bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility and effectiveness of an evidence-based intervention bundle to improve peri-operative care of older adults
Authors: Olotu Cynthia , Lebherz Lisa , Mende Anna , Hempel Cordelia , Philipp Rebecca , Schroeter Jennifer , Plümer Lili , Koch Birgit , Härter Martin , Zöllner Christian , Kriston Levente , Kiefmann Rainer
Published: July 2024

BACKGROUND

Maintaining functional status is an essential therapeutic goal in peri-operative care of older adults. Although several recommendations concerning peri-operative management are available, pragmatic approaches to their sustainable implementation are lacking.

OBJECTIVE

Multiple evidence-based recommendations for peri-operative care of older adults were bundled into a multicomponent intervention and assessed for feasibility and effectiveness.

DESIGN

A quality improvement study with before–after comparison using a hybrid implementation-effectiveness approach.

SETTING

University Medical Centre. The trial was conducted from 2017 to 2020, follow-up was 1 week, 1 month and 6 months after surgery.

PATIENTS

Patients at least 65 years old were scheduled for surgery; excluded: intercranial, ophthalmological, and emergency surgery; planned postoperative stay in the intensive care unit. A total of 720 patients were eligible; 278 patients were recruited, 95 (34) of whom were female.

INTERVENTIONS

The intervention consisted of a set of recommended measures for peri-operative management of older patients, including pre-operative assessment and measures to manage frailty, malnutrition, polypharmacy, cognitive impairment and delirium. Patients were sequentially assigned to three groups: control (no change from usual care), transition (to implementation of the intervention) and intervention (fully implemented).

MAIN OUTCOME MEASURES

Feasibility was assessed by determining the level of implementation, and barriers were identified by conducting qualitative interviews with the medical staff. Intervention effectiveness was estimated by Instrumental Activities of Daily Living (IADL; Lawton and Brody, primary clinical outcome) 1 and six months postoperatively. The secondary outcomes included postoperative complications, cognitive performance, quality of life and length of hospital stay.

RESULTS

The implementation rate was 77%. Pre-operative IADL was 9.9/10 (range 8 to 10; SD 0.4) and 9.7/10 (6 to 10, 0.8) for the control and intervention groups, respectively. There was no statistically significant difference between the groups in IADL (0.07, 95% CI −0.23 to 0.36, P = 0.66) and 6 months after surgery (0.01, 95% CI −0.29 to 0.31, P = 0.95).

CONCLUSION

The implementation of evidence-based interventions to improve peri-operative care of older patients showed good feasibility in clinical routine but did not improve patients’ functional status, which was already at a high level pre-operatively.

TRIAL REGISTRATION

ClinicalTrials.gov, Identifier: NCT03325413
Ivabradine Approved and Other Uses in Clinical Practice: A Systematic Review
Authors: Hajiqasemi Mohsen , Ebrahimzade Mandana , Ghelichkhan Zahra A. , Huang Xena , Morkos Demyana , Jennings Douglas , Talasaz Azita H.
Published: July 2024

Heart rate (HR) stands as a prognostic indicator of cardiovascular disease and a modifiable risk factor in heart failure (HF). Medication intolerance can curtail the application of conventional HR-lowering β-blockers to the optimum target dose. Ivabradine (IVA), a specific negative-chronotropic agent, selectively inhibits If current in pacemaker cells of the sinoatrial node without depressing myocardial contractility or comprising hemodynamics. This review summarized ivabradine's clinical labeled and off-label uses and mechanism of action focusing on the clinical outcomes. PubMed was searched up to January 2024 using the main keywords of IVA, coronary artery disease (CAD), HF, postural tachycardia syndrome (POTS), and tachyarrhythmia. To comprehensively review IVA's clinical indications, mechanisms, and therapeutic effects, all studies investigating treatment with IVA in humans were included, comprising different types of studies such as randomized controlled trials and longitudinal prospective observational studies. After screening, 141 studies were included in our review. A large number of reviewed articles were allocated to heart failure with reduced ejection fraction and CAD, suggesting IVA as an alternative to β-blockers in case of contraindications or intolerance. The beneficial effects of IVA as premedication for coronary computed tomography angiography, HR lowering in POTS, and inappropriate sinus tachycardia constituted most studies among off-label uses. The promising results have been reported on the efficacy of IVA in controlling HR, especially in patients with inappropriate sinus tachycardia or POTS. Owing to the unique mechanism of action, IVA has the potential to be used more frequently in future clinical practice.
Quality of life and spiritual health in motorcycle accident survivors: An analysis using the SF-36 Questionnaire and Spiritual Scale
Authors: Huang Ching-Ya , Peng Shu-Hui , Lin Hui-Ping , Hsu Shiun-Yuan , Hsieh Ching-Hua
Published: July 2024

Background

Motorcycle traffic accidents rate remained high in Taiwan letting posttrauma care an imperative issue. This study investigates the spiritual, psychological, and physical impacts of motorcycle traffic accidents in Taiwan, focusing on the role of the Injury Severity Score (ISS) in influencing quality of life (QOL) and spiritual well-being outcomes, aiming to enhance holistic recovery strategies for trauma survivors.

Materials and Methods

A prospective study was conducted from April 2022 to March 2024 in a level I trauma center. Patients aged 20 and above with trauma from motorcycle accidents were enrolled and divided into major (ISS ≥ 16) and nonmajor (ISS < 16) trauma groups. QOL and spiritual health were assessed using 36-item short-form general health survey measures (SF-36) and spiritual scale before discharge and 6 months later.

