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The most frequently performed invasive procedures in hospitals and healthcare centers are needle-related procedures, such as intravenous cannulation and phlebotomy, and they are identified as the major sources of pain, fear, and anxiety in children and adolescents. The objective of this systematic review was to evaluate the effectiveness of VR as a distraction measure to reduce pain, fear, and anxiety in children and adolescents undergoing needle-related invasive procedures. For this purpose, the CINAHL, Scopus, WOS, and Cochrane Library scientific databases were used. The protocol review was registered in PROSPERO (ID:42024563245), and inclusion and exclusion criteria were applied. Twenty-one studies were included in the systematic review, involving a total of 2663 participants. Significant differences favored the use of virtual reality for the control of pain intensity (WBFSpatients p = 0.001; MD = −1.83; 95% CI −2.93 to −0.72; WBFSparents p = 0.0002; MD = −2.61; 95% CI −4.00 to −1.23; WBFSnurses p = 0.0001; MD = −2.71; 95% CI −2.82 to −2.60; VAS/NRS p = 0.001, MD = −0.71; 95% CI −1.13 to −0.28), anxiety (CAMpatient p = 0.02, MD = −2.92; 95% CI −5.45 to −0.38; CAMparents p = 0.01, MD = −3.87; 95% CI −6.99 to −0.75) and fear (CFSpatients p = 0.0005, MD = −1.27; 95% CI −1.99 to −0.56; CFSparents p = 0.0005, MD = −1.33; 95% CI −2.08 to −0.58; and CFSnurses p = 0.04, MD = −1.13; 95% CI −2.24 to −0.03). However, high heterogeneity was noted. The use of virtual reality as a distraction appears to be a valuable strategy for reducing pain, fear, and anxiety during needle-related procedures, although further studies with higher methodological rigor, based on a standardized protocol, are needed. [ABSTRACT FROM AUTHOR]

The most frequently performed invasive procedures in hospitals and healthcare centers are needle-related procedures, such as intravenous cannulation and phlebotomy, and they are identified as the major sources of pain, fear, and anxiety in children and adolescents. The objective of this systematic review was to evaluate the effectiveness of VR as a distraction measure to reduce pain, fear, and anxiety in children and adolescents undergoing needle-related invasive procedures. For this purpose, the CINAHL, Scopus, WOS, and Cochrane Library scientific databases were used. The protocol review was registered in PROSPERO (ID:42024563245), and inclusion and exclusion criteria were applied. Twenty-one studies were included in the systematic review, involving a total of 2663 participants. Significant differences favored the use of virtual reality for the control of pain intensity (WBFSpatients p = 0.001; MD = −1.83; 95% CI −2.93 to −0.72; WBFSparents p = 0.0002; MD = −2.61; 95% CI −4.00 to −1.23; WBFSnurses p = 0.0001; MD = −2.71; 95% CI −2.82 to −2.60; VAS/NRS p = 0.001, MD = −0.71; 95% CI −1.13 to −0.28), anxiety (CAMpatient p = 0.02, MD = −2.92; 95% CI −5.45 to −0.38; CAMparents p = 0.01, MD = −3.87; 95% CI −6.99 to −0.75) and fear (CFSpatients p = 0.0005, MD = −1.27; 95% CI −1.99 to −0.56; CFSparents p = 0.0005, MD = −1.33; 95% CI −2.08 to −0.58; and CFSnurses p = 0.04, MD = −1.13; 95% CI −2.24 to −0.03). However, high heterogeneity was noted. The use of virtual reality as a distraction appears to be a valuable strategy for reducing pain, fear, and anxiety during needle-related procedures, although further studies with higher methodological rigor, based on a standardized protocol, are needed.

Background and purpose: Trauma to the knee is one of the most common injuries in people, especially young people, and delay in the diagnosis of knee fractures and soft tissue injuries in the knee causes limitation of movement, instability, and constant knee pain. In this research can show the correlation between the initial symptoms of the patients and the need for further procedures. To be able to identify traumatic knee injuries that are not clear in the simple knee radiography and to evaluate the findings of the patients for further procedure. Materials and methods: This research is an observational study in which all patients who presented with knee trauma during the course of the study were included in the study. All the information of these patients in a form including age, age group and sex, admission and discharge information such as visit date, discharge date, duration of hospitalization, mechanism of trauma, underlying disease, knee pain, limitation of range of motion, hemarthrosis, associate injury, skin abrasion, Inability to walk, history of knee trauma, radiography findings, knee CT findings, MRI findings, arthroscopy findings, Lysholm and Tegner knee score, probable diagnosis in the emergency room, type of treatment the emergency room, duration of hospitalization in the emergency room, discharge from the emergency room, in The hospitalization form of the performed procedures, the time of hospitalization in the ward and the definitive diagnosis were collected, and then 4 weeks after discharge, they were followed up by phone call with referral to the orthopedic clinic, and other diagnostic and therapeutic measures were reviewed in these patients. The information was provided by the project manager without interfering in the patient care process. Quantitative data were expressed as mean and standard deviation and qualitative data were expressed as frequency and percentage. Independent student t-tests were used to evaluate quantitative variables in two groups, and the Chi-Square test and Fisher's exact test were used to evaluate qualitative variables. Results: During the study period, 177 people were studied. The average age of the patients was 24.21±13.08, of which 138 (76.7%) were men. Most of the injury was caused by traffic accidents. The initial diagnosis in the emergency department had a significant relationship with the definite diagnosis. A statistically significant relationship was seen between MRI findings with knee movement limitation and non-weight bearing. There was a statistically significant relationship between the existence of definitive injury in the knee, limitation of knee movement, lacerations and scratches on the knee, and non-weight bearing. The mechanism of knee injury and laceration, the inability to weight bearing, and the positive findings of X-ray and MRI in the patients who underwent invasive procedures were significantly different from those who received conservative treatment. Conclusion: Injury mechanisms in patients and clinical symptoms such as knee range of motion limitation and non-weigh bearing and abrasion or laceration of the skin on the knee, despite the lack of findings in the initial investigations in the emergency department, is a high chance of injury to the knee joint and they need further evaluation and follow-up.

This study was conducted to determine the effect of using virtual reality (VR) during burn dressing on the level of fear, anxiety, and pain that children would experience. This randomized controlled trial was conducted in a pretest-posttest design. Randomization of the participants (n = 65) was performed with the block randomization method. Then, 33 children were included in the intervention and 32 children in the control group with simple sequential randomization. The study data were collected using the "Family and Child Personal Information Form," "Physiological Parameters Registration Form," "Wong–Baker Faces Pain Scale," "Children's Fear Scale," and "Children's Anxiety Meter-State." The chi-square test, t -test, Shapiro–Wilk, mean, and percentile distributions were used for the data analysis. After dressing, the physiological parameters of the children who used VR were found to be within normal limits (HR: 108.48 ± 12.43, O2: 98.39 ± 1.14) compared to the children who did not use (HR: 117.38 ± 15.25, O2: 97.81 ± 1.35) (P <.05). After the dressing, children using VR (0.85 ± 1.23) were determined to have less fear than those who did not use them (3.03 ± 1.06), and similarly, children who used VR (2.64 ± 2.73) experienced less anxiety than those who did not use them (5.84 ± 2.26). When the pain levels were evaluated, the VR group (1.79 ± 2.04) was reported to feel less pain compared to the control group (5.50 ± 2.36). The VR used by children aged 5-10 years during burn dressing has been found to affect their physiological parameters and is effective in reducing fear, anxiety, and pain levels. [ABSTRACT FROM AUTHOR]

