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Direct oral anticoagulants are the preferred treatment for stroke patients with atrial fibrillation. Pharmacy dispensing data represent a practical method to identify suboptimal medication adherence. This study investigates whether pharmacy dispensing data are indicative of real-life adherence behavior, using data from 130 patients in the MAAESTRO study (2018–2022) in Basel, Switzerland. This secondary data analysis of the MAAESTRO study (Dietrich, 2024) included patients with electronic monitoring (EM) and dispensing data for 12 months. Patients with at least two refills were included in the analysis. We categorized refill series into three adherence patterns using the Delta T method (Baumgartner, 2022): all refills on time, erratic refills, end-gaps ≥10 days. EM-adherence was assessed through "taking adherence" and "missing days" (24h without intake). We analyzed: i) all dispensing data ("all refills"); ii) all data independently of the MAAESTRO phase ("all phases"); iii) the last two dispensing data ("last"), and iv) EM data from the MAAESTRO phase that match the date of the last refill ("matched"). Associations between refill patterns and adherence were examined using Spearman correlation and Fisher's exact test. Data analyzed from 50 patients (mean age 76.4 ± 9.1 years, 56.0 % male) included 252 refills with a median of 4 refills per patient. Refill patterns were: all refills on time (40.0 %), erratic refills (36.0 %), and end-gaps >10 days (24.0 %). Mean taking adherence was 89.3 ± 13.7 %. EM data revealed missing days in 82.0 % of patients, with 61.0 % having irregular refill patterns. Matched taking adherence was moderately associated with Delta T over all refills (p = 0.034) and the last refill (p = 0.013). Dispensing data processed with the Delta T method correlate moderately with EM data. The Delta T value for the last two refills shows promise for estimating irregular adherence, suggesting potential for targeted interventions in pharmacy practice. [ABSTRACT FROM AUTHOR]

Gastrointestinal biofilms are matrix-enclosed, highly heterogenic and spatially organized polymicrobial communities that can cover large areas in the gastrointestinal tract. Gut microbiota dysbiosis, mucus disruption, and epithelial invasion are associated with pathogenic biofilms that have been linked to gastrointestinal disorders such as irritable bowel syndrome, inflammatory bowel diseases, gastric cancer, and colorectal cancer. Intestinal biofilms are highly prevalent in ulcerative colitis and irritable bowel syndrome patients, and most endoscopists will have observed such biofilms during colonoscopy, maybe without appreciating their biological and clinical importance. Gut biofilms have a protective extracellular matrix that renders them challenging to treat, and effective therapies are yet to be developed. This review covers gastrointestinal biofilm formation, growth, appearance and detection, biofilm architecture and signalling, human host defence mechanisms, disease and clinical relevance of biofilms, therapeutic approaches, and future perspectives. Critical knowledge gaps and open research questions regarding the biofilm's exact pathophysiological relevance and key hurdles in translating therapeutic advances into the clinic are discussed. Taken together, this review summarizes the status quo in gut biofilm research and provides perspectives and guidance for future research and therapeutic strategies. [ABSTRACT FROM AUTHOR]

• Ultra-longterm EEG recordings provide additional information on ictal epileptic events over periods of many months. • Objective information on seizure occurrence has a wide spectrum of use cases, including epilepsy diagnosis, differentiation of epileptic and non-epileptic seizure types and their time course. • Ultra-longterm EEG can be useful for diagnostic classification, risk assessment, treatment monitoring and medicolegal decisions. We assessed clinical cases to investigate the spectrum of indications for ultra-longterm EEG monitoring using a subcutaneous implantable device in adult patients with focal epilepsy. Electronic charts were reviewed from patients undergoing ultra-longterm recordings at the European Epilepsy centers Barcelona, Freiburg and Vienna. Specific patient settings approached in the three centers were analyzed, and the main clinical question was extracted. Results from recordings were analyzed based on the specific results and information obtained. 24 patients in whom ultra-longterm recordings were available were analyzed. A total of 11 main indications for subcutaneous long-term EEG recordings were identified, including the identification of active epilepsy in patients with low seizure frequency, under- and overreporting of patients, differentiation of non-epileptic from epileptic events, assessment of seizure severity, circadian and multidian rhythms of seizure occurrence, validation of treatment efficacy, improvement of patient-based reporting and medicolegal evidence for seizure freedom. This is reported with patient-specific case vignettes. Ultra-longterm monitoring using subcutaneous implantable EEG devices can provide relevant diagnostic and treatment information in a large spectrum of clinical situations. This is discussed considering the intrinsic limitations of the method related to spatial coverage, sensitivity and validity as a biomarker of ongoing seizures. [ABSTRACT FROM AUTHOR]

TIPS is the most effective treatment for portal hypertension. Patient selection remains important to achieving optimal post-TIPS outcomes. The study evaluates 1-year mortality factors in cirrhotic patients receiving TIPS. Methods: 87 cirrhotic patients received a TIPS between 2015 - 2021. Predictors of 1-year and overall mortality were assessed by estimating cumulative incidence functions and Grey's test to adjust for liver transplantation as a risk competing with mortality. Variables with p < 0.05 were checked for collinearity and included in the multivariate Cox proportional hazards model. Model discrimination was evaluated by calculating the area under the ROC curve. Results: 87 patients were included (68% men; 22% ≥70 years). ALD was the primary cirrhosis cause. Most patients were Child-Pugh class B, MELD-Na score was 13.6 ± 6.0 points. The most frequent indication for TIPS was bleeding (51.7%), followed by refractory ascites (42.5%). The variables positively associated with mortality in univariate analysis were ascites, clinically overt sarcopenia and MELD-Na score, while ongoing nutritional supplementation improved survival. In the multivariate analysis, only clinically overt sarcopenia and MELD-Na score remained independently associated with mortality. A MELD-Na/sarcopenia model demonstrated a good discrimination, AUROC: 0.86 (95% CI 0.77 – 0.95). Conclusion: MELD-Na score, and sarcopenia were significantly associated with 1-year survival in cirrhotic patients who received TIPS. [ABSTRACT FROM AUTHOR]

Treating seizure-related shoulder injuries is challenging, and an evidence-based consensus to guide clinicians is lacking. The aim of this prospective single-center observational clinical trial was to evaluate the clinical results of a cohort of patients undergoing treatment of seizure-related shoulder injuries, to categorize them according to the lesion's characteristics, with special focus on patients with proximal humerus fracture-dislocations (PHFDs), and to define groups at risk of obtaining unsatisfactory results. We hypothesized that patients with a PHFD, considered the worst-case scenario among these injuries, would report worse clinical results in terms of the quick Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH) as compared to the other patients. Patients referred to a tertiary epilepsy center who have seizure-related shoulder injuries and with a minimum follow-up of 1 year were included. A quality-of-life assessment instrument (EQ-5D-5L), a district-specific patient-reported outcome measure (qDASH), and a pain assessment tool (visual analog scale [VAS]) were used for the clinical outcome evaluation. Subjective satisfaction and fear of new shoulder injuries was also documented. Categorization and subgroup analysis according to the presence and features of selected specific lesions were performed. A total of 111 patients were deemed eligible and 83 were available for follow-up (median age 38 years, 30% females), accounting for a total of 107 injured shoulders. After a median follow-up of 3.9 (1.6-8.2) years, overall moderate clinical results were reported. In addition, 34.1% of the patients reported a VAS score ≥35 mm, indicating moderate to severe pain, and 34.1% a qDASH score ≥40 points, indicating severe disability of an upper limb. These percentages rose to, respectively, 45.5% and 48.5% in the subgroup of patients with PHFDs and to 68.8% and 68.8% in patients experiencing posterior PHFD. Overall, 46.9% of the patients considered themselves unsatisfied with the treatment and 62.5% reported a persistent fear of a new shoulder injury. Patients with seizure-related shoulder injuries reported only moderate clinical results at their midterm follow-up. Older age, male sex, and absence or discontinuation of antiepileptic drug (AED) treatment were identified as characterizing features of patients with posterior dislocation episodes. In patients with PHFD, a tendency to worse clinical results was observed, with posterior PHFD patients emerging as a definite subgroup at risk of reporting unsatisfying results after treatment. [ABSTRACT FROM AUTHOR]

