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Objective: To present the contemporary evidence on transvaginal urogenital fistulae (UGF) repair with Martius fat pad (MFP), compared to direct graftless fistula repair. Methods: We reviewed all available studies reporting lower UGF repair via the transvaginal approach in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). The primary outcome of interest was the fistula closure rates. When available, patients' baseline characteristics, indications for surgery, and early and late postoperative complications with focus on MFP‐related complications are reported. Results and Discussion: In obstetric fistulae, tissue interposition has been almost completely abandoned, with contemporary large series reporting closure rates of >90% with graftless repair, even for complex fistulae. Similarly, most simple, non‐irradiated iatrogenic fistulae can be closed safely without or with tissue interposition with success rates ranging between 86% and 100%. However, MFP is valuable in fistulae with difficulty achieving tension‐free and layered closure, with significant tissue loss, urethral involvement and with poorly vascularised tissues after radiotherapy, with reported success rates between 80% and 97% in those challenging situations. Conclusion: A UGF repair should be individualised after considering the specific characteristics and complexity of the procedure. MFP interposition is probably unnecessary for the majority of low (obstetric) fistulae within otherwise healthy tissues. However, MFP may still have a place to maximise outcomes in low‐income settings, in select cases with higher (iatrogenic) fistulae, and in most cases with radiotherapy. [ABSTRACT FROM AUTHOR]

Background Intracranial vascular injury (VI) due to surgery is a critical complication that can lead to serious neurologic deficits. To our knowledge, only a few review articles on VI during an operation have been published so far. We retrospectively investigated the type, cause, and measurement of VI during surgery at our institution. Methods Unexpected VI cases occurred in 18 of 2,228 craniotomy procedures, including 794 aneurysm clippings and 357 tumor resections. We investigated the causes and coping techniques of the VI cases, as well as their full details. Results There were six cases of aneurysm neck tear, one case of sylvian vein injury, and one case of superior trunk perforation during direct clipping. Regarding tumor resection procedures, nine cases of arterial injury and one case of cortical vein injury were extracted. Almost all VIs were caused by carelessness or basic manipulation mistakes. We repaired all these cases with simple placement of suture threads with or without pinch clips, flow alteration using bypass techniques, and in 16 cases no neurologic deficit or deterioration on imaging occurred; however, 3 patients were verified to have ischemic changes on postoperative imaging. Conclusions Most VIs were directly caused by a simple error and carelessness of an operator or an assistant. Many of these injuries can be avoided if a basic set of rules are followed and remembered during the surgical procedure. However, the surgical procedure involves human work, and errors cannot be eradicated even upon maximum concentration levels. Neurosurgeons should be prepared for an eventual quick repair of an unexpected cerebral VI. [ABSTRACT FROM AUTHOR]

Ecological momentary assessment (EMA) can be used to examine the dynamics of suicidal ideation in daily life. While the general acceptability and feasibility of EMA in suicide research has been established, further examination of potential iatrogenic effects (i.e., negative reactivity) and identifying those more likely to react negatively is needed. Participants (N = 82) with current suicidal ideation completed 21 days of EMA (4×/day) and filled in M = 78% (Med = 84%) of the EMA. No positive or negative affect reactivity was observed in EMA ratings over the study period. Retrospectively, most participants rated their experience as positive (69%); 22% indicated mood worsening, and 18% suicidal ideation reactivity. Those with more borderline personality traits, posttraumatic stress disorder (PTSD), and higher depressive, anxiety, and suicidal ideation symptoms, were more likely to report iatrogenic effects. In conclusion, while high compliance rates and lack of affect reactivity during EMA indicate that EMA is well tolerated in suicide research, a minority of participants may report subjective mood effects in retrospect. [ABSTRACT FROM AUTHOR]

This study's objective is to discuss hypnogenesis parting from one of Erickson's chronic pain cases, analyzing hypnogenesis involvement in iatrogenesis and in the therapeutic interventions. Hypnogenesis is a concept for how clinical relationships tend to reproduce the ideas and theories of the therapist in the subject's subjectivity. In hypnotherapy, hypnogenesis is implicated in the relational nature of the hypnotic experience, addressing the difficulty in separation between fabricated and revealed realities. A case of trigeminal neuralgia is analyzed and discussed to illustrate the implications of hypnogenesis in iatrogenesis and its therapeutic potential for chronic patients. The study draws a theoretical possibility on how hypnogenesis highlights iatrogenesis by the neglect of the subject's needs in clinical consultations. Then, the study demonstrates how Erickson uses hypnogenesis in the patient's therapy, favoring her well-being. To approach hypnogenic communicational processes, Charles Peirce's concept of habit and is utilized as a complex system of subjective processes. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this therapeutic update is to provide pharmacists with a general overview of the pathophysiology of hyperchloremia and describe strategies to help prevent development of this electrolyte abnormality in hospitalized patients. Summary Hyperchloremia is an electrolyte abnormality associated with an increased incidence of acute kidney injury and metabolic acidosis. Intravenous (IV) fluids utilized for volume resuscitation, medication diluents, and total parental nutrition all may contribute to the development of hyperchloremia. Current evidence suggests that administration of balanced crystalloids for either fluid resuscitation or maintenance fluids may impact serum chloride levels and patient outcomes. In multiple randomized controlled trials, administering balanced crystalloids for fluid resuscitation in critically ill patient populations did not decrease mortality. However, further analyses of subpopulations within these trials have demonstrated that patients with sepsis may benefit from receiving balanced crystalloids for initial fluid resuscitation. Results from several small studies suggest that altering the composition of these IV fluids may help prevent development of hyperchloremia. Conclusion Management of hyperchloremia is preventative in nature and can be mitigated through management of resuscitation fluids, medication diluents, and total parenteral nutrition. Inpatient pharmacists should be aware of the potential risk of fluid-associated hyperchloremia and assist with optimal fluid management to prevent and manage hyperchloremia. [ABSTRACT FROM AUTHOR]

Impacted mandibular canines often result in a variety of clinical dilemmas. Orthodontic disimpaction of severely displaced mandibular canines may be extremely challenging and associated with significant patient discomfort and a high risk of iatrogenic damage. This case report demonstrates the interdisciplinary management of a horizontally impacted permanent mandibular canine, utilising a combination of three‐dimensional radiology, biomodel fabrication and subsequent endodontic treatment. © 2024 Australian Dental Association. [ABSTRACT FROM AUTHOR]

Background: Standard training for ultrasound-guided cyst needle aspiration is currently performed on live patients during residency. This practice presents risk of iatrogenic injury to patients and provides a high-stress learning environment for medical trainees. Simulation training using synthetic cysts in a formalin-embalmed cadaver model may allow for realistic, practical, and effective training free from patient risk. Methods: Thirty first-year medical students viewed an orientation video, then attended a skills workshop to perform cyst needle aspiration in formalin-embalmed cadaver tissue under ultrasound guidance. Participants were randomly assigned to one of three ultrasound-trained instructor-types which included a medical student, clinical anatomist, or an ultrasound fellowship trained emergency medicine physician. After training, participants underwent a 5-min skills test to assess their ability to drain a synthetic cyst independently. Pre- and post-training self-confidence surveys were administered. Results: Ultrasound images of synthetic cysts in formalin-embalmed tissue were clear and realistic in appearance, and sonographic needle visualization was excellent. Participants took an average of 161.5 s and 1.9 attempts to complete the procedure. Two of the 30 participants could not complete the procedure within the time limit. Participants' self-reported confidence with respect to all aspects of the procedure significantly increased post-training. Mean confidence scores rose from 1.2 (95% CI 0.96 to 1.39) to 4.4 (95% CI 4.09 to 4.53) (P < 0.0001) Procedure time, number of attempts, performance scores, and self-confidence outcomes were not significantly affected by instructor type. Conclusions: The use of synthetic cysts in formalin-embalmed cadaveric tissue is feasible, realistic, and efficacious for the teaching of ultrasound-guided needle aspiration to novice medical trainees. This simulation training method can be delivered effectively by multiple instructor types and may allow medical trainees to increase their tactical skill and self-confidence prior to performing ultrasound-guided cyst needle aspiration on live patients. [ABSTRACT FROM AUTHOR]

