bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural and Functional Optic Nerve Changes in Patients on Amiodarone Therapy
Authors: Eldien Youssef Norhan Mohmed Kamal , Ashour Doaa Maamoun Mohamed , Shehata Emad Effat , Ebeid Weam Mohamed Ahmed , El-Shazly Amany Abd El-Fattah
Published: August 2023

Purpose

To investigate the structural and functional optic nerve changes in patients on amiodarone therapy.

Methods

A total of 30 eyes were examined were divided into two groups, study group of patients included (15 eyes) of cardiac patients on amiodarone therapy for more than four consecutive months, and control group included (15 eyes) of age- and sex-matched healthy participants. Both groups have underwent full ophthalmological examination, optical coherence tomography examination for optic nerve head scan, electrophysiological studies included (pattern visual evoked potential).

Results

Electrophysiological studies were the tool for the assessment of the functionality of the ocular structure in our study, the pattern visual evoked potential results have shown to be of no statistically significant difference between the N75 latency (ms) (P-value=0.972), P100 latency (ms) (P-value 0.547) and N75-P100 amplitude (µV) (P-value =0.18), in the numeric values between the control and cases groups. And for qualitative structural assessment we have performed optical coherence tomography scan imaging for the optic nerve head for all the participants in this study, and the results revealed no statistically significant differences in the obtained values regarding NFL thickness map. This agrees with the obtained electrophysiological tests results to be both within normal limits

Conclusion

The current study revealed normal electrophysiological as well as optical coherence tomography measurements in the included sample of patients on chronic amiodarone therapy. All the included patients had good, best corrected visual acuity (BCVA) and none complained of any visual symptoms. None had clinically suspected optic nerve affection and this was confirmed by the detailed imaging and electrophysiological assessment for both macula and optic nerve.
Primary Repair of Anterior Cruciate Ligament Tear
Authors: Sobhy Mohamed Hassan , El Abd Mostafa Aly , Amin Fraig Fraig
Published: August 2023

Background

Initially, authors reported deterioration in the outcomes of ACL open primary repair. Consequently, authors considered ACL reconstruction surgery as the gold standard approach in treating ACL injuries. Recently, with the introduction of modern-day technology such as MRIs and arthroscopic repair, emerging reports gained interest in reevaluating the outcomes of primary repair.

Aim of the Work

We aim to evaluate to evaluate the results of different techniques regarding ACL repair, and determine the ideal candidates for this procedure

Patients and Methods

We conducted an electronic search via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till August 2020. We included randomized, nonrandomized trials, prospective or retrospective cohort and case control studies that were published in English with full text available. We restricted our search to patients diagnosed with acute ACL tear whom underwent open or arthroscopic ACL repair. Outcomes of interest were Functional outcomes (Lysholm, Bivot and Lachman scores), complications and failure rates.

Results

From a total 2089 screened citations, 24 studies met our inclusion criteria. Eleven studies evaluated primary ACL suture repair of the (1 study used a biologic scaffold in the ACL repair, 4 used microfracturing techniques, and 5 used some form of mechanical augmentation). The remaining 11 studies used dynamic intraligamentary stabilization (DIS). There was male predominance across the studies, with patients aged between 6 to 43.3 years and patients were follow-up to 16 years. There was a wide range of ACL repair survivorship between 60 % and 100% with reoperation rate ranged between 0 % and 51.5%. Re-rupture of the ACL, revision ACLR procedures, and implant removal were as high as 18.2%, 20%, and 100%, respectively. However, results were improved when ACL repair was combined with biological enhancers e.g. microfracturing and scaffolding. In the four comparative studies (primary repair vs. ACLR), there was no significant difference between both approaches regarding; IKDC, Lysholm, Tegner and Lachman, scores.but ACLR was slightly superior in certain outcomes e, g, failure rates and proper positioning.

Conclusion

We found that still ACL reconstruction is superior to ACL primary repair however, with strict selection criteria mainly; proximal ACL rupture and excellent tissue quality, primary ACL repair could be reconsidered as an effective treatment especially when combined with microfracturing and scaffolding.
Effectiveness of Arthroscopic Decompression in Treatment of Anterolateral Ankle Impingement Syndrome: A Systematic Review
Authors: Diab Hossam Saeed , Sallam Ahmed Mohamed , Kamel Elshenawy Mahmoud
Published: August 2023

Background

Soft tissue impingement of the ankle is a common cause of chronic ankle pain that usually arises at the lateral and/or anterolateral compartment of the ankle joint after an inversion injury. Approximately 3% of ankle sprains may lead to anterolateral impingement.

Aim of the Work

In this systemic review we aimed to highlight the prevalence of ankle impingement syndrome, and to evaluate the effectiveness of arthroscopic decompression in such instance.

Material and Methods

A total of 246 cases were included 135 were males and mean age was 29.6 years, The mean follow up period among included studies was 29.5 months min-max 15-83.7. The main complaint was pain, ankle swelling, limited ankle movement and limited functional activity. Mean AOFAS score pre was 40.75 which increased post treatment to 84.2.