The results of the most prevalent environmental lifecycle assessments represent the relative impact on the environment caused by the object being assessed. Hereby, the object is compared to its alternatives (to derive: Which is the better solution?) rather than to the carrying capacities of nature (to determine: Is it ultimately sustainable or not?). This poses a problem for implementing and assessing the progress towards sustainable development. In connection to this, prior research has started categorizing the constitutive research on lifecycle-based absolute environmental sustainability assessments. This paper adds to these efforts and provides a new point of view by categorizing the absolute environmental sustainability assessment approaches within the driver-pressure-state-impact-response framework. Hereby, we focus on the absolute environmental sustainability assessment approaches of (1.) the precedent methods of absolute pressures, and (2.) the state-of-the-art approaches of the impacts on nature. Their common challenges and limitations are discussed, along with a theoretical example. From there, we conclude the proposal of incorporating the absolute environmental sustainability pressure methods into the current discussion on lifecycle-based absolute environmental sustainability assessment approaches. Ultimately, we conclude that further research is required to connect the approaches to the level of application. [ABSTRACT FROM AUTHOR]

Digital battery passports are a potentially helpful tool to facilitate the recycling of lithium-ion batteries. This is due to the information asymmetry between battery producers and end-of-life (EoL) actors. Tailoring a battery passport to EoL offers the opportunity to go beyond the current state of the art of battery passport legislation and add further details that are important for the recycling process. Therefore, this research looks at a suitable way to set up a battery passport to support the EoL of lithium-ion batteries. First, the data needs of the EoL phase were analyzed based on use cases described by eight experts through interviews. The results show a need for material related- and dynamic data, such as the state of health. The same expert interviews were then used to answer how these needed data could be provided. The results confirm the availability of most data but with gaps regarding dynamic data and use-phase information. Both the data needs and provision are then categorized and summarized into a data model. The discussion also provides an overview of the challenges and estimates the impact, depending on the scale of implementation. The results were used to set up a prototype platform for a battery passport. [ABSTRACT FROM AUTHOR]

Despite stricter emission controls and the planned reduction of newly sold Internal Combustion Engine (ICE) cars, adequate repairing and recycling of old ICE cars remains vital, reflected also by the recent EURO7 standard that explicitly refers to repairability. Digital Product Passports (DPPs) have gained attention as enablers of transparent and traceable value chains and improved product lifecycle management. While the focus has been put on creating DPPs for electric vehicle batteries, research on the potentials and requirements for DPPs for the ICE and its well-known components, like the exhaust gas turbocharger, does not exist. Thus, this study systematically investigates what information such DPP needs to contain to support value chain actors' sustainability/circularity-related decision-making. A mixed-method approach is applied. The Supply Chain Oriented Process to Identify Stakeholders (SCOPIS) method, as well as two expert workshops (N = 8 and N = 6) and an expert survey (N = 8) served for identifying the stakeholders and their most relevant information requirements. The results consist of a refined and prioritized list of information requirements, a conceptual model of a DPP for the turbocharger, and the presentation of two use cases: refurbishment and recycling. This contribution serves as the foundation for handling ICEs sustainably and circularly. [ABSTRACT FROM AUTHOR]

The Constant score (CS) is often used clinically to assess shoulder function and includes a muscle strength assessment only for abduction. The aim of this study was to evaluate the test-retest reliability of isometric shoulder muscle strength during various positions of abduction and rotation with the Biodex dynamometer and to determine their correlation with the strength assessment of the CS. Ten young healthy subjects participated in this study. Isometric shoulder muscle strength was measured during 3 repetitions for abduction at 10° and 30° abduction in the scapular plane (with extended elbow and hand in neutral position) and for internal and external rotation (with the arm at 15° abduction in the scapular plane and elbow flexed at 90°). Muscle strength tests with the Biodex dynamometer were measured in 2 different sessions. The CS was acquired only in the first session. Intraclass correlation coefficients (ICCs) with 95% confidence interval, limits of agreement, and paired t tests for repeated tests of each abduction and rotation task were calculated. Pearson's correlation between the strength parameter of the CS and isometric muscle strength was investigated. Muscle strength did not differ between tests (P >.05) with good to very good reliabilities for abduction at 10° and 30°, external rotation and internal rotation (ICC >0.7 for all). A moderate correlation of the strength parameter of the CS with all isometric shoulder strength parameters was observed (r > 0.5 for all). Shoulder muscle strength for abduction and rotation measured with the Biodex dynamometer are reproducible and correlate with the strength assessment of the CS. Therefore, these isometric muscle strength tests can be further employed to investigate the effect of different shoulder joint pathology on muscle strength. These measurements consider a more comprehensive functionality of the rotator cuff than the single strength evaluation in abduction within the CS as both abduction and rotation are assessed. Potentially, this would allow for a more precise differentiation between the various outcomes of rotator cuff tears. [ABSTRACT FROM AUTHOR]

Since its inception, tissue engineering and regenerative medicine (TERM) has been relying on either scaffold-based or scaffold-free strategies. Recent reports outlined the possibility of a synergistic, convergence approach, referred to as the third TERM strategy, which could alleviate bottlenecks of the two previous options. This strategy requires the fabrication of highly porous microscaffolds, allowing to create single spheroids within each of them. The resulting tissue units can then be combined and used as modular building blocks for creating tissue constructs through a bottom-up self-assembly. Such strategy can have a significant impact for the future of TERM, but so far, no reports have assessed its feasibility in detail. This work reports a first systematic study, which includes a comparison of the in vitro behavior of tissue units based on adipose derived stem cell spheroids cultured within microscaffolds versus conventional spheroids. We first proved that the presence of the microscaffold neither impairs the cells 'ability to form spheroids nor impacts their viability. Importantly, the fusiogenic and the differentiation potential (i.e. chondrogenesis and osteogenesis), which are important features for cellularized building blocks to be used in TERM, are preserved when spheroids are cultured within microscaffolds. Significant benefits of microscaffold-based tissue units include the enhanced cell retention, the decreased compaction and the better control over the size observed when larger tissue constructs are formed through self-assembly. The proof of concept study presented here demonstrates the great potential offered by those microsize tissue units to be used as building blocks for directed tissue self-assembly. One of the most exciting and recent advances in tissue engineering and regenerative medicine (TERM) is to combine together multiple micro-size cellularized units, which are able to self-assemble altogether to recreate larger tissue constructs. In this work, we produce such modules by forming single spheroids within highly porous microscaffolds, and study how this new microenvironment impacts on the spheroid's behavior and stemness potential. This work highlights as well that such novel route is enabled by two-photon polymerization, which is an additive manufacturing technique offering high spatial resolution down to 100 nm. These findings provide a first scientific evidence about the utilization of hybrid spheroid microscaffold-based tissue units with great perspective as a modular tool for TERM. [Display omitted] [ABSTRACT FROM AUTHOR]

