Notes

Multiple disease-prediction construction utilizing hybrid strong mastering: an ideal conjecture design.
scusses eight main challenges that can be understood as current challenges in this process.
Practical training on the patient is crucial in medical students' last year education - the so-called practical year (PJ) in Germany. Due to difficulties in combining student training with the everyday tasks on ward, it is often criticised as not sufficient for a good preparation for later practical work. The Medical Faculty of the University of Jena therefore designed a project called "PJplus". The project includes mentoring and workplace-based assessment by means of Mini-Clinical Evaluation Exercise (Mini-CEX) in combination with training workshops for supervisors. Three years after the first clinical departments started voluntary participation, the project was evaluated by comparing the experience and the self-assessed learning progress of students from departments participating in this project (PJplus group) with those non-participating (control group).

An online questionnaire was sent to all medical students registered at the University of Jena for PJ between March 2016 and April 2017. The students we PJ helps to better prepare students for their practical work after finishing studies. With the project presented, it is feasible to integrate these elements in a structured way. Nevertheless, a good control of the elements' implementation and consistent training of the supervising physicians is needed to ensure long-term success.
Adding mentoring and feedback to the PJ helps to better prepare students for their practical work after finishing studies. With the project presented, it is feasible to integrate these elements in a structured way. Nevertheless, a good control of the elements' implementation and consistent training of the supervising physicians is needed to ensure long-term success.Acute upper limb ischemia is considered a vascular emergency. These events are mostly thromboembolic and are often detected in patients with atrial fibrillation (AF). Surgical thrombectomy and percutaneous mechanical thrombectomy are the usual methods to treat this medical emergency. In this case, we report the case of a 75-years old woman with a history of AF who initially presented to our center because of syncope resulting from Torsades de pointes due to a known long-QT syndrome. Those episodes were treated adequately from the implanted ICD. In addition to the symptoms of syncope, the patient also noted symptoms of right upper-limb ischemia. Using duplex sonography, we noticed a thrombotic occlusion at the level of the axillary artery. Using femoral access, we performed an antegrade angiography of the axillary artery, which confirmed a fresh thrombotic occlusion. The initially performed thrombus aspiration wasn't successful, and the decision was made to use an ekosonic endovascular system (Ekosonic ™ Endovascular System, Boston Scientific, EKOS) catheter to perform catheter-directed thrombolysis. Locally, 10 mg Actilyse were administrated. Then an EKOS Catheter was delivered to the occlusion area and was placed for 6 h. Symptoms of ischemia were resolved, and the angiographic control showed normal flow in the axillary artery. The patient was discharged without any local deficits of the right hand.
Most pivotal transcatheter aortic valve replacement (TAVR) trials have excluded patients with bicuspid aortic stenosis (AS). This study compared TAVR in low-risk patients with bicuspid AS to those with tricuspid AS, incorporating data from prospective trials.

We selected prospective US low-risk TAVR trials containing a bicuspid arm for this meta-analysis, examining outcomes at 30 days. Study results were pooled using a hierarchical Bayesian random-effects model.

Included were 3 Food and Drug Administration (FDA)-approved investigational device exemption (IDE) trials that enrolled a total of 1810 low-risk patients with symptomatic severe AS for TAVR. We compared 380 bicuspid patients with 1430 tricuspid patients. Event rates at 30 days overall were low, with similar mortality (odds ratio [OR], 0.38; 95% credible interval [CrI] 0.08, 1.78; I
, 0%), non-disabling stroke (OR, 0.45; 95% CrI 0.15, 1.07; I
, 9%), and permanent pacemaker implantation (OR, 0.86; 95% CrI 0.41, 1.47; I
, 59%). There were statistically significant differences in disabling stroke (OR, 0.16; 95% CrI 0.01, 0.90; I
, NA) and coronary obstruction (OR, 0.21; 95% CrI 0.05, 0.91) that disappeared after sensitivity analysis by adding a single event to the tricuspid arm. Hemodynamics were similar at 30 days.

Preliminary data from the FDA-approved IDE trials of low-risk patients with bicuspid AS undergoing TAVR demonstrated 30-day outcomes comparable to low-risk tricuspid patients, except for a trend toward higher stroke in bicuspid patients. Randomized trials are warranted to reassure the safety and long-term outcome of TAVR in patients with severe bicuspid AS.
Preliminary data from the FDA-approved IDE trials of low-risk patients with bicuspid AS undergoing TAVR demonstrated 30-day outcomes comparable to low-risk tricuspid patients, except for a trend toward higher stroke in bicuspid patients. Randomized trials are warranted to reassure the safety and long-term outcome of TAVR in patients with severe bicuspid AS.
Anal cancer is a rare disease, more prevalent in women. Men who have sex with men (MSM) are a high-risk neglected population.

The primary objective was to assess quality of life (QoL) and sexual function (SxF) among MSM treated with radical chemoradiation for anal cancer. Secondary objectives were to assess survivals and to describe the sexual habits of the target population.

