Numerical Score Research Articles

Predictors of patient satisfaction in the surgical treatment of cervical spondylotic myelopathy.

Patients with cervical spondylotic myelopathy (CSM) experience progressive neurological impairment. Surgical intervention is often pursued to halt neurological symptom progression and allow for recovery of function. In this paper, the authors explore predictors of patient satisfaction following surgical intervention for CSM. This is a retrospective review of prospectively collected data from the multicenter Quality Outcomes Database. Patients who underwent surgical intervention for CSM with a minimum follow-up of 2 years were included. Patient-reported satisfaction was defined as a North American Spine Society (NASS) satisfaction score of 1 or 2. Patient demographics, surgical parameters, and outcomes were assessed as related to patient satisfaction. Patient quality of life scores were measured at baseline and 24-month time points. Univariate regression analyses were performed using the chi-square test or Student t-test to assess patient satisfaction measures. Multivariate logistic regression analysis was conducted to assess for factors predictive of postoperative satisfaction at 24 months. A total of 1140 patients at 14 institutions with CSM who underwent surgical intervention were included, and 944 completed a patient satisfaction survey at 24 months postoperatively. The baseline modified Japanese Orthopaedic Association (mJOA) score was 12.0 ± 2.8. A total of 793 (84.0%) patients reported satisfaction (NASS score 1 or 2) after 2 years. Male and female patients reported similar satisfaction rates (female sex: 47.0% not satisfied vs 48.5% satisfied, p = 0.73). Black race was associated with less satisfaction (26.5% not satisfied vs 13.2% satisfied, p < 0.01). Baseline psychiatric comorbidities, obesity, and length of stay did not correlate with 24-month satisfaction. Crossing the cervicothoracic junction did not affect satisfactory scores (p = 0.19), and minimally invasive approaches were not associated with increased patient satisfaction (p = 0.14). Lower baseline numeric rating scale neck pain scores (5.03 vs 5.61, p = 0.04) and higher baseline mJOA scores (12.28 vs 11.66, p = 0.01) were associated with higher satisfaction rates. Surgical treatment of CSM results in a high rate of patient satisfaction (84.0%) at the 2-year follow-up. Patients with milder myelopathy report higher satisfaction rates, suggesting that intervention earlier in the disease process may result in greater long-term satisfaction.

Clinical and Epidemiological Profile of Patients Presenting With Acute Abdomen to the Emergency Department of a Tertiary Care Hospital.

Acute abdomen is a common and urgent clinical condition requiring prompt diagnosis and treatment. This study determines the clinical and epidemiological profile of patients presenting with acute abdomen at a tertiary care hospital. To describe the demographic characteristics, provisional diagnoses, treatment modalities, and pain management effectiveness in patients with acute abdomen. This prospective observational study was conducted in the Emergency Medicine department at Dr. D. Y. Patil Medical College, Hospital & Research Center, Pimpri, Pune, over a specified period. The study included patients presenting with acute abdomen, aged above 14 years, excluding those with traumatic acute abdomen and pregnant patients. A sample size of 146 was calculated based on the proportion of ureteric colic cases, with a 95% confidence interval and a 6% margin of error; however, a total of 176 patients were included in the study. Data collection involved recording demographic details, clinical features, provisional diagnoses, and pain scores, as well as performing required blood investigations and ultrasonography. Pain scores were assessed before and after treatment. Patients will be given non-steroidal anti-inflammatory drugs(NSAIDs) or opioid analgesia, depending on the clinical severity. Emergency medicine residents, in consultation with the on-call consultant, determined the disposition of patients, deciding if they required surgical or conservative management. The study found that the majority of patients, n = 130 (73.86%), were aged 26-50 years, with cases n = 103 (58.52%) being males and cases n = 73 (41.48%) females. Acute appendicitis was the most common diagnosis, n = 41 (24.43%), followed by urolithiasis n = 33 (18.75%). Surgical interventions were required for n = 78 (45.08%) of patients, highlighting the urgent nature of these conditions. Pain management was effective, with significant reductions in pain scores post-treatment (mean visual analog score (VAS) decreased from 6.22 to 2.33, and mean numerical rating score (NRS) from 6.05 to 2.10; p < 0.001). The study underscores the high prevalence of gastrointestinal and renal conditions in patients with acute abdomen, particularly in middle-aged adults. The high rate of surgical interventions reflects the urgent nature of these conditions. Significant reductions in pain scores demonstrated effective pain management. Comprehensive care strategies are essential for optimizing patient outcomes. Future research with larger sample sizes and multi-center participation is recommended to validate these findings and enhance management protocols for acute abdomen.

