Management Outcomes Research Articles

Short-term outcomes of endovascular management of acute limb ischemia using aspiration mechanical thrombectomy.

Management of acute limb ischemia (ALI) has seen greater utilization of catheter-based interventions over the last two decades. Data on their efficacy is largely based on comparisons of catheter-directed thrombolysis (CDT) and open thrombectomy. During this time, many adjuncts to CDT have emerged with different mechanisms of action, including pharmacomechanical thrombolysis (PMT) and aspiration mechanical thrombectomy (AMT). However, the safety and efficacy of newer adjuncts like AMT have not been well established. This study is a retrospective analysis of the contemporary management of ALI comparing patients treated with aspiration mechanical thrombectomy to patients treated with the more established CDT adjunct, pharmacomechanical thrombolysis. Patients undergoing peripheral endovascular intervention for ALI using an adjunctive device were identified through query of the Vascular Quality Initiative (VQI) Peripheral Vascular Intervention (PVI) module from 2014 to 2019. Patients with a nonviable extremity (Rutherford ALI Stage 3), prior history of ipsilateral major amputation, popliteal aneurysm, procedures that were deemed elective (>72h from admission), procedures that did not utilize an endovascular adjunctive device, and patients without short-term follow-up were all excluded from analysis. The primary outcome was a composite outcome of freedom from major amputation and/or death in the perioperative time period. We identified 528 patients with Rutherford ALI Stage 1 or 2 who were treated with an endovascular adjunct. 433 patients did not undergo aspiration mechanical thrombectomy (no AMT group) and 95 patients did undergo aspiration mechanical thrombectomy (AMT group). The amputation-free survival across all patients was 93.4%. There were significant differences in demographic, comorbidity, and treatment variables between groups (e.g., gender, prior percutaneous coronary intervention (PCI), history of prior peripheral artery disease intervention, and history of prior infra-inguinal PVI), so a propensity score matched analysis was included to account for these group differences. In the propensity score matched analysis, there was no significant difference in major amputation (AMT 7.4% vs no AMT 3.2%, p = 0.13) or death (AMT 95.8% survival vs no AMT 98.4% survival, p = 0.23) with the use of aspiration mechanical thrombectomy. However, there was significantly worse amputation-free survival with the use of aspiration mechanical thrombectomy (AMT 88.4% vs no AMT 95.3%, p = 0.03). On multivariate analysis, prior supra-inguinal bypass (OR 4.85, 1.70-13.84, p = 0.003), Rutherford ALI Stage 2B (OR 3.13, 1.47-6.67, p = 0.003), and aspiration mechanical thrombectomy (OR 2.71, 1.03-7.17, p = 0.05) were associated with the composite outcome. Short-term amputation-free survival rates of endovascular management of acute limb ischemia are adequate across all modalities. However, aspiration mechanical thrombectomy was associated with significantly worse amputation-free survival compared to other endovascular adjuncts alone (i.e., pharmacomechanical thrombolysis). Severe limb ischemia (Rutherford ALI Stage 2B) and prior supra-inguinal bypass were associated with worse amputation-free survival regardless of the choice of endovascular intervention.

Negative Pressure Wound Therapy With and Without Instillation in Necrotizing Soft Tissue Infections.

Background: Necrotizing soft tissue infections (NSTIs) are rare but deadly infections that require early and often extensive surgical debridement. After debridement, patients frequently have substantial morbidity because of large, open wounds. Hypothesis: Negative pressure wound therapy with instillation (NPWTi) results in higher wound closure rates compared with traditional negative pressure wound therapy (NPWT) or wet to dry dressings (moist wound care dressing). Patients and Methods: A prospectively maintained Acute and Critical Care Surgery database spanning 2008-2018 was queried for patients with a diagnosis of necrotizing fasciitis, Fournier gangrene, or gas gangrene. Data were collected on patient comorbidities, operative management, and clinical outcomes. Patients were stratified by use of moist wound care dressing, traditional NPWT, or NPWTi. Data were analyzed using analysis of variance (ANOVA), χ2, and logistic regression. Results: During the 10-year study period, patients were treated for NSTI; 173 were managed with moist wound care dressing, 150 with NPWT, and 48 with NPWTi. Patients were similar in terms of demographics, body mass index (BMI), diabetes mellitus, and smoking rates. Overall, complication rates were not substantially different, but mortality was higher in the moist wound care dressing group (16.2% vs. 10.7% NPWT vs. 2.1% NPWTi; p = 0.02). In the moist wound care dressing group, 81.5% of patients had an open wound at discharge compared with 52.7% of the NPWT group and only 14.6% of the NPWTi group (p < 0.001). On multivariable regression, NPWTi was associated with closure rates five times higher than the NPWT group (odds ratio [OR], 5.28; 95% confidence interval [CI], 2.40-11.61; p < 0.001) after controlling for smoking status, intravenous drug use, number of operations, and involvement of the most common region of the body. Conclusions: Negative pressure wound therapy with instillation is associated with higher rates of wound closure without increasing complication rates in patients with NSTI compared with traditional NPWT or moist wound care dressing. Although prospective studies are needed, this indicates the potential to improve patient quality of life through reduced pain and outpatient home health needs.

