High Need Research Articles

The Relationship Between Interpersonal Stress and Internet Usage among Adolescents

In recent years, the problems focusing on interpersonal stress of teenagers and internet usage become a hit. During adolescence, gender differences, biological changes, and social-emotional development have a significant impact on pubertal development as well as interpersonal stress. For example, females have a obviously higher need for companionship and interpersonal interaction. They use social media more frequently, and they are at higher risk of being victimized by their peers, which exacerbates their high rates of depression and interpersonal stress, leading them to rely on the internet as well. The growth of the internet and social media also deepens comparisons between people. For example, body shame, where adolescents continue to enhance content when they receive compliments and overly pander to make themselves look perfect when they receive dissatisfaction, can, to some extent, increase their anxiety and cause disturbances in their psychological development. Similarly, positive online bloggers who post videos can be inspiring, but posting about negativity or venting about reality can make immature teens more prone to depression and anxiety and further derivation into internet addiction, leading to depression and interpersonal problems. In this article, the relationship between interpersonal interactions and internet use is explored.

Adult Day Center Use among Older Mexican Americans with Dementia in California and Texas

Background. Dementia is one of the most common causes of disability and dependence in the world and is a frequent reason that older people require supportive living arrangements. Providing such arrangements on a broad scale will require a broad public dialogue and insights from social science, especially with respect to the neediest, who suffer from a profound gap in access to care. New and innovative social policy, in line with Recommendation #10 of the European Society of Medicine Policy Framework Reducing the Burden of Neurodegenerative Diseases in Europe and Beyond, is vital. The current study offers insights based on dementia care for Latinos in California and Texas, a population with a high incidence of the disease and few low access to resources. Objective. This study investigates how a growing number of Latino families use adult day care services. We focus on California and Texas, the two states with the largest Latino populations of Mexican origin with dual-eligible (Medicare and Medicaid) beneficiaries. Methods. We employ the 2015 Hispanic Established Epidemiologic Studies of the Elderly to compare the socioeconomic characteristics of Mexican Americans 80 and over who are day care service users living with and without dementia in both states (n = 406). Logistic regressions are used to determine the likelihood of participation in adult day care programs in both states by insurance status. Results. Compared to California, restrictive income eligibility requirements in Texas limit participation in adult day care despite a higher need for care. Multivariate analyses reveal that foreign-born dual-eligibles in Texas are particularly dependent on family, to provide dementia caregiving in comparison to the native born; they do not report using adult day health services. Conclusion. The paper ends with a discussion of viable policy options for promoting equity in access to affordable and sustainable adult day health centers as well as other community-based long-term care services in Texas and California. A multi-faceted approach is necessary and must involve all levels of government, as well as private and charitable organizations.

Inequity in Washington state covid-19-related crowdfunding

The first seven months of the US COVID-19 pandemic saw a massive increase in COVID-19-related crowdfunding campaigns. Despite their popularity, these campaigns were rarely successful in reaching their monetary goals, with nearly 40% of them not receiving a single donation. Previous research has indicated that crowdfunding has increased inequities and disparities in wealth, and this study set out to examine the situation in Washington State, an area greatly divided socio-economically, culturally, and geographically. Using GIS-based Multi-Criteria Evaluation (MCE) models with Quantile classification, we created geospatial representations of composite independent variables representing the impacts of COVID-19 and social marginalization on Washington state counties. We then examined the relationships between these variables with the dependent variables, campaign prevalence and outcome (campaign median amount raised), and assessed for relationships through ANOVA tests. These representations allowed us to assess the possibility that both COVID-19 impact and social marginalization may be amplifying already present inequities in Washington state by influencing crowdfunding monetary outcomes and prevalence. Our research indicates that county-wide social marginalization is associated with COVID-19-related crowdfunding campaign prevalence, generally pointing towards counties with lower social marginalization producing more campaigns. We also found that COVID-19 impact is, surprisingly, not associated with campaign prevalence, and that there was no relationship between campaign outcome and marginalization or COVID-19 impact. These findings indicate that inequitable access to, and use of, technologies like crowdfunding may be further contributing to COVID-19 inequities within Washington state. Policy-makers should be advised to use crowdfunding information with extreme caution when considering it as a useful tool in assessing community needs within counties and allocating resources, because those with the highest need likely are not being represented in this data due to lack of access.

