Standard Of Care For Patients Research Articles

Results of an Online Survey on Intensive Care Management of Patients with Aneurysmal Subarachnoid Hemorrhage in German-Speaking Countries.

Background: The clinical course of patients with aneurysmal SAH (aSAH) is often dynamic and highly unpredictable. Since its management varies between hospitals despite guidelines, this survey aimed to assess the current state of intensive care treatment for aSAH in the German-speaking region and provide insights that could aid standardization of care for aSAH patients in the intensive care setting. Methods: From February 2023 to April 2023, medical professionals of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the Initiative of German Neuro-Intensive Trial Engagement (IGNITE) network and manually recorded clinics with intensive care units were invited to participate in a standardized anonymous online questionnaire including 44 questions. The questionnaire was validated in multiple steps by experts of different specialties including those from the DIVI. A descriptive data analysis was carried out. Results: A total of 135 out of 220 participants answered the survey completely. The results showed that most patients were treated in anesthesia-led intensive care units at university and maximum care hospitals. Aneurysms were usually treated within 24 h after bleeding. If vasospasm was detected, induced hypertension was usually implemented as the first treatment option. In refractory vasospasm, interventional spasmolysis with calcium antagonists was usually carried out (81%), despite unclear evidence. There were significant discrepancies in blood pressure target values, particularly after aneurysm repair or after delayed cerebral ischemia (DCI), as well as in hemoglobin limit values for erythrocyte substitution. Despite the limited level of evidence, most institutions used temperature management (68%), including hypothermia (56%), for severe cases. Conclusions: While we anticipated variations between individual intensive care facilities, our survey identified numerous similarities in the treatment of aSAH patients. Methods such as interventional spasmolysis and temperature management were used frequently despite limited evidence. Our results can serve as a fundamental framework for formulating recommendations for intensive care treatment and planning of multicenter studies.

Emerging Radiotherapy Technologies for Head and Neck Squamous Cell Carcinoma: Challenges and Opportunities in the Era of Immunotherapy.

Radiotherapy (RT) is an integral component in the multidisciplinary management of patients with head and neck squamous cell carcinoma (HNSCC). Significant advances have been made toward optimizing tumor control and toxicity profiles of RT for HNSCC in the past two decades. The development of intensity modulated radiotherapy (IMRT) and concurrent chemotherapy established the standard of care for most patients with locally advanced HNSCC around the turn of the century. More recently, selective dose escalation to the most radioresistant part of tumor and avoidance of the most critical substructures of organs at risk, often guided by functional imaging, allowed even further improvement in the therapeutic ratio of IMRT. Other highly conformal RT modalities, including intensity modulated proton therapy (IMPT) and stereotactic body radiotherapy (SBRT) are being increasingly utilized, although there are gaps in our understanding of the normal tissue complication probabilities and their relative biological effectiveness. There is renewed interest in spatially fractionated radiotherapy (SFRT), such as GRID and LATTICE radiotherapy, in both palliative and definitive settings. The emergence of immune checkpoint inhibitors (ICIs) has revolutionized the treatment of patients with recurrent and metastatic HNSCC. Novel RT modalities, including IMPT, SBRT, and SFRT, have the potential to reduce lymphopenia and immune suppression, stimulate anti-tumor immunity, and synergize with ICIs. The next frontier in the treatment of HNSCC may lie in the exploration of combined modality treatment with new RT technologies and ICIs.

Improved survival of patients with newly diagnosed oligometastatic prostate cancer through intensified multimodal treatment

