Chronic Problems Research Articles

Post-Intensive Care Syndrome in Neurocritical Care Patients.

Post-intensive care syndrome (PICS) refers to unintended consequences of critical care that manifest as new or worsening impairments in physical functioning, cognitive ability, or mental health. As intensive care unit (ICU) survival continues to improve, PICS is becoming increasingly recognized as a public health problem. Studies that focus on PICS have typically excluded patients with acute brain injuries and chronic neurodegenerative problems. However, patients who require neurocritical care undoubtedly suffer from impairments that overlap substantially with those encompassed by PICS. A major challenge is to distinguish between impairments related to brain injury and those that occur as a consequence of critical care. The general principles for the prevention and management of PICS and multidomain impairments in patients with moderate and severe neurological injuries are similar including the ICU liberation bundle, multidisciplinary team-based care throughout the continuum of care, and increasing awareness regarding the challenges of critical care survivorship among patients, families, and multidisciplinary team members. An extension of this concept, PICS-Family (PICS-F) refers to the mental health consequences of the intensive care experience for families and loved ones of ICU survivors. A dyadic approach to ICU survivorship with an emphasis on recognizing families and caregivers that may be at risk of developing PICS-F after neurocritical care illness can help improve outcomes for ICU survivors. In this review, we will summarize our current understanding of PICS and PICS-F, emerging literature on PICS in severe acute brain injury, strategies for preventing and treating PICS, and share our recommendations for future directions.

Exploring Biopsychosocial Stress Markers in Women With Fibromyalgia

Identification of fibromyalgia has been a challenge for healthcare professionals due to the lack of a clinical biomarker. A well-supported integrative hypothesis holds that this condition is a chronic pain problem partly caused by long-term dysregulation of stress response. Therefore, stress assessment from a biopsychosocial perspective may be a useful approach to recognizing fibromyalgia. A cross-sectional case-control study was conducted to explore stress markers from a multidimensional perspective, including heart rate variability (as a biomarker of stress) as well as psychological distress and social stress. Forty-seven women with fibromyalgia were recruited from support groups and another 47 were recruited as matched pain-free controls. Comparison and discriminant function analyses were performed. The data support the goodness of biopsychosocial stress markers in women with fibromyalgia, resulting in the identification of between 70% and 74.5% of fibromyalgia cases (sensitivity) and 85%-87% pain-free controls (specificity), with medium-high levels of fit (λ = 0.58 and λ = 0.59; p < .00). Women with fibromyalgia were characterized by high levels of psychological distress, social stress (disorder levels), and autonomic dysregulation. Although distress and social stress had a greater weight in discriminant functions, dysregulation in terms of low parasympathetic activity and high sympathetic activity at rest was also relevant. A biopsychosocial approach to stress with an objective biomarker such as heart rate variability may be a useful tool to identify and manage FM.

Group arts therapies for patients with schizophrenia: a protocol of systematic review and meta-analysis

IntroductionSchizophrenia, a chronic mental problem, significantly impacts cognition, emotion and social functioning. Conventional pharmacotherapy faces challenges including numerous side effects, low adherence to medication and substantial costs. In this context,...

Heat-treated Limosilactobacillus fermentum LM1020 with menthol, salicylic acid, and panthenol promotes hair growth and regulates hair scalp microbiome balance in androgenetic alopecia: A double-blind, randomized and placebo-controlled clinical trial.

Androgenetic alopecia (AGA) is a common and chronic problem characterized by hair follicle miniaturization. In this study, heat-treated Limosilactobacillus fermentum LM1020 (HT-LM1020) was investigated in human follicle dermal papilla cell (HFDPC), scalp tissue, and clinical trials for patients with AGA. Cell proliferation and the expression of cyclins and cyclin-dependent kinases (CDKs) were measured in HFDPC. The relative gene expression of 5α-reductase and growth factors were investigated in hair scalp. This double-blind, randomized, placebo-controlled clinical trial was conducted over 24 weeks. Primary efficacy was evaluated by measuring hair density, and secondary efficacy was assessed by experts and self-assessment. Changes in the microbiota of the hair scalps were analyzed using 16S metagenome amplicon sequencing. HT-LM1020 promoted cell growth (p < 0.001) and cyclin B1 expression, and it reduced 5α-reductase and induced fibroblast growth factor 7 (FGF7), FGF10, and epithelial growth factor7 (EGF7) (p < 0.001). In the clinical trial, the experimental group demonstrated an increase in hair density from 133.70 to 148.87 n/cm2 at Week 24 (p < 0.001), while also expressing satisfaction with their hair density, reduced hair loss, and hairline. At Week 24, the total ratio of lactic acid bacteria operational taxonomic unit (OTU) in the scalp increased from 6.65% to 26.19%. At the same period, placebo-controlled group decreased Staphylococcus caprae OTU from 77.95% to 14.57% while experimental group decreased from 65.80% to 41.02%. These present results showed that HT-LM1020 was a co-effector of ingredients for anti-hair loss contributing to cell proliferation and the expression of CDKs.

