Complete Case Research Articles

The longitudinal network of peer problems and emotional symptoms among Australian adolescents: Bayesian structure learning of directed acyclic graphs.

Adolescence is a period in which peer problems and emotional symptoms markedly increase in prevalence. However, the causal mechanisms regarding how peer problems cause emotional symptoms at a behavioral level and vice versa remain unknown. To address this gap, the present study investigated the longitudinal network of peer problems and emotional symptoms among Australian adolescents aged 12-14 years. Data were from the Longitudinal Study of Australian Children. The complete case samples included adolescents who participated in the Longitudinal Study of Australian Children B (n = 2,694) or K (n = 3,144) Cohorts at two study follow-ups (ages 12 and 14). Peer problems and emotional symptoms were measured with the self-report Strengths and Difficulties Questionnaire. The analytical steps were (a) in Study 1, a causal discovery algorithm, Bayesian structure learning of directed acyclic graphs (DAGs), was used to identify the longitudinal network in the K Cohort; (b) the DAG discovered was evaluated with Bayesian structural equation modeling in an independent sample (the B Cohort) and compared against a DAG established through expert knowledge; and (c) in Study 2, the longitudinal network was again evaluated but considered contemporaneous effects. The empirically discovered DAG provided a better explanation of independent data than the expert DAG. Based on the discovered DAG, several plausible causal effects were identified such as that being bullied at age 12 negatively affected popularity at age 14. This study provides new insights into potential causal effects established between peer problems and emotional symptoms among Australian adolescents aged 12-14 years. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Predicting risk of maternal critical care admission in Scotland: Development of a risk prediction model.

Identifying women at highest or lowest risk of perinatal intensive care unit (ICU) admission may enable clinicians to risk stratify women antenatally so that enhanced care or elective admission to ICU may be considered or excluded in birthing plans. We aimed to develop a statistical model to predict the risk of maternal ICU admission. We studied 762,918 pregnancies between 2005 and 2018. Predictive models were constructed using multivariable logistic regression. The primary outcome was ICU admission. Additional analyses were performed to allow inclusion of delivery-related factors. Predictors were selected following expert consultation and reviewing literature, resulting in 13 variables being included in the primary analysis: demographics, prior health status, obstetric history and pregnancy-related factors. A complete case analysis was performed. K-fold cross validation was used to mitigate against overfitting. Complete data were available for 578,310 pregnancies, of whom 1087 were admitted to ICU (0.19%). Model performance was fair (area under the ROC curve = 0.66). A comparatively high cut-point of ⩾0.6% for ICU admission risk resulted in a negative predictive value (NPV) of 99.8% (specificity 97.8%) but positive predictive value (PPV) of 0.8% (sensitivity 9.1%). Models including delivery-related factors demonstrated superior discriminative performance. Our model for maternal ICU admission has an acceptable discriminative performance. The low frequency of ICU admission and resulting low PPV indicates that the model would be unlikely to be useful as a 'rule-in' test for pre-emptive consideration of ICU admission. Its potential for improving efficiency in screening as a 'rule-out' test remains uncertain.

Incidence of chronic pelvic pain after childbirth and its causal association with C-section.

This study aimed to report the incidence of chronic pelvic pain in women 12 to 24 months postpartum, to identify the independently associated factors, and to conduct a causal inference with C-section as the exposure. This was a cross-sectional study nested within 2 distinct prospective cohorts from 2 Brazilian cities. Chronic pelvic pain was the dependent variable. Independent variables were collected. Fisher exact test or Pearson χ2 test and t test or Wilcoxon rank-sum test were performed as appropriate, with P-values adjusted. Data were assumed to be missing at random, and multivariate imputation by chained equations was performed. Sensitivity analysis was conducted using complete cases. Multicollinearity was assessed by computing the variance inflation factor. Binomial logistic regression was used to obtain an interpretable model. Odds ratios and 95% confidence intervals were used as measurements. A directed acyclic graph was used for causal inference. A total of 2160 women were included. The incidence of chronic pelvic pain was 12.7%. C-sections doubled the odds of developing chronic pelvic pain (CPP). Additional factors associated with increased odds included city of birth, feelings of discrimination, severe symptoms of anxiety, dissatisfaction with the care received during childbirth, and mental suffering. Women who underwent C-sections had a 6.1% higher incidence of CPP compared to those who did not undergo the procedure. The incidence of CPP postpartum is high, and there is a potential causal effect of C-sections. City of birth, discrimination, anxiety, dissatisfaction with the care, and mental suffering were also associated with an increased odds.

