Significant Mean Improvement Research Articles

Outcomes of minimally invasive spine decompression in lumbar spinal stenosis and intervertebral disc prolapse: A prospective study

Introduction: Lumbar spinal stenosis and intervertebral disc prolapse are the most common cause of back pain and sciatica. Both conditions are traditionally treated by a midline lumbar incision, after which the paraspinous muscles are elevated from the spinous processes and lamina and retracted laterally and extensively. Minimally invasive lumbar decompression is a procedure designed to debulk hypertrophied ligamentum flavum and removal of the herniated disc with a goal of relieving neural compression. Our study aimed to assess the outcome in terms of improvement in neurology, extent of pain relief in the postoperative period and complications in patients undergoing minimally invasive spine decompression.Methodology: The present study was conducted in a tertiary care hospital. A total of 16 patients who satisfied both the inclusion and exclusion criteria and gave informed consent were recruited for the study from January 2020 to March 2021. All patients underwent minimally invasive spine decompression by tubular retractors. Outcome measures used are Visual analog score for leg pain and back pain, Modified Oswestry Disability Index (MODI), Roland Morris Disability Questionnaire (RMDQ) and neurological examination preoperatively and postoperatively at 6 weeks, 3 months and 6 months.Results: Out of 16 patients, ten patients had intervertebral disc prolapse and six had lumbar spinal stenosis. L4L5 was the most common level seen in our patients. Mean pre-operative VAS score was 6.88 and 4.44 for leg pain and back pain, there was significant reduction at the end of 6 months. Mean preoperative MODI score was 66.38, preoperatively 13 patients (81%) had crippling back pain, 3 patients (18.75%) had severe disability. At the end of 6 months, all 16 patients had less than minimal disability. Mean preoperative roland morris disability score was 11.31+ 0.61. There was a significant mean improvement at 6 months postoperatively from the preoperative baseline score. Nine patients (43.8%) had a motor deficit of which 4 patients had a significant motor power improvement. Two patient had complications, one patient had CSF leak intraoperatively and the other patient developed a superficial wound infection.Conclusion: Minimally invasive spine surgery is an excellent surgical option in patients with lumbar spinal stenosis and prolapsed intervertebral disc. Patients who underwent minimally invasive spine decompression had satisfactory functional outcome in terms of pain relief, minimal hospital stay and early return to day to day activities.

Impact of long-term administration of maralixibat on children with cholestasis secondary to Alagille syndrome.

There is growing interest in, but limited data about, intestinal bile acid transport inhibitors as treatment for cholestatic liver disease. The current analyses combine two similar randomized placebo‐controlled trials with subsequent extension phases investigating the impact of maralixibat in children with severe cholestasis secondary to Alagille Syndrome (n = 57). The primary outcomes were measures of pruritus (ItchRO[Obs]) and clinician scratch scale (CSS), both increasing in severity from 0 to 4) and quality of life (QoL) (Parent PedsQL and Multidimensional Fatigue Scale module [MFS] scaled 0–100 with increased QoL) at week 48 of the extension phase relative to the baseline of the placebo‐controlled trials (week 13). Secondary assessments included other clinical and biochemical parameters assessed in participants at week 72 or end of treatment (after week 48). At week 48, statistically and clinically significant least square mean (95% CI) improvements in pruritus and QoL were observed (ItchRO[Obs] −1.59 [−1.81, −1.36], CSS −1.36 [−1.67, −1.05], PedsQL +10.17 [4.48, 15.86], and multidimension fatigue [MFS] +13.97 [7.85, 20.08]). At week 48, serum bile acids, platelet count, and cholesterol decreased, whereas alanine aminotransferase (ALT) increased and total bilirubin (TB) and albumin were stable. Changes were durable at week 72 and end of treatment. There were no deaths; 2 participants underwent liver transplantation. Study drug was discontinued in 9 participants after treatment‐emergent adverse events, 6 of which were events of increased ALT or TB. Conclusion: Maralixibat administration was associated with marked improvement in pruritus and QoL. Interpretation of these findings is complicated by the complex natural history of severe cholestasis in Alagille syndrome.

