Main Interventions Research Articles

Outcomes of Left Main Chronic Total Occlusion Percutaneous Coronary Interventions.

Percutaneous coronary intervention (PCI) of left main (LM) chronic total occlusions (CTO) has received limited study. We compared the clinical and procedural characteristics and outcomes of patients who underwent LM versus non-LM CTO PCI at 41 US and non-US centers between 2012 and 2024. During the study period 85 of 15,254 CTO PCIs (0.6%) performed in 14,969 patients were LM CTO PCIs. LM CTO PCI patients were older, had higher rates of dyslipidemia and heart failure and most (88.8%) had prior coronary artery bypass graft surgery (CABG). They were more likely to have moderately or severely calcified lesions (80.7% vs. 45.7%, p < 0.001) and had higher J-CTO (2.76 ± 1.17 vs. 2.37 ± 1.26, p = 0.008), PROGRESS-CTO MACE (3.56 vs. 2.57, p < 0.001), Mortality (2.45 vs. 1.68, p < 0.001), Pericardiocentesis (2.74 vs. 1.87, p < 0.001), Acute MI (1.72 vs. 0.89, p < 0.001) and Perforation (3.21 vs. 2.19, p < 0.001) scores. There was no difference in technical success (80.5% vs. 87.2%, p = 0.086) or major cardiovascular adverse events (MACE) (2.4% vs. 2.0%, p = 0.700). LM CTO PCI patients with and without prior CABG surgery had similar technical success and MACE. The retrograde approach in prior CABG patients was more likely to be performed through saphenous vein grafts. LM CTO PCI is infrequently performed, is associated with high comorbidity burden and angiographic complexity but can be performed with high success and acceptable complication rates.

Evidence Map of Interventions to Reduce Alcohol ConsumptionMapa de la evidencia sobre intervenciones para reducir el consumo de alcohol

Systematize evidence on the effect of global interventions to reduce the consumption and/or sale of alcoholic beverages. Evidence map based on searches in nine bibliographic databases, including 182 studies of systematic reviews with or without meta-analysis, reviews of interventions, and reviews of reviews. The studies evaluated the effect of interventions grouped into comprehensive sets of actions: communication for behavior change; health-promoting environments; and systemic changes. Two outcomes of interest were considered: reduction in alcohol consumption and reduction in its purchase/sale. A total of 207 associations between different interventions and outcomes were recorded, with emphasis on communication for behavior change (81.64%) and reduction of consumption (98.55%). Most of the associations showed a positive (40.58%), inconclusive (28.99%), or potentially positive (26.57%) effect. The main interventions with positive or potentially positive results were: a government monopoly on the sale of alcoholic beverages, control of the density of points of sale, charging a minimum price per unit, health warnings on alcoholic beverage labels, and multiple integrated interventions. It is hoped that this map will help public policy makers and healthcare professionals adapt experiences to their own contexts, stimulating intersectoral actions to reduce alcohol consumption.

Morphology and agents of urban transformation

The study aims to propose a method of analysis that promotes a clearer perception of the spatial transformation resulting from the action of certain social groups to shape the urban space according to their interests. The territorial transformation related to the role of different agents is investigated, through urban morphology, in order to understand the correlation between the Brazilian urban form with public management and the direction of public investments. To analyze how the city is shaping over time, the work was structured from a case study, which mapped the urban transformations of the municipalities of Cuiabá and Várzea Grande, during the 2006-2021 interval. The method adopted by the research proposes as tools for investigating the territory: the conception of thematic cartographies through the comparison of aerial images from Google Earth, the establishment of analysis categories that allow the identification of the different types of building transformations preponderant of the urban blocks and the main interventions on the road system and the impact of important events that occurred in the cities in the period studied. A quantitative analysis is presented, with the approximate values of areas in hectares (ha), which represent the categories of analysis indicated. As a result, it can be seen, through the maps, that the relationship between the different forms of urban land occupation and the road infrastructure implemented ends up reinforcing the process of socio-spatial segregation. It is concluded that the proposed method, combined with historical and socioeconomic studies, manages to reconstitute urbanization processes in order to understand them in order to intervene in the reality of our cities.