Relationship of C-reactive Protein/Serum Albumin Ratio and qPitt Bacteremia Score With An All-Cause In-Hospital Mortality in Patients With Bloodstream Infections.

Bloodstream infections remain a major cause of morbidity and mortality despite notable advances in their diagnosis and treatment. C-reactive protein/serum albumin ratio and the quick Pitt bacteremia score are two useful tools for clinicians to assess severity and predict mortality risk in patients with sepsis attributable to bloodstream infections. This study examined the relationship between C-reactive protein/serum albumin ratio and Q Pitt bacteremia score with all-cause in-hospital mortality in patients with bloodstream infections. Hospitalized adult patients with bacteremic bloodstream infections between January 1, 2020, and December 31, 2021, were retrospectively reviewed. Patients' demographics and clinical and laboratory data were retrieved from patient electronic records. C-reactive protein/albumin ratio was calculated using CRP (mg/L) and serum albumin (g/L) values obtained within 24 hours of blood culture collection and quick Pitt bacteremia score was calculated for each patient with each of the five variables of the score determined within 24 hours of blood culture collection and each patient was assigned a numerical score of 0-5 accordingly. The relationship between C-reactive protein/albumin ratio and quick Pitt bacteremia score with all-cause in-hospital mortality was determined. A total of 187 hospitalized adult patients with non-repeat bacteremic bloodstream infections were identified.Escherichia coliwas the most common Gram-negative blood isolate whileStaphylococcus aureuswas the predominant Gram-positive isolate. One hundred and five (56.1%) patients were male with a cohort mean age of 56.9 ± 2.7 years. All-cause in-hospital mortality was 27.3%. The mean CRP/albumin ratio (8.6 ±1.7) and mean quick Pitt bacteremia score (2.8 ±0.4) were significantly higher in patients with bloodstream infections who died during their hospitalization compared to those who survived. The all-cause in-hospital mortality was 8%, 12%, 22%, 46%, 93%, and 100% for patients with quick Pitt scores of 0, 1, 2, 3, 4, and 5, respectively. In hospitalized patients with bacteremic bloodstream infections, an incremental increase in quick Pitt bacteremia score and mean C-reactive protein/albumin ratio of >8 was associated with higher mortality.

Correlating Advanced Pharmacy Practice Experience Exam Scores and Pharmacist Licensure Status in a Single Program

ObjectivePharmacist licensure exam first-time pass rates have declined for several years. Predictors of licensure exam performance, including the Pharmacy College Admission Test, are no longer required, necessitating alternative strategies. Our aim is to assess the relationship between numerical scores on advanced pharmacy practice experience (APPE) exams and pharmacist licensure exams first-time pass rates. MethodsWe conducted a single-center, retrospective, observational analysis. APPE examination results between May 2020 and November 2023 were analyzed for association with licensure information from the Texas State Board of Pharmacy. Exam scores were collected for student cohorts graduating from 2021 to 2022 as study cohort data. Correlation between exam scores and probability of successful licensure was assessed using logistic regression. A classification and regression tree analysis identified the most significant threshold. Predictive ability of the best-fit model was prospectively validated using the 2023 graduate cohort. ResultsThe overall licensure success rate was 80.6% for the study cohort (2021–2022, n = 206). Exam scores were well correlated to the likelihood of licensing success. The most significant threshold was 77.8%. The success rate was 82.5% vs 16.7% for those scoring above and below the threshold, respectively. The observed and predicted licensure success rates were 91.0% and 88.8%, respectively, in the validation cohort (2023, n = 89). The positive and negative prediction values were 94.9% and 40.0%, respectively. ConclusionThe performances on APPE exams were reasonable in predicting the first-time licensure success rate for a graduating class. Our assessment appears promising as a risk-stratification tool for students in gaining successful pharmacist licensure.

