Routine Assessment Research Articles

Cultural or Spiritual End-of-Life Practice Preference Assessment and Documentation: Identifying Current Practice in Pediatric Hospice.

Communities use rituals at end of life to foster a peaceful death, ensure passage to the afterlife, and grieve their lost loved ones. Studies report fear of misunderstanding or impeding rituals as a barrier to accepting hospice care. However, there has been little research on cultural and spiritual rituals in the setting of hospice care or how patient preference should be assessed, documented, and supported by hospice staff. This project sought to identify the current practice for assessment of cultural or spiritual end-of-life practice preferences, and the documentation of those preferences, within pediatric hospice programs in a Midwestern state. In surveys of 2 pediatric hospice programs, employee respondents reported routine assessment (97.3%) and routine documentation (70.3%) of cultural or spiritual end-of-life practice preferences. Most respondents reported documentation was written by various disciplines and in various locations in the medical record. Additionally, a retrospective chart review was performed including decedents of 1 pediatric hospice program over a 5-year period. Documentation affirming familial spiritual beliefs was identified in 75.9% of charts, of which, only 12.2% had documentation regarding end-of-life-specific spiritual needs. Standardized documentation practices may help foster equitable hospice care for all patients by ensuring care providers are aware of the patient and/or family's end-of-life spiritual needs.

Angiopoietin-2 and D-dimer add prognostic information to clinical risk in pulmonary arterial hypertension

Thrombosis and endothelial injury are pathologic hallmarks of pulmonary arterial hypertension (PAH). We aimed to evaluate whether markers of endothelial dysfunction and coagulation in the blood would provide insight into disease activity, treatment response, and outcomes in PAH. MethodsWe prospectively collected baseline and 3-month follow-up blood samples from treatment-naïve PAH patients (n=22) and those who had a clinical indication to intensify therapy (n=19). In addition, we recruited 12 healthy people and clinically stable PAH patients (n=45) as controls who had two blood samples collected twice within 14 days. We generated platelet-free plasma and measured D-dimer, angiopoietin-2, thrombin time, soluble P-selectin, von Willebrand factor, and vascular endothelial growth factor. We assessed treatment response with Reveal Lite 2 scores (all patients had NT-pro-BNP, 6-minute-walk, and functional class assessment at both visits) and followed clinical outcomes for 3 years. ResultsAngiopoietin-2 levels were elevated and fell with response to effective therapy (drop in Reveal Lite 2 score). At follow-up, persistently elevated angiopoietin-2 levels predicted clinical events and even identified low-risk participants who subsequently had events. D-dimer levels were also elevated in PAH patients but didn’t change in response to therapy. Several other abnormalities in endothelial and platelet activation were identified (including elevated soluble P-selectin, elevated von Willebrand factor, and elevated vascular endothelial growth factor) but these did not change with treatment or predict outcome. ConclusionsAngiopoietin-2 and D-dimer are elevated in PAH patients and may add prognostic information to routine clinical assessment.

Tumor Budding: A Prognostic Marker of Aggressiveness and Metastatic Potential in Epithelial Cancers, with a Focus on Colorectal and Urothelial Carcinomas

A hallmark of malignancy is the ability of a tumor to disseminate and metastasize, a process that requires specific cellular adaptations. The American Joint Committee on Cancer developed the TNM staging system to classify malignancies and guide treatment strategies, reflecting the biological behavior and clinical outcomes of cancers. Despite its usefulness, ongoing efforts aim to identify additional diagnostic and prognostic parameters to improve accuracy and treatment outcomes. One such parameter is tumor budding, a distinctive morphological feature observed in epithelial cancers. tumor budding is characterized by single tumor cells or small clusters of up to four cells that detach from the invasive front and invade the surrounding stroma. First described in colorectal cancer, tumor budding has since been widely investigated and recognized as a predictor of adverse outcomes, including lymph node invasion, local and distant metastasis, lymphovascular invasion, and poor survival rates across multiple cancer types. Independent of pathological stage, tumor budding correlates with aggressive tumor behavior, highlighting its prognostic significance. In urothelial cancers, tumor budding has been linked to stage progression, distant metastasis, and survival outcomes, particularly in non-muscle invasive bladder cancer and muscle-invasive bladder cancer. This review examines the mechanisms underlying tumor budding, its clinical significance across various tumor types, and its prognostic implications in epithelial cancers. Understanding these factors could provide valuable insights into integrating tumor budding into routine pathological assessments and improving cancer management strategies.

