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Physician-assisted suicide (PAS)-commonly but misleadingly called 'medical aid in dying' (1)--is now legal in 11 jurisdictions in the US. PAS remains an area of great controversy among physicians, medical ethicists, [...]

Background: YouTube has educational videos on inhalers. However, their content and quality are not adequately known. Objectives: This study investigated the quality and content of educational YouTube videos on inhalers. Methods: This descriptive study analyzed 178 YouTube videos on inhalers between May and July 2022. Two researchers independently evaluated the videos. The Global Quality Score (GQS), Journal of American Medical Association (JAMA) Benchmark Criteria, and Inhaler Application Checklist (IAC) were used to assess the quality and content of the videos. Spearman's correlation, Kruskal–Wallis, Mann–Whitney U, ANOVA, and Post hoc analysis Bonferroni test were used for data analysis. Results: The videos had a mean GQS score of 3.70 ± 1.24, and JAMA score of 2.22 ± 0.60. A negative correlation was between the quality score of the videos and views, likes, comments, duration, and likes/views (respectively; r = −0.237 p < 0.005, r = −0.217 p < 0.003, r = −0.220 p < 0.005, r = −0.147, p < 0.005). The videos narrated by nurses and doctors had significantly higher mean JAMA and GQS scores than others (p = 0.001). The videos missed some procedural steps [gargling (29.1%), adding no more than five ml of medication and device cleaning (41.9%), and exhaling through the nose (37.5%)]. Videos uploaded by individual missed significantly more procedural steps than professional organizations (p < 0.05). Conclusions: YouTube videos about inhaler techniques have a moderate level of quality. Videos uploaded by doctors and nurses as content narrators were of higher quality. The videos missed some procedural steps. Individual video uploaders had higher missed procedural steps. Counseling should be provided to patients regarding the reliability of online information. [ABSTRACT FROM AUTHOR]

Objectives: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long‐term debilitating illness characterised by profound and persistent fatigue (JAMA: The Journal of the American Medical Association, 313, 2015, 1101). The current study aims to explore the experiences of women with ME/CFS living with their partners during the COVID‐19 pandemic in the United Kingdom. Design: The study adopted a qualitative design comprising semi‐structured interviews with participants. Interviews were analysed using thematic analysis (TA). Methods: Participants were women with ME/CFS (n = 21) recruited through ME/CFS support groups in the United Kingdom. All participants were in romantic relationships and lived with their partners. Results: Data were organised into three themes: (1) lockdown disrupting routine, (2) reducing difference and (3) fear of getting COVID‐19. People with ME/CFS found that lockdown disrupted their well‐established routines. Although routines were disrupted by partners and increased working‐from‐home practices, participants found having partners at home helpful. People with ME/CFS believed that the changes induced by the pandemic reduced the differences between themselves and the outside world which, prior to lockdown, had felt prominent. They were fearful of getting COVID‐19 as they believed this would make their ME/CFS worse. This meant that for people with ME/CFS, the lifting of the lockdown restrictions was an anxiety‐provoking time, hence impacting symptoms. People with ME/CFS continued to adhere to government guidelines after national restrictions were eased. Conclusions: This study outlines the experiences of women with ME/CFS during COVID‐19, alongside the long‐term impact this has had due to the changes that the pandemic imposed. These findings may have implications for those with long COVID. [ABSTRACT FROM AUTHOR]

Aim: To identify Attributes, Characteristics and Demonstrations of nursing practice from both nurses' and people perspectives in today's healthcare environments. A secondary aim was to identify relevant differences between female and male nurses in the context of ACDs. Design: This systematic review was informed by the Joanna Briggs Institute Convergent Integrated Approach to Mixed Study Systematic Reviews. Methods: The search included articles ranging from the years 2000 to 2023 across 10 electronic databases and multiple grey literature outlets. McMaster critical review forms and the Mixed Methods Appraisal Tool were used to appraise article quality. The Convergent Integrated Approach to Mixed Study Systematic Reviews was used to guide data synthesis. Results: Twenty articles were included in this review, 13 qualitative, five quantitative and two mixed‐methods studies. Three themes emerged, including knowledge, practice skills and interpersonal relationships. Differences in Attributes, Characteristics and Demonstrations of professional practice between women and men in nursing were also explored. Conclusion: Findings suggest that evolving healthcare environments challenge nurses to remain focused on patient‐centred and compassionate care. The review also supports nurses caring in a manner that empowers people, increases well‐being, and reduces suffering. Impact: Identified characteristics and attributes of nursing practice, including emphasis on continuous learning, interpersonal relationships and compassion, have a profound impact on nursing. Nurses should remain adaptable, compassionate and patient‐focused in an ever‐evolving healthcare environment. These foundational care principles are necessary for improving patient outcomes, enhancing trust between people and healthcare providers, and increasing inclusivity and diversity in the nursing workforce. Wider Global Community: Nurses worldwide should strive to embody these attributes to provide high‐quality, patient‐centred care in an inclusive environment in today's demanding healthcare environment.Gender‐specific differences in the perception and expression of professional Attributes, Characteristics and Demonstrations can inform inclusion and diversity efforts in the workplace. Reporting Method: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Introduction: One of the primary reasons for fatalities and impairments on a global scale is cardiovascular disease (CVD), encompassing a cluster of illnesses impacting the heart and blood vessels. A CVD risk assessment is a screening tool that measures an individual's risk of developing CVD. Objective: The objective of this study was to compare and evaluate cardiovascular risk using internationally recognized CVD risk scoring systems. Methodology: A prospective, cross-sectional study was carried out for 2 months after the approval of the ethics committee. Naive myocardial infarction (MI) patients presenting to the cardiology department and conforming to the inclusion criteria were enrolled in the study. Patients who are taking statins or any lipid-lowering drugs, as well as patients who are on low-dose aspirin and antidiabetic medications. Using the aforementioned gathered data, the cardiovascular risk scores were computed employing the American College of Cardiology/American Heart Association (ACC/AHA), Framingham risk scores (FRS), European Society of Cardiology (ESC) – CVD risk calculator, and QRISK→3-2018, and subsequently categorized as low risk, intermediate, or high risk based on the individual risk scores. Results: We enrolled 42 patients, with a mean age of 60 years with male dominance. The mean body mass index was 25.5. With a cholesterol/high-density lipoprotein (HDL) ratio of 4.9, the mean systolic blood pressure/diastolic blood pressure was 126/77 mm of Hg. The mean ACC/AHA cardiovascular risk score for 10-year atherosclerotic cardiovascular disease (ASCVD) risk was 11.34%, FRS mean score was 12%, ESC CVD risk calculator mean score was 15.45%, and QRISK3-2018 risk calculator mean score was 20.87% in patients presenting with first time with MI. Conclusion: QRISK3-2018 risk calculator is the most effective out of all the risk calculators with a maximum detection rate of MI in first time presented patients with Naïve MI patients. [ABSTRACT FROM AUTHOR]

