Psychoactive Plant Database - Neuroactive Phytochemical Collection

1. Int J Nurs Stud Adv. 2024 Oct 23;7:100248. doi: 10.1016/j.ijnsa.2024.100248. 
eCollection 2024 Dec.

From 'strong recommendation' to practice: A pre-test post-test study examining 
adherence to stroke guidelines for fever, hyperglycaemia, and swallowing (FeSS) 
management post-stroke.

Coughlan K(1)(2), Purvis T(3), Kilkenny MF(3)(4), Cadilhac DA(4)(5), Fasugba 
O(1)(2), Dale S(1)(2), Hill K(5), Reyneke M(3), McInnes E(1)(2), McElduff 
B(1)(2), Grimshaw JM(6), Cheung NW(7), Levi C(8), D'Este C(9)(10), Middleton 
S(1)(2).

Author information:
(1)Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's 
Hospital Melbourne and Australian Catholic University, Level 5, deLacy Building, 
390 Victoria Street, Darlinghurst, NSW 2010, Australia.
(2)School of Nursing, Midwifery and Paramedicine, Australian Catholic 
University, 33 Berry Street, North Sydney, NSW 2060, Australia.
(3)Sroke and Ageing Research, School of Clinical Sciences, Monash University. 
Monash Medical Centre, Block E, Level 5, 246 Clayton Rd, Clayton, VIC 3168, 
Australia.
(4)Stroke Theme, The Florey Institute of Neuroscience and Mental Health, 
University of Melbourne, 245 Burgundy Street, Heidelberg, VIC 3084, Australia.
(5)Stroke Foundation, Level 7/461 Bourke St, Melbourne, VIC 3000, Australia.
(6)Ottawa Health Research Institute, Ottawa Hospital - General Campus, Centre 
for Practice-Changing Research (CPCR); and University of Ottawa, 501 Smyth Box 
511, Ottawa, ON K1H 8L6, Canada.
(7)Centre for Diabetes and Endocrinology Research, Westmead Hospital and 
University of Sydney, Hawkesbury Road, Westmead, NSW 2145, Australia.
(8)John Hunter Hospital, University of Newcastle. Lookout Rd, New Lambton 
Heights, NSW 2305, Australia.
(9)Sax Institute, Level 3/30C Wentworth St, Glebe, NSW 2037, Australia.
(10)School of Medicine and Public Health, College of Health, Medicine and 
Wellbeing, University of Newcastle, Newcastle, NSW, Australia.

BACKGROUND: The Quality in Acute Stroke Care (QASC) Trial demonstrated that 
assistance to implement protocols to manage Fever, hyperglycaemia (Sugar) and 
Swallowing (FeSS) post-stroke reduced death and disability. In 2017, a 'Strong 
Recommendation' for use of FeSS Protocols was included in the Australian 
Clinical Guidelines for Stroke Management. We aimed to: i) compare adherence to 
FeSS Protocols pre- and post-guideline inclusion; ii) determine if adherence 
varied with prior participation in a treatment arm of a FeSS Intervention study, 
or receiving treatment in a stroke unit; and compare findings with our previous 
studies.
METHODS: Pre-test post-test study using Australian acute stroke service audit 
data comparing 2015/2017 (pre-guideline) versus 2019/2021 (post-guideline) 
adherence. Primary outcome was adherence to all six FeSS indicators (composite), 
with mixed-effects logistic regression adjusting for age, sex, stroke type and 
severity (ability to walk on admission), stroke unit care, hospital prior 
participation in a FeSS Intervention study, and correlation of outcomes within 
hospital. Additional analysis examined interaction effects.
RESULTS: Overall, 112 hospitals contributed data to ≥1 one Audit cycle for both 
periods (pre=7011, post=7195 cases); 42 hospitals had participated in any 
treatment arm of a FeSS Intervention study. Adherence to FeSS Protocols 
post-guideline increased (pre: composite measure 35% vs post: composite measure 
40 %, aOR:1.2 95 %CI: 1.2, 1.3). Prior participation in a FeSS Intervention 
study (aOR:1.6, 95 %CI: 1.2, 2.0) and stroke unit care (aOR 2.3, 95 %CI: 2.0, 
2.5) were independently associated with greater adherence to FeSS Protocols. 
There was no change in adherence over time based on prior participation in a 
FeSS Intervention study (p = 0.93 interaction), or stroke unit care (p = 0.07 
interaction).
CONCLUSIONS: There is evidence of improved adherence to FeSS Protocols following 
a 'strong recommendation' for their use in the Australian stroke guidelines. 
Change in adherence was similar independent of hospital prior participation in a 
FeSS Intervention study, or stroke unit care. However, maintenance of higher 
pre-guideline adherence for hospitals prior participation in a FeSS Intervention 
study suggests that research participation can facilitate greater guideline 
adherence; and confirms superior care received in stroke units. Nevertheless, 
less than half of Australian patients are being cared for according to the FeSS 
Protocols, providing impetus for additional strategies to increase uptake.

