Standard Of Care For Patients Research Articles

Infantile Nystagmus Syndrome—Associated Inherited Retinal Diseases: Perspectives from Gene Therapy Clinical Trials

Inherited retinal diseases (IRDs) are a clinically and genetically diverse group of progressive degenerative disorders that can result in severe visual impairment or complete blindness. Despite their predominantly monogenic inheritance patterns, the genetic complexity of over 300 identified disease-causing genes presents a significant challenge in correlating clinical phenotypes with genotypes. Achieving a molecular diagnosis is crucial for providing patients with definitive diagnostic clarity and facilitating access to emerging gene-based therapies and ongoing clinical trials. Recent advances in next-generation sequencing technologies have markedly enhanced our ability to identify genes and genetic defects leading to IRDs, thereby propelling the development of gene-based therapies. The clinical success of voretigene neparvovec (Luxturna), the first approved retinal gene therapy for RPE65-associated Leber congenital amaurosis (LCA), has spurred considerable research and development in gene-based therapies, highlighting the importance of reviewing the current status of gene therapy for IRDs, particularly those utilizing adeno-associated virus (AAV)-based therapies. As novel disease-causing mutations continue to be discovered and more targeted gene therapies are developed, integrating these treatment opportunities into the standard care for IRD patients becomes increasingly critical. This review provides an update on the diverse phenotypic–genotypic landscape of IRDs, with a specific focus on recent advances in the understanding of IRDs in children with infantile nystagmus syndrome (INS). We highlight the complexities of the genotypic–phenotypic landscape of INS-associated IRDs, including conditions such as achromatopsia, LCA, congenital stationary night blindness, and subtypes of retinitis pigmentosa. Additionally, we provide an updated overview of AAV-based gene therapies for these diseases and discuss the potential of gene-based therapies for underlying IRDs that lead to INS, offering a valuable resource for pediatric patients potentially eligible for ongoing clinical trials.

Prognostic role of serum cytokines level in non-small cell lung cancer patients with anti-PD-1 and chemotherapy combined treatment.

Chemotherapy combined with PD-1 inhibitor treatment has revolutionized the standard of care for patients with NSCLC. However, the benefit is not universal, highlighting the need for precise prediction factors. Given their relationship with the immune system and non-invasive nature, serum cytokines are potential candidates for predicting the clinical effects of chemoimmunotherapy. Our study aims to evaluate the association of serum cytokines with the prognosis of patients with NSCLC treated with chemoimmunotherapy. Levels of 10 serum cytokines were detected in 60 NSCLC patients receiving chemotherapy plus PD-1 inhibitor-based treatment. Of these, dynamic samples from 19 patients were collected at baseline and after two treatment cycles. Their association with patients' clinicopathological characteristics, PFS and OS was described and investigated using survival analysis, cox regression and time-dependent ROC analysis. Preliminary evaluation of changes in cytokine levels associated with treatment response was conducted. Patients with lower baseline levels of serum IL-6, IL-5, IL-8, TNF-α and IL-10 had longer PFS, while patients with higher levels of IL-4 had longer PFS. Patients with lower levels of serum IL-6, IL-8, IL-22, TNF-α and IL-10 had longer OS, while patients with higher levels of IL-4 had longer OS. Multivariate analysis suggested that higher IL-6 and IL-5 levels were associated with poorer PFS, and higher IL-6 levels were associated with dismal OS. Additionally, changes in serum cytokine levels could be associated with treatment response. Our study suggests that serum cytokines, specifically IL-6, IL-5, IL-8, TNF-α, IL-10, and IL-4, are potential prognostic factors for patients with NSCLC receiving chemotherapy plus PD-1 inhibitor treatment.

Touching Technology-Parents' Experiences of Remote Consultations for Children With Severe Congenital Cardiac Conditions: Quasi-Experimental Cohort Study.