Background and purpose: Trauma to the knee is one of the most common injuries in people, especially young people, and delay in the diagnosis of knee fractures and soft tissue injuries in the knee causes limitation of movement, instability, and constant knee pain. In this research can show the correlation between the initial symptoms of the patients and the need for further procedures. To be able to identify traumatic knee injuries that are not clear in the simple knee radiography and to evaluate the findings of the patients for further procedure. Materials and methods: This research is an observational study in which all patients who presented with knee trauma during the course of the study were included in the study. All the information of these patients in a form including age, age group and sex, admission and discharge information such as visit date, discharge date, duration of hospitalization, mechanism of trauma, underlying disease, knee pain, limitation of range of motion, hemarthrosis, associate injury, skin abrasion, Inability to walk, history of knee trauma, radiography findings, knee CT findings, MRI findings, arthroscopy findings, Lysholm and Tegner knee score, probable diagnosis in the emergency room, type of treatment the emergency room, duration of hospitalization in the emergency room, discharge from the emergency room, in The hospitalization form of the performed procedures, the time of hospitalization in the ward and the definitive diagnosis were collected, and then 4 weeks after discharge, they were followed up by phone call with referral to the orthopedic clinic, and other diagnostic and therapeutic measures were reviewed in these patients. The information was provided by the project manager without interfering in the patient care process. Quantitative data were expressed as mean and standard deviation and qualitative data were expressed as frequency and percentage. Independent student t-tests were used to evaluate quantitative variables in two groups, and the Chi-Square test and Fisher's exact test were used to evaluate qualitative variables. Results: During the study period, 177 people were studied. The average age of the patients was 24.21±13.08, of which 138 (76.7%) were men. Most of the injury was caused by traffic accidents. The initial diagnosis in the emergency department had a significant relationship with the definite diagnosis. A statistically significant relationship was seen between MRI findings with knee movement limitation and non-weight bearing. There was a statistically significant relationship between the existence of definitive injury in the knee, limitation of knee movement, lacerations and scratches on the knee, and non-weight bearing. The mechanism of knee injury and laceration, the inability to weight bearing, and the positive findings of X-ray and MRI in the patients who underwent invasive procedures were significantly different from those who received conservative treatment. Conclusion: Injury mechanisms in patients and clinical symptoms such as knee range of motion limitation and non-weigh bearing and abrasion or laceration of the skin on the knee, despite the lack of findings in the initial investigations in the emergency department, is a high chance of injury to the knee joint and they need further evaluation and follow-up. [ABSTRACT FROM AUTHOR]

This article provides guidelines for assessing and managing bleeding risk before invasive procedures. It recommends individualized assessment and decision-making based on the specific procedure and patient characteristics. The article discusses the management of anticoagulant and antiplatelet therapy, the limitations of routine coagulation testing, and the potential use of global haemostatic and platelet function testing to predict bleeding risk. It also addresses the use of plasma products and platelet transfusions in the ICU, emphasizing the lack of evidence supporting their prophylactic use. The article highlights the importance of operator and procedural factors in reducing the risk of complications during procedures. [Extracted from the article]

Abstract Background Abdominal pain occurs in 20% of geriatric patients who visit the emergency department (ED). Geriatric patients usually have more severe conditions and a higher mortality rate. We aimed to determine the factors associated with serious abdominal conditions in geriatric patients who visit the ED with abdominal pain. Methods This retrospective cohort study was conducted from January 1, 2017 to June 30, 2021. The inclusion criteria were patients aged ≥ 65 years and presented at the ED with acute abdominal pain. Significantly associated factors for serious abdominal conditions were examined using univariate and multivariate logistic regression analyses. Results A total of 1221 patients were included in this study. Multivariate logistic regression analysis showed that the significant factors associated with serious abdominal conditions were male (adjusted odds ratio [AOR] 2.29, 95% CI:1.3–4.04; p = 0.004), anorexia (AOR 2.16, 95% CI:1.08–4.32; p = 0.03), NEWS 5–6 (AOR 2.96, 95% CI:1.35–6.49; p = 0.007), SBP 100–125 mmHg (AOR 1.5, 95% CI:0.75–2.99; p ≤ 0.001), guarding (AOR 6.92, 95% CI:3.39–14.12; p ≤ 0.001), WBC ≥ 14,000 cells/mm3 (AOR 2.08, 95% CI:1.06–4.09; p = 0.034), ED length of stay (EDLOS) 4–8 h (AOR 2.17, 95% CI:1.08–4.36; p = 0.03), and EDLOS ≥ 8 h (AOR 3.22, 95% CI:1.15–9; p = 0.025). Conclusions The statistically significant factors associated with serious abdominal conditions in geriatric patients were male, anorexia, NEWS 5–6, SBP 100–125 mmHg, guarding, WBC ≥ 14,000 cells/mm3, EDLOS 4–8 h, and EDLOS ≥ 8 h.

This text provides a summary of a study conducted on the effects of watching cartoons and playing with a moving musical toy on children's pain and fear during vascular access procedures. The study included a control group, a cartoon group, and a moving musical toy group. The results showed that both watching cartoons and playing with a moving musical toy effectively reduced children's pain and fear during the procedures. These findings are consistent with previous research that has shown the positive effects of distraction methods on children's pain and fear levels. The study suggests that nurses should be informed about these techniques and encouraged to implement them in practice. Further research is recommended to test the effectiveness of non-pharmacological methods in different painful procedures and age groups. [Extracted from the article]

Background: Abdominal pain occurs in 20% of geriatric patients who visit the emergency department (ED). Geriatric patients usually have more severe conditions and a higher mortality rate. We aimed to determine the factors associated with serious abdominal conditions in geriatric patients who visit the ED with abdominal pain. Methods: This retrospective cohort study was conducted from January 1, 2017 to June 30, 2021. The inclusion criteria were patients aged ≥ 65 years and presented at the ED with acute abdominal pain. Significantly associated factors for serious abdominal conditions were examined using univariate and multivariate logistic regression analyses. Results: A total of 1221 patients were included in this study. Multivariate logistic regression analysis showed that the significant factors associated with serious abdominal conditions were male (adjusted odds ratio [AOR] 2.29, 95% CI:1.3–4.04; p = 0.004), anorexia (AOR 2.16, 95% CI:1.08–4.32; p = 0.03), NEWS 5–6 (AOR 2.96, 95% CI:1.35–6.49; p = 0.007), SBP 100–125 mmHg (AOR 1.5, 95% CI:0.75–2.99; p ≤ 0.001), guarding (AOR 6.92, 95% CI:3.39–14.12; p ≤ 0.001), WBC ≥ 14,000 cells/mm3 (AOR 2.08, 95% CI:1.06–4.09; p = 0.034), ED length of stay (EDLOS) 4–8 h (AOR 2.17, 95% CI:1.08–4.36; p = 0.03), and EDLOS ≥ 8 h (AOR 3.22, 95% CI:1.15–9; p = 0.025). Conclusions: The statistically significant factors associated with serious abdominal conditions in geriatric patients were male, anorexia, NEWS 5–6, SBP 100–125 mmHg, guarding, WBC ≥ 14,000 cells/mm3, EDLOS 4–8 h, and EDLOS ≥ 8 h. [ABSTRACT FROM AUTHOR]

Abstract Objectives The aim of the study was to provide an overview of the practices of French general dentists (GDs) and specialists (SDs) concerning the management of patients with inflammatory bowel diseases (IBDs), rheumatic inflammatory diseases (IRDs), and vasculitis on biologic disease-modifying antirheumatic drugs (bDMARDs), conventional DMARDs, or immunosuppressants (ISs). Materials and methods An online national cross-sectional survey with 53 questions was developed by a multidisciplinary team including rheumatologists, gastroenterologists and dentists based on their clinical experience. It was refined following a test with nine dentists in private practice and in hospital before being disseminated to the members of French scientific societies and colleges of dentistry teachers over 3 months. Responses of general dentists versus specialists were compared with respect to their experience in managing patients with IRDs or IBDs, knowledge/training, type of invasive procedure performed, management of medical treatment, perioperative oral-care protocols, and frequency of postoperative complications after invasive dental care procedures. Result In total, 105 practitioners fully completed the survey (participation rate 11.1%). SDs more frequently performed invasive surgical procedures and were more aware of the recommendations of learned societies than GDs. They encountered more post-operative complications for patients on bDMARDs. For both SDs and GDs, most patients were managed without stopping treatment and pre- and postoperative antibiotics were prescribed to more than 75% of patients. When medical treatment was stopped, the decision was made by the prescribing physician. Conclusion Complications were reported more frequently by SDs when highly invasive procedures were performed on patients under active drug therapy. Certain common procedures, such as scaling and root planing, appear to be safe, regardless of treatment management. However, adapted guidelines for the practice of dentistry are needed to standardize the management of patients on bDMARDS, conventional DMARDs, or ISs. Clinical relevance French dentists perform a wide range of oral procedures on patients on bDMARDS, conventional DMARDs, or ISs under antibiotic coverage and antiseptic mouthwashes. SDs reported more postoperative complications after extensive invasive procedures for patients under active drug therapy, despite their greater knowledge of recommendations on how to manage such patients.

