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The Journal of Behavioral Health... Jul 2024Collaborative Care, an evidence-based model, has proven effective in treating depression and anxiety in healthcare settings. However, limited attention has been paid to...
Collaborative Care, an evidence-based model, has proven effective in treating depression and anxiety in healthcare settings. However, limited attention has been paid to exploring treatment outcome differences by clinical variables and diagnosis within this model. While previous research suggests that early and frequent contacts and swift treatment access lead to positive outcomes for depression and anxiety, these aspects have not been comprehensively examined in Collaborative Care. This study investigates the impact of clinical variables on treatment completion in patients primarily diagnosed with anxiety or depression who received collaborative care treatment as a treatment program. Analysis was completed as an observational study of patients (n =2018) with behavioral health diagnoses spanning from 2016 to 2023. Classification analysis offers insights into optimal practices for implementing Collaborative Care across diverse healthcare populations from pediatric to geriatric. Identifying clinical characteristics associated with successful treatment in Collaborative Care has far-reaching implications for model adoption and enhancing patient outcomes. Across all results, patients who received more clinical support and had shorter enrollment durations showed a strong association with successful treatment completion.
PubMed: 38955986
DOI: 10.1007/s11414-024-09892-5 -
Journal of Imaging Informatics in... Jul 2024Despite the importance of communication, radiology departments often depend on communication tools that were not created for the unique needs of imaging workflows,...
Despite the importance of communication, radiology departments often depend on communication tools that were not created for the unique needs of imaging workflows, leading to frequent radiologist interruptions. The objective of this study was test the hypothesis that a novel asynchronous communication tool for the imaging workflow (RadConnect) reduces the daily average number of synchronous (in-person, telephone) communication requests for radiologists. We conducted a before-after study. Before adoption of RadConnect, technologists used three conventional communication methods to consult radiologists (in-person, telephone, general-purpose enterprise chat (GPEC)). After adoption, participants used RadConnect as a fourth method. Technologists manually recorded every radiologist consult request related to neuro and thorax CT scans in the 40 days before and 40 days after RadConnect adoption. Telephone traffic volume to section beepers was obtained from the hospital telephone system for the same period. The value and usability experiences were collected through an electronic survey and structured interviews. RadConnect adoption resulted in 53% reduction of synchronous (in-person, telephone) consult requests: from 6.1 ± 4.2 per day to 2.9 ± 2.9 (P < 0.001). There was 77% decrease (P < 0.001) in telephone volume to the neuro and thorax beepers, while no significant volume change was noted to the abdomen beeper (control group). Survey responses (46% response rate) and interviews confirmed the positive impact of RadConnect on interruptions. RadConnect significantly reduced radiologists' telephone interruptions. Study participants valued the role-based interaction and prioritized worklist overview in the survey and interviews. Findings from this study will contribute to a more focused work environment.
PubMed: 38955962
DOI: 10.1007/s10278-024-01157-z -
Inflammopharmacology Jul 2024Previous observational studies have indicated a complex association between gut microbiota (GM) and neuropathic pain (NP). Nonetheless, the precise biological mechanisms...
BACKGROUND
Previous observational studies have indicated a complex association between gut microbiota (GM) and neuropathic pain (NP). Nonetheless, the precise biological mechanisms underlying this association remain unclear. Therefore, we adopted a Mendelian randomization (MR) approach to investigate the causal relationship between GM and neuropathic pain including post-herpetic neuralgia (PHN), painful diabetic peripheral neuropathy (PDPN), and trigeminal neuralgia (TN), as well as to explore the potential mediation effects of immune cells.
METHODS
We performed a two-step, two-sample Mendelian randomization study with an inverse variance-weighted (IVW) approach to investigate the causal role of GM on three major kinds of NP and the mediation effect of immune cells between the association of GM and NP. In addition, we determine the strongest causal associations using Bayesian weighted Mendelian randomization (BWMR) analysis. Furthermore, we will investigate the mediating role of immune cells through a two-step Mendelian randomization design.
RESULTS
We identified 53 taxonomies and pathways of gut microbiota that had significant causal associations with NP. In addition, we also discovered 120 immune cells that exhibited significant causal associations with NP. According to the BWMR and two-step Mendelian randomization analysis, we identified the following results CD4 on CM CD4 + (maturation stages of T cell) mediated 6.7% of the risk reduction for PHN through the pathway of fucose degradation (FUCCAT.PWY). CD28 + DN (CD4-CD8-) AC (Treg) mediated 12.5% of the risk reduction for PHN through the influence on Roseburia inulinivorans. CD45 on lymphocyte (Myeloid cell) mediated 11.9% of the risk increase for TN through the superpathway of acetyl-CoA biosynthesis (PWY.5173). HLA DR + CD8br %T cell (TBNK) mediated 3.2% of the risk reduction for TN through the superpathway of GDP-mannose-derived O-antigen building blocks biosynthesis (PWY.7323). IgD-CD38-AC (B cell) mediated 7.5% of the risk reduction for DPN through the pathway of thiazole biosynthesis I in E. coli (PWY.6892).