Results

Of 98 patients, we observed significant postdischarge declines in both physical and mental QOL scores, regardless of ISS. However, spiritual scores improved significantly after discharge, with notable enhancements in interpersonal relationships and adversity transcendence observed in patients with ISS < 16, but not in those with ISS ≥ 16. SF-36 analysis revealed that nonreligious groups experienced significant declines in mental health scores postdischarge, unlike religious groups, which remained stable. In addition, religious individuals showed significant postdischarge improvements in interpersonal relationships and adversity transcendence, while nonreligious showed no improvement. This suggests a beneficial link between religious adherence and enhanced spiritual well-being.

Conclusions

Motorcycle accidents reduce QOL and heighten spiritual needs for survivors, regardless of accident severity categorized by ISS score. Integrating spirituality into rehabilitation processes can positively impact overall well-being. Holistic care, addressing physical, psychological, social, and spiritual needs, is vital for optimizing long-term recovery and improving prognosis in trauma survivors, especially in regions with high rates of traffic accidents like Taiwan.
Enhancing Mortality Probability Model II (MPM II) Predictive Accuracy with the Lethal Triad in ICU Trauma Patients
Authors: Huang Ching-Ya , Kuo Pao-Jen , Yang Johnson Chia-Shen , Su Wei-Ti , Hsieh Ching-Hua
Published: July 2024

Introduction

The Mortality Probability Model II (MPM II) is a well-recognized predictive tool in the intensive care unit (ICU) scoring system. The presence of a lethal triad, including hypothermia, acidosis, and coagulopathy, is associated with a worse outcome for trauma patients. This study aimed to assess whether integrating the lethal triad could enhance the MPM II predictive accuracy for trauma patients in the ICU.

Methods

The study conducted a retrospective analysis of adult trauma patients admitted to an ICU from January 1, 2016, to December 31, 2022, in a Level I trauma center in southern Taiwan. It assessed the impact of the lethal triad variables incorporated into MPM II scores using the area under the receiver operating characteristic curve (AUC of ROC).

Results

Of the 3,410 patients included, 257 had the lethal triad and 3,153 do not. The mortality rate was significantly higher in patients presenting the lethal triad than those without (46.7% vs. 8%, p < 0.001). However, there was no significant improvement in predictive accuracy with both the MPM II with or without incorporating the variable of lethal triad having an area under the Receiver Operating Characteristic curve of 0.893.

Conclusion

While the lethal triad is important for understanding trauma-induced physiological changes, straight inclusion into MPM II has no substantial prognostic value. These findings indicate that the existing variables in the MPM II may already be indirectly capturing the impacts of the lethal triad, emphasizing the intricate interplay of physiological components in trauma patients. This underscores the importance of continued study in improving the prognostic modeling to ultimately predicting outcomes for trauma patients.
Long-term outcome and risk stratification in compensated advanced chronic liver disease after HCV-cure
Authors: Semmler Georg , Alonso López Sonia , Pons Monica , Lens Sabela , Dajti Elton , Griemsmann Marie , Zanetto Alberto , Burghart Lukas , Hametner-Schreil Stefanie , Hartl Lukas , Manzano Marisa , Rodriguez-Tajes Sergio , Zanaga Paola , Schwarz Michael , Gutierrez María L. , Jachs Mathias , Pocurull Anna , Polo Benjamín , Ecker Dominik , Mateos Beatriz , Izquierdo Sonia , Real Yolanda , Balcar Lorenz , Carbonell-Asins Juan A. , Gschwantler Michael , Russo Francesco P. , Azzaroli Francesco , Maasoumy Benjamin , Reiberger Thomas , Forns Xavier , Genesca Joan , Bañares Rafael , Mandorfer Mattias
Published: July 2024

Background and Aims:

Around 750,000 patients per year will be cured of HCV infection until 2030. Those with compensated advanced chronic liver disease remain at risk for hepatic decompensation and de novo HCC. Algorithms have been developed to stratify risk early after cure; however, data on long-term outcomes and the prognostic utility of these risk stratification algorithms at later time points are lacking.

Approach and Results:

We retrospectively analyzed a cohort of 2335 patients with compensated advanced chronic liver disease (liver stiffness measurement≥10 kPa) who achieved HCV-cure by interferon-free therapies from 15 European centers (median age 60.2±11.9 y, 21.1% obesity, 21.2% diabetes).

During a median follow-up of 6 years, first hepatic decompensation occurred in 84 patients (3.6%, incidence rate: 0.74%/y, cumulative incidence at 6 y: 3.2%); 183 (7.8%) patients developed de novo HCC (incidence rate: 1.60%/y, cumulative incidence at 6 y: 8.3%), with both risks being strictly linear over time.

Baveno VII criteria to exclude (FU-liver stiffness measurement <12 kPa and follow-up platelet count >150 g/L) or rule-in (FU-liver stiffness measurement ≥25 kPa) clinically significant portal hypertension (CSPH) stratified the risk of hepatic decompensation with proportional hazards. Estimated probability of CSPH discriminated patients developing versus not developing hepatic decompensation in the gray zone (ie, patients meeting none of the above criteria).

Published HCC risk stratification algorithms identified high-incidence and low-incidence groups; however, the size of the latter group varied substantially (9.9%–69.1%). A granular “HCC-sustained virologic response” model was developed to inform an individual patient’s HCC risk after HCV-cure.

