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This study examined the effects of a combined virtual-reality- and gym-based physical activity (PA) program on PA levels, motor skills, and social skills of children with a developmental disability (DD). Twenty-five children with DD were randomly assigned to experimental and control groups. The intervention was conducted for 60 min, two times a week, for 12 weeks. Pre- and postintervention assessments encompassing PA levels measured via Gravity Estimator of Normal Everyday Activity, motor skills evaluated using the Test of Gross Motor Development-Third Edition, and social skills gauged via the Social Skills Rating System-Parent were conducted. Additionally, a follow-up assessment was administered to the experimental group 12 weeks postintervention. The findings unequivocally demonstrate that the combined virtual-reality- and gym-based PA program yielded significant enhancements in PA levels, motor skills, and social skills among children with DD in the experimental group. Notably, these improvements were sustained 12 weeks after the intervention. These findings may help professionals develop and implement better PA programs for children with DD. [ABSTRACT FROM AUTHOR]

Talent transfer has enabled elite athletes to be successful in another sport, with great potential in para-sport. Previous research suggests that similarities between donor and recipient sports may facilitate talent transfer; however, this remains unclear in para-sport. This study investigated patterns between donor and recipient sports' characteristics, identifying the impact on talent transfer in para-sport. An Australian case study utilizing secondary data of 38 Australian Paralympians who competed at the Paralympic Games from 2000 through 2020 was analyzed. Results demonstrated that similarities between sports were not significantly associated with successful talent transfers between Paralympic sports. Understanding patterns associated with successful Paralympic talent transfers offers a foundation of knowledge for designing and developing future talent-transfer pathways and research. Based on this study, it is recommended that sport administrators and practitioners explore greater opportunity for talent transfer in para-sport, rather than limiting talent-transfer opportunities based on athletes' donor sports. [ABSTRACT FROM AUTHOR]

Objective: To rate athletes' functional ability and return to sport (RTS) success at the end of their individual, formal, medically prescribed rehabilitation after anterior anterior cruciate ligament (ACL) reconstruction. Methods: In our prospective multicenter cohort study, 88 (42 females) adults aged 18-35 years after acute unilateral ACL rupture and subsequent hamstring grafting were included. All patients were prospectively monitored during their rehabilitation and RTS process until the end of their formal rehabilitation and RTS release. As outcome measures, functional hop and jump tests (front hop, balance hops, and drop jump screening test) and self-report outcomes (Knee Injury and Osteoarthritis Outcome Score, ACL-RTS after injury) were assessed. Literature-based cut-off values were selected to rate each performance as fulfilled or not. Results: At 7.5 months (SD 2.3 months) after surgery, the percentage of participants meeting the functional thresholds ranged from 4% (Knee Injury and Osteoarthritis Outcome Score SPORT) and over 44% (ACL-RTS after injury sum score) to 59% (Knee Injury and Osteoarthritis Outcome Score activities of all daily living) in the self-report and from 29% (Balance side hop) to 69% (normalized knee separation distance) in performance testing. Only 4% fulfilled all the cut-offs, while 45% returned to the same type and level of sport. Participants who successfully returned to their previous sport (type and level) were more likely to be "over-cut-off-performers." Conclusions: The low share of the athletes who fulfilled the functional RTS criteria highlights the importance of continuing the rehabilitation measures after the formal completion to assess the need for and success of, inter alia, secondary-preventive therapies. [ABSTRACT FROM AUTHOR]

Children and adolescents with cerebral palsy (CP) show a reduced physical activity (PA) level compared with their typically developed peers. This study aimed to identify potential predictors of objectively evaluated habitual PA using data from a national clinical registry—the Cerebral Palsy Follow-Up Program (CPFP)—and proxy-reported questionnaires. Data from the CPFP database showed that female sex was associated with a lower PA level. Additional questionnaire data revealed age, popliteal angle limitation, Pediatric Outcomes Data Collection Instrument–Sports and Physical Functioning Scale score, screen time, Functional Mobility Scale score at 50 m, and fatigue as predictors. The proposed models can be used for the prediction and early detection of the PA level and consequently for the potential improvement among ambulant/semiambulant individuals with CP. Further research should investigate the predictive impact of personal, social, and environmental factors on the PA level and the gap in PA levels between girls and boys. [ABSTRACT FROM AUTHOR]

Objective: Our primary outcome was to determine the feasibility of patients with post‐traumatic headache (PTH) keeping a daily headache diary and using sumatriptan as directed. Secondary outcomes include determining if sumatriptan is effective in aborting PTH and whether headache resolution is dependent on PTH phenotype. Background: PTH is prevalent and persistent after traumatic brain injury, yet there have been few studies evaluating the effects of pharmacological treatments in individuals with PTH. Methods: This is a single‐arm, prospective, non‐randomized phase 2 clinical trial registered at Clinicaltrials.gov (NCT01854385) and conducted from 2013 to 2017. Data analysis was completed in 2022. Of the 299 participants screened, 40 were enrolled in the study. Participants kept a headache diary documenting headache characteristics and severity. Headache characteristics were used to determine PTH phenotypes of migraine‐like, probable migraine‐like, or non‐migraine‐like. Participants reported whether sumatriptan was used for their headache, their response to the medication, if a second dose was taken, and their response to the second dose. Results: A total of 15 participants out of the 40 enrolled (mean [SD] age, 41.9 [14.2] years, and 53% [21/40] male), met the criteria for the use of sumatriptan, and completed all assessments. Average headache diary compliance rate for the final month of the study was 80% (372/465). While sumatriptan was used for only 19% (122/654) of all reported headaches, 72% (88/122) of those headaches resolved within 2 h of taking the medication. Resolution of headaches with sumatriptan was not significantly different among headache phenotypes (migraine‐like: 22/38 [58%], probable migraine‐like: 24/29 [83%], non‐migraine‐like: 6/15 [40%]; p = 0.154). Conclusions: A daily headache diary is feasible for tracking headache symptoms. Preliminary results also suggest that sumatriptan, a migraine‐specific medication, may be beneficial for the treatment of PTH of different clinical phenotypes. Future studies, such as a phase 3 clinical trial with a larger sample size, are needed to better understand the efficacy of sumatriptan in the treatment of PTH. Plain Language Summary: Headache is the most common persistent symptom after traumatic brain injury, yet there are no evidence‐based treatments for post‐traumatic headache (PTH). In this study, we evaluated the ability of individuals with PTH to complete a daily headache diary and their response to treatment with sumatriptan. About 80% of participants completed the daily headache diary, and 72% of headaches resolved within 2 h of taking sumatriptan, so we concluded that a daily headache diary is useful in documenting headache symptoms and sumatriptan may be an effective treatment for PTH. [ABSTRACT FROM AUTHOR]

Background: Caprini score and D-dimer are well-recognized markers in deep vein thrombosis (DVT) assessment. However, their utility in guiding post-arthroplasty DVT risk is hampered by susceptibility to various post-operative factors, limiting their effectiveness as reminders. Conversely, these markers exhibit greater stability in the pre-operative setting. Despite this, research on the pre-operative predictive value of Caprini score and D-dimer for DVT following primary total knee arthroplasty (TKA) remains scarce. Methods: In a retrospective study, we analyzed data from patients who underwent primary TKA, between August 2015 and December 2022. Upon admission, Caprini scores were assessed, and comprehensive blood panels were obtained from fasting blood samples. For all patients, lower limb vascular Doppler ultrasonography was performed pre-operatively to exclude those with pre-existing DVT, and all patients underwent DVT examination again post-operatively. Results: Our study included 2,873 patients, averaging 67.98 ± 7.54years, including 676 men and 2,197 women. In this study, 303 (10.55%) patients developed postoperative DVT, and 57 (1.98%) cases presented with lower limb symptoms. DVT incidence in patients with pre-operative Caprini scores of 1–2 (6.50%), 3 (10.28%), and ≥ 4 (18.05%) showed significant differences (P < 0.05). DVT rates were 14.80% in patients with pre-operative D-dimer levels of ≥ 1 mg/L, higher than the 8.98% in those with levels of < 0.5 mg/L, and 10.61% in those with levels 0.5-1 mg/L (P < 0.05). In patients with Caprini scores of 1–2 and D-dimer levels ≤ 0.5 mg/L, the occurrence rate of postoperative DVT was only 5.84%. For patients with Caprini scores ≥ 4 and D-dimer levels ≥ 1.0 mg/L, the postoperative DVT occurrence rate soared to 24.81%, with the OR(odds ratio) was 4.744 compared to the former group. Conclusion: Patients with preoperative higher Caprini scores and D-dimer are more likely to develop DVT after TKA. Additionally, those with a preoperative Caprini score ≥ 4 and D-dimer level ≥ 1.0 mg/L have a significantly increased risk (24.81%) of developing DVT, identifying them as a high-risk group for DVT following TKA. These findings hold significant value for DVT risk stratification in primary TKA patients and the formulation of preoperative interventions to mitigate the risk of DVT. [ABSTRACT FROM AUTHOR]

Accurate and timely interpretation of microcytic anemia can be diagnostically challenging in the primary care setting. We sought to develop a novel model for distinguishing iron-deficiency anemia from thalassemia trait in the modern pediatric population. Demographic history and red blood cell indices were retrospectively characterized for 76 children referred to our pediatric hematology clinic for evaluation of microcytic anemia. Statistically significant variables were sequentially added into a logistic regression model to develop the final model. The final discriminating model incorporates red cell distribution width, mean corpuscular hemoglobin concentration, and red blood cell values. Favorable predictive performance is seen in the initial (sensitivity 89.2%, specificity 92.3%) and external validation cohort (sensitivity 84.4%, specificity 88.9%). This novel tool may aid in determining the cause of hypochromic, microcytic anemia in the primary care setting. Finally, the study cohort reflects an underrepresented group in the development of screening tools, and thus offers generalizability. [ABSTRACT FROM AUTHOR]

