The Cost-Effectiveness of Early Invasive Procedures for Acute Coronary Syndrome in Low-Income Regions: A Prospective Cohort Study in Pakistan.

Background Acute coronary syndrome (ACS) is a significant cause of mortality and morbidity globally, necessitating effective intervention strategies. Early invasive procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are often recommended for high-risk patients. However, their cost-effectiveness in low-income regions remains uncertain, particularly in Pakistan, where healthcare resources are limited. Objective This study aims to evaluate the cost-effectiveness of early invasive procedures compared to standard care for ACS in low-income regions of Pakistan. Methods We conducted a prospective cohort study from January 1, 2021, to January 31, 2021, at four major hospitals in Pakistan: Army Cardiac Center Combined Military Hospital (CMH) Lahore, National Institute of Cardiovascular Diseases in Karachi, Lady Reading Hospital in Peshawar, and Mardan Medical Complex. The participants included 436 patients diagnosed with ACS aged 18 years or older and presenting within 24 hours of symptom onset. The patients were divided into two groups: the early invasive procedure group (n = 218) and the standard care group (n = 218). The primary outcome was the 30-day mortality rate. Secondary outcomes included recurrent myocardial infarctions, hospital readmissions, healthcare costs, and procedural complications. Data were analyzed using SPSS version 25.0 (IBM SPSS Statistics, Armonk, NY), employing descriptive statistics, chi-square tests, independent t-tests, and Kaplan-Meier survival analysis. Results The early invasive procedure group showed a mortality rate of 18 (8%) compared to 33 (15%) in the standard care group, demonstrating a significant reduction in mortality (p = 0.01). Additionally, the average healthcare cost was significantly lower in the early invasive group, with mean costs of Pakistani rupee (PKR) 187,200 (US dollar {USD} 1,200) compared to PKR 280,800 (USD 1,800) in the standard care group (p < 0.01). Recurrent myocardial infarctions occurred in 11 (5%) of the early invasive group versus 26 (12%) in the standard care group (p < 0.05). Hospital readmission rates were lower in the early invasive group, 22 (10%) compared to 39 (18%) in the standard care group (p < 0.05). Healthcare costs were significantly lower in the early invasive group, with mean costs of PKR 187,200 (USD 1,200) compared to PKR 280,800 (USD 1,800) in the standard care group (p < 0.01). Conclusion Early invasive procedures for ACS significantly improve survival rates, reduce complications, and lower healthcare costs in low-income regions of Pakistan. These findings suggest that such strategies should be considered in resource-limited settings to optimize patient outcomes and healthcare resource utilization.

Interventional Radiology Awareness Among Family Physicians and General Practitioners in Jazan Region, Saudi Arabia.

Background Interventional radiology (IR) utilizes minimally invasive procedures guided by imaging to diagnose and treat various conditions, offering less invasive alternatives to traditional surgery. Despite its importance, awareness among family medicine practitioners can vary, affecting patient care. While IR has advanced in Saudi Arabia, there are limited data on family medicine practitioners' understanding of IR. This study assesses awareness of IR procedures among family medicine doctors in Jazan and their perceived need for further education. Methods A cross-sectional interview-administered survey was conducted online among family medicine doctors in Jazan via social media. The survey assessed demographic data, awareness of IR procedures, self-rated knowledge, and attitudes towards IR. Participants' understanding of IR training, hospital privileges, outpatient clinics, and recognition by the Saudi Commission for Health Specialties (SCHS) was evaluated. Data were analyzed using descriptive statistics and chi-square tests. Results Out of 395 respondents, the age distribution was as follows: 20-29 years (44.3%), 30-39 years (32.9%), and 40 years or older (22.8%). Gender distribution was as follows: females (44.6%) and males (55.4%). Specialties included family medicine consultants (10.6%), residents (32.4%), specialists (22.8%), and general practitioners (34.2%). Awareness of IR procedures varied: uterine fibroid embolization (58.7%), coronary angiography (57.5%), vascular angioplasty (63.5%), radiofrequency ablation (61.3%), peripheral vascular bypass (61.8%), brain biopsy (56.2%), nephrostomy tube placement (59.5%), varicose veins treatment (63.0%), and cystoscopic tumor resection (54.7%). Self-rated knowledge was as follows: poor (46.8%), adequate (27.1%), good (15.7%), and excellent (10.4%). Most believed that interventional radiologists' training was in radiology (62.8%), with fewer attributing it to vascular surgery (20.5%) or a combination (16.7%). Regarding privileges and facilities, 248 (62.8%) reported hospital admitting privileges for IRs, 251 (63.5%) reported outpatient clinics, and 45 (11.4%) were unsure about admitting privileges. SCHS recognition was confirmed by 267 (67.6%). Referrals to IRs were made by 283 (71.6%), and 260 (65.8%) would increase referrals with more knowledge. The perceived benefit of additional education was as follows: no benefit (48.4%), some benefit (30.6%), and significant benefit (21.0%). Conclusion The study reveals gaps in awareness and knowledge of IR among family medicine doctors in Jazan. While there is recognition of IR's value and a willingness to refer patients, variations in knowledge highlight the need for targeted educational interventions. Improving education on IR could enhance integration into patient care and optimize outcomes.

