Lack Of Improvement Research Articles

A longitudinal study of hospital workers' mental health from fall 2020 to the end of the COVID-19 pandemic in 2023.

Most longitudinal studies of healthcare workers' mental health during COVID-19 end in 2021. We examined trends in hospital workers eight times, ending in 2023. A cohort of healthcare workers at one organization was surveyed at 3-month intervals until Spring 2022 and re-surveyed in Spring 2023 using validated measures of common mental health problems. Of 538 workers in the original cohort, 289 (54%) completed the eighth survey. Repeated-measures ANOVA revealed significant changes in psychological distress (F = 7.4, P < .001), posttraumatic symptoms (F = 14.1, P < .001), and three dimensions of burnout: emotional exhaustion (F = 5.7, P < .001), depersonalization (F = 2.7, P = .01), and personal accomplishment (F = 2.8, P = .008). Over time, psychological distress and depersonalization increased, posttraumatic symptoms and personal accomplishment decreased, and emotional exhaustion fluctuated significantly without net change. Most measures did not improve significantly in the year prior to the declaration of the pandemic's end. The lack of improvement in psychological distress, emotional exhaustion, depersonalization, and personal accomplishment during the period in which COVID-19 case rates declined and public health measures were relaxed is a concerning indication of the chronicity of the impact of the pandemic on healthcare workers.

Factors Influencing the Central Nervous System (CNS) Distribution of the Ataxia Telangiectasia Mutated and Rad3-Related Inhibitor Elimusertib (BAY1895344): Implications for the Treatment of CNS Tumors.

Glioblastoma (GBM) is a disease of the whole brain, with infiltrative tumor cells protected by an intact blood-brain barrier (BBB). GBM has a poor prognosis despite aggressive treatment, in part due to the lack of adequate drug permeability at the BBB. Standard of care GBM therapies include radiation and cytotoxic chemotherapy that lead to DNA damage. Subsequent activation of DNA damage response (DDR) pathways can induce resistance. Various DDR inhibitors, targeting the key regulators of these pathways such as ataxia telangiectasia mutated and Rad3-related (ATR), are being explored as radio- and chemosensitizers. Elimusertib, a novel ATR kinase inhibitor, can prevent repair of damaged DNA, increasing efficacy of DNA-damaging cytotoxic therapies. Robust synergy was observed in vitro when elimusertib was combined with the DNA-damaging agent temozolomide; however, we did not observe improvement with this combination in in vivo efficacy studies in GBM orthotopic tumor-bearing mice. This in vitro-in vivo disconnect was explored to understand factors influencing central nervous system (CNS) distribution of elimusertib and reasons for lack of efficacy. We observed that elimusertib is rapidly cleared from systemic circulation in mice and would not maintain adequate exposure in the CNS for efficacious combination therapy with temozolomide. CNS distribution of elimusertib is partially limited by P-glycoprotein efflux at the BBB, and high binding to CNS tissues leads to low levels of pharmacologically active (unbound) drug in the brain. Acknowledging the potential for interspecies differences in pharmacokinetics, these data suggest that clinical translation of elimusertib in combination with temozolomide for treatment of GBM may be limited. SIGNIFICANCE STATEMENT: This study examined the disconnect between the in vitro synergy and in vivo efficacy of elimusertib/temozolomide combination therapy by exploring systemic and central nervous system (CNS) distributional pharmacokinetics. Results indicate that the lack of improvement in in vivo efficacy in glioblastoma (GBM) patient-derived xenograft (PDX) models could be attributed to inadequate exposure of pharmacologically active drug concentrations in the CNS. These observations can guide further exploration of elimusertib for the treatment of GBM or other CNS tumors.

High-Frequency Percussive Ventilation: A Promising Rescue Strategy in Severe Lung Disease of Extremely Low Gestational Age Neonates.

