Medical Center Research Articles

Implementation of a university-wide health-system collaborative to provide pharmacy preceptor development across multiple institutions

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The University of California Preceptor Development Collaborative was established in 2022 across 5 academic medical centers and 3 schools of pharmacy. The collaborative aimed to streamline preceptor development efforts, enhance collaboration, and meet accreditation standards efficiently by providing quarterly preceptor development programming across all sites to residency and school preceptors. This article describes the implementation of the collaborative and assesses the number of attendees, attendee satisfaction, and cost during the pilot year. Summary During the pilot year, 5 live virtual preceptor development modules were developed for pharmacist preceptors. There were 631 credit hours claimed (196 from session 1, 106 from session 2, 68 from session 3, 123 from session 4, and 138 from session 5). Preceptor satisfaction, as measured from completed postsession evaluations (n = 704), was high (a median score of 5 on a Likert scale where 1 = none at all, 2 = a little, 3 = a moderate amount, 4 = a lot, and 5 = a great deal) for meeting educational, professional, teaching, or clinical needs. There was strong agreement (median score of 5 on Likert scale where 1 = strongly disagree, 2 = somewhat disagree, 3 = neither agree nor disagree, 4 = somewhat agree, and 5 = strongly agree) that the modules improved knowledge, ability to change practice, and ability to have positive impacts on trainees and patients. The cost per attendee for this series was $1.58 per continuing education credit. Conclusion A multi-institution state-wide preceptor collaborative effort produced quarterly continuing education for residency and school of pharmacy preceptors who were affiliated with the sites. This approach to preceptor development is a convenient, satisfactory, and cost-effective method to deliver training for pharmacy preceptors.

Comparison of functional outcome after intracerebral hemorrhage in patients with or without end stage renal disease on hemodialysis: a propensity-score matched study

Abstract Background End stage renal disease (ESRD) requiring hemodialysis (HD) increases mortality among patients with intracerebral hemorrhage (ICH). The aim of this study is to investigate the clinical characteristics and outcome of ICH patients with ESRD on HD versus propensity-score matched controls. Methods This is a single center retrospective study. Consecutive ICH admissions at the University of California, Irvine Medical Center from January 1, 2018 to July 31, 2022 were analyzed. Results Among 347 ICH admissions that met inclusion criteria, 24 patients (6.92%) had ESRD on HD. Compared to patients without ESRD, patients with ESRD on HD had significantly higher rate of diabetes mellitus (79.2% vs. 36.8%, p < 0.01) and in-hospital mortality (25% vs. 7.43%, p < 0.01). There were no significant differences in demographics, other comorbidities, clinical characteristics, good (mRS score 0–3) or poor (mRS score 4–5) functional outcomes, rate of comfort care and the time to comfort care decision between the 2 groups. After propensity score matching, the ESRD group had a significantly higher in-hospital mortality rate (27.3% vs. 8%, p = 0.012) and a lower rate of obesity (9.1% vs. 34.1%, p = 0.02). Among patients who died during admission, ESRD on HD status did not inadvertently influence end-of-life care decisions. Univariate logistic regression and area under curve analysis showed that ICH score ≥ 3 was a predictor of increased mortality in both ESRD and non-ESRD groups. Conclusions ICH patients with ESRD on HD had significantly higher in-hospital mortality and lower rate of obesity than propensity score matched controls, suggesting a survival benefit from obesity. ICH score ≥ 3 is an independent predictor for poor outcomes in both ESRD and non-ESRD groups.

