Improve Patient Care Research Articles

Implementation of pharmacogenomics: Experience at Ochsner Health.

Pharmacogenomics is the study of how individual responses to medication are influenced by genetics. As medication experts, pharmacists are uniquely suited to practicing this application of precision medicine. Fundamental operational aspects of developing a pharmacy clinical pharmacogenomics practice are described, and the specific experience of a multisite health system in developing a pharmacogenomics service is discussed. Considerations for the development of a clinical pharmacy-driven pharmacogenomics service include understanding testing selection, targeting the appropriate patient population, exploration of reimbursement, design of the practice, and education of the pharmacogenomics workforce. Testing can be preemptive or reactive, can occur in house or as a send-out service, and can be panel based or specific to a single gene. Pharmacogenomics is applicable to many medicine specialties, making deployment of services to strategic groups essential. Reimbursement for pharmacogenomics is variable and may pose a barrier to implementation. The demand for pharmacogenomics education for pharmacy students and as a formal postgraduate career path is growing. Pharmacogenomics service planning and implementation details for a multisite health system are described. The practice of pharmacogenomics presents a remarkable opportunity for clinical pharmacists and health systems to improve patient care outcomes and experiences.

Abdominal Applications of Photon-Counting CT.

Photon-counting computed tomography (PCCT) has shown promising advancements in abdominal imaging in clinical use. Though more peer-reviewed primary literature is needed, this commentary explores PCCT's potential applications, focusing on enhancing diagnostic accuracy, optimizing radiation dose management, and improving patient care. PCCT offers improved spatial and contrast resolution, lower image noise, and reduced radiation dose. Increased spatial resolution provides better detail in abdominal imaging, aiding in the detection of small lesions and subtle pathological changes. However, this generates more images per scan, raising concerns about "image overload" in PACS, potentially leading to longer reading times and increased stress for radiologists. PCCT's improved contrast resolution enhances tissue differentiation, reducing the need for intravenous contrast agents. The technology's advanced tissue characterization provides several advantages, such as non-invasive and opportunistic liver disease evaluation and improved differentiation of renal and adrenal masses. PCCT's optimized radiation dose management is crucial for patients requiring frequent scans. Enhanced diagnostic accuracy through spectral information aids in tissue differentiation, improving confidence in diagnoses. Streamlined workflows, particularly in emergency settings, and oncologic imaging, are potential benefits, reducing the need for additional imaging studies. Future integration of PCCT into clinical practice requires collaboration, education, and research to fully harness its potential, ensuring optimized abdominal imaging and improved patient care.

EVALUATION OF THE ROLE OF THE ACUTE MEDICAL REGISTRAR IN ORTHOPAEDICS

This project hoped to evaluate a new role, encompassing an in-hours registrar physician being based on the orthopaedic wards for advice, patient reviews, and patient journey optimisation. This service aimed to provide input for all patients who required them outwith the already established ortho-geriatric service.The success of this role was assessed through feedback questionnaires, as well as through the auditing of functional indicators such as the burden on the on-call orthopaedic registrar and other departments for advice from junior doctors, plus the number of medical emergencies.The survey received a total of 42 responses from various staff roles. All respondents thought the role had improved patient care or the functioning of the department. Respondents thought the role primarily enhanced patient care and safety and led to increased support for junior doctors and nursing staff. Data showed a 44% reduction in medical emergency calls since the role began. Total calls outwith the department for medical support reduced by 100% in hours and 50% out of hours when analysed over 22 days. Over a 14 day period, calls to the on-call orthopaedic registrar also reduced by 100% in hours, with no significant difference out of hours.This role has improved patient care and safety and allowed faster medical support with reduced impact on orthopaedic and general medical services. Feedback has been very positive from all staff. The major limitation is lack of 24 hour support. Next steps will include expanding the role, as well as introduction of framework for professional development.

Observable, but Not Unobservable Health Numbers are Associated With Self-Reported Health: NHANES 2017-2020.