Abstract Background Platelet (PLT) transfusion was the most practical way to increase patients’ PLT counts before invasive hepatic procedures such as radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). A novel drug that raises the PLT count by acting on the thrombopoietin receptor has recently become available. Methods Lusutrombopag 3 mg was administered daily for 7 days to patients who underwent RFA for liver tumors with low PLT counts ( 50,000 PLT µL− 1 had higher PLT counts before lusutrombopag administration. The degree of splenomegaly did not affect the rate of PLT count elevation. There was no specific adverse effect by administrating lusutrombopag for patients with PLT counts of around 50,000 µL− 1 but > 50,000 µL− 1. Conclusions Lusutrombopag administration before RFA was effective and seemed to be relatively safe for hepatocellular carcinoma patients with low PLT counts. Trial registration This study was approved by Japanese Red Cross Medical Center Institutional Reseach Comittie (#862, 07/03/2016), and was registered in a publically accessible primary register (#UMIN000046629, registered date: 14/01/2022).

The harm associated with imaging abnormalities related to lung cancer screening (LCS) is not well documented, especially outside the clinical trial and academic setting. What is the frequency of invasive procedures and complications associated with a community based LCS program, including procedures for false-positive and benign, but clinically important, incidental findings? We performed a single-center retrospective study of an LCS program at a nonuniversity teaching hospital from 2016 through 2019 to identify invasive procedures prompted by LCS results, including their indication and complications. Among 2,003 LCS participants, 58 patients (2.9%) received a diagnosis of lung cancer and 71 patients (3.5%) received a diagnosis of any malignancy. Invasive procedures were performed 160 times in 103 participants (5.1%), including 1.7% of those without malignancy. Eight invasive procedures (0.4% of participants), including four surgeries (12% of diagnostic lung resections), were performed for false-positive lung nodules. Only 1% of Lung Imaging Reporting and Data System category 4A nodules that proved benign were subject to an invasive procedure. Among those without malignancy, an invasive procedure was performed in eight participants for extrapulmonary false-positive findings (0.4%) and in 19 participants (0.9%) to evaluate incidental findings considered benign but clinically important. Procedures for the latter indication resulted in treatment, change in management, or diagnosis in 79% of individuals. Invasive procedures in those without malignancy resulted in three complications (0.15%). Seventy nonsurgical procedures (6% complication rate) and 48 thoracic surgeries (4% major complication rate) were performed in those with malignancy. The use of invasive procedures to resolve false-positive findings was uncommon in the clinical practice of a nonuniversity LCS program that adhered to a nodule management algorithm and used a multidisciplinary approach. Incidental findings considered benign but clinically important resulted in invasive procedure rates that were similar to those for false-positive findings and frequently had clinical value. [ABSTRACT FROM AUTHOR]

Background: Platelet (PLT) transfusion was the most practical way to increase patients’ PLT counts before invasive hepatic procedures such as radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). A novel drug that raises the PLT count by acting on the thrombopoietin receptor has recently become available. Methods: Lusutrombopag 3 mg was administered daily for 7 days to patients who underwent RFA for liver tumors with low PLT counts (< 50,000 PLT µL− 1). We collected demographic data concerning the patients’ liver function and PLT counts. Results: Lusutrombopag was administered to 91 patients, with a median age of 71 years (range 51–86). Forty-two patients had hepatitis C, 12 had hepatitis B, 21 had alcoholic liver disease, 11 had nonalcoholic steatohepatitis, and five had other diseases. The median Child-Pugh score was 7 (range 5–11). Thirty-seven patients had stage I tumors, 41 had Stage II, 12 had stage III, and one had stage IV. PLT count was elevated from 4.4 × 104 ± 1.4 × 104 to 8.6 × 104 ± 2.5 × 104 PLT µL− 1. Lusutrombopag administration prevented PLT transfusions in 84/91 patients (92%). No patient had bleeding complications after RFA. One had portal thrombosis after lusutrombopag administration. Patients who achieved PLT counts of > 50,000 PLT µL− 1 had higher PLT counts before lusutrombopag administration. The degree of splenomegaly did not affect the rate of PLT count elevation. There was no specific adverse effect by administrating lusutrombopag for patients with PLT counts of around 50,000 µL− 1 but > 50,000 µL− 1. Conclusions: Lusutrombopag administration before RFA was effective and seemed to be relatively safe for hepatocellular carcinoma patients with low PLT counts. Trial registration: This study was approved by Japanese Red Cross Medical Center Institutional Reseach Comittie (#862, 07/03/2016), and was registered in a publically accessible primary register (#UMIN000046629, registered date: 14/01/2022). [ABSTRACT FROM AUTHOR]

Abstract Background Unfavorable outcomes occur in patients with acute abdominal pain who visit the emergency department (ED). We aimed to determine the factors associated with unfavorable outcomes in patients with acute abdominal pain visiting the ED. Methods This retrospective cohort study was conducted from July 1, 2015 to June 30, 2016. The inclusion criterion was patients aged older than 18 years who presented to the ED with acute abdominal pain. Significant factors associated with unfavorable outcomes were examined using univariate and multivariate logistic regression analyses. Results A total of 951 patients were included in the study. Multivariate logistic regression analysis showed that the ED length of stay (EDLOS) > 4 h (adjusted odds ratio (AOR) 2.62, 95% confidence interval [CI]: 1.33–5.14; p = 0.005), diastolic blood pressure (DBP) 75% (AOR 2.83, 95% CI: 1.39–5.75; p = 0.004) were revealed as significant factors associated with unfavorable outcomes. Conclusions The present study revealed that the significant clinical signs associated with the occurrence of unfavorable outcomes were DBP 75%. Additionally, patients with abdominal pain visiting the ED who had an EDLOS longer than 4 h were associated with unfavorable outcomes.

Objective To evaluate the association between prophylactic plasma transfusion and postoperative bleeding rate in critically ill patients undergoing different invasive procedures. Methods The information of ICU patients who received different invasive procedures from January 2019 to December 2019 in 6 tertiary hospitals in China were retrospectively investigated. The inclusion criteria of patients were as follows: age ≥ 18 years; received invasive procedures; INR ≥ 1.5 within 72 hours before surgery. Exclusion criteria were patients with incomplete case records. The patients finally included in the study were divided into prophylactic plasma transfusion group and non-prophylactic plasma transfusion group according to their plasma transfusion status. The outcome variable was the incidence of invasive procedure-related bleeding within 48 hours after different invasive procedures. Results A total of 407 patients underwent invasive procedures, and 362 patients were finally included in this study after excluding 45 patients with incomplete case records. The proportions of prophylactic plasma transfusion in different types of invasive procedures were central venous catheterization (46/146, 31.5%), thoracentesis (13/37, 35.1%), bronchoscopy (8/31, 25.8%), tracheal intubation (9/38, 23.7%), arterial catheterization (9/50, 18.0%) and others (13/60, 21.7%). The bleeding rates showed that different invasive procedures presented no statistical difference between the groups received plasma transfusion or not. In the prophylactic plasma transfusion group, the bleeding rate of arterial catheterization (4/9, 44.4%) was the highest, but all were potential bleeding, followed by tracheal intubation (4/10, 40.0%) and central venous intubation (16/46, 34.8%), with a higher rate of significant bleeding. Conclusion Prophylactic infusion of plasma did not reduce the bleeding rate after different invasive procedures, but prospective studies are needed to further confirm the conclusion; this study also provides a certain data basis for later prospective studies.

Background: Unfavorable outcomes occur in patients with acute abdominal pain who visit the emergency department (ED). We aimed to determine the factors associated with unfavorable outcomes in patients with acute abdominal pain visiting the ED. Methods: This retrospective cohort study was conducted from July 1, 2015 to June 30, 2016. The inclusion criterion was patients aged older than 18 years who presented to the ED with acute abdominal pain. Significant factors associated with unfavorable outcomes were examined using univariate and multivariate logistic regression analyses. Results: A total of 951 patients were included in the study. Multivariate logistic regression analysis showed that the ED length of stay (EDLOS) > 4 h (adjusted odds ratio (AOR) 2.62, 95% confidence interval [CI]: 1.33–5.14; p = 0.005), diastolic blood pressure (DBP) < 80 mmHg (AOR 3.31, 95% CI: 1.71–6.4; p ≤ 0.001), respiratory rate ≥ 24 breaths/min (AOR 2.03, 95% CI: 1.07–3.86; p ≤ 0.031), right lower quadrant (RLQ) tenderness (AOR 3.72, 95% CI: 1.89–7.32; p ≤ 0.001), abdominal distension (AOR 2.91, 95% CI: 1.29–6.57; p = 0.010), hypoactive bowel sounds (AOR 2.89, 95% CI: 1.09–7.67; p = 0.033), presence of specific abdominal signs (AOR 2.07, 95% CI: 1.1–3.88; p = 0.024), white blood cell count ≥ 12,000 cells/mm3 (AOR 2.37, 95% CI: 1.22–4.6; p = 0.011), and absolute neutrophil count (ANC) > 75% (AOR 2.83, 95% CI: 1.39–5.75; p = 0.004) were revealed as significant factors associated with unfavorable outcomes. Conclusions: The present study revealed that the significant clinical signs associated with the occurrence of unfavorable outcomes were DBP < 80 mmHg, tachypnea (≥ 24 breaths/min), RLQ tenderness, abdominal distension, hypoactive bowel sounds, and presence of specific abdominal signs. Moreover, the associated laboratory results identified in this study were leukocytosis and ANC > 75%. Additionally, patients with abdominal pain visiting the ED who had an EDLOS longer than 4 h were associated with unfavorable outcomes. [ABSTRACT FROM AUTHOR]

