American Society Research Articles

The impact of early surgery on mortality and functional recovery in older adults with traumatic intracranial lesions: a propensity score-based analysis.

There is skepticism about the benefit of surgery in elderly patients affected by traumatic brain injury (TBI) due to the negative effect of age on the outcome and surgical complications. However, there are few studies that have investigated differences in patient's outcome between surgically and conservatively managed patients after adjusting for the imbalance in preinjury characteristics and clinical and radiological features. The primary aim of this study was to evaluate the effect of early surgery on mortality and functional recovery in a cohort of older adults with acute traumatic intracranial lesions after adjustment by Propensity Score (PS) matching. MATERIALS AND METHODS: We conducted a retrospective cohort study on older adult patients (≥ 65 years) admitted for TBI between 2013 and 2023 to a single level 1 trauma center. Patients were categorized based on whether they underwent early surgery (< 48h after TBI) for a space-occupying lesion evacuation. PS model was constructed based on age, frailty, comorbidities (Charlson comorbity index and American Society of Anaesthesiologists score), anticoagulants, hypoxia, shock, pupillary abnormalities and GCS motor response upon admission, midline shift, basal cistern effacement, volume of subdural and intracerebral hematomas, and limitation of life-sustaining treatment decisions.The effect of early surgery on 30-day mortality and unfavorable functional outcomes (GOSE 1-3) at 6 and 12 months were investigated after matching by paired test. We identified and reviewed 301 patients who met all inclusion criteria and contained no exclusions. After matching, 62 patients (31 pairs of conservative and surgical patients) remained as the matched datasets. Our key finding was that older adult TBI patients who underwent early surgery had a statistically significant reduction in the risk of 30-day mortality (OR 0.313, 95% CI 0.114-0.853, p = 0.023) and unfaourable outcome at 12 months after TBI (OR 0.286, 95% CI 0.094-0.868, p = 0.027). Early surgery was associated with decreased 30-day mortality and better functional outcome at 12 months after TBI in older adults with few comorbidities and good functionality when clinically affected by acute traumatic intracranial lesions with mass effect.

Assessing the efficacy of sugammadex based on ideal body weight for reversal of moderate neuromuscular blockade in obstetric patients across different BMI categories: A prospective study

Background: This investigation aimed to evaluate the effectiveness of administering 2 mg/kg intravenous (IV) sugammadex, dosed according to the ideal body weight (IBW) of obstetric patients across three different BMI groups, for the reversal of neuromuscular blockade caused by rocuronium.Materials and Method: A total of ninety female patients, who were categorized as American Society of Anesthesiologists (ASA) II and were 18 years or older, participated in this study. These patients were all scheduled to undergo elective cesarean sections under general anesthesia, providing a well-defined cohort for our investigation. Participants were separated into three groups according to their BMI: Group 1 (n=30) consisted of patients with a BMI less than 30 kg/m², Group 2 (n=30) included those with a BMI ranging from 30 to 39.9 kg/m², and Group 3 (n=30) comprised patients with a BMI over 40 kg/m². At the end of the surgery, each patient received intravenous sugammadex at 2 mg/kg based on ideal body weight, with additional doses as needed, while recording the total amount administered and the times for extubation, motor responses, and first breastfeeding.Results: The total sugammadex dose was found to be notably higher in Group 3 (p=0.002). The time required to reach a Train of Four (TOF) ratio greater than 90% was similar across the groups (p=0.120). However, the recorded durations between sugammadex administration and extubation, accurate motor response, and the time to first breastfeeding significantly differed between the groups.Conclusions: We found that IV sugammadex 2 mg/kg, administered according to the IBW of patients, was effective for reversing moderate neuromuscular blockade in patients of weight categories. However, administering a sugammadex dose of IBW+25% appears to be safer for class III obese patients.

Consensus Statement on Pain Management for Pregnant Patients with Opioid-Use Disorder from the Society for Obstetric Anesthesia and Perinatology, Society for Maternal-Fetal Medicine, and American Society of Regional Anesthesia and Pain Medicine.

