Improvement In Scores Research Articles

The impact of forest therapy on functional recovery after acute ischemic stroke

Stroke is a leading cause of disability worldwide, with a growing need for effective rehabilitation strategies. Forest therapy, involving structured activities in natural environments, has shown significant beneficial effects in various health-related outcomes but no studies have assessed its direct effect on functional recovery after acute ischemic stroke. We assessed whether forest therapy is effective in recovering functional outcome of acute ischemic stroke compared to conventional rehabilitation therapy. This prospective cohort study included patients with acute ischemic stroke admitted within 24 hours of symptom onset. Participants were randomized into forest therapy (n=15) and control (n=27) groups. The forest therapy group underwent five sessions of guided activities in a national forest center, while the control group received standard outpatient rehabilitation. Primary outcome was changes in the modified Rankin Scale (mRS) scores, with secondary outcomes including grip strength, body composition, and psychological well-being assessed using the Worker's Stress Response Inventory and the Positive and Negative Affect Schedule from the time of hospital discharge to 3 months after stroke onset. Change of mRS were analyzed using the generalized estimating equation to compare changes over time between the two groups. At three-month follow-up, the forest therapy group demonstrated a significant improvement in mRS scores compared to the control group (p=0.034). Although no significant differences were found in grip strength or body composition, reductions in somatization and job-related stress were observed in the forest therapy group. No significant changes in positive or negative affect were detected. Forest therapy can contribute to functional recovery and reduce stress-related indicators in acute ischemic stroke patients. These findings support that the integration of forest therapy into stroke rehabilitation protocols to address both physical and psychological aspects of recovery, highlighting the potential for multidisciplinary approaches in post-stroke care.

Olfactory dysfunction management following unilateral cranial resection for olfactory neuroblastoma.

Despite advances in techniques for olfactory neuroblastoma (ONB), such as unilateral cranial resection, preserving the patient’s sense of smell remains a challenge. This study aimed to examine the effectiveness of post-operative olfactory training in patients who underwent unilateral resection of ONB. This retrospective cohort study assessed the effect of post-operative olfactory training on olfactory preservation in patients with ONB undergoing unilateral cranial resection. Patients were divided into training intervention (n = 5) and non-intervention (n = 6) groups. Olfactory tests were conducted pre-operatively and at multiple post-operative intervals. Partial olfactory function was preserved in all cases in the training intervention group, whereas only 17% of cases in the non-intervention group maintained partial olfactory function. Significant improvements in olfactory test scores were observed in the training intervention group compared with the non-intervention group. Our findings suggest that post-operative olfactory training could aid in olfactory preservation for patients with ONB after unilateral cranial resection. However, these results should be interpreted with caution, and further research with larger cohorts and extended follow-up periods is needed to confirm these observations.

"Fully endoscopic preperitoneal ascending suprapubic approach for minimally invasive repair of anterior and lateral abdominal wall hernias".

The aim of this work is to describe the rational, feasibility and clinical and Quality-of-life improvement results of a fully endoscopic preperitoneal repair for midline and lateral abdominal wall hernias, starting from the space of Retzius in a "bottom-to-up" approach. An observational prospective data-collected and quality of life study is performed in selected patients with less than 10cm. in diameter midline and lateral abdominal wall hernias. A suprapubic upward e-TEP technique from a previously dissected Retzius space, is performed in all cases. The surgical goal is to perform a total free-tension abdominal wall reconstruction followed by a prosthetic hernioplasty. Clinical Data is classified in preoperative, intraoperative, and postoperative variables, including a quality-of-life clinical evaluation based on an improvement of HerQLes score. A total of 30 patients underwent this approach from September 2017 to October 2022 in a single-surgeon practice. A total restoration of the previous abdominal wall anatomy and a prosthetic repair were achieved in all cases. The mean operative time was 142.53min, with a significant shorter time in lateral hernias approach. Minor complications (Clavien-Dindo I) were collected in 10% of the patients. Major complications (Clavien-Dindo IIIb) occurred in 6.66% of the patients. The mean pain at discharge was 1.83 VAS, with a significant lower pain in M-eTEP approach for lateral hernias. The mean hospital stay was 42.4h. No seroma, hematoma, chronic pain, or recurrence was observed in the mean follow-up (20.33months). A clinical and quality of life improvement was found in 92.9% of the patients, measured by a minimal clinical important difference (MCID) between preoperative and postoperative HerQLes score. Despite being a technically demanding approach, the results obtained by this approach are compatible in safety and feasibility with other minimally invasive preperitoneal hernia repair techniques, in addition to obtaining a significant improvement in the quality of life of patients.

