Inclusion Criteria Research Articles

Efficacy of Chemoimmunotherapy versus Chemotherapy for Gastric Cancer: A Meta-Analysis of Survival Outcomes.

Gastric cancer has been traditionally treated with chemotherapy as the primary mode of treatment. However, recent studies have shown that chemoimmunotherapy is also effective and, in some cases, better than chemotherapy treatment. Current study aimed to find the efficacy of chemoimmunotherapy versus chemotherapy in the treatment of gastric cancer. Using electronic databases, including PubMed, Embase, and EBSCO, a thorough literature search was carried out for the years 2006 to 2023. The search strategy was designed to identify relevant studies based on chemoimmunotherapy and chemotherapy intervention, and the search was conducted using appropriate keywords and MeSH terms. The retrieved studies were screened for relevance based on their titles, abstracts, and full texts. The studies' inclusion criteria were predefined, and the selected studies were then subjected to a quality assessment using GradePro GDT. The data from selected studies were extracted and analyzed using Revman version 5.4. The study found that chemoimmunotherapy treatment resulted in a significant improvement in overall survival (OS) with a risk ratio (RR) of 1.54 and a 95% Confidence Interval (CI) of 1.25 to 1.89. The overall effect was also found to be significant, with a p-value of less than 0.001. Furthermore, we also observed an improvement in the 1-year, 3-year, and 5-year survival rates with risk ratio (RR) of 1.09 (95% CI: 1.01, 1.17), 1.43 (95% CI: 1.28, 1.60), and 1.59 (95% CI: 1.10, 2.30), respectively. In addition, it's also found that chemoimmunotherapy treatment also resulted in an improvement in DFS with an RR of 1.94 and a 95% CI of 1.44 to 2.59. Overall, these results suggest that chemoimmunotherapy treatment can be an effective approach in comparison to chemotherapy for improving overall survival and disease-free survival in the studied population. This study comparing chemoimmunotherapy versus chemotherapy for gastric cancer showed that both treatments were effective, but chemoimmunotherapy had more significant efficacy. To support these results, additional studies with a large sample size and a longer follow-up time are required.

Progression of valve heart disease in a cohort of patients undergoing renal replacement therapy.

Cardiovascular disease is an important cause of death among patients with chronic kidney disease (CKD). Valve calcification is a predictor of cardiovascular mortality and coronary artery disease. To assess heart valve disease frequency, associated factors, and progression in CKD patients. We conducted a retrospective study on 291 CKD patients at Hospital das Clínicas de Pernambuco. Inclusion criteria were age ≥ 18 with CKD and valve disease, while those on conservative management or with missing data were excluded. Clinical and laboratory variables were compared, and patients were categorized by dialysis duration (<5 years; 5-10 years; >10 years). Statistical tests, including chi-square, Fisher's exact, ANOVA, and Kruskal-Wallis, were employed as needed. Simple and multivariate binary regression models were used to analyze valve disease associations with dialysis duration. Significance was defined as p < 0.05. Mitral valve disease was present in 82.5% (240) of patients, followed by aortic valve disease (65.6%; 86). Over time, 106 (36.4%) patients developed valve disease. No significant association was found between aortic, pulmonary, mitral, or tricuspid valve disease and dialysis duration. Secondary hyperparathyroidism was the sole statistically significant factor for mitral valve disease in the regression model (OR 2.59 [95% CI: 1.09-6.18]; p = 0.031). CKD patients on renal replacement therapy exhibit a high frequency of valve disease, particularly mitral and aortic valve disease. However, no link was established between dialysis duration and valve disease occurrence or progression.

Assessment of Nutritional status, Anthropometry and Sleep patterns of the Obese patients during pre and post COVID-19 Illness