Present study explored the influence of self-reported health on diff between observable and unobservable health factors. Data obtained through the 2017-2020 pre-pandemic dataset of the National Health and Nutrition Examination Survey (NHANES). A series of analyses of covariance were conducted with self-reported health as the independent variable, and measures of blood pressure, waist-to-hip ratio, fasting glucose and total cholesterol as dependent variables. Family income served as a covariate. Results revealed significant differences in self-reported health and blood pressure, waist-to-hip ratio, and fasting glucose. Individuals who rated their health excellent or very good tended to have better health numbers than those who rated their health as fair or poor. No statistically significant difference was found with self-reported health and cholesterol. It is possible that health numbers that can be observed (or assessed) at home, without a health care professional, may be more aligned with how individuals perceive their own health. Health care professionals may want to further help patients recognize their own health status. The use of wearable technologies may provide added health information resulting in more accurate perception of health. A more accurate perception of a patient's own health may aid health care professionals in further improving patient care.

Enhancing Clinical Data Quality to Improve Patient Care in Rural Health Facilities

WHO recognizes that high-quality research is not just a scientific pursuit but a crucial factor in achieving global health, health equity, and economic development. It is not just about the numbers but about the lives we can save and improve. In this context, four research priority areas have been identified: prioritizing health needs, building research capacity, ensuring good research practice, and ensuring good evidence is translated into practice. Local health research tailored to local needs remains an important global health goal, with the potential to revolutionize patient care in rural health facilities. Researchers and policymakers in low- and middle-income countries have expressed serious concerns about the limited access to high-quality data, a fundamental requirement for reliable and valid research. The assessment of data quality is typically categorized into five key areas: availability, usability, dependability, relevance, and presentation quality. This concept is further clarified by demonstrating how a robust healthcare data environment can enhance patient management through research efforts. The term ‘health data environment' encompasses the entire process of gathering, storing, managing, analysing, and utilizing health-related data to improve patient care and healthcare policies through informed decision-making. In this context, we present the challenges that undermine the quality of research data and propose solutions. Specifically, we identify the lack of adequate human resources, reliance on paper-based records systems, and the high costs of internet connectivity as the primary barriers to collecting and sharing high-quality data for research in low-resource settings. To tackle these challenges, we advocate for governments and funding institutions to invest in data management and communication systems, recruit and train data management staff to support clinicians, and reduce connectivity costs. Furthermore, we propose the deployment of a decentralized system as a cost-effective and less labor-intensive solution that only requires data entry staff at health facilities in resource-limited settings. This article explores current data collection, storage, and interpretation challenges and proposes innovative improvement solutions. It emphasizes the transformative potential of digitization, standardization, and staff training to enhance data quality. It further addresses the impact of quality data on evidence-based practice, ultimately leading to improved health outcomes. Focusing on rural healthcare facilities sheds light on the unique barriers these settings face, proposing tailored strategies that can bridge the gap between urban and rural health service delivery. These insights offer valuable guidance for policymakers, healthcare administrators, and practitioners striving to improve patient care in rural areas through data-driven strategies.

Navigating into the Paradigm of Nose-to-brain Delivery of Nanotherapeutics and their Repurposing as Nanotheranostics for Neurodegenerative Diseases.

Repurposing drugs for neurodegenerative diseases using the nose-to-brain route of administration is an intriguing concept with potential benefits. The nose-to-brain route involves delivering drugs directly to the brain via the olfactory or trigeminal pathways, bypassing the blood-brain barrier, which can improve drug efficacy and reduce systemic side effects. Treatment of numerous neurodegenerative diseases such as Multiple sclerosis, Amyotrophic lateral sclerosis, Huntington's, Alzheimer's, and Parkinson's diseases has been attempted using this route of administration. These drugs may include neuroprotective agents, anti-inflammatory drugs, antioxidants, or diseasemodifying therapies. Nanotheranostics, which integrates therapeutic and diagnostic functions in a nanosystem, improves treatment precision and efficacy. Repurposing nanotherapeutics as nanotheranostics for neurodegenerative diseases through the nose-to-brain route of administration holds great potential for both diagnosis and treatment. This review highlights the various mechanisms engaged in transporting nanocarriers from nose-to-brain and the proposed fate of these nanocarriers using different live imaging techniques. Additionally, the discussion covers the recent combinatorial therapeutic approaches and theranostic applications of various nanocarriers used for neurodegenerative diseases through the nose-to-brain. Toxicity to the CNS and nasal mucosa and regulatory considerations about these delivery systems are also deliberated. Overall, repurposed nanoparticles designed as nanotheranostic agents offer a versatile platform for precise diagnosis, targeted therapy, and personalized management of neurodegenerative diseases, holding great promise for improving patient care and advancing our understanding of these complex disorders.

