bluuebunny/crossref_metadata_2025 huggingface dataset:
1213 The Endourological Management of Renal Infundibular Stenosis Secondary to Renal Tuberculosis: A Case Report
Authors: Singal S , Malik S , Ahmad S
Published: August 2024

Renal calyceal dilatation secondary to infundibular stenosis is a rare Urological condition for which management is necessary to treat symptoms and to prevent the formation of complications.

We present a case report which describes the presentation and investigation of a case of urinary TB which gave rise to infundibular stenosis and subsequent calyceal dilatation and flank pain in a 22-year-old lady.

Management of this condition is poorly described in the literature, in part due to its rarity. We extensively describe a novel endourological surgical procedure whereby dilation of the infundibular stenosis was achieved under direct vision using guidewires, Holmium laser and a flexible ureteroscope.

Under direct vision with a flexible ureteroscope, a sensor guidewire was used to create a punctum within the stenosed infundibulum and to passively dilate this. A 200-micron Holmium laser fibre was then used to extend this punctum creating an infundibulotomy. The sensor guidewire was repositioned to pass into the obstructed calyx which allowed for the flexible ureteroscope to be railroaded over the second guidewire into the right upper pole calyx, further passively dilatating the infundibulum. Finally, a 6Fr 26cm ureteric stent was passed into the right upper pole calyx.

The surgical management of this rare condition is poorly described in the literature. Our novel surgical technique is readily possible in most endourological units and will lead to an excellent clinical outcome.
1248 Novel Omentoplasty Technique in Salvage Robotic Prostatectomy Enhances Urinary Continence and Recovery
Authors: Asif A , Nathan A , Dhanoya G , Narain T A , Nathan S
Published: August 2024

Aim

We investigated an innovative surgical technique — omentoplasty at the bladder neck — used in salvage robotic prostatectomy for patients who have previously undergone radiotherapy. We hypothesise that this approach potentially decreases the incidence of anastomotic leaks, thereby reducing the duration of post-operative catheterisation and possibly enhancing early urinary continence outcomes.

Method

Between 2014 and 2023, consecutive patients who underwent salvage robotic prostatectomy (sRARP) following primary radiation treatment for prostate cancer were included. The ten most recent cases involved performing omentoplasty. Peri- and post-operative outcomes were prospectively collected on these cases. The primary outcome was duration of catheter dwell time.

Results

Out of 54 patients, 44 underwent standard sRARP, and 10 received omentoplasty sRARP. The average age was comparable between groups. The operative times were similar, with the omentoplasty group showing a slightly shorter duration. The omentoplasty group exhibited no post-operative complications and experienced a significant reduced catheterisation period (time to TWOC) (19.3 days vs. 63.61 days). Additionally, they had lower rates of anastomotic leaks and used fewer incontinence pads at three months.

Conclusions

Implementing omentoplasty around the vesicourethral anastomosis seems to facilitate improved healing at the bladder neck following salvage robotic prostatectomy after radiation therapy. It not only shortens the necessary duration for post-operative catheterisation but also contributes to better early continence recovery. Even with the addition of the omentoplasty procedure, the overall operative time and hospital stay duration remained comparable to standard sRARP. Given this, we advocate considering this novel technique for patients undergoing salvage robotic prostatectomy post-radiation therapy.
595 Dilemma in the Management of Saccular Aortic Aneurysms
Authors: Pradip G , Gambhir R , Miller F
Published: August 2024

Saccular aortic aneurysms (SAAs), characterized by spherical protrusions along a segment of the aortic circumference, lack well-defined management guidelines compared to fusiform aneurysms. Despite geometric indications of higher stress forces and rupture predisposition, real-world experiences differ. ESVS guidelines suggest earlier treatment for SAAs, but with a IIb C recommendation and limited evidence. This study aims to analyse SAAs between 2012-2022.

All CT scan reports between 2012 to 2022 from a radiology database at a teaching were interrogated for the word “Saccular aneurysm”. The electronic patient records of these patients were then retrieved. Clinical and radiological findings were documented and analysed. Aneurysm growth rate was documented from the follow-up scans.

Fifty-six patients (male: female ratio 3:1, mean age 78) were identified. Locations included ascending aorta (11%), aortic arch (8%), descending thoracic aorta (17%), and abdominal aorta (56%). Associated aneurysmal diseases were prevalent (77%), with thoracic aortic aneurysms (TAA) in 25% and abdominal aortic aneurysms (AAA) in 73%. SAA sizes ranged from 0.6 to 4.9 cm. During follow-up, 12 patients died (none from SAA rupture). Among 42 patients with follow-up scans, the average annual SAA growth rate was 1.26 cm, TAA was 0.61 cm, and AAA was 1.23 cm.

Our small study did not find any faster growth rate of saccular aneurysm compared to the other co-existing fusiform aneurysms. Most incidental saccular aneuryms remained asymptomatic and relatively benign on follow up scans. Annual radiologic follow-up should be done for all but treatment should be offered after multidisciplinary discussion, on a case to case basis.
743 Validation of the Global Limb Anatomic Staging System in Chronic Limb Threatening Ischaemia Using the Bypass Versus Angioplasty in Severe Ischaemia of the Leg Prospective Cohort Study
Authors: Bello S , Meecham L , Kelly L , Bate G , Davies H , Bradbury A , Popplewell M
Published: August 2024

Aim

To evaluate the application of an angiographic tool (Global Limb Anatomic Staging System - GLASS) designed to predict immediate treatment failure (ITF) and other clinical outcomes in patients undergoing revascularisation for chronic limb threatening ischaemia (CLTI) using a large prospective registry.

