Transcutaneous auricular vagus nerve stimulation for epilepsy.

BACKGROUND: Several studies have suggested that transcutaneous vagus nerve stimulation (tVNS) may be effective for the treatment of epilepsy. However, auricular acupoint therapy (including auricular acupuncture and auricular point-sticking therapy), a method of stimulating the vagus nerve, has been poorly reviewed. This systematic review is the first to categorize auricular acupoint therapy as transcutaneous auricular vagus nerve stimulation (taVNS), aiming to assess the efficacy of taVNS in patients with epilepsy (PWE), and to analyse the results of animal experiments on the antiepileptic effects of taVNS. METHODS: We searched MEDLINE, EMBASE, Web of Science, Scopus, and various Chinese databases from their inception to June 10, 2023 and found nine clinical studies (including a total of 788 PWE) and eight preclinical studies. We performed a meta-analysis and systematic review of these articles to assess the efficacy of taVNS in PWE and the association between taVNS and electroencephalogram (EEG) changes. We also analysed the effects on epileptic behaviour, latency of the first seizure, and seizure frequency in epileptic animals. The PRISMA 2020 checklist provided by the EQUATOR Network was used in this study. RESULTS: taVNS had a higher response rate in PWE than the control treatment (OR = 2.94, 95 % CI = 1.94 - 4.46, P < 0.05). The analysis showed that the taVNS group showed wider EEG changes than the control group (OR = 2.17, 95 % CI 1.03 to 4.58, P < 0.05). The preclinical studies analysis revealed significant differences in epileptic behaviour (SMD = -4.78, 95 % CI -5.86 to -3.71, P < 0.05) and seizure frequency (SMD = -5.06, 95 % CI -5.96 to -4.15, P < 0.05) between the taVNS and control groups. No statistical difference was found in the latency of the first seizure between the two groups (SMD =13.54; 95 % CI 7.76 to 19.33, P < 0.05). CONCLUSION: Based on the available data, PWE may benefit from the use of taVNS. taVNS is an effective procedure for improving epileptic behaviour in animal models.

Technical Note: Improving the workflow in a carbon ion therapy center with custom software for enhanced patient care.

Carbon-ion radiation therapy (CIRT) is an up-and-coming modality for cancer treatment. Implementation of CIRT requires collaboration among specialists like radiation oncologists, medical physicists, and other healthcare professionals. Effective communication among team members is necessary for the success of CIRT. However, the current workflows involving data management, treatment planning, scheduling, and quality assurance (QA) can be susceptible to errors, leading to delays and decreased efficiency. With the aim of addressing these challenges, a team of medical physicists developed an in-house workflow management software using FileMaker Pro. This tool has streamlined the workflow and improved the efficiency and quality of patient care.

The Clinical Efficacy of Adding Ceftazidime/Avibactam to Standard Therapy in Treating Infections Caused by Carbapenem-Resistant Klebsiella pneumonia with blaOXA-48-like Genes.

Ceftazidime/avibactam (CAZ-AVI) is FDA-approved for managing infections caused by resistant gram-negative bacilli, particularly infections via carbapenem-resistant Enterobacterales pathogens. The clinical data are still limited, particularly those in Saudi Arabia. The present study is a retrospective cohort study that was carried out at the Armed Forces Hospital in the southern region of Saudi Arabia to compare the clinical and microbiological outcomes for CAZ-AVI-treated patients as monotherapy and as an add-on to standard therapy for carbapenem-resistant Klebsiella pneumonia (CRKP) OXA-48 infections to those treated with standard drugs. The study included CRKP OXA-48-like infected patients who were administered antibiotics for more than seven days from 1 August 2018 to May 2023. Patients' baseline characteristics and demography were extracted from the clinical records, and their clinical/microbiology efficiencies were assessed as per the corresponding definitions. Univariate and multivariate logistic regressions were conducted to identify the potential independent variable for CAZ-AVI efficiency. A total of 114 patient files were included for the evaluation. Among these patients, 64 used CAZ-AVI combined with standard therapy and were included in the intervention group, and 50 of them used standard therapy and were included in the comparative group. Following analysis, CAZ-AVI's clinical success was 42.2% (p = 0.028), while the intervention versus comparative groups showed decreased 30-day all-cause mortality (50.0% versus 70.0%; p = 0.036) and infection recurrence (7.8% versus 24.0%; p = 0.019), as well as substantially increased rates of microbial eradication (68.8% versus 42.0%; p = 0.007). CAZ-AVI add-on therapy rather than monotherapy showed statistically significant favored clinical and microbial outcomes over the standard therapy. Furthermore, sex (female %), ICU admission, and fever were negatively associated with patients' 30-day all-cause mortality, serving as independent negative factors. Only fever, CRP bio levels, inotropes, and ICU admissions were significant predictors influencing the CAZ-AVI's clinical efficiency. The duration of CAZ-AVI therapy positively influenced CAZ-AVI's microbial eradication, while both WBC counts and fever experiences were negative predictors. This study shows the effective usage of CAZ-AVI against CRKP OXA-48-like infections. The influencing independent variables depicted here should recommend that clinicians individualize the CAZ-AVI dose based on co-existing risk factors to achieve optimal survival and efficacy. Prospective multicenter and randomized control studies are recommended, with individualized CAZ-AVI precision administration implemented based on patients' characteristics.

