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Expert Review of Cardiovascular Therapy Jul 2024Triple antithrombotic therapy (TAT) with aspirin, a P2Y inhibitor, and oral anticoagulation in patients with atrial fibrillation (AF) undergoing percutaneous coronary...
BACKGROUND
Triple antithrombotic therapy (TAT) with aspirin, a P2Y inhibitor, and oral anticoagulation in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) raises concerns about increased bleeding. Regimens incorporating more potent P2Y inhibitors over clopidogrel have not been investigated adequately.
RESEARCH DESIGN AND METHODS
A retrospective observational study was performed on 387 patients with AF receiving TAT for 1 month ( = 236) or ≤1 week ( = 151) after PCI. Major and clinically relevant non-major bleeding and major adverse cardiac and cerebrovascular events (MACCE) were assessed up to 30 days post-procedure.
RESULTS
Bleeding was less frequent with ≤1 week versus 1 month of TAT (3.3 vs 9.3%; = 0.025) while MACCE were similar (4.6 vs 4.7%; = 0.998). No differences in bleeding or MACCE were observed between ticagrelor/prasugrel and clopidogrel regimens. For patients receiving ≤1 week of TAT, no excess of MACCE was seen in the subgroup given no further aspirin post-PCI compared with those given aspirin for up to 1 week (3.6 vs 5.2%).
CONCLUSIONS
TAT post-PCI for ≤1 week was associated with less bleeding despite greater use of ticagrelor/prasugrel but similar MACCE versus 1-month TAT. These findings support further studies on safety and efficacy of dual therapy with ticagrelor/prasugrel immediately after PCI.
PubMed: 38949642
DOI: 10.1080/14779072.2024.2374366 -
BJS Open Jan 2024Textbook outcomes are composite outcome measures that reflect the ideal overall experience for patients. There are many of these in the elective surgery literature but...
BACKGROUND
Textbook outcomes are composite outcome measures that reflect the ideal overall experience for patients. There are many of these in the elective surgery literature but no textbook outcomes have been proposed for patients following emergency laparotomy. The aim was to achieve international consensus amongst experts and patients for the best Textbook Outcomes for non-trauma and trauma emergency laparotomy.
METHODS
A modified Delphi exercise was undertaken with three planned rounds to achieve consensus regarding the best Textbook Outcomes based on the category, number and importance (Likert scale of 1-5) of individual outcome measures. There were separate questions for non-trauma and trauma. A patient engagement exercise was undertaken after round 2 to inform the final round.
RESULTS
A total of 337 participants from 53 countries participated in all three rounds of the exercise. The final Textbook Outcomes were divided into 'early' and 'longer-term'. For non-trauma patients the proposed early Textbook Outcome was 'Discharged from hospital without serious postoperative complications (Clavien-Dindo ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation or death). For trauma patients it was 'Discharged from hospital without unexpected transfusion after haemostasis, and no serious postoperative complications (adapted Clavien-Dindo for trauma ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation on or death)'. The longer-term Textbook Outcome for both non-trauma and trauma was 'Achieved the early Textbook Outcome, and restoration of baseline quality of life at 1 year'.
CONCLUSION
Early and longer-term Textbook Outcomes have been agreed by an international consensus of experts for non-trauma and trauma emergency laparotomy. These now require clinical validation with patient data.
Topics: Humans; Laparotomy; Delphi Technique; Postoperative Complications; Consensus; Emergencies; Outcome Assessment, Health Care
PubMed: 38949628
DOI: 10.1093/bjsopen/zrad145 -
Medical Physics Jul 2024Lung cancer is the most common type of cancer. Detection of lung cancer at an early stage can reduce mortality rates. Pulmonary nodules may represent early cancer and...
BACKGROUND
Lung cancer is the most common type of cancer. Detection of lung cancer at an early stage can reduce mortality rates. Pulmonary nodules may represent early cancer and can be identified through computed tomography (CT) scans. Malignant risk can be estimated based on attributes like size, shape, location, and density.
