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Introduction: Early recognition and indicated prevention is a promising approach to decrease the incidence of Major depressive episodes (MDE), targeting the patients during their clinical high-risk state of MDE (CHR-D). The identification of a set of stressors at the CHR-D increases the success of indicated prevention with personalized early interventions. The study evaluated stressors in the early phase of depression, developed on the basis of a patient survey on stressors. Methods: Sixty-eight inpatients (ICD10: F3x.xx) with a reported high risk state for major depressive episode (CHR-D) were included in the current study. Stressors during CHR-D were retrospectively explored using a semi-structured clinical interview supplemented by open-ended questions. A qualitative explorative content analysis was provided to identify a pattern of stressors during the prodromal phase of the patients, based on the patient's perspective. A frequency analysis was performed for the evaluation of the prevalence of reported source of stress. Results: All patients reported stressors in the prodromal phase of depression. Results demonstrates that patients with depressive disorder typically report multiple stressors, with the most common number being four. First, 18 stressors-groups were identified during coding. Interpersonal conflicts and disappointments in close relationships were most frequently reported stressors during the prodromal phase at 44.1%. The second most frequent stressor mentioned was the high qualitative or quantitative demands at work (38.2%). The third frequent source of stress was changes in close relationships and in family relationships (33.8%). Based on the categories of stressors described in the patient survey during the prodromal phase we suggested a model of stressors in CHR-D during the prodromal phase of the MDE. Discussion: The identification of a set of stressors at the early stage of MDE may increase opportunities for early intervention. In everyday clinical practice, preventive psychiatry needs clinical and adapted instruments for recording stressors in today's society. This knowledge is necessary in order to develop precisely indicated prevention for depressive disorders. [ABSTRACT FROM AUTHOR]

Background: HIV clinical guidelines recommend hypertension detection and management to lower cardiovascular disease risk, but these have not been effectively implemented for people living with HIV (PWH). Addressing this implementation gap requires community-engaged implementation studies focused on addressing implementation barriers specific to the HIV care context. Methods: This protocol describes a type 2 effectiveness-implementation hybrid study conducted in nine primary care clinics in Johannesburg. The study will evaluate the effect of implementation strategies on guideline-recommended blood pressure assessment and management in HIV clinics and the effects of assessment/management on patient blood pressure. A stepped-wedge, cluster randomized study design was used to randomize clinics to the time at which they receive the implementation strategies and patient intervention. The implementation strategies tested include identifying and preparing care champions, changing record systems, conducting ongoing training, providing audit and feedback, and changing the physical structure/equipment. The patient intervention tested includes detection of elevated blood pressure, educational materials, lifestyle modification advice, and medication where needed. Implementation outcomes include adoption, fidelity (co-primary outcome), cost, and maintenance of the blood pressure assessment protocol in participating clinics, while patient outcomes include reach, effectiveness (co-primary outcome), and long-term effects of the intervention on patient blood pressure. These will be assessed via direct observation, study records, staff logs, medical chart reviews, and patient and healthcare worker surveys. To examine effects on the implementation (intervention fidelity) and effectiveness (patient blood pressure changes) co-primary outcomes, we will use the standard Hussey and Hughes model for analysis of stepped-wedge designs which includes fixed effects for both interventions and time periods, and a random effect for sites. Finally, we will examine the costs for the implementation strategies, healthcare worker time, and patient-facing intervention materials, as well as the cost-effectiveness and cost-utility of the intervention using study records, patient surveys, and a time and motion assessment. Discussion: This study will address knowledge gaps around implementation of cardiovascular disease preventive practices in HIV care in South Africa. In doing so, it will provide a dual opportunity to promote evidence-based care in the South African HIV care context and help refine implementation research methods to better serve HIV populations globally. Trial registration: ClinicalTrials.gov: NCT05846503. Registered on May 6, 2023. https://classic.clinicaltrials.gov/ct2/show/NCT05846503. [ABSTRACT FROM AUTHOR]

Background: Female pattern hair loss (FPHL) is women's most common form of alopecia. The study aimed to evaluate the efficacy of extracorporeal shock waves for hair growth and regeneration in women with FPHL. Methods: A prospective single‐center noncontrolled study was conducted in patients with FPHL who underwent eight treatment sessions with C‐Actor, a shock wave applicator. Outcome measures included total hair count, number of follicular units (FUs)—single FUs, double FUs, triple and bigger FUs—the average thickness, cumulative hair thickness, and changes in the Derived Sinclair scale, assessed with Tricholab (Fotofinder System). Patients completed a survey to assess their subjective perceptions of hair improvement regarding softness, hair loss, quality, and volume. Results: Twenty women were included with a mean age of 43 (SD = 5.65). The mean increase in total hair count was 8.9% (p < 0.00001), in number of FUs 4.6% (p = 0.00031), in number of triple and bigger FUs 18.4% (p = 0.0004), in cumulative hair thickness 8.0% (p < 0.00001), with a decrease of 5.7% in mean Derived Sinclair scale value by 2.2–2.1 (p < 0.0001). After 3 months, 85% of patients perceived improvement in hair volume. Conclusion: Extracorporeal shock waves for hair growth and capillary regeneration in women with FPHL showed statistically significant outcomes, and all patients reported an improvement in hair characteristics. [ABSTRACT FROM AUTHOR]

Background: Despite several reports on red blood cell (RBC) alloimmunization, the actual prevalence and factors contributing to RBC alloimmunization in transfused patients remain poorly investigated. We examined the association between clinical factors and the development and evanescence of RBC antibodies after transfusion. Study Design and Methods: Each participating institution performed antibody screens before and after RBC transfusion. A survey including patient characteristics, results of antibody screen and identification, antibody screen methods, total amount of RBC transfused, and adverse reactions, was conducted. Results: Between October 2018 and March 2023, 1194 patients were registered at five institutions. Overall, 958 patients underwent at least one follow‐up RBC antibody screen after transfusion, revealing new antibody development in 44 (4.6%). Anti‐E was identified in 25 patients, anti‐Jka in 5, and anti‐c in 4. The number of RBC units transfused was significantly associated with antibody development after transfusion (p <.001). Among 55 patients in whom antibodies were identified after transfusion, including historical antibodies, antibodies evanesced in 18 (33%); anti‐E in 7, anti‐Jka in 4, and anti‐Lea in 2. Evanescent antibodies were identified more frequently by saline and/or enzyme methods than persistent antibodies (p =.012). Discussion: The number of RBC units transfused can impact antibody development, and antibodies identified only by saline and/or enzyme methods, deemed clinically insignificant, are likely to have a high evanescence rate. Antibody screen should be carefully performed, especially in those receiving a large number of RBC units. Confirming previous antibody screen results should be performed to prevent omitting evanesced antibodies regardless of clinical relevance. [ABSTRACT FROM AUTHOR]

Background and objective: A range of diagnostic criteria are applied for the heterogenous patient group with fatigue or postviral fatigue syndromes with or without Post Exertional Malaise (PEM). We explored whether DePaul Symptom Questionnaires (DSQ) based symptoms reported in an open online survey called MECOV, served to identify more homogenous sub-groups. Method: Patients living in Norway were invited to participate in an open online survey in 2022. The questionnaire covered diagnostic history, SARS-CoV-2, general health, RAND-36 and DSQ symptoms, treatments and background information. Results: 2362 patients responded to the survey. 1904 respondents had Fatigue or Postviral disease. 1026 fulfilled CCC criteria with multi-dimensional PEM and 14 h recovery period or ICC criteria for ME. 384 fulfilled IOM/NICE or CCC criteria with only less rigid PEM, while 494 respondents fulfilled only broad fatigue and Fukuda criteria. Self-reported health status, number of treatments tried, and reported effect of activity-based treatments varied significantly across the three groups. Conclusion: DSQ symptom-based survey diagnoses served to identify more homogenous subgroups of patients with Fatigue or Postviral diseases (ME and CFS) and may serve as a valid supplement to standard medical examinations. Symptoms, treatment, management strategies and further research may gain from being tailored to the three sub-groups. [ABSTRACT FROM AUTHOR]

