Search Results (16)

The optimal long-term antithrombotic treatment of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) remains controversial. Current guidelines recommend a short initial period of triple antithrombotic therapy (e.g., 1 week), followed by dual therapy consisting of an oral anticoagulation agent and a single antiplatelet agent for 6 months in patients undergoing elective PCI and 12 months in patients with acute coronary syndromes. After this course of combination therapy, anticoagulation monotherapy is recommended. In daily practice, however, the optimal strategy for long-term antithrombotic therapy remains debated. A growing body of evidence supports the safety and efficacy of oral anticoagulation monotherapy, but its use in clinical practice remains inconsistent. This review aims to evaluate the available evidence on chronic antithrombotic regimens in patients with AF undergoing PCI, with a focus on key clinical considerations, such as the selection of optimal long-term therapy that balances ischemic and bleeding risks. It also highlights that, despite robust supporting evidence, significant gaps persist in real-world implementation. Full article

Background/Objectives: The percentage of the world’s population with Class II obesity (body mass index (BMI) ≥ 35) and above is increasing annually. Bariatric (elective weight-loss) surgery is performed for less than one percent of eligible patients. A recent Delphi was unable to reach a consensus recommendation for or against mandated weight loss targets prior to bariatric surgery. This systematic review, performed according to the PRISMA 2020 guidelines, looks at the literature to determine whether there is evidence that pre-operative weight loss affects long-term (≥5 years) outcomes of bariatric surgery (weight loss, co-morbidity resolution). Methods: MEDLINE, EMBASE, CABI Digital Library, and Cochrane Central Register of Controlled Trials (Central) were searched from 1 January 2000 to 1 March 2025. Twenty-one full papers were then assessed, and only three papers met the eligibility criteria for inclusion in this review. Results: 1072 patients were included (age range 26–73 years, sleeve: bypass 60.3%:49.7%, F:M 70.2%:29.8%). The studies differed in their pre-operative preparation and selection criteria for surgery: one paper used an intensive pre-operative information course and mandated 5% weight loss. This study reported a significant association between pre-operative weight loss and long-term outcomes. Two papers had no mandated pre-operative weight-loss target and found there was no association between pre-operative weight loss and long-term outcomes. Conclusions: There is limited and conflicting evidence that pre-operative weight loss percentage affects long-term outcomes of bariatric surgery. Further research looking at five-, ten-, and twenty-year outcomes for bariatric patients is required, particularly randomised controlled trials or tier one evidence. Full article

The veterinary profession is rapidly evolving, requiring curricular renewal to address emerging challenges and enhance graduate preparedness. A survey was conducted among students and alumni of the School of Medicine and Biomedical Sciences of the University of Porto (n = 279), Portugal, to evaluate the need for an updated veterinary curriculum. Respondents conveyed a strong preference for companion animal medicine, likely influenced by sociocultural factors and media representation. To address current and future demands, it was recommended to re-evaluate curricular structures (e.g., course duration and electives), incorporate non-technical skills, and enhance practical education. Additional reforms should be supported by feedback mechanisms and stakeholder consultations. Alumni expressed dissatisfaction with the job market, which should be addressed through continuous education and specialization and greater intervention of the Portuguese Veterinary Board. In summary, areas for improvement and increased stakeholder involvement were identified as opportunities for veterinary curricular renewal. Full article

Client compliance with prescribed medication instructions to treat their pets is a concern. This study describes factors associated with the noncompliance of dog owners with veterinary recommendations for medication, as well as client-reported barriers and aids to administering medications. A cross-sectional survey of dog owners’ compliance with veterinary medication recommendations was performed from 9 January 2019 to 18 July 2020. A convenience sample of owners who prescribed medication for their dogs during or following elective veterinary examination was surveyed regarding medication administration experience and compliance. Owners were followed up to determine if the course of medication had been completed. Compliance data were analyzed descriptively. Logistic regression was performed with compliance as the outcome. Medication noncompliance was recorded for 47% (71/151) of owners. Increasing dog age was associated with better owner compliance (p < 0.05). Pet owners who used “nothing” as an aid to medicating were less likely to be noncompliant (p < 0.05). Forty-seven percent (71/151) of owners reported that “nobody” showed them how to administer the medication. One-third of dog owners (47/151) reported challenges in medicating their pets. The most common reason cited by clients reporting challenges was a resistant pet. Demonstration of medication administration techniques and discussion about available aids to medicating a pet may improve client compliance. Full article