Method

The Bypass versus Angioplasty in Severe Ischaemia of the Leg Prospective Cohort Study (BASIL-PCS) collated data regarding 152 patients with CLTI who presented to a large academic vascular unit and underwent infrainguinal endovascular treatment (EVT). Each patient was given a GLASS score based on review of appropriate imaging by blinded, trained assessors. The relationship of GLASS with the following clinical outcomes was assessed; immediate technical failure (ITF), amputation free survival (AFS), major adverse limb event (MALE), limb salvage (LS), and overall survival (OS).

Results

A higher technical failure rate was associated with increasing GLASS stage in those undergoing endovascular treatment (EVT), ITF rate for GLASS I, II and III were 1/21 (4.8%), 4/35 (11.4%) and 17/76 (22.4%) respectively. There was no significant relationship between GLASS and other clinical outcomes (AFS, MALE, LS, and OS).

Conclusions

In our cohort ITF was correlated with increasing GLASS stage which is in line with the assumptions of the Global Vascular Guidelines (GVG). However, GLASS did not predict other longer term clinical outcomes and requires further evaluation in a larger cohort.
755 Comparative Safety and Efficacy of Local vs General Anaesthesia in Patients Undergoing Radiofrequency Ablation of Truncal Varicose Vein with Multiple Avulsions
Authors: Jaques A , Haidar O , Guest M , Metcalfe M , Selvakumar S , Sadat U , Shaikh F
Published: August 2024

Aim

Local anaesthesia (LA) and general anaesthesia (GA) are both commonly employed in patients undergoing Radiofrequency Ablation (RFA) treatment for varicose veins. There is a current gap in the literature comparing the two methods with respect to patient safety and operative time efficiency. Assessment is vital in optimising patient outcomes, accurate risk counselling and planning service provision. We aim to compare the safety and efficiency of LA versus GA in patients undergoing RFA with multiple avulsions (MA).

Method

Between July 2022 and October 2023, 85 patients (43 males, mean age 58 years) who underwent radiofrequency ablation of truncal veins with multiple avulsions under general anaesthesia or local anaesthesia were retrospectively analysed.

Results

Of the 85 patients, 39 were LA and 46 were GA. Combined anaesthetic and operative time was significantly shorter in the LA cohort. Local anaesthetic procedures were associated with shorter time from anaesthetic room to operation start time (11.97 +/- 10.2) 29.26 +/- 10.9 mins [p<0.001]) and shorter procedures (57.85 vs 70.67 mins [p<0.05]). There was no significance increase in postoperative venous thromboembolism and or emergency attendance within 30 days between the two groups. Findings were consistent when controlling for age, sex, ASA grade, anaesthetic type, and disease severity (as per CEAP scoring).

Conclusions

Performance of RFA with multiple avulsions in the treatment of varicose veins under local rather than general anaesthesia increases time efficiency of operative services without compromising on patient safety. Vascular surgeons should utilise local anaesthetic, where possible, to manage the long waiting lists patients with superficial venous incompetence.
1051 Audit of Statin Optimisation in Peripheral Arterial Disease and Abdominal Aortic Aneurysmal Disease
Authors: Chowdhury T , Christoforou S , Harland G , Ali S , Nair H
Published: August 2024

Aim

High-intensity statins are clinically an effective option for secondary prevention of cardiovascular disease and shown to improve patient outcomes, particularly in patients with peripheral arterial disease (PAD) or abdominal aortic aneurysms (AAA). NICE guidelines state Atorvastatin 80mg as the most cost-effective choice. This guideline provides a clear standard for all patients, which is auditable.

Method

A prospective study of 314 inpatients under vascular surgery of which 124 were part of the initial data collection. Following an educational intervention, 190 were collected in the second round. Exclusion criteria were applied to both cycles and a total of 52 and 67 patients remained respectively. Those that were switched to Atorvastatin 80mg on discharge were deemed to have been successfully optimised.

Results

Patients who were suitable for optimisation were compared to those who were discharged on Atorvastatin 80mg showing that 15 out of 52 patients were optimised in the first round and 43 out of 67 patients in the second round. Overall, the percentage optimised increased from 29% to 64% between the two cycles of data collection demonstrating a 2.2-fold increase in the percentage optimised.

Conclusions

Educational awareness between MDT members has successfully increased statin optimisation amongst PAD and AAA patients. This audit is applicable to most vascular comorbid patients and vital in preventative efforts to reduce the risk of future adverse limb or cardiovascular events, improving overall survival benefit.
1239 Morbidity and Mortality Following Salvage of Acute Limb Ischaemia
Authors: Rao M , Chand C , Ali R , Tang S , Wallace T
Published: August 2024

Aim

Beyond short-term technical results, the wider clinical impact of Acute Limb Ischaemia (ALI) is not well described in the literature. This study aims to establish the outcomes following surgical thromboembolectomy for ALI, with specific reference to amputation-free survival and 12-month survival.

