Treatment Practices Research Articles

Progress in treatment of pathological neuropathic pain after spinal cord injury

Pathological neuropathic pain is a common complication following spinal cord injury. Due to its high incidence, prolonged duration, tenacity, and limited therapeutic efficacy, it has garnered increasing attention from both basic researchers and clinicians. The pathogenesis of neuropathic pain after spinal cord injury is multifaceted, involving factors such as structural and functional alterations of the central nervous system, pain signal transduction, and inflammatory effects, posing significant challenges to clinical management. Currently, drugs commonly employed in treating spinal cord injury induced neuropathic pain include analgesics, anticonvulsants, antidepressants, and antiepileptics. However, a subset of patients often experiences suboptimal therapeutic responses or severe adverse reactions. Therefore, emerging treatments are emphasizing a combination of pharmacological and non-pharmacological approaches to enhance neuropathic pain management. We provide a comprehensive review of past literature, which aims to aim both the mechanisms and clinical interventions for pathological neuropathic pain following spinal cord injury, offering novel insights for basic science research and clinical practice in spinal cord injury treatment.

A new treatment and updated clinical practice guidelines for MASLD

A new treatment and updated clinical practice guidelines for MASLD

Status of HPV disease and vaccination programmes in LMICs: Introduction to special issue

Sexually transmitted human papillomavirus (HPV) infections are extremely common in both men and women and while most will clear naturally, some may progress to cervical cancer and other cancers. Despite the availability of prophylactic vaccines and well-established screening and treatment practices, the global burden of HPV-related disease remains high, particularly in low-and-middle-income countries (LMICs). We outline the current global epidemiology of cervical cancer disease incidence and mortality, with the highest burden in Africa and Asia. As part of a strategy to eliminate cervical cancer as a public health problem, the WHO recommends a 3-fold approach combining the use of prophylactic vaccines with cervical cancer screening and treatment. This overview focuses on the globally available HPV vaccines and current status of vaccine introduction in LMICs. We describe decreased HPV vaccination coverage in recent years and highlight the need for emphasis on new vaccine introductions and existing vaccine programme strengthening in order to reach goals for the elimination of cervical cancer as a public health problem. It is estimated that US$3.20 will be returned on each dollar invested in cervical cancer prevention efforts through 2050 [1]. Success for these initiatives centers on strategic vaccine delivery and collaborations that foster political support and engagement with civil society organisations and educational sector stakeholders. Recent increases in vaccine supply and single-dose efficacy evidence pave the way for cervical cancer elimination through vaccination coupled with screening and treatment. Subsequent manuscripts in this supplement will outline case studies and lessons from two symposia held in Africa and South Asia by the Coalition to Strengthen the HPV Immunization Community in 2022 including evidence for a one-dose strategy, the challenges of maintaining vaccine programmes during the COVID-19 pandemic, and progress in cervical cancer screening programmes.

Gonorrhea and early syphilis treatment practices among community healthcare providers in Baltimore City, Maryland

Gonorrhea and early syphilis treatment practices among community healthcare providers in Baltimore City, Maryland

Global techno-economic analysis of MBR for hospital wastewater treatment

This study comprehensively examines and characterizes global membrane bioreactor (MBR) practices for hospital wastewater treatment, focusing on development trends, technical performance (pollutant removal and carbon emissions), and economic costs, including both capital expenditures (CAPEX) for civil engineering and equipment procurement, and operational expenditures (OPEX) for electricity, membrane replacement, labor, and chemical costs, as well as system footprint. The results show that MBR has been widely used for hospital wastewater treatment for over two decades, with global applications and scales significantly increasing, especially after the COVID-19 pandemic. A notable shift in membrane types has occurred, with hollow fiber membranes dominating before 2010 and flat inorganic membranes gaining prominence after 2020. MBR not only effectively removes conventional pollutants but also greatly reduces pathogens, ARBs and ARGs before disinfection, thus alleviating the subsequent disinfection burden. In addition, MBR is a crucial step in the process of completely removing emerging contaminants (ECs) that pose significant environmental and health risks. The CAPEX of MBR has decreased at the technical level in recent years. MBR requires only 62 % and 21 % of footprint for conventional activated sludge (CAS) and biofilm-based processes, respectively. MBR's land-saving advantage offsets the CAPEX gap with CAS in high land-cost areas. From before 2010 to after 2020, membrane costs saw the largest reduction in OPEX, dropping by 71 %, while electricity consumption saw a 10.71 % reduction, now comparable to biofilm-based processes. Currently, MBR's OPEX (0.158 USD/m3) is only slightly higher than that of biological contact oxidation (0.138 USD/m3). MBR also minimizes sludge production, reducing both treatment costs and associated disposal risks. MBR exhibit minimal concerns of excessive carbon emissions, with a carbon emission intensity (1.11 kg CO2eq·m−3), only slightly higher than biofilm-based processes (0.92 kg CO2eq·m−3). This study demonstrates that MBR is the valuable and practical solution for hospital wastewater treatment, as well as a preferred choice for upgrading existing facilities.