Papular acne scars are a special type of acne scar, and the prevalence and treatment of this disease have rarely been reported in the literature; moreover, the prevalence of this disease is often neglected, and treatment is difficult. Our study revealed a high prevalence of this type of acne scar in the clinic and explored an effective and safe method. This retrospective study aimed to analyse the prevalence of papular acne scarring among patients attending our Dermatology Laser Clinic and evaluate the clinical efficacy of fractional CO2 lasers. We retrieved the data of 370 patients with acne scarring who visited our hospital between April 2021 and November 2022 and analysed the prevalence of papillary acne scarring among them. Among these patients, 35 underwent CO2 laser treatment using an artificial grid pattern. A total of three treatments were administered, with a two-month interval between each session. Scar assessment was conducted using the Global Scar Scale (GSS) and the Acne Scar Clinical Assessment (ECCA) scale, along with physician visual evaluation and patient satisfaction surveys, both before the first treatment and one month after the final treatment. Adverse reactions were recorded during follow-up visits after each treatment. Among the 370 patients with acne scarring, 128 exhibited papular acne scarring, resulting in a prevalence rate of 34.6%. Among them, 37.5% were male and 32.6% were female. A total of 90.6% of patients had combined other types of acne scarring, while 9.4% had papular acne scarring exclusively. Following CO2 laser grid treatment, there was a significant reduction in GSS scores and ECCA values, accompanied by a noticeable improvement in physician visual evaluation and patient satisfaction scores. Papular acne scarring has a relatively high incidence rate, and there is no significant sex difference. It often coexists with other types of acne scarring. CO2 laser treatment using an artificial grid pattern effectively improved papular acne scarring with a good safety profile. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Analytic Method Results Conclusions We hypothesized that many neurologists underestimate patients’ willingness to self‐administer injectable Parkinson's disease (PD) medication.To evaluate patient and physician perceptions contributing to underutilization of PD medications for acute OFF episodes.Data were collected using an online survey including n = 4063 PD patients experiencing OFF episodes and n = 200 neurologists.89% of patients were willing to self‐inject rescue therapies to treat acute OFF episodes. After reviewing patient survey data, 54% of general neurologists and 37% of movement disorder specialist (MDS) demonstrated a change in perceptions about patients’ willingness to use self‐injected therapies (P < 0.05). 37% of general neurologists and 21% of MDS indicated a greater likelihood of prescribing these treatments (P < 0.05).Most patients suffering from OFF episodes would be willing to self‐inject to abort their symptoms. Neurologists underestimate this patient acceptance. Understanding patient attitudes and further education about rescue therapies is likely to increase use of these therapies. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this scoping review was to investigate in the literature how a learning health system (LHS) can be implemented in cases of complex, costly, chronic (3C) conditions. Methods: A scoping review of literature published in English since 2007 was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature, and Scopus. Two authors screened the resulting articles and two authors extracted study details on the structure, process, and outcome of each LHS. Eligibility criteria included studies of LHSs that focused on populations experiencing a complex chronic health condition. A narrative synthesis of data was conducted using deductive qualitative methods. Results: Application of the authors' search strategy resulted in 656 publications that were analyzed for this review. The authors included 17 studies that focused on 13 LHSs. The structure of the LHSs had many components, and many included data from either patient surveys or patient charts. The processes varied widely, from engaging patients in the process to exclusively analyzing the data. The outcomes were largely patient-reported, though several clinical outcomes were also used to benchmark the success of the LHS. Discussion: Our review shows that LHS definitions, structures, processes, and outcomes in 3C applications vary widely. Many have shown substantial potential to be implemented and improve care in 3C populations. To deliver on this goal, future work will need to focus on better specification, formalization, and definition of LHS approaches, as well as better design of their structures, processes, and outcomes to fit the needs of the intended population. [ABSTRACT FROM AUTHOR]

Patient experiential knowledge is important for the quality and responsiveness of healthcare systems. However, it is not rare for patients to struggle to have their knowledge recognised as credible and valuable. This study explores how patient organisations work to adjust patient knowledge to formats recognisable and acceptable by healthcare governance decision-makers. Using the case of patient organisations in Russia, we show that such formatting involves changes in language, practices, and materiality that contribute to channelling patient participation into specific routes and forms while marginalising others. Channelling of patient participation, then, rather than being a result of direct coercion, emerges as a distributed process continuously co-produced by a multitude of actors, such as state administration, patient organisations themselves, patient surveys, consultative spaces, and normative acts. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness and safety of treating erythematotelangiectatic rosacea using fractional radiofrequency (FRF). Methods: Twenty patients with a confirmed diagnosis of erythema capillaris rosacea were selected, and one side of each patient's face was randomly assigned to receive FRF treatments for three to six times, with an interval of 2 weeks between each treatment. VISIA, dermoscopy, and the Clinician's Erythema Evaluation Scale (CEA) were applied to evaluate the efficacy of the treatment before and after the treatment, to record the VAS scores and adverse reactions, and to conduct a patient satisfaction survey. Results: The characteristic counts and scores of red zone and porphyrin as assessed by VISIA test were significantly decreased, and the difference between the treated side and the pretreatment side was statistically significant (p < 0.05), and the efficacy of the treatment was statistically insignificant compared with the control side, except for the red zone and porphyrin which were statistically significant before and after the treatment (p > 0.05). By CEA score, the difference between the treated side after treatment and the control side was statistically significant (p < 0.05), and the difference between the treated side before and after treatment was statistically significant (p < 0.05); the difference between the control side before and after treatment was not statistically significant (p > 0.05). Dermatoscopic observation showed reduction in pore size, reduction of yellowish‐white and black horn plugs within the pores, lightening of the red background and thinning and blurring of the capillary structure on the treated side of the skin compared to the control side, and the skin on the treated side showed the above mentioned changes before and after the treatment as well. The mean pain score of the subjects was obtained by VAS score 3.67 ± 0.90. Adverse effects included mild edema, erythema, and microscopic crusting; no long‐term adverse effects were seen in all patients. The efficacy of FRF treatment was evaluated 1 month after the final treatment, and 85% of the subjects rated it as satisfactory, very satisfactory, and very satisfactory. Conclusion: FRF for the treatment of erythematous capillary dilatation rosacea is effective, safe, and suitable for clinical promotion. [ABSTRACT FROM AUTHOR]

Background: Inactivity and bedrest during hospitalisation have numerous adverse consequences, and it is especially important that older patients are mobile during hospitalisation. This study aimed to identify whether the introduction of formal education of clinical staff and a Mobilisation Initiative (MI) could increase mobilisation of patients in a geriatric and a medical ward. Furthermore, to explore patients' and health care staffs' view on facilitators and barriers for mobilisation during hospitalisation. Methods: The study was a pragmatic clinical study. Both qualitative and quantitative methods were used. The patients' level of mobilisation was obtained through short interview-based surveys and observations. Focus group interviews and formal education of clinical staff was initiated to increase awareness of mobilisation along with the implementation of a MI. Results: 596 patient surveys were included. Of all patients, 50% in the geriatric ward and 70% in the medical ward were able to independently mobilise. The highest percentage of patients sitting in a chair for breakfast and lunch in the geriatric ward was 57% and 65%, and in the medical ward 23% and 26%, respectively. A facilitator for mobilisation was interdisciplinary collaboration, and barriers were lack of chairs and time, and the patients' lack of help transferring. Conclusions: This study adds new knowledge regarding the lack of in-hospital mobilisation in geriatric and medical departments. Mealtimes are obvious mobilisation opportunities, but most patients consume their meals in bed. A potential for a MI is present, however, it must be interdisciplinarily and organisationally anchored for further investigation of effectiveness. Trial registration: Retrospectively registered at ClinicalTrials.gov with the trial number NCT05926908. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsThe purpose of this study is to evaluate the usage of oxymetazoline hydrochloride ophthalmic solution, 0.1% in the treatment of Graves’ disease to improve lid symmetry.Fourteen patients were identified with unilateral upper eyelid retraction, secondary to Graves’ disease. A phenylephrine test was performed to evaluate whether treating the unaffected (non-retracted) side would result in improved symmetry using Hering’s law. Patients were prescribed oxymetazoline hydrochloride ophthalmic solution, 0.1% to instill into the unaffected eye. Marginal reflex distance 1 (MRD1) measurements were taken pre- and post-treatment and patient satisfaction surveys were completed.The average pre-treatment MRD1 difference between the right eye (OD) and the left eye (OS) was 2.46 [range 1.50–4.00]. The average post-treatment MRD1 difference between OD and OS was 0.39 [range 0.00–1.00]. One hundred percent of patients were satisfied or very satisfied with the improvement in symmetry.Oxymetazoline hydrochloride ophthalmic solution, 0.1% is a potential method to improve symmetry in patients with Graves’ disease and unilateral upper eyelid retraction via Hering’s law, especially for non-surgical candidates or those who prefer non-surgical treatment. Our results indicate improved MRD1 differences between fellow eyes and patient satisfaction regarding the symmetry of the upper eyelids. [ABSTRACT FROM AUTHOR]

This case study presents a 47-year-old male who was diagnosed with Gorham-Stout syndrome (GSS) 10 years ago in the occipitocervical junction. The pathology caused the resorption of the suboccipital bone, clivus, foramen magnum, and C1–C3 laminae. After his first fusion attempt in 2010 using occipital plate-cervical lateral mass screws, he needed many revision surgeries either for the progression of the pathology or for instrumentation failure and wound healing problems. Eventually, a new occipital plate and cervical pedicle screws were applied to obtain the exact solution. The involvement of the craniovertebral junction in GSS may be challenging for spinal surgeons due to the inadequate bone reserve for stabilization. As lateral mass screws cannot provide a strong pull-out force, cervical pedicular screws may be used as the first choice for unstable cervical GSS cases. [ABSTRACT FROM AUTHOR]

Facial neuromuscular rehabilitation (fNMR) is an evidence-based practice for the treatment of peripheral facial palsy (PFP). Surgical reconstruction can be indicated for patients who demonstrate poor or no recovery to support symmetry, function, and aesthesis. There is paucity of research demonstrating the therapeutic benefit of a multidisciplinary team (MDT) in facial recovery of this specific subpopulation of patients. This article will outline the role of specialist facial therapy in the remediation of PFP, focusing on those who undergo surgical reconstruction to optimize their facial recovery. Case studies are used to demonstrate surgical and therapeutic outcomes as well as the results of a patient survey conducted for a service evaluation. We discuss the role of the MDT in supporting recovery as well as the role of targeted fNMR. The term fNMR is often used interchangeably with facial therapy or facial rehabilitation. We will refer to fNMR as a technique of facial rehabilitation. We aim to demonstrate that an MDT approach to the treatment of people with facial palsy provides positive outcomes for this surgical population and that future research would be beneficial to support this service delivery model. [ABSTRACT FROM AUTHOR]

