Standard Of Care For Patients Research Articles

China’s national continuing medical education program for general practitioners: a cross-sectional survey (2016–2023)

BackgroundPursuing excellence in healthcare delivery systems is an ongoing process. In this process, continuing medical education (CME) is essential for medical professionals to maintain high standards of patient care. In China, where the healthcare sector is undergoing considerable reforms and faces challenges owing to socioeconomic development and demographic shifts, an effective CME system is vital for general practitioners (GPs).MethodsA cross-sectional survey of CME programs was conducted between 2016 and 2023. The external characteristics of the programs were systematically gathered and statistically analyzed. The programs were subsequently subjected to a competency-based assessment by using the six core competencies outlined by the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education as a framework. Furthermore, keywords were extracted for the CME program names based on the International Classification of Primary Care. Visual analysis was performed via VOSviewer software, facilitating a content-based evaluation of the programs.ResultsA total of 6,607 items were obtained. A total of 3,815 CME programs were subjected to statistical analysis, and 2,895 CME programs were comprehensively evaluated for content and capability. A diverse range of CME providers were identified, with hospitals and publishing/education companies being the primary providers. Since 2019, a significant increase in online CME offerings has been noted. However, the regional distribution of the CME programs was uneven, with Shanghai, Zhejiang, and Beijing leading but western China lagging. Furthermore, most programs focused on patient care and medical knowledge in competency-based CME evaluations, with less emphasis on interpersonal and communication skills. Content-based CME evaluations revealed that the teaching focus is the diagnosis, treatment, and primary care management of elderly patients and chronic diseases such as diabetes and hypertension.ConclusionsOur findings underscore the essential role of CME in equipping GPs with the competencies required to navigate the evolving landscape of medical knowledge and practice, suggesting a more systematic, relevant, and individualized approach to training GPs. Therefore, there is an opportunity to increase the quality of primary care and contribute to the Healthy China 2030 Plan.

The Immune–Genomics of Cholangiocarcinoma: A Biological Footprint to Develop Novel Immunotherapies

Cholangiocarcinoma (CCA) represents approximately 3% of all gastrointestinal cancers and is a highly heterogeneous and aggressive malignancy originating from the epithelial cells of the biliary tree. CCA is classified by anatomical location into intrahepatic (iCCA), extrahepatic (eCCA), gallbladder cancer (GBC), and ampullary cancers. Although considered a rare tumor, CCA incidence has risen globally, particularly due to the increased diagnosis of iCCA. Genomic and immune profiling studies have revealed significant heterogeneity within CCA, leading to the identification of molecular subtypes and actionable genetic alterations in 40–60% of cases, particularly in iCCA. Among these, FGFR2 rearrangements or fusions (7–15%) and IDH1 mutations (10–20%) are common in iCCA, while HER2 amplifications/overexpression are more frequent in eCCA and GBC. The tumor-immune microenvironment (TIME) of CCAs plays an active role in the pathogenesis and progression of the disease, creating a complex and plastic environment dominated by immune-suppressive populations. Among these, cancer-associated fibroblasts (CAFs) are a key component of the TIME and are associated with worse survival due to their role in maintaining a poorly immunogenic landscape through the deposition of stiff extracellular matrix and release of pro-tumor soluble factors. Improved understanding of CCA tumor biology has driven the development of novel treatments. Combination therapies of cisplatin and gemcitabine with immune checkpoint inhibitors (ICIs) have replaced the decade-long standard doublet chemotherapy, becoming the new standard of care in patients with advanced CCA. However, the survival improvements remain modest prompting research into more effective ways to target the TIME of CCAs. As key mechanisms of immune evasion in CCA are uncovered, novel immune molecules emerge as potential therapeutic targets. Current studies are exploring strategies targeting multiple immune checkpoints, angiogenesis, and tumor-specific antigens that contribute to immune escape. Additionally, the success of ICIs in advanced CCA has led to interest in their application in earlier stages of the disease, such as in adjuvant and neoadjuvant settings. This review offers a comprehensive overview of the immune biology of CCAs and examines how this knowledge has guided clinical drug development, with a focus on both approved and emergent treatment strategies.

