Rapid activation of the cardiac catheterization laboratory (CCL) for ST-segment elevation myocardial infarction (STEMI) is essential to minimize time to reperfusion. However, system-wide efforts to reduce treatment delays have been accompanied by increased false activations (FA), defined as activations that do not result in emergent coronary intervention. False activations contribute to unnecessary team mobilization (UTM), staff fatigue, workflow disruption, and inefficient resource utilization. To evaluate whether implementation of a cloud-based care coordination platform (Stenoa) was associated with reductions in FA and UTM at a high-volume tertiary cardiac center. In September 2021, the McGill University Health Centre (MUHC) implemented Stenoa, a mobile cloud-based STEMI coordination platform enabling systematic case validation using electrocardiographic and clinical data. A retrospective cohort study was conducted including all CCL activations between September 2020 and December 2022. Activations were grouped as pre-implementation (Group 0: Sept 2020-Sept 2021) and post-implementation (Group 1: Sept 2021-Dec 2022). False activation was defined as CCL activation followed by case cancellation before any procedure was performed. The primary outcome was the rate of UTM. A total of 632 activations were analyzed (overall: Group 0: n =288, Group 1: n =344; off- hours activations: Group 0: n =265, Group 1: n =316.) UTM decreased from 8.7% (23/265) to 4.4% (14/316) following platform implementation (P = .04). FA frequency decreased from 10.2% (27/265) to 7.0% (22/316), although this did not reach statistical significance (P = .16). Among false activations, the proportion resulting in UTM declined from 85% to 64% (P =.08). Implementation of a cloud-based STEMI coordination platform was associated with a significant reduction in unnecessary catheterization laboratory team mobilization. Structured digital communication may improve workflow efficiency and resource utilization in STEMI systems of care. Further multicenter evaluation is warranted.

Tumor-agnostic therapies represent a transformative shift in oncology, targeting molecular alterations irrespective of cancer histology. These therapies offer new hope for patients with rare and difficult-to-treat malignancies, yet their integration into clinical practice remains inconsistent because of the absence of guidelines. Traditional organ-based classifications hinder timely access to precision treatments, despite evidence supporting molecular-driven approaches. Living guidelines, continuously updated frameworks based on emerging data, are essential to bridge this gap. They enable just-in-time incorporation of new therapies, streamline biomarker-driven care, and address the unique needs of rare and ultrarare cancers. Regulatory approvals for tumor-agnostic agents, such as NTRK inhibitors and immunotherapies for microsatellite instability-high/mismatch repair-deficient tumors, underscore the urgency for unified guidance. Trials like TAPUR, TRACK, and NCI-MATCH demonstrate the feasibility and benefit of molecular profiling across diverse cancer types. Tools like ESMO's ETAC-S provide structured criteria for evaluating tumor-agnostic potential, yet real-world implementation lags. Living guidelines can harmonize testing practices, improve access, and educate clinicians on cross-tumor applicability. They also facilitate proactive biomarker testing, reduce treatment delays, and enhance patient safety through tailored toxicity management. As oncology evolves toward molecular precision, living tumor-agnostic guidelines are critical for ensuring equitable, evidence-informed care for all patients, particularly those with rare cancers. National organizations must prioritize their development to fully realize the promise of precision medicine.

Burkitt's lymphoma (BL) is common in sub-Saharan Africa, yet diagnosis is often delayed due to limited pathology capacity. Here we evaluated blood-based liquid biopsies from 377 children and young adults with clinically suspected lymphoma at four hospitals in Tanzania and Uganda, assessing diagnostic accuracy and turnaround time (TAT). After extensive pathology capacity building, a gold-standard diagnosis was established using tissue morphology, a limited validated immunohistochemistry panel and independent dual histopathologist review. Using clinical features and circulating tumor DNA markers (MYC mutations, MYC-immunoglobulin translocations and Epstein-Barr virus fragmentomics), we trained six penalized logistic regression models with tenfold crossvalidation (n = 212). The best-performing model was externally validated in a prospective real-world cohort (n = 56). Diagnostic accuracy, yield and TAT were compared head to head between liquid biopsy and the gold standard in 58 participants. The comprehensive model achieved the highest performance (area under the curve (AUC) 0.95, 95% confidence interval (95% CI) 0.901-0.981, sensitivity 0.86, specificity 0.95), confirmed by external validation (AUC 0.98, 95% CI 0.942-1.000). Liquid biopsy was the only diagnostic result available at the multidisciplinary review in 42% of participants and reduced median diagnostic TAT from 46.8 d to 6.5 d (P = 4.42 × 10-10). These findings demonstrate that liquid biopsy enables fast, highly accurate molecular diagnosis of EBV+ BL and may substantially reduce treatment delays in resource-limited settings.