Delirium after cardiac arrest: incidence, risk factors, and association with neurologic outcome—insights from the Freiburg Delirium Registry

Abstract Aim Delirium in patients treated in the intensive care unit (ICU) is linked to adverse outcome, according to previous observations. However, data on patients recovering after cardiac arrest are sparse. The aim of this study was to assess incidence, risk factors, and outcome of patients with delirium after cardiac arrest in the Freiburg Delirium Registry (FDR). Methods In this retrospective registry study, all patients after cardiac arrest treated in the Freiburg University Medical Center medical ICU between 08/2016 and 03/2021 were included. Delirium was diagnosed using the Nursing Delirium screening scale (NuDesc), assessed three times daily. Favorable neurological outcome was defined as cerebral performance category (CPC) score at ICU discharge ≤ 2. Results Two hundred seventeen patients were included and among them, delirium was detected in one hundred ninety-nine (91.7%) patients. Age was independently associated with the incidence of delirium (p = 0.003), and inversely associated with the number of delirium-free days (p < 0.001). Favorable neurological outcome was present in 145/199 (72.9%) with, and 17/18 (94.4%) patients without delirium (p = 0.048). While the incidence of delirium was not independently associated with a favorable neurologic outcome, the number of delirium-free days strongly predicted the primary endpoint [OR 2.14 (1.73–2.64), p > 0.001]. Conclusion Delirium complicated the ICU course in almost all patients after cardiac arrest. The number of delirium-free days was associated with favorable outcome while incidence of delirium itself was not. Graphical abstract

Pediatric endocardial temporary pacemaker implantation: Clinical characteristics and outcomes from a Chinese National Regional Health Center

AbstractEndocardial temporary pacemakers (TP) are widely used in the treatment of cardiovascular diseases in adults, but their application and clinical experience in the treatment of pediatric cardiovascular cases are relatively limited. This study aims to share the experience of using endocardial TP at a pediatric medical center in China. The study included patients who received their first endocardial TP implantation in the Department of Cardiology at Children's Hospital of Chongqing Medical University, China, from 2016 to 2022. A retrospective analysis of their clinical data was conducted. Our study involved 45 children who underwent endocardial TP implantation. Among these, 25 children (55.56%) converted to sinus rhythm after pacemaker parameter adjustment and the pacemaker was successfully removed; 13 children (28.89%) did not recover sinus rhythm and ultimately required a permanent pacemaker; in 4 cases, the family refused permanent pacemaker implantation; in 1 case, the treatment was abandoned by the family; and 2 children died during hospitalization. Notably, among the 20 children with fulminant myocarditis (FM), 16 children (80.00%) converted to sinus rhythm after pacemaker parameter adjustment and the pacemaker was successfully removed; 3 children (15.00%) ultimately received a permanent pacemaker; and 1 child died during hospitalization. Endocardial TP have shown remarkable efficacy in the treatment of critical heart disease, especially FM.

Characterization of non‐IgA vasculitis: Demographic, clinical, and treatment‐related features in a retrospective analysis of 28 biopsy‐confirmed cases from a German university hospital

AbstractNon‐IgA vasculitis is a rare disease that belongs to the group of small‐vessel vasculitides. Due to nomenclature and classification changes introduced in 2018, there are few published data under this name. The aim of this study is to characterize non‐IgA vasculitis as an independent vasculitis entity in terms of demographic, clinical, and treatment‐related features. A retrospective data analysis of patients with biopsy‐confirmed non‐IgA vasculitis treated at the Department of Dermatology at the University Medical Center Hamburg‐Eppendorf between January 1, 2018, and December 31, 2022, was performed. A total of 28 patients with non‐IgA vasculitis were included; 53.6% (15/28) were women and 42.9% (12/28) were older than 71 years. Previous infection as a possible triggering factor was found in 42.6% (12/28) of the cases. Palpable purpura was the most common skin finding (78.6%, 22/28) and 28.6% patients (8/28) had skin lesions above the waist. On direct immunofluorescence, C3 (89.3%, 25/28) was the most frequent deposition, followed by fibrinogen (71.4%, 20/28) and IgM (53.6%, 15/28). Hospitalization was required in 85.7% (24/28), with a mean hospital stay of 9.4 ± 4.1 days. No fatal courses were reported. This study is the first characterization of non‐IgA vasculitis based on patient cases from Germany and contributes to a better understanding of non‐IgA vasculitis as an independent entity. Non‐IgA vasculitis primarily affects older patients of both sexes, with most cases having an identifiable trigger. Our results indicate that cutaneous manifestations often extend beyond the lower legs. Treatment is usually required in the inpatient setting and requires a longer stay than other dermatological conditions. With proper treatment, the disease is not expected to be fatal.