Do Ventilator Bundles Reduce Ventilator-Associated Pneumonia? A Meta-Analysis of Randomized Controlled Trials

Background: Ventilator-associated pneumonia (VAP) is a serious complication in mechanically ventilated patients, leading to increased morbidity, mortality, and healthcare costs. Ventilator bundles are evidence-based practices aimed at preventing VAP. This meta-analysis evaluated the effectiveness of ventilator bundles in reducing VAP incidence in critically ill adults. Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted from January 2013 to December 2024. Randomized controlled trials (RCTs) comparing ventilator bundles to standard care in adult patients receiving mechanical ventilation were included. The primary outcome was the incidence of VAP. Secondary outcomes included mortality, length of intensive care unit (ICU) stay, and duration of mechanical ventilation. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: Nine RCTs involving 2,850 patients met the inclusion criteria. The implementation of ventilator bundles was associated with a significant reduction in VAP incidence (RR 0.68, 95% CI 0.55-0.84, p=0.0002). Mortality (RR 0.89, 95% CI 0.75-1.05, p=0.16) and duration of mechanical ventilation (mean difference -1.2 days, 95% CI -2.8 to 0.4, p=0.13) did not significantly differ between groups. However, a significant reduction in ICU length of stay was observed in the ventilator bundle group (mean difference -2.1 days, 95% CI -3.5 to -0.7, p=0.004). Conclusion: This meta-analysis demonstrates that ventilator bundles are effective in reducing VAP incidence in critically ill adults. While no significant impact on mortality was observed, ventilator bundles were associated with a shorter ICU length of stay. These findings reinforce the importance of implementing ventilator bundles as a standard of care in ICUs to improve patient outcomes.

Human leukocyte antigen and donor-specific antibodies in liver transplantation.

In this article, we comment on an article published in a recent issue of the World Journal of Gastroenterology. We specifically focus on the roles of human leukocyte antigen (HLA) and donor-specific antibodies (DSAs) in pediatric liver transplantation (LT), as well as the relationship between immune rejection after LT and DSA. Currently, LT remains the standard of care for pediatric patients with end-stage liver disease or severe acute liver failure. However, acute and chronic rejection continues to be a significant cause of graft dysfunction and loss. HLA mismatch significantly reduces graft survival and increases the risk of acute rejection. Among them, D→R one-way mismatch at three loci was significantly related to graft-versus-host disease incidence after LT. The adverse impact of HLA-DSAs on LT recipients is already established. Therefore, the evaluation of HLA and DSA is crucial in pediatric LT.

Stability comparison of prasugrel tablets unit‐dose packaged versus maintained in the manufacturer container over 90 days

AbstractBackgroundUnit‐dosing medications can improve time to drug administration and patient safety in inpatient settings. No available information supports the practice of unit‐dosing for prasugrel.AimThe stability of unit‐dosed prasugrel tablets was evaluated against tablets maintained in the manufacturer container.MethodThree lots of 10 mg prasugrel tablets were packaged as individual unit‐doses and stored at room temperature. Tablets were analysed for prasugrel concentration over a 90‐day period and compared against control tablets retained in the manufacturer's container. Prasugrel was quantified using a previously validated stability‐indicating high‐performance liquid chromatography method with ultraviolet detection. Experimental lots were monitored for >10% loss of potency. A non‐linear one‐phase decay curve was used to describe drug potency changes in experimental versus control tablets. Ethics approval was not required for this research article as it was a stability study and did not involve human subjects.ResultsAverage potency in all groups remained above 90% for the duration of the study; however, some individual experimental samples dropped below 90% at 7 days. Control tablets did not show a statistically significant potency change until 90 days. Modelling data indicated the ending average potencies in the experimental versus control tablets were 9.083 mg and 9.736 mg, respectively.ConclusionUnit‐dosing 10 mg prasugrel tablets has a negative effect on potency, which was most pronounced by day 7. The average potency remained above 9.00 mg over the 90‐day period. Conservative interpretation of these data may allow institutions to unit‐dose prasugrel tablets and discard after 72 h, when individual data points showed <90% potency. The decision to unit‐dose prasugrel must consider several factors surrounding patient care and individual institutional standards.

Multiomic analysis reveals cellular, transcriptomic and epigenetic changes in intestinal pouches of ulcerative colitis patients.

