Outcome Criteria Research Articles

Innovations in Pain Management for Abdominoplasty Patients: A Systematic Review

Background/Objectives: Abdominoplasties are prevalent surgical procedures for improving lower abdominal contours, necessitating effective pain management. Insufficient management can increase opioid usage, dependency risks, and adverse effects. This review investigates various strategies in abdominoplasty pain management, aiming to reduce opioid dependence and improve patient care. Methods: A comprehensive systematic literature search (MEDLINE, Cochrane, PubMed, Web of Science, EMBASE) was conducted, spanning from their inception to January 2024, using keywords such as ‘abdominoplasty’ and ‘postoperative pain management’. Included studies focused on nonopioid interventions in adults, encompassing various study designs. Non-English publications and those not meeting outcome criteria were excluded. Bias in studies was assessed using specific tools for randomized and non-randomized trials. Results: Thirty-five studies, published between 2005 and 2024, were included, involving 3636 patients with an average age of 41.8. Key findings highlighted the effectiveness of transversus abdominis plane blocks in reducing opioid use and pain. Pain pump catheters also showed promise in improving pain management and reducing opioid dependency. Local anesthetics demonstrated varying degrees of efficacy, while other alternatives like ketamine and NSAIDs successfully reduced postoperative pain and opioid requirements. The bias assessment of the RCTs revealed “low” and “some concerns” ratings, indicating a need for more detailed methodology reporting and management of missing data. The cohort studies generally attained “moderate” risks of bias, primarily due to confounding variables and outcome data reporting. Conclusions: Nonopioid analgesics show potential in postoperative pain management for abdominoplasties, but further research is needed to confirm their effectiveness and optimize patient care.

No Sex-based Differences in Self-reported Empathy between Patients with Schizophrenia and Control Subjects.

Schizophrenia, one of the most disabling disorders worldwide, is characterized by impaired empathy, which appears to be more common in women. This study aimed to compare empathy levels between control subjects and patients with schizophrenia by sex. We compared sixty-two patients with schizophrenia and 166 control subjects. All participants completed the Empathy Quotient (EQ) questionnaire. A multivariate analysis of variance model was performed with the EQ as the outcome criterion, and group and sex as fixed factors to test for interaction effects. Overall, patients obtained lower scores in the cognitive, emotional reactivity and social skills domains of empathy (p < 0.001). No differences between men and women were found and no interaction effect was identified between sex and group (schizophrenia vs. control) (p > 0.05). This study adds to the evidence on differences in social cognition between people with and without a mental illness such as schizophrenia. It also identifies the absence of sex differences between men and women, observed in both the group of patients and control subjects, which warrants further exploration.

Ultrasound assessment of embryo cardiac function as a predictive criterion of adverse pregnancy outcome

Purpose to evaluate the value of the embryo/fetus heart rate (HR) in early pregnancy assessed by ultrasound for the formation of a group at high risk of adverse pregnancy outcomes.Materials and methods. A retrospective analysis of ultrasound examinations of 1073 pregnant women at 5+0–10+6 weeks was carried out. The embryo/fetus heart rate was compared with the gestational age calculated by the crown rump length (CRL) and the date of the last menstruation period (LMP). Retrospectively, all examined pregnant women were divided into two groups: group 1—with intrauterine embryo death before 14 weeks of pregnancy (n = 107); group 2—with prolongation of pregnancy until the second trimester (n = 966). When analyzing the data array using a decision tree, the embryo heart rate was assessed at various stages of pregnancy by LMP, CRL, and regardless of the exact period of pregnancy.Results. Analysis of heart rate values at different stages of pregnancy by LMP showed significant differences in heart rate between groups, the cases of later embryo loss characterized by lover heart rate values. There were no significant differences in heart rate between the groups at different stages of pregnancy by CRL (significant differences were obtained only at 8+0–9+6 weeks). Cut-off values of embryo heart rate for prediction of adverse pregnancy outcomes have been proposed for different stages of pregnancy, as well as a universal cut-off for the entire embryonic period.Conclusion. The proposed cut-off values of embryo heart rate for different stages of pregnancy, calculated by LMP, may be used for timely prediction of adverse pregnancy outcomes. When the exact gestational age is unknown, a universal heart rate cut-off value of &lt;116 bpm may be used. All proposed HR cut-off values were characterized by high specificity, but none of them by high sensitivity. A sensitivity of HR cut-off values can be increased by the use in combination with other ultrasound and clinical signs of adverse pregnancy outcome.

