Relative Benefits Research Articles

Dapagliflozin and Timing of Prior Heart Failure Hospitalization: A Patient-Level Meta-Analysis of DAPA-HF and DELIVER

BackgroundPatients recently hospitalized for heart failure (HF) are at a higher risk of adverse clinical outcomes, but they may experience a greater absolute and relative benefit from effective therapies than individuals who are considered more “stable.” ObjectivesThe authors examined the effects of dapagliflozin according to the timing of prior HF hospitalization in a patient-level pooled analysis of DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) and DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure). MethodsA total of 11,007 patients were randomized in DAPA-HF and DELIVER. The primary outcome was the composite of worsening HF or cardiovascular death. ResultsIn total, 12.4% were hospitalized for HF within 3 months of randomization, 14.2% between 3 and 12 months, and 16.8% more than 1 year before randomization, whereas 56.5% had not been hospitalized. The risk of the primary endpoint was inversely associated with time from prior HF hospitalization, and patients with a recent HF hospitalization had the highest risk. Compared with placebo, dapagliflozin reduced the risk of the primary outcome across HF hospitalization category (0-3 months, HR: 0.66 [95% CI: 0.55-0.81]; 3-12 months, HR: 0.73 [95% CI: 0.59-0.90]; >1 year, HR: 0.91 [95% CI: 0.74-1.12]; and no prior hospitalization, HR: 0.83 [95% CI: 0.73-0.94]; Pinteraction = 0.09). The number of patients needed to treat with dapagliflozin to prevent 1 event over the median follow-up of 22 months was 13, 20, 23, and 28, respectively. The beneficial effect was consistent across the range of LVEF regardless of HF hospitalization category. ConclusionsThe relative benefits of dapagliflozin were consistent across the range of LVEF regardless of the timing of the most recent HF hospitalization with a greater absolute benefit in patients with recent hospitalization.

Comparing Glycopyrronium/Formoterol Combination Therapy With Monotherapy in Moderate-to-Severe Chronic Obstructive Pulmonary Disease (COPD): A Narrative Review.

Chronic obstructive pulmonary disease (COPD) imposes a significant burden on individuals and healthcare systems globally. While bronchodilators, such as glycopyrronium and formoterol, are cornerstone therapies for COPD management, combining these agents has gained attention for potentially improving outcomes compared to monotherapy. This comprehensive review aims to assess the efficacy and safety of glycopyrronium/formoterol (GFF) combination therapy versus glycopyrronium monotherapy in patients with moderate-to-severe COPD. Through a systematic evaluation of clinical trials and real-world evidence, we analyze the impact of combination therapy on lung function, symptom control, exacerbation rates, and health-related quality of life (HRQoL). Furthermore, we examine the safety profile of combination therapy, including adverse cardiovascular and respiratory events. Comparative analyses with glycopyrronium monotherapy provide insights into the relative benefits and considerations for treatment selection. Factors influencing treatment choice and future directions in COPD management are also discussed. This review underscores the potential of combination therapy in optimizing COPD treatment outcomes and highlights areas for further research and clinical practice refinement.

Hydroprocessing of fossil fuel-based aviation kerosene – Technology options and climate impact mitigation potentials

Aviation contributes about 4 % of global anthropogenic climate forcing primarily by contrails, CO2 and NOx emissions. Renewably sourced aviation kerosene can help to reduce the climate impact from CO2 and from contrails, but so far, its production capacities are very small. Hence, the climate impact of using fossil fuel-based kerosene with a hydrogen content increased by hydroprocessing as short term mitigation measure is studied here. Therefore, the change in net energy forcing (ΔEFnet) in 2019 is calculated as the sum of the change in contrail energy forcing (ΔEFcontrail) and additional CO2 emissions (ΔEFhydroprocessing) from aviation kerosene hydroprocessing (ΔEFnet = ΔEFcontrail + ΔEFhydroprocessing). The results show that hydroprocessed aviation kerosene can reduce the net energy forcing EFnet by about 33 % with ΔEFhydroprocessing penalty of 5 %-points. Increasing the hydroprocessing severity increases the relative climate benefit, which is only slightly affected by the emissions factor for hydroprocessing or the choice of the time horizon. Data limitations about fuel composition and its effect on contrails and climate cause considerable uncertainties and the fuel's compliance with specification standards needs consideration. This study on the climate effect of hydroprocessed fossil kerosene can help to assess near-term measures to reduce the climate impact from aviation.

