Positive Treatment Outcomes Research Articles

Patient knowledge of surgical informed consent and shared decision-making process among surgical patients in Ethiopia: a systematic review and meta-analysis

BackgroundInformed consent is one of the safeguarding of the patient in medical practice at different standards such as ethical, legal, and administrative purposes. Patient knowledge and perception of informed consent are one of the priority concerns in surgical procedures. Patient knowledge and perception towards informed consent increased patient satisfaction, feeling high power on their determination, and accountability for the management, and facilitated positive treatment outcomes. Despite this, in Ethiopia, there are small-scale primary studies with inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis study estimated the pooled prevalence of patient knowledge and perception of informed consent and its determinants in Ethiopia.MethodsWe searched major databases such as PubMed, Hinary, MEDLINE, Cochrane Library, EMBASE, Scopus, African Journal Online (AJO), Semantic Scholar, Google Scholar, google, and reference lists. Besides this, University databases in the country were also searched from August 20, 2023, until September 30, 2023,. All published and unpublished studies that report the prevalence of patient knowledge and perception toward informed consent and its associated factors were included. All studies reported in English were included. Studies conducted between January 01, 2015 to September 30, 2023 were included. There are three outcome measurements pooled level of patient knowledge towards informed consent, pooled level of patient perception towards informed consent, and pooled effect that affects patient knowledge of informed consent. Three reviewers (MMM, NK, and YT) independently screened the articles that fulfilled the inclusion criteria to avoid the risk of bias. The studies’ quality was appraised using a modified Newcastle-Ottawa Scale (NOS) version.ResultsThe pooled prevalence of appropriate patient knowledge and perception towards informed consent was 32% (95% CI: 21, 43) and 40% (95% CI: 16, 65) respectively. Having formal education 2.69 (95% CI: 1.18, 6.15) and having a history of signed informed consent before 3.65 (95% CI:1.02,13.11) had a statistically significant association with good patient knowledge towards informed consent.ConclusionThe appropriate patient knowledge and perception of informed consent in Ethiopia is low. Formal education and history of signed informed consent were positive factors for appropriate patient knowledge of informed consent in Ethiopia. Physicians, policymakers, and health facility managers should focus on patients without prior experience with signed informed consent and not have formal education to improve patient knowledge towards informed consent. The protocol was registered at Prospero with number CRD42023445409 and is available from: https://www.crd.york.ac.uk/PROSPERO/#myprospero.

Cone-beam computed tomography in implant dentistry - guidelines, current concepts and limitations for practice

This article issues scientific background of Cone-beam computed tomography (CBCT) and the importance of taking x-rays before and after implant placement in daily practice as a common care. The review will introduce cone-beam computed tomography guidelines, restrictions and intraoperartive issues for instance nerve damage and bleeding incidents. Modern CBCT technology enables specialists to avoid making a wrong diagnosis, which translates into a higher percentage of people with a positive treatment outcome.
 Diagnostic radiology is a crucial element of every dental treatment planning. CBCT market is expanding gradually since two decades, there are more than 85 distinct CBCT tools available. CBCT is a three-dimensional (3D) imaging used nowadays in dentistry with increased frequency and offers volumetric data on jaw bones and teeth with relatively low radiation doses and costs. Currently, the greatest advantage of CBCT examinations over radiographs is the fact that the image obtained is presented in a 3D projection and not, as is the case, in 2D. It has the ability to help a wider range of patients, but the use of CBCT also has negative consequences. Routine or excessive use has resulted in increased radiation doses accumulating in the patient's body, which translates into an increased risk of adverse effects. The risk varies according to the age of the patient under study and is directly proportional to it, that is, it is highest for young people and lower for older people. The potential risk is also slightly higher in the female population. For this reason, creating awareness of the mandatory patient safety management of CT scans is a key process by which X-ray exposures can be optimised.