Experiences of People With Persistent Nonspecific Neck Pain Who Used Immersive Virtual Reality Serious Games in the Home Setting: A Qualitative Study.

The purpose of this study was to explore the experiences of individuals with persistent nonspecific neck pain who used immersive virtual reality (VR) serious games at home for 2weeks. In this descriptive qualitative study, semi-structured one-on-one interviews were conducted at the participant's home after the 2-week period. Interviews were analyzed using qualitative content analysis. Sample size was determined using the information power concept (where "information power" refers to the amount of relevant information the sample provides for addressing the research question). Eleven adults with continuous or recurrent nonspecific neck pain participated in the study. Three main categories were identified. The first revolves around the home environment, revealing that participants had mixed perceptions about being at home, yet held a positive perspective on the utilization of immersive VR in that setting. The second pertains to immersive VR as a novel technology, indicating its overall comfort, user-friendliness, and varying degrees of immersion and presence experienced by the participants. The third focuses on exercising in immersive VR, drawing comparisons with conventional exercises, exploring the facilitators and barriers to usage, and addressing various aspects of integrating this technology into rehabilitation. Immersive VR was deemed comfortable for almost all participants and easy to use. Participants found exercising in immersive VR motivating and enjoyable, compared to conventional exercises. The home environment proved suitable for using immersive VR, though challenges included autonomy and reduced human contact. Participants highlighted facilitators and barriers in using immersive VR serious games, as well as immersive VR's rehabilitation potential. They also underscored the crucial role of physical therapists for guidance, remote supervision, and personalized treatment. These findings could help clinicians to better understand the experiences of individuals with persistent nonspecific neck pain when using immersive VR, as well as its use at home. This understanding can improve patient care and optimize the effectiveness of immersive VR as a treatment method.

One path, two solutions: Network-based analysis identifies targetable pathways for the treatment of comorbid type II diabetes and neuropsychiatric disorders

Comorbid diseases complicate patient outcomes and escalate healthcare costs, necessitating the need for a deeper mechanistic understanding. Neuropsychiatric disorders (NPDs) such as Neurotic Disorder, Major Depression, Bipolar Disorder, Anxiety Disorder, and Schizophrenia significantly exacerbate Type 2 Diabetes Mellitus (DM2), often leading to suboptimal treatment outcomes. The neurobiological mechanisms underlying this comorbidity remain poorly understood. To address this gap, we developed a novel pathway-based network computational framework to identify critical shared disease mechanisms between DM2 and these five prevalent comorbid NPDs. Our approach involves reconstructing an integrated DM2 ∩ NPDs KEGG pathway-pathway network and employs two complementary analytical methods, including the "minimum path to comorbidity" method to identify the shortest path fostering comorbid development. This analysis uncovered shared pathways like the PI3K-Akt signaling pathway and highlighted key nodes such as calcium signaling, MAPK, estrogen signaling, and apoptosis pathways. Dysregulation of these pathways likely contributes to the development of DM2-NPDs comorbidity. These findings have significant clinical implications, as they identify promising therapeutic targets that could lead to more effective treatments addressing both DM2 and NPDs simultaneously. Our model not only elucidates the intricate molecular interactions driving this comorbidity but also identifies promising therapeutic targets, paving the way for innovative treatment strategies. Additionally, the framework developed in this study can be adapted to study other complex comorbid conditions, advancing personalized medicine for comorbidities and improving patient care.

Big data analysis reveals significant increases in complications, costs, and hospital stay in revision total knee arthroplasty compared to primary TKA.