Musculoskeletal Diseases as the Most Prevalent Component of Multimorbidity: A Population-Based Study.

Background/Objectives: Due to their high frequency, common risk factors, and similar pathogenic mechanisms, musculoskeletal disorders (MSDs) are more likely to occur with other chronic illnesses, making them a "component disorder" of multimorbidity. Our objective was to assess the prevalence of multimorbidity and to identify the most common clusters of diagnosis within multimorbidity states, with the primary hypothesis that the most common clusters of multimorbidity are MSDs. Methods: The current study employed data from a population-based 2019 European Health Interview Survey (EHIS). Multimorbidity was defined as a ≥2 diagnosis from the list of 17 chronic non-communicable diseases, and to define clusters, the statistical method of hierarchical cluster analysis (HCA) was performed. Results: Out of 13,178 respondents, multimorbidity was present among 4398 (33.4%). The HCA method yielded six multimorbidity clusters representing the most common diagnoses. The primary multimorbidity cluster, which was prevalent among both genders, age groups, incomes per capita, and statistical regions, consisted of three diagnoses: (1) lower spine deformity or other chronic back problem (back pain), (2) cervical deformity or other chronic problem with the cervical spine, and (3) osteoarthritis. Conclusions: Given the influence of musculoskeletal disorders on multimorbidity, it is imperative to implement appropriate measures to assist patients in relieving the physical discomfort and pain they endure. Public health information, programs, and campaigns should be utilized to promote a healthy lifestyle. Policymakers should prioritize the prevention of MSDs by encouraging increased physical activity and a healthy diet, as well as focusing on improving functional abilities.

Biochanin A mitigates ulcerative colitis and intestinal inflammation in mice by inhibiting MAPK/NF-kB (p65) axis.

Ulcerative colitis (UC) is a chronic problem of the intestine and relapsing in nature. Biochanin A is a nature-derived isoflavonoid and has numerous bioactivities. However, its role against UC and intestinal inflammation remains obscure. We aimed to comprehensively explore the pharmacological effect of biochanin A in alleviating colitis and to evaluate the potential mechanisms. Initially, we explored the anti-inflammatory action of biochanin A (15, 30, and 60 μM) by employing lipopolysaccharide (LPS)-activated RAW 264.7 cells. In RAW 264.7 cells under LPS stimulation, biochanin A inhibited the elevation of reactive oxygen species (ROS) (p < 0.0001), interleukin (IL)-1β(p < 0.0001), IL-18 (p < 0.01), and tumor necrosis factor (TNF)-α (p < 0.01) release, nitrite production (p < 0.0001), and the expression of inducible nitric oxide synthase (iNOS)and cyclooxygenase-2 (COX-2)proteins. Next, we studied the effectiveness of biochanin A (20 and 40 mg/kg) in mouse colitis induced with dextran sulfate sodium (DSS)by assessing colon length, disease activity index (DAI)scoring, and performing colonoscopy and histological analysis. The pro-inflammatory cytokines were estimated using ELISA. Western blot studies were performed to assess underlying mechanisms. In mice, biochanin A treatment alleviated DAI score (p < 0.0001), restored colon length (p < 0.05) and morphology, and re-established colon histopathology. Biochanin A affects the phosphorylation of proteins associated with NF-κB (p65) and mitogen-activated protein kinase (MAPK)axis and regulates colonic inflammation by reducing the expression of inflammatory cytokines and myeloperoxidase (MPO)activity. Altogether, our findings support the idea that the anticolitis potential of biochanin A is allied with anti-inflammatory activity by inhibiting the MAPK/NF-κB(p65) axis. Hence, biochanin A may be an alternative option to alleviate the risk of colitis.

