Optimal Patient Care Research Articles

Exploring the impact of recent COVID-19 infection on perfusion and functional parameters derived from gated myocardial perfusion imaging in patients undergoing evaluation for coronary artery disease.

This study seeks to evaluate how recent COVID-19 infection affects myocardial perfusion and functional parameters derived from gated myocardial perfusion imaging in patients undergoing evaluation for coronary artery disease. The goal is to enhance our understanding of COVID-19's influence on the cardiovascular system. Conducted at Farshchian Heart Hospital from 2022 to 2023, this case-control study enrolled patients suspected of coronary artery disease, stratified into two groups: those with confirmed COVID-19 infection within the past 6months (study group) and those without prior COVID-19 infection (control group). Employing a 2-day protocol, stress testing and gated SPECT MPI were performed. Statistical analysis included descriptive statistics, Chi-square test, Student's t test, and Mann-Whitney U test. Among the 86 patients included, 43 were in each group. Significantly higher summed stress core and summed difference score values were observed in the study group compared to the control group (p < 0.05). In addition, the study group exhibited significantly altered global left ventricular ejection fraction, end-diastolic volume, and end-systolic volume (p < 0.05). Non-perfusion findings, including transient ischemic dilation and transient right ventricular visualization, were more prevalent in the study group. Recent COVID-19 infection is associated with impaired myocardial perfusion and altered functional parameters as detected by MPI. These findings underscore the intricate interplay between COVID-19 and cardiovascular health, emphasizing the importance of comprehensive evaluation and management strategies to address cardiac complications in affected individuals. Further research is warranted to elucidate the underlying mechanisms and optimize patient care in the context of COVID-19-associated cardiovascular manifestations.

The knowledge, attitudes, and practices of arteriovenous access assessment among hemodialysis nurses: A multicenter cross-sectional survey.

Hemodialysis nurses' cannulation technique, monitoring, and management methods can affect patients' vascular access longevity. An arteriovenous access assessment comprises a medical history and vascular assessment through physical examination and surveillance. However, further exploration is needed to fully understand hemodialysis nurses' knowledge, attitudes, and practices (KAP) in this area. Between June and July 2023, we recruited hemodialysis nurses from 21 cities in Guangdong Province using a convenience sampling method. Four questionnaires-the General Data Questionnaire, the KAP Scale of Arteriovenous Access Assessment among Hemodialysis Nurses, the Utrecht Work Engagement Scale, and the NASA Task Load Index-were utilized for data collection through the Questionnaire Star platform. Of the 530 hemodialysis nurses participating in the study, 458 (86.4%) had a valid response. The participants demonstrated moderate knowledge and practice levels regarding arteriovenous access assessment and exhibited positive attitudes. We identified several factors related to arteriovenous access assessment that predict KAP in hemodialysis nurses. These factors included years of experience as a hemodialysis nurse, whether a nurse's knowledge of physical examination was sufficient to meet clinical needs, whether a nurse had received training in performing physical examination, whether a nurse's department regularly checked the quality of physical examination, and nurses' levels of work engagement and mental workload. All factors explained 32.4% of the variance in participants' KAP regarding arteriovenous access assessment. Improving hemodialysis nurses' assessment of arteriovenous access is crucial to ensure optimal patient care. Dialysis center managers and educators should prioritize understanding hemodialysis nurses' KAP of arteriovenous access assessment and any factors influencing these areas.

Understanding diffuse leptomeningeal glioneuronal tumors.

Diffuse leptomeningeal glioneuronal tumors (DLGNTs) pose a rare and challenging entity within pediatric central nervous system neoplasms. Despite their rarity, DLGNTs exhibit complex clinical presentations and unique molecular characteristics, necessitating a deeper understanding of their diagnostic and therapeutic nuances. This review synthesizes contemporary literature on DLGNT, encompassing epidemiology, clinical manifestations, pathological features, treatment strategies, prognostic markers, and future research directions. To compile the existing body of knowledge on DLGNT, a comprehensive search of relevant databases was conducted. DLGNT primarily affects pediatric populations but can manifest across all age groups. Its diagnosis is confounded by nonspecific clinical presentations and overlapping radiological features with other CNS neoplasms. Magnetic resonance imaging (MRI) serves as a cornerstone for DLGNT diagnosis, revealing characteristic leptomeningeal enhancement and intraparenchymal involvement. Histologically, DLGNT presents with low to moderate cellularity and exhibits molecular alterations in the MAPK/ERK signalling pathway. Optimal management of DLGNT necessitates a multidisciplinary approach encompassing surgical resection, chemotherapy, radiotherapy, and emerging targeted therapies directed against specific genetic alterations. Prognostication remains challenging, with factors such as age at diagnosis, histological subtypes, and genetic alterations influencing disease progression and treatment response. Long-term survival data are limited, underscoring the need for collaborative research efforts. Advancements in molecular profiling, targeted therapies, and international collaborations hold promise for improving DLGNT outcomes. Harnessing the collective expertise of clinicians, researchers, and patient advocates, can advance the field of DLGNT research and optimize patient care paradigms.