Objective: The aim of this study was to evaluate high-frequency percussive ventilation (HFPV) as a rescue strategy for extremely low gestational age neonates (ELGANs) with severe lung disease. Methods: This is a retrospective review of 16 ELGANs with severe lung disease who were placed on HFPV following a lack of improvement on other modes of conventional and high-frequency ventilation. Results: The gestational age of these 16 infants was 25 (24, 26) weeks and their birth weight was 640 (535, 773) grams [median (IQR)], with the survivors being more immature compared to those who died [24 (23, 26) and 26 (25, 28) weeks, respectively; (p = 0.04)]; and with an overall mortality of 31% (N = 5). Of those who died, 60% were SGA (p = 0.02). Following placement on HFPV, the survivors had a statistically significant decrease in their respiratory severity scores (RSSs) [11 (9, 14) to 6 (5, 13), p = 0.03] compared to those who did not survive [15 (11, 16) to 11 (6.8, 14.5), p = 0.32] due to an improvement in their oxygenation [FiO2: 0.95 (0.85, 1) to 0.6 (0.4, 0.9), p = 0.01; compared to 1 (1, 1) to 1 (0.7, 1); survivors and non-survivors, respectively; p = 0.32]. Chest X-rays also showed significantly improved aeration due to decreased areas of atelectasis in those who survived. Conclusions: HFPV may be an appropriate rescue mode of high-frequency ventilation in the ELGAN population with severe lung disease, particularly for patients with impaired oxygenation and ventilation difficulties due to shifting atelectasis and mucous plugging.

An incomplete form of Kawasaki disease in a 2-month-old girl. How the diagnostic algorithm works in practice

BACKGROUND. Kawasaki disease is a rare, self-limiting inflammatory disease primarily affecting children under 5 years old. In 25 % of cases, it can lead to coronary artery aneurysms if not treated promptly with intravenous human immunoglobulin. A significant portion of Kawasaki disease patients present with an incomplete form, complicating diagnosis, while the risk of coronary artery aneurysms remains unchanged. Particularly vulnerable are infants under 6 months old, who may exhibit even more limited clinical symptoms, making them especially susceptible to severe cardiac complications. OBJECTIVE. To analyze a clinical case of an incomplete form of Kawasaki disease in a 2-month-old girl, raise awareness of Kawasaki disease, including its incomplete form, among healthcare workers in Ukraine, emphasize the critical importance of proper diagnostic evaluation of coronary arteries, and underscore the necessity of early administration of immunoglobulin when Kawasaki disease is suspected, even in the absence of pathological changes in the heart. MATERIALS AND METHODS. The study involved collecting medical history, physical examination data, laboratory and instrumental studies, and their analysis. The diagnosis of Kawasaki disease, including its incomplete form, was based on the 2017 recommendations of the American Heart Association. CLINICAL CASE. A 2-month-old girl presented with symptoms initially resembling a urinary tract infection, with no therapeutic response to multiple courses of antibacterial therapy. During the second week of illness, she developed swelling in her hands and feet, which, along with persistent fever, significant inflammatory response, and lack of improvement with antibiotics, led to the suspicion and diagnosis of Kawasaki disease based on the algorithm for incomplete Kawasaki disease. After administration of an immunomodulatory dose of intravenous human immunoglobulin at 2 g/kg on the 11th day of illness, there was a rapid regression of symptoms, normalization of inflammation markers, and overall improvement in the child's condition. By the second week of illness, small aneurysms of the right and left coronary arteries had formed but regressed within a few weeks from the onset of the disease. CONCLUSIONS. Kawasaki disease requires prompt therapeutic intervention and should be suspected in any child, especially those under one year of age, with a high fever lasting at least 5 days, unexplained by a preliminary diagnosis, and no response to antibiotic treatment in the presence of “bacterial” blood tests. Serial echocardiograms assessing coronary arteries, absolute dimensions, and Z-scores are mandatory.

When Bell's Palsy is Cancer - Avoiding Misdiagnosis and Its Implications.

Facial paralysis due to cancer can be misdiagnosed as Bell's palsy. This study aims to clearly identify and quantify diagnostic differentiators and further evaluate prognostic implications of misdiagnosis. Adult patients older than 18 years with facial palsy of unknown or cancerous etiology presenting between 2009 and 2023 were reviewed. Patient characteristics, exam findings, and clinical course, were compared between facial paralysis patients with cancer misdiagnosed as Bell's Palsy (Cancer-Bell's-Palsy group) and patients correctly diagnosed with Bell's Palsy (Bell's-Palsy Group). Additionally, morbidity and mortality were compared between facial paralysis patients with cancer initially misdiagnosed with Bell's Palsy to facial paralysis patients initially correctly diagnosed with cancer (Cancer-Palsy group). Two-hundred-forty-three patients participated including 43 Cancer-Palsy, 18 Cancer-Bell's-Palsy, and 182 Bell's-Palsy patients. Cancer-Bell's-Palsy patients were significantly less likely than Bell's-Palsy patients to develop synkinesis (Odds Ratio (OR)=0.0042, 95% Confidence Interval (CI) [0.0005, 0.0339]; p<0.0001), significantly more likely to experience gradual onset facial paralysis (OR=1004.69, 95% CI [54.40, 18555.77); p<0.0001), and significantly more likely to have additional non-facial cranial nerve neuropathies (OR=49.98, 95% CI [14.61, 170.98]; p<0.0001). Cancer-Bell's-Palsy patients were more likely than Cancer-Palsy patients to have a greater than six-month period from initial cancer-attributable symptom onset to cancer diagnosis (OR=47.62, 95% CI [9.26, 250.00]; p<0.001), stage IV cancer (OR=12.36, 95% CI [1.49, 102.71]; p=0.006), and decreased duration of life after cancer diagnosis (median [interquartile range] months, 40.0 [87.0] versus 12 [56.3] respectively; p=0.025). Facial paralysis related to cancer must be differentiated from Bell's palsy, as misdiagnosis leads to delayed intervention and poorer prognosis. Gradual onset facial palsy, multiple cranial nerve neuropathies, lack of synkinesis, and lack of improvement, were nearly definitive differentiators for underlying cancer.