Comparison of two labor induction regimens with intravaginal misoprostol 25 μg and adverse perinatal outcomes.

The aim of the study was to compare two labor induction regimens (4 and 6 h), to determine predictors of successful labor induction with intravaginal misoprostol 25 μg tablets, and to evaluate the association with adverse perinatal outcomes. This was a retrospective cohort study that included singleton pregnancies undergoing induction of labor with an intravaginal misoprostol 25 μg tablet between 37 and 42 weeks of gestation. The pregnant women were divided into two groups: Group 1-intravaginal misoprostol 25 μg every 4 h and Group 2-intravaginal misoprostol 25 μg every 6 h. Pregnant women were divided into Group 1 (n=289) and Group 2 (n=278). Group 1 had a higher median number of intravaginal misoprostol 25 μg tablets (3.0 vs. 2.0 tablets, p<0.001), a lower prevalence of postpartum hemorrhage (7.6 vs. 32.7%, p<0.001), and a higher need for oxytocin (odds ratio [OR]: 2.1, 95%CI: 1.47-2.98, p<0.001) than Group 2. Models including intravaginal misoprostol 25 μg tablets every 4 and 6 h [x2(1)=23.7, OR: 4.35, p<0.0001], parity [x2(3)=39.4, OR: 0.59, p=0.031], and Bishop's score [x2(4)=10.8, OR: 0.77, p=0.019] were the best predictors of failure of labor induction. A statistically significant difference between groups was observed between the use of the first intravaginal misoprostol 25 μg tablet at the beginning (Breslow p<0.001) and the end of the active labor phase (Long Hank p=0.002). Pregnant women who used intravaginal misoprostol 25 μg every 4 h had a longer time from the labor induction to the beginning of the active phase of labor and higher rates of adverse perinatal outcomes than women who used intravaginal misoprostol 25 μg every 6 h.

Effectiveness of senna in treating chronic constipation in geriatric patients presenting to the emergency department: A randomized, double-blind, multicenter study

Introduction: Chronic constipation is prevalent in the geriatric population. Undiagnosed and untreated constipation can lead to complications and decreased health-related quality of life. The aim of this study was to compare the therapeutic effectiveness of senna alone with a combination of bisacodyl and senna in patients diagnosed with chronic constipation. Materials and Method: This prospective, multicenter, double-blind, randomized controlled trial included patients aged 65 years and older who presented to the emergency department with chronic constipation, diagnosed according to the Rome IV criteria, between July and October 2023. Patients were randomly assigned to either the senna group (20 mg sennoside B) or the senna + bisacodyl group (3 mg sennoside B + 5 mg bisacodyl). Participants took the drugs twice daily for 28 days. The Constipation Scoring System and Patient Assessment of Constipation Quality of Life scores were calculated before and after treatment for each patient. Results: The study included 105 patients, with 54 in the senna group and 51 in the senna + bisacodyl group. There was a statistically higher need for dose reduction because of drug side effects in the senna + bisacodyl group compared with the senna group (p=0.026). Following treatment, the senna group had a higher score on the Constipation Scoring System and Patient Assessment of Constipation Quality of Life compared with the senna + bisacodyl group, and the difference was statistically significant (p&lt;0.001, p=0.012). Conclusion: In geriatric patients, short-term treatment of chronic constipation with senna is more effective than senna+bisacodyl regarding constipation severity and quality of life. Keywords: Aged; Bisacodyl; Constipation; Quality of Life; Sennosides.