Background: Managing diagnostic uncertainty is a major challenge in primary care due to factors such as the absence of definitive tests, variable symptom presentations and disease evolution. Maintaining patient trust during a period of investigative uncertainty, whilst minimising scope for diagnostic error is a challenge. Mismanagement can lead to diagnostic errors, treatment delays, and suboptimal patient outcomes. Objective: Our aim was to explore how UK primary care physicians (GPs) address and communicate diagnostic uncertainty in practice. Design: This qualitative study used video and audio-recordings. Verbatim transcripts were coded with a modified, validated tool to capture GPs' actions and communication in primary care consultations that included diagnostic uncertainty. The tool includes items relating to advice regarding new symptoms or symptom deterioration (sometimes called 'safety netting'). Video data was analysed to identify GP and patient body postures during and after the delivery of the management plan. Participants: All patient participants had a consultation with a GP, were over the age of 50 and had (1) at least one new presenting problem or (2) one persistent problem that was undiagnosed. Approach: Data collection occurred in GP-patient consultations during 2017–2018 across 7 practices in UK during 2017–2018. Key results: GPs used various management strategies to address diagnostic uncertainty, including (1) symptom monitoring without treatment, (2) prescribed treatment with symptom monitoring, and (3) addressing risks that could arise from administrative tasks. GPs did not make management plans for potential treatment side effects. Specificity of uncertainty management plans varied among GPs, with only some offering detailed actions and timescales. The transfer of responsibility for the management plan to patients was usually delivered rather than negotiated, with most patients confirming acceptance before concluding the discussion. Conclusions: We offer guidance to healthcare professionals, improving awareness of using and communicating management plans for diagnostic uncertainty. [ABSTRACT FROM AUTHOR]

Background: Many studies have shown that injury to the popliteus tendon has little consequence for the static stability of the knee following total knee arthroplasty (TKA). However, very few studies have evaluated the effect of intraoperative iatrogenic popliteus tendon injury on the patient-reported outcome measures (PROMs) following TKA. This study aimed to determine the incidence of iatrogenic popliteus tendon injury in our subset of the population and to find out its effect on PROMs. Methods: 100 consecutive osteoarthritic varus knees with flexion deformities less than 20° were operated upon by a single senior experienced arthroplasty surgeon. Patients were assessed intraoperatively for any iatrogenic popliteus tendon injury, the injury site, and the amount of injury which was quantified and graded. PROMs applied for assessment at 1-year follow-up were Knee Society Score (KSS 1), Knee Function Score (KSS 2), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Results: 17% of cases had an iatrogenic popliteus tendon injury. Thirteen had grade II injuries, whereas four had grade III injuries. There was no statistical significance in post-operative knee mobility and PROMs among those with popliteus tendon injury versus non-injured patients. Conclusion: The incidence of iatrogenic popliteus tendon injury is higher than what we expected. The tendon injury remains a risk, but it is unclear how the popliteus tendon injury will affect patients after the TKA. In our series, such an injury during knee replacement does not affect the functioning of the knee in the short term; however, a long-term follow-up is warranted. [ABSTRACT FROM AUTHOR]

Cricothyroidotomy remains one of the reliable methods for securing the airway when all other methods fail. A broken surgical blade lodged in the neck which stemmed from this procedure is almost unheard of. The objective of this case report is to highlight the challenges in managing foreign bodies in the neck due to iatrogenic causes and the utilization of imaging studies to locate the foreign bodies. We present a case of a 50-year-old lady who was in a 'Can't Intubate, Can't Oxygenate' situation and underwent a cricothyroidotomy but complicated with two fragments of surgical blades were broken and lodged in the neck. [ABSTRACT FROM AUTHOR]

Severe hypertension without acute end‐organ damage is commonly encountered in inpatients. Despite this, there is a lack of international guidelines to manage this disorder. We conducted an audit to investigate the local practices within our health district. Current practices favour the use of rapidly acting antihypertensive drugs, which have been associated with iatrogenic injury. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Little is known about how mental health services can cause harm in ways other than medication, talking therapies, diagnosis and detention under the Mental Health Act.The outcomes of people who avoid seeking help from mental health services due to previous experiences of harm are not well known. What this article adds to existing knowledge?: I provide a first‐person perspective of experiences of harm within mental health services, how this impacted my care, the long‐term effects of the harm on my well‐being and my ongoing experiences of avoiding mental health services. What are the implications for mental health nursing?: Healthcare professionals should be aware of the multitude of ways service provision can harm patients, and how, unknown to professionals, patients may create an internal understanding of how to best navigate harmful service environments.Healthcare professionals should have a deeper understanding of the reasons why people may choose not to engage with mental health services, and what impact this may have on them. The recent announcement of the first ever statutory public inquiry into a UK mental health service indicates a growing recognition of iatrogenic harm in mental healthcare. Despite the potential for harm across all services and practices, restrictive practices, psychotherapy, diagnosis and psychiatric medications are often the only areas of mental healthcare given significant attention. While the topic is widely discussed in survivor communities, accounts of harm caused by the everyday workings of services, including team cultures, administrative processes and staff–patient interactions, are missing from academic literature. In this article, I describe my 10‐year journey through mental health services, and how everyday practices, cultures and staff behaviour deeply impacted my ability to receive appropriate care, replicated previously traumatic environments, and damaged my mental health. Taking steps to protect myself from further harm, I self‐discharged and am currently living as a 'service‐avoider'. The ongoing implications of this decision and the long‐term impacts of harm are discussed. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Creutzfeldt‐Jakob disease (CJD) is a rapidly progressive, fatal neurodegenerative disorder. This case highlights parkinsonism as a rare initial manifestation of sporadic CJD (sCJD), emphasizing the need for heightened clinical awareness to prevent misdiagnosis. Early and accurate diagnosis of sCJD is crucial for preventing potential iatrogenic transmission and optimizing patient management. Creutzfeldt‐Jakob disease (CJD) is a fatal neurodegenerative illness. While movement disorders may be present at the onset of the disease in about half of those with sporadic CJD (sCJD), parkinsonism is a rare initial presentation. In this article, we report a case of CJD with parkinsonism as the initial presentation of the disease. We report a 69‐year‐old lady with initial symptoms of gait difficulty, tremor, and bradykinesia. Later, she developed cognitive impairment, ataxia, chin tremor, and myoclonic jerks. Her condition worsened to the point of akinetic mutism. She was diagnosed with probable sCJD after detecting protein 14‐3‐3 in her cerebrospinal fluid and observing typical imaging features.This case report illustrates important aspects of an inevitably fatal and rapidly progressing disease's early presentation and clinical features. The uncommon initial presentations of sCJD should be considered with the intent of preventing misdiagnosis in the future. Early diagnosis of sCJD can prevent possible iatrogenic disease transmission and improve patient care. [ABSTRACT FROM AUTHOR]

