Significant Reduction In Scores Research Articles

Quetiapine Oral Solution in Alzheimer's Disease: Efficacy and Dosage Insights from a Real-World Retrospective Study.

Neuropsychiatric symptoms (NPS) are distressing for patients with dementia, often accelerating functional decline and nursing home placement. Medications such as quetiapine are used to alleviate NPS, but their side effects require cautious use. Liquid formulations such as quetiapine oral suspension suit specific populations; however, real-world data on their use in patients with dementia are limited. The purpose of this retrospective, naturalistic study was to provide preliminary data on the effects of treatment with quetiapine oral suspension on behavioral and psychiatric disturbances in Alzheimer's disease (AD) outpatients in Taiwan. Between January 2022 and June 2023, data were collected from outpatients with a diagnosis of probable AD who received treatment with Qting® (quetiapine oral solution 25 mg/ml). Primary outcome measures were changes in Neuropsychiatric Inventory (NPI) total score and its sub-items from baseline to the endpoint. We recruited 66 AD patients with a mean age of 72.1±7.6 years, most of whom were female (69.7%). Twenty-three patients had data on neuropsychological test and NPI scores before and after quetiapine treatment. There was no significant change in global cognitive function from baseline to the endpoint. A significant reduction in NPI total score after quetiapine treatment was noted, while the effect on NPI sub-items was limited. The average maintenance dose was 1.5±0.6 ml. We demonstrated our clinical experience of the use of quetiapine oral solution in AD patients with NPS. Our results showed that quetiapine oral solution treatment significantly improved these symptoms at a relatively low dose.

Effect of intermittently scanned continuous glucose monitoring in people with diabetes with a psychosocial indication for initiation.

To understand the effect of intermittently scanned continuous glucose monitoring (isCGM) in people with diabetes with a 'psychosocial' indication for access. The study utilized baseline and follow-up data from the Association of British Clinical Diabetologists nationwide audit of people with diabetes in the UK. Diabetes-related distress (DRD) was assessed using the two-item diabetes-related distress scale (DDS). Participants were categorized into two groups: high DRD (DDS score ≥ 3) and lower DRD (DDS score < 3). The t-test was used to assess the difference in the pre- and post-isCGM continuous variables. The study consisted of 17 036 people with diabetes, with 1314 (7%) using isCGM for 'psychosocial' reasons. Follow-up data were available for 327 participants, 322 (99%) of whom had type 1 diabetes with a median diabetes duration of 15 years; 75% (n = 241) had high levels of DRD. With the initiation of isCGM, after a mean follow-up period of 6.9 months, there was a significant reduction in DDS score; 4 at baseline versus 2.5 at follow-up (P < .001). The prevalence of high DRD reduced from 76% to 38% at follow-up (50% reduction in DRD, P < .001). There was also a significant reduction in HbA1c (78.5 mmol/mol [9.3%] at baseline vs. 66.5 mmol/mol [8.2%] at follow-up; P < .001). This group also experienced an 87% reduction in hospital admissions because of hyperglycaemia/diabetic ketoacidosis (P < .001). People with diabetes who had isCGM initiated for a psychosocial indication had high levels of DRD and HbA1c, which improved with the use of isCGM.

Impact of Crisaborole in Treatment-Experienced Patients With Mild-to-Moderate Atopic Dermatitis.

Background: Crisaborole ointment, 2%, is a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of patients with mild-to-moderate atopic dermatitis (AD). Objective: To assess the efficacy and safety of crisaborole in patients with AD who had received prior treatment with (a) corticosteroids (systemic or topical) or topical calcineurin inhibitors (TCIs) or (b) topical corticosteroids (TCSs) or TCIs or (c) who were treatment-naive (TN). Methods: This post hoc analysis comprised patients aged ≥2 years with mild-to-moderate AD. Patients were assigned (2:1) to receive crisaborole or vehicle twice daily for 28 days. Patient response was assessed with the Investigator's Static Global Assessment (ISGA), Dermatology Life Quality Index (DLQI), Children's Dermatology Life Quality Index (CDLQI), and Dermatitis Family Impact (DFI) tools. Safety was also assessed. Results: A significantly higher percentage of patients treated with crisaborole versus vehicle achieved ISGA success regardless of treatment history. Patients treated with crisaborole had significant reductions in DLQI, CDLQI, and DFI scores versus those who received vehicle regardless of treatment history, with the exception of DLQI and DFI scores in the TN group. Crisaborole was well tolerated in all subgroups. Conclusion: Crisaborole demonstrated a favorable efficacy and safety profile in both treatment-experienced and TN patients. ClinicalTrials.gov, NCT02118766 and NCT02118792.