Prevalence and incidence of sarcopenia in Swiss postmenopausal women: findings from the OsteoLaus Cohort

STUDY AIMS: Sarcopenia is a progressive, age-related loss of muscle mass, strength and function. Given the ageing population and the adverse outcomes associated with sarcopenia, monitoring its epidemiology is particularly important. This study aimed to describe sarcopenia prevalence, 5-year incidence and agreement between definitions using the latest operational criteria in Swiss postmenopausal women. METHODS: Postmenopausal women from the last 5 years of the CoLaus/OsteoLaus prospective population-based cohort were included based on complete case analysis (April 2015 to October 2022; Lausanne, Switzerland). We assessed appendicular lean mass via Dual X-ray Absorptiometry (GE Lunar iDXA), handgrip strength using a Jamar Dynamometer and 6-metre gait speed at multiple visits. Sarcopenia was defined based on handgrip strength and/or appendicular lean mass and/or gait speed using 11 definitions, including that from the European Working Group on Sarcopenia in Older People (EWGSOPII, 2019). Prevalence was measured as the number and rate of sarcopenic cases at the last visit, while incidence was measured as the number and rate of new sarcopenic cases over 2.5 or 5 years. RESULTS: A total of 930 women were included, with a mean (standard deviation) age of 72.9 (6.9) years, BMI of 25.7 (4.8) kg/m2, appendicular lean mass 16.8 (2.5) kg, handgrip strength 21.2 (5.5) kg, gait speed 1.1 (0.2) m/s. Sarcopenia prevalence based on EWGSOPII definitions ranged from 2.2% to 5.7%, while other definitions varied from 0.5% to 13.4%. The 5-year incidence rates based on EWGSOPII were 1.9% to 4.7%. Prevalence and incidence increased significantly between the lowest and highest age tertiles (Fisher’s exact test, p <0.05) for most definitions. Agreement between definitions was predominantly “none” or “minimal” according to the Cohen Kappa score. CONCLUSION: This population-based cohort of postmenopausal women highlights an increase in sarcopenia prevalence and incidence beginning in the seventh decade of life, underscoring the accelerated decline in muscle health with age. The minimal agreement between the definitions highlights the need for a consensus, which would improve future research and clinical implementations.

Examining Healthy Lifestyles as a Mediator of the Association Between Socially Determined Vulnerabilities and Incident Heart Failure.

Increased burden of socially determined vulnerabilities (SDV), which include nonmedical conditions that contribute to patient health, is associated with incident heart failure (HF). Mediators of this association have not been examined. We aimed to determine if a healthy lifestyle mediates the association between SDV and HF. We included adults aged 45 to 64 years old across the United States from the REGARDS cohort study (Reasons for Geographic and Racial Differences in Stroke) without evidence of HF at baseline. The primary exposure was a count of SDV based on the Healthy People 2030 framework. The primary outcome was incident HF. We assessed the role of a healthy behavior score (HBS range, 0-8) and its components (adherence to a Mediterranean diet, physical activity, lack of sedentary lifestyle, and smoking abstinence) as potential mediators of the association between SDV and incident HF. We included 13 on 525 participants. The median HBS was 4, with 16% with low HBS (0-2), 55% with moderate HBS (3-5), and 29% with high HBS (6-8). Increasing burden of SDV was associated with a stepwise increase in incident HF (adjusted hazard ratio, 1.84 [95% CI, 1.32-2.52] for 1 SDV, 2.59 [95% CI, 1.87-3.60] for 2 SDV, and 4.20 [95% CI, 3.08-5.73] for ≥3 SDV). There was no statistically significant mediation of HBS for the association of SDV count of 1 and incident HF. HBS score mediated 10.6% of the association between SDV count of 2 and incident HF and 11.1% of the association for those with ≥3 SDV. This increased to 10.8% and 18.3%, respectively, in the complete case analysis. Regarding individual components of HBS as mediators, only avoidance of a sedentary lifestyle was statistically significant (8.6% mediation) for the association of SDV count of 2 and incident HF. A healthy lifestyle plays a small role in mediating the association between high SDV count and incident HF.