Determine the acute effect of high-intensity interval training as an alternative of moderate-intensity aerobic exercise on behavioral and neuroelectric measures of inhibitory control in preadolescent children. A randomized controlled trial. Seventy-seven children (8–10 years) were randomly assigned to three groups to complete a modified flanker task to measure behavioral and neuroelectric (N2/P3 of event-related potential and frontal theta oscillations) outcomes of inhibitory control before and after a 20-min session of high-intensity interval training (N = 27), moderate-intensity aerobic exercise (N = 25), and sedentary reading activity (N = 25). The accuracy of the inhibitory control performance improved over time across three groups but response time was selectively improved only for the high-intensity interval training group. Analysis on N2 showed a time-related decrease in N2 latency selectively for the high-intensity interval training but not the other groups. Analysis on P3 showed a time-related decrease in P3 amplitude for the sedentary and high-intensity interval training groups while the moderate-intensity aerobic exercise group exhibited maintained P3 amplitude from the pretest to the posttest and a larger P3 amplitude compared with the high-intensity interval training group at the posttest. While there was evidence of conflict-induced modulation of frontal theta oscillations, such an effect was unaffected by exercise interventions. A single bout of high-intensity interval training has facilitating effects on the processing speed involving inhibitory control in preadolescent children but not neuroelectric index of attention allocation that only benefited from moderate-intensity aerobic exercise. [ABSTRACT FROM AUTHOR]

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Bariatric Surgical Risk/Benefit Calculator uses procedure-specific prediction models to generate individualized surgical risk/outcome estimates. This tool helps guide informed consent and operative selection. We hypothesized that calculator use would influence patient procedure choice. To assess patient perspectives on the bariatric surgical calculator. A randomized controlled trial at an MBSAQIP-accredited center. During the preoperative bariatric surgical office consultation, patients were randomized into 2 groups: the control group received conventional surgeon-led counseling, whereas surgeons used the risk/benefit calculator to guide decision making for the calculator group. Surveys were completed by patients following consultations to evaluate satisfaction and perceived impact of the risk/benefit calculator on operative selection. Between 2020 and 2022, 61 patients were randomized to the calculator group and 68 patients to the control group. The percentage of patients whose procedure of choice changed following consultation was similar in the calculator versus control group (44.3% versus 41.2%; P =.723). However, calculator group patients were less likely to perceive surgeon counseling as very important for their decision making (43.3% versus 76.5%; P <.001). Eighty-five percent of calculator group patients rated the calculator as useful or very useful, and only 1.7% found it not very important. The reasons patients changed procedure choice were similar between the groups (P =.091); the most common cause was to improve their anticipated outcome (48.7% versus 54.8%). While the risk/benefit calculator was perceived as a helpful tool by most patients, its use did not influence their procedure choice. However, the patient-reported usefulness and importance of the calculator during surgeon counseling suggest that the information provided has weight in patient decision making. [ABSTRACT FROM AUTHOR]

Hypothermic circulatory arrest is a protective technique used when complete cessation of circulation is required during cardiac surgery. Prior efforts to decrease neurologic injury with the NMDA receptor antagonist MK801 were limited by unacceptable side effects. We hypothesized that ketamine would provide neuroprotection without dose-limiting side effects. Canines were peripherally cannulated for cardiopulmonary bypass, cooled to 18°C, and underwent 90 minutes of circulatory arrest. Ketamine-treated canines (n = 5; total dose 2.85 mg/kg) were compared to untreated controls (n = 10). A validated neurobehavioral deficit score was obtained at 24, 48, and 72 hours (0 = no deficits/normal exam; higher score represents increasing deficits). Biomarkers of neuronal injury in the cerebrospinal fluid were examined at baseline and at 8, 24, 48, and 72 hours. Brain histopathologic injury was scored at 72 hours (higher score indicates more necrosis and apoptosis). Ketamine-treated canines had significantly improved, lower neurobehavioral deficit scores compared to controls (overall P = 0.003; 24 hours: median 72 vs 112, P = 0.030; 48 hours: 47 vs 90, P = 0.021; 72 hours: 30 vs 89, P = 0.069). Although the histopathologic injury scores of ketamine-treated canines (median 12) were lower than controls (16), there was no statistical difference (P = 0.10). Levels of phosphorylated neurofilament-H and neuron specific enolase, markers of neuronal injury, were significantly lower in ketamine-treated animals (P = 0.010 and = 0.039, respectively). Ketamine significantly reduced neurologic deficits and biomarkers of injury in canines after hypothermic circulatory arrest. Ketamine represents a safe and approved medication that may be useful as a pharmacologic neuroprotectant during cardiac surgery with circulatory arrest. [Display omitted] [ABSTRACT FROM AUTHOR]

Increased demands on healthcare make it more and more important to schedule the appointments of the patients' treatments and care optimally. The optimised patient scheduling may decrease the patients' waiting times, reduce the length of the treatments, and utilise healthcare resources more effectively. However, as the patient scheduling problems differ significantly, it raises the question of how a general patient scheduling problem can be formulated and solved independently from the application areas. This study suggests a general way to define and solve the patient scheduling problem. The proposed method utilises the standard elements of the Fast Healthcare Interoperability Resource standard to define the input elements of the patient scheduling problem, then automatically converts the task to a process optimisation problem and solves it using the P-graph methodology. The proposed method can be applied to solve any patient scheduling problem, and it does not require a specific mathematical description and formulation defined for each problem separately. [ABSTRACT FROM AUTHOR]

CT-derived measures of muscle mass may help to identify patients with sarcopenia. We investigated the prognostic significance of CT-derived sarcopenia and muscle attenuation with nutritional markers, clinical outcomes and response to nutritional support in medical in-patients at nutritional risk. Within this secondary analysis of the randomized-controlled Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) comparing individualized nutritional support with usual care nutrition in medical inpatients, we investigated associations of CT-based sarcopenia and muscle attenuation at the level L3 with different nutritional and clinical outcomes, and the response to the nutritional intervention. The primary composite endpoint was adverse clinical outcome within 30 days of hospital admission. We included 573 of 2028 EFFORT patients with available CT scans, of which 68.4% met the CT-based definition of sarcopenia and 72.9% had low muscle attenuation. In multivariate analysis, low skeletal muscle index was associated with higher nutritional risk (coefficient per NRS class −0.94 (95%CI −1.87 to −0.01) p = 0.049) and higher risk for adverse clinical outcomes (adjusted odds ratio 1.59 (95% CI 1.06 to 2.38), p = 0.024). Low muscle attenuation was also associated with adverse clinical outcome (adjusted odds ratio 1.67 (95%CI 1.08 to 2.58), p = 0.02). Nutritional support tended to be more effective in reducing mortality in non-sarcopenic patients compared to patients with CT-based sarcopenia (p for interaction 0.058). Within a population of medical patients at nutritional risk, CT-based sarcopenia and muscle attenuation were associated with several nutritional parameters and predicted adverse clinical outcomes. Information from CT scans, thus may help to better characterize these patients, and may be helpful in guiding therapeutic interventions. [ABSTRACT FROM AUTHOR]