What’s inside matters: an assessment of the family planning content of digital self-care platforms

BackgroundDigital technology has proliferated rapidly in low- and middle-income countries in recent decades. This trend will likely persist as costs decrease, dramatically expanding access to reproductive health and family planning (FP) information. As many digital tools aim to support informed choice among individuals with unmet contraceptive need, it is essential that high-quality information is provided. We set out to assess the accuracy and comprehensiveness of FP content in select user-facing digital self-care platforms.MethodsWe identified 29 digital tools in circulation between 2018–2021 and selected 11 that met our eligibility criteria for analysis. Referencing global guidance documents such as the Family Planning Handbook, Medical Eligibility Criteria for Contraceptive Use, and the Digital Health for Social and Behavior Change High Impact Practice Brief, we developed an original rubric outlining 12 key content areas necessary to support informed, person-centered counseling. We applied this to each tool, enabling assignment of a numerical score that represents content accuracy and comprehensiveness across the 12 key areas.ResultsFP content of digital tools varied greatly in accuracy and comprehensiveness. Of the 12 identified key content areas, 5 were included in all 11 tools, while 6 were addressed inconsistently or not at all. Four content areas were the most accurate and comprehensive: complete list of modern methods, duration of protection, dual method use, and return to fertility. The lowest scoring content areas were side effect management, non-contraceptive benefits, effectiveness, side effects, and instructions for use. ConclusionsComplete, accurate, and evidence-based FP content is a foundational element of quality digital self-care. Inaccuracies and omissions can impact individual user experiences and decision-making in critical ways. FP content quality should be verified before digital tools are scaled or researched at the programmatic level. From this exercise, we developed a checklist for use in conjunction with global guidance documents to improve future FP content of user-facing digital tools.

SOCIO-CULTURAL AND PHYTOCHEMICAL RANKING OF FICUS MICROCARPA IN COMPARISM WITH SIX SELECTED INDIGENOUS BROWSE PLANTS FROM SOUTHEASTERN NIGERIA.

Domestic animals such as ruminants depend on the availability of biological diversity for sustenance which enables the selection of indigenous available raw materials in a given location. The present study focuses on socio-cultural and phytochemical ranking of Ficus microcarpa in comparism with six selected indigenous browse plants of Southeastern Nigeria. Socio-cultural and physicochemical studies of F. microcapa was carried out followed by its numerical scoring alongside six other plants; Garcinia kola,Mucuna pruriens, Gongronema latifolium, Manniophyton /illvunr, Nuaclea popegnine and Manihot utilissima to obtain a comparism across the plant types. The socio-cultural scoring scales were given as; whether the plant was planted by man in the compound, used as browse plant, has human food value, has medicinal value, amenable to vegetative propagation, evergreen all year round, and serves as firewood. Thereafter a scoring scale of 7 was used to rank the seven plants across nine selected phytochemical parameters which were based on the crude protein, ash, metabolizable energy, NDF, copper, iron, antioxidants, trypsin inhibitor and cyanide contents of the leaf meals. The two score results were then tallied to obtain the final mean score for each plant.Ficus "licrocarpa recorded the highest score of 85.71% in socio-cultural valueswhereas lowest score of 28.57% was recorded by M. pruriens. Based on the phytochemical parameters considered, F. microearpa scored a moderate 47.61% only better than 44.44% scored by M. fillvum.The present study has shown that Ficusmicrocarpa recorded the highest socio-cultural score across 6 other indigenous plants compared with it and recorded relatively lower phytochemical score than plants such as M utilissima,G. latifolium, G. kola, M. pruriens and N. popegnine. The combination of socio-cultural and phytochemical parameters has led to the development of a more reliable though sophisticated ranking method.lt is recommended that F. microcarpa be promoted as a browse of promise in the hot humid tropical zones of Nigeria and beyond.

Breast implant illness: A United Kingdom patient-centred approach

Silicone breast implants are widely prevalent. An increasing group of patients detail self-reported somatic and psychological symptoms that have been ascribed as breast implant illness (BII) and seek capsulectomy and implant removal. To guide consultations and shared decision making, more outcome data relating to this intervention are required. To present a multicentre study of patient-centred (n = 100) outcome data, following total capsulectomy with implant removal for BII. A questionnaire survey was cross-referenced with medical records. Collected data included demographics, operation details, pre- and postoperative symptom scores, overall self-perceived percentage improvement in BII symptoms and breast shape satisfaction ratings after explantation. The 10 most frequently self-reported symptoms were fatigue (81%), pains/aches (72%), brain/memory fog (56%), mood disturbances (36%), neuropathic pain (28%), hair loss (28%), headaches (25%), gastric symptoms/intolerances (24%), eczema/rash (18%) and vision disturbance (17%). A high proportion of patients (98%) experienced a 62 ± 4% average symptom improvement; most self-reported symptoms (21/28) improved significantly after explantation with total capsulectomy (p < 0.05). Furthermore, patients had high overall self-perceived BII percentage improvement (76 ± 3%) and satisfaction with breast shape numerical rating score (8 ± 0.30) postoperatively. Despite BII not being a defined disease entity, symptom association with silicone breast implants continues for a growing number of patients. It is important to recognise that in this patient group, capsulectomy and implant removal may not be curative, however we have demonstrated that symptom improvement can occur. It is very difficult to prove a causal link between breast implants and BII; to do so will require extensive prospective data collection.