Total proctocolectomy with ileal pouch anal anastomosis is the standard of care for patients with severe ulcerative colitis. We generated a cell-type-resolved transcriptional and epigenetic atlas of ileal pouches using scRNA-seq and scATAC-seq data from paired biopsy samples of the ileal pouch and the ileal segment above the pouch (pre-pouch) from patients (male=4, female=2), and paired biopsies of the terminal ileum and ascending colon from healthy individuals (male=3, female=3) serving as reference. Our study finds previously uncharacterized populations of absorptive and secretory epithelial cells within the pouch but not the pre-pouch. These pouch- specific enterocytes express a subset of colon-specific genes, including CEACAM5 and CD24 . However, compared to normal colonocytes, expression of these genes is lower, and these enterocytes also express inflammatory and secretory genes while maintaining expression of some ileal-specific genes. This cell-type-resolved transcriptomic and epigenetic atlas of the ileal pouch establishes a reference for investigating pouch physiology and pathology.

A co-registration method to validate in vivo optical coherence tomography in the breast surgical cavity.

Breast-conserving surgery accompanied by adjuvant radiotherapy is the standard of care for patients with early-stage breast cancer. However, re-excision is reported in 20-30% of cases, largely because of close or involved tumor margins in the specimen. Several intraoperative tumor margin assessment techniques have been proposed to overcome this issue, however, none have been widely adopted. Furthermore, tumor margin assessment of the excised specimen provides only an indirect indication of residual cancer in the patient following excision of the primary tumor. Handheld optical coherence tomography (OCT) probes and their functional extensions have the potential to detect residual cancer in vivo in the surgical cavity. Until now, validation of in vivo OCT has been achieved through correlation with ex vivo histology performed on the specimen removed during surgery that is adjacent to the tissue scanned in vivo. However, this indirect approach cannot accurately validate in vivo imaging performance. To address this, we present a method for robust co-registration of in vivo OCT scans with histology performed, not on the main specimen, but on cavity shavings corresponding directly to the tissue scanned in vivo. In this approach, we use ex vivo OCT scans as an intermediary, surgical sutures as fiducial markers, and extend the in vivo field-of-view to 15×15mm2 by acquiring partially overlapping scans. We achieved successful co-registration of 78% of 139 in vivo OCT scans from 16 patients. We present a detailed analysis of three cases, including a case where a functional extension of OCT, quantitative micro-elastography, was performed.

Explainable Machine Learning to Predict Treatment Response in Advanced Non-Small Cell Lung Cancer.

Immune checkpoint inhibitors (ICIs) have demonstrated promise in the treatment of various cancers. Single-drug ICI therapy (immuno-oncology [IO] monotherapy) that targets PD-L1 is the standard of care in patients with advanced non-small cell lung cancer (NSCLC) with PD-L1 expression ≥50%. We sought to find out if a machine learning (ML) algorithm can perform better as a predictive biomarker than PD-L1 alone. Using a real-world, nationwide electronic health record-derived deidentified database of 38,048 patients with advanced NSCLC, we trained binary prediction algorithms to predict likelihood of 12-month progression-free survival (PFS; 12-month PFS) and 12-month overall survival (OS; 12-month OS) from initiation of first-line therapy. We evaluated the algorithms by calculating the AUC on the test set. We plotted Kaplan-Meier curves and fit Cox survival models comparing survival between patients who were classified as low-risk (LR) for 12-month disease progression or 12-month mortality versus those classified as high-risk. The ML algorithms achieved an AUC of 0.701 (95% CI, 0.689 to 0.714) and 0.718 (95% CI, 0.707 to 0.730) for 12-month PFS and 12-month OS, respectively. Patients in the LR group had lower 12-month disease progression (hazard ratio [HR], 0.47 [95% CI, 0.45 to 0.50]; P < .001) and 12-month all-cause mortality (HR, 0.31 [95% CI, 0.29 to 0.34]; P < .0001) compared with the high-risk group. Patients deemed LR for disease progression and mortality on IO monotherapy were less likely to progress (HR, 0.53 [95% CI, 0.46 to 0.61]; P < .0001) or die (HR, 0.30 [95% CI, 0.24 to 0.37]; P < .001) compared with the high-risk group. An ML algorithm can more accurately predict response to first-line therapy, including IO monotherapy, in patients with advanced NSCLC, compared with PD-L1 alone. ML may better aid clinical decision making in oncology than a single biomarker.

Tunneled Pleural Catheters: An Effective Nonsurgical Alternative for Nonexpandable Lung in Chronic Pleural Infection.