Background: The European Society for Medical Oncology (ESMO) guidelines are among the most comprehensive and widely used clinical practice guidelines (CPGs) globally. However, the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated. This study assessed ESMO CPG levels of evidence (LOE) and grades of recommendations (GOR), as well as their trends over time across various cancer settings. Methods: We manually extracted every recommendation with the Infectious Diseases Society of America (IDSA) classification from each CPG. We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types. Results: Among the 1,823 recommendations in the current CPG, 30% were classified as LOE I, and 43% were classified as GOR A. Overall, there was a slight decrease in LOE I (-2%) and an increase in the proportion of GOR A (+1%) in the current CPG compared to previous versions. The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials (LOE I-II) shows a decrease (71% vs. 63%, p = 0.009) while recommendations based on lower levels of evidence (LOE III-V) show an increase (29% vs. 37%, p = 0.01) between previous and current version. In the current versions, the highest proportion of LOE I (42%) was found in recommendations related to pharmacotherapy, while the highest proportion of GOR A recommendations was found in the areas of pathology (50%) and diagnostic (50%) recommendations. Significant variability in LOE I and GOR A recommendations and their changes over time was observed across different cancer types. Conclusion: One-third of the current ESMO CPG recommendations are supported by the highest level of evidence. More well-designed randomized clinical trials are needed to increase the proportion of LOE I and GOR A recommendations, ultimately leading to improved outcomes for cancer patients. [ABSTRACT FROM AUTHOR]

The REPRIEVE trial investigated the use of statin therapy to prevent cardiovascular disease (CVD) in people with HIV. The trial involved over 7,700 participants from 12 countries and found that statin therapy reduced major adverse cardiovascular events by 36% over 5.6 years. This therapy was effective and safe, even for individuals without traditional risk factors. The results of the trial are applicable globally and emphasize the importance of considering factors such as sex, genetics, and local plaque biology when recommending CVD prevention therapy for people with HIV. The collaboration between various stakeholders was essential for the success of the study. [Extracted from the article]

The article focuses on a 59-year-old woman with a longstanding breast lesion and recent neurological symptoms, who was referred to a multidisciplinary breast oncology clinic. Topics include the diagnosis of acute infarction, positive SARS-CoV-2 screening, and imaging findings of a large breast mass with potential metastases and evidence of ischemic stroke.

This research letter examines the cost-effectiveness of using natriuretic peptides (NPs) to screen for and treat stage B heart failure in individuals with type 2 diabetes. The study suggests that the NP screening strategy is valuable according to American Heart Association guidelines after 7 years. However, the study has limitations, such as not considering additional therapy options and using Medicare pricing for medications and imaging studies. Further research is needed to address these limitations and determine the most effective screening strategy for clinical practice guidelines. The study was funded in part by the American Heart Association, and the authors have no conflicts of interest. The data supporting the findings are available upon request. [Extracted from the article]

The article discusses the use of ChatGPT, an artificial intelligence language model, in the field of medicine, specifically in providing information about community-acquired pneumonia (CAP). ChatGPT is capable of generating human-like responses to natural language inputs and has been found to produce quality and empathetic responses to patient questions about CAP. However, the accuracy and reliability of ChatGPT-generated responses are not verified or authenticated, as it does not provide references to support the information provided. The article recommends further research to quantify the accuracy of ChatGPT-generated responses and suggests collaboration among physicians to develop a new AI software that can generate cross-referenced and verified responses to patient queries. [Extracted from the article]

Introduction: Geriatric fracture is a pressing global health issue, marked by elevated mortality and morbidity rates and escalating health care costs. The evolving health care system from fee-for-service to quality-based reimbursement has led to externally driven reward and reimbursement systems that may not account for the complexity of caring for older adults with fracture. Significance: The aim of this review is to highlight the need for a shift towards meaningful metrics that impact geriatric fracture care and to issue a call to action for all medical societies to advocate for national reimbursement and ranking systems that focus on metrics that truly matter. Results: Traditional metrics, while easier to capture, may not necessarily represent high quality care and may even have unintentional adverse consequences. For example, the focus on reducing length of stay may lead to older patients being discharged too early, without adequately addressing pain, constipation, or delirium. In addition, a focus on mortality may miss the opportunity to deliver compassionate end-of-life care. Existing geriatric fracture care metrics have expanded beyond traditional metrics to include assessment by geriatricians, fracture prevention, and delirium assessments. However, there is a need to further consider and develop patient-focused metrics. The Age-Friendly Health Initiative (4 Ms), which includes Mobility, Medication, Mentation, and what Matters is an evidence-based framework for assessing and acting on critical issues in the care of older adults. Additional metrics that should be considered include an assessment of nutrition and secondary fracture prevention. Conclusion: In the realm of geriatric fracture care, the metrics currently employed often revolve around adherence to established guidelines and are heavily influenced by financial considerations. It is crucial to shift the paradigm towards metrics that truly matter for geriatric fracture patients, recognizing the multifaceted nature of their care and the profound impact these fractures have on their lives. [ABSTRACT FROM AUTHOR]

Objective Materials and Methods Results Conclusions To describe the evolution and aims of the European Association for Osseointegration (EAO) Junior Committee (JC).Former members of the EAO JC and members of the board were interviewed, and current projects and initiatives were summarized.The EAO JC was launched in 2007 as the first young committee in Europe. Despite initial skepticism, it became a famous initiative, and the concept was copied by other dental and medical associations and societies. Since 2010, the committee organizes summer camps allowing young talents to discuss, network and interact beyond traditional boundaries.The EAO JC is giving fresh energy to the entire society and provides education and network opportunities for young clinicians and scientists. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion To describe the management and treatment practices of venous thromboembolism (VTE) in cancer patients, assess compliance with the 2023 European Society for Medical Oncology recommendations, and identify factors that may limit or influence their application.We conducted, in a Tunisian center, a retrospective study that included patients treated for cancer or hematologic malignancies and diagnosed with deep vein thrombosis (DVT) and/or pulmonary embolism between January 1, 2022, and August 1, 2023.The study involved 90 patients. DVTs were significantly predominant (81.1%). VTE mostly occurred within 3 months of the cancer diagnosis (41.1%). All patients received anticoagulant treatment. The most frequently prescribed class of anticoagulants was direct oral anticoagulants (42.2%), followed by low molecular weight heparin (36.7%), and finally vitamin K antagonists (21.1%). Financial constraints and/or refusal of social security to provide the treatment were the main cause for changes in the anticoagulant therapy (16.7%). Deaths (25.5%) and repermeabilization of the initially thrombosed venous network on imaging (11.1%) were the two primary reasons for treatment discontinuation. Bleeding complication was the cause of treatment modification or discontinuation in 7.7% and 5.5% of patients, respectively. Overall, guidelines were fully followed in 49 patients (54.4%) concerning the choice of pharmacological class, dose and duration of treatment. Financial constraints experienced by patients were significantly and independently associated with lower adherence to recommendations (p = 0.032).Adherence to guidelines is insufficient. Measures must be implemented to enhance the management of VTE and to develop strategies for improving access to anticoagulants. [ABSTRACT FROM AUTHOR]

