The public health risks of counterfeit pills.

Synthetic illicit drugs, such as nitazenes and fentanyls, are becoming commonplace in countries around the world, including in Europe, Australia, and Latin America, which raises concern for overdose crises like those seen in North America. An important dimension of the risk represented by synthetic drugs is the fact that they are increasingly packaged in counterfeit pill form. These pills-often indistinguishable from authentic pharmaceuticals-have substantially widened the scope of populations susceptible to synthetic drug overdose in North America (eg, among adolescents experimenting with pills or tourists from the USA seeking psychoactive medications from pharmacies in Mexico).

Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications.

Purpose: This study evaluated the impact of choosing the right versus left internal jugular vein (IJV) for initial central venous catheter (CVC) placement on hemodialysis catheter-related outcomes in critically ill patients.

Materials And Methods: Medical records from the University of Maryland Medical Center were reviewed for adult critical care patients who received an IJV CVC between January 1, 2019, and December 31, 2022, and later required an additional temporary hemodialysis catheter.

Results: The study included 214 patients, with 100 (46.

Nursing Practices for Preventing Delirium in Patients with Cancer with Prognoses of Months and Weeks: A Multi-Site Cross-Sectional Study in Japan.

Background: Delirium is a condition characterized by an acute and transient disturbance in attention, cognition, and consciousness. It is increasingly prevalent at the end of life in patients with cancer. While non-pharmacological nursing interventions are essential for delirium prevention, their effectiveness in terminally ill patients with cancer remains unclear.

The correlation between discrepancies in clinical and pathological T stages and overall survival in upper urinary tract urothelial carcinoma: Analysis of the hospital-based cancer registry data in Japan.

Objective: Our study assessed the correlation between discrepancies in clinical and pathological T stages and overall survival (OS) in patients with upper urinary tract urothelial carcinoma (UTUC), including renal pelvis (UCP) and ureter (UCU) carcinoma, treated with radical surgery.

Methods: We utilized data from the Japanese Hospital-Based Cancer Registry (HBCR) to identify UTUC cases (n = 2376), consisting of UCP cases (n = 1196) and UCU cases (n = 1180), diagnosed with cTa-3N0M0 between 2012 and 2013. All cases were histologically confirmed and treated solely with radical surgery, excluding any chemotherapy or radiotherapy.

Blood glucose levels in out-of-hospital cardiac arrest undergoing targeted temperature management and ECPR.

Aim: Targeted temperature management (TTM) for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) has not been fully studied. This study aimed to investigate the association between blood glucose levels during TTM and neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients undergoing ECPR.

Methods: This was a secondary analysis of the SAVE-J II study, a retrospective, multicenter study of OHCA patients treated with ECPR in Japan.

Exercise therapy can effectively improve trunk performance and sitting balance in spinal cord injury: a systematic review and meta-analysis.

Objective: To determine the effects of exercise on trunk performance and balance in patients with spinal cord injury (SCI).

Methods: We searched the databases MEDLINE, Cochrane Library, EMBASE, Physiotherapy Evidence Database, Web of Science, PsycINFO, and CINAHL from inception to June 2020. Our search targeted studies such as randomized or non-randomized controlled trials and randomized crossover trials that evaluated the effects of exercise on trunk performance and balance in patients with SCI.

The relationship between symptoms and regurgitant severity in primary mitral regurgitation: a cardiovascular magnetic resonance study.

In the ACC/AHA guidelines, the presence of symptoms plays a central role in determining timing surgery in primary mitral regurgitation (MR). Studies have shown a disconnect between the severity of MR and symptoms. The purpose of this study is to assess risk factors for symptoms in patients with chronic primary MR.

Splenic artery embolization for trauma: a narrative review.

The management of traumatic splenic injuries has evolved significantly over the past several decades, with the majority of these injuries now being treated nonoperatively. Patients who exhibit hemodynamic instability upon initial evaluation typically require surgical intervention, while the remainder are managed conservatively. Conservative treatment for traumatic splenic injuries encompasses both medical management and splenic artery angiography, followed by embolization in cases where patients exhibit clinical signs of ongoing splenic hemorrhage.

Observational study of the third delay in emergency obstetric triage at the referral national hospital in Tanzania: Baseline survey.

Aim: This study aimed to grasp the third delay using an observational method of actual nurses/midwives' practice overtime during care provision to emergency obstetric patients in a tertiary referral national hospital.

Methods: A prospective quantitative design was employed to observe the 24-h obstetric triage process from February 4 to March 7, 2023.

Results: This study involved observations of 120 obstetric patients with mean maternal age of 29.

General procrastination and bedtime procrastination as serial mediators of the relationship between temporal perspective and sleep outcomes.

Adequate and sufficient sleep is essential for good health, effective functioning, and well-being, yet recent trends show increasing sleep deprivation, especially among adolescents and young adults. General procrastination and bedtime procrastination understood as the tendency to delay going to bed without external pressure, may contribute to sleep deprivation and fatigue. This study investigated how individual differences in time perspective are related to sleep sufficiency and daytime fatigue, two different sleep outcomes.

Complications that arise with nasogastric tubes after hospitalization in the pediatric population: A mixed methods systematic review.

Children use nasogastric tubes (NGTs) to ensure optimum nutrition and medication delivery when oral feeding fails or when they experience faltering growth. Although this method is less invasive, children may experience complications associated with NGTs. There is a gap in the literature regarding the types and prevention of complications of NGTs in the pediatric population at home.

Definitions, epidemiology, and outcomes of persistent/chronic critical illness: a scoping review for translation to clinical practice.