Results

According to Meislen criteria patients showed excellent (n124), good (n71) fair (n 14), poor (n3). As regard mobility patients showed after treatment normal (n 130), persistent pain (n24), painful limited dorsiflexion at 15(n2). Complications founded among 24 cases after treatment in form of hypoesthesia in 4 cases, infection in 2 cases, injuries in 7 cases, Intraarticular haemarthros in 1 case, consistent GW attacks in 4 cases, abnormal scar tissue in 3 cases, nerve irritation in 1 case, numbness in 2 cases. Patients were highly satisfied

Conclusion

In conclusion, we believe that arthroscopic debridement of the anterolateral impingement soft tissues are a good and effective method of treatment. Arthroscopic treatment of anterolateral ankle impingement gives significant therapeutic benefits on pain management and rapid resumption of daily physical and sports activities. Technically, distraction is not required which reduces the frequency of complications. The outcome was satisfactory in most cases, with marked improvement of pain and function. The procedure proved to be safe, with minimal morbidity and few complications. This procedure proved to be safe and effective, with minimal morbidity and few complications so it is recommended in Patients with persistent pain, tenderness, and feelings of instability after conservative treatment are excellent candidates for arthroscopy.
Serum Cystatin C as a Marker for Acute Kidney Injury Evaluation in Neonates Treated with Colistin
Authors: Shady Nancy Mohamed Abu , Mahmoud Ramy Mohamed , Aziz Ahmed Fawzy Abdel , Barakat Noha Mokhtar
Published: August 2023

Background

Colistin is increasingly used worldwide due to the emergence of multi-drug resistant (MDR) gram negative bacilli with concerns about its side effects especially nephrotoxicity. Serum cystatin C (CysC) is an endogenous protease inhibitor produced at a constant rate by nucleated cells and used as a filtration marker of glomerular filtration rate (GFR).

Aim

to study the effect of colistin on serum cystatin C as a marker for acute kidney injury in neonates in relation to serum urea and serum creatinine.

Patients and method

78 neonates with gestational age of at least 30 weeks after treatment with colistin or antibiotics were divided into two groups non – colistin group and colistin group 39 pateints on each group. Kidney function tests were assessed before treatment and also after treatment but together with Kidney Disease Improving Global Outcome (KDIGO) criteria & serum cystatin C.

Results

Serum cystatin C was found to be significantly higher in colistin group than non – colistin group. No significant differences were found between both groups regarding serum creatinine, serum urea and even KDIGO criteria of acute kidney injury in neonates.

Conclusion

Serum cystatin C is an early marker of acute kidney injury in neonates which may not be detected by serum urea or serum creatinine
Prevalence of Insulin Resistance and Metabolic Syndrome in Pediatric Patients with Type 1 Diabetes Mellitus and Its Association with Macrovascular Complications
Authors: El-Samahy Mona H , Elhenawy Yasmine I , Elsayed Eman M , Abd El-Aziz Hassan H
Published: August 2023

Background

Insulin resistance (IR) is an independent risk factor for the development of micro and macrovascular diseases in both type 2 diabetes (T2DM) and type 1 diabetes (T1DM) patients.

Objective

To assess the frequency of insulin resistance and metabolic syndrome among pediatric patients with T1DM and highlight the factors associated with both.

Subjects and Methods

Analytical cross-sectional study, including eighty (80) patients with T1DM divided into two equal groups according to body mass index(BMI) (Group1= 40 patients with normal BMI, Group 2= 40 obese or overweight patients). Both groups were subjected to: Detailed history, through clinical examination with special emphasis on assessment of Insulin Resistance and Metabolic Syndrome. Carotid intima media thickness (CMIT) was assessed as a marker of macrovascular complication.

Results

In group 2, (93%) of participants showed manifestations of metabolic syndrome Also, the same group showed significantly higher HbA1c (P < 0.05) and waist/ hip ratio (P < 0.05). Estimated glucose disposal rate formula (eGDR) (5.49 ± 3.53) were significantly lower in group 2 compared with group 1 (10.51 ± 2.20) (P < 0.05).The best cut-off value of eGDR for prediction of IR among patients with T1DM was < 7.15 mg/kg/min. CIMT was significantly higher in group 2 (0.93 ± 0.13) compared to group 1 (0.66 ± 0.09) (P < 0.05). Furthermore, there was a strong negative correlation between eGDR and CIMT.

Conclusion

Overweight and obese youth with T1DM had significantly higher prevalence of components of metabolic syndrome including insulin resistance. A specific novel finding of this study is the relationship between eGDR and macrovascular complications.
Central Line Associated Bloodstream Infection in Neonatal Intensive Care Unit
Authors: El-Farrash Rania Ali , Abushady Nancy Mohamed , Eldin Mohamed Ragab Zein , Barakat Noha Mokhtar
Published: August 2023

Background

Central-line–associated bloodstream infections (CLABSIs) are a major source of healthcare-associated infections in neonatal intensive care units (NICUs), and they are associated with increased morbidity, mortality.

Aim

To describe the epidemiology, demographic and, etiological characteristics of CLABSI at NICUs of Ain Shams University Hospitals.

Patients and Methods

Prospective observational study included 136 neonates with central venous catheters (CVCs) over period of 9 months, two blood cultures samples were taken from each patient thought to be infected based on clinical signs suggestive of infection (apnea, bradycardia, bad perfusion, temperature instability) and laboratory markers like Creactive protein (CRP) with one culture sample from CVC and the other from a peripheral vein, CLABSI was diagnosed according to Centers for Disease Control and Prevention (CDC) criteria.

