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Background: Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation has comparable efficacy and safety to the gold standard of radiofrequency ablation in the treatment of symptomatic atrial fibrillation (AF). Initial randomized control trials were performed using Arctic Front Advance Pro™ (AFr) (Medtronic, Dublin, Ireland) CB system. Novel CB systems have recently become available, including the POLARx™ (Px) (Boston Scientific, Marlborough, Massachusetts, USA) system. We aimed to compare PVI using the Px and the AFr CB systems in our patient population in terms of efficacy, safety and procedure characteristics in a routine clinical setting. Methods: We performed a retrospective analysis of our internal AF ablation registry, containing 452 consecutive patients (pts) that underwent first procedure cryo-PVI for symptomatic AF. Primary endpoints were AF recurrence after 3 and 12 months, complication rate, procedure duration, fluoroscopy time and fluoroscopy dose. Secondary endpoints were minimal freeze temperature, time to isolation (TTI) and temperature at TTI for each of the pulmonary veins as well as minimal esophageal temperature during the procedure. Results: The primary efficacy endpoints of AF recurrence after 3 and 12 months were similar between the AFr and the Px systems (25.5% vs 21.3%, p = 0.416 and 22.2% vs 20.6%, p = 0.794, respectively). Complication rates were similar (3.9% vs 6.8%, p = 0.18) between groups and consisted mostly of mild vascular complications. The AFr group showed a significantly shorter procedural duration (68 (55–77) vs 73 (60–80) min, p = 0.002), and lower fluoroscopy dose compared to the Px system. Fluoroscopy times remained similar, however. Minimal freeze temperatures and temperatures at time of isolation were significantly lower in the Px group. However, the time to isolation and minimal procedural esophageal temperature were similar in both groups. Conclusion: PVI using the AFr and the Px systems showed comparable safety and efficacy. Procedural times were longer for the Px system. The Px system showed lower freeze temperature measurements but seemed to have a comparable biological effect. [ABSTRACT FROM AUTHOR]

Minimally Invasive Robotic Surgery (MIRS) has emerged as a transformative approach in surgical practice, offering reduced patient trauma and enhanced precision. However, challenges persist, including the loss of tactile feedback for surgeons. This study explores the application of machine learning algorithms, specifically variational autoencoders, in vibro-acoustic (VA) signal analysis to address this issue. Our comparative analysis evaluates the potential of supervised learning in surgical data analysis, contributing to advancements in surgical technology. Despite achieving an accuracy of 81%, our results indicate opportunities for further refinement, considering the superior accuracies reported in previous studies. This research underscores the importance of innovative approaches in medical data analysis for optimizing patient care in minimally invasive surgery. [ABSTRACT FROM AUTHOR]

Radial artery spasm (RAS) is a common complication associated with transradial access (TRA) for coronary interventions, particularly affecting elderly patients in whom radial access is preferred due to its benefits in reducing bleeding complications, improving clinical outcomes, and lowering long-term costs. This review examines the incidence, prevention, and treatment of RAS. Methods included an online search of PubMed and other databases in early 2024, analyzing meta-analyses, reviews, studies, and case reports. RAS is characterized by a sudden narrowing of the radial artery due to psychological and mechanical factors with incidence reports varying up to 51.3%. Key risk factors include patient characteristics like female sex, age, and small body size as well as procedural factors such as emergency procedures and the use of multiple catheters. Preventive measures include using distal radial access, hydrophilic sheaths, and appropriate catheter sizes. Treatments involve the intraarterial administration of nitroglycerine and verapamil as well as mechanical methods like balloon-assisted tracking. This review underscores the need for standardizing RAS definitions and emphasizes the importance of operator experience and patient management in reducing RAS incidence and improving procedural success. [ABSTRACT FROM AUTHOR]

Introduction: This study analyzed oncologic patient management from initial tumor diagnosis to tumor follow-up in oral and maxillofacial surgery (OMFS) in Germany. Material and methods: A dynamic online questionnaire with a total of 44 questions was used to generate general and specific data regarding oncologic patient management with head and neck malignancies, supportive care, and (pre-) rehabilitation from initial tumor diagnosis to tumor follow-up and head and neck cancer center (HNCC) structures in OMFS in Germany. The questionnaire was sent to 81 OMFS departments affiliated with the German-Austrian-Swiss Working Group for Tumors of the Jaw and Facial Region (DÖSAK) and the German Association of Oral and Maxillofacial Surgery (DGMKG). Data analysis was conducted descriptively. Results: Forty-eight OMFS departments participated (response rate 59.26%), of which 36/48 (75%) were certified HNCC. 28/34 (82.4%) reported subjective improvements in oncologic care, most often interdisciplinary collaboration (21/33, 63.64%) and clinic structure changes (21/34, 61.76%). Nearly all OMFS departments present patients in multidisciplinary tumor boards (45/46, 97.83%) and aim for osseous reconstruction post-tumor resection (43/44, 97.73%). Significant discrepancies regarding the frequency of masticatory-functional dental rehabilitation following osseous reconstruction were observed. Before oncologic therapy, patients are offered various supportive services, mostly psychotherapy and psycho-oncological support (24/26, 92.31%). Post-therapy, speech therapy (43/43, 100%), physiotherapy (40/43, 93.02%), lymphatic drainage, and follow-up rehabilitation (39/43, 90.7%, respectively) are most often offered. 17/43 (39.53%) have oncological nursing staff. 36/40 (90%) manage patients and side effects during adjuvant therapy, while 5/41 (12.2%) provide proprietary palliative care. 36/41 (87.8%) offer counseling to patients and families. Conclusion: Oncologic patient care in OMFS is highly standardized and potentially attributable to many certified HNCCs in Germany. Certain treatment aspects are handled differently, possibly due to institution-specific reasons. Clinical relevance: The high homogeneity in treatment protocols reflects the widespread high and comparable treatment quality of head and neck malignancies in OMFS in Germany. [ABSTRACT FROM AUTHOR]

• Obstructive sleep apnea (OSA) is a frequent in pregnancy that may affect negatively maternal and fetal outcomes. • Limited diagnostic and screening tools restrict the practitioner ability to appropriately manage gestational OSA patients. • Current screening and treatment options are summarized, proposing a clinical approach for managing OSA in pregnancy. • Improved knowledge will allow the practitioner to better counsel toward mitigating the effects of OSA on mother and fetus. Obstructive sleep apnea (OSA) is a frequent condition during pregnancy and its occurrence is increased in obese women. There are growing concerns about both pre-existing OSA and the development of gestational OSA and their effect on maternal pregnancy outcomes, fetal development, and even early childhood. A strong body of research has revealed maternal complications of OSA, but far fewer studies explore its impact on the developing fetus, highlighting an important area of future research. As evidence in both areas mounts about the negative reproductive impact of OSA, studies have emerged that explore the limitations of current diagnostic criteria and screening tools for this disorder in pregnancy which, in turn, limit the practitioner's ability to appropriately refer patients for OSA diagnosis and treatment. This expert review summarizes the current data regarding OSA screening tools in pregnancy, the limitations of these tools, and available OSA treatments and their efficacies. Our objective is to develop recommendations for how to best screen and manage OSA in pregnancy. We conclude that improved understanding of available tools and treatments will allow the obstetric practitioner to better counsel patients and help mitigate the deleterious effects of OSA on mother and fetus. We herein propose a clinical approach for the screening and management of OSA in pregnancy. [ABSTRACT FROM AUTHOR]