Subclavian artery pseudoaneurysm is an uncommon entity caused by trauma or iatrogenic arterial injury. Endovascular management is the preferred treatment strategy but can be complicated by endoleaks. We report a case of type I endoleak occurring after endovascular covered stent placement to treat a traumatic pseudoaneurysm of proximal left subclavian artery. [ABSTRACT FROM AUTHOR]

Introduction: Acquired amyloid neuropathy is an iatrogenic disease that appears years after a domino liver transplant. The objectives of our study are to analyze the efficacy and tolerability of tafamidis for the treatment of acquired amyloid neuropathy in domino liver transplant recipients. This post-authorization, prospective, longitudinal study included seven domino liver transplant recipients with acquired amyloid neuropathy who received treatment with tafamidis for 18 months. Methods: The primary endpoints were the response rate, defined as those patients with an increase of < 2 points on the Neurological Impairment Score (NIS) from baseline, and the change in the NIS score from baseline. Secondary endpoints included the Quantitative Sensory Test, 10-m walk test, quality of life (Norfolk), and disability (Rasch-built Overall Disability Scale). As safety parameters, the evidence of graft rejection, changes in immunosuppressive trough levels and changes in antiviral and allogeneic cellular immunity before and 12 months after tafamidis treatment were also assessed. Results: Six patients (85.7%) had responded at 18-months. Compared to baseline, we observed non-statistically significant improvement in mean NIS score at 6 months (− 2.54 points, CI − 5.92 to 0.84), 12 months (− 3.25 points; CI − 6.63 to 0.13), and 18 months (− 2.35 points; CI − 5.74 to 1.02). Changes in the Quantitative Sensory Test, 10-m walk tests and the quality of life and disability questionnaires were not statistically significant. The use of tafamidis did not induce relevant side effects or drug interactions. Also, no acute rejections events nor changes in functional adaptive immunity were observed. Conclusion: Our study supports the safety and tolerability of tafamidis for the treatment of acquired amyloid neuropathy in domino liver transplant recipients. Tafamidis shows promise as a useful treatment in the clinical management of these patients. Future randomized placebo-controlled clinical trials with longer follow-up durations are needed. [ABSTRACT FROM AUTHOR]

We encountered the aberrant muscle called transverse carpal muscle (TCM) anterior to the transverse carpal ligament (TCL) during endoscopic carpal tunnel release (ECTR) for a 56-year-old female with left carpal tunnel syndrome (CTS). Our ECTR technique started with making the distal portal and the anomalous muscle emerged in the portal. We changed ECTR to open carpal tunnel release to clarify the anatomy around TCL to avoid iatrogenic tendon and neurovascular injuries. The TCM does not necessarily exist bilaterally, and our case has also it unilaterally, because the TCM was not observed during the ECTR on the opposite side. Distal incision first ECTR technique enabled us to find the TCM which we could not encounter if conventional ECTR was performed. [ABSTRACT FROM AUTHOR]

Background: Postoperative resorption of hard and soft tissues occurs as a consequence of tooth extraction. The Benex®-Control extractor allows minimally invasive extraction of the tooth without causing pronounced iatrogenic trauma. The aim of this study was to verify whether the resorption of the tissues after extraction can be reduced by using the Benex® system compared to the conventional extraction method. Methods: Postoperative intraoral scans were superimposed after surgery (t0), after 7 days (t1), after 14 days (t2), after 30 days (t3), after 60 days (t4), and after 90 days (t5) within the two groups (study n = 14, control n = 16), and defined regions of interest (ROIs) (1–8) and volume changes were analyzed. In addition, the influence of gingival thickness and the thickness of the labial cortical plate was investigated. Results: The greatest decrease in volume was observed in both groups in ROI3, although there was no significant difference observed between the groups. In the presence of an adjacent tooth, there was less volume loss in the affected ROIs (1, 2 and 7, 8). The thickness of the gingiva and the bony lamella did not significantly influence the change in volume. Conclusions: Due to the small cohort, the results are limited, and the hypothesis is rejected. [ABSTRACT FROM AUTHOR]

This evidence-based opinion piece explores the totalising risk averse nature of secure and forensic mental health services and associated iatrogenic harms in England and Wales. Drawing on the research literature I consider the various influences, both external and internal which impact on the provision of such services and how both the therapeutic alliance and recovery potential for patients may be improved. Especial attention is paid to the deployment of restrictive practise, practitioner attitudes, the potential for non-thinking, and how these may impact on decision-making and the care and treatment of mentally disordered offenders. [ABSTRACT FROM AUTHOR]

This scoping review examined current case series and reports on guided surgical endodontic applications in order to provide a critical platform for future research. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) extension for scoping reviews guidelines were followed. A search on PubMed and Scopus yielded 611 articles, with 17 case reports and 1 series meeting inclusion criteria. Overall, guided surgery addressed anatomical complexities, with 15 articles employing static protocols and 3 dynamic. Results showed minimal iatrogenic errors and reduced chair time, with no postoperative issues reported. Within the cases described, guided endodontic surgery exhibited satisfactory results in management of anatomical complex cases. Cost‐effectiveness, the need for adequate follow‐up, procedure's reproducibility and accuracy, and objective measurement of the reduction in operative times and iatrogenic errors are some of the limitations in the current reports that need to be considered for planning of future experimental and cohort studies. [ABSTRACT FROM AUTHOR]

Trypanosoma evansi infection has started to become a wide spread phenomena around the camel-rearing areas of North Africa and the Middle East. The disease caused by trypanosomes is locally known as "Surra" and it can seriously impact not only the health of domestic animals but the local economy as well. After taking over the management of a farm containing approximately 700 camels, it was found that a large number were suffering from trypanosome infection and it was of the utmost importance to find the source of this infection. An extensive dive into the records and observations were initially made to identify the infected population. Under closer inspection it was found that the infection was limited mostly to female individuals that had undergone extended reproductive analysis or treatment. Blood samples were taken from each of the individuals for buffy coat test and blood smears. Among the total number of tested camels (n = 590), almost 40% were infected with trypanosomes. The number and percentage of infection correlate with the number of fertility and pregnancy treatments that the camels had undergone. The most severely infected group, underwent between 17 and 20 instances of treatment or tests, had an infection rate of almost 90%. The devastating effect of trypanosomiasis on camel pregnancy and birth were also verified with 61% of all abortions and 82% of all neonatal deaths coming from trypanosome infected individuals. These results clearly demonstrate how damaging iatrogenic infections of T. evansi can be and how simply they could have been prevented. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the long-term outcomes of saphenous nerve (SN) injuries from hamstring tendon harvesting during ACL reconstruction, focusing on clinical results and patient satisfaction after at least two years. Additionally, it investigates the incidence, recovery patterns, and impact of these injuries on functional outcomes, daily activities, and ACL re-rupture rates immediately post-surgery and at final follow-up. Materials and methods: A retrospective review was conducted on patients who had undergone ACL reconstruction with hamstring tendon grafts at a single institution between January 2015 and January 2020. The incidence of SN injuries was assessed immediately after surgery and at final follow-up. Additionally, the recovery rate and time were evaluated, and the impact of these injuries on functional outcomes was measured using the Lysholm Knee Score (LKS) and patient-reported effects on daily activities. Results: Of the 159 patients analyzed, iatrogenic SN injuries were initially observed in 87 (54.7%) patients post-ACLR. By the final follow-up, paresthesia had resolved in 36 (22.6%) patients within an average of 11.1 months. Persistent SN injuries were recorded in 51 (32.1%) patients, affecting various extents of the infrapatellar branch (IPBSN) and the sartorial branch (SBSN) of the saphenous nerve. Patients with persistent SN injuries experienced a significant impact on daily activities and had lower LKS scores compared to those without injuries or with recovered injuries. Furthermore, a higher re-rupture rate was associated with persistent SN injuries. Conclusions: The study finds that SN injuries during hamstring graft harvesting for ACL reconstruction are common, with a significant portion of patients experiencing persistent sensory deficits for at least two years postoperatively. These injuries are observed to adversely affect patient satisfaction and functional outcomes and to increase the re-rupture rate. [ABSTRACT FROM AUTHOR]

