Pub Date : 2023-01-01DOI: 10.18103/mra.v11i7.2.4204
U. Guevara-López, M. Luna, E. Ramírez
Background: The teaching-learning process is a fundamental competence in high-risk environments such as the operating room. Although conventional approaches are based on learning from negative performance, it is convenient to visualize the virtuous behavior of actors in specialties where security events are latent. Objective: to explore through a survey the perception of crisis in the teaching of anesthesia in Mexico, and to identify the possible causes and precipitating factors. Methods: A prospective observational design was used, prior approval from the research ethics committee. It was studied by means of a survey with 40 items to people who carry out their professional practice in the Mexican Republic. The positive and/or negative characteristics of specialists, student teachers, the educational program and work environment were explored. Results: 1,125 participants responded. The highest percentage believed that there is a severe deficit in the teaching of the specialty, indicating in descending order the students, the work environment, and in similar proportions, the structure of the program and the characteristics of the teachers as the causes. Significant statistical differences were found in the attitude and values of the residents, in lack of adherence to educational programs, in the lack of stimuli, motivation and lack of recognition and encouragement to teachers, p < 0.000. Conclusions: Our findings indicate that anesthesiologists are doing many things "right", but the existing educational deficit can be corrected to avoid an eventual crisis, suggesting a clinical practice based on evidence and values in a better environment.
{"title":"Education in Anesthesiology: Crisis, Values and Perspectives","authors":"U. Guevara-López, M. Luna, E. Ramírez","doi":"10.18103/mra.v11i7.2.4204","DOIUrl":"https://doi.org/10.18103/mra.v11i7.2.4204","url":null,"abstract":"Background: The teaching-learning process is a fundamental competence in high-risk environments such as the operating room. Although conventional approaches are based on learning from negative performance, it is convenient to visualize the virtuous behavior of actors in specialties where security events are latent. Objective: to explore through a survey the perception of crisis in the teaching of anesthesia in Mexico, and to identify the possible causes and precipitating factors. Methods: A prospective observational design was used, prior approval from the research ethics committee. It was studied by means of a survey with 40 items to people who carry out their professional practice in the Mexican Republic. The positive and/or negative characteristics of specialists, student teachers, the educational program and work environment were explored. Results: 1,125 participants responded. The highest percentage believed that there is a severe deficit in the teaching of the specialty, indicating in descending order the students, the work environment, and in similar proportions, the structure of the program and the characteristics of the teachers as the causes. Significant statistical differences were found in the attitude and values of the residents, in lack of adherence to educational programs, in the lack of stimuli, motivation and lack of recognition and encouragement to teachers, p < 0.000. Conclusions: Our findings indicate that anesthesiologists are doing many things \"right\", but the existing educational deficit can be corrected to avoid an eventual crisis, suggesting a clinical practice based on evidence and values in a better environment.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88951717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The restricted donor area in paediatric patients demands the use of Human Amniotic membrane (hAM) in the management of difficult-to-manage wounds. It can be used directly over wounds or used to grow stem cells by different culture methods. The hAM can be used “fresh” i.e., +4O glycerol preserved or “cryopreserved”. Methods: In this literature review, we searched ‘PubMed’, ’Web of Science’ and ’SCOPUS’ for experimental models, RCT, Observational studies, case series, and case reports involving the usage of hAM in the treatment of neonatal and paediatric (<14 yrs.) patients, published in from 1993 to April 2022. The search included the keywords, “amnion”, “biomaterials”, “biological dressing”, “clinical study”, “congenital defects”, “human amniotic membrane”, “paediatric wound”, “neonatal wounds”, and “regenerative medicine”. The Search was extended by snowballing the reference list of all included studies. Results: The final analysis included one experimental RCT, three review articles, and twelve case reports. The experimental studies were in rat, pup, and porcine models. The paediatric second-and third-degree thermal burn followed by paediatric ocular diseases viz corneal epithelial ulcers, conjunctiva reconstruction following Steven Johnson Syndrome, and scarring after surgery of strabismus were the most common indications for the usage of AM. Five cases of meningomyelocele repair (intradural & extradural placement of AM) and 2 cases of gastroschisis repair (as an antiadhesive layer) were reported. Freeze-dried hAM is most frequently used in clinical practice. Autologous hAM was used in antenatally detected birth defects. In the adults, the fresh hAM was found equally effective as freeze-dried AM, but with the risk of transmission of contagious diseases. The literature on Fresh amnion is deficient in paediatric patients. Conclusion: hAM as a skin substitute in paediatric wounds/defects has shown an enhanced rate of healing. However, further studies, regarding the utility of hAM in the management of paediatric wounds, congenital anatomical defects, and diseases along with analysis of outcome and economic constraints in developing countries are needed.
