bluuebunny/crossref_metadata_2025 huggingface dataset:
Are We Monitoring Our Lithium Patients as Well as We Should be? A Two-Cycle Audit Evaluating Lithium Clinic Documentation in a District General Hospital in Wales
Authors: Mohammed Huda , Islam Rahatul , Sparrow Cressida , Chan Timothy
Published: August 2024

Aims

Lithium is a mood-stabiliser with a narrow therapeutic index. Patients are known to be at risk of lithium toxicity if they are unaware of how to recognise its signs. NICE guidelines outline the information that must be relayed to these patients. Furthermore, GMC Good Medical Practice highlights the importance of clear and contemporaneous patient records that contain relevant clinical information.

The aim of this two-cycle audit was to assess the quality of documentation for patients reviewed in lithium clinic and to analyse the consistency of the notes recorded to ensure high quality care provision and communication within the department, in line with the NICE guidelines.

Methods

The inclusion criteria were patients over the age of 65, prescribed lithium and were actively reviewed in the monthly lithium clinic at the Older Person's Mental Health Service (OPMHS) at Princess of Wales Hospital in Wales.

A data collection form was created to ensure all the relevant data in line with NICE guidelines was captured including serum lithium level, lithium dose, other psychotropics, side effects, renal function, patient mood, safety netting advice provided including signs of toxicity and awareness of lithium card. A standard of 100% was set for this data to be captured for each patient.

Results

Cycle 1 was completed in November 2023 where a total of 18 patient records were selected (N = 18). Lithium dose, lithium level and renal function were recorded in over 83.3% (n = 15) of the files audited. Details on psychotropics were recorded in 61.1% (n = 11), side effects in 50% (n = 9) and patient mood in 77.8% (n = 14). Safety netting advice was recorded in 11.1% (n = 2). Furthermore, it was noted data recorded varied between clinicians.

The results of this audit were disseminated to OPMHS team. A proforma was introduced to encourage capture of all relevant information and to ensure consistency. Feedback was collected from clinicians using the proformas and relevant changes were made.

A second cycle of this audit was carried out after the proforma was introduced to the subsequent clinic (N = 12). This showed an improvement in record-keeping including lithium dose, lithium levels, psychotropics and side effects of 100% (n = 12). Renal function and mood were recorded in 91.7% (n = 11) of files and safety netting advice provision in 75% (n = 9) of files audited.

Conclusion

Introduction of a proforma is a simple and effective way to ensure relevant and important details are documented. This is not only for good clinical practice, but for medico-legal reasons also.
An Interdisciplinary Approach to the Management of Ketamine Induced Uropathy
Authors: McKnight Rebecca , Horgan Patrick
Published: August 2024

Aims

This report describes the treatment of a patient with ketamine induced uropathy. This condition can be significantly debilitating due to its severe effect on the urinary system. This report outlines an interdisciplinary approach to the care of the patient involving addictions services, urology and primary care.

Methods

The patient presented with a history of inhalation of ketamine intermittently for four years and daily for three years. His highest daily use was 14 grams per day.

He developed multiple urinary symptoms including dysuria, urgency, incontinence, haematuria and abdominal and urethral pain. He had significant weight loss and suicidal thoughts. After six years of use, he was reviewed by urology, however was discharged within a year, after missing appointments. Investigations included ultrasound which showed kidneys of normal appearance; flexible cystoscopy which showed a small bladder with acute bleeding and posterior wall ulcer; urodynamic studies showed overactive bladder.

He attended a private, inpatient detoxification programme, however relapsed after this admission and self-referred to local addictions services. When assessed there, a detailed history and physical examination were completed. Baseline electrocardiogram and blood investigations were completed and were broadly normal.

It was felt that a collaborative approach between addictions services, primary care, urology, and a regional addictions detoxification centre could help him manage his symptoms and achieve more sustained abstinence. Following interdisciplinary discussions, he was commenced on solifenacine to treat his urinary frequency, mirtazapine for his mood and buscopan for pain. Motivation interviewing approaches were used to help him reduce his ketamine use.

Results

Ketamine is a synthetic drug with marked dissociative, stimulant and hallucinogenic properties. There has been a rising trend in adults entering treatment with harmful ketamine use in recent years. In 2023, 2,211 people entered treatment for harmful ketamine use in England, a fivefold increase from 2014. Ketamine induced uropathy would be expected to occur in a high proportion of these people. A survey of adolescents demonstrated that 60% of ketamine users had lower urinary tract symptoms. There are a range of medical and surgical options to treat ketamine induced uropathy but no clear agreed approach for its holistic management in the UK.

Conclusion

This case report highlights the consequences of prolonged ketamine use on the urinary tract system. It highlights an example of effective interdisciplinary working between addictions services, primary care and urology. The authors recommend the development of nationally agreed guidelines on ketamine induced uropathy with emphasis on collaborative, inter-service working.
Transcending Erotomania: A Case of Long-Term Multi-Comorbid Management in an Adolescent Medium Secure Unit
Authors: Shahid Manzar , Shah Parag , Siddique Muhammad Saqib
Published: August 2024

Aims

20 year old patient open to mental health services since the age of 8. Through the years, they have had work-up and diagnoses of ADHD, ASD, Schizoaffective Disorder (with prominent erotomanic delusions) and sexual identity concerns.

They spent a number of years in psychiatric in-patient units following an index offence. Initially in an adolescent LSU and subsequently in an adolescent MSU.

After 5 years of their stay at the MSU, their transition to an adult rehabilitation ward was planned and completed.

Methods

20 year old, oldest of 5 siblings, born with no complications during or after pregnancy and at full-term. First referred to mental health services aged 6 regarding difficulties at school leading to a diagnosis of ADHD.