Early diagnosis of melanoma: a randomized trial assessing the impact of the transmission of photographs taken with a smartphone from the general practitioner to the dermatologist on the time to dermatological consultation

BackgroundDifficulty obtaining a dermatological consultation is an obstacle to the early diagnosis of melanoma. On the one hand, patients survival depends on the lesion thickness at the time of diagnosis. On the other hand, dermatologists treat many patients with benign lesions. Optimizing patient care pathways is a major concern. The aim of the present study was to assess whether the e-mail transmission of photographs of suspected melanoma lesions between general practitioners (GPs) and dermatologists reduces the time to dermatological consultation for patients whose suspicious skin lesions ultimately require resection.MethodsWe conducted a cluster-randomized controlled study in primary care involving 51 French GPs between April 2017 and August 2019. A total of 250 patients referred to a dermatologist for a suspected melanoma lesion were included GPs were randomized to either the smartphone arm or the usual care arm. In the smartphone arm, the GPs referred patients to the dermatologist by sending 2 photographs of the suspicious lesion using their smartphone. The dermatologist then had to set up an appointment at an appropriate time. In the usual care arm, GPs referred patients to a dermatologist according to their usual practice. The primary outcome was the time to dermatological consultation for patients whose lesion ultimately required resection.Results57 GPs volunteered were randomized (27 to the smartphone arm, and 30 to the usual care arm). A total of 125 patients were included in each arm (mean age: 49.8 years; 53% women) and followed 8 months. Twenty-three dermatologists participated in the study. The time to dermatological consultation for patients whose suspicious skin lesion required resection was 56.5 days in the smartphone arm and 63.7 days in the usual care arm (mean adjusted time reduction: -18.5 days, 95% CI [-74.1;23.5], p = .53).ConclusionsThe e-mail transmission of photographs from GPs to dermatologists did not improve the dermatological management of patients whose suspicious skin lesions ultimately required resection. Further research is needed to validate quality criteria that might be useful for tele-expertise in dermatology.Trial RegistrationRegistered on ClinicalTrials.gov under reference number NCT03137511 (May 2, 2017).

#2594 Patient-reported inter- and intradialytic symptoms in HD &amp; HDF patients

Abstract Background and Aims Patients on hemodialysis (HD) experience a wide range of symptoms during and between dialysis that negatively affect their well-being. Addressing these symptoms, particularly from the patient's perspective, is a crucial component in the treatment. Our findings suggest a beneficial effect of hemodiafiltration (HDF) over hemodialysis (HD) on mortality and quality of life. This study aimed to investigate the differences in symptom severity between patients on HD and HDF. Method Patient-reported outcomes data of 1264 hemodialysis patients were extracted from CONVINCE, an international randomized controlled trial comparing high-dose hemodiafiltration with high-flux hemodialysis, including baseline and quarterly follow-up data up to 24 months. Symptoms were assessed using the CONVINCE peridialytic symptoms questionnaire covering inter- as well as intradialytic symptoms (see Table 1) with items scored between 0-100, higher scores indicating fewer symptoms. Prevalence and scores of all inter- and intradialytic symptom items at baseline and during follow-up visits were assessed and compared between HD and HDF groups. The association of changes of symptom scores over time with dialysis modality (HD vs. HDF) was assessed by Mixed Models for Repeated Measures (MMRM). Results MMRM analyses showed no significant main effects of dialysis modality on symptoms at the p &amp;lt;.05 level. However, descriptive statistics and plots indicated higher scores for most symptoms in the HDF group. The highest score differences between HDF and HD group over all timepoints were found for itchy skin (2.09 [95% CI −0.09-4.26]), numbness in hands or feet (2.03 [95% CI −0.22-4.28]), being washed out or drained (1.88 [95% CI −0.23-3.99]) and lack of appetite (1.73 [95% CI −0.03-3.50]). Plots for these symptoms can be found in Fig. 1. Furthermore, no significant interactions were found between dialysis modality and time, indicating that the rate of change in symptom scores did not differ significantly between the HDF and HD group. Conclusion No statistically significant differences in patient-reported symptoms between HDF and HD patients were found. We may not have the granularity of data to fully explore factors which may have contributed to the positive effects of HDF that have been reported previously. This might be due to the method of symptom assessment used or specific issues with perception of symptom burden. Our results highlight the complexity of symptom management in dialysis patients and underscore the need for future symptom assessments to allow for personalized treatment strategies that further optimize patient care.