Acalvaria is a rare congenital malformation of unknown etiopathogenesis that affects the development of the skull and surrounding muscular structures. There is scant literature regarding the pathophysiology, and no standardized guidelines exist for patient management. Herein, we present a case of acalvaria in a newborn and our multidisciplinary approach from diagnosis to 1 year of age. [ABSTRACT FROM AUTHOR]

Background: An increasing number of clinical trials for new therapeutic strategies are underway or being considered for dystrophinopathy. Having detailed data on the natural progression of this condition is crucial for assessing the effectiveness of new drugs. However, there's a lack of data regarding the long-term data on the natural course and how it's managed in China. In this study, we offer a comprehensive overview of clinical and molecular findings, as well as treatment outcomes in the Chinese population. Methods: Institutional data on all patients with dystrophinopathy from August 2011 to August 2021 were retrospectively reviewed. The data included geographic distribution, age at diagnosis, molecular findings, and treatment options, such as corticosteroids, cardiac interventions, and clinical outcomes. Results: In total, 2097 patients with dystrophinopathy, including 1703 cases of Duchenne muscular dystrophy (DMD), 311 cases of Becker muscular dystrophy (BMD), 46 cases of intermediate muscular dystrophy (IMD), and 37 cases categorized as "pending" (individuals with an undetermined phenotype), were registered in the Children's Hospital of Fudan University database for dystrophinopathy from August 2011 to August 2021. The spectrum of identified variants included exonic deletions (66.6%), exonic duplications (10.7%), nonsense variants (10.3%), splice-site variants (4.5%), small deletions (3.5%), small insertions/duplications (1.8%), and missense variants (0.9%). Four deep intronic variants and two inversion variants were identified. Regarding treatment, glucocorticoids were administered to 54.4% of DMD patients and 39.1% of IMD patients. The median age at loss of ambulation was 2.5 years later in DMD patients who received glucocorticoid treatment. Overall, one cardiac medicine at least was prescribed to 7.4% of DMD patients, 8.3% of IMD patients, and 2.6% of BMD patients. Additionally, ventilator support was required by four DMD patients. Eligibility for exon skipping therapy was found in 55.3% of DMD patients, with 12.9%, 10%, and 9.6% of these patients being eligible for skipping exons 51, 53, and 45, respectively. Conclusions: This is one of the largest studies to have evaluated the natural history of dystrophinopathy in China, which is particularly conducive to the recruitment of eligible patients for clinical trials and the provision of real-world data to support drug development. [ABSTRACT FROM AUTHOR]

Recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) is a challenging disease, requiring personalized management by a multidisciplinary team. The aim of this retrospective multicentric study was to characterize real-world healthcare resource use and patient care for R/M HNSCC in Portugal during the first year after diagnosis. A total of 377 patients ineligible for curative treatment were included, mostly male (92.8%), aged 50–69 years (74.5%), with heavy alcohol (72.7%) or smoking habits (89.3%). Oropharynx (33.2%) and oral cavity (28.7%) were primary tumor locations, with lung metastases being the most common (61.4%). Eligible patients for systemic treatment with palliative intent (80.6%) received up to four treatment lines, with varied regimens. Platinum-based combination chemotherapy dominated first-line treatment (>70%), while single-agent chemotherapy and anti-PD1 immunotherapy were prevalent in later lines. Treatment approaches were uniform across disease stages and primary tumor locations but varied geographically. Treated patients received more multidisciplinary support than those who were ineligible. This study provides the first Portuguese real-world description of R/M HNSCC patient characteristics, treatment patterns, and supportive care during the year after diagnosis, highlighting population heterogeneity and aiming to improve patient management. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this review is to identify common mood concerns in ICD patients and suggest brief psychological screeners essential for early detection and monitoring in patient care. Areas covered: Reliable and valid psychological assessment tools are reviewed, including those specifically designed for ICD patient populations. Expert opinion: Psychological assessment, in combination with cardiologic standard of care, can help overcome many barriers associated with poor implantable cardioverter-defibrillator (ICD) management and related cardiovascular outcomes. Earlier identification and treatment of mood concerns in ICD patients has been shown to improve quality of life (QOL) and patient outcomes. At this time, however, logistical challenges and time restraints, in addition to knowledge of appropriate treatment plans or referral options, remain central barriers to providing integrated, patient-centered care. Ultimately, all cardiology clinics would benefit from a collaborative care team that includes a mental health consultant or in-house psychologists who can provide consultations or referral services. Additionally, all patients that come to the clinics should complete proactive screening measures as routine component of care to assess the presence of mood concerns to improve patient outcomes and aid in treatment planning. [ABSTRACT FROM AUTHOR]

Aim: This study aims to perform a comprehensive bibliometric analysis of academic publications on AI applications in vascular surgery, identifying key authors, influential journals, prevalent research themes, and international collaborations, focusing on infrastructure, conceptual structure, and social networks within the field. Material and Methods: The analysis covers 815 documents published from 2020 to 2024, retrieved from the Web of Science Core Collection database. Metrics analyzed include publication growth, citation rates, key contributors, leading journals, prevalent themes, and international collaborations. Results: The research output showed a 15% annual growth rate, peaking in 2023. Despite increasing publications, the average citation rate per article declined. The study identified 5039 contributors with significant international co-authorship. Leading authors included Lareyre F and Raffort J, and the "Journal of Vascular Surgery" was the most influential journal. The USA and China led in contributions, reflecting robust research infrastructure. Key themes include risk assessment, diagnostic methods, and patient management, highlighting AI's role in enhancing diagnostic accuracy, treatment planning, and patient outcomes in vascular surgery. Conclusion: The analysis highlights the rapid growth and collaborative nature of AI research in vascular surgery. Key contributors, influential journals, and emerging themes were identified, emphasizing AI's role in improving diagnostics and patient outcomes. Limitations include the focus on one database and a five-year period, suggesting future research should include more databases and a longer timeframe. Exploring high-impact studies and practical applications will further advance the field. [ABSTRACT FROM AUTHOR]