Remote consultations (RCs) using videoconferencing was recommended by the General Medical Council as the method for clinicians to provide patient consultations during the COVID-19 pandemic. Facilitating this while providing high-quality care depends on the usability and acceptability of the technology. This project aimed to investigate parents' experiences of using videoconferencing technology for real-time RCs with children who had congenital heart defects during the COVID-19 pandemic lockdown. This study's design was quasi-experimental and was underpinned by the Unified Theory of Acceptance and Use of Technology model that seeks to explain and predict an individual's intention to use a technology. Parents were informed of this study by the medical team, posters were made available in the wards and clinics, and leaflets were left for browsing. Clinician screening of potential participants led to the identification of 33 children and parents who were enrolled on this study. The intervention was a web-based RC by medical staff using a secure, interactive videoconferencing platform (Pexip). Each child and their mother or father received 8 RCs with the same specialist doctor or nurse. Measurements were taken using web-based questionnaires pre and post consultation at the first, middle, and last events; questions were focused on the acceptability, usability, and clinical applicability of RCs. Parents' experiences were explored using recorded interviews and analyzed thematically. In total, 29 children aged 4-1052 (mean 95, SD 191.14) days completed the project, receiving a total of 189 RCs as part of their routine care. Parents' prior experience of consultation via videoconference was low; however, as time progressed, their use and acceptance of the technology increased. The intervention was warmly received by all parents who found the face-to-face component particularly useful for discussion with their child's medical team. Furthermore, parents noted the savings on time, money, and childcare. While in-person consultations are considered the gold standard of patient care, increasing pressures on health services and staff reduce availability. Given the ease of access and additional benefits experienced by parents and their children, it is proposed that hybrid models of consultation and care provision are equal, if not superior, to in-person consultations in the management of children with severe congenital heart defects while reducing costs and pressure on the health service and parents.

Polatuzumab Vedotin for Diffuse Large B-Cell Lymphoma: Innovation's Allure versus a Time-Honored Tradition

AbstractChemotherapy with R-CHOP (rituximab, cyclophosphamide, Adriamycin, vincristine, prednisolone) is the standard of care for patients with diffuse large B-cell lymphoma as the first-line therapy. The recent approval of polatuzumab as the first-line therapy after demonstration of its efficacy in the Polatuzumab Vedotin in Previously Untreated Diffuse Large B-Cell Lymphoma (POLARIX) trial is the first significant change in this treatment regimen over two decades. This concise appraisal of trial evidence and clinical context highlights the limited potential for a clinically significant benefit with the addition of polatuzumab to the first-line therapy for this common hematologic malignancy.

Safety Analysis of Fiberoptic Bronchoscopy in Children

Fiberoptic bronchoscopy (FOB) is a crucial procedure in pediatric pulmonology, providing significant diagnostic and therapeutic benefits. This study evaluates the safety of FOB in children at The People's Hospital of Keyouqianqi, Inner Mongolia. A retrospective analysis was conducted on the medical records of 10 pediatric patients who underwent FOB between 2018 and 2023. The study assessed the incidence, types, and severity of complications, as well as factors contributing to these complications. The findings indicated a complication rate of 20%, with transient hypoxia and mild bleeding as the most common minor complications. No severe complications, such as severe bleeding, bronchospasm, or pneumothorax, were observed. Statistical analysis revealed that procedural factors significantly influenced the occurrence of complications. The study concludes that FOB is generally safe for pediatric patients, with a low incidence of severe complications. Recommendations include enhancing training and protocols, continuous monitoring, preventive measures, further research, and policy development to ensure the highest standards of patient care.

Effectiveness of an Educational Package on Knowledge Regarding Telehealth among B.Sc Nursing Final Year Students in Selected College of Indore, Madhya Pradesh

The onset of Covid-19 emerged the need of telehealth as a new standard of care for patient. The current study aimed to evaluate the effectiveness of an educational package on telehealth among B.Sc. nursing final year students. A quantitative approach with pre experimental one group pre-test, post-test design was adopted for the study. The samples from the selected college were selected using purposive sampling technique. The sample consist of 200 B.Sc. nursing final year students. The tool used for data collection was structured knowledge questionnaire. Comparing the knowledge level between pretest and posttest revealed that the mean pretest score rose from 9.05 to mean score 12.98 in posttest and was found to be statistically significant at p<0.001. Study result showed significant improvement in the level of knowledge among B.Sc nursing final year students on telehealth.

