Outcome Index Research Articles

Telehealth and Telemedicine in the Management of Adult Patients after Liver Transplantation: A Scoping Review.

Introduction: Telemedicine can support home-based self-care for liver transplant recipients after discharge from the hospital. This study aimed to (1) provide an overview of the forms of home care for liver transplant patients; (2) identify the content elements of telemedicine in the home care of liver transplant patients; and (3) summarize the effect and outcome indexes of using telemedicine in liver transplantation patients. Methods: A search was performed in the electronic databases of PubMed, CINAHL, Web of Science, Cochrane Library, Embase, Google Scholar, CNKI, Wan Fang data and Wei Pu database through March 1, 2024. Subject heading and keywords were used to reflect the concepts of telemedicine, hepatic transplantation. Studies of tele-home care after transplantation in liver transplant recipients over 18 years of age and the form, content elements, and outcome assessments of telemedicine were included. Results: A total of 16 articles met the inclusion criteria, and from this, the application form of telemedicine in liver transplantation patients, intervention elements and evaluation outcome indexes were identified. The forms of application include internet platform, applications, network communication software, and portable devices; and the elements of intervention include telemonitoring, remote health guidance, telerecordings, teleconsultation, and telerehabilitation; and the outcome indicators include physiological indicators, psychological status, Quality of life, self-management ability, compliance, satisfactory degree, complication rate, readmission rate, and feasibility. Conclusion: Telemedicine is active and feasible in the home-based self-care of patients after liver transplantation, but its application is immature and there are still some problems.

Efficacy and Safety of Acupuncture in the Treatment of Radicular Cervical Spondylosis: A Systematic Review and Meta-Analysis.

Cervical spondylotic radiculopathy is a serious and common degenerative disease of the cervical spine due to irritation and compression of the nerve roots of the cervical spine, resulting in a series of clinical symptoms based on sensory, motor and reflex disorders, such as numbness and pain in the neck, shoulders, upper limbs and fingers. Acupuncture is highly effective in treating CSR and has become a common treatment accepted by patients. This study aims to systematically review and analyze existing randomized controlled trials (RCTs) to evaluate the efficacy and safety of acupuncture in the treatment of CSR. We used the following eight databases for literature data search: PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Biology Medicine Disc ( CBMdisc), Wanfang Database and China Science and Technology Journal Database (VIP). The search consisted of randomized controlled studies of acupuncture for CSR between 2000 and 2020 and the methodological quality of the included studies was assessed according to the Cochrane Collaboration's "Risk of Bias Assessment Tool."RevMan 5.4 software was used for statistical analysis only. Study screening, data extraction and statistics, and assessment of the risk of bias of the included studies were performed independently by two reviewers. 27 studies with 3124 patients were included. The results of the meta-analysis of the total efficiency index for acupuncture for CSR were [RR = 1.14,95% CI (1.09,1.19)]. The results of the meta-analysis of the PPI index were [MD = -0.35, 95% CI (-0.61,-0. 09)]. The results of META analysis of the total effective rate, VAS score, PRI(A) score, PRI(S) score and PRI(T) score showed heterogeneity in the studies included for each outcome index, and sources of heterogeneity were sought through subgroup analysis and sensitivity analysis to ensure more stable and reliable data results. The results of the combined meta-analysis showed that the treatment group was significantly more effective than the control group and more effective in lowering the nerves to reduce the pain index in patients with CSR, with a statistically significant difference (P<0.05). This indicates that acupuncture treatment is superior to traction for CSR. Acupuncture is significantly more effective than traction therapy in the treatment of cervical spondylosis and can reduce the pain index of patients with CSR.