Background and aimsUntil COVID-19, obesity was the main pandemic of 21 century. To date, there have been 767984989 confirmed cases, and 6943390 include death cases of COVID-19 (WHO). To find the prevalence of Obesity among adults, to adjudge the attitude and behavior of selected subjects towards eating healthy and weight loss during pre- and post-COVID-19. MethodologySubject selection was done through non-probability judgemental sampling. Initially, 70 young adults between 18 - 39 years of age were selected from different localities of Delhi (NCR). The study was conducted based on a questionnaire developed for the survey. Based on the inclusion criteria only 50 subjects were selected for further study. The study was constructed into three phases and the arrangement of subjects was elaborated as under. Phase 1 includes field study, clinical examination, and biochemical analysis, phase II includes the division of experimental and control groups, whereas Phase III includes the pre& post-COVID nutritional status, anthropometric assessment, beverage consumption, and sleep patterns were also assessed. ResultThe nutrition intervention in E3 (balanced diet + nutrient supplement) showed a significant difference with the control group followed by E2 (nutrient supplement) and E1 (balanced diet). Our findings showed that the subjects have Calorie, protein, fat, carbohydrates, sodium, and potassium intake significantly decreased (P= <0.001) during post-intervention, whereas, the fiber, vitamin A, vitamin C, and iron (P= <0.001), and calcium (p=0.006), intake significantly increased during post-intervention. The changes in anthropometric parameters such as waist-to-hip ratio (WHR), body mass index (BMI), and fat% for pre-COVID-19 were higher for both men and women, but after following the dietary recommendation and physical activity found a significant reduction in WHR, BMI, and fat% (P= <0.001) for both men and women. The p-value for subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbances, and daytime dysfunction appears to be less than 0.05 which shows that it is significant. The daily consumption of various beverages listed above with a comparison of pre-post intervention, which shows that only for kada the p-value is 0.001 which is less than 0.05 hence it seems significant. The p-value for people with no comorbidity appears less than 0.05, indicating it is significant. majority of participants (12%) with diabetes took comparatively longer than the participants suffering from other comorbidities followed by Hypertension (7%), Hyperthyroidism (4%), Hypothyroidism, and polycystic ovarian disease (PCOD) (3% each) respectively. ConclusionIn the present study, we provided survey data about the key aspects of the nutritional management of COVID-19 (pre-and-post), based on the current knowledge.

Efficacy and safety of sympathetic mapping and ablation of renal nerves for the treatment of hypertension (SMART): 6-month follow-up of a randomised, controlled trial

Previous trials of renal denervation (RDN) have been designed to investigate reduction of blood pressure (BP) as the primary efficacy endpoint using non-selective RDN without intraoperatively verified RDN success. It is an unmet clinical need to map renal nerves, selectively denervate renal sympathetic nerves, provide readouts for the interventionalists and avoid futile RDN. We aimed to examine the safety and efficacy of renal nerve mapping/selective renal denervation (msRDN) in patients with uncontrolled hypertension (HTN) and determine whether antihypertensive drug burden is reduced while office systolic BP (OSBP) is controlled to target level (＜140mmHg). We conducted a randomized, prospective, multicenter, single-blinded, sham-controlled trial. The study combined two efficacy endpoints at 6 months as primary outcomes: The control rate of patients with OSBP ＜140mmHg (non-inferior outcome) and change in the composite index of antihypertensive drugs (Drug Index) in the treatment versus Sham group (superior outcome). This design avoids confounding from excess drug-taking in the Sham group. Antihypertensive drug burden was assessed by a composite index constructed as: Class N (number of classes of antihypertensive drugs)×(sum of doses). 15 hospitals in China participated in the study and 220 patients were enrolled in a 1:1 ratio (msRDN vs Sham). The key inclusion criteria included: age (18-65 years old), history of essential HTN (at least 6 months), heart rate (≥70 bpm), OSBP (≥150mmHg and ≤180mmHg), ambulatory BP monitoring (ABPM, 24-h SBP ≥130mmHg or daytime SBP ≥135mmHg or nighttime SBP ≥120mmHg), renal artery stenosis (＜50%) and renal function (eGFR ＞45mL/min/1.73m2). The catheter with both stimulation and ablation functions was inserted in the distal renal main artery. The RDN site (hot spot) was selected if SBP increased (≥5mmHg) by intra-renal artery (RA) electrical stimulation; an adequate RDN was confirmed by repeated electronic stimulation if no increase in BP otherwise, a 2nd ablation was performed at the same site. At sites where there was decreased SBP (≥5mmHg, cold spot) or no BP response (neutral spot) to stimulation, no ablation was performed. The mapping, ablation and confirmation procedure was repeated until the entire renal main artery had been tested then either treated or avoided. AftermsRDN, patients had to follow a predefined, vigorous drug titration regimen in order to achieve target OSBP (＜140mmHg). Drug adherence was monitored by liquid chromatography-tandem mass spectrometry analysis using urine. This study is registered with ClinicalTrials.gov (NCT02761811) and 5-year follow-up is ongoing. Between July 8, 2016 and February 23, 2022, 611 patients were consented, 220 patients were enrolled in the study who received standardized antihypertensive drug treatments (at least two drugs) for at least 28 days, presented OSBP ≥150mmHg and ≤180mmHg and metall inclusion and exclusion criteria. In left RA and right RA, mapped sites were 8.2 (3.0) and 8.0 (2.7), hot/ablated sites were 3.7 (1.4) and 4.0 (1.6), cold spots were 2.4 (2.6) and 2.0 (2.2), neutral spots were 2.0 (2.1) and 2.0 (2.1), respectively. Hot, cold and neutral spots was 48.0%, 27.5% and 24.4% of total mapped sites, respectively. At 6M, the Control Rate of OSBP was comparable between msRDN and Sham group (95.4% vs 92.8%, p=0.429), achieved non-inferiority margin-10% (2.69%; 95% CI-4.11%, 9.83%, p ＜ 0.001 for non-inferiority); the change in Drug Index was significantly lower in msRDN group compared to Sham group (4.37 (6.65) vs 7.61 (10.31), p=0.010) and superior to Sham group (-3.25; 95% CI-5.56,-0.94, p=0.003), indicating msRDN patients need significantly fewer drugs to control OSBP ＜140mmHg. 24-hour ambulatory SBP decreased from 146.8 (13.9) mmHg by 10.8 (14.1) mmHg, and from 149.8 (12.8) mmHg by 10.0 (14.0) mmHg in msRDN and Sham groups, respectively (p<0.001 from Baseline; p>0.05 between groups). Safety profiles were comparable between msRDN and Sham groups, demonstrating the safety and efficacy of renal mapping/selective RDN to treat uncontrolled HTN. The msRDN therapy achieved the goals of reducing the drug burden of HTN patients and controlling OSBP <140mmHg, with only approximately four targeted ablations per renal main artery, much lower than in previous trials. SyMap Medical (Suzhou), LTD, Suzhou, China.