Digital product passports (DPPs) may help bridge prevailing information gaps along value chains, and thus support actors' sustainable product management (SPM) decisions by providing needed product life cycle data. However, different factors influence their successful adoption. This paper provides empirical insights into the perceived potential of DPP adoption in SPM. The focus was placed on DPPs for electric vehicle batteries. Research entailed conducting stakeholder online focus group workshops, expert interviews, follow-up stakeholder consultations, and subsequent qualitative content analysis. Diffusion of innovation (DOI) theory and the technology-organization-environment (TOE) framework were used as theoretical basis. The results illustrate stakeholder perspectives on DPP use in SPM support, as well as stakeholder classification based on innovation adopter categories of DOI theory. Furthermore, DPP adoption barriers, enablers and drivers are presented and discussed in the context of the TOE framework and DOI theory. This paper adds to the literature on digitalization as an enabler of SPM and circular value chains, and to the field of innovation adoption and diffusion in the context of DPPs. As the identified DPP adoption factors help support the uptake of DPPs in facilitating SPM, it is also of clear practical relevance. [ABSTRACT FROM AUTHOR]

Digital product passports (DPPs) are an emerging technology and are considered as enablers of sustainable and circular value chains as they support sustainable product management (SPM) by gathering and containing product life cycle data. However, some life cycle data are considered sensitive by stakeholders, resulting in a reluctance to share such data. This contribution provides a concept illustrating how data science and machine learning approaches enable electric vehicle battery (EVB) value chain stakeholders to carry out confidentiality-preserving data exchange via a DPP. This, in turn, can support overcoming data sharing reluctances, consequently facilitating sustainability data management on a DPP for an EVB. The concept development comprised a literature review to identify data needs for sustainable EVB management, data management challenges, and potential data science approaches for data management support. Furthermore, three explorative focus group workshops and follow-up consultations with data scientists were conducted to discuss identified data sciences approaches. This work complements the emerging literature on digitalization and SPM by exploring the specific potential of data science, and machine learning approaches enabling sustainability data management and reducing data sharing reluctance. Furthermore, practical relevance is given, as this concept may provide practitioners with new impulses regarding DPP development and implementation. [ABSTRACT FROM AUTHOR]

A 2-year-old spayed female Labrador Retriever with clinical signs of heart failure presented to necropsy with a pericardial defect with most of the left ventricle non-reducibly herniated into the pleural space. The herniated cardiac tissue was constricted by a ring of pericardium that allowed subsequent infarction, evidenced by a marked depression on the epicardial surface. A congenital defect was considered more likely than a traumatic cause, since the margin of the pericardial defect was smooth and fibrous. Histologically, the herniated myocardium was acutely infarcted while the epicardium at the defect margin was markedly compressed, including the coronary vessels. This appears to be the first report of ventricular cardiac herniation with incarceration and infarction (strangulation) in a dog. Similar cardiac strangulations may rarely occur in humans with congenital pericardial defects or acquired pericardial defects secondary to blunt trauma or thoracic surgery. Left ventricular herniation and incarceration with infarction (strangulation) due to a pericardial sac defect, as shown here in a dog, is a sporadically reported lesion with limited descriptions in veterinary medicine, which contrasts with human medicine. [Display omitted] [ABSTRACT FROM AUTHOR]

Self-administered surveys are a widespread data collection method in tourism research. However, survey-based data are prone to what is widely referred to as common method variance (CMV). Common method variance represents systematic error variance which can potentially have a substantial confounding influence on empirical findings, since it can lead to incorrect assessments of construct validity and reliability as well as biased parameter estimates. Surprisingly, addressing common method variance issues is still an exception in tourism research. This study advocates the use of two approaches and it demonstrates the practical implementation of these approaches by drawing on a seven-country online survey of tourists' perceptions of and intentions to visit Italy conducted on a sample of 4550 respondents intercepted in Brazil, China, India, Indonesia, Russia, South Africa, and Turkey. Findings clearly reveal that common method variance is not a trivial issue that can be safely ignored when estimating models aimed at assessing country and destination images and at explaining tourists' intentions to visit and/or positive word of mouth. Therefore, the study provides concrete insights and directions to tourism researchers seeking to address this issue in their empirical endeavors. • Surveys remain a common data collection technique in destination image research. • Self-administered questionnaires are prone to common method variance. • Surprisingly, addressing response bias is still the exception in tourism research. • This study advocates the use of two practical approaches for addressing this issue. • Results show the effects of inattention to method bias on the validity of outcomes. [ABSTRACT FROM AUTHOR]

While recent technological advancements are reshaping the landscape of surgical epilepsy management, the established techniques of resective and disconnective surgeries guided by electrographic monitoring remain the workhorse interventions for the management of refractory seizures and have the highest likelihood of achieving complete seizure resolution. Here we discuss examples of recent developments in surgical approaches and techniques for resective and disconnective surgeries with discussion of their indications and potential advantages. [ABSTRACT FROM AUTHOR]

Background: Patients with polypharmacy are challenged with the management of their daily medication. Medication management strategies for direct oral anticoagulants (DOAC) are especially important to guarantee medication adherence and to prevent thromboembolic events. Patients are often left alone with finding an appropriate strategy.Objective(s): To explore medication management strategies, to measure adherence to DOAC with the aim of deducing recommendations for practice.Methods: Face-to-face semi-structured interviews were conducted at the home of outpatients who were taking ≥4 medications daily including a DOAC, and self-managing their medication. A small electronic device (Time4Med™) was given to record medication intake during the four following weeks. During a second home visit, participants saw a graph of their medication intake as dot chart, and obtained a feedback. Interviews were transcribed verbatim and thematically analysed. Medication adherence was calculated with electronic data.Results: Eighteen individuals (61.1% female; median age 77.5 years) were interviewed and reported 30 different medication management strategies, together with triggers, advantages and limitations. They combined at least five strategies, composed of internal (memory-based) and external (packaging-based or intake-based) strategies. The number of strategies was neither associated with the number of medications nor with medication adherence. Taking adherence was <100% for eight patients (44.4%). The inability of any medication management strategy to adapt to ageing and cognitive decline emerged as its most dramatic limitation, especially because individuals would fail to notice when their strategy became unsuited.Conclusions: Elderly patients develop manifold medication management strategies, which can inspire future medication users. Limitations are present such as forgetting medication intake in spite of a management strategy. The moment to adapt the strategy to ageing or cognitive decline is crucial and often goes unnoticed. It is therefore decisive that healthcare professionals regularly re-evaluate the appropriateness of the medication management strategies during counselling or ideally during home visits. [ABSTRACT FROM AUTHOR]