Factors Associated With Delay in Seeking Abortion Care Until the Second Trimester at Jimma University Medical Centre: A Prospective Cross‐Sectional Study Jimma, Southwest Ethiopia

ABSTRACTObjectiveAlthough the overall abortion‐related maternal mortality ratio has shown a downward trend in Ethiopia, the case‐fatality rate from abortion is still high. This study identified factors associated with delays in seeking an abortion until the second trimester at Jimma Medical Centre, Jimma, southwest Ethiopia.MethodsFrom February to August 2023, we conducted a cross‐sectional study on pregnant women seeking safe abortion care. Participants were selected through systematic sampling from a sample size of 260 calculated based on a previous study's prevalence of second‐trimester abortion (19.2%), with 80% power and a 5% margin of error. Participants were selected using systematic sampling and data were collected by an interviewer‐administered questionnaire. P‐value adjusted odds ratios (AORs) with their 95% confidence interval (CI) were used to determine the association between variables.ResultsThe study found a high prevalence of second‐trimester abortion at 58%. Factors significantly associated with delays in seeking abortion services until the second trimester included being from a rural area (AOR = 2.1, 95% CI: 1.2–3.8), experiencing social stigma (AOR = 4.2, 95% CI: 2.9–7.8), being unmarried (AOR = 1.6, 95% CI: 1.0–3.0), having limited knowledge of menstrual periods (AOR = 2.3, 95% CI: 1.2–4.6), delaying suspicion and testing for pregnancy (AOR = 18.2, 95% CI: 2.1–8.9–37.3), postponing the decision to have an abortion by more than 1 week (AOR = 4.9, CI: 1.0–23.7), and being a primigravidae (AOR = 2.1, CI: 1.1–4.1).ConclusionsBeing from a rural area, social stigma surrounding abortion, being unmarried, limited knowledge of menstrual periods, and being a primigravidae were found to be significantly associated with delays in seeking abortion services until the second trimester. A multifaceted approach and efforts should focus on improving access to healthcare resources in rural areas, reducing social stigma surrounding abortion through education and advocacy, and providing comprehensive reproductive health education to enhance knowledge about menstrual cycles and pregnancy testing adapting to local contexts including employing community‐based approaches, using visual and interactive tools, and ensuring cultural sensitivity.

Quantifying the Effect of the Cross‐Facial Nerve Graft on the Nonparalyzed Side

AbstractObjectiveThe cross‐facial nerve graft (CFNG) is employed in facial reanimation surgery to restore neural connectivity from the nonparalyzed side of the face to the paralyzed side, facilitating spontaneous smiling. Typically, the sural nerve, due to its length, serves as the donor graft. Implantation involves functional facial branch transection to provide graft input. However, impact of this transection on a patient's smile has not been conclusively quantified.Study Setting & DesignTertiary Care Academic Medical Center; retrospective chart review.MethodsIn a chart review of patients from 2018 to 2022, 15 patients with unilateral flaccid facial paralysis who underwent CFNG were identified. Demographic and clinical data were collated including medical history and operative details. Emotrics software was used to compare preoperative and postoperative photographs by measuring smile parameters. Percent change was analyzed via Student's T‐test.ResultsA zygomatic branch was sacrificed in 8/15 (53%) surgeries and a buccal branch in 4/15 (27%) surgeries. When evaluating smile angle, dental show, upper lip height deviation, and commissure excursion for open and closed smiles, the average relative change for the nonparalyzed side was 3.4%, 2.8 mm, 12.5%, 3.0 mm, and 1.9% respectively. When comparing these metrics preoperatively and postoperatively in the functional side, there was no statistically significant difference (P = .13, P = .65, P = .33, P = .36, P = .64).ConclusionThere was no significant difference in our assessment of smile after facial branch transection in CFNG, suggesting the impact on a patient's smile may be negligible. Additional studies are needed to characterize qualitative impact on patients and result generalizability.

