Intravenous ibuprofen versus ketorolac for perioperative pain control in open abdominal hysterectomy: a randomized controlled trial.

BACKGROUND: We aimed to compare the analgesic effects of intravenous ibuprofen to ketorolac after open abdominal hysterectomy. METHODS: This randomized double-blinded controlled trial included adult women scheduled for elective open abdominal hysterectomy. Participants were randomized to receive either 30 mg ketorolac (n = 50) or 800 mg ibuprofen (n = 50) preoperatively, then every 8 h postoperatively for 24 h. All participants received paracetamol 1 gm/6 h. Rescue analgesic was given if the visual analogue scale (VAS) for pain assessment was > 3. The primary outcome was the mean postoperative dynamic VAS during the first 24 h. Secondary outcomes were static VAS, intraoperative fentanyl consumption, postoperative morphine consumption, time to independent movement, and patient's satisfaction. RESULTS: Forty-six patients in the ibuprofen group and fifty patients in the ketorolac group were analyzed. The 24-h dynamic and static VAS were similar in the two groups. The median (quartiles) dynamic VAS was 1.1 (0.9, 1.9) in the ibuprofen group versus 1.0 (0.7, 1.3) in the ketorolac group, P-value = 0.116; and the median (quartiles) static VAS was 0.9 (0.6, 1.3) in the ibuprofen group versus 0.7 (0.4, 1.1) in the ketorolac group, P-value = 0.113. The intra- and postoperative analgesic requirements were also similar in the two groups. However, patient satisfaction was slightly higher in the ketorolac group than that in the ibuprofen group (median [quartiles]: 6 [5, 7] versus 5 [4, 7], respectively), P-value: 0.009. CONCLUSION: The two drugs, intravenous ibuprofen and ketorolac produced similar analgesic profile in patients undergoing open abdominal hysterectomy receiving multimodal analgesic regimen. NCT05610384, Date of registration: 09/11/2022 CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05610384. https://clinicaltrials.gov/ct2/show/NCT05610384.

Oral midodrine for prophylaxis against post-spinal anesthesia hypotension during hip arthroplasty in elderly population: a randomized controlled trial.

BACKGROUND: We aimed to evaluate the efficacy of midodrine as a prophylaxis against post-spinal hypotension in elderly patients undergoing hip arthroplasty. METHODS: This randomized controlled trial included elderly patients undergoing hip arthroplasty under spinal anesthesia. Ninety minutes before the procedure, patients were randomized to receive either 5-mg midodrine or placebo (metoclopramide). After spinal anesthesia, mean arterial pressure (MAP) and heart rate were monitored every 2 min for 20 min then every 5 min until the end of the procedure. Post-spinal hypotension (MAP < 80% baseline) was treated with 10 mg ephedrine. The primary outcome was intraoperative ephedrine consumption. Secondary outcomes were the incidence of post-spinal hypotension, bradycardia, and hypertension (MAP increased by > 20% of the baseline reading). RESULTS: We analyzed 29 patients in the midodrine group and 27 in the control group. The intraoperative ephedrine consumption was lower in the midodrine group than in the control group (median [quartiles]: 10 [0, 30] mg versus 30 [20, 43] mg, respectively, P-value: 0.002); and the incidence of intraoperative hypotension was lower in the midodrine group than that in the control group. The incidence of hypertension and bradycardia were comparable between the two groups. CONCLUSION: The use of 5 mg oral midodrine decreased the vasopressor requirements and incidence of hypotension after spinal anesthesia for hip surgery in elderly patients. CLINICAL TRIAL REGISTRATION: This study was registered on September 22, 2022 at clinicaltrials.gov registry, NCT05548985, URL: https://classic. CLINICALTRIALS: gov/ct2/show/NCT05548985 .

Effectiveness of mobile produce markets in increasing access and affordability of fruits and vegetables among low-income seniors.