Results

Twenty-three episodes of CLABSI were reported with a rate of 20.8 per 1000 catheter days. The mean gestational age and mean weight of CLABSI cases were 33.57±2.83 weeks and 1.97 ± 0.71 kg respectively. No statistically significant differences between CLABSI cases and others with no CLABSI as regards demographic characteristics. The use of invasive respiratory support was significantly associated with a high rate of CLABSI episodes. CLABSI was significantly associated with prolonged hospitalization with a mean of 18.78±9.10 days. Klebsiella was the most common isolated organism among CLABSI cases with a percentage of 52.1 %. The percentage of mortality was 56.5% among CLABSI cases

Conclusions

Evaluation of infection prevention programs is required to determine if specific strategies can be implemented to further reduce infection risk.
Role of 68Ga-Labelled PSMA PET/CT in Assessment and Staging of Prostate Cancer
Authors: Ragheb Samar Ramzy , El-Din Mohammed Fatma Salah , Ahmed Ahmed Magdi
Published: August 2023

Background

Prostate cancer (PCa) is the most common worldwide tumor in men with increasing incidence.

Aim of the Work

The purpose of our study is to evaluate the potential role of 68Ga-labelled PSMA PET/CT in assessment and staging of prostate cancer and correlate those positive findings with biopsy.

Patients and Methods

Thirty patients with pathologically confirmed prostate cancer who underwent PET/CT study. They were selected from Department of Radiology at Ain Shams University Hospital from November 2020 to May 2021. The patients’ ages ranged between 53 and 89 years old (mean age 66.43 ± 8.9 years). All patients underwent a 68Ga-PSMA PET/CT examination. For each patient, we determined the disease stage, the Gleason score, and the maximum standardized uptake value (SUVmax) for primary prostatic tumor and extraprostatic metastases. The diagnostic sensitivity and specificity of 68Ga-PSMA PET/CT for diagnosis and staging of PC were established by histopathology as the reference standard.

Results

Median SUVmax for the primary tumor was 12.88 (range, 6.7–25). Nineteen patients had associated PSMAavid lymph nodes, median SUVmax for those was 11 (range, 3.7–29). 68Ga-PSMA PET/CT detected extraprostatic metastases in 19 (63.3%) patients. The most common site of extraprostatic metastases was the bone (17 patients). The sensitivity of 68Ga-PSMA PET/CT examination in the diagnosis of PC was 90.9% and specificity was 68.4%.

Conclusion

68Ga-PSMA PET/CT is a valuable tool with high diagnostic sensitivity and good specificity for diagnosis and staging of patients with newly diagnosed PC.
Comparison between the Computed Tomography (CT) Coronary Angiography by Using “Coronary Artery Disease - Reporting and Data System (CAD-RADS)” and the Conventional Coronary Angiography in Assessment of the Coronary Artery Stenosis Severity
Authors: Guirguis Mounir Sobhy , Samy Ahmed , Hagggag Ahmed Mohammed Abdelmonem Ibrahim
Published: August 2023

Background

Coronary CTA is established as the first-line diagnostic imaging tool to exclude coronary artery disease (CAD) at low to intermediate risk. Reporting and interpretation of the findings gap between the referring physicians and radiologist are wide.

Aim of the Work

To evaluate the clinical efficacy of Computed Tomography (CT) coronary angiography by using Coronary Artery Disease - Reporting and Data System (CAD-RADS) versus invasive coronary angiography in the assessment of coronary artery stenosis severity.

Patients and Methods

The study included 24 patients suffered from typical chest pain or fatigue, 9 were female patients and 15 were male patients, with mean patient ages above 40 years old. The study was conducted at Ain Shams University Hospitals.

Results

The main goals of the CAD-RADS are to decrease variability between readers and enhance communication between interpreting and referring doctors, which affects the best patient care outcome. Many clinical case scenarios are not accurately addressed by CAD-RADS and in which classes of CAD-RADS category is not straightforward. Multiple scenarios are still vague and at the maximum point of conflict about the adoption of CAD-RADS role in practice.

Conclusion

Hoping the next new versions of CAD-RADS classification would have addressed those vague situations and scenarios.
Role of Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) of Main Tumor in Breast Cancer in Prediction of Occult Axillary Lymph Node Metastasis
Authors: Kora Amir Tarek Borham , Othman Amal Ibrahim Ahmed , Mohamed Aya Yassin Ahmed
Published: August 2023

Background

In breast cancer, the axillary lymph node (ALN) status has been well established to be a significant prognostic factor and essential for treatment decisions that consider systemic and locoregional approaches. Axillary lymph node dissection (ALND) was performed to examine pathologic information regarding axillary lymph node during breast surgery (e.g. breast conserving surgery or mastectomy), which may cause critical complications such as lymphedema, pain, and movement restriction.

Aim of the Work

To assess the clinical significance of total lesion glycolysis (TLG) and metabolic tumor volume (MTV) of primary breast cancer using 18F-FDG PET/CT. To predict positive axillary lymph node metastasis in clinically negative axillary lymph nodes in breast cancer patients.

