Stages Of Illness Research Articles

Rehabilitation needs of critically Ill patient’s at General Hospital -Kafr- ELsheikh Governorate

Background Assessing rehabilitation needs is an essential part of the care provided to critically ill patients and is used to identify areas of need to develop an individualized care plan for each patient. Aim To explore rehabilitation needs of critically ill patients during the acute stage of illness. Research question What are the different rehabilitation needs of critically ill patients at a general hospital- Kafr- El sheikh Governorate over a period of 6 months? Design descriptive exploratory research design was used. Sample Purposive sample consist of 100 conscious adult male and female patients, aged from 18- 60 years within period of 6 months was included. Setting Four intensive care units affiliated to General Hospital- Kafr Elsheikh Governorate. Tools Two tools were utilized (A) Rehabilitation needs of critically ill patient assessment tool, (B) Patient Categorization Assessment Tool (PCAT). Result More than half (52%) of patients were the age group 51-60 years old, more than half (54%) of them were females. More than half (55%) of patients stayed 4-6 days at the hospital, all of them were fully conscious. More than one quarters (37%) of the studied patients had a cardiac disease. There were statistical significant difference (χ 2=25.28, P=0.00) with deterioration in chest sound 42% of patient (n=100)had abnormal chest sound in first day elevated to 70% of them(n=10) at the last day of their hospitalization. there were significant statistical differences (p≤0.05) in daily living activity between the hospitalization days among critically ill patients. there were significant statistical differences (p≤0.05) in mobility between the hospitalization days among critically ill patients. the cognitive aspect needs were the same at the hospitalization days. There were statistical significant difference (χ 2=94.5, P=0.03) with deterioration in psychological stressors presence 71% of them had psychological stressors in first day increased to all of them at the last day of their hospitalization. Conclusion Critically ill patients have variable rehabilitation needs that change throughout acute stage of their illness. Recommendation Putting into practice the rehabilitation needs assessment for critically ill patients, which is regarded as the initial stage in creating rehabilitation programs. Replication of this study on a larger probability sample from different geographical locations in Egypt is recommended.

Changing landscapes: helping caregivers, an experience from Tuscany.

Introduction: While multi-professional care interventions are guaranteed through an integrated care model, sometimes there is no possibility to support full-time assisting patients’ families in terms of allowing them the time for their life and home management activities. The role of the caregiver is essential throughout the day to address the patient’s needs: in this way, an appropriate level of well-being can be assured to who is undergoing the last stages of illness. The growing need for forms of support caregivers who assist those patients at home, generated a reflection by the family and community nurses operating in the territory of Pistoia, Tuscany. 
 Targeted population and stakeholders: Caregivers and families that care for under 63 patients in the end-stages of disease. 
 Timeline: The project started in 2022 and will not be interrupted. 
 Highlights: The patient may be untreatable, but never incurable: the healthcare professionals take care of the person and until the end. This resolution gave rise to the idea of a project called "Quick Assistance”, aimed at expanding the available services at the local level. It provides a package of 20 hours of a healthcare assistant presence at home to be used by the families needing them and provided by private firms. The activation of the service is guaranteed by the professionals’ network that revolves around the patient (Family and Community Nurses, GPs), that can identify a manifest, latent or unexpressed need and provide the appropriate response. The project is supported by the Società della Salute Pistoiese, a public entity constituted by Municipalities and the Local Health Autority for the associated exercise of territorial, socio-sanitary, and social activities. Where needs arise, care must be available to the patient and to the caregivers. This is the way in which the Tuscan NHS engages with the population, that is implementing the concept of integrated care at the microlevel, with the goal of enabling the extended concept of “patient” (patients and caregivers) to be at the centre of the care coordination. In other words, the system is adapting to the real needs expressed by the population, filling “unintentional gaps” that derive from an ongoing population knowledge process: through a participatory approach, solutions are shaped. This was the case of a 63-year-old patient in the last stages of illness that couldn’t benefit from the services offered by the system being him under 65, age above which the NHS provides for a very wide range of services, designed for elderly and fragile people. 
 Conclusions: The project aims to provide support to families in the surveillance and assistance of the patient. “Quick Assistance” strengthens the implementation of care provision at home and is effective in reducing the caregiver burden to prevent a more serious condition, as the caregiver’s burnout. The latter becomes more frequent in modern societies: that is due to changing cultural and social characteristics that have delegated the function of proximity and presence to external subjects.