Masticatory function and three-dimensional facial morphology of soft tissues: One year after orthognathic surgery

ObjectiveDentofacial deformities (DFD) require orthodontic treatment, orthognathic surgery, and speech therapy for aesthetic and functional problems. This longitudinal study analyzed changes in masticatory function and three-dimensional (3D) facial soft tissue in patients with Class II and Class III DFD after orthognathic surgery. In addition, the study investigated the relationship between facial measurements, maximum bite force (MBF), and orofacial myofunctional status (OMS). DesignThe sample consisted of 46 participants, including 10 patients with Class II DFD, and 11 patients with Class III DFD. These groups were assessed before (T0) and 6 months (T1) after surgery. Twelve patients who completed the treatment protocol were evaluated 12 months post-surgery (T2). The patient groups were compared with each other and with a control group (CG) of 25 healthy subjects. The participants underwent MBF and clinical evaluation of OMS, including masticatory behavior, using a validated protocol. The 3D facial soft tissue was assessed using laser scanning. ResultsCompared to the CG, DFD patients showed reduced MBF, masticatory behavior, and OMS scores at T0. At T2, there was an improvement in MBF, masticatory, and OMS scores, but differences were observed compared to the CG. Changes in facial soft tissue followed the underlying hard tissue movement resulting from surgery, and reduction of vertical measurements contributed to improvements in masticatory function. ConclusionThese findings indicated that combined surgery, orthodontic treatment, and speech therapy can lead to a significant improvement in masticatory function and facial soft tissue in DFD patients, although not completely 12 months post-surgery.

A randomized, double-blind, placebo-controlled trial of DaxibotulinumtoxinA for Injection for the treatment of upper limb spasticity in adults after stroke or traumatic brain injury.

Intramuscular injection of botulinum toxin type A is a first-line pharmacotherapy for adults with upper limb spasticity (ULS). However, reemergence of symptoms within 12 weeks of treatment is common and longer-lasting treatments are needed. To evaluate the efficacy and safety of three doses of DaxibotulinumtoxinA for Injection (DAXI) for treatment of ULS in adults with stroke or traumatic brain injury. Intramuscular injections of placebo (N = 24), DAXI 250 U (N = 22), DAXI 375 U (N = 19), or DAXI 500 U (N = 18) to the suprahypertonic muscle (SMG) and other muscle groups. Randomized, double-blind, placebo-controlled study. Twenty-six study centers across the United States. Eighty-three adult patients with ULS were randomly assigned to each treatment group and followed for up to 36 weeks. Co-primary endpoints were the Modified Ashworth Scale (MAS) score change from baseline in the designated SMG and Physician Global Impression of Change (PGIC) at Week 6. The mean changes from baseline in MAS score for the designated SMG for placebo and the DAXI 250 U, 375 U, and 500 U groups were -0.6, -0.9, -0.9, and -1.8, respectively, at Week 4 and -0.8, -0.9, -1.0, and -1.5, respectively, at Week 6. Statistically significant improvement in MAS score compared with placebo was reported only for the 500 U dose (Week 4: p < .001; Week 6: p = .049). Significant improvements in PGIC ratings compared with placebo were reported for DAXI 375 U (p = .015) and DAXI 500 U (p = .009) at Week 4 but not for any DAXI doses at Week 6. All DAXI doses were well tolerated with no trend toward more adverse events with increased dose. Results from this Phase 2 study indicate that DAXI 500 U is effective and well tolerated for treatment of adults with ULS.