Background: Benzodiazepines and opioids are commonly administered to severely ill children in the pediatric intensive care unit (PICU) for analgesia and sedation. Long-term opioid medication often results in iatrogenic withdrawal syndrome (IWS) as well as tolerance when the dosage of benzodiazepines and opioids are gradually lowered or entirely stopped. Objectives: This review aimed to review and summarize existing knowledge and information on IWS in pediatrics. Conclusion: IWS in critically ill children is difficult to diagnose and manage. However, detecting and successfully managing IWS is critical to minimizing potentially negative effects during a patient's ICU stay and after discharge. Further research is required to ascertain the exact and reliable prevalence of IWS among pediatric patients, as well as the benefits and drawbacks of existing assessment tools and treatments. [ABSTRACT FROM AUTHOR]

Background: The present systematic review intended to evaluate the current evidence on the modalities used for treating iatrogenic late paresthesia in the oral tissues innervated by the mandibular branch of the trigeminal nerve. Main text: As a common side effect of dental procedures, paresthesia can exert a profound adverse effect on patients' quality of life. The inferior alveolar nerve (IAN) and lingual nerve (LN) have the highest chance of injury during several dental procedures, including mandibular orthognathic surgeries, implant placement, extraction of the third molar, anesthetic injections, flap elevation, and endodontic treatments. Moreover, several methods have been proposed for treating iatrogenic late paresthesia, including photobiomodulation (PBM), microsurgery, medication, and close observation until achieving spontaneous recovery of sensation. However, no gold standard treatment for iatrogenic paresthesia has been agreed upon up to now. The present study included a comprehensive search of the databases of PubMed, Embase, Scopus, and Web of Science up to December 04, 2023, resulting in a total of 3122 related studies. Then, the titles, abstracts, and full texts of the studies were evaluated. Ultimately, seven controlled randomized trials (RCTs) were included in the final analysis. Also, the risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Among all fields, randomization, allocation concealment, and data analysis were found to have the highest chance of bias in the included studies. Conclusions: In conclusion, PBM, vitamin B12, and corticosteroids could accelerate the recovery of late paresthesia. However, considering the low sample size of the included studies and the high risk of methodological bias, it is recommended to perform further RCTs with robust study designs following Good Clinical Practice (GCP) guidelines to achieve more reliable results. [ABSTRACT FROM AUTHOR]

External ventricular drainage (EVD) is a common procedure in neurosurgical practice. Presently, the three methods used most often include direct EVD (dEVD), long-tunneled external ventricular drains (LTEVDs), and EVD via the Ommaya reservoir (EVDvOR). But they possess drawbacks such as limited duration of retention, vulnerability to iatrogenic secondary infections, and challenges in regulating drainage flow. This study aimed to explore the use of a modified ventriculoperitoneal shunt (mVPS)—the abdominal end of the VPS device was placed externally—as a means of temporary EVD to address the aforementioned limitations. This retrospective cohort study, included 120 cases requiring EVD. dEVD was performed for 31 cases, EVDvOR for 54 cases (including 8 cases with previously performed dEVD), and mVPS for 35 cases (including 6 cases with previously performed EVDvOR). The one-time success rate (no need for further other EVD intervention) for dEVD, EVDvOR, and mVPS were 70.97%, 88.89%, and 91.42%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Puncture needle displacement or detachment was observed in nearly all cases of EVDvOR, while no such complications have been observed with mVPS. Apart from this complication, the incidence of postoperative complications was 35.48%, 14.81%, and 8.5%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Mean postoperative retention for EVD was 14.68 ± 9.50 days, 25.96 ± 15.14 days, and 82.43 ± 64.45 days, respectively (P < 0.001). In conclusion, mVPS significantly extends the duration of EVD, which is particularly beneficial for patients requiring long-term EVD. [ABSTRACT FROM AUTHOR]

This report demonstrates the successful treatment of a carotid artery pseudoaneurysm using percutaneous thrombin injection. The patient, a 62-year-old woman with multiple comorbidities, experienced a pseudoaneurysm following an unintentional carotid artery puncture during a failed attempt to place a triple lumen catheter in the right jugular vein. Percutaneous thrombin injection was chosen as the treatment method, with Doppler ultrasound monitoring. Follow-up examinations showed no signs of recurrence, and the patient was discharged after nine days without complications. [ABSTRACT FROM AUTHOR]

This article aims to show how the iatrogenicity of the training of therapists is the effect of a form of leadership whereby a teacher/therapist, having not adequately elaborated their archaic narcissistic needs, produces a split group imago. This, projected onto the group, yields the phenomenon of the scapegoat, a specific psychological game signaling the developmental block of the group. The concepts of psychological games, enactment, and setting violation are used to describe how transference phenomena, when not elaborated, are acted out. The author describes a particular type of psychological game, from the psychodynamic literature on the educational setting, that exemplifies a harmful type of leadership based on a misuse of power. A clinical case highlights how the assumption of the dual role of trainer/therapist may have iatrogenic effects. [ABSTRACT FROM AUTHOR]

To evaluate plaintiff and defendant characteristics associated with iatrogenic genitourinary (GU) trauma litigation and outcomes of closed claims. LexisNexis was queried in April 2023 using terms related to GU organs and injury, and manually reviewed for iatrogenic cases. Case details including defendant, organ involvement, and legal outcome were obtained. Multinomial regression analysis was performed to identify factors associated with outcome. Four hundred ten cases involving 611 defendants were identified, with the ureter the most commonly affected organ (202/410, 49.3%). Most cases involved adult plaintiffs (380, 92.7%) and resulted in favor of the defense (227, 55.4%). Injuries resulted most frequently from gynecologic surgeries (179, 43.7%). Defendants were most commonly obstetricians/gynecologists (243/611, 39.8%) and urologists (168, 27.5%). Penile (OR 6.3 [95% CI 2.5-16.1]) and urethral (OR 4.8 [2.0-11.7]) injuries were associated with greater odds of a plaintiff verdict relative to ureter injury. A plaintiff verdict was also more likely when defendants were academic hospitals compared to individual practitioners (OR 4.3 [1.9-9.9]). In cases ruling in favor of the plaintiff, indemnity payments were larger when the defendants were comprised of individual practitioners compared to a hospital or medical group (median $549,613 vs $250,000, P <.001). Urologists may be involved in medical malpractice lawsuits for iatrogenic injury even when they are uninvolved in the index procedure. Most cases that reach litigation result in defense verdicts regardless of the GU organ injured. Defendant characteristics associated with plaintiff verdicts are more nuanced, and providers should be aware of potential downstream effects of litigation. [ABSTRACT FROM AUTHOR]