Impact of a Reading Room Coordinator on Efficiency of On-Call Radiology Residents.

OBJECTIVES: Few level I trauma, tertiary care, academic centers have a paid, permanent reading room coordinator (RRC) to facilitate image management services during off-hour calls, to minimize interruptions to reading workflow. The purpose of this study is to investigate the effect of an RRC on the efficiency of radiology residents signing preliminary reports for emergency department (ED) and inpatient studies. METHODS: A pre- and postintervention retrospective review was performed, using carestream PACS to retrieve imaging studies read on call during two time periods-July 1 to December 1, 2019 (pre-RRC), and July 1 to December 1, 2021 (post-RRC). Efficiency of residents signing preliminary reports was measured by turnaround time (TAT), defined as the time from when a study was marked complete by a technologist to when a preliminary report was signed by a resident, in PACS. RESULTS: In the above time periods, residents interpreted a total of 64,406 studies on call. For ED studies, the mean TAT was 7.0 min shorter post-RRC, compared with pre-RRC (95% confidence interval [CI]: -7.8 to -6.1, (t = 15.50, degrees of freedom (df) = 31,866, P < .0001). The percentage of ED studies signed within 30 min increased from 57.7% to 65.8%, an increase of 8.1% (95% CI: 7.0% to 9.1%) after employing an RRC (χ2 = 228.11, df = 1, P < .0001). For inpatient studies, the mean TAT was 10.2 min shorter post-RRC (95% CI: -12.3 to -8.0, t = 9.22, df = 25,193, P < .0001). CONCLUSIONS: An RRC increased radiology resident on-call workflow efficiency, facilitating care for patients in both the ED and inpatient setting.

Attitudes on Equal Health Care Access versus Efficient Clinical Decisions across a Not-for-Profit Health Care System.

BACKGROUND: Professional roles within a hospital system may influence attitudes behind clinical decisions. OBJECTIVE: To determine participants' preferences about clinical decisions that either value equal health care access or efficiency. DESIGN: Deidentified survey asking participants to choose between offering a low-cost screening test to a whole population ("equal access") or a more sensitive, expensive test that could be given to only half of the population but resulting in 10% more avoided deaths ("efficient"). Data collection took place from August 18, 2021, to January 24, 2022. Study 1644 was determined to be exempt by Tufts Health Sciences Institutional Review Board (IRB). SETTING: Tufts Medicine Healthcare System. PARTICIPANTS: Approximately 15,000 hospital employees received an e-mail from the Tufts Medicine Senior Vice President of Academic Integration. MEASUREMENTS: Analysis of survey responses with chi-square and 1-sample t tests to determine the proportion who chose each option. Logistic regression models fit to examine relationships between professional role and test choice. RESULTS: A total of 1,346 participants completed the survey (∼9.0% response rate). Overall, approximately equal percentages of respondents chose the "equal access" (48%) and "efficient" option (52%). However, gender, professional role (categorical), and clinical role (dichotomous) were significantly associated with test choice. For example, among those in nonclinical roles, women were more likely than men to choose equal health care access. In multivariable analyses, having clinical roles was significantly associated with 1.73 times the likelihood of choosing equal access (95% confidence interval = 1.33-2.25). LIMITATIONS: Generalizability concerns and survey question wording limit the study results. CONCLUSION: Clinicians were more likely than nonclinicians to choose the equal health care access option, and health care administrators were more likely to choose efficiency. These differing attitudes can affect patient care and health care quality. HIGHLIGHTS: Divergent preferences of valuing equal health care access and efficiency may be in conflict during clinical decision making.In this cross-sectional study that included 1,346 participants, approximately equal percentages of respondents chose the "equal access" (48%) and "efficient" option (52%), a nonsignificant difference. However, gender, professional role (categorical), and clinical role (dichotomous) were significantly associated with test choiceSince clinicians were more likely than nonclinicians to choose the equal health care access option and health care administrators were more likely to choose efficiency, these differing attitudes can affect patient care and health care quality.