Conclusions:

In patients with compensated advanced chronic liver disease, the risks of hepatic decompensation and HCC remain constant after HCV-cure, even in the long term (>3 y). One-time post-treatment risk stratification based on noninvasive criteria provides important prognostic information that is maintained during long-term follow-up, as the hazards remain proportional over time.
Regional Workshop on Optimization of Protection in Pediatric Interventional Radiology in Latin American and Caribbean Countries
Authors: Ubeda Carlos , Vano Eliseo , del Rosario Perez María , Ramirez Raúl , Nader Alejandro , Miranda Patricia , Fernandez José Miguel , Pérez-Peña Mar
Published: July 2024

The purpose of this article is to describe the activities developed within the framework “Regional Workshop on Optimization of Protection in Pediatric Interventional Radiology in Latin American and Caribbean countries,” developed between October 16th and 19th of the year 2023 in the city of San José, Costa Rica. The workshop was carried out as part of a joint work between the Pan American Health Organization (PAHO) and the World Health Organization (WHO), in cooperation with the International Atomic Energy Agency (IAEA). The main objective of the regional workshop was to gather the experiences and future work planning among participants in the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean (OPRIPALC) program. It involved professionals from 14 centers across 11 countries in the region, along with 4 experts from PAHO/WHO/IAEA. The work modalities during the workshop consisted of keynote presentations, individual presentations, group work, and general discussions. An online survey was carried out after the workshop, with the objective of knowing the opinion of the event participants and determining the impact and projection of the OPRIPALC program. During the workshop the centers had to present their experiences: the use of the DOLQA dose management system was presented and work was done on the consensus document on good practices. The activities, topics and organization of the workshop were valued positively by the participants. There is unanimity among the centers that the OPRIPALC program has had a positive impact and they wish to continue actively participating in the next biennium.
Association of Social Determinants of Health With the Likelihood of Treatment With Laser Trabeculoplasty in a US Database
Authors: Huang Bonnie B. , Tanna Angelo P.
Published: July 2024

Précis:

Among 1861 adults with ocular hypertension or mild or moderate primary open angle glaucoma, those with Medicaid or no insurance had a statistically significantly lower likelihood of receiving laser trabeculoplasty compared with those with other insurance.

Purpose:

To determine whether social determinants of health are associated with undergoing treatment with laser trabeculoplasty (LTP) among individuals with ocular hypertension (OHT) or mild or moderate primary open angle glaucoma (POAG).

Methods:

In this cross-sectional study, we included patients with OHT or mild or moderate POAG from the National Institutes of Health All of Us Research Program, a diverse US nationwide data set. Logistic regression was performed to study the association between LTP treatment status and 7 covariates (diagnosis severity, age, gender, race/ethnicity, income, insurance status, and education).

Results:

A total of 1861 subjects were included (median age of 72 y). In univariable logistic regression, diagnosis severity, older age, higher income, and insurance (non-Medicaid) were associated with LTP treatment. On multivariable logistic regression models, those with mild POAG (OR, 3.49; 95% CI: 2.12–5.87) and moderate POAG [OR, 7.15 (4.49–11.8)] were still more likely than OHT patients to have received LTP. Moreover, compared with participants with Medicaid or no insurance, participants with other insurance (eg, employer-provided, Medicare) were still more likely to have received LTP [OR, 2.24 (1.08–5.29)]. There was no significant difference in the LTP treatment likelihood based on race/ethnicity.

Conclusions:

After controlling for confounders, the likelihood of receiving LTP appears to be driven primarily by insurance rather than income or race/ethnicity. Potential reasons for decreased utilization of LTP among Medicaid patients include higher rates of declining the procedure, or LTP may have been offered less frequently due to Medicaid’s lower levels of reimbursement and longer reimbursement delays.
A Review of Studies on the Treatment of Premature Ejaculation with Traditional Chinese Medicine
Authors: Ma Dongyue , Wang Anmin , Wang Hao , Yang Jiutian , Luo Dicheng , Zhao Ziwei , Guo Jun , Colonnello Elena , Wang Fu , Jannini Emmanuele A.
Published: July 2024

By combing the literature and analyzing the current status of traditional Chinese medicine (TCM) treatment for premature ejaculation (PE), the strengths and shortcomings of the existing studies were identified. Building upon this assessment, we put forward a prospect for the establishment of TCM-specific strategies for PE, including more targeted and individualized comprehensive diagnosis and treatment approaches for PE, the establishment of a TCM hierarchical management program, and the exploration of the most effective entry points for collaborative treatment of PE using both TCM and Western medicine. Indeed, integrating therapeutical strategies from the two perspectives in a multifaceted and complex symptom such as PE, would enhance the possibility of success, possibly also reducing side effects. Moreover, with the help of well-established and new scientific and technological tools, we can explore the key links and targets in treating PE by TCM. At the same time, the mechanism of TCM treatment for PE could and should be examined in depth to lay the foundation for widespread clinical application. Finally, we suggest conducting multicenter, nationwide standardized clinical studies on treating PE with TCM. These studies should employ high-quality randomized controlled trial designs to obtain robust evidence-based medical data.
Percutaneous transluminal angioplasty and stenting for severe stenosis of the intracranial carotid artery and its branches: Comparison of the Wingspan stent vs the Credo stent
Authors: Lin Te-Ming , Wu Chia-Hung , Chung Chih-Ping , Yu Kai-Wei , Tai Wei-An , Luo Chao-Bao , Lirng Jiing-Feng , Chang Feng-Chi
Published: July 2024

Background:

Despite the widespread use of the Wingspan stent system for treating severe medically refractory intracranial artery stenosis (SMR-ICAS), a new Credo stent system was approved because it could integrate stent delivery within the balloon catheter. However, the therapeutic outcomes of these two systems have not been compared. This preliminary study aimed to compare the results of percutaneous angioplasty and stenting (PTAS) in SMR-ICAS patients treated with either Wingspan or Credo stents within the anterior cerebral circulation.

