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• Retained pregnancy tissue can be successfully treated with office hysteroscopy. • Office hysteroscopy had high acceptability rates without complications. • Pain scores at office hysteroscopy were comparable to other office procedures. • A full-scale trial evaluating pregnancy rates after office hysteroscopy is feasible. To evaluate the feasibility of performing a full-scale, adequately powered, multi-center randomized controlled trial (RCT) assessing the effectiveness of office hysteroscopy (OH) for the treatment of retained pregnancy tissue (RPT) after miscarriage, compared with standard treatment (ST) (expectant/medical/surgical), on future pregnancy outcome. Single-center pilot RCT performed at Birmingham Women's Hospital, UK. Patients opting for non-surgical miscarriage management at ≤14 weeks gestation who wanted to conceive as soon as possible were recruited and offered a transvaginal ultrasound scan (TVUS) eight weeks later to check for the presence of RPT. Patients with RPT were randomized in a 1:1 ratio using a computer-generated online random allocation sequence to either OH (performed using the TruClear 5.0 hysteroscopic tissue retrieval system) or ST (the type of which was recommended based on symptoms, urinary pregnancy test and scan findings). 158 participants were approached for inclusion into the trial, of which 149 (94.3%) agreed. Of the 126 that underwent TVUS, RPT were diagnosed in 42 patients (33.3%). 21 patients were randomized to OH, of whom 18 underwent the procedure because three fell pregnant after their TVUS. OH was deemed acceptable to all patients without any serious complications. 21 patients were randomized to ST where 16 patients (76%) were recommended expectant management and five (24%) were recommended surgical management. 115 patients (91%) were able to provide pregnancy data, however, the study was not powered to show a clinically significant difference. A full-scale, adequately powered, randomized clinical trial investigating OH against ST for the treatment of RPT following miscarriage is clinically relevant and feasible owing to high rates of participation, acceptability and satisfaction and low rates of attrition associated with the proposed interventions. [ABSTRACT FROM AUTHOR]

Chilldcare and school facilities healthcare is one of the important elements of the healthcare system in Bulgaria and is a fundamental factor in early childhood healthcare. Health offices are organized at schools and childcare facilities. Regional health inspectorates methodically guide the activities of doctors and medical specialists in health offices on the problems of disease prevention and health promotion. The current study aims to offer an opportunity to attract new personnel to the childcare and school facilities healthcare system to overcome the shortage of medical professionals. For the purposes of the study, I conducted a survey among the students studying in the "Public Health Inspector" specialty at the Medical College at the Medical University of Plovdiv and among the working inspectors in the Regional Health Inspectorate system from the Epidemic Control Department. The students' practical skills and theoretical knowledge were assessed, as well as their desire and motivation to work as health professionals in health offices in childcare and school facilities. Legislative measures are needed in this direction, which will provide opportunities for professional opportunities for the realization of the students in training. [ABSTRACT FROM AUTHOR]

The need to study patient satisfaction with specialized outpatient medical care is related to the need to improve the quality and efficiency of this medical care. The purpose of this article is to present and analyze the opinion of patients about their satisfaction with the specialists in outpatient care /ophthalmologists/. A survey was conducted among 516 patients who visited a specialist ophthalmologist in the specialized outpatient medical center in the city of Sofia in the period 02/01/2021. - 31.01.2022. The opinion of the respondents was studied regarding their satisfaction with the work /examination and prescribed treatment/ of the doctor they visited, the waiting time in front of the examination office, the assessment of the medical assistance provided by the doctor. The results show that 53.6% of the respondents who visited a specialist ophthalmologist are completely satisfied with his work, although they waste a lot of time waiting in front of the office for an examination. 71.3% of those examined by an ophthalmologist gave an excellent and very good assessment of the medical care provided by the doctor they visited.. [ABSTRACT FROM AUTHOR]

Objectives: Little is known about whether the Oncology Care Model (OCM) affected care for non-Medicare patients. Study Design: The quasi-experimental design here compares participant providers with non-participant providers during the first year of the program compared with the prior year. Methods: Relative different levels of office visits and total costs across four cancers – breast, lung, colon, and prostate cancer – are measured for patients with Medicare Advantage, private insurance, and Medicaid and compared with the Medicare population. Results: OCM participation is associated with 11.6% fewer Medicare breast cancer visits (estimate = −0.11, 95% CI: −0.20 to −0.01, p = 0.03) and 9.3% fewer Medicaid breast cancer visits (estimate = −0.10, 95% CI: −0.21 to 0.02, p = 0.09). Practices seeing more Medicare patients drive this result; every 10 percentage points more Medicare patients seen by OCM providers correlate with 6.1% fewer Medicaid visits (estimate = −0.66, 95% CI: −1.39 to 0.06, p = 0.07). Some patterns like lower costs did not extend to non-Medicare patients while others absent in Medicare were measured in non-Medicare patients. Conclusions: This analysis suggests that care patterns are different under the OCM for both Medicare and non-Medicare lives, but that these differences are modest and inconsistent. [ABSTRACT FROM AUTHOR]

Objective: To present a novel technique for office resection of pedunculated endometrial polyps under ultrasound guidance. Methods: A prospective trial was conducted at an academic center where women with abnormal uterine bleeding (AUB) who were diagnosed an endometrial polyp following saline infusion sonogram (SIS), were offered polyp removal under ultrasound guidance using a universal grasping forceps (2.5 mm × 25 cm). The primary outcome was to evaluate the feasibility of this technique for complete removal of the polyp. The secondary outcomes were to evaluate the patients' pain score, satisfaction score using visual analogue score (VAS), and efficacy of the technique in alleviating symptoms in patients with AUB due to polyps. Results: Thirty patients participated, with a mean age of 54.8 ± 11 years. Average polyp volume was 1.87 cm3 and mean duration for polypectomy was 11 minutes 31 seconds. The median pain score immediately post‐procedure was 5 (0–9). We were unable to complete the procedure in two patients due to patient discomfort and poor visualization. Complete removal of polyp was ensured by checking for a thin endometrial echo at the end of the procedure and by performing SIS at 3‐months post‐procedure. Of the 22 patients who returned for follow‐up, 19 (86.36%) showed no evidence of polyp on SIS and all reported resolution of AUB symptoms. The median satisfaction score at the follow‐up was 10/10. Adequate pathology samples were obtained from all cases, diagnosing malignancy in one and endometrial hyperplasia in one patient. Conclusion: This technique offers safe and effective removal of pedunculated endometrial polyps in an office setting, avoiding the need for general anesthesia. It can be offered as a therapeutic option at the initial point of contact, providing symptom relief and tissue diagnosis while reducing costs and patient visits. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethodsResultsConclusionsThe diagnostic workflow for endometrial carcinoma in postmenopausal asymptomatic women remains an ongoing dilemma. Whereas an ultrasonographic endometrial thickness greater than 4.0 or 5.0 mm is adequate for warranting further investigations in women with postmenopausal vaginal bleeding, there is still no unanimous consensus on what the ideal endometrial thickness cut-off should be, justifying additional inspection through endometrial sampling when bleeding is absent.A comprehensive overview of the most recent literature to summarize the clinical pathway necessary for the diagnostic assessment of a postmenopausal asymptomatic woman with increased ultrasonographic endometrial thickness.An endometrial thickness cut-off between 3.0 and 5.9 mm seems to show the lowest specificity while also reducing the chances of missing malignancy. If endometrial thickness can be a valid starting point, a careful evaluation of the other ultrasonographic endometrial features and a thorough scrutiny of patients’ risk factors are pivotal to standardizing the diagnostic process while avoiding overtreatment. Although preventing unnecessary procedures is crucial, stratifying the risk and proceeding with further investigations (preferably through outpatient or office hysteroscopically-guided targeted biopsies) should be the goal.Closer collaboration between different fields of medicine (ultrasonography, hysteroscopy, and oncology) is strongly encouraged to facilitate early diagnosis of asymptomatic postmenopausal women at risk of developing endometrial malignancy. [ABSTRACT FROM AUTHOR]

