Medical Research Articles

Prospective evaluation of hospital-acquired skin lesions in dogs: A case-control study.

Hospital-related dermatological conditions are well-studied and reported in human medicine. However, studies about these dermatological disorders in veterinary medicine are lacking. To report the incidence, type and distribution of hospital-acquired skin lesions (HASL) in dogs, and to investigate risk factors that may be associated with their development. Hospitalised client-owned dogs with HASL and a control group of hospitalised dogs without skin lesions. Prospective clinical evaluation of all HASL and dermatological tests, when indicated, were performed, over 6 months. A variety of potentially predisposing factors also were recorded. Thirty-one dogs with HASL and a matched control group of 60 hospitalised dogs without skin lesions were included. The incidence of HASL was 11.2% (31 of 278). The most common lesion was erythema in 74.2% of dogs (23 of 31) and the most affected area was the abdomen in 58.1% (18 of 31) of dogs. Faecal and/or urinary incontinence was identified as an important risk factor for the development of skin lesions during hospitalisation (odds ratio 14.445, 95% confidence interval 1.444-144.479, p = 0.023). Immobilisation and changes in body temperature also may play a role in the development of such lesions in dogs. Faecal and/or urinary incontinence was found to be an important factor in the development of HASL. The impact of HASL on patient outcomes and the prevention of these lesions requires further investigation.

Synthesis and Biomedical Applications of Covalent Organic Frameworks for Disease Diagnosis and Therapy.

Covalent organic frameworks (COFs) have emerged as a distinguished class of porous materials. Owing to their ability to be constructed through covalent bonds involving light elements, such as hydrogen, boron, carbon, nitrogen, and oxygen, COFs offer greater stability and lower cytotoxicity than metal organic frameworks do, addressing critical limitations in in vivo applications. Their unique attributes, such as high surface area, customizable pore sizes, and versatile surface functionalities, make them ideal for various biomedical applications. This review aims to provide an overview of the recent advancements in modern COFs for biomedical uses. First, a variety of methods for the synthesis of COFs are outlined, which ensures their suitability for medical use. Next, we delve into innovative biomedical applications, emphasizing their role in disease diagnostics and therapies. Finally, challenges, such as clinical translation, biocompatibility, and controlled drug release, are critically discussed, providing comprehensive insight into the potential of COFs in revolutionizing biomedical technologies. Overall, this review offers a comprehensive overview of COFs' capabilities and future prospects in enhancing biomedical technologies.

Thalidomide: History of Research and Perspectives for Its Medical Use (Review)

Thalidomide: History of Research and Perspectives for Its Medical Use (Review)

Reducing UVR Exposure in Pregnant Women and Infants: A Pilot Study.

Sun protection during pregnancy is critical for both maternal and infant skin cancer prevention, yet gaps remain in addressing this behavior in pre and postnatal settings. This pilot study aimed to evaluate the feasibility and acceptability of a peer-led intervention for expectant mothers' sun protection behaviors for themselves and their newborns and examine the preliminary effects on mothers' skin cancer knowledge, attitudes, and sun protection behaviors for themselves and their infants. Expectant mothers were recruited from medical clinics and community settings and were asked to complete surveys and interviews. The intervention, informed by the Cognitive-Social Health Information Processing model, consisted of two peer coach-led remote sessions. The majority of mothers (81%) attended both intervention sessions and reported increased understanding of (88%) and improved sun protection practices for themselves (79%; such as wearing sunscreen and reapplying sunscreen while outside). Additionally, 89% agreed that SUNRISE content is beneficial for new mothers. Moreover, maternal self-efficacy for implementing sun protection, intention to implement sun-safe behaviors for their infants, and knowledge of infant skin cancer prevention also increased with large effect sizes (d = 0.8-1.3). Mothers reported significantly decreased barriers to sun safety pre- to post-intervention. Feasibility of recruitment and delivery of a peer-led intervention focused on sun safety in women and their infants was high, and the intervention was acceptable to participating women. Mothers improved their sun protection behaviors over time, and implementation of sun protection behaviors for their infants was high. Intervention efficacy with a larger and more diverse sample is warranted, with longer follow-up.