Technical methods of improving the biomechanics of feet in people with diabetes

This article discusses the role of orthoses in correcting biomechanics for patients with diabetic foot syndrome. It also analyzes literature on the use of specialized orthopedic shoes to address biomechanical foot issues and complicated forms of diabetes mellitus. Today, the general requirements for designing orthopedic shoes for patients with diabetes are described: a stiff sole with an artificial cushion; a suitable volume, a wide sole, an insole without a memory function; a thermally changeable elastic material; a minimum number of seams in the lining; an elastic upper and lining material in the toe area of the shoe; an increased fullness and additional volume in the toe region of the shoe, an angle of the bevel at the toe end of the sole, and the ability to adjust the interior volume of the shoe by using a hard heel that is stabilized with additional softness from the lining, as well as a smooth, non-traumatic upper. Indications for orthopedic unloading in patients with diabetic foot syndrome are highlighted.There is a negative approach towards conservative methods of treating patients with diabetic feet, but amputation in these cases cannot be considered a positive outcome of treatment. Nearly 70 to 90 percent of ulcers in this patient group heal without amputation. Techniques using specially designed shoes are less expensive and more cost-effective than limb loss. The use of orthotic shoes in diabetic foot patients serves as a method of both correction and rehabilitation.

Therapy with bone marrow mesenchymal stem cells in bone regeneration in children with osteonecrosis secondary to sickle cell disease.

This study aimed to describe the evolution of bone regeneration in children with hip osteonecrosis associated with sickle cell disease, treated with bone marrow-derived mesenchymal stem cell implants at the Professor Edgar Santos University Hospital Complex. A non-randomized clinical trial was conducted with 48 patients of both sexes, aged between 11 and 18years, diagnosed with femoral head osteonecrosis secondary to sickle cell disease. Patient selection was based on strict criteria, including confirmed diagnosis of sickle cell anemia and a stage of osteonecrosis compatible with the proposed treatment. Bone regeneration assessment was performed through radiographic examinations and magnetic resonance imaging, following the Ficat & Arlet criteria and the Salter-Thompson classification. Statistical analysis revealed a significant association between the patients' age and positive treatment outcomes, suggesting that autologous bone marrow cell implantation is a safe and effective approach in the early stages of osteonecrosis. The majority of patients (87.5%) reported complete pain relief, while 10.42% experienced significant symptom improvement. Only one patient (2.08%) did not observe improvement. The results indicate that cell therapy can regenerate or slow the progression of bone necrosis, reducing the need for more invasive surgical procedures. The study demonstrates the potential of bone marrow-derived mesenchymal stem cell implantation in treating hip osteonecrosis in children with sickle cell disease, emphasizing the importance of long-term monitoring of bone structure stability.

Prevalence of type 2 diabetes mellitus and hypertension in patient's visiting the conservative dentistry and endodontics department: a cross-sectional study in Surabaya City.

This descriptive cross-sectional study focuses on the prevalence of hypertension (HTN) and type 2 diabetes mellitus (T2DM) amongst patients who visited the Conservative Dentistry and Endodontics department. Recognizing these incidence statistics is critical for improving endodontic therapy delivery and assuring high-quality dental care with positive treatment outcomes. In advance of getting dental care, all patients visiting the department were advised to get their blood sugar and blood pressure levels checked at random. Measurements were taken with digital equipment, and individuals with high levels were encouraged to seek medical advice before undergoing dental procedures. The obtained data was imported into Excel and analyzed with IBM SPSS software (version 21). The investigation had 1,100 participants (55.8% female and 44.2% male), with an average age of 44.58 ± 12.77 years. Of the individuals, 40.6% were referred for type 2 diabetes, 12.6% for hypertension, and 24.0% for both diseases. There was a significant correlation (p<0.05) between referral status and gender. The average blood pressure and random blood sugar readings were 141.02 mmHg ± 56.28 mmHg (systolic), 79.83 mmHg ± 10.68 mmHg (diastolic), and 126.68 mg/dL ± 15.36 mg/dL, respectively. There was a substantial (p<0.05) difference in mean systolic blood pressure between men and women. Furthermore, age was strongly connected with random blood sugar levels (p<0.05) and systolic and diastolic blood pressure (p<0.05). There were significant (p<0.05) variations in mean blood pressure and blood sugar levels between referred and non-referred individuals. Age had a relationship with higher random blood sugar levels, systolic blood pressure, and diastolic blood pressure. Dentists should consider patient age while planning treatment, as type 2 diabetes mellitus and hypertension require unique techniques to emphasize patient safety and produce excellent outcomes.