Helicopter emergency medical services (HEMS) response to out-of-hospital cardiac arrest (OHCA) in the United States

IntroductionHelicopter emergency medical services (HEMS) are used in the United States and globally to respond to patients with critical illness and victims of traumatic injury. Relatively limited research has examined their role in responding to out-of-hospital cardiac arrests (OHCA) in the United States. In this study, we compared OHCA treated by HEMS units with cardiac arrests treated by ground ambulances. MethodsWe queried a large national-level database of emergency medical services (EMS) activations in the United States (NEMSIS). Inclusion criteria were OHCA activations between January 1, 2022 and December 31, 2022 treated by either HEMS or ground ambulance. Key arrest data from both groups were then compared. Interfacility transfers and cardiac arrests after EMS arrival were excluded. ResultsA total of 1,233 cardiac arrests treated by HEMS and 341,096 cardiac arrests treated by ground ambulances met inclusion criteria. Comparing the two groups, cardiac arrests with HEMS response were more likely to be male (66.7% vs. 62.8%, p < 0.01), White (50.2% vs. 45.7%, p < 0.01), under 18 years old (10.9% vs. 2.7%, p < 0.001), associated with traumatic injury (19.1% vs. 5.7%, p < 0.001), witnessed (72.7% vs. 37.3%, p < 0.001), and initially-shockable (24.7% vs. 11.1%, p < 0.001). ConclusionOur comparison of cardiac arrests treated by HEMS with cardiac arrests treated by ground ambulance reveals significant differences between the two groups. Further research is needed to better characterize HEMS’ ideal role in the response to OHCA as new prehospital resuscitative techniques for non-traumatic and traumatic cardiac arrest are developed.