Взаимосвязь уровня цинка в сыворотке крови с тяжестью и характером течения COVID-19

Zinc is a trace element with potent immunoregulatory and antiviral properties, and it is used for the prevention and treatment of coronavirus disease 2019 (COVID-19) at the beginning of epidemic. However, we do not know the clinical significance of serum zinc levels in COVID-19 patients. This study was conducted to evaluate the relationship between serum zinc levels and COVID-19 infection. Patients and methods. A prospective study was carried out in Al-Basrah city, Iraq, from November 2021 to March 2022. Initially, serum zinc levels were compared between COVID-19 patients and healthy controls. Then COVID-19 patients with zinc deficiency were compared to those with normal zinc levels. Results. COVID-19 patients showed significantly lower zinc levels after exclusion of zinc intake compared to healthy controls (p = 0.027). Among COVID-19 patients, 60 (40%) were found to be zinc deficient. These patients had a longer recovery period and a higher need for hospitalization. Conclusion. Zinc is an important trace element that plays a crucial role in immunity function, and the results of the present study demonstrate significantly lower zinc levels in COVID-19 patients compared to healthy controls. Key words: COVID-19, zinc, immune system

Threat or opportunity? - Managers’ and employees’ perception of automation and digitalization in the horticultural sector

While technology advancements are present in all parts of the agricultural sector, horticulture is particularly effected: horticulture has the highest need for manual labor and tasks are increasingly taken over by technology. The aim of our research is to explore and contrast farm managers’ and employees’ assessments of automation and digitalization in the horticultural sector. We collect data from 156 horticultural managers and 132 horticultural employees from Germany via an online survey. We focus on both groups, as farm managers are the decision-makers on investments and technology, but these decisions directly affect employees and their daily work. Overall, participating horticultural managers and employees view automation and digitalization mostly positive and both groups share similar views. Both groups view, on average, that automation and digitalization (i) is a solution to the ongoing skill shortage, (ii) can increase the control over production and data, (iii) effect current employees and their work positively (e.g., reduces stress and physical strain), (iv) change the industry image to the better, and (v) can reduce overall costs and increase productivity. However, both groups do also, on average, expect a shift towards large farms due to automation and digitalization and find acquisitions to be costly. Slight disagreements between the groups arise only in terms of one of the two groups expecting even clearer advantages from automation or digitalization. Our survey is the first to identify and contrast both managers and employees perception on the opportunities and risks of automation and digitalization.

Prevalence, risk factors, and outcomes of acute kidney injury in a pediatric cardiac intensive care unit: A cross-sectional study.

Acute kidney injury (AKI) is a common complication in pediatric cardiac intensive care unit (CICU). This study aims to identify the prevalence, risk factors, and outcomes of AKI in pediatrics admitted to a CICU unit of a tertiary hospital. We retrospectively gathered the data of 253 randomly selected patients admitted to the CICU unit from March 2018 to March 2022. Data were collected from EHRs. We used the Kidney Disease Improving Global Outcomes (KDIGO) criteria for identifying AKI in patients. Overall, AKI prevalence was 22.9% in our population. In the multivariable analysis, vancomycin intake (odds ratio [OR]: 2.109, 95% confidence interval [CI]: 1.15-3.84), angiography (OR: 4.38, 95% CI: 1.28-14.93), and mechanical ventilation (OR: 2.08, 95% CI: 1.02-4.23) were independent risk factors of AKI development and patients with AKI had a higher in-hospital mortality rate (OR: 5.81, 95% CI: 2.55-13.19), higher need for cardiopulmonary resuscitation(OR: 3.08, 95% CI: 1.17-8.09), and longer ICU length of stay(OR: 6.49, 95% CI: 3.31-9.67). Furthermore, furosemide administration was associated with lower risk of developing AKI (OR: 0.52, 95% CI: 0.27-0.97). AKI is common and is associated with worse outcomes in patients with congenital heart disease. Our results emphasize the importance of early identification and monitoring of AKI in the pediatric CICU setting.

