Brampton Civic Hospital is an acute care hospital in Brampton, Ontario and part of the William Osler Health System. It is a community teaching hospital for the Michael G. DeGroote School of Medicine of McMaster University.
Emotion-focused model of care delivery creates a supportive environment for persons with dementia. There is a lack of certainty regarding one such emotion-focused model's effectiveness (Butterfly) in an acute care environment, primarily because prior research has been confined to long-term care (LTC) facilities. Studies have demonstrated reduced neuropsychiatric symptoms (NPS) when person-centred dementia care models are deployed for persons living with dementia (PLWD). A multi-site cross-sectional design assessed NPS in PLWD using the NPI-Q scale in hospitalized patients on a Emotion-focused unit for 7-21 days. We identified 177 PLWD (88 from an acute care for elderly unit, 89 from general medicine units). The two cohorts had 40 female and 48 male patients in the ACE unit and 35 female and 54 male patients in the general medicine unit. The average age between the two groups was 83 and 84 yrs, respectively. NPI-Q symptom severity was lower on the ACE unit in comparison to the general medicine unit. Mean improvement for motor behaviours and sleep were significant. Caregiver distress scores were significantly lower for delusions, agitation, anxiety, irritability, motor behaviour and sleep. Emotion-focused care made a statistically significant change in NPS severity and caregiver distress when compared to care provided in general medicine units.
Developing autonomous technologies will enable humanity to considerably expand our lunar and space exploration capabilities. Along with the technical challenges of developing autonomous technologies, there is also the issue of trust—stakeholders are often resistant to their use for a variety of psychological reasons. Nevertheless, several successful methods for gradually building trust have been developed for both terrestrial and space applications. Relevant case studies provide insights on how trust is built for stakeholders when it comes to self-driving vehicles, Artificial Intelligence in aviation, space station operations, satellite rendezvous missions, and Mars rover surface operations. Based on these case studies, we propose a generalized method for building trust with stakeholders and have applied it to a lunar construction pathfinder mission currently in development. Metrics for assessing success criteria for autonomous systems are provided as a means to progress through the proposed phases of autonomy deployment.
e16058 Background: Gastric cancer is projected to affect 17,720 men and 12,580 women in 2025, according to the American Cancer Society. Minimally invasive gastrectomy(MIG) has rapidly gained popularity as a safe alternative to open surgery—unfortunately, no gender-based studies comparing postoperative outcomes between males and females after MIG were available. Therefore, we aim to investigate these differences and develop an understanding of the sex-specific outcomes of this procedure, which refers to outcomes unique to each biological sex due to physiological and anatomical differences. Methods: Between 2016 and 2022, we performed a retrospective analysis using the National Inpatient Sample(NIS) database, which includes information on many inpatient stays, to identify gastric cancer patients who underwent MIG. We utilized multivariable regression models to analyze in-hospital complications and any sex-based differences. Results: There were 13,315 MIG procedures, including 8,620 (64.7%) in males and 4,695 (35.3%) in females. Both groups were similar in age (mean age 65.33 years for males vs. 64.71 years for females, p = 0.618) and Charlson Comorbidity Index (CCI) scores (mean CCI 4.06 for males vs. 3.84 for females, p = 0.219). Malnutrition was present in 15.2% of females and 17.6% of males (p < 0.01), while 22.8% of females and 24.8% of males had metastasis (p = 0.011). The multivariable regression revealed that males had higher odds of complications, including surgical wound disruption (aOR 1.843, 95% CI 1.316-2.580, p < 0.01), sepsis (aOR 1.557, 95% CI 1.280-1.894, p < 0.01), pneumothorax (aOR 1.580, 95% CI 1.263-1.977, p < 0.01), and acute kidney injury (AKI) (aOR 1.517, 95% CI 1.305-1.763, p < 0.01). Additionally, males had a higher risk of bleeding (aOR 1.328, 95% CI 1.031-1.711, p < 0.01) but no significant difference in blood transfusion rates (aOR 0.942, 95% CI 0.818-1.084, p = 0.405). Both sexes had similar mortality odds (aOR 1.021, 95% CI 0.753-1.385, p = 0.894). Length of hospital stay was significantly shorter for females (mean 8.04 days) compared to males (mean 8.91 days, p < 0.01). Conclusions: In our study, 64.7% of MIG procedures were performed in males. Males had higher odds of several postoperative complications, including surgical wound disruption, sepsis, pneumothorax, bleeding, and AKI, but no significant differences in blood transfusion rates or mortality. These findings underscore the importance of considering sex-based disparities in postoperative outcomes, as they can inform the development of more effective clinical guidelines for both sexes. Additionally, the limitations of the National Inpatient Sample, including a lack of post-discharge data, indicate the need for future research addressing long-term outcomes and follow-up.
