Score Mean Research Articles

Development & evaluation of a training programme to address complex post-COVID psychological needs

Background & objectives In India, mental health treatment gaps are significant, and related to shortage of trained personnel. Published literature has identified gaps in existing training programmes including - delivering psychological interventions for complex concerns such as intensified post-COVID grief, trauma, suicidality; ongoing mentoring; and culture-sensitive interventions. Despite government initiatives, gaps in treatment and training have been compounded by a surge in psychological distress following COVID-19. This study aimed to develop, implement and evaluate a training programme for psychologists to identify, assess, and treat complex post-COVID psychological concerns. Methods The study employed a sequential mixed exploratory research design with tailored programme development (Phase I) and programme delivery with pre-post evaluations of participation, satisfaction, learning and competence using Moore’s framework (Phase II). Psychologists with postgraduate qualifications, engaged in direct client contact were invited through flyers to participate in the free online training programme. Results The final programme included ten modules; with knowledge, skills, and application components; comprising synchronous and asynchronous elements. Fifty-three participants enrolled in the programme and 70 per cent completed the course. Pre-post evaluations indicated high satisfaction (93.54% rated as met/exceeded expectations); improvements in competence (pre training mode = 3; post-training mode = 4); and average to above average learning scores (mean scores ≥3 on 7 out of 9 module quizzes). Participant feedback revealed that the focus on complex concerns, practical learning through interactive sessions and role play recordings, and case-based supervision were helpful. Interpretation & conclusions The programme focused on training gaps identified through a needs assessment survey. It was received well in terms of participation, satisfaction, content, accessibility and learning. The indigenous and skill-focused training has implications to contribute to future mental health preparedness and scope for large-scale deployment.

Implementation of the STAD Cooperative Learning Model to Improve Indonesian Language Learning Outcomes in Elementary School

Indonesian language learning at the elementary school level faces challenges in engaging students and improving learning outcomes. This study aims to enhance Indonesian language learning outcomes in fourth-grade students at SD Lafau Fadorozai through the implementation of the STAD (Student Teams-Achievement Divisions) cooperative learning model. The study adopts a Classroom Action Research (CAR) design involving a single class as the research subject. Data were collected through observations, learning outcome tests, and questionnaires on student response. The implementation of the STAD cooperative learning model was conducted two cycles, focusing on Indonesian language learning. The research results indicate a significant improvement in students' learning outcomes with average score after the application of the STAD model, as evidenced by an increase in The average post-test score (Mean = X) was significantly higher than the average pre-test score (Mean = Y), with a significant difference (p < 0.05) on learning outcome tests and positive student responses toward cooperative learning. The pre-test score was 63.47 and the post-test 66.53 the increase was 4.82%. These findings suggest that the STAD cooperative learning model is an effective strategy for improving Indonesian language learning outcomes at the elementary school level. This study underscores the importance of cooperative learning models in enhancing the quality of Indonesian language education at the elementary school level.

Camp Wonder Provides Short-Term Health-Related Quality of Life Benefits for Participants With Chronic Skin Disease.

Chronic skin diseases in children can significantly impair their quality of life (QOL) due to physical discomfort and psychosocial challenges. Disease-focused summer camps, like Camp Wonder (CW), offer a supportive environment for children to engage in activities and build friendships, potentially improving their QOL. This prospective cohort study evaluated the short-term QOL benefits of CW as measured by the Children's Dermatology Life Quality Index (CDLQI). Data were collected from 58 camp participants aged 8-17 years. The CDLQI was administered on the first and last days of CW. The paired sample t-test was used to compare pre-camp and post-camp CDLQI scores. A multiple linear regression analysis examined predictors of QOL improvement, including age, diagnosis category, sex, and initial CDLQI severity. CW participants showed significant improvements in total CDLQI scores (mean change = -3.8 points, p < 0.0001) and in all constituent domains. Participants with "very large" initial QOL impacts experienced an average reduction of 8.4 points, while those with "extremely large" impacts had a reduction of 15.3 points relative to the reference group. Age, sex, and diagnosis were not significant predictors of QOL changes. CW provides significant short-term QOL benefits, particularly for children with severe impairments due to chronic skin disease. These findings suggest that summer camp experiences may be useful as part of a comprehensive care strategy, especially for pediatric patients with severe QOL impacts.