Food providers and public health professional’s experiences with the adoption and implementation of the National Healthy Food and Drink Policy in New Zealand healthcare facilities

Publicly-funded healthcare facilities in Australia(1) and New Zealand(2) have adopted healthy food and drink policies to enable staff and visitors to choose and consume healthier options. However, adopting such policies does not translate to their full implementation and compliance by food providers, who face barriers to providing healthier food and drinks(3). As part of the wider HealthY Policy Evaluation (HYPE) study, we interviewed hospital food providers and public health dietitians/professionals to understand their experiences implementing the voluntary National Healthy Food and Drink Policy introduced in New Zealand in 2016. Semi-structured interviews focused on the awareness, understanding of, and attitudes towards the Policy; level of support received; perceived customer response; tools and resources needed to support implementation; and unintended or unforeseen consequences. All semi-structured interviews were transcribed verbatim, inductively coded with the assistance of QSR’s NVivo software, and analysed using the reflexive thematic analysis method by Braun and Clarke(4). Twelve participants from across New Zealand were interviewed. Time in their roles ranged from one to 14.5 years, and many were not in the position when the Policy was first adopted. There was a discrepancy in the awareness of the voluntary Policy. However, there was agreement that hospitals should be healthy eating role models for the wider community. Reflexive thematic analysis identified three themes relating to the implementation of the Policy in New Zealand: 1) complexities of operating food outlets under the Policy in hospitals; 2) adoption, implementation and monitoring of the Policy as a series of incoherent ad-hoc actions; and 3) the Policy as (currently) not achieving the desired impact. Participants recognised that the current food supply, presence of food outlets nearby hospitals serving unhealthy foods and culture of unhealthy eating, combined with the difficulty of changing people’s eating habits, leaves doubts if the Policy and healthier options served in the healthcare facilities have any tangible positive impact on staff or visitors. Key suggestions to promote successful Policy implementation included adoption of a mandatory National Policy, funding of central government support for implementation (including supportive implementation tools), regular and systematic monitoring of food availability in each region, and frequent and ongoing communication with staff and visitors using positive messaging around healthy eating and non-health related benefits (e.g. sustainability) to increase their buy-in. Findings from stakeholder interviews and the remaining parts of the HYPE evaluation study are informing the update of the National Policy and associated supportive tools, and highlight the potential positive impact a comprehensive policy evaluation could have on improving policy implementation.

A Network Meta-analysis of the Efficacy of Drug Therapy in First-line Treatment of Advanced Hepatocellular Carcinoma.

Systemic therapy is mainly recommended for advanced hepatocellular carcinoma (HCC). Considering the variety of treatments available for HCC, there is a need to understand their relative benefits and risks, especially for the newly approved combination of immune checkpoint inhibitors and vascular endothelial growth factor inhibitors represented by atezolizumab in combination with bevacizumab. A reticulated meta-analysis was used to evaluate the efficacy and safety of atezolizumab-bevacizumab combination therapy compared with other first-line systemic therapies for the treatment of patients advanced HCC. PubMed, The Cochrane Library, Web of Science, and Embase databases were searched from the time of library construction to 01 December 2022, and the data were extracted and analyzed using Stata16.0 for Meta-analysis. The data were extracted separately, and a meta-analysis was performed using the software Stata16.0. 16 clinical studies with 8,779 subjects were identified from 13,417 records and were used to build the evidence network for all trials. TThe combination therapy of atezolizumab and bevacizumab has the advantage of prolonging the OS of patients when treating advanced HCC [HR=5.71, 95%CI (4.30, 7.12), p<0.05] Also, the combination therapy has the advantage of prolonging the patient's progression free survival [HR=1.60, 95%CI (0.89, 2.49), p<0.05]. Atezolizumab-bevacizumab combination therapy can improve clinical outcomes such as OS and PFS in patients with advanced HCC.