© 2024 The Author(s).

DOI: 10.1016/j.ijnsa.2024.100248
PMCID: PMC11539718
PMID: 39507681

Conflict of interest statement: KH (National Manager Stroke treatment, Stroke 
Foundation) MK, MR, TP and DC are responsible for the independent and alloy 
analysis of National Stroke Audit data on behalf of the Stroke Foundation MK 
(member of the Research Advisory Committee at the Stroke Foundation) SM, CL, 
DAC, SD, NWC, JG, CDE, EM, KC, OF, BM (Investigators QASC Research Program: QASC 
QASCIP,T3 and QASC Europe Studies)The authors declare the following financial 
interests/personal relationships which may be considered as potential competing 
interests: Professor Sandy Middleton reports financial support was provided by 
National Health and Medical Research Council Investigator Grant. Kelly Coughlan 
reports financial support was provided by Australian Government Research 
Training Program Scholarship. Monique Kilkenny reports financial support was 
provided by National Heart Foundation of Australia fellowship. Kelly Coughlan 
reports financial support was provided by St Vincent's Hospital (Melbourne) 
Limited. Kelvin Hill reports a relationship with Stroke Foundation Australia 
that includes: employment. Co-author Monique Kilkenny is a member of the 
Research Advisory Committee at Stroke Foundation Australia Co-authors Monique 
Kilkenny, Megan Reyneke, Tara Purvis and Dominique Cadilhac are responsible for 
the independent and alloy analysis of National Stroke Audit data on behalf of 
the Stroke Foundation Corresponding author and co-authors Sandy Middleton, 
Christopher Levi, Dominique Cadilhac, Simeon Dale, N Wah Cheung, Jeremy 
Grimshaw, Cate DEste, Elizabeth McInnes, Kelly Coughlan, Oyebola Fasugba, are 
investigators for the QASC Research Program (QASC QASCIP,T3 and QASC Europe 
Studies) If there are other authors, they declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


2. Eur Urol Open Sci. 2024 Oct 22;70:79-85. doi: 10.1016/j.euros.2024.10.003. 
eCollection 2024 Dec.

Incidence of and Risk Factors for Urinary Stones Among Patients with Spinal Cord 
Injury: A Systematic Review with Meta-analysis.

Zhang W(1)(2)(3), Shen R(1)(2)(3), Shang Z(1)(2)(3), Wang Z(1)(2)(3), Yu 
Y(1)(2)(3), Zhang K(4), Yang Y(1)(2)(3), Pang M(1)(2)(3).

Author information:
(1)Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-Sen 
University, Guangzhou, China.
(2)Guangdong Provincial Center for Engineering and Technology Research of 
Minimally Invasive Spine Surgery, Guangzhou, China.
(3)Guangdong Provincial Center for Quality Control of Minimally Invasive Spine 
Surgery, Guangzhou, China.
(4)School of Public Health, Lanzhou University, Lanzhou, China.

BACKGROUND AND OBJECTIVE: Urinary stones are a significant and common 
complication among patients with spinal cord injury (SCI), but epidemiological 
data are scarce and the evidence regarding risk factors remains unclear. Our aim 
was to investigate the incidence of and risk factors for urinary stones in SCI 
patients to provide evidence for better prevention and treatment strategies.
METHODS: Relevant studies were identified from the PubMed, Web of Science, 
Cochrane, Embase, and Scopus databases. Literature screening, information 
extraction, and quality evaluation were conducted in accordance with established 
standards. Data analysis was performed using the metaprop and metan commands in 
Stata 16.0.
KEY FINDINGS AND LIMITATIONS: A total of 65 studies involving 64 059 patients 
were included in the analysis. Meta-analysis using a random-effects model 
revealed that the overall incidence of urinary stones after SCI was 16.6% (95% 
confidence interval 14.1-19.3%). Over time, the incidence rate has stabilized 
between 15% and 20%, although annual rates varied significantly, ranging from 
2.2% to 68.7%. The highest incidence was observed for bladder stones, with lower 
incidence rates for kidney and ureteral stones. Among the 13 factors assessed, 
male sex, a complete injury, and the use of intermittent, indwelling, and condom 
catheters were identified as independent risk factors for urinary stones.
CONCLUSIONS AND CLINICAL IMPLICATIONS: The incidence of urinary stones after SCI 
is high, with a number of risk factors identified. However, further high-quality 
research is needed to explore additional potential risk factors.
PATIENT SUMMARY: We reviewed the results of previous studies on urinary stones 
in patients with a spinal cord injury. We found a high rate of urinary stones of 
about 17% for this patient group. Males are more prone to urinary stones and use 
of a catheter is a risk factor. More research is needed to identify other risk 
factors.