Long-term outcomes of the Universal 2 total wrist arthroplasty

AimsThe Universal 2 total wrist arthroplasty (TWA) aims to alleviate wrist pain and restore function. This study investigates the survival time, revision rate, complication rate, and performs radiological analysis on Universal 2 TWAs in the long term. MethodsForty-seven Universal 2 TWA in 45 patients were performed between 2006 and 2014. Patient satisfaction, DASH score, complications, revision rate and radiological analysis of the TWA were recorded. ResultsMean follow-up was 11.7 years (range 2.5–17.6 years). There was significant improvement in post-operative DASH score (mean 58.3, SD 13) compared to preoperative DASH scores (mean 33, SD 20, p < 0.001). At latest follow-up, 65 % of patients would undergo the procedure, a reduction from 87 % at mid-term follow-up. On radiological analysis, 26 wrists had lucencies of at least one component. Complications occurred in 18 wrists (38 %). Eleven TWA (23 %) were revised at a mean 7.3 years post-operation (range 2.0–13.7 years). Mean survival of the implant was 13.6 years (12.2–15.0 years 95 % CI). Kaplan-Meier analysis identified no significant differences in survivorship between inflammatory arthritis (13.2 years, 11.5–14.9 years 95 % CI) and osteoarthritis (12.9 years, 11.0–14.8 years 95 % CI, p = 0.39). ConclusionAt long-term follow-up, the Universal 2 TWA can produce significant improvements in DASH scores and good satisfaction rates. However, a significant number of implants showed radiological loosening, with a high associated complication and revision rate. Patients should be adequately counselled on these risks pre-operatively.

Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy in the Treatment of Lumbar Disc Herniation Linked with Posterior Ring Apophysis Separation: A Retrospective Study

ObjectivesPosterior ring apophysis separation (PRAS) associated with lumbar disc herniation (LDH) is a relatively rare form of disc herniation. This study aims to evaluate the clinical effectiveness of unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) in the treatment of PRAS with LDH. MethodsWe enrolled 41 patients who met the inclusion criteria to undergo either unilateral biportal endoscopic discectomy (UBE) (15 cases) or percutaneous endoscopic lumbar discectomy (PELD) (26 cases) between October 2022 and October 2023. Perioperative evaluation parameters included mean operative time, hemoglobin (Hb) loss, length of stay (LOS), and postoperative complications. Outcomes were assessed at admission, as well as at 1, 3, and 6 months post-surgery using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Additionally, we evaluated the results according to the modified MacNab criteria. ResultsBoth groups demonstrated improvements in postoperative VAS and ODI scores. However, there were no significant differences between the two groups in VAS and ODI scores before surgery, or at 1, 3, and 6 months post-surgery. Additionally, no notable differences were observed in the modified MacNab criteria. The UBE group experienced greater hemoglobin (Hb) loss, longer mean operative time, and increased length of stay (LOS) compared to the PELD group. Furthermore, two patients in the PELD group reported recurrence, while one patient in the UBE group experienced a dural tear. ConclusionsUBE and PELD possess strong clinical effectiveness for treating PRAS with LDH. Although the UBE group had a longer mean operative time and LOS, with more Hb loss, the UBE group had a lower recurrence rate. Therefore, UBE remains safe and innovative for the treatment of PRAS with LDH.

Metabolic syndrome and patient-reported outcome two years after hip and knee arthroplasty.

The influence of metabolic syndrome (MetS) on the outcome after hip and knee arthroplasty is debated. We aimed to investigate the change in patient-reported outcome measure (PROM) scores after hip and knee arthroplasty, comparing patients with and without MetS. From 1 May 2017 to 30 November 2019, a prospective cohort of 2,586 patients undergoing elective unilateral hip and knee arthroplasty was established in Denmark. Data from national registries and a local database were used to determine the presence of MetS. Patients' scores on Oxford Hip Score (OHS) or Oxford Knee Score (OKS), EuroQol five-dimension five-level questionnaire (EQ-5D-5L), University of California, Los Angeles (UCLA) Activity Scale, and Forgotten Joint Score (FJS) at baseline, three, 12, and 24 months after surgery were collected. Primary outcome was the difference between groups from baseline to 12 months in OHS and OKS. Secondary outcomes were scores of OHS and OKS at three and 24 months and EQ-5D-5L, UCLA Activity Scale, and FJS at three, 12, and 24 months after surgery. Generalized linear mixed model was applied, adjusting for age, sex, Charlson Comorbidity Index, and smoking to present marginal mean and associated 95% CIs. A total of 62.3% (1,611/2,586) of the cohort met the criteria for MetS. Both groups showed similar increase in mean OHS (MetS group 22.5 (95% CI 21.8 to 23.1), non-MetS group 22.1 (21.3 to 22.8); p = 0.477) and mean OKS (MetS group 18.0 (17.4 to 18.6), non-MetS group 17.8 (17.0 to 18.7); p = 0.722) at 12 months' follow-up. Between groups, similar improvements were seen for OHS and OKS at three and 24 months postoperatively and for the mean EQ-5D-5L, EuroQol-visual analogue scale (EQ-VAS), UCLA Activity Scale, and FJS at every timepoint. Patients meeting the criteria for MetS obtain the same improvement in PROM scores as individuals without MetS up to 24 months after hip and knee arthroplasty. This is important for the clinician to take into account when assessing and advising patients with MetS.