For the Long Haul: Management of Long-Term Survivors after Melanoma Systemic Therapy.

This review summarizes the latest advancements in survivorship care for patients with advanced melanoma who received systemic therapy and emphasizes the areas where more research is needed. Over the last decade there have been remarkable advances in the treatment of advanced and metastatic melanoma. Due to these novel treatments, including several immune checkpoint inhibitors and tyrosine kinase inhibitors, there are and will continue to be increasing numbers of long-term melanoma survivors who have been treated with systemic therapy. These patients will navigate new challenges are they are essentially among the first long term survivors after these novel therapies. Survivorship care focuses on improving the health-related quality of life of patients including the physical, emotional, social and functional effects of cancer that begin at diagnosis and continue through the end of life. Survivorship also includes screening for cancer recurrence and second cancers. As the number of melanoma survivors who received systemic therapy continues to grow, the survivorship care plan will become increasingly important for optimal care of patients even after their cancer treatments. Understanding the many domains of survivorship care for this group of patients is imperative for their care now and to identify unmet needs for future research.

ASHP National Survey of Pharmacy Practice in Hospital Settings: Operations and Technology - 2023.

Results of the 2023 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented. Pharmacy directors at 1,497 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online using Qualtrics. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA's hospital database. The response rate was 21.6%. Inpatient pharmacists independently prescribe medications in 26.7% of hospitals. Advanced analytics are used in 5.7% of hospitals. Basic analytics are used in 87.3% of hospitals. Pharmacists work in ambulatory or primary care clinics in 54.2% of hospitals operating outpatient clinics. Most hospitals (86.1%) use automated dispensing cabinets as the primary method of maintenance dose distribution. Machine-readable coding is used in 73.6% of hospitals to verify doses during dispensing in the pharmacy. Autoverification functionality in the electronic health record system is used in 73.4% of hospitals. Most hospitals report some integration of pharmacy services to optimize patient care transitions (60.0%), while 24.9% report no integration. Traditional technician activities still predominate, but more advanced roles are emerging. Technologies to assist sterile product preparation are used in 62.8% of hospitals. Drug distribution continues to trend toward decentralized models with medications available closer to patients. Technologies are enabling this transition to occur without a significant negative impact on patient safety. The pharmacy workforce is stable, and more advanced responsibilities are being assigned to pharmacy technicians, enabling pharmacists to increase their clinical role.

#2454 Meeting guideline goals at hemodialysis patients impact their survival?

