6-month Period Research Articles

Association of accommodation and convergence with axial length elongation in children with basic intermittent exotropia: a 12-month observational study.

To investigate the association of parameters related to accommodation and convergence and axial elongation in basic intermittent exotropia (IXT) patients and the potential clinical predictors of axial length (AL) growth. A total of 140 basic IXT patients were recruited in this study. The medians of AL growth in different age brackets were chosen to divide the subjects into Group A (slower axial elongation group, n=69) and Group B (faster axial elongation group, n=71). Parameters of dominant and nondominant eyes were compared and analyzed during the 12-month follow-up period. The parameters, including baseline refraction, angle of deviation, Newcastle score (NCS), accommodative amplitude (AMP), accommodative facility (AMF), accommodative response, positive or negative relative accommodation (PRA/NRA), and near point of convergence (NPC), were analyzed via univariate and multivariate regression. Subjects in faster axial elongation group tended to have more myopic spherical equivalents (t=3.956, P<.001), greater accommodative amplitudes of dominant eyes (t=-2.238, P=.027) and less near points of convergence (t=2.347, P=.020) than in slower axial elongation group. For dominant eyes, logistic and linear regression analysis revealed that more negative spherical equivalents (OR=0.603, P<.001; β=-0.045, P<.001), greater accommodative amplitudes (OR=1.201, P=.027; β=0.023, P=.010) and less near points of convergence (OR=0.883, P=.021; β=-0.012, P=.019) were correlated with the faster axial elongation. For nondominant eyes, more myopic spherical equivalent (OR=0.682; P=.001; β=-0.029, P=.005) was the only parameter correlated with faster axial elongation through regression analysis. In children with basic intermittent exotropia, faster axial elongation in the dominant eyes were associated with more myopic spherical equivalents, greater accommodative amplitudes, and lower near points of convergence. These accommodative parameters can serve as potential clinical indicators for monitoring myopia progression in addition to axial length.

The Correlation Between Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) and miR-142-3p in Maintenance Hemodialysis Patients With End-Stage Renal Disease.

Patients with end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) are at high risk for major adverse cardiovascular and cerebrovascular events (MACCE), which are prone to be detrimental to patients' lives. Identifying risk factors for MACCE can help target measures to prevent or reduce the occurrence of MACCE. The aim was to investigate the correlation between miR-142-3p and MACCE in ESRD patients on MHD and to provide a new predictor for MACCE occurrence. Blood samples were collected from subjects to detect the expression of miR-142-3p using RT-qPCR. The correlation of miR-142-3p with HDL-C and hs-CRP was assessed by the Pearson method. The occurrence of MACCE in patients during the 36-month follow-up period was recorded. The clinical value of miR-142-3p in MACCE occurrence was analyzed by the Kaplan-Meier curve, multivariate logistic regression, and ROC curve. In ESRD patients on MHD, miR-142-3p was downregulated, and it showed a positive correlation with HDL-C but a negative correlation with hs-CRP. The cumulative incidence of MACCE at 1, 2, and 3 years was 8.9%, 20.0%, and 30.4%, respectively. miR-142-3p levels were reduced in patients who developed MACCE and were associated with the cumulative incidence of MACCE. miR-142-3p was a risk factor for MACCE and showed a predictive value with specificity and sensitivity of 89.36% and 56.10%, respectively. miR-142-3p was a risk factor of MACCE in ESRD patients undergoing MHD.

Borderline personality disorder and parenting capacity: Understanding child protection population characteristics

Objective This paper describes an audit of borderline symptoms, risk factors for maltreatment and types of abuse among parents who completed a parenting capacity assessment at a South Australian health-based child protection service. Method A retrospective case note audit within a 28-month period was conducted and included parents ( n = 107) who had completed a Mclean’s screening instrument for borderline personality disorder and/or had a psychiatric review with a formal diagnosis. Parents who had a borderline personality disorder diagnosis or endorsed five or more symptoms were categorised into the ‘high’ borderline symptom group. Rates of parental risk factors for maltreatment and type of abuse were compared between parents with low or high borderline symptoms. Results Forty percent of parents endorsed at least five borderline symptoms on the screening tool. On average, parents high in borderline symptoms had a greater number of parental risk factors. Conclusions These findings highlight the importance of screening for personality pathology among parents presenting to child protection services. Foundational training for staff and making evidence-based interventions available should be considered in such settings.

