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Respiration; International Review of... 2024Bronchopleural fistula (BPF) with empyema caused by severe necrotizing pulmonary infection is a complicated clinical problem that is often associated with poor general...
Inverted Placement of Endoscopic One-Way Endobronchial Valve Combined with Gelfoam in the Closure of Bronchopleural Fistula with Empyema in a Mechanically Ventilated Patient: A Case Report.
Bronchopleural fistula (BPF) with empyema caused by severe necrotizing pulmonary infection is a complicated clinical problem that is often associated with poor general condition so surgical interventions cannot be tolerated in most cases. Here, we present the successful management of multiple BPF with empyema in a mechanically ventilated patient with aspiration lung abscess. Occlusion utilizing Gelfoam followed by endobronchial valves (EBVs) implanted inverted via bronchoscope decreased the air leaking significantly and made intrapleural irrigation for empyema achievable and safe. This is the first report of a novel way of EBV placement and the combination use with other occlusive substances in BPF with empyema in a patient on mechanical ventilation. This method may be an option for refractory BPF cases with pleural infection.
Topics: Humans; Gelatin Sponge, Absorbable; Respiration, Artificial; Bronchial Fistula; Pleural Diseases; Empyema
PubMed: 38330927
DOI: 10.1159/000535478 -
Addiction Science & Clinical Practice Jan 2024The opioid epidemic has resulted in expanded substance use treatment services and strained the clinical workforce serving people with opioid use disorder. Focusing on...
BACKGROUND
The opioid epidemic has resulted in expanded substance use treatment services and strained the clinical workforce serving people with opioid use disorder. Focusing on evidence-based counseling practices like motivational interviewing may be of interest to counselors and their supervisors, but time-intensive adherence tasks like recording and feedback are aspirational in busy community-based opioid treatment programs. The need to improve and systematize clinical training and supervision might be addressed by the growing field of machine learning and natural language-based technology, which can promote counseling skill via self- and supervisor-monitoring of counseling session recordings.
METHODS
Counselors in an opioid treatment program were provided with an opportunity to use an artificial intelligence based, HIPAA compliant recording and supervision platform (Lyssn.io) to record counseling sessions. We then conducted four focus groups-two with counselors and two with supervisors-to understand the integration of technology with practice and supervision. Questions centered on the acceptability of the clinical supervision software and its potential in an OTP setting; we conducted a thematic coding of the responses.
RESULTS
The clinical supervision software was experienced by counselors and clinical supervisors as beneficial to counselor training, professional development, and clinical supervision. Focus group participants reported that the clinical supervision software could help counselors learn and improve motivational interviewing skills. Counselors said that using the technology highlights the value of counseling encounters (versus paperwork). Clinical supervisors noted that the clinical supervision software could help meet national clinical supervision guidelines and local requirements. Counselors and clinical supervisors alike talked about some of the potential challenges of requiring session recording.
CONCLUSIONS
Implementing evidence-based counseling practices can help the population served in OTPs; another benefit of focusing on clinical skills is to emphasize and hold up counselors' roles as worthy. Machine learning technology can have a positive impact on clinical practices among counselors and clinical supervisors in opioid treatment programs, settings whose clinical workforce continues to be challenged by the opioid epidemic. Using technology to focus on clinical skill building may enhance counselors' and clinical supervisors' overall experiences in their places of work.
Topics: Humans; Analgesics, Opioid; Artificial Intelligence; Preceptorship; Counseling; Technology
PubMed: 38245783
DOI: 10.1186/s13722-024-00435-z -
Arthroscopy Techniques Dec 2023We present an evidence-based approach to optimize the biologic incorporation of osteochondral allografts: (1) The donor graft is gradually rewarmed to room temperature...
We present an evidence-based approach to optimize the biologic incorporation of osteochondral allografts: (1) The donor graft is gradually rewarmed to room temperature to reverse the metabolic suppression from cold storage. (2) The graft is harvested while submerged in saline to limit thermal necrosis. (3) Subchondral bone depth is preferred at 4 to 6 mm depth (total plug depth ∼5-8 mm including articular cartilage) to reduce graft immunogenicity and to promote incorporation. (4) The bone is prepared with grooves/beveling to decrease impaction forces, increase access to subchondral deep zones during preparation, and promote graft-host interface healing. (5) High-pressure pulsed lavage is used to reduce antigenicity by removing marrow elements. (6) Pressurized carbon dioxide following pulsed lavage further reduces marrow elements and improves graft porosity for orthobiologic incorporation. (7) Orthobiologic substances (e.g., concentrated bone marrow aspirate) may enhance incorporation on imaging and result in greater osteogenic potential. (8) A suture is placed behind the graft to facilitate removal and repositioning; atraumatic graft insertion without high impaction forces maintains chondrocyte viability. These evidence-based pearls for osteochondral allograft handling optimize metabolic activity, reduce thermal necrosis, reduce antigenicity with removal of marrow elements, enhance biologic potential, and maintain chondrocyte viability to optimize biologic healing and clinical success.