OBJECTIVE: Mobile produce markets (MPM) offering Supplemental Nutrition Assistance Program (SNAP) incentive programmes have the potential to provide accessible and affordable fruits and vegetables (FV) to populations at risk of food insecurity. The objective of this study is to characterise the customer base of an MPM and describe their participation at twelve market sites serving low-income seniors. DESIGN: In 2018, customers from an MPM in Rhode Island (RI) participated in a cross-sectional survey (n 330; 68 % response rate), which measured dietary patterns, food security and food shopping behaviours. We compared the shopping habits and market experiences of customers who currently received SNAP benefits with those who did not currently receive SNAP benefits. SETTING: An MPM in RI which offers a 50 % discount for FV purchased with SNAP benefits. PARTICIPANTS: This study describes current market customers at twelve market sites serving low-income seniors. RESULTS: Market customers were mostly low-income, female, over the age of 50 years and Hispanic/Latino. Most customers received SNAP benefits, and almost half were food insecure. In addition, three quarters of SNAP customers reported their SNAP benefits last longer since shopping at the markets. Mixed logistic regression models indicated that SNAP customers were more likely to report buying and eating more FV than non-SNAP customers. CONCLUSIONS: MPM are critical resources of affordable produce and have been successful in improving access to FV among individuals of low socio-economic status in RI. This case study can inform policy and programme recommendations for MPM and SNAP incentive programmes.

Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial.

BACKGROUND: Data on the best norepinephrine bolus dose for management of hypotension are limited. The aim of this study was to compare the efficacy and safety of two norepinephrine bolus doses in the rescue management of maternal hypotension during cesarean delivery. METHODS: This randomized, controlled trial included mothers scheduled for cesarean delivery with spinal anesthesia with a prophylactic norepinephrine infusion. Following spinal anaesthesia administration, a participant was considered hypotensive if systolic blood pressure was ≤80% compared to the baseline reading. Participants were allocated to receive either 6 mcg or 10 mcg norepinephrine bolus for the management of hypotensive episodes. The hemodynamic response after administration of norepinephrine bolus was recorded. The episode was considered successfully managed if systolic blood pressure returned to within 80% from the baseline reading within 2 min after norepinephrine bolus administration, and did not drop again within 6 min after the norepinephrine bolus. The primary outcome was the incidence of successful management of the first hypotensive episode. Other outcomes included systolic blood pressure, heart rate, incidence of maternal bradycardia, and reactive hypertension. RESULTS: One hundred and ten mothers developed hypotensive episodes and received norepinephrine boluses for management. The number of successfully managed first hypotensive episodes was 50/57 (88%) in the 6 mcg-treated episodes and 45/53 (85%) in the 10 mcg-treated episodes (p = 0.78). Systolic blood pressure was comparable after administration of either bolus dose. Heart rate was lower after administration of 10 mcg bolus compared to 6 mcg bolus, without significant bradycardia requiring atropine administration. The incidence of reactive hypertension was comparable between both groups. CONCLUSION: In mothers undergoing elective cesarean delivery under prophylactic norepinephrine infusion at 0.05 mcg/kg/min, there was no advantage to the use of 10 mcg norepinephrine bolus over 6 mcg norepinephrine bolus for the rescue management of first hypotensive episode. Neither of the 2 bolus doses reached a 100% success rate. The incidences of bradycardia and reactive hypertension were comparable between both norepinephrine doses. TRIAL REGISTRATION: At clinicaltrial.gov registry system on January 4, 2019 Clinical trial identifier: NCT03792906.

Modified-ramped position: a new position for intubation of obese females: a randomized controlled pilot study.