Suppurative cervical lymphadenitis sometimes resolves with oral antibiotic treatment; however, many children are hospitalized for intravenous treatment due to lack of improvement. When there is no substantial improvement, the possibility of a liquefaction process is considered, and as a result, source control such as needle aspiration or open surgical drainage is recommended. We examined, among pediatric patients hospitalized with suppurative cervical lymphadenitis, clinical and laboratory predictors for invasive intervention that may lead to early imaging and intervention, hasten recovery, and shorten length of hospitalization. We compared laboratory and clinical characteristics of pediatric patients hospitalized with suppurative cervical lymphadenitis during 2010-2017, according to 3 treatments: needle aspiration (N = 54), open surgical drainage (N = 37), and conservative adequate antibiotic treatment only (N = 292). Physical indicators such as local erythema and fluctuation were found as predictors for invasive interventions in hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis. No significant associations were found between invasive interventions and laboratory parameters assessed in this study. Children who underwent interventions displayed a prolonged average length of hospitalization and received extended antibiotic treatment prior to hospital admission. In hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis, physical examination findings are the main predictive factors for invasive interventions. Consequently, when such straightforward clinical findings are observed in the context of insufficient improvement during antibiotic treatment, they should prompt consideration of invasive intervention. [ABSTRACT FROM AUTHOR]

Familial Mediterranean fever (FMF) is an autoinflammatory disease which may cause endothelial dysfunction and arterial stiffness. In this study, we evaluated patients with FMF in terms of arterial stiffness indicators and investigated whether there was any difference according to colchicine response. This is a single-center, prospective, case-control study conducted on pediatric patients with FMF. Patients were categorized into 2 groups: patients on colchicine monotherapy (group 1) and patients who used anti-interleukin-1 (IL-1) plus colchicine (group 2). Patient age, mutations in the MEFV gene, overall duration of treatments, and general characteristics of symptoms were recorded. Laboratory values in an attack-free period were noted. Pulse wave velocity (PWV) was measured in all patients. Erythrocyte sedimentation rate and C-reactive protein, nocturnal hypertension, and PWV were higher in group 2. Arterial stiffness develops due to subclinical inflammation in patients with FMF. It is more pronounced in colchicine-resistant patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to determine whether a health service system is an independent influencing factor of having pressure injury problems in individuals with chronic spinal cord injury living in three countries Design: This is a cross-sectional study. Methods: Data from the International Spinal Cord Injury Community Survey were analyzed. The pressure injury problems were assessed using the Spinal Cord Injury Secondary Condition Scales (dichotomized to “having problem” and “not having problem”). Health service systems were categorized as an inpatient-oriented spinal cord injury–specialized system and a primary care–oriented system. A directed acyclic graph was applied to create a multivariable logistic regression model to determine the independent influencing factors of pressure injury problems. Results: Of 790 included participants, 277 (35%) had pressure injury problems. Being recruited from countries with inpatient-oriented spinal cord injury–specialized systems (model 1) and visiting rehabilitation medicine/spinal cord injury physicians at least once a year (model 2) is an independent negative correlating factor of pressure injury problems (odds ratio = 0.569 [95% confidence interval = 0.374–0.866] and 0.591 [95% confidence interval = 0.405–0.864], respectively). Conclusions: Spinal cord injury–specialized health service systems might be a protective factor of pressure injury problems in middle-income country contexts. This result suggests the importance of having spinal cord injury–specialized services in middle-income countries to reduce the prevalence of pressure injury problems. [ABSTRACT FROM AUTHOR]

Background Encapsulated pancreatic fluid collection (PFC) is a requisite for endoscopic drainage procedures. The 4-week threshold for defining walled-off necrosis does not capture the dynamic process of encapsulation. We aim to investigate the changes in the wall characteristics of PFC in acute necrotizing pancreatitis (ANP) by comparing baseline contrast-enhanced computed tomography (CECT) with follow-up CT scans. Methods This retrospective study comprised consecutive patients with ANP who underwent a baseline CECT within first 2 weeks and follow-up CECT in the third to fifth weeks of illness. Presence, extent, and encapsulation thickness (defined as enhancing wall around the collection) on baseline CECT were compared with follow-up CT (done in the third–fifth weeks of illness). Results Thirty patients (19 males and 11 females; mean age 41.5 ± 13.5 years) were included in the study. The mean time to first CECT was 10 ± 3.6 days. There were 58 collections. The most common site was the lesser sac (n = 29), followed by the left pararenal space (n = 15). At baseline CT, 52 (89.7%) collections had varying degree of encapsulation (15.3%, complete encapsulation). Complete encapsulation was seen in 52 and 82.6% collections in third and fourth week, respectively. All collections in fifth week and beyond were encapsulated. The wall was thicker on follow-up CECT scans (p < 0.01). The mean wall thickness was not significantly associated with the degree of encapsulation (p = 0.417). There was no significant association between the site and degree of encapsulation (p = 0.546). Conclusion Encapsulation is dynamic and collections may get "walled off" before 4 weeks. Walled-off collections should be defined based on imaging rather than a fixed 4-week revised Atlanta classification threshold. [ABSTRACT FROM AUTHOR]

Background: Mixed Arterial and Venous Leg Ulcers (MAVLU) are challenging. Clinical evidence specific to MAVLU management is scarce. We evaluated our recent experience with MAVLU patients and reviewed current data regarding MAVLU epidemiology, aetiology, diagnostic assessment and management options. Methods: A prospective leg ulcer database was retrospectively interrogated to determine the prevalence and clinical outcome of MAVLU over 2-year period (2021-2022). The literature was reviewed to determine if optimal treatment strategies. Results: 307 patients attended the ulcer clinic over a 2-year period. Most were venous leg ulcers (71%), 24% were arterial and 5% were MAVLU. The highest healing rate was in MAVLU (93%), followed by (74%) and (41%), in arterial and venous leg ulcer groups, respectively. Conclusion: Evidence-based guidelines for MAVLU remain lacking. Well-developed randomised controlled trials are warranted to guide current clinical practice. [ABSTRACT FROM AUTHOR]

Background: Cefazolin is guideline recommended for perioperative prophylaxis in orthopedic surgery. Despite its unique R1 side chain, cefazolin is often avoided in patients with beta-lactam allergy with concern for cross reactivity. Objectives: The primary outcome was the percentage of patients who received cefazolin perioperatively. Secondary outcomes included the percentage of patients with a beta-lactam allergy clarified following the telephone interview and clinical outcomes including acute kidney injury, surgical site infection, Clostridioides difficile infection, and re-admission at 30 and 90 days. Methods: This single-center, quasi-experimental study evaluated a pilot program in which a pharmacist phoned patients > 18 years of age with a scheduled orthopedic surgery and a documented beta-lactam allergy to assess their allergy preoperatively. Recommendations to use cefazolin were based on an algorithm. Patients were divided into pre- and post-intervention cohorts. Results: A total of 832 patients were screened for inclusion with 135 and 66 patients included in the pre- and post-intervention cohorts. No significant difference was identified in the primary outcome. In the post-intervention cohort, 62% had a beta-lactam reaction updated in the electronic medical record. Those with a beta-lactam allergy delabeled or made less severe were numerically more likely to receive cefazolin than those with an unchanged reaction or a reaction made more severe (95.2% vs 68% vs 65%). There were no differences in clinical outcomes between groups. Conclusion: A pharmacist-conducted preoperative beta-lactam allergy interview in adult patients undergoing elective orthopedic surgery improved beta-lactam allergy documentation but, did not result in increased utilization of cefazolin. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have investigated the role of gender in clinical symptoms, social functioning, and neuropsychological performance in people with first-episode psychosis (FEP). However, the evidence of gender differences for metacognition in subjects with FEP is still limited and controversial. The aim of the present study was to explore gender differences in cognitive insight and cognitive biases in this population. Methods: Cross-sectional study was carried out in a sample of 104 patients with FEP (35 females and 69 males) recruited from mental health services. Symptoms were assessed with the Positive and Negative Syndrome Scale, cognitive insight with the Beck Cognitive Insight Scale, and cognitive bias by the Cognitive Biases Questionnaire for Psychosis. The assessment also included clinical and sociodemographic characteristics. Results: After controlling for potential confounders (level of education, marital status, and duration of psychotic illness) analysis of covariance revealed that males presented greater self-reflectiveness (p = 0.004) when compared to females. However, no significant differences were found in self-certainty and composite index of the cognitive insight scale, as in the cognitive biases assessed. Conclusions: Gender was an independent influence factor for self-reflectiveness, being better for males. Self-reflectiveness, if shown to be relatively lacking in women, could contribute to the design of more gender-sensitive and effective psychotherapeutic treatments, as being able to self-reflect predicts to better treatment response in psychosis. [ABSTRACT FROM AUTHOR]