Impact of a Pediatric Fruit and Vegetable Prescription Program on Food Security and Dietary Patterns Following Two Years of Exposure

ObjectivesIn August 2018, a pediatric clinic in Flint, Michigan introduced a program that provided one $15 prescription for fresh fruits and vegetables to all patients (0–18 years of age) at the conclusion of their office visits. Prescriptions were redeemable only for fresh fruits and vegetables at a downtown farmers’ market or a local mobile market. The objective of this study was to examine changes in dietary patterns and food security among a sample of caregiver-child dyads who participated in this fruit and vegetable prescription program for two years. MethodsThis non-controlled longitudinal intervention trial included a sample of caregiver–child dyads who were exposed to the pediatric fruit and vegetable prescription program for two years. A consecutive sample of caregivers whose children were 8–18 years of age at baseline were invited to participate in the study. Dyads separately completed in-person surveys that evaluated food security and dietary behaviors prior to receipt of their first prescription. Dyads completed the identical surveys via a secure digital platform again at approximately 24 months. Results104 caregiver-child dyads enrolled in the study and completed baseline and two-year follow-up assessments. At follow-up, most of the children (mean age 14.24 ± 2.4) were African American (66%) and residents of Flint (76%). The majority of caregivers (mean age 41.3 ± 8.9) were female (95%) and African American (69%). Among the 96 children who completed the food screener at baseline and two-year follow-up, significant improvements in mean daily intake of vegetables (p < 0.001), whole grains (p < 0.001), and dairy (p < 0.001) were reported. Improvements in caregiver-reported household food security (p < 0.001) as well as child-reported food security (p = 0.012) were also observed. ConclusionsThe current study provides evidence to support the long-term effectiveness of pediatric fruit and vegetable prescription programs. Funding SourcesMichigan Health Endowment Fund.

Efficacy of a novel journal club series at an academic hematology/oncology fellowship program.

11027 Background: Journal club (JC) is an essential tool in hematology/oncology fellowship to develop critical appraisal skills. The traditional JC format of reviewing an article followed by group discussion may not provide optimal education in appraising literature. We applied a novel JC curriculum and measured impact on fellow comfort with trial design, statistics, and endpoint interpretation. Methods: A novel JC curriculum was implemented for hematology/oncology fellows at Vanderbilt in the 2021-2022 academic year. JC for the prior year utilized the traditional format. We developed five focused learning objectives (LO’s) for each JC and emphasized the goal was to not place the paper in clinical context but to focus on developing the foundational tools for critical appraisal skills. The sessions involved (1) 15 minute introductory lecture from a biostatistician to cover foundations of the LO’s; (2) group discussion led by an upper year fellow to describe the paper in the context of the LO’s; (3) question and answer session from the fellows to both the statistician and a clinical trial expert. We developed anonymous pre and post surveys to understand the impact of the novel JC curriculum on a 5-point Likert scale. Two sample unpaired t-test was used to compare mean differences. Results: A total of 15/22 fellows (68%) completed the pre-survey and 12/22 fellows (55%) completed the post survey. There was an even distribution of fellows by year in the pre survey and 33% first years, 41% second years, and 25% third years in the post survey. There was a statistically significant improvement in pre and post mean fellow comfort in understanding differences in trial types (2.9 vs. 4, p &lt; 0.001), randomization strategy (2.6 vs. 4.25, p &lt; 0.001), endpoints (3 vs. 4.1, p &lt; 0.001), and interpretation of the statistical methodology of represented data (3 vs. 4.3, p &lt; 0.001) on a 1-5 Likert scale (5 being entirely comfortable). In a subset analysis, we did a direct comparison of fellows who had previously participated in both JC formats (n = 9); the new format was rated as a more useful tool for learning data interpretation than prior with a mean of 4.8/5. When comparing fellow perception in the utility of traditional compared to the novel JC, there was a statistically significant mean improvement in utility of JC to prepare fellows to understand differences in trial types (1.9 vs. 4.1, p &lt; 0.001), randomization strategy (1.4 vs. 4.5, p &lt; 0.001), endpoints (2.7 vs. 4.5, p &lt; 0.001), and interpretation of the statistical methodology of represented data (2.33 vs. 4.6, p &lt; 0.001) favoring the novel JC. Conclusions: Fellows’ comfort with trial design and content significantly improved with our novel JC. To our knowledge, this is the first time such a curriculum has been used in hematology/oncology training. Our successfully piloted novel JC model can be adapted to other fellowships to improve foundational skills in the critical appraisal of clinical trials.