Cost-effectiveness of first-line IV vs oral iron for iron-deficiency anemia in women with heavy menstrual bleeding.

Contemporary care of patients with ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI) is still dominated by “24/7 PCI-capable” hospital model, whereas a novel approach encompassing true “PCI now” capabilities could provide meaningful clinical benefits. Indeed, prehospital electrocardiogram (ECG) acquisition, early emergency medical service activation of the interventional team, direct transfer to the catheterization laboratory when appropriate, and continuous in-house staff coverage may reduce treatment delays, especially during off-hours, and may improve clinical outcomes. In this perspective, first-medical-contact-to-PCI and total ischemic time appear more meaningful quality indicators than door-to-balloon time alone, as also testified by regional data from Lazio and the experience from Santa Maria Goretti Hospital in Latina which show how delays frequently arise when patients first present to non-PCI hospitals, whereas organized direct-transfer pathways may streamline care. Development of centralized, sectorized STEMI networks, together with transparent auditing of performance and safeguards against false-positive activation, including ECG transmission, teleconsultation, standardized criteria, and validated artificial intelligence tools, may allow a safer and more effective management of STEMI. We hereby thus formally propose the universal adoption of such PCI now approach for STEMI care.

Objectives: The study aims to assess clinicians’ attitudes, knowledge, and awareness regarding the potential establishment of a multidisciplinary vascular anomalies clinic at Muhimbili National Hospital (MNH). It will also evaluate the current landscape of vascular anomalies treatment at MNH, identifying key areas for improvement. Finally, the study seeks to uncover opportunities to enhance the quality of care, foster a multidisciplinary culture, improve clinical training, strengthen patient education, and promote research collaboration. Methods: Semistructured interviews were conducted with 11 health care providers from relevant specialties, including interventional radiology, plastic surgery, hematology-oncology, general surgery, dermatology, otorhinolaryngology, and pediatrics. Thematic analysis identified key themes in benefits, challenges, patient factors, and local structural considerations. Results: Four themes emerged: (1) need for a multidisciplinary approach, (2) barriers to establishing a multidisciplinary clinic, (3) patient-specific challenges, and (4) current clinical practices for vascular anomalies. Providers were largely supportive of a multidisciplinary model, noting its potential to enhance patient outcomes. However, challenges were highlighted, including time constraints, insufficient provider numbers, financial limitations, and the absence of clearly defined roles and interspecialty collaborations. Conclusion: The establishment of a multidisciplinary vascular anomalies clinic at MNH could improve patient outcomes by streamlining care and reducing treatment delays. It could also address existing gaps by fostering cross-specialty collaboration, reducing treatment delays, and enhancing provider expertise. However, addressing barriers related to staffing, funding, and provider training is crucial. The current camp model provides an effective interim solution, but further efforts are needed to enhance multidisciplinary collaboration and access to care in low-resource settings. This study offers insights applicable to the development of vascular anomalies care models in other low- and middle-income countries. Level of evidence: Level 6.

