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Introduction: The efficient utilization of resources is a crucial aspect of healthcare, particularly in both Level I and Level II American College of Surgeons (ACS)-verified trauma centers. The effect of resource allocation on emergency department length of stay (ED-LOS) of trauma patients has remained under-investigated. As ED crowding has become more prevalent, especially at quaternary care centers, an evaluation of the potential disparities in ED-LOS between Level I and Level II trauma centers is warranted. We hypothesized a longer ED-LOS at Level I centers compared to Level II centers.Methods: We queried the 2017–2021 Trauma Quality Improvement Process (TQIP) database for trauma patients ≥18 years of age presenting to either a Level-I or -II center. The TQIP defines ED-LOS as the time from arrival until the time an ED disposition (admission or discharge) order is written. We excluded transferred patients and those with missing data regarding ACS trauma center verification level. We performed bivariate analyses, as well as subgroup analyses based on location of disposition.Results: Of 2,225,067 trauma patients, 59.3% (1,318,497) received treatment at Level I centers. No significant differences were found in Injury Severity Scores between patients admitted to the operating room or non-intensive care unit (ICU) locations, or discharged home from Level-I and -II centers (all P < 0.05). The ED-LOS for trauma patients was longer at Level-I centers for all patient categories: overall (198 vs 145 minutes [min], P < 0.001), discharged home (286 vs 160 min, P < 0.001), non-ICU admissions (234 vs 164 min, P < 0.001), and those requiring surgery (126 vs 101 min, P < 0.001).Conclusion: Even when treating patients with similar injury severity, trauma patients at Level I trauma centers had longer ED-LOS compared to Level II centers, irrespective of the patients’ final disposition (surgery, non-ICU admission, or discharge). To optimize resource utilization and alleviate ED saturation, further research must delve into the underlying causes of these discrepancies to identify best practices and solutions.

This article proposes a blockchain-based system to address the inefficiencies of the current healthcare credentialing process that contribute to workforce shortages. Leveraging blockchains unique features, the proposed system aims to reduce time, cost, and labor, offering significant time savings, increased trustworthiness, and enhanced staffing resilience. Real-world blockchain examples demonstrate the feasibility of this approach. The study concludes that a blockchain-based credentialing system could streamline healthcare credentialing, enhance preparedness for future challenges, and improve healthcare delivery and patient outcomes.

The overarching goal of medical education is to train clinicians who achieve and maintain competence in patient care. Although the field of medical education research has acknowledged the importance of education on clinical practices and outcomes, most research endeavors continue to focus on learner-centered outcomes, such as knowledge and attitudes. The absence of clinical and patient-centered outcomes in pulmonary and critical care medicine medical education research has been attributed to barriers at multiple levels, including financial, methodological, and practical considerations. This Perspective explores clinical outcomes relevant to pulmonary and critical care medicine educational research and offers strategies and solutions that educators can use to accomplish what many consider the prize of medical education research: an understanding of how our educational initiatives impact the health of patients.

Background: The aim of our work was to examine differences between trauma patients in rural and urban areas who presented to a tertiary trauma centre in the province of Saskatchewan, Canada. Methods: We identified a historical cohort of all level 1 trauma activations presenting to Royal University Hospital (RUH) from April 1, 2020, to March 31, 2022. We divided the cohort into 2 groups (urban and rural), according to the trauma location. The primary outcome of interest was 30-day mortality. Secondary outcomes of interest were hospital length of stay, readmission to hospital within 30 days of discharge, and complication rate. Results: Trauma patients in rural areas were younger (34.1 v. 37 yr; p = 0.002) and more likely to be male (80.3% v. 74.4%; p = 0.040), with higher Injury Severity Scores (12.3 v. 8.3; p < 0.0001). Trauma patients in urban areas were more likely to sustain penetrating trauma (42.5% v. 28.5%; p < 0.0001). We saw no differences in morbidity and mortality between the 2 groups, but the rural trauma group had longer median lengths of stay (5 v. 3 d; p < 0.0007). Conclusion: Although we identified key differences in patient demographics, injury type, and injury severity, outcomes were largely similar between the urban and rural trauma groups. This finding contradicts comparable studies within Canada and the United States, a difference that may be attributable to the lack of inclusion of prehospital mortality in the rural trauma group. The longer length of stay in trauma patients from rural areas may be attributed to disposition challenges for patients who live remotely. Contexte: Notre travail avait pour but d'analyser les diff rences entre les patient les de traumatologie provenant de milieux ruraux et urbains ayant consult dans un centre de traumatologie tertiaire de la province de la Saskatchewan, au Canada. M thodes: Nous avons constitu une cohorte historique de tous les cas d'activation de niveau 1 en traumatologie ayant consult l'H pital universitaire royal entre le 1er avril 2020 et le 31 mars 2022. Nous avons scind la cohorte en 2 groupes (milieux urbains et ruraux), selon le lieu de survenue du traumatisme. Le param tre principal tait la mortalit 30 jours. Les param tres secondaires taient la dur e du s jour hospitalier, la r hospitalisation dans les 30 jours suivant le cong , et le taux de complications. R sultats: La patient le de traumatologie provenant de r gions rurales tait plus jeune (34,1 c. 37 ans; p = 0,002) et plus susceptible d' tre de sexe masculin (80,3% c. 74,4%; p = 0,040) et de pr senter des indices de gravit des blessures plus lev s (12,3 c. 8,3; p < 0,0001). La patient le de traumatologie provenant de milieux urbains tait plus susceptible d'avoir subi un traumatisme p n trant (42,5% c. 28,5%; p < 0,0001). Nous n'avons observ aucune diff rence aux plans de la morbidit et de la mortalit entre les 2 groupes, mais la dur e m diane du s jour hospitalier du groupe provenant de milieux ruraux a t plus longue (5 c. 3 j; p < 0,0007). Conclusion: M me si nous avons observ des diff rences cl s aux plans des donn es d mographiques ainsi que du type et de la gravit des blessures, les param tres se sont r v l s assez semblables entre les patient les de traumatologie des milieux urbains et ruraux. Cette observation se d marque de celles d' tudes canadiennes et am ricaines comparables, ce qui pourrait s'expliquer par l'exclusion de la mortalit pr hospitali re dans le groupe de milieux ruraux. La dur e plus longue du s jour chez la patient le de traumatologie de milieux ruraux pourrait tre attribuable des enjeux relatifs l' tat de ces malades au moment de leur cong ., The province of Saskatchewan, Canada, has a geographically dispersed population, with about 60% living more than an hour away from a tertiary care centre and 48% living more than an [...]

Tuberculosis (TB) remains a major public health challenge and the most frequent cause of illness and death among persons living with HIV (PLHIV) (1). Globally, TB occurs in congregate settings [...]

Background: The evidence on the benefits and drawbacks of involving neurosurgical residents in the care of patients who undergo neurosurgical procedures is heterogeneous. We assessed the effect of neurosurgical residency programs on the outcomes of such patients in a large single-payer public health care system. Methods: Ten population-based cohorts of adult patients in Ontario who received neurosurgical care from 2013 to 2017 were identified on the basis of procedural codes, and the cohorts were followed in administrative health data sources. Patient outcomes by the status of the treating hospital (with or without a neurosurgical residency program) within each cohort were compared with models adjusted for a priori confounders and with adjusted multilevel models (MLMs) to also account for hospital-level factors. Results: A total of 46 608 neurosurgical procedures were included. Operative time was 8%-30% longer in hospitals with neurosurgical residency programs in 9 out of 10 cohorts. Thirty-day mortality was lower in hospitals with neurosurgical residency programs for aneurysm repair (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.20-0.44), cerebrospinal fluid shunting (OR 0.52, 95% CI 0.34-0.79), intra cerebral hemorrhage evacuation (OR 0.66, 95% CI 0.52-0.84), and posterior lumbar decompression (OR 0.32, 95% CI 0.15-0.65) in adjusted models. The mortality rates remained significantly different only for aneurysm repair (OR 0.19, 95% CI 0.05-0.69) and cerebrospinal shunting (OR 0.42, 95% CI 0.21-0.85) in MLMs. Length of stay was mostly shorter in hospitals with neurosurgical residents, but this finding did not persist in MLMs. Thirty-day reoperation rates did not differ between hospital types in MLMs. For 30-day readmission rates, only extracerebral hematoma decompression was significant in MLMs (OR 1.41, 95% CI 1.07-1.87). Conclusion: Hospitals with neurosurgical residents had longer operative times with similar to better outcomes. Most, but not all, of the differences between hospitals with and without residency programs were explained by hospital-level variables rather than direct effects of residents. Contexte : Les donn es relatives aux avantages et aux inconv nients de la participation des r sidentes et r sidents en neurochirurgie aux interventions de cette sp cialit sont h t rog nes. Nous avons valu l'effet des programmes de r sidence en neurochirurgie sur les r sultats chez les malades concern s au sein d'un volumineux syst me de sant universel payeur unique. M thodes : Dix cohortes populationnelles compos es de malades adultes ayant re u des soins en neurochirurgie en Ontario entre 2013 et 2017 ont t identif es partir des codes d'acte, et suivies au moyen des bases de donn es administratives sur la sant . Les r sultats chez les malades de chaque cohorte selon le statut de leur h pital (offrant ou non un programme de r sidence en neurochirurgie) ont t compar s des mod les ajust s pour tenir compte de variables de confusion a priori, et des mod les multiniveaux ajust s (MMN) pour tenir compte aussi de facteurs propres aux h pitaux. En tout, nous avons inclus 46 608 interventions neurochirurgicales. Le temps op ratoire a t 8%-30% plus long dans les h pitaux offrant un programme de r sidence en neurochirurgie dans 9 cohortes sur 10. La mortalit 30 jours a t moindre dans les h pitaux offrant un programme de r sidence en neuro chirurgie pour les r parations d'an vrisme (rapport des cotes [RC] 0,30, intervalle de confance [IC] de 95% 0,20-0,44), les d rivations du liquide c phalorachidien (RC 0,52, IC de 95% 0,34-0,79), le drainage des h morragies intrac r brales (RC 0,66, IC de 95% 0,52-0,84) et la d compression post rieure lombaire (RC 0,32, IC de 95% 0,15-0,65) dans les mod les ajust s. Les taux de mortalit sont demeur s significativement diff rents uniquement pour les r parations d'an vrisme (RC 0,19, IC de 95% 0,05-0,69) et les d rivations du liquide c phalorachidien (RC 0,42, IC de 95% 0,21-0,85) dans les MMN. La dur e des s jours a t majoritairement moindre dans les h pitaux offrant un programme de r sidence en neurochirurgie, mais cette observation ne se maintenait pas dans les MMN. Les taux de r intervention 30 jours n'ont pas diff r entre les types d'h pitaux dans les MMN. Les taux de r admission 30 jours n'ont t significatifs que pour les cas de d compression d'h matomes extrac r braux dans les MMN (RC 1,41, IC de 95% 1,07-1,87). Conclusion : Les temps op ratoires ont t plus longs dans les h pitaux offrant un programme de r sidence en neurochirurgie, et les r sultats ont t similaires ou meilleurs. La plupart des diff rences entre les h pitaux offrant ou non un programme de r sidence en neurochirurgie ont pu s'expliquer par des variables propres aux h pitaux plus que par un quelconque effet direct des programmes de r sidence en neurochirurgie., Evidence from studies that have examined resident influence on the outcome of surgical procedures, in general, is heterogenous. (1-6) This is expected because of the different natures and complexities of [...]