Methods:

SMR-ICAS patients with >70% stenosis in the anterior circulation who underwent PTAS using either the Wingspan or Credo stent system were retrospectively analyzed. We evaluated the technical success, safety, and outcomes of the two-stent systems.

Results:

A total of 29 patients were analyzed, including 17 patients treated with Wingspan stents and 12 with Credo stents. The outcomes of the Wingspan stent vs Credo stent were as follows: technical success (16/17 [94%] vs 11/12 [92%], p = 1.00); periprocedural intracranial hemorrhage (2/17 [12%] vs 0/12 [0%], p = 0.50); silent embolic ischemic lesions on periprocedural magnetic resonance imaging (MRI) (13/17 [76%] vs 7/12 [58%], p = 0.42); and significant (>50%) in-stent restenosis in 1 year (4/17 [24%] vs 2/12 [17%], p = 1.00). No recurrent stroke or mortality was noted within 30 days after the procedures or during the 1-year follow-up period.

Conclusion:

The technical success, safety, and outcomes of the Credo stent system were comparable to those of the Wingspan stent system in the management of SMR-ICAS patients. Further large-scale studies are warranted to substantiate these findings.
True lumen expansion but no aortic remodeling following thoracic endografting and distal bare stent for subacute complicated type B aortic dissection
Authors: Chen I-Ming , Kuo Tzu-Ting , Huang Chun-Yang , Chen Po-Lin , Shih Chun-Che
Published: July 2024

Background:

The effects of thoracic endovascular aneurysm repair (TEVAR) with additional distal bare metal stents (BMSs) in patients with subacute complicated type B aortic dissection (cTBAD) are unclear and are investigated in this retrospective study.

Methods:

The medical records of 67 patients who received TEVAR due to subacute cTBAD were reviewed. Areas of true lumen (TL) and false lumen at five levels—pulmonary artery (PA), diaphragm, renal artery (RA), middle of the infrarenal aorta, and aortic bifurcation—were measured using computed tomography before and 3, 6, and 12 months after surgery. The TL ratio (TL area/total aortic area) and total aortic area at each time point were compared between the TEVAR + BMS (n = 37) and TEVAR-only (n = 30) groups. The effects of BMS use and time were evaluated using generalized estimating equations and generalized linear regression models.

Results:

Baseline characteristics, remodeling types, and clinical outcomes did not differ significantly between the two groups. Postoperative TL ratios at the diaphragm and RA were significantly higher in the TEVAR + BMS group than in the TEVAR-only group (p < 0.05). BMS use and time had significant interaction effects at the PA, diaphragm, and RA (all p < 0.05), but effects on total aortic area were not significant at any of the five parts. TL ratios at the diaphragm and RA exhibited greater improvement in the TEVAR + BMS group than in the TEVAR-only group at postoperative months 6 and 12 (all p < 0.001). Aortic diameters at all five parts were significantly smaller in the TEVAR + BMS group than in the TEVAR-only group (all p < 0.05).

Conclusion:

In patients with subacute cTBAD, TEVAR with BMS implantation effectively expands the TL from the thoracic aorta to the RA but neither enhances aortic remodeling nor elicits any change in total aortic area in whole dissected aorta relative to TEVAR only.
A Pragmatic Approach to Assessing Supervisor Leadership Capability to Support Healthcare Worker Well-Being
Authors: Dyrbye Liselotte N. , Satele Daniel , West Colin P.
Published: July 2024

Goal:

We sought to build upon previous studies that have demonstrated how healthcare workers’ ratings of their immediate supervisor’s leadership capabilities relate to their well-being and job satisfaction.

Methods:

In 2022, we analyzed cross-sectional data from 1,780 physicians and 39,896 allied health professionals (collected in 2017) and 729 residents (collected in 2019), as well as longitudinal data from 1,632 physicians (collected from 2015 to 2017), to identify a psychometrically strong, broadly applicable, actionable, and low-burden approach to assessing supervisor leadership capability to support healthcare worker well-being.

Principal Findings:

The magnitude of association between our 1-, 2-, 3-, and 9-item leadership indexes and burnout, and between our 1-, 2-, 3-, and 9-item leadership indexes and satisfaction with the organization were similar to each other in the cross-sectional and longitudinal cohorts and across diverse groups of healthcare workers, including physicians, residents, and allied health professionals. The likelihood ratio for a high leadership score increased with an increasing score for each leadership measure. The area under the receiver operating characteristic curve for the 1-, 2-, and 3-item measures for a high leadership score was 0.9349, 0.9672, and 0.9819, respectively.

