Cureus最新文献

{"title":"Association Between the Use of Proton Pump Inhibitors and Severe Clinical Outcomes in COVID-19 Patients: A Retrospective Observational Study.","authors":"Sharon Pinto, Hadia Al Lawati, Marwa Al Raisi, Balqees Al Maawali","doi":"10.7759/cureus.72385","DOIUrl":"10.7759/cureus.72385","url":null,"abstract":"<p><p>Background Proton pump inhibitors (PPIs) increase the risk of pneumonia secondary to PPI-induced hypochlorhydria. We aim to investigate the association between PPI and disease severity in coronavirus disease 2019 (COVID-19)-positive patients and the risk of hospitalizations in Muscat, Oman. Methodology COVID-19-positive patients aged 18 years and above at the time of diagnosis were included in this retrospective observational study. The details of the patients were retrieved from the electronic health records of the Al Shifa Hospital Information Management System and Tarassud. The composite primary endpoint was COVID-19 admission to a government tertiary hospital ward or intensive care within 14 days of diagnosis. Results A total of 506 COVID-19-positive patients were identified during the specified period. The mean age was 44 ± 15 years. The majority of the patients were Omani, and a female preponderance was observed. Overall, 104 (20.4%) patients were current PPI users. Admission due to COVID-19 was significantly associated with the presence of comorbid conditions such as diabetes mellitus (p = 0.001), hypertension (p = 0.001), and chronic kidney disease (p < 0.001). However, current PPI use (p = 0.140) was not significantly associated with an increased risk of hospitalization. Conclusions This data suggests that the use of PPIs during COVID-19 infection did not increase the risk of severe COVID-19 infection and poor outcomes leading to hospitalization in Muscat, Oman. However, the presence of other medical comorbidities, such as diabetes and hypertension, was associated with a higher risk of adverse clinical symptoms that resulted in hospitalization.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11510648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Procalcitonin Does Not Always Indicate a Bacterial Infection.","authors":"Hamza Shahzad, Adan J Khokhar, Saad Ibrahim, Mian U Farooq, Rimsha Rashid, Hameed U Raheem, Gurjit Singh","doi":"10.7759/cureus.72274","DOIUrl":"10.7759/cureus.72274","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Procalcitonin (PCT) has become essential for differentiating bacterial infections from viral infections and noninfectious causes of inflammation, as most inflammatory markers rise with inflammation without indicating a specific etiology. The significance of PCT was underscored during the COVID-19 pandemic, when many patients exhibited elevated inflammatory markers, complicating decisions regarding antibacterial therapy without PCT levels. However, a rise in PCT cannot always be attributed to a bacterial infection, as it is also a precursor of calcitonin produced in the thyroid gland. We present a case of a 77-year-old female patient with a history of medullary thyroid cancer, which she underwent surgical resection and radiotherapy for in 1980. She also experienced right vocal cord palsy as a side effect of radiotherapy and had stable liver metastases. Her past medical history included hypothyroidism, trigeminal neuralgia, gastroesophageal reflux disease, prediabetes, meningioma, vertebral fracture, osteoporosis, depression, and chronic kidney disease stage 4. The patient had recurrent episodes of aspiration pneumonia and poor swallowing. She presented with progressive dysphagia, and her chest X-ray revealed consolidation, with positive Mycoplasma IgM. At the end of her antibiotic course, there were no residual infective symptoms. Prior to admission, a CT scan of the thorax, abdomen, and pelvis showed bilateral upper zone medial fibrotic changes related to radiation, with no sinister lung lesions. It also revealed a few non-united fractures involving the left-sided ribs posteriorly, while biliary distension and liver and bone disease appeared stable. Interestingly, her PCT levels remained consistently elevated at &gt;100 ng/L throughout her admission, despite normal CRP and white blood cell counts. This case was extensively discussed with the infectious diseases team, who suggested that the elevated PCT levels were likely related to thyroid cancer metastases, which can synthesize PCT. Consequently, PCT would be functionally increased in such circumstances and would be an unreliable marker for infection. Further analysis indicated that the PCT elevation resulted from her stable medullary thyroid cancer liver metastases, which were dormant and not affecting liver function but were secreting PCT. This case illustrates that a patient with medullary thyroid cancer metastases to the liver, who was treated for pneumonia, exhibited