Abstract Background and Aims The Institute of Medicine (IOM) defines clinical practice guidelines as "statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options". First publication of Clinical Guidelines by the National Kidney Foundation (NKF), addressing good clinical practice in hemodialysis, was published in 1998. The aim of the present study was to investigate the influence of adherence to current guidelines of Mineral and Bone Disorders, Anemia and Adequacy of Dialysis, on their survival in patients undergoing hemodialysis. Method This is a single center retrospective study of 113 chronic hemodialysis patients (79 males and 34 females), with median age 70 years (56, 78), median duration on hemodialysis 52 months (21, 95). Based on whether or not they met the KDIGO guidelines’ targets for anemia, bone disease, dialysis adequacy, and the targets of all three guidelines during the last three years, patients were divided in two groups: group A with the patients who met the goals of the guidelines and group B with the patients who did not meet the goals. Clinical and biochemical parameters were compared among the groups of patients as well as hemodialysis adequacy (Kt/V). The survival analysis of the patients was calculated by Kaplan-Meier, while the possible effect of any parameter on survival was also evaluated with Cox-Regression. Results There was significant difference between the two groups in age, phosphorous (P), PTH, Kt/V, URR and Alb. There was no significant difference between the two groups in sex, duration of HD, Hemoglobin (Hg), Calcium (Ca++), Hypertension and Diabetes (Table). In Cox analyses, patient survival was associated with delivered dialysis dose (single pool Kt/V, p=0.044). There was no significant difference between the two groups when we compare the adherence to guidelines for MBD (p=0.507) and anemia (p=0.394). There was no statistical difference when we compare the achievement of targets of all three guidelines (p=0.796). We identified as an independent risk factor for patient survival the serum albumin (p&amp;lt;0.001). Patient survival was better with higher dialysis dose and adequate serum albumin level. Conclusion Clinical guidelines are useful tools for good clinical practice for hemodialysis patients. Adherence to clinical guidelines regarding dialysis adequacy is an independent risk factor for better survival of patients undergoing hemodialysis.

Biallelic FANCA variants detected in sisters with isolated premature ovarian insufficiency.

Premature ovarian insufficiency is a common form of female infertility affecting up to 4% of women and characterised by amenorrhea with elevated gonadotropin before the age of 40. Oocytes require controlled DNA breakage and repair for homologous recombination and the maintenance of oocyte integrity. Biallelic disruption of the DNA damage repair gene, Fanconi anemia complementation group A (FANCA), is a common cause of Fanconi anaemia, a syndrome characterised by bone marrow failure, cancer predisposition, physical anomalies and POI. There is ongoing dispute about the role of heterozygous FANCA variants in POI pathogenesis, with insufficient evidence supporting causation. Here, we have identified biallelic FANCA variants in French sisters presenting with POI, including a novel missense variant of uncertain significance and a likely pathogenic deletion that initially evaded detection. Functional studies indicated no discernible effect on DNA damage sensitivity in patient lymphoblasts. These novel FANCA variants add evidence that heterozygous loss of one allele is insufficient to cause DNA damage sensitivity and POI. We propose that intragenic deletions, that are relatively common in FANCA, may be missed without careful analysis, and could explain the presumed causation of heterozygous variants. Accurate variant curation is critical to optimise patient care and outcomes.

Enhancing Transparency in Optimum Patient Care Research Database Access Procedures: A Multifaceted Approach Addressing Improvements in Transparency Standards

Enhancing Transparency in Optimum Patient Care Research Database Access Procedures: A Multifaceted Approach Addressing Improvements in Transparency Standards

Enhancing medication management in hemodialysis patients: Exploring the impact of patient-centered pharmacist care and motivational interviewing.

Patients on hemodialysis (HD) often uses several medications, making them highly susceptible to medication-related problems (MRP) thereby leading to medication nonadherence. Therefore, an innovative pharmaceutical care strategy incorporating drug therapy optimization (DTO) and motivational interviewing (MI) can mitigate medication-related problems and optimize patient care. The objective of this study is to assess the efficacy of pharmacist led interventions in utilizing DTO and MI techniques in managing medication related problems among patients undergoing hemodialysis. A12-months, cross sectional prospective study was conducted among 63 End Stage Renal Disease (ESRD) patients on HD. DTO was conducted by the pharmacist to identify the MRP by reviewing complete medication list gathered from patient interview and medical records. All MRPs was classified using the PCNE classification version 9.00 and medication issues, that require patient involvement were categorized as patient-related, while those that necessitate physician intervention were classified as physician-related. The DTO was performed at the baseline, 6-month and at the final month of the study. Identified medication issues were communicated to the site nephrologist and was tracked during next follow up. Whereas MI was conducted physically at Month-3 and via telephone on month-6 and month-9 to address patient related medication issues. Mean age of the study population was 48.5±14 years. While the mean number of prescribed medications was 8.1±2 with 57% of the patients taking more than 5 types of medication. After 12 months of pharmacist intervention using DTO and MI, a mean reduction in MRP was observed for both patient-related and physician-related MRPs across three time series. However, further analysis using repeated measure ANOVA revealed that the reduction in patient-related MRPs was statistically significant [F(1.491, 92.412) = 60.921, p < 0.05], while no statistically significant difference was detected in physician-related MRPs [F(2, 124) = 2.216, P = 0.113]. Pharmaceutical care service through DTO and MI can effectively reduce and prevent drug-related issues to optimize medication therapy among HD patients.