Background and objectivesThe standard of care for patients with metastatic hormone-sensitive prostate cancer (mHSPC) includes androgen deprivation therapy (ADT), novel antihormonal therapies (NHT) and/or chemotherapy. Patients with newly diagnosed oligometastatic prostate cancer (omPCa) represent a distinct subgroup of mHSPC, for which the optimal treatment, particularly the role of radical prostatectomy (RP) and metastasis-directed therapy (MDT), is currently under debate.Materials and methodsIn this single center, retrospective analysis, 43 patients with newly diagnosed omPCa were included. All patients underwent RP as part of a multimodal, personalized treatment approach. Other treatments included ADT, NHT, MDT (surgery or radiotherapy), adjuvant radiotherapy (prostatic fossa and/or pelvic lymph nodes) or chemotherapy in various combinations. Clinical endpoints were progression free and cancer specific survival (PFS, CSS).ResultsNo patient with omPCa died from prostate cancer during an up to ten years follow-up period after intensified multimodal treatment i.e., RP, ADT, adjuvant radiation therapy and MDT (n=13). In contrast, patients requiring chemotherapy (n=10) showed a significantly worse PFS (p<0.001) and CSS (p<0.001). Patients receiving various combinations (<4 therapeutic modalities; n=20) showed a more favorable outcome than patients receiving chemotherapy, but differences in PFS and CSS were not statistically significant compared to patients receiving an intensified multimodal treatment.ConclusionsAn intensified, multimodal treatment approach including RP can lead to excellent survival outcomes in patients with newly diagnosed omPCa. Patients requiring chemotherapy have most likely a more aggressive disease and therefore a more rapid tumor progression. Future studies to identify markers for risk stratification in patients with omPCa are therefore needed.

Neurological Pupil Index and Intracranial Hypertension in Patients With Acute Brain Injury

Invasive intracranial pressure (ICP) is the standard of care in patients with acute brain injury (ABI) with impaired consciousness. The Neurological Pupil Index (NPi) obtained by automated pupillometry is promising for noninvasively estimating ICP. To evaluate the association between repeated NPi and invasive ICP values. This study is a secondary analysis of the Outcome Prognostication of Acute Brain Injury With the Neurological Pupil Index (ORANGE), a multicenter, prospective, observational study of patients with ABI performed from October 1, 2020, to May 31, 2022, with follow-up at 6 months after ABI. The ORANGE study was performed at neurologic intensive care units of tertiary hospitals in Europe and North America. In ORANGE, 514 adult patients receiving mechanical ventilatory support were admitted to the intensive care unit after ABI. Invasive ICP monitoring and automated pupillometry assessment every 4 hours during the first 7 days, considered as a standard of care. Association between ICP and NPi values over time, using bayesian joint models, with linear and logistic mixed-effects longitudinal submodels. The study included 318 adult patients (median [IQR] age, 58 [43-69] years; 187 [58.8%] male) who required intensive care unit admission, intubation, and mechanical ventilatory support due to acute traumatic brain injury (n = 133 [41.8%]), intracerebral hemorrhage (n = 104 [32.7%]), or aneurysmal subarachnoid hemorrhage (n = 81 [25.5%]) and had automatic infrared pupillometry used as part of the standard evaluation practice and ICP monitoring. A total of 8692 ICP measurements were collected, with a median (IQR) of 31 (18-37) evaluations per patient. The median (IQR) NPi and ICP for the study population were 4.1 (3.5-4.5) and 10 (5-14) mm Hg, respectively. In a linear mixed model, the mean change in the NPi value, as a continuous variable, was -0.003 (95% credible interval [CrI], -0.006 to 0.000) for each 1-mm Hg ICP increase. No significant association between ICP and abnormal NPi (<3; odds ratio, 1.01; 95% CrI, 0.99-1.03) or absent NPi (0; odds ratio, 1.03; 95% CrI, 0.99-1.06) was observed. Although an abnormal NPi could indicate brainstem dysfunction, in this large and heterogeneous population of patients, NPi values were not significantly associated overall with ICP values. Repeated NPi measurements may not be a sufficient replacement for invasive monitoring. ClinicalTrials.gov Identifier: NCT04490005.

