Differences In Scale Scores Research Articles

Innovative Game-Based Teaching Methods for Promoting Nursing Students' Cultural Competence and Attitudes Toward Refugees: An Explanatory Sequential Mixed Study.

Nursing cultural competence is crucial for enhancing the quality of care for refugees. While innovative game-based teaching methods have been used to foster in a wide range of clinical competences, little is known about its use on refugees' care. This study aims to evaluate the effect of these methods on nursing students' cultural competence and attitudes toward refugees. An explanatory sequential mixed design was conducted from March to May 2023. One-hundred forty-one nursing students participated. There were no statistically significant differences in total Outgroup Threat Perception Scale and Cultural Competence Assessment Scale scores between the experimental and control groups, pre- or post-intervention. However, students reported increased awareness and empathy for refugee issues. The study showed that innovative game-based teaching methods effectively increased nursing students' awareness of health-related issues faced by refugees. It recommends incorporating transcultural nursing courses into curricula and professional training, with updated content on migration and refugee issues.

Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures.

The incidence of limb fractures in patients living with HIV (PLWH) is increasing. However, due to their immunodeficiency status, the operation and rehabilitation of these patients present unique challenges. Currently, it is urgent to establish a standardized perioperative rehabilitation plan based on the concept of enhanced recovery after surgery (ERAS). This study aimed to validate the effectiveness of ERAS in the perioperative period of PLWH with limb fractures. A total of 120 PLWH with limb fractures, between January 2015 and December 2023, were included in this study. We established a multidisciplinary team to design and implement a standardized ERAS protocol. The demographic, surgical, clinical, and follow-up information of the patients were collected and analyzed retrospectively. Compared with the control group, the ERAS group had a shorter operating time, hospital stay, preoperative waiting time, postoperative discharge time, less intraoperative blood loss, and higher albumin and haemoglobin on the first postoperative day. The time to removal of the urinary catheter/drainage tube was shortened, and the drainage volume was also significantly reduced in the ERAS group. There was no significant difference in the visual analogue scale (VAS) scores on postoperative return to the ward, but the ERAS group had lower scores on the first, second, and third postoperative days. There were no significant differences in the incidence of complications, other than 10% more nausea and vomiting in the control group. The limb function scores at one-year follow-up were similar between the two groups, but time to radiological fracture union and time to return to physical work and sports were significantly reduced in the ERAS group. The implementation of a series of perioperative nursing measures based on the concept of ERAS in PLWH with limb fracture can significantly reduce the operating time and intraoperative blood loss, reduce the occurrence of postoperative pain and complications, and accelerate the improvement of the functional status of the affected limb in the early stage, which is worthy of applying in more medical institutions.

Association of Smoking with Disease Progression in Persons with Multiple Sclerosis Undergoing Autologous Hematopoietic Cell Transplantation: A Single-Center Experience.

Background: Smoking remains a significant issue that increases the prevalence of multiple sclerosis (MS) and its progression to secondary progressive forms. Objectives: The goal is to identify the relationship between smoking and disease progression in MS patients who have undergone autologous hematopoietic stem cell transplantation (auto-HSCT) at the Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Mexico. Methods: This retrospective study involved MS patients treated with auto-HSCT, followed for 12 months. The response to transplantation was measured using the difference in Expanded Disability Status Scale (EDSS) scores before and 12 months after the transplant. A difference of -0.5 or greater indicated a good response, while a difference below 0.5 indicated a poor response. Results: The study included 419 patients, with a median age of 47 years (IQR: 40-53). The majority were non-smokers (315) compared to smokers/ex-smokers (104). In patients with PMSS, EDSS stabilization at 12 months was observed in both smokers/ex-smokers (median 6, interquartile range (IQR) = 1 vs. 6, IQR = 1, p = 0.466) and non-smokers (median 6, IQR = 1 vs. 6, IQR = 1.5, p = 0.001), although non-smokers showed a statistically significant difference. Conclusion: Smoking may negatively impact MS progression, especially in its progressive forms. (Rev Invest Clin. 2024;76(5):223-9).

