Retrospective Evaluation Research Articles

TCD-Guided management in carotid endarterectomy: a retrospective study

BackgroundːStroke, primarily resulting from ischemic conditions, is the foremost cause of mortality and long-term impairment and is frequently associated with narrowing of the carotid arteries. Although carotid endarterectomy (CEA) is the treatment of choice, it carries the risk of cerebral ischemia and reduced blood flow. Transcranial Doppler (TCD) ultrasound offers a nonintrusive method to assess cerebral blood circulation during CEA, potentially enhancing surgical outcomes. The objective of this study was to assess the clinical utility and safety of TCD monitoring during CEA and to identify factors influencing postoperative complications.MethodsThis retrospective analysis included 158 CEA patients (from January 2021–August 2023) who underwent TCD monitoring and whose data were compared to historical standard care data. The primary outcomes were operation duration and artery occlusion time. Secondary outcomes included carotid shunt usage, seven-day postoperative complications, and six-month carotid artery patency. Logistic regression identified factors linked to adverse reactions, and a predictive model was evaluated with a receiver operating characteristic (ROC) curve.ResultsːComparative analysis indicated significant reductions in both the duration of surgery (113.26 ± 7.29 min) and artery occlusion time (21.85 ± 2.92 min) for patients monitored with TCD (P < 0.001) and an increase in carotid shunt implementation (25% as opposed to traditional care). The observed postoperative complications were minor, with a nonsignificant trend that favored the use of TCD-monitored procedures (1% vs. historical rates). Factors such as patient age and plaque echogenicity were found to be predictive of postoperative issues, with plaque echogenicity emerging as a significant predictive factor (OR = 10.70, 95% CI: 2.14–202, P = 0.02) upon multivariate analysis. The predictive model exhibited high precision (AUC = 0.93).ConclusionThis retrospective evaluation suggested that TCD monitoring in the CEA may reduce procedural time and potentially decrease postoperative complications, supporting its use for personalized surgical planning.

When are predictions useful? A new method for evaluating epidemic forecasts

BackgroundCOVID-19 will not be the last pandemic of the twenty-first century. To better prepare for the next one, it is essential that we make honest appraisals of the utility of different responses to COVID. In this paper, we focus specifically on epidemiologic forecasting. Characterizing forecast efficacy over the history of the pandemic is challenging, especially given its significant spatial, temporal, and contextual variability. In this light, we introduce the Weighted Contextual Interval Score (WCIS), a new method for retrospective interval forecast evaluation.MethodsThe central tenet of the WCIS is a direct incorporation of contextual utility into the evaluation. This necessitates a specific characterization of forecast efficacy depending on the use case for predictions, accomplished via defining a utility threshold parameter. This idea is generalized to probabilistic interval-form forecasts, which are the preferred prediction format for epidemiological modeling, as an extension of the existing Weighted Interval Score (WIS).ResultsWe apply the WCIS to two forecasting scenarios: facility-level hospitalizations for a single state, and state-level hospitalizations for the whole of the United States. We observe that an appropriately parameterized application of the WCIS captures both the relative quality and the overall frequency of useful forecasts. Since the WCIS represents the utility of predictions using contextual normalization, it is easily comparable across highly variable pandemic scenarios while remaining intuitively representative of the in-situ quality of individual forecasts.ConclusionsThe WCIS provides a pragmatic utility-based characterization of probabilistic predictions. This method is expressly intended to enable practitioners and policymakers who may not have expertise in forecasting but are nevertheless essential partners in epidemic response to use and provide insightful analysis of predictions. We note that the WCIS is intended specifically for retrospective forecast evaluation and should not be used as a minimized penalty in a competitive context as it lacks statistical propriety. Code and data used for our analysis are available at https://github.com/maximilian-marshall/wcis.

