Medical Procedures Research Articles

Virtual Reality in Cancer Care: Enhancing Knowledge and Reducing Anxiety about Chemotherapy among Patients and Caregivers.

Virtual reality (VR) technology has evolved from entertainment to significant applications in healthcare and education. Despite its potential, there is limited research on the role of VR in cancer care. This study investigates VR's ability to simulate the chemotherapy process, aiming to enhance patients' knowledge and mitigate anxiety associated with chemotherapy. Utilizing a two-arm, mixed-methods pre/post-survey design, the study measured changes in patients' anxiety and knowledge before and after exposure to a VR simulation. Participants (n = 267) engaged with VR simulations or interactive 360-degree videos depicting the chemotherapy process. Data analyses revealed a significant median increase in chemotherapy knowledge post-exposure to the VR content (z = 12.511, p < 0.001). Demographic factSors significantly influenced perceptions of VR realism and usefulness (p < 0.05). Additionally, VR exposure was correlated with reduced anxiety levels and improved treatment expectations (p < 0.05). Participants with higher post-understanding chemotherapy scores considered VR a useful tool for managing anxiety about chemotherapy and recommended VR for other medical procedures (p < 0.001). These findings underscore VR technology's potential as a valuable tool in cancer treatment, suggesting it can enhance patient education and reduce anxiety, thereby improving patient outcomes during cancer therapy.

Upper Extremity Deep Vein Thrombosis: Incidence, Risk Factors, and Effectiveness of Chemoprophylaxis.

Upper extremity deep vein thrombosis (UEDVT) is associated with pulmonary embolism and other complications, but there are no recommendations for UEDVT prophylaxis. The purpose of this study was to establish incidence and risk factors for UEDVT and to determine efficacy of pharmacologic prophylaxis for UEDVT prevention. For this retrospective cohort study, we identified medical patients aged 18 years and older admitted to 13 Cleveland Clinic hospitals from January 2011 to December 2019. Patients with venous thromboembolism (VTE) on admission, length of stay <1 day, and who received therapeutic anticoagulation were excluded. The potential risk factors included demographics, comorbidities, and medical procedures. Comorbidities were identified via International Classification of Diseases codes, (ICD9 and ICD10), procedures from flowsheets, and prophylaxis from medications administered in the electronic medical record. DVT events were identified by a combination of International Classification of Diseases codes and confirmed by chart review. We performed multivariable logistic regression to identify independent risk factors and the association between VTE prophylaxis and UEDVT. The model's C statistic was obtained using 1000 bootstrap runs. Of 194,809 patients, 496 (0.25% of cohort, 36.8% of all VTE) developed UEDVT by 14 days. In the logistic regression model (bias-corrected C statistic 0.87), 11 risk factors predicted UEDVT, the strongest being peripherally inserted central catheter (odds ratio [OR] 4.62, 95% confidence interval [CI] 3.81-5.60) and central venous catheter (OR 3.57, 95% CI 2.91-4.37). The predicted risk among individuals ranged from 0.02% to 23.4%. Prophylaxis was negatively associated with the development of UEDVT (OR 0.72, 95% CI 0.60-0.87). UEDVT is rare but some patients are high risk. Therefore, UEDVT risk factors should be added to VTE risk assessment models, and patients at high risk for UEDVT should receive chemoprophylaxis.

Real-World Experience Using a Multi-Modality System using Intense Pulsed Light, Radiofrequency Microneedling, High-Intensity Focused Ultrasound, or Thermal Radiofrequency, 808, HIFU for Skin Rejuvenation Treatment.

Medical aesthetic procedures for facial rejuvenation with laser and energy-based devices (EBDs) are rapidly increasing. The following cases highlight real-life experience using a multi-modality system with various handpieces that combine intense pulsed light (IPL), laser hair removal (808 diode), high-intensity focused ultrasound (HIFU), radiofrequency microneedling (RFM), and thermal radiofrequency (RF) for antiaging and rejuvenation treatment. Laser and RFM treatments may improve skin conditions by inducing cutaneous changes that remodel the skin matrix. Six physicians who treat patients for skin rejuvenation reported on clinical cases from their practice using a multi-modality system with various handpieces. During the meeting, the advisors discussed 15 cases and agreed to select seven patients with different ages and skin phototypes receiving various treatments for photodamage of the face, neck, and décolleté. The advisors discussed why they selected the case, previous treatment, type of treatment, results, and clinical pearls. Sharing best practices in medical aesthetics using combination treatments on a single multi-modality energy-based device such as laser and MRF for facial, neck, and chest skin may support healthcare providers treating patients for skin rejuvenation to improve clinical outcomes.