Background: Medical advances in intensive care units (ICUs) have resulted in the emergence of a new patient population-those who survive the initial acute phase of critical illness, but require prolonged ICU stays and develop chronic critical symptoms. This condition, often termed Persistent Critical Illness (PerCI) or Chronic Critical Illness (CCI), remains poorly understood and inconsistently reported across studies, resulting in a lack of clinical practice use. This scoping review aims to systematically review and synthesize the existing literature on PerCI/CCI, with a focus on definitions, epidemiology, and outcomes for its translation to clinical practice.

Impact of long-term trends on outcomes in the management of colonic diverticular bleeding: mediation analyses in a large multicenter study.

Background: Despite accumulating evidence and recommendations for management of colonic diverticular bleeding (CDB), the changes in its clinical management and outcomes remain unknown.

Methods: We performed a retrospective tendency analysis on a biennial basis, a propensity score-matched cohort study between the first and latter half groups, and mediation analyses to compare the diagnostic and treatment methods between January 2010 and December 2019 (CODE BLUE-J Study).

Results: A total of 6575 patients with CDB were included.

The eSAH score: a simple practical predictive model for SAH mortality and outcomes.

We developed a simple quantifiable scoring system that predicts aneurysmal subarachnoid hemorrhage (aSAH) mortality, delayed cerebral ischemia (DCI), and modified Rankin scale (mRS) outcomes using readily available SAH admission data with SAH volume (SAHV) measured on computed tomography (CT). We retrospectively analyzed a cohort of 277 patients with aSAH admitted at our Comprehensive Stroke Center at Mayo Clinic in Jacksonville, Florida, between January 5, 2012, and February 24, 2022. We developed a mathematical radiographic model SAHV that measures basal cisternal SAH blood volume using a derivation of the ABC/2 ellipsoid formula (A = width/thickness, B = length, C = vertical extension) on noncontrast CT, which we previously demonstrated is comparable to pixel-based manual segmentation on noncontrast CT.

Clinicopathological significance of androgen receptor expression and tumor infiltrating lymphocytes in triple-negative breast cancer: a retrospective cohort study.

Background: Triple-negative breast cancer (TNBC) is a serious disease with limited treatment options. We explored the significance of androgen receptor (AR) expression and tumor-infiltrating lymphocytes (TILs) in predicting neoadjuvant chemotherapy (NAC) resistance in TNBC, hypothesizing that AR/TIL classification using pretreatment biopsies can identify NAC-resistant subgroups and improve the understanding of apocrine differentiation.

Methods: This retrospective study included 156 consecutive patients with TNBC treated with NAC.

Impact of intravascular ultrasound on limb events in endovascular therapy for patients with peripheral arterial disease: insights from the TOMA-CODE registry.

Intravascular ultrasound (IVUS) has become a standard procedure for performing coronary intervention, but its impact on peripheral endovascular therapy (EVT) remains unclear. To assess the usefulness of IVUS during EVT, this study analyzed over 2000 consecutive patients from the TOkyo-taMA peripheral vascular intervention research COmraDE (TOMA-CODE) registry with peripheral arterial disease (PAD) in Japan. The primary outcome was chronic limb events (a composite of clinically driven target lesion revascularization (cTLR) and major amputation) during a two-year follow-up period.

Neuroblastoma Masquerading as Constipation: Reducing Diagnostic Error With the Pediatric Abdominal Point-of-Care Ultrasound Survey.

Abdominal pain is a common pediatric complaint in the emergency department and other clinical settings. While most causes are benign, dangerous and time-sensitive conditions may be present. Point-of-care ultrasound (POCUS) is a diagnostic modality that can help more thoroughly explore the differential diagnosis at a relatively low cost, without exposure to ionizing radiation, and in a timely manner.

Japanese Health Insurance Coverage of Fertility Treatment in 2022: Does Coverage Change Patient Perspectives?

Objective: This study aimed to evaluate the change in the patient's background and attitude toward infertility treatment both before and after the initiation of insurance coverage and to explore future issues from the patients' perspectives.

Materials And Methods: A cross-sectional survey was conducted in a fertility clinic in Japan from February to June 2022. An original questionnaire was given for two groups of new patients at a fertility clinic on their first visit: before fertility treatment insurance coverage started (Before-coverage) and after fertility treatment insurance coverage started (After-coverage).

On-Table Virtual Reality to Reduce Anxiety/Distress during Radiotherapy Treatments: A Pilot Randomized Trial.

We report the first randomized trial of a virtual reality (VR) headset used on-table during external beam radiotherapy treatments to reduce anxiety/distress during receipt of radiotherapy. A small pilot study was conducted among 10 patients, with VR randomized to start in the first week ('immediate VR') vs. second week ('delayed VR') of treatment.

Optimizing the Appropriate Mode of the Pulse-Modulated Holmium Laser in a Pop-Dusting Benchtop Model.

Objectives: To investigate the effectiveness of different holmium:yttrium-aluminum-garnet (Ho:YAG) laser modes for lithotripsy in the "dusting era" and identify the optimal laser mode for producing stone fragments measuring ≤0.5 mm.

Methods: We used plaster of Paris-made artificial stones crushed into 2-3 mm pieces, weighing 1 g in total.

Transvaginal ovarian drilling for polycystic ovary syndrome prior to in vitro fertilization dramatically improves embryo yield, implantation, and ongoing pregnancy rates.

Purpose: To evaluate the effect of transvaginal ovarian drilling (TVOD) on IVF outcomes in subjects with clomiphene-resistant PCOS and a history of IVF failure.

Methods: Between 2008 and 2011, 19 subjects with sonographically PCOS and a history of failure to ovulate to high-dose clomiphene citrate were prospectively followed and underwent TVOD at a university hospital-based IVF program.

Results: In 15 subjects who underwent 30 fresh paired IVF cycles TVOD resulted in a significantly higher number of oocytes retrieved (7.