Procedural Guidelines Research Articles

Nuclear medicine procedure guideline for sentinel lymph node localization

The authors present a procedure guideline for scintigraphic detection of sentinel lymph nodes in malignant melanoma, in breast cancer, in penile and vulva tumors, in head and neck cancer, and in prostate carcinoma. Important goals of sentinel lymph node scintigraphy comprise reduction of the extent of surgery, lower postoperative morbidity and optimization of histopathological examination focussing on relevant lymph nodes. Sentinel lymph node scintigraphy itself does notdiagnose tumorous lymph node involvement and is not indicated when lymph node or distant metastases have been definitely diagnosed before sentinel lymph node scintigraphy. Procedures are compiled with the aim to reliably localise sentinel lymph nodes with a high detection rate typically in early tumour stages. New aspects in this guideline are new radiopharmaceuticals such as tilmanocept and Tc-99m-PSMA and SPECT/CT allowing an easier anatomical orientation. Initial dynamic lymphoscintigraphy in breast cancer is of little significance nowadays. Radiation exposure is low so that pregnancy is not a contraindication for sentinel lymph node scintigraphy. A one-day protocol should preferentially be used. Even with high volumes of scintigraphic sentinel lymph node procedures surgeons, theatre staff and pathologists receive a radiation exposure < 1 mSv/year so that they do not require occupational radiation surveillance. Aspects of quality control were included (scintigraphy, quality control of gamma probe, 6 h SLN course for surgeons, certified breast centers, medical surveillance center).

Non-compliance of Hospital X Employee in Implementing Standard Operational Procedures of Instrument Decontamination and Chest X-Ray Services

Good hospital management is important to maintain the safety of patients, staff and hospital visitors. Each hospital employee responsible for patient safety by carrying out work according Standard Operating Procedure (SOP) guidelines agreed by organization. This study aims to identify the casues factors and the solution for hospital employees to not comply with the SOP. This study uses a qualitative descriptive approach. Methods of data collection by conducting direct observation and interviews. Subjects in the study were determined based on purposive sampling, as many as 8 respondents consisting of the inpatient room's head, nurses and radiology officers. It is important to apply a system approach in the management of an organization. The elements included in the systems approach are planning, organizing, actuating and controlling. From those elements, there are things that not properly carried in the hospital. The existing procedures were not followed by the employees, for example, procedures regarding instrument decontamination in the inpatient room and photo reading at the radiology service. Non-compliance with this procedure is influenced by several factors, namely the staff lack of discipline and responsibility, inappropriate procedures, facilities that are not available, and there is no socialization of the procedure to hospital employees. The non-compliance of employees at X hospital was caused by procedural factors, decontamination and radiology officer's performance factors and hospital's facilities. For this reason, it is necessary to conduct periodic outreach, monitoring and evaluation of the SOP and hospital employees to improve the quality of hospital services and customer satisfaction.

Validation of EPG/SAG Rev. 4 of the Kuosheng Nuclear Power Plant Using the MAAP5 Code

The Boiling Water Reactor Owner’s Group released Emergency Procedure Guidelines and Severe Accident Guidelines Revision 4 (EPG/SAG Rev. 4) in 2018. The major improvement to EPG/SAG Rev. 4 was Contingency 1 (Alternate Level/ Pressure Control). Contingency 1 coordinates the reactor pressure vessel (RPV) water level and RPV pressure control action to prolong the availability of steam-driven injections and optimize the transfer to motor-driven systems. In this study, the effectiveness of the EPG/SAG Rev. 4 Contingency 1 strategy was compared with those of EPG/SAG Revision 2 Contingency 1 and Specific Major Incident Guidelines (SMI) using the Modular Accident Analysis Program, Version 5 (MAAP5). SMI was developed by the Taiwan Power Company to mitigate a Fukushima-like accident. The surrogate plant that analyzed is the Kuosheng Nuclear Power Plant (NPP). The Kuosheng NPP is BWR-6 Mark-III containment. MAAP5 is an integral severe accident analysis program that simulates the responses of a light water reactor power plant during a severe accident. This program has been used extensively for probabilistic risk assessments and for verification and validation of mitigation actions specified in severe accident management guidelines. The simulation scenarios were extended loss of alternative-current power and loss of ultimate heat sink. The low-capacity, motor-driven portable pump was the only available system for RPV injection in the first hour of the accident. In this time period, the RPV water level and pressure were controlled by reactor core isolation cooling and safety relief valves. After this study, the strategy of EPG/SAG Rev. 4 Contingency 1 was successfully validated, and the effectiveness of minimum pre-depressurization RPV water level and the low-capacity, motor-driven portable pump were also demonstrated in this study.