Much of the literature that examines critical science agency (CSA) focuses on how students enact their CSA to support knowledge construction and agentic action. Few studies, however, address how science curricula can be specifically designed to support students in exercising their CSA. In this study, I examine features of a community-based science (CBS) curricular design that engages students in justice-oriented science learning to advance their CSA. More specifically, I analyze the design and structure of an environmental science elective course to investigate features of CBS curricular design that support students in exercising their CSA, including: (1) leveraging learning goals to create community change, (2) developing students’ toolkits, (3) cultivating spaces for advocacy and critical hope, and (4) critical and ongoing reflection. The findings suggest that science curriculum can be purposefully designed to assist students in exercising their CSA through generative learning experiences that empower them as community change agents. As we move toward more equity and justice-centered science learning, I recommend that future science curricula take community-based science approaches to design, structuring learning around students’ CSA by attending to how formal science learning can be used as an avenue to support community change. Full article

ChatGPT (GPT-3.5), an intelligent Web-based tool capable of conducting text-based conversations akin to human interaction across various subjects, has recently gained significant popularity. This surge in interest has led researchers to examine its impact on numerous fields, including education. The aim of this paper is to investigate the perceptions of undergraduate students regarding ChatGPT’s utility in academic environments, focusing on its strengths, weaknesses, opportunities, and threats. It responds to emerging challenges in educational technology, such as the integration of artificial intelligence in teaching and learning processes. The study involved 257 students from two university departments in Greece—namely primary and early childhood education pre-service teachers. Data were collected using a structured questionnaire. Various methods were employed for data analysis, including descriptive statistics, inferential analysis, K-means clustering, and decision trees. Additional insights were obtained from a subset of students who undertook a project in an elective course, detailing the types of inquiries made to ChatGPT and their reasons for recommending (or not recommending) it to their peers. The findings offer valuable insights for tutors, researchers, educational policymakers, and ChatGPT developers. To the best of the authors’ knowledge, these issues have not been dealt with by other researchers. Full article

This paper addresses the practical problem of scheduling operating room (OR) elective surgeries to minimize the likelihood of surgical delays caused by the unavailability of capacity for patient recovery in a central post-anesthesia care unit (PACU). We segregate patients according to their patterns of flow through a multi-stage perioperative system and use characteristics of surgery type and surgeon booking times to predict time intervals for patient procedures and subsequent recoveries. Working with a hospital in which 50+ procedures are performed in 15+ ORs most weekdays, we develop a constraint programming (CP) model that takes the hospital’s elective surgery pre-schedule as input and produces a recommended alternate schedule designed to minimize the expected peak number of patients in the PACU over the course of the day. Our model was developed from the hospital’s data and evaluated through its application to daily schedules during a testing period. Schedules generated by our model indicated the potential to reduce the peak PACU load substantially, 20-30% during most days in our study period, or alternatively reduce average patient flow time by up to 15% given the same PACU peak load. We also developed tools for schedule visualization that can be used to aid management both before and after surgery day; plan PACU resources; propose critical schedule changes; identify the timing, location, and root causes of delay; and to discern the differences in surgical specialty case mixes and their potential impacts on the system. This work is especially timely given high surgical wait times in Ontario which even got worse due to the COVID-19 pandemic. Full article

The present review aims to provide a critical appraisal of the sonographic diagnosis and follow-up and to evaluate the optimal clinical management of monochorionic twin pregnancies where one of the twins is complicated by selective fetal growth restriction (sFGR). The classification is based on the umbilical artery (UA) diastolic flow reflecting the outcome. If the sFGR twin has positive diastolic flow (Type I) then the prognosis is good, and it does not require close surveillance. Biweekly or weekly sonographic and Doppler surveillance and fetal monitoring are recommended strategies to detect unpredictable complications in type II and type III forms, which are defined by persistently absent/reverse end-diastolic flow (AREDF) or cyclically intermittent absent/reverse end-diastolic flow (iAREDF) in the umbilical waveforms, respectively. The latest forms are associated with an increased risk of unexpected fetal demise of the smaller twin and 10–20% risk of neurological injury in the larger twin in addition to the overall risk of prematurity. The clinical course can be affected by elective fetal therapy (‘dichorinization’ of the placenta with laser or selective fetal reduction) or elective delivery in the presence of severe fetal deterioration. The prediction of the clinical outcome in complicated cases of type II and III sFGR cases remains elusive. Novel routines in fetal and placental scans in order to predict neurological impairments and unexpected fetal death to optimize the delivery time-point are needed. Full article

