Publication Of Guidelines Research Articles

A Tertiary Study for Process Mining

Background: This tertiary study lists the secondary studies published in the process mining domain and provides an analysis related to a set of research questions. It is the first tertiary study in this area. The objective is to provide information about the available secondary studies in process mining, respond to research questions relating to the thematic areas covered in the studies, as well as trends regarding their quality, and report on findings for publication venues, citations, guidelines used, and demographics. Method: A tertiary study based on systematic secondary studies published up to March 2023. A total of 25 secondary studies related to process mining have been identified following the application of inclusion/exclusion criteria and quality assessment. Results: The most popular thematic areas addressed are technologies and applications for process mining and healthcare. The secondary studies in process mining have a medium quality score of 3.5. The guidelines introduced by Kitchenham over the years are preferred in secondary studies in this field. There is no trend related to the number of primary studies included in secondary studies in process mining. Conclusion: Although numerous secondary studies exist for process mining, there is still room for more research, specifically in the areas highlighted in this study. Future researchers can use this study for reference, and they can also use the listed research topics to dive deep into the issues identified.

Completion Thyroidectomy Trends and Rates: A Systematic Review and Meta-Analysis.

In January 2016, the American Thyroid Association (ATA) published an update to the guidelines concerning the management of adult patients with thyroid nodules and well-differentiated thyroid cancers. One of the revised recommendations states that lobectomy is a reasonable surgical approach for low-risk patients. This systematic review compares the rates of completion thyroidectomy surgeries before and after the publication of the recent ATA guidelines. A systematic review was conducted according to the PRISMA guidelines of the preferred reporting items for systematic reviews and meta-analyses. PubMed and Embase databases were searched to find articles which demonstrate the rates of completion thyroidectomy surgeries in the last 6 years, before and after the recent ATA guidelines publication. Overall, 8744 titles and abstracts were screened, and 964 articles were fully assessed for eligibility. Eventually, 40 studies were included for data extraction. More than 48 000 patients with thyroid malignancy were included in the review, and were divided into three time periods according to the publication date of 2015 ATA guidelines. We found that the rate of completion thyroidectomy was 51.8% before 2016 and 43.1% after the 2015 ATA guidelines publication. We observed a 17% reduction of early completion thyroidectomy surgeries since the 2015 ATA guidelines publication relative to previous periods, among patients with malignant pathology. Apparently, more centres worldwide implemented the new guidelines and prefer a conservative surgical approach as compared to the pre-ATA 2015 era.

Trends in Overactive Bladder Therapy: Associations Between Clinical Care Pathways, Practice Guidelines, and Therapy Utilization Patterns.

Overactive bladder (OAB) is a chronic condition with significant financial and health-related consequences. Guidelines and treatment pathways were created to optimize care and provide a clinical framework for diagnosing and managing OAB. However, the impact of these efforts and patterns of medical treatment for OAB are poorly understood. Therefore, we sought to evaluate overall trends in therapy utilization before and after the 2014 American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) OAB guideline amendment and publication of the OAB clinical care pathway in 2016. In this retrospective cohort study, we analyzed data from Optum, a national administrative health and pharmacy claims database, between 2013 and 2018. All adult patients diagnosed with idiopathic OAB were identified by the International Classification of Diseases 9th and 10th Revision codes. Oral OAB therapies were identified using National Drug Codes, while third-line therapy procedures, onabotulinumtoxinA (BTX), sacral neuromodulation (SNM), and percutaneous tibial nerve stimulation (PTNS), were identified using Current Procedural Terminology (CPT) codes. The study's primary outcome was the annual number of OAB prescriptions filled by pharmacotherapy class and the number of minimally invasive therapies performed during the study period. The secondary outcome was the association between OAB therapy utilization and various clinical and sociodemographic factors. Patterns of care were analyzed from 2013 to 2018, and initial treatment with each therapy was collected, excluding repeat procedures from the analysis. 1 825 782 patients were included in the study. The mean age was 61.1 ± 16.7 years, and 1 071 420 patients were female (58.7%). The number of new OAB diagnoses increased by 369% from 2013 to 2017. During the 6-year study period, 347 052 (19%) patients were treated with oral and/or third-line therapies. The overall number of oral medications prescribed peaked in 2016, followed by a 17% decline between 2016 and 2018. In 2013, the two most prescribed oral medications were oxybutynin (46%) and solifenacin (31.8%). By 2018, mirabegron (18.5%) surpassed solifenacin (16.5%), with oxybutynin still accounting for most prescriptions written (55%). Eighty percent of all initial mirabegron prescriptions were filled by patients over the age of 65. The rate of third-line therapy procedures almost doubled between 2013 and 2018 (9-17 procedures per 1000 OAB patients, p < 0.001). Following the publication of the first OAB guidelines, there was an increase in OAB diagnoses, followed by a decrease in anticholinergic medication use, and a rise in beta-3 agonist utilization in patients over 65 years old. Additionally, there was greater adoption of third-line OAB therapies. These trends indicate that OAB therapy guidelines and clinical practice pathways may influence treatment patterns. Given the recent publication of the OAB guidelines, further studies are necessary to assess their impact on therapy utilization patterns.