Preoperative Bilateral External Oblique Intercostal Plus Rectus Sheath Block for Postoperative Pain Management Following Laparoscopic Cholecystectomy: A Noninferior Double-Blind Placebo-Controlled Trial.

The transversus abdominis plane (TAP) block has proven efficacy and is an important component of multimodal analgesia in laparoscopic cholecystectomy (LC). The external oblique intercostal (EOI) block can provide a dermatomal sensory blockade of T6 to T10 using an anterior axillary line injection. The bilateral rectus sheath (RS) block can significantly reduce early postoperative pain caused by umbilical or periumbilical incisions. The current study aimed to compare the analgesic efficacies of ultrasound-guided subcostal TAP (UG-TAP) combined with the RS block and ultrasound-guided EOI (UG-EOI) combined with the RS block for LC. Patients were randomly assigned to TAP or EOI group. Patients in TAP group received UG-TAP combined with an RS block. Patients in EOI group received UG-EOI combined with an RS block. The primary outcome was postoperative 24-hour sufentanil consumption. A total of 49 patients were included in the final analysis. The postoperative 24-hour sufentanil consumption in the EOI group was significantly lower than that in the TAP group (9.79±10.22 vs. 18.67±12.58µg; P [noninferiority] <0.01; noninferiority confirmed). Fewer patients in the EOI versus TAP group had a numerical rating score of >3 during motion. Furthermore, the mean postoperative 48-hour sufentanil consumption was lower in the EOI versus TAP group (11.54±11.70 vs. 23.04±17.10µg; P =0.01). The mean postoperative 24-hour Quality of Recovery-15 score was higher in the EOI versus TAP group (135.21±4.40 vs. 131.91±5.11; P =0.02). These findings suggest that UG-EOI combined with an RS block was superior to UG-TAP combined with an RS block for postoperative pain management in patients undergoing LC.

Availability of Observational Pain Assessment Tools in Hospitalized Patients with Osteoporotic Vertebral Fractures.

Background and Objectives: Osteoporotic vertebral fractures in older patients cause lower back pain and abnormal posture, resulting in impaired activities of daily living (ADLs). Assessing pain using self-reported assessment tools is difficult, especially in patients with moderate-to-severe cognitive impairment. Recently, observational assessment tools have been used when self-reported ones were difficult to administer. No studies have reported the usefulness of observational assessment tools in patients with acute-phase orthopedic disorders without complication. This study aimed to examine the availability of observational tools for pain assessment in patients with lumbar vertebral fractures. Materials and Methods: Patients admitted to our hospital with acute-phase vertebral fractures were enrolled in this prospective observational study. Pain was assessed using Japanese versions of the Abbey pain scale and Doloplus-2 observational assessment tools, and the Numerical Rating Scale, a self-reported assessment tool. To compare the pain assessment tool, we examined whether each tool correlated with ADLs and ambulatory status. ADLs were assessed using the Barthel Index. Ambulatory status was assessed using the Functional Ambulation Categories and the 10-m walking test. Results: Similar to the Numerical Rating Scale scores, assessments with the Abbey pain scale and Doloplus-2 showed significant decreases in scores over time. A significant positive correlation was observed between the self-reported and observational assessment tools. Each pain assessment tool was significantly negatively correlated with ADLs and ambulatory status. Conclusions: When self-reported assessment with the Numerical Rating Scale is difficult for patients with cognitive impairment, pain can be estimated using the Abbey pain scale and Doloplus-2 observational assessment tools.

