenge. Often CMI patients require confirmation by further testing and observation, prolonging patient length of stay. Further, reliably obtaining serial hs-cTn samples at 60-minutes in a busy ED setting may be difficult. A potential explanation for only 5-6% of Australian sites adopting 0h/1h hs-cTn testing. Methods and Results We undertook a case-control study between March and August 2023 among patients with suspected ACS presenting to Liverpool Hospital ED (Sydney, Australia). 185 patients (cases) underwent hs-cTnT sampling at 30- and 60-minutes (± 5 minutes) after baseline. Diagnosis of MI was made in 8.6%, 35.7% were placed into a further observation group and MI ruled-out in 55.7%. The latter two groups were matched to 169 patients (controls) who received ‘usual’ care, which was a 0h/1h hs-cTnT testing protocol. The case and control arms were matched by age, gender, time from symptom onset and main presenting symptom. Control patients had a median sampling interval of 118 [85 to 174] minutes, rather 60 minutes as the protocol directs. When comparing the paired differences between the case and control arms, there was a mean reduction in length of stay of 104 (95% CI: 41 to 186, P = 0.01) and 47 (95% CI: 11 to 84, P = 0.01) minutes, for the observation and rule-out MI groups respectively. The figure shows the distribution of lengths of stay by group. Among the rule-out group, Wilcoxon signed rank test indicated the control arm had a longer median length of stay of 6.3 [5.1 to 8.4] hours, compared to 5.0 [4.5 to 7.1] hours in the case arm (P=0.005). Similarly, in the further observation group, control patients also had a longer median length of stay of 9.2 [6.9 to 10.4] hours compared to case patients of 8.1 [5.1 to 10.3] hours (P = 0.009). At 30-days, ED representation rates were 10.7% in controls and 8.3% in cases, rehospitalisation 3.6% in controls and 5.3% in cases, cardiac death 0% in both arms and non-cardiac death 1% in both arms. There were no differences in event rates between each arm (P &amp;gt; 0.05). Conclusion Accurate 0h/1h hs-cTnT testing reduces patient length of stay in ED and offers more personalised prediction of MI risk. The importance of adherence to protocol-directed sampling times is clear, where further studies are required regarding routine implementation in a busy ED setting.Exact 60 min TnT and LOSOutcomes at 30 days