Identification of risk factors for necrotizing enterocolitis in twins: a case-control matching analysis of over ten-years' experience.

The identification of risk factors is crucial for the clinical prevention and diagnosis of necrotizing enterocolitis (NEC). Monochorionic twins (MCT), due to the high genetic homogeneity, provided a valuable model for investigating the risk factors of various diseases. This study aimed to explore the risk factors for NEC using MCT. A retrospective review was conducted on the medical records of monochorionic twins (MCT) treated at Guangzhou Women and Children's Medical Center from January 2012 to March 2023. We compared perinatal condition, feeding and preceding condition between MCT pairs with NEC (NEC MCT) and without NEC(No NEC MCT).Logistic regression analysis was utilized to identify independent risk factors. In 85 pairs of monochorionic twins (MCT), NEC occurred in one twin in 78.8% of cases, whereas both twins were affected in 21.2% of cases. In the final cohort of 60 pairs of MCT, several parameters were found to differ significantly between NEC MCT group and No NEC MCT group. Compared to No NEC MCT group, the incidence of umbilical cord abnormalities was significantly higher in the NEC MCT group (25% vs. 8.3%, P = 0.014). Meanwhile, NEC MCT group showed higher prevalence of SGA infants (48.3% vs. 21.7%, P = 0.002) and sFGR (38.3% vs. 6.7%, P = 0.000). Furthermore, TTTs (13.3% vs. 3.3%, P = 0.027) and septicemia (25% vs. 5%, P = 0.002) were more common in NEC MCT group. In a multivariable logistic regression model, sFGR (OR 6.81,95%CI 2.1-21.9, p = 0.001) was eventually output as an independent risk factor. Non-genetic factors play a predominant role in the pathogenesis of NEC. Umbilical cord abnormalities, SGA, sFGR, TTTs and septicemia significantly increase the risk of NEC. sFGR is an independent risk factor of NEC.

Emotion-Related Syncope in A Young Female Patient

Abstract A female patient in her 20s presented to our medical center with recurrent attacks of transient loss of consciousness that were essentially related to severe emotional situations. During hospital admission, she suffered an exercise-related presyncope while performing a stress ECG which recorded a transition from regular sinus rhythm into a bidirectional ventricular tachyarrhythmia which is a characteristic pattern of catecholaminergic polymorphic ventricular tachycardia.

Cotoneaster Side Effects Following the Treatment of Neonatal Jaundice

Background: There has been significant interest in using Cotoneaster for treating jaundice or elevated bilirubin levels in newborns, and it has, in many cases, replaced phototherapy in herbal medicine. However, using these compounds to treat hyperbilirubinemia can lead to complications in neonates, potentially resulting in morbidity and even death. Objectives: This study examined the side effects of Cotoneaster consumption in jaundiced neonates admitted to the Children’s Medical Center between 2021 and 2022. Methods: We conducted a cross-sectional study involving healthy neonates who consumed Cotoneaster following treatment for neonatal jaundice and subsequently experienced complications. The data were recorded using pre-prepared questionnaire forms. Results: The most common complications following Cotoneaster derivatives were exaggerated hyperbilirubinemia, dehydration, and poor feeding. Conclusions: Given the sensitivity of neonates, the treatment of jaundice in babies should be approached with caution and supported by extensive studies. The use of herbal medicines in neonates remains questionable due to associated complications.

Anti-integrin αvβ6 autoantibody in primary sclerosing cholangitis: a Japanese nationwide study.