The Influence of Students Academic Performance on Their Employability in the Field of Education

The study aims to determine the influence of academic performance to employability of the students in the field of education.The experimental research design will be structured for this study in which numeric score rating gathered the perception of the respondents observed in a structured pattern. This research design will deal at the problem of the study scientifically, to establish a clear cause and effect of Education Major students’ academic performance to their employability.The students’ perception on their employability in the field of education revealed that many disagreed their course is very important in their future work, and expressed that they are not more likely to work on a private school Majority of the students disagreed that they are more likely to work on a public school, and shared that their field of study is in-demand in terms of work opportunities in the education sector. Further, more students disagreed on the other indicators which are; they are confident that their skills and knowledge will match their work and confident that they will work in teaching or education sector, teachers are more likely to teach students than doing admin works, student skills are honed enough to move in an education work environment and they chose their field of study based on work demands of the education sector, teachers are more likely to do admin works than teaching students, students are more ready to teach and experience work environment, and lastly students already planned where they are going to work.

Effect of Bilateral Erector Spinae Plane Block versus Fentanyl Infusion on Postoperative Recovery in Cardiac Surgeries via Median Sternotomy: A Randomized Controlled Trial

ObjectivesThe effect of ultrasound-guided Erector Spinae Plane block (ESPB) on the time to extubation is unclear. This study aimed to assess the effect of ultrasound-guided bilateral ESPB on the time to extubation in patients who had cardiac surgery through midline sternotomy. DesignRandomized controlled trial. SettingCairo university hospital and national heart institute, Egypt. ParticipantsPatients aged from 18-70 years old who underwent cardiac surgery procedure through midline sternotomy. InterventionsRecruited patients were randomized to receive either preoperative single shot ultrasound guided bilateral ESPB or fentanyl infusion. MeasurementsThe primary outcome was the time to extubation. other outcomes included: total perioperative fentanyl consumption, pain score using the numerical rating score (NRS), length of ICU stay and incidence of perioperative complications. Main resultsTwo hundred and nineteen patients were available for final analysis. In the ESPB group, the mean time of extubation was significantly shorter (159.5 ± 109.5) minutes, compared to the control group (303.2 ± 95.9) minutes, mean difference (95% CI): -143.7(-171.1, -116.3) minutes, p= 0.0001. Ultrafast track (immediate postoperative) extubation was achieved in 23 (21.1%) patients in ESPB group compared to one patient (0.9%) in the control group. The ICU stay was significantly reduced in the ESPB group (47.2 2 ± 13.3) hours compared to the control group (78.9 ± 25.2) hours, p= 0.0001. There was significant reduction in NRS in ESPB group than control group for up to 24 hours postoperatively, p =0.001. ConclusionAmong adult patients undergoing cardiac surgery through medline sternotomy, the extubation time was halved in patients who received single shot bilateral erector spinae plane block compared to patients who received fentanyl infusion. Clinical trial identifierNCT05356715. Registration URLhttps://clinicaltrials.gov/study/NCT05356715

Olivar: towards automated variant aware primer design for multiplex tiled amplicon sequencing of pathogens

Tiled amplicon sequencing has served as an essential tool for tracking the spread and evolution of pathogens. Over 15 million complete SARS-CoV-2 genomes are now publicly available, most sequenced and assembled via tiled amplicon sequencing. While computational tools for tiled amplicon design exist, they require downstream manual optimization both computationally and experimentally, which is slow and costly. Here we present Olivar, a first step towards a fully automated, variant-aware design of tiled amplicons for pathogen genomes. Olivar converts each nucleotide of the target genome into a numeric risk score, capturing undesired sequence features that should be avoided. In a direct comparison with PrimalScheme, we show that Olivar has fewer mismatches overlapping with primers and predicted PCR byproducts. We also compare Olivar head-to-head with ARTIC v4.1, the most widely used primer set for SARS-CoV-2 sequencing, and show Olivar yields similar read mapping rates (~90%) and better coverage to the manually designed ARTIC v4.1 amplicons. We also evaluate Olivar on real wastewater samples and found that Olivar has up to 3-fold higher mapping rates while retaining similar coverage. In summary, Olivar automates and accelerates the generation of tiled amplicons, even in situations of high mutation frequency and/or density. Olivar is available online as a web application at https://olivar.rice.edu and can be installed locally as a command line tool with Bioconda. Source code, installation guide, and usage are available at https://github.com/treangenlab/Olivar.

Efficacy of cannabinoids compared to the current standard treatments on symptom relief in persons with multiple sclerosis (CANSEP trial): study protocol for a randomized clinical trial.

Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system. More than 90,000 Canadians are affected; a cure is yet to be found. Available treatments to manage the disease course are only partially effective. For many years, persons with MS (PwMS) have used cannabis to relax, to reduce pain and spasticity, or to improve sleep and daily functioning, despite the lack of scientific evidence on the efficacy of specific cannabinoids [i.e., tetrahydrocannabinol (THC) and cannabidiol (CBD)] on these MS symptoms. The purpose of this clinical trial is to assess the effectiveness of different doses of these cannabinoids, alone or combined, on spasticity relief, compared to placebo. Moreover, we aim to determine which treatment is best effective to address other key MS conditions. A double-blinded, randomized, factorial, placebo-controlled trial will be performed. We intend to include up to 250 PwMS aged over 21 recruited from the Centre hospitalier de l'Université de Montréal MS Clinic. PwMS will be randomly assigned on a 1:1:1:1 ratio to one of the trial arms: THC alone, CBD alone, THC/CBD combination, or placebo, using stratified blocked randomization, with random blocks within each stratum. The primary outcome is a self-assessment of spasticity using the mean Numeric Rating Scale score over 7 days. The main outcome will be the difference in this score at 4 weeks compared to baseline. Secondary outcomes include assessments of spasticity as measured by a clinician, pain, fatigue, sleep, bowel, bladder, and sexual dysfunction, restless legs syndrome, mental health, quality of life, mobility, cognitive functioning, and adverse events. Treatment responders are eligible for a 12-week extension phase, using the same treatment allocation and assessments. Previous clinical studies examined the efficacy of cannabis-based medicines in PwMS, mostly using products with 1:1 THC/CBD ratio. The major barrier to effectively use cannabis in real-world clinical settings is the lack of evidence on benefits of specific cannabinoids and information on possible related risks. The CANSEP study will contribute to overcome these limitations and identify the risks and benefits of cannabis-based treatments in PwMS. ClinicalTrials.Gov, NCT05092191.

Key components identification of EMU complex system faults with interval intuitionistic fuzzy set and multi-attribute group decision-making based on FMECA method

With the continuous acceleration of high-speed railway, the high-voltage traction system of the EMU is an important part for ensuring the operation speed and safety. If the failure does not discontinued effectively, it will cause major dangerous accidents, so the key components identification of system is crucial. This paper focus on the contradictions of the expert evaluation information ambiguity, the difference of expert risk appetite and the rationality of risk priority number (RPN) calculation method in the traditional failure analysis method FMECA. The interval intuitionistic fuzzy set (IIFS) is introduced to transform the expert evaluation into the form of membership interval and non-membership interval, which reduced the ambiguity of the specific numerical score. The interval intuitive fuzzy entropy was used to determine the entropy values of the occurrence (O), severity (S), and undetectable degree (D) of each failure mode under each expert score, which was used to calculate the weight value [Formula: see text], to weaken the influence caused by subjective risk preference. The interval intuition fuzzy ensemble operator (AIVIFWM) is used to assemble a single scoring matrix into a comprehensive score, which weakens the subjective influence of expert evaluation. Combined with the multi-attribute group decision-making idea, the score function [Formula: see text] is calculated for each comprehensive evaluation interval of each failure mode after assembly, so as to sort the failure mode risk and finally identify the key components. Based on the fault data of the high-voltage traction system of a certain type of EMU in 2022, 39 failure modes of 30 components are researched and summarized. The results show that rectifier, converter cooling unit, and carbon skateboard are the key components of EMU high-voltage traction system, which provided basic support for the detection and maintenance decision.

Anesthetic recovery outcomes after 2 methods of nasal mucosal preparation for endoscopic sinus surgery

PurposeOur institution uses two approaches for nasal mucosal preparation during endoscopic sinus surgery (ESS) to improve surgical field visualization: topical epinephrine (TE) versus topical cocaine with injection of lidocaine containing epinephrine (TCLE). We aimed to compare anesthetic outcomes after ESS using these techniques. Methods and materialsWe retrospectively identified adult patients at our institution who underwent ESS from May 2018 through January 2023 under general anesthesia with propofol and remifentanil infusions. Postoperative anesthetic outcomes, including pain and recovery time, were compared between patients who had mucosal preparation with TE versus TCLE using inverse probability of treatment weighting (IPTW) to adjust for potential confounders. ResultsAmong 1449 patients who underwent ESS, 585 had TE, and 864 had TCLE. Compared with TE, during anesthetic recovery, the TCLE group had fewer episodes of severe pain (numeric pain score ≥ 7) (IPTW-adjusted odds ratio, 0.65; 95 % CI, 0.49–0.85; P = .002), less opioid analgesic administration (IPTW-adjusted odds ratio, 0.55; 95 % CI, 0.44–0.69; P < .001), and shorter recovery room stay (IPTW-adjusted ratio of the geometric mean, 0.90; 95 % CI, 0.85–0.96; P = .002). Postoperative nausea and vomiting and postoperative sedation were similar between groups. ConclusionsPatients who received preparation of the nasal mucosa with TCLE, compared with TE, were less likely to report severe pain or receive an opioid analgesic in the postanesthesia recovery room and had faster anesthetic recovery. This observation from our large clinical practice indicates that use topical and local anesthetic during endoscopic sinus surgery may have benefit for ambulatory ESS patients.