Improving clinical efficiency in screening for cognitive impairment due to Alzheimer's.

INTRODUCTION: To reduce demands on expert time and improve clinical efficiency, we developed a framework to evaluate whether inexpensive, accessible data could accurately classify Alzheimer's disease (AD) clinical diagnosis and predict the likelihood of progression. METHODS: We stratified relevant data into three tiers: obtainable at primary care (low-cost), mostly available at specialty visits (medium-cost), and research-only (high-cost). We trained several machine learning models, including a hierarchical model, an ensemble model, and a clustering model, to distinguish between diagnoses of cognitively unimpaired, mild cognitive impairment, and dementia due to AD. RESULTS: All models showed viable classification, but the hierarchical and ensemble models outperformed the conventional model. Classifier "error" was predictive of progression rates, and cluster membership identified subgroups with high and low risk of progression within 1.5 to 3 years. DISCUSSION: Accessible, inexpensive clinical data can be used to guide AD diagnosis and are predictive of current and future disease states. HIGHLIGHTS: Classification performance using cost-effective features was accurate and robustHierarchical classification outperformed conventional multinomial classificationClassification labels indicated significant changes in conversion risk at follow-upA clustering-classification method identified subgroups at high risk of decline.

Oxidative Stress Mediated Therapy in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of this meta-analysis is to explore all the available literature to obtain updated data about the potential use of antioxidants in the treatment of rheumatoid arthritis (RA) and its ability to reduce disease progression and cardiovascular risk. METHODS: This systematic review and meta-analysis was performed strictly in accordance with the PRISMA guidelines. English and Chinese databases were searched with a retrieval time up to March 2023. These databases included the PubMed, Embase, Medline Complete, Web of Sciences and Cochrane Collaboration, Wanfang, China National Knowledge Infrastructure, and VIP databases. This literature search was formulated by the two researchers independently. The search strategy consists of reading, collecting the literature, and conducting the preliminary screening. After that, they provide the final selection of the literature according to the inclusion criteria and data extraction. Also, for all studies, the risk bias was assessed to evaluate the quality of the included references. The content of the risk assessment of bias included the following criteria: random allocation method, allocation plan hiding, blind method, completeness of result data, and selectivity of reporting of results, as well as other biases. The main outcomes were clinical efficiency of antioxidant therapy (C-reactive protein, DAS28 score, HAQ, Number of tender joints, etc.) and oxidative stress indicators (catalase, superoxide dismutase, or total antioxidant capacity). RESULTS: We observed, in most of the studies, the small or moderate effects of antioxidant treatment. The mean effect size is 0.525, and that means that moderate effects were observed in 30 selected RCTs. Also, this effect is confirmed in the 1652 patients with RA with the mean confidence interval of 0.276 (lower limit) and 0.983 (upper limit). Cohen coefficient was calculated at 0.05. CONCLUSION: The existing evidence is that antioxidants can reduce systemic and local oxidative stress and can reduce damage as the main agent involved in autoimmune diseases such as rheumatoid arthritis.

Imaging Service Navigators: An Approach Toward More Efficient and Effective Communications.