Determinants of Toddlers’ History with Stunting Incidence in the Coastal Community

The main nutritional problem in toddlers that is still commonly found in many countries around the world is stunting. Stunting is a chronic nutritional problem caused by long-term malnutrition. Infectious diseases and malnutrition can cause stunting. The aim of the study was to determine the relationship between the history of children and the incidence of stunting in the people of the Coastal Village of Kamarian. This research is an analytic survey research with a cross sectional design. This research was carried out on June 1 -31 2022. The sample in this study was 113 toddlers aged 2-5 years using total sampling. This study uses the Chi-Square test. The results showed that there were 22.9% (27 children) who were stunted. There is a relationship between birth weight (ρ=0.000), exclusive breastfeeding (ρ=0.013), infectious diseases (ρ=0.000), complementary feeding (ρ=0.002) and stunting. Low birth weight, exclusive breastfeeding, infectious diseases, and early complementary feeding (MP-ASI) can affect the incidence of stunting in children.

Bacterial blight: Once a menacing disease of cotton in India, now tamed and fading from research spotlight

AbstractBacterial blight, incited by Xanthomonas citri pv. malvacearum (Xcm), is historically one of the most devastating diseases of cotton globally. In India, the initial documentation of the disease dates back to 1918 and it assumed a great magnitude after 1947, primarily triggered by cultivation of tetraploid cotton, as the earlier cultivated indigenous diploid cotton was naturally resistant to the pathogen, and became widespread during the 1970s. Among 20 races of bacterial blight pathogen documented at global level, Race 18 is the most virulent one and prominent in India. The pathogen inflicts damage at all crop stages, beginning with seedlings. The disease caused regular yield losses of 30%–35% in India and had become a formidable adversary to cotton cultivation in the country; however, over the years its appearance diminished. Much larger gains were apparently achieved when disease was managed with a combination of seed treatment, foliar sprays and bio‐agents. Furthermore, extensive breeding programmes led to development of resistant cultivars, which proved instrumental in managing the disease. The disease exhibited a sharp decline from the beginning of the 21st century and is now no longer a chronic problem in India. This comprehensive review attempts to provide insight into the dynamic nature of bacterial blight threatening cotton cultivation in India during the last century and the underpinning multifaceted research efforts that paved the way for countering the disease. An attempt is made to discuss the qualitative and quantitative studies on genetics of bacterial blight for facilitating the breeding programmes.

Maxillofacial Abscess et Causa Odontogenic Infection: A Case Report

Background: Odontogenic infection is an infection that occurs in the oral cavity caused by carious teeth and periodontal disease where the disease can spread to surrounding tissues to the face, jaw and neck. Maxillofacial abscess is a manifestation of periapical or periodontal infection. incicus, canicus or molar teeth, where periapical infection is the most frequent source of odontogenic infection compared to periodontal. Inflammation or damage to chronic dental problems can cause complications of abscesses in the surrounding area. The main complaint that causes sufferers to come to the hospital is pain in the abscess area. These complaints can also be accompanied by trismus, dysphagia, stridor caused by compression of the trachea, and even respiratory tract obstruction. Objective: To determine the progression of maxillofacial abscess so that medical management can be provided up to surgical incision and drainage. Case report: We report 2 cases of maxillofacial abscess due to odontogenic infection with management according to the progression of each case. Conclusion: The most common cause or etiology that can cause maxillofacial abscess is toothache. Management of maxillofacial abscesses begins with empirical antibiotics, which is the first step to reduce bacterial infections that produce beta lactamase. In maxillofacial abscesses, medical therapy can be given in the form of antibiotics combined with ceftriaxone with metronidazole, or meropenem with metronidazole and termination measures in the form of incision and drainage. Treatment can be chosen based on the presence or absence of warning signs and signs of complications. Incision and drainage is performed when complaints do not improve after administration of antibiotics, multiple abscesses and airway obstruction threaten the patient's life.