Prevalence of Career Indecision and Factors Influencing it among Medical Students and Interns in Oman

Aim and objectives: Career indecision (CI) is a broad term refers to the uncertainty and difficulty of decision- making of the future career among junior professionals. This study aims primarily to estimate the prevalence of CI among senior medical students and medical interns in Oman. Secondly, it assesses the association of socio-demographics factors influencing it. Finally, it examines the association between participation in career development activities and CI among them during the academic year of 2022-2023. Methods: A cross-sectional study was conducted using anonymous self-administered questionnaire in English language. We used a 21-item Career Factors Inventory (CFI) to determine CI score. CI scores were further classified to low-level CI (score 27-71) and high-level CI (score 72-105). Results: Total number of participants was 161. The minimum sample size calculated was 153 participants for 95% confidence interval. Unpaired t test and ANOVA test were used to determine association. The results showed the prevalence of high-level CI is 63.4% (95% CI 55.4% - 70.8%) among the participants. Participants with one of their parents in healthcare professions and those who did not participate in career development activities have high CI scores with P-value 0.002 and 0.022 respectively. Moreover, participants younger than 25 years of age in comparison to older participants had higher Need for Self-Knowledge (NSK) scores (p-value 0.018). Conclusion: Study participants showed high prevalence of high-level CI among senior medical students and medical interns in Oman. Few factors were found to be statistically associated, especially participation in career development activities. Further studies are recommended to investigate the causality of high CI levels among junior professionals in Oman and the contributing factors. Curricular and extra-curricular career development activities and counselling may improve CI and reduce its burden.

무력충돌시 문화재 파괴 행위에 대한 국제형사책임의 과제

Since the 1990s, situations in which culturally significant heritage sites serve as symbolic targets for intentional attacks, leading to the 'destruction of enemy communities,' have frequently occurred. The International Criminal Tribunal for the former Yugoslavia (ICTY), established to prosecute serious violations of international humanitarian law within the former Yugoslav territories, addresses prominent cases of intentional attacks and destruction of cultural property during the armed conflict, specifically targeting the annihilation of ethnic identity. This article examines the implications and limitations of international legal norms regarding the protection of cultural heritage during armed conflicts, focusing on the Dubrovnik Old Town shelling incident, a representative case of cultural property destruction prosecuted by the ICTY. Firstly, the intentional destruction of cultural heritage is undeniably a significant violation of values that the international community must protect. The pursuit of individual criminal responsibility for the destruction of cultural heritage within the international criminal tribunal signifies a substantial advancement in international efforts to protect cultural heritage during armed conflicts. The negative impact of the intentional destruction of cultural property on human dignity and universal human values is undeniable. However, ensuring effective protection of cultural property in the current normative context, where attacks on cultural property for military purposes may be justified, remains challenging. Secondly, military necessity, rooted in customary international law, limits attacks on enemy forces to military objectives, focusing on the centralization of enemy forces, balancing the military necessity of concentrated attacks on enemy forces with humanitarian considerations to protect civilian objects. However, determining what qualifies as a military objective can be challenging, as it depends on the circumstances of combat and operations. Regardless of whether the principle of proportionality is applicable, evaluating the military necessity from the perspective of cultural heritage protection is crucial. ICTY recognizes that even when military necessity justifies attacks on civilian objects, the intentional destruction of cultural heritage can have a significant impact on the psychological well-being of civilians and may upset the balance with military superiority. Thus, careful consideration is necessary when assessing the military necessity in cases where the protection of cultural property, with a higher need for protection than general civilian objects, is involved. Moreover, even if a target has dual-use, being considered a military objective, evaluating proportionality in the attack is essential to prevent harm to civilians, in accordance with the principle of proportionality. In conclusion, the intentional destruction of cultural heritage should be treated as a threat to the common values of the international community, necessitating appropriate legal and policy responses in line with the actual circumstances of the armed coflict. Military commanders should not only view attacks on cultural heritage as inevitable collateral damage but also recognize the gravity of such acts as war crimes and consider them strategically within military operations.