Mindfulness and creative process engagement: the mediating role of workplace relational systems

PurposeDespite widespread recognition of the importance of mindfulness in organizational science literature, little is known about how mindfulness motivates individuals to configure information processing and team member exchange relationships to increase creative process engagement. Drawing on motivated information processing theory, this study conceptualizes and empirically examines whether and how mindfulness motivates individuals toward creative process engagement.Design/methodology/approachThe authors collected data through an online survey from 311 respondents working in the Research and Development (R&D) departments of organizations in multiple industries in Pakistan. For analytical purposes, the authors have applied the structural equation modeling technique.FindingsThis study advances a different view of individual mindfulness on the creative process engagement in the following ways. First, mindfulness enables individuals to self-regulate in specific situations and become effective in fostering creative process engagement. Second, this study extends research on relational information processing by linking it to mindfulness and creative process engagement. Relational information processing partially mediates the relationship between mindfulness and creative process engagement. Third, this study highlights that mindfulness motivates individuals to focus more on developing quality working relationships, but they seem less willing to participate in idea generation and problem-solving solutions.Originality/valueThe study findings provide implications for research on mindfulness, creativity and motivated information processing to enhance individuals’ creative process engagements. The authors also discuss the implications for executives on the relational and creative benefits of mindfulness.

Primary cytoreductive surgery compared with neoadjuvant chemotherapy in patients with BRCA mutated advanced high grade serous ovarian cancer: 10 year survival analysis

ObjectivesGiven the high response to platinum based chemotherapy in BRCA 1/2 mutated high grade serous ovarian cancers, there is uncertainty about the relative benefits of primary cytoreductive surgery versus neoadjuvant...

Impact of Lifting Straps on the Relationship Between Maximum Repetitions to Failure and Lifting Velocity During the Prone Bench Pull Exercise.

Fastest mean (MVfastest) and peak (PVfastest) velocity of the set have been proposed to predict the maximum number of repetitions to failure (RTF) during the Smith machine prone bench pull (PBP) exercise. Goodness-of-fit would be higher for individualized compared with generalized RTF-velocity relationships and comparable for both execution equipment conditions (with or without straps), and the MVfastest and PVfastest associated with each RTF would be comparable between execution equipment and prediction methods (multiple- vs 2-point method). Cross-sectional study. Level 3. After determining the PBP 1-repetition maximum (1RM), 20 resistance-trained male athletes performed 2 sessions randomly, with and without lifting straps, consisting of single sets to failure against the same load sequence (60% to 80% to 70% 1RM). Generalized (pooling data from all subjects) and individualized (separately for each subject using multiple-point or 2-point methods) RTF-velocity relationships were constructed. Individualized RTF-velocity relationships were always stronger than generalized RFT-velocity relationships, but comparable with (MVfastest: r2 = 0.87-0.99]; PVfastest: r2 = 0.88-1.00]) and without (MVfastest: r2 = 0.82-1.00; PVfastest: r2 = 0.89-0.99]) lifting straps. The velocity values associated with each RTF were comparable between execution equipment (P ≥ 0.22), but higher for the multiple-point compared with the 2-point method (P < 0.01). The use of lifting straps during the Smith machine PBP exercise does not affect the goodness-of-fit of the RTF-velocity relationships or the velocity values associated with different RTFs. However, caution should be exercised when using different methods. The benefits of the RTF-velocity relationships can be extrapolated when using lifting straps, and the 2-point method can also be used as a quick and more fatigue-free procedure. Nevertheless, it is imperative for coaches to ensure that these relationships are reflective of fatigue experienced during training.