Continuous Aspiration Mechanical Thrombectomy for the management of intermediate- and high-risk pulmonary embolism: Data from the first cohort in Portugal

IntroductionThis study describes the experience of a reference center using continuous aspiration mechanical thrombectomy for acute high- and intermediate-high-risk pulmonary embolism (PE). MethodsTwenty-nine consecutive patients with acute central PE (48.3% high-risk PE; 82.8% in class >III from the original Pulmonary Embolism Severity Index score; median Charlson Comorbidity Index of 4) were treated with the Indigo® Mechanical Thrombectomy System between March 2018 and March 2020. Technical success was defined as successful placement of the device and initiation of aspiration thrombectomy. Clinical success was defined as any improvement in hemodynamic and/or oxygenation parameters, pulmonary hypertension or right heart strain at 48 hours, and survival to hospital discharge. Safety was defined as freedom from severe adverse events potentially related to the procedure. Three-month follow-up results were collected. ResultsTechnical success was 96.6%. Miller index and systolic pulmonary arterial pressure were significantly reduced after the procedure (-5.5±3.0, and -10.2±11.5 mmHg, respectively, both p<0.001). There was a significant improvement in mean paO2/FiO2 ratio (+77.1±103.2; p=0.001), shock index (-0.4±0.4; p<0.001), need for aminergic support at 48 h after the procedure (-75.0%, p=0.006) and improvement in right ventricular function in 66.6% (p=0.008). Clinical success was 75.9%. Severe adverse event rate was 10.3%: two deaths during the procedure and one pulmonary macroembolization during device progression. In-hospital and three-month survival rates were 82.8% and 72.4%, respectively. ConclusionsAspiration thrombectomy for acute high- and intermediate-high-risk PE is feasible with a high technical and clinical success rate. Nevertheless, all-cause mortality is still high, probably related to the baseline high-risk features of the studied population and associated comorbidities.

Mindful Caring: A pilot study of an online mindfulness workshop for medical students to improve self-compassion

Background: This study examines the effectiveness of a pilot Mindful Caring workshop in improving self-compassion, mindfulness, and empathy, while reducing stress. Methods: Year 3 and 4 medical students from the National University of Singapore underwent 16 hours of online workshops over 4 days with didactic and experiential learning activities on self-compassion and mindfulness. Primary outcomes of self-compassion were measured with the Self-Compassion Scale (SCS). Secondary outcomes include mindfulness measured with the Five Facet Mindfulness Questionnaire-15 (FFMQ-15), empathy and stress levels. Qualitative comments were also sought in the feedback. Results: Out of 21 participants, 90.5% (n =19) completed both pre- and post-intervention questionnaires. Participants experienced significant mean improvements in self-compassion (p&lt;0.05) and mindfulness (p&lt;0.05), while improvements in empathy and stress levels did not reach statistical significance. Conclusions: A short online Mindful Caring workshop could be an avenue to improve self-compassion and mindfulness, which may have a downstream effect on burnout.

Experience and clinical efficacy of gut-directed hypnotherapy in an Asian population with refractory irritable bowel syndrome.

Background and AimRecent studies have highlighted the high worldwide prevalence of irritable bowel syndrome (IBS) and disparities in its management between ethnic groups. For instance, gut‐directed hypnotherapy (GDH), one of the most effective evidence‐based treatments for IBS, is not recommended in Asian countries partly due to lack of population‐specific outcome data. In this context, we evaluated the outcomes of GDH in an Asian population.MethodsConsecutive British Asian patients with refractory IBS who received 12‐sessions of GDH using the Manchester protocol were included. Patients were treated by a team including a therapist able to speak several Asian languages. All patients prospectively completed the following questionnaires before and after GDH: IBS symptom severity score (IBS‐SSS), hospital anxiety and depression scale (HADS), non‐colonic symptom score, and the quality‐of‐life (QOL) score. The primary outcome measure was response to GDH defined by ≥50‐point reduction in IBS‐SSS. Pre‐ and post‐treatment data were compared statistically.ResultsForty‐four Asian patients with IBS (age 49 ± 13 years; 29 [66%] female; baseline IBS‐SSS: 332.8 ± 94.6) completed GDH. Overall, 37 of 44 (84%) achieved a ≥50‐point reduction in IBS‐SSS and 25 of 44 (57%) achieved ≥30% reduction in abdominal pain scores. Following GDH, there were also significant mean improvements in IBS‐SSS (−132.1, P < 0.0001), non‐colonic symptom score (P < 0.0001), QOL score (P < 0.0001), HADS‐anxiety (P < 0.0001), and HADS‐depression (P < 0.0001), compared with baseline.ConclusionRegardless of the ethnicity of the therapist, GDH was highly effective with similar response rates to outcomes in other IBS populations, supporting the development of GDH in Asian countries.