Alcohol use disorders (AUD) are pressing social problems. News media play a key role in setting the agenda for the public discourse and framing these problems. They provide people affected and unaffected with health-related information on different facets of the disease and present the topic in various contexts. In doing so, they shape the public opinion and influence behaviors. On the basis of an explorative quantitative content analysis of N = 402 articles published in 2019 in nine German newspapers and magazines, this study provides information on the topic-specific framing with regard to AUD. The results show only scant contextualization of the topic in the German media. This deficiency has particular regard to causal relationships and treatment opportunities, leaving room for interpretation from the audience. The topic-specific framing analysis showed that articles on AUD mostly appear either in the context of celebrities, endorsing favorable presentations of recovered people, or in the context of crime and violence, which goes hand in hand with portraying acutely affected people as perpetrators. Increased news coverage that includes the portrayal of non-famous people who have successfully engaged in alcohol treatment and recovery is necessary. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the current knowledge and experiences of consumers in Australia on adverse drug reaction (ADR) reporting and their reasons for reporting or not reporting ADRs, with a focus on the use of digital tools for ADR reporting. Methods: A cross-sectional online survey was conducted among adults who had taken medicine in Australia. A structured questionnaire with multiple choice or Likert scale responses with an option for participants to provide free-text responses and pretested for face validity was used. Consumer characteristics, knowledge, and ADR reporting practices were analyzed using descriptive statistics and the chi-square test or Fisher's exact test. Results: A total of 544 survey responses were included in the analysis. The majority of respondents were women (68%), and 22% were aged between 65 and 74 years. Fifty-eight percent (n = 317) of respondents knew that they could report ADRs to either the Therapeutic Goods Administration (TGA), state or territory government health department, or healthcare professionals. Three-quarters (n = 405) of respondents stated that they had experienced an ADR; of these, 36% reported an ADR to either the TGA, state or territory government health department, or healthcare professionals. Among those who reported ADRs, 58% were unaware that they could use digital tools to report ADRs. The main reason for not reporting was that they did not think the ADR was serious enough to report (39%). Conclusion: Over half of consumers knew that they could report ADR; however, improved consumer awareness about using digital tools for ADR reporting and increased ADR reporting is needed. [ABSTRACT FROM AUTHOR]

Objective While there are known racial disparities in cesarean delivery (CD) rates, the exact etiologies for these disparities are multifaceted. We aimed to determine if differences in induction of labor (IOL) management contribute to these disparities. Study Design This retrospective cohort study evaluated all nulliparous patients with an unfavorable cervix and intact membranes who underwent IOL of a term, singleton gestation at a single institution from October 1, 2018, to September 30, 2020. IOL management was at clinician discretion. Patients were classified as Black, Indigenous, and People of Color (BIPOC) or White based on self-report. Overall rates of CD were compared for BIPOC versus White race. Chart review then evaluated various IOL management strategies as possible contributors to differences in CD by race. Results Of 1,261 eligible patients, 915 (72.6%) identified as BIPOC and 346 (27.4%) as White. BIPOC patients were more likely to be younger (26 years interquartile range (IQR): [22–30] vs. 32 years IQR: [30–35], p < 0.001) and publicly insured (59.1 vs. 9.9%, p < 0.001). Indication for IOL and modified Bishop score also differed by race (p < 0.001; p = 0.006). There was 40% increased risk of CD for BIPOC patients, even when controlling for confounders (30.7 vs. 21.7%, p = 0.001; adjusted relative risk (aRR) = 1.41, 95% confidence interval (CI): [1.06–1.86]). Despite this difference in CD, there were no identifiable differences in IOL management prior to decision for CD by race. Specifically, there were no differences in choice of cervical ripening agent, cervical dilation at or time to amniotomy, use and maximum dose of oxytocin, or dilation at CD. However, BIPOC patients were more likely to undergo CD for fetal indications and failed IOL. Conclusion BIPOC nulliparas are 40% more likely to undergo CD during IOL than White patients within our institution. These data suggest that the disparity is not explained by differences in IOL management prior to cesarean, indicating that biases outside of induction management may be important to target to reduce CD disparities. Key Points The etiologies for racial disparities in cesarean are likely multifaceted. In this work, there were no differences by race in measures of labor induction management. Biases outside of induction management during labor may be targeted to reduce CD disparities. [ABSTRACT FROM AUTHOR]

Objectives. To assess differences in contextual factors by intent among pediatric firearm injury patients and determine factors associated with data missingness. Methods. We retrospectively queried the American College of Surgeons Firearm Study database (March 1, 2021–February 28, 2022) for patients aged 18 years or younger. We stratified preinjury, firearm-related, and event-related factors by intent and compared them by using Fisher exact, χ2, or 1-way analysis of variance testing. Secondary analysis estimated the adjusted odds of missingness by using generalized linear modeling with binominal logit link. Results. Among 17 395 patients, 2974 (17.1%) were aged 18 years or younger; 1966 (66.1%) were injured by assault, 579 (19.5%) unintentionally, and 76 (2.6%) by self-inflicted means. Most contextual factors differed by intent, including proportion of youths with previous adverse childhood experiences, mental illness, and violent assaults or injury, firearm type and access, perpetrator relationship, and injury location. In adjusted analyses, age, trauma center designation, intent, and admission status were associated with missingness. Conclusions. Contextual factors related to pediatric firearm injury vary by intent. Specific predictors associated with missingness may inform improved future data collection. Public Health Implications. Contextual factors related to pediatric firearm injury can be obtained in a systematic manner nationally to inform targeted interventions. (Am J Public Health. 2024;114(10):1097–1109. https://doi.org/10.2105/AJPH.2024.307754) [ABSTRACT FROM AUTHOR]

We aimed to explore attitudes and training experiences of medical students toward gender medicine (GM). A cross-sectional study with convenience sampling was conducted (sample size = 430). To assess predictors of high GM consideration in patient management, a multivariable logistic regression was performed. A total of 82% considered sex and gender important; 61% stated that they would use GM skills in their careers. A total of 76% had never discussed GM with their tutors, with differences between male and female students (p =.002). Predictors of high GM consideration were: age (adjOR = 1.4, 95%CI = 1.1–1.8) and the impression that tutors considered patients' sex and gender during practice (adjOR = 3.9, 95%CI = 2.0–7.6). Thus, participants considered GM important, but some students were unsure whether it could be useful in practice. The strongest predictor of high GM consideration was the tutors' good example during training. It would be advisable to implement the teaching of this topic during both courses and traineeships. [ABSTRACT FROM AUTHOR]

Background: The management of hemodynamically unstable pelvic ring injuries necessitates surgical intervention, often involving procedures such as external fixation and percutaneous screw placement. Given the infrequent performance of these procedures, regular training is imperative to ensure readiness for emergencies. Our pre- post simulation study aimed to adapt and validate a realistic simulation model for stabilizing unstable pelvic ring injuries, facilitating participants' knowledge retention and procedural confidence enhancement. Methods: A standardized simulator of an unstable pelvic ring utilizing synthetic pelvic bones featuring complete disruption of the symphysis and sacroiliac joint was developed. Trauma surgeons of a level one academic hospital were invited to perform external fixation and emergency sacroiliac screw application under C-arm guidance. Prior to and following the simulation session, participants completed a subjective questionnaire assessing their confidence in emergency interventions on a 10-point Likert scale (10-LS). Objective parameters, such as intraoperative imaging quality, reduction accuracy, and the positioning of screws, wires, and external fixators, were also evaluated as secondary outcome measures. Results: Fifteen trauma surgeons (10 residents, 5 consultants) participated in the simulation over the course of one day. The mean total operation time was 20.34 ± 6.06 min, without significant differences between consultants and residents (p = 0.604). The confidence for emergency SI-Screw placement increased significantly after the simulator (10-LS: Before = 3.8 ± 3.08 vs. After = 5.67 ± 2.35; p = 0.002) as well as after external fixation (10-LS: Before = 3.93 ± 2.79 vs. After = 6.07 ± 2.52; p = 0.002). In addition, confidence in (intraoperative) pelvic imaging increased significantly (10-LS: Before = 4.60 ± 3.0 vs. After = 6.53 ± 2.39; p = 0.011). Overall, the model was rated as a realistic simulation of clinical practice (10-LS = 7.87 ± 1.13). Conclusions: Our unstable pelvis fracture model is a tool to practice emergency interventions such as external fixation and percutaneous techniques. Participants benefitted from this in terms of technical instrumentation as well as intraoperative imaging. Further studies are required to validate the objective benefits and improvements that participants undergo through frequent training. [ABSTRACT FROM AUTHOR]

Objectives: The incidence of hemidiaphragmatic paresis (HDP) in superior trunk block (STB) usually depends on the dose of local anesthetic. This study aimed to further evaluate the impact of a lower volume (10 mL) of the same low concentration (0.25%) ropivacaine compared to a conventional volume (15 mL), on diaphragmatic function and analgesic efficacy under a multimodal analgesia regimen for shoulder arthroscopy. Methods: Patients scheduled to undergo shoulder arthroscopy were randomized allocated to receive either 10 mL or 15 mL of 0.25% ropivacaine in the STB under ultrasound guidance prior to general anesthesia. The primary outcome was the percentage reduction in diaphragm excursion (ΔDE) between baseline and 30 min after block. Secondary outcomes included DE and diaphragm thickening fraction (DTF) before and after block, incidence of HDP, onset of sensory/motor block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity, pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, and adverse events post-surgery. Results: Compared with 15 mL volume, 10 mL ropivacaine significantly reduced the incidence of post-block HDP (as measured by ΔDE: 39.47% vs. 64.10%; and by post-block DTF: 13.16% vs. 33.33%). There was no significant difference in onset of sensory block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity between the two groups, except that the onset of motor block was significantly slower in the 10 mL group than in the 15 mL group. Pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, or postoperative adverse events were not significantly different between the two groups. Conclusion: In shoulder arthroscopy, STB with 10 mL of ropivacaine can reduce the incidence of HDP with no significant difference in analgesic effects under a multimodal analgesia regimen compared with 15 mL. Trial registration: We registered the study at chictr.org (ChiCTR2200057543 , 14/03/2022. https://www.chictr.ogr.cn [ABSTRACT FROM AUTHOR]