Pharmacists are increasingly involved in medication history taking, medication reconciliation, and review in their daily practice. The objectives of this study were to investigate third-year pharmacy students’ self-assessed competency in medication reviews and gather their feedback for further development of medication review training in their curriculum. The study was conducted as a self-assessment of third-year pharmacy students at the completion of their second three-month internship period in a community pharmacy in 2017–2018. The students were assigned to review medications of a real patient under the supervision of a medication review accredited pharmacist during their internship. The self-assessment was carried out via an e-form, which was created for this study. Recently established national medication review competence recommendations for pharmacists were used as a reference. Students (n = 95, participation rate: 93%) self-assessed their competency as good or very good in 91% (n = 28) of the competency areas listed in the self-assessment. The highest proportion of competencies that were self-assessed as good or very good included using medication risk management databases and evaluating the clinical importance of the information (97%, n = 92). The lowest proportion of competencies was found in applying clinical information from the key laboratory tests to patient care and knowing which laboratory tests are most important to monitor in each condition and medication (36%, n = 34). The students suggested that their pharmacy education should contain more medication review assignments as group work and that an elective course on medication reviews should be compulsory for all pharmacy students. Full article

Undergraduate (UG) research is regarded as a fundamental component in dental education. The present study was designed to examine the perception of the clinical students and the graduates of dentistry profession programs in the past 10 years on UG research as a compulsory course at the Faculty of Dentistry Universitas Indonesia. A total of 310 respondents, consisting of clinical students (64.8%) and alumni (35.2%), participated in this study. The majority of respondents (81.3%) agreed to UG research as part of compulsory courses in the curriculum of dentistry study programs. The positive impact of UG research on their professional careers was perceived by 78.3% of participants. Only 11.6% of participants responded that UG research experiments were not important in dental education, and 18.7% preferred UG research as an elective course. UG research as a compulsory course in the dental curriculum was well received by the majority of participants. Recommendations included student autonomy to select research topics of interest, longer duration to complete UG research, and more opportunities to present the research results in scientific conferences and to publish in scientific journals. Dental schools and their faculties play essential roles in improving the research environment for undergraduate dental students. Full article

The selection of elective courses based on an individual’s domain interest is a challenging and critical activity for students at the start of their curriculum. Effective and proper recommendation may result in building a strong expertise in the domain of interest, which in turn improves the outcomes of the students getting better placements, and enrolling into higher studies of their interest, etc. In this paper, an effective course recommendation system is proposed to help the students in facilitating proper course selection based on an individual’s domain interest. To achieve this, the core courses in the curriculum are mapped with the predefined domain suggested by the domain experts. These core course contents mapped with the domain are trained semantically using deep learning models to classify the elective courses into domains, and the same are recommended based on the student’s domain expertise. The recommendation is validated by analyzing the number of elective course credits completed and the grades scored by a student who utilized the elective course recommendation system, with the grades scored by the student who was subjected to the assessment without elective course recommendations. It was also observed that after the recommendation, the students have registered for a greater number of credits for elective courses on their domain of expertise, which in-turn enables them to have a better learning experience and improved course completion probability. Full article

Homeopathic products are available over the counter in many pharmacies in the United States and are popular among consumers, although there is no conclusive evidence of their therapeutic effects. Pharmacists are obligated to provide well-informed, evidence-based information on these products, but many graduates may not be receiving adequate training in this area. This report outlines the results of a survey assessing whether taking a focused elective course in complementary and integrative health (CIH) affects knowledge and perceptions regarding homeopathy. A 22-question survey was developed and distributed to graduates of Idaho State University College of Pharmacy. Responses on survey items were compared between those who had reported taking the CIH elective course and those who had not. Of the 475 pharmacists, 89 completed the survey (response rate of 18.7%). Pharmacists who had taken the CIH elective course reported being more comfortable answering patient questions (82% vs. 44%, p < 0.001), felt more able to make recommendations (75% vs. 36%, p < 0.001), and felt they could explain the proposed mechanism of action of homeopathic remedies to their patients (87% vs. 61%, p = 0.002). Those who took the elective course were also more likely to say that any benefits of homeopathy were due to the placebo effect (82% vs. 64%, p = 0.007). A significantly higher portion of respondents who had not taken the elective course indicated that they could benefit from further training on CIH topics when compared with those who had taken the elective course (85% vs. 51%, p = 0.02). There was no significant difference between groups with respect to their use of reliable resources (e.g., PubMed and Natural Medicines) vs. unreliable sources (other internet searches or personal anecdotes) when addressing CIH-related questions. These findings indicate that pharmacists with more focused training in CIH are more comfortable, confident, and knowledgeable when discussing homeopathy. Such education should be provided more broadly to students in colleges of pharmacy. Full article