BARRIERS TO HEALTH CARE ACCESS AMONG UNDOCUMENTED IMMIGRANTS: PERSPECTIVE OF PALLIATIVE CARE HEALTH CARE PROVIDERS

Abstract Undocumented immigrants face numerous barriers to obtaining healthcare services, largely due to fear of deportation and limited access to health care. The purpose of this study was to learn about challenges and facilitators palliative care healthcare providers experience in caring for seriously ill undocumented immigrants and the factors affecting access to care in this seriously ill population. From November 2022 to January 2023, we conducted semi-structured, individual telephone interviews with 11 palliative care healthcare providers from two inner city hospitals in California. Our interview protocol elicited providers’ experience caring for undocumented immigrants, including the patients’ stage of illness when providers encounter them, referrals made by the healthcare team, and gaps in care they have witnessed for these undocumented immigrants. Transcripts were analyzed using thematic analysis. Themes related to provider perceived patient care-seeking behaviors and challenges include complications of postponing care, financial burden, fear of deportation, transportation, health literacy, lack of family support, lack of awareness and misperceptions of palliative care. Themes related to provider care challenges include language barriers, longer care process, and cultural barriers. Facilitators and recommendations include awareness of care options and reassurance, importance of social and community resources, expanded palliative care awareness, knowledge, and access, and improved cultural competence. Our findings underscore the need for intervention studies that focus on alleviating identified barriers for undocumented immigrants. Future studies are needed to elicit the perspectives of seriously ill undocumented patients.

Adjuvant chemotherapy in pancreatic cancer at different AJCC stages: a propensity score matching analysis

ObjectiveIn the treatment of resectable pancreatic cancer, adjuvant chemotherapy is viewed as essential. However, it is yet unclear how well adjuvant chemotherapy works at different illness stages. This study aims to investigate the efficacy of adjuvant chemotherapy in various pancreatic cancer stages.Materials and methodsPatients with pancreatic cancer who underwent surgical intervention at Sun Yat-sen University Cancer Center between January 2018 and January 2021 were included in this retrospective analysis.Results168 patients were divided into two groups: the group receiving adjuvant chemotherapy (AC) and the group receiving independent surgery (no-AC). Survival analysis reveals that among stage I patients, the AC group demonstrates significant superiority over the no-AC group in terms of recurrence-free survival (RFS) and overall survival (OS) (P = 0.0028; P = 0.022). While there was no discernible difference in RFS between the AC and no-AC groups for patients with stage II illness (P = 0.69), the AC group significantly outperformed the no-AC group in terms of OS (P = 0.047). There was no discernible difference in RFS or OS between the AC and no-AC groups for patients with stage III pancreatic cancer (P = 0.40 and P = 0.20, respectively).ConclusionsThe administration of adjuvant chemotherapy has been shown to improve the prognosis of patients diagnosed with stage I and II pancreatic cancer. However, its efficacy is limited in individuals with stage III pancreatic cancer. Therefore, there is an urgent need to investigate and develop more effective therapeutic options for patients in the advanced stage.

Challenges regarding informed consent in recruitment to clinical research: a qualitative study of clinical research nurses’ experiences

BackgroundClinical research nurses (CRNs) have first-hand experience with ethical challenges and play a crucial role in upholding ethical conduct and adherence to the principles of informed consent in clinical research. This study explores the ethical challenges encountered by CRNs in the process of obtaining informed consent for clinical research.MethodsA qualitative exploratory design. Semistructured interviews (n = 14) were conducted with diverse CRNs in Sweden. These CRNs covered a wide range of research fields, including pharmaceutical and academic studies, interventions, and observational research, spanning different trial phases, patient categories, and medical conditions. The interviews were analysed using inductive qualitative content analysis.ResultsThe analysis identified three main categories: (i) threats to voluntariness, (ii) measures to safeguard voluntariness, and (iii) questionable exclusion of certain groups. CRNs face challenges due to time constraints, rushed decisions, information overload, and excessive reliance on physicians’ recommendations. Overestimating therapeutic benefits in stages of advanced illness emerged as a risk to voluntariness. CRNs outlined proactive solutions, such as allowing ample decision-making time and offering support, especially for terminally ill patients. Concerns were also voiced about excluding certain demographics, such as those with language barriers or cognitive impairments.ConclusionsIn conclusion, upholding ethical research standards requires recognising various factors affecting patient voluntariness. Researchers and CRNs should prioritise refining the informed consent process, overcoming participation challenges, and aligning scientific rigour with personalised care. Additionally, a concerted effort is vital to meet the diverse needs of patient populations, including equitable inclusion of individuals with language barriers or cognitive limitations in clinical studies. These findings have significant implications for enhancing the ethics of clinical research and advancing person-centred care.