Intensive care unit patients' experiences of receiving music therapy sessions during invasive procedures: A qualitative phenomenological study.

BACKGROUND: Excessive noise in intensive care units poses a significant challenge, impacting both patients and staff by elevating stress, disrupting recovery, and impeding effective communication among healthcare professionals. Despite the World Health Organization recommending noise levels below 35 dB, alarms in these units often surpass these limits, contributing to consistently high noise levels. OBJECTIVES: The aim of this study is to explore intensive care unit patients' experiences with music therapy sessions during invasive procedures. METHODS: This study was conducted using a qualitative hermeneutic phenomenological methodology grounded in Heideggerian philosophy. Interventions were conducted with a music therapist, and 14 in-depth interviews were collected. Reflexive inductive thematic analysis was performed. RESULTS/FINDINGS: From the thematic analysis extracted from the 14 personal interviews, three themes were described that represent the bulk of the experiences and emotions of the study participants following the completion of the music therapy sessions. The most noteworthy results are described in the following, organised according to each theme: (i) music therapy against noise, sounds, and light; (ii) music therapy in the face of invasive tests and techniques; and (iii) music therapy as a strategy and tool. CONCLUSIONS: Music therapy has significant potential to enhance the quality of life for patients in the intensive care unit. Music therapy can promote relaxation, reduce stress and anxiety, alleviate pain and discomfort, and improve emotional and physical wellbeing during patients' stay and invasive procedures.

Device associated healthcare associated infection (DA-HAI): a detailed analysis of risk factors and outcomes in a university hospital in Rome, Italy.

Introduction: This study investigates the impact of invasive procedures on healthcare-associated infections (HAI) at Policlinico Universitario Tor Vergata in Rome, Italy, aiming to understand their role in device-associated HAI and to inform prevention strategies. Methods: A retrospective cohort analysis was conducted, examining mandatory discharge records and microbiology data from 2018 across all departments. The study focused on adult patients, analysing the correlation between invasive procedures and HAI through univariate and multivariate logistic regression. Results: Of the 12,066 patients reviewed, 1,214 (10.1%) experienced HAI. Univariate analysis indicated an association between invasive procedures and HAI (OR = 1.81, P < 0.001), which was not observed in multivariable analysis. Specific procedures significantly raised HAI risks: temporary tracheostomy (AOR = 22.69, P <0.001), central venous pressure monitoring (AOR = 6.74, P <0.001) prolonged invasive mechanical ventilation (AOR = 4.44, P <0.001), and venous catheterisation (AOR = 1.58, P <0.05). Aggregated high-risk procedures had an increased likelihood of HAI in multivariable analysis (OR = 2.51, P < 0.001). High-risk departments were also notably associated with HAI (OR = 6.13, P < 0.001). Conclusions: This study suggests that specific invasive procedures, such as temporary tracheostomy, significantly increase HAI risks. The results highlighting the need for targeted infection prevention and control procedures and supports the need for innovative methods such as record-linkage in policymaking to address HAI. These findings inform clinical practice and healthcare policy to improve patient safety and care quality.

A Scoping Review of Audiovisual Distraction Techniques Among Children in Reducing Invasive Procedure Pain.

