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Introduction: The routine use of post-operative esophogram has come under evaluation for multiple upper GI surgeries such as with bariatric surgery and gastric resections. A major complication following Per Oral Endoscopic Myotomy (POEM) is a leak from the myotomy site. A post-operative contrast esophogram is often utilized to evaluate the presence of a leak, however it is not a standardized care practice for all patients. Presently it is selectively performed depending on physician assessment intra-operatively. This project will evaluate the necessity of post-operative contrast esophogram following POEM. Materials and Methods: We retrospectively reviewed 277 patients diagnosed with achalasia who underwent POEM by two surgeons from 2011 to 2022. 173 patients met the inclusion criteria. A post-operative esophogram was used for the evaluation of a leak. Post-operative esophagram were selectively performed on day 1 following surgery using a water-soluble material. Data was evaluated using Stata. Results: There were 3 detected leaks in the group that underwent esophagrams compared to the non-esophagram group in the early post-operative period. The overall complication rate was 5.5% in the non-esophagram versus 7.9% in the esophagram group. Length of stay was 1.48 days in the non-UGI vs 1.76 days in the esophagram group. Readmission rate was 10.9% in non-esophagram versus 8.7% in esophagram group. Conclusion: There was no statistically significant difference in outcomes in patients undergoing POEM who received post-operative esophagram verses patients who did not receive post-operative esophagram. The routine use of a contrast esophogram to detect a leak following POEM may not be justified. This study suggests that esophagrams should be performed depending on the clinical signs/symptoms post-operatively that would warrant imaging and intervention. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Laparoscopic splenectomy and esophagogastric devascularization (LSED) are minimally invasive, effective, and safe in treating esophageal-fundic variceal bleeding with portal hypertension (PHT). The study aimed to assess the learning curve of LSED by cumulative summation (CUSUM) analysis. The 10-year follow-up data for LSED and open surgery were also examined. Patients and methods: Five hundred and ninety-four patients were retrospectively analyzed. Operation time, intraoperative blood loss, open operation conversion, and postoperative complications were selected as the evaluation indicators of surgical ability. The learning curve of LESD was assessed by the CUSUM approach. Patient features, perioperative indices, and 10-year follow-up data were examined. Results: Totally 236 patients underwent open surgery, and 358 underwent LSED. Patient characteristics were similar between groups. The LSED patients experienced less intraoperative blood loss, fewer complications, and faster recovery compared to the open surgery cohort. The learning curve of LESD was maximal for a case number of 50. Preoperative general characteristics were comparable for both stages. But the skilled stage had decreased operation time, reduced blood loss, less postoperative complications, and better recovery compared to the learning stage. The LSED group had higher recurrent hemorrhage-free survival rate and increased overall survival in comparison with cases administered open surgery in the 10-year follow-up. Free-liver cancer rates were similar between two groups. Conclusions: About 50 cases are needed to master the LSED procedure. Compared to open surgery, LSED is a safer, feasible, and safe procedure for PHT patients, correlating with decreased rebleeding rate and better overall survival. [ABSTRACT FROM AUTHOR]

Background: An increasing number of reflux patients opt for magnetic sphincter augmentation (MSA) instead of fundoplication. However, few studies compare the medium-term efficacy and safety of the procedures. Methods: We conducted a retrospective single-center analysis of consecutive MSA and Nissen fundoplication cases between 01/2015 and 06/2020. Patients underwent surgery, including hiatoplasty, for medical treatment-resistant reflux due to hiatal hernia. Surgical revision and proton pump inhibitor (PPI) reuptake rates were the primary outcomes. We also compared adverse event rates. Patients with severe preoperative dysphagia/motility disorders were assigned different treatment pathways and excluded from the analysis. We used propensity-score matching to reduce confounding between treatments. Results: Out of 411 eligible patients, 141 patients who underwent MSA and 141 with fundoplication had similar propensity scores and were analyzed. On average, patients were 55 ± 12 years old and overweight (BMI: 28 ± 5). At 3.9 years of mean follow-up, MSA was associated with lower surgical revision risk as compared to fundoplication (1.2% vs 3.0% per year, respectively; HR: 0.38; 95% CI 0.15–0.96; p = 0.04), and similar PPI-reuptake risk (2.6% vs 4.2% per year; HR: 0.59; 95% CI 0.30–1.16; p = 0.12). Adverse event rates during primary stay were similar (MSA vs. fundoplication: 1% vs. 3%, p = 0.68). Fewer patients experienced adverse events in the MSA group after discharge (24% vs. 33%, p = 0.11), driven by higher rates of self-limiting dysphagia (1% vs. 9%, p < 0.01) and gas/bloating (10% vs. 18%, p = 0.06) after fundoplication. Differences between MSA and fundoplication in dysphagia requiring diagnostic endoscopy (11% vs. 8%, p = 0.54) or surgical revision (2% vs. 1%, p = 1.0) were non-significant. The device explantation rate was 4% (5/141). Conclusion: MSA reduces the re-operation risk compared to fundoplication and may decrease adverse event rates after discharge. Randomized head-to-head studies between available surgical options are needed. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic pancreatoduodenectomy (LPD) is one of the most challenging operations and has a long learning curve. Artificial intelligence (AI) automated surgical phase recognition in intraoperative videos has many potential applications in surgical education, helping shorten the learning curve, but no study has made this breakthrough in LPD. Herein, we aimed to build AI models to recognize the surgical phase in LPD and explore the performance characteristics of AI models. Methods: Among 69 LPD videos from a single surgical team, we used 42 in the building group to establish the models and used the remaining 27 videos in the analysis group to assess the models' performance characteristics. We annotated 13 surgical phases of LPD, including 4 key phases and 9 necessary phases. Two minimal invasive pancreatic surgeons annotated all the videos. We built two AI models for the key phase and necessary phase recognition, based on convolutional neural networks. The overall performance of the AI models was determined mainly by mean average precision (mAP). Results: Overall mAPs of the AI models in the test set of the building group were 89.7% and 84.7% for key phases and necessary phases, respectively. In the 27-video analysis group, overall mAPs were 86.8% and 71.2%, with maximum mAPs of 98.1% and 93.9%. We found commonalities between the error of model recognition and the differences of surgeon annotation, and the AI model exhibited bad performance in cases with anatomic variation or lesion involvement with adjacent organs. Conclusions: AI automated surgical phase recognition can be achieved in LPD, with outstanding performance in selective cases. This breakthrough may be the first step toward AI- and video-based surgical education in more complex surgeries. [ABSTRACT FROM AUTHOR]