Pain management in pregnant and postpartum people with an opioid-use disorder (OUD) requires a balance between risks associated with opioid tolerance, including withdrawal or return to opioid use, considerations around social needs of the maternal-infant dyad, and the provision of adequate pain relief for the birth episode that is often characterized as the worst pain a person will experience in their lifetime. This multidisciplinary consensus statement between the Society for Obstetric Anesthesia and Perinatology (SOAP), Society for Maternal-Fetal Medicine (SMFM), and American Society of Regional Anesthesia and Pain Medicine (ASRA) provides a framework for pain management in obstetric patients with OUD. The purpose of this consensus statement is to provide practical and evidence-based recommendations and is targeted to health care providers in obstetrics and anesthesiology. The statement is focused on prenatal optimization of pain management, labor analgesia, and postvaginal delivery pain management, and postcesarean delivery pain management. Topics include a discussion of nonpharmacologic and pharmacologic options for pain management, medication management for OUD (eg, buprenorphine, methadone), considerations regarding urine drug testing, and other social aspects of care for maternal-infant dyads, as well as a review of current practices. The authors provide evidence-based recommendations to optimize pain management while reducing risks and complications associated with OUD in the peripartum period. Ultimately, this multidisciplinary consensus statement provides practical and concise clinical guidance to optimize pain management for people with OUD in the context of pregnancy to improve maternal and perinatal outcomes.

The Association Between Perioperative Red Blood Cell Transfusions and 1-Year Mortality After Major Cancer Surgery: An International Multicenter Observational Study.

Packed red blood cell (pRBC) transfusions in patients undergoing surgery for cancer are given to treat anemia or acute hemorrhage. Evidence indicates that pRBC transfusions are associated with poor perioperative and oncological outcomes. The ARCA-1 (Perioperative Care in the Cancer Patient-1) study was designed to test the association between perioperative pRBC transfusions and postoperative morbidity and mortality in patients undergoing cancer surgery. The primary hypothesis of our study was that perioperative pRBC transfusions have a negative impact on postoperative morbidity and 1-year mortality. ARCA-1 was an international multicenter prospective observational cohort study. Participating centers enrolled a minimum of 30 consecutive adult patients with cancer who underwent surgery with curative intent. The primary end point was all-cause mortality 1 year after major cancer surgery. Secondary end points were rates of perioperative blood product use, 1-year cancer-specific mortality, overall survival, and 30-day morbidity and mortality. We performed a propensity score matching analysis to adjust for selection bias. A multivariable logistic regression model was fitted to estimate the effects of significant covariates on 1-year mortality, cancer-related mortality, and overall survival. A total of 1079 patients were included in the study. The rate of perioperative pRBC transfusions was 21.1%. Preoperative comorbidities, including anemia, American Society of Anesthesiologists (ASA) score of III to IV, a history of coronavirus disease 2019 (COVID-19), myocardial infarction, stroke, need for dialysis, history of blood transfusions, and metastatic disease were statistically significantly more frequent in transfused patients compared to nontransfused patients. The 1-year mortality rate was higher in transfused patients before (19.7% vs 6.5%; P < .0001) and after (17.4% vs 13.2%; P = .29) propensity score matching. 1-year mortality was 1.97 times higher in transfused than in no-transfused patients (odd ratio [OR], 1.97; 95% confidence interval [CI], 1.13-3.41). The odds of 1-year cancer mortality for patients who had perioperative pRBCs was 1.82 times higher (OR, 1.82; 95% CI, 0.97-3.43) compared to those who did not receive perioperative pRBC transfusion. The effect of perioperative pRBC transfusion on overall survival was also significant (hazard ratio [HR], 1.85; 95% CI, 1.15-2.99). Transfused patients also had a higher rate of 30-day postoperative mortality before (3.5% vs 0.7%; P = .0009) and after propensity score matching (4.2% vs 1.8%; P = .34). This international, multicenter observational study showed that perioperative pRBC transfusion was associated with an increased mortality risk.

Analysis of clinical phenotypes and genetic variations in two pedigrees affected with Weiss-Kruszka syndrome.