© 2024 The Authors.

DOI: 10.1016/j.euros.2024.10.003
PMCID: PMC11538624
PMID: 39507510


3. Afr J Lab Med. 2024 Oct 18;13(1):2509. doi: 10.4102/ajlm.v13i1.2509.
eCollection  2024.

An audit of the iron status of patients at Chris Hani Baragwanath Academic 
Hospital, in Johannesburg, South Africa.

Grove JS(1)(2), Khoza S(1)(2), Mabuza DV(3), Khan SB(1)(2).

Author information:
(1)Department of Chemical Pathology, Faculty of Health Sciences, University of 
the Witwatersrand, Johannesburg, South Africa.
(2)National Health Laboratory Service, Johannesburg, South Africa.
(3)Department of Chemical Pathology, Faculty of Pathology, PathCare 
Laboratories, Johannesburg, South Africa.

BACKGROUND: Iron deficiency is a common disorder, especially in developing 
countries. Accurately assessing iron status remains challenging, particularly 
for patients with chronic diseases such as HIV and chronic kidney disease, 
prevalent in South Africa.
OBJECTIVE: This study aimed to determine how ferritin cut-offs affect iron 
status classification in adult patients treated at a tertiary hospital in South 
Africa. Additionally, it assessed the frequency of these conditions and the 
impact of age and gender on iron status.
METHODS: This retrospective study analysed iron profiles in adult patients from 
01 October 2020 to 31 March 2021. Iron status was categorised into five groups: 
iron deficiency anaemia (IDA), anaemia of chronic disease, IDA with anaemia of 
chronic disease, iron deficiency without anaemia, and iron replete based on 
haemoglobin, transferrin saturation, and ferritin levels. The impact of using 
two different ferritin cut-off values (15 µg/L and 30 µg/L) was investigated.
RESULTS: The study included 3221 complete iron profiles. There was a 
predominance of female patients (2.2:1 ratio). Anaemia of chronic disease was 
the most prevalent iron disorder (39%), regardless of ferritin cut-off. Using a 
higher ferritin cut-off of 30 µg/L significantly increased the detection rates 
of both IDA and iron deficiency without anaemia (p < 0.001).
CONCLUSION: This study suggests that a higher ferritin threshold (30 µg/L) might 
improve diagnosis of iron disorders in settings with high inflammatory diseases. 
Further studies are needed to refine thresholds. Local guidelines should be 
adjusted to consider higher ferritin cut-offs, and longitudinal studies are 
recommended to evaluate long-term outcomes.
WHAT THIS STUDY ADDS: This study confirms the use of higher ferritin cut-offs 
for enhanced detection of iron deficiency states. The findings also emphasise 
the ongoing need for establishing simple, standardised, and accurate methods for 
iron status classification.

© 2024. The Authors.

DOI: 10.4102/ajlm.v13i1.2509
PMCID: PMC11538453
PMID: 39507475

Conflict of interest statement: The authors declare that they have no financial 
or personal relationships that may have inappropriately influenced them in 
writing this article.


4. J Educ Teach Emerg Med. 2024 Oct 31;9(4):C1-C120. doi: 10.21980/J8WH2K. 
eCollection 2024 Oct.

A Simulation and Small-Group Pediatric Emergency Medicine Course for Generalist 
Healthcare Providers: Gastrointestinal and Nutrition Emergencies.

Kosoko AA(1), Genisca AE(2), Peoples NA(3), Tompkins C(3), Sorensen R(3), Mackey 
J(4).

Author information:
(1)McGovern Medical School at the University of Texas Health Science Center at 
Houston, Department of Emergency Medicine, Houston, TX.
(2)The Warren Alpert Medical School of Medicine Brown University/Hasbro 
Children's Hospital, Departments of Emergency Medicine and Pediatrics, 
Providence, RI.
(3)The Baylor College of Medicine, Houston, TX.
(4)Henry J.N. Taub Baylor College of Medicine, Department of Emergency Medicine, 
Houston TX.