背景:儿科患者供体面积有限，需要使用人羊膜(hAM)来处理难以处理的伤口。它可以直接用于伤口上，也可以通过不同的培养方法来培养干细胞。火腿可以使用“新鲜”，即+ 40甘油保存或“冷冻保存”。方法:在这篇文献综述中，我们检索了PubMed、Web of Science和SCOPUS，检索了1993年至2022年4月发表的涉及使用hAM治疗新生儿和儿科(<14岁)患者的实验模型、随机对照试验、观察性研究、病例系列和病例报告。搜索关键词包括“羊膜”、“生物材料”、“生物敷料”、“临床研究”、“先天性缺陷”、“人羊膜”、“儿科伤口”、“新生儿伤口”和“再生医学”。通过滚雪球式地扩大所有纳入研究的参考文献列表，扩大了搜索范围。结果:最终分析包括1项实验性RCT, 3篇综述文章和12例病例报告。实验研究以大鼠、幼犬和猪为模型。小儿二度和三度热烧伤后的儿童眼部疾病，如角膜上皮溃疡、史蒂文·约翰逊综合征后结膜重建和斜视手术后瘢痕形成是使用AM的最常见适应症。本文报告5例脊膜膨出修补术(硬膜内和硬膜外放置AM)和2例胃裂修补术(作为抗粘连层)。冻干火腿最常用于临床实践。自体hAM用于产前检测出生缺陷。在成人中，发现新鲜火腿与冻干AM同样有效，但具有传播传染病的风险。关于新鲜羊膜的文献在儿科患者中缺乏。结论:火腿作为一种皮肤替代品，在儿童伤口/缺陷中显示出更高的治愈率。然而，需要进一步研究人工智能在处理儿科伤口、先天性解剖缺陷和疾病方面的应用，并分析发展中国家的结果和经济限制。
{"title":"Human Amniotic Membrane Usage from Bench to Bedside in Congenital Defects and Wounds in Paediatric Surgery: A Systematic Review","authors":"Intezar Ahmed","doi":"10.18103/mra.v11i3.3628","DOIUrl":"https://doi.org/10.18103/mra.v11i3.3628","url":null,"abstract":"Background: The restricted donor area in paediatric patients demands the use of Human Amniotic membrane (hAM) in the management of difficult-to-manage wounds. It can be used directly over wounds or used to grow stem cells by different culture methods. The hAM can be used “fresh” i.e., +4O glycerol preserved or “cryopreserved”. Methods: In this literature review, we searched ‘PubMed’, ’Web of Science’ and ’SCOPUS’ for experimental models, RCT, Observational studies, case series, and case reports involving the usage of hAM in the treatment of neonatal and paediatric (<14 yrs.) patients, published in from 1993 to April 2022. The search included the keywords, “amnion”, “biomaterials”, “biological dressing”, “clinical study”, “congenital defects”, “human amniotic membrane”, “paediatric wound”, “neonatal wounds”, and “regenerative medicine”. The Search was extended by snowballing the reference list of all included studies. Results: The final analysis included one experimental RCT, three review articles, and twelve case reports. The experimental studies were in rat, pup, and porcine models. The paediatric second-and third-degree thermal burn followed by paediatric ocular diseases viz corneal epithelial ulcers, conjunctiva reconstruction following Steven Johnson Syndrome, and scarring after surgery of strabismus were the most common indications for the usage of AM. Five cases of meningomyelocele repair (intradural & extradural placement of AM) and 2 cases of gastroschisis repair (as an antiadhesive layer) were reported. Freeze-dried hAM is most frequently used in clinical practice. Autologous hAM was used in antenatally detected birth defects. In the adults, the fresh hAM was found equally effective as freeze-dried AM, but with the risk of transmission of contagious diseases. The literature on Fresh amnion is deficient in paediatric patients. Conclusion: hAM as a skin substitute in paediatric wounds/defects has shown an enhanced rate of healing. However, further studies, regarding the utility of hAM in the management of paediatric wounds, congenital anatomical defects, and diseases along with analysis of outcome and economic constraints in developing countries are needed.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"55 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90054991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Adolescence is a phase blended with various challenges and changes. How someone takes these challenges and accepts the changes (physically, emotionally, or psychologically) are the major concerns of social scientists. Objective: Keeping that objective in mind, current research has been done to assess if emotional regulation leads to impulsivity and anxiety through the moderating effect of mindfulness. Method: For the purpose, correlational research design has been followed and randomly 150 young adolescent females were selected from various public as well as private schools following similar kinds of academic board (CBSE). Standardized tools pertaining to emotion regulation, impulsivity, anxiety, and mindfulness were administered. To accomplish the objectives of the study, apart from descriptive statistics correlation of coefficients was run followed by structural equation modeling (SEM) to highlight the mediating role of mindfulness between emotion regulation, impulsivity, and anxiety. Conclusion: Major findings of the study revealed the direct effect of emotional suppression on anxiety and impulsivity through the moderating role of mindfulness whereas no such results were obtained for cognitive reappraisal. Hence, the proposed model has been partially found to be significant with the goodness of fitness index value of 0.935.