Adapting the design of the ongoing RAMPART trial in response to external evidence: An example for trials which take many years to run and report

Clinical trials to establish the efficacy of new agents in the adjuvant cancer setting typically take many years to complete. During that time, external factors can impact recruitment and reporting plans. An example is a new standard of care becoming available during the recruitment period.In this paper we describe how we modified the design of the RAMPART trial (NCT03288532) which was set up to investigate immune checkpoint inhibitor therapy in the adjuvant renal cancer setting. The trial had been initiated when no globally accepted adjuvant strategy after nephrectomy existed. A subsequent change in the standard of care for many patients with early renal cancer meant it was no longer feasible to continue to recruit. We needed to find a way to maximise the contribution that RAMPART participants could make to the evidence base for immune checkpoint inhibitor therapy without introducing bias or detriment to the integrity of the trial results. We describe how we agreed and incorporated all design and timeline changes while remaining blinded to accumulating data within the trial, thus protecting the reliability of the future results. We share details of our design modifications to guide others who may have similar experiences, particularly as more agents and combinations of agents are developed and investigated in similar adjuvant settings.

Evolving Practice and Outcomes in Grade 2 Glioma: Real-World Data from a Multi-Institutional Registry.

Background: Grade-2 gliomas (G2-glioma) are uncommon. In 2016, RTOG9802 established the addition of chemotherapy after radiation (CRT) as a new standard of care for patients with high-risk G2-glioma, defined as subtotal resection or age ≥40 yrs. Here, we report current practices using real-world data. Methods: Patients diagnosed with G2-glioma from 1 January 2016 to 31 December 2022 were identified in BRAIN, a prospective clinical registry collecting data on patients with brain tumours. High- and low-risk were defined as per RTOG9802. Two time periods, January 2016-December 2019 (TP1) and January 2020-December 2022 (TP2), were defined. Survival was estimated using the Kaplan-Meier method. Results: 224 patients were identified. Overall, 38 (17%) were low-risk, with 35 (91%) observed without further treatment. A total of 186 (83%) were high-risk, with 96 (52%) observed, 63 (34%) receiving CRT, and 19 (10%) receiving radiation. Over time, CRT use increased (TP1 vs. TP2: 22% vs. 36%, p = 0.004), and the rate of biopsy (TP1 vs. TP2: 35% vs. 20%, p = 0.02) and radiotherapy alone (TP1 vs. TP2: 14% vs. 4%, p = 0.01) decreased. Median progression-free survival (PFS) was significantly longer in high-risk patients who received CRT (NR) over observation (39 months) (HR 0.49, p = 0.007). In high-risk patients who were observed, 59 (61%) were progression-free at 12 months and 10 (10%) at 5 years. OS data remains immature. Conclusions: Congruent with RTOG9802, real-world BRAIN data shows CRT is associated with improved PFS compared to observation in high-risk G2-glioma. Whilst CRT use has increased over time, observation after surgery remains the most common strategy, with some high-risk patients achieving clinically meaningful PFS. Validated biomarkers are urgently required to better inform patient management.

Robotic-Assisted Versus Laparoscopic Approach for Treatment of Acute Cholecystitis in Children.