Abstract Background An increasing number of clinical trials for new therapeutic strategies are underway or being considered for dystrophinopathy. Having detailed data on the natural progression of this condition is crucial for assessing the effectiveness of new drugs. However, there’s a lack of data regarding the long-term data on the natural course and how it’s managed in China. In this study, we offer a comprehensive overview of clinical and molecular findings, as well as treatment outcomes in the Chinese population. Methods Institutional data on all patients with dystrophinopathy from August 2011 to August 2021 were retrospectively reviewed. The data included geographic distribution, age at diagnosis, molecular findings, and treatment options, such as corticosteroids, cardiac interventions, and clinical outcomes. Results In total, 2097 patients with dystrophinopathy, including 1703 cases of Duchenne muscular dystrophy (DMD), 311 cases of Becker muscular dystrophy (BMD), 46 cases of intermediate muscular dystrophy (IMD), and 37 cases categorized as “pending” (individuals with an undetermined phenotype), were registered in the Children’s Hospital of Fudan University database for dystrophinopathy from August 2011 to August 2021. The spectrum of identified variants included exonic deletions (66.6%), exonic duplications (10.7%), nonsense variants (10.3%), splice-site variants (4.5%), small deletions (3.5%), small insertions/duplications (1.8%), and missense variants (0.9%). Four deep intronic variants and two inversion variants were identified. Regarding treatment, glucocorticoids were administered to 54.4% of DMD patients and 39.1% of IMD patients. The median age at loss of ambulation was 2.5 years later in DMD patients who received glucocorticoid treatment. Overall, one cardiac medicine at least was prescribed to 7.4% of DMD patients, 8.3% of IMD patients, and 2.6% of BMD patients. Additionally, ventilator support was required by four DMD patients. Eligibility for exon skipping therapy was found in 55.3% of DMD patients, with 12.9%, 10%, and 9.6% of these patients being eligible for skipping exons 51, 53, and 45, respectively. Conclusions This is one of the largest studies to have evaluated the natural history of dystrophinopathy in China, which is particularly conducive to the recruitment of eligible patients for clinical trials and the provision of real-world data to support drug development.

Recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) is a challenging disease, requiring personalized management by a multidisciplinary team. The aim of this retrospective multicentric study was to characterize real-world healthcare resource use and patient care for R/M HNSCC in Portugal during the first year after diagnosis. A total of 377 patients ineligible for curative treatment were included, mostly male (92.8%), aged 50–69 years (74.5%), with heavy alcohol (72.7%) or smoking habits (89.3%). Oropharynx (33.2%) and oral cavity (28.7%) were primary tumor locations, with lung metastases being the most common (61.4%). Eligible patients for systemic treatment with palliative intent (80.6%) received up to four treatment lines, with varied regimens. Platinum-based combination chemotherapy dominated first-line treatment (>70%), while single-agent chemotherapy and anti-PD1 immunotherapy were prevalent in later lines. Treatment approaches were uniform across disease stages and primary tumor locations but varied geographically. Treated patients received more multidisciplinary support than those who were ineligible. This study provides the first Portuguese real-world description of R/M HNSCC patient characteristics, treatment patterns, and supportive care during the year after diagnosis, highlighting population heterogeneity and aiming to improve patient management.

Abstract Objective This study aimed to analyze the factors influencing glycemic control in patients with type 2 diabetes mellitus (T2DM). Methods Baseline data, encompassing basic information, lifestyle habits, and treatment of 305 T2DM patients from March 2021 to January 2023, were collected and analyzed using SPSS 26.0 software. Results Univariate and multivariate logistic regression analyses identified insulin therapy (OR = 2.233; 95%Cl = 1.013–4.520; P = 0.026) and regular clinic visits (OR = 0.567; 95%Cl = 0.330–0.973; P = 0.040) as independent factors influencing glycemic control. No observed interactions between the two variables were noted. Conclusion History of insulin therapy and regular clinic visits were significantly and independently associated with glycated hemoglobin control in T2DM patients. Tailored interventions based on individual circumstances are recommended to optimize glycemic control.

Gastric cancer (GC) is one of the most common types of cancer and is associated with relatively low survival rates. Despite its considerable burden, there is limited guidance for Canadian clinicians on the management of unresectable metastatic GC and gastroesophageal junction cancer (GEJC). Therefore, we aimed to discuss best practices and provide expert recommendations for patient management within the current Canadian unresectable GC and GEJC landscape. A multidisciplinary group of Canadian healthcare practitioners was assembled to develop expert recommendations via a working group. The often-rapid progression of unresectable GC and GEJC and the associated malnutrition have a significant impact on the patient’s quality of life and ability to tolerate treatment. Hence, recommendations include early diagnosis, identification of relevant biomarkers to improve personalized treatment, and relevant support to manage comorbidities. A multidisciplinary approach including early access to registered dietitians, personal support networks, and palliative care services, is needed to optimize possible outcomes for patients. Where possible, patients with unresectable GC and GEJC would benefit from access to clinical trials and innovative treatments.

Objective: This study aimed to analyze the factors influencing glycemic control in patients with type 2 diabetes mellitus (T2DM). Methods: Baseline data, encompassing basic information, lifestyle habits, and treatment of 305 T2DM patients from March 2021 to January 2023, were collected and analyzed using SPSS 26.0 software. Results: Univariate and multivariate logistic regression analyses identified insulin therapy (OR = 2.233; 95%Cl = 1.013–4.520; P = 0.026) and regular clinic visits (OR = 0.567; 95%Cl = 0.330–0.973; P = 0.040) as independent factors influencing glycemic control. No observed interactions between the two variables were noted. Conclusion: History of insulin therapy and regular clinic visits were significantly and independently associated with glycated hemoglobin control in T2DM patients. Tailored interventions based on individual circumstances are recommended to optimize glycemic control. [ABSTRACT FROM AUTHOR]

Background: Rare diseases, predominantly caused by genetic factors and often presenting neurological manifestations, are significantly underrepresented in research. This review addresses the urgent need for advanced research in rare neurological diseases (RNDs), which suffer from a data scarcity and diagnostic challenges. Bridging the gap in RND research is the integration of machine learning (ML) and omics technologies, offering potential insights into the genetic and molecular complexities of these conditions. Methods: We employed a structured search strategy, using a combination of machine learning and omics-related keywords, alongside the names and synonyms of 1840 RNDs as identified by Orphanet. Our inclusion criteria were limited to English language articles that utilized specific ML algorithms in the analysis of omics data related to RNDs. We excluded reviews and animal studies, focusing solely on studies with the clear application of ML in omics data to ensure the relevance and specificity of our research corpus. Results: The structured search revealed the growing use of machine learning algorithms for the discovery of biomarkers and diagnosis of rare neurological diseases (RNDs), with a primary focus on genomics and radiomics because genetic factors and imaging techniques play a crucial role in determining the severity of these diseases. With AI, we can improve diagnosis and mutation detection and develop personalized treatment plans. There are, however, several challenges, including small sample sizes, data heterogeneity, model interpretability, and the need for external validation studies. Conclusions: The sparse knowledge of valid biomarkers, disease pathogenesis, and treatments for rare diseases presents a significant challenge for RND research. The integration of omics and machine learning technologies, coupled with collaboration among stakeholders, is essential to develop personalized treatment plans and improve patient outcomes in this critical medical domain. [ABSTRACT FROM AUTHOR]

