Lack Of Consensus Research Articles

Features of Lateral Pelvic Lymph Nodes Associated With Pathological Involvement After Total Neoadjuvant Therapy in Patients Undergoing Lateral Pelvic Lymph Node Dissection

BACKGROUND: There is a lack of consensus regarding treating involved lateral pelvic lymph nodes in rectal cancer. OBJECTIVE: This study aimed to evaluate the clinical and magnetic resonance imaging-based factors associated with pathological lateral pelvic lymph node metastasis in patients undergoing total neoadjuvant therapy and lateral pelvic lymph node dissection. DESIGN: This is a retrospective study. SETTINGS: This study was conducted at a single comprehensive cancer center. PATIENTS: A total of 107 patients with advanced low rectal cancer with pretreatment enlarged lateral pelvic lymph nodes (≥7 mm in long-axis) undergoing total neoadjuvant therapy with long-course chemoradiotherapy, followed by total mesorectal excision and lateral pelvic lymph node dissection, were enrolled. MAIN OUTCOME MEASURES: Pathological lateral pelvic lymph node metastasis and survival. RESULTS: Among 107 patients, 48 had a short-axis lateral node diameter <7 mm at baseline, while 59 had ≥7 mm. The ≥7 mm group showed significantly higher rates of pathological lateral pelvic lymph node metastasis (44.1% vs. 2.1%; p < 0.0001). In this group, pathological lateral pelvic lymph node metastasis was independently associated with pre-treatment malignant features and post-treatment short-axis diameter ≥4 mm. Five-year relapse-free survival was significantly lower in patients with post-treatment lateral node diameter ≥ 4 mm than those with <4 mm (71.1% vs. 86.2%, p = 0.0364). Patients with pathological lateral pelvic lymph node metastasis had significantly lower overall survival, relapse-free survival, and local recurrence-free survival rates. LIMITATIONS: Selection bias exists in a retrospective analysis. CONCLUSIONS: Pathological lateral pelvic lymph node metastasis is rare in patients with pre-treatment short-axis diameter <7 mm. In patients with pre-treatment short-axis diameter ≥7 mm, pre-treatment malignant features and post-treatment short-axis diameter are both associated with pathological lateral pelvic lymph node metastasis. These factors should be considered when deciding whether to proceed with lateral pelvic lymph node dissection after total neoadjuvant therapy. See Video Abstract.

BN SO63 - A systematic review of Hiatus Hernia classifications

Abstract Background Hiatus hernias (HH) are common, an important cause of symptoms, and a strong risk factor for complications and oesophageal dysplasia and adenocarcinoma. However, there is a lack of consensus as to how they should be classified. This has significant implications for benchmarking and standardising practice, as well as generating and answering research questions. The aim of this review was to systematically identify and appraise what classification systems have been described, and to identify any novel approaches to HH classifications and their association with treatment outcomes. Method We undertook a systematic review of the PubMed and EMBASE databases on the 17th January 2023. Inclusion criteria were any studies containing a HH classification described within adults. Exclusion criteria were studies not in English, animal studies and case reports. Results 847 articles were identified. 245 were included, with a further 9 studies identified that tested a novel approach to classifying HH against surgical outcomes. Most classification systems (64.9%) were anatomical, but with significant variation as regards stratification of size of the hernia, and its contents (primarily the proportion of herniated stomach). A small number of classifications described endoscopic, manometry, symptomatic and intra-operative classifications. There was considerable heterogeneity in the definitions used for larger HH. The quality of studies comparing classifications with outcomes was limited; however, some possible associations were reported based on anatomical and physiological parameters. Conclusion We found a wide range of HH classification systems. These were mainly anatomical and based on the traditional type I-IV system. Whilst the evidence is limited, it seems likely that other components (anatomical and physiological) may have utility in better classifying HH and guiding treatment, standardisation and research.

Definitions and Characteristics of Patient Digital Twins Being Developed for Clinical Use: Scoping Review.

