Fisher's Test Research Articles

Evaluating the Clinical Impact of Ureteral Frozen Section Analysis During Radical Cystectomy: A Single-Center Retrospective Study.

Introduction The objective of this study is to find out if there are any differences in upper urinary tract recurrence and overall mortality between patients who underwent a frozen section analysis during radical cystectomy and those who did not. Materials and methods In an observational retrospective cohort study, we evaluated data from 164 patients who underwent radical cystectomy in our institution over a five-year period from 2013 to 2018. Fisher's exact test was applied to find any difference in upper urinary tract recurrence between the two groups. The Kaplan-Meier method and the log-rank (Mantel-Cox) test were used to determine differences or equivalence between treatment groups. Results The sensitivity was 84.6% and the specificity was 95.3% for the frozen section. There was no statistically significant relationship between performing a frozen section and upper urinary tract recurrence, as indicated by Fisher's exact test (p=0.619). The Kaplan-Meier test showed no statistically significant relationship between performing a frozen section analysis and overall mortality. Discussion The use of ureteric frozen section analysis during radical cystectomy is traditionally taught during surgical training, but the evidence base for this practice is sketchy. Frozen section analysis is thought to reduce the chances of local recurrence and arguably upper urinary tract recurrence. The overall upper urinary tract recurrence after radical cystectomy is reported to be 2-6%, consistent with the 3.3% observed in our study. Conclusion Our study demonstrates that while frozen section analysis is sensitive and specific in detecting dysplasia, it does not significantly impact upper tract recurrence or overall mortality.

The Prognostic Significance of Plasma Beta2-Glycoprotein I Levels in Hepatocellular Carcinoma Patients.

Beta2-glycoprotein I (β2-GPI) is a plasma glycoprotein with multiple physiological functions, but its relationship with hepatocellular carcinoma (HCC) is still poorly understood. HCC is one of the most common forms of liver cancer and is a leading cause of cancer-related death worldwide. This study aimed to investigate the association between β2-GPI and liver cancer and further validate its potential as a biomarker for HCC. Thirty-six patients diagnosed with HCC at the Division of Gastroenterology and Hepatology, E-Da Hospital, Taiwan, were included in the study. The expression levels of β2-GPI in plasma specimens from patients with HCC were determined by enzyme immunoassay and analyzed in relation to clinicopathological variables using the Chi-square test or Fisher's exact test. The predictive significance of β2-GPI for both overall survival (OS) and disease-free survival (DFS) was assessed using Kaplan-Meier estimates, and the statistical significance of differences was evaluated through the log-rank test. Cox proportional hazards regression models were used to evaluate the association between OS/DFS time and clinicopathological characteristics. Results: Plasma β2-GPI levels were significantly lower in patients with HCC compared to non-cancer controls and significantly correlated with aspartate aminotransferase (AST) levels of HCC. High plasma β2-GPI levels were significantly associated with better OS and DFS in HCC patients. Furthermore, in multiple variates analyses, OS was found to be significantly better in HCC patients with higher plasma β2-GPI expression. Elevated levels of β2-GPI protein in the plasma of HCC patients were identified as an independent factor predictive of improved OS and DFS. Activating β2-GPI in individuals at high risk could serve as a promising way for mitigating the progression of HCC.

The benefit of automated sac volume measurements in postoperative endovascular aortic repair surveillance