Thromboembolism in Patients with Cancer: A Practical Guide to Recurrent Events.

Cancer patients have an increased risk of venous thromboembolism (VTE), and VTE is the second most common cause of death among them. Anticoagulation plays a key role in the treatment of cancer-associated thrombosis (CAT). Low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) are effective and generally safe options for cancer-associated VTE. However, those patients have a 10-20% risk of VTE recurrence in spite of using anticoagulants. The main reasons for recurrent VTE (rVTE) can be non-compliance, inadequate dosing of anticoagulants, thrombocytopenia and malignancy progression. Despite the publication of major guidelines regarding the management of CAT, the treatment of patients with rVTE is undefined. Treatment options for rVTE include bridging to LMWH in cases of oral anticoagulants use, LMWH dose escalation, and sometimes considering inserting a vena cava filter. This review paper summarizes the management of cancer-associated VTE, risk factors for rVTE and the treatment algorithm of rVTE.

HUMANIZED PRENATAL CARE

Humanized prenatal care is a concept that aims to ensure that pregnant women receive respectful and personalized care, promoting an emotionally supportive and welcoming environment during pregnancy. This approach aims not only to ensure the physical health of the mother and fetus, but also to improve the psychological and emotional well-being of women during pregnancy, which can have a positive impact on maternal and fetal outcomes. Studies have shown that a humanized approach is a determining factor in reducing complications during pregnancy and childbirth, as well as strengthening the bond between mother and baby. This summary seeks to analyze the influence of humanized care during prenatal care on maternal and fetal outcomes, discussing the importance of welcoming and personalized practices for increasing the quality of care. It also examines how humanized care can have a positive impact on both the physical and emotional health of pregnant women, promoting more favorable outcomes for mother and baby. This study used a qualitative methodology based on a literature review, focusing on humanization practices in prenatal care, exploring their impact on maternal and fetal health and public policy guidelines in Brazil. Humanized prenatal care involves practices such as respect for the autonomy of the pregnant woman, active listening, inclusion of the family in the process and psychological support, as well as comprehensive care for the woman’s physical health. Research shows that pregnant women who receive this type of care have lower rates of anxiety and depression, factors that are associated with obstetric complications and negative outcomes. In addition, humanized care contributes to pregnant women’s adherence to prenatal appointments and tests, reducing the risks of premature births, low birth weight and neonatal mortality. Care that respects a woman’s individuality also facilitates the control of conditions such as hypertension and gestational diabetes, promoting a safer pregnancy. Humanized prenatal care therefore plays a crucial role in maternal and fetal outcomes, promoting a healthier pregnancy and reducing the risks associated with labour and birth. In addition to improving the physical health of the mother and fetus, humanized care strengthens the emotional health of the pregnant woman and facilitates the mother-baby bond, factors that are essential for the healthy development of the newborn. The implementation of humanized practices in health services is therefore a fundamental strategy for improving the quality of prenatal care and promoting better outcomes for mothers and babies.