Inappropriate medication prescribing, polypharmacy, potential drug-drug interactions and medication regimen complexity in older adults attending three referral hospitals in Asmara, Eritrea: a cross-sectional study

BackgroundOlder adults often face several chronic illnesses that require them to take multiple medications. The increased number of prescribed medications has led to more complex medication regimens, putting older adults at a higher risk of potential drug-drug interactions, inappropriate medication prescribing, and adverse events. This study aimed to assess inappropriate prescribing practices, polypharmacy, medication regimen complexity, and their determinants in older adults.MethodsA cross-sectional study was conducted among older adults (aged 65 years and above) who visited three referral hospitals in Asmara, Eritrea, between June and August, 2023. A stratified random sampling technique was used, and data were collected from patient prescriptions, medical cards, and through interviews with a questionnaire. Inappropriate medication prescribing was evaluated using STOPP (Screening Tool of Older Person's Prescriptions)/ START (Screening Tool to Alert to Right Treatment) criteria version 3. Potential drug-drug interactions (pDDIs) and medication regimen complexity (MRC) were assessed using Lexi-comp drug interaction checker and MRC index, respectively. Descriptive statistics, logistic regression, Pearson’s correlation coefficient, independent samples t-test, one-way Analysis of Variance, and paired t-test were employed using IBM SPSS (version-26.0).ResultsA total of 430 respondents, with a similar male to female ratio, were included. The prevalence of polypharmacy was 5.3% (95%CI: 3.2, 7.5). Moreover, the prevalence of clinically significant pDDI was 51% (95%CI: 46, 56). The most common medicines involved in clinically significant pDDIs were enalapril (n = 179) and acetylsalicylic acid (n = 124). The presence of chronic illness (AOR = 7.58, 95%CI: 3.73, 15.39) and the number of drugs prescribed (AOR = 2.80, 95%CI: 1.91, 4.10) were predictors of clinically significant pDDIs. The prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were 27.4% (95% CI: 23.4, 31.8) and 13.3% (95% CI: 10.3, 16.7), respectively. The most common PIMs were long-acting sulfonylureas (n = 63) and aldosterone antagonists (n = 19). Besides, proton pump inhibitors (PPIs) (n = 41) and cardio-selective beta-blockers (n = 14) were the most common PPOs identified. Age (AOR: 0.95, 95% CI: 0.92, 0.98), presence of chronic illness (AOR: 1.51, 95% CI: 0.81, 2.80), and number of drugs prescribed (AOR: 2.01, 95% CI: 1.51, 2.69) were significant factors associated with PIM. MRCI score was a significant determinant of PPO (AOR: 1.25, 95% CI: 1.14, 1.38). The mean (SD) of the overall MRCI score was 9.1 (3.7), with dose frequency being the major contributor. The number of drugs prescribed was a determinant of MRCI score (r = 0.625, p < 0.001).ConclusionInappropriate medication prescribing and clinically significant drug-drug interactions were common among older adults, highlighting the need for immediate attention from policymakers, program managers, and healthcare professionals.

The Effect of Online Infant Care Education and Postpartum Counseling Based on Meleis's Transition Theory on Mothers' Self-Esteem and Infant Health: A Randomized Controlled Trial.

The aim of this research was to assess the effects of online infant care education and postnatal counseling, based on Meleis's transition theory, on maternal self-esteem and infant health. The randomized controlled trial was conducted between November 2022 and May 2023 with 102 mothers and their infants, n = 52 in the intervention and n = 50 in the control. The intervention group received training across two sessions between 32 and 38 weeks of gestation and counseling support for 3 months postbirth. The control group was shared with additional educational materials in PDF format in addition to their usual care. In the intervention group, the subdimension and total score mean of the Karitane Parental Self-Confidence Scale during pregnancy, postpartum, first, second, and third months were higher than the control group (p = 0.001). The proportion of exclusive breastfeeding in the third month was higher in the intervention group than in the control group (p = 0.001). Newborn nurses' care on Meleis' transition theory will increase the quality of care and newborn health. In our study, Meleis's transition theory provides a strong foundation for understanding mothers' psychological and physical transitions in the postpartum period. Trial Registration: NCT05812833.

Assessment of the Roles of Critical Care Nurses: Tool Development, Psychometric Properties, and Nurses' Perceptions.