Seizure-Related Injuries among Patients with Epilepsy at the Douala General Hospital, Cameroon: A Retrospective Cohort Study

Abstract Background Seizures can lead to injuries in patients with epilepsy (PWE). This study seeks to determine the 1-year incidence, types, and associated factors of seizure-related injuries in PWE compared with that of patients without epilepsy. Methods A retrospective cohort study was carried out at the Douala General Hospital, Douala, Cameroon. Patients with active epilepsy within the past 5 years were compared to patients without epilepsy after matching them by age and gender during a 12-month period. Data was collected from patient records using a questionnaire and analyzed using the SPSS version 20 software. The chi-square test was used to compare the proportions of injuries at a significant level of p < 0.05 and a confidence interval (CI) of 95%. Results A total of 155 participants were recruited in each group. Note that 51.6% were males, and the mean age was 25.46 ± 16.35 years. The 1-year incidence of all injuries was 26.5% in PWE against 16.8% among patients without epilepsy, respectively (p = 0.038; odds ratio = 1.8, 95% CI: 1.03–3.10). Soft tissue injury was higher in PWE (82.9%, p < 0.05) compared to those without epilepsy (50%), whereas patients without epilepsy had more cases of burns compared to PWE (p < 0.05). PWE and having frequent seizures with falls and those on more than one antiseizure medication had an increased risk of injuries (p < 0.05). Conclusion PWE have a double risk of having mild soft tissue injuries attributed to epileptic seizures. The risk is increased in PWE having seizures with falls and those taking more than one antiseizure medication.

Lipid Emulsion Type and Liver Function in Parenteral Nutrition Patients: A Retrospective Study of Patients and Prescribing Practices

Parenteral nutrition (PN) is a life-sustaining method to provide adequate nutrients to patients unable to receive oral or enteral nutrition. PN typically contains a mixture of macro- and micro-nutrients, although the lipid composition has been identified as a concern for liver disease. Therefore, the study of the intravenous lipid emulsion (ILE) prescribing practices in home-based PN (HPN) patients and whether differing lipid PN alters liver function tests (LFTs) is needed. Methods: A retrospective study of monthly LFTs from a random sample of 105 adult HPN patients in the U.S. over a 6-month period was conducted. Patients were receiving olive oil/soy oil (n = 53, Clinolipid), mixed ILE (n = 39, SMOF Lipid), soy oil (SO; n = 4, Intralipid), or none (n = 7). LFTs monitored were alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate transaminase (AST), and total bilirubin (T Bili). Results: No differences were observed in baseline LFTs across groups (all, p > 0.25, η2 < 0.04), nor were there differences in age, body mass index, days of PN, or mean PN volume (all, p > 0.36, η2 < 0.05). There were no significant interactions between ILE type and time (all p > 0.64, ηp2 < 0.03), no effect of ILE type (all p > 0.60, ηp2 < 0.03), and no effect of time (all p > 0.69, ηp2 < 0.01) in terms of LFTs. Average LFTs over six months were also not different between ILE types (all p > 0.30, η2 < 0.04). Conclusion: These findings suggested that patients were mostly prescribed mixed or ILE PN containing more than one lipid source and that differing ILEs in long-term HPN patients did not alter LFTs over a six-month period.

Healing patterns of alveolar bone following ridge preservation procedures.