Introduction: Laparoscopic cholecystectomy (Lap-C) is the standard of care for patients requiring cholecystectomy in the acute setting. Although robotic-assisted cholecystectomy (RA-C) performance has increased, utilization in the acute setting has not been widely reported. We describe the feasibility of RA-C for pediatric patients undergoing acute inpatient cholecystectomy. Methods: A single institutional retrospective review of patients receiving RA-C while admitted for acute cholecystitis and/or choledocholithiasis (June 2017-June 2022) was compared with a matched cohort who underwent traditional multiport Lap-C (June 2021-June 2022). Demographic, perioperative, and postoperative data were analyzed. Results: Fifty patients were included: 25 each in the RA-C and Lap-C groups. Fifty-four percent were female; 66% were non-Hispanic white. Median age (15.7 years [interquartile range, IQR 14.7, 17.3] versus 15.3 years [IQR 14.5, 16.9], P = .91) and preoperative weight (92.6 kg [IQR 60, 105.9] versus 72.3 kg [IQR 61.6, 85.6], P = .15) were similar between the RA-C and Lap-C groups, respectively. No differences were observed in median operating time (89 minutes [IQR 76, 103] versus 88 minutes [IQR 77, 137], P = .70), postoperative length of stay (22.5 hours [21.4, 24.9] versus 20.6 hours [18.0, 25.1], P = .06), or 30-day complications (12% versus 16%, P = .69). Although opioid utilization (.23 milliequivalents/kilogram [MME/kg] [IQR .03, .30] versus .03 MME/kg [0, .09], P = .02) was higher in the RA-C cohort overall, no differences were detected during an analysis of the most recent 2 years (P = .96). Conclusion: RA-C in the acute setting can be performed safely in the pediatric population with comparable procedural times as well as perioperative and 30-day outcomes.

Fluid balance neutralization secured by hemodynamic monitoring versus protocolized standard of care in patients with acute circulatory failure requiring continuous renal replacement therapy: results of the GO NEUTRAL randomized controlled trial.

Net ultrafiltration (UFNET) during continuous renal replacement therapy (CRRT) can control fluid balance (FB), but is usually 0ml·h-1 in patients with vasopressors due to the risk of hemodynamic instability associated with CRRT (HIRRT). We evaluated a UFNET strategy adjusted by functional hemodynamics to control the FB of patients with vasopressors, compared to the standard of care. In this randomized, controlled, open-label, parallel-group, multicenter, proof-of-concept trial, adults receiving vasopressors, CRRT since ≤ 24h and cardiac output monitoring were randomized (ratio 1:1) to receive during 72h a UFNET ≥ 100ml·h-1, adjusted using a functional hemodynamic protocol (intervention), or a UFNET ≤ 25ml·h-1 (control). The primary outcome was the cumulative FB at 72 h and was analyzed in patients alive at 72 h and in whom monitoring and CRRT were continuously provided (modified intention-to-treat population [mITT]). Secondary outcomes were analyzed in the intention-to-treat (ITT) population. Between June 2021 and April 2023, 55 patients (age 69 [interquartile range, IQR: 62; 74], 35% female, Sequential Organ Failure Assessment (SOFA) 13 [11; 15]) were randomized (25 interventions, 30 controls). In the mITT population, (21 interventions, 24 controls), the 72 h FB was -2650 [-4574; -309] ml in the intervention arm, and 1841 [821; 5327] ml in controls (difference: 4942 [95% confidence interval: 2736-6902] ml, P < 0.01). Hemodynamics, oxygenation and the number of HIRRT at 72 h, and day-90 mortality did not statistically differ between arms. In patients with vasopressors, a UFNET fluid removal strategy secured by a hemodynamic protocol allowed active fluid balance control, compared to the standard of care.

Surgical Ethics in the Safavid Era, 16th Century AD.

Medicine-and specifically surgery and surgical ethics-have long been part of the history of science. Surgical ethics play a pivotal role in ensuring successful outcomes and maintaining the highest standards of patient care. It includes the ethics of surgeons, the responsibility of surgeons, surgical errors, and the competence of a surgeon. Many works have been written about surgery, including during Iran's Safavid period (1501 to 1736)-a period in which a surgeon needed to have a set of moral principles in addition to practical surgical skills. One of the most valuable is Dhakhīrıh Kāmılıh, written by military surgeon Hakim Mohammad in the sixteenth and seventeenth centuries. In this work, Ḥakim Muhāmmad dedicates a chapter specifically to the topic of surgical ethics, aiming to provide moral and legal recommendations for surgeons in addition to explaining surgical techniques and methods. Some of these recommendations include improving surgical skills through observation and practical training, paying attention to hygiene to prevent the spread of infection, and giving patients hope for recovery. Dhakhīrıh Kāmılıh is a landmark text in the history of surgical ethics.