Enhancing and Implementation of ML in Healthcare Sector

This research paper explores the transformative impact of machine learning (ML) on the healthcare industry, particularly through the emergence of ML-driven health and medical platforms. With the ongoing shift from offline to online shopping, the future of healthcare is envisioned to heavily rely on specialized online doctor consultations and pharmacies. Leveraging ML technologies, these platforms offer personalized services such as real-time video consultations, appointment scheduling, prescription management, and health record maintenance, ultimately prioritizing safety and convenience. This paper elucidates the potential of ML in optimizing patient care, expediting processes, and enhancing decision-making in healthcare. Additionally, it delves into the global trend of online medicine purchasing, highlighting its advantages and examining its impact on the Indian healthcare market.

A Machine Learning-Based Mortality Prediction Model for Patients with Chronic Hepatitis C Infection: An Exploratory Study.

Background: Chronic hepatitis C (HCV) infection presents global health challenges with significant morbidity and mortality implications. Successfully treating patients with cirrhosis may lead to mortality rates comparable to the general population. This study aims to utilize machine learning techniques to create predictive mortality models for individuals with chronic HCV infections. Methods: Data from chronic HCV patients at Sultan Qaboos University Hospital (2009-2017) underwent analysis. Data pre-processing handled missing values and scaled features using Python via Anaconda. Model training involved SelectKBest feature selection and algorithms such as logistic regression, random forest, gradient boosting, and SVM. The evaluation included diverse metrics, with 5-fold cross-validation, ensuring consistent performance assessment. Results: A cohort of 702 patients meeting the eligibility criteria, predominantly male, with a median age of 47, was analyzed across a follow-up period of 97.4 months. Survival probabilities at 12, 36, and 120 months were 90.0%, 84.0%, and 73.0%, respectively. Ten key features selected for mortality prediction included hemoglobin levels, alanine aminotransferase, comorbidities, HCV genotype, coinfections, follow-up duration, and treatment response. Machine learning models, including the logistic regression, random forest, gradient boosting, and support vector machine models, showed high discriminatory power, with logistic regression consistently achieving an AUC value of 0.929. Factors associated with increased mortality risk included cardiovascular diseases, coinfections, and failure to achieve a SVR, while lower ALT levels and specific HCV genotypes were linked to better survival outcomes. Conclusions: This study presents the use of machine learning models to predict mortality in chronic HCV patients, providing crucial insights for risk assessment and tailored treatments. Further validation and refinement of these models are essential to enhance their clinical utility, optimize patient care, and improve outcomes for individuals with chronic HCV infections.

German guidelines for airway management 2023.

The German airway management guidelines are intended to serve as an orientation and decision-making aid and thus contribute to the optimal care of patients undergoing anesthesiologic- and intensive medical care. As part of the pre-anesthesiologic evaluation, anatomical and physiological indications for difficult mask ventilation and intubation shall be evaluated. This includes the assessment of mouth opening, dental status, mandibular protrusion, cervical spine mobility and existing pathologies. The airway shall be secured while maintaining spontaneous breathing if there are predictors or anamnestic indications of difficult or impossible mask ventilation and/or endotracheal intubation. Various techniques can be used here. If there is an unexpectedly difficult airway, avideo laryngoscope is recommended after unsuccessful direct laryngoscopy, consequently avideo laryngoscope must be available at every anesthesiology workplace. The airway shall primarily be secured with avideo laryngoscope in critically ill- and patients at risk of aspiration. Securing the airway using translaryngeal and transtracheal techniques is the "ultima ratio" in airway management. The performance or supervision of airway management in the intensive care unit is the responsibility of experienced physicians and nursing staff. Appropriate education and regular training are essential. Clear communication and interaction between team members are mandatory before every airway management procedure. Once the airway has been secured, the correct position of the endotracheal tube must be verified using capnography.

Histologic Hitchhikers: A Review of Common Exogenous Artifacts Encountered During Mohs Micrographic Surgery.