Exploring the digital psychology of environmental sustainability: the mediating influence of technological innovation in advanced physical education development in China”

The study aims to investigate the precise processes by which the advancement of physical education and technological progress leads to ecological conservation efforts within China’s distinctive socio-cultural and economic framework. Acknowledging the pivotal role that economic advancement plays in a nation’s environmental sustainability, this research utilizes cross-sectional quantitative data gathered using a five-point Likert scale survey. The sample size included 503 undergraduate students from Zhengzhou, China, and structural equation modeling was utilized to analyze the data. The study investigates how technology progress influences the relationship between compatibility, environmental sustainability, and the relative benefits of physical education. It fills the gap in the literature by illuminating how technical innovation and advanced physical education development contribute to China’s pursuit of a sustainable environment. The findings emphasize the critical significance of higher physical education in fostering environmental sustainability. Furthermore, the research indicates that students participating in more rigorous physical education programs tend to possess a more well-rounded and mature mindset. This mindset is essential for healthy and long-lasting mental development, motivating individuals to critically consider environmental sustainability. The study provides valuable theoretical and practical insights that can be applied to enhance environmental sustainability in the country.

Identification of minimum thresholds for dietary self-monitoring to promote weight-loss maintenance.

Reduced schedules of dietary self-monitoring are typically recommended after the end of behavioral weight-loss programs; however, there exists little empirical evidence to guide these recommendations. We explored potential thresholds for dietary self-monitoring during a 9-month maintenance period following a 3-month weight-loss program in 74 adults with overweight or obesity (mean [SD] age = 50.7 [10.4] years, BMI = 31.2 [4.5] kg/m2) who were encouraged to self-monitor weight, dietary intake, and physical activity daily and report their adherence to self-monitoring each week via a study website. Greater self-monitoring was correlated with less weight regain for thresholds of ≥3 days/week, with the largest benefit observed for thresholds of ≥5 to ≥6 days/week (all p < 0.05); significant weight gain was observed for thresholds of ≥1 to ≥2 days/week, whereas no change in weight was observed for thresholds of ≥3 to ≥4 days/week, and weight loss was observed with thresholds of ≥5 or more days/week. Results demonstrate that self-monitoring at least 3 days/week may be beneficial for supporting long-term maintenance, although greater benefit (in relation to weight loss) may be realized at thresholds of 5 to 6 days/week. Future research should investigate whether individuals who were randomized to self-monitor at these different thresholds demonstrate differential patterns of weight-loss maintenance.

Tree abundance, species richness, or species mix? Exploring the relationship between features of urban street trees and pedestrian volume in Jinan, China

Accumulating evidence has confirmed that urban greenery, especially street trees, is beneficial to walking behaviors. Existing street greenery exposure-walking behavior studies have focused on the quantity of greenery, which is often measured by normalized difference vegetation index (NDVI) or green view index (GVI). However, some important qualities of street trees, the dominant component of urban greenery, were often overlooked, due to the labor-intensive and expensive nature of on-site surveys. To address this issue, we proposed a cutting-edge deep learning technique to identify street tree species at the individual tree level. We established a citywide dataset of all street trees with species information via 185,831 Baidu Street View images (BSV) in Jinan, China. Population-level walking intensity, measured by pedestrian volume, was retrieved from BSV images using Baidu AI. We further adopted spatial regression models to investigate the association between pedestrian volume and street tree characteristics, including street tree abundance (number of street trees), species richness (number of unique tree species) and species mix (the degree of diversity of tree species). The built environment and urban greenery covariates were adjusted in the models. The results indicate that the street tree abundance and species mix are positively associated with pedestrian volume. Species richness is not associated with it. Besides, spatial mismatch is identified between abundance and species mix of street trees in the study area. Hence, to facilitate walking behavior and deliver related health benefits, it is necessary to develop fine-grained measures of street greenery features.