Practical Applications:

A single item assessing perceptions of leadership capability efficiently provides useful information about leadership qualities of healthcare workers’ immediate supervisors. The inclusion of this item in healthcare worker surveys may be useful for evaluating interventions and galvanizing organizational action to support healthcare worker well-being.
Leadership to Accelerate Healthcare’s Digital Transformation: Evidence From 33 Health Systems
Authors: Lemak Christy Harris , Pena Dalton , Jones Douglas A. , Kim Dae Hyun , Guptill Janet
Published: July 2024

Goal:

The COVID-19 pandemic, healthcare market disruptors, and new digital healthcare technologies have made a substantial impact on the delivery of healthcare services, highlighting the critical roles of leaders in hospitals and health systems. This study sought to understand the evolving roles of CEOs, CIOs, and other executive leaders in the postpandemic era and highlight the adaptability and strategic vision of executives in shaping the future of healthcare delivery.

Methods:

Between October 2022 and May 2023, 51 interviews were conducted with CEOs, CIOs, and other executives responsible for delivering technology solutions for 33 nonprofit health systems in the United States. They were asked to describe their backgrounds; how information solutions and technologies were viewed within their organizations’ strategy, operations, and governance; and the key characteristics of executive leaders.

Principal Findings:

The study has found that effective CEOs have an authentic belief in technology’s role in achieving their organization’s mission and that contemporary CIOs are strategic executive partners who align strategy with culture to improve care. This study examines how healthcare systems are creating digitally savvy executive leadership teams that operate in a new, integrated model that unites previously siloed functions.

Practical Applications:

Some healthcare CIOs are unprepared for current and future business challenges, and some CEOs are unsure how to leverage digital technologies and C-suite expertise to transform their organizations. This research provides insights into how the nation’s health systems are building and sustaining leadership teams capable of adapting to the healthcare environment and accelerating organizational transformation.
Using Artificial Intelligence in Electronic Health Record Systems to Mitigate Physician Burnout: A Roadmap
Authors: Fawzy Eid Mariam
Published: July 2024

Physician burnout, a significant problem in modern healthcare, adversely affects healthcare professionals and their organizations. This essay explores the potential of artificial intelligence (AI) to positively address this issue through its integration into the electronic health record and the automation of administrative tasks. Recent initiatives and research highlight the positive impact of AI assistants in alleviating physician burnout and suggest solutions to enhance physician well-being. By examining the causes and consequences of burnout, the promise of AI in healthcare, and its integration into electronic health record systems, this essay explores how AI can not only reduce physician burnout but also improve the efficiency of healthcare organizations. A roadmap provides a visualization of how AI could be integrated into electronic health records during the previsit, visit, and postvisit stages of a clinical encounter.
Intranasal Delivery of Medications for the Treatment of Neurologic Conditions: A Pharmacology Update
Authors: Shafer Patricia Osborne , Dean Patricia , Brooks Lai , Gidal Barry , Misra Sunita N. , Carrazana Enrique
Published: July 2024

INTRODUCTION: Nurses have a central role in educating patients and families about treatment options and how to integrate them into action plans for neurologic conditions. In recent years, a growing number of intranasal formulations have become available as rescue therapy for neurologic conditions or symptoms including migraine, opioid overdose, and seizures. Rescue therapies do not replace maintenance medications or emergency care but are designed to enable rapid treatment of urgent or disabling conditions in community settings. Yet, discussion of rescue therapies for neurologic conditions remains limited in nursing literature. CONTENT: Intranasal formulations are specifically formulated for delivery and absorption in the nose and have several characteristics that are well suited as rescue therapies for neurologic conditions. Intranasal formulations include triptans for migraine, naloxone and nalmefene for opioid overdose, and benzodiazepines for seizure clusters in patients with epilepsy. Therapeutic attributes discussed here include ease of use in community settings by nonmedical professionals, relatively rapid onset of action, and favorable safety profile and patient experience. This information is critical for nurses to make informed decisions about rescue therapy options, incorporate these into plans of care, and educate patients, care partners, and other healthcare providers. CONCLUSION: Rescue therapies are increasingly important in the care of people with neurologic conditions. Various formulations are available and continue to evolve, offering easy and quick ways for nurses, patients, and nonmedical care partners to administer critical rescue medications. For nurses overseeing medication management, the attributes of intranasal rescue therapies should be considered in the context of providing patients with the right care at the right time.
The Immediate Effect of the Novel Hybrid Passive Spring Damper Ankle-Foot Orthosis on Spatiotemporal Parameters of Walking in Patients with Multiple Sclerosis
Authors: Pourhoseingholi Ensieh , Tafti Nahid
Published: July 2024

Introduction

Patients with multiple sclerosis (PwMS) experience damage to their central nervous system, which can lead to unilateral or bilateral drop foot. The presently utilized ankle-foot orthoses (AFOs) for PwMS have exhibited limited clinical efficacy.

Objective

This current study evaluated the immediate effects of the Novel Hybrid Passive Spring Damper Ankle-Foot Orthosis (HPSDAFO) on walking in PwMS.

Study design

A cohort trial.

Methods

Twelve PwMS suffering of unilateral drop foot took part in this study. They were given the novel HPSDAFO and underwent kinematic assessment including walking along a 10-m walkway at a self-selected speed, both with and without the HPSDAFO.

Results

The novel HPSDAFO device significantly changed gait parameters of ankle range of motion, single limb support duration, and step and stride length of the affected side (P < 0001). Furthermore, the device also improved the symmetry index and resulted in increased walking speed and cadence.

Conclusions

The application of the novel HPSDAFO on the affected side of PwMS resulted in a notable enhancement in the symmetry of spatial parameters, which highlights the need for additional research in this area.

