Practical Protocol Research Articles

Modular Universal Tumor and Revision System Prostheses in Patients with Bone Cancer of the Lower Limbs: A Narrative Review of Functional Outcomes.

The optimal management of bone tumors requires a multidisciplinary strategy to guarantee high-quality care. At specialized centers, the medical team responsible for managing patients with bone cancer comprises oncologists, surgeons, radiologists, pathologists, and rehabilitation specialists. The goal of treatment is to achieve long-term survival with minimal disability and pain. Postoperative rehabilitation is a fundamental therapeutic approach to enhance functionality and sustain the utmost quality of life following a limb-sparing surgery. Currently, megaprostheses are used for reconstructing bone defects after tumor resection, but in the literature, only a few studies have investigated rehabilitation outcomes in terms of functionality and impact on daily activities. This narrative review explores the functional and quality of life outcomes after the implantation of MUTARS® prostheses in patients with lower extremity bone tumors. A comprehensive search was conducted on PubMed and Scopus using the following MESH terms: "MUTARS", "Megaprosthesis", "bone", "tumors", "metastasis", "lower limb", "rehabilitation", "outcome", and "quality of life", and 10 studies were included. The most frequent oncological pathology was found to be primitive bone tumors treated with modular prostheses. The outcome measures used were the Henderson et al. classification, Harris Hip Scale, Musculoskeletal Tumor Society score, Visual Analog Scale, Range Of Motion, Karnofsky Performance Scale, and quality of life questionnaire. MUTARS® is a well-established treatment option after bone tumor resection, although it involves extensive and complex post-resection reconstruction that exposes joints and tissues to substantial mechanical stress. Proper rehabilitation after MUTARS® surgery is a fundamental therapeutic step, although there is still insufficient evidence in the literature focusing on functional and rehabilitative outcomes. Therefore, more studies and guidelines are needed to define standardized rehabilitation protocols for clinical practice after orthopedic oncologic surgery.

A practical assessment protocol for clinically relevant P-glycoprotein-mediated drug-drug interactions.

Drug-drug interactions (DDIs) may influence the effectiveness and safety of medication treatment, which may require additional monitoring, dose adjustment or avoidance of certain drugs. DDIs involving P-glycoprotein (P-gp) affect many drugs, but current official product information is often insufficient to guide the management of these DDIs in clinical practice. The aim of this paper is to describe a protocol to assess DDIs involving P-gp and to develop and implement practice recommendations for clinically relevant P-gp-mediated DDIs that affect clinical outcomes through changes in systemic drug exposure. A combined literature review and expert opinion approach will be used according to the following seven steps: set up an expert panel (step 1), establish core concepts and definitions (step 2), select potential P-gp-modulators (i.e., P-gp-inducers and -inhibitors) and P-gp-substrates to be evaluated (step 3), select and extract evidence-based data, and present findings in standardized assessment reports (step 4), discuss and adopt classifications and practice recommendations with the expert panel (step 5), publish and integrate information and alerts in clinical decision support systems (CDSS) (step 6), (re)assessments of DDIs and potential new DDIs when new information is available or when initiated by healthcare providers (step 7). The expert panel will classify potential P-gp-modulators and -substrates as clinically relevant P-gp-inducer, -inhibitor and/or -substrate and draw conclusions about which combinations of classified modulators and substrates will lead to clinically relevant DDIs. This may include the extrapolation of conclusions for DDIs where limited or no data are available, based on the pharmacological characteristics of these drugs. For (potential) DDIs that are considered to be clinically relevant, practice recommendations will be developed. This protocol describes a standardized, evidence- and expert opinion-based assessment of P-gp-mediated DDIs that affect clinical outcomes. This approach will generate alerts with practice recommendations for clinically relevant DDIs and transparent rationales for DDIs that are considered to be irrelevant. These recommendations will improve individual patient care by supporting healthcare professionals to make consistent decisions on how to manage P-gp mediated DDIs.

MHealth Service Effects for Negative Emotions Among Parents of Preterm Infants: A Systematic Review and Meta-Analysis.