Exogenous artifacts can interfere with accurate histologic tissue evaluation on frozen sections during Mohs micrographic surgery (MMS). Mohs surgeons should be aware of these anomalies to avoid potential misdiagnoses. To review exogenous artifacts encountered in frozen tissue pathology during MMS. A literature search was conducted in PubMed to identify studies reporting on exogenous artifacts encountered during MMS and a list of previously described exogenous artifacts was compiled. A retrospective examination of frozen histology slides from recent Mohs cases at the authors' institution was performed to obtain illustrative examples of these artifacts, supplemented by formalin-fixed paraffin-embedded samples when frozen examples could not be found. Exogenous artifacts represent foreign bodies that have been externally introduced into the skin or artifacts resulting from other external factors. If frozen section evaluation is inaccurate, overdiagnosis can occur during MMS, resulting in unnecessary layers, larger margins, and more complex reconstructions. These exogenous tissue changes can mimic inflammatory processes and melanocytic or keratinocyte malignancies on histology. Exogenous artifacts are common findings during margin assessment in Mohs micrographic surgery. The resulting histological findings can be confusing but correlating them with the clinical and surgical history often reassures surgeons. Recognizing these artifacts facilitates accurate diagnosis and promotes optimal patient care.

Clinical and electroencephalographic correlates of carbamazepine-associated hiccups in epileptic patients.

Carbamazepine, a commonly prescribed antiepileptic drug, is known to induce hiccups in a subset of epileptic patients. Although relatively uncommon, can have significant clinical implications. This comprehensive review delves into the clinical and electroencephalographic correlates of carbamazepine-associated hiccups, aiming to enhance understanding and management of this neurological side effect. The authors' review synthesizes qualitative epidemiological data, revealing that carbamazepine-induced hiccups occur in a subset of patients receiving the medication, with reported incidence rates ranging from 2.5 to 40%. Despite its relatively low prevalence, hiccups pose substantial challenges for patients and healthcare providers. Complications associated with carbamazepine-induced hiccups include disruption of sleep, impaired social functioning, and decreased quality of life, underscoring the clinical significance of this side effect. Effective management strategies can be implemented through a multidisciplinary approach, including collaboration among neurologists, pharmacists, and other healthcare professionals. These may include dose adjustments, medication discontinuation, and adjunctive therapies such as diaphragmatic breathing exercises or acupuncture. Additionally, close monitoring for adverse effects and timely intervention are essential to mitigate the impact of hiccups on patient well-being. Essentially, carbamazepine-induced hiccups represent a clinically relevant phenomenon that warrants attention in the management of epilepsy. By recognizing the clinical manifestations, understanding the underlying pathophysiology, and implementing evidence-based management strategies, healthcare providers can optimize patient care and improve outcomes in this patient population.

Assessment of Cefuroxime and Cefuroxime Clavulanic Acid Prescription Practices for Infection Management in Routine Indian Healthcare Settings: Expert Insights

Background: Cefuroxime axetil has shown effectiveness as part of intravenous/oral sequential therapy for community-acquired pneumonia (CAP) treatment, although some countries currently lack dosage recommendations for this regimen. In addition, the perspectives of clinicians were not studied. So, this study evaluated the prescription practice of cefuroxime, and cefuroxime+ clavulanic acid in the management of infections in routine Indian settings. Methods: The cross-sectional survey, titled ‘Cefuroxime &amp; Cefuroxime+Clavulanic acid in Management of Infections: Expert Perspective (CARE) Study’, utilized a 20-item, multiple-response questionnaire to gather expert opinion from specialists regarding the clinical use of cefuroxime and cefuroxime + clavulanic acid in managing infections. The survey encompassed questions about current prescription practices, clinical observations, preferences, and experiences related to the use of these antibiotics in routine settings. Results: Among the 164 clinicians surveyed, 78% of the respondents indicated that cefuroxime was highly effective in managing lower respiratory tract infections. Additionally, 91% of the experts stated that the combination of cefuroxime and clavulanic acid was very effective in managing infections. The majority of clinicians recommended cefuroxime + clavulanic acid as the initial therapy for complicated urinary tract infections (88%), as well as first-line therapy for uncomplicated skin and soft tissue infections (45%) and community-acquired pneumonia (58%). According to 40% of the clinicians, cefuroxime + clavulanic acid was recommended as the initial therapy for 21-30% of patients suspected of methicillin-resistant Staphylococcus aureus infection. Most respondents (88%) preferred cefuroxime + clavulanic acid as the antibiotic for managing Pseudomonas aeruginosa infection. Conclusion: The survey has emphasized the critical role of cefuroxime and cefuroxime + clavulanic acid as antibiotics in managing diverse infections. Clinicians' recognition of their efficacy and preference for combination therapy has underscored the importance of antibiotic stewardship in optimizing patient care.