The application of unattended blood pressure measurement (uAOBPM) for resting heart rate (RHR) assessment is unknown. To assess the agreement between RHR measured during uAOBPM and other methods, the authors conducted a comparability study with office blood pressure measurement (OBPM), ambulatory blood pressure monitoring (ABPM), and electrocardiogram (ECG) in a group of 110 participants referred for ABPM. RHR measured with uAOBPM (70.8 ± 12.5 bpm) was significantly lower than OBPM (72.8 ± 12.6 bpm) but higher than measured by 24 h ABPM (67.5 ± 10.2 bpm). There was no significant difference was found between RHR measured by uAOBPM and daytime ABPM (70.3 ± 11.2 bpm) or ECG (69.1 ± 11.6 bpm). Using Bland‐Altman statistics, the authors discovered a small difference in agreement between RHR measured by uAOBPM and daytime ABPM (bias: 0.4 with 95% confidence interval: ‐0.8 to 1.6 bpm), with a poorer agreement with OBPM (bias ‐2 with 95% confidence interval: ‐2.8 to ‐1.3 bpm) and ECG (bias 1.6 with 95% confidence interval: 0.5 to 2.7 bpm). The authors found significant agreement between uAOBPM and ECG in identifying subjects with RHR > 80 bpm OBPM, with Cohen's kappa coefficients of 0.783 and 0.671, respectively. Their findings indicate that RHR measured with uAOBPM remains in acceptable agreement with OBPM, ABPM, and ECG, the best agreement obtained with RHR from daytime ABPM. [ABSTRACT FROM AUTHOR]

Frontotemporal dementia (FTD) is one of the most prevalent forms of early-onset dementia cases and a kind of primary degenerative dementia. Assessment of criminal responsibility is one of the most important issues for forensic psychiatry due to the help of justice. A 55-year-old male who allegedly committed an offense of threat and libel to a doctor was referred to the psychiatric clinic at our hospital by the prosecution office for the evaluation of his criminal responsibility. Seventeen years ago, he suffered severe head trauma. After this trauma, his mental and behavioral problems began to develop. It was realized that his ability to think abstractly, reasoning, and reality testing are impaired. Brain magnetic resonance imaging revealed atrophy characterized by sulcal widening and brain parencymal volume loss, which are more prominent in the bilateral frontal and temporal lobes. Additionally, disinhibited behaviors in his medical history such as verbal violence and suddenly leaving the house were noticed. A diagnosis of frontotemporal dementia was made. We understood the onset of symptoms of our case began when he was 40-year-old from the medical records. With this aspect, our case has a remarkably young age of initiation of symptoms. The purpose of this case report is to draw physicians’ attention to the medical symptoms and medicolegal consequences of a patient with early-onset FTD. [ABSTRACT FROM AUTHOR]

Identifying unknown deceased individuals, especially those in advanced stages of decomposition, dismemberment, or burning, is a major medico-legal challenge. Forensic anthropologists play a crucial role in these cases due to the numerous characteristics that can be derived from bone remains. Their methods help evaluate the biological profile and individual characteristics, narrowing potential matches. This research investigates the identification methods used by forensic anthropologists in Medicolegal Institutes and Medical Examiner’s Offices in Brazil and the USA. Case reports from forensic anthropology institutes in Vitória, Rio de Janeiro, Porto Velho (Brazil), and New York City (USA) were analysed. In resolved cases, details such as the biological profile, trauma, decomposition extent, and individualization markers were documented. Statistical tests evaluated the association between these variables and identification outcomes. Conventional identification methods included dental analysis, DNA testing, and fingerprint analysis. Additionally, Bayesian methods, visual identification, prosthetics, and X-ray comparison proved useful. This study highlights that forensic anthropologists can employ a variety of methodologies beyond standard practices, enhancing the identification process in complex cases. [ABSTRACT FROM AUTHOR]

Background: Over the last 2 decades, various education and training programmes have been launched by the European School of Urology (ESU) on behalf of the European Association of Urology (EAU) Education Office. These include e-learning platforms, in-person meetings, courses, podcasts, webinars, sub-specialisation meetings and the European Urology Resident Education Programme (EUREP), all of which aim to achieve standardisation in urological education (SISE) and training at the highest level. Methods: Data from the last 2 decades of all ESU activities were collected by the EAU/ESU office and analyzed for attendance, geographical, gender and age trends. Demographic data on registrations and attendances at EUREP were also monitored and analysed. A descriptive analysis of participation and trends is provided. Results: A total of 4750 participants have completed ESU courses (including guideline courses, specialization courses and webinar courses). Similarly, a total of 5958 trainees attended the EUREP from 2004 to 2022 of which the male: female ratio was 3.75:1. However, the proportion of females increased 3.5-fold from 10.7% in 2004 to 37.1% in 2022(p < 0.001). There is a growing interest in the meeting, with increasing registrations over this time (353 in 2004 to 599 in 2023, p < 0.001). The mean age of participants is constantly decreasing (32.6 years in 2004 to 31.54 in 2022), with a mean yearly decrease of -0.18% (p < 0.001). Conclusion: ESU courses have had increasing interest and participation from young urologists worldwide. During EUREP, while the trainee age has decreased, there has been a surge in the proportion of female trainees. ESU is providing all modes of education and training across the world with both virtual and in-person meetings and courses, which would help in the development and preparation of urologists of the future and provide the best patient care. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions This trial analyzes the effects of home‐based isometric handgrip training (IHT) and aerobic exercise training (AET) on ambulatory and office blood pressure (BP) in older adults with high normal to established hypertension.This randomized controlled trial included 84 participants (46 women, 71.1 ± 3.6 years, systolic BP [SBP] 137.1 ± 13.8 mmHg, diastolic BP [DBP] 80.8 ± 8.3 mmHg). Participants were randomized into IHT (n = 28), AET (n = 28), or usual medical care plus lifestyle advice (UC, n = 28). Participants performed IHT or AET three times/week for 8 weeks. IHT consisted of 4 × 45 s bilateral contractions at 50% of maximum voluntary contraction with 1‐min rest between sets. AET consisted of walking 30 min at 50%–70% of estimated maximum oxygen consumption. UC received standardized medical care including lifestyle advice.Seventy‐six participants completed the intervention: 27 in IHT, 26 in AET, and 23 in UC. At baseline, BP values were similar among groups. No differences were observed in 24‐h ambulatory, daytime, and nighttime SBP and DBP in any group (p > 0.05). IHT and AET reduced office SBP (−8.0 ± 13.4 mmHg; p = 0.004; −5.6 ± 12.2 mmHg; p = 0.027, respectively). IHT reduced office DBP (−3.3 ± 7.4 mmHg; p = 0.024), but AET did not. No differences occurred in office BP in UC. There was no difference in office BP among groups (p > 0.05).An 8‐week home‐based IHT and AET failed to reduce ambulatory SBP, while office SBP was reduced by 8/5 mmHg. Only IHT reduced office DBP by 3 mmHg. Thus, IHT and AET may be effective for lowering office BP in older adults with high normal to established hypertension. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To evaluate the safety, efficacy, tolerability, and cost‐effectiveness of bedside or office‐based ureteric stent insertion.Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses‐Protocols (PRISMA‐P) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 guidelines, we searched PubMed/the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and Dimensions for English‐language studies from 1978 to April 2023. Inclusion criteria focused on primary ureteric stent placements outside of the operating theatre (OT).A total of 15 studies involving 2072 stents were included. Success rates for correctly positioned stents in bedside or office‐based insertions ranged from 60% to 95.8%, with most studies reporting ≥80% success rates. Common failure reasons included impacted stones and difficulty identifying the ureteric orifice. Pain and tolerability were assessed using various methods, with validated tools indicating moderate pain levels, but most patients would undergo the procedure again under local anaesthesia. Complication rates were generally low, with minor complications such as haematuria or postoperative fever being the most common. Procedural costs were significantly lower in non‐OT settings, with estimates indicating savings of up to four‐fold.Bedside or office‐based ureteric stent insertion is a viable alternative to OT procedures, offering high success rates, manageable pain levels, low complication rates, and substantial cost savings. This approach is particularly advantageous in settings with limited OT access, highlighting its potential for broader adoption in urological practice. Future research should focus on standardising pain assessment methods and randomised studies. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Diagnosis of empty nose syndrome (ENS) relies on the ENS six‐item questionnaire (ENS6Q) with a score of ≥11, followed by a “positive” cotton test yielding seven‐point reduction from baseline ENS6Q score via cotton placement to the inferior meatus (IM). Given the intricacies of diagnosing ENS and the propensity for false positives with the standard cotton test, we modified the classic single‐step cotton test into a four‐part Stepwise Empty Nose Syndrome Evaluation (SENSE) cotton test to reduce bias and evaluate the placebo effect.Individuals diagnosed with ENS underwent the SENSE test, a single‐blinded, four‐step, office‐based cotton test, without topical anesthesia or decongestants. Conditions included: (1) placebo/no cotton placed; (2) complete cotton‐blockade of nasal vestibule; (3) cotton placed medially against the nasal septum; and (4) cotton placed laterally in the IM (site of inferior turbinate tissue loss). With each condition, patients completed an ENS6Q.Forty‐eight ENS patients were included. Twenty‐nine percent demonstrated a placebo effect (p < 0.001), 40.4% had a positive response to complete cotton‐blockade (p < 0.001), 64.4% to septum‐placed cotton, and 79.1% to IM‐placed cotton (p < 0.001), corresponding to a mean ENS6Q reduction of 11.9 points (p < 0.001). Notably, the mean difference in ENS6Q scores between septum and IM placement was 1.7 (p < 0.001).The SENSE test offers further insight into subtleties of nasal breathing experienced by ENS patients. The placebo effect can be prominent and important to consider with individual patients. While most ENS patients prefer any intranasal cotton placement over baseline, blinded testing reveals these patients can accurately discriminate minimal changes in nasal aerodynamics. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate differences in health care utilization and guideline adherence for postpartum individuals with hypertensive disorders of pregnancy (HDP) who are engaged in a remote monitoring program, compared with usual care. METHODS: This was a retrospective cohort study of postpartum individuals with HDP who delivered between March 2019 and June 2023 at a single institution. The primary exposure was enrollment in a remote hypertension management program that relies on patient home blood pressure (BP) measurement and centralized nursing team management. Patients enrolled in the program were compared with those receiving usual care. Outcomes included postpartum readmission, office visit within 6 weeks postpartum, BP measurement within 10 days, and initiation of antihypertensive medication. We performed multivariable logistic and conditional regression in a propensity score matched cohort. Propensity scores, generated by modeling likelihood of program participation, were assessed for even distribution by group, ensuring standardized bias of less than 10% after matching. RESULTS: Overall, 12,038 eligible individuals (6,556 participants, 5,482 in the control group) were included. Program participants were more likely to be White, commercially insured, be diagnosed with preeclampsia, and have higher prenatal and inpatient postpartum BPs. Differences in baseline factors were well-balanced after implementation of propensity score. Program enrollment was associated with lower 6-week postpartum readmission rates, demonstrating 1 fewer readmission for every 100 individuals in the program (propensity score-matched adjusted risk difference [aRD] 21.5, 95% CI, 22.6 to 20.46; adjusted risk ratio [aRR] 0.78, 95% CI, 0.65-0.93). For every 100 individuals enrolled in the program, 85 more had a BP recorded within 10 days (propensity score-matched aRD 85.4, 95% CI, 84.3-86.6), and six more had a 6-week postpartum office visit (propensity score-matched aRD 5.7, 95% CI, 3.9-7.6). Program enrollment was also associated with increased initiation of an antihypertensive medication postpartum (propensity score-matched aRR 4.44, 95% CI, 3.88-5.07). CONCLUSION: Participation in a postpartum remote BP monitoring program was associated with fewer postpartum hospital readmissions, higher attendance at postpartum visits, improved guideline adherence, and higher rates of antihypertensive use. [ABSTRACT FROM AUTHOR]