Efficacy and safety of systemic treatment for progressive and refractory desmoid tumor: a systematic review and Bayesian network meta-analysis.

Desmoid tumors (DT) are rare, locally invasive tumors originating from connective tissue. Surgical intervention is no longer the standard treatment for DT, as systemic therapy gradually replaces it due to its superior efficacy. Despite the availability of various treatment modalities, there is a need for a first-line systemic treatment regimen that offers both effective disease control and acceptable safety profiles. To assess the efficacy and safety of different systemic treatment agents for DT, we conducted a systematic review and network meta-analysis. Eligible studies were identified through searches of PubMed, Embase, and the Cochrane Library databases, and data were extracted according to predefined inclusion criteria. Three articles and clinical data from 295 patients with progressive and refractory DT were included in this Bayesian network meta-analysis. When considered by objective response rate (ORR), the efficacy of γ-secretase inhibitor versus placebo (OR 0.12, 95%CI 0.01-1.68) is superior to that of TKI (OR 0.49, 95%CI 0.03-7.62) and chemotherapy (OR 0.90, 95%CI 0.02-40.00). Vascular endothelial growth factor (VEGF)-TKI (OR, 0.09; 95% CI, 0.01-1.79) seemed to have the highest improvement in terms of 1-yr PFS rate, while chemotherapy seemed to have the highest improvement across all therapies in terms of 2-yr PFS rate across all therapies (OR, 0.06; 95 percent CI, 0.01-2.98). In terms of safety, the incidence of AEs is highest for γ-secretase inhibitor versus placebo (OR 0.16, 95%CI 0.02-1.55), while TKI is associated with the least AEs (OR 0.62, 95%CI 0.06-6.97). γ-secretase inhibitor provides superior local control of tumors, while chemotherapy and TKI may offer better long-term survival benefits. Among the three regimens, TKI demonstrated better treatment-related safety. These findings have important implications for guiding clinical practice in systemic treatment of DT.

Treat-to-Target in Inflammatory Bowel Disease: An Updated Survey of Treatment Strategies among Portuguese Gastroenterologists

Background: In 2018, the authors surveyed the clinical practices among Portuguese gastroenterologists (PGEs) regarding treatment targets in Crohn’s disease (CD) and ulcerative colitis (UC). Since then, new evidence has emerged supporting additional targets, such as transmural remission and histological remission. This study provides an updated assessment of treatment practices among PGE with special emphasis on these new targets. Methods: Using the Portuguese Inflammatory bowel disease Study Group (GEDII) physician database, we invited PGE to participate in an anonymous online survey. Results: Fifty-six physicians agreed to participate in the study. Deep remission, steroid-free clinical remission, endoscopic remission, and biomarker remission were ranked among the most important treatment targets in CD (89%, 80%, 89%, and 84%, respectively) and UC (82%, 84%, 79%, and 84%, respectively). In CD, transmural remission was considered a target by 70% of participants, with 48% agreeing to intensify treatment to achieve it. In UC, histological remission was aimed by only 45% of PGE with most (88%) being unwilling to intensify treatment to achieve this goal. Physicians were more likely to seek endoscopic remission in CD and UC in younger and healthier patients, compared to older patients with comorbidities. Conclusion: PGEs are increasingly pursuing tougher treatment targets such as transmural remission in CD and, to a lesser extent, histological remission in UC. Physicians are more willing to escalate treatment to achieve endoscopic remission in younger patients.

