Management Group Research Articles

Service evaluation of the research outputs for 23/24 at a large London teaching hospital

Abstract Introduction The recent report of a UK survey of pharmacy professionals’ involvement in research1 found only small numbers of the pharmacy workforce are currently undertaking research. A number of reasons for this are identified and the report contains a list of recommendations to support the embedding of research into pharmacy careers.1 Within the pharmacy department at King’s College Hospital NHS Foundation Trust (KCH) all research proposals are presented at the pharmacy research and audit group and a log is kept of department research outputs by the clinical academic research lead. The analysis of this data will provide a benchmark. For the purposes of this study, research encompasses audit, service evaluation and research studies as defined by the Health Research Authority defining research table.2 Aim To identify, over the financial year 23/24, the frequency of different types of research outputs from the pharmacy department at KCH broken down by output type, specialty and role. Methods Regular emails were sent April 23 – March 24 to remind staff to identify and share research outputs with the clinical academic research lead. Outputs received were circulated by newsletter to encourage and motivate others. The clinical academic research lead engaged with individual pharmacy teams throughout the year to encourage and support research outputs. Research output data was collected, April 23 – March 24, on an Excel spreadsheet including staff name, role, specialty, type of research output and date the output was completed. Research outputs were categorised into published articles, published abstracts, attendance at conference, abstracts presented at conference and presentations at conference or national webinar. Ethics was not required as the study is defined as a service evaluation. Results There were a total of 89 research outputs by the pharmacy department across the year. These were broken down into published articles (20), published abstracts (16), attendance at conference (24), abstracts presented at conference (26) and presentations at conference or national webinar (3). The two specialty teams who produced or took part in the most research outputs over the year were critical care (15) and liver (11). Consultants pharmacists were involved in the most research activity (32) followed closely by principal pharmacists (26), specialist pharmacists (25) and the deputy chief pharmacists (19). Pharmacy technicians, pharmacists taking part in the STEP programme and non-registered pharmacy staff scored the least in terms of research activity relative to size of staff group. Consultant pharmacists and principle pharmacists were the groups that published the most articles (8 each). Discussion and conclusion The trust implemented a new electronic patient record system during the year which may have impacted the number of research outputs. A limitation to this study is that there are likely to be unrecorded research outputs. The data broken down by specialty and role will allow the pharmacy management group and clinical academic research lead to support, engage and motivate in those areas to allow staff to have the time, skills and guidance to carry out research activities. The results can be used by other healthcare organisations to benchmark against.

Application of detailed nursing management intervention in neurosurgical nursing

BACKGROUND: In the contemporary healthcare environment, optimizing patient care strategies is of importance, particularly in neurosurgical environments. While traditional nursing methods have the foundation of patient care, there exists a growing recognition of the potential benefits of comprehensive nurse management. Despite this acknowledgment, there remains a gap in understanding the comparative effectiveness of comprehensive nurse management versus traditional approaches in reducing postoperative psychological stress, enhancing patient satisfaction, and promoting adherence in neurosurgical patients. OBJECTIVE: This study compares the efficacy of comprehensive nurse management against traditional methods in facilitating the postoperative recovery of neurosurgical patients. METHODS: Taking the traditional nursing management and detailed nursing management of neurosurgical patients in a municipal neurosurgical hospital from March 2021 to March 2022 as an example, the neurosurgery was divided into 50 patients in the detailed nursing management group and 50 patients in the traditional nursing management group. In the clear nursing management group, there were 50 patients, 20 male patients, with an average age of 58.7 ± 3.8 years, and 30 female patients, with an average age of 60.4 ± 4.3 years; In the traditional nursing management group, there were 50 patients, 26 male patients, with an average age of 59.7 ± 3.7 years, and 24 female patients, with an average age of 59.4 ± 3.9 years; Among the 100 patients, there were 60 cases of cerebral infarction, 25 cases of intracerebral hemorrhage and 15 cases of other neurosurgical diseases. RESULTS: Hundred neurosurgical patients were divided into two groups: comprehensive nursing management group and traditional nursing management group. The results showed that the comprehensive treatment effect of patients with detailed nursing management was better than that of the routine nursing group. At the same time, the complications were reduced, and the patient’s satisfaction was higher. CONCLUSION: Through retrospective analysis and investigation of patients, this paper discusses the clinical application of a detailed nursing management model in neurosurgery, which can reduce the probability of infection and other complications and improve the quality of life and treatment effect of patients.