This review aims to ascertain the effects of mHealth on negative emotions among parents of preterm infants and analyze the current state of mHealth services in this context. Caring for preterm infants often engenders negative emotions in parents, such as anxiety, depression, and stress. Mobile Health (mHealth) services offer potential benefits for preterm infant care. However, there are several uncertainties regarding the impact of mHealth services on parental emotions. Randomized controlled trial (RCT) and quasi-RCT were published in English and Chinese until 2023 and are available in the electronic databases of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINHAHL), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Database, and China Science and Technology Journal Database were reviewed. Review Manager 5.4 was employed for random-effects meta-analysis. Seven RCTs and 6 quasi-RCTs with high risks were included, most of them were based on small sample size and single-centered. Meta-analysis demonstrated that mHealth interventions mitigated negative emotions, including anxiety (standard mean difference [SMD]=-1.07; 95% confidence interval [CI], -1.47 to -0.66; P<0.0001), depression (SMD=-1.94; 95% CI, -3.01 to -0.86; P<0.0001), and stress (SMD=-1.24; 95% CI, -2.07 to -0.40; P<0.0001), among parents of preterm infants. It is recommended to develop independent specialized software for mHealth, enhance theoretical underpinnings, and standardize practical protocols. Incorporating early recognition and screening of negative emotions within mHealth could offer comprehensive support for the mental health of parents with preterm infants. The mHealth-based interventions are needed to focus on the parents' emotional needs and minimize the impacts associated with mental stress.

Medical Emergencies in Dental Practice

Medical emergencies in Dental Practice:Abstract "In the middle of difficulty lies opportunity."– Albert Einstein.In the realm of dental practice, the presence of medical emergencies poses both challenges and opportunities for dental professionals.We will look into specific emergencies such as syncope,seizures, asthma attacks, allergic reactions, anaphylaxis, airway obstruction,diabetes-related issues, and cardiac emergencies. Each emergency will be discussed in terms of its occurrence in dental practice, underlying causes,symptoms, and effective treatment protocols. Two more important topics:Importance of history taking,Medico legal aspect of medical emergency in dental office will be seen.

The Effectiveness of a Self-Management and Multifactorial Program for Blood Pressure Control Among Older Home-Based Workers in Urban Bangkok, Thailand

Older adults aged between 50-65 years old have a high risk of hypertension. With the growing numbers of home-based workers among adults and older adults in Thailand, this study aimed to evaluate the effectiveness of self-management with a multifactorial program to control blood pressure among older adults. A randomized controlled trial was conducted. Participants who worked as home-based workers aged between 50-65 years old were recruited from a community in the western area of Bangkok. Approximately 70 participants were randomly and equally assigned to the intervention and control groups (35 participants in each group). Participants in the intervention group received the program that consisted of education regarding food selection, work time management and arm swinging; a practical protocol, an exercise program, a heart rate monitor, a recorded book for facilitating participants’ progress to ensure their safety and efficiency in a health professional manner for a week/month. While those in the control group received usual care. A Knowledge Attitude Practice questionnaire was utilized to assess their knowledge, attitude, and practice, which demonstrated a content validity index and Cronbach alpha of 0.80, respectively. The Citizen CH-403C was utilized to measure blood pressure and heart rate. Two-way Repeated Measures ANOVA was employed to analyze the differences in outcome scores at baseline, 3-month after program, and 6-month follow up. The results showed a significant increase in participant’s knowledge, attitudes, and behaviors toward hypertension and a decrease in blood pressure to nearly normal after 3months following the completion of the program and 6-month follow-up. Therefore, the self-management and multifactorial program could be an effective preventive intervention for older adults with pre-hypertension conditions to offer them valuable knowledge on work-life balance as well as to help prevent hypertension, and related stroke complications.

Synthesis of Sulfoxides by Palladium-Catalyzed Arylation of Sulfenate Anions with Aryl Thianthrenium Salts.

A novel and highly efficient Pd-catalyzed arylation of sulfenate anions with aryl thianthrenium salts is demonstrated. This procedure provides a practical protocol to synthesize various diaryl and alkyl aryl sulfoxides in moderate-to-good yields. The new approach shows mild reaction conditions, broad substrate scope, and good functional group tolerance.

