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Sökmen Y, Koç Z. Perinatal death witnessed by midwifery students during clinical practice and their coping methods: A qualitative study. Nurse Educ Today 2024; 136:106135. [PMID: 38387212 DOI: 10.1016/j.nedt.2024.106135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/31/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE The aim of this study was to determine the perinatal death experience of midwifery students during clinical practice and their coping methods. DESIGN A qualitative, descriptive, phenomenological design was used. SETTINGS The study was conducted with midwifery students. PARTICIPANTS The study was conducted with 14 midwifery students at a state university in northern Turkey between April and July 2023. METHODS Perinatal death experiences that students witnessed during clinical practice and their coping methods were analyzed using the individual in-depth interview technique. Data were analyzed using the thematic analysis method. The results obtained from the study were reported according to the COREQ criteria. FINDINGS As a result of the analysis, four main themes: (1) the perception of the concept of death, (2) the first encounter with death, (3) methods of coping with death, and (4) students' suggestions were elicited from the data. Students who witnessed perinatal death were affected by this situation, experienced negative emotions, and resorted to different methods to cope with their negative feelings about death. CONCLUSIONS Midwifery students who witnessed perinatal death were negatively affected emotionally and professionally; therefore, education and policy-oriented regulations are needed to cope with perinatal death.
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Affiliation(s)
- Yasemin Sökmen
- Department of Midwifery, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Türkiye.
| | - Zeliha Koç
- Department of Midwifery, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Türkiye
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Gong J, Yang J, Liu L, Chen X, Yang G, He Y, Sun R. Evaluation and clinical practice of pathogens and antimicrobial resistance genes of BioFire FilmArray Pneumonia panel in lower respiratory tract infections. Infection 2024; 52:545-555. [PMID: 38123753 PMCID: PMC10955009 DOI: 10.1007/s15010-023-02144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Existing panels for lower respiratory tract infections (LRTIs) are slow and lack quantification of important pathogens and antimicrobial resistance, which are not solely responsible for their complex etiology and antibiotic resistance. BioFire FilmArray Pneumonia (PN) panels may provide rapid information on their etiology. METHODS The bronchoalveolar lavage fluid of 187 patients with LRTIs was simultaneously analyzed using a PN panel and cultivation, and the impact of the PN panel on clinical practice was assessed. The primary endpoint was to compare the consistency between the PN panel and conventional microbiology in terms of etiology and drug resistance, as well as to explore the clinical significance of the PN panel. The secondary endpoint was pathogen detection using the PN panel in patients with community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). RESULTS Fifty-seven patients with HAP and 130 with CAP were included. The most common pathogens of HAP were Acinetobacter baumannii and Klebsiella pneumoniae, with the most prevalent antimicrobial resistance (AMR) genes being CTX-M and KPC. For CAP, the most common pathogens were Haemophilus influenzae and Staphylococcus aureus, with the most frequent AMR genes being CTX-M and VIM. Compared with routine bacterial culture, the PN panel demonstrated an 85% combined positive percent agreement (PPA) and 92% negative percent agreement (NPA) for the qualitative identification of 13 bacterial targets. PN detection of bacteria with higher levels of semi-quantitative bacteria was associated with more positive bacterial cultures. Positive concordance between phenotypic resistance and the presence of corresponding AMR determinants was 85%, with 90% positive agreement between CTX-M-type extended-spectrum beta-lactamase gene type and phenotype and 100% agreement for mecA/C and MREJ. The clinical benefit of the PN panel increased by 25.97% compared with traditional cultural tests. CONCLUSION The bacterial pathogens and AMR identified by the PN panel were in good agreement with conventional cultivation, and the clinical benefit of the PN panel increased by 25.97% compared with traditional detection. Therefore, the PN panel is recommended for patients with CAP or HAP who require prompt pathogen diagnosis and resistance identification.
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Affiliation(s)
- Jinru Gong
- Department of Pulmonary and Critical Care Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiasheng Yang
- Department of Pulmonary and Critical Care Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Lihong Liu
- Department of Pulmonary and Critical Care Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaoxuan Chen
- Department of Pulmonary and Critical Care Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guangyu Yang
- Department of Pulmonary and Critical Care Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yaowei He
- Department of Pulmonary and Critical Care Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Ruilin Sun
- Department of Pulmonary and Critical Care Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Palagini L, Manni R, Liguori C, De Gennaro L, Gemignani A, Fanfulla F, Ferri R, Nobili L, Ferini-Strambi L. Evaluation and management of insomnia in the clinical practice in Italy: a 2023 update from the Insomnia Expert Consensus Group. J Neurol 2024; 271:1668-1679. [PMID: 38063870 DOI: 10.1007/s00415-023-12112-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Insomnia is the most reported sleep disorder in industrialized countries, affecting, in the chronic form, around 10% of the European population. In Italy, such a percentage seems to be even higher. Although insomnia can be an independent disorder, it is frequently described as comorbid condition and may precipitate, exacerbate, or prolong a broad range of physical and mental disorders. Evaluating and targeting insomnia in the Italian clinical practice should be a priority. METHODS The present expert opinions and recommendations represent an update from 2020 and insights from Insomnia Expert Consensus Group, based on systematic reviews according to PRISMA on available options in Italy from January 2020 to March 2023. RESULTS We evaluated 28 papers among international guidelines, expert opinions, systematic reviews, and meta-analysis produced during the last 26 months. CONCLUSIONS Our findings suggest that symptoms of insomnia must be assessed in the Italian clinical practice by evaluating nocturnal and daytime symptoms, comorbid conditions, and lifestyle. Cognitive behavioral therapy for insomnia should be the first option according to availability. The choice of the drug should be based on different factors including type of insomnia, age, comorbidities, and potential side effects. If the choice would be a Z-drug or a short-acting benzodiazepine (in subjects < 65 years old), the use should be in the short term (≤ 4 weeks). Indeed, eszopiclone, as a new option in Italy, may present a different profile and may be used for up to 6 months, also in the elderly. If the choice is melatonin, it should be used melatonin 2 mg prolonged release in adults ≥ 55 years for up to 13 weeks. A new dual orexin antagonist, daridorexant, is available in Italy; it has been shown to be effective in adults and elderly and it can be used for at least 3 months and up to 1 year.