Developing a Data-Driven AI Model to Enhance Energy Efficiency in UK Residential Buildings

Residential buildings contribute 30% of the UK’s total final energy consumption. However, with less than one percent of its housing stock being replaced annually, retrofitting existing homes has significant importance in meeting energy-efficiency targets. Consequently, many physics-based and data-driven models and tools have been developed to analyse the effects of retrofit strategies from various points of view. This paper aims to develop a data-driven AI model that predicts buildings’ energy performance based on their features under various retrofit scenarios. In this context, four different machine learning models were developed based on the EPC (Energy Performance Certificate) dataset for residential buildings and standard assessment procedure (SAP) guidelines in the UK. Additionally, an interface was designed that enables users to analyse the effect of different retrofit strategies on a building’s energy performance using the developed AI models. The results of this study revealed the artificial neural network as the most accurate predictive model, with a coefficient of determination (R2) of 0.82 and a mean percentage error of 11.9 percent. However, some conceptual irregularities were observed across all the models when dealing with different retrofit scenarios. All summary, such tools can be further improved to offer a potential alternative or support to physics-based models, enhancing the efficiency of retrofitting processes in buildings.

Implementing the EU HTA regulation: Insights from semi-structured interviews on patient expectations, Belgian and European institutional perspectives, and industry outlooks.

Introduction: The goal of the Health Technology Assessment (HTA) Regulation 2021/2282 is to establish a more harmonized HTA framework, fostering member states cooperation and enabling equal patient access to innovative health technologies in Europe. This research aimed to assess the impact of the regulation on national HTAs, the strategic implications for health technology developers, and its influence on price and reimbursement negotiations. Methods: A scoping literature review encompassing peer-reviewed literature as well as grey literature was conducted. Between February and March 2023, semi-structured interviews (n = 20) were performed with stakeholders from Belgian governmental institutions, European institutions, advanced therapy medicinal product developers, academics, and sickness funds. The interviews were analyzed using the framework analysis method. Results: Numerous steps, such as the development of implementing acts and procedural guidelines remain to be taken. At member state level, national/regional HTA bodies and payers must act to adopt the new concepts of Joint Scientific Consultations (JSC) and Joint Clinical Assessments (JCA) within their national legislation, as well as revise their timelines and prepare for interactions at a European level. Compiling a harmonized PICO (Population, Intervention, Comparator, and Outcome), adapting local procedures, and increasing capacity to actively take part in the JSC and JCA are seen as primary barriers by several stakeholders. Training and education will help HTA bodies, payers, and health technology developers to participate in the European processes. Conclusion: While practical and legal challenges were identified, recommendations (such as actively preparing for the upcoming changes and increasing capacity while providing training) were provided to adapt national and European procedures to the needs of the HTA Regulation 2021/2282. The importance of fostering collaborations and aligning local HTA procedures with the new way of working set out by the Regulation was demonstrated with this study.

Framework to Quantify Uncertainty in Microplastic Concentrations in Wastewaters and Sludges Incorporating Analytical Recovery Information into Data Analysis.