Clinical Relevance

Using the novel HPSDAFO, PwMS can walk without adverse effects, promoting the normalization of their spatiotemporal walking parameters.
History of Multiple Allergies and Gradual Onset Running-Related Injuries in Distance Runners: SAFER XXXV
Authors: van Vreden Chanel , Schwellnus Martin , Ramagole Dimakatso , Swanevelder Sonja , Jordaan Esme , Sewry Nicola
Published: July 2024

Objective:

To determine if any gradual onset running-related injury (GORRI) was associated with any allergies, multiple allergies (allergies to animals, plants, medication), and allergy medication use.

Design:

Cross-sectional descriptive study.

Setting:

Two Oceans Marathons (56 km, 21.1 km), South Africa.

Participants:

A total of 76 654 race entrants (2012–2015).

Independent Variables:

The prevalence (%) and prevalence ratios (PR; 95% confidence intervals) for history of (1) any allergies, (2) multiple allergies to broad categories of allergens (animal material, plant material, allergies to medication, and other allergies), and (3) allergy medication use.

Main Outcome Measures:

Using a compulsory online screening questionnaire, the outcome was a history of any GORRIs, and subcategories of GORRIs (muscle, tendon) in the past 12 months and history of GORRIs (and subtypes of GORRIs) were reported.

Results:

In 68 258 records with injury and allergy data, the following were significantly associated with reporting any GORRIs: a history of any allergy (PR = 2.2; P < 0.0001), a history of allergies to broad categories of allergens (animal, plant, medication allergy, other) (P < 0.0001), and the use of allergy medication (P < 0.0001). A history of any allergies (PR = 2.4; P < 0.0001), all broad categories of allergies, and allergy medication use were significantly associated with muscle (P < 0.0001) and tendon injuries (P < 0.0001). The risk of reporting a GORRI increased as the number of reported categories of allergies increased (P < 0.0001).

Conclusions:

A novel finding was the cumulative risk effect with a history of multiple allergies. Further studies should aim to determine the underlying mechanism relating allergies and GORRIs.
Reduction in Balloon Pump Size Reduces Axillary Intraaortic Balloon Pump Failure Risk
Authors: Inglis Sara S. , Kanwar Ardaas , Bonilla Hilda Gonzalez , Singh Swaiman , Pearson Jennifer Y. , Abbas Mohsin , Folkens Lori A. , Ou Narith N. , Spencer Philip J. , Villavicencio Mauricio A. , Clavell Alfredo L. , Frantz Robert P. , Rosenbaum Andrew N. , Behfar Atta
Published: July 2024

Axillary artery intra-aortic balloon pump (axIABP) placement has been implemented as a bridging solution before heart transplantation. This study evaluates complications associated with axIABP support and describes an approach to minimize adverse events. We previously described a percutaneous approach for axIABP placement. However, patients receiving axIABP between September 1, 2017, and September 26, 2019 (n = 32) demonstrated a high rate of balloon pump malfunction (8/32; 25%) and other complications (totaling 15/32; 47%). Sixty-four patients were sequentially treated under a revised protocol. Compared to the initial cohort, no significant differences in demographics were noted. A significant reduction in rate of balloon malfunction (8/32, 25% vs. 1/64, 2%; p < 0.001) and total complications (15/32, 47% vs. 10/64, 16%; p = 0.0025) during the period of support were noted after intervention. Subsequent analysis of total complications per device size (40 vs. ≤ 34 ml balloon) revealed significantly reduced complications in patients with smaller devices (40% vs. 13%, respectively; p = 0.0022). This study provides guidelines to limit complications in patients supported with axIABP, facilitating a protracted period of bridging support.
Entecavir vs. tenofovir disoproxil fumarate in the treatment of chronic hepatitis B patients with severe acute exacerbation
Authors: Lin Chih-Yang , Sun Wei-Chih , Lu Chia-Ming , Chen Wen-Chi , Tsay Feng-Woei , Tsai Tzun-Jiun , Kuo Feng-Yu , Tsai Wei-Lun
Published: July 2024

Background

The efficacy of different nucleos(t)ide analogs in the treatment of chronic hepatitis B virus (CHB) with severe acute exacerbation (SAE) remained unclear. Thus, this study aimed to compare the short-term efficacy of tenofovir disoproxil fumarate (TDF) and entecavir (ETV) in patients having CHB with SAE.

Methods

We analyzed consecutive patients with treatment-naive CHB receiving TDF (n = 36) or ETV (n = 65) for SAE. The primary endpoint was overall mortality or receipt of liver transplantation (LT) by 24 weeks. The secondary endpoints are the comparison of ETV vs. TDF influences on renal function and virological and biochemical responses at 4, 12, 24, and 48 weeks.

Results

The baseline characteristics were comparable between the two groups. By 24 weeks, 8 (22%) patients in the TDF group and 10 (15%) patients in the ETV group had either died (n = 15) or received LT (n = 3) (P = 0.367). Cox-regression multivariate analysis revealed age (P = 0.003), baseline international normalized ratio of prothrombin time (P = 0.024), and early presence of hepatic encephalopathy (P = 0.003) as independent factors associated with mortality or LT. The two groups of patients achieved comparable biochemical and virological responses at 48 weeks. No significant difference was found in the estimated glomerular filtration rate (eGFR) between the TDF and the ETV groups. However, a significant reduction in the eGFR at 48 weeks, as compared with the baseline, was found in each group.