Abdominal aortic aneurysm (AAA) shrinkage is considered a marker for success following endovascular aortic repair (EVAR). Although maximum diameter is widely used to assess sac behavior, research indicates that changes in AAA morphology do not always affect the maximum diameter. The aim of this study is to investigate if automated AAA sac volume measurements after EVAR can add more nuanced information on sac behavior compared with maximum diameter evaluation alone. A retrospective review of all patients treated for AAA with a standard or fenestrated EVAR at two tertiary referral centers was performed. Patients with a pre- and postoperative computed tomography angiography (CTA) ≥ two years after treatment were included. Data were collected using medical charts, radiologic institutional databases, and a deep learning based method called Augmented Reality for Vascular Aneurysm (ARVA). Volume and diameter assessments were automatically performed on CTAs using ARVA. Preoperative sac volumes and diameters were compared with those obtained at least two years after repair. Information on endoleaks (ELs) was collected. Continuous data were tested using t-test, and categorical data were tested using chi-square or Fishers test, depending on sample size. A total of 89 patients (standard EVAR n=46; fenestrated EVAR n=43) were included in this study. Of the 89 patients, 41 (46%) had sac diameter shrinkage, 38 (43%) had stable sac diameters, and 10 (11%) had diameter sac growth during follow-up. The distribution of sac volume behavior was different amongst these patients: 51 (57%) had volume shrinkage, only 9 (10%) had stable volumes, and 29 (33%) had volume growth. Significantly more patients had sac growth, and fewer had sac stability, when assessed with volume compared with diameter, p=.003 and p<.001, respectively. The increase in patients with volume-assessed sac shrinkage (57% vs 46%) was not statistically significant. Of the 18 (20%) patients with stable sac diameters and simultaneous volume growth, 13 (72%) had ELs (T2ELs: n=9, T1ELs, n=2, T3EL: n=1, and EL of undefined origin: n=1). This study found that volume-assessed sac behavior identifies more sac shrinkage or growth, and less sac stability than diameter does. If confirmed by larger studies, sac volume assessment should be performed routinely after endovascular repair.

Congenital Anomalies of the Kidney and Urinary Tract in Patients with Hirschsprung Disease.

To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease. An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022. All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant. Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis. Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT. Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

Pharmacologic properties and results of a clinical study of oxybutynin hydrochloride lotion (APOHIDE® Lotion 20%) as a novel treatment for primary palmar hyperhidrosis

APOHIDE® Lotion 20% is a topical agent for treating primary palmar hyperhidrosis that contains the active ingredient oxybutynin hydrochloride. Oxybutynin hydrochloride has anticholinergic effects and inhibits sweating by binding to the M3 receptor, a subtype of the muscarinic acetylcholine receptor, in eccrine sweat glands. The clinical response to oxybutynin hydrochloride treatment also involves N-desethyloxybutynin, an active metabolite of oxybutynin. A clinical study in Japanese patients with primary palmar hyperhidrosis showed superiority of APOHIDE® Lotion 20% over placebo, i.e., there were significantly more responders (i.e., patients with a reduction in sweat volume ≥50% from baseline) in the APOHIDE® Lotion 20% group (APOHIDE® Lotion 20% group: 52.8%, placebo group: 24.3%; treatment difference: 28.5%; P < 0.001, Fisher's exact test). This and other clinical studies reported some adverse events (AEs) associated with the drug's anticholinergic effects and some application site AEs, but most of the AEs were mild. Clinical response did not decrease with long-term (52-week) treatment, and only a few patients (2 of 125) discontinued treatment because of AEs. Taken together, study results indicate that APOHIDE® Lotion 20% may be an effective and safe new treatment option for patients with primary palmar hyperhidrosis.

Public school teachers' perceptions of internet gaming problems among students: current status and challenges

Objectives This study aimed to identify and understand the challenges faced by public school teachers regarding issues related to Internet gaming.Methods An electronic questionnaire was administered to 400 public school teachers in the Saitama Prefecture from September to November 2021. A total of 352 valid responses were obtained. The survey content included teachers' knowledge of gaming disorders, whether their students experienced gaming-related problems, difficulties perceived by teachers, how they discovered the problems, how they dealt with them, the challenges they faced in dealing with the problems, and desired support. Data were analyzed based on the teachers' roles, responsibilities, type of school, and knowledge of gaming difficulties. Fisher's exact probability tests were used to determine significance, and adjusted standardized residuals were used to assess the differences between groups.Results Nearly 63.1% of the teachers already had knowledge of gaming disorders, and 49.4% acknowledged the existence of students with gaming problems. The most common reasons for discovering problems were disrupted daily rhythm (51.7%) and increased tardiness and early dismissal (34.7%). The main actions taken to address gaming problems were "consultation and information sharing with families" (48.6%) and "individual guidance by teachers" (34.1%). Approximately half of the teachers indicated that they regularly experienced difficulties in activities related to prevention, early detection, student support, and interaction with parents. Specific challenges included limited guidance and involvement with families (61.4%) and the inability to intervene and provide effective support (62.5%). Teachers' support included programs for addiction recovery (56.8%), awareness programs for parents (56.0%), and staff training to increase the understanding of gaming disorders (50.5%). The responses varied according to teacher role and school type, indicating that implementation rates and difficulties were higher in middle schools.Conclusion We found that teachers tended to view internet gaming problems as family problems and provide complementary support for home education. Teachers also found it difficult to deal with students with gaming problems. Depending on the teacher's role in the school and the type of school, requests for support varied. Elementary and special-needs schools needed teaching materials that could be used for classroom and school-wide instruction and guidance for concerned students and their parents; junior high schools needed a consultation system with school counselors and other professionals and cooperation with healthcare; and high schools needed measures and support, including social support.