Impact of the Healthy Lifestyle Community Program (HLCP-3) on Trimethylamine N-Oxide (TMAO) and Risk Profile Parameters Related to Lifestyle Diseases During the Six Months Following an Intervention Study.

The dietary components choline, betaine, and L-carnitine are converted by intestinal microbiota into the molecule trimethylamine (TMA). In the human liver, hepatic flavin-containing monooxygenase 3 oxidizes TMA to trimethylamine-N-oxide (TMAO). TMAO is considered a candidate marker for the risk of cardiovascular disease. The Healthy Lifestyle Community Program cohort 3 (HLCP-3) intervention was conducted with participants recruited from the general population in Germany (intervention: n = 99; control: n = 48). The intervention included intensive educational workshops, seminars, and coaching activities. The assessment was conducted using a complete case analysis (CCA) of the participants. The intervention was carried out for a ten-week intensive phase and an alumni phase. The interventional program emphasizes adopting a healthy plant-based diet and reducing meat consumption, as adherence to such a diet may lead to lowering TMAO levels. Additionally, it provides general recommendations about physical activity, stress management, and community support. The control group did not receive any intervention. TMAO was evaluated using stable isotope dilution liquid chromatography, and tandem mass spectrometry was used to measure fasting plasma levels of TMAO. The present study aimed to determine the impact of the Healthy Lifestyle Community Program (HLCP-3) on risk profiles for lifestyle-related diseases and TMAO plasma levels. Significant decreases in most risk profile parameters were detected, and a non-significant decrease in plasma TMAO levels was observed in the intervention group (0.37 (-1.33; 0.59) µmol/L). Furthermore, for the intervention group, after a six-month follow-up period, there was a significant negative correlation between higher healthy plant diet index (hPDI) scores and a decrease in plasma TMAO (ß = -0.200, p = 0.027). Additionally, a significant negative correlation was observed between the TMAO level and the scores for adherence to the plant diet index (PDI) (r = -0.195; p = 0.023). HLCP-3 is effective at improving adherence to a plant-based diet and improving risk profile parameters. However, long-term interventions involving stricter dietary programs in the sense of a plant-based diet are recommended if significant decreases in TMAO levels are to be obtained.

Exploring the impact of age on the predictive power of the National Early Warning score (NEWS) 2, and long-term prognosis among patients reviewed by a Rapid Response Team: A prospective, multi-centre study.

To explore the impact of age on the discriminative ability of the National Early Warning Score (NEWS) 2 in prediction of unanticipated Intensive Care Unit (ICU) admission, in-hospital cardiac arrest (IHCA) and mortality within 24 hours of Rapid Response Team (RRT) review. Furthermore, to investigate 30- and 90-day mortality, and the discriminative ability of NEWS 2 in prediction of long-term mortality among RRT-reviewed patients. Prospective, multi-centre study based on 830 complete cases. Data was collected by RRTs in 24 hospitals between October 2019, and January 2020. All NEWS 2 scores were uniformly calculated by the study team. Age was analysed as a continuous variable, in a spline regression model, and categorized into five different models, subsequently explored as additive variables to NEWS 2. The discriminative ability of NEWS 2 was evaluated using the Area under the receiver operating characteristics (AUROC). The discriminative ability of NEWS 2 alone in predicting 30-day mortality was weak. Adding age as a covariate improved the predictive performance (AUROC 0.66, 0.62-0.70 to 0.70, 0.65-0.73, p = 0.01, 95 % Confidence Interval). There were differences across age groups, with the best discriminative ability identified among patients aged 45-54 years. The 30- and 90-day mortality was 31% and 33% respectively. Adding age as a covariate improved the discriminative ability of NEWS 2 in the prediction of 30-day mortality among RRT-reviewed patients, with variations observed across age categories. The long- term prognosis of RRT-reviewed patients was poor.

SAHD-10: Development and initial validation of a short version of the Schedule of Attitudes Toward Hastened Death based on a large multinational sample.