Objective: To prove that the "sports rehabilitation bed" is a device aimed at improving the precision of stretching, which can help to reduce the difficulty of rehabilitation therapy, cut down the manpower input of rehabilitation therapy, and shorten the therapy duration as well. Methods: This was a clinical comparative study. Twenty patients who underwent stretching therapy in Sichuan Province Orthopedic Hospital from June 2020 to August 2020 were randomly selected to carry out a control study on both lower extremities. The experimental group was given sports rehabilitation bed to assist rehabilitation therapy, while the control group was given conventional bare-handed stretching rehabilitation therapy. The stretching angle, stretching value, and the effective rate of stretching therapy between the two groups to analyze the clinical value of the new sports rehabilitation therapy bed. Results: The stretching angle in the experimental group when using the sports rehabilitation therapy bed for stretching was lower than the conventional bare-handed stretching in the control group (T<0, P=0.05), with a statistically significant difference; the stretching values of the experimental group were lower than those of the control group(P<0.01), with a statistically significant difference. Moreover, the response rate of stretching therapy in the experimental group was lower than that in the control group(P<0.05), with a statistically significant difference. Conclusion: Sports rehabilitation therapy beds can results in the advantages of effectively preventing iatrogenic injury in the process of stretching, and providing a more accurate and convenient stretching therapy method than the current commonly used bare-handed stretching for sports rehabilitation and intervention. [ABSTRACT FROM AUTHOR]

Introduction: The aims of this study were to investigate the independent risk factors associated with iatrogenic withdrawal syndrome in pediatric intensive care units (PICUs) and to establish receiver operator characteristic (ROC) curve to facilitate the diagnosis of iatrogenic withdrawal syndrome in clinical settings. Methods: Pediatric patients who received analgesic and sedative medication at a tertiary hospital in the southern Zhejiang region of China between January 2016 and December 2022 were selected for the study. Clinical case data were retrospectively analyzed to gather information including age, gender, weight, total dose of analgesic and sedative medication, total treatment duration, average maintenance dose, and other relevant parameters. Medically induced withdrawal symptom scores were assessed using the Sophia Observation Scale for Withdrawal Symptoms (SOS). Univariate and multivariate logistic regression analyses were conducted on the above indicators to identify the risk factors for iatrogenic withdrawal, and an ROC curve was constructed. Results: The study encompassed a total of 104 pediatric patients, comprising 47 patients in the SOS score ≥4 group and 57 patients in the SOS score ≤3 group. The incidence of iatrogenic withdrawal was 45.19%. Univariate analysis identified cumulative total dose of fentanyl, average daily dose of fentanyl, average daily dose of midazolam, and patient weight (p < 0.05) as factors associated with iatrogenic withdrawal syndrome. The logistic multiple regression analysis revealed that the average daily dose of fentanyl was an independent risk factor for the occurrence of iatrogenic withdrawal syndrome in critically ill children (p < 0.05). ROC curve analysis indicated an area under the curve of 0.711 (95% CI: 0.610–0.811) with sensitivity and specificity of 73.7% and 61.7%, respectively. Conclusion: The average daily maintenance dose of fentanyl holds significant clinical value in diagnosing and evaluating the prognosis of iatrogenic withdrawal syndrome and can provide a scientific foundation for enhancing sedative and analgesic management in clinical practice. [ABSTRACT FROM AUTHOR]

Key content: Premature ovarian insufficiency (POI) is a clinical syndrome involving ovarian follicle depletion and defined by loss of ovarian function before 40 years of age.The diagnostic workup in women with suspected POI is in two steps: confirming the diagnosis and establishing its cause; it is important to understand the rationale for performing each diagnostic test, how to interpret results and appropriate multidisciplinary team involvement.Treatment options include various regimens and preparations of hormone replacement therapy (HRT), monitoring and surveillance, induction of puberty in those with very early POI, complimentary treatment and fertility treatment.Management of POI requires a comprehensive and personalised strategy that addresses not only the physical symptoms and disease risks, but also the psychosocial and reproductive health aspects, and it is important that women receive adequate counselling. Learning objectives: To raise awareness of early diagnosis of POI.To be able to discuss the implications of POI for the health of women affected and their families, as well as for different hormonal and non‐hormonal treatment options.To understand various fertility treatment options for POI. Ethical issues: It is important to consider the reproductive and diagnostic implications for women with chromosomal or genetic problems (e.g. Turner syndrome, Fragile X mutation carriers) and for their family members.A diagnosis of POI may have differing implications based on social and cultural factors, and healthcare providers should consider a patient's values, beliefs, cultural background and preferences. [ABSTRACT FROM AUTHOR]

Inpatient treatment of hyperkalaemia with insulin and dextrose can be complicated by iatrogenic hypoglycaemia. We sought to assess the incidence of hypoglycaemia in hospitalised patients with renal disease and assess the impact of the introduction of a local guideline incorporating the use of sodium zirconium cyclosilicate (SZC) for patients with moderate hyperkalaemia. After establishing a significant burden of hypoglycaemia in the initial observation period, a requirement for hourly capillary blood glucose monitoring (for up to 6 h) following the administration of insulin for hyperkalaemia was incorporated into the guidelines. The two-fold introduction of SZC alongside changes in patient care after the administration of insulin/dextrose resulted in more appropriate use of insulin/dextrose, as well as a significant (73%) reduction in the iatrogenic burden of hypoglycaemia (P = 0.04). [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to inform the revision of a targeted surveillance risk registry by identifying which risk factors predict postnatally identified hearing loss (PNIHL) in children who pass newborn hearing screening and to determine whether hearing surveillance beyond the age of 1 year is warranted. Method: We used retrospective analysis of the audiological outcomes of children born in the state of Queensland, Australia, between January 1, 2010, and December 31, 2019, who passed the newborn hearing screen with risk factors. Results: Approximately one third of children were lost to follow-up and could not be included in the analysis. Risk factors that predicted PNIHL in the analyzed cohort were as follows: syndromes associated with hearing loss, craniofacial anomalies, perinatal infections, and family history of permanent childhood hearing loss. Severe asphyxia did not predict PNIHL but yielded some cases of significant bilateral hearing loss. Hearing loss in children with a history of prolonged ventilation was mild and/or unilateral in nature (except in cases where the hearing loss was due to an unrelated etiology). There were no cases of PNIHL in children with hyperbilirubinemia or neonatal bacterial meningitis. For the risk factors that predicted PNIHL, nearly all hearing losses were detected by 1 year of age, except for children with family history where one quarter of hearing losses had a later onset. Conclusions: The four risk factors recommended for efficient postnatal identification of hearing loss are as follows: syndromes associated with hearing loss, craniofacial anomalies, perinatal infection, and family history of permanent childhood hearing loss. Hearing surveillance through to 1 year old is sufficient except for children with a family history, where a second phase assessment is indicated. Alternative targeted surveillance protocols and models of care are required to minimize loss to follow-up. [ABSTRACT FROM AUTHOR]