Feline Infectious Peritonitis Effusion Index: A Novel Diagnostic Method and Validation of Flow Cytometry-Based Delta Total Nucleated Cells Analysis on the Sysmex XN-1000V®

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led the medical and scientific community to explore the pathogenesis and clinical manifestations of coronaviruses. In felines, a widespread coronavirus known as feline coronavirus (FCoV) can lead to feline infectious peritonitis (FIP), a highly fatal disease characterised by severe systemic inflammation. Diagnosing FCoV remains challenging due to the limited accuracy of the available methods. The present study introduces the FIP Effusion Index, a novel diagnostic method that combines the albumin-to-globulin (ALB/GLOB) ratio with the delta total nucleated cell (∆TNC) count obtained via flow cytometry using the Sysmex XN-1000V® analyser in effusions. Samples from cats (n = 50) with suspected FIP were analysed for ∆TNC, with findings showing that a ∆TNC ≥ 2.1 is highly indicative of FIP and a ∆TNC ≥ 4.9 can be considered diagnostic. The FIP Effusion Index enhanced diagnostic precision in our group of samples, achieving 96.3% sensitivity and 95.7% specificity for values ≥ 5.06, and reaching perfect specificity (100%) with 96.3% sensitivity for values ≥ 7.54. This combined approach surpasses the accuracy of individual parameters, establishing the FIP Effusion Index as a superior diagnostic tool for FIP, with potential applications in both veterinary and human medicine for related coronavirus diseases.

Mediterranean diet as an element of treatment and prevention of cardiovascular diseases

Currently, the issues of treatment and prevention of cardiovascular diseases are still relevant, as cardiovascular pathology remains one of the leading causes of disability and mortality in all developed countries of the world. In the Russian Federation there is a high incidence of the diseases of the circulatory system, so they have the top priority among health problems, despite a slight decrease in morbidity in recent years. The main purpose of this review is to study the experience of applying the Mediterranean diet and its components in therapy and prevention of cardiovascular pathology. Research method: we searched electronic databases PubMed, Scopus, Web of Science, MedLine, Science Direct and eLIBRARY.RU using the following terms: "Mediterranean diet", "cardiovascular diseases", "prevention of cardiovascular diseases", "diet therapy of cardiovascular diseases". On the basis of numerous world clinical studies analysis, it can be assumed that the Mediterranean diet is one of the most reliable and well-studied in terms of prevention of cardiovascular pathology. The aim of this review is to draw the attention of the medical community to such a long-known, extensively studied, scientifically confirmed, accessible and simple way of rationalizing daily nutrition as the consumption of elements of the Mediterranean diet in the daily one. Further wide informing of patients about this way of nutrition from different specialists (general practitioners, cardiologists, nutritionists, gerontologists and others) is required.

REHABILITATION AFTER SURVIVING OCULAR ONCOLOGY. LITERATURE REVIEW

New drugs and methods of early diagnosis of malignant tumors of the visual organ have appeared in the last decades. Nevertheless, the problem of untimely diagnosis and treatment of these diseases remains in practical ophthalmology, which leads to more radical and less organ-preserving methods of treatment and, as a consequence, to the deterioration of cosmetic and functional results in subsequent eye prosthetics.Aim. To analyze and discuss the literature on the following topics: ocular prosthetics and ophthalmic oncology using available databases.Material and methods. Optimization of domestic and foreign scientific papers using eLibrary, PubMed, ScienceDirect and Google Scholar databases.Results. The 52 most relevant sources of domestic and foreign literature were analyzed.Conclusions. Having analyzed the literature data in domestic and foreign sources, we can conclude that the world medical community has not fully disclosed the issue of eye prosthetics in patients after oncological treatment. More research and practical recommendations are needed in this area. The use of a staggered prosthetic method, as well as the shape of the eye prosthesis, taking into account the individual characteristics of the conjunctival cavity, will help to achieve the best results.