Financial Performance Analysis And Stock Valuation of PT Kimia Farma Tbk.

Laparoscopic cholecystectomy is the surgical method of choice for gallbladder removal. Enhanced Recovery After Surgery (ERAS) is a program designed to accelerate patient recovery after surgery by reducing length of stay, pain, and accelerating initial mobilization. This study aims to evaluate the effectiveness of the ERAS nursing program on pain levels, initial mobilization, and length of hospitalization of post-laparoscopic cholecystectomy patients at Pluit Hospital Jakarta. A total of 65 patients undergoing laparoscopic cholecystectomy were sampled, with 40 patients in the ERAS group and 25 patients in the control group. Data were collected using questionnaires and observation sheets, and analyzed using the ANCOVA test. The results showed that the ERAS group had lower numerical scale scores for pain (1.87 vs 5.72, p &lt; 0.001), earlier mobilization (3.45 hours vs 9.12 hours, p &lt; 0.001), and shorter length of stay (27.13 hours vs 74.84 hours, p &lt; 0.001) compared to the control group. The implementation of the ERAS nursing program has proven to be effective in reducing pain levels, accelerating initial mobilization, and reducing the length of stay of patients after laparoscopic cholecystectomy at Pluit Hospital Jakarta. This study supports the use of ERAS protocol to improve the quality of surgical care in Indonesia.

Transforming Hospital Housekeeping: The Kayakalp Journey.

The Kayakalp guidelines for public healthcare facilities under the Swachh Bharat Abhiyan (Clean India Mission) focus on improving sanitation, cleanliness, and infection control at public hospitals in India. This study was conducted in a 960-bed tertiary-level teaching hospital in eastern India. Housekeeping has been a challenge in public institutions, with factors like overcrowding and resource constraints. Tobacco and betel nut chewing, spitting, poor sanitation practices, and open urination are major challenges in ensuring sanitation at the hospital. The research objective was to study the implementation of the Kayakalp guidelines for quality improvement in housekeeping services at the institution. A pre- and post-interventional study was conducted using the Plan-Do-Check-Act (PDCA) quality tool. Plan phases included the gap assessment using the Kayakalp checklist with numerical scoring. Necessary interventions were done under three headings: structure, processes, and outcomes in the "Do" phase. The "Check" phase included monitoring of the activities followed by the "Act" phase, which included a review of the action plan. External experts nominated by the government conducted the final assessments and recommended it as one of the cleanest hospitals. A 360-degree improvement was observed in hospital services, with assessment score improvement from 73.68% to 95.0%. The institution received the first prize in 2020 and 2021 and runners-up Kayakalp National Award under category "B" (Institute of National Importance) Hospitals in 2019. The implementation of Kayakalp guidelines of the Government of India proved to be efficient in the improvement of housekeeping and infection control practices in the institution.

A Prospective Randomised Comparative Study to Evaluate the Effect of Single Dose (6.25Gy Vs 8Gy) Palliative Radiotherapy with Zoledronic Acid in Patients with Painful Bone Metastases