BACKGROUND: Endotracheal intubation requires optimum position of the head and neck. In obese females, the usual ramped position might not provide adequate intubating conditions. We hypothesized that a new position, termed modified-ramped position, during induction of anesthesia would facilitate endotracheal intubation through bringing the breasts away from the laryngoscope and would also improve the laryngeal visualization. METHODS: Sixty obese female patients scheduled for general anesthesia were randomly assigned into either ramped or modified-ramped position during induction of anesthesia. In the ramped position (n = 30), the patient head and shoulders were elevated to achieve alignment of the sternal notch and the external auditory meatus; while in the modified-ramped position (n = 30), the patient shoulders were elevated using a special pillow, and the head was extended to the most possible range. Our primary outcome was the incidence of failed laryngoscopic insertion in the oral cavity (the need for patient repositioning). Other outcomes included time till vocal cord visualization, time till successful endotracheal intubation, difficulty of the mask ventilation, and Cormack-Lehane grade for laryngeal view. RESULTS: Fourteen patients (47%) in ramped group required repositioning to facilitate introduction of the laryngoscope in the oral cavity in comparison to one patient (3%) in the modified-ramped position (p < 0.001). Modified-ramped position showed lower incidence of difficult mask ventilation, shorter time for glottic visualization, and shorter time for endotracheal tube insertion compared to the ramped position. The Cormack-Lehane grade was better in the modified-ramped position. CONCLUSION: Modified-ramped position provided better intubating conditions, improved the laryngeal view, and eliminated the need for repositioning of obese female patients during insertion of the laryngoscope compared to ramped position. CLINICAL TRIAL REGISTRATION: Identifier: NCT03640442. Date: August 2018.

Norepinephrine Infusion for Preventing Postspinal Anesthesia Hypotension during Cesarean Delivery: A Randomized Dose-finding Trial.

BACKGROUND: Norepinephrine has been recently introduced for prophylaxis against postspinal hypotension during cesarean delivery; however, no data are available regarding its optimum dose. The objective of this study is to compare three infusion rates of norepinephrine for prophylaxis against postspinal hypotension during cesarean delivery. METHODS: The authors conducted a double-blinded, randomized, controlled study including full-term pregnant women scheduled for cesarean delivery. Norepinephrine infusion was commenced after subarachnoid block. Patients were randomized into three groups, which received norepinephrine with starting infusion rates of 0.025 µg · kg(-1) · min(-1), 0.050 µg · kg(-1) · min(-1), and 0.075 µg · kg(-1) · min(-1). Infusion was stopped when intraoperative hypertension occurred. The primary outcome was the frequency of postspinal hypotension (defined as decreased systolic blood pressure less than 80% of the baseline reading). The three groups were compared according to the following: systolic blood pressure, heart rate, frequency of intraoperative hypertension, frequency of bradycardia, and neonatal outcomes. RESULTS: Two hundred eighty-four mothers were included in the analysis. The frequency of postspinal hypotension was lower for both the 0.050-µg · kg(-1) · min(-1) dose group (23/93 [24.7%], odds ratio: 0.45 [95% CI: 0.24 to 0.82], P = 0.014) and the 0.075-µg · kg(-1) · min(-1) dose group (25/96 [26.0%], odds ratio: 0.48 [95% CI:0.26 to 0.89], P = 0.022) compared with the 0.025-µg · kg(-1) · min(-1) dose group (40/95 [42.1%]). The two higher-dose groups (the 0.050-µg · kg(-1) · min(-1) group and the 0.075-µg · kg(-1) · min(-1) group) had higher systolic blood pressure and lower heart rate compared with the 0.025 µg · kg(-1) · min(-1) group. The three groups were comparable in the frequency of intraoperative hypertension, incidence of bradycardia, and neonatal outcomes. CONCLUSIONS: Both the 0.050-µg · kg(-1) · min(-1) and 0.075-µg · kg(-1) · min(-1) norepinephrine infusion rates effectively reduced postspinal hypotension during cesarean delivery compared with the 0.025-µg · kg(-1) · min(-1) infusion rate.

The FLEX study school-based physical activity programs - measurement and evaluation of implementation.

