Background: Hysterectomies are one of the most frequently performed surgical procedures in the United States. There are a wide variety of diagnoses that require a patient to obtain this procedure, ...but the majority of hysterectomies are performed for benign indications. Currently, gynecologists do not follow a standardized protocol surrounding postoperative laboratory ordering, and healthcare professionals can order a wide range of tests as often as they choose. Extraneous laboratory orders are disruptive to the patients’ well-being and risk their health following surgery. These orders are costly for hospital systems, take up precious time of hospital employees, and influence the course of patient treatment only in extremely rare circumstances. There are few studies that develop exclusion criteria for patients who may not require a laboratory test following surgery. Though systems to predict postoperative hematocrit have been created, they are complicated and difficult to use. The few studies that were performed are yet to be accepted by the medical community, in part because of their limited scope. This study will be the first to incorporate the results of robotic surgery in the analysis. Objective: The purpose of this study is to determine concrete parameters to indicate that a patient is in need of postoperative laboratory work and at risk for anemia or transfusion. We aim to develop two comprehensive models that guide surgical practitioners to identify the cases which do not require laboratory data. Methods: A total of 1027 gynecologic surgeries were performed at Saint Francis Hospital and Medical Center between April 1, 2014 and May 31, 2016. This retrospective study extracted data from EPIC EMR according to 42 variables preconceived to be the leading indicators of postoperative hematocrit and overall healing. Five healthcare professionals were surveyed to identify the variables that influence their postsurgical patient assessments and their decisions to order blood testing. This information was developed into score sheets with differing levels of stringency. Correlation highlighted 14 of the initial 42 variables as contributors to postoperative hematocrit and an equation model was built. Stepwise linear regression was used for univariate and multivariate analyses, from which we created our equation to predict all patients’ postoperative hematocrit. Results: Out of the 1027 initial cases, a total of 602 cases were identified as hysterectomies for benign indications. Survey data gave the highest value to urine output and heart rate as key indicators of postoperative anemia. From the survey data, two clinical scoring sheets with differing stringency were created to guide practitioner laboratory ordering. These sheets gave parameters of heart rate and urine output the largest correlative weight in determining postoperative hematocrit. However, based on regression analysis, parameters of age (AGE), body mass index (BMI), preoperative platelet count (PPC), estimated blood loss during surgery (IO EBL), preoperative hematocrit (PHCT) and postoperative fluid bolus orders (POSTOP FB) proved to be the key variables impacting postoperative hematocrit (POSTOP HCT). These items were translated into the equation: POSTOP HCT = 22.51 – 0.40*POSTOP FB – 0.01*IO EBL + 0.25 PHCT + 0.09*BMI + 0.06*AGE – 0.01*PPC (R-squared = 0.310). Conclusions: This study aims to decrease superfluous laboratory testing, as well as to contribute to a larger conversation considering the potential merits of clinical judgement in a data-driven healthcare system. We have created a number of comparable strategies in order to reduce the number of unnecessary blood draws: two clinical scoring sheets and an equation. The score sheets indicate when to order additional testing. These sheets are representative of a range of surgical practitioners’ conventional clinical judgement. The equation serves as an evidence-based guide for determining postoperative hematocrit following benign gynecologic surgery. These predictive mechanisms will be validated and a superior method determined as our research continues with prospective application. We eventually expect to use the most accurate mechanism to reduce postoperative blood testing following all surgeries.
Mealtime family functioning is important in shaping health behaviors associated with overweight/obesity, particularly for preschool-aged children. Parental controlling feeding behaviors (i.e., ...restriction and pressure to eat), may impact mealtime family functioning and thus be targets of prevention and intervention efforts. The current study aimed to address literature gaps by examining both mother and father self-reports of controlling feeding behaviors, and the discrepancies between parents' reports. Further, the study examined the associations among controlling feeding behaviors and objective mealtime family functioning in a community sample of preschool-aged children.