At age 13, re-engaged with mental health services following concerns around self-harm, disappearing from home, alcohol use. Also with difficulties around gender identity and sexual orientation. Shortly after, elements of ASD were identified, including social and communication difficulties and special interests which included single females.

Around age 16, patient developed erotomanic delusions. First towards a female friend in dance class – patient wanted to run away with them and have their babies, and carried a knife to hurt anyone who tried to get in their way, eventually leading to the index offence. In addition, there were similar erotomanic delusions with regards to at least 2 famous female music personalities.

With a significant mood component accompanying the psychosis, she was diagnosed and managed as having Schizoaffective Disorder.

Results

The patient presented with a complex, multimodal presentation which took time and a comprehensive holistic approach. They were trialled on 3 different antipsychotics and eventually clozapine which needed stopping due to side effects. Best response was eventually observed with a return to olanzapine.

Patient also had 19 treatments of ECT (13 being high dose) with marked transient improvement.

Psychology, OT and the MDT largely focussed on building therapeutic relationships with the patient which gradually helped the patient develop insight around their erotomanic delusions and the impact on their life.

Conclusion

Despite the complexities of this case, it highlighted that a robust, consistent, holistic approach can change lives even though this may take some time. The patient was utilizing leaves off the ward, taking part in the education sessions and activities on the ward and has recently been transferred to an adult rehabilitation ward after years in an adolescent specialist in-patient service.
The impact of transformational leadership on workers’ personal resources: latent profile analysis and links with physical and psychological health
Authors: Cortés-Denia Daniel , Pulido-Martos Manuel , Bosak Janine , Lopez-Zafra Esther
Published: August 2024

Background

Several studies have examined the impact of leadership on employee well-being and health. However, this research has focused on a variable-centred approach. By contrast, the present study adopts a person-centred approach.

Aims

To (a) identify latent ‘resources’ profiles among two samples combining vigour at work, work engagement and physical activity levels; (b) examine the link between the identified profiles and indicators of psychological/physical health; and (c) test whether different levels of transformational leadership determine the probability of belonging to a particular profile.

Method

Two samples of workers, S1 and S2 (NS1 = 354; NS2 = 158), completed a cross-sectional survey before their annual medical examination.

Results

For S1, the results of latent profile analysis yielded three profiles: spiritless, spirited and high-spirited. Both high-spirited and spirited profiles showed a positive relationship with mental health, whereas spiritless showed a negative relationship. For S2, two profiles (spirited and spiritless) were replicated, with similar effects on mental health, but none of them was related to total cholesterol. In both samples, transformational leadership determined the probability of belonging to a particular profile.

Conclusions

Transformational leadership increased the probability of belonging to a more positive profile and, therefore, to better workers’ health.
Systematic Review of Referral and Care Pathways for Children and Young People of Black Ethnicity Through Child and Adolescent Mental Health Services Compared With Other Ethnic Groups: An International Comparison
Authors: Odebiyi Babatunde , Ani Cornelius , Sultana Rezina , Ayodeji Eunice , Dubicka Bernadka
Published: August 2024

Aims

The review explored differences in sources of referrals and utilisation of child and adolescent mental health services (CAMHS) among children and young people (CYP) of black ethnicity compared with other ethnicities. We also explored international differences.

Methods

We searched MEDLINE (through Ovid), PsycINFO, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Web of Science using a priori defined search terms to identify relevant records. We used the “Population, Exposure, and Outcome” (PEO) framework to define search terms. Pairs of authors assessed papers for inclusion, extracted the data and conducted quality assessment. The systematic review was pre-registered with PROSPERO (CRD42021249619).

Results

We identified 110 studies which all had quantitative design. The results indicate that compared with other ethnic groups, CYP of black ethnicity were less likely to be screened for mental disorders, and more likely to be referred by non-voluntary sources such as social/child welfare services and juvenile justice systems. CYP of black ethnicity were also less likely to utilise all types and levels of mental health services with the exception of school-based services. CYP of black ethnicity were less likely to access psychological intervention or to be prescribed psychotropic medications. Also, CYP of black ethnicity were more likely to experience coercive treatments, and to receive poorer quality of care. These findings were similar across different countries.

Conclusion

CYP of black ethnicity experience significant disadvantages across their care journeys through CAMHS. Addressing the drivers for these disadvantages is crucial for improving access to care for this group.
Emergency Department (ED) Walkouts in a Mental Health Crisis: West London NHS Trust Liaison Psychiatry Response to the London Metropolitan Police's Right Care Right Person Approach
Authors: Bielli Margherita , Rosen David , Patel Sachin , Cho Yena
Published: August 2024

Aims

Patients walking out of ED during mental health crises are commonly encountered in Liaison Psychiatry. Responsibility for high-risk or vulnerable walkouts had predominantly fallen on the police due to resource pressures in health and social care services. In 2023, London's Metropolitan Police announced a new partnership model, the “Right Care Right Person” (RCRP) approach. This supported the withdrawal of police involvement in mental health crises and allowed health and social care agencies who have the expertise and authority to act, to fulfil their role. This QI project aimed to understand the extent of police involvement in ED walkouts prior to the implementation of RCRP, introduce a new protocol for managing these situations, and evaluate its impact in terms of resource use and patient outcomes.

Methods

The Trust's incident reporting system was used to identify mental health-related ED walkouts between May–August 2023, prior to the introduction of RCRP. Patients’ notes were reviewed to identify immediate actions taken following the walkout, including whether the police were involved, what action they took and patient outcomes. This was used to create a new Trust-wide ED walkout protocol, incorporating the Metropolitan Police's risk assessment tools. This was disseminated to frontline staff. A repeat analysis took place in November–December 2023, post-RCRP, to analyse how ED walkouts were being managed, and by which service. Furthermore, the analysis explored the nature of any patient harm which occurred following the incidents.