Examine the histomorphometric bone composition, following alveolar ridge preservation techniques and unassisted socket healing. Forty-two patients (42) requiring a single rooted tooth extraction were randomly allocated into three groups (n = 14 per group): Group 1: Guided Bone Regeneration (GBR) using deproteinised bovine bone mineral (DBBM) and a porcine collagen membrane; Group 2: Socket Seal (SS) technique using DBBM and a porcine collagen matrix; Group 3: Unassisted socket healing (Control). Trephined bone biopsies were harvested following a 4-month healing period. Forty-two samples underwent Back-Scattered Electrons -Scanning Electron Microscopy (BSE-SEM) imaging, with 15 samples examined using Xray Micro-Tomography (XMT) (n = 6 for each GBR/SS and n = 3 Control). Images were analysed to determine the percentage (%) of connective tissue, new bone formation, residual DBBM particles and direct bone to DBBM particle contact (osseointegration). BSE-SEM analysis demonstrated that new bone formation was higher in the Control (45.89% ± 11.48) compared to both GBR (22.12% ± 12.7/p < .004) and SS (27.62% ± 17.76/p < .005) groups. The connective tissue percentage in GBR (49.72% ± 9), SS (47.81% ± 12.57) and Control (47.81% ± 12.57) groups was similar. GBR (28.17% ± 16.64) and SS (24.37% ± 18.61) groups had similar levels of residual DBBM particles. XMT volumetric analysis indicated a lower level of bone and DBBM particles in all test groups, when matched to the BSE-SEM area measurements. Osseointegration levels (DBBM graft and bone) were recorded at 35.66% (± 9.8) for GBR and 31.18% (± 19.38) for SS. GBR and SS ARP techniques presented with less bone formation when compared to unassisted healing. GBR had more direct contact/osseointegration between the DBBM particles and newly formed bone.

Improving the safety of radiotherapy treatment processes via incident-driven FMEA feedback loops.

Failure mode and effects analysis (FMEA) is a valuable tool for radiotherapy risk assessment, yet its outputs might be unreliable due to failures not being identified or due to a lack of accurate error rates. A novel incident reporting system (IRS) linked to an FMEA database was tested and evaluated. The study investigated whether the system was suitable for validating a previously performed analysis and whether it could provide accurate error rates to support the expert occurrence ratings of previously identified failure modes. Twenty-three pre-identified failure modes of our external beam radiotherapy process, covering the process steps from patient admission to treatment delivery, were proffered on dedicated FMEA feedback and incident reporting terminals generated by the IRS. The clinical setting involved a computed tomography scanner, dosimetry, and five linacs. Incoming reports were used as basis to identify additional failure modes or confirm initial ones. The Kruskal-Wallis H test was applied to compare the risk priorities of the retrospective and prospective failure modes. Wald's sequential probability ratio test was used to investigate the correctness of the experts' occurrence ratings by means of the number of incoming reports. Over a 15-month period, 304 reports were submitted. There were 0.005 (confidence interval [CI], 0.0014-0.0082) reported incidents per imaging study and 0.0006 (CI, 0.0003-0.0009) reported incidents per treatment fraction. Sixteen additional failure modes could be identified, and their risk priorities did not differ from those of the initial failure modes (p=0.954). One failure mode occurrence rating could be increased, whereas the other 22 occurrence ratings could not be disproved. Our approach is suitable for validating FMEAs and deducing additional failure modes on a continual basis. Accurate error rates can only be provided if a sufficient number of reports is available.

Preventing Hypothermia in Newborns With Congenital Anomalies in the Delivery Room.

Thermoregulation interventions in the delivery room have historically focused on preterm infants and studies often exclude term infants or those infants with known congenital anomalies. The purpose of this quality improvement project was to reduce the rate of admission hypothermia in neonates of all gestational ages born with congenital anomalies and admitted to the intensive care unit (ICU). Utilizing the Institute for Healthcare Improvement model for improvement, implementation of plan, do study, act cycles focused on standardizing temperatures of the delivery room and resuscitation bed, recommendations for temperature monitoring, trialing polyethylene lined hats, and implementing a delivery room thermoregulation checklist. Overall, the mean rate of neonates admitted to the ICU hypothermic (<36.5°C) decreased from 27% to 9% over an 8-month period. The interventions significantly reduced the number of neonates admitted to the ICU with hypothermia. Implementation of thermoregulation bundles should apply to all neonates with congenital anomalies to decrease risks associated with hypothermia.