ANALISIS FAKTOR-FAKTOR YANG BERPENGARUH TERHADAP KEMISKINAN DI KABUPATEN/KOTA PROVINSI BALI

Poverty is a condition of life that is completely lacking experienced by a person or household so that he is unable to meet the needs that are proper for his life. Poverty has become a complex and chronic problem at the national and regional levels so overcoming it requires appropriate and sustainable strategies. The purpose of this study was to analyze the effect of PAD, PDRB, unemployment, HDI, and population simultaneously and partially on poverty in districts/cities of Bali Province. The data used is secondary data in the districts/cities of Bali Province from 2015-2020 sourced from the BPS Provinsi Bali (Central Statistics Agency for the Province of Bali), with a total of 54 observations. The analysis technique used is panel data regression analysis which is then followed by multiple linear regression analysis. Based on the results of data analysis, it is known that PAD, PDRB, unemployment, HDI, and total population simultaneously have a significant effect on poverty in districts/cities of Bali Province. PAD and HDI have no significant effect on poverty, population and unemployment have a positive and significant effect on poverty, and PDRB has a negative and significant effect on poverty in districts/cities of Bali Province.

Body awareness disturbances in patients with low back pain: a systematic review.

The pain-neuroscience literature has recently emphasized body perception or awareness. Impaired body perception results have been reported in many different chronic pain problems. Studies have reported that individuals with low back pain (LBP) also have body perception disturbances related to the lumbar spine. This review aimed to determine the evidence that body awareness alterations in individuals with LBP. Systematic review. Studies were searched in PubMed, Cochrane Library, and Pedro databases up to January 2021. Each database was searched independently, according to a specific iteration research string. The protocol record of the systematic review was entered into the PROSPERO system. Nine studies were included in this research. We found evidence to support more perceptual impairments in patients with LBP than healthy counterparts. In addition, the results of the studies showed an association between disrupted body awareness and pain severity, pain catastrophizing, and disability. Body perception disturbances in LBP seem to be a promising path that needs to be further explored, with the ultimate goal of developing treatment contents targeting body awareness as a more comprehensive and valid evaluation and therapeutic method. The registration number was CRD42021235934.

Fractional CO2 laser, platelet rich plasma and combination of both in treatment of female pattern hair loss

Background Female pattern hair loss (FPHL) is one of the most common chronic problems seen by dermatologists worldwide. Hair loss has a significant influence on the quality of life and is associated with low self-esteem and depression. The treatment modalities vary from medical approaches to surgical interventions. However, limited perceived efficacy of a therapeutic regimen may lead to premature stoppage of treatment. Objective To evaluate the efficacy of platelet rich plasma (PRP), fractional CO2 laser and combination of both in treatment of FPHL. Patients and methods This is a split-scalp prospective interventional study in which thirty patients presenting with FPHL received PRP in one area, fractional CO2 in another one, combined fractional CO2 and PRP in a third one and saline intradermal injection in the fourth area in frontal and mid scalp region of scalp. The sessions were scheduled every 2 weeks for 4 sessions, then monthly for 2 months. Patients were evaluated after each session and 3months after the last session. The results were evaluated by trichoscopic and folliscopic examination in the four examined areas. Assessment of treatment response was done according to the count of terminal and vellus hair, the thickness and density of hair shafts and the percentage of change, determined by folliscopic examination. Patients’ satisfaction and side effects were evaluated. Results There was significant difference between the studied groups as regards percentage of change of terminal hair, vellus hair, hair thickness and hair density after treatment. Pairwise comparisons showed that the combined group was statistically better than either PRP, fractional CO2, or saline group as regards all studied parameters (P value was &lt;0.05 for each). Conclusion Combination of fractional CO2 laser and topical PRP application would have a synergistic effect in treatment of FPHL. The technique would be an excellent alternative to injections in order to stimulate hair growth in patients with FPHL.

The Relationship Between Sleep Quality, Sleep Duration, Social Jet Lag and Obesity in Adolescents.

The frequency of obesity and poor sleep quality among adolescents is increasing and causes many chronic problems. The objective was to investigate the correlation between body mass index (BMI), sleep quality, sleep duration and social jet lag (SJL) among adolescents. This study is cross-sectional. A cohort of 416 adolescents, ranging in age from 12 to 18 participated in the study. Adolescents were divided into three groups according to BMI SDS: adolescents with normal weight, adolescents with overweight and adolescents with obesity. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to determine the sleep quality of the adolescents. The calculation of SJL and sleep-corrected social jet lag (SJLsc) was performed. The mean age of the adolescents was 15.0 ± 2.9 years.There were 222 males (53.4%). SJL and PSQI scores were significantly higher in the adolescents with obesity compared to the adolescents with normal weight and overweight (p < 0.001). An analysis of the relationship between the PSQI and BMI SDS revealed a correlation that was statistically significant (r = 0.667; p < 0.001). Adolescents with obesity reveal poorer sleep quality and a longer duration of SJL compared to adolescents with normal-weight. Moreover, increased SJL was linked to an increase in BMI. Maintaining good sleep quality and less exposure to SJL may help reduce the risk of obesity.