BACKGROUND: Increasing children's physical activity (PA) at school is critical to obesity prevention and health promotion. Implementing novel, low-cost PA programs offers potential to contribute to children's in-school PA, particularly in resource-constrained schools. This evaluation describes implementation fidelity, reach, and dose of two PA programs in the Fueling Learning through Exercise (FLEX) Study. METHODS: Thirteen diverse, low-income Massachusetts elementary schools were recruited and randomized to the 100 Mile Club walking/running program (n = 7) or CHALK/Just Move classroom activity break PA program (n = 6). Intervention programs were delivered across two school years. Surveys with program champions/teachers and children, in-session measurement of children's PA by accelerometry (Actigraph GT3X) in a subset of schools, and key informant interviews were used to collect information on implementation, including fidelity, dose, reach, and sustainability, and to calculate an implementation score. RESULTS: Six CHALK/Just Move schools implemented the program in both years. Two schools randomized to 100 Mile Club did not implement at all, and only three schools implemented both years. Implementing schools had similar implementation scores (range = 0-3; 100 Mile Club = 2.0 vs. CHALK/Just Move = 1.9) but fidelity to core and enhanced elements differed between programs. In 100 Mile Club schools, dose of program delivered was greater than in CHALK/Just Move schools (34.9 vs. 19.7 min per week). Dose of PA received per session was also greater in 100 Mile Club schools (n = 55, 2 schools) compared with CHALK/Just Move schools (n = 160, 2 schools) (13.6 min vs. 2.7 min per session). A slightly higher proportion of eligible children participated in CHALK/Just Move compared to 100 Mile Club (54.0% vs. 31.2%). Both programs were well received by champions/teachers and students. CONCLUSIONS: Program implementation varied across programs and schools, and erosion in delivery was seen over the two years. However, among implementing schools, additional PA was delivered and received, and the programs were generally well-received. Although school resource issues remain barriers to implemention, this evaluation demonstrates that low-cost programs may enhance PA opportunities. Future research should evaluate how multiple programs can be implemented to increase children's PA at school. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02810834 . Registered May 11, 2015.

Variable versus fixed-rate infusion of phenylephrine during cesarean delivery: a randomized controlled trial.

BACKGROUND: Phenylephrine is the most commonly used vasopressor for prophylaxis against maternal hypotension during cesarean delivery; however, the best regimen for its administration is not well established. Although variable infusion protocols had been suggested for phenylephrine infusion, evidence-based evaluation of variable infusion regimens are lacking. The aim of this work is to compare variable infusion, fixed on-and-off infusion, and intermittent boluses of phenylephrine for prophylaxis against maternal hypotension during cesarean delivery. METHODS: A randomized controlled study was conducted, including full-term pregnant women scheduled for elective cesarean delivery. Participants were divided into three groups which received phenylephrine by either intermittent boluses (1.5 mcg/Kg phenylephrine), fixed on-and-off infusion (with a dose of 0.75 mcg/Kg/min), or variable infusion (with a starting dose of 0.75 mcg/Kg/min). The three groups were compared with regard to frequency of: maternal hypotension (primary outcome), second episode hypotension, reactive hypertension, and bradycardia. Other outcomes included heart rate, systolic blood pressure, physician interventions, and neonatal outcomes. RESULTS: Two-hundred and seventeen mothers were available for final analysis. The 2 infusion groups showed less incidence of maternal hypotension {26/70 (37%), 22/71 (31%), and (51/76 (67%)} and higher incidence of reactive hypertension compared to the intermittent boluses group without significant differences between the two former groups. The number of physician interventions was highest in the variable infusion group compared to the other two groups. The intermittent boluses group showed lower systolic blood pressure and higher heart rate compared to the two infusion groups; whilst the two later groups were comparable. CONCLUSION: Both phenylephrine infusion regimens equally prevented maternal hypotension during cesarean delivery compared to intermittent boluses regimen. Due to higher number of physician interventions in the variable infusion regimen, the current recommendations which favor this regimen over fixed infusion regimen might need re-evaluation.

Evaluation of the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease.

BACKGROUND: Dexmedetomidine infusion improves oxygenation and lung mechanics in patients with chronic obstructive lung disease; however, its effect in patients with restrictive lung disease has not been thoroughly investigated yet. The aim of this work was to evaluate the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease. METHODS: Forty-two morbidly obese patients scheduled for bariatric surgery were included in the study. Patients were randomized to receive either dexmedetomidine infusion at a bolus dose of 1mcg/Kg followed by infusion at 1 mcg/Kg/hour for 90 min (Dexmedetomidine group), or normal saline infusion (Control group). Both groups were compared with regard to: oxygenation {P/F ratio: PaO2/fraction of inspired oxygen (FiO2)}, lung compliance, dead space, plateau pressure, blood pressure, and heart rate. RESULTS: Dexmedetomidine group showed significant improvement of the PaO2/FiO2 ratio, and higher lung compliance compared to control group by the end of drug infusion. Dexmedetomidine group demonstrated decreased dead space, plateau pressure, blood pressure, and heart rate compared to control group by the end of drug infusion. CONCLUSION: A 90-min dexmedetomidine infusion resulted in moderate improvement in oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease. TRIAL REGISTRATION: clinicaltrials.gov : NCT02843698 on 20 July 2016.