Mycosis fungoides refractory to treatment - importance of a multidisciplinary approach.

We report a case of difficult-to-control mycosis fungoides (MF), where the role of the dental surgeon was crucial for the control and prognosis of the disease. A 62-year-old female patient diagnosed with MF had a previous record of red patches and small raised bumps on the face, along with a cancerous growth in the cervical and vulvar region. The patient was initially treated with methotrexate and local radiotherapy without resolution. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone was then started (CHOP protocol). The dental team of a reference hospital was consulted to evaluate swelling in the anterior region of the palate, which had been developing for two months, reporting discomfort when eating. The role of the dentistry team was fundamental in the differential diagnosis of oral lesions with dental infections, second neoplasia, or even a new site of disease manifestation, in addition to controlling mucosal changes resulting from chemotherapy. After ruling out dental infection, the dentistry team performed a lesion biopsy to confirm the diagnosis. The histopathological and immunohistochemical analysis showed atypical lymphoid infiltration of T cells (CD3+/CD4+/CD7-/CD8-), coexpression of CD25, and presence of CD30 cells, corresponding to the finding for MF. Identifying CD30 + allowed for a new chemotherapy protocol with brentuximab vedotin (BV) combined with gemcitabine. This protocol effectively controlled MF, which previous protocols had failed to do. The diagnosis by the dental team was essential for therapeutic change and improvement of the patient's clinical condition without the need for invasive medical procedures.

Improving Cardiopulmonary Resuscitation Quality and Resuscitation Training by Using Real-Time Audiovisual-Assisted Devices.

Context Cardiac arrest occurring outside of a medical facility is a significant cause of death and disability worldwide. In developing nations, it accounts for a notable portion of total mortality, with only a small percentage of those affected surviving beyond the initial emergency department intervention. Despite the critical importance of high-quality cardiopulmonary resuscitation (CPR) in these situations, there has been limited research on the effectiveness of audiovisual feedback devices in improving CPR performance among laypersons or non-medical caregivers. These caregivers, often untrained in advanced medical procedures, play a crucial role in the immediate response to cardiac arrest before professional help arrives. This study aims to address this gap by evaluating the impact of such devices on CPR quality delivered by non-medical individuals. Aim This study aimed to determine whether the use of audiovisual devices would improve cardiopulmonary resuscitation performance among non-medical care providers. Materials and methods Using amultiple-choice questionnaire, an audiovisual aid-based prospective observational study (non-interventional observation study) was conducted at a medical college hospital in Kochi from June 2022 to February 2024. A minimum sample size of 66 was derived from pilot studies, with 95% confidence and 90% power. A total of 146 participants met the inclusion criteria (non-medical personnelof 18-50 years of age). After the exclusion ofpregnant women and non-interested participants, the study participants were analyzed for the quality of cardiopulmonary resuscitation in a mannequin with the help of audiovisual devices.Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, New York, released in 2011). Categorical variables were expressed as frequency and percentage. McNemar's Chi-square test wasapplied to compare the CPR compression rates with and without the visual feedback device, and the kappa statistic was used to assesshow consistently participants performed within the same compression rate category (less than 100, 100-120, or more than 120 compressions per minute) with and without the feedback device. Results The improvement inCPR quality, which was visualized as a green color in the CPR feedback device, was significant, with 109 participants (74.7%) showing good outcomes. The chest compression rate also significantly improved from 95 to 117 with the use of feedback devices (p -0.011, Kappa - 0.167) among non-medical care providers. While the kappa value suggests that some variability exists in compression rates when switching between with and without feedback, the overall improvement is still noteworthy. Conclusion The majority of participants (74.7%) were able to consistently maintaingreen light in the visual feedback watch, which means their chest compression rate was within optimal range (100-120/min) when using the audiovisual feedback device. This indicated that use of audiovisual devicessignificantly improved compression rates among non-medical care providers andeffectively helped them perform high-quality CPR.