Abstract Aim Rectal prolapse is a full‐thickness intussusception of the rectum beyond the anal canal. It is often mistaken for other anorectal pathologies, leading to inaccurate referrals to colorectal surgeons and inappropriate management. However, the frequency of misdiagnosis is not well characterized. We aimed to assess the diagnostic accuracy of rectal prolapse referrals to three tertiary medical centres. Methods This is a retrospective study of patients referred for rectal prolapse to colorectal surgeons at the Mayo Clinic in Rochester, Jacksonville, and Phoenix from 2020 to 2024. The primary outcome is the accuracy of rectal prolapse diagnosis. The secondary outcomes are factors that correlate with diagnostic accuracy. Results Rectal prolapse was inaccurately diagnosed in 38.7% (186/480) of patients. Among misdiagnosed patients, the correct diagnosis was haemorrhoids (68.0%, n = 134), pelvic floor dysfunction (24.3%, n = 48) and rectocele (18.7%, n = 37). A diagnosis of rectal cancer was found in 3 patients (1.5%). The most common presenting symptoms were protrusion (66.3%, n = 345) and bleeding (33.6%, n = 175). Among the referring physicians, only 50.5% ( n = 227) performed an anorectal examination. Overall, there was significant variability in diagnostic accuracy across different specialties, with the highest accuracy from colorectal practices (84.0%) and the lowest from urologists (50.0%). Internal medicine physicians had a lower diagnostic accuracy with anorectal examination than without, though it did not reach statistical significance (44.0% vs. 59.5%, p = 0.2). Conclusion Over one‐third of rectal prolapse referrals were incorrectly diagnosed. This study highlights the opportunity for further training of referring providers on anorectal pathologies to improve diagnostic accuracy which could reduce treatment delays and optimize clinical outcomes.

Decision-making delays in endovascular treatment for acute ischemic stroke: A qualitative study of perspectives from family surrogates, physicians, and nurses.

Radiotherapy planning traditionally requires a dedicated simulation CT (sCT), which can introduce delays in initiating treatment. This is particularly impactful in spinal palliative care, where timely treatment is often important for symptom control and prevention of neurological deterioration. Although diagnostic CT (dCT) is frequently available earlier in the workflow, it can lead to geometric and dosimetric inaccuracies when used directly for treatment planning due to discrepancies in patient positioning, vertebral alignment, and table curvature. To develop and evaluate an AI-based method that transforms dCT into a simulation-equivalent planning CT (AI-pCT), enabling a clinically feasible simulation-free workflow for spinal palliative radiotherapy. Two neural networks were trained to correct spine position and body contour using paired dCT-sCT images from 50 patients (42 train/validation, 8 internal tests) in a safety net hospital and externally evaluated on 7 additional academic medical center (AMC) patients. After rigid bone-based alignment to sCT, dosimetric accuracy was assessed by comparing DVH endpoints (Dmean, Dmax, D95, D99, V100, V107) and DVH Root-Mean-Square (RMS) error for plans recalculated on dCT versus AI-pCT versus sCT. Four radiation oncologists scored image suitability. Significance was evaluated using the Wilcoxon signed-rank test. In the safety net cohort, AI-pCT substantially reduced geometric and dosimetric error relative to dCT (e.g., Dmean error 2.0%→0.57%; RMS DVH error 6.4%→2.2%, all p<0.05), improved physician plan-quality ratings from "Acceptable" to "Good-Perfect," and increased plan-level clinical goal achievement from 37.5% to 100%. In the AMC cohort, where baseline dCT was already closely aligned to sCT, AI-pCT produced smaller but still statistically significant gains. AI-pCT achieves sCT-level geometric and dosimetric fidelity without requiring a separate simulation scan, enabling a simulation-free planning workflow for spinal palliative RT. This approach has the potential to reduce treatment delays and improve access, particularly in resource-constrained environments.