Assessing the Risk of Interfacility Transport in Pregnant Patients Due to Progression of Labor: Lessons From a Specialized Maternal-Fetal Transport Program.

Background Pregnant laboring patients sometimes require interfacility transfer to a higher level of care. There is a paucity of evidence to inform when it is safe to transfer a laboring patient and when delivery may be too imminent to transfer. Methods This is a retrospective study of pregnant patients undergoing interfacility transfer with a specialized obstetric transport team deployed from a large Midwest regional healthcare system. The primary outcome was delivery prior to or within one hour of arrival at the receiving institution due to progression of labor. Data collected included basic demographics, vital signs, gravidity, parity, gestational age, contraction frequency if contractions were present, and cervical dilation. We sought to define the association between these variables and the primary outcome to inform risk assessment for precipitous delivery among patients being considered for interfacility transfer. Results Of the 370 pregnant patients for whom the specialized transfer team was requested, 11 (3%) met the primary outcome. Those with more advanced cervical dilation and those who did not receive regular prenatal care were more likely to meet the criteria for the primary outcome. For every centimeter of cervical dilation, the odds of meeting the primary outcome increased 2.3-fold (95% CI: 1.5-3.4). Conclusions We identified risk factors for early delivery among pregnant patients for whom an interfacility transfer was requested and described patients who were high-risk for obstetric interfacility transport due to the progression of labor. Our results can help inform risk assessments for transferring potentially high-risk laboring patients.

Analytic Rubrics for the Practical Assessment of Students’ Performances in Engineering Survey Course

The use of analytic rubrics as an assessment tool has been an integral component of education. In Surveying courses, it is essential to evaluate the psychomotor skills under simulated conditions of actual practise. The main objective of this study is to determine the comparative and efficacy of practical assessment conducted at the diploma and degree levels in the Civil Engineering programme. In order to achieve the objective, implementing rubrics in the continuous assessment of the Surveying courses to facilitate a profound comprehension of physics, mathematics, and engineering principles needs to be executed. Previously, a practical assessment has been conducted in a traditional method which gauges the student performance according to the time records during certain practical tasks given resulting in inadequate assessment tools that failed to capture the psychomotor component of practical assessments effectively. As for methodology, a comparative analysis was conducted to examine the consistency and usefulness of analytic rubrics in assessing the course and program outcomes of Surveying courses at both diploma and degree levels. The analysis aimed to determine the impact of these rubrics on student performance. This comparison should be conducted in order to prevent redundant actions, as it pertains to diploma level students who will be integrated into the degree program. This assessment reveals that most students met all performance criteria at an acceptable level. This indicates that the analytical rubric used for the Practical Test in Surveying courses is adequate and effective as a grading instrument. As for the results, the comprehensive analysis indicates that a significant majority, ranging from 75% to 81%, exhibited commendable performance in achieving the criteria for various Programme Outcomes (PO), particularly in PO4, PO5, PO9, and PO10.

The Conceptualization and Derivation of the Cervical Lordosis Distribution Index.

