Medical Stabilization Research Articles

A Community Based Interventional Study to Assess the Knowledge, Attitude and Practice of Disposal of Medicines in Dakshina Kannada

The use of pharmaceuticals is increasing every year worldwide. Proper storage of medicines is essential for the stability of medications. Each medicine should be stored on the specified storage condition, otherwise leading to many harmful impacts and affects the drug stability. An interventional study was carried out among the voluntary participants of Dakshina Kannada with a sample size of 150 with the help of Questionnaire and patient information leaflets (PIL). Informed consent has been obtained from voluntary study participants and the collected data was analyzed using Chi Square test and MS Excel 2017. During the pre-interventional study, it was observed that improper storage of medications was found to be high which were found to be reduced during post intervention. The study emphasizes on bringing awareness to the community and to educate people about the proper storage of medications. Keywords: PIL (Patient Information Leaflet), storage, pre-intervention, post-intervention

Sex differences in cholesterol and triglyceride levels among hospitalized adolescents and young adults with eating disorders.

To determine sex differences in cholesterol and triglyceride levels among adolescents and young adults hospitalized for medical complications of eating disorders. A retrospective electronic medical record review of patients aged 9-25 years admitted to the University of California, San Francisco Eating Disorders Program for medical stabilization, between 2012 and 2020, was conducted. Non-fasting total cholesterol and triglycerides were collected; however, LDL and HDL levels were not available. Among 83 males and 441 females, mean ± SD age was 15.5 ± 2.8 years, 64.1% had anorexia nervosa, and admission percent median body mass index was 87.3 ± 13.9. The proportion of males and females with high total cholesterol (13.3% vs. 18.1%, Cramer's V = 0.05, p = .28) and high triglyceride levels (9.6% vs. 8.1%, Cramer's V = 0.02, p = .63) did not differ. Mean total cholesterol levels were higher in females compared to males (F 169.6 ± 41.1 mg/dL vs. M 154.5 ± 45.1 mg/dL, Cohen's d = 0.36, p = .003), although a majority were within the normal range. In adjusted linear regression models, male (compared to female) sex (B = -14.40, 95% CI -24.54, -4.27) and higher percent median body mass index (B = -0.33, 95% CI -0.60, -0.06) were associated with lower total cholesterol levels in adjusted models (R2 = 0.04). Building on prior work showing equally severe complications of eating disorders in males compared to females, we did not find sex differences in those presenting with high total cholesterol or triglycerides. Future research is needed to understand the pathophysiology and role of dyslipidemia in acute malnutrition, and the impact of nutritional rehabilitation and weight restoration. We found that the proportion of male and female adolescents and young adults hospitalized for medical complications of an eating disorder with high total cholesterol did not significantly differ. Although average total cholesterol levels were higher in female compared to male patients with eating disorders, a majority of these levels remained within the normal range. Patients with more severe malnutrition had a higher risk of elevated total cholesterol levels. Clinicians should consider monitoring cholesterol levels in young people hospitalized for restrictive eating disorders.

Premature drug reduction after subthalamic nucleus deep brain stimulation leading to worse depression in patients with Parkinson's disease

BackgroundReduction of medication in Parkinson's disease (PD) following subthalamic nucleus deep brain stimulation (STN-DBS) has been recognized, but the optimal timing for medication adjustments remains unclear, posing challenges in postoperative patient management.ObjectiveThis study aimed to provide evidence for the timing of medication reduction post-DBS using propensity score matching (PSM).MethodsIn this study, initial programming and observation sessions were conducted over 1 week for patients 4–6 weeks postoperatively. Patients were subsequently categorized into medication reduction or non-reduction groups based on their dyskinesia evaluation using the 4.2-item score from the MDS-UPDRS-IV. PSM was employed to maintain baseline comparability. Short-term motor and neuropsychiatric symptom assessments for both groups were conducted 3–6 months postoperatively.ResultsA total of 123 PD patients were included. Baseline balance in motor and non-motor scores was achieved between the two groups based on PSM. Short-term efficacy revealed a significant reduction in depression scores within the non-reduction group compared to baseline (P < 0.001) and a significant reduction compared to the reduction group (P = 0.037). No significant differences were observed in UPDRS-III and HAMA scores between the two groups. Within-group analysis showed improvements in motor symptoms, depression, anxiety, and subdomains in the non-reduction group, while the reduction group exhibited improvements only in motor symptoms.ConclusionThis study provides evidence for the timing of medication reduction following DBS. Our findings suggest that early maintenance of medication stability is more favorable for improving neuropsychiatric symptoms.