Comparative effectiveness of delirium recognition with and without a clinical decision assessment system on outcomes of hospitalized older adults: Cluster randomized controlled trial.

Early recognition of delirium is essential for effective management, but it often goes unrecognized, resulting in adverse outcomes. Clinical decision support systems can enhance adherence to guidelines and improve patient outcomes. We developed a mobile-based clinical decision assessment tool (3D-DST) based on the 3-minute diagnostic interview for confusion assessment method-defined delirium (3D-CAM). Implementing the 3D-DST may enhance delirium recognition and adherence to interventions among healthcare professionals, potentially improving outcomes in older adults. To test whether improved recognition of delirium could lead to better clinical outcomes in older adults. A cluster randomized controlled trial with pair-matching. A tertiary geriatric hospital. Patients aged ≥65years. Four general wards were paired and randomly assigned to the intervention group (two wards) or the control group (two wards). The intervention included routine delirium assessments by nurses using either the 3D-DST or the 3D-CAM, along with delirium prevention and intervention measures carried out by a multidisciplinary team. Outcomes measured included delirium incidence, duration, severity, length of stay, and adherence to the delirium assessment, prevention, and treatment protocol. A trained nursing researcher collected data on demographics, clinical characteristics, and primary and secondary outcomes. 211 eligible patients participated (106 in the intervention group and 105 in the control group), with 21 identified as delirium-positive using the 3D-DST. The median Charlson comorbidity index score among older adults in the intervention group was 1 (1-2), compared to 2 (1-3) in the control group (P=0.032). Nurses' adherence to delirium assessment was significantly higher in the intervention group than in the control group (73% vs. 31%). The recognition rate of delirium among nurses was 89% in the intervention group and 42% in the control group. There were no statistically significant differences in delirium duration (6 [3-9] vs. 7 [2-14], P=0.967), incidence (8.5% vs. 11.4%, P=0.500), severity (2 [1-3] vs. 2 [1-4], P=0.891) or length of hospital stay (15 [14-18] vs. 18 [13-22], P=0.568) between the intervention and control groups. The 3D-DST enhanced adherence to routine delirium recognition by nurses. However, effective strategies are urgently needed to strengthen multidisciplinary collaboration and enhance adherence to delirium management among healthcare professionals. Chinese Clinical Trial Registry, Identifier: ChiCTR1900028402.

Examining the Feasibility and Acceptability of Identifying Signs of Social Anxiety, in University Students Aged 18-25, While Watching 360° Immersive Films.

Timely, accurate assessment and treatment for social anxiety disorder (SAD) in young people is crucial. There is potential for the adoption of tailored virtual reality interventions for a complementary diagnostic tool using heart rate monitoring as a response indicator. This study examined the feasibility and acceptability of this concept by exposing healthy individuals, aged 18-25, to developed 360° immersive films while collecting heart rate sensor data. Two immersive scenarios were designed with a participatory advisory youth group. A clinical consultant nurse mapped scenario events against validated routine assessment subscales in child and adolescent services. The films were shown to seven participants through a VR headset while monitoring heart rate. They provided qualitative feedback on their quality, acceptability and usability. The study indicated that this approach has the potential to enhance assessments in child and adolescent mental health services. The study has several limitations which are discussed with recommendations for consideration if this concept is taken further. The intervention could act as a potential portable, user-friendly complementary diagnostic tool for clinicians in practice. However, further research is needed to examine its validity.

Factors Delaying Antenatal Management Leading to Maternal Morbidity: Empirical Evidence from Tertiary Care Hospital KPK

Antenatal care is a branch of preventive medicine focused on the early detection and prevention of pregnancy disorders. Objective: To determine the frequency of factors responsible for delaying antenatal management leading to maternal morbidity. Methods: This cross-sectional was conducted at Khyber Teaching Hospital. In this study, a total of 151 patients were observed. Before data collection, approval was obtained from the hospital's ethical committee after approval of the synopsis. All the admitted patients (pregnant women) presented to labor room in Khyber Teaching Hospital meeting the inclusion criteria were recruited for the study explaining the objective of the study to every patient. Inform consent was obtained from the patients. Patients were thoroughly examined according to the routine health assessment protocol of the hospital. Data were collected with the help of a Performa attached. Results: The mean age was 30 ± 12.45 years. 67% of patients were from rural areas while 50 (33%) patients were from urban areas. 65 (43%) patients were un-educated, 53 (35%) patients had primary to secondary education and 33 (22%) patients had an education level above secondary. There was a significant association (p-value=0.001) between the distance from the hospital and delays in antenatal care. Conclusions: It was concluded that antenatal care is essential for reducing maternal and fetal mortality, particularly in developing regions where the maternal mortality ratio remains significantly high. This study identifies key barriers to Antenatal care utilization in Pakistan, such as low education levels, poor socioeconomic status, geographical inaccessibility, and systemic healthcare issues.