Long-Term Impact of an Online Physician Group-Coaching Program to Improve Burnout and Self-Compassion in Trainees

SUMMARY Goal To evaluate long-term outcomes of Better Together Physician Coaching, a digital life-coaching program to improve resident well-being. Methods We performed a secondary analysis of survey data from the pilot program implementation between January 2021 and June 2022. An intention-to-treat analysis was completed for baseline versus post-6 months and baseline versus post-12 months for all outcome measures. Principal Findings Of 101 participants, 95 completed a baseline survey (94%), 66 completed a 6-month survey (65%) and 36 completed a 12-month survey (35%). There were no significant differences in burnout scale scores between baseline to 6 or 12 months. Self-compassion scores (i.e., means) improved after 6 months, from 33.2 to 38.2 (p < .001) and remained improved after 12 months at 36.7 (p = .020). Impostor syndrome score means decreased after 6 months, from 5.41 to 4.38 (p = .005) but were not sustained after 12 months (4.66, p = .081). Moral injury score means decreased from baseline to 6 months from 41.2 to 37.0 (p = .018), but reductions were not sustained at 12 months (38.1, p = .166). Practical Applications This study showed significant, sustained improvement in self-compassion for coaching program participants.

Development of a brief stigma and perceptions questionnaire for pharmacists: An exploratory factor analysis approach in New York state counties enrolled in the healing communities study

IntroductionLittle is known about how pharmacists' attitudes and stigma toward naloxone and Medication for opioid use disorder (MOUD) influence effective linkage to treatment. We examine the psychometrics of a new Pharmacist Opioid Use Disorder Perceptions Questionnaire (P-OUDP-Q), a multidimensional measure to examine pharmacists' stigma and perceptions related to MOUD in the New York State (NYS) site of the HEALing Communities Study. MethodsThe study recruited a sample of 324 pharmacists from 16 counties in NYS between January and June 2022. A 74-item questionnaire assessed pharmacists' familiarity with opioid-related medications, protocols, policies and attitudes regarding their role, confidence, and beliefs centered around delivery of MOUD and naloxone in the community. Exploratory factor analysis assessed individual and community-level factors associated with four underlying constructs. Factor scores were compared across the demographic predictors. Variables factor loadings <0.4 were eliminated from the factor analysis and the process was reiterated. ResultsEighty-six percent (n = 280) of the pharmacists were white. A little over half, 57 % (n = 186), were female, 35 % (n = 113) were 30–35 years old. The mean number of years practicing (SD) was 18 (SD: 13). Exploratory factor analysis identified four underlying constructs: (1) practice confidence, (2) practice familiarity, (3) practice attitudes, and (4) methadone attitudes. Statistically significant (p < .05) mean factor scale score differences by race were observed for practice familiarity (white reporting higher than non-white); by pharmacy size for practice familiarity (across all groups; non-significant Tukey post-hoc) and practice attitudes (hospital/clinic greater than big chain pharmacies); by gender (males greater than females) for practice familiarity and methadone attitudes; by poverty quartile for practice attitudes (lowest less than highest quartile); and urban versus rural pharmacist county setting for practice familiarity (rural greater than urban). ConclusionsFindings show the P-OUDP-Q is a concise measure of pharmacists' perceptions of their role in dispensing MOUD and naloxone, including distinct “stigma” dimensions, which is valuable for use with pharmacists in communities highly impacted by the opioid epidemic. The development and validation of a reliable measure to assess pharmacists' perceptions of stigma and barriers represents a valuable contribution to the field, to inform the design/implementation of targeted interventions and support systems.

Effect of bioceramic-based and resin-based sealers on postoperative discomfort following root canal therapy: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to furnish evidence-based recommendations for the utilization of bioceramic-based and resin-based sealers in clinical endodontics, with a focus on reducing postoperative discomfort. The investigation's methodology was registered on the International Prospective Database of Systematic Reviews (PROSPERO: CRD42022355506) and executed using the 2020 PRISMA protocol. Articles were selected utilizing the PICO technique and applying specific inclusion and exclusion criteria. Articles published between January 2000 and August 2022, PubMed, MEDLINE, and DOAJ were utilized as primary data sources. After the identification of studies, two autonomous reviewers evaluated the titles and abstracts, and data from qualifying studies were extracted. Nine published studies were included in this analysis. The findings indicate that there were no significant differences in the Visual Analog Scale (VAS) scores between resin-based and bioceramic root canal sealers at intervals of 6 hours, 12 hours, 24 hours, and 48 hours after treatment. The findings of this systematic review and meta-analysis suggest that after the utilization of bioceramic sealers during root canal therapy, the pain and discomfort levels were not significantly different from those experienced pain after the use of resin-based sealers.