The Role of TNF-Alpha in the Wound Healing Process: Molecular and Clinical Perspectives - A Systematic Literature Review

Wounds are conditions of damage and partial loss of body tissue caused by physical trauma, sharp objects, blunt objects, temperature fluctuations, chemical exposure. Wound healing is a complex interaction between cells, cytokines, mediators, and blood vessels as a natural physiological response to tissue damage. TNF-α has a crucial role in the wound healing process, facilitating body immunity, immune cell mobilization, fibroblast cell proliferation, keratinocytes, and growth factor expression. Although TNF-alpha has benefits in the early stages of wound healing, excessively high levels or a sustained inflammatory response can lead to problems, such as excessive scar tissue formation or blockages, which can impede the wound healing process. This study utilized the PRISMA-ScR (Scoping Review) protocol. A review was conducted of articles discussing the Role of TNF-Alpha in the Wound Healing Process: Molecular and Clinical Perspectives within the last 10 years. Literature search in this study using PubMed, ScienceDirect, Elsivier and Google Scolar databases Search using English, abstract and full text. After searching with the keywords: The Role of TNF-Alpha, 19,022 articles were found. The search continued using the keyword The Role of TNF-Alpha in the Wound Healing found 346 articles. The last search using the keyword The Role of TNF-Alpha in the Wound Healing: Molecular and Clinical found 26 articles. TNF-α plays an important role in the early stages of cutaneous wound healing, significantly delayed after day 3, but not by day 7. TNF-α has a crucial role in the early stages of skin wound healing, and its administration is recognized to have a positive impact on the healing response, which may pave the way for innovative strategies to address chronic skin wound healing problems.

The Aftermath of COVID-19: Exploring the Long-Term Effects on Organ Systems.

Post-acute sequelae of SARS-CoV-2 infection (PASC) is a complicated disease that affects millions of people all over the world. Previous studies have shown that PASC impacts 10% of SARS-CoV-2 infected patients of which 50-70% are hospitalised. It has also been shown that 10-12% of those vaccinated against COVID-19 were affected by PASC and its complications. The severity and the later development of PASC symptoms are positively associated with the early intensity of the infection. The generated health complications caused by PASC involve a vast variety of organ systems. Patients affected by PASC have been diagnosed with neuropsychiatric and neurological symptoms. The cardiovascular system also has been involved and several diseases such as myocarditis, pericarditis, and coronary artery diseases were reported. Chronic hematological problems such as thrombotic endothelialitis and hypercoagulability were described as conditions that could increase the risk of clotting disorders and coagulopathy in PASC patients. Chest pain, breathlessness, and cough in PASC patients were associated with the respiratory system in long-COVID causing respiratory distress syndrome. The observed immune complications were notable, involving several diseases. The renal system also was impacted, which resulted in raising the risk of diseases such as thrombotic issues, fibrosis, and sepsis. Endocrine gland malfunction can lead to diabetes, thyroiditis, and male infertility. Symptoms such as diarrhea, nausea, loss of appetite, and taste were also among reported observations due to several gastrointestinal disorders. Skin abnormalities might be an indication of infection and long-term implications such as persistent cutaneous complaints linked to PASC. Long-COVID is a multidimensional syndrome with considerable public health implications, affecting several physiological systems and demanding thorough medical therapy, and more study to address its underlying causes and long-term effects is needed.

Open intraperitoneal onlay mesh repair with anterior component separation as a bail-out procedure in the management of complex hernias.

