Search

Alginate hydrogels are gaining traction for use in drug delivery, regenerative medicine, and as tissue engineered scaffolds due to their physiological gelation conditions, high tissue biocompatibility, and wide chemical versatility. Traditionally, alginate is decorated at the carboxyl group to carry drug payloads, peptides, or proteins. While low degrees of substitution do not cause noticeable mechanical changes, high degrees of substitution can cause significant losses to alginate properties including complete loss of calcium cross-linking. While most modifications used to decorate alginate deplete the carboxyl groups, we propose that alginate modifications that replenish the carboxyl groups could overcome the loss in gel integrity and mechanics. In this report, we demonstrate that restoring carboxyl groups during functionalization maintains calcium cross-links as well as hydrogel shear-thinning and self-healing properties. In addition, we demonstrate that alginate hydrogels modified to a high degree with azide modifications that restore the carboxyl groups have improved tissue retention at intramuscular injection sites and capture blood-circulating cyclooctynes better than alginate hydrogels modified with azide modifications that deplete the carboxyl groups. Taken together, alginate modifications that restore carboxyl groups could significantly improve alginate hydrogel mechanics for clinical applications. Chemical modification of hydrogels provides a powerful tool to regulate cellular adhesion, immune response, and biocompatibility with local tissues. Alginate, due to its biocompatibility and easy chemical modification, is being explored for tissue engineering and drug delivery. Unfortunately, modifying alginate to a high degree of substitution consumes carboxyl group, which are necessary for ionic gelation, leading to poor hydrogel crosslinking. We introduce alginate modifications that restore the alginate's carboxyl groups. We demonstrate that modifications that reintroduce carboxyl groups restore gelation and improve gel mechanics and tissue retention. In addition to contributing to a basic science understanding of hydrogel properties, we anticipate our approach will be useful to create tissue engineered scaffolds and drug delivery platforms. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: Patients at the end of their life typically endure physical, emotional, interpersonal, and spiritual challenges. Although physicians assume a clearly defined role in approaching the physical aspects of terminal illness, the responsibility for helping their patients' spiritual adaptation is also important.Methods: This article (1) describes the terms and definitions that have clinical utility in assessing the spiritual needs of dying patients, (2) reviews the justifications that support physicians assuming an active role in addressing the spiritual needs of their patients, and (3) reviews clinical tools that provide physicians with a structured approach to the assessment and treatment of spiritual distress.Results: This review suggests that physicians can and should be equipped to play a key role in relieving suffering at the end of life.Significance Of Results: Physicians can help their patients achieve a sense of completed purpose and peace. [ABSTRACT FROM AUTHOR]

As part of the response of the Royal Thai Army to the outbreak of human immunodeficiency virus (HIV) in Thailand, a collaboration was established with the U.S. Army to jointly work toward the development of vaccines for the prevention of HIV infection. During the first decade of this collaboration, studies have been carried out in the diverse disciplines that are crucial to providing the foundations for efficacy trials of candidate HIV vaccines. Studies of host, pathogen, and vaccine interventions included studies of viral diversity, epidemiology, disease course, potential vaccine cohorts, and Phase I/II clinical trials. Collaborations were expanded to other Thai institutions and to overseas partners, resulting in the Thai AIDS Vaccine Evaluation Group. The efforts of these collaborations resulted in the development of candidate vaccines specifically designed for use in Thailand, and sequential evaluations that have lead to the threshold of the world's next and largest efficacy trial of HIV vaccines. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of interdisciplinary Higher Educational Academics within Nursing, Midwifery, Pharmacy and Biomedical Science in the use of teaching squares as a formative, collaborative pedagogical tool to promote reflection., Background: One approach to enhancing academic teaching practice involves the provision of feedback to individual academics. This approach can be challenging for the reviewer, hence other less intimidating approaches are popular. One such approach is the teaching square. In this approach typically 4 other teaching staff are involved in observing their peers' teaching methods (synchronous or asynchronous) and then engaging in a cycle of personal reflection. Reflection on teaching practices of their peers can provide opportunity to improve their own teaching. Typically teaching squares involve participants from the same academic discipline, however, in this study participants from related yet different disciplines were purposely connected and the benefits of this approach assessed., Design: A qualitative descriptive design was used to explore the participants' experiences of undertaking interdisciplinary teaching squares through online questionnaires and focus