Long-term outcome of diabetic patients after unprotected left main percutaneous coronary interventions

Abstract Background Diabetes mellitus (DM) represents an elevated risk in terms of percutaneous coronary intervention (PCI), especially in patients with significant left main (LM) disease. Purpose Our aims were to investigate the 60-month mortality and event-free survival of consecutive patients with DM undergoing unprotected LM PCI at our centre and sought to determine the independent predictors of event-free survival. Methods We included all patients undergoing unprotected LM PCI at our tertiary care centre between 1 January 2007 and 31 December 2014. The primary endpoint was the composite of all-cause mortality, myocardial infarction, and target lesion revascularization at 60 months. Survival curves were constructed using the Kaplan-Meier non-parametric estimator. ROC analysis was used to investigate the predictive power of conventional risk scores (SYNTAX, SYNTAX II, EuroSCORE II, additive and logistic EuroSCORE, ACEF, GRACE 2). Independent predictors were determined by univariate and multivariate analysis. Results A total of 513 patients (mean age 68 ± 12 years, 64% male) underwent unprotected LM PCI during this period, among these 310 (60%) were non-diabetic (non-DM) and 203 (40%) were diabetic (DM). In terms of indication, 157 (31%) elective and 356 (69%) acute LM PCI were performed. There was no significant difference between the non-DM and DM groups in terms of acute indication (218 (70%) vs. 138 (68%), p=0.574). Within the DM group, 135 (67%) were treated with oral antidiabetics (OAD) and 68 (33%) were treated with insulin (IDM). The mean survival (34.6 vs. 39.7 vs. 43.1 months, p=0.003) and event-free survival (29.3 vs. 34.7 vs. 39.3 months, p=0.001) were significantly lower in the IDM and OAD groups compared to non-DM, respectively. Of the risk scores, the SYNTAX score was the most predictive in diabetic patients (AUC=0.767). Based on the SYNTAX score, diabetic patients with a low SYNTAX score (&amp;lt;23) had less events (59% vs. 66%, p=0.043) than those having a moderate/high SYNTAX score (≥23). LVEF (HR 0.976; 95% CI, 0.965-0.987, p&amp;lt;0.001), right coronary artery occlusion (HR 2.031; 95% CI, 1.346-3.064, p=0.001), acute coronary syndrome (HR 1.861; 95% CI, 1.252-2.767, p=0.002), use of FFR (HR 0.481; 95% CI, 0.265-0.871, p=0.016), true bifurcation lesion (HR 1.559; 95% CI, 1.068-2.277, p=0.021) and newer DES generation (HR 0.706; 95% CI, 0.568-0.877, p=0.002) were predictors of event-free survival in diabetics by univariate analysis. Glomerular filtration rate (HR 0.982; 95% CI, 0.973-0.991, p&amp;lt;0.001) emerged as an independent predictor according to multivariate analysis. Conclusion Consecutive diabetic patients with significant unprotected LM stenosis have poor long-term outcome after LM PCI. Anatomical complexity of the lesions is a significant predictor of event-free survival. Careful intervention planning and the use of appropriate tools can improve the outcome in this high-risk population.

Long-term outcomes of transapical-transcatheter aortic valve replacement.

Transapical-transcatheter aortic valve replacement is one of the main interventions indicated for patients where access via peripheral vessels is challenging. However, there have been no reports on the long-term outcomes of this intervention. Here, we report the long-term outcomes of this intervention. Among 178 patients who underwent transapical-transcatheter aortic valve replacement between October 2009 and July 2023, 173 patients who underwent this intervention for native aortic stenosis were included in this study, and early and long-term results were evaluated. The mean age was 82.4 ± 6.4years, 52.6% were women, mean body area was 1.46 ± 0.17 m2, and the Society of Thoracic Surgeons Predicted Risk of Mortality was 11.2 ± 9.9%. In-hospital mortality was observed in three patients (1.7%). Mean follow-up duration was 4.3 ± 2.8years, and the survival rates at 1-, 3-, 5-, and 8-years were 84.9%, 67.1%, 47.0%, and 22.1%, respectively. Freedom from cardiovascular mortality at 1, 3, 5, and 8-years was 92.9%, 86.1%, 75.8%, and 53.5%, respectively. The freedom from disabling stroke rates at 1, 3, 5, and 8-years were 95.0%, 92.4%, 92.4%, and 90.8%, respectively. Multivariate analysis revealed that male (Hazard Ratio 1.85, 95%Confidence Interval 1.27-2.70, p = 0.0012) and hemodialysis (Hazard Ratio 1.64, 95%Confidence Interval 1.00-2.67, p = 0.049) were significant poor prognosis factors. Long-term outcomes of transapical-transcatheter aortic valve replacement were satisfactory. Despite the variety of available approaches, the role of transapical-transcatheter aortic valve replacement, which has low vascular impact, has not been completely lost.