Comparing Three-dimensional Radiologic Outcomes Between Early Versus Late Secondary Alveolar Bone Grafting.

Secondary alveolar bone grafting (SABG) during mixed dentition is the standard of care for patients with complete cleft of lip and palate. Early SABG (E-SABG; 4 to 7y) occurs before the eruption of lateral incisors, whereas late SABG (L-SABG; 8 to 12y) occurs before the eruption of maxillary permanent canines. This study compares outcomes of E-SABG versus L-SABG among patients with unilateral cleft of lip and palate (UCLP). A prospective cohort study was conducted evaluating nonsyndromic patients with UCLP who underwent SABG from April 2018 to January 2020, 48 consecutive patients with UCLP were included. Preoperative and 6 to 10-month postoperative cone beam computed tomography imaging were obtained to assess graft and periodontal outcomes. Among 48 patients with UCLP, of which 21 were in the E-SABG group (6.9 ± 1.1y), and 28 were in the L-SABG cohort (10.4 ± 1.6y). The initial alveolar cleft width is significantly smaller in the E-SABG cohort compared with the L-SABG cohort (5.1 ± 1.5 versus 6.5 ± 2.0mm, P = 0.008). Compared with the L-SABG cohort, the E-SABG cohort had higher rates of bony bridge formation (77.3% versus 65.4%, P= 0.367), thicker bony bridges (5.7 ± 2.1 versus 3.9 ± 1.5mm, P= 0.004), lower Bergland scores [1.5 (interquartile range: 1 to 2) versus 2.25 (interquartile range: 1.5 to 3.5), P= 0.026], and greater alveolar bone coverage (79.8 ± 16.7% versus 67.9 ± 18.1%, 0.024). The authors' findings suggest that patients who undergo E-SABG at ∼7 years may have better graft outcomes and benefits to the periodontal bone support on cleft-adjacent incisor compared with L-SABG at 11 years.

Immune Checkpoint Inhibitor Therapy and Associations with Clonal Hematopoiesis

Cancer cohorts are now known to be associated with increased rates of clonal hematopoiesis (CH). We sort to characterize the hematopoietic compartment of patients with melanoma and non-small cell lung cancer (NSCLC) given our recent population level analysis reporting evolving rates of secondary leukemias. The advent of immune checkpoint blockade (ICB) has dramatically changed our understanding of cancer biology and has altered the standards of care for patients. However, the impact of ICB on hematopoietic myeloid clonal expansion remains to be determined. We studied if exposure to ICB therapy affects hematopoietic clonal architecture and if their evolution contributed to altered hematopoiesis. Blood samples from patients with melanoma and NSCLC (n = 142) demonstrated a high prevalence of CH. Serial samples (or post ICB exposure samples; n = 25) were evaluated in melanoma and NSCLC patients. Error-corrected sequencing of a targeted panel of genes recurrently mutated in CH was performed on peripheral blood genomic DNA. In serial sample analysis, we observed that mutations in DNMT3A and TET2 increased in size with longer ICB exposures in the melanoma cohort. We also noted that patients with larger size DNMT3A mutations with further post ICB clone size expansion had longer durations of ICB exposure. All serial samples in this cohort showed a statistically significant change in VAF from baseline. In the serial sample analysis of NSCLC patients, we observed similar epigenetic expansion, although not statistically significant. Our study generates a hypothesis for two important questions: (a) Can DNMT3A or TET2 CH serve as predictors of a response to ICB therapy and serve as a novel biomarker of response to ICB therapy? (b) As ICB-exposed patients continue to live longer, the myeloid clonal expansion may portend an increased risk for subsequent myeloid malignancy development. Until now, the selective pressure of ICB/T-cell activating therapies on hematopoietic stem cells were less known and we report preliminary evidence of clonal expansion in epigenetic modifier genes (also referred to as inflammatory CH genes).