Best practices guidelines in the postoperative management of patients who underwent cervical and lumbar fusions.

There is a lack of standardization in spine surgery in particular, as relates to postoperative care for the most common spine procedures such as cervical and lumbar fusions. The goal of this study was to develop a standardized postoperative treatment protocol for common spine procedures such as cervical and lumbar fusion to reduce unnecessary visits, imaging studies, and create a standard for all spine surgeons to adhere while maintaining quality. We developed a best practices protocol (BPP) for postoperative spine care for anterior cervical diskectomy and fusion (ACDF) and posterior lumbar interbody fusion (PLIF). We compared outcome to retrospective controls (pre-BPP) and a national database [Quality Outcomes Database (QOD)/American Spine Registry (ASR)]. Pre-BPP retrospective controls (n=1,010) were compared to patients enrolled in BPP (n=750). BPP reduced postoperative visits (POV) from 2,201 to 1,061 (52%). Total additional imaging studies computed tomography (CT) and magnetic resonance imaging (MRI) beyond standard X-ray were reduced from 192 studies to 57 (70%); 53% for lumbar fusion and 67% for cervical fusion. Comparing pre-BPP to BPP groups for complications, the number of adverse events was reduced by 52% overall; 45% for lumbar fusion, and 62% for cervical fusion. A subset of BPP patients (n=450) with available data were compared to a national registry QOD and ASR where lumbar and cervical fusion patients showed comparable less lengths of stay, lower 3-month complication rates and lower readmission rates. This is one of the first studies to standardize postoperative spine care as a first step towards creating uniformly accepted models for value-based care (VBC) in spine surgery.

A Prototype Model of Zero Trust Architecture Blockchain with EigenTrust-Based Practical Byzantine Fault Tolerance Protocol to Manage Decentralized Clinical Trials

The COVID-19 pandemic necessitated the emergence of decentralized Clinical Trials (DCTs) due to patient retention, accelerate trials, improve data accessibility, enable virtual care, and facilitate seamless communication through integrated systems. However, integrating systems in DCTs exposes clinical data to potential security threats, making them susceptible to theft at any stage, a high risk of protocol deviations, and monitoring issues. To mitigate these challenges, blockchain technology serves as a secure framework, acting as a decentralized ledger, creating an immutable environment by establishing a zero-trust architecture, where data are deemed untrusted until verified. In combination with Internet of Things (IoT)-enabled wearable devices, blockchain secures the transfer of clinical trial data on private blockchains during DCT automation and operations. This paper proposes a prototype model of the Zero-Trust Architecture Blockchain (z-TAB) to integrate patient-generated clinical trial data during DCT operation management. The EigenTrust-based Practical Byzantine Fault Tolerance (T-PBFT) algorithm has been incorporated as a consensus protocol, leveraging Hyperledger Fabric. Furthermore, the Internet of Things (IoT) has been integrated to streamline data processing among stakeholders within the blockchain platforms. Rigorous evaluation has been done for immutability, privacy and security, mutual consensus, transparency, accountability, tracking and tracing, and temperature‒humidity control parameters.

The hygienist's role in the management of the implant patient in primary care.

The scope of practice for dental hygienists includes the care of implants and peri-implant tissues. Hygienists in primary care settings must therefore be competent and confident in assessing, managing, and treating implant restorations and their peri-implant health. Dental hygienists also play a key role in the education of patients on oral health as part of their daily practice, a recognised and valued aspect of their clinical care responsibilities. Dental hygienists and therapists therefore have a pivotal role as adjunct support in a patient's implant journey where they can offer essential support throughout their treatment period and can provide guidance and education at regular intervals.Using current guidelines, dental hygienists and therapists can create and implement practice protocols to help deliver the necessary clinical care during pre-implant, peri-implant, and post-implant phases of care. This article discusses the processes required to achieve a healthy implant patient, how the dental team can support the patient, and how clinicians can work together to achieve the best possible clinical outcome. This article will explore current evidence-based guidance and how to implement guidance in a practice setting, with protocols for all members of the dental team, with the final goal of a dentally healthy, motivated patient.