Assessment of health-related quality of life of children with idiopathic nephrotic syndrome and their caregivers in China

AimsThe primary aim of this study was to characterize the health-related quality of life (HRQoL) and identify the associated factors among children aged 2 to 18 in China diagnosed with idiopathic nephrotic syndrome (INS). Additionally, the study aimed to evaluate the HRQoL and caregiving burden of their caregivers and investigate the correlation between the HRQoL of the children and that of their caregivers.MethodsThis study recruited 181 children diagnosed with INS from Children’s Hospital, Zhejiang University School of Medicine in China. The proxy-reported PedsQL Generic Core Module (PedsQL™ 4.0 GCM) was used to measure the HRQoL of children, and the EuroQol five-dimensional questionnaire, five-level version (EQ-5D-5L) was applied to measure caregivers’ HRQoL. Differences in scale scores and total scores of PedsQL™ 4.0 GCM were assessed using t-tests and one-way ANOVA. Multivariate linear regression analysis was used to identify the factors associated with children’s HRQoL. Pearson correlation analysis evaluated the correlation between children’s HRQoL and caregiver’s HRQoL.ResultsHRQoL of Children with INS declines with increasing age, and children aged 5-18 had lower scores in physical functioning, emotional functioning, school functioning, psychosocial health summary score, and total PedsQL™ 4.0 GCM score compared to healthy children. Various factors, including the mother filling out the questionnaire, the father being unemployed, and the use of other medications except for steroids, were associated with worse HRQoL of children (p values < 0.05). Additionally, a correlation exists between children’s HRQoL and their caregivers’ HRQoL.ConclusionThis study evaluated the HRQoL of children aged 2-18 years diagnosed with INS in China, along with the HRQoL of their caregivers. Multiple factors potentially influence the HRQoL of children. A significant correlation was observed between the HRQoL of children and their caregivers, who frequently experienced varying levels of caregiving burden. Therefore, it is recommended that healthcare professionals prioritize optimizing HRQoL for children with INS and their caregivers.

Effects of cooperative learning and situational simulation on nursing competence in clinical practice among nursing students: A quasi-experimental study

BackgroundAppropriate cooperative learning and situational simulation designs can enhance mental health and nursing competence in clinical practice. This approach is crucial for cultivating the clinical nursing competence of nursing students. AimTo determine the effect of combining cooperative learning and situational simulation on nursing competence in clinical practice. DesignA quasi-experimental study. Setting and participantsThis study was conducted with 142 s-year students in the nursing department of a university in Taiwan. MethodsThe experimental group received cooperative learning combined with situational simulation methods, while the control group used only cooperative learning methods. Data were collected using the Clinical Practice Stress Scale and the Fundamental Nursing Competence Scale. Percentiles and frequency distributions were used to analyze the data, and independent t-tests were conducted to compare differences between the groups. ResultsThere were no significant differences in descriptive characteristics between the groups (p > .05). Post-test measurements of nursing technical performance, total score on the fundamental nursing competence scale and six sub-dimensional scores of the students in the experimental group were significantly improved compared to the control group (p < .001). However, there were no significant differences in total clinical practice stress scale scores between the groups (p > .05). Interestingly, the knowledge score of the control group was significantly higher than that of the experimental group (p < .05). ConclusionThe combined methods of cooperative learning and situational simulation have been shown to positively impact students' academic and nursing technical performance. The results indicate improvements in nursing competence in clinical practice, with signs of a reduction in clinical practice-related stress. Nurse educators can apply these strategies in clinical nursing education to achieve better outcomes.