Prevalence and odds of anxiety and depression in cutaneous malignant melanoma: a proportional meta-analysis and regression.

The psychological burden of cutaneous malignant melanoma (CM) is all-encompassing, affecting treatment adherence, recurrence and mortality. However, the prevalence and risk factors of anxiety and depression in CM remain unclear. To establish a benchmark pooled prevalence of anxiety and depression in CM, to provide magnitudes of association for clinical, therapeutic and demographic correlates, and to elucidate temporal trends in anxiety and depression from the time of diagnosis. This review followed the MOOSE guidelines. MEDLINE, Embase, PsychINFO, Web of Science and the Cochrane Library were queried from database inception to 24 August 2023. Study selection, data extraction and quality assessment were performed by two independent authors, utilizing both the Joanna Briggs Institute (JBI) and National Institutes of Health risk-of-bias tools for the latter. The GRADE approach was used to rate the certainty of evidence. Prevalence rates, 95% confidence intervals (CIs) and prediction intervals (PIs) were derived using a random-effects model and estimating between- and within-study variance. Nine longitudinal and 29 cross-sectional studies were included (7995 patients). Based on the JBI and NIH tools, respectively, quality assessment found 20 and 17 to be at low risk of bias, 12 and 15 to be at moderate risk and 6 and 5 to be at high risk of bias. The prevalence of anxiety [30.6% (95% CI 24.6-37.0; PI 18-47%)] and depression [18.4% (95% CI 13.4-23.9; PI 10-33%)] peaked during treatment, declining to pretreatment levels after 1 year [anxiety: 48% vs. 20% (P = 0.005); depression: 28% vs. 13% (P = 0.03)]. Female sex [odds ratio (OR) 1.8, 95% CI 1.4-2.3; P < 0.001], age < 60 years (OR 1.5, 95% CI 1.2-2.0; P = 0.002) and low educational level (OR 1.5, 95% CI 1.2-2.0; P < 0.001) were likely to result in a large increase in the odds of anxiety. Depression was 12.3% higher in those with stage IV vs. those with stage I CM (P = 0.05). Relative to immune checkpoint inhibition, the rates of depression were 22% (P = 0.002) and 34% (P < 0.001) higher among patients with advanced-stage CM receiving interferon-α and chemotherapy, respectively. A significant reduction in self-reported depression scores was demonstrated over time (P = 0.003). Notably, anxiety and depression in CM affect women, those younger than 60 years of age and the less educated, with up to 80% higher odds of anxiety in these groups. Anxiety and depression surge during chemotherapy and interferon treatment, especially in advanced CM. Our findings facilitate risk stratification and underscore the need for multidisciplinary vigilance.

Intraoperative Protection of Pharyngeal Autonomic Nerves: Preventing Dysphagia After Anterior Cervical Decompression and Fusion Surgery

The study aims to investigate whether intraoperative protection of the pharyngeal autonomic nerve can effectively reduce the incidence of postoperative dysphagia following anterior cervical decompression and fusion surgery (ACDF). A retrospective analysis was conducted on 130 cases that underwent ACDF from January 2018 to June 2022 at our hospital. Divided into nonautonomic neuroprotection (NANP) group and autonomic neuroprotection group based on whether receive protective measures for the pharyngeal autonomic nerve during surgery. General data were recorded and compared between the 2 groups. Postoperative outcomes were evaluated using Neck Disability Index, Japanese Orthopaedics Association (JOA) score, and JOA improvement rate. The incidence and severity of postoperative dysphagia were assessed using Bazaz dysphagia assessment criteria and swallowing-quality of life questionnaire. There were no significant differences in general data (P > 0.05). The average operation time and intraoperative blood loss also showed no significant differences (P > 0.05). Both groups showed significant improvements in Neck Disability Index and JOA scores at all follow-up time points compared to preoperative scores (P < 0.01). The incidence of postoperative dysphagia in the autonomic neuroprotection group was significantly lower than that in the NANP group at all follow-up time points (P< 0.05). Both group showed a significant reduction in scores 3 days postoperatively compared to preoperative scores (P < 0.01), and the NANP group also showed significant reductions in scores at 3 month and 1 year postoperative follow-up time points compared to preoperative scores (P < 0.01). The adoption of pharyngeal autonomic nerve protective measures during ACDF can effectively lower the probability of postoperative dysphagia.