persistently high PCT levels despite completing the treatment. Calcitonin levels, checked on one occasion, were also elevated, reinforcing that the rise in PCT was attributed to production from medullary cancer metastatic cells rather than an inflammatory response. In bacterial septicemia, PCT is produced through alternate pathways, either directly or indirectly, and is therefore not related to the rise in calcitonin. Consequently, persistently high PCT levels in the absence of other infection markers should prompt further i","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11506317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Medication of Medical Students at Erzincan Binali Yıldırım University in Turkey: A Cross-Sectional Study.","authors":"Sema Turan","doi":"10.7759/cureus.72319","DOIUrl":"10.7759/cureus.72319","url":null,"abstract":"<p><strong>Introduction: </strong>Responsible self-medication (SM) can save time, money, reduce the number of visits to the doctor, and alleviate pressure on health services. However, while there are clear benefits, SM also carries significant risks, such as increased drug side effects, inappropriate use of prescription drugs, drug interactions, misdiagnosis, drug dependence, masking of medical conditions, and antibiotic resistance.</p><p><strong>Aim: </strong>This study aimed to investigate the practices of medical students at a public university in Türkiye towards SM, as well as to determine the factors influencing such practices.</p><p><strong>Method: </strong>The population of this cross-sectional study included first-, fourth-, and sixth-year medical students. As the goal was to reach the entire population (375 students), no sample selection was made. A total of 332 students (88.5%) participated in the study. The relevant literature was used for the basis of the questionnaire used in the study. In the statistical evaluation, percentages, means, standard deviations, medians, minimum, and maximum values were used to present the descriptive data, while factors influencing SM were analyzed using the chi-square test and bivariate and multivariate logistic regression analysis.</p><p><strong>Results: </strong>The overall rate of SM among the participants was found to be 96.1%. No statistically significant difference was observed in SM rates based on the year of study (p>0.05). The rate of students using antibiotics without a prescription was 19.3%. Additionally, 82.5% of the students reported reading the package insert before using a drug. The most common symptoms leading to SM were headaches (83.1%) and the common cold (63.6%). The most frequently self-administered medications were analgesics (86.1%), common cold medicines (54.8%), and vitamins (34.0%). Furthermore, 79.3% of the participants indicated that they self-medicate because they perceive their condition as a simple illness, 64.6% because they had experienced a similar illness before, and 28.2% because they believed they had sufficient knowledge of medications. In multivariate regression analysis, keeping medicines at home/in the dormitory for later use and not having a chronic disease were found to be effective factors in students' practice of SM.</p><p><strong>Conclusion: </strong>It is important to plan educational interventions to promote the development of responsible SM behaviors. Starting these educational programs in the first year of medical school is thought to contribute significantly to the fostering of responsible SM practices.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multisystem Inflammatory Syndrome in Children: A Case Report.","authors":"Thryambak Ganapathy, Kirsten Emily M Villagracia, Saharsh S Kuditini, Sorivel Sosa Hilario","doi":"10.7759/cureus.72303","DOIUrl":"10.7759/cureus.72303","url":null,"abstract":"<p><p>This case report delves into the case of a patient in the Dominican Republic with multisystem inflammatory syndrome in children (MIS-C). MIS-C is a rare, hyper-inflammatory condition that develops in children as a delayed response to a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, typically appearing with general markers of inflammation such as erythema and, in severe cases, cardiorespiratory symptoms. The three-year-old patient discussed in this report presented with signs of inflammation, such as erythema, rashes, and chapped skin, and reported experiencing diarrhea, vomiting, and fever for multiple days. Notably, a concurrent parasitic presence was found in the patient's fecal sample, and antibiotics were heavily used throughout the course of treatment. We explain the merits and drawbacks behind using antibiotic therapy for MIS-C and suggest steps that clinicians and researchers can take in order to minimize the potential misuse of antibiotics. Specifically, we identify that prioritizing tests for concurrent infections or illnesses is imperative in treating MIS-C patients, and we conclude by stating that using blood cultures and coprological examinations in tandem is an effective strategy for this purpose.