The Association Between Perceived Athletic Competence and Physical Activity: Implications for Low-Income Schoolchildren.

PURPOSE: Socioeconomic status (SES) may impact children's physical activity (PA) behaviors and confidence to participate in PA. We examined how SES modifies the relationship between children's perceived athletic competence (PAC) and moderate to vigorous PA (MVPA). METHODS: Children (N = 1157; 45% male; grades 3-4) were recruited for the Fueling Learning through Exercise study. Free/reduced price lunch eligibility was used as an indicator of SES. Seven-day accelerometry (ActiGraph GT3X+) was used to measure daily MVPA, out-of-school MVPA (O-MVPA), and school-time MVPA. PAC was assessed using the Harter's Self-Perception Profile for Children (6 items, scored 1-4; median split: high and low PAC). RESULTS: MVPA and PAC differed between low-SES [n = 556; 41.6 (17.1) min/d; high PAC = 45%] and middle-SES children [n = 412; 49.6 (22.7) min/d; high PAC = 62%]. There was an interaction between SES and PAC for MVPA (P < .001) and O-MVPA (P < .001), but not for school-time MVPA (P > .05). Middle-SES children with high PAC were more likely to engage in MVPA (ß = 6.6 min/d; 95% confidence interval, 3.9 to 9.3; P < .001) and O-MVPA (ß = 4.8 min/d; 95% confidence interval, 2.8 to 6.8; P < .001), associations that did not exist for low-SES children (P > .05). CONCLUSIONS: PAC was positively associated with daily MVPA and O-MVPA, but not among low-SES children. Research is needed to elucidate the factors that shape the relationship between PAC and MVPA.

Digital workflow in full-arch implant rehabilitation with segmented minimally veneered monolithic zirconia fixed dental prostheses: 2-year clinical follow-up.

OBJECTIVE: To illustrate a digital workflow in full-arch implant rehabilitation with minimally veneered monolithic zirconia and to report the outcomes including technical complications. CLINICAL CONSIDERATIONS: Three patients (5 edentulous arches) received full-arch fixed implant rehabilitation with monolithic zirconia and mild facial porcelain veneering involving a digital workflow. The incisal edges and occluding surface areas were milled out of monolithic zirconia to reduce the possibility of chipping. Porcelain veneering was applied on the facial aspect to improve the esthetic result. Outcomes and technical complications are reported after 2 years of clinical and radiographic follow-up. CONCLUSION: Implant and prosthesis survival rates were 100% after a short-term follow-up of 2 years. Technical complications were encountered in one patient. They did not adversely affect prosthesis survival or patient satisfaction and were easily addressed. A digital workflow for the design and fabrication of full-arch monolithic zirconia implant fixed implant prostheses has benefits, but caution is necessary during CAD planning of the prosthesis to ensure a successful outcome. Long-term clinical studies are needed to corroborate the findings discussed in this report. CLINICAL SIGNIFICANCE: This article presents an integrated digital workflow that was implemented for the implant-prosthodontic rehabilitation of three edentulous patients with monolithic zirconia prostheses. Monolithic zirconia has been successfully incorporated in implant prosthodontics in an effort to reduce the technical complications associated with bilayered ceramics. This workflow simplifies design and fabrication of the zirconia prostheses. However, caution should be taken during CAD planning of the prosthesis to make sure the zirconia cylinder is sufficiently thick at the interface with the titanium insert. Additionally, when cutback is planned for facial porcelain veneering, the functional occluding cusps and incisal edges should be fabricated in monolithic zirconia to avoid chipping.

