The key to successful systemic secondary fracture prevention lies in empowering local sites to initiate and maintain impactful programs. In Latin America, we detail the genesis, execution, and consequences of a regional fracture liaison service (FLS) mentorship program, which resulted in 64 FLS establishments and the care of 17,205 patients.
Despite the existence of diverse treatments and service models geared toward secondary fracture prevention, a substantial number of patients who experience a fragility fracture lack the necessary treatment. To refine the effectiveness and speed of FLS deployment, we present the creation, application, and testing of a worldwide program that fosters national FLS mentoring networks throughout Latin America, integrated with the Capture the Fracture Partnership.
To equip mentors with the knowledge and tools to establish FLS, improve services, and provide effective mentorship, the University of Oxford and the IOF regional team crafted the corresponding curriculum and resources. The process of selecting mentors began with a preparatory meeting, followed by their rigorous training through live online sessions and subsequent sustained mentoring meetings led by them. S961 The program's efficacy was ascertained by a pre-training needs assessment and a post-training evaluation that were both measured against Moore's outcomes.
The mentorship program's launch locations included Mexico, Brazil, Colombia, and Argentina. Multidisciplinary mentors were present, covering the fields of orthopaedic surgery, rehabilitation, rheumatology, endocrinology, geriatrics, gynaecology, and internal medicine. All attendees actively participated in the training sessions, and feedback indicated a high level of satisfaction. 22 FLS facilities have been built in Mexico, 30 in Brazil, 3 in Colombia, and 9 in Argentina since the training program's launch; however, Chile only received 2, while no other LATAM countries, excluded from the mentorship program, received any. The identification of 17,025 more patients between 2019 and 2021 can be attributed to the implementation of the mentorship program. 58 FLS have been engaged by mentors for service development purposes. Included in post-training activities are two published national best practice guidelines, as well as resources specific to each country and available in the local language for FLS.
Although the COVID-19 pandemic persisted, the Capture the Fracture Partnership's mentorship program cultivated a network of FLS mentors, leading to a quantifiable enhancement in national FLS support. Developing mentor communities in foreign countries is facilitated by this potentially scalable program.
The Capture the Fracture Partnership's mentorship program, undeterred by the COVID-19 pandemic, developed a community of FLS mentors, resulting in quantifiable progress towards enhancing national FLS provision. The program's design facilitates the expansion of mentor communities to other nations, demonstrating its potential scalability.
Six patients, suspected of having chronic schistosomiasis, underwent baseline microbiological testing, revealing no evidence of the infection. Each patient underwent empirical praziquantel treatment, ultimately resulting in seroconversion, occurring between 20 and 60 days after treatment. Chronic schistosomiasis diagnosis might be facilitated by detecting seroconversion post-praziquantel treatment.
The establishment of freestanding emergency departments (FSEDs) has led to enhancements in key hospital metrics, specifically decreased emergency department wait times and improved patient selection. Evaluation of patient outcomes and process safety procedures has not been performed. A study exploring the safety of FSED virtual triage applications among emergency general surgery (EGS) patients is detailed here.
All adult EGS patients admitted to a community hospital between 2016 and 2021 were subject to a retrospective evaluation. The study encompassed patients who attended a freestanding emergency service for virtual evaluation by a surgical team (fEGS) or those who presented to the hospital's emergency department for in-person evaluation by the same surgical team (cEGS). Building a propensity score model entailed the use of patient demographics, acute care utilization history, and clinical characteristics observed during the initial visit. Subsequently, stabilized Inverse Probability of Treatment Weights (IPTW) were employed to generate a weighted sample. Employing a weighted sample, multivariable regression models were subsequently used to ascertain the treatment effect of virtual triage compared to in-person evaluation on short-term outcomes: length of stay, 30-day readmission, and mortality. tissue-based biomarker The multivariable analyses accounted for variables, such as surgical duration and procedure type, observed during the index visit.
Of the 1962 total patients, 631 (32.2%) were initially assessed using a virtual method (fEGS), while the remaining 1331 (67.8%) underwent in-person evaluation (cEGS). The cohorts' baseline characteristics differed significantly with respect to gender, ethnicity, payer type, body mass index, and Charlson Comorbidity Index scores. The IPTW-weighted sample showed a well-proportioned distribution of baseline risks, with the standard deviation spanning from 0.0002 to 0.018. Multivariable analysis of the balanced groups revealed no statistically substantial differences in the metrics of 30-day readmission, 30-day mortality, and length of stay (LOS), all with p-values greater than 0.05.