Effect of nusinersen on respiratory and bulbar function in children with spinal muscular atrophy: Real world experience from a single center.

Due to the limited data from clinical trials and real-world settings in the realm of nusinersen, there is a need for further evidence. This study seeks to assess the impact of nusinersen, when combined with standard care, on bulbar function, respiratory function, and the necessity for respiratory support among pediatric patients with spinal muscular atrophy (SMA). Prospective observational study, involving pediatric SMA patients (types 1-3) undergoing nusinersen treatment at the Hospital Universitario Virgen del Rocío in Spain over at least a 24-month period. The cohort included 11 SMA type 1 patients, comprising 6 type 1b and 5 type 1c, 12 SMA type 2 patients, and 5 SMA type 3 patients. 28 pediatric patients were enrolled, with a majority being male (n=20). Patients with type 1 were diagnosed and received treatment significantly earlier than those with types 2 and 3 (P<0.001). Additionally, there was a longer period between diagnosis and the start of treatment in types 2/3 (P=0.002). Follow-up revealed statistically improved functional and respiratory outcomes associated with earlier initiation of nusinersen treatment at 6, 12, and 24 months in all phenotypes. The ability to swallow and feed correctly remained unchanged throughout the study, with SMA type 1c patients maintaining oral feeding in contrast to patients with SMA type 1b. Notably, no deaths were recorded. This study provides important insights into the real-world clinical progress of pediatric SMA patients and their response to nusinersen treatment, highlighting the significance of early intervention for better functional and respiratory outcomes.

Compliance with Headgear Evaluated by Force- and Temperature-Sensitive Monitoring Device: A Case-Control Study

The aim was to objectively assess compliance in patients prescribed headgear and evaluate the impact of monitoring awareness, treatment duration, gender, and age on compliance levels. A total of 22 patients with Class II malocclusion wore the headgear integrated with the force and temperature sensitive Smartgear monitoring system (Smartgear, Swissorthodontics AG, Cham, Switzerland). Patients were instructed to wear the headgear for 13 h daily over a 3-month period. Randomly, 11 patients were informed that they monitored and 11 were not informed. Data were organized using Microsoft Excel and analyzed using R for statistical estimates, graphs, and hypothesis testing. Smartgear recorded an average daily compliance of 6.7 h. No statistically significant differences were found in cooperation between study group and control group over the 3 months of treatment, regardless of gender and age. However, there was slight greater cooperation in the first month than in the other months, and patients ≤10 years of age had almost 2 h more cooperation than their older counterparts. Moreover, the informed group exhibited an average of 1.1 more hours of cooperation per day than the uninformed group, which may carry clinical significance. This cooperation primarily occurred at night and was found to be statistically significant. Compliance among young patients typically remained lower than the prescribed level, regardless of their gender and psychological maturity. Although an awareness of monitoring does not seem to improve compliance, implementing such systems could still offer dentists a valuable means of obtaining objective information about their patients’ adherence.

Parental financial support and family emotional support to young adults during COVID-19: A help or a hindrance?