Influence of the treatment setting on the treatment of patients with rheumatoid arthritis or psoriatic arthritis within the delegation to rheumatological specialist assistants - A post hoc analysis of the StärkeR study

The StärkeR study has shown the non-inferiority of ateam-based form of care with delegation to rheumatological specialist assistants (RFA) compared to standard care in patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA). Exploratory analyses regarding apossible influence of the treatment setting (specialist practice/outpatient clinic) on various outcome parameters in patients with RA or PsA in the context of delegation to RFA. Patients with RA or PsA and stable adjustment with low disease activity from 3 outpatient clinics and 14rheumatological specialist practices that participated in the StärkeR study were included in this post hoc analysis. The effectiveness of the team-based form of care depending on the treatment setting was investigated using interaction analyses in linear regression models with respect to disease activity, functional capacity, pain and fatigue, among others. Out of 588 patients 466 were treated in specialized practices and 92 in hospital outpatient clinics. The analyses showed asignificant interaction for one of nine outcomes examined: functional capacity (scale0-1) had slightly lower values in the hospital outpatient clinics compared to standard care (-0.07 [-0.12; -0.02]), while no such difference was found in the practices. For other outcomes, the team-based form of care in the practice setting tended to show an advantage. These exploratory analyses point to the potential benefits of evaluating different forms of care, such as the delegation of medical services to qualified RFA, in terms of benchmarking.

Outcome of Patients With Lupus Nephritis Treated With an Anti-CD40 Monoclonal Antibody According to Kidney Biopsy Features.

A phase 2 trial tested different doses of the anti-CD40 monoclonal antibody BI 655064 as an add-on therapy to the standard of care in patients with class III or IV lupus nephritis (LN) with active disease. A post hoc analysis showed a potential benefit of the higher tested doses (180 and 240 mg) versus a low dose (120 mg) or placebo. We investigated whether the treatment effect of BI 655064 on kidney outcomes may be modified by the presence of glomerular monocytes, a target for this drug with a well-known role in LN pathogenesis. One hundred one renal biopsies of patients with LN enrolled in the BI 655064 trial were scored centrally. The estimated glomerular filtration rate (eGFR), spot urine protein/urine creatinine ratio (UP/UC), and complete renal response (CRR) were evaluated over 52 weeks. Patients were divided according to a "better" or "worse" performance than the average of all patients in the cohort, predicted by a mixed model for repeated measurements. Logistic regression models adjusted for potential confounders were used to assess the association between different treatment doses and outcomes according to the presence or absence of monocytes. A higher BI 655064 dose (180 or 240 mg) was associated with better outcomes of UP/UC and CRR when glomerular monocytes were present in kidney biopsy samples (odds ratio [OR] 3.66 [95% confidence interval (CI) 1.09-12.3], P = 0.04; OR 4.58 [95% CI 1.24-16.9], P = 0.02). A trend toward improved eGFR was also observed in these patients (at 52 weeks, P = 0.08). In LN kidney biopsy samples with glomerular monocytes, high-dose BI 655064 treatment improved proteinuria at 52 weeks and resulted in a higher CRR compared to biopsy samples without glomerular monocytes. Histologic features may guide the choice of treatment for individual patients with LN.

Survival Outcomes of Durvalumab in Combination with Cisplatin and Gemcitabine in Advanced Biliary Tract Cancer: Real-World Results from a Single Italian Institution

Introduction: The TOPAZ-1 phase III trial showed a survival benefit with durvalumab plus gemcitabine and cisplatin in patients with advanced biliary tract cancer (BTC). To understand this combinationʼs real-world efficacy and tolerability, we conducted a retrospective analysis of its first-line treatment outcomes. Methods: We included patients with unresectable, locally advanced, or metastatic BTC treated with cisplatin, gemcitabine, plus durvalumab. The primary endpoint was overall survival (OS). Results: Thirty-three patients were enrolled. Median OS was NR and median progression free survival (PFS) was 7.6 months, after a median follow-up of 13.5 months. The investigator-assessed overall response rate was 34.5%, with stable disease in 53.0% of patients. High baseline CEA levels were associated with poor survival. Any grade adverse events (AEs) occurred in 97% of patients. Immune-related AEs (irAEs) occurred in 16% (grade >2: 6%). Presence of TP53 mutation was related to a worse OS; conversely the presence of ARID1A genomic alteration was related to a better PFS. A tendence toward a better OS was found for BRCAness patients which did not reach the statistical significance. On the other hand, BRCAness patients showed significantly higher PFS compared to no BRCAness patients. Conclusion: This real-world analysis largely confirmed the TOPAZ-1 findings, supporting gemcitabine, cisplatin, and durvalumab as a first-line standard of care for patients with advanced BTC.