group feedback opportunities., Methods: This study was undertaken between August 2022 to June 2023 at an Australian university. Sixteen academic staff members from Nursing, Midwifery, Pharmacy & Pharmaceutical science and Biological science expressed an interest in the project. Five participants elected not to continue citing time pressures and 11 staff members participated in the project. Participation involved completing the teaching square experience and a subsequent focus group that were held to explore their experiences of undertaking a teaching square. The demographic survey data were presented and the focus group interviews were recorded, transcribed and analysed thematically., Results: Triangulation of the findings resulted in the identification of four main themes: Teaching squares for professional networks; Perceptions of Safety; Stepping in and out of a reflective cycle; and Time Constraints vs. Time Value., Conclusions: The study aimed to explore the effectiveness of teaching squares in encouraging academic reflection on teaching and fostering a collaborative teaching culture within interdisciplinary higher education academics. An unexpected finding was the value and promotion of interdisciplinarity professional relationships and networks. The findings from this research project offer valuable insights into the benefits of adopting teaching squares in health education and contributes to evidence-based pedagogical practices., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Length of stay (LOS) is an important measure of hospital quality and may be impacted by patient participation. However, concepts of patient participation, like health confidence, have received little examination in hospitalized patients' LOS, especially in diverse populations., Objective: To determine if the Health Confidence Score (HCS) is associated with hospital LOS and readmission in a socioeconomically diverse population., Designs, Settings, and Participants: We conducted a prospective cohort study in 2022 of adult general medicine patients at an academic hospital in Chicago, Illinois., Intervention: None., Main Outcome and Measures: Patient-reported responses to the HCS (scored 0 [lowest health confidence] to ‒12 [highest health confidence]), as well as demographic, socioeconomic, and clinical questions, were collected. Primary outcome was LOS and secondary outcomes were 30- and 90-day readmission., Results: Among 2797 socioeconomically diverse patients who completed the survey (response rate 28.5%), there was an average HCS of 9.19 (SD 2.68, range 0-12). Using linear regression, patients with high HCS (HCS ≥ 9) had a 1.53-day lower LOS (p < .01, 95% confidence interval [CI] [-2.11, -0.95]) than patients with a low HCS (HCS < 9). This association remained when examining individual HCS questions and controlling for covariates. In logistic regression, HCS was not significantly associated with readmission, but the question "I am involved in decisions about me" (adjusted model: odds ratio 0.83; 95% CI [0.71, 0.96]; p = .01) was associated with 90-day readmission., (© 2024 The Author(s). Journal of Hospital Medicine published by Wiley Periodicals LLC on behalf of Society of Hospital Medicine.)

Background: Cancer stage at diagnosis is an important prognostic indicator for patient outcomes, with detection at later stages associated with increased mortality and morbidity. The impact of cancer stage on patient-reported outcomes is poorly understood. This research aimed to understand symptom burden and health related quality of life (HRQoL) impact by cancer stage for ten cancer types: 1) ovarian, 2) lung, 3) pancreatic, 4) esophageal, 5) stomach, 6) head and neck, 7) colorectal, 8) anal, 9) cervical, and 10) liver and bile duct., Methods: Ten narrative literature reviews were performed to identify and collate published literature on patient burden at different stages of disease progression. Literature searches were conducted using an AI-assisted platform to identify relevant articles published in the last five (2017-2022) or ten years (2012-2022) where articles were limited. Conference abstracts were searched for the last two years (2020-2022). The geographic scope was limited to the United States, Canada, Europe, and global studies, and only journal articles written in English were included., Results: A total of 26 studies with results stratified by cancer stage at diagnosis (and before treatment) were selected for the cancer types of lung, pancreatic, esophageal, stomach, head and neck, colorectal, anal, and cervical cancers. Two cancer types, ovarian cancer, and liver and bile duct cancer did not return any search results with outcomes stratified by disease stage. A general trend was observed for worse patient-reported outcomes in patients with cancer diagnosed at an advanced stage of disease compared with diagnosis at an earlier stage. Advanced disease stage was associated with greater symptom impact including general physical impairments such as pain, fatigue, and interference with functioning, as well as disease/region-specific symptom burden. Poorer HRQoL was also associated with advanced disease with commonly reported symptoms including anxiety and depression., Conclusions: Overall, the general trend for greater symptom burden and poorer HRQoL seen in late stage versus early-stage disease across the included cancer types supports the importance for early diagnosis and treatment to improve patient survival and decrease negative impacts on disease burden and HRQoL., (© 2024. The Author(s).)