Background: This study focused on type 2 diabetes mellitus (T2DM) in a group of adult Mixe, an Indigenous population from Oaxaca, Mexico. Mixe comprised an estimated 9.4% (n ≅ 90 000) of the Indigenous population in Oaxaca. Mexico. Objective: This study focused on a group of adult Mixe, an Indigenous population from Oaxaca, Mexico. To compare the prevalence of T2DM, overweight (OW), obesity (OB), and hypertension (HTN) between 2007 and 2017 for a small, isolated Mixe community in the Valley of Oaxaca, Mexico. We test whether or not environmental changes have affected T2DM prevalence. Methods and Materials: Demographic and medical record data were collected in the community in 2007 and 2017 from the medical clinic and the mayor's office. T2DM was medically diagnosed among adults (>34 years old), in 2007 (n = 730) and in 2017 (n = 829). Results: T2DM crude prevalence increased from 6.7% to 12.1% (p <.001) from 2007 to 2017. The mean age of the sample analyzed was 60.6 (SD = 9.7). Age‐adjusted T2DM prevalence increased from 6.7% to 10.8% (p <.002). T2DM was 5.7%–5.5% among males (p <.53) and 7.1%–13.6% among females (p <.001). Sex‐specific OW and OB simulation studies indicate females had 7% less OW in 2007, and males were unchanged compared with 2017. OB among males and females was significantly higher in 2017 compared with 2007 (increased by 15.2% and 8.3%, males and females, respectively). Sexes combined OW + OB increased 12.7% among males but was unchanged in females (−0.5%). In the sexes combined analysis, OW prevalence increased 12.7% to 27.1% (p <.001) and OB prevalence increased 10.7%–27.9% (p <.001) from 2007 to 2017. HTN did not change significantly from 2007 to 2017 (15.4% and 14.6%, respectively) (p =.63) in adults. Among T2DM individuals, the frequency of HTN was not significantly different in 2007 and 2017 (57.1% and 37%, respectively) (p =.65). Transition to a Western diet consisting of high‐carbohydrate foods occurred at the same time as increased T2DM from 2007 to 2017, with a higher prevalence of T2DM noted among females in 2017. Conclusions: An increased prevalence of T2DM, OW, and OB but not HTN was observed in the Mixe community from 2007 to 2017 and was associated with the adoption of a high‐carbohydrate Western diet. [ABSTRACT FROM AUTHOR]

Background: Blood pressure can be monitored during regular activities like resting and light to moderate activity using ambulatory blood pressure monitoring (ABPM). The majority of the most current major hypertension guidelines suggest using it as a blood pressure measurement technique at home. Numerous studies now available demonstrate that when it comes to monitoring blood pressure and forecasting the risk and occurrence of cardiovascular (CV) events, ABPM is more accurate than office blood pressure disease. Many studies have shown that ambulatory blood pressure especially at night is a more reliable indicator of cardiovascular issues and overall mortality than office blood pressure. By cross-classifying patients according to their office and ambulatory blood pressure readings, it is possible to differentiate between those with white-coat hypertension and those with persistent hypertension, as well as between those with masked hypertension and normotension. White-coat hypertension was not associated with high CV risk, whereas concealed and chronic hypertension were. This review article's goal is to assess ambulatory blood pressure monitoring's utility. Conclusions: ABPM is acknowledged as a crucial component of excellent clinical practice in the field and plays a significant role in the diagnosis and treatment of hypertension. This is the only method of blood pressure monitoring available outside of an office that can give data on the 24-hour blood pressure profile, which includes nocturnal hypertension, morning blood pressure rise, and BPV. These factors are all significant indicators of TOD as well as cardiovascular and cerebrovascular risk. [ABSTRACT FROM AUTHOR]