Background: cardiovascular diseases, including acute myocardial infarction (AMI) and takotsubo cardiomyopathy (TTC), are significant causes of morbidity and mortality worldwide. Timely differentiation of these conditions is essential for effective patient management and improved outcomes. Methods: We conducted a review focusing on studies that applied artificial intelligence (AI) techniques to differentiate between acute myocardial infarction (AMI) and takotsubo cardiomyopathy (TTC). Inclusion criteria comprised studies utilizing various AI modalities, such as deep learning, ensemble methods, or other machine learning techniques, for discrimination between AMI and TTC. Additionally, studies employing imaging techniques, including echocardiography, cardiac magnetic resonance imaging, and coronary angiography, for cardiac disease diagnosis were considered. Publications included were limited to those available in peer-reviewed journals. Exclusion criteria were applied to studies not relevant to the discrimination between AMI and TTC, lacking detailed methodology or results pertinent to the AI application in cardiac disease diagnosis, not utilizing AI modalities or relying solely on invasive techniques for differentiation between AMI and TTC, and non-English publications. Results: The strengths and limitations of AI-based approaches are critically evaluated, including factors affecting performance, such as reliability and generalizability. The review delves into challenges associated with model interpretability, ethical implications, patient perspectives, and inconsistent image quality due to manual dependency, highlighting the need for further research. Conclusions: This review article highlights the promising advantages of AI technologies in distinguishing AMI from TTC, enabling early diagnosis and personalized treatments. However, extensive validation and real-world implementation are necessary before integrating AI tools into routine clinical practice. It is vital to emphasize that while AI can efficiently assist, it cannot entirely replace physicians. Collaborative efforts among clinicians, researchers, and AI experts are essential to unlock the potential of these transformative technologies fully. [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndrome (ACS) is a severe cardiovascular disease with globally rising incidence and mortality rates. Traditional risk assessment tools are widely used but are limited due to the complexity of the data. Methods: This study introduces a gated Transformer model utilizing machine learning to analyze electronic health records (EHRs) for an enhanced prediction of major adverse cardiovascular events (MACEs) in ACS patients. The model's efficacy was evaluated using metrics such as area under the curve (AUC), precision–recall (PR), and F1-scores. Additionally, a patient management platform was developed to facilitate personalized treatment strategies. Results: Incorporating a gating mechanism substantially improved the Transformer model's performance, especially in identifying true-positive cases. The TabTransformer+Gate model demonstrated an AUC of 0.836, a 14% increase in average precision (AP), and a 6.2% enhancement in accuracy, significantly outperforming other deep learning approaches. The patient management platform enabled healthcare professionals to effectively assess patient risks and tailor treatments, improving patient outcomes and quality of life. Conclusion: The integration of a gating mechanism within the Transformer model markedly increases the accuracy of MACE risk predictions in ACS patients, optimizes personalized treatment, and presents a novel approach for advancing clinical practice and research. [ABSTRACT FROM AUTHOR]

Introduction: Physiotherapy in the private sector has a great presence and weight in today's health care. Knowing the satisfaction between private health insurance patients and private patients will help to improve quality standards in Physiotherapy treatment, and thus clinical outcomes. Material and method: survey carried out during 2023 in Google forms distributed among private clinics in Galicia between March and August. More than 300 survey responses were obtained with a correct distribution. Results: patients with private health insurance showed lower satisfaction than private patients. Behavioural and organizational aspects were considered. The factors evaluated show a clear difference between the two groups, being more positively valued by patients treated by private Physiotherapy. Conclusion: treatment time, fewer resources, accessibility, communication and patient management should be valued and taken into account in order to offer a higher quality of care in Physiotherapy. Lower satisfaction is related to lower perceived quality and worse clinical outcomes. [ABSTRACT FROM AUTHOR]

Gastric cancer (GC) is one of the most common types of cancer and is associated with relatively low survival rates. Despite its considerable burden, there is limited guidance for Canadian clinicians on the management of unresectable metastatic GC and gastroesophageal junction cancer (GEJC). Therefore, we aimed to discuss best practices and provide expert recommendations for patient management within the current Canadian unresectable GC and GEJC landscape. A multidisciplinary group of Canadian healthcare practitioners was assembled to develop expert recommendations via a working group. The often-rapid progression of unresectable GC and GEJC and the associated malnutrition have a significant impact on the patient's quality of life and ability to tolerate treatment. Hence, recommendations include early diagnosis, identification of relevant biomarkers to improve personalized treatment, and relevant support to manage comorbidities. A multidisciplinary approach including early access to registered dietitians, personal support networks, and palliative care services, is needed to optimize possible outcomes for patients. Where possible, patients with unresectable GC and GEJC would benefit from access to clinical trials and innovative treatments. [ABSTRACT FROM AUTHOR]

Intensive care units have been developed for the purposes of disposal of life threatened patients. The beginnings of intensive care were in surgical "shock" rooms which were used during the time allocated independent intensive care units led by anesthesiologist. The units can be open or closed. In the open units every patient has his doctor that comes when it suits him or to call. In the closed units doctors and nurses constantly work and is responsible for everything that happens in the unit. Working in intensive care is teamwork. Exactly one knows who is responsible for which part. The determination and provision of treatment and rest. Basic control in the ICU is very important to timely detect possible complications of treatment and other issues that can occur as an unfavorable course oftreatment. The nurse should be constantly visit patients, provide a complete care, and observe and notice the changes in patients. The remainder of this paper will show that the indications for the reception of patients, organization of work in the ICU, the demands of nursing care, the type of monitoring that are used, burnout in intensive care and special training of doctors and nurses. [ABSTRACT FROM AUTHOR]

Introduction: There are concerns with rising rates of antimicrobial resistance (AMR) across countries with appreciable impact on morbidity, mortality and costs. Amongst low- and middle-income countries, a key driver of AMR is the excessive use of antibiotics in ambulatory care, with a critical area being the appreciable selling of antibiotics without a prescription often driven by patient demand and limited knowledge. There is currently conflicting evidence in South Africa regarding this practice. Consequently, there is a need to explore these critical issues amongst patients, especially in more rural areas of South Africa. A pilot study was undertaken to address this. Methods: A two-step descriptive approach was undertaken. This involved two questionnaires amongst patients exiting chain and independent community pharmacies followed by cognitive interviews. Results: Overall, 21 patients were approached for an interview, including 11 for Part 1 of the questionnaire with 3 declining, and 10 for Part 2, with 2 declining. Subsequently 8 patients completed each part of the questionnaire.. On average, it took 2 min 13 s to complete both parts. 3 of the 5 patients being dispensed an antibiotic were dispensed one without a prescription, with all 3 patients exiting from independent pharmacies. Key reasons for self-purchasing included money and convenience. There was mixed knowledge regarding antibiotics and AMR amongst the 8 patients interviewed with Part 2. Overall, there was a satisfactory understanding of the Part 1 questions, although some modifications were suggested. Some participants had difficulty with fully understanding the questions in Part 2, with a number of suggestions made to improve this for the main study. Conclusion: There were concerns with the extent of purchasing antibiotics without a prescription in this pilot study as well as the knowledge of patients regarding antibiotics and AMR. Both areas need addressing and will be explored further in the main study. [ABSTRACT FROM AUTHOR]