The Caregiver-Child Relationship Checkup Program for Infants 4–12 Months of Age: Application for Family Centers

The current government support for families with infants centers around financial aid and physical health checkups. This study aims to extend these narrow approaches by developing a new type of checkup that focuses on the relationship between caregivers and infants, as well as the entire family system. Based on various theoretical perspectives, including family systems theory, attachment theory, and cognitive-behavioral theory, the online caregiver-child relationship checkup, which consists of assessment and feedback sessions, was conducted using multiple methods (self-report questionnaires, observations of parent-child play interactions, and clinical interviews). Four families with infants aged 4 to 12 months participated in this study. A single-case research design, specifically a multiple baselines design, was employed. The results from 7 to 9 assessment points over 4 months showed that the relationship checkup improved multiple outcome indices, including the understanding of parental strengths and weaknesses, knowledge of relationship improvement, co-parenting relationships, parental stress, and parent-child relationships. Additionally, participants reported a high level of satisfaction with the program and a strong intention to recommend it. Qualitative interviews indicated that they received reliable guidance from their family consultant amidst the abundant information provided by pseudo-experts on social networking sites (SNS). Coaching while reviewing videos of parent-child interactions was also considered effective in terms of improving their parental competence. Implications for practice and policy were also discussed.

Prospective Observational Cohort Study of Tenecteplase: Results From the Indian Registry in Ischemic Stroke-Tenecteplase.

Tenecteplase has been approved for acute ischemic stroke at a dose of 0.2 mg/kgby the Indian licensing authority. A registry to evaluate the safety of tenecteplase was mandated by the licensing authority. The research aim was to use the Indian Registry in Ischemic Stroke-Tenecteplase (IRIS-TNK) to assess the safety and clinical outcomes in patients treated with tenecteplase in routine clinical practice. In this prospective, registry-based observational, cohort study, the primary outcome was proportion of symptomatic intracerebral hemorrhages at 36±6 hours after treatment. Secondary outcomes included improvement in National Institutes of Health Stroke Scale (NIHSS) score by either ≥4 or 8 points or an NIHSS score of 0, assessment of excellent outcome (modified Rankin Scale score 0 or 1), functional independence (modified Rankin Scale score 0-2), and Barthel Index score. From October 2017 to May 2023, 1015 patients with a median age of 62 years (interquartile range [IQR, 52-71 years]) were recruited across India. The median baseline NIHSS score was 9 (IQR, 6-13). The proportion of patients with symptomatic intracerebral hemorrhage was 0.6% (95% CI, 0.2-1.3%), and 10 patients (1% [95% CI, 0.5-1.9%]) died within 3 months. Improvement in NIHSS score by ≥4 points or an NIHSS score of 0 at 24 hours was observed in 34.4% (95% CI, 31.5-37.4%) of patients. An excellent outcome (modified Rankin Scale score 0 or 1) at 3 months was achieved in 55.4% (95% CI, 52.3-58.5%) of patients. These results confirm that tenecteplase at a dose of 0.2 mg/kg is safe in routine clinical practice, when administered within 4.5 hours of symptom onset. https://ctri.nic.in/Clinicaltrials/. Identifier: CTRI/2017/11/010380.

The Spatial Effect of Digital Economy Enabling Common Prosperity—An Empirical Study of the Yellow River Basin

The digital economy enhances economic efficiency and improves economic structure, driving economic growth through transformations in efficiency, momentum, and quality. It has become a new driving force for advancing common prosperity. This study uses SDM, SDID, and SPSTR models to explore the impact of digital economy on common prosperity, which constructs the index system to evaluate the common prosperity from process index and outcome index. According to the panel data of 76 cities in the Yellow River Basin from 2011 to 2021, and the findings are as follows: (1) The digital economy exhibits a development pattern characterized by high activity downstream and lower activity upstream, and the development trend is stable. The development pattern of common prosperity has changed from sporadic distribution to regional agglomeration, and the level of common prosperity in most cities has improved. (2) The digital economy has a significant positive spatial effect on common prosperity. And the findings are robust after introducing the “Big Data” exogenous policy impact, dynamic SDM model, and other methods. Moreover, spatial heterogeneity exists. The promotion effect in the upper and lower reaches is stronger, while the middle reaches are weakly affected by the digital economy. (3) The spatial spillover effect of the digital economy on common prosperity has a boundary, and the positive spillover reaches a maximum value at 600–650 KM. (4) Nonlinear analysis confirms that the digital economy provides momentum for common prosperity industrial structure optimization that can effectively stimulate the “endogenous” growth mechanism, strengthen the marginal increasing effect of the digital economy driving common prosperity and enhance the effect of “making a bigger pie”. The digital economy makes effective use of digital resources and technologies, promotes the equalization of public services, exerts a positive impact on the realization of common prosperity, and consolidates the effect of “dividing a better cake”.