Abstract 4133161: Variation in Prevalence, Treatment, and Outcomes in Heart Failure with Improved Ejection Fraction by Race and Ethnicity

Background: Racial and ethnic disparities exist in heart failure with reduced ejection fraction (HFrEF), but little is known about how race and ethnicity relate to patients with HF with improved EF (HFimpEF). Research Question: Do the epidemiology, treatment, and outcomes vary by race and ethnicity in patients with HFimpEF? Aim: To describe the relationship between race and ethnicity and HFimpEF within a large, integrated health care delivery system. Methods: We identified adults aged ≥18 years with incident HFrEF (LVEF≤40%) from 2013-2018 within Kaiser Permanente Northern California. HFimpEF was defined as LVEF>40% within 12 months after incident HFrEF. Self-reported race and ethnicity were classified as non-Hispanic White, non-Hispanic Black, Asian American/Native Hawaiian/Pacific Islander (AANHPI), Hispanic, and other. Incidence rates of worsening HF (WHF) events (i.e., HF hospitalization, ED visit, or urgent outpatient WHF visits) or all-cause death were compared across patients with HFimpEF and persistent HFrEF using Cox proportional hazard models adjusted for age, sex, and LVEF at incident HFrEF, stratified by race and ethnicity. Results: Among 12,639 adults with incident HFrEF, 7,562 (59.8%) were White, 1,481 (11.7%) were AANHPI, 1,385 (11.0%) were Black, and 1,537 (12.2%) identified as Hispanic. Rates of HFimpEF following incident HFrEF was lowest among Black patients (26%), but similar among other race and ethnicities (36%, 34%, 30%, and 30% for AANHPI, White, Hispanic, and other, respectively, chi-squared p<0.01). Medication use was similar across groups at time of HFimpEF, but generally declined thereafter (Panel A) . Among patients with HFimpEF, Black and Hispanic patients had significantly higher crude rates of WHF or death compared to White patients (34 and 30 compared to 23 per 100 person-years, p<0.01 for each). Despite these differences in absolute rates, relative associations between HFimpEF (vs. persistent HFrEF) and WHF or death remained similar across all race and ethnicities (AANHPI: aHR=0.52 [95%CI 0.42-0.65], Black: aHR=0.70 [95%CI 0.56-0.87], Hispanic: aHR=0.60 [95%CI 0.49-0.73], White: aHR=0.53 [95%CI 0.48-0.58], p interaction =0.13) (Panel B) . Conclusions: HFimpEF is common within 12 months after incident HFrEF, and HF medication adherence declines in the years following. HFimpEF is associated with improved clinical outcomes across race and ethnicity, but occurs less frequently in Black patients despite similar HF medical therapy use.

Abstract 4113411: Long Term Outcomes of Hypertension and Antihypertensive Drugs in Young Healthy Adults: A Nationwide Population-based Prospective Cohort Study in Korea

Background: Long term follow-up data on elevated blood pressure (BP) or antihypertensive drugs in young adults are scarce. The effect of hypertension (HTN) and antihypertensive medications on the cardiovascular disease incidence in young healthy adults (20~45 years) was analyzed using a large-scale population medical use database in Korea. Methods: In total, 4,590,597 young Korean adults without comorbidities who underwent regular health examination were included in this study. They were stratified into four groups according to their BP (optimal BP, normal BP, high normal BP, and HTN). The primary outcome was a composite of the incidence of myocardial infarction and ischemic and hemorrhagic stroke, obtained by tracking the medical use data of the first-ever ICD-10 codes. Subgroup analysis was conducted by categorizing the HTN group into two subgroups according to the prescription ratios of the antihypertensive drugs during the follow-up period. Results: The average age was 33.8 years and median follow-up duration was 15.9 years. HTN elevated the incidence risk of major cardiovascular disease by 2.16 times compared to that of the optimal BP group. Dyslipidemia and HTN were the most dominant risk factors for myocardial infarction and stroke, respectively. In the subgroup analysis, antihypertensive medications decreased the incidence of cardiovascular disease by 70% in all diseases. Conclusions: Cardiovascular risk factors, including HTN, contribute to major cardiovascular disease incidence in young adults. The antihypertensive medications decreased the major cardiovascular disease incidence estimates.