Effect of COVID-19 lockdown on Moroccan patients with type 1 and type 2 diabetes

BackgroundThe implementation of coronavirus disease of 2019 (COVID-19) lockdown has affected the daily practices of subjects with chronic diseases such as diabetes and caused negative impact on their lifestyle and habits such as physical activity, dietary habits and accessibility to medications. Diabetic people are considered the most vulnerable groups to COVID-19, and the lockdown measure has disturbed the diabetes self-management. In our study, we aimed to assess, for the first time at the regional level (Souss Massa Region), the COVID-19 lockdown impact on HbA1c levels in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). We carried out a cross-sectional quantitative analysis at the health center of the industrial district in Agadir City.ResultsWe found a significant improvement in post-lockdown mean ± SD HbA1c in 150 subjects suffering from T1D and T2D; p = 0.005). Our analysis revealed a significant association of HbA1c deviation with educational level and medical coverage (p = 0.01). No significant association was detected between HbA1c deviation and age, gender, weight, height, current BMI status, fasting blood sugar, family history, urban or rural areas, marital status, professional activity, socioeconomic income, type of diabetes, dietary, comorbidities, diabetic complications, housing, adherence to the dietary recommendations, physical activity, medical appointments, stopping medication, self-monitoring, fasting and anxiety about getting COVID-19.ConclusionsCOVID-19 lockdown had no deleterious effect on HbA1c levels in Moroccan patients with T1D and T2D.

Mindful Caring: A pilot study of an online mindfulness workshop for medical students to improve self-compassion

Background: This study examines the effectiveness of a pilot Mindful Caring workshop in improving self-compassion, mindfulness, and empathy, while reducing stress. Methods: Clinical-year medical students from the National University of Singapore underwent 16 hours of online workshops over 4 days with didactic and experiential teachings on self-compassion and mindfulness. Primary outcomes of self-compassion and mindfulness were measured with the Self-Compassion Scale (SCS) and the Five Facet Mindfulness Questionnaire-15 (FFMQ-15) respectively. Secondary outcomes measured included empathy and stress levels. Qualitative feedback was also sought. Results: Primary outcomes included improvements in self-compassion and mindfulness. Out of 21 participants, 19 (90.5%) completed both pre- and post-intervention questionnaires. Participants experienced significant mean improvements in self-compassion (p&lt;0.05) and mindfulness (p&lt;0.05), while improvements in empathy and stress levels did not reach statistical significance. Conclusions: A short online Mindful Caring workshop could be an avenue to improve self-compassion and mindfulness, which may have a downstream effect on burnout.

Satisfactory Functional Outcome and Significant Correlation with the Length of Haglund's Deformity after Endoscopic Calcaneoplasty: A Minimum 4-Year Follow-Up Study.

Background Haglund's syndrome is a posterosuperior calcaneal prominence with posterior heel pain causing functional disability to the patient. Operative treatment is indicated after failure of conservative measures and includes resection of the bony hump along with retrocalcaneal bursectomy. This study aimed to evaluate the functional outcome and degree of patient satisfaction after endoscopic resection of Haglund's deformity with assessment of correlation with the length of bony exostosis. Methods Seventeen patients (21 feet) with a mean age of 44.7 ± 5.1 years were included in this study. Six females and 11 males underwent endoscopic calcaneoplasty. Clinical outcome evaluation included the assessment of the visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society score (AOFAS). The preoperative and postoperative lengths of bony exostosis were measured radiologically. The paired t test and the Wilcoxon signed-rank test compared the preoperative and final postoperative means. P < 0.05 was considered statistically significant. Results The mean follow-up period was 56.4 ± 5.1 months. Statistically significant improvements in the preoperative mean of AOFAS (from 55.7 ± 9.3 to 94.3 ± 7.1) and VAS (from 8.1 ± 1.4 to 0.7 ± 1.04) at the final follow-up were noted (P < 0.0001). There was a statistically significant correlation between clinical scores (AOFAS and VAS) and the final postoperative length of the bone above parallel pitch lines (PPLs). The patients were satisfied and returned to their previous activities without reporting major morbidities except one patient who had mild pain with exertion. Conclusion Endoscopic calcaneoplasty is a safe, less invasive surgical procedure for the management of Haglund's syndrome after failure of conservative treatment. It provided a satisfactory clinical result without serious complications at a minimum 4-year follow-up.