Method

A retrospective review of all patients who underwent surgical thromboembolectomy, 01/01/2019 – 01/01/2022. Patients were identified from our unit database and their EPR interrogated with a follow-up period of 12 months. Patients with known established peripheral arterial disease, or cases of acute-on-chronic ischaemia were excluded.

Results

81 patients met the inclusion criteria (38 male vs 43 female). The median age was 78 (IQR 53-85), with a median clinical frailty score of 4 (IQR 3-5). Patients were grouped according to their presenting symptoms using the Rutherford classification for ALI, and 57% were presenting with immediately threatened limb (Class IIb). Successful revascularisation was established in 74 patients; 5 of these still progressed to major limb amputation (MLA), while 4 of 7 failed revascularisations resulted in MLA. Overall, 12-month amputation-free survival was achieved in 72 patients. 30-day MACE (including pulmonary embolism) occurred in 11 cases and 30-day mortality was seen in 7 cases. All-cause mortality was seen in 24 of 81 patients at 12 months.

Conclusions

Acute limb ischaemia carries significant morbidity and mortality despite surgical success for many. A greater understanding of longer-term outcomes should aid patient counselling.
Extent of Equivalence of Results for Urine Albumin among 3 Candidate Mass Spectrometry Reference Measurement Procedures
Authors: Miller W Greg , Bachmann Lorin M , Budd Jeffrey , Beasley-Green Ashley , Phinney Karen W , Tan Hwee Tong , Teo Tang Lin , Liu Qinde , Shiba Seiei , Seegmiller Jesse
Published: August 2024

Background

Urine albumin (UA) is an important biomarker of chronic kidney disease. Current in vitro diagnostic medical devices (IVD-MDs) for measuring UA are not standardized, and median results among IVD-MDs differ by approximately 45%. Since fixed decision values are used to interpret UA, higher-order reference measurement procedures (RMPs) are needed for metrological traceability. Three candidate liquid chromatography-tandem mass spectrometry RMPs have been developed for UA.

Methods

Eight single-donation human urine samples were measured by 3 candidate RMPs. Results were compared using t-test and variance component analysis.

Results

The mean results for each urine sample from each RMP laboratory were not statistically different from the overall mean value by t-test. The median total CV including contributions from bias and imprecision among the 3 RMP laboratories was 6.23% using variance component analysis for each sample. The allowable bias to the RMP for an end-user IVD-MD was ≦9.0% or ≦3.0% based on the desirable or optimal total allowable error of 30% or 24%, respectively. A maximum allowable standard uncertainty for an RMP result was determined to be 4.3% or 3.3% for desirable or optimal performance, respectively. The standard uncertainties for all of the RMP laboratories meet the desirable and optimal standard uncertainty specifications.

Conclusion

The candidate RMPs for UA in these 3 laboratories have suitable agreement of results and uncertainties for use as higher-order RMPs in the metrological traceability of end-user IVD-MDs for measuring UA.
Comparison of 2 Free Light Chain Assays: Performance of the Free Light Chain Ratio as a Risk Factor for MGUS Progression
Authors: Wang Qian , Andress Benjamin D , Pazdernik Vanessa M K , Larson Dirk R , Coker Jonathan D , Dasari Surendra , Rajkumar Vincent , Dispenzieri Angela , Murray David L , Willrich Maria Alice V
Published: August 2024

Background

New immunoglobulin free light chain (FLC) assays are available. Despite analytical differences, it seems possible to use free light chain ratios (FLCr) generated by different assays and apply similar cut-points for the diagnosis of multiple myeloma. It is still unknown if we can use different assays for risk stratification of patients with monoclonal gammopathy of undetermined significance (MGUS).

Methods

Patients diagnosed with MGUS (N = 923) had FLC tested using a nephelometric FreeLite (Binding Site) assay on BNII instruments (Siemens) and a Sebia FLC assay (Sebia) on a DS2 ELISA analyzer (Dynex). Patients were followed up for progression to any plasma cell dyscrasia (PCD) for several decades. The Mayo MGUS risk stratification model for progression was assessed with both assays (M-spike >1.5 g/dL; non-IgG isotype and abnormal FLCr), using package insert reference intervals (RI) and a new metric called principal component 2 (PC2).

Results

There were 94 events of progression to PCD in the cohort during a median of 38 years of follow-up. Freelite and Sebia FLC showed similar hazard ratios in the risk models for elevated FLCr. An alternative clinical decision point lower than the package insert RI was evaluated for the Sebia assay, which improved risk stratification for patients with a low FLCr. The PC2 metric showed similar performance to the FLCr in models, without superior benefit.

Conclusions

The Sebia ELISA-based FLC assay can be employed in an MGUS risk stratification model with similar performance to the original 2005 risk stratification model using the FreeLite assay.
Nested Randomized Controlled Trials in Large Databases: An Opportunity for Inflammatory Bowel Disease?
Authors: Temido Maria Jose , Honap Sailish , Danese Silvio , Jairath Vipul , Magro Fernando , Portela Francisco , Peyrin-Biroulet Laurent
Published: August 2024

Introduction

Although randomized controlled trials (RCTs) are the gold standard for investigating the efficacy and safety of interventions, they present major operational challenges due to their complexity, time-consuming nature, and costs. To address some of these difficulties, RCTs nested in cohorts (RCTsNC) have been developed. The aim was to review the opportunities and challenges of RCTsNC in inflammatory bowel disease (IBD).