Critical care nursing is considered one of the most challenging and demanding fields in nursing. Critical care nurses work in high-stress environments, tending to patients who are experiencing acute illness and necessitate intensive care. Nurses play a crucial role in providing nursing care for critically ill patients, encompassing duties such as assessment, administration of medications, ventilator management, diligent monitoring, and responding to life-saving situations. Despite the significance of their contributions, there are limited assessment tools used to assess critical care nurses' perceptions about their roles and responsibilities in intensive care units (ICU). The main aim of this study was to develop a tool to assess the critical care nurses' knowledge, awareness, and perception of their roles and responsibilities in the critical care units. The researcher developed the Critical Care Nurses' Roles and Responsibilities Assessment Tool. Subsequently, the tool underwent content validity assessment by five nursing experts, resulting in a final tool with 17 Likert-scale items. The scores ranged from 17 to 85, with intervals indicating varying levels of awareness. To assess the nurses' perception of the roles and responsibilities identified in the tool, a study was conducted on 120 registered nurses working in the ICU units across 9 governmental hospitals in Jordan. Data were collected through an online questionnaire covering demographical data and the roles and responsibilities of critical care nurses in the ICU. The collected data were subjected to quantitative analysis using appropriate statistical methods. Regarding the results among the experts, the content validity index (CVI) of the tool was 0.93. Among the participants, Cronbach alpha was measured to assess the reliability and internal consistency of the tool and the result was 0.912. Regarding the nurses' perception, a small percentage of participants, specifically (9%), demonstrated a moderate level of agreement with the roles and responsibilities mentioned in the tool (mean of scores=40 - 63). Conversely, a substantial majority of participants (91%), exhibited a high level of agreement (mean of scores=64 - 85). In conclusion, the results of this study revealed a powerful and reliable tool that has earned widespread acclaim among experts and participants alike.

Prediction of Different Risk Factors in Relation to Hyperlipidemia Using Framingham Risk Score and Cholesterol Risk Score in a Tertiary Care Hospital.

A condition that affects the circulatory system of the human body is referred to as a cardiovascular disease (CVD). Cardiovascular diseases (CVDs) are responsible for a significant number of fatalities globally. Annually, CVDs result in the demise of 17.9 million people, which accounts for 31% of all fatalities on a global scale. The objective of the study was to assess the demographic profile of diabetic and nondiabetic patients suffering from cardiovascular disease. The aim of the study is to predict risk factors in relation to hyperlipidaemia using two different scales, the Framingham Risk Scale (FRS) and the Cholesterol Risk Calculator (CRC), and to determine the frequency of hypercholesterolemia in relation to CVD. A cross-sectional study was conducted in Guru Gobind Singh Medical College and Hospital, Punjab, India. The mean age of patients was found to be M= (51.23), SD= (9.348) years, and among 331 patients (52.6%) were female patients. The mean of Framingham Risk Score was found to be (29.07%). The Framingham Risk Score was found significant with gender and calorie intake below the recommended dietary allowances of the patient (p=0.001). The Framingham Risk Score was found significant with physical activity and employment status of the patients (p= 0.001). In linear regression, the Framingham Risk Score was found significant with the lipid profile of the patients (p=0.001) i.e., the higher the value of cholesterol level, the higher the Framingham Risk Score. The chi-square test showed a significant relation between Cholesterol Risk Score and employment status, physical activity, calorie intake, gender, and occupation of the patients (p=0.001, p=0.001, p=0.001, p=0.004) respectively. The present study demonstrated that patients with high Framingham risk score and cholesterol risk score are at increased risk of diabetes and cardiovascular disease. The present study concludes that the FRS is higher in patients below RDA, patients doing low physical activity, and sedentary workers. In order to provide proper assistance and counselling, healthcare professionals must continuously analyze each patient's risk factor for CVD and barriers to healthy and preventive behaviors. There is a lack of comprehensive studies comparing the effectiveness of the Framingham Risk Score and Cholesterol Risk Score in predicting hyperlipidemia and associated cardiovascular risks within the context of a tertiary care hospital setting.

Assessment of dysphagia and its associations in patients with secondary progressive multiple sclerosis.

In this cross-sectional study in patients with secondary progressive multiple sclerosis receiving anti-CD20 monoclonal antibodies, we assessed complaint of dysphagia and evaluated their association with sex, age, disease duration, disability severity, and disease-modifying therapies (DMTs). The validated Persian version of Dysphagia in Multiple Sclerosis (DYMUS) questionnaire was used. A total of 66 patients were included. The median DYMUS score was 1.0 [interquartile range: 0.0-2.3] and 40 (60.6%) had positive DYMUS. Only DMT showed a significant association with DYMUS score, with patients receiving reituximab exhibiting higher scores (mean estimated difference: 0.96 (±0.39), p = 0.014). Grouping patients into positive and negative DYMUS scores, no significant associations were observed (p > 0.05).