Involvement of anesthesiologists in pediatric sedation and analgesia outside the operating room in Japan: is it too late, or is there still time?

The global COVID-19 pandemic highlighted significant existing supply-demand imbalances in anesthesia workforce, particularly impacting non-operating room anesthesia. Despite documented risks and mortality rates associated with pediatric procedural sedation and analgesia (PPSA) outside the operating room (OR), there is a pressing need for improvements in safety infrastructure. Comparative analysis with international practices reveals that anesthesiologists' involvement is associated with fewer adverse events and improved outcomes. However, lower reimbursement rate for sedation and anesthesia workforce shortage, and decentralized health resources are contributing factors to limit their participation in PPSA outside the OR in Japan. Enhancing the involvement of anesthesiologists through the public health frameworks such as "high-risk approach" and "population approach" can contribute to improvement of the safety and quality of PPSA. By tackling these challenges and implementing effective solutions, anesthesiologists can play a key role in ensuring safer and more effective PPSA outside the OR. Future challenges include enhancing training, addressing reduced clinical exposure due to work style reform, and developing effective educational systems. Research on improved educational approaches and fundamental outcome indices is crucial for improving PPSA practices outside the OR.

Implementing the Global Leadership Initiative on Malnutrition (GLIM) criteria in Crohn's disease: Prevalence of malnutrition and association with clinical outcomes

Background & AimsLimited data exist regarding the implementation of the Global Leadership Initiative on Malnutrition (GLIM) criteria for diagnosing malnutrition in Crohn’s disease (CD), and its association with CD prognosis. In the present study eighteen GLIM combinations and a combined one were implemented to identify differences in the prevalence of malnutrition and to investigate potential associations with clinical outcomes at 6 months. MethodsDifferent methodologies to diagnose malnutrition were used at baseline, namely the Subjective Global Assessment (SGA), eighteen different combinations of phenotypic and etiologic GLIM criteria and a combined version based on all GLIM combinations (GLIMcv) to test differences in the estimated prevalence and outcomes’ prognosis. At 6 months, data for clinical outcomes were collected (i.e. hospitalization, antibiotics use, intensification/change of biologic agent, initiation of biologic agent/corticosteroids, surgery, disease activity), and an overall adverse clinical outcome index was created. Results250 people with CD (54.8% males, mean age 41.2±14.1 years, 37.2% with active disease) were enrolled. Prevalence of malnutrition based on SGA and GLIMcv was 23% and 52%, respectively, and 5.8-63% based on different GLIM combinations. Malnutrition diagnosed with GLIMcv was associated with an increased likelihood of intensification/change of biologic agent [Odds ratio (OR): 1.82, 95% Confidence interval (CI): 1.00-3.42, p=0.05] and an overall adverse clinical outcome (OR: 2.18, 95% CI: 1.23-3.87, p=0.008) at 6 months, after adjustment for age, sex, disease location and duration. Malnutrition diagnosed through SGA was not associated with clinical outcomes at 6 months. ConclusionsBased on GLIMcv, half of the sample was diagnosed with malnutrition. Malnutrition significantly increased the likelihood of uncontrolled disease requiring treatment upgrading and leading to an overall adverse clinical outcome short term.

Predictive values of four nutritional indices for adverse outcomes in patients with hypertension.