Efficacy of Thiocolchicoside for Musculoskeletal Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Despite the fact that thiocolchicoside has been widely used in the treatment of musculoskeletal pain, its efficacy has never been systematically evaluated. We carried out a systematic review and meta-analysis of randomized clinical trials (RCTs) to appraise the existing evidence on the efficacy of thiocolchicoside for musculoskeletal pain management. Methods: The literature search was performed on multiple databases, extracting reports of RCTs evaluating the efficacy of thiocolchicoside compared to placebo or no exposure. The reduction in pain intensity was evaluated through between-groups mean differences (MDs) in Visual Analogue Scale (VAS) scores after the intervention. The pooled effect estimates were compared to a minimally important difference (MID) of 1 point on a scale from 0 to 10. Results: We retrieved eight RCTs, including a total of 1397 patients. All the included studies were determined as being at high risk of bias. Seven trials evaluated patients with acute low back pain. After 2-3 days of treatment, the pooled MD in VAS score was -0.49 (95%CI = -0.90; -0.09) compared to controls. After 5-7 days of treatment, the summary MD was -0.82 (95%CI = -1.46; -0.18). Conclusions: Although thiocolchicoside was found to significantly reduce patient-reported low back pain, the clinical impact was very small, as the pooled effect estimates were below the MID, and the overall certainty of evidence was very low. In light of the safety concerns raised by the European Medicine Agency, an in-depth analysis on the risk-benefit balance of thiocolchicoside is required.

The effect of simulated problem learning in nursing ethics on moral sensitivity, empathy and critical thinking of nursing students: A quasi-experimental study

AimCompare the effects of Simulation with problem-based learning (SPBL) and Problem-based learning (PBL) in nursing ethics education on nursing students’ moral sensitivity, empathy, critical thinking, test scores and teaching satisfaction. BackgroundPromoting nursing students’ individual and ethical and abilities through education is an essential way to improve their ethical performance and build trustful relationship with patients. Despite significant efforts in this area, few have evaluated the effectiveness of Simulation with problem-based learning and Problem-based learning as applied to nursing ethics education. DesignA quasi-experimental design based on a non-equivalent control group pre-test/post-test. MethodsA quasi-experimental design was used. Participants were 161 undergraduate nursing students from two levels of a university, 88 subjects in the experimental group were taught using Simulation with problem-based learning and 73 subjects in the control group were taught using Problem-based learning. A pre-test, post-test and questionnaire were used to assess the effectiveness of student nursing ethics education. χ2 test was used to examine group differences in students’ characteristics and satisfaction with teaching post-intervention. Student’s t-test was used to assess group differences in scale scores and test scores. ResultsCompared to the pre-test, empathy as well as critical thinking were significantly higher in the PBL group (P<0.05), but there was no significant change in moral sensitivity (P>0.05); moral sensitivity, empathy and critical thinking were significantly higher in the SPBL group (P<0.05). Moreover, this study also showed that improvement in moral sensitivity, empathy, critical thinking and grades was more significant in the SPBL group of nursing students compared to the PBL group (P<0.05) and no statistically significant difference was found between the two groups in terms of teaching satisfaction (P>0.05). ConclusionThe use of Simulation with problem-based learning in nursing ethics education has a positive impact on nursing students' competency development and knowledge acquisition. Nurse educators should consider this teaching method and promote change to increase the effectiveness of nursing ethics education.

Factors affecting the therapeutic effects of multiple intra-articular injections of platelet-rich-plasma for knee osteoarthritis

BackgroundPlatelet-rich-plasma (PRP) is rapidly spreading as a conservative treatment option for knee osteoarthritis (KOA), however, its therapeutic efficacy is controversial. This study aimed to investigate the factors affecting the therapeutic effect of intra-articular PRP therapy for KOA in patients who received multiple PRP injections (PRP-I). MethodsThis is a historical cohort study included 1057 knees of 701 patients who received PRP-I during KOA treatment from 2018 to 2020. The difference in visual analog scale (VAS) scores before and after PRP-I was defined as the amount of change in VAS (ΔVAS). A linear mixed-effects model was employed with ΔVAS as a random effect and age, sex, BMI, KL classification, pre-treatment VAS, treatment duration, and the number of PRP injections as fixed effects. Evaluations using the Kellgren-Lawrence (KL) classification were added. ResultsAge, KL grade, and VAS score before treatment and after three, four, and five PRP-I were significantly associated with ΔVAS score. According to KL grade, age was significantly associated with ΔVAS score in the KL grade 4 group. VAS score before treatment was significantly associated with ΔVAS score, regardless of KL grade. Three-time PRP-I were significantly associated with ΔVAS in the KL-grade 1 and 2 groups. For KL grade 4, two or more PRP-I were significantly associated with the high efficacy. ConclusionsAge, pain before treatment, KL grade and number of injections were associated with pain reduction after intra-articular PRP-I for KOA treatment. Pain reduction can be expected after PRP-I when patients are younger or experience severe pain before treatment. Three-time PRP-I are recommended to reduce pain in early-stage KOA and more than three times in advanced-stage KOA. Trial registrationRetrospectively registration.