Emergency department (ED) providers face increasing task burdens and requirements related to documentation and paperwork. To decrease the mental task burden for providers, our institution developed an infographic that illustrates which forms are necessary for complete documentation of nonemergent invasive procedures. Our study aims to analyze the effect of a nonelectronic health record-based infographic, paired with direct feedback, on compliance with nonemergent invasive procedure documentation performed in the ED. This was a retrospective, observational study of all procedure documentation performed in the ED with a pre-/post-test design. The study included two 8-month study periods, 1 year apart. The preimplementation period used for comparison was January 1, 2019–August 31, 2019, and the postimplementation period was January 1, 2020–August 31, 2020. All invasive procedures that required documentation in addition to a procedure note were included in the study. The primary outcome was the percentage of compliance with documentation requirements. During the pre- and postimplementation study periods, 486 and 405 charts with nonemergent procedures were identified, respectively. In the preimplementation period, 278 (57%) procedures were compliant with all documentation, vs. the postimplementation period, where 287 (71%) procedures were compliant (p < 0.001). Implementing an invasive procedure documentation infographic and direct feedback improved overall documentation compliance for nonemergent invasive procedures. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Mechanical ventilation (MV) being an integral part of intensive care for critically ill patients. Topics include significant improvement in technology, ventilatory software and ventilatory modes from different positive pressure ventilator developers; and decreasing morbidity and mortality associated with ventilatory support.

Introduction: Patients with thrombocytopenia and chronic liver disease are at increased risk of bleeding during invasive procedures due to low platelet counts. Lusutrombopag, an orally active thrombopoietin receptor agonist, increases platelet count and reduces the need for platelet transfusion in chronic liver disease patients with thrombocytopenia undergoing a planned invasive procedure. The safety of lusutrombopag in patients with Child-Pugh class C chronic liver disease is not known. The present analysis was performed to determine the pharmacokinetics, efficacy, and safety of lusutrombopag in patients with Child-Pugh class C chronic liver disease.Methods: Data for patients with Child-Pugh class C chronic liver disease were collected from three data sets: a phase 1/2 Child-Pugh class C study (n = 5) (JapicCTI-163289 [Japan Pharmaceutical Information Center]), a phase 3 pivotal study (L-PLUS 2, n = 3) (NCT02389621 [Clinicaltrials.gov]), and ongoing post-marketing surveillance (n = 27) (JapicCTI-163432 [Japan Pharmaceutical Information Center]). Patients received lusutrombopag at 3 mg for up to 7 days. Safety and efficacy assessments were collected from two clinical studies and the post-marketing surveillance; pharmacokinetic data were collected from the phase 1/2 study.Results: Mean Cmax and AUC0-τ were lower in Child-Pugh class C patients than Child-Pugh class A and B; individual patients' Cmax and AUC0-τ values overlapped among Child-Pugh classes. In lusutrombopag patients who did not receive platelet transfusion (n = 4 in phase 1/2, n = 1 in phase 3, n = 24 in post-marketing surveillance), the median (range) maximum platelet count was 88.5 × 109/L (54-105 × 109/L), 80 × 109/L, and 91 × 109/L (41-186 × 109/L; n = 23), respectively. There were no treatment-related adverse events or treatment-related serious adverse events. One patient from the phase 1/2 study had a non-serious portal vein thrombosis, which was not considered treatment-related.Conclusions: The analysis presented in this study suggests that lusutrombopag increases platelet counts in Child-Pugh class C patients and is safe and well tolerated in this patient population.Trial Registration: L-PLUS 2: NCT02389621 (Clinicaltrials.gov). Phase 1/2: JapicCTI-163289 (Japan Pharmaceutical Information Center [JAPIC]). Post-marketing surveillance: JapicCTI-163432 (JAPIC). [ABSTRACT FROM AUTHOR]

Introduction: Lusutrombopag is an oral thrombopoietin receptor agonist (TPO-RA). Clinical trials have shown lusutrombopag's efficacy in reducing need for preoperative platelet transfusion in patients with chronic liver disease (CLD) and severe thrombocytopenia. This analysis assessed efficacy and safety of lusutrombopag in patients with severe thrombocytopenia and CLD undergoing planned invasive procedures.Methods: An electronic database search (through 1 December 2020) identified three randomised, placebo-controlled, double-blind clinical trials comparing lusutrombopag with placebo in patients with CLD and platelet count below 50 × 109/L scheduled to undergo a procedure with a perioperative bleeding risk. A random-effects meta-analysis examined treatment effect, with Cochrane Collaboration's tool assessing risk of bias.Results: The meta-analysis included 343 (lusutrombopag 3 mg, n = 173; placebo, n = 170) patients. More patients met the criteria for treatment response (platelet count at least 50 × 109/L and increase of at least 20 × 109/L from baseline anytime during the study) with lusutrombopag versus placebo (risk ratio [RR] 6.39; 95% confidence interval [CI] 3.69, 11.07; p < 0.0001). The primary efficacy outcome, proportion of patients requiring no platelet transfusion and no rescue therapy for bleeding for at least 7 days post procedure, was achieved by more patients treated with lusutrombopag versus placebo (RR 3.42; 95% CI 1.86, 6.26; p = 0.0001). The risk of any bleeding event was significantly lower with lusutrombopag compared to placebo (RR 0.55; 95% CI 0.32, 0.95; p = 0.03); conversely, thrombosis event rates were similar between lusutrombopag and placebo (RR 0.79; 95% CI 0.19, 3.24; p = 0.74).Conclusion: This meta-analysis showed that treatment of severe thrombocytopenia with lusutrombopag in patients with CLD prior to a planned invasive procedure was efficacious and safe in increasing platelet counts, avoiding the need for platelet transfusions, and reducing risk of bleeding, thereby enhancing the certainty of evidence supporting the efficacy and safety of lusutrombopag. [ABSTRACT FROM AUTHOR]