Medical Equipment Supply Chain Optimization and Stability Study using Deep Reinforcement Learning

Medical equipment is a critical resource during the COVID-19 pandemic. An efficient and stable supply chain of medical equipment (masks, goggles, protective coveralls, etc.) enables medical workers and first responders to effectively and safely fight against this highly contagious disease. In my research, I design and investigate two agents based on the traditional (s,Q) policy and the Deep Reinforcement Learning (DRL) algorithm and apply them respectively to optimize a two-echelon medical equipment supply chain where one distribution center and multiple retailers are involved. To my knowledge, this is the first implementation of DRL algorithm for medical supply chain optimization. I implement the DRL algorithm in Python using Ray and RLlib packages and conduct experiments using Google Colab with GPU support. To maximize the DRL algorithm’s potential, I optimize the reward function and the hyperparameters of this algorithm. By testing the agents in different environment initializations, I find that the DRL algorithm outperforms the static (s, Q) agent, which is one of the most commonly used methods in many inventory optimization systems, by returning a 17.33% greater cumulative reward on average. Additionally, the relative standard deviation of baseline (s,Q) Policy is 1.97% and that of DRL is 2.49% based on ten repeated trials. Thus, the DRL approach is not only stable but can also significantly improve the retailer’s profit. My DRL model can be further applied to more complicated multi-echelon supply chain systems and lays a solid foundation for optimizing large-scale medical supply chains [TF18].

SAT311 A Time And Place For Metyrosine: Successful Treatment Of A Pheochromocytoma Presenting With Hypotension And Multisystem Organ Failure

Abstract Disclosure: R. Shafiq: None. J. Giordano: None. Pheochromocytomas are rare neuroendocrine catecholamine-secreting tumors. The surgical excision of pheochromocytoma is definitive management which requires presurgical preparation with an alpha blocker, beta blocker, and sometimes metyrosine to reduce perioperative hemodynamic instability. We present a case of pheochromocytoma complicated with acute on chronic renal failure and acute on chronic heart failure with hypotension requiring metyrosine in presurgical preparation due to hypotension and intolerance to alpha-blocker with successful surgical excision of the tumor. Case: 67 yo M admitted for acute on chronic heart failure and acute on chronic renal failure. He was noted to have an incidental right adrenal mass of 4.3 x 4.5 cm on the CT chest. He denied any prior history of hypertension, episodes of flushing, sweating, palpitations, headaches, or any family history of adrenal malignancies. His labs were consistent with significantly elevated plasma metanephrines to 4.5 nmol/L (normal range < 0.5 nmol/L) and normetanephrine 36 nmol/L (normal range < 0.9 nmol/L). Levels were repeated with slight worsening of metanephrines to 5.6 and normetanephrine to 42. He was hypotensive on presentation initially on milrinone drip that was slowly tapered off. His echo on admission showed left ventricle global hypokinesis with EF 25-30%. He had a worsening renal function on admission and required a few dialysis sessions before being referred to our hospital. He had an MRI adrenal done w/o contrast in the setting of renal failure with a heterogenous mass concerning for pheochromocytoma. PET CT was done which was negative for metastatic disease. Due to strong suspicion of uncontrolled pheochromocytoma as a cause of his heart failure and acute on chronic renal failure, the team and patient opted for unilateral adrenalectomy. He was started on metyrosine pre-surgically as he could not tolerate alpha blockade due to hypotension. His metanephrine levels improved from 5.6 to 1.8 and normetanephrine from 43 to 15 with metyrosine prior to surgery. He had a successful right adrenalectomy and pathology confirmed pheochromocytoma. Of note, he had a history of diabetes with uncontrolled hyperglycemia during admission. Hyperglycemia resolved after adrenalectomy. His plasma metanephrine levels normalized post-adrenalectomy and remained normal on the follow-up visit. Conclusion: Preoperative medical stabilization is a crucial step before surgical resection of pheochromocytoma that traditionally includes an alpha blocker followed by a beta-blocking agent to reduce intra-operative hypertensive crisis. Metyrosine is an often-overlooked agent due to cost, however, should remain in our armamentarium for pheochromocytoma crisis complicated with hypotension when the patient is unable to tolerate an alpha-blocking agent. Presentation: Saturday, June 17, 2023

