Standard Recommendations Research Articles

Features of nutrition and care of patients with jejunostomy

Introduction. A common type of palliative intervention is the imposition of nutritional fistulas for enteral nutrition in dysphagia. The operation of choice is gastrostomy, in which the gastric stage of digestion is preserved. This is more physiological and reduces the risk of developing dumping syndrome and metabolic disorders that can develop with the introduction of nutrition into the jejunum directly. Ejunostomy is applied when gastrostomy is technically impossible due to damage to the stomach, or as a stage in another operation. The infrequent use of jejunostomy leads to a lack of awareness among medical professionals about the specifics of care and nutrition through jejunostomy, which differ significantly from the standard recommendations for gastrostomy. The aim is to study. Offer advice on care and nutrition through the jejunostomy. Materials and Methods. The recommendations are based on literature data and the clinical experience of the authors who perform these operations, teach patients and their relatives care, nutrition through the jejunostomy, and manage these patients at the outpatient stage. The results and their discussion. The article provides recommendations for the care of jejunostomy, depending on the type of jejunostomy and feeding tube. The technique of feeding through the jejunostomy is described in the details, while an original method for the slow introduction of the nutrient mixture in the absence of special systems for drip nutrition is proposed. General recommendations on the selection of a nutrient mixture for feeding through the jejunostomy are given. Conclusion. Fistula care and feeding of patients with jejunostomy are differ from similar activities carried out in patients with gastrostomy. The proposed article will improve the orientation of medical workers in the problem and may serve as the beginning of the development of domestic recommendations for the care of the fistula and nutrition of patients with jejunostomy.

Vitamin D supplementation decrease asthma exacerbations in children: a systematic review and meta-analysis of randomized controlled trials

Background Observational studies have linked low vitamin D (VD) levels to increased asthma attacks in children. Subsequent meta-analyses of adults and children revealed that VD treatment might benefit asthmatic patients by reducing the incidence of exacerbations. Therefore, this review aims to analyze the effects of VD supplementation in reducing asthma exacerbations in children. Methods Published reports from PubMed, Cochrane, and Google Scholar were systematically searched until April 2023. The study protocol was registered in the PROSPERO database CRD42023411796. Randomized controlled trial studies were included in this review. Meta-analysis was performed using Cochrane RevMan 5.1 and presented with 95% confidence intervals (CIs). Results Ten relevant studies enrolled 1243 asthmatic children (631 children receiving vitamin D3 supplementation, 612 children receiving placebo) were included in this review. Our pooled analysis found that VD supplementation had a significant effect on lowering the total number of asthma exacerbations (RR 0.62; 95% CI: 0.44, 0.87; p = 0.01). Subgroup analysis revealed that a daily dose of VD given based on standard daily dose recommendation had a significant improvement on asthma exacerbations [(RR 0.41; 95% CI: 0,18, 0,92; p = 0.03). Conclusions Vitamin D supplementation can lower the occurrence of exacerbations in children with asthma, along with the improvement of FEV1.

Optimal tongue weight selection criteria for light vehicle-trailer combinations

When towing a trailer, proper weight distribution between the vehicle and trailer axles is crucial for system stability and manoeuvrability. Therefore, drivers are strongly recommended to keep the tongue weight, the downward force applied by the trailer at the hitch, within 10–15% of the trailer's gross weight. Despite extensive searches, the current academic and technical literature appears to lack quantitative analyses justifying the standard tongue weight recommendations. This paper presents comprehensive analyses of the lateral behaviour characteristics of light vehicle-trailer combinations influenced by variations in tongue weight. Subsequently, it proposes two novel selection criteria for determining the optimal tongue weight from the perspectives of stability and consistency. The optimal tongue weights for the stability and consistency of the nominal vehicle-trailer system are identified as 22.61% and 48.61% of the trailer weight respectively. Finally, the effectiveness of the proposed criteria is verified through CarSim simulation experiments, assessing 3% settling time and Root-Mean-Square error of vehicle yaw rate.