Although specific biomarkers for primary sclerosing cholangitis (PSC) are required, no such biomarkers have been identified. We previously reported that patients with PSC had anti-integrin αvβ6 autoantibodies at only two hospitals. In this study, we aimed to validate the accuracy of the autoantibodies in diagnosing PSC using the newly developed Anti-integrin αvβ6 enzyme-linked immunosorbent assay (ELISA) Kit, which enables quantitation and comparison of antibodies among different facilities. Overall, 81 patients with PSC in a Japanese PSC registry recruited from 17 medical centers and hospitals, and 358 controls were enrolled. We retrospectively assessed anti-integrin αvβ6 autoantibodies using the Anti-integrin αvβ6 ELISA Kit and in-house ELISA. Anti-Integrin αvβ6 ELISA Kit and in-house ELISA exhibited a significant correlation (r = 0.97, P < 0.001). Anti-integrin αvβ6 autoantibodies were detected in 67 of 81 (82.7%) patients with PSC and 20 of 358 (5.6%) controls, resulting in a sensitivity of 82.7% and specificity of 94.4% for PSC, using the anti-integrin αvβ6 ELISA Kit. When focusing on the presence or absence of inflammatory bowel disease (IBD), the sensitivities for PSC with ulcerative colitis, Crohn's disease, unclassified-IBD, and without IBD were 97.8% (43/44), 100% (1/1), 80.0% (8/10), and 53.8% (7/13), respectively. Antibody concentrations were significantly higher in PSC patients without IBD than in controls (P < 0.001). We validated that anti-integrin αvβ6 autoantibodies have high sensitivity and specificity for diagnosing PSC. This study provides further evidence that anti-integrin αvβ6 autoantibodies are a useful biomarker for diagnosing PSC.

Clinicopathologic features of primary central nervous system anaplastic large cell lymphoma: a multicenter study identifies age and ALK status as prognostic factors.

Anaplastic large cell lymphoma with primary presentation in, and disease limited to, the central nervous system (primary CNS ALCL) is a rare and aggressive lymphoma found in a sensitive anatomic site. We report the clinical and pathologic characteristics of 17 primary CNS ALCL cases that are newly reported from six academic medical centers. We are investigating the characteristics of these cases, alongside their commonalities and differences from systemic ALCL arising at conventional anatomic sites. Clinical, pathologic, and outcome data were extracted by medical record review. The median patient age was 32years with a male-to-female ratio of 2.4:1. Cases presented with either localized or multifocal central nervous system (CNS) disease without coinciding systemic disease. Histologically, the common pattern prevailed, and loss of pan-T-cell markers was frequent. There was a similar proportion of anaplastic lymphoma kinase (ALK) positivity in primary CNS ALCL (12/17, 71%) compared to that reported in systemic ALCL (70-80%). Our data indicate a 5-year overall survival (OS) rate of 65% and a 5-year progression-free survival (PFS) rate of 48%. Five patient deaths occurred in this study of which all were in the ALK-negative group, and all were patients over 40years old. ALK-positive patients were significantly younger than ALK-negative patients, and survival analyses showed that both ALK-positive and younger age (≤ 40years) were favorable prognostic factors. This is the largest series of primary CNS ALCL reported to date, which demonstrates a high proportion of ALK-positive cases and favorable outcomes for both younger and ALK-positive patients despite the involvement of a sensitive anatomic site.

Detection of BRCA-1 gene mutations in epithelial ovarian tumors at tertiary care hospital Karachi