Yilgor et al developed the lumbar Lordosis Distribution Index to individualize the pelvic mismatch to each patient's pelvic incidence. The cervical lordosis distribution in relation to its apex has not been characterized. Tailor correction of cervical deformity by incorporating the cervical apex into a distribution index(CLDI) to maximize clinical outcomes while lowering rates of junctional failure. Retrospective cohort. CD patients with complete 2Y data were included. Optimal outcome is defined by no DJF, and meeting Virk et al Good Clinical Outcome Criteria:[Meeting 2 of 3: 1)an NDI<20 or meeting MCID, 2)mJOA>=14, 3)an NRS-Neck<=5 or improved by 2 or more points]. C2-T2 lordosis was divided into cranial (C2 to apex) and caudal (apex to T2) arches postoperatively. A cervical lordosis distribution index(CLDI) was developed by dividing the cranial lordotic arch(C2 to apex) by the total segment(C2-T2) and multiplying by 100. Cross-tabulations developed categories for CLDI producing the highest chi-square values for achieving Optimal Outcome at two years and outcomes were assessed by multivariable analysis controlling for significant confounders. 84 CD patients were included. Cervical apex distribution postoperatively was: 1% C3, 42% C4, 30% C5, 27% C6. Mean cervical LDI was 117±138. Mean cranial lordosis was 23.2±12.5°. Using cross-tabulations, a CLDI between 70 and 90 was defined as 'Aligned'. Chi-square test revealed significant differences among CLDI categories for DJK, DJF, Good Clinical Outcome, and Optimal Outcome(all P<0.05). Patients aligned in CLDI were less likely to develop DJK(OR: 0.1, [0.01-0.88]), more like to achieve GCO (OR: 3.9, [1.2-13.2]) and Optimal Outcome (OR: 7.9, [2.1-29.3] at two years. Patients aligned in CLDI developed DJF at a rate of 0%. The cervical lordosis distribution index, classified through the cranial segment, takes each unique cervical apex into account and tailors correction to the patient in order to better achieve good clinical outcomes and minimize catastrophic complications following cervical deformity surgery. III.

Private benefit of β-lactamase dictates selection dynamics of combination antibiotic treatment

β-lactam antibiotics have been prescribed for most bacterial infections since their discovery. However, resistance to β-lactams, mediated by β-lactamase (Bla) enzymes such as extended spectrum β-lactamases (ESBLs), has become widespread. Bla inhibitors can restore the efficacy of β-lactams against resistant bacteria, an approach which preserves existing antibiotics despite declining industry investment. However, the effects of combination treatment on selection for β-lactam resistance are not well understood. Bla production confers both private benefits for resistant cells and public benefits which faster-growing sensitive cells can also exploit. These benefits may be differentially impacted by Bla inhibitors, leading to non-intuitive selection dynamics. In this study, we demonstrate strain-to-strain variation in effective combination doses, with complex growth dynamics in mixed populations. Using modeling, we derive a criterion for the selection outcome of combination treatment, dependent on the burden and effective private benefit of Bla production. We then use engineered strains and natural isolates to show that strong private benefits of Bla are associated with increased selection for resistance. Finally, we demonstrate that this parameter can be coarsely estimated using high-throughput phenotyping of clonal populations. Our analysis shows that quantifying the phenotypic responses of bacteria to combination treatment can facilitate resistance-minimizing optimization of treatment.

Prognostic criteria for surgical treatment of stress urinary incontinence in combination with cystocele in postmenopausal women