PURPOSE: Many practices have implemented support services to assist radiologists with noninterpretive tasks; however, little research has been performed to assess the overall effect of these services. The purpose of this study was to evaluate the effect of a team of imaging service navigators (ISNs) incorporated into a practice on (1) number of communications, (2) time saved by radiologists, and (3) radiologist satisfaction with the service. METHODS: The numbers and types of reports dictated by radiologists were captured for 6-month periods before and after ISN implementation. Communication rates before and after implementation were then calculated. The amount of perceived time savings using the ISN team and satisfaction with the service were assessed through pre- and postimplementation surveys of participating radiologists. Mean and median time savings and satisfaction rates were calculated. RESULTS: The overall communication rate increased from 2.196% before ISNs to 3.278% after ISNs (49% increase; 95% confidence interval, 47%-52%). Communication rates increased among all communication subtypes (critical, urgent, routine, and actionable), with the highest increases in urgent (94%) and actionable (75%) findings. Before implementation, radiologists reported spending 39 min on average per day on communications tasks, with only 33% of radiologists indicating that the communication process was efficient. After implementation, radiologists reported mean time savings of 28 min (95% confidence interval, 19.9-35.1), and 82% of radiologists indicated a positive or highly positive view of the ISN service. CONCLUSIONS: After ISN implementation, communication rates increased and radiologists reported spending less time performing communications. Most radiologists were satisfied with the service.

Immediate or Delayed Sequential Bilateral ICL Surgery: a Survey of Chinese Ophthalmologists.

INTRODUCTION: In China, the demand for implantable collamer lens (ICL) surgery is booming. Immediate sequential bilateral ICL surgery (ISBICLS) benefits patients and clinics, but it remains controversial and lacks standardization. We aim to investigate the prevalence of, factors for, and surgeon attitudes toward ISBICLS. METHODS: In this cross-sectional survey study, an electronic questionnaire about the practice and attitudes toward performing ISBICLS or delayed sequential bilateral ICL surgery (DSBICLS) was distributed to 792 qualified ICL surgeons in Mainland China, between 4 April and 22 April 2022. RESULTS: A total of 531 surgeons (66.79%) from 30 provinces in Mainland China responded. Among them, 374 (67.23%) were currently performing ISBICLS. Fifty-two percent (277) of surgeons reported performing ISBICLS more than 50% of the time, while 85.05% of surgeons chose to perform the second eye surgery 1 day after the first eye surgery. Seventy percent (248) of surgeons performing ISBICLS chose to perform the second eye surgery less than 30 min after the first eye surgery. Surgeons who started ICL surgery earlier (before 2010, OR = 2.772, 95% CI = 1.290-5.957, P = 0.009; 2011-2013, OR = 2.479, 95% CI = 1.060-5.800, P = 0.036), completed one-eye ICL surgery faster (< 3 min, OR = 3.936, 95% CI = 1.505-10.293, P = 0.005) and modified the second eye ICL selection less frequently (1-25%, OR = 0.203, 95% CI = 0.054-0.771, P = 0.019; 26-50%, OR = 0.173, 95% CI = 0.041-0.726, P = 0.017; 51-75%, OR = 0.299, 95% CI = 0.041-0.726, P = 0.123; 76-100%, OR = 0.163, 95% CI = 0.039-0.688, P = 0.014) tended to perform ISBICLS. No significant association was found among clinical settings, preoperative measurement devices, and hospital policies with performing ISBICLS. Regarding their attitudes toward ISBICLS, 54.63% preferred ISBICLS and 45.37% preferred DSBICLS. The main supporting reasons were patient convenience (98.64%), faster vision rehabilitation (73.56%), and improved perioperative compliance (73.22%). The concerns regarding ISBICLS included the risk of endophthalmitis (62.22%), lack of recommendation in expert consensus (61.67%), and decreased vault predictability (60.93%). The most common desires for further adoption were expert consensus on surgical criteria and patient indicators for ISBICLS (82.3%). CONCLUSIONS: ISBICLS has been gradually adopted in Mainland China, but has not been widely accepted as a routine procedure. Surgeons' experience and skills mainly influence whether ISBICLS is performed. Further research is needed to explore standardized protocols to prevent endophthalmitis, the appropriate time interval of two eye surgery, and requisitions for surgeon skills.