Abstract Introduction: Breast cancer (BC) in adolescents and young adults (AYAs), defined as individuals aged 15-39 years, poses distinct clinical and public health challenges as underrepresentation in guidelines or screening exclusion. It is the most common solid tumor in young women, contributing substantially to morbidity and mortality. AYAs are more likely to experience diagnostic delays, aggressive subtypes, and worse outcomes due to unique biological and psychosocial vulnerabilities. In Brazil, where ethnic and socioeconomic disparities are pronounced, understanding the drivers of BC mortality in young women treated in the public healthcare system is essential. This study investigates factors associated with mortality in a nationwide cohort of Brazilian women aged 15-39 years diagnosed with BC over a 23-year period. Methods: A secondary database study was conducted, including women aged 15 to 39 years who were diagnosed and treated for BC (ICD-10 C50) within Brazil’s public healthcare system, as recorded in the national Hospital Cancer Registry between 2000 and 2023. Non-analytic cases were excluded. The primary end point was death occurring after diagnosis and during the initial course of proposed treatment. Sociodemographic, clinical, and tumor-related variables were collected. Descriptive analysis was performed, and multivariable logistic regression using the Stepwise Forward method was applied to identify factors associated with the outcome. Variables with a p-value &amp;lt; 0.05 were retained in the final model. Results: Of 66,726 eligible women, most were aged 30-39 (87.3%), self-identified as Black or mixed-race (55.4%), had ≥9 years of education (59.0%), and lived with a partner (54.3%). The majority were from the Southeast (44.8%) and Northeast (26.9%). Invasive carcinoma of no special type was the most common subtype (86.8%). At diagnosis, 40.3% were stage II and 36.7% stage III. Treatment initiation exceeded 60 days in 44.6% of cases. Neoadjuvant chemotherapy was administered to 39.5%, surgery to 49.3%, radiotherapy to 8.3%, and endocrine therapy to 2.0%. A total of 2,337 women (3.5%) died before or during the initial course of treatment. In adjusted analyses, younger age was associated with higher mortality, with a 2% reduction in odds of death per year of age (OR 0.98; 95% CI: 0.96-0.99; p = 0.003). Black or mixed-race women had a 40% higher risk of death (OR 1.40; 95% CI: 1.23-1.61), and those with lower education, a 36% increase (OR 1.36; 95% CI: 1.21-1.52). Living in the North, Northeast, or Central-West was associated with 30% higher mortality (OR 1.30; 95% CI: 1.14-1.47), and absence of a partner increased the risk by 23% (OR 1.23; 95% CI: 1.10-1.38). Advanced stage (III/IV) was the strongest predictor of death (OR 7.54; 95% CI: 6.37-8.93; p &amp;lt; 0.001). Conclusion: This nationwide study demonstrates a high burden of early mortality among young Brazilian women with breast cancer, particularly those from marginalized racial, educational, and geographic backgrounds. Non-white ethnicity, low educational attainment, absence of a partner, and residence in underserved regions were independently associated with increased risk of death. Late-stage diagnosis was the most significant predictor. These findings underscore the urgent need for targeted public health interventions to promote earlier diagnosis, reduce treatment delays, and improve equity in breast cancer care across Brazil. Citation Format: A. Pires, A. Gonçalves, C. Resende, L. Thuler, M. Bello, A. Bergmann, G. Bretas. Early Mortality in Young Women with Breast Cancer: Insights from 66,000 Cases in the Brazilian Public Health System (2000-2023) [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-06-27.