Open window thoracostomy (OTW) is the standard of care for debilitated patients with chronic pleural infection and nonexpandable lungs (NEL) who are not candidates for major surgical intervention. Tunneled pleural catheters (TPC) offer tremendous treatment potential in this setting based on their efficacy in malignant pleural effusion and NEL. We aim to assess the efficacy, safety, and health care utilization of TPC in this setting. We retrospectively evaluated patients who underwent TPC procedures for the long-term management of chronic pleural infection and NEL who were not candidates for major surgical intervention. Clinically, complete treatment success was defined as fever abatement, normalization of white cell count, and stoppage of antimicrobial therapy without requiring surgical intervention. It is deemed a partial success if chronic antimicrobial suppression is still needed. There were 20 patients who had TPC placed for chronic pleural infection with NEL. Clinical and partial treatment success was achieved in 9/17 and 8/17 patients, respectively, excluding 3 patients who were placed on comfort measures only. The median change in pleural volume was -218 mL. The median length of stay after TPC placement was 4.5 days. TPC was removed in 8 patients due to successful obliteration of pleural space in a median duration of 46.5 days. Four patients passed away with TPCs in place, 7 retained TPCs at the last health care system contact, and 1 patient had OTW due to TPC failure. This exploratory study suggests that TPC is an effective and safe intervention for the management of patients with chronic pleural infection and NEL lung who are not candidates for surgical intervention.

Early-Stadium Chronic Kidney Disease Patients Experiences of Self Management on A Cultural perspective: A Qualitative Study

Background : Self-management is the gold standard of care for early CKD patients which is useful for preventing complications and slowing down the decline in kidney function. The experience of early CKD patients in carrying out self-management is very important to improve the ability, independence and right decision making in carrying out self-management. This study aimed to explore the self-management experience in adults diagnosed early chronic kidney disease in culture perspective of Javanes.Methods : This study is a qualitative with a phenomenological approach, using semi-structured in-depth interviews with 27 adult patients diagnosed with early stage 1-3 chronic kidney disease. Data were analyzed using thematic analysis with the Colaizzi analysis method.Results : The results of the analysis reveal the experiences of early chronic kidney disease patients with self-management, consist of 4 main themes: 1) family support in self-management, 2) Care decision making with family, 3) unhealty eating habit, and 4) using traditional medicine in kidney health maintenance. Conclusion : The results of the study concluded that the Javanese culture that is in line with self-management in early chronic kidney disease patients is family relationships and traditional medicine. Family relationships in Javanese culture has high philosophical values ​​and supports health care. Traditional medicine is also still the choice of early chronic kidney disease patients with Javanese ethnicity in carrying out self-management. This study recommends the need for nursing interventions that are tailored to the patient's culture by integrating family care practices and traditional medicine to improve self-management in early chronic kidney disease patients.

Acupuncture Dosage and Its Correlation with Effectiveness in Patients with Chronic Stable Angina: A Systematic Review and Meta-Analysis of Randomized Controlled Trial.

This systematic review aimed to compare the efficacy of various acupuncture dosages for Chronic Stable Angina (CSA) using randomized controlled trials (RCTs), addressing the unclear relationship between dosage and effectiveness despite acupuncture's potential. We searched eight bibliographic databases from inception to October 31, 2024, evaluating RCTs comparing acupuncture to placebo or standard care for CSA patients, focusing on angina attack frequency as the primary outcome. Studies were categorized into high (HDG), moderate (MDG), and low (LDG) dosage groups based on acupuncture characteristics: the number of acupoints, total sessions, frequency per week, and the need for "Deqi". Of the 807 citations screened, 16 studies (1240 patients) were included: 3 studies in LDG, 10 in MDG, and 3 in HDG. Acupuncture significantly reduced angina attacks compared to placebo (SMD, -0.51; 95% CI [-0.77, -0.25], P = 0.0001, I 2=62%), and standard care (SMD, -1.25, 95% CI [-1.89, -0.61], P = 0.00001, I2 =92%) without increasing adverse events. MDG showed a notable difference in reducing angina attacks (SMD, -0.60, 95% CI [-0.91, -0.29], P = 0.001, I2 =60%) while LDG and HDG did not. There is no difference in adverse events between groups. The evidence quality ranged from very low to moderate, and the results should be cautiously applied. Acupuncture therapy effectively and safely alleviates CSA symptoms. Moderate dosage demonstrated the potential for better effects in reducing symptoms, suggesting optimal dosage considerations for future treatments. CRD42022321547.

