Use In Routine Clinical Practice Research Articles

Validation of NEWS2, SIRS, and qSOFA in Postoperative Cardiac Patients: A Retrospective Cohort Study

IntroductionThe ‘quick Sepsis Related Organ Failure Assessment’ (qSOFA), ‘Systemic Inflammatory Response Syndrome’ (SIRS), and ‘National Early Warning Score’ 2 (NEWS2) scores are yet to be comparatively validated in ward-based cardiac surgical patients despite widespread routine use in clinical practice. We sought to assess the predictive validity of NEWS, SIRS, and qSOFA in identifying postoperative, ward-level cardiac surgical patients at risk of poor short-term mortality. MethodsAll adult patients who underwent cardiac surgery at a single tertiary center between November 2014 and October 2017 were identified. Data for bedside observations, hematological results, and microbiology requests were obtained from electronic health records. Survival data were acquired from a national registry. The primary outcome was the discriminatory ability, measured by the area under the receiver operating characteristic (AUROC), of each score for in-hospital mortality. ResultsOne thousand five hundred forty three (male n = 1101, 71%) patients were included. Overall in-hospital mortality was 2.4%. There was no significant difference in discriminatory ability of NEWS (AUROC 0.5060), SIRS (AUROC 0.4874), and qSOFA (AUROC 0.5139) for in-hospital mortality (P = 0.881). Sensitivity for this outcome was ubiquitously low (13.51-40.54%). ConclusionsCurrent illness-severity scores show a low discriminatory ability for in-hospital mortality in ward-based cardiac surgical patients. Caution should be used in the application of these prognostic screening tools for early detection of poor outcomes in this population.

Validation of 3- and 5-point severity scales to assess ARIA-E.

Anti-amyloid-β (Aβ) monoclonal antibodies (mAbs) offer the promise of disease modification and are emerging treatment options in Alzheimer's disease. Anti-Aβ mAbs require brain magnetic resonance imaging (MRI) examinations to detect anti-amyloid-induced amyloid-related imaging abnormalities (ARIA), important adverse drug reactions associated with some anti-Aβ mAbs currently available in the United States and in clinical development. We present a simple rating system for ARIA-edema (ARIA-E) that can assess severity on a 3- or 5-point scale based upon a single linear measurement of the largest area of lesion, and dissemination in space, termed the 3-point Severity Scale of ARIA-E (SSAE-3) and the 5-point Severity Scale of ARIA-E (SSAE-5), respectively. MRI results were collected from 75 participants from the SCarlet RoAD (NCT01224106) and Marguerite RoAD (NCT02051608) studies of gantenerumab. Three neuroradiologists experienced with the detection of ARIA-E were selected to read all cases independently. One rater was then chosen for a second read to assess intra-reader reproducibility. The three raters had high agreement in identifying and grading ARIA-E. The Cohen/Fleiss kappa (κ) scores (95% confidence interval [CI]) for the inter- and intra-reader comparisons for SSAE-3 and SSAE-5 were 0.79 (0.70-1.00), 0.94 (0.94-1.00), 0.73 (0.66-1.00), and 0.90 (0.90-1.00), respectively. Our study suggests that SSAE-3 and SSAE-5 are valid ARIA-E rating scales for use in routine clinical practice by experienced radiologists in specialized settings. The application of these scales in everyday use in clinical practice will support the expansion of anti-Aβ mAbs as a treatment option for people living with Alzheimer's disease. A simple rating scale is needed to rate severity of amyloid-related imaging abnormalities-edema (ARIA-E) in both research and clinical settings.The 3- and 5-point Severity Scales of ARIA-E (SSAE-3/-5) have good inter- and intra-reader agreement.The SSAE-3/-5 have been used in most major Alzheimer's disease (AD) trials to date and are suitable for large-scale use in routine clinical practice, which may help support the expansion of anti-amyloid antibodies as treatment options for AD.