Pharmacy and nursing students' stigma and perceptions toward individuals with mental illness impacted through interaction with a website featuring lived experiences

AbstractIntroductionDespite its high prevalence and negative impact, mental illness is often sub‐optimally treated, in part, due to stigma among health care professionals. Future health care professionals are at the forefront of a potential solution for the provision of stigma‐free, equitable mental health care. Innovative approaches to reducing the stigma toward individuals with mental illness are needed. One approach is utilization of the SNAP the Stigma website (www.snapthestigma.com), a collection of photos and reflections by individuals with lived experiences with mental illness.ObjectiveThis study was conducted to address the question: Does interacting with the SNAP the Stigma website impact pharmacy and nursing students' perceptions and social distance preference toward an individual with mental illness?MethodsA pre‐ and post‐survey employed the Bogardus social distance scale (SDS) to assess stigma toward a vignette individual before and after website interaction. In the post‐survey, participants reflected on one or more posts from the website that impacted them. A qualitative analysis was performed to identify themes from the responses.ResultsA statistically significant reduction in total SDS scores occurred as a result of interaction with SNAP. Three themes were derived including symbolism of mental illness, increased empathy/reduced stereotyping, and lessons regarding what a health care professional can do and offer.ConclusionThese findings suggest that use of the SNAP website as a stigma‐reduction intervention could be a valuable tool for current and future health care professionals to decrease stigma toward those with mental illness and to build intentionality toward empathic and non‐discriminatory behavior in health care practice.

Training using a commercial immersive virtual reality system on hand–eye coordination and reaction time in students: a randomized controlled trial

The implementation of VR games opens up a wide range of opportunities for the development of dexterity, speed and precision of movements among various professional groups. The aim of this study was to investigate the effects of a commercial immersive VR music game on hand–eye coordination and reaction time speed in students. This study enrolled 32 individuals, randomly assigned to the experimental or control group. The intervention consisted of a 15-min training session of the immersive music game “Beat Saber”, once a day for 5 consecutive days. The primary outcomes included reaction time measurements: the plate tapping test and the ruler-drop test (Ditrich's test), trial making test (TMT) A and TMT B to assess coordination and visual attention, likewise VR sickness assessment by Virtual Reality Sickness Questionnaire (VRSQ). The secondary outcome included an energy expenditure assessment (SenseWear Armband). The data analysis revealed a statistically significant improvement in hand–eye coordination in the experimental group, with no improvement in the control group. The results were similar in measurements of reaction time. Analysis of the VRSQ questionnaire results showed a statistically significant reduction in oculomotor domain symptoms and total score during successive training days. The immersive VR music game has the potential to improve reaction time and hand–eye coordination in students.Graphical abstract

Exploratory analysis of the effectiveness of virtual reality in cardiovascular rehabilitation

Virtual reality therapy has been shown to be effective in coping with psychological disorders accompanied by cardiovascular disease. Age appears to be a factor that can affect the effectiveness of psychological therapy in a virtual environment. Therefore, the aim of the study was to explore whether there are age-related differences in the effectiveness of reducing levels of depression and anxiety during a virtual reality psychological intervention implemented for rehabilitation. The study included 25 younger (< 65 years) and 25 older (65 +) patients with cardiovascular disease who participated in virtual reality therapy to cope with anxiety and depression. The Hospital Anxiety and Depression Scale was used to assess anxiety and depressive disorders before and after intervention. Significant reductions in anxiety and depression scores after intervention were observed in both age-matched groups, and no significant differences were found between the younger and older participants. Further evaluation of patient age as a predictor of the effectiveness of psychological intervention in virtual reality did not show a significant effect of age on effectiveness in reducing anxiety and depressive disorders. The results obtained suggest that older patients benefit similarly to younger patients from psychological intervention in a virtual environment. Furthermore, age does not appear to be considered a predictor of effectiveness in reducing the level of anxiety and depression in patients with cardiovascular disease using virtual reality therapy.