Community Flexible Endoscopic Evaluation Of Swallowing (FEES): A Prospective Cohort Study Of Clinical, Process And Patient-Reported Outcomes

Abstract Background Dysphagia prevalence increases with age, impacts on quality of life and increases healthcare utilisation and cost (Atrill 2018). Instrumental swallowing assessment is essential for accurate diagnosis and treatment of dysphagia but can be difficult to access in the community. FEES is a gold-standard instrumental assessment delivered by speech and language therapists (SLTs). The aim of this abstract is to report clinical, process and patient-reported outcomes of participants who had a community FEES over a 6-month period. Methods A prospective cohort study recruiting adults who accessed community FEES in Ireland's Mid-West. Baseline assessment data (demographics, a range of validated tools and process data) were recorded at index visit. A structured phone interview was completed at six months. The primary outcome was the rate of medical complications potentially caused by dysphagia at follow-up. Secondary outcomes included healthcare utilisation, dysphagia severity, functional status and quality of life. Results 62 participants were recruited: mean age: 70.98 (SD=15.01), 55.4% were female. At follow-up, 27.42% reported medical complications potentially attributable to dysphagia, 27.4% had attended general practice, 3.23% attended medical assessment units, 6.45% attended emergency departments. 82.26% were diagnosed with dysphagia or modified independence: Dysphagia Outcome Severity Scale (DOSS) ≤6, (M=5.2, SD=1.53). Changes to dysphagia care plans were recommended in 60.94% of cases. There was significant difference in Functional Oral Index Scale (FOIS) scores across time, F (1.75, 106.78) = 5.38, p = 0.008. FOIS scores at 6 months (M=5.92, SD=1.50) were significantly higher than pre-FEES (M=6.42, SD=1.37). Significant differences in quality of life (EQ5D5L-VAS) scores p&amp;lt;0.001 were detected: higher scores at 6-months (M=69.35; SD=20.42) compared to index visit (M=64.52; SD=19.44). Conclusion Access to community FEES for older persons may improve outcomes by reducing the frequency of dysphagia-related complications and healthcare utilisation, improving functional swallowing status, enhancing quality of life and contribute to evidence-based dysphagia diagnosis and care planning.

Instrumental activities of daily living in neuro-oncology: International validation of the EORTC IADL-BN32 questionnaire

BackgroundNeurocognitive impairments are common in patients with a brain tumour, and may negatively impact on functioning in daily life, particularly on instrumental activities of daily living (IADL). The EORTC IADL-BN32 questionnaire was developed to measure IADL in this patient population. MethodsIn this international validation study, we evaluated the EORTC IADL-BN32 questionnaire on several psychometric properties in a large sample of patients with a primary or metastatic brain tumour. We administered the 32-item questionnaire three times: at ‘baseline’, after 2 weeks and after 3 months. Procedures were in accordance with EORTC Quality of Life Group module development guidelines. ResultsIn total, 326 patients participated in the study. A bifactor scale structure showed satisfactory model fit measures, with five multi-item scales and two single items, and an IADL sum score. The internal consistency of the multi-item scales ranged from good to excellent (range Cronbach’s α: 0.86–0.97). We found significant differences in scale scores between patients with and without neurocognitive impairments or complaints, supporting the construct validity. Initial cross-cultural validity analyses showed indications of item response biases for certain items. Analyses indicated moderate to good test-retest agreement (intraclass correlation coefficient > 0.70) between baseline and the 2-week follow-up assessment for all but one scale. Deterioration of EORTC IADL-BN32 scale scores were consistent with clinically relevant deterioration on other functional measures with small to large effect sizes, however, subgroup sample sizes were small. ConclusionOverall, the EORTC IADL-BN32 questionnaire exhibited adequate to excellent psychometric properties. Cross-cultural validity and responsiveness should be further explored.