Background: The 2021 World Health Organization (WHO) guidelines on cervical cancer screening and treatment provide countries with evidence-based recommendations to accelerate disease elimination. However, evidence shows that health providers' adherence to screening guidelines is low. We conducted a study in Argentina to analyze health providers' knowledge and perceptions regarding the 2021 WHO Guidelines. Methods: A qualitative study was conducted based on individual, semi-structured interviews with health providers specializing in gynecology (n = 15). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research. Results: Although health providers perceive WHO as a reliable institution, they do not know the 2021 guidelines, its supporting evidence, and its elaboration process. Their clinical practice is mainly guided by local recommendations developed by national professional medical associations (PMAs). For interviewees, WHO guidelines should be disseminated through health authorities and national PMAs, mainly through in-service training. Health providers had a positive assessment regarding WHO Recommendation 1 (screen, triage, and treatment for women aged 30 + with HPV-testing every 5 to 10 years) and perceived a favorable climate for its implementation. HPV-testing followed by triage was considered a low-complexity practice, enabling a better detection of HPV, a better selection of the patients who will need diagnosis and treatment, and a more efficient use of health system resources. However, they suggested adapting this recommendation by removing screening interval beyond 5 years. WHO Recommendation 2 (screen-and-treat approach with HPV-testing for women aged 30 + every 5 to 10 years) was predominantly rejected by interviewees, was considered an algorithm that did not respond to women's needs, and was not adequate for the Argentinean context. Regarding the HPV-test modality, clinician-collected tests were the preferred mode. Health providers considered that HPV self-collection should be used primarily among socially vulnerable women to increase screening coverage. Conclusion: WHO guidelines should be widely disseminated among health providers, especially in settings that could benefit from a screen-and-treat approach. Identifying areas of partnership and collaboration with PMAs in implementing WHO guidelines is essential. [ABSTRACT FROM AUTHOR]

The Food and Drug Administration's (FDA) obesity drug guidance is set on the basis of body mass index (BMI), with thresholds of either BMI ≥30 or BMI ≥27 kg/m² with weight-related comorbidities. While BMI is associated with obesityrelated health outcomes, there are known limitations to use as a direct measure of body fat or metabolic health, and the American Medical Association has highlighted limitations of BMI in assessing individual obesity risks. BMI thresholds impose a barrier to treatment. In a sample from the NHANES dataset (n=6,646 men and women), 36% of individuals with metabolic syndrome (MetS) may not be eligible for obesity pharmacotherapy. This analysis provides quantifiable justification for refinement of the BMI treatment criteria with a more holistic assessment of individual obesity-related disease risk. [ABSTRACT FROM AUTHOR]

The article present a case study of a 30-year-old woman who experienced postpartum anxiety and intrusive thoughts following the birth of her first child. Topics discussed include the clinical presentation of postpartum psychiatric disorders; the differential diagnosis; and the management strategies, particularly focusing on postpartum obsessive-compulsive disorder and coexisting major depressive disorder.

The article discusses the case of a Belgian Malinois dog with colorectal pythiosis with partial obstruction and marked colonic dilatation. Topics discussed include tenesmus, hematochezia, intermittent chronic diarrhea and weight loss presented by the dog, the cytological, histopathological and laboratory findings, and euthanasia performed on the dog due to financial constraints and poor prognosis.

Follicular lymphoma (FL) is the most common indolent non‐Hodgkin lymphoma subtype, accounting for 15–20% of all lymphoma diagnoses. Although typically slow‐growing and responsive to frontline therapies, advanced‐stage FL remains incurable with current treatments and typically follows a chronic relapsing/remitting course with increasingly shorter responses to subsequent lines of therapy. Outcomes are highly variable; some patients experience prolonged first remissions that may approximate a 'functional cure'. By contrast, a significant minority of patients experience disease progression shortly after frontline treatment resulting in high rates of lymphoma‐related mortality. Reflecting on the heterogeneous natural history of FL, clinical practice varies widely, particularly in controversial areas, including appropriate disease staging, selection of management strategies and duration of clinical follow‐up. This position statement presents an evidence‐based synthesis of the literature for application in Australasian practice. [ABSTRACT FROM AUTHOR]

Background: This study was an introduction to the Swedish ALSrisc Study and explored the association of lifestyle and medical conditions, with risk and progression of amyotrophic lateral sclerosis (ALS). Methods: We included 265 newly diagnosed ALS patients during 2016–2022 in Stockholm and 207 ALS-free siblings and partners of the patients as controls. Information on body mass index (BMI), smoking, and history of head injuries, diabetes mellitus, hypercholesterolemia, and hypertension was obtained through the Euro-MOTOR questionnaire at recruitment. Patients were followed from diagnosis until death, invasive ventilation, or November 30, 2022. Results: Higher BMI at recruitment was associated with lower risk for ALS (OR 0.89, 95%CI 0.83–0.95), especially among those diagnosed after 65 years. One unit increase in the average BMI during the 3 decades before diagnosis was associated with a lower risk for ALS (OR 0.94, 95%CI 0.89–0.99). Diabetes was associated with lower risk of ALS (OR 0.38, 95%CI 0.16–0.90), while hypercholesterolemia was associated with higher risk of ALS (OR 2.10, 95%CI 1.13–3.90). Higher BMI at diagnosis was associated with lower risk of death (HR 0.91, 95%CI 0.84–0.98), while the highest level of smoking exposure (in pack-years) (HR 1.90, 95%CI 1.20–3.00), hypercholesterolemia (HR 1.84, 95%CI 1.06–3.19), and hypertension (HR 1.76, 95%CI 1.03–3.01) were associated with higher risk of death, following ALS diagnosis. Conclusions: Higher BMI and diabetes were associated with lower risk of ALS. Higher BMI was associated with lower risk of death, whereas smoking (especially in high pack-years), hypercholesterolemia, and hypertension were associated with higher risk of death after ALS diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: To provide guidance for the optimal administration of repetitive transcranial magnetic stimulation, based on scientific evidence and supplemented by expert clinical consensus. Methods: Articles and information were sourced from existing guidelines and published literature. The findings were then formulated into consensus-based recommendations and guidance by the authors. The guidelines were subjected to rigorous successive consultation within the RANZCP, involving the Section of ECT and Neurostimulation (SEN) Committee, its broader membership and expert committees. Results: The RANZCP professional practice guidelines (PPG) for the administration of rTMS provide up-to-date advice regarding the use of rTMS in clinical practice. The guidelines are intended for use by psychiatrists and non-psychiatrists engaged in the administration of rTMS to facilitate best practice to optimise outcomes for patients. The guidelines strive to find the appropriate balance between promoting best evidence-based practice and acknowledging that evidence for rTMS use is a continually evolving. Conclusion: The guidelines provide up-to-date advice for psychiatrists and non-psychiatrists to promote optimal standards of rTMS practice. [ABSTRACT FROM AUTHOR]