Optimizing Emergency Department Length of Stay and Quality of Care: A Quality Improvement Project.

Background Patients' long length of stay (LOS) in the emergency department (ED) is a common measure of quality of care that could be a cause of increased morbidity and mortality. This quality improvement project (QIP) aimed to identify causes of long LOS and to improve common causes such as long consultation times. Methodology Over two months, three plan, do, study, and act (PDSA) cycles were conducted aiming to identify causes of long ED LOS and improve common causes that extended ED LOS beyond four hours. Additionally, the projectaimed to reduce the time taken from requesting a consultation from another specialty until it was completed and documented to an average of 60 minutes. Main interventions included raising awareness of staff and administration through video presentations, printed posters, direct contact, and optimizing the electronic health records system to audit performance. Results From PDSA cycle 1 through PDSA cycle 3, average consultation times decreased from 91 to 65 minutes. Common organization-related causes of long LOS included pending radiology or laboratory investigations, awaiting inpatient admission, and awaiting consultations from other specialties. Physician-related factors included delay in documentation likely resulting from heavy workload. Pending investigations and admissions were factors that could be amended with better administrative control. Conclusions A multifaceted approach that tackles physician-related and organization-related factors could be a necessity to improve LOS and the quality of care in the ED. Having staff and administration aware of targets and performance along with utilizing the electronic health records system to audit performance and increase efficiency are beneficial in improving the LOS in the ED.

Reaching Student Engagement by Balancing Gamification and Challenges in the Minor Serious Gaming

This study originated from a Senior University Teaching Qualification on student engagement that withstanding many efforts on problem and challenge based education still is a concern. Within the minor Serious Gaming, third year students (n=35) where studied with mixed methods with the main question how to improve student engagement with challenges in serious gaming? First, a systematic literature study led to a new definition of student engagement: Student engagement is a multi-faceted concept that involves the interplay of various factors, including behavior, motivation, challenges, and autonomy. Then a pretest was done with last year’s teaching team, a motivational survey and general evaluation survey was done and a focus group with group representatives was created. This led to two main interventions, a gamified business modelling workshop and direct feedback loops. From a gamification point of view, rewards are the best intervention but we could not implement them in this year’s course. The value of this study is in understanding the complexity of student engagement. Improvement of engagement is possible with gamification, challenges and direct feedback. This study confirms that a high autonomy leads to a high engagement, future study has to be done with courses with low autonomy.

Open ecosystems restoration: a global review shows biases and mismatches between theory and practice

Ecological restoration aims to recover the structure, biodiversity, and function of degraded ecosystems. However, open ecosystems have been largely overlooked in restoration, and the extent of theory‐based restoration is unclear. We systematically review papers on open ecosystems restoration from 2011 to 2021, examining publication trends with data on restored site age, size, indicators, and assessment frequency. We also explore the relationships between interventions, indicators, and ecological concepts. By analyzing 343 papers, we found that open ecosystems restoration is concentrated in North America and Europe, with nearly 75% of restored areas originating in these continents. Restored areas are small, assessed for a short duration, with a plethora of indicators and no establishment of clear control or reference areas for meaningful comparisons. Common open ecosystems restoration sites interventions involved trees and shrubs management, soil management, seeding, and transfer of plant material as the main interventions. From our analyzed papers, we found that 30% of them mentioned any ecological concepts, with community assembly and succession being the most mentioned ones. Furthermore, our exploratory analysis revealed no relationship between interventions, indicators, and ecological concepts, suggesting a widespread mismatch between theory and practice. As the Decade for Ecosystem Restoration unfolds, we call practitioners, researchers, and stakeholders working on open ecosystems to address challenges and curtail widespread biases. Despite the uniqueness of each restoration project, a clear, well‐planned design encompassing site‐specific variables and solid theoretical bases is expected to enhance restoration outcomes, optimizing costs and biodiversity gains.

