Application of group model building in implementation research: A systematic review of the public health and healthcare literature.

BACKGROUND: Group model building is a process of engaging stakeholders in a participatory modeling process to elicit their perceptions of a problem and explore concepts regarding the origin, contributing factors, and potential solutions or interventions to a complex issue. Recently, it has emerged as a novel method for tackling complex, long-standing public health issues that traditional intervention models and frameworks cannot fully address. However, the extent to which group model building has resulted in the adoption of evidence-based practices, interventions, and policies for public health remains largely unstudied. The goal of this systematic review was to examine the public health and healthcare applications of GMB in the literature and outline how it has been used to foster implementation and dissemination of evidence-based interventions. METHODS: We searched PubMed, Web of Science, and other databases through August 2022 for studies related to public health or health care where GMB was cited as a main methodology. We did not eliminate studies based on language, location, or date of publication. Three reviewers independently extracted data on GMB session characteristics, model attributes, and dissemination formats and content. RESULTS: Seventy-two studies were included in the final review. Majority of GMB activities were in the fields of nutrition (n = 19, 26.4%), health care administration (n = 15, 20.8%), and environmental health (n = 12, 16.7%), and were conducted in the United States (n = 29, 40.3%) and Australia (n = 7, 9.7%). Twenty-three (31.9%) studies reported that GMB influenced implementation through policy change, intervention development, and community action plans; less than a third reported dissemination of the model outside journal publication. GMB was reported to have increased insight, facilitated consensus, and fostered communication among stakeholders. CONCLUSIONS: GMB is associated with tangible benefits to participants, including increased community engagement and development of systems solutions. Transdisciplinary stakeholder involvement and more rigorous evaluation and dissemination of GMB activities are recommended.

Community coalition and key stakeholder perceptions of the community opioid epidemic before an intensive community-level intervention.

INTRODUCTION: Opioid overdoses are a major public health emergency in the United States. Despite effective treatments that can save lives, access to and utilization of such treatments are limited. Community context plays an important role in addressing treatment barriers and increasing access. The HEALing Communities Study (HCS) is a multisite community-level cluster-randomized trial that will study implementation and outcomes of a community coalition-based intervention (Communities that HEAL [CTH]) that implements evidence-based practices (EBPs) to reduce opioid overdose deaths in four states. To examine contextual factors critical to understanding implementation, we assessed the perspectives of community members about their communities, current substance use-related services, and other important issues that could impact intervention implementation. METHODS: Researchers conducted 382 semi-structured qualitative interviews in the HCS communities. Interviews were audio-recorded and transcribed; researchers subsequently analyzed data using directed content analysis based on the constructs of the RE-AIM/PRISM implementation science framework to identify key themes within the external community context. RESULTS: Despite the diversity in states and communities, four similar themes related to the external community context emerged across communities: These themes included the importance of understanding: 1) community risk perceptions, 2) levels of stigma, 3) the health services environment and the availability of substance use services, and 4) funding for substance use services. CONCLUSION: Understanding and addressing the external community context in which the CTH intervention and EBPs are implemented are crucial for successful health services-related and community engaged interventions. While implementing EBPs is a challenging undertaking, doing so will help us to understand if and how a community-based intervention can successfully reduce opioid overdose deaths and influence both community beliefs and the community treatment landscape.

Metastatic Spread of Neuroblastoma to the Left Atrium Mimicking Atrial Myxoma: A Rare Occurrence in an Adolescent.

Neuroblastoma is the most common childhood malignancy arising from the sympathetic neuroblast cells. The most common sites of origin are the adrenal glands and paravertebral regions. However, the involvement of the heart is a rare occurrence in adolescents. Here, we report a case of a 12-year-old male child who was misdiagnosed as a case of cardiac myxoma on initial presentation. Following surgical resection and histological examination, neuroblastoma was revealed. This case report highlights the differential diagnosis for the cardiac mass in an adolescent with an unknown primary origin and also the importance of tissue histopathology for the diagnosis and management of neuroblastoma.

Traumatic brain injury causing intestinal dysfunction: A review.