Trends and Hospitalization Outcomes of Tetanus Cases: A Multicenter Retrospective Study in Suzhou, 2013-2023.

To investigate the epidemiology, and hospitalization of tetanus in Suzhou, Jiangsu Province, China, focusing on the severity of the disease, treatment, outcomes and hospitalization costs, and to explore the risk factors for severe tetanus. This retrospective, multicenter observational study analyzed tetanus patients admitted to various medical institutions between 2013 and 2023. Patients were classified into two groups as severe or non-severe, using the Ablett classification. Differences between the two groups were compared using the Chi-squared test, Fisher's exact test and Mann-Whitney U-test. Binary logistic regression analysis was used to evaluate potentialrisk factors for severe disease. A total of 63 patients with tetanus were included in this study. The median age of the patients was 57.0 (48.0-74.0) years, with a predominance of males (65.1%). There was an overall increasing trend in the rate of severe illness in tetanus patients from 2013-2023 (P<0.001). The proportion of patients admitted to the hospital was highest (39.7%) in summer (June-August) (P=0.001). The rate of severe tetanus was significantly higher in patients aged ≥65 years than in those aged 0-40 years and 41-64 years (P=0.019). The incubation period was 8.0(5.0-11.0) days for severe tetanus patients and 11.0 (8.0-18.0) days for non-severe patients (P=0.005). Compared to the non-severe group, the severe group shouldered a higher hospitalization cost, with total costs amounting to US $19062.8(4675.4-29,385.4) and US $4291.1(1356.6-19,635.4), respectively. Binary logistic regression analysis revealed that patients aged 65 years and above significantly increased the risk of developing severe disease (OR = 3.345, 95% CI: 1.039-10.770). Tetanus occurs primarily in the summer in Suzhou City, Jiangsu Province, China. The incubation period is shorter in patients with severe tetanus. The elderly are the main affected population, with the risk of developing severe disease escalating with advancing age. Knowledge of tetanus immunoprophylaxis should be strengthened to further reduce morbidity and mortality.

Identification of Risk Factors Associated with Early Discontinuation of Physical Therapy Following Shoulder Surgery.

Postoperative physical therapy (POPT) is a critical aspect of patient recovery following orthopedic shoulder surgery. Despite the importance of POPT, some patients do not complete their course of physical therapy, which can affect postoperative recovery and outcomes. This study aimed to identify risk factors that influence patient adherence and attendance of POPT. Patients >90 days postop from elective shoulder surgery were retrospectively recruited for this study from an urban, academic tertiary medical center. Patient charts were reviewed for demographic factors with eligible patients being contacted via telephone call to answer a questionnaire concerning their use of POPT. Inadequate levels of POPT were defined as stopping formal physical therapy earlier than the physical therapist recommended. Final analysis cohorts were compared using Fisher's Exact Test and Wilcoxon Rank Sum Test. A total of 104 patients were included in the final analysis with 84 completing POPT and 20 reporting having stopped therapy early. Patient medical history including elevated BMI (mean significance difference 3.8, [0.018 to 7.6 95% CI]) p=0.026)), being a smoker (p=0.027), having diabetes (p<0.001), and having Medicaid as their primary insurance (p=0.008) were significantly associated with stopping physical therapy earlier than recommended by the physical therapist (Table I). Demographic factors such as requiring additional assistance to get to medical appointments (p=0.012) and living farther away from a physical therapy center (p=0.007) were also substantially associated with a greater risk of stopping physical therapy earlier than recommended by the physical therapist (Table II). Elevated BMI, tobacco use, diabetes, Medicaid enrollment status, requiring additional assistance to get to PT appointments, and living farther away from their physical therapy center are risk factors associated with patients stopping PT after elective shoulder surgery earlier than recommended by a physical therapist. Knowledge of these patient-specific risk factors should be considered by orthopedic surgeons and physical therapists when tailoring a POPT protocol.