TCT-562 Long-term Outcome of Diabetic Patients After Unprotected Left Main Percutaneous Coronary Interventions

TCT-562 Long-term Outcome of Diabetic Patients After Unprotected Left Main Percutaneous Coronary Interventions

Research trends and hotspots of acupuncture therapy for obesity from 2004 to 2023: A bibliometric analysis

BackgroundAcupuncture has been increasingly used in obese people, yet no bibliometric analysis of acupuncture studies for obesity exists. This bibliometric study analyzed research trends, cooperation, and knowledge dissemination on acupuncture for obesity over the past 20 years to inform future directions. ObjectivesTo investigate the characteristics, hotspots, and frontiers of global scientific output in acupuncture research for obesity over the past two decades. MethodsWe retrieved publications on acupuncture for obesity published from 2004 to 2023 from the Web of Science Core Collection. Using Citespace, VOSviewer, and Bibliometrix, we analyzed and visualized the publications, countries, institutions, authors, journals, and keywords from various angles. ResultsA total of 357 articles were retrieved. The results showed that the number of annual publications on acupuncture for obesity has increased over time. China had the most publications (217 articles, 60.87%), with Chengdu University of Traditional Chinese Medicine (24 articles, 6.72%) as the most prolific institution. Ergene Neyhan, Huang Wei, and Zhou Zhongyu were the most productive authors (9 articles), and the article published by Cho SH in 2009 was the most cited article (60 citations). The most published journal was Evidence-based Complementary and Alternative Medicine, while the Journal of American Journal of Chinese Medicine was the most frequently cited. Recently, “electroacupuncture” “insulin resistance” and “systematic review” appeared frequently. The research hotspots and trends of acupuncture for obesity mainly focus on interventions, hotspot diseases, and mechanism exploration. According to keyword analysis, randomized controlled trials of catgut embedding and mechanistic studies of gut flora are the trends for future research. ConclusionAlthough China is the leading producer, multinational co-operation still needs to be strengthened. Currently, the main interventions for obesity were acupuncture and electroacupuncture, and the hot diseases were obesity combined with polycystic ovary syndrome and metabolic syndrome. In addition, randomised controlled trials of catgut embedding and mechanistic studies of gut flora may be potential directions for future research in the field of acupuncture for obesity.

Fusion versus decompression alone for lumbar degenerative spondylolisthesis and spinal stenosis: a target trial emulation with index trial benchmarking

PurposeThe value of adding fusion to decompression surgery for lumbar degenerative spondylolisthesis and spinal canal stenosis remains debated. Therefore, the comparative effectiveness and selected healthcare resource utilization of patients undergoing decompression with or without fusion surgery at 3 years follow-up was assessed.MethodsUsing observational data from the Lumbar Stenosis Outcome Study and a target trial emulation with index trial benchmarking approach, our study assessed the comparative effectiveness of the two main surgical interventions for lumbar degenerative spondylolisthesis—fusion and decompression alone in patients with lumbar degenerative spondylolisthesis and spinal canal stenosis. The primary outcome-measure was change in health-related quality of life (EuroQol Health Related Quality of Life 5-Dimension 3-Level questionnaire [EQ-5D-3L]); secondary outcome measures were change in back/leg pain intensity (Numeric Rating Scale), change in satisfaction (Spinal Stenosis Measure satisfaction subscale), physical therapy and oral analgesic use (healthcare utilization).Results153 patients underwent decompression alone and 62 had decompression plus fusion. After inverse probability weighting, 137 patients were included in the decompression alone group (mean age, 73.9 [7.5] years; 77 female [56%]) and 36 in the decompression plus fusion group (mean age, 70.1 [6.7] years; 18 female [50%]). Our findings were compatible with no standardized mean differences in EQ-5D-3L summary index change score at 3 years (EQ-5D-3L German: 0.07 [95% confidence interval (CI), − 0.25 to 0.39]; EQ-5D-3L French: 0.18 [95% CI, − 0.14 to 0.50]). No between-group differences in change in back/leg pain intensity or satisfaction were found. Decompression plus fusion was associated with greater physical therapy utilization at 3 years follow-up.ConclusionDecompression alone should be considered the primary option for patients with lumbar degenerative spondylolisthesis and spinal stenosis.