Comparison of oral health-related quality of life among endodontic patients with irreversible pulpitis and pulp necrosis using the oral health-related endodontic patient's quality of life scale.

This prospective cohort study aimed to clarify differences in the longitudinal effects on oral health-related quality of life (OHRQoL) among patients undergoing endodontic treatment for irreversible pulpitis and for pulp necrosis, using a newly developed oral health-related endodontic patient's quality of life (OHQE) scale. This study included 131 patients diagnosed with irreversible pulpitis and pulp necrosis. Comprehensive data regarding the patient's background, medical history, and dental history were collected. The OHQE was administered three times to each patient: before and after endodontic treatment, as well as 2weeks after endodontic treatment as a follow-up. Statistical analysis was performed using a linear mixed model for repeated measurements of changes in the OHQE score over time in cases of irreversible pulpitis and pulp necrosis. The patients consisted of 48 (36.6%) males and 83 (63.4%) females with a mean age of 36.2 (standard deviation, 12.6) years. Of these, 62 (47.3%) had irreversible pulpitis, and 69 (52.7%) had pulp necrosis. Intragroup comparisons showed an improvement in the OHQE scores over time in both groups (p < 0.001). Group comparisons revealed no significant differences at any time point. No interactions or changes over time were observed between the two groups. No difference in the improvement of quality of life after endodontic treatment was seen in the two disease groups, and both groups improved over time. However, patients' expectations of receiving endodontic treatment remained unchanged after treatment. Therefore, dental providers should consider explaining the value of endodontic treatment to patients and address the measures that contribute to patient satisfaction.

Exploratory analysis of the variable response to an intensive lifestyle change program for metabolic syndrome

BackgroundSubstantial variability in response to lifestyle interventions has been recognized for many years, and researchers have begun to disentangle sources of error from inherent differences in individual responsiveness. The objective of this secondary analysis of an intensive lifestyle intervention (diet and exercise) for metabolic syndrome (MetS) was to identify potentially important differences among study completers grouped by treatment response as measured by change in a continuous metabolic syndrome score (Gurka/MetS).MethodsAll study completers from a 12-month primary care study were categorized into one of five groups according to change in the Gurka/MetS score. A change of 0.4 in z-score defined clinically relevant change in line with results of previous studies. Repeated measures analysis of variance was used to examine cardiovascular disease risk and individual clinical indicators of MetS over 12 months, looking for differences in response over time by the five groups.ResultsOf 176 participants, 50% (n = 88) had stable scores, 10% (n = 18) had relevant change scores in the first 3 months only and reverted toward baseline, 20% (n = 35) achieved meaningful change over the whole study, 11% (n = 20) had a delayed response at 3–12 months, and 9% (n = 15) demonstrated worsening scores. Significant differential patterns were noted for groups over the duration of the intervention (p < .001). Improvement in diet quality and fitness scores were similar across all groups. Other available variables were tested and did not account for the differences.ConclusionWork is needed to identify key factors that account for differences in responses to lifestyle interventions that can be used to guide treatment decisions for intensive lifestyle interventions for this common condition.Trial RegistrationClinicalTrials.gov Identifier: NCT01616563; first registered June 12, 2012.

Efficacy of a single dose of cryopreserved human umbilical cord mesenchymal stromal cells for the treatment of knee osteoarthritis: a randomized, controlled, double-blind pilot study.