Bowen’s Theory: Case Study Review in the Light of Differentiation of Self

The major purpose of this paper is to illustrate the theory, practice, and outcome of Bowen’s Family Systems Theory. Murray Bowen’s Family Systems Theory is considered by many to be the most thorough and thoughtful set of ideas that family therapy has created (Nichols &amp; Schwartz, 1995). Murray Bowen is a founder of the family systems theory and one of the pioneers in family therapy. Bowen defined the term “differentiation of self” as a capacity to gain a balance between emotional and intellectual functioning without fusion. Bowen established this term in light of the family system theory and he believed selfdifferentiation is closely related to an individual’s family life. Family system theory explains the causes of being undifferentiated in the concept of family relations, and it names some of the characteristics of the family that led to undifferentiation such as triangulation, marital conflict, sibling position, emotional cut off etc. A gap Bowen’s therapy is the fact that this theory lacks specific techniques to directly address the family issues. The focus is primarily on increasing individual differentiation and the therapeutic techniques may not be as explicit or directive as in other approaches. Bowen structured his work around the weekly 60minutes session. He invited family members for interview and saw fragments of whole families and individuals. The interviews resolved around a calm discussion of the clients struggle and situation. The question and response sequence provideds the structure of the session. Bowen found out that understanding one’s family story can help to understand their psyche, human relationship systems and how they operate within their physical an emotional nature. Bowen thus recommends that in psychosocial therapeutic counseling, the individual should not be attended without an understanding of their family story. According to Murray Bowen, based on clinical observations and client selfreports, the effectiveness of Family Systems Theory rests not so much on empirical research but on clinical reports of positive treatment outcomes, the personal benefits experienced by the families that underwent this kind of treatment, and the elegance of Bowen’s theory. He conducted more clinical observations of schizophrenic families than controlled experiments. Current evidence for the effectiveness of Bowen’s theory reflects that one-third of the clients get no better or worse, one-third of the clients improve some- what, and one-third of the clients significantly improve (Nichols &amp; Schwartz, 1995). This article involves emphasizing the formulation of Bowen theory and application to a case example of an individual who struggles with differentiation. First, this paper will review the development of Bowen’s theory, then, it will illustrate Bowen’s eight interlocking terms. Finally, this paper will present a clinical example, applying family systems therapy to an individual who struggles with differentiation and discusses the outcomes.

Tofacitinib real-world experience in ulcerative colitis in Finland (FinTofUC): a retrospective non-interventional multicenter patient chart data study

Objectives The aim was to define the effectiveness of tofacitinib and to characterize the patient population receiving tofacitinib in a real-world cohort clinical setting for ulcerative colitis (UC) in Finland. Methods This is a retrospective non-interventional multicenter patient chart data study conducted in 23 Finnish Inflammatory Bowel Disease (IBD) centers. Baseline demographic and clinical data, clinical remission, steroid-free remission rate and time to tofacitinib discontinuation, colectomy or UC-related hospitalization were studied. Results The study included 252 UC patients of which 69% were male. Most patients had extensive disease (71%) and were bio-experienced (81%). Tofacitinib demonstrated positive treatment outcomes with clinical response, clinical remission, and steroid-free clinical remission at one year in 33%, 34% and 31% of patients, respectively. Moreover, 64% of patients in pMayo remission at week 16 from the start of tofacitinib were still in remission at one year. Only no or mild disease activity compared to moderate activity at baseline was associated with a higher probability of achieving remission according to pMayo at six months, p = .008. Hospitalizations and/or colectomies during the study period (before treatment discontinuation/end of follow-up) were low (n = 24), with less than 5 colectomies. Conclusions In this real-world cohort, including a majority of bio-experienced UC patients, tofacitinib was effective in achieving steroid-free clinical remission in a third of the population at one year. A majority of patients in remission at week 16 were also in remission at one year. Results are in line with earlier published real-world studies. Registration: ClinicalTrials.gov NCT05082428.