Are ‘second generation’ water regulators the catalyst for sustainable water outcomes and an integrated water sector in sub-Saharan Africa? Insights from Zimbabwe

In 1998 Zimbabwe became one of the first countries in sub-Saharan Africa to adopt and implement IWRM. Twenty-five years later, IWRM principles are yet to be fully operationalised. More importantly, the principle of separating operational and regulatory aspects of water management is becoming more blurred due in part to a water development agenda that is eclipsing water management instead of being in tandem with it. This paper interrogates the merits of establishing a regulator in Zimbabwe's water sector, the only major sector that operates without a regulator, as a catalyst for a better-coordinated and integrated water sector, and an anchor for sustainable water resource management and water supply outcomes. The paper argues for a ‘second generation’ regulator that covers the entire water value chain in line with SDG 6, as opposed to a ‘first generation’ regulator, which exclusively focuses on water supply and sanitation. To enhance prospects for sustainability of the regulator, critical success factors, namely mandate, institutional form, financing model and reporting mechanisms should clearly be defined. The insights from Zimbabwe are relevant for other sub-Saharan African countries, which aim to increase prospects for achieving SDG 6 targets.

Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes

Randomized clinical trials of bariatric surgery have been limited in size, type of surgical procedure, and follow-up duration. To determine long-term glycemic control and safety of bariatric surgery compared with medical/lifestyle management of type 2 diabetes. ARMMS-T2D (Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes) is a pooled analysis from 4 US single-center randomized trials conducted between May 2007 and August 2013, with observational follow-up through July 2022. Participants were originally randomized to undergo either medical/lifestyle management or 1 of the following 3 bariatric surgical procedures: Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding. The primary outcome was change in hemoglobin A1c (HbA1c) from baseline to 7 years for all participants. Data are reported for up to 12 years. A total of 262 of 305 eligible participants (86%) enrolled in long-term follow-up for this pooled analysis. The mean (SD) age of participants was 49.9 (8.3) years, mean (SD) body mass index was 36.4 (3.5), 68.3% were women, 31% were Black, and 67.2% were White. During follow-up, 25% of participants randomized to undergo medical/lifestyle management underwent bariatric surgery. The median follow-up was 11 years. At 7 years, HbA1c decreased by 0.2% (95% CI, -0.5% to 0.2%), from a baseline of 8.2%, in the medical/lifestyle group and by 1.6% (95% CI, -1.8% to -1.3%), from a baseline of 8.7%, in the bariatric surgery group. The between-group difference was -1.4% (95% CI, -1.8% to -1.0%; P < .001) at 7 years and -1.1% (95% CI, -1.7% to -0.5%; P = .002) at 12 years. Fewer antidiabetes medications were used in the bariatric surgery group. Diabetes remission was greater after bariatric surgery (6.2% in the medical/lifestyle group vs 18.2% in the bariatric surgery group; P = .02) at 7 years and at 12 years (0.0% in the medical/lifestyle group vs 12.7% in the bariatric surgery group; P < .001). There were 4 deaths (2.2%), 2 in each group, and no differences in major cardiovascular adverse events. Anemia, fractures, and gastrointestinal adverse events were more common after bariatric surgery. After 7 to 12 years of follow-up, individuals originally randomized to undergo bariatric surgery compared with medical/lifestyle intervention had superior glycemic control with less diabetes medication use and higher rates of diabetes remission. ClinicalTrials.gov Identifier: NCT02328599.