Cystic fibrosis is caused by biallelic pathogenic variants in the CFTR gene, which contains a polymorphic (TG)mTn sequence (the "poly-T/TG tract") in intron 9. While T9 and T7 alleles are benign, T5 alleles with longer TG repeats, e.g., (TG)12T5 and (TG)13T5, are clinically significant. Thus, professional medical societies currently recommend reporting the TG repeat size when T5 is detected. Sanger sequencing is a cost-effective method of genotyping the (TG)mTn tract; however, its polymorphic length substantially complicates data analysis. We developed CFTR-TIPS, a freely available web-based software tool that infers the (TG)mTn genotype from Sanger sequencing data. This tool detects the (TG)mTn tract in the chromatograms, quantifies goodness of fit with expected patterns, and visualizes the results in a graphical user interface. It is broadly compatible with any Sanger chromatogram that contains the (TG)mTn tract ± 15 bp. We evaluated CFTR-TIPS using 835 clinical samples previously analyzed in a CLIA-certified, CAP-accredited laboratory. When operated fully automatically, CFTR-TIPS achieved 99.8% concordance with our clinically validated manual workflow, while generally taking less than 10 s per sample. There were two discordant samples: one due to a co-occurring heterozygous duplication that confounded the tool and the other due to incomplete (TG)mTn tract detection in the reverse chromatogram. No clinically significant misclassifications were observed. CFTR-TIPS is a free, accurate, and rapid tool for CFTR (TG)mTn tract genotyping using cost-effective Sanger sequencing. This tool is suitable both for automated use and as an aid to manual review to enhance accuracy and reduce analysis time. [ABSTRACT FROM AUTHOR]

A scientific panel was created consisting of 23 interdisciplinary and interprofessional experts in intensive care medicine, physiotherapy, nursing care, surgery, rehabilitative medicine, and pneumology delegated from scientific societies together with a patient representative and a delegate from the Association of the Scientific Medical Societies who advised methodological implementation. The guideline was created according to the German Association of the Scientific Medical Societies (AWMF), based on The Appraisal of Guidelines for Research and Evaluation (AGREE) II. The topics of (early) mobilisation, neuromuscular electrical stimulation, assist devices for mobilisation, and positioning, including prone positioning, were identified as areas to be addressed and assigned to specialist expert groups, taking conflicts of interest into account. The panel formulated PICO questions (addressing the population, intervention, comparison or control group as well as the resulting outcomes), conducted a systematic literature review with abstract screening and full-text analysis and created summary tables. This was followed by grading the evidence according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence and a risk of bias assessment. The recommendations were finalized according to GRADE and voted using an online Delphi process followed by a final hybrid consensus conference. The German long version of the guideline was approved by the professional associations. For this English version an update of the systematic review was conducted until April 2024 and recommendation adapted based on new evidence in systematic reviews and randomized controlled trials. In total, 46 recommendations were developed and research gaps addressed. [ABSTRACT FROM AUTHOR]

The incidence of brain death/death by neurologic criteria (BD/DNC) among all hospital deaths in the US is approximately 2.06% or 15,000-20,000 cases annually. This article reviews the latest guidelines for adult and pediatric BD/DNC. Although there have not been many changes to the guidelines over the years, BD/DNC guideline updates maintain consistency in determining BD/DNC. [ABSTRACT FROM AUTHOR]

Background: The healthcare system plays a pivotal role in environmental sustainability, and the operating room (OR) significantly contributes to its overall carbon footprint. In response to this critical challenge, leading medical societies, government bodies, regulatory agencies, and industry stakeholders are taking measures to address healthcare sustainability and its impact on climate change. Healthcare now represents almost 20% of the US national economy and 8.5% of US carbon emissions. Internationally, healthcare represents 5% of global carbon emissions. US Healthcare is an outlier in both per capita cost, and per capita greenhouse gas emission, with almost twice per capita emissions compared to every other country in the world. Methods: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the European Association for Endoscopic Surgery (EAES) established the Sustainability in Surgical Practice joint task force in 2023. This collaborative effort aims to actively promote education, mitigation, and innovation, steering surgical practices toward a more sustainable future. Results: Several key initiatives have included a survey of members' knowledge and awareness, a scoping review of terminology, metrics, and initiatives, and deep engagement of key stakeholders. Discussion: This position paper serves as a Call to Action, proposing a series of actions to catalyze and accelerate the surgical sustainability leadership needed to respond effectively to climate change, and to lead the societal transformation towards health that our times demand. [ABSTRACT FROM AUTHOR]

This article explores the potential use of biologic therapies for the treatment of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), a rare inflammatory bowel disease. The effectiveness of current treatments for CMUSE varies, and glucocorticoids, the preferred treatment, can lead to resistance and dependency. The article presents a case report of a patient who was successfully treated with infliximab, a monoclonal TNF-α antibody, after becoming refractory to glucocorticoid treatment. However, due to the limited evidence available and the challenges in diagnosing CMUSE, further research and larger studies are needed to evaluate the therapeutic outcomes and determine the optimal biologic agent for CMUSE treatment. [Extracted from the article]