1115P Comparison of efficacy and toxicity of dabrafenib/trametinib versus vemurafenib/cobimetinib therapy in routine medical practice: Eight years of BRAF/MEK inhibitor use in routine clinical practice

1115P Comparison of efficacy and toxicity of dabrafenib/trametinib versus vemurafenib/cobimetinib therapy in routine medical practice: Eight years of BRAF/MEK inhibitor use in routine clinical practice

B-288 The Beginning of the End: AGO2 Protein Identified and Validated as a Novel Biomarker for Multi-cancer Diagnosis Through Bioinformatics Analysis and Immunoassay

Abstract Background Despite significant progress in cancer research, the complexity and heterogeneity of the disease still pose major challenges to accurate diagnosis and effective treatment. Recent advancements in biomedical technologies have led to the identification of reliable potential cancer biomarkers. In this sense, the link between microRNAs (master regulators of gene expression) & cancer is well-established, but there has been little research on the microRNA machinery itself. We aim to investigate whether changes in the expression of genes & proteins involved in the miRNA pathway can be used for multi-cancer detection. Method We analyzed RNASeq data from the TCGA (The Cancer Genome Atlas) and GTEX (The Genotype-Tissue Expression) projects to compare the expression of core components in the miRNA biogenesis pathway, including AGO2, DGCR8, XPO5, RAN, DROSHA, DICER, and TARBP2, in normal and tumorous samples across 22 tissue types, including adrenocortical, AML, breast, colon, lung, liver, esophageal, prostate, pancreas, stomach, thyroid, rectum, uterus and ovarian cancer. We accessed and analyzed the TCGA and GTEx datasets using the UCSC Xena Browser. We also measured the protein concentrations of all these microRNA regulators in 15 normal adrenal cortex, 15 benign adenoma, and 15 adrenocortical cancer tissue homogenate samples using commercial ELISA kits. The Human Protein Argonaute-2 (EIF2C2) ELISA Kit-AE45910HU (Abebio-Co.Ltd) was used for the assay procedure, which was performed according to the manufacturer’s instructions. Statistical analysis was performed using GraphPad Prism, Version 9 (GraphPad Software, CA, USA). A P-value of less than 0.05 was considered statistically significant. Results Our RNASeq analysis results showed that among all microRNA regulators, AGO2 is most highly significantly over-expressed in samples derived from cancer patients compared with normal controls (P < 0.05). In addition, we analysed the protein expression of AGO2 in adrenocortical tissue homogenate samples. Our results demonstrated that the protein expression of AGO2 in adrenocortical carcinoma samples was significantly higher than in normal adrenal cortex and benign adrenocortical tumour samples (P < 0.001). Conclusion Our study highlights the potential role of Argonaute 2 protein (AGO2) in cancer development and progression. AGO2 is a key component of the RNA-induced silencing complex, which regulates gene expression. Our findings show that AGO2 is overexpressed in cancer samples compared to normal controls across a range of cancer types. This suggest that AGO2 could be used as a promising marker for the development of more accurate and specific methods for cancer diagnosis, in combination with other markers. Furthermore, the potential for using AGO2 protein expression in serum samples as a non-invasive diagnostic tool is a promising area for future research. This could be achieved through automated immunoassay, making it a practical diagnostic tool for use in routine clinical practice.

Webtool to enhance the accuracy of diagnostic algorithms for HFpEF: a prospective cross-over study.

Diagnosis of heart failure with preserved ejection fraction (HFpEF) can be challenging. This study aimed to evaluate the potential of a webtool to enhance the scoring accuracy when applying the complex HFA-PEFF and H2 FPEF algorithms, which are commonly used for diagnosing HFpEF. We developed an online tool, the HFpEF calculator, that enables the automatic calculation of current HFpEF algorithms. We assessed the accuracy of manual vs. automatic scoring, defined as the percentage of correct scores, in a cohort of cardiologists with varying clinical experience. Cardiologists scored eight online clinical cases using a triple cross-over design (i.e. two manual-two automatic-two manual-two automatic). Data were analysed in study completers (n=55, 29% heart failure specialists, 42% general cardiologists, and 29% cardiology residents). Manually calculated scores were correct in 50% (HFA-PEFF: 50% [50-75]; H2 FPEF: 50% [38-50]). Correct scoring improved to 100% using the HFpEF calculator (HFA-PEFF: 100% [88-100], P<0.001; H2 FPEF: 100% [75-100], P<0.001). Time spent on clinical cases was similar between scoring methods (±4min). When corrections for faulty algorithm scores were displayed, cardiologists changed their diagnostic decision in up to 67% of cases. At least 67% of cardiologists preferred using the online tool for future cases in clinical practice. Manual calculation of HFpEF diagnostic algorithms is often inaccurate. Using an automated webtool to calculate HFpEF algorithms significantly improved correct scoring. This new approach may impact the eventual diagnostic decision in up to two-thirds of cases, supporting its routine use in clinical practice.