PubMed: 38196872
DOI: 10.1016/j.eats.2023.07.056 -
Healthcare (Basel, Switzerland) Dec 2023(1) Background: Cigarette smoking, risky alcohol consumption, and marijuana smoking are the most common behaviors related to legal and illicit drug use worldwide,...
Cigarette Smoking, Risky Alcohol Consumption, and Marijuana Smoking among University Students in Germany: Identification of Potential Sociodemographic and Study-Related Risk Groups and Predictors of Consumption.
(1) Background: Cigarette smoking, risky alcohol consumption, and marijuana smoking are the most common behaviors related to legal and illicit drug use worldwide, including among university students. To plan effective evidence-based programs to prevent the risky consumption of these substances among university students, the present study aimed to identify potential sociodemographic and study-related risk groups and predictors of consumption. (2) Methods: A cross-sectional online health survey with approximately 270 health-related items was conducted among students at the University of Mainz, Germany. Cigarette smoking, risky alcohol consumption (AUDIT-C score: female ≥ 4, male ≥ 5), and marijuana smoking were chosen as dependent variables. Of the 270 health-related items, 56 were chosen as independent variables and collated into five groups (sociodemographic, psychological, study-related psychosocial, general psychosocial and health behavior). The prevalence of cigarette smoking, risky alcohol consumption, and marijuana smoking was assessed using established and validated instruments. Pearson's chi-square test was used to analyze the differences in prevalence between the sociodemographic and study-related groups, and binary logistic regression was used for analyses with stepwise inclusion of the five variable groups. (3) Results: Of the 3991 university students who entered the analyses, 14.9% reported smoking cigarettes, 38.6% reported risky alcohol consumption, and 10.9% reported smoking marijuana. The prevalence of these differed between genders, fields of study, and aspired degree level, among other factors. Binary logistic regression analyses revealed nine significant predictors ( ≤ 0.05) of cigarette smoking (Nagelkerke R = 0.314), 18 significant predictors of risky alcohol consumption (Nagelkerke R = 0.270), and 16 significant predictors of marijuana smoking (Nagelkerke R = 0.239). (4) Conclusions: This study showed cigarette smoking, risky alcohol consumption, and marijuana smoking among university students in Germany to be associated with multiple factors, especially health behaviors. Furthermore, each of the substances was highly associated with each of the two other substances we examined. Other variable groups, such as psychological or psychosocial variables, seemed to play a rather minor role. Therefore, our recommendation for future prevention programs is that substance use among university students should be addressed as a whole, not just in terms of specific substances.
PubMed: 38132073
DOI: 10.3390/healthcare11243182 -
Cureus Nov 2023Background The first electronic sports (esports) tournament was recorded in 1972, and since then, gaming leagues and tournaments with prizes have been established....
Background The first electronic sports (esports) tournament was recorded in 1972, and since then, gaming leagues and tournaments with prizes have been established. Nowadays, the commercialization of competitive gaming may drive players to cheat their way to success and neglect their physical and mental well-being. The issue is all the more vital, as it is often overlooked by classically educated doctors, including sports medicine specialists. The aim of this study was to investigate the current situation of doping in esports and the future of anti-doping actions in this field, as well as to present a more generalised approach and to point out and discuss other possible health risks associated with the rising popularity of esports. Methods A standardised online survey was published in a social media group for Polish fans and people associated with esports. Two hundred and forty-one responses were collected and subjected to a statistical analysis. Only filled-out forms containing answers to all of the questionnaire's questions from people considering themselves regular players of either League of Legends (LoL) and/or Counter-Strike: Global Offensive (CS:GO) were considered viable. The study group was divided into amateur and professional players. The calculation of test power was done post hoc to determine whether the data collected were of sufficient quality to be used further. The normal distribution was assessed using the Shapiro-Wilk test. Then, between-group differences comparing the data results from the questionnaire were analysed with Mann-Whitney U tests and Chi-square tests. The significance level was set at p <0.05. Then, the literature was screened for relevant articles. Results The majority of gamers (85.5%), despite most of them being amateurs, strive to achieve the best results when playing. Borderline legal substances are commonly used, including energy drinks (97.8%), coffee (81.6%), beer (29.7%), herbs (15.7%), and available medicines (15.1%), while more than half the participants have heard about situations during tournaments involving the use of substances forbidden by the World Anti-Doping Agency (WADA). In most answers, there were no significant differences between professionals and amateurs. Statistically significant differences were observed in the following areas: the usage of legal stimulants in the responders' environments; outlooks on implementing more strict anti-doping regulations; and the perceived usage of forbidden doping substances in a tournament setting. Conclusions E-competitors suffer from a plethora of both physical and mental health problems. These issues may be more prevalent than generally thought and include repetitive strain injuries, sleep disorders, anxiety, and depression. The largest esports organisations have started to implement measures to provide a holistic approach to esports healthcare; however, it remains a distant dream for most amateurs and aspiring e-athletes.