Background: Depression is common in Parkinson's disease (PD) but is underrecognized clinically. Although systematic screening is a recommended strategy to improve depression recognition in primary care practice, it has not been widely used in PD care., Methods: The 15-item Geriatric Depression Scale (GDS-15) was implemented at 5 movement disorders clinics to screen PD patients. Sites developed processes suited to their clinical workflow. Qualitative interviews with clinicians and patients provided information on feasibility, acceptability, and perceived utility., Results: Prior to implementation, depression screening was recorded in 12% using a formal instrument; 64% were screened informally by clinical interview, and no screening was recorded in 24%. Of 1406 patients seen for follow-up care during the implementation period, 88% were screened, 59% using the GDS-15 (self-administered in 51% and interviewer administered in 8%), a nearly 5-fold increase in formal screening. Lack of clinician or staff time and inability to provide the GDS-15 to the patient ahead of the visit were the most commonly cited reasons for lack of screening using the GDS-15; 378 (45%) patients completing the GDS-15 screened positive for depression, and 137 were enrolled for a 12-month prospective follow-up. Mean GDS-15 scores improved from 8.8 to 7.0 (P < 0.0001) and the 39-item Parkinson's Disease Questionnaire emotional subscore from 42.2 to 36.7 (P = 0.0007)., Conclusions: Depression screening in PD using a formal instrument can be achieved at much higher levels than is currently practiced, but there are barriers to implementing this in clinical practice. An individual site-specific process is necessary to optimize screening rates., (© 2024 The Author(s). Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Background: Transplant surgery has historically been a less desirable fellowship among general surgery graduates. Limited work has been done to understand factors associated with residents' interest in transplantation. Using a multi-institutional cohort, we examined how the resident experience on transplant surgery may influence their decision to pursue transplant fellowship., Methods: Individual demographics, program characteristics, and transplant-specific case logs were collected for graduates from 2010 to 2020 at 20 general surgery residency programs within the US Resident OPerative Experience (ROPE) Consortium. Residents who pursued transplant surgery fellowship were compared to those who went directly into practice or pursued a non-transplant fellowship., Results: Among 1342 general surgery graduates, 52 (3.9%) pursued abdominal transplant fellowship. These residents completed more transplant (22 vs. 9), liver (14 vs. 9), pancreas (15 vs. 11), and vascular access operations (38 vs. 30) compared to residents who did not pursue transplant fellowship (all p < 0.05). Multivariable logistic regression found that residents underrepresented in medicine were three times more likely (95% CI 1.54-6.58, p < 0.01) and residents at a program co-located with a transplant fellowship six times more likely (95% CI 1.95-18.18, p < 0.01) to pursue transplant fellowship. Additionally, a resident's increasing total transplant operative volume was associated with an increased likelihood of pursuing a transplant fellowship (OR = 1.12, 95% CI 1.09-1.14, p < 0.01)., Conclusion: The findings from this multi-institutional study demonstrate that increased exposure to transplant operations and interaction within a transplant training program is associated with a resident's pursuit of transplant surgery fellowship. Efforts to increase operative exposure, case participation, and mentorship may optimize the resident experience and promote the transplant surgery pipeline., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: First bite syndrome (FBS) is a rare complication of transoral surgery (TOS) for oropharyngeal cancer (oropharyngeal squamous cell carcinoma [OPSCC]). Risk factors for developing this complication are not well described. In this study, we attempt to identify risks for developing FBS in TOS., Study Design: Retrospective chart review., Setting: Tertiary care medical center., Methods: This study was exempted by the Mayo Clinic institutional review board. We performed a review from January 2017 to November 2022 of all patients who underwent TOS for OPSCC by a single provider. Exclusion criteria included less than 6 months follow up, prior treatment of head and neck cancer, or incomplete records. Demographic data, comorbidities, tumor characteristics, surgical details, adjuvant treatment details, functional outcomes, and oncologic outcomes were assessed. Fisher's Exact test and Kruskal-Wallis rank sum test were used to identify significant variables, and multivariable logistic regression was used to address confounding., Results: One hundred and one patients were identified. Eighty-nine met the inclusion criteria. The mean follow-up was 34 months (median 33). Seven patients (7.9%) developed FBS. Palatine tumor primary (P = .041), resection of styloglossus/stylopharyngeus (P = .039), and parapharyngeal fat manipulation (P = .015) were associated with the presence of FBS. After adjusting for tumor location, manipulation of parapharyngeal fat maintained significance (P = .025). T and N staging, tumor volume, adjuvant radiation, and ligation of lingual/facial arteries were not associated with the development of FBS. Eighty-six percent (6/7) of patients had a resolution of FBS at an average of 11.3 months., Conclusion: Manipulation of the parapharyngeal space is independently associated with developing FBS in TOS in our cohort. Further confirmatory studies are warranted., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Introduction: Anosognosia, defined as reduced awareness of one's deficit or symptom, is common in Huntington's disease (HD) and detectable at each disease stage. The impact of anosognosia on self-reporting in HD