Malnutrition, evaluated by nutritional indices, is reportedly related to a poor prognosis in patients with hypertension. However, clinical evidence on which index is more suitable for predicting a kidney prognosis is limited, and it has not been evaluated in hypertension. The aim of the present study was to investigate and compare the predictive values of four nutritional indices: Geriatric Nutritional Risk Index (GNRI); Prognostic Nutrition Index (PNI); Triglycerides × Total cholesterol × Body weight Index (TCBI); and the controlling nutritional status (CONUT) score. A retrospective, cohort study of 1255 hypertensive patients under care in the Fukushima Cohort Study was conducted. The primary outcome was kidney events, defined as a combination of a 50% decline in eGFR from baseline and renal failure requiring dialysis therapy or kidney transplantation. Kaplan-Meier analyses and multivariate Cox regression analyses were conducted to examine associations between the four nutritional indices and kidney events. The area under the curve (AUC) values of the receiver-operating characteristic curves were also examined to compare the predictive values of these nutritional indices. Lower GNRI, lower PNI, and higher CONUT score were significantly related to a higher risk of kidney events. GNRI (AUC = 0.729, 95% confidence interval 0.681-0.777) and PNI (AUC = 0.710, 95% confidence interval 0.665-0.756) had significantly higher AUCs for kidney events than the TCBI and CONUT score. GNRI and PNI showed greater predictive values for kidney events than other nutritional indices in patients with hypertension.

Learning-to-learn as a metacognitive correlate of functional outcomes after stroke: a cohort study.

Meta-learning is a metacognitive function for successful, efficient learning in various tasks. While it is possible that meta-learning is linked to functional recovery in stroke, it has not been investigated in previous clinical research on metacognition. Examine if individual meta-learning ability is associated with functional outcomes. Cohort study. Rehabilitation ward in Fujita Health University Hospital. Twenty-nine hemiparetic people after stroke. The study measured individual sensorimotor adaptation rate, meta-learning (acceleration of adaptation through training), and Functional Independence Measure (FIM) motor effectiveness, an index of functional outcome measuring improvement in proficiency of activity of daily living (ADL). Participants performed visuomotor adaptation training sessions with their less-affected arm. They made arm-reaching movements to hit a target with cursor feedback, which was occasionally rotated with regard to their hand positions, requiring them to change the movement direction accordingly. Initial adaptation rate and meta-learning were quantified from pre- and post-training tests. The relationship between these indices of adaptation ability and FIM motor effectiveness was examined by multiple linear regression analyses. One participant was excluded before data collection in the motor task. In the remaining 28 individuals, the regression analyses revealed that FIM motor effectiveness positively correlated with meta-learning (µ=0.90, P=0.008), which was attenuated by age (µ=-0.015, P=0.005), but not with initial adaptation rate (P=0.08). Control analyses suggested that this observed association between FIM motor effectiveness and meta-learning was not mediated by patients' demographics or stroke characteristics. This study demonstrates that those who can accelerate adaptation through training are likely to improve ADL, suggesting that meta-learning may be linked with functional outcomes in some stroke individuals. Meta-learning may enable the brain to keep (re-)learning motor skills when motor functions change abruptly due to stroke and neural recovery, thereby associated with improvement in ADL. Meta-learning is part of metacognitive functions that is positively associated with functional outcomes.

An Evaluation of the Estimated Aligners Needed to Correct Malocclusion Traits Using Invisalign ClinCheck™ Pro Software: A Retrospective Study.

Background: This study evaluated the number of aligners that Invisalign ClinCheck™ Pro Software estimates for correcting different malocclusion traits. Methods: This retrospective study included 157 non-extraction patients over the age of 12 years old with easy to mild malocclusions who were treated with Invisalign aligners. The Index of Complexity, Outcome, and Need (ICON) was used to evaluate the malocclusion complexity level. The number of aligners (upper, lower, and total) required to correct the malocclusion was compared based on sex, ICON level, molar and canine class, occlusal asymmetry, overbite, overjet, crowding, incisor inclination, and Bolton discrepancy. A Mann-Whitney U test (for comparisons between two groups) or a Kruskal-Wallis test (for comparisons between three or more groups) (p < 0.05) was used to evaluate differences in the number of aligners across variable categories. Results: ICON, molar class, overbite, and overjet presented significant differences (p < 0.05) in the number of aligners (upper, lower, and total) required to correct a malocclusion. Canine class and lower dental crowding showed significant differences in the lower and total number of aligners (p < 0.05). Conclusions: The number of aligners increases when the malocclusion presents any of the following elements: the absence of molar or canine class I, an altered overjet or overbite, severe lower crowding, or a higher complexity level. The clinician should consider these malocclusion traits when estimating the number of aligners needed for correction.