Abstract Su802: Feasibility of detecting CPR compression frequency using machine-learning software in video footage of CPR

Background: Several studies have demonstrated that video assisted cardiopulmonary resuscitation (V-CPR) is efficient in improving cardiopulmonary resuscitation (CPR) quality and patient outcome. However, currently the technique depends on 911 dispatchers who evaluate the video footage and may thus be subject to inter-operator variations. Research Question: We hypothesized that using an open-source machine learning supported software (“artificial intelligence” – AI) would be able to provide real-time feedback on CPR frequency in a video of CPR. Aims: To evaluate the feasibility and accuracy of a selected AI software to correctly detect the actual compression frequency in video footage of CPR performed in a CPR manikin. Methods: MediaPipe Pose Landmark Detection (Google LLC, Mountain View, CA, USA), an open-source AI software using machine-learning models to detect human body postures in images and videos, was programmed to assess compression frequency of nine videos showing CPR on a manikin, each with a different fixed compression frequency and compression depth. Camera angle and distance were standardized. Frequency was assessed from compression to compression with AI software and the manikin’s internal software (QCPR, Laerdal, Stavanger, Norway). After testing for Gaussian distribution, means were compared using Wilcoxon matched-pairs signed rank test. Results: There were high levels of agreement between compression frequencies derived from AI and manikin’s software (Statistic comparisons are presented in Figure 1, correlations of measurements are presented in Figure 2 ). Conclusions: In this pilot study, an open-source landmark detection AI software was able to assess CPR compression frequency with high agreement to actual frequency derived from a CPR manikin. Since the software used is currently not intended for medical use, further development is necessary before the technology can be evaluated for real-life CPR.

Abstract 4112926: Echocardiography in Hypertrophic Cardiomyopathy: Virtual Continuing Medical Education Advances Physician Knowledge and Confidence

Purpose: This study examined whether online CME could improve the knowledge and confidence of cardiologists regarding the use of echocardiography for HCM diagnosis and management. Methods: The CME intervention comprised of a series of 6 online interviews between 1 moderator and 2 expert faculty. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed knowledge, and 1, rated on a Likert-type scale, assessed confidence. A paired samples t-test was conducted on overall average number of correct responses and for confidence rating, and a McNemar’s test was conducted at the question level (significance level, P < .05). Data were collected August 8-September 8, 2023. Results: 165 cardiologists answered all assessment questions during the study period. Analysis of pre- vs. post-intervention responses demonstrated a significant improvement in overall knowledge; average correct responses increased from 48% pre-assessment to 74% post-assessment ( P <.001). Specific areas of improvement include: Knowledge of the quantification of LVOT gradients, MR, and LVEF in the echocardiographic workup of HCM: 21% improved and 62% reinforced; the correct response increased (P<.001) from 65% (pre) to 84% (post). Knowledge of the utility of echocardiography for follow-up and monitoring response to HCM treatment: 48% improved and 35% reinforced; the correct response increase (P<.001) from 39% (pre) to 70% (post). Post-education, 48% of cardiologists had a measurable increase in their ability to diagnose HCM using echocardiographic parameters, resulting in 43% who were mostly or very confident after education (24% pre vs 43% post; P<.001). Conclusion: This study demonstrated the success of online CME at improving the knowledge and confidence of cardiologists related to the use of echocardiography to identify and manage HCM.

Practical tips for teaching medicine in the metaverse

The metaverse is based on immersive technologies such as virtual and augmented reality, body tracking, tactile sensation, etc. A growing number of studies are demonstrating the potential of the metaverse as an attractive resource for learning medicine. However, in practice, medical teachers and students often encounter significant challenges when utilizing the underlying technologies, potentially leading to frustrating learning experiences. A significant part of the teaching time is often devoted to troubleshooting technical issues with the metaverse, and the medical content itself taking a backseat until students become proficient in navigating the metaverse environment. Therefore, it is essential to fit the metaverse's underlying technologies specifically for medical education, minimizing technical hurdles for both teachers and students. In this paper, we deal with this challenge and we present a collection of practical tips that serves as a guide for medical educators making decisions in this emerging field, where they may lack prior experience. Drawing on our observation with a cohort of 776 medical students, we conclude how to effectively identify, design, or implement educational applications tailored for efficient medical learning through the metaverse. Our work may support teachers considering metaverse learning platforms for their classrooms and it is a beneficial reference for the medical education community during the initial stages of implementing the metaverse for teaching.