Outcomes of endoscopic management of benign maxillary sinus lesions 5-year experience, non-randomized clinical trials

BackgroundWhen medical therapy fails to control maxillary sinus (MS) disease, surgery is required. There are many advanced MS endoscopic approaches, each one with its anatomical limitations and possible complications. This study aimed to review the outcomes of three endoscopic approaches to the MS (middle meatal antrostomy approach (MMAA), prelacrimal recess approach (PLRA), and canine fossa approach (CFA)) to manage benign MS lesions.MethodsSixty-three patients with diseased MS require surgery. Endoscopic MS approaches used include MMAA, PLRA, and CFA. Each approach was used in 21 patients. The outcome of each approach was measured regarding lesion accessibility and clearance, complications (intraoperative or postoperative), and recurrence.ResultsThe maxillary sinus posterior wall was accessible in all approaches. Other walls and different recesses were also accessible in the case of PLRA and CFA with statistically significant difference between the three approaches. There was no significant difference between patients operated by PLRA and CFA regarding accessibility to different walls and recesses of the MS. Endoscopic and radiological recurrence were found in three (15%) patients who were operated by MMAA. There was no evidence of recurrence in patients operated by the other approaches. Complications like crustations, fascial pain, fascial welling, and fascial hypoesthesia occurred in a few patients.ConclusionBy using a suitable endoscopic approach, the different walls and recesses of the MS were completely accessible, so benign MS lesions that required open surgical approaches can be managed endoscopically while preserving the sinus structure and function.

The diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in children

Over the last two decades, immunoglobulin G (IgG) antibodies against myelin oligodendrocyte glycoprotein (MOG), previously thought to be a biomarker of multiple sclerosis (MS), have been shown to cause a distinct disease called MOG antibody-associated disease (MOGAD). MOGAD accounts for approximately one-third of all demyelinating syndromes in children and is the second most common central nervous system (CNS) demyelinating disease after MS. The diagnosis is made by detecting anti-MOG IgG antibodies against the natural MOG antigen, in the presence of compatible clinical and neuroradiological features. However, due to controversies in the methodologies for detecting anti-MOG antibodies and their diagnostic cutoff values, as well as the expanding clinical spectrum, accurate diagnosis may be challenging, at least in a subset of patients. Clinical presentations of MOGAD vary by age; the highest rates are seen in acute disseminated encephalomyelitis in younger children and optic neuritis, myelitis, or brainstem symptoms in older children. Although it was previously thought to be a milder demyelinating disorder and to have a monophasic course in the majority of patients, recent studies have shown that relapses occur in about half of the patients and sequelae develop in a significant proportion of them, especially in those with persistently high antibody titers, leukodystrophy-like magnetic resonance imaging (MRI) lesions, and spinal cord involvement. However, due to the monophasic course in about half of the patients, long-term treatment is not recommended after the first clinical episode but is recommended for patients who experience relapse. Accurate and early diagnosis of MOGAD is essential for proper management and better outcome. This review covers the challenges in the diagnosis of MOGAD in children.

Lifestyle modification interventions for adults with intellectual disabilities: systematic review and meta-analysis at intervention and component levels.

Adults with intellectual disabilities (IDs) are susceptible to multiple health risk behaviours such as alcohol consumption, smoking, low physical activity, sedentary behaviour and poor diet. Lifestyle modification interventions can prevent or reduce negative health consequences caused by these behaviours. We aim to determine the effectiveness of lifestyle modification interventions and their components in targeting health risk behaviours in adults with IDs. A systematic review and meta-analysis were conducted. Electronic databases, clinical trial registries, grey literature and citations of systematic reviews and included studies were searched in January 2021 (updated February 2022). Randomised controlled trials and non-randomised controlled trials targeting alcohol consumption, smoking, low physical activity, sedentary behaviours and poor diet in adults (aged≥18years) with ID were included. Meta-analysis was conducted at the intervention level (pairwise and network meta-analysis) and the component-level (component network meta-analysis). Studies were coded using Michie's 19-item theory coding scheme and 94-item behaviour change taxonomies. Risk of bias was assessed using the Cochrane Risk of Bias (ROB) Version 2 and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I). The study involved a patient and public involvement (PPI) group, including people with lived experience, who contributed extensively by shaping the methodology, providing valuable insights in interpreting results and organising of dissemination events. Our literature search identified 12180 articles, of which 80 studies with 4805 participants were included in the review. The complexity of lifestyle modification intervention was dismantled by identifying six core components that influenced outcomes. Interventions targeting single or multiple health risk behaviours could have a single or combination of multiple core-components. Interventions (2 RCTS; 4 non-RCTs; 228 participants) targeting alcohol consumption and smoking behaviour were effective but based on limited evidence. Similarly, interventions targeting low physical activity only (16 RCTs; 17 non-RCTs; 1413 participants) or multiple behaviours (low physical activity only, sedentary behaviours and poor diet) (17 RCTs; 24 non-RCTs; 3164 participants) yielded mixed effectiveness in outcomes. Most interventions targeting low physical activity only or multiple behaviours generated positive effects on various outcomeswhile some interventions led to no change or worsened outcomes, which could be attributed to the presence of a single core-component or a combination of similar core components in interventions. The intervention-level meta-analysis for weight management outcomes showed that none of the interventions were associated with a statistically significant change in outcomes when compared with treatment-as-usual and each other. Interventions with core-components combination of energy deficit diet, aerobic exercise and behaviour change techniques showed the highest weight loss [mean difference (MD)=-3.61, 95% credible interval (CrI) -9.68 to 1.95] and those with core-components combination dietary advice and aerobic exercise showed a weight gain (MD 0.94, 95% CrI -3.93 to 4.91). Similar findings were found with the component network meta-analysis for which additional components were identified. Most studies had a high and moderate risk of bias. Various theories and behaviour change techniques were used in intervention development and adaptation. Our systematic review is the first to comprehensively explore lifestyle modification interventions targeting a range of single and multiple health risk behaviours in adults with ID, co-produced with people with lived experience. It has practical implications for future research as it highlights the importance of mixed-methods research in understanding lifestyle modification interventions and the need for population-specific improvements in the field (e.g., tailored interventions, development of evaluation instruments or tools, use of rigorous research methodologies and comprehensive reporting frameworks). Wide dissemination of related knowledge and the involvement of PPI groups, including people with lived experience, will help future researchers design interventions that consider the unique needs, desires and abilities of people with ID.