Microbiological findings in acohort of patients with coronavirus disease 2019 and venovenous extracorporeal membrane oxygenation.

Venovenous extracorporeal membrane oxygenation (VV ECMO) is an established support option for patients with very severe respiratory failure and played an important role during the coronavirus disease 2019 (COVID-19) pandemic. Bacteria and fungi can lead to severe infectious complications in critically ill patients. The aim of this study was to describe the microbiological spectrum of bacteria and fungi detected in patients with COVID-19-associated respiratory failure supported with VV ECMO in our center. This retrospective single-center analysis included all patients with COVID-19-associated respiratory failure supported with VV ECMO in our center between March 2020 and May 2022. All findings from microbiological samples, taken as part of clinical routine assessment from initiation of VV ECMO until day30 were included. Samples were described by site and time of detection and microbiological characteristics. From March 2020 through May2022, 88patients with COVID-19-associated respiratory failure received VV ECMO support at our center. In 83/88 patients (94.3%), one or more pathogens were found in microbiological samples. Most pathogens were isolated from samples from the respiratory tract (88.6%). Earliest detection occurred in samples from the respiratory tract with amedian time of 5days to first detection. The most frequently detected pathogens were Staphylococcus spp., Candida spp., Klebsiella spp., Escherichia coli and Enterococcus spp. In this cohort of severely ill COVID-19 patients receiving VV ECMO support, pathogens were frequently detected.

Migraine and ergot use increase plasma pentraxin 3 levels: an Egyptian study

ABSTRACT Background Endothelial dysfunction and inflammation are linked to migraine, which may contribute to atherogenesis and increase the risk of ischemia. In migraineurs, preclinical vascular involvement manifested as compromised structural characteristics of vessel wall has not received enough attention or evaluation. Objectives To measure plasma pentraxin 3 as an indicator of endothelial dysfunction in migraine in comparison to controls and to examine its correlation with clinical characteristics, headache severity, and brain magnetic resonance imaging findings. Subjects and methods This study was conducted on 40 migraineurs and 40 healthy matched control subjects. The severity and intensity of headaches were quantified using the Headache Impact Test and the translated Arabic version of Migraine Disability assessment questionnaires. Both patients and controls underwent routine laboratory assessment, brain MR imaging, and measurement of plasma pentraxin 3 level. Results Patients with migraine had a significantly higher mean plasma pentraxin 3 when compared to controls. Patients with chronic migraine and those taking ergots also had significantly higher plasma pentraxin 3 levels. Additionally, there were statistically significant positive correlation between frequency of headaches and duration of the disease with plasma pentraxin 3 level. For diagnosing endothelial dysfunction in migraine patients, the sensitivity and specificity of pentraxin 3 levels were 85% and 95%, respectively, with cut-off value of 3.100 ng/ml. Conclusion Pentraxin 3 levels could be used as a chemical biomarker for endothelial dysfunction in migraines with high sensitivity and specificity. Higher plasma levels of pentraxin 3 in patients receiving ergots may influence the selection of treatment for migraine patients.

Value of multi-parameter 123I-MIBG scintigraphy in the differential diagnosis of Parkinson’s disease

Background123I-MIBG scintigraphy plays a significant role in diagnosing Parkinson's disease (PD), with most studies primarily targeting cardiac uptake and relying on traditional ratio-based parameters for assessment. However, due to variations in scanning conditions and image processing methodologies, the clinical utility of different parameters remains a subject of debate. This study aims to evaluate the diagnostic accuracy of multi-parameter 123I-3-Iodobenzylguanidine (MIBG) scintigraphy and to identify the most reliable metrics for distinguishing PD from Parkinson-plus syndromes.ResultWe recruited 56 PD patients and 44 non-PD controls, who underwent 123I-MIBG scintigraphy and clinical evaluation. MIBG uptake and washout rates (WR) for the heart, salivary glands, and thyroid were assessed, with semi-quantitative methods used to calculate heart-to-mediastinum (H/M) and gland-to-background (P/B, S/B, T/B) ratios. Diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curves. The H/M ratio and cardiac WR parameters scintigraphy exhibited excellent diagnostic efficacy for PD and PPS. The 4 h H/M ratio showed superior diagnostic performance with an area under the ROC curve (AUC) of 0.980. Background and time decay correction improved cardiac WR diagnostic performance (AUC = 0.963). Although P/B, S/B, and T/B ratios showed no significant differences for differential diagnosis, the WR values of the parotid and thyroid glands exhibited moderate diagnostic efficacy with AUCs of 0.648 and 0.638, respectively.ConclusionThe heart H/M ratio and cardiac WR in 123I-MIBG scintigraphy show high diagnostic efficacy for both diagnosing and differentiating PD. Including cardiac WR in routine assessments is recommended. The diagnostic potential of WR in the parotid and thyroid glands also holds promise for PD diagnosis. Incorporating these parameters could enhance the accuracy of PD diagnosis, particularly in clinical scenarios where concurrent cardiac disease may confound the diagnosis.