Methods

A literature search was conducted using MEDLINE, Embase, Cochrane and Clinicaltrials.gov from inception until March 2024 to identify studies focusing on this topic.

Results

RCTsNC is an emerging trial design, which has been successfully utilized across several medical disciplines but not IBD. It enables the use of longer-term longitudinal data for safety and efficacy assessment, and enhanced recruitment and follow up processes. Observational data for IBD, derived from research (cohort and case-control studies) and non-research sources (electronic health records and registries), provides access to comprehensive records for a large number of IBD patients, which could present an opportunity to enhance the performance of RCTsNC. Leveraging pre-existing cohorts and their organizational structures improves patient acceptance and is more economical compared to traditional randomized trials. It may permit researchers to address knowledge gaps in IBD (specific sub-populations, or the effect of environmental exposures on disease course). Limitations of RCTsNC include the risk of selection bias and constraints related to comparisons with placebo.

Conclusion

RCTsNC offers a promising opportunity for IBD research and provides an alternative study design given the challenges of conventional trial designs in the current IBD RCT landscape.
Genetic characterization of candidate ecdysteroid kinases in Drosophila melanogaster
Authors: Scanlan Jack L , Robin Charles
Published: August 2024

Ecdysteroids are major hormones in insects and control molting, growth, reproduction, physiology, and behavior. The biosynthesis of ecdysteroids such as 20-hydroxyecdysone (20E) from dietary sterols is well characterized, but ecdysteroid catabolism is poorly understood. Ecdysteroid kinases (EcKs) mediate the reversible phosphorylation of ecdysteroids, which has been implicated in ecdysteroid recycling during embryogenesis and reproduction in various insects. However, to date, only 2 EcK-encoding genes have been identified, in the silkworm Bombyx mori and the mosquito Anopheles gambiae. Previously, we identified 2 ecdysteroid kinase-like (EcKL) genes—Wallflower (Wall) and Pinkman (pkm)—in the model fruit fly Drosophila melanogaster that are orthologs of the ecdysteroid 22-kinase gene BmEc22K. Here, using gene knockdown, knockout, and misexpression, we explore Wall and pkm's possible functions and genetically test the hypothesis that they encode EcKs. Wall and pkm null mutants are viable and fertile, suggesting that they are not essential for development or reproduction, whereas phenotypes arising from RNAi and somatic CRISPR appear to derive from off-target effects or other artifacts. However, misexpression of Wall results in dramatic phenotypes, including developmental arrest, and defects in trachea, cuticle, and pigmentation. Wall misexpression fails to phenocopy irreversible ecdysteroid catabolism through misexpression of Cyp18a1, suggesting that Wall does not directly inactivate 20E. Additionally, Wall misexpression phenotypes are not attenuated in Cyp18a1 mutants, strongly suggesting that Wall is not an ecdysteroid 26-kinase. We hypothesize that the substrate of Wall in this misexpression experiment and possibly generally is an unknown, atypical ecdysteroid that plays essential roles in Drosophila development, and may highlight aspects of insect endocrinology that are as-yet uncharacterized. We also provide preliminary evidence that CG5644 encodes an ecdysteroid 22-kinase conserved across Diptera.
Combined Advanced Targeted Therapy in Inflammatory Bowel Diseases: An Extensive Update
Authors: Cornet Nicole , Aboubakr Aiya , Ahmed Waseem , Battat Robert
Published: August 2024

Lay Summary

This article discusses the rationale for and the current data on the efficacy and safety of combined advanced targeted therapy (CATT) for the treatment of moderate-to-severe inflammatory bowel disease.
A Jurisdictional Vertigo: Compulsory Arbitration, Sports and the European Court of Human Rights
Authors: Shahlaei Faraz
Published: August 2024

This article discusses jurisdictional issues when cases related to arbitral awards of the Court of Arbitration for Sport end up before the European Court of Human Rights (ECtHR). By focusing on the ECtHR’s Third Chamber judgment in the Semenya case, it discusses how the unique governance structure of sports governing bodies, as the benchmark for such disputes, has distorted the traditional jurisdictional paradigms of the ECtHR, posing challenges for the Court in addressing potential human rights violations in the realm of sports. This article argues that human rights claims arising from sports activities form a new class of human rights litigation stemming from the activities of private actors with a strong public character. Such dynamics grant the ECtHR a central role as the ultimate arbiter in protecting human rights within the realm of sports and require it to subject the sports proceedings to a comprehensive review both on procedural and substantive grounds, even with relation to athletes residing outside the territory of Council of Europe member States.
Gallstone in the gastric remnant after bariatric surgery
Authors: da Cunha Sofia Teixeira , Vergos Georgios , Pfefferkorn Urs
Published: August 2024