Abstract Background: Oncotype DX testing plays a central role in guiding adjuvant treatment decisions for patients with early-stage estrogen receptor-positive (ER+), HER2-negative, node-negative (N0) breast cancer. While the assay informs chemotherapy decisions and may help avoid overtreatment, delays in ordering or resulting may contribute to postponed therapy initiation. This study characterizes the timing of Oncotype DX testing in relation to surgery and evaluates its association with initiation of chemotherapy, endocrine therapy (ET), and radiation therapy (RT). Methods: We conducted a retrospective review of 373 ER+/HER2–/N0 breast cancer patients treated at a single academic center between January 2018 and November 2024. Inclusion required an Oncotype DX order and available treatment dates. Patients treated externally or with missing key dates were excluded. Data collected included demographics, tumor characteristics, and dates of definitive surgery, Oncotype DX order/result, and treatment initiation. The primary outcome was time from surgery to first treatment. We also evaluated intervals from surgery to Oncotype order/result and from result to treatment. Results: The cohort had a mean age of 58.9 years (range 30–88) and was predominantly female (98.9%). Racial/ethnic distribution was 57.7% White, 31.3% Black, and 43.3% Hispanic. Most tumors were stage IA (90.1%) with low (55.6%) or intermediate (31.8%) recurrence scores. Oncotype DX was ordered before surgery in 40 patients (8.6%), on the day of surgery in 105 (22.5%), and a mean of 30.2 days postoperatively (SE 2.59) in the remainder. Results became available a mean of 41.1 days after surgery (SE 1.33), excluding 21 patients with preoperative results and one with same-day result. Chemotherapy was the first treatment in 65 patients, initiated a mean of 64.2 days after surgery and 33.7 days after the Oncotype result. ET was first in 135 patients; 13 began therapy preoperatively and 29 started before Oncotype results. Among those who initiated ET postoperatively and post-result, the mean time to treatment was 61.3 days after surgery and 36.4 days after result. RT was the first treatment in 173 patients, excluding 70 who received intraoperative RT. Among these, RT began a mean of 63.8 days after surgery and 28.8 days after Oncotype result. Two patients began ET and RT on the same day, averaging 41 days post-surgery and 25.5 days post-result. Conclusion: Delays in Oncotype DX ordering and resulting were associated with prolonged time to treatment. Patients with earlier testing had shorter delays. When compared to national guidelines, many patients initiated therapy later than recommended. Adjuvant chemotherapy is ideally started within 4–6 weeks and no later than 12 weeks post-surgery; our cohort averaged over 9 weeks, with some beyond 12 weeks. RT is recommended within 6–8 weeks of surgery (or 4–6 weeks post-chemotherapy), but was frequently delayed. While ET is more flexible, most patients started beyond 6 weeks. Workflow adaptations during the COVID-19 pandemic, including use of core-biopsy Oncotype testing and neoadjuvant ET to bridge surgical delays, may have contributed to these patterns. Early integration of Oncotype testing into the surgical workflow may reduce treatment delays and improve adherence to care timelines. Citation Format: E. Kohilakis, J. Taylor, S. Jao, E. Hakim, M. Rony, L. Coe, S. Harbour, N. Degrezia, A. Brooks, S. Feldman, A. Gupta, E. Ravetch, M. Sheckley, M. McEvoy. Timing of Oncotype DX Testing and Its Impact on Treatment Initiation in ER+/HER2-/N0 Breast Cancer Patients [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-11-23.

Cancer navigation guides patients through cancer care, addressing barriers like late diagnosis, financial constraints, and emotional distress. In Africa, it supports early detection, treatment, and survivorship amid poor infrastructure and limited access. Expanding these programs can reduce mortality and improve outcomes. Cancer cases are rising rapidly in Africa and are expected to double by 2050. Access to care is hindered by limited facilities, few trained oncologists, geographic barriers, cultural stigma, high treatment costs, and lack of screening programs. Most services are urban-centered, leaving rural areas underserved. Financial hardship, poor governance, inadequate research funding, and scarce cancer registries worsen the problem. Coordinated, sustainable efforts are needed to improve cancer prevention, treatment, and care. Patient navigation significantly enhances cancer care in sub-Saharan Africa by addressing barriers to early detection, diagnosis, treatment, and support. Navigators facilitate screening, improve awareness, and coordinate care across healthcare levels. They reduce treatment delays, offer psychosocial support to patients and caregivers, and help with financial, transport, and lodging challenges. Successful programs in South Africa, Uganda, and Nigeria demonstrate improved outcomes, including increased screenings, faster diagnoses, and better treatment adherence, showcasing the transformative impact of navigation on cancer control in resource-limited settings. Strengthening cancer navigation systems is essential, focusing on healthcare infrastructure, workforce training, policy reform, and community engagement. Key strategies include expanding cancer centers, integrating trained patient navigators (both clinical and non-clinical navigators), leveraging telemedicine and AI, and increasing collaborations. Formal navigator certification, education campaigns, and improved health financing are crucial. These efforts aim to improve cancer detection, treatment, and outcomes across Africa's diverse healthcare settings.