First modern Russian plasma-derived coagulation factor VIII concentrate (Eytoplasm): Results of clinical study of pharmacokinetics, efficacy and safety

Introduction. Replacement therapy with coagulation factor VIII concentrates remains the standard of care for patients with hemophilia A. In 2023, the drug Eytoplasm, the first modern plasma-derived coagulation factor VIII concentrate developed in the Russian Federation, was authorized for medical use in the Russian Federation.Aim: to study the efficacy, safety, immunogenicity, and pharmacokinetic properties of Eytoplasm.Methods. A multicenter, prospective, open-label clinical trial was conducted in 55 patients over 12 years of age with severe hemophilia A who had previously received treatment with coagulation factor VIII concentrates (at least 150 exposure days). All patients received the drug for prophylactic treatment 2–3 times a week; the treatment duration was 6 months (at least 50 exposure days). In addition, the drug was used to treat bleeding. Ten patients underwent 10 surgical interventions (2 major and 8 minor). Pharmacokinetic parameters were determined after the first administration of the drug to patients and after 6 months of therapy.Results. Eytoplasm pharmacokinetics properties are comparable with other plasma-derived coagulation factor VIII concentrates. No bleeding was recorded in 75.9% of patients. In 92.3 % of patients, a single administration of the drug was sufficient to stop an episode of bleeding. In all participants who completed the study, the residual activity of coagulation factor VIII 48–72 hours after drug administration was at least 1 %. Positive dynamics of APTT was showed during the study. Serious adverse events, allergic reactions, thrombotic and thromboembolic complications were absent in patients. In 3 patients, 4 adverse events associated with the use of the drug were registered: 2 cases of increased serum concentration of direct bilirubin and 2 cases of headache. An inhibitor to coagulation factor VIII was not detected in any patient. In none of the patients who did not have antibodies to parvovirus B19 before the first dose of Eytoplasm, antibodies were detected after 6 months of therapy.Conclusion. Eytoplasm is an effective option for the prevention and treatment of bleeding, and during surgical interventions, including major ones, in patients with hemophilia A. The drug has a favorable safety profi le; its use was not associated with the formation of inhibitory antibodies, allergic reactions, thrombotic and thromboembolic complications.

Preliminary study on the preparation of lyophilized acellular nerve scaffold complexes from rabbit sciatic nerves with human umbilical cord mesenchymal stem cells.

The gold standard of care for patients with severe peripheral nerve injury is autologous nerve grafting; however, autologous nerve grafts are usually limited for patients because of the limited number of autologous nerve sources and the loss of neurosensory sensation in the donor area, whereas allogeneic or xenografts are even more limited by immune rejection. Tissue-engineered peripheral nerve scaffolds, with the morphology and structure of natural nerves and complex biological signals, hold the most promise as ideal peripheral nerve "replacements". To prepare allogenic peripheral nerve scaffolds using a low-toxicity decellularization method, and use human umbilical cord mesenchymal stem cells (hUC-MSCs) as seed cells to cultivate scaffold-cell complexes for the repair of injured peripheral nerves. After obtaining sciatic nerves from New Zealand rabbits, an optimal acellular scaffold preparation scheme was established by mechanical separation, varying lyophilization cycles, and trypsin and DNase digestion at different times. The scaffolds were evaluated by hematoxylin and eosin (HE) and luxol fast blue (LFB) staining. The maximum load, durability, and elastic modulus of the acellular scaffolds were assessed using a universal material testing machine. The acellular scaffolds were implanted into the dorsal erector spinae muscle of SD rats and the scaffold degradation and systemic inflammatory reactions were observed at 3 days, 1 week, 3 weeks, and 6 weeks following surgery to determine the histocompatibility between xenografts. The effect of acellular scaffold extracts on fibroblast proliferation was assessed using an MTT assay to measure the cytotoxicity of the scaffold residual reagents. In addition, the umbilical cord from cesarean section fetuses was collected, and the Wharton's jelly (WJ) was separated into culture cells and confirm the osteogenic and adipogenic differentiation of mesenchymal stem cells (MSCs) and hUC-MSCs. The cultured cells were induced to differentiate into Schwann cells by the antioxidant-growth factor induction method, and the differentiated cells and the myelinogenic properties were identified. The experiments effectively decellularized the sciatic nerve of the New Zealand rabbits. After comparing the completed acellular scaffolds among the groups, the optimal decellularization preparation steps were established as follows: Mechanical separation of the epineurium, two cycles of lyophilization-rewarming, trypsin digestion for 5 hours, and DNase digestion for 10 hours. After HE staining, no residual nuclear components were evident on the scaffold, whereas the extracellular matrix remained intact. LFB staining showed a significant decrease in myelin sheath composition of the scaffold compared with that before preparation. Biomechanical testing revealed that the maximum tensile strength, elastic modulus, and durability of the acellular scaffold were reduced compared with normal peripheral nerves. Based on the histocompatibility test, the immune response of the recipient SD rats to the scaffold New Zealand rabbits began to decline3 weeks following surgery, and there was no significant rejection after 6 weeks. The MTT assay revealed that the acellular reagent extract had no obvious effects on cell proliferation. The cells were successfully isolated, cultured, and passaged from human umbilical cord WJ by MSC medium, and their ability to differentiate into Schwann-like cells was demonstrated by morphological and immunohistochemical identification. The differentiated cells could also myelinate in vitro. The acellular peripheral nerve scaffold with complete cell removal and intact matrix may be prepared by combining lyophilization and enzyme digestion. The resulting scaffold exhibited good histocompatibility and low cytotoxicity. In addition, hUC-MSCs have the potential to differentiate into Schwann-like cells with myelinogenic ability following in vitro induction.