Transplant in myeloma: who, when, and why?

High-dose melphalan supported by autologous transplantation has been the standard of care for eligible patients with newly diagnosed multiple myeloma for nearly 30 years. Several randomized clinical trials have reaffirmed the strong position of transplant in the era of triplets combining proteasome inhibitors, immunomodulatory drugs, and dexamethasone. Although quadruplets are becoming the standard in transplantation programs, no data are currently available on the need for a transplant with new regimens incorporating anti-CD38 monoclonal antibodies. Outcomes remain heterogeneous, with different response depths and durations depending on the cytogenetics at diagnosis. The improvement of disease prognostication using sensitive and specific tools allows for adapting the strategy to initial and dynamic risks. This review examines which patients need a transplant, when transplantation is preferable, and why.

Compliance with care standards and professional knowledge of operating theatre personnel before, during and after laparoscopic bariatric surgery: A study in public hospitals in Iran.

By adhering to care standards, many adverse outcomes for patients, such as pressure injuries, tissue necrosis and patient falls, can be prevented. The aim of this study was to investigate the level of compliance with care standards before, during and after various types of bariatric surgeries. This study was a cross-sectional descriptive study conducted in the operating theatres of selected teaching hospitals in Isfahan (Iran). The study sample consisted of all operating theatre personnel in the selected teaching hospitals who met the inclusion criteria. Compliance with care standards was measured using a researcher-developed checklist. A researcher-developed questionnaire with 43 true/false questions was used to evaluate the operating theatre personnel's professional knowledge. The data were analysed using SPSS version 20 and descriptive and inferential statistics. The mean score of adherence to care standards and the mean score of professional knowledge of operating theatre personnel regarding care of laparoscopic bariatric surgery were 78.35 ± 9.49 and 29.45 ± 6.17, respectively. There is no significant relationship between these two variables, with a two-tailed significance (Sig.) of 0.056 and a correlation coefficient (r) of 0.199. In general, it can be concluded that the specific knowledge of the local operating theatre personnel regarding minimally invasive laparoscopic surgery care is at an intermediate level. Requirements for training in this area were therefore successfully identified. In addition, not all operating theatre personnel adhere to the standards of care for patients undergoing laparoscopic bariatric surgery. This non-adherence could be due to insufficient training or the absence of established standards in hospitals.

Evaluation of Antibiotic Usage Patterns, Patient Factors, and Economic Implications in ICU

Background: One of today's most significant public health issues is antibiotic resistance, which is caused by the overuse or abuse of antibiotics. Effective antimicrobial therapy is essential for treating patients in the intensive care unit (ICU), including those with severe sepsis, septic shock, and infections linked to healthcare. This study assesses the economic burden of broad-spectrum antibiotic usage on the overall cost of ICU care. Methods: An observational, cross-sectional study was conducted in the ICUs in a tertiary care center, over 1 month. Results: The gender distribution in the study shows a higher prevalence of male patients (60%) compared to female patients (40%), with a total sample size of 40 patients. Most of the patients were in the age group of 58–68 years (32.5%). The comorbidity scores indicate that a significant proportion of patients had a score of 4 (37.5%), which was also the most frequent score (mode). The most common length of stay was 2 days (mode), and the range extended from 1 to 9 days. Most patients had shorter stays, with 27.5% staying for 2 days and only a small fraction (2.5%) requiring a 9-day stay. Conclusion: The study emphasizes the need for a careful balance between cost-effective antibiotic treatment and optimal patient care to improve health outcomes and reduce financial strain. It highlights the crucial role of antimicrobial stewardship programs in promoting responsible antibiotic use, curbing resistance, and elevating patient care standards. Investing in diagnostics and educating healthcare providers about their advantages can further refine treatment approaches and long-term patient outcomes, particularly in resource-constrained environments.