Introduction: The Fundamental Critical Care Support Course (FCCS) is a standardized multidisciplinary program designed to educate participants on the basics of identification and management of patients with critical illness. Our objective was to evaluate the effect of FCCS participation on confidence in the assessment and management of critically ill patients and attitudes towards multidisciplinary education and interprofessional care in a multidisciplinary group of participants. Methods: Participants enrolled in the FCCS course from May 2018 to November 2019 were solicited to participate in a series of surveys evaluating their course experience and confidence in critical care. Attitudes towards multidisciplinary education and interprofessional care were evaluated using the Student Perceptions of Interprofessional Clinical Education-Revised Instrument version 2 (SPICE-R2) tool. A prospective pre- and post-design with a self-report survey including retrospective pre-training assessment and a 3-month follow-up was conducted. Statistical analysis was performed using descriptive statics and non-parametric methods. Results: 321 (97.9%) of the course participants enrolled in the study and completed the confidence survey and SPICE-R2 tool pre-course. Nurses (113, 35.4%) and physicians (110, 34.4%) made up the largest groups of participants, although physician assistants and paramedics were also well represented. Confidence in recognition and management of critical illness significantly improved across all studied domains after course completion, with the mean total confidence score improving from 32.96 pre-course to 41.10 post-course, P < 0.001. Attitudes towards multidisciplinary education and interprofessional care also improved (mean score 41.37 pre-course vs 42.71 post-course, P < 0.001), although pre-course numbers were higher than expected which limited the significance to only certain domains. Discussion: In a multidisciplinary group, completion of FCCS training led to increased confidence in all aspects of critical illness measured. A modest increase in attitudes regarding multidisciplinary education and interprofessional care was also demonstrated. Further study is needed to assess whether this increased confidence translates to improvements in patient care and outcomes. [ABSTRACT FROM AUTHOR]

Objective: Breast cancer clinical stage and nodal status are the most clinically significant drivers of patient management, in combination with other pathological biomarkers, such as estrogen receptor (ER), progesterone receptor or human epidermal growth factor receptor 2 (HER2) receptor status and tumor grade. Accurate prediction of such parameters can help avoid unnecessary intervention, including unnecessary surgery. The objective was to investigate the role of magnetic resonance imaging (MRI) radiomics for yielding virtual prognostic biomarkers (ER, HER2 expression, tumor grade, molecular subtype, and T-stage). Materials and Methods: Patients with primary invasive breast cancer who underwent dynamic contrast-enhanced (DCE) breast MRI between July 2013 and July 2016 in a single center were retrospectively reviewed. Age, N-stage, grade, ER and HER2 status, and Ki-67 (%) were recorded. DCE images were segmented and Haralick texture features were extracted. The Bootstrap Lasso feature selection method was used to select a small subset of optimal texture features. Classification of the performance of the final model was assessed with the area under the receiver operating characteristic curve (AUC). Results: Median age of patients (n = 209) was 49 (21-79) years. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the model for differentiating N0 vs N1-N3 was: 71%, 79%, 76%, 74%, 75% [AUC = 0.78 (95% confidence interval (CI) 0.72-0.85)], N0-N1 vs N2-N3 was 81%, 59%, 24%, 95%, 62% [AUC = 0.74 (95% CI 0.63-0.85)], distinguishing HER2(+) from HER2(-) was 79%, 48%, 34%, 87%, 56% [AUC = 0.64 (95% CI 0.54-0.73)], high nuclear grade (grade 2-3) vs low grade (grades 1) was 56%, 88%, 96%, 29%, 61% [AUC = 0.71 (95% CI 0.63-0.80)]; and for ER (+) vs ER(-) status the [AUC=0.67 (95% CI 0.59-0.76)]. Radiomics performance in distinguishing triple-negative vs other molecular subtypes was [0.60 (95% CI 0.49-0.71)], and Luminal A [0.66 (95% CI 0.56-0.76)]. Conclusion: Quantitative radiomics using MRI contrast texture shows promise in identifying aggressive high grade, node positive triple negative breast cancer, and correlated well with higher nuclear grades, higher T-stages, and N-positive stages. [ABSTRACT FROM AUTHOR]

Introduction: Clinical manifestations of cranial nerve palsies are of great importance, and surgeons should consider them before planning surgical protocol. Materials and Methods: This retrospective study was conducted on preoperative hospital records of 598 Iranian patients with different types of extraocular muscle palsy, including third (90 patients), fourth (501 patients), and fifth (7 patients) nerve palsy at Farabi Hospital, Tehran Province, Iran. Results: In terms of fourth nerve palsy, the mean spherical equivalent (SE) in the right and left eye was 0.23±1.51 and 0.19±1.45 diopter, respectively. Also, the mean angle of vertical deviation was 15.54±8.85 Δ at near and 15.66±8.93 Δ at far. In patients with third nerve palsy, the mean SE in the right and left eye was -0.02±2.08 and 0.08±1.95 diopter, respectively. Also, the mean angle of vertical deviation was 17.8±17.4 Δ at near and 17.8±17.5 Δ at far. In terms of six nerve palsy, the mean SE in the right and left eye was -1.27±3.37 and -1.08±2.52 diopter, respectively. Also, the mean angle of esotropia was 32.4±7.7 Δ at near and 33±6.7 Δ at far. The frequency of amblyopia in patients with third, fourth, and sixth nerve palsies was 21 patients (23.3%), 70(14%), and 4(57.1%), respectively. Conclusion: The clinical characteristics of patients with different types of EOM palsy are remarkably different, which can be attributed to the different properties of these kinds of deviations. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 which is an infectious disease caused by the SARS-CoV-2 virus hurts patients' respiratory health by necessitating oxygen therapy. The affected patients with COVID-19 experience anxiety and stress with quality of life (QoL) impacted due to frequent medication, hospitalizations, fear of dying, and isolation. In individuals with respiratory problems, physiotherapy is useful in improving oxygenation, stress reduction, and QoL. Therefore, our goal was to assess how physiotherapy management affected the oxygenation rates and QoL of hospitalized COVID-19 patients. Materials and Methods: The study included 60 hospitalized cases of COVID-19 pneumonia (25-65 years) admitted to the RCU/Al-Hussein teaching hospital. The oxygenation rate was recorded by hospital monitoring. A physiotherapy management prepared according to the pulmonary rehabilitation recommendations for COVID-19 patients. QoL was assessed by the Arabian version of the short-form health survey questionnaire (SF-36) at baseline, at discharge, and 1 month after discharge. Results: The mean baseline oxygenation percent was 86.10±12.93. The baseline QoL score was 29.14±18.52. A significant increase (P<0.0001) in oxygenation (by 10.22%) was observed at discharge as compared to the baseline values. The QoL was significantly higher (P<0.0001) at 1-month post-discharge as compared to the baseline and the values at discharge (by 157.76%). Similar effects were observed in males and females. Conclusion: A short-term course of physiotherapy management was effective in increasing the oxygenation rates and QoL in hospitalized male and female COVID-19 patients. A combination of breathing exercises, early mobilization, and positioning can act as an adjuvant in the clinical management of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Erosive oral lichen planus (EOLP) represents a significant challenge in dental and medical management due to its chronic inflammatory nature, painful symptoms, and impact on quality of life. This study aims to evaluate the current diagnostic approach with novel non-invasive techniques, such as dermoscopy, and also the landscape of treatment options for EOLP, focusing on its efficacy, safety, and the challenges that it present in clinical practice. Through a comprehensive literature review, we explored the use of topical corticosteroids, systemic immunosuppressants, biologics, and Janus kinase (JAK) inhibitors in treating EOLP, alongside examining patient compliance, psychological impacts, and the risk of adverse effects and recurrence. Our findings reveal that while topical corticosteroids are the cornerstone of EOLP treatment, offering symptomatic relief, their long-term use is limited by side effects and tolerance development. Systemic therapies and biologics provide alternatives for refractory cases but necessitate careful adverse effect monitoring. JAK inhibitors show promise as an innovative treatment avenue but require more evidence on long-term safety and efficacy. This study highlights the necessity of personalized treatment approaches due to the variable disease course and response to treatment, underscoring the importance of a multidisciplinary strategy in managing EOLP. The complexity of EOLP treatment, compounded by its psychological and quality of life impacts, demands ongoing research into targeted therapies, the establishment of standardized treatment protocols, and the development of effective outcome measures to improve patient care and treatment outcomes. [ABSTRACT FROM AUTHOR]