Assessing Psychosocial Burden in Psoriasis Patients Using the PRISM-RII Tool: A Comprehensive Evaluation

Introduction: Psoriasis is a chronic, immune-mediated inflammatory disease that significantly impacts patients' quality of life due to its visible lesions and associated stigma. Psychological comorbidities are prevalent among psoriasis patients. Objectives: This study aimed to evaluate the utility of the Pictorial Representation of Illness and Self Measure Revised II (PRISM-RII) tool in assessing the psychosocial burden, including internalized stigma, in psoriasis patients. Methods: A cross-sectional study was conducted with 190 psoriasis patients recruited from a university hospital's dermatology treatment center. Participants completed the PRISM-RII Psoriasis Internalized Stigma Scale (PISS), Hospital Anxiety and Depression Scale (HADS), and Dermatology Life Quality Index (DLQI). Clinical severity was measured using the Psoriasis Area and Severity Index (PASI). Results: Significant correlations were observed between PRISM-RII parameters and measures of quality of life, internalized stigma, anxiety, and depression. Our study revealed significant differences in PASI scores among different Illness Perception Measures (IPM). A negative correlation was found between PASI and Self-Illness Separation (SIS), suggesting that increased disease severity is associated with a higher perceived burden of illness. Additionally, significant negative correlations were observed between SIS and DLQI, HADS, and PISS. Patients with larger IPM reported higher levels of anxiety, depression, and internalized stigma, as well as lower treatment satisfaction. Conclusions: The PRISM-RII tool effectively captures the psychosocial burden of psoriasis including internalized stigmatization, highlighting the need to address both physical and psychological aspects in clinical practice. Incorporating PRISM-RII into routine assessments can enhance patient-centered care by identifying and addressing the psychosocial dimensions of psoriasis.

How to assess pulse wave velocity during transthoracic echocardiography? Comparison of femoral, carotid and radial time to flow

Abstract Background Pulse Wave Velocity (PWV) is a key parameter for arterial stiffness assessment, which provides significant prognostic information in a wide range of patients. However, the access to the dedicated devices, additional time and logistics needed during the separate study limit significantly the feasibility of this important variable. Purpose Our aim was to elaborate the simplest and timesaving method for routine TTE assessment, noninvasive and in maximal way patient and user friendly. We tested pulsed wave velocity calculation with TTE (ePWV) which however includes the measurement of the distance between carotid and femoral artery and its simplification by using as a proxy time to the onset of blood flow in femoral artery (TF) with possible indexing to patient’s height for further standardization and inter-patient comparisons. In the second step we compared the utility of time to flow measured with linear probe in radial artery (TR) which my further simplify the procedure by easier access to radial artery. Methods We included 56 patients with wide age-range from 20 to 94 years(mean age 55 years; 65% female), who underwent TTE with Doppler examination of flow in left and right carotid (TC), femoral(TF) and radial arteries (TR) using respectively cardiac probe for carotid and femoral (for simplification and minimizing the time of the examination) and linear probe for radial arteries. Pulsed wave Doppler spectra were registered and times from R wave of ECG to onset of flow were measured as well as the distance between respective points of measurements. ePWV was calculated as the distance divided by estimated pulse wave transit time, see Figure 1. Results We found very good to good significant correlations, with p<0.0001, between parameters measured in respective left and right arteries (with r= 0.92 for femorals, 0.82 for carotids and 0.73 for radials respectively). Similarly, median times to flow did not differ significantly between left and right-sided arteries although numerically the right-sided values were a few miliseconds longer e.g. 139 (118-154) vs 133 (116 – 155) ms in respective femorals, p=ns. Calculated ePWV correlated significantly with time to flow in femoral artery (TF), underscoring its potential as a fast proxy parameter, r= -0.67, p<0.0001. Moreover, TF correlated well with TC, age and intima media thickness (IMT), whereas TR did not show significant relationships with those parameters, see Figure 2, compare left and right panels. Conclusions The assessment of ePWV by TTE is safe, fast and feasible with the possibility of further simplification while using time to flow in left or right femoral artery (TF). However analogous parameter obtained from radial artery did not show correlations neither with age nor with IMT as exponents of cardiovascular burden so could not be use in place of femoral examination. Time to flow measurements. Comparison of TF and TR correlations.