The Impact of Blood Morphological Parameters on Treatment Outcomes in Tennis Elbow Patients Receiving Platelet-Rich Plasma (PRP) Therapy: A Prospective Study.

Platelet-rich plasma (PRP) therapy holds substantial promise for the treatment of tennis elbow, a complex and challenging musculoskeletal condition. The aim of the study was to assess whether there are correlations between the levels of individual morphotic elements determined in whole blood and the outcomes of tennis elbow treatment with PRP injection, as measured using patient-reported outcome measures (PROMs) such as the Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE). A prospective analysis was conducted on 107 patients (132 elbows) undergoing lateral epicondylitis treatment with (PRP) injections. Patients completed VAS, PRTEE, and QDASH questionnaires on the day of PRP administration and at established checkpoints (2, 4, 8, 12, 24, 52, and 104 weeks). Minimal clinically important difference (MCID) was employed to assess the treatment effects. Then, correlations were measured within each PROM, and the impact of the concentration of individual blood parameters on the MCID outcomes was assessed. Analyzing the relationships between the MCID+ and MCID- groups, significant correlations for the VAS and QDASH scales were observed. The level of individual morphotic elements in the blood may have influenced the treatment outcome, as measured using specific patient-reported outcome measures (PROMs). Regarding the VAS scale, factors favoring a positive treatment outcome included higher values of eosinophils (EOS) and basophils (BASO). For the QDASH scale, these factors were a lower value of mean corpuscular volume (MCV) and a higher mean corpuscular hemoglobin (MCH). The levels of certain blood parameters, such as EOS and BASO, in the current study influenced the classification of patients into MCID+ or MCID- groups, based on the VAS and QDASH scales.

Bilingual Primary Progressive Aphasia: A Scoping Review of Assessment and Treatment Practices.

Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by speech and/or language impairment with relatively spared cognition. Research investigating behavioral speech-language intervention and methods for cognitive-linguistic assessment in PPA has predominantly centered around monolingual speakers. This gap hinders the widespread adoption of evidence-based approaches and exacerbates the inequities faced by culturally and linguistically diverse populations living with PPA. This scoping review synthesizes the current evidence for assessment and treatment practices in bilingual PPA as well as the operationalization of bilingualism in PPA. Arksey & O'Malley's scoping review methodology was utilized. Information was extracted from each study and entered into a data-charting template designed to capture information regarding operationalization of bilingualism in PPA and assessment and treatment practices. Of the 16 identified studies, 14 reported the results of assessments conducted in both languages. Three studies reported positive naming treatment outcomes. Thirteen studies included English-speaking participants, revealing linguistic bias. Most studies reported age of acquisition, proficiency, and patterns of language use rather than providing an operational definition for bilingualism. Neither formal assessment measures nor clear guidelines for assessment of bilingual PPA currently exist; however, language-specific measures are emerging. Speech-language intervention in bilingual PPA has been relatively unexplored, representing a significant gap in the literature. In order to improve diagnostic and treatment options for bilingual PPA, targeted efforts to increase representation of bilinguals from various sociocultural contexts, as well as those who speak a variety of language pairs, is necessary.

Exploring the Important Determinants Shaping Treatment Preferences: Qualitative Insights into Breast Cancer Patient Experiences and Perspectives in New Zealand.