Conclusion

TDF and ETV achieved similar short-term clinical outcomes and treatment responses in CHB patients with SAE.
Growth hormone augmentation in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials
Authors: Mohamed Islam , Gautam Misha , Abosheaishaa Hazem , Hussain Sophia , Kumar Kopal , Kotak Anaya , Baugh Macy , Qureshi Raabia , Jaber Fouad , Dahiya Dushyant Singh , Alba Laura , Duong Nikki
Published: July 2024

Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by hepatic steatosis and metabolic dysregulation. Growth hormone (GH) augmentation has emerged as a potential therapeutic intervention for treating MASLD. This systematic review and meta-analysis aimed to evaluate the impact of GH augmentation on different parameters of MASLD. A systematic literature search identified randomized controlled trials investigating GH augmentation in MASLD patients. Search results were screened via Covidence and the Risk of Bias 2 tool was used to assess bias in randomized controlled trials. Statistical analysis utilized RevMan v5.3. We combined dichotomous outcomes employing odds ratios and continuous outcomes utilizing mean difference (MD), each with a 95% confidence interval (CI). Statistical significance was indicated by a P-value less than 0.05. Heterogeneity was evaluated using I
2 tests. Our results showed that GH augmentation resulted in a significant reduction in both relative (MD: −46.26; 95% CI: −71.52, −21.00; P = 0.0003) and absolute (MD: −5.15; 95% CI: −7.93, −2.37; P = 0.0003) hepatic fat fraction. GH augmentation significantly reduced alanine aminotransferase (MD: −5.97; 95% CI: −10.31, −1.62; P = 0.007) and gamma-glutamyl transferase (MD: −16.18; 95% CI: −30.76, −1.59; P = 0.03) levels. No significant changes were observed in hemoglobin A1c, C-reactive protein, fasting serum glucose, BMI, triglycerides, and low-density lipoprotein cholesterol levels. Our meta-analysis highlights GH augmentation as a promising therapy for reducing liver steatosis and improving liver enzyme levels in MASLD patients. Further large-scale trials are warranted to examine the long-term effects, safety profiles, and potential impact on various measures.
Predictors of residual neoplasia after noncurative (R1) endoscopic submucosal dissection of lesions in the gastrointestinal tract
Authors: Ayoub Fares , Khalaf Mai , Kuang Andrew G. , Keihanian Tara , Jawaid Salmaan , Othman Mohamed O.
Published: July 2024

Background

Endoscopic submucosal dissection (ESD) is a minimally invasive resection technique that enables the en bloc resection of gastrointestinal lesions. Despite en bloc resection, pathological evaluation of lesions can reveal positive vertical or horizontal margins, which is referred to as R1 resection. Not all R1 lesions referred for surgical resection or endoscopic surveillance show evidence of residual tumor. We aimed to identify the predictors of residual neoplasia in patients with an R1 resection following ESD.

Patients and methods

All lesions resected via ESD between June 2016 and September 2021 at a tertiary referral center were retrospectively identified. Lesions with an R1 resection and adequate follow-up were eligible for inclusion. Patient, lesion, and procedural characteristics were analyzed to identify predictors of residual neoplasia.

Results

Of 614 lesions, 163 (28%) had R1 resection. Of these, 56 lesions in 51 patients had complete follow-up and were included. Thirteen patients (25.5%) underwent surgical resection and the remainder underwent endoscopic surveillance. Seven (12.5%) patients had residual disease. All patients with residual disease had esophageal carcinoma. Positive deep and lateral margins, severe submucosal fibrosis, and moderate/poorly differentiated tumors were identified as significant predictors of residual neoplasia.

Conclusion

Most R1 lesions (87.5%) resected by ESD did not have residual disease on follow-up. Those without identified risk factors for residual disease, such as esophageal carcinoma, severe submucosal fibrosis, or both histological margin positivity, may benefit from a strategy of close endoscopic surveillance rather than referral for surgical resection.
Causal relationships between psychological disorders and functional gastrointestinal disorders: a bidirectional two-sample Mendelian randomization study
Authors: Liu Tangyi , Wang Zeyu , Kang Xiaoyu , Wang Xiangping , Ren Gui , Lv Yong , Li Jing , Liu Yaling , Liang Shuhui , Nie Yongzhan , Luo Hui , Pan Yanglin
Published: July 2024

Background and Aims:

Observational studies have shown bidirectional associations between psychological disorders (e.g. depression and anxiety) and functional gastrointestinal disorders. However, whether the relationships are causal is uncertain. Here, we used a bidirectional two-sample Mendelian randomization method to investigate the association between psychological disorders and functional gastrointestinal disorders (FGIDs).

Methods

We obtained genome-wide association study summary statistics for two common psychological disorders: depression (170 756 cases) and anxiety (31 977 cases), as well as for three common FGIDs: functional dyspepsia with 6666 cases, constipation with 26 919 cases, and irritable bowel syndrome (IBS) with 7053 cases. These summary statistics were retrieved from several publicly available genome-wide association study databases. The inverse variance weighted method was used as the main Mendelian randomization method.

Results

Inverse variance weighted Mendelian randomization analyses showed statistically significant associations between genetically predicted depression and risk of functional dyspepsia [odds ratio (OR): 1.40, 95% confidence interval (CI): 1.08–1.82], constipation (OR: 1.28, 95% CI: 1.13–1.44), and IBS (OR: 1.51, 95% CI: 1.37–1.67). Genetically predicted anxiety was associated with a higher risk of IBS (OR: 1.13, 95% CI: 1.10–1.17) instead of functional dyspepsia and constipation. In addition, genetically predicted IBS instead of functional dyspepsia and constipation was associated with a higher risk of depression (OR: 1.33, 95% CI: 1.12–1.57) and anxiety (OR: 2.05, 95% CI: 1.05–4.03).