Wastewater treatment plants (WWTPs) serve a pivotal role in transferring microplastics (MPs) from wastewater to sludge streams, thereby exerting a significant influence on their release into the environment and establishing wastewater and biosolids as vectors for MP transport and delivery. Hence, an accurate understanding of the fate and transport of MPs in WWTPs is vital. Enumeration is commonly used to estimate concentrations of MPs in performance evaluations of treatment processes, and risk assessment also typically involves MP enumeration. However, achieving high accuracy in concentration estimates is challenging due to inherent uncertainty in the analytical workflow to collect and process samples and count MPs. Here, sources of random error in MP enumeration in wastewater and other matrices were investigated using a modeling approach that addresses the sources of error associated with each step of the analysis. In particular, losses are reflected in data analysis rather than merely being measured as a validation step for MP extraction methods. A model for addressing uncertainty in the enumeration of microorganisms in water was adapted to include key assumptions relevant to the enumeration of MPs in wastewater. Critically, analytical recovery, the capacity to successfully enumerate particles considering losses and counting error, may be variable among MPs due to differences in size, shape, and type (differential analytical recovery) in addition to random variability between samples (nonconstant analytical recovery). Accordingly, differential analytical recovery among the categories of MPs was added to the existing model. This model was illustratively applied to estimate MP concentrations from simulated data and quantify uncertainty in the resulting estimates. Increasing the number of replicates, counting categories of MPs separately, and accounting for both differential and nonconstant analytical recovery improved the accuracy of MP enumeration. This work contributes to developing guidelines for analytical procedures quantifying MPs in diverse types of samples and provides a framework for enhanced interpretation of enumeration data, thereby facilitating the collection of more accurate and reliable MP data in environmental studies.

Opiate-reduction protocol for common outpatient spinal procedures: a long-term feasibility study and single-center experience.

The opioid epidemic continues to be at the forefront of public health. As a response to this crisis, many statewide and national medical groups have sought to develop opioid-prescribing guidelines for both acute and chronic pain states. Given the lack of evidence in the neurosurgical landscape, the authors' institution implemented opioid-prescribing guidelines for common outpatient spinal procedures in 2017, subsequently demonstrating a significant reduction in the narcotics prescribed. However, the ability to maintain the results garnered from such guidelines long term has not been described. The objective of this study was to evaluate postoperative opioid utilization at a high-volume quaternary referral center 5 years after the initial implementation of an opioid-reduction protocol for common outpatient spinal procedures. From the electronic medical records, authors collected data on the number of tablets and total morphine equivalent dose (MED) prescribed, acute postoperative readmissions for pain concerns, refill requests, and conversion to long-term opiate use in the 5 years following implementation of an opioid-reduction protocol for common outpatient spinal procedures. These procedures, undertaken in opiate-naive patients, included 1- or 2-level anterior cervical discectomy and fusion, 1- or 2-level cervical disc replacement, and 1- or 2-level laminectomy, laminotomy, or foraminotomy (cervical or lumbar). The total quantity of narcotics was reduced by 37.0 tablets per patient after protocol implementation and over the 5-year period thereafter. Generally, patients were discharged with an average of 23.3 tablets, concurrent with the initial goal of 24 tablets, set forth in 2017. These results confirm an ongoing reduction in opiate quantities prescribed and overall morphine equivalent totals at the time of discharge over the course of 5 years after initial protocol implementation. A standardized discharge protocol for postoperative outpatient spinal procedures can lead to long-term reductions in opioid discharge quantity, without compromising patient safety or increasing the utilization of hospital resources through readmissions, refill requests, or clinic phone calls. This study provides an example of a feasible and effective discharge prescription regimen that may be generalizable to common outpatient neurosurgical procedures with long-term evidence that a small intervention can lead to ongoing reduced quantities of postoperative opioids at the time of discharge.

Why do marionette lines appear? Exploring the anatomical perspectives and role of thread-based interventions.