Quality by Design Approach: Progress in Pharmaceutical method Development and Validation

Pharmaceutical analysis plays a significant role in pharmaceutical formulation quality assurance and control. Due to the pharmaceutical industries' rapid expansion and the production of pharmaceuticals all over the world, there is a greater need for novel analytical procedures in this sector. Establishing the identification, purity, physical properties, and potency of medications as well as the medication's bioavailability and stability is the goal of analytical method development. A few new drug applications were recently given regulatory flexibility by the Food and Drug Administration for an analytical method based on quality by design. With Quality by design, product design and development are performed methodically. Analytical methodologies have similar opportunities for implementing Quality by design as production procedures do. It consequently enhances formulation design, development efficiency, and capacity. The underpinnings of the QbD approach have been explored in this article due to their use in the creation and validation of analytical procedures. Additionally, a summary of experimental studies reporting the application of the QbD methodology to method development is included.

Inpatient Simulation Resource Utilization for Inpatient Radiation Oncology Consults

Previous data have shown that inpatient radiation oncology consult services result in high-value care, with decreased length of stay, adoption and delivery of shorter fractionation schedules, and lower hospital costs. As such, institutions are increasingly creating inpatient radiation oncology services, although little is known about the allocation of limited resources for patients who may have limited prognosis, complex simulation requirements, and may have difficulty tolerating treatment. Thus, we sought to examine the utilization of simulation appointments for inpatient emergencies. At our institution, inpatient consults are placed to a specialized inpatient palliative radiation oncology service, consisting of radiation oncologists specialized in metastatic and palliative RT, dedicated advanced practitioners, and nurses who specifically assess patients for medical appropriateness prior to simulation, including changes in disposition, medical stability, and adequate premedication. Electronic health record data was used to explore utilization trends of a single-institution inpatient radiation oncology consult service in 2020. Data regarding the nature and timing of consults, subsequent simulations and treatments, and patient outcomes including 14-day mortality and 30-day mortality from radiation (RT) start were assessed. Descriptive statistics are presented. From 1/1/2020-12/31/2020, 1557 consults were placed. These consults led to 220 (14.1%) inpatient simulations. Of these planned simulations, 210 (95.5%) simulations occurred (of which 10 [4.8%] were rescheduled and eventually completed) and 179 (85.2%) completed treatment. Of 169 with mortality data available, 16 (9.5%) died within 14 days of RT start, and 41 (24.5%) died within 30 days of RT start. Of those with scheduling data (N = 193), 122 were same-day simulations (63.2%), and 507 (93.8%) occurred within 7 days or fewer. Of 1557 inpatient consultations in one year, with appropriate metastatic and palliative experience, only a minority of consultations required inpatient simulation (14.1%). With appropriate nursing assessment, over 95% were able to complete simulation, with nearly two-thirds completing simulation on the same day, and nearly all patients completing simulation within a week of consultation. Most of these patients completed treatment and survived 30 days from treatment start. Thus, with highly specialized radiation oncologist clinical judgment in conjunction with appropriate nursing assessment prior to simulation scheduling, patients booked for simulation represent high-value utilization of resources.