Wishes to hasten death (WTHDs) are common in patients with serious illness. The Schedule of Attitudes Toward Hastened Death (SAHD) is a validated 20-item instrument for measuring WTHD. Two short versions have also been developed based on statistical item selection. However, all existing versions show some limitations with potential for improvement. This study aims to develop and initially validate a theory-driven and statistically sound SAHD short version based on a large multinational sample to advance the WTHD assessment in different countries and with different legislations. A 3-step procedure was carried out including (1) theory-driven item selection, (2) exploratory, and (3) confirmatory factor analysis. We used a data set collected between 1998 and 2020 across 3 different countries (Germany, Spain, USA). Participants were N = 1156 complete cases (n = 181 German, n = 101 Spanish and n = 874 US) of severely ill adult in- and outpatients. They had to be ≥18 years and give informed consent. The exploratory factor analysis revealed that 10 of 11 items previously selected theory-driven loaded on either of 2 factors: (1) WTHD and (2) internal locus of control. These factors showed good to excellent reliability according to Cronbach's α and McDonald's Ω, as well as an excellent fit of our data as an overall model for the total sample. The developed SAHD-10 represents a reliable and valid alternative to the SAHD and an efficient means to measure and further investigate a WTHD in cross-cultural clinical and research settings.

Combined associations of takeaway food availability and walkability with adiposity: Cross-sectional and longitudinal analyses.

Diet and physical activity are important determinants of energy balance, body weight and chronic health conditions. Peoples' health and behaviour are shaped by their environment. For example, the availability of unhealthy takeaway food in residential neighbourhoods and the ability to easily walk to a range of local destinations (high "walkability") influence diets and physical activity levels. Most existing evidence on the associations between residential neighbourhood and adiposity is cross-sectional and examines either walkability or takeaway availability, but not both in combination.We examined the cross-sectional and longitudinal associations of residential neighbourhood walkability and takeaway food availability with markers of adiposity separately and combined. With data from the Fenland Study (Cambridgeshire, UK; n=12,435), we used linear regression to estimate associations for walkability and takeaway availability separately and in mutually adjusted models, in addition to combining both into a measure of neighbourhood supportiveness for active living and healthy eating. Objective measures of BMI were examined cross-sectionally at baseline (2005-2015) and as change between baseline and follow-up (2014-2020). Additional outcomes (percentage body fat, waist circumference and hip circumference) were also examined both cross-sectionally and longitudinally. Complete case analyses indicated that neighbourhoods with greater walkability and lower takeaway availability were associated with lower BMI (n=10,607) and more favourable trends over time (n=5508). For example, compared with the lowest exposure group (Q1), Q4 of walkability and takeaway food availability was associated with a difference in BMI of -0.69kg/m2 (95% CI=-1.09 to -0.29) and 0.99kg/m2 (95% CI=0.58 to 1.39) respectively. These associations were more consistent when both neighbourhood measures were included in mutually adjusted models. The combined supportiveness measure was associated with lower BMI. High walkability and low takeaway availability were also associated with lower body fat percentage, waist circumference and hip circumference. These findings are consistent with the residential environment having a role in shaping people's health and behaviour. Living in an area that supports walking and cycling and affords less access to unhealthy food may support people to maintain a healthy lifestyle. It was important to consider walkability and takeaway food availability together because to examine them separately risks unobserved confounding by the other. Future research could incorporate additional environmental measures, especially those likely to be correlated.

COPYRIGHT AND IMAGE AND VOICE RIGHTS RELATED TO TEACH REMOTELY AT THE INSTITUTO FEDERAL DA BAHIA

Objective: The objective of this narrative literature review article is to address the electronic cigarette, an invention created in recent years, which has been widely used by adolescents, young people and adults, and is a product that has been causing several problems in the oral mucosa, dental structure and oral health, impacting in an extremely negative way. Methodology: To construct this narrative literature review article, a methodology was outlined in a thoughtful and strategic way, so that the maximum amount of information that could be added to the topic of the article could be obtained from online books, doctoral and master's theses, course completion papers, case reports, review articles, monographs, PICs and research on the topic addressed. Thus, to obtain this range of information, research was carried out in the following databases and websites: DeCs, BVS/BIREME, PROSPERO, Web of Science, CAPES Periodicals Portal, Science Direct, Scielo, PUBMED Central, The Cochrane Library, LUMEN ET VIRTUS Magazine, FT Magazine, Research, society and development journal combined with the Google Academy website. Results: The electronic cigarette was initially created as something that was supposed to be less corrosive and would cause fewer problems than the conventional cigarette, being something that was created for people who already smoke, so that they would start using this “healthier” cigarette, until the dependence diminished so that smokers could later quit all types of cigarettes. Conclusion: Thus, it is seen that the electronic cigarette has a range of harmful effects on the human body, being a product that causes problems in the oral cavity.