Background: Home blood pressure monitoring (HBPM) is commonly used to diagnose hypertension (HT), with a diagnostic threshold of ≥135/85 mm Hg, the same as daytime ambulatory BP monitoring (ABPM). This study hypothesizes that training and adherence to HBPM guidelines will yield more accurate BP readings compared to ABPM. Methods: The study involved 129 patients with elevated office BP but no prior HT diagnosis. After a two-week observation period with lifestyle advice, HBPM was conducted over a week before and after structured measurement training, with ABPM performed in each period. Adherence to instructions post-training was also assessed. Results: Post-training, mean systolic and diastolic home BP values significantly decreased (from 128 ± 13.1/84.9 ± 8.2 to 122.6 ± 12.7/81.8 ± 7.8; P < 0.001 for both), while daytime ABPM values remained unchanged (131.7 ± 11.1/86.7 ± 9.3 before vs. 130.7 ± 11.7/85.9 ± 8.6 after; P = 0.185). Although HBPM values were consistently lower than ABPM values, the discrepancy grew post-training. The number of patients reaching the HT threshold via HBPM decreased significantly post-training [71 (55%) to 54 (41.9%); P = 0.006], whereas the number via daytime ABPM remained similar [82 (64.3%) vs. 84 (65.1%); P = 1.000]. Conclusion: Training and adherence to HBPM guidelines led to lower BP readings and fewer HT diagnoses. Contrary to the hypothesis, this method under "ideal conditions" underestimated HT prevalence when compared to daytime ABPM. Further studies with clinical endpoints are needed to refine HBPM methods and establish new BP thresholds for more accurate HT detection. [ABSTRACT FROM AUTHOR]

Background: There is no molecular test for Alzheimer's disease (AD) using self-collected samples, nor is there a definitive molecular test for AD. We demonstrate an accurate and potentially definitive TempO-Seq® gene expression test for AD using fingerstick blood spotted and dried on filter paper, a sample that can be collected in any doctor's office or can be self-collected. Objective: Demonstrate the feasibility of developing an accurate test for the classification of persons with AD from a minimally invasive sample of fingerstick blood spotted on filter paper which can be obtained in any doctor's office or self-collected to address health disparities. Methods: Fingerstick blood samples from patients clinically diagnosed with AD, Parkinson's disease (PD), or asymptomatic controls were spotted onto filter paper in the doctor's office, dried, and shipped to BioSpyder for testing. Three independent patient cohorts were used for training/retraining and testing/retesting AD and PD classification algorithms. Results: After initially identifying a 770 gene classification signature, a minimum set of 68 genes was identified providing classification test areas under the ROC curve of 0.9 for classifying patients as having AD, and 0.94 for classifying patients as having PD. Conclusions: These data demonstrate the potential to develop a screening and/or definitive, minimally invasive, molecular diagnostic test for AD and PD using dried fingerstick blood spot samples that are collected in a doctor's office or clinic, or self-collected, and thus, can address health disparities. Whether the test can classify patients with AD earlier then possible with cognitive testing remains to be determined. [ABSTRACT FROM AUTHOR]

Background: Several patient‐reported outcome measures (PROMs) have been developed for research to assess the multiple dimensions of chronic pruritus (CP). The acceptability and perceived benefits of their use in clinical practice remain unknown. Objectives: To assess the acceptability and perceived benefits of validated PROMs from the perspective of patients and physicians in dermatological offices and clinics. Methods: Patients with CP due to atopic dermatitis, psoriasis, chronic prurigo or chronic urticaria were recruited at 10 dermatological offices and two dermatological clinics in Germany. Patients completed a set of validated PROMs on pruritus intensity (numerical rating scale, NRS), symptom control (itch‐controlled days, ItchCD), quality of life (Dermatology Life Quality Index, DLQI; 5‐pruritus life quality, 5PLQ) and general health status (EuroQol, EQ‐VAS). Acceptability (relevance, difficulty of completion, length) and benefits (usefulness, feasibility) of these tools were assessed on a NRS (0–10) by patients and physicians, respectively. Data were analysed descriptively. Linear regression was used to study potential associations between age, sex, occupation, office versus clinic, change of therapy and physician‐reported benefits. Results: N = 523 patients (46% male, average age: 53.5 years) participated. Acceptability of PROMs by patients was high, indicated by low difficulty (Md = 0, IQR = 0–1 for all PROMs) and high relevance (Md = 8, IQR = 4–10 for all PROMs). Also, most patients (89–95%) rated length of the questionnaires as 'exactly right'. Physicians rated the NRS as the most beneficial instrument (feasibility: Md = 8, IQR = 6–10; usefulness: Md = 9, IQR = 7–10). Hierarchical linear regression revealed that only recruitment site (dermatological office vs. clinic) was significantly associated with usefulness and feasibility (higher ratings for clinical context; βs = 0.149–0.258, ps <0.05; except feasibility for EQ5d, β = ns). Conclusions: PROMs are welcomed by patients, while physicians consider instruments measuring pruritus intensity and impairment of quality of life as beneficial for the clinical routine. Widespread implementation of PROMs in daily clinical work is needed to improve care. [ABSTRACT FROM AUTHOR]

The average number of times a person will have surgery in their lifetime, and the amount of surgical healthcare resources they use, is unknown. Lifetime risk is a measure of the risk of an average person having a specific event within their lifetime. We report the lifetime risk of surgery and the change observed during the first year of the COVID-19 pandemic. We conducted a population cohort study using hospital episode statistics to identify all patients undergoing surgery between January 1, 2016, and December 31, 2020, in England. We calculated age- and sex-specific incidence rates of surgery and combined these with routinely available population and mortality data from the Office for National Statistics. We computed the probability of requiring surgery stratified by 5-yr epochs (age 0–4 to ≥90 yr). Our primary analysis calculated lifetime risk for all surgery using the life table method. We assessed the impact of the COVID-19 pandemic, comparing a pre-pandemic and a pandemic period. Between 2016 and 2020, 23 427 531 patients underwent surgery, of which 11 937 062 were first surgeries. The average denominator population for England was 55.9 million. The lifetime risk of first surgery was 60.2% (95% confidence interval 55.1–65.4%) for women and 59.1% (95% confidence interval 54.2–64.1%) for men. The COVID-19 pandemic decreased the lifetime risk of first surgery by 32.3% for women and by 31.7% for men. This estimated lifetime risk should only be applied to the English population. This population epidemiological analysis suggests that approximately 60% of people in England will undergo surgery in their lifetime. [ABSTRACT FROM AUTHOR]

Current literature on internal bordering has suggested understanding health care as a key migration control field. This article takes a closer look at the humanitarian medical offices in Frankfurt am Main, Germany, and patients from Romania and Bulgaria in precarious life circumstances. It addresses the strategies identified in the accounts of frontline workers beyond the mere provision of access to free and anonymous medical attention. Based on 16 interviews with medical staff, social workers and administrative officers, two approaches emerged. One clearly strives for the formalisation of the human right to health care in close collaboration with, or by challenging the local bordering actors; the other insists on bypassing any point of contact with them, focusing exclusively on informal and direct solutions. The interviews showcase how the resulting strategies can contribute to internal bordering and debordering on an urban scale, and affect the individuals' trajectories as patients and as migrants. [ABSTRACT FROM AUTHOR]

The article explores the potential for drug research and manufacturing in space, focusing on the success of Varda, a Californian start-up that produced an HIV drug in space. Other companies, including Bristol Myers Squibb, Amgen, and Gilead Sciences, are also investigating space for drug research. Microgravity in space allows for the production of higher quality drugs, as crystals grow in a more ordered and stable manner. The potential revenue from space-based drugs is estimated to be between $2.8 billion and $4.2 billion. Research conducted on the International Space Station has demonstrated that microgravity can enhance crystal properties, leading to increased interest in utilizing space for pharmaceutical research. However, the cost of conducting research and manufacturing in space remains a challenge that needs to be addressed for the space economy to flourish. [Extracted from the article]