Background. The relevance of the problem of stress urinary incontinence (SUI) in combination with cystocele has increased significantly over the past decades, due to the high prevalence of the disease in the population, as well as increased awareness of patients about treatment options. It is known that one-stage surgical treatment significantly reduces the need for re-intervention and, accordingly, the rehabilitation period. The identification of significant criteria that are decisive in the effectiveness of various methods of surgical correction of SUI in combination with cystocele dictates the need for further research in this direction.The purpose of the study. To determine outcome criteria for surgical treatment of stress urinary incontinence in combination with cystocele in postmenopausal women based on a comprehensive preoperative examination.Materials and methods. A prospective randomized study was conducted, which included 80 women with stress urinary incontinence in combination with postmenopausal cystocele, who were routinely hospitalized in the gynecological department of the Federal State Budgetary Institution Research Institute of OMM for surgical treatment. All patients, after signing voluntary informed consent to participate in the study and conducting a comprehensive preoperative examination using a random number generator, were randomized into two groups of equal size. The first group included 40 women who received surgical treatment including anterior colporrhaphy in combination with urethropexy with a synthetic loop; the second group consisted of 40 patients who underwent surgical treatment using the method of paraurethral injection of a volume-forming gel in combination with anterior colporrhaphy.Results and discussion. Criteria for predicting the outcome of surgical treatment of stress urinary incontinence in combination with cystocele in postmenopausal women were determined based on a comprehensive preoperative examination. Conclusion: Analysis of complex urodynamic and ultrasound examination methods in women revealed statistically significant differences between groups of women with positive and negative outcomes of surgical treatment. The identified criteria for predicting the outcome of surgical treatment serve to assist the clinician in choosing the optimal, most effective method of treating SUI in combination with cystocele in postmenopausal women.Conclusions. Analysis of complex urodynamic and ultrasound methods of examination in women revealed statistically significant differences between groups of women with positive and negative outcomes of surgical treatment. The identified criteria for predicting the out-come of surgical treatment serve to assist the clinician in choosing the optimal, most effective method of treating SUI in combination with cystocele in postmenopausal women.

Prognostic Factors and Outcome Measures After Rituximab Therapy in Central Nervous System Vasculitis: A Systematic Review.

Given the growing popularity of Rituximab (Rmab) treatment as a potential substitute for cyclophosphamide, we conducted this review to determine aspects related to Rmab therapy in central nervous system vasculitis (CNSV) patients, aiming to establish both the beneficial and detrimental consequences of Rmab while providing clinical guidance for managing patients' conditions. This systematic review was prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Web of Science, and Scopus databases were utilized to investigate Rmab treatment in CNSV from January 2015 to May 2024. The research question was structured using the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) criteria. Case series with only three or more unique cases, prospective or retrospective non-randomized studies, and randomized controlled trials (RCTs) were addressed. The initial evaluations were performed in PubMed, Scopus, and Web of Science. After removing duplicate entries, 177 publications were obtained, and 41 were chosen for full-text assessment. The review then incorporated information gathered from 27 studies, including 4 case series, 15 non-randomized cohorts, and 8 RCTs. Rmab is generally regarded as effective for CNSV therapy. Given its success, induction Rmab therapy is now frequently employed as maintenance therapy for CNSV patients. Rmab is a viable option for the induction of remission and maintenance treatment, with a successful reduction in relapse rates.

Reporting standards in randomized controlled trials involving neuro-oncology caregivers: A systematic review report from the RANO-Cares working group

Abstract BACKGROUND Family caregivers in neuro-oncology (e.g., spouse, family member, friend to a patient) have high unmet support needs, yet intervention trials and effective support options are scarce. The Response Assessment in Neuro-Oncology (RANO-) Cares working group investigated the methodological quality of neuro-oncology caregiver outcomes reporting in randomized controlled trials (RCTs). METHODS A systematic review was performed to evaluate to what extent RCTs assessing outcomes of caregivers of adult primary brain tumor patients adhere to minimum reporting standards. A 33-item checklist (23 applicable to secondary analysis reports) based on the International Society for Quality of Life Research (ISOQOL) criteria for patient-reported outcome (PRO) reporting was used. Risk of bias was assessed per RCT. RESULTS Fifteen publications from 11 unique RCTs included 676 neuro-oncology caregivers, with low overall risk of bias. Ten publications (66%) reported on caregiver outcomes as a primary aim, of which eight (80%) satisfied ≥2/3 of the key methodological criteria. Of the five secondary analysis reports (33%) two (40%) met ≥2/3 of applicable key criteria. Criteria often not reported adequately included sample size calculations (reported adequately in n=8, 53%), participant flow (n=9, 60%) window for data collection (n=1, 6%), and extent of (n=10, 66%), reasons for (n=9, 60%), and statistical approaches in dealing with (n=4, 26%) missing data. CONCLUSION Whilst there are opportunities to enhance reporting standards, RCTs that include neuro-oncology caregiver outcomes generally adhere to high quality reporting standards, and have low risk of bias, indicating good potential to impact clinical practice.