Efficacy and Safety of Bacillus coagulans LBSC in Drug Induced Constipation Associated With Functional Gastrointestinal Disorder: A Double-Blind, Randomized, Interventional, Parallel, Controlled Trial a Clinical Study on Bacillus coagulans LBSC for Drug Induced Constipation Associated With FGIDs.

Active drugs and nutraceutical supplements commonly induce various gastrointestinal illnesses, and constipation is a major gastrointestinal symptom accompanied with functional gastrointestinal disorders. Drug-induced imbalance in gut microbiota may play critical role in such physiological disturbances. Probiotics have been known for resuming normal and healthy gut microbiome. To investigate the clinical efficacy and safety of Bacillus coagulans LBSC in the treatment of drug induced constipation associated with functional gastrointestinal disorder (FGID) symptoms. A prospective, interventional, randomized, double-blind, parallel, multi-arm, controlled trial with 168 patients experiencing drug induced constipation associated with FGID symptoms (DICAWFGID) screened through Rome IV criteria were randomized into 2 arms, i.e. placebo arm (n = 28) and atorvastatin, atenolol, metformin, amitriptyline, and calcium in test arm (n = 28/arm). Patients in both arms received similar dosages (1g sachet, 3 times a day) for 35 days. The occurrence of constipation using Bristol Stool Form Scale, assessment of degree of constipation on 4-point Likert scale, occurrence of hard stool and degree of stool expulsion on 3-point scale, and defecation frequency were primary endpoints. While, secondary outcomes consisted of the changes in severity of FGID symptoms, visual analogue scale and tolerance to IP, along with reports of adverse events (AEs) and severe adverse events (SAEs). There was a significant reduction in occurrence of constipation (≥98.6% and P-value <0.05) in test arm over the placebo arm. Assessment of co-primary endpoints showed significant improvements in degree of stool consistency (P-value 0.0232; CI: 0.1870, 1.1629), borderline significantly superior in degree of stool expulsion (P-value 0.0553; CI: 0.0378, -0.4939), while the other co-primary efficacy endpoints displayed considerably improved advancement (non-significant, P-value ≥0.05). The intra group analysis of symptoms at start of treatment (SOT) and end of treatment (EOT) revealed a significant reduction in scores for occurrence of constipation and degree of constipation, whereas significant improvement in the scores for degree of stool consistency and degree of stool expulsion (P-value <0.001) after the intervention period. In secondary endpoints, the processed responses clearly signified a considerable positive improvement (non-significant, P-value ≥0.05) in other symptoms of constipation associated with FGIDs as determined by the changes in the EOT-SOT score. The study data also highlighted the safety of Bacillus coagulans LBSC at the studied dose. No AEs and/or SAEs were documented during the investigation. At the studied dose, Bacillus coagulans LBSC was safe for oral consumption and effective in the management of the drug induced constipation associated with FGIDs symptoms.

Ayurvedic management of acute calcaneal spur with Viddhakarma and Siravedha: A case report

The feet are a highly dependent yet most neglected part of the body. The negligence may result in various levels of discomforts and associated heel pain. Abnormal pressure over foot muscles and ligaments may lead to chronic plantar heel pain and further development of calcaneal spur, which are the most encountered orthopedic problems. Various modern treatment options are available for the management of calcaneal spur, but either they involve longer duration or are expensive. Hence, there is a need to opt treatment approaches that may provide satisfactory results with minimum adversities. Viddhakarma (~therapeutic needle-piercing) and Siravedha (~therapeutic bloodletting) are the therapies of Ayurveda origin, with proven efficacy in pain management and can be used in conditions such as calcaneal spur. A 42-year-old female patient presented to the outdoor patient department in the hospital on August 17, 2022, complaining of sharp pricking pain with heat sensation in the right heel, morning stiffness in bilateral heels, and difficulty in walking for four days. On assessment, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), and Foot Function Index Scale for the right foot of the patient were scored 47, 9 and 127, respectively. The X-ray of the bilateral foot (anterio-posterior and lateral view) showed an inferior bony spur projecting forward from calcaneal tuberosity more on the right side than on the left. The patient was treated with Viddhakarma, Siravedha of the right foot, along with oral Ayurvedic medicines. On completion of the treatment, the WOMAC and VAS scores were reduced significantly to 37 and 6, respectively. Further, there was a significant reduction in the Foot Function Index scale score to 96 within ten days of the treatment. Based on the clinical observations, it may be inferred that a combination of Viddhakarma, Siravedha, and oral Ayurvedic medicines can be safe, convenient, and effective in managing patients suffering from calcaneal spur. Both of these procedures can be performed by trained health-care professionals on an outpatient basis, thus convenient to the sufferers too.