Exploring The Future of Prosthetics and Orthotics: Harnessing The Potential of 3D Printing.

This paper explores the transformative impact of 3D printing on Orthotics and Prosthetics, focusing on enhancing patient outcomes and clinical efficiency. Over the past decade, the integration of additive manufacturing has revolutionized device fabrication, particularly in diagnostic socket production, leading to significant time reductions in patient care. This article addresses challenges such as material limitations and the need for equivalent strength to traditional sockets, exploring the use of PETG filaments and advanced printers. It emphasizes the role of digital scanning and model modification technology, highlighting affordable solutions like Structure Sensor Scanners and iPhone-based capture systems in shaping the digital workflow. The importance of a standardized digital workflow in clinical settings is discussed, showcasing reduced practitioner time and improved patient care. The paper concludes by outlining ongoing efforts to enhance patient care through automation and flexible prints. In summary, this paper provides a concise overview of the impactful advancements in Orthotics and Prosthetics through 3D printing, highlighting its potential for improved clinical efficiency and patient outcomes.

Clinical Efficiency and Safety of Hypofractionated Thoracic Radiotherapy Combined with EP Chemotherapy on Patients with Limited-stage Small-cell Lung Cancer / 肿瘤防治研究

Objective To investigate the efficacy and safety of hypofractionated thoracic radiotherapy combined with EP chemotherapy in the treatment of limited-stage small-cell lung cancer (LS-SCLC). Methods A total of 117 patients with LS-SCLC were enrolled and randomly divided into test group (n=59) and control group (n=58). Patients in the experiment group were given hypofractionated thoracic radiotherapy combined with EP chemotherapy, while patients in the control group were given hyperfractionation radiotherapy combined with EP chemotherapy. Objective response rate (ORR), 2-year overall survival (OS), 2-year progression free survival (PFS), and immune cell level were used to evaluate clinical efficacy. We compared the incidence of side effects between the two groups. Results After the treatment, the ORR of patients in the test group was higher than that in the control group (P > 0.05). The mean OS and PFS of patients in the test group were significantly longer than those in the control group (P < 0.05). The levels of CD3+, CD4+, CD4+/CD8+, and NK cells in the test group were significantly higher, whereas the levels of CD8+ were significantly lower than those in the control group (P < 0.05). The incidence of radiation pneumonitis, radiation esophagitis, and severe dermatitis in the test group was significantly lower than that in the control group (P < 0.05). Conclusion Hypofractionated radiotherapy combined with EP chemotherapy for treatment of LS-SCLC can effectively improve the anticancer efficacy and patient survival, reduce the damage to the body's immune function, and alleviate adverse reaction of radiotherapy.

Using patient flow analysis with real-time patient tracking to optimize radiation oncology consultation visits.

PURPOSE: Clinical efficiency is a key component of the value-based care model and a driver of patient satisfaction. The purpose of this study was to identify and address inefficiencies at a high-volume radiation oncology clinic. METHODS AND MATERIALS: Patient flow analysis (PFA) was used to create process maps and optimize the workflow of consultation visits in a gastrointestinal radiation oncology clinic at a large academic cancer center. Metrics such as cycle times, waiting times, and rooming times were assessed by using a real-time patient status function in the electronic medical record for 556 consults and compared between before vs after implementation of the PFA recommendations. RESULTS: The initial PFA revealed four inefficiencies: (1) protracted rooming time, (2) inefficient communications, (3) duplicated tasks, and (4) ambiguous clinical roles. We analyzed 485 consult-visits before the PFA and 71 after the PFA. The PFA recommendations led to reductions in overall median cycle time by 21% (91 min vs 72 min, p < 0.001), in cumulative waiting times by 64% (45 min vs 16 min; p < 0.001), which included waiting room time (14 min vs 5 min; p < 0.001) and wait for physician (20 min vs. 6 min; p < 0.001). Slightly less than one-quarter (22%) of consult visits before the PFA lasted > 2 h vs. 0% after implementation of the recommendations (p < 0.001). Similarly, the proportion of visits requiring < 1 h was 16% before PFA vs 34% afterward (p < 0.001). CONCLUSIONS: PFA can be used to identify clinical inefficiencies and optimize workflows in radiation oncology consultation clinics, and implementing their findings can significantly improve cycle times and waiting times. Potential downstream effects of these interventions include improved patient experience, decreased staff burnout, financial savings, and opportunities for expanding clinical capacity.