The sample included 27 children between 2 and 6 years of age and their immediate family members. Two mealtimes were videotaped for each family and coded for family functioning using the Mealtime Interaction Coding System, and self-reports of feeding practices were collected using the Child Feeding Questionnaire.
Mother controlling feeding behaviors were not significantly related to any mealtime family functioning domain. Father controlling feeding behaviors were only significantly related to interpersonal involvement. However, discrepancies in the use of controlling feeding behaviors accounted for nearly one fourth of the variance in overall family functioning and affect management, with greater discrepancies being related to poorer family functioning.
Interventions may be designed to reduce parental discrepancies in the use of controlling feeding behaviors. Future research should consider longitudinal design, using larger, more representative samples, to better understand the impact of parental controlling feeding behaviors, particularly the impact of parental discrepancies in these areas, on mealtime family functioning and subsequent health outcomes.
Pathomechanisms in IgA pemphigus are assumed to rely on Fc-dependent cellular activation by antigen-specific IgA autoantibodies; however, models for the disease and more detailed pathophysiologic ...data are lacking. In this study, we aimed to establish in vitro models of disease for IgA pemphigus, allowing us to study the effects of the interaction of anti-keratinocyte IgA with cell surface FcαRs. Employing multiple in vitro assays, such as a skin cryosection assay and a human skin organ culture model, in this study, we present mechanistic data for the pathogenesis of IgA pemphigus, mediated by anti–desmoglein 3 IgA autoantibodies. Our results reveal that this disease is dependent on FcαR-mediated activation of leukocytes in the epidermis. Importantly, this cell-dependent pathology can be dose-dependently abrogated by peptide-mediated inhibition of FcαR:IgA-Fc interaction, as confirmed in an additional model for IgA-dependent disease, that is, IgA vasculitis. These data suggest that IgA pemphigus can be modeled in vitro and that IgA pemphigus and IgA vasculitis are FcαR-dependent disease entities that can be specifically targeted in these experimental systems.
Youth engage in a variety of methods to manage their weight, including unhealthy weight control behaviors (UWCBs). The purpose of this study was to examine factors associated with youth's engagement ...in UWCBs, including media influence, youth's BMI z-score and self-esteem.
Participants were 179 youth, aged 10–17, attending a primary care clinic appointment. Youth completed questionnaires assessing frequency of UWCBs, global self-worth, and perception of media influence to lose weight. BMI z-score was calculated based on height and weight measurements obtained from medical charts. The SPSS macro, PROCESS, was used to conduct moderation analyses.
Over 40% of youth endorsed using at least one UWCB in the past year. Girls reported using more UWCBs and engaging in UWCBs more frequently than boys. For boys, media influence to lose weight was only related to UWCB frequency for those with a BMI z-score of 1.23 and above. For girls, media influence was only related to UWCB frequency for those with low to average levels of global self-worth.
Girls' and boys' use of UWCBs is impacted by different factors. Prevention efforts should consider targeting factors, such as weight status and self-esteem, which are uniquely associated with gender.
•We examined factors influencing youth's unhealthy weight control behaviors (UWCBs).•About 41% of youth reported using UWCBs in the past year.•BMI moderated the media exposure to UWCB relationship in males.•Global self-worth moderated the media exposure to UWCB relationship in females.