Knee osteoarthritis (OA) is the most prevalent degenerative musculoskeletal disorder, which is particularly common in older population. While conventional treatments have limited effectiveness, the development of more effective therapeutic strategies is necessary to address this primary source of pain and disability. Umbilical cord mesenchymal stromal cells (UC-MSCs) offer a promising therapeutic approach for treating knee OA.This randomized, prospective, double-blind and controlled pilot study was carried out to evaluate and compare the safety and therapeutic efficacy of a single intra-articular injection of a standardized product CellistemTMOA (5 × 106 ± 5 × 105 UC-MSCs), vs. triamcinolone (a synthetic corticosteroid) (10 mg/mL) in thirty patients with symptomatic knee OA (Kellgren-Lawrence grade II or III).The outcomes included changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores based on a Likert scale, numerical rating score (NRS) for pain, Magnetic Resonance Imaging (MRI), and quality of life (SF-36 questionnaire), from baseline and throughout 12-months of follow-up.Patients treated with CellistemTMOA showed significant improvement in WOMAC score (including the three subscale scores (pain, stiffness and function), NRS in pain, and SF-36 profile from baseline to 12 months (p < 0.05) compared to the triamcinolone group, and no severe adverse events were reported.There were no significant differences in MRI WORMS scores between the two groups. However, patients who received the cellular treatment experienced a significant improvement in their SF-36 profile (p < 0.05).This pilot study revealed that a single dose of CellistemTMOA is safe and superior to the active comparator in knee OA at 1-year of follow-up, making it a compelling therapeutic alternative to treat symptomatic OA patients.

The impact of ventricular remodeling on quality-of-life outcomes after Transcatheter aortic valve replacement

BackgroundAmong patients with aortic stenosis, ventricular remodeling by hypertrophy can limit the augmentation of flow with exertion, even after valve intervention. However, the effect of hypertrophy on quality of life (QoL) improvement has not been studied. We aimed to determine the effect of ventricular hypertrophy on QoL outcomes after transcatheter aortic valve replacement (TAVR). MethodsAll patients undergoing TAVR from 2011 to 2021 at our institution were included. Groups were divided into none/mild ventricular hypertrophy (non-remodeled, NR) and moderate/severe left ventricular hypertrophy (VH) according to guideline-recommended cut-offs for left ventricular (LV) wall thickness. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was utilized to assess QoL; primary outcome was KCCQ change <5 from baseline to 30 days and 1 year. ResultsWe analyzed 679 patients (NR: N = 389, VH: N = 290). Groups differed by septal thickness (1.12 cm vs. 1.44 cm, p < 0.001), posterior wall thickness (1.08 cm vs. 1.33 cm, p < 0.001), and LV internal diastolic diameter (4.34 cm vs. 4.19 cm, p = 0.006). The primary outcome was similar between NR and VH at 30 days (31.6 % vs. 28.6 %, p = 0.449) and 1 year (27.7 % vs. 21.5 %, p = 0.217). NR and VH experienced similar proportions of worsening, no change, or small, moderate, and large improvements in KCCQ score. Both groups experienced similar domain score changes and New York Heart Association class improvement. A subgroup analysis of VH patients did not reveal interaction with cavity size or stroke volume. ConclusionPatients with significant ventricular remodeling by hypertrophy and aortic stenosis have similar QoL changes after intervention compared to patients without significant remodeling.

Demonstration-based learning for few-shot biomedical named entity recognition under machine reading comprehension

Objective: Although deep learning techniques have shown significant achievements, they frequently depend on extensive amounts of hand-labeled data and tend to perform inadequately in few-shot scenarios. The objective of this study is to devise a strategy that can improve the model’s capability to recognize biomedical entities in scenarios of few-shot learning.Methods: By redefining biomedical named entity recognition (BioNER) as a machine reading comprehension (MRC) problem, we propose a demonstration-based learning method to address few-shot BioNER, which involves constructing appropriate task demonstrations. In assessing our proposed method, we compared the proposed method with existing advanced methods using six benchmark datasets, including BC4CHEMD, BC5CDR-Chemical, BC5CDR-Disease, NCBI-Disease, BC2GM, and JNLPBA.Results: We examined the models’ efficacy by reporting F1 scores from both the 25-shot and 50-shot learning experiments. In 25-shot learning, we observed 1.1% improvements in the average F1 scores compared to the baseline method, reaching 61.7%, 84.1%, 69.1%, 70.1%, 50.6%, and 59.9% on six datasets, respectively. In 50-shot learning, we further improved the average F1 scores by 1.0% compared to the baseline method, reaching 73.1%, 86.8%, 76.1%, 75.6%, 61.7%, and 65.4%, respectively.Conclusion: We reported that in the realm of few-shot learning BioNER, MRC-based language models are much more proficient in recognizing biomedical entities compared to the sequence labeling approach. Furthermore, our MRC-language models can compete successfully with fully-supervised learning methodologies that rely heavily on the availability of abundant annotated data. These results highlight possible pathways for future advancements in few-shot BioNER methodologies.