BACKGROUND: Injury is a major cause of death and disability in Ethiopia. ALERT Hospital, one of only three designated trauma centers in the country, has employed a basic trauma registry since its inception in 2016; however, these data had not been used. In joint efforts with the Federal Ministry of Health, we aimed to understand patient injury characteristics and predictors of mortality, to inform priorities in resource and training investments. METHODS: Data from 12 816 consecutive patients in the first 3 years of the trauma registry were reviewed retrospectively. Modified Early Warning Score was used at triage to indicate injury severity (red=critically injured, green=minor injury). No physiologic data for calculating Injury Severity Scores or in-hospital intervention data were available. Triage groups were compared and multivariate logistic regression conducted to determine predictors of in-emergency department (ED) mortality. RESULTS: Most patients presented with minor injuries with 64.7% triaged as yellow and 16.4% triaged as green, and most (75.9%) referred from another facility. Of those who were critically injured, only 31.0% arrived by ambulance. Most injuries were soft tissue (51.1%) and fractures (23.0%); when stratified by triage category, most critical (red) patients had sustained head injuries (52.7%). Arrival by ambulance (OR 2.20, p=0.017) and head injury (OR 3.11, p

Background: The FACE‐Q Aesthetics is used extensively to measure patient reported outcomes for minimally invasive and surgical facial aesthetic treatments. We recently developed a new FACE‐Q scale to assess satisfaction with the appearance of the temples. Aim: The aim of this study was to field test the FACE‐Q Satisfaction with Temples scale to examine its psychometric properties. Methods: The FACE‐Q Satisfaction with Temples scale was administered to 171 adults (22 years or older) seeking minimally invasive treatment to improve temple hollowing as part of a clinical trial. The severity of temple hollowing was established through the clinician‐reported Allergan Temple Hollowing scale (clinician‐rated). The psychometric properties of the FACE‐Q Satisfaction with Temples scale were established by testing Rasch Measurement Theory (RMT) assumptions and model fit; unidimensionality by principal component analysis; and construct validity by hypothesis testing. Results: The study sample consisted of 171 adults (mean age 54.7 ± 9.9, range, 25–82 years). RMT analysis provided evidence for the scientific soundness of a 12‐item Satisfaction with Temples scale. The data fit the Rasch model (χ2 = 20.47, df = 24, p = 0.67), all items had ordered thresholds, and good item fit. Scale reliability was high, with Person Separation Index and Cronbach alpha values with and without extremes ≥0.93. Principal component analysis revealed a single component with high factor coefficients. Construct validity was established as scores for the Satisfaction with Temples and Face Overall scales were correlated (r = 0.623, p < 0.001). Conclusion: The FACE‐Q Satisfaction with Temples scale is a reliable and valid measure that can be used in clinical practice and research to measure outcomes following treatment for temple hollowing. [ABSTRACT FROM AUTHOR]

To work with a psychological therapies service to implement a recovery plan, as required by a government body, aimed at improving patient outcomes (effectiveness) and decreasing practitioner variability (equity). A case-study utilizing components of a learning health system, including nationally mandated patient outcome data, comprising three 18-month phases: (1) retrospective baseline; (2) improving patient outcomes (management-led); and (3) reducing practitioner variability (clinician-led). Primary analyses focused on 35 practitioners (NPR = 35) who were constant across the three phases and their patients in each phase (NPA = 930, 1226, 1217, respectively). Reliable improvement rates determined patient outcomes and multilevel modeling yielded practitioner effects. To test generalizability, results were compared to the whole practitioner sample for each phase: (1) NPR = 81, NPA = 1982; (2) NPR = 80, NPA = 2227; (3) NPR = 74, NPA = 2267. Ethical approval was granted by the Health Research Authority. Patient outcomes improved in successive phases for both the core and whole practitioner samples with the largest impact occurring in the management-led intervention. Practitioner variability decreased in successive phases in both the core and whole practitioner samples except in the management-led intervention of the whole sample. Compared with the management-led intervention, the practitioner-led intervention yielded a decrease in practitioner effect exceeding 60% in the core sample and approaching 50% in the whole sample. The implementation of multiple components of a learning health system can lead to improvements in both the effectiveness and equity of a psychological therapy service. Clinical or Methodological Significance of this Article: A sequential combination of management-led interventions targeted at improving patient outcomes followed by a compassionate and bespoke feedback to practitioners utilizing principles derived from deliberate practice is a feasible strategy for improving patient outcomes (effectiveness) and reducing practitioner variability (equity), thereby yielding a more equitable delivery of patient care. [ABSTRACT FROM AUTHOR]

Purpose: The primary objective of this study was to explore the potential disparity in postoperative fistula occurrence rates between patients who undergo (partial) lateral parotidectomy and those who undergo the extracapsular dissection technique for the management of benign parotid gland tumours. Methods: A consecutive series of 363 patients treated with (partial) lateral parotidectomy and extracapsular dissection technique for benign parotid gland tumours at one tertiary centre between 2018 and 2022 were included. To evaluate the impact of the surgical technique and possible other risk factors (tumour location, tumour size, Body Mass Index, age, smoking, diabetes mellitus, arterial hypertension) for the development of fistulas, multivariate logistic regression analyses using backward lection were applied to estimate odds ratios (ORs) and 95%‐confidence intervals (CIs). Results: In 363 patients, 21 patients (5.8%) developed a fistula. Patients who underwent (partial) lateral parotidectomy had three times higher chance of developing a fistula compared to patients who were operated using the extracapsular dissection technique (ORadjusted = 2.6, 4.1% vs. 12.5%, p = 0.044). In the multivariate analyses, no other risk factors for the development of fistulas were statistically significant in this cohort. The incidence of facial nerve paralysis was not significantly different between the extracapsular dissection and lateral parotidectomy group (5/73 = 6.8% vs. 11/290 = 3.8%, p = 0.333). Conclusion: Fistulas occur more often in patients treated by means of a (partial) lateral parotidectomy approach compared to patients treated using the extracapsular dissection technique. Therefore, surgeons should be vigilant about postoperative fistula risks in lateral parotidectomy and consider preventive measures. [ABSTRACT FROM AUTHOR]