Background: Little information regarding the management of invasive procedures in people with hemophilia B (HB) after undergoing gene therapy is available. Here, we report the management of invasive procedures in people with severe or moderately severe HB who had previously been treated with etranacogene dezaparvovec in the phase 2b and phase 3 Health Outcomes with Padua Gene; Evaluation in Hemophilia B clinical trials (NCT03489291 and NCT03569891)., Objectives: The objective of this study was to describe the use of exogenous FIX, endogenous FIX activity prior to invasive procedures, and peri- and postoperative bleeds in participants who underwent invasive procedures after receiving etranacogene dezaparvovec gene therapy., Methods: This retrospective analysis included invasive procedures performed within 3 and 2 years following a single infusion of 2 × 10 13 gc/kg of etranacogene dezaparvovec in participants in the phase 2b and Health Outcomes with Padua Gene; Evaluation in Hemophilia B trials, respectively. Data for factor (F)IX dosing, duration of postoperative FIX use, FIX activity prior to invasive procedures, and postoperative bleeds were collected and analyzed., Results: The analysis included 64 procedures in 29 participants: 9 major surgeries, 24 minor surgeries, 11 endoscopies, 3 endoscopies with biopsy/polypectomy, and 17 dental procedures. Uncontaminated endogenous FIX activity corresponded to mild hemophilia or normal levels prior to 98% of all procedures, with a median endogenous FIX activity of 43.8 IU/dL (range, 3.1-113 IU/dL). All major surgeries were managed with exogenous FIX, 67% with ≤4 days of FIX infusion. Most minor surgeries (88%), endoscopies (82%), and dental procedures (94%) were managed with no or a single FIX infusion. Postoperative bleeds occurred after 1 minor surgery and 4 dental procedures. There were no symptomatic thrombotic events or FIX inhibitor developments., Conclusion: Etranacogene dezaparvovec has the potential to facilitate perioperative management in people with HB by reducing the need for perioperative exogenous FIX and its associated risks., Competing Interests: Declaration of competing interests N.O. has received financial support for research from Sobi; received consultancy fees from F. Hoffmann-La Roche Ltd, uniQure, Sobi, and CSL Behring; and is a member of Speakers Bureaus for F. Hoffmann-La Roche Ltd, Sobi, CSL Behring, Takeda, Bayer, and Novo Nordisk. All fees are donated to an institutional charitable body that supports education in hemostasis and thrombosis. P.v.d.V. has received consultancy fees from Bayer. E.G. is a member of the Global Blood Therapeutics Speaker Bureau and has received consultant fees from CSL Behring. P.E.M. is an employee of CSL Behring. S.L.Q. is an employee of CSL Behring. S.E.C. has received consultancy fees from Novartis for service on a data safety monitoring board and has received payment for service on advisory boards from Pfizer, Sanofi, and Medexus. M.C. has received financial support for research from Anthos, Bayer, CSL Behring, Novo Nordisk, and Hoffmann-La Roche and honoraria for lecturing or consultancy from Alexion, CSL Behring, Daiichi Sankyo, Sanofi, Spark Therapeutics, Octapharma, Pfizer, Sobi, and Viatris. All funds were received by his institution. Nonfinancial conflicts of interest include being a member of the gene therapy working group of the European Association for Haemophilia and Allied Disorders (EAHAD) and a member of the European Reference Network (ERN) EuroBloodNet. R.L. has received fees for consulting, advisory boards, and speakers’ bureaus from CSL Behring, Pfizer, and Novo Nordisk. G.C. has received financial support for research from CSL Behring, Pfizer, and Sobi; has consulted for and received honoraria from Bayer, Roche, Sobi, Grifols, Novo Nordisk, Werfen, and Kedrion; and was a member of the Board of Directors or advisory committees for Ablynx, Alexion, Bayer, LFB, Takeda, CSL Behring, Novo Nordisk, Pfizer, Roche, Sanofi, Sobi, and uniQure. R.K. has received honoraria from and/or been a member of advisory committees for Bayer, BioMarin, Biotest, CSL Behring, Grifols, Novo Nordisk, Octapharma, Pfizer, Roche/Chugai, Sanofi, Sobi, and Takeda. E.S. has received support for attending conferences from CSL Behring, Roche, and Novo Nordisk. D.V.Q. has received fees for consulting/advisory boards/speakers bureaus from Bayer, BioMarin, CSL Behring, Genentech/Roche, Novo Nordisk, Pfizer, Sanofi, and Takeda. P.K. has received consultancy fees from BioMarin, CSL Behring, Novo Nordisk, Takeda, and uniQure., (Copyright © 2024. Published by Elsevier Inc.)

Yunfei Li,1 Akira Babazono,1 Aziz Jamal,1,2 Ning Liu,3 Reiko Yamao1 1Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; 2Health Administration Program, Faculty of Business & Management, Universiti Teknologi Mara, Selangor, Malaysia; 3Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, JapanCorrespondence: Yunfei Li; Aziz JamalDepartment of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanTel +81-80-8088-6969; +81-80-8497-5375Email yunfei.li90@gmail.com; azizabduls.jamal@gmail.comBackground: Acute myocardial infarction (AMI) management strategies, involving treatment and post-care, are much more difficult for patients with dementia. This study investigated the factors influencing the use of invasive procedures and long-term care in the management strategies for AMI patients with dementia and the factors associated with these patients’ survival.Methods: This multilevel study combined information from two databases, namely later-stage elderly healthcare insurance and long-term care insurance claims, from 2013 to 2019. Of 214,963 individuals with dementia, we identified 13,593 patients with AMI. The primary outcomes were the use of invasive procedures for treatment and long-term care for post-care management. Survival outcomes were also measured over a 6-year period, adjusting for individual- and regional-level characteristics in multilevel models.Results: A total of 1954 (14.38%) individuals received an invasive procedure during treatment, and 7850 (87.18%) used long-term care for post-care management after AMI. After multivariate adjustment, patients aged ≥ 85 years and women were less likely to receive invasive procedures and more likely to use long-term care. Patients undergoing invasive procedures had a lower use of long-term care. Better survival outcome was significantly associated with invasive management and long-term care, regardless of the type of care.Conclusion: Age and sex determine the use of invasive procedures and long-term care after AMI among patients with dementia. AMI patients with dementia receiving invasive procedures and long-term care had better survival outcomes.Keywords: acute myocardial infarction, dementia, invasive procedure, long-term care, older adult, multilevel analysis

During the last five decades, lung sonography has developed into a core competency of intensive care medicine. It is a highly accurate bedside tool, with clear diagnostic criteria for most causes of respiratory failure (pneumothorax, pulmonary edema, pneumonia, pulmonary embolism, chronic obstructive pulmonary disease, asthma, and pleural effusion). It helps in distinguishing a hypovolemic from a cardiogenic, obstructive, or distributive shock. In addition to diagnostics, it can also be used to guide ventilator settings, fluid administration, and even antimicrobial therapy, as well as to assess diaphragmatic function. Moreover, it provides risk-reducing guidance during invasive procedures, e.g., intubation, thoracocentesis, or percutaneous dilatational tracheostomy. The recent pandemic has further increased its scope of clinical applications in the management of COVID-19 patients, from their initial presentation at the emergency department, during their hospitalization, and after their discharge into the community. Despite its increasing use, a consensus on education, assessment of competencies, and certification is still missing. Deep learning and artificial intelligence are constantly developing in medical imaging, and contrast-enhanced ultrasound enables new diagnostic perspectives. This review summarizes the clinical aspects of lung sonography in intensive care medicine and provides an overview about current training modalities, diagnostic limitations, and future developments. [ABSTRACT FROM AUTHOR]

Distraction is a known behavioral intervention that is widely used for pain management in the pediatric population. However, there is a shortage of reviews reporting the efficacy of distraction for procedural pain reduction in pediatric oncology settings. To determine the current evidence on the effects of distraction on procedural pain in children with cancer. This systematic review and meta-analysis was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines Six different databases from 1990 to June 2019. A literature search was conducted to identify the effects of distraction on procedural pain reduction in children with cancer. A meta-analysis was undertaken along with applying a mixed effect model to quantify the standardized mean difference in the 95% confidence interval (CI) as the overall effects. Ten randomized controlled trials were included. Distraction during an invasive procedure had a large effect on pain intensity (–0.92, 95% CI –1.48 to –0.36, p =.001) and on needle insertion as well (–1.12, 95% CI –1.52 to –0.72, p =.000), but only a moderate effect on lumbar puncture procedures (-0.57, 95% CI -1.02 to -0.12, p =.012). Uncertain effects on pain relief showed up in a virtual reality (VR) distraction (-0.93, 95% CI -2.63 to 0.76, p =.28) and during active distraction (-0.72, 95% CI -1.48 to 0.03, p =.06). Distraction is an efficacious intervention to reduce procedural pain during needle insertion or lumbar puncture procedures in children with cancer. However, the efficacy of active distraction and VR remain uncertain. Future research should focus on specific comparisons of different forms of distractions with larger sample sizes. [ABSTRACT FROM AUTHOR]

Introduction: The essential actions aim to promote specific improvements that allow providing safe and quality care; one of them is infusion therapy, being one of the procedures most used by the nursing professional for the administration of medications intravenously. In addition, it is important to carry out compliance with each of them, as well as adherence to the guidelines of NOM-022, for the prevention of adverse events, such as incorrect identification of the patient. Clinical case: It deals with a patient who realized the incorrect administration of the intravenous solution since the data written on the label of the solution belonged to another patient. Conclusion: The management of infusion therapy is a standardized procedure performed by the nursing staff that, when applied well, will reduce adverse events and contribute to quality care. [ABSTRACT FROM AUTHOR]