Investigation of the Frequency of Reactions and Consequences of Blood Transfusion in an Academic Center Guilan-Iran

Background: Blood transfusion is a life-saving procedure, but there are always potential risks, such as blood transfusion reactions. Objectives: Considering the importance of the subject and the lack of a similar study in Guilan province, this research was conducted to analyze blood transfusion reactions. Methods: This retrospective descriptive study was conducted at Al-Zahra Hospital in Guilan, Iran, between 2020 and 2022. The files of all patients who received blood products at this center and experienced a reaction were reviewed. A checklist was completed, which included details such as the hospital ward, age, blood group, underlying disease, type of surgery, type of injected product, history of transfusion, history of reaction and allergy, type of reaction, and treatment intervention. Results: During the study period, 4,887 cases received transfusions. Among them, 18 cases (0.36%) showed reactions during transfusion, of which 14 cases (0.35% of total packed cell injections) were related to packed cell injection. Shivering was the most common reaction, occurring in 8 cases (15.38%). The main interventions included the administration of steroids in 10 cases (25%), antihistamines in 7 cases (17.5%), and oxygen therapy in 7 cases (17.5%). Three cases (7.5%) were transferred to the ICU, and in three cases (7.5%), the blood transfusion was stopped. One mortality was reported, and no cases of incompatible blood transfusion were documented. Conclusions: The incidence of reactions to blood product injections at this center appears to be acceptable. However, it was found that the information recording systems were very inefficient, and forms were incompletely filled, which should be addressed and corrected.

Analysis of clinical study registration characteristics of traditional medicine for the treatment of type 2 diabetes mellitus based on the International Clinical Trials Registry Platform

Objective: To analyze clinical trials of traditional medicine (including Chinese herbal medicine and nonpharmacological therapies) for the treatment of type 2 diabetes mellitus (T2DM) registered in the International Clinical Trials Registry Platform (ICTRP), and accordingly to explore their clinical trial registration characteristics, development trend and intervention status, in an attempt to provide references for future research design, diagnosis and management of traditional Chinese medicine therapy for T2DM. Methods: The clinical trials related to Chinese herbal medicine and nonpharmacological therapies for treating T2DM were retrieved on the ICTRP online from the time of database construction to August 13, 2023, to analyze the time of registration, country and institution of the study, source of funding, type and design of the study, randomization and blinding methods, clinical staging, therapeutic measures, and main therapeutic effect indexes. Descriptive statistical analysis was performed using R4.3.0 and Excel software. Results: A total of 774 clinical trials for T2DM treatment were included, of which 127 were traditional herbal therapies and 647 were nonpharmacological therapies. The T2DM clinical trial registration institutions were distributed in 50 countries worldwide involving 15 clinical registration platforms, with the most registrations in Iran, China, and Australia, and the top 3 registration platforms were the Iranian Clinical Trial Registry, the Australian New Zealand Clinical Trials Registry, and the ICTRP. Universities (551, 71.19%) were the main funding sources. Intervention studies (750, 96.90%) were the primary study type, including randomized controlled trials (432, 56. 4%), and 225 studies mentioned the blinding method. A total of 530 (68.48%) with a sample size ≤100 were included. Study phases were predominantly phase 2 and phase 3 (108, 51.43%). The interventions of traditional medicine for T2DM were composed of Chinese herbal medicines (mainly ginseng and astragalus compound), nonpharmacological therapies (mainly exercise and diet therapies), and 2 or more comprehensive treatment regimes. According to the type of study design, the first 3 main therapeutic indexes were fasting blood glucose (286 times), glycated hemoglobin (282 times), and insulin resistance (120 times), and the top 3 secondary therapeutic indexes were body mass index (179 times), fasting blood glucose (175 times), and glycated hemoglobin (134 times). Conclusion: The study dissects the current status and trend of registration of clinical trials on traditional medicine for T2DM treatment. The number of trial registrations is on the rise year by year, and there are obvious geographical differences in the countries and platforms of registration. The trial design is mainly randomized controlled blind trials with a sample size of &lt;100, and the main interventions are nonpharmacological therapies. Correct and standardized registration of clinical trials and timely reporting of study results are greatly important to facilitate the implementation of clinical trials, reduce publication bias, provide high-level diagnostic and therapeutic bases for clinical practice guidelines, and develop effective treatment strategies. This study is expected to help other scholars, health care professionals, patients, and the public to understand the latest research trends and hotspots in this field and provide certain references and inspirations for the future research design and clinical practice of traditional Chinese medicine in the treatment of T2DM.