Practical patient care appraisals with use of new potassium binders in heart failure and chronic kidney diseases.

Hyperkalaemia is a life-threatening condition leading to significant morbidity and mortality. It is common in heart failure and in chronic kidney disease (CKD) patients due to the diseases themselves, which often coexist, the high co-presence of diabetes, the fluctuations in renal function, and the use of some drugs [i.e. renin-angiotensin-aldosterone system (RAAS) inhibitors]. Hyperkalaemia limits their administration or uptitration, thus impacting on mortality. New K+ binders, namely patiromer and sodium zirconium cyclosilicate (ZS-9), are an intriguing option to manage hyperkalaemia in heart failure and/or CKD patients, both to reduce its fatal effects and to let clinicians uptitrate RAAS inhibition. Even if their real impact on strong outcomes is still to be determined, we hereby provide a practical approach to favour their use in routine clinical practice in order to gain the correct confidence and provide an additive tool to heart failure and CKD patients' wellbeing. New trials are welcome to fill the gap in knowledge.

Diagnostic specificity of the child psychosis-risk screening system with a focus on the differentiation of schizophrenia spectrum disorders and neurodevelopmental disorders

BackgroundResearch on early psychosis has begun to identify psychiatric characteristics of the prodromal period of schizophrenia; however, subclinical characteristics of children in non-psychiatric fields have not been fully investigated. In our previous study, we developed the Child Psychosis-risk Screening System (CPSS).ObjectiveIn the present cross-sectional study, we attempted to identify the risk of developing psychosis in pediatric (n = 216) and psychiatric outpatients (n = 120), aged 6– 18 years, with the CPSS.MethodsAn analysis of variance of CPSS risk was performed in six diagnostic categories to examine specificity for each diagnosis. Receiver operating characteristic (ROC) curve analysis was conducted using the onset of schizophrenia spectrum as the outcome, and the discriminatory power and cut off values of the CPSS were determined. Logistic regression analysis was performed using clinical data to identify factors associated with the risk group (those at high risk of developing psychosis in the future) identified using the CPSS.ResultsThere were significant differences in risk variance among diagnostic categories (p &amp;lt; 0.001), especially between schizophrenia spectrum disorders (SSD) and neurodevelopmental disorders (p = 0.001). CPSS had sufficient discriminatory power for SSD diagnosis [area under the ROC curve = 0.853 (95% confidence interval: 0.774–0.931)]. The cut off value for the risk of SSD was determined to be 98.1%, achieving the best mean of the sum of sensitivity (90.9%) and specificity (84.0%). Cross-sectional logistic regression analysis showed that along with “SSD diagnosis,” “winter birth,” and “maltreatment” were factors associated with the risk group (odds ratio = 38.05 [p = 0.001], 2.30 [p = 0.016], and 0.12 [p = 0.024], respectively).ConclusionCPSS may have potential use in the early detection of psychosis and differentiation from neurodevelopmental disorders, but this study was small and further studies with larger sample sizes and longitudinal study designs are required prior to its use in routine clinical practice.

Role of Prophylactic Oral Antibiotics in the Prevention of Post-cataract Surgery Acute Infective Endophthalmitis.

Purpose To evaluate the role of perioperative oral antibiotics in the prevention of acute infective endophthalmitis (IE) after cataract surgery. Methods A prospective cohort study of patients older than 18 years of age undergoing uncomplicated phacoemulsification was conducted. Group A was given post-op oral ciprofloxacin for three days, whereas Group B was not. Both groups received 5% povidone-iodine (PVI) preparation for five minutes in the conjunctival cul-de-sac, and intracameral (IC) 0.5% moxifloxacin was administered at the end of the procedure as prophylaxis. The minimum post-opfollow-up period was six weeks. Results Out of 2161 patients, 859 (39.8%) were included in Group A, and 1302 (60.2%) were included in Group B. No significant difference in anterior chamber (AC) reaction was found on day 1 (p = 0.67), day 14 (p = 0.03), or day 45(p = 0.1). One patient developed acute post-op IE (0.04%)and two patients developed toxic anterior segment syndrome (TASS) from Group A. The non-oral antibiotic group had no serious complications. Conclusion Perioperative oral antibiotic use in routine clinical practice is not recommended for the prevention of acute post-op IE. Pre-op conjunctival PVI 5% for five minutes and IC moxifloxacin at the end of surgery were proven to be effective prophylactic measures in our study.