RETRACTION: The Design for Supply Chain Management of Intelligent Logistics System Using Cloud Computing and the Internet of Things

Retraction: H. Wang, Y. Yin, and X. Wang, “,” Expert Systems 41, no. (2024): . https://doi.org/10.1111/exsy.13271. The above article, published online on 02 March 2023, in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor‐in‐Chief, David Camacho; and John Wiley &amp; Sons Ltd. The article was submitted as part of a guest‐edited special issue. Following publication, it has come to the attention of the journal that this article was accepted solely on the basis of a compromised peer review process. In addition, the authors did not provide a statement regarding individual consent for the images used in Figure 13, which violates the journal's and the publisher's guidelines. The editors have therefore decided to retract the article. The authors did not respond to the notice of retraction.

Management of Adult Patients with Newly Diagnosed or Relapsed Primary Immune Thrombocytopenia in Eastern Austria.

Treatment sequence in primary immune thrombocytopenia (ITP) is based on national and international recommendations, treatment availability, and physician expertise. This article aimed to provide real-world data on treatment sequence and responses to first- and second-line treatments in newly diagnosed and relapsed adult ITP patients. We analyzed a cohort of 46 adult ITP patients from the Vienna ITP Biobank, who started first-line therapy within 1 week before their first study visit between February 2016 and March 2023. We investigated clinical patient characteristics and patient management in our specialized center and examined the impact of the international ASH guidelines on ITP treatment. Forty-six primary ITP patients, 27 (58.7%) with newly diagnosed ITP and 19 (41.3%) with relapsed ITP, were investigated. Most patients were female (65.2%) with a median platelet count of 9 × 109/L, and 31 patients (67.4%) had bleeding symptoms. All patients received first-line treatment with oral prednisolone; 15 patients received oral prednisolone combined with intravenous immunoglobulins (IVIGs), which were more commonly administered in newly diagnosed than in relapsed ITP patients. First-line therapy resulted an overall response in 82.6% of patients after a median (interquartile range [IQR]) time of 10 (5-25) days. There was no difference in treatment responses between newly diagnosed and relapsed ITP patients, but newly diagnosed patients had a shorter time to response (median [IQR]: 8 [5-14] and 14 [8-27], p = 0.02). Twenty-three (50%) of the patients (11/27 newly diagnosed [40.7%], 12/19 relapsed [63.2%]) required second-line ITP therapy. Thrombopoietin-receptor agonists (TPO-RAs) were the most commonly used second-line therapy with a response rate of 73.7%, and a median (IQR) time to treatment response of 15 (12-20) days. Overall response rates to TPO-RA treatment did not differ between newly diagnosed and relapsed ITP. Following the publication of novel guidelines in 2019, the median (IQR) duration of corticosteroid treatment shortened (100-52 days, p = 0.01), as did the time to second-line treatment (160-47 days, p = 0.01), and the median number of first-line therapies decreased from 2 (1-3) to 1 (1-2). Initial treatment with corticosteroids was effective in the majority of newly diagnosed and relapsed ITP. Response rates to initial corticosteroid treatment in ITP patients are consistent with previous data, but only 50% achieve sustained remission. TPO-RAs, which are well tolerated and effective, are the most commonly used second-line therapy in our study population. International guidelines have led to faster treatment transitions and reduced splenectomy rates. Integration of real-life experience, expert consensus, and guidelines optimizes ITP patient management.

Changes in diagnostics and treatment pathways for developmental dysplasia of the hip after the introduction of national guidelines: An updated questionnaire amongst paediatric orthopaedic surgeons in The Netherlands.