Sex matters: Differences in prodromes, clinical and neuropsychological features in individuals with a first episode mania or psychosis

ObjectiveThis study was aimed at identifying sex differences in patients presenting a first episode mania (FEM) or psychosis (FEP) to help shaping early treatment strategies focused on sex differences. MethodsPatients with a FEM or FEP underwent a clinical, neuropsychological (neurocognitive functions and emotional intelligence) and functional assessment. Performance on those variables was compared between groups through general linear model, with sex and group (FEM vs FEP) as main effects and group by sex interactions. ResultsThe total sample included 113 patients: FEM = 72 (45.83 % females) and FEP = 41 (46.34 % females). There were significant main effects for group (not for sex) for most of the clinical features (depressive, negative and positive symptoms) and psychosocial functioning (χ2 = 8.815, p = 0.003). As for neuropsychological performance, there were significant main effects for sex and group. Females performed better than males in verbal memory (χ2 = 9.038, p = 0.003) and obtained a higher emotional intelligence quotient (χ2 = 13.20, p < 0.001). On the contrary, males obtained better results in working memory (χ2 = 7.627, p = 0.006). FEP patients significantly underperformed FEM patients in most cognitive domains. There were significant group by sex interactions for few neuropsychological variables, namely processing speed (χ2 = 4.559, p = 0.033) and verbal fluency (χ2 = 8.913, p = 0.003). LimitationsDifferences between sexes were evaluated, but the influence of gender was not considered. Retrospective evaluation of prodromes and substance use. No healthy control group comparator. ConclusionThe main finding is the presence of significant sex effect and group by sex interaction on specific neurocognitive cognition and emotional intelligence measures. Tailored sex-based early treatment strategies might be implemented.

Clinical application of photoacoustic imaging for cervical precursor lesion detection.

Early diagnosis of a precursor lesion in the uterine cervix is an essential factor in uterine cervical cancer prevention. Although colposcopy is an established procedure for detecting high-risk patients, its accuracy and reproducibility are relatively low. Some supportive or alternative techniques to improve the early diagnosis of a precursor lesion have been studied, and correct diagnosis with high reliability using a minimally invasive, cost-effective technique has been pursued. This study aimed to examine the possibility of using photoacoustic (PA) imaging as a supportive technique to improve the accuracy of early diagnosis of cervical precursor lesions. A PA imaging system for microvessels was used to detect angiogenesis in severe lesions. A total of 21 patients who underwent surgical treatment and 114 outpatients who visited our colposcopy clinic were examined. A retrospective evaluation of PA images was performed as follows: (i) pathological assessment of the specific PA findings and (ii) retrospective evaluation of the severe lesion detection rate through PA. PA image evaluation and pathological findings showed dense angiogenesis in a severe precursor lesion appearing as a "hot spot" in the PA image. A comparison with colposcopy findings was performed for accuracy evaluation, and the detection rate of severe lesions using PA was relatively high (positive predictive value, 84.5%; negative predictive value, 82.1%). Our results indicate the possibility of using PA imaging for early diagnosis of severe cervical precursor lesions. With its ability to yield quantitative information, PA imaging can improve ultrasound diagnosis.

Predictors of the development of abnormal patterns of circadian blood pressure rhythm in patients with hypertension after a new coronavirus infection

Objective. To determine the predictors of the development of abnormal patterns of circadian blood pressure (BP) rhythm in patients with arterial hypertension (AH) after a new coronavirus infection (NСVI). Materials and methods. The study is a comparative clinical research of the same patients with hypertension before and after NCVI with retrospective evaluation of the data. Within 2 years from 842 patients with cardiovascular risk factors, according to the inclusion and non-inclusion criteria 70 patients with target levels of office BP, home monitoring and 24-hour blood pressure monitoring (ABPM) on the background of a continuous antihypertensive therapy were included in the study. Abnormal patterns of circadian BP were recorded after NCVI during ABPM in all of them. All patients with hypertension underwent a complete examination before and after NCVI. Results. After NCVI in patients with AH who had achieved the target ranges of office BP before its development, at home measurement and ABPM against the background of continuous antihypertensive therapy with high adherence to treatment, in more than 50 % of patients BP readings were not in the target values, in more than 50 % of the examined patients, BP variability was higher than the permissible values, in 73 % of patients the average daily BP was above 53 mm Hg. Abnormal patterns of circadian BP rhythm in patients with hypertension after NCVI were detected in 61.5 %: "Non-dipper" in 28.6 %; "Night-dipper" – in 21.9 %, masked nocturnal hypertension – in 17.1 %. Conclusion. The indicative significance of the development of abnormal patterns of circadian BP rhythm in patients with hypertension after NCVI was demonstrated by 3 qualitative indicators: glomerular filtration rate with cystatin C 60 ml/min/1.73 m2, cardio-ankle vascular index (CAVI) ≥ 9, and a high frequency of AGT gene polymorphism – T/T genotype (in 54.3 % of patients).