Assessing risk for nonmedical opioid use among patients with cancer: Stability of the CAGE-AID questionnaire across clinical care settings.

The Cut down, Annoyed, Guilty, and Eye opener- Adapted to Include Drugs (CAGE-AID) questionnaire (CA) is a validated screening tool used to assess risk for nonmedical opioid use (NMOU) in patients receiving opioids for cancer pain. Data on consistencies and variations in responses to the CA between different clinical settings are lacking. We evaluated the frequency and consistency in scoring of the CA among patients seen between the first inpatient consult (T1) and the first outpatient follow-up (T2) visits. A retrospective chart review of 333 consecutive patients seen at both T1 and T2 within 3months between August 2016 and March 2017 was reviewed. Median age was 58years (range, 18-87years); 53% were female. CA was completed for 88% of patients at T1 and 94% at T2. Of these, 10% and 13% were CAGE-AID positive, respectively. CA score changed from negative to positive in 4% and from positive to negative in 1% of patients between T1 and T2. Kappa coefficient for agreement of CA between T1 and T2 was 0.74 (95% CI: 0.62-0.86, p=0.02). Completion rate and consistency of patient responses to the CA were high irrespective of clinical setting. Of these patients, 10% and 13% were CA positive which is suggestive of high risk for NMOU. Further studies are needed to evaluate ways to ensure more consistency in the completion of the CA and enhance its utilization in routine clinical practice.

Diagnostic criteria in dementing illness. What's new?

The spectrum of neurodegenerative diseases that primarily affect cognition and behaviorspreads from asymptomatic preclinical disease to very mild cognitive impairment to frank dementia. Alzheimer's disease (AD) is the most common cause of a decline in cognitive ability. Also, it is a devastating condition that affects patients and their entirefamilies of caregivers, exacting tremendous financial hardships. Diagnosis may be complicated by other forms of dementia that have symptoms and pathologies similar to AD. Knowing the key features and pathology of each type of dementia can help in the accurate diagnosis of patients, so they will receive the treatment and support services appropriate for their condition and maintain the highest possible functioning in daily life and quality of life. Differentiate, based on clinical criteria, neuropathology, and biomarkers, AD and its atypical variants from other common dementias including Dementia with Lewy Bodies, Vascular Cognitive Impairment, Frontotemporal Degeneration, and less frequent cognitive disorders. The importance of getting an accurate and early diagnosis of dementiais now increasingly significant to make important decisions about treatment, support, and care. Nonpharmacological as well as pharmacological interventions should be initiated once the diagnosis is obtained. Biochemical markers to identify Alzheimer's disease play a central role in the new diagnostic criteria for the disease and in the recent biological definition of AD. This review article presents up-to-date data regarding the recent diagnostic criteria of Alzheimer´s disease and related disorders, emphasizing its usefulness in routine clinical practice.

Imaging Features of Retinal Vasculitis and/or Retinal Vascular Occlusion after Brolucizumab Treatment in the Postmarketing Setting

The aim of this analysis was to characterize the spectrum of inflammatory changes arising from brolucizumab use in routine clinical practice. Retrospective analysis of fluorescein angiography (FA), fundus photography (FP) and OCT images taken at the time of adverse event. Brolucizumab-treated patients with neovascular age-related macular degeneration with retinal vasculitis (RV) and/or retinal vascular occlusion (RO) reported to Novartis Patient Safety between February 2020 and January2021. Ocular images were reviewed by an external reading center using predefined grading lists for FA, FP, and OCT. Classification of images, the most common imaging features of RV and/or RO by each imaging modality, and the anatomical location of the adverse event in relation to the macula. Gradable images (N= 475; 222 eyes; 198 patients) were classified as RV only (n= 72); RO only (n=9), RV+ RO (n= 63); posterior segment intraocular inflammation (n= 31); or none by imaging (n= 47). Of the 144 eyes with RV and/or RO, the most common imaging features were vascular leakage on FA, perivascular sheathing on FP, and hyperreflective dots in the vitreous humor on OCT. Retinal vascular occlusion was mainly branched and arterial, affecting multiple vessels. Although no distinct inflammatory phenotype pathognomonic to brolucizumab-related inflammation was identified, this study increases our understanding of the spectrum of posterior segment inflammatory changes that may occur in brolucizumab-treated neovascular age-related macular degeneration patients, highlighting the potential value of widefield retinal imaging and angiography to detect these inflammatory adverse events. Proprietary or commercial disclosure may be found after the references.