Background: Invasive procedures in children can lead to painful and uncooperative procedures. It is essential to determine the appropriate method to create a comfortable environment for children during invasive procedures. However, audiovisuals are one of the distraction techniques used in pain management. Purpose: This study aims to identify and categorize related audiovisual distraction techniques in reducing pain due to invasive procedures among children. Methods: This study uses a systematic scoping review. A literature review was conducted using PubMed, EBSCO, Science Direct, Scopus and grey literature through Google Scholar. The study was eligible for inclusion if it included articles published from 2012 to 2022, full-text and open accessed articles, and in Indonesian and English language. Studies were excluded if they were review studies and the adult population. The keywords in English were "Children" OR 'Child' OR "Kids" OR 'Youth' OR 'Adolescents' OR 'Teenager' OR 'Teens' OR 'Young People' OR 'Pediatric' OR 'Paediatric' OR 'Childhood' AND "Audiovisual" OR 'Movie' OR 'Video' OR 'Animation' AND "Pain" AND "Invasive procedures" and keyword in Indonesia were "Anak" OR 'Remaja' OR 'Bayi' OR 'Balita' AND "Audiovisual" OR 'Film' OR "Video" OR 'Animasi' OR "Nyeri" AND 'Prosedur invasif'. Results: We found 15 articles showing audiovisual distraction techniques in managing pain among children undergoing invasive procedures. Three types of audiovisual interventions were used, including virtual reality (VR), video music, and animated cartoons. In addition, types of invasive procedures that benefited from the analyzed interventions were infusion, surgery, injection, blood draw, dressing change, circumcision, endoscopy, and phlebotomy. Conclusion: Our findings highlight that virtual reality, video music, and animated cartoons have clinical implications in helping to distract from pain in children undergoing invasive procedures. Our study indicates that the potential of audiovisual intervention can be used as an intervention strategy in the pediatric nursing area.

Abordagem estética e conservadora para fechamento de múltiplos diastemas: relato de caso / Aesthetic and conservative approach to multiple diastema closure: case report / Enfoque estético y conservador para el cierre de múltiples diastemas: relato de caso

Introdução:Na odontologia moderna, a estética vem ocupando um espaço cada vez mais expressivo, e o desejo por dentes mais brancos, a insatisfação com o alinhamento dos dentes e com a anatomia dentária, têm sido os motivos mais relevantes de procura dos pacientes nos consultórios odontológicos.Objetivo:O presente artigo tem como objetivo descrever, através de relato de caso clínico, uma abordagem terapêutica estética e conservadora para fechamento de múltiplos diastemas anterossuperiores com a utilização de facetas de resina composta.Relato de caso:Paciente do sexo masculino, 21 anos de idade, procurou atendimento queixando-se de insatisfação estética pelos diastemas apresentados. Por meio de um planejamento digital das facetas em resina, com mockup e modelo impresso em 3D, as restaurações foram feitas respeitando anatomia, forma, opacidade e cores dos dentes naturais do paciente. O resultado dos procedimentos adotados foi satisfatório, demonstrando que a técnica empregada foi eficaz, sendo capaz de devolver um sorriso estético e biológico ao paciente. A odontologia contemporânea tem ofertado cada vez mais materiais com capacidade de devolver estética e função em dentes de forma minimamente invasivas, além de passar total confiabilidade em tratamentos a longo prazo, agradando o paciente desde a apresentação digital do planejamento traçado pelo cirurgião dentista com previsibilidade dos resultados, até o momento final do tratamento.Conclusões:O recontorno estético com resina composta representa uma opção funcional e de baixo custo para o tratamento de pacientes que apresentam diastemas múltiplos, principalmente em pacientes jovens pela preservação daestrutura dentária e possibilidade de reparo, sendo considerado um procedimento reversível, rápido e de baixo custo (AU).

Introduction:Aesthetics have been occupying an increasingly significant role in modern dentistry, and the desire for whiter teeth, dissatisfaction with tooth alignment, and dental anatomy concerns have been the most relevant reasons for patients seeking dental care. Objective:This article aims to describe an aesthetic and conservative therapeutic approach for closing multiple anterior upper diastemas using composite resin veneers in a clinical case report. Case report:A 21-year-old male patient sought treatment, expressing dissatisfaction with the diastemas he had. The restorations were performed using digital planning of the resin veneers with a mockup and a 3D-printed model, while respecting the patient's natural tooth anatomy, shape, opacity, and colors. The results of the adopted procedures were satisfactory, demonstrating effectiveness of the employed technique in restoring an aesthetic and biologically harmonious smile to the patient. Contemporary dentistry has been offering increasingly more materials capable of providing aesthetics and function to teeth through minimally invasive approaches. This not only ensures long-term treatment reliability, but also pleases the patient with a digital presentation of the treatment plan outlined by the dentist, predicting the results up to the final stages of the treatment. Conclusions:Aesthetic contouring using composite resin presents a functional and cost-effective option for treating patients with multiple diastemas, especially among young patients due to its preservation of dental structure, repair potential, and being considered a reversible, fast, and low-cost procedure (AU).