STUDY OF SOFT PALATE DIMENSION AND NASOPHARYNGEAL DEPTH (NEED’S RATIO) USING LATERAL CEPHALOMETRICS X- RAY

Background: Soft palate is a tissue mass that hangs behind the hard palate mainly to seal the pharyngeal airway. The length of the soft palate should be adequate to close the pharyngeal depth. Failure to completely seal leads to velopharyngeal insufficiency while longer palatal length leads to obstructive sleep apnea. This study aimed to find the need’s ratio among the general Nepalese population. Methods: Lateral cephalograms of 591 of 17 years and above cases without any history of palatal surgery, orthodontic treatment or congenital defect were studied. The length of the soft palate, pharyngeal depth and thickness of the palatal tissue was measured using VLX computer program in lateral cephalograms obtained from gendex orthoralix 9200. The ratio of palatal length pharyngeal depth was calculated as Need’s ratio. Results: Soft palate length was 33.27 + 7.74 and 24.82 + 4.53 respectively. The Need’s ratio calculated is 0.75. The rat tail shape of soft palate was highly prevalent 173 (28.3%) while S shape was least 51 (8.6%) . Crook type of soft palate has highest Need’s ratio. Conclusions: The mean Need’s ratio of Nepalese population is 0.75. Need’s ratio also varies from shape of the soft palate.

Assimilation of Retail Green Marketing Strategies, Institutional Pressure and Mediating Role of Green Marketing Culture

This study examines the process of incorporating retail green marketing tactics, investigating the impact of institutional pressure and the intermediate function of green marketing culture. The results, obtained from a group of knowledgeable participants who have strong connections to their organisations, indicate a significant agreement in the implementation of environmentally friendly marketing tactics in the specific setting under investigation. Supermarkets are increasingly adopting environmentally conscious practises due to the need to protect the environment, comply with environmental legislation, and meet the growing demand for eco-friendly items. The consumer market demonstrates a greater recognition of the importance of ecological concerns, resulting in a higher need for products that are ecologically friendly. Businesses, in response to this consumer sentiment, are obligated to implement sustainable practises, placing emphasis on the necessity to furnish consumers with thorough information regarding environmentally-friendly items. Adopting environmentally friendly practises is not just a way to save money, but also a way for organisations to gain a competitive edge by establishing themselves as leaders in sustainability. This dedication not only improves the financial position but also adds to favourable environmental results, exemplifying corporate accountability.

Intraoperative Extracorporeal Support during Lung Transplantation: Not Just for the High-Risk Patient.

The use of intraoperative mechanical support during lung transplantation has traditionally been a controversial topic. Trends for intraoperative mechanical support strategies swing like a pendulum. Historically, cardiopulmonary bypass (CPB) was the modality of choice during transplantation. It provides full hemodynamic support including oxygenation and decarboxylation. Surgical exposure is improved by permitting the drainage of the heart and provides more permissive retraction. CPBs contain drainage reservoirs with hand-held pump suction catheters promoting blood conservation through collection and re-circulation. But CPB has its disadvantages. It is known to cause systemic inflammation and coagulopathy. CPB requires high doses of heparinization, which increases bleeding risks. As transplantation progressed, off-pump transplantation began to trend as a preferable option. ECMO, however, has many of the benefits of CPB with less of the risk. Outcomes were improved with ECMO compared to CPB. CPB has a higher blood transfusion requirement, a higher need for post-operative ECMO support, a higher re-intubation rate, high rates of kidney injury and need for hemodialysis, longer ICU stays, higher incidences of PGD grade 3, as well as overall in-hospital mortality when compared with ECMO use. The focus now shifts to using intraoperative mechanical support to protect the graft, helping to reduce ischemia-reperfusion injury and allowing for lung protective ventilator settings. Studies show that the routine use of ECMO during transplantation decreases the rate of primary graft dysfunction and many adverse outcomes including ventilator time, need for tracheostomy, renal failure, post-operative ECMO requirements, and others. As intraoperative planned ECMO is considered a safe and effective approach, with improved survival and better overall outcomes compared to both unplanned ECMO implementation and off-pump transplantation, its routine use should be taken into consideration as standard protocol.