Poster 373: Perceptions &amp; Opinions on Cannabidiol Among Sports Medicine Orthopaedic Surgeons

Objectives: Cannabidiol (CBD) is a known pain modulator which is beginning to garner increased attention in the orthopaedic world, with many patients now presenting to clinics having tried CBD for pain relief. However, there may be a considerable knowledge gap with particular reference to orthopedic sports medicine surgeons and how they perceive the use of this therapeutic agent in clinical practice. The purpose of this study is to (1) examine the knowledge and beliefs of sports medicine orthopaedic surgeons with respect to the role of cannabidiol (CBD) in a multi-modal post-operative pain management regimen (2) deliver an educational component regarding CBD to practicing surgeons, and to (3) elucidate potential future barriers to the widespread use of this treatment modality by providing an anonymous forum for surgeons to voice their opinions. Methods: A three-component, 25-question online survey was distributed to fellowship-trained sports medicine orthopaedic surgeons. The first 20 questions were designed to assess baseline knowledge and opinions of sports surgeons regarding cannabidiol. These were followed by a 1-page summary sheet detailing the current legal status of CBD, as well as a brief literature review of its potential role in pain management within the field of orthopaedics. Lastly, 5 additional questions assessed whether the respondents’ opinions had shifted after learning more about CBD. A Visual Analog Scale (VAS) was used for one question (“Please indicate the likelihood you would recommend CBD as part of a pain management regimen.”), which was repeated before and after the summary sheet to see if respondents modified their answer after completing the educational component. Results: One hundred responses were collected from sports medicine surgeons. Most surgeons (76.2%) believe there is a role for CBD in post-operative pain management. While only 62.4% of respondents believe that CBD could be effective in managing acute pain and inflammation following injury, an overwhelming majority (94.1%) believed that CBD has a role in chronic pain management. A large majority stated that CBD would have no effect on soft tissue (89.1%) or bony (90.1%) healing post- operatively. Most surgeons admitted they were not knowledgeable about the mechanism (84.2%), modes of administration (73.3%), or their states’ laws (66.3%) concerning CBD. A minority (24.8%) believe that CBD has psychoactive properties and 18.8% believe CBD has addictive potential. While most surgeons (76.2%) did not believe they would be stigmatized if they were to suggest CBD to a patient, only 47.5% have ever suggested CBD to a patient. Notably, 94.1% of surgeons have encountered patients who reported trying CBD to treat pain. In the optional open-response section, 32 respondents elaborated on their concerns with most sentiments falling into three predominant themes: a) more evidence is required (10, 31.3%); b) stigmatization from patients (8, 25.0%); c) more regulation is required (5, 15.6%). After reading through the fact sheet, 51.4% of the survey respondents stated that their opinion on CBD had changed, and 62.9% stated they felt inclined to investigate the topic further on their own. Conclusions: A majority of sports medicine surgeons believe that CBD has a role in post-operative and chronic pain management. Surgeons are somewhat familiar with CBD, in part due to its remarkable prevalence among their patient populations, however there is clearly a knowledge gap, suggesting more education is necessary involving what is currently known about the subject and that more research should be targeted toward this developing industry. Current barriers to its routine use in clinical practice include unfamiliarity of the mechanism and dosing, limited evidence and regulation, and patient concerns or patient/surgeon stigmatization.

Effect of Autologous Conditioned Plasma Injections in Patients With Knee Osteoarthritis.