Adapted physical activity: Benefit on oxidative, functional capacity and exercise tolerance of elderly people in Kinshasa

In basketball, shooting stands out as a vital technique directly affecting the game results. Identifying shooting mechanics early in a basketball player's career can significantly develop shooting performance in subsequent years. This study aimed to explore shooting percentages based on angular positions of joint parts in the shooting techniques of youth basketball players. Fifteen male participants (average age: 14.1±0.7 years, height: 180.7±7.9 cm, body weight: 65.4±10.0 kg, sports experience: 4.7±0.4 years) voluntarily participated in the study. They were divided into high shooting rate (n: 7) and low shooting rate (n: 8) groups. Both groups attempted 60 shots from the free throw line (20 shots), right forward position (20 shots), and left forward position (20 shots). Joint angle values during the initial and final shooting phases were compared between groups using Independent t-tests. Significant differences were found between groups in the shoulder part during the beginning phase and the wrist part during the final shooting phase (p

Efficacy of Homoeopathy in the Management of Dysfunctional Uterine Bleeding: A Review

Background: Dysfunctional uterine bleeding (DUB) is a prevalent condition affecting women during their reproductive years. It is characterized by irregular or abnormal menstrual bleeding patterns and can significantly impact a woman's quality of life. Studies suggest it affects around 1 in 5 women during their reproductive years. Homoepathic approach can prove to be efficient in successfully treating and managing cases of DUB. Aims and Objectives: This study was aimed to critically evaluate the existing evidence on the efficacy of homoeopathy in treating DUB. Specific outcome parameters, therapeutic approach, criteria for assessment and treatment outcomes were noted and compared having variable impact in cases of DUB. Methods: A comprehensive literature search was conducted through databases like PubMed and Google Scholar. Search criteria was focused on targeting analysis from randomized controlled trials (RCTs), clinical studies, observational studies and case reports. Results: 6 articles having an in depth relation to action of homeopathy on DUB were identified. It included one(01) randomized controlled trial, one(01) experimental study, one(01) prospective and observational study, one(01) prospective clinical study and two(02) case reports. All studies were obtained from peer-reviewed journals. Conclusion: This study aimed at contributing valuable insights into the current state of knowledge regarding homoeopathy's role in managing DUB and exploring the need for enhanced value based research in the field of homoeopathy.

Neurological Manifestation of Neonatal Acute Kidney Injury: Focusing on the Clinico-Radiological Profile.

Purpose This study aimed atstudying the neurological manifestation of neonatal acute kidney injury, focusing on the clinico-radiological profile. Methodology In this cross-sectional study, newborns hospitalized in the neonatal intensive care unit of a tertiary care hospital were enrolled over a study period of one year. As per the Kidney Disease: Improving Global Outcome (KDIGO) criteria, 74 neonates were enrolled, and magnetic resonance imaging (MRI) was performed on the same neonates. Result In this study, acute kidney injury (AKI) was seen more often in neonates with admission weights between 1,500 and 2,499 grams, accounting for 52.7% of total study participants. In the current study, neonates admitted with AKI presented more with signs and symptoms of encephalopathy, such as lethargy (78.4%), seizures (64.8%), and irritability (35.1%) at admission. Signs and symptoms of fever and decreased urine output were more common after the first week of life. Abnormal MRI findings were observed in 64.9% of neonates with AKI. The mean blood urea and serum creatinine levels in neonates with abnormal MRI were 188.14 ± 108.25 mg/dL and 2.93 ± 2.16 mg/dL, respectively. The mean blood urea and serum creatinine levels in neonates with normal MRI were 169.84 ± 65.45 mg/dL and 2.41 ± 1.85 mg/dL, respectively. Of the 74 neonates enrolled with AKI, 12 (16.21%) had CSVT. These neonates had a mean blood urea level of 231.58 ± 111.66 mg/dL (p = 0.047) and a mean creatinine level of 3.77 ± 2.78 mg/dL. Conclusion Neonatal AKI has a variable presentation with high mortality and morbidity. Elevated serum urea and creatinine can be used to predict CSVT.