Background: There is much heterogeneity in the instrumentation used for parenchymal transection in minimally invasive liver surgery. Instruments specifically designed for robotic parenchymal transection of the liver are lacking. We aim to gain insight into the safety and effectiveness of the SynchroSeal (Intuitive Surgical, Inc., Sunnyvale, CA), a novel bipolar electrosurgical device, in the context of liver surgery. Methods: The present study is a post-hoc analysis of prospectively collected data from patients undergoing robotic liver resection (RLR) using the SynchroSeal in two high-volume centres. The results of the SynchroSeal were compared with that of the previous generation bipolar-sealer; Vessel Sealer Extend (Intuitive Surgical, Inc., Sunnyvale, CA) using propensity score matching, after excluding the first 25 Vessel Sealer procedures per center. Results: During the study period (February 2020–March 2023), 155 RLRs meeting the eligibility criteria were performed with the SynchroSeal (after implementation in June 2021) and 145 RLRs with the Vessel Sealer. Excellent outcomes were achieved when performing parenchymal transection with the SynchroSeal; low conversion rate (n = 1, 0.6%), small amounts of intraoperative blood loss (median 40 mL [IQR 10–100]), short hospital stays (median 3 days [IQR 2–4]), and adequate overall morbidity (19.4%) as well as severe morbidity (11.0%). In a matched comparison (n = 94 vs n = 94), the SynchroSeal was associated with less intraoperative blood loss (48 mL [IQR 10–143] vs 95 mL [IQR 30–200], p = 0.032) compared to the Vessel Sealer. Other perioperative outcomes were similar between the devices. Conclusion: The SynchroSeal is a safe and effective device for robotic liver parenchymal transection. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic distal gastrectomy (LDG) has become a common procedure for treating advanced gastric cancer (AGC) in China. However, there is uncertainty regarding its oncological outcomes compared to open distal gastrectomy (ODG). This study aims to compare the 3-year disease-free survival (DFS) rates among patients who underwent surgery for AGC in northern China. Methods: A multicenter, non-inferiority, open-label, parallel, randomized clinical trial was conducted to evaluate patients with AGC who were eligible for distal gastrectomy at five tertiary hospitals in North China. In this trial, patients were randomly assigned preoperatively to receive either LDG or ODG in a 1:1 allocation ratio. The primary endpoint was postoperative morbidity and mortality within 30 days and the secondary endpoint was the 3-year DFS rate. This trial has been registered at ClinicalTrials.gov (Identifier: NCT02464215). Results: A total of 446 patients were randomly allocated to LDG (n = 223) or ODG group (n = 223) between March 2014 and August 2017. After screening, a total of 214 patients underwent the open surgical approach, while 216 patients underwent laparoscopic surgery. The 3-year DFS rate was 85.9% for the LDG group and 84.72% for the ODG group, with no significant statistical difference (Hazard ratio 1.12; 95% CI 0.68–1.84, P = 0.65). Body mass index (BMI) < 25 kg/m2, advanced pathologic T4, and pathologic N2-3 category were confirmed as independent risk factors for DFS in the Cox regression. Conclusions: In comparison to ODG, LDG with D2 lymphadenectomy yielded similar outcomes in terms of 3-year DFS rates among patients diagnosed with AGC. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic simultaneous resection (LSR) of primary colorectal tumors and synchronous colorectal liver metastases (sCRLM) has been recently performed. This study aimed to evaluate the postoperative outcomes after LSR and determine the risk factors for resection surface-related complications (RSRC), such as postoperative biliary fistula and liver-transection surface abscess. Methods: Between 2009 and 2022, consecutive patients with sCRLM who underwent LSR were included. We retrospectively analyzed clinicopathological data, including intraoperative factors and postoperative outcomes. The difficulty level of all liver resections was classified according to the IWATE difficulty scoring system (DSS). We then performed univariate and multivariate analyses to identify the risk factors for RSRC. Results: Of the 112 patients, 94 (83.9%) underwent partial hepatectomy and colorectal surgery. The median DSS score was 5 points (1–11), with 12 (10.7%) patients scoring ≥ 7 points. Postoperative complications were observed in 41 (36.6%) patients, of whom 16 (14.3%) experienced severe complications classified as Clavien–Dindo grade IIIa or higher. There was no postoperative mortality. The most common complication was RSRC (19 patients, 17.0%). Multivariate analysis identified American Society of Anesthesiologists (ASA) classification ≥ 3 [odds ratio (OR) 10.3, 95% confidence interval (CI) 1.37–77.8; P = 0.023], DSS score ≥ 7 points (OR 5.08, 95% CI 1.17–20.0; P = 0.030), and right-sided colectomy (OR 4.67, 95% CI 1.46–15.0; P = 0.009) as independent risk factors for RSRC. Postoperative hospital stays were significantly longer for patients with RSRC than for those without RSRC (22 days vs. 11 days; P < 0.001). Conclusion: Short-term outcomes of LSR for patients with sCRLM were acceptable in an experienced center. RSRC was the most common complication, and high-difficulty hepatectomy, right-sided colectomy, and ASA classification ≥ 3 were independent risk factors for RSRC. [ABSTRACT FROM AUTHOR]

Background: Febrile urinary tract infections (UTIs) are among the most severe bacterial infections in infants, in which a subset of patients develops complications. Identifying infants at risk of recurrent infections or kidney damage based on clinical signs is challenging. Previous observations suggest that genetic factors influence UTI outcomes and could serve as predictors of disease severity. In this study, we conducted a nationwide survey of infant genotypes to develop a strategy for infection management based on individual genetic risk. Our aims were to identify genetic susceptibility variants for renal scarring (RS) and genetic host factors predisposing to dilating vesicoureteral reflux (VUR) and recurrent UTIs. Methods: To assess genetic susceptibility, we collected and analyzed DNA from blood using exome genotyping. Disease-associated genetic variants were identified through bioinformatics analysis, including allelic frequency tests and odds ratio calculations. Kidney involvement was defined using dimercaptosuccinic acid (DMSA) scintigraphy. Results: In this investigation, a cohort comprising 1087 infants presenting with their first episode of febrile UTI was included. Among this cohort, a subset of 137 infants who underwent DMSA scanning was subjected to gene association analysis. Remarkable genetic distinctions were observed between patients with RS and those exhibiting resolved kidney involvement. Notably, the genetic signature indicative of renal scarring prominently featured mitochondrial genes. Conclusions: In this nationwide study of genetic susceptibility to RS after febrile UTIs in infancy, we identified a profile dominated by mitochondrial polymorphisms. This profile can serve as a predictor of future complications, including RS and recurrent UTIs. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To understand and describe attitudes toward general health checkups, breast health knowledge, cultural beliefs, and health-promoting behaviors among Myanmar American immigrant women in the United States. SAMPLE & SETTING: 267 women participated in the study. 10 women were excluded because of missing data, so the total sample size was 257 participants. METHODS & VARIABLES: A descriptive, crosssectional survey design was used to describe and investigate breast health perceptions and behaviors. RESULTS: Nearly 75% of the study sample reported having negative attitudes toward general health checkups and were found to have less accurate breast health knowledge and more fatalistic views about breast cancer. Only 29% of older women adhered to mammogram recommendations. Younger women reported more barriers to mammograms, and older women reported fewer barriers to mammograms. IMPLICATIONS FOR NURSING: This study demonstrated the need for additional research focusing on unique perspectives when investigating breast health practices among Myanmar American immigrant women. The findings highlight the essential need to build a strong partnership with stakeholders to combat breast health disparities and address the complex nature of acculturation. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the short- and medium-term outcomes of hip dislocation in infants who failed Pavlik harness therapy and were subsequently treated with brace, closed reduction (CR) or open reduction (OR) before 6 months of age. Methods: Fifty infants (66 hip dislocations) who failed Pavlik harness therapy between 2000 and 2018 and were treated with a rigid abduction brace or undergoing a CR or OR/cast were evaluated. All demographic data obtained from the medical system, developments and complications during the follow-up and treatment process were recorded and evaluated. Results: Fifty infants (66 hips) with dislocated hips failed Pavlik harness therapy. Of these, 9 infants (12 hips) underwent rigid abduction splint therapy: 9 hips were successful, 2 hips had CR and 1 had OR. Thirty-eight infants (51 hips) had index CR, of which 3 (3 hips) failed and had OR. Radiographs of 49 hips (44 patients) were normal at the final evaluation. Pavlik harness therapy starting after 3 weeks (P = 0.028) and unilateral dislocations (P = 0.028) increased the risk of needing operating room. There was an association between OR and avascular necrosis (P = 0.025), but not between OR and other complications—dysplasia and re-dislocation/subluxation (P = 0.257 and P = 0.508, respectively). Conclusion: Closed treatment of hip dislocation is possible in most babies who fail Pavlik treatment. Babies who are started on Pavlik therapy after 3 weeks of age may be at increased risk of needing an operating room. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Association between liver cirrhosis (LC) and glucose intolerance has been known since long. Many studies in the past have attempted to explore the correlation of glucose metabolism disorders (GMD) with the severity of LC with mixed results (some favouring i.e. higher prevalence of GMD in more severe LC; others negating). This study was conducted to shed further light on the significance of this association. Objective: This study has been carried out with the aim of studying the correlation between GMD and the severity of LC, as determined by the Child-Turcotte-Pughe (CTP) score. Methods: 100 patients with LC admitted in medical wards were studied and tested with fasting plasma glucose (FPG), 2 h post-75 g oral glucose load plasma glucose (PPG), glycosylated haemoglobin (HbA1c) and fasting plasma insulin. They were categorized based on the severity of LC into CTP A, B or C class and then patients belonging to different classes were compared for the presence of GMD and insulin resistance (IR). Conclusion: Out of 100 patients, 6, 21 and 73 were respectively found as falling under CTP class A, B and C of LC. The frequency of diabetes mellitus (DM) was found to progressively increase with worsening grade of cirrhosis (17%-A, 24%-B and 27%-C), however this was not significant (p value 0.82). The p values for IR, GMD (pre-diabetes or DM), pre-diabetes (pre-DM) were 0.629, 0.382 and 0.189 respectively. To conclude, development of GMD and IR may be independent of the severity of LC. However more studies may be required to further study this association. [ABSTRACT FROM AUTHOR]

Objective: Tropical diabetic hand syndrome (TDHS) is rarely described and recognized in the literature as a complication in people with diabetes, and Mexico has high incidence rates of diabetes mellitus II (DMII). The minor or major amputation of the arm represents a physically and economically significant morbidity problem in patients. To optimize the diagnosis and treatment, in this work, we identify prognostic factors and their association with the severity of TDHS and the need for amputation in patients with diabetes mellitus and hand tissue infection. Methods: A total of 55 patients with a confirmed diagnosis of DMII with soft tissue infection in the hand referred to the plastic and reconstructive surgery department were studied for their evaluation and treatment. We analyze sociodemographic and clinical factors and follow-up of remission and recovery in limb functions. Results: In our study, we identified factors associated with amputation such as schooling under 6 years (OR: 21.98, confidence interval (CI): 1.21–3.98, p = 0.003), body mass index ≥ 20 (OR: 0.07, CI = 0.003–1.41, p = 0.031), and history of amputation (no upper limb) (OR: 5.9, CI = 1.11–32.1, p = 0.032). Furthermore, people with TDHS requiring amputation had slightly higher glycated hemoglobin (Hb1Ac) ≥ 10% (OR: 2.36, CI = 0.62–8.98, p = 0.338), and the risk of death was also increased (OR: 3.4, CI = 0.355–32.6, p = 0.288), although these outcomes did not reach statistical significance. Conclusions: Risk factors for amputation as a treatment of THDS are directly linked to lower schooling status, poor nutrition/low weight, as well as previous amputation procedures in patients. These data will help to establish a timelier evaluation and management in patients with suspected THDS. [ABSTRACT FROM AUTHOR]