Results

We found 29 walkouts from A&E between May–August 2023 (pre-RCRP), compared with 35 between November–December 2023 (post-RCRP). Police were called in 79% of cases pre-RCRP and 74% post-RCRP. Pre-RCRP police was not involved in 41% of cases, and in 81% of cases post-RCRP. Mental health services made first contact following walkout in 41% of cases pre-RCRP, and in 46% post-RCRP. LAS made contact in 29% of cases post-RCRP. Post-RCRP 26% of patients who walked out were admitted to a Mental Health Trust within 7 days. 20 patients had their treatment delayed, 5 suffered from neglect. 3 patient walkouts resulted in harm to others, and 2 resulted in self-harm.

Conclusion

As expected, police responded to fewer walkout reports, and our data shows this gap has been filled by other services. The Trust's risk assessment-based approach to managing walkouts has shown promising results. The next stage of the project will focus on developing local protocols for the identification and management of patients at high risk of walkout.
Trastuzumab Deruxtecan in Advanced Solid Tumors With Human Epidermal Growth Factor Receptor 2 Amplification Identified by Plasma Cell-Free DNA Testing: A Multicenter, Single-Arm, Phase II Basket Trial
Authors: Yagisawa Masataka , Taniguchi Hiroya , Satoh Taroh , Kadowaki Shigenori , Sunakawa Yu , Nishina Tomohiro , Komatsu Yoshito , Esaki Taito , Sakai Daisuke , Doi Ayako , Kajiwara Takeshi , Ono Hiromi , Asano Masatoshi , Hirano Nami , Odegaard Justin , Fujii Satoshi , Nomura Shogo , Bando Hideaki , Sato Akihiro , Yoshino Takayuki , Nakamura Yoshiaki
Published: August 2024

PURPOSE

HERALD/EPOC1806 was conducted as a multicenter phase II trial assessing trastuzumab deruxtecan (T-DXd) therapy for patients with human epidermal growth factor receptor 2 (
HER2
)–amplified progressive stage solid tumors detected by cell-free DNA (cfDNA) testing.

PATIENTS AND METHODS

Patients exhibited advanced solid tumors with
HER2
amplification that was identified via next-generation sequencing of cfDNA testing, without the requirement for immunohistochemical HER2 testing. The studied group was administered T-DXd at 5.4 mg/kg once every 3 weeks until onset of disease progression or intolerable toxicity.

RESULTS

Overall, 4,734 patients underwent cfDNA testing from December 2019 to January 2022, and 252 demonstrated
HER2
amplification. Finally, the study included 62 patients with 16 cancer types with a median baseline plasma
HER2
copy number (CN) of 8.55 (range, 2.4-73.9). Confirmed overall response rate (ORR) by investigator assessment was 56.5% (95% CI, 43.3 to 69.0), thus showing a value beyond the 5% threshold. Responses were evaluated for 13 cancer types, including
KRAS
-mutant colorectal (1/3),
PIK3CA
-mutant endometrial (5/6), and tissue HER2-negative gastric (1/2) cancers. Plasma
HER2
CN above versus below the baseline median value did not differ for impact response; however, clearance of
HER2
amplification in cfDNA on cycle 2 day 1 had higher response values compared with persistence. Median progression-free survival and response duration were 7.0 (95% CI, 4.9 to 9.7) and 8.8 (95% CI, 5.8 to 11.2) months, respectively, with the majority of complications being mild to moderate. Interstitial lung diseases were identified in 16 (26%) patients, including 14 patients with grade 1 disease, one patient with grade 2 disease, and one patient with grade 3 disease.

CONCLUSION

T-DXd treatment demonstrated high ORR with durable response in patients with advanced
HER2
-amplified solid tumors determined with cfDNA testing.
Relationship Between 1,5-Anhydroglucitol and Renal Function Assessed by Dynamic Renal Scintigraphy in Type 2 Diabetes
Authors: Ni Jiaying , Su Hang , Wang Yaxin , Lu Wei , Wang Yufei , Bao Yuqian , Lu Jingyi , Zhou Jian
Published: August 2024

Context

The reliability of serum 1,5-anhydroglucitol (1,5-AG) in patients with type 2 diabetes and renal insufficiency remains controversial.

Objective

To evaluate the relationship between renal function and serum 1,5-AG and to assess the extent to which renal function influences 1,5-AG.

Methods

A total of 5337 participants with type 2 diabetes were enrolled. The measured glomerular filtration rate (mGFR) was assayed using 99mTc-DTPA dynamic renal scintigraphy. All subjects were stratified into 5 groups based on mGFR (≥120 [n = 507], 90-120 [n = 2015], 60-90 [n = 2178], 30-60 [n = 604], and <30 mL/min/1.73 m2 [n = 33]).

Results

Overall, the serum 1,5-AG and mGFR levels were 3.3 (1.7-7.0) μg/mL and 88.6 ± 24.1 mL/min/1.73 m2, respectively. mGFR was found to be negatively correlated with 1,5-AG levels (r = −0.189, P < .001). Multiple linear regression revealed that mGFR was independently and negatively related to serum 1,5-AG after adjusting for covariates including hemoglobin A1c (HbA1c; P < .001). In subgroups with mGFR ≥ 30 mL/min/1.73 m2, the correlation coefficients between 1,5-AG and HbA1c, fasting plasma glucose, postprandial plasma glucose, and the differences between postprandial and fasting plasma glucose remained significant (range, −0.126 to −0.743, all P < .01). However, the link between 1,5-AG and traditional glycemic markers was attenuated in individuals with mGFR < 30 mL/min/1.73 m2. Sensitivity analysis after excluding anemic patients showed similar results regarding the relationship between serum 1,5-AG and HbA1c across the mGFR subgroups.