Evaluating Transcranial Direct Current Stimulation as an Adjunct to Inpatient Physiotherapy in Paediatric Acquired Brain Injury: A Randomized Feasibility Trial

Purpose: Evaluate the feasibility of transcranial direct current stimulation (tDCS) as an adjunct to inpatient physiotherapy for children and youth with acquired brain injury (ABI). Method: This randomized feasibility trial allocated children (5–18 years of age with moderate to severe ABI) to receive either active or sham anodal tDCS immediately prior to 16 of their existing inpatient physiotherapy sessions. Participants, physiotherapists, assessors, and primary investigators were blinded to treatment allocation. Eligibility, recruitment, retention, tolerance, and preliminary treatment outcomes were evaluated against a priori feasibility targets. Results: Of 232 children admitted over 21 months, six were eligible (2.6%) and four were recruited (66.7%). One participant completed the entire study protocol, two were withdrawn for unrelated changes in medical stability, and one could not commence the study due to COVID-19 restrictions. Participants completed all tDCS sessions that were started with the primary transient side effect being sub-electrode itchiness. Conclusions: While the study was infeasible from eligibility and retention perspectives, study procedures (e.g., assessment, treatment, side effect tracking, physiotherapy documentation) were viable and should be applied to future paediatric tDCS studies.

Effects of work-family conflict on turnover intention among primary medical staff in Huaihai Economic Zone: a mediation model through burnout.

Countries worldwide face the challenge of how medical personnel manage conflicts between work and family. Especially after the challenge of the COVID-19 epidemic, it is necessary to explore the possible mechanisms of work-family conflict, burnout, and turnover intention among primary medical staff. This study aims to observe the turnover intention of Chinese primary medical staff and explore the relationship between work-family conflict, burnout, and turnover intention. A cross-sectional study included a turnover intention questionnaire, the Maslach Burnout Inventory-General Survey (MBI-GS), and the Work-Family Conflict Scale (WFCS) to understand turnover intention, burnout, and work-family conflict among primary medical staff in four cities (Xuzhou, Linyi, Huaibei, and Shangqiu cities) within the Huaihai Economic Zone. Spearman correlation analysis and hierarchical multiple regression analysis were used to examine the related factors of turnover intention. Structural equation modeling (SEM) was used to study the mediating role of burnout between work-family conflict and turnover intention. In this study, there is a positive correlation between work-family conflict and turnover intention (P < 0.01). Demographic characteristics, work-family conflict, and burnout explained 2.3%, 20.3%, and 8.8% of the incremental variances, respectively. Burnout mediated the association between work-family conflict and turnover intention. Burnout can be regarded as a mediator between two different variables: work-family conflict and turnover intention. Improving work-family conflict and alleviating burnout may play a key role in reducing the willingness of primary medical staff to resign. Corresponding measures can be taken to balance the conflict between work and family, alleviate burnout, reduce turnover rates, and build a primary medical staff team with higher medical service quality and stability.

Modification of an inpatient medical management protocol for pediatric Avoidant/Restrictive Food Intake Disorder: improving the standard of care

BackgroundNo guidelines currently exist that represent a standardization of care for Avoidant/Restrictive Food Intake Disorder (ARFID) on an inpatient service. Unique features of this diagnosis (e.g., sensory sensitivity contributing to involuntary emesis) suggest that established protocols that were developed for anorexia nervosa might be less effective for adolescents with ARFID. To inform improved inpatient medical stabilization and care for these patients, we first provide an overview of clinical characteristics for patients with ARFID who presented to a pediatric hospital for inpatient eating disorder care. We use these descriptives to outline the rationale for, and executions of, modifications to an inpatient protocol designed to flexibly meet the needs of this clinical population.MethodsChart review with descriptive statistics were conducted for patients who had received an ARFID diagnosis from March 2019 to March 2023 (N = 32, aged 9–23). We then present a case series (n = 3) of adolescents who either transitioned to a novel adjusted protocol from an original standard of care on the inpatient service, or who received only the standard protocol.ResultsThe sample was aged M(SD) = 15.6 (3.3) years, 53% male, and a majority (69%) presented with the ARFID presentation specific to fear of negative consequences. On average, patients had deviated from their growth curve for just over two years and presented with mean 76% of their estimated body weight. Of those requiring nasogastric tube insertion during admission (n = 8, 25%), average duration of tube placement was 15 days. From within this sample, case series data suggest that the adjusted protocol will continue to have a positive impact on care trajectory among adolescents admitted for ARFID including improved weight gain, reduction of emesis, and improved food intake.ConclusionsFindings demonstrate the likely need to tailor established medical inpatient protocols for those with ARFID given different symptom presentation and maintenance factors compared to patients with anorexia nervosa. Further research is warranted to explore the longer-term impact of protocol changes and to inform standardization of care for this high priority clinical population across care sites.