Traumatic brain injuries (TBI) and its sequelae are becoming one of the most pressing public health concerns worldwide. It is one of the leading causes of increased morbidity and mortality. The primary insult to the brain can cause ischemic brain injury, paralysis, concussions, death, and other serious complications. Brain injury also involves other systems through a secondary pathway resulting in multiple complications during and after hospitalization. The focus of our article is to assess the literature available on traumatic brain injury and intestinal dysfunctional to highlight the aspects of epidemiology, pathophysiology, and different diagnostic approaches for early diagnosis of gut dysfunction. We review studies done in both humans and animals, to better understand this underrated topic, as it costs billions of dollars to the healthcare industry because of delayed diagnosis.

Artificial Intelligence: A New Paradigm in Obstetrics and Gynecology Research and Clinical Practice.

Artificial intelligence (AI) is growing exponentially in various fields, including medicine. This paper reviews the pertinent aspects of AI in obstetrics and gynecology (OB/GYN) and how these can be applied to improve patient outcomes and reduce the healthcare costs and workload for clinicians. Herein, we will address current AI uses in OB/GYN, and the use of AI as a tool to interpret fetal heart rate (FHR) and cardiotocography (CTG) to aid in the detection of preterm labor, pregnancy complications, and review discrepancies in its interpretation between clinicians to reduce maternal and infant morbidity and mortality. AI systems can be used as tools to create algorithms identifying asymptomatic women with short cervical length who are at risk of preterm birth. Additionally, the benefits of using the vast data capacity of AI storage can assist in determining the risk factors for preterm labor using multiomics and extensive genomic data. In the field of gynecological surgery, the use of augmented reality helps surgeons detect vital structures, thus decreasing complications, reducing operative time, and helping surgeons in training to practice in a realistic setting. Using three-dimensional (3D) printers can provide materials that mimic real tissues and also helps trainees to practice on a realistic model. Furthermore, 3D imaging allows better depth perception than its two-dimensional (2D) counterpart, allowing the surgeon to create preoperative plans according to tissue depth and dimensions. Although AI has some limitations, this new technology can improve the prognosis and management of patients, reduce healthcare costs, and help OB/GYN practitioners to reduce their workload and increase their efficiency and accuracy by incorporating AI systems into their daily practice. AI has the potential to guide practitioners in decision-making, reaching a diagnosis, and improving case management. It can reduce healthcare costs by decreasing medical errors and providing more dependable predictions. AI systems can accurately provide information on the large array of patients in clinical settings, although more robust data is required.

Landau-Kleffner Syndrome: A Diagnostic Challenge.

The Landau-Kleffner syndrome (LKS), formerly known as acquired epileptic aphasia, is a rare syndrome that typically presents in early childhood with language regression and seizures. We report a case of LKS in an 7-year-old boy who presented with aggressive behavior, difficulty in maintaining posture, and language regression. Systemic examination, including neurological evaluation, was normal. Cerebrospinal fluid (CSF) analysis and magnetic resonance imaging (MRI) were normal. Electroencephalogram (EEG) showed abnormal findings associated with generalized seizure discharge during sleep with more spikes being noted in bilateral frontal and temporal regions. LKS was diagnosed and was treated with anticonvulsants and steroids. On follow-up, the child showed improvement in maintaining posture, was able to walk independently and had improved linguistic functions. This case adds another variant of LKS to the existing literature.

The Top Most-Cited and Influential Published Articles in Atrial Fibrillation from 1900 to 2019.