Weiss-Kruszka syndrome (WSKA) is a rare autosomal dominant syndrome characterized by multiple congenital anomalies caused by variants in the zinc finger protein 462 gene (ZNF462). About 40 cases of Weiss-Kruszka syndrome have been reported worldwide, and the aim of this study was to investigate the genetic causes of three patients from two Weiss-Kruszka syndrome family pedigrees with the aim of accumulating more data on the disease. To explore the clinical and genetic characteristics of two pedigrees with Weiss-Kruszka syndrome. The clinical data and family history of patients and family members of two pedigrees with Weiss-Kruszka syndrome were collected, and the pathogenic genes of the patients were analysed by whole-exon sequencing. Suspicious variants were verified by Sanger sequencing verification and bioinformatics prediction. Proband 1 has developmental delay, autistic behaviour, and abnormal electroencephalogram results. WES revealed a classical heterozygous c.6696-2A > C splice variant of the ZNF462 gene, which was detected in neither parent. This position was conserved, and the variant was predicted to be deleterious. Minigene assays revealed that three types of aberrantly spliced mRNAs were produced. MRI of proband 2 suggested dysplasia of the corpus callosum with the formation of hemispheric cleft cysts, with a teardrop-like appearance in the lateral ventricle. WES revealed that a heterozygous c.4891C > T:p. The Glu1631Ter nonsense variant of the ZNF462 gene was inherited from her mother. According to the guidelines of the American Society of Medical Genetics and combined with its clinical manifestations, c.6696-2A > C and c.4891C > T:p. Glu1631Ter was determined to be a possible pathogenic variant. The c.6696-2A>C and c.4891C > T:p.Glu1631Ter of the ZNF462 gene likely underlies Weiss-Kruszka syndrome in children (foetus), which enriches the variant spectrum of Chinese patients with Weiss-Kruszka syndrome and provides a basis for prenatal diagnosis and genetic counselling.

Is the Use of a Buprenorphine Transdermal Patch More Effective Than Oral Medications for Postoperative Analgesia After Arthroscopic Rotator Cuff Repair? A Randomized Clinical Trial.

Appropriate analgesic protocols for patients following arthroscopic rotator cuff repair remain controversial. Although transdermal buprenorphine patches might potentially provide better pain control and fewer side effects, it is worth noting that there is limited evidence for this given a lack of direct comparisons with oral pain regimens. Among patients undergoing arthroscopic rotator cuff repair, and compared with an analgesic approach using oral tramadol plus celecoxib: (1) Does perioperative use of buprenorphine patches provide better pain relief by a clinically important margin? (2) Does perioperative use of buprenorphine patches improve shoulder joint function recovery? (3) Does perioperative use of buprenorphine patches have a lower frequency of adverse reactions? This was a prospective, single-center, randomized controlled trial. We included patients who underwent arthroscopic rotator cuff repair for partial- or full-thickness rotator cuff tears < 3 cm in size in the anterior to posterior direction as estimated by preoperative MRI and excluded those who had obesity, were pregnant, had opioid dependence, had history of cardiac bypass surgery or ipsilateral rotator cuff repair, had allergies to trial medications, were taking anticoagulants or antidepressants, were being treated with other postsurgical pain management methods, or had severe liver or kidney dysfunction. Based on these criteria, 64% (72 of 112) of patients were eligible. The patients were randomly assigned into either the control group (oral tramadol and celecoxib) or the experimental group (buprenorphine patches). The control group received 100 mg of tramadol and 200 mg of celecoxib every 12 hours for 2 weeks after surgery. The experimental group received buprenorphine patches about 48 hours before surgery without any oral medication. A medication journal was given to the patients to self-report their compliance in taking the drugs. The dosage regimen adhered strictly to protocol. After enrollment, 11% (4 of 36) of patients in the control group and 17% (6 of 36) of patients in the experimental group could not be fully analyzed because of loss to follow-up or missing data. The surveillance period was 3 months, and there was no crossover between groups. The groups did not differ at baseline in terms of demographic parameters and relevant clinical characteristics, including age, gender, BMI, American Society of Anesthesiologists classification, tear size, concomitant procedures, and number of anchors. The outcomes were (1) numeric rating scale (NRS) for pain score at rest or with movement, which ranges from 0 to 10, where 0 indicates no pain, and 10 indicates the worst pain; (2) the American Shoulder and Elbow Surgeons (ASES) score for joint function, which ranges from 0 to 100, with higher scores indicating better shoulder joint function; and (3) the incidence of postoperative adverse reactions. We defined the minimum clinically important difference on the NRS as 2 of 10 points and on the ASES score as 15 of 100 points, based on anchor-based approaches reported in other studies. We found no clinically important between-group differences in NRS pain scores at any time point, either at rest or with movement. Likewise, we found no clinically important between-group differences in ASES scores at any time point. Postoperative dizziness or drowsiness (20% [6 of 30 patients] versus 44% [14 of 32 patients]; p = 0.04) and nausea (10% [3 of 30 patients] versus 34% [11 of 32 patients]; p = 0.02) during the hospital stay were slightly lower in the experimental group compared with the control group. In this randomized trial, we found no clinically important advantages in pain or function to the use of buprenorphine patches after arthroscopic rotator cuff repair, and insufficient evidence exists to confirm whether the minor differences in transient side effects could justify the use of a new and largely untested analgesic approach in this context. That being so, we recommend against the routine use of buprenorphine patches for this indication. In general, we found that pain levels were low after the procedure in both groups. Future studies, therefore, should focus on the efficacy of buprenorphine patches for more invasive or more painful procedures. Level I, therapeutic study.