B - 48 Gender-Based Network Comparisons of the Post-Concussion Symptom Scale at Acute Post-Concussion

Abstract Objective Prior literature suggests there may be gender-based differences in Post-Concussion Symptom Scale (PCSS) scores, with girls reporting more symptoms than boys at pre- and post-concussion. PCSS network analysis comparisons on gender have been conducted at pre-concussion but not post-concussion, which can determine whether gender-based differences in symptom relationships exist post-concussion. We conducted network comparisons between boys and girls from a sample of high school athletes at acute post-concussion to analyze differences in symptom relationships. Method Separate network analyses were conducted on acute post-concussion PCSS scores (within 72 hours post-suspected concussion) for boys (n = 2032) and girls (n = 1246), with nodes representing PCSS items and edges representing partial correlations between them. Expected influence was calculated to determine node importance in each network. Network Comparison Tests were used to compare network structure, global connectivity, and expected influence. Results Both networks’ expected influences and edge weights were stable and interpretable. There were no significant differences in network structure, connectivity, and expected influence between the groups. Networks consisted of positive and negative edges; strongest edges connected symptoms within similar domains (e.g., light and noise sensitivity). Conclusions Current results suggest that prior reports of gender-based differences in PCSS scores following concussion do not appear to be accounted for by differences in how PCSS items interact and influence each other. Differences may reflect actual differences in type and severity of post-concussion symptoms experienced by boys and girls or reflect differences in symptom reporting based on cultural influences. Future research could examine cultural or societal factors that influence gender-based differences in symptom reporting.

Intrathecal Drug Delivery System in Prepontine Cistern for Patients with Intractable Craniofacial Cancer Pain: A Multicenter Retrospective Study.

Patients with craniofacial cancer frequently suffer from severe pain. The traditional intrathecal, oral, or intravenous analgesics could only provide insufficient pain relief with many side effects. Thus, a more effective analgesia approach is required. This study aimed to investigate the safety and efficacy of placing the catheter of an intrathecal morphine pump in the prepontine cistern for the treatment of craniofacial cancer pain. We performed a retrospective study of patients with primary or metastatic craniofacial cancer pain who received the catheter placement of an intrathecal morphine pump into the prepontine cistern in eleven medical centers from September 2019 to December 2023. Friedman test and pairwise signed-rank test were used to evaluate the difference in numeric rating scale (NRS) scores, the number of breakthrough pain episodes, dose of intrathecal morphine, and dose of systemic morphine equivalents (oral, patch, intravenous) from preoperative period to postoperative days 1, 7, and 30. P values were corrected for multiple comparisons using Bonferroni test. The study included 33 patients. The median (interquartile range [IQR]) of NRS scores at days 1, 7, and 30 postimplant were 2.0 (1.0-3.5), 2.0 (1.0-2.0), and 1.0 (1.0-2.0), respectively, which was significantly lower than that before surgery (median, 8.0; IQR, 7.0-10.0; all P < .001). Compared to baseline number/d of breakthrough pain episodes (median, 6.0; IQR, 4.5-10.0), there was a progressive decrease in the number/d of breakthrough pain episodes at day 1, day 7, and day 30 postimplant, and the median (IQR) were 1.0 (0.0-3.0), 2.0 (0.0-3.0), and 0.0 (0.0-1.2), respectively (all P < .001). Approximately 78.8% and 96.7% of patients reported pain relief >50% at days 1 and 30 postimplant, respectively. Compared with that at day 1 postimplant, the proportion of patients with a pain relief rate >75% at day 30 postimplant also increased with continued intrathecal treatment. Compared to the dose of baseline systemic morphine equivalents (median, 228 mg.d-1; IQR, 120-408 mg.d-1), the dose of systemic morphine equivalents reduced significantly from 0(0-120) mg.d-1 at day 1 postimplant (P = .001), to 0 (0-0) mg.d-1 at days 7 and 30 postimplant (both P < .001). Few patients reported perioperative adverse events, including nausea, constipation, hypotension, urinary retention, dry mouth, headache, and sedation. No severe adverse events occurred. Placing the catheter tip of an intrathecal morphine pump into the prepontine cistern could effectively relieve refractory craniofacial cancer pain with an extremely low total morphine dose requirement and few adverse events. This procedure could be considered in patients with severe refractory craniofacial cancer pain.