Objective: To estimate the risk of fetal loss associated with chorionic villus sampling (CVS) in twin pregnancy, using propensity score analysis. Methods: This was a multicenter cohort study of women with twin pregnancy undergoing ultrasound examination at 11–13 weeks' gestation, performed in eight fetal medicine units in which the leadership were trained at the Harris Birthright Research Centre for Fetal Medicine in London, UK, and in which the protocols for screening, invasive testing and pregnancy management are similar. The risk of death of at least one fetus was compared between pregnancies that had and those that did not have CVS, after propensity score matching (1:1 ratio). This procedure created two comparable groups by balancing the maternal and pregnancy characteristics that lead to CVS being performed, similar to how randomization operates in a randomized clinical trial. Results: The study population of 8581 twin pregnancies included 445 that had CVS. Death of one or two fetuses at any stage during pregnancy occurred in 11.5% (51/445) of pregnancies in the CVS group and in 6.3% (515/8136) in the non‐CVS group (P < 0.001). The propensity score algorithm matched 258 cases that had CVS with 258 non‐CVS cases; there was at least one fetal loss in 29 (11.2%) cases in the CVS group and in 35 (13.6%) cases in the matched non‐CVS group (odds ratio (OR), 0.81; 95% CI, 0.48–1.35; P = 0.415). However, there was a significant interaction between the risk of fetal loss after CVS and the background risk of fetal loss; when the background risk was higher, the risk of fetal loss after CVS decreased (OR, 0.46; 95% CI, 0.23–0.90), while, in pregnancies with a lower background risk of fetal loss, the risk of fetal loss after CVS increased (OR, 2.45; 95% CI, 0.95–7.13). The effects were statistically significantly different (P‐value of the interaction = 0.005). For a pregnancy in which the background risk of fetal loss was about 6% (the same as in our non‐CVS population), there was no change in the risk of fetal loss after CVS, but, when the background risk was more than 6%, the posterior risk was paradoxically reduced, and when the background risk was less than 6%, the posterior risk increased exponentially; for example, if the background risk of fetal loss was 2.0%, the relative risk was 2.8 and the posterior risk was 5.6%. Conclusion: In twin pregnancy, after accounting for the risk factors that lead to both CVS and spontaneous fetal loss and confining the analysis to pregnancies at lower prior risk, CVS seems to increase the risk of fetal loss by about 3.5% above the patient's background risk. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. Linked article: There is a comment on this article by Li and Li. Click here to view the Correspondence. [ABSTRACT FROM AUTHOR]

Anticoagulation therapy is prescribed for the prevention of recurrence in patients with venous thromboembolism, which could be temporarily interrupted during invasive procedures. The COMMAND VTE Registry is a multicenter registry enrolling 3027 consecutive patients with acute symptomatic VTE in Japan between January 2010 and August 2014. We identified patients who underwent invasive procedures during the entire follow-up period and evaluated periprocedural managements and clinical outcomes at 30 days after invasive procedures. During a median follow-up period of 1213 (IQR: 847–1764) days, 518 patients underwent invasive procedures with the cumulative incidences of 5.8% at 3 months, 11.1% at 1 year, and 24.0% at 5 years. Among 382 patients in high bleeding-risk category of invasive procedures, anticoagulation therapy had been discontinued already in 62 patients (16%) and interrupted temporarily in 288 patients (75%) during the invasive procedures with bridging anticoagulation therapy with heparin in 214 patients (56%). Among 80 patients in low bleeding-risk category, anticoagulation therapy had been already discontinued in 15 patients (19%) and interrupted temporarily in 31 patients (39%) during invasive procedure with bridging anticoagulation therapy with heparin in 17 patients (21%). At 30 days after the invasive procedures, 14 patients (2.7%) experienced recurrent VTE, while 28 patients (5.4%) had major bleeding. This study elucidated the real-world features of peri-procedural management and prognosis in patients with VTE who underwent invasive procedures during follow-up in the large multicenter VTE registry. The 30-day incidence rates of recurrent VTE and major bleeding events were 2.7% and 5.4%. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of implementing cell-free DNA (cfDNA) testing on gestational age (GA) at termination of pregnancy in a French perinatal network.Methods: We conducted a retrospective study. All women having undergone a termination of pregnancy between 1 January 2012 and 31 December 2017 were included. We compared the periods before and after the introduction of second-line cfDNA testing, which started on 1 January 2015. Throughout the study period, the invasive procedures were foetal karyotyping and chromosomal microarray analysis. The primary study outcome was GA at termination. The secondary outcomes were GA at termination for trisomy 21 and the frequency and GA at the time of invasive procedures.Results: During the 6-year study period, 840 women underwent termination. The median GA at termination before and after the implementation of cfDNA testing was 19.4 and 19.0 weeks, respectively (p = 0.38). Although the frequency of termination for trisomy 21 increased significantly from 23% to 32% (p < 0.01), the median GA at termination did not change significantly (p = 0.80). The implementation of cfDNA testing was associated with a decrease in the frequency of invasive procedures in general and chorionic villus sampling in particular (p = 0.04).Conclusion: The introduction of cfDNA testing does not increase the GA at termination for trisomy21. [ABSTRACT FROM AUTHOR]

To evaluate the accessibility of pregnant women to prenatal screening and diagnostic tests during the COVID-19 pandemic process and analyze the effect of the pandemic process on acceptance-rejection rates of fetal diagnostic procedures for high risk pregnancies. As part of this cross-sectional study, during the pandemic, between the dates of 11 March 2020–30 June 2020 at Karadeniz Technical University Faculty of Medicine Perinatology Clinic, fetal structural anomaly detected by ultrasonography or with increased risk in screening test in the first and second trimester of high risk pregnancies, who were therefore recommended a prenatal diagnosis test, were defined as the control group and retrospectively compared with high risk pregnancies of the same periods (11 March 2019–30 June 2019) in the previous year. A total of 267 cases were evaluated within the scope of the study. The rate of pregnant women undergoing the first and second trimester screening tests was 83% in the control group and 56% for pregnant women in the study group. When the total number of prenatal diagnostic procedures and the year each of the procedures performed are compared, a statistically significant difference was found between the study and control groups (p:.041 and p <.001, respectively). When evaluating the rates of performed prenatal diagnostic procedures during the first patient visit in comparison to years, a statistically significant difference was observed in the A/S group and in the total number of cases (p =.023, p <.001, respectively). Similarly, the rate of performed prenatal diagnostic procedure during the first patient visit and the patient's city of residence was similarly statistically significant from year to year (p <.05). The decrease in number of prenatal diagnosis and screening tests during the COVID-19 pandemic draws attention. Prenatal care services are a serious issue that cannot be overcome by any deficiencies in both maternal and fetal care. [ABSTRACT FROM AUTHOR]

Background: During hospitalization, infants are exposed to unpleasant stimuli such as stress, pain, noise, and invasive procedures. These stimuli produce significant changes in vital signs. Touch and sound therapies are a therapy given to the infants in the form of a mother's touch and a light pat on the baby's hands, feet, body, and head. This procedure is accompanied by rhythmic sounds that have been made in the form of audio files. Objective: This study aimed to determine whether touch and sound therapy can affect the level of pain and physiological parameter (heart rate, respiratory rate, and oxygen saturation) in infants by venous blood sampling. Method: This research is an experimental study with a control time-series design, which was conducted from July to October 2013. The research subjects are 30 infants aged 1-12 months who took venous blood samples. Research data were analyzed statistically by the t-test. Result: The results showed that the NIPS scores differed significantly between the intervention and control groups p = 0.000 (p 0.05). Heart rate has a significant effect between the intervention and control groups p = 0.011 (p 0.05). The respiratory rate in the intervention group was lower compared to the control group p = 0.033 (p 0.05). There was no significant difference in oxygen saturation between the intervention and control groups p = 0.232 (p0.05). Conclusion: Touch and Sound therapy decrease levels of pain, heart rate, and respiratory rate, but does not affect oxygen saturation.

Background: Based on the histological confirmation of the presence of nerve structure in the fascia, hence, myofascial pain was treated by the mechanism referred to as interfascial block. To date, the studies of physiological saline for treating patients with myofascial pain has been limited. Ultrasound (US) guided with physiological saline injection (PSI) technique has been routinely practiced among patients with myofascial pain in outpatient service at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. The main objective of this present study is to find the overview data including the percentage of patients responding, acceptable pain period, and adverse events. Materials and Methods: Electronic medical reports among 142 patients receiving US-guided PSI from August 1, 2016, to November 20, 2017, at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, were retrospectively reviewed by the first author. Procedures were performed by the last author. The analysis was independently performed by the first author. Results: One hundred and forty-two patients with complete medical records were compatible with analysis. The average age of patients was 55 years. Most of the patients were female (68.3%). Most of the patients (76.8%) had chronic suffering from myofascial pain. Approximately half of the patients (56.4%) are currently received pain-relieving medications. Upper trapezius muscle (19.5%) was the most common muscle receiving the procedure, followed by multifidus (10.0%) and quadratus lumborum (9.5%). Most of the patients (86.8%) received the procedure one muscle. Approximately 30% of the patients were able to stop pain-relieving medications after the procedure. The median of acceptable pain period was 63 days. The percentage of patients having an acceptable pain period >3 months was 43.9%. No major adverse events were demonstrated. Conclusion: US-guided PSI technique demonstrated pain reduction in 72.8% of the analyzed patients, with an acceptable pain period of 63 days. No major adverse events were demonstrated among all the patients. This technique should be considered as another invasive procedure for eradication myofascial trigger point.