Introducción: En la odontología moderna, la estética viene ocupando un espacio cada vez más destacado, y las ganas de tener dientes más blancos, la insatisfacción con el alineamiento de los dientes, y la anatomía dental son las razonesmás relevantes por las cuales los pacientes acuden a las consultas odontológicas. Objetivo:El presente artículo tiene como objetivo describir, a través de un relato de caso clínico, un abordaje terapéutico estético y conservador para el cierre de múltiples diastemas anterosuperiores mediante el uso de carillas de resina compuesta. Informe de caso:Paciente del sexo masculino, 21 años de edad, buscó atendimiento quejándose de insatisfacción estética debido a los diastemas presentados. A través de una planificación digital de las carillas en resina, con un mockup y un modelo impreso en 3D, las restauraciones fueron ejecutadas, respetándose la anatomía, forma, opacidad y colores de los dientes naturales del paciente. El resultado de los procedimientos adoptados fue satisfactorio y demostró que la técnica utilizada fue eficaz, siendo capaz de restituir una sonrisa estética y funcional al paciente. La odontología contemporánea viene ofreciendo cada vez más materiales con la capacidad de devolver estética y función a los dientes de maneras mínimamente invasivas, además de brindar total confiabilidad en tratamientos a largo plazo, satisfaciendo al paciente desde la presentación digital del plan trazado por el cirujano dentista con la previsibilidad de los resultados, hasta el momento final del tratamiento. Conclusiones:El recontorneado estético con resina compuesta representa una opción funcional y de bajo costo para el tratamiento de pacientes con múltiples diastemas, especialmente en pacientes jóvenes, debido a la preservación de la estructura dental y la posibilidad de reparación. Se considera, de este modo, que se trata de un procedimiento reversible, rápido y económico (AU).

Contribution and advances of robotics in percutaneous oncological interventional radiology.

The advent of robotic systems in interventional radiology marks a significant evolution in minimally invasive medical procedures, offering enhanced precision, safety, and efficiency. This review comprehensively analyzes the current state and applications of robotic system usage in interventional radiology, which can be particularly helpful for complex procedures and in challenging anatomical regions. Robotic systems can improve the accuracy of interventions like microwave ablation, radiofrequency ablation, and irreversible electroporation. Indeed, studies have shown a notable decrease of an average 30% in the mean deviation of probes, and a 40% lesser need for adjustments during interventions carried out with robotic assistance. Moreover, this review highlights a 35% reduction in radiation dose and a stable-to-30% reduction in operating time associated with robot-assisted procedures compared to manual methods. Additionally, the potential of robotic systems to standardize procedures and minimize complications is discussed, along with the challenges they pose, such as setup duration, organ movement, and a lack of tactile feedback. Despite these advancements, the field still grapples with a dearth of randomized controlled trials, which underscores the need for more robust evidence to validate the efficacy and safety of robotic system usage in interventional radiology.

Clinical Characteristics of Abdominal Infections Caused by Raoultella Spp.: A Retrospective Study.

Background: In recent years, Raoultella spp. have attracted clinical attention as a new type of pathogen. The most common of human infection with Raoultella are bacteremia, urinary tract infections, abdominal infections, etc. Abdominal infection is a serious and complex infection problem. However, there have been no systematic reports of abdominal infections caused by Raoultella. The objective of this study was to explore the clinical characteristics of Raoultella abdominal infections and provide a reference for clinical practice. Methods: A review of publications on abdominal infections caused by the genus Raoultella between 2009 and 2024 is carried out. This review studied seven parameters: infection type, number of cases, gender, age, comorbidities, treatment, and outcome, and descriptive statistical methods were used to analyze the results. Results: A total of 40 cases (16 Raoultella ornithinolytica and 24 Raoultella planticola) were analyzed: 20 cases of biliary tract infection, 5 cases of liver infection, and 4 cases of peritonitis. Fever and abdominal pain were the main symptoms, and some patients present with multiple skin flushes, systemic erythema. Of the 40 cases, 92.5% of patients had underlying diseases. Among them, malignant disease, immunodeficiency, and invasive operations increase the risk of infection. On the basis of the drug susceptibility results, the preferred antibiotics are quinolone, third generations of cephalosporins, carbapenems, and aminoglycoside. Last, patients with abdominal infections caused by Raoultella spp. mostly have a good prognosis after early use of sensitive antibiotics. Conclusions: According to existing literature reports, the main type of abdominal infection caused by Raoultella is biliary tract infection, and most patients have other underlying diseases. Malignancy, immune deficiency, and invasive procedures are risk factors for bacterial infections. This review also emphasizes that Raoultella spp. is a rarely found opportunistic pathogen, which can cause a high incidence of healthcare-associated infections after invasive procedures.