Surgical repair of complex abdominal wall hernias remains technically demanding and is widely recognized as a risk factor for unfavorable outcomes with high recurrence and morbidity rates. The objective is to assess short- and long-term complications after open intraperitoneal onlay mesh (IPOM) repair combined with bilateral anterior component separation (ACS) for large and difficult incisional hernias, alongside evaluating hernia recurrence rates. This retrospective analysis utilized data sourced from Hospital electronic health records and a prospective database at an academic tertiary referral center. Data collection was carried out from patients operated between January 2006 and December 2017. Eligible patients had complex incisional hernias measuring at least 10cm in their transverse diameter and had an open IPOM repair with bilateral ACS. In our study group of 45 patients, the 30-day surgical site occurrence (SSO) rate was high (37.8%), primarily consisting of superficial postoperative complications as seroma (17.8%) and wound dehiscence (6.7%). Among six patients (13.3%), wound complications escalated to chronic infected mesh-related problems, leading to complete mesh removal in four cases (8.9%) and partial mesh removal in two cases (4.4%). Regarding long-term complications, five patients (11.1%) developed enterocutaneous fistula. The recurrence rate was modest [5 out of 41 (12.2%)] over a median follow-up period of 99 months. Despite a high SSO rate, application of the open IPOM technique with ACS could serve as a valuable rescue option for managing large and complex hernias, with acceptable hernia recurrence rates at long-term follow-up.

Long-term neurocognitive, psychosocial, and physical outcomes after prenatal exposure to radiotherapy: a multicentre cohort study of the International Network on Cancer, Infertility, and Pregnancy

The main data available on the safety of radiation during pregnancy originate from animal studies and from studies of survivors of atomic or nuclear disasters. The effect of radiotherapy to treat maternal cancer on fetal development is uncertain. This report presents a unique cohort and aims to determine the long-term neurocognitive, psychosocial and physical outcomes of offspring of mothers treated with radiotherapy during pregnancy. In this international, multicentre, mixed retrospective-prospective cohort study, we recruited participants between Aug 5, 2006, and Aug 24, 2023, aged between 1·5 and 46 years, at three referral centres in Belgium, the Netherlands, and the USA. Participants were eligible if they were born from mothers treated with radiotherapy during pregnancy. Fetal radiation doses were obtained from medical records and participants were followed up at predefined ages (1·5, 3, 6, 9, 12, 15, and 18 years) and 5-yearly in adulthood, based on age at enrolment, using a neurocognitive test battery (measuring intelligence, attention, and memory), parent-reported executive function and psychosocial questionnaires, and a medical assessment. Results were compared with test-specific normative data. Linear regression models investigated associations between radiotherapy factors (fetal radiation dose, gestational age at the start and end of radiotherapy, and radiotherapy duration) and outcomes. 68 maternal cases of radiotherapy during pregnancy were registered by the three participating centres, of which 61 resulted in a livebirth and were therefore eligible to participate in the child follow-up study. After excluding those who did not give consent, 43 participants born from 42 mothers treated with radiotherapy during pregnancy were included in the study (median age at first assessment 3 years [IQR 2-11]; median age at last assessment 12 years [9-18]; median number of assessments two [1-4]). 18 (42%) of the included participants were female and 25 (58%) male, and 37 (86%) were of White ethnicity. Mean neurocognitive outcomes of the entire cohort were within normal ranges. No associations were found with fetal radiation dose or timing of radiotherapy during pregnancy. Six (16%) of 38 participants with neurocognitive outcomes scored lower than one SD on at least one neurocognitive outcome, three (7%) reported chronic medical conditions (spasmophilia, spastic diplegia, and IgG deficiency), and three (7%) were diagnosed with attention-deficit hyperactivity disorder (of whom two scored lower on attention). Of ten (23%) participants with lower neurocognitive score(s), a chronic medical condition, or attention-deficit hyperactivity disorder, eight were born preterm. The remaining 33 (77%) participants showed no neurocognitive, psychosocial, or chronic physical problems. We show on average normal neurocognitive, psychosocial, and physical outcomes after prenatal exposure to radiotherapy. Differences in outcomes could not be explained by exposure to radiotherapy during pregnancy. These results suggest that extra-abdomino-pelvic radiotherapy exposure during pregnancy in general does not adversely affect outcomes of liveborn children. Further research with a larger sample is necessary to confirm these findings. Kom Op Tegen Kanker, KWF Kankerbestrijding, Stichting Tegen Kanker, Research Foundation Flanders.