A systematic review exploring the factors that contribute to increased primary care physician turnover in socio-economically deprived areas

Background The declining trend in the number of primary care physicians worldwide has led to shortages especially within socioeconomically deprived areas. Socioeconomically deprived areas in the context of this review are defined by regions where there are lower levels of income and access to essential services such as primary healthcare compared to other areas. This shortage contributes to a higher incidence of preventable hospital admissions, unnecessarily straining healthcare infrastructure and negatively affecting patient outcomes. Previous studies have often been limited in scope, focusing on isolated factors or specific regions. Therefore, the objective of this systematic review is to synthesise current research to provide a better understanding of the underlying causes of this high turnover, ultimately informing strategies to address the global shortage of primary care physicians. Methods This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Refer to S1 Table for the PRISMA 2020 checklist. A comprehensive search was conducted across PubMed (1970 to September 2024) and Embase (1974 to September 2024). The eligibility criteria included quantitative empirical studies that included a measurement of at least one of the factors behind increased primary care physician turnover or retention within socio-economically deprived or disadvantaged areas. However, the included studies were required to employ a specific methodology for classifying or defining socioeconomic deprivation. The references were screened, the studies selected, the data extracted, and the risk of bias assessed using the ROBINS-I tool, with both reviewers in agreement. Results Thirteen studies were identified. The factors measured in the studies driving increased turnover in deprived areas included region of work (n = 7), income (n = 2), burnout (n = 2) and social values (n = 2). Some studies found additional challenges specific to socioeconomically deprived areas, such as familial concerns about regional safety, limited employment opportunities for spouses, or personal career development challenges. However, some studies identified increased hours and sickness presenteeism as stronger contributors to burnout. However, this link can be presumed to be stronger in deprived areas due to staffing shortages, though none of the studies in this systematic review have directly measured this correlation. Though longer-term methods of retention within socioeconomically deprived areas included more collaborative working environments and flexible working hours, this can also be applied to benefit healthcare settings across all regions. Conclusions The studies reviewed have consistently highlighted the repeating cycle of persistent staff shortages contributing to an increased turnover rate within disadvantaged areas internationally. Therefore, implementation of targeted policies by governments and healthcare organisations is required to retain primary care physicians within these areas to ultimately improve and standardise patient care.

Perioperative methadone compared to placebo in elderly hip fracture patients: a study protocol for a randomized controlled trial (MetaHip trial)

BackgroundHip fractures are a source of severe pain among the elderly population and pose challenges due to limited analgesic tolerance. Perioperative methadone has shown promise in our pilot study suggesting a safe dose of 0.10 mg/kg, prompting further investigation into its benefits for elderly hip fracture patients.MethodsThis study employs a double-blinded randomized controlled trial to assess the analgesic effects of a single dose of methadone during hip fracture surgery. Patients aged ≥ 60 years are consecutively enrolled and randomized to receive either perioperative methadone (treatment group) or a saline solution (placebo group). A sample size of 130 patients is required for 88% statistical power. The medication is administered intravenously at anesthesia induction and monitored until discharge. A follow-up observation is conducted 3 months post-surgery.DiscussionPrimary outcome: Daily consumption of opioids within the first 3 days after surgery. Secondary outcomes include pain, mobility, nausea, vomiting, time to discharge, need for antidote, delirium, and constipation. The 3-month follow-up includes opioid use, pain, EQ-5D-5L scores, mobility, and persistent side effects. If statistically significant advantages are found in the treatment group, perioperative methadone could be considered as standard care for hip fracture patients, potentially enhancing their pain management. The study’s outcomes will provide insights into the feasibility and effectiveness of incorporating methadone into routine clinical practices for this patient group.Trial registrationClinicalTrials.gov ID: NCT06086171, submitted 4. October 2023. EU-CT: 2023–506252-24–00, UTN: U1111-1294–6125.

