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Integrated person-centred care (IPCC) for vulnerable groups is complex and multifaceted and cannot be reduced to simple cause-and-effect relationships. The effectiveness varies across settings due to differing contexts and mechanisms. By applying realist research, this dissertation examines the relationships between the context in which IPCC for vulnerable groups in the Netherlands is applied, the mechanisms by which IPCC (does not) work(s), and the outcomes resulting from this interaction. The findings provide deeper insights into interrelatedness of items that influence effectiveness of IPCC, emphasizing the significance of understanding their interplay and recognizing that they form a larger interconnected system rather than acting independently. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the postoperative recovery and outcomes in patients with morbid obesity undergoing anesthesia. Methods: A thorough search across four databases identified 720 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, the search yielded 358 publications, of which 90 full-text articles were reviewed, and 5 met the eligibility criteria for evidence synthesis. Results: We included 5 studies with a total of 477 patients with morbid obesity and less than half of them were females 219 (45.9%). The results indicate that in morbidly obese patients, total intravenous anesthesia (TIVA) with propofol and dexmedetomidine (DEX) was more effective than inhalation anesthesia, leading to reduced analgesic use, fewer postoperative nausea and vomiting episodes, and shorter recovery times. Propofol alone, however, was associated with cardiovascular depression in morbidly obese individuals. DEX outperformed fentanyl by reducing extubation time, opioid consumption, and early postoperative pain scores. Furthermore, sevoflurane was superior to propofol in minimizing complications and optimizing recovery time and hospital stay, while Penthrox demonstrated safety and high satisfaction rates during colonoscopy. Conclusion: The evidence indicates that DEX, particularly in combination with TIVA, offers superior postoperative outcomes for morbidly obese patients compared to other anesthetic options, such as inhalation anesthesia or fentanyl. Sevoflurane also demonstrated benefits in reducing complications and enhancing recovery metrics. These findings emphasize the importance of selecting tailored anesthetic regimens to improve surgical outcomes in this patient population. Further research is warranted to confirm these results in diverse clinical settings and to explore the long-term impact of these anesthetic strategies. [ABSTRACT FROM AUTHOR]

Byline: Smile. Kajal, Syed. Naeem, Pooja. Gupta, Arvind. Kairo, Anam. Ahmed, Prankur. Verma, Ashish. Saini OBJECTIVES: Sinonasal mucormycosis is a serious fungal infection. Early diagnosis and prompt antifungal therapy along [...]

Background and Aim: While European Society of Pediatric Gastroenterology Hepatology and Nutrition advocates a no‐biopsy pathway for the diagnosis of celiac disease (CeD) in children if IgA anti‐tissue transglutaminase antibody (anti‐tTG ab) titer is ≥10‐fold upper limit of normal (ULN) and have a positive IgA anti‐endomysial antibody (EMA); the data for anti‐tTG Ab titer‐based diagnosis of CeD in adults is still emerging. We planned to validate if IgA anti‐tTG Ab titer ≥10‐fold predicts villous abnormalities of modified Marsh grade ≥2 in Asian adult patients with CeD. Methods: We recruited 937 adult patients with positive anti‐tTG Ab from two databases, including AIIMS Celiac Clinic and Indian National Biorepository. The diagnosis of definite CeD was made on the basis of a positive anti‐tTG Ab and the presence of villous abnormalities of modified Marsh grade ≥2. Results: Of 937 adult patients with positive anti‐tTG Ab, 889 (91.2%) showed villous abnormalities of modified Marsh grade ≥2. Only 47.6% of 889 adults with CeD had anti‐ tTG Ab titers of ≥10‐fold. The positive predictive value (PPV) and specificity of anti tTG Ab titer ≥10‐fold for predicting modified Marsh grade ≥2 were 99.8% and 98%, respectively. At anti‐tTG Ab titer ≥11‐fold, specificity and PPV were 100% for predicting villous abnormalities of modified Marsh grade ≥2. Conclusions: Approximately 50% of adults with CeD may benefit from the no biopsy pathway, reducing the health burden and risks of gastroscopy/anesthesia. [ABSTRACT FROM AUTHOR]