Median arcuate ligament (MAL) syndrome or celiac artery (CA) compression syndrome previously treated mainly by vascular surgeons using the open approach is now being increasingly performed by general surgeons with training in advanced laparoscopy. Although this approach has all the advantages of minimal access surgery, the procedure is fraught with serious complications like injury to major vascular structures during dissection. Vascular injury by far is the major cause of conversion to open procedure. Herein, we report a laparoscopic repair of iatrogenic CA injury by intra-corporeal suturing during MAL release. We also elaborate the causes, the preventive measures that can be applied to avoid such catastrophic occurrences in future. To the best of our knowledge, this is the first report of a laparoscopic repair of CA bleed during MAL release. [ABSTRACT FROM AUTHOR]

Context and Aims: Despite its rarity, iatrogenic urinary tract injury can cause severe morbidity and mortality. The purpose of this study was to determine the frequency of urinary tract injuries caused by medical treatment in a hospital in Medan, Indonesia. Settings and Design: This retrospective descriptive study was conducted at H. Adam Malik General Hospital and Universitas Sumatera Utara Hospital in Medan from March to August 2022. Subjects and Methods: Medical data of individuals who had iatrogenic urinary tract injuries in a Medan teaching hospital from 2018 to 2022 were obtained using total sampling. SPSS version 25 was utilized to analyze patient characteristics, the type of surgery, urinary tract injuries, and urologic procedures. Results: There were 11 ureteral injuries and 23 bladder injuries in 32 iatrogenic urinary tract injuries. The average age of the patients was 40.5 ± 13.3. Patients who received obstetrical care had the highest rate of iatrogenic urinary tract injury (56.3%), followed by patients who received gynecological care (21.9%) and surgical care (21.9%). The procedure most likely to cause iatrogenic urinary tract injury was hysterectomy (40.6%). Bladder rupture (65.5%) and ureteral transection (28.1%) were common types of iatrogenic bladder and ureteral injuries. Majority of iatrogenic urinary tract injuries were treated with bladder repair (68.8%). Conclusions: Obstetrical and gynecologic procedures, especially hysterectomy, were the most common causes of iatrogenic urinary tract injury; bladder repair was the most common treatment. Iatrogenic urinary tract injury is best managed by knowing the anatomical position of the urinary tract inside the operative field. [ABSTRACT FROM AUTHOR]

BACKGROUND: About 3.5 million trauma patients are hospitalized every year, but 35%–40% require further care after discharge. Nurses' ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care. OBJECTIVE: The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients. METHODS: This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics. RESULTS: A total of n = 29,642 patients were included, of which n = 21,469 (72%) were male, n = 16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4–1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor. CONCLUSIONS: Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients' long-term outcomes. [ABSTRACT FROM AUTHOR]

PURPOSE To evaluate the efficacy of interventional radiological (IR) procedures in iatrogenic urinary tract injury and investigate the factors affecting the outcome. METHODS Fifty-eight patients (21 male) with a mean age of 50.3 ± 15.8 years referred for iatrogenic urinary tract injury were enrolled in this study. Technical success was defined as (i) successful placement of a nephrostomy catheter within the renal pelvis and/or (ii) successful antegrade ureteral stent placement (double J stent) between the renal pelvis and bladder lumen. Complete resolution was defined as maintained ureteral patency without an external drain and ureteral stent. The factors that may affect complete resolution [ureteral avulsion, ureterovaginal fistula (UVF), history of malignancy/ radiotherapy, and time to IR management] were also investigated. The receiver operating characteristic analysis was performed to estimate the cut-off time point for the IR management timing affecting complete resolution. RESULTS The technical success rate for nephrostomy and ureteral stent placement was 100% (n = 58/58) and 78% (n = 28/36), respectively. In 14 patients, non-dilated pelvicalyceal systems were evident. In 18 patients, no further intervention after percutaneous nephrostomy was performed due to (i) poor performance status (n = 6) and (ii) reconstruction surgery upon clinicians' and/or patients' request (n = 12). Reconstruction surgery was required in 11 of the remaining 40 patients due to failure of percutaneous treatment (n = 11/40, 27.5%). In six of the patients, ureteral stents could not be removed due to the development of benign ureteral strictures (n = 6/40, 15%). Our complete resolution rate was 57.5% (n = 23/40). Age, gender, type of surgery (endoscopic or open), side and location of the injury did not statistically affect the complete resolution rate. The presence of ureteral avulsion, history of malignancy and radiotherapy individually or in combination significantly affected the complete resolution rate negatively. The presence of UVF also had a negative effect on the complete resolution rate; however, it did not reach statistical significance. Delayed intervention was also a significant factor related to lower complete resolution. The optimal cut-off point of the time interval for favorable clinical outcome was found to be 0--19th day following the surgery. CONCLUSION IR procedures are safe and effective in the management of iatrogenic urinary tract injuries. Antegrade ureteral stenting should be performed as soon as possible to establish ureteral integrity without the development of stricture. [ABSTRACT FROM AUTHOR]

Background: Iatrogenic hypoparathyroidism is a common cause of postthyroidectomy hypocalcaemia. It has varying incidence rates after neck surgery in Saudi Arabia, ranging from 0.07% to 65.30%. Hypoparathyroidism can manifest with a spectrum of symptoms, ranging from mild to severe and life‐threatening. This study aimed to assess the rate and predictors of iatrogenic hypoparathyroidism after thyroid surgery and its natural course. Methods: This retrospective cohort study used a data collection form to extract patient information from the electronic healthcare system (Best‐Care) for patients treated from 2017 to 2022. Patients' demographics, surgical specifics and biochemical profiles were recorded for subsequent analysis. Results: Among the 343 patients who underwent thyroidectomy, 130 (37.9%) developed hypoparathyroidism, primarily within the first day after surgery. Calcium or vitamin D supplementation before surgery did not significantly influence hypoparathyroidism development. Notably, extensive combined lymph node dissection was significantly associated with postoperative hypoparathyroidism development (p = 0.0004). More patients who underwent central and lateral lymph node dissection (n = 19, 79.17%) developed hypoparathyroidism than patients who underwent central (n = 18, 40.91%) or lateral (n = 8, 38.10%) dissection alone. Permanent hypoparathyroidism was observed in 40 patients (11.66%). Conclusion: This study revealed a high incidence of iatrogenic hypoparathyroidism and high rates of permanent hypoparathyroidism. Further research is warranted to better comprehend the risk factors and optimise management strategies for iatrogenic hypoparathyroidism. Overall, our findings emphasise the need for vigilant monitoring and effective management of patients undergoing thyroidectomy and the significance of postoperative replacement therapies. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Urinary system injuries may occur iatrogenically during some surgical procedures especially gynecological and obstetrical surgeries. Unfortunately, these injuries can lead to serious complications in patients. In this multicentric study, we aimed to review and report our experiences and results of urinary tract injuries identified during gynecological and obstetrical surgery. METHODS: We included women with urinary tract injuries during gynecological and obstetrical surgeries between January 2018 and October 2023 at four centers. Detailed data collected include patient demographics, surgical details, injury characteristics, diagnostic and treatment methods, timing of injury diagnosis and management reports of the patients. The incidence of bladder and ureter injuries was evaluated and the rate of intraoperative urological consultations was recorded. RESULTS: In a total of 328 patients with a median age of 47 years (24-90), urinary tract injuries were diagnosed, including 227 (69.2%) iatrogenic bladder injuries (IBI) and 101 (30.8%) iatrogenic ureteral injuries (IUI). These injuries were diagnosed in 299 patients (91.2%) during surgery and in 29 patients (8.8%) after the surgical procedure. We observed intraoperative detection rates of 71.9% for IBI and 28.1% for IUI. IBI (71.9%) was diagnosed significantly more frequently than IUI (28.1%) (p=0.001). Cesarean section resulted in significantly more frequent IBI, whereas tumor debulking surgeries resulted in more IUI (n=52, 56.5%) than the other types of procedures (p<0.001). CONCLUSION: Our study provides a comprehensive overview of iatrogenic urological injuries during gynecological and obstetrical surgeries. Although the bladder is the most frequently injured organ during gynecological and obstetric surgeries, early diagnosis and urological intervention are mandatory to prevent delayed complications. Surgeons must have a thorough understanding of the pelvic anatomy and appropriate surgical techniques to prevent iatrogenic injuries during surgery and ensure timely diagnosis and treatment of urinary tract injuries. [ABSTRACT FROM AUTHOR]