The present study focuses on the role of family support to young adult children during COVID-19 in ameliorating the negative financial impact of the pandemic. Guided by the Conservation of Resources (COR) Theory of stress and coping, we conceptualize the negative financial impact due to COVID-19 as a source of financial stress that would be associated with lower levels of both financial wellbeing and positive outlook of young adults. We rely on data collected from a multinational sample of young adults (ages 18-30) from six countries (China, Italy, Lithuania, Portugal, Slovenia, US; N = 2102) over a 3-month period (July 2020-September 2020). We tested the potential effects of two types of support (i.e., parental financial support and family emotional support) using path analysis. While we find a consistent positive association between family emotional support and both financial wellbeing and positive outlook, we also find a consistent negative association between parental financial support and financial wellbeing, and a nonsignificant or negative association (Lithuania only) with a positive outlook. The significant interaction between COVID-19 financial impact and family emotional support on young adults' positive outlook reveals that the benefit of family emotional support is more evident when the negative financial impact is low or moderate. We discuss the implications of these findings in assisting young adults to cope with financial disruptions.

Economic burden of recurrent hyperkalemia in patients with chronic kidney disease.

Hyperkalemia is a common complication of chronic kidney disease (CKD) and can become recurrent in half of cases. However, the incremental economic burden associated with recurrent hyperkalemia is unknown. To evaluate all-cause health care resource utilization (HRU) and medical costs in patients with stage 3/4 CKD with recurrent hyperkalemia vs normokalaemia and vs nonrecurrent hyperkalemia. Data were from Optum's de-identified Market Clarity Data (January 1, 2016, to August 1, 2022). This retrospective observational cohort study compared patients with stage 3/4 CKD with recurrent hyperkalemia (≥2 hyperkalemia events within 1 year [hyperkalemia event: hyperkalemia diagnosis or potassium [K+]>5 mmol/l]; index was the first hyperkalemia event) with an exact- and propensity score-matched cohort of patients with normokalemia (K+ ≥3.5 to ≤5 mmol/l; random K+ as index) and separately with a matched cohort of patients with nonrecurrent hyperkalemia (1 hyperkalemia event within 1 year; index was hyperkalemia event). Patient characteristics, medication use, HRU, and medical costs were compared between cohorts using standardized mean differences during the 12-month baseline period. All-cause HRU and medical costs during the 12-month follow-up were compared using Wilcoxon rank sum tests for continuous variables and McNemar tests for categorical variables. Substudies of recurrent hyperkalemia vs normokalemia were conducted for patients with Medicare coverage and renin-angiotensin-aldosterone system inhibitor (RAASi) use. The recurrent hyperkalemia vs normokalemia sample comprised 4,549 matched pairs (Medicare substudy: 3,151; RAASi substudy: 3,535) and the recurrent hyperkalemia vs nonrecurrent hyperkalemia sample comprised 1,599 matched pairs. Baseline characteristics, HRU, and medical costs of the cohorts were similar after matching. During follow-up, patients with recurrent hyperkalemia had a mean of 11.2 more health care encounters (0.5 more inpatient admissions, 0.3 more emergency department visits, and 7.2 more outpatient visits) than patients with normokalemia. Patients with recurrent hyperkalemia also had double the total annual medical costs vs normokalemia ($34,163 vs $15,175; P < 0.001), mainly driven by inpatient costs ($21,250 vs $7,392), which accounted for 62.2% and 48.7% of total costs, respectively. Results were similar in the RAASi and Medicare substudies. Recurrent hyperkalemia was associated with a mean 4.3 more all-cause health care encounters and $14,057 higher medical costs (both P < 0.001) than nonrecurrent hyperkalemia. Recurrent hyperkalemia in patients with stage 3/4 CKD was associated with higher all-cause HRU and medical costs compared with normokalemia (including in patients with Medicare coverage and RAASi use) and nonrecurrent hyperkalemia. Research is needed to understand if long-term treatment strategies aimed at preventing hyperkalemia recurrence may alleviate this economic burden.

Associations between readmission and patient-reported measures in acute psychiatric inpatients: a multicenter prospective longitudinal study.