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Evaluation of the Safety of Half-Dose Direct Oral Anticoagulants Following Total Joint Arthroplasty: A Pilot Study.","authors":"Harrison A Patrizio, Rex W Lutz, Stephanie A Kwan, Adam Lencer, Gregory K Deirmengian","doi":"10.7759/cureus.72283","DOIUrl":"https://doi.org/10.7759/cureus.72283","url":null,"abstract":"<p><p>Background Total joint arthroplasty (TJA) patients on preoperative anticoagulation therapy present a challenge for adult reconstruction surgeons. The goal in managing such patients is to limit bleeding complications associated with administering the medications while preventing medical complications from withholding them. At our institution, we began a protocol in 2017 that utilizes a half-dose direct oral anticoagulant (DOAC) regimen for one week followed by resuming of the full-dose regimen in select patients who underwent TJA. This study investigated the 90-day safety profile associated with this protocol compared to previous literature. Methodology A retrospective review of 898 patients from a single institution was conducted including all patients receiving a half-dose DOAC protocol for one week followed by resuming of the full-dose regimen after total knee and total hip arthroplasty between 2017 and 2022. Data were collected on patient demographics, type of surgery, and DOAC dosage. Ninety-day complications were collected and separated into reduced dose complications of DOAC (such as cerebrovascular accidents (CVAs) or venothrombotic events (VTEe)) and DOAC therapy-related complications (including wound and bleeding complications). Results In the total hip arthroplasty (THA) subgroup (n = 396, 44.10%), there were four major VTE occurrences, aligning with the range seen in historical protocols. Deep vein thrombosis (DVT) and pulmonary embolism (PE) incidents were three and one, respectively, both within the historical range. In the total knee arthroplasty (TKA) subgroup of 502 (55.90%) patients, there were seven major VTE events, with five DVTs and two PEs, also aligning with historical ranges. Medical complications in the THA group included no CVA events and one myocardial infarction, with the latter slightly higher than the historical range. In the TKA group, there were two medical complications, both being CVAs. Regarding bleeding complications, THA patients showed four major bleeding incidents, two blood transfusions, and two hemorrhages, with these numbers comparable to or lower than historical ranges. There were seven minor bleeding events. For TKA, there were two major bleeding events, two blood transfusions, no hemorrhages, and five minor bleeding events. Wound complications in THA included five surgery-related complications, two cases of wound dehiscence, and three infections. TKA patients experienced 17 surgery-related complications, six cases of wound dehiscence, and 11 infections. Conclusions This study suggests that the half-dose DOAC protocol in patients undergoing TJA is non-inferior to historical full-dose DOAC protocols warranting further investigation to generalize across broader populations.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Management of Root Perforation: A Review of the Literature.","authors":"Maram M Alshehri, Bushra F Alhawsawi, Atheer Alghamdi, Salem O Aldobaikhi, Maha H Alanazi, Fahad A Alahmad","doi":"10.7759/cureus.72296","DOIUrl":"https://doi.org/10.7759/cureus.72296","url":null,"abstract":"<p><p>Root canal perforation is defined as an opening or communication of the root to the outer oral tissue that occurs either accidentally during root canal therapy or due to unknown pathological causes, which generally result in complications in patients due to the passage of microorganisms to the surrounding tissues. These complications may necessitate extraction of the affected tooth. In this literature review, 42 articles were reviewed initially; 33 of them were included in the final analysis based on exclusion and inclusion criteria. Root perforation may occur due to caries, external and internal resorption, trauma, as well as iatrogenic causes. Many studies have suggested that perforation can be identified by radiographs, unexpected bleeding and pain during instrumentation, blood on paper points, electronic apex locator, and dental operating microscope. Several materials have been used in endodontic perforation repairs, such as indium foil, super 2-ethoxybenzoic acid (super EBA), as well as bioceramic materials like mineral trioxide aggregate (MTA) and biodentine. These materials must achieve biocompatibility, bacteriostatic ability, and radio-opacity. Many studies have reported the superior properties of MTA in comparison with other materials. Based on our literature review, management of root perforation should be performed based on multiple significant factors. Clinicians must possess a comprehensive understanding of tooth anatomy to prevent perforation occurrence. Furthermore, clinical management and prognosis of root perforation have been enhanced by the availability of advanced materials and sealing techniques.