ABSTRACT Background: Ovarian cancer is the most common and lethal gynecological malignancy. Ovarian malignancy is the 3rd most common cancer in Pakistan. More than 90% ovarian cancers are of epithelial cell origin, about 24-40% such cancers have hereditary or sporadic mutation in the BRCA-1 or BRCA-2 genes. The present study was designed to detect BRCA-1 gene mutations in different histological sub-types of epithelial origin of benign, borderline and malignant ovarian tumors. Methods: This cross-sectional study was based on the analysis of BRCA-1 gene mutations in the epithelial origin of benign, borderline and malignant ovarian tumors received at the department of Pathology, Basic Medical Sciences Institute, Jinnah Post graduate Medical Centre, from 01-01-2011 to 31-12-2015. A total of 80 diagnosed cases were selected and analyzed for PCR. Results: BRCA-1 gene mutations were detected in 22 (27.5%) cases out of the 80 randomly selected epithelial ovarian tumors. Serous cyst adenocarcinoma was the commonest including 63% cases. BRCA-1 gene mutations were also positive in other epithelial ovarian tumors, including Mucinous cyst adenocarcinoma (13.6%), Endometroid adenocarcinoma and Mixed Mullerian tumor (4.5% each). In addition mutations were also detected in borderline tumors including Mucinous borderline tumor (9.09%) and Seromucinous borderline tumors (4.5%).The observations and results of the study were elaborated with the assistance of tables, figures and photomicrographs. Conclusion: BRCA-1 gene mutations manifestations were identified in a large number of serous malignant ovarian tumor cases. Small percentages of borderline and malignant mucinous tumors, endometroid adenocarcinoma and mixed mullerian tumor were also positive for BRCA-1 gene mutations.

Socioeconomic determinants of malaria and hepatitis infections: insights from the Federal Medical Center, Makurdi, North Central, Nigeria.

Malaria and hepatitis are prevalent public health issues in Nigeria, significantly impacting health outcomes. Given the importance of the Federal Medical Center, Makurdi, as a key healthcare provider in the region, it is crucial to understand the prevalence and factors associated with these diseases within this setting. This study is designed to address this need, aiming to evaluate the prevalence and risk factors of malaria and hepatitis B and C among patients at the Federal Medical Center, Makurdi. A cross-sectional study design was employed, involving the meticulous analysis of patient records and diagnostic data from the Federal Medical Center, Makurdi. Data on malaria and hepatitis B and C prevalence were collected from laboratory reports and patient interviews. Socioeconomic information, including income, education level, and healthcare access, was also gathered. Statistical analyses were performed with utmost care to identify associations between disease prevalence and risk factors. The study examined 248 patients at the Federal Medical Centre, Makurdi, assessing malaria, Hepatitis B surface antigen (HBsAg), and Hepatitis C virus (HCV). Malaria prevalence was 52.4%, with higher rates in males (57.7%) than females (47.2%). HBsAg prevalence was 6.9%, and HCV was 4.8%, with no significant differences by sex or marital status. Income level impacted HCV rates, with middle-income individuals showing higher prevalence (21.4%). Malaria was most common in the 26-40 age group (35.4%). The findings underscore the need for targeted public health interventions. Enhanced access to preventive measures, such as insecticide-treated nets and safer blood transfusion practices, and educational disease prevention programs, are essential. Addressing socioeconomic disparities is crucial for effective disease control. To mitigate the burden of malaria and hepatitis B and C at the Federal Medical Center, Makurdi, a multifaceted approach is required. Improving preventive measures, healthcare access, and addressing socioeconomic determinants will reduce disease prevalence and improve patient outcomes.

Needs assessment for a new military burn care educational curriculum focused on prolonged field care: The Burns for Providers Program (BP2).

We performed a needs assessment to determine the essential elements for a curriculum teaching burn care during Large Scale Combat Operations against peer/near-peer adversaries within multi-domain contested combat environments. Virtual and face-to-face site visit meetings were conducted with 20 stakeholders at 3 levels: 1) Subject Matter Experts (SMEs) in military burn casualty care at the U.S. Army Institute of Surgical Research (USAISR), the Joint Trauma System (JTS), and the U.S. Army Medical Center of Excellence (US Army MedCOE) in Joint Base San Antonio (JBSA) - Fort Sam Houston, TX; 2) Course Directors, Instructors, Curriculum Innovators and Writers for the Combat Paramedic Branch and the Critical Care Flight Paramedic Program (CCFPP) at JBSA; and 3) regulatory administrators providing education, research and IRB administration for USAISR and US Army MEDCOE. The identified terminal learning objectives consisted of training in: burn casualty monitoring and principles of burn wound care according to available resources; best practices during PCC for pain, nutrition, and infection control; specific management of inhalation, chemical, radiation, electrical, pediatric, and mass casualty burn injuries; and procedural skill training for patient decontamination, debridement, dressings, and escharotomy. Additionally, needs were identified for novel technology that provides asynchronous individual learning opportunities using interactive role play simulations, immersive simulation, or virtual reality simulation as well as hands-on procedure simulators. Stakeholder engagement resulted in identification of sixteen terminal learning objectives that were subsequently used as the basis for a military curriculum we are calling the "Burns for Providers Program" (BP2).