Conclusion

Although we observed a weak inverse correlation (r = −0.189) between mGFR and serum 1,5-AG in type 2 diabetes, 1,5-AG remains a valid marker for assessing glucose control in subjects with mild or moderate renal dysfunction.
The Association Between Thyroid Differentiation Score and Survival Outcomes in Papillary Thyroid Carcinoma
Authors: Wang Jennifer R , Zafereo Mark E , Cabanillas Maria E , Wu Chia Chin , Xu Li , Dai Yaoyi , Wang Wenyi , Lai Stephen Y , Henderson Ying , Erasmus Lauren , Williams Michelle D , Joshu Corinne , Ray Debashree
Published: August 2024

Context

Thyroid differentiation score (TDS), calculated based on mRNA expression levels of 16 genes controlling thyroid metabolism and function, has been proposed as a measure to quantify differentiation in papillary thyroid carcinoma (PTC).

Objective

The objective of this study is to determine whether TDS is associated with survival outcomes across patient cohorts.

Methods

Two independent cohorts of patients with PTC were used: (1) The Cancer Genome Atlas (TCGA) thyroid cancer study (N = 372), (2) MD Anderson Cancer Center (MDACC) cohort (N = 111). The primary survival outcome of interest was progression-free interval (PFI). Association with overall survival (OS) was also explored. The Kaplan–Meier method and Cox proportional hazards models were used for survival analyses.

Results

In both cohorts, TDS was associated with tumor and nodal stage at diagnosis as well as tumor driver mutation status. High TDS was associated with longer PFI on univariable analyses across cohorts. After adjusting for overall stage, TDS remained significantly associated with PFI in the MDACC cohort only (adjusted hazard ratio [aHR] 0.67, 95% CI 0.52-0.85). In subgroup analyses stratified by tumor driver mutation status, higher TDS was most consistently associated with longer PFI in BRAFV600E-mutated tumors in the MDACC cohort after adjusting for overall stage (TCGA: aHR 0.60, 95% CI 0.33-1.07; MDACC: aHR 0.59, 95% CI 0.42-0.82). For OS, increasing TDS was associated with longer OS in the overall MDACC cohort (aHR = 0.78, 95% CI 0.63-0.96), where the median duration of follow-up was 12.9 years.

Conclusion

TDS quantifies the spectrum of differentiation status in PTC and may serve as a potential prognostic biomarker in PTC, mostly promisingly in BRAFV600E-mutated tumors.
Autoimmune Encephalitis
Authors: Irani Sarosh R.
Published: August 2024

OBJECTIVE

This article focuses on the clinical features and diagnostic evaluations that accurately identify patients with ever-expanding forms of antibody-defined encephalitis. Forms of autoimmune encephalitis are more prevalent than infectious encephalitis and represent treatable neurologic syndromes for which early immunotherapies lead to the best outcomes.

LATEST DEVELOPMENTS

A clinically driven approach to identifying many autoimmune encephalitis syndromes is feasible, given the typically distinctive features associated with each antibody. Patient demographics alongside the presence and nature of seizures, cognitive impairment, psychiatric disturbances, movement disorders, and peripheral features provide a valuable set of clinical tools to guide the detection and interpretation of highly specific antibodies. In turn, these clinical features in combination with serologic findings and selective paraclinical testing, direct the rationale for the administration of immunotherapies. Observational studies provide the mainstay of evidence guiding first- and second-line immunotherapy administration in autoimmune encephalitis and, whereas these typically result in some clinical improvements, almost all patients have residual neuropsychiatric deficits, and many experience clinical relapses. An improved pathophysiologic understanding and ongoing clinical trials can help to address these unmet medical needs.

ESSENTIAL POINTS

Antibodies against central nervous system proteins characterize various autoimmune encephalitis syndromes. The most common targets include leucine-rich glioma inactivated protein 1 (LGI1), N-methyl-d-aspartate (NMDA) receptors, contactin-associated proteinlike 2 (CASPR2), and glutamic acid decarboxylase 65 (GAD65). Each antibody-associated autoimmune encephalitis typically presents with a recognizable blend of clinical and investigation features, which help differentiate each from alternative diagnoses. The rapid expansion of recognized antibodies and some clinical overlaps support panel-based antibody testing. The clinical-serologic picture guides the immunotherapy regime and offers valuable prognostic information. Patient care should be delivered in conjunction with autoimmune encephalitis experts.
NMOSD and MOGAD
Authors: Sechi Elia
Published: August 2024

OBJECTIVE

This article reviews the clinical features, MRI characteristics, diagnosis, and treatment of aquaporin-4 antibody–positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD). The main differences between these disorders and multiple sclerosis (MS), the most common demyelinating disease of the central nervous system (CNS), are also highlighted.

LATEST DEVELOPMENTS

The past 20 years have seen important advances in understanding rare demyelinating CNS disorders associated with AQP4 IgG and myelin oligodendrocyte glycoprotein (MOG) IgG. The rapidly expanding repertoire of immunosuppressive agents approved for the treatment of AQP4-NMOSD and emerging as potentially beneficial in MOGAD mandates prompt recognition of these diseases. Most of the recent literature has focused on the identification of clinical and MRI features that help distinguish these diseases from each other and MS, simultaneously highlighting major diagnostic pitfalls that may lead to misdiagnosis. An awareness of the limitations of currently available assays for AQP4 IgG and MOG IgG detection is fundamental for identifying rare false antibody positivity and avoiding inappropriate treatments. For this purpose, diagnostic criteria have been created to help the clinician interpret antibody testing results and recognize the clinical and MRI phenotypes associated with AQP4-NMOSD and MOGAD.