Effect of a yoga and naturopathy-based lifestyle intervention with nine-month follow-up on lipid profile in patients with hypertension: A two-arms parallel group randomized controlled trial.

Hypertension is recognized as a modifiable risk factor for cardiovascular diseases, alongside dyslipidemia. Studies have revealed that between 15% to 31% of individuals have both hypertension and dyslipidemia. However, emerging evidence suggests that natural therapies and yoga can help manage mild increases in blood pressure. This study aims to evaluate the impact of yogic and naturopathy treatments on lipid profiles in hypertensive patients, thereby contributing to the existing literature. A randomized controlled experiment was conducted, involving 262 hypertensive patients randomly assigned to either the study group (SG) or control group (CG). The SG, consisting of 131 individuals, received yoga and naturopathic treatments for 10 days, while the CG (n=131) did not. The lipid profile was measured at the beginning and end of the 10 days and they were followed-up and reassessed after 9 months. The study involved a total of 262 individuals, with 111 in the SG and 125 in the CG. After the 10-day intervention period, the SG showed significant reductions in Total cholesterol (TC), Triglycerides (TG), High-density lipoprotein (HDL-C), Low-density lipoprotein (LDL-C), Very-low density lipoprotein (VLDL), Apolipoprotein-A (Apo-A), Apolipoprotein-B (Apo-B), and Lipoprotein-A(Lp-A) (p<0.001) compared to the CG. Also, the change was observed after 9 months in Apo-A, Apo-B, and Lp-A significantly (p<0.001). These findings underscore the potential of naturopathic and yogic interventions in improving lipid profiles in hypertensive patients, thereby contributing to the current literature. In conjunction with conventional management, these specific interventions could be considered as a safer form of complementary therapy in the treatment of dyslipidemia among hypertensive patients. Thus, these findings hold promise for the integration of naturopathic and yogic therapies in the standard care of hypertensive patients.

INTRAVENOUS INFUSION OF ALBUMIN IN A MULTIDISCIPLINARY CLINIC

Rationale: Albumin is one of the most important proteins, playing a significant role in maintaining colloid osmotic pressure, wound healing, reducing oxidative damage, transport of drugs and endogenous substances, and coagulation.Objective: To identify patterns of albumin infusions in a multidisciplinary hospital, to assess the compliance of albumin use with the standards of medical care.Methods: Retrospectively, based on materials from 43,710 electronic medical records, the infusion of albumin solution to hospital patients at the Pirogov Center in 2023 was studied. Infusions of 25% albumin solution in 50 ml bottles (Kedrion, Italy) were performed. The data were studied using descriptive and inductive statistics, analysis of variance ANOVA at a significance level of 0.05.Results: 146 people (0.3%) received albumin infusions. In total, patients received 2466 vials of albumin, or an average of approximately 211 grams of albumin per patient. There were 5 groups of albumin recipients: 1) cardiac surgery (n = 45); 2) oncohematology (n = 14); 3) oncology (n = 35); 4) trauma/orthopedics (n = 16); 5) other (n = 36). There were no gender differences in albumin recipients in terms of age, duration of treatment, mortality, volume or regimen of albumin administration. In the selected groups of patients, significant differences in age were revealed. Minimum age – in the oncohematology group: median (quartiles) – 43 (35; 52) years, maximum age – in the oncology group: 67 (59; 73) years (p&lt;0.001). The groups also differed in terms of hospital treatment: minimum – in the cardiac surgery group: median (quartiles) – 13 (9; 17) days, maximum – in the group of other diseases: 22 (15; 35) days (p&lt;0.001) and in intensive care: minimum – in the cardiac surgery group: median (quartiles) – 4 (3; 7) days, maximum – in the group of other diseases: 6.5 (4; 20) days (p&lt;0.001). Body weight is known in 7 patients of the Pirogov Center with a minimum albumin concentration in 2023 (from 11.6 g/l to 18.4 g/l). If we apply a target albumin concentration of 30 g/l, then the prescribed dose of the drug will range from 35.4 g to 91.7 g.Conclusion: At the Pirogov Center, a 25% albumin solution is administered for replacement purposes, focusing on the target concentration of albumin in the patient’s serum of about 30 g/l. The dosage and duration of albumin administration differs in different groups of patients: the minimum amount of albumin was received by patients in the cardiac surgery group: median (quartiles) – 75 (37.5; 122.5) grams for 2 (1; 3) days, the maximum – by patients in the other group diseases: 110 (62.5; 337.5) grams for 3 (1; 6) days (p = 0.009 and p = 0.012, respectively).It is advisable:a) make changes to 11 standards of medical care regulating the dose of albumin in milliliters, without indicating the concentration of the solution;b) to clarify the possibly overestimated average daily dose of albumin of 100 grams, determined by 4 standards of medical care for cardiac surgery patients.