Formulation, Evaluation and Medicinal Properties of Medicated Herbal Cream Containing Extract of Tridax Procumbens

At present, herbal medicine has a great impact on human health and diseases herbal medicine plays an important role in general aspects such as economy and medicine. The use of this herbal medicine is increasing day by day due to its quality, efficacy and safety. The present study explored a novel formulation containing extracts of Tridax procumbens, Ficus religiosa, Azadirachta indica and Curcuma longa in cream form (O/W). The formulation was characterized by determining the pharmaceutical properties such as pH, appearance, viscosity, spreadability, etc. The chemical constituents such as carbohydrates, alkaloids, steroids, etc. were detected using identification assays. The cream formulation was designed using excipients such as stearyl alcohol, beeswax, sorbitol monooleate, methylparaben, propylparaben and liquid paraffin. Compared with the control drug, the herbal drug was found to be safer. While allergy medications are associated with some side effects, the formulation of cream is much better than other formulations in terms of absorption and penetration of the active ingredient in the tropics.

Abstract 4138433: Prevalence, Clinical Characteristics, and Outcomes in Heart Failure with Improved Ejection Fraction by Chronological Age

Background: HF incidence increases with age. Modern treatments have led to more patients recovering LVEF, classified as HF with improved ejection fraction (HFimpEF). However, the age-related epidemiology and prognosis of HFimpEF remain unclear. Hypothesis: Compared to younger patients, older patients will have lower rates of HFimpEF after incident HFrEF and higher rates of HF-related morbidity and mortality. Aims: To describe the clinical characteristics and outcomes in HFimpEF across the age spectrum within a healthcare delivery system in the US. Methods: We identified adults ≥18 years with incident HFrEF (LVEF≤40%) between 2013-2018 within Kaiser Permanente Northern California (KPNC), a healthcare system serving 4.5 million members. HFimpEF was defined as baseline LVEF <40% with subsequent >10% improvement to >40%. HFimpEF incidence was assessed by baseline age categories (<50, 50-64, 65-79, ≥80 years [yrs]). Rates of worsening HF (WHF) events (i.e. HF-related hospitalization, ED, or outpatient visits) were compared between HFimpEF and persistent HFrEF patients across age using Cox proportional hazards models adjusted for sex and EF at the time of incident HFrEF, including potential interaction by age modeled continuously (cubic splines with 3 knots). Data: Among 12,639 adults with incident HFrEF, 33% experienced HFimpEF, with lower rates at older ages: 42% (<50 yrs), 41% (50-64 yrs), 35% (65-79 yrs) and 18% (≥80 yrs). Among patients with HFimpEF alive at 1-year post-HFrEF (N=9954), WHF incidence (per 100 p-y) remained high (10.7) in younger (<50 yrs) patients and increased by age: 14.5 (50-64 yrs), 21.6 (65-79 yrs), and 33.7 (≥80 yrs)(P <0.001 for trend; Figure, Panel A). Patients with HFimpEF, compared to those with persistent HFrEF, had lower adjusted rates of WHF across the spectrum of age (pinteraction by age < 0.001; Figure, Panel B). Conclusion: HFimpEF is common within a year of incident HFrEF, more prevalent in younger patients, and is associated with significant residual clinical risk. Compared to persistent HFrEF, improvements in LVEF are associated with a lower risk of WHF or death. Additional research is needed to understand HF symptom burden and medical therapy use in this population.

Abstract Su705: Predictive Model and Factors for Out-of-Hospital Cardiac Arrest in Geriatric Patients with insomnia: A Longitudinal Study