Introduction: Adenoid cystic carcinoma (AdCC) is a rare tumor whose clinical course is burdened by local recurrence and distant dissemination. Lymph node metastasis is not believed to be common and its clinical impact is controversial. The aim of this study was to determine: (1) the prevalence of occult metastasis at diagnosis in cN0 head and neck AdCC, (2) its prognostic role, and (3) the consequent need to perform elective neck dissection (END). Material and Methods: A systematic review and meta-analyses following PRISMA guidelines was performed. PubMed, Embase, and Central databases were questioned up to July 2021 to identify studies reporting on the prevalence of occult neck metastases in head and neck AdCC. A single-arm meta-analysis was then performed to determine the pooled prevalence of occult lymph node metastases among the retained studies. Results: Of the initial 6317 studies identified, 16 fulfilled the inclusion criteria, and they were included in the meta-analysis. Of a population of 7534 patients, 2530 cN0 patients were treated with END, which revealed 290/2530 cases of occult metastases (pN+/cN0). Meta-analysis of the results of END in the 16 studies estimated an overall prevalence of occult metastases at diagnosis of 17%. No further subgroup analysis was possible to identify factors influencing lymph node involvement and the prognostic role of END. Conclusions: Taking 20% as an historically proposed cut off, a 17% prevalence of occult metastases represents a borderline percentage to get a definitive conclusion about the indication to END for head and neck AdCC. A more advanced UICC stage, an oropharyngeal minor salivary glands origin, and a high-grade transformation are factors to be considered in a comprehensive patient’s tailored therapeutic strategy. Multicenter prospective studies are the key to finding stronger recommendations on this topic. Full article

The sustainable development of science and environmental education is a core mechanism in the world education system. The implementation of the goal of establishing science and environmental education comprehensively in higher education, especially in vocational education, poses a challenge. Basic vocational education is a category of the education system, as well as sustainable development, which involves the technical and vocational education (TVE) system (20–30 general/compulsory/elective credits required). Awareness of the sustainable development in science and environment is getting more and more emphasized by educators. For students’ learning to use, it was recommended that universities use education for sustainable development (ESD) in TVE programs. This study proposes clarifying whether anticipating the needs of TVE university students is more conducive for them. Also, for the global understanding about innovative education, the “awareness of the sustainable development in science and environment” was involved in our experimental items. The learning satisfaction derived from students from the collaborative teaching of the industry experts in the TVE system is another point of focus. Students who take the course attend six weekly three-hour periods in class. An e-learning system is utilized so that learning resources created by industry experts can be provided. The deployment facilitates the evaluation of basic vocational education because teaching is not only performed in a traditional class but also prompted via a valuable e-learning system. The results showed that “Level of respect during the collaborative teaching of industry experts” (mean = 3.93; S.D. = 0.751) was rated by students as satisfactory and “Overall efficiency of teaching materials” (mean = 3.47) was rated as the lowest of the items. “Awareness of the sustainable development in science and environment” (mean = 3.86; S.D. = 0.752) was rated by students as highly satisfactory. To verify the result, an analysis of the improvement of learning satisfaction is discussed. Practical implications and future work are also discussed. Full article

Schwannomas are generally benign, slow growing tumors. They are rarely observed in the gastrointestinal tract with the most common site being the stomach. These tumors are usually asymptomatic. The preoperative diagnosis via endoscopy is a challenging issue due to the difficulty of differentiation from other submucosal tumors. A 54-year-old woman presented with epigastric pain persisting for the last 10 months. Upper endoscopy revealed an elevated submucosal mass of the gastric antrum. The overlying mucosa was normal. Biopsy specimens yielded only unspecific signs of mild inactive chronic inflammation. Endoscopic ultrasound examination noted a hypoechoic homogeneous mass lesion located in the gastric antrum. The mass appeared to arise from the muscularis propria, and there was no perigastric lymphadenopathy. A contrast-enhanced computed tomography scan identified a homogeneous round mass and arising from the antrum of the stomach. Submucosal tumor was suspected and surgical intervention was recommended. The patient underwent an elective laparoscopic partial gastrectomy. The histopathologic features and immunohistochemical-staining pattern were consistent with a benign gastric schwannoma. Our patient shows no recurrence with a follow-up of one year. The definitive diagnosis of gastric schwannomas requires immunohistochemical studies. Complete margin negative surgical resection, as in this case, is the curative treatment of choice. The clinical course is generally benign. Full article