Methods

Between November 2020 and May 2021, The study was carried out on 40 female breast cancer patients with clinically negative axillary lymph nodes who had undergone surgical resection of the primary breast tumor followed by sentinel lymph node biopsy only or axillary lymph node dissection along with sentinel lymph node biopsy.

Results

We found that, 10 (25.0%) of total 40 patients were proven to have ALN metastasis based on the final pathology. A primary breast tumor with TLG > 6.2 &MTV > 4 was associated with a significantly higher prevalence of ALN metastasis than tumors with TLG ≤ 6.2& MTV ≤ 4.

Conclusion

We suggest that the metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of primary breast tumor were independent predictive factors for ALN metastasis. Since the incidence of pathologic ALN metastasis in breast cancer with cN-ALN is not negligible, volume-based PET/CT parameters of primary breast tumors upon preoperative workup may be potentially helpful to enhance the negative predictive value for occult ALN metastasis and to determine patient selection for surgical procedures.
Role of Artificial Intelligence in CXR Interpretation in Pediatric Intensive Care Unit Ain Shams University
Authors: Mahmoud Maha , Arafa Ahmed , Mohammad Shaimaa Abdelsattar , Yacoub George Ezzat Elkess
Published: August 2023

Background

Artificial intelligence (AI) is a branch of computer science in which statistical techniques are used to classify, simulate, or optimize data based on previous observations. An AI system can interpret and prioritize abnormal chest X-rays with critical findings, potentially reducing the backlog of exams and bringing urgently needed care to patients more quickly.

Aim of the Work

Our study aims to test the diagnostic performance of the AI system in PICU CXR interpretation regarding its sensitivity, specificity, as well as its accuracy. we also investigate the effect of AI aid on residents performance regarding diagnostic accuracy, sensitivity time consumption.

Patients and Methods

This was a Cross sectional study which conducted at Pediatric Ain Shams University Hospitals from January to June 2021. The study was performed on convenient sample consists of 30 CXRs done at the Ain Shams Pediatric hospital intensive care unit and meeting the study inclusion criteria.

Results

Overall in this study we found that the resident diagnostic accuracy, sensitivity and time consumption improved across a large number of clinical CXRs findings as well as strengthening of the residents agreement with the expert radiologist when assisted by the deep-learning model. Effective implementation of the model has the potential to improve clinical practice. Research is underway to assess the generalizability of results to various clinical environments and health systems.

Conclusion

We raised the possibility of the potential use of AI systems in future radiology workflows for preliminary interpretations that target the most prevalent findings, leaving the final reads to be done by a more experienced radiologist in a suitable practice atmosphere to catch any potential misses from the less-prevalent fine-grained findings.
Vesical Imaging-Reporting and Data System (VI-RADS): Inter-Observer Agreement and Impact of Reader's Experience
Authors: Taha Shohenda Magdy , Taha Noha Mohamed , Hussein Rasha S
Published: August 2023

Background

The Vesical Imaging Reporting and Data System (VI-RADS) is based on multiparametric MRI (mpMRI), to provide accurate information to differentiate between muscleinvasive bladder cancer (MIBC) and non-muscle –invasive bladder cancer (NMIBC).

Aim of the Work

To evaluate inter-observer agreement according to observer experience and diagnostic performance of the new scoring system based on magnetic resonance imaging called Vesical Imaging-Reporting and Data System (VI-RADS) to differentiate between invasive and non-invasive bladder cancer.

Patients and Methods

This study included 38 patients who were diagnosed with Transitional Cell Carcinoma (TCC) who underwent multiparametric Magnetic Resonance Imaging (mpMRI) at the department of Radiodiagnosis in Ain-Shams University from April 2021 till October 2021. Three radiologists with different levels of experience reviewed and scored all MRI examinations according to VI-RADS, compared them with the histopathological findings and inter-observer agreement was assessed.

Results

This study included 38 patients; the patients’ age ranged from 47 to 83 years old with mean age 62.26 (+8.18 SD). The total number of lesions in all cases were 43; 12 of them (27.9 %) were non-muscle-invasive urothelial carcinoma and 31 (72.1%) were muscle invasive. Using a VI-RADS score of 4 or greater as the cutoff value, the sensitivity, specificity, accuracy, PPV, and NPV for reader 1 were 96.8%, 83.3 %, 93%, 93.8%, and 90.9%, and for reader 2 were 93.5 %, 91.7%, 93%, 96.7% and 84.6%, and finally for reader 3 were 96.8%, 83.3%, 93 %, 93.8% and 90.9%. The agreement was excellent between each reader with the pathology and the readers with each other (Kappa over 0.75).

Conclusion

The Vesical Imaging-Reporting and Data System (VI-RADS) is an effective comprehensive scoring system, with satisfactory sensitivity, specificity, and diagnostic value for detecting detrusor muscle invasion. We can recommend VI-RADS scoring for use in the prediction of detrusor muscle invasion in patients with bladder cancer, but further multicenter validation studies containing multiple magnetic field strength devices also must be conducted.
Hepatocellular Carcinoma in Hepatitis C Virus Patients after Treatment by Directly Acting Antiviral Drugs Compared to Hepatitis C Virus Non Treated Patients
Authors: Mahmoud Ahmed Abd Elhamid , Aly Heba Ismail Saad , Montasser Iman Mohamed Fawzy , EL Gindy Eman Mohamed
Published: August 2023

Background

Hepatocellular carcinoma (HCC) is one of the most prevalent cancers globally. It is considered as leading cause of cancer related death that occurs mostly in patients with underlying significant liver fibrosis and cirrhosis.