Palliative care consultation in patients hospitalized with out-of-hospital cardiac arrest: Impact on invasive procedures, do-not-resuscitate orders, and healthcare costs.

BACKGROUND: The impact of palliative care consultation on the management and outcomes of patients hospitalized with out-of-hospital cardiac arrest (OHCA) remains poorly understood. This study examined associations between palliative care consultation and in-hospital outcomes of patients hospitalized with OHCA, stratified by survival status. METHOD: This cross-sectional study used data from the National Inpatient Sample (2016-2021). Adult patients hospitalized with OHCA who received cardiopulmonary resuscitation were included. Multivariable analyses assessed associations between palliative care consultation and outcomes in non-terminal and terminal OHCA hospitalizations, adjusting for demographics, hospital characteristics, and comorbidities. RESULTS: Among 488,700 OHCA hospitalizations, palliative care consultation was associated with lower odds of invasive procedures in non-terminal hospitalizations, including percutaneous coronary intervention (PCI) (aOR 0.30, 95 % CI 0.25-0.36), mechanical circulatory support (aOR 0.54, 95 % CI 0.44-0.68), permanent pacemaker (aOR 0.27, 95 % CI 0.20-0.37), implantable cardioverter defibrillator insertion (aOR 0.22, 95 % CI 0.16-0.31), and cardioversion (aOR 0.62, 95 % CI 0.55-0.70). In terminal hospitalizations, palliative care was associated with lower odds of PCI (aOR 0.78, 95 % CI 0.70-0.87) and cardioversion (aOR 0.91, 95 % CI 0.85-0.97), but higher odds of therapeutic hypothermia (aOR 3.12, 95 % CI 2.72-3.59), gastrostomy (aOR 1.22, 95 % CI 1.05-1.41), and renal replacement therapy (aOR 1.19, 95 % CI 1.12-1.26). Palliative care was associated with higher DNR utilization in both subgroups and lower hospital costs in non-terminal hospitalizations but higher costs in terminal hospitalizations. CONCLUSION: Palliative care consultation in OHCA is associated with differences in invasive procedures, DNR utilization, and hospital costs, varying by survival status.

Shortwave Infrared Imaging of a Quantum Dot-Based Magnetic Guidewire Toward Non-Fluoroscopic Peripheral Vascular Interventions.

Peripheral vascular interventions (PVIs) offer several benefits to patients with lower extremity arterial diseases, including reduced pain, simpler anesthesia, and shorter recovery time, compared to open surgery. However, to monitor the endovascular tools inside the body, PVIs are conducted under X-ray fluoroscopy, which poses serious long-term health risks to physicians and patients. Shortwave infrared (SWIR) imaging of quantum dots (QDs) has shown great potential in bioimaging due to the non-ionizing penetration of SWIR light through tissues. In this paper, a QD-based magnetic guidewire and its system is introduced that allows X-ray-free detection under SWIR imaging and precise steering via magnetic manipulation. The QD magnetic guidewire contains a flexible silicone tube encapsulating a QD polydimethylsiloxane (PDMS) composite, where HgCdSe/HgS/CdS/CdZnS/ZnS/SiO2 core/multi-shell QDs are dispersed in the PDMS matrix for SWIR imaging upon near-infrared excitation, as well as a permanent magnet for magnetic steering. The SWIR penetration of the QD magnetic guidewire is investigated within an artificial tissue model (1% Intralipid) and explore the potential for non-fluoroscopic PVIs within a vascular phantom model. The QD magnetic guidewire is biocompatible in its entirety, with excellent resistance to photobleaching and chemical alteration, which is a promising sign for its future clinical implementation.

Top Three Healthcare Trends in Orthopaedics Affecting Musculoskeletal Care in the Elderly.