Objective: The main objective of this study was to compare the knowledge and attitude of general dentists, senior dental students, and orthodontic residents toward obstructive sleep apnea (OSA). Materials and Methods: A questionnaire was designed and administered among 73 senior dental students, 84 general dentists, and 50 orthodontic residents. The questionnaire asked for demographic information of the participants and assessed their knowledge and attitude toward OSA. The validity and reliability of the questionnaire were confirmed by experts. Data were analyzed by the Kruskal−Wallis and Bonferroni tests using SPSS (α = 0.05). Results: The mean knowledge scores of general dentists and senior dental students were significantly lower than those of orthodontic residents (p < 0.001). However, there was no significant difference in the knowledge score of senior dental students and general dentists (p = 1). The mean knowledge score was significantly higher in dentists with 1–3 years of professional clinical experience (p = 0.02). The knowledge score was the highest in dentists working in private clinics followed by private offices and public clinics. The mean attitude score was the highest in orthodontic residents followed by general dentists and dental students. There was no significant difference in attitude based on the attended university, age, or time of graduation. Conclusion: According to the results, general dentists had insufficient knowledge about OSA, which could result in under‐diagnosis or misdiagnosis of patients with OSA. This finding highlights the need for further education and training for dentists to properly identify and refer OSA patients to orthodontists or sleep specialists. [ABSTRACT FROM AUTHOR]

BACKGROUND Previous studies with several limitations have comparatively analyzed the relationship between ambulatory blood pressure (BP) and self-measured BP and biomarkers of organ damage. This study extends this line of research by examining the relationship between ambulatory and self-measured BP and cardiac, renal, and atherosclerotic biomarkers in outpatients at cardiovascular risk. METHODS In 1,440 practice outpatients who underwent office, ambulatory, and self-measured BP monitoring, we assessed the relationships of each BP with organ damage biomarkers including b-type natriuretic peptide (BNP), echocardiographic left ventricular mass index (LVMI), urine albumin-creatinine ratio (UACR), and brachial-ankle pulse wave velocity (baPWV). RESULTS In the comparison of correlation, self-measured systolic BP (SBP) was more strongly correlated to log-transformed (Ln) BNP (n  = 1,435; r  = 0.123 vs. r  = −0.093, P  < 0.001), LVMI (n  = 1,278; r  = 0.223 vs. r  = 0.094, P  < 0.001), Ln-UACR (n  = 1,435; r  = 0.244 vs. r  = 0.154, P  = 0.010), and baPWV (n  = 1,360; r  = 0.327 vs. r  = 0.115, P  < 0.001) than daytime ambulatory SBP. In the linear regression models including office, ambulatory, and self-measured SBP, only self-measured SBP was significantly related to Ln-BNP (P  = 0.016) and LVMI (P  < 0.001). In the logistic regression models for the top quartile of LVMI, adding self-measured SBP improved the model predictability (P  = 0.027), but adding daytime ambulatory SBP did not. However, adding daytime ambulatory SBP improved the model predictability in the logistic model for the top quartile of baPWV including office and self-measured SBP (P = 0.030). CONCLUSIONS Our study findings suggested that self-measured BP was associated with cardiac biomarkers independent of ambulatory BP. [ABSTRACT FROM AUTHOR]

Aims: Arterial hypertension (aHTN) plays a fundamental role in the pathogenesis and prognosis of heart failure with preserved ejection fraction (HFpEF). The risk of heart failure increases with therapy‐resistant arterial hypertension (trHTN), defined as inadequate blood pressure (BP) control ≥140/90 mmHg despite taking ≥3 antihypertensive medications including a diuretic. This study investigates the effects of the BP lowering baroreflex activation therapy (BAT) on cardiac function and morphology in patients with trHTN with and without HFpEF. Methods: Sixty‐four consecutive patients who had been diagnosed with trHTN and received BAT implantation between 2012 and 2016 were prospectively observed. Office BP, electrocardiographic and echocardiographic data were collected before and after BAT implantation. Results: Mean patients' age was 59.1 years, 46.9% were male, and mean body mass index (BMI) was 33.2 kg/m2. The prevalence of diabetes mellitus was 38.8%, atrial fibrillation was 12.2%, and chronic kidney disease (CKD) stage ≥3 was 40.8%. Twenty‐eight patients had trHTN with HFpEF, and 21 patients had trHTN without HFpEF. Patients with HFpEF were significantly older (64.7 vs. 51.6 years, P < 0.0001), had a lower BMI (30.0 vs. 37.2 kg/m2, P < 0.0001), and suffered more often from CKD‐stage ≥3 (64 vs. 20%, P = 0.0032). After BAT implantation, mean office BP dropped in patients with and without HFpEF (from 169 ± 5/86 ± 4 to 143 ± 4/77 ± 3 mmHg [P = 0.0019 for systolic BP and 0.0403 for diastolic BP] and from 170 ± 5/95 ± 4 to 149 ± 6/88 ± 5 mmHg [P = 0.0019 for systolic BP and 0.0763 for diastolic BP]), while a significant reduction of the intake of calcium‐antagonists, α2‐agonists and direct vasodilators, as well as a decrease in average dosage of ACE‐inhibitors and α2‐agonists could be seen. Within the study population, a decrease in heart rate from 74 ± 2 to 67 ± 2 min−1 (P = 0.0062) and lengthening of QRS‐time from 96 ± 3 to 106 ± 4 ms (P = 0.0027) and QTc‐duration from 422 ± 5 to 432 ± 5 ms (P = 0.0184) were detectable. The PQ duration was virtually unchanged. In patients without HF, no significant changes of echocardiographic parameters could be seen. In patients with HFpEF, posterior wall diameter decreased significantly from 14.0 ± 0.5 to 12.7 ± 0.3 mm (P = 0.0125), left ventricular mass (LVM) declined from 278.1 ± 15.8 to 243.9 ± 13.4 g (P = 0.0203), and e′ lateral increased from 8.2 ± 0.4 to 9.0 ± 0.4 cm/s (P = 0.0471). Conclusions: BAT reduced systolic and diastolic BP and was associated with morphological and functional improvement of HFpEF. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association between white-coat hypertension (WCH) and acute retinal vein occlusion (RVO). Methods: In this retrospective case-control study, patients aged 40 years or older diagnosed with acute-phase RVO were included. Patients with other pathologies served as non-RVO controls. Blood pressure (BP) was measured in the office during their initial visit, and information about home BP and hypertension (HTN) medication was obtained through interviews. After 1:2 age and sex-matching between the RVO and non-RVO groups, the proportions of HTN cases were compared. A similar comparison was made in subgroups with or without HTN medication. Results: Fifty-one patients with RVO and 102 with non-RVO were included in the analysis. For the entire cohort, the RVO group exhibited a significantly greater proportion of WCH and sustained HTN compared to the non-RVO group. In the subgroup without HTN treatment, the proportion of WCH or sustained HTN was still significantly higher in the RVO group. However, in the subgroup receiving HTN treatment, the proportion of WCH or sustained HTN was higher in the RVO group than in the non-RVO group, though not statistically significant. Conclusion: This case-control study suggests that WCH may be associated with RVO, particularly in patients without HTN treatment. Given that interventions for WCH have not been standardized, a more detailed and prospective study is warranted to elucidate the risk of WCH for RVO and other retinal vascular diseases. [ABSTRACT FROM AUTHOR]

Optimal blood pressure (BP) for patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains unclear. This study aims to identify the optimal BP by investigating the association between average office BP and future clinical events in patients undergoing PCI. Consecutive patients undergoing PCI from 2012 to 2016 were included. They were divided into five groups according to the average follow-up BP after discharge. The co-primary outcomes were net adverse clinical events (NACE) and major adverse cardiac and cerebrovascular events (MACCE) up to 5 years. NACE was defined as a composite of MACCE (all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke, or any revascularization) or major bleeding. A total of 2845 patients were included, and among them, 787 (27.7%) experienced the NACE during the follow-up period. Patients in the highest SBP group (adjusted hazard ratio [HR] 1.495, confidence interval [CI] 1.189–1.880) and lowest SBP group (adjusted HR 1.625, CI 1.214–2.176) had a significantly higher risk of 5-year NACE. Similar associations were observed between SBP and the risk of MACCE, and similar results based on DBP categories were also observed. There was a J-curve relationship between SBP and DBP with respect to 5-year NACE and MACCE. The nadir point of risk for NACE and MACCE was found at 121.4/74.8 and 120.4/73.7 mmHg. In patients underwent PCI, there is a significant correlation between office BP level and clinical events, indicates the importance of efforts for optimal BP control to reduce ischemic and bleeding events. Trial registration: HanYang University Medical Center (HYUMC) Registry, NCT05935397. [ABSTRACT FROM AUTHOR]