In the last decades, bariatric surgery has been widely performed to treat obesity and its co-morbidities, with the laparoscopic Roux-en-Y gastric bypass (LRYGB) being the second most commonly performed procedure. Abdominal pain after LRYGB is a common symptom. This report concerns a case of a rare cause of chronic abdominal pain after LRYGB and cholecystectomy in a 48-year-old woman due to a cholesterol stone within the gastric remnant that was removed via open gastrectomy. This is the first documented case of cholesterol stone formation in the gastric remnant and underscores the importance of vigilance for atypical complications in patients undergoing bariatric procedures.
Type I choledochal cyst. Total laparoscopic resection and Roux-en-Y reconstruction to two separated ducts
Authors: Reyes Natalia , Sotomayor Camila , Inzunza Martín , Briceño Eduardo , Viñuela Eduardo , Martínez Jorge , Jarufe Nicolás
Published: August 2024

A choledochal cyst is a rare condition that requires surgical treatment to prevent complications, such as obstructive jaundice, cyst rupture, cholangitis, and the risk of malignancy. Complete cyst excision is considered the best option, as it reduces the risk of inflammation and the development of cholangiocarcinoma. Therefore, cholecystectomy and complete cyst resection followed by reconstruction with a Roux-en-Y hepaticojejunostomy is the treatment of choice. We present a case (with video) that shows the complete resection of a type I choledochal cyst with Roux-en-Y reconstruction of two separate ducts since the right posterior duct reached the cyst independently. The laparoscopic approach offers all the advantages of mini-invasive surgery and better visualization of the structures; however, biliary reconstruction to fine ducts implies a surgical challenge that requires high training in mini-invasive surgery.
Nursing Ethics as an Independent Subfield of Healthcare Ethics
Authors: Vogelstein Eric
Published: August 2024

This chapter explores the question of whether there is a unique field of nursing ethics that is important to separate from the ethics of the other healthcare professions, and if so, what the nature and ground of such a field would be. It is argued that norms intrinsic to the practice of nursing probably do not ground a unique set of ethical norms for the profession, while contingent yet institutionally embedded factors related to power structures, as well as the prevalence and type of interactions nurses typically have with patients (compared with other healthcare professionals), do generate unique ethical problems and obligations for nurses. Thus, it is those aspects of modern nursing practice that form the basis for a robust and important field of nursing ethics.
The Relevance of Feminist Ethics for Moral Communities in Healthcare Work
Authors: Liaschenko Joan , Peter Elizabeth
Published: August 2024

This chapter examines the concept of moral community, arguing that the characteristics of a moral community can be well articulated using the theoretical representation of morality in feminist ethics. The authors reflect on the history of the concept in nursing and medicine that draws attention to the importance of relationships in delivering care in increasingly complex environments that function best when people are accountable to each other in fulfilling their responsibilities. Next, they examine empirical studies that demonstrate the role of moral communities in preventing and diminishing the moral concerns of nurses by fostering positive identities, repairing damaged identities, and supporting moral agency. Particular attention to the feminist concept of situated knowing is explored to add understanding to how the perspectives of people are variously respected in a moral community. Ultimately, moral communicative work and institutional and structural support are essential in building and sustaining moral communities.
Moral Expertise and Epistemic Peerhood
Authors: Watson Jamie Carlin
Published: August 2024

Nurses face increasing pressure to contribute to complex moral decisions. This contribution requires robust competence in ethical judgment. And while this need for ethical competence is explicit, how one acquires that competence is often vague, and nursing education does not always prepare nurses to cultivate skill in moral decision-making. In this chapter, the author introduces concepts from expertise studies and contemporary debates over moral expertise to discuss how nurses might enhance these skills, whether they are new graduates or seasoned veterans. And while leaving it an open question whether anyone can acquire robust moral expertise, the author summarizes recent empirical work that suggests not only that nurses can enhance their moral judgment, but also highlights concrete strategies for improving ethics education in nursing, both formal curricular instruction and continuing professional development, from the bedside to roles in institutional leadership.
Revisiting Moral Agency
Authors: Bartlett Jennifer L. , Taylor Carol
Published: August 2024

Moral agency requires moral character, the formation of values and identification of motivation, moral sensibility and responsiveness, ethical reasoning and discernment, moral accountability, and the gumption to enact change through transformative moral leadership. The development of moral agency in nursing parallels professional development in other healthcare professions. Nurses must possess moral agency as individuals caring for patients, families, and communities, but they cannot ignore the agency required of nurses in system, institution, sociopolitical, and global environments. This chapter considers moral agency in several situations designed to highlight the role of the nurse as an essential part of the healthcare system. Moral agency remains embedded in the fabric of nursing—the authors of this chapter seek to articulate its application.
The Ethical Rationale for Comprehensive Neonatal Intensive Care Unit Follow-Up
Authors: Carter Angel C. , Carter Brian S.
Published: August 2024