P-957. Introducing PrEP to Primary Care: A Resident-Focused Initiative

Abstract Background Despite studies showing that HIV pre-exposure prophylaxis (PrEP) dramatically decreases risk of HIV acquisition, it is only currently prescribed to 30% of those who could benefit. The buy in of primary care providers (PCPs), who have an essential role as preventionists, is critical for the most successful reach; however, studies have shown that PCPs often do not feel knowledgeable about PrEP or may be uncomfortable discussing sexual activity or HIV. We hypothesized that dedicated PrEP training for PCPs in a resident clinic would increase prescribing habits. Methods At an Internal Medicine residency clinic with 73 trainees in New Orleans, LA, a pre-intervention survey was distributed to gauge baseline PrEP knowledge and comfort in discussing sexual practices, HIV status and risk factors. Following the training, residents attended a one-hour PrEP training. A post-training survey then assessed interest and intent to prescribe PrEP. We abstracted primary care clinic records to evaluate PrEP prescribing outcomes post-training, from October 2023 to April 2024. Results Forty-four residents completed the pre-training assessment. Most indicated non-routine discussions regarding sexual practices (37/44, 84.1%) and HIV risk assessments (41/44, 93.2%). Many trainees reported being not at all familiar with PrEP indications (40.9%), medications (45.5%), or monitoring (81.8%). Most (61.4%) had never discussed PrEP with clients. 53/73 (72.6%) residents attended the educational session, and 26/73 (35.6%) completed the post-training survey. All of the residents who completed both indicated that the training was informative, and 20/21 (95.2%) reported willingness to prescribe PrEP. In the six months post-training, we found that 11 clients were successfully initiated on PrEP. One client was diagnosed with HIV on intake labs, and 3 clients were found to have sexually transmitted infections, all of whom were treated or referred for treatment. Conclusion The results of this initiative’s pre-training surveys highlight a lack of routine sexual health and HIV risk assessments in a resident primary care clinic, as well as deficiencies in education regarding HIV PrEP. Following training, residents began prescribing PrEP, demonstrating promise for scaling such educational programs. PrEP Primary Care Pocket Card A pocket card adapted from the CDC PrEP TRAIN module was provided to trainees in the resident clinic. Contains information regarding medications available, contraindications, side effects, laboratory monitoring (on back side), ICD-10 code, etc. Disclosures Meredith E. Clement, MD, Gilead Sciences: Grant/Research Support|Viiv Pharmaceuticals: Advisor/Consultant

Improving risk stratification in heart failure with reduced ejection fraction by using three-dimensional right ventricular ejection fraction