{"title":"Effect of Emotional Regulation on Impulsivity and Anxiety Through the Mediating Role of Mindfulness","authors":"Neeraj Panwar, N. Agarwal, Shivani Tanwar","doi":"10.18103/mra.v11i5.3807","DOIUrl":"https://doi.org/10.18103/mra.v11i5.3807","url":null,"abstract":"Background: Adolescence is a phase blended with various challenges and changes. How someone takes these challenges and accepts the changes (physically, emotionally, or psychologically) are the major concerns of social scientists. Objective: Keeping that objective in mind, current research has been done to assess if emotional regulation leads to impulsivity and anxiety through the moderating effect of mindfulness. Method: For the purpose, correlational research design has been followed and randomly 150 young adolescent females were selected from various public as well as private schools following similar kinds of academic board (CBSE). Standardized tools pertaining to emotion regulation, impulsivity, anxiety, and mindfulness were administered. To accomplish the objectives of the study, apart from descriptive statistics correlation of coefficients was run followed by structural equation modeling (SEM) to highlight the mediating role of mindfulness between emotion regulation, impulsivity, and anxiety. Conclusion: Major findings of the study revealed the direct effect of emotional suppression on anxiety and impulsivity through the moderating role of mindfulness whereas no such results were obtained for cognitive reappraisal. Hence, the proposed model has been partially found to be significant with the goodness of fitness index value of 0.935.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"84 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91403502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health technology assessments are evaluation tools used by decision makers and governing bodies to evaluate the relative effectiveness, safety, and cost of new health technologies. Despite the significant access and reimbursement implications of the decisions informed by health technology assessments, health equity is not consistently included in these assessments. This review explores current health technology assessment approaches using global examples, examines how health technology assessments include health equity considerations, reviews how health equity is not optimally included in health technology assessments using a case study example, and discusses emerging practices to include more health equity related metrics using examples from sponsors and health technology assessment agencies. Results show that health technology assessments do not have a consistent, clearly defined measures of health equity impact or methods to include health equity-oriented measures in assessments. Additionally, most do not provide differentiated value assessments for health equity-oriented data or impact. However, innovators and health technology assessment organizations are presenting new approaches to evaluation. Some outside groups are advocating for change and investing in developing health equity checklists and frameworks for incorporation in health technology assessments. Moving forward, more research is needed to understand how to best incorporate heath equity-oriented measures into health technology assessments and how innovators can get more involved to inform both product development and evaluation efforts. If done well, health technology assessments can be developed to reward technologies and research programs that have a significant and measurable impact on delivering more equitable health outcomes.