DISCUSSION
These findings provided evidence supporting the causal effect of GM with NP, with immune cells playing a mediating role. These findings may inform prevention strategies and interventions directed toward NP. Future studies should explore other plausible biological mechanisms.
PubMed: 38955934
DOI: 10.1007/s10787-024-01514-y -
Techniques in Coloproctology Jul 2024Laser hemorrhoidoplasty has demonstrated significant therapeutic effectiveness. To diminish postoperative bleeding and enhance overall outcomes, we have additionally...
BACKGROUND
Laser hemorrhoidoplasty has demonstrated significant therapeutic effectiveness. To diminish postoperative bleeding and enhance overall outcomes, we have additionally adopted suture ligating the feeding vessels. This study aimed to understand the treatment outcomes and any associated complications.
METHODS
This study comprised patients with symptomatic grade II-III hemorrhoids who underwent laser hemorrhoidoplasty with feeding vessel suture ligation and Milligan-Morgan hemorrhoidectomy between 1 September 2020, and 31 August 2022. Surgical-related details, postoperative pain, discomfort after discharge, hemorrhoid recurrence, and any complications were collected from inpatient records, outpatient follow-ups, and telephone interviews. Initially, we will analyze the distinctions between the laser group and the traditional group, followed by an investigation into complications and satisfaction within the laser surgery subgroup.
RESULTS
The study included 323 patients, with 173 undergoing laser hemorrhoidoplasty (LHP) and 150 undergoing Milligan-Morgan hemorrhoidectomy. Regarding pain assessment, the LHP group exhibited superior performance compared to traditional surgery at postoperative 4 h, before discharge, and during the first and second outpatient visits, with statistically significant differences. Additionally, the LHP group had a lower rate of urinary retention and experienced significantly less pain, with statistically significant differences.
CONCLUSIONS
Laser hemorrhoidoplasty with feeding vessels suture ligation has been shown to reduce postoperative pain and appears to be a promising minimally invasive treatment option for symptomatic grade II and III hemorrhoids.
Topics: Humans; Hemorrhoids; Ligation; Female; Retrospective Studies; Male; Hemorrhoidectomy; Middle Aged; Treatment Outcome; Adult; Pain, Postoperative; Laser Therapy; Suture Techniques; Aged; Recurrence; Postoperative Complications; Patient Satisfaction; Sutures
PubMed: 38955875
DOI: 10.1007/s10151-024-02940-4 -
Environmental Management Jul 2024Agricultural nutrients nitrogen and phosphorus can subsequently be transported to waterways and are often managed through the adoption of best management practices...
Agricultural nutrients nitrogen and phosphorus can subsequently be transported to waterways and are often managed through the adoption of best management practices (BMPs). However, we have a poor understanding of how the use of BMPs varies spatially and how BMP adoption might be related to nutrient yields in surface waters. To address this, we performed a survey of agricultural landowners across New York State and compared this with estimates of annual incremental nitrogen and phosphorus yields of agricultural origin from the Spatially Referenced Regressions On Watershed attributes (SPARROW) model. Using these socio-behavioral data and SPARROW predictions, we perform colocation analysis to identify areas where watersheds with high nutrient yield from agriculture are collocated with non-use of agricultural BMPs. This colocation analysis offers a novel methodology for identifying areas where monitoring of waterways and promotion of best management practices could be targeted to achieve the greatest benefits.
PubMed: 38955869
DOI: 10.1007/s00267-024-02008-x -
Journal of Cancer Research and Clinical... Jul 2024To explore the effect and mechanism of relaxin (RLX) in the growth and metastasis of livercancer after combination treatment with transarterial chemoembolization (TACE).
OBJECTIVE
To explore the effect and mechanism of relaxin (RLX) in the growth and metastasis of livercancer after combination treatment with transarterial chemoembolization (TACE).
MATERIALS AND METHODS
HCCLM3 and Huh-7 cells were adopted to evaluate the effect of tumor proliferation, migration, and invasion after RLX administration in vitro. The rabbit VX2 model was used to evaluate the biosafety, doxorubicin penetration, local tumor response, tumor metastasis, and survival benefit of RLX combined with TACE treatment.