Local and regional anesthesia are commonly employed methods in eye surgery, there are situations in which general anesthesia becomes necessary. Some patients may decline local or regional anesthesia, be unable to maintain a steady position, or lie flat during the procedure. This is particularly pertinent for pediatric patients and individuals with allergies to local anesthetics, who may require general anesthesia. In all cases, meticulous patient preparation is paramount in eye surgery. A thorough evaluation is essential before administering anesthesia, with the choice of anesthesia method dependent on factors such as the patient's overall health, the specific surgical procedure, and the surgeon's expertise. In this review, necessary anesthesia methods in ophthalmic surgeries and perioperative patient management will be discussed. [ABSTRACT FROM AUTHOR]

AbstractThe essential roles and responsibilities of healthcare professionals commissioned on the frontlines of active war zone/s are indispensible, wherein they are explicitly exposed to detrimental conditions due to conflicting situations. With compromised healthcare infrastructure in active war zones, the role of healthcare workers becomes fundamental in delivering urgent medical care while facing significant risks. Beyond instantaneous availability of medication, healthcare workers manoeuvre through the psychological trauma of war, addressing prevalent ordeal and inadequate mental health support. They appear as supporters for peace, documenting rampant atrocities and contribute actively to post-war revival by rebuilding healthcare infrastructure, providing psychosocial support and participation in public health initiatives. This viewpoint highlights the comprehensive impact of conflicting situations on healthcare infrastructure, thus underscoring the necessity for cooperation required for safeguarding of mental wellbeing of healthcare professionals required at the intersection of health and war. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty (THA) is a procedure that removes damaged bone and cartilage and replaces it with prosthetic components and is performed by orthopedics. Objective: management of post-operative rehabilitation of THA patients in terms of content and completion criteria of physiotherapy sessions. The research aims to explore the experience of Romanian physiotherapists about the content and completion criteria of physiotherapy sessions involved in the management of postoperative rehabilitation after THA. Methods: The method used in this study was a questionnaire-based survey, with 120 Romanian specialists in the field completing an online screening tool that contained, along with a socio-demographic questionnaire, a series of questions about their professional experience. Results: One of the most important results of the study is the identification of statistically significant associations between the completion criteria of physiotherapy sessions and three techniques included in the rehabilitation program after THA: edema management, gait re-education exercises, and exercises to increase hip mobility. Conclusion: The the research revealed that the experience of Romanian specialists regarding postoperative rehabilitation after THA is concordant with the experience of specialists in the field, and can be used to develop and test an individualized therapeutic protocol and to design continuing professional training programs for physiotherapists in Romania. [ABSTRACT FROM AUTHOR]

Critical care injuries, such as burn trauma, require specialized skillsets and knowledge. A clinical decision support system to aid clinicians in providing burn patient management can increase proficiency and provide knowledge content for specific interventions. In austere environments, decision support tools can be used to aid in decision making and task guidance when skilled personnel or resources are limited. Therefore, we developed a novel software system that utilizes augmented reality (AR) capabilities to provide enhanced step-by-step instructions based on best practices for managing burn patients. To better understand how new technologies, such as AR, can be used for burn care management, we developed a burn care application for use on a heads-up display. We developed four sub-set applications for documenting and conducting burn wound mapping, fluid resuscitation, medication calculations, and an escharotomy. After development, we conducted a usability study utilizing the System Usability Scale, pre- and post- simulation surveys, and after-action reviews to evaluate the AR-based software application in a simulation scenario. Results of the study indicate that the decision support tool has generalized usability and subjects were able to use the software as intended. Here we present the first use case of a comprehensive burn management system utilizing augmented reality capabilities to deliver care. [ABSTRACT FROM AUTHOR]

Medical doctors can encounter significant challenges in both the radiology image interpretation service and their ability to interpret images to promote effective patient management. This study aimed to explore the experiences of medical doctors in a low-resource setting regarding the image interpretation service received in state-funded hospitals and the potential role of radiographers. A qualitative approach with a descriptive phenomenology design was employed. Thirteen medical officers and medical interns, with a maximum of three years of experience, were purposively selected from three state-funded hospitals. Semi-structured interviews were conducted in English, and data analysis followed the conventional content analysis method using Atlas.ti for Windows (version 9). Three main themes emerged from the data. The first theme was a poor image interpretation service which highlighted issues such as long turnaround times for image reporting and compromised patient management. The second theme was training and support deficiency which revealed the inadequacy of image interpretation training and the need for additional on-the-job support. The third theme was the inconspicuous radiographer role which showcased the potential opportunities for radiographers to aid in filling the gaps in the image interpretation system. Medical doctors in this low-resource setting experience significant delays in radiology image interpretation, leading to compromised patient management. Their training in image interpretation is inadequate, and they often lack on-the-job support. Radiographers potentially play a role in image interpretation which may provide solutions to these contextual challenges. There is a need to review and develop a comprehensive image interpretation system that effectively supports medical doctors in image interpretation, possibly involving the collaboration of radiographers. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) and Helicobacter pylori (H. pylori) infection are different disease states that are united by the core role of acid suppression in their management. In GERD, proton pump inhibitors (PPIs) have long been standard therapy based on abundant positive clinical trial data supporting their efficacy and safety. In H. pylori, PPIs are also a critical element of therapy in combination with 1 or more antibiotics to achieve and maintain a pH that maximizes the efficacy of therapy. Despite the considerable clinical success and widespread use of PPIs, room remains for agents with differentiated pharmacokinetic and pharmacodynamic profiles. The potassium-competitive acid blockers (PCABs) are mechanistically distinct from PPIs but are acid-stable and do not require activation of the proton pump by coadministration of food. In pharmacodynamic studies, these agents have shown greater durations of acid suppression above the critical threshold of pH 4 (for GERD) and pH 6 (for H. pylori), which have been shown to optimize therapeutic efficacy in these settings. These results have translated in clinical studies to similar and, in some cases, improved outcomes relative to PPIs in these disease states. This review summarizes current knowledge on the physiology of acid secretion, pathophysiology and management of GERD and H. pylori, and key characteristics and clinical trial data for PPIs and PCABs. [ABSTRACT FROM AUTHOR]