Lecanemab's Path Forward: Navigating the Future of Alzheimer's Treatment in Europe Amidst the EMA's Rejection.

Lecanemab (Leqembi©, Biogen), a humanized anti-amyloid-beta monoclonal antibody, has been approved for early-stage Alzheimer's disease (AD) in several countries, including the US and Japan. However, the European Medicines Agency (EMA) recently issued a negative opinion on its marketing authorization, reflecting concerns over the clinical value and manageability of anti-amyloid treatments. This decision highlights the ongoing disconnect between research advancements and clinical practice, where the focus on biological markers over tangible clinical improvements remains contentious. Despite promising biological effects, lecanemab's clinical outcomes have been modest, raising questions about its therapeutic role. The EMA's refusal underscores the need to address doubts surrounding the real-world effectiveness and safety of such treatments, especially concerning amyloid-related imaging abnormalities (ARIAs), a common side effect observed in clinical trials. The recent approval of lecanemab by the UK's Medicines and Healthcare products Regulatory Agency, despite the National Institute for Health and Care Excellence's rejection on cost-effectiveness grounds, further fuels the debate on the feasibility of anti-amyloid therapies. This commentary emphasizes the importance of real-world data on lecanemab's impact on cognitive decline, daily functioning, and side-effect management. As the global clinical use of lecanemab increases, continuous and standardized reporting on its outcomes is crucial for guiding future regulatory decisions and for potentially bridging the gap between research and practice in AD treatment.

IMPLEMENTATION AND OUTCOME OF A PROTOCOL-BASED TREATMENT FOR DIABETIC KETOACIDOSIS IN A TERTIARY CARE PEDIATRIC EMERGENCY DEPARTMENT

BackgroundThe standardization of clinical practice in emergency treatment of diabetic ketoacidosis (DKA) is a prerequisite for improving patient care. For this purpose, a standardized DKA protocol incorporating a two-bag system has been implemented since January 2020 in our center. ObjectivesTo assess the impact of the development and utilization of the standard treatment pathway for DKA on patient outcomes. MethodsThis retrospective cohort study involved patients diagnosed with DKA and admitted to the pediatric emergency department (PED). The entire period of the study was from January 2017 to September 2022. Patients with DKA managed before and after implementation of the protocol were compared in terms of clinical outcomes. ResultsOut of 145 patients, 77 (53%) patients were in the pre-protocol group, 68 (47%) were in the protocol group. Age, sex, and severity of DKA were similar between the groups. Implementation of the protocol resulted in shorter resolution time of acidosis and ketosis (p = 0.007, p < 0.001, respectively), higher correction rates of bicarbonate and blood ketones (p = 0.003, p < 0.001, respectively), shorter duration of IV insulin treatment (p = 0.008), more appropriate potassium dosage administrating to IV fluids (p < 0.001), lower incidence of hypokalemia, hypophosphatemia, and hypoglycemia (p = 0.008, p = 0.002, p = 0.036, respectively), and smaller number of IV bags use (p < 0.001). ConclusionImplementation of a protocol-based pathway for DKA involving a two-bag system provided earlier correction of ketoacidosis, decreased the risk of complications, and reduced resource utilization in the PED.

Sustainable management of end of life crystalline silicon solar panels in Australia: Advancing circular economy practices