Predictive biomarkers in lymphoma: a systematic research review

Lymphoma is a diverse group of blood cancers originating in the lymphatic system, with varying clinical presentations and prognoses. Identifying and utilizing predictive biomarkers in lymphoma can significantly impact the management and outcome of patients. For instance, the presence of the BCL2 gene rearrangement in follicular lymphoma is associated with a poorer prognosis, while the expression of the CD20 protein in diffuse large B-cell lymphoma is a predictor of response to rituximab. These biomarkers are molecular or cellular indicators that can help forecast disease progression, therapeutic response, and patient prognosis. This abstract provides an overview of the current landscape of predictive biomarkers in lymphoma, focusing on their role which can help physicians to build personalized treatment strategies. We explore key types of biomarkers, including genetic mutations, protein expressions, and cellular markers, that have shown potential in predicting treatment response and survival outcomes across different lymphoma subtypes. Furthermore, we delve into recent advancements in biomarker discovery through high-throughput technologies such as next-generation sequencing and their strategic integration into clinical practice. The use of predictive biomarkers not only enhances the precision of treatment regimens but also contributes to better risk stratification and patient monitoring. The future of this field involves the refinement of biomarker panels for improved predictive accuracy and the exploration of novel targets for therapy. The strategic application of predictive biomarkers in lymphoma presents promising opportunities for optimizing patient care and advancing precision medicine in hematological malignancies.

Horizontal Gaze Assessment: An Extensive Narrative Review

Bipedalism was a significant milestone in the evolutionary development of Homo sapiens sapiens, influencing neocortical evolution and subsequent behavioral changes. Coordinated visual and sensory inputs are crucial for posture, environmental interaction, and surgical planning, with horizontal gaze being a pivotal parameter. This narrative review aims to explore various geometric measures used to assess horizontal gaze in patients, highlighting their applications in surgical planning. A literature review was conducted in indexed databases using Mesh terms like "Cervical Vertebrae" and "Visual Fields" along with keywords such as "horizontal gaze" and "sagittal spine parameters." Among 477 initially identified articles, 41 were selected for inclusion after rigorous filtering. The most recognized method for assessing horizontal gaze is the Chin Brow Vertical Angle (CBVA), initially described in patients with ankylosing spondylitis. Clinical photography is employed as a tool for CBVA calculation, while other measures like McGregor slope and Slope of the Line of Sight have been considered as alternatives to CBVA. Each method presents its unique advantages and limitations. This review highlights the need for further research into horizontal gaze measurement methods. Developing novel approaches to determine horizontal gaze can significantly enhance surgical planning and, consequently, improve patient outcomes. The ongoing exploration of these geometric measures offers promising prospects for advancing the field and optimizing patient care.

Comprehensive Review of the Imaging Recommendations for Diagnosis, Staging, and Management of Thyroid Carcinoma.

Thyroid cancer is the most common head and neck cancer (HNC) in the world. In this article, we comprehensively cover baseline, posttreatment, and follow-up imaging recommendations for thyroid carcinomas along with the eighth edition of the tumor, node, metastasis (TNM) staging system proposed by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). We include characterization and risk stratification of thyroid nodules on ultrasound (US) proposed by various international bodies. Management guidelines (depending upon the type of thyroid carcinoma) based on the international consensus recommendations (mainly by the American Thyroid Association) are also extensively covered in this article, including the role of a radioiodine scan. The management of recurrent disease is also briefly elucidated in this article. In addition, we cover the risk factors and etiopathogenesis of thyroid carcinoma along with the non-imaging diagnostic workup essential for thyroid carcinoma management, including the significance of genetic mutations. US is the diagnostic imaging modality of choice, with US-guided fine needle aspiration (FNA) being the procedure of choice for tissue diagnosis. The roles of computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) in thyroid carcinoma staging are also specified. Through this article, we aim to provide a comprehensive reference guide for the radiologists and the clinicians in the pursuit of optimal care for patients with thyroid carcinoma.