Despite significant advancements in total knee arthroplasty (TKA), some patients require revision surgery (R-TKA) due to complications such as infection, mechanical loosening, instability, periprosthetic fractures, and persistent pain. This study aimed to explore the specific causes leading to R-TKA, associated complications, including infection, mechanical failure, and wound issues, as well as costs, mortality rates, and hospital length of stay (LOS) using data from a large national database. Data from the nationwide inpatient sample (NIS), the largest publicly available all-payer inpatient care database in the United States were analysed from 1 January 2016 to 31 December 2019. The study included 44,649 R-TKA cases, corresponding to 223,240 patients, with exclusions for nonelective admissions. Various statistical analyses were used to assess clinical outcomes, including in-hospital mortality, postoperative complications, LOS, and hospitalization costs. Among 2,636,880 TKA patients, 8.4% underwent R-TKA. R-TKA patients had higher rates of chronic conditions, including mental disorders (36.4%) and renal disease (9.9%). Additionally, these patients often experienced instability, necessitating revision surgery. Infection (22.3%) was the primary reason for R-TKA, followed by mechanical loosening (22.9%) and instability. Compared to primary TKA patients, R-TKA patients exhibited higher in-hospital mortality (0.085% vs. 0.025%), longer LOS (3.1 vs. 2.28 days), and higher total charges ($97,815 vs. $62,188). Postoperative complications, including blood transfusion (4.6% vs. 1.3%), acute kidney injury (4.4% vs. 1.8%), venous thromboembolism (0.55% vs. 0.29%), infection, and wound problems, were significantly higher in R-TKA patients. This study provides detailed insights into t LOS, costs, and complications associated with specific etiologies of revision TKA. Our findings emphasize the need for targeted preoperative optimization and patient education. This approach can help reduce the incidence and burden of R-TKA, improve patient care, optimize resource allocation, and potentially decrease the overall rates of complications in revision surgeries. Level III.

Analysis of European Association of Urology Guidelines 2023 and its adherence to GRADE methodology

AbstractIntroductionThe European Association of Urology (EAU) has reported the use of a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for developing guideline recommendations since 2018; however, the full adoption of GRADE remains a work in progress.MethodsTwo members of the research team identified and independently abstracted all individual recommendations and summary of evidence statements available from all EAU guidelines published in 2023. We evaluated the current adherence to established criteria for appropriate GRADE use, the proportion of strong and weak recommendations, the underlying strength of evidence, and criteria for appropriate use of GRADE.ResultsWe included a total of 20 guideline documents with a total number of 1985 recommendations. The median number of strong recommendations was 46 (interquartile range: 32–87), representing 62.6% of all recommendations. The surgical thromboprophylaxis guideline had the lowest percentage of strong recommendations (18.2%; 30/165), and the neuro‐urology guideline had the highest percentage (95.5%; 42/44). EAU guidelines provided 2580 summaries of evidence statements, of which 1608 reported a level of evidence. The reported levels of evidence were I, II, III and IV/V at 31.8%, 28.5%, 32.4% and 7.3%, respectively. Of the six criteria for the appropriate use of GRADE, criterion 6, which reports the framing of recommendations as strong or weak, was met consistently; all other criteria were met only by a single guideline on thromboprophylaxis.ConclusionsThe EAU guidelines adoption of GRADE has been largely limited to the framing of recommendations as strong or weak. In all but one guideline, published guidelines did not meet any of the other criteria for appropriate GRADE use. Increased efforts to fully adopt GRADE, similar to its implementation in the thromboprophylaxis guideline in future editions, may enhance trust and uptake of EAU guidelines, thereby assisting policymakers and improving patient care.

Bridging the Knowledge Gap on Iron Deficiency Anemia Among Nursing Students

Background: Iron deficiency anemia (IDA) is a prevalent nutritional disorder characterized by a significant reduction in the body’s iron stores, affecting oxygen transport and leading to various health complications. Specific Background: The understanding of IDA among nursing students is underdeveloped, especially regarding the differences between morning and evening study cohorts. Knowledge Gap: Understanding nursing students' knowledge of IDA is critical for enhancing educational strategies and improving patient care, yet limited studies have assessed this demographic's awareness of the condition and its management. Aims: This study aims to evaluate nursing students' knowledge about IDA and to compare the levels of knowledge between morning and evening students at the College of Nursing, University of Basrah, over a six-month period from November 2023 to March 2024. Results: A descriptive cross-sectional study was conducted involving 145 students (72 morning and 73 evening) who completed a questionnaire. Results indicated that 40.2% of morning students and 53.4% of evening students suffered from iron deficiency. While 86.1% of morning students had prior knowledge of IDA compared to 67.1% of evening students, the mean knowledge levels were deemed good for both groups, with no significant statistical difference between them. Novelty: This research contributes to the existing literature by highlighting knowledge levels of IDA among nursing students in Iraq, revealing that both morning and evening cohorts possess substantial understanding yet exhibit slight discrepancies. Implications: The findings underscore the necessity for targeted educational interventions to bridge the knowledge gap regarding IDA, ultimately enhancing nursing students' competencies in managing this condition in clinical settings. Highlights: IDA Prevalence: 40.2% morning students and 53.4% evening students affected. Knowledge Difference: 86.1% morning vs. 67.1% evening students aware of IDA. Educational Need: Targeted interventions required for improved IDA management in nursing education. Keywords: Iron deficiency anemia, nursing students, knowledge assessment, educational interventions, Iraq