Despite the importance of acknowledging patient preferences in treatment decision-making, little is known about the treatment preferences and the factors underlying those preferences of breast cancer patients. This study aims explore patient experience and perspective regarding treatment preferences and identify the important determinants that shape these preferences in the context of New Zealand. Semi-structured online interviews comprised of six focus group discussions and five individual interviews were performed with 26 breast cancer patients. The interviews were recorded, transcribed, and analyzed using the reflexive thematic analysis approach. Four main themes were derived: (1) positive treatment outcomes; (2) the negative impact of treatment-related side effects on quality of life; (3) treatment accessibility, availability, and timeliness; (4) cost of treatment. Patients revealed a strong preference towards treatments that yield longer survival, achieve remission, and prevent cancer recurrence. Additionally, patients favored treatments with minimal side effects that had minimal impact on their quality of life. There was a notable preference for treatments that were easily accessible and available in a timely manner. However, patients faced challenging decisions in balancing the costs of treatments with their benefits, leading to a consistent preference for treatments supported by government funding or medical insurance to alleviate financial burdens. Our study reveals that breast cancer patients in New Zealand have different perceptions and preferences regarding cancer treatment. Patients frequently find themselves making trade-offs among various attributes of a treatment, aligning these decisions with their personal values and beliefs. By considering these preferences and trade-offs in future studies that measure patient preferences, healthcare professionals can enhance their support for patients in making informed choices that align with their values and priorities. Additionally, healthcare policymakers can develop patient-centered policies that cater to the unique needs and preferences of breast cancer patients.

Understanding compulsive sexual behaviours through the lens of attachment

Compulsive sexual behaviours are misunderstood creating a lot of debates and arguments amongst psychotherapists on how to best conceptualise these presentations and how to treat them. The debate on whether the best conceptualisation is the one of "sex addiction" or a sexological-informed one is ongoing. The nomenclature that we assign to this clinical presentation is important because it will guide the clinician in their choice of treatment. A "sex addiction" diagnosis will inform a behavioural and abstinence-based therapy, whereas a sexological approach may offer more possibilities to understand the erotic and relational processes of clients for which attachment theories are useful for a positive long-term treatment outcome.

Moderators of treatment effect in a randomised controlled trial of single- and multi-family therapy for anorexia nervosa in adolescents and emerging adults.

Multi-family therapy for anorexia nervosa (MFT-AN) is a novel, group-based intervention that intensifies single-family therapy for anorexia nervosa (FT-AN), with the aim of improving outcomes. The current study explored treatment moderators in a randomised controlled trial (N=167) of FT-AN and MFT-AN for young people (adolescents/emerging adults aged 13-20years) with anorexia nervosa. Data were analysed using multiple linear regression. Six hypothesised baseline participant and parent factors were tested as possible moderators of treatment effect on end-of-treatment and follow-up percentage of median Body Mass Index (%mBMI); age, eating disorder symptom severity, perceived family conflict (young person and parent ratings) and parent-rated experiences of caregiving (positive and negative). Greater parent-rated positive caregiving experiences moderated treatment outcomes at follow-up (β=-0.47, 95%CI: -0.91, -0.03, p=0.04), but not end-of-treatment. Participants who had fewer parent-rated positive caregiving experiences at baseline had higher weight at follow-up if they had MFT-AN compared to FT-AN. No other hypothesised baseline factors moderated treatment outcome (p's>0.05). The current study suggests MFT-AN may be indicated for families who present with fewer positive caregiving experiences to treatment. The MFT-AN group context may help to promote mentalisation and hope for these families, which may be harder to achieve in single-family treatment. Future research is needed to empirically evaluate how and why MFT-AN supports this group more. ISRCTN registry: ISRCTN11275465, registered 29 January 2007.