Mobile money and financial inclusion in Africa: Emerging themes, challenges and policy implications

Mobile money is purported to promote financial inclusion. The growing number of studies have largely focused on transactions and related benefits with limited attention to emerging challenges, policies and initiatives that address the relative needs of different stakeholders. Consequently, little has been done to probe the ‘bottom-of-the-pyramid’ paradigm that underpins these assumptions. There has been inadequate endeavour to examine ways that empirical research could shed more light on these challenges and how to overcome them. To address these gaps, this study reviews the emerging literature on mobile money that explores both benefits and challenges. From our study three main themes emerge that suggest areas where challenges to the efficacy of the mobile money-financial inclusion link still appears not to have been adequately addressed by policymakers: ensuring integrity, privacy and security; addressing resource and infrastructure constraints; and integrating stakeholder benefits. Yet we suggest merely addressing these challenges does not go far enough in safeguarding the needs of local communities, as major stakeholders. Evidence from our study suggests little direct benefit to the poorer sections of local communities, only to the strata above and to elites and external stakeholders. This has implications for development and social change through technology adoption.

Acceptance and use of condoms among school-aged young people in Australia.

Despite availability of vaccines or medical prophylaxis for some sexually transmissible infections (STIs), promoting condom use remains an important public health strategy for the prevention of STIs. Recent research shows that regular condom use among young people in Australia has declined over the past decade, while the rate of common STIs has increased. In this paper, we report findings from a large survey of school-aged young people in Australia (14-18years old) in which we looked at the association between condom use and positive feelings about sex, beliefs about social acceptability of condoms and confidence talking with partners about sex and condoms. Communication and relational factors supported more consistent condom use. Participants were more likely to regularly use condoms if they discussed condom use with a sexual partner, perceived condom use to be easy (a measure that included perceived ease of discussing condoms with a partner) and perceived condom use to offer social or relational benefits, including perceiving condom use as a demonstration of care for a partner. Young men were more likely to report positive feelings about sex and regular condom use than young women. Young women were less likely than young men or trans and non-binary young people to report regular condom use. The study shows the importance of supporting young people to build confidence expressing sexual needs and wants with partners. Public health approaches to STI prevention need to consider condom promotion in the context of young people's contemporary sexual, gendered and relationships cultures.

Abstract MP22: Age-Varying Implications of Recalibration of Cardiovascular Disease Risk Prediction in a New England-Based Healthcare System

Introduction: Atherosclerotic cardiovascular disease (ASCVD) risk estimation via the 2013 Pooled Cohort Equations (PCE) overestimates risk in population-based cohorts. We evaluated its recalibration performance in a contemporary healthcare cohort. Methods: We identified 160,926 patients in the Mass General Brigham healthcare system aged 40-79 years and without prior ASCVD or lipid-lowering medication use between 2010 and 2012. Recalibration was achieved using sex- and race-specific baseline survival and risk factor distributions of the derivation (80%) set. Internal validation compared Kaplan-Meier-adjusted observed and predicted risk based on original versus recalibrated PCE. Changes in sensitivity and specificity were calculated across various treatment thresholds for each age decile. Results: Of the 160,926 patients (mean [SD] age: 54.6 [8.6] years; 61.4% female; 82.7% non-Hispanic White), 20,373 (12.7%) underwent ASCVD over 10 years. The original PCE underestimated ASCVD risk (observed vs. predicted incidence rate: 0.13 vs. 0.05) globally and across all sex, race, and risk categories. After recalibration (observed vs. predicted incidence rate: 0.13 vs. 0.18), the prediction closely mirrored the actual ASCVD incidence in low-to-borderline risk but overestimated risk in the high risk. At ≥7.5% treatment threshold, patients aged 40-49 years derived the greatest net relative benefit (sensitivity: +42.9%; specificity: -26.6%) whereas the extent of specificity loss surpassed that of sensitivity gain beyond age 50 years with minimal reclassification by seventh decade in life. Treatment threshold yielding the greatest net benefit was incrementally higher with older age from ≥7.4% in age 40-49 years to ≥24.1% in 60-69 years. Conclusion: In healthcare setting, PCE significantly underestimated risk. Recalibration recovered sensitivity at the expense of reduced specificity in age-differential manner, highlighting the need for individualized prediction and clinical decision-making.