The worldwide adaptation of Photovoltaic (PV) technology as a sustainable alternative to fossil fuels, has experienced exponential growth in recent years. However, the lack of effective waste management policies has hindered efficient PV panel disposal and recycling practices. In the absence of effective policies, the worldwide End-of-Life (EoL) PV module accumulation is predicted to reach a critical stage in the early 2030s. This study examines the environmental impacts of different EoL management practices using Life Cycle Assessment (LCA), based on a comprehensive database generated from both literature and industrial data. Five different EoL scenarios were considered for 1000 kg of Crystalline Silicon (c-Si) PV modules with a focus on Australia as a case study, while considering the energy recovery options and emphasizing the economic benefits. From a comprehensive LCA study, it is found that upcycling options reduce the environmental impacts significantly compared to downcycling, while chemical treatment emerges as a preferred option, demonstrating a reduced environmental burden. Nevertheless, the utilization of toxic chemicals during chemical treatment-based PV recycling needs to be reconsidered. Additionally, the usage of chemicals during the metal recovery process of PV module recycling caused the highest environmental burden, necessitating the importance of moving to greener treatment practices. This research study will enable the identification of optimum EoL c-Si module recycling options, contributing to sustainable waste management.

Polycaprolactone-zinc oxide biocomposite membranes for wastewater treatment by ultrafiltration process: synthesis, characterization and removal of inorganic pollutants

The severe droughts impacting North Africa have intensified the pressure on potable water supplies and agricultural irrigation, highlighting the urgent need for sustainable water management solutions. This study explores the potential of poly(ε-caprolactone)/zinc oxide (PCL/ZnO) biocomposites as ultrafiltration membranes for treating urban wastewater, with the goal of enabling water reuse in agriculture. PCL/ZnO membranes, fabricated using the solvent-casting method, were thoroughly characterized using FTIR, XRD, EDAX, SEM, AFM, DSC, TGA, and water contact angle (WCA) measurements. Key findings revealed that increasing ZnO content (1-4wt%) significantly enhanced membrane thickness, crystallinity, mechanical robustness, and surface roughness, while lowering WCA values to improve hydrophilicity. These enhanced properties are critical for ultrafiltration, as they contribute to higher contaminant rejection and improved water permeability. Performance tests demonstrated ion retention rates of 32% to 61% post-filtration, including for toxic metals, effectively reducing pollutant levels. Notably, the treated water met the Food and Agriculture Organization (FAO) standards for irrigation quality, indicating its suitability for agricultural applications. This work highlights the efficacy of PCL/ZnO membranes in facilitating sustainable wastewater recycling under drought conditions, presenting a promising, adaptable solution for water reclamation in water-scarce regions. The results underscore the potential of these biocomposite membranes to advance sustainable water treatment practices, supporting both environmental resilience and agricultural productivity.

Talking About Incarceration History: Engaging Patients and Healthcare Providers in Communication.

Incarcerated individuals in carceral facilities demonstrate an elevated prevalence of chronic disease conditions which are likely to persist post-release. Healthcare providers may not be trained on how exposure to incarceration may influence patient health outcomes and patient-provider communication. To examine the self-perceived preparedness of healthcare providers to interview patients regarding history of incarceration and the potential related health consequences. This cross-sectional study consisted of a web-based self-administered questionnaire distributed via email to a random sample of healthcare providers in the Department of Medicine at Brigham and Women's Hospital. In total, 400 healthcare providers were invited to participate; 114 respondents completed the survey, of which 26% were medical doctors (n=30), 41% were physician assistants (n=47), and 32% were nurse practitioners (n=37). Understanding healthcare provider training in caring for formerly incarcerated patients, current treatment practices and confidence caring for patients who have experienced incarceration, and implications for clinical care. Of 114 respondents, 73% reported that they currently care for formerly incarcerated patients. However, only 8% received specialized training for the care of formerly incarcerated patients. While most respondents did not ask their patients about prior history of incarceration (81%), when asked about comfortability in doing so, 60% reported low levels of comfort. Most providers (77%) reported high agreement that incarceration impacted health, with 54% reporting that it led to significant healthcare access barriers, but 64% reported low confidence levels in addressing the needs of formerly incarcerated patients. Healthcare workers recognized incarceration as a detrimental health exposure. However, providers reported low levels of confidence in understanding and addressing the unique needs of patients who experienced incarceration. Findings support the need for further training regarding how to address the needs of formerly incarcerated patients, which would support efforts towards achieving equitable healthcare.

Identifying transdiagnostic and multidimensional prognostic indicators among veterans with PTSD symptoms in brief integrated care settings.