Conclusion

Depression is a causal risk factor for three common FGIDs. A bidirectional causal relationship between IBS and anxiety or depression was also identified.
Outcomes of Home Emergency Physical Readiness Education for Older Adults
Authors: Arena Sara K. , Wilson Christopher M. , Boright Lori , Reed John , Shriver Will , Castillo-Trigilio Jasmine , Nolff Spencer
Published: July 2024

Emergency preparedness initiatives are a Medicare condition of participation in home healthcare, yet limited evidence on the impact of associated programming is available. The purpose of this exploratory pilot study was to examine the outcomes of an individualized emergency preparedness educational program provided by a physical therapist (PT) in the homes of older adults. The investigators recruited older adults (n = 30) using convenience sampling. An emergency preparedness education module was developed. Demographics, functional and environmental outcome measures, a pre- and post-education confidence survey, and learning outcomes were ascertained and analyzed. Participants reported being female (n = 23), 70 to 79 years (n = 15), and 19 individuals reported 35 different lifetime emergency events. Hearing and vision impairments, inability to change a battery or navigate stairs, and environmental deficits including clutter and poor lighting were identified. Closing bedroom doors at nighttime, functioning carbon monoxide and smoke detectors, creating an evacuation plan, and assembling first aid kits were learning outcomes. Trends toward increased confidence were identified, with statistically significant improvements in the ability to respond to a fire (P = .01), a heat wave (P = .03), and to crawl on hands and knees (P = .05) identified. This study provides emerging evidence that PTs have a role in improving an older adult's confidence to prepare for and respond to an emergency event.
Update
Authors: Gorski Lisa A.
Published: July 2024

The Infusion Therapy Standards of Practice provide evidence-based recommendations for infusion and access device related care in any healthcare setting. Developed and published by the Infusion Nurses Society, the Standards have increased the frequency of the revision process from an every 5-year cycle to a 3-year cycle due to the growing base of literature and to deliver the most updated and current practice recommendations. This article provides an overview of the development process and a brief description of selected standards. Notably, a new standard entitled Home Infusion Therapy was added in this latest edition. The Standards are an essential reference that should be available to every home care agency that provides home infusion therapy.
Gastrointestinal and Gastroesophageal Reflux Scale Reference Values
Authors: Pados Britt Frisk , Hill Rebecca R.
Published: July 2024

Purpose:

The purpose of this study was to determine age-based reference values for the Gastrointestinal and Gastroesophageal Reflux (GIGER) Scale for Infants and Toddlers.

Study Design and Methods:

GIGER data from healthy, full-term born children under 2 years of age were used to determine reference values. For each age group, median, interquartile range, 90th, and 95th percentile scores were calculated for each subscale and the total score. 90th percentile scores were also calculated for each of the 36 items based on the full sample.

Results:

Data from 625 children were used to determine reference values for children 0-2, 2-4, 4-6, 6-8, 8-10, 10-12, and 12-24 months. In healthy, full-term infants, gastrointestinal and gastroesophageal reflux symptoms improved over the first 24 months of life, with the most improvement occurring over the first 2 months.

Clinical Implications:

The GIGER is a 36-item measure of gastrointestinal and gastroesophageal reflux symptoms for children under 2 years old that has evidence of adequate psychometrics for clinical practice and research. The age-based reference values established in this study can be used to guide score interpretation and determine when a child's symptoms warrant further investigation. This may help identify infants and toddlers with significant symptoms earlier so that they can obtain the care they need.
Predictive Factors for Delayed Recovery From Anesthesia in Patients Receiving Free Vascularized Flap Reconstruction for Head and Neck Defects: A Retrospective Cohort Study
Authors: Zeng Meigu , Wu Jiayao , Liu Xiongying , Xiao Xiliang , Cao Minghui , Wang Chengli
Published: July 2024

Objective:

Free flap reconstruction for head and neck defects is currently a common procedure. This study aimed to create and validate a predictive model for identifying patients at risk of delayed recovery from anesthesia after free flap reconstruction for head and neck defect.

Methods:

Electronic medical records from all patients were retrospectively collected. The primary outcome variable was delayed recovery from anesthesia. The least absolute shrinkage and selection operator regression model was employed to identify the most relevant features, followed by the construction of a nomogram model using multivariable logistic regression analysis. The discriminatory power, calibration, and clinical utility of the nomogram model were assessed using receiver operating characteristic curve analysis, calibration curve analysis, and decision curve analysis, respectively.

Results:

This novel nomogram model incorporated 4 predictors for delayed recovery from anesthesia: preoperative albumin, intraoperative fresh frozen plasma infusion, preoperative platelet-to-lymphocyte ratio, and duration of intraoperative hypotension. The area under the receiver operating characteristic curve (area under the curve) for the nomogram model was determined to be 0.821 (95% CI: 0.803–0.836). After internal validation, the corrected area under the curve was found to be 0.768 (95% CI: 0.639–0.812). In addition, the model exhibited well-fitted calibration curves and demonstrated favorable clinical usability as indicated by the calibration curve and decision curve analysis curve.

Conclusion:

The authors created and validated a novel predictive model utilizing a limited number of 4 predictors, yet exhibiting commendable predictive performance. This innovative tool holds the potential to mitigate delayed recovery from anesthesia and enhance the efficient allocation of medical resources.