The pathogenesis of marionette lines involves a complex interplay of anatomical, physiological, and age-related factors leading to the development of wrinkles around the oral commissures. This exploration delves into the distinct anatomical predispositions observed among different ethnicities, emphasizing the role of compact modiolus structures and muscle compositions. Notably, individuals of East Asian descent exhibit inherent facial structures that predispose them to pronounced sagging around the oral commissures during aging. The emergence of distinct facial lines, such as the commissural line and the melolabial fold, contributes to the formation of marionette lines. This specific wrinkle pattern, resembling a marionette puppet's mouth contours, is influenced by various factors like bone resorption, gravitational forces, fat compartment variations, muscle compression, ligament tethering, and skin aging. Treatment strategies for marionette lines encompass diverse interventions, including filler injections, botulinum neurotoxin, surgeries targeting fat reduction, thread lifting, and volumizing fillers. These approaches aim to address the underlying causes and mitigate the appearance of marionette lines. Botulinum neurotoxin injections, for instance, weaken specific facial muscles, reducing downward strain and aiding in tissue retraction. Anatomical considerations during procedures are crucial to avoid nerve or vascular damage. Delicate manipulation and precise entry points are essential to prevent inadvertent injuries, particularly concerning blood vessels like the facial artery and nerves like the mental nerve. Technical guidelines for procedures targeting marionette lines involve specific techniques like cogged thread reverse methods and volumizing thread placements. Attention to entry points, tissue engagement, and the direction of threads is crucial for effective treatment outcomes, minimizing complications, and ensuring patient safety.

Applications of digital twin technology in construction safety risk management: a literature review

PurposeWith increasing complexity of construction projects and new construction processes and methods are adopted, more safety hazards are emerging at construction sites, requiring the application of the modern risk management methods. As an emerging technology, digital twin has already made valuable contributions to safety risk management in many fields. Therefore, exploring the application of digital twin technology in construction safety risk management is of great significance. The purpose of this study is to explore the current research status and application potential of digital twin technology in construction safety risk management.Design/methodology/approachThis study followed a four-stage literature processing approach as outlined in the systematic literature review procedure guidelines. It then combined the quantitative analysis tools and qualitative analysis methods to organize and summarize the current research status of digital twin technology in the field of construction safety risk management, analyze the application of digital twin technology in construction safety risk management and identify future research trends.FindingsThe research findings indicate that the application of digital twin technology in the field of construction safety risk management is still in its early stages. Based on the results of the literature analysis, this paper summarizes five aspects of digital twin technology's application in construction safety risk management: real-time monitoring and early warning, safety risk prediction and assessment, accident simulation and emergency response, safety risk management decision support and safety training and education. It also proposes future research trends based on the current research challenges.Originality/valueThis study provides valuable references for the extended application of digital twin technology and offers a new perspective and approach for modern construction safety risk management. It contributes to the enhancement of the theoretical framework for construction safety risk management and the improvement of on-site construction safety.

Dupuytren's Disease: A Review with a Surgical Approach

One prevalent fibroproliferative hand disorder is Dupuytren's disease (DD). Observation, non-operative management, and operative management are the three types of DD management. Percutaneous needle fasciotomy (PNF), open fasciotomy (OF), injections of Clostridium collagenase histolyticum (CCH), limited fasciectomy (LF), and dermofasciectomy are examples of operative therapies (DF). A overview is given of the many approaches to treating DD. This page outlines the many DD treatment methods, their advantages and disadvantages, and procedural guidelines.

Mapping Ethical Artificial Intelligence Policy Landscape: A Mixed Method Analysis

As more national governments adopt policies addressing the ethical implications of artificial intelligence, a comparative analysis of policy documents on these topics can provide valuable insights into emerging concerns and areas of shared importance. This study critically examines 57 policy documents pertaining to ethical AI originating from 24 distinct countries, employing a combination of computational text mining methods and qualitative content analysis. The primary objective is to methodically identify common themes throughout these policy documents and perform a comparative analysis of the ways in which various governments give priority to crucial matters. A total of nineteen topics were initially retrieved. Through an iterative coding process, six overarching themes were identified: principles, the protection of personal data, governmental roles and responsibilities, procedural guidelines, governance and monitoring mechanisms, and epistemological considerations. Furthermore, the research revealed 31 ethical dilemmas pertaining to AI that had been overlooked previously but are now emerging. These dilemmas have been referred to in different extents throughout the policy documents. This research makes a scholarly contribution to the expanding field of technology policy formulations at the national level by analyzing similarities and differences among countries. Furthermore, this analysis has practical ramifications for policymakers who are attempting to comprehend prevailing trends and potentially neglected domains that demand focus in the ever-evolving field of artificial intelligence.