This study examined whether patient-reported measures (PRMs) addressing quality of life, personal agency, functional impairment, and treatment satisfaction at hospital discharge were associated with future readmission during a 12-month follow-up period. The study also examined whether readmission influenced changes in the same measures. A multicenter prospective cohort study was conducted at 21 psychiatric hospitals in Japan. Participants completed the EuroQol-five-dimensions-five-level (EQ-5D), the Five-item Subjective Personal Agency Scale, and the Sheehan Disability Scale (SDS) at the time of index admission (T1), discharge from index admission (T2), and 6months (T3) and 12months (T4) after discharge. Inpatient treatment satisfaction was assessed at T2. Readmission and variables potentially associated with hospitalization and PRMs were evaluated using mixed-effects logistic regression models and mixed models for repeated measures. A total of 491 participants were followed for 12months (attrition rate: 19.4%), and 480 were included in the EQ-5D analysis. The most common diagnoses were schizophrenia (59%), depression (14%), and bipolar disorder (13%). No patient-reported measures were significantly associated with readmission over the follow-up period. Interaction of readmission and time did not significantly affect changes in EQ-5D. Readmission did significantly influence SDS score changes between T2 and T3 (B = 1.78, 95% CI = 0.30-3.25, p = 0.018) and between T3 and T4 (B = 1.43, 95% CI = 0.14-2.72, p = 0.029).The same influence of readmission on SDS score changes was not observed in the model which adjusted for all potential covariates. Readmission was potentially associated with changes in self-reported functional impairment. Findings highlight the potential role of intensive post-discharge services in preventing readmission, rather than relying on time-of-discharge PRMs in order to predict readmission risk. This study was registered in UMIN Clinical Trials Registry (UMIN000034220).

Exploring the Role of Homeopathic Intervention in Post-COVID Functional Gastrointestinal Disorders: A Case Series of 12 Patient Profiles.

In the last 2 years of the pandemic, a wide range of cases of post-COVID functional gastrointestinal disorders (PC-FGIDs) has been reported. This case series aimed to investigate the role of homeopathic intervention in the treatment of PC-FGIDs. This is a retrospective analysis of the clinical data of individuals who had suffered from PC-FGIDs that were diagnosed based on clinical symptoms using the Gastrointestinal Symptoms Rating Scale (GSRS) and treated exclusively with individualized homeopathic medicines. Cases that had undergone regular monthly assessment using the GSRS and had a Post-COVID-19 Functional Status (PCFS) score for up to 3 months were considered. Thirty cases were screened and twelve were included according to the study criteria. The mean age of seven women and five men was 36 years. GSRS and PCFS scores showed marked improvement in each of 10 cases within the 3-month treatment period. Homeopathic intervention proved beneficial in 10 of 12 patients with PC-FGIDs. The findings may help researchers plan future controlled clinical studies in this field.

Advancing Sustainable Nutrition: Enhancing Physical and Nutritional Qualities of Cookies with Apple Pomace Extrudates

Apple pomace is a by-product of the apple processing industry and can be used for various uses such as animal feed, for composting, or to extract valuable compounds such as pectin or antioxidants. In recent years, it has also gained attention as a potential food ingredient due to its fibre content and antioxidant properties. The aim of this study was to examine the effect of three parameters: the percentage of wheat flour replaced by extrudate (5%, 10%, and 15%), the percentage of apple pomace in the extrudate (15%, 30%, and 45% based on the mass of corn grits), and the particle size of the extrudate (&lt;250 µm; 250–1000 µm; 1000–2000 µm) on the properties of cookies, using the Box–Behnken experimental design. The addition of extrudates enriched with apple pomace significantly increased the total fibre and ash content of the cookies. The hydroxymethylfurfural content also increased, but not above the permitted limits (25 mg/kg). The sensory quality was strongly influenced by the particle size, especially the hardness, graininess, and appearance of the cookies. The addition of extrudate led to a darker colour of the cookies and a significant increase in the proportion of red tones, but generally had no negative influence on the acceptability of the cookies and their microbiological stability during the 6-month storage period.