Use of Naturally Sourced Ergogenic Products and their Effects on Athletes and Physically Active Individuals: A Scoping Review Protocol

Abstract The global rise in sports participation has sparked a significant interest in ergogenic products, particularly those naturally sourced ergogenic products, due to their potential benefits in enhancing athletic performance and recovery. Despite the growing use of these products, challenges exist in standardization, dosage, and evidence-based recommendations. This scoping review aims to address these issues by systematically examining the use of naturally sourced ergogenic products and their effects on athletes and physically active individuals. The review follows Arksey and O’Malley’s framework, incorporating stages of identifying research questions, relevant studies, study selection, charting information, summarizing results, and consulting stakeholders. Article search will be done on PubMed, SCOPUS, WOS, Sport Discuss, and CNKI. Athlete, exercise, sport and ergogenic aid are the keywords to be used. The review will include experimental and cross-sectional studies focusing on active individuals and athletes. Studies involving ordinary people, older adults, patients, and animals will be excluded. The literature will be analyzed to provide an overview of the general characteristics of these studies, focusing on sources and types, timing, dosage, and effects of naturally sourced ergogenic products. This scoping review will systematically synthesize knowledge regarding the sources, types, timing, and dosing of the naturally sourced ergogenic products consumed by athletes and physically active individuals. The review will also report any side effects and suggest the direction of future studies related to this area. This protocol is registered on OSF osf.io/jp3nm.

Prenatal and postnatal antiviral therapies for the prevention and treatment of congenital cytomegalovirus infections.

Congenital cytomegalovirus infection (cCMV) is the leading infectious cause of sensorineural hearing loss and lifelong neurodevelopmental disabilities. Studies suggest antiviral therapy can prevent fetal infection after maternal primary infection, as well as halt the progression of hearing loss and neurodevelopmental disabilities in newborns with symptomatic cCMV. With growing worldwide momentum on early detection and diagnosis of cCMV, this review describes the exciting recent advances in antiviral therapies in CMV infected pregnant mothers and babies, as well as emerging evidence on anti-CMV vaccines. New opportunities for prenatal and neonatal interventions have driven a rising interest in screening and identification of asymptomatic CMV infection. Routine screening of pregnant women to identify primary infection in first trimester is now advocated in Western Europe but has yet to be examined from a public health perspective in other regions. Evidence is emerging for maternal valaciclovir therapy to prevent fetal infection after a maternal primary CMV infection in the first trimester of pregnancy. For those infants who are born with symptomatic cCMV, a 6-month course of valganciclovir, started within the first 4 weeks of life, and possibly up to 13 weeks of life, is the current recommended therapy. However, there is unclear evidence for the benefit of treatment for asymptomatic cCMV and cCMV with isolated hearing loss. Research to identify more effective antivirals and an effective CMV vaccine continues. More research is needed to determine the region-specific applicability of the new European recommendations for routine CMV screening in pregnancy. Areas of uncertainty in postnatal management include timing of initiation, duration of treatment and identifying pediatric subgroups that benefit from modification of the standard treatment recommendations.

VascuFit: Aerobic exercise improves endothelial function independent of cardiovascular risk: A randomized-controlled trial.

Background and aimsEndothelial dysfunction predicts elevated cardiovascular (CV) risk in healthy individuals. Aerobic exercise reduces endothelial dysfunction in part by improving CV risk factors. Yet, this explains less than 50% of the effect and a direct influence of exercise training on the endothelium is discussed as possible contributor. The VascuFit study applied non-linear periodized aerobic exercise (NLPE) training to assess its multilevel effects on endothelial function including potential epigenetic endothelial modifications by circulating micro-ribonucleic acids (endomiRs). MethodsSedentary adults with elevated CV risk between 40-60 years were randomized 2:1 and engaged in an eight-week ergometer-based NLPE training (n=30) or received standard exercise recommendations (n=14). Macro-, microvascular, cellular and molecular adaptations were assessed via brachial-arterial flow-mediated dilation (baFMD), static retinal vessel analysis (SVA), flow cytometry, and endomiRs regulating key pathways of endothelial function. Statistics included ANCOVA, Principal Component Analysis (PCA), and regression analyses. ResultsbaFMD improved by 2.38% (CI:0.70-4.06, p=0.007) independent of CV risk, whereas SVA parameters and circulating endothelial (progenitor) cells did not significantly change in the NLPE group. The mean distance between baseline and follow-up PCA loadings of the endomiR dataset explaining 44.2% of dataset variability was higher in the NLPE-group compared to the control group (2.71±2.02 vs. 1.65±0.93). However, regression analyses showed no evidence of endomiRs explaining the improvement of baFMD. ConclusionsThe improvement of macrovascular endothelial function by aerobic exercise training was independent from CV risk factors. Increased heterogeneity among endomiRs did not explain this effect, but suggests an adaptive response to the exercise stimulus on the epigenetic level.