Cone beam computed tomography (CBCT) and megavoltage computed tomography (MVCT)-based radiomics in head and neck cancers: a systematic review and radiomics quality score assessment.

Cone beam computed tomography (CBCT) and megavoltage computed tomography (MVCT)-based images demonstrate measurable radiomics features that are potentially prognostic. This study aims to systematically synthesize the current research applying radiomics in head and neck cancers for outcome prediction and to assess the radiomics quality score (RQS) of the studies. A systematic search was performed to identify available studies on PubMed, Web of Science, and Scopus databases. Studies related to radiomics in oncology/radiotherapy fields and based on predefined Patient, Intervention, Comparator, Outcome, and Study design (PICOS) criteria were included. The methodological quality of the included study was evaluated independently by two reviewers according to the RQS. The Mann-Whitney U test was performed according to subgroups. The P values <0.05 were considered statistically significant. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting guidelines were adhered to. From a total of 743 identified studies, six original studies were eligible for inclusion in the systematic review (median =97 patients). The intraclass correlation coefficient (ICC) for inter-reviewer on total RQS was excellent with 0.99 [95% confidence interval (CI) of 0.946< ICC <0.999]. There were no significant differences in the analyses between each RQS domain and subgroup components (P always >0.05). Numerically higher RQS domains score for publication year ≤2022 than 2023 and number of patients > median than ≤ median but not statistically significant. The number of radiomics studies involving CBCT and MVCT is still very limited. Self-reported RQS assessments should be encouraged for all radiomics studies.

Multidisciplinary approach to repair of intra-articular fractures of the distal radius in a complicated setting (prehabilitation)

Introduction Treatment of malunited periarticular fracture of the distal metaepiphysis of the radius in a complicated setting is challenging and involved orthopaedic care and related specialties of neurologists, neurosurgeons and rehabilitation specialists. New methods are offered for repair of the distal radius fractures but the results obtained to date cannot be considered satisfactory, since the treatment is aimed at the restoration of the anatomical relationships and the hand function.The objective was to demonstrate the role of prehabilitation preparing patients for elective reconstructive surgery, to present a multidisciplinary approach to the treatment of malunited radius fracture complicated by posttraumatic compression ischemic multineuropathy.Material and methods The medical history of a 56-year-old patient with distal radius malunion complicated by posttraumatic compression ischemic multineuropathy was reviewed. Outcome criteria included absence of complaints and restored function of the hand and the wrist.Results A positive functional outcome was recorded after prehabilitation and surgery. Early postop, the DASH scored 35, palmar flexion measured 64° with dorsiflexion of 61° and dynamometry of 30 kg seen with the left involved hand. A faster recovery of the hand function occurred due to regression of neurological disorders.Discussion Treatment of the distal radius malunion in a complicated setting suggests the involvement of related specialists including neurologists, neurosurgeons, professionals in functional and diagnostic radiology, rehabilitation specialists so that the approach must be multidisciplinary. A preoperative course of prehabilitation supervised by a neurologist and a rehabilitation specialist is essential for the patient to achieve a higher basic level of functionality. Surgical treatment must be a stage of multi-stage multidisciplinary treatment of distal radius malunion in a complicated setting.Conclusion The clinical case showed an effective multidisciplinary approach in the treatment of distal radius malunion in a complicated setting. Preoperative preparation (prehabilitation) had a positive effect on the postoperative recovery and functional results.