The concept of digital twins, widely adopted in industry, is entering health care. However, there is a lack of consensus on what constitutes the digital twin of a patient. The objective of this scoping review was to analyze definitions and characteristics of patient digital twins being developed for clinical use, as reported in the scientific literature. We searched PubMed, Scopus, Embase, IEEE, and Google Scholar for studies claiming digital twin development or evaluation until August 2023. Data on definitions, characteristics, and development phase were extracted. Unsupervised classification of claimed digital twins was performed. We identified 86 papers representing 80 unique claimed digital twins, with 98% (78/80) in preclinical phases. Among the 55 papers defining "digital twin," 76% (42/55) described a digital replica, 42% (23/55) mentioned real-time updates, 24% (13/55) emphasized patient specificity, and 15% (8/55) included 2-way communication. Among claimed digital twins, 60% (48/80) represented specific organs (primarily heart: 15/48, 31%; bones or joints: 10/48, 21%; lung: 6/48, 12%; and arteries: 5/48, 10%); 14% (11/80) embodied biological systems such as the immune system; and 26% (21/80) corresponded to other products (prediction models, etc). The patient data used to develop and run the claimed digital twins encompassed medical imaging examinations (35/80, 44% of publications), clinical notes (15/80, 19% of publications), laboratory test results (13/80, 16% of publications), wearable device data (12/80, 15% of publications), and other modalities (32/80, 40% of publications). Regarding data flow between patients and their virtual counterparts, 16% (13/80) claimed that digital twins involved no flow from patient to digital twin, 73% (58/80) used 1-way flow from patient to digital twin, and 11% (9/80) enabled 2-way data flow between patient and digital twin. Based on these characteristics, unsupervised classification revealed 3 clusters: simulation patient digital twins in 54% (43/80) of publications, monitoring patient digital twins in 28% (22/80) of publications, and research-oriented models unlinked to specific patients in 19% (15/80) of publications. Simulation patient digital twins used computational modeling for personalized predictions and therapy evaluations, mostly for one-time assessments, and monitoring digital twins harnessed aggregated patient data for continuous risk or outcome forecasting and care optimization. We propose defining a patient digital twin as "a viewable digital replica of a patient, organ, or biological system that contains multidimensional, patient-specific information and informs decisions" and to distinguish simulation and monitoring digital twins. These proposed definitions and subtypes offer a framework to guide research into realizing the potential of these personalized, integrative technologies to advance clinical care.

Core Content, Competencies, and Accreditation in US Global Health Fellowships: A Survey of Leaders' Perspectives.

The number of global health (GH) fellowships in the United States has increased over the past two decades. However, there are currently no standard requirements, shared core content, or widespread systems of accreditation. With the growth in programs, it is appropriate to consider these issues. We conducted a national survey to understand GH fellowship leaders' perspectives on the existence of core content and competencies and on the need for accreditation, including by the Accreditation Council of Graduate Medical Education (ACGME). We sent survey invitations to 123 fellowship leaders. Forty-five completed the survey (37%), representing seven specialties. Eighty-nine percent of respondents indicated that there is important core content for fellows to learn regardless of specialty; 30% indicated that accreditation would be "very" or "extremely" beneficial, whereas 21% indicated that it would be "not at all" beneficial. When asked what form of accreditation would result in training the most competent GH practitioners, 35% indicated that accreditation is unnecessary. Of those selecting a form of accreditation, the largest proportion (21%) selected accreditation from a professional society; 52% "disagreed" or "strongly disagreed" that ACGME accreditation is needed. More than 65% indicated that loss of training flexibility, funding restrictions, and increased administrative and fellow funding burdens are "very" or "extremely" important barriers. These results suggest that broad agreement on important core content exists across specialties, with a lack of consensus about the need for accreditation. More discussion with stakeholders, including international partners, is needed to understand their perceptions and build consensus before pursuing fellowship accreditation.