National Health Education Standards: Model Guidance for Curriculum and Instruction (Third Edition).

Since the 1990s, national standards have been developed in K-12 subject areas. National standards in health education were first released in 1995 with a second set released in 2007. A third edition, the National Health Education Standards: Model Guidance for Curriculum and Instruction was developed in 2022 under the auspices of the National Consensus for School Health Education. The purpose of this article is to present an overview of the third edition including descriptions of the development process;the 8 standards and aligned performance expectations; considerations related to the translation, dissemination, and implementation of the standards; and projections for potential impact regarding teaching and student outcomes. To develop new standards, the National Consensus formed 3 groups: the Management, Development, and Expert Review Groups. These groups employed an iterative process that included the development of 3 drafts of the standards before finalization. This process included a review of each draft by the 3 groups. The second draft included additional qualitative feedback from over 500 school health education leaders, practitioners, and stakeholders. The third edition includes 8 standards with aligned performance expectations. A description and rationale are provided for each standard along with standard-specific teaching guidance. The third edition of the National Standards for School Health Education provides guidance to state departments of education and local schools in the development and implementation of health instruction that promotes meaningful learning to guide students in the promotion of their own health and the health of others.

Efficacy of a WeChat-Based, Multidisciplinary, Full-Course Nutritional Management Program on the Nutritional Status of Patients With Ovarian Cancer Undergoing Chemotherapy: Randomized Controlled Trial.

As the most malignant type of cancer in the female reproductive system, ovarian cancer (OC) has become the second leading cause of death among Chinese women. Chemotherapy is the main treatment for patients with OC, and its numerous adverse effects can easily lead to malnutrition. It is difficult to centrally manage patients with OC in the intervals between chemotherapy. The use of WeChat, an effective mobile tool, in chronic disease management has been highlighted. This study aimed to implement a continuous follow-up strategy and health monitoring based on the WeChat platform for patients with OC undergoing chemotherapy to ensure that each phase of chemotherapy was delivered on schedule and to improve the survival rate of patients with OC. Participants were recruited and randomly assigned to either the WeChat-based nutrition intervention group or the usual care group. A self-administered general information questionnaire was used at enrollment to obtain basic information about the patients. The Patient-Generated Subjective Global Assessment (PG-SGA) Scale was used to investigate the nutritional status of the patients at 3 time points (T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). The blood indices of patients were investigated through the inhospital health care system at 3 times（T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). Patients in the intervention group were introduced to the nutrition applet, invited to join the nutrition management group chat, and allowed to consult on nutritional issues in private chats with nutrition management team members. Linear mixed models were used to analyze changes in each nutritional indicator in the 2 groups, with their baseline measurements as covariates; with group, time, and group-time interactions considered as fixed effects; and with patients considered as random effects. A total of 96 patients with OC undergoing chemotherapy were recruited into the study. Distribution was based on a 1:1 ratio, with 48 patients each in the nutrition intervention group and the usual care group. The attrition rate after the first chemotherapy session was 18.75%. The mixed linear model revealed that the group-based effect and the group-time interaction effect on PG-SGA scores were significant (F38,38=4.763, P=.03; F37,37=6.368, P=.01), whereas the time-based effect on PG-SGA scores was not (F38,38=0.377; P=.54). The findings indicated that the group-based effect, the time-based effect, and the group-time interaction effect on nutrition-inflammation composite indices were significant (F38,38=7.653, P=.006; F38,38=13.309, P<.001; F37,37=92.304, P<.001; F37,38=110.675, P<.001; F38,38=10.379, P=.002; and F37,37=5.289, P=.02). This study provided evidence that a WeChat-based, multidisciplinary, full-course nutritional management program can significantly improve the nutritional status of patients with OC during chemotherapy.

PELATIHAN WIRAUSAHA KELOMPOK PEMUDA PENANGGULANGANBENCANA DI KAWASAN MERAPI, YOGYAKARTA

The purpose of community service activities for youth disaster management groups in the Merapi area is to improve entrepreneurial skills, introduce online promotional media, develop design and promotional skills, and train them in marketing products and services. The challenge faced by this group is how to improve their economic level even though their knowledge and skills are limited to natural disaster management. The methods of implementing this activity include providing motivation, instilling an entrepreneurial spirit, financial management training, graphic design training, and ongoing mentoring. This activity has succeeded in fostering an entrepreneurial spirit among youth in the Merapi area, improving their knowledge and skills, and connecting them with online media to market their products and services.