Physical and mental health trajectories: A longitudinal SF-36 analysis in Alpha-1 antitrypsin deficiency-associated COPD

BackgroundThe Short Form 36-Item Health Survey (SF-36) is a health-related quality of life (HRQoL) measure validated in people with chronic obstructive pulmonary disease (COPD). While physical health is often more impaired than mental health in people with COPD, research on alpha-1 antitrypsin deficiency (AATD)-associated COPD is limited. This longitudinal study examines changes in physical and mental health in individuals with AATD and associated factors. MethodsAnalyses included participants of AlphaNet, a disease management program for individuals with AATD-associated lung disease who are prescribed augmentation therapy. Norm-based SF-36 scores for mental and physical component summaries (MCS and PCS) and 8 scales were analyzed. Linear mixed models evaluated mean changes in SF-36 scores over time. ResultsThe study included 2165 participants (mean age 56.9 ± 10.0 years, 47.0 % female). At enrollment, mean PCS score was 37.5 ± 9.6, and mean MCS score was 51.9 ± 10.5. Mean mMRC dyspnea score was 2.3 ± 1.3; 54.6 % had ≥2 exacerbations annually, and 46.5 % used oxygen regularly. Average follow-up was 6.6 ± 3.2 years. The HRQoL remained stable; MCS improved by 0.16 points/year (p < 0.0001), while the PCS score declined by 0.49 points/year (p < 0.0001). Subscales followed similar trends. ConclusionsAt baseline, mental HRQoL scores were higher than physical HRQoL scores, indicating better mental health than physical health in this cohort with AATD-associated lung disease. Stable HRQoL with a slight improvement in mental scores over time and a small decrease in physical scores may be a unique feature of this cohort. Further studies are needed to correlate these findings with disease-specific instruments and patient physiology.

Functional and radiological sinonasal outcomes of CFTR modulators for sinus disease in cystic fibrosis: A meta-analysis.

Cystic fibrosis transmembrane conductance regulator (CFTR) modulators improve pulmonary outcomes in cystic fibrosis (CF) by stabilizing the CFTR protein on respiratory epithelial surfaces. To determine the efficacy of CFTR modulators on sinonasal outcomes in patients with CF, we performed a meta-analysis of clinical trials to date that include functional and radiographic evidence of sinus disease. English full-text articles were searched in PubMed, Embase, and Scopus databases. Two reviewers screened articles and a third reviewer resolved disagreements. Articles were included if they reported functional or radiological sinonasal outcomes in patients with CF before and after CFTR modulator therapies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the risk of bias in non-randomized studies of interventions tool was used for quality assessment. The generic inverse variance method with random effects model was used for meta-analysis. Standardized mean difference (SMD) and mean difference (MD) were used as effect measurements. Seven prospective and two retrospective studies representing 248 patients were included in this analysis. There was a significant improvement in sinonasal outcome test-22 scores on elexacaftor‒tezacaftor‒ivacaftor (MD=12.80, [95% confidence interval, CI: 10.46‒15.13], p<0.001, n=222), with no heterogeneity detected (I2=0%, p=0.820). There was also a significant improvement in Lund‒Mackay scores (SMD=1.25, [95% CI: 0.58‒1.91], p<0.001, n=88), with heterogeneity detected (I2=67%, p=0.030). CFTR modulators improve functional and radiologic sinonasal outcomes. Given the utility of CFTR modulators, the treatment paradigm for CF-related chronic rhinosinusitis promises to evolve.

Fostering TBL Success at Alfaisal University: A Complex Adaptive Systems Approach.

This study explores the implementation of Team-Based Learning (TBL) at Alfaisal University's College of Medicine through the lens of Complex Adaptive Systems (CAS) theory. The research question investigates how the application of CAS principles can enhance the implementation and effectiveness of TBL in medical education. The study employed a convergent parallel mixed methods longitudinal design, integrating quantitative performance metrics and qualitative themes. Quantitative analysis revealed modest improvements in individual and team-based learning scores, with a promising trend of students moving from the lower to the higher quartiles over time. Qualitative insights aligned with CAS principles, highlighting the adaptive implementation, emergent outcomes, self-organization, positive feedback loops, and depth of learning facilitated by TBL. The findings demonstrate the value of a CAS-informed approach in navigating the complexities of educational change and fostering a more resilient and adaptive educational model. The study contributes to the understanding of how CAS theory can guide the successful implementation of innovative pedagogies like TBL in medical education.