A digital intervention for cognitive deficits following COVID-19: a randomized clinical trial.

Post-COVID-19 cognitive deficits are common, persistent, and disabling. Evidence on effective treatments is limited. The goal of this study was to investigate the efficacy of a digital intervention to reduce cognitive and functional deficits in adults with persistent post-COVID-19 cognitive dysfunction. We used the remotely-delivered intervention in a randomized clinical trial conducted from July 13, 2021 to April 26, 2023. We hypothesized that participants in the intervention group would improve in measures of cognition and daily functioning. Participants were adults with cognitive deficits persisting >4 weeks following acute COVID-19 illness. Of 183 participants screened, 110 were enrolled; 98 participants (78.6% female; mean age = 48.1) completed at least one study visit. Participants were randomized 1:1 to the intervention (AKL-T01) or waitlist control. AKL-T01 is a digital therapeutic using a videogame interface to target attention and executive control. The intervention was delivered remotely for 6 weeks. The primary outcome was change in performance on a sustained attention measure (Digit Symbol Matching Task). The difference in the primary outcome between the intervention (n = 49) and controls (n = 49) was not statistically significant (F [3,261] = 0.12, p = 0.95). Secondary cognitive outcomes of task-switching (F[3,262] = 2.78, p = 0.04) and processing speed (F[3,267] = 4.57, p = 0.004) improved in the intervention relative to control. Secondary measures of functioning also improved in the intervention relative to control, including disability (F[1,82] = 4.02, p = 0.05) and quality of life (F[3,271] = 2.66, p = 0.05). Exploratory analyses showed a greater reduction in total fatigue (F[1,85] = 4.51, p = 0.04), cognitive fatigue (F[1,85] = 7.20, p = 0.009), and anxiety (F[1,87] = 7.42, p = 0.008) in the intervention relative to control. Despite the lack of improvement in sustained attention, select post-COVID-19 cognitive deficits may be ameliorated by targeted cognitive training with AKL-T01, with associated improvements in quality of life and fatigue. If replicated, the scalable nature of this digital intervention may help address substantial need for accessible, effective treatments among individuals with long COVID.

Assessment of the approach to managing medical emergencies during dental procedures.

This study aims to investigate the knowledge of dental interns and post-graduated doctors regarding dental emergencies and their occurrence in the clinic and examine the doctors' ability to intervene in these emergencies. Note that, 150 dental interns and 101 post-graduated doctors were surveyed with sixteen questions regarding their knowledge and experience with syncope, orthostatic hypotension, myocardial infarction, angina pectoris, asthma, and anaphylactic shock. Also, post-graduate doctors answered nine additional questions about their emergency response capabilities. This study found that interns and doctors exhibited similar knowledge about emergencies. Nonetheless, the count of dental interns encountering emergencies is relatively limited. Syncope was the most frequently encountered condition (61.8%). Doctors' increase in years of experience correlated positively with a higher rate of intervention in epilepsy, orthostatic hypotension, and anaphylactic shock (p=0.001, 0.024, and 0.02, respectively). The ability to check the carotid pulse and to perform intramuscular injections was high in post-graduated doctors (90.09% and 81.2%, respectively). Although interns believe their knowledge about emergencies to be sufficient, their intervention skills may need to be improved due to the low frequency of encounters. After graduation, their inability to intervene adequately during emergencies in the clinic can lead to fatal consequences. The lack of improvement in doctors' knowledge and intervention abilities with experience could be attributed to insufficient training after completing their formal education. To prevent such scenarios, regular training sessions should be provided to interns and doctors, focusing on the emergencies they may encounter.