Emergency Management of Vastivyapath with Oral Administration of Kamadudharasa

Vasti is one among the most widely used therapeutic procedures in Ayurveda especially in neurological and degenerative diseases. Proper guidelines for Panchakarma procedures are laid out in the classics for better outcome and minimal complications. Till date, the guidelines hold value and current practices revolve around the same. Though there are plenty of insights into the benefits of Vasti, minimal information is available about the complications and management. This case report is an attempt to understand how the administration of a Kashaya vasti in a known case of lumbar spondylosis resulted in complication and managed with oral administration of Kamadudharasa. A 64 year old male patient with primary complaint of low back ache developed pain and burning sensation per abdomen after giving Erandamooladi niruhavasti. He went to a state of confusion. Initial management was done using Dhanvantaram gutika, which failed to revive the patient. A single dose of Kamadudha rasa was administered sublingually following which he regained consciousness. This was followed by a reduction in the burning sensation and the patient felt better. On detailed analysis, it was found that the patient had a history of gastritis and was on medication for the same. The Teekshna guna of Erandamuladi vasti probably worsened the state of Pitta in his Koshta and lead to the complications such as Sula, Daha and Moha. A detailed understanding of the selection of the right type of Niruha vasti is necessary for better outcomes. This brings our attention to the importance of Sameekshya bhava and how it plays an important role in deciding the outcome of Panchakarma procedures. Failure to do so may result in Vyapath/complications.

Evaluation dilemmas: Lessons learned in improving intervention outcomes and sustainability in Latin American communities

AbstractA significant number of studies on program evaluations in Latin America have limited, if any, information on procedures, impact, and sustainability. Scholarly work emphasizes how evaluation designs must be deeply cognizant of socioeconomic, ecological, and resource contexts to be effective. The purpose of this article is to bring together research findings from three types of knowledge centered on evaluation processes and practices for working within Latin American countries. A scan of the empirical literature, expert interviews, and a case study are triangulated to assess the barriers and impacts of program evaluations in economically disadvantaged Latin American countries. We conclude by describing long‐standing principles and guidelines for evaluation procedures to promote community engagement and human capital development in all evaluation collaborations. Lessons learned reinforce the tenets of culturally responsive evaluation (CRE) procedures as critical to reproduce interventions that improve the lives of communities. Equity, contextual knowledge, and equal partnership are driving forces in centering social problems and developing human capital and the betterment of community conditions in our partnering countries.

Use of Direct Oral Anticoagulants Among Patients With Hip Fracture Is Not an Indication to Delay Surgical Intervention.

To compare outcomes in patients on direct oral anticoagulants (DOACs) treated within 48 hours of last preoperative dose with those with surgical delays >48 hours. Retrospective cohort study. Three academic Level 1 trauma centers. Patients 65 years of age or older on DOACs before hip fracture treated between 2010 and 2018. Patients were excluded if last DOAC dose was >24 hours before admission, patient suffered from polytrauma, and/or delay to surgery was not attributed to DOAC. Primary outcome measures were the postoperative complication rate as determined by diagnosis of deep venous thrombosis or pulmonary embolus, wound breakdown, drainage, or infection. Secondary outcomes included transfusion requirement, perioperative bleeding, length of stay, reoperation rates, readmission rates, and mortality. Two hundred five patients were included in this study, with a mean cohort age of 81.9 years (65-100 years), 64% were (132/205) female, and a mean Charlson Comorbidity Index of 6.4 (2-20). No significant difference was observed among age, sex, Charlson Comorbidity Index, or fracture pattern between cohorts (P > 0.05 for all comparisons). Seventy-one patients had surgery <48 hours after final preoperative DOAC dose; 134 patients had surgery >48 hours after. No significant difference in complication rate between the 2 cohorts was observed (P = 0.30). Patients with delayed surgical management were more likely to require transfusion (OR 2.39, 95% CI, 1.05-5.44; P = 0.04). Patients with early surgical management had significantly shorter lengths of stay (5.9 vs. 7.6 days, P < 0.005). There was no difference in estimated blood loss, anemia, reoperations, readmissions, 90-day mortality, or 1-year mortality (P > 0.05 for all comparisons). Geriatric patients with hip fracture who underwent surgical management within 48 hours of their last preoperative DOAC dose required less transfusions and had decreased length of stay, with comparable mortality and complication rates with patients with surgery delayed beyond 48 hours. Providers should consider early intervention in this population rather than adherence to elective procedure guidelines. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Septoplasty and Nasal Packs From Otolaryngologists' Perspectives: A Cross-Sectional Survey.