The Strategies to Improve Primary Health Care Services: A Scoping Review

Context: Evaluation of health policies and identification of their challenges are vital for improving and implementing reforms in the healthcare system. The present study was conducted to identify interventions aimed at improving primary healthcare (PHC) services in Iran. Evidence Acquisition: This research utilizes a scoping review to examine reform interventions in PHC services across 10 selected countries: Qatar, Oman, Turkey, Georgia, Armenia, United Arab Emirates, Saudi Arabia, Bahrain, Kazakhstan, and Kuwait. The study covers areas such as the PHC delivery system, human resource management, financial mechanisms, and the framework of community participation and intersectoral collaboration from 2010 to 2022. Results: The main reform strategies for PHC systems in the reviewed countries included the establishment of family medical centers with nurse support as a comprehensive strategy for service provision in public health centers; providing comprehensive and quality healthcare service packages including maternal and child health, infectious disease immunization, chronic disease monitoring, and dental care services; health education; access to essential medications; improvement of electronic health services; implementation of health promotion and continuous prevention programs; capacity enhancement; and a greater focus on health screening programs and grading of healthcare centers. Conclusions: The major findings from the reviewed countries indicate that healthcare policymakers focus on providing preventive care services, reducing maternal and child mortality, and increasing life expectancy. Programs such as referral systems, service grading, and the adoption of electronic health services are part of their reform agenda.

Dual trigger versus human chorionic gonadotropin trigger for blastocyst quality and cumulative live birth.

To evaluate the difference in the number of euploid blastocysts and cumulative live birth rate (LBR) between dual and human chorionic gonadotropin (hCG) triggers in poor and normal ovarian responders undergoing preimplantation genetic testing (PGT) cycles. This retrospective cohort study was enrolled from July 2018 to December 2021 and followed up until June 2024 at a single reproductive medical center. Overall, 1040 in vitro fertilization (IVF)-PGT and 784 frozen-thawed embryo transfer (FET) cycles were assessed. Dual (triptorelin acetate 0.2 mg and recombinant hCG [rhCG] 250 µg) or hCG (rhCG 250 µg) trigger was used for oocyte maturation in the gonadotropin-releasing hormone antagonist protocol and PGT cycles. We assessed the embryo outcomes and FET cumulative pregnancy outcomes. The number of oocytes retrieved (10.17 ± 5.22 vs 10.27 ± 5.14, P = 0.789), MII oocytes (8.24 ± 4.26 vs 8.28 ± 4.05, P = 0.888), blastocysts (2.16 ± 1.50 vs 2.12 ± 1.49, P = 0.729), euploid blastocysts (1.06 ± 1.14 vs 1.09 ± 1.23, P = 0.726), and the rate of cumulative LBR (24.9% vs 24.9%, P = 1.000) in the dual trigger group were comparable with those in the hCG group. The trigger method was not correlated with higher LBR based on logistic regression analysis (odds ratio[OR] = 1.040 [0.778-1.392], P = 0.790). For poor and normal ovarian responders, the dual trigger, compared with the hCG trigger, did not improve the PGT embryo outcomes and FET cumulative pregnancy outcomes.

A prospective multicenter birth cohort in China: pregnancy health atlas.