Background: Patients with Ehlers-Danlos syndromes (EDS) often experience high rates of joint subluxations and dislocations, and associated pain that may require surgical interventions. Orthopaedic surgical management is challenging in this population, and patients will often undergo multiple unsuccessful surgeries. Outcomes data specific to patients with EDS are sparse in the orthopaedic surgery literature. We conducted a scoping review to evaluate the evidence and outcomes for orthopaedic surgery specifically for the EDS population. Methods: PubMed MEDLINE, Embase, The Cochrane Library, Cochrane Controlled Register of Trials (CENTRAL), CINHL, and Scopus from their inception to February 28, 2024 for all studies that reported outcomes for orthopaedic surgery in patients with EDS. Two reviewers independently determined study eligibility, rated study quality, and extracted data. Methodology followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The studies in this scoping review include Level III (retrospective cohort and case control) and Level IV (case series) evidence. Results: The literature search yielded a total of 71 citations published between 1990 and 2023. All were primary studies. 38 were single case studies, 14 were case series, and 19 were retrospective cohort studies. No randomized clinical studies or systematic reviews were identified. Overall, the reported findings for the various anatomical sites and procedures indicated that surgery outcomes were inconsistent. Our review highlights the need for future research to determine whether currently established surgical approaches for various orthopaedic conditions offer long-term clinical benefit in patients with EDS. This is clearly a challenging diagnosis, and more rigorous clinical studies are required to identify optimal treatment approaches. Conclusions: Our review found little evidence-based research to guide optimal surgical treatment in EDS. Established surgical techniques that have been shown to be successful in the wider orthopaedic population should be studied to determine their efficacy in the EDS population. [ABSTRACT FROM AUTHOR]

Background: ICU nurses play a critical role in managing delirium in critically ill patients, yet their competency in this area remains under-explored. Aim: To assess ICU nurses' competency including their knowledge, practice, and attitudes toward delirium among critically ill patients. Methods: A correlational descriptive study was conducted with 67 nurses in the medical intensive care unit at Suez Canal University Hospitals. Data was collected using an online survey and analyzed using descriptive statistics, ANOVA, and Pearson's correlation. Results: Nurses showed a moderate knowledge level (M = 8.55), a low practice level (M = 6.62), and positive attitudes (M = 21.65) toward ICU delirium. ANOVA results indicated significant differences in practice scores based on educational level, F (2, 64) = 3.361, p =.041, and in knowledge scores based on ICU experience, F(3, 63) = 6.455, p <.001. Nurses with Master of Science in Nursing (MSN) degrees had higher practice scores than those with diplomas or Bachelor of Science in Nursing (BSN) degrees. There were no significant differences in knowledge and attitude scores based on educational level or age. Gender differences were minimal, with male nurses slightly outperforming female nurses. Correlation analysis showed positive relationships between age, education, ICU experience, and ICU nurses' levels of knowledge and practice. Conclusion: ICU nurses demonstrate a knowledge-practice gap in delirium management. Targeted educational interventions, mentorship programs, and a focus on practical skills are essential to enhance delirium care. Relevance to clinical practice: These findings highlight the urgent need for comprehensive delirium education and training programs for ICU nurses. By improving nurses' knowledge and practice, healthcare organizations can significantly enhance the early detection, prevention, and management of delirium, ultimately leading to improved patient outcomes and reduced length of stay in the ICU. [ABSTRACT FROM AUTHOR]

Background: Electroconvulsive therapy (ECT) is a well-established treatment for various psychiatric disorders. This retrospective study evaluates anesthesia practices, patient characteristics, and outcomes in ECT over a two-year period at the "Dr. Gheorghe Preda" Clinical Psychiatry Hospital in Sibiu, Romania. Methods: From March 2022 to July 2024, the Neuroscience Scientific Research Collective at our institution carried out a retrospective observational study on patients who underwent ECT. The evaluation and treatment protocol involved patients from all over the country. Results: The study involved 30 patients aged between 22 and 67 years and a mean age of 39.4 years; among them, 57% were male. The majority of the patients (68%) lived in urban areas, and 80% came from a different county. Schizophrenia was the most prevalent diagnosis (56.6%), followed by depression (40%) and bipolar disorder (3.4%). Common comorbidities included obesity/overweight, high blood pressure, and sinus tachycardia. A total of 330 ECT sessions were conducted, with an average of 11 sessions per patient, and 10 patients underwent multiple treatment courses. The reported adverse events included arterial hypertension, agitation, tachycardia, and shivering. Conclusions: This study underlines the safety and effectiveness of ECT when patients are closely monitored. Our results are consistent with the global data, suggesting that ECT is a good treatment option for severe psychiatric conditions with a manageable incidence of adverse events. [ABSTRACT FROM AUTHOR]

Objective. To determine the impact of psoas muscle health [crosssectional area (CSA)] on achieving minimal clinically important differences (MCID) in patient-reported outcome measures (PROMs) following laminectomy for patients with predominant back pain (PBP) and leg pain (PLP). Summary of Background Data. Psoas muscle health is linked to postoperative outcomes in decompression patients, with MRIbased grading of psoas CSA correlating with these outcomes. However, evidence on its impact on symptomatic recovery, measured by PROMs, is lacking. Methods. One hundred six patients with PBP (VAS back > VAS leg) and 139 patients with PLP (VAS leg > VAS back) who underwent laminectomy from 2017 to 2021 were included. Axial T2 MRI images were analyzed for psoas CSA using a validated method. Based on the lowest-quartile normalized total psoas area (NTPA) thresholds, patients were divided into "good" and "poor" muscle health groups. The correlation analyses were performed between the psoas CSA and changes in PROMs. Kaplan--Meier survival analysis was conducted to determine the probability of achieving MCID as a function of time. Results. Of 106 patients with PBP, 83 (78.3%) had good muscle health, and 23 (21.6%) had poor muscle health. Of 139 patients with PLP, 54 (38.8%) had good muscle health, and 85 (61.1%) had poor muscle health. In the PBP group, older age was associated with poor muscle health (69.70± 9.26 vs. 59.92 ± 15.01, P= 0.0002). For both cohorts, there were no differences in the rate of MCID achievement for any PROMs between the good and poor muscle health groups. In the PBP group, Kaplan-- Meier analysis showed patients with good psoas health achieved MCID-VAS back and Oswestry Disability Index (ODI) in median times of 14 and 42 days (P=0.045 and 0.015), respectively. Conclusion. Good psoas muscle health is linked to faster attainment of MCID, especially in patients with PBP compared with PLP after decompression surgery. [ABSTRACT FROM AUTHOR]

Background/Objectives: Empathy and emotional regulation (susceptibility and resistance) play an important role in a nurse's well-being and the provision of high-quality care. This phenomenon has not yet been studied in the context of nurses working in neuroscience. This study aimed to explore the perceptions related to empathy among nurses working in neuroscience contexts. Methods: Employing a mixed-methods approach, we conducted an online quantitative survey with 211 nurses working in various neuroscience settings using the Balanced Emotional Empathy Scale (BEES) and 15 online semistructured qualitative interviews to delve deeper into empathetic experiences. The mean and measures of dispersion, such as standard deviation, were used to analyze the quantitative data. Thematic analysis investigated qualitative data, and data triangulation was performed. Results: The quantitative findings revealed no significant differences in empathy or emotional regulation across the different neuroscience settings but highlighted an increase in susceptibility related to young age (under 29) and years of service (first 5 years). The interviews brought to light the challenges nurses face in highly emotional situations and the strategies they employ to manage empathy and maintain professional detachment, such as self-care strategies, awareness development, and team support. One hindering factor is managers. Conclusions: The findings of this study underscore the essential role of empathetic capability in nursing care in neuroscience. The experience of younger nurses and the first 5 years of employment are elements to be considered by managers for burnout risk. Nurses demonstrate susceptibility and resistance and maintain a balance in dealing with high-emotional-stress situations. The implications of these findings are significant and should guide future research and practice in the field of neuroscience nursing. [ABSTRACT FROM AUTHOR]

Background Aim Study Design and Methods Results Conclusions Relevance to Clinical Practice Position change and interventions to increase lung capacity should be considered in mechanically ventilated patients. The most effective of these is the prone position.This systematic review and meta‐analysis aimed to determine the effects of the prone position on respiratory parameters and outcomes and to guide nurses working in the intensive care unit.This systematic review‐meta‐analysis was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta‐Analyses guideline. ScienceDirect, CINAHL, Academic Search Complete (EBSCOhost), MEDLINE, EMBASE, Web of Science, Cochrane and PubMed databases were searched between January 2022 and January 2023 to access studies related to prone position in COVID‐19 patients.Twenty‐three studies were included. This meta‐analysis shows that a prone position is feasible and can achieve improvements in gas exchange. Prone position increases PaO2/FiO2 in the majority of patients followed with a diagnosis of COVID‐19 and severe hypoxemic.The study has shown that the prone position is effective in improving patients' respiratory function and oxygenation.The results presented in this article support the notion that the prone position can be an effective strategy in the clinical management of COVID‐19 patients. [ABSTRACT FROM AUTHOR]