Postpartum Care by Midwives: Socioeconomic Status has a Strong Influence on the Amount of Care Received An Analysis with Routine Data from BARMER Health Insurance

Socio-economic situation is associated with inequalities in access to health care and health-related resources. This also applies to pregnancy, birth and the postpartum period. Compared to other European countries, Germany has very good care options for the postpartum period. It has an unique system of postpartum care, which comprises home visits by midwives for 12 weeks after birth and beyond in problem cases and thus has structurally good care options. So far, however, there are hardly any studies based on routine data that show which mothers receive homevisits in postpartum care and to what extent. The study population comprised 199,978 women insured with BARMER who gave birth to at least one child in the years 2017-2020. Some women were pregnant several times in this period of time. The services billed by freelance midwives for outreach midwifery care in the puerperium were considered for 227,088 births, taking into account the socioeconomic situation of the mothers. According to the definition of the German Institute for Economic Research, 26% of the mothers belonged to a low income group, 46% to a medium income group and 29% to a high income group. Similar to what was shown for midwifery care during pregnancy, large differences were also found with regard to postpartum care: While 90.5% of the women with a high income received home visits, only 83.5% of women with a medium income did so, and only 67.9% of women with a low income. The groups did not differ with regard to other characteristics such as rate of caesarean section, preterm births, twins, age or concomitant diseases to an extent that could explain the differences in care. Women who had received midwifery services in pregnancy were much more likely to receive home visits by a midwife in the postpartum period. Furthermore, there was a correlation with the density of midwives in the respective region. The results suggest that access to home-based postpartum care by freelance midwives is significantly limited for low-income women. In contrast to antenatal care, women in the postpartum period cannot switch to other service providers, as outreach postpartum care is a reserved activity of midwives. Women with low incomes thus receive less midwifery care, although they have a higher need for support (Eickhorst et al. 2016).

Coping with expectation violations in education: the role of optimism bias and need for cognitive closure

Although most individuals experience expectation violations in their educational years, individuals’ coping strategies differ depending on situational and dispositional characteristics with potentially decisive influence on educational outcomes. As a situational characteristic, optimism bias indicates that individuals tend to update their expectations after unexpected positive feedback and to maintain their expectations after unexpected negative feedback. As a dispositional characteristic, a higher need for cognitive closure (NCC) indicates that individuals tend to both update (accommodation) and try to confirm expectations (assimilation) after unexpected negative feedback. To better understand mechanisms behind optimism bias and context-dependent effects of NCC in an educational context, we included controllability (attribution of success/failure to internal or external causes) and self-enhancement (amplifying positive self-relevant aspects) in an experimental case vignettes study. Our sample of n = 249 students was divided into four experimental groups (high/low controllability × positive/negative valence) and read four different case vignettes referring to expectation violations in an educational context. MANCOVA revealed that individuals updated their expectations after unexpected positive feedback only with stronger (vs. weaker) self-enhancement and that individuals maintained their expectations after unexpected negative feedback in controllable (vs. uncontrollable) situations. Furthermore, interindividual differences in NCC interacted with controllability in predicting expectation update. We conclude that considering the influences of controllability and self-enhancement, we can better understand and evaluate the adaptivity of the optimism bias and context-dependent effects of NCC in an educational context.