PURPOSE
Deep learning algorithms have achieved remarkable advancements in this domain compared to traditional machine learning methods. Nevertheless, many existing anchor-based deep learning algorithms exhibit sensitivity to predefined anchor-box configurations, necessitating manual adjustments to obtain optimal outcomes. Conversely, current anchor-free deep learning-based nodule detection methods normally adopt fixed-size nodule models like cubes or spheres.
METHODS
To address these technical challenges, we propose a multiscale 3D anchor-free deep learning network (M3N) for pulmonary nodule detection, leveraging adjustable nodule modeling (ANM). Within this framework, ANM empowers the representation of target objects in an anisotropic manner, with a novel point selection strategy (PSS) devised to accelerate the learning process of anisotropic representation. We further incorporate a composite loss function that combines the conventional L2 loss and cosine similarity loss, facilitating M3N to learn nodules' intensity distribution in three dimensions.
RESULTS
Experiment results show that the M3N achieves 90.6% competitive performance metrics (CPM) with seven predefined false positives per scan on the LUNA 16 dataset. This performance appears to exceed that of other state-of-the-art deep learning-based networks reported in their respective publications. Individual test results also demonstrate that M3N excels in providing more accurate, adaptive bounding boxes surrounding the contours of target nodules.
CONCLUSIONS
The newly developed nodule detection system reduces reliance on prior knowledge, such as the general size of objects in the dataset, thus it should enhance overall robustness and versatility. Distinct from traditional nodule modeling techniques, the ANM approach aligns more closely with the morphological characteristics of nodules. Time consumption and detection results demonstrate promising efficiency and accuracy which should be validated in clinical settings.
PubMed: 38949577
DOI: 10.1002/mp.17283 -
Clinical Oral Implants Research Jul 2024To investigate the early impact of plaque accumulation in a buccal dehiscence defect on peri-implant marginal bone resorption.
OBJECTIVE
To investigate the early impact of plaque accumulation in a buccal dehiscence defect on peri-implant marginal bone resorption.
MATERIALS AND METHODS
In six male Mongrel dogs, four dental implants were placed in the posterior maxilla on both sides (two implants per side). Based on the group allocation, each implant was randomly assigned to one of the following four groups to decide whether buccal dehiscence defect was prepared and whether silk ligation was applied at 8 weeks post-implant placement for peri-implantitis induction: UC (no defect without ligation); UD (defect without ligation); LC (no defect with ligation); and LD (defect with ligation) groups. Eight weeks after disease induction, the outcomes from radiographic and histologic analyses were statistically analyzed (p < .05).
RESULTS
Based on radiographs, the exposed area of implant threads was smallest in group UC (p < .0083). Based on histology, both the distances from the implant platform to the first bone-to-implant contact point and to the bone crest were significantly longer in the LD group (p < .0083). In the UD group, some spontaneous bone fill occurred from the base of the defect at 8 weeks after implant placement. The apical extension of inflammatory cell infiltrate was significantly more prominent in the LD and LC groups compared to the UC group (p < .0083).
CONCLUSION
Plaque accumulated on the exposed implant surface had a negative impact on maintaining the peri-implant marginal bone level, especially when there was a dehiscence defect around the implant.
PubMed: 38949573
DOI: 10.1111/clr.14324 -
Advances in Neonatal Care : Official... Jun 2024Acquired human cytomegalovirus (CMV) is a noteworthy disease in infants. This case study will highlight the influence of early diagnosis of CMV retinitis (CMVR) on avoid...
BACKGROUND
Acquired human cytomegalovirus (CMV) is a noteworthy disease in infants. This case study will highlight the influence of early diagnosis of CMV retinitis (CMVR) on avoid visual impairment.
CLINICAL FINDINGS
We describe a preterm female infant with a birth weight of 2060 gr that was admitted for tracheostomy placement due to hypoxic-ischemic encephalopathy. There were no signs of CMV infection or sepsis in laboratory results upon admission such as serology (IgG, IgM antibodies), Toxoplasma gondii, Rubella virus, Herpes simplex virus, CMVR and urine polymerase chain reaction (PCR).