This paper aims to identify and address gaps in cancer treatment and diagnosis within European health services, focusing specifically on discrepancies between clinical guidelines and policy guidelines. It seeks to highlight how the underutilization of advanced diagnostic techniques recommended by medical societies contributes to missed opportunities for improving patient outcomes.A comprehensive analysis was conducted across multiple European countries to assess the compliance and integration of clinical guidelines with the availability of advanced diagnostic technologies. Secondary data related to clinical and policy guidelines in cancer care were collected and analyzed. Key indicators of adoption and utilization of next-generation sequencing and liquid biopsy were examined to evaluate their impact on health service efficiency and patient care.The analysis revealed significant discrepancies between the recommendations of medical societies regarding advanced diagnostic techniques and their adoption in health policy decisions across Europe. Country-specific assessments indicated varying levels of alignment between clinical guidelines and the availability of advanced diagnostics. These findings underscored missed opportunities for optimizing patient care and health service efficiency through better alignment and integration of clinical guidelines with policy decisions.This study concludes that there is a critical need for health policy decision-makers to prioritize the adoption of clinical guidelines in resource allocation and health service organization. Greater attention to the recommendations of medical societies regarding advanced diagnostic techniques could significantly enhance diagnostic accuracy, treatment efficacy, and overall patient outcomes in cancer care. The paper advocates for policy reforms that acknowledge and leverage the potential benefits of advanced diagnostics in improving health service performance and patient-centered care across Europe. [ABSTRACT FROM AUTHOR]

We compared different LLMs, notably chatGPT, GPT4, and Google Bard and we tested whether their performance differs in subspeciality domains, in executing examinations from four different courses of the European Society of Neuroradiology (ESNR) notably anatomy/embryology, neuro-oncology, head and neck and pediatrics. Written exams of ESNR were used as input data, related to anatomy/embryology (30 questions), neuro-oncology (50 questions), head and neck (50 questions), and pediatrics (50 questions). All exams together, and each exam separately were introduced to the three LLMs: chatGPT 3.5, GPT4, and Google Bard. Statistical analyses included a group-wise Friedman test followed by a pair-wise Wilcoxon test with multiple comparison corrections. Overall, there was a significant difference between the 3 LLMs (p < 0.0001), with GPT4 having the highest accuracy (70%), followed by chatGPT 3.5 (54%) and Google Bard (36%). The pair-wise comparison showed significant differences between chatGPT vs GPT 4 (p < 0.0001), chatGPT vs Bard (p < 0. 0023), and GPT4 vs Bard (p < 0.0001). Analyses per subspecialty showed the highest difference between the best LLM (GPT4, 70%) versus the worst LLM (Google Bard, 24%) in the head and neck exam, while the difference was least pronounced in neuro-oncology (GPT4, 62% vs Google Bard, 48%). We observed significant differences in the performance of the three different LLMs in the running of official exams organized by ESNR. Overall GPT 4 performed best, and Google Bard performed worst. This difference varied depending on subspeciality and was most pronounced in head and neck subspeciality. [ABSTRACT FROM AUTHOR]

Patients use the internet to learn more about health conditions. Non-English–speaking patients may face additional challenges. The quality of online breast cancer information, the most common cancer in women, is uncertain. This study aims to examine the quality of online breast cancer information for English and non-English–speaking patients. Three search engines were queried using the terms: "how to do a breast examination," "when do I need a mammogram," and "what are the treatment options for breast cancer" in English, Spanish, and Chinese. For each language, 60 unique websites were included and classified by type and information source. Two language-fluent reviewers evaluated website quality using the Journal of American Medical Association benchmark criteria (0-4) and the DISCERN tool (1-5), with higher scores representing higher quality. Scores were averaged for each language. Health On the Net code presence was noted. Inter-rater reliability between reviewers was assessed. English and Spanish websites most commonly originated from US sources (92% and 80%, respectively) compared to Chinese websites (33%, P < 0.001). The most common website type was hospital-affiliated for English (43%) and foundation/advocacy for Spanish and Chinese (43% and 45%, respectively). English websites had the highest and Chinese websites the lowest mean the Journal of American Medical Association (2.2 ± 1.4 versus 1.0 ± 0.8, P = 0.002) and DISCERN scores (3.5 ± 0.9 versus 2.3 ± 0.6, P < 0.001). Health On the Net code was present on 16 (8.9%) websites. Inter-rater reliability ranged from moderate to substantial agreement. The quality of online information on breast cancer across all three languages is poor. Information quality was poorest for Chinese websites. Improvements to enhance the reliability of breast cancer information across languages are needed. [ABSTRACT FROM AUTHOR]

Most cases of optic neuritis (ON) occur in women and in patients between the ages of 15 and 45 years, which represents a key demographic of individuals who seek health information using the internet. As clinical providers strive to ensure patients have accessible information to understand their condition, assessing the standard of online resources is essential. To assess the quality, content, accountability, and readability of online information for optic neuritis. This cross-sectional study analyzed 11 freely available medical sites with information on optic neuritis and used PubMed as a gold standard for comparison. Twelve questions were composed to include the information most relevant to patients, and each website was independently examined by four neuro-ophthalmologists. Readability was analyzed using an online readability tool. Journal of the American Medical Association (JAMA) benchmarks, four criteria designed to assess the quality of health information further were used to evaluate the accountability of each website. Freely available online information. On average, websites scored 27.98 (SD ± 9.93, 95% CI 24.96–31.00) of 48 potential points (58.3%) for the twelve questions. There were significant differences in the comprehensiveness and accuracy of content across websites (p <.001). The mean reading grade level of websites was 11.90 (SD ± 2.52, 95% CI 8.83–15.25). Zero websites achieved all four JAMA benchmarks. Interobserver reliability was robust between three of four neuro-ophthalmologist (NO) reviewers (ρ = 0.77 between NO3 and NO2, ρ = 0.91 between NO3 and NO1, ρ = 0.74 between NO2 and NO1; all p <.05). The quality of freely available online information detailing optic neuritis varies by source, with significant room for improvement. The material presented is difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide comprehensive information regarding non-therapeutic aspects of the disease. Ophthalmology organizations should be encouraged to create content that is more accessible to the general public. [ABSTRACT FROM AUTHOR]