Preoperative management and anticoagulant efficacy in atrial myxoma-associated acute ischemic stroke: a case report and literature review

Acute ischemic stroke (AIS) is a common complication of atrial myxoma (AM), and most emboli originate from a thrombus attached to the surface of the myxoma, with occasional shedding of tumor fragments leading to stroke. Clinical manifestations of AM include mitral valve obstruction, systemic embolism, and weakness. However, neurological deficits and other nonspecific manifestations may mask the presence of AM. The surgical resection is the most effective treatment for these conditions. However, the main problem is the lack of consensus regarding the prevention and treatment of stroke complicated by myxoma during the perioperative period. This study aims to improve the diagnosis and treatment of AM and the associated AIS. Here, we report the case of a 27-year-old patient with AM who presented with chest pain, palpitations, and sudden dizziness and had a stroke under anticoagulant treatment during the admission period. We also reviewed and summarized the clinical presentations and characteristics of similar previously reported cases. Our review emphasized the importance of early diagnosis and appropriate perioperative management of AM and its associated AIS.

Chemotherapy-induced constipation among children: An observational study

Objectives Chemotherapy-induced constipation [CIC] is a common and underreported morbidity among children. There is a lack of consensus about its reporting and management. Material and Methods A prospective observational study was conducted on children receiving chemotherapy for various malignancies. Exclusion was made for preexisting gastrointestinal disorders, children in intensive care, or in an altered sensorium. Constipation assessment and Bristol stool form scales were used to assess the incidence of CIC. Result A total of 90 children were observed and CIC was reported by 41 (45.5%) cases as self-declared as well as on the constipation assessment scale. On the Bristol stool form scale, 47 (52.3%) cases had some grade of CIC. CIC was associated with vincristine, cytarabine, and L-asparaginase chemotherapy schedules. Oral laxatives were the most common remedy used and only 11 cases required rectal enema. Despite interval admission noted among 12 cases and chemotherapy schedule modification among 22 cases, the impact of CIC on the quality of life was expressed by 26.6 % of caregivers only. Conclusion CIC is a common morbidity and it needs more active surveillance.

Relative facial width, and its association with canine size and body mass among chimpanzees and bonobos: Implications for understanding facial width-to-height ratio expression among human populations.

Facial width-to-height ratio (fWHR) has been widely investigated in the context of its role in visual communication, though there is a lack of consensus about how fWHR serves as a social signal. To better understand fWHR variation in a comparative context, we investigate the associations between fWHR and canine crown height (CCH) and body mass, respectively, among two chimpanzee subspecies (Pan troglodytes schweinfurthii, Pan troglodytes troglodytes) and bonobos (Pan paniscus). We collected landmark data from 3D surface models of 86 Pan cranial specimens to quantify fWHR and upper CCH, and to estimate body mass. We used Spearman's r and Kruskal-Wallis tests to test for significant relationships among variables, and to assess sexual dimorphism. There is an inverse relationship between fWHR and CCH in both sexes of Pan, however there are interpopulation differences in the relationship between fWHR and CCH among Pan taxa. Pan paniscus have relatively wide faces and small canine crowns, and wide faces in Pan t. schweinfurthii males may be driven by body size constraints. Pan troglodytes and Pan paniscus show fWHR dimorphism, and Pan paniscus have significantly higher fWHRs than do either Pan troglodytes subspecies. Our findings indicate that CCH and facial breadth may serve subtly different signaling functions among Pan taxa. Further research into the circumstances in which wide faces evolved among chimpanzees and bonobos will likely afford deeper insights into the function of relatively wide faces in the context of visual signaling among humans and our extinct hominin relatives.

Assessment of coronary microvascular dysfunction by angiography-based index of microcirculatory resistance: an indirect meta-analysis.

There is a lack of consensus on diagnosing coronary microvascular dysfunction (CMD) using the angiography-based index of microcirculatory resistance (Angio-IMR) due to the absence of evidence. This study aims to explore the efficacy of Angio-IMR in diagnosing CMD. A systematic search was conducted in PubMed, Embase, Scopus, and Cochrane Library for studies primarily focusing on Angio-IMR diagnosing CMD, using IMR as the gold standard. The primary results were pooled sensitivity, specificity, and the area under curve (AUC). A total of 15 studies involving 2202 individuals and 2330 vessels were included in our study, Angio-IMR demonstrated high performance in predicting IMR with overall pooled sensitivity and specificity of 0.84 (95% confidence interval (CI): 0.81 to 0.87) and 0.87 (95%CI: 0.83 to 0.99), respectively, and AUC=0.91 (95%CI: 0.89 to 0.94). This indicates that Angio-IMR has good diagnostic characteristics. Subgroup analysis by indirect meta-analysis showed higher sensitivity in the rest state. However, there is no significant difference in sensitivity and specificity between the hyperemic and rest states when using the AccuIMR system. Furthermore, sensitivity and specificity were more pronounced in the group without coronary pressure monitoring compared to the group with monitoring. Angio-IMR is an alternative tool to identify CMD.