AUDIENCE AND TYPE OF CURRICULUM: This is a review curriculum utilizing multiple 
methods of education to enhance the skills of generalist healthcare providers in 
low- and middle-income countries (LMICs) in the identification and stabilization 
of pediatric respiratory emergencies. Our audience of implementation was 
Belizean generalist providers (nurses and physicians).
LENGTH OF CURRICULUM: 8-10 hours.
INTRODUCTION: Early recognition and stabilization of critical pediatric patients 
can improve outcomes. Compared with resource-rich systems, many low-resource 
settings (i.e., LMICs) rely on generalists to provide most pediatric acute care. 
We created a curriculum for general practitioners comprising multiple 
educational modules focused on identifying and stabilizing pediatric 
emergencies. Our aim was to develop an educational framework to update and teach 
generalists on the recommendations and techniques of optimally evaluating and 
managing pediatric nutritional and gastrointestinal emergencies: bowel 
obstructions, gastroenteritis, and malnutrition.
EDUCATIONAL GOALS: The aim of this curriculum is to increase learners' 
proficiency in identifying and stabilizing acutely ill pediatric patients with 
gastrointestinal medical or surgical disease or complications of malnutrition. 
This module focuses on the diagnosis and management of gastroenteritis, acute 
bowel obstruction, and deficiencies of feeding and nutrition. The target 
audience for this curriculum is generalist physicians and nurses in 
limited-resource settings.
EDUCATIONAL METHODS: The educational strategies used in this curriculum include 
didactic lectures, medical simulation, and small-group sessions.
RESEARCH METHODS: We evaluated written pretests before and posttests after 
intervention and retested participants four months later to evaluate for 
knowledge retention. Participants provided qualitative feedback on the module.
RESULTS: We taught 21 providers. Eleven providers completed the pretest/posttest 
and eight completed the retest. The mean test scores improved from 8.3 ± 1.7 in 
the pretest to 12.2 ± 2.6 in the posttest (mean difference: 1.4, P=0.027). The 
mean test score at pretest was 8.3 ± 2.3, which increased to 10.8 ± 3.0 at 
retest (mean difference: 2.5, P=0.060). Seven (71.4%) and four (28.5%) 
participants found the course "extremely useful" and "very useful," respectively 
(n=11).
DISCUSSION: This curriculum may be an effective and welcome training tool for 
Belizean generalist providers. There was a statistically significant improvement 
in the test performance but not in retesting, possibly due to our small sample 
size and high attrition rate. Evaluation of other modules in this curriculum, 
application of this curriculum in other locations, and measuring clinical 
practice interventions will be included in future investigations.
TOPICS: Medical simulation, rapid cycle deliberate practice (RCDP), Belize, 
gastrointestinal, nutrition, emergency, gastroenteritis, acute bowel 
obstruction, Belize, low- and middle-income country (LMIC), collaboration, 
global health.

© 2024 Kosoko, et al.

DOI: 10.21980/J8WH2K
PMCID: PMC11537732
PMID: 39507474


5. J Educ Teach Emerg Med. 2024 Oct 31;9(4):S24-S48. doi: 10.21980/J8CK98. 
eCollection 2024 Oct.

Bridging Hospital Resource Variability: Adapting the Escape Room to Integrate 
Procedure Teaching for Emergency Medicine Trainees in India.

DeJohn J(1), Ahluwalia T(2), Madhok M(3), Gidwani S(4), Douglass K(4), Owens 
S(1).

Author information:
(1)University of Kentucky, Department of Emergency Medicine, Lexington, KY.
(2)Children's National Hospital, Department of Emergency Medicine, Washington, 
DC.
(3)Children's Minnesota, Department of Emergency Medicine, Minneapolis, MN.
(4)George Washington University, Department of Emergency Medicine, Washington, 
DC.