The prevalence of malocclusion and oral health-related quality of life among 12- and 15-year-old schoolchildren in Shanghai, China: a cross-sectional study

BackgroundMalocclusion is one of the three major oral diseases and may cause deterioration in oral health-related quality of life (OHRQoL). This study aims to determine the prevalence of malocclusion by gender and its impact on quality of life among 12- and 15-year-old children in Shanghai.MethodsThis study summarizes the data obtained in the Shanghai Oral Health Epidemiological Survey conducted in 2019. Random cluster sampling was used to select students in Shanghai. A total of 1591 12-year-old children and 747 15-year-old children were included. Each student underwent an oral examination and completed a questionnaire. The Index of Complexity, Outcome and Need (ICON) was adopted to measure the objective severity of malocclusion and Child Oral Health Impact Profile (COHIP) was applied to evaluate quality of life of schoolchildren. Comparisons of COHIP scores were performed among different treatment needs and difficulties by t-test and analysis of variance (ANOVA).ResultsNo significant difference was found between genders except that the prevalence of deep overbite in 12-year-old boys (1.11 ± 0.95) was significantly higher than that in girls (0.93 ± 0.88) while the prevalence of crossbite among 12-year-old girls (26%) is significantly higher than boys (20%). Malocclusion in 15-year-old children was descended compared with 12-year-old. 15-year-old students demonstrates larger impact of malocclusion on oral health than 12-year-old group except self-image. Health impacts (COHIP) increase significantly as the malocclusion becomes severer except self-image in 12-year-old group.ConclusionsIn Shanghai, the severity of malocclusion in 15-year-old children was less than 12-year-old children. Malocclusion has greater influence on oral health of 15-year-old children than 12-year-old children. Severer malocclusion generally correlates with higher level of oral health impacts in schoolchildren.

CT-based sarcopenia assessment: Predicting outcomes in acute infection patients.

In this retrospective cohort study, we investigated the prognostic value of sarcopenia evaluated by Computed Tomography (CT)-based indices for adverse hospitalization outcomes in patients with acute infections. We analyzed data from 225 patients admitted to the hospital for acute infections between 2019 and 2020. Patients who had undergone an abdominal CT scan either up to 1 month before or within the first 3 days of hospitalization were included. CT image analysis was used to evaluate skeletal muscle mass (by skeletal muscle index (SMI)) and muscle quality (by psoas muscle density, pMD). Low pMD was associated with higher in-hospital mortality (31% vs 11.4% p < 0.001) as well as higher longer-term mortality rates (p = 0.008 for 30 days and <0.001 for 90- and 1-year mortality). Low pMD remained an independent poor prognostic factor after controlling for confounders, with an adjusted odds ratio (aOR) of 2.74, (95% CI 1.33-5.67, p = 0.006) for 1-year mortality, and aOR of 2.61, (95% CI 1.23-5.55) for a prolonged hospital stay. Low SMI was associated with adverse outcomes, although this association was not independent after controlling for confounders. Notably, patients with both low SMI and pMD exhibited the poorest hospitalization outcomes: aOR for 1-year mortality 5.015 (95% CI 1.767-14.23, p = 0.002), and prolonged length of stay aOR 3.197, (95% CI 1.159-8.821, p = 0.025). CT-based muscle indices serve as independent prognostic factors in medical patients admitted with acute infection. Incorporating radiological assessments of sarcopenia into routine care for hospitalized patients with acute infection may enable risk stratification and early intervention in reversible conditions.