{"title":"Are Health Technology Assessments Keeping Pace with Health Equity Priorities: A Review of Existing Approaches and Discussion of Emerging Practices","authors":"S. Garfield, Shannon Armstrong, Julie Nguyen, Christine Hildreth, Bianca Wu, Isabella James, Sylvie Babat, Malu Foley","doi":"10.18103/mra.v11i6.3903","DOIUrl":"https://doi.org/10.18103/mra.v11i6.3903","url":null,"abstract":"Health technology assessments are evaluation tools used by decision makers and governing bodies to evaluate the relative effectiveness, safety, and cost of new health technologies. Despite the significant access and reimbursement implications of the decisions informed by health technology assessments, health equity is not consistently included in these assessments. This review explores current health technology assessment approaches using global examples, examines how health technology assessments include health equity considerations, reviews how health equity is not optimally included in health technology assessments using a case study example, and discusses emerging practices to include more health equity related metrics using examples from sponsors and health technology assessment agencies. Results show that health technology assessments do not have a consistent, clearly defined measures of health equity impact or methods to include health equity-oriented measures in assessments. Additionally, most do not provide differentiated value assessments for health equity-oriented data or impact. However, innovators and health technology assessment organizations are presenting new approaches to evaluation. Some outside groups are advocating for change and investing in developing health equity checklists and frameworks for incorporation in health technology assessments. Moving forward, more research is needed to understand how to best incorporate heath equity-oriented measures into health technology assessments and how innovators can get more involved to inform both product development and evaluation efforts. If done well, health technology assessments can be developed to reward technologies and research programs that have a significant and measurable impact on delivering more equitable health outcomes.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83308269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To empirically confirm the utility of photobiomodulation (PBM) in the treatment of acute and long COVID-19 guided by a mechanistic analysis of the photochemical effects of pulsed light on SARS-CoV-2 infections and disease progression. Background: COVID-19 comprises a coronavirus severe inflammatory disease infecting tissue populated by ACE-2 receptors of the upper and lower respiratory tract and AEC causing an overexpression of pro-inflammatory cytokines. Once in the lungs, viremic spread and cytokine profusion progresses into multi-organ hyperinflammation of visceral epithelium, vascular endothelium, and neurons of the CNS, PNS, ANS, and brain with long-term sequelae. In response to an oxidative state, red and NIR PBM down-regulates proinflammatory cytokines, activating M2 macrophages and Th2 helper cells to increase anti-inflammatory immune response in accordance with a biphasic dose response. Published reports confirm efficacious therapy of COVID-19 using conformal LED pads or scanned lasers. Results: A series of two acute COVID case studies comprising 69 ambulatory (stage 1-to-5) and five stage-6 hospitalized patients confirm the efficacious impact of whole-organ deep-tissue PBM using algorithmically-pulsed conformal LED pad optical delivery methods. Together, acute symptomatic recovery from two 64-84 min PBM sessions occurred within three days for 62/62 patients. Full recovery occurred within four sessions for all PBM patients (all but two cases resolved within one week). Prophylactic benefits were recorded in 17/17 asymptomatic-to-mild (stage 0-1) patients exposed to viral shedding of infected family members. PBM of long COVID outcomes include total resolution of dyspnea, ability to maintain SpO2 above 97% without oxygen supplementation, relief from digestive distress, elimination of brain fog, improved memory recall, restored executive function, and symptomatically managing emotional deficits. Total whole-organ PBM treatments to date comprise approximately three-hundred fifty cases comprising 60% acute COVID-19, 20% metabolic and respiratory long COVID, and 20% neurological long COVID. Unresolved cases totaling 0.25% include two cases of severe long COVID anxiety and nosophobia where PBM was found to deliver only short-term palliative relief. Conclusion: Ongoing results increasingly support the application of whole-organ deep tissue PBM in the treatment of acute and long COVID-19. Both conformal LED pads and scanning lasers demonstrate favorable outcomes. LED pads deliver higher fluences than scanned lasers in the same session times. Further studies of the prophylactic benefits of PBM are indicated.