Congenital Anomalies of the Kidney and Urinary Tract in Patients with Hirschsprung Disease.

To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease. An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022. All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant. Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis. Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT. Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

Frailty prevalence and associated factors in community dwelling older adults: An examination of the frailty care model

BackgroundAge-related changes put older adults at risk for frailty. The Frailty Care Model was created to inform the care of older adults with or at risk for frailty. The purpose was to test the Frailty Care Model. MethodsThis was a cross-sectional study to identify associations between factors in the Frailty Care Model, and frailty components in older adults’ strength, fatigue, ability to ambulate, and weight loss over the last year. Comparisons across frailty groups used Pearson's chi-square tests or Fisher's exact tests. ANOVA tests and Kruskal-Wallis tests were used. Multivariable ordinal regression models were fit. ResultsOdds of frailty increased by 137% for those who lived alone, 20% for those who were depressed, and 433% for those who were classified as “at risk for malnutrition”. ConclusionsThis study was the first to test the Frailty Care Model with a focus on modifiable factors that predict frailty.

Variations in Trauma Education Practices Across Emergency Medicine Residencies: Insights from a National Survey of Program Directors.

Care of the acutely injured trauma patient is integral to the practice of emergency medicine. It is currently unknown how most emergency medicine residencies structure their residents' trauma experience and little guidance for competency assessment is provided by the Residency Review Committee. Our study aimed to determine current emergency medicine residency practices in trauma resuscitation. We conducted a cross-sectional survey of members of the Council of Residency Directors in Emergency Medicine (CORD) listserv in April 2023. Frequency with percentage of item responses is reported and differences across trauma levels assessed via Fisher's exact test (α = 0.05). Fifty-seven program directors responded to the survey (21.9%), the majority of whom operate at Level I facilities. Significantly more Level II/ III centers send residents to other sites for trauma experience compared to Level I (p = 0.000). Residents participate in all key procedures (eg, airway management, central venous access) when managing traumas except thoracotomy where participation was notably lower and statistically different across levels (p = 0.000). Lastly, program directors were very confident their residents can lead traumas independently and few acknowledged citations for deficiency in trauma training. Trauma training and confirmation of competency is critical among EM residents who may serve as the sole lead in rural emergency departments. This study demonstrates that there is considerable variability in how residency programs structure trauma education, particularly with regards to the exposure to invasive procedures and the opportunity to lead trauma resuscitations. As the American Board of Emergency Medicine has introduced requirements for program directors to attest specifically to the competence of residents to lead trauma resuscitations, standardized and validated tools should be adopted to support this attestation and ensure competence regardless of the program hospital's trauma level.

Comparing the Exactech Equinoxe Reverse TSA for Fracture versus Degenerative Conditions: Five-Year Minimum Follow-Up