Interventions based on alternative and sustainable strategies for postharvest control of anthracnose and maintain quality in tropical fruits.

Colletotrichum spp. is a phytopathogen causing anthracnose in a variety of tropical fruits. Strategies used to control postharvest diseases in tropical fruits typically rely on the use of synthetic fungicides, which have stimulated the emergence of resistant pathogens. Safer alternative strategies to control anthracnose in tropical fruits have been described in the literature. This review presents and discusses the main innovative interventions concerning the application of sustainable alternative strategies in the postharvest control of pathogenic Colletotrichum species in tropical fruits, with a particular emphasis on the studies published in the last 5 years. The available studies have shown the use of various methods, including physical barriers, natural antimicrobials, and biological control with antagonistic microorganisms, to reduce anthracnose lesion severity and incidence in tropical fruits. The available literature showed high inhibitory activity in vitro, reduced anthracnose incidence and lesion diameter, and total disease inhibition in tropical fruits. Most studies focused on the inhibition of Colletotrichum gloeosporioides on avocado, papaya, and mango, as well as of Colletotrichum musae on banana; however, the inhibition of other Colletotrichum species was also demonstrated. The application of emerging sustainable alternative methods, including natural antimicrobial substances, also stimulated the induction of defense systems in tropical fruits, including enzymatic activity, such as polyphenol oxidase, peroxidase, and phenylalanine ammonia-lyase. The retrieved data helped to understand the current state of the research field and reveal new perspectives on developing efficient and sustainable intervention strategies to control pathogenic Colletotrichum species and anthracnose development in tropical fruits.

STRATEGIES FOR THE PREVENTION AND CONTROL OF HYPERTENSION IN RURAL COMMUNITIES

Hypertension is a prevalent chronic condition that can lead to serious complications such as cardiovascular disease, stroke and kidney failure. The prevalence of hypertension is especially high in rural communities, where factors such as limited access to health care, lack of health information and socioeconomic conditions can contribute to a lack of control of the disease. Prevention and control strategies tailored to these communities are crucial to reducing the burden of hypertension and improving the overall health of the rural population. This brief explores effective strategies for the prevention and control of hypertension in rural communities, highlighting innovative approaches and associated challenges. The aim of this paper is to review and analyze strategies for the prevention and control of hypertension in rural communities. It aims to identify the main interventions that have proved effective, discuss approaches adapted to the needs and resources of rural communities, and address the challenges faced in implementing these strategies. This is a literature review, using qualitative and quantitative assumptions, using the PubMed, Scopus and Google Scholar databases. The health descriptors “Hypertension”, “Hypertension Management in Rural Areas”, “Telemedicine”, “Community Interventions” and “Rural Health Policies” were used to refine the research. The time frame covers the years 2018 to 2022. The focus is to promote a comprehensive understanding of best practices and areas that need more attention to improve the management of hypertension in rural contexts. Preventing and controlling hypertension in rural communities requires a multifaceted approach that takes into account the particularities of these areas, including barriers to accessing healthcare, resource limitations and specific cultural needs. Education is key to preventing hypertension. Awareness programs about risk factors, the importance of regular blood pressure monitoring and lifestyle changes can have a significant impact. Community initiatives such as workshops, lectures and local media campaigns can help raise awareness of hypertension and promote healthy habits. Improving access to healthcare is crucial for hypertension control in rural areas. This can include the implementation of mobile health units, telemedicine and partnerships with health organizations to provide regular medical services and blood pressure monitoring. Community screening programs and regular consultations can help identify and treat cases of hypertension early. Interventions that encourage a healthy diet, rich in fruit, vegetables and low in sodium, as well as regular physical activity, are essential for the prevention and control of hypertension. Nutritional education programs and the promotion of community physical activities, such as walking groups or sports, can be effective in promoting a healthy lifestyle. Thus, many people with hypertension also have other health conditions, such as diabetes or obesity. Integrated strategies that address hypertension alongside other health conditions can improve overall outcomes. This includes chronic disease management programs that provide support for managing multiple health conditions simultaneously. Involving the community in the planning and implementation of prevention and control strategies can increase the acceptance and effectiveness of interventions. Community groups, local leaders and non-governmental organizations can play an important role in promoting health programs and mobilizing resources. The effective implementation of hypertension control strategies in rural communities faces several challenges. Barriers can include a lack of adequate health infrastructure, a shortage of health professionals, limited access to medicines and treatments, and cultural factors that can affect the acceptance of interventions. In addition, logistical and financial difficulties can limit the ability to implement and maintain health programs in remote areas. Therefore, the approach to preventing and controlling hypertension in rural communities must be adapted to the specific needs and characteristics of these areas. Effective strategies include community education and awareness, improving access to health care, promoting a healthy lifestyle and integrated management of comorbidities. Involving the community and overcoming challenges related to infrastructure and resources are critical aspects for the success of these strategies. With a multifaceted and collaborative approach, it is possible to reduce the prevalence and impact of hypertension in rural communities, promoting better health and an improved quality of life for their inhabitants.