Intermediate vs. High Oxygen Saturation Targets in Preterm Infants: A National Cohort Study

Introduction: Optimal oxygen saturation targets remain unknown for extremely preterm infants. Methods: Cohort analysis of eligible preterm infants born <29 weeks’ gestation admitted between 2011 and 2018 to centers submitting data to the Canadian Neonatal Network (CNN) database. Site questionnaires to determine saturation targets, alarm settings, and date of change, allowed assignation of centers to intermediate (88–93%) or high (90–95%) saturation targets. A 6-month washout period was applied to sites which switched targets during the study period. Our primary outcome was survival free of major morbidity. Secondary outcomes were death, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), treated retinopathy of prematurity, and evidence of brain injury during admission. Generalized estimating equations were applied to compensate for demographic differences and site practices. Results: There were 2,739 infants in the high (mean gestational age [GA] 26 ± 1.6 weeks) and 6,813 infants in the intermediate (mean GA 26.2 ± 1.6 weeks) saturation target group. Survival without morbidity was higher in the intermediate target group (adjusted odds ratio [aOR] 1.59; 95% CI: 1.04, 2.45). There was no difference in mortality between groups (aOR 0.81; 95% CI: 0.59, 1.11), in NEC, treated retinopathy, or brain injury. On subgroup analysis, restricting data to sites which switched targets during the study, intermediate saturation targets were associated with lower rates of BPD (aOR 0.45; 95% CI: 0.28, 0.72). Conclusion: For neonates <29 weeks’ gestation, intermediate saturation target was associated with higher odds of survival without major morbidity compared to higher oxygen saturation target.

Australian fresh frozen plasma audit: A National Blood Transfusion Committee and Blood Matters collaboration.

There is a paucity of high-quality data to guide appropriate fresh frozen plasma transfusion with current recommendations based on consensus opinion. The limitations of the product and testing modalities are poorly understood with the rare but potentially serious side effects underappreciated. Combined this has resulted in the widespread misuse of FFP. Retrospective data capturing FFP transfusion within the 12-month period of April 1, 2022 and March 31, 2023 was entered by Australian health care providers. Appropriate transfusion was assessed by the adjudicators and defined as one in keeping with current recommendations. Descriptive and comparative analyses were performed using SAS Studio version 9.4. During the study period, 935 FFP transfusion episodes were captured. The most frequent indications for FFP were massive hemorrhage 344 (37%), bleeding 141 (15%), and preoperative use 90 (10%). Males received 534 (60%) transfusions. Critical care specialists were the largest users of FFP, prescribing 568 (63%) of transfusions. FFP was used appropriately in 546 (61%) transfusions. However, when massive hemorrhage was excluded only 202 (37%) transfusions were appropriate. Patients with an INR <1.5 received 37% of transfusions. Transfusion associated adverse events were reported in 2% (15) of transfusions including two non-fatal anaphylactic reactions. This audit assesses the appropriate use of FFP across all major clinical indications and provides the largest body of evidence of Australian plasma transfusion practices. It highlights the widespread misuse of FFP, which is predominantly guided by consensus recommendations due to a lack of high-quality data.

Feasibility of an innovative medical dental integration program to provide overdue adolescent vaccinations in a federally qualified health center.

To determine the feasibility of a medical dental integration program to provide overdue vaccinations to adolescents ages 9-17 and evaluate the facilitators and barriers to the process. The program was developed and implemented at one dental clinic co-located within a medical clinic at a federally qualified healthcare center in Denver, Colorado. Utilizing a shared electronic health record, human papillomavirus, meningococcal, and/or tetanus-diphtheria-acellular pertussis vaccines were recommended by dental providers and then administered by the medical team. Plan-do-study-act cycles informed implementation. Descriptive analyses of eligible patients were performed and run charts were used track process implementation outcomes. One hundred and sixty eligible adolescents were identified during a 6-month period. Overall, 29 patients (18%) received 41 vaccines. Process facilitators included staff buy-in and individual provider feedback and barriers included staff shortages and family vaccine refusal/preference to receive vaccines in the medical home. Many adolescents see dental providers more than their primary care providers, creating an opportunity to vaccinate adolescents overdue for immunizations during dental visits. A medical dental integration program to provide adolescent vaccinations was feasible in a federally qualified health center with co-located medical and dental services. Expansion to diverse healthcare settings is necessary to further explore implementation outcomes.