Outcomes of Median Nerve Release in Complex Regional Pain Syndrome Type 1 of the Hand: A Prospective Case Series

Pain, allodynia, and stiffness in complex regional pain syndrome (CRPS) greatly affects social, vocational, and community engagement. The aim of this study was to evaluate the effect of isolated median nerve releases on the outcome of CRPS 1 of the hand. In this prospective case series, people of any age diagnosed with and treated for CRPS 1 of the upper limb attending the author's practice were consecutively recruited. All were self-referrals dissatisfied with the treatment provided previously. Only patients who had been treated with nerve release to control their symptoms were included. Primary outcome measures were pain and Disabilities of the Arm, Shoulder, and Hand score. A secondary outcome was withdrawal from pain medication. Full resolution was defined as 0 pain, on a scale of 0-10, and total withdrawal from pain medication at the latest follow-up. Between January 2018 and December 2022, 82 participants with CRPS 1 of the hand for an average of 20 months were evaluated. Eighty-five nerve releases were performed. As per protocol, carpal tunnel release was performed in all, and three patients also received an endoscopic pronator release. Minor procedures unrelated to the pain were carried out concomitantly in 17 patients. Significant improvements were observed in pain score (mean 8.9 ± 1.2 at baseline vs 0.6 ± 1.8 at 35 months) and in Disabilities of the Arm, Shoulder, and Hand score (82 ± 13 vs 13 ± 20) for the same period. Five patients (6%) were considered failures. In contrast, 65 patients (79%) had full resolution of their symptoms. This study demonstrates that a large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release. Future research is needed to understand the pathophysiology and the failures. Therapeutic II.

Multi-Institutional Comparison of Quality of Life Between Open Versus Endoscopic Skull Base Approaches.

The primary objective of this prospective review was to compare quality of life between patients undergoing endoscopic and open skull base approaches. Prospective Review. Five centers recruited consecutive patients treated surgically for skull base neoplasms between 2012 to 2018. The Skull Base Inventory (SBI), Anterior Skull Base (ASB), and Sinonasal Outcome Test (SNOT-22) were administered up to 12 months post-operatively. Mean change from baseline scores were compared with univariable and multivariable analyses. A total of 180 patients were included: 108 (60%) F and 72 (40%) M, of whom 126 (70%) underwent endoscopic and 54 (30%) underwent open approaches. Patients undergoing endoscopic approaches were more likely to have sellar or clival pathology (68 vs. 15%, p < 0.001). Those undergoing endoscopic approaches had better disease-specific quality of life at one year using the SBI and ASB (mean change from baseline = 7.2 vs. 0.69, p = 0.004; 5.8 vs. -1.1, p = 0.002), respectively. On multivariable analysis, endoscopic approach was associated with greater improvement in overall quality of life (mean difference in change scores from baseline = 6.5, p = 0.009), as well as endocrine (mean difference = 8.3, p = 0.011), neurologic (mean difference = 8.3, p = 0.012), visual (mean difference = 7.9; p = 0.032), financial (mean difference = 9.7, p = 0.03), and spiritual domain scores (mean difference = 4.0, p = 0.035). Subgroup analyses of pituitary and non-pituitary histopathologies demonstrated trends towards greater quality of life at 1-year compared to baseline in the endoscopic approach compared to the open group. Endoscopic approaches are associated with better quality of life compared to open approaches. However, baseline differences in histopathology between the group limit the direct comparison of the open and endoscopic approaches. Future studies with larger and more homogenous samples are required. Level IV evidence.

Reporting completeness and methodological quality of guidelines for nutritional care of critically ill patients: A meta-research utilizing Reporting Items for practice Guidelines in HealTh Care (RIGHT) and Appraisal of Guidelines for Research & Evaluation (AGREE II).

Studies have demonstrated that the quality and transparency of reporting Clinical Practice Guidelines (CPGs) in healthcare are low. This meta-research aimed to evaluate the adherence of nutrition CPGs for critically ill adults to the reporting RIGHT checklist and its association with the methodological quality assessed by AGREE II, along with other potential publication-related factors. A systematic search for CPGs until December 2024 was conducted. RIGHT and AGREE II were applied. Reporting completeness score was created using the data from the evaluations of whether each broken-down item of the RIGHT. Eleven CPGs were identified, none demonstrated adherence greater than 60% to the RIGHT checklist, and the mean of RIGHT score was 33.5±15.5%. There was a strong correlation between the RIGHT score and AGREE II (r=0.886). A development CPGs team including methodologist and/or statistician was associated with a higher RIGHT score (48.9±4.5 versus 27.2±11.0) and it was higher in CPGs recommended or recommended with modifications by AGREE II in comparison to those not recommended (50.1±4.6 versus 37.7±8.1 versus 17.0±6.8), and in those with acceptable and moderate compared to those with low methodological quality (50.1±4.6 versus 32.2±14.5 versus 19.3±6.2). It was also related to the language of publication, being higher in those published in English. The reporting completeness in CPGs for critically ill adults was low, with a strong correlation with the methodological quality. High values of reporting completeness scores were observed between CPGs recommended by AGREE II (with moderate or acceptable quality) and in those including a methodologist/statistician in the development team.