Asking the generalist – evaluation of a General Practice rounding and consult service

BackgroundVascular surgery patients admitted to the hospital are often multimorbid. In case of questions regarding chronic medical problems different specialties are consulted, which leads to a high number of treating physicians and possibly contradicting recommendations. The General Practitioner´s (GP) view could minimize this problem. However, it is unknown for which medical problems a GP would be consulted and if regular GP-involvement during rounds would be considered helpful by the specialists. The aim of this study was to establish and describe a General Practice rounding service (GP-RS), to evaluate if the GP-RS is doable in a tertiary care hospital and beneficial to the specialists and to explore GP-consult indications.MethodsThe GP-RS was established as a pilot project. Between June-December 2020, a board-certified GP from the Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf (UKE) joined the vascular surgery team (UKE) once-weekly on rounds. The project was evaluated using a multi-methods approach: semi-structured qualitative interviews were conducted with vascular surgery physicians that had either participated in the GP-RS (G1), had not participated (G2), other specialists usually conducting consults on the vascular surgery floor (G3) and with the involved GP (G4). Interviews were analyzed using Kuckartz’ qualitative content analysis. In addition, two sets of quantitative data were descriptively analyzed focusing on the reasons for a GP-consult: one set from the GP-RS and one from an established, conventional “as needed” GP-consult service.Results15 interviews were conducted. Physicians perceived the GP-RS as beneficial, especially for surgical patients (G1-3). Optimizing medication, avoiding unnecessary consults and a learning effect for physicians in training (G1-4) were named as other benefits. Critical voices saw an increased workload through the GP-RS (G1, G3) and some consult requests as too specific for a GP (G1-3). Based on data from 367 vascular surgery patients and 80 conventional GP-consults, the most common reasons for a GP-consult were cardiovascular diseases including hypertension and diabetes.ConclusionsA GP-RS is doable in a tertiary care hospital. Studies of GP co-management model with closer follow ups would be needed to objectively improve patient care and reduce the overall number of consults.Trial registrationNot applicable.

Modeling the causal mechanism in process safety management (PSM) systems from historical accidents

Process safety management (PSM) underpins reducing major accidents in the process industries. For decades, PSM systems have been implemented globally. However, few studies have modeled the complexities within the PSM system, leading to some underlying chronic problems within organizations that go unnoticed. Here, we investigate causal mechanisms among PSM elements from historical accidents to deliver a practical tool for safety intervention formulation. Specifically, based on the Center for Chemical Process Safety's (CCPS) PSM framework, 100 chemical accident reports derived from the U.S. Chemical Safety and Hazard Investigation Board (CSB) were analyzed and converted into structured information stored in 22 PSM elements. Then, employing two causal structure learning algorithms, the causal structures among 22 elements were learned from the processed accident information. Finally, the causal effects among PSM elements were estimated by extending Rubin's counterfactual causal framework to an approach applicable to multi-treatment scenarios. We demonstrate that the causal structures and effects learned from accident reports reveal the causal mechanism within the PSM system. A total of 20 significant causal relationships among single elements, nine significant causal relationships among element combinations, and several interesting PSM failure paths were identified. According to these causal patterns, the PSM effort will shift from the traditional "what to do" to "how to do it."

Burden of Wilson Disease among patients and care partners in the United States: results from a cross-sectional survey

Objective This study assessed the burden of Wilson Disease (WD) among patients and care partners (WD-CPs) in the US and compared it to a US general population of adults (GPs) and care partners (GP-CPs). Methods This cross-sectional, self-reported survey included patients with WD and WD-CPs aged ≥18 years recruited through the Wilson Disease Association (WDA), while data for GPs and GP-CPs were obtained from the 2022 National Health and Wellness Survey. GPs and GP-CPs were propensity score matched (3:1) with WD patients and WD-CPs for demographics and health characteristics. Bivariate analysis evaluated differences in comorbidity burden and health-related outcomes of the WD cohorts compared to matched GP cohorts. Results Thirty-seven patients with WD and 53 WD-CPs completed the survey. Most patients reported some treatment burden (73.3%), experienced sleep problems (60%), and visited a healthcare provider (HCP) in the past 6 months (91.9%). Compared with matched GPs, patients with WD had a significantly higher mortality risk (p < .001) and reported greater rates of chronic liver disease, cirrhosis (both, p < .001), migraines (p = .032), non-alcoholic steatohepatitis (p = .004), sleep problems (p = .009) and HCP visits (p = .002). Most WD-CPs (75.5%) reported high burden of caring (mean ZBI-12 score, 26.5) and more negative impact on esteem than GP-CPs. Conclusion This study highlights the burden of WD experienced by patients and WD-CPs, with patients experiencing high treatment burden, comorbidity burden and healthcare resource utilization, and WD-CPs experiencing high impact of caring, including impact on employment and self-esteem.