Preoperative Embolization of Glomus Tumors: Role, Effectiveness, and Complications.

Purpose: Paragangliomas represent a surgical challenge due to their hypervascularization. The preoperative selective embolization of these tumors significantly decreases intraoperative blood loss. However, the literature on preoperative embolization in glomus tumors is limited. The aim of this study is to contribute additional evidence regarding the role of preoperative embolization, as well as to evaluate risks and complications in the treatment of glomus tumors. Methods: A retrospective evaluation of all the embolizations of glomus tumors from 2009 to 2023 was conducted. The primary outcome parameter was the rate of devascularization after embolization and the occurrence of significant perioperative hemorrhages. The secondary outcome was embolization-related complications. Results: Twenty-one embolizations in 20 patients were investigated in the study. In 43% of the cases more than 90% devascularization was achieved by embolization, while in the remaining cases, 80 to 90% devascularization was reached. In one case (5%), significant perioperative bleeding after embolization occurred. In one case (5%), a symptomatic complication occurred periinterventionally due to the brief dislocation of the coaxial and microcatheter into the internal carotid artery (ICA), which led to fresh punctate DWI lesions on the subsequent MRI. No patients developed nerve palsy following embolization. Conclusions: The preoperative embolization of glomus tumors can lead to significant tumor devascularization and a reduction in perioperative bleeding, with a low complication rate.

Development and Evaluation of the OF Pelvis Score for Osteoporotic Pelvic Ring Fractures - A Retrospective Assessment of Therapy Recommendations for 107 Patients.

The aim of this study was to develop a simple and reliable score which supports decision making between non-operative and operative treatment in patients with osteoporotic pelvic fractures.Between 2018 to 2020, the OF Pelvis Score was developed during a total of 5 meetings of the Working Group on Osteoporotic Fractures of the Spine Section of the German Society of Orthopaedics and Trauma. The OF Pelvis Score as a decision aid between non-surgical and surgical treatment was developed by expert consensus after analysis of numerous geriatric sacral and pelvic ring fractures from several hospitals. Subsequently, retrospective evaluation of the score was performed on consecutive patients from three hospitals.The following parameters were considered relevant to decision making between non-surgical and surgical treatment and were incorporated into the score: fracture morphology using the OF Pelvis Classification, pain status, level of mobilisation, fracture-related neurological deficits, health status, and the modifiers already integrated into the OF Pelvis classification. If the score is <8, non-surgical therapy is recommended; if the score is >8, surgical therapy is recommended; if the score is 8, there is a relative indication for surgery. The OF Pelvis Score was then evaluated retrospectively in a total of 107 patients, according to records. The OF Pelvis Score was 8 points in 4 patients (3.7%), all of whom received surgical treatment. Of the remaining 103 patients, 93 received score-compliant therapy (90.3%). Among these, 4 of the patients who did not receive score-compliant care refused the recommended surgery, so the actual therapy recommendation was score-compliant in 94.2%.The OF Pelvis Score can be used to derive a therapy recommendation in many patients in clinical practice. Because of the possible change of clinical parameters during the course of the disease, the score has a dynamic character. In the retrospective evaluation, the recommendations from the OF Pelvis Score were in close accordance with the therapy actually performed.

ICan, Empowering Recovery: Evaluating a Patient-Centred Cancer Rehabilitation Programme across the Cancer Care Continuum.

The adverse effects of cancer and the long-term sequelae of associated treatments result in reduced quality of life and increased mortality for patients. Supporting patients with cancer to mitigate adverse outcomes is an important aspect of oncology care and the primary purpose of cancer rehabilitation. A retrospective service evaluation was conducted to evaluate the effectiveness of the core iCan patient-centred cancer rehabilitation service. At the beginning and end of a five-week programme, a series of questionnaires evaluating changes in mental health and wellbeing, and physical activity performance/attitudes, and functional capacity were administered to participants. Following iCan, we found that functional capacity was improved (30 s sit-to-stand: +6.3 repetition; d = -1.00, p < 0.001) and that self-reported physical activity was increased (~1173 MET-mins/wk; d = -0.76, p < 0.001); participants also perceived greater capability, opportunity, and motivation to be active. Mental wellbeing was also improved (SWEMWBS: d = -0.69, p < 0.001), whilst fatigue was reduced (FACIT: d = -0.77, p < 0.001). It appears that iCan has beneficial effects upon the physical/functional and psychological health of its participants. Where data are available, there appear to be clinically significant improvements across the range of measured functional, wellbeing, and activity/sedentariness outcomes, which suggest that participation in iCan is instrumental in adding value to the health and wellbeing of patients.