Background: Pneumonia has a high incidence in traumatic brain injury (TBI) patients and lacks effective treatments. Early mobilization (EM) may be a potentially effective treatment. Aim: To explore the impact of EM on TBI‐related pneumonia in the neurosurgical intensive care unit (NICU). Study Design: This study was a historical control study. 100 TBI patients who received EM intervention were prospectively included as the experimental group (EM cohort), and 250 TBI patients were retrospectively included as the control group. The propensity score matching (PSM) method was employed to balance baseline and minimize potential bias. The relationship between EM and TBI‐related pneumonia was investigated by univariate and multivariate logistic regression, then further determined by subgroup analysis. The influence of other variables was excluded by interaction analyses. Finally, the effect of EM on the prognosis of TBI patients was analysed by comparing the Glasgow Coma Scale (GCS) and the hospital stay. Results: After screening, 86 patients were included in the EM cohort and 199 patients were included in the control cohort. There were obvious differences between the two cohorts at baseline, and these differences were eliminated after PSM, when the incidence of pneumonia was significantly lower in the EM cohort than in the control cohort (35.0% vs. 61.9%, p <.001). Multivariate logistic regression showed that EM was an independent risk factor for TBI‐related pneumonia and was significantly associated with a decreased incidence of pneumonia. This correlation was present in most subgroups and was not affected by other variables (p for interaction >.05). Patients in the EM cohort had shorter length of ICU stay (6 vs. 7 days, p =.017) and higher GCS at discharge (12 vs. 11, p =.010). Conclusion: EM is a safe and effective treatment for TBI patients in NICU, which can reduce the incidence of pneumonia, help to improve prognosis and shorten the length of ICU stay. Relevance to Clinical Practice: Although the utilization rate of EM is low in TBI patients for various reasons, EM is still an effective method to prevent complications. Our study confirms that a scientific and detailed EM strategy can effectively reduce the incidence of pneumonia while ensuring the safety of TBI patients, which is worthy of further research and clinical application. [ABSTRACT FROM AUTHOR]

Objective: To analyse the influence of the COVID‐19 pandemic and the perception of self‐efficacy on the health professionals of the Spanish out‐of‐hospital emergency services. Design: Observational, cross‐sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February–30 April, 2021). Methods: The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self‐efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self‐efficacy on mental health. Results: The means of the sample for stress, anxiety, depression and self‐efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self‐efficacy. Self‐efficacy had a direct effect on the mental health for working in patient care. Conclusions: Healthcare workers showed moderate stress, severe anxiety, mild depression and good self‐efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self‐efficacy is a determining factor of mental health in the direct care modality. Implications: The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out‐of‐hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self‐efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk. Reporting Method: We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros ‐ ASISA Foundation (Spain). Patient or Public Contribution: 'No patient or public involvement'. [ABSTRACT FROM AUTHOR]

This study aimed to examine the effectiveness of psychosexual care using the conceptual framework of the Salutogenic Model in promoting sexual well-being in women undergoing infertility treatment. This was a two-armed parallel randomised controlled trial which conducted with seventy primary infertility women undergoing infertility treatment assigned to receive either psychosexual care (intervention group, n = 35) or routine care (control group, n = 35). The effects of psychosexual care were estimated by the t-test with the intention-to-treat principle. Sexual function was improved in the intervention group and significantly reduced in the control group. Sexual satisfaction was preserved in the intervention group and significantly reduced in the control group. Sexual esteem and self-efficacy significantly improved in women after psychosexual care compared with routine care. Although depression levels were improved in the intervention group, the difference in depression levels was not statistically significant between the intervention and the control groups. However, sense of coherence was significantly improved in the intervention group compared with the control group. Psychosexual care protected and promoted sexual well-being in women undergoing infertility treatment. Application of the health-oriented Salutogenesis Model may be useful to develop care interventions that enable women to reach a state of sexual well-being. [ABSTRACT FROM AUTHOR]

This trial was carried out to investigate the effect of forced air warming in various body areas of women on hypothermia during cesarean delivery. The patients in the study groups (n = 76) were assigned to the full-body warming group, upper-extremity warming group, lower-extremity warming group, and control groups. The intervention groups received forced-air warming 30 min before the surgery and continued until 30 min after surgery. The incidence of hypothermia was significantly higher in the control group than in the other groups at the 60th minute of the operation (p < 0.01). The intervention and control groups showed significant differences in the frequency of shivering at the entrance to the PACU (p = 0.001). Thermal comfort scores have significant difference between the control group and all of the intervention groups (p<.001). It is said that the full-body forced-air warming technique prevents hypothermia, shivering, and thermal discomfort in women Cesarean Section (CS). [ABSTRACT FROM AUTHOR]

In this study, we examined the effectiveness of Women's Postpartum Sexual Health Program (WPSHP) on Iranian women's sexual health in the postpartum period. A single-blinded randomized clinical trial was conducted in 2016 on 80 postnatal women in Iran. We used the Female Sexual Function Index, Sexual Quality of Life - Female questionnaire and Female Sexual Distress Scale. The intervention group received counseling based on WPSHP. After 28 weeks, the mean score of the Female Sexual Function Index and Female Sexual Quality of Life significantly increased in the WPSH group (p < 0.001, p < 0.001), while the mean score of the Female Sexual Distress significantly decreased in the WPSH group (p < 0.001). We concluded that Women's Postpartum Sexual Health Program could promote postnatal women's sexual function and female sexual quality of life and reduces female sexual distress in women suffering from sexual problems in the postpartum period. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether qualitative and quantitative imaging phenotypes can predict the grade of oligodendroglioma. Methods: Retrospective chart and imaging reviews were conducted on 180 adults with oligodendroglioma (IDH-mutant and 1p/19q codeleted) between 2005 and 2021. Qualitative imaging characteristics including tumor location, calcification, gliomatosis cerebri, cystic change, necrosis, and infiltrative pattern were analyzed. Quantitative imaging assessment was performed from the tumor mask via automatic segmentation to calculate total, contrast-enhancing (CE), non-enhancing (NE), and necrotic tumor volumes. Logistic analyses were conducted to determine predictors of oligodendroglioma grade. Results: This study included 180 patients (84 [46.7%] with grade 2 and 96 [53.3%] with grade 3 oligodendrogliomas), with a median age of 42 years (range 23–76 years), comprising 91 females and 89 males. On univariable analysis, calcification (odds ratio [OR] = 6.00, P < 0.001), necrosis (OR = 21.84, P = 0.003), presence of CE tumor (OR = 7.86, P < 0.001), larger total (OR = 1.01, P < 0.001), larger CE (OR = 2.22, P = 0.010), and larger NE (OR = 1.01, P < 0.001) tumor volumes were predictors of grade 3 oligodendroglioma. On multivariable analysis, calcification (OR = 3.79, P < 0.001) and larger CE tumor volume (OR = 2.70, P = 0.043) remained as independent predictors of grade 3 oligodendroglioma. The multivariable model exhibited an AUC, accuracy, sensitivity, specificity of 0.78 (95% confidence interval 0.72–0.84), 72.8%, 79.2%, 69.1%, respectively. Conclusion: Presence of calcification and larger CE tumor volume may serve as useful imaging biomarkers for prediction of oligodendroglioma grade. Clinical Relevance Statement: Assessment of intratumoral calcification and CE tumor volume may facilitate accurate preoperative estimation of oligodendroglioma grade. Summary statement: Presence of intratumoral calcification and larger contrast-enhancing tumor volume were the significant predictors of higher grade oligodendroglioma based on the 2021 WHO classification. [ABSTRACT FROM AUTHOR]