P-976. The Effectiveness of Augmented Reality Handouts for Learning Microbiology in Medical Students

Abstract Background Augmented reality (AR) is a novel technology-enabled active learning for medical education. The goal of this study was to determine effectiveness of self-directed learning AR handouts as a learning material for teaching medical microbiology in the 3rd year medical students, Doctor of Medicine (English Program), Thammasat University. Example of the traditional handouts and the AR handouts in this study Methods A randomized controlled trial study was conducted by comparing academic performances (MCQs scores), the motivation level (Motivation Scores Learning Questionnaire, MSLQ) and satisfaction survey scores in the students after studied AR handouts (intervention group) and traditional handouts (control group). The content of AR handout was similar to the traditional handout (topic: common Gram-positive bacteria). Study Procedures and Methods Results Twenty-four students were enrolled in this study (n = 02 each group). The both groups had no differences on age, gender, total GPA, pre-test scores (means of 5.08). The both groups also had similar increases in the post-test scores means of 11.25 (intervention group) and 10.58 (control group). MSLQ (topic of intrinsic goal orientation) was significantly higher in the intervention group than the control group (5.73 vs 4.81, p = 0.002). Satisfaction survey scores (topic of "Handouts are stimulating" and "Handouts are exciting") were significantly higher in the intervention group than the control group (4.58 vs 3.50, p = 0.025 and 4.42 vs 3.17, p = 0.019). Conclusion AR handouts for learning medical microbiology and infectious diseases was effective to improve the knowledge in medical students. Based on cognitive information theory, the AR handouts help learning process by increased students' motivation, and satisfaction. Disclosures All Authors: No reported disclosures

Health System, Community-Based, or Usual Dementia Care for Persons With Dementia and Caregivers: The D-CARE Randomized Clinical Trial.

The effectiveness of different approaches to dementia care is unknown. To determine the effectiveness of health system-based, community-based dementia care, and usual care for persons with dementia and for caregiver outcomes. Randomized clinical trial of community-dwelling persons living with dementia and their caregivers conducted at 4 sites in the US (enrollment June 2019-January 2023; final follow-up, August 2023). Participants were randomized 7:7:1 to health system-based care provided by an advanced practice dementia care specialist (n = 1016); community-based care provided by a social worker, nurse, or licensed therapist care consultant (n = 1016); or usual care (n = 144). Primary outcomes were caregiver-reported Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score for persons living with dementia (range, 0-36; higher scores, greater behavioral symptoms severity; minimal clinically important difference [MCID], 2.8-3.2) and Modified Caregiver Strain Index for caregivers (range, 0-26; higher scores, greater strain; MCID, 1.5-2.3). Three secondary outcomes included caregiver self-efficacy (range, 4-20; higher scores, more self-efficacy). Among 2176 dyads (individuals with dementia, mean age, 80.6 years; 58.4%, female; and 20.6%, Black or Hispanic; caregivers, mean age, 65.2 years; 75.8%, female; and 20.8% Black or Hispanic), primary outcomes were assessed for more than 99% of participants, and 1343 participants (62% of those enrolled and 91% still alive and had not withdrawn) completed the study through 18 months. No significant differences existed between the 2 treatments or between treatments vs usual care for the primary outcomes. Overall, the least squares means (LSMs) for NPI-Q scores were 9.8 for health system, 9.5 for community-based, and 10.1 for usual care. The difference between health system vs community-based care was 0.30 (97.5% CI, -0.18 to 0.78); health system vs usual care, -0.33 (97.5% CI, -1.32 to 0.67); and community-based vs usual care, -0.62 (97.5% CI, -1.61 to 0.37). The LSMs for the Modified Caregiver Strain Index were 10.7 for health system, 10.5 for community-based, and 10.6 for usual care. The difference between health system vs community-based care was 0.25 (97.5% CI, -0.16 to 0.66); health system vs usual care, 0.14 (97.5% CI, -0.70 to 0.99); and community-based vs usual care, -0.10 (97.5% CI, -0.94 to 0.74). Only the secondary outcome of caregiver self-efficacy was significantly higher for both treatments vs usual care but not between treatments: LSMs were 15.1 for health system, 15.2 for community-based, and 14.4 for usual care. The difference between health system vs community-based care was -0.16 (95% CI, -0.37 to 0.06); health system vs usual care, 0.70 (95% CI, 0.26-1.14); and community-based vs usual care, 0.85 (95% CI, 0.42 to 1.29). In this randomized trial of dementia care programs, no significant differences existed between health system-based and community-based care interventions nor between either active intervention or usual care regarding patient behavioral symptoms and caregiver strain. ClinicalTrials.gov Identifier: NCT03786471.