Managers’ Productivity and Recruitment in the Public Sector

Governments face many constraints in attracting talented managers to the public sector, which often lacks high-powered incentives. In this paper, we study how a civil service reform in Chile changed the effectiveness of a vital group of public sector managers: school principals. First, we estimate principal effectiveness by using an extension of the canonical teacher value-added model. Then we evaluate the effect of the reform on principal effectiveness using a difference-in-differences approach. We find that public schools appointed more effective managers and improved their students’ outcomes after increasing the competitiveness and transparency of their selection process. (JEL D73, H83, I21, J24, J45, O15)

MANDALA DA SUSTENTABILIDADE NO TURISMO

Contemporary times have been marked by the trivial and excessive use of the adjective “sustainable”, tourism has not been left out of this trend. The lauded “sustainable destination” title has become a central premise among territorial management groups. However, developing public policies to meet this status has evidenced reductionist and sometimes misguided treatments that fail to incorporate the true complexity of sustainability into tourism. The results are disconnected, one-off, ineffective actions based on guesswork or the interests of particular actors in the territory. This essay presents a simplified and didactic proposal for a territorial planning instrument (Sustainability Mandala in Tourism – TSM) to contribute to the attempt to seek sustainability in tourism development. The TSM comprises 21 indicators, defined from the analysis of international instruments and national strategies in force in tourism planning. The instrument covers the seven dimensions of sustainability (environmental, territorial, political, cultural, social, economic, and technological), and it has been developed to guide local and regional tourism management groups pragmatically. Keywords: Sustainability Indicators; Tourism; Public Policy; Mandala of Sustainability in Tourism; Local Development.

Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis

Development of myocardial fibrosis in patients with aortic stenosis precedes left ventricular decompensation and is associated with an adverse long-term prognosis. To investigate whether early valve intervention reduced the incidence of all-cause death or unplanned aortic stenosis-related hospitalization in asymptomatic patients with severe aortic stenosis and myocardial fibrosis. This prospective, randomized, open-label, masked end point trial was conducted between August 2017 and October 2022 at 24 cardiac centers across the UK and Australia. Asymptomatic patients with severe aortic stenosis and myocardial fibrosis were included. The final date of follow-up was July 26, 2024. Early valve intervention with transcatheter or surgical aortic valve replacement or guideline-directed conservative management. The primary outcome was a composite of all-cause death or unplanned aortic stenosis-related hospitalization in a time-to-first-event intention-to-treat analysis. There were 9 secondary outcomes, including the components of the primary outcome and symptom status at 12 months. The trial enrolled 224 eligible patients (mean [SD] age, 73 [9] years; 63 women [28%]; mean [SD] aortic valve peak velocity of 4.3 [0.5] m/s) of the originally planned sample size of 356 patients. The primary end point occurred in 20 of 113 patients (18%) in the early intervention group and 25 of 111 patients (23%) in the guideline-directed conservative management group (hazard ratio, 0.79 [95% CI, 0.44-1.43]; P = .44; between-group difference, -4.82% [95% CI, -15.31% to 5.66%]). Of 9 prespecified secondary end points, 7 showed no significant difference. All-cause death occurred in 16 of 113 patients (14%) in the early intervention group and 14 of 111 (13%) in the guideline-directed group (hazard ratio, 1.22 [95% CI, 0.59-2.51]) and unplanned aortic stenosis hospitalization occurred in 7 of 113 patients (6%) and 19 of 111 patients (17%), respectively (hazard ratio, 0.37 [95% CI, 0.16-0.88]). Early intervention was associated with a lower 12-month rate of New York Heart Association class II-IV symptoms than guideline-directed conservative management (21 [19.7%] vs 39 [37.9%]; odds ratio, 0.37 [95% CI, 0.20-0.70]). In asymptomatic patients with severe aortic stenosis and myocardial fibrosis, early aortic valve intervention had no demonstrable effect on all-cause death or unplanned aortic stenosis-related hospitalization. The trial had a wide 95% CI around the primary end point, with further research needed to confirm these findings. ClinicalTrials.gov Identifier: NCT03094143.