Differentiated instruction in reading in elementary schools: a systematic review

&lt;span lang="EN-US"&gt;Increasingly diverse learners in today’s classroom might require teachers to implement differentiated instruction (DI) to create an effective learning process. This systematic review provides an overview of how DI was implemented in reading instruction in elementary education. For this purpose, the researchers systematically searched five databases (APA PsycINFO, Education Research Complete, ERIC, Scopus, and Web of Science). Based on the inclusion criteria, 28 empirical studies from 2002 to 2022 were selected for review. To be included in the review, the studies should be empirical, written in English, peer-reviewed, focusing on reading in elementary education, and include students with or without disabilities. The researchers created content coding in Microsoft Excel spreadsheet to extract relevant information from the selected studies. The findings indicated that implementing DI in reading instruction to elementary school students includes differentiation in content, process, and product, increased quality and quantity of explicit reading instruction, assessments informed instructions, and integrating DI with other instructional models. This emphasizes that although differentiation might seem complex, it is possible to implement it in reading instruction.&lt;/span&gt;

Protocol for Conducting a Systematic Review on Diagnostic Accuracy in Clinical Research

In the landscape of modern medicine, the ability to accurately diagnose various clinical conditions is paramount. As new diagnostic tools continue to emerge, their accuracy must be rigorously assessed before clinical implementation. This paper introduces a systematic review protocol tailored for diagnostic accuracy studies, drawing inspiration from a review on dysphagia screening in post-stroke patients. The protocol, designed with precision and transparency at its core, facilitates a thorough synthesis of evidence, employing tools such as the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and the Standards for Reporting of Diagnostic Accuracy Studies (STARD) checklist for robust evaluation. The protocol emphasizes registration with the PROSPERO database and adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic search approach encompasses a comprehensive exploration of databases and precise keyword combinations. Distinctive inclusion and exclusion criteria, coupled with a dual-reviewer methodology, ensure the selection of high-quality studies. This framework has the potential to serve as a benchmark for systematic reviews in diagnostic accuracy, highlighting the importance of standardization, transparency, and adaptability in clinical research. This approach paves the way for a research methodology that delves deeper into diagnostic tools across various clinical scenarios, promoting evidence-based advancements in patient care.

The relation of complex problem solving with reflective abstraction: a systematic literature review

&lt;span lang="EN-US"&gt;Complex problem solving (CPS) is a new paradigm in solving problems and is one of the soft skills needed to face the industrial revolution 4.0. Reflective abstraction is associating and modifying pre-existing conceptions into new situations. This article reviews research on CPS and reflective abstraction. This research is needed to know the relationship between reflective abstraction and CPS. The systematic writing of this review was assisted by the Publish or Perish 7 application, Mendeley, and VOSviewer. A literature search was performed through the ScienceDirect and ERIC databases. Based on the search results with the term “complex problem solving” and several exclusion criteria, 58 articles were found, whereas with the word “reflective abstraction” there were 23 articles, totaling 81 papers. Based on the literature review, it was found that there is a relationship between CPS and reflective abstraction by obtaining common ground in the form of prior knowledge. CPS requires prior knowledge from reflective abstraction to integrate the most relevant information. To improve CPS, efforts and special attention can be made to build initial knowledge through reflective abstraction. This article contributes to further research and becomes a study for the themes of CPS and reflective abstraction in learning and education.&lt;/span&gt;

Enhancing student career readiness: a two-decade systematic literature review

This study intends to discover the elements that impact student career readiness growth, analyze the components that dominate that growth, and identify the factors that dominate student career readiness. The methods used to review selected articles are discussed including publication standards, databases, eligibility and exclusion criteria, stages of the review process (identification, screening, feasibility) as well as abstraction and analysis of data. By following the guidelines of item preferred reporting items for systematic reviews and meta-analyses (PRISMA) to produce this review. Based on the commonalities and traits of the first identified components, these factors have been separated into two categories, internal and external. Self-efficacy factors for internal factors and job training factors for external factors are the two factors with the maximum frequency and dominance over the others. Pursuing formal and non-formal education relevant to the chosen career field, making short-term and long-term career plans, establishing a strong professional network, and seeking relevant work experience through internships, part-time jobs, or volunteer work are all components of a career readiness strategy. Develop the necessary skills for an industry or career field, improve your communication skills, think positively, and be willing to confront career challenges. Maintain a balance between personal and professional life.