Diagnostics and treatment pathways for developmental dysplasia of the hip are highly variable in clinical practice. Recently, two national guidelines were developed in the Netherlands, providing a uniform protocol for the diagnosis and treatment of developmental dysplasia of the hip in children under the age of 1 year. The aim of this survey study was to assess whether diagnostic and treatment strategies have changed amongst paediatric orthopaedic surgeons in the Netherlands compared to a similar survey study in 2011, after the introduction of the guidelines. A web-based online questionnaire was developed and shared amongst the members of the Dutch Paediatric Orthopaedic Society. The questions concerned the diagnosis and treatment of developmental dysplasia of the hip, ranging from mildly dysplastic to dislocated hips, in children under the age of 1 year. We used a questionnaire similar to the previous study and evaluated the results. Thirty-four participants completed the survey. Regarding diagnosis and follow-up, ultrasonography was generally applied for children younger than 6 months, while radiography was more frequently used for children aged 6-12 months. In 2011, radiography was more widely applied in all age groups. Initial treatment for dysplastic, stable hips was mostly active monitoring, while this was generally a rigid splint in 2011. For dislocated unstable hips, the first step in treatment was generally the Pavlik harness, as in 2011. The diagnostic and treatment pathways of developmental dysplasia of the hip in children under the age of 1 year seem to have partially changed amongst Dutch paediatric orthopaedic surgeons compared to 2011, after the publication of new guidelines.

Pediatric Adenotonsillectomy Opioid Prescriptions Before and After Practice Guidelines and American Academy of Pediatrics Challenge.

The opioid epidemic continues to concern the CDC and public health officials but recent trends in opioid prescribing rates following common pediatric otolaryngology surgeries are unexplored. This retrospective cohort study queried the TriNetX Research database from January 1, 2010, through December 31, 2023, for pediatric patients who underwent tonsillectomy and/or adenoidectomy and received oral opioids within 5 days of surgery. Prescription trends from 2010 to 2017 were compared to 2022 to 2023, after the publication of multiple clinical practice guidelines (CPGs). Of 286,572 surgeries, 29% of patients received postoperative opioids. Comparing the 2 time periods, a significant decrease was observed in the risk of postoperative opioid prescriptions following 2022 (RR 0.87, CI95% 0.86-0.88). Prescribing rates decreased between 2018 and 2023 from 34% to 24%. Publication of CPGs were associated with a decrease in opioid prescribing rates and may have contributed to an encouraging trend in opioid stewardship.

Breaking boundaries: exploring recent advances in anticoagulation and thrombosis management: a comprehensive review.

Thromboembolic disorders globally contribute to morbidity and mortality, emphasizing adequate anticoagulation and thrombosis management. Therapeutic advances are essential in preventing complications like pulmonary embolism, stroke, and myocardial infarction. This review summarizes recent anticoagulation advances, current challenges, future directions, and novel anticoagulants and drug delivery systems on clinical outcomes. This paper assesses the effectiveness and safety of new anticoagulants through a systematic review of recent clinical trials, meta-analyses, and guideline publications. Key studies, including PACIFIC-AF, RIVER, ENAVLE, ENVISAGE-TAVI AF, and ARCADIA, were analyzed to provide a perspective on therapeutic advancements. The review highlights key findings from vital clinical trials. Asundexian, in the PACIFIC-AF trial, demonstrated a 34% reduction in bleeding events compared to Apixaban. In the RIVER trial, Rivaroxaban reduced significant bleeding events by 20% compared to warfarin in patients with bioprosthetic mitral valves. In the ENAVLE trial, Edoxaban achieved a 3.7% decrease in thromboembolic events compared to warfarin without increasing significant bleeding rates. In the ENVISAGE-TAVI AF trial, edoxaban was noninferior to VKAs in preventing thromboembolic events but showed a slight increase in major bleeding events by 1.5%. Lastly, the ARCADIA trial highlighted that apixaban did not significantly reduce recurrent stroke risk compared to aspirin, with both treatments having an annualized stroke rate of 4.4%. Advances in anticoagulant therapies and drug delivery systems aim to enhance patients' clinical outcomes for thromboembolic disorders. While recent trials show promising data, ongoing patient-specific responses and monitoring challenges require further research. Continuous innovation and investigation are essential to refine anticoagulation practices and tailor treatments.