Background and Aim: Celiac disease (CeD) has now become a global disease with a worldwide prevalence of 0.67%. Despite being a common disease, CeD is often not diagnosed and there is a significant delay in its diagnosis. We reviewed the impact of the delay in the diagnosis on the severity of manifestations of CeD. Methods: We reviewed clinical records of 726 consecutive patients with CeD from the Celiac Clinic database and the National Celiac Disease Consortium database. We extracted specific data including the demographics, symptoms at presentation, time of onset of symptoms, time to diagnosis from the onset of the symptoms, and relevant clinical data including fold‐rise in anti‐tissue transglutaminase antibody (IgA anti‐tTG Ab) and severity of villous and crypt abnormalities as assessed using modified Marsh classification. Results: The median duration between the onset of symptoms and the diagnosis of CeD was 27 months (interquartile range 12–60 months). A longer delay in the diagnosis of CeD from the onset of symptoms was associated with lower height for age, lower hemoglobin, higher fold rise in IgA Anti tTG titers, and higher severity of villous and crypt abnormalities. About 18% of patients presented with predominantly non‐gastrointestinal complaints and had a longer delay in the diagnosis of CeD. Conclusions: There is a significant delay in the diagnosis of CeD since the onset of its symptoms. The severity of celiac disease increases with increasing delay in its diagnosis. There is a need to keep a low threshold for the diagnosis of CeD in appropriate clinical settings. [ABSTRACT FROM AUTHOR]

The removal of phenolic compounds is of great importance because of their toxic nature and potentially harmful effects on the environment and human health. This study examines the use of rice husk as a biosorbent for eliminating phenolic compounds, particularly resorcinol, from industrial wastewater. Three types of rice husk, namely raw rice husk (RRH), chemically treated rice husk (CTRH), and thermally treated rice husk (TTRH), are utilized after grinding and methanol treatment. Characterization techniques including X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), and optical microscopy are used to analyze the rice husk-based adsorbents. The microscopic analysis reveals the presence of nano-pores in TTRH and the existence of carbonyl and hydroxyl groups in all sorbent samples. XRD analysis confirms the presence of silica in biosorbents. This study also examines the influence of dosage and initial concentration on resorcinol sorption. Optimized dosages of 0.5 g (RRH), 0.5 g (CTRH), and 1.5 g (TTRH) result in sorption capacities of 14 mg/g (RRH), 11 mg/g (CTRH), and 5 mg/g (TTRH). Isotherm analysis indicates that the Langmuir isotherm best describes the sorption behavior of TTRH, while the Freundlich isotherm is observed for CTRH, and both RRH and CTRH follow the Temkin isotherm. [ABSTRACT FROM AUTHOR]

Objectives: 1) to analyse the total average healthcare costs of a patient with an out-of-hospital cardiac arrest (OHCA), as well as estimating the operational costs of the citizen-rescuer system (CRS); 2) to conduct an early modelling of the effects and healthcare costs of the Dutch CRS in comparison to no CRS. Methods: A health economic modelling study was conducted. Adult patients with OHCA from cardiac causes in the province of Limburg (the Netherlands) were included. The time horizon was from OHCA occurrence up to one year after hospital discharge. First, the total average healthcare costs of OHCA patients were analysed as well as the yearly operating costs of the CRS. Second, an early modelling was conducted to compare from the healthcare perspective the healthcare costs of OHCA patients with the CRS being activated but no responders attended (CRS-NV) versus the CRS being activated with attendance of ≥1 responder(s) (CRS-V). Results: The total average healthcare costs per patient are €42,533. The yearly operating costs for the CRS are approximately €1.5 million per year in the Netherlands. The early modelling of costs and effects showed that the incremental healthcare costs per patient thus were €4,131 in the CRS-V versus the CRS-NV group (€25,184 in the CRS-V group and €21,053 in the CRS-NV group). Incremental quality-adjusted life years (QALYs) was 5 per 100 patients (16 per 100 patients in the CRS-V group versus 11 per 100 patients in the CRS-NV group). The incremental cost-effectiveness ratio (ICER) was €79,662 per QALY for the CRS-V group. Conclusion: This study shows that patients in the CSR-V group had additional health care costs of €4,131 per patient compared to patients in the CRS-NV group. This increase is caused by patients surviving more often, who then continue to utilise health services, which results in a (logic) increase in healthcare costs. For future research, accurate and up-to-date data on effectiveness and costs of the CRS needs to be collected. [ABSTRACT FROM AUTHOR]