Enhancing Laboratory Outcomes Through “Stacked” Professional Credentials: A Study of ASCP BOC Trends

Abstract Introduction/Objective Laboratory medicine and pathology are rapidly evolving, requiring laboratory professionals to continuously adapt and enhance their skills to ensure high standards of patient care. The American Society for Clinical Pathology (ASCP), Board of Certification (BOC) has observed a notable increase in the number of credential holders obtaining multiple, or stacked, BOC credentials. This phenomenon is not limited to the U.S. but is also evident in various countries globally. This study aims to explore the trends of stacking credentials among BOC credential holders, examining its implications for professional development, career progression, and the overall impact on laboratory outcomes. Methods/Case Report This study utilized a comprehensive analysis of ASCP BOC’s credentialing data, focusing on individuals with multiple credentials. Data were segmented by degree (Bachelor’s, MBA, PhD, etc.), credential count (ranging from 2 to 10), and geographical distribution across the U.S. and internationally. The analysis sought to identify patterns, growth trends, and the professional demographics most inclined towards obtaining stacked credentials. Results (if a Case Study enter NA) The study revealed that approximately 11% of BOC credential holders possess two or more credentials, indicating a significant trend towards continuous professional development and specialization. The breakdown of stacked credentials by degree shows a higher percentage propensity among individuals with MBAs (as one degree type). Geographical analyses highlighted hotspots for professionals seeking multiple credentials both at the domestic U.S. level and internationally. Conclusion This suggests the BOC, and by extension the laboratory medicine and pathology community, can greatly benefit from promoting and facilitating the acquisition of multiple credentials. By doing so, the field can ensure a workforce that is not only highly qualified but also adaptable to the changing dynamics of healthcare, thereby reinforcing the indispensable role of laboratory professionals in the broader healthcare ecosystem.

Artificial Intelligence in Oral and Maxillofacial Surgery: Bridging the Gap between Technology and Clinical Practice a Narrative Review

Objective: To provide a comprehensive overview of current applications and future prospects of artificial intelligence (AI) in oral and maxillofacial surgery (OMFS), while critically analyzing implementation challenges and exploring potential advancements.  Methods A systematic literature review was conducted using PubMed/MEDLINE and Embase databases, encompassing English-language articles up to December 30, 2023. Search terms combined OMFS and AI concepts, with database-specific syntax employed.  Results AI applications in OMFS span multiple domains, including image analysis, surgical planning, intraoperative guidance, and clinical decision support. Deep learning models have demonstrated high accuracy in detecting mandibular fractures, performing cephalometric analyses, and classifying maxillofacial pathologies. AI-enhanced surgical planning and robotic systems show promise in improving precision and outcomes across various OMFS procedures. However, challenges persist in data quality, clinical validation, and seamless workflow integration.  Conclusions AI technologies have the potential to significantly enhance diagnostic accuracy, surgical precision, and treatment outcomes in OMFS. Future research directions include developing multimodal AI systems, advancing AI-powered surgical navigation, and exploring federated learning approaches. Successful implementation of AI in OMFS practice will require collaborative efforts among clinicians, researchers, engineers, and policymakers to address technical, ethical, and regulatory challenges. As these hurdles are overcome, AI is poised to become an integral part of OMFS, augmenting surgical capabilities and elevating patient care standards.

Comparison of programmed sedation care with conventional care in patients receiving mechanical ventilation for acute respiratory failure.