The realities of modern practice and prospects for the implementation of standards of secondary care for patients with acute stroke in the Left Bank of Kyiv Region according to the data of the hospital register (literature review and own research)

Background. The purpose of our work is to study the main indicators of the quality of care for patients with an acute stroke in individual hospitals of the Left Bank of the Kyiv Region of Ukraine. Materials and methods. The research was carried out at the Department of Nervous Diseases of the Shupyk National Healthcare University of Ukraine, on the basis of CNCE “Brovary Multidisciplinary Clinical Hospital”, angioneurological department with 85 beds (hereinafter — BMCH), and 4 secondary care centers with decentralized localization in the Kyiv Region (hereinafter — CDHKRLBU). The named departments are located 80–100 km, and BMCH is 15 km away from the regional center. They work according to an approved local protocol that meets industry standards for the management of patients with acute cerebral stroke and existing clinical guidelines. A total of 10,608 hospitalized patients with acute cerebral stroke were included in the prospective, cohort study (5,818 patients in BMCH and 4,790 patients in CDHKRLBU). For each case, the RES-Q (version 1.2) was filled out — a report form in an international program developed by the ESO-EAST initiative. Results. The study showed that the quality of care for stroke patients can be influenced by the material and technical base of the institution, as well as availability of diagnostic equipment, bed capacity and, of course, the logistical location, distance from the regional center. All quality indicators point to the leadership of BMCH compared to CDHKRLBU, and this has explanations. Conclusions. The study identified both positive and negative aspects of the therapeutic and diagnostic work in healthcare facilities, as well as factors influencing the success of treatment outcomes for patients with acute stroke. These findings have convincingly confirmed the relevance of studying quality care indicators and support the further implementation of the hospital registry method (based on RES-Q registry principles) in other areas of Kyiv Region and across Ukraine to evaluate and monitor the quality of medical care, including the analysis of the effectiveness of new technologies. During the study, BMCH purchased a new SCT, Philips Intera 1.5T MRI scanner (Netherlands), and Siemens angiograph in 2021, which improved the diagnosis of cerebral strokes and the use of treatment of thrombolytic therapy, thrombus extraction within the Left Bank of the Kyiv Region of Ukraine. Neighboring hospitals acquired SCT and expanded thrombolytic therapy for ischemic stroke. Of course, the research conducted is positive, because it becomes possible to identify certain shortcomings in the work and formulate recommendations for planning measures to improve medical care for stroke patients, as well as to compare the results of activities at the international and national levels.

Reflection on a professional advisory group to inform the use of patient empowerment tools within an implementation science research project

Professional advisory groups, with patient and public involvement (PPI) representatives, can be used for co-production within research projects. This paper aims to document the benefits and challenges of undertaking stakeholder and participant engagement for an implementation research project within NHS (National Health Service) Wales. A patient focused research project, initiated by clinicians, on the use of patient empowerment tools within standard patient care, used a professional advisory group to identify appropriate tools to use within the research proposal. The professional advisory group was made up of therapists, NHS stakeholders, academics and PPI representatives. A hybrid-meeting style was employed to optimise participation for all members of the group. Benefits of the professional advisory group included increased engagement and ownership of the study due to co-creation, and obtaining important contextual information and lived experience. However, challenges included keeping the discussion on topic due to pre-conceived agendas, pleasing everyone in the room due to varied backgrounds, and technological issues. Future professional advisory groups should consider how to facilitate the full involvement of PPI representatives within the discussion and having a variety of resources to present the topic of discussion. Furthermore, clearly communicating what the purpose and direction of the research project is and how it fits into the wider system, should be carefully considered. Overall, it was recognised that the professional advisory group was of significant value to shape the research proposal. Due to the situational challenges faced by healthcare professional within the NHS and preconceived ideas for solutions, it is hoped that by involving stakeholders early in the process there will be greater acceptance and usability of the research findings.