{"title":"The Emerging Role of Photobiomodulation in COVID-19 Therapy Part II","authors":"Richard Williams","doi":"10.18103/mra.v11i8.4028","DOIUrl":"https://doi.org/10.18103/mra.v11i8.4028","url":null,"abstract":"Purpose: To empirically confirm the utility of photobiomodulation (PBM) in the treatment of acute and long COVID-19 guided by a mechanistic analysis of the photochemical effects of pulsed light on SARS-CoV-2 infections and disease progression. Background: COVID-19 comprises a coronavirus severe inflammatory disease infecting tissue populated by ACE-2 receptors of the upper and lower respiratory tract and AEC causing an overexpression of pro-inflammatory cytokines. Once in the lungs, viremic spread and cytokine profusion progresses into multi-organ hyperinflammation of visceral epithelium, vascular endothelium, and neurons of the CNS, PNS, ANS, and brain with long-term sequelae. In response to an oxidative state, red and NIR PBM down-regulates proinflammatory cytokines, activating M2 macrophages and Th2 helper cells to increase anti-inflammatory immune response in accordance with a biphasic dose response. Published reports confirm efficacious therapy of COVID-19 using conformal LED pads or scanned lasers. Results: A series of two acute COVID case studies comprising 69 ambulatory (stage 1-to-5) and five stage-6 hospitalized patients confirm the efficacious impact of whole-organ deep-tissue PBM using algorithmically-pulsed conformal LED pad optical delivery methods. Together, acute symptomatic recovery from two 64-84 min PBM sessions occurred within three days for 62/62 patients. Full recovery occurred within four sessions for all PBM patients (all but two cases resolved within one week). Prophylactic benefits were recorded in 17/17 asymptomatic-to-mild (stage 0-1) patients exposed to viral shedding of infected family members. PBM of long COVID outcomes include total resolution of dyspnea, ability to maintain SpO2 above 97% without oxygen supplementation, relief from digestive distress, elimination of brain fog, improved memory recall, restored executive function, and symptomatically managing emotional deficits. Total whole-organ PBM treatments to date comprise approximately three-hundred fifty cases comprising 60% acute COVID-19, 20% metabolic and respiratory long COVID, and 20% neurological long COVID. Unresolved cases totaling 0.25% include two cases of severe long COVID anxiety and nosophobia where PBM was found to deliver only short-term palliative relief. Conclusion: Ongoing results increasingly support the application of whole-organ deep tissue PBM in the treatment of acute and long COVID-19. Both conformal LED pads and scanning lasers demonstrate favorable outcomes. LED pads deliver higher fluences than scanned lasers in the same session times. Further studies of the prophylactic benefits of PBM are indicated.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80819208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Neoadjuvant Nivolumab plus chemotherapy improved event-free survival in early resectable lung cancer. The target therapy Osimertinib is used as neoadjuvant, adjuvant and in advanced advanced/metastatic non-small lung cancer (a/m- NSCLC). The current clinical practice in a/m- NSCLC is to continue Osimertinib, if effective and safe. The estimated 3-year cost was $745,116, necessitating placement of $500,000 cap. The median immune check point inhibitors (ICI) 3-year cost of $404,388 was below the cap (Guirgis, ESMED, 2023). We aimed to quantify and compare ICI-and Osimertinib costs in earlier vs advanced stages in multiple solid tumors. Methods: Annual 2019-2020 costs of Osimertinib were calculated ad monthly optimal dose x 12. The ICI were calculated as dose x mg/m2 or per 80 kg x price x number of cycles. Results: The, 2-year Osimertinib cost in 1 st and 2 nd -line metastatic disease was $496,744, adjuvant 1-year $248,372 and neoadjuvant $31,046.