Safety of the Off-Label Use of Antitumor Drugs in Real Clinical Practice: Experience of Oncologists of the Russian Federation

Introduction. One of the key issues associated with the off-label use of antitumor drugs is safety. Typically, the advantages of such prescriptions in oncology are linked to the potential clinical benefits outweighing the risks of complications.Aim. To assess the safety of the off-label antitumor drug therapy in comparison with the on-label drug administration in the context of real clinical practice among oncologists in the Tula region.Materials and methods. The study was conducted at the Tula Regional Clinical Oncology Center, Russia. Over a six-month period in 2019, clinical data, provided by the regional information system, were analyzed for 919 completed treatment cases of 201 patients over 18 years of age who received antitumor drug therapy for malignant neoplasms. The study enrolled patients who had at least one hospitalization and got off-label antitumor drug therapy, as well as those receiving on-label drug treatment. The study assessed the safety of the off-label antitumor drug therapy in comparison with that of the on-label treatment, estimating the frequency of adverse events (AEs), spectrum of adverse events, severity of adverse events, fatal outcomes, treatment delays and discontinuations, and hospitalizations due to toxicity. A comparative analysis involved the results of using off-label and on-label antitumor drug therapy in terms of the aforementioned parameters. Results and discussion. No unforeseen adverse events were revealed in the study. The spectrum of adverse events encompassed 40 clinical and laboratory abnormalities with varying frequencies across the studied groups. Adverse events were observed in the majority of patients across both studied groups (83% and 86%). A predominance of grade I and II toxicity was noted. In some instances, therapy was discontinued and treatment was suspended; however, the frequency of these occurrences was significantly lower compared to current literature data. One fatal outcome due to complications from the administered therapy was recorded. All adverse events were reported in both studied groups with similar frequencies. The most commonly observed adverse events in both groups included hepatotoxicity, anemia, thrombocytopenia, nephropathy, cephalalgia, leukocytosis, skin toxicity, dyslipidemia, hypertension, bone pain syndrome, and dizziness. Other adverse events occurred sporadically with similar frequency. The most severe presentations were noted in the following adverse events: thrombocytopenia, gastrointestinal toxicity, leukocytosis, hyperglycemia, and immune-mediated diabetes mellitus with ketoacidotic coma.Conclusion. In real clinical practice, the safety of off-label and on-label antitumor drug therapy reveals no significant difference.

Solution of Linear Radiative Transfer Equation in Hollow Sphere by Diamond Difference Discrete Ordinates and Decomposition Methods

In this article, we present a methodology to solve radiative transfer problems in spherical geometry without other forms of heat exchange. We use a decomposition method based on the Adomian formulations, together with a diamond difference scheme and a trapezoidal rule to approximate the integral part of the solution. The algorithm is simple, highly reproducible, and can be easily adapted to further problems or geometries. Also, we demonstrate its consistency and showed that using an analytical solution with a trapezoidal rule improves the order of convergence compared to using the finite difference method. These considerations are necessary for future applications in more complex cases. The numerical results are compared with some classical and recent cases in the literature, along with a simplified version of a complete (fully coupled with heat exchange) case.