Influence of physical activity on the epigenetic clock: evidence from a Japanese cross-sectional study

BackgroundBiological age, especially epigenetic age derived from the epigenetic clock, is a significant measure of aging, considering the differences in aging rates among individuals. The epigenetic clock, a machine learning-based algorithm, uses DNA methylation states to estimate biological age. Previous studies have reported inconsistent associations between physical activity (PA) and the epigenetic clock, especially second-generation clocks such as PhenoAge and GrimAge. This study aimed to clarify this relationship using cross-sectional data from Japanese participants aged 40–69.MethodsWe used two datasets from the Saga J-MICC study, of which 867 samples were available for analysis. DNA methylation data from peripheral blood samples were used to calculate the epigenetic age using the epigenetic clocks PhenoAge and GrimAge. PA and sedentary time were measured using a single-axis accelerometer, while self-reported PA, sedentary time, and covariates were assessed using a self-administered questionnaire. The association between PA or sedentary time and epigenetic age acceleration was assessed using multiple linear regression.ResultsPearson's correlation coefficients between accelerometer-based and self-reported PA variables ranged from 0.09 to 0.20. Multivariable regression analysis showed that accelerometer-based PA and sedentary time were associated with epigenetic age decelerations and accelerations, respectively. However, self-reported PA was not associated with the epigenetic age accelerations.ConclusionsThese results indicate that reducing sedentary time and increasing PA were associated with slowing both PhenoAge and GrimAge, even in East Asian populations with different exercise habits, body shapes, and lifestyles. This study highlights the potential of objective second-generation epigenetic age acceleration as an outcome index for healthcare interventions and clinical applications.

Analysis of the outcomes in treatment of ulcerative colitis with acupuncture and moxibustion

To clarify the key outcomes of acupuncture-moxibustion treatment of ulcerative colitis. The clinical randomized controlled trials (RCTs) for ulcerative colitis treated with acupuncture and moxibustion were searched from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, and Web of Science, from the inception of each database to March 20th, 2023. The basic information of literature, intervention measures and outcome indexes were collected. The selection of primary and secondary outcomes, the use frequency of each index and the combination of them in utility were analyzed; and index domains of acupuncture and moxibustion for ulcerative colitis were summarized. A total of 215 RCTs were included and 54 outcomes were involved, classified into 6 categories, i.e. TCM syndromes, symptoms/physical signs, physical and chemical tests, quality of life, long-term prognosis and safety events. The top 3 outcomes with high use frequency were clinical effect evaluation, adverse reactions of acupuncture and moxibustion and the score of main symptoms. Only 3 articles clearly reported the primary outcome and the secondary ones, 180 articles used two types of outcomes simultaneously, 3 articles clearly described the time points of the observation indexes, and 126 articles determined the sources of the evaluation criteria of therapeutic effect, with 57 criteria involved. At present, the outcomes have not been standardized in RCTs of acupuncture and moxibustion for ulcerative colitis. It needs to clarify the primary one and the secondary ones. The criteria have not been unified for the evaluation of therapeutic effects and there is less consideration on the quality of life in patients, the follow-up visit and safety events. The attention should be paid to develop the outcome set, in which, the endoscopic score is taken as the objective, and the improvements in the symptoms/physical signs and the biochemical examination as the supplementary.

Composite endpoints in COVID-19 randomized controlled trials: a systematic review.