Background: Rates of cesarean birth (CBs) are steadily increasing and account for 36.7% of all births in New South Wales (NSW), with primary cesareans driving the increase. NSW Health guidelines recommend women attempt a vaginal birth after a previous CB (VBAC); however, rates of VBAC are decreasing, particularly within the private hospital setting. This study aimed to determine the rates of adverse outcomes for women who planned a VBAC (pVBAC) compared with women who planned an elective repeat CB (pERCB) at one private hospital in Sydney, Australia. Method: This retrospective data review evaluated patient records over a 10‐year period (2010–2019). Records (n = 2039) were divided into four groups: pVBAC, pVBAC + EMCB, labor + ERCB (lab + ERCB), and pERCB. The incidence of adverse maternal and neonatal outcomes is reported as counts and percentages. Regression and chi‐squared tests were used to compare groups. Significance was determined at a p‐value of <0.05. Results: Overall, very low rates (N = 148, 7.3%) of women had a VBAC compared with a repeat CB at this private hospital over the 10‐year period. The incidence of adverse outcomes was low regardless of study group. Outcomes differed significantly between groups for postpartum hemorrhage (pERCB seven times less likely than VBAC group) and special care nursery admission (pVBAC + EMCB is 4.6 times more likely than in the VBAC group). Conclusion: Overall, it is safe to attempt a VBAC at this private hospital, and labor after a cesarean should be recommended, yet very few women had a VBAC at the study site. The incidence of adverse outcomes was low compared with other published research. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether induction of labor (IOL) is associated with cesarean birth (CB) and perinatal mortality in uncomplicated first births at term compared with expectant management outside the confines of a randomized controlled trial. Methods: Population‐based retrospective cohort study of all births in Victoria, Australia, from 2010 to 2018 (n = 640,191). Preliminary analysis compared IOL at 37 weeks with expectant management at that gestational age and beyond for uncomplicated pregnancies. Similar comparisons were made for IOL at 38, 39, 40, and 41 weeks of gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women with uncomplicated pregnancies and excluding those with a medical indication for IOL. We compared perinatal mortality between groups using Chi‐square tests and multivariable logistic regression for all other comparisons. Adjusted odds ratios and 99% confidence intervals were reported. p < 0.01 denoted statistical significance. Results: Among nulliparous, uncomplicated pregnancies at ≥37 weeks of gestation in Victoria, IOL increased from 24.6% in 2010 to 30.0% in 2018 (p < 0.001). In contrast to the preliminary analysis, the primary analysis showed that IOL in lower‐risk nulliparous women was associated with increased odds of CB when performed at 38 (aOR 1.23(1.13–1.32)), 39 (aOR 1.31(1.23–1.40)), 40 (aOR 1.42(1.35–1.50)), and 41 weeks of gestation (aOR 1.43(1.35–1.51)). Perinatal mortality was rare in both groups and non‐significantly lower in the induced group at most gestations. Discussion: For lower‐risk nulliparous women, the odds of CB increased with IOL from 38 weeks of gestation, along with decreased odds of perinatal mortality at 41 weeks only. [ABSTRACT FROM AUTHOR]

Purpose: To explore student and tutor perspectives on the learning efficacy of virtual, compared to in-person, problem-based tutorial (PBT) in occupational therapy, physiotherapy, and speech-language pathology health professional programs. Materials and Methods: This was a quality improvement study using a cross sectional survey at a single institution. Separate student and tutor surveys were disseminated online. Students received the survey at two timepoints, tutors received the survey at one timepoint. Descriptive statistics summarized quantitative survey questions. Chi-squared or Fischer's Exact analyses explored differences between in-person and virtual PBT. Exploratory analyses determined if associations amongst programs and/or between cohorts existed on variables of interest. Open-ended survey questions were analyzed using content analysis. Results: A total of 241 students and 85 tutors completed the survey. Results demonstrate most students and tutors were satisfied with the use of virtual tutorials (77%; 89% respectively) and felt that they were effective in exploring content within the PBT course. However, students in the most recent cohort rated virtual tutorials more highly (p = 0.01). Conclusions: Virtual modes of PBT were successful in achieving course objectives and led to high satisfaction in users. Health professional programs can use this information when designing virtual problem-based tutorial courses in the post-pandemic era. IMPLICATIONS FOR REHABILITATION: Problem-based learning (PBL) involves the active engagement of students in self-directed learning where learning gaps are identified, and information is retrieved and critically appraised to apply clinical reasoning to healthcare decisions. Traditionally, the PBL process has been implemented in-person through the use of small group tutorial with six to eight students and a tutor, however, the COVID-19 pandemic led to a quick transition to virtual tutorials. This study found that virtual modes of conducting PBL tutorial were successful in achieving course objectives and both students and tutors were satisfied with using virtual means to achieve course objectives in three professional rehabilitation programs (Occupational Therapy, Physiotherapy, Speech Language Pathology). Health professional programs in rehabilitation can use this information when designing courses using PBL processes in the future, and clinicians can use this information when considering the use of virtual means for care and for collaboration between professionals in various healthcare settings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Left ventricular assist devices (LVAD) improve survival for patients with cardiac failure, but LVAD-specific infection (VSI) remains a challenge with poorly understood predictive risk factors. The indications and use of escalating medical treatment to surgical debridement and potential flap reconstruction are not well characterized. STUDY DESIGN: A retrospective review of consecutive patients undergoing primary LVAD implantation at a tertiary academic center was performed. The primary outcome measures were 90-day and overall mortality after VSI. Cox proportional hazards regression was used to generate a risk prediction score for mortality. RESULTS: Of the 760 patients undergoing primary LVAD implantation, 255 (34%) developed VSI; of these patients, 91 (36%) were managed medically, 134 (52%) with surgical debridement, and 30 (12%) with surgical debridement and flap reconstruction. One-year survival after infection was 85% with median survival of 2.40 years. Factors independently associated with increased mortality were diabetes (hazard ratio [HR] 1.44, p = 0.04), MRSA infection (HR 1.64, p = 0.03), deep space (pump pocket or outflow cannula) involvement (HR 2.26, p < 0.001), and extracorporeal membrane oxygenation after LVAD (HR 2.52, p < 0.01). Factors independently associated with decreased mortality were flap reconstruction (HR 0.49, p = 0.02) and methicillin-sensitive Staphylococcus aureus infection (HR 0.63, p = 0.03). A clinical risk prediction score was developed using these factors and showed significant differences in median survival, which was 5.67 years for low-risk (score 0 to 1), 3.62 years for intermediaterisk (score 2), and 1.48 years for high-risk (score ≥3; p < 0.001) patients. CONCLUSIONS: We developed a clinical risk prediction score to stratify patients with VSI. In selected cases, escalating surgical treatment was associated with increased survival. Future work is needed to determine whether early surgical debridement and flap reconstruction can alter outcomes in select cases of VSI. [ABSTRACT FROM AUTHOR]

Background: Oncology nurses constantly provide emotional support to patients and are confronted with their suffering, which represents chronic stress leading to the development of burnout syndrome. Aim: This study aimed to evaluate the prevalence of burnout and identify associated factors in a sample of oncology nurses. Methods: We conducted a descriptive cross‐sectional study with 70 oncology nurses at the Salah Azaiez Institute of Oncology in Tunisia. Burnout was assessed using the Maslach Burnout Inventory Human Service Survey. This study follows the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Guidelines. Results: Burnout affected 60 nurses (85.7%), with a high level in 20% of cases. High scores of emotional exhaustion, depersonalisation, and low personal accomplishment were recorded in 65.7%, 50% and 25.7% respectively. Emotional exhaustion was associated with higher age, marital status, having 2 or 3 or more dependent children, number of patients under care exceeding 15, professional experience and history of psychiatric problems. Depersonalisation was correlated with age, marital status, professional grade and history of psychiatric problems. Low levels of personal accomplishment increased with the number of patients under care, history of psychiatric problems and the regret of professional choice. Conclusion: Burn‐out is a reality in oncology hospital with an alarming rate. Interventions including rationalisation of workload, support groups, training in emotion and stress management would improve the mental health of these nurses and increase their performance. The screening for burnout should be included as a regular practice in health promotion programmes for oncology health professionals, particularly for a vulnerable subgroup that possesses the risk mentioned above factors. [ABSTRACT FROM AUTHOR]

Background: Post-extubation dysphagia occurs in 3% to 62% of adults who have received invasive mechanical ventilation in an intensive care unit (ICU). A stepwise approach to identify dysphagia includes a routine swallow screening in patients who are recently extubated followed by a formal assessment by a Speech and Language Pathologist (SLP), in the event of a failed swallow screen, has been suggested. This quality improvement project aimed to implement and evaluate a new post-extubation swallow screening process. Methods: Using the Model for Improvement framework, a new process that included the Yale Swallow Protocol (YSP) was developed, implemented, and evaluated between July and December 2022 in a 20-bed tertiary ICU. All patients with at least four hours post-extubation were included in the project. Process development included a literature review and feedback from ICU educators, nurses, physicians, SLPs, and Registered Dietitians (RDs). Education was provided to critical care nurses prior to implementation. Data on patient characteristics, process indicators, and outcomes were collected between September and December 2022 to evaluate the project implementation. Descriptive statistics were used to describe the data and bivariate analyses were used to compare data between patients who passed and failed the YSP. Results: Fifty-four patients were extubated and evaluated using the new swallow screening process. Post-extubation dysphagia was diagnosed by an SLP in 30.0% of patients. Dysphagia was diagnosed in 90.0% of patients who failed, compared with 8.6% of patients who passed the YSP (P<0.001). Conclusion: A swallow screening process using the YSP was successfully adopted in a tertiary ICU. [ABSTRACT FROM AUTHOR]