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Affiliation(s)
- Laura Palagini
- Unit of Psychiatry, Department of Neuroscience, Azienda Ospedaliero Universitaria Pisana AUOP, Pisa, Italy.
| | - Raffaele Manni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Neurology Unit, Sleep Medicine Centre, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, 00185, Rome, Italy
- Body and Action Lab, IRCSS Fondazione Santa Lucia, 00179, Rome, Italy
| | - Angelo Gemignani
- Psychology Unit, Department of Neuroscience, University of Pisa, Pisa, Italy
| | - Francesco Fanfulla
- Respiratory Function and Sleep Medicine Unit, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
| | - Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology Sleep Disorders Centre, RCCS San Raffaele Scientific Institute, Milan, Italy
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Huang Y, Chen D, Li C, Fan Y, Wu Y. The mediating role of academic support perception in the relationship between emotional intelligence and bullying behaviours in clinical practice: A cross-sectional study. Nurse Educ Today 2024; 135:106129. [PMID: 38342038 DOI: 10.1016/j.nedt.2024.106129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/22/2024] [Accepted: 02/07/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Bullying behaviours experienced by nursing interns in clinical practice are a considerable and serious concern. Understanding the factors that influence such behaviours in clinical practice is crucial for developing effective preventive measures and fostering a supportive learning environment. PURPOSE This study aims to investigate the prevalence and influencing factors of bullying behaviours experienced by nursing interns and examine the mediating role of academic support perception in the relationship between emotional intelligence and bullying behaviours in clinical practice. METHODS This is a cross-sectional study that used convenience sampling. A socio-demographic information questionnaire, Bullying Behaviours in Nursing Education Scale, Wong and Law's Emotional Intelligence Scale, and Academic Support in the Practicum Scale were used to collect data from nursing interns (n = 813) at seven tertiary hospitals in Changsha, China. Binary logistic regression and mediating analyses were used to explore the factors influencing bullying behaviours in nursing practice and examine the potential mediating role of academic support perception. RESULTS The prevalence of bullying behaviours in clinical practice among 813 nursing interns was 82.7 %. Binary logistic regression analyses indicated that attitude toward the nursing profession, emotional intelligence, and academic support perception were significantly associated with bullying behaviours in clinical practice. Academic support perception (β = 0.375, p < 0.001) played a significant mediating role in the relationship between emotional intelligence and bullying behaviours in clinical practice, accounting for 55.7 % of the total effect. CONCLUSION Nursing educators and administrators should recognise that improving emotional intelligence and enhancing academic support perception among nursing interns can reduce the occurrence of bullying behaviours in clinical practice.
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Affiliation(s)
- Yi Huang
- Nursing Department, Medical College, Hunan Normal University, Changsha, China
| | - Dan Chen
- Nursing Department, Medical College, Hunan Normal University, Changsha, China.
| | - Chaofeng Li
- Nursing Department, Medical College, Hunan Normal University, Changsha, China
| | - Yingying Fan
- Nursing Department, Medical College, Hunan Normal University, Changsha, China
| | - Yuwei Wu
- Nursing Department, Medical College, Hunan Normal University, Changsha, China
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Vasconcelos APSL, Lucchetti ALG, Cavalcanti APR, da Silva Conde SRS, Gonçalves LM, Moriguchi EH, Chazan ACS, Tavares RLC, da Silva Ezequiel O, Lucchetti G. Comparison of the Role of Different Levels of Religiousness and Spirituality in Controversial Ethical Issues and Clinical Practice among Brazilian Resident Physicians: Results from the Multicenter SBRAMER Study. J Relig Health 2024; 63:1268-1284. [PMID: 36449250 DOI: 10.1007/s10943-022-01702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
This study compares clinical practice and objections to controversial ethical issues among 836 Brazilian resident physicians according to levels of religiousness/spirituality. Residents with low religiousness/spirituality (s/r) believed less in the influence of spirituality on clinical practice, were less comfortable addressing this issue, tended to listen less carefully and try to change the subject more than other groups. Residents with high spirituality and low religiousness (S/r) inquired more about religious/spiritual issues, while those with high religiousness/spirituality (S/R) were more supportive and reported fewer barriers to addressing these issues. Concerning ethical issues (e.g., physician-assisted suicide, withdrawal of life support, abortion), S/R had more objections than others.
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Affiliation(s)
| | | | | | | | - Lidia Maria Gonçalves
- School of Medicine, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 155 - Setor Azul, São Paulo, Brazil
| | - Emilio Hideyuki Moriguchi
- School of Medicine, Universidade Federal Do Rio Grande Do Sul, R. Ramiro Barcelos, 2400 - Santa Cecilia, Porto Alegre, Brazil
| | - Ana Cláudia Santos Chazan
- School of Medicine, Universidade Do Estado Do Rio de Janeiro, Avenida Professor Manoel de Abreu 444 - 2Nd Floor - Vila Isabel, Rio de Janeiro, Brazil
| | - Rubens Lene Carvalho Tavares
- School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte, Brazil
| | - Oscarina da Silva Ezequiel
- School of Medicine, Universidade Federal de Juiz de Fora, Av. Eugênio Do Nascimento, S/N° - Dom Bosco, Juiz de Fora, Brazil
| | - Giancarlo Lucchetti
- School of Medicine, Universidade Federal de Juiz de Fora, Av. Eugênio Do Nascimento, S/N° - Dom Bosco, Juiz de Fora, Brazil.
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Thomsen HS, Jørgensen BE, Kynde Schøtz J, Bech LM, Grønkjær LL. Evaluation of a new concept to improve and organize clinical practice in nursing education: a pilot-study. BMC Nurs 2024; 23:203. [PMID: 38532438 DOI: 10.1186/s12912-024-01888-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/21/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Nursing students may experience clinical practice as unsafe due to the interactions with patients, fear of making mistakes, lack of clinical experience and supervision, which results in anxiety and stress. Thus, interventions to improve and organize the learning environment in clinical practice for nursing students are warranted, and the aim of this pilot-study was to evaluate a new concept of clinical practice in order to get insight on the different initiatives and gain knowledge for further developing. METHODS The new concept consisted of nursing students being affiliated to the same department during their clinical practices, reflective supervision, and participation in a self-compassion course. Data was collected using questionnaires and focus group interviews of 17 nursing students, 17 clinical supervisors, and 14 head nurses. A mixed-methods strategy was employed to give the study a pragmatic approach. Finding from the questionnaires and focus group interviews were analyzed separately and then weaved together into themes. RESULTS The results generated four themes: Information and involvement before and during the new concept, Learning outcomes, safety, and well-being, Impact of reflective supervision and self-compassion course, and Transition from study life to working life. In general, the participating nursing students, clinical supervisors, and head nurses had positives experiences regarding the new concept. They felt well-informed, and they experienced that it contributed to a safe learning environment, increased well-being, strengthened the relationship between nursing students and clinical supervisors and healthcare staff at the department, and prepared the nursing students to working life. CONCLUSION Our results complement the suggestion that improved quality of clinical practice for nursing students is an effective strategy to establish a safe and supportive learning environment that contribute with satisfaction, successful experiences, and attraction of future nurses. However, further intervention studies are needed to compare the effect of the new concept with traditional clinical practice.