Technique to Match Gingival Shade when Using Pink Ceramics for Anterior Fixed Implant Prostheses.

Use of pink gingival ceramics can reduce the necessity for extensive surgical procedures attempting to restore missing soft and hard tissues in the maxillary esthetic zone. Selecting the appropriate shade for pink porcelain poses a challenge, especially when the patient presents with a high smile line. This paper describes a simple and effective technique to facilitate shade selection for gingival ceramics to match the patient's existing gingival shade.

Digital vs. conventional full-arch implant impressions: a comparative study.

PURPOSE: To test whether or not digital full-arch implant impressions with two different intra-oral scanners (CEREC Omnicam and True Definition) have the same accuracy as conventional ones. The hypothesis was that the splinted open-tray impressions would be more accurate than digital full-arch impressions. MATERIAL AND METHODS: A stone master cast representing an edentulous mandible using five internal connection implant analogs (Straumann Bone Level RC, Basel, Switzerland) was fabricated. The three median implants were parallel to each other, the far left implant had 10°, and the far right had 15° distal angulation. A splinted open-tray technique was used for the conventional polyether impressions (n = 10) for Group 1. Digital impressions (n = 10) were taken with two intra-oral optical scanners (CEREC Omnicam and 3M True Definition) after connecting polymer scan bodies to the master cast for groups 2 and 3. Master cast and conventional impression test casts were digitized with a high-resolution reference scanner (Activity 880 scanner; Smart Optics, Bochum, Germany) to obtain digital files. Standard tessellation language (STL) datasets from the three test groups of digital and conventional impressions were superimposed with the STL dataset from the master cast to assess the 3D deviations. Deviations were recorded as root-mean-square error. To compare the master cast with conventional and digital impressions at the implant level, Welch's F-test was used together with Games-Howell post hoc test. RESULTS: Group I had a mean value of 167.93 µm (SD 50.37); Group II (Omnicam) had a mean value of 46.41 µm (SD 7.34); Group III (True Definition) had a mean value of 19.32 µm (SD 2.77). Welch's F-test was used together with the Games-Howell test for post hoc comparisons. Welch's F-test showed a significant difference between the groups (P < 0.001). The Games-Howell test showed statistically significant 3D deviations for all three groups (P < 0.001). CONCLUSION: Full-arch digital implant impressions using True Definition scanner and Omnicam were significantly more accurate than the conventional impressions with the splinted open-tray technique. Additionally, the digital impressions with the True Definition scanner had significantly less 3D deviations when compared with the Omnicam.

Comparison of Two Norepinephrine Rescue Bolus Doses for Management of Severe Post-Spinal Hypotension During Elective Caesarean Delivery: A Randomized, Controlled Trial.

Background: Post-spinal hypotension is associated with maternal and neonatal complications; therefore, prompt control maternal blood pressure is necessary. In this study, we aimed to compare the efficacy and safety of two norepinephrine bolus doses in the rescue management of severe maternal hypotension during elective Cesarean delivery. Methods: We included full-term pregnant women scheduled for Cesarean delivery under spinal anesthesia. Patients were randomized to receive either 5-mcg norepinephrine (n=79) or 10-mcg norepinephrine (n=79) for treatment of severe postspinal hypotension (systolic blood pressure ≤60% of baseline reading). The management of the hypotensive episode was considered successful if systolic blood pressure was >80% of the baseline within 2 mins of the bolus. The primary outcome was the incidence of successful management of severe post-spinal hypotension. Secondary outcomes included the incidence of reactive bradycardia, reactive hypertension, umbilical blood gases, and neonatal Apgar score at 5-min post-delivery. Results: We included 73 patients in the 5-mcg group and 76 patients in the 10-mcg group into the final analysis. The incidence of successful management of severe hypotensive episodes was comparable between the two groups (43/73 [59%] and 46/76 [60%] in the 5-and 10-mcg group, respectively, P=0.917). The incidence of reactive hypertension, bradycardia, and neonatal outcomes were comparable between the two groups. Conclusion: In mothers undergoing Cesarean delivery under spinal anesthesia, 10-mcg norepinephrine bolus was not superior to the 5-mcg bolus in the management of severe hypotension. Furthermore, the incidence of reactive bradycardia and hypertension was comparable in the two doses. Clinical Trial Registration: NCT05290740, URL: https://clinicaltrials.gov/ct2/show/NCT05290740.