Importance: Individuals with sickle cell disease (SCD) are at heightened risk of poor neurocognitive and academic outcomes. The relationship between fine motor skills and academic outcomes is not well understood. Objective: To compare the fine motor skills of individuals with SCD with normative expectations, test whether demographic and medical factors are associated with fine motor performance, and determine the impact of fine motor performance on academic performance. Design: Cross-sectional. Setting: St. Jude Children's Research Hospital. Participants: Individuals with SCD (N = 376; ages 8–24 yr). Outcomes and Measures: Fine motor outcomes included visual–motor integration, manual dexterity, and graphomotor speed. Academic outcomes included math fluency and word reading. Demographic and medical variables were obtained via medical records and interviews. Results: Compared with normative expectations, the performance of individuals with SCD on all fine motor measures was lower than expected. Male sex, lower socioeconomic status, and lower oxygen saturation was associated with slower graphomotor speed. Lower socioeconomic status and older age were associated with lower visual–motor integration scores. Performance on all fine motor measures was positively associated with math fluency and word reading. Conclusions and Relevance: Individuals with SCD exhibited poorer than expected fine motor skills across multiple motor domains, and these deficits were associated with poorer academic outcomes. Early referral to intervention services for fine motor skills may facilitate improved academic outcomes for individuals with SCD. Plain-Language Summary: This study had three objectives: (1) Compare the fine motor skills of people with sickle cell disease (SCD) with normative expectations, (2) test whether demographic and medical factors are associated with fine motor performance, and (3) determine the impact of fine motor performance on academic performance. We found that SCD is a risk factor for lower than expected fine motor performance across multiple fine motor domains and that these deficits also affect functional academic skills. The study found that sickle cell disease is a risk factor for lower than expected fine motor performance across multiple domains and that these deficits also affect functional academic skills. [ABSTRACT FROM AUTHOR]

Background: Hypertensive patients with high-risk comorbidities require medications for each condition, leading to greater burden. The number of chronic conditions can affect patients' concurrent medication adherence. Objective: We aimed to compare the characteristics of groups based on their concurrent medication adherence and investigate the association between the number of high-risk comorbidities and concurrent medication adherence for patients with hypertension and high-risk comorbidities. Methods: A secondary data analysis was performed with the 2018 Korea Health Panel Survey, including 2230 patients with hypertension and at least 1 high-risk comorbidity who were prescribed medications for at least 2 conditions. Using medication adherence for each condition, we identified 3 concurrent medication adherence groups: adherent, suboptimal, and nonadherent groups. Multinominal logistic regression was used to determine the association between the number of high-risk comorbidities and the concurrent medication adherence groups. Results: Adherent, suboptimal, and nonadherent groups included 85%, 11%, and 4% of the patients, respectively. Whereas having more high-risk comorbidities was associated with belonging to the suboptimal group compared with the adherent group (adjusted odds ratio, 1.46), having fewer high-risk comorbidities was associated with belonging to the nonadherent group compared with the adherent group (adjusted odds ratio, 0.52). Conclusions: We identified 3 groups based on their concurrent medication adherence. Our results indicated that the relationship of the number of high-risk comorbidities with the concurrent medication adherence group was inconsistent. [ABSTRACT FROM AUTHOR]

Background: Limited knowledge exists regarding patients' denial of myocardial infarction (MI) before hospitalization for an MI. Objective: The aim of this study was to determine the prevalence and correlates of denial of MI in the prehospital phase of a confirmed MI. Methods: This secondary analysis included 166 hospitalized patients (mean [SD] age, 54.1 [10.5] years) who developed MI outside a healthcare facility and had high congruence between their experienced and expected symptoms. Measurements included the Denial subscale of the Brief COPE Inventory, the modified Response to Symptoms Questionnaire, and a Likert scale measuring perceived risk for MI. Patients who arrived at a hospital at least 1 hour after the onset of their symptoms were considered to have prolonged prehospital delay. Results: Despite their high symptom congruence, 77% of patients denied the possibility of having an MI before hospitalization. The lower denial group was characterized by cardiac history, whereas the higher denial group was distinguished by nonsmoking, a lower perceived risk of MI, less anxiety at symptom onset, and more concerns about seeking medical help. Compared with the lower denial group, patients in the higher denial group were more likely to underestimate the seriousness of their symptoms and delay seeking medical help. The higher denial group responded to symptoms in a more passive manner (eg, waiting), whereas the lower denial group showed a more problem-solving approach (eg, contacting emergency services). Conclusions: Denial of MI is highly prevalent in the prehospital phase and is negatively linked with cognitive, emotional, and behavioral responses to MI symptoms. [ABSTRACT FROM AUTHOR]

Most research focuses around impairments in body function and structure, with relatively only a small number exploring their social impact. 1) compare characteristics for individuals who before stroke were blue collar vs. white collar workers 2) identify clinical, functional, and job-related factors associated with return to work within 1 year after discharge 3) identify specific ADL individual items (assessed at rehabilitation discharge) as return to work predictors and 4) identify return to work causal mediators. Retrospective observational cohort study, analyzing adult patients with stroke admitted to rehabilitation between 2007 and 2021, including baseline Barthel Index (BI) and return to work assessments between 2008 and 2022. Kaplan–Meier survival curves and Cox proportional hazards were applied. Causal mediation analyses using 1000-bootstrapped simulations were performed. A total of 802 individuals were included (14.6% returned to work), 53.6% blue-collar and 46.4% white-collar. Blue-collar workers showed significantly higher proportion of ischemic stroke, diabetes, dyslipidemia, and hypertension. Individuals not returning to work presented a higher proportion of blue collar, dominant side affected, aphasia, lower BI scores, and larger length of stay (LOS). Multivariable Cox proportional hazards identified age at injury, aphasia, hypertension, and total discharge BI score (C-Index = 0.74). Univariable Cox models identified three independent BI items at all levels of independence: bathing (C-Index = 0.58), grooming (C-Index = 0.56) and feeding (C-Index = 0.59). BI efficiency (gain/LOS) was a causal mediator. Blue collar workers showed higher proportion of risk factors and comorbidities. Novel factors, predictors, and a return to work mediator were identified. [ABSTRACT FROM AUTHOR]

Background: Maternal height has been for long a contributory anthropometric factor that can determine the obstetric outcome. There is always a need of a consistent, reliable, and simple risk indicator which is easy to use for preventing unnecessary complications in a country like India where often antenatal care is provided by dais in rural areas. The background of this research aims to ascertain the relationship between maternal height and mode of delivery based on other intrapartum factors which influence labor and consequent maternal and neonatal outcome. Materials and Methods: All primigravidae at term gestation (>37 weeks) with cephalic presentation on admission to labor suite with no other comorbidities were recruited in the study. Their mode of delivery, maternal outcome, along with neonatal outcome was documented. Results: Out of the 680 patients, 104 patients are considered for the short-stature group (15.29%) who were <150 cm in height. Other group comprised patients who were >150 cm in height, a total of 576 (84.71%). There was a higher incidence of induced labor in the study group (66.35%) and emergency lower-segment cesarean section done due to cephalopelvic disproportion (CPD) (60%) was also higher among the short-stature group. The incidence of normal labor (32.99%) was higher in the tall-stature group. Conclusion: Short height (<150 cm) is an independent risk factor for cesarean delivery due to CPD. Statistical correlation was found between mothers of short stature and babies being born with low birth weight. As labor is influenced by multiple factors, it is fair enough to give a trial of labor for short primigravidae except in uncommon circumstances. [ABSTRACT FROM AUTHOR]

Background: Biomaterials and surgical techniques for reconstructive tympanic membrane surgery are under development. Objectives: The objective of this study is to analyze the functional and surgical outcomes of a novel fascia with cartilage reinforcement technique for anterior tympanic membrane perforation in tympanoplasty. Methods: Records of 198 patients with anterior tympanic membrane perforation who underwent tympanoplasty between August 2018 and March 2021 were prospectively reviewed. Patients with dry anterior quadrant perforations of the tympanic membrane were included and underwent tympanoplasty using two methods: Type 1 tympanoplasty with temporalis fascia only, and tympanoplasty with fascia and cartilage reinforcement. Postoperative functional and surgical outcomes were analyzed. Results: Comparing the pre-operative and post-operative air conduction levels and air-bone gaps showed significant improvement in both groups (P < 0.001). Additionally, no significant difference was observed between air-bone gap closure (P = 0.316) and increase in air conduction levels (P = 0.222) according to graft type. Conclusions: Both temporalis muscle fascia and temporalis muscle fascia with cartilage reinforcement revealed satisfactory functional and surgical outcomes. Furthermore, the novel combined cartilage-fascia technique had a comparable graft take rate and hearing results in anterior perforations, with no significant change in tympanic membrane vibratory properties. [ABSTRACT FROM AUTHOR]

