Adherence to Clinical Practice Guidelines for Non-ST Elevation Acute Coronary Syndrome in the Emergency Department: Exploring the Role of Social, Healthcare-system, and Clinical Determinants.

OBJECTIVES: The aim of this study was to assess adherence to the European Society of Cardiology 2020 non-ST elevation acute coronary syndrome (NST-ACS) guidelines, identify factors affecting this compliance, and explore the link between adherence and adverse cardiac outcomes. METHODS: This prospective cohort study was conducted in a tertiary-level academic hospital between January 2022 and January 2023. Patients diagnosed with NST-ACS in the emergency department (ED) were included. The primary outcome measured was the rate of adherence to the guidelines, and secondary outcomes were factors affecting this adherence in the ED and its association with 28-day adverse cardiac outcomes. RESULTS: Of the 298 patients included, guideline adherence was achieved in 32.2% in the ED. The highest compliance was observed in performing a 12-lead electrocardiogram (ECG) within 10 minutes (99.7%), while the lowest was found for obtaining additional right and posterior ECG leads when ongoing ischemia was suspected (42.3%). Factors associated with better adherence included the experience level of the treating physician, the presence of cardiac-quality chest pain, initial ischemic ECG findings, higher initial troponin levels, and advanced history, electrocardiogram, age, risk factors, and troponin score and Charlson comorbidity index. Complete guideline adherence over 28 days was achieved in 19.1% of patients and was found to be significantly associated with lower rates of adverse cardiac outcomes. CONCLUSIONS: Adherence to NST-ACS guidelines was generally low but was associated with improved patient outcomes. This study highlighted the importance of various factors associated with guideline adherence. Future research should explore further barriers to guideline adherence and develop targeted interventions.

Evaluation of mid-buccal gingival recessions and occlusal interferences.

BACKGROUND: Dental malocclusions may cause disruption in occlusal harmony, and destructive interferences during mandibular functional movements can be seen. Ideal occlusal contacts during dynamic mandibular movements may be crucial for preventing the occurrence of mid-buccal gingival recession (mbGR). While determining mbGR risk factors in young adults, the effect of occlusal interferences on mbGR has not yet been focused on. Based on this gap, this field needs to be clarified with new studies. OBJECTIVE: The aim of this case-control study was to evaluate the relationships between the presence, extent and severity of mbGRs to dental malocclusions, occlusal interferences in anterior (AG) and lateral guidance (LG) and to determine the potential risk indicators in a young population. METHODS: A total of 149 dental students were comprised and 70 of them presented mbGR(s) and 79 did not (18-25 years, 4553 teeth). Periodontal status was assessed with full mouth bleeding (FMBS) and plaque score (FMPS), probing depth, clinical attachment level, recession depth and keratinised tissue width (KTW) by a periodontist. Malocclusions and occlusal interferences were evaluated by an orthodontist. Logistic regression analyses provided data on the effect of occlusal interferences and the other indicators towards mbGR. RESULTS: The mean of the number of teeth with mbGR(s) per subject was 4.3. The mean of the overall extent of teeth with mbGR(s) was 14.2%. FMBS, decreased KTW, self-reported bruxism, group function occlusion, increased contact number of all teeth and only premolars/molars in AG or LG and Class III malocclusions were significantly associated with the presence of mbGR. Decreased KTW presenting mbGR in the mandible and non-carious cervical lesion adjunct to mbGR significantly increased the odds of the severity of mbGR. Group function occlusion revealed higher mbGRs in premolar/molars than canine guided occlusion. CONCLUSION: Increase in the occlusal interferences in premolars/molars during lateral and anterior guidance may have an effect on the presence and severity of mbGR. Further studies should be designed to confirm these findings.

Mental health symptoms, spiritual well-being and meaning in life among older adults living in nursing homes and community dwellings.

BACKGROUND: Ageing is a process involving physical, social, psychological, spiritual and cultural changes. The elderly's personal characteristics may change, and the place where they live can lead to differences in their individual life expectations. Nursing home or community dwelling, where the elderly live can affect their psychological and spiritual well-being and their search for meaning in life. This study aimed to determine mental health symptoms, spiritual well-being and meaning in life among older adults living in nursing homes and community dwellings. METHODS: This cross-sectional study was conducted in three provinces of Turkey with the highest population of elderly people aged 60 and above. A total of 144 elderly people (71 living in nursing homes and 73 in community dwellings) participated in the study. The Descriptive Information Form, Brief Symptom Inventory (BSI), Spiritual Well-Being Scale and Meaning in Life Questionnaire were used for data collection. For the statistical analysis, the Kruskal-Wallis test, Mann-Whitney U-test and Spearman correlation analysis were applied. RESULTS: About 42.3% of the elderly living in nursing homes were aged 80 and above, while 61.6% of those living in community dwellings were in the age range of 60-69 years. The hostility score in the community-dwelling elders was statistically higher than that of elders living in nursing homes. However, the harmony with nature score was lower in the community-dwelling elders. Negative relationships were found between total spiritual well-being and depression, anxiety, negative self and somatisation. Meanwhile, existing meaning in life found positive relationships among transcendence and harmony with nature. CONCLUSIONS: The awareness of healthcare workers is very important in helping the elderly make sense of the changes they experience. Moreover these healthcare workers should undergo systematic training to help the elderly prepare for old age by making sense of preserving mental integrity and seeking meaning in their lives.