Integration and Challenges of Excipients with Pharmacological Efficacy

Excipients are extra compounds that are included with the primary active ingredients in medicinal products. They are essential in enhancing the stability and accessibility of medications. Although excipients are a common component of daily life, incorporating them with pharmaceuticals still offers some difficulties. Although there are many different kinds of excipients, not all of them can completely match a medicine. Excipients will be used in diverse ways as carriers as a result of the various pharmaceutical production methods, which will modify the excipients that are chosen. Excipients often engage in the body's absorption and metabolism just like active pharmaceutical substances do. Different excipients have been tested in vitro and in vivo by researchers. They matched in vitro activity tests of 25 excipients to clinical safety tests. As a result, they discovered an extra 109 activities. Many individuals now understand that considering excipient toxicity is important. Researchers integrated it with cell models in animal trials and discovered that five excipients can predict the fingerprint of systemic toxicity. Additional research is required on the exposure of seven excipients, including thimerosal intestine exposure. Effect and risk ratio are two factors that are taken into consideration while assessing an excipient's safety. When examining a patient's response to a medication and how it varies, drug researchers may come across a range of circumstances. This article's objectives are to introduce the idea of excipients, examine some typical excipient usage instances, and provide an overview of excipient use in pharmaceuticals. Drug development is a dynamic process that is always changing. Although excipients have been employed in therapeutic settings, there are still a great deal of undiscovered excipients that require further study, analysis, and summarization.

REVIEW ON COMPREHENSIVE DESCRIPTION OF DEVELOPMENT AND ASSESSMENT OF CO-CRYSTAL DRUG DELIVERY SYSTEM

Over the past few decades, co-crystal Drug Delivery System (DDS) has attracted interest due to their potential to increase the solubility, stability, and bioavailability of medications that aren't sufficiently soluble. In this study, we factualized to develop a co-crystal chemical delivery system utilizing an experimental model. We utilized caffeine and succinic acid as model chemicals and prepared co-crystals utilizing different methods, including solvent evaporation, grinding, and spray drying. The co-crystals have been characterized utilizing X-ray powder diffraction, Fourier-transform infrared spectroscopy, and differential scanning calorimetry. The solubility and dissolution rate of the co-crystals has been evaluated in simulated digestive and intestinal juices. The outcomes showed that when compared to co-crystals made utilizing the solvent evaporation and spray drying procedures, those organized utilizing the grinding approach exhibited the maximum solubility and dissolution rate. This study underlines the potential of co-crystals as a workable method for enhancing the administration of pharmaceuticals that are not adequately soluble and provides a helpful experimental paradigm for the development of co-crystal chemical delivery systems.

Importance of assessment of carotid plaques in the managementof acute ischemic stroke: floating intracarotid plaque

Mobile atheromatous plaques affecting large arteries are a major risk factor for embolic strokes. We report a case of extensive embolic cerebral infarction secondary to a vulnerable internal carotid artery plaque. A 67-year-old female was admitted with sudden left-sided weakness. A computed tomography brain scan revealed early ischemic changes in the right middle cerebral territory. The ultrasound Doppler showed soft mobile plaque with thrombus in the right internal carotid artery causing 90% stenosis. Magnetic resonance imaging brain scan performed later showed extensive right cerebral infarction. A computed tomography angiogram revealed ulcerated non-occlusive soft tissue plaque in the right internal carotid artery. She was also diagnosed with bladder cancer during this admission and was managed medically due to her performance status. Unstable vulnerable plaques can be symptomatic even in the absence of significant carotid stenosis. Hence, early identification of the plaque vulnerability, using new imaging modalities, and its medical stabilization can help to reduce the risk of cerebrovascular insults. The etiopathogenesis of inflammation within unstable vulnerable plaques and its concordance with inflammatory markers is still unclear. It is feasible in our case the malignantprocess could also be contributing to the inflammation within the blood vessels promoting vulnerability of the plaques.