Temporal and regional variation in the use of biologic and targeted synthetic DMARDs for rheumatoid arthritis: a nationwide cohort study.

To evaluate temporal and regional variation in biologic and targeted synthetic DMARD (b/tsDMARD) initiation for rheumatoid arthritis (RA) in England and Wales. An observational cohort study was conducted for people with RA enrolled in the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and April 2022 who had 12-month follow-up data. Temporal trends in escalation to b/tsDMARDs within 12 months of initial rheumatology assessment were explored, including comparisons before and after publication (July 2021) of national guidelines that lowered the threshold for b/tsDMARD initiation to include moderate-severity RA. Case-mix-adjusted, mixed-effects regression was used to evaluate regional and hospital-level variation in b/tsDMARD initiation. Of 6,098 RA patients with available follow-up, 508 (8.3%) initiated b/tsDMARDs within 12 months of initial assessment. b/tsDMARD escalation increased marginally towards the end of the study period (9.2% in May 2021/22); however, no significant differences were evident after guidelines were published permitting b/tsDMARDs for moderate-severity RA. The proportion of individuals escalated to b/tsDMARDs varied considerably between regions, ranging from 5.1% in Wales to 10.7% in North-West England. Following case-mix adjustment, the intraclass correlation (ICC) for hospitals within regions was 0.17, compared with a between-region ICC of 0.0, suggesting that the observable regional variation reflected hospital-level differences rather than systematic differences between regions themselves. There is marked variation in escalation to b/tsDMARDs for people newly-diagnosed with RA throughout England and Wales, despite a universal healthcare system. These disparities must be addressed if we are to deliver equitable access to b/tsDMARDs, regardless of geography.

Time to surgical treatment for hip fracture care.

Studies have demonstrated beneficial outcomes associated with timely surgical treatment of hip fracture. Subsequently, practice recommendations changed with 24-48 h as the recommended time for surgery from admission; however, recent data on timing of hip fracture surgery and how this impacts outcomes are lacking. This retrospective cohort study included patients who had a primary diagnosis of hip fracture and underwent a subsequent surgical repair within 3 days of admission (Premier Healthcare claims 2006-2021 data). The primary exposure of interest was time from hip fracture diagnosis to surgery (categorized as 0-1 day, 2 days, and 3 days). Outcomes included any major complication, mortality, and intensive care unit (ICU) admission. Mixed-effects models measured the association between timing of surgery and outcomes. We report odds ratios (OR) and 95% confidence intervals. Among 501,267 surgical hip fracture patients, 26.0%, 56.0%, and 18.1% of patients received surgery on days 0-1, 2, and 3, respectively. The median ages were 83, 84, and 84 years old, and there were 73.3%, 72.2%, and 68.8% female in each group respectively. Compared with repair on day 0-1, hip fracture surgical treatment on day 2 or day 3 was associated with increased odds of major complications (OR 1.06, 95% CI 1.03-1.08 and OR 1.17, 95% CI 1.13-1.2), mortality (OR 1.08, 95% CI 1.02-1.14 and OR 1.2, 95% CI 1.12-1.28), and ICU admission (OR 1.06, 95% CI 1.04-1.09 and OR 1.36, 95% CI 1.32-1.4) after adjusting major comorbidities; all p < 0.001. Despite the publication of society guidelines in 2015, most fracture patients still received surgery on day 2 or day 3 of admission and were associated with worse outcomes. Balancing optimization of clinical factors with timing of surgery can be challenging, and further research is needed. Nonetheless, our findings reiterate the importance of timely surgical intervention.

Practical tips for writing a scientific article

The text explores the importance of scientific publishing in the medical field and the dual role of the author/reviewer. The reviewer's work is crucial, as their objective is to assist other authors in improving their manuscripts and ensuring that methods are reproducible, which allows for the validation of results in future studies. In the interest of greater transparency, we emphasise the role of publication guidelines, such as CONSORT, which promote rigorous and reproducible research. There is substantial evidence demonstrating that adherence to these guidelines can enhance the quality of articles. Finally, researchers are encouraged to contribute honestly to the advancement of knowledge and best clinical practices, with the hope that their findings will translate into public health benefits.