PRIMARY DIAGNOSIS
Incidentally, upon screening for retinopathy of prematurity, diffuse occlusive vasculitis was detected in the retinal image on the 112th day of life.
INTERVENTION
Intravenous and intraocular ganciclovir were administered for 4 weeks.
OUTCOMES
In the follow-up visit 6 weeks after discharge from the hospital, visual impairment was detected on both sides.
PRACTICE RECOMMENDATIONS
This is a report of a case of acquired CMVR, a silent finding, as an uncommon complication in preterm neonates during the hospital stay. This diagnosis should be taken into consideration in preterm infants, since early diagnosis and treatment are crucial to avoid visual impairment.
PubMed: 38949554
DOI: 10.1097/ANC.0000000000001174 -
Obstetrics and Gynecology Jul 2024To evaluate maternal and neonatal outcomes by type of antihypertensive used in participants of the CHAP (Chronic Hypertension in Pregnancy) trial. (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
OBJECTIVE
To evaluate maternal and neonatal outcomes by type of antihypertensive used in participants of the CHAP (Chronic Hypertension in Pregnancy) trial.
METHODS
We conducted a planned secondary analysis of CHAP, an open-label, multicenter, randomized trial of antihypertensive treatment compared with standard care (no treatment unless severe hypertension developed) in pregnant patients with mild chronic hypertension (blood pressure 140-159/90-104 mm Hg before 20 weeks of gestation) and singleton pregnancies. We performed three comparisons based on medications prescribed at enrollment: labetalol compared with standard care, nifedipine compared with standard care, and labetalol compared with nifedipine. Although active compared with standard care groups were randomized, medication assignment within the active treatment group was not random but based on clinician or patient preference. The primary outcome was the occurrence of superimposed preeclampsia with severe features, preterm birth before 35 weeks of gestation, placental abruption, or fetal or neonatal death. The key secondary outcome was small for gestational age (SGA) neonates. We also compared medication adverse effects between groups. Relative risks (RRs) and 95% CIs were estimated with log binomial regression to adjust for confounding.
RESULTS
Of 2,292 participants analyzed, 720 (31.4%) received labetalol, 417 (18.2%) received nifedipine, and 1,155 (50.4%) received no treatment. The mean gestational age at enrollment was 10.5±3.7 weeks; nearly half of participants (47.5%) identified as non-Hispanic Black; and 44.5% used aspirin. The primary outcome occurred in 217 (30.1%), 130 (31.2%), and 427 (37.0%) in the labetalol, nifedipine, and standard care groups, respectively. Risk of the primary outcome was lower among those receiving treatment (labetalol use vs standard adjusted RR 0.82, 95% CI, 0.72-0.94; nifedipine use vs standard adjusted RR 0.84, 95% CI, 0.71-0.99), but there was no significant difference in risk when labetalol was compared with nifedipine (adjusted RR 0.98, 95% CI, 0.82-1.18). There were no significant differences in SGA or serious adverse events between participants receiving labetalol and those receiving nifedipine.
CONCLUSION
No significant differences in predetermined maternal or neonatal outcomes were detected on the basis of the use of labetalol or nifedipine for treatment of chronic hypertension in pregnancy.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT02299414.
Topics: Humans; Pregnancy; Female; Labetalol; Nifedipine; Antihypertensive Agents; Adult; Pregnancy Outcome; Hypertension; Infant, Newborn; Pregnancy Complications, Cardiovascular; Hypertension, Pregnancy-Induced; Administration, Oral; Infant, Small for Gestational Age; Pre-Eclampsia; Chronic Disease
PubMed: 38949541
DOI: 10.1097/AOG.0000000000005613 -
European Journal of Psychotraumatology 2024Despite its popularity, evidence of the effectiveness of Psychological First Aid (PFA) is scarce. To assess whether PFA, compared to psychoeducation (PsyEd), an... (Randomized Controlled Trial)
Randomized Controlled Trial
The effect of a single session of psychological first aid in the emergency department on PTSD and depressive symptoms three months post-intervention: results of a randomised controlled trial.