Several trends toward patient-centered multi-care models employing translational research strategies are currently emerging in orthopaedics. These align seamlessly with epigenetics discussions in pain, a clinical approach to pain management that prioritizes tailoring healthcare to individual needs, preferences, and circumstances. Recognizing the unique genetic and epigenetic factors influencing pain perception, healthcare providers can integrate personalized insights into their patient-centered approach, offering more targeted and effective pain management strategies tailored to each individual's experience. Custom 3D-printing technologies may also become increasingly relevant to more effectively and reliably treat painful degenerative structural abnormalities. They are expected to go hand-in-hand with the precision medicine redefinition of musculoskeletal care. More effective analysis of surgeons' clinical decision-making and patients' perception of high-value orthopaedic care is needed. Shared Decision Making (SDM) is critical to identifying the best solution for each patient and improving stakeholders' understanding of factors influencing the diverse prioritizing values of surgical or non-surgical treatments by payers, systems, and other providers. Identifying high-value orthopaedic surgeries via effective SDM in orthopedic surgery requires more than just presenting patients with information. The Rasch analysis of patient expectations can provide this nuanced approach that involves understanding patient values, addressing misconceptions, and aligning surgical recommendations with patient-specific goals. Optimizing orthopaedic treatment within the patient-centered framework can drive innovation in reimbursement policies that support the field more broadly. Research on separating high-value from low-value orthopaedic procedures may likely impact healthcare decision- makers' resource allocation.

Standardized procedure for preventing late intestinal complications following minimally invasive total gastrectomy for gastric cancer: a single-center retrospective cohort study.

BACKGROUND: Although minimally invasive total gastrectomy for gastric cancer is commonly performed, reports regarding late complications are limited. We have made several improvements each time we experienced severe late complications since 2009. This study aimed to evaluate the clinical efficacy of these improved procedures in preventing late complications. METHODS: Between January 2009 and December 2019, 302 patients who underwent laparoscopic or robotic total gastrectomy for gastric cancer were enrolled. The patients were divided into two groups: Period-I (2009-2013, before established standardization of procedure, 166 patients) and Period-II (2014-2019, after established standardization of procedure, 136 patients). The standardized procedure comprised four major steps, including closure of the mesentery defects and diaphragm crus, circumferential fixation of the anastomotic site into the diaphragm, and linearization around the anastomotic site of esophagojejunostomy. The incidence of late complications was retrospectively compared between the two groups. RESULTS: Late overall complications that occurred over 30 days after surgery were observed in 19 (6.3%) patients. In all, 14 of 24 (58.3%) patients admitted due to late intestinal complications eventually required reoperation for treatment. The most frequent complication was nonstenotic outlet obstruction of the distal jejunal limb. The incidence of late overall complications was significantly lower in Period-II than in Period-I (2.9 vs 9.0%, p = 0.030). Intestinal complications were reduced considerably in Period-II. The 3-year cumulative incidence rate of late overall complications was significantly lower in Period-II than in Period-I (0.03 vs 0.10, p = 0.035). Period-I as the only independent risk factor for the development of late intestinal complications. CONCLUSION: Late complications after laparoscopic total gastrectomy sometimes occurred, and more than half of the patients with intestinal complications required reoperation. Our standardized procedure was associated with a lower risk of late intestinal complications after minimally invasive total gastrectomy followed by intracorporeal esophagojejunostomy using linear staplers in a cohort of patients with gastric cancer.

Singular entry point technique for forehead and temple filler augmentation: Anatomical and clinical perspectives.

BACKGROUND: The depressed volume of the forehead and temple is resolved by filler injection. However, the current method has the potential to cause pain and side effects in patients, depending on the skill of the clinician. Therefore, this study proposes a new method for safer and simpler injection using only one injection entry point. METHODS: Using the novel injection method, the filler was injected into the forehead and temple regions in three unembalmed cadavers and two healthy Korean volunteers. The cannula and filler locations were identified using dissection, ultrasonography, and three-dimensional (3D) scanning. RESULTS: Ultrasonographic images and dissection results showed that the filler injected into the cadavers was in the target layer. The cannula and filler were located on the layer as the supraperiosteal layer on the forehead and the supra deep temporal fascia layer in the temple. Finally, 3D scanning images showed that the filler was injected precisely and effectively into the forehead and temples of the volunteer who underwent the procedure. CONCLUSIONS: This method can reduce pain and minimize externally visible wounds caused by injections. The injected filler was naturally connected from the forehead to the temple and maintained for around 3 months. Additionally, it is possible to inject fillers into the forehead and temple at a constant and safe depth without requiring specific skills. It is expected that this method will become a universal method because it minimizes the burden on both patients and clinicians.

Currently Available Treatment Modalities for Uterine Fibroids.