Background: Previous studies have shown that geriatric insomnia can impact the quality of life and lead to various health risks and comorbidities, which may further result in out-of-hospital cardiac arrest (OHCA). Therefore, assessing the risk of OHCA in elderly patients with insomnia is crucial. Hypothesis: We hypothesized that a predictive model incorporating demographic, clinical, and treatment adherence factors can effectively estimate the risk of OHCA among geriatric patients with insomnia. Aim: This study aimed to develop and validate a predictive model for OHCA in geriatric patients with insomnia using a large-scale population-based analysis. Method: A retrospective cohort study was conducted using data from Taiwan's Health and Welfare Data Science Center spanning from 2011 to 2020. The study included elderly patients diagnosed with insomnia who received medication. Predictors of OHCA, such as age, sex, comorbidities, medication adherence, and psychotherapy, were analyzed using multivariable logistic regression. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC) with both internal and temporal validation. Results: Among 438,147 eligible elderly patients with insomnia, 7,666 experienced OHCA. Using data from 2011 to 2018 for model development, the AUROC for predicting OHCA within 7 days, 30 days, and 90 days ranged from 0.749 to 0.762 in the training set and 0.768 to 0.784 in the validation set. Key predictors included older age, male sex, prior medical resource use, hemodialysis, pre-existing comorbidities, medication possession ratio, medication changes, and recent psychotherapy (Figure 1). The model was also tested in 2019 and 2020 dataset (began of the COVID-19 in Taiwan), respectively, demonstrating consistent predictive performance (Figure 2). Specifically, the 7-day model in 2019 showed a sensitivity of 0.776, specificity of 0.632, and accuracy of 0.632, with a positive likelihood ratio (PLR) of 2.11, and negative likelihood ratio (NLR) of 0.36. In 2020, it achieved a sensitivity of 0.739, specificity of 0.661, accuracy of 0.661, PLR of 2.18, NLR of 0.40. Conclusion: The study developed a reliable predictive model for OHCA in geriatric patients with insomnia, highlighting significant predictors such as age, comorbidities, medication adherence, and recent psychotherapy. This model can aid clinicians in identifying high-risk patients and improving preventative care strategies.

Heart Failure: A Deficiency of Energy—A Path Yet to Discover and Walk

Heart failure is a complex syndrome and our understanding and therapeutic approach relies mostly on its phenotypic presentation. Notably, the heart is characterized as the most energy-consuming organ, being both a producer and consumer, in order to satisfy multiple cardiac functions: ion exchange, electromechanical coordination, excitation–contraction coupling, etc. By obtaining further knowledge of the cardiac energy field, we can probably better characterize the basic pathophysiological events occurring in heart disease patients and understand the metabolic substance changes, the relationship between the alteration of energy production/consumption, and hence energetic deficiency not only in the heart as a whole but in every single cardiac territory, which will hopefully provide us with the opportunity to uncover the beginning of the heart failure process. In this respect, using (a) newer imaging techniques, (b) biomedicine, (c) nanotechnology, and (d) artificial intelligence, we can gain a deeper understanding of this complex syndrome. This, in turn, can lead to earlier and more effective therapeutic approaches, ultimately improving human health. To date, the scientific community has not given sufficient attention to the energetic starvation model. In our view, this review aims to encourage scientists and the medical community to conduct studies for a better understanding and treatment of this syndrome.

Disseminated Knowledge: The Advancement of Finnish Occupational Medicine and Work Psychology in a Transnational Context, c. 1945–1952

Summary This article focuses on the advancement of Finnish occupational medicine in the immediate post-war period, situating its development within a transnational context. Its objective is to offer insight into Finnish post-war industrial medicine and particularly developments in mental health care. The empirical methodology addresses a previously unexplored case study: the connections between the Finnish Institute of Occupational Health (FIOH) and Roffey Park Rehabilitation Centre, established in 1943 to address various cases of industrial neurosis. The case study sheds light on the ways in which FIOH adopted reformist ideas from transnational medical communities by aligning them with the needs of Finland’s war reparations industry. The article argues that FIOH’s experts advanced new theories of mental disorder for Finland’s newly modern industrial society, and that these initiatives should be situated within broader transnational endeavours in the mental hygiene movement.

Visualization of anatomical structures in the carpal region of the horse using cone beam computed tomography in comparison with conventional multidetector computed tomography

IntroductionIn the diagnostics of orthopedic diseases in the horse, diagnostic imaging often plays a decisive role. Cone beam computed tomography (CBCT) imaging is used in both human and small animal medicine and becoming increasingly popular. To see whether CBCT imaging can be useful in the diagnosis of orthopedic diseases of the carpal region of the horse and to explore possible limitations we compared CBCT images with multidetector computed tomography (MDCT) images of the carpal region of equine cadaveric specimens.Materials and methodsTwenty-eight forelimbs from fifteen horses, slaughtered for reasons unrelated to this study, were examined. Native and contrast enhanced CBCT and MDCT scans were performed. Anatomical structures were blindly evaluated by three independent experienced observers using a visual scoring system previously reported and adapted to the equine carpal region. A descriptive evaluation was carried out as well as Spearman’s rank correlation and interobserver agreement was shown by percent agreement (PA).ResultsVisualization of osseous structures was excellent in both MDCT and CBCT. Articular cartilage could only be assessed in contrast enhanced scans whereby MDCT showed a slightly better visualization than CBCT. Soft tissue structures were generally difficult to assess. An exception were the medial and lateral palmar intercarpal ligament, which could not be visualized in native but were well visualized in contrast enhanced scans in both MDCT and CBCT images.Discussion/conclusionFor the evaluation of osseous structures and some intraarticular ligaments after contrast enhancement, CBCT serves as a reliable diagnostic imaging modality for the equine carpal region. However, soft tissue structures and cartilage are imaged more reliably using MDCT.