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Affiliation(s)
- Helle Skou Thomsen
- Department of Education, Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Britt Egeris Jørgensen
- Department of Education, Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Jette Kynde Schøtz
- Department of Education, Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
- Nursing Education, University College South Denmark, Esbjerg, Denmark
| | - Line Muff Bech
- Department of Education, Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Lea Ladegaard Grønkjær
- Department of Gastroenterology, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
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Liau MYQ, Toh EQ, Muhamed S, Selvakumar SV, Shelat VG. Can propensity score matching replace randomized controlled trials? World J Methodol 2024; 14:90590. [DOI: 10.5662/wjm.v14.i1.90590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/05/2024] [Accepted: 02/23/2024] [Indexed: 03/07/2024] Open
Abstract
Randomized controlled trials (RCTs) have long been recognized as the gold standard for establishing causal relationships in clinical research. Despite that, various limitations of RCTs prevent its widespread implementation, ranging from the ethicality of withholding potentially-lifesaving treatment from a group to relatively poor external validity due to stringent inclusion criteria, amongst others. However, with the introduction of propensity score matching (PSM) as a retrospective statistical tool, new frontiers in establishing causation in clinical research were opened up. PSM predicts treatment effects using observational data from existing sources such as registries or electronic health records, to create a matched sample of participants who received or did not receive the intervention based on their propensity scores, which takes into account characteristics such as age, gender and comorbidities. Given its retrospective nature and its use of observational data from existing sources, PSM circumvents the aforementioned ethical issues faced by RCTs. Majority of RCTs exclude elderly, pregnant women and young children; thus, evidence of therapy efficacy is rarely proven by robust clinical research for this population. On the other hand, by matching study patient characteristics to that of the population of interest, including the elderly, pregnant women and young children, PSM allows for generalization of results to the wider population and hence greatly increases the external validity. Instead of replacing RCTs with PSM, the synergistic integration of PSM into RCTs stands to provide better research outcomes with both methods complementing each other. For example, in an RCT investigating the impact of mannitol on outcomes among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial, the baseline characteristics of comorbidities and current medications between treatment and control arms were significantly different despite the randomization protocol. Therefore, PSM was incorporated in its analysis to create samples from the treatment and control arms that were matched in terms of these baseline characteristics, thus providing a fairer comparison for the impact of mannitol. This literature review reports the applications, advantages, and considerations of using PSM with RCTs, illustrating its utility in refining randomization, improving external validity, and accounting for non-compliance to protocol. Future research should consider integrating the use of PSM in RCTs to better generalize outcomes to target populations for clinical practice and thereby benefit a wider range of patients, while maintaining the robustness of randomization offered by RCTs.
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Affiliation(s)
- Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - En Qi Toh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Shamir Muhamed
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Surya Varma Selvakumar
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Vishalkumar Girishchandra Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Surgical Science Training Centre, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Hughes LJ, Alcock J, Wardrop R, Stone R, Pierce B. Remediation in clinical practice for student nurses - A scoping review. Nurse Educ Today 2024; 137:106180. [PMID: 38522256 DOI: 10.1016/j.nedt.2024.106180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Clinical practice provides an opportunity for undergraduate nursing students to develop the professional attitudes, knowledge and skills required for the delivery of safe competent care. Some students, however, are challenged to consolidate learning in clinical practice and are therefore at risk of failing courses or programmes. Supporting these students requires remediation strategies specific to clinical practice. This is challenging, however, as remediation approaches frequently centre on supporting students in theoretical components of courses/programmes, rather than clinical practice. OBJECTIVES A scoping review was conducted to explore and summarise literature in undergraduate nurse education related to remediation support for clinical practice. METHODS The research question was developed using the Population/Concept/Context model. Following the identification of keywords, five databases (CINHAL Plus, MEDLINE, ProQuest, Scopus and Informit) were searched. Abstracts and full-text articles were independently screened by two authors. Data from included studies was extracted and then thematically analysed. RESULTS Twenty papers met inclusion/exclusion criteria (five literature reviews, one concept analysis, six commentary papers and eight original research studies). Research studies used qualitative, quantitative, or mixed methods research designs. Populations included nurse academics, mentors/preceptors, health professional students (including nursing students) and nursing students exclusively. Three themes were identified: pre-placement remediation strategies; on-placement remediation strategies and post-placement remediation strategies. All authors highlighted the importance of remediation for at-risk students in clinical practice. CONCLUSIONS This review identified several remediation strategies that may support undergraduate nursing students in clinical practice. Few, however, were well-defined or rigorously evaluated, highlighting the need for additional research on nursing student remediation in clinical practice. A partnership-based approach to remediation that engages students, educators, and healthcare providers and is underpinned by clear processes may be of further benefit to nursing students in clinical practice.
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Affiliation(s)
- Lynda J Hughes
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia.
| | - Julia Alcock
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia
| | - Rachel Wardrop
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia
| | - Renee Stone
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia
| | - Beth Pierce
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia
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Hassabo M, Mc Cluskey P, Browne J, Ntlholang O. A survey of non-consultant hospital doctors' perspectives, knowledge, and practices toward delirium in a large Irish hospital. Ir J Med Sci 2024:10.1007/s11845-024-03661-1. [PMID: 38489126 DOI: 10.1007/s11845-024-03661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/29/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Delirium is a common condition in hospitals, particularly among older people. This refers to a dramatic decline in mental capabilities, which is marked by diminished concentration and consciousness. AIM The purpose of this study was to assess the views, knowledge, and behavior of non-consultant hospital doctors in managing delirium in a large Irish hospital. METHODS Questionnaires were administered to 28 healthcare professionals from various departments according to Davis and MacLullich (Age Ageing 38(5):559-563, 2009). It was conducted between July and September 2023, with an emphasis on determining the prevalence rate, diagnostic criteria, and management strategies for delirium. RESULTS The study established that the majority of respondents recognized the importance of delirium, but there appears to be a gap in the practical management of this clinical syndrome. Although many doctors agreed that delirium was significant, most lacked confidence in its diagnosis and management. The use of standardized assessment tools, such as the 4AT, was limited. CONCLUSIONS This study highlights the disparity between what is known and practiced by hospital doctors regarding delirium care. This implies increased training for delirium management with frequent use of assessment tools and ongoing education aimed at enhancing patient outcomes in cases of delirium.
