Empathy development through game-based learning: An investigative study on nursing professionals.

BACKGROUND: Empathy is at the core of patient-centred care. Evidence has continually found that empathy helps foster therapeutic relationships and is essential in the delivery of quality healthcare. In India, many factors are barriers to empathy for nursing professionals. OBJECTIVES: DESIGN AND METHODS: The IDEO design thinking process was followed to design the game. A focus group discussion with 18 nurses helped identify relevant scenarios and barriers to empathy. A scenario of an interaction between a nurse and a cancer patient was identified to create the game. The game mechanics, rubrics, and scenarios were built based on feedback from diverse professionals consisting of doctors, nurses, and UX designers. A learner feedback form assessing usability, contextual specificity, engagement, and perceived learnability was created and its reliability was tested. The game was tested on 60 nurses, followed by administration of the learner feedback form. To assess changes in empathy, an empathy scale was administered before the intervention and seven days after the intervention on 20 nurses. RESULTS: The learner feedback form was found to have Cronbach's Alpha >0.70, and therefore reliable. The responses to the learner feedback form were analysed using the Chi Square test and were found to be positive and statistically significant (p-value<0.001). The differences in pretest and posttest empathy scores were analysed using the Wilcoxon Signed Ranks test and were found to be statistically significant as well (p-value<0.001). CONCLUSIONS: The positive response to the learner feedback form, and the improvement in empathy scores after the intervention, indicates that games have a potential role in teaching empathy to Nursing Professionals.

A mixed-method study to develop and evaluate a structured therapeutic communication module on psychological distress and perceived needs among caregivers of critically ill patients in Critical Care Units.

AIMS AND OBJECTIVES: To develop and evaluate the effectiveness of a structured therapeutic communication module on psychological distress and perceived needs among caregivers of critically ill patients. BACKGROUND: Caregivers of critically ill patients experience intense psychological distress, and their needs often go unexpressed or unidentified. Structured therapeutic communication enables nurses to explore and fulfill these needs. METHOD: A mixed-method study was conducted among 30 caregivers of critically ill patients. During phase one, a qualitative interview was conducted, and a structured therapeutic communication module was developed based on Hildegard Peplau's Interpersonal Relations Theory. In the second phase, one group pre-test and post-test design was adopted. The Hospital Anxiety and Depression Scale (HADS) and a Semi-structured interview schedule were used to assess psychological distress and perceived needs, respectively. RESULTS: Half of (50 %) the caregivers reported a high level of anxiety before intervention, with a mean of 11.30 (SD: 4.0), and 66.7 % of them had a high level of depression, with a mean of 12.03 (SD: 0.08). There was a statistically significant difference in anxiety (CI: 0.451-2.016) and depression (CI: 0.261-1.538) before and after the intervention. The qualitative analysis revealed unmet needs perceived by caregivers. CONCLUSION: Using a structured therapeutic communication module helps nurses to alleviate the psychological distress experienced by caregivers of CCU patients. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be sensitive to the unexpressed needs of caregivers of critically ill patients. The structured therapeutic communication modules can be integrated into routine nursing care practice to ensure family-centered care.

Adverse pregnancy outcomes in maternal malarial infection: A systematic review and meta-analysis.

Background: Malaria in pregnancy is a critical public health issue that can lead to severe adverse outcomes for both mother and fetus. This systematic review and meta-analysis evaluated the prevalence of adverse birth outcomes in malaria-infected pregnancies and examines their association with the condition. Method: We searched databases up to January 30, 2024, for observational studies on pregnant women with malaria. Data were analyzed using a random-effects model to calculate pooled prevalence rates and risk ratios (RRs) for adverse outcomes, with statistical support from R software version 4.3. Results: Thirty-one studies were included, showing high prevalence of low birth weight (LBW; 17.4 %), preterm birth (17.9 %), and small for gestational age (SGA; 16.1 %) in malaria-affected pregnancies. Infected mothers were significantly more likely to have LBW infants (RR = 1.755), preterm births (RR = 1.484), and SGA infants (RR = 1.554). The risk of stillbirth was not significantly increased (RR = 1.238). Conclusion: Malaria in pregnancy significantly elevates the risk of LBW, preterm birth, and SGA, underscoring the need for effective malaria prevention and treatment strategies in endemic regions. Future research should aim to refine and implement these strategies to enhance maternal and neonatal health outcomes.

Liquid drop interferometry on reflective surfaces.