Objectives: Precision medicine is data‐driven health care tailored to individual patients based on their unique attributes, including biologic profiles, disease expressions, local environments, and socioeconomic conditions. Emergency medicine (EM) has been peripheral to the precision medicine discourse, lacking both a unified definition of precision medicine and a clear research agenda. We convened a national consensus conference to build a shared mental model and develop a research agenda for precision EM. Methods: We held a conference to (1) define precision EM, (2) develop an evidence‐based research agenda, and (3) identify educational gaps for current and future EM clinicians. Nine preconference workgroups (biomedical ethics, data science, health professions education, health care delivery and access, informatics, omics, population health, sex and gender, and technology and digital tools), comprising 84 individuals, garnered expert opinion, reviewed relevant literature, engaged with patients, and developed key research questions. During the conference, each workgroup shared how they defined precision EM within their domain, presented relevant conceptual frameworks, and engaged a broad set of stakeholders to refine precision EM research questions using a multistage consensus‐building process. Results: A total of 217 individuals participated in this initiative, of whom 115 were conference‐day attendees. Consensus‐building activities yielded a definition of precision EM and key research questions that comprised a new 10‐year precision EM research agenda. The consensus process revealed three themes: (1) preeminence of data, (2) interconnectedness of research questions across domains, and (3) promises and pitfalls of advances in health technology and data science/artificial intelligence. The Health Professions Education Workgroup identified educational gaps in precision EM and discussed a training roadmap for the specialty. Conclusions: A research agenda for precision EM, developed with extensive stakeholder input, recognizes the potential and challenges of precision EM. Comprehensive clinician training in this field is essential to advance EM in this domain. [ABSTRACT FROM AUTHOR]

This article explores the health challenges faced by sled dogs in the Canadian Arctic during the 19th century. As outsiders began to explore the region, they discovered the importance of using dog teams and wearing furs for warmth. However, diseases like distemper and rabies posed a threat to the dogs, with accounts of dogs exhibiting symptoms of hydrophobia (rabies) being recorded. Firsthand accounts from expeditions led by Dr. Elisha Kane and Dr. Isaac Israel Hayes describe the symptoms and deaths of their dogs, although the cause of these health issues remains unclear. The article also discusses the experiences of explorers Charles Francis Hall and Sir George S. Nares, who faced challenges with their dogs, including a mysterious disease that caused seizures and death. The explorers attempted various treatments, some of which may have contributed to the deaths of the dogs. The author emphasizes the need for a better understanding of the fate of these animals and acknowledges the limitations of medical knowledge during that time period. [Extracted from the article]

Poststroke shoulder pain (PSSP), also known as hemiplegic shoulder pain, is a common condition that occurs after a stroke. It can cause physical distress and interfere with daily activities. PSSP can be caused by factors such as impaired motor control and altered nervous activity. Treatment options include analgesia, positioning, range of motion exercises, and physical modalities. Medications such as baclofen, antidepressants, and antiepileptics can be used as first-line treatments. Referral to a specialist may be necessary for severe pain or limited range of motion. A multidisciplinary approach is recommended for optimal treatment outcomes. [Extracted from the article]

This article titled "Clinics in diagnostic imaging (220)" provides information on the diagnosis, clinical course, and imaging techniques used to detect psoas abscesses. It discusses the case of a 67-year-old man with a history of appendiceal adenocarcinoma and peritoneal metastases who presented with thigh and lower back pain. Abdominal radiographs and CT scans revealed a gas-containing right psoas abscess from colonic perforation. The article includes case studies and imaging findings to illustrate different presentations of psoas abscesses and emphasizes the importance of careful evaluation of radiographs for abnormalities in the psoas muscle. Treatment typically involves antibiotic therapy and drainage, with surgical intervention reserved for certain cases. [Extracted from the article]

The article highlights the recognition of exceptional members of AsMA.

Sickle cell disease is a prime example of the devastating impact of healthcare inequities. The End Sepsis Initiative developed after a tragic death due to sepsis, provides a powerful model for the sickle cell community. This model recognizes the importance of evidence-based protocols and policy recommendations/mandates to drive transformative systems change. We propose that the sickle cell community mirror this approach. We propose that hospital systems, healthcare organizations, and insurers implement evidence-based protocols, including personalized pain plans, stigma reduction through staff training, vaccinations, preventative screening, disease-modifying therapies, pediatric to adult transition, and connecting unaffiliated SCD patients to a medical home. We recommend state-level interventions, such as using SCD navigator in electronic health records for quality reporting, supporting community health workers' use, and ensuring rural hospitals have access to SCD specialists. [ABSTRACT FROM AUTHOR]

Copyright of Bulletin of Legal Medicine / Adli Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses the neglect of lifesaving medical devices in the Federal Budget. Various essential medical devices, such as CT scans, MRIs, laboratory kits and analyzers, operation theater equipment, ICU ventilators and monitors, and blood bank screening kits, have been ignored in the budget. The importance of medical devices in diagnosing diseases and providing proper treatment is highlighted, with examples given of the consequences of not having access to these devices. The article argues against the imposition of taxes on medical devices, as it will increase the cost of treatment and suggests that the authorities should consider removing or reducing the taxation on these devices. [Extracted from the article]