Autologous conditioned plasma (ACP) is a commercially available platelet concentrate with promising results from clinical trials. To evaluate the clinical outcome after 3 consecutive injections of ACP in patients with knee osteoarthritis (OA) and study the influence of ACP composition and different patient factors as predictors of treatment effect. Case series; Level of evidence, 4. This prospective case series included 260 patients (307 knees) who received ACP treatment for knee OA. The mean patient age was 51 ± 10 years. Improvement up to 12 months' follow-up was measured using the Knee injury and Osteoarthritis Outcome Score (KOOS). ACP composition was analyzed in 100 patients. The predictive value of age, sex, history of knee trauma, Kellgren-Lawrence OA grade, body mass index, and ACP composition was evaluated using generalized estimating equations. The mean overall KOOS improved from 38 ± 14 at baseline to 45 ± 18 at 3 months, 45 ± 18 at 6 months, and 43 ± 18 at 12 months (all P < .05); 40% of patients achieved an improvement above the minimal clinically important difference (MCID) of 8 after 6 months and 33% after 12 months. The variation in ACP composition did not correlate with KOOS (P > .05). Older age led to a greater clinical benefit (β = 0.27; P = .05), whereas bilateral treatment predicted worse outcomes (β = -5.6; P < .05). The improvement in KOOS after treatment with ACP did not reach the MCID in most study patients. Older age was a predictor for better outcomes. The composition of ACP varied between patients but did not predict outcomes within the evaluated range. The study findings show the limited benefit of ACP treatment for knee OA and call for caution with routine use in clinical practice.

Sensor Technology in Fracture Healing.

SMART sensor technology may provide the solution to bridge the gap between the current radiographic determination of fracture healing and clinical assessment. The displacement and rigidity between the fracture ends can be accurately measured using strain gauges. Progressively increasing stiffness is a sign of fracture consolidation which can be monitored using sensors. The design of standard orthopaedic implants can remain the same and needs no major modifications as the sensor can be mounted onto the implant without occupying much space. Data regarding various fracture morphologies and their strain levels throughout the fracture healing process may help develop AI algorithms that can subsequently be used to optimise implant design/materials. The literature search was performed in PubMed, PubMed Central, Scopus, and Web of Science databases for reviewing and evaluating the published scientific data regarding sensor technology in fracture healing. SMART sensor technology comes with a variety of uses such as determining fracture healing progress, predicting early implant failure, and determining fractures liable for non-union to exemplify a few. The main limitations are that it is still in its inception and needs extensive refinement before it becomes widely and routinely used in clinical practice. Nevertheless, with continuous advances in microprocessor technology, research designs, and additive manufacturing, the utilisation and application of SMART implants in the field of trauma and orthopaedic surgery are constantly growing. Mass production of such SMART implants will reduce overall production costs and see its use in routine clinical practice in the future and is likely to make a significant contribution in the next industrial revolution termed 'Industry 5.0' which aims at personalised patient-specific implants and devices. SMART sensor technology may, therefore, herald a new era in the field of orthopaedic trauma.

Saw Palmetto may fight prostate cancer.

Saw Palmetto may fight prostate cancer.

Noninvasive prediction of axillary lymph node breast cancer metastasis using morphometric analysis of nodal tumor microvessels in a contrast-free ultrasound approach

PurposeChanges in microcirculation of axillary lymph nodes (ALNs) may indicate metastasis. Reliable noninvasive imaging technique to quantify such variations is lacking. We aim to develop and investigate a contrast-free ultrasound quantitative microvasculature imaging technique for detection of metastatic ALN in vivo.Experimental designThe proposed ultrasound-based technique, high-definition microvasculature imaging (HDMI) provides superb images of tumor microvasculature at sub-millimeter size scales and enables quantitative analysis of microvessels structures. We evaluated the new HDMI technique on 68 breast cancer patients with ultrasound-identified suspicious ipsilateral axillary lymph nodes recommended for fine needle aspiration biopsy (FNAB). HDMI was conducted before the FNAB and vessel morphological features were extracted, analyzed, and the results were correlated with the histopathology.ResultsOut of 15 evaluated quantitative HDMI biomarkers, 11 were significantly different in metastatic and reactive ALNs (10 with P << 0.01 and one with 0.01 < P < 0.05). We further showed that through analysis of these biomarkers, a predictive model trained on HDMI biomarkers combined with clinical information (i.e., age, node size, cortical thickness, and BI-RADS score) could identify metastatic lymph nodes with an area under the curve of 0.9 (95% CI [0.82,0.98]), sensitivity of 90%, and specificity of 88%.ConclusionsThe promising results of our morphometric analysis of HDMI on ALNs offer a new means of detecting lymph node metastasis when used as a complementary imaging tool to conventional ultrasound. The fact that it does not require injection of contrast agents simplifies its use in routine clinical practice.

