Grantham Hospital

Effective advance care planning depends on clinician-patient communication quality. However, ACP-CAT, the only validated observer-rated instrument, remains untested in real-world clinical encounters and non-Western contexts. Validating ACP-CAT in assessing clinician-patient communication quality with advanced cancer and chronic kidney disease in Hong Kong, comparing against patient and family ratings of clinician communication. Cross-sectional study of adult patients with advanced cancer or chronic kidney disease from five hospitals and one hospice service. Two independent raters evaluated audiotaped advance care planning conversations using ACP-CAT, while patients and family members assessed communication quality using the Chinese Quality of Communication Questionnaire (C-QOC). We assessed the psychometric properties, including interrater reliability, convergent and discriminant validity. One hundred and thirty-seven advance care planning conversations involving 84 cancer patients, 53 renal patients, 107 family members, and 20 clinicians. ACP-CAT demonstrated high interrater reliability (mean Gwet's AC1 = 0.81; 88.6% agreement). Convergent validity was demonstrated through significant correlations between ACP-CAT total score and patient-rated C-QOC End-of-life planning subscale (r = 0.29, p < 0.01), family-rated C-QOC summary score (r = 0.27, p < 0.05), and family-rated C-QOC End-of-life planning subscale (r = 0.34, p < 0.01). Discriminant validity was supported by absence of correlations with patients' self-rated health status and information or decision-making preferences (all p > 0.05). Clinicians frequently explored patients' fears and health goals, but rarely discussed nonmedical priorities, valued activities, or surrogate decision makers. ACP-CAT demonstrates strong concurrent validity with patient- and family-rated measures and ecological validity in real clinical settings. These findings support its reliability for assessing advance care planning communication quality across diverse cultural contexts.

BACKGROUNDSilicone oil (SiO) migration to the central nervous system (CNS) is a rare complication of SiO tamponade after vitreo-retinal surgeries, it could masquerade hemorrhage on computed tomography neuro-imaging. Only limited cases were reported in the literature, certain intra-operative and post-operative ocular risk factors might contribute to the different extend of SiO migration in the CNS.AIMTo study the risk factors for cerebral ventricular migration (CVM) on top of visual pathway migration (VPM).METHODSConforming to the preferred reporting items for systematic reviews and meta-analyses guidelines, literature searches on PubMed, MEDLINE, EMBASE were performed on June 1, 2024. Publications on SiO migration to CNS were included in this review. Non-English articles, and studies without neuro-imaging of the CNS were excluded. Patient demographics, SiO filled eyes' ocular characteristics and vitrectomy surgical details were extracted from included studies in this review. VPM and CVM were assigned as group 1 and group 2 respectively. Fisher's exact tests, Mann-Whitney U tests and binary logistic regression were performed.RESULTSTotal 68 articles were obtained after searches, 48 publications were included for analysis. Total 54 SiO filled eyes were analyzed. Post-vitrectomy intraocular pressure (IOP) was found to be significant in both Mann-Whitney U test (P = 0.047) and binary logistic regression (P = 0.012). Diabetic was found to be significant in binary logistic regression (P = 0.037), but at borderline risk for CVM in Fisher's exact test (P = 0.05). Other significant factors include longer SiO tamponade time (P = 0.002 in Fisher's exact test) and visual acuity (P = 0.011 in binary logistic regression). Optic nerve atrophy or disc cupping (P = 1.00, P = 0.790) and congenital optic disc anomalies (P = 0.424) were all with P > 0.05.CONCLUSIONSiO migration to CNS is rare with limited case reports only. Our analysis of the existing literature demonstrated higher post-vitrectomy IOP was associated with CVM, followed by patients’ diabetic status, longer SiO tamponade time and visual acuity. Optic nerve atrophy, disc cupping and congenital optic disc anomalies were not associated. Modifiable risk factors of post-vitrectomy IOP and SiO tamponade time should be closely monitored by vitreo-retinal surgeons. Lower IOP target post-vitrectomy and earlier SiO removal surgeries should be arranged.

Abstract Background For patients with chronic thromboembolic pulmonary hypertension (CTEPH), balloon pulmonary angioplasty (BPA) has been associated with superior reductions in mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) when compared to riociguat. In patients with pulmonary arterial hypertension (PAH), greater clinical improvements were observed after switching from phosphodiesterase-5 inhibitors (PDE5i) to riociguat. However, the impact of transitioning from PDE5i to riociguat on pulmonary haemodynamics and functional outcomes after BPA remains unclear. Methods This prospective, open-label, single-arm, study enrolled CTEPH patients who remained symptomatic following BPA. After a 24-hour PDE5i washout period, patients were switched to riociguat. At week 26, primary outcomes assessed changes in haemodynamics including mPAP and PVR. Secondary endpoints evaluated cardiac index; functional status including WHO functional class, 6-minute walking distance (6MWD), REVEAL Lite 2 score; biochemical markers such as N-terminal prohormone of brain natriuretic peptide (NT-proBNP); and echocardiographic measurements of right-heart function. Treatment-related adverse events and clinical worsening were monitored throughout the study. Results From July 2024 to January 2025, 16 patients (mean age 62.3 ± 14.6 years; 75% female) were recruited, with 14 completing the 26-week follow-up. At week 26, significant reductions occurred in mPAP (-4.79 mmHg; Confidence Interval [CI] -8.05 to -1.52; p = 0.007) and PVR (-2.16 Wood units; CI -3.64 to -0.69; p = 0.007). Significant improvements were also noted in cardiac index, WHO functional class, 6MWD, REVEAL Lite 2 score and NT-proBNP levels. Echocardiographic measurements of right-heart function did not demonstrate significant improvement. Treatment-related adverse events were observed in 11 patients (68.75%). Clinical worsening occurred in four patients, including two deaths unrelated to treatment and two unplanned hospitalisations due to pulmonary hypertension. Conclusion In CTEPH patients after completion of BPA, replacing PDE5i with riociguat significantly enhanced pulmonary haemodynamics and functional capacity but was accompanied by a considerable risk of treatment-related adverse events. Trial registration: ClinicalTrials.gov Identifier NCT06715280 retrospectively registered on 26/11/2024.

A 76-year-old woman with atrial septal defect (ASD) had previously undergone occluder implantation at another institution. At that time, preoperative transesophageal echocardiography revealed an ASD with deficient retro-aortic rim.

The authors describe a novel recrossing technique that facilitates near-simultaneous leaflet laceration and self-expanding valve deployment. Clinical Images from Journal of Invasive Cardiology. self-expanding valve