Background: No study has investigated the perioperative management and clinical outcomes in patients who are receiving rivaroxaban 2.5 mg twice a day and acetylsalicylic acid (ASA) 81 to 100 mg daily., Objective: To assess perioperative management and outcomes in patients who are receiving low-dose rivaroxaban, 2.5 mg twice-daily, and low-dose ASA, 81 to 100 mg daily. To assess perioperative management and outcomes in patients who are receiving low-dose rivaroxaban, 2.5 mg twice-daily, and low-dose ASA, 81 to 100 mg daily., Methods: Subanalysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial was performed to assess perioperative management and clinical outcomes in patients with stable coronary or peripheral artery disease who were randomized to receive rivaroxaban 2.5 mg twice a day plus ASA 100 mg daily, rivaroxaban 5 mg twice a day, or ASA 100 mg daily. Patients studied required a surgery/procedure during the trial. The study outcomes, which included myocardial infarction, angina, stroke, acute limb ischemia, bleeding, and death, were assessed according to treatment allocation., Results: There were 2632 patients studied (mean age, 68 years; 80% male) who had a surgery/procedure, comprising percutaneous coronary interventions (∼43%), carotid or other arterial angioplasty (∼15%), pacemaker or internal cardiac defibrillator implantation (∼9%), and coronary artery bypass graft surgery (∼7%). Perioperative study drug management varied, with about one-third of patients not interrupting study drug and the remainder interrupting it between 1 and ≥10 days preprocedure. The incidences of adverse outcomes across treatment groups were 12.7% to 15.3% for myocardial ischemia, 0.8% to 1.2% for stroke, 0.1% to 0.2% for venous thromboembolism, and 3.1% to 4.2% for any bleeding. There was no statistically significant difference in outcome rates across treatment groups., Conclusion: In patients in the COMPASS trial who required a surgery/procedure, there was no significant difference in perioperative adverse outcomes whether patients were receiving rivaroxaban 2.5 mg twice a day and ASA 100 mg daily, rivaroxaban 5 mg twice a day, or ASA alone., Competing Interests: Declaration of competing interests There was no funding provided for the development and for any other aspect of the work in this manuscript. J.D.D. reports consulting and lecture honoraria from Servier Canada, Leo Pharma, Pfizer, and Fresinius Kabi. Q.L. reports no disclosures. D.L.B. reports advisory for Angiowave, Bayer, Boehringer Ingelheim, Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, High Enroll, Janssen, Level Ex, McKinsey, Medscape Cardiology, Merck, MyoKardia, NirvaMed, Novo Nordisk, PhaseBio, PLx Pharma, Regado Biosciences, and Stasys and research funding from Abbott, Acesion Pharma, Afimmune, Aker Biomarine, Amarin, Amgen, AstraZeneca, Bayer, Beren, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cardax, CellProthera, Cereno Scientific, Chiesi, CinCor, CSL Behring, Eisai, Ethicon, Faraday Pharmaceuticals, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Garmin, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Janssen, Javelin, Lexicon, Lilly, Medtronic, Merck, Moderna, MyoKardia, NirvaMed, Novartis, Novo Nordisk, Owkin, Pfizer, PhaseBio, PLx Pharma, Recardio, Regeneron, Reid Hoffman Foundation, Roche, Sanofi, Stasys, Synaptic, The Medicines Company, Youngene, and 89Bio. E.M. reports being employed as a global clinical lead by Bayer AG, Germany. M.K.W. reports no disclosures. S.C. reports grants from Bayer AG and personal fees from BMS, Pfizer, Portola, Boehringer Ingelheim, Servier, Daiichi Sankyo, and Medtronic. S.Y. reports grants and personal fees from Bayer, Boehringer Ingelheim, AstraZeneca, Bristol-Myers Squibb, and Cadila. A.P.M. reports receiving personal fees from Bayer, AstraZeneca, and Novartis. J.W.E. reports grants and/or personal fees from Anthos, Bayer AG, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daiichi Sankyo, Idorsia, Janssen, Astra Zeneca, Eli Lilly, GlaxoSmithKlein, and Sanofi Aventis., (Copyright © 2024 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)

Background: Because selective termination for discordant dichorionic twin anomalies carries a risk of pregnancy loss, deferring the procedure until the third trimester can be considered in settings where it is legal., Objective: To determine whether perinatal outcomes were more favorable following deferred rather than immediate selective termination., Study Design: A French multicenter retrospective study from 2012 to 2023 on dichorionic twin pregnancies with selective termination for fetal conditions, which were diagnosed before 24 weeks gestation. Pregnancies with additional risk factors for late miscarriage were excluded. We defined 2 groups according to the intention to perform selective termination within 2 weeks after the diagnosis of the severe fetal anomaly was established (immediate selective termination) or to wait until the third trimester (deferred selective termination). The primary outcome was perinatal survival at 28 days of life. Secondary outcomes were pregnancy losses before 24 weeks gestation and preterm delivery., Results: Of 390 pregnancies, 258 were in the immediate selective termination group and 132 in the deferred selective termination group. Baseline characteristics were similar in both groups. Overall survival of the healthy co-twin was 93.8% (242/258) in the immediate selective termination group vs 100% (132/132) in the deferred selective termination group (P<.01). Preterm birth <37 weeks gestation was lower in the immediate than in the deferred selective termination group (66.7% vs 20.2%; P<.01); preterm birth <28 weeks gestation and <32 weeks gestation did not differ significantly (respectively 1.7% vs 0.8%; P=.66 and 8.26% vs 11.4%; P=.36). In the deferred selective termination group, an emergency procedure was performed in 11.3% (15/132) because of threatened preterm labor, of which 3.7% (5/132) for imminent delivery., Conclusion: Overall survival after selective termination was high regardless of the gestational age at which the procedure was performed. Postponing selective termination until the third trimester seems to improve survival, whereas immediate selective termination reduces the risk of preterm delivery. Furthermore, deferred selective termination requires an expert center capable of performing the selective termination procedure on an emergency basis if required., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The Ramsay scale is the most widely used scale during pediatric procedures although it has not been formally validated. Objective: To validate the Ramsay scale during invasive procedures under sedation in pediatrics. Methods: A prospective analytic study was conducted in two hospitals. All patients ≥6 months that were undergoing invasive procedures under sedation were enrolled. All were recorded, and these videos were edited and randomized. 150 videos were scored by four observers (a pediatrician, a pediatric intensive care unit nurse, an anesthetist, and an operating room nurse). All videos were scored with the Ramsay scale and University of Michigan Sedation Scale. Observers were blinded to drug administration. Construct validity was measured through Wilcoxon test paired samples after administration of sedatives. Criterion validity, intra‐observer reliability, and interobserver correlation were evaluated by comparing the scores of the scales using Spearman's correlation coefficient. Interobserver agreement was measured using the intraclass correlation coefficient. To assess test‐retest reliability, 50 videos were randomly selected and reevaluated. Results: Sixty‐five patients were included. Construct validity was demonstrated through changes in the Ramsay scale scoring after administration of sedatives (p <.0001). Regarding criterion validity, the Ramsay scale had a high correlation with the UMSS (ρ = 0.621). Intra‐observer agreement was ρ = 0.884. The Ramsay scale showed interobserver reliability with an intraclass correlation coefficient = 0.94 when comparing it with the University of Michigan Sedation Scale. Internal consistency was α = 0.91. Regarding applicability, in our study, it was applied in two hospitals in different areas by four professionals from distinct categories. Conclusions: The Ramsay scale is valid, reliable, and applicable to monitoring sedation for invasive procedures under deep sedation in pediatrics. [ABSTRACT FROM AUTHOR]

The coagulopathy of chronic liver disease causes derangement of the results of traditional laboratory tests. As such, there is an expectation that when undergoing invasive procedures patients with cirrhosis are at increased risk of bleeding. Standard practice is to optimise laboratory values with prophylactic transfusions of platelets, plasma and fibrinogen to reduce perceived bleeding risk. There has been a shift in thinking regarding coagulation in patients with chronic liver disease, whereby a rebalancing of haemostasis occurs with reduction in both procoagulants and anticoagulants. Guidelines for the preprocedural management of patients with chronic liver disease are inconsistent and may not account for this new paradigm. The risk of prophylactic transfusion should be measured against the risk of bleeding while considering the rebalancing of haemostasis. Future management may be guided by whole blood viscoelastic tests or use of thrombopoietin receptor agonists to optimise patients in these scenarios. [ABSTRACT FROM AUTHOR]

Anxiety in children who care in hospitalizatin most be solved. children in preschool age (3-5 years) who received invasive procedure in a hospital is a state of crisis due to a change in health status, environment, family factors, habits or procedures that may cause pain so that the loss of independence of children. State of anxiety that occurs in children will be longer the treatment process than increase the risk of nosocomial infection and traumatic posthospitalization. Preschoolers assume pain is something scary, losing a safe environment. Child in the hospital need the participation of the family in the treatment process and they anxiety. therapy to reduce children's anxiety by parents is therapeutic touch and talk. This study aimed to determine the effect of therapeutic touch and talk to the anxiety of preschool who getting invasive at RSUD Dr. Moewardi. The kind of research was quantitative with quasy experimental nonequivalent control group design. The subject were 30 children ( 15 experiment, 15 control) purposive sampling were selected. Using anxiety cheklist in the adaptation of the theory of stuart and sudden was evaluated. The score were examined by independent sample t-test. A result was found that no different score pre test in experiment and control groub (p-value = 0,449) and have a different score post test in experiment and control groub (p-value = 0,000).