Background: Myocardial infarction (Ml) patients face a higher risk of recurrent cardiovascular events and reduced quality of life. Cardiac rehabilitation (CR) is a comprehensive secondary prevention program that improves outcomes, but adherence remains suboptimal. Perceived social support has been identified as a potential determinant of CR adherence. The current study explored the connection between Ml patients' adherence to CR and their perceived social support. Methods: This cross-sectional study was conducted at a tertiary care hospital in Baghdad, Iraq. The sample included 150 Ml patients enrolled in a CR program. The MSPSS (Multidimensional Scale of Perceived Social Support) was employed to evaluate perceived social support, and attendance records measured adherence to CR. Clinical and sociodemographic data were collected. Logistic regression analyses, including multivariate and univariate approaches, were carried out to analyze the association between adherence to CR and perceived social support. Results: Adherent patients had significantly higher MSPSS scores than non-adherent patients (68.3 ± 12.8 vs. 57.2 ± 14.1, P <0.001). In the multivariate analysis, perceived social support was significantly associated with adherence to CR (adjusted OR=1.06, 95% Cl: 1.031.10, P <0.001) after controlling for sociodemographic and clinical variables. Education level was also significantly associated with adherence, with patients having a secondary education or higher showing 2.4 times higher odds of adherence (adjusted OR = 2.40, 95% Cl: 1.08-5.34, P = 0.032). The association between perceived social support and adherence to CR was significant among male participants but not among female participants. Conclusion: Increased perceived social support was significantly associated with higher CR adherence, especially in male patients (adjusted OR=1.06, 95% 0=1.03-1.10, P<0.001). Interventions to enhance social support, especially for male patients and those with lower education levels, may improve CR participation and completion rates. Healthcare providers should assess patients' social support networks and engage family members and significant others in the CR process to promote better cardiovascular health outcomes. [ABSTRACT FROM AUTHOR]

Advances in endoscopic endonasal transsphenoidal surgery have led to improved postoperative outcomes after pituitary adenoma resection, including reduced length of stay, complications and readmission rates, without compromising safety and satisfaction. Our team implemented a perioperative protocol in January 2021 for patients undergoing endoscopic, transsphenoidal pituitary surgery. This study compares preoperative characteristics and postoperative outcomes in 279 patients between 2016 and 2022 (128 preprotocol and 151 postprotocol). Our protocol includes interdisciplinary preoperative evaluations, unified communication, cortisol thresholds for postoperative glucocorticoid replacement, and fluid restriction to prevent delayed hyponatremia. Median age was 54 ± 17 years with 50.8% female patients. There were 229 (82.1%) macroadenomas (>1 cm) and 50 (17.9%) microadenomas/cysts (<1 cm). Mean diameter was 18 (transverse), 18 (craniocaudal), 16 (anteroposterior) mm. Tumor types included 125 (44.8%) gonadotroph, 46 (16.4%) adrenocorticotroph, 40 (14.3%) lactotroph, 26 (9.3%) Rathke cysts, 19 (6.8%) somatotroph, 13 (4.6%) nondiagnostic, 3 (1%) somatotroph-lactotroph, 3 (1%) mammosomatotroph, 2 (0.71%) null cell, and 2 (0.7%) thyrotroph adenomas. Postprotocol, 74.2% of patients were discharged on postoperative day 1 compared with 46.1% preprotocol (P < 0.0001). Transient arginine vasopressin deficiency decreased from 10.4% (preprotocol) to 4.6% postprotocol (P = 0.101). Hyponatremia occurred in 13.3% pre-protocol and 4.6% postprotocol. Emergency department visits dropped from 9.4% to 3.9%, and readmissions decreased from 7.8% to 2.6%. Persistent arginine vasopressin deficiency affected 2.3% preprotocol and 1.3% postprotocol patients. Cerebrospinal fluid leaks occurred in 8.5% preprotocol and 7.3% postprotocol. Implementing an interdisciplinary, perioperative protocol for transsphenoidal endoscopic pituitary surgery improves length of stay while minimizing readmissions and surgery-related complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: While issues related to lesbian, gay, bisexual, and transgender (LGBT) health are increasingly incorporated into medical training, there remains limited guidance and opportunities for continuing medical education in LGBT health. It is unclear how participation in LGBT-specific training is distributed across physician specialties and practice regions. Additionally, national data assessing cultural competency training for physicians are scarce and do not delineate LGBT-specific training or training completed prior to, during, or after graduate medical education. METHODS: Using data from the 2016 National Culturally and Linguistically Appropriate Services Physician Survey, this study evaluated patterns of post-residency cultural competency training, as well as associations between LGBT-specific training and provider perceptions of patient care outcomes. RESULTS: Provider specialty, practice region, and receiving cultural competency training as a trainee were associated with post-residency LGBT-specific training. Surgical providers (odds ratio [OR]: 0.42; confidence interval [CI] 0.25–0.73; p =.002) and those practicing in the South (OR: 0.49; CI: 0.26–0.92; p =.025) had lower odds of completing LGBT-specific cultural competency training while in independent practice. Post-residency LGBT-specific training was associated with provider agreement that cultural competency training improves the quality of care (OR: 2.76; CI: 1.44–5.28; p =.002), patient satisfaction (OR: 2.55; CI: 1.32–4.93; p =.005), and patient comprehension (OR: 2.03; CI: 1.05–3.90; p =.034). CONCLUSIONS: Our findings provide disaggregated analyses that nuance the assessment of cultural competency interventions and support a broader effort to increase attention to LGBT health in continuing medical education. [ABSTRACT FROM AUTHOR]

Ideally, evidence-based patient outcomes would be collected on a 6-monthly basis, allowing accurate measurement of treatment progress. This would encourage research and subsequent development of forensic mental health services. Lack of standardised routine outcome collection within Scotland may be acting as a barrier to this. The Royal College of Psychiatrists recommends that evidence-based clinical and patient-reported data should be collected; however, no specific measures are recommended. COnsensus-based Standards for health Measurement INstruments (COSMIN) guidelines for systematic reviews of outcome measures were followed and their Risk of Bias tool used to evaluate the quality of studies. Instrument content validity, for the purposes of measuring forensic patient recovery, was analysed separately through review of articles relating to instrument development and user feedback. From four evaluative instruments selected by predefined criteria, only Structured Assessment of Protective Factors for violence risk (SAPROF) and Instrument for Forensic Treatment Evaluation (IFTE) possessed the core psychometric properties of a useful outcome measure. These two instruments can therefore be recommended for the purpose of monitoring forensic patient recovery, with SAPROF being the more feasible option. HCR-20 and HoNOS-secure were found to lack content validity for this purpose. Additional psychometric studies for SAPROF are recommended. [ABSTRACT FROM AUTHOR]

Preanesthesia screening is critical to evaluate the patient's medical and surgical history before any procedure or surgery to assess for risks and to optimize outcomes during the perioperative period. The purpose of this quality improvement project was to decrease the number of missed appointments in the outpatient preanesthesia and surgical screening clinic and the impact on provider satisfaction. The design of this quality improvement project was pre and post design. Automated and live phone calls reminders were provided for patients scheduled in the outpatient preanesthesia. Data were collected to compare missed appointment rates from a 3-month period before the project implementation and a 3-month period afterward. Predata collection included the number of no-shows in the electronic health record system from the previous 3 months. Participants included all adult patients who are scheduled for a preanesthesia surgical screening appointment. Provider satisfaction was assessed using a 5-question survey, pre and postinnovation. Reminder systems had a statistically significant impact on reducing the number of no-shows in the preanesthesia and surgical screening clinic. No significant impact was shown in provider satisfaction. Implementation of a reminder system can help to reduce no-show rates in clinics. Patient no-shows overload the health system by reducing the productivity of providers and waste resources including use of clinic staff, longer wait times for other patients, and the timing providers put into chart preparation. [ABSTRACT FROM AUTHOR]

Background and Objectives: Breast cancer in patients with prior breast augmentation poses unique challenges for detection, diagnosis, and management. Mastectomy rates are increasing, and patients with prior augmentation often have a lower body mass index, making autologous techniques unsuitable. This study aims to assess the best reconstructive option in patients with a history of subglandular or dual-plane breast augmentation. Materials and methods: A prospective analysis was conducted on patients who underwent breast reconstruction after mastectomy. Patients with subglandular or dual-plane breast augmentation were included. Patients were divided into submuscular breast reconstruction (Group 2) or prepectoral breast reconstruction (Group 1) groups. Demographic and surgical data were collected. Results: A total of 47 patients were included, with 23 in Group 1 and 24 in Group 2. Complications occurred in 11 patients (23.4%), with significant differences between groups. The most common complication was seroma formation. Implant loss occurred in 4.3% of cases in Group 1, while no implant loss was observed in Group 2. Patient-reported satisfaction scores were similar between groups at 12 months postoperatively. Conclusions: Subpectoral breast reconstruction with a tissue expander seems a safer and effective technique for patients with prior breast augmentation. It resulted in fewer complications. This approach should be considered as an option for breast reconstruction after mastectomy in this cohort of patients. [ABSTRACT FROM AUTHOR]