The aim of this study is to evaluate the effectiveness of planned sedation therapy in comparison to standard care for patients receiving mechanical ventilation for acute respiratory failure (ARF). The research included a total of sixty individuals who underwent mechanical ventilation for acute respiratory failure (ARF). Utilizing the random number table method, these patients were randomized at random to either the planned sedation care group (Group PSC) or the conventional care group (Group C). The objective was to assess and contrast the impact of treatment on the two groups. Significantly shorter durations of mechanical ventilation, sedative use, ICU therapy, length of stay, incidence of delirium, and adverse events were observed in Group PSC compared with Group C (P < 0.05). A higher 1-month survival rate following mechanical ventilation, a higher post-intervention forced expiratory volume in one second (FEV1) as a percentage of the expected value, a higher post-intervention forced vital capacity (FVC), and a higher patient family care satisfaction rate were observed in Group PSC compared to Group C (P < 0.05). The scheduled administration of sedative therapy in patients receiving mechanical ventilation for acute respiratory failure (ARF) offers significant, reliable, and effective therapeutic benefits.

Digital-assisted diagnosis and orthodontic management of an impacted mandibular lateral incisor: a case report

BackgroundThe impaction of mandibular lateral incisors presents significant aesthetic and functional challenges in orthodontics, including Bolton ratio discrepancies and anterior occlusal anomalies. The increasing preference for nonextraction treatment further complicates space management within the dental arch. However, the advent of digital-assisted orthodontic technologies, particularly advanced digital simulations, has revolutionized the precision and effectiveness of diagnosis and treatment planning. These technologies enable clinicians to strategically leverage natural jaw development and create the necessary space for the alignment of impacted teeth without resorting to extraction.Case presentationThis case report details the treatment of a 12-year-old male with an impacted mandibular lateral incisor, which resulted in both aesthetic concerns and functional impairments, alongside Class II malocclusion. By employing a digital-assisted diagnostic approach, including comprehensive digital simulations, we meticulously evaluated the feasibility of a nonextraction treatment plan. The strategy centred on harnessing the patient’s mandibular growth potential to expand the available space naturally. The treatment involved surgical exposure of the impacted tooth, followed by precise orthodontic traction guided by continuous digital monitoring. The integration of digital tools throughout the treatment process was crucial in achieving successful eruption and alignment of the impacted tooth, thus restoring optimal aesthetics and function without the need for extraction.ConclusionThis case highlights the transformative impact of digital-assisted technologies in the management of complex orthodontic cases, such as impacted mandibular lateral incisors. The successful integration of these advanced tools with a nonextraction treatment approach underscores their potential to significantly enhance clinical outcomes. Digital technologies not only improve the accuracy and effectiveness of treatment but also facilitate a multidisciplinary approach that elevates the standard of patient care in addressing complex orthodontic challenges.

The Effect of the Adoption of the National Accreditation Program for Rectal Cancer Process on Compliance Standards at a Single Institution.

Background: The National Accreditation Program for Rectal Cancer (NAPRC) was developed to enhance the quality of rectal cancer care in the United States. This project compared NAPRC compliance at a single tertiary care academic hospital before and after the institution adopted these standards in 2019. Methods: Rectal cancer patients from 2016 to 2023 who met NAPRC eligibility criteria were retrospectively reviewed for compliance with pre-selected patient care standards. Patients diagnosed prior to August 1, 2019 (pre-NAPRC) were compared with those diagnosed afterward (post-NAPRC) to determine whether compliance with these standards differed following the institution's adoption of new guidelines. Results: This study included 353 patients, 146 pre-NAPRC and 207 post-NAPRC. The post-NAPRC group demonstrated significantly higher compliance with pretreatment standards compared to the pre-NAPRC group, including attaining magnetic resonance imaging (MRI) (P = .015), computed tomography (CT) (P < .001), and a carcinoembryonic antigen (CEA) level (P < .001). Postoperative standards were more frequently met in the post-NAPRC group regarding the photographing of surgical specimens (P < .001). No significant differences were observed in confirming a tissue diagnosis, starting treatment within a 60-day timeframe, or completing surgical pathology reports. Prior to initiation of the NAPRC process, the institution had achieved accreditation-level compliance in 2 of the 7 standards. Within 2years of adopting NAPRC standards, complete compliance was met in 6 of the 7 measures. Conclusions: A single institution's adoption of NAPRC standards improved compliance with multiple rectal cancer care standards, achieving near-complete accreditation level compliance within 2years.