Background: Keratinocyte carcinoma (KC) is a common malignancy characterized by a high recurrence rate and considerable psychological distress. The incidence of KC is increasing in China, raising concerns about its psychological consequences and adverse effects on quality of life. Demographic and clinical factors are thought to influence mental health outcomes in these patients. Nonetheless, data on the prevalence of anxiety in Chinese patients with KC and the factors associated with this anxiety are notably lacking. Therefore, a comprehensive investigation into the anxiety of patients with KC is imperative. Objective: This study aimed to investigate the prevalence of anxiety in patients with KC, a disease that can significantly affect a patient's appearance and overall quality of life. Understanding the level of anxiety in this population is critical to developing targeted interventions, improving treatment outcomes, supporting mental health, and improving patient care practices. Methods: This cross-sectional study was conducted at China's largest dermatology hospital from November 2017 to September 2022. A consecutive sampling method was used to recruit participants. Anxiety status was surveyed by the Self-rating Anxiety Scale (SAS). Explanatory variables were surveyed by demographic data questionnaires. Non-parametric test and Chi-square test analyses were used to compare the differences between groups. Multiple linear regression analysis was performed to identify factors associated with anxiety. Results: A total of 192 patients with KC were included. The median score of SAS was 35 (IQR 16.25). The prevalence of anxiety in patients with KC was 20.8%. Females (p = 0.008), under 60 years old (p = 0.011), living in rural (p = 0.010) or urban areas (p = 0.029), having fewer than three children (p = 0.016), with a history of skin diseases (p < 0.001), with a history of long-term oral medication (p = 0.001), and experiencing pain or itching (p = 0.001) had SAS scores that were significantly higher than their counterparts. Conclusion: This study showed that the prevalence of anxiety was very high among Chinese patients with KC, especially among women, young patients, rural residents, patients with fewer than three children, and individuals with a history of skin disease, long-term oral medications, or symptoms of pain or itching. Targeted psychological interventions for these specific populations should be implemented to effectively alleviate anxiety and improve quality of life in these at-risk groups. [ABSTRACT FROM AUTHOR]

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: While absenteeism refers to not attending work, presenteeism is defined as not being present at work. These two conditions, which negatively affect employee health, can be indicators of work efficiency, work peace, work safety and work engagement. OBJECTIVE: Several factors were evaluated in this study concerning absenteeism and presenteeism among factory workers. METHODS: This cross-sectional study was conducted among workers in a factory operating in a heavy industry in southern Turkey in 2021. A survey consisting of 57 questions was applied to 152 factory workers by face-to-face interview method. The participants' behaviour over the last month was evaluated regarding absenteeism and presenteeism. RESULTS: It was reported that 24 (15.8%) of all employees were absent from work in the last month (absenteeism), excluding holidays and sick leave, and that 20 (13.2%) employees engaged in presenteeism, working when they should not have been at the workplace. There was a high absenteeism rate among employees who had an acute illness and were dissatisfied with their jobs. Several factors have been associated with presenteeism, including poor economic conditions, family health problems, previous unemployment, working overtime, job dissatisfaction, poor relationships with colleagues and difficulty finding a replacement, acute illness, sleep problems and fatigue. CONCLUSIONS: To increase the productivity and commitment of employees, it may be useful to identify the reasons for absenteeism and present behaviours, to facilitate effective interpersonal communication skills by examining the organisational climate of employees, and to regulate workload based on a comprehensive assessment of the health status of employees. [ABSTRACT FROM AUTHOR]

Myasthenia gravis (MG) patients often require long-term glucocorticoid therapy, which may affect bone health. This study aimed to assess long-term changes in bone mineral density (BMD), evaluate osteoporotic fracture incidence, and examine the relationship between MG-specific factors and bone health outcomes over a 10-year period. This single-center, prospective cohort study included 28 MG patients. BMD, T-scores, Z-scores, and bone turnover markers were measured at baseline. FRAX® scores were calculated and adjusted for glucocorticoid dose. Fracture occurrence was monitored for over 10 years. Five (17.9%) patients experienced major osteoporotic fractures during follow-up. The fracture group had significantly lower baseline BMD and T-scores than the no-fracture group. Baseline FRAX® scores for major osteoporotic fracture risk were significantly higher in the fracture group (median 19.0% vs. 5.7%, p = 0.001). The fracture group progressed from osteopenia at baseline to osteoporosis by the end of this study. This study highlights the importance of early and regular bone health assessments in MG patients, particularly those receiving long-term glucocorticoid therapy. The FRAX® tool may be valuable for fracture risk stratification in this population. These findings can inform clinical practice and improve long-term management strategies for MG patients who are at risk of osteoporotic fractures. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a life-changing event that often results in chronic physical damage and challenges in maintaining a good quality of life as it affects every aspect of life. These situations require adjustment, increasing vulnerability to psychological disorders. The objective of this study was to evaluate the impact of SCI on psychological morbidity in individuals with subacute and chronic SCI. The present investigation was designed to determine the presence and extent of psychological complications following SCI. We used two reliable questionnaires and validated psychological assessments to study depression (BDI) and anxiety (STAI), a broad range of factors derived from SCI that may be predictors of certain psychological problems. The psychological assessment revealed alterations in depression and anxiety, although the data do not exceed those of previous investigations. No clear predisposing factors leading to certain psychological pathologies were found. In addition, individuals in the subacute and chronic stages differed in their scores. In individuals with SCI, identifying predictors of psychological problems is difficult, but premature assessment of mental state is essential. This early diagnosis of possible problems or changes at the mental level is fundamental and necessary to avoid possible alterations at the cognitive level and, of course, more serious mental complications. [ABSTRACT FROM AUTHOR]

Background: Lateral and medial elbow tendinopathies are common soft tissue disorders affecting 1–3% of the general population, causing significant pain and functional impairment in the elbow and upper limb. While often associated with overuse and repetitive strain, their exact etiology, including potential associations with prior injuries in adjacent joints, remains unclear. This preliminary study aims to explore the distribution of lateral and medial elbow tendinopathies and investigate the occurrence of previous lesions in adjacent joints among diagnosed individuals, providing foundational insights for future research. Methods: A multicenter cross-sectional observational study was conducted involving 90 subjects diagnosed with lateral and/or medial elbow tendinopathy. The data collection occurred during the initial consultations, including demographic information, clinical assessments, and history of prior injuries in adjacent joints. Results: Among the sample, 44.4% reported prior injuries to adjacent joints in the affected upper limb, with 45.6% of these injuries identified as musculotendinous in nature. The analysis also showed that the type of elbow tendinopathy was significantly associated with sex (p = 0.01) and occupational origin (p = 0.022). Conclusions: While a notable percentage of the subjects reported prior musculoskeletal injuries in the same limb, the study's geographic limitations and reliance on self-reported data introduce potential recall bias. These preliminary findings suggest a possible relationship between prior adjacent joint injuries and elbow tendinopathy. Further research with larger sample sizes and more rigorous study design is needed to confirm these observations and explore the underlying mechanisms. [ABSTRACT FROM AUTHOR]

The highest prevalence of cardiovascular risk factors has been associated with obesity, sedentary lifestyle, and elevated blood pressure due to high workload and work stress. This study aimed to analyze the cardiometabolic risk and lifestyles among the health sciences university academics and campus administrators at a private university in Spain. A cross-sectional study was conducted during the 2018–2019 academic year by the Nursing Department, using a self-administered questionnaire and face-to-face assessments of anthropometric variables related to cardiovascular risk in university personnel. The variables measured included sociodemographics, cardiovascular risk history, comorbidities, toxic habits, Mediterranean diet adherence, physical exercise, psychosocial stress, and physical, anthropometric, and analytical data. Cardiovascular risk was categorized into relative (<40 years), absolute, and vascular age (>40 years). Among the 101 participants, 61.4% were women, with a mean age of 41.3 years ± 9 years. The smoking prevalence was 21.8% (68.2% women), 27.7% were sedentary, and 51.0% adhered to the Mediterranean diet, with higher adherence among the academics. Emotional risk was present in 32.7% of the participants. A prior diagnosis of hypertension was significantly more frequent in the men (15.4%) compared to the women (3.2%). The blood pressure measurements were mostly optimal across both genders and professional groups, but the proportion of hypertension grade 1 was significantly higher among the academics (10%) compared to the administrators (4.5%) and among the men (11.1%) compared to the women (5.9%). The absolute cardiovascular risk among the university employees was generally low, but the men exhibited a more moderate risk compared to the women. It is necessary for the university to promote health within its community, with the Nursing Department playing a key role in health promotion and research. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is the gold standard in infant nutrition. Successful breastfeeding depends on many factors, including the help of medical personnel in teaching breastfeeding, the need for professional work, and breastfeeding-friendly places in public spaces. The main goal was to identify various barriers among mothers to breastfeeding. Methods: This study used a quantitative descriptive research design. We recruited 419 mothers aged at least 18 years old through social media. Results were analysed using Pearson's chi-squared and Fisher's tests of independence for pairs of dependent and independent variables. Results: Most often, women gave birth at the age of 25–30, had one or two children, and attended higher education. Almost half of them lived in a large city and gave birth to a child by caesarean section. A total of 83.1% of mothers planned to breastfeed, but not all of them were able to do so for various reasons. One-third of them felt sorry for themselves that they had to change their feeding method. The majority of mothers did not receive sufficient help in the hospital in terms of learning how to breastfeed (61%), did not use the help of a lactation consultant (67%), and answered that there was no lactation consultant in their place of residence (65%). Only 43.2% of mothers returned to work without ceasing breastfeeding. A total of 42% of mothers experienced feelings of embarrassment when breastfeeding in a public place. The most frequently indicated barrier to breastfeeding in a public place was the lack of a suitable location where a woman would feel comfortable, calm, and intimate. Conclusion: There are various barriers towards breastfeeding: too few lactation consultants, problems with breastfeeding when the mother wants to return to work, and unfriendly places for breastfeeding in public spaces. Efforts must be made to support mothers in breastfeeding. [ABSTRACT FROM AUTHOR]