Estimating the severity of obstructive sleep apnea during wakefulness using speech: A review

Obstructive sleep apnea (OSA) is a chronic breathing disorder during sleep that affects 10-30% of adults in North America. The gold standard for diagnosing OSA is polysomnography (PSG). However, PSG has several drawbacks, for example, it is a cumbersome and expensive procedure, which can be quite inconvenient for patients. Additionally, patients often have to endure long waitlists before they can undergo PSG. As a result, other alternatives for screening OSA have gained attention. Speech, as an accessible modality, is generated by variations in the pharyngeal airway, vocal tract, and soft tissues in the pharynx, which shares similar anatomical structures that contribute to OSA. Consequently, in this study, we aim to provide a comprehensive review of the existing research on the use of speech for estimating the severity of OSA. In this regard, a total of 851 papers were initially identified from the PubMed database using a specified set of keywords defined by population, intervention, comparison and outcome (PICO) criteria, along with a concatenated graph of the 5 most cited papers in the field extracted from ConnectedPapers platform. Following a rigorous filtering process that considered the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach, 32 papers were ultimately included in this review. Among these, 28 papers primarily focused on developing methodology, while the remaining 4 papers delved into the clinical perspective of the association between OSA and speech. In the next step, we investigate the physiological similarities between OSA and speech. Subsequently, we highlight the features extracted from speech, the employed feature selection techniques, and the details of the developed models to predict OSA severity. By thoroughly discussing the current findings and limitations of studies in the field, we provide valuable insights into the gaps that need to be addressed in future research directions.

Navigating a Paradigm Shift Venetoclax Treatment Redefines Landscape of Acute Myeloid Leukemia.

Acute myeloid leukemia (AML) is a heterogeneous disease characterized by the accumulation of malignant myeloid progenitor hematopoietic cells in the bone marrow and peripheral blood. Recent studies have shown promising results with the use of small molecule inhibitors and targeted therapy in the treatment of patients with AML. One such molecule is venetoclax, which has been approved in AML by the FDA in combination with hypomethylating agents or low-dose cytarabine. We thoroughly searched electronic literature related to venetoclax and its role in AML, using databases such as MEDLINE, PubMed, Google Scholar, and PsychInfo, through April 2024. We applied population, intervention, comparison, and outcome criteria, specifically focusing on studies with a population using venetoclax from review articles and clinical trials. All selected studies were required to be in English, and any study that did not involve the use of venetoclax was excluded. A meticulous literature review was conducted to consolidate the current knowledge and new combination therapies on AML. In our review article, we focused on the latest advances in the treatment of patients with AML. Based on the literature, we recommend that physicians prioritize the use of venetoclax in the management of this deadly disease because it has been shown to significantly impact the course of the disease.

Performance of the ERC/ESICM-recommendations for neuroprognostication after cardiac arrest: Insights from a prospective multicenter cohort

AimTo investigate the performance of the 2021 ERC/ESICM-recommended algorithm for predicting poor outcome after cardiac arrest (CA) and potential tools for predicting neurological recovery in patients with indeterminate outcome. MethodsProspective, multicenter study on out-of-hospital CA survivors from 28 ICUs of the AfterROSC network. In patients comatose with a Glasgow Coma Scale motor score ≤3 at ≥72 h after resuscitation, we measured: (1) the accuracy of neurological examination, biomarkers (neuron-specific enolase, NSE), electrophysiology (EEG and SSEP) and neuroimaging (brain CT and MRI) for predicting poor outcome (modified Rankin scale score ≥4 at 90 days), and (2) the ability of low or decreasing NSE levels and benign EEG to predict good outcome in patients whose prognosis remained indeterminate. ResultsAmong 337 included patients, the ERC-ESICM algorithm predicted poor neurological outcome in 175 patients, and the positive predictive value for an unfavourable outcome was 100% [98–100]%. The specificity of individual predictors ranged from 90% for EEG to 100% for clinical examination and SSEP. Among the remaining 162 patients with indeterminate outcome, a combination of 2 favourable signs predicted good outcome with 99[96–100]% specificity and 23[11–38]% sensitivity. ConclusionAll comatose resuscitated patients who fulfilled the ERC-ESICM criteria for poor outcome after CA had poor outcome at three months, even if a self-fulfilling prophecy cannot be completely excluded. In patients with indeterminate outcome (half of the population), favourable signs predicted neurological recovery, reducing prognostic uncertainty.