Background: Implementation strategies targeting individual healthcare professionals and teams, such as audit and feedback, educational meetings, opinion leaders, and reminders, have demonstrated potential in promoting evidence-based nursing practice. This systematic review examined the effects of the 19 Cochrane Effective Practice and Organization Care (EPOC) healthcare professional-level implementation strategies on nursing practice and patient outcomes. Methods: A systematic review was conducted following the Cochrane Handbook, with six databases searched up to February 2023 for randomized studies and non-randomized controlled studies evaluating the effects of EPOC implementation strategies on nursing practice. Study selection and data extraction were performed in Covidence. Random-effects meta-analyses were conducted in RevMan, while studies not eligible for meta-analysis were synthesized narratively based on the direction of effects. The quality of evidence was assessed using GRADE. Results: Out of 21,571 unique records, 204 studies (152 randomized, 52 controlled, non-randomized) enrolling 36,544 nurses and 340,320 patients were included. Common strategies (> 10% of studies) were educational meetings, educational materials, guidelines, reminders, audit and feedback, tailored interventions, educational outreach, and opinion leaders. Implementation strategies as a whole improved clinical practice outcomes compared to no active intervention, despite high heterogeneity. Group and individual education, patient-mediated interventions, reminders, tailored interventions and opinion leaders had statistically significant effects on clinical practice outcomes. Individual education improved nurses' attitude, knowledge, perceived control, and skills, while group education also influenced perceived social norms. Although meta-analyses indicate a small, non-statistically significant effect of multifaceted versus single strategies on clinical practice, the narrative synthesis of non-meta-analyzed studies shows favorable outcomes in all studies comparing multifaceted versus single strategies. Group and individual education, as well as tailored interventions, had statistically significant effects on patient outcomes. Conclusions: Multiple types of implementation strategies may enhance evidence-based nursing practice, though effects vary due to strategy complexity, contextual factors, and variability in outcome measurement. Some evidence suggests that multifaceted strategies are more effective than single component strategies. Effects on patient outcomes are modest. Healthcare organizations and implementation practitioners may consider employing multifaceted, tailored strategies to address local barriers, expand the use of underutilized strategies, and assess the long-term impact of strategies on nursing practice and patient outcomes. Trial registration: PROSPERO CRD42019130446. [ABSTRACT FROM AUTHOR]

ABSTRACT The stepped care model (SCM) is a patient‐centred approach to mental health care, offering a range of services from least to most intensive, tailored to individual needs. This scoping review examines the adoption, effectiveness, challenges and implications associated with applying SCM within primary mental health service delivery. Evidence from global sources suggests the model is viable, effective and useful. This review explores the literature available, clarifies fundamental concepts and identifies existing knowledge gaps. The literature search included CINAHL, MEDLINE, PsycINFO, Scopus, the Federation University library, Google and Google Scholar databases. A systematic keyword‐based search using terms like “stepped care model,” “mental health,” and “primary care”; and a combination of keywords and subject headings, were used. The search strategy was refined by considering factors such as relevance, publication date, objectives and outcomes. This strategy yielded 20 papers compiled in this review. They include randomised controlled trials and cross‐sectional studies. The review supports SCM adoption in primary mental health care but acknowledges the need for further research. Key inclusions of the review include cost‐effectiveness, diverse diagnoses, efficacy and the model's structural configuration. Clear treatment details, delivery methods, intervention durations and chronological sequences are essential. This systematic approach enhances generalisability across different SCM models and areas, strengthening reliable inferences. In summary, the SCM holds promise for enhancing mental health service delivery. However, there is a need to further examine the factors that determine its effectiveness and understand the different ways in which SCM is implemented. Such inquiry forms the foundation for implementing and advancing mental health care services in Australia and internationally. [ABSTRACT FROM AUTHOR]

The integration of artificial intelligence (AI) in cardiovascular imaging has revolutionized the field, offering significant advancements in diagnostic accuracy and clinical efficiency. However, the complexity and opacity of AI models, particularly those involving machine learning (ML) and deep learning (DL), raise critical legal and ethical concerns due to their "black box" nature. This manuscript addresses these concerns by providing a comprehensive review of AI technologies in cardiovascular imaging, focusing on the challenges and implications of the black box phenomenon. We begin by outlining the foundational concepts of AI, including ML and DL, and their applications in cardiovascular imaging. The manuscript delves into the "black box" issue, highlighting the difficulty in understanding and explaining AI decision-making processes. This lack of transparency poses significant challenges for clinical acceptance and ethical deployment. The discussion then extends to the legal and ethical implications of AI's opacity. The need for explicable AI systems is underscored, with an emphasis on the ethical principles of beneficence and non-maleficence. The manuscript explores potential solutions such as explainable AI (XAI) techniques, which aim to provide insights into AI decision-making without sacrificing performance. Moreover, the impact of AI explainability on clinical decision-making and patient outcomes is examined. The manuscript argues for the development of hybrid models that combine interpretability with the advanced capabilities of black box systems. It also advocates for enhanced education and training programs for healthcare professionals to equip them with the necessary skills to utilize AI effectively. Patient involvement and informed consent are identified as critical components for the ethical deployment of AI in healthcare. Strategies for improving patient understanding and engagement with AI technologies are discussed, emphasizing the importance of transparent communication and education. Finally, the manuscript calls for the establishment of standardized regulatory frameworks and policies to address the unique challenges posed by AI in healthcare. By fostering interdisciplinary collaboration and continuous monitoring, the medical community can ensure the responsible integration of AI into cardiovascular imaging, ultimately enhancing patient care and clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Effective medication adherence is vital for managing acute myocardial infarction (AMI) and enhancing patient well-being. This study aimed to evaluate medication adherence levels and associated factors among AMI patients using standardized assessment tools. Methods: Employing a cross-sectional descriptive design, the study involved 210 patients diagnosed with acute myocardial infarction. Participants completed the General Medication Adherence Scale (GMAS), Hospital Anxiety and Depression Scale (HADS), and provided socio-demographic details. Results: The study revealed partial adherence to medications among AMI patients, with mean scores of 24.89 (± 3.64) out of 33. Notably, good adherence was observed in non-adherence due to patient behavior (mean ± SD = 11.8 ± 2.3 out of 15) and additional disease burden (mean ± SD = 8.65 ± 2.21 out of 12), while partial adherence was noted in non-adherence due to financial constraints (mean ± SD = 4.44 ± 1.34 out of 6). Patients reported mild anxiety (mean ± SD = 8.38 ± 2.81) and no depressive symptoms (mean ± SD = 7.43 ± 2.42). Multiple linear regression analysis indicated that employed status, younger age, shorter duration of MI, lower anxiety, and depression levels were associated with higher medication adherence. However, factors such as monthly income, gender, educational level, and marital status did not predict medication adherence. Conclusion: The study highlights the significance of addressing anxiety and depression levels and considering socio-demographic factors when designing interventions to enhance medication adherence among AMI patients. Further research is needed to explore additional determinants of medication adherence and develop tailored interventions to improve patient outcomes post-AMI. [ABSTRACT FROM AUTHOR]

Accumulating evidence supports an effect of physician gender (or sex, a surrogate used in many studies) on important patient outcomes such as death, complications, and hospital length of stay. Recent studies suggest that these effects result from the gender diversity of the team rather than individual physician gender. Here, we reflect on the potential mechanisms of an effect of physician gender on patient outcomes. [ABSTRACT FROM AUTHOR]

Most patients diagnosed with oral squamous cell carcinoma (OSCC) present with locally advanced stages, which are typically associated with poor outcomes. Although immunotherapy offers potential improvements in patient survival, its efficacy is hampered by low response rates. The microbiome is widely involved in tumor immunity and may play a role in immunotherapy. This study aimed to investigate the potential association between the oral (salivary) microbiome and immunotherapy response in patients with OSCC. Salivary metagenome sequencing was performed on 47 patients with OSCC undergoing neoadjuvant immunotherapy (NAIT) in a clinical trial (NCT04649476). Patients were divided into responders and nonresponders based on their pathological responses. The results showed that the species richness of the salivary microbiome was lower in the nonresponders before NAIT than in the responders. Differential analysis revealed that nonresponders exhibited a lower relative abundance of 34 bacterial species and a higher relative abundance of 4 bacterial species. Notably, low levels of Eubacterium infirmum, Actinobaculum, and Selenomas (EAS) in the saliva may be associated with the nonresponse of patients with OSCC to NAIT. A nomogram based on EAS was developed and validated to determine the efficacy of NAIT. The area under the curve for the training cohort was 0.81 (95% confidence interval, 0.66 to 0.81). Quantitative polymerase chain reaction confirmed that low levels of salivary EAS effectively identified nonresponders to NAIT. Furthermore, the low abundance of salivary EAS was closely correlated with a low density of intratumoral CD4+, CD14+, CD68+, and FOXP3+ cells. Metabolic functional annotation revealed numerous biosynthetic processes associated with EAS that were more active in responders. In summary, this study provides valuable data resources for the salivary microbiome and reveals that nonresponders have different salivary microbiome profiles than responders do before NAIT. Low salivary EAS levels can serve as potential biomarkers for distinguishing nonresponders from responders. [ABSTRACT FROM AUTHOR]