Professionalism Program Evaluation and Its Impact on Undergraduate Medical Students.

Objective The study aims to evaluate the effectiveness of a professionalism program by conducting focus group discussions (FGDs). The research focuses on understanding how the program influences the development of professionalism skills among medical students, as well as their perceptions and experiences regarding the program. The study's objectives revolve around identifying the strengths and weaknesses of the program from the perspective of the students. Methods This was a qualitative study done after obtaining approval from the Institutional Review Committee, Islamic International Medical College. Students of 4th year Bachelor of Medicine and Bachelor of Surgery (MBBS; 56 students) were selected for the study. A convenience sampling technique was used to select the participants for FGDs. Seven separate FGDs were conducted, with eight participants in each group. All the FGDs were audiotaped. Data were transcribed and translated. Data were analyzed using the thematic analysis on Atlas. Both obvious and hidden content were analyzed. Codes and themes were identified, which were then finalized with consensus. Codes were then categorized into sub-themes, and finally, themes were generated. Results Participants identified the problems associated with applying professionalism during FGDs. These challenges encompassed hefty workloads and a perceived disparity between theoretical knowledge and practical implementation. The students highlighted the importance of practical teaching methods, the cultivation of role models, the alignment of curriculum with real-world experiences, and the revision of assessment methods. This study analyzes the obstacles and potential advantages associated with professionalism education and presents significant perspectives on improving it for upcoming healthcare practitioners. Conclusion Professionalism is a crucial component, and each graduate of a medical school should be fully qualified as a professional after graduation. As we want our future doctors to be skilled at both professional qualities and diagnosis, it is crucial that medical institutions teach professionalism.

Formative evaluation of a STEAM and nutrition education summer program for low-income youth.

In-depth formative evaluations are vital for curriculum development and program planning but are often not conducted before a program pilots. A formative evaluation of Project stRIde was conducted to gain insight from experts and identify revisions to the curriculum. Project stRIde is a science, technology, engineering, arts, and mathematics (STEAM) and nutrition-based curriculum developed for 4th and 5th grade students from low-income and diverse families. Nine experts spanning the fields of nutrition education, cultural competency, elementary education, summer programs, and STEAM outreach were recruited to participate in an expert content review (ECR) survey and virtual interviews. Seven core themes were identified: effectively promoting student engagement, increased guidance or support needed, activity too difficult for age, time, confidence in teaching lessons, cultural appropriateness, and strengths of curriculum in promoting STEAM education and innovation. Across the lessons, all reviewers agreed that the lessons were accurate, incorporated STEAM concepts, and were culturally appropriate for this population. Future major edits to the curriculum include creating supplemental videos, modifying some activities for age level, and incorporating more opportunities for participant engagement. Overall, an ECR is an effective way to examine a program's strengths and limitations and should be included in the beginning stages of program planning.

Development and validation of the ASKFV-SE tool to measure children's self-efficacy for requesting fruits and vegetables.

The aim of the present study was to develop the ASKFV-SE tool to measure self-efficacy (SE) towards requesting fruits and vegetables (FV) in the home and school environment with school-age children (grades 4-5) from urban, ethnically diverse, low-income households. Cognitive interviews reduced the tool from eleven items to seven. The 7-item questionnaire was tested with 444 children. The items loaded on two factors: home SE (four items) and school SE (two items) with one item was excluded (<0⋅40). The reduced 6-item, 2-factor structure was the best fit for the data (χ 2 = 45⋅09; df = 9; CFI = 0⋅835; RMSEA = 0⋅147). Confirmatory factory analysis revealed that the 4-item home SE had high reliability (α = 0⋅73) and marginally acceptable reliability for the 2-item school SE (α = 0⋅53). The pre-COVID intra-class correlation coefficient (ICC) was 0⋅584 (P < 0⋅001; fair; n = 57) compared to 0⋅736 during-COVID (P < 0⋅001; good; n 50). The ASKFV-SE tool measures children's SE for asking for FVs with strong psychometric properties and low participant burden.