Objective: There is growing evidence that simultaneous bilateral open wedge high tibial osteotomy(SBOWHTO) and simultaneous bilateral unicompartmental knee arthroplasty(SBUKA) is an effective surgical treatment for bilateral medial knee osteoarthritis (MKOA). However, which intervention is more beneficial for bilateral MKOA patients remains unknown. Therefore, the aim of this study was to compare the effectiveness of these two strategies through early clinical outcomes, complication rates, and prosthetic survival. Methods: The clinical data of 60 patients with bilateral MKOA admitted to the Affiliated Hospital of Qingdao University from January 2018 to December 2022 were retrospectively analyzed, and they were divided into SBOWHTO group (n = 28) and SBUKA group (n = 32) according to different treatment methods. Clinical relevant indexes, Hospital for Special Surgery (HSS) score, Knee Society Knee (KSS) score, range of motion(ROM), postoperative complications and prosthetic survival rate were compared between the two groups. Results: Patients in the SBOWHTO group were followed up for 27 to 50 months, with an average of (37.18 ± 6.84) months. Patients in the SBUKA group were followed up for 24 to 59 months, with an average of (39.38 ± 9.74) months. There were no significant differences in postoperative KSS, HSS and ROM between SBOWHTO group and SBUKA group (p > 0.05). There was no significant difference in complication rate between the two groups (p = 0.721). There was no significant difference in prosthetic survival rate (p = 0.622) and prosthetic survival curve (χ2 = 0.546, p = 0.46) between the two groups. Conclusions: This study compared early clinical outcomes, complication rates, and prosthesis retention rates after SBOWHTO and SBUKA, and found that the early clinical benefits of SBOWHTO and SBUKA were comparable in patients with bilateral MKOA. [ABSTRACT FROM AUTHOR]

Background: Health service development aims to close the gap between evidence and practice by adopting and appropriately utilizing the latest findings. To address this gap, dissemination and implementation research has been promoted and developed. Despite promoting evidence-based programs over the years, public health nurses have had few training opportunities in evidence-based public health. This study evaluated the effectiveness of a web-based training in building the basic program implementation capacity of public health nurses with two to five years of experience. Methods: We developed a simulation-powered web-based training according to an Implementation Degree Assessment Sheet for health programs. This was a randomized, single-blind, parallel-group trial. The primary outcome, the result of implementation capacity for public health nurses, was assessed by the total score of the Implementation Degree Assessment Sheet, and scores for its five domains. The secondary outcome was evaluated by the level of understanding. The primary outcome was analyzed utilizing the t-test and analysis of covariance, whereas the secondary outcome was assessed utilizing the U-test and Quade's analysis of covariance. Data were collected directly before intervention (T1: baseline), immediately post-intervention (T2), and four weeks post-intervention (T3: endpoint). Results: The 197 participants were randomly allocated to either the intervention group (n = 98) or the control group (n = 99). A full analysis set of 152 samples and a per-protocol set of 104 samples were analyzed. The intervention group exhibited a significantly higher total score and five domain-wise scores at the endpoint compared with the control group. The disparity between the endpoint and baseline scores was significantly larger for the intervention group for all scores. The level of understanding was significantly higher in the intervention group than in the control group at T2 and T3. The effect size of the total score was higher in the full analysis set (Cohen's d = 0.5) than in the per-protocol set (d = 0.48). Conclusions: This web-based training was effective in building the program implementation capacity of participants four weeks post-intervention. Trial registration: University Hospital Medical Information Network Center Clinical Trials Registry UMIN000048421. [ABSTRACT FROM AUTHOR]

Background: Klotho plays a pivotal role in human aging. Metabolic syndrome (MetS) is composed of multiple conditions that are also risk factors for cardiovascular disease and diabetes. We try to discuss gender-specific differences in Klotho and the associations between Klotho and MetS components. Materials and methods: The National Health and Nutrition Examination Survey database from cycle 2015–2016 was analyzed. MetS was defined according to the 2005 updated criteria by the American Heart Association and National Heart Lung and Blood Institute. Gender-specific differences in serum Klotho, and associations between Klotho level and MetS components were examined. Results: A total of 2475 participants (40–79 years old) with comprehensive data were included (52% women). In general, lower Klotho was associated with advanced age, male sex, tobacco use, elevated triglycerides, renal insufficiency, inflammation, low estradiol, and low sex hormone-binding globulin (SHBG). The correlation between MetS and Klotho was more obvious in women, mainly in waist circumference and triglyceride. There were no gender-specific differences in the associations between Klotho and renal dysfunction, but multivariate linear regression analysis showed gender differences in other factors associated with Klotho. Estradiol, SHBG, high-density lipoprotein cholesterol (HDL), and high-sensitivity C-reactive protein (CRP) were associated with Klotho levels independent of age and renal function in men, whereas in women, Klotho was independently associated with triglycerides and white blood cell count. Conclusion: Klotho levels had gender disparities regardless of age, renal function, and sex hormones. In the current cohort, triglycerides were the major component of MetS that was independently associated with serum Klotho levels, and the association was particularly seen in women. However, HDL was found to be the male-specific MetS component independently associated with Klotho. [ABSTRACT FROM AUTHOR]

Background: Efficacy of inhaled therapy such as Nitric Oxide (iNO) during mechanical ventilation may depend on airway patency. We hypothesized that airway closure and lung collapse, countered by positive end-expiratory pressure (PEEP), influence iNO efficacy. This could support the role of an adequate PEEP titration for inhalation therapy. The main aim of this study was to assess the effect of iNO with PEEP set above or below the airway opening pressure (AOP) generated by airway closure, on hemodynamics and gas exchange in swine models of acute respiratory distress syndrome. Fourteen pigs randomly underwent either bilateral or asymmetrical two-hit model of lung injury. Airway closure and lung collapse were measured with electrical impedance tomography as well as ventilation/perfusion ratio (V/Q). After AOP detection, the effect of iNO (10ppm) was studied with PEEP set randomly above or below regional AOP. Respiratory mechanics, hemodynamics, and gas-exchange were recorded. Results: All pigs presented airway closure (AOP > 0.5cmH2O) after injury. In bilateral injury, iNO was associated with an improved mean pulmonary pressure from 49 ± 8 to 42 ± 7mmHg; (p = 0.003), and ventilation/perfusion matching, caused by a reduction in pixels with low V/Q and shunt from 16%[IQR:13–19] to 9%[IQR:4–12] (p = 0.03) only at PEEP set above AOP. iNO had no effect on hemodynamics or gas exchange for PEEP below AOP (low V/Q 25%[IQR:16–30] to 23%[IQR:14–27]; p = 0.68). In asymmetrical injury, iNO improved pulmonary hemodynamics and ventilation/perfusion matching independently from the PEEP set. iNO was associated with improved oxygenation in all cases. Conclusions: In an animal model of bilateral lung injury, PEEP level relative to AOP markedly influences iNO efficacy on pulmonary hemodynamics and ventilation/perfusion match, independently of oxygenation. [ABSTRACT FROM AUTHOR]

Background: The Individual Care Plan (ICP) for pediatric palliative care translates the general guideline recommendations into a personalized plan for the child. Various documents exist in pediatrics globally, aimed at facilitating anticipatory care or coordinating end-of-life care. The ICP aims both, but user experiences have not been studied post-development. Objective: The overall aim is to enhance knowledge and understanding of the content of the ICP from the perspectives of parents and healthcare professionals (HCPs). Design and method: We conducted a mixed-method study using a convergent parallel design consisting of questionnaires and individual and focus group interviews among parents and HCPs having user experience with the ICP. The questionnaire and interview data were analyzed separately. Quantitative data were descriptively analyzed using mean, ±SD, and median. Qualitative data were thematically analyzed. A narrative approach and joint display were used to describe the results. Results: In total, 27 parents and 161 HCPs participated. Overall, the content of the ICP was seen as important and complete, but changes and additions were called for on language, structure, and content. The chapter on the needs and wishes of child and parents was considered most important. HCPs would like to see this chapter expanded to incorporate more advance care planning outcomes, and parents wished for this chapter to reflect better who their child is. HCPs mentioned missing a chapter for palliative sedation, mainly to guide other HCPs. The ICP was appraised as not user-friendly and might possibly improve by making the ICP available in a secure digital environment. Conclusion: To meet the needs of parents and HCPs considering importance and completeness of the content of the ICP and its user-friendliness, changes are necessary in the content of the ICP, and preferably the ICP should be made digitally available. Although various documents exist globally to facilitate anticipatory care or coordinating end-of-life care, it appears that the combination of describing the values and preferences of the child and parents, along with medical decisions and life-sustaining treatments, makes the ICP a unique and comprehensive care plan. [ABSTRACT FROM AUTHOR]