ESSENTIAL POINTS

An awareness of the specific clinical and MRI features associated with AQP4-NMOSD and MOGAD and the limitations of currently available antibody testing assays is crucial for a correct diagnosis and differentiation from MS. The growing availability of effective treatment options will lead to personalized therapies and improved outcomes.
Pediatric Autoimmune Neurologic Disorders
Authors: Hacohen Yael
Published: August 2024

OBJECTIVE

This article discusses common principles in diagnosing and managing autoimmune neurologic conditions in children.

LATEST DEVELOPMENTS

The key to improving outcomes in all patients with autoimmune neurologic diseases is making an early diagnosis, promptly initiating treatment, and identifying patients who will benefit from long-term maintenance treatment. Some neuroinflammatory syndromes can be diagnosed with an antibody biomarker (eg, aquaporin-4 antibodies, N-methyl-d-aspartate [NMDA] receptor antibodies), whereas others require clinical diagnostic criteria (eg, multiple sclerosis, opsoclonus-myoclonus syndrome). A proportion of children will be labeled as seronegative, and further investigations for other inflammatory or monogenetic etiologies need to be carried out in parallel with treating the central nervous system inflammation. Time to treatment and treatment escalation were shown to correlate with outcomes in many patients with these disorders. The choice and duration of treatment should be evaluated considering side effects and risks in the short and long terms. The presence of a highly inflammatory disease process in children supports the use of highly effective disease-modifying therapies in pediatrics.

ESSENTIAL POINTS

The phenotypes of pediatric autoimmune neurologic conditions may change across different age groups, as the brain is still actively developing. In general, the presentation in children is more inflammatory, but overall disability is lower, likely because of better neuroplasticity and repair. Convincing evidence has increasingly emerged to support the biological rationale that effective immunosuppressive therapies used in adult neuroimmunology are equally effective in children.
The Effectiveness of Virtual and Augmented Reality in Surgical Pain Management: A Systematic Review of Randomized Controlled Trials
Authors: Levit Tal , Grzela Patrick , Lavoie Declan C.T. , Wang Li , Agarwal Aashna , Couban Rachel J. , Shanthanna Harsha
Published: August 2024

BACKGROUND:

Satisfactory management of postoperative pain remains challenging. Nonpharmacological modalities such as virtual and augmented reality (VR/AR) offer potential benefits and are becoming increasingly popular. This systematic review evaluates the effectiveness and safety of VR/AR interventions on postoperative pain and recovery.

METHODS:

MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL databases were searched from inception to July 27, 2023, for randomized controlled trials (RCTs), published in English, evaluating the use of VR/AR interventions for surgical pain relief. Study selection and data extraction were performed by pairs of reviewers independently and in duplicate, and potential risk of bias was determined using the Risk of Bias-version 2 (RoB 2) tool. Our outcomes included pain relief, reduction of anxiety, satisfaction, and adverse effects. Due to substantial heterogeneity, a narrative synthesis without meta-analysis was performed.

RESULTS:

We included 35 trials among 2257 citations, categorized as surgery (n = 12), minor procedures (n = 15), and postoperative physiotherapy (n = 8). Surgical group included various surgeries, with 11 using immersive VR predominantly in the postoperative period, and most reporting no differences in pain, but potential for reduced anxiety and sedation requirements. In the minor procedures group, most studies reported decreased pain and anxiety during the procedural performance. Two studies reported increased heart rate, while 2 others reported better hemodynamic stability. Home-based AR physiotherapy achieved (n = 6) similar pain and functional outcomes after knee replacement, with 1 large study (n = 306) reporting reduction of mean costs by $2745 for provision of 12 weeks physiotherapy. There were some concerns around potential bias for most studies, as the nature of interventions make it challenging to blind assessors and participants. No important adverse effects were noted using VR/AR technology.

CONCLUSIONS:

Evidence from RCTs indicates that the use of immersive VR during minor procedures may reduce procedural pain, decrease anxiety, and improve satisfaction. However, small studies, inconsistent effect, and variation in the application of interventions are important limitations. Evidence to support the application of AR/VR for major surgeries is limited and needs to be further investigated. Use of home-based physiotherapy with AR likely has economic advantages, and facilitates virtual care for appropriate patients who can access and use the technology safely.
Turkey vultures tune their airspeed to changing air density
Authors: Rader Jonathan A. , Hedrick Tyson L.
Published: August 2024

Animals must tune their physical performance to changing environmental conditions, and the breadth of environmental tolerance may contribute to delineating the geographic range of a species. A common environmental challenge that flying animals face is the reduction of air density at high elevation and the reduction in the effectiveness of lift production that accompanies it. As a species, turkey vultures (Cathartes aura) inhabit a >3000 m elevation range, and fly considerably higher, necessitating that they accommodate for a 27% change in air density (0.890 to 1.227 kg m−3) through behavior, physiology or biomechanics. We predicted that birds flying at high elevation would maintain aerodynamic lift performance behaviorally via higher flight speeds, rather than increases in power output or local phenotypic adaptation. We used three-dimensional videography to track turkey vultures flying at three elevations, and data supported the hypothesized negative relationship between median airspeed and air density. Additionally, neither the ratio of horizontal speed to sinking speed nor flapping behavior varied with air density.
Palmitoylethanolamide Does Not Affect Recovery from Exercise-Induced Muscle Damage in Healthy Males
Authors: SCHOUTEN MONIEK , DALLE SEBASTIAAN , COSTAMAGNA DOMIZIANA , RAMAEKERS MONIQUE , BOGAERTS STIJN , VAN THIENEN RUUD , PEERS KOEN , THOMIS MARTINE , KOPPO KATRIEN
Published: August 2024

Introduction

Strenuous eccentric exercise (EE) induces microstructural muscle damage, which decreases muscle performance. Palmitoylethanolamide (PEA) exerts analgesic and anti-inflammatory effects in clinical pain conditions and preclinical models of experimentally induced inflammation. This might hold clues for improved recovery from EE. Therefore, the current study evaluates the effect of PEA supplementation on functional and molecular responses to a single EE bout.