Intensive blood pressure lowering after endovascular thrombectomy in acute ischaemic stroke: an updated systematic review and meta-analysis of randomized controlled trials

Abstract Background Endovascular thrombectomy is an effective treatment in those with acute ischemic stroke. However, following successful reperfusion there are still many uncertainties as to the factors which influence patient outcome. Effective blood pressure management in this cohort has been elicited as one of these factors, with worse outcomes seen at both the high and low extremes. Purpose Pinpointing an optimal systolic blood pressure target after this procedure is still uncertain. We aimed to perform an updated meta-analysis of randomised controlled trials (RCTs) to evaluate the safety and efficacy of intensive blood pressure management as compared to conventional blood pressure management in this patient population. Methods We searched various electronic databases, including Embase, MEDLINE (via PubMed), and CENTRAL, to retrieve relevant RCTs evaluating a strategy of intensive blood pressure management after endovascular thrombectomy compared to conventional management. We pooled risk ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) with 95% CI for continuous outcomes, using RevMan 5.4. Results The meta-analysis included 4 RCTs with a total of 1560 patients. According to the analysis, intensive blood pressure management was associated with a statistically significant decrease in the number of patients showing functional independence (modified Rankin scale mRS score=0-2) at 90 days (RR 0.81; CI = 0.72-0.91; I2 = 12%). Regarding 90-day mortality, the pooled results from three RCTs showed no statistically significant difference between the intensive blood pressure management group and the conventional blood pressure management group (RR 1.17; CI = 0.90-1.52; I2 = 0%). There was no statistically significant difference between the two groups regarding the incidence of intracerebral haemorrhage (ICH) (RR 1.05; CI = 0.90-1.23; I2 = 0%) and the incidence of symptomatic intracerebral haemorrhage (sICH) (RR 1.10; CI = 0.76-1.60; I2 = 0%). Conclusion The meta-analysis showed no benefit of intensive lowering of blood pressure in terms of functional independence at 90 days, mortality rates, and incidence of ICH. Future large-scale trials should focus on other interventions to improve prognosis in these patients.Figure 1Figure 2

A novel nurse-led, multidisciplinary, and guideline-directed disease intensive management program improves long-term survival of pulmonary hypertension patients

Abstract Background Although the overall survival of pulmonary hypertension (PH) patients improved in the current era, better management strategy for PH patients still needs further exploration. Here, we proposed a novel nurse-led, multidisciplinary, and guideline-directed disease intensive management program and hypothesized this strategy would improve the overall survival of PH patients. Methods Patients were prospectively enrolled and divided into the intensive management group (IDM) and the conventional disease care (CDC) group voluntarily. Intensive management was nurse-led and delivered by multidisciplinary teams, including patient education, symptoms monitoring, and patient adherence improvement with careful outpatient or inpatient assessment every 3 months and medicine prescription whenever needed. Patients with conventional care were treated by primary cardiologists’ consultants and telephone follow-ups every year. Results Overall, 413 PH patients were finally included. Both total survival (p&amp;lt;0.001) and event-free survival (p=0.008) of the IDM group were significantly higher than the CDC group. After adjustment of age and sex, intensive management was also an independent protective predictor for both primary [all-cause mortality, HR 0.378, 95% CI (0.214-0.668), p&amp;lt;0.001] and composite endpoints [all-cause mortality and re-hospitalization, HR 0.648, 95% CI (0.454-0.927), p=0.017]. In subgroup analysis, IDM was beneficial in prolonging the overall survival of patients in high-risk situations (HR 0.283, 95% CI 0.125-0.641, p=0.002) and with advanced RV dysfunction (HR 0.250, 95% CI 0.123-0.510, p&amp;lt;0.001). Conclusion Nurse-led, multidisciplinary, and guideline-directed disease intensive management program represented an ideal method to strengthen the overall and event-free survival of PH patients, especially for those in advanced stages of PH.Novel management program

Gather "Round": An Integrated Care Model for the Emergency Department Multi-Visit Patient.