Prospective single institution trial of MSM who were treated for anal cancer with curative intent between 2015 and 2019. QoL and SxF were the primary end-points and were assessed by validated questionnaires and sexual inventory. Overall survival, locoregional relapse-free, distant metastases free, and colostomy-free survivals were evaluated.

Quality of life and sexual function.

Nineteen patients were accrued between November 2015 and August 2019. Median age was 59.3 years. Stage III disease was 53.4% and mean tumor size was 5.4 cm. Fifteen (79.0%) patients were living with HIV (PLHIV). Median follow-up was 21.8 months. Mean oved its treatment represent a burden to MSM regarding QoL and SxF. Mauro GP, da Conceição Vasconcelos KGM, Carvalho HDA, Quality of Life and Sexual Function of Men Who Have Sex With Men Treated for Anal Cancer A Prospective Trial of a Neglected Population. J Sex Med 2021;181461-1466.
Anal cancer and its treatment represent a burden to MSM regarding QoL and SxF. Mauro GP, da Conceição Vasconcelos KGM, Carvalho HDA, Quality of Life and Sexual Function of Men Who Have Sex With Men Treated for Anal Cancer A Prospective Trial of a Neglected Population. J Sex Med 2021;181461-1466.
Routine positron emission tomography/computed tomography (PET/CT) has been recommended even for clinical stage I non-small-cell lung cancer (NSCLC). In spite of the progress in the screening procedure, and revisions to TNM classification, there is no evidence to support brain imaging screening of patients assessed with the current staging protocol including PET/CT.

We retrospectively investigated the frequency of extrathoracic metastasis in 466 consecutive patients with clinical stage T1-2 N0 NSCLC with the complete staging assessment comprised of thin-section CT, PET/CT, and brain contrast-enhanced magnetic resonance imaging between 2008 and 2016. All patients were reclassified according to the eighth edition of the tumor, node, and metastasis (TNM) classification.

Among all patients, 70% of the tumors were pure solid and 30% had part-solid ground-glass opacity on thin-section CT, and 388 (83%) and 78 (17%) were classified into clinical stages T1 and T2, respectively. Eight patients (1.7%) had extrathoracic metastasis, including 3 (0.6%) with brain metastasis, and all showed pure-solid tumors. The frequency of extrathoracic and brain metastasis was 1.0% and 0.5% in 388 T1 patients, and 5.0% and 3.0% in 78 T2 patients. Although brain metastases were detected in 2 of 7 patients (29%) with PET/CT detectable extrathoracic metastases and 1 of 459 patients (0.2%) without PET/CT detectable extrathoracic metastasis, there were no neurologically asymptomatic brain metastases in patients with early-stage NSCLC confirmed by PET/CT.

Routine screening of brain imaging is unnecessary in patients with early-stage NSCLC, assessed with the current staging protocol including PET/CT.
Routine screening of brain imaging is unnecessary in patients with early-stage NSCLC, assessed with the current staging protocol including PET/CT.Agree-disagree (AD) or Likert questions (e.g., "I am extremely satisfied strongly agree … strongly disagree") are among the most frequently used response formats to measure attitudes and opinions in the social and medical sciences. This review and research synthesis focuses on the measurement properties and potential limitations of AD questions. The research leads us to advocate for an alternative questioning strategy in which items are written to directly ask about their underlying response dimensions using response categories tailored to match the response dimension, which we refer to as item-specific (IS) (e.g., "How satisfied are you not at all … extremely"). In this review we 1) synthesize past research comparing data quality for AD and IS questions; 2) present conceptual models of and review research supporting respondents' cognitive processing of AD and IS questions; and 3) provide an overview of question characteristics that frequently differ between AD and IS questions and may affect respondents' cognitive processing and data quality. Although experimental studies directly comparing AD and IS questions yield some mixed results, more studies find IS questions are associated with desirable data quality outcomes (e.g., validity and reliability) and AD questions are associated with undesirable outcomes (e.g., acquiescence, response effects, etc.). Based on available research, models of cognitive processing, and a review of question characteristics, we recommended IS questions over AD questions for most purposes. For researchers considering the use of previously administered AD questions and instruments, issues surrounding the challenges of translating questions from AD to IS response formats are discussed.
Benzodiazepines and sedative-hypnotic drugs (BZD/SHD) are commonly utilized in the acute care setting for insomnia and anxiety and are associated with cognitive impairment, falls, and fractures. Interventions to reduce use of BZD/SHD in hospitals are not well characterized.

The objective was to conduct a scoping review to identify and characterize interventions to reduce the use of BZD/SHD by adults in the acute care setting.

English language studies and abstracts that described an intervention to reduce BZD/SHD in adult hospital patients were included. Six databases (PubMed, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science) were searched up to July 2018 and updated to February 3, 2021. The grey literature (Opengrey, Grey Matters, Google Advanced) was searched up to July 2018. Titles and abstracts were screened and full-text articles were reviewed and charted by three independent reviewers. Stakeholders were consulted to inform the scoping review and collect perspectives on the findings.

There were 13,046 records identified and 43 studies included.
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