Retrospective analysis of HPV infection: Cotesting and HPV genotyping in cervical cancer screening within a large academic health care system.

In 2019, the American Society for Colposcopy and Cervical Pathology introduced fundamental shifts toward "risk-based" guidelines, with human papillomavirus (HPV) genotyping as a principal test for investigating squamous intraepithelial lesions. This study aims to provide practice-based evidence and supplement the updated guidelines by investigating HPV demographic distribution and uncovering the pathological features of high-grade squamous intraepithelial lesions (HSILs) caused by high-risk HPV (hrHPV) subtypes. Patients who underwent Papanicolaou screening and HPV testing in two hospital systems over the course of 4 years were recruited. The cytology results were categorized on the basis of the 2014 Bethesda classification. DNA sequences of 14 types of hrHPV were detected by Aptima test. The histological features of HSILs caused by different subtypes were compared between biopsies and excisions. A total of 63,709 cases were included. The HPV prevalence was 14.70%, predominantly in the 30 to 39-year-old age group, with slightly higher rates observed in African Americans. There was no significant racial distribution difference between HPV 16/18/45 and other types. HPV 16/18/45 infection was directly correlated with the severity of abnormal cytology, although the other subtypes were the major causes of cytological abnormalities. The trend for HPV prevalence was consistent across calendar years, and was associated with 8.77% negative for intraepithelial lesion or malignancy, 30.46% atypical squamous cell of undetermined significance, 64.62% low-grade squamous intraepithelial lesion, 66.75% atypical squamous cell-cannot exclude a high-grade squamous intraepithelial lesion, and 91.80% HSIL. Furthermore, 29.09% of HSILs associated with other subtypes were not detectable on subsequent resections. Given the HPV demographic distribution and the histological features of HSILs caused by different subtypes, cotesting with reflex HPV genotyping in specific populations, or expanding the subtypes in the primary HPV screening test, should be considered.

Studying bats using a One Health lens: bridging the gap between bat virology and disease ecology.

Accumulating data suggest that some bat species host emerging viruses that are highly pathogenic in humans and agricultural animals. Laboratory-based studies have highlighted important adaptations in bat immune systems that allow them to better tolerate viral infections compared to humans. Simultaneously, ecological studies have discovered critical extrinsic factors, such as nutritional stress, that correlate with virus shedding in wild-caught bats. Despite some progress in independently understanding the role of bats as reservoirs of emerging viruses, there remains a significant gap in the molecular understanding of factors that drive virus spillover from bats. Driven by a collective goal of bridging the gap between the fields of bat virology, immunology, and disease ecology, we hosted a satellite symposium at the 2024 American Society for Virology meeting. Bringing together virologists, immunologists, and disease ecologists, we discussed the intrinsic and extrinsic factors such as virus receptor engagement, adaptive immunity, and virus ecology that influence spillover from bat hosts. This article summarizes the topics discussed during the symposium and emphasizes the need for interdisciplinary collaborations and resource sharing.