Fitness for Work in the Long Journey of Tuberculosis Infection to Chronic Posttuberculosis Disease Case Report and Literature Review

Abstract The long journey of tuberculosis (TB) from exposure to latent or progressive TB infection, from primary stage to second stage of illness with or without infectious status, and then to chronic post-TB sequelae is very complex and still unclear, including a various spectrum of stages and manifestations. A case report of a 55 year-old woman with personal history of pleural effusion, in her youth, 2 previous episodes of COVID-19 infections, having no exposure to active smoking but occupational exposure to wood dust, hot steam, barbeque smoke, was admitted to Constanta Clinical Pneumology Hospital in October 2022 for hemoptysis and fatigue. Clinical and paraclinical investigations highlighted an acute evolutive episode of Pulmonary TB with metastatic bilateral nodular pattern, negative smears, positive cultures and positive QuantiFERON TB Gold in Tube (QFT-GIT). TB standard regimen of therapy was started, based on QFT-GIT positivity, and after it ended, chronic obstructive pulmonary disease was detected by spirometry and small airways dysfunction by impulse oscillometry. TB illness does not stop after directly observed therapy ends. So, systematical screening of pulmonary, bronchial or pleural sequelae should be performed and identified syndromes need to be treated, as well as reintegration in the job process by a careful monitoring.

Recruitment of caregivers of persons living with dementia for an Online Support Group Programme– Learnings from India

AbstractBackgroundCaregivers of persons living with dementia (CGPwD) tend to have limited access to dementia care‐oriented support group and relevant resources. The disparity in the ratio of mental health professionals available and the number of people with dementia plays a pivotal role in care and services. Support group interventions may not be available or accessible to the vast majority, more so in the Indian context. Hence, the need to test feasibility of providingsupport via using video‐conferencing software were explored.MethodFamily caregivers of those persons living with dementia who had accessed an out‐patient facility at a Geriatric Clinic as part of a tertiary care center between January 2020 – January 2023 was screened for recruitment into a single group quasi‐experimental study (n = 341). The responses of the family caregivers were noted down along with the experience of the mental health professionals involved in the process. Content analysis (Krippendorff, 2004, Neuendorf, 2002) was carried out using Atlas.ti.9 web version.ResultThe mean age of the CGPwD was 42.5 ± 8.5 years and the mean years spent in care‐giving was 4.02 ± 1.5 years; 42.8% of the persons living with dementia had a definitive diagnosis of Alzheimer’s Disease and majority were in the moderate stage of illness. One‐fourth of the caregivers showed interest to sign up for the support group with the first invitation. Of them, Spousal caregivers were noted to show more interest; followed by daughters‐in‐law. Apart from technological challenges, a good number of caregivers measured d that their loved one with dementia has “improved” due to decline in challenging behaviours.ConclusionUse of technology in psychosocial interventions is a relatively new concept in LAMIC countries such as India. Therefore, familiarization and orientation of such services may pave way to increase in demand for video‐conferencing based support groups at a larger level in the near future.

Team‐Based Learning Approach to Practice Improvements in a Memory Clinic

AbstractBackgroundWorkface projections indicate an increasing shortfall in neurologists and other medical specialists to treat persons with Alzheimer’s disease and other causes of dementia (Dall et al. Neurology 2013). This problem will be further magnified by available disease modifying therapies aimed at earlier stages of illness, markedly expanding the patient pool (Anderson et al. J Prev Alzheimers 2022; Hlavka et al. Rand 2019). With the Alzheimer’s disease treatment landscape approaching these turning points the University of Alabama at Birmingham Brain Aging and Memory (BAM) Clinic undertook a multidisciplinary expansion to improve access and increase the role of nonphysician professionals to optimize care. Onboarding this interdisciplinary team was complicated by separation of staff members mandated by the COVID‐19 pandemic. These factors, along with emerging use of “team‐based learning” educational models led to the creation of the BAM Learning Club (BAM LC).MethodsBAM LC is a weekly synchronous online series of didactics, lectures, case discussions, journal reviews, and team‐building wellness activities. Participants include Neurologists, Psychiatrists, Psychologists, RN Case managers, RN Clinical Care Coordinators, Social Workers, Nurse Practitioners, Pharmacists, Caregiver Counselors, Research Scientists, Clinical Trial Coordinators, Postdoctoral Fellows, Residents, and Medical Students. Sessions are recorded for future onboarding and educational needs. Content is generated by the BAM LC members with support from its director.ResultsBAM LC began in June 2021 and has continued weekly with increasing interest and attendance. Shared learning has led to practice improvements, a collaborative environment, and a cohesive multidisciplinary team. Recorded sessions have been used to provide education outside of our cohort and will be maintained for future use.ConclusionTeam‐based learning has resulted in better academic, clinical, and communication outcomes among health care professionals (Joshi et al. Cureus 2022). Multidisciplinary team‐led learning opportunities focused on dementia care could serve as a tool to promote further practice improvement, collaboration, and cohesion within healthcare organizations. Normalization of synchronous remote learning during the pandemic facilitated acceptance, uptake, and participation across disciplines. This process also has the potential to provide further system‐wide education in health systems to diversify the workforce and improve readiness to treat a rapidly expanding patient population.