P 42 Pilot clinical and EEG-biomarker results of transcranial pulse stimulation in Alzheimer's disease

Introduction: Transcranial Pulse Stimulation (TPS) is a new non-invasive neuromodulation therapy that uses shockwaves for the treatment of Alzheimeŕs Disease (AD). In humans, there is first evidence for beneficial clinical effects after a series of six TPS sessions. Long-term results and controlled trials are not yet reported. Experience from other centers is lacking. We report on first clinical experience from a center in Germany with additional longitudinal EEG recordings. Patients and Methods: A consecutive number of ten TPS-treated AD-patients was examined. Patients received 4-12 sessions of 3000-6000 pulses per session with 4 Hz of 0.2 mJ/mm2 (MRI navigated bifrontal biparietal, bitemporal and praecuneus) using the Neurolith System (Storz Medical). Session were planned for six initial sessions over two weeks with a booster session every four weeks. Up to now, data is available for 1-24 weeks of treatment period. Numerous cognitive and affective scores were assessed (e.g. ADAS, MMST, MoCa, BDI). For exploratory reasons a heterogeneous group with MMST range from 2 to 27 was included. EEG recordings were done before and after the first sessions and after the complete cycle of six sessions. Results: Treatment was very well tolerable with a low number of side effects. One patient reported transient headache, two patient transient diffuse symptoms of nausea und a restless feeling. All patients improved at least transiently in one neuropsychological test. Caregivers confirmed improvement of activity of daily living in most of the patients. Significant mean improvement was best detected in the ADAS sum score with 18%. Some patients only showed minor improvements, but best improvement in a patient was 40%. Marked improvement of mood was seen in some patients. EEG showed increase of power across all frequency bands after the first session (n.s.); more consistent changes of EEG entropy were noticed. Conclusion: These pilot results confirm the recently published results from Austria with respect to low side effects and extent of cognitive improvement. The sample was heterogeneous but some patients showed a marked improvement of mood and cognition. Thus, more data and subgroups need to be analyzed. Prospective controlled trials would be the next step to proof the efficacy of this new technique. EEG entropy might be a promising tool as a biomarker for treatment response.

Novel VMAT Planning Technique Improves Dosimetry for Head and Neck Cancer Patients Undergoing Definitive Chemoradiotherapy

<h3>Purpose/Objective(s)</h3> Intensity modulated radiotherapy (IMRT) allows for substantial sparing of organs-at-risk (OARs) without compromising delivery of curative-intent doses in patients with head and neck cancers. Volumetric modulated arc therapy (VMAT) allows for rapid treatment delivery and minimizes fractional treatment time. Given the intrinsic complexity of VMAT planning, standard two-arc techniques often fail to achieve planning objectives. We hypothesize that a simple, institutional approach improves OAR dosimetry compared to a standard two-arc technique. <h3>Materials/Methods</h3> Head and neck cancer patients who received definitive chemoradiotherapy were included in this single institution study. VMAT plans were generated per institutional protocol using 6 MV photon beams. Briefly, three single arcs were employed with assigned collimator angles of (C) 0°, (C) 90°, and (C) 90°. The maximum jaw extension of the (C) 0° field encompassed the entirety of the treatment volume. The inferior jaw on the first collimated arc was set with a maximum extension of 1 cm beyond the isocenter, while the superior jaw of the second collimated arc was set with a maximum extension of 1 cm beyond the isocenter. Comparison plans were generated for each patient using the manufacturer's recommended beam arrangement, comprising two collimated arcs - (C) 30° and a reciprocal (C) 330° - with jaw tracking enabled. Mean differences in target volume and OAR dosimetry between planning approaches were calculated. A two-tailed, paired Student's t-test was employed to determine statistically significant differences in dosimetry between standard and institutional plans. <h3>Results</h3> Ten patients were planned using institutional and standard two-arc protocols. Statistically significant mean improvements were observed in ipsilateral parotid mean dose (∆314.7 cGy, p = 0.007) and V30Gy (∆6.62%, p = 0.004), contralateral parotid mean dose (∆292.6 cGy, p = 0.006) and V30Gy (∆5.36%, p = 0.004), parotid volume receiving less than 20 Gy (∆7.36 cc, p = 0.010), pharyngeal constrictor mean dose (∆269.3 cGy, p = 0.003), ipsilateral brachial plexus maximum dose (∆96.0 cGy, p = 0.036), and global maximum dose (∆1.73%, p = 0.047) with the three-arc technique. No significant differences in PTV, spinal cord, mandible, cricopharyngeus, cochlear, or contralateral brachial plexus dosimetry were identified. Subjectively, dosimetrists reported shorter planning time and easier achievement of objectives with the three-arc approach. <h3>Conclusion</h3> Our institutional approach to head and neck VMAT conveys significant dosimetric improvements compared to a standard VMAT beam arrangement. This approach represents a simple and reproducible solution to planning for head and neck cancer patients which may reduce planning time. Additional research is warranted to further optimize this technique and quantify reductions in planning time.