Use and value of self-management (SM) recommendations in a real-world evidence study evaluating digital patient monitoring (DPM) of patients (pts) receiving cancer care.

1603 Background: SM includes pts’ abilities and activities to manage symptoms, treatment (tx), and any problems inherent to a chronic condition. Tailored SM support is recommended in cancer care. DPM enables pts to systematically self-report disease- or tx-related symptoms, communicate directly with healthcare professionals (HCPs), and access support materials. This observational study evaluated the real-world use of the Symptom Navi Program (SNP; Bern, Switzerland) SM materials on the Kaiku Health DPM platform (Helsinki, Finland) in collaboration with F. Hoffmann-La Roche Ltd (Roche; Basel, Switzerland). Methods: Adults diagnosed with locally advanced or metastatic non-small/small cell lung cancer, or any stage HER2-positive breast cancer being treated with locally approved and reimbursed drugs with an expected tx duration of &gt;3 months, had access to a DPM solution that provided disease- and tx-tailored modules, including SNP SM recommendations for selected mild or moderate symptoms. The co-primary endpoints were DPM adoption and adherence. Here we report secondary endpoints; the perceived clinical impact, DPM module and service experience (assessed via Customer Effort Score [CES] and Customer Satisfaction Score [CSS]), and use of DPM features such as SM recommendations, via a DPM tool questionnaire. Results: Of the 89 enrolled pts, 66 had completed the DPM tool questionnaire at Week 6 of DPM use (data cutoff: June 9, 2022). Among the educational content, the symptom feedback library was accessed most. Pts spent up to a median of 12 minutes on Roche educational or SNP SM materials. The majority of pts (45/66 [68%]) considered the symptom questionnaires to cover all/most of the symptoms they experienced; 18/66 (27%) experienced only fair/partial symptom coverage; 49% (25/51) of pts whose symptoms were not covered contacted their HCP team. 34 pts (52%) took action based on the symptom questionnaire feedback; the most common action was SM recommendations applied according to symptom level (21/66 [32%]), followed by sending a message via the platform to the care team (8/66 [12%]). Half of pts found the SNP SM recommendations helpful/very helpful and 22 pts agreed that the SNP SM recommendations almost always/sometimes supported them in delaying contacting an HCP at an emergency room. At Week 6, the CES was 80%, CSS was 71%, and 48% (32/66) of pts felt that this service improved their care. Conclusions: Pt feedback showed that SNP SM recommendations were the most used action in response to the symptom questionnaire feedback and were perceived by most to be helpful/very helpful. These results support the use of SM recommendations in pts with cancer to help them self-manage tx-related symptoms experienced; future studies are needed to further explore their impact and usefulness, and to form recommendations for routine use in clinical practice.

Utility of the New Early Warning Score (NEWS) in combination with the neutrophil–lymphocyte ratio for the prediction of prognosis in older patients with pneumonia

ObjectivePredictors of prognosis are necessary for use in routine clinical practice for older patients with pneumonia, given the ageing of the population. Recently, the National Early Warning Score (NEWS), a...

HSD31 Real-World Pediatric Oncologist Utilization and Perceptions of Next Generation Sequencing

While integration of next-generation sequencing (NGS) techniques has the potential to improve care and outcomes for certain pediatric oncology patients, data are sparse assessing utilization in routine clinical practice. This survey-based study aimed to examine physician perceptions of NGS-based testing utilization among practicing pediatric oncologists in the U.S.

Renal Biomarkers in Cardiovascular Patients with Acute Kidney Injury: A Case Report and Literature Review.

Biomarkers have become important tools in the diagnosis and management of cardiorenal syndrome (CRS), a complex condition characterized by dysfunction in both the cardiovascular and renal systems. Biomarkers can help identify the presence and severity of CRS, predict its progression and outcomes, and facilitate personalized treatment options. Several biomarkers, including natriuretic peptides, troponins, and inflammatory markers, have been extensively studied in CRS, and have shown promising results in improving diagnosis and prognosis. In addition, emerging biomarkers, such as kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin, offer potential for early detection and intervention of CRS. However, the use of biomarkers in CRS is still in its infancy, and further research is needed to establish their utility in routine clinical practice. This review highlights the role of biomarkers in the diagnosis, prognosis, and management of CRS, and discusses their potential as valuable clinical tools for personalized medicine in the future.