Adductor canal block combined with genicular nerve block versus local infiltration analgesia for total knee arthroplasty: a randomized noninferiority trial

ObjectiveThis randomized controlled and double-blind study aimed to investigate whether the analgesic effect of the adductor canal block (ACB) combined with the genicular nerve block (GNB) after total knee arthroplasty is noninferior to that of the adductor canal block combined with local infiltration analgesia (LIA).MethodsA total of 102 patients undergoing total knee arthroplasty under general anesthesia were included and randomly divided into: ACB + GNB and ACB + LIA groups; the ACB + LIA group received 80 mL of 0.2% ropivacaine with adrenaline 10 µg/mL for LIA, whereas the ACB + GNB group received 4 mL of 0.2% ropivacaine for the blockade of five peri-knee nerves. The primary outcome was the median difference in the visual analog scale scores at rest at 24 h between the two groups. Secondary outcomes involved the median differences in the pain scores at other time points. Other outcomes included the cumulative dosage of opioids calculated in morphine equivalents in the first 24 h and indicators related to knee joint functional recovery.ResultsIn total, 36 and 38 patients were included in the ACB + GNB and ACB + LIA groups, respectively. We found that the median difference (95% confidence internal) in postoperative rest pain at 24 h (noninferiority criteria, △ = 1) was − 0.5 (− 1 to 0, p = 0.002). The median difference in cumulative opioid consumption was 1 mg (− 1 to 3, p = 0.019), meeting the noninferiority criteria, △ = 7.7 mg.ConclusionsACB combined with GNB provides noninferior analgesia compared to ACB with LIA on the first day after total knee arthroplasty while significantly reducing local anesthetic use.Trial registrationName of the Registry: Chinese Clinical Trial Registry; Trial Registration Number: ChiCTR2300074274; Date of Registration. August 2, 2023.

The outcomes of component separation technique versus no component separation technique in the repair of large ventral hernias and impact on quality of life: a multicenter retrospective cohort study.

This study aimed to compare the results of patients who underwent anterior component separation techniques (ACST) and those who did not undergo component separation techniques (non-CST) in complicated ventral hernia repairs (VHRs) and to investigate the effect of these techniques on quality of life (QoL). A total of 105 patients who were operated for large ventral hernias were retrospectively analyzed. The patients were divided into the ACST group (n = 48) and the non-CST group (n = 57). Demographic, intraoperative, and postoperative data were recorded. Postoperative follow-up was conducted at 2 and 4 weeks, and 6, 12, and 24 months. The primary and secondary outcomes and QoL were measured. The female ratio was higher in both groups (P = 0.512). There was no significant difference between age and body mass index between the groups (P = 0.705 and P = 0.803). The mean defect size and mesh size were similar between the groups (P = 0.775 and P = 0.245). The mean operation duration and amount of blood loss were similar between the groups (P = 0.801 and P = 0.142). There was no statistically significant difference in the median visual analog scale scores between the groups (P = 0.551). During follow-up, only 3 patients (6.3%) in the ACST group and 4 patients (7.0%) in the non-CST group had recurrence. There was no significant difference in the short- and long-term QoL between the groups. The ACST is a feasible surgical option for patients with complicated VHRs. In addition, by improving QoL, the recurrence rate is similar to patients undergoing standard VHR.

Perioperative Dexamethasone Split Between Two Doses Further Reduced Early Postoperative Nausea and Vomiting Than Single-Dose Dexamethasone: A Randomized Blinded Placebo-Controlled Trial

BackgroundWe investigated whether two doses of dexamethasone are more effective than a single dose in reducing early postoperative nausea and vomiting (PONV) during total knee arthroplasty (TKA). MethodsA total of 150 patients between June 2021 and June 2022 were randomized into 3 groups: two doses of normal saline (group A), a single dose of 10 mg dexamethasone before surgery and normal saline after surgery (group B), and two doses of 5 mg dexamethasone during the perioperative period (group C). Primary outcomes were incidences and severity of PONV within 24 hours after surgery, the number and consumption of patients requiring morphine and metoclopramine, and visual analog scale scores for nausea and vomiting at 2, 4, 6, and 24 hours after surgery. Blood glucose levels on days 1, 2, and 3 after operation and incidences of surgical site infection (SSI) as well as gastrointestinal bleeding (GIB) within 45 days after operation were compared. ResultsWithin 24 hours after operation, the number and consumption of patients requiring morphine and metoclopramide in groups B and C were significantly lower than those in group A. Incidences and severity of PONV in groups B and C were significantly lower than those in group A. And these differences between groups B and C were significant. At 2, 4, 6, and 24 hours after operation, there were significant differences in visual analog scale scores of PONV between groups A and B, A and C, as well as B and C. On postoperative days 1, 2, and 3, there were no significant differences in blood glucose levels among the groups, and there were no incidences of SSI or GIB in any group within 45 days after operation. ConclusionDexamethasone significantly reduces PONV within 24 hours after TKA, does not result in significant changes in postoperative blood glucose levels, and does not increase the risk of SSI or GIB, particularly on group C. Registration numberChiCTR2400088512. Registration centerChinese Clinical Trial Registry (ChiCTR). Websitewww.chictr.org.cn.