Impacts of New Implementing Strategies for Surface and Model Physics Perturbations in TREPS on Forecasts of Landfalling Tropical Cyclones

To improve the ensemble prediction system of the tropical regional atmosphere model for the South China Sea (TREPS) in predicting landfalling tropical cyclones (TCs), the impacts of three new implementing strategies for surface and model physics perturbations in TREPS were evaluated for 19 TCs making landfall in China during 2014–16. For sea surface temperature (SST) perturbations, spatially uncorrelated random perturbations were replaced with spatially correlated ones. The multiplier f, which is used to form perturbed tendency in the Stochastically Perturbed Parameterization Tendency (SPPT) scheme, was inflated in regions with evident convective activity (f-inflated SPPT). Lastly, the Stochastically Perturbed Parameterization (SPP) scheme with 14 perturbed parameters selected from the planetary boundary layer, surface layer, microphysics, and cumulus convection parameterizations was added. Overall, all these methods improved forecasts more significantly for non-intensifying than intensifying TCs. Compared with f-inflated SPPT, the spatially correlated SST perturbations generally showed comparable performance but were more (less) skillful for intensifying (non-intensifying) TCs. The advantages of the spatially correlated SST perturbations and f-inflated SPPT were mainly present in the deterministic guidance for both TC track and wind and in the probabilistic guidance for reliability of wind. For intensifying TCs, adding SPP led to mixed impacts with significant improvements in probability-matched mean of modest winds and in probabilistic forecasts of rainfall; while for non-intensifying TCs, adding SPP frequently led to positive impacts on the deterministic guidance for track, intensity, strong winds, and moderate rainfall and on the probabilistic guidance for wind and discrimination of rainfall.

Microneedling with topical vitamin C versus microneedling with topical insulin in the treatment of atrophic post-acne scars: A split-face study.

Post acne scars following sebaceous injury and abnormal wound healing during the course of acne is a prevalent and challenging to treat condition To evaluate microneedling by dermapen with topical vitamin C versus microneedling with topical insulin in treating atrophic post-acne scars. A split-face comparative study included 30 subjects with atrophic post-acne scars. Human insulin was topically applied to the left side of the face and on the right side, vitamin C serum was applied. Scars were assessed via the Acne Scar Assessment Scale (ASAS) and Scar quartile grading scale (SQGS). After 1 month of 4 treatments, a statistically significant mean improvement in ASAS value was reported on both split sides of the face (2.13 and 1.83) compared to baseline (3.03 and 2.93) (p=0.005; p=0.001 respectively). When compared to baseline, the mean ASAS value improved significantly with a slight more improvement on the vitamin c treated side. Topical insulin and vitamin c combined with microneedling, may both achieve comparable significant improvement for treating post acne scars. Insulin can be a promising novel anti-scarring therapy pending larger controlled studies to verify its efficacy.

Randomized, evaluator-blinded comparative study of a potassium titanyl phosphate (KTP) 532-nm picosecond laser and an alexandrite 755-nm picosecond laser for the treatment of solar lentigines in Asians.

Various pigment-specific lasers can be used to treat solar lentigines. However, the most effective treatment options remain to be explored to reduce complications, such as postinflammatory hyperpigmentation, especially in dark-skinned patients. This study aims to compare the efficacy and safety between the KTP 532-nm picosecond laser and the alexandrite 755-nm picosecond laser for the treatment of solar lentigines in Asians. Thirty patients who had at least two solar lentigines on their arms were enrolled. A total of 30 paired lentiginous lesions were randomly selected for a single treatment with either a KTP 532-nm picosecond laser or an alexandrite 755-nm picosecond laser. Mean luminance score (L*) was evaluated at baseline and at 6 and 12weeks to determine treatment efficacy. Improvement was assessed by a blinded physician using a 5-point score. Satisfaction was rated by patients using a visual analog scale. All adverse events were documented. All 30 patients completed the study. Both lasers showed significant improvement in mean L* from baseline (p<0.001). With the parameter settings employed, lesions treated with the alexandrite 755-nm picosecond laser showed greater improvement in mean L* when compared with treatment with the KTP 532-nm picosecond laser at 12weeks follow-up (p=0.002). According to physician scoring, more than 50% improvement was observed in 25 and 19 lesions of the alexandrite 755-nm picosecond laser group and the KTP 532-nm picosecond laser group, respectively. Adverse events did not differ between groups. A significantly higher satisfaction score was observed with the alexandrite 755-nm picosecond laser at the last visit (p=0.038). Both types of picosecond laser may be used to treat solar lentigines. Proper treatment settings and endpoint observation are the most important factor to achieve a successful outcome.