Reverse total shoulder arthroplasty (rTSA) has become the operative treatment of choice for acute proximal humerus fractures in the elderly population, but little data exists on the long-term outcomes or how they compare to rTSA done for degenerative conditions. The purpose of this study is to compare the clinical and radiographic outcomes of patients undergoing rTSA for acute fracture versus degenerative conditions with a minimum 5-year follow-up. Data was extracted from an international registry of patients with the Exactech Equinoxe rTSA implant from 2007-2018. Patients with a minimum follow-up of 5 years were then split into fracture and degenerative cohorts and matched 1:3 based on age, sex, and follow-up duration. Clinical and radiographic outcomes were compared between the cohorts including range of motion (ROM), patient-reported outcome measures (PROM), VAS pain score, complication and revision rates, implant characteristics, and scapular notching. This data was analyzed using Welch's t-test, Fisher's exact test, or Wilcoxon rank sum test. There were 384 total patients included in the study, with 96 fractures and 288 degenerative. At a mean follow-up of 6.4 years, the degenerative cohort had significant improvements in all PROMs and ROM, compared to their preoperative status. At the latest follow-up, the mean ASES score was 83 and the mean VAS pain score was 1.1 for both cohorts. Patients with degenerative indications had greater forward elevation which did not meet the minimally clinically important difference and greater internal rotation which did not meet the substantial clinical benefit threshold. Patient satisfaction was very high for both cohorts, with 97% in the degenerative cohort and 91% in the fracture cohort satisfied with the procedure (p=0.276). Complication and revision rates were similar between the two cohorts. Patients in the fracture cohort had a larger glenosphere diameter (p=0.045) and greater combined liner/tray offset (p=0.05). Patients in the elective cohort more frequently required an augmented baseplate (p<0.001). Scapular notching was 11% in the degenerative cohort and 9% in the fracture cohort (p=0.82). This study demonstrates no significant differences in the clinical or radiographic outcomes at a minimum of 5 years follow-up for patients undergoing rTSA for acute fracture versus degenerative conditions. Patients undergoing rTSA for either indication have similar rates of complications, revisions, and scapular notching, with high patient satisfaction. Patients undergoing rTSA for an acute fracture can expect similar results to those undergoing rTSA for degenerative conditions at minimum 5-year follow-up.

Use of Injectable Progesterone as a Pre-Synchronisation Strategy in a Timed Artificial Insemination Protocol Based on Gonadotropin-Releasing Hormone and Progesterone in Bos indicus Beef Cows in Anoestrous.

This study evaluated the effects of pre-synchronisation with injectable progesterone (P4) on the ovarian follicular dynamics of Bos taurus indicus cows in anoestrous treated with a timed artificial insemination (TAI) protocol. Multiparous Nelore females (n = 47) at 30-60 days postpartum were used in this study. 10 days before (D-10) the TAI protocol, antral follicle count (AFC; follicles ≥ 3 mm), ovarian condition and body condition score (BCS; 1-5) were assessed and were randomly allocated into two groups: Pre-sync (n = 25), which underwent pre-synchronisation with 150 mg of injectableP4 intramuscularly (i.m.), and control (n = 22), which received the same volume of NaCL 0.9%. On D0, the ovarian assessment was repeated, and TAI protocol was initiated in all animals, with the insertion of an intravaginal P4 device and administration of 10.5 μg of buserelin acetate (gonadotropin-releasing hormone-GnRH). On D7, the P4 device was removed, and 300 IU of equine chorionic gonadotropin, 150 μg of D-cloprostenol and 1 mg of estradiol cypionate were administered i.m. On the same day (D7), the presence of the corpus luteum (CL) was assessed, the dominant follicle was measured, and the tail was painted to evaluate estrous expression. On D9, the largest follicle was remeasured, and TAI was performed. Animals that were not detected in oestrous at the time of AI were administered 10.5 μg of GnRH i.m. Numerical data were analysed using the Mann-Whitney U test. Binary data were analysed using the Fisher's exact test (5%). BCS, both at the beginning of pre-synchronisation (p = 0.45) and TAI protocol initiation (p = 0.20), and AFC (p = 0.36) did not differ between control and Pre-sync groups. The diameter of the largest follicle was similar between the control and Pre-sync groups on D-10 (p = 0.32), D0 (p = 0.33), D7 (p = 0.29) and D9 (p = 0.22). On D7 of the protocol, the Pre-sync group had a higher percentage of CL visible on transrectal ultrasonography (84.0%; p = 0.02) than the control group (54.5%); however, the expression during oestrous did not differ between groups (p = 0.59). The pregnancy rate was similar (p = 0.64) between groups and was not influenced by the CL rate on D7 (p = 0.48), oestrous expression (p = 0.20) or their interaction (p > 0.1). Pre-synchronisation effectively increased the proportion of cows with CL on D7 without altering the diameter of the largest follicle, oestrous expression or pregnancy rate in anoestrous cows treated with a GnRH/P4-based TAI protocol.