Chemical Cleaning Techniques for Fouled RO Membranes: Enhancing Fouling Removal and Assessing Microbial Composition.

Membrane fouling, a major challenge in desalination, is addressed in this study by investigating three different chemical cleaning protocols (A, B, and C) targeting fouled reverse osmosis (RO) membranes and microbial community composition. Cleaning protocols A and B involve different chemical treatments selected based on preliminary tests and literature review, while protocol C follows the manufacturer's standard recommendation. Membrane morphology, foulant composition, and microbial community variability in fouled, virgin, and cleaned membranes are studied. Effective biofilm removal is observed across all protocols using scanning electron microscopy (SEM), while spectroscopic techniques highlight interactions between foulants and membranes. Importantly, a critical gap in understanding how cleaning strategies influence microbial communities on membranes is addressed. Shifts in dominant bacterial phyla (Proteobacteria, Firmicutes, and Actinobacteria) after cleaning are identified through 16S rRNA amplicon sequencing. Cleaning A showed the best results in reducing microbial counts and restoring composition similar to virgin membranes. Additionally, chemical treatment increased dominance of resistant genera such as Staphylococcus, Bacillus, Citrobacter, and Burkholderia. This study emphasizes the necessity for tailored fouling cleaning strategies for RO membranes, with Cleaning A is a promising solution, paving the way for enhanced water purification technologies.

Safety and efficacy of Lippia multiflora in the management of stage I hypertension: outcomes of a randomised controlled trial

IntroductionHypertension is a growing public health problem in the developing world. The chronic nature of the disease has been a driver for the use of traditional medicines. Clinical validation of such products for their safety and efficacy is thus of public health importance. We report on the clinical safety and effectiveness of a Lippia multiflora-based herbal antihypertensive (LMT-19). MethodsA randomised controlled study was conducted among 80 volunteers clinically diagnosed, per the WHO criteria, with stage I hypertension. Participants received either an aqueous infusion of LMT-19 plus a standard lifestyle and dietary recommendation based on a Dietary Approaches to Stop Hypertension (DASH) diet or the lifestyle and dietary recommendation alone. ResultsThe use of LMT-19 resulted in a significant decline of blood pressure over a 60-day period. Diastolic blood pressure in the LMT-19 group was found to be significantly lower compared to the control (mean diff: 8.25 (±1.50); P ≤ 0.001). Systolic blood pressure was also significantly better compared to the control group (mean diff: 12.70 ± 2.02; P ≤ 0.001). The product was also well tolerated as no adverse drug reactions were also recorded during the study. ConclusionThese outcomes suggest LMT-19 as a potential alternative remedy for management of stage I hypertension. Clinical trial registrationPan-African Clinical Trial Registry, PACTR202107733803271.