The use of epinephrine infusion for the prevention of spinal hypotension during Caesarean delivery: A randomized controlled dose-finding trial.

BACKGROUND: This study aimed to compare three epinephrine doses for the prevention of spinal hypotension during Caesarean delivery. METHODS: This randomized controlled trial included full-term pregnant women undergoing elective Caesarean delivery under spinal anesthesia. The participants received prophylactic epinephrine infusions at rates of 0.01, 0.02, or 0.03 mcg/kg/min. Spinal hypotension (systolic blood pressure <80% of baseline) was managed with a 9-mg ephedrine bolus. The primary outcome was the incidence of spinal hypotension. Secondary outcomes included total ephedrine requirement, the incidence of severe spinal hypotension, excessive tachycardia and hypertension, and neonatal outcomes. RESULTS: The final analysis included 271 patients. The incidence of hypotension was lowest in the 0.03 mcg group (11/90 [12%]), followed by the 0.02 mcg (32/91 [35%]) and the 0.01 mcg (55/90 [61%]) groups (p < 0.001). The median ephedrine requirements (quartiles) were also the lowest in the 0.03 mcg group (0 [0-0] mg), followed by the 0.02 mcg (0 [0-9] mg) and the 0.01 mcg (9 [0-18] mg) groups. The incidence of severe hypotension was lower in the 0.03 mcg and 0.02 mcg groups than in the 0.01 mcg group (3/90 [3%], 5/91 [6%], and 15/90 [17%], respectively). The incidences of excessive tachycardia, hypertension, and neonatal outcomes were comparable among the groups. CONCLUSION: The use of epinephrine to prevent spinal hypotension during Caesarean delivery is feasible and effective. An initial dose of 0.03 mcg/kg/min produced the lowest incidence of hypotension compared to 0.02 mcg/kg/min and 0.01 mcg/kg/min doses. The three doses were comparable in terms of the incidence of tachycardia, hypertension, and neonatal outcomes. STUDY REGISTRATION: ClinicalTrials.gov Identifier: NCT05279703.

Comparison of the hemodynamic effects of opioid-based versus lidocaine-based induction of anesthesia with propofol in older adults: a randomized controlled trial.

BACKGROUND: The present study aims to compare the hemodynamic profile of lidocaine and fentanyl during propofol induction of general anesthesia. METHODS: This randomized controlled trial included patients aged above 60 years undergoing elective non-cardiac surgery. The included patients received either 1 mg/kg lidocaine (n = 50) or 1 mcg/kg fentanyl (n = 50) based on total body weight with propofol induction of anesthesia. Patient's hemodynamics were recorded every minute for the first 5 min then every 2 min until 15 min after induction of anesthesia. Hypotension (mean arterial pressure [MAP] <65 mmHg or >30% reduction from baseline) was treated by intravenous 4 mcg bolus of norepinephrine. Outcomes included norepinephrine requirements (primary), the incidence of postinduction hypotension, MAP, heart rate, intubation condition, and postoperative delirium via the cognitive assessment method. RESULTS: Forty-seven patients in the lidocaine group and 46 patients in the fentanyl group were analyzed. None in the lidocaine group experienced hypotension, while 28/46 (61%) of patients in the fentanyl group developed at least one episode of hypotension requiring a median (25th and 75th quartiles) norepinephrine dose of 4 (0,5) mcg, p-value <0.001 for both outcomes. The average MAP was lower in the fentanyl group than in the lidocaine group at all time points after anesthesia induction. The average heart rate was comparable between the two groups nearly at all time points after anesthesia induction. The overall intubation condition was comparable between the two groups. None of the included patients developed postoperative delirium. CONCLUSION: Lidocaine-based regimen for induction of anesthesia reduced the risk of postinduction hypotension in older patients compared to the fentanyl-based regimen.