Short-term high-intensity interval training improves fitness before surgery: A randomized clinical trial.

PurposeImproving cardiopulmonary reserve, or peak oxygen consumption(V˙ O2peak), may reduce postoperative complications; however, this may be difficult to achieve between diagnosis and surgery. Our primary aim was to assess the efficacy of an approximate 14‐session, preoperative high‐intensity interval training(HIIT) program to increase V˙ O2peak by a clinically relevant 2 ml·kg−1·min−1. Our secondary aim was to document clinical outcomes.MethodologyIn this prospective study, participants aged 45–85 undergoing major abdominal surgery were randomized to standard care or 14 sessions of HIIT over 4 weeks. HIIT sessions involved approximately 30 min of stationary cycling. Interval training alternated 1 min of high (with the goal of reaching 90% max heart rate at least once during the session) and low/moderate‐intensity cycling. Cardiopulmonary exercise testing(CPET) measured the change in V˙ O2peak from baseline to surgery. Clinical outcomes included postoperative complications, length of stay(LOS), and Short Form 36 quality of life questionnaire(SF‐36).ResultsOf 63 participants, 46 completed both CPETs and 50 completed clinical follow‐up. There was a significant improvement in the HIIT group's mean ± SD V˙ O2peak (HIIT 2.87 ± 1.94 ml·kg1·min−1 vs standard care 0.15 ± 1.93, with an overall difference of 2.73 ml·kg1·min−1 95%CI [1.53, 3.93] p < 0.001). There were no statistically significant differences between groups for clinical outcomes, although the observed differences consistently favored the exercise group. This was most notable for total number of complications (0.64 v 1.16 per patient, p = 0.07), SF‐36 physical component score (p = 0.06), and LOS (mean 5.5 v 7.4 days, p = 0.07).ConclusionsThere was a significant improvement in V˙ O2peak with a four‐week preoperative HIIT program. Further appropriately powered work is required to explore the impact of preoperative HIIT on postoperative clinical outcomes.

Feasibility of the SOAR (Stop OsteoARthritis) program

ObjectiveAssess the feasibility of a virtually-delivered, physiotherapist-guided knee health program (SOAR) that targets self-management of knee health and osteoarthritis risk after an activity-related knee injury. DesignIn this quasi-experimental feasibility study, individuals with varied lived experience of knee trauma completed a 4-week SOAR program. This included: 1) Knee Camp (group education, 1:1 exercise and activity goal-setting); 2) weekly home-based exercise and activity program with tracking, and; 3) weekly 1:1 physiotherapy-guided action-planning. SOAR program feasibility was assessed with implementation (attrition, adherence, intervention fidelity), practicality (adverse events, goal completion), acceptability and efficacy (change in Knee injury and Osteoarthritis Outcome Score subscales, Patient Specific Functional Scale (PSFS), Godin Leisure-Time Exercise Questionnaire (GLTEQ), Partner in Health Scale (PHS)) outcomes. Descriptive statistics, disaggregated by gender, were calculated. ResultsThirty participants (60% women, median (min-max) age 30 years (19–50), time from injury 5.6 years (1.2–25.2)) were enrolled. No participant attrition or adverse events were reported, and 90% of mandatory program components were completed. Participants rated their adherence at 80%, and 96% of exercise-therapy and 95% of activity goals were fully or partially achieved. Both women and men reported significant group mean (95%CI) improvements in GLTEQ scores (women: 22 METS (6,37), men: 31 METS (8,54)), while women alone reported improvements in PHS (−7 (−11,-3) and PSFS (1.7 (0.6,2.8) scores. ConclusionThe SOAR program is feasible for persons at various timepoints post-knee trauma, and gender may be an important consideration for SOAR implementation and assessment. A randomized controlled trial to assess intervention efficacy is warranted.