Caregivers' Perspectives on Discussions of Medical Treatment Preferences for People Living with Dementia Are Associated with Their Dementia Health Literacy and the Caregiving Relationship.

People living with dementia experience progressive functional decline and increased dependence on caregivers. This study examined the influence of caregivers' dementia health literacy on perceptions of medical care preferences and advanced care planning (ACP) in people living with dementia. This analysis used data from a cross-sectional survey, "Care Planning for Individuals with Dementia", administered nationwide by Alzheimer's Disease Centers. We conducted binary, ordinal, and multinomial logistic regression. On average, surveyed caregivers (n=431) were 78.3 years, had 16 years of education, and were mainly white (88.5%). Most lived with (76.8%) and were the designated healthcare proxy (95.1%), with high dementia knowledge scores (mean=8.4/10). As caregivers' dementia knowledge scores increased, they were 1.27 times more likely (p=0.02) to endorse comfort care. Caregivers with greater knowledge about severe dementia were less likely to need further treatment preference-related discussions (knowing a lot: OR=0.17, p<0.001; knowing some things: OR=0.37, p=0.006). Caregivers live apart from patients were 2.71 times more likely to know about such discussions (p<0.001). Caregivers of people in earlier stages endorsed greater needs for further conversations with clinicians (no impairment & MCI: OR=7.38, p=0.002; mild impairment: OR=5.32, p=0.005) and their care recipients (no impairment & MCI: OR=5.24, p=0.02). These findings highlight the role of dementia-specific education in ACP discussions among people living with dementia, caregivers, and healthcare clinicians. These findings are important since evidence suggests that ACP may promote quality of life, reduce iatrogenic harm, minimize healthcare overutilization, and alleviate care-related burdens.

Surgery or not? A retrospective observational study in eclamptic patients with malignant posterior reversible encephalopathy syndrome (PRES) and intracerebral hemorrhage.

The study aims to evaluate the outcomes of surgical intervention in eclamptic patients with malignant posterior reversible encephalopathy syndrome (PRES) complicated by intracranial hemorrhage (ICH). A retrospective review of 22 eclamptic women diagnosed with PRES between January 2013 and November 2023 was conducted. Patients were categorized into four groups: Group 1 (no ICH, GCS 15, and no signs of increased intracranial pressure [IICP]), Group 2 (no ICH, GCS <15, with neurological deficits), Group 3 (ICH <10 ml, no mass effect, and no signs of IICP), and Group 4 (ICH >10 ml, with mass effect and signs of IICP). Patient demographics, obstetrical outcomes, radiological findings, and functional recovery (measured by mRS) were analyzed. No patients in Groups 1 or 2 required surgery, while all patients in Group 4 underwent surgical intervention. At presentation, Group 4 exhibited significantly worse mRS scores (mean 4.4) compared to Groups 1 (mean 1.2) and 2 (mean 2.29, p<0.001). However, at the 1- and 2-year follow-ups, mRS scores were comparable across all groups (p=0.458 and p=0.883, respectively), reflecting substantial recovery regardless of initial severity. Eclamptic women with malignant PRES and ICH can achieve long-term outcomes comparable to those without hemorrhagic transformation through timely surgical intervention following AHA guidelines, though the natural course of such cases remains unclear.

Assessment of Intern Medical Students and Emergency Medicine Residents’ Skill Levels in Interpreting Lung CT Scans of Patients with COVID-19 at the AJA Teaching Hospitals