We resolve the main bottleneck of achieving optimal fringe contrast on highly reflective surfaces through the innovative application of rear surface mirrors, unveiling a pioneering approach to precision measurements exemplified by the modified liquid drop interferometry (LDI) technique. By utilizing a liquid drop on a highly reflective surface, the need for a reference lens with a specific coating is eliminated, showcasing the technique's versatility. Furthermore, we first validate a novel, to our knowledge, expression for p-polarization-dependent radiation pressure, addressing a century-old problem reported in the literature. Beyond advancing measurement techniques, this study broadens the scope of applications requiring high precision, particularly in nanotechnology and surface characterization of metallic-coated surfaces.

Outcomes of definite vs probable/presumed cardiac sarcoidosis: a systematic review and meta-analysis.

BACKGROUND: Diagnosing cardiac sarcoidosis (CS), which can be associated with arrhythmias and heart failure, remains challenging despite multiple advances over time. The 2014 Heart Rhythm Society (HRS) consensus statement recommends an endomyocardial biopsy (EMB) to establish a definite diagnosis of CS. In the absence of a positive EMB, a diagnosis of probable or presumed CS is made on the basis of clinical and imaging criteria. OBJECTIVE: To investigate whether there is any difference in outcomes between definite vs probable/presumed CS. METHODS: PubMed/MEDLINE, Embase, and the Cochrane Library databases were searched for relevant studies published after 2014. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using the random effects model and presented in forest plots. RESULTS: 6 studies involving 2,103 patients were identified. The cohort had a mean age of 56.8 years (SD:±13.6 years). The median duration of follow-up was 40.5 months. No statistically significant difference was observed between definite and probable/presumed CS for reduced risk of the composite endpoint (RR: 1.06, 95% CI: 0.66 to 1.72), all-cause death (RR: 1.03, 95% CI: 0.73 to 1.46), sudden cardiac death (RR: 1.59, 95% CI: 0.99 to 2.56), arrhythmias (RR: 0.80, 95% CI: 0.60 to 1.07), and HF-related hospitalizations (RR: 0.91, 95% CI: 0.59 to 1.38). CONCLUSION: This meta-analysis demonstrated the equivalence of clinical course and prognosis between definite and probable/presumed CS. This highlights the importance of a multi-disciplinary approach to CS care and emphasizes that histological confirmation should not be a prerequisite to diagnose or manage this condition.

Assessment of Thrombotic Complications among Coronavirus Disease 2019 Positive Hospitalized Patients at One of Government Tertiary Care Centres of Gujarat: A Retrospective Observational Study.

OBJECTIVES: The objectives of the study were to (1) study risk factors of thrombotic complications in coronavirus disease 2019 (COVID-19) pneumonitis, and (2) study progression of thrombotic complications after COVID-19 pneumonitis and its outcome. MATERIALS AND METHODS: A total of 50 COVID-19-positive admitted patients were studied using a purposive random sampling method. A questionnaire was used to collect data from patients' case records. RESULTS: Diabetes (42%) and hypertension (40%) were common comorbidities. The most common presentation of patients was thromboembolism, followed by cerebrovascular accident (CVA) and myocardial infarction (MI). Around 32% of patients died during the course of treatment. Deaths were more commonly seen in the age-group of 56 years or above than in those below 56 years. Death rates were higher among the group of patients with diabetes, hypertension, and ischemic heart diseases than the group of patients without those diseases, respectively. Patients in whom intubation was needed had a higher death rate than those without the need for it. The mean C-reactive protein (CRP) value was higher in patients who died than in those who survived. The death rate was lower in patients who were thrombolysed than in those who were not, in both pulmonary embolism and MI cases. CONCLUSION: The most common age-group admitted to the hospital was 46-55 years. The two most common underlying risk factors were diabetes and hypertension. Three common presentations of patients were thromboembolism, followed by CVA and MI. Around 32% of patients died during the course of treatment. Deaths were more commonly seen in the age-group of 56 years or above than in those below 56 years. Death rates were higher among the group of patients with diabetes, hypertension, and ischemic heart diseases than the group of patients without those diseases, respectively. Patients in whom intubation was needed had a higher death rate than those without the need for it. The mean CRP value was higher in patients who died than in those who survived.

Clinical outcomes with cardiac resynchronization therapy in patients with Cardiac Sarcoidosis: A systematic review and proportional meta-analysis.