Arterial hypertension-Current recommendations for action

Arterial hypertension (aHT) currently affects nearly 1 in every 3 persons in Germany and the number of those affected is steadily increasing. Only half of the patients treated show a controlled blood pressure in the follow-up. A suboptimal treatment involves the danger of cardiovascular and renal events that under certain circumstances can have a fatal course. The publication of the first national treatment guidelines (NVL) on hypertension and the new guidelines of the European Society of Hypertension (ESH) 2023 simultaneously represent two updates. Both emphasize the necessity to avoid hypertension-mediated organ damage (HMOD) and the identification of high blood pressure. The focussing on preventive measures and lifestyle recommendations as well as the simplification of target blood pressure values play important roles in the routine practice. This article provides a practical summary of the current recommendations of both guidelines on the diagnostics and treatment of aNT, discusses relevant differences and provides routinely applicable advice.

Changes in practice of exercise advice provision following the publication of ESC 2020 guidelines on sports cardiology and exercise at a central London inherited cardiac conditions outpatient service

Abstract ESC 2005 and AHA guidelines 2015 in sports cardiology restricted individuals with hypertrophic cardiomyopathy (HCM) from moderate and high intensity exercise and limited them to low intensity sport.1,2 Perceived increased risk of sudden cardiac death (SCD) with vigorous exercise in individuals with HCM was based on early registry data from the United States.3 This enforced sedentary lifestyle has led to an increasing trend towards obesity, atrial fibrillation and atherosclerotic coronary artery disease in patients with HCM.4 Recent ESC 2020 guidelines on exercise5 has enabled clinicians to recommend safe levels of exercise for these patients. We audited how well our outpatient practice reflected the guidance set out in 2020 ESC guidelines on exercise for patients with cardiovascular disease. Electronic records of 731 patients with a clinical diagnosis of HCM seen in our outpatient service between 2008-2023 were audited to determine whether written advice on exercise was given and if this was in line with the current ESC guidelines at any encounter. 731 patients with a mean age of 62±14.5 (range 17-91 years) were seen in our specialist outpatient service. 68% were male. 51% of patients received exercise advice either at their initial visit ± a follow-up visit. A significant proportional increase (16%,P&amp;lt;0.001) was seen in the number of patients receiving exercise advice at their initial visit after publication of the ESC 2020 guidelines (Table 1). 43% (270/634) of those who had their initial visit pre-guidelines received updated exercise advice as per 2020 ESC guidelines during follow-up. There was an increase in the proportion of patients receiving exercise advice each year after publication of ESC guidelines (Graph 1). Immediately following the publication, a high proportion received specific advice pertaining to intensity and duration of exercise (68% in 2020) with a slight decline subsequently (43%, 36% and 47% in 2021, 2022 and 2023 respectively). 27 patients had an implantable cardioverter defibrillator (ICD) in situ at the time of initial review with a further 127 undergoing ICD insertion under our care. SCD risk was documented for 66% (468/704) of patients according to the 2014 ESC Risk-SCD Model. 63% (214/338) of low-risk patients received exercise advice, whilst 77% (40/52) and 54% (42/78) of intermediate and high-risk patients received exercise advice respectively. 22 deaths (3%) were recorded during the follow-up period with none occurring during exercise. All cases except 2 were non-cardiac related. An overall improvement was seen in our practice with a significant increase in the number of patients receiving exercise advice after publication of the new guidelines. Despite this, only 51% of our patients received any written guidance on exercise demonstrating a need for further improvement in our outpatient practice to reflect the paradigm shift in the approach to exercise in individual with HCM as set out by the ESC 2020 guidance.

