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ObjectivesTo perform a Bayesian reanalysis of a recent trial of psilocybin (COMP360) versus escitalopram for Major Depressive Disorder (MDD) in order to provide a more informative interpretation of the indeterminate outcome of a previous frequentist analysis.DesignReanalysis of a two-arm double-blind placebo controlled trial.ParticipantsFifty-nine patients with MDD.InterventionsTwo doses of psilocybin 25mg and daily oral placebo versus daily escitalopram and 2 doses of psilocybin 1mg, with psychological support for both groups.Outcome measuresQuick Inventory of Depressive Symptomatology-Self-Report (QIDS SR-16), and three other depression scales as secondary outcomes: HAMD-17, MADRS, and BDI-1A.ResultsUsing Bayes factors and 'skeptical priors' which bias estimates towards zero, for the hypothesis that psilocybin is superior by any margin, we found indeterminate evidence for QIDS SR-16, strong evidence for BDI-1A and MADRS, and extremely strong evidence for HAMD-17. For the stronger hypothesis that psilocybin is superior by a 'clinically meaningful amount' (using literature defined values of the minimally clinically important difference), we found moderate evidence against it for QIDS SR-16, indeterminate evidence for BDI-1A and MADRS, and moderate evidence supporting it for HAMD-17. Furthermore, across the board we found extremely strong evidence for psilocybin's non-inferiority versus escitalopram. These findings were robust to prior sensitivity analysis.ConclusionsThis Bayesian reanalysis supports the following inferences: 1) that psilocybin did indeed outperform escitalopram in this trial, but not to an extent that was clinically meaningful--and 2) that psilocybin is almost certainly non-inferior to escitalopram. The present results provide a more precise and nuanced interpretation to previously reported results from this trial, and support the need for further research into the relative efficacy of psilocybin therapy for depression with respect to current leading treatments.Trial registration numberNCT03429075.

• Patients given combination amiodarone and beta-blockers had significantly lower risks of developing postoperative atrial fibrillation (POAF) in comparison to those given beta-blockers alone. • Combination amiodarone and beta-blockers saw no significant difference with beta-blockers alone in terms of treatment-related drug discontinuations (TRDD) or mortality. • Amiodarone alone saw no significant difference when compared with beta-blockers in terms of POAF prevention. Guideline recommendations regarding the preferred preventive measures for postoperative atrial fibrillation (POAF) are unclear, nor have we found any review articles addressing the combination of amiodarone and beta-blockers for the prevention of POAF. To investigate the efficacy and safety of combination beta-blockers and amiodarone in the prevention of POAF while also comparing the use of amiodarone and beta-blockers individually. We used Pubmed as the primary resource. POAF incidence was the primary outcome of this study. The secondary outcomes were hospital length of stay (LOS), ICU LOS, treatment-related drug discontinuation (TRDD), and mortality. The random-effects model assessed all pooled outcomes with 95% confidence intervals. Statistical significance was set at p ≤0.05. The amiodarone subgroup of POAF incidence saw a Risk Ratio (RR) of 0.81 [0.63, 1.06], p =0.12, while the combination subgroup resulted in a RR of 0.63 [0.49, 0.80], p <0.001. TRDD for the amiodarone subgroup resulted in a RR of 0.68 [0.25, 1.82], p =0.44, while the combination subgroup saw a RR of 0.84 [0.57, 1.23], p =0.36. For mortality, the amiodarone subgroup resulted in a RR of 0.97 [0.48, 1.98], p =0.93, while the combination subgroup resulted in a RR of 1.04 [0.27, 4.05], p =0.96. Both hospital and ICU LOS saw no significant difference between treatment arms for both the combination subgroup and amiodarone alone. Except for the incidence of postoperative atrial fibrillation (POAF) in the combination prophylaxis group, most of the measured outcomes did not meet the optimized information size (OIS) that was estimated. Combination prophylaxis with amiodarone and beta-blockers significantly lowered risks of POAF incidence in comparison to beta-blockers alone while also having comparative mortality and TRDD outcomes. [ABSTRACT FROM AUTHOR]