The ethics of adult medical tourism

Is the NHS responsible for providing care for botched medical procedures carried out abroad?

Medical Emergency In Dentistry By Local Anaesthetics

Justification: Local anaesthesia is widely used in various procedures in dental specialties. However, even though it is rare, a medical emergency may occur. Objective: The article aims to show the necessary care in the administration of local anaesthetic in dentistry and the medical emergencies, signs and symptoms and first procedures. Show the importance of the dental surgeon be alert to any signs and symptoms during the application of anaesthetic, and able to intercede in any risk to health or the patient's death and knowing the formula and possible side effects of anaesthetic use and their medicine interactions with legal and/or illegal drug. Methodology: research on the main electronic health platforms, BIREME, LILACS and Medline, using as descriptors: LOCAL ANAESTHETIC /+/ ODONTOLOGY and MEDICAL EMERGENCIES/AND/ODONTOLOGY, in Portuguese, French, Spanish and English, and the professional experience of the authors in First Aid and Medical Emergency in Dental Offices. Conclusion: There are risks in the administration of local anaesthetics, however they are minimal and can be predicted when there is a correct anamnesis and treatment plan and/or surgical adequate for each identified situation. Knowledge of the anatomy of irrigation and drainage, foramen, among others, besides of the physiology and neuroanatomy of the region where the anaesthetic will be applied, is important to minimise the risks. The dental surgeon should be alert to any signs and symptoms during the application of anaesthetic, and able to intercede in any risk to health or of the patient's death and knowing the formula and possible side effects of anaesthetic use and their medicine interactions with legal and/or illegal drug. The most serious side effects of a local anaesthetic focus on the central and peripheral nervous system, the cardiovascular tract and renal tract. Hence, there need to know both the physiology of the systems and the interaction of the medications with the specific anaesthetics. However, the patient may not always be able to receive anaesthetics with vasoconstrictors, and surgery is not always elective to know such medicine interactions, and not always is possible to know if there is any allergy to any specific anaesthetic without prior testing before surgery. Hence, there is needed to know emergency medical procedures in dental offices and clinics

Ralstonia mannitolilytica infection in a tertiary care centre: an outbreak report

BackgroundIn this paper we describe an outbreak of Ralstonia mannitolilytica infection declared in our facility between January 2021 and January 2022. MethodsIn order to identify the source of the outbreak, we applied widespread epidemiological investigation and infection control measures, including device isolation, environmental sampling, and PFGE typing. ResultsThirty-six cases of R. mannitolilytica infection were identified, mostly adults (78%) and males (75%). Initially, neurological procedures were a common risk factor among cases, leading to sampling of related environmental settings. Cases with other medical procedures started to be reported. The PFGE results showed most R. mannitolilytica isolates were indistinguishable which expanded our investigation to all hospital areas. The infection source was discovered later as a single lot number of sodium chloride solution that had been used in practice. The contaminated solution was recalled from all hospital units and the findings were reported to the Saudi FDA to communicate with the manufacturer and other healthcare organizations involved. No new cases of R. mannitolilytica were identified thereafter. ConclusionOur findings indicate that identifying the source of an outbreak could be challenging. An extended incubation period might be considered to improve and accelerate the identification of R. mannitolilytica. In order to minimize similar incidents, it is essential to regularly monitor the compliance of manufacturers and suppliers with regulations related to the safety of solutions administered in medical practice.

No Longer and Not Yet Absent: Resisting Loss in Colombe Schneck’s Dix-sept ans

Abstract: In 2015, Colombe Schneck published Dix-sept ans , a novel recounting the experience of her own abortion, performed in a post-legalization context. The abortion is initially presented in a manner that suggests its occurrence is inconsequential, as though it were a commonplace medical procedure having left no trace. However, the narrative is imbued with a pervasive silence and a discourse of negation and resistance that says much about the lived experience. This article analyzes the significance of these discursive features and explores the complex and often paradoxical emotions felt by women who have had an abortion.