Despite its popularity, evidence of the effectiveness of Psychological First Aid (PFA) is scarce. To assess whether PFA, compared to psychoeducation (PsyEd), an attention placebo control, reduces PTSD and depressive symptoms three months post-intervention. In two emergency departments, 166 recent-trauma adult survivors were randomised to a single session of PFA (= 78) (active listening, breathing retraining, categorisation of needs, assisted referral to social networks, and PsyEd) or stand-alone PsyEd ( = 88). PTSD and depressive symptoms were assessed at baseline (T0), one (T1), and three months post-intervention (T2) with the PTSD Checklist (PCL-C at T0 and PCL-S at T1/T2) and the Beck Depression Inventory-II (BDI-II). Self-reported side effects, post-trauma increased alcohol/substance consumption and interpersonal conflicts, and use of psychotropics, psychotherapy, sick leave, and complementary/alternative medicine were also explored. 86 participants (51.81% of those randomised) dropped out at T2. A significant proportion of participants in the PsyEd group also received PFA components (i.e. contamination). From T0 to T2, we did not find a significant advantage of PFA in reducing PTSD ( = .148) or depressive symptoms ( = .201). However, we found a significant dose-response effect between the number of delivered components, session duration, and PTSD symptom reduction. No significant difference in self-reported adverse effects was found. At T2, a smaller proportion of participants assigned to PFA reported increased consumption of alcohol/substances (OR = 0.09, = .003), interpersonal conflicts (OR = 0.27, = .014), and having used psychotropics (OR = 0.23, = .013) or sick leave (OR = 0.11, = .047). Three months post-intervention, we did not find evidence that PFA outperforms PsyEd in reducing PTSD or depressive symptoms. Contamination may have affected our results. PFA, nonetheless, appears to be promising in modifying some post-trauma behaviours. Further research is needed.
Topics: Humans; Stress Disorders, Post-Traumatic; Male; Female; Adult; Depression; Emergency Service, Hospital; First Aid; Survivors; Psychotherapy; Middle Aged; Treatment Outcome; Psychiatric Status Rating Scales
PubMed: 38949539
DOI: 10.1080/20008066.2024.2364443 -
Physiotherapy Theory and Practice Jul 2024Therapeutic relationship and social support are critical components in physiotherapy that shape patient outcomes. However, defining these constructs, discerning their...
BACKGROUND/PURPOSE
Therapeutic relationship and social support are critical components in physiotherapy that shape patient outcomes. However, defining these constructs, discerning their similarities and differences, and measuring them pose challenges. This article aims to facilitate scientific and clinical advancement on social support and the therapeutic relationship in physiotherapy by (a) providing conceptual clarity, (b) discussing measurement tools, and (c) offering practical recommendations for the deliberate incorporation of these constructs in clinical practice.
METHODS
This is a perspective paper drawing on examples from existing research.
KEY RESULTS
Assessing the nature and strength of social support and promoting naturally occurring social support networks are practical ways for physiotherapists to foster social support in physiotherapy clinical practice. Physiotherapists can offer direct support, facilitate the development of an individual's social skills, and promote participation in group activities. To strengthen the therapeutic relationship, it is important to maintain good communication, foster connectedness with the patient, demonstrate professional skills, and adopt a reflective practice. Physiotherapists are encouraged to establish clear roles and responsibilities, prioritize individualized patient-centered care, and involve patients in shared decision-making, ensuring congruence in goals and expectations. Willingness to dedicate time and energy within and beyond direct patient-therapist interactions can foster connections. Moreover, using the body - which is the main point of contact with patients - and physical touch can help physiotherapists to connect with patients. Finally, physiotherapists must be prepared to address and mend any conflicts which can impact the relationship's trajectory.