Novel nomograms to predict risk and prognosis in hospitalized patients with severe fever with thrombocytopenia syndrome.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging and life-threatening infectious disease caused by SFTS virus. Although recent studies have reported the use of nomograms based on demographic and laboratory data to predict the prognosis of SFTS, no study has included viral load, which is an important factor that influences the prognosis, when compared with other risk factors. Therefore, this study aimed to develop a model that predicts SFTS prognosis before it reaches the critical illness stage and to compare the predictive ability of groups with and without viral load. Two hundred patients with SFTS were enrolled between June 2018 and August 2023. Data were sourced from the first laboratory results at admission, and two nomograms for mortality risk were developed using multivariate logistic regression to identify the risk variables for poor prognosis in these patients. We calculated the area under the receiver operating characteristic curve (AUC) for the two nomograms to assess their discrimination, and predictive abilities were compared using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). The multivariate logistic regression analysis identified four independent risk factors: age, bleeding manifestations, prolonged activated partial thromboplastin time, and viral load. Based on these factors, a final nomogram predicting mortality risk in patients with SFTS was constructed; in addition, a simplified nomogram was constructed excluding the viral load. The AUC [0.926, 95% confidence interval (CI): 0.882-0.970 vs. 0.882, 95% CI: 35 0.823-0.942], NRI (0.143, 95% CI, 0.036-0.285), and IDI (0.124, 95% CI, 0.061-0.186) were calculated and compared between the two models. The calibration curves of the two models showed excellent concordance, and decision curve analysis was used to quantify the net benefit at different threshold probabilities. Two critical risk nomograms were developed based on the indicators for early prediction of mortality risk in patients with SFTS, and enhanced predictive accuracy was observed in the model that incorporated the viral load. The models developed will provide frontline clinicians with a convenient tool for early identification of critically ill patients and initiation of a better personalized treatment in a timely manner.

The five aspects mealtime environment observation instrument for assessing mealtime environments in nursing homes: Development and validation.

To further develop and validate the Mealtime instrument, an observational instrument for assessing mealtime environments in nursing homes originating from the theoretical framework: Five Aspects Meal Model (FAMM). A mealtime experience is significant for a sense of well-being. In nursing homes, residents' personal preferences, combined with their diagnoses and different stages of illness, influence their mealtime experience and provide a complexity that has been found difficult to assess. Using FAMM, a theoretical framework as its base, this study, attempts to look at different parts of the mealtime environment. FAMM structures the mealtime environment in to five aspects: room, meeting, product, management control system and atmosphere. This study's design includes instrument development and validation. This study has been approved by the Swedish Ethical Review Authority (dnr 2019-05477). Methodological study. An existing instrument, the Mealtime instrument with FAMM as a theoretical framework, was used as a foundation for the development of the Five Aspects Mealtime Environment Observation Instrument (FAME-OI). Content validity index (CVI) was used to validate FAME-OI. FAME-OI's item-CVI, scale-CVI and modified Kappa displayed high validity. Changes were made in its structure and phrasing. These developments resulted in having a distinct structure in FAME-OI, in reference to FAMM. FAME-OI is applicable for clinical use in nursing homes and in research; however, adjustments may be needed before its use in other health care facilities.