Uterine fibroids (leiomyomas and myomas) are the most common benign gynecological condition in patients presenting with abnormal uterine bleeding, pelvic masses causing pressure or pain, infertility and obstetric complications. Almost a third of women with fibroids need treatment due to symptoms. OBJECTIVES: In this review we present all currently available treatment modalities for uterine fibroids. METHODS: An extensive search for the available data regarding surgical, medical and other treatment options for uterine fibroids was conducted. REVIEW: Nowadays, treatment for fibroids is intended to control symptoms while preserving future fertility. The choice of treatment depends on the patient's age and fertility and the number, size and location of the fibroids. Current management strategies mainly involve surgical interventions (hysterectomy and myomectomy hysteroscopy, laparoscopy or laparotomy). Other surgical and non-surgical minimally invasive techniques include interventions performed under radiologic or ultrasound guidance (uterine artery embolization and occlusion, myolysis, magnetic resonance-guided focused ultrasound surgery, radiofrequency ablation of fibroids and endometrial ablation). Medical treatment options for fibroids are still restricted and available medications (progestogens, combined oral contraceptives andgonadotropin-releasing hormone agonists and antagonists) are generally used for short-term treatment of fibroid-induced bleeding. Recently, it was shown that SPRMs could be administered intermittently long-term with good results on bleeding and fibroid size reduction. Novel medical treatments are still under investigation but with promising results. CONCLUSIONS: Treatment of fibroids must be individualized based on the presence and severity of symptoms and the patient's desire for definitive treatment or fertility preservation.

The vaginal route for minimally invasive surgery: a practical guide for general surgeons.

INTRODUCTION: Vaginal approaches have become routine in the field of gynecologic surgery, whereas in general surgery vaginal wall transection is an infrequent practice typically reserved for extensive tumor resections. Approximately two decades ago, natural orifice transluminal endoscopic surgery (NOTES) revolutionized conventional boundaries by accessing the peritoneal cavity transorally, transrectally, or transvaginally, enabling general surgery without visible scars. Although transvaginal approaches have been successfully used for various abdominal procedures by general surgeons, a gap remains in comprehensive training to fully exploit the potential of this route. MATERIAL AND METHODS: PubMed, Google Scholar, and Scopus databases were searched to retrieve relevant articles illustrating how general surgeons can adeptly manage vaginal approaches. RESULTS: The article presents a practical framework for general surgeons to execute a complete vaginal approach, addressing the management of vaginal specimen extraction and vaginal cuff closure, even in the absence of an experienced gynecologist. CONCLUSION: The evolution of abdominal surgery is moving towards less invasive techniques, emphasizing the importance of understanding the nuances and challenges associated with the vaginal route. This approach is linked to minimal oncological, sexual, and infective complications, and to the absence of pregnancy-related complications. Such knowledge becomes increasingly crucial, particularly with the renewed demand for transvaginal access in robot-assisted NOTES procedures.

Management of low-risk papillary thyroid cancer. Minimally-invasive treatments dictate a further paradigm shift?

BACKGROUND: Current management options for PTMC include lobo-isthmectomy and active surveillance (AS). Recently, ultrasound-guided minimally invasive procedures (MITs) are offered as a nonsurgical therapy for PTMC because they do not require hospitalization and general anaesthesia, and do not result in loss of thyroid function or cosmetic damage. MITs are reported to consistently provide, mostly in large retrospective series of patients, a rapid, safe, and cost-effective way to eradicate low-risk thyroid malignancies. However, conclusive data from well-conducted prospective studies on the histologically-proven completeness of tumor ablation and the long-term clinical advantages versus AS are still lacking. OBJECTIVES: This study aimed to evaluate the efficacy and safety of ultrasound-guided minimally invasive treatments (MITs) for PTMC in comparison to traditional surgical methods and active surveillance, and to assess their role in current clinical practice. METHODS: A structured literature review was conducted using keywords related to PTMC, MIT, and comparative techniques. Studies were evaluated based on treatment modality, patient selection, follow-up duration, complication rates, and clinical outcomes. RESULTS: MITs have shown promising results in the management of PTMC. These treatments offer several advantages over surgery, such as reduced use of surgical resources, lower costs, minimal work disruption, and fewer major complications. However, there are still limitations, including the need for long-term surveillance and the potential risk of incomplete tumor ablation. CONCLUSIONS: MITs represent a promising non-surgical option for managing low-risk PTMC, especially for patients ineligible for or refusing surgery. Despite favorable outcomes, more robust prospective data are needed to confirm their long-term benefits and completeness of tumor ablation. Interdisciplinary discussions and thorough patient education on the advantages and limitations of MITs are crucial for informed decision-making.