Abstract Introduction Osteoporosis affects approximately 3.5 million individuals in the UK, resulting in over 500,000 fragility fractures annually. An initial fracture significantly increases the risk of subsequent fractures, particularly in very high-risk patients. Current clinical guidelines advocate a ‘treat-to-target’ strategy, recommending anabolic treatment for individuals at very high risk of fracture. The objective of this study was to evaluate biochemical safety, service delivery efficiency, and imminent fracture risk among osteoporosis patients receiving anabolic agents. Methods We conducted a retrospective review of Aneurin Bevan Fracture Liaison Service (AB-FLS) between August 2023 and June 2025. Of the initial 71 patients identified, 62 patients who received Romosozumab were included in the final analysis. Three Romosozumab patients were excluded due to disengagement from follow-up or declining treatment. Patients treated with Teriparatide (n = 5) and Abaloparatide (n = 1) were excluded due to small sample sizes. Data collected included patient demographics, fracture types, T-scores at the spine and femoral neck, biochemical markers (serum calcium, alkaline phosphatase (ALP), 25-hydroxyvitamin D [Vit D]), service metrics (waiting times from initial consultation to treatment initiation), incidence of hypocalcaemia (calcium &amp;lt;2.20 mmol/L), ALP elevation (&amp;gt;25% from baseline), vitamin D deficiency (&amp;lt;50 nmol/L), re-fracture incidence, and mortality. Results Mean age for all women (n = 62) was 72 years (range 40–83), 58% were vertebral, 24% were wrist/arm. Mean T-score at spine and femoral neck were − 3.20 (range − 5.39 to −0.70) and − 2.65 (range − 4.40 to −0.90) respectively. Median treatment initiation time post-initial consultation was 42 days (interquartile range 35–78 days). Biochemically, hypocalcaemia occurred in only 1 patient (1.6%) at the 4-month follow-up. Significant ALP elevations (&amp;gt;25%) were most common at 2 months (45%, 28/62) and gradually declined over subsequent follow-ups. Pre-treatment vitamin D deficiency was present in nine patients, all of whom received supplementation. Four patients (6.5%) experienced re-fracture between 84 to 275 days (mean 167 days). No mortality was recorded post initiation of anabolic. Conclusion Romosozumab treatment demonstrated good biochemical safety profiles and a low incidence of hypocalcaemia. We observed delays of nearly 6 weeks in treatment initiation for very high-risk patients. Given the observed imminent fracture risk of 6.5% whilst on treatment, efforts to reduce treatment delays by introducing stronger partnerships working with a dedicated FLS Pharmacists could be tested.

Background and Purpose: Patients presenting with both stroke symptoms and trauma criteria pose a challenge in emergency care, often leading to delays, missed imaging, and poor communication. To address this, the Dual Activation Protocol was developed to activate both stroke and trauma teams simultaneously. The purpose is to improve coordination, reduce treatment delays, and enhance care quality for complex, dual-pathway emergencies. Methods: A multidisciplinary team including stroke and trauma services, emergency medicine, imaging, transfer center staff, and emergency department leadership developed a Dual Activation Protocol to simultaneously mobilize stroke and trauma teams for patients meeting criteria for both. Implementation included: establishing clear activation criteria, conducting targeted staff education across departments, integrating stroke orders into trauma workflows and revising CT protocols to prioritize imaging and reduce contrast load, streamlining transfer center communication, performing retrospective chart reviews to assess time-to-intervention and imaging completion and holding regular case reviews to refine the protocol and address operational barriers. This structured approach aimed to improve coordination and timely care for complex emergency presentations. Results: Dual Activation improved emergency department workflow and interdisciplinary coordination. Time-to-CT imaging met stroke benchmarks despite trauma complexity. Imaging completion rates increased, with fewer delays and missed scans. Staff reported greater confidence and clarity due to improved communication and role definition. High protocol adherence and regular case reviews supported ongoing refinements. The approach demonstrated that timely, coordinated care is achievable without compromising safety or efficiency. Conclusion: The Dual Activation Protocol has improved coordination and reduced delays in managing patients presenting with both stroke and trauma in the initial patients meeting the criteria. Clear activation criteria and streamlined workflows have supported timely imaging and intervention. Staff reported greater clarity and efficiency in responding to complex cases. These results demonstrate that dual activation can enhance emergency care without compromising safety or speed. Further data to be available prior to or for the presentation.