The effects of anaesthesia and analgesia on short- and long-term outcomes following colorectal cancer surgery

BACKGROUND Colorectal cancer (CRC) is the second most frequent cause of global cancer mortality. Most patients with CRC require surgical tumour resection, with certain stages of CRC (Stage II/III) also requiring postoperative chemotherapy. The timing of postoperative chemotherapy is largely determined by postoperative recovery. Delayed return to intended oncologic therapy (RIOT) by &gt;8 weeks results in worse oncologic outcomes. RIOT is thus an important surrogate marker of outcome for patients with stage II/III CRC. We will test the hypothesis that anaesthetic technique during CRC resection surgery may affect RIOT. OBJECTIVE To test the association between anaesthetic and analgesic technique during CRC surgery and RIOT. To document Short-term Secondary outcomes including individual postoperative complications and a composite of all postoperative complications, the Comprehensive Complications Index (CCI) and to measure the time to recurrence (TTR) of cancer at 3 years. DESIGN This is a prospective, international, multicentre, observational cohort study. SETTING Global healthcare setting, with &gt;140 centres in &gt;30 nations. PATIENTS Inclusion criteria: All patients age &gt;18 years, ASA I–III, with CRC stage I–III scheduled for elective CRC surgery (open or minimally invasive). Exclusion criteria: Uncontrolled renal or liver disease, restrictive (limiting mobility) heart failure or ischemic heart disease (ASA IV–V). Speech, language, or cognitive difficulties precluding signing informed consent to participate and Stage IV CRC. PRIMARY OUTCOME MEASURES Short -term: The duration from day of surgery to RIOT among patients expected to receive postoperative chemotherapy. Long-term: incidence of recurrence and time to recurrence (TTR) at 3 years after primary curative surgery SECONDARY OUTCOMES Postoperative complications within 30 days of surgery, length of hospital stay, Days at Home at 30 and 90 days (DAH-30, DAH-90) after surgery, and adverse events related to oncological treatment. We will also assess the burden of preoperative modifiable comorbid disease in patients. Exploratory endpoints will assess practice variation (including incidence of RIOT by demographic e.g. gender of patient, type of institution, country). RESULTS N/A. CONCLUSIONS N/A. TRIAL REGISTRATION The Effects of aNesthesia in COloREctal cancer outcome study: ENCORE, ClinicalTrials.gov Identifier: NCT04493905.

Artificial intelligence and internet of things in manufacturing decision processes

This paper explores the influence of the internet of things (IoT) and artificial intelligence (AI) on the decision-making processes of modern manufacturing systems. With the proliferation of IoT devices and the development of AI technologies, manufacturing companies increasingly leverage these technologies to improve their decision-making abilities. This study aims to investigate the potential benefits, difficulties, and ramifications of integrating IoT and AI in manufacturing systems. The review employs the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method with a systematic mapping process with four research questions. A total of 1282 articles were collected between 2017 and 2023, reviewed in accordance with the inclusion and exclusion criteria, and 66 articles were chosen. The research on IoT and AI technologies influentially affects other research in the production control layer manufacturing area based on the top-ten cited articles. In contrast, the research in this area focused on the operations management layer, specifically manufacturing analytics processes. This paper’s findings contribute to a greater understanding of the impact of IoT and AI on decision-making in modern multi-domain manufacturing systems and provide direction for future research in this field.

Association of PD-L1 Expression with Clinicopathologic Characters in Gastric Cancer: A Comprehensive Meta-analysis.

The expression level of programmed death ligand-1(PD-L1) in patients with gastric cancer is the key to determining the use of immune drugs. The relationship between PD-L1 expression level and clinical characteristics is worth exploring. By setting the search terms correlated to PD-L1 and gastric cancer, a nearly comprehensive search was carried out in four major databases, and the deadline for searching was September 1, 2022. The retrieved documents were further screened by strict inclusion and exclusion criteria after removing the duplication. Next, the quality of the included studies was evaluated with the Newcastle-Ottawa Scale (NOS) scale. Finally, the STATA15.1 software was used to process data and draw plots, and the odds ratios (ORs) were adopted to assess the pooled effect size. A total of 85 works of literature were included in this study through screening strictly, and detailed data were extracted after evaluating the quality of the literature. The process of analysis was conducted in the whole population, Asia-Africa population, European and American population, and Asian population with CPS≥1, amd all found that the expression of PD-L1 in gastric cancer was correlated with age, tumor size, EBV infection, Her-2 expression and microsatellite status. However, the subgroup of the region also found some differences in Asian and Western regions, which was interesting and worth studying further. The included research of this study did not have significant publish bias. After careful analysis, this study found that age (>60 years), tumor size (>5cm), EBV infection (+), Her-2 expression (+), microsatellite status (MSI), and mismatch repair status (dMMR) were risk factors for positive expression of PD-L1 in gastric cancer.