Background: The lung CT scan is one of the most important methods for identifying patients with COVID-19. The skill of doctors to interpret CT scan results is very important for disease control and prevention of its serious complications. Therefore, this study was conducted to determine the skill level of intern medical students and emergency medicine residents in interpreting the lung CT scans of patients with COVID-19. Method: The present cross-sectional study was conducted on 100 intern medical students and emergency medicine residents in AJA teaching hospitals in Tehran in 2019. In this study, each participant was given 10 lung CT scans from patients with COVID-19 to interpret. The sex, academic year of the students, and the type of students (intern medical students and emergency medicine residents) were recorded. The mean score of the correct interpretation of the participants was calculated. Then, Chi-square tests or Fisher's exact test, one-way analysis of variance or Kruskal–Walli’s test, and independent t-test or Mann-Whitney test were used to analyze the data. All analyses were performed in Excel and SPSS16 software. All p-values were two-tailed, and the significance level was set at 0.05. Results: In the present study, 61% of the participants were male, and 84% were intern medical students. The mean correct interpretation score of lung CT-scan results was 53.16±24.07, and the skill level of correct interpretation of 54% of students was moderate. Also, there was no statistically significant difference between sex, academic year of the students, and the type of student with the mean of correct interpretation scores. Conclusion: Given that the skill level in interpretation of lung CT scan results among students was moderate, implementation of targeted interventions, including training courses for intern medical students and emergency medicine residents, is needed to increase their skills in correct interpretation of CT scan results.

Rate and Timing of Progression to Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction in Patients With Systemic Inflammatory Disease: A Long-term Propensity-Matched Cohort Study.

Anterior cruciate ligament reconstruction (ACLR) is one of the most common orthopaedic procedures and one of the most well studied. Despite extensive research dedicated to ACLR, there is limited understanding of how chronic inflammatory systemic diseases (CIDs) such as rheumatoid arthritis and systemic lupus erythematosus affect outcomes. To compare the outcomes of ACLR in cohorts of patients with and without CID. Cohort study; Level of evidence, 3. A retrospective query of a regional data set was conducted for all patients who underwent ACLR from 1990 to 2021 for traumatic ACL rupture. All patients with CID were identified and propensity matched to non-CID controls. Baseline characteristics and clinical outcomes were identified through retrospective chart review, and patients were contacted for subjective outcomes. A total of 30 patients with ACLR and a diagnosis of CID were identified. These patients were propensity matched to 120 non-CID controls. Baseline demographic and surgical characteristics demonstrated no statistical differences. Follow-up duration was similar between the CID and non-CID groups (mean, 14.6 vs 14.2 years; P = .868). The CID cohort had a higher arthrofibrosis rate (16.7% vs 4.3%; P = .031), higher osteoarthritis rate (33.3% vs 16.7%; P = .041), higher total knee arthroplasty (TKA) rate (16.7% vs 3.3%; P = .016), and earlier time to TKA (14.7 vs 23.5 years; P = .032). Knee range of motion, infection rate, retear rate, time to retear, and time to osteoarthritis were not statistically different between the cohorts. The CID cohort had higher visual analog scale pain scores (mean, 2.00 vs 1.20; P = .043) but slightly higher satisfaction (mean, 3.92 vs 3.39; P = .043). There were no differences in preinjury Tegner, postoperative Tegner, change in Tegner, or IKDC score. In a univariate Cox regression model, the CID cohort had a retear hazard ratio of 1.43 (95% CI, 0.46-4.51; P = .537). Kaplan-Meier survival revealed no significant differences in retear-free survival between the CID and non-CID cohorts at 25 years (85.7% vs 87.3%; P = .53). The CID cohort had a TKA hazard ratio of 3.94 (95% CI, 1.05-14.8; P = .042). Kaplan-Meier survival demonstrated significantly decreased TKA-free survival at 25 years in the CID cohort (64.9% vs 91.2%; P = .029). CID increases the incidence of arthrofibrosis, osteoarthritis, and TKA in those undergoing ACLR. Patients with CID also undergo TKA significantly sooner than non-CID counterparts. Notably, the majority of patient-reported outcome measures are no worse in patients who have a CID diagnosis. Thus, ACLR constructs themselves may not necessarily fare worse in patients with CID. Nonetheless, these patients need to be cautiously counseled on the clinical outlook after their ACLR.

Association Between the Community Gatherings Places and the Kihon Checklist Score: JAGES Longitudinal Study.

The purpose of this study was to examine the relationship between the number of program types and CGA in community gathering places to gain valid insights into the provision of programs in community gathering places. The study is longitudinal in nature and uses prospective cohort data from the Japan Gerontological Evaluation Study. The participants were 8758 older adults recruited from 28 cities and towns. The dependent variable was the CGA using the KCL. The independent variable was the number of program types in community gathering places. The participants were classified under four groups, namely, No Participation, One Type, Two Types, and More Than Three Types. The study performed linear regression analysis. The mean of the KCL scores by the number of types was 3.8 ± 3.3, 3.5 ± 3.0, 3.3 ± 2.9, and 3.2 ± 2.8 points for the four groups, respectively. CGA was better for two and three or more types of program participation. CGA at 3 years was better when the community gathering places implemented two or more types of program.