An Overview of Contemporary Phenotypes, Present Challenges, and Novel Implications for Medical Services in the Diagnosis of Spinal Muscular Atrophy

Spinal muscular atrophy (SMA) is a form of muscle disease induced by SMN1 gene mutations. It can cause motor neurons and muscle strength to weaken. The intensity of the disease’s progression varies depending on the stage of development. Over the past ten years, new ways to help people with SMA have been found. These include the use of gene therapy and the modification of the SMN2 and SMN1 genes. First drugs approved for this condition were able to significantly alter the course of the disease. However, the evidence that is now available for these novel therapies is frequently constrained to a small range of individuals in terms of age and illness stage. To better understand the impact of treatment on people with all SMA subtypes and to build a platform for clinical decision-making in SMA, it will be necessary to gather real-world data with standardized outcome markers.

EOLP-07. A REAL-WORLD INTEGRATED OUTPATIENT PALLIATIVE AND SUPPORTIVE CARE CLINIC IN A REGIONAL COMMUNITY NEURO-ONCOLOGY PRACTICE

Abstract BACKGROUND Palliative care (PC), a specialty focused on alleviating suffering, is appropriate at any stage of serious illness and can improve quality of life, survival and reduce care partner distress. Integration within the care of neuro-oncology (NOC) patients remains difficult. At our center, patients who might benefit from specialty palliative care have been seen by a dual fellowship trained NOC and PC specialist (A.S.) since February 2021. We present our experience here. METHODS This was a retrospective chart review including records from the electronic medical record system from February 2021 to May 2023. RESULTS/ CONCLUSION A total of 58 patients received integrated PC from 651 seen in the general NOC practice. The most common diagnosis was glioma (59%), with the rest being a mixture of lymphoma or systemic cancer with brain involvement. Majority of patients were male (53%) and identified as White/Caucasian (86%). The average age of patients at referral was 58. The most common focus was symptom management (40%), followed by guidance around decision-making (14%), care partner support (11%), advance care planning (10%), and support with coping (9%). The most common symptoms discussed included fatigue (36%), seizures (22%), and pain (21%). By the submission of this abstract, 28 (48%) patients had passed away, 22 of whom (79%) had formally enrolled on hospice with an average of 24 days prior to death. The primary cause of death was respiratory failure towards end of life (71%). Three patients (11%) had chosen to employ the California End of Life Act. Advanced directives were discussed and completed in 82% and a proxy had been identified in 100%. This model of integrated PC for NOC clinics appears to be feasible, meaningful and is welcomed for it allows focused, dedicated attention to symptom management, distress alleviation, advance care planning and hospice transition.

Abstract 13632: Predictors of Death and/or Readmission in Extremely Elderly Patients Hospitalized for Decompensated Heart Failure

Introduction: Heart Failure (HF) is the final stage of cardiac illness, and it has become highly prevalent with the aging population. The extremely elderly population is underrepresented in HF clinical studies. This study aims to identify predictors of readmission and mortality in extremely elderly patients hospitalized for decompensated heart failure. Research Question: What are the predictors of readmission and mortality in extremely elderly patients hospitalized for decompensated heart failure? Methods: Retrospective cohort study in the model of a single-center registry including data from 2019 to 2022. The study was conducted at a private tertiary institution located in Salvador-BA, Brazil and included patients ≥ 80 years old admitted with a diagnosis of HF. Data was collected from electronic medical records and through follow-up performed 30 days after discharge, analyzed using descriptive statistics and compared by parametric or non-parametric tests, as appropriate. Multivariate analysis with logistic regression was performed to evaluate independent predictors of readmission and death from HF. Results: A total of 221 extremely elderly patients hospitalized for decompensated HF were included. There was a higher prevalence of females (57.4%), mean age of 87.6 ± 4.9 years, and mean Left Ventricular Ejection Fraction (LVEF) of 49.5 ± 17.1%. After 30 days, it was found that 14.9% of this sample had a death outcome and 16.7% were readmitted, totaling 28.1% of combined outcome (death and/or rehospitalization). The outcome group had older age (88.7 ± 4.6 years vs. 87.2 ± 4.9; p = 0.039), lower diastolic blood pressure (DBP) (74.8 ± 18.4 mmHg vs. 81.5 ± 15.6 mmHg; p = 0.007), higher rate of past ischemic stroke (30.6% vs. 13.2%; p = 0.002), and higher palliative care rate (27.4% vs. 3.2%; p = 0.001). In logistic regression, history of ischemic stroke [OR: 3.43 (CI: 1.30 - 9.05); p = 0.013], DBP [OR: 0.96 (CI: 0.93 - 0.99); p = 0.010], and palliative care [OR: 66.71 (CI: 8.18 - 543.66); p < 0.001] were independent risk factors for the combined outcome at 30 days. Conclusion: In extremely elderly patients admitted for heart failure, death or hospitalization at 30 days demonstrated an independent association with a history of ischemic stroke, DBP and palliative care.