The China Prospective Multi-Center Birth Cohort Study was launched in 2022. In collaboration with medical centers in 12 cities, it aims to establish a high-quality, multidimensional cohort comprising 20,000 natural pregnancy and assisted reproductive families. As of June 26, 2024, 12,911 pregnant women have participated in this study, and 161,122 biological samples have been collected. These samples cover four critical periods (early pregnancy, mid-pregnancy, late pregnancy, and postpartum) and comprise 10 different types such as serum, plasma, and urine. The study has collected comprehensive information from early pregnancy to newborns. The participants have an average age of 29.76years, an average height of 160.46cm, an average pre-pregnancy BMI of 23.11, and an average BMI of 27.25 before delivery. The cohort includes individuals from 26 ethnic groups, with 25 minority groups comprising 5.03% of the population. Guizhou Province exhibits the highest percentage of ethnic minorities at 24.96% and Guangdong Province owns the highest proportion (12.22%)of women with two or more children. The prevalence of thalassemia in Guangdong Province is seven times higher than in other provinces. Among pregnant women over 35years old, the prevalence of gestational diabetes mellitus is twice that of women under 35. Additionally, the prevalence of preeclampsia in women with assisted reproductive pregnancies is more than twice that of those with natural pregnancies. The study extensively collected diverse data and biological samples, making this cohort an ideal candidate for DOHaD field and multi-omics research.

Nomogram for predicting early recurrence of hepatocellular carcinoma with narrow resection margin.

Narrow resection margin hepatocellular carcinoma (NRM-HCC) has a high incidence of early recurrence. Our study was designed to identify prognostic factors in patients with NRM-HCC, establish and validate a nomogram model to predict early recurrence of NRM-HCC patients. We retrospectively analyzed data from 2957 NRM-HCC patients who underwent radical hepatectomy at three medical centers between December 2009 and January 2015. Patients were randomly assigned to a training cohort (n = 2069) and a validation cohort (n = 888). Using univariate and multivariate COX regression to determine early relapse factors in NRM-HCC patients, and used these factors to construct a nomogram. The accuracy of the prediction was evaluated using the C-index, receiver operating characteristic (ROC) and calibration curve. Decision curve analysis (DCA) assessed the predictive value of the models. Finally, the recurrence-free survival of different risks was analyzed using Kaplan-Meier (K-M) method. The nomogram of NRM model contains alpha-fetoprotein (AFP), alkaline phosphatase (ALP), tumor size, tumor number, microvascular invasion (MVI), tumor capsular, and satellite nodules. The model shows good discrimination with C-indexes of 0.71 (95% CI: 0.69-0.72) and 0.72 (95% CI: 0.70-0.75) in the train cohort and test cohort respectively. Decision curve analysis demonstrated that the model is clinically useful and the calibration of our model was favorable. Our model stratified patients into two different risk groups, which exhibited significantly different early recurrence. The web-based tools are convenient for clinical practice. NRM model demonstrated favorable performance in predicting early recurrence in NRM-HCC patients. This novel model will be helpful to guide postoperative follow-up and adjuvant therapy.

Survey on Cardiologists’ Perspectives on Cardiac Point-of-Care Ultrasounds (POCUS)

Introduction: Cardiac point of care ultrasound (POCUS) has been used with increasing frequency. As a result of this trend, this study sought to characterize cardiologists’ perspectives on cardiac POCUS. Methods: An 18-question survey on demographics, cardiac POCUS clinical practice, education, and infrastructure was distributed by 16 academic medical centers. Likert scale responses were categorized into three groups: 1) “strongly agree” or “agree” 2) “strongly disagree” and “disagree” and 3) “neutral.” Results: Of the 140 survey responses collected from January to September 2021, 41% of respondents used cardiac POCUS more than twice in an inpatient week. Seventy-one percent of cardiologists believed that cardiac POCUS should be integrated more regularly into clinical practice and into cardiology fellowship education. Less than half of respondents (44%) reported easy access to POCUS devices, and more than half of respondents (56%) did not think there was appropriate institutional infrastructure to easily upload and document cardiac POCUS images (56%). Conclusions: Academic cardiologists had varying opinions on the use and impact of cardiac POCUS. However, most cardiologists believed that cardiac POCUS should be more incorporated within practice despite persisting infrastructure barriers.