Integration of Artificial Intelligence Into Sociotechnical Work Systems-Effects of Artificial Intelligence Solutions in Medical Imaging on Clinical Efficiency: Protocol for a Systematic Literature Review.

BACKGROUND: When introducing artificial intelligence (AI) into clinical care, one of the main objectives is to improve workflow efficiency because AI-based solutions are expected to take over or support routine tasks. OBJECTIVE: This study sought to synthesize the current knowledge base on how the use of AI technologies for medical imaging affects efficiency and what facilitators or barriers moderating the impact of AI implementation have been reported. METHODS: In this systematic literature review, comprehensive literature searches will be performed in relevant electronic databases, including PubMed/MEDLINE, Embase, PsycINFO, Web of Science, IEEE Xplore, and CENTRAL. Studies in English and German published from 2000 onwards will be included. The following inclusion criteria will be applied: empirical studies targeting the workflow integration or adoption of AI-based software in medical imaging used for diagnostic purposes in a health care setting. The efficiency outcomes of interest include workflow adaptation, time to complete tasks, and workload. Two reviewers will independently screen all retrieved records, full-text articles, and extract data. The study's methodological quality will be appraised using suitable tools. The findings will be described qualitatively, and a meta-analysis will be performed, if possible. Furthermore, a narrative synthesis approach that focuses on work system factors affecting the integration of AI technologies reported in eligible studies will be adopted. RESULTS: This review is anticipated to begin in September 2022 and will be completed in April 2023. CONCLUSIONS: This systematic review and synthesis aims to summarize the existing knowledge on efficiency improvements in medical imaging through the integration of AI into clinical workflows. Moreover, it will extract the facilitators and barriers of the AI implementation process in clinical care settings. Therefore, our findings have implications for future clinical implementation processes of AI-based solutions, with a particular focus on diagnostic procedures. This review is additionally expected to identify research gaps regarding the focus on seamless workflow integration of novel technologies in clinical settings. TRIAL REGISTRATION: PROSPERO CRD42022303439; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=303439. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40485.

The association between phase of illness and resource utilisation-a potential model for demonstrating clinical efficiency?

Background: Healthcare efficiency involves demonstrating flexible inter-relationships between resource utilisation and patient need. In palliative care, five phases of patient illness have been identified: stable, unstable, deteriorating, terminal and bereaved. Evaluating the association between phase of illness and nursing activities could demonstrate clinical efficiency. Aim: The aim of this study was to evaluate the association between the phase of illness and the intensity of nursing care in a specialist palliative care unit. Methods: This was a prospective, observational cohort study of consecutive admissions (n=400) to a specialist palliative care unit. Patient phase of illness was documented on admission and daily thereafter. A nursing activity tool was developed, which scored daily nursing interventions (physical, psychological, family care and symptom control). This score was called the nursing total score (NTS) and reflected the intensity of nursing activities. Data were entered into SPSS and descriptive statistics weregenerated. Results: A total of 342 (85%) patients had full data recorded on admission. Stable, unstable, deteriorating and terminal phases were associated with progressively increasing median NTSs on days 1, 2, 3 and 4 (all P<0.01). Phase stabilisation from the unstable to the stable phase during this timeframe resulted in reductions in physical care (p=0.038), symptom management (p=0.007) and near-significant reductions in family support (p=0.06). Conclusion: A significant association was demonstrated between phase of illness and intensity of nursing activities, which were sensitive to phase changes, from unstable to stable. This demonstrates technically efficient resource utilisation and identifies a potential efficiency model for future evaluations of inpatient palliative care.

Comparative Evaluation of Ease of Dental Treatment and Clinical Efficiency of Midazolam vs Midazolam and Ketamine Combination for Sedation in Young Uncooperative Pediatric Patients: A Systematic Review.