Purpose: Less invasive decision support tools are desperately needed to identify occult high-risk disease in men with prostate cancer (PCa) on active surveillance (AS). For a variety of reasons, many men on AS with low- or intermediate-risk disease forgo the necessary repeat surveillance biopsies needed to identify potentially higher-risk PCa. Here, we describe the development of a blood-based immunocyte transcriptomic signature to identify men harboring occult aggressive PCa. We then validate it on a biopsy-positive population with the goal of identifying men who should not be on AS and confirm those men with indolent disease who can safely remain on AS. This model uses subtraction-normalized immunocyte transcriptomic profiles to risk-stratify men with PCa who could be candidates for AS. Materials and Methods: Men were eligible for enrollment in the study if they were determined by their physician to have a risk profile that warranted prostate biopsy. Both training (n = 1017) and validation cohort (n = 1198) populations had blood samples drawn coincident to their prostate biopsy. Purified CD2D and CD14D immune cells were obtained from peripheral blood mononuclear cells, and RNA was extracted and sequenced. To avoid overfitting and unnecessary complexity, a regularized regression model was built on the training cohort to predict PCa aggressiveness based on the National Comprehensive Cancer Network PCa guidelines. This model was then validated on an independent cohort of biopsy-positive men only, using National Comprehensive Cancer Network unfavorable intermediate risk and worse as an aggressiveness outcome, identifying patients who were not appropriate for AS. Results: The best final model for the AS setting was obtained by combining an immunocyte transcriptomic profile based on 2 cell types with PSA density and age, reaching an AUC of 0.73 (95% CI: 0.69-0.77). The model significantly outperforms (P < .001) PSA density as a biomarker, which has an AUC of 0.69 (95% CI: 0.65-0.73). This model yields an individualized patient risk score with 90% negative predictive value and 50% positive predictive value. Conclusions: While further validation in an intended-use cohort is needed, the immunocyte transcriptomic model offers a promising tool for risk stratification of individual patients who are being considered for AS. [ABSTRACT FROM AUTHOR]

The article investigates the epidemiology of irritable bowel syndrome (IBS), discussing its escalating prevalence worldwide and its profound implications for individuals and healthcare systems. It also examines treatment options, including medications and therapies, aimed at alleviating symptoms and enhancing patients' quality of life. It also mentions the crucial role of healthcare providers in assisting patients with dietary modifications to effectively manage their IBS symptoms.

Pasireotide is a somatostatin analogue for the treatment of acromegaly, a chronic condition caused by excess growth hormone. Despite the therapeutic benefits of pasireotide as a second-line treatment for inadequately controlled acromegaly, a major concern is its hyperglycemic side-effect. Here, we provide guidance on how to select appropriate patients with acromegaly for treatment with pasireotide. We summarize baseline characteristics of patients at high risk for pasireotide-associated hyperglycemia and recommend a monitoring strategy based on the risk profile. Self-monitoring of blood glucose levels (SMBG), measurements of fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and regular HbA1c measurements are the foundation of our proposed monitoring approach. The pathophysiology of pasireotide-induced hyperglycemia involves decreased secretion of the incretin hormones GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1). Our expert recommendations address the specific pathophysiology of pasireotide-induced hyperglycemia by recommending the incretin-based therapeutics dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in all appropriate patients as an alternative to first-line monotherapy with metformin. Furthermore, we emphasize the importance of adequate control of acromegaly, excellent diabetes education, nutrition and lifestyle guidance and advise to consult expert diabetologists in case of uncertainty in the management of patients with hyperglycemia under pasireotide. [ABSTRACT FROM AUTHOR]

Background: Poor medication adherence remains one of the major problems in the treatment of tuberculosis (TB) patients, while digital technologies have been proven effective to improve the treatment results. However, reports on the effectiveness of comprehensive practice integrating different intervention methods and technologies are limited. The aim of this study is to evaluate the effectiveness of an integrated digital adherence intervention for TB patients. Methods: We developed a digital adherence intervention platform integrating instant WeChat message, electronic medication monitors (EMMs), and manual reminders. The primary goal of the platform was to improve the accessibility of digital adherence technologies, and thus improve treatment adherence. TB patients were newly diagnosed at 10 TB-designated hospitals and came from 220 communities, from January to June 2022. The basic characteristics and treatment adherence of TB patients in WeChat, EMM, and conventional groups were compared, and the influencing factors of high medication adherence were analyzed by logistic regression. Results: A total of 2,498 TB patients were enrolled in the study, 14.5% were managed by digital technologies, 9.5% by WeChat, and 5.0% by EMM, respectively. After intervention, the median medication rate of TB patients was significantly higher in the WeChat group (95.3%) and EMM group (95.7%) compared with that of the conventional group (83.8%). On the contrary, the median number of missed medications among patients of the conventional group (nine times) was significantly higher than that in the WeChat (three times) group and EMM (three times) group. The proportion of high adherence (adherence medication rate ≥90%) among TB patients was 64.7%, 64.5%, and 43.2% in WeChat, EMM, and conventional group, respectively. Conclusions: The application of the integrated digital adherence intervention platform could significantly improve medication adherence among TB patients. The accessibility of digital adherence technologies could be improved by integrating complementary technologies in practice. [ABSTRACT FROM AUTHOR]

Simple Summary: [18F]FDG-PET/CT is a new imaging modality used in routine practice for many tumor diseases. The combination of morphological and metabolic information has demonstrated superiority over pure morphological imaging, significantly impacting treatment decisions and patient outcomes in many tumor entities. However, the role of [18F]FDG-PET/CT in differentiated thyroid carcinoma remains unclear. While potential benefits are acknowledged, there is a lack of clear recommendations and guidelines on when to use this imaging technique. Our study aims to evaluate the influence of FDG-PET/CT on decision making in clinical routines. The impact on clinical decision making was evaluated through questionnaires given to referring physicians before and after PET/CT examinations. The results demonstrate a significant influence of [18F]FDG-PET/CT on patient management in our cohort, leading to the avoidance of both additional invasive and imaging diagnostics. Therefore, our study suggests that the (clinically indicated) use of PET/CT in differentiated thyroid carcinoma could result in better therapy management and ultimately lead to improved patient outcomes. Purpose: To investigate the impact of [18F]FDG-PET/CT on the management of differentiated thyroid carcinoma (DTC) in routine clinical settings. Material and methods: In total, 98 patients (55 females, age 56 ± 18 years) with histologically confirmed thyroid cancer, including all types of DTC and poorly differentiated thyroid cancer (PDTC, n = 7), underwent [18F]FDG-PET/CT for staging or recurrence diagnostics performed using a state-of-the art clinical scanner (Biograph mCT, Siemens Healthineers) with a standardized examination protocol. The impact of PET/CT on clinical decision making was prospectively evaluated using standardized questionnaires completed by the referring physicians before and after PET/CT. Patient outcome was analyzed for OS drawn from patient records. Results: Referring physicians were unable to establish a treatment plan for 81% of patients with thyroid cancer in the absence of PET/CT. The use of PET/CT had a notable influence on patient management, leading to the development of a well-defined treatment plan for 92% of patients. Moreover, after PET/CT a change in pre-PET/CT-intended treatments occurred in 32% of cases, and further invasive diagnostic could be waived in 7% of cases. [18F]FDG-PET/CT revealed a tumor detection rate of 68% (local tumor: 19%, lymph node metastases: 40%, distant metastases: 42%). HTg levels, when stimulated via TSH, were considerably higher in patients with metastases detected on PET/CT, compared to those without metastatic findings (p = 0.02). OS was significantly worse in patients with PDTC (p = 0.002) compared to follicular thyroid cancer (FTC) and PTC or even in patients with distant metastases at first diagnosis (p = 0.03). Conclusions: This prospective registry study confirms that [18F]FDG-PET/CT used in a routine clinical setting has a very important impact on the management of patients with thyroid cancer by initiating treatments and reducing the uses of additional imaging and invasive tests. [ABSTRACT FROM AUTHOR]