Objective

to compare characteristics and behavior of de novo Hepatocellular carcinoma (HCC) in chronic HCV patients who received direct acting antiviral treatment with those who didn't receive DAAs.

Patients and Methods

The study was conducted on patients with de novo HCC presented at HCC Clinic and Tropical medicine department at Ain Shams University Hospitals from January 2019 to January 2020. Total number of HCC cases visited the HCC clinic was 382 patients. 196 patients with de novo HCC were enrolled in the study according to inclusion criteria and divided into two groups: Group (A): included 79 patients with de novo HCC that received DAAs according to NCCVH. 64 males (81%), 15 females (19%) with mean age of 60 years. Group (B): included 117 patients with de novo HCC that didn’t receive DAAs treatment before; 82 males (70.1%) 35 females (29.9%) with a mean age of 61.9 years.

Results

In the current study we found there was no difference in tumor aggressiveness between patients with de novo HCC following DAA and patients with HCC that didn’t receive DAA regarding different scoring system except for Child pugh score was significantly higher in group (A), and for BCLC staging was significantly more advanced in group(A). The Current study revealed 69 patients (87.3%) of Group (A) achieved SVR with DAAs. with no significant statistical value between different regimens of DAAs regarding relapsing rate or behavior of HCC.

Conclusion

Despite the great advance in HCV treatment in the era of DAA drugs, HCC remains to be a great risk for cirrhotic patients. Moreover, patients with a history of HCC have to be closely monitored before and after treatment with DAA. There were no difference between studied group regarding tumor size, tumor number, tumor site, tumor extension, tumor metastasis, vascular invasion or AFP. but lymph node invasion was more significant in group (A). There were no difference between studied group regarding Child grade, FIB-4 score or PST. Patients of group (A) showed more advanced liver disease regarding BCLC stage than those of group (B).
From the Patient to the Human Experience
Authors: Kirton Carl A.
Published: August 2023

Designing a health care system that is safe and equitable
National Drug Shortages Affect Patient Care
Authors: Fink Jennifer
Published: August 2023

Navigating record-high, ongoing shortages
The Clinical Nurse Specialist
Authors: Saunders Mitzi M. , Heiden Giulia
Published: August 2023

These APRNs improve the workflow of nurses in health care systems.
Pneumococcal Vaccination in Adults
Authors: Walter Joseph , Rudawsky Nicole
Published: August 2023

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recently updated the adult pneumococcal vaccine recommendations to include two new pneumococcal conjugate vaccines (PCVs): PCV15 and PCV20. The authors review the updated guideline recommendations, their advantages and disadvantages, and nursing implications.
Supporting new graduate nurses' transition to practice
Authors: Riess Dawn L.
Published: August 2023

How new graduate nurses are supported may determine whether or not they stay at the bedside. A strong preceptorship, mentoring, and support system can retain and grow this workforce. This article presents practical guidelines for experienced nurses when supporting colleagues new to clinical practice.
Oral and oropharyngeal cancer
Authors: Pullen Richard L.
Published: August 2023

Approximately 1 in 60 men and 1 in 141 women will develop oral and oropharyngeal cancer in the US. This article presents the risk factors, pathogenesis, clinical presentation, and management of patients with oral and oropharyngeal squamous cell carcinoma.
HOCUS POCUS: ultrasound beyond regional anesthesia in the ambulatory setting
Authors: Arumugam Sivasenthil , Siddaiah Harish , Kalagara Hari
Published: August 2023

Purpose of review

Application of ultrasound in clinical anesthesia practice extends beyond regional anesthesia. In this review, we have discussed other point of care applications of ultrasound in perioperative care and anesthetic management with special emphasis on ambulatory practice.

Recent findings

Point of care ultrasound (POCUS) for anesthesiologists has gained widespread interest and popularity. Recent literature has highlighted multiple perioperative POCUS applications on various organ systems and its benefits. We have analyzed the recent available data and evidence for perioperative POCUS, its benefits and limitations in perioperative medicine.

Perioperative POCUS skill is a natural extension of ultrasound guided regional anesthesia. Utilizing POCUS in the perioperative period would accelerate the level of appropriate care, safety and improve outcomes in ambulatory centers. More anesthesiologists embracing POCUS would enhance patient care in a timely fashion at the ambulatory centers. POCUS in ambulatory practice can be valuable in avoiding delay or cancellation of surgeries and improving patient satisfaction.
Effectiveness of Virtual Reality Simulation Among BSN Students: A Meta-analysis of Randomized Controlled Trials
Authors: Uslu-Sahan Fatma , Bilgin Aylin , Ozdemir Leyla
Published: August 2023