Introduction: Emerging evidence from private sector hospitals indicates that a chief well-being officer (CWO) can be an impactful role to lead organizational burnout mitigation efforts in health care systems. A descriptive process evaluation was conducted to learn about facilitators and barriers of integrating this role within the Veterans Health Administration (VA). A pilot intervention inclusive of three domains—culture of well-being, efficiency of practice, and personal resilience—was implemented. Method: Eight VA medical centers and two regional network offices received 18 months of implementation support from October 2021 to March 2023. Appointed CWOs were tasked with implementing key interventions in at least two work units at each location. Administrative records were used to track implementation progress. Surveys were administered to participating work units pre- and postintervention to assess changes in key measures. Qualitative interviews elicited information about intervention implementation including barriers and facilitators. Results: Not formally hiring CWOs in the role resulted in limited time to work on intervention implementation. This was insufficient and it impacted their ability to truly function in the role. Several work units experienced multiple challenges and were unable to implement the full intervention. Despite these challenges, when examining work unit changes, improvements in culture of health and well-being and change readiness were observed. Conclusion: The results support the importance of a formalized CWO role; however, findings highlight important factors that must be addressed for successful integration of role to drive intervention effectiveness. Comprehensive interventions addressing both system- and individual-level drivers of burnout show promise for improving VA workforce well-being but warrant further study. Public Significance Statement: Public and private health care systems have made significant investments in initiatives to mitigate burnout and foster clinician well-being, including establishing executive-level wellness leadership roles with the responsibility to strategically embed such efforts within the organizational culture. Very little information has been published that provides guidance on how wellness leaders can implement organization-wide interventions to foster well-being and demonstrate effectiveness. Our results suggest that contextual factors, including site readiness, executive leadership active engagement, dedicated resources (including staff), and relative priority, may impact successful implementation of such efforts. [ABSTRACT FROM AUTHOR]

The document introduces a special section on addressing burnout, well-being, and resilience in healthcare teams. The authors conducted research to identify positive team experiences that contribute to workforce well-being and resilience. The document highlights the importance of social support and positive team relationships in combating burnout. It also discusses various interventions and approaches at individual, team, and system levels to address burnout and enhance well-being in healthcare settings. The authors emphasize the need for system-wide initiatives and user-focused solutions to support healthcare professionals effectively. [Extracted from the article]

Background: Chest pain is one of the most common causes of emergency room visits and also accounts for numerous visits to the family physician's office or Outpatient Clinics of cardiology or internal medicine. Case Report: Here we present a case of a 48-year-old female patient who presented to our hospital emergency unit but refused hospital admission. She presented in our Outpatient Clinic with a complaint of typical chest pain indicating it to be of coronary origin. A computed tomography (CT) coronary angiography for the evaluation of this chest pain was indicated. While ruling out the coronary origin of this chest pain, we were surprised to have incidentally identified the presence of an esophageal tumor mass that had intimate contact with carina of the trachea. After the diagnosis of esophageal leiomyoma was made and its surgical treatment was performed, the patient was asymptomatic. Approximately one year after the surgical intervention was performed, following the cessation of antiplatelet therapy and statin, the patient returned to our Outpatient Clinic complaining of chest pain again with the same characteristics as previously presented, being terrified by the possibility of the recurrence of the esophageal leiomyoma. Upon resuming investigations, it was proven through coronary angio-CT evaluation that the etiology of the chest pain was indeed coronary this time. However, the patient still refused hospital admission and the performance of percutaneous coronary angiography with the potential implantation of a coronary stent. Conclusions: Chest pain can be due to various underlying pathologies and should not be neglected. A thorough investigation and timely management are key to treating this possible fatal symptom. In our case, the patient presented twice with the complaint of typical chest pain indicating a possible coronary event, but at the first presentation, it was due to esophageal leiomyoma, while a year later, the patient had similar pain, which was indeed this time due to coronary blockage. Hence, it is of utmost importance to think of all possible scenarios and to investigate accordingly, leaving no stone unturned. [ABSTRACT FROM AUTHOR]

Student-faculty interaction (SFI) is an important indicator of student engagement that positively associates with academic achievement and retention. Quantitative information regarding the impact of emergency remote teaching (ERT) during COVID-19 on SFI is limited. This retrospective, observational cohort study tests the hypothesis that COVID-19 ERT negatively affected SFI in a gender-dependent manner. Electronic records of office hour (OH) appointments, used to measure SFI, for first-year medical students across three time periods, before, during and after COVID, were obtained and analyzed. A concerning, marked decline in SFI during and after the COVID-19 pandemic is noted. Before COVID, significantly more women (75.20%) made at least one OH appointment compared with men (40.54%). During COVID, the proportion of women making an OH appointment (69.71%) was statistically indistinguishable from women before COVID-19. In contrast, significantly fewer men during COVID (10.34%) than before COVID made an OH appointment. On return to face-to-face teaching, no rebound effect was observed. Compared with before COVID gender-matched peers, fewer men and women after COVID made OH appointments. Discipline-based analyses show that for all three time periods physiology emerged as the content area in which students made most OH appointments. The reduction in SFI observed, combined with the consistency with which the participants in our study indicated a need for assistance with the physiology discipline, emphasizes the importance of active promotion of faculty support and deliberate efforts to reconnect with students in the post-COVID context. NEW & NOTEWORTHY: Applying readily available data, we quantify a persistent, negative impact of the shift to emergency remote teaching (ERT) on a measure of student-faculty interaction (SFI) among first-year medical students. A gender-based component to these effects is also discussed. Before, during, and after COVID, physiology emerged as the most engaged-with discipline as measured by office hour (OH) appointment volume. [ABSTRACT FROM AUTHOR]

Previous research has outlined evident disparities in the prevalence of chronic conditions among African Americans compared to other groups, with low-income African American men disproportionately affected by almost every disorder. Self-management programs are useful tools for managing chronic disorders beyond the doctor's office. This monograph provides a detailed looking into the current state of the research on low-income African American men with chronic health conditions. An intersectional approach is used to provide a nuanced synthesis of relevant literature. The project outlines the need for programs designed to engage low-income African American men with skills, resources, and tools for managing chronic conditions. Authors argue that improvements to traditional self-management programs can be realized by emphasizing culture, including end-users in the creation of programs, and offering culturally tailored strategies to improve health. Thus, any targeted program must include culturally detailed information about nutrition, exercise, stress, mental health, and leveraging social support. [ABSTRACT FROM AUTHOR]

Background: A number of advancements have been implemented in recent years to reduce pain during office hysteroscopy and boost completion rates, for reduction of this pain, many drugs are offered as Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol. Paracetamol act centrally by inhibition of brain cyclooxgynase (Cox). This study aimed to assess the analgesic effect of paracetamol and ipubrofen tablets in pain perception during and after outpatient diagnostic hysteroscopy without anaesthesia. Methods: This was a Prospective, Randomized-Controlled clinical trial, conducted at the endoscopy unit of obstetrics and gynecology department at Zagazig university hospitals. Sixty patients included in our trial. The included women were divided into 3 groups; control group: did not receive any medication before the procedure. Group 2 (Paracetamol group): included 20 women received a 1000-mg oral paracetamol tablet, Group 3 (Ibuprofen group): included 20 women received a ibuprofen 600-mg tablet of the same appearance. The treatment was given one hour before the hysteroscopy. Results: The main indication for hysteroscopy was abnormal uterine bleeding in paracetamol group 12(60%), ibuprofen group 10(50%) and control group 7(35%). We found that uterine polyps were the major findings. In paracetamol group 8(40%), ibuprofen group 8(40%) and control group 5(25%). The pain scores, which comprised the VAS before hysteroscopy (p=0.976) and the VAS following hysteroscopy (p=0.832). Conclusions: The injection of ibuprofen and paracetamol one hour before to an office hysterscopy did not lessen pain during the procedure. [ABSTRACT FROM AUTHOR]