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Affiliation(s)
- Mohamed Hassabo
- Department of General Medicine/Acute Medicine, St James's Hospital, Dublin 8, Ireland.
| | - Patrick Mc Cluskey
- Department of General Medicine/Acute Medicine, St James's Hospital, Dublin 8, Ireland
| | - Joseph Browne
- Department of General Medicine/Acute Medicine, St James's Hospital, Dublin 8, Ireland
| | - Ontefetse Ntlholang
- Department of General Medicine/Acute Medicine, St James's Hospital, Dublin 8, Ireland
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Alqifari SF, Alkomi O, Esmail A, Alkhawami K, Yousri S, Muqresh MA, Alharbi N, Khojah AA, Aljabri A, Allahham A, Prabahar K, Alshareef H, Aldhaeefi M, Alrasheed T, Alrabiah A, AlBishi LA. Practical guide: Glucagon-like peptide-1 and dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus. World J Diabetes 2024; 15:331-347. [DOI: 10.4239/wjd.v15.i3.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/06/2023] [Accepted: 01/15/2024] [Indexed: 03/15/2024] Open
Abstract
In 2005, exenatide became the first approved glucagon-like peptide-1 receptor agonist (GLP-1 RA) for type 2 diabetes mellitus (T2DM). Since then, numerous GLP-1 RAs have been approved, including tirzepatide, a novel dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RA, which was approved in 2022. This class of drugs is considered safe with no hypoglycemia risk, making it a common second-line choice after metformin for treating T2DM. Various considerations can make selecting and switching between different GLP-1 RAs challenging. Our study aims to provide a comprehensive guide for the usage of GLP-1 RAs and dual GIP and GLP-1 RAs for the management of T2DM.
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Affiliation(s)
- Saleh Fahad Alqifari
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Omar Alkomi
- Department of Clinical Sciences, Sulaiman Alrajhi University - College of Medicine, Al Bukayriyah 52726, Saudi Arabia
| | - Abdullah Esmail
- Department of Clinical Sciences, Sulaiman Alrajhi University - College of Medicine, Al Bukayriyah 52726, Saudi Arabia
| | - Khadijeh Alkhawami
- Department of Clinical Sciences, Sulaiman Alrajhi University - College of Medicine, Al Bukayriyah 52726, Saudi Arabia
| | - Shahd Yousri
- Department of Clinical Sciences, Sulaiman Alrajhi University - College of Medicine, Al Bukayriyah 52726, Saudi Arabia
| | - Mohamad Ayham Muqresh
- Department of Clinical Sciences, Sulaiman Alrajhi University - College of Medicine, Al Bukayriyah 52726, Saudi Arabia
| | - Nawwarah Alharbi
- Department of Clinical Sciences, Sulaiman Alrajhi University - College of Medicine, Al Bukayriyah 52726, Saudi Arabia
| | - Abdullah A Khojah
- Department of Family Medicine, Dr. Soliman Fakeeh Hospital DSFH, Jeddah 21461, Saudi Arabia
| | - Ahmed Aljabri
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Abdulrahman Allahham
- Department of Clinical Sciences, Sulaiman Alrajhi University - College of Medicine, Al Bukayriyah 52726, Saudi Arabia
| | - Kousalya Prabahar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Hanan Alshareef
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Mohammed Aldhaeefi
- Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, DC 20059, United States
| | - Tariq Alrasheed
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Ali Alrabiah
- Department of Pharmacy Practice, Raabe College of Pharmacy, Ohio Northern University, Ohio, OH 45810, United States
| | - Laila A AlBishi
- Department of Pediatric, Faculty of Medicine, University of Tabuk, Tabuk 71491, Saudi Arabia
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Kohanová D, Gurková E, Kirwan M, Žiaková K, Kurucová R. Nursing students' perceptions of unfinished nursing care: A cross-sectional study. Nurse Educ Pract 2024; 76:103942. [PMID: 38522345 DOI: 10.1016/j.nepr.2024.103942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/17/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
AIM To investigate the prevalence, patterns and reasons for unfinished nursing care as perceived by nursing students. BACKGROUND Unfinished nursing care (UNC) is a frequently observed phenomenon in the acute care setting. To date, studies have focused primarily on the perspective of nurses or patients, but another important perspective is that of nursing students who provide nursing care in all healthcare settings. DESIGN A descriptive cross-sectional study. METHODS The study included 738 undergraduate nursing students from nine Slovak universities. Data were collected between September 2022 and February 2023 using the Slovak version of the Unfinished Nursing Care Survey tool (UNCS). Data were analyzed using descriptive and inferential statistics. RESULTS The mean composite score of UNCS was 2.48 (SD=0.68). In general, 100% of nursing students reported that nurses missed at least one or more nursing care activities during their last clinical placement. The average number of missed nursing care activities was 11.2 per nurse as perceived by nursing students during their last clinical placement. Nursing students reported that the most frequently omitted nursing care activity was spending time with patients and their caregivers (3.15 ± 1.11; 92.9%). The most frequently reported reason for UNC was an inadequate number of nurses on the ward (4.31 ± 1.01; 98.1%). In the study, reported UNC could be predicted by previous experience in healthcare, previous clinical rotation, number of patients per shift, perceived staff adequacy and outcome expectations (p <0.05). CONCLUSIONS The findings reveal that UNC is a widespread phenomenon and all nursing students report this phenomenon during their clinical placements. Spending time with patients and their caregivers emerged as the most frequently omitted nursing care activity, highlighting the importance of patient-centered care. The primary reason cited for UNC was an inadequate number of nurses, highlighting staffing issues as a significant contributing factor. These findings emphasize the need for targeted interventions to address staff shortages and improve nursing education to prepare students to address UNC in their future practice.