In this chapter, the authors (a neonatology physician and ethicist and a neonatal nurse practitioner, who both work in the Neonatal Intensive Care Unit [NICU] Follow-Up Clinic) look at how best to conduct follow-up care for high-risk NICU graduates from Level III and IV NICUs. The common goals for neonatal follow-up include clinical assessments of feeding and physical growth; attainment of developmental milestones; monitoring neurocognitive, neuromotor, and special sensory functioning (vision, hearing, speech, and language) throughout the infant-toddler period and enlisting necessary special services such as physical, occupational, and/or speech therapies to optimize the baby’s outcome. Such service provision brings with it the need to attend to ethical issues such as: addressing care coordination improvement; dealing with community-based pediatric-specific resource capacity; addressing the social determinants of health; and using follow-up data to inform perinatal-neonatal counseling and the development of NICU best practices.
How Confucian Values Shape the Moral Boundaries of Family Caregiving
Authors: Chan Helen Yue-lai , Kim Richard , Leung Doris Yin-ping , Cheng Ho-yu , Chong Connie Yuen-yu , Chien Wai-tong
Published: August 2024

The moral values within the modern healthcare system are primarily shaped by a number of Western moral frameworks, such as consequentialism and Kantianism, that aspire for universal applicability, cutting across culture and time. However, human morality, like human beings, is significantly shaped by the norms, roles, and responsibilities that are constitutive of one’s particular culture and society. In East Asia, where Confucian values have been deeply institutionalized in the culture, filial piety (xiao) remains the core value prescribing how children should demonstrate reciprocal care to their parents and older relatives. Other values and virtues, including guilt, shame (chi), benevolence (ren), and ritual propriety (li), also constitute the ethics of family caregiving and impact a range of important issues such as truth-telling and end-of-life care. Given that concepts such as individuality and autonomy are not prioritized in East Asian cultures, substantial power is given to the family of individuals regarding many critical healthcare decisions. How exactly, if at all, these Confucian values can be applied to the contemporary healthcare setting is not clear, and the divergent ways that people understand these values from both a traditional and contemporary point of view raise further challenges. This chapter examines how the historical and contemporary interpretations of Confucian values shape family caregiving and discusses a number of ethical issues that emerge when these values are applied to contemporary healthcare situations.
Constructing Avenues for Agency
Authors: Guidry-Grimes Laura K.
Published: August 2024

The aim of this chapter is to elucidate how persons with disabilities can be rendered vulnerable in various clinical contexts, which has implications for how nurses should identify and address different types of barriers for patients in their care. The chapter begins by surveying the conceptual territory surrounding the term “disability,” since how this term is conceptualized will make a difference for framing the nature of vulnerabilities as they arise. Next, the chapter examines how institutional environments (such as hospitals and nursing homes) can limit opportunities for agency, and this discussion will include the challenges faced by persons with physical, intellectual, and psychiatric disabilities. This chapter emphasizes how nurses, nurse assistants, and healthcare facilities should proactively mitigate vulnerabilities for disabled people and enable different forms of agency.
Teaching With Pictures
Authors: Wilkenfeld Daniel A. , Johnson Christa M.
Published: August 2024

Nursing ethics educators (and educators more generally) frequently find value in presenting and discussing with students tragic historical events in clinical practice or medical research. In this chapter, the authors argue that the use of images of victims in these cases is ethically problematic. Specifically, they argue that it is not acceptable in a classroom setting to use identifiable photographs of people in a heightened vulnerable state without at least their implied consent, even for otherwise laudable goals. While there is undoubtedly consequentialist value in utilizing such tools, the authors ultimately argue that doing so violates deontological constraints (e.g., with regard to autonomy and respect for persons). If one grants (as is largely assumed) that ends do not typically justify means, this provides grounds for revising current practice.
Effects of Indomethacin in Premature Infants With Patent Ductus Arteriosus
Authors: Mitra Souvik
Published: August 2024

Indomethacin is a nonselective cyclooxygenase inhibitor indicated for treatment of patent ductus arteriosus (PDA) in preterm infants. This multicenter randomized controlled trial (RCT) explored the efficacy of 2 strategies of indomethacin therapy in preterm infants with a symptomatic PDA, as part of initial therapy or following a trial of conservative medical management. Infants who received indomethacin as an initial therapy had a significantly higher primary PDA closure rate compared with conservative management alone (79% vs 35%; p <0.001). When indomethacin was used as a backup therapy for infants who failed to respond to conservative medical management, 27% ultimately underwent PDA ligation (as compared with 21% of infants originally treated with indomethacin). There were no statistically significant differences noted for mortality, BPD, IVH, or NEC between any of the groups.
Pressure-Regulated Volume Control Ventilation vs Synchronized Intermittent Mandatory Ventilation for Very Low Birth Weight Infants
Authors: Jensen Erik A.
Published: August 2024

At the time of this trial, the risks and benefits of synchronized volume-control versus pressure-guarantee mechanical ventilation in preterm infants were uncertain. D’Angio et al. randomized 212 ventilated infants with birth weights of 500 to 1249 g to receive synchronized pressure-regulated volume control (PRVC) ventilation or pressure-limited synchronized intermittent mandatory ventilation (SIMV) beginning within 6 hours after birth. No differences were observed between PRVC and SIMV in the primary outcome of proportion of infants alive and extubated at 14 days (36.5% versus 40.7%), the length of mechanical ventilation in survivors (median 33 versus 24 days), or survival without bronchopulmonary dysplasia (63.5% versus 57.1%).
Palivizumab, a Humanized Respiratory Syncytial Virus Monoclonal Antibody, Reduces Hospitalization From Respiratory Syncytial Virus Infection in High-Risk Infants
Authors: King Brian Christopher
Published: August 2024