This study aimed to determine the prevalence of ordinal, binary, and numerical composite endpoints among coronavirus disease 2019 trials and the potential bias attributable to their use. We systematically reviewed the Cochrane COVID-19 Study Register to assess the prevalence, characteristics, and bias associated with using composite endpoints in coronavirus disease 2019 randomized clinical trials. We compared the effect measure (relative risk) of composite outcomes and that of its most critical component (i.e. death) by estimating the Bias Attributable to Composite Outcomes index [ln(relative risk for the composite outcome)/ln(relative risk for death)]. Composite endpoints accounted for 152 out of 417 primary endpoints in coronavirus disease 2019 randomized trials, being more frequent among studies published in high-impact journals. Ordinal endpoints were the most common (54% of all composites), followed by binary or time-to-event (34%), numerical (11%), and hierarchical (1%). Composites predominated among trials enrolling patients with severe disease when compared to trials with a mild or moderate case mix (odds ratio = 1.72). Adaptations of the seven-point World Health Organization scale occurred in 40% of the ordinal primary endpoints, which frequently underwent dichotomization for the statistical analyses. Mortality accounted for a median of 24% (interquartile range: 6%-48%) of all events when included in the composite. The median point estimate of the Bias Attributable to Composite Outcomes index was 0.3 (interquartile range: -0.1 to 0.7), being significantly lower than 1 in 5 of 24 comparisons. Composite endpoints were used in a significant proportion of coronavirus disease 2019 trials, especially those involving severely ill patients. This is likely due to the higher anticipated rates of competing events, such as death, in such studies. Ordinal composites were common but often not fully appreciated, reducing the potential gains in information and statistical efficiency. For studies with binary composites, death was the most frequent component, and, unexpectedly, composite outcome estimates were often closer to the null when compared to those for mortality death. Numerical composites were less common, and only two trials used hierarchical endpoints. These newer approaches may offer advantages over traditional binary and ordinal composites; however, their potential benefits warrant further scrutiny. Composite endpoints accounted for more than a third of coronavirus disease 2019 trials' primary endpoints; their use was more common among studies that included patients with severe disease and their point effect estimates tended to underestimate those for mortality.

Creatinine Filtration as a Novel Index of Muscle Mass and Adverse Outcomes among Older Adults

Creatinine Filtration as a Novel Index of Muscle Mass and Adverse Outcomes among Older Adults

Predictive Value of Current Perception Threshold for Prognosis of Pulsed Radiofrequency in Patients with Acute Herpetic Neuralgia.

This study aimed to evaluate the prognostic accuracy of the Current Perception Threshold (CPT) in Acute Herpetic Neuralgia (AHN) patients receiving Pulsed Radiofrequency (PRF) therapy and to develop a corresponding prognostic model. We retrospectively analyzed data from 106 AHN patients treated with PRF between January 2022 and May 2023. The occurrence of Postherpetic Neuralgia (PHN) after treatment categorized patients into non-PHN and PHN groups. The predictive role of CPT indices for PRF outcomes was assessed using the Receiver Operating Characteristic (ROC) curve and Area Under Curve (AUC). Then the dataset was split into a training set (n=74) and a validation set (n=32). Factors associated with PHN development were identified using univariate and multivariate logistic regression. A nomogram model was developed using significant predictors and internal validation was performed using valid set data. Among the 106 patients, 45had a poor prognosis. Significant differences in age, preoperative Numerical Rating Scale (NRS) score, and 5Hz CPT ratio were observed between the groups (p<0.05). Logistic regression identified these factors as independent predictors for PRF prognosis (p<0.05). The 5Hz CPT ratio demonstrated predictive value (AUC= 0.764, 95% CI: 0.674-0.855). The nomogram model, incorporating these predictors, showed high AUC in both the training (0.863, 95% CI: 0.776-0.950) and validation sets (0.859, 95% CI: 0.721-0.998). Calibration curves indicated good model fit, and the Hosmer-Lemeshow test confirmed this (p>0.05). Decision Curve Analysis (DCA) highlighted the model's predictive advantage. The 5Hz CPT ratio can predict the prognosis of PRF in AHN patients. The nomogram model has high precision and clinical utility. It can help identify AHN patients with a poor PRF prognosis at an early stage and assist in clinical decision-making.