Methods

Eleven healthy male participants were included in a double-blind crossover study in which they received PEA (350 mg Levagen+) or placebo (maltodextrin) supplements, in a randomized order. In each experimental condition, participants performed an acute bout of EE (24 × 10 eccentric contractions of the knee extensors on an isokinetic dynamometer). At baseline, 24 (D1), 48 (D2), 72 (D3), and 120 h (D5) following EE, maximal voluntary contraction and jump height were measured. Blood samples were collected at baseline and on D1–D5, and muscle biopsies were collected at baseline and on D2. Perceived muscle soreness, sleep quality, and food intake were recorded daily.

Results

Muscle strength and jump height decreased following EE (up to ~40% and ~17%, respectively; P
time < 0.05) in both conditions. This drop was accompanied by an increase in plasma creatine kinase and perceived muscle soreness (P
time < 0.05). Furthermore, EE, but not PEA, increased the expression of the myogenic marker Pax7 and of the catabolic markers p-FoxO1-3a, p62, and LC3BII/I (P
time < 0.05).

Conclusions

PEA supplementation does not improve muscle soreness, muscle strength, and jump performance following a single EE bout. In addition, PEA supplementation had no effect on local or systemic markers of muscle damage, catabolism, or regeneration.
Collagen Peptide Supplementation during Training Does Not Further Increase Connective Tissue Protein Synthesis Rates
Authors: KIRMSE MARIUS , LOTTMANN THEO M. , VOLK NICOLA R. , DE MARÉES MARKUS , HOLWERDA ANDREW M. , VAN LOON LUC J. C. , PLATEN PETRA
Published: August 2024

Introduction

Protein supplementation increases postexercise muscle protein synthesis rates and, as such, supports exercise-induced muscle conditioning. Collagen protein has been suggested as the preferred protein source to stimulate muscle connective protein synthesis rates during recovery from exercise. Here we assessed the effects of hydrolyzed collagen peptide supplementation on both myofibrillar as well as muscle connective protein synthesis rates during 1 wk of strenuous resistance exercise training.

Methods

In a randomized, double-blind, parallel design, 25 young men (24 ± 3 yr, 76.9 ± 6.4 kg) were selected to perform 1 wk of intense resistance–type exercise training. Subjects were randomly assigned into two groups receiving either 15 g hydrolyzed collagen peptides (COL) or a noncaloric placebo (PLA) twice daily during the intervention. Subjects were administered deuterated water (2H2O) daily, with blood and skeletal muscle tissue samples being collected before and after the intervention to determine daily myofibrillar and muscle connective protein synthesis rates.

Results

Post-absorptive plasma glycine, proline, and hydroxyproline concentrations increased following collagen peptide supplementation (P < 0.05) and showed higher levels when compared with the placebo group (P < 0.05). Daily muscle connective protein synthesis rates during the intervention period exceeded myofibrillar protein synthesis rates (1.99 ± 0.38 vs 1.34 ± 0.23%·d−1, respectively; P < 0.001). Collagen peptide supplementation did not result in higher myofibrillar or muscle connective protein synthesis rates (1.34 ± 0.19 and 1.97 ± 0.47%·d−1, respectively) when compared with the placebo group (1.34 ± 0.27 and 2.00 ± 0.27%·d−1, respectively; P > 0.05).

Conclusions

Collagen peptide supplementation (2 × 15 g daily) does not increase myofibrillar or muscle connective protein synthesis rates during 1 wk of intense resistance exercise training in young, recreational athletes.
Varus Thrust Assessment Identified Responders to Quadriceps Exercise in Individuals at Risk of or with Knee Osteoarthritis
Authors: IIJIMA HIROTAKA , AOYAMA TOMOKI
Published: August 2024

Purpose

Identification of responders/nonresponders to unsupervised therapeutic exercise represents a critical challenge toward establishment of tailored self-management at home. Focusing on visualized varus thrust during gait as a possible effect moderator, this study determined whether and how varus thrust influences the therapeutic effects of home-based quadriceps exercise in individuals at increased risk of, or with, established knee osteoarthritis.

Methods

This study is a secondary subgroup analysis of a randomized controlled trial (n = 50). Varus thrust at baseline was assessed via recorded gait movie. Analysis of covariance and subsequent mediation analysis were used to determine whether and how varus thrust influences the therapeutic effect of home-based quadriceps exercise after adjustment for covariates. To address the possible distinct impact of varus thrust on unsupervised and supervised exercise, the results were cross-checked with previous supervised exercise cohort using a meta-analysis.

Results

Individuals without varus thrust displayed greater and clinically meaningful pain relief after exercise after adjustment for covariates. The greater pain relief in individuals without varus thrust was attributed, at least partly, to an improvement in knee flexion range of motion. Notably, the meta-analysis revealed that unsupervised and supervised exercise programs induce consistent and clinically meaningful pain reduction in individuals without varus thrust.