Respiratory syncytial virus (RSV) is a leading cause of respiratory illness in high-risk infants. The IMpact-RSV trial investigated whether prophylactic monthly injections of a monoclonal antibody targeting RSV, palivizumab, would safely reduce hospitalizations due to RSV. One thousand five hundred and two formerly preterm infants were randomized in a 2:1 ratio to palivizumab or a placebo in a double-blind approach during a single RSV season. Monthly palivizumab injections resulted in a 55% reduction in RSV-related hospitalizations (4.8% versus 10.6%; 95% confidence interval [CI] 0.38 to 0.72, p <0.001). There were also significant reductions in hospital days (36.4 versus 62.6; p <0.001) and days with supplemental oxygen (30.3 versus 50.6; p <0.001) for the palivizumab group, without significant adverse events.
Multicenter Trial of Cryotherapy for Retinopathy of Prematurity
Authors: Hagadorn James I.
Published: August 2024

Although use of cryotherapy for severe retinopathy of prematurity (ROP) was gaining acceptance in some countries, controlled trials defining its safety and efficacy were lacking. The CRYO-ROP trial randomized individual eyes of babies with severe ROP to cryotherapy or observation and followed structural and visual outcomes. Cryotherapy entailed transscleral cryotherapy of the avascular retina. At interim analysis, structural outcome was better at 3 months following treatment in eyes undergoing cryotherapy, as compared with untreated eyes (21.8% versus 43%; χ2 20.5, p <0.0001), prompting early halt of randomization. The most common complications during the procedure were hemorrhage (retinal, preretinal, or vitreous; 19.1%), conjunctival or subconjunctival hematoma (10.2%), and bradycardia or other arrhythmia (8.9%).
Newborn-Care Training and Perinatal Mortality in Developing Countries
Authors: Ehret Danielle E. Y.
Published: August 2024

Most neonatal deaths and stillbirths occur in low-resourced settings. This study assessed the effectiveness of 2 newborn-care training programs implemented in phases. First, instructors trained birth attendants from rural communities in 6 low- and middle-income countries in the World Health Organization Essential Newborn Care (ENC) course (before-and-after design; n = 57,643). Next, investigators conducted a cluster-randomized, controlled trial of a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (NRP) compared with no further training (n = 62,366). Following ENC training, there was no significant reduction in the primary outcome of early neonatal mortality (RR 0.99, 95% CI 0.81 to 1.22). Regarding secondary outcomes, perinatal mortality was unchanged (RR 0.85, 95% CI 0.70 to 1.02); although there was a significant reduction in stillbirth rate (RR 0.69, 95% CI 0.54 to 0.88, p <0.01). Following NRP training, there was no reduction in early neonatal mortality, stillbirth, or perinatal mortality.
Stress and Burnout in Healthcare
Authors: Heinz Eric R. , Nguyen Hieu T.
Published: August 2024

Burnout is classically considered a multifaceted syndrome that can affect any individual in the workplace setting. It can occur in any workplace environment, but, in the past several years, its prevalence in the healthcare industry has gained more attention. Burnout has been defined as consisting of emotional exhaustion, depersonalization, and low personal accomplishment. Up to 40% of physicians have reported burnout. Risk factors that contribute to physician burnout include female gender, young age, long working hours, low job satisfaction, and presence of a work–home conflict. Physical activity, mindfulness, and institutional wellness programs that include cognitive behavioral therapy and stress management may reduce the prevalence of burnout in healthcare workers.
Diversity and Equity in the Workplace
Authors: Clarke Callisia N.
Published: August 2024

Creating and maintaining a diverse physician workforce is vital to eliminating healthcare disparities and improve health equity for all. Despite formal efforts to increase the pipeline of physicians coming from backgrounds underrepresented in medicine, adequate representation for these groups continues to lag. Disparities in recruitment, retention, promotion, and leadership advancement contribute to discriminatory policies and practices that hinder professional growth and personal job satisfaction, leading to high rates of attrition. Attempts to improve diversity in the physician workforce must start with an inclusive environment where effective recruitment practices and retention efforts align with departmental and institutional goals. Leaders must commit to creating an atmosphere of equity, inclusivity, tolerance, and empowerment and apply significant financial and structural support to achieve and maintain this. Specific areas to address include reducing barriers to leadership and promotion for minority groups, minimizing the objective effects of implicit bias, preventing social and academic isolation, and following fair and transparent guidelines for promotion and compensation.
One-Minute Preceptor
Authors: Timme Kathleen , Good Brian
Published: August 2024

As learners progress from early health professions education to the clinical learning environment, there is a need for high-quality instruction from their clinical preceptors to foster the application of knowledge to patient care. The busy clinical environment poses challenges to both learners and educators because of time constraints to meet both the learner’s and patient’s needs. The One-Minute Preceptor is an easily learned clinical teaching tool that features five microskills initiated by the educator: getting a commitment from the learner, probing for supporting evidence, teaching a general rule, reinforcing what was done right, and correcting mistakes. This model has been well-studied. It effectively and efficiently imparts high-quality education to the learner without compromising patient care. It is a preferred modality by learners and preceptors alike. Although the original intent was for use in the ambulatory care setting while working with a learner one-on-one, it can be adapted in a variety of settings. Several factors can facilitate the model’s success, including educator adaptability and focusing on the principles of effective feedback.
How to Design an Engaging Workshop
Authors: Nyquist Julie G. , Cohen Ira Todd
Published: August 2024