Abstract Background In patients hospitalized for heart failure with reduced ejection fraction (HFrEF), the occurrence of right ventricular (RV) dysfunction emerged as a prognostic factor for morbidity and mortality. Standard two-dimensional echocardiographic (2DE) parameters have been utilized to assess risk of cardiac death in these patients, but their predictive accuracy varies across different cardiac conditions. This underscores the necessity for more reliable novel parameters, to improve prognosis and to guide therapeutical and interventional management. Purpose To assess independent and comparative prognostic utility of three-dimensional (3D) against standard 2D parameters of RV function in predicting mortality and HF hospitalization (HFH). Methods We prospectively enrolled 366 patients hospitalized for HFrEF (60±13 years, 81% men), of ischemic and non-ischemic etiology (51% vs. 49%). Patients underwent comprehensive 2D and 3D echocardiography, including full volume acquisition of the right (RV) and left ventricles (LV). By 2DE, we measured TAPSE, RV fractional area change (FAC), S’ systolic velocity, and RV global (GLS) and free wall longitudinal strain (FWLS). By 3DE, we measured RV volumes and RVEF, and derived RVFAC and TAPSE. Primary outcome was cardiac death (CD). Secondary outcome was heart failure hospitalization (HFH). Follow up was 24±8 months. Results Mean 3D LVEF was 31±10%, while mean 3D RVEF was 39±10%. Binary logistic regression identified 3D RVEF as an independent significant predictor of CD (β=-0.16, OR 0.84, 95%CI 0.81-0.89, p<0.001) and HFH (β=-0.09, OR 0.92, 95%CI 0.88-0.95, p<0.001), better than standard 2DE parameters, such as 2D RVFAC (β=-0.04, OR 0.96, 95%CI 0.93-0.98 for CD and β=-0.02, OR 0.97, 95%CI 0.96-0.99 for HFH, both p<0.05) and 2D TAPSE (β=-0.13, OR 0.88, 95%CI 0.82-0.95 for CD and β=-0.08, OR 0.92, 95%CI 0.86-0.99 for HFH, both p<0.05). Comparative ROC analysis showed that 3D RVEF was superior for predicting CD (Fig. A) and HFH (AUCs of 0.82 and 0.71, respectively) to 2D TAPSE (AUCs of 0.63 and 0.60, respectively), 2D RVFAC (AUCs of 0.62 and 0.60, respectively), and S’ (AUC 0.56 and 0.50, respectively), all p<0.05. Kaplan-Meier survival analysis (Fig. B) showed that a 3D RVEF of 35% (χ²=25.1, p<0.001) differentiates the best between survivors and non-survivors. Conclusion 3D RVEF provides superior prognostic information for mortality and heart failure hospitalization in patients with HFrEF, better than 2D echo parameters. Inclusion of 3D RVEF in routine clinical assessment of patients with HFrEF might improve risk stratification and targeted interventions in this population.

Pulmonary artery effective elastance in patients with tricuspid valve regurgitation: a simple effective echo marker for risk stratification

Abstract Background/Introduction Tricuspid valve regurgitation (TR) is a common valvular disease associated with increased mortality. There is a need for tools to assess the interaction between the pulmonary artery (PA) circulation and the right ventricle (RV) in patients with TR and to investigate their association with outcomes. Various echo parameters have emerged that assess RV-PA coupling, including the ratio of TAPSE to RV systolic pressure (RVSP) and the PA pulsatility index (PAPi). The effective PA elastance (PA Ea) is a composite measure of RV afterload that refers to the measure of the pulmonary vascular load that the RV must overcome to eject blood into the PA. PA Ea is simple to estimate by echo and found to be an independent haemodynamic risk measure in various left heart and pulmonary hypertension (PH) diseases. Whether PA Ea discriminates risk in unselected patients with significant TR and how it compares to other measures of RV-PA coupling is untested. Purpose To ascertain the prognostic value of PA Ea in patients with TR. Methods In consecutive patients with a first diagnosis of ≥ moderate TR (regardless of aetiology), we compared all-cause mortality at five years based on the PA Ea (defined as the RVSP/stroke volume as measured by transthoracic echocardiography). As stroke volume was measured by Doppler at the left ventricular (LV) outflow tract, patients with > moderate aortic valve regurgitation were excluded. The Tricuspid Regurgitation Impact on Outcomes (TRIO) score was calculated as previously described. PA Ea was separated into 4 groups for comparison based on the separation of quartiles of PA Ea rounded to one decimal place. Results In the 13,608 patients studied, PA Ea could be calculated in 12,682 patients (94.4%). The median PA Ea was 0.68 mmHg/mL (IQR 0.50, 0.92). Increasing levels of PA Ea were associated with clinical comorbidities including heart failure, liver and kidney disease and clinical markers of risk such as the TRIO score. Increasing levels of PA Ea were also associated with larger RVs, worse RV systolic function, higher NT-pro BNP levels, and greater degrees of right heart failure (Table). Each quartile of PA Ea was associated with a significant increase in all-cause mortality (Figure). After adjusting for age and sex, PA Ea was associated with higher risk of death (HR 2.41 (2.28-2.56); p<.0001). While worsening degrees of PA Ea correlated with both declining levels of TAPSE/PASP and PAPi (Table), PA Ea was independently predictive of outcome in a combined model: PA Ea HR 1.65 (1.51-1.80, Chi-squ 120, p<.0001); PAPi HR 0.84 (0.80-0.89, Chi-squ 48, p<.0001) and TAPSE/PASP HR 0.32 (017-0.60, Chi-squ 12, p=.0004). Conclusion(s) In patients with significant TR, PA Ea is highly feasible and higher PA Ea is progressively associated with RV dysfunction, right heart failure, and worse survival. Incorporating PA Ea into the routine echo assessment may help stratify disease severity in patients with significant TR. Table Assoc. of PA Ea with mortality in TR