Citation classics are widely being implemented in the field of medical and scientific research assessment. The frequency of citation of a particular article is used to gauge its contribution and impact on the clinical world of practice and research. A thorough search of the literature showed a lack of bibliometric analysis on atrial fibrillation (AF). Thereby the main purpose of this study is to pinpoint the trend of the top 100 cited articles on AF. In June 2019, 2 databases, Scopus and Web of Science, were used to acquire the articles published on AF, which belonged to various genres including medicine, medical and interventional cardiology, electrophysiology, and thoracic surgery. The data were thoroughly reviewed and analyzed by 2 reviewers with regards to the number of citations for each article, publications per area, document type, first author name, country of origin, institute of origin, and year of publication. Approval of the Institutional Board Review was not required as we used publically available data retrospectively. The number of citations in the top 100 articles ranged from 622 to 6,641 times with an average citation of 1041.3 per article. The most significant number of articles was published in the year 2004 which ranged up to 11 in total. All the articles are published in 21 English language journals. In these 100 articles, the most were from the United States (n = 63) followed by Canada (n = 24), and other countries (n = 17). The top 5 institutions include McMaster University (n = 9), Institut de Cardiologie de Montreal (n = 8), Population Health Research Institute (n = 8), Harvard Medical School (n = 7), and Mayo Clinic (n = 7). In conclusion, authors seeking to publish a highly referenced article on AF will be determined by source journal, the language of publication, geographic origin, methodology, or research outcome.

Efficacy and Satisfaction Rate in Postpartum Intrauterine Contraceptive Device Insertion: A Prospective Study.

Background Postpartum intrauterine contraceptive device (PPIUCD) reduces the rate of abortions and it is a cost-effective, reversible, and convenient choice of contraception. The objective of our study was to evaluate the efficacy and satisfaction rate in women with postpartum intrauterine contraceptive device insertion. Methods This prospective study of immediate PPIUCD insertion was conducted at our institute from March 2016 to February 2019. Approval from the Institutional Review Board (IRB) was taken before starting the study. A total of 372 women were enrolled in the study after taking informed consent. All the women were counseled regarding different methods of contraception and birth control during antenatal checkups, early labor and immediately postpartum (within 48 hours). All the enrolled women in the study were followed for three years to determine the satisfaction and success rate of PPIUCD continuation. We also kept the record of women who discontinued PPIUCD.  Results After the exclusion criteria, 372 women were recruited in the study. The mean gestation age at the time of delivery was 38.5 weeks with a standard deviation (SD) of 1.45. All the women were followed for short-term and long-term complications and satisfaction rates. Out of 372, 51.07% of women (n = 190) had a spontaneous vaginal delivery, and 48.9% of women (n = 182) had a cesarean section but there was no significant long-term satisfaction outcome difference in both the groups. The highest success rate of the postpartum long-acting intrauterine contraceptive device was noted in patients who were counseled thoroughly in the antenatal and intrapartum period 61.5% as compared to those patients who were counseled either antenatally 42.2 %, intrapartum 35.4%, or immediate postpartum 22.4% alone. Conclusion PPIUCD insertion is an opportunity not to be missed. It allows women to obtain safe, long-acting, highly effective contraception while already within the medical system. More research data are needed in the literature with regard to counseling timings for PPIUCD insertion during the antenatal and postnatal period as it can affect the decision of women to prevent unplanned pregnancy. PPIUCD has one of the highest patient satisfaction rates among all the contraceptives.

An Adult Kawasaki Disease with Coronary Artery Involvement: A Unique Case Report and Literature Review.

Kawasaki disease (KD) is an acute, febrile, vasculitis of mainly large to medium-sized vessels. KD is a self-limited illness of infancy and childhood and 80% of the patients are younger than four years of age with an incidence of 5.6/100,000 in the United States. We present an unusual case of an 18-year-old man with several unique features of KD. He was admitted to the hospital with fever, rash, and arthralgia for one week. KD was among the differentials for fever, rash, and arthralgia. Later all the laboratory diagnosis for bacterial and viral infections including blood and urine culture came out negative and he was further evaluated for KD with electrocardiography (EKG), echocardiography, and angiography which showed myocarditis. Based on typical features of fever, rash, arthralgia, bilateral conjunctival injection, cervical lymphadenopathy, and prominent tongue papillae he was diagnosed with KD.

A Rare Case Report of Biloma After Cholecystectomy.