Purpose: Chordomas are rare malignant neoplasms primarily treated surgically. Disparities related to race and socioeconomic status, may affect patient outcomes. This study aims to identify prognostic factors for access to care and survival in patients with spinal chordomas. Methods: The NCDB database was queried between the years 2004 and 2017. Kaplan-Meier curves were constructed to compare survival probabilities among different groups, based on race and socioeconomic determinents. Results: 1769 patients were identified, with 87% being White, 5% Hispanic, 4% Black, and Asian each. The mean age was 61.3 years. Most patients received care at academic/research centers and lived in a large metropolitan area, with no difference between races. A significantly higher percentage of Black patients did not undergo surgery (p < 0.001), with no statistically significant difference in survival between races (p = 0.97). A higher survival probability was seen in patients with other government insurances (p < 0.0001), in higher income quartiles (p < 0.0001), in metropolitan areas (p = 0.023), and at an academic/research center (p < 0.0001). A lower survival probability was seen in patients who are uninsured, in rural areas, and at community cancer programs (p < 0.0001). Conclusion: This study highlights disparities in access to surgical intervention for patients with spinal chordomas, especially among Black individuals. It emphasizes the significant impact of insurance status and income on access to surgical care and highlights geographical and institutional variations in survival rates. Addressing socioeconomic differences is crucial for fostering equity in neurosurgical outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: An American Psychiatric Nurses Association (APNA) task force reviewed current staffing research to revise and update the 2011 APNA "Staffing inpatient psychiatric units" position paper and provide recommendations to the APNA Board of Directors on how psychiatric mental health (PMH) nurses might champion the staffing needs of inpatient psychiatric units. METHODS: Current research on staffing and nursing practice in inpatient psychiatric units was reviewed as well as variables believed to influence staffing and nursing practice, such as consumer needs and workplace culture. Since current nurse staffing principles emphasize nursing value and how that value is connected to outcomes, the literature search included a focus on staffing and related patient outcomes. RESULTS: PMH nurses are critical to the safety and quality of care in inpatient psychiatric units. However, there are little existing data on the relationship between staffing levels and even common adverse events such as staff injury and restraint of patients. Furthermore, there is scant research conducted on inpatient psychiatric units that informs optimal staffing models or establishes links between staffing and patient outcomes. CONCLUSIONS: Consistent with current evidence, the universal use of a single method or model of determining staffing needs (e.g., nursing hours per, case mix index, or mandatory ratios) is not recommended. PMH nurses should champion systematic evaluation of staffing on their inpatient units against select patient, nurse, and system outcomes. A data repository of PMH nurse-sensitive outcomes is necessary to benchmark unit performance and staffing. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with Ehlers-Danlos syndromes (EDS) often experience high rates of joint subluxations and dislocations, and associated pain that may require surgical interventions. Orthopaedic surgical management is challenging in this population, and patients will often undergo multiple unsuccessful surgeries. Outcomes data specific to patients with EDS are sparse in the orthopaedic surgery literature. We conducted a scoping review to evaluate the evidence and outcomes for orthopaedic surgery specifically for the EDS population. Methods PubMed MEDLINE, Embase, The Cochrane Library, Cochrane Controlled Register of Trials (CENTRAL), CINHL, and Scopus from their inception to February 28, 2024 for all studies that reported outcomes for orthopaedic surgery in patients with EDS. Two reviewers independently determined study eligibility, rated study quality, and extracted data. Methodology followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The studies in this scoping review include Level III (retrospective cohort and case control) and Level IV (case series) evidence. Results The literature search yielded a total of 71 citations published between 1990 and 2023. All were primary studies. 38 were single case studies, 14 were case series, and 19 were retrospective cohort studies. No randomized clinical studies or systematic reviews were identified. Overall, the reported findings for the various anatomical sites and procedures indicated that surgery outcomes were inconsistent. Our review highlights the need for future research to determine whether currently established surgical approaches for various orthopaedic conditions offer long-term clinical benefit in patients with EDS. This is clearly a challenging diagnosis, and more rigorous clinical studies are required to identify optimal treatment approaches. Conclusions Our review found little evidence-based research to guide optimal surgical treatment in EDS. Established surgical techniques that have been shown to be successful in the wider orthopaedic population should be studied to determine their efficacy in the EDS population.

Abstract Background ICU nurses play a critical role in managing delirium in critically ill patients, yet their competency in this area remains under-explored. Aim To assess ICU nurses’ competency including their knowledge, practice, and attitudes toward delirium among critically ill patients. Methods A correlational descriptive study was conducted with 67 nurses in the medical intensive care unit at Suez Canal University Hospitals. Data was collected using an online survey and analyzed using descriptive statistics, ANOVA, and Pearson’s correlation. Results Nurses showed a moderate knowledge level (M = 8.55), a low practice level (M = 6.62), and positive attitudes (M = 21.65) toward ICU delirium. ANOVA results indicated significant differences in practice scores based on educational level, F (2, 64) = 3.361, p = .041, and in knowledge scores based on ICU experience, F(3, 63) = 6.455, p

Christoph U Correll,1– 4,&ast; Jose M Rubio,1– 3,&ast; Leslie Citrome,5,&ast; Marko A Mychaskiw,6 Stephen Thompson,6 Kelli R Franzenburg,7 Mark Suett,8 Sameer Kotak,9 John M Kane1– 3,&ast; 1Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; 2Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; 3Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; 4Department of Child and Adolescent Psychiatry, Charité – Universitätsmedizin Berlin, Berlin, Germany; 5Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA; 6Global Health Economics and Outcomes Research, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA; 7Global Medical Affairs, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA; 8Global Medical Affairs, Teva UK Limited, Harlow, United Kingdom; 9Yorker Health Corp., Glen Rock, NJ, USA&ast;These authors contributed equally to this workCorrespondence: Christoph U Correll, Email ccorrell@northwell.eduAbstract: Despite evidence of benefits beyond those of oral antipsychotics, long-acting injectable antipsychotics (LAIs) are underused in schizophrenia treatment. Underuse may be partially a result of misconceptions held by some healthcare professionals (HCPs) pertaining to LAIs. A panel of four experts convened between January 2022 and May 2022 to identify these misconceptions, and example cases or scenarios were created to illustrate common clinical situations relevant to these beliefs. Ultimately, an online platform and heuristic tool, Schizophrenia Clinical Outcome Scenarios and Patient-Provider Engagement (S.C.O.P.E.™), was developed to help prescribing clinicians and other HCPs better understand common clinical dilemmas, as well as the place for LAIs in schizophrenia treatment. Three main misconceptions related to the use of LAIs to treat schizophrenia were identified and included “physicians/providers know when patients are nonadherent”, “patients do not accept/want LAI treatment”, and “LAIs are only appropriate for patients who have demonstrated nonadherence”. All misconceptions are refuted by current evidence and were used to develop clinical scenarios with questions to consider when patients present to various sites of care for treatment. These cases are presented on the S.C.O.P.E. educational platform. The platform also includes videos designed to help non-prescribing HCPs and mental health professionals address patient/caregiver concerns and to communicate LAI benefits. In addition, S.C.O.P.E. provides a section with information about each LAI that is currently FDA approved in the United States for the treatment of schizophrenia, to help familiarize HCPs with characteristics of LAIs. S.C.O.P.E. is an educational tool designed for HCPs to help improve their understanding of how to manage common clinical dilemmas in the treatment of people with schizophrenia, to clarify the role of LAIs in medication management, and to increase understanding of the characteristics of available LAIs. S.C.O.P.E. also aims to improve care in schizophrenia by facilitating increased awareness to patients and caregivers.Plain Language Summary: Schizophrenia is a serious, lifelong mental health disorder that affects about 2.8 million adults in the United States and many more worldwide. Symptoms can include hallucinations (ie, hearing “voices”), delusions (ie, convinced something is true when it is not), poor attention, lack of motivation and interest, and cognitive problems. Schizophrenia can have considerable impact on people with the disorder as well as their families, friends, and communities. There are several treatment options available for healthcare professionals (HCPs), patients, and caregivers to consider, with antipsychotic medicines being the cornerstone of the treatment for schizophrenia. Long-acting injectable antipsychotics (LAIs) have shown benefits over antipsychotics taken orally (by mouth), but are underused, and this is likely due to some common misconceptions.Four experts in schizophrenia treatment met repeatedly online to identify some of these misconceptions and created a tool to help HCPs learn about misconceptions, using example cases of patients with schizophrenia who have different types of clinical situations and concerns. On the Schizophrenia Clinical Outcome Scenarios and Patient-Provider Engagement (S.C.O.P.E.™) interactive digital platform, HCPs can choose in which type of case they are interested in and see details of the case, information they should obtain about the case, and appropriate considerations for LAI use. The tool also provides videos about communicating with patients and their families about LAIs, and information about the different LAIs currently available.The goal of providing this tool to HCPs is to improve understanding of how to treat patients with schizophrenia and the role that LAIs can play.Keywords: long-acting injectable antipsychotic, schizophrenia, treatment, education, patient outcomes

Abstract Background Effective medication adherence is vital for managing acute myocardial infarction (AMI) and enhancing patient well-being. This study aimed to evaluate medication adherence levels and associated factors among AMI patients using standardized assessment tools. Methods Employing a cross-sectional descriptive design, the study involved 210 patients diagnosed with acute myocardial infarction. Participants completed the General Medication Adherence Scale (GMAS), Hospital Anxiety and Depression Scale (HADS), and provided socio-demographic details. Results The study revealed partial adherence to medications among AMI patients, with mean scores of 24.89 (± 3.64) out of 33. Notably, good adherence was observed in non-adherence due to patient behavior (mean ± SD = 11.8 ± 2.3 out of 15) and additional disease burden (mean ± SD = 8.65 ± 2.21 out of 12), while partial adherence was noted in non-adherence due to financial constraints (mean ± SD = 4.44 ± 1.34 out of 6). Patients reported mild anxiety (mean ± SD = 8.38 ± 2.81) and no depressive symptoms (mean ± SD = 7.43 ± 2.42). Multiple linear regression analysis indicated that employed status, younger age, shorter duration of MI, lower anxiety, and depression levels were associated with higher medication adherence. However, factors such as monthly income, gender, educational level, and marital status did not predict medication adherence. Conclusion The study highlights the significance of addressing anxiety and depression levels and considering socio-demographic factors when designing interventions to enhance medication adherence among AMI patients. Further research is needed to explore additional determinants of medication adherence and develop tailored interventions to improve patient outcomes post-AMI.