Vasectomy histology: Is it still useful?

To determine if histological evaluation of the vasa is useful when post-vasectomy semen analysis (PVSA) compliance is low and to determine whether compliance could be predicted. A retrospective evaluation of patients undergoing vasectomy between 2018 and 2022 was undertaken. A comparison of the PVSA between three vasa histological categorisations was made: complete divisions, incomplete division(s), absent vas(a). A multivariate model was constructed to predict PVSA compliance. From 388 patients, 191 (49.2%) undertook PVSA. Four patients had a revision of vasectomy. On 3 occasions this was due to the histology findings and once from semen analysis with normal histology. There was no significant difference in the number of azoospermic samples (95.4% vs 91.2%, ns), of samples with presence of Rare Non-Motile Sperm (RNMS) (2.6% vs 8.8%, ns) and those with sperm present (2.0 vs 0%, ns), between patients with complete division of the vasa on both sides and those with incomplete division on one side respectively. There was no difference in patient characteristics between those who complied with PVSA and those who did not. This paper suggests that there is a role for histological evaluation of the vasa when PVSA compliance is poor. Incompletely divided vasa on histology are not associated with an adverse PVSA.

Retrospective evaluation of implementation of caring contacts for youth suicide prevention in an emergency department.

Caring Contacts are brief caring messages sent to patients with suicidal thoughts or behaviors after an emergency department (ED) visit or hospitalization, which may decrease subsequent suicide attempts. We aimed to retrospectively evaluate the implementation of Caring Contacts in a children's hospital ED. We conducted a retrospective observational study to evaluate the implementation of Caring Contacts within routine clinical care at an academic children's hospital ED from May 2020 to April 2023. Patients 5‒18 years old presenting for suicidal thoughts or behaviors were eligible to receive six handwritten cards with individualized caring messages, mailed over 12 months. We assessed enrollment rates (the percentage of patients offered Caring Contacts who agreed to receive them), fidelity to the intended schedule and card writer, return visits for suicidal ideation or behaviors while receiving Caring Contacts, and program costs. Of 627 encounters eligible for and offered Caring Contacts, 614 (98%) resulted in enrollment. Among instances of enrollment, 587 (96%) had cards sent per the intended schedule and 541 (88%) had cards written by the intended writer. A return ED visit for suicidal ideation or behaviors occurred for 168 (27%) during program participation. Costs per participant were $4.54 in materials and 0.9h of personnel time. In a children's hospital ED, Caring Contacts were feasible to implement with low costs and high fidelity to the intended schedule and card writer. Prospective studies are needed to assess Caring Contacts' effectiveness in reducing suicide risk among adolescents following an ED visit.

Outcomes and complications of vertical parasagittal hemispherotomy in children: a nationwide population-based study.

The goal of this study was to assess the complications associated with vertical parasagittal hemispherotomy (VPH), the impact of incomplete disconnection on long-term seizure freedom, and how VPH impacts cognitive development. A retrospective evaluation was performed in all patients who had undergone VPH during 1991-2022 at the authors' institution. Two-year follow-up data were available for 45 patients, and there were 6-month data for 3 more. All available postoperative MRI studies (31/48, 64.6%) were reviewed. Before 2010, postoperative MRI was only performed if seizures recurred. Primary VPH led to Engel class I in 73% of patients. Acquired etiologies had a higher rate of Engel I compared to developmental and progressive etiologies (96% vs 46% and 44%, p < 0.001). Nearly half of patients (45%) showed improved cognitive trajectories as opposed to their preoperative ones, whereas in 45% trajectories remained unchanged. Additionally, 5 patients (10%) exhibited new major deficits or accelerated cognitive deterioration after VPH. Surgical complications occurred in 14 patients (29%) after the first VPH; 4 cases were classified as transient, resolving during follow-up without surgical intervention. Nontransient complications included 8 cases of hydrocephalus requiring surgical treatment, 1 shunted subdural hygroma, and 1 case of CSF leakage from the wound. Diabetes insipidus occurred in 6 patients, with all resolving spontaneously. Residual connections were present in 16 patients, primarily in the temporomesial region. Seven patients remained seizure free despite visible residual connections. VPH is a highly effective treatment for drug-resistant hemispheric epilepsy, resulting in durable seizure freedom and often favorable cognitive outcomes. Diabetes insipidus in addition to hydrocephalus is a common complication after VPH. Incomplete disconnection does not necessarily preclude seizure freedom.