Managing understandings of palliative care as more than care immediately before death: Evidence from observational analysis of consultations.

Evidence suggests that public, and some professional, understandings of palliative care are limited to care provided immediately before death, which contrasts palliative care's scope as care provided across a range of illness stages. To examine how clinicians manage patients'understandings of palliative care during initial consultations. Initial palliative care consultations were video-recorded and analysed using conversation analytic methods. Consultations were recorded in a specialist palliative care outpatient unit within an Australian public hospital. Participants included 20 newly referred patients and their families, and three palliative care clinicians. During initial consultations, it was observed that specialist palliative care clinicians frequently managed the possibility that patients may understand palliative care as limited to care provided immediately before death. Clinicians used recurrent practices that seemed designed to pre-empt and contradict patients'possible narrow understandings. When discussing the palliative care inpatient unit, clinicians recurrently explained inpatient care could include active treatment and referred to the possibility of being discharged. These practices contradict possible understandings that future admission to the inpatient unit would be solely for care immediately before death. The findings demonstrate that palliative care clinicians are aware of possible narrow understandings of their discipline among members of the public. The practices identified show how clinicians pre-emptively manage these understandings to patients newly referred to palliative care. These findings highlight scope for greater partnership with teams referring patients to palliative care, to assist patients in understanding the range of reasons for their referral. The observational method of conversation analysis provides direct insight into matters that are relevant for patients, as raised in their consultations with clinicians. This direct evidence enables analysis of their lived experience, as it occurs, and grounds analysis in observable details of participants'conduct, rather than interpretations of subjective experiences. The patients'contributions, therefore, were to allow observation into their initial palliative care consultations.

57 Validation of a List Learning Task for Monolingual Spanish Speaking Older Adults

Objective:The prevalence of dementia is higher among minoritized Hispanic/Latino populations in the U.S. Development of linguistically relevant and validated cognitive assessments are urgently needed to adequately address the care needs of this at-risk group. List learning tasks are widely used to evaluate verbal episodic memory and are consistently shown to be sensitive to memory deficits across variousneurologic etiologies. The aim of this study was to validate a Spanish list learning task developed as a linguistically appropriate measure of memory in a diverse sample of Spanish speaking Bay Area older adults who identify as Hispanic/Latino.Participants and Methods:Cognitive scores were assessed in 72 Spanish-speaking older adults living in the Bay Area, California, originally from different countries across South and Central America [(n=29 with CDR scores of 0; n=31 with CDRs of 0.5; and n=12 with CDR of 1), aged 54-96, 30% male)], who completed the Spanish list learning task and a brief neuropsychological battery. The list learning task contains 9 words, 3 words from 3 different semantic categories. Category exemplars were excluded. Administration includes three immediate recall trials, a 30-second delay free recall, 10-minute delay free and cued recall, and yes/no recognition. In this initial validation study, we selected the 10-minute delay recall trial as our primary variable and looked at several indices of construct validity. We hypothesized delayed free recall would: 1) correlate highly with other episodic memory tasks, and minimally with non-memory tests (controlling for CDR sum of boxes), and 2) show step-wise declines as total CDR increased from 0 to 1 (controlling for age, sex, and education).Results:Delayed recall scores of 30-seconds and 10-minutes showed step-wise declines as CDR scores increased (CDR 0 vs. 1, p<0.001 and CDR 0.5 vs. 1, p=0.001). There were no differences in delayed recall between CDR 0 vs. CDR 0.5 (p>0.05). 10-minute delay showed medium-to-large correlations with UDS Craft Story Delayed Recall (partial r =0.45, p<0.001) and Benson Complex Figure Recall (partial r=0.63, p<0.001). Nonsignificant, weaker associations were observed with measures of executive (F Word Verbal Fluency partial r=0.10, Digit Span Forward partial r=0.12), and language (Animal Fluency partial r=0.18) function.Conclusions:Although there is heterogeneity within Hispanic/Latino populations in the U.S., findings begin to support ecological and construct validity of the Spanish list learning task as a measure of verbal memory in older Spanish-speaking adults in the Bay Area. Supporting ecological validity, delayed recall scores significantly differentiated functionally impaired (CDR=1) from functionally mild or unimpaired older adults (CDR=0 or 0.5), though evidenced less sensitivity differentiating unimpaired from mild stages of illness. The Spanish list learning task evidenced strong construct validity as a measure of episodic memory, including strong correlations with other validated memory tasks, and non-significant correlations with non-memory tasks. Larger studies should account for diversity of Spanish speakers in the U.S to see how region of origin, education, and differences between first- and second-generation Spanish speakers influences performance on the task. Future work incorporating imaging markers of brain structure may help further validate the Spanish list learning task as an appropriate measure of memory.