Lower Limb Compartment Syndrome Among Colorectal Patients: Risk Factors and Proposed Guidelines

Background: Lower limb compartment syndrome (LLCS) is a rare but potentially devastating complication of prolonged lithotomy positioning in colorectal surgery. The mechanisms appear to be related to prolonged pressure on muscle compartments, leading to hypoperfusion followed by reperfusion injury. This study aims to identify the incidence of LLCS after colorectal surgery and identify associated risk factors to inform evidence-based prevention strategies. Study Design: Adults from the American College of Surgeons-National Surgical Quality and Improvement Program (2006-2022) undergoing colorectal surgery were included. The primary outcome was postoperative compartment syndrome leading to fasciotomy. Patients with concurrent vascular procedures and embolism diagnoses were excluded. The association between operative time and fasciotomy was assessed using multivariable logistic regression. Results: Among 773,981 patients, 35 underwent fasciotomy within 2 days of their colorectal procedure. The median operative time was 388 minutes (IQR 165, 539) for the fasciotomy group and 162 minutes (IQR 113,320) for the non-fasciotomy group (p<0.001). Adjusted multivariable analysis demonstrated a time-response relationship between operative time and fasciotomy as the odds of fasciotomy was 3.5-fold higher after 3-5 hours and increased with longer operative time. In addition, other factors associated with fasciotomy included age <50 years, ASA IV-V, and preoperative transfusion. Conclusions: Providers should exercise caution when operating on younger patients in lithotomy position with an operative time over 3-5 hours, as prolonged operative time is associated with an increased risk of fasciotomy. Improving awareness alongside the development of guidelines for routine intraoperative lower extremity assessment can facilitate early recognition and prevention of LLCS.

Adaptation and Validation of the Supportive and Palliative Care Indicators Tool (SPICT): A Quantitative Methodological Study.

To translate the Supportive and Palliative Care Indicators Tool (SPICT) into Chinese and conduct preliminarily tests of its performance in hospitalized patients with cancer. A cross-sectional validation study conducted from January to March 2024. SPICT 2022 was translated in both directions, following the Brislin translation model, and the Chinese version culturally debugged through expert consultation and pre-testing. Content validity was evaluated by expert scoring. Tool internal consistency was evaluated using KR-20 coefficient, and retest reliability was evaluated using kappa coefficient. The screening performance was evaluated by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Of 388 hospitalized cancer patients included, approximately one-quarter had potential palliative care needs. Content validity of the Chinese version of SPICT was good, as were internal consistency and test-retest reliability. Accuracy (0.905), sensitivity (0.806), specificity (0.943), PPV (0.845), and NPV (0.926) for the Chinese version of SPICT indicated that it is an acceptable instrument. The Chinese version of SPICT can be applied for screening of palliative care needs in hospitalized patients with cancer in China. The Chinese version of SPICT had been adapted to assist clinicians or nurses in quickly identifying hospitalized patients with cancer who may have palliative care needs. This is conducive to help clinical team to start palliative care consultation, care goal discussion and (or) referral for patients in clinical practice. And it probably helps to advance integration between palliative care assessment and routine oncology care assessment. This study provided a screening tool for palliative care, with good validity and reliability, as well as excellent screening performance to facilitate palliative care need screening in clinical practice, promote palliative care referrals and improve patient quality of life. This study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. No patient or public contribution.

The Johns Hopkins Hope at Hopkins Clinic: supporting the comprehensive needs of individuals with metastatic breast cancer.

Individuals with metastatic breast cancer (MBC) may live with their disease for many years. We initiated the Johns Hopkins Hope at Hopkins Clinic to assess the needs and optimize the care of these patients. Patients with MBC who agreed to participate in the Clinic in addition to usual care completed patient-reported outcome (PRO) surveys. They met with a navigator and underwent core consults (cancer rehabilitation, integrative medicine, supportive and palliative care, social work, and nutrition), clinical trial eligibility assessment, and optional services based on PRO responses and selection from a Clinic Menu. A medical oncologist provided a Care Plan during a final consult. Participants were asked to complete 3- and 6-month follow-up PRO surveys. We report on initial Clinic implementation, participant characteristics, and baseline PROs. From 11/2020 to 6/2022, 45 patients completed baseline surveys and participated in the Clinic. Median age was 58 (32-86); the majority (71%) were white and had estrogen receptor-positive (84%) tumors. Baseline physical and mental health were not good for ≥ 14days of the past month for 22 and 10%, respectively. PROMIS measure scores were > 1 standard deviation worse than average for 32% for Physical Health, 16% for Mental Health, and 23% for Physical Function. PHQ-8 and GAD-7 scores suggested depression and anxiety for 22 and 7%, respectively. More than 80% of participants received specific recommendations from the core consultants. Only 20% of participants completed follow-up surveys. Patients living with MBC have multiple needs. We used our results to implement routine PRO assessments and to expand services for patients with MBC. Our experience can serve as a model for coordinated care in other systems.