Conserving the Pilbara leaf-nosed bat: directions for future research and management

The Pilbara leaf-nosed bat (Rhinonicteris aurantia ‘Pilbara form’) is a threatened insectivorous microbat endemic to the Pilbara region of Western Australia. It is at risk of significant population decline, particularly due to habitat loss from mining. To address its key threats, stakeholders from a range of backgrounds collectively listed and prioritised research actions in 2013. This exercise was repeated in 2022 to evaluate and update progress of the research priorities. We conducted a review of scientific and grey literature (2013–2023) to: (1) identify the work undertaken to date that addressed the research priorities identified in the 2013 stakeholder workshop; (2) identify the current knowledge gaps in Pilbara leaf-nosed bat ecology, conservation, and threatening processes; and (3) highlight how these gaps relate to the newly ranked 2022 priority list for both research and management outcomes. We found that the 2013 research priorities were largely unaddressed, with most publications and unpublished industry reports in the review period primarily reporting presence or monitoring data around areas of interest to the resources sector, with minimal focus on the species’ conservation or management directly. Therefore, the knowledge gaps identified in 2013 were still largely relevant in 2022. Further targeted research is required to meet the 2022 priorities and better understand the habitat characteristics, movement ecology, disturbance buffer requirements, and cumulative impacts of mining on Pilbara leaf-nosed bat colonies. Overall, targeted research beyond traditional mining outputs, changes to regulatory procedure, and collaborative, adaptive management, are key to supporting the long-term persistence of Pilbara leaf-nosed bats.

Enhancing diagnostic value in urethral imaging: the case for urologist‐performed urethrograms

Urologist‐performed urethrograms in males and voiding cystourethrograms in females provide superior diagnostic imaging compared with traditional radiology‐performed studies. The authors argue that implementing urologist‐performed urethrograms and cystourethrograms as standard practice would improve urethral stricture disease management and other urethral pathology outcomes.

Present State and Recent Developments of Artificial Intelligence and Machine Learning in Gastric Cancer Diagnosis and Prognosis: A Systematic Review

Objective: The objective of this study is to thoroughly investigate the use of artificial intelligence (AI) and machine learning (ML) techniques for diagnosing and predicting prognosis in gastric cancer, utilizing the latest available data. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)guidelines, a systematic review investigated AI and ML applications in gastric cancer diagnosis and prognostic prediction. PubMed and Google Scholar were searched from February 2019 to January 2024 using specific syntax. Eligible trials were selected based on inclusion criteria including recent publication, focus on AI and ML in gastric cancer, and reporting diagnostic or prognostic outcomes. Data were extracted and quality assessed independently, with discrepancies resolved through discussion. Due to design heterogeneity, detailed analysis was omitted, and descriptive summaries of included articles were provided. Results: This review included a total of 8 articles. AI and ML techniques, including convolutional neural networks (CNN) and deep learning models, have played pivotal roles in accurately diagnosing chronic atrophic gastritis, predicting postoperative gastric cancer prognosis, and identifying peritoneal metastasis in gastric cancer patients. These technologies offer potential advantages such as streamlining diagnostic procedures, guiding treatment decisions, and enhancing patient outcomes in gastric cancer management. Conclusion: In the near future, AI applications may have a significant role in the diagnosis and prognosis prediction of gastric cancer.