Aneurisma aórtico roto associado com salmonelose difusa: Um relato de caso

Case report: A 63-year-old female patient, hypertensive and diabetic, reported a sudden onset of chest pain at night, which persisted continuously for 20 days. According to CT scans and computed tomography angiography, the diagnostic hypothesis of ruptured thoracic aortic aneurysm was considered. During the postoperative evolution, the patient presented difficulty in extubation and persistence of infectious symptoms, because of this, new tests were performed, which indicated a possible fistula with subsequent upper digestive endoscopy. During this period, the patient persisted with infectious symptoms and lack of improvement. Bronchoalveolar lavage fluid culture was performed at the same time, which identified bacterial growth of Salmonella spp. Discussion: A study that analyzed 129 cases of Salmonella in a hospital in Massachusetts showed that DM is one of the most common risk factors for Salmonella spp in adults. In a study carried out in China, it was evident that 28.9% of the cases were considered asymptomatic, that is: presence of the bacteria, but absence of diarrhea. In the scientific society, there is concern about the antimicrobial resistance of Salmonella spp. Because of this, treatment with antibiotics is indicated, especially in cases with a higher risk of complications. It is considered that the consequences of the bacterium on the body can lead the patient to septic shock and death. Final considerations: Thus, having knowledge about triggering factors, main symptoms, and appropriate treatment becomes essential for the best evolution of the clinical condition of infected patients.

The role of progesterone and estrogen receptors in treatment choice after endometriosis surgery: A cross-sectional study.

The lack of improvement in some endometriotic people's pain after surgery even while using hormone treatment may suggest an inappropriate response to routine hormonal therapies. This study aimed to determine a cut-off point for selecting the most appropriate treatment based on the hormone receptors of endometriotic lesions. In this cross-sectional study, by reviewing the medical records of participants and testing their archive samples and phone interviews (if needed), 86 symptomatic women after endometriosis surgery who were operated into governmental hospitals, Shahid Faghihi and Hazrate Zeinab Shiraz Iran were enrolled between March 2017 and March 2019. Women were divided into 2 groups: responsiveness (n = 73 for dysmenorrhea, n = 60 for dyspareunia) to medical treatment and surgery, and unresponsiveness (n = 13, n = 7). We examined the pathological slides of 86 women to determine the amount of hormone receptors and the relationship between the type of medical treatment and the level of hormone receptors on pain relief within 1 yr after surgery. Based on the receiver operating characteristic curve, dysmenorrhea in the presence of tissue estrogen receptors 60% (p = 0.1065), and dyspareunia in the presence of tissue progesterone receptors 80% (p = 0.0001) responded well to medical treatment after surgery. In the presence of endometrioma-dysmenorrhea showed the best response to oral contraceptive pills (69.4%), while in deep infiltrative endometriosis-dyspareunia showed the best response to progesterone treatment (75%). Prescribing an appropriate hormone therapy based on a specific immunohistochemistry staining pattern can improve the life quality of postoperative endometriosis individuals.

Provider perceptions of young people living with HIV and unhealthy alcohol use in Southwestern Uganda: a qualitative study

BackgroundUnhealthy alcohol use is a common public health problem in HIV care settings in Africa and it affects the HIV continuum of care. In Uganda and other low-income countries, HIV care providers are a key resource in caring for young people (15–24 years) living with HIV (YPLH) with unhealthy alcohol use. Caring for YPLH largely depends on care providers’ perceptions of the problem. However, data that explores HIV care providers’ perceptions about caring for YPLH with unhealthy drinking are lacking in Uganda. We sought to describe the perceptions of HIV care providers regarding caring for YPLH with unhealthy drinking in the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in southwestern Uganda.MethodsWe used semi-structured in-depth interviews (IDIs) to qualitatively explore HIV care providers’ perceptions regarding caring for YPLH with unhealthy alcohol use. The study was conducted at the adolescent immunosuppression (ISS) clinic of Mbarara Regional Referral Hospital. Interviews were tape-recorded and transcribed verbatim. Using thematic content analysis, data from 10 interviews were analyzed.ResultsHIV care providers were concerned and intended to care for YPLH with unhealthy alcohol use. They understood that unhealthy drinking negatively impacts HIV care outcomes and used counseling, peer support, and referrals to routinely intervene. They however, did not apply other known interventions such as health education, medications and follow-up visits because these required family and institutional support which was largely lacking. Additional barriers that HCPs faced in caring for YPLH included; gaps in knowledge and skills required to address alcohol use in young patients, heavy workloads that hindered the provision of psychosocial interventions, late payment of and low remunerations, lack of improvement in some YPLH, and inadequate support from both their families and hospital management.ConclusionHIV care providers are important stakeholders in the identification and care of YPLH with unhealthy alcohol use in Southwestern Uganda. There is a need to train and skill HCPs in unhealthy alcohol use care. Such training ought to target the attitudes, subjective norms, and perceived control of the providers.