A novel outpatient treatment model for patients with severe and enduring anorexia nervosa: an observational study of patient characteristics, treatment goals, and treatment course

BackgroundApproximately 20–30% of people with anorexia nervosa develop an enduring form of the disorder. In the present study a newly developed outpatient treatment unit for patients with severe and enduring anorexia nervosa was described. The treatment model is flexible, patient-centered, and aims at enhancing quality of life, maintaining medical stability, and minimizing harm. Treatment contents, patient characteristics, treatment goals, and course of treatment from the first five years of operation were described and analyzed.MethodsThe participants (N = 22) consisted of all referrals resulting in an assessment or treatment period at the unit between May 2017 and May 2022. All participants were women. The study was a registry study. Information regarding patient characteristics, treatment goals, and the course of treatment was gathered from medical records.ResultsOn average, the participants had had a diagnosed eating disorder for 12.80 years, and self-reported eating disorder symptoms for 19 years. Their symptomatology included severe eating disorder symptoms, psychiatric comorbidities, extreme underweight, and co-occurring medical conditions. Their treatment goals commonly concerned improving physical health, reducing eating disorder symptoms, improving psychological well-being, and improving quality of life. The majority of participants for whom this information was available benefited from the treatment (60%) and their treatment goals were met or partly met (66.6%), as measured by evaluations made by the patient or the treatment team. More than two thirds (69.2%) of the participants for whom this information was available remained weight stable or showed an increase in BMI.ConclusionsThis observational study suggests that many individuals with severe and enduring anorexia nervosa may benefit from flexible treatment, aiming at supporting quality of life. The results highlight the importance of coordinating and integrating the treatment of severe and enduring anorexia nervosa and co-occurring psychiatric disorders as well as medical complications. Further research and international dialogue about the how treatment for this vulnerable patient group should best be organized is called for.Trial registration Trial registration number: NCT05708404. Date of registration: 01/23/2023 (retrospectively registered).

Hospitalization patterns for adolescents with eating disorders during COVID-19

PurposeThe purpose of this study was to examine differences in clinical characteristics and hospital length of stay (LOS) for adolescents with eating disorders (EDs) requiring medical stabilization during the pre-COVID-19 and COVID-19 time periods.MethodsMedical record data were abstracted for patients with EDs hospitalized for medical stabilization between 1/1/2019–2/29/2020 (pre-COVID-19) and 3/1/2020–12/31/2021 (during COVID-19). Patient demographics, clinical characteristics and LOS were compared between COVID-19 eras. Patients were categorized as boarding if they remained hospitalized ≥ 1 day after medical stabilization. Multivariate negative binomial linear regression models were performed to determine incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for factors related to increased LOS.ResultsOf the 467 admissions during this study, 120 were pre-COVID-19 and 347 were during COVID-19. Monthly admissions for EDs were higher during COVID-19 versus pre-COVID-19 (15.8 vs. 8.6, p = 0.001). On multivariate analysis, factors associated with increased LOS included admission during COVID-19 (IRR 1.27, 95% CI 1.15–1.40), p = 0.001), boarding (IRR 1.77, 95% CI 1.63–1.93, p = 0.001), public insurance (IRR 1.12, 95% CI 1.01–1.23, p = 0.032), nasogastric tube usage (IRR 1.62, 95% CI 1.48–1.76, p = 0.001), heart rate < 40 beats per minute (IRR 1.21, 95% CI 1.11–1.33, p = 0.001) and abnormal electrocardiogram (IRR 1.25, 95% CI 1.14–1.37, p = 0.001).ConclusionIn addition to clinical factors, we found that admission during COVID-19, boarding, and public insurance were associated with increased LOS among patients with EDs. There is a need for greater availability of ED treatment centers to care for patients with EDs after medical stabilization.

Knowledge Retention From Emergency Medicine Simulation-Based Learning Curriculum for Pre-clinical Medical Students.