Background: In Nigeria, the attitudes of community pharmacists toward providing pharmaceutical care (PC) for people with mental illnesses remain unclear. This study aimed to assess the community pharmacists' attitudes and barriers toward providing PC services for clients with mental disorders in Enugu, Nigeria. Methods: A cross-sectional survey was conducted among all eligible community pharmacists in Enugu, Nigeria. The data were obtained using validated self-administered questionnaire adapted from the literature and a sociodemographic form. The data collected were analyzed using descriptive statistics and Chi-square/Fisher's Exact test. P values less than 0.05 were considered significant. Results: A total of 155 community pharmacists took part in the survey, giving a response rate of 95.6%. The findings showed that more than half of the community pharmacists (n = 80, 51.6%) had positive attitudes toward providing PC services for patients with mental illness. Positive attitudes were associated with having a family member with mental illness (p = 0.038) and a good self-rated knowledge of mental illness (p < 0.001). The most frequently reported barriers to PC were patient factors associated with their symptoms (59.4%) and a lack of patient information (52.9%). Conclusion: The attitudes of community pharmacists toward providing PC for patients with mental illness is largely positive but suboptimal. Patient factors related to their symptoms were cited as the major obstacle to providing PC. Therefore, continued education and training and supportive environment are encouraged to improve the situation. [ABSTRACT FROM AUTHOR]

Background: Healthy lifestyle behavior includes appropriate behaviors such as eating habits, physical activity and weight control in order to stay healthy and prevent diseases. The aim of this cross-sectional study is to evaluate healthy lifestyle behaviors, physical activity levels and social media use of dental students. Methods: An online questionnaire including demographic characteristics, International Physical Activity Questionnaire Short Version (IPAQ-S) and Health Promoting Lifestyle Profile (HPLP) was filed by 420 dental students. The data were evaluated statistically. Results: The mean age was 21.6 ± 1.96 years and the majority of the students (71.7%) were living with their families. Obesity and overweight in males and underweight in females were statistically higher. There was no difference between the genders in terms of social media use. The most preferred applications were Instagram (92.7%), YouTube (85%) and Twitter (59.7%). In terms of IPAQ durations and HPLP scores, there was no gender difference. According to the IPAQ classification, while the majority of students (64.3%) were physically low active, 23.1% were physically inactive. As the total HPLP score increased, the total IPAQ score increased. Conclusion: It is concluded that as the university students make up the majority of the young adults, encouraging their health-promoting behaviors is crucial for improving public health. [ABSTRACT FROM AUTHOR]

Introduction: Angiography is associated with anxiety, stress, and changes in patients' vital signs. The role of the liaison nurse is to bridge gaps and solve problems between departments, thereby preventing the occurrence of undesired complications during patient transfers. Proper preparation of patients by the liaison nurse may lead to an improvement in the hemodynamic status of patients. The present study was conducted to investigate the effect of liaison nurse on hemodynamic status during transfer process to angiography. Method: This randomized controlled trial was conducted from December 2019 to March 2020 on 62 patients who were candidates for elective angiography at Imam Reza Hospital in Mashhad. Participants were selected using a convenience sampling method and then randomly assigned to either the control or intervention group using a lottery system. In the intervention group, patients benefited from the presence of a liaison nurse from the moment the transfer order was issued by the doctor. Tools used included a demographic information questionnaire and a hemodynamic signs checklist. Data were analyzed using SPSS 25 with independent T-tests, paired T-tests, Wilcoxon, Mann-Whitney test, chi-squared, and Fisher's exact test. Result: Following the intervention, the mean systolic blood pressure, heart rate, and respiratory rate in the intervention group were found to be significantly lower than those in the control group (p < 0.05). In contrast, the mean body temperature, diastolic blood pressure and the percentage of arterial blood oxygen saturation did not exhibit a statistically significant difference between the two groups (p > 0.05). Conclusion: The liaison nurse role emerges as a valuable strategy for enhancing patients' hemodynamic stability, and its implementation can have a positive impact on patient outcomes in hospital settings. [ABSTRACT FROM AUTHOR]

Background: New daily persistent headache (NDPH) is a continuous, unremitting headache from onset that yields suboptimal results with traditional medicines. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising non-invasive treatment for other headache disorders, such as migraine, and neuromodulation has not been well-studied in NDPH. The objective of the study was to evaluate the efficacy of rTMS in reducing the frequency and severity of headaches, and associated anxiety and depressive symptoms in NDPH patients. Methods: This was an open label prospective, single arm, interventional pilot study conducted between October 2022 and September 2023. All eligible participants received 10 Hz rTMS (600 pulses, 10 trains), delivered to the left prefrontal cortex for three consecutive days. The post-rTMS headache severity was recorded weekly for four weeks and headache free days/functional disability, PHQ-9, and GAD-7 scores at the end of four weeks and compared with pre-rTMS parameters. The primary outcome was defined by ≥ 50% reduction in headache severity on Visual Analogue Scale (VAS) score, decrease in headache days from the baseline and secondary outcome was ≥ 6 point reduction in HIT-6 score at 4 weeks. Results: Fifty NDPH patients (mean [SD] age, 35.06 [13.91] years; 31 females [62%]) participated in this study. Thirty-five patients (70%) reported ≥ 50% improvement in pain severity (p-value < 0.001), with a mean reduction of 10.84 (4.88) headache days per 28 days from a baseline of 28 headache days (p-value < 0.001). Thirty-eight patients (76%) reported a ≥ 6 point's reduction in HIT score at 4 weeks. Maximum improvement in the above parameters was observed in NDPH patients with chronic migraine. Two patients reported intolerance to the sound of the rTMS. The median (IQR) PHQ-9 and GAD-7 scores reduced from 11.5(3.75,20) to 7(2,15) (p-value < 0.001) and 10(3,14) to 5.5(0,9) (p-value < 0.001) respectively. Conclusion: rTMS was well tolerated and effective in reducing pain severity, headache days and headache related disability, depressive and anxiety symptoms. Trial registration: CTRI/2023/05/053247. [ABSTRACT FROM AUTHOR]

Background: Malay herbal medicine (MHM) is a popular medication and supplementation among Malaysian mothers during pregnancy and postpartum. It is expected to improve the baby's health, increase breastmilk production, promote slimming and uterine involution, and improve the mother's general health. Recent increases in reports of heavy metal contamination have raised safety concerns. Objective: This pilot exploratory study employed a comparative cross-sectional design to investigate the types of MHM ingested during pregnancy and postpartum, their possible heavy metal contamination and associated health risks. Method: This study involved 167 healthy postpartum Malay women. Findings: MHM consumption was significantly associated with the mother's number of pregnancies and children (p < 0.05) as well as her pre-pregnancy weight (p < 0.05). Mothers who consume MHM were twice as likely (95% CI 1.077–3.963) to experience threatened abortion. Heavy metals were detected in the three most widely consumed MHM samples. The mean concentration of heavy metals in these samples were 47.44 ± 67.74 μg/kg for As, 25.34 ± 2.48 μg/kg for Cd, 3685.87 ± 5683.36 μg/kg for Cr and 194.33 ± 195.19 μg/kg for Pb. The calculated non-carcinogenic hazard health risks (HQ) and health index (HI) were less than one, suggesting no adverse health impacts under the exposure conditions studied. Conclusion: While the HQ and HI values indicate no immediate health risks, the potential transfer from mother to foetus during pregnancy and from mother to infant during breastfeeding warrants further investigation. Additional studies are essential to confirm our findings and monitor the health of mothers and infants. [ABSTRACT FROM AUTHOR]

Background: There is a lack of literature which assesses both patient and health care provider (HCP) perceptions of barriers and facilitators to diabetes health care in immigrant and refugee populations within the United States. This study uniquely incorporates both cohorts' perceptions on the same topic to assess for congruency and discrepancies in perspectives. Methods: Surveys were deployed to patients with diabetes and HCPs to solicit perceptions of barriers and facilitators to diabetes care, with the intention to determine similarities and differences between cohorts. A literature review was conducted to explore barriers and facilitators to diabetes care in immigrant/refugee populations in the US to aid in development of the survey used in this study, as no validated survey existed. Broad recruitment strategies were used, including snowball sampling. Descriptive statistics were calculated and reported p-values were derived from a chi-squared or Fisher's exact test and used for categorical data and a Wilcoxon rank sum or Kruskal–Wallis rank sum test was used for continuous data. Qualitive analysis was completed using the inductive analysis method. Results: Among 19 immigrant and refugee patients and 35 HCPs, almost all facilitators to diabetes care were endorsed by patients and HCPs as helpful. The highest ranked facilitator among patients and HCPs was having access to health insurance. Patients rated stress, while HCPs rated lack of health insurance as the biggest barriers to diabetes care for immigrants and refugees. Patients and HCPs differed in perspective on who held primary responsibility for diabetes management. Patients wanted more diabetes education and nutrition support, while HCPs thought understanding patients' cultural context/sensitivity, providing more education, and having language/translation services were the most important things HCPs can do to care for patients' diabetes. Conclusions: Immigrant/refugee patients and HCPs largely agree about what factors are most helpful in managing diabetes, with access to health insurance as the greatest facilitator. However, while HCPs identified lack of health insurance as the greatest barrier to care, immigrant and refugee patients cited the role of stress as the greatest challenge in managing their diabetes. There was a striking difference in perception of responsibility for diabetes management, with 89% of patient participants responding that the patient is responsible, while only 17% of HCPs responded that the patient was responsible. Future work should include surveys translated into languages other than English to further elicit the perspective of diabetes care in immigrant/refugee populations. Clinical recommendations based on this study include assessing and supporting patient stressors, assuring patients understand that diabetes management is a partnership, providing culturally tailored diabetes education, and increasing access to health insurance. [ABSTRACT FROM AUTHOR]