The purpose of this study is to evaluate the reduction in time from hospital arrival to endovascular treatment (EVT) when using a non-contrast CT (NCCT)-based artificial intelligence (AI) solution to screen and notify clinicians of patients with emergent large vessel occlusion (ELVO). In real-world clinical practice, NCCT is primarily used to determine the presence of cerebral hemorrhage. However, if ELVO-suspected patients can be screened and flagged at the NCCT stage, it may improve clinical outcomes by reducing treatment delays. To evaluate clinical effectiveness, we compared the time from emergency room (ER) arrival to reperfusion before and after implementation of the AI-based triage and notification system. Patients aged over 19 years who visited a thrombectomy-capable stroke center with acute stroke symptoms and underwent EVT were included. Post-AI group data were prospectively collected after the implementation of the AI solution (May 1, 2022 – December 31, 2023), while a control group (Pre-AI) was retrospectively selected (May 1, 2020 – April 30, 2022) using 1:3 propensity score matching based on age, sex, and NIHSS score. The primary endpoint was the time from ER door to EVT. Secondary endpoints included time intervals from ER door to CT scan, CT scan to stroke team treatment (STT), and STT to EVT. Time differences between groups were analysed using an unpaired t-test with Welch's correction. A total of 25 Pre-AI cases and 70 Post-AI cases were analysed. The primary outcome showed a significant reduction in time from ER to EVT in the Post-AI group (147.7 ± 31.6 min) compared to the Pre-AI group (174.7 ± 75.0 min, p = 0.0155). Among the secondary endpoints, only the time from CT scan to STT was significantly shorter in the Post-AI group (20.2 ± 7.9 min vs. 35.4 ± 41.3 min, p = 0.0043). These findings demonstrate that early screening and clinician notification of ELVO patients via an AI solution at the initial stage of the clinical workflow can significantly reduce time to EVT and may positively impact patient outcomes. This study demonstrated how AI improved the hyperacute endovascular treatment workflow, by showing the impact on reducing door-to-reperfusion time. It will be particularly valuable in remote regions where clinical experts may be limited.

Capnography in diabetic ketoacidosis (DKA) diagnosis: a systematic review and meta-analysis.

Introduction: Hyperacute MRI (hMRI) has been increasingly implemented in the evaluation of acute ischemic stroke (AIS) to expand eligibility for thrombolysis or thrombectomy in patients who would otherwise be excluded. In the setting of suspected stroke mimic, wake-up stroke, or computed tomography (CT) contrast allergy, hMRI can “rule in” a recent-onset stroke or large vessel occlusion (LVO), thereby converting otherwise ineligible patients into candidates for acute treatment. Despite these advantages, hMRI is resource-intensive and its yield remains uncertain. Using a large hMRI database, we examined treatment yield, workflow, and safety across different clinical indications. Methods: We retrospectively reviewed prospectively collected data on all consecutive patients who underwent hMRI for code stroke at a tertiary center between June 2018 and November 2024. Indications were categorized as: (1) stroke mimic (&lt;4.5 hours from last known normal), (2) wake-up or unwitnessed stroke (&lt;4.5 hours from symptom discovery), or (3) LVO rule-out with magnetic resonance angiography (MRA) (&lt;24 hours from last known normal). Clinical characteristics, workflow metrics, thrombolysis rates, and safety outcomes were compared between groups. Number needed to scan (NNS) was calculated as the total hMRIs performed per indication divided by the number of patients treated with thrombolysis. Results: Among 698 patients, hMRI indications included stroke mimic (n=388), wake-up (n=268), and LVO rule-out (n=42). Baseline characteristics were broadly similar, except wake-up patients were older and more often hypertensive than stroke mimic patients (p&lt;0.001 for both). Thrombolysis was administered in 36 (9%) stroke mimic, 42 (16%) wake-up, and 6 (14%) LVO rule-out cases. NNS was 10.9, 6.4, and 7.0, respectively. Door-to-hMRI order and door-to-needle times were shorter in wake-up compared to stroke mimic patients (28 vs 36 min, p&lt;0.001; and 74 vs 89 min, p=0.013). Symptomatic ICH was rare (1–3%) across groups. Conclusion: hMRI identified thrombolysis-eligible patients with an overall NNS of 8.3; yield was highest in wake-up and LVO rule-out indications. Treatment was feasible within therapeutic windows, and the low rate of ICH supports its safety. Further workflow optimization is needed to reduce treatment delays, minimize variability between indications, and improve the efficiency of hMRI integration into acute stroke protocols.