The outcomes of EGS diagnoses are indistinguishable for patients utilizing virtual triage compared to those opting for in-person triage. hepatic steatosis A safe and efficient means of initial evaluation for EGS patients is possible via virtual triage at FSED.
EGS diagnoses treated via virtual triage show results consistent with those receiving in-person triage. For EGS patients seeking initial evaluation, virtual triage at FSED may be a safe and effective means of assessment.
Delayed bleeding, a frequent complication, follows endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) of large colon polyps. For the purpose of reducing bleeding risk, prophylactic clipping using through-the-scope clips (TTSCs) is now a prevalent practice. Nonetheless, the over-the-scope clip (OTSC) procedure may prove more advantageous in attaining hemostasis than TTSCs. This study investigates the safety and effectiveness of prophylactic OTSC clipping following endoscopic surgery, either ESD or EMR, on large colon polyps.
This study's retrospective analysis involves a prospective database assembled by three endoscopic centers over the period between 2009 and 2021. The study population comprised patients harboring colon polyps of 20 mm or greater. Endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) were the techniques used for removal of all polyps. Following the resection procedure, OTSCs were used as a preventive measure on areas of the mucosal defect at high risk for delayed bleeding or perforation. The key outcome measure was the occurrence of delayed bleeding.
Within the colorectum cohort, 75 patients received either ESD (representing 67%, or 50 patients) or EMR (representing 33%, or 25 patients). Specimen diameters, following resection, averaged 57mm241, with a spread from 22mm to 98mm. A mean of two OTSCs (with a range of one to five) was found within the mucosal defect. The mucosal flaws remained unsealed, every single one. Intraprocedural bleeding (53%, ESD 20%, EMR 30%; P=0.0105) and perforation (67%, ESD 8%, EMR 4%; P=0.0659) were observed during procedures. 100% of intraprocedural bleeding instances saw hemostasis achieved, but two patients required conversion to surgery for intraprocedural perforations. In the group of 73 patients who underwent prophylactic clipping, 14% experienced delayed bleeding (ESD 0%, EMR 42%; P=0.0329). No delayed perforation was seen.
The use of OTSCs to partially close large post-ESD/EMR mucosal defects is a proactive measure that can help prevent delayed bleeding and perforation. Using OTSCs for a prophylactic partial closure of large, intricate post-ESD/EMR mucosal defects may function as an efficient technique to lessen the risk of delayed bleeding and perforation.
To mitigate the risk of delayed bleeding and perforation following ESD/EMR procedures, prophylactic partial closure of substantial mucosal defects using OTSCs represents a viable strategy. The use of OTSCs for a prophylactic, partial closure of substantial post-ESD/EMR mucosal lesions is a promising approach to lowering the incidence of delayed bleeding and perforation.
Children in cardiogenic shock may find life-saving assistance through the use of VA-ECMO. Decannulation, while often treated with surgical vascular repair as the current gold standard, is not without substantial risks. Using a collagen plug-based vascular closure device (MANTA), a series of eight patients successfully underwent decannulation of the common femoral artery. The cannulas of seven patients were removed without vascular complications at their access points, proving a successful procedure. An arterial repair, achieved through surgical cut-down, was essential due to a device failure. This series in pediatric patients underscores the successful implementation of the MANTA device in percutaneous VA-ECMO decannulation, thereby bringing into sharp relief the technical challenges that may impede success.
Women in Morocco face cervical cancer as the second most common cancer diagnosis, subsequent to breast cancer's higher incidence. The continuous public health need to encourage more women to practice cervical cancer screenings persists. Data pertaining to Pap smear test awareness and the determinants of its acceptability in Morocco are inadequate. This research effort is committed to evaluating the level of awareness of cervical cancer and HPV infection amongst Moroccan women and to pinpoint the elements contributing to the acceptance of Pap smear tests. In Morocco, a cross-sectional study involving 857 women across the Casablanca-Settat, Marrakech-Safi, and Tanger-Tetouan-Al Hoceima regions was conducted between November 2019 and February 2020 using a structured, interviewer-administered questionnaire.