Ten-year phantom limb pain with only four sessions of Fu's subcutaneous needling: A case report and systematic review

Phantom limb pain (PLP) is a distressing consequence commonly encountered by individuals who have undergone amputations. The efficacy of treatment options for PLP is limited. In this study, we present a case of a 64-year-old male who suffered from PLP for a duration of 10 years following an above-the-knee amputation. Despite unsuccessful attempts with painkillers and neurotrophic drugs over the course of a decade, the patient sought relief through Fu's Subcutaneous Needling (FSN), an innovative acupuncture therapy that specifically targets the subcutaneous tissue for pain management. Remarkably, the patient experienced a significant reduction in PLP and subsequently decreased his reliance on medication, as well as experiencing improved sleep after undergoing one session of FSN per day for four consecutive days. A follow-up conducted three years later demonstrated positive treatment outcomes. FSN demonstrated a significant influence on PLP, resulting in reduced analgesic requirements and enhanced quality of life. Therefore, FSN may be recommended as an additional treatment option for PLP. In order to gain a comprehensive understanding of the effects of acupuncture on PLP, a systematic review of relevant literature was conducted in PubMed, Embase, Cochrane Library and Web of Science in recent 20 years (from January 1, 2003 to October 16, 2023), using different combinations of the following terms: (phantom acrodynia), (residual limb pain), (phantom limb pain), (acupuncture), (electroacupuncture), (auriculoacupuncture), and (needling). 9 articles with 18 cases including one randomized controlled trial (n = 8) were obtained. This review provided additional evidence supporting the efficacy and safety of needling therapies for PLP. This systematic review offers additional evidence supporting the effectiveness and safety of needling therapies for PLP. However, there were no precedent reports using FSN treatment for PLP. Hence, this case may provide some implications for clinicians in practice.

87 Suitability of the I-InTERACT-North Parenting Program for families with autistic children

Objective:I-InTERACT-North is a stepped-care telepsychological parenting intervention designed to promote positive parenting skills and improve child behaviour. Initially developed for children with traumatic brain injury, our pilot study has shown efficacy in increasing positive parenting skills and reducing problem behaviours for children with early brain injury (e.g., stroke, encephalopathy). Recently, the program has expanded to include children with neurodevelopmental disorders, including Autism Spectrum Disorder. Although positive parenting programs (e.g., Parent-Child Interaction Therapy) can be effective for autistic children, it is unknown whether the goals most important to these families can be addressed with IInTERACT-North program. An examination of suitability and preliminary efficacy was conducted.Participants and Methods:Parent participants of autistic children between 3 and 9 years (n= 20) were recruited from the neonatal, neurology, psychiatry, or cardiology clinics at The Hospital for Sick Children and the Province of Ontario Neurodevelopmental Disorders (POND) Network. Top problems, as reported by parents at baseline, were analyzed qualitatively through a cross-case analysis procedure in order to identify common themes and facilitate generalizations surrounding concerning behaviours. Parent-reported intensity of their children’s top problem behaviours on a scale from 1 (“not a problem”) to 8 (“huge problem”) were quantified. To explore preliminary program efficacy, t-tests were used to compare pre- and post-intervention problems and intensity on the Eyberg Child Behavior Inventory (ECBI) (n=16).Results:A total of 56 top problem data units were examined, with convergent thematic coding on 53 of 56 (94.6% inter-coder reliability). Four prevalent, high-agreement themes were retained: emotion dysregulation (19; 33.9%), non-compliance (12; 21.4%), sibling conflict (7; 12.5%), and inattention and hyperactivity (7; 12.5%). Average problem intensity for these themes ranged from 5.85 to 6.53 (where 8 is greatest impairment) with emotion dysregulation having the highest intensity (6.53) compared to the others. Scores on the ECBI were lower post-intervention (Intensity scale: M= 59.06, SD= 8.1; Problem scale: M= 60.69, SD= 11.5) compared to pre-intervention (Intensity scale: M= 61.19, SD= 10.4; Problem scale: M= 64.31, SD= 11.7), but small sample size precluded detecting statistical significance (p’s = .16 and .07, respectively).Conclusions:Thematic analysis of top problems identified by parents of autistic children suggested that concerns were transdiagnostic in nature, and represent common treatment targets of the I-InTERACTNorth program. Though challenging behaviours related to restricted interests or repetitive behaviours may exist in our sample, parental behavioural goals appeared to align with the types of concerns traditionally raised by participants of the program, supporting a transdiagnostic approach. Preliminary data point to positive treatment outcomes in these families.