Effectiveness of Plaque Removal Using Different Toothbrushes in Children - A Comparative Study.

Effective plaque control is essential for improved oral health. Advancements in mechanical plaque removal using toothbrushes still continue. One such sophisticated intervention is the app-based toothbrush, a new innovative technology that helps to track the child's brushing habits. The aim of this study is to evaluate the plaque removal efficacy of three different toothbrushes in children aged 6-8 years. A randomized controlled clinical trial was conducted among primary school children with decayed missing filled teeth (dmft) score of ≤2. Baseline plaque score was collected using Turesky modification of the Quigley and Hein Index 1 week after oral prophylaxis. Children were randomly divided into three groups. Group I received conventional toothbrush (n = 25), group II received powered toothbrush (n = 25), and group III received app-based toothbrush (n = 25). Post-intervention plaque score, toothbrush wear and bite mark scores were done at the 15th, 30th, 45th and 90th day. Participant's opinion on their toothbrushes was evaluated using a questionnaire. App-based toothbrush showed maximum plaque reduction followed by powered and conventional toothbrush. Significant reduction in plaque score was seen at 30th-, 45th- and 90th-day follow-up in group II (<0.001) and group III (<0.001). There was no appreciable difference in the toothbrush wear and bite mark score between the three groups. Children preferred app-based toothbrush in spite of the complex nature of using it.

Effects of integrated nursing and psychological intervention on pain relief and patient satisfaction in urinary calculi patients.

We aimed to assess the impact of integrated nursing and psychological intervention on pain intensity and patient satisfaction in individuals with urinary calculi. This retrospective study included 94 urological patients from the Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, between January 2020 and June 2022. Participants were divided into a control group (n=48), receiving routine nursing and psychological intervention, and a study group (n=46), receiving integrated nursing and psychological intervention. We compared pain intensity, pain relief rate, patient satisfaction, Numeric Rating Scale (NRS) score, Pittsburgh Sleep Quality Index (PSQI) score, Self-rating Depression Scale (SDS) score, Self-rating Anxiety Scale (SAS) score, and quality of life scores between the groups. The study group had shorter hospital stays and lower hospitalization costs than the control group (both P < 0.05). Pain relief and satisfaction rates were higher in the study group (both P < 0.05). Post-intervention, both groups showed significant reductions in NRS, PSQI, SDS, and SAS scores, with greater reductions in the study group (all P < 0.05). Quality of life scores increased in both groups, more so in the SG (P < 0.05). The study group also had fewer adverse events (P < 0.05). Both groups showed decreased serum creatinine and blood urea nitrogen levels post-intervention, with a more significant decline in the study group (P < 0.05). Education, marital status, and occupation were major factors influencing outcomes in urinary calculi patients. Integrated nursing and psychological intervention significantly alleviates pain, improves emotional well-being, enhances sleep quality, increases overall life quality, and contributes to high patient satisfaction among urinary calculi patients.

Evaluating the Efficacy of a Multifaceted Health Behavior Training Program on Psychological Distress

This study aimed to assess the effectiveness of a comprehensive Health Behavior Training Program in reducing psychological distress among adults. The program, integrating cognitive behavioral therapy, mindfulness, stress management, and health education, sought to provide participants with effective tools to manage distress and improve overall well-being. A randomized controlled trial design was employed, involving 50 participants with mild to moderate psychological distress, randomly assigned to either the experimental group receiving the Health Behavior Training Program or a control group receiving no intervention. The intervention consisted of 8 weekly sessions, each lasting 90 minutes. Psychological distress was measured at baseline, post-intervention, and at a three-month follow-up using the Kessler Psychological Distress Scale (K10). The experimental group exhibited a significant reduction in psychological distress scores from pre-test (Mean = 33.81, SD = 4.19) to post-test (Mean = 27.44, SD = 4.42) and maintained these improvements at the three-month follow-up (Mean = 27.39, SD = 4.37). In contrast, the control group showed no significant changes in distress scores over time. Analysis of variance with repeated measurements indicated significant effects of time (F(2) = 6.33, p &lt; 0.01), group (F(1) = 7.10, p &lt; 0.01), and their interaction (F(2) = 6.40, p &lt; 0.01) on psychological distress scores, underscoring the effectiveness of the intervention. The Health Behavior Training Program significantly reduced psychological distress among participants compared to a control group, with sustained effects at a three-month follow-up. These findings support the implementation of multifaceted health behavior interventions as effective tools for managing psychological distress and enhancing mental health outcomes.