Emergency departments (EDs) are a vital component of the United States healthcare system and care for over 130 million patient visits annually. Nonurgent ED visits can contribute to crowding, delays in care, and adverse effects. Many high-utilizing ED patients may present with complex medical, behavioral, and social needs that are not necessarily emergent or urgent in nature. The authors created an Integrated Care Model, called the Multi-Visit Patient (MVP) program, for patients with 5 or more visits to the ED in a rolling 12-month period. The MVP program incorporated an interdisciplinary group of ED leadership and case management (CM) to identify, engage, and intervene with ED MVPs, aiming to improve their ED utilization. Patients received comprehensive screenings for depression, falls, alcohol use disorder, caregiver support, social determinants of health, and more. Based on these screenings, the CM team implemented interventions such as connecting patients with outpatient specialists and linking patients to community-based organizations to optimize stability, wellness, and reduce ED utilization. The collaboratively developed MVP program was implemented in the ED of a large, suburban, tertiary care academic hospital. The MVP program identified 221 MVP patients over a 20-month period and successfully connected with 89% of them. Of these 221 patients, 78% (172 patients) chose to engage in the MVP program, with 160 completing their engagement with an outcome. Among the patients who completed their engagement and for whom the study could match separate utilization data (151 patients), the study observed a 57% reduction in ED visits. Case managers play a crucial role in the effectiveness of the MVP program by coordinating comprehensive care for high-utilizing ED patients. The MVP program includes transition of care initiatives designed to improve patient outcomes. Through screenings and targeted interventions, case managers identify and address the complex medical, behavioral, and social needs of MVP patients. This collaborative, interdisciplinary approach underscores the importance of timely and coordinated care, benefiting both patients and the health system. The MVP program exemplifies the critical role of case managers in reducing unnecessary ED visits and enhancing overall patient care.

The School Budget Management under the Nakhon Ratchasima Primary Educational Service Area Office 4

Background and Aims: Budgeting in its present form began in England around the 16th-17th centuries. During that time The House of Representatives successfully reserved the power to approve government revenue and expenditures. This shows that current budgeting is related to the evolution of the governance system. After the preparation of this budget, it was extended to local government organizations, educational institutions, and other agencies, both public and private. The purpose of this research is to study and compare the level of opinions of personnel regarding budget management of schools under the Nakhon Ratchasima Primary Educational Service Area Office 4. Classified by position, school size, and work experience. Including the study of guidelines for developing budget management for schools under the said organization. Methodology: The sample used in the research consisted of 196 school administrators and heads of budget management groups of educational institutions under the Nakhon Ratchasima Primary Educational Service Area Office 4, which were selected using a stratified random sampling method. The research instrument was a questionnaire with a 5-level rating scale with an IOC between 0.80 - 1.00 and a confidence value of 0.85. In addition, a structured interview was used to collect data for data analysis. Various statistics were used, including frequency, percentage, mean, and standard deviation, T-test and F-test. Results: The results of the research are as follows: (1) School budget management Under the jurisdiction of the Nakhon Ratchasima Primary Educational Service Area Office 4, the overall level is at a high level. And when considering each aspect, it was found that budget management was at a high level in every aspect. (2) Comparative analysis of budget management of schools under the jurisdiction of the Nakhon Ratchasima Primary Educational Service Area Office 4, found to be significantly different at the 0.05 level. When classified by position but when classified by school size and work experience, no differences were found. (3) The budget management guidelines of schools under the Nakhon Ratchasima Primary Educational Service Area Office 4 that should be implemented include: Analysis of strengths and weaknesses Budget allocation is adequate and comprehensive. Having an internal audit system Creating a fundraising plan and using resources from outside agencies or stakeholders. Including having proof of receipt and payment. Preparing accurate accounts according to regulations and reporting information on supplies and equipment (M-OBEC), including creating up-to-date information on buildings, land, structures, and assets (B-OBEC). Conclusion: Budget management of schools under the jurisdiction of the Nakhon Ratchasima Primary Educational Service Office, District 4, that were all assessed were considered to have a high level of expertise. To ensure continued efficiency and transparency in financial management. There should be various guidelines such as detailed data analysis. Establishment of an internal audit system and recording information correctly All of which should be strictly implemented to strengthen confidence in the budget management process.

Development and Initial Implementation of a Clinical Monitoring Strategy in a Non-regulated Trial: a research note from the ReStOre II Trial

Background Data and Safety Monitoring is integral to quality assurance of clinical trials. Although monitoring is a core legal component of regulated clinical trials, non-regulated trials are not mandated to incorporate monitoring. Consequently, the monitoring process has been underutilised and underreported in this setting. This research report outlines the development and plans for implementing a bespoke Clinical Monitoring Strategy within the ‘Rehabilitation Strategies Following Oesophagogastric and Hepatopancreaticobiliary Cancer (ReStOre II) Trial’, a non-regulated trial comparing a 12-week multidisciplinary programme of rehabilitation to standard care in a cohort of 120 cancer survivors. Methods This research note provides a detailed overview of the ReStOre II Clinical Monitoring Strategy and describes the development of the strategy pre and post awarding of the grant. The strategy consists of the establishment and implementation of a comprehensive trial governance structure, inclusive of a Trial Management Group, Trial Steering Committee Meeting, and Independent Data Monitoring Committee. In addition, external trial monitoring by the Clinical Research Facility at St James’s Hospital. Three monitoring visits will be conducted during the trial; i) site initiation visit, ii) interim monitoring visit, and iii) close our visit. Results The Clinical Monitoring Strategy has been finalised and is currently being implemented within the ReStOre II Trial. Two site initiation visits and one interim monitoring visit have been completed to date. Conclusion This research note provides a template for implementation of a Clinical Monitoring Strategy in a non-regulated clinical trial. Registration ReStOre II Trial: https://clinicaltrials.gov/ct2/show/NCT03958019