A (Dis)orderly Progression: The Lasting Impact of Pandemic on Community-Based Organizations

ABSTRACT Community-based organizations (CBOs) serving older ethnic minority adults, especially older immigrants, are vital to satisfy their complex social, health, and behavioral health needs. This study uses organizational theories and a case study approach to examine how the organizational responses to the multifaceted impact of the COVID-19 pandemic and progress beyond the pandemic-related responses. Four CBOs serving older Chinese immigrants in New York City were examined. Results indicate that driven by unmet psychosocial needs of older Chinese immigrants and public health measures, CBOs modified practice protocols and established (or strengthened) collaborative relationships with medical providers and other CBOs. COVID-19 responses include CBOs’ transformations in organizational structures (e.g. collaboration) and operational activities (e.g. telehealth). Successful transformations of CBOs were primarily due to prior adaptiveness to integrated care reform and assured needed resources before the pandemic; the transformation reflected orderly organizational progress rather than a temporary management strategy.

Ni-Catalyzed Enantioselective Reductive Cyclization/Amidation and Amination of 1,6-Enynes and 1,7-Enynes.

Transition-metal-catalyzed hydroamination of unsaturated hydrocarbons is an appealing synthetic tool for the construction of high value-added chiral amines. Despite significant progress in the asymmetric hydroamination of alkenes, allenes, and 1,3-dienes, asymmetric hydroamination of 1,6-enynes or 1,7-enynes remains rather limited due to the enormous challenges in controlling the chemoselectivity and stereoselectivity of the reaction. Herein, we report a Ni-catalyzed chemo- and enantioselective reductive cyclization/amidation and amination of 1,6-enynes and 1,7-enynes using dioxazolones or anthranils as nitrene-transfer reagents. This mild, modular, and practical protocol provides rapid access to a variety of enantioenriched 2-pyrrolidone and 2-piperidone derivatives bearing an aminomethylene group at the 4-position in good yields (up to 83%) with excellent enantioselectivities (40 examples, up to 99% ee).Mechanistic experiments and density functional theory calculations indicate that the reaction is initiated by hydronickelation of alkynes followed by migratory insertion into alkenes, rather than by a [2+2+1] oxidative addition process of nickel to alkenes and alkynes.

Ni‐Catalyzed Enantioselective Reductive Cyclization/Amidation and Amination of 1,6‐Enynes and 1,7‐Enynes

Transition‐metal‐catalyzed hydroamination of unsaturated hydrocarbons is an appealing synthetic tool for the construction of high value‐added chiral amines. Despite significant progress in the asymmetric hydroamination of alkenes, allenes, and 1,3‐dienes, asymmetric hydroamination of 1,6‐enynes or 1,7‐enynes remains rather limited due to the enormous challenges in controlling the chemoselectivity and stereoselectivity of the reaction. Herein, we report a Ni‐catalyzed chemo‐ and enantioselective reductive cyclization/amidation and amination of 1,6‐enynes and 1,7‐enynes using dioxazolones or anthranils as nitrene‐transfer reagents. This mild, modular, and practical protocol provides rapid access to a variety of enantioenriched 2‐pyrrolidone and 2‐piperidone derivatives bearing an aminomethylene group at the 4‐position in good yields (up to 83%) with excellent enantioselectivities (40 examples, up to 99% ee). Mechanistic experiments and density functional theory calculations indicate that the reaction is initiated by hydronickelation of alkynes followed by migratory insertion into alkenes, rather than by a [2+2+1] oxidative addition process of nickel to alkenes and alkynes.