Empagliflozin improves quality of life in nondiabetic HFrEF patients. Sub-analysis of the EMPATROPISM trial

Background and aimsInitially considered as just anti-diabetic agents, SGLT2-i show remarkable cardiac and renal benefits independently of its hypoglycemic activity. MethodsWe used the Kansas City Cardiomyopathy Questionnaire (KCCQ), which has recently been qualified as a Clinical Outcome Assessment, in the EMPATROPISM trial. ResultsA significant mean improvement of 22 points with KCCQ was seen with Empagliflozin versus only 2 points in the Placebo. The proportion of patients experiencing clinically important changes in the Empagliflozin group was higher. Patients with the lowest starting KCCQ score saw significantly greater improvements. ConclusionsEmpagliflozin benefits quality of life in the non-diabetic, ethnic minority represented, EMPATROPISM trial population.

Combined prick and patch tests for diagnosis of food hypersensitivity in dogs with chronic pruritus.

Previous studies have shown that patch testing with food extracts can assist formulation of elimination diets (ED) in human patients with suspected adverse food reactions (AFR). Little is known about the use of these tests in dogs. To evaluate the effectiveness of a combination of prick and patch testing in current protocols, and food challenge (FC) tests in dogs with AFR. Prick and patch tests were performed on 21 dogs with chronic, nonseasonal pruritus. Dogs then were fed an ED formulated on the basis of the results. All dogs with improved clinical signs then were challenged with a food to which there had been a positive reaction in the tests. Six dogs subsequently were challenged with a food to which they had been negative on testing. Pruritus Visual Analog Scale (pVAS) and Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) were evaluated on Day (D)0, D30 and D60 of the ED. Sensitivity (SE), specificity (SP), positive (PPV) and negative (NPV) predictive values, and the Kappa (κ)value were calculated. Of the 21 dogs, there was a significant mean improvement in pVAS and CADESI-04 scores in 16 (76%) dogs after D30 (P < 0.01) and D60 (P < 0.01) of the ED. There were no statistical differences between D30 and D60. The combination of tests had SE, SP, PPV, NPV and κ values of 80%, 66.7%, 66.7%, 80% and -0.17, respectively. The combination of prick and patch testing reached high values of SE and NPV. A diagnosis of AFR was made in 76% of the dogs, and test results were useful for the selection of an ED.

Assessing the Impact of Interactive Educational Videos and Screencasts Within Pre-clinical Microanatomy and Medical Physiology Teaching.

Modern medical curricula adopt the use self-directed learning approaches, which frequently include the use of technology enhanced learning resources. Often, students prefer those which are available via mobile devices because it can facilitate flexibility and autonomy with their learning, more so than with traditional modalities. Although the production value of resources may be appealing to users, those that work most effectively for education align well to existing pedagogies. One such pedagogy is the cognitive theory of multimedia learning. It is a framework that can be used to facilitate the construction of educational video, that can benefit learning gain through reducing the cognitive load.Although much research has been conducted on how information should be presented in video resources, there is very limited evidence within the subject of clinical anatomy and physiology or when applying different types of educational video, such as screencasts, or interactive video. In the field of anatomy education recent approaches have sought to standardize a robust methodology to evaluate digital resources. This procedure utilizes a combination of normalized learning gain and learner perceptions to gain an accurate picture of educational impact.The current study investigated the impact of both interactive educational videos and screencasts compared with traditional teaching techniques in the challenging subjects of histology and pain physiology. A quasi-randomized, cross-sectional study was conducted with 135 medical students enrolled at the University of Southampton. Sixty fourth- and fifth-year students assessed the histology resources, and 75second-year students assessed the pain histology resources. Participants were randomly assigned to either a text-based resource, interactive video, or screencast group. Outcomes measured were: 1. Normalized knowledge gain (and retention) assessed using one-best-answer multiple choice question tests 2. Student perceptions using 1-10 Likert-scale style questionnaires. A significant improvement in mean normalized knowledge gain was observed for all teaching modalities. For pain physiology, the means were: Text-49.0% (n=23), interactive video-70.1% (n=26), and screencast-53.8% (n=26). For all learning gains, P<0.001. For histology, there was a mean normalized learning gain for text-80.0% (n=20), interactive video-74.4% (n=20), and screencast groups-68.3% (n=20). For all learning gains, P<0.001.For pain physiology resources, interactive videos significantly improved learning gain compared to the screencast (P<0.05) and the text resource groups (P<0.01). There was no significant difference between those who used the text or screencast resources. There was also no significant difference in knowledge retention between the different teaching methods for each subject.Following teaching, all three teaching modalities had similar effects on student confidence in the subjects, desire for educational channels dedicated to each topic, and preference for locally produced vs. externally produced videos. These findings have the potential to inform educators on which types of resources to create or to select for their students to have the best impact on learning.