This chapter focuses on developing workshops that are impactful, engaging, and scholarly. To be impactful a workshop must meet a need for the participants. To be engaging the workshop must be interactive. In addition, to submit a workshop for presentation at a professional meeting or to be able to award continuing medical education (CME) units, it must be scholarly. This requires a rationale, a formal plan, learner outcome objectives, and interactive methods that must meet the requirements of the professional association or organization awarding the CME units. This chapters walk the reader through development of a workshop plan using. a Five-Step Workshop Planning Worksheet.
Telehealth in the 21st Century
Authors: Guzman Cirila Estela Vasquez , Ellenby Miles S. , Cheng Anthony
Published: August 2024

Telehealth is an essential tool to ensure that patients can safely access the healthcare services they need when they need them. The telehealth landscape rapidly evolved as a result of the COVID-19 pandemic. The nation has adopted telehealth rapidly as a result of COVID-19, requiring careful and ongoing reflection in order to transform—rather than build on—the current healthcare system to better meet not only patients’ needs but also gives providers the ability to provide holistic contextual care to all patients. Discussions centered on the digital divide have shifted to not only concerns about adoption, but also to implementation. This chapter presents two cases that explore nuances of telehealth services. The first case study introduces the possibilities of telehealth with an example of remote assessment of an acute complaint through a video visit, touching on medico-legal considerations of care across state lines and the benefits of continuity of care. The second case study explores some risks introduced by telehealth, such as the digital divide and structural determinants of health, providing care in the absence of vital signs, interprofessional care, and design justice. Through these two in-depth case studies, topics around implementation, stakeholders, policy, and equity are addressed.
REM Sleep Behavior Disorder
Authors: Diederich Nico J. , Arnulf Isabelle
Published: August 2024

Rapid eye movement (REM) sleep behavior disorder (RBD) is an abnormal behavior of the REM sleep, characterized by loss of muscle atonia and various motor behaviors with concordant dream content. This “acting out of dreams” is frequently violent, but soft movements, reminiscent of daily life activities, may also occur. RBD is seen in synucleinopathies, even as a harbinger syndrome. Animal models based on pontine lesions or on pharmacological induction of RBD replicate aggressive/defeating movements. The dysfunctional locus subcoeruleus is responsible for the loss of muscle atonia. Interaction with brainstem nuclei such as the pedunculopontine nucleus and the superior colliculi may contribute to the syndrome. These nuclei are evolutionarily old, often staying behind the exponential telencephalization. Their dysfunction is evidenced by neuropathology and neuroimaging studies. Nuclear dysfunction may also induce disinhibition of central pattern generators, responsible for automatized basic behaviors. The threat simulation theory suggests that, similarly to evolutionarily purposeful mental rehearsal of threatening life events during REM sleep, there may be motor rehearsal of such events during RBD. This could explain why RBD movements are often violent, jerky, and faster, as being driven by a direct pathway from the motor cortex to the spinal cord, circumventing the basal ganglia. Future research should focus on why there are variable trajectories of RBD syndromes, if there are triggering life events, and what may be better targeted treatments. Beyond RBD, these “solid mental images” should advance our general understanding of dream functions.
Ongoing Human Evolution?
Authors: Bender Nicole , Rühli Frank , Henneberg Maciej
Published: August 2024

Cultural evolution and human niche construction led to relaxed natural selection in several traits, including those of the brain. These processes and the environment of the Anthropocene contribute to an increasing mismatch between the human genome and the modern physical and social environment, increasing the risk for several diseases. These include non-communicable diseases such as the metabolic syndrome, certain cancers, musculoskeletal diseases, and mental health. Other disease risks derive from our ancient legacy and can be explained by pleiotropic gene effects, such as Tay-Sachs disease, or certain risk gene variants for Huntington’s disease or Alzheimer’s disease, among others. The study not only of evolutionary processes but also of non-evolutionary adaptive mechanisms, such as epigenetics, secular trends of changes in traits, and ontogenetic plasticity, might lead to novel insights into therapeutic or preventive strategies for human diseases.
Epilepsy and cognition
Authors: Baker John , Butler Chris
Published: August 2024

Cognitive impairment is common among people with epilepsy. Almost 50% of people with epilepsy describe difficulties with memory, concentration, or thinking. For many, these symptoms are more problematic than the seizures themselves, and are associated with marked disability and socioeconomic cost. For some, cognitive problems persist after adequate seizure control has been established with antiseizure medications. In some cases, these medications themselves cause additional cognitive side effects. The relationship between epilepsy and cognition is bidirectional: many conditions causing cognitive impairment also increase the risk of epilepsy and epilepsy can lead to cognitive impairment itself, a fact which is especially pertinent in conditions where cognitive impairment predates epilepsy onset and where seizures can lead to further decline. Despite this intimate relationship between epilepsy and cognition, the neuropsychological assessment of individuals diagnosed with epilepsy is still not standard practice, particularly in adult populations.