A framework for data collection and visualization of operational deviation at a Volvo truck manufacturing plant implementing Volvo Group's production system, Volvo Production System (VPS), is presented. This includes visualisation of daily quality performance indicators to support decision making and improvement actions at the shop foor team level. The approach is evaluated in a qualitatively study using a survey instrument to collect responses from managers and team leaders, which acted as input for the actual use of the data and as validation of the framework. The results from this evaluation show that potentially operational deviations can be reduced, impacting positively quality performance indicators such as frst-time through (FTT). This paper also provides a brief description of the VPS in connection with data analytics and visualization. [ABSTRACT FROM AUTHOR]

Background: The WHO is exploring the value of adding RSV testing to existing influenza surveillance systems to inform RSV control programs. We evaluate the usefulness of four commonly used influenza surveillance case-definitions for influenza and RSV surveillance.Methods: SHIVERS, a multi-institutional collaboration, conducted surveillance for influenza and RSV in four New Zealand hospitals. Nurses reviewed admission logs, enrolled patients with suspected acute respiratory infections (ARI), and obtained nasopharyngeal swabs for RT-PCR. We compared the performance characteristics for identifying laboratory-confirmed influenza and RSV severe acute respiratory infection (SARI), defined as persons admitted with measured or reported fever and cough within 10 days of illness, to three other case definitions: 1. reported fever and cough or shortness of breath, 2. cough and shortness of breath, or 3. cough.Results: During April-September 2012-2016, SHIVERS identified 16,055 admissions with ARI; of 6374 cases consented and tested for influenza or RSV, 5437 (85%) had SARI and 937 (15%) did not. SARI had the highest specificity in detecting influenza (40.6%) and RSV (40.8%) but the lowest sensitivity (influenza 78.8%, RSV 60.3%) among patients of all ages. Cough or shortness of breath had the highest sensitivity (influenza 99.3%, RSV 99.9%) but the lowest specificity (influenza 1.6%, RSV 1.9%). SARI sensitivity among children aged <3 months was 60.8% for influenza and 43.6% for RSV-both lower than in other age groups.Conclusions: While SARI had the highest specificity, its sensitivity was limited, especially among children aged <3 months. Cough or shortness of breath was the most sensitive. [ABSTRACT FROM AUTHOR]

Several cohort studies have found associations between long-term exposure to air pollution and stroke risk. However, it is unclear whether the surrounding ecology may modify these associations. This study evaluates associations of air pollution with stroke risk by ecoregions, which are areas of similar type, quality, and quantity of environmental resources in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. We assessed the incidence of stroke in 26,792 participants (45+ yrs) from the REGARDS study, a prospective cohort recruited across the contiguous United States. One-yr and 3-yr means of PM 2.5 , PM 10 , O 3 , NO 2 , SO 2 , and CO were estimated at baseline using data from the Center for Air, Climate, & Energy Solution, and assigned to participants at the census block group level. Incident stroke was ascertained through September 30, 2020. Relations of air pollutants with the risk of incident stroke were estimated using Cox proportional hazards models, adjusting for relevant demographics, behavioral risk factors, and neighborhood urbanicity. Models were stratified by EPA designated ecoregions. A 5.4 μg/m3 (interquartile range) increase in 1-yr PM 10 was associated with a hazard ratio (95 %CI) for incident stroke of 1.07 (1.003, 1.15) in the overall study population. We did not find evidence of positive associations for PM 2.5 , O 3 , NO 2 , SO 2 , and CO in the fully adjusted models. In our ecoregion-specific analysis, associations of PM 2.5 with stroke were stronger in the Great Plains ecoregion (HR = 1.44) than other ecoregions, while associations for PM 10 were strongest in the Eastern Temperate Forests region (HR = 1.15). The associations between long-term exposure to air pollution and risk of stroke varied by ecoregion. Our results suggests that the type, quality, and quantity of the surrounding ecology can modify the effects of air pollution on risk of stroke. [Display omitted] • Long-term PM 10 concentrations were positively related to stroke risk. • PM effects were significantly modified by the ecological region of participants. • Associations of PM 2.5 on stroke were strongest in the Great Plains. • Urbanicity modified the relations between air pollution and stroke risk. [ABSTRACT FROM AUTHOR]

We sought to compare student performance on acute care advanced pharmacy practice experiences (APPEs) pre- and post-incorporation of mock acute care patient simulations into the curriculum. A series of mock acute care APPE simulations (MACAS) were developed and incorporated into Touro University California College of Pharmacy curriculum for first- and second-year pharmacy students. Results for student performance on Acute Care I and Acute Care II APPEs were collected for students who received none, one year, or two years of the MACAS. Student admission characteristics and didactic academic performance (grade point average [GPA]) were also gathered. Student characteristics and APPE performance were compared across cohorts of students who received none, one year, and two years of MACAS. Multivariate models were created to measure the impact of the MACAS while controlling for student characteristics. The final cohort included 394 students. In unadjusted analyses, students with one or two years of MACAS received significantly higher preceptor acute care APPE evaluations for communication, professionalism, and patient scores vs. students who received no MACAS. In multivariate models controlling for age, gender, and undergraduate GPA, one year of MACAS increased student acute care APPE communication, professionalism, and patient care scores, relative to no MACAS. Similar increases in acute care APPE scores were seen for students who received two years of MACAS. MACAs significantly improved acute care APPE scores relative to students with no MACAS. This improvement in acute care APPEs occurred after students received a single year of MACAS. [ABSTRACT FROM AUTHOR]

Background: Limited data exist on the impact of gender and specialized care on the requirement of repeat treatment of supraventricular tachycardia (SVT) in adult patients with congenital heart disease (ACHDs).Objective: The study aimed to assess independent predictors of a combined end point of re-catheter ablation (CA) or cardioversion at 3 years of follow-up, including the impact of gender and specialized ACHD care.Methods: All ACHDs registered in a database of one of the largest German health insurers (≈9.2 million members) who underwent CA for SVT were analyzed.Results: Of 38,892 ACHDs 16 years or older, 485 (49.5% women; median age 58.4 years; interquartile range 42.1-70.8 years) underwent CA for SVT. Over 3-year follow-up, the number of yearly CA procedures increased significantly, particularly for atrial fibrillation (+195%) and atrial flutter (+108%). Moderate to severe complexity heart disease (odds ratio [OR] 1.66; P = .01), advanced age (OR 1.85 per year; P = .02), chronic kidney disease (OR 1.70; P = .01), and atrial fibrillation (OR 2.02; P = .002) emerged as independent predictors of retreatment. Retreatment was significantly less often performed if primary CA was carried out at a specialized CHD center (P = .009) in patients with moderate to severe complexity heart disease. Women treated in specialist centers had a 1.6-fold reduced risk of undergoing retreatment (P = .01).Conclusion: CA for SVT is increasingly performed in ACHDs, especially for atrial flutter and atrial fibrillation. Patients with moderate and severe complexity congenital heart defects and female ACHDs benefit from upfront referral to specialized CHD centers for CA. Centralization of care for ACHD arrhythmias should thus be advocated. [ABSTRACT FROM AUTHOR]