BACKGROUND: Cardiac sarcoidosis (CS) is an inflammatory condition that can present with heart failure (HF). Cardiac resynchronization therapy (CRT) is known to improve clinical outcomes for patients with left bundle branch block in the general HF population. However, data about the outcomes of CRT in CS is limited. METHODS: A systematic literature search was conducted using PubMed/Medline, Embase, and the Cochrane Library from inception to February 2024 to identify studies that reported clinical outcomes following the use of CRT in patients with CS. Data for outcomes was extracted, pooled, and analyzed. OpenMetaAnalyst was used for pooling untransformed proportions along with the corresponding 95 % confidence intervals (CIs). RESULTS: Five studies with a total of 176 CS patients who received CRT were included. The pooled incidence for all-cause mortality was 7.6 % (95 % CI: -3 % to 18 %), for HF-related hospitalizations 23.2 % (95 % CI: 2 % to 43 %), and for major adverse cerebral and cardiovascular events 27 % (95 % CI: 8 % to 45 %) after a mean follow-up of 60.1 (±48.7) months. The pooled left ventricular ejection fraction (LVEF) was 34.28 % (95 % CI: 29.88 % to 38.68 %) demonstrating an improvement of 3.75 % in LVEF from baseline LVEF of 30.58 % (95 % CI: 24.68 % to 36.48 %). The mean New York Heart Association (NYHA) functional class was 2.16 (95 % CI: 1.47 to 2.84) after CRT as compared to the baseline mean NYHA of 2.58 (95 % CI: 2.29 to 2.86). CONCLUSION: Although improvements were observed in LVEF and mean NYHA, mortality was high in CS patients with CRT.

Impact of age at first calving on fertility and production performance in Murrah buffalo.

The present study analyses the effect of age at first calving (AFC) on future fertility and productivity in Murrah buffaloes. The data of 314 buffalo heifers of animal farm section, ICAR-CIRB, Hisar were collected over a period of 9 years from 2010 to 2018. The buffalo heifers were categorized into six groups according to the AFC named as 30-35, 36-41, 42-47, 48-53, 54-59 and 60-65 months. The influence of AFC on standard lactation milk (SLMY), peak yield (PY), days in milk (DIM), calving to first service, service per conception, calving to conception interval (CCI) and calving interval till fifth lactation were studied. The study revealed poor productive traits in buffalo heifers calved at younger age (30-35 months) during first parity. The productive value positively corresponded with increase in AFC. During successive lactations, higher mean milk yield (SLMY and PY) was found in groups with 36-41, 42-47 and 48-53 months. The mean number of services per conception was lower in buffalo heifers with 36-41 and 42-47 months following first calving till fifth lactation. Similarly, the said groups had lower mean calving to first service, CCI and CI up to fifth lactation. The survival rate was higher in heifers with AFC 36-41, 42-47, 48-53 and 54-59 months than with AFC 30-35 and 60-65 months. The buffalo heifers with 36-41 and 42-47 months of AFC had higher survival rate and better productive and reproductive traits till fifth parity in the current study. The study concluded that a minimum ideal AFC of 36-41 months yielded the highest productive gain.

Adverse cardiovascular outcomes associated with proton pump inhibitor use after percutaneous coronary intervention: a systematic review and meta-analysis.

BACKGROUND: Proton pump inhibitors (PPIs) are commonly prescribed for gastroprotection in patients undergoing percutaneous coronary intervention (PCI), who are at increased risk of gastrointestinal bleeding due to antiplatelet therapy. However, emerging evidence suggests that PPIs may adversely impact cardiovascular outcomes. This systematic review and meta-analysis sought to assess the relationship between using PPIs and cardiovascular outcomes in patients following PCI. METHODS: We searched various databases up to March 15, 2024, for observational studies and randomized controlled trials (RCTs) assessing the cardiovascular effects of PPIs in PCI patients. Data were extracted on study characteristics, patient demographics, PPI use, and cardiovascular outcomes. The Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool 2 assessed study quality. Meta-analyses were conducted using a random-effects model using R software version 4.3. RESULTS: A total of 21 studies involving diverse populations and study designs were included. Observational studies suggested a moderate increase in risk for composite cardiovascular diseases (CVD), myocardial infarction (MI), and major adverse cardiac events (MACE) associated with PPI use, with pooled hazard ratios (HRs) of 1.20 (95% CI: 1.093-1.308) for CVD, 1.186 (95% CI: 1.069-1.303) for MI, and 1.155 (95% CI: 1.001-1.309) for MACE. However, RCTs showed no significant link between PPI therapy and negative cardiovascular events (Relative Risk: 1.016, 95% CI: 0.878-1.175). Substantial heterogeneity was observed among observational studies but not RCTs. CONCLUSION: The findings indicate that while observational studies suggest a potential risk of adverse cardiovascular events with post-PCI use of PPI, RCTs do not support this association. Further large-scale, high-quality studies are required to understand the cardiovascular implications of individual PPIs better and optimize patient management post-PCI. This analysis shows the complexity of PPI use in patients with coronary artery diseases and the necessity to balance gastroprotective benefits against potential cardiovascular risks.