Does progress in microfracture techniques necessarily translate into clinical effectiveness?

Multitudinous advancements have been made to the traditional microfracture (MFx) technique, which have involved delivery of various acellular 2nd generation MFx and cellular MFx-III components to the area of cartilage defect. The relative benefits and pitfalls of these diverse modifications of MFx technique are still not widely understood. To comparatively analyze the functional, radiological, and histological outcomes, and complications of various generations of MFx available for the treatment of cartilage defects. A systematic review was performed using PubMed, EMBASE, Web of Science, Cochrane, and Scopus. Patients of any age and sex with cartilage defects undergoing any form of MFx were considered for analysis. We included only randomized controlled trials (RCTs) reporting functional, radiological, histological outcomes or complications of various generations of MFx for the management of cartilage defects. Network meta-analysis (NMA) was conducted in Stata and Cochrane's Confidence in NMA approach was utilized for appraisal of evidence. Forty-four RCTs were included in the analysis with patients of mean age of 39.40 (± 9.46) years. Upon comparing the results of the other generations with MFX-I as a constant comparator, we noted a trend towards better pain control and functional outcome (KOOS, IKDC, and Cincinnati scores) at the end of 1-, 2-, and 5-year time points with MFx-III, although the differences were not statistically significant (P > 0.05). We also noted statistically significant Magnetic resonance observation of cartilage repair tissue score in the higher generations of microfracture (weighted mean difference: 17.44, 95% confidence interval: 0.72, 34.16, P = 0.025; without significant heterogeneity) at 1 year. However, the difference was not maintained at 2 years. There was a trend towards better defect filling on MRI with the second and third generation MFx, although the difference was not statistically significant (P > 0.05). The higher generations of traditional MFx technique utilizing acellular and cellular components to augment its potential in the management of cartilage defects has shown only marginal improvement in the clinical and radiological outcomes.

Parenteral Anticoagulation at First Medical Contact Improves Infarct Related Artery Patency in STEMI.

(1) Background: Acute ST-segment elevation myocardial infarction (STEMI) remains one of the main morbidity and mortality contributors worldwide. Its main treatment, primary percutaneous coronary intervention (pPCI), can only be performed with a high anticoagulation regimen, usually with heparin. There is still not enough evidence regarding the timing of heparin administration. (2) Methods: We conducted a multicenter observational study of 614 consecutive STEMI patients treated between 2017 and 2019. We split the population in two groups: one that received heparin at the first medical contact, as early as possible, and the second group that received heparin at the PCI capable center or in the cath lab. (3) Results: There was a significantly higher rate of infarct-related artery (IRA) patency at the time of the coronary angiogram in the pre-transfer heparin group than in the on-site heparin group, 44.7% vs. 37.3%, p = 0.042. Also, the early heparin group received shorter and wider stents. There was no difference in bleeding rates or in the in-hospital and two-year mortality rates. (4) Conclusions: Early administration of heparin leads to a higher rate of reperfusion in the IRA, before pPCI, with significant related benefits, such as better stent implantation parameters, without increased bleeding rates.

Вопросы теории и практики стимулирования бизнеса посредством института страховых взносов

Due to the need to develop certain types of commercial and industrial activities, the state is on the path of permanent search and optimization of tools and methods for such development. A special place among them is given to tax incentives as a system that provides attractive business conditions, including by reducing insurance premium rates. As a result, there is an increasing need for scientific substantiation of the processes of using tax incentives for business. The article examined the rules establishing the use of benefits in relation to individual payers of insurance premiums, which made it possible to discover the peculiarities of tax incentives for these subjects. The positions available in legal science on the issues of work were also studied. The conclusion about the need for further legislative reform of tax incentives for individual business entities is substantiated. You should also take into account the long-term results of applying benefits on insurance premiums associated with the further development of the IT technology market and the increase in the number of small and medium-sized businesses.