376P Ataluren in patients with nonsense mutation DMD (nmDMD): retrospective evaluation from a tertiary referral center in Turkey

376P Ataluren in patients with nonsense mutation DMD (nmDMD): retrospective evaluation from a tertiary referral center in Turkey

Clinical analysis and literature review of 7 cases of plasmacytoma first diagnosed with head and neck symptoms

Objective:In order to better understand the condition and provide the groundwork for early detection and treatment of plasmacytomas, it is important to examine the clinical characteristics, therapeutic options, and effectiveness of plasmacytomas that are initially identified with head and neck symptoms. Methods:Retrospective analysis, evaluation, and discussion of the clinical data of 7 patients with plasmacytoma initially diagnosed with head and neck symptoms and admitted to the Affiliated Hospital of Qingdao University during the period of June 2013 to November 2022 was done in combination with pertinent literature. Results:All seven patients were diagnosed with plasmacytoma by histopathology, with lesions located in the nasopharyngeal oropharynx in 4 cases, nasal sinuses in 2 cases, and ventricular zone in 1 case. Clinical manifestations and imaging were atypical, with localized manifestations, of which 2 cases were accompanied by multiple skeletal lesions throughout the body, and 4 cases had lymph node metastasis. Surgery was preferred for all patients, and individualized treatment was recommended after surgery. Of the 7 patients, 3 patients underwent surgery and chemotherapy, 2 patients underwent surgery and radiotherapy and chemotherapy, 1 patient underwent surgery and radiotherapy, and 1 case was treated with surgery only. The follow-up period was 3-60 months, with a 100% follow-up rate. 5 cases were alive and 2 cases died of multiple myeloma after 4-5 years Conclusion:Plasmacytomas first diagnosed with head and neck symptoms are rare, and extramedullary plasmacytomas have a better prognosis, while more advanced multiple myeloma has a poorer prognosis; Therefore, enhancing the quality of survival as well as the duration of survival for patients with plasmacytomas requires early diagnosis and individualized treatment.

Paramedic educational programs maintain entry level competency throughout the COVID-19 pandemic.

The COVID-19 pandemic required unprecedented changes to emergency medical services (EMS) educational frameworks in the United States. It is unclear if pandemic-related changes impacted paramedic educational outcomes. We aimed to evaluate curricular and performance changes resulting from the initial COVID-19 pandemic on paramedic educational programs. We performed a retrospective cross-sectional evaluation of paramedic educational programs in 2019 and 2020 using the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions annual reports. These reports contain detailed program components and measures of program success. We included programs reporting at least one graduate in the study period. Descriptive statistics (proportions [%], median [interquartile range, IQR]) were calculated for paramedic program characteristics in 2019 and 2020, as well as pandemic specific curriculum changes. Wilcoxon rank-sum and Fisher's exact tests were used to evaluate differences in characteristics by year. The number of paramedic educational programs in our population decreased from 640 programs in 2019 to 612 in 2020, with a statistically significant decrease in clinical hours (2019: 219 [IQR 168‒272]; 2020: 200.5 [IQR 157‒261]). There was no difference in first or third-attempt certification examination success between years. Temporary shutdown was experienced in 34% of programs (duration: 3weeks [2‒7]) and 72% of required curricular changes. Curricular changes commonly included decreased in-person education (86%), traditional classroom lectures (78%), number of clinical sites (78%), and increased online didactic education (92%). Only 20% of programs decreased laboratory simulation or total training hours. During the pandemic, paramedic educational programs changed educational delivery with no observed differences on overall program performance. Identifying key curricular changes and best practices for implementation may be necessary to better optimize future educational delivery.