Introduction Septoplasty is a commonly performed surgery by otolaryngologists. This study examines the routine use of non-absorbable nasal packs in the postoperative period in Kuwait. Our aim is to assess the views of otolaryngologists in Kuwait regarding the routine use of non-absorbable nasal packing after septoplasty with or without turbinoplasty. Materials and methods A cross-sectional study, an anonymous survey, consisting of 10 questions, using Google Forms was conducted. It was distributed via WhatsApp and in person hard copies to otolaryngologists - head and neck surgeons in Kuwait. Data were securely stored and analyzed using Stata (StataCorp LLC, College Station, Texas) software. Results Fifty participants have completed the survey. The majority were routinely performing septoplasty for a symptomatic deviated nasal septum (n= 47, 94%). Out of those, 43% (n = 21) usually use silastic splints to prevent postoperative complications, including bleeding, hematoma formation, and adhesions. The use of quilting sutures for the same purpose was done by 21% (n = 10), and 17% (n = 8) used non-absorbable nasal packs. Only two participants believed that no specific intervention was required. More than half used postoperative nasal packs in the case of intra-operative bleeding (n=26, 52%), while 18% (n = 9) believed that it is only necessary in selected cases with predisposing factors to bleeding. Ninety-two percent (n = 46) thought that pain and discomfort were associated with the use of non-absorbable nasal packs, and 50% (n = 25) believed that it could cause hemodynamic instability. Moreover, 66% (n = 33) agreed that quilting or trans-septal sutures can safely substitute nasal packs following septoplasty. Awareness of recent updates on the complications related to nasal packing varied, with more than half of the otolaryngologists being knowledgeable (n = 29, 58%). Discussion Septoplasty, a common surgical intervention for correcting a misaligned nasal septum, addresses various symptoms, such as nasal obstruction, obstructive sleep apnea, epistaxis, and headache. While the practice of nasal packing for 24-48 hours post-septoplasty is widespread, it remains a topic of controversy. Current literature supports the continued use of nasal packing for patients at high risk of bleeding. However, potential drawbacks, including increased pain, headache, and prolonged hospital stay, raise concerns about its overall benefits. An alternative approach, utilizing quilting sutures without nasal packs, has shown promising results in comparative studies, demonstrating less pain and minimal bleeding. Additionally, trans-septal sutures emerge as a safe alternative, minimizing dead space and reducing post-operative complications. Conclusion It appears that otolaryngologists in Kuwait have diverse opinions with regard to nasal packing following septoplasty. Further research is needed to establish evidence-based guidelines for this common procedure.

An Evaluation of Gastric Emptying Scintigraphy Protocols in Health Care Institutions When Compared with the Society of Nuclear Medicine and Molecular Imaging Procedure Guidelines.