AUDIENCE: This is an in-person escape room and procedure simulation activity 
based on complications of human immunodeficiency virus (HIV) in India, which was 
created by using local HIV management guidelines. Emergency Medicine (EM) 
trainees of all post-graduate levels are the target audience. This may also be 
used by trainees in other specialties, such as infectious disease or internal 
medicine, who require an understanding of HIV and its complications. This escape 
room can be completed in teams of varying sizes and is designed to be adaptable 
to local resource availability.
BACKGROUND: Patients with HIV present to the Emergency Department (ED) for a 
variety of reasons such as initial viral syndrome, medication side effects, and 
opportunistic infections. While the widespread use of antiretroviral therapy 
(ART) has significantly increased the life expectancy of patients living with 
HIV and decreased the incidence of classical opportunistic infections, EM 
providers should still be vigilant and competent in diagnosing and managing 
these pathologies. This is particularly critical in India, where the prevalence 
of HIV was most recently estimated at 0.22% (2.2 million people older than 15 
years) in 2020.1 This patient population, primarily infected through unprotected 
heterosexual contact, is at high risk for interruptions in ART and development 
of opportunistic infections for a variety of reasons including migration for 
work, low social status of women, and significant social stigma against HIV.2 
Simulation is an educational opportunity to review these high-acuity 
low-occurrence presentations to prepare EM trainees for independent practice.
EDUCATIONAL OBJECTIVES: By the end of the escape room, learners should be able 
to: 1) describe the mechanism of action of antiretroviral therapies available in 
India, 2) prescribe initial antiretroviral therapy to a patient presenting to 
the emergency department with a new diagnosis of HIV, 3) develop a differential 
diagnosis for a patient with HIV presenting to the ED with chest pain, 4) 
identify common dermatologic manifestations of opportunistic infections in 
patients with HIV, 5) identify computerized tomography scan and lumbar puncture 
features for central nervous system infections seen in patients with Acquired 
Immunodeficiency Syndrome (AIDS), 6) identify red flag features and appropriate 
workup for a patient with HIV presenting with a headache to the ED, 7) interpret 
images obtained during a Rapid Ultrasound for Shock and Hemorrhage (RUSH) exam, 
8) identify cardiac tamponade and perform a pericardiocentesis, and 9) 
communicate and collaborate as a team to manage a complex, unstable patient with 
HIV in the ED.
EDUCATIONAL METHODS: We sought to create and implement an educational tool that 
could meet the complex education needs of EM trainees while being low cost, 
easily adapted to local resources, and engaging for trainees. Hospitals 
participating in the Masters in Emergency Medicine (MEM) program, a global 
partnership between the Ronald Reagan Institute for Emergency Medicine at the 
George Washington University and 18 hospitals in India, have resource 
variability for traditional simulation. The escape room created combines 
simulation, content review specific to the contextual practice of EM in India 
focused on HIV and its complications, and critical procedure teaching on 
pericardiocentesis. This innovation framework is based on Kolb's experiential 
learning cycle and incorporates the gamification principles of a sense of 
autonomy, perception of competitiveness, and learner-relatedness.3-4 Escape 
rooms have been shown to engage learners, and low-fidelity procedure models 
could further maximize the experience for learners in resource variable 
settings.5 A pericardiocentesis model was adapted from Lord et al.'s 
low-fidelity model, ensuring it could be assembled with materials readily 
available in-country.6.
RESEARCH METHODS: We adapted the escape room format to combine simulation, 
content review, and procedural training in a cost-effective, contextually 
relevant, and scalable way. The escape room was trialed using a case of chest 
pain and altered mental status caused by a pericardial effusion due to 
tuberculosis in a patient with HIV. Local practice patterns and guidelines were 
used to develop puzzles and clinical clues. A pericardiocentesis model was 
constructed using materials readily available in India. Pre- and post-surveys 
were developed to assess baseline trainee experience with escape rooms, 
self-reported knowledge of the differential diagnosis and management for altered 
mental status, and ways to incorporate escape room content into daily practice.
RESULTS: A total of 47 trainees participated; 41 of 47 participants completed 
both pre- and post-surveys (87% response rate). Participants represented all 
program trainee levels: 49% (n = 20) PGY-1, 27% (n = 11) PGY-2, and 24% (n = 10) 
PGY-3. Based on a score greater than seven on a 1-10 Likert scale, the escape 
room was rated as "highly effective" by 93.5% of respondents in reviewing 
medical knowledge. The trainees were allotted 60 minutes to escape the room; the 
median time for escape room completion was 57 minutes. The escape room and 
pericardiocentesis model cost under $100 USD, were repeated up to six times in 
one day, and could be recycled for future use.
DISCUSSION: Utilizing simulation in the escape room format that can be adaptable 
to variable resource settings is a valuable educational tool. The integrated 
escape room and procedure training proved to be an effective educational tool 
that was scalable and maintained efficacy across variable hospital resource 
levels. The next step includes adapting this format for other disease 
pathologies. This is a useful way to meet the education needs of MEM program 
trainees, regardless of hospital resource availability, that could be replicable 
in other EM training programs.
TOPICS: HIV, AIDS, dermatologic manifestations of HIV, HIV medications, CNS 
complications of HIV, chest pain, headache, tuberculosis, RUSH exam, 
pericardiocentesis, escape room, simulation.

© 2024 DeJohn, et al.

DOI: 10.21980/J8CK98
PMCID: PMC11537725
PMID: 39507469