INTERSECTION OF RACE AND PLACE-BASED DISPARITIES AMONG 65+ IN MISSISSIPPI

Abstract Disparities in healthy aging have been attributed to race, gender, SES, and zipcode. The Mississippi Healthy Aging Data Report (HADR) is a new resource in the state to advance age-friendly progress reporting 150 indicators related to healthy aging for 82 counties. The present study explored how race and place may be associated with community health outcomes. The main data sources include the American Community Survey, the Behavioral Risk Factor Surveillance System, and the Centers for Medicare and Medicaid Services. Bivariate statistical analyses and mapping were conducted to compare the 65+ population in Mississippi living in rural (N=65) and urban areas (N=17); counties with high (N=44) and low (N=38) proportions of 65+ black residents; and high and low black populations by rural (high: N= 38; low: N=27) and urban counties (high: N=6; low: N=11). Bivariate analyses found that the rural counties with high proportions of 65+ black residents reported consistently worse rates for 26 out of 28 indicators of healthy aging. ArcGIS Mapping demonstrated that the Mississippi rural, black population tended to be centralized to the Delta region, a historically impoverished area. This population reported the highest rates of chronic conditions and poverty, lowest rates of education and life expectancy, and the lowest access to primary care providers and hospitals. This study underscores the importance of data tools like HADR to improve healthy aging for everyone. Understanding the distribution of community rates makes disparities evident and may help practitioners and policymakers to allocate resources to areas of highest need.

Sphericity index for bedside diagnosis of acute myocarditis

BackgroundDifferentiating acute myocarditis (AMY) from dilated cardiomyopathy (DCM) in a patient presenting with acute heart failure and poor systolic function is of utmost importance to initiate timely anti-inflammatory treatment in AMY. Using cardiac magnetic resonance (CMR) or endomyocardial biopsies (EMB) as gold standards might be limited due to the likelihood of hemodynamic compromise. Eccentric myocardial remodeling as measured by sphericity index (SPI) might be useful in differentiating AMY from DCM, due to the progressive increase in transverse LV diameter in DCM. The primary outcome parameter of our study was to test the diagnostic accuracy of SPI in the differentiation of AMY from DCM, while the secondary outcome parameter was to compare the diagnostic accuracy of SPI to troponin I in the same context. For this purpose, we conducted a retrospective study involving a chart review of the files of sixty patients admitted with acute heart failure due to hypokinetic left ventricle in our hospital. Patients were divided after CMR imaging into two groups: group 1 with AMY (n = 30) and group 2 with DCM (n = 30). Demographic and clinical characteristics of the patients, including heart rate, need for mechanical ventilation, use of milrinone, epinephrine and norepinephrine, troponin I, and 2D-derived sphericity index, were collected from patients’ files.ResultsPatients with AMY had a higher need for mechanical ventilation inopressors and vasopressors; 73% of AMY patients required mechanical ventilation and epinephrine use, compared to less than 50% of DCM patients. Troponin I elevation was more marked in AMY compared to DCM patients (0.25 ± 0.04 vs. 0.21 ± 0.03, respectively). SPI was significantly higher in DCM compared to AMY cases, denoting a spherical configuration of the myocardium acquired due to progressive remodeling, because of the chronicity of the pathology. ROC analysis revealed that an SPI ≤ 0.38 was 100% sensitive in differentiating DCM from AMY, compared to a 53% sensitivity with the commonly used troponin I.ConclusionAMY diagnosis can be achieved by the assessment of sphericity index rather than troponin I. The bedside nature and noninvasiveness of SPI should reshape the practice in this context. SPI assessment can be part of point-of-care echocardiography, taught to emergency room (ER) physicians and intensivists.

Longitudinal Antiracism Training for Family Medicine Residency Faculty.