Evaluating the visual literacy of the Kuwaiti government’s Arabic infographics during the COVID-19 pandemic: an automated visual analysis and AI approach

PurposeWith infographics emerging as key communication tools on social media platforms, this study explores the visual literacy of governments in creating effective infographics, especially during crises. Using the Kuwaiti government during the COVID-19 pandemic as a case study, the investigation evaluates the government’s visual competency and strategy in its infographics on X.Design/methodology/approachFor competence, AI-based techniques were employed to analyze the proportion of text region size to total infographic size, word count per infographic and the most prominent colors used. Regarding strategy, the study utilized the crisis and emergency risk communication (CERC) model as a framework to examine how the Kuwaiti government integrated crisis communication response strategies into infographics.FindingsWhen communicating complex messages, the government resorted to text-heavy infographics instead of creative visualizations, casting doubt on its visual competence. The inconsistent use of colors further undermined a recognizable visual identity. Regarding strategy, infographics on crisis updates were most frequent, supporting CERC’s emphasis on reducing uncertainty. Yet, prioritizing bolstering strategies above empathy and action steps goes against the advice of existing literature.Originality/valueWhile crisis communication research is widely based on textual analysis, this study extends the literature by examining visuals, specifically infographics. Additionally, focusing on Arabic infographics from Kuwait, the study expands the crisis communication literature, which has mainly concentrated on Western countries and the English language. Given the lack of consensus on the best methods to measure visual literacy, this study’s AI approaches contribute to the literature.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-03-2024-0172

The Great Controversy of Obstructive Sleep Apnea Treatment for Cardiovascular Risk Benefit: Advancing the Science Through Expert Consensus. An Official American Thoracic Society Workshop Report.

The prevalence of obstructive sleep apnea (OSA) is on the rise, driven by various factors including more sensitive diagnostic criteria, increased awareness, enhanced technology through at-home testing enabling easy and cost-effective diagnosis, and a growing incidence of comorbid conditions such as obesity. Treating symptomatic patients with OSA syndrome to enhance quality of life remains a cornerstone approach. However, there is a lack of consensus regarding treatment to improve cardiovascular disease (CVD) outcomes, particularly in light of overall negative results from several randomized controlled trials (RCT) indicating no benefit of positive airway pressure (PAP) therapy on primary and secondary CVD events. These RCTs were limited by suboptimal PAP adherence, use of composite CVD outcomes, and limited diversity and generalizability to Sleep Clinic patients. As such, this workshop assembled clinical experts, as well as researchers in basic and translational science, epidemiology, clinical trials, and population health to discuss the current state, and future research directions to guide personalized therapeutic strategies and future research directions in OSA. There was overall consensus among workshop participants that OSA represents a heterogeneous disease with variable endotypes and phenotypes, and heterogeneous responses to treatment. Future research should prioritize employing multi-modal therapeutic approaches within innovative and adaptive trial designs, focusing on specific subgroups of OSA patients hypothesized to benefit from a CVD perspective. Future work should also be inclusive of diverse populations and consider the life-course of OSA to better comprehend treatment strategies that can address the disproportionate impact of OSA on racially minoritized groups. Further, a more holistic approach to sleep must be adopted to include broader assessments of symptoms, sleep duration, and comorbid sleep and circadian disorders. Finally, it is imperative to establish a sleep research consortium dedicated to collecting raw data and biospecimens categorized by OSA subtypes. This will facilitate mechanistic determinations, foster collaborative research, and help bolster the pipeline of early-career researchers.