Introduction Traditional medical school curricula rely on textbook-based learning during the first two years, often limiting students' clinical exposure. Simulation-based learning (SBL) provides an opportunity for students to gain clinical exposure and competency with common procedures as well as to gain knowledge related to common clinical topics. Retention of factual knowledge is a current topic of discussion as medical learners often have difficulty with long-term retention. The aim of this study was to assess if students would learn, retain, and enjoy emergency medicine (EM)-focused SBL. Materials and methods We developed an EM-focused SBL curriculum consisting of four main educational events: suturing, medical stabilization, mass casualty triage, and point-of-care ultrasound (POCUS). Participants were first- and second-year healthcare students enrolled in a traditional, preclinical curriculum, who completed pre- and post-event quizzes consisting of multiple-choice questions on topics covered during the SBL scenario. We compared pre- and post-event quiz scores using a one-way paired t-test. Quizzes were readministered up to 100 days after each SBL event to test knowledge retention, and scores were compared across time by repeated-measures analysis of variance (RMANOVA). Results For suture (n=22), mass casualty (n=20), and ultrasound simulations (n=17), post-event mean quiz scores increased significantly in comparison to mean quiz scores from before the event (p≤0.05). Medical stabilization simulation post-event scores were increased but did not reach statistical significance. Data collected at 45, 74, and 94 days following the suture lab as well as 29 and 49 days after the medical evacuation event, and 20 days after the mass casualty event showed no statistical decrease in quiz means suggesting retention of knowledge amonglearners. Subjective assessments of participant satisfaction demonstrated an enjoyment of the events. Discussion EM-focused SBL events offered enjoyable learning opportunities for students to effectively obtain and possibly retain clinical knowledge. Conclusion SBL has the potential to improve student retention of clinical knowledge during the preclinical years and, therefore, should be further explored and implemented as a core pillar of medical education as opposed to its current state as a learning adjunct.

Effect of Unified Protocol on neuroticism, emotion regulation skills, and symptom severity—A case series

BackgroundThere has been a shift from single disease protocols to interventions that address shared vulnerabilities across disorders with high comorbidity. Unified Protocol (UP) is an emotion-focused transdiagnostic intervention that addresses neuroticism, a shared mechanism identified in emotional disorders by enhancing emotion regulation skills. In this study, we attempted to understand the effect of the (UP) on symptom severity, emotion regulation, and neuroticism. MethodsA non-concurrent multiple baseline design was adopted. Six clients with a primary diagnosis of an anxiety disorder were randomly assigned to a 2, 3, or 4-week baseline period, following medication stabilization for 4 weeks. Following the baseline period, UP was delivered over 15–18 sessions. Neuroticism and emotion regulation were assessed at baseline, post, and follow-up. Anxiety severity was measured weekly by both an independent rater and on self-report. ResultsOf the 6 clients randomized, 3 completed the intervention. Visual analysis was used to examine changes in symptom severity and Reliable Change Index (RCI) was used to examine changes in scores on neuroticism and emotion regulation across time points for the 3 completers. Reliable change was observed in 1 out of 3 clients for neuroticism and in 2 out of 3 clients for emotion regulation skills. Change in slope, and level of symptom severity was observed across participants. ConclusionsUP is a parsimonious approach to addressing co-morbidities. Our findings support the role of emotion regulation skills in the management of anxiety. A larger sample is required to establish these findings more robustly and support generalization of findings.

Pharmaceutical formulation design for enhancing solubility, stability, and bioavailability of poorly water-soluble drugs: An Analytical Perspective

The development of pharmaceutical formulations for drugs with poor water solubility presents significant challenges in achieving desired therapeutic outcomes. These drugs have limited solubility, which result in suboptimal bioavailability, reduced stability, and compromised efficacy. To overcome challenges, formulation strategies required to enhance drug solubility, stability, and bioavailability. Several approaches explored in pharmaceutical formulation design to address the solubility issues with poorly water-soluble drugs. These approaches particle size reduction, solid dispersion, lipid-based formulations, cyclodextrin complexation, and nanotechnology-based delivery systems. Particle size reduction techniques, such as micronization and nanonization, can significantly increase the surface area and improve dissolution rates, thereby enhancing drug solubility. Techniques such as hot melt extrusion and spray drying help disperse medications with low solubility into water-loving carriers, which boosts their solubility and ability to dissolve. Formulations that are lipid-based, like self-emulsifying drug delivery systems (SEDDS) and lipid nanoparticles, can optimize solubility and absorption of drugs by taking advantage of naturally occurring physiological pathways connected to lipid digestion and absorption. Furthermore, cyclodextrins have the capability to form complexes that aid in the increased solubility and preserving stability of medications that have little water solubility.