SOS/VOD is a life-threatening complication of hematopoietic stem cell transplantation, especially in children, with incidences reaching up to 15-20%. Despite efforts, SOS/VOD remains unpredictable with significant morbidity and mortality. High-risk criteria are clearly defined, and the pediatric EBMT diagnostic criteria have improved sensitivity, reducing treatment delays and enhancing outcomes. A meta-analysis combining retrospective and prospective studies found a risk ratio of 0.30 for SOS/VOD with defibrotide (DF) prophylaxis. Additionally, two prospective trials were conducted: the pediatric prevention trial (NCT00272948) and the Harmony Trial (NCT02851407), involving adults and children, with primary outcomes of incidence and SOS/VOD-free survival, respectively. The trials produced conflicting results regarding the effectiveness of prophylactic DF. Despite significant limitations of the Harmony trial, a direct healthcare professional communication (DHPC) from the European Medicines Agency (EMA) advised against prophylactic DF. This recommendation has serious consequences for children, especially infants, who are among the most vulnerable groups receiving HSCT. Therefore, a panel of experts issued guidelines for children at high risk for SOS/VOD, in which DF prophylaxis is considered justified. These guidelines include a weighted scoring system based on all relevant high-risk criteria to predict SOS/VOD, supporting decisions regarding the use of prophylactic DF in children.

China's rapid population aging and shrinking family structures challenge healthcare access for older adults, especially those living alone. While the link between solitary living and poor health is well-documented, its underlying mechanisms remain unclear. This study examines how living alone shapes healthcare-seeking preferences and behaviors to elucidate its pathways to health in later life. Using longitudinal data from the China Family Panel Studies (2010-2020), restricted to a sample of adults aged 60 and above, we employed a linear probability model with individual and time fixed effects to examine the impact of living alone on two key outcomes: the probability of consulting a doctor when ill (n = 3,911) and the preference for primary healthcare centers (PHCs) (n = 11,956). The model controlled for a set of covariates including demographic characteristics, family attributes, and health status measures. Heterogeneity analyses were conducted by gender, hukou status, and household income. Living alone was associated with a significant reduction in the probability of consulting a doctor (20.2% points), with the effect more pronounced among older women, suggesting that emotional or psychological barriers may exacerbate their vulnerability. In contrast, older adults living alone demonstrated a stronger preference for PHCs (10.9% points), a tendency that was particularly evident among lower-income and urban residents, likely due to the greater accessibility, lower cost, and shorter waiting times of PHCs. Strengthening community-based interventions and enhancing the quality and coverage of primary care-particularly in rural areas-are essential to reducing treatment delays and promoting early care-seeking. Policy efforts should prioritise the unique vulnerabilities of older women, low-income individuals, and rural residents by addressing emotional barriers, improving health literacy, and enhancing the accessibility of services. Rebuilding trust in primary care requires sustained investment in provider professionalism, facility infrastructure, and efficient referral systems.

Colorectal cancer (CRC) is a leading cause of cancer-related mortality among older adults. Delays in diagnosis and treatment negatively impact survival outcomes. In Argentina, access barriers in this population have not been adequately characterized. We conducted an ambispective cohort study including older adults diagnosed with CRC within the past five years. Telephone interviews were carried out to collect data on time intervals and perceived barriers across five stages of the diagnostictherapeutic process (from symptom onset or screening to treatment initiation). Multivariable linear and logistic regression models were used to assess associations between sociodemographic factors, perceived barriers, and both total time to treatment and stage-specific delays. A total of 225 participants were included. The median time to treatment initiation was 6 months. Perception of barriers was significantly associated with a higher likelihood of delay in all stages analyzed. The most frequently reported barrier was accessibility -mainly difficulties in obtaining medical appointments- present throughout the care continuum. In later stages, resource shortages were also reported. Female sex was associated with longer time to treatment. Our findings highlight the need for structural health system interventions aimed at reducing treatment delays in older adults with CRC. Identifying and addressing perceived barriers could enhance equity and efficiency in access to oncological care. Time to treatment exceeded internationally recommended standards. Perceived barriers were present in all stages and were significantly associated with delays in care delivery.