Purpose: After stroke, upper limb somatosensation can be impaired which affects motor control. Vision is often used to compensate for this. A clinical assessment which assesses the combined sensorimotor function in the absence of vision would be beneficial in studies targeting sensorimotor improvement. Methods and materials: We adapted the Action Research Arm Test (ARAT) to be performed without vision and called this modified version the sensorimotor ARAT (sARAT). Sixty healthy participants and 22 participants with chronic stroke performed the ARAT, sARAT, Fugl-Meyer upper extremity assessment (FM-UE) and Erasmus modified Nottingham sensory assessment (EmNSA). Discriminative validity of sARAT was evaluated by comparing performance between healthy participants and participants with chronic stroke. Convergent validity was evaluated by correlating sARAT with FM-UE and EmNSA. Results: Participants with stroke performed worse on the sARAT compared to healthy participants (p < 0.001), with median scores of 52 (IQR 32-57) and 57 (IQR 57-57), respectively. The sARAT showed high correlations with FM-UE and EmNSA (r = 0.80-0.90). Conclusions: The sARAT shows good discriminative and convergent validity in people with chronic stroke. It allows a quick assessment of the combined upper limb sensorimotor function, by performing the well-known ARAT with the eyes closed. IMPLICATIONS FOR REHABILITATION: The sensorimotor adaptation of the Action Research Arm Test (sARAT) is a clinical assessment of upper limb activity which is performed with the eyes closed. Combining the gold standard ARAT with the sensorimotor adaptation sARAT can inform about the influence of somatosensory impairments on upper limb activity in stroke survivors when vision is blocked. The sARAT shows good discriminative and convergent validity in persons with chronic stroke. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic contact restrictions considerably changed maternal visiting contacts during the time in which breastfeeding is initiated. We wanted to know how maternity ward staff and mothers rated the conditions of starting breastfeeding under contact restrictions. Methods: In the Breastfeeding in North Rhine-Westphalia (SINA) study, Germany, 2021/22, chief physicians as well as ward staff from 41 (out of 131) maternity hospitals (82 members of the healthcare sector in total) were surveyed by telephone concerning structural and practical conditions for breastfeeding support before and during the pandemic; 192 (out of 426 eligible) mothers answered an online-questionnaire about their breastfeeding experiences at 2 weeks and 2 months after birth. Results: In almost all of the hospitals, visits were restricted due to the pandemic, with the exception of the primary support person. After more than one year of pandemic experience, the ward staff were convinced that the restrictions were mostly positive for the mothers (97.6%) and for the ward staff themselves (78.0%). A total of 80.5% of the ward staff would maintain the restrictions beyond the pandemic. The mothers themselves mostly rated the restrictions in the hospital as being just right; moreover, many mothers voluntarily maintained the restrictions at home, at least in part. Conclusions: The unprecedented visiting restrictions in hospitals during the pandemic were like an "experiment" born out of necessity. Restricting visiting arrangements may be an underestimated beneficial component for the development of the mother-infant dyad in perinatal breastfeeding care, particularly in healthcare systems where almost all births occur in the maternity hospital. Trial registration: German Clinical Trials Register (DRKS) (DRKS00027975). [ABSTRACT FROM AUTHOR]

Background: COPD patients show higher mortality and worse prognosis in the acute phase of COVID-19, and survivors may suffer persistent symptoms that could make them more vulnerable to exacerbations. Objectives: We aimed to evaluate the impact of COVID-19 on the exacerbations, symptoms, quality of life, and mental health of a cohort of COPD patients. Methods: Retrospective case-control single-centre study including all COPD patients from the pulmonary consultation of University Hospital Santa Maria (Lleida, Spain) surviving COVID-19 between March 2020 and September 2021, and similar propensity-score-matched (1:2) COPD patients. Differences in COPD exacerbations, COPD clinical evolution (lung function, dyspnoea, CAT and symptoms), long COVID-19 symptoms, quality of life, and mental health, were assessed at the end of 2021. Results: We included 39 COVID-19 COPD patients and 78 similar non-COVID-19. No differences were found on exacerbations (46(59%) vs. 27(69.2%), p = 0.380), dyspnoea (2 [1; 3] vs. 2 [1; 3], p = 0.921) CAT (14.5 [10.0; 18.8] vs. 13.0 [10.0; 16.0], p = 0.432). Only the prevalence of smell or taste disorders, hair loss and tingling was higher in COVID-19 patients. No differences were found in quality of life or mental health. Conclusions: COPD patients surviving COVID-19 were not at a higher risk of COPD exacerbations nor showed significant changes in COPD clinical evolution, and only showed differences in a few very specific COVID-19 symptoms. These unexpected results suggest that the conditions triggered by the pandemic and its management could have affected COPD patients as much as actually having had COVID-19. [ABSTRACT FROM AUTHOR]

Background: The prevalence of heart failure is increasing owing to the aging of the population, resulting in growing medical costs and an increasing number of patients with multimorbidity. The optimal management of heart failure by general physicians in addition to internal medicine physicians, such as cardiologists, is essential, although the specifics are unclear. In this study, we aimed to determine the differences in heart failure management outcomes among older patients between those managed by general physicians and those managed by internal medicine physicians, especially in terms of hospitalization and mortality rates. Methods: This was a retrospective cohort study of patients with heart failure who visited a community hospital in Japan. Patients with heart failure were selected based on International Classification of Diseases codes from electronic medical record data over 9 years, from September 2015 to August 2023. The independent variables were whether a general physician treated the patient; the primary outcome was death; the secondary outcome was hospitalization; and the covariates were patient background, including comorbidities. Multiple logistic regression analysis was used to evaluate the association between being managed by a general physician and death and hospitalization, after adjusting for confounding factors. Results: A total of 1032 patients with heart failure were identified, with a mean age of 82.4 years, and 48.9% were men. Patients treated by general physicians were older, were more likely to have dementia and were more likely to need care than those treated by internal medicine physicians. Being treated by a general physician was significantly negatively associated with death (odds ratio [OR], 0.62) and hospitalization (OR, 0.73). Conclusions: In Japan, where medical specialties are increasingly differentiated, the comprehensive management of older patients with heart failure and multiple comorbidities by general physicians may reduce hospitalization and mortality rates. Appropriate education of general physicians and an increase in their numbers may prove essential for the successful management of patients with heart failure in aging communities. [ABSTRACT FROM AUTHOR]

Background: Severe trauma is the leading cause of disability and mortality in the patients under 35 years of age. Surgical site infections (SSI) represent a significant complication in this patient population. However, they are often inadequately investigated, potentially impacting the quality of patient outcomes. The aim of this study was to investigate the epidemiology of SSI and risk factors in severe trauma patients. Methods: We conducted a multicenter retrospective cohort study screening the severe trauma patients (STP) admitted to two intensive care units of an academic institution in Marseille between years2018 and 2019. Those who underwent orthopedic or spinal surgery within 5 days after admission were included and classified into two groups according to the occurrence of SSI (defined by the Centers for Disease Control (CDC) international diagnostic criteria) or not. Our secondary goal was to evaluate STP survival at 48 months, risk factors for SSI and microbiological features of SSI. Results: Forty-seven (23%) out of 207 STP developed an SSI. Mortality at 48-months did not differ between SSI and non-SSI patients (12.7% vs. 10.0%; p = 0.59). The fractures of 22 (47%) severe trauma patients with SSI were classified as Cauchoix 3 grade and 18 (38%) SSI were associated with the need for external fixators. Thirty (64%) severe trauma patients with SSI had polymicrobial infection, including 34 (72%) due to Gram-positive cocci. Empirical antibiotic therapy was effective in 31 (66%) cases. Multivariate analysis revealed that risk factors such as low hemoglobin, arterial oxygenation levels, hyperlactatemia, high serum creatinine and glycemia, and Cauchoix 3 grade on the day of surgery were associated with SSI in severe trauma patients. The generated predictive model showed a good prognosis performance with an AUC of 0.80 [0.73–0.88] and a high NPV of 95.9 [88.6–98.5] %. Conclusions: Our study found a high rate of SSI in severe trauma patients, although SSI was not associated with 48-month mortality. Several modifiable risk factors for SSI may be effectively managed through enhanced perioperative monitoring and the implementation of a patient blood management strategy. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this cross-sectional study was to investigate if serum levels of granulocyte-macrophage colony-stimulating factor (GM-CSF) and CC chemokine ligand 17 (CCL17) correlate with disease activity in axial spondyloarthritis (axSpA) and peripheral spondyloarthritis (pSpA) patients. Patients and methods: The cross-sectional study was conducted with 80 individuals (48 females, 32 males; mean age: 47.7±11.5 years) between March 2021 and September 2021. Of the participants, 20 were axSpA, 20 were pSpA, and 20 were active rheumatoid arthritis patients, and the remaining 20 were healthy controls. Age, sex, body mass index, disease duration, comorbid diseases, smoking status, medical treatments, C-reactive protein (CRP) level and human leukocyte antigen B27 (HLA-B27) positivity were recorded. Serum GM-CSF and CCL17 levels were analyzed by ELISA. Ankylosing Spondylitis Disease Activity Score with CRP (ASDAS-CRP) was used to evaluate the disease activity of patients with spondyloarthritis. Functional status of spondyloarthritis patients was evaluated by Bath Ankylosing Spondylitis Functional Index (BASFI). Results: While the serum GM-CSF levels were similar in the axSpA and pSpA groups, they were significantly higher than the healthy control group (p=0.021 and p=0.009, respectively). There was a significant correlation between GM-CSF levels and ASDAS-CRP (r=0.545, p=0.013) and BASFI (r=0.546, p=0.013) in the axSpA group. In active axSpA patients, the cut-off value for GM-CSF was 15.89 pg/mL (sensitivity 50%, specificity 100%). No differences were detected in serum CCL17 levels among the groups. Conclusion: The results suggest that serum GM-CSF levels may be used as a new marker for the evaluation of disease activity in axSpA, and GM-CSF might be a therapeutic target. [ABSTRACT FROM AUTHOR]