Mineralizing pulmonary elastosis (MPE) is a rare and unique phenomenon that has been reported in humans, typically secondary to recurrent pulmonary haemorrhage. MPE has a complex histopathological appearance, often containing iron-calcium deposits that can be mistaken as fungal organisms or other inorganic material. This report documents the first case of MPE in an animal species. A 10-year-old female domestic cat with respiratory failure was submitted for necropsy. The lungs were consolidated with severe pulmonary haemosiderosis, and widely disseminated granulomas surrounded large aggregates of hyphae-like structures. The pulmonary vasculature and airway smooth muscle were partially mineralized and fragmented. Histochemical stains revealed that the fungus-like material stained strongly with Prussian blue and alizarin red but only sparingly with von Kossa and negative with Gomori's methenamine silver stain. These findings are similar to those of MPE in humans. As most veterinary pathologists may not be familiar with MPE, it is important to avoid possible misinterpretation by recognizing its distinct features and the ancillary testing that may be required. [ABSTRACT FROM AUTHOR]

Objectives: Pharmacist collaboration in transitions of care (TOC) programs is integral to increase patient education and adherence after discharge. This study aimed to conduct a qualitative evaluation of stakeholder perspectives to inform the design and implementation of a TOC program between an emergency department (ED) and regional supermarket chain pharmacies.Methods: Pharmacies from a regional supermarket chain were identified for inclusion on the basis of geographic proximity to a local community hospital ED. Semistructured, one-on-one interviews with the primary investigator were conducted. Interview questions were based on the Consolidation Framework for Implementation Research (CFIR). The following 5 CFIR domains were used: (1) intervention characteristics, (2) outer setting, (3) inner setting, (4) characteristics of individuals, and (5) process. Interviews were audio-recorded and transcribed. Two investigators coded each transcript independently. A thematic analysis was performed.Results: A total of 19 interviews were conducted, and the following 7 major themes emerged on analysis: (1) enhance real-time interprofessional communication, (2) establish data sharing between the ED and the community pharmacy, (3) provide timely resolution of prescription insurance issues for new therapies post-ED discharge, (4) use off-site pharmacy resources to support community pharmacy workflow, (5) increase patient education to prevent primary medication nonadherence, (6) reinforce discharge care plans, and (7) focus on community-dwelling older adult patients in an ED care transition program.Conclusion: Health care providers including pharmacists, physicians, nurses, and care managers, view an ED-to-community pharmacy TOC program as a valuable service to increase patient education on new medications and discharge planning. Establishment of data sharing and reimbursement is integral to the development, implementation, and sustainability of such programs. There is an untapped opportunity for community pharmacists to bridge the gap in care after ED discharge. [ABSTRACT FROM AUTHOR]

Purpose: Epilepsy is one of the most common chronic neurological disorders, and long-term treatment with antiseizure medication is often central to its management. The costs of antiseizure medication are more evident than other disease-related costs; thus, we assessed the direct and indirect costs of epilepsy focusing on both drug expenditure and other cost-driving factors.Methods: Outpatient records and questionnaires applied in a tertiary epilepsy centre in Vienna were used in this bottom-up cost-of-illness study to evaluate disease duration, age at onset, epilepsy syndrome, seizure frequency, sex, healthcare utilisation, diagnostic evaluations, antiseizure medication, and occupation. Cost data were clustered in a histogram-based data analysis, and multivariate regressions were performed to identify cost drivers.Results: The average annual costs of 273 patients amounted to €9,256 ($10,459): €4,486 ($5,069) direct costs and €4,770 ($5,390) indirect costs. A histogram of semi-annual costs revealed distinct groups with low costs (< €2,500 = $2,825) and high costs (> €2,500 = $2,825). Seizure-free patients were clustered in the group with low costs; patients with ongoing seizures appeared more frequently in the group with high costs. Working patients were more often found in the group with low costs, whereas unemployed patients were more prevalent in the group with high costs. The regression analysis confirmed worklessness as the main cost driver.Conclusion: Non-productivity and poorly controlled disease with ongoing seizures are associated with higher costs in epilepsy. Providing high-level care and optimal drug treatment that enables patients to remain in work may help reduce the economic burden of epilepsy. [ABSTRACT FROM AUTHOR]

Predictive models for reintervention may guide clinicians to optimize selection, education, and follow-up of patients undergoing endovascular iliac revascularization. Although the impact of lesion- and device-related characteristics on iliac restenosis and reintervention risk is well-defined, data on patient-specific risk factors are scarce and conflicting. This study aimed to explore the value of patient-related factors in predicting the need for clinically driven target-vessel revascularization (CD-TVR) in patients undergoing primary endovascular treatment of iliac artery disease. Consecutively enrolled patients undergoing endovascular revascularization for symptomatic iliac artery disease at a tertiary vascular referral center between January 2008 and June 2020 were retrospectively analyzed. Primary and secondary outcomes were CD-TVR occurrence within 24 months and time to CD-TVR, respectively. Patients who died or did not require CD-TVR within 24 months were censored at the date of death or at 730 days, respectively. Multiple imputation was used to account for missing data in primary analyses. A total of 1538 iliac interventions were performed in 1113 patients (26% females; 68 years). CD-TVR occurred in 108 limbs (74 patients; 7.0%) with a median time to CD-TVR of 246 days. On multivariable analysis, increasing age was associated with lower likelihood of CD-TVR (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.50-0.83; P =.001) and decreased risk of CD-TVR at any given time (hazard ratio [HR], 0.66; 95% CI, 0.52-0.84; P =.001). Similarly, a lower likelihood of CD-TVR (OR, 0.75; 95% CI, 0.59-0.95; P =.017) and decreased risk of CD-TVR at any given time (HR, 0.73; 95% CI, 0.58-0.93; P =.009) were observed with higher glomerular filtration rates. Lastly, revascularization of common vs external iliac artery disease was associated with lower likelihood of CD-TVR (OR, 0.48; 95% CI, 0.24-0.93; P =.030) and decreased risk of CD-TVR at any given time (HR, 0.48; 95% CI, 0.25-0.92; P =.027). No associations were observed between traditional cardiovascular risk factors (sex, hypertension, higher low-density lipoprotein cholesterol, higher hemoglobin A1c, smoking) and CD-TVR. In this retrospective cohort study, younger age, impaired kidney function, and external iliac artery disease were associated with CD-TVR. Traditional markers of cardiovascular risk were not seen to predict reintervention. [ABSTRACT FROM AUTHOR]