Background: Vestibular disorders are common among the pediatric population, but these cases often go undiagnosed due to a lack of vestibular assessment. Accurate diagnosis can be achieved through a thorough combined assessment of vestibular and neurological functions. Aim: The present work aims to 1) evaluate the vestibular findings and 2) detect the complementary role of vestibular to neurological assessment in dizzy children. Methods: This observational, case-control study involved 40 children: 20 healthy children and 20 children experiencing dizziness. All participants underwent full history taking, otological examination, basic audiological evaluation, neurological evaluation (clinical neurological examination, magnetic resonance imaging [MRI], and electroencephalography [EEG]), vestibular assessment (office tests and VNG), and the pediatric dizziness questionnaire. Results: Clinical neurological assessment of dizzy children revealed normal findings. However, EEG exhibited two patients with epilepsy, while MRI displayed positive findings in one case. However, vestibular assessment revealed impaired vestibular functions in the study group. Using the VNG, showed higher latency and lower velocity of saccadic test in both directions in the study group compared to the control group. Additionally, the pediatric dizziness questionnaire showed a mean vestibular category score of 4.1 ± 2.51 and a mean neurological category score of 3.2 ± 2.19. The questionnaire revealed that 45% of cases had vestibular disorders, 35% had neurologic disorders, and 20% had a combination of both. Conclusion: Neurological examinations alone may fail to diagnose dizziness in children. Despite the low prevalence of cases diagnosed with MRI and EEG, these investigations remain important for uncovering obscure conditions that were not revealed during clinical examinations and require urgent intervention. Additionally, vestibular assessment in dizzy children is a useful tool for diagnosing vestibular lesions. The pediatric dizziness questionnaire also complements the findings of vestibular and neurological assessments. [ABSTRACT FROM AUTHOR]

This article explores the dynamics of the author-editor-publisher relationship in orthopaedic publishing. It emphasizes the importance of collaboration, mutual respect, and shared goals between authors and editors. The role of authors is to create and innovate, while editors refine and validate their contributions. The manuscript writing process involves challenges such as presenting complex scientific ideas clearly and adhering to journal formatting requirements. Editors play a crucial role in enhancing the manuscript's readability and impact, providing feedback, and ensuring ethical guidelines are followed. The article also includes a humorous perspective on the collaborative process. The editors' authority is earned through their skills, and they use rhetorical strategies such as editorial dialogue, defining the audience, citing authoritative sources, and teaching authors to establish their authority. The article concludes by highlighting the responsibility of editors to ensure a fair and prompt peer-review process. The goal of International Orthopaedics, as the official journal of SICOT, is to publish top-quality orthopedic research and support learning and improvement among surgeons globally. [Extracted from the article]

Objective: Despite its widespread use, in vitro fertilization (IVF) outcomes are challenged by implantation failure, largely due to factors such as embryo quality and endometrial receptivity. In this study, we investigated the clinical effect of office hysteroscopy (OH) on the subsequent frozen–thawed embryo transfer (FET) in infertile women who experienced a failed IVF–embryo transfer (IVF‐ET) cycle. Methods: We included 577 infertile women who underwent OH because of a history of failed ET between October 2019 and September 2021. During OH, visible endometrial polyps (EPs) were diagnosed and removed by curette or biopsy forceps; chronic endometritis (CE) was diagnosed by histopathology and immunohistochemistry and treated with oral doxycycline (0.2 g/d) for 14 days. According to the hysteroscopic findings and endometrial pathology with immunohistochemistry, patients were divided into three groups: group A (n = 161) had CE with or without EPs, group B (n = 156) had EPs only, and group C (n = 260) had no CE or EPs. Results: In the following FET cycle, the implantation rates were 47%, 51%, and 45% (P = 0.411); the clinical pregnancy rates were 56%, 62%, and 55% (P = 0.436); the live birth rates were 45%, 51%, and 42% (P = 0.205); and the miscarriage rates were 18%, 16%, and 22% (P = 0.497) in groups A, B, and C, respectively. There were no significant differences among groups (P > 0.05). Conclusion: OH is helpful for diagnosis and treatment of abnormal intrauterine environment in women with a failed IVF cycle and further improves their pregnancy outcome in the following FET. Synopsis: Before subsequent fertilization–embryo transfer, office hysteroscopy is helpful for improving pregnancy outcome in women with failed in vitro fertilization. [ABSTRACT FROM AUTHOR]

Background and Objectives: Recent increases in methamphetamine use among people seeking treatment for opioid use disorder (OUD) has created significant demand for effective approaches to support this clinical population. This study assessed the extent to which office‐based opioid treatment (OBOT) patients, who were diagnosed with methamphetamine use disorder (MUD), engaged with providers. Methods: A retrospective analysis was conducted of adult patients (n = 470) seeking treatment for OUD who attended at least one visit between March 2020 and March 2023 at a rural regional OBOT provider. Approximately one quarter (28.7%) of patients were diagnosed with MUD in addition to receiving an OUD diagnosis. Bivariate methods and multivariate negative binomial regression models were estimated to examine the associations between clinical measures and the numbers of office visits, peer visits, and telehealth visits. Results: Regression results indicated patients who met criteria for MUD in addition to OUD attended a higher rate of peer visits (incidence rate ratio [IRR] = 2.63, p =.036) when compared to patients who did not meet criteria for MUD. In contrast, patients with MUD and OUD diagnoses displayed significantly lower (IRR = 0.68, p <.001) engagement rates through fewer office visits relative to those who did not meet MUD criteria. Discussion and Conclusions: Patients seeking treatment for OUD who meet criteria for MUD are more likely to engage through peer support specialists rather than office visits. Scientific Significance: This study demonstrates the ways patients who meet criteria for OUD and MUD engage with providers to receive treatment. [ABSTRACT FROM AUTHOR]

Executive Summary: This paper explores how qualitative information may be used to enhance understanding and inform recommendations for improved accounting of migrant deaths along the Texas-Mexico border. While border crossing related deaths affect jurisdictions throughout the US's Southwestern border states and Northern Mexican states, Texas has unique challenges that merit specific examination. In short, the management and investigation of unidentified migrant decedents in Texas is severely fragmented and often noncompliant with Texas Criminal Code Procedure. I explore a way to improve accounting of migrant deaths leveraging qualitative information, local newspaper articles from South Texas and Northern Mexico, by using descriptive summaries coupled with Sankey Diagrams and a programmatic technique, qualitative spatial representation (QSR). QSR enabled me to identify under-recognized stakeholders (South Texas locals, Mexican consulates) and under-supported counties (i.e., those with migrant deaths that do not share a border directly with Mexico). I found that local English-language newspapers obscured the prevalence of migrant deaths and that their narrative tone of "business as usual" normalized the occurrence of such deaths. The Spanish-language articles better represented the diversity of agencies and individuals that were involved in the various aspects of migrant remains management and forensic investigation, most notably residents of South Texas themselves (or situational participants who first found the remains) and Mexican consulates. Finally, I noted that the collaborations among Texas counties and between Texan and Mexican jurisdictions, when they were described in the newspapers, highlighted that the phenomenon of migrant deaths penetrates beyond the dividing line of the Rio Grande/Río Bravo River. Migrant deaths must be accounted for in a way that reflects a regional experience in which people may perish as far as ~100 miles into Texas' interior. Considering these observations, I have two policy recommendations. First, the Office of the Texas Governor should establish funds distinct from the Operation Lone Star program for the management of unidentified human remains. Currently, grants through the Operation Lone Star Program are the only funds available in Texas to support identification of migrant decedents. However, this program is explicitly designed to further border security operations in the state of Texas, which can contradict efforts around recovery and identification. The documentation and forensic investigation of the unidentified deceased can be eclipsed or neglected under the larger deterrence aims of Operation Lone Star. Second, to improve accounting and increase documentation of migrant deaths, a Regional Identification Center should be established in South Texas. Not every county in Texas has or has access to a Medical Examiner's office, including the means to transport and pay for autopsy or other forensic services. The Center would provide training, store extra equipment such as mobile refrigerated morgues, and hire personnel to inventory cases, and report information to the state (e.g., vital statistics) and to foreign consulates. A Regional Identification Center would counteract the challenges highlighted in the local newspaper summaries and QSR by decreasing the isolation of counties experiencing migrant deaths and serve as a documentary and communication hub for stakeholders in Texas and Mexico. [ABSTRACT FROM AUTHOR]