1118 Background: Patients with breast cancer (BC) are frequently prescribed opioids for pain management, placing them at risk of opioid use disorder (OUD). This study analyzes the prevalence of OUD and identifies factors contributing to its risk among BC patients in the United States. Methods: We conducted a retrospective analysis using the National Inpatient Sample (NIS) database, a Healthcare Cost and Utilization Project (HCUP) component. Females with BC were identified through ICD-10 codes. The Cochran-Armitage trend test assessed OUD prevalence trends from 2016 to 2022. Multivariable regression models estimated the impact of multiple patient demographics and comorbidities on the presence of OUD. Results: Among 1,189,884 females aged≥18 with BC, 2.3% (27,500) had OUD. The mean age of OUD patients was 58.38 years, compared to 64.46 years in the non-OUD cohort. OUD prevalence was highest in those aged 18–50 years (3.8%), followed by 51–60 years (3.0%), and lowest in those > 60 years (1.7%). Between 2016 and 2020, OUD prevalence increased from 1.9% to 2.8%, followed by a decline to 2.4% in 2022 (p-trend < 0.01). Factors that were linked with higher OUD involved patients with neoplasm-related pain(NRP)(aOR 5.718, 95% CI 5.549-5.893, p < 0.01), on palliative care (aOR 1.397, 95% CI 1.353-1.443, p < 0.001), with metastasis (aOR 1.573, 95% CI 1.526-1.621, p < 0.01), depression (aOR 1.447, 95% CI 1.400-1.495, p < 0.01), bipolar disorder (aOR 2.173, 95% CI 2.038-2.317, p < 0.01), suicidality (aOR 3.228, 95% CI 2.938-3.546, p < 0.01), and anxiety (aOR 1.617, 95% CI 1.572-1.664, p < 0.01). Moreover, substance use such as cocaine (aOR 5.252, 95% CI 4.708-5.859, p < 0.01) and amphetamine (aOR 3.948, 95% CI 3.443-4.527, p < 0.01) was also associated with higher odds, while cannabis users (aOR 0.876, 95% CI 0.793-0.968, p < 0.01) had lower odds of OUD. Our study further found racial disparities, with reduced odds among Blacks ( vs Whites, aOR 0.933, 95% CI 0.901-0.967, p < 0.01) and Hispanics (vs.Whites, aOR 0.866, 95% CI 0.827-0.906, p < 0.01). Socio-economic differences were also noted, with lower odds among those of the 26th-50th (vs. 0-25th, aOR 0.932, 95% CI 0.9-0.966, p < 0.01), 51st-75th (vs. 0-25th, aOR 0.951, 95% CI 0.918-0.986, p < 0.01), and 76th-100th (vs. 0-25th, aOR 0.916, 95% CI 0.882-0.951, p < 0.01) household income quartiles. Conclusions: This study showcases the significant prevalence and impact of OUD among BC patients, identifying socioeconomic and racial disparities, and key risk factors such as NRP, psychiatric comorbidities, and concurrent substance use, like cocaine and amphetamines. Interestingly, cannabis use was associated with a lower risk of OUD, which may reflect its role as an alternative pain management strategy. Overall, this study suggests the need to adopt crucial preventative measures against OUD in patients exhibiting these characteristics.
e18569 Background: Cancer patients, especially those with chronic myeloid leukemia (CML), are susceptible to infections and develop sepsis, which can lead to septic shock and increased mortality. This study aims to identify the predictors of septic shock in BCR-ABL-positive CML patients hospitalized for sepsis. Methods: We conducted a retrospective analysis using the National Inpatient Sample, an extensive database of admission records from the United States. We focused on BCR-ABL-positive CML patients not in remission who were admitted with sepsis from 2016 to 2022. Multivariable logistic regression models were used to identify these patients' factors associated with septic shock. Results: Among 13,540 admissions for septicemia, 3,250 (24%) developed septic shock. The median age of patients with septic shock was 72 years, compared to 71 years in the non-shock group (p<0.01). Both sexes had similar mortality odds (aOR 1.021, 95% CI 0.753-1.385, p=0.894). Factors significantly associated with septic shock included age ≥60 years (aOR 1.278, 95% CI 1.132-1.443, p<0.01), frailty (aOR 1.353, 95% CI 1.212-1.51, p<0.001), malnutrition (aOR 1.354, 95% CI 1.186-1.546, p<0.001), liver cirrhosis (aOR 2.942, 95% CI 2.587-3.345, p<0.001), chronic kidney disease (aOR 1.161, 95% CI 1.059-1.273, p=0.001), and congestive heart failure (aOR 1.574, 95% CI 1.437-1.724, p<0.001). There were no significant sex-based differences (aOR 0.968, 95% CI 0.888-1.054, p=0.452). While Black patients had comparable odds of septic shock to Whites (aOR 1.027, 95% CI 0.902-1.168, p=0.69), Hispanics were less likely to develop septic shock (aOR 0.816, 95% CI 0.697-0.955, p=0.011). No statistical significance was found for other variables, like COPD, obesity, diabetes, metastasis, weekend admissions, or Medicaid/Private insurance status. Septic shock was associated with a more extended hospital stay (7.0 days vs. 5.0 days, p<0.01) and higher hospital charges ($90,661 vs. $50,475, p<0.01). Conclusions: Several factors, including age, frailty, malnutrition, and comorbidities such as liver cirrhosis, chronic kidney disease, and congestive heart failure, were identified as key predictors of septic shock in BCR-ABL-positive CML patients hospitalized for sepsis. These findings have the potential to significantly improve patient outcomes by helping healthcare providers triage and prioritize high-risk patients who develop septic shock.