Sosialisasi Pencegahan Stunting di Dusun Muteran Desa Kejagan, Kecamatan Trowulan, Kabupaten Mojokerto

Stunting remains a significant public health challenge in Indonesia, especially in rural areas. The national stunting prevalence was recorded at 24.4% in 2021, still far above the maximum threshold of 14% set in the SDGs for 2024. To tackle this problem, the KKN-T Bela Negara Group 8 team of the National Development University "Veteran" East Java in collaboration with UPT Puskesmas Tawangsari carried out a socialization program on stunting prevention in Muteran Hamlet, Kejagan Village, Trowulan District, Mojokerto Regency on August 2, 2024. This program involved 38 participants of mothers with children under five years old and focused on three main interventions including measuring children's height, weighing children, and giving vitamin A. This activity aims to know how to prevent stunting from various aspects, knowing how to measure and weigh toddlers appropriately according to health procedures and learning how to give vitamin A to children. Through this collaborative effort, it is hoped that the prevalence of stunting in Muteran Hamlet can be significantly reduced so that it can contribute to improving the quality of human resources in the future.

Reducing Central Line-Associated Bloodstream Infections With a Multipronged Nurse-Driven Approach.

Despite implementation of central catheter bundles, central line [catheter]-associated bloodstream infections (CLABSIs) remain a preventable hospital-acquired infection. A new population of patients with pulmonary artery catheters was introduced to the cardiac progressive care unit, increasing central catheter days, device use, and CLABSI rate. A quality improvement project was conducted. Nursing staff implemented a standardized central catheter rounding process 3 days a week to critically assess all central catheter dressings, deter-mine the necessity of each central catheter, and educate patients on the importance of keeping central catheter dressings clean, dry, and intact. Data were collected during central catheter rounds for each patient, entered in an electronic survey tool via mobile devices, and analyzed. From July 2019 through June 2022, a total of 2692 rounds were conducted for 707 individual patients with 3064 central catheters. Main interventions were dressing management, monitoring insertion site bleeding that extended beyond edges of the chlorhexidine gluconate pad, treating patients' allergies to products, and maintaining sustainability within the unit. Central catheter rounds decreased the CLABSI rate from 1.86 to 0.0 despite the continued increase in central catheter days. Central catheter dressing assessment, intervention, and education help reduce CLABSIs. Central catheter rounds are an important adjunct to the CLABSI bundle. A central catheter dressing management algorithm helps nurses decide when to change a dressing and which type of dressing to use.

An Update on Guidelines to Prevent and Manage Atrial Fibrillation After Cardiac Surgery and a Survey of Practice in the UK

ObjectivesPostoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery and affects around 30% of patients. Variable guidelines from multiple organisations exist for the prevention of POAF after cardiac surgery. We conducted a survey of UK practice was conducted to define “usual care” for a platform trial of interventions to prevent POAF after cardiac surgery. To provide context for the survey, we reviewed all current guidelines for the prevention and management of AF after cardiac surgery. DesignOnline survey and literature review SettingSurvey: All 35 UK National Health Service Cardiac Surgery Centres. Literature Review: Guidelines from specialist societies and other guideline making organisations from the UK, Europe and North America. ParticipantsEstablished link network of researchers. Measurements and Main ResultsReview: Five relevant guidelines were identified. All guidelines recommend β-blockade for prevention of AF after cardiac surgery. Treatment of AF is recommended using either rate or rhythm control. Cardioversion is recommended only for the haemodynamically unstable patient. Patients who remain in AF for over 48 hours should be considered for anticoagulation. Patients should be followed up within 60 days to review the need for anti-arrhythmic and anticoagulant therapy. Survey: 31/35 (89%) of centres responded. 11 of 31 (35.5%) centres followed local guidance for prevention of POAF, 4 (13%) centres followed Society of Cardiovascular Anesthesiologists / European Association of Cardiothoracic Anaesthesia guidelines, 4 (13%) followed UK National Institute of Health and Care Excellence guidance and 4 followed “other” guidance. 8 of 31 (26%) followed no guidelines to prevent POAF. 28 of 31 (90%) centres did not risk-stratify their patients for POAF. Most centres (23/31, 74%) do not have a care-package in place to prevent POAF, but 14 of 31 (45%) try in some way to prevent AF in patients presenting in sinus rhythm. The most common interventions to prevent POAF are β-blocker use post-operatively (23/31, 74%), use of magnesium (20/31, 64.5%) and maintaining a serum K+ ≥4.5mmol/L (26/31, 84%). ConclusionsGuidance to prevent AF after cardiac surgery clusters around the use of β-blockade. Although patients in the UK do not appear to be risk-assessed for POAF, the main interventions used to prevent it are similar; β-blockade and maintenance of serum K+ and Mg2+ levels.

Medicinal Plant Extracts against Cardiometabolic Risk Factors Associated with Obesity: Molecular Mechanisms and Therapeutic Targets.

Obesity has increasingly become a worldwide epidemic, as demonstrated by epidemiological and clinical studies. Obesity may lead to the development of a broad spectrum of cardiovascular diseases (CVDs), such as coronary heart disease, hypertension, heart failure, cerebrovascular disease, atrial fibrillation, ventricular arrhythmias, and sudden cardiac death. In addition to hypertension, there are other cardiometabolic risk factors (CRFs) such as visceral adiposity, dyslipidemia, insulin resistance, diabetes, elevated levels of fibrinogen and C-reactive protein, and others, all of which increase the risk of CVD events. The mechanisms involved between obesity and CVD mainly include insulin resistance, oxidative stress, inflammation, and adipokine dysregulation, which cause maladaptive structural and functional alterations of the heart, particularly left-ventricular remodeling and diastolic dysfunction. Natural products of plants provide a diversity of nutrients and different bioactive compounds, including phenolics, flavonoids, terpenoids, carotenoids, anthocyanins, vitamins, minerals, fibers, and others, which possess a wide range of biological activities including antihypertensive, antilipidemic, antidiabetic, and other activities, thus conferring cardiometabolic benefits. In this review, we discuss the main therapeutic interventions using extracts from herbs and plants in preclinical and clinical trials with protective properties targeting CRFs. Molecular mechanisms and therapeutic targets of herb and plant extracts for the prevention and treatment of CRFs are also reviewed.

Complementary and Alternative Medicine for Autism - A Systematic Review.

Complementary and Alternative Medicine (CAM) is a therapeutic option currently used by autistic people with continued interest and uptake. There remains limited evidence regarding the efficacy of CAM use in autism. The aim of this systematic review is to comprehensively review published clinical trials to explore the efficacy of CAM in autism. A systematic literature review of available research published from June 2013 to March 2023 was conducted. Our literature search identified 1826 eligible citations, and duplications removed (n = 694) with 102 articles eligible for title/abstract screening. After full text review, 39 studies were included. The results of this systematic review identified that for autistic people, vitamin and mineral supplements may only be of benefit if there is a deficiency. The results also found that the main interventions used were dietary interventions and nutraceuticals, including targeted supplements, vitamins and minerals, omega 3s and prebiotics, probiotics and digestive enzymes. The evidence does not support some of the most frequently utilised dietary interventions, such as a Gluten Free Casein Free (GFCF) diet, and the use of targeted nutraceutical supplements may be of benefit, but more conclusive research is still required to direct safe and effective treatment.