Brief integrated care settings hold promise for accessible and effective trauma-informed interventions. However, clinicians often have difficulty efficiently forecasting who is most appropriate for interventions in such settings and how to target individualized care. Multidimensional and transdiagnostic evaluations may provide valuable information to improve stepped-care and treatment practices for veterans. A middle-out approach was used to concurrently evaluate self-reported posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and physical health problems using cross-sectional (latent profile analysis) and longitudinal (latent growth mixture modeling) analyses that identified unique symptom profiles, trajectories of traumatic stress reactions, and correlates of these health outcomes. Data from 234 veterans who participated in a randomized controlled trial of primary care PTSD intervention were analyzed at 0, 8, 16, and 24 weeks. Latent profile analysis identified two homogenous baseline profiles: global symptoms (33.8%); low dysphoria-lower negative cognitions, mood, and depressive symptoms (66.2%). Low dysphoria participants reported more social relationships (OR = 1.32) and fewer environmental (OR = 0.89) and financial (OR = 0.23-0.35) stressors. Latent growth mixture modeling identified three trajectories: (a) reducing symptoms ("responders"; 21.3%) and chronic symptoms of (b) moderate (59.6%) and (c) high (19.1%) severity. Low dysphoria participants were 4.35 times more likely to be responders over time compared to participants with moderate severity symptoms. Findings indicated that veterans with moderate PTSD symptoms and physical health problems but low dysphoria may respond best to trauma-informed intervention in brief integrated care settings, while others may require further individualized stepped care. Findings demonstrate unique traumatic stress reactions that support individualized stepped care and may offer greater treatment utilization, retention, and efficacy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comparative Study of Biosorption and Traditional Methods for Heavy Metal Removal from Industrial Wastewater in Panipat

In this research paper, I have thoroughy described about the topic Comparative Study of Biosorption and Traditional Methods for Heavy Metal Removal from Industrial Wastewater in Panipat.” Industrial wastewater contamination by toxic heavy metals poses a significant environmental threat globally, especially in rapidly industrializing regions like Panipat District in Haryana, India. Panipat, renowned for its extensive textile and chemical industries, generates substantial volumes of wastewater laden with heavy metals such as lead (Pb), cadmium (Cd), and mercury (Hg). Recent studies have revealed that the concentrations of these metals in Panipat's industrial effluents frequently surpass the permissible limits set by environmental regulations. Traditional methods for heavy metal removal, including chemical precipitation and ion exchange, are widely utilized but often entail high operational costs and the generation of secondary pollutants like sludge. Biosorption, an emerging and sustainable technology, offers a promising alternative by utilizing biological materials such as algae, bacteria, and agricultural waste to adsorb heavy metals from wastewater. This study aims to investigate the effectiveness, cost-effectiveness, and environmental impact of biosorption compared to traditional methods in Panipat District. By examining heavy metal removal efficiencies, conducting cost analysis, and assessing environmental implications, this research seeks to provide valuable insights into sustainable wastewater treatment practices.

Global outcomes and prognosis for relapsed/refractory mature T-cell and NK-cell lymphomas: Results from PETAL consortium

Variances in global access to drugs and treatment practices make it challenging to understand the benefit of contemporary therapies in patients with relapsed and refractory (R/R) mature T-cell and NK-cell lymphomas (MTCL and MNKCL). We conducted an international retrospective cohort study of 925 patients with R/R MTCL and MNKCL. In PTCL-NOS and ALK- ALCL, patients with relapsed lymphoma demonstrated a superior median overall survival (OS) relative to refractory from the time of second-line treatment. We identified several independent predictors of OS for R/R lymphoma including age >60, primary refractory disease, histological subtype other than AITL, extranodal sites >1, Ki67 ≥40%, and absolute lymphocyte count <LLN. A multivariable model incorporating these formed the basis for a prognostic index for R/R TCL (PIRT), in which patients are stratified into low-risk (0-1 risk factor), intermediate-risk (2-3 risk factors), or high-risk (≥4 risk factors) groups, which were associated with 3-year OS of 57.14% (95% CI: 17.1-83.7), 23.3% (8.7-41.9), and 7% (0.4-26.9), respectively. Patients received either a "novel" single agent (SA, 35%) or cytotoxic chemotherapy (CC, 60%) for their second line treatment. Higher progression-free survival was observed with SA over CC for the entire cohort with a higher 3-year OS in AITL and ALK- ALCL. Among the SA, small molecule inhibitors demonstrated OS advantage relative to CC in AITL. Our results underscore efficacy of novel drugs and the potential of a new prediction model in informing heterogeneous prognosis within the R/R population of MTCL and MNKCL.