Discussion on the Splitting Treatment Technique in Gamma Knife Treatment Plans

Objective: In clinical Gamma Knife treatment, when patients have multiple or large lesions, a single Gamma Knife plan may require extended treatment time, making it difficult for patients to complete the session. This study explores the proper application of the splitting treatment technique in Gamma Knife treatment plans to create segmented plans for patients. Methods: Utilizing the design and output functions of the radiotherapy planning system, this study examines the typical errors in clinical treatment plans designed for the Moonlight Gamma Knife. Different splitting approaches were analyzed by comparing beam-on time for each target and calculating beam-on time error rates. Based on this, the appropriate splitting treatment technique for Gamma Knife treatment plans was discussed. Results: Scenarios where dose curves of multiple lesions intersect were categorized into three types: complete intersection, partial intersection, and no intersection. Complete intersection cases were further divided into Type I and Type II complete intersections. For cases with completely intersecting dose curves, the Gamma Knife plans should be split using the upper-lower segmentation method. For cases with no intersection, plans can be split based on individual lesions. For partial intersection cases, either the upper-lower segmentation or lesion-based segmentation method may be used. However, careful handling of target weighting at the dose curve intersection is necessary to ensure dose accuracy. For large lesions, the upper-lower segmentation method is recommended. Conclusion: To meet clinical treatment requirements, the proper application of the splitting treatment technique in Gamma Knife treatment plans is essential. This ensures dose accuracy in radiotherapy, thereby guaranteeing treatment efficacy and patient safety.

Atherothrombotic Outcomes After Sodium-Glucose Cotransporter 2 Inhibitors Versus Dipeptidyl Peptidase-4 Inhibitors in Patients With Type 2 Diabetes: A Territory-Wide Retrospective Cohort Study.

This study compared the risks of atherothrombotic major adverse cardiovascular events in patients with type 2 diabetes taking SGLT2 (sodium-glucose cotransporter 2) inhibitors to those taking DPP-4 (dipeptidyl peptidase-4) inhibitors. All adult patients (≥18 years of age) with type 2 diabetes and newly prescribed with SGLT2 inhibitors or DPP-4 inhibitors across all public hospitals in Hong Kong between January 2015 and December 2019 were included. Patients were propensity matched in a 1:1 ratio using a caliper distance of 0.2 without replacement. The primary outcome was atherothrombotic major adverse cardiovascular events as a composite outcome of cardiovascular mortality, nonfatal stroke, and nonfatal myocardial infarction. Time-to-first event analysis was conducted using a univariable Cox proportional hazards model. Primary and secondary analyses were repeated using stabilized inverse probability weighting and propensity score adjustment in the complete case cohort. A total of 20 642 patients (10 321 SGLT2 inhibitors versus 10 321 DPP-4 inhibitors) were included in the final analysis. The mean age was 59±11 years, and 13 142 (63.7%) were men. The median follow-up period was 2.9 years. The use of SGLT2 inhibitors was associated with a significant reduction in atherothrombotic major adverse cardiovascular events (453 [4.4%] versus 719 [7.0%]; hazard ratio, 0.64 [95% CI, 0.57-0.72]; P<0.001) compared with DPP-4 inhibitors. SGLT2 inhibitors were independently associated with reduced all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and incident dialysis (all P values <0.001). SGLT2 inhibitors in patients with diabetes were independently associated with reduction in atherothrombotic major adverse cardiovascular events, all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, and incident dialysis, compared with DPP-4 inhibitors.

The effect of stand-alone and additional preoperative video education on patients' knowledge of anaesthesia: A randomised controlled trial.

Fully digital preoperative information could save valuable time and resources. However, compared with face to face consultations, equivalent levels of safety, patient satisfaction and participation need to be maintained when using other methods to inform patients. This trial compared knowledge retention between preoperative stand-alone video education and face-to-face education by an anaesthesiologist. To assess if video education, alone or combined with face-to-face education, leads to better knowledge retention more than conventional face-to-face education. A randomised controlled trial with four arms: Video, Anaesthesiologist, Video & Anaesthesiologist, and Reference for baseline measurements and exploration of a test-enhanced learning effect. A Dutch tertiary care centre from February 2022 to February 2023. A total of 767 adult patients undergoing preoperative consultation for elective non-cardiothoracic surgery, with 677 included in the complete case analysis. Stand-alone preoperative video education and video education in combination with face-to-face education in the preoperative outpatient clinic. Primary outcome, measured by the Rotterdam Anaesthesia Knowledge Questionnaire, was knowledge retention on day 0. Secondary outcomes included knowledge retention at 14 and 42 days, preoperative anxiety, and the need for additional information using the Amsterdam Preoperative Anxiety and Information Scale. Other outcomes were satisfaction, self-assessed knowledge, and test-enhanced learning effect. Stand-alone video education led to higher Rotterdam Anaesthesia Knowledge Questionnaire scores than face-to-face education on day 0: median [IQR], 87.5 [81.3 to 93.8] vs. 81.3 [68.8 to 87.5], P < 0.001. Combined education in the "Video & Anaesthesiologist" group led to better knowledge retention compared with both the "Anaesthesiologist" group and the Video group: 93.8 [87.5 to 93.8] vs. 81.3 [68.8 to 87.5], P < 0.001; 93.8 [87.5 to 93.8] vs. 87.5 [81.3 to 93.8], P = 0.01, respectively. No differences in the patients' preoperative anxiety and satisfaction levels were found. Compared with face-to-face education by an anaesthesiologist, stand-alone video and combined video education improve short-term knowledge retention, without increasing patient anxiety. ClinicalTrials.gov Identifier: NCT05188547 (https://clinicaltrials.gov/ct2/show/NCT05188547).