ACT in school settings: A pilot study of ACT-based universal group psycho-educational program among Japanese early adolescents

The objective of this investigation was to assess the efficacy of an Acceptance and Commitment Therapy (ACT)-based group psycho-educational intervention within school environments, administered by psychologists, for early adolescents in Japan. The effectiveness indices measured in this study were ‘clarification of value and commitment (CVC)’ and ‘experiential avoidance (EA)’ as indicators of psychological flexibility of ACT, and self-esteem and self-determination disposition as outcome indices related to well-being. The participants in this study were Japanese junior high school students with a mean age of 14.85 years (SD = 0.86), 112 in the intervention group and 143 in the control group, who completed questionnaires at three time points: before the program (pre), after attending the program (post) and three weeks after the posttest (follow-up). The intervention program, which consisted of three short-term sessions, was shown to be effective in the CVC, self-esteem, and self-determination disposition scores. Conversely, the group-time interaction did not yield a notable impact on the persistence of avoidance behaviors and EA scores, suggesting a potential avenue for refinement in intervention methodologies regarding these domains. These findings offer insight into the potential effectiveness of ACT-based group psycho-educational endeavors in school settings led by psychologists.

Vaginal Uncomplicated Delivery Rate as a Quality Indicator Compared to Cesarean Delivery Rate: A Quantitative Analysis of a Population Database

ObjectivesThe objective of this study is to compare the vaginal uncomplicated delivery (VUD) rate, defined as all vaginal deliveries (including forceps and vacuum) without an adverse maternal or neonatal labour outcome, to the cesarean delivery (CD) rate, as a performance indicator. MethodsThis is a retrospective cohort analysis from a provincial database of all term deliveries by an obstetrician in a single year, excluding diagnoses preventing active labour. Most obstetricians in this jurisdiction practice consultative obstetrics, focused on supporting primary maternity care. We investigated the association of adverse delivery (AD), measured by the adverse outcome index, with CD and VUD rates. ResultsWe report 16 620 deliveries by 210 obstetricians, with a vaginal delivery rate of 39.6%, of which 36.6% were operative vaginal delivery. The overall AD rate was 9.9%, and the overall VUD rate was 34%. While the CD and VUD both correlated with the mode of delivery, only the VUD rate was correlated to the AD rate. ConclusionsQuality assurance in obstetrics must balance the needs of 2 patients based on limited data. Our data shows the shortcomings of the prevailing performance indicator, CD rate, which does not correlate with birth outcomes for the pregnant patient or infant. The VUD rate provides an alternative that assesses both mode of delivery and labour outcomes. Shifting the quality lens to focus on the VUD rate will provide a better metric that measures optimal outcomes for pregnant people and their babies.

Comparative Study between Endoscopic Lumbar Discectomy and Lumbar Fixation in Management of Recurrent Lumbar Disc Prolapse

Abstract Background There is a great controversy in operative methods which can be used for recurrent lumbar disc herniation such as repeated endoscopic discectomy or repeated open discectomy either using fusion or not Endoscopic revision surgery can be conducted using the endoscopic interlaminar discectomy. Open surgery can be used for recurrent discectomy and lumbar fixation can be used in addition. Interbody fusion might be used as well. Patients and Methods The current study is a prospective, comparative study that included 90 patients with recurrent lumbar disc prolapse, who were scheduled for reoperation in Neurosurgical departments in Ain Shams University Hospitals and Other Affiliated Hospitals during time period from November 2016 to February 2022. Using spine endoscopy in 45 patients with recurrent disc prolapse (group 1) and fixation in another 45 patients (group 2). Results Operative time, wound length in centimeters, intraoperative bleeding, and the presence of a drain were compared between Group 1 and Group 2. All these variables showed statistically significant differences between the two groups showing better results in endoscopic group. Preoperatively, there was no statistically significant difference in JOA scores between Group 1 and Group 2. Immediately postoperative and at 1 week interval, endoscopic group had significantly higher JOA scores, indicating better outcomes. Preoperatively, there was no statistically significant difference in disability scores between Group 1 and Group 2. Immediately postoperative and at early time intervals, endoscopic group had significantly lower disability scores compared to fixation group. There were no statistically significant differences between Group 1 and Group 2 in terms of recurrence and stability rates. There was no statistically significant difference between Group 1 and Group 2 in terms of motor power outcome index. Conclusion Endoscopic lumbar discectomy is superior to open lumbar discectomy using fixation with or without fusion in the management of recurrent lumbar disc herniation, as for short-term results, however both techniques are equal in long-term results