Challenges in the evaluation of suicide prevention measures and quality of suicide data in Germany, Austria, and Switzerland: findings from qualitative expert interviews

BackgroundSuicide prevention requires diverse, integrated, and evidence-based measures. Comprehensive evaluation of interventions and reliable suicide data are crucial for guiding policy-making and advancing suicide prevention efforts. This study aimed to analyze current issues and gaps in the evaluation of suicide prevention measures and the quality of suicide data in Germany, Austria, and Switzerland to derive specific recommendations for improvement.MethodsOnline, semi-structured interviews were conducted with 36 experts in suicide prevention from Germany, Austria, and Switzerland, covering insights from policy, science, and practice. The interviews took place between September 2022 and February 2023, were audio-recorded, transcribed verbatim, and analyzed using the Framework method.ResultsWhile solid evidence supports the effectiveness of some suicide prevention interventions, experts indicated that the evaluation of many other measures is weak. Conducting effectiveness studies in suicide prevention presents a range of methodological and practical challenges, including recruitment difficulties, choosing adequate outcome criteria, ethical considerations, and trade-offs in allocating resources to evaluation efforts. Many interviewees rated the quality of national suicide statistics in Germany, Austria, and Switzerland as comparatively high. However, they noted limitations in the scope, timeliness, and reliability of these data, prompting some regions to implement their own suicide monitoring systems. None of the three countries has national routine data on suicide attempts.ConclusionWhile some challenges in evaluating suicide prevention measures are inevitable, others can potentially be mitigated. Evaluations could be enhanced by combining traditional and innovative research designs, including intermediate outcomes and factors concerning the implementation process, and employing participatory and transdisciplinary research to engage different stakeholders. Reliable suicide data are essential for identifying trends, supporting research, and designing targeted prevention measures. To improve the quality of suicide data, a standardized monitoring approach, including uniform definitions, trained professionals, and cross-sector agreement on leadership and financing, should be pursued. This study provides actionable recommendations and highlights existing good practice approaches, thereby supporting decision-makers and providing guidance for advancing suicide prevention on a broader scale.

Rationality and implication of catheter-based adrenal ablation for bilateral primary aldosteronism.

Mineralocorticoid receptor antagonists (MRAs) for bilateral primary aldosteronism (PA) are the mainstay option recommended by guidelines, but poor compliance occurs due to numerous side effects. We aimed to examine whether catheter-based adrenal ablation could be an alternative treatment for bilateral PA.644 PA patients were included from a total of 6054 hypertensive patients. Adrenal CT scan and adrenal venous sampling (AVS) were both performed for PA subtype classification. Clinical and biochemical outcomes were assessed at 6 months after treatment according to the Primary Aldosteronism Surgical Outcome (PASO) criteria.93 patients with PA were recruited to be treated by adrenal ablation, including 25 bilateral PA and 68 unilateral PA according to AVS results. Office SBP and DBP significantly decreased from baseline levels, serum potassium levels increased and ARR significantly decreased (p < 0.01) in both the bilateral and unilateral groups. In the bilateral group, complete, partial and absent clinical success was achieved in 6 (24.0%), 11 (44.0%) and 8(32.0%) patients, respectively. In the unilateral group, complete, partial and absent clinical success was achieved in 12 (17.6%), 37 (54.4%), and 19 (27.9%) patients, respectively. The numbers of patients achieving complete, partial, and absent biochemical success were 15 (60.0%), 6 (24.0%), and 4 (16.0%), respectively, in the bilateral group versus 37 (54.4%), 9 (13.2%), and 22 (32.3%), respectively, in the unilateral group. In conclusion, we provide evidence for the beneficial outcomes of unilateral adrenal ablation for patients with bilateral PA. Our findings provide insight into an alternative option for patients with bilateral excess aldosterone.