Background Pectus excavatum deformities are usually repaired with a minimally invasive approach in which a metal bar is used to correct the chest wall abnormality. We aimed to evaluate long-term outcomes and patient satisfaction after surgical correction. Methods Patients who underwent pectus excavatum repair and subsequent bar removal at a single tertiary care center from January 2000 to December 2020 were identified. A retrospective chart review was performed, and a telephone survey was conducted to evaluate perceived inward chest movement, need for surgeon reevaluation, surgical reintervention, and overall satisfaction. Data are presented as medians with interquartile ranges (IQRs) and frequencies with percentages. Results A total of 583 patients were included. The survey response rate was 26.2% (n = 153). The respondents were predominantly male (80.4%, n = 123) with a median age at surgical correction of 14.9 years (IQR 12.9, 16.1) and a median Haller index (HI) of 3.8 (IQR 3.4, 4.5). Median time to bar removal was 2.9 years (IQR 2.5, 3.0) with a median age at removal of 17.7 years (IQR 15.5, 19.0). Median time from surgery to survey follow-up was 9.6 years (IRQ 5.0, 11.4) with respondents having a median age at follow-up of 25 years (IQR 22.0, 28.4). The satisfaction rate was 96.7% (n = 148) with a reintervention rate of 2.0% (n = 3). The perceived inward chest movement was 30.7% (n = 47) with 12.8% (n = 6) of those requesting surgical reevaluation. Conclusion There is a high level of satisfaction many years after correction of pectus excavatum and bar removal. With the advent of cryoablative therapy since 2017, patient satisfaction improved by experience of less postoperative pain. Reintervention rate is low despite some patients reporting a perceived chest wall inward movement. [ABSTRACT FROM AUTHOR]

Diagnosis and effective treatment of axial spondyloarthritis (AxSpA) are often delayed due to inadequate awareness and poor patient-physician communication. Some AxSpA patients fail to maintain an active lifestyle by exercising regularly, further worsening their disease management. The evolving concept of patient-centred care necessitates better understanding of patient awareness and their needs. We aimed to survey AxSpA patients to reflect on healthcare planning and management perspectives. Our self-administered questionnaire focused on perceptions of AxSpA diagnosis and management, particularly exploring issues of physical activity and active lifestyle. Satisfaction with AxSpA medical care and its accessibility, diagnostic delays, patient-physician communication, and support for disease management were also explored. This offline survey was arranged at the Department of Rheumatology, Immunology, and Internal Medicine of Jagiellonian University Medical College and Krakow University Hospital. We surveyed patients with AxSpA attending outpatient clinics between December 1st, 2023 and April 22nd, 2024. The questionnaire included questions on types of physical activities, barriers to exercising, satisfaction with medical care, patient-physician interactions, diagnostic delays, and use of teleconsultations. A total of 117 patients with AxSpA were enrolled (mean age 41.62 years). The majority (n = 93, 79.5%) were employed. There was a male predominance (69, 59%). The average diagnostic delay was 5.5 years. Notably, 104 (88.9%) responders perceived physical activity as a factor influencing their disease course. However, only 32 (27.35%) managed to exercise regularly (≥ 30 min, 2–3 times a week). The majority (70, 59.83%) were irregularly engaged in some form of physical activity, with 15 (12.8%) not exercising at all, and nearly half (48%) reported at least one barrier to maintaining a physically active lifestyle. Pain (32, 27.35%), fatigue (27, 23.08%), lack of motivation (17, 14.53%), and lack of time (12, 10.26%) were noted as barriers to exercising. The respondents preferred to exercise at home. The survey identified critical areas where patient dissatisfaction or uncertainty were notably prevalent: 38 (32.5%) were uncertain and 35 (30%) were dissatisfied with rehabilitation access. For spa therapy, 63 (53.85%) reported uncertainty and 23 (19.7%) expressed dissatisfaction. Only 48 (41%) were treated by a rehabilitation specialist last year. Only 23% of AxSpA patients took part in teleconsultations last year, and 65% preferred in-person visits. While AxSpA patients recognize the importance of physical activity, significant barriers exist to engaging them regularly in exercising. Addressing these barriers through personalized, motivational, and educational strategies could improve patient outcomes. Improving patient satisfaction with healthcare services, particularly in areas of rehabilitation and physician-patient communication, is crucial for improving the overall care of AxSpA patients. [ABSTRACT FROM AUTHOR]

Introduction: Myasthenia gravis (MG) has a negative impact on patients' health-related quality of life; however, many clinicians do not fully understand their patients' lived experience of the disease. To understand the actual conditions of patients with MG and clarify the problems they perceive, we conducted a survey to evaluate the effects of the disease on patients' daily life and work. Methods: A questionnaire-based, qualitative, cross-sectional, non-interventional survey was conducted in Japan between April and May 2022 in patients with MG who were receiving regular outpatient treatment. The questionnaire included items regarding the patients' disease characteristics and experience, satisfaction with life, current treatment status, and treatment satisfaction. Results: In total, 452 patients were included in the survey population (66.6% aged ≥ 60 years; 64.6% with MG disease duration ≥ 10 years; 76.6% acetylcholine receptor [AChR] autoantibody positive). The symptoms of MG had a significant impact on the patients' daily lives, with the most common symptoms being fatigability (74.8%), ptosis (59.7%), diplopia (54.2%), and weakness in the arms and/or legs (50.9%). Patients commonly identified exercise (73.7%), work 68.0%), hobbies (60.4%), travel (60.0%), and socializing with friends (59.7%) as being difficult to perform, with approximately 50% of patients reporting that hospitalization sometimes interfered with their ability to work. In total, 27.2% of patients were dissatisfied with life, with the highest rates of dissatisfaction among patients who were either positive for muscle-specific kinase (MuSK) autoantibodies or seronegative for both AChR and MuSK autoantibodies. Conclusion: In Japanese patients with MG, over 25% are dissatisfied with life, indicating several unmet needs in this population. [ABSTRACT FROM AUTHOR]

Background and Aims: Chronic wounds present a growing challenge in the aging population, resulting in an extended course of treatment and an increased influx of patients with recalcitrant wounds seeking admission to hospitals. Furthermore, the general trend in patient care is toward simple and inexpensive treatment methods, feasible in an outpatient setting with little material costs. This retrospective case study aims to elucidate the operative procedure and outcomes associated with hair follicle unit transplantation utilizing punch grafts from the scalp for the management of hard‐to‐heal wounds. Methods: A cohort of 28 patients, comprising 20 males and eight females, with a mean age of 72.61 years (range: 48−89) and an average wound area of 82.49 cm2, underwent dissection of punch grafts containing hair follicles (2−3 mm in diameter) from the scalp. Subsequently, these grafts were transplanted into the wound bed. The retrospective evaluation of ulcer healing encompassed photo documentation and clinical records, while patient satisfaction was assessed through structured questionnaires. Results: In 78.6% (22) of the cases, a favorable impact on wound healing was observed, characterized by epithelization, and in 57.1% (16) of the patients, complete wound closure was achieved. With the exception of one donor site, all other sites healed without complications. The patient survey indicated that the majority of individuals subjected to the procedure did not perceive it as painful or time‐consuming. Notably, 81% (17) of individuals expressed a willingness to undergo the treatment again. Even in challenging wound conditions, such as pyoderma gangrenosum, our method demonstrated a positive effect on wound healing. Conclusion: Within our cohort, the utilization of hair follicle units in the management of hard‐to‐heal wounds resulted in either complete or partial wound closure for the majority of patients, accompanied by minimal morbidity, reduced operation time, and a low incidence of complications and associated costs. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Post mastectomy breast reconstruction uptake remains low in the developing countries. We examined patient perspectives about it in a cohort of Indian breast cancer patients.This prospective study was conducted at a tertiary care center in central India. All post mastectomy patients for breast cancer were interviewed via a survey questionnaire to assess their perspective regarding post mastectomy breast reconstruction.None of the 192 patients underwent immediate or delayed reconstruction by the end of 24 months follow‐up. Age, education level, occupation and marital status did not affect the uptake of post mastectomy breast reconstruction. The most common patient‐reported reasons for not having reconstruction were the desire to avoid additional surgery and the belief that it was not important (80% for each). System related factors such as additional cost of surgery and additional length of stay were reported to be important by 55% and 65% patients respectively.Our survey of 192 post mastectomy breast cancer patients showed that none opted for post mastectomy reconstruction, suggesting significant barriers to it. Understanding and addressing these barriers are crucial to ensuring comprehensive care for these breast cancer patients. [ABSTRACT FROM AUTHOR]