THE ROLE OF DYNAMIC CERVICAL MRI IN DETERMINING THE LEVEL OF POSTERIOR DECOMPRESSION IN CERVICAL SPONDYLOTIC MYELOPATHY.

Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction in adults, often progressing silently. Static MRI is the standard imaging tool but may miss compression caused by neck movement. Dynamic MRI, by capturing flexion and extension views, provides a clearer picture of spinal cord compression, aiding surgical planning and improving outcomes. However, its use is limited due to higher costs and specialized requirements, making its clinical value essential to assess. Eighty-two CSM patients undergoing posterior decompression surgery were divided into two groups: static MRI-based planning (n=43) and combined static and dynamic MRI-based planning (n=39). Neurological outcomes were evaluated using modified Japanese Orthopaedic Association (mJOA) and Visual Analog Scale (VAS) scores pre- and postoperatively. Compression levels identified on static and dynamic MRI were compared. Demographic characteristics were similar between groups. Dynamic MRI identified additional compression levels, mainly at C5-C6 and C6-C7, in 18 patients. Patients in the dynamic MRI group showed significantly greater improvements in mJOA scores (mean: 15.8 ± 1.6 vs. 14.5 ± 1.8, p=0.01) and VAS scores (mean: 3.2 ± 1.4 vs. 4.5 ± 1.8, p=0.01) compared to the static MRI group. Dynamic cervical MRI enhances the identification of compression levels overlooked by static MRI, improving surgical precision and postoperative outcomes in CSM patients. Incorporating dynamic MRI into routine preoperative evaluations may be particularly beneficial for complex, multilevel cases.

Estimating Trends in Cardiovascular Disease Risk for the EXPOSE (Explaining Population Trends in Cardiovascular Risk: A Comparative Analysis of Health Transitions in South Africa and England) Study: Repeated Cross-Sectional Study.

Cardiovascular diseases (CVDs) are the leading cause of death globally. Demographic, behavioral, socioeconomic, health care, and psychosocial variables considered risk factors for CVD are routinely measured in population health surveys, providing opportunities to examine health transitions. Studying the drivers of health transitions in countries where multiple burdens of disease persist (eg, South Africa), compared with countries regarded as models of "epidemiologic transition" (eg, England), can provide knowledge on where best to intervene and direct resources to reduce the disease burden. The EXPOSE (Explaining Population Trends in Cardiovascular Risk: A Comparative Analysis of Health Transitions in South Africa and England) study analyzes microlevel data collected from multiple nationally representative population health surveys conducted in these 2 countries between 1998 and 2017. Creating a harmonized dataset by pooling repeated cross-sectional surveys to model trends in CVD risk is challenging due to changes in aspects such as survey content, question wording, inclusion of boost samples, weighting, measuring equipment, and guidelines for data protection. This study aimed to create a harmonized dataset based on the annual Health Surveys for England to estimate trends in mean predicted 10-year CVD risk (primary outcome) and its individual risk components (secondary outcome). We compiled a harmonized dataset to estimate trends between 1998 and 2017 in the English adult population, including the primary and secondary outcomes, and potential drivers of those trends. Laboratory- and non-laboratory-based World Health Organization (WHO) and Globorisk algorithms were used to calculate the predicted 10-year total (fatal and nonfatal) CVD risk. Sex-specific estimates of the mean 10-year CVD risk and its components by survey year were calculated, accounting for the complex survey design. Laboratory- and non-laboratory-based 10-year CVD risk scores were calculated for 33,628 and 61,629 participants aged 40 to 74 years, respectively. The absolute predicted 10-year risk of CVD declined significantly on average over the last 2 decades in both sexes (for linear trend; all P<.001). In men, the mean of the laboratory-based WHO risk score was 10.1% (SE 0.2%) and 8.4% (SE 0.2%) in 1998 and 2017, respectively; corresponding figures in women were 5.6% (SE 0.1%) and 4.5% (SE 0.1%). In men, the mean of the non-laboratory-based WHO risk score was 9.6% (SE 0.1%) and 8.9% (SE 0.2%) in 1998 and 2017, respectively; corresponding figures in women were 5.8% (SE 0.1%) and 4.8% (SE 0.1%). Predicted CVD risk using the Globorisk algorithms was lower on average in absolute terms, but the pattern of change was very similar. Trends in the individual risk components showed a complex pattern. Harmonized data from repeated cross-sectional health surveys can be used to quantify the drivers of recent changes in CVD risk at the population level.