Bibliometric Review of Passive Cooling Design Strategies and Global Thermal Comfort Assessment: Theories, Methods and Tools

Globally, a variety of factors, ranging from ethnicity and occupants’ lifestyles to the local climate characteristics of any studied location, as well as people’s age, can affect thermal comfort assessments. This review paper investigates the energy effectiveness of state-of-the-art passive systems in providing neutral adaptive thermal comfort for elderly people by exploring passive design strategies in four distinct climates, namely Canada, India, Abu Dhabi and the Eastern Mediterranean basin. The aim of the study is to analyse the available data provided by the American Society of Heating, Refrigerating and Air-Conditioning Engineers’ (ASHRAE) Global Thermal Comfort Database II, version 2.1. The main objective of the study is to develop an effective methodological framework for the on-going development of adaptive thermal comfort theory. To this extent, this study presents a comprehensive review of the assessment of energy effectiveness of passive design systems. To accomplish this, the impact of climate change factors in passive design systems was investigated. A meta-analysis method was adopted to determine the input variables for the statistical analysis. Cramer’s V and Fisher’s Exact tests were used to assess occupants’ thermal sensation votes (TSVs). The findings revealed that there are discrepancies detected between the in situ field experiments and the data recorded in the ASHRAE Global Thermal Comfort Database II. The study findings contribute to the development of adaptive thermal comfort theory by reviewing the existing methodologies globally. Furthermore, a critical review of the significance of occupants’ age differences should be conducted in the identification of neutral adaptive thermal comfort.

Balancing Fertility Preservation and Treatment Efficacy in (Neo)adjuvant Therapy for Adolescent and Young Adult Breast Cancer Patients: a Narrative Review.

Adolescent and young adult (AYA) breast cancer survivors face a significant risk of infertility due to the gonadotoxic effects of (neo)adjuvant therapy, which complicates their ability to conceive post-treatment. While (neo)adjuvant therapy primarily aims to improve recurrence-free and overall survival, fertility preservation strategies should also be considered for young patients. This narrative review explores recent advancements in fertility preservation techniques, such as oocyte, embryo, and ovarian tissue cryopreservation, and evaluates the feasibility of modifying breast cancer (neo)adjuvant therapy to preserve fertility without compromising survival outcomes. Our review highlights that clinical trials with co-primary endpoints of oncological safety and fertility preservation are limited, and substituting standard treatment regimens solely for fertility preservation is currently not recommended. Nevertheless, new clinical studies have emerged that either exclude highly ovarian-toxic agents, such as cyclophosphamide, or omit adjuvant therapy altogether, even if fertility preservation is not their primary endpoint. Unfortunately, many of these trials have not evaluated ovarian toxicity. Notably, since 2020, major oncology organizations, including the American Society of Clinical Oncology (ASCO), the European Society of Medical Oncology (ESMO) have advocated for the routine assessment of ovarian toxicity in all clinical trials. The review underscores the importance of incorporating ovarian toxicity as a standard endpoint in future trials involving premenopausal breast cancer patients to identify treatment regimens that can effectively balance fertility preservation with treatment efficacy.

Comparative Analysis of Ultrasound Guided Transversus Abdominis Plane Block with or without Buprenorphine Following Inguinal Hernia Repair

Background and Aims Inguinal hernia is a commonly performed surgical procedure globally, which is often accompanied by significant post-operative pain that peaks on the day of the surgery. The transversus abdominis plane block (TAP) offers better postoperative pain relief for lower abdominal procedures. However, the duration of TAP block is restricted by the effects of given local anaesthetic drugs, necessitating the use of an adjuvant, such as buprenorphine, to improve the quality and duration of analgesia. Hence, we designed the present study to analyse the effect of a TAP block with buprenorphine on the relief of pain after inguinal hernia repair surgery. Methods A prospective, randomized, double-blinded study was conducted on fifty American Society of Anaesthesiologists Physical Status I and II patients posted for elective unilateral inguinal hernia repair under spinal anaesthesia. At the end of the surgery, group B patients received 20 ml of 0.25% bupivacaine and group BB patients received 20 ml of 0.25% bupivacaine along with 300 mg of buprenorphine for ultrasound-guided transversus abdominis plane block. The duration of analgesia, postoperative analgesic consumption and pain scores at rest and during sitting up to 24 h were recorded. Results Patients who received perineural buprenorphine experienced prolonged duration of analgesia (870.32 ± 27.86 vs. 385.64 ± 27.86 minutes), lower tramadol consumption (135.08 ± 23.05 vs. 246.72 ± 38.8 mg), and decreased pain scores both at rest and during sitting for up to 24 hours post-surgery. Conclusion The present study shows that the addition of buprenorphine to bupivacaine in TAP block after inguinal hernia repair produces superior postoperative analgesia compared with the control group without any significant side effects.