Genophenotypic correlates and long-term outcome prognosticators of left ventricular non-compaction in children

BackgroundTo investigate the outcomes, clinical prognosticators, and genetic profiles of pediatric left ventricular non-compaction (LVNC). MethodsAll subjects were <18 years old, diagnosed with LVNC between January 2008 and December 2020. Whole-exome sequencing was undertaken. The primary endpoint was composite outcome, including death, heart transplant, and left ventricular assist device implantation. ResultsThirty-three patients were enrolled, males predominating (57.6%). Median age at diagnosis was 0.33 (0.1–7.2) years. Family history was documented in four (12.1%). Five (15.2%) had sustained arrhythmias. Mean follow-up period was 9.5 years, and 5- and 10-year event-free survival were 84.8% and 66.9%, respectively. Seven died of heart failure, four received heart transplants, and one required left ventricular assist device placement. Log of baseline NT-proBNP (adjusted odds ratio [aOR] = 4.4, p = 0.012) and lack of improvement in NT-proBNP (aOR = 41.2, p = 0.033) impacted the primary outcome most significantly. Eighteen out of 25 genetic testing (72%) revealed chromosomal anomalies, or pathogenic or likely pathogenic variants. Three genetic variants (PLEKHM2 p.G419R, RYR2 p.V2571A, and SCN5A p.M1676I) were significantly associated with the primary outcome (p = 1.52 × 10−6). ConclusionsPediatric LVNC is a rare disorder with variable genetic underpinnings. Baseline NT-proBNP values and lack of improvement in NT-proBNP levels were important predictors of poor long-term outcomes. Pathogenic genetic variants or chromosomal anomalies are not unusual.

Data Assimilation of Ion Drift Measurements for Estimation of Ionospheric Plasma Drivers

AbstractDuring geomagnetic storms, the capabilities of current climate models in predicting ionospheric behavior are notably limited. A data assimilation tool, Estimating Model Parameters Reverse Engineering (EMPIRE), implements a Kalman filter to ingest electric density rate correcting the background electric potential and neutral wind. For the baseline setup, or case (1), EMPIRE ingests electron density global map output from the Ionospheric Data Assimilation 4‐Dimensional (IDA4D) algorithm. In this work, a new augmentation method is evaluated in which ion drift measurements are also assimilated into EMPIRE. The ion drift measurements used in the new augmentation method are obtained from Super Dual Auroral Radar Network (SuperDARN) sites in the mid‐to‐high latitude region of the northern hemisphere. Cases (2) and (3) are set up for evaluating the impacts from ingesting different types of observations: SuperDARN fit and grid data, respectively. Six independent data sources are used as validation data sets to compare outcomes with or without ingesting ion drifts. One is the vector ion velocities derived from the Millstone Hill Incoherent Scatter Radar (MHISR) and a second is the vertical drift from Arecibo site. The other four are SuperDARN ion velocity grid data from Saskatoon, Kapuskasing, Christmas Valley West, and Hokkaido East. Results show improvements in performance at mid‐latitudes by augmenting electron density rates with 3D spatially distributed line‐of‐sight ion drift measurements, with negligible improvements to low and high latitude estimations. The lack of improvement at high‐latitudes is attributed to the increase in EMPIRE ion drift error poleward of 60° magnetic.