The validity and reliability of the Arabic version of the EQ-5D in atrial fibrillation patients in a conflict country: a study from Syria

BackgroundThe EQ-5D is one of the most commonly used tools to establish health-related quality of life (QoL). EQ-5D data in atrial fibrillation (AF) patients in the Middle East are lacking.ObjectivesThis study aims to evaluate the reliability and validity of the Arabic version of the EQ-5D in AF inpatients in Syria.MethodsThe study involved patients admitted to the emergency department of Tishreen’s University Hospital in Latakia with AF as the primary diagnosis between the 1st of June 2021 and the 1st of June 2023. Arabic versions of the EQ-5D, EQ-VAS and SF36 questionnaires were administered to patients. Validation was done using convergent, discriminant, and known-groups validity, while reliability was conducted using EQ-5D retesting within 2–4 weeks.Results432 participants were included in the study with a mean ± standard deviation of 63 ± 15. Males represented 242 (56%) of the participants. All hypotheses relating EQ-5D responses to external variables were satisfied. All three validation hypotheses demonstrated that the EQ-5D had the convergent, discriminant and known group validity to assess QoL in this cohort. The intraclass correlation coefficient (ICC) for test-retest reliability ranged between 0.74 and 0.88, while Cohen’s κ ranged between 0.72 and 0.86. Cronbach’s α value for internal consistency was 0.73.ConclusionThe Arabic version of EQ-5D was valid and reliable in measuring QoL in AF inpatients in Syria. This validation opens the door for more widespread use of the EQ-5D in Arabic-speaking regions, facilitating better-informed healthcare decisions and improving patient care strategies in Syria and other Middle Eastern countries.

Literature Supported Model for Implementing Effective Use of Simulation and Debriefing in Paramedic Education

The purpose of this paper is to provide a literature supported pathway to incorporating effective simulated learning experiences (SLE) into paramedic precertification courses. The literature is sparse on simulation incorporation into paramedic programs; however, it demonstrates extensive benefit in medicine and nursing. Paramedic educators have access to simulation equipment, yet seldom use it for more than skills development. Studies show that effective simulation can lead to improved patient care, outcomes, and safety, but requires ongoing faculty development, especially in the area debriefing. Learning the structure and purpose of debriefing and committing to practicing the skill is crucial to unpacking meaning from a SLE. This paper describes the reasons for implementing SLEs into paramedic precertification courses, suggests a comprehensive model for faculty development, describes a debriefing method for immersive SLEs, and provides guidance for ongoing simulation professional development.

Painful Realities: Navigating the Complexities of Head and Neck Cancer Pain.

Head and neck cancer (HNC) and its treatments can cause significant pain, which can profoundly impact patients' quality of life and treatment outcomes. Understanding the full scope of HNC pain is essential for effective management and improved patient care. This review aims to comprehensively analyze the multifaceted nature of pain experienced by individuals with HNC, including its various etiologies and management strategies. HNC pain can arise from tumor extent, treatment-related toxicity, or comorbid conditions. The pathophysiology involves complex interactions between nociceptive, neuropathic, and inflammatory mechanisms. Optimal pain control requires a multimodal patient-tailored approach utilizing both pharmacological and non-pharmacological therapies. Enhancing our understanding of HNC pain and optimizing its management is imperative for improving the overall well-being and treatment outcomes of affected individuals. Future research should focus on understanding detailed pain mechanisms, with the goal of developing personalized pain management strategies and exploring novel therapeutic targets. By implementing comprehensive approaches to HNC pain management, healthcare providers can better support patients through their cancer treatment journey.