Technology-supported cooperative learning as a universal mental health intervention in middle and high school.

Adolescent mental health issues are a major public health concern, highlighted by the US Surgeon General as a crisis. Traditional school-based interventions show inconsistent success, creating a demand for effective solutions. This study evaluates the impact of technology-supported cooperative learning (CL) on adolescent mental health, focusing on positive peer relations and peer victimization. Participants included 813 adolescents (50.2% female; 70.7% White) from 12 middle and high schools in the Pacific Northwest. The study used hierarchical linear modelling (HLM) to assess the effectiveness of CL facilitated via PeerLearning.net. Implementing CL led to significant improvements in peer relations and reductions in victimization and mental health problems, with moderate-to-large effect sizes observed across different demographics. Positive peer relations significantly predicted lower victimization and improved mental health. The findings highlight the potential of technology-supported CL in addressing adolescent mental health by enhancing protective factors and reducing risks. Such interventions offer a scalable and sustainable approach for schools to address mental health challenges. Technology-supported cooperative learning offers a promising strategy for improving adolescent mental health, demonstrating significant benefits in peer relations and reducing victimization. This approach provides schools with an accessible and effective tool to tackle the mental health crisis among students.

On-the-Job Learning: Bright Spots of Governmental Public Health Employee Reflections on the COVID-19 Response.

This article is one of 3 research briefs that highlight valuable experiences and opportunities that can be thought of as "bright spots" of the governmental public health workforce's pandemic response. Using PH WINS 2021 data, we qualitatively examined responses to an open-ended survey question about workforce experiences during the pandemic response. On-the-job learning was emphasized as a critical component of employees' experiences. Seven "on-the-job learning" subthemes were identified among 91 responses. Findings indicate that the pandemic facilitated opportunities for on-the-job learning for various skills and workplace activities. Public health employees were appreciative of the opportunity to gain new technical and practical skills including communicating with the public and to experience new roles and responsibilities. Respondents reported other related benefits including career growth and leadership opportunities. Highlighting these unexpected benefits of the COVID-19 pandemic is important for employee morale and continued workforce development planning.

Cisternal nicardipine for prevention of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a comparative retrospective cohort study

PurposeIntrathecal vasoactive drugs have been proposed in patients with aneurysmal subarachnoid hemorrhage (aSAH) to manage cerebral vasospasm (CV). We analyzed the efficacy of intracisternal nicardipine compared to intraventricular administration to a control group (CG) to determine its impact on delayed cerebral ischemia (DCI) and functional outcomes. Secondary outcomes included the need for intra-arterial angioplasties and the safety profile.MethodsWe performed a retrospective analysis of prospectively collected data of all adult patients admitted for a high modified Fisher grade aSAH between January 2015 and April 2022. All patients with significant radiological CV were included. Three groups of patients were defined based on the CV management: cisternal nicardipine (CN), ventricular nicardipine (VN), and no intrathecal nicardipine (control group).ResultsSeventy patients met the inclusion criteria. Eleven patients received intracisternal nicardipine, 18 intraventricular nicardipine, and 41 belonged to the control group. No cases of DCI were observed in the CN group (p = 0.02). Patients with intracisternal nicardipine had a reduced number of intra-arterial angioplasties when compared to the control group (p = 0.03). The safety profile analysis showed no difference in complications across the three groups. Intrathecal (ventricular or cisternal) nicardipine therapy improved functional outcomes at 6 months (p = 0.04) when compared to the control group.ConclusionAdministration of intrathecal nicardipine for moderate to severe CV reduces the rate of DCI and improved long-term functional outcomes in patients with high modified Fisher grade aSAH. This study also showed a relative benefit of cisternal over intraventricular nicardipine, thereby reducing the number of angioplasties performed in the post-treatment phase. However, these preliminary results should be confirmed with future prospective studies.