Objectives: The objective of the study is to determine the incidence, clinical and ultrasound characteristics of choroid plexus cyst diagnosed during the 18 -23 weeks anomaly scan and the genetic outcome in 6 pregnancies that underwent molecular diagnosis. Methods: The information obtained from the clinical records of pregnancies with ultrasound diagnosis of choroid plexus cyst Data are analyzed and presented in simple frequency tables. Results: Choroid plexus cyst was diagnosed in 8 (0.9%) pregnancies. The majority of the cysts were solitary (75.0%), unilateral in location (62.5%) and with no associated aneuploidy marker (75.0%). Echogenic bowel and ventricular septal defect was found in 1 fetus each (25%). Six (75.0%) out of the 8 fetuses with chorionic plexus cyst had molecular diagnosis. Two (25%) were trisomy 21 and 1 was trisomy 18. Maternal age > 35 years, multiple cysts and bilateral cyst location was reported in 2 (66.7%) of the 3 fetuses with aneuploidy. Conclusions: Trisomy 21 was the more frequent aneuploidy in fetuses with choroid plexus cyst. Maternal age > 35 years, bilateral location, multiple cysts and presence of soft aneuploidy marker are suggested as indications for molecular diagnosis in CPC.

During the last five decades, lung sonography has developed into a core competency of intensive care medicine. It is a highly accurate bedside tool, with clear diagnostic criteria for most causes of respiratory failure (pneumothorax, pulmonary edema, pneumonia, pulmonary embolism, chronic obstructive pulmonary disease, asthma, and pleural effusion). It helps in distinguishing a hypovolemic from a cardiogenic, obstructive, or distributive shock. In addition to diagnostics, it can also be used to guide ventilator settings, fluid administration, and even antimicrobial therapy, as well as to assess diaphragmatic function. Moreover, it provides risk-reducing guidance during invasive procedures, e.g., intubation, thoracocentesis, or percutaneous dilatational tracheostomy. The recent pandemic has further increased its scope of clinical applications in the management of COVID-19 patients, from their initial presentation at the emergency department, during their hospitalization, and after their discharge into the community. Despite its increasing use, a consensus on education, assessment of competencies, and certification is still missing. Deep learning and artificial intelligence are constantly developing in medical imaging, and contrast-enhanced ultrasound enables new diagnostic perspectives. This review summarizes the clinical aspects of lung sonography in intensive care medicine and provides an overview about current training modalities, diagnostic limitations, and future developments.

Introduction: Children are the most valuable resource, and childhood is the world of a miracle. Every child in a lifetime may face many illnesses and hospitalisation. Pain is a common problem faced by a hospitalised child. Venepuncture is an invasive procedure followed in the hospital, which may produce pain, fear, anxiety, and discomfort in children. The animation distraction is one of the cost-effective non-pharmacological methods which may distract the child during any procedure and reduce the pain stimuli. Aim: To find the effect of animation distraction on pain response during venepuncture. Materials and Methods: An evaluative research approach with a quasi-experimental (post-test only control group) design was adopted in the study. The sample comprised of 40 children (20 each in the control and experimental group) aged 4-12 years undergoing venepuncture was selected by using a nonprobability purposive sampling technique. A small 5-20 minutes of animated videos based on the children’s age and choice were displayed to the experimental group during the venepuncture procedure. Wong–Baker Faces Pain Rating Scale was used to assess the pain response after venepuncture in both the control and experimental group. Results: The data was collected, recorded systematically, and analysed with descriptive and inferential statistics. The experimental group’s mean post-test pain score (3.4±1.68) was lower than the control group (8.2±1.53) with p

Invasive procedures involving a needle are capable of causing pain and anxiety in children, as they imply an expectation of physical suffering and loss of control of the situation. The use of playful activities aims to minimize the effects of painful processes, constituting humanization strategies for the hospital context. This paper investigated the effects of the serious game "Hospital Mirim" as a strategy for coping with the invasive blood collection procedure. Forty children aged between six and 10 years participated, being 20 from the control group and 20 from the experimental group (intervention), randomly drawn. The instruments included: (a) Semi-structured interview, (b) "Hospital Mirim" digital game, (c) Pain scale and (d) Invasive procedure observation scale. The results showed that: (a) the control group in the postinvasive procedure stage presented a higher perception of pain level compared to the experimental group; (b) there was a significant difference in the groups between pain perception and behaviors presented during the procedure; (c) there was no difference between groups regarding behaviors during the invasive procedure. In general, the game was a facilitating instrument to cope with the blood collection in children, reducing the perception of pain. [ABSTRACT FROM AUTHOR]

Introduction: Injury to the inferior epigastric artery (IEA) has been reported following lower abdominal wall surgical incisions, abdominal peritoneocentesis and trocar placements at laparoscopic port sites, resulting in the formation of abdominal wall haematomas that may expand considerably due to lack of tissue resistance. The aim of this study was to localise its course in relation to standard anatomic landmarks and suggest safe areas for performance of invasive procedures. Materials and Methods: Sixty IEAs of 30 adult cadavers (male = 19; female = 11) were dissected and the course of the IEA noted in relation to the mid-inguinal point, anterior superior iliac spine (ASIS) and umbilicus. Results: The mean distance of the IEA from the midline was 4.45 ± 1.42 cm at the level of the mid-inguinal point, 4.10 ± 1.15 cm at the level of ASIS and 4.49 ± 1.15 cm at the level of umbilicus. There was an average of 3.3 branches per IEA with more branches arising from its lateral aspect. The IEA was situated within one-third (32%) of the distance between the midline and the sagittal plane through ASIS at all levels. Conclusion: To avoid injury to IEA, trocars can be safely inserted 5.5 cm [mean + 1 standard deviation (SD)] away from the midline (or) slightly more than one-third of the distance between the midline and a sagittal plane running through ASIS. These findings may be useful not only for laparoscopic procedures but also for image-guided biopsy, abdominal paracentesis, and placement of abdominal drains.

Background: Amniocentesis is a well-known invasive procedure which is commonly carried out in the second trimester. The indication for amniocentesis varies throughout countries and centers. Despite providing significant prenatal diagnosis; many maternal and fetal complications have been reported from previous studies. Materials and methods: This retrospective study aimed to determine the maternal and fetal complications following amniocentesis. This study involved all patients who underwent amniocentesis from January 2012 until June 2017 in a tertiary centre. Maternal age, parity, premorbid medical conditions, amniocentesis indications, gestational age during amniocentesis, karyotyping results, complications during and post procedure and the fetal outcomes were reviewed and analyzed. Results: One hundred and fourteen patients' medical records were reviewed and the majority of patients (50.9%) ranged in age from age 30 to 39 years old with mean age of 34.29 years. Amniocentesis was performed during the second trimester in the majority of patients (71.1%). The indications for amniocentesis in this study were polyhydramnios (7.9%), advanced maternal age (9.6%), risk of Down's syndrome (31.6%), increased risk of Patau syndrome (6.1%), increased risk of Edward's syndrome (4.4%) and abnormal fetal ultrasonography (70.2%). Cytogenetics results of amniocentesis were normal in 82 patients (71.9%). The majority of patients (86.0%) had no complications. Two patients (12.5%) had intrauterine death presumed to be procedural related. Conclusion: This 5-year retrospective study on amniocentesis procedure showed that the majority of amniocentesis were safe as 86.0% of the patients were free from any complications. Anticipating its complication is important as there is always a risk even though it is a safe procedure in general. [ABSTRACT FROM AUTHOR]