Aim: To assess and compare the effectiveness of midazolam vs midazolam and ketamine combination in the management of young uncooperative pediatric patients. Materials and methods: The research question was developed by using population, intervention, comparison, outcome, and study design framework. The literature search was performed using three electronic databases: PubMed, Scopus, and EBSCOhost. The risk of bias of the studies was independently appraised using the Cochrane Handbook for Systematic Reviews of Interventions. Results: Out of 98 preliminary records, five studies were selected for analysis. Three hundred forty-six uncooperative children were randomized through the five randomized controlled trials (RCTs), with a mean age of 5.8 years. Midazolam with ketamine was the most successful combination for delivering rapid and sufficient analgosedation in uncooperative children. The clinical efficiency of midazolam and ketamine combination had an overall success rate of 84% when compared to ketamine and midazolam alone. 50% of children in the midazolam and ketamine group demonstrated calm behavior, compared to 37% in the midazolam group. 44% of the children experienced modest intra and/or postoperative adverse effects that did not necessitate any special treatment. Conclusion: Midazolam and ketamine combination is more efficient than midazolam alone with respect to ease of treatment and clinical efficiency. How to cite this article: Rathi GV, Padawe D, Takate V, et al. Comparative Evaluation of Ease of Dental Treatment and Clinical Efficiency of Midazolam vs Midazolam and Ketamine Combination for Sedation in Young Uncooperative Pediatric Patients: A Systematic Review. Int J Clin Pediatr Dent 2022;15(6):680-686.

[Clinical efficiency of holmium laser enucleation of the prostate for small-volume benign prostatic hyperplasia with severe LUTS].

OBJECTIVE: To evaluate the safety and clinical efficiency of holmium laser enucleation of the prostate (HoLEP) in the treatment of small-volume BPH (SBPH) complicated by severe lower urinary tract symptoms (LUTS). METHODS: We retrospectively analyzed the clinical data on 82 cases of SBPH with severe LUTS treated by HoLEP from January 2017 to December 2018. The patients were aged (65.5 ± 7.6) years, with a mean prostate volume of <40 ml, a total IPSS of 24.8 ± 4.6, a QOL score of 5.2 ± 0.8, the maximum urinary flow rate (Qmax) of (7.6 ± 3.7) ml/s, and a mean PSA level of (1.8 ± 1.4) µg/L. RESULTS: All the operations were successfully completed, the mean operation time averaging (30.2 ± 5.0) min, enucleation time (26.7 ± 5.6) min and comminution time (3.5 ± 1.1) min, and the enucleated tissue weighing (20.3 ± 4.9) g. After surgery, the bladders were irrigated for (3.5 ± 1.9) h, with (3.0 ± 1.7) L of rinse solution, and catheterization lasted (24.8 ± 9.7) h. Histopathology revealed moderate or severe lymphocytic infiltration in 69 cases (84.1%). At 6 months after operation, significant improvement was observed in the IPSS, QOL, Qmax and PSA level compared with the baseline (P < 0.05). To date, no urethral stricture-related reoperation was ever necessitated. CONCLUSIONS: HoLEP is safe and effective for the treatment of SBPH complicated by severe LUTS and can be employed after adequate preoperative evaluation of the patient.《.

A Novel Shorthand Approach to Knee Bone Age Using MRI: A Validation and Reliability Study.