Directionality and representativeness are differentiable components of stereotypes in large language models

Abstract Representativeness is a relevant but unexamined property of stereotypes in language models. Existing auditing and debiasing approaches address the direction of stereotypes, such as whether a social category (e.g., men, women) is associated more with incompetence vs. competence content. On the other hand, representativeness is the extent to which a social category’s stereotypes are about a specific content dimension, such as Competence, regardless of direction (e.g., as indicated by how often dimension-related words appear in stereotypes about the social category). As such, two social categories may be associated with competence (vs. incompetence), yet one category’s stereotypes are mostly about competence, whereas the other’s are mostly about alternative content (e.g., Warmth). Such differentiability would suggest that direction-based auditing may fail to identify biases in content representativeness. Here, we use a large sample of social categories that are salient in American society (based on gender, race, occupation, and others) to examine whether representativeness is an independent feature of stereotypes in the ChatGPT chatbot and SBERT language model. We focus on the Warmth and Competence stereotype dimensions, given their well-established centrality in human stereotype content. Our results provide evidence for the construct differentiability of direction and representativeness for Warmth and Competence stereotypes across models and target stimuli (social category terms, racialized name exemplars). Additionally, both direction and representativeness uniquely predicted the models’ internal general valence (positivity vs. negativity) and human stereotypes. We discuss implications for the use of AI in the study of human cognition and the field of fairness in AI.

Current status and challenges in HER2 IHC assessment: scoring survey results in Japan.

This study aimed to assess the concordance of human epidermal growth factor receptor 2 (HER2) expression scoring by immunohistochemistry (IHC) among practicing pathologists in Japan, given the challenging nature of scoring and the critical role of HER2 status in breast cancer management. Whole slide images (WSI) from 20 invasive breast cancer cases (1 representative WSI per case) selected to represent a diverse IHC scores and staining patterns were used in an online survey involving seven reference pathologists who established consensus HER2 IHC scores (0 to 3 +) decided by majority interpretation. Participating pathologists nationwide scored the same 20 WSI cases online using the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) 2018 guidelines. Deidentified case metadata were registered in the uPath system. A total of 144 participating pathologists responded. The scoring results of the participating pathologists most commonly agreed with the consensus IHC score, followed by a ± 1 point deviation and no survey responses with > 1 point deviation. The mean percentage of agreement with the consensus score for all 20 cases was 63.4%. In cases where the reference pathologists' scores were discordant, the participating pathologists also showed a lower concordance rate. This study highlighted the current status of HER2 expression scoring by IHC for breast cancer among pathologists in Japan. These findings underscore the challenges in HER2 IHC scoring cases and emphasize the need for improved standardization and training, especially in the evolving landscape of HER2-targeted therapies.

A tribute to Darrell Whiteman

Darrell Whiteman was the Lifetime Achievement Awardee of the American Society of Missiology in 2024. This brief tribute notes his academic achievements and personal qualities for which he deserves the ASM’s highest award.

Reimagining sacred spaces and spiritual leadership: Response to Andrea Baker’s paper Sacred Spaces

Through Andrea Baker’s paper, the realities of abuse and the failure of churches to protect the oppressed are brought closer to our hearts and minds. Baker presents a prophetic call to imagine how Christians may embody the kingdom of God and restore ‘sacred spaces’ in our ecclesial institutions. In light of such a prophetic challenge, as a response, this paper reflects on a couple of aspects that can be pertinent to missiologists. They are: 1) to reimagine how we understand ‘sacred spaces’ and 2) to envision the possibility of holistic leadership development that fosters ‘sacred spaces.’ Consequently, one can discern God’s redeeming presence beyond the four walls of the church while working to restore churches as ‘sacred spaces’ where the love and resurrection power of Jesus Christ become an embodying reality. This paper was read in response to Andrea Baker's plenary address titled ‘Sacred Spaces’ at the Annual Conference of the American Society of Missiology, 2024.