RESULTS
RLX did not affect the proliferation, migration, or invasion of HCCLM3 and Huh-7 cells, and the expression of E-cadherin and HIF-1α also remained unchanged while the MMP-9 protein was upregulated in vitro. In the rabbit VX2 model, compared to the normal saline group (NS), RLX group (RLX) and TACE mono-therapy group (TACE), the group that received TACE combined with RLX (TACE + RLX) showed an improved local tumor response and survival benefit. Furthermore, TACE combined with RLX was found to reduce tumor metastasis. This combination therapy reduced the fibrotic extracellular matrix in the tumor microenvironment, allowing for better penetration of doxorubicin, improved infiltration of CD8+ T cells and affected the secretion of cytokines. Additionally, RLX combined with TACE was able to decrease the expression of HIF-1α and PD-L1. The biosafety of TACE combined with RLX was also confirmed.
CONCLUSION
RLX synergized with TACE by mitigating the fibrotic extracellular matrix and tumor hypoxic microenvironment, improving the therapeutic effect and inhibiting metastasis during the treatment of liver cancer.
Topics: Animals; Chemoembolization, Therapeutic; Rabbits; Relaxin; Liver Neoplasms; Doxorubicin; Humans; Combined Modality Therapy; Cell Proliferation; Cell Line, Tumor; Disease Models, Animal; Carcinoma, Hepatocellular; Neoplasm Metastasis
PubMed: 38955827
DOI: 10.1007/s00432-024-05864-6 -
Zhonghua Yu Fang Yi Xue Za Zhi [Chinese... Jun 2024To investigate the distribution rules of artemisia pollen and the clinical sensitization characteristics of allergic rhinitis (AR) induced by artemisia pollen in three...
To investigate the distribution rules of artemisia pollen and the clinical sensitization characteristics of allergic rhinitis (AR) induced by artemisia pollen in three urban and rural areas of Inner Mongolia. From March to October 2019, in 3 central cities (Chifeng, Hohhot, Ordos) and rural areas of Inner Mongolia, an epidemiological investigation method combining multi-stage stratified random sampling and face-to-face questionnaire survey was adopted to screen suspected AR patients, and skin prick test (SPT) was applied for diagnosis. At the same time, pollen monitoring was carried out in 3 areas to analyze the distribution and clinical sensitization characteristics of artemisia pollen.SPSS26.0 statistical software was used to process all the data. Chi-square test was used to compare rates among different age, sex, region and nationality, Spearman test was used to describe correlation analysis, and pairwise comparison of positive rates among multiple samples was used Bonferroni method. Among the 6 393 subjects, 1 093 cases were diagnosed with AR, and the prevalence of AR was 17.10% (1 093/6 393). Among them, pollen-induced allergic rhinitis, the prevalence of PiAR was 10.97% (701/6 393), accounting for 64.14%(701/1 093).The highest incidence was in the youth group (20-39 years old), accounting for 46.94% (329/701).The diagnosed prevalence was higher in females than in males (11.35% 10.64%, value 12.304, <0.001).The prevalence rate of ethnic minority was higher than that of Han nationality (13.01% 10.65%, value 6.296, =0.008).The prevalence in urban areas was also significantly higher than that in rural areas (18.40% 5.50%, value 10.497, <0.001).There was significant difference in prevalence rate among the three regions in Inner Mongolia (6.06% in Chifeng, 13.46% in Hohhot, 16.39% in Ordos, value 70.054, <0.001).The main clinical symptoms of artemisia PiAR were sneezing (95.58%), nasal congestion (91.73%) and nasal itching (89.30%).Allergic conjunctivitis accounted for 79.60% (558/701), chronic sinusitis for 55.63% (390/701), asthma for 23.25% (163/701).The pattern of artemisia pollen sensitization was mainly multiple sensitization, and the frequency of clinical symptoms and clinical diseases induced by hypersensitization with other allergens accounted for more than that caused by single artemisia pollen. The spread period of Artemisia pollen in the three regions was from June to October, and the peak state was in August in summer. The peak time of clinical symptoms in artemisia PiAR patients was about 2 weeks earlier than the peak time of pollen concentration, and the two were significantly positively correlated (=0.7671, <0.001). Artemisia pollens are the dominant pollens in late summer and early autumn in Inner Mongolia, and the prevalence of artemisia PiAR is high. Controlling the spread of Artemisia pollens is of great significance for the prevention and treatment of AR.