Real-world antiseizure medication treatment outcomes in drug-resistant focal epilepsy patients.

To gather real-world evidence on antiseizure medications (ASMs) treatment patterns and related outcomes in patients with drug-resistant focal epilepsy. Medical insurance claims from the start of 2014 till the end of 2019 were used. Patient selection criteria included International Classification of Diseases (ICD) codes followed by documented ASM use. Baseline patient demographics along with ASM and rescue medication use patterns and related patient outcome were documented for first (index) ASM regimen. Patients who failed the first regimen and then failed the second regimen were considered drug resistant. Multivariate analyses were performed to identify risks and other characteristics for positive or negative treatment outcomes. Study cohort consisted of 46 474 patients with a mean age of 47.23 (SD: 16.94). Levetiracetam was the most first-encountered ASM (37.94%). At baseline, 87.14% were treated with ASMs prior to having study-confirmed diagnoses. Mental comorbidities were present in 37.86% of patients. After first-year ASM treatment, 34.61% of patients persisted on their index regimen and 5.91% were seizure-free. Patients failing first ASM regimen numbered 12 868 (27.69%). Drug-resistant patients who failed first and then second ASM regimens numbered 6335 (49.23%). Percentages of patients who had successful second treatment and seizure-free were 21.32 and 3.65, respectively. Initiating patients on lamotrigine or carbamazepine (relative to levetiracetam), baseline use of index ASM, rescue medications, and older age or male gender all lowered the risk for treatment failure. Having higher comorbidity, comorbid mental illness, headache, or neoplasty increased such a risk. Baseline use of index ASM, depressive episode, or anxiety disorder all entailed higher risk of failing second ASM treatment. Overall, reported findings indicated that patient history at baseline and the early selection of an ASM all influenced treatment outcomes. Findings pointed to the complex nature of ASM treatment in drug-resistant focal epilepsy patients calling for additional research to identify the optimal treatment to achieve beneficial patient outcomes.

The use of endoscopic vacuum therapy for esophageal rupture

The authors are demonstrating a positive outcome of treatment of a 52-year-old patient using endoscopic vacuum therapy for spontaneous rupture of the esophagus (Burhave syndrome). The patient was discharged after 15 days with epithelization of the defect. Thus, this method, in the form of a combination of use of a special polyurethane sponge and constant aspiration, prevented the development of complications and contributed to the reparation of esophageal rupture.

A single case experimental design study using an operationalised version of the Kaufman Speech to Language Protocol for children with childhood apraxia of speech

Purpose A Phase I study was conducted to examine the treatment effectiveness of the Kaufman Speech to Language Protocol using a research-operationalised protocol. It was hypothesised that articulatory accuracy would improve as a result of the treatment and that these improvements would be maintained after treatment was discontinued. Method A single case experimental design was used to evaluate the effectiveness of the Kaufman Speech to Language Protocol. Four children with a confirmed childhood apraxia of speech diagnosis were included in this study. Each child received 12 individual 1 hr treatment sessions that each consisted of an approximation setting phase and a practice phase. Probe data was collected during treatment and at post-treatment time points to measure treatment effectiveness and to measure changes in the untreated words. Untreated (control) sounds were included to test whether recorded improvements in articulatory accuracy could be attributed to the Kaufman Speech to Language Protocol. Result Two of the four children demonstrated a response to the intervention and maintenance of these changes, while the two remaining children demonstrated some generalisation in the absence of improved target (treatment) words. No specific child factors were clearly associated with positive treatment outcomes. Conclusion This study replicated the findings of an earlier pilot study and found that the operationalised protocol for the Kaufman Speech to Language Protocol is effective in improving articulatory accuracy for some children with childhood apraxia of speech. Additional replication with a further refined treatment protocol and a larger sample size is needed to support a recommendation of clinical use of the Kaufman Speech to Language Protocol.