Development and evaluation of an online education module to improve clinician knowledge and management of eating disorders in the peripartum: a pre-post survey study

ObjectiveEating disorders (EDs) comprise a range of illnesses characterised by disordered eating, distressing thoughts, and changes in weight. EDs in the perinatal period are a growing concern. Maternity staff receive little training in this area and often report feeling ill-equipped to recognise or respond to presentations of ED during this time. The study aimed to develop and evaluate an online educational module for clinicians and support workers to improve knowledge of EDs in the perinatal period.MethodEducation modules were developed using a co-design process with consumer advocates, peer support workers, clinicians, and experts. Consumer perspectives, evidence-based videos, activities, and text relating to screening, management, monitoring and referral of perinatal individuals with EDs were included in the module. Quantitative and qualitative data from pre- and post- surveys were used to evaluate changes in knowledge and confidence before and after completing the module, and to assess staff satisfaction, usability, and obtain feedback for improvement.ResultsUse of the online education module significantly increased staff knowledge of EDs in the perinatal period. Participants also felt more confident in discussing the topic with patients, screening, supporting, and referring a person with ED in the perinatal period. Participants also reported the module was engaging and easy-to-use.ConclusionsFindings indicate that the ED online education module is an engaging and easy-to-use tool for improving the knowledge and skills of the healthcare workforce, thereby improving patient care and health outcomes. The development of additional online resources for clinicians would be beneficial for increasing staff capability and improving patient services.

Plasmonics-enhanced spikey nanorattle-based biosensor for direct SERS detection of mRNA cancer biomarkers.

We present a plasmonics-enhanced spikey nanorattle-based biosensor for direct surface-enhanced Raman scattering (SERS) detection of mRNA cancer biomarkers. Early detection of cancers such as head and neck squamous cell carcinoma (HNSCC) is critical for improving patient outcomes in regions with limited access totraditional diagnostic methods. Our method targets Keratin 14 (KRT14), a promising diagnostic mRNA biomarker for HNSCC, using a sandwich hybridization approach with magnetic beads and SERS spikey nanorattles (SpNR). We synthesized SpNR with a core-gap-shell structure to enhance SERS signals, achieving a limit of detection of 90 femtomolar. A pilot study using clinical samples demonstrated the efficacy of our biosensor in distinguishing between tissue with positive or negative diagnosis for HNSCC, highlighting its potential for rapid and sensitive cancer diagnostics in low-resource settings. This plasmonic assay offers a promising avenue for portable and high-specificity detection of nucleic acid biomarkers, with implications for early cancer detection and improved patient care, especially in middle and low-resource settings.

Optimizing Electronic Health Records for Enhanced Clinical Decision Support and Improved Patient Care through Advanced Data Integration and Machine Learning Algorithms

Electronic Health Records (EHRs) have changed the way healthcare is provided by recording patient information, making it easier to handle data, and letting healthcare workers talk to each other without any problems. But EHRs haven't completely come to their full guarantee however when it comes to making strides quiet care and making proficient choices superior. This theoretical talks almost a other way to make strides EHR frameworks by utilizing progressed information integration and machine learning methods. The objective is to create clinical choice back way better and, within the conclusion, make understanding comes about way better. The recommended approach makes the foremost of the colossal sum of information in electronic wellbeing records (EHRs) by combining distinctive sorts of information, such as organized clinical information, unorganized composed notes, restorative images, genetic information, and real-time real signs. Diverse information sources are brought together utilizing progressed information integration strategies to form a full understanding profile that appears the patient's wellbeing state and therapeutic foundation as a entirety. This bound together data environment is the premise for building progressed machine learning models that can draw valuable conclusions, figure how patients will do, and recommend the most excellent care for each individual. Machine learning methods are exceptionally vital for getting valuable data from EHR information. These calculations can discover mystery associations and complex designs by utilizing strategies like profound learning, normal dialect preparing, and expectation modeling. They can also accurately predict clinical events. These models are always learning and getting better, so they can change to new patient data and clinical situations.

Efficacy and safety of the OZil phacoemulsification handpiece in dropped lens fragment surgery: a randomized controlled trial.