This study aimed to evaluate the effect of virtual reality simulation in nursing education in five domains: knowledge, skill performance, self-confidence, self-efficacy, and satisfaction. Randomized controlled trials were obtained from the databases SCOPUS, Web of Science, PubMed, and EBSCO from inception until September 2021. The standardized mean differences with 95% confidence intervals were determined for the main variables, and heterogeneity was analyzed using the I
2 test. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Checklist was used. Meta-analysis was performed using the Stata 15.0 software. Among the 2074 records identified, 18 trials were included. The meta-analysis of these trials indicated that virtual reality simulation caused a significant improvement in knowledge with a moderate effect, skill performance with a moderate effect, and satisfaction with a moderate effect compared with the control group. However, virtual reality simulation did not significantly influence self-confidence and self-efficiency. The findings of this study suggested that virtual reality simulation might significantly benefit knowledge, skill performance, and satisfaction but not self-confidence and self-efficiency. Further well-designed randomized controlled trials with a larger sample size are recommended to confirm these findings.
Analysis of Inclusive Gender, Sexuality and Sexual Orientation Data Elements in Academic Electronic Health Records
Authors: Byrne Matthew , Borzalski Cheena
Published: August 2023

Findings from an analysis of three vended academic electronic health records used in health science education are presented in this article. The quality assurance project examined the lexical and semantic fit and content coverage of gender, sexuality, and sexual orientation data elements within the academic electronic health records. A semantic comparative content analysis using a cognitive walkthrough was conducted as a means of comparing the ideal set of gender, sexuality, and sexual orientation data elements with those found in the three vended academic electronic health records. The results indicated a need for alignment to the research literature, expert consensus, and technical standards similar to what is expected for electronic health records used in clinical practice because of a lack of ideal state data elements. The findings align with ongoing issues with bias and disparities seen in the care of the lesbian, gay, bisexual, and transgender population and a lack of diverse, inclusive media and teaching technologies in health science education. The quality project and findings can inform academic electronic health record vendors on how they can create more inclusive systems and bring awareness to healthcare educators about the potential for implicit and explicit bias in their teaching technologies.
Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants
Authors: Wu Lei , Wei Siwei , Xiang Zhen , Yu Eryou , Chen Zheng , Qu Shuangquan , Du Zhen
Published: August 2023

BACKGROUND

Neuromuscular block (NMB) is routinely used in paediatric and adult anaesthesia to facilitate endotracheal intubation and optimise surgical conditions. However, there are limited data regarding NMB and optimising the conditions for laparoscopic surgery in neonates and small infants.

OBJECTIVE

The goal of this study was to determine the effect of NMB on the conditions for laparoscopic surgery in neonates and small infants.

DESIGN

A randomised controlled trial.

SETTING

Single-centre Children's Hospital, conducted from November 2021 to December 2022.

PATIENTS

One hundred and two ASA I–II neonates and small infants aged up to 60 weeks postmenstrual age who were scheduled to undergo an elective laparoscopic Ladd's procedure were included in the study.

INTERVENTIONS

Patients were randomised into three groups: no NMB group, shallow NMB group and moderate NMB group. Each group was given different doses of rocuronium to achieve the target depth of NMB.

MAIN OUTCOME MEASURES

The primary outcome was the quality of the surgical conditions evaluated with the Leiden-Surgical Rating Scale (L-SRS) by a blinded surgeon. Secondary outcomes included tracheal intubating conditions and adverse events.

RESULTS

The percentage of L-SRS scores of 4 or 5 was similar among the three groups at all the assessment times (P > 0.05 for each time interval). The distribution of L-SRS scores was also similar among the three groups. There were no significant differences in operating condition scores between the groups at any time interval (P > 0.05 for each time interval). The incidence of adverse events during anaesthesia induction was significantly higher in the no NMB group (51.4%) than in the other two groups (13.6% and 14.7%) (adjusted P = 0.012 and adjusted P = 0.003). In particular, clinically unacceptable intubation conditions occurred in 12 patients (34.3%) in the no NMB group, significantly more than in the shallow NMB group (6.1%, adjusted P = 0.012) and moderate NMB group (2.9%, adjusted P = 0.003). There was no statistically significant difference in the incidence of adverse events in the PACU among the three groups (P = 0.103).

CONCLUSIONS

The depth of NMB was not associated with superior surgical conditions during laparoscopic surgery, but it was associated with a reduction in adverse events during induction and maintenance of anaesthesia in neonates and small infants.

TRIAL REGISTRATION

Registered at www.chictr.org.cn (ChiCTR2100052296).
The evolving role of emergency medicine in family planning services
Authors: Preiksaitis Carl , Henkel Andrea
Published: August 2023

Purpose of review

The emergency department serves as an essential access point for a variety of healthcare services. This review will examine the recent expansion of family planning and reproductive health services in the emergency department.

Recent findings

An increasing number of patients present to emergency departments for early pregnancy loss (EPL), abortion care, and contraceptive management. Availability of comprehensive EPL management varies dramatically, possibly due to lack of provider knowledge or training. Particularly in remote settings, educational interventions – such as providing information about medication management and training in uterine aspiration – may standardize this management. Restrictive abortion laws raise concerns for changing and increased patient presentations to the emergency department for complications related to unsafe or self-managed abortion. Emergency medicine providers should anticipate that more patients will present without a prior ultrasound confirming intrauterine pregnancy prior to initiating no-touch or self-managed abortions. Particularly among pediatric patients, there may be a role for contraceptive counseling during an emergency department visit. Novel strategies, including web-based interventions and emergency department-based curricula for contraceptive counseling, may help reach those who otherwise may not seek reproductive healthcare in a clinic setting.