Position Paper of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Roentgen Society (DRG) on Structural and Professional Requirements in Interventional Oncology.

Interventional oncology (IO) employs various techniques to enable minimally invasive, image-guided treatment of tumor diseases with both curative and palliative goals. Additionally, it significantly contributes to managing tumor-related and perioperative complications, offering diverse supportive procedures for patients at all stages of their diseases. The execution of IO procedures places unique demands on the equipment, personnel, and structural organization of radiological clinics, necessitating specific expertise from interventional radiologists.This position paper aims to comprehensively outline the multifaceted aspects of IO and discuss the requisite criteria for hospitals, radiological clinics, and interventional radiologists (IRs). Furthermore, it underscores overarching considerations of quality assurance that clinics and professional societies should prioritize.The requirements for hospitals, radiological clinics, and IRs are varied and demand not only a high level of proficiency in performing IO procedures but also in-depth knowledge of the differential therapy for various tumor diseases. This expertise is essential for effectively serving as clinical partners in the interdisciplinary treatment of oncologic patients. Additionally, a thorough understanding and safe handling of ionizing radiation technologies, along with proficiency in radiation protection methods, which are fundamental aspects of radiological specialist training, is crucial for ensuring the safety of IO procedures for both patients and staff. The Deutsche Gesellschaft für Interventionelle Radiologie und minimal-invasive Therapie (DeGIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) have long-established dedicated quality management programs, accrediting radiology clinics and certifying IRs. These initiatives aim to uphold the highest standards of care and meet the quality expectations set by politics in healthcare system, particularly in the realm of interventional radiology. · The various procedures in the field of interventional oncology (IO) are complex medical interventions that require not only the most advanced technical equipment but also adequate human resources, particularly specialized expertise in interventional radiology, diagnostic imaging, oncology, and radiation protection.. · This expertise is an integral part of the specialized medical training in radiology and is certified by professional societies such as the German Society for Interventional Radiology (DeGIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).. · Professional societies like DeGIR, CIRSE, and the American Society of Interventional Radiology (SIR) establish the necessary quality assurance framework for comprehensive, high-quality IO therapy through quality assurance (QA) registries, standard operating procedure (SOP) documents, and participation in guideline development.. · Currently, radiology is the only discipline that provides physicians with the theoretical and practical knowledge, skills, and competencies required to perform the demanding procedures in the field of IO through specialized training programs and tailored certification processes.. · Isfort P, Sommer CM, Bruners P et al. Position Paper of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Roentgen Society (DRG) on Structural and Professional Requirements in Interventional Oncology. Fortschr Röntgenstr 2024; DOI 10.1055/a-2373-1013.

A Comparative Analysis of Age, BMI, Age/BMI Ratio, Nottingham Hip Fracture Score, and American Society of Anesthesiologists (ASA) Grade as Predictors of 30-Day Mortality After Neck of Femur Fractures: A Retrospective Cohort Study

A Comparative Analysis of Age, BMI, Age/BMI Ratio, Nottingham Hip Fracture Score, and American Society of Anesthesiologists (ASA) Grade as Predictors of 30-Day Mortality After Neck of Femur Fractures: A Retrospective Cohort Study

American Society for Microbiology evidence-based laboratory medicine practice guidelines to reduce blood culture contamination rates: a systematic review and meta-analysis.