Comparative efficacy of pharmacological and non-pharmacological interventions for mitigating pain and anxiety associated with venipuncture: a randomised controlled trial

BackgroundVenipuncture is one of the most commonly performed medical procedures in paediatric care, but it can also be one of the most painful and distressing experiences for patients. Finding effective...

Intrusion of the other: identity, ethics and transplantation in Sui Ishida’s Tokyo Ghoul

This essay examines the profound themes and complex narratives presented in Sui Ishida’s Tokyo Ghoul, focusing on the illegal xenotransplantation and the transformation of the protagonist, Ken Kaneki, as he...

Radiation Hazards, Protection, and Cultivating a Radiologically Safe Environment for Nurses

Medical diagnostics has been revolutionized with the discovery of X-rays. The number of radiological procedures performed globally has increased rapidly during past decades and according to UNSCEAR 2021 report, 4.2 billion medical radiological procedures are performed annually. Ionizing radiations if not used appropriately and carefully can lead to health hazards for health professionals involved in the radiation work as well as patients undergoing the radiological procedure. However, the awareness about the ionising radiation and radiation safety is very limited among the healthcare professionals. This educational paper will provide basic insights in radiation protection training, and key topics to cover during education and training for nurses working in various medical radiological procedures of patients. Nurses need to understand radiation protection principles and ways to minimize their exposure of radiation during radiological procedures. They should be able to practically apply radiation protection principles in healthcare settings with enhanced patient and occupational safety without Radiophobia. Applying radiation safety culture in nursing practice improves quality and safety in patient care.

Radiation Hazards, Protection, and Cultivating a Radiologically Safe Environment for Nurses

Medical diagnostics has been revolutionized with the discovery of X-rays. The number of radiological procedures performed globally has increased rapidly during past decades and according to UNSCEAR 2021 report, 4.2 billion medical radiological procedures are performed annually. Ionizing radiations if not used appropriately and carefully can lead to health hazards for health professionals involved in the radiation work as well as patients undergoing the radiological procedure. However, the awareness about the ionising radiation and radiation safety is very limited among the healthcare professionals. This educational paper will provide basic insights in radiation protection training, and key topics to cover during education and training for nurses working in various medical radiological procedures of patients. Nurses need to understand radiation protection principles and ways to minimize their exposure of radiation during radiological procedures. They should be able to practically apply radiation protection principles in healthcare settings with enhanced patient and occupational safety without Radiophobia. Applying radiation safety culture in nursing practice improves quality and safety in patient care.

Diagnosis and Treatment of Cervical Spine Fractures in Children

Background. Cervical spine injuries in children are relatively uncommon and account for approximately 1.5% of trauma admissions. The aim of our study was to determine the incidence and patterns of pediatric cervical spine fractures in a single Trauma Center over the last decade.Material and methods. The hospital’s medical database was queried for data from the period between January 2014 and December 2023. An initial search revealed that 511 patients had been hospitalized with neck injuries in that time frame. Among these records, we identified 24 patients with a fracture of the cervical spine. The inclusion criteria were: (1) age under 18 yo, (2) fracture of the cervical spine (3) follow-up of at least 6 months. A thorough analysis was performed, including injury mechanism, diagnosis, medical procedures and final outcome., A Neck Disability Index (NDI) was assessed for all patients at the six months’ follow-up visit to evaluate treatment outcomes.Results. The study group consisted of 14 boys and 10 girls aged 4.6 to 18 years (average age 14.2). We diagnosed one case of an isolated C1 fracture, six C2 fractures, two C4 fractures, two C5 fractures, two C7 fractures, and nine cases of multiple spinal fractures. Additionally, we diagnosed two cases of cervical spine dislocation: one of right-sided rotational dislocation of C6/C7 and one of complete dislocation of C2/C3. Eight patients were treated surgically by open reduction combined with anterior plate fixation. Four patients were treated using a halo vest. Eleven patients were treated conservatively: six using a Minerva orthosis, four with a cervical-thoracic orthosis, and one with a rigid cervical collar. The highest NDI values were encountered in the group of patients with concomitant intracerebral injury, where the mean value was 18.6/45 (12-26/45). The mean NDI score for the remaining patients was 4/45 (0 - 9/45).Conclusions. 1. The incidence of cervical spine fractures in children is low. 2. Most cervical spine injuries in children are treated conservatively with good outcomes. 3. Both conservative and surgical treatment of cervical spine fractures in children produces good results 4. Computed Tomography remains the gold standard for diagnosing cervical spine fractures in children. 5. The halo-vest in pediatric patients suffering from C2 fractures was well tolerated and provided good outcomes. 6. Surgical treatment of lower cervical fractures by open reduction with anterior fusion is efficient in terms of fusion status and patient satisfaction. 7. Prospective, randomized, multicenter studies are required to assess the epidemiology, methodology, and treatment effects of cervical spine fractures in children.