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Affiliation(s)
- Dominika Kohanová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, Slovakia.
| | - Elena Gurková
- Department of Nursing, Faculty of Health Care, University of Prešov, Slovakia
| | - Marcia Kirwan
- School of Nursing, Psychotherapy and Community Health, Dublin City University in Dublin, Ireland.
| | - Katarína Žiaková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| | - Radka Kurucová
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
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Tabak AG, Kempler P, Guja C, Eldor R, Haluzik M, Klupa T, Papanas N, Stoian AP, Mankovsky B. Expert Opinion on Current Trends in the Use of Insulin in the Management of People with Type 2 Diabetes from the South-Eastern European Region and Israel. Diabetes Ther 2024:10.1007/s13300-024-01556-z. [PMID: 38472626 DOI: 10.1007/s13300-024-01556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
Despite the availability of various antihyperglycaemic therapies and comprehensive guidelines, glycaemic control in diabetes management has not improved significantly during the last decade in the real-world clinical setting. Treatment inertia arising from a complex interplay among patient-, clinician- and healthcare-system-related factors is the prime reason for this suboptimal glycaemic control. Also, the key factor leading to inadequate glycaemic levels remains limited communication between healthcare professionals (HCPs) and people with type 2 diabetes (PwT2D). Early insulin administration has several advantages including reduced glucotoxicity, high efficacy and preserved β-cell mass/function, leading to lowering the risk of diabetes complications. The current publication is based on consensus of experts from the South-Eastern European region and Israel who reviewed the existing evidence and guidelines for the treatment of PwT2D. Herein, the experts emphasised the timely use of insulin, preferably second-generation basal insulin (BI) analogues and intensification using basal-plus therapy, as the most-potent glucose-lowering treatment choice in the real-world clinical setting. Despite an increase in the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), the experts urged timely insulin initiation for inadequate glycaemic control in PwT2D. Furthermore, the combination of BI and GLP-1 RA addressing both fasting plasma glucose and post-prandial excursions as a free- or fixed-ratio combination was identified to reduce treatment complexity and burden. To minimise discontinuation and improve adherence, the experts reiterated quality, regular interactions and discussions between HCPs and PwT2D/carers for their involvement in the diabetes management decision-making process. Clinicians and HCPs should consider the opinions of the experts in accordance with the most recent recommendations for diabetes management.
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Affiliation(s)
- Adam G Tabak
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, 2/a Korányi S. Str., 1083, Budapest, Hungary.
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
- UCL Brain Sciences, University College London, London, UK.
| | - Peter Kempler
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, 2/a Korányi S. Str., 1083, Budapest, Hungary
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Disease, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Roy Eldor
- Diabetes Unit, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Martin Haluzik
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tomasz Klupa
- Center for Advanced Technologies in Diabetes & Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre, Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Disease, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Boris Mankovsky
- Department of Diabetology, National Healthcare University of Ukraine, Kiev, Ukraine
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Carteri RB, Padilha M, de Quadros SS, Cardoso EK, Grellert M. Shock index and its variants as predictors of mortality in severe traumatic brain injury. World J Crit Care Med 2024; 13:90617. [DOI: 10.5492/wjccm.v13.i1.90617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/28/2023] [Accepted: 01/22/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The increase in severe traumatic brain injury (sTBI) incidence is a worldwide phenomenon, resulting in a heavy disease burden in the public health systems, specifically in emerging countries. The shock index (SI) is a physiological parameter that indicates cardiovascular status and has been used as a tool to assess the presence and severity of shock, which is increased in sTBI. Considering the high mortality of sTBI, scrutinizing the predictive potential of SI and its variants is vital.
AIM To describe the predictive potential of SI and its variants in sTBI.
METHODS This study included 71 patients (61 men and 10 women) divided into two groups: Survival (S; n = 49) and Non-survival (NS; n = 22). The responses of blood pressure and heart rate (HR) were collected at admission and 48 h after admission. The SI, reverse SI (rSI), rSI multiplied by the Glasgow Coma Score (rSIG), and Age multiplied SI (AgeSI) were calculated. Group comparisons included Shapiro-Wilk tests, and independent samples t-tests. For predictive analysis, logistic regression, receiver operator curves (ROC) curves, and area under the curve (AUC) measurements were performed.
RESULTS No significant differences between groups were identified for SI, rSI, or rSIG. The AgeSI was significantly higher in NS patients at 48 h following admission (S: 26.32 ± 14.2, and NS: 37.27 ± 17.8; P = 0.016). Both the logistic regression and the AUC following ROC curve analysis showed that only AgeSI at 48 h was capable of predicting sTBI outcomes.
CONCLUSION Although an altered balance between HR and blood pressure can provide insights into the adequacy of oxygen delivery to tissues and the overall cardiac function, only the AgeSI was a viable outcome-predictive tool in sTBI, warranting future research in different cohorts.
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Affiliation(s)
- Randhall B Carteri
- Department of Nutrition, Centro Universitário CESUCA, Porto Alegre 94935-630, Brazil
| | - Mateus Padilha
- Department of Analysis and Systems Development, Centro Universitário CESUCA, Porto Alegre 94935-630, Brazil
| | - Silvaine Sasso de Quadros
- Department of Nutrition, Hospital Pronto Socorro de Porto Alegre, Porto Alegre 90040-192, Rio Grande do Sul, Brazil
| | - Eder Kroeff Cardoso
- Department of Physiotherapy, Hospital Pronto Socorro de Porto Alegre, Porto Alegre 90040-192, Rio Grande do Sul, Brazil
| | - Mateus Grellert
- Institute of Informatics, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 91501-970, Rio Grande do Sul, Brazil
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14
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Boudreau D, Wykretowicz H, Kinsella EA, Fuks A, Saraga M. Discovering clinical phronesis. Med Health Care Philos 2024:10.1007/s11019-024-10198-8. [PMID: 38453732 DOI: 10.1007/s11019-024-10198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 03/09/2024]
Abstract
Phronesis is often described as a 'practical wisdom' adapted to the matters of everyday human life. Phronesis enables one to judge what is at stake in a situation and what means are required to bring about a good outcome. In medicine, phronesis tends to be called upon to deal with ethical issues and to offer a critique of clinical practice as a straightforward instrumental application of scientific knowledge. There is, however, a paucity of empirical studies of phronesis, including in medicine. Using a hermeneutic and phenomenological approach, this inquiry explores how phronesis is manifest in the stories of clinical practice of eleven exemplary physicians. The findings highlight five overarching themes: ethos (or character) of the physician, clinical habitus revealed in physician know-how, encountering the patient with attentiveness, modes of reasoning amidst complexity, and embodied perceptions (such as intuitions or gut feeling). The findings open a discussion about the contingent nature of clinical situations, a hermeneutic mode of clinical thinking, tacit dimensions of being and doing in clinical practice, the centrality of caring relations with patients, and the elusive quality of some aspects of practice. This study deepens understandings of the nature of phronesis within clinical settings and proposes 'Clinical phronesis' as a descriptor for its appearance and role in the daily practice of (exemplary) physicians.