Non-Invasive Ventilation Failure in Pediatric ICU: A Machine Learning Driven Prediction.

Background/Objectives: Non-invasive ventilation (NIV) has emerged as a possible first-step treatment to avoid invasive intubation in pediatric intensive care units (PICUs) due to its advantages in reducing intubation-associated risks. However, the timely identification of NIV failure is crucial to prevent adverse outcomes. This study aims to identify predictors of first-attempt NIV failure in PICU patients by testing various machine learning techniques and comparing their predictive abilities. Methods: Data were sourced from the TIPNet registry, which comprised patients admitted to 23 Italian Paediatric Intensive Care Units (PICUs). We selected patients between January 2010 and January 2024 who received non-invasive ventilation (NIV) as their initial approach to respiratory support. The study aimed to develop a predictive model for NIV failure, selecting the best Machine Learning technique, including Generalized Linear Models, Random Forest, Extreme Gradient Boosting, and Neural Networks. Additionally, an ensemble approach was implemented. Model performances were measured using sensitivity, specificity, AUROC, and predictive values. Moreover, the model calibration was evaluated. Results: Out of 43,794 records, 1861 admissions met the inclusion criteria, with 678 complete cases and 97 NIV failures. The RF model demonstrated the highest AUROC and sensitivity equal to 0.83 (0.64, 0.94). Base excess, weight, age, systolic blood pressure, and fraction of inspired oxygen were identified as the most predictive features. A check for model calibration ensured the model's reliability in predicting NIV failure probabilities. Conclusions: This study identified highly sensitive models for predicting NIV failure in PICU patients, with RF as a robust option.

Skin Graftless Dorsal Metacarpal Island VY Advancement Flap vs. Dorsal Rectangular Flap with Skin Grafting in 213 Simple Syndactyly Releases.

Simple syndactyly is a common congenital upper extremity difference. Traditional reconstructive approaches utilize skin grafts; however, recent studies suggest skin graftless techniques may improve outcomes. We hypothesized that patients who underwent reconstruction with a skin graftless dorsal metacarpal island VY advancement flap would have fewer postoperative complications compared to those released with a dorsal rectangular flap with skin grafts. Patients 0-17 years of age presenting for primary reconstruction of simple syndactyly were retrospectively analyzed at a large pediatric hospital. Medical records were identified using ICD-9/10 codes, CPT codes, and case logs from six hand surgeons. Outcomes of interest included early postoperative complications (within 30 days) such as infection, hematoma, seroma, wound healing issues, unplanned returns to the operating room, and digit loss. Late complications (greater than 30 days) included web creep and development of pathologic scar formation. In total, 213 syndactyly repairs from 153 patients were analyzed (rectangular=94 webspaces, 58 patients; VY=119 webspaces, 95 patients). The rectangular group had significantly more early complications (p=0.04). The rectangular group had significantly higher incidences of web creep and hypertrophic scarring (19.3% vs 1.8%, p<0.001; 19.1% vs 5.9%, p=0.003, respectively). The rectangular flap with skin grafts was the only variable predictive of web creep and hypertrophic scar formation on regression analysis (p<0.001 and p=0.004, respectively). Subgroup analyses of syndromic and nonsyndromic cases and incomplete and complete cases mirrored overall cohort results. Simple syndactyly releases with the skin graftless technique produces fewer complications compared to the traditional approach with skin grafts.

Enhanced Emergency Medical Services Case Definition to Identify Suspected Nonfatal Opioid Overdose-Related Incidents in Rhode Island.