The Lived Experience of Patients with Vascular Malformations: A Qualitative Meta-synthesis

Objective: The purpose of this study was to synthesize the existing qualitative literature on the lived experience of patients with vascular malformations to identify emergent themes and new areas for clinical care and research. Methods: A formal meta-synthesis was conducted, which followed 4 steps: (1) form the clinical question and refine search criteria; (2) complete a literature review following Preferred Reporting Items for Reviews and Meta-Analysis; (3) quality appraisal of included literature with Lett’s Critical Review Form; and (4) completion of team-based reciprocal translation and thematic analysis to synthesize the literature. PubMed, CINAHL, Johanna Briggs, and Embase were used to retrieve English language, peer-reviewed qualitative, and mixed-method articles from 1996 to May 2023. Results: Six articles met the criteria for inclusion. A wide range of vascular malformations were represented, ranging from slow-flow malformation to high-flow or complex with associated overgrowth. Studies were conducted in the United States, France, and Germany, focusing mainly on the adult experience, with 1 article focusing solely on pediatrics. Three main themes emerged: social isolation, uncertainty and hope, and healthcare experiences. Conclusion: The overarching themes of social isolation, uncertainty and hope, and healthcare experiences each offer avenues to inform clinical practice, provide education for healthcare providers managing patients with vascular malformations, and future research to better understand how each of these themes affect patients. This qualitative meta-synthesis is a novel method for this field and provides new insights into the lived experience of those with vascular malformations.

Museum visit intervention in K-12 education: a scoping review

This scoping review aims to provide an overview of empirical studies on worldwide museum visit intervention in K-12 education. The study employed Mendeley citation software to identify the articles in the database. A meta-analysis PRISMA statement is used for reporting the items. Out of 135 possibly rich articles, the present study reviewed 18 studies that met the inclusion criteria and were subjected to descriptive and content analyses published between 2017 and 2021. Most of the studies are experimental and from primary school contexts. It is revealed that science is the subject matter context majority of the studies, but philosophy, disaster management, language, and environmental science are also represented. The content analysis resulted in the following learning and social outcomes. It states that social outcome is explored chiefly, followed by learning outcome. The findings indicate that museum visit intervention positively impacts students learning and social outcome. The review also identifies the need for further research on museum visit intervention in the Asia Pacific region.

NSTEMI mortality and hospital outcomes in patients with atrial fibrillation: A propensity score-matched analysis

BackgroundAtrial fibrillation (AF) is associated with increased cardiovascular mortality. Data regarding the relationship between coronary artery disease (CAD) and AF is mixed. It is uncertain if AF directly increases the risk for future coronary events and if such patients are appropriately evaluated for CAD. MethodsThis cross-sectional study was performed on hospitalized patients with NSTEMI and concurrent AF in 2019 using the National Inpatient Sample. In-hospital mortality, rates of diagnostic cardiac angiography, percutaneous coronary intervention, ventricular tachycardiac (VT), ventricular fibrillation (VF), cardiogenic shock, cardiac arrest, length of stay (LOS), and total hospitalization charges were studied. ResultsA total of 433,965 patients met inclusion criteria (169,725 females [39.1 %], 307,985 Caucasian [71 %], 51,570 African American [11.8 %], 37,265 Hispanic [8.6 %]; mean [SD] age, 67.9 [6.2] years). 86,200 (19.8 %) patients with NSTEMI had AF, including 32,775 (38 %) female patients before propensity matching. Patients with NSTEMI and AF had increased odds of mortality (adjusted Odds ratio, 1.32; CI, 1.21–1.43; p < 0.001). AF patients were less likely to undergo diagnostic coronary angiography and PCI and had higher odds of VT, VF, cardiogenic shock, cardiac arrest, tracheal intubation, mechanical ventilation, increased LOS, and higher hospital charges than those without AF. ConclusionAF was independently associated with increased mortality and serious cardiac complications in patients admitted with NSTEMI.