BACKGROUND: Bone-age determination remains a difficult process. An atlas for bone age has been created from knee-ossification patterns on magnetic resonance imaging (MRI), thereby avoiding the need for radiographs and associated costs, radiation exposure, and clinical inefficiency. Shorthand methods for bone age can be less time-consuming and require less extensive training as compared with conventional methods. PURPOSE: To create and validate a novel shorthand algorithm for bone age based on knee MRIs that could correlate with conventional hand bone age and demonstrate reliability across medical trainees. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Included in this study were adolescent patients who underwent both knee MRI and hand bone age radiographs within 90 days between 2009 and 2018. A stepwise algorithm for predicting bone age using knee MRI was developed separately for male and female patients, and 7 raters at varying levels of training used the algorithm to determine the bone age for each MRI. The shorthand algorithm was validated using Spearman rho (r S) to correlate each rater's predicted MRI bone age with the recorded Greulich and Pyle (G&P) hand bone age. Interrater and intrarater reliability were also calculated using intraclass correlation coefficients (ICCs). RESULTS: A total of 38 patients (44.7% female) underwent imaging at a mean age of 12.8 years (range, 9.3-15.7 years). Shorthand knee MRI bone age scores were strongly correlated with G&P hand bone age (r S = 0.83; P < .001). The shorthand algorithm was a valid predictor of G&P hand bone age regardless of level of training, as medical students (r S = 0.75), residents (r S = 0.81), and attending physicians (r S = 0.84) performed similarly. The interrater reliability of our shorthand algorithm was 0.81 (95% CI, 0.73-0.88), indicating good to excellent interobserver agreement. Respondents also demonstrated consistency, with 6 of 7 raters demonstrating excellent intrarater reliability (median ICC, 0.86 [range, 0.68-0.96]). CONCLUSION: This shorthand algorithm is a consistent, reliable, and valid way to determine skeletal maturity using knee MRI in patients aged 9 to 16 years and can be utilized across different levels of orthopaedic and radiographic expertise. This method is readily applicable in a clinical setting and may reduce the need for routine hand bone age radiographs.

Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination.

Nearly all patients interact with critical gatekeepers-insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.

Impact of a medical scribe on clinical efficiency and quality in an academic general internal medicine practice.

BACKGROUND: Scribes have been proposed as an intervention to decrease physician electronic health record (EHR) workload and improve clinical quality. We aimed to assess the impact of a scribe on clinical efficiency and quality in an academic internal medicine practice. METHODS: Six faculty physicians worked with one scribe at an urban academic general internal medicine clinic April through June 2017. Patient visits during the 3 months prior to intervention (baseline, n = 789), unscribed visits during the intervention (concurrent control, n = 605), and scribed visits (n = 579) were included in the study. Clinical efficiency outcomes included time to close encounter, patient time in clinic, and number of visits per clinic session. Quality outcomes included EHR note quality, rates of medication and immunization review, population of patient instructions, reconciliation of outside information, and completion of preventative health recommendations. RESULTS: Median time to close encounter (IQR) was lower for scribed visits [0.4 (4.8) days] compared to baseline and unscribed visits [1.2 (5.9) and 2.9 (5.4) days, both p < 0.001]. Scribed notes were more likely to have a clear history of present illness (HPI) [OR = 7.30 (2.35-22.7), p = 0.001] and sufficient HPI information [OR = 2.21 (1.13-4.35), p = 0.02] compared to unscribed notes. Physicians were more likely to review the medication list during scribed vs. baseline visits [OR = 1.70 (1.22-2.35), p = 0.002]. No differences were found in the number of visits per clinic session, patient time in clinic, completion of preventative health recommendations, or other outcomes. CONCLUSIONS: Working with a scribe in an academic internal medicine practice was associated with more timely documentation.

Clinical Efficiency of Non-invasive Prenatal Screening for Common Trisomies in Low-Risk and Twin Pregnancies.

To evaluate the clinical efficiency of non-invasive prenatal screening (NIPS) for fetal aneuploidies in low-risk and twin pregnancies, patients who received NIPS in a tertiary university hospital were enrolled, and their clinical data, NIPS results and pregnancy outcomes were collected. Patients were divided into singleton and twin pregnancies, and then those with singleton pregnancies were divided into low- and high-risk pregnancies. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated. Comparisons were made on the clinical efficiency of NIPS between singleton and twin pregnancies, as well as between low- and high-risk pregnancies. Of 66,172 patients enrolled, 59,962 were eligible for analysis. The sensitivity, specificity and NPV were ≥ 99% in singleton and twin pregnancies. The PPVs were 90.4, 56.6, and 13.0% in singleton pregnancies, while 100, 33.3, and 0% in twin pregnancies for trisomy 21 (T21), trisomy 18 (T18) and trisomy 13 (T13), respectively (P > 0.05 for all). The PPVs were 97.4 and 90.0% in high-risk pregnancies, while 78.6 and 16.7% in low-risk pregnancies for T21 and T18, respectively (P < 0.05 for all). In summary, the performance of NIPS in singleton pregnancies was similar to that in twin pregnancies. NIPS can be recommended for all pregnancies regardless of the risks.