Correlation of Preoperatively Planned Humeral Component Size and Actual Implanted Size: A Retrospective and Prospective Evaluation of Anatomic and Reverse Shoulder Arthroplasty

BackgroundThe aims of the study were to (1) evaluate the correlation of planned humeral component diameter with implanted humeral component diameter for reverse total shoulder arthroplasty (rTSA) and (2) to evaluate the correlation of planned humeral components with executed humeral components for stemless anatomic total shoulder arthroplasty (aTSA). MethodsFour shoulder surgeons participated in two phases of the study. In the retrospective arm, 3 months of TSA and rTSA cases which were completed with preoperative CT-based planning, but without any humeral planning, were re-planned using humeral planning, and the components from the virtual planning compared to the implanted components. In the prospective arm, 3 months of TSA and rTSA cases were prospectively planned by each surgeon. The planned and implanted components were similarly compared. Results97 rTSAs were included (50 retrospective, 48 prospective). In the retrospective analysis, in 60% of cases, the rTSA stem diameter was within one size of the plan; in 84%, it was within two sizes; in 90%, it was within 3 sizes. In the prospective analysis, the rTSA stem diameter was within one size in 73% of cases; in 90% within 2 sizes, and in 94% within 3 sizes (p > 0.05 all comparisons). The cup diameter was always within one size of the plan; it matched in 84% of the retrospective cases and 90% of the prospective cases (p > 0.05). 77 TSA were included (33 retrospective, 44 prospective). For prosthetic head diameter, in the retrospective analysis, it was an exact match in 52% of patients, within one size in 85% and within two sizes in 100%. In the prospective analysis, the diameter was an exact match in 57%, within one size in 86% and within two sizes in 100% (p > 0.05 all comparisons). The thickness of the prosthetic component was a match to the plan in 88% of the retrospective cases and 86% of prospective cases (p > 0.05). ConclusionsFor the utilized planning software and implants, humeral planning for rTSA affords some predictability for stem diameter regardless of whether assessed retrospectively or prospectively, with 84-90% of cases within two diameters of the plan. The inlay humeral cup diameter was an exact match to the plan in 84-90% of cases. For stemless aTSA, the humeral component diameter was an exact match to the plan in 52-57%, but within one size in 85-86% of cases. There were no significant differences if the planning was performed retrospectively or prospectively.

Brownfields to Healthfields: A Retrospective Ripple Effect Mapping Evaluation in Three Rural Communities

The environments in which we live influence our health behaviors and outcomes. The redevelopment of brownfields sites to health-promoting land uses may provide an array of benefits to individuals and communities, but these impacts can be particularly difficult to assess in rural communities using traditional evaluation approaches. Using Ripple Effects Mapping, we evaluated three rural brownfields redevelopment sites across Appalachian portions of EPA Region 3. Adult members of these communities participated in guided reflection on the redevelopment and subsequent impacts. Data were constructed as digital mind maps, then coded to the Community Capitals Framework by two authors coding independently. Member checking was conducted with representative workshop participants. Commonly cited impacts were site improvements, facilitation of social and physical activity, and engaging community identity. The most discussed community capitals were social and built; the least discussed capitals were natural and political. Future directions for brownfield redevelopment evaluation are discussed.