The mediating role of professional identity between work environment and caring behavior: a cross-sectional survey among hospice nurses in China

BackgroundAs core members of hospice care team, the hospice nurses’ ability to care for patients not only directly affects the standard of patient care, but also significantly impacts patient quality of life. It can be seen that it is very meaningful for patients to improve the caring behavior of hospice nurses. Therefore, it is necessary to deeply explore the influencing factors of nurses’ caring behavior and further clarify the mechanism between them.MethodsThe STROBE guideline was performed to report this study. We conducted a cross-sectional survey from December 2023 to February 2024. In this study, 392 hospice nurses were recruited from tertiary public hospitals in East China by convenient sampling method. Participants were investigated using the Practice Environment Scale, Professional Identity Scale, and Caring Behaviors Inventory. Structural equation modelling was utilized to verify the research hypotheses.ResultsThe results revealed that there were significant and positive correlations between work environment, professional identity and caring behavior. Furthermore, professional identity partially mediated the relationship between work environment and caring behavior.ConclusionWork environment is critical to improving hospice nurses’ caring behavior. Professional identity plays an intermediary role impacting how work environment promotes caring behavior among Chinese hospice nurses. Nursing managers should have a correct understanding of the relationship between them. Targeted measures and coping strategies need to be actively taken to create a better working environment for hospice nurses. This would enhance professional identity, and thereby promote caring behavior.

Multiomics reveals tumor microenvironment remodeling in locally advanced gastric and gastroesophageal junction cancer following neoadjuvant immunotherapy and chemotherapy

BackgroundPerioperative chemotherapy is the standard of care for patients with locally advanced gastric and gastroesophageal junction cancer. Recent evidence demonstrated the addition of programmed cell death protein 1 (PD-1) inhibitors...

Real-World Treatment Patterns and Clinical Outcomes in Patients With Multiple Myeloma Previously Treated With Lenalidomide and an Anti-CD38 Monoclonal Antibody.

This analysis explored real-world characteristics, treatment patterns and clinical outcomes in patients with relapsed or refractory multiple myeloma (RRMM) previously treated with lenalidomide and an anti-CD38 monoclonal antibody (mAb) and requiring subsequent treatment. The PREAMBLE and Connect MM prospective registries of patients with multiple myeloma (MM), and the US nationwide Flatiron Health electronic health record-derived de-identified database were analysed. MM-specific treatment patterns (prior/index therapies) and outcomes (progression-free survival [PFS]/overall survival [OS]) were assessed. This analysis included: PREAMBLE n = 215; Connect MM n = 232; Flatiron Health n = 845. Median age at index was 69.0 years, median 3 prior lines of therapy; > 50% male. The most common index regimens accounted < 15% of treatments (most common PREAMBLE, Connect MM: carfilzomib±dexamethasone; Flatiron Health: pomalidomide+daratumumab+dexamethasone); most patients received classes that they had previously; ≥ 93% were triple-class exposed (immunomodulatory drug, proteasome inhibitor, anti-CD38 mAb). In PREAMBLE, Connect MM and Flatiron Health, respectively: 80.9%, 68.1% and 77.2% were lenalidomide- and anti-CD38 mAb-refractory; 69.3%, 67.2% and 71.1% were triple-class refractory (TCR); median PFS: 5.2 (95% CI 3.7-6.7), 4.4 (3.5-5.6) and 5.3 months (4.8-6.0); median OS: 19.3 (15.8-26.1), 14.2 (11.0-16.9) and 23.1 months (19.0-28.6). PFS and OS were shorter in lenalidomide- and anti-CD38 mAb-refractory patients versus those who were not refractory to both. A similar pattern was observed for TCR patients versus non-TCR patients. There is no uniform standard of care for patients with RRMM with prior exposure to lenalidomide and anti-CD38 mAbs. Survival outcomes are poor, with a need for effective treatments for these patients.

A Review of Current and Future Antibody Drug Conjugates in Breast Cancer.