The intersection of emergency medicine and reproductive healthcare is a promising frontier for providing immediate, patient-centered, family planning care. Continued research and provider education are necessary to refine these approaches, address disparities, and respond to the changing reproductive healthcare landscape.
Moving Forward with ESG, Sustainability, and Corporate Responsibility
Authors: Nakielski Monica L.
Published: August 2023

Healthcare leaders have two especially profound responsibilities. In addition to ensuring quality, they must also drive sustainable practices that benefit their organizations, communities, and the planet. Environmental, social, and governance (ESG) principles—along with sustainability and corporate social responsibility (CSR) concepts—have gained significant prominence in recent years, and an understanding of their nuances within healthcare and in the general business context is essential for effective governance and implementation. To fully integrate ESG principles into their operations, healthcare leaders should understand the essential role of governance in ESG and the differences among ESG, sustainability, and CSR. The concrete examples provided here will illustrate the relevance of ESG reporting frameworks to healthcare operations.
Transfusion thresholds in acute coronary syndromes
Authors: Mistry Nikhil , Jiang Helen , Chin Kyle , Hare Gregory M.T. , Verma Subodh , Mazer C. David
Published: August 2023

Purpose of review

Anemia is prevalent in patients with acute coronary syndromes. In this setting, there is uncertainty and controversy surrounding the optimal transfusion strategy for managing anemia. The goal of this review is to summarize the current clinical evidence, guidelines, and future directions for managing transfusion in acute coronary syndromes.

Recent findings

There is limited evidence from randomized trials evaluating restrictive versus liberal transfusion in patients hospitalized with and/or for acute coronary syndromes. The results from these studies suggest clinical equipoise between transfusion strategies for short term outcomes, and a trend toward favoring a liberal strategy for long term major adverse cardiac events. There is inconsistency across clinical practice guidelines with respect to the optimal strategy for managing anemia and transfusion in acute coronary syndromes due to insufficient evidence.

More evidence is urgently needed to conclusively establish the optimal strategy for transfusion management in the setting of acute coronary syndromes. These data will directly inform harmonization of clinical practice guidelines. Future investigations should explore alternative strategies to hemoglobin for quantifying the degree of anemic stress for personalizing transfusion therapy, the effects on functional outcomes, and managing anemia following hospital discharge.
Minimization of facial synkinesis
Authors: Tikhtman Raisa , Hsieh Tsung-yen
Published: August 2023

Purpose of review

To summarize the treatment options available for the management of postparalytic facial synkinesis which include facial rehabilitation, chemodenervation, and a spectrum of surgical interventions.

Recent findings

Facial rehabilitation and botulinum toxin chemodenervation represent the foundation of facial synkinesis management, with specific treatment paradigms directed by individual patient needs. Evolving surgical approaches range from isolated selective myectomies or neurectomies to combination approaches which may incorporate various types of nerve transfer with gracilis free muscle transplantation.

Postparalytic facial synkinesis bears significant patient morbidity due to aesthetic and functional implications. Management strategies must balance patient goals with treatment risks and typically progress stepwise from the least to most invasive interventions. Emerging techniques reveal a convergence in approaches to facial reanimation and synkinesis mitigation.
A Clinician’s Guide to Gluten Challenge
Authors: Singh Arunjot , Kleinhenz Julia , Brill Herbert , Fahey Lisa , Silvester Jocelyn A. , Sparks Brandon , Verma Ritu , Lee Dale , Mallon Daniel , Leonard Maureen M.
Published: August 2023

Gluten challenge is an essential clinical tool that involves reintroducing or increasing the amount of gluten in the diet to facilitate diagnostic testing in celiac disease (CD). Nevertheless, there is no consensus regarding the applications of gluten timing, dosing, and duration in children. This review aims to summarize the current evidence, discuss practical considerations, and proposes a clinical algorithm to help guide testing in pediatric patients.

Childhood development, social circumstances, and long-term health concerns must be considered when identifying a candidate for gluten challenge. Based on previous studies, the authors suggest baseline serology followed by a minimum of 3–6 grams of gluten per day for over 12 weeks to optimize diagnostic accuracy for evaluation of CD. A formal provider check-in at 4–6 weeks is essential so the provider and family can adjust dosing or duration as needed. Increasing the dose of gluten further may improve diagnostic yield if tolerated, although in select cases a lower dose and shorter course (6–12 weeks) may be sufficient.

There is consensus that mild elevations in celiac serology (<10 times the upper limit of normal) or symptoms, while supportive are not diagnostic for CD. Current North American Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines recommend histologic findings of intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy as the accurate and most appropriate endpoint for gluten challenge.
A feasibility study of application of purpose-design frame and 3-D clinical ultrasound in assessment and design of spinal orthoses for adolescent idiopathic scoliosis
Authors: Hassan Beygi Babak , Lou Edmond , Sin Sai Wing , Kwok Wing Kwan , Kee Ho Man , Wong Man Sang
Published: August 2023

Background:

The immediate in-orthosis correction of adolescent idiopathic scoliosis (AIS) is a useful prognostic parameter for the long-term orthotic treatment outcome. The 3-D clinical ultrasound technique is considered a noninvasive alternative to assess scoliotic deformities that could be applied in the orthotic treatment of AIS.