Management Outcome and Associated Factors of Perforated Peptic Ulcer Disease at Yekatit 12 Hospital Medical College and Tirunesh Beijing Hospital

Background: Perforated peptic ulcer disease is one of the emergency surgical conditions of peptic ulcer complications with high mortality and morbidity. Although this emergency condition is prevalent in the study areas it is the first study that showed its magnitude and management outcome. Objective: The purpose of this study was to determine the outcome and factors associated with perforated peptic ulcer disease. Methodology: A cross-sectional study design was used. Data were analyzed using SPSS version 25 and binary logistic regression was used to see factors associated with outcomes. P value ≤0.05 was considered significant. Result: A total of 95 patients were studied. Males outnumbered females by a ratio of 8.5:1. The mean and median age of patients was 31.74±13.83 and 27 years respectively. Most perforations were located on the first part of the duodenum (78, 76.5%). Most patients (90, 88.2%) had Graham’s omental patch repair. There were fifty-six post-operative complications recorded in 20 (21.1%) patients. Superficial surgical site infection (10.5%), wound dehiscence (9.5%), respiratory infections (20.1%), sepsis (17.9%), acute kidney injury (12.6%), and ECF (1.1%) were the complications recorded. Co-morbidity [AOR: 19.46 (2.39-158.39)] and SBP&lt;90mmHg [AOR: 5.76 (1.74-19.18)] were significantly associated with post-operative complications. The mortality rate was 5.3% (95% CI: 1.7% to 11.9%) and only co-morbidity [AOR: 10.85 (7.64, 15.40)] was stastically associated with mortality. Conclusion: The mortality rate of this study was low as compared with the majority of studies done the country and the region.

Histopathologic evaluation of gastric intestinal metaplasia in non-neoplastic biopsy specimens: Accuracy and interobserver reliability among general pathologists and pathology residents

ObjectivesThis study aimed to evaluate the accuracy and interobserver reliability of diagnosing and subtyping gastric intestinal metaplasia (IM) among general pathologists and pathology residents at a university hospital in Thailand, focusing on the challenges in the histopathologic evaluation of gastric IM for less experienced practitioners. MethodsThe study analyzed 44 non-neoplastic gastric biopsies, using a consensus diagnosis of gastrointestinal pathologists as the reference standard. Participants included 6 general pathologists and 9 pathology residents who assessed gastric IM and categorized its subtype (complete, incomplete, or mixed) on digital slides. After initial evaluations and receiving feedback, participants reviewed specific images of gastric IM, as agreed by experts. Following a one-month washout period, a reevaluation of the slides was conducted. ResultsDiagnostic accuracy, interobserver reliability, and time taken for diagnosis improved following training, with general pathologists showing higher accuracies than residents (median accuracy of gastric IM detection: 100 % vs. 97.7 %). Increased years of experience were associated with more IM detection accuracy (p-value<0.05). However, the overall median accuracy for diagnosing incomplete IM remained lower than for complete IM (86.4 % vs. 97.7 %). After training, diagnostic errors occurred in 6 out of 44 specimens (13.6 %), reported by over 40 % of participants. Errors involved omitting 5 slides with incomplete IM and 1 with complete IM, all showing a subtle presence of IM. ConclusionsThe study highlights the diagnostic challenges in identifying incomplete gastric IM, showing notable discrepancies in accuracy and interobserver agreement. It underscores the need for better diagnostic protocols and training to enhance detection and management outcomes.

Patterns of case fatality and hospitalization duration among nearly 1 million hospitalized COVID-19 patients covered by Iran Health Insurance Organization (IHIO) over two years of pandemic: An analysis of associated factors.