Managing Bullwhip Effect in Acoustic Guitar Manufacturing: A Case Study Through Vendor Managed Inventory (VMI) Approach

The Bullwhip Effect is a condition where differences arise between the supply and demand numbers within supply chain management. This acoustic guitar manufacturing faces challenges resulting from demand fluctuations, supply chain complexities, and inventory inefficiencies, which often lead to the Bullwhip Effect. The company experiences fluctuations in both demand and supply, consequently leading to inventory accumulation in its warehouses. This study aims to reduce the Bullwhip Effect score in acoustic guitar manufacturing by implementing the Vendor Managed Inventory (VMI) method. VMI acts as a regulatory mechanism during distribution, ensuring better control over dispatched products by incorporating forecasting techniques such as single exponential smoothing, double exponential smoothing, and linear regression. Before implementing VMI, the Bullwhip Effect scores were 1.42 for Retailer 1 and 1.69 for Retailer 2. After the successful implementation of VMI, significant reductions in the Bullwhip Effect scores were observed, with scores of 0.48 and 0.91 recorded for Retailer 1 and Retailer 2, respectively.

Efficacy of combined use of Tetradium ruticarpum (A. juss.) patch and Chinese massage (tuina) for the treatment of insomnia in elderly chronic heart failure patients

Introduction/Objective. The objective of the paper was to evaluate the efficacy of Tetradium ruticarpum (A. Juss.) patch (TRP) in combination with Chinese massage (tuina) for the treatment of insomnia in elderly patients with chronic heart failure (CHF). Methods. A cohort of 320 elderly CHF patients with comorbid insomnia, treated at the Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou Hospital from January 2019 to July 2022, were enrolled and equally divided into four groups (80 patients per group). The control group received standard pharmacological intervention with eszopiclone. Patients in the TRP group received TRP alone, while those in the tuina group received tuina therapy alone. Patients in the combined treatment group received both TRP and tuina therapy. All treatments lasted 14 days. Sleep quality was assessed at baseline and then on days 7 and 14 after treatment using the Pittsburgh Sleep Quality Index Scale (PSQI). Results. There were significant reductions in total PSQI scores in all groups on day 7 compared to baseline (p &lt; 0.05). On day 14, the combined treatment, tuina, and TRP groups showed significantly reduced total PSQI scores relative to baseline, while a reversal of this trend was seen in the control group (p &lt; 0.05). The combined treatment group had the lowest total PSQI scores on both days 7 and 14. Conclusion. The combined use of tuina and TRP may be effective in alleviating insomnia in elderly CHF patients. It resulted in consistent and sustained efficacy, potentially reducing the likelihood of drug resistance.

Deep Brain Stimulation with Double Targeting of the VIM and PSA for the Treatment of Rare Tremor Syndromes

Introduction: In tremor syndromes, pharmacological therapy is the primary treatment, but deep brain stimulation (DBS) is used when it is insufficient. We explore the use of DBS, focusing on the globus pallidus internus for dystonia and the ventral intermediate nucleus (VIM) for tremor conditions. We introduce the posterior subthalamic area (PSA) as a potential target, suggesting its efficacy in tremor reduction, particularly in rare tremor syndromes. We aim to evaluate the efficacy and safety of double targeting the VIM and PSA in rare tremor conditions, highlighting the limited existing data on this. Methods: Between 2019 and 2023, 22 patients with rare tremor syndromes were treated with bilateral DBS of the VIM and PSA. This case series consisted of 7 isolated head tremor, 1 hepatic encephalopathic tremor due to Abernethy syndrome, 2 voice tremor, 4 dystonic tremor, and 8 Holmes tremor (2 multiple sclerosis, 2 cerebellar insult, and 4 posttraumatic) patients. Patients’ preoperative and 12-month postoperative tremor scores were compared, and the optimum VIM and PSA stimulation areas were investigated. Results: There was a significant reduction in the mean TRS score from 3.70 (±0.57) to 0.45 (±0.68) after 12 months of surgery. Specific outcomes for different indications were observed: for head tremor, 6 of 7 patients showed a reduction in TRS scores to 0 points; the vocal tremor patients demonstrated improvement; this change was not statistically significant, which is likely to be due to the low number of patients in this subgroup; the dystonic tremor patients showed either complete tremor abolition or a reduction in TRS scores; the Holmes tremor patients showed an 80% reduction in TRS scores; and the hepatic encephalopathy tremor and Abernethy syndrome patients showed a 75% improvement in TRS scores. The stimulation parameters converged on the VIM and dorsal PSA. Complications included the need for electrode repositioning, infections requiring electrode removal and re-implantation, dysarthria, and stimulation-induced ataxia, which was resolved by adjusting the stimulation parameters. Discussion: The literature on DBS for rare tremors is limited. Double targeting of the VIM and PSA appears to produce promising improvements on the outcomes reported in the existing literature on VIM-only DBS. The proximity of the VIM and PSA allows for flexible electrode placement, contributing to the potential success of the dual-target approach. We also discuss the theoretical advantages of targeting the PSA based on the distribution of tremor circuits, emphasizing the need for further research and electrophysiological studies.