Conclusions

Varus thrust is a robust effect moderator of the pain-reducing effect of quadriceps exercise. Furthermore, greater pain reduction may be a function of improvement of knee flexion range of motion. These studies provide evidence that varus thrust assessment represents valuable approach to identify responders/nonresponders to quadriceps exercise even for unsupervised protocol at their home environment.
Manufacturing Technique Characteristics of the ｢Shide (monk)｣ Mural Painting in Yeongsanjeon Hall, Seonunsa Temple, Gochang
Authors: Yu Yeong Gyeong , Lee Ye Hyeon , Lee Hwa Soo
Published: August 2024

In this study, in order to understand the manufacturing technique characteristics of the ｢Shide (monk)｣ mural painting in Yeongsanjeon Hall, Seonunsa Temple, Gochang, we conducted microscopic, SEM-EDS, XRD, particle size analysis, FT-IR, and starch-iodine reactions. As a result of the study, the ｢Shide (monk)｣ mural painting reflects the manufacturing style of Joseon Dynasty temple murals that have been studied to date, in terms of the composition of the wall and the material characteristics, such as the pigments used. However, the fact that the middle layer has not been confirmed and that there are multiple ground layers below the painting layer is confirmed by the unique manufacturing technique that can only be found in the ｢Shide (monk)｣ mural painting in Yeongsanjeon Hall, Seonunsa Temple. In particular, the technique in which the surface of the finishing layer is coated with a carbohydrate-based adhesive component and a coarse-grained layer is plastered on top of it is considered to be a different characteristic from the composition trend of the Buddhist mural painting previously studied. It is believed that the results of this research on the manufacturing techniques and characteristics of the ｢Shide (monk)｣ mural painting can contribute to establishing a direction for conservation treatment of murals in Yeongsanjeon and preparing long-term conservation plans. It is also hoped that it will provide important materials for research into the characteristics of the manufacturing techniques and conservation management of murals inspected during the late Joseon Dynasty.
Outcome of Nasal continuous positive airway pressure in neonates: A cross-sectional study
Authors: Fatima Kaneez , Zulfiqar Sughra , Farooq Ammara , Aziz Musfirah
Published: August 2024

Objective: This study aimed to assess the efficacy of nasal continuous positive airway pressure (CPAP) in term and preterm neonates with respiratory distress by evaluating successful outcomes, identifying factors contributing to treatment failure, and documenting associated complications.
Method: A comparative cross-sectional study design was employed. The research was conducted at Combined Military Hospital (CMH) Rawalpindi from November 2022 to July 2023. All consecutive neonates admitted during the specified period with respiratory distress requiring CPAP treatment and meeting inclusion criteria were enrolled. Pre- and post-CPAP respiratory distress levels, relevant biochemical markers, as well as mortality and morbidity rates were documented. Both descriptive and inferential statistical analyses were employed.
Results: The mean age of the study cohort was 53.3±85.6 minutes. The average time to initiate CPAP was 82.4 ± 94.7 minutes. Mean gestational age stood at 34.68±2.8 weeks. CPAP was successful in 97% of babies. The low birth weight below 1200grams was the main factor related to failure of CPAP. The mean Downes score decreased from 5.8±1.3 before CPAP to 3.3±1.6 after 12 hours of CPAP and further to 1.85±2 after 24 hours. Significant improvements in Downes score were noted after 24 hours of CPAP usage (p < 0.05) using paired sample T-test.
Conclusion: This study affirms the effectiveness of CPAP in addressing neonatal respiratory distress. The utilization of CPAP emerges as a valuable intervention that not only reduces the requirement for invasive ventilation but also exhibits the potential to alleviate morbidity and mortality rates among neonatal populations.
doi: https://doi.org/10.12669/pjms.40.8.8753
How to cite this: Fatima K, Zulfiqar S, Farooq A, Aziz M. Outcome of Nasal continuous positive airway pressure in neonates: A cross-sectional study. Pak J Med Sci. 2024;40(8):---------. doi: https://doi.org/10.12669/pjms.40.8.8753
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
What do medical faculty students think about telehealth?
Authors: Egici Memet Taskin , Özmen Sever Seda , Zeren Öztürk Güzin , Bektemür Güven , Bağcı Hasan , Bukhari Mulazim Hussain
Published: August 2024

Objective: We aimed to evaluate medical school students’ knowledge and approaches regarding telehealth.
Method: In this descriptive study, an electronic survey was conducted among students attending the Faculties of Medicine at Health Sciences University. The first part of the Form included questions evaluating individual characteristics and telehealth approaches, and the second part included opinions and suggestions regarding telehealth usage topics.
Results: Of 698 participants, 435 (64.9%) students were in the preclinical period. One hundred nine (15.6%) believed they had sufficient knowledge about telehealth while 399 (57.2%) believed that telehealth should be included in medical education. When asked about their opinions on using telehealth in their professional careers, 298 (42.7%) stated that they considered using them. Those who perceived themselves as having sufficient knowledge about telehealth were more inclined to consider using it more in their professional careers (p=0.000). Participants who believed that healthcare services could be provided through telehealth were more likely to think that disease monitoring would be better, patient follow-up quality would improve, unnecessary hospital admissions would decrease (p<0.05).
Conclusions: The majority of medical faculty students lack sufficient knowledge about telemedicine and believe that education on this topic should be included in the medical curriculum. It is suggested that incorporating pre-clinical courses on telemedicine and providing internship opportunities in practical settings would effectively address this gap.
doi: https://doi.org/10.12669/pjms.40.8.9055
How to cite this: Egici MT, Sever SO, Bektemur G, Ozturk GZ, Bagcı H, Bukhari MH. What do medical faculty students think about telehealth? Pak J Med Sci. 2024;40(8):---------. doi: https://doi.org/10.12669/pjms.40.8.9055
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ο Ρόλος της Διοίκησης Ανθρώπινου Δυναμικού στην Ανάπτυξη Οριζόντιων και Κοινωνικών Δεξιοτήτων του Ανθρώπινου Δυναμικού (Εκπαιδευτικοί, Διευθυντές) στους Εκπαιδευτικούς Οργανισμούς
Authors: Νεραντζάκη Αναστασία , Παπαγεωργίου Ελευθερία , Τζήλου Γεωργία , Χουλιάρα Ελένη
Published: August 2024