The missing links in climate services for health and heat-health services: Examining climate-heat services in peri-urban districts in South Africa

Climate services for health can facilitate health resilience and adaptation to climate change, particularly if they are well-calibrated to promote wellness and save lives. In this study, the status of climate services for health in South Africa’s Agincourt sub-district, Mpumalanga province, was assessed. A qualitative case study methodology encompassing multiple methods of data collection was used. The results show that climate services for health in the Agincourt sub-district, albeit essential, are fragmented and underdeveloped. Scientifically informed heat-health services are non-existent. Notwithsatnding this gap, healthcare and allied professionals are aware of the importance of climate services for health. The main barrier to climate services delivery is the paucity of interagency coordination; for example, coordination to plan and respond to climate-health information between the South African Weather Services and the Departments of Health and Education is lacking. Inclusive climate services for health are essential for positive prevention and treatment outcomes. Future studies must provide an investment case for climate services for health, demonstrating the benefits of acting and the costs of inaction.

Study of burn injuries and pattern with seasonal variation in a tertiary care centre

Background: Burn injuries pose a significant public health concern, necessitating a detailed investigation to enhance injury prevention strategies. This study investigates the distribution and patterns of burn injuries in a tertiary care centre, focusing on gender, age, burn types, outcomes, and seasonal variations. Methods: Data from a multi-year retrospective analysis (2018-2022) were collected and analysed to determine the gender distribution of burn incidents. Additionally, age distributions were examined to understand the prevalence of burns across different age groups. Burn types were classified into flame, scald, electric, and chemical/miscellaneous, while outcomes were categorised as discharged, abscond/LAMA (left against medical advice), death, or transfer to other departments. The study also investigated the seasonal variations in scald and flame burn incidents. Results: The highest gender disparities were observed in 2018 and 2019, with 748 and 661 male cases, respectively, compared to 355 and 345 female cases. Children aged 1-10 constituted the largest burn cases, followed by individuals aged 25-40. Flame burns were the most common, accounting for the highest number of cases throughout the study period. Scald burns ranked second, followed by electric and chemical/miscellaneous burns. Most burn incidents resulted in discharge, followed by abscond/LAMA cases. Deaths and transfers to other departments were less frequent outcomes. The number of discharged cases increased gradually over the study period, indicating positive treatment outcomes. Conclusions: The conclusions emphasize the necessity for all-encompassing preventative initiatives, including public awareness campaigns, safety education, and interventions for vulnerable groups.

Three-dimensional evaluation of skeletal stability after surgery-first bimaxillary surgery for class III asymmetry in 70 consecutive patients

Background/purposeSkeletal stability after orthognathic surgery is essential for positive treatment outcome. This study evaluated the stability of osteotomy segments after surgery-first bimaxillary surgery for class III asymmetry. Materials and methodsSeventy adults with class III asymmetry consecutively corrected through surgery-first Le Fort I and bilateral sagittal split osteotomies were investigated. Cone-beam computed tomography before treatment (T0), 1-week after surgery (T1), and after all treatment (T2, ≥1-year after surgery) was used to assess surgical movement (T0 to T1) and skeletal stability (T1 to T2) regarding the translation and rotation of the maxillary, mandibular distal, and proximal segments. ResultsAt T1, the maxillary segment had moved forward and upward, turned to the deviated side, and rotated downward (all P < 0.01). The distal segment of mandible had moved forward and upward and rotated upward (all P < 0.001). The deviated proximal segment had moved upward, tilted to the opposite side, and rotated upward (all P < 0.001). The opposite proximal segment had moved upward and tilted to the deviated side (both P < 0.01). At T2, significant relapse occurred in the mandible. The distal segment moved forward and upward and rotated upward (all P < 0.001). The deviated proximal segment moved upward, tilted to the opposite side, and rotated upward (all P < 0.001). The opposite proximal segment moved upward and tilted to the deviated side (both P < 0.01). ConclusionClinically significant relapse of class III asymmetry was discovered on the mandibular distal and opposite proximal segments.