Background: In the recent years, there has been a rapid increase in the use of robot assisted neck dissection (RAND) as an alternative method for conventional neck dissection. Several recent reports have emphasized upon the feasibility and effectiveness of this technique. However, substantial technical and technological innovation is still essential in spite of the availability of multiple approaches for RAND. Materials and Methods: The present study describes a novel technique, i.e., Robotic Infraclavicular Approach for Minimally Invasive Neck Dissection (RIA MIND) used in head and neck cancers with the help of Intuitive da Vinci Xi Surgical System. Results: After RIA MIND procedure, the patient was discharged on the third post operative day. Also, the total wound size was less than 3.5 cm which enhanced the patient recovery time and required minimal post operative care. The patient was further reviewed 10 days after the procedure for the removal of sutures. Conclusion: RIA MIND technique was effective and safe for performing neck dissection for oral, head and neck cancers. However, additional detailed studies will be required for establishing this technique. [ABSTRACT FROM AUTHOR]

A recent study published in JAMA Psychiatry explores the potential use of psilocybin, a compound found in certain mushrooms, for the treatment of bipolar II depression. The study involved 15 participants with bipolar II depression who were given a high dose of psilocybin alongside psychological support. The results showed significant improvements in depression symptoms, with 80% of participants meeting criteria for response and remission. Importantly, there were no significant adverse events reported. While the study has limitations, such as a small sample size and lack of a control group, it provides preliminary evidence for the safety and potential efficacy of psilocybin in treating bipolar II depression. However, caution should be exercised in generalizing these findings to bipolar I disorder, which is characterized by more severe manic episodes. Further research is needed to explore the long-term effects and risks associated with psilocybin treatment. [Extracted from the article]

• The county-level SVI is a significant predictor for the asthma-related EDV and hospitalization rates. • There is an apparent resources mismatch between the EDP/PCP densities and the SVI. • Environmental and psychosocial factors are significant predictors for asthma-related outcomes. The Social Vulnerability Index (SVI) is a publicly available dataset to identify communities in greatest need of resources. To examine the utility of using the county-level SVI as predictors of asthma-related outcomes. We used the American Community Survey-derived SVI and the National Environmental Public Health Tracking Network – Query Tool to retrieve data for all counties with available SVI data and at least one matched outcome of interest. Then, we tested SVI as a predictor for emergency department visits (EDV) and hospitalizations, with investigating disparities in primary care physician (PCP) density and emergency department physicians (EDP) density. Linear and logistic regression models were used. Compared to counties of the lowest SVI quartile, counties of mid-low, mid-high, and highest SVI quartiles had 1%, 4%, and 5% higher odds of asthma-related EDV per 10,000 population, respectively, and 4%, 21%, and 24% higher odds of asthma-related hospitalization per 10,000 population, respectively. Moreover, the data showed an apparent resources mismatch between the EDP densities per 10,000 populations and the SVI quartiles, and the effect of the county level SVI on the asthma-related EDV and hospitalization is not strongly affected by PCP or EDP densities. The counties with the highest SVI -and the most vulnerable to asthma hazards- have a lower coverage of PCP and EDP. Interventions directed to address persistent social vulnerability would offer the opportunity of primary prevention with less exhaustion for the medical resources. [ABSTRACT FROM AUTHOR]

• Pre-stroke metformin usage was associated with improved AIS outcomes. • Functional independence rate at discharge was higher in metformin users. • Metformin group showed lower 90-day mortality rate. • No significant difference was found in sICH between the two groups. Stroke is a leading cause of mortality and disability globally, with limited treatment options available for acute ischemic stroke (AIS) patients. Type 2 diabetes mellitus (T2DM) is not only widespread but also a known risk factor for stroke. Our meta-analysis aims to assess the influence of pre-stroke metformin use on the clinical outcomes in AIS patients with T2DM. We conducted this study following PRISMA guidelines, searching the following databases: Medline, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials up to February 29, 2024. All studies providing separate data on AIS patients using metformin were included, and statistical analysis was conducted using R software to pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI). Out of 1051 studies, 7 met the inclusion criteria for our meta-analysis with a total of 11589 diabetic patients, including 5445 patients taking metformin and 6144 diabetic patients in the non-metformin group. Compared to the non-metformin group, the metformin group had a significantly higher rate of mRS 0-2 score at discharge (OR 1.56; 95% CI 1.25:1.95; p=< 0.01) and a lower rate of 90-day mortality (OR 0.51; 95% CI 0.42:0.61; p=< 0.01), with no significant difference in sICH (OR 0.88; 95% CI 0.47:1.64; p= 0.68) between the two groups. Our meta-analysis demonstrated that pre-stroke metformin use is associated with higher functional independence and lower mortality in AIS patients with T2DM. [ABSTRACT FROM AUTHOR]