Η παρούσα εργασία αποτελεί μια ομαδική προσπάθεια να μελετηθεί ο ρόλος της διοίκησης ανθρώπινου δυναμικού στην ανάπτυξη οριζόντιων και κοινωνικών δεξιοτήτων των εκπαιδευτικών της Πρωτοβάθμιας Εκπαίδευσης. Αρχικά, πραγματοποιήθηκε βιβλιογραφική ανασκόπηση σχετικά με το τι σημαίνει διοίκηση ανθρώπινου δυναμικού, ποιες δεξιότητες απαιτούνται για την κατάλληλη διοίκηση σε έναν εκπαιδευτικό οργανισμό και ποιες τεχνικές μπορεί να χρησιμοποιηθούν, ώστε να επιφέρουν τα προσδοκώμενα αποτελέσματα βέλτιστης λειτουργίας του. Τέλος, παρατίθεται μία μελέτη περίπτωσης η οποία αφορά στη διαχείριση σύγκρουσης μεταξύ των μελών ενός εκπαιδευτικού οργανισμού και την καίρια παρέμβαση της διεύθυνσης του σχολείου με θετικά αποτελέσματα ως προς την έκβασή της.
Η ευρωπαϊκή διαχείριση του προσφυγικού ζητήματος
Authors: Μαργαρίτη Γεωργία
Published: August 2024

Οι μεταναστευτικές και προσφυγικές μετακινήσεις προς τα κράτη μέλη της ΕΕ αποτελούν ένα επίκαιρο, μα και διαχρονικό ζήτημα, λόγω των γενεσιουργών αιτιών μετανάστευσης που δε θα πάψουν να υπάρχουν. Η διδακτορική διατριβή εξετάζει τις μικτές ροές, Σύριων και άλλων μετακινούμενων, που πέρασαν από την Τουρκία στην Ελλάδα με προορισμό άλλες χώρες της Ευρωπαϊκής Ένωσης. Το φαινόμενο κορυφώθηκε το 2015-16 στα ελληνοτουρκικά θαλάσσια σύνορα και αποτέλεσε κορυφαίο θέμα της ευρωπαϊκής ατζέντας. Μέχρι σήμερα, οι θεωρητικές προσεγγίσεις ανάλυσης δεν κατάφεραν να αναδείξουν τους παράγοντες, οι οποίοι επηρέασαν την πυροδότηση της προσφυγικής κρίσης, μία κατάσταση που χαρακτηρίστηκε ξαφνική και καθόλου προβλέψιμη. Σκοπός της διδακτορικής διατριβής είναι η διερεύνηση των παραγόντων που επηρέασαν την προσφυγική μετακίνηση του 2015-16 από γνωστές οδούς, τμήμα της μεσογειακής μεταναστευτικής διαδρομής, εννοώντας από την Τουρκία στην Ελλάδα, προκειμένου να ανευρεθεί η ποιοτική επίδραση της ευρωπαϊκής διαχείρισης στις ποσοτικές μεταβολές των διελεύσεων. Αποδεικνύεται ότι από τον Μάρτιο του 2016, η δημιουργία των Κέντρων Καταγραφής και Ταυτοποίησης και η κοινή δήλωση ΕΕ – Τουρκίας περιόρισαν το φαινόμενο των πολυάριθμων μετακινήσεων από τα ελληνοτουρκικά θαλάσσια σύνορα.Για τους σκοπούς της διατριβής το φαινόμενο εξετάστηκε σε δύο διαστάσεις. Η πρώτη αφορά την περιπτωσιολογική μελέτη των νησιών του Αιγαίου. Εξετάστηκαν οι συνθήκες υποδοχής στη Λέσβο, στη Σάμο και στη Χίο. Συλλέχθηκαν μηνιαία δεδομένα και δημιουργήθηκαν διαγράμματα εξαρτημένων μεταβλητών στο περιβάλλον της R. Πάνω στα διαγράμματα αποτυπώθηκαν οι παρεμβάσεις - ανεξάρτητες ποιοτικές μεταβλητές και ακολούθησε η ποιοτική ανάλυση των παρεμβάσεων. Η δεύτερη διάσταση σχετίζεται με την ανάπτυξη ενός προσαρμοσμένου ποιοτικού μοντέλου στις μεταναστευτικές μετακινήσεις, προκειμένου να αναδειχθούν οι παράγοντες, οι οποίοι επηρέασαν τις μεταβολές των διελεύσεων από την Τουρκία στην Ελλάδα και στη συνέχεια σε άλλους προορισμούς, εξετάζοντας την περίπτωση κυρίως Σύριων μετακινούμενων που βρέθηκαν στη Γερμανία και σε άλλα κράτη μέλη. Εν ολίγοις, η διατριβή επιτυγχάνει να αναπτύξει ένα νέο αναλυτικό πλαίσιο μελέτης περί των παραγόντων που τελικά επέδρασαν στις ποσοτικές μεταβολές των ροών από το τμήμα της ανατολικής μεσογειακής διαδρομής υπό μελέτη, εντοπίζοντας τις πρωτοβουλίες της ΕΕ, οι οποίες επηρέασαν την τόνωση και τον περιορισμό του φαινομένου.