Completing the Completeness Measure: the MIDS Specification

The need to rapidly digitise millions of specimens in natural history collections has seen the development of a staged approach for data capture by institutions that have been carrying out mass digitisation projects. The cost and difficulty of transcribing labels associated with specimens has necessitated an approach that prioritises parts of the data based on research and curatorial requirements as well as ease of transcription and methodology available. This approach means that there is currently a wide variation in the completeness of data capture and imaging of specimens within and between collections. The Biodiversity Information Standards (TDWG) Minimum Information about a Digital Specimen (MIDS) specification has been designed to provide a framework for measuring and monitoring the completeness of the data transcribed from the specimen and the presence of an image or other media file. This framework enables a consistent and standardised approach to the calculation of the level of digitisation of specimens within a collection and, by extension/extrapolation, to the collection itself. Four levels of digitisation have been defined in the MIDS specification including a pre-digitisation level. These have been developed to correspond to practical requirements and existing large-scale digitisation programmes. MIDS level 0 (Bare): A bare or skeletal record making the association between an identifier of a physical specimen and its digital representation, allowing for unambiguous attachment of all other information. MIDS level 1 (Basic): A basic record of specimen information enabling basic discoverability as well as how the user is permitted to use the data. MIDS level 2 (Regular): A regular level of information including data that have been agreed over time as essential for most scientific purposes. MIDS level 3 (Extended): An extended level of information about a specimen including identifiers enabling connections to be made to other data present or known about the specimen. The scope of MIDS does not directly include the quality of data entered. Instead, MIDS can be seen as a tool to support the continuing improvement of data access and quality. It provides guidance for prioritising the data to be captured as well as recommendations for data standards and mapping structures. Here we present the progress in the development of the MIDS specification and its implementation. The MIDS elements for each of the four levels have now been defined and a draft version is available here. A machine-readable mapping to Darwin Core and ABCD has been compiled following the Simple Standard for Sharing Ontological Mappings (SSSOM). The differing data relevances and priorities for different disciplines have been recognised and the inclusion of required elements at each level is discipline specific (biology, palaeontology and geology). In addition, MIDS level scores have been increasingly implemented in existing specimen management systems, allowing an evaluation of the levels achieved in various contexts. There are two implementations of MIDS calculators that have been developed and are available to test. One, developed at the Meise Botanic Garden, uses a zipped Global Biodiversity Information Facility (GBIF) annotated archive (a commonly used GBIF download format based on Darwin Core Archive) and is available here. The other, developed at The Natural History Museum London, interacts directly with the GBIF API and is available here. We encourage users to try these and provide feedback to the TDWG MIDS Task Group.

Development of theoretical framework and digital competence assessment checklist (DCAC) for nursing students

BackgroundThe rapid development of digital technology impacts all aspects, including nursing education. Nursing programs are tasked with equipping graduates with both clinical skills and digital competence. However, inconsistencies in the conceptual understanding of digital competence in nursing literature, underscore the need to refine the concept. DesignThis study involved two phases including a modified Delphi approach and psychometric testing. In Phase 1, the panel of experts in nursing was invited to evaluate the theoretical framework, domain, and item of assessment checklist. In Phase 2, the psychometric properties of the assessment checklist were tested using a quantitative survey. SettingThe study was conducted in Taiwan, Indonesia, and Vietnam. ParticipantParticipants included 12 nursing experts from Taiwan, Indonesia, and Vietnam during the development phase and 417 nursing students from these countries in the validation phase. MethodsPhase 1 utilized a modified Delphi approach establishing a theoretical framework and assessment checklist. Experts provided feedback on a Likert scale, aiming for consensus. Phase 2 involved a quantitative survey where graduate nursing students rated the DCAC. The analysis process following the recommendation of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). ResultsThe theoretical framework defined digital competence across four domains. In the first Delphi round, all items were rated above the consensus threshold. After two rounds, the CVI ranged from .8 to 1.0, suggesting strong agreement among experts. The second phase revealed high discriminant validity among survey items, with Cronbach's alpha indicating high internal consistency. The refined 22-item DCAC showed improved fit indices, confirming the assessment checklist's structure. ConclusionThe developed 22-item DCAC is a valid and reliable tool for measuring digital competence among nursing students. Integration of digital competence into nursing education is essential for preparing students to excel in the healthcare environment.