Use of water in dialysis and its impact on the environment.

The climate crisis poses significant challenges across various sectors, including healthcare, where resource consumption often exacerbates environmental issues. This review addresses concerns over current levels of water use for dialysis treatment, a critical procedure for patients with kidney failure. Despite its life-saving importance, the dialysis process consumes large quantities of water, contributing to water scarcity and increased carbon emissions associated with water treatment and distribution. Through a comprehensive analysis of current practices, we identify inefficiencies and propose sustainable alternatives aimed at reducing water usage in dialysis. Findings indicate that optimizing treatment protocols and considering innovative technologies can significantly mitigate the environmental impact while maintaining patient care standards. This review underscores the urgent need for the healthcare sector to adopt sustainable practices in response to the climate crisis.

Optimizing Nurse Rostering: A Case Study Using Integer Programming to Enhance Operational Efficiency and Care Quality.

Background/Objectives: This study addresses the complex challenge of Nurse Rostering (NR) in oncology departments, a critical component of healthcare management affecting operational efficiency and patient care quality. Given the intricate dynamics of healthcare settings, particularly in oncology clinics, where patient needs are acute and unpredictable, optimizing nurse schedules is paramount for enhancing care delivery and staff satisfaction. Methods: Employing advanced Integer Programming (IP) techniques, this research develops a comprehensive model to optimise NR. The methodology integrates a variety of constraints, including legal work hours, staff qualifications, and personal preferences, to generate equitable and efficient schedules. Through a case study approach, the model's implementation is explored within a clinical setting, demonstrating its practical application and adaptability to real-world challenges. Results: The implementation of the IP model in a clinical setting revealed significant improvements in scheduling efficiency and staff satisfaction. The model successfully balanced workload distribution among nurses, accommodated individual preferences to a high degree, and ensured compliance with work-hour regulations, leading to optimised shift schedules that support both staff well-being and patient care standards. Conclusions: The findings underscore the effectiveness of IP in addressing the complexities of NR in oncology clinics. By facilitating a strategic allocation of nursing resources, the proposed model contributes to operational excellence in healthcare settings, underscoring the potential of Operations Research in enhancing healthcare delivery and management practices.

Pixels to precision: Neuroradiology's leap into 3D printing for personalized medicine.

The realm of precision medicine, particularly its application within various sectors, shines notably in neuroradiology, where it leverages the advancements of three-dimensional (3D) printing technology. This synergy has significantly enhanced surgical planning, fostered the creation of tailor-made medical apparatus, bolstered medical pedagogy, and refined targeted therapeutic delivery. This review delves into the contemporary advancements and applications of 3D printing in neuroradiology, underscoring its pivotal role in refining surgical strategies, augmenting patient outcomes, and diminishing procedural risks. It further articulates the utility of 3D-printed anatomical models for enriched comprehension, simulation, and educational endeavors. In addition, it illuminates the horizon of bespoke medical devices and prosthetics, illustrating their utility in addressing specific cranial and spinal anomalies. This narrative extends to scrutinize how 3D printing underpins precision medicine by offering customized drug delivery mechanisms and therapies tailored to the patient's unique medical blueprint. It navigates through the inherent challenges of 3D printing, including the financial implications, the need for procedural standardization, and the assurance of quality. Prospective trajectories and burgeoning avenues, such as material and technological innovations, the confluence with artificial intelligence, and the broadening scope of 3D printing in neurosurgical applications, are explored. Despite existing hurdles, the fusion of 3D printing with neuroradiology heralds a transformative era in precision medicine, poised to elevate patient care standards and pioneer novel surgical paradigms.