Objectives: The novel 2019 coronavirus (COVID-19) crisis has caused considerable upheaval in the U.S. healthcare system. The current study examined patient-reported experiences in substance use disorder (SUD) treatment during the early stages of the COVID-19 crisis. Methods: Participants in SUD treatment were recruited via online crowdsourcing from April 14, 2020 to May 26, 2020, during the early stages of the COVID-19 crisis. Participants reported disruptions in SUD treatment, stress and anxiety caused by these disruptions on a 0-100 point visual analogue scale (VAS), stress associated with childcare responsibilities on a 0-100 VAS, current stress on the Perceived Stress Scale (PSS), anxiety symptoms on the Beck Anxiety Inventory (BAI), sleep disturbances on the Insomnia Severity Index (ISI), and whether they used drugs or alcohol during the COVID-19 crisis. Results: Participants (N = 240) endorsed that at least 1 SUD treatment was switched to telemedicine (63.7%), had some appointments cancelled (37.5%), or was discontinued due to COVID-19 (29.6%). Participants who did versus did not endorse drug/alcohol use reported difficulty obtaining medications to treat their SUD (OR = 2.47, 95% CI, 1.17-5.22, [chi]2 = 5.98, P =.016), greater scores on VAS treatment-related stress (F 1,197 = 5.70, P =.018) and anxiety (F 1,197 = 4.07, P =.045), greater VAS stress related to childcare (F 1,107 = 10.24, P =.002), and greater scores on the PSS (F 1,235 = 19.27, P <.001), BAI (F 1,235 = 28.59, P <.001), and ISI (F 1,235 = 14.41, P <.001). Conclusions: Providers and public health officials should work to improve continuity and quality of care during the COVID-19 crisis, with special attention on addressing childcare difficulties and providing remote methods to improve stress, anxiety, and sleep for persons in SUD treatment. [ABSTRACT FROM AUTHOR]

Medical devices are one way by which healthcare-associated infections can be transmitted. Medical equipment can be categorized based on its risk of spreading infection and these categories aid decisions about whether to decontaminate or dispose of a used medical device. Decontamination is the process by which a reusable device is rendered safe for further use through cleaning and either disinfection or sterilization. It is frequently an automated process which usually involves thermal or chemical techniques and is subject to extensive quality control. Most microorganisms are inactivated or destroyed by disinfection but sterilization is required to eliminate resistant organisms and bacterial spores. Single-use medical devices are now commonplace and avoid the need for decontamination altogether. [ABSTRACT FROM AUTHOR]

Medical devices are one way by which healthcare-associated infections can be transmitted. Medical equipment can be categorized based on its risk of spreading infection and these categories aid decisions about whether to decontaminate or dispose of a used medical device. Decontamination is the process by which a reusable device is rendered safe for further use through cleaning and either disinfection or sterilization. It is frequently an automated process which usually involves thermal or chemical techniques and is subject to extensive quality control. Most microorganisms are inactivated or destroyed by disinfection but sterilization is required to eliminate resistant organisms and bacterial spores. Single-use medical devices are now commonplace and avoid the need for decontamination altogether. [ABSTRACT FROM AUTHOR]

Background Since 2008, multiple guidelines have endorsed incorporation of chest CT in the radiographic staging assessment of newly diagnosed colorectal cancer (CRC). Radiographic staging practices performed after CRC is detected have not been studied. Objective To evaluate radiographic staging practices for newly diagnosed CRC between gastroenterologists versus non-gastroenterologists. Design Observational cohort study. Setting Single, tertiary-care referral center. Patients Patients newly diagnosed with a T1 or higher stage CRC at time of colonoscopy between 2008 and 2013. Interventions Radiographic staging. Main Outcome Measurements Radiographic preoperative staging examinations ordered by gastroenterologists in comparison to those ordered by non-gastroenterology specialists. Results This study included 277 patients with CRC newly diagnosed by colonoscopy. There were 141 total ordering physicians (68 gastroenterologists and 73 non-gastroenterologists). The majority of preoperative radiographic staging was performed by gastroenterologists (59.2% of patients, n = 164). Colorectal surgeons managed staging in 28.7% of patients (n = 47). Gastroenterologists were more likely to omit a staging chest CT than were non-gastroenterologists (64.6% vs 46.9%; P < .001). Physician practice setting, rectal location of tumor, and advanced endoscopic appearance of tumors were predictors of chest CT inclusion. Limitations Single center, moderate sample size of both providers and patients. Conclusion Gastroenterologists more frequently ordered the initial radiographic staging studies in newly diagnosed CRC patients. However, gastroenterologists were less likely to include chest CT in the initial staging of CRC despite current guideline recommendations to do so. If confirmed with further studies, educational efforts to improve compliance and standardization may be needed. [ABSTRACT FROM AUTHOR]