Sex disparities in cardiac sarcoidosis patients undergoing implantable cardioverter-defibrillator implantation.

INTRODUCTION: In patients with cardiac sarcoidosis (CS), implantable cardioverter-defibrillators (ICDs) are important for preventing sudden cardiac death. This study aimed to investigate sex disparities in CS patients undergoing ICD implantation. METHODS: The 2016-2020 National Inpatient Sample (NIS) database compared the characteristics and outcomes of males and females with CS receiving ICDs. RESULTS: Among 760 CS patients who underwent inpatient ICD implantation, 66.4% were male. Males were younger (55.0 vs. 56.9 years, p < .01), had higher rates of diabetes (31.7% vs. 21.6%, p < .01) and chronic kidney disease (CKD) (16.8% vs. 7.8%, p < .01) but lower prevalence of atrial fibrillation (AF) (11.9% vs. 23.5%, p < .01), sick sinus syndrome (4.0% vs. 7.8%, p = .024), ventricular fibrillation (VF) (9.9% vs. 15.7%, p = .02), and black ancestry (31.9% vs. 58.0%, p < .01). Unadjusted major adverse cardiovascular events (MACE), defined as a composite of in-hospital death, myocardial infarction (MI), and ischemic stroke, was higher in females (11.8% vs. 6.9%, p = .024), but when adjusted for age and tCharlson Comorbidity Index (CCI), females demonstrated significantly lower odds of experiencing MACE (aOR: 0.048, 95% CI: 0.006-0.395, p = .005). Incidence of acute kidney injury (AKI) post-ICD was significantly lower in females (15.7% vs. 23.8%, p = .01) as was the adjusted odds (aOR: 0.282, 95% CI: 0.146-0.546, p < .01). There was comparable mean length of stay and hospital charges. CONCLUSION: ICD utilization in CS patients is more common among males, who have a higher prevalence of diabetes and CKD but a lower prevalence of AF, sick sinus syndrome, and VF. Adjusted MACE and AKI were significantly lower in females.

Scalable organocatalytic one pot asymmetric Strecker reaction via camphor sulfonyl functionalized crown-ether-tethered calix[4]arene.

In this communication, we designed a highly selective camphor sulfonyl functionalized crown-ether-tethered calix[4]arene-derived organocatalyst for asymmetric Strecker reaction to provide the desired cyano adducts in high yields (∼99.9% yield) and enantioselectivities (up to 99.3% ee). Furthermore, 2 step facile syntheses of the antiplatelet drug (S)-clopidogrel exemplify the potential of this method for the preparation of commercial compounds.

Cardiac sarcoidosis and neurosarcoidosis - multidisciplinary approach for diagnosis.

PURPOSE OF REVIEW: The current review aims to highlight the role of multidisciplinary approach in the diagnosis of patients with cardiac and neurosarcoidosis. Multidisciplinary approach integrates the available clinical information, imaging and histopathological results aiming to reach a definite or at least provisional diagnosis and allow appropriate management. Multidisciplinary approach is the reference standard for diagnosis of interstitial lung disease and should be strongly considered in complex clinical conditions such as cardiac sarcoidosis (CS) and neurosarcoidosis. RECENT FINDINGS: Histopathological confirmation of noncaseating granulomatous inflammation provides a definite diagnosis of sarcoidosis involving any organ. However, a provisional high confidence or even definite clinical diagnosis can be reached using multidisciplinary evaluation of all available evidence. The diagnosis of cardiac sarcoidosis and neurosarcoidosis requires the integration of different expertise based on the current diagnostic criteria sets. Identifying typical or at least compatible patterns on advanced imaging modalities (CMR and Fluro-Deoxy-Glucose Positron Emission Tomography (FDG-PET)) seems key for the diagnosis of CS, while a confident diagnosis of extra-cardiac disease supports an at least provisional diagnosis. Similarly, in neurosarcoidosis integrating compatible MRI appearances and cerebrospinal fluid results in patients with systemic sarcoidosis allows an at least provisional diagnosis. Exclusion of alternative differential diagnoses is crucial and requires high clinical suspicion, imaging review expertise and appropriate tests performance. SUMMARY: There have been considerable advances in the diagnostic approach of patients with cardiac and neurosarcoidosis. Multidisciplinary approach for both diagnosis and management is required to reach a confident clinical diagnosis and should be applied when possible.