populations is critical to understand given growing use of patient-reported outcomes in HD clinical care and research. We aimed to determine the influence of anosognosia on patient-reported outcome measures assessing psychiatric symptoms and quality of life in HD., Methods: We enrolled HD patients to complete a battery of patient-reported and rater-administered measures, including the Anosognosia Scale, at baseline and 6 months later. Patient-reported outcome measures included NeuroQoL short forms for depression, anxiety, satisfaction with social roles and activities, and positive affect and well-being and Patient-Reported Outcomes Measurement Information System short forms for emotional distress-anger and sleep-related impairment. Anosognosia Scale-Difference Score indexed patient-clinician agreement on patient motor, cognitive, and behavioral abilities. We conducted multivariable linear regression analyses to quantify the association of baseline anosognosia with 6-month patient-reported outcomes., Results: Of 79 patients with complete Anosognosia Scale data at baseline, 25 (31.6 %) met the scale's criterion for anosognosia. In the regression analyses, baseline Difference Score improved prediction of 6-month patient-reported outcomes for depression, anxiety, anger, and positive affect and well-being (χ 2 (1) value range for likelihood ratio tests contrasting models with and without Difference Score: 13.1-20.9, p-values <0.001). Patients with more anosognosia self-reported less severe psychiatric symptoms and more positive affect and well-being., Conclusion: Study results suggest that anosognosia influences patient-reported outcomes for psychiatric symptoms and quality of life in HD populations., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: David A. Isaacs reports financial support was provided by Teva Branded Pharmaceutical Products, R&D, Inc. David A. Isaacs reports financial support was provided by National Institute of Neurological Disorders and Stroke. Jessie S. Gibson reports financial support was provided by the National Institute of Nursing Research and the iTHRIV Scholar Program at the University of Virginia. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery (TOS) for oropharyngeal HPV-mediated squamous cell carcinoma. Controversy exists regarding adequate resection margins for balancing functional and oncologic outcomes., Methods: This retrospective study was exempted by the IRB. Patients who underwent TOS from January 2017 to October 2022 were included. Patient characteristics, treatment details, and oncologic and functional outcomes were evaluated., Results: Fifty-five patients were included. Mean and median follow-up was 34 months. 98% of patients were AJCC stage I/II. Recurrence-free survival was 96% with no local recurrences. Univariate analysis demonstrated an association between VPI and pT stage (p = 0.035), medial pterygoid resection (p = 0.049), and palatal attachment sacrifice (p < 0.001). Multivariate analysis showed sacrifice of the palatal attachments remained a significant risk for VPI (p = 0.009)., Conclusion: Loss of soft palate pharyngeal attachments is an independent risk factor for VPI. When oncologically appropriate, the palatal attachments to the pharynx may be preserved., (© 2024 Wiley Periodicals LLC.)

Canalicular-like pleomorphic adenomas are a relatively recently described entity, that possess features of both canalicular adenomas and pleomorphic adenomas. The presence of unusual HMGA2 -fusion partners (most commonly HMGA2::WIF1 gene fusions) has established canalicular-like pleomorphic adenoma as a distinct entity. The use of intraoperative frozen section analysis and surrogate HMGA2 IHC are 2 tools that can provide the surgical team with valuable insight into intraoperative decision making and final classification of rare tumors of the parotid gland, respectively. We present a case of canalicular-like pleomorphic adenoma and characterize its appearance on frozen section analysis. HMGA2 IHC staining was retroactively performed, assisting in the confirmation of the tumor subtype., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Forehead contouring can be a component of facial feminization surgery (FFS). Its complications have been rarely reported on and are often described as "hypothetical." Methods: A case report of complications from forehead contouring resulting in frontal osteomyelitis and sinusitis. Results: A female patient presented with frontal osteomyelitis, sinusitis, and forehead contour deformity after a type III forehead contouring surgery. She had failed prior treatment including oral antibiotics, IV antibiotics, revision sinus surgery, and revision nasal surgery. For definitive treatment, she underwent an anterior table resection, sinus obliteration with bony contouring, and pericranial flap. Conclusions: Forehead contouring represents a recent significant advancement in FFS and gender-affirming therapy. Descriptions of complications and their management are important when novel therapies such as FFS are introduced. This case demonstrates complications from type III forehead contouring including osteomyelitis, frontal sinusitis, and forehead deformity.

Abstract: Bias-free content in nursing education prepares students to provide equitable care. The process of assessing content promotes the dismantling of systemic bias in health care, advancing social justice, diversity, equity, and inclusion. Unfortunately, there are no published studies to guide the evaluation of nursing curricula for the presence of bias. This innovative project aimed to identify bias in a course and develop a structure to guide the wider evaluation of the curriculum to identify and remove biased content. A modified version of the Upstate Bias Checklist was applied to a 15-week, three-semester hour, prelicensure, graduate-level nursing course., Competing Interests: The authors have declared no conflict of interest., (Copyright © 2023 National League for Nursing.)