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Affiliation(s)
- Donald Boudreau
- Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, 1110 Pine Avenue West, H3A 1A3, Montreal, Canada.
| | - Hubert Wykretowicz
- Centre Hospitalier Universitaire Vaudois, Av. de Beaumont 23, 1011, Lausanne, Switzerland
| | - Elizabeth Anne Kinsella
- Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, 1110 Pine Avenue West, H3A 1A3, Montreal, Canada
| | - Abraham Fuks
- Department of Medicine, McGill University, 3647 Peel Street, H3A 1X1, Montreal, Canada
| | - Michael Saraga
- General Psychiatry, Centre Hospitalier Universitaire Vaudois, Route de Cery 60, 1008 Prilly, Lausanne, Switzerland
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15
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Nanetti L, Kearney M, Boesch S, Stovickova L, Ortigoza-Escobar JD, Macaya A, Gomez-Andres D, Roze E, Molnar MJ, Wolf NI, Darling A, Vasco G, Bertini E, Indelicato E, Neubauer D, Haack TB, Sagi JC, Danti FR, Sival D, Zanni G, Kolk A, Boespflug-Tanguy O, Schols L, van de Warrenburg B, Vidailhet M, Willemsen MA, Buizer AI, Orzes E, Ripp S, Reinhard C, Moroni I, Mariotti C. Child-to-adult transition: a survey of current practices within the European Reference Network for Rare Neurological Diseases (ERN-RND). Neurol Sci 2024; 45:1007-1016. [PMID: 37853291 DOI: 10.1007/s10072-023-07101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Transition from child-centered to adult-centered healthcare is a gradual process that addresses the medical, psychological, and educational needs of young people in the management of their autonomy in making decisions about their health and their future clinical assistance. This transfer is challenging across all chronic diseases but can be particularly arduous in rare neurological conditions. AIM To describe the current practice on the transition process for young patients in centers participating in the European Reference Network for Rare Neurological Diseases (ERN-RND). METHODS Members of the ERN-RND working group developed a questionnaire considering child-to-adult transition issues and procedures in current clinical practice. The questionnaire included 20 questions and was sent to members of the health care providers (HCPs) participating in the network. RESULTS Twenty ERN-RND members (75% adult neurologists; 25% pediatricians; 5% nurses or study coordinators) responded to the survey, representing 10 European countries. Transition usually occurs between 16 and 18 years of age, but 55% of pediatric HCPs continue to care for their patients until they reach 40 years of age or older. In 5/20 ERN-RND centers, a standardized procedure managing transition is currently adopted, whereas in the remaining centers, the transition from youth to adult service is usually assisted by pediatricians as part of their clinical practice. CONCLUSIONS This survey demonstrated significant variations in clinical practice between different centers within the ERN-RND network. It provided valuable data on existing transition programs and highlighted key challenges in managing transitions for patients with rare neurological disorders.
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Affiliation(s)
- Lorenzo Nanetti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Mary Kearney
- Patient Advocate at the European Reference Network Representing Individuals With Ataxia, and Neurology Research Fellow at the National Ataxia Centre, Tallaght University, Dublin, Ireland
| | - Sylvia Boesch
- Center for Rare Movement Disorders, Department of Neurology, Innsbruck, Austria
| | - Lucie Stovickova
- Centre of Hereditary Ataxias, Department of Pediatric Neurology, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | | | - Alfons Macaya
- Pediatric Neurology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, and Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Gomez-Andres
- Pediatric Neurology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, and Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Emmanuel Roze
- Sorbonne University, INSERM, CNRS, Paris Brain Institute, APHP Salpêtrière Hospital, Paris, France
| | - Maria-Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Nicole I Wolf
- Amsterdam Leukodystrophy Center, Department of Child Neurology, Emma's Children's Hospital, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Amsterdam, The Netherlands
| | - Alejandra Darling
- Pediatric Neurology Department, Institut de Recerca Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Gessica Vasco
- Research Unit of Neurorehabilitation, IRCCS Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disease, IRCCS Bambino Gesù Children's Research Hospital, Rome, Italy
| | | | - David Neubauer
- UMCL, Children's Hospital Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics University of Tübingen, Tübingen, Germany
| | - Judit C Sagi
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
- Department of Paediatrics, Semmelweis University, Dept. of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Federica R Danti
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Deborah Sival
- Department of Paediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ginevra Zanni
- Unit of Neuromuscular and Neurodegenerative Disease, IRCCS Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Anneli Kolk
- Tartu University Hospital Children's Clinic, Department of Pediatrics and Neurology, Tartu, Estonia
| | - Odile Boespflug-Tanguy
- APHP, Université Paris Cité, INSERM UMR1141, Hôpital Robert Debré, Service de Neuropédiatrie, Centre de Reference LEUKOFRANCE, Paris, France
| | - Ludger Schols
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, and German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Bart van de Warrenburg
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marie Vidailhet
- Sorbonne University, INSERM, CNRS, Paris Brain Institute, APHP Salpêtrière Hospital, Paris, France
| | - Michèl A Willemsen
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Emma Children's Hospital, Amsterdam, Vrije Universiteit, Amsterdam, Amsterdam Movement Science, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Enrico Orzes
- Osservatorio Malattie Rare - Rarelab S.R.L., Rome, Italy
| | - Sophie Ripp
- Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Carola Reinhard
- Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Isabella Moroni
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Caterina Mariotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy.