The Knowledge, Attitudes, and Practices of Healthy Eating Questionnaire: a pilot validation study in Chinese families.

Identifying the knowledge, attitudes, and practices (KAP) gaps of healthy eating can inform the design of effective interventions. This study aimed to test the validity and psychometric properties of a KAP of Healthy Eating Questionnaire (KAP-HEQ) tailored to the Chinese culture. The dimensions and potential items of each KAP scale were identified from published KAP and health literacy questionnaires, which were supplemented by the findings of a previous qualitative healthy eating study. Content validity of the KAP-HEQ was evaluated by eight experts and eight Chinese parent-adolescent dyads in Hong Kong through content validity ratio (CVR), content validity index (CVI), and qualitative feedback. The feasibility, construct validity, reliability, and sensitivity of the KAP-HEQ were evaluated in this pilot study among 60 adolescent-parent dyads (120 persons) through an online survey. The first 30 dyads who completed the KAP-HEQ were invited to repeat the KAP-HEQ 2 weeks later to assess the test-retest reliability. The final 44-item KAP-HEQ was completed in 10-15 min by both adolescents and their adult parents. The CVR ranged from -0.38 to 1, and the CVI ranged from 0.56 to 1. Over 80% of the items achieved convergent validity (a significantly positive correlation with its hypothesized scale) and discriminant validity (a higher correlation with its hypothesized scale than with the other two scales). Cronbach's alpha for the internal consistency of the Overall, Attitude, and Practice scales was >0.7, while that of the Knowledge scale was 0.54. The intraclass correlation coefficient (ICC) on test-retest reliability of the Overall and individual scales were all >0.75 except that of the Knowledge scale (ICC = 0.58). The significant differences in KAP scale scores with small to large effect sizes were found between known groups as hypothesized, except the Attitude score between groups by household income, which supported the sensitivity of the KAP-HEQ. The KAP-HEQ has shown good validity, reliability, and sensitivity among Chinese adolescents and adults, which can be applied to evaluate KAP status and gaps to inform the design and assess the effectiveness of healthy eating interventions.

Depression and Implantable Cardioverter-Defibrillator Implantation in Black Patients at Risk for Sudden Cardiac Death.

Black patients meeting indications for implantable cardioverter-defibrillators (ICDs) have lower rates of implantation compared with White patients. There is little understanding of how mental health impacts the decision-making process among Black patients considering ICDs. Our objective was to assess the association between depressive symptoms and ICD implantation among Black patients with heart failure. This is a secondary analysis of the VIVID (Videos to Address Racial Disparities in ICD Therapy via Innovative Designs) randomized trial, which enrolled self-identified Black individuals with chronic systolic heart failure. Depressive symptoms were assessed by the Patient Health Questionnaire-2 and the Mental Component Summary of the 12-Item Short-Form Health Survey. Decisional conflict was measured by an adapted Decisional Conflict Scale (DCS). ANCOVA was used to assess differences in Decisional Conflict Scale scores. Multivariable logistic regression was used to examine the association between depressive symptoms and ICD implantation. Among 306 participants, 60 (19.6%) reported depressed mood, and 142 (46.4%) reported anhedonia. Participants with the lowest Mental Component Summary of the 12-Item Short-Form Health Survey scores (poorer mental health and higher likelihood of depression) had greater decisional conflict regarding ICD implantation compared with those with the highest Mental Component Summary of the 12-Item Short-Form Health Survey scores (adjusted mean difference in Decisional Conflict Scale score, 3.2 [95% CI, 0.5-5.9]). By 90-day follow-up, 202 (66.0%) participants underwent ICD implantation. There was no association between either the Patient Health Questionnaire-2 score or the Mental Component Summary of the 12-Item Short-Form Health Survey score and ICD implantation. Depressed mood and anhedonia were prevalent among ambulatory Black patients with chronic systolic heart failure considering ICD implantation. The presence of depressive symptoms did not impact the likelihood of ICD implantation in this population.