The impact of bullying and cyberbullying on mental health: a systematic review

Bullying, including cyberbullying, has a devastating impact on mental health, particularly among adolescents. This literature study aims to identify mental health issues caused by bullying and cyberbullying. A systematic review was conducted in the last five years using the keywords "bullying, cyberbullying, mental health, adolescent" and the population, intervention, comparison, outcome, study design (PICOS) framework within Scopus (29 articles), ProQuest (187 articles), Science Direct (193 articles), and SAGE (58 articles) published databases in the last five years using the keywords of “bullying, cyberbullying, mental health, adolescent”. The selected articles are those applying quantitative and longitudinal studies published in 2018-2022 in which study participants were adolescents who had experiences as victims of bullying and cyberbullying. The 25 articles met the inclusion criteria for review. Based on the results of the review of the article, it was found that mental health problems can occur in all roles in bullying and cyberbullying, but the highest is in the role of victim. Mental health problems that occur in victims include anxiety, stress, depression, low self-esteem, suicidal ideation, and suicide attempts. Based on these results, different interventions are needed for the roles involved in bullying and cyberbullying, especially for victims, because psychological problems are more common in victims.

Utilization and safety of off-label prothrombin complex concentrate (4F-PCC) in a nonsurgical population.

The aim of this study was to evaluate and describe the utilization and safety of 4F-PCC in a nonanticoagulated, nonsurgical patient population at an academic, tertiary care center. This retrospective, single-center chart review evaluated nonanticoagulated adult patients at least 18 years of age who had at least one dose of 4F-PCC administered between January 1, 2017, and September 30, 2022, for a nonsurgical indication. Hemostatic efficacy following 4F-PCC administration was the primary outcome, and secondary outcomes included an assessment of blood product administration, thrombotic events within 30 days post4F-PCC administration, in-hospital mortality, and the length of hospital stay. A total of 59 patients met the inclusion criteria, and 10 patients received 4F-PCC for coagulopathy associated with liver disease, 34 for intracranial hemorrhage (ICH), and 15 for other indications. For the primary outcome of hemostatic efficacy, 17 non-ICH patients (85%) had achieved hemostasis post-4F-PCC, and among the ICH patient population, 18 (64%) did not show expansion on repeat CT post4F-PCC, suggesting hemostasis. Blood product and hemostatic agent usage was frequent, with 72.9% of patients requiring products post-4F-PCC. Acute thromboembolic events occurred in six patients (10.2%), and in-hospital mortality occurred in 55.9% of patients. Off-label 4F-PCC use is common despite a lack of robust guidance for use. Following 4F-PCC administration, blood product use was frequent, the incidence of in-hospital mortality was high, and thromboembolic complications such deep vein thrombosis (DVT), pulmonary embolism (PE), and stroke were reported. Further studies are needed to validate the off-label administration of 4F-PCC in nonanticoagulated patients.

Gestational diabetes mellitus and development of intergenerational non-alcoholic fatty liver disease (NAFLD) after delivery: a systematic review and meta-analysis

It is known that gestational diabetes mellitus (GDM)-complicated pregnancies could affect maternal cardiometabolic health after delivery, resulting in hepatic dysfunction and a heightened risk of developing non-alcoholic fatty liver disease (NAFLD). Hence, this study aims to summarise existing literature on the impact of GDM on NAFLD in mothers and investigate the intergenerational impact on NAFLD in offspring. Using 4 databases (PubMed, Embase, Web of Science and Scopus) between January 1980 and December 2023, randomized controlled trials and observational studies that assessed the effect of maternal GDM on intergenerational liver outcomes were extracted and analysed using random-effects meta-analysis to investigate the effect of GDM on NAFLD in mothers and offspring. Pooled odds ratio (OR) was calculated using hazards ratio (HR), relative risk (RR), or OR reported from each study, with corresponding 95% confidence intervals (CI), and statistical heterogeneity was assessed with the Cochran Q-test and I2 statistic, with two-sided p values. The study protocol was pre-registered on PROSPERO (CRD42023392428). Twenty studies pertaining to mothers and offspring met the inclusion criteria and 12 papers were included further for meta-analysis on intergenerational NAFLD development. Compared with mothers without a history of GDM, mothers with a history of GDM had a 50% increased risk of developing NAFLD (OR 1.50; 95% CI: 1.21-1.87, over a follow-up period of 16 months-25 years. Similarly, compared with offspring born to non-GDM-complicated pregnancies, offspring born to GDM-complicated pregnancies displayed an approximately two-fold elevated risk of NAFLD development (2.14; 1.57-2.92), over a follow-up period of 1-17.8 years. This systematic review and meta-analysis suggests that both mothers and offspring from GDM-complicated pregnancies exhibit a greater risk to develop NAFLD. These findings underline the importance of early monitoring of liver function and prompt intervention of NAFLD in both generations from GDM-complicated pregnancies. No funding was available for this research.