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Ulbing S, Infanger L, Fleischmann E, Prager G, Hamp T. Author's Reply to the "Letter to the Editor Regarding 'The Performance of Opioid-Free Anesthesia for Bariatric Surgery in Clinical Practice'". Obes Surg 2024; 34:1020-1021. [PMID: 37752325 DOI: 10.1007/s11695-023-06817-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 08/23/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Stefan Ulbing
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, 1090, Wien, Vienna, Austria
| | - Lukas Infanger
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Vienna, Austria
| | - Edith Fleischmann
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Vienna, Austria
| | - Thomas Hamp
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Vienna, Austria.
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Różyńska J, Zawiła-Niedźwiecki J, Maćkiewicz B, Czarkowski M. Tough Clinical Decisions: Experiences of Polish Physicians. HEC Forum 2024; 36:111-130. [PMID: 35939219 PMCID: PMC10864525 DOI: 10.1007/s10730-022-09491-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/29/2022]
Abstract
The paper reports results of the very first survey-based study on the prevalence, frequency and nature of ethical or other non-medical difficulties faced by Polish physicians in their everyday clinical practice. The study involved 521 physicians of various medical specialties, practicing mainly in inpatient healthcare. The study showed that the majority of Polish physicians encounter ethical and other non-medical difficulties in making clinical decisions. However, they confront such difficulties less frequently than their foreign peers. Moreover, Polish doctors indicate different circumstances as a source of the experienced problems. The difficulties most often reported relate to (i) patients (or their proxies) requests for medically non-indicated interventions; (ii) problems with communication with patients (or their proxies) due to the patients' negative attitude, unwillingness to cooperate, or aggression; and (iii) various difficulties with obtaining informed consent. Polish physicians report difficulties associated with disagreements among care givers or scarcity of resources less frequently than doctors from other countries. The study's findings provide support for the thesis that a significant portion of Polish physicians still follow a traditional, paternalistic, and hierarchical model of healthcare practice. Instead of promoting patient's empowerment, engagement, and rights, they often consider these ideas as a threat to physicians' professional authority and autonomy. The study leads to the conclusion that due to insufficient training in medical ethics, communication skills, and medical law, many Polish physicians lack the knowledge and competence necessary to adequately respond to challenges posed by modern healthcare practice.
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Affiliation(s)
- Joanna Różyńska
- Center for Bioethics and Biolaw, Faculty of Philosophy, University of Warsaw, Krakowskie Przedmieście 3, 00-047, Warsaw, Poland
| | - Jakub Zawiła-Niedźwiecki
- Center for Bioethics and Biolaw, Faculty of Philosophy, University of Warsaw, Krakowskie Przedmieście 3, 00-047, Warsaw, Poland.
| | - Bartosz Maćkiewicz
- Center for Bioethics and Biolaw, Faculty of Philosophy, University of Warsaw, Krakowskie Przedmieście 3, 00-047, Warsaw, Poland
| | - Marek Czarkowski
- Collegium Medicum Cardinal Stefan Wyszyński University in Warsaw, ul. Kazimierza Wóycickiego 1/3, 01-938, Warsaw, Poland
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Anzueto A, Cohen M, Echazarreta AL, Elassal G, Godoy I, Paramo R, Sayiner A, Torres-Duque CA, Acharya S, Aggarwal B, Erkus H, Levy G. Delphi Consensus on Clinical Applications of GOLD 2023 Recommendations in COPD Management: How Aligned are Recommendations with Clinical Practice? Pulm Ther 2024; 10:69-84. [PMID: 38112909 PMCID: PMC10881920 DOI: 10.1007/s41030-023-00248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION The objective of this Delphi study was to understand and assess the level of consensus among respiratory experts on the clinical application of GOLD 2023 recommendations in management of patients with chronic obstructive pulmonary disease (COPD). METHODS The study comprised two online surveys and a participant meeting with 34 respiratory experts from 16 countries. Responses of 73 questions were recorded using a Likert scale ranging from 0 (disagreement) to 9 (agreement). The consensus threshold was 75%. RESULTS Survey 1 and survey 2 had 34 and 32 participants, respectively; and 25 attended the participant meeting. Consensus was reached on survey 1: 28/42; survey 2: 18/30 close-ended questions. A consensus was reached on the clinical relevance of most updates in definitions and diagnosis of COPD. Mixed results for the treatment recommendations by GOLD were noted: 74% agreed with the recommendation to initiate treatment with dual bronchodilators for group E patients; 63% agreed for including inhaled corticosteroids (ICS)/long-acting β2 agonist(LABA)/ Long-acting muscarinic receptor antagonists (LAMA) as a treatment option for GOLD B patients. Also, consensus lacked on removing ICS + LABA as an initial therapeutic option, in countries with challenges in access to other treatment option;. 88% agreed that they use GOLD recommendations in their daily clinical practice. CONCLUSIONS This Delphi study demonstrated a high level of consensus regarding key concepts of GOLD 2023 report, with most participants favoring recent updates in definitions, diagnosis, management, and prevention of COPD. More evidence on the etiotype based management and treatment options for group B and E are required which could further strengthen clinical application of the GOLD report.
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Affiliation(s)
- Antonio Anzueto
- University of Texas Health and South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Mark Cohen
- Hospital Centro Medico, Guatemala City, Guatemala
| | | | - Gehan Elassal
- Department of Pulmonology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Irma Godoy
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu Campus, Pneumology Area, São Paulo, Brazil
| | | | - Abdullah Sayiner
- Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | | | | | | | - Gur Levy
- Emerging Markets, GSK, Panama City, Panama
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19
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Scheen A. [GLP-1 receptor agonists in type 2 diabetes : paradoxical real-life underuse in patients with atherosclerotic cardiovascular disease]. Rev Med Liege 2024; 79:146-151. [PMID: 38487908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce the risk of cardiovascular (CV) complications in patients with type 2 diabetes (T2DM) and atherosclerotic cardiovascular disease (ASCVD) in placebo-controlled CV outcome trials. This article compares the proportion of T2DM patients treated with GLP-1RAs in retrospective observational studies that recruited T2DM patients with versus without established ASCVD. Nine cohorts from seven studies were collected in the international literature between 2019 and 2022. Overall, the percentages of patients treated with GLP-1RAs were low (< 10 %) in most studies. Surprisingly, the use of GLP-1RAs in patients with ASCVD was slightly lower in 7 out of 9 cohorts when compared to the use in patients without ASCVD (odds ratio 0.80, 95% CI 0.79-0.81). Despite a positive trend over the last decade, the real-world use of GLP-1RAs remains limited, especially in patients with established ASCVD. The reasons for this underuse are diverse. Bridging the gap between clinical evidence of cardioprotective effects of GLP-1RAs and their underuse in clinical practice in T2DM patients at high/very high CV risk, more particularly those with established ASCVD, should be considered as a key objective for health care providers, especially cardiologists.