Different populations and areas of the world experienced diverse COVID-19 hospitalization and mortality rates. Claims data is a systematically recorded source of hospitalized patients' information that could be used to evaluate the disease management course and outcomes. We aimed to investigate the hospitalization and mortality patterns and associated factors in a huge sample of hospitalized patients. In this retrospective registry-based study, we utilized claim data from the Iran Health Insurance Organization (IHIO) consisting of approximately one million hospitalized patients across various hospitals in Iran over a 26-month period. All records in the hospitalization dataset with ICD-10 codes U07.1/U07.2 for clinically/laboratory confirmed COVID-19 were included. In this study, a case referred to one instance of a patient being hospitalized. If a patient experienced multiple hospitalizations within 30 days, those were aggregated into a single case. However, if hospitalizations had longer intervals, they were considered independent cases. The primary outcomes of study were general and intensive care unit (ICU) hospitalization periods and case fatality rate (CFR) at the hospital. Besides, various demographic and hospitalization-associated factors were analyzed to derive the associations with study outcomes using accelerated failure time (AFT) and logistic regression models. A total number of 1 113 678 admissions with COVID-19 diagnosis were recorded by IHIO during the study period, defined as 917 198 cases, including 51.9% females and 48.1% males. The 61-70 age group had the highest number of cases for both sexes. Among defined cases, CFR was 10.36% (95% CI: 10.29-10.42). The >80 age group had the highest CFR (26.01% [95% CI: 25.75-26.27]). The median of overall hospitalization and ICU days were 4 (IQR: 3-7) and 5 (IQR: 2-8), respectively. Male patients had a significantly higher risk for mortality both generally (odds ratio (OR) = 1.36 [1.34-1.37]) and among ICU admitted patients (1.12 [1.09-1.12]). Among various insurance funds, Foreign Citizens had the highest risk of death both generally (adjusted OR = 2.06 [1.91-2.22]) and in ICU (aOR = 1.71 [1.51-1.92]). Increasing age groups was a risk of longer hospitalization, and the >80 age group had the highest risk for overall hospitalization period (median ratio = 1.52 [1.51-1.54]) and at ICU (median ratio = 1.17 [1.16-1.18]). Considering Tehran as the reference province, Sistan and Balcuchestan (aOR = 1.4 [1.32-1.48]), Alborz (aOR = 1.28 [1.22-1.35]), and Khorasan Razavi (aOR = 1.24 [1.20-1.28]) were the provinces with the highest risk of mortality in hospitalized patients. Hospitalization data unveiled mortality and duration associations with variables, highlighting provincial outcome disparities in Iran. Using enhanced registry systems in conjunction with other studies, empowers policymakers with evidence for optimizing resource allocation and fortifying healthcare system resilience against future health challenges.

Patterns and management outcomes of intracranial extra-axial hematomas in low-resource setup: a 6-month prospective observational study at Jimma University Medical Center, Ethiopia

IntroductionIntracranial hematoma is the collection of blood in various intracranial spaces. Knowledge of patterns, origins, causes and outcomes of ICH conditions is important for decision-making for urgent surgical interventions such as craniotomy and hematoma evacuations. No prior study was conducted in our setup. Hence, this study aimed to assess the patterns and management outcomes of intracranial hematomas in low-resource setting and tailored our management approach at Jimma University Medical center.MethodsAn institution-based prospective observational study was conducted at Jimma University Medical Center, Ethiopia, for six consecutive months from June to December 2020. Different data sources and interview methods were used and analyzed using SPSS version 24. A bivariate and multivariate logistic regression was conducted to determine the association between the variables.ResultsA total of 91 eligible patients were recruited during the study period, with a mean age of 34 years. The majority of patients were males [73 (80.2%)] and more common in reproductive age groups (62.6%), from rural areas (50.5%). About 93.4% of patients reported a history of trauma, and road traffic accidents & fighting account for 63.8% of the trauma cases. Sixty-five percent of patients arrive in the hospital within 24 h. Upon presentation, there were loss of consciousness (48.4%), convulsion (11%), aspiration (9.9%) and increased ICP (12%). The majority (49.5%) of the patients had a mild head injury. The focal neurologic deficits were hemiparesis (29.7%) and hemiplegia (5.5%). Acute epidural hematoma (68.1%) was a common finding, followed by sub-acute subdural hematoma. Of the total study participants, 11% had died. All the surviving patients were accessed at 30 days after discharge and re-assessed, 66 patients had good neurologic recovery (62 upper and 4 lower good recovery), 11 patients had moderate disability (7 lower and 4 upper-moderate disabilities), two patients had a severe disability, and two patients (among those with severe disability) had died.ConclusionTrauma was invariably the cause of intracranial hematoma, and patients with low GCS, papillary abnormalities, aspiration and increased ICP had an increased risk of dying from their illness. It is good to formulate policies to enhance injury prevention and bring about health-oriented behavioral change.

Social determinants of health and health disparities in glaucoma: A review.