This study aimed to analyze the compliance of health care institutions with the Society of Nuclear Medicine and Molecular Imaging (SNMMI) procedure guidelines for gastric emptying scintigraphy (GES). Methods: A 19-question survey on demographics and the GES protocol was conducted using a Google form. The demographic questions covered position, number of technologists in the department, location, type of health care institution, and number of GES studies per month. The protocol questions included patient preparation, meal preparation, withholding of scheduled medications, radiopharmaceutical type, and radiopharmaceutical dose. The survey was sent to 7 nuclear medicine Facebook groups and a list of clinical affiliates provided by the Indiana University School of Medicine Nuclear Medicine Program. Descriptive statistics were compiled for most questions. A Fisher exact test with a significance level of 0.05 was used to compare the type of health care institution with compliance with the SNMMI GES protocol regarding radiolabeling time, meal preparation, and meal components, as well as to compare the type of health care institution with the number of GES studies performed per institution. Results: In total, 240 people responded to the survey. Most were nonsupervisory nuclear medicine technologists (72%) in nonacademic institutions (72%) and groups with 4 or more technologists (62%). Of the respondents, 72% followed the SNMMI guideline of adding the radiopharmaceutical before cooking, but only 37% followed the meal component guideline. There was no significant association between the type of institution or the number of GES studies and compliance with radiolabeling time or with meal preparation or components. Most respondents asked patients to withhold medications per SNMMI guidelines and used the recommended radiopharmaceutical (99mTc-sulfur colloid, 95%) at the recommended dose (18.5-37 MBq, 84%). Conclusion: Although most respondents followed most aspects of the SNMMI guidelines for GES, more than half did not use the recommended meal of liquid egg whites. Compliance did not vary between academic and nonacademic institutions or between groups performing a large or a small number of GES studies.

Longevity of dental restorations in Sjogren’s disease patients using electronic dental and health record data

BackgroundDecreased salivary secretion is not only a risk factor for carious lesions in Sjögren’s disease (SD) but also an indicator of deterioration of teeth with every restorative replacement. This study determined the longevity of direct dental restorations placed in patients with SD using matched electronic dental record (EDR) and electronic health record (EHR) data.MethodsWe conducted a retrospective cohort study using EDR and EHR data of Indiana University School of Dentistry patients who have a SD diagnosis in their EHR. Treatment history of patients during 15 years with SD (cases) and their matched controls with at least one direct dental restoration were retrieved from the EDR. Descriptive statistics summarized the study population characteristics. Cox regression models with random effects analyzed differences between cases and controls for time to direct restoration failure. Further the model explored the effect of covariates such as age, sex, race, dental insurance, medical insurance, medical diagnosis, medication use, preventive dental visits per year, and the number of tooth surfaces on time to restoration failure.ResultsAt least one completed direct restoration was present for 102 cases and 42 controls resulting in a cohort of 144 patients’ EDR and EHR data. The cases were distributed as 21 positives, 57 negatives, and 24 uncertain cases based on clinical findings. The average age was 56, about 93% were females, 54% were White, 74% had no dental insurance, 61% had public medical insurance, < 1 preventive dental visit per year, 94% used medications and 93% had a medical diagnosis that potentially causes dry mouth within the overall study cohort. About 529 direct dental restorations were present in cases with SD and 140 restorations in corresponding controls. Hazard ratios of 2.99 (1.48–6.03; p = 0.002) and 3.30 (1.49–7.31, p-value: 0.003) showed significantly decreased time to restoration failure among cases and positive for SD cases compared to controls, respectively. Except for the number of tooth surfaces, no other covariates had a significant influence on the survival time.ConclusionConsidering the rapid failure of dental restorations, appropriate post-treatment assessment, management, and evaluation should be implemented while planning restorative dental procedures among cases with SD. Since survival time is decreased with an increase in the number of surfaces, guidelines for restorative procedures should be formulated specifically for patients with SD.

Glucagon-Like Peptide-1 Receptor Agonists During Electroconvulsive Therapy: Case Report With Evolving Concerns and Management Considerations.