背景:新辅助纳武单抗加化疗可改善早期可切除肺癌的无事件生存率。靶向治疗奥西替尼被用作新辅助、辅助和晚期晚期/转移性非小细胞肺癌(a/m- NSCLC)。目前a/m- NSCLC的临床实践是继续使用奥西替尼，如果有效和安全的话。估计3年成本为745,116美元，需要设置50万美元的上限。免疫检查点抑制剂(ICI)的3年中位成本为404,388美元，低于上限(Guirgis, ESMED, 2023)。我们的目的是量化和比较ici和奥西替尼在多发性实体瘤早期和晚期的成本。方法:计算2019-2020年奥西替尼年度费用和每月最佳剂量x12。ICI计算为剂量x mg/m2或每80 kg x价格x周期数。结果:奥西替尼治疗一线和二线转移性疾病的2年成本为496,744美元，辅助治疗1年成本为248,372美元，新辅助治疗1年成本为31,046美元。
{"title":"Neoadjuvant and Adjuvant Therapy; Calculating Costs","authors":"H. Guirgis","doi":"10.18103/mra.v11i8.4313","DOIUrl":"https://doi.org/10.18103/mra.v11i8.4313","url":null,"abstract":"Background: Neoadjuvant Nivolumab plus chemotherapy improved event-free survival in early resectable lung cancer. The target therapy Osimertinib is used as neoadjuvant, adjuvant and in advanced advanced/metastatic non-small lung cancer (a/m- NSCLC). The current clinical practice in a/m- NSCLC is to continue Osimertinib, if effective and safe. The estimated 3-year cost was $745,116, necessitating placement of $500,000 cap. The median immune check point inhibitors (ICI) 3-year cost of $404,388 was below the cap (Guirgis, ESMED, 2023). We aimed to quantify and compare ICI-and Osimertinib costs in earlier vs advanced stages in multiple solid tumors. Methods: Annual 2019-2020 costs of Osimertinib were calculated ad monthly optimal dose x 12. The ICI were calculated as dose x mg/m2 or per 80 kg x price x number of cycles. Results: The, 2-year Osimertinib cost in 1 st and 2 nd -line metastatic disease was $496,744, adjuvant 1-year $248,372 and neoadjuvant $31,046.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84639731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emergency Medical Systems differ around the world and perform at varying levels of effectiveness. This study analyzed how well countries met the emergency response requirements for emergency medical teams set by the World Health Organization and professional literature recommendations in the three levels of country classifications set by the United Nations. This was conducted through a stratified random sample of ten countries in the categories: developed, economies in transition, and developing, for a total of thirty countries. Each country was qualitatively analyzed for emergency response times, types of public-to-provider communication, insurance/financial coverage, certification level of emergency care provider, and level of emergency hospital care. These areas were compared to the WHO recommendations and the higher standards of care recommended by the professional literature. It was found that 90% of developing countries did not meet the WHO recommendation compared to 50% of transitioning economies, and 10% of developed countries. There was a strong positive correlation between Gross Domestic Product and overall effectiveness of an EMS system. Moving forward, it is recommended that the underlying problems be identified, risk factors evaluated, possible interventions created, and implementing interventions in developing countries to improve communication from public to provider in pre-hospital care, and hospital emergency care
{"title":"A Global Emergency: Identifying Priorities for Reforming International Emergency Medical Systems","authors":"S. Thygerson, Gregory Memmott, Robbie Chaney","doi":"10.18103/mra.v11i5.3922","DOIUrl":"https://doi.org/10.18103/mra.v11i5.3922","url":null,"abstract":"Emergency Medical Systems differ around the world and perform at varying levels of effectiveness. This study analyzed how well countries met the emergency response requirements for emergency medical teams set by the World Health Organization and professional literature recommendations in the three levels of country classifications set by the United Nations. This was conducted through a stratified random sample of ten countries in the categories: developed, economies in transition, and developing, for a total of thirty countries. Each country was qualitatively analyzed for emergency response times, types of public-to-provider communication, insurance/financial coverage, certification level of emergency care provider, and level of emergency hospital care. These areas were compared to the WHO recommendations and the higher standards of care recommended by the professional literature. It was found that 90% of developing countries did not meet the WHO recommendation compared to 50% of transitioning economies, and 10% of developed countries. There was a strong positive correlation between Gross Domestic Product and overall effectiveness of an EMS system. Moving forward, it is recommended that the underlying problems be identified, risk factors evaluated, possible interventions created, and implementing interventions in developing countries to improve communication from public to provider in pre-hospital care, and hospital emergency care","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"R-30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84754353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emerging evidence suggests that a high postprandial glucose level in plasma or blood is an important factor for the etiology of non-communicable disorders like the metabolic syndrome, diabetes, obesity and cardiovascular disease. A high sugar content of the food naturally increases the postprandial glucose level. However, quite a few studies provided proof in the past that the physical properties like viscosity, temperature, and water content of the food we consume also may influence the level of this parameter. The aim of this study is to give a narrative review of present findings that showed the physical properties of consumed food influenced the postprandial glucose level. The online databases Medline, Pubmed, Google Scholar and Hinari have been searched for publications on “plasma glucose” and “temperature” or “viscosity” or “solubility” or “water content”. All articles dealing with the influence on the postprandial glucose level in the blood have been included. Articles written in a language we could not understand or without a proper translation into English have been excluded. In general, most available studies showed that the physical properties temperature, viscosity, and water content of consumed food influenced the postprandial glucose. An increased temperature, increased viscosity and decreased water content of the food is generally associated with a higher postprandial glucose level in blood or plasma after consumption. Further detailed studies in both preclinical as well as clinical trials should be considered to obtain more detailed results regarding this.