In/Visible – A Photographic Journey Into the Lives of Egg Donors in Spain

ABSTRACT The result of a collaboration between an anthropologist and a photographer, in this photo essay we aim to visualize the medical process of egg donation and the quotidian lives of egg donors in Spain. By extending their biographies beyond the moment of extraction, we shed light on the intertwined messiness of medical procedures and everyday life and the precarious circumstances in which egg donation takes place in Spain today. Our aim is to highlight the participants who, although they matter most in the egg donation economy, are concealed: the egg donors.

Perceptual effect of color use in patient rooms

Messages are conveyed to users through every element within the space. People receive these messages through sense organs. People and space interact constantly because of the way that they perceive and transmit space. People also establish their action boundaries, identify their motivational criteria, and feel a sense of belonging to the place they experience as a result of this interaction. In this way, the location, with all of its characteristics, influences the mental health of those who inhabit it. The colors chosen for patient rooms have a significant impact on the emotional and mental health of the patients, given the medical procedures and rehabilitation programs that they undergo. Patients' healing processes may vary based on the physical characteristics of the environment in which they are situated. Hospitals are intricate functional structures, so specific design requirements should be established by assessing every department independently. The purpose of this study is to determine how people's perception of spatial quality in general patient rooms where two adults stay during treatment is affected by the use of color. In the research method, adjective pairs were determined in line with spatial quality in order to reveal the perceptual effect of color variables in patient rooms. The survey technique was applied according to this experimental design. By simulating the patient room- which was proposed as the study area- in a digital environment with a one-to-one scale, the colors identified as the dependent variable in the study's methodology were visualized independently. The survey technique was employed to ask questions about the perceptual effect of colors on people who have experienced patient rooms by using adjective pairs based on the spatial quality level. The orange color used in patient room interior design was found to be eye-catching, communication facilitator, inviting, pleasing, encouraging, and sincere, while the blue color was found to be comforting and refreshing, based on data acquired from the survey, which was administered to 168 people in total. Many spaces in hospital buildings serve a variety of purposes, and the patients who use these spaces have a range of needs. For this very reason, it is advised that these hospital units be included in the interior design process utilizing information supported by empirical research, with each space being specially designed to meet its unique requirements and functions.

Legal liability of medical personnel and health workers who commit negligence during medical procedures (Normative Study After the Enactment of Law Number 17 of 2023 Concerning Health)

Medical personnel and health workers are part of health human resources who are basically tasked with providing health services to service recipients, in this case patients and/or providing the necessary medical measures. Medical personnel and health workers who commit negligence when carrying out their duties legally can be subject to legal liability. Since the enactment of Law Number 17 of 2023 concerning Health, there have been several important aspects of health law that have changed, one of which is related to legal liability. For this reason, it is necessary to conduct an assessment, especially about legal liability for medical personnel and health workers if they commit negligence when performing medical procedures. The type of research carried out is normative juridical research. The approach taken is a statutory approach and is descriptive analysis. The resources used for secondary data are by processing data from primary legal materials, secondary legal materials and tertiary legal materials. The data collection tool used is document study (library research) and analyzed by qualitative analysis. Based on the results of the study, it is known that the duties and functions of medical personnel and health workers in carrying out medical actions on patients are mainly to provide health services to patients in the form of promotive, preventive, curative, rehabilitative, and/or palliative. Then it is known that the legal responsibility of medical personnel and health workers when committing negligence after the enactment of Law Number 17 of 2023 concerning Health is divided into 3 (three) forms, namely administrative liability, namely the temporary deactivation of STR; and/or recommendations for revocation of SIP, civil liability in the form of compensation and criminal liability in the form of imprisonment and fines.