Executive Summary: The United States is no stranger to migration across its borders. In 2020, its Southwestern border saw a drastic increase in apprehensions by the Border Patrol. While imperfect and an undercount of the true number of migration events, apprehension data is often used as a proxy to understand migration patterns. The rise in migration was coupled with an increased but unknown number of deaths along migration routes. This article focuses on the New Mexico portion of the El Paso Border Patrol Sector and the increased migrant caseload at New Mexico's Office of the Medical Investigator (OMI) over the last few years. To the best of our knowledge, this article is the first academic study to examine migrant deaths in detail in southern New Mexico. We begin by contextualizing the changing pattern of migrant deaths in New Mexico within the broader framework of border policing strategies that have intentionally pushed migration routes to remote areas. We describe the work of the OMI, highlighting its very recent initiatives to track migrant deaths in its database. We then discuss the changes seen by the OMI in its migrant caseload from fiscal year (FY) 2009 to 2023, with the most drastic increase in cases occurring from 2022 to 2023. For instance, the data indicate that most of the identified migrants that have died in New Mexico were recovered in June and July (45 percent), crossed through Doña Ana County (66 percent), were male (60 percent), and among those identified, were from Mexico (65 percent) and between 20 and 39 years of age (69 percent). Of the 248 cases of migrant deaths, 87 percent have been identified. The most common causes of death were undetermined (46 percent) and environmental exposure (41 percent). We then explore the effects of changing governmental policies and state initiatives to curb/reduce migration in the US on OMI's increased caseload. We discuss the impact that the rapid shift in migration deaths is having on the OMI and how OMI is working to respond and adjust to the dynamic situation. This work highlights the collateral damage of border security measures, underscored by the increasing number of deaths and challenges faced by the OMI. We consider the need for new and amended policies aimed at mitigating the humanitarian crisis that continues to unfold, emphasizing the need for the humane treatment of migrants. Finally, we suggest allocating resources to death investigating agencies. These resources would provide essential support to find, identify, and repatriate migrants, improve agencies' abilities to collaborate with governmental agencies and programs such as Border Patrol's Missing Migrant Program, and improve our understanding of the circumstances along the Southwestern border. [ABSTRACT FROM AUTHOR]

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Vaccination is crucial in reducing the spread of disease and improving overall patient mortality. Limited information exists regarding pharmacist accessibility outside traditional medical settings or impact on older patients' intention to vaccinate. This study aimed to examine patient perceptions regarding pharmacist accessibility and vaccination intention. Researchers used a quantitative research method of older people from Ohio, Kentucky, and Indiana. A survey was given to community-dwelling older people who attended different vaccine clinics. The survey included 10 questions describing reasons for not receiving vaccines in the past, how likely they are to receive vaccines if administered at community events, and the importance of having easy access to vaccines. For Likert-type items, a 5-point scale was used. The surveys were collected electronically and anonymously from several community events. Aggregate data were analyzed with descriptive and inferential statistics. One hundred seventy-eight responses were collected. The average age of participants was 75 years, and 70.8% were females. Of the respondents, 44.9% preferred to receive vaccines at a community center, 17.4% at the doctor's office, 4.5% at a clinic, and 9.6% at a sporting event like a boxing match. Men were more likely to receive a vaccine at a sporting event, while women were more likely to be interested in receiving a vaccine at a community center (P < 0.05). Respondents somewhat agreed (median = 4, interquartile range = 3-5) that they do not have transportation to places with vaccines. Age was significantly and negatively correlated with educational attainment (P < 0.001). However, as participants' ages increased, they were significantly more likely to have a belief that vaccines do not work (P = 0.011). The study addressed how pharmacists should consider more community outreach events in convenient locations, like community centers, for older people to improve vaccination rates. [ABSTRACT FROM AUTHOR]

Objective. The prevalence of hypertension, a major cardiovascular risk factor, is increased in patients with rheumatoid arthritis (RA) and may be driven by immune activation. The purpose of this study was to determine if ambulatory 24-hour blood pressure (BP) is elevated in RA vs control participants and whether it is associated with immune activation. Methods. We conducted a cross-sectional study of 46 patients with RA and 23 control participants. Participants wore an ambulatory BP monitor that obtained diurnal BP every 15-30 minutes and nocturnal BP every 30 minutes. Inflammatory mediators in plasma were measured using an inflammation proteomics panel. Differences in BP measurements were assessed by Mann-Whitney U test, and association with inflammatory mediators was assessed by Spearman correlation. Results. Patients with RA and control participants had similar office BP, but median ambulatory systolic BP (SBP) measurements (24-hour [RA 121 mmHg vs control 116 mmHg; P = 0.01], diurnal [RA 128 mmHg vs control 120 mmHg; P = 0.003], and nocturnal [RA 112 mmHg vs control 103 mmHg; P = 0.002]) were higher in patients with RA. Patients with RA also had higher nocturnal diastolic BP (DBP; RA 63 mmHg vs control 57 mmHg; P = 0.02), but other DBP measurements were similar. Nocturnal BP dipping was less in patients with RA (12%) compared to control participants (16%; P = 0.02). In patients with RA, higher 24-hour and nocturnal SBPs and less nocturnal dipping were strongly correlated with a wide range of inflammatory mediators. Conclusion. Despite similar office measurements, 24-hour and nocturnal SBP measurements were higher in patients with RA than in control participants and were strongly associated with inflammation. [ABSTRACT FROM AUTHOR]

This paper presents a Machine Learning and IoT-based intelligent medical system for the detection and monitoring of patient stress. This system is made up of a medical kit measuring the oxygen saturation, the heart rate and the galvanic skin response thanks to sensors attached at the top of the patient's hand which send the measured physiological values to the Firebase server. A voting classifier, combining five Machine Learning algorithms (Logistic Regression, K-Nearest Neighbors, Support Vector Machine, Decision Tree and Random Forest) using holdout and K-fold cross-validation, was implemented on a Raspberry board installed in the doctor's office. The proposed system can make predictions with the Soft Voting classifier with an accuracy that reaches 78%. [ABSTRACT FROM AUTHOR]

Background and Objectives: We evaluated the prevalence and characteristics of isolated nighttime masked uncontrolled hypertension (IN-MUCH) in treated patients. Materials and Methods: Participants aged 20 years or older who were on antihypertensive medication underwent three-day office blood pressure (BP) and 24 h ambulatory BP measurements. Hypertension phenotypes were classified as controlled hypertension (CH), isolated daytime masked uncontrolled hypertension (ID-MUCH), IN-MUCH, and daytime and nighttime masked uncontrolled hypertension (DN-MUCH). Results: Among 701 participants, 544 had valid BP data and controlled office BP (<140/90 mmHg). The prevalence of IN-MUCH was 34.9%, with a higher prevalence of men and drinkers than in those with CH. Patients with IN-MUCH had higher office systolic BP (SBP) and diastolic BP (DBP) than those with CH. The prevalence of IN-MUCH was 37.6%, 38.5%, and 27.9% in patients with optimal, normal, and high-normal office BP levels, respectively. Among IN-MUCH patients, 51.6% exhibited isolated uncontrolled DBP and 41.1% uncontrolled SBP and DBP. Younger age (p = 0.043), male sex (p = 0.033), and alcohol consumption (p = 0.011) were more prevalent in patients with isolated uncontrolled DBP than in those with uncontrolled SBP and DBP. Age and alcohol consumption were positively associated, whereas high-normal office BP exhibited a negative association with IN-MUCH. Conclusions: The IN-MUCH was significantly more prevalent in patients with normal or optimal office BP, posing treatment challenges. Further investigation is needed to determine whether differentiation between isolated uncontrolled DBP and combined uncontrolled SBP and DBP is necessary for prognostic assessment of IN-MUCH. [ABSTRACT FROM AUTHOR]