Background Method Results Conclusion One of the core indicators recommended by the Lancet Commission is surgical workforce density, aiming to improve the number of surgery, anesthetists, and obstetric (SAO) providers to 20 per 100,000 population by 2030. We assessed SAO workforce capacity in Somalia and made recommendations for improvement.A cross‐sectional study was conducted using a structured questionnaire from the WHO Program for Global Surgery and Social Change (PGSSC) Surgical Assessment Tool. All hospitals that offer surgical care services were included. A descriptive analysis was conducted using the statistical software SPSS.Of the 55 surveyed facilities providing surgical care services, 28 (50.9%) were public, mainly in urban areas. We found that there were 474 SAO specialists and non‐specialists (SAO providers) and 446 other important personnel (e.g., midwives, radiologists, and pathologists). Out of 474 SAOs, Banadir had 288. Overall, surgery specialties were the most prevalent profession among SAO providers' workforce, accounting for 160 (33.7%) surgery specialists, with 1.2 per 100,000 population. The six states of Somalia have 54 OB/GYN specialists (0.4 per 100,000 population). There were a total of 22 anesthesia specialists, with a ratio of 0.2 anesthesia specialists per 100,000 population.We found a serious shortage of the SAO workforce in Somalia, and it is unlikely to meet the 2030 Lancet Commission on Global Surgery targets. There is a need for additional training of SAO providers who can offer effective leadership in surgical care services to combat the extremely avoidable surgical‐related morbidities and mortalities. [ABSTRACT FROM AUTHOR]

Background: Generic substitution policies have been widely implemented worldwide to enhance the accessibility of medications. Nevertheless, certain patients have voiced discontent with these policies. This study aimed to evaluate the patient preferences for generic substitution policies and explore the potential for optimization to enhance patient acceptance. Methods: A discrete choice experiment (DCE) was conducted to estimate the relative importance (RI) of five attributes, including generic consistency evaluation (GCE), reimbursement rate, medication use control, information disclosure, and post-marketing surveillance. Respondents were recruited among inpatients and outpatients in three cities and surveys were conducted face-to-face. Preference coefficients, RI of attributes, and the uptake rate of various policies were computed using a mixed logit model. The interaction effects were also included to examine preference heterogeneity. Results: A total of 302 patients completed the survey. All five attributes significantly impacted policy acceptance. GCE held the highest RI value at 56.64%, followed by reimbursement rate (RI = 12.62%), information disclosure (RI = 12.41%), post-marketing surveillance (RI = 9.54%), and medication use control (RI = 8.80%). Patient preferences varied depending on their gender and income. The patient uptake rate of China's current policy was only 68.56%. If all generics were to pass GCE without altering the other attributes, the uptake rate of policies would rise to 82.63%. Similarly, implementing information disclosure without changing other attributes would result in a 78.67% uptake rate, which is comparable to the effect of a 10% increase in reimbursement rate for generics (78.81%). Combining these policies could mitigate the adverse effects of mandatory substitution on patient. Conclusion: Chinese patient preferences for generic substitution policies were mainly influenced by GCE. China's current generic substitution policy has room for further optimization to enhance patient acceptance. [ABSTRACT FROM AUTHOR]

Le Dantec virus (LDV), assigned to the species Ledantevirus ledantec, genus Ledantevirus, family Rhabdoviridae has been associated with human disease but has gone undetected since the 1970s. We describe the detection of LDV in a human case of undifferentiated fever in Uganda by metagenomic sequencing and demonstrate a serological response using ELISA and pseudotype neutralisation. By screening 997 individuals sampled in 2016, we show frequent exposure to ledanteviruses with 76% of individuals seropositive in Western Uganda, but lower seroprevalence in other areas. Serological cross-reactivity as measured by pseudotype-based neutralisation was confined to ledanteviruses, indicating population seropositivity may represent either exposure to LDV or related ledanteviruses. We also describe the discovery of a closely related ledantevirus in blood from the synanthropic rodent Mastomys erythroleucus. Ledantevirus infection is common in Uganda but is geographically heterogenous. Further surveys of patients presenting with acute fever are required to determine the contribution of these emerging viruses to febrile illness in Uganda. Author summary: Understanding the viruses capable of human infection is important for outbreak prevention and early intervention in viral epidemics. Le Dantec virus (LDV) is a member of the viral genus Ledantevirus (Rhabodoviridae) and has previously been isolated only once previously in a child with febrile illness in Senegal in 1965. We detected the genome of LDV in blood sampled from a patient presenting with febrile illness in Western Uganda in 2012. To estimate the extent to which LDV may be causing human infection in the region, we tested stored blood samples collected in 2016 for evidence of antibodies to LDV, revealing that up to 76% of Ugandans in some areas had previously been exposed to either to LDV or a closely related virus. Seroprevalence was highest in Western Uganda, an area of high biodiversity where several other ledanteviruses have been isolated in association with ectoparasites of bats. To investigate potential ecological reservoirs of zoonotic viruses we tested blood from wild rodents inhabiting areas close to human settlements. We detected a new ledantevirus, closely related to LDV, in blood from a wild rodent Mastomys erythroleucus. Our work shows that ledanteviruses are a common cause of human infection in Uganda. [ABSTRACT FROM AUTHOR]

Objective: Vulvar lichen sclerosus (VLS) is an underestimated chronic disease. It can cause significant symptom burden and sexual dysfunction. This study aimed to evaluate patient satisfaction and current challenges in the management of VLS in a certified dysplasia unit, particularly during the COVID-19 pandemic. Methods: This survey analyzed patients who had been diagnosed with VLS and treated at our DKG-certified dysplasia unit. The study was conducted during the COVID-19 pandemic in the Department of Gynecology and Obstetrics at the University of Aachen. The questionnaire contained 43 questions on general treatment, diagnostic delays, disease education, psychologic and sexual issues, and specific questions regarding the COVID-19 pandemic. The questionnaires were distributed between January 2021 and September 2023. Results: This study included 103 patients diagnosed with VLS, who were treated at our certified dysplasia unit. Overall, 48% of the patients were satisfied with the success of the therapy. Most participants reported psychologic problems (36.8%), fear of cancer (53.3%), or sexual restrictions (53.3%). Among the patients, 38% were bothered by the regular application of topical cortisone. However, 72% were willing to undergo treatment for more than 24 months. The COVID-19 outbreak in March 2020 had a significant negative impact on general VLS care from the patient's perspective (3.83/5 before vs. 3.67/5 after; p = 0.046). There was a general request for booklets to inform and educate the patients about their disease. Furthermore, the respondents demanded a telephone hotline to answer the questions and wished for follow-up visits via e-mail to cope better with their current situation. Conclusion: This study highlights the need for more effective treatments for VLS and an increased awareness of psychologic and sexual distress. To ensure patient well-being and satisfaction, it is imperative to offer individualized care with adequate disease education in a team of specialists from various disciplines. [ABSTRACT FROM AUTHOR]

Background: Breast units (BUs) provide breast cancer (BC) care, including prevention, treatment, and genetic assessment. Genetic research has highlighted BRCA1/2 mutations as key hereditary BC risk factors. BRCA testing is crucial for personalized treatment and prevention strategies. However, the integration of BRCA testing in Italian BUs faces multiple challenges. This study, by Senonetwork Italia, aimed to evaluate genetic testing practices and identify obstacles within Italian BUs. Methods: Senonetwork Italia conducted a 16-question web-based survey involving 153 BUs. The survey assessed aspects of BRCA testing, including timing, urgency, counseling, patient selection, and multi-gene panels. Results: Of the 153 BUs, 109 (71.2%) responded. Testing before surgery was performed by 70.6% of centers, with urgent cases acknowledged by 87.2%. Most centers (56.0%) arranged urgent pre-test counseling within a week. BRCA mutation status influenced treatment decisions in 99.1% of cases. Multi-gene panels were used by 33.0% of centers for all genetic counseling cases, while 56.0% followed standard referral criteria. The main challenges included cost, reimbursement, and reporting timelines. Conclusions: This survey highlights significant variations in BRCA testing practices across Italian BUs and identifies key logistical and financial challenges. There is a need for standardized practices of genetic testing to ensure personalized and effective BC management in Italy. [ABSTRACT FROM AUTHOR]

Resident doctors constitute an important workforce of the Nigerian healthcare system wherein they undergo structured training to become competent specialists in different fields of medicine. The aim of this survey was to audit the surgical residency training process, incorporating both the trainer's and the trainee's perspectives, with a view to improving both residency training and overall patient care. This was a multicenter descriptive cross-sectional study involving consultant surgeons and surgical trainees in selected tertiary healthcare institutions in Nigeria. A link to an online semi-structured and pretested questionnaire was sent to study participants whose agreement to fill out the questionnaire was taken as implied consent for the study. The perception of respondents on key areas of surgical residency training like the quality of training, skill acquisition, mentorship, supervision, operative exposures, research, funding, didactic sessions, and work schedule was assessed using a Likert scale. Their perceived challenges to training and measures to improve the quality of training were recorded. Data were analysed using version 23 of the SPSS. A total of 127 participants (25 trainers and 102 trainees) were recruited with a mean age of 34.8 ± 3.5 y for the trainees and 47.5 ± 6.9 y for the trainers. The majority of both the trainers and trainees (72%, n = 18 and 93%, n = 96, respectively) were dissatisfied with the quality of surgical residency training in Nigeria with the trainers (88%, n = 22) and trainees (97.1%, n = 99) mostly agreeing that surgical training should be standardized across training centres in Nigeria. The trainees and trainers rated mentorship, research, funding, and overall quality of surgical residency training as inadequate, while most of the trainees and trainers rated supervision of trainees as adequate. The trainees predominantly identified poor training facilities as the most important challenge to surgical residency, followed by high clinical workload, while the majority of the trainers identified workplace bullying and high clinical workload as being the predominant factors. The nine-pronged recommendations by both the trainers and trainees to improve surgical training in Nigeria include mentorship program for trainees, funding of surgical residency training, provision of facilities and equipment for training, adequate supervision of trainees by trainers, job description and defined work schedule for trainees, health insurance of patients, overseas training of trainees during the residency program, improved remuneration of trainees, and adequate motivation of trainers. The quality of surgical residency training in Nigeria is perceived as suboptimal by trainees and trainers. Perceived common challenges to surgical residency training include poor training facilities, workplace bullying, and high clinical workload. Adequate funding of surgical residency program, standardized mentorship, and training of trainees with improved remuneration of trainees and motivation of their trainers would enhance the overall quality of surgical residency training in Nigeria. [ABSTRACT FROM AUTHOR]

The author discusses articles which analyze the health of transgender people in England using the GP Patient Survey. Topics include the question on sex which was replaced in 2021 by two questions on gender, distribution of answers to the two gender questions, and the need for the GP Patient Survey to replace two gender questions with properly validated questions.