Background: To assess the effectiveness of a single fraction dose of radiotherapy (6.25Gy versus 8 Gy) with zoledronic acid in cancer patients with painful bone metastases in treating pain; quality of life; duration of pain response and incidence of skeletal related events (SREs). Material and methods: A total of 80 patients with bone metastases presented in the department of Radiation Oncology, S.M.S hospital were randomly assigned to: Group A, received single dose of 6.25Gy with Zoledronic acid 4mg and Group B, received single dose of 8Gy with Zoledronic acid 4mg. The main variable was pain which was assessed with 11 point Numeric pain Rating Score (NRS). Results: There were total 80 patients, 40 in each group, with mean age 54.6 years and 54.5 years in group A and B respectively. Most frequent primary malignant sites were lung (36.2%), breast (28.7%), and prostate (8.7%). At 4 weeks post radiotherapy, complete response was 25% in group A, 27.5% in group B and overall response was 82.5% in group A, 85% in group B. At 2 months post radiotherapy complete response was observed in 25% of patients in group A, while 30% in group B and overall response in 85 % in group A and 87.5% in group B. Quality of life improved in both groups. Mean duration of pain relief was 13.5 weeks vs. 14.5 weeks respectively in group A and group B. Conclusion: There was improvement in pain relief and quality of life post radiotherapy in both the groups. On comparison between 2 groups, the overall pain relief was insignificant between the two dose schedules. So a lower dose 6.25Gy is almost as effective as 8 Gy single fractions for treatment of painful bone metastases.

Designing of potential polymer donors with lower reorganization energy and chemical space exploration in search of materials for efficient organic solar cells

Machine learning with fascinating material predicting capabilities has emerged as a growing throughput artificial intelligence technology to accelerate the design, screening and prediction of material properties. In this study, chemical descriptors are employed to train machine learning (ML) models for the designing of potential polymer donor materials aimed at enhancing the efficiency of organic solar cells (OSCs). To achieve this, ten ML models are evaluated. Among all, the random forest regressor model has shown better predictive ability. In addition, to quantify the importance of features, the numerical scores of the significance of the features are determined through Feature importance analysis. Moreover, 10k new polymers are generated employing the python-based method and their reorganization energies are further predicted using a pre-trained ML model. The assemblage of polymers is done on the basis of the reorganization energy, those with lower reorganization energy being preferred. Furthermore, the synthetic accessibility and thus the structural diversity among the chosen polymers donors are examined, revealing a structural difference among the chosen polymers. This work paves a way for the designing and screening of efficient semiconductors with low reorganization energy to increase the efficiency of OSCs.

Efficacy of using adipose-derived stem cells and PRP on regeneration of 40 -mm long sciatic nerve defect bridged by polyglycolic-polypropylene mesh in canine model

BackgroundSciatic nerve repair becomes a focus of research in neurological aspect to restore the normal physical ability of the animal to stand and walk. Tissue engineered nerve grafts (TENGs) provide a promising alternative therapy for regeneration of large gap defects. The present study investigates the regenerative capacity of PRP, ADSCs, and PRP mixed ADSCs on a long sciatic nerve defect (40-mm) bridged by a polyglycolic polypropylene (PGA-PRL) mesh which acts as a neural scaffold.Materials and methodsThe study was conducted on 12 adult male mongrel dogs that were randomly divided into 4 groups: Group I (scaffold group); where the sciatic defect was bridged by a (PGA-PRL) mesh only while the mesh was injected with ADSCs in Group II (ADSCs group), PRP in Group III (PRP group). Mixture of PRP and ADSCs was allocated in Group IV (PRP + ADSCs group). Monthly, all animals were monitored for improvement in their gait and a numerical lameness score was recorded for all groups. 6 months-post surgery, the structural and functional recovery of sciatic nerve was evaluated electrophysiologically, and on the level of gene expression, and both sciatic nerve and the gastrocnemius muscle were evaluated morphometrically, histopathologically.ResultsNumerical lameness score showed improvement in the motor activities of both Group II and Group III followed by Group IV and the scaffold group showed mild improvement even after 6 months. Histopathologically, all treated groups showed axonal sprouting and numerous regenerated fascicles with obvious angiogenesis in proximal cut, and distal portion where Group IV exhibited a significant remyelination with the MCOOL technique. The regenerative ratio of gastrocnemius muscle was 23.81%, 56.68%, 52.06% and 40.69% for Group I, II, III and IV; respectively. The expression of NGF showed significant up regulation in the proximal portion for both Group III and Group IV (P ≤ 0.0001) while Group II showed no significant difference. PDGF-A, and VEGF expressions were up-regulated in Group II, III, and IV whereas Group I showed significant down-regulation for NGF, PDGF-A, and VEGF (P ≤ 0.0001).ConclusionADSCs have a great role in restoring the damaged nerve fibers by secreting several types of growth factors like NGF that have a proliferative effect on Schwann cells and their migration. In addition, PRP therapy potentiates the effect of ADSCs by synthesis another growth factors such as PDGF-A, VEGF, NGF for better healing of large sciatic gap defects.