Rates and correlates of medication non-adherence behaviors and attitudes in adult patients with early psychosis.

Literature on antipsychotic medication adherence in early psychosis primarily assessed adherence behaviors and focused on young patients. There is a paucity of research investigating negative medication attitude and its determinants in the early illness course, particularly in older-aged sample. We aimed to examine prevalence and correlates of medication non-adherence behaviors and negative medication attitudes separately in adult patients with early psychosis. One hundred ninety-nine Chinese early psychosis patients aged 26-55years who had received three-year treatment for first psychotic episode in Hong Kong were examined. Assessments encompassing socio-demographics, premorbid adjustment, clinical and treatment profiles, self-stigma and therapeutic alliance were conducted. Patients were evaluated with Medication Compliance Questionnaire, which is a modified Chinese-translated version of Medication Adherence Rating Scale and includes items measuring adherence behaviors and attitudes towards medications. Rates of medication non-adherence and negative attitude towards medications were 38.7% and 50.8%, respectively. Multivariate regression analysis showed that more severe positive symptoms, greater self-stigma and negative medication attitude were independently associated with medication non-adherence. Negative attitude towards medications was significantly associated with younger age, higher educational attainment, diagnosis of other psychotic disorders, poorer insight, greater self-stigma and less satisfaction with communication with healthcare staff, which represented an index reflecting suboptimal therapeutic alliance. Antipsychotic non-adherence and negative medication attitudes are frequently observed in adult early psychosis patients. Our findings indicate that poor insight, elevated self-stigma and suboptimal therapeutic alliance may constitute potential treatment targets for promoting medication adherence and rectifying negative medication attitudes in the early illness stage.

Top Ten Tips Palliative Care Clinicians Should Know About Physical Therapy, Occupational Therapy, and Speech Language Pathology.

This article provides guidance on the integral role of physical therapy, occupational therapy (OT), and speech language pathology (SLP) in palliative care (PC), underlining the necessity for effective communication between physicians and therapists, the importance of caregiver education and support, the application of holistic treatment modalities in OT, the underutilization of resources in PC settings, the role of SLP professionals in feeding and nutrition, and the challenges in communication during the advanced stages of illness. The article draws on various studies and expert opinions to elucidate these issues, offering a valuable resource to health care professionals in ensuring high-quality patient-centered PC.

The Memory Alteration Test Is Correlated with Clinical, Cerebrospinal Fluid, and Brain Imaging Markers of Alzheimer Disease in Lima, Peru

Introduction: As disease-modifying therapies become available for Alzheimer’s disease (AD), detection of AD in early stages of illness (mild cognitive impairment [MCI], early dementia) becomes increasingly important. Biomarkers for AD in low- and middle-income countries (LMICs) are costly and not widely available; hence, it is important to identify cognitive tests that correlate well with AD biomarker status. In this study, we evaluated the memory alteration test (M@T) to detect biomarker-proven AD and quantify its correlation with neurodegeneration and cerebrospinal fluid (CSF) AD biomarkers in a cohort of participants from Lima, Peru. Methods: This is a secondary analysis of a cohort of 185 participants: 63 controls, 53 with amnestic MCI (aMCI), and 69 with dementia due to AD. Participants underwent testing with M@T and a gold standard neuropsychological battery. We measured total tau (t-tau), phosphorylated tau (p-tau), and beta-amyloid (β-amyloid) in CSF, and evaluated neurodegeneration via medial temporal atrophy score in MRI. We used receiver-operator curves to determine the discriminative capacity of the total M@T score and its subdomains. We used the Pearson coefficient to correlate M@T score and CSF biomarkers. Results: The M@T had an area under the curve (AUC) of 0.994 to discriminate between controls and cognitively impaired (aMCI or AD) patients, and an AUC of 0.98 to differentiate between aMCI and AD patients. Free-recall and cued recall had the highest AUCs of all subdomains. Total score was strongly correlated with t-tau (−0.77) and p-tau (−0.72), and moderately correlated with β-amyloid (0.66). The AUC for discrimination of neurodegeneration was 0.87. Conclusion: The M@T had excellent discrimination of aMCI and dementia due to AD. It was strongly correlated with CSF biomarkers and had good discrimination of neurodegeneration. In LMICs, the M@T may be a cost-effective screening tool for aMCI and dementia caused by AD.