Background and Aims: Anesthesiologists' services extend to many critical areas of any healthcare setup. However, there needs to be more understanding among the public regarding their crucial role. Preanesthesia evaluation (PAE) visits can disseminate information about anesthesiologists and services. We aimed to evaluate patient's knowledge and the impact of interview-based surveys on increasing knowledge about anesthesiologists and anesthesia services. Methodology: It was a single-center, cross-sectional survey involving 550 patients aged 18-65 undergoing elective surgeries. Pre- and postoperative interviewer-assisted questionnaires were administered to assess patients' baseline knowledge and perception of anesthesia and anesthesiologists. Statistical analysis focused on demographic, educational, and previous anesthesia exposure among subgroups; a P-value <0.05 was considered significant. Results: Less than half comprehended anesthesia's role as a specialist in inducing unconsciousness. 55.3% were unaware of general anesthesia, and 69.6% were unaware of regional anesthesia as a technique. Higher education and previous anesthesia exposure correlated with better awareness with regard to the perioperative role of anesthesiologists and their fields of work (P < 0.05). The postoperative survey indicated good satisfaction with anesthesiologists' services, which might be attributable to the survey-based interaction. Conclusion: A significant need for more understanding regarding anesthesia and anesthesiologists' roles still prevails. Interview-based effective communication during PAE visits, perioperative period, and shared decision-making (SDM) improves patients' knowledge, comprehension, and satisfaction. [ABSTRACT FROM AUTHOR]

Background: Having a weakened immune system can make patients easily get nosocomial infection (NI) with multi-drug resistant (MDR) bacteria and put them in a dangerous situation. It causes long hospital stays, disability, economic burden, and even death. The present study aimed to determine the prevalence of NI in patients suffering from COVID-19. Methods: In this retrospective study, the information on 250 patients suffering from COVID-19 in the intensive care unit (ICU) (2020 to 2021) was considered. For statistical analysis, analysis of variance (ANOVA), paired samples t-test, and chi-square using SPSS-23 software were used (p<0.05). Results: Two hundred and fifty hospitalized (107 females and 143 males, mean ± standard deviation (SD) of age; 56.50 ± 17.20) patients were considered. The most (97.60%) medicine prescribed was remdesivir. Candida spp. (two females), Escherichia coli (two females), Acinetobacter spp. (one female), Citrobacter spp. (one female), Pseudomonas spp. (one male), Sphingomonas spp. (one male), Stenotrophomonas spp. (one male) and Enterobacter spp. (one male) were isolated from the patient's specimens. Four of seven bacterial isolates were positive for MDR. NI was diagnosed in six patients. There was no significant relationship between the age with the isolated microbes (P=0.154) and MDR (P=0.987) and also between gender with common microbes (P=0.576) and MDR (P=0.143). Conclusion: The coexistence of bacteria and NI was observed in patients. Remdesivir was prescribed for most patients. Most bacteria were resistant to antibiotics, especially, β-lactams. [ABSTRACT FROM AUTHOR]

Background: Surveys suggest a low level of implementation of clinical guidelines, although they are intended to improve the quality of treatment and patient safety. Which guideline recommendations are not followed and why has yet to be analysed. In this study, we investigate the proportion of European and national guidelines followed in the area of pre-operative anaesthetic evaluation prior to non-cardiac surgery. Methods: We conducted this monocentric retrospective observational study at a German university hospital with the help of software that logically links guidelines in such a way that individualised recommendations can be derived from a patient's data. We included routine logs of 2003 patients who visited our pre-anaesthesia outpatient clinic between June 2018 and June 2020 and compared the actual conducted pre-operative examinations with the recommendations issued by the software. We descriptively analysed the data for examinations not performed that would have been recommended by the guidelines and examinations that were performed even though they were not covered by a guideline recommendation. The guidelines examined in this study are the 2018 ESAIC guidelines for pre-operative evaluation of adults undergoing elective non-cardiac surgery, the 2014 ESC/ESA guidelines on non-cardiac surgery and the German recommendations on pre-operative evaluation on non-cardiothoracic surgery from the year 2017. Results: Performed ECG (78.1%) and cardiac stress imaging tests (86.1%) indicated the highest guideline adherence. Greater adherence rates were associated with a higher ASA score (ASA I: 23.7%, ASA II: 41.1%, ASA III: 51.8%, ASA IV: 65.8%, P < 0.001), lower BMI and age > 65 years. Adherence rates in high-risk surgery (60.5%) were greater than in intermediate (46.5%) or low-risk (44.6%) surgery (P < 0.001). 67.2% of technical and laboratory tests performed preoperatively were not covered by a guideline recommendation. Conclusions: Guideline adherence in pre-operative evaluation leaves room for improvement. Many performed pre-operative examinations, especially laboratory tests, are not recommended by the guidelines and may cause unnecessary costs. The reasons for guidelines not being followed may be the complexity of guidelines and organisational issues. A software-based decision support tool may be helpful. Trial registration: ClinicalTrials.gov ID NCT04843202. [ABSTRACT FROM AUTHOR]

Purpose: To examine the ability of generative artificial intelligence (GAI) to answer patients' questions regarding colorectal cancer (CRC). Methods: Ten clinically relevant questions about CRC were selected from top-rated hospitals' websites and patient surveys and presented to three GAI tools (Chatbot Generative Pre-Trained Transformer [GPT-4], Google Bard, and CLOVA X). Their responses were compared with answers from the CRC information book. Response evaluation was performed by two groups, each consisting of five healthcare professionals (HCP) and patients. Each question was scored on a 1–5 Likert scale based on four evaluation criteria (maximum score, 20 points/question). Results: In an analysis including only HCPs, the information book scored 11.8 ± 1.2, GPT-4 scored 13.5 ± 1.1, Google Bard scored 11.5 ± 0.7, and CLOVA X scored 12.2 ± 1.4 (P = 0.001). The score of GPT-4 was significantly higher than those of the information book (P = 0.020) and Google Bard (P = 0.001). In an analysis including only patients, the information book scored 14.1 ± 1.4, GPT-4 scored 15.2 ± 1.8, Google Bard scored 15.5 ± 1.8, and CLOVA X scored 14.4 ± 1.8, without significant differences (P = 0.234). When both groups of evaluators were included, the information book scored 13.0 ± 0.9, GPT-4 scored 14.4 ± 1.2, Google Bard scored 13.5 ± 1.0, and CLOVA X scored 13.3 ± 1.5 (P = 0.070). Conclusion: The three GAIs demonstrated similar or better communicative competence than the information book regarding questions related to CRC surgery in Korean. If high-quality medical information provided by GAI is supervised properly by HCPs and published as an information book, it could be helpful for patients to obtain accurate information and make informed decisions. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic dramatically changed health service delivery with vulnerable patients advised to isolate and appointments provided virtually. This change affected recruitment into an observational cohort study, undertaken at a single site, where participants with mitochondrial disorders were due to have specialist hospital-based audiovestibular tests. To ensure study viability, the study protocol was amended to allow home-based assessment for vulnerable participants. Here, we report outcomes of an online survey of participants who underwent home-based assessment, related to the experience, perceived benefits, and drawbacks of home audiovestibular assessments. Seventeen participants underwent home-based neuro-otological assessment, due to the need to isolate during COVID-19. Following the assessment, 16 out of 17 participants completed an anonymised online survey to share their experiences of the specialist home-based assessment. One hundred percent of participants rated the home-based assessment 'very positively' and would recommend it to others. Sixty-three percent rated it better than attending hospital outpatient testing settings. The benefits included no travel burden (27%) and reduced stress (13%). A majority reported no drawbacks in having the home visit. The patient-reported feedback suggests a person-centred approach where audiovestibular assessments are conducted in their homes is feasible for patients, acceptable and seen as beneficial to a vulnerable group of patients. [ABSTRACT FROM AUTHOR]

Summary: Enhanced recovery after surgery (ERAS) protocols are shown to improve patient outcomes and reduce length of hospital stay. However, there is currently limited consensus on the perioperative management of patients undergoing bariatric and metabolic surgery (BMS) in the United Kingdom. This study aims to survey the level of consistency in patient care undergoing BMS. Bariatric nurse specialists from 30 bariatric units completed an anonymised, online survey from 21 December 2022 to 21 February 2023. Most units (77%) have implemented a premade postoperative care bundle protocol including predetermined timing of oral intake (77%) and postoperative day 1 bloods (60%). 63% of units have also established pre‐set analgesia and anti‐emetic bundles. Date of discharge is variable, ranging from 1 day after surgery (50%) to a 'two night stay' protocol (33%) to within 4 days after surgery (17%). Most follow‐up clinics are either led by dietitians (33%) or both bariatric nurse specialists and dietitians collaboratively (57%). Patients are usually established on solid food 6 weeks after surgery in 53% (16/30) units. Chemical venous thromboembolism (VTE) prophylaxis was either given on day of surgery postoperatively (60%), day before (20%) or after (17%) surgery. Our study shows significant variability of care throughout the surgical pathway, in the study population. The results suggest a need for consensus guidelines outlining the best‐practice approach to managing patients undergoing BMS; due to the heterogeneity of the patient group, these guidelines should contain overarching generalisable recommendations that can then be tailored to individual patients. [ABSTRACT FROM AUTHOR]