Phacoemulsification is the predominant method for cataract surgery, but complications like lens nuclei dislodgment into the vitreous cavity pose significant risks, including inflammation, glaucoma, retinal tears, and vision loss. Traditional management involves pars plana vitrectomy with phacofragmentation, which can increase the risk of retinal damage due to repulsive forces. This study tests whether the OZil phacoemulsification handpiece, employing torsional movement, offers a safer alternative by minimizing repulsive forces and reducing surgical duration compared to the traditional phacofragmatome. This prospective study, conducted in a tertiary care hospital in eastern India from January to June 2023, enrolled 40 patients with nucleus dislocation during cataract surgery. Patients were randomized into Group 1 (traditional phacofragmatome) and Group 2 (OZil handpiece). Primary objectives included comparing the duration of surgery and intraoperative complications. Secondary objectives assessed postoperative best-corrected visual acuity (BCVA), surgical site safety, and cystoid macular edema (CME) incidence. Group 2 demonstrated significantly shorter surgical durations (110±2.54 seconds) compared to Group 1 (152±2.23 seconds, p < 0.001). The frequency of nucleus falls was considerably lower in Group 2 (p < 0.001). Postoperative BCVA and CME incidence showed no significant differences between groups. Multiple regression analysis confirmed the OZil handpiece significantly reduced surgical duration (β = -0.40, p < 0.001) without compromising safety. The OZil handpiece's rotational cutting mechanism offers a significant advantage in reducing surgical time while improving the followability of lens fragments, as compared to the traditional phacofragmatome. It addresses one of the key limitations of phacofragmentation by minimizing fragment displacement, where repulsive forces can complicate the procedure. Although both techniques showed similar safety profiles, the OZil handpiece's operational efficiency makes it a promising alternative for managing posteriorly displaced lens fragments in complex cases. The OZil phacoemulsification handpiece significantly enhances surgical efficiency and safety in nucleus drop surgeries. Its integration into existing phacofragmatome systems can lead to major advancement in the ophthalmic surgical armamentarium, ensuring improved patient care.

Combination treatment with monoclonal antibodies for the management of severe asthma and immune-mediated inflammatory diseases: a comprehensive review.

Biological drugs have revolutionized the management of severe asthma, and a tailored treatment approach made it possible to consider remission as an achievable treatment target. The incidence of autoimmune diseases is increasing in many parts of the world. Patients suffering from severe asthma, eligible or already treated with an asthma-approved biologic agent, may suffer from another immune-mediated inflammatory disease (IMID) that could require the simultaneous use of a second monoclonal antibody. The real-life studies available in the literature describing the concurrent administration of an asthma-approved biologic agent with another biologic for a different immune disease, obtained through a systematic search on online databases based on monoclonal antibodies, were collected and analyzed. 26 articles were included in this review according to the prespecified inclusion and exclusion criteria. All included papers were retrospective in nature. Study designs were case reports (n=18), case series (n=3), retrospective chart reviews (n=3), retrospective observational studies (n=1), and cohort studies (n=1). The study is intended to present, within the current literature, all the administered combinations of severe asthma-approved biologics with monoclonal antibodies for a different indication. Those were grouped according to the IMID for whom the second biologic agent, with a different mechanism of action, was prescribed. The combinations prescribed to the cohort of patients specifically treating uncontrolled severe asthma were deeper evaluated in the discussion section, since an analysis of these therapeutic combinations deriving from real-life experiences may be useful to optimize the management of patients with severe asthma, ultimately leading to improved patient care and outcomes. Prospective registries and future studies are required to assess the safety and efficacy of combination therapies for severe asthmatic patients who suffer from an IMID.

Continuous measurement in neurocritical care of cerebral blood flow (CBF) calculated from ICP and central venous pressure

The cerebral blood flow, CBF, is an important clinical parameter in neuro-intensive care. The possibility to continuously monitor CBF, computed from referential ICP, rICP (calculated from measured intracranial pressure, ICP, and central venous pressure, CVP) and venous outflow resistance, Rv, could importantly improve patient care. For the CBF(1) method the pulsative part of CBF (with rICP increase due to vascular volume increase) gives the venous outflow resistance, Rv. The CBF max method finds Rv from the close correlation between rICP and Rv. For both CBF(1) and CBF max, rICP divided with Rv gives CBF. The parameters rICP, Rv and CBF were calculated from measurements of ICP increase, and of intracerebral venous volume increase in nine subjects, by the CBF(1) method. The result, together with the finding of a close correlation between rICP and Rv, which made CBF dependent on rICP only, gave confirmation of the theory for computation of CBF, with two methods for continuous monitoring of CBF from rICP, one (CBF(1)) using the systolic ICP increase to find Rv, and one (CBF max) using the relationship between Rv and rICP at rICP exceeding about 10 mmHg in this study.