Боковой амиотрофический склероз и его маски, коморбидная патология с быстрым летальным исходом: клинический случай

INTRODUCTION. Despite the fact that more than 150 years have passed since the first mention of amyotrophic lateral sclerosis (ALS), the issues of etiology, pathogenesis, diagnosis and treatment of this disease are still not fully resolved. However, the results of recent research in the field of genetics with the identification of genes associated with ALS, understanding the mechanisms of disease development and, as a result, the creation of effective drugs give hope that in the near future the disease will cease to be fatal. AIM. To analyze domestic and foreign publications on the etiology, pathogenesis, diagnosis and treatment of amyotrophic lateral sclerosis. To present a clinical case of a patient with amyotrophic lateral sclerosis. MATERIAL AND METHODS. The analysis of domestic and foreign publications for the period 1997-2024 is carried out. The sources of the Russian scientific electronic library eLibrary, RSCI databases, PubMed were used. CASE PRESENTATION. A patient is presented who, at the age of 56, developed mixed paresis of the right hand, followed by the development of mixed tetraparesis and simultaneously bulbar syndrome within 3 months. Differential diagnosis was performed between spondylogenic cervical myelopathy, endocrinopathy and ALS. Based on anamnestic data, clinical picture, rate of progression of symptoms, results of electroneuromyography, lack of improvement against the background of therapy, the main diagnosis was made: amyotrophic lateral sclerosis, a primary generalized form with mixed tetraparesis, bulbar syndrome. 2 weeks after discharge from the hospital in a stable condition, the patient was diagnosed with COVID-19 coronavirus infection, with a rapid fatal outcome from respiratory failure (7 months after the debut of ALS). CONCLUSION. A feature of the described ALS case is a rather rare primary generalized form of the disease (having such unfavorable prognosis factors as the development of bulbar syndrome at the beginning of the disease, a short time period from the appearance of the first symptoms to diagnosis), the presence of masking pathology in the form of spondylogenic myelopathy and the addition of COVID-19 with a rapid fatal outcome. With all the severity of ALS and an unfavorable prognosis, the presence of comorbid pathology can make the course of the disease even more dramatic. KEYWORDS: amyotrophic lateral sclerosis, comorbid pathology, coronavirus infection (COVID-19)

Women improving nutrition through self-help groups in India: Does nutrition information help?

Women’s self-help groups (SHGs) are an important platform for reaching poor women in India. Despite SHGs' women-focused programming, evidence of the impact of SHG-based interventions on nutrition outcomes is limited, and most evaluations of nutrition interventions have not examined intermediate outcomes along the impact pathways or outcomes for women themselves. This paper evaluates the effectiveness of an integrated agriculture-nutrition intervention delivered through women’s SHGs in five states in central and eastern India. The interventions involved the delivery of nutrition behavior change communication to groups through participatory approaches, community engagement around key issues, and the strengthening of collective organizations. Our analysis is based on three rounds of rich panel data on close to 2700 rural women and their households from eight districts in these five states and qualitative work from an accompanying process evaluation. Using difference-in-difference models with nearest neighbor matching methods, we present results on women’s anthropometry and diet-related outcomes.We do not observe any improvements in women’s BMI or overall dietary diversity. Although more women in the nutrition intensification arm consumed animal source foods, nuts and seeds, and fruits, this was not enough to increase overall dietary diversity scores or the proportion of women achieving minimum dietary diversity. We measure intermediate outcomes along the program’s impact pathways and find improvements in household incomes, cultivation of home gardens, and utilization of government schemes but not in women’s empowerment. The lack of improvement in anthropometry and diets despite changes in some intermediate outcomes can be attributed to several factors such as low implementation intensity, poor facilitator capacity and incentives, the lack of relevance of the BCC topics to the average SHG member, and resource and agency constraints to adoption of recommended practices. Although we do not have data to test the parallel trends assumption and so do not interpret our results as causal, these findings do suggest that optimism about using group-based platforms needs to be tempered in resource-poor contexts.

Persistently Elevated C-Reactive Protein Levels and Low Body Mass Index Are Associated with a Lack of Improvement in Bone Mineral Density in Crohn's Disease.

Osteoporosis prevalence is increased in Crohn's disease (CD). Its pathogenesis in these patients is incompletely understood. To identify factors associated with decreased bone mineral density (BMD) status in CD patients on a time-line course. A retrospective study was performed that followed CD patients who underwent at least two bone mineral density scans (DEXAs). Follow-up began one year prior to the first DEXA test and lasted at least one year after a second test. Possible correlations between baseline and follow-up variables and changes in BMD status were examined. Change in BMD was defined as a transition from one bone density category to another (normal vs. osteopenia vs. osteoporosis). Binary variables were assessed using the Cochrane-Armitage test. Categorical variables were assessed using the chi-squared test. A multivariate analysis was performed. The study included 141 patients. At baseline, 33 patients (23.4%) had normal BMD, 75 (53.2%) had osteopenia, and 33 (23.4%) had osteoporosis. Patients with low BMD had a lower baseline BMI compared to those with normal BMD (p < 0.0001). After a median follow-up of 48 months (IQR 29-71), BMD status worsened in 19 (13.5%) patients, whereas in 95 (67.3%) and 27 (19.1%) patients, BMD remained unchanged or improved, respectively. On the multivariate analysis, elevated median CRP throughout follow-up (OR = 0.8, 95% CI: 0.68-0.93) and low baseline BMI (OR = 0.9, 95% CI: 0.83-0.98) were associated with a lack of BMD status improvement. Persistently elevated CRP and low BMI are associated with a lack of improvement in BMD. These findings underscore the importance of effective inflammation control and nutritional support to maintain and improve bone health.