Opioid Prescription Trends Among Sleep Surgeons in the United States.

This study aimed to describe trends in opioid prescriptions among US sleep surgeons between 2013 and 2021 via a retrospective analysis conducted using publicly available data. Utilizing the CMS part D database, we analyzed data from 82 sleep surgeons, focusing on metrics including number of opioid beneficiaries and claims, opioid cost, and opioid day supply per beneficiary. We employed statistical methods including ANOVA, t-tests, Fisher's exact test with Monte Carlo Simulation, and regression models. There were no significant changes in the number of opioid claims (p = 0.782) or beneficiaries per provider (p = 0.590) nor was there a decrease in opioid day supply per beneficiary (p = 0.489) over time. Surgeons who graduated residency before 2000 prescribed significantly more opioids over the course of the study period compared to those graduating after 2000 with higher opioid day supply per beneficiary (13.34 vs. 7.42, p < 0.001), higher opioid beneficiaries per provider (21.62 vs. 19.36, p = 0.028), and higher opioid claims per provider (30.30 vs. 21.78, p < 0.001). A significant annual decrease in opioid cost per beneficiary (ANOVA, p = 0.006) was noted. This study illuminates a significant impact of provider years in practice on opioid prescribing trends, alongside a decreasing trend in opioid cost per beneficiary. Despite the evolving paradigm emphasizing opioid reduction and evidence of decreasing opioid prescriptions in other otolaryngology subspecialties, our findings depict that opioid prescriptions among sleep surgeons remained stable from 2013 to 2021. 3 Laryngoscope, 134:4810-4817, 2024.

Massachusetts Pediatric Injury Equity Review (MassPIER): A Process to Address Injury Inequities.

Significant inequities in pediatric injury outcomes exist. We aim to develop a process to assist child death review (CDR) teams in identifying upstream factors that lead to inequitable outcomes in pediatric injuries. We spent 6 months (November 2021-April 2022) working with 3 CDR teams in Massachusetts to understand their tools and processes for CDR. During that time, we began to iteratively develop a pediatric injury equity review process and tools. Between May and October 2022, acceptability and adaptability of the resulting Massachusetts Pediatric Injury Equity Review (MassPIER) process and tools were evaluated through focus groups and a Research Electronic Data Capture survey of participants. We compared the prevention recommendations of the CDR teams before the implementation of MassPIER with those generated using MassPIER. A χ2 and Fisher's exact test assessed whether the 2 sets of recommendations differed with regard to equity. A 7-step process was developed, along with 2 tools for use during the MassPIER process. From an acceptability and adaptability standpoint, 100% of participants strongly agreed or agreed that the MassPIER process was simple to follow and adaptable to any type of injury. Ninety-five percent of participants agreed or strongly agreed that the approach could be replicated by other teams. Furthermore, the MassPIER process increased the likelihood of generating equity-focused recommendations in general (P < .05), and particularly recommendations focusing on economic inequities (P < .05). MassPIER is effective in facilitating equity-focused discussion and recommendation development. It is acceptable to team members, and adaptable to other types of injury.

Differentiating Seborrheic Keratosis from Melanoma Among Lesions Exhibiting Blue-White Veil: A Retrospective Study

Differentiating melanoma (MM) from seborrheic keratosis (SK) containing a blue-white veil (BWV) remains challenging. Identify dermoscopic features that can improve upon the differentiation between MMs and SKs exhibiting BWV. Images from 110 MMs and 121 SKs containing BWV were aggregated, and 91 MMs and 62 SKs from this dataset had complete agreement on the presence of BWV according to 3 expert dermoscopists. Independent readers recorded the presence or absence of dermoscopic structures using a web-based data collection instrument. Odds ratios were used to evaluate the association between features and diagnosis, and Fisher's exact test was used to determine significance of associations. The combination of milia-like cysts and/or comedo-like openings (MCCO) within the BWV and BWV encompassing the entire lesion occurred in 56% of SKs and 0% of MM. All MMs had at least one MM-specific structure other than BWV or lacked MCCO. Agreement on dermoscopic feature prevalence was variable. The subset of lesions with complete agreement on the presence of BWV may not be representative of lesions encountered in an individual clinician's practice. Lesions exhibiting BWV with MCCO and no additional MM-specific features suggests a benign diagnosis, as was not seen in any cases of MM.