Gabapentin for Delirium in Infants in the Neonatal Intensive Care Unit

OBJECTIVE A protocol was developed for neonatal intensive care unit (NICU) delirium: Step 1, gabapentin for pain or melatonin for sleep; Step 2, add on other Step 1 agent; Step 3, antipsychotics. The purpose of this study was to describe the utility and dosing of gabapentin for NICU delirium. METHODS Retrospective evaluation of NICU patients from January 1, 2021–December 31, 2022 who received &amp;gt;1 dose of gabapentin based on the delirium protocol. Data collection included demographics, gabapentin regimen, and concomitant sedatives and analgesics. The primary objective was to identify the number of patients receiving gabapentin for Step 1 or Step 2. Secondary objectives included identifying the number of patients requiring antipsychotics (Step 3), the gabapentin regimen, comparison of Échelle de Douleur et d'Inconfort du Nouveau-né (EDIN), Cornell Assessment of Pediatric Delirium (CAPD), and Withdrawal Assessment Tool-1 (WAT-1) scores 72 hours pre- and post-gabapentin initiation, and comparison of opioids, clonidine, and melatonin 24 hours pre- and 72 hours post-gabapentin initiation. Wilcoxon signed rank tests were employed with significance defined at p &amp;lt; 0.05. RESULTS Twenty-nine patients were studied. The majority (n = 22; 75.9%) received gabapentin for Step 1; no patients required Step 3. The median initial dose was 14.4 mg/kg/day divided every 8 hours. Twelve (41.4%) required increase to a median of 16.9 mg/kg/day. A significant decrease in EDIN and WAT-1 scores was noted, but there was no change in CAPD scores or opioid, clonidine, or melatonin doses pre- versus post-gabapentin. CONCLUSION The majority received gabapentin at a median dose of 14 mg/kg/day as Step 1 for delirium. Gabapentin was associated with a significant decrease in pain and withdrawal scores.

Retrospective Evaluation of Fiber Post Treatment Success

Retrospective Evaluation of Fiber Post Treatment Success

Retrospective evaluation of the world falls guidelines-algorithm in older adults.

The World Falls Guidelines (WFG) propose an algorithm that classifies patients as low-, intermediate-, and high-risk. We evaluated different operationalizations of the WFG algorithm and compared its predictive performance to other screening tools for falls, namely: the American Geriatrics Society and British Geriatrics Society (AGS/BGS) algorithm, the 3KQ on their own and fall history on its own. We included data from 1509 adults aged ≥65years from the population-based Longitudinal Aging Study Amsterdam. The outcome was ≥1 fall during 1-year follow-up, which was ascertained using fall calendars. The screening tools' items were retrospectively operationalized using baseline measures, using proxies where necessary. Sensitivity ranged between 30.9-48.0% and specificity ranged between 77.0-88.2%. Operationalizing the algorithm with the 3KQ instead of fall history yielded a higher sensitivity but lower specificity, whereas operationalization with the Clinical Frailty Scale (CFS) classification tree instead of Fried's frailty criteria did not affect predictive performance. Compared to the WFG algorithm, the AGS/BGS algorithm and fall history on its own yielded similar predictive performance, whereas the 3KQ on their own yielded a higher sensitivity but lower specificity. The WFG algorithm can identify patients at risk of a fall, especially when the 3KQ are included in its operationalization. The CFS and Fried's frailty criteria may be used interchangeably in the algorithm's operationalization. The algorithm performed similarly compared to other screening tools, except for the 3KQ on their own, which have higher sensitivity but lower specificity and lack clinical recommendations per risk category.

Directly printed aligner therapy: A 12-month evaluation of application and effectiveness

Directly printed aligners (DPAs) are gaining in popularity, potentially streamlining manufacturing, decreasing environmental waste, and offering enhanced adaptation and tailoring. This transition has been facilitated by advances in materials, software, and production. Although DPAs may have enhanced versatility and application in the management of more complex malocclusions, there is little research evaluating their effectiveness. A total of 54 patients undergoing treatment with DPAs were evaluated for occlusal improvement, overall treatment duration, and adverse effects. Regression models were fit to evaluate the association between the need for refinement, final peer assessment rating (PAR) score, and independent variables, including the total number of aligners and treatment indications. The mean number of aligners in the initial plan was 7.1 ± 2.9 and 5.1 ± 4.3 in maxillary and mandibular arches. Refinement was required in 40.8% (n= 20). The pretreatment PAR score of 17.01 ± 7.93 showed a significant improvement (86.6%), with a final PAR score of 2.25 ± 1.15. Minor complications were noted in 3 participants. The need for refinement was unrelated to the total number of aligners (odds ratio, 1.05; 95% confidence interval, 0.94-1.18; P= 0.36). There was weak evidence of an association between the final PAR score and the total number of aligners (odds ratio, -0.03; 95% confidence interval, -0.07 to 0.003, P= 0.07). On the basis of this preliminary retrospective evaluation, DPAs may be used to manage mild-moderate malocclusion, producing a significant reduction in PAR score. Nevertheless, additional prospective research is required to confirm these findings and compare the relative merits of DPAs to alternatives.