The prognostic value of changes in pulmonary vein flow patterns after surgical repair for primary mitral regurgitation

Background: The pulmonary vein (PV) flow pattern is influenced by the presence of mitral regurgitation (MR). After a successful reduction in MR severity, the pattern is expected to be changed. We aimed to evaluate the prognostic value of a change in the PV flow pattern in patients with primary MR undergoing mitral valve repair (MVR). Methods: The PV flow pattern was assessed with transthoracic echocardiography in 216 patients (age 65 [IQR 56–72] years, 70% male) with primary MR before and after surgical MVR. The population was divided according to a change in the PV flow pattern following MVR into ‘improvers’ and ‘non-improvers’. Results: Non-improvers (15%) had a higher prevalence of paroxysmal AF at baseline (46% vs. 22%, p = 0.004), left ventricular dysfunction (LVEF ≤60%) (39% vs. 21%, p = 0.020), and had lower systolic pulmonary artery pressure (28[IQR 25–38] vs. 35[IQR 26–48] mmHg, p = 0.018) compared to improvers (85%). After a median follow-up of 83[IQR 43–140] months, 26(12%) patients died. Non-improvers had higher mortality rates than improvers (p = 0.009). On multivariable Cox regression analysis, a lack of improvement in the PV flow pattern remained independently associated with all-cause mortality (HR 2.322, 95% CI 1.140 to 4.729, P = 0.020). Conclusion: A lack of improvement in the PV flow pattern is independently associated with worse long-term survival in patients with primary MR undergoing MVR.

Enhancing HIV treatment and support: a qualitative inquiry into client and healthcare provider perspectives on differential service delivery models in Uganda

BackgroundHIV/AIDS continues to be a significant contributor to illness and death, particularly in sub-Saharan Africa. In this study, we conducted a qualitative assessment to understand Client and Healthcare Provider Perspectives on Differential Service Delivery Models in Uganda. The purpose was to establish strengths and weaknesses within the services delivery models, inform policy and decision-making, and to facilitate context specific solutions.MethodsBetween February and April 2023, a qualitative cross-sectional study was utilised to gather insights from a targeted selection of individuals, including People Living with HIV (PLHIV), healthcare workers, HIV focal persons, community retail pharmacists, and various stakeholders. The data collection process included eleven in-depth interviews, nine key informant interviews, and eight focus group discussions carried out across eight districts in Central Uganda. The collected data was analyzed through inductive thematic analysis with the aid of Excel.ResultsThe various Differentiated Service Delivery Models (DSDMs), notably Community-Client-Led Drug Distribution (CCLAD), Community Drug Distribution Point (CDDP), Community Retail Pharmacy Drug Distribution Point (CRPDDP), and the facility-based Facility Based Individual Model (FBIM), were reported to have several positive impacts. These included improved treatment adherence, efficient management of antiretroviral (ARV) supplies, reduced exposure to infectious diseases, enhanced healthcare worker hospitality, minimized travel time for ART refills, stigma reduction, and decreased waiting times. Concern was raised about the lack of improvement in HIV status disclosure, opportunistic infection treatment, adherence to seasonal appointments, and sustainability due to the overreliance of the DSDMs on donor funding, suggesting potential discontinuation without funding. Doubts about health workers’ commitment surfaced. Notably, the CCLAD model displayed self-sustainability, with clients financially supporting group members to collect medicines.ConclusionCommunity-based DSDMs, such as CCLAD and CDDP, improve ART refill convenience, social support, and client experiences. These models reduce travel and waiting times, lowering infection risks. Addressing challenges and enhancing facility-based models is vital. In order to maintain funding after donor funding ends, sustainability measures like cross-subsidization can be used. If well implemented, the DSDMs have the potential to produce better or comparable ART outcomes compared to the FBIM model.