{"title":"Physical Factors of Food Influencing the Postprandial Blood or Plasma Glucose Level: A Narrative Review","authors":"R. Bipat, I. Magali, R. Soekhoe, J. Toelsie","doi":"10.18103/mra.v11i4.3739","DOIUrl":"https://doi.org/10.18103/mra.v11i4.3739","url":null,"abstract":"Emerging evidence suggests that a high postprandial glucose level in plasma or blood is an important factor for the etiology of non-communicable disorders like the metabolic syndrome, diabetes, obesity and cardiovascular disease. A high sugar content of the food naturally increases the postprandial glucose level. However, quite a few studies provided proof in the past that the physical properties like viscosity, temperature, and water content of the food we consume also may influence the level of this parameter. The aim of this study is to give a narrative review of present findings that showed the physical properties of consumed food influenced the postprandial glucose level. The online databases Medline, Pubmed, Google Scholar and Hinari have been searched for publications on “plasma glucose” and “temperature” or “viscosity” or “solubility” or “water content”. All articles dealing with the influence on the postprandial glucose level in the blood have been included. Articles written in a language we could not understand or without a proper translation into English have been excluded. In general, most available studies showed that the physical properties temperature, viscosity, and water content of consumed food influenced the postprandial glucose. An increased temperature, increased viscosity and decreased water content of the food is generally associated with a higher postprandial glucose level in blood or plasma after consumption. Further detailed studies in both preclinical as well as clinical trials should be considered to obtain more detailed results regarding this.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88576573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18103/mra.v11i7.2.4167
Monal Karkar, Abhinav Lambe
Introduction: Congenital heart disease (CHD) is a common birth defect that occurs in approximately 1% of live births worldwide. Cleft lip and palate (CLP), another common birth defect, affecting approximately 1 in 600- 800 live births in India. Several studies have reported an association between CHD and CLP, however, there is limited data on the prevalence and types of CHD in patients with CLP in rural areas of developing countries, including India. This study aimed to investigate the prevalence and types of CHD in patients with CLP at a rural hospital in central Maharashtra, India. Methods: This retrospective study included medical records of patients with isolated Cleft lip, isolated cleft palate and patients with cleft lip and palate, between January 2018 and December 2020. The study was conducted at a rural hospital in central Maharashtra, India. The patients’ records were examined for any heart disease. Patients who had a diagnosis of CHD were identified through medical records and echocardiography reports. The prevalence and types of CHD were compared between the two groups using descriptive statistics and chi-square tests. Results: A total of 291 patients were included in our study. 169 were males and 122 were females. Congenital heart diseases were found in 12.37% (n=36) patients.5 Cleft lip (13%), 12 Cleft lip and palate (48%), 19 Isolated cleft palate (39%) were diagnosed with Congenital heart diseases. The types of Congenital Heart Diseases reported in our study were atrial septal defect, Ventricular septal defect, Patent ductus arteriosus, Pulmonic Stenosis and Tetralogy of Fallot. Conclusion: The most common types of CHD in both groups were ASD and VSD, but the prevalence of these defects was significantly higher in the CLP group. These findings have important implications for the multidisciplinary Perioperative management of patients with CLP, as they may require close monitoring for CHD and appropriate intervention if necessary, especially in resource-limited settings.