SUMMARYBlood cultures (BCs) are one of the critical tests used to detect bloodstream infections. BC results are not 100% specific. Interpretation of BC results is often complicated by detecting microbial contamination rather than true infection. False positives due to blood culture contamination (BCC) vary from 1% to as high as >10% of all BC results. False-positive BC results may result in patients undergoing unnecessary antimicrobial treatments, increased healthcare costs, and delay in detecting the true cause of infection or other non-infectious illness. Previous guidelines from the Clinical and Laboratory Standards Institute, College of American Pathologists, and others, based on expert opinion and surveys, promoted a limit of ≤3% as acceptable for BCC rates. However, the data supporting such recommendations are controversial. A previous systematic review of BCC examined three practices for reducing BCC rates (venipuncture, phlebotomy teams, and pre-packaged kits). Subsequently, numerous studies on different practices including using diversion devices, disinfectants, and education/training to lower BCC have been published. The goal of the current guideline is to identify beneficial intervention strategies to reduce BCC rates, including devices, practices, and education/training by providers in collaboration with the laboratory. We performed a systematic review of the literature between 2017 and 2022 using numerous databases. Of the 11,319 unique records identified, 311 articles were sought for full-text review, of which 177 were reviewed; 126 of the full-text articles were excluded based on pre-defined inclusion and exclusion criteria. Data were extracted from a total of 49 articles included in the final analysis. An evidenced-based committee's expert panel reviewed all the references as mentioned in Data Collection and determined if the articles met the inclusion criteria. Data from extractions were captured within an extraction template in the US Agency for Healthcare Research and Quality's Systematic Review Data Repository (https://srdr.ahrq.gov/). BCC rates were captured as the number of events (contaminated samples) per arm (standard practice versus improvement practice). Modified versions of the National Heart, Lung, and Blood Institute Study Quality Assessment Tools were used for risk of bias assessment (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). We used Grading of Recommendations, Assessment, Development and Evaluations to assess strength of evidence. There are several interventions that resulted in significant reduction in BCC rates: chlorhexidine as a disinfectant for skin preparation, using a diversion device prior to drawing BCs, using sterile technique practices, using a phlebotomy team to obtain BCs, and education/training programs. While there were no substantial differences between methods of decreasing BCC, our results indicate that the method of implementation can determine the success or failure of the intervention. Our evidence-based systematic review and meta-analysis support several interventions to effectively reduce BCC by approximately 40%-60%. However, devices alone without an education/training component and buy-in from key stakeholders to implement various interventions would not be as effective in reducing BCC rates.

An Expansion Of Liberty

This primary source analysis examines the relationship between church and state in early American society from the point of view of the anonymous pamphlet, The Freeman’s Remonstrance Against an Ecclesiastical Establishment, being some remarks On a Late Pamphlet, Entitled The Necessity OfAn Established Church In Any State; By A Freeman Of Virginia. written in 1777. The Freeman uses many ideas from the American Revolution such as American unity, the expansion of liberty, and expansion ofequality to argue for disestablishment. This topic is important because of the ever-evolving debate over church and state in the United States.&amp;nbsp;&amp;nbsp;

Risk model for predicting failure to rescue after hepatectomy: Cohort study of 1371 consecutive patients.

Although hepatectomy is a complex surgical procedure, its incidence among older patients has increased due to global aging. However, few studies have focused on the association between age and failure to rescue (FTR) posthepatectomy. This study aimed to investigate the association between age and FTR and develop a risk model for FTR following hepatectomy. We analyzed a total of 1371 consecutive patients who underwent primary hepatectomy between July 2003 and September 2022. The patients were divided into three groups according to their age: young-old (<65years), pre-old (65-74years), and old group (≥75years). Additionally, the associations among age, FTR, and risk factors for FTR were investigated. Subsequently, a risk model was developed to predict the FTR. Of the 1371 patients, 373 (27.2%) experienced major complications, and FTR occurred in 15 patients. The older group showed a higher FTR rate (8.4%) than the young-old (1.3%) and pre-old (4.3%) groups (p=0.03). Multivariate analyses indicated that older age (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00-1.15; p=0.045) and American Society of Anesthesiologists Physical Status score ≥3 (OR 4.35; 95% CI 1.24-15.2; p=0.02) were independent predictive factors for FTR. The risk model exhibited an accuracy with an area under the curve of 0.80 (95% CI 0.69-0.92). Calibration plots of the model revealed a concordance index of 0.73. This study identified an association between age, FTR, and risk factors for FTR posthepatectomy. Together, our risk model is a clinically relevant, internally validated, and useful tool for predicting FTR posthepatectomy.