Background: With the rapid growth of the ageing population, chronic diseases such as osteoarthritis have become one of the major diseases affecting the quality of life of elderly people. The main pathological manifestation of osteoarthritis is articular cartilage damage. Alleviating and repairing damaged cartilage has always been a challenge. The application of cartilage tissue engineering methods has shown promise for articular cartilage repair. Many studies have used cartilage tissue engineering methods to repair damaged cartilage and obtained good results, but these methods still cannot be used clinically. Therefore, this study aimed to investigate the effect of incorporating nerve growth factor (NGF) into a silk fibroin (SF)/chitosan (CS) scaffold containing bone marrow-derived mesenchymal stem cells (BMSCs) on the repair of articular cartilage defects in the knees of rabbits and to explore the possible underlying mechanism involved. Materials and methods: Nerve growth factor-loaded sustained-release microspheres were prepared by a double emulsion solvent evaporation method. SF/CS scaffolds were prepared by vacuum drying and chemical crosslinking. BMSCs were isolated and cultured by density gradient centrifugation and adherent culture. NGF-SF/CS-BMSC composites were prepared and implanted into articular cartilage defects in the knees of rabbits. The repair of articular cartilage was assessed by gross observation, imaging and histological staining at different time points after surgery. The repair effect was evaluated by the International Cartilage Repair Society (ICRS) score and a modified Wakitani score. In vitro experiments were also performed to observe the effect of different concentrations of NGF on the proliferation and directional differentiation of BMSCs on the SF/CS scaffold. Results: In the repair of cartilage defects in rabbit knees, NGF-SF/CS-BMSCs resulted in higher ICRS scores and lower modified Wakitani scores. The in vitro results showed that there was no significant correlation between the proliferation of BMSCs and the addition of different concentrations of NGF. Additionally, there was no significant difference in the protein and mRNA expression of COL2a1 and ACAN between the groups after the addition of different concentrations of NGF. Conclusion: NGF-SF/CS-BMSCs improved the repair of articular cartilage defects in the knees of rabbits. This repair effect may be related to the early promotion of subchondral bone repair. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsThe state of Illinois’ Opioid Alternative Pilot Program (OAPP) is the first and only official harm-reduction program in the US to address the opioid crisis via facilitation of safe and legal access to medical cannabis. This study evaluates the association of medical cannabis use with pain level and frequency of opioid use in the first cohort of OAPP participants in 2019.A survey was sent OAPP enrollees between February and July 2019. Cannabis users (n = 626) were compared to non-users (n = 234) to determine whether there was an association between cannabis use and self-reported (a) pain level and (b) frequency of opioid use. Backward stepwise regression models were used.A total of 860 participants was included in the analysis. Overall, 75% of the study sample reported pain as their primary medical symptom, and 67% of cannabis users reported having a disability. The mean difference in pain level between cannabis users and non-users was 4.5 units (on a 100-point scale) higher among cannabis users than non-users (p = 0.03); and cannabis use was statistically associated with pain level. High-frequency opioid users had lower odds of reporting cannabis use within the past year than low/no opioid users.Although there was a statistical association between cannabis use and pain, the difference of 4.5 points in pain level between users and non-users was too small to reflect a clinically meaningful relative difference. This study may provide useful information to providers and clinicians about how the OAPP and similar programs may reduce opioid use and improve health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Possessing ethical intelligence and cognitive flexibility can play a significant role in the acceptable performance of nurses. Furthermore, respecting the privacy of patients should always be a primary ethical principle that nurses focus on. This study aimed to investigate the ethical intelligence and cognitive flexibility of nurses and their role in predicting the level of patients' privacy observance. Also, determining the overall status of patient privacy protection and its two domains, namely human dignity domain and maintaining personal privacy, were specific objectives of this study. Methods: This cross-sectional descriptive-analytical study was conducted in 2022. A sample of 340 nurses and 1067 patients from teaching hospitals affiliated with Shiraz University of Medical Sciences in southern Iran were selected. Standard questionnaires of ethical intelligence and cognitive flexibility were used for nurses, and a privacy observance questionnaire was used for patients. Data were analyzed using t-tests, ANOVA, Pearson correlation coefficient, and multiple linear regression with the SPSS23 software. Results: The mean score of ethical intelligence and cognitive flexibility for nurses was 98.33 ± 18.06 (out of 200) and 74.56 ± 16.76 (out of 140), respectively. The mean score of patients' privacy observance was 79.74 ± 14.53 (out of 150). The results of multiple linear regression showed that the dimensions of perseverance and assertiveness towards rights (β = 0.540, p < 0.001), action based on principles, values, and beliefs (β = 0.454, p < 0.001), responsibility towards personal decisions (β = 0.410, p < 0.001), accepting responsibility for serving others (β = 0.393, p < 0.001), ability to forgive one's mistakes (β = 0.301, p = 0.001), ability to forgive others' mistakes (β = 0.287, p = 0.002), honesty (β = 0.275, p = 0.004), acknowledgment of mistakes and failures (β = 0.263, p = 0.005), commitment to promises (β = 0.242, p = 0.005), and interest in others (β = 0.237, p = 0.01) from the dimensions of ethical intelligence, as well as the dimensions of perceived control (β = 0.580, p < 0.001), perception of multiple solutions (β = 0.511, p < 0.001), and perception of justifications (β = 0.373, p < 0.001) from the dimensions of cognitive flexibility had a positive and significant effect on the level of patients' privacy observance. Conclusion: Ethical intelligence and cognitive flexibility of nurses and the level of patient privacy protection were estimated to be at a moderate level. Also, the level of ethical intelligence and cognitive flexibility of nurses played a predictive role in the level of patients' privacy observance. It is suggested that hospital managers and policymakers enhance nurses' ethical intelligence and cognitive flexibility through educational, welfare, managerial, motivational, and job-related programs, thereby improving the status of patient privacy protection. [ABSTRACT FROM AUTHOR]

Aims Methods and Results Conclusions Judicious antimicrobial use in companion animal practice is critical for maintaining the effectiveness of antimicrobial agents against bacterial infections and reducing the selection of antimicrobial‐resistant bacteria. This study aimed to provide insights into companion animal veterinarians' antimicrobial treatment recommendations for common bacterial infections in dogs and cats and describe the factors influencing their prescription choices.An online survey using QualtricsXM® software was administered between September and November 2022 to companion animal veterinarians who were Illinois State Veterinary Medical Association members. Descriptive and text analyses were conducted to assess the participants' responses. A total of 78 surveys were included in the analysis. Skin infections were ranked as the most common bacterial infections for which veterinarians prescribed antimicrobial agents, followed by ear, urinary tract, respiratory, and enteric infections. The severity of clinical symptoms and the results of bacterial culture and susceptibility tests were the most influential factors for veterinarians when making antimicrobial prescription choices. Veterinarians were aware of the current antimicrobial prescription guideline recommendations when prescribing antimicrobials empirically to nine hypothetical scenarios of bacterial infections. According to the results of the text analysis that assessed veterinarians' responses to an open‐ended question, regarding their challenges when prescribing antimicrobial agents, the pairwise correlation of word frequencies within each response showed the highest correlations between the words ‘owner’ and ‘compliance’, ‘administration’ and ‘route’, ‘cost’ and ‘culture’, and ‘patients’ and ‘acceptance’.The study results can support animal health stakeholders in the development of antimicrobial stewardship programmes to promote appropriate antimicrobial use and limit the emergence of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background Study design Endpoints Methods and analysis Ethics and dissemination Trial registration number Salvage radiotherapy (SRT) and androgen‐deprivation therapy (ADT) are widely used in routine clinical practice to treat patients with prostate cancer who develop biochemical recurrence (BCR) after radical prostatectomy (RP). However, there is no standard‐of‐care consensus on optimal duration ADT. Investigators propose three distinct risk groups in patients with prostate cancer treated with SRT in order to better define the indications and duration of ADT combined with SRT.The URONCOR 06‐24 trial (ClinicalTrials.gov identifier NCT05781217) is a prospective, multicentre, randomised, open‐label, phase III, clinical trial. The aim of the trial is to determine the impact of short‐term (6 months) vs long‐term (24 months) ADT in combination with SRT on distant metastasis‐free survival (MFS) in patients with prostate cancer with BCR after RP (intermediate and high risk).The primary endpoint is 5‐year MFS rates in patients with prostate cancer treated with long‐ vs short‐term ADT in combination with SRT. Secondary objectives are biochemical‐relapse free interval, pelvic progression‐free survival, time to start of systemic treatment, time to castration resistance, cancer‐specific survival, overall survival, acute and late toxicity, and quality of life.Total of 534 patients will be randomised 1:1 to ADT 6 months or ADT 24 months with a luteinizing hormone‐releasing hormone analogue in combination with SRT, stratified by risk group and pathological lymph node status.The study is conducted under the guiding principles of the World Medical Association Declaration of Helsinki. The results will be disseminated at research conferences and in peer‐reviewed journals.EudraCT number 2021‐006975‐41. [ABSTRACT FROM AUTHOR]