Antibody-drug conjugates (ADCs) are a novel class of anti-cancer agents that have changed the standard of care for patients with breast cancer. Their targeted approach delivers potent anti-cancer drugs to cancer cells bearing specific surface antigens, thereby maximizing anti-cancer effects and minimizing systemic toxicity. Currently, there are three ADCs available for use in breast cancer: trastuzumab emtansine for HER2 positive breast cancer (early stage and metastatic), trastuzumab deruxtecan for HER2 positive and HER2 low breast cancer (metastatic) and sacituzumab govitecan for triple negative and hormone receptor positive (HR +), HER2 negative breast cancer(metastatic). Trials have shown that these drugs have improved both progression free survival and overall survival in the metastatic setting, and trastuzumab emtansine has improved overall survival in early-stage breast cancer as well. The future of this class of compounds is very exciting. This field is rapidly evolving with new ADCs being investigated and clinical trials looking at the use of known ADCs in earlier stage disease.

Robotic-Assisted Versus Laparoscopic Approach for Treatment of Acute Cholecystitis in Children.

Introduction: Laparoscopic cholecystectomy (Lap-C) is the standard of care for patients requiring cholecystectomy in the acute setting. Although robotic-assisted cholecystectomy (RA-C) performance has increased, utilization in the acute setting has not been widely reported. We describe the feasibility of RA-C for pediatric patients undergoing acute inpatient cholecystectomy. Methods: A single institutional retrospective review of patients receiving RA-C while admitted for acute cholecystitis and/or choledocholithiasis (June 2017-June 2022) was compared with a matched cohort who underwent traditional multiport Lap-C (June 2021-June 2022). Demographic, perioperative, and postoperative data were analyzed. Results: Fifty patients were included: 25 each in the RA-C and Lap-C groups. Fifty-four percent were female; 66% were non-Hispanic white. Median age (15.7 years [interquartile range, IQR 14.7, 17.3] versus 15.3 years [IQR 14.5, 16.9], P = .91) and preoperative weight (92.6 kg [IQR 60, 105.9] versus 72.3 kg [IQR 61.6, 85.6], P = .15) were similar between the RA-C and Lap-C groups, respectively. No differences were observed in median operating time (89 minutes [IQR 76, 103] versus 88 minutes [IQR 77, 137], P = .70), postoperative length of stay (22.5 hours [21.4, 24.9] versus 20.6 hours [18.0, 25.1], P = .06), or 30-day complications (12% versus 16%, P = .69). Although opioid utilization (.23 milliequivalents/kilogram [MME/kg] [IQR .03, .30] versus .03 MME/kg [0, .09], P = .02) was higher in the RA-C cohort overall, no differences were detected during an analysis of the most recent 2 years (P = .96). Conclusion: RA-C in the acute setting can be performed safely in the pediatric population with comparable procedural times as well as perioperative and 30-day outcomes.

Palliative Electroconvulsive Therapy: A Descriptive Cohort Study.

Palliative care (PC) is the standard of care for patients with serious medical illnesses, or those conditions associated with high risk of mortality and negative impact on quality of life (QOL). Electroconvulsive therapy (ECT) is the gold standard treatment for certain psychiatric conditions, which may co-occur with serious medical illnesses. However, the use of "palliative ECT" (PECT) in this context is understudied. We conducted a descriptive retrospective cohort study reviewing the indications, outcomes, and regimens of PECT. We included patients who had an ECT consultation, in addition to either a PC consultation or a do-not-attempt-resuscitation (DNAR) code status between 2018 and 2023. Thirty-one patients met our inclusion criteria and 21 received ECT. The cohort was predominantly female (70%) with a mean age of 67.6 (range 25-90). Catatonia (64.5%) and treatment-resistant depressive disorder (35.5%) were the most common indications for ECT. At the time of ECT consultation, 16 patients (51.6%) had a serious medical illness, including cancer (19.4%) or end-organ disease (22.6%). Fourteen patients had major neurocognitive disorder (MNCD) (45.2%). Surrogate decision-makers consented for ECT in 64.5% of cases. All 21 patients who received ECT experienced psychiatric symptom improvement. ECT was associated with reduced mortality risk in five (23.8%) cases. Five patients initially misdiagnosed with MNCD experienced recovery in cognitive function after ECT and the diagnosis was revised to depression-related cognitive dysfunction (DRCD). Eight patients retained a comorbid MNCD diagnosis but experienced a mean Montreal Cognitive Assessment (MoCA) improvement of five points (range 0 to 17) with ECT. This work highlights the use of ECT among patients with serious medical illnesses, identifying cases when ECT was beneficial or deemed unsuitable. Patients with serious medical illnesses who also had an indication for ECT experienced improved QOL with ECT. Misdiagnoses, such as confusing DRCD and catatonia for MNCD, were effectively addressed through ECT. The findings underscore the importance of cross-specialty collaboration between C-L psychiatry and PC. Patients who receive PECT experience reduced suffering and improved QOL. PECT may be helpful in scenarios of life-threatening psychiatric illnesses, terminal medical illness with comorbid treatment-refractory psychiatric illness, and diagnostic uncertainty with MNCD.