PubMed: 38074032
DOI: 10.7759/cureus.48490 -
Biomolecules Oct 2023Aging is a natural and inescapable phenomenon characterized by a progressive deterioration of physiological functions, leading to increased vulnerability to chronic... (Review)
Review
Aging is a natural and inescapable phenomenon characterized by a progressive deterioration of physiological functions, leading to increased vulnerability to chronic diseases and death. With economic and medical development, the elderly population is gradually increasing, which poses a great burden to society, the economy and the medical field. Thus, healthy aging has now become a common aspiration among people over the world. Accumulating evidence indicates that substances that can mediate the deteriorated physiological processes are highly likely to have the potential to prolong lifespan and improve aging-associated diseases. Foods from natural sources are full of bioactive compounds, such as polysaccharides, polyphenols, carotenoids, sterols, terpenoids and vitamins. These bioactive compounds and their derivatives have been shown to be able to delay aging and/or improve aging-associated diseases, thereby prolonging lifespan, via regulation of various physiological processes. Here, we summarize the current understanding of the anti-aging activities of the compounds, polysaccharides, polyphenols, carotenoids, sterols, terpenoids and vitamins from natural food sources, and their modes of action in delaying aging and improving aging-associated diseases. This will certainly provide a reference for further research on the anti-aging effects of bioactive compounds from natural food sources.
Topics: Aged; Humans; Aging; Carotenoids; Polyphenols; Vitamins; Terpenes; Sterols; Polysaccharides
PubMed: 38002283
DOI: 10.3390/biom13111600 -
International Journal of Environmental... Nov 2023Excessive alcohol consumption carries a significant health, social and economic burden. Screening, brief intervention and referral to treatment (SBIRT) is one approach...
Alcohol Prevention in Urgent and Emergency Care (APUEC): Development and Evaluation of Workforce Digital Training on Screening, Brief Intervention, and Referral for Treatment.
Excessive alcohol consumption carries a significant health, social and economic burden. Screening, brief intervention and referral to treatment (SBIRT) is one approach to identifying patients with excessive alcohol consumption and providing interventions to help them reduce their drinking. However, healthcare workers in urgent and emergency care settings do not routinely integrate SBIRT into clinical practice and raise a lack of training as a barrier to SBIRT delivery. Therefore, "Alcohol Prevention in Urgent and Emergency Care" (APUEC) training was developed, delivered, and evaluated. APUEC is a brief, stand-alone, multimedia, interactive digital training package for healthcare workers. The aim of APUEC is to increase positive attitudes, knowledge, confidence and skills related to SBIRT through the provision of (a) education on the impact of alcohol and the role of urgent and emergency care in alcohol prevention, and (b) practical guidance on patient assessment, delivery of brief advice and making referral decisions. Development involved collaborative-participatory design approaches and a rigorous six-step ASPIRE methodology (involving = 28 contributors). APUEC was delivered to healthcare workers who completed an online survey ( = 18) and then participated in individual qualitative interviews ( = 15). Analysis of data was aligned with Levels 1-3 of the Kirkpatrick Model of Training Evaluation. Survey data showed that all participants (100%) found the training useful and would recommend it to others. Insights from the qualitative data showed that APUEC digital training increases healthcare workers' perceived knowledge, confidence and skills related to alcohol prevention in urgent and emergency care settings. Participants viewed APUEC to be engaging and relevant to urgent and emergency care workers. This digital training was perceived to be useful for workforce skills development and supporting the implementation of SBIRT in clinical practice. While the impact of APUEC on clinician behaviour and patient outcomes is yet to be tested, APUEC digital training could easily be embedded within education and continuing professional development programmes for healthcare workers and healthcare trainees of any discipline. Ultimately, this may facilitate the integration of SBIRT into routine care and contribute to population health improvement.