This article from the New England Journal of Medicine presents a case study of a 30-year-old woman who developed postpartum fever, abdominal pain, and skin ulcers. The patient's symptoms worsened over time, leading to further diagnostic tests. The article discusses the diagnosis of Sweet's syndrome, a rare condition characterized by skin lesions and inflammation. Treatment options for Sweet's syndrome include systemic glucocorticoids, and the prognosis is generally favorable. The text also highlights the importance of timely identification and management of Sweet's syndrome during pregnancy to prevent complications. The patient in the case study was successfully treated with intravenous methylprednisolone and oral nifedipine. [Extracted from the article]

Background: Concern over medical students' well-being is a global issue, with studies showing high psychological distress rates. Impostor Phenomenon (IP), i.e., underestimating one's abilities, attributing success to external factors, and feeling like a fraud, has been implicated as one reason behind these troubling findings. Meanwhile, resilience has been suggested to protect against psychological distress. This study aimed to investigate the prevalence of IP and its association with resilience among undergraduate medical students. Methods: The Clance Impostor Phenomenon Scale (CIPS), the Brief Resilience Scale (BRS), and sociodemographic questions were completed by 457 medical students registered in their 2-10th semester at a Swedish university. Of the respondents, 62.6% identified as women, 36.1% as men, and 1.3% as others. Results: The prevalence of IP was 58.4% (defined as CIPS score ≥ 62). According to the CIPS scoring guidelines, 10.3% of participants had low IP, 29.5% moderate, 41.6% frequent, and 18.6% intense IP. Of all participants, almost 90% experienced at least moderate and 60.2% frequent to intense IP. Women had significantly higher CIPS scores and lower BRS scores than men. In contrast, neither attending semester nor age group significantly impacted CIPS scores. Finally, there was a moderate inverse correlation between the level of resilience and the prevalence of IP. Conclusions: Our findings suggest that the majority of Swedish medical students feels like an impostor, and of these students, most do so frequently. Furthermore, IP is more prevalent among female students – who also show lower levels of resilience. Moreover, our results indicated that IP could hinder achieving higher resilience. Future longitudinal studies should investigate how gender norms may contribute to IP feelings and explore the potential advantages of counteracting IP and strengthening resilience among medical students. However, targeted interventions addressing individual students' IP and resilience are insufficient. There is also a need to address structural aspects of the educational environment, such as gender stereotypes, that may contribute to IP. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to assess the percentage of patients treated according to the European Society for Medical Oncology (ESMO) 2018 guidelines for breakthrough cancer pain (BTcP) and the impact of guidelines adherence on patients' quality of life (QoL). Methods: Adult opioid-tolerant patients diagnosed with BTcP and locally advanced or recurrent metastatic cancer with a life expectancy of >3 months prospectively were included. Patients were followed up for 28 days. Results: Of 127 patients included, 37 were excluded due to the impossibility to establish adherence to the ESMO guidelines. Among the evaluable patients [51.1% female; with mean (SD) age of 66.4 (11.8) years], all were adherent. BTcP was diagnosed by the Association for Palliative Medicine algorithm in 47.8% of patients and by clinical experience in 52.2% of patients. The mean number of daily BTcP episodes ranged between 1 and 8, with a mean (95% CI) severity of 7.3 (7.0; 7.6) at week 0 and 6.2 (5.8; 6.6) at week 4. Time to maximum pain intensity was 3-15 min in 52.2% of patients, and BTcP lasted 30-60 min in 14.4% of patients at week 0 and 4.4% of patients at week 4. Mean (95% CI) treatment effectiveness was 6.6 (6.1; 7.1) at week 0 and 7.4 (7.0; 7.8) at week 4. Median (Q1-Q3) patients' global impression of clinical condition was 4.0 (4.0-4.0) at week 0 and 3.0 (2.0-3.0) at week 4. Conclusion: A clear BTcP assessment and strict follow-up could be crucial to guidelines adherence and for patient's QoL. [ABSTRACT FROM AUTHOR]

Simple Summary: Cervical cancer, a very aggressive gynecological malignancy that also affects young women, remains significantly prevalent despite worldwide efforts in HPV vaccination campaigns. Cervical cancer research is experiencing a period of significant change, with intense ongoing debates on issues that could potentially transform current guidelines. Therefore, in light of these changes, guidelines and protocols will soon need significant updates. Hence, this paper aims to summarize and compare the most recent recommendations published by international gynecological oncology societies for patients with cervical cancer. A comparative analysis of American, Asian, and European guidelines was conducted to evaluate the different recommendations for diagnostic, surgical, medical, and follow-up management. Cervical cancer continues to have a significant incidence, despite global efforts in HPV vaccination campaigns. Managing this condition involves a diverse team of healthcare professionals. Research in this field is undergoing a period of great revolution in multiple areas, and international guidelines will soon have to adapt to new scientific evidence. This could be true mainly in locally advanced stages, and it could also be true for minimal invasive surgery. This paper aims to summarize and compare the most recent recommendations published by international gynecological oncological societies for patients with cervical cancer. From their comparison, common aspects and disagreements emerged, especially in the diagnostic pathway and follow-up strategies. Several issues that remain to be debated in the literature were addressed and compared, highlighting similarities and differences, from the role of the sentinel lymph node in early stages to that of the adjuvant hysterectomy in locally advanced tumors. On the surgical side, for this last subset of patients, currently, a laparotomic approach is recommended. At the same time, the advent of immunotherapy has just opened up new and promising scenarios in systemic treatment for locally advanced cervical cancer, and international guidelines will soon introduce it into their algorithms. [ABSTRACT FROM AUTHOR]

This article provides information on hypothermia and frostbite, focusing on their causes, recognition, and management. It emphasizes the importance of quick intervention for hypothermia and provides guidelines for rewarming techniques. The article also discusses the classification and management of frostbite, including the use of medications to enhance tissue viability. Long-term complications of frostbite are mentioned, such as amputation, chronic nerve damage, and chronic arthritis. The text highlights the importance of preventing future episodes by avoiding cold exposure. [Extracted from the article]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)