Introduction Gastroparesis (GP) is a chronic debilitating gastric motility disorder defined as delayed emptying of the stomach content without mechanical obstruction. It can result in nutritional deficiencies, leading to poor overall outcomes. We assessed the impact of malnutrition on in-hospital outcomes in patients with gastroparesis. Methods Patients with a primary discharge diagnosis of GP between January 2016 and December 2019 were included in the National Inpatient Sample (NIS) database. Data on patient demographics, hospital characteristics, the Charlson Comorbidity Index (CCI), and the etiology of gastroparesis were collected. The association between malnutrition and outcomes, including mortality, deep vein thrombosis (DVT), pulmonary embolism (PE), sepsis, acute kidney injury (AKI), length of stay (LOS), and total hospitalization charges (THC), were analyzed using the multivariate regression model. Results A total of 182,580 patients with gastroparesis were included in the analysis. Patients with gastroparesis and malnutrition had a higher risk of mortality (adjusted odds ratio {aOR}, 3.29; p

This paper aims to systematically review the status of using artificial intelligence (AI) in Saudi healthcare systems to improve patient outcomes. In the review, the status of Saudi Arabia was compared with those of some resource-poor, low-to-middle income and developing countries, using 20 papers each collected from Google Scholar. The review showed both similarities and differences in their approaches to using AI in healthcare systems. Saudi Arabia is a late-comer. However, it developed many innovative AI applications for the hajj season. These applications can be used for public health problems also. Being a resource-rich and high-income country, Saudi Arabia must only be willing to adopt AI in its healthcare system. There is a lot of scope for researching and developing more innovative AI applications to facilitate the building up of a healthy and productive population, as stipulated in its Vision 2030 goals. Six recommendations have been listed to indicate how to raise the level of AI adoption and integration into the Saudi healthcare systems to enhance patient outcomes.

Context: The study purpose was to compare the ankle muscle activation and dynamic ankle joint stability of subjects who underwent endoscopy-assisted Achilles tendon repair (ATR; at ≥ 2 y postsurgery) with age, gender, and activity level-matched healthy control group subjects. Design: Prospective, cross-sectional study. All functional tests were performed on the involved ankle of the ATR group, and at the matched side of healthy age, gender, and activity-level control group subjects. Methods: Fifteen men in each group were evaluated for medial and lateral gastrocnemius, soleus, tibialis anterior, and peroneus longus muscle activation during modified star excursion balance test and heel-rise test performance. The weight-bearing lunge test (ankle dorsiflexion) and heel-rise test distance (ankle plantar flexion) also determined weight-bearing, active ankle mobility magnitudes. The Achilles Tendon Total Rupture Score and Foot and Ankle Outcome Score provided patient-reported outcome perceptions specific to Achilles tendon rupture and comprehensive foot and ankle symptoms and function, respectively. Results: Medial (P = .005) and lateral (P = .012) gastrocnemius displayed greater activation amplitudes in the ATR group during the star excursion balance test, and peroneus longus displayed greater activation amplitudes during the heel-rise test (P = .006). The star excursion balance test reach distance was comparable between groups. Active weight-bearing ankle plantar flexion (heel-rise test) and dorsiflexion (weight-bearing lunge test) mobility magnitudes were lower in the ATR group. Conclusions: Subjects who underwent endoscopy-assisted percutaneous ATR had reduced active weight-bearing ankle dorsiflexion and plantar flexion mobility magnitudes and greater gastrocnemius and peroneus longus neuromuscular activation when performing the same tasks as healthy control group subjects. As surgical approaches evolve to less invasive, soft tissue preserving methods with less tissue morbidity and faster healing, rehabilitation approaches may likewise need to evolve. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

The burden of simultaneous acute code stroke activation (ACSA) is not known. We aim to assess the effect of simultaneous ACSA on workflow metrics and home time at 90 days in patients undergoing reperfusion therapies in the emergency department. Simultaneous ACSA was defined as code activation within 60 min of the arrival of any patient receiving intravenous thrombolysis, within 150 min of the arrival of any patient receiving endovascular thrombectomy, within 45 min of the arrival of any patient receiving no reperfusion therapies (based on mean local door-to-needle and door-to-puncture times). Simultaneous ACSA was further graded as 1, 2 and 3. We assessed workflow metrics as door-to-CT (DTC) time, in minutes, and functional outcome as home time at 90 days. A total of 2605 patients were assessed as ACSA at a mean ± SD activations of 130.8 ± 17.1/month and 859 (33%) were simultaneous. Among all ACSA, 545 (20.9%) underwent acute reperfusion therapy with a mean age of 70.6 ± 14.2 years, 45.9% (n = 254) were female with a median (IQR) NIHSS of 13 (8–18). A total of 220 (40.4%) patients underwent simultaneous treatments. The median DTC time, in minutes, was prolonged in grade 3 simultaneous ACSA (18 (13, 28)) compared to non-simultaneous ACSA (15 (11, 21) β = 0.23, p < 0.0001). There was no difference in the median home time at 90 days between the simultaneous (58, 0–84.5 days) and non-simultaneous (54, 0–85 days) patients. Simultaneous ACSA is frequent in patients receiving acute reperfusion therapies. An optimal workflow in high-volume centers may help mitigate the clinical and system burden associated with simultaneity.

Aim: To evaluate patient satisfaction outcomes with respect to pain, discomfort, and quality of life with hematology/oncology referrals undergoing CT-guided bone marrow biopsy and compare these scores with those of patients undergoing in-office biopsy. Methods: A retrospective chart review was performed over 2 years with all patients who underwent CT-guided bone marrow biopsy at our university set-up. Age, gender, BMI, radiation dose (CTDI/DLP), number of in-office biopsies, number of CT-guided biopsies, type/amount of moderate sedation used, technical and pathologic success rates, and complication rates were recorded. All patients who underwent both in-office and CT-guided biopsy were contacted by telephone to answer a brief survey regarding pain, discomfort, quality of life, and future preference with respect to each biopsy. Results: A total of 32 patients underwent CT-guided bone marrow biopsy. Moderate sedation was utilized for all CT patients, and 19 patients underwent both in-office and CT-guided biopsies. Upon surveying the 19 patients who underwent both kinds of biopsies, on a scale of 1–10 (10 = highest discomfort and highest pain), the patients on an average reported 7.8 for in-office vs. 2.1 for CT for the discomfort level (p < 0.001) and 7.9 vs. 1.7 for the pain (p < 0.001). The patients reported an average quality-of-life score of 82 (out of a scale of 100) after CT procedures and 53 for in-office (p < 0.001). All patients reported that they would prefer CT-guided procedures with sedation versus in-office procedures in the future. Conclusion: CT-guided bone marrow biopsy is the preferred and more comfortable procedure, especially in low-pain-tolerant patients, although it involves more cost, conscious sedation, and radiation exposure.

Abstract Background Lung transplantation (LT) represents a high-risk procedure for end-stage lung diseases. This study describes the outcomes of patients undergoing LT that require massive transfusions as defined by the universal definition of perioperative bleeding (UDPB). Methods Adult patients who underwent bilateral LT at a single academic center were surveyed retrospectively. Patients were grouped by insignificant, mild, or moderate perioperative bleeding (insignificant-to-moderate bleeders) and severe or massive perioperative bleeding (severe-to-massive bleeders) based on the UDPB classification. Outcomes included 1-year survival and primary graft dysfunction (PGD) of grade 3 at 72 h postoperatively. Multivariable models were adjusted for recipient age, sex, body mass index (BMI), Lung allocation score (LAS), preoperative hemoglobin (Hb), preoperative extracorporeal membrane oxygenation (ECMO) status, transplant number, and donor status. An additional multivariable model was created to find preoperative and intraoperative predictors of severe-to-massive bleeding. A p-value less than 0.05 was selected for significance. Results A total of 528 patients were included, with 357 insignificant-to-moderate bleeders and 171 severe-to-massive bleeders. Postoperatively, severe-to-massive bleeders had higher rates of PGD grade 3 at 72 h, longer hospital stays, higher mortality rates at 30 days and one year, and were less likely to achieve textbook outcomes for LT. They also required postoperative ECMO, reintubation for over 48 h, tracheostomy, reintervention, and dialysis at higher rates. In the multivariate analysis, severe-to-massive bleeding was significantly associated with adverse outcomes after adjusting for recipient and donor factors, with an odds ratio of 7.73 (95% CI: 4.27–14.4, p