Social Determinants of Health and Disparities in Guideline-Directed Medical Therapy Optimization for Heart Failure.

Fewer than 20% of eligible patients with heart failure with reduced ejection fraction receive all 4 pillars of guideline-directed medical therapy. Understanding disparities by race, ethnicity, sex, and adverse social determinants of health is necessary to equitably optimize quadruple therapy. Utilizing the American Heart Association's Get With The Guidelines-Heart Failure registry, we examined associations between race and ethnicity, sex, and adverse social determinants of health (insurance type and documented social need [any barrier to accessing health care]) with quadruple therapy optimization (QTO) in patients with heart failure with reduced ejection fraction hospitalized between July 1, 2021, and September 30, 2023, with complete medication data at discharge. We calculated adjusted mean differences (AMDs) in the discharge QTO score (range, 0%-100%) reflecting the proportion of eligible use of renin-angiotensin system inhibitors, β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors and compared across demographic and adverse social determinants of health groups. Among 82 637 patients (median age, 66 years; 32.5% female; 57.0% non-Hispanic White; 76.4% prior heart failure with reduced ejection fraction), the overall mean QTO score was 56.2% (SD, 25.5). After adjustment, compared with non-Hispanic White individuals, Black (AMD, 2.56 percentage points [95% CI, 2.16-2.96]) and Hispanic individuals (AMD, 0.71 percentage points [95% CI, 0.11-1.31]) had higher QTO scores. Females had higher QTO scores than males (AMD, 1.94 percentage points [95% CI, 1.58-2.31]). Patients with no insurance (AMD, -4.90 percentage points [-5.62 to -4.17]), Medicaid (AMD, -0.45 percentage points [-0.89 to -0.01]), and Medicare (AMD, -1.64 percentage points [-2.10 to -1.18]) had lower QTO scores versus private insurance. Those with an identified social need (n=24 651) had lower QTO scores than those without (AMD, -3.40 percentage points [95% CI, -4.10 to -2.71]). Disparities in QTO were most evident for patients with no insurance, Medicaid, Medicare, or potentially an identified social need. Future efforts should focus on reducing gaps to improve equitable guideline-directed medical therapy use.

Impact of the COVID-19 pandemic on medical office assistants (MOAs) Working in Primary Care: A Qualitative Study.

Medical Office Assistants (MOAs), also known as receptionists and clerks, are front line workers and the most accessible member of the primary care team. Historically, their contributions to primary care have been unrecognised and undervalued. The COVID-19 pandemic put pressure on existing roles and systems in primary care: how MOAs adapted is unknown. To explore the experiences of MOAs working in primary care during the COVID-19 pandemic from the perspectives of MOAs and family physicians (FPs) who worked with MOAs during this period. A qualitative study using Constructivist Grounded Theory, conducted in Ontario, Canada METHOD: Seventeen participants were recruited through professional contacts of the research team. Individual semi-structured interviews were conducted with MOAs and FPs across the province. MOAs' many responsibilities in primary care intensified during the pandemic. MOAs leveraged their healthcare system knowledge and therapeutic relationships with patients to reduce patient distress. Unfortunately, MOAs experienced more frustration, and in some cases, abuse from patients. MOAs' ability to adapt to new systems and respond to high patient needs seemed to be positively influenced by their relationships with patients and FPs. FPs expressed concern for MOA welfare and recognised their critical role on primary care teams. MOAs made significant contributions to primary care during the COVID-19 pandemic. This study suggests MOAs have greater capacity than previously recognised which has important implications for planning in an era of under-resourced healthcare.