Objective:

This study aimed to investigate the feasibility of a purpose-design assessment frame in estimating biomechanical effects of the controlling pads of a spinal orthosis under the guidance of the ultrasound system.

Methods:

Twenty-six subjects with AIS were recruited and arranged to position inside the assessment frame, and controlling pads were applied strategically while the scoliotic deformities were assessed by clinical ultrasound to obtain at least 30% curvature correction, and the body shape was then captured using a computer-aided design and computer-aided manufacture system, and spinal orthoses were subsequently fabricated. The preorthosis and immediate in-orthosis coronal and sagittal X-rays were used for comparison.

Results:

X-ray assessments showed that the mean coronal Cobb angle and lumbar lordosis of the subjects from the preorthosis to immediate in-orthosis visits decreased significantly (p < 0.05) from 29.6° to 16.6°, and from 47.2° to 35.3°, respectively.

Conclusions:

This feasibility study showed that the proposed method would have a good potential to improve orthotic treatment outcome in a documented approach that should be considered for implementation into routine clinical practice aiming to reduce the chance of deformity deterioration leading to surgical intervention. However, a controlled group study is required to compare the results.
Predictors of Cognitive Change in Parkinson Disease
Authors: Gasca-Salas Carmen , Duff-Canning Sarah , McArthur Eric , Armstrong Melissa J. , Fox Susan , Meaney Christopher A. , Tang-Wai David F. , Gill David , Eslinger Paul J. , Zadikoff Cindy , Marshall Fred J. , Mapstone Mark , Chou Kelvin L. , Persad Carol , Litvan Irene , Mast Benjamin T. , Gerstenecker Adam T. , Weintraub Sandra , Marras Connie
Published: August 2023

Background:

Mild cognitive impairment is common in Parkinson disease (PD-MCI). However, instability in this clinical diagnosis and variability in rates of progression to dementia raises questions regarding its utility for longitudinal tracking and prediction of cognitive change in PD. We examined baseline neuropsychological test and cognitive diagnosis predictors of cognitive change in PD.

Methods:

Persons with PD, without dementia PD (N=138) underwent comprehensive neuropsychological assessment at baseline and were followed up to 2 years. Level II Movement Disorder Society criteria for PD-MCI and PD dementia (PDD) were applied annually. Composite global and domain cognitive z-scores were calculated based on a 10-test neuropsychological battery.

Results:

Baseline diagnosis of PD-MCI was not associated with a change in global cognitive z-scores. Lower baseline attention and higher executive domain z-scores were associated with greater global cognitive z-score worsening regardless of cognitive diagnosis. Worse baseline domain z-scores in the attention and language domains were associated with progression to MCI or PDD, whereas higher baseline scores in all cognitive domains except executive function were associated with clinical and psychometric reversion to “normal” cognition.

Conclusions:

Lower scores on cognitive tests of attention were predictive of worse global cognition over 2 years of follow-up in PD, and lower baseline attention and language scores were associated with progression to MCI or PDD. However, PD-MCI diagnosis per se was not predictive of cognitive decline over 2 years. The association between higher executive domain z-scores and greater global cognitive worsening is probably a spurious result.
Temperature-dependent synthesis of dimethyl ether (DME) from methanol over beta zeolite: a novel approach to a sustainable fuel
Authors: Chaudhary Puneet Kumar , Arundhathi Racha , Kasture Mahesh W. , Samanta Chanchal , Vankayala Rakesh , Thota Chiranjeevi
Published: August 2023

Crystalline beta zeolite molecular sieve with SiO
2
/Al
2
O
3
molar ratio of 28.5 was synthesized by the hydrothermal crystallization method and examined for methanol dehydration reaction. The micro-mesoporous beta zeolite was active between 280 and 450°C. Dimethyl ether (DME) was observed as the predominant product at all reaction temperatures, with a maximum selectivity of 47.9% at 300°C and a methanol turnover frequency (TOF
MeOH
) of 741.9 h
−1
. At increased reaction temperatures, beta zeolite showed enhanced strong acid site fraction, promoting higher hydrocarbon formation following the olefin-based cycle. It was revealed that the crystallinity, porosity and acidity of beta zeolite change in the reaction environment. Amorphous carbon deposition occurred on beta zeolite, which involved a loss in crystallinity to some extent. The temperature increase showed a pore-broadening phenomenon at elevated temperature regions. Regeneration cycle testing demonstrated beta zeolite activity maintained stable throughout a 280 h time-on-stream period.
A sustainable food future
Authors: Horton Peter
Published: August 2023

The adverse environmental impacts of food production, the ill-health resulting from excess consumption and malnutrition, and the lack of resilience to the increasing number of threats to food availability show that the global system of food provision is not fit for purpose. Here, the causative flaws in the food system are identified and a framework presented for discovering the best ways to eliminate them. This framework is based upon an integrated view of the food system and the socio-economic systems in which it functions. The framework comprises an eight-point plan to describe the structure and functioning of the food system and to discover the optimum ways to bring about the changes needed to deliver a sustainable food future. The plan includes: priorities for research needed to provide options for change; an inclusive analytical methodology that uses the results of this research and incorporates acquisition, sharing and analysis of data; the need for actions at the local and national levels; and the requirements to overcome the barriers to change through education and international cooperation. The prospects for implementation of the plan and the required changes in the outcomes of the food system are discussed.