Introduction: To determine if anti-Xa testing is associated with improved outcomes for patients <19-years-old on ECMO. Methods: We evaluated the clinical benefit of anti-Xa heparin monitoring utilizing the Bleeding and Thrombosis during ECMO (BATE) database of 514 patients <19-years-old. The BATE database includes incidences of bleeding, thrombosis, and mortality. The database also describes anti-coagulation test utilization. We grouped and analyzed patients based on ECMO indication (cardiac, respiratory, or extracorporeal cardiopulmonary resuscitation [E-CPR]) and age (neonatal vs pediatric). We constructed multivariable logistic regression models to analyze the impact of anti-Xa testing on mortality, bleeding, and thrombosis in each group. Results: Across the entire population, anti-Xa testing did not have a significant effect on the incidence of mortality (43% with anti-Xa testing vs 49% without), bleeding (68% vs 74%), or thrombosis (37% vs 39%). However, among cardiac indicated patients on ECMO (n = 207), anti-Xa testing was significantly associated with reduced odds ratio (OR) of mortality (adjusted OR 0.527, p =.040) and bleeding (adjusted OR 0.369, p =.021). In addition, among neonatal patients on ECMO (n = 264), anti-Xa testing was associated with a significant reduction in the odds ratio of bleeding (adjusted OR 0.534, p =.046). Conclusion: Anti-Xa testing is associated with improved outcomes among cardiac indicated and neonatal patients on ECMO. Additional research to find the optimal heparin monitoring regimen is needed to better support these critically ill patients. In the interim, we recommend clinicians consider utilizing anti-Xa assays as part of their heparin monitoring plan for neonatal and cardiac indicated patients on ECMO. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the blood protective effect of autologous platelet-rich plasma in aortic root reconstruction under longtime cardiopulmonary bypass. Method: Patients who underwent aortic root reconstruction between August 2018 and August 2022 were included and divided into experimental and control groups according to whether autologous platelet-rich plasmapheresis was used or not. The experimental group included 112 patients (90 males aged 39.00 [28.75–49.00] years), and the control group included 112 patients (90 males aged 37.00 [27.00–46.25] years). The clinical data for example EuroSCORE II cardiovascular surgery risk score, blood routine and other indicators were collected from the two groups. Results: The transfusion volume of allogeneic red blood cells in the experimental group (52 cases without blood transfusion, 23 cases with 1–2 units, 15 cases with 3–4 units, and 22 cases with 5 units and above) was significantly lower than that in the control group (32 cases without transfusion, 34 cases with 1–2 units, 22 cases with 3–4 units, and 24 cases with 5 units or more) (Z = −2.06, p < 0.05). Resternotomy/thoracotomy occurred in 11 cases (9.8%) in the experimental group and 23 cases (20.5%) in the control group (RR = 2.37, 95% CI: 1.1–5.14, p < 0.05). The number of bleeding events in the experimental group (18 cases, 16.1%) was significantly less than that in the control group (33 cases, 29.5%) (RR = 2.18, 95% CI: 1.14–4.17, p < 0.05). Conclusions: The application of autologous platelet-rich plasma in a long-time cardiopulmonary bypass aortic root reconstruction can reduce the amount of allogeneic blood transfusion and the occurrence of bleeding events, which is beneficial for blood protection. [ABSTRACT FROM AUTHOR]

Background: Postcardiotomy extracorporeal membrane oxygenation (ECMO) in pediatric patients can be affected by the place of initiation, either in the operating room (OR) or the pediatric cardiac intensive care unit (PCICU). This study aimed to characterize and compare patients who had postcardiotomy ECMO initiation in the OR or PCICU and evaluate risk factors for hospital mortality. Methods: This retrospective study included 103 patients who required postcardiotomy ECMO support after the repair of congenital cardiac lesions from 2010 to 2022. Patients were grouped according to the place of ECMO insertion into two groups. Group 1 (n = 69) had ECMO insertion in the OR, and Group 2 (n = 34) had ECMO insertion in the PCICU. Results: Cardiac arrest occurred significantly more often in patients with ECMO insertion in the PCICU (21 (61.76%) vs. 13 (18.84%); p < 0.001). Pre-ECMO lactate levels, pH, VIS, base deficit, and PaO2 did not differ between the groups. Re-exploration for bleeding was significantly higher in Group 1 (32 (46.38%) vs. 8 (23.53%); p = 0.03). Cannula repositioning (4 (11.76%) v. 2 (2.90%); p = 0.09) and mechanical ventilation time were nonsignificantly higher in Group 2 (19.5 (10–31) vs. 11 (5–25) days; p = 0.07). No difference in mortality was found between groups (42 (60.87%) vs. 23 (67.65%), p = 0.50). By multivariable analysis, elevated lactate on ECMO and low pH before ECMO were associated with mortality. Conclusions: ECMO insertion in the OR has a comparable mortality rate to PCICU insertion. Pre-ECMO low pH and high lactate during ECMO could predict mortality. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate whether surgery performed during night compared with daytime were associated with an increased risk of operative mortality of type A aortic dissection (TAAD) patients. Methods: A total of 2015 TAAD patients who underwent surgical repair were collected from two cardiovascular centers from Jan 2015 to Jan 2021. According to the start time of surgery, patients were divided into daytime group (06:01 a.m. to 06:00 p.m.) and night-time group (06:01 p.m. to 06:00 a.m.), and retrospective analyses were performed between them. Results: The operative mortality of night-time group (12.2%, 43/352) was dramatically higher than daytime group (6.9%, 115/1663; p = 0.001). There was significant difference between night-time and daytime groups in terms of 30-days mortality (5.8% vs 10.8%; p = 0.001) and in-hospital mortality (3.5% vs 6.0%; p = 0.03). The night-time group had a longer duration of intensive care unit stay (4 vs two; days; p < 0.001) and ventilation support (34 vs 19; hours; p < 0.001), compared with daytime group. The risk factors for operative mortality were night-time surgery (odds ratio [OR], 1.545; p = 0.027), age (odds ratio, 1.152; p < 0.001), total arch replacement (OR, 2.265; p < 0.001) and previous aortic surgery (OR, 2.376; p = 0.003). Conclusion: Night-time surgical repair may be associated with higher operative mortality of patients with TAAD. Nevertheless, it is reasonable to offer emergency surgery at night-time for such patients who were more likely to present disastrous complications with delayed surgical intervention, as outcomes indicate acceptable operative mortality. [ABSTRACT FROM AUTHOR]

Background: Myocardial protection is essential in cardiac surgery with cardiopulmonary bypass The Del Nido cardioplegia which was initially used in pediatric cardiac surgery, has been increasingly used in adult cardiac surgery recently. However, no literature has reported the efficacy of DNC in hypertrophic obstructive cardiomyopathy. Methods: This retrospective study involved elective patients who underwent extended surgical myectomy with or without concomitant cardiac surgical procedures between September 2017 and June 2022. Patients were distributed into two groups, the DNC and the CBC group. The primary outcome was high-sensitivity cardiac troponin I (hs-TnI) and creatine kinase-MB (CK-MB) levels at the 0, 1, and 2 postoperative days. The secondary outcomes contained: intraoperative LVEF, return to spontaneous rhythm; postoperative myocardial infarction, worsening or deteriorating of EF, mechanical circulatory support; new-onset atrial fibrillation; mechanical ventilation duration; intensive care unit hours; in-hospital days. Results: Fifty-nine patients were included and divided into the CBC (n = 15) and the DNC group (n = 44). There was no statistical difference in patients' demographics and preoperative parameters between the two groups. No in-hospital mortality. The total cardioplegia volume [21.93(18.36,26.07) vs. 25.68(23.17,37.12), p = 0.012] and infusion times [1(1,1) vs. 2(2,3), p = 0.000] were less and the incidence of return to spontaneous rhythm after declamping was higher in the DNC group [97.7% vs. 73.3%, p = 0.013]. Postoperative hs-TnI and CK-MB levels were comparable between the two groups. A longer DNC infusion interval was associated with higher levels of CK-MB on postoperative day 1 and day 2 (p = 0.009 and p = 0.011, respectively). Conclusions: The use of DNC in extended surgical myectomy procedure was as safe and effective as CBC. However, DNC infusion interval over 60 minutes was associated with increased postoperative CK-MB levels. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effect of simulation‐based training on hand hygiene knowledge and practices among palliative caregivers. The study was conducted with 60 caregivers in a palliative care clinic between December 2022 and September 2023. The participants were divided into two groups by simple randomization. The intervention and control groups received the same hand hygiene theoretical education and demonstration. The intervention group also received additional simulation‐based hand hygiene practices recommended by the World Health Organization. A pretest‐posttest design was used to assess hand hygiene knowledge and practices. Data were collected with personal information, hand hygiene knowledge, and hand hygiene practice forms. Analysis of covariance was performed to compare posttest scores between the groups. Simulation‐based hand hygiene training programs offer an effective and feasible strategy to improve the hand hygiene knowledge and practices of caregivers. It should be integrated into clinical areas to increase palliative caregivers' hand hygiene knowledge and practices. Evidence‐based practices can be improved by increasing randomized controlled studies on the effectiveness of simulation‐based hand hygiene training for caregivers. Trial Registration: The study was registered at ClinicalTrials.gov with registration number NCT05848596. [ABSTRACT FROM AUTHOR]