Abstract only Background: Cardiac troponins are the gold standard for diagnosis and risk stratification of patients with ACS. As a threshold for troponins, the serum concentration which is identical ...to the 99 th percentile of a healthy population has been defined. However, this threshold has to measurable with sufficient analytical precision (CV<10%). In the past, troponin assays were not able to measure a troponin concentration at the 99th percentile with sufficient precision. However newly developed highsensitive troponin assays will enable measurement at the 99th percentile with the required precision. The aim of the present study is to evaluate the diagnostic and prognostic value of a new hs TnT assay in comparison to the established TnT assay. Methods and results: From April 2003 until April 2005 all consecutive patients (n=1023, 30% females, median age 65 years) admitted because of an ACS within the last 48 hours were included. Diagnosis was myocardial infarction in 857 (84%) patients. Clinical follow up after 6 months was available. During this period 72 (7.0%) patients died. Conventional TnT was measured on admission and at day 1 (Elecsys®, Roche, Germany). A TnT > 0.03 ng/ml was considered positive. High sensitive troponin T (hsTnT) was measured on admission (Elecsys®, Roche, Germany). For this assay, a threshold of 0.012 ng/ml, which is the 99 th percentile and identical with the 10% CV, has been applied. On admission 694 (68%) of the patients were TnT positive, yielding a sensitivity of 81% for the diagnosis of MI. In comparison, 879 (86%) of the patients were hsTnT positive on admission yielding a sensitivity of 96%. The AUC of the ROC curves for TnT and hsTnT for the diagnosis of MI were comparable (0.929 for TnT and 0.954 for hsTnT). Among the 329 patients who were TnT negative on admission, in 133 patients MI could have been diagnosed correctly by hsTnT (sensitivity of 82%, specificity of 67%). In a multivariate Cox regression model, hsTnT was an independent predictor for mortality. In this model, conventional TnT lost its predictive value. Conclusion: A new hs TnT assay enables early diagnosis of MI with a higher sensitivity as conventional TnT assays. Furthermore, hsTnT levels provide stronger prognostic information for mortality within 6 months as conventional TnT levels.
Abstract Introduction: Recent advances in antibody engineering have created a portfolio of highly potent therapeutic approaches like antibody-drug conjugates (ADCs), radioimmunoconjugates (RITs), ...chimeric antigen receptors (CARs) or bi-specifics. Due to the increased potency, these drugs are more than ever dependent on very clean targets to prevent side effects. We aim to address this major problem through our approach to develop antibodies with improved tumor specificity and reduced on-target/off-tumor binding utilizing the aberrant O-glycosylation on tumor cells. Altered glycosylation of proteins and lipids is one of the most drastic changes in cancer, giving rise to truncated or highly fucosylated and highly sialylated glycans which are almost absent on normal cells. Thus, developing antibodies against protein/carbohydrate combined epitopes (GlycoTargets) comprising these tumor-specific glycans enables highly potent therapies with reduced off-tumor toxicity. Experimental procedures: A workflow and corresponding database was established to evaluate the O-glycosylation of proteins. The first and most basic criterion is the presence of suitable O-glycosylated peptide stretches in the extracellular domain of a protein based on predictions. For proteins fulfilling this criterion cancer-relevant expression is analyzed in a second step. This is done either using publicly available data or experimentally (immunohistochemistry or protein expression data). During the final major step, the theoretical existence of suitable O-glycosylation is confirmed by our own experimental data. This includes analysis of cellularly expressed proteins by anti-glycan antibodies and mass spectrometric studies. Results summary: Case studies will be presented that highlight our workflow to identify suitable GlycoTargets based on publicly available data analysis and experimental confirmation. Additionally, the subsequent development of antibodies against the identified GlycoTargets will be shown. Conclusion: A standardized process was developed for the data collection and prioritization of potential GlycoTargets. The obtained information is subsequently used for targeted discovery of antibodies that bind to protein/carbohydrate combined glycoepitopes (GlycoTargets) offering increased tumor-specificity compared to simple protein targets. Citation Format: Patrik Kehler, Johanna Gellert, Lisa Kalfhues, Sophie Marinoff, Manon Weis, Andreas Franz, Naomi Kast, Stephanie Gurka, Marianne Morche, Evelyn Hartung, Timo Lischke, Sarah Mayer-Hain, Antje Danielczyk. Platform approach to develop antibodies specifically recognizing cancer-associated glycoforms abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5896.