Monitoring fatigue damage in aircraft fuselages using Paris Law parameters C and m

This study proposes an innovative methodology for integrating the Paris Law parameters, C and m, into the analysis, design, and maintenance of aircraft fuselages to enhance fatigue life predictions and structural integrity. The approach combines macro- and micro-scale analyses, leveraging the Boundary Element Method (BEM) to calculate internal stress fields, identify critical stress points, and guide crack propagation simulations at the micro-scale. These simulations utilize C and m to estimate remaining fatigue life under various operational scenarios. The methodology is implemented using a custom computational tool that integrates the BemLab GUI and BemCracker2D solver, automating stress evaluation, compliance calculations, and crack growth simulations. Case studies validate the approach, illustrating how variations in C and m affect fatigue life predictions and enable optimized material selection and inspection strategies. The first case examines a fuselage section under normal and shear loading, while the second includes additional stress components to evaluate their influence on damage tolerance. This methodology provides a practical alternative to traditional crack size-based evaluations by incorporating C and m into routine assessments. It enhances maintenance strategies, improves safety, reduces operational costs, and extends the service life of fuselage structures, presenting a significant advancement in aerospace engineering.

Bioelectrical Impedance Analysis as a Helpful Tool in Pediatric Obesity Monitoring: A Case Report

Background and Clinical Significance: Childhood obesity and its associated complications are an emerging public health problem; thus, non-communicable chronic disease prevention should be implemented as early as possible. On the other hand, obesity management in children is a challenge in terms of achieving fat tissue reduction without any adverse outcomes on overall development. This is why close cooperation with young patients and their parents is crucial for success. Moreover, non-invasive but detailed monitoring guaranties insight in this process’s progress and safety. As obesity is a chronic disease with a tendency for recurrence, further follow-up should also be considered. Case Presentation: We present a case of a 10-year-old boy who was referred to a dietitian due to concerns about a diagnosis of obesity and metabolic complications including abnormal lipid profile and liver function. During the dietary consultation, body composition assessment with bioelectrical impedance analysis was conducted, which confirmed obesity. A detailed interview allowed for the identification of improper dietary patterns. The implemented lifestyle education and qualitative diet modifications led to fat mass reduction without any significant muscle loss after just one month. The metabolic profile was also improved. The patient remained under the care of a dietitian for the next 4 years with constant body composition monitoring, which enabled the relevant parties to address if body mass gain was a part of his normal development or if he suffered from obesity recurrence. The patient and his parents benefited from an individualized, patient-centered approach including dietary education, overall lifestyle modification, and detailed body composition monitoring. This way, the patient succeeded in fat content reduction with the constant assessment of the safety of this process. Moreover, the dietary education impacted the whole family’s lifestyle. Conclusions: This case emphasizes the role of body composition assessment in children. Obesity and metabolic complications resulting from an improper lifestyle can affect pediatric patients. Bioelectrical impedance analysis is a non-invasive tool that can improve the safety and effectiveness of nutritional interventions and could be included in routine pediatric obesity assessment.

Word class deficits in individuals with aphasia: A syntactic analysis at discourse and single word production in the Kannada language

Aphasia commonly leads to word retrieval issues, particularly with nouns and verbs. Traditional assessments often focus on single-word. This study uses qualitative and quantitative methods to assess word class deficits in Kannada-speaking Individuals with Aphasia (IWA) compared to Neurotypical Individuals (NTI) in single-word production and discourse production. Twenty IWAs (aged 20-50) and twenty age/gender-matched NTIs were recruited. Confrontation naming evaluated single-word production, while structured picture description (picnic scene) assessed discourse. Both tasks included a fixed set of nouns and verbs for comparison. The results were that IWAs performed poorer than NTIs in both tasks. Statistically significant noun and verb usage differences were observed between IWAs and NTIs in the picture description task (p<0.05). However, word class differences in the IWA group were insignificant across tasks. NTIs showed significant differences only in the picture description task. This study underscores word class deficits in aphasia, particularly at the discourse level. Discourse analysis is crucial for understanding language characteristics in aphasia and should be integrated into routine assessments.