Academic Neurosurgery in Nigeria- Past, Present, and Future: A Review.

Nigeria's neurosurgical field faces profound challenges, including a critically low neurosurgeon-to-patient ratio and significant migration of medical professionals to developed countries. High costs, low socioeconomic status, and the urban-centric location of neurosurgical centers impede access to care. Key barriers to service delivery include lack of manpower, insufficient emergency care, limited imaging modalities, inadequate operative equipment, and ineffective political and administrative policies. Neurotrauma is the primary reason for neurosurgical intervention but is poorly managed due to delayed access and insufficient guidelines. The neurosurgical education system is strained by limited training capacity and the absence of subspecializations, restricting specialized care. Research output is low, hindered by limited infrastructure, lack of databases, insufficient funding, and minimal international collaboration. To address these issues, it is critical to enhance the imaging capabilities, ensure the availability of operative equipment, and establish effective policies for task sharing and communication at different levels of care. Other approaches include expanding training capacity, particularly in rural areas, implementing a uniform match system for residency, addressing gender disparities, and utilizing dual practice to ensure adequate compensation for neurosurgeons. Furthermore, stakeholders should develop subspecialization programs in areas such as neurovascular, neuro-oncology, pediatric neurosurgery, and minimally invasive neurosurgery to expand service scope. To transform the neurosurgical research landscape, efforts should be made to establish electronic medical databases, foster international collaborations to ensure funding, and make research mandatory for accreditation renewal to ensure continuous academic contribution.

The role of infliximab in treating refractory cardiac sarcoidosis. Case series and systematic review of literature.

Cardiac sarcoidosis is associated with significant morbidity and mortality. Immunosuppressive treatment focuses on suppressing myocardial inflammation, which can lead to major adverse events especially when progressing to fibrosis. Conventional management usually includes steroids and steroid sparing agents such as methotrexate and azathioprine. Tumour necrosis factor alpha inhibitors are often reserved for those with a worsening clinical status and/or evidence of persistent inflammatory activity despite conventional therapy. Refractory cardiac sarcoidosis (CS) can be defined as the persistence or progression of active disease, evidenced either by lack of clinical response or persistence or progression of imaging abnormalities, despite being on conventional therapy. In the United Kingdom, tumour necrosis factor alpha inhibitors are currently not licensed for cardiac sarcoidosis as there are no randomised controlled trials to assess the efficacy of infliximab in this patient cohort. In this study, we present the outcomes of six patients treated with infliximab for refractory cardiac sarcoidosis at Royal Brompton Hospital and performed a systematic review of the existing literature on use of infliximab in cardiac sarcoidosis. We searched the Cochrane Library, OVID Medline, OVID Embase, Web of Science and Pubmed to identify 7 full-text studies assessing the role of infliximab in the management of cardiac sarcoidosis. Infliximab was found to play a vital role in stabilising refractory cardiac sarcoidosis by stemming clinical deterioration, arrythmia burden and even reducing steroids requirements. Further prospective trial data is necessary to validate these findings.

Characterization, phytochemical profiling, antioxidant, and cytotoxicity of underutilized medicinal plants and composite flour.

In this investigation, three medicinal plant powders and a composite flour developed from them were analyzed. FESEM/EDS illustrated irregularly shaped particles in the plant powders except for Withania, which had round to oval shape particles. XRD analysis displayed a semi-crystalline nature of powders, except for Asparagus, which showed amorphous behavior. Both methanol and ethanol plant extracts exhibited significantly higher antioxidants, total phenols, and cell viability. Amongst, optimized composite flour (OCF) methanolic extract demonstrated the highest total phenolic content (69.2 ± 0.11 µg GAE/ml), potent cell viability against A549 cells (3.35 ± 0.15% at 50 µg/ml), and strong free-radical scavenging activity (48.89 ± 0.67 at 200 µg/ml). GCMS and FTIR analyses of the methanolic extracts demonstrated the presence of essential phytoconstituents and functional groups. In silico studies of the phytocomponents, ethyl isoallocholate, 3-Deoxy-d-mannoic lactone, and 4,5-Diamino-2-hydroxypyrimidine suggested good binding affinity against BAX, P53, and EGFR proteins with no toxicity and a good drug score.