Pigtail Catheter Compared to Formal Intercostal Catheter for the Management of Isolated Traumatic Pneumothorax: A Systematic Review and Meta-Analysis

(1) Background: The optimal management approach for adults with traumatic pneumothorax without haemothorax remains an area of debate. Specifically, there is lack of consensus as to whether insertion of a pigtail catheter is superior to a formal intercostal catheter in improving complication rates. (2) Methods: Medline, EMBASE, Cochrane Central, and the World Health Organisation International Clinical Trials Registry Platform databases were systematically searched for studies evaluating pigtail catheters compared to formal intercostal catheters for the management of traumatic pneumothorax. Investigative outcomes of interest included pain, duration management, failure, need for formal thoracoscopic surgery, need for supplemental oxygen, length of stay, infection and overall total complications. (3) Results: Three studies evaluating 280 patients were included in this analysis. There was no significant difference in total complications, rates of failure, length of stay or duration of management between pigtail catheters and formal intercostal catheters. This evidence was based on studies of low to moderate risk of bias with poor control for confounding factors. (4) Conclusions: This systematic review and meta-analysis demonstrates lack of evidence to suggest pigtail catheters are superior to formal intercostal catheter for traumatic pneumothorax. These findings may reflect a true absence of effect between either approach for this patient cohort or non-committal findings in light of limitations of the underlying evidence. Further prospective trials with larger sample sizes and control for confounders are required to validate the outcomes between these two modalities of treatment.

Pupillary manifolds: uncovering the latent geometrical structures behind phasic changes in pupil size

The size of the pupils reflects directly the balance of different branches of the autonomic nervous system. This measure is inexpensive, non-invasive, and has provided invaluable insights on a wide range of mental processes, from attention to emotion and executive functions. Two outstanding limitations of current pupillometry research are the lack of consensus in the analytical approaches, which vary wildly across research groups and disciplines, and the fact that, unlike other neuroimaging techniques, pupillometry lacks the dimensionality to shed light on the different sources of the observed effects. In other words, pupillometry provides an integrated readout of several distinct networks, but it is unclear whether each has a specific fingerprint, stemming from its function or physiological substrate. Here we show that phasic changes in pupil size are inherently low-dimensional, with modes that are highly consistent across behavioral tasks of very different nature, suggesting that these changes occur along pupillary manifolds that are highly constrained by the underlying physiological structures rather than functions. These results provide not only a unified approach to analyze pupillary data, but also the opportunity for physiology and psychology to refer to the same processes by tracing the sources of the reported changes in pupil size in the underlying biology.

Role of Investing in Human Resources in Enhancing the Organizational Renewal Capabilities of the Pharmaceutical Industry

This study aims to explore the role of the dimensions investing in human resources in enhancing the organizational renewal capabilities of companies operating in the pharmaceutical industry. An online survey was conducted among a sample of (350) individuals who worked in pharmaceutical companies in the Kingdom of Saudi Arabia. The results indicate that the dimensions of investing in human resources as assessed by employees of pharmaceutical companies positively enhance all four studied dimensions of organizational renewal capabilities (strategic competence, learning orientation connectivity, leadership practices, exploiting time) for a wide range of pharmaceutical companies. The results confirm that enhancing the investing in human resources is a promising path toward improving the regulatory renewal capabilities of pharmaceutical companies. Despite the interest in investing in human resources, the lack of consensus on the specific elements of investing in human capital limits the understanding of their implications. Building on recent developments in visualizing and measuring investing in human resources, this study addresses this gap by exploring how the investing in human resources relates to the regulatory renewal capabilities of pharmaceutical companies. Received: 25 August 2024 / Accepted: 30 October 2024 / Published: 05 November 2024

Relations between reflexivity and institutional work: A case study in a public organisation

Reflexivity is often considered a prerequisite for institutional work. However, the relationship between reflexivity and institutional work has rarely been examined rigorously in empirical research, and there is a lack of consensus on when and how reflexivity motivates such efforts. This study aims to address this gap by reviewing existing operationalisations of reflexivity and exploring how different forms of reflexivity impacted employees’ engagement in institutional work in a public organisation undergoing institutional change. The empirical results revealed seven distinct patterns of reflexivity and institutional work, indicating that variations across three dimensions of reflexive evaluation – scope, openness and relationality – contributed to decisions about whether and how to engage in institutional work. The results also demonstrated that reflexivity is profoundly grounded in individuals’ concerns and shaped by their work and professional histories. These findings suggest that researchers and practitioners must develop a deeper understanding of the multidimensional nature of reflexivity in order to foster meaningful employee contributions to institutional processes.