Patients with phenylketonuria (PKU) require a strict diet to maintain phenylalanine (Phe) levels within the desired range. However, the diet can be onerous, resulting in poor adherence. We carried out the first online national survey in Italy to better understand the perceptions, knowledge, and experiences of both patients with PKU and caregivers with the goal of improving patient outcomes. An online survey of 35 questions to patients and 36 questions to caregivers was distributed in September 2022 through physicians and relevant Italian associations. The information collected included knowledge and impact of PKU, unmet needs, knowledge of available drugs, and satisfaction with therapy. Overall, 241 questionnaires were completed by 85 patients and 156 caregivers (96.0% were parents). Knowledge of the pathogenic basis of PKU was generally high. The most common patient-reported symptoms were agitation/anxiety (48.8%), fatigue (41.1%), mood disorders (39.8%), and difficulty concentrating (33.4%). Different perspectives on adherence to a low-Phe diet were observed (22.9% of patients reported strict adherence vs. 47.0% of caregivers). Drugs that allow more freedom were needed by 49.4% of patients and 61.7% of caregivers, along with a wider range of choices of non-dietary treatments (48.2% and 60.0%, respectively). Unmet informational needs of patients included PKU and pregnancy, complications, travel, sports, and transition into adult care. Our data showed that patients with PKU and their caregivers reported difficulties in adherence to diet therapy and indicated interest in new therapeutic approaches. Apparent differences between patient and caregiver perspectives were identified. More informational resources on PKU are needed. Some people are born with an abnormality in a gene called phenylalanine (Phe) hydroxylase, which controls the production of an enzyme that helps convert Phe (an important amino acid that forms proteins) to tyrosine. When Phe cannot be converted to tyrosine, it builds up in the body and becomes toxic. Phenylketone bodies then form and accumulate in the blood, resulting in a disease called phenylketonuria (PKU), which can lead to intellectual disability and epilepsy. People with PKU should follow a strict low-Phe diet so that Phe levels can remain low. However, following this diet is often difficult, resulting in poor control of PKU. We carried out the first online survey in Italy to better understand the perceptions, knowledge, and experiences of patients with PKU and their caregivers. The questionnaire was distributed in Italy in September 2022. The information collected included knowledge and impact of PKU, unmet needs of patients, knowledge of available drugs, and satisfaction with therapy. Overall, 241 questionnaires were completed by 85 patients and 156 caregivers (most were parents). Knowledge of the serious consequences of PKU was generally high. The most common symptoms were agitation/anxiety (48.8%), fatigue (41.1%), mood disorders (39.8%), and difficulty concentrating (33.4%). Our data showed that patients and caregivers reported difficulties in following the strict low-Phe diet and showed interest in treatments that allowed more freedom. There were notable differences between some patient and caregiver perspectives. More informational resources on PKU and pregnancy, complications, travel, sports, and transition from child to adult care are needed. [ABSTRACT FROM AUTHOR]

Purpose: A national additional risk minimization measures (aRMMs) program was implemented to train pharmacists for safe supply of non-prescription Viagra Connect® (VC) to erectile dysfunction (ED) patients in United Kingdom (UK). A survey aimed to evaluate the effectiveness of aRMMs. Methods: A cross-sectional, web-based survey enrolled ED patients who purchased at least 1 supply of VC in UK, using a structured self-administered questionnaire. Patients were assessed for the suitability of VC and received appropriate advice from pharmacists. Descriptive statistics were used. Results: The final sample had 297 patients, who reported that pharmacists inquired about blood pressure and heart comorbidities (91.9%), relevant illnesses (87.9%), medications (86.5%), ED diagnosis (82.2%), and were advised to consult their doctor regarding ED (51.2%). Furthermore, 85.5% of patients were advised on how to take VC correctly, 82.2% on possible side effects for which they might have to discontinue taking VC and consult their doctor, 80.1% on being informed that ED could be caused by underlying conditions. About 65.0% reported that they had visited (19.2%) or planned to visit (45.8%) their doctor. A majority (68.7%) also indicated that they had received advice on lifestyle modifications to manage their ED-related health risks. Conclusion: This survey provided a reasonable confirmation of the effectiveness of the VC aRMMs program and assurance that ED patients, when requesting and purchasing VC in UK pharmacies, are assessed appropriately for suitability of VC and receive the appropriate advice from pharmacists. Plain Language Summary: A national additional risk minimization measures (aRMMs) program was implemented to train pharmacists for safe supply of non-prescription VC to erectile dysfunction (ED) patients in United Kingdom (UK). A cross-sectional, web-based survey enrolled ED patients who purchased at least 1 supply of VC in UK, using a structured self-administered questionnaire. Patients were assessed for the suitability of VC and received appropriate advice from pharmacists. The final sample had 297 patients, who reported that pharmacists inquired about blood pressure and heart comorbidities, relevant illnesses, medications, ED diagnosis, and were advised to consult their doctor regarding ED. Additionally, most of the patients had consulted or planned to consult their doctors, on how to take VC correctly, on possible side effects for which they might have to discontinue taking VC and consult their doctor, on being informed that ED could be caused by underlying conditions, and on lifestyle modifications. A majority also indicated that they had received advice on lifestyle modifications to manage their ED-related health risks. This survey provided a reasonable confirmation of the effectiveness of the VC aRMMs program and assurance that ED patients, when requesting and purchasing VC in UK pharmacies, are assessed appropriately for suitability of VC and receive the appropriate advice from pharmacists. [ABSTRACT FROM AUTHOR]

Purpose: Despite the impact of physician-scientists on scientific discovery and translational medicine, several reports have signalled their declining workforce, reduced funding, and insufficient protected research time. Given the paucity of outcome data on Canadian MD/PhD programs, this study presents a national portrait of the sociodemographic characteristics, training trajectories, productivity, and satisfaction in trainees and alumni from Canadian MD/PhD and MD/MSc programs. Methods: Quantitative data were collected in a national survey launched in 2021. Respondents included 74 MD/PhD alumni and 121 trainees across 12 Canadian MD/PhD and MD/MSc programs. Results: Among MD/PhD alumni, 51% were independent practitioners/researchers while others underwent residency training. Most trainees (88%) were in MD/PhD programs. Significantly more alumni identified as men than did trainees. Significantly more alumni conducted clinical and health services research, while more trainees conducted basic science research. Average time to MD/PhD completion was 8 years, with no correlation to subsequent research outcomes. Self-reported research productivity was highest during MD/PhD training. Concerning training trajectories, most alumni completed residency, pursued additional training, and practised in Canada. Finally, regression models showed that trainees and alumni were satisfied with programs, with significant moderators in trainee models. Conclusion: Survey findings showed Canadian MD/PhD and MD/MSc programs recruit more diverse cohorts of trainees than before, provide productive research years, and graduate alumni who pursue training and academic employment in Canada. Both alumni and trainees are largely satisfied with these training programs. The need to collect in-depth longitudinal data on Canadian MD/PhD graduates to monitor diversity and success metrics is discussed. [ABSTRACT FROM AUTHOR]