Radiology during a war - experience in Ukraine.

Military radiology, an integral part of military medicine, plays a pivotal role in medical triage, diagnosis, and treatment. Its significance lies in providing timely and accurate assessments in challenging situations.The utilization of contemporary sonographic techniques enables rapid identification of life-threatening conditions, ensuring prompt medical aid and facilitating regional anesthesia. Computed tomography emerges as a critical tool for assessing injury extent, planning surgeries, monitoring postoperative phases, and conducting retrospective evaluations, especially when anatomical dissection is complex.Battlefield radiology not only enhances the understanding of injury mechanisms and battlefield traumas but also contributes significantly to the overall improvement of diagnostic and treatment approaches. Ukrainian doctors actively engaged in diverse stages of patient care accumulate a wealth of knowledge, substantially elevating the survival rates of wounded individuals. This experience serves as the foundation for ongoing enhancements and the advancement of military radiology, even during periods of peace. · Military radiology is essential in medical triage, diagnosis, and treatment within military contexts.. · Modern sonographic methods enable swift identification of life-threatening conditions.. · Computed tomography is indispensable for assessing injuries, planning surgeries, and conducting retrospective evaluations.. · Ukrainian doctors actively contribute to the knowledge base, improving diagnostic and treatment practices.. · The acquired experience serves as a foundation for ongoing advancements in military radiology, extending its impact beyond wartime scenarios.. · Nehria N, Nehria Y, Bukharin T. Radiology during a war - experience in Ukraine. Fortschr Röntgenstr 2024; DOI 10.1055/a-2326-7724.

Clinicians' Knowledge, Attitudes, and Practices Regarding the Management of Functional Gastrointestinal Disorders With Neuromodulators and Psychological Treatment.

Little is known about the practical clinical application of neuromodulators and psychiatric treatments in patients with functional gastrointestinal disorders (FGIDs). We investigate the knowledge, attitudes, and practices of Korean clinicians regarding the use of neuromodulators and psychiatric treatments for FGIDs. This prospective, online, cross-sectional study was conducted between May and August 2022. A questionnaire regarding the knowledge, attitude, and practice of neuromodulators and psychiatric treatments for FGIDs was developed and administered to primary care clinicians and gastroenterologists in university hospitals in Korea. Overall, 451 clinicians from primary (n = 179, 39.7%), secondary (n = 113, 25.1%), and tertiary (n = 159, 35.3%) hospitals participated in the survey. Most of them considered that neuromodulators (98.7%) and psychiatric treatment (86.5%) were required for patients with FGIDs. However, approximately one-third of them did not prescribe neuromodulators, mainly due to unfamiliarity with the drugs, and only one-quarter considered psychiatric referral. Compared to gastroenterologists at university hospitals, primary care clinicians' prescriptions had a lower rate (87.2% vs 64.2%, P < 0.001) and shorter duration of neuromodulator. The psychiatric referral rate was lower for primary care clinicians than for gastroenterologists at university hospitals (19.0% vs 34.2%, P < 0.001). Knowledge, attitude, and practice levels regarding neuromodulators and psychiatric treatment among clinicians are inhomogeneous, and a knowledge gap exists between primary care clinicians and gastroenterologists at university hospitals. Encouraging ongoing education for Korean clinicians regarding the appropriate use of neuromodulators and psychiatric treatments in patients with FGIDs is suggested.