Social determinants of health and barriers to care can significantly impact patients' access to glaucoma care and treatment, resulting in disparities within disease presentation, progression, management, and treatment outcomes. The widespread adoption of electronic health record systems has allowed researchers and clinicians to further explore these relationships, identifying factors such as race, ethnicity, and socioeconomic status to be risk factors for more severe disease and lower treatment adherence. These disparities highlight potential targets for interventions to combat these disparities and improve overall patient outcomes. This article provides a summary of the available data on health disparities within glaucoma disease presentation, progression, management, treatment, and outcomes and discusses interventions to improve care delivery and outcomes among patients with glaucoma.

Outcome of Open Repair of Thoracoabdominal Aortic Aneurysm in Takayasu Arteritis: A Retrospective Analysis

Takayasu Arteritis (TA) is an immune mediated arteritis causing inflammation of the aorta and its branches, which can result in aortic aneurysms. Our aim is to describe the outcome of surgical management in these patients who presented with Thoracoabdominal aortic aneurysm (TAAA). Between 2003 and 2023, 40TA patients with TAAA underwent operative repair. There were 24 females and 16 males, in the age group of 19-53years, with hypertension in 20 patients. Raised Erythrocyte sedimentation Rate was present in 13 patients. According to Crawford classification, there were 2 patients with type I, 2 with type II, 17 with type III, 12 patients with type IV and 7 with type V aneurysm. Multiple steno-occlusive lesions of aortic branches were present in 21 patients, with majority affecting the renal artery. Femoral Artery Femoral Vein Partial cardiopulmonary bypass was used for types I, II, III and V. Separate bypass to visceral branches was done in eight patients, of whom five had multiple bypasses and three patients only had renal bypass. Twelve patients underwent reimplantation of branches, out of which nine had multiple vessel reimplantation. Four patients underwent staged repair of the aneurysm, which included visceral debranching in the first day, followed by repair of the aneurysm in the next day. In the immediate postoperative period, ten patients developed acute kidney injury and two required dialysis. Other morbidities included acute respiratory distress syndrome (ARDS), spinal cord dysfunction, bleeding, and wound complications. Three patients expired in the immediate postoperative period. Mean duration of intensive care unit stay was 4.1days and hospital stay was 12.7days. Comparison of disease activity with morbidity and mortality was statistically insignificant. Patients were on follow-up for a range of 6months to 14years and median follow-up of 25months. Over this time period four patients expired and four developed anastomotic pseudoaneurysm requiring intervention. On comparing the disease activity at the time of surgery with the long-term arteritis related complications that required intervention, the P value was 0.653 and hence statistically not significant. The 10-year survival rate is 84.4%. Surgical repair has good and satisfactory outcome, with low early and late mortality rates. Progression of disease can occur at any stage of the disease, hence indicating the need for long term follow-up and frequent imaging.

Validation and verification framework and data integration of biosensors and invitro diagnostic devices: a position statement of the IFCC Committee on Mobile Health and Bioengineering in Laboratory Medicine (C-MBHLM) and the IFCC Scientific Division.

Advances in technology have transformed healthcare and laboratory medicine. Biosensors have emerged as a promising technology in healthcare, providing a way to monitor human physiological parameters in a continuous, real-time, and non-intrusive manner and offering value and benefits in a wide range of applications. This position statement aims to present the current situation around biosensors, their perspectives and importantly the need to set the framework for their validation and safe use. The development of a qualification framework for biosensors should be conceptually adopted and extended tocover digitally measured biomarkers from biosensors for advancing healthcare and achieving more individualized patient management and better patient outcome.

An innovative method for building electricity energy management in smart homes based on electric vehicle energy capacity

The surging demand for electricity, fueled by environmental concerns, economic considerations, and the integration of distributed energy resources, underscores the need for innovative approaches to smart home energy management. This research introduces a novel optimization algorithm that leverages electric vehicles (EVs) as integral components, addressing the intricate dynamics of household load management. The study’s significance lies in optimizing energy consumption, reducing costs, and enhancing power grid reliability. Three distinct modes of smart home load management are investigated, ranging from no household load management to load outages, with a focus on the time-of-use (ToU) tariff impact, inclining block rate (IBR) pricing, and the combined effect of ToU and IBR on load management outcomes. The algorithm, a multi-objective approach, minimizes the peak demand and optimizes cost factors, resulting in a 7.9% reduction in integrated payment costs. Notably, EVs play a pivotal role in load planning, showcasing a 16.4% reduction in peak loads and a 7.9% decrease in payment expenses. Numerical results affirm the algorithm’s adaptability, even under load interruptions, preventing excessive increases in paid costs. Incorporating dynamic pricing structures like inclining block rates alongside the time of use reveals a 7.9% reduction in payment costs and a 16.4% decrease in peak loads. In conclusion, this research provides a robust optimization framework for smart home energy management, demonstrating economic benefits, peak load reduction potential, and enhanced reliability through strategic EV integration and dynamic pricing.

Efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study.

Optimal treatment strategy for nonagenarians and centenarians with hip fractures (NCHF) remained unknown. The authors aimed to compare the outcomes of surgical and conservative management in NCHF. A prospective cohort study was conducted based on CPMHF database with NCHF patients hospitalized during 2014-2020. Comorbidities were evaluated by mECM score and restricted cubic spline was utilized to visually assess the dose-effect relationship between the mECM and outcomes. Propensity score matching was performed to balance baseline characteristics between nonsurgical and surgical groups. Multivariate logistic regression, Cox proportional hazard analysis, and survival analysis were employed for unfavorable outcomes (UFO) evaluation. Competing risk of death were analyzed based on Fine and Gray's hazard model and then constructed nomogram models for predicting survival rates. Subgroup analyses were used to determine potential population heterogeneity and sensitivity analyses were performed to test robustness of the results. The authors found increasing trends for UFO with the increase in the mECM score, and that high mECM score (HMS, ≥3) was independently associated with a 2.42-fold (95% CI: 2.07-3.54; P =0.024) increased risk of UFO, which remained significant after considering the competing role of death and were more pronounced in nonsurgical treatment, women, no insurance, and patients with spouse (all P for interaction <0.05). Surgical intervention was identified to be significant protective factors for UFO (RR, 0.59; 95% CI: 0.46-0.75; P <0.001) and severe complications (RR, 0.63; 95% CI: 0.41-0.96; P =0.033) after propensity score matching, as well as survival (HR, 0.40, 95% CI: 0.28-0.58; P <0.001), which remained significant after considering the competing role of death and in all sensitivity analyses and were more pronounced in HMS participants ( P for interaction=0.006). Subgroup analyses revealed surgical patients with HMS had a significantly higher UFO rate (excluding death, P <0.001) while nonsurgical patients with HMS had higher mortality rate as compared to the others ( P =0.005). Surgical treatment for NCHF yields better outcomes compared to conservative treatment.

Leading in a Time of Crisis: The Coronavirus Effect on Leadership in America

In light of the COVID-19 pandemic, an unprecedented global health emergency, the study explores the vulnerabilities and challenges faced by leadership. The crisis, exemplified by issues such as the misinformation around Omicron Boosters in rural America, has brought to light the complex interplay between leadership, public health initiatives, and societal dynamics. This scenario underscores the study's aim: to analyze and understand the specific attributes, styles, and communication strategies that define effective crisis leadership within the American context. Adopting a quantitative research methodology, the study conducted a survey with 521 respondents, encompassing a diverse cross-section of American society, including members of minority communities, volunteers, students, healthcare workers, business owners, and residents of areas significantly impacted by the pandemic. The survey, focused on collecting data through a structured questionnaire, to assess the interplay between the independent variables (transparency, empathy, stakeholder engagement, context-sensitive leadership style, adaptable leadership styles, targeted communication, and culturally sensitive communication strategies) and the dependent variables (success of crisis leadership and improved crisis management), using Likert scale questions. The data collected were used to test the hypothesis, using regression analysis. The findings reveal significant insights: transparency, empathy, and engagement with stakeholders are crucial for successful crisis leadership; context-sensitive and adaptable leadership styles are more effective than rigid ones in diverse crisis scenarios; and targeted, culturally sensitive communication strategies significantly improve crisis management outcomes. These results underscore the multifaceted nature of crisis leadership and the importance of nuanced, adaptable approaches in times of uncertainty while the study agrees with the assertions of McGregor Burns (2004) and Kouzes and Posner (2023) on the leader’s competencies as key to successful leadership in moments of crisis, this study further reveals the vitality of stakeholders’ engagement and contributions in crisis leadership. Also, while the study’s findings align with those of Erickson (2021) on transparency in communication, the study further reveal that exhibiting empathy along with transparency is very essential in crisis leadership. Therefore, the study recommends developing leadership qualities that emphasize transparency, empathy, and stakeholder engagement, and enhancing adaptability in leadership styles. Additionally, it highlights the need for culturally sensitive communication strategies, tailored to diverse audiences.