Introduction: Vitiligo is a chronic autoimmune disease characterized by destruction of melanocytes, leading to skin depigmentation. Vitiligo can have a high quality-of-life burden and profound impact on psychosocial well-being. The objectives of this study were to describe the self-reported patient burden among patients with nonsegmental vitiligo with ≤ 10% affected body surface area, summarize the physician-reported psychosocial and psychological impact of vitiligo on patient lives, and describe disease characteristics and treatment history, goals, and satisfaction. Methods: Data were drawn from the Adelphi Vitiligo Disease Specific Programme™, a real-world, cross-sectional survey with retrospective data collection of physicians and patients with vitiligo, collected in the United States between October 2021 and April 2022. Separate surveys for dermatologists and patients contained questions on clinical and demographic characteristics of patients with vitiligo and burden of vitiligo. Treatment history, goals, and satisfaction were assessed together with the impact of vitiligo on quality of life. Results: Sixty-one dermatologists provided data for 326 patients with ≤ 10% affected body surface area (adults, n = 221; adolescents, n = 105); 90 of those patients also responded to the survey. The most common treatments were topical corticosteroids, topical calcineurin inhibitors, and narrow-band ultraviolet-B phototherapy, with the main treatment goal being repigmentation. Physician-reported treatment satisfaction was 56%; 25% of patients reported frustration with treatment options. Physicians reported impact of vitiligo on everyday life in 46% of patients. Patients reported 12.7% overall work impairment; mean scores for Hospital Anxiety and Depression Scale anxiety and depression domains were 3.5 and 2.2, respectively, and mean Vitiligo-specific Quality of Life index score was 26.9. Patients with facial involvement experienced higher burden than those without. Conclusion: A high patient burden was reported by dermatologists and their patients with vitiligo who had ≤ 10% affected body surface area, including psychosocial and psychological consequences. These findings highlight an unmet need in the treatment of vitiligo. Plain Language Summary: Vitiligo is a chronic disease in which cells that produce the skin pigment melanin are attacked, causing patches of skin to lose color and become pale. Vitiligo can have emotional impacts such as social or psychological distress that can affect the day-to-day well-being of individuals. However, there is a lack of studies that assess the ways that vitiligo affects the everyday lives of people with the condition in the United States. Dermatologists and people with vitiligo answered survey questions on treatment goals, any vitiligo treatments currently and previously used, and how satisfied they were with the results of treatment. The surveys also contained questions that assessed the impact of vitiligo on everyday life. Sixty-one dermatologists answered questions about 326 patients and 90 of those patients also provided their own answers to the survey questions. Both dermatologists and patients reported that restoring color to patches of pale skin was their goal in treating vitiligo. However, dermatologists and patients both reported that they were dissatisfied with the results of available treatments. Dermatologists and patients both reported that vitiligo impacted aspects of everyday life. Emotional and psychological impacts such as anxiety and depression were reported, as well as negative effects on patients' work and social lives due to vitiligo. These results confirm that vitiligo impacts the day-to-day well-being of patients. Furthermore, this study highlights that there is a need for improvements in the treatment of vitiligo. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the association between peri‐implant diseases and systemic inflammation assessed by serum C‐reactive protein (CRP) levels in a sample of patients with hypertension. Methods: A total of 151 participants with hypertension were included in a cross‐sectional study. The population was divided into six groups according to their peri‐implant and periodontal status (healthy controls, mucositis, peri‐implantitis, periodontitis, periodontitis and mucositis, periodontitis, and peri‐implantitis). Linear, logistic regression, and correlation analyses were performed. Results: CRP levels were statistically significantly higher in participants with periodontitis alone (median 3.2 mg/L, interquartile range [IQR] 1.8, p = 0.012), combined with mucositis (3.10 mg/L, IQR 2.35, p < 0.001) or peri‐implantitis (2.7 mg/L, IQR 2.53, p = 0.002) when compared to the healthy controls (1 mg/L, IQR 1.2). This association was independent of age, sex, smoking status, and adiposity differences. Participants with periodontitis with and without peri‐implant diseases had the greatest odds of exhibiting CRP > 3 mg/L (odds ratio = 7.3, 95% confidence interval 1.6–33.9). Conclusions: Peri‐implant diseases are associated with systemic inflammation, but the nature of the association should be further investigated. [ABSTRACT FROM AUTHOR]

The article presents findings from a national survey conducted by the French hemophilia society, gathering patient perspectives on gene therapy for hemophilia. Most of the 18 participants who underwent gene therapy reported positive outcomes, such as reduced treatment burden and improved quality of life. Patients expressed satisfaction with healthcare support and the efficacy of gene therapy in managing bleeding and pain, although some concerns about potential side effects were raised. Overall, the majority of patients recommended gene therapy to others and had no regrets about their decision. Two studies on patient experiences and perspectives of gene therapy for hemophilia are discussed in the text, providing further insights into this treatment option. [Extracted from the article]

Background: Approximately 25–50% of patients undergoing radiotherapy (RT) experience psychological distress and anxiety, which can detrimentally affect both their quality of life and treatment outcomes. While previous research has demonstrated that relaxation exercises can enhance the tolerability of RT and alleviate associated stress and anxiety, the specific needs for such therapies in radiation oncology remain under-explored. This study aims to investigate the demand for and preferences toward relaxation exercises among radiotherapy patients, addressing a critical gap in patient-centered care. Methods: A prospective pseudonymized survey study using a one-time paper-based questionnaire was conducted from 2022 to 2023 among patients undergoing curative-intent RT for breast cancer or patients undergoing palliative RT for bone metastases. Patients were asked in a 11-item questionnaire about their anxiety, pre-existing practice of relaxation exercises/interventions, their interest in relaxation exercises, and preferences on the type and format of instruction. Data were analyzed descriptively. Results: 100 patients (74 female and 26 male) responded, of whom 68 received curative-intent adjuvant RT and 32 palliative RT. Median age was 62 years. 78% of patients indicated a desire to be actively involved in their radiotherapy, but only 27% had used relaxation exercises prior to RT. 44.8% of both curatively and palliatively treated patients who wanted to be actively involved in their therapy desired to learn how to best relax. 56.4% of respondents were willing to spend extra time learning offered exercises. Conclusion: The survey indicates that patients undergoing RT, both for curative or palliative intent, desire relaxation exercises to relieve stress and anxiety from RT. It is therefore important to assess the need for relaxation interventions in individual patients and to develop suitable programs or collaborate with other healthcare professionals to meet these needs. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) causes an economic impact on the patients and their households. Although Thailand has expanded the national health benefit package for TB treatment, there was no data on out-of-pocket payments and income losses due to TB from patients and their household perspectives. This national TB patient cost survey was conducted to examine the TB-related economic burden, and assess the proportion of TB patients and their households facing catastrophic total costs because of TB disease. A cross-sectional TB patient cost survey was employed following WHO methods. Structured interviews with a paper-based questionnaire were conducted from October 2019 to July 2021. Both direct and indirect costs incurred from the patient and their household perspective were valued in 2021 and estimated throughout pre- and post-TB diagnosis episodes. We assessed the proportion of TB-affected households facing costs > 20% of household expenditure due to TB. We analyzed 1400 patients including 1382 TB (first-line treatment) and 18 drug-resistant TB patients (DR-TB). The mean total costs per TB episode for all study participants were 903 USD (95% confident interval; CI 771–1034 USD). Of these, total direct non-medical costs were the highest costs (mean, 402 USD, and 95%CI 334–470 USD) incurred per TB-affected household followed by total indirect costs (mean, 393 USD, and 95%CI 315–472 USD) and total direct medical costs (mean, 107 USD, and 95%CI 81–133 USD, respectively. The proportion of TB-affected households facing catastrophic costs was 29.5% (95%CI 25.1–34.0%) for TB (first-line), 61.1% (95%CI 29.6–88.1%) for DR-TB and 29.9% (95%CI 25.6–34.4%) overall. This first national survey highlighted the economic burden on TB-affected households. Travel, food/nutritional supplementation, and indirect costs contribute to a high proportion of catastrophic total costs. These suggest the need to enhance financial and social protection mechanisms to mitigate the financial burden of TB-affected households. [ABSTRACT FROM AUTHOR]

Background: Several studies have been conducted with the 1.0 version of the Hospital Survey on Patient Safety Culture (HSOPSC) in Norway and globally. The 2.0 version has not been translated and tested in Norwegian hospital settings. This study aims to 1) assess the psychometrics of the Norwegian version (N-HSOPSC 2.0), and 2) assess the criterion validity of the N-HSOPSC 2.0, adding two more outcomes, namely 'pleasure of work' and 'turnover intention'. Methods: The HSOPSC 2.0 was translated using a sequential translation process. A convenience sample was used, inviting hospital staff from two hospitals (N = 1002) to participate in a cross-sectional questionnaire study. Data were analyzed using Mplus. The construct validity was tested with confirmatory factor analysis (CFA). Convergent validity was tested using Average Variance Explained (AVE), and internal consistency was tested with composite reliability (CR) and Cronbach's alpha. Criterion related validity was tested with multiple linear regression. Results: The overall statistical results using the N-HSOPSC 2.0 indicate that the model fit based on CFA was acceptable. Five of the N-HSOPSC 2.0 dimensions had AVE scores below the 0.5 criterium. The CR criterium was meet on all dimensions except Teamwork (0.61). However, Teamwork was one of the most important and significant predictors of the outcomes. Regression models explained most variance related to patient safety rating (adjusted R2 = 0.38), followed by 'turnover intention' (adjusted R2 = 0.22), 'pleasure at work' (adjusted R2 = 0.14), and lastly, 'number of reported events' (adjusted R2=0.06). Conclusion: The N-HSOPSC 2.0 had acceptable construct validity and internal consistency when translated to Norwegian and tested among Norwegian staff in two hospitals. Hence, the instrument is appropriate for use in Norwegian hospital settings. The ten dimensions predicted most variance related to 'overall patient safety', and less related to 'number of reported events'. In addition, the safety culture dimensions predicted 'pleasure at work' and 'turnover intention', which is not part of the original instrument. [ABSTRACT FROM AUTHOR]

Context: Patient portals, designed to give ready access to medical records, have led to important improvements in patient care. However, there is a downside: much of the information available on portals is not designed for lay people. Pathology reports are no exception. Access to complex reports often leaves patients confused, concerned and stressed. We conducted a systematic review to explore recommendations and guidelines designed to promote a patient centered approach to pathology reporting. Design: In consultation with a research librarian, a search strategy was developed to identify literature regarding patient-centered pathology reports (PCPR). Terms such as "pathology reports," "patient-centered," and "lay-terms" were used. The PubMed, Embase and Scopus databases were searched during the first quarter of 2023. Studies were included if they were original research and in English, without date restrictions. Results: Of 1,053 articles identified, 17 underwent a full-text review. Only 5 studies (≈0.5%) met eligibility criteria: two randomized trials; two qualitative studies; a patient survey of perceived utility of potential interventions. A major theme that emerged from the patient survey/qualitative studies is the need for pathology reports to be in simple, non-medical language. Major themes of the quantitative studies were that patients preferred PCPRs, and patients who received PCPRs knew and recalled their cancer stage/grade better than the control group. Conclusion: Pathology reports play a vital role in the decision-making process for patient care. Yet, they are beyond the comprehension of most patients. No framework or guidelines exist for generating reports that deploy accessible language. PCPRs should be a focus of future interventions to improve patient care. [ABSTRACT FROM AUTHOR]