Objective: Rumination syndrome (RS) is a disorder of gut-brain interaction (DGBI) for which evidence-based intervention includes behavioral treatment (BT). However, youth with DGBIs, including RS, ...face numerous barriers to accessing behavioral health care. This brief report describes the initiation of a quality improvement project that (a) assessed RS education and referral practices within our gastroenterology (GI) division, (b) developed patient education materials about RS and BT, and (c) implemented a process to monitor the educational initiative's impact on BT referrals. Method: Baseline referral and education practices were assessed by a provider survey. The authors developed a patient handout, a two-part video, and a provider documentation phrase about RS and BT to be used in the electronic medical record (EMR). A newly developed EMR-based registry tracks patients diagnosed with RS, use of education materials, and referrals to BT. A follow-up survey assessed providers' knowledge and use of new education tools. Results: Data from 39 GI providers indicated multiple BT referral barriers. Providers expressed confidence in educating patients/families about RS but endorsed limited time for comprehensive education. In response, we developed and disseminated educational materials about RS and BT. Follow-up data from 25 providers indicated general awareness of education materials, with 50% of providers disseminating RS materials to patients/families. After this educational intervention, BT referrals increased from 50.8% to 61.3% of patients diagnosed with RS. Conclusions: Development and distribution of RS educational materials increased referrals to BT. Providing standard educational materials may decrease variability in care and increase the acceptability of appropriate therapy for RS and, potentially, other DGBIs.
Implications for Impact StatementYouth with rumination syndrome (RS) may not be referred for evidence-based behavioral treatment (BT) in a timely manner. Medical providers also have limited time and resources to fully educate patients and families about treatment. This study suggests that providing consistent education materials to medical providers, patients, and families increases how many newly diagnosed patients with RS are referred to BT.
There is a wide range of smartwatches and emergency watches on the market that are specifically designed for older people. The products are freely available, which is why there is an urgent need for ...information about the reliability and functionality of the products among potential users, but also health professionals and decision-makers. As part of a systematic product comparison test, the functionality and quality of seven smartwatches were investigated.
Four watches for seniors, one watch for adults and two watches for children, but with comparable functionalities, were included in the test. For the test, real-life situations were simulated and, in addition to emergency calls, GPS tracking, fall detection and geofencing, the battery life, call quality, stability/robustness of the products and service/support were evaluated. From the total number of points, a grade was determined based on the German school grading system (1 = very good to 6 = insufficient).
All smartwatches evaluated were rated at least "3-satisfactory". The two best-rated watches received a score of 1.8. The differences were particularly evident in the emergency call functionality, battery life, precision of the tracking function, and service/support. The call quality, with one exception, and the stability/robustness were consistently rated as "1-very good". Three watches in the test were able to detect falls with variable results.
The functionality and usability of the tested products differed considerably. A focus on a few main functions can even provide added value for older, frail people. Continuous comparative testing of products for this target group with new and updated products is desirable.
A substantial proportion of pre-health profession undergraduate students relied on cues of pediatric patient and mother weight status (healthy weight or obese) when making assessments about ...anticipated treatment adherence and responsibility for health.
Abstract
Bias toward individuals with overweight/obesity (OV/OB) exists among health professionals and trainees with the potential to affect the quality of healthcare interactions. Given most research is adult-focused, this study aimed to examine the influence of weight status on clinical judgments in a pediatric context. Sixteen virtual human scenes representing hypothetical medical encounters of pediatric patients and their mothers were presented to prehealth profession undergraduates (n = 92). Characteristics, or cues, of patient and mother weight status (healthy weight vs. obese) and dyad race (Caucasian vs. African American) were manipulated across scenes. Participants provided ratings for assessment questions, including perceived treatment adherence and responsibility for health, for each scene. Data were examined via idiographic (i.e., individual-level) analysis, which involved generation of separate multiple regressions per participant per assessment question to capture the influence of the cues on participants' ratings. Results represent secondary outcomes from another study published elsewhere. Current analyses revealed that 12%–22% of participants relied on cues of weight status when making assessments about patient and mother adherence and responsibility for health. The majority of these participants equated higher weight status with poorer anticipated treatment adherence and greater health responsibility. Results suggest that the weight status of pediatric patients and their mothers' plays a considerable role in prehealth profession undergraduates' clinical judgments, with the future potential to affect disparities in pediatric care. This study highlights the importance of considering child and maternal factors and utilizing a novel approach that may serve as a model for further investigation of this issue.
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