Biloma is an encapsulated collection of bile outside or inside the biliary system within the abdominal cavity. It is a rare condition with an incidence of 0.3%-2%. The most common cause of spontaneous biloma is choledocholithiasis, and other causes include abdominal trauma and surgery, bile duct tumors, liver infarction, percutaneous catheter drainage, transhepatic cholangiogram and endoscopic retrograde cholangiopancreatography (ERCP) but the exact cause is yet to be discovered. We herein present a case report of biloma as a complication of laparoscopic cholecystectomy. A 58-year-old male presented to our hospital emergency room with complaints of fever, nausea, vomiting, and pain in the right upper quadrant after six weeks of laparoscopic cholecystectomy for cholecystitis. He was diagnosed with computed tomography (CT) scan quickly, and he has treated with pigtail catheter percutaneous drainage. On a follow-up visit, after four weeks, his abdominal pain had improved and white blood count was also reduced to baseline.

Non-Traumatic Pneumocephalus and Sub-Dural Empyema as a Complication of Chronic Sinusitis.

Infectious sinusitis is extremely common in children, and persistent infection can lead to many complications. The most dangerous and commonly reported complications are intracranial. These intracranial complications include pneumocephalus, cerebral abscess, subdural empyema, meningitis, cellulitis, orbital abscess, and cavernous sinus thrombosis. Pneumocephalus is the presence of air in the cranium and sometimes it can lead to intracranial infection and localized pus collection in the potential space between meninges. Herein, we report a case of a 12-year-old girl who presented to a pediatric emergency in a confused and disoriented state. The cerebrospinal fluid (CSF) analysis provided a picture of bacterial meningitis, but her CT scan showed pneumocephalus and subdural empyema. This case report will help clinicians overcome this diagnostic challenge using the appropriate imaging and treatment modalities to prevent neurological sequelae.

Spondyloepiphyseal Dysplasia Congenita: A Rare Cause of Respiratory Distress.

Spondyloepiphysal dysplasia (SED) is an inheritable dysplasia of the bone due to a defect in collagen. It has a prevalence of 3.4 per million. It has two important types, congenita and tarda, which are differentiated by the age presentation and heritage mode. SED congenita can present a significant reduction in the upper segment to a lower segment ratio. Collagen mutation results in abnormal growth and development of spine and limb bones. The complex pattern of craniofacial anomalies is due to defective ossification and connective tissue problem. We here present the case of a three-hour-old girl with a short trunk and craniofacial anomalies that brought in respiratory distress to the neonatal intensive care unit. This condition is rare and thus poses a major diagnostic challenge at an early stage.

A Challenging Diagnosis of Systemic Lupus Erythematosus with Status Epilepticus.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder of unknown pathogenesis. In SLE, the body's immune system mistakenly attacks healthy tissues and organs thereby involving multiple body systems including joints, skin, blood, brain, heart, and lungs. SLE has a wide variation in the symptoms, hence making the diagnosis more challenging at the time of initial presentation. Sometimes, the patient presents with Status epilepticus (SE) without prior history of epilepsy, as SE is common at the beginning in the course of SLE. In this report, there is a case showing correlation of seizures with SLE, without prior history of epilepsy. A 43-year-old female presented in the emergency department of the hospital with SE. Her previous medical and family history for epilepsy was unremarkable. The patient had high titers for positive anti-nuclear antibody (ANA), while other autoimmune workup was negative. A complete evaluation of the symptoms and investigations revealed that she met the criteria of American College of Rheumatology (ACR) for the diagnosis of SLE. Hence, physicians should be diligent with regards to the variations in the initial presentation and complications of SLE. With the advancement in treatment modalities of SLE, it can be managed successfully, if diagnosed early.

A Case Report of Seronegative Limbic Encephalitis.

Most patients with autoimmune encephalitis do not present with well-described symptoms. Demographic data and information regarding co-morbidities could help in diagnosing the underlying disorder, but a definitive diagnosis is made by the result of autoimmune antibodies. Limbic encephalitis (LE), a variant of autoimmune encephalitis, is the inflammation of the limbic system of the brain. The disorder presents with the rapid development of confusion, working memory impairment, mood changes, and often seizures. LE could have paraneoplastic or non-paraneoplastic etiology. We present the case of a 15-year-old girl with seronegative LE, who presented with cognitive decline and seizures. This condition is rare, and therefore poses a great challenge in diagnosis at an early stage.