Introduction: Retrospective data suggest that pediatric hematopoietic cell transplant (HCT) patients placed on non-invasive ventilation (NIV) prior to intubation have increased risk of mortality compared to patients who are intubated earlier in their course. The HCT-CI subgroup of the PALISI Network set out to gain a better understanding of factors that influence clinician's decisions surrounding timing of intubation of pediatric HCT patients. Methods: We validated and distributed a brief survey exploring potential factors that may influence clinician's decisions around timing of intubation of pediatric HCT patients with acute lung injury (ALI). Results: One hundred and four of the 869 PALISI Network'smembers responded to the survey; 97 of these respondents acknowledged caring for HCT patients andwere offered the remainder of the survey. The majority of respondents were PICU physicians (96%), with a small number of Advanced Practice Providers and HCT physicians. As expected, poor prognosis categories were perceived as a factors that delay timing to intubation whereas need for invasive procedures was perceived as a factor shortening timing to intubation. Concerns for oxygen toxicity or NIVassociated lung injury were not believed to influence timing of intubation. Discussion: Our survey indicates increased risk of ALI from prolonged NIV and oxygen toxicity in HCT patients are not a concern for most clinicians. Further education of pediatric ICU clinicians around these risk factors could lead to improvement in outcomes and demands further study. Additionally, clinicians identified concerns for the patient's poor prognosis as a common reason for delayed intubation. [ABSTRACT FROM AUTHOR]

Objective: Hypothyroidism is a common endocrine condition usually managed with levothyroxine (LT4). However, controversy remains around the use of liothyronine (LT3). We aimed to investigate the practices of Australian endocrinologists when managing patients with hypothyroidism, their use of LT3 + LT4 combination therapy and use of thyroid hormones in euthyroid patients. Design and Participants: Members of the Endocrine Society of Australia (ESA) were invited to participate in an online questionnaire. Measurements: We analysed questionnaires that had complete demographic data. Results: Eighty‐seven questionnaires fulfilled the criteria. LT4 was used as first line treatment for hypothyroidism by all respondents. Only 45% reported that their patients were dispensed the brand of LT4 that they recommend. LT3 (alone or in combination) was prescribed by 44% in their clinical practice. Although 49% of respondents would consider LT3 + LT4 in patients with normal TSH who had ongoing symptoms of hypothyroidism, the inability of LT4 to restore normal physiology was ranked the least likely explanation for persistent symptoms and only 32% would consider it for themselves if they were diagnosed with hypothyroidism. The majority (55%), in accordance with evidence, would not prescribe thyroid hormone to euthyroid individuals but 39% would consider use in euthyroid female infertility with high levels of thyroid antibodies and 11% in euthyroid patients with a simple goitre growing over time. LT4 use in pregnancy was variable among members. Conclusions: Australian endocrinologists mostly follow international guidelines when prescribing thyroid hormone therapy and many prescribe combination LT3 and LT4 therapy, particularly for patients who remain symptomatic on LT4 monotherapy. Prescribing practices are largely similar to other countries who have completed similar questionnaires. [ABSTRACT FROM AUTHOR]

Background: Payers are increasingly interested in quality improvement for opioid use disorder (OUD) treatment, including incorporating patient experiences. Medicaid is the largest payer for OUD treatment, yet we know little about the treatment benefits Medicaid members report, how these vary across members, or changed with the COVID-19 pandemic. Objective: To examine Medicaid members' report of outpatient treatment benefits, employment, and housing outcomes before and during the pandemic. Methods: A representative sample of 1,032 Virginia Medicaid members (52% women) receiving OUD treatment completed a survey of treatment benefits, health status and social needs. A reported treatment benefit index was created based on seven self-reported items. Multivariable linear regression models, pooled and stratified by time (pre-COVID-19/COVID-19), assessed member characteristics associated with reported treatment benefit, employment and housing outcomes. Results: Members reported strong treatment benefit (mean: 21.8 [SD: 5.9] out of 28 points) and improvements in employment (2.4 [1.3] out of 5) and housing (2.8 [1.2] out of 5). After adjustment, mental distress (regression coefficient: −3.00 [95% CI:-3.97;-2.03]), polysubstance use (−1.25 [−1.99;-0.51]), and food insecurity (−1.00 [−1.71;-0.29]), were associated with decreased benefits from treatment. During COVID-19, justice-involved individuals reported decreased benefits (−2.17 [−3.54; −0.80]) compared to before the pandemic (−0.09 [−1.4-;1.24] p <.05). Conclusions: Medicaid members receiving outpatient OUD treatment reported positive treatment benefits, and housing and employment outcomes. However, those with comorbid health and social conditions often benefited the least. As payers move toward quality improvement and value-based purchasing initiatives, collecting and integrating patient reported outcomes into quality metrics is critical. [ABSTRACT FROM AUTHOR]

BACKGROUND: Elevator-type evacuation devices have proven to be feasible in high-rise buildings through studies on safety performance and evacuation time. However, there is a lack of research on safety using biosignal analysis in the elderly population. OBJECTIVE: A carbon material is used in this study to reduce the weight of an evacuation elevator. The impact on the human body is evaluated by conducting a satisfaction survey involving elderly and youth groups and quantitatively analyzing biological signals, including electromyography (EMG) and plantar pressure, during five repeated uses of the proposed device. METHODS: The study involves 12 healthy adults in their 20s and 20 elderly individuals with no experience in using an evacuation elevator. The EMG and left and right plantar pressures are analyzed to evaluate the physical factors affected by repeated use. RESULTS: The experiment results showed that the normalization of EMG to maximum voluntary contraction showed a significant decrease with repeated use, especially in the right tibialis anterior muscle. Moreover, plantar pressure shows a significant difference, which decreased with repetition, and the left and right balance gradually tilted to the left. CONCLUSION: This suggests that with more repeated use, muscle tension decreases owing to adaptation, resulting in lower muscle activity and plantar pressure. Particularly, the tibialis anterior muscle experiences significant muscle activity, indicating increased load, but without any apparent danger. In the future, it will be necessary to evaluate elevators for disabled individuals. [ABSTRACT FROM AUTHOR]

Background: Preoperative very low energy diet (VLED) interventions are used routinely in patients undergoing bariatric surgery, a surgical subspecialty that deals almost exclusively with patients with obesity. Yet, their use and study has been limited in non-bariatric abdominal surgery. To investigate the use of VLEDs in non-bariatric surgery, we plan on conducting a randomized controlled trial (RCT). Prior to proceeding, however, we have designed two surveys as important pre-emptive studies aimed at elucidating patient and provider perspectives regarding these interventions. Methods: The patient survey is a cross-sectional, single-center survey aimed at assessing the safety, adherence, barriers to adherence, and willingness to participate in preoperative optimization protocols with VLEDs prior to undergoing elective non-bariatric intra-abdominal surgery (S1 File). The population of interest is all adult patients with obesity undergoing elective non-bariatric intra-abdominal surgery at St. Joseph's Healthcare Hamilton who were prescribed a course of preoperative VLED. The primary outcomes will be safety and adherence. The target sample size is 35 survey responses. The provider survey is a cross-sectional national survey of practicing surgeons in Canada who perform major non-bariatric abdominal surgery aimed assessing the willingness and ability to prescribe preoperative weight loss interventions amongst practicing Canadian surgeons who perform major non-bariatric abdominal surgery (S2 File). The population of interest is independent practicing surgeons in Canada who perform major non-bariatric abdominal surgery. The primary outcome will be willingness to prescribe preoperative VLED to patients with obesity undergoing major non-bariatric abdominal surgery for both benign and malignant indications. The target sample size is 61 survey responses. Descriptive statistics will be used to characterize the sample populations. To determine variables associated with primary outcomes in the surveys, regression analyses will be performed. Discussion: These survey data will ultimately inform the design of an RCT evaluating the efficacy of preoperative VLEDs for patients with obesity undergoing major abdominal surgery. [ABSTRACT FROM AUTHOR]

Introduction: Medium-term clinical outcome data are lacking for cyanoacrylate glue (CAG) ablation for symptomatic varicose veins, especially from the Asian population. Objectives: Aim was to determine the 3-year symptomatic relief gained from using the VenaSeal™ device to close refluxing truncal veins from the Singaporean ASVS prospective registry. Methods: The revised Venous Clinical Severity Score (rVCSS) and three quality of life (QoL) questionnaires were completed to assess clinical improvement in venous disease symptoms along with a dedicated patient satisfaction survey. 70 patients (107 limbs; 40 females; mean age of 60.9 ± 13.6 years) were included at 3 years. Results: At 3 years, rVCSS showed sustained improvement from baseline (5.00 to 0.00; p < 0.001) and 51/70 (72.9%) had improvement by at least 2 or more CEAP categories. Freedom from reintervention was 90% and 85.7% patients were extremely satisfied with the treatment outcome. No further reports of further hypersensitivity reactions after one year. Conclusion: The 3-year follow-up results of the ASVS registry demonstrated continued and sustained clinical efficacy with few reinterventions following CAG embolization in Asian patients with chronic venous insufficiency. Trial registration: ClinicalTrials.gov Registration: NCT03893201. [ABSTRACT FROM AUTHOR]