Background: Physicians and associate (non-physician) clinicians conduct cesarean sections in Tanzania and Malawi. Urogenital fistulas may occur as complications of cesarean section. Location and circumstances can indicate iatrogenic origin as opposed to ischemic injury following prolonged, obstructed labor. Methods: This retrospective review assessed the frequency of iatrogenic urogenital fistulas following cesarean sections conducted by either associate clinicians or physicians in Tanzania and Malawi. It focuses on 325 women with iatrogenic fistulas among 1290 women who had fistulas after cesarean birth in Tanzania and Malawi between 1994 and 2017. An equivalence test compared the proportion of iatrogenic fistulas after cesarean sections performed by associate clinicians and physicians (equivalence margin = 0.135). Logistic regression was used to model the occurrence of iatrogenic fistula after cesarean section, controlling for cadre, date, maternal age, previous abdominal surgery and parity. Results: Associate clinicians attended 1119/1290 (86.7%) cesarean births leading to fistulas, while physicians attended 171/1290 (13.3%). Iatrogenic fistulas occurred in 275/1119 (24.6%) cesarean births by associate clinicians and in 50/171 (29.2%) cesarean births by physicians. The risk difference and 90% confidence interval were entirely contained within an equivalence margin of 13.5%, supporting a conclusion of equivalence between the two cadres. The odds of iatrogenic fistula after cesarean section were not statistically significantly different between associate clinicians and physicians (aOR 0.90; 95% CI 0.61–1.33). Conclusions: Associate clinicians appear equivalent to physicians performing cesarean sections in terms of iatrogenic fistula risk. Lower iatrogenic proportions for associate clinicians could reflect different caseloads. The occurrence of iatrogenic fistulas illustrates the importance of appropriate labor management and cesarean section decision-making, irrespective of health provider cadre. Given the noninferior performance and lower costs of employing associate clinicians, other countries with insufficient and/or unequally distributed health workforces could consider task-shifting cesarean sections to associate clinicians. [ABSTRACT FROM AUTHOR]

This study aimed to register and analyse outcomes after iatrogenic ureteral injuries (IUI) with special emphasis on potential consequences of a delayed diagnosis, and further to analyse if the incidence of IUI has changed during the study period. 108 patients treated for an IUI during 2001–2021 were included. Injuries due to endourological procedures, planned tumour resection and traumatic injuries were excluded. All relevant information to answer the research questions were entered into a database. Chi-square and t-tests were used for categorical and continuous variables respectively. Regression analysis was used to evaluate potential change of incidence in IUIs over time. Our results showed that most IUIs (74, 69%) were caused by gynaecological surgery. 49 (45%) had a delayed diagnosis (not diagnosed intraoperatively). Younger age (mean 50 vs 62 years, p < 0.001) and benign indication for laparoscopic hysterectomy (OR 8.0, p < 0.001) predisposed for a delayed diagnosis. Patients with a delayed diagnosis had a higher number of secondary injury related procedures (mean 4.6 vs 1.7, p < 0.001), hospital admissions (mean 3.0 vs 0.8, p < 0.001) and longer hospital stays (mean 20.6 vs 3.9 days p < 0.001) compared to patients with an intraoperative diagnosis. There was complete recovery for 91% of the patients. We did not observe any changes in IUI incidence during the study period. In conclusion, our study underlines that IUI can cause major morbidity for the patient affected if not diagnosed intraoperatively. Benign indication and younger age are predictors for a delayed diagnosis. The prognosis is good, with 91% full recovery. No significant changes in incidence of IUIs were observed. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: The Over-the-Scope-Clip (OTSC) System is a class of endoscopic clips intended to provide improved strength and tissue capture compared to conventional through-the-scope clips. These clips are generally safe and effective in managing many gastrointestinal conditions, with a low overall adverse event rate. Although the OTSC has been used to treat gastrointestinal bleeding and bowel perforations for many years, it often is relegated to second-line therapy and has only recently become a first-line hemostatic therapy for gastrointestinal bleeding. Case Report: Here, we present a unique adverse event of the OTSC causing iatrogenic ligation of the gastroduodenal artery (GDA). A 71-year-old man presented with 6 months of epigastric abdominal pain and 2 weeks of hematemesis, and was ultimately diagnosed with a bleeding duodenal ulcer. He underwent multiple endoscopic interventions to attempt to control the duodenal ulcer bleeding, including placement of the OTSC on a visible vessel. Soon after OTSC placement, he became hypotensive with recurrent hematochezia, and Interventional Radiology was consulted for endovascular management of the bleeding. Angiography showed the OTSC had been deployed across the midportion of the GDA from the duodenal lumen, effectively ligating the GDA, causing bleeding due to direct vascular injury. This bleeding was ultimately controlled with coil embolization. However, this iatrogenic ligation of the midportion of the GDA by the OTSC significantly complicated endovascular intervention to control the bleeding. Conclusions: As the OTSC device becomes more commonly used in the endoscopy suite, it is important to share potential pitfalls that may be encountered in the clinical setting that impact not only endoscopists and patients, but other specialties as well. [ABSTRACT FROM AUTHOR]

Facial nerve palsy is most commonly idiopathic, but it can also result from infections, inflammatory and cerebrovascular disorders, tumors, and trauma. We report the case of a 68-year-old patient who developed iatrogenic facial nerve palsy subsequent to dermatological cryosurgery on the right cheek. Remarkably, a full recovery occurred within 8 weeks. Drawing upon the promising outcome of this case and the existing literature on neuropathies linked with cold application in sports injuries, we propose neurapraxia as the probable pathomechanism underlying cryotherapy-induced nerve damage. [ABSTRACT FROM AUTHOR]