John Twomey-Kozak, Kwabena Adu-Kwarteng,&ast; Kiera Lunn,&ast; Damon Vernon Briggs, Eoghan Hurley, Oke A Anakwenze, Christopher S Klifto Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA&ast;These authors contributed equally to this workCorrespondence: John Twomey-Kozak, Duke University Medical Center, Department of Orthopaedic Surgery, Durham, NC, USA, Email jnt25@duke.eduPurpose of Review: This narrative review comprehensively aims to analyze recent advancements in shoulder arthroplasty, focusing on implant systems and their impact on patient outcomes. The purpose is to provide a nuanced understanding of the evolving landscape in shoulder arthroplasty, incorporating scientific, regulatory, and ethical dimensions.Recent Findings: The review synthesizes recent literature on stemless implants, augmented glenoid components, inlay vs onlay configurations, convertible stems, and associated complications. Notable findings include improved patient-reported outcomes with stemless implants, variations in outcomes between inlay and onlay configurations, and the potential advantages of convertible stems. Additionally, the regulatory landscape, particularly the FDA’s 510(k) pathway, is explored alongside ethical considerations, emphasizing the need for standardized international regulations.Summary: Recent innovations in shoulder arthroplasty showcase promising advancements, with stemless implants demonstrating improved patient outcomes. The review underscores the necessity for ongoing research to address unresolved aspects and highlights the importance of a standardized regulatory framework to ensure patient safety globally. The synthesis of recent findings contributes to a comprehensive understanding of the current state of shoulder arthroplasty, guiding future research and clinical practices.Keywords: shoulder arthroplasty, rTSA, stemless implants, glenoid components, patient outcomes, innovations in arthroplasty

Mahmoud Izraiq,1 Kais AlBalbissi,2 Raed Alawaisheh,1 Ahmad Toubasi,2 Yaman B Ahmed,3 Marah Mahmoud,1 Karam I Khraim,1 Mohammed AL-Ithawi,1 Obada Mohammad Mansour,1 Anoud Hamati,1 Farah A Khraisat,2 Hadi Abu-Hantash4 1Cardiology Section, Internal Medicine Department, Specialty Hospital, Amman, Jordan; 2Cardiology Section, Internal Medicine Department, Jordan University Hospital, Amman, Jordan; 3Cardiology Section, Internal Medicine Department, King Abdullah University Hospital, Irbid, Jordan; 4Department of Cardiology, Amman Surgical Hospital, Amman, JordanCorrespondence: Mahmoud Izraiq, Email izraiq@yahoo.comBackground: Heart failure (HF) is a global health challenge affecting millions, with significant variations in patient characteristics and outcomes based on ejection fraction. This study aimed to differentiate between HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) with respect to patient characteristics, risk factors, comorbidities, and clinical outcomes, incorporating advanced machine learning models for mortality prediction.Methodology: The study included 1861 HF patients from 21 centers in Jordan, categorized into HFrEF (EF < 40%) and HFpEF (EF ≥ 50%) groups. Data were collected from 2021 to 2023, and machine learning models were employed for mortality prediction.Results: Among the participants, 29.7% had HFpEF and 70.3% HFrEF. Significant differences were noted in demographics and comorbidities, with a higher prevalence of males, younger age, smoking, and familial history of premature ASCVD in the HFrEF group. HFpEF patients were typically older, with higher rates of diabetes, hypertension, and obesity. Machine learning analysis, mainly using the Random Forest Classifier, demonstrated significant predictive capability for mortality with an accuracy of 0.9002 and an AUC of 0.7556. Other models, including Logistic Regression, SVM, and XGBoost, also showed promising results. Length of hospital stay, need for mechanical ventilation, and number of hospital admissions were the top predictors of mortality in our study.Conclusion: The study underscores the heterogeneity in patient profiles between HFrEF and HFpEF. Integrating machine learning models offers valuable insights into mortality risk prediction in HF patients, highlighting the potential of advanced analytics in improving patient care and outcomes.Keywords: Heart failure, mortality prediction, machine learning, patient outcomes, Jordan heart failure registry

Background: Postoperative gastrointestinal dysfunction (POGD) remains a common morbidity after gastrointestinal surgery. POGD is associated with delayed hospital recovery, increased length of stay, poor patient satisfaction and experience, and increased economic hardship. The I-FEED scoring system was created by a group of experts to address the lack of a consistent objective definition of POGD. However, the I-FEED tool needs clinical validation before it can be adopted into clinical practice. The scope of this phase 1 Quality Improvement initiative involves the feasibility of implementing percussion into the nursing workflow without additional burden. Methods: All gastrointestinal/colorectal surgical unit registered nurses underwent comprehensive training in abdominal percussion. This involved understanding the technique, its application in postoperative gastrointestinal dysfunction assessment, and its integration into the existing nursing documentation in the Electronic Health Record (EHR). After six months of education and practice, a six-question survey was sent to all inpatient GI surgical unit nurses about incorporating the percussion assessment into their routine workflow and documentation. Results: Responses were received from 91% of day-shift nurses and 76% of night-shift registered nurses. Overall, 95% of the nurses were confident in completing the abdominal percussion during their daily assessment. Conclusion: Nurses’ effective use of the I-FEED tool may help improve patient outcomes after surgery. The tool could also be an effective instrument for the early identification of postoperative gastrointestinal dysfunction (POGD) in surgical patients.

Abstract Background Improving outcomes after surgery is a major public health research priority for patients, clinicians and the NHS. The greatest burden of perioperative complications, mortality and healthcare costs lies amongst the population of patients aged over 50 years who undergo major non-cardiac surgery. The Volatile vs Total Intravenous Anaesthesia for major non-cardiac surgery (VITAL) trial specifically examines the effect of anaesthetic technique on key patient outcomes: quality of recovery after surgery (quality of recovery after anaesthesia, patient satisfaction and major post-operative complications), survival and patient safety. Methods A multi-centre pragmatic efficient randomised trial with health economic evaluation comparing total intravenous anaesthesia with volatile-based anaesthesia in adults (aged 50 and over) undergoing elective major non-cardiac surgery under general anaesthesia. Discussion Given the very large number of patients exposed to general anaesthesia every year, even small differences in outcome between the two techniques could result in substantial excess harm. Results from the VITAL trial will ensure patients can benefit from the very safest anaesthesia care, promoting an early return home, reducing healthcare costs and maximising the health benefits of surgical treatments. Trial registration ISRCTN62903453. September 09, 2021.

Introduction Metastases account for the vast majority of cancer-related deaths (1), however, why some cancers metastasize while others do not is poorly understood. Specific genetic alterations do not define metastatic [...], Metastasis is the leading cause of cancer-related deaths. It is unclear how intratumor heterogeneity (ITH) contributes to metastasis and how metastatic cells adapt to distant tissue environments. The study of these adaptations is challenged by the limited access to patient material and a lack of experimental models that appropriately recapitulate ITH. To investigate metastatic cell adaptations and the contribution of ITH to metastasis, we analyzed single-cell transcriptomes of matched primary tumors and metastases from patient-derived xenograft models of breast cancer. We found profound transcriptional differences between the primary tumor and metastatic cells. Primary tumors upregulated several metabolic genes, whereas motility pathway genes were upregulated in micrometastases, and stress response signaling was upregulated during progression. Additionally, we identified primary tumor gene signatures that were associated with increased metastatic potential and correlated with patient outcomes. Immune-regulatory control pathways were enriched in poorly metastatic primary tumors, whereas genes involved in epithelial-mesenchymal transition were upregulated in highly metastatic tumors. We found that ITH was dominated by epithelial-mesenchymal plasticity (EMP), which presented as a dynamic continuum with intermediate EMP cell states characterized by specific genes such as CRYAB and S100A2. Elevated expression of an intermediate EMP signature correlated with worse patient outcomes. Our findings identified inhibition of the intermediate EMP cell state as a potential therapeutic target to block metastasis.

Background: In healthcare systems prioritizing care of older adults, resource limitations and escalating demand often impede access to outpatient specialized geriatric services. Objectives: This study, theoretically guided by the Consolidated Framework for Implementation Research (CFIR), aimed to explore barriers and facilitators in implementing a centralized "Geri-Hub." The Geri-Hub is a centralized intake system established within 2 hospital systems to coordinate outpatient and community-based services for older adults, aiming to connect them with the most appropriate care in a timely manner. Methods: Qualitative insights were gathered from healthcare professionals at 2 academic institutions in the process of consolidating services. Through open-ended surveys and semi-structured interviews, we solicited feedback on referral management, waiting times, and overall work experiences. Results: Thirteen frequently referring providers and a cohort of 9 geriatricians, along with 4 administrators, contributed to the study. Geriatricians emphasized streamlined referrals, flexible scheduling for urgent cases, and a target wait time of 3 months. Administrators stressed standardized referral procedures, defined roles, and accessible referral information. Discussion: The findings underscored the need for straightforward referral processes, enhanced communication on referral statuses, and reduced wait times. Optimizing these processes could potentially mitigate resource utilization issues and improve patient outcomes in healthcare systems. This research highlights the critical role of timely access to geriatric services during transformative phases in healthcare delivery. [ABSTRACT FROM AUTHOR]