The haemophilia joint health score for the assessment of joint health in patients with haemophilia.

The haemophilia joint health score (HJHS) is a tool used to assess joint changes in patients with haemophilia. There is lack of consensus on the interpretation of HJHS scores and their clinical relevance. To evaluate available literature reporting HJHS changes over time and assess a possible cut-off value for clinically relevant outcomes and the ideal follow-up for a meaningful score change. We conducted a literature search of studies published between 2011 and 2023 where the HJHS version 2.1 had been adopted to detect changes in joint health in patients with haemophilia. We focused on studies that assessed clinical relevance of HJHS changes, evaluated the use of cut-off values and reported a follow-up over time. Our search identified 213 publications of which 53 (25%) were deemed relevant for this review. Of these, 33 (62%) publications reported the total HJHS score and 20 (38%) reported a single joint HJHS score, while the way of reporting HJHS scores/change was highly variable. Ten publications (19%) assessed clinical relevance, but their methods of calculation differed (defining a cut-off score, measuring standardised response mean or minimal detectable change). The follow-up duration varied from 2weeks to 8years in these 10 studies. High variability in assessing HJHS change over time is the primary consequence of its low sensitivity, and the lack of consensus on interpretation and clinical relevance of the score. Therefore, more sensitive tools should be used alongside HJHS to better define the joint health status of patients with haemophilia.

Diagnosis and management of adult Moyamoya angiopathy: An overview of guideline recommendations and identification of future research directions.

Despite the progress made in understanding the management and outcomes of Moyamoya angiopathy (MMA), several aspects of the disease remain largely unknown. In particular, evidence on the disease history and management of MMA is lacking, mainly due to methodological and selection biases in the available studies and the lack of large, randomized prospective studies. Therefore, the care of MMA patients remains limited to a few expert centers worldwide, and management is often based on local expertise and available resources. Over the years, recommendations or expert opinions have been written to provide guidance to physicians in the treatment of this condition with the goal of reducing the risk of stroke recurrence and long-term disability. However, there is no complete agreement between the available guidelines and recommendations due to differences in the articles addressed, methodologies, expertise, and validated approaches to literature review. This lack of consensus on the management of MMA may confuse clinicians and highlight some important issues and points. The aim of this comprehensive review article is to critically examine three recent guidelines and recommendations on MMA, discussing their differences and similarities and highlighting gaps in MMA care that need to be covered.

Trigger warnings in medical student education: A scoping review.

Medicine is recognised as a challenging course where exposure to potentially distressing content is inevitable. Some educators provide students with warnings before they encounter potentially upsetting content-trigger warnings. In this scoping review, we mapped the existing literature seeking to better understand how trigger warnings are implemented in medical schools and how they are influencing education within them. Bibliographic databases were searched to identify relevant literature, including searching for grey literature. Articles were included if they focussed on medical school education and were written in English. Data analysis was undertaken using both quantitative and qualitative approaches (thematic analysis). Searching generated 1284 potential records for inclusion. Articles not related to the primary research question were excluded. Abstracts of the remaining 841 articles were screened, and ultimately, 12 articles met criteria for full-text review. Of these, there were three empirical research studies. Qualitative analysis identified five main themes: purpose, implementation, student distress, responsibility and problems with terminology. The use of trigger warnings within medical student education remains contentious. There is a lack of consensus as to their purpose and much diversity in how they are implemented. There was limited published empirical evidence to inform practice in this area.