To improve rapid detection and response to spikes in suspected nonfatal opioid overdoses in the community, the Rhode Island Department of Health (RIDOH) sought to modify its case definition to align with newly released guidance from the Council of State and Territorial Epidemiologists (CSTE). RIDOH used CSTE guidance to create 2 alternative criteria (CSTE-guided and RIDOH-modified CSTE) to replace one of RIDOH's original criteria. We gathered emergency medical services (EMS) records from 4 months in 2022 to determine whether they met any criteria, and we reviewed them to determine the accuracy of identifying an opioid overdose. We calculated the positive predictive value for each criterion individually and as a complete case definition (RIDOH original definition, CSTE-guided definition, and RIDOH-modified CSTE definition). The RIDOH-modified CSTE case definition was adopted because it had a positive predictive value of 91.5% in identifying nonfatal opioid overdose-related EMS incidents, similar to the original definition (91.3%) and higher than the CSTE-guided definition (82.2%). The RIDOH-modified CSTE case definition identified 624 additional nonfatal opioid overdoses in EMS data from 2018 through 2022, a 7% increase from the original definition. The RIDOH-modified CSTE case definition increased RIDOH's ability to detect suspected nonfatal opioid overdoses while maintaining the accuracy of the case definition. With the new case definition, RIDOH aims to improve allocation of resources to communities experiencing increased overdose burden.

Longitudinal Integrated Clerkships, empathy and patient centredness: A prospective cohort study

Purpose Ethical erosion literature describes medical students’ patient centredness and empathy declines through their clinical years of training. Longitudinal Integrated Clerkships (LICs), an alternate clinical educational design, have been hypothesised to reduce ethical erosion. The authors aimed to measure change in medical students’ patient centredness and empathy at an institution with the largest LIC worldwide. Method Two whole LIC cohorts (LIC1 and LIC2) were invited to complete a questionnaire, which included patient centredness and empathy scales. Students completed the questionnaire at the start and end of each academic year. Block-rotation students (Non-LIC) were a comparator cohort. Complete cases data were analysed. Results 22 Non-LIC, 66 LIC1 and 33 LIC2 students responded. Non-LIC students experienced a significant decline in empathy ([start] 113.14 vs. [end] 102.68, p<.001). Empathy did not significantly decline in the LIC cohorts. Patient centredness in LIC1 and LIC2 grew and reduced in the Non-LIC cohort, however, these changes were not statistically significant. Conclusions This study supports the hypothesis LICs may reduce ethical erosion when compared to block-rotation placements. The results provide evidence that ethical erosion occurs in students who have completed block-rotation placements. This is the first study of UK-based medical students measuring empathy and patient centredness following completion of an LIC.

Development of primary health care in Moscow: New polyclinic standard

The increase in the number of chronic noncommunicable diseases, changes in the age structure of the population, and an increase in demand for medical services in the primary health care system determine the need for an adequate response of health systems to these requests. Standardization is one of the effective mechanisms for managing the quality and accessibility of medical care provided to the population. The development of the Moscow healthcare system today is focused on the redistribution of forces towards primary healthcare and large-scale digitalization. Aim. To evaluate the results of the implementation of standardized solutions in the primary health care management system provided in outpatient clinics subordinate to the Department of Health of the city of Moscow. Materials and methods. Statistical and analytical methods, the method of expert interviews and content analysis of literature sources of domestic authors, as well as normative legal acts for 2018-2023 were used in the work. The main performance indicators of the outpatient clinics of Moscow are analyzed. Results. Important purposes of the healthcare system have been achieved: the created modern framework of outpatient care provided the opportunity to ensure equal access to quality care; the introduction of a single standard of polyclinics contributes to the rationalization of territorial planning, improvement and development of infrastructure, the use of innovative medical technologies and solutions; managerial and reorganization changes in the structure of polyclinics allowed to build convenient and clear routing of patients to receive medical care in the required volume and shorter terms. Changes in the Moscow primary health care system affect both external and internal processes, are aimed at maximizing the coverage of the population with health services, improving the provision of modern equipment to Moscow polyclinics, and creating a digital polyclinic. Conclusion. Bringing Moscow polyclinics to a single standard required reengineering of existing processes, restructuring of procedures focused on managing the completed case. The quality and accessibility of medical care to the population of Moscow remains a top priority in the development of outpatient care.