Study of the therapeutic management of pollen allergy and assessment of quality of life of patients at Bengaluru Allergy Centre

Abstract INTRODUCTION: Pollen is one of the most common triggers of an allergy or hay fever. It is a fine yellowish powder that fertilizes other plants and is carried by the wind, birds, insects, or other animals. Between 10% and 40% of the Indian population has a pollen allergy which makes it one of the most common outdoor allergies in the country. In Bengaluru, 20% of allergies are caused by pollens – Parthenium, Amaranthus spinosus, Prosopis juliflora, and Ricinus communis. AIMS: The aim was to study the therapeutic management of patients who are allergic to pollen at Bengaluru Allergy Centre and assessment of the quality of life (QOL) of patients. SETTINGS AND DESIGN: It was a prospective, interventional study conducted at Bengaluru Allergy Centre. SUBJECTS AND METHODS: Both male and female patients who have had chronic allergic rhinitis (CH AR) and also CH AR with other comorbidities and who have been taking treatment for more than 6 months are involved. The data were collected from case records of patients in the data collection form. Questionnaires were used to assess the QOL, and counseling was done to the pollen allergy patients. STATISTICAL ANALYSIS: A paired t-test was done using SPSS software for analyzing the P value, simple descriptive graphs, and pie charts, and the percentage was calculated. RESULTS: A total of 60 patients were enrolled in the study where 26 were male and 34 were female. The maximum number of patients was affected with weed pollen. Cynodon dactylon (13.97%) is the major sensitivity seen in patients. Sneezing, running nose, and itchy eyes are commonly seen in patients with AR due to pollens. The classification of AR with other comorbidities is CH AR (78.33%), CH AR + ANB (10%), CH AR + urticaria (6.66%), and CH AR + AD (5%). Patients’ symptoms were persistent at day (5%), night (8.33%), and both day and night (86.66%), whereas symptom severity in Bengaluru amounted to 41.66%, other than Bengaluru 16.66%, and both in and out of Bengaluru 41.66%. In Bengaluru Allergy Centre (BAC), the main treatment given is sublingual immunotherapy, nasal spray, vitamin supplements, pre- and probiotics, and influenza vaccine. Nasal and eye symptoms are commonly seen in patients with AR due to pollen, and QOL factors that significantly impacted were productivity at home/work, mental concentration, reading books or newspapers, outdoor life (e.g., sports and picnics), going out, visiting friends or relatives, sleeping, and tiredness. A decrease in the symptoms and an increase in the QOL were achieved by proper patient counseling and treatment. There is a significant reduction in symptom scores after the intervention. The intervention has a significant effect in reducing the symptom scores (t = 17.99, P &lt; 0.001). CONCLUSIONS: It can be concluded that intervention by clinical pharmacists by way of patient counseling can help improve the reduction of symptoms and QOL of patients.

A Delirium Prevention and Management Initiative: Implementing a Best Practice Recommendation for the NICU.