Efficacy and safety of preoperative intravenous iron versus standard care in colorectal cancer patients with iron deficiency anemia: a systematic review and meta-analysis.

Anemia, particularly iron deficiency (ID) anemia, is common in colorectal cancer (CRC) patients, affecting up to 58% of individuals. This study aimed to compare the effectiveness and safety of preoperative intravenous iron (IVI) with standard care (no iron or oral iron) in CRC patients with ID anemia. A systematic search across multiple databases identified studies comparing IVI versus no iron or oral iron in CRC patients with ID anemia. Pooled data were analyzed for changes in hemoglobin (Hb) levels, need for red blood cell transfusions (RBCT), overall mean number of transfused RBC units, overall survival (OS), disease-free survival (DFS), and complications. The authors analyzed data from 11 studies with 2024 patients and found that IVI significantly increased Hb levels at crucial time points: preoperative (MD=1.17, 95% CI [0.95-1.40], P<0.01), postoperative day one (MD=1.32, 95% CI [0.89-1.76], P<0.01), hospital discharge (MD=0.76, 95% CI [0.28-1.24], P=0.002), and 30 days postoperative (MD=1.57, 95% CI [1.27-1.87], P<0.01). IVI significantly decreased the overall need for RBCT, particularly in the postoperative period (RR=0.69, 95% CI [0.52-0.92], P=0.01). It also reduced the mean number of transfused RBC units, total complications, and wound dehiscence. However, there were no significant differences in total death, hospital stay, infections, paralytic ileus, OS, or DFS. Preoperative IVI significantly increased Hb levels at critical time points and markedly reduced the overall need for RBCT, complications, and wound dehiscence. To further validate these findings and ensure robust conclusions, more well-designed randomized controlled trials are warranted.

Anti-amyloid treatments in Alzheimer's disease: elegance, evidence and ethics.

The so-called "amyloid cascade hypothesis" provides an elegant explanation of Alzheimer's disease (AD), has motivated the amyloid-lowering therapeutic strategy, and led to the elaboration of a rich experimental and conceptual toolkit for the field to progress. But it might be incorrect. The scientific evidence base supporting the efficacy and safety of current anti-amyloid antibody treatments in AD is weak. Nevertheless, we argue that there is a bias towards the amyloid-lowering therapeutic strategy amongst key opinion leaders in the research and advocacy communities. To demonstrate this, we first focus on the AD lexicon: while any accrual of amyloid on a brain PET scan can now permit diagnosis/definition of AD, lowering positron emission tomography (PET) amyloid is considered disease modification, and treatment-induced side-effects are hidden behind neutral-sounding acronyms: ARIA (amyloid-β (Aβ)-related imaging abnormalities: brain bleeding and swelling) and ARPA (amyloid-β (Aβ) removal-related pseudo-atrophy: brain shrinkage). Second, we underline that drugmakers did not test anti-amyloid antibodies against the best proven interventions and did not adequately inform trial participants of risks, thus violating research ethics of the Declaration of Helsinki on 2 counts. In conclusion, we are critical of over-reliance on the idea that PET amyloid-lowering treatments for AD are a therapeutic revolution as claimed, and consider that optimism does not excuse a lack of scientific, regulatory, and ethical integrity. We argue for rigorous, properly controlled (e.g. donepezil) anti-amyloid trials demonstrating cognitive and functional benefit before accepting amyloid-lowering drugs as the new standard of care for AD patients.