Bleached Hair as Standard Template to Insight the Performance of Commercial Hair Repair Products

The increasing demand for effective hair care products has highlighted the necessity for rigorous claims substantiation methods, particularly for products that target specific hair types. This is essential because the effectiveness of a product can vary significantly based on the hair’s condition and characteristics. A well-defined bleaching protocol is crucial for creating a standardized method to assess product efficacy, especially for products designed to repair damaged hair. The objective of this study was to create a practical bleaching protocol that mimics real-world consumer experiences, ensuring that hair samples exhibit sufficient damage for testing. This approach allows for a reliable assessment of how well various products can repair hair. The protocol serves as a framework for evaluating hair properties and the specific effects of each product on hair structure. Color, brightness, lightness, morphology, and topography were primarily used to understand the big differences in the hair fiber when treated with two repair benchmark products, K18® and Olaplex®, in relation to the Bleached hair. The devised bleaching protocol proved to be a fitting framework for assessing the properties of hair and the unique characteristics of each tested product within the hair fiber. This protocol offers valuable insights and tools for substantiating consumer claims, with morphological and mechanical methods serving as indispensable tools for recognizing and validating claims related to hair. The addition of K18® and Olaplex® demonstrated an increase in hair brightness (Y) and lightness (L* and a*) in relation to the Bleached samples, which were considered relevant characteristics for consumers. Olaplex®’s water-based nature creates a visible inner sheet, effectively filling empty spaces and improving the disulfide linkage network. This enhancement was corroborated by the increased number of disulfide bonds and evident changes in the FTIR profile. In contrast, K18®, owing to the lipophilic nature of its constituents, resulted in the formation of an external layer above the fiber. The composition of each of the products had a discrete impact on the fiber distribution, which was an outcome relevant to the determination of spreadability by consumers.

Using the RE-AIM and TDF frameworks to evaluate the implementation of a standardized cognitive assessment protocol in outpatient rehabilitation.

Impairments in cognition significantly affect patient functioning and rehabilitation outcomes. Assessment is essential to identifying at-risk individuals and guiding care plans. A cognitive assessment protocol was implemented in occupational therapy (OT) and speech-language pathology (SLP) outpatient practice. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and Theoretical Domains Framework (TDF), this study (1) measured the reach and adoption of the cognitive assessment protocol and (2) explored determinants and strategies that may affect adoption. Sequential mixed methods. Two outpatient rehabilitation clinics (A and B) within a health care network. Medical records from 220 adult patients with neurologic diagnosis and 15 OT and SLP clinicians. Cognitive assessment protocol. Reach of the assessment protocol across patient characteristics and adoption across clinical sites were measured quantitatively via retrospective electronic medical records review. Qualitative data on effectiveness and the implementation process were collected via clinician focus groups. Protocol adoption rates were 71% and 54% at clinics A and B, respectively. Site B OT was more likely to be noncompliant with protocol adoption compared to Site A, when controlling for patient characteristics, (81% vs. 16%, respectively; odds ratio = 11.4, 95% confidence interval [3.36-38.64], p ≤ .001). Patient age was a significant factor for protocol reach; older age was associated with noncompliance of the SLP protocol adoption, p < .05. Both sites employed implementation strategies targeting the provider level (eg, education/training); Site A additionally included organization-level strategies (eg, leadership engagement). In the absence of organization-level strategies, OT and SLP clinicians at Site B identified barriers related to leadership support, resources, and workflow. Standardized practice protocols are feasible to implement within the rehabilitation setting, though multilevel implementation strategies may be needed to promote adoption. Aligning practices with the needs, values and priorities of the organization, providers, and patients and families is imperative.

Lung Involvement in Systemic Sclerosis—From Pathogenesis to Prediction

Systemic sclerosis (SSc) is a rare, multifactorial autoimmune disease characterized by widespread vascular damage and fibrosis. Pulmonary involvement is a significant manifestation of SSc, contributing to considerable morbidity and mortality. Therefore, identifying reliable biomarkers is of the utmost importance. This review explores emerging biomarkers to enhance diagnostic accuracy, prognostic assessment, and disease monitoring in SSc lung involvement. We discuss recent findings in immunological biomarkers, inflammatory indicators, and other parameters that can function as potential diagnostic and prognostic tools. A comprehensive understanding of these biomarkers could result in earlier and more accurate detection of pulmonary complications in SSc, aiding in timely intervention. Furthermore, we explore the advances in disease monitoring through innovative biomarkers, focusing on their roles in disease activity and treatment response. Integrating these novel biomarkers into current clinical practice and therapeutic protocols through clinical trials can revolutionize the management of SSc-related lung disease, ultimately improving patient outcomes and quality of life.