Abstract: Medical devices are one way by which healthcare-associated infections can be transmitted. Medical equipment can be categorized based on its risk of spreading infection and these categories aid decisions about whether to decontaminate or dispose of a used medical device. Decontamination is the process by which a reusable device is rendered safe for further use through cleaning and either disinfection or sterilization. It is frequently an automated process which usually involves thermal or chemical techniques and is subject to extensive quality control. Most microorganisms are inactivated or destroyed by disinfection but sterilization is required to eliminate resistant organisms and bacterial spores. Single-use medical devices are now commonplace and avoid the need for decontamination altogether. [Copyright &y& Elsevier]

B Background: b The number of lymph nodes retrieved in the surgical specimen carries prognostic information for the staging and oncological outcomes in colorectal cancer. The paucity of lymph node yield in patients undergoing resection after preoperative chemo-radiotherapy (CRT) in rectal cancer was seen which correlated with tumor regression grade. B Conclusions: b Retrieval of fewer than 12 lymph nodes in the surgical specimen of rectal cancer who had received neo-adjuvant radiotherapy with or without chemotherapy should be considered as a better prognostic factor with better local disease control as well as disease-specific overall survival. [Extracted from the article]

Objective: Robot-assisted neck dissection requires a larger wound, is expensive and requires specialised equipment which is not easily available. We have developed an inexpensive minimally invasive neck dissection (MIND) procedure using simple endoscopic instruments in the past. This study was conducted to evaluate the safety, efficacy and reproducibility of the technique., Materials and Methods: From January 2013 to December 2016, we performed MIND on 45 patients with oral cancer using the standard endoscopic equipment. CO 2 gas insufflation was used to create the working space. Intra-operative data, post-operative data and pathological characteristics were evaluated and overall survival (OS) and disease-free survival (DFS) Kaplan-Meier curves were compared using the Log-Rank test., Results: Median operative time was 130 (80-190) min with a mean blood loss of 63 (20-150) ml. Major intra-operative complications were not observed. The median number of nodes retrieved was 14 (range: 7-38). Three patients with a positive lymph node were advised to undergo adjuvant radiotherapy. After consultation, 12 out of 13 tongue cancer patients with a tumour depth >3 mm underwent adjuvant radiotherapy. Mean follow-up period was 31.5 (95% confidence interval [CI] 27.9-35.1) months and 27.8 (95% CI 23.6-32.1) months for OS and DFS, respectively. Four (8.9%) deaths and 8 (17.8%) recurrences were observed. The 3-year OS and DFS was 91.1% and 82.2%, respectively., Conclusion: MIND is aesthetically better than conventional procedures for oral cancer patients due to its safety, efficacy and reproducibility at any centre using the standard laparoscopic equipment., Competing Interests: None

Introduction: The worldwide incidence of colorectal cancer has increased rapidly in the past few decades and dietary habits have been implicated in the cause. Though the Indian diet varies substantially from western diet, there have not been detailed studies on any association., Materials and Methods: This is hospital based case control study enrolling 108 cases and 324 controls, all hailing from the Malabar region of Kerala, India. The subjects were interviewed using food frequency questionnaires for commonly consumed dietary items in the region., Results: A strong association was found between colorectal cancer and tapioca (OR= 2.7 p= 0.001), beef (OR= 4.25, p= 0.000) and pungent spices (OR= 9.62, p= 0.018). Fruits and vegetables a showed strong inverse association (OR= 0.15 p= 0.002). Fish consumption on a daily basis showed a 25% reduction in risk on univariate analysis. Heavy consumption of sugar (OR= 2.80) and tobacco use (OR= 8.79) showed significant high risk., Conclusions: There is strong evidence from our study that intake of beef, refined carbohydrates and tobacco can promote colorectal cancer. Our study has also thrown light on some of the other commonly consumed items, like tapioca and spices, which have positive associations. These are commonly consumed in Malabar region of Kerala. A cohort study is now needed to confirm our findings.