Microfracture for medium size to large knee chondral defects has limited long-term efficacy: A systematic review.

To evaluate clinical and radiographic outcomes, return to sport, failure rate, operations and complications in patients undergoing microfracture of the knee, including the femoral condyle, tibial plateau, patella and trochlea, at a mean 10-year or greater follow-up. A literature search was performed by querying SCOPUS, PubMed, Medline and the Cochrane Central Register for Controlled Trials from database inception through May 2023 according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Inclusion criteria were level I-IV human studies reporting on outcomes, reoperations and complications following microfracture of the knee at a mean 10-year or greater follow-up. Biomechanical and epidemiological studies, including patients undergoing concomitant realignment procedures, and studies with patients under 18 years old were excluded. Data regarding failure, as defined by each study, as well as reoperations were gathered. Study quality was assessed via the Methodological Index for Nonrandomized Studies criteria. Nine studies from 2003 to 2018, consisting of 727 patients (mean age 38.9 ± 8.1 years; range 25.8-47.6) undergoing microfracture for chondral defects in the knee were identified. Mean follow-up ranged from 10 to 17 years. Males composed 56.5% of patients, with a mean defect size ranging from 2.3 to 4.01 cm2. Based on radiographs at follow-up, osteoarthritis progression occurred in 40%-48% of patients. Magnetic Resonance Observation of Cartilage Repair Tissue scores were low. Patient-reported outcome measures showed significant improvement in postoperative scores at final follow-up. Return-to-sport rate ranged from 17.2% to 20%. Longitudinal analysis revealed declining clinical outcomes and return-to-sport rates from short- and mid- to long-term follow-up. There was high variability in failure definition and reoperations, with 2.9%-41% of patients requiring total knee arthroplasty. At a mean 10-year or greater follow-up, microfracture for chondral defects of the knee 2-4 cm2 in size demonstrated a high rate of osteoarthritis progression with poor healing of the chondral defect and low overall return-to-sport rates. Failure and reoperation rates ranged from 2.9% to 41%, with declining outcomes from short- and mid- to long-term follow-up. The advantages of microfracture relating to availability, complexity, and cost should be weighed against concerns about long-term success, particularly with medium-size and larger lesions. Level IV systematic review.

Improved Fatigue Management in Primary Sjögren's Syndrome: A Retrospective Analysis of the Efficacy of Methotrexate in Chinese Patients.

To assess the efficacy of methotrexate (MTX) and hydroxychloroquine (HCQ) in improving fatigue symptoms in patients with primary Sjögren's syndrome (pSS). A single-center retrospective study was conducted on pSS patients experiencing fatigue symptoms. All patients received either MTX, HCQ, or a combination of MTX + HCQ for a period of six months. Clinical efficacy was measured using the European League Against Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), fatigue severity scale (FSS), and visual analog scale (VAS) score. These measures were assessed at baseline and at 1, 2, 3, and 6 months. A total of 86 pSS patients with fatigue symptoms were enrolled (27 received MTX, 29 received HCQ, and 30 received MTX + HCQ). Patients receiving MTX and MTX + HCQ showed significant improvements at 6th month in ESSDAI, ESSPRI, FSS, FACIT-F, and VAS scores (all P < 0.01) compared with baseline. Repeated-measures analysis of variance revealed that patients treated with MTX and MTX + HCQ experienced significant improvements in ESSDAI, FSS, FACIT-F, and VAS scores (all P < 0.01) from baseline to the 6th month. The HCQ group did not show significant improvement in FSS, FACIT-F, and VAS scores (all P > 0.05), although their ESSDAI and ESSPRI scores did improve significantly (all P < 0.01). Patients in the MTX group showed the most improvement in mean changes of ESSDAI score, FSS score, FACIT-F score, and VAS score from baseline to the 6th month. And patients received MTX treatment significantly had more fatigue remission numbers (all P < 0.05). In clinical practice, methotrexate is more effective than hydroxychloroquine in improving fatigue symptoms, as measured by patient-reported fatigue scales (FSS, FACIT-F, and VAS scores) in patients with pSS.