Intravenous Low-Dose Cyclophosphamide Pulses Followed by Rituximab for Ocular Mucous Membrane Pemphigoid.

Cyclophosphamide (CyP) is the immunosuppressive agent of choice in ocular MMP. However, guidelines do not specify the regimen modality of CyP treatment. We introduce our practical management protocol for ocular MMP utilizing fixed-low dose intravenous pulses of CyP followed by IV rituximab, accompanied by two case studies in elderly patients who achieved complete and enduring remissions without adverse effects.

Use of Mental Practice to Reduce Severe Upper Extremity Hemiparesis: A Pilot Study

Abstract Date Presented 03/22/24 This study examined the efficacy and feasibility of a mental practice protocol to address severe upper extremity hemiparesis. The results suggest that mental practice is an efficacious, appropriate, and feasible intervention for this population. Primary Author and Speaker: Teresa M. Green Additional Authors and Speakers: Farida S. Gayle Contributing Authors: Asha Vas

Beamforming design for Star-RIS assisted secure wireless communication system under hardware impairments

Simultaneous transmission and reflection reconfigurable intelligent surface (Star-RIS) has been recently introduced as one of the hopeful technologies in future communications. In this work, we investigate a beamforming design for Star-RIS-assisted secure wireless communications with two practical protocols, namely energy splitting (ES) and mode switching (MS). We assume that our transceivers are not ideal and have residual hardware impairments that lead to distortion noise. We aim to maximize the total secrecy rate by optimizing the beamforming in BS and Star-RIS under the limitation of transmission power consumption. The proposed non-convex optimization problem is solved via successive convex approximation and alternating optimization.

Visible-Light-Mediated Azidation of α-Diazoesters with TMSN3 via Direct Photoexcitation and SH2 Mechanism.

A visible light-mediated azidation of α-diazoesters with TMSN3 to synthesize valuable α-azidoesters has been developed. Without using any catalysts and additives, the reaction proceeded smoothly under visible light irradiation at room temperature. A variety of α-diazoesters were successfully converted to the desired α-azidoesters, showing good functional group tolerance. The products could be readily transformed into triazole, α-azidoacid, and α-azidoamide. Mechanistic studies suggested that the reaction is mainly carrying out via direct photoexcitation and SH2 mechanism. This work provides a novel, mild, and practical protocol for synthesizing α-azidoesters.

Health and well-being of refugee women in sex work: A systematic literature review

Introduction: Refugees face many barriers when arriving in a new country, and these barriers are especially felt by women, who often travel alone or with children. These barriers create a situation where some women turn to sex work, either voluntarily or involuntarily. Both refugees and sex workers face adversities related to their mental health and well-being, however little research has examined the intersections between both identities outside of STI incidence and violence. Objective: This systematic literature review aimed to explore mental health and overall well-being of women refugees who engage in sex work. Themes were extracted to better understand experiences to inform clinical and community practice. Methods: A systematic literature review was conducted using PsycInfo, CINAHL, Scopus, Web of Science, PubMed, Google Scholar, ProQuest, and Medline, as well as grey literature for articles published between 2013 and 2023. The JBI Critical Appraisal Checklist for Qualitative Research was used to evaluate the quality of the primary research articles. 11 articles were included in the final synthesis. Results: The five themes included Fear, Mental/Psychological Health, Social Well-being, Economic/Financial Well-being, and Spiritual Struggles. These themes were interconnected to shape the experiences of these women within their circumstances. Engaging in sex work as a refugee, particularly in instances of sex trafficking, created significant challenges in all aspects of well-being, and the circumstances related to being a refugee often increased vulnerabilities to become involved in sex work for survival. Conclusion: These results suggest the need for policies, community programs, and clinical practice protocols to address the unique needs of women refugees to mitigate factors drawing them to sex work, and better support those who are currently involved in it.