Williamslundqvist6656
(2) The prospective oversight and approval process was bureaucratic and (3) the mandatory online system to manage AD was a barrier. (4) These factors caused unnecessary delays which (5) impeded AD for very sick patients. (6) However, this prospective process protected doctors and ensured system safety.
Potential barriers to accessing AD posed by prospective approval should be evaluated carefully by jurisdictions implementing or considering such a model. Attention is needed not only to law but to system design and how AD is implemented in practice.
Potential barriers to accessing AD posed by prospective approval should be evaluated carefully by jurisdictions implementing or considering such a model. Attention is needed not only to law but to system design and how AD is implemented in practice.
Over one third of patients with posttraumatic stress disorder (PTSD) do not respond to current interventions. Ketamine presents a potential treatment option; however, its effects are temporary. Metabolism activator Administering ketamine alongside psychotherapy is one potential means of prolonging its effects; however, only a few studies have investigated this treatment method to date, and none have tested ketamine with internet-based or electronically delivered cognitive behavioral therapy (e-CBT).
This open-label randomized controlled trial aims to assess the efficacy of a combined treatment method of subanesthetic intravenous ketamine and e-CBT for treating patients with PTSD.
In total, 20 patients with refractory PTSD recruited from a community clinic will be randomly assigned to either an experimental group (n=10), receiving a combination of ketamine and therapist-administered e-CBT over 14 weeks, or a waitlist control group (n=10), receiving the experimental treatment after 14 weeks. Both groups will be assessed for the symptoms of PTSD and comorbid disorders before treatment, at two midway points, and at the end of the experiment.
PTSD symptoms of participants in the experimental group are expected to improve significantly more than those of participants in the waitlist control group (P=.05) with a large effect size (η
=0.14).
This is the first study to assess the relationship between e-CBT and ketamine and their combined ability to treat refractory PTSD. If successful, this study will open web-based, asynchronous therapeutic options for patients with PTSD and will provide new insights into the functional role of glutamate in trauma-related disorders as well as in learning, memory, and fear extinction.
ClinicalTrials.gov NCT04771767; https//clinicaltrials.gov/ct2/show/NCT04771767.
PRR1-10.2196/30334.
PRR1-10.2196/30334.
The use of artificial intelligence based chatbots as an instrument of psychological intervention is emerging, however no studies have been reported in Latin America.
The objective of the present study was to evaluate the viability, acceptability and potential impact of Tess, a chatbot, on symptoms of depression and anxiety in university students.
This was a pilot randomized controlled trial. The experimental condition used Tess for eight weeks and the control condition was assigned to a psychoeducation book on depression. Comparisons were conducted using Mann-Whitney U and Wilcoxon tests for depression symptoms, and Independent and Paired Samples t Tests to analyze anxiety symptoms.
The initial sample consisted of 181 Argentinian college students (87.2% female) ages 18 to 33. A total of 39 (39%) participants in the experimental condition and 34 (41%) in the control group, provided data at week eight. There was an average of 472 (SD=249.52) messages exchanged and an average of 116 (SD=73.87) of the messages were sent from the user in response to Tess. A higher number of messages exchanged with Tess was associated with positive feedback (F2,36=4.37; P =.02). No significant intergroup differences from baseline to week eight between the experimental group and the control group were found for depression and anxiety symptoms. However, significant intragroup differences demonstrated that the experimental group showed a significant decrease in anxiety symptoms; no differences were observed for the control group. No significant differences were found for depressive symptoms within the groups.
Students engaged a considerable amount of time exchanging messages with Tess and positive feedback was associated with higher numbers of messages exchanged. The initial results show promising evidence for the usability and acceptability of Tess in the Argentinian population. Research on chatbots is still in its initial stages and further research is needed.
The purpose of this study was to assess apparent diffusion coefficient (ADC) values associated with medication-related osteonecrosis of the jaws (MRONJ) at each stage of the disease compared to controls.
The magnetic resonance imaging data of 38 patients in the 4 stages of MRONJ and 10 controls were analyzed. Mean ADC values of bone marrow in the controls and patients in each stage of MRONJ were calculated. The significance of differences was analyzed by using the Kruskal-Wallis test and post-hoc Mann-Whitney tests with Bonferroni adjustment. A receiver operating characteristic (ROC) curve was plotted to distinguish controls from MRONJ stage 0. P < .05 was considered statistically significant.