Medical educators have often perpetuated misunderstandings about race-based medicine and at times failed to create safe educational environments for diverse learners who frequently experience mistreatment. It is imperative that family medicine faculty be equipped to recognize and mitigate bias and inequities in our teaching, research, and clinical care. Our residency formed a diversity, equity, inclusion, and antiracism (DEIA) faculty work group to address the need for faculty training. We developed and administered a 32-item needs assessment survey in 2020 to determine gaps in antiracist knowledge and skills among our faculty members. Over the following year, faculty members designed and implemented a series of faculty training sessions including a half-day faculty retreat to address the highest need areas. We reassessed faculty confidence and skills using a follow-up survey in 2021. Faculty respondents demonstrated increased confidence in their knowledge of various DEIA topics and ability to intervene when observing biased or culturally insensitive behaviors from colleagues. Participants also reported increased confidence in their ability to mitigate bias in their teaching and clinical work. Our longitudinal DEIA faculty training series, embedded into the existing structure of the residency, resulted in improvements in DEIA-related confidence and skills among faculty members. This training model could be adapted to a variety of residency settings as one step toward dismantling racism in medical education and clinical practice.

Improving Postgraduate Medical Training In Germany: A Proposal

Postgraduate (vocational, residency) training in Germany is regulated by the Physicians' Chamber in each federal state. Although training requirements are specified in detail by regulatory documents, young doctors are left on their own to find training posts and suitable learning experiences. There are no programmes in place to support trainees nor to identify the need of the health care system regarding the composition of its medical workforce. Hospitals and practices pay salaries to physicians in training from funding obtained for services they provide. We propose a systematic and continuing process of identifying gaps in the workforce. Disciplines with a lack of qualified doctors will be supported by additional funds directed to practices and hospitals. Regional rotation schemes will coordinate and improve the quality of training. Apart from an administrative overhead, this system of regulation will not need additional resources because a limited part of current budgets will be explicitly channelled into salaries for trainees in specialties for which there is a higher need than into others.

Unveiling Sex Differences in Tricuspid Valve Disease: A Systematic Review and Meta-Analysis of Surgical Management.

Tricuspid regurgitation (TR) is a heart condition where blood flows backward through the tricuspid valve. Tricuspid valve disease constitutes a major valvular heart condition that is receiving heightened attention due to tailored treatment options and sex-specific differences in treatment outcomes. The study aims to investigate whether biological sex has a significant influence on the development, progression, and treatment outcomes of tricuspid valve disease in adults. We conducted a comprehensive search to identify studies examining the impact of sex on the pathophysiology of TR as well as treatment outcomes in patients with TR. We searched PUBMED/MEDLINE, SCOPUS, and Excerpta Medica dataBASE (EMBASE) from inception to September 2023 to identify relevant studies. Twelve studies totaling 22,574 patients met our eligibility criteria. These studies were categorized into three subgroups: patients with TR without intervention (3,848 patients, with 48.1% males and 51.9% females), those who underwent open heart surgery (17,498 patients: 46.2% males and 53.8% females), and those who underwent transcatheter tricuspid valve repair/replacement (TTVR; 1,687 patients: 41.6% males and 58.4% females). Analysis revealed no major differences in terms of TR etiology. Males tended to have a slightly lower mean age difference (mean difference (MD): -0.60 years; 95% confidence interval (CI) (-1.49, -0.04); p = 0.10) but had more frequent chronic lung disease (risk ratio (RR): 1.12, 95% CI (1.01, 1.25), p = 0.03). Males showed higher baseline TR volume (MD: 4.11, 95% CI (0.53, 7.68), p = 0.02) and lower left ventricular ejection fraction (MD: -5.85, 95% CI (-6.97, -4.73), p < 0.00001). Following open heart surgery for TR treatment, males required more frequent permanent pacemaker implantation (PPM; RR: 1.57, 95% CI (1.21, 2.03), p = 0.0006). Similarly, TTVR showed a higher need for PPM in males (RR: 1.45, 95% CI (1.10, 1.93), p = 0.010). In-hospital mortality exhibited no sex differences, but males had a slightly elevated late mortality risk. Sex differences in TR patients were notable in baseline characteristics, with males having a higher risk of certain conditions. The more frequent requirement for PPM was a major sex-based difference in terms of prognosis.