Purpose: Systemic amyloidosis represents a yet poorly characterized complex and multifaceted rare multisystem disease with high mortality. Clinical presentation, clinical course, and treatment vary within and across subtypes. Established biomarkers are predominantly non-specific. Diagnosis and management of these patients require specifically tailored interdisciplinary structures. Well-characterized patient cohorts are needed to optimize diagnostic tools and treatment options. Method: The prospective cohort study AmyKoS was established as a monocentric observational study for patients with suspected and proven systemic and localized amyloidosis at the Interdisciplinary Amyloidosis Centre of Northern Bavaria in 2018. We here describe the study rationale and design based on the underlying clinical structures. The primary aim is to establish a large in-detail characterized patient population with appropriate biomaterial resources. The primary endpoint is overall survival; secondary endpoints are disease-associated complications, prevalence and incidence of ICD-10-coded psychological disorders and characterization of organ involvement and response. Results/conclusions: AmyKoS serves as an umbrella structure for clinical and translational research. It differs at least partly from other amyloidosis cohort studies by its cross-subtype approach and is unique regarding the inclusion of patients under suspicion regardless of confirmation of amyloidosis. Therefore, AmyKoS simultaneously generates a negative control group for the evaluation of diagnostic markers and methods and allows to test their generalizability to all subtypes. As a special feature, the multi-step AMY-NEEDS substudy systematically evaluates the established structures with the aim of improving patient-orientated care and the interfaces with referring physicians. The characteristics of the AmyKoS cohort are congruent with the findings of large clinical trials. [ABSTRACT FROM AUTHOR]

BACKGROUND: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a diverse family of cancers that occur within the gastrointestinal tract and pancreas. Peptide receptor radionuclide therapy (PRRT) via 177Lu-DOTATATE is a newer therapeutic option for certain patients with somatostatin receptor--positive GEP-NETs. OBJECTIVES: This review informs on how oncology nurses treating patients with GEP-NETs receiving PRRT using 177Lu-DOTATATE can facilitate care. METHODS: Guidance on the monitoring, management, and care of patients undergoing PRRT for GEP-NETs was developed based on published literature and the nursing experience of the authors. A case study is summarized to highlight key concepts. FINDINGS: Oncology nurses provide assessment, education, direct care, and emotional support when caring for patients with GEP-NETs receiving PRRT with 177Lu-DOTATATE. As the treatment landscape evolves, so too will these roles and responsibilities. [ABSTRACT FROM AUTHOR]

Despite all the advancements in science, medical knowledge, healthcare, and the healthcare industry, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. The main reasons are the inadequacy of preventive health services and delays in diagnosis due to the increasing population, the failure of physicians to apply guide-based treatments, the lack of continuous patient follow-up, and the low compliance of patients with doctors' recommendations. Artificial intelligence (AI)-based clinical decision support systems (CDSSs) are systems that support complex decision-making processes by using AI techniques such as data analysis, foresight, and optimization. Artificial intelligence-based CDSSs play an important role in patient care by providing more accurate and personalized information to healthcare professionals in risk assessment, diagnosis, treatment optimization, and monitoring and early warning of CVD. These are just some examples, and the use of AI for CVD decision support systems is rapidly evolving. However, for these systems to be fully reliable and effective, they need to be trained with accurate data and carefully evaluated by medical professionals. [ABSTRACT FROM AUTHOR]

Tuberculosis is a severe and life-threatening illness that affects numerous individuals worldwide every day. The key objective of this study was to create a system that could enhance the monitoring and management of tuberculosis patients. To achieve this goal, the Mobile D methodology was utilized because of its effectiveness in project management. This methodology emphasizes test-driven development, continuous integration, and optimization to enhance software processes. The outcome of this research was a prototype of a mobile application specifically designed for individuals with tuberculosis. Professionals and people affected by the disease assessed the quality of the prototype. They evaluated its effectiveness, user-friendliness, design, and functionality and gave ratings of 4.77 and 4.69 on a Likert scale, respectively. These figures indicate that the prototype meets high-quality criteria. In conclusion, this research successfully created an efficient prototype that enhances the monitoring and control of tuberculosis patients. The prototype includes features such as real-time consultations for immediate interaction between physicians and patients, clinical history visualization, and medication reminders, all of which improve the user’s experience. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to determine the demographic, clinical characteristics, and outcomes of the patients who applied to the emergency department (ED) of Akdeniz University Faculty of Medicine Hospital (Antalya, Türkiye) after the Kahramanmaraş-Pazarcık earthquake dated February 6, 2023, as earthquake victims were included in the study. The results of the study could be a guide in terms of emergency health services and the healthy management of disasters. Methods: The study included patients over the age of 18 who presented as earthquake victims to the ED of Akdeniz University Medical Faculty Hospital from February 6, 2023 through March 8, 2023. The demographic data of the patients, including age, gender, earthquake zone, time and manner of arrival to the ED, time under debris, length-of-stay (LOS) in the service and intensive care unit (ICU), infection rates, culture results, and mortality, were retrospectively analyzed using the hospital automation system. Results: A total of 1,833 earthquake victims presented to the ED. Of these patients, 1,294 were adults and 539 were children. Services and the ICU admitted a total of 137 adult patients. In the first week, 414 (31.99%) of the patients presented to the ED, while 82 (59.85%) of the hospitalized patients were admitted. Hatay ranked first with 573 (44.28%) patients in the distribution of patients presented to the ED according to earthquake regions. In the distribution of hospitalized patients by earthquake regions, the patients requiring the most hospitalization were from the province of Hatay, with 68 (49.63%) patients. During hospital observations, the medical staff took 132 culture samples based on the positive clinic of the patient. The microorganisms detected in the culture studies were different from the flora of the hospital. The mortality at seven days was two (1.45%), and at the end of 30 days, the mortality was six (4.37%). Conclusions: The ED evaluated all affected cases, with most patients being brought by their relatives using their own means, and had low mortality rates despite presenting with fewer injuries. New environmental conditions that developed after the earthquake caused unexpected results, especially in terms of community-acquired agents. [ABSTRACT FROM AUTHOR]