Assessment of knowledge and perception of prescribers towards rational medicine use in the Ashanti Region of Ghana.

Prescribers must possess extensive knowledge and maintain a positive attitude towards the rational use of medicines to achieve desirable treatment outcomes and effectively prevent treatment failures, increased costs, drug toxicities, and interactions. The objective of this study was to evaluate prescribers' understanding and perception concerning the rational use of medicines in public hospitals. Additionally, the study aimed to identify the factors that influence rational prescribing practices. A structured data instrument was developed to collect demographic data and evaluate participants' knowledge and perception of rational medicine use, in line with the study objectives. Chi-squared statistics and Fisher's exact test were utilized to identify factors associated with good knowledge and perception among participants. Logistic regression was then employed to assess the strength of the associations, with odd ratios reported at a significant level of 0.05. Out of 192 participants, 85.4% held a positive view of rational medicine use, stressing patient safety and recognizing risks like antimicrobial resistance and polypharmacy. Perception was influenced by factors such as prescriber profession, access to references, and drug bulletin updates. Additionally, 65.6% demonstrated good knowledge of rational medicine use, which was notably influenced by factors like using standard prescribing guidelines, having a functional Drug and Therapeutics Committee, prescriber profession, and the frequency of drug bulletin updates. The study emphasizes the critical need to address knowledge gaps among healthcare professionals, especially nurses and other prescribers, to ensure the safe and effective use of medications. It highlights the positive influence of utilizing preferred prescribing references and the existence of functional Drug and Therapeutics Committees in hospitals on knowledge levels. However, the unexpected findings regarding the limited impact of frequent updates of drug bulletins require further investigation.

Evaluation of postoperative pain on Transversus Abdominis Plane block and Erector Spinae Plane block in patients undergoing gynecological surgery: a prospective, comparative study

INTRODUCTION: Moderate to severe pain after gynecological surgery has an impact on postoperative recovery and mobilization. Transversus Abdominis Plane (TAP) block and Erector Spinae Plane (ESP) block have been used as multimodal analgesia for abdominal surgery. OBJECTIVES: This study aims to compare postoperative pain in patients undergoing either ESP blocks or TAP blocks, and the need for postoperative morphine in patients undergoing gynecological surgery.MATERIALS AND METHODS: This was a single-center, prospective, double-arm, comparative study. Forty subjects were enrolled in this study, and classified into two groups. One group of 20 subjects underwent ESP block, and the remaining 20 subjects underwent TAP block following a gynecologic surgical procedure. Patients were then assessed using with the Numeric Rating Scale (NRS) pain score which will be observed at intervals of 0–1 hour, 1–6 hours, 6–12 hours, and 12–24 hours. Numerical data analysis was done using an unpaired T-test on normally distributed data and the Mann-Whitney test on non-normally distributed data. Categorical data analysis was done using Fisher's Exact Test. RESULTS: NRS score at rest was higher in the TAP block group at 1–6 hours and 6–12 hours (pain scale 3) than in the ESP block group (pain scale 1). Movement-evoked pain NRS score was higher in the TAP block groups significantly. CONCLUSION: ESP block results in a lower postoperative pain score NRS value and reduces the need for morphine in post-gynecological surgery patients with a median incision compared to the TAP block.