This study in China aimed to explore the impact of maternal depression on infant–mother attachment and whether parenting status moderated this relationship. Women underwent depression assessments at seven perinatal time points: ≤12, 17, 21, 31, and 37 weeks of pregnancy, as well as 1 and 6 weeks postpartum. Those completing at least three times assessments, along with their infants, were invited for infant–mother attachment assessment at 12–18 months postpartum. Among 233 infant–mother pairs completing the infant–mother attachment assessment, 62 and 80 mothers had postnatal depression and perinatal major depression, respectively; 75 (32.2%) of infants exhibited insecure attachment. While infants whose mothers had maternal depression showed a slightly elevated rate of insecure attachment, this difference did not achieve statistical significance. Additionally, parenting status did not influence the relationship between maternal depression and infant–mother attachment. Nevertheless, the study hinted that more physical contact between mother and infant might reduce insecure attachment likelihood. Future research should expand sample sizes and assessment points for better understanding. In addition, encouraging close interaction and physical touch between mother and infant may be beneficial. [ABSTRACT FROM AUTHOR]

Children with chronic tic disorders (CTD), including Tourette syndrome (TS), have significantly reduced serum 25-hydroxyvitamin D [25(OH)D]. While vitamin D3 supplementation (VDS) may reduce tic symptoms in these children, its mechanism is unclear. The study aim was to investigate the effects and mechanisms of vitamin D deficiency (VDD) and VDS on TS model behavior. Forty 5-week-old male Sprague–Dawley rats were randomly divided into (n = 10 each): control, TS model, TS model with VDD (TS + VDD), or TS model with VDS (TS + VDS; two intramuscular injections of 20,000 IU/200 g) groups. The VDD model was diet-induced (0 IU vitamin D/kg); the TS model was iminodipropionitrile (IDPN)-induced. All groups were tested for behavior, serum and striatal 25(OH)D and dopamine (DA), mRNA expressions of vitamin D receptor (VDR), glial cell line-derived neurotrophic factor (GDNF), protooncogene tyrosine–protein kinase receptor Ret (c-Ret), and DA D1 (DRD1) and D2 (DRD2) receptor genes in the striatum. TS + VDD had higher behavior activity scores throughout, and higher total behavior score at day 21 compared with TS model. In contrast, day 21 TS + VDS stereotyped behavior scores and total scores were lower than TS model. The serum 25(OH)D in TS + VDD was < 20 ng/mL, and lower than control. Striatal DA of TS was lower than control. Compared with TS model, striatal DA of TS + VDD was lower, while in TS + VDS it was higher than TS model. Furthermore, mRNA expression of VDR, GDNF, and c-Ret genes decreased in TS model, and GDNF expression decreased more in TS + VDD, while TS + VDS had higher GDNF and c-Ret expressions. VDD aggravates, and VDS ameliorates tic-like behavior in an IDPN-induced model. VDS may upregulate GDNF/c-Ret signaling activity through VDR, reversing the striatal DA decrease and alleviating tic-like behavior. [ABSTRACT FROM AUTHOR]

Aims: Echocardiographic diastolic parameters are used to diagnose and monitor increased left ventricular filling pressure (LVFP) and we hypothesized that increased loading conditions cause increased E/e′. Our aim was to assess the effect of preload augmentation on diastolic parameters among both healthy subjects and subjects with known cardiac disease. Methods and results: We included 129 subjects merged from two cohorts; one dialysis cohort (n = 47) and one infusion cohort (n = 82). Echocardiography was performed immediately before and after hemodialysis (HD) or saline infusion, under low and high loading conditions. Elevated LVFP was defined as septal E/e′ ≥ 15 and/or lateral E/e′ ≥ 13 at high‐loading conditions. The population was divided according to elevated LVFP (n = 31) and normal LVFP (n = 98). The load difference for the population was 972 ± 460 mL, with no differences in load difference between elevated and normal LVFP (p NS). The subjects with elevated LVFP were older (63 ± 11 vs. 46 ± 16 years, p <.001), and had lower LV ejection fraction (50 ± 14 vs. 59 ± 8.1%, p <.01). After augmented preload, EDV increased in the normal LVFP group (p <.01) but remained unchanged in the elevated LVFP group (p NS). Both E and e′ increased among the subjects with normal LVFP, whereas E/e′ remained unchanged (∆E/e′ +.1 [‐.5–1.2]), p NS). Among the subjects with elevated, LVFP we observed increased E but not e′, resulting in significantly increased E/e′ (∆ average E/e′ +2.4 [0–4.0], p <.01). Conclusion: Augmented preload does not seem to affect E/e′ among subjects with normal LVFP, whereas E/e′ seems to increase significantly among subjects with elevated LVFP. [ABSTRACT FROM AUTHOR]

Objective: The primary treatment for stage I non-small cell lung cancer (NSCLC) in medically inoperable patients is stereotactic body radiation therapy (SBRT). The current study aimed to retrospectively analyze patients who underwent SBRT. Methods: A total of 188 patients with stage I NSCLC treated with SBRT between 2014 and 2020 were enrolled. Local control (LC), progressionfree survival (PFS), overall survival (OS), and treatment-related toxicities were analyzed. Results: Patients were mostly male (65.7%, n=71), with a median age of 68 (56-88). Based on tumor size and location, 69 patients (63.9%) received between 50 and 60 Gy in 5 fractions, 26 patients (24.1%) received 54 Gy in 3 fractions, 11 patients (10.2%) received 60 Gy in 8 fractions, and 2 patients (1.8%) received 60 Gy in 3 fractions. The median follow-up time was 32 months (12-47 months). Locoregional relapse occurred in 11 patients, among whom 4 (3.7%) developed distant metastasis. The 3-year LC, OS, and PFS rates were 89.5%, 83%, and 72%, respectively. Advanced age and presence of chronic obstructive pulmonary disease were associated with a decreased 3-year OS. In smokers and those with large tumor volumes, PFS decreased to 3 years. No grade 3 or 4 treatment-related toxicities were observed. Conclusion: SBRT is a fast, safe, and valuable therapeutic approach for patients with early-stage medically inoperable NSCLC, providing significant tumor control rates with low toxicity. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study was to characterize the differences between respiration and swallowing in patients with dysphagia after cervical spinal cord injury (CSCI) and to explore the underlying physiological changes. Method: A total of 95 participants were recruited for bedside swallowing evaluation followed by a flexible endoscopic evaluation of swallowing and surface electromyography with a thermocouple nasal airflow sensor examination: 32 with dysphagia, 33 without dysphagia, and 30 healthy controls. The differences in respiratory patterns, swallowing apnea duration (SAD), inspiratory-expiratory ratio, and swallowing efficiency were observed among healthy adults, CSCI patients with and without dysphagia after CSCI. Results: Compared with those of healthy controls and patients without dysphagia after CSCI, the postswallow respiratory pattern of patients with dysphagia after CSCI was an inspiratory pattern, and the SAD was significantly shorter in patients with dysphagia after CSCI (p < .001). Additionally, the expiratory time in patients with dysphagia was significantly shorter than the inspiratory time, and the swallowing efficiency was reduced, requiring multiple swallows. Moreover, the index of SAD was statistically significant for predicting the development of dysphagia in patients with CSCI (p < .001). Conclusion: Patients with CSCI have an inspiratory pattern after swallowing, and the SAD is significantly reduced; SAD can be used as the predictor of dysphagia in patients after CSCI; the pattern of coordination between respiration and swallowing in patients with dysphagia after CSCI is different from that of healthy controls and patients without dysphagia after CSCI. [ABSTRACT FROM AUTHOR]

Background: Intraoperative anxiety is a common problem when Monitored Anesthesia Care (MAC) is used instead of general anesthesia during minor surgical procedures such as port catheter placement. Nonpharmacological anxiolytics such as aromatherapy have been studied for their effects on preoperative anxiety, but no placebo-controlled study of aromatherapy during surgeries under MAC has yet been performed. Methods: After IRB approval, 70 patients were randomized 1:1 to receive either a lavender/peppermint aromatherapy patch (Elequil Aromatabs®; Beekley Corporation) or a matching placebo patch. The primary outcome, time to readiness for discharge from postoperative acute care units (PACU; min), was assessed every 15 min until a modified postanesthesia recovery score for ambulatory patients (PARSAP) score of 18 or higher was reached. In the preoperative holding area, the assigned patch/placebo was activated and affixed to a folded towel placed aside the subject's head, contralateral to the side of the planned surgery. The towel and patch/placebo were discarded when the subject left the operating room (OR). Results: No difference was found between the treatment and placebo groups on the primary outcome of time to discharge readiness (mean [standard deviation, SD]: 82 [15] vs. 89 [21] min, respectively, p = 0.131). No difference was found between the treatment and placebo groups on the secondary outcomes of intraoperative midazolam dose, intraoperative opioid dose, intraoperative ondansetron dose, or intraoperative promethazine dose. No difference was found between the treatment and placebo groups in the proportion of subjects requiring rescue postoperative nausea and vomiting (PONV) medication in the PACU or the proportion of subjects requiring opioids in the PACU. No difference was found between the treatment and placebo groups in pain intensity in PACU, average PONV score in PACU, or patient satisfaction in PACU. PACU patient satisfaction was high for both the patch and placebo groups (35/35 [100%] vs. 32/34 [94%] "very satisfied," p = 0.239). Conclusions: Aromatherapy treatment is not indicated intraoperatively to reduce anxiety or the use of antiemetics in patients requiring Port catheter placement. Trial registration: Clinicaltrials.gov, identifier: NCT05328973. [ABSTRACT FROM AUTHOR]