Flow-weighted sourcing of freshwater runoff from Pacific-draining continental and coastal basins in south-western Patagonia (41-56° S): characterizing regional inputs to Chilean fjords

Global estimates of the supply of dissolved and suspended materials to the ocean, in order to be relevant at either political or ecological scales, belie a finer-scale analysis necessary for understanding specific terrestrial-marine interactions. This is especially true for continental runoff to the marine critical zone of inland fjords and channels, where mechanisms, drivers, and predictions need to be elaborated in the context of changing land use and shifting climate forcing. In fjords in south-western Patagonia, runoff from small coastal and large continental basins (~310 x103 km2), sourced from a diverse geography and wide climatic gradient (<150 – 6,000+ mm/year), correspond with a very low density of hydrological and water quality observations. Based on the recently developed regional runoff model (FLOW), we estimated the coastal freshwater discharges and characterized flow-weighted sourcing (land use-cover type, climate, glaciers/geology, and soil province) for Pacific drainages from 41° to 56° south latitude. An estimated 692 km3/year (mean across 1979-2018), or 2% of worldwide total, is more than 85% of previous estimates for the much larger Pacific South American input. Based on limited water quality observations and inference from runoff sourcing, we predict general patterns of export for four groups of continental resources important for marine productivity, including: significant regional variation in flow seasonality, a N-S gradient in declining input of silicic acid and increased glacial input of sediment and iron, and potential shift in dissolved organic matter input sources from rainforest (potentially labile) to peatlands (refractory). Finally, we emphasize the temporal and spatial consequences of near-reference condition river runoff for marine ecosystem productivity and function in the Patagonian fjords, with specific recommendations for water quality standards and sustained monitoring for coupled river and marine ecosystems.

Radiological Assessment of Different Retroperitoneal Lymph Node Measurements in Stage 1 Testicular Cancer Patients: Impact on Clinical Stage and Treatment.

Background: In staging for testicular germ cell tumor (GCT), current guidelines lack consensus regarding the measurement of retroperitoneal lymph node metastasis, concerning the recommended plane and dimension. This exploratory study aimed to assess its impact on clinical stage (cS) and therapy. Methods: We retrospectively examined 154 cSI (retroperitoneal lymph nodes < 10 mm in axial short-axis diameter (SAD)) GCT patients, without adjuvant therapy and a follow-up ≥ 24 months. Retroperitoneal lymph nodes were measured in staging images in different dimensions (SAD and long-axis diameter (LAD)) and planes (axial, sagittal and coronal). Results: Overall survival was 100%, with 82% free of recurrence after a median follow-up of 83 months. All patients were classified as cSI, based on axial SAD (RECIST 1.1). However, significantly more patients would have been classified as cSIIA (0% vs. 38% vs. 52%) or even cSIIB (0% vs. 1% vs. 25%) according to axial LAD (SWENOTECA, German S3 guideline) or maximum LAD in any plane (EAU, ESMO, AJCC and onkopedia) (p < 0.001). Overtreatment was predicted in 0%, 31% and 61% of patients based on axial SAD, axial LAD and maximum LAD, while undertreatment was estimated at 18%, 10% and 2%, respectively, (p < 0.001). Conclusions: These findings indicate considerable variability in cS based on current lymph node staging recommendations, suggesting that axial SAD (RECIST 1.1) could be the most appropriate parameter for standardized guideline recommendations.

From a Cup of Tea to Cardiovascular Care: Vascular Mechanisms of Action.

Tea consumption is increasingly recognized for its potential benefits to cardiovascular health. This study reviews the available research, concentrating on the major components of tea and their mechanisms of action in the cardiovascular system. Tea is abundant in bioactive compounds, such as flavonoids and polysaccharides, which possess significant antioxidant and anti-inflammatory properties. These compounds play a crucial role in mitigating oxidative stress and inflammation, thereby supporting cardiovascular health. They enhance endothelial function, leading to improved vascular relaxation and reduced arterial stiffness, and exhibit antithrombotic effects. Additionally, regular tea consumption is potentially associated with better regulation of blood pressure, improved cholesterol profiles, and effective blood sugar control. It has been suggested that incorporating tea into daily dietary habits could be a practical strategy for cardiovascular disease prevention and management. Despite the promising evidence, more rigorous clinical trials are needed to establish standardized consumption recommendations and fully understand long-term effects. This review offers a more comprehensive analysis of the current evidence based on endothelium function and identifies the gaps that future research should address.