Infants are exceptionally fragile and physically vulnerable. Continuous monitoring of their vital characteristics and physiological parameters is vital for assessing their exact health status. The progressive achievements of bioelectrical, biophysical, biochemical and hybrid soft monitoring technologies in infant are discussed. We offer insights into the remaining challenges and translational hurdles of soft electronics for clinical-grade infant monitoring from the benchtop to the bedside. [Display omitted] Infants are exceptionally fragile and physically vulnerable who need special healthcare. Continuous monitoring of vital information of infants is essential for understanding their health status. Whereas modern infant health monitoring is carried out with dedicated facilities in controlled hospital settings, they are associated with several issues such as potential iatrogenic injuries, barriers for skin-to-skin parental bonding, and even complications during basic clinical tasks. Recently, soft electronics have become an accessory and mobile infant monitoring platform with remarkable advantages over existing technologies. This review comprehensively summarizes the research advances on soft electronics for advanced infant monitoring. We first introduce the physiological characteristics from anatomy, diseases, and treatments of infants. In accordance with these characteristics, we discuss the progressive achievements of soft bioelectrical, biophysical, biochemical, and hybrid monitoring technologies for infants. In addition, we offer insights into the remaining challenges and future directions of a soft electronics based intelligent system for clinical-grade infant monitoring from sensor design, data processing, power supply, and digital interactions in the era of Internet of Things. Finally, we highlight the translational challenges to be considered in bringing soft electronics for infant monitoring from the benchtop to the bedside. [ABSTRACT FROM AUTHOR]

Objectives Expandable transforaminal interbody fusion (TLIF) devices have been developed to introduce more segmental lordosis through a narrow operative corridor, but there are concerns about the degree of achievable correction with a small graft footprint. In this report, we describe the technical nuances associated with placing bilateral expandable cages for correction of iatrogenic deformity. Materials and Methods A 60-year-old female with symptomatic global sagittal malalignment and a severe lumbar kyphotic deformity after five prior lumbar surgeries presented to our institution. We performed multilevel posterior column osteotomies, a L3–4 intradiscal osteotomy, and placed bilateral lordotic expandable TLIF cages at the level of maximum segmental kyphosis. Results We achieve a 21-degree correction of the patient's focal kyphotic deformity and restoration of the patient global sagittal alignment. Conclusion This case demonstrates both the feasibility and utility of placing bilateral expandable TLIF cages at a single disc space in the setting of severe focal sagittal malalignment. This technique expands the implant footprint and, when coupled with an intradiscal osteotomy, allows for a significant restoration of segmental lordosis. [ABSTRACT FROM AUTHOR]

Background and purpose: An increasing number of cases of iatrogenic cerebral amyloid angiopathy (CAA) have now been reported worldwide. Proposed diagnostic criteria require a history of medical intervention with potential for amyloid‐β transmission, for example those using cadaveric dura mater or requiring instrumentation of the brain or spinal cord. Clinical presentation occurs after an appropriate latency (usually three or four decades); to date, most patients with iatrogenic CAA have had 'early‐onset' disease (compared to sporadic, age‐related, CAA), as a consequence of childhood procedures. Results: We describe five cases of possible iatrogenic CAA in adults presenting in later life (aged 65 years and older); all had prior neurosurgical interventions and presented after a latency suggestive of iatrogenic disease (range 30–39 years). Use of cadaveric dura mater was confirmed in one case, and highly likely in the remainder. Conclusion: The presentation of iatrogenic CAA in older adults widens the known potential spectrum of this disease and highlights the difficulties of making the diagnosis in this age group, and particularly in differentiating iatrogenic from sporadic CAA. Increased vigilance for cases presenting at an older age is essential for furthering our understanding of the clinical phenotype and broader implications of iatrogenic CAA. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Most health professionals working in psychiatric care will experience adverse events (AE) such as service user suicide or violence, during their careerNorway lacks measures to capture potential iatrogenic injuries, such as risk assessment measures, to evaluate patient records for AEs in both inpatient and outpatient psychiatric clinics in hospitals What the paper adds to existing knowledge: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translationWe have incorporated the understanding of health professionals and service users; to bring together the lifeworld of the patient with the professional definition of AEs, triggers and risk areas of AEs in a psychiatric context. The service users' experiences resulted in modifications to the tool. What are the implications for nurses: Applying the 'Global Trigger Tool—Psychiatry' in Norway and Sweden can help mental health nurses to prevent iatrogenic harm and reduce the occurrence of AEs through the identification of potential triggers.Implementing 'Global Trigger Tool—Psychiatry' might help mental health nurses to improve patient safety in Norway and Sweden. Introduction: There is little consensus on cross‐cultural and cross‐national adaptation of research instruments. Aim/Question: To translate and validate a Swedish research tool (GTT‐P) to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals in the process. Method: The GTT‐P, designed to identify events in patient records that were triggers for adverse events, was translated to Norwegian using a cross‐cultural adaptation approach. This involved two focus groups with clinical staff, one of which involved service users, and a joint discussion at a Dialogue Conference to generate consensus on the definition of the triggers of potential adverse events identifiable in patient records. Results: We highlight both the differences and commonalities in defining the nature of risks, the adverse events and the triggers of such events. The Dialogue Conference resulted in three modifications of the tool, based on service users' experiences. Service user involvement and co‐production was essential for both the translation and adaptation of the research instrument. Discussion: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translation. This approach enables a more nuanced understanding of potential risks within a psychiatric context as it engages differences in the care delivery. Applying the GTT‐P in hospital‐based psychiatric care might help to identify processes that need to be changed in order to promote patient safety and a safer work environment for mental health nurses. Implications for practice: When translating and validating the GTT‐P from Swedish to Norwegian, we have considered the knowledge and experiences of both service users and health professionals. The application of the GTT‐P can promote greater patient safety in hospital settings. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to report a case of iatrogenic pharyngoesophageal diverticulum post-anterior cervical discectomy and fusion (ACDF) surgery, its management and management of postoperative complications. We also did a thorough review of literature about iatrogenic pharyngoesophageal diverticulum which is a rarely encountered complication occurring after a commonly performed surgery; ACDF. Methods: Here we describe a case of iatrogenic pharyngoesophageal diverticulum post-ACDF surgery. In this paper we also make comparisons to the 23 cases reported in the literature in terms of: presentations, clinical findings, management courses, and complications. This study was approved by the Institution Review Board of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. (Ref. no.: IRB-2023-01-473). The reported subject provided written informed consent before initiation of this study. Results: Our case is a 45-year-old male with a history of ACDF surgery 8 years ago. He presented with dysphagia and regurgitations which started 1 year after ACDF. He was labeled as a case of Zenker's diverticulum and underwent multiple failed open and endoscopic surgeries prior to presenting to us. Upon presenting to our center, barium swallow showed the pharyngoesophageal diverticulum. Patient definitive diagnosis of iatrogenic rather than Zenker's diverticulum was established intraoperatively with esophagoscopy which revealed exposed hardware inside the diverticulum. He underwent open diverticulectomy and diverticulopexy. Postoperatively he developed pharyngocutanous fistula and right vocal fold palsy, both successfully managed conservatively. Conclusion: Iatrogenic Pharyngoesophageal diverticulum is a rare complication following ACDF, however prolonged dysphagia shall warrant further investigation by contrast studies. Open diverticulectomy with muscle reinforcement is a good management modality. Due to the complicated anatomy secondary to previous operations, we recommend conservative management for patients with postoperative pharyngocutaneous fistula. [ABSTRACT FROM AUTHOR]

A 5‐month‐old, spayed female domestic shorthair cat presented to the emergency department with rectal bleeding and lethargy subsequent to intended ovariohysterectomy earlier that day. An exploratory celiotomy revealed a loop of the distal descending colon and the colorectal junction encircled and entrapped by uterine horn remnants, which were ligated together around the intestine. This case represents a novel complication of ovariohysterectomy and illustrates the importance of adequate anatomic visualisation and appropriate surgical technique. [ABSTRACT FROM AUTHOR]