Antibiotic Stewardship through Use of a Preferred Antibiotic Regimen is Associated with Decreased Organ Space Surgical Site Infections in Uncomplicated and Complicated Pediatric Appendicitis.

Background: There is a lack of consensus on the optimal antibiotic regimen for pediatric appendicitis, and conflicting data exist regarding the need for extended-spectrum use in this population. We implemented an antibiotic stewardship program with a standard, preferred antibiotic regimen for both uncomplicated and complicated appendicitis and hypothesized that clinical outcomes would be equivalent. Methods: This is a single-institution, retrospective study of pediatric patients (≤18 y) who underwent appendectomy for acute appendicitis between October 2015 and May 2022. We used institutional data from our stewardship program supplemented by manual chart review. Patients were assigned to pre- and post-pathway cohorts on the basis of appendectomy date. Patients were further stratified on the basis of whether they met criteria for complicated appendicitis on the basis of intra-operative findings. Results: There were 752 patients that were included: 346 (46.0%) in the pre-pathway cohort and 406 (54.0%) in the post-pathway cohort. The pre-pathway cohort had a higher rate of complicated appendicitis (40.2 vs. 25.6%). However, pre- and post-pathway cohorts had similar rates of post-operative infections, readmissions, and reoperations. When separated by complicated operative findings, patients with uncomplicated appendicitis had a shorter length of stay post-pathway implementation (p < 0.001). After controlling for complicated operative findings and pertinent covariates, the preferred antibiotic regimen was independently associated with decreased odds of post-operative organ space surgical site infections (SSI) (adjusted odds ratio 0.22, 95% CI: 0.05-0.99). Discussion: Antibiotic stewardship to increase the use of a standardized, preferred antibiotic regimen did not result in worse clinical outcomes. The preferred regimen was significantly associated with a decreased rate of organ space SSI, even when controlling for complicated operative findings. The mechanism of this finding requires additional study.

Knowledge and perception of dental educators regarding relative value units: A pilot study.

The aim of this pilot study was to evaluate the knowledge and perception among dental educators regarding the use of relative value units (RVUs) in medicine, perceived benefits in dentistry, and the relative ranking of the components to define RVUs in dentistry. A convenience sample of dental educators participating in the American Dental Education Association's Leadership Institute (2023-2024) cohort was surveyed for their knowledge and perception regarding RVUs. The responses were stratified based on experience with RVUs prior to statistical analyses (α=0.05). Twenty-six dental educators from 18 different North American dental schools and nine different dental specialties participated in this pilot study. Although not significant, a higher proportion of dental educators with prior experience perceived RVUs as a valuable tool in dental practice for assigning chair time, developing payment models, and tracking student-resident progress in a clinical course. There was a lack of consensus among dental educators regarding the components for determining dental procedural RVUs. This pilot study provides limited evidence that prior knowledge of RVUs may be related to its perceived benefits among dental educators, but a broader study design is needed to draw meaningful conclusions and universally acceptable components for determining RVUs in dentistry.

Asian Pacific Society of Cardiology Position Statement on the Use of Transcatheter Aortic Valve Implantation in the Management of Aortic Stenosis

Transcatheter aortic valve implantation (TAVI) has been established as an effective treatment modality in patients with severe aortic stenosis and the uptake of TAVI is rapidly growing in the Asia-Pacific region. However, there exists a heterogeneity in the management of aortic stenosis and the use of TAVI among countries in the region. Reasons for these differences include anatomical variations, disparity in healthcare resources and infrastructure and the lack of consensus on the optimal management of aortic stenosis in the Asia-Pacific region. Hence, an Asian Pacific Society of Cardiology (APSC) working group, including a multidisciplinary group of general and interventional cardiologists, cardiac surgeons and imaging specialists, developed a position statement on the recommendations for TAVI in the management of aortic stenosis. The APSC expert panel reviewed and appraised the available evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Recommendations were developed and put to an online vote. Consensus was reached when 80% of votes for a given recommendation were in support of ‘agree’ or ‘neutral.’ The resulting 28 statements provide guidance for clinical practitioners in the region on the use of TAVI in the treatment of patients with aortic stenosis.