Diet and Nutrients in Rare Neurological Disorders: Biological, Biochemical, and Pathophysiological Evidence.

Background/Objectives: Rare diseases are a wide and heterogeneous group of multisystem life-threatening or chronically debilitating clinical conditions with reduced life expectancy and a relevant mortality rate in childhood. Some of these disorders have typical neurological symptoms, presenting from birth to adulthood. Dietary patterns and nutritional compounds play key roles in the onset and progression of neurological disorders, and the impact of alimentary needs must be enlightened especially in rare neurological diseases. This work aims to collect the in vitro, in vivo, and clinical evidence on the effects of diet and of nutrient intake on some rare neurological disorders, including some genetic diseases, and rare brain tumors. Herein, those aspects are critically linked to the genetic, biological, biochemical, and pathophysiological hallmarks typical of each disorder. Methods: By searching the major web-based databases (PubMed, Web of Science Core Collection, DynaMed, and Clinicaltrials.gov), we try to sum up and improve our understanding of the emerging role of nutrition as both first-line therapy and risk factors in rare neurological diseases. Results: In line with the increasing number of consensus opinions suggesting that nutrients should receive the same attention as pharmacological treatments, the results of this work pointed out that a standard dietary recommendation in a specific rare disease is often limited by the heterogeneity of occurrent genetic mutations and by the variability of pathophysiological manifestation. Conclusions: In conclusion, we hope that the knowledge gaps identified here may inspire further research for a better evaluation of molecular mechanisms and long-term effects.

Creatine Supplementation Prior to Strength Exercise Training Is Not Superior in Preventing Muscle Mass Loss Compared with Standard Nutritional Recommendations in Females After Bariatric Surgery: A Pilot Study.

This study examines whether creatine supplementation combined with strength training mitigates muscle mass loss in women during early rehabilitation post-bariatric surgery, as its effectiveness remains untested in this context. Fifteen women (37.8 ± 9.6 years; BMI, 38.8 ± 5.6 kg/m2) completed the intervention (creatine group = 7; placebo group = 8). Both groups followed a strength training program three times a week for 8 weeks. The dosage for both the creatine and placebo was 8 g prior to each exercise session. Body weight, skeletal muscle mass, fat mass, handgrip strength, and physical activity levels were measured before and after the intervention. The creatine group showed a reduction of 9.5 ± 1.5 kg in body weight, with a 0.72 ± 0.6 kg decrease in muscle mass and an 8.64 ± 1.2 kg reduction in fat mass. The placebo group had a reduction of 9.6 ± 3.5 kg in body weight, with a 0.6 ± 1.2 kg decrease in muscle mass and an 8.88 ± 3.2 kg reduction in fat mass, without significant differences between groups (p > 0.05). The pre-session strength exercise training creatine supplementation is not superior to placebo regarding body weight and fat mass losses and the attenuation of muscle mass loss during the first weeks of rehabilitation following bariatric surgery.

First year report of the IMSS Multicenter Hip Fracture Registry.

Hip fracture registries provide a means to compare care and establish improvement processes. The Mexican population has aged; thus, there is a greater risk of osteoporosis, and its main consequence is hip fracture due to fragility. Its incidence is high, and it is expected to increase due to aging in our country. International guidelines provide standardized recommendations for the care of people with hip fractures, while hip fracture registries provide a means to compare care with local, national, and international clinical standards and establish improvement processes. Describe the standards of care for hip fractures in various hospital centers of the Mexican Social Security Institute. This was an observational, multicenter, longitudinal, and descriptive study. It included 24 hospital centers in Mexico. Informed consent was obtained. Data were recorded during the hospital stay, epidemiological data, and management, and follow-up was carried out 30 and 120days after discharge. The information was analyzed using SPSS version 22.0. A total of 1042 subjects aged 79.5 ± 7.6years participated, mostly women (n = 739; 70.9%) from the community (n = 1,021; 98.0%) and with functional independence (Barthel 80.9 ± 22.2). The transfer time to the emergency room was 4.6 ± 14.6days. Pertrochanteric hip fracture was the most common (n = 570, 54.7%). The most common type of procedure was dynamic hip screw (DHS) (n = 399; 40.1%). Documented thromboprophylaxis was granted in 91.5% (n = 953) and antibiotic prophylaxis in 53.0% (n = 552) of the patients. The goal of 36h for the surgical procedure was achieved in 7.6% of the subjects (n = 76), with the most frequent cause being a delay in scheduling (n = 673, 67.6%). The mean time from emergency room to surgery was 7.8 ± 7.0days. The acute mortality rate was 4.3%. Secondary pharmacologic prevention upon discharge occurred in 64.2% of patients. At 30days, 370 subjects (37.1%) were lost to follow-up, with a mortality of 3%, while at 120days, 166 subjects (27.8%) were lost, with a mortality of 2.8%. In the hospital centers where the study was carried out, there are still no standards of care for hip fractures, which makes it necessary to rethink the care for this population group through a strategy focused on meeting those standards.