Topics: Humans; Crisis Intervention; Alcoholism; Health Personnel; Emergency Medical Services; Referral and Consultation; Mass Screening; Substance-Related Disorders
PubMed: 37998259
DOI: 10.3390/ijerph20227028 -
Cureus Oct 2023Orthodontic treatment signifies a transformative journey for individuals seeking not only enhanced oral health but also a boost in aesthetics and self-confidence.... (Review)
Review
Orthodontic treatment signifies a transformative journey for individuals seeking not only enhanced oral health but also a boost in aesthetics and self-confidence. Nonetheless, the protracted timeline associated with conventional orthodontic care has been a persistent concern for both patients and practitioners. In this comprehensive review, we embark on an exploration of innovative strategies aimed at expediting orthodontic tooth movement (OTM). By doing so, we aspire to curtail treatment duration and mitigate potential risks, ultimately culminating in an elevated and more fulfilling patient experience. Traditionally, orthodontists heavily leaned on surgical techniques to hasten tooth movement. However, the recent landscape of orthodontics has been profoundly shaped by technological advancements and groundbreaking research findings, ushering in an era characterized by the embrace of minimally invasive approaches. These progressive methodologies encompass procedures like Piezocision, Discision, and Microosteoperforation (Alveocentesis). Beyond the obvious benefits of reduced patient discomfort, these techniques significantly truncate treatment periods, a development that addresses a primary concern of many patients. Moreover, this review delves into non-invasive alternatives, including cyclic vibrations, photobiomodulation, direct light electric current, and static or pulsed magnetic fields, as well as systemic and local administration of biological substances and hormones, all of which hold substantial promise in optimizing OTM. Furthermore, our exploration extends to a diverse spectrum of medications that have demonstrated their efficacy in expediting OTM. These encompass NSAIDs, acetaminophen, corticosteroids, bisphosphonates, herbal medicine biomaterials, and synthetic biomaterials like graphene dioxide. Every technique and medication is subjected to meticulous evaluation, taking into account its indications, contraindications, advantages, disadvantages, clinical implications, and limitations. Through this review, we endeavor to equip orthodontic professionals with a profound understanding of these innovative strategies. By doing so, we enable them to make informed decisions, tailored meticulously to meet the unique needs of each patient. In an ever-evolving field like orthodontics, staying abreast of these advancements becomes paramount, ultimately contributing to heightened treatment efficacy and enhanced patient satisfaction. The adoption of these innovative strategies not only holds the potential for improved clinical outcomes but also champions a patient-centric approach that could fundamentally reshape the landscape of orthodontic care.
PubMed: 37954770
DOI: 10.7759/cureus.46824 -
European Journal of Case Reports in... 2023We present a rare case of large bilateral pleural effusion, pericardial effusion and pneumomediastinum caused by a peripherally inserted central catheter (PICC) line...
UNLABELLED
We present a rare case of large bilateral pleural effusion, pericardial effusion and pneumomediastinum caused by a peripherally inserted central catheter (PICC) line rupturing the left brachiocephalic vein, causing severe respiratory failure. The PICC line had been inserted with the aim of providing total parenteral nutrition (TPN). The patient developed symptoms within a day with effusions diagnosed on computer tomography pulmonary angiogram (CTPA). Bilateral pleural drains were inserted with a white milk-like substance drained consistent with TPN, prompting a further review of the CTPA revealing the mediastinal-positioned PICC line. The patient was transferred to the thoracic unit and was successfully managed with conservative measures. We propose some ideas such as the use of intracavitary electrocardiogram (IC-ECG) guidance as an adjuvant to obtain a correct and safe position.
LEARNING POINTS
PICC lines, although seen as safer, have potential for catastrophic adverse effects.The use of intracavitary electrocardiogram may be a safe adjunct and even an alternative to the use of a chest X-ray.Aspirating blood from all lumens with particular emphasis on the distal most lumen is very important.
PubMed: 37920225
DOI: 10.12890/2023_004103 -
Cureus Sep 2023Left ventricular noncompaction (LVNC) is a rare congenital condition defined by the presence of prominent trabeculations in the myocardial layer of the left ventricle....
Left ventricular noncompaction (LVNC) is a rare congenital condition defined by the presence of prominent trabeculations in the myocardial layer of the left ventricle. The clinical presentation is varied as some patients are asymptomatic and others have symptoms of decompensated heart failure, arrhythmias, or thromboembolism. We present the case of a 42-year-old female with a past medical history of asthma and substance use disorder who presented to the Emergency Department following a syncopal event. The patient had used heroin intranasally, following which she became unresponsive for several minutes. Her husband witnessed the event and initiated chest compressions. When examined by emergency medical services (EMS), she had a palpable pulse and was given naloxone. The patient underwent further evaluation and was admitted for the treatment of aspiration pneumonia. Throughout her hospital stay, she complained of chest pain with musculoskeletal characteristics, likely secondary to chest compressions. However, due to the persistence of pain, she had further cardiac evaluation done. Her electrocardiography (EKG) revealed a normal sinus rhythm with no acute ischemic changes. Her echocardiography revealed left ventricular apical trabeculations with normal systolic and diastolic function, in line with the diagnosis of LVNC. Upon discharge, she was extensively counseled to abstain from substance use and to follow up with cardiology for a cardiac event monitor. Given her initial syncopal event and high-risk substance use behavior, she would benefit from close follow-up for the presence of arrhythmias.
PubMed: 37849596
DOI: 10.7759/cureus.45366