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Serum Interleukin-6 Levels, Systemic Immune-Inflammation Index, and Other Biomarkers Across Different Rheumatoid Arthritis Severity Levels.","authors":"Shah Zeb, Zahir Khan, Ashraf, Mustafa Javaid, Rumman, Muhammad Arsalan Azmat Swati, Zenab Javaid, Muhammad Luqman","doi":"10.7759/cureus.72334","DOIUrl":"10.7759/cureus.72334","url":null,"abstract":"<p><p>Background Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by joint inflammation, pain, and progressive disability. Identifying biomarkers that accurately reflect disease severity is crucial for effective management. Interleukin-6 (IL-6) is a pro-inflammatory cytokine involved in the pathogenesis of RA, and the systemic immune-inflammation index (SII) is emerging as a useful marker of systemic inflammation. This study aims to explore the relationship between serum IL-6 levels, SII, and various biomarkers to better predict disease severity in RA patients. Objective To determine the relationship between serum IL-6 levels and the SII, along with various biomarkers, across different severity levels for predicting the severity of RA in patients. Methods This cross-sectional, observational study was conducted at the Mardan Medical Complex from January 2024 to August 2024, involving 67 RA patients. Clinical assessments included demographic data, disease activity (DAS28), pain (VAS), joint damage (Larsen score), and functional status (HAQ-DI). Serum IL-6 levels, along with other biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and the SII, were measured through fasting blood samples. Statistical analyses, including density plots, scatter plots, boxplots with ANOVA, and random forest models, were performed to explore associations between IL-6 and all other variables. Significance was set at p < 0.05. Results The study included 67 RA patients (mean age: 41.79 ± 10.51 years, 53.73% male). Elevated IL-6 levels (mean: 80.28 ± 35.27 pg/mL) were strongly associated with disease severity. Patients with DAS28 > 5.5 had IL-6 levels over 100 pg/mL, while those in remission had around 40 pg/mL. IL-6 levels correlated with joint damage (100 pg/mL in severe cases) and pain (over 120 pg/mL for severe pain). Patients with metabolic and cardiovascular comorbidities had the highest IL-6 levels, particularly with diabetes and hypertension (98.6 pg/mL) or cardiovascular disease (119.3 pg/mL). IL-6 correlated strongly with CRP (r = 0.65), ESR (r = 0.51), and SII (r = 0.62). Regression confirmed IL-6 as an independent predictor of severity (p < 0.001), with comorbidities being key predictors. Conclusion Elevated IL-6 and SII levels serve as critical markers for predicting the severity of RA. Addressing these markers may lead to more targeted and effective therapeutic strategies for managing disease progression.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11516189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not Just Myocarditis: Mixed Connective Tissue Disease (MCTD) and Overlap Myositis With Anti-Ku Positivity in a Young Male With Shortness of Breath.","authors":"Kawthar Alsulami, Julie D'Aoust","doi":"10.7759/cureus.72310","DOIUrl":"https://doi.org/10.7759/cureus.72310","url":null,"abstract":"<p><p>Mixed connective tissue disease (MCTD) is an autoimmune disorder characterized by high levels of anti-U1 ribonucleoprotein (RNP) antibodies and overlapping clinical features of autoimmune diseases, such as systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and polymyositis (PM). Anti-Ku antibodies have been associated with overlap syndromes, which can present with symptoms such as Raynaud's phenomenon, arthritis, and myositis.  A 19-year-old male athlete presented with myositis, notable for cardiac involvement. Diagnostic testing revealed elevated anti-RNP and anti-Ku antibodies, and a muscle biopsy indicated scleromyositis/overlap myositis. The patient was treated with high-dose corticosteroids, intravenous immunoglobulin (IVIG), rituximab, and mycophenolate mofetil, which led to significant improvement in muscle strength and cardiac function. This case highlights the diagnostic complexity of MCTD when associated with positive anti-Ku antibodies, overlap syndromes, and cardiac involvement. Successful management emphasizes the importance of a tailored, multi-modal therapeutic approach.