Allogeneic hematopoietic stem cell transplantation (alloHSCT) is frequently associated with impaired oral intake and malnutrition, which potentially increases morbidity and mortality. Therefore, nutrition is one of the major challenges in the post-transplant period. To document the current clinical approach in nutritional treatment, we designed a questionnaire concerning the current practice in nutrition after alloHSCT and distributed it to German speaking centers performing alloHSCT in Germany, Austria and Switzerland between November 2018 and March 2020. Twenty-eight (39%) of 72 contacted centers completed the survey, 23 from Germany, two from Austria and three from Switzerland, representing 50% of alloHSCT activity within the participating countries in 2018. All centers reported having nutritional guidelines for patients undergoing alloHSCT, whereby 86% (n = 24) provided a low-microbial diet during the neutropenic phase. The criteria to start parenteral nutrition (PN) directly after alloHSCT seemed to be consistent, 75% (n = 21) of the corresponding centers started PN if the oral nutritional intake or the bodyweight dropped below a certain limit. In the setting of intestinal graft-versus-host disease (GvHD) the current practice appeared to be more heterogenous. About 64% (n = 18) of the centers followed a special diet, added food stepwise modulated by GvHD symptoms, while only four centers regularly stopped oral intake completely (intestinal GvHD grade >1). Half of the centers (54%, n = 15) applied a lactose-free diet, followed by 43% (n = 12) which provided fat- and 18% (n = 5) gluten-free food in patients with intestinal GvHD. Supplementation of micronutrients in acute intestinal GvHD patients was performed by 54% (n = 15) of the centers, whereas vitamin D (89%, n = 25) and vitamin B 12 (68%, n = 19) was added regularly independently of the presence of GvHD. Only 5 (18%) participating centers ever observed a food-associated infection during hospitalization, whereas food-associated infections were reported to occur more often in the outpatient setting (64%, n = 18). The survey documented a general consensus about the need for nutritional guidelines for patients undergoing alloHSCT. However, the nutritional treatment in clinical practice (i.e. lactose-, gluten- or fat-free in intestinal GvHD) as well as the use of food supplements was very heterogeneous. In line with current general recommendations the centers seemed to focus on safe food handling practice rather than providing a strict neutropenic diet. More high-quality data are required to provide evidence-based nutrition to patients during and after alloHSCT. [ABSTRACT FROM AUTHOR]

In polymorbid patients with bronchopulmonary infection, malnutrition is an independent risk factor for mortality. There is a lack of interventional data investigating whether providing nutritional support during the hospital stay in patients at risk for malnutrition presenting with lower respiratory tract infection lowers mortality. For this secondary analysis of a randomized clinical trial (EFFORT), we analyzed data of a subgroup of patients with confirmed lower respiratory tract infection from an initial cohort of 2028 patients. Patients at nutritional risk (Nutritional Risk Screening [NRS] score ≥3 points) were randomized to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). The primary endpoint of this analysis was all-cause 30-day mortality. We included 378 of 2028 EFFORT patients (mean age 74.4 years, 24% with COPD) into this analysis. Compared to usual care hospital nutrition, individualized nutritional support to reach caloric and protein goals showed a similar beneficial effect of on the risk of mortality in the subgroup of respiratory tract infection patients as compared to the main EFFORT trial (odds ratio 0.47 [95%CI 0.17 to 1.27, p = 0.136] vs 0.65 [95%CI 0.47 to 0.91, p = 0.011]) with no evidence of a subgroup effect (p for interaction 0.859). Effects were also similar among different subgroups based on etiology and type of respiratory tract infection and for other secondary endpoints. This subgroup analysis from a large nutrition support trial suggests that patients at nutritional risk as assessed by NRS 2002 presenting with bronchopulmonary infection to the hospital likely have a mortality benefit from individualized inhospital nutritional support. The small sample size and limited statistical power calls for larger nutritional studies focusing on this highly vulnerable patient population. Registered under ClinicalTrials.gov Identifier no. NCT02517476. [ABSTRACT FROM AUTHOR]

Purpose: Accurate characterization and quantification of seizure types are critical for optimal pharmacotherapy in epilepsy patients. Technological advances have made it possible to continuously monitor physiological signals within or outside the hospital setting. This study tested the utility of single-channel surface-electromyography (sEMG) for characterization of motor epileptic seizure semiology.Methods: Seventy-one subjects were prospectively enrolled where vEEG and sEMG were simultaneously recorded. Three epileptologists independently identified and classified seizure events with upper-extremity (UE) motor activity by reviewing vEEG, serving as a clinical standard. Surface EMG recorded during the events identified by the clinical standard were evaluated using automated classification methods and expert review by a second group of three independent epileptologists (blinded to the vEEG data). Surface EMG classification categories included: tonic-clonic (TC), tonic only, clonic only, or other motor seizures. Both automated and expert review of sEMG was compared to the clinical standard.Results: Twenty subjects experienced 47 motor seizures. Automated sEMG event classification methods accurately classified 72 % (95 % CI [0.57, 0.84]) of events (15/18 TC seizures, 5/9 tonic seizures, 1/3 clonic seizures, and 13/17 other seizures). Three independent reviewers' majority-rule analysis of sEMG correctly classified 81 % (95 % CI [0.67, 0.91]) of events (16/18 TC seizures, 8/9 tonic seizures, 1/3 clonic seizures, and 13/17 other manifestations).Conclusions: Continuous monitoring of sEMG data provides an objective measure to evaluate motor seizure activity. Using sEMG from a wearable monitor recorded from the biceps, automated and expert review may be used to characterize the semiology of events with UE motor activity, particularly TC and tonic seizures. [ABSTRACT FROM AUTHOR]

Objective: There is a harmful myth that persists in modern culture that one should place objects into a seizing person's mouth to prevent "swallowing the tongue." Despite expert guidelines against this, the idea remains alive in popular media and public belief. We aimed to investigate the myth's origins and discredit it.Methods: A medical and popular literature review was conducted for the allusions to "swallowing one's tongue" and practice recommendations for and against placing objects into a seizing person's mouth. Current prevalence of these beliefs and relevant anatomy and physiology were summarised.Results: The first English language allusions to placing objects in a patient's mouth occurred in the mid-19th century, and the first allusions to swallowing one's tongue during a seizure occurred in the late 19th century. By the mid-20th century, it was clear that some were recommending against the practice of placing objects in a patient's mouth to prevent harm. Relatively recent popular literature and film continue to portray incorrect seizure first aid through at least 2013. There is ample modern literature confirming the anatomical impossibility of swallowing one's tongue and confirming the potential harm of putting objects in a patient's mouth.Conclusion: One cannot swallow their tongue during a seizure. Foreign objects should not be placed into a seizing person's mouth. We must continue to disseminate these ideas to our patients and colleagues. As neurologists, we have an obligation to champion safe practices for our patients, especially when popular media and culture continue to propagate dangerous ones. [ABSTRACT FROM AUTHOR]

Evidence-based medicine is the art of combining "best external evidence", "clinical judgement" and "patient values" for improved daily clinical decision making and is the ultimate goal in modern medicine. Historically, in the field of medical nutrition, there had been a lack of strong evidence from large and high-quality trials resulting in often weak guideline recommendations and therefore insufficient implementation in clinical practice. Particularly in the field of malnutrition, the medical community has long struggled to find evidence-based approaches for effective management by means of screening, assessment and treatment of patients. With recent trials showing that individual medical nutrition therapy has strong effects on clinical outcomes, we should now aim to practice "evidence-based medical nutrition" (EBMN) by combining clinical judgement (e.g., thorough clinical assessment of the malnourished patient), patient preferences (e.g., integration of perspectives of patients and relatives, consideration of comorbidities to define specific energy/protein goals and appropriate route of medical nutrition therapy) and the most current scientific evidence (e.g., trial-supported use of nutritional interventions for individual patients). Such an approach may certainly be helpful to improve clinical outcomes of the vulnerable population of malnourished medical inpatients. [ABSTRACT FROM AUTHOR]