Enhancing oxytocin and prolactin levels to address oligogalactia through emotional management and massage in working mothers

Emotional management, combined with oxytocin massage and breast care, offers a comprehensive approach to boost prolactin release, enhance milk production, and improve breastfeeding outcomes. The aim of this study was to evaluate the effectiveness of combining emotional management with oxytocin massage and breast care in increasing oxytocin and prolactin hormone levels to address oligogalactia in working postpartum mothers. A quasi-experimental study was conducted at Kudus Community Health Center, Kudus Regency, Central Java, Indonesia, from January to March 2024. A total of 93 postpartum mothers were randomly assigned to three groups: (1) emotional management with oxytocin massage; (2) emotional management with breast care; and (3) lactation education only. Blood samples were collected before and after the interventions to measure oxytocin and prolactin levels. The present study found that emotional management combined with oxytocin massage significantly increased oxytocin levels from 505.0±264.0 pg/mL to 600.0±231.3 pg/mL (mean difference: 103 pg/mL; p=0.002) and prolactin levels from 191.0±67.3 ng/mL to 233.0±86.8 ng/mL (mean difference: 27 ng/mL; p=0.001). The emotional management and breast care group showed a smaller increase in oxytocin (362.0±175.1 pg/mL to 418.0±185.1 pg/mL; mean difference: 23 pg/mL; p=0.048) and a significant increase in prolactin (195.0±48.8 ng/mL to 255.0±82.3 ng/mL; mean difference: 38 ng/mL; p=0.049). In contrast, the lactation education group showed no significant changes in oxytocin (p=0.756) or prolactin levels (p=0.341). In conclusion, emotional management combined with oxytocin massage significantly increased both oxytocin and prolactin levels, suggesting that integrating emotional management and oxytocin massage may be an effective strategy for postpartum lactation support.

Neuropsychological outcomes following endovascular clot retrieval and intravenous thrombolysis in ischemic stroke.

Cognitive impairment, anxiety, depression, fatigue, and dependence in instrumental activities of daily living (ADL) are common after stroke; however, little is known about how these outcomes may differ following treatment with endovascular clot retrieval (ECR), intravenous tissue plasminogen activator (t-PA), or conservative management. Patients were recruited after acute treatment and invited to participate in an outcome assessment 90-120 days post-stroke. The assessment included a cognitive test battery and several questionnaires. The COVID-19 pandemic led to significant disruptions in recruitment and data collection, and the t-PA and conservative management groups were combined into a standard medical care (SMC) group. Sixty-two participants were included in the study (ECR = 31, SMC = 31). Mean age was 66.5 (20-86) years, and 35 (56.5%) participants were male. Participants treated with ECR had significantly higher National Institutes of Health Stroke Scale scores at presentation and significantly lower education. After adjusting for stroke severity, premorbid intellectual ability, and age, treatment with ECR was associated with significantly better performances on measures of cognitive screening, visual working memory, and verbal learning and memory. Participants treated with ECR also experienced less fatigue and were more likely to achieve independence in basic and instrumental ADLs. Despite this, cognitive impairment and fatigue were still common among participants treated with ECR and anxiety and depression symptoms were experienced similarly by both groups. Cognitive impairment and fatigue were less common but still prevalent following treatment with ECR. This has important practical implications for stroke rehabilitation, and routine assessment of cognition, emotion, and fatigue is recommended for all stroke survivors regardless of stroke treatment and functional outcome.