Manipulation of Serum Protein Adsorption by Nanoengineered Biomaterials Influences Subsequent Immune Responses.

The adsorption of serum proteins on biomaterial surfaces is a critical determinant for the outcome of medical procedures and therapies, which involve inserting materials and devices into the body. In this study, we aimed to understand how surface topography at the nanoscale influences the composition of the protein corona that forms on the (bio)material surface when placed in contact with serum proteins. To achieve that, we developed nanoengineered model surfaces with finely tuned topography of 16, 40, and 70 nm, overcoated with methyl oxazoline to ensure uniform outermost chemistry across all surfaces. Our findings revealed that within the studied height range, surface nanotopography had no major influence on the overall quantity of adsorbed proteins. However, significant alterations were observed in the composition of the adsorbed protein corona. For instance, clusterin adsorption decreased on all the nanotopography-modified surfaces. Conversely, there was a notable increase in the adsorption of ApoB and IgG gamma on the 70 nm nanotopography. In comparison, the adsorption of albumin was greater on surfaces that had a topography scale of 40 nm. Analysis of the gene enrichment data revealed a reduction in protein adsorption across all immune response-related biological pathways on nanotopography-modified surfaces. This reduction became more pronounced for larger surface nanoprotrusions. Macrophages were used as representative immune cells to assess the influence of the protein corona composition on inflammatory outcomes. Gene expression analysis demonstrated reduced inflammatory responses on the nanotopographically modified surface, a trend further corroborated by cytokine analysis. These findings underscore the potential of precisely engineered nanotopography-coated surfaces for augmenting biomaterial functionality.

Healthcare Operations Management: Optimizing Patient Flow and Quality Care in India

Patients' preferences changed from general practice to sub-specialty practice because there was no referral system in place. Most people would rather speak with a medical expert. The cheap medical tariff may make it easier for patients to see a doctor. Patients can see a doctor for even less money thanks to medical insurance companies. In addition, the cost of a doctor's appointment remains the same regardless of how straightforward the case may be. It fosters competition between general practitioners and experts, with the belief that the latter are superior. In addition, confusion and repeated visits to the doctor are caused by a patient's lack of trust in medical professionals and their ignorance of medical procedures. Social Security recipients' hospitals are overworked. The quality of services decreases as the patient base grows. Equipment and facilities are ageing out of date. Providers are forced to restrict their flexibility and ability to adjust to the unique needs of their patients due to staffing shortages and scheduling constraints. Physicians may be forced to refer patients to paramedical departments instead of doing a complete examination in order to deliver a proper diagnosis due to the rising demand for medical services. The current study, which makes reference to India, focusses on healthcare quality management strategies in multispecialty hospitals.

Prevalence of internal iliac artery anatomical variants in a Mexican population

The internal iliac artery arises as a terminal extension of the common iliac artery and supplies blood to the pelvic region. This study aims to identify the anatomic variations of the internal iliac artery (IIA) in a Mexican population sample. This is a retrospective cross-sectional observational study. A total of 81 angiographies via the femoral artery approach performed on patients undergoing various medical procedures were included. Variations in the IIA branching patterns were identified by evaluating the angiographic images and grouped according to Adachi’s classification into five types (I–V). A total of 139 hemipelvises were analyzed (78 right and 61 left). The frequencies of each type of variation were as follows: Type I (71.2%), Type II (10.79%), Type III (0 cases), Type IV (0.7%), Type V (12.94%), and unclassified (4.31%). The most frequent anatomical variants of the IIA in the western Mexican population sample were Type I, followed by Types V and II. Even though Type V is rare in most populations, it was the second most frequent variant in this study. Understanding the variants of the IIA branching pattern is necessary for performing invasive procedures in the pelvic region with precision and minimizing complications.