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Among Changes in Body Composition, Activity, Muscle Recovery, and Obesity Following Total Knee Arthroplasty: A Retrospective Study.","authors":"Kyohei Nagayama, Takaaki Shishido, Tsunehito Ishida, Norihiko Iwasa, Yohei Nishikawa, Toshiyuki Tateiwa, Toshinori Masaoka, Kengo Yamamoto","doi":"10.7759/cureus.72282","DOIUrl":"https://doi.org/10.7759/cureus.72282","url":null,"abstract":"<p><strong>Purpose: </strong>Total knee arthroplasty (TKA) is expected to improve knee pain and enable patients to regain the ability to walk, but the associations between preoperative and postoperative changes in body composition, muscle strength, and activity remain unclear. In this study, we investigated the association between changes in body composition before and after TKA surgery, the recovery process of muscle strength, and changes in activity, as well as the effects of obesity on TKA.</p><p><strong>Methods: </strong>A total of 124 patients with unilateral knee osteoarthritis (OA) who underwent TKA were retrospectively evaluated. Body weight (BW) and body composition (body fat percentage (BFP) and diseased limb muscle mass (DLMM)), measured by bioelectrical impedance analysis, quadriceps muscle strength (QMS), measured using the isometric muscle strength meter, number of steps (NOS), and Japanese Orthopaedic Association (JOA) OA knee diseases treatment outcome criteria (JOA score) before the operation, at postoperative six months (PO6M), and at postoperative one year (PO1Y) after the operation were investigated and compared between the non-obese (BMI < 25 kg/m²) group, including underweight (<18.5 kg/m²) and normal weight patients (18.5 to 24.9 kg/m²), and obese (BMI ≥ 25 kg/m²) group, including overweight (25.0 to 29.9 kg/m²) or obese patients (≥30.0 kg/m²).</p><p><strong>Results: </strong>In all patients, JOA scores significantly improved from 59.7 preoperatively to 81.2 at PO6M, and 82.7 at PO1Y (both p < 0.01). QMS significantly increased from 112.4 N preoperatively to 144.0 N at PO6M, and 151.0 N at PO1Y (both p < 0.01). On the other hand, there was no significant change in BW, BFP, NOS, and DLMM. A comparison between the obese (n = 76) and non-obese (n = 48) groups demonstrated that there was no significant difference in JOA scores preoperatively, but scores at PO1Y were significantly higher in the non-obese group (p < 0.01), and QMS increased significantly postoperatively in both groups, but the enlargement rate at PO1Y was 1.4% in the obese group versus 10.4% in the non-obese group (p = 0.04).</p><p><strong>Conclusion: </strong>In the body composition of TKA patients, BW, BFP, and DLMM/BW did not change significantly from preoperatively to PO1Y, but QMS and JOA scores showed significant improvement at PO6M and PO1Y compared to preoperatively. The obese patients showed less improvement in JOA scores than non-obese patients, and the rate of increase in QMS at PO1Y was smaller, suggesting that rehabilitation focusing on muscle-strengthening training is necessary even at PO6M, especially in obese patients.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Workforce-Driven Innovation in Healthcare.","authors":"Alaa I Al-Saleem, Manal K Aldakheel","doi":"10.7759/cureus.72316","DOIUrl":"https://doi.org/10.7759/cureus.72316","url":null,"abstract":"<p><p>Healthcare systems are continually developing new ways of delivering care in pursuit of quality improvement, increasing patient and provider satisfaction, and enhancing efficiency. This review measures the barriers to workforce-driven innovation in healthcare, a crucial yet underexamined area of study. Research into workforce-driven innovation in healthcare identifies several key barriers and solutions. Major impediments include a lack of knowledge and resources, as well as financial constraints, which hinder the implementation of innovations. Research findings from different regions enumerate organizational capability, leadership quality, and the adequacy of human resource management as influencing factors for innovation. Poor leadership, lack of inter- and cross-organizational learning, and structural barriers related to inadequate communication and formal forums also hinder progress. In addition, the resistance to change and the inability to engage employees effectively further obstruct innovation efforts. These issues can be addressed through the creation of a supportive innovation environment, enhancing training and development, and improving communication networks. Despite thorough database searches, the emerging nature of this topic has resulted in limited literature, restricting a comprehensive comparison of studies. Future research studies should be longitudinal in design, from diverse geographic contexts, and focus on the effects of emerging technologies to comprehensively understand these barriers and develop effective strategies for overcoming them.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}