Overview of mom's confidence when planning to return low birth weight baby from the hospital

Introduction: Babies with low birth weight are one of the health problems often faced by mothers and families in various countries, including Indonesia. The return of babies with low birth weights from the hospital became a critical stage in their care after a period of intensive hospitalization. Objective: Describe the mother's confidence level when planning to return a baby with a low birth weight to the hospital. Method: quantitative research with a descriptive design involving 29 respondents. This study used non-probability and consecutive sampling techniques to determine subjects who met the inclusion criteria. The measuring instrument uses the Maternal Confidence Questionnaire Instrument, and the analysis results are descriptive data equipped with tables. Results: Most of the self-confidence of mothers planning to return home with high-birth-weight babies from the hospital was high among 16 respondents (55.2%). Factors that influence a mother's confidence include previous experience caring for a child, social support from family and friends, information and education provided by medical personnel, and an adequate financial condition and environment for the care of the baby. Conclusion: The mother's self-confidence plays a crucial role in planning the return of a low-birthweight baby from the hospital. Social support, knowledge of baby care, interaction with health workers, and understanding of the baby's health condition contribute to the mother's confidence. A holistic approach involving adequate social support, information and education, and financial and environmental readiness to increase maternal confidence in caring for a low-birth-weight baby after discharge from the hospital

The effect of early weight-bearing and later weight-bearing rehabilitation interventions on outcomes after ankle fracture surgery: A systematic review and meta-analysis of randomised controlled trials.

This systematic review aimed to analyse the effect of early weight bearing versus late weight bearing on rehabilitation outcomes after ankle fractures, which primarily include ankle function scores, time to return to work/daily life and complication rates. The China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China Science and Technology Journal, Web of Science, PubMed, Embase and Cochrane Library databases were searched. The focus was on identifying randomised controlled trials centred on early weight-bearing interventions for post-operative ankle fracture rehabilitation. All databases were searched for eligible studies published within the period from database inception to 20 June 2023. The eligible studies were screened according to the inclusion criteria. Study quality was evaluated using the methodology recommended by the Cochrane Handbook for the Systematic Evaluation of Interventions. Two authors independently performed the literature search and data extraction. Eligible studies were subjected to meta-analyses using Review Manager 5.3. Based on the time points at which post-operative ankle function was reported in the studies included in this paper, we decided to perform a meta-analysis of ankle function scores at 6weeks post-operatively, 12weeks post-operatively, 24-26weeks post-operatively and 1year post-operatively. A total of 11 papers, comprising 862 patients, were included. Meta-analysis indicated that patients receiving early weight-bearing interventions, which referred to weight-bearing for 6weeks post-operatively, experienced enhancements in ankle function scores (Olerud-Molander score, AOFAS score or Baird-Jackson score) at various post-operative milestones: 6weeks (SMD=0.69, 95% CI: 0.49-0.88 and p<0.01), 12weeks (SMD=0.57, 95% CI: 0.22-0.92 and p<0.01) and the 24-26weeks range (SMD=0.52, 95% CI: 0.20-0.85 and p<0.01). The results of subgroup analyses revealed that the effects of early weight-bearing interventions were influenced by ankle range-of-motion exercises. Additionally, early weight bearing allows patients to return to daily life and work earlier, which was evaluated by time when they resumed their preinjury activities (MD=-2.74, 95% CI: -3.46 to -2.02 and p<0.01), with no distinct elevation in the incidence of complications (RR=1.49, 95% CI: 0.85-2.61 and p>0.05). The results showed that early weight bearing is effective in improving ankle function among post-operative ankle fracture patients and allows patients to return to daily life earlier. Significantly, the safety profile of early weight bearing remains favourable, with no higher risk of complications than late weight bearing.