The mean ADC values of controls and stages 0 to 3 were significantly different, with the lowest value in the controls (P < .001). ROC analysis revealed a cutoff ADC value of 1.06×10
mm
/s to distinguish between the control group and MRONJ stage 0 patients, producing values of sensitivity, specificity, accuracy, and area under the ROC curve ranging from 0.89 to 0.94.
The ADC values of bone marrow affected by MRONJ are significantly different among controls and stages 0 to 3. ADC values may be useful for distinguishing normal from MRONJ stage 0.
The ADC values of bone marrow affected by MRONJ are significantly different among controls and stages 0 to 3. ADC values may be useful for distinguishing normal from MRONJ stage 0.We present the clinical case of a seventy-year-old female patient with hypertension in treatment with olmesartan since one year ago and no other past medical history of interest. She was hospitalized in the internal medicine department in order to study constitutional symptoms which consisted of confirmed weight loss of 13 kg, chronic diarrhea, loss of appetite, asthenia, and intermittent colic-like abdominal pain. After an initial screening for neoplastic disease, other possible options were considered.
The COVID-19 pandemic has had a significant impact on Spanish hospitals, which have had to allocate all available resources to treat these patients, reducing the ability to attend other common pathologies. link2 The aim of this study is to analyze how the treatment of acute appendicitis has been affected.
A national descriptive study was carried out by an online voluntary specific questionnaire with Google Drive™ distributed by email by the Spanish Association of Surgeons (AEC) to all affiliated surgeons currently working in Spain (5203), opened from April 14th to April 24th.
We received 337 responses from 170 centers. During the first month of the pandemic, the incidence of acute appendicitis decreased. Although conservative management increased, the surgical option has been the most used in both simple and complicated appendicitis. Despite the fact that the laparoscopic approach continues to be the most widely used in our services, the open approach has increased during this pandemic period.
Highlight the contribution of this study in terms of knowledge of the status of the treatment of acute appendicitis during this first month of the pandemic, being able to serve for a better possible organization in future waves of the pandemic and a reorganization of current protocols and management of acute appendicitis in a pandemic situation.
Highlight the contribution of this study in terms of knowledge of the status of the treatment of acute appendicitis during this first month of the pandemic, being able to serve for a better possible organization in future waves of the pandemic and a reorganization of current protocols and management of acute appendicitis in a pandemic situation.
Chronic abdominal pain (CAP) in children is a symptom that frequently leads to a visit to the paediatrician, which affects family life and occasionally requires the need to perform diagnostic studies (DS). The objective was to carry out a qualitative, quantitative, and economic analysis on the tests requested.
An observational, prospective and multicentre study was conducted that included children between 4-15 years old affected by CAP. The difference between organic and functional disorders was taken into account. The following variables were collected history, warning signs and symptoms, DS, and the cost of these.
The study included 235 children with CAP (Age; mean 9.7±2.7 SD). The large majority (79%) were functional disorders and 21% organic disorders. Almost half of the patients had some warning sign or symptom, but urinary symptoms were only associated with organic disorders. The abdominal ultrasound, faecal parasites, breath test, and endoscopy were the most associated with organic disorders. link3 There was a difference between the costs of the DS according to each centre. The total economic cost was 52,490.80 euros, with 195 euros per patient for functional disorders and 306 euros for organic disorders.
Signs and symptoms of alarm in CAP were very frequent, but had low discriminative capacity. The abdominal ultrasound and faecal parasites are innocuous DS, and could be useful as a first level study. The endoscopy and the breath test were the most discriminative of organic disease. The economic cost of DS arising from the diagnosis of exclusion in CAP was high.
Signs and symptoms of alarm in CAP were very frequent, but had low discriminative capacity. The abdominal ultrasound and faecal parasites are innocuous DS, and could be useful as a first level study. The endoscopy and the breath test were the most discriminative of organic disease. The economic cost of DS arising from the diagnosis of exclusion in CAP was high.
Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset.
We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory.
Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge.