Glucagon-like peptide-1 receptor agonists are an emerging class of medications transforming the management of diabetes mellitus and obesity, two highly prevalent and chronic medical conditions associated with significant morbidity and posing serious public health concerns. Although generally well tolerated and relatively safe to use, case reports of patients taking these medications while undergoing elective procedures with general anesthesia describe a potential heightened risk of regurgitation and pulmonary aspiration of gastric contents, deriving from the delayed gastric emptying effect of these agents. Based on increased recognition of this risk, the American Society of Anesthesiologists convened a task force to review available data, resulting in the promulgation of a new procedural management guideline for patients on these drugs and undergoing elective procedures with general anesthesia. However, this guideline pertains mostly to procedures and situations that are distinct from electroconvulsive therapy (ECT). This case report describes the experience of a patient on semaglutide, a glucagon-like peptide-1 receptor agonist for obesity, undergoing ECT, provides a general overview of this novel drug class, identifies issues specific to ECT management, and suggests potential adaptations to patient care over different phases of ECT practice.

Problems with Adults Following Ultrasound-Guided Percutaneous Nephrostomy. A retrospective study

Background: Obstructive uropathy, which represents 10% of acute renal failure, calls for effective remedies. Percutaneous nephrostomy (PCN) is increasingly used in the treatment of obstructions in the renal collecting system. This Institute of Kidney Diseases study from the city of Peshawar in Pakistan now remedies a lack of knowledge in adult PCN guided by ultrasonography. Objectives: With this retrospective survey we wanted to know which patients are suitable candidates for PCN; what is the success rate; and how often complications arise using PCN that is guided by the use of ultrasound technology. Methods: We did a retrospective analysis in the Institute of Kidney Diseases, Peshawar, of those persons who had ultrasound-guided PCN for obstructive uropathy from January 5, 2022 to December 31, 2023. Data were from the Department of Urology registrations and HIS Records. Subjects must be over 16 years old. Exclusion criteria were incomplete records, pregnancy, and non-obstructive uropathy indications: those things should not have made it into the sample!IBM SPSS was used to do data analysis. Results: There were 851 patients included in the study; the average age was 38.50 ± 14.78 years. Successful PCN installs were achieved in 96.1% of cases, 67 patients had to go through multiple trials. Complications occurred in 18.9% of cases, mostly mild (17.6%), occasionally severe (1%) headaches. The most common complications were macroscopic hematuria (6.9%), PCN dislodgment (1.9%), and block the tube (1.8%). Statistical analysis showed associations between complications and demographic factors, such as age, gender, number of attempts. Conclusion: Ultrasound-guided percutaneous nephrostomy (PCN) is safe and effective in the treatment of obstructive uropathy. These findings contribute to improving treatment protocols and procedural guidelines at the Institute of Kidney Diseases, Peshawar, with urinary stones as the main etiology.

Kitab Kuning dan Pesantren: Peran MA Baitussalam Melestarikan Warisan Intelektual

Kitab kuning viewed as theory and values contributor that followed al-Quran and Hadis Nabi as a background. In pesantren world, kitab kuning position are very strategic because it used as text book, references, and curriculum within pesantren education system. Aside from being religion procedure guideline, kitab kuning also functioned as universalreferences on responding every life challenge among pesantren people. This writing presents the results of research on the tradition of reading "kitab kuning" (yellow books) in Islamic boarding schools (Pondok Pesantren). The research employed a data collection method involving the reading and interpretation of various models of learning "kitab kuning" in pesantren, with a particular focus on observing Islamic Boarding School Baitussalam. The findings of this research indicate that the tradition of learning to read "kitab kuning" is still ongoing in Pondok Pesantren. The in-depth study and learning models of "kitab kuning" have become distinctive features in developing literacy and scholarly references in the world of pesantren. Classic texts, commonly known as "kitab kuning," play a crucial role in advancing the teachings of Islam. This underscores the importance of studying these yellow books. Islamic scholars have compiled these teachings into uniquely yellow-colored books, which are studied in Madrasahs and Pondok Pesantren. These books contain Islamic knowledge, particularly in the field of Islamic jurisprudence (Fikih), and are written or printed in Arabic script, using Arabic or Malay, Javanese, Sundanese, and other languages.