Cholesteatoma is a benign tumor of the middle ear. Tympanoplasty is performed to remove cholesteatoma, prevent recurrence, and avoid complications. Previously, microscopy was used for tympanoplasty; however, endoscopy has become increasingly popular for this procedure. The effectiveness of endoscopy and the appropriate candidacy for endoscopic ear surgery remain controversial. In this retrospective chart review study, we enrolled 107 patients with cholesteatoma who underwent tympanoplasty and compared the microscopic approach (71 patients) and the endoscopic approach (36 patients) at different stages to clarify the benefits of using endoscopy and to determine candidacy for endoscopic ear surgery. Approach selection, complication rate, recurrence rate, and postoperative hearing threshold were compared between microscopic and endoscopic approaches in stages I, II, and III. Endoscopy was used more often than microscopy for early-stage (stage I) cholesteatoma (p = 0.005) and less frequently for advanced-stage (stage II) cholesteatoma (p = 0.02). Endoscopy surgery resulted in chorda tympani injury less often than microscopic surgery (p = 0.049); however, there were no significant differences between these two groups in terms of recurrence rate or postoperative hearing outcome. Endoscopy is particularly useful for early-stage cholesteatoma, and both approaches show no difference in hearing outcome in stage I and II; nevertheless, further research is required to determine an appropriate approach for more advanced stages (stage III). [ABSTRACT FROM AUTHOR]

Men who have sex with men are at an increased risk of acquiring sexually transmitted infections, and although behavioral and contextual interventions have improved, infections continue to spread. Therefore, a new focus on recent trends in sexual health in this population is needed. The aim of this study was to describe the relationship between sociodemographic and behavioral characteristics according to Grindr usage patterns, the prevalence of sexually transmitted infections (STIs), and attitudes toward HIV testing. In January 2020, a cross-sectional study was conducted using a sample of 881 men who have sex with men (MSM) who completed an online questionnaire. We evaluated their Grindr use patterns (moderate or intensive) and explored the associations of these with sociodemographic behavioral characteristics, STIs, and attitudes toward HIV testing. Of 881 participants in total, 587 (66.6%) were intensive Grindr users. Compared to moderate users, these participants reported significantly higher numbers of casual sexual partners (76.2% vs. 23.8%; p < 0.001), were more likely to participate in Chemsex (77.3% vs. 22.7%: p = 0.031), and had a higher self-reported number of STIs (69.9% vs. 30.1; p = 0.046). They also demonstrated better attitudes toward HIV testing (69.7% vs. 30.3%; p = 0.045) and perceived themselves to be at moderate risk of HIV (71.2% vs. 28.8%: p = 0.048). Moreover, intensive Grindr users were 1.36 times more likely than moderate users to test positive for STIs (95%CI = 1.15–1.91; p = 0.048). With some limitations, age, sexual partners, intensive Grindr users, and PrEP uses were associated with the risk of STIs in the sample of Spanish Grindr users studied. As Grindr users are vulnerable to sociodemographic and behavioral factors that determine STIs and HIV infection, mainly among intensive users, it is necessary to highlight the importance of new trends such as online dating apps, PrEP use, substance use in sex, and Chemsex, and these need to be incorporated into online public health strategies. [ABSTRACT FROM AUTHOR]

Background: Preparing healthcare systems for emergencies is crucial to maintaining healthcare quality. Nursing homes (NHs) require tailored emergency plans. This article aims to develop a typology of French private NHs and study their early COVID-19 responses and mortality outcomes. Methods: We conducted a cross-sectional survey among NHs of a French network consisting of 290 facilities during the first wave of the COVID-19 pandemic. A Hierarchical Clustering on Principal Components (HCPC) was conducted to develop the typology of the NHs. Association tests were used to analyze the relationships between the typology, prevention and control measures, COVID-19 mortality, and the satisfaction of hospitalization requests. Results: The 290 NHs vary in size, services, and location characteristics. The HCPC identified three clusters: large urban NHs with low levels of primary care (Cluster 1), small rural NHs (Cluster 2), and medium urban NHs with high levels of primary care (Cluster 3). The COVID-19 outcomes and response measures differed by cluster, with Clusters 1 and 2 experiencing higher mortality rates. Nearly all the NHs implemented preventive measures, but the timing and extent varied. Conclusions: This typology could help in better preparing NHs for future health emergencies, allowing for targeted resource allocation and tailored adaptations. It underscores the importance of primary care territorial structuring in managing health crises. [ABSTRACT FROM AUTHOR]

(1) Background: During and after the pandemic, individuals with type 1 and type 2 diabetes struggled to maintain a healthy lifestyle due to psychological distress and the struggle to accommodate contextual challenges and changes in their family and work obligations and expectations. This study aims to explore the long-term impacts of the pandemic on proactive self-management behaviors and outcomes that consider contextual and environmental factors, such as family and work dynamics. (2) Methods: In this mixed-method study, data were collected from 418 participants using the Hospital Anxiety and Depression Scale (HADS) and the Insomnia Severity Index (ISI), followed by 16 individual interviews. (3) Results: The prevalence of depression was 37.1%, that of anxiety was 59.1%, and that of insomnia was 66.3%. Significant differences were observed in anxiety by age (p = 0.02), while individuals with other comorbidities were more likely to report insomnia (p = 0.3). Overall, various challenges during the pandemic have exacerbated emotional distress and complicated self-care routines and adherence to healthy lifestyles. (5) Conclusions: The COVID-19 pandemic has prompted individuals with type 1 and 2 diabetes to adopt alternative health-management methods, such as self-care, proactive initiatives, and daily challenges. Enhancing proactiveness, awareness, and an understanding of individuals' needs is crucial for alleviating stress, controlling disease, and preparing for potential future health crises in the wake of the pandemic's long-term effects. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify the demographic-, radiographic-, and surgery-related factors influencing postoperative functional internal rotation (fIR) following reverse total shoulder arthroplasty (RTSA). Methods: In this retrospective cohort study, patients who underwent RTSA between June 2013 and April 2018 at a single institution were assigned to two groups ("IROgood" or "IRObad"). Patients were classified as having good fIR (≥8 points in the Constant–Murley score (CS) and fIR to the twelfth thoracic vertebra or higher) or poor fIR (≤2 points in the CS and fIR to the twelfth thoracic vertebra or lower) after RTSA with a single implant model. The minimum follow-up period was two years. Standardized shoulder-specific scores (Visual Analogue Scale (VAS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Score (ASES), Constant–Murley score (CS)) were used to assess the pre- and postoperative functional status of patients. Postoperative radiographic evaluation included the distalization shoulder angle (DSA), lateralization shoulder angle (LSA), critical shoulder angle (CSA), acromiohumeral distance (AHD), glenoid inclination (GI), medialization of the center of rotation (COR), lateralization of the humerus, and distalization of the greater tuberosity. Additionally, preoperative evaluation included rotator cuff arthropathy according to Hamada, glenoid version, anterior or posterior humeral head subluxation, and fatty infiltration of the rotator cuff according to Goutallier. Univariate analysis of demographic, surgical, radiographic, and implant-associated parameters was performed to identify factors associated with postoperative fIR. The Shapiro–Wilk test assessed the normal distribution of the data. Intergroup comparisons regarding demographic and surgery-related factors were conducted using the Mann–Whitney-U Test. Radiographic changes were compared using chi-square or Fisher's exact tests. The significance level was set at p < 0.05. Results: Of a total of 42 patients, 17 (age: 73.7 ± 5.0 years, follow-up (FU) 38 months [IQR 29.5–57.5]) were included in the "IRObad" group, and 25 (age: 72 ± 6.1 years, FU 47 months [IQR 30.5–65.5]) were included in the "IROgood" group. All patients were treated with the same type of implant (glenosphere size: 36 mm, 14.3%; 39 mm, 38.1%; 42 mm, 47.6%; neck-shaft angle: 135° in 68.0%; 155° in 32.0%) and had comparable indications. Univariate analysis did not reveal any of the investigated demographic, radiographic, or surgery-related parameters as risk factors for poor postoperative fIR (p > 0.05). Conclusion: None of the investigated factors, including implant-associated parameters, influenced postoperative fIR after RTSA in this cohort. [ABSTRACT FROM AUTHOR]