Effects of Ketamine 0.5 mg/kgBW administration as preemptive analgesia on analgesia duration and the need for Fentanyl following hysterectomy surgery: a randomized controlled trial

INTRODUCTION: Hysterectomy is a surgical procedure with a high number of moderate to severe postoperative pain complications. Preemptive analgesia prevents central sensitization before surgery, hampering postoperative hyperesthesia. Ketamine is one of several preemptive analgesia available. This study aims to study the effects of ketamine 0.5 mg/kgBW administration as preemptive analgesia on analgesia duration and the need for fentanyl following hysterectomy surgery. MATHERIALS AND METHODS: This study is a double-blind randomized controlled trial experiment on two groups: the treatment group (n = 20) was given ketamine 0.5 mg/kgBW and the control group (n = 20). The duration was measured starting from surgery completion up to the need for additional fentanyl 25 µg analgesia through Patient Controlled Analgesia (PCA) within 24-hour periods following surgery. Numerical data statistical analysis was done using unpaired T-test and Mann—Whitney for normally distributed data and non-normally distributed data respectively. Categorical data statistical analysis was done using the Exact Fisher test. RESULTS: The mean time recorded until additional analgesia was needed in the treatment group was 246.00 ± 33.150 minutes and in the control group was 121.50 ± 23.792 minutes. The mean total 24-hour post-surgery additional analgesia was 82.50 ± 11.75 µg and 118.75 ± 11.10 µg for the treatment group and control group respectively. There were statistically significant differences in the duration of analgesia and the need for additional analgesia between the two subject groups (p &lt; 0.05). CONCLUSIONS: Administration of ketamine preemptive analgesia at a dose of 0.5 mg/kgBW resulted in longer analgesia duration and reduced the need for fentanyl as an additional analgesic in postoperative patients compared with no preemptive analgesia and showed no significant side effects.

Efficacy of 1.5% levofloxacin otic solution in treating acute otitis externa: A post hoc analysis of ENT103-3001, a multicenter randomized double-blind parallel-group placebo-controlled phase III study in otitis media with persistent otorrhea

ObjectiveIn this post hoc analysis, we aimed to evaluate the efficacy of 1.5% levofloxacin (LVFX) otic solution for the treatment of acute otitis externa (AOE) in patients with nonintact tympanic membrane (NTM) accompanied by chronic suppurative and acute otitis media. MethodsDigital endoscopic images of the tympanic membrane and cavity were evaluated. In addition, the full analysis set from the original ENT103-3001 study was analyzed to determine the efficacy of the 1.5% LVFX otic solution in treating patients with otitis media with persistent otorrhea. AOE was diagnosed by a study-specific blinded independent review committee (BIRC) in the present study, which reviewed the presence of inflammatory findings, such as edema, erosion, and/or erythema (redness), in the external ear canal on the digital endoscopic images acquired at screening. The improvement in the inflammatory findings in each diseased ear was evaluated by examining the digital endoscopic images acquired at the end of treatment (EOT; including study discontinuation) and follow-up (F/U) visits. Data regarding residual purulent otorrhea at EOT and F/U visits were assessed by the BIRC of the ENT103-3001 study. Similarly, otological symptoms at EOT were recorded in the patients’ diaries, and the bacterial eradication rates were used from the ENT103-3001 study. Improvement was defined as the resolution of the inflammatory findings and purulent otorrhea. ResultsAmong the 201 patients with otitis media, 161 patients had AOE (LVFX group, 82; placebo group, 79). The difference (95% confidence interval) between the groups at EOT was 27.3% (12.7, 40.3), and the proportion of patients showing improvement in all inflammatory findings in the external ear canal in the LVFX group (47.6%, 39/82) was significantly higher than that in the placebo group (20.3%, 16/79; Fisher's exact test, p < 0.001). Similarly, the bacterial eradication rate in the LVFX group (94.3%, 66/70) was also significantly higher than that in the placebo group (10.3%, 7/68; Fisher's exact test, p < 0.001). ConclusionThe use of 1.5% LVFX otic solution resulted in a significantly higher rate of improvement in inflammatory findings in the external ear canal and bacterial eradication rate, indicating its efficacy. Thus, 1.5% LVFX otic solution may be an effective treatment for chronic suppurative otitis media and acute otitis media, as well as AOE with NTM.