The effect of virtual reality glasses used during intravenous catheter application on the Child's emotional responses.

PURPOSE: This study was conducted to determine the effect of virtual reality glasses used during intravenous catheter insertion on the child's emotional responses. DESIGN AND METHODS: The sample of the research, which was carried out as a randomized controlled experimental study, consisted of 102 children, including 51 in the control group and 51 in the study group, who were aged between 7 and 12 years and were on treatment in the pediatric emergency department(PED). Research data were collected using a Descriptive Data Form for Children and the Children's Emotional Manifestation Scale. No intervention was applied to the control group. After the tourniquet was tied in the study group, the children started watching a video of their choice through virtual reality glasses. When the process was completed, the video was stopped. During this period, the child was evaluated using the Children's Emotional Manifestation Scale. RESULTS: A statistically significant difference was found between the Children's Emotional Manifestation Scale scores of the children in the study and control groups (p = 0.000). The scores of the children in the study group were statistically significantly lower than the scores of the children in the control group. CONCLUSION: During the intravenous catheter insertion process, children who watched cartoons on virtual reality glasses showed less negative emotional behavior than those who did not. PRACTICE IMPLICATIONS: The use of virtual reality glasses is a developing technology in child health services, and it is recommended to encourage their use in these services.

Analysis of trends in radiofrequency ablation in a tertiary care center practice.

BACKGROUND: Radiofrequency ablation (RFA) for thyroid nodules has recently been introduced into the United States healthcare system landscape. Little is known about the process of incorporating this procedure into existing clinical practice. METHODS: A retrospective chart review of a single institution was conducted to examine referral patterns and decision-making after the introduction of RFA into an endocrine surgery-focused practice. Patient demographics and thyroid-specific data were recorded. Two reviewers abstracted and coded reasons for the noncompletion of RFA. Two-sample t tests were used to compare groups; linear regression was used to assess trends and practice patterns. RESULTS: Chart review identified 451 patients referred for consideration of RFA from January 2020 to December 2022. Only 255 (56.5%) went on to receive the treatment. There was no significant difference in nodule volume between treated and nontreated groups (18.5 vs. 14.9 cm3, p = 0.07). Concern for malignancy on genetic testing, size (too large/too small), recommendation for Ethanol ablation, and multinodular disease without target nodules were the most common reasons for physician deferral. Of patients who declined to proceed, 46% opted to undergo surgical excision. Linear regression showed that referral numbers significantly increased with time; however, the proportion of patients receiving treatment decreased yearly, primarily because of higher rates of physician deferral. CONCLUSIONS: This study reflects the complex decision-making in offering minimally invasive thyroid nodule ablation. Despite a greater number of referrals over time, physician criteria became increasingly selective. Optimal candidacy in RFA is an evolving determination requiring patient and physician input to guide ideal practice patterns.

Cumulative sum learning curve for cordocentesis among maternal-fetal medicine fellows in a low-cost simulation model.

OBJECTIVE: To determine the individual learning curves for cordocentesis in a low-cost simulator for maternal-fetal medicine (MFM) fellows. METHODS: This observational, descriptive, educational, and prospective study was performed from July through November 2022. After an introductory course based on a standardized technique for cordocentesis, each second-year MFM fellow who accepted to participate in the study performed this procedure using a low-cost simulation model, and experienced operators supervised the cordocenteses. Learning curves were then created using cumulative sum analysis (CUSUM). RESULTS: Seven second-year MFM fellows with no previous experience in cordocentesis accepted to participate in the study. A total of 2676 procedures were assessed. On average, residents performed 382 ± 70 procedures. The mean number of procedures to achieve proficiency was 369 ± 70, the overall success rate was 84.16%, and the corresponding failure rate was 15.84%. At the end of the study, all fellows were considered competent in cordocentesis. One fellow required 466 attempts to achieve competency, performing a total of 478 procedures, but the resident with the fewest attempts to reach competency required 219 procedures, completing 232 procedures. Some of the most frequent reasons for failed attempts included not reaching the indicated point for vascular access (20.99%) and being unable to retrieve the sample (69.10%). CONCLUSION: CUSUM analysis to assess learning curves, in addition to using low-cost simulation models, helped to appraise individualized learning, allowing an objective demonstration of competency for cordocentesis among MFM fellows.