A - 169 Efficacy, Retention and Predictors of Response to Treatment of Group Based Remotely Delivered Goal Management Training for Acquired Brain Injury.

Given the gap in group-based, remotely delivered executive interventions, and the ubiquitousness of executive impairment in acquired brain injury (ABI), we examined: (1) pre-to-post-to-follow-up efficacy of remotely-delivered, group-based Goal Management Training (GMT; a metacognitive, executive intervention) in individuals with neurological disorders in the chronic stages of illness (2) predictors of response to treatment. Participants and Protocol. N = 160 adults with ABI >6months post-diagnosis, participated in this single-group study at the Telerehab Centre for ABI @KITE, University Health Network, Toronto, Canada. GMT - which enhances self-awareness, task engagement and task follow-through - was delivered remotely and in group format to allow scalability, peer-to-peer support, cost-effectiveness, and geographical reach. Primary outcomes. Cognitive Failures Questionnaire (CFQ); Dysexecutive Questionnaire (DEX). Predictors of response to treatment. Demographics (age, education); time since injury; and symptom burden (i.e., cognitive, somatic, and emotional). Linear mixed effects models measured efficacy and predictors of change. Significant pre/post and pre/follow-up improvements on the CFQ total and "forget", "false", and "distract" subscales (95% CI; p = 0.000 all comparisons). Significant pre/post improvements observed for the DEX (95% CI; p = 0.000), but not significant retention. No effects of age, education or time since injury found, indicating generalizability. High symptom burden negatively associated with pre/post and pre/ follow-up improvements on CFQ. Encouragingly, this group-based, remotely delivered GMT offers promise of efficacy and retention regardless of age, time since injury or educational attainment of patients, and can reach patients regardless of geographic location. Lower response with heavy symptom burden suggests collateral treatment of symptoms may improve treatment response.

The clinical and genotypic-phenotypic findings of mucopolysaccharidosis VI patients: an Iraqi single-study descriptive study.

Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI; MPS VI) is a chronic illness that causes progressive enlargement, inflammation, or scarring of several tissues and organs until their collapse. In most cases, an infant with MPS VI shows no symptoms. The early signs and symptoms of MPS VI in children often develop in the first few months of life. MPS VI affects various systems in the body, including the skeletal, cardiac, and respiratory systems. The authors aim in our study to describe the clinical and genotypic-phenotypic findings of MPS VI patients in 'children Welfare Teaching Hospital, Medical City Complex.' The single-center study was conducted at the 'children Welfare Teaching Hospital, Medical City Complex' from November 2016 to May 2022. The research recruited 72 MPS VI patients from Iraq, all under 20. The authors investigated the sociodemographic characteristics, hematological lab results, gene-phenotype findings, and clinical features and evaluated the severity and progression of the MPS 6 disease. Seventy-two Iraqi MPS VI patients were involved in the study, and the average age of the study sample was 6.38±3.4 (0.3-19). The consanguinity rate was 94.4%. In the research, females comprised 56.9% of the patients, and the Z-scores for body mass index and occipital-frontal head circumference were -2.66 and 1.2. The fascial features at diagnosis, 'coarse facies' (90.3%), dysostosis multiplex (93%), short stature (94.4%), and recurrent respiratory infections (91.6%), were the most common clinical features among the enrolled patients. The most frequent mutation was (complementary DNA: c.753C>G, protein effect: p.(Tyr2*) or p.(Tyr251Term), and the codon cross-tabulation: premature stop codon, or homozygous stop nonsense mutation/exon N.3) (33/69 (47.82%)). Furthermore, a statistically significant correlation existed between lower weight and height readings and the progressed and severe stages of the MPS VI illness. As the first research in Iraq with a sufficient sample size of MPS VI patients, the investigation presented important clinical and gene-phenotype findings and revealed the necessity for enhancing the diagnosis of MPS VI, including the updated molecular analysis and monitoring the multisystem parameters, aberrant comorbidities, and the progression and severity.