CONCLUSION
Social support and therapeutic relationships are complementary aspects of one's health care, and it is crucial to purposefully account for both in physiotherapy practice to optimize person-centered care and rehabilitation outcomes.
PubMed: 38949505
DOI: 10.1080/09593985.2024.2372687 -
The Journal of Craniofacial Surgery Jul 2024Alveolar bone graft (ABG) or repair has become a routine part of treatment protocols for individuals with cleft lip and/or palate. However, the necessity and potential...
BACKGROUND/OBJECTIVE
Alveolar bone graft (ABG) or repair has become a routine part of treatment protocols for individuals with cleft lip and/or palate. However, the necessity and potential benefits of presurgical orthodontic treatment in influencing the outcomes of secondary alveolar bone grafting remain inconclusive. This systematic review aimed to assess the impact of presurgical orthodontics on preparing patients for secondary alveolar bone grafts.
STUDY DESIGN
The authors systematically searched for relevant articles in PubMed, Web of Science, and Embase databases spanning the period from January 1, 2000, to December 31, 2023, using keywords related to alveolar bone grafting and orthodontic treatment for patients with cleft lip and/or palate. The review encompassed various study designs, including prospective and retrospective studies, observational studies, cross-sectional studies, randomized and nonrandomized clinical trials, cohort studies, and case-control studies. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the risk of bias was evaluated in studies selected for full-text review.
RESULTS
The search strategy identified 809 publications. After initial screening and application of exclusion criteria, 11 studies were included for final review. Three were prospective studies, 8 were retrospective studies, and 3 were cross-sectional cohort studies. On the basis of ROBINS-I and RoB 2 risk assessment, 9 studies were found to be of moderate risk of bias, one study was categorized as of high risk of bias, and 1 study was categorized as low risk of bias.
CONCLUSIONS
Drawing from the latest and most reliable studies, 7 out of 11 included studies provided compelling evidence that presurgical orthodontics preceding alveolar bone grafting (ABG) leads to significantly improved outcomes compared with cases without presurgical orthodontic intervention. Notably, individuals with specific conditions, such as severely collapsed upper arch and mispositioned upper incisors, appear to derive the greatest benefits from presurgical orthodontic treatment. However, a call for additional studies characterized by high methodological quality and with longer follow-up periods is emphasized to enhance the safety considerations for both practitioners and patients concerning the utilization of presurgical orthodontics in the treatment of individuals with cleft lip and palate.
PubMed: 38949493
DOI: 10.1097/SCS.0000000000010431 -
Curationis Jun 2024In South Africa, screening for tuberculosis during pregnancy is a serious challenge. Tuberculosis is one of the leading indirect causes of mortality in pregnant women.
BACKGROUND
In South Africa, screening for tuberculosis during pregnancy is a serious challenge. Tuberculosis is one of the leading indirect causes of mortality in pregnant women.
OBJECTIVES
The objective of the study was to explore the challenges experienced by midwives regarding tuberculosis in pregnant women.
METHOD
A qualitative exploratory research method was used to conduct the study. The study population comprised midwives who worked at primary healthcare clinics in the selected local area, Capricorn District, Limpopo province. Purposive non-probability sampling was used to select 10 participants. Data from participants were acquired using in-depth individual semi-structured interviews. Data analysis was carried out using manual thematic analysis following Tesch's technique.
RESULTS
The outcomes of this study included midwives knowing their roles regarding tuberculosis screening among pregnant women. They further highlighted their challenges while screening tuberculosis in pregnant women, such as shortage of screening tools, withholding of tuberculosis information, and language barrier.
CONCLUSION
Midwives should have the necessary equipment and be trained in various languages used in the province to improve tuberculosis screening among all pregnant women.Contribution: Infected pregnant women and their unborn children's health can be improved by tuberculosis screening.
Topics: Humans; South Africa; Female; Pregnancy; Mass Screening; Midwifery; Qualitative Research; Tuberculosis; Adult; Interviews as Topic
PubMed: 38949423
DOI: 10.4102/curationis.v47i1.2533