Growth dynamics of Rathke's Cleft cyst: a risk score system for surgical decision making

ObjectiveRathke's cleft cysts (RCCs) exhibit variable growth patterns, thus posing a challenge in predicting progression. While some RCCs may not cause symptoms, others can insidiously cause pituitary dysfunction, which is often irreversible, even following surgery. Hence, it is crucial to identify asymptomatic RCCs that grow rapidly and pose a higher risk of causing endocrinologic dysfunction. This enables timely surgical intervention to prevent permanent damage. Our study examines the growth rate of RCCs, identifies factors that accelerate growth, and discusses the clinical implications of these findings.MethodsA retrospective analysis of a prospectively maintained electronic database revealed 45 patients aged 18–80 years who underwent endoscopic endonasal surgery (EEA) for RCCs between 2010 and 2022 at our center. Of these, 20 required early operative intervention. The remaining 25 patients were followed closely clinically and radiologically before requiring surgery (initial conservative management group). We conducted an analysis of the factors predicting growth over time in this group. Using a regression model, we constructed a risk score system to predict RCC growth over time.ResultsPatients in the initial conservative group had smaller cysts and were generally older than those in the early surgery group. Patients with preoperative pituitary dysfunction showed a higher median growth of 1.0 mm in the longest diameter compared to those with normal pituitary function, with an increase of 0.5 mm. A sum of annual cyst growth of all (z, y, x) diameters, at a rate of 3 mm or greater, was associated with a clinically significant increase in the risk of pituitary dysfunction, exceeding 50%.The most significant factors predicting rapid growth in RCCs were smoking status, age, and T1-weighted magnetic resonance imaging (MRI) intensity of cysts. Smoking was the most critical risk factor for rapid cyst growth (p = < .001). Our risk score system accurately predicted RCC growth with a 74% accuracy rate, 73% sensitivity, and 75% specificity.ConclusionOur analysis showed a strong link between active smoking and the rapid growth of RCC. This novel finding has significant preventive implications but needs validation by a large population database. Surgical intervention for RCC currently is often reserved for symptomatic cases. However, utilizing our risk-based scoring system to predict rapidly growing cysts may indicate early surgery in minimally symptomatic patients, thereby potentially preserving pituitary function.

DESIGN AND SET UP OF A RANDOMISED CONTROLLED TRIAL OF MEDICINAL CANNABINOIDS IN RECURRENT GLIOBLASTOMA - THE ARISTOCRAT TRIAL

Abstract AIMS ARISTOCRAT is a unique, randomised, double-blind, placebo-controlled phase II trial of cannabinoids (nabixo- mols) alongside temozolomide in patients with MGMT-methylated recurrent GBM and is open to recruitment in 12 centres across the UK. It was rapidly funded through a crowdfunding campaign organised by The Brain Tumour Charity during the COVID-19 pandemic. METHOD This pragmatic phase II randomised trial was designed and set up by a multi-disciplinary team of co-applicants and trial management group (TMG) members comprising of clinicians, statisticians, trialists, Patient &amp; Public Involvement (PPI), pharmacists and quality of life (QoL) researchers. The protocol randomises on a 2:1 ratio between nabiximols or matched placebo with standard dose temozolomide in patients at first recurrence of IDH wild-type GBM. Unique aspects include self-titration of nabiximols based on individual tolerance, and fully blinded randomisation with matched placebo. The primary outcome measure is overall survival time with key secondary outcomes including survival at 6, 12 and 24 months, progression-free survival time, health-related QoL and adverse events. Intermediate assessment of feasibility to confirm safety, compliance and achievability of recruitment will be undertaken after 40 patients are randomised. PPI input has been critical in the trial and patient-facing information design. RESULTS The trial has promoted a high level of patient and public interest, including press coverage. The trial aims to recruit a total of 234 patients over an 18 month period. CONCLUSION ARISTOCRAT will provide unique, robust clinical data on the role of nabiximols (combined with temozolomide) in improving overall survival and the impact on QoL for patients with recurrent GBM and is the first of its kind in cancer patients.

Impact of Co-Management Mode on Diagnosis and Treatment Compliance in Community-Level Diabetic Patients with Retinopathy.