Topics: Humans; Artemisia; Pollen; Rural Population; China; Prevalence; Urban Population; Skin Tests; Rhinitis, Allergic; Surveys and Questionnaires; Allergens; Rhinitis, Allergic, Seasonal; Male; Female; Adult; Young Adult
PubMed: 38955727
DOI: 10.3760/cma.j.cn112150-20230927-00228 -
Health Policy and Planning Jul 2024New vaccine policy adoption is a complex process, especially in low-and-middle-income countries (LMICs), requiring country policymakers to navigate challenges such as...
New vaccine policy adoption is a complex process, especially in low-and-middle-income countries (LMICs), requiring country policymakers to navigate challenges such as competing priorities, human and financial resource constraints, and limited logistical capacity. Since the Expanded Programme on Immunization's (EPI) beginning, most new vaccine introductions under this structure have not been aimed at adult populations. The majority of adult vaccines offered under the EPI are not typically tested among and tailored for pregnant persons, except those that are specifically recommended for pregnancy. Given that new maternal vaccines, including RSV and GBS vaccines, are on the horizon, it is important to understand what barriers may arise during the policy development and vaccine introduction process. In this study, we sought to understand information needs among maternal immunization policymakers and decision-makers in Kenya for new vaccine maternal policy adoption through in-depth interviews with 20 participants in Nakuru and Mombasa counties in Kenya. Results were mapped to an adapted version of an established framework by Levine et al., (2010) focused on new vaccine introduction in LMICs. Participants reported that the policy process for new maternal vaccine introduction requires substantial evidence as well as coordination among diverse stakeholders. Importantly, our findings suggest that the process for new maternal vaccines does not end with the adoption of a new policy, as intended recipients and various actors can determine the success of a vaccine program. Previous shortcomings, in Kenya, and globally during HPV vaccine introduction show the need to allocate adequate resources in education of communities given the sensitive target group. With maternal vaccines targeting a sensitive group - pregnant persons- in the pipeline, we are at an opportune time to understand how to ensure successful vaccine introduction with optimal acceptance and uptake, while also addressing vaccine hesitancy to increase population benefit.
PubMed: 38955674
DOI: 10.1093/heapol/czae059 -
Microscopy (Oxford, England) Jul 2024Scanning Transmission Electron Microscopy (STEM) enables direct determination of atomic arrangements in materials and devices. However, materials such as battery...
Scanning Transmission Electron Microscopy (STEM) enables direct determination of atomic arrangements in materials and devices. However, materials such as battery components are weak for electron beam irradiation and low electron doses are required to prevent beam-induced damages. Noise removal is thus essential for precise structural analysis of electron beam sensitive materials at atomic resolution. Total square variation (TSV) regularization is an algorithm that exhibits high noise removal performance. However, the use of the TSV regularization term leads to significant image blurring and intensity reduction. To address these problems, we here propose a new approach adopting L2 norm regularization based on higher-order total variation. An atomic-resolution STEM image can be approximated as a set of smooth curves represented by quadratic functions. Since the third-degree derivative of any quadratic function is 0, total third-degree variation (TTDV) is suitable for a regularization term. The application of TTDV for denoising the atomic-resolution STEM image of CaF2 observed along the [001] zone axis is shown, where we can clearly see the Ca and F atomic columns without compromising image quality.
PubMed: 38955673
DOI: 10.1093/jmicro/dfae031 -
Journal of Cardiothoracic and Vascular... Jun 2024Postcardiotomy shock in the cardiac surgical patient is a highly morbid condition characterized by profound myocardial impairment and decreased systemic perfusion... (Review)
Review
Postcardiotomy shock in the cardiac surgical patient is a highly morbid condition characterized by profound myocardial impairment and decreased systemic perfusion inadequate to meet end-organ metabolic demand. Postcardiotomy shock is associated with significant morbidity and mortality. Poor outcomes motivate the increased use of mechanical circulatory support (MCS) to restore perfusion in an effort to prevent multiorgan injury and improve patient survival. Despite growing acceptance and adoption of MCS for postcardiotomy shock, criteria for initiation, clinical management, and future areas of clinical investigation remain a topic of ongoing debate. This article seeks to (1) define critical cardiac dysfunction in the patient after cardiotomy, (2) provide an overview of commonly used MCS devices, and (3) summarize the relevant clinical experience for various MCS devices available in the literature, with additional recognition for the role of MCS as a part of a modified approach to the cardiac arrest algorithm in the cardiac surgical patient.
PubMed: 38955616
DOI: 10.1053/j.jvca.2024.06.014