Introduction: In addition to key interventions, including bystander CPR and defibrillation, successful resuscitation of out-of-hospital cardiac arrest (OHCA) is also associated with several patient-level factors, including a shockable presenting rhythm, younger age, Caucasian race and female sex. An additional patient-level factor that may influence outcomes is patient weight, yet this attribute has not been extensively studied within the context of OHCA, despite globally increasing obesity rates. Objective: To assess the relationship between patient weight and return of spontaneous circulation (ROSC) during OHCA. Methods: This retrospective study included adult patients from a national emergency medical services (EMS) patient record, with witnessed, non-traumatic OHCA prior to EMS arrival from January to December 2020. Logistic regression was used to evaluate the relationship between patient weight and ROSC. Results: Complete records were available for 9096 patients, of which 64.3% were males and 25.3% were ethnic minorities. The mean age of the participants was 65.01 years (SD = 15.8), with a mean weight of 93.52 kg (SD = 31.5). Altogether, 81.8% of arrests were of presumed cardiac aetiology and 30.3% presented with a shockable rhythm. Bystander CPR and automated external defibrillator (AED) shock were performed in 30.6% and 7.3% of cases, respectively, and 44.0% experienced ROSC. ROSC was less likely with patient weight >100 kg (OR = 0.709, p <0.001), male sex (OR = 0.782, p <0.001), and increasing age and EMS response time (OR = 0.994 per year, p <0.001 and OR = 0.970 per minute, p <0.001, respectively). Patients with shockable rhythms were more likely to achieve ROSC (OR = 1.790, p <0.001), as were patients receiving bystander CPR (OR = 1.170, p <0.001) and defibrillation prior to EMS arrival (OR = 1.658, p <0.001). Although the mean first adrenaline dose (mg/kg) followed a downward trend due to its non-weight-based dosing scheme, the mean total adrenaline dose administered to achieve ROSC demonstrated an upward linear trend of 0.05 mg for every 5 kg of body weight. Conclusions: Patient weight was negatively associated with ROSC and positively associated with the total adrenaline dose required to attain ROSC. [ABSTRACT FROM AUTHOR]

BACKGROUND: The use of ureteral access sheaths (UAS), which offer advantages in flexible ureteroscopic lithotripsy (fURL), may lead to undesirable conditions such as ureteral injury, ischemia, and prolonged ureteral stenosis. The aim of this study was to investigate the effect of the distal ureteral lateralization angle on successful UAS placement. METHODS: We analyzed the data of patients who underwent fURL for kidney and/or proximal ureteral stones retrospectively. Based on the preoperative computed tomographic examinations of the patients, the bladder outlet was considered the zero point. We calculated the angle values between the horizontal axis passing through this point and the most lateralized point of the distal ureter. The patients were divided into two groups: those to whom UAS was successfully placed and those to whom UAS placement failed. RESULTS: No significant difference was detected between the groups with successful UAS placement (n=36) and those without UAS placement (n=12) in terms of sex, laterality, localization, number of stones, stone burden, and bladder volumes evaluated with preoperative computed tomography (p>0.05). However, a significant difference was found between the two groups regarding age and distal ureteral lateralization angle (p<0.001, p=0.013). CONCLUSION: The distal ureteral lateralization angle is considered to be an effective factor in the placement of UAS in patients scheduled for fURS. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Modified Early Obstetric Warning System (MEOWS) is a score-based or color-coded system that detects changes in physiological parameters and enables earlier diagnosis and care of worsening obstetric patients. The aim of this study is to evaluate the tool's performance and contribute to its use in Türkiye by translating MEOWS into Turkish. METHODS: This prospective and descriptive study, approved by the local ethics committee, included 350 obstetric in-patients who gave birth at Samsun Training and Research Hospital, Gynecology and Children's Hospital between April and August 2022. The study involved patients with a gestational week greater than 28 weeks and up to six weeks postpartum. RESULTS: The average age of the patients was 28.9±5.9 (18-40) years, with trigger values occurring in 34.6% (n=121) and morbidity occurring in 30.9% (n=108) of the cases. The most common trigger among the individual physiological indicators was high systolic blood pressure (28.3%). When the performance of MEOWS was evaluated, a statistically significant correlation was found between trigger and morbidity (Kappa=0.605; p<0.001). The sensitivity of MEOWS in estimating morbidity was 77.78% (95% confidence interval [CI]: 68.76-85.21%), specificity was 84.71% (95% CI: 79.55-89.00%), Positive Predictive Value (PPV) was 69.42% (95% CI: 62.40-75.64%), Negative Predictive Value (NPV) was 89.52% (95% CI: 85.67-92.43%), and accuracy was 82.57% (95% CI: 78.18-86.40%). CONCLUSION: MEOWS was found to be an effective screening tool for predicting morbidity in this study and performs well in Turkish with sufficient sensitivity, specificity, and accuracy. However, the inclusion of long-term results would provide a more comprehensive understanding of the effectiveness of MEOWS. [ABSTRACT FROM AUTHOR]

Background & Objective: Endometrial carcinoma (EC) is one of the most common cancers and the fourth most common cancer affecting females, mostly affecting postmenopausal women. EC originates from the endometrium and is further subdivided into two types that are estrogen dependent; type 1 and type 2 with different gene expression patterns. Materials & Methods: This research was carried out between December 2021 and August 2022 in the Laboratories of the College of Science/Department of Biology and the other local lab and PCR was employed to establish HOXA11 presence. The aims of the study were to reveal the histological alterations in malignant and benign tumors and normal endometrium and to examine the relationship between HOXA11 levels and clinicopathological parameters including stage, grade, muscle and lymph node invasion, and histological type. Results: The mean HOXA11 expression values were compared in cancer, benign, and control endometrial patients' groups. The mean HOXA11 expression level was the lowest in endometrial cancer patients; they had a mean of 0. 24±0. 03, those with benign endometrial tumors had the second lowest with a mean of 0. 94±0. 06, while the control patients had the highest mean expression with 1. 00±0. 07. The comparison of the HOXA11 expression between the endometrial cancer patients and the control group showed a statistically significant difference (P-value >0. 001), thus underlining its diagnostic value. Also, there was a significant difference in the HOXA11 expression means between patients with benign tumors and control patients (P-value = 0. 021). As for HOXA11, the mean expression was relatively lower in the patients with benign endometrial tumors, 0. 94±0. 06 as compared to the control group 1. 00±0. 07. In addition, the mean HOXA11 expression in endometrial cancer patients was 0. 24±0. 03 which was significantly (P-value >0. 001) less than that in benign endometrial tumor patients. Conclusion: These results stress the importance of HOXA11 expression as a diagnostic marker and its possible application in differential diagnosis between endometrial cancer and benign neoplasms and normal tissues. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy and safety of Sanjie Analgesic Capsule (SAC) in Chinese patients with endometriosis-associated pain. Methods: This was a multicenter, randomized, double-blind, placebo-controlled trial conducted at 15 centers between November 2013 and July 2017 in China. Eligible 323 patients with endometriosis were randomized at a 3:1 ratio to the SAC group (241 cases) and placebo group (82 cases) by stratified block randomization. Patients in the SAC or placebo groups were given SAC or placebo 1.6 g 3 times per day, orally, respectively since the first day of menstruation for 3 consecutive menstrual cycles. The primary endpoint was clinical response to dysmenorrhea evaluated using a 10-point Visual Analogue Scale at 3 and 6 months. The secondary endpoint was the pain score evaluated by VAS (chronic pelvic pain, defecation pain, and dyspareunia) at 3 and 6 months, and the pain recurrence rate at 6 months. Adverse events (AEs) were recorded during the study. Results: A total of 241 women were included in the SAC group, and 82 were in the placebo group. Among these women, 217 (90.0%) and 71 (86.6%) completed the intervention, respectively. At 3 months, overall response rate (ORR) was significantly higher in women administered SAC (80.1%) compared with those who received a placebo (30.5%, P<0.01). Six months after treatment, the ORR for dysmenorrhea was 62.7% in the SAC group and 31.7% in the placebo group (P<0.01). Chronic pelvic pain and defecation pain were significantly improved by SAC compared with placebo (both P<0.05). The incidence rates of total AEs events in the SAC and placebo groups were 6.6% and 9.8%, respectively, and no significant difference was shown between the two groups (P=0.339). Conclusion: SAC is well-tolerated and may improve dysmenorrhea in women with endometriosis-associated pain. (Trial registration: ClinicalTrials.gov, No. NCT02031523) [ABSTRACT FROM AUTHOR]