Material Technologies for Improved Diabetic Foot Ulcer (DFU) Treatment: A Questionnaire Study of Healthcare Professionals’ Needs

Background/Objectives: Diabetic foot ulcers (DFUs) are a common and severe complication of diabetic patients, with significant global prevalence and associated health burdens, including high recurrence rates, lower-limb amputations, and substantial associated economic costs. This study aimed to understand the user needs of healthcare professionals treating diabetic foot ulcers for newly developed material technologies. Methods: An open-ended questionnaire was used to identify user needs, identify the limitations of current treatments, and determine the specific requirements for ideal treatment. This information was used to develop a list of key considerations for creating innovative material technologies to improve diabetic wound treatment results. Results: Most respondents indicated that they followed published treatment guidelines for DFUs but noted that treatment often required a case-specific approach. Antibiotics and surgical debridement were commonly used for infection control. The participants showed a strong preference for wound dressings with lasting antibacterial properties. Respondents identified ideal properties for new products, including ease of use, enhanced antibacterial properties, affordability, and targeted biological activity. The respondents also highlighted the importance of a holistic approach to DFU management, integrating product development with comprehensive care strategies and patient education. Conclusions: This study highlights the complexity of DFU care, emphasizing that no single product can address all treatment needs. Future materials could focus on combination therapies and specific use cases. Additionally, understanding global variations in treatment practices and educating users on the proper application of newly developed material technologies is crucial for improving the management of DFUs and patient outcomes.

Intra-articular knee injections in patients with primary osteoarthritis in a tertiary clinical setting: a best practice implementation project.

This project aimed to improve physicians' adherence to evidence-based practices regarding the selection and administration of intra-articular knee injections for patients with osteoarthritis. The project also aimed to empower patients by increasing their awareness of these evidence-based practices. In the management of knee osteoarthritis, intra-articular injections are commonly used when initial treatments prove inadequate. However, issues such as patients' demand for rapid relief and variability in physicians' familiarity with optimal practices often lead to suboptimal treatment decisions and potential adverse outcomes. This project followed the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process. Initially, physicians were surveyed on the topic under consideration, and hospital records were reviewed. Subsequently, targeted interventions were implemented, including briefings and the distribution of informative flyers. The baseline audit indicated low adherence with all audit criteria. Various parameters, such as adherence to best clinical practices, informed decision-making by patients, and the recommendation of alternative treatment modalities, were significantly lacking. Following the interventions, substantial improvements were observed, including higher rates of adherence to best clinical practices by physicians for multiple criteria, such as stepwise referral to conservative therapy options and the content of intra-articular injections. Adherence to best clinical practices can be improved through educational briefings for physicians on the most current evidence-based treatment practices for injectable substances in knee osteoarthritis. The active engagement of patients, facilitated by informative flyers and physician assistance, contributed to better involvement in their treatment choices. However, the participation of health care institutions and providers as well as lifelong education practices may be necessary for more comprehensive and sustainable changes. http://links.lww.com/IJEBH/A277.

Infant feeding and treatment practices could lead to enhanced transmission of Kaposi’s sarcoma-associated herpesvirus (KSHV) and other orally shed infections via saliva, in rural south-western Uganda

ABSTRACT This qualitative sub-study investigated household practices affecting orally shed infections using Kaposi’s sarcoma-associated herpesvirus (KSHV) as a focus. Participants enrolled from 50 households in rural south-western Uganda were followed monthly up to three times. At enrolment, in-depth interviews were completed, and venous blood collected. KSHV seropositivity was defined as anti-KSHV antibody detection to any of 25 antigens by multiplex bead-based assay. Mouthwash samples from every visit were tested by qPCR and KSHV shedders defined as individuals with KSHV DNA detected. At least one KSHV seropositive person was in 48/49(98%) households. Among those, 79% had 1+ KSHV shedders including 45% with 1+ always shedders and 92% with 1+ intermittent shedders, not mutually exclusively. All respondents reported feeding infants with pre-masticated hard food/fruits and testing food/tea temperature. Temperature was tested by tasting, pouring tea on their hand, or touching the cup to their cheek. Some cooled food/tea using a utensil or blowing over it. Food sharing amongst children and adults and using the same dish was common practice. To treat colic pain, carers/mothers reported chewing herbs and spitting into the child’s mouth. Feeding and treatment practices did not vary by KSHV status. We identified potential KSHV transmission modes in rural Ugandan households.