Characteristics of fatal COVID-19 among pregnant women admitted to hospitals in Kazakhstan

Abstract Background The factors contributing to the fatal outcome of COVID-19 in pregnant women remain not entirely clear. We compared the prevalence rates of comorbidities and laboratory test results in pregnant survivors and non-survivors. Methods This retrospective study relied on clinical and laboratory data obtained from medical records of pregnant women with COVID-19 admitted to three hospitals of the Republic of Kazakhstan from 16.07.2021 to 31.01.2022. Overall, we obtained data on 157 pregnant women with COVID-19, of whom 95.9 % survived and 4.1 % died in the hospitals. Results Arterial hypertension was present in 50% of non-survivors vs. 7.9% of survivors (P = 0.001), diabetes mellitus was diagnosed in 16.7% of non-survivors vs. 2.3% of survivors (P = 0.044), and the rate of hyperglycemia was 40% and 7.2%, respectively (P = 0.009). Heart rhythm disturbance was present in 50% of non-survivors vs. 6.4% of survivors (P &amp;lt; 0.001), and already at the time of admission to the hospital, the non-survivors had significantly higher heart and respiratory rates. Laboratory tests showed that non-survivors had higher erythrocytes sedimentation rate, C-reactive protein, leukocyte count, and D-dimer levels (P = 0.001, P &amp;lt; 0.001, P = 0.038, P = 0.014, respectively). The creatinine level was within the normal range in both study groups, but it was relatively higher in the deceased pregnant women (71.3; IQR: 66-251.75) vs. 52; IQR: 43-63; P = 0.001). Finally, a higher proportion of those who died presented with abnormal chest CT as compared with the survivors (33.3% vs. 4.2%, P &amp;lt; 0.001). Conclusions The deceased had a higher rate of comorbidities. Given the vulnerability of pregnant women to COVID-19, it is essential to plan a prospective study to provide insights into the factors that contribute to severe COVID-19 outcomes in pregnant women. Key messages • Determining risk factors for fatal COVID-19 is crucial for effective medical care of pregnant women. • Identifying potential risk factors of fatal COVID-19 among pregnant women could help inform public health policies and clinical guidelines.

Vasospasm management: a meta-synthesis of current modalities used by different medical societies

Background: Cerebral vasospasm is a life-threatening complication of an aneurysmal subarachnoid hemorrhage (aSAH), with approximately 6 to 10 cases per 100,000 patients yearly. Despite the publication of numerous guidelines from various medical societies, there is a lack of standardized consensus on what the optimal management strategies for this severe complication truly are. This meta-synthesis aims to synthesize these endorsed recommendations to ultimately identify standardized care guidelines and improve patient outcomes after aSAH. Methods: A comprehensive database search of existing guidelines published by major medical societies in the past 10 years was performed. Results: The analysis included 28 relevant documents from 7 major medical societies. Key findings included: 1) Unanimous endorsement for oral nimodipine administration for 21 days post-aSAH. 2) Varying recommendations for alternative calcium channel blockers and hemodynamic management methods. 3) Targeted hypermagnesemia and routine statin therapy were not universally recommended due to insufficient evidence. 4) Use of antifibrinolytics was considered on a case-by-case basis. 5) Endovascular interventions were recommended for refractory cases, specifically. Conclusion: This meta-synthesis reveals consistencies and divergences in vasospasm management recommendations across medical societies, highlighting the need for more robust clinical trials, regular guideline updates, and increased medical society collaboration. Keywords: Vasospasm, cerebral vasospasm, aSAH, management, guidelines, meta-synthesis

Analysis of Opioid Prescribing Trends Following Thyroidectomy and Parathyroidectomy Before and After the 2021 American Academy of Otolaryngology-Head and Neck Surgery Opioid Prescribing Clinical Practice Guidelines.