An Institutional Febrile Neutropenia Protocol Improved the Antibacterial Treatment and Encouraged the Development of a Computerized Clinical Decision Support System.

We investigated the influence of a local guideline on the quality of febrile neutropenia (FN) management and the applicability of a computerized decision support system (CDSS) using real-life data. The study included 227 FN patients between April 2016 and January 2019. The primary outcome measure was the achievement of a 20% increase in the rate of appropriate empirical treatment of FN in bacteremic patients. The compatibility of the CDSS (the development of which was completed in November 2021) with local protocols was tested using standard patient scenarios and empirical antibiotic recommendations for bacteremic FN patients. In total, 91 patients were evaluated before (P1: between April 2016 and May 2017) and 136 after (P2: between May 2017 and January 2019) the guideline's release (May 2017). The demographic characteristics were similar. Appropriate empirical antibacterial treatment was achieved in 58.3% of P1 and 88.1% of P2 patients (p = 0.006). The need for escalation of antibacterial treatment was significantly lower in P2 (49.5% vs. 35.3%; p = 0.03). In P2, the performance of the CDSS and consulting physicians was similar (CDSS 88.8% vs. physician 88.83%; p = 1) regarding appropriate empirical antibacterial treatment. The introduction of the local guideline improved the appropriateness of initial empirical treatment and reduced escalation rates in FN patients. The high rate of compliance of the CDSS with the local guideline-based decisions in P2 highlights the usefulness of the CDSS for these patients.

Defining minimum workforce standards for intensive care physiotherapy in Australia and New Zealand: A Delphi study

BackgroundIntensive care staffing guidelines provide recommendations for the safe and effective delivery of health care while recognising professional requirements of the workforce. To guide recommendations for physiotherapy staffing guidelines, profession-specific consultation is needed. ObjectivesThe objective of this study was to develop consensus-based recommendations for minimum workforce standards for physiotherapy in intensive care. MethodsA Delphi survey process was conducted involving physiotherapists from Australia and New Zealand. ResultsThe panel consisted of 65 physiotherapists in the first round and 60 in the second round (92% retention). Respondents were from both Australia (49, 76%) and New Zealand (16, 24%) who had been physiotherapists for an average of 18.8 ± 9.0 years and were primarily senior intensive care physiotherapists (44, 68%). Respondents had experience across level 3 (50, 77%), level 2 (18, 28%), and level 1 (5, 8%) adult intensive care units (ICUs), adult high-dependency units (27, 42%), and paediatric intensive care (6, 9%). A total of 42 statements were presented, with 37 reaching consensus after two rounds. After two rounds, consensus was achieved for a minimum staffing ratio in paediatric ICUs of one physiotherapist per six (1:6) beds. For adult ICUs, use of the median value of the participant's responses was supported to establish minimum staffing ratios of 1:8, 1:7, 1:6, and 1:8 for levels 1, 2, and 3 ICUs and high-dependency units, respectively. The requirement for an additional allocation for senior physiotherapist staffing for each ICU level was also established. Statements that also gained consensus included recommendations for access to on-call and weekend services for all ICU settings and the consideration of evening shifts specifically for level 3 and paediatric ICUs. ConclusionsRecommendations for minimum staffing for physiotherapy in intensive care settings were achieved and supported requirements for clinical service delivery, supervision, and training.