Perceptions of medical doctors and patients about imaging for people with low back pain: A qualitative study.

Low-value care is the use of substitutive/ineffective/harmful strategies based on available evidence, and it is considered one of the main contributors to the burden related to low back pain in health care systems. The use of routine imaging for patients with low back pain is the main example of inappropriate care. Therefore, understanding the perceptions of medical doctors and patients from Brazil about this practice may help propose strategies to reduce imaging rates. To investigate the perceptions of medical doctors and patients about imaging for the diagnosis of nonspecific low back pain. A qualitative study using the framework analysis method. Primary and secondary care. Fifteen patients with low back pain and 15 doctors participated in this study. Sociodemographic data were collected from all participants, and the interviews were performed using a set of questions created based on the literature. Patients and doctors believe that the main reason for ordering imaging tests is to identify the source of pain, and imaging could be useful for tracking disease progression over time or if there is a lack of improvement after treatment. Patients' expectations and pressures play a role in the decision to order imaging tests, but clinicians believe that education is the preferred strategy to reduce imaging rates. Identifying the source of pain, tracking the disease progression, and patients' expectations and pressures were the main drivers of imaging requests for low back pain. Educational strategies were suggested to reduce the use of routine imaging.

Utilising Wordwall-Based Digital Learning Games to Enhance Student Learning Results

The lack of improvement in student learning outcomes is still a problem, so this research was carried out. For this reason, a solution is needed in the form of a learning strategy to help solve this problem, namely implementing a wordwall-based digital learning model. The aim of this research is to describe teacher and student activities using wordwall-based digital learning games and to describe how student learning outcomes in social studies lessons can be improved through the use of wordwall-based digital learning games. This research uses the stages of classroom action research, namely research consisting of two cycles, where one cycle consists of four implementation stages, namely planning, implementation, observation, and reflection. The focus of the research is the use of wordwall-based digital learning games and social studies learning outcomes. The subjects in this research were 25 class VI students (two recovered), consisting of 13 male students and 12 female students. Data is obtained through observation, tests, and documentation. Data analysis techniques include the selection stage, the presentation stage, and the conclusion stage. The results of the research showed that there was a significant increase in teacher activity and student activity in cycle I (60.42%) with medium criteria and in cycle II (93.75%) with high criteria, as well as social studies learning outcomes in cycle I (70,00) with medium criteria and in cycle II (81.34) with high criteria. Thus, using wordwall-based digital learning games can improve social studies learning outcomes.

IMPACT OF CREATING MENTAL HEALTH HELPLINE AT A TERTIARY CARE PSYCHIATRIC SET-UP IN PAKISTAN DURING THE COVID -19 PANDEMIC

Objectives The objectives of this study were to analyze the calls received at a 24-hour helpline service set up at the Institute of Psychiatry during the first wave of the COVID-19 pandemic for the demographics of the service users, the reasons for calling the helpline phone, and the guidance provided. Design Descriptive retrospective clinical audit Place and Duration of Study The Institute of Psychiatry, from June 2020 and February 2021 Patients and Methods The entries made detailing the call records by psychiatry residents managing the helpline were analyzed. Data was extracted regarding age, area of residence, and reasons for calling by the service users of the helpline, as well as the advice given by the resident on call. The statistical analysis was performed using SPSS version 26, and findings were evaluated in terms of age, geographical distribution, reasons for seeking assistance, and the type of guidance provided thereof. Results Of the 102 calls analyzed, most of the callers were between 30 to 39 years of age (33.3%), and hailed from Rawalpindi (78.4%), followed by Kashmir (5.9%), Chakwal (4.9%) and Murree (3.9%). The most frequently stated reasons for calling were to ask about availability of out-patient services (36.3%), to have medication revised (23.5%), and to enquire about the side effects of medication (11.8%). Other reasons included recurrence of symptoms or lack of improvement in patients already taking treatment (15.7%) and to seek help regarding new psychiatric symptoms (12.7%). The responses given to the callers were invitation to come to the hospital (44.1%), provision of relevant information about the particular questions asked (for example, relating to hospital timings) (36.3%), adjustment of medications (11.8%), and prescribing medication with advice of physical follow-up (7.8%). Conclusion Despite psychiatric out-patient department being temporarily closed down during the initial waves of the COVID 19 pandemic, efforts were made to continue service provision through innovative means, like the 24-hour helpline service. There is a need to further incorporate the use of technology in the delivery of psychiatric services.