Duplex ultrasound (DUS) is used for routine surveillance of stents in iliocaval veins, but direct visualisation is often challenging. Duplex ultrasound criteria for detecting venous stent obstruction (VSO) have not been defined to date. A nested case control study of 120 patients (42 ± 17 years, 53% women, mean 2.7 ± 1.8 stents) was performed, and the performance of various duplex parameters for detecting VSO (defined as > 50% lumen diameter reduction or occlusion) was tested, confirmed by biplane venography or intravascular ultrasound (IVUS). Forty patients with VSO (25 with stent occlusion, 15 with >50% in stent stenosis) were matched to 80 control patients by age, gender and index diagnosis who fulfilled the following criteria: (1) ongoing symptom control (Villalta score < 5), (2) good image quality of entire stent segment, (3) spontaneous colour Doppler signal > 50% of lumen in entire stent segment, (4) at least two DUS where the baseline DUS was obtained within 24 h after successful venous intervention. The best test was the combination of peak flow velocity and flow pattern analysis at the stent inlet. A peak flow velocity >10 cm/s and a flow pattern spontaneously modulated by respiration ruled out VSO with a specificity of 93.7% (95% CI 86.0%–97.3%). A peak flow velocity ≤10 cm/s or any Doppler flow pattern other than spontaneously modulated by respiration was 92.1% (95% CI 79.2%–97.3%) sensitive to detect VSO. The combination of peak flow velocity and analysis of Doppler flow pattern at the stent inlet is accurate to diagnose or rule out stent occlusion. Indirect criteria should always be combined with direct visualisation of iliocaval stents since those may be less sensitive for detecting stent stenosis. [ABSTRACT FROM AUTHOR]

This study describes presentation, cardiovascular abnormalities, etiology, and outcome of canine myocarditis in geographic areas not endemic for Trypanosoma or Leishmania. Sixty-four (presumed antemortem diagnosis) and 137 (postmortem diagnosis only) client-owned dogs at two tertiary care facilities were included. Medical records of dogs with clinical or histopathological diagnosis of myocarditis were reviewed retrospectively. Common examination findings in dogs with a presumed antemortem diagnosis included fever (21%) and heart murmur (19%). Median cardiac troponin I was 12.2 ng/mL (range: 0.2–808.0 ng/mL), and troponin exceeded 1.0 ng/mL in 26 of 29 (90%) dogs. Ventricular ectopy was the most common arrhythmia (54%), whereas decreased left ventricular systolic function was the most common echocardiographic abnormality (56%). An infectious etiology was diagnosed in 35 of 64 (55%) dogs. Confirmed infectious etiologies included bacterial sepsis (n = 9) or extension of endocarditis (3), toxoplasmosis or neosporosis (3), parvovirus (2), and one case each of bartonellosis, trypanosomiasis, leptospirosis, and dirofilariasis. Median survival time was 4 days (range: 0–828 days) for all dogs vs. 82 days for dogs who survived at least 2 weeks after diagnosis. Presence of pericardial effusion or azotemia was a significant predictor of non-survival. The most common inflammatory infiltrate on histopathology was neutrophilic (47%), and 20 of 137 (14.5%) dogs had concurrent bacterial endocarditis on postmortem. Bacterial infection was the most common confirmed etiology of myocarditis in this study. Prognosis for canine myocarditis is guarded and similar to that reported for infective endocarditis. Criteria for the antemortem diagnosis of canine myocarditis are suggested. [ABSTRACT FROM AUTHOR]

Objectives: Findings during the 2009 pandemic suggest severe maternal infection with pandemic influenza had adverse perinatal health consequences. Limited data exist evaluating the perinatal health effects of severe seasonal influenza and non-influenza infections during pregnancy.Methods: A retrospective cohort of pregnant women from Australia, Canada, Israel, and the United States was established using birth records to identify pregnancies and birth outcomes and hospital and laboratory testing records to identify influenza and non-influenza associated acute respiratory or febrile illness (ARFI) hospitalizations. ARFI hospitalized women were matched to non-hospitalized women (1:4) by country and season of conception. Log-binomial regression was used to estimate the relative risk (aRR) of preterm birth (PTB), small-for-gestational-age (SGA), and low birthweight (LBW) birth, adjusting for pre-existing medical conditions, maternal age, and parity.Results: 950 pregnant women hospitalized with an ARFI were matched with 3,800 non-hospitalized pregnant women. Compared to non-hospitalized women, risk of PTB was greater among women hospitalized with influenza-associated ARFI (aRR: 1.57; 95% CI: 1.15-2.15) and non-influenza ARFI (aRR: 2.78; 95% CI: 2.12-3.65). Similar results were observed for LBW; there were no associations with SGA birth.Conclusions: ARFI hospitalization during pregnancy was associated with increased risk of PTB and LBW. [ABSTRACT FROM AUTHOR]

ED pain score reassessment and documentation rates were drastically low according to sampled data from the St. Margaret Hospital Emergency Department, leading to difficult pain management encounters for clinicians. The purpose of this project was to improve pain score reassessment rates in ED patients who were discharged with extremity pain. This project was an 8-month, pre-postinterventional (preintervention: September-November 2018, intervention: December 2018-January 2019, and postintervention: February-April 2019) quality improvement project that took place in a community hospital emergency department. Emergency nurses participated in 6 focus groups, allowing for the creation of focus group-themed interventions at the request of the nursing staff. Daily audits of pain reassessment and documentation rates for individual nurses took place during the month of January 2019. In addition, a weekly newsletter was created and reported the ED pain reassessment and documentation rates. All patient encounters (581) were reviewed over the 8-month period. Baseline pain score reassessment and documentation rates were 36.2% (confidence interval, 30.3%-42.3%) in the emergency department. Pain reassessment and documentation rates increased to 62.3% (confidence interval, 56.8%-67.6%) during the 3-month postintervention period. Implementing daily audits and weekly newsletters that created transparency of individual and group performances increased pain score reassessment and documentation rates. [ABSTRACT FROM AUTHOR]

Over the last few decades the ILAE classifications for seizures and epilepsies (ILAE-EC) have been updated repeatedly to reflect the substantial progress that has been made in diagnosis and understanding of the etiology of epilepsies and seizures and to correct some of the shortcomings of the terminology used by the original taxonomy from the 1980s. However, these proposals have not been universally accepted or used in routine clinical practice. During the same period, a separate classification known as the "Four-dimensional epilepsy classification" (4D-EC) was developed which includes a seizure classification based exclusively on ictal symptomatology, which has been tested and adapted over the years. The extensive arguments for and against these two classification systems made in the past have mainly focused on the shortcomings of each system, presuming that they are incompatible. As a further more detailed discussion of the differences seemed relatively unproductive, we here review and assess the concordance between these two approaches that has evolved over time, to consider whether a classification incorporating the best aspects of the two approaches is feasible. To facilitate further discussion in this direction we outline a concrete proposal showing how such a compromise could be accomplished, the "Integrated Epilepsy Classification". This consists of five categories derived to different degrees from both of the classification systems: 1) a "Headline" summarizing localization and etiology for the less specialized users, 2) "Seizure type(s)", 3) "Epilepsy type" (focal, generalized or unknown allowing to add the epilepsy syndrome if available), 4) "Etiology", and 5) "Comorbidities & patient preferences". [ABSTRACT FROM AUTHOR]