Neuropsychiatric Manifestation of Addison's Disease: A Rare Case Report.

Addison's disease (AD), also known as primary adrenal insufficiency, is a rare autoimmune disorder affecting males and females equally. The most common cause of AD is autoimmune adrenalitis and other causes include metastatic cancers, tuberculosis and acquired immunodeficiency syndrome. AD presents with a wide variety of signs and symptoms and thus, making a diagnosis challenging. The common symptoms of this disease include weakness and fatigability, orthostatic hypotension, nausea, vomiting, diarrhea, anorexia and weight loss. Addison's disease often presented with other autoimmune disorders, such as autoimmune polyglandular syndrome. We herein report a case of a patient who presented in a hospital emergency department, with Addisonian crisis and predominant neuropsychiatric manifestation. On review of the patient's history, combined with biochemical testing, a diagnosis of Addison's disease was established. This type of presentation is relatively uncommon.

A Bibliometric Analysis of the Top 30 Most-cited Articles in Gestational Diabetes Mellitus Literature (1946-2019).

Objective The aim of this bibliometric analysis is to evaluate the importance and impact of the articles that have been published with the title gestational diabetes mellitus (GDM) in the specialty of obstetrics & gynecology and endocrinology during the period 1946-2019. It also reveals that the area of GDM has received increased attention and interest by researchers, research funding institutions, and practitioners. Material and methods A thorough database search of Scopus and Web of Science was performed and the articles pertaining to gestational diabetes mellitus that were published between 1946 and 2019 were reviewed by two reviewers, Iftikhar PM and Ali F, with respect to their year of publication, authors, country of origin, journal of publication, and the affiliated institutions of the authors as well as journals. Institutional review board approval was not required for this study, as the data being analyzed were already available electronically, and otherwise, in libraries and databases. Results The 30 most-cited articles on gestational diabetes mellitus were thoroughly analyzed. The top article was cited 5028 times while the least number of citations for any article was 328. Among these 30 articles, five were published in the year 2005, which is the highest number of publications in any given year of the timeline being considered in this study. Most of the articles (n = 18) were from the United States of America, followed by Australia (n = 3); other countries contributed to two or fewer articles. Diabetes Care made most (n = 8) of the list. We found one author who had three publications and the rest contributed two or less articles. The top article in our study was cited almost 5028 times; meanwhile, there are 13 journals from different specialties that have referenced the most cited articles pertaining to gestational diabetes. Conclusion Our bibliometric analysis provides a picture of scientific research, which will help in evidence-based descriptions, comparisons, and visualizations of research output in GDM, and it can be used to explicate and describe the patterns of performance and impact of GDM research.

Prediction of successful trial of labour in patients with a previous caesarean section.

OBJECTIVE: To determine the prediction rate of success in trial of labour after one previous caesarean section. METHODS: The cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Cantonment General Hospital, Rawalpindi, from January 1, 2012 to January 31, 2013, and comprised women with one previous Caesarean section and with single alive foetus at 37-41 weeks of gestation. Women with more than one Caesarean section, unknown site of uterine scar, bony pelvic deformity, placenta previa, intra-uterine growth restriction, deep transverse arrest in previous labour and non-reassuring foetal status at the time of admission were excluded. Intrapartum risk assessment included Bishop score at admission, rate of cervical dilatation and scar tenderness. SPSS 21 was used for statistical analysis. RESULTS: Out of a total of 95 women, the trial was successful in 68 (71.6%). Estimated foetal weight and number of prior vaginal deliveries had a high predictive value for successful trial of labour after Caesarean section. Estimated foetal weight had an odds ratio of 0.46 (p < 0.001), while number of prior vaginal deliveries had an odds ratio of 0.85 with (p = 0.010). Other factors found to be predictive of successful trial included Bishop score at the time of admission (p < 0.037) and rate of cervical dilatation in the first stage of labour (p < 0.021). CONCLUSION: History of prior vaginal deliveries, higher Bishop score at the time of admission, rapid rate of cervical dilatation and lower estimated foetal weight were predictive of a successful trial of labour after Caesarean section.