Inter-observer consistency on subsolid nodule follow-up recommendation based on National Comprehensive Cancer Network (NCCN) guidelines in low-dose computed tomography (LDCT) lung cancer screening.

Follow-up management of pulmonary nodules is a crucial component of lung cancer screening. Consistency in follow-up recommendations is essential for effective lung cancer screening. This study aimed to assess inter-observer agreement on National Comprehensive Cancer Network (NCCN) guideline-based follow-up recommendation for subsolid nodules from low-dose computed tomography (LDCT) screening. A retrospective collection of LDCT reports from 2014 to 2017 for lung cancer screening was conducted using the Radiology Information System and keyword searches, focusing on subsolid nodules. A total of 110 LDCT cases containing subsolid nodules were identified. Two senior radiologists provided standardized follow-up recommendation. Follow-up recommendation was categorized into four groups (0-, 3-, 6-, and 12-month). To ensure overall balance and representativeness of the follow-up categories, 60 scans from 60 participants were included (distribution ratio 1:1:2:2). Cases were categorised into follow-up recommendation groups by five observers following NCCN guidelines. Fleiss' kappa statistic was used to evaluate inter-observer agreement. Overall accuracy rate for follow-up recommendation among five observers was 72.3%. Chest radiologists' overall agreement was significantly higher than radiology residents (P<0.01). The overall agreement among the five observers was moderate, with a Fleiss' kappa of 0.437. For all paired readers, the mean Cohen's kappa value was 0.603, with 95% confidence interval (CI) from 0.489 to 0.716. Chest radiologists demonstrated substantial agreement, evidenced by a Cohen's kappa of 0.655 (95% CI: 0.503-0.807). In contrast, the mean Cohen's kappa among radiology residents was 0.533 (95% CI: 0.501-0.565). The majority of cases with discrepancies, accounting for 73.5%, were associated with the same risk-dominant nodules. A higher proportion of part-solid nodule was a risk factor for discrepancies. Of the 600 paired readings, major discrepancies and substantial discrepancies were observed in 27.5% and 4.8% (29/600) of the cases. In subsolid nodules, category evaluation of observer follow-up recommendation based on NCCN guidelines achieved moderate consistency. Disagreements were mainly caused by measurement and type disagreements of identical risk-dominant nodules. Part-solid nodule was a contributor for discrepancies in follow-up recommendation. Major and substantial management discrepancies were 27.5% and 4.8% in the paired evaluations.

286. TREATMENT WITH CURATIVE INTENT FOR OLIGOMETASTATIC GASTROESOPHAGEAL CANCER-RESULTS OF A PROSPECTIVE MULTICENTER STUDY

Abstract Background Oligometastatic gastroesophageal cancer is a clinical entity with no standard treatment recommendation. Treatment with curative intent has recently emerged as an option in selected patients in contrast to the traditional palliative treatment strategy. This prospective study aimed to assess the safety and efficacy of combined systemic and local treatment with curative intent for patients with oligometastatic gastroesophageal cancer. Methods In a multicenter collaborative study, consecutive patients with gastroesophageal cancer and metastases in the liver and/or extra-regional lymph nodes were screened for inclusion. Eligible patients were offered treatment with combined systemic and local therapy within the study. Primary endpoints were treatment safety and feasibility, secondary outcomes included postoperative mortality, treatment response, progression-free and overall survival. Subgroup analyses were stratified based on oligometastatic location. Results A total of 29/35 patients completed systemic and local treatment with surgical resection, liver ablation or definitive chemoradiotherapy. The majority of postoperative complications were mild-moderate, no patient died due to postoperative complications within 30 days of surgery. Median progression-free survival was 7.1 (interquartile range 4.3-12.4) months and median overall survival was 23.8 (interquartile range 12.3-33.0) months. Conclusion This study found combined systemic and local treatment to be a safe treatment option and to potentially improve long-term survival in strictly selected patients with oligometastatic gastroesophageal cancer.