The effectiveness of enhanced reality simulation on postmastectomy patient care management provided by nursing students: a quasi-experimental study

AimThe aim of this study was to evaluate the effect of enhanced reality simulation on nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. BackgroundBreast cancer is a common disease with increasing incidence and mastectomy is the treatment of choice. Postmastectomy patient care is a multidimensional and complex process. For various reasons, nursing students today graduate with inadequate clinical skills and do not have experience with many cases. DesignThis quasi-experimental study was conducted using a pretest–posttest design with a nonequivalent control group. MethodsThis study was conducted with fourth-year nursing students (78 students). Students were allocated to each group through a simple random allocation using IBM SPSS Statistics version 24. Research data were collected at the Clinical Simulation Training Center of the university in 2020–2021 academic year. The study group (n=39) learned using a scenario-based learning approach with moulage in a real clinical setting using enhanced reality simulation, while the control group (n=39) learned using the same scenario-based approach with the routine practice adult standard patient care model. The data were collected through the “Student Sociodemographic and Descriptive Characteristics Data Collection Form”, the “Student Satisfaction and Self-Confidence in Learning Scale”, the “Postmastectomy Patient Care Skills Checklist” and the “Pre–Post Knowledge Test on Postmastectomy Patient Care Management”. ResultsAll 78 participants completed the training course. The training significantly increased the Student Satisfaction and Self-Confidence in Learning Scale subdimension scores of both groups (p<0.05). The Postmastectomy Patient Care Management scores of the study group students who received enhanced reality simulation training significantly increased (p<0.05), while there was no significant effect on the scores of the control group students (p>0.05). While most the students in the study group increased their rates of correct answers to Postmastectomy Patient Care Management questions significantly (p<0.05) after the enhanced reality simulation training, the students in the control group showed no significant improvement (p>0.05). The training significantly (p<0.001) increased the mean postmastectomy patient care skills control scores. This increase had a high effect size on the study group. ConclusionEnhanced reality simulation is a learning method that increases nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. Learning with enhanced reality simulation is an effective approach for nursing education that improves nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care.

Implementation of Genetic Carrier Screening at Gynecologic-Related Visits

ObjectiveTo increase patients’ knowledge and access to genetic carrier screening (GCS) in a gynecologic setting by implementing a protocol to universally offer GCS education and screening to reproductive-age women during the preconception period at gynecologic-related visits. DesignThe model for improvement quality improvement process model was used to guide this initiative. Local Problem/SettingScreening for genetic disease has been a part of preconception and genetic care for the past 50 years. Despite its longstanding presence and better accessibility and affordability of testing, there are no established protocols to universally offer screening to reproductive-age women during preconception care in the United States. The project was implemented at an outpatient gynecology clinic in Phoenix, Arizona. ParticipantsFifty-one women ages 18 to 51 years. Intervention/MeasurementsA protocol was implemented to universally offer expanded GCS and health education to reproductive-age women during the preconception period at gynecologic-related visits. Women’s responses to being offered GCS and the rationale for their response was documented on a spreadsheet. ResultsAll 51 participants were offered GCS during their visit. None of those 51 participants had any previous knowledge of GCS. All 51 participants declined GCS; reasons included the following: would consider it once closer to childbearing (53%), did not have any childbearing plans (31.3%), did not have any further childbearing plans (9.8%), or were not worried about the possibility of genetic disease (5.8%). None cited cost as a reason for declining GCS. After project completion, 3 of the 51 participants returned to the clinic to undergo GCS, and the clinic has adopted the intervention described here as its standard of care for patients who meet criteria for GCS. ConclusionIt is imperative to provide health education about GCS to women during preconception care so that they can make informed choices about family planning.