{"title":"Congenital Heart Diseases in the Cleft Lip Palate Patients and its Perioperative Implications: An Observational Study In Rural Central Maharashtra, India","authors":"Monal Karkar, Abhinav Lambe","doi":"10.18103/mra.v11i7.2.4167","DOIUrl":"https://doi.org/10.18103/mra.v11i7.2.4167","url":null,"abstract":"Introduction: Congenital heart disease (CHD) is a common birth defect that occurs in approximately 1% of live births worldwide. Cleft lip and palate (CLP), another common birth defect, affecting approximately 1 in 600- 800 live births in India. Several studies have reported an association between CHD and CLP, however, there is limited data on the prevalence and types of CHD in patients with CLP in rural areas of developing countries, including India. This study aimed to investigate the prevalence and types of CHD in patients with CLP at a rural hospital in central Maharashtra, India. Methods: This retrospective study included medical records of patients with isolated Cleft lip, isolated cleft palate and patients with cleft lip and palate, between January 2018 and December 2020. The study was conducted at a rural hospital in central Maharashtra, India. The patients’ records were examined for any heart disease. Patients who had a diagnosis of CHD were identified through medical records and echocardiography reports. The prevalence and types of CHD were compared between the two groups using descriptive statistics and chi-square tests. Results: A total of 291 patients were included in our study. 169 were males and 122 were females. Congenital heart diseases were found in 12.37% (n=36) patients.5 Cleft lip (13%), 12 Cleft lip and palate (48%), 19 Isolated cleft palate (39%) were diagnosed with Congenital heart diseases. The types of Congenital Heart Diseases reported in our study were atrial septal defect, Ventricular septal defect, Patent ductus arteriosus, Pulmonic Stenosis and Tetralogy of Fallot. Conclusion: The most common types of CHD in both groups were ASD and VSD, but the prevalence of these defects was significantly higher in the CLP group. These findings have important implications for the multidisciplinary Perioperative management of patients with CLP, as they may require close monitoring for CHD and appropriate intervention if necessary, especially in resource-limited settings.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88801093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18103/mra.v11i7.1.4043
Mhay S., S. S., Kapadia U., Nair N., Nalliah RP.
Background: We evaluated malpractice payments and adverse actions against pharmacists in the United States. Malpractice is defined as professional negligence by act or omission. Adverse actions are actions administered by the board of registration in a health profession against a provider. The purpose of the study is to analyze the trends in malpractice payments and adverse actions for pharmacists during the period 1990-2022. Methods: This is a retrospective study that utilizes the National Practitioner Data Bank (NPDB) data analysis tool for the period 1990-2022. This information was exported to a data visualization tool and trends were studied. Results: During the period of the study there were 2480 malpractice payments and 44,204 adverse action reports made against pharmacists. In the current study we found that there has been a 19.56% decline in the number of malpractice payments against pharmacists in the last 5 years from 46 in 2018 to 37 in 2022. Similarly, adverse action reports also show a downward trend from 2016 to 2022. Conclusion: Pharmacy profession implements multiple processes to protect patients from medication errors. As the volume of prescriptions increases in the US, there is an increased risk of error and subsequent litigation against pharmacists. Even though malpractice payments and adverse actions against pharmacists have continued to decline, the probability of an adverse action remains high for practicing pharmacists. As the role of pharmacist continues to evolve there is a need to keep up with the changes in the healthcare market.
{"title":"Trends in Malpractice Payments and Adverse Actions against Pharmacists in the United States between 1990-2022","authors":"Mhay S., S. S., Kapadia U., Nair N., Nalliah RP.","doi":"10.18103/mra.v11i7.1.4043","DOIUrl":"https://doi.org/10.18103/mra.v11i7.1.4043","url":null,"abstract":"Background: We evaluated malpractice payments and adverse actions against pharmacists in the United States. Malpractice is defined as professional negligence by act or omission. Adverse actions are actions administered by the board of registration in a health profession against a provider. The purpose of the study is to analyze the trends in malpractice payments and adverse actions for pharmacists during the period 1990-2022. Methods: This is a retrospective study that utilizes the National Practitioner Data Bank (NPDB) data analysis tool for the period 1990-2022. This information was exported to a data visualization tool and trends were studied. Results: During the period of the study there were 2480 malpractice payments and 44,204 adverse action reports made against pharmacists. In the current study we found that there has been a 19.56% decline in the number of malpractice payments against pharmacists in the last 5 years from 46 in 2018 to 37 in 2022. Similarly, adverse action reports also show a downward trend from 2016 to 2022. Conclusion: Pharmacy profession implements multiple processes to protect patients from medication errors. As the volume of prescriptions increases in the US, there is an increased risk of error and subsequent litigation against pharmacists. Even though malpractice payments and adverse actions against pharmacists have continued to decline, the probability of an adverse action remains high for practicing pharmacists. As the role of pharmacist continues to evolve there is a need to keep up with the changes in the healthcare market.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89355256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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