To evaluate the trends in opioid and nonopioid prescribing for thyroidectomy and parathyroidectomy before and after the publication of guidelines by the American Academy of Otolaryngology-Head and Neck Surgery in April 2021. Retrospective. Eighty-three health care organizations in the United States that contribute to the TriNetX database. Deidentified patient data were retrieved from the TriNetX. Patients who were prescribed either opioids or nonopioid analgesic within 1 to 5 days following thyroid surgery and parathyroidectomy were included. Evaluation of the prescription trends was performed by interrupted time series analysis in Statistical Analysis System 9.4 with significance set at P < .05 to assess trends before and after the new opioid prescription guidelines. For thyroid surgery, there was an immediate effect of the guideline change indicated by a 3.3% decrease in the opioid prescription trend (P = .03) and a significant increase in nonopioid use of overtime by 0.13% every 3 months (P < .0001). The opioid prescription trend following parathyroidectomy significantly decreased over time by 0.28% every 3 months (P < .0001), while the nonopioid prescription trend increased by 0.14% (P < .0001). There was an associated immediate reduction in the opioid prescribing trend for thyroidectomy, but the change was not sustained overtime. There was an associated decrease in the opioid prescribing trend for parathyroidectomy, but not immediately after the initial publication of the prescription guidelines. Level III.

Can clinical guidelines reduce variation in transfusion practice? A pre-post study of blood transfusions during cardiac surgery.

Previously published studies have consistently identified significant variation in red blood cell (RBC) transfusions during cardiac surgery. Clinical guidelines can be effective at improving the average quality of care; however, their impact on variation in practice is rarely studied. Herein, we estimated how variation in RBC use across cardiac surgeons changed after the publication of national patient blood management guidelines. We performed a pre-post study estimating change in variation in RBC transfusions across 80 cardiac surgeons in 29 hospitals using a national cardiac surgery registry. Variation across surgeons was estimated using fixed-effects regressions controlling for surgery and patient characteristics and an empirical Bayes shrinkage to adjust for sampling error. RBC use was measured by three metrics-the total number of units transfused, the proportion of patients transfused and the number of units transfused, conditional on receiving RBC. The primary analysis utilized 35,761 elective cardiac surgeries performed between March 2009 and February 2015 and identified a 24.5% reduction (p < 0.0001) in mean total units transfused accompanied by a 37.2% reduction (p = 0.040) in the variation across surgeons. The reduction in mean total units was driven by both the proportion of patients transfused and the number of units transfused, conditional on receiving RBC, while the reduction in variation was only driven by the latter. In our study of RBC transfusions across cardiac surgeons, the surgeons who used more RBC in the pre-guideline period experienced larger reductions in RBC use after the guidelines were published.

Animal breeding and feeding tools may close human nutrition gaps

The last century has witnessed many innovations in agriculture and food technologies that have ensured the production of sufficient quantities of good hygienic food. Animal scientists have contributed substantially to efficient breeding and feeding practices by adapting animals for faster growth and improving feed efficiency and utilization. Breeding goals and feeding recommendations have been proposed with a primary focus on profitability to promote significant changes in the macronutrient content, i.e., animal body protein and fat reduction. However, improving the nutritional quality of meat was not included in the profit assessment. Increasing the lean meat fraction is consistent with the goal of public dietary guidelines for human nutrition proposed in 1980, emphasizing the importance of reducing the consumption of animal fat, particularly saturated fat. The application of breeding and feeding tools to modify and improve the fatty acid composition has been partly implemented in pigs and broiler chickens to supplement the dietary recommendations for humans. The health benefits of lean “red meat” have been questioned in recent years, with dietary guidelines and upper limits being introduced for human intake. Animal breeding indirectly reduces the total and heme iron (the redness generator) content in meat, due to covariation with priority breeding goals. Two micronutrients play important roles in the human diet and are derived largely from meat (selenium) and milk (iodine) if the amount provided and absorbed is sufficient and predictable. The iodine content can be highly dependent on the use of novel (more sustainable) feeds. The micronutrients discussed in this study (Fe, Se, I, and vitamin D) highlight opportunities for the utilization of breeding and feeding knowledge to adjust their levels to procure meat with a high nutrient density. The gaps in micronutrient levels in humans must be addressed by navigating within approved animal feeding levels. Animal scientists must recognize the nutritional impact of breeding and feeding and advertise them. In addition, human nutritionists must acknowledge the existing and potential changes in animal production to meet the dietary guidelines. Sustainable food production within the “One Health” concept can only be achieved through cooperation.