Aims/Background To implement a co-management mode among community-level diabetes patients and analyze its impact on diagnosis and treatment compliance and diabetic retinopathy of the patients. Methods A total of 80 patients who underwent diabetic retinopathy examination in Lanxi People's Hospital from January 2021 to March 2022 were retrospectively selected as the study objects. The clinical data of the patients were analyzed, including 40 patients who adopted the conventional diabetes management mode from January 2021 to August 2021 as the control group. From September 2021 to March 2022, 40 patients in the county medical service community diabetes management team model were adopted as the management group. The two groups of patients were compared in terms of diabetic retinopathy indictors, biochemical examination indicators, self-management ability, and nursing management satisfaction. Results Number of patients complying with treatment protocols in the management group was higher than that in the control group (p < 0.05). The blood spot area, macular thickness, hemangioma volume, and visual-field grayscale value in the management group at the last follow-up were all lower than those in the control group (p < 0.05). The levels of diastolic blood pressure (DBP), systolic blood pressure (SBP), fasting blood glucose (FBG), hemoglobin A1C (HbA1c), total cholesterol (TC), and triglyceride (TG) in the management group at the last follow-up were all lower than those in the control group (p < 0.05). The scores of disease cognition ability, self-management ability, and nursing management satisfaction in the management group were all higher than those in the control group (p < 0.05). Conclusion By changing management concept and implementing the whole-process management and treatment mode for diabetic patients within the scope of the county medical service community, the diagnosis and treatment compliance of the patients can be improved, and the effective control of blood glucose, blood pressure, and blood lipid levels can be achieved, thereby improving the self-management ability and nursing management satisfaction of the patients and providing a new nursing mode for chronic disease management.

Automotive workers: the role of coordinative and conditional abilities as effectiveness wellness indicator.

Noncommunicable diseases are on the rise due to sedentary and unhealthy lifestyles. The World Health Organization (WHO) and the American College of Sports Medicine (ACSM) recommend maintaining a healthy diet and engaging in regular physical activity, particularly in the workplace. Prolonged and repetitive work tasks can result in extended sick leave and decreased productivity while at work. Therefore, it is important to identify predictive factors that can act as indicators of the health status of employees. Utilizing motor abilities assessment tests can help to identify health issues at an early stage. Promoting preventive health measures is crucial for addressing chronic diseases and enhancing overall occupational well-being. The purpose of the study was to characterize workers' motor abilities and fitness levels and identify potential indicators. A total of 605 workers participated in this study, including 529 male participants with a height of 176 ± 0.09 cm and a body mass of 75.9 ± 14.1 kg and 77 female participants with a height of 162 ± 0.11 cm and an average body mass of 58.9 ± 11.1 kg. These individuals were enrolled during an Italian automotive corporation's mandatory annual medical check-up. The participants were categorized into three groups based on their occupational roles: blue-collar, manager, and white-collar groups. The participants underwent motor abilities assessment tests for upper-limb strength, trunk flexibility, and reaction time. The blue-collar group reported the best results in upper-limb strength (93.3 kgf ± 18.60), but had the worst results in flexibility (21.7 cm ± 7.90), total reaction time (58.8 s ± 4.74); and average intermedium (0.68 ms ± 0.11). The white-collar group reported the best result in flexibility (23.7 cm ± 8.94) and reaction time (48.5 s ± 4.38; 0.64 ms ± 0.09). Despite being frequently used to assess health status, handgrip measurements may not provide accurate differentiations because of the common use of blue-collar workers for tasks that require upper-limb strength. In contrast, reaction time metrics appear more reliable and discriminative in evaluating a worker's physical fitness.

Long-Term Prospective Quality-of-Life Outcomes in 445 Patients with Sporadic Vestibular Schwannoma.

To evaluate the long-term changes in sporadic vestibular schwannoma (VS) disease-specific quality-of-life (QOL) outcomes. Prospective longitudinal study using the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale. National survey. Patients with sporadic VS who completed a baseline survey before treatment and at least one follow-up survey recruited through the authors' center and through the Acoustic Neuroma Association. Observation, microsurgery, radiosurgery. Changes in PANQOL scores from baseline to most recent survey. Among 445 eligible patients the mean duration of follow-up was 4.4 (SD, 2.3) years, including 122, 218, and 105 in the observation, microsurgery, and radiosurgery groups, respectively. Patients managed with observation (p = 0.03) or microsurgery (p < 0.001) demonstrated improvement in anxiety scores. Changes in facial function scores differed significantly by management group (p = 0.01), with patients undergoing microsurgery demonstrating a mean decline of 10 points in facial function scores compared with mean declines of 3 for those managed with observation or radiosurgery. Hearing loss scores decreased similarly over time for all three groups (p = 0.3). There were minimal changes in total PANQOL scores over time across all management groups (p = 0.5). Long-term changes in total QOL among VS management groups are not significantly different. Microsurgery may continue to confer an advantage regarding improvement in anxiety postoperatively, but with a greater decline in facial function when compared to observation or radiosurgery. Long-term declines in hearing loss scores were not statistically significantly different among groups.