Medically complex infants experiencing NICU stays can be difficult to manage, exhibiting refractory agitation, disengagement, or both-all signs of delirium, which can present in a hypoactive, hyperactive, or mixed form. Though documented in other settings, delirium is under-recognized in NICUs. Pediatric studies show that a high percentage of patients with delirium are under the age of 12 months. Delirium is associated with increased ventilation days, hospital days, and costs. It negatively affects neurodevelopment and social interaction. Studies show that pediatric nurses are unprepared to recognize delirium. Our nurse-led multidisciplinary group created a best practice recommendation (BPR) focused on detecting delirium and minimizing risk through thoughtful sedation management, promotion of sleep hygiene and mobility, and facilitation of meaningful caregiver presence. Occasionally, medications, including melatonin and risperidone, are helpful. In 2019, we introduced this BPR to reduce delirium risk in our NICU. Practice changes tied to this initiative correlate with a significant reduction in delirium scores and risk including exposure to deliriogenic medications. A multidisciplinary care bundle correlates with decreased delirium screening scores in NICU patients.

Early complications and quality of life in patients with immediately loaded implant-supported maxillary partial rehabilitations: A prospective cohort study.

Immediate loading of dental implants is considered an excellent option to reestablish function and aesthetics in a short period of time, thereby reducing the psychological impact of edentulism. The aim of this study was to describe the incidence of complications in immediately loaded implant-supported single or partial maxillary provisional rehabilitations; to assess changes in patient quality of life (QoL); to evaluate patient overall satisfaction; and to determine whether the occurrence of complications affects these outcomes. Patients requiring partial rehabilitation with implants in the maxilla were included in a prospective cohort study. In all cases, implant-based restoration with an immediate loading protocol was indicated. A provisional restoration was placed within 72 hours after implant placement. Patient QoL was measured at the first appointment and just before placing the final restoration, using two validated questionnaires. All mechanical and biological complications occurring up until placement of the final restoration were documented. A descriptive and bivariate analysis of the data was performed. Thirty-five patients with 40 prostheses supported by 60 implants were analyzed. Three implant failures were observed, yielding a 95% survival rate. Five provisional prosthesis fractures and two prosthetic screw loosenings were recorded in four patients. A significant reduction in OHIP-14 score was observed. Likewise, significant differences were found in the results of the QoLFAST-10, with a mean difference in score of 7.3 between the initial and final evaluation. Patients receiving immediately loaded implant-supported single or partial maxillary provisional rehabilitations seem to have a low risk of developing early mechanical (13.3%) or biological complications (5%). These patients appear to experience significant improvement in QoL and report excellent overall satisfaction with the treatment received - though the occurrence of complications seems to affect these outcomes.

Effect of Yoga Nidra on Perceived Stress Section in Individuals with High Blood Pressure: A Quasi-experimental Study

Introduction: A persistently high level of stress can lead to a variety of diseases, such as anxiety, depression, sleeplessness, muscle discomfort, high Blood Pressure (BP) and a compromised immune system. Although 15% of adults in India suffer from hypertension, significant progress has been made in preventing and managing this condition. One alternative form of treatment that may help with stress management and BP regulation is Yoga Nidra. Aim: To assess the effect of Yoga Nidra on perceived stress in Individuals with High Blood Pressure. Materials and Methods: The present quasi-experimental study was conducted at various medical and physiotherapy Outpatient Departments (OPDs) in Veraval, Gujarat, India, from June 2021 to September 2022. A total of 49 individuals diagnosed with high BP, including both prehypertensive and hypertensive individuals (with BP &gt;120/80 mmHg), were selected. Essential demographic information was gathered from the participants, who were also asked to complete the Perceived Stress Scale (PSS) questionnaire. Participants were introduced to the concept of Yoga Nidra and provided with instructions on how to perform the Yoga Nidra technique. They engaged in 12 sessions of this technique. After completing these 12 sessions, participants once again completed the PSS questionnaire. Since the collected data did not exhibit a normal distribution, a paired t-test was conducted at a significance level of 95%. Results: Out of 49 study participants, 22 (45%) were females and 27 (55%) were males, and mean±Standard Deviation (SD) age was 47.86±10.62 years. The analysis revealed a significant reduction in PSS scores following the Yoga Nidra sessions (p-value=0.0001). Additionally, both Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) showed decrease with a p-value of 0.0001. Conclusion: Yoga Nidra has a significant effect on reducing perceived stress in individuals with high blood pressure, along with a reduction in blood pressure. This research provides valuable findings regarding the potential of Yoga Nidra as an additional relaxation therapy to help manage hypertension and enhance overall well-being.