Neurointerventional Treatment of Vein of Galen Malformation (VGM): A Structured Review with a Proposal for the Comparison of Outcome Quality

Background: Vein of Galen malformation (VGM) is a congenital intracranial vascular anomaly consisting of arteriovenous fistulas and/or malformations between various arterial feeders and the median prosencephalic vein of Markowski (MPV). Despite its rare occurrence, VGM is of particular clinical relevance, as the excessive intracranial shunt volume leads to high mortality without appropriate treatment. Methods: The objective of this article is to review the published data on neurointerventional treatment and compare outcome quality in the included studies. Eight studies were included and synthesized. One study was multicentric and the rest were retrospective monocentric (level 4 evidence studies according to the Oxford Centre for Evidence-based Medicine). Results: The total number of included patients was 480 and patient age ranged from 1 day to 18 years. Mild or severe heart failure, hydrocephalus, and other reasons led to the indication for neurointerventional treatment, which was performed in all studies in the form of embolization. Under consideration of the introduced semiquantitative multidimensional scoring system, the highest total score, i.e., the best outcome quality, was found for the study “Houston” 2002–2018 (19 points) and the study “Duisburg” 2001–2010 (19 points). Conclusions: Neurointerventional treatment represents the essential pillar in the interdisciplinary management of patients with VGM, although standardization is lacking—based on the results of the structured review. As complementary treatments, pediatric critical care is mandatory and includes medical hemodynamic stabilization.

Advancements in Inpatient Medical Management of Malnutrition in Children and Adolescents with Restrictive Eating Disorders

There is an urgent need to identify best practices for hospital treatment of youth with malnutrition secondary to restrictive eating disorders, including anorexia nervosa (AN) and avoidant/restrictive food intake disorder (ARFID). Certain physical health complications of malnutrition, such as bradycardia, hypotension, and hypothermia, often lead to hospitalization. These acute medical complications improve with refeeding, or short-term nutritional rehabilitation, and will resolve with ongoing recovery. Historically, refeeding was approached with extreme caution, with lower calorie protocols that advanced slowly and required weeks to restore medical stability.( 1 Shamim T. Golden N.H. Arden M. Filiberto L. Shenker I.R. Resolution of vital sign instability: an objective measure of medical stability in anorexia nervosa. J Adolesc Health. 2003; 32: 73-77 Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar , 2 Garber A.K. Mauldin K. Michihata N. Buckelew S.M. Shafer M.A. Moscicki A.B. Higher calorie diets increase rate of weight gain and shorten hospital stay in hospitalized adolescents with anorexia nervosa. J Adolesc Health. 2013; 53: 579-584 Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar , 3 Golden N.H. Keane-Miller C. Sainani K.L. Kapphahn C.J. Higher caloric intake in hospitalized adolescents with anorexia nervosa is associated with reduced length of stay and no increased rate of refeeding syndrome. J Adolesc Health. 2013; 53: 573-578 Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar ) Prolonged hospitalizations place eating disorders among the top 6 most “common and costly” pediatric mental health diagnoses.( 4 Bardach N.S. Coker T.R. Zima B.T. Murphy J.M. Knapp P. Richardson L.P. Edwall G. Mangione-Smith R. Common and costly hospitalizations for pediatric mental health disorders. Pediatrics. 2014; 133: 602-609 Crossref PubMed Scopus (150) Google Scholar ) This paper reviews current evidence on refeeding approaches for hospitalized youth with eating disorders. Recent findings suggest that high calorie refeeding is a clinically safe method of inpatient management and, more importantly, improves clinical outcomes.