Results of the AMIC® method in patients operated on for an osteochondral lesion of the talar dome (OLTD) at a mean follow-up of 34 months. A retrospective multicenter study

BackgroundSymptomatic osteochondral lesions of the talar dome (OLTD) represent a real therapeutic challenge. In the absence of appropriate treatment, these lesions can evolve into tibiotalar osteoarthritis. Stage 3 lesion of the SFA classification and resistant to medical non-operative treatment may require surgical treatment. The results of the membrane-induced chondrogenesis (AMIC®) technique in the knee have been previously reported. At the ankle, few publications exist. Our objective was to evaluate clinical results of the AMIC® technique. HypothesisAMIC® technique is clinically effective for the treatment of LODT with a minimum follow-up of 12 months after surgery. Material and methodThis was a multicenter (5 centers) retrospective study including patients operated on for an OLTD stage 3 of SFA between January 2019 and March 2021 using the AMIC® technique with a ChondroGide® membrane. A functional assessment by questionnaire (AOFAS, EFAS, FFI scores), clinical (VAS) and return to sport were carried out. Results21 patients (10 men and 11 women), aged 16–69 years (mean age 34 years) were included. The average follow-up was 34 months (min 12 months; max 72 months). The average loss of substance was 1.83 cm2 (min 0.6 cm2; max 6 cm2). The results showed a significant improvement in the AOFAS functional score which went on average from 71 [CI = 64; 77] to 90 [CI = 82; 97], EFAS which went from 15 [CI = 10; 20] to 32 [CI = 10; 20] = 26; 38], FFI which went from 28% [CI = 19%; 38%] to 10% [CI = 2%; 18%] and the EVA which decreased by 4 [CI = 3.9; 4.7] to 1 [CI = 0.5; 2.4]. 60% of patients returned to sport at the same level and 80% of patients were satisfied with the surgery. DiscussionAMIC® method improved the functional results of patients with SFA stage 3 OLTD at an average follow-up of 34 months post-operatively. Level of evidenceIV; retrospective observational cohort study.

Effectiveness of hybrid simulation training on medical student performance in whole-task consultation of cardiac patients: The ASSIMILATE EXCELLENCE randomized waitlist-controlled trial

BackgroundAssessment of comprehensive consultations in medicine, i.e. a complete history, physical examination, and differential diagnosis, is regarded as authentic tests of clinical competence; however, they have been shown to have low reliability and validity due to variability in the real patients used and subjective examiner grading. In the ASSIMILATE EXCELLENCE study, our aim was to assess the effect(s) of expert tuition with hybrid simulation using a simulated patient wearing a novel auscultation vest, i.e. a hybrid simulated patient, and repeated peer grading using scoring checklists on student learning, performance, and acumen in comprehensive consultations of patients with valvular heart disease.MethodsASSIMILATE EXCELLENCE was a randomized waitlist-controlled trial with blinded outcome assessment undertaken between February 2021 and November 2021. Students at the Royal College of Surgeons in Ireland in either the second or third year of the four-year graduate-entry medical degree programme were randomized to a hybrid simulation training or waitlist control group and undertook three consultation assessments of three different clinical presentations of valvular heart disease (cases: C1–C3) using hybrid simulation. Our primary outcome was the difference in total score between and within groups across time; a secondary outcome was any change in inter-rater reliability across time. Students self-reported their proficiency and confidence in comprehensive consultations using a pre- and post-study survey.ResultsIncluded were 68 students (age 27.6 ± 0.1 years; 74% women). Overall, total score was 39.6% (35.6, 44.9) in C1 and increased to 63.6% (56.7, 66.7) in C3 (P < .001). On intergroup analysis, a significant difference was observed between groups in C2 only (54.2 ± 7.1% vs. 45.6 ± 9.2%; P < .001), a finding that was mainly driven by a difference in physical examination score. On intragroup analysis, significant improvement in total score across time between cases was also observed. Intraclass correlation coefficients for each pair of assessors were excellent (0.885–0.996 [0.806, 0.998]) in all cases. Following participation, students’ confidence in comprehensive consultation assessments improved, and they felt more prepared for their future careers.ConclusionsHybrid simulation-based training improves competence and confidence in medical students undertaking comprehensive consultation assessment of cardiac patients. In addition, weighted scoring checklists improve grading consistency, learning through peer assessment, and feedback.Trial registrationClinicalTrials.gov Identifier: NCT05895799