Microsurgery and vasospasms: Spasms’ predictive factors during harvesting

BackgroundVasospasm (VS) in microsurgery is a source of surgical complications, repeat operations, stress for the patient and the surgical team, as well as increased length of stay. Various risk factors have been identified but knowledge regarding the implicated mechanism remains limited. HypothesisOur objective was to determine if the harvesting conditions for microsurgical toe transfers could increase the risk of VS. Our secondary objective was to determine the correlation between VS occurrence before flap division, and the occurrence of vascular complications after completion of vascular anastomoses. Patients and methodsPrimary endpoints were the existence of locoregional anaesthesia of the lower limb, the Gilbert classification, the nature of the graft taken from the foot, the characteristics of the patients and smoking status. Our secondary endpoints were the presence of secondary VS or microsurgical failure. This series consists of 14 toe transfers over a 30-month period. Primary VS was defined as occurring prior to flap division, while secondary VS occurred after transfer. ResultsIn this series, we identified 4 cases of primary VS. The average age of the operated population was 30.6 ± 11.2 years (16-58). The patients who presented with primary VS had a mean age of 35.3 ± 16.2 years (21-58), with no statistical difference with the other group (p = 0.54). There was a statistically significant difference between the absence of locoregional anaesthesia and the occurrence of primary VS in toe transfer (p = 0.0008). Microsurgical failure occurred in 1 case. This failure was linked to the presence of a primary VS. Gilbert's classification and type of graft were not predictive of VS (p = 0.15 and p = 0.08, respectively). The occurrence of secondary VS was statistically linked to the occurrence of primary VS (p = 0.009). DiscussionThe occurrence of VS remains unpredictable and the effectiveness of available treatments is debated in the literature. Faced with the failure of curative treatments, this study aimed to determine predictive factors for VS. The existence of secondary VS, when prolonged and non-responsive to conventional measures, can lead to anastomotic revision. Performing locoregional anaesthesia on the lower limb makes it possible to effectively combat the occurrence of VS. The absence of primary VS was correlated with an absence of secondary VS and an absence of microsurgical failure. In addition to controlling vasospasm, regional anaesthesia provides effective analgesia at the harvesting site. Level of evidenceIV

Learning from therapists about the challenges and opportunities of training in cognitive behavioral therapy for psychosis: qualitative findings from a US-based service evaluation

ABSTRACT Background CBT for psychosis (CBTp) is a care standard for people with psychosis in the United States (US). However, CBTp access is poor. The context differs from the UK, where CBTp was primarily developed. This US-based service evaluation addresses a knowledge gap and forms a pilot study: a broad goal was to learn about CBTp training’s impact on therapists. Specific aims were to: 1) describe the challenges and opportunities of CBTp training by interviewing therapists competent in formulation-driven CBTp; 2) make recommendations for practice and research. Methods Therapists’ experiences of a 3-day CBTp workshop and 12-month consultation period in a US outpatient service were evaluated via focus groups. Participants were eight of ten therapists achieving CBTp competency. Results Thematic analysis of focus group content yielded four themes: 1) Before CBTp: Support and medication; 2) Hope and possibility; 3) A reality check; 4) The future: Ongoing development or “flavor of the week”. Discussion Therapist perspectives help elucidate barriers and facilitators for US CBTp implementation, from the challenge for therapist-case managers of accommodating CBTp, to the potential of shared therapeutic models for team cohesion. Recommendations include clarifying how best to use CBTp within large caseloads, and mixed method longitudinal studies of training.