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Affiliation(s)
- André Scheen
- Service de Diabétologie, Nutrition et Maladies métaboliques et Unité de Pharmacologie clinique, CHU Liège, Belgique
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20
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Zhou L, Lu Y, Liu W, Wang S, Wang L, Zheng P, Zi G, Liu H, Liu W, Wei S. Drug conjugates for the treatment of lung cancer: from drug discovery to clinical practice. Exp Hematol Oncol 2024; 13:26. [PMID: 38429828 PMCID: PMC10908151 DOI: 10.1186/s40164-024-00493-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
A drug conjugate consists of a cytotoxic drug bound via a linker to a targeted ligand, allowing the targeted delivery of the drug to one or more tumor sites. This approach simultaneously reduces drug toxicity and increases efficacy, with a powerful combination of efficient killing and precise targeting. Antibody‒drug conjugates (ADCs) are the best-known type of drug conjugate, combining the specificity of antibodies with the cytotoxicity of chemotherapeutic drugs to reduce adverse reactions by preferentially targeting the payload to the tumor. The structure of ADCs has also provided inspiration for the development of additional drug conjugates. In recent years, drug conjugates such as ADCs, peptide‒drug conjugates (PDCs) and radionuclide drug conjugates (RDCs) have been approved by the Food and Drug Administration (FDA). The scope and application of drug conjugates have been expanding, including combination therapy and precise drug delivery, and a variety of new conjugation technology concepts have emerged. Additionally, new conjugation technology-based drugs have been developed in industry. In addition to chemotherapy, targeted therapy and immunotherapy, drug conjugate therapy has undergone continuous development and made significant progress in treating lung cancer in recent years, offering a promising strategy for the treatment of this disease. In this review, we discuss recent advances in the use of drug conjugates for lung cancer treatment, including structure-based drug design, mechanisms of action, clinical trials, and side effects. Furthermore, challenges, potential approaches and future prospects are presented.
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Affiliation(s)
- Ling Zhou
- Department of Respiratory and Critical Care Medicine, National Health Commission (NHC) Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunlong Lu
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Wei Liu
- Department of Geriatrics, Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shanglong Wang
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Lingling Wang
- Department of Respiratory and Critical Care Medicine, National Health Commission (NHC) Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengdou Zheng
- Department of Respiratory and Critical Care Medicine, National Health Commission (NHC) Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guisha Zi
- Department of Respiratory and Critical Care Medicine, National Health Commission (NHC) Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, National Health Commission (NHC) Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wukun Liu
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
- Department of Respiratory and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030000, China.
| | - Shuang Wei
- Department of Respiratory and Critical Care Medicine, National Health Commission (NHC) Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Department of Respiratory and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030000, China.
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Romagnoli A, Zovi A, Santoleri F, Lasala R. Antidepressant deprescribing: State of the art and recommendations-A literature overview. Eur J Clin Pharmacol 2024; 80:417-433. [PMID: 38189859 DOI: 10.1007/s00228-023-03617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION In recent years, the consumption of antidepressants has arisen. However, deprescribing antidepressant therapy is very complicated. The aim of this study was to implement practical recommendations for the development of guidelines to be used for antidepressant deprescription in clinical practice. MATERIALS AND METHODS The literature search has been conducted on March 13, 2023, using Scopus and PubMed databases. The following search string has been used: "antidepressants AND (deprescribing OR deprescription)". All studies reporting a deprescribing intervention for antidepressant medication, regardless of the study design, have been included. Studies that did not report antidepressant drug deprescription interventions and non-English-language papers have been excluded. RESULTS From the literature search, a total of 230 articles have been extracted. Applying the exclusion criteria, 26 articles have been considered eligible. Most of the analyzed studies (16, 61%) have been carried out in the real world, 3 (11%) were RCTs, 5 (19%) were qualitative studies, in particular expert opinions, 1 (4%) was a literature review, and 1 (4%) was a post-trial observational follow-up of an RCT. In 8 out of 26 studies (31%), the analyzed antidepressants have been specified: 2 (8%) focused on anticholinergics, 2 (8%) on SSRIs, 3 (11%) on tricyclic antidepressants, and 1 (4%) on esketamine. Nineteen out of 26 studies (73%) did not stratify antidepressants by therapeutic class. The sample sizes analyzed in the studies ranged from a minimum of 4 patients to a maximum of 113,909, and 12 studies included geriatric age as an inclusion criterion. A patient's therapy review has been the main deprescribing intervention, and it has been identified in 14 (54%) articles. Interventions have been carried out by clinicians in 4 (15%) studies, general practitioners in 5 (19%) studies, nurses in 2 (8%) studies, pharmacists in 4 (15%) studies, multidisciplinary teams in 10 (38%) studies, and patients in 1 (4%) study. CONCLUSIONS From the literature review, it emerged that there is no clear evidence useful to support clinicians in antidepressant deprescribing interventions.
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Affiliation(s)
- Alessia Romagnoli
- Territorial Pharmaceutical Service, Local Health Unit Lanciano Vasto Chieti, Chieti, Italy.
| | - Andrea Zovi
- Ministry of Health, Viale Giorgio Ribotta 5, 00144, Rome, Italy
| | | | - Ruggero Lasala
- Hospital Pharmacy of Corato, Local Health Unit of Bari, Corato, Italy
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Hedlund J, Blomberg K, Hjelmqvist H, Jaensson M. Nurse anaesthetists' experiences of student nurse anaesthetist learning during clinical practice: a qualitative interview study. BMC Nurs 2024; 23:141. [PMID: 38419018 PMCID: PMC10902972 DOI: 10.1186/s12912-024-01818-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The professional role of a nurse anaesthetist involves taking a pedagogical approach towards students, including supervision during clinical practice. Although supervisors are facilitators of student learning, they are offered little training in adult learning principles. The aim of this study was to describe supervisors' experience of student nurse anaesthetist learning during clinical practice in the operating room. METHOD In this qualitative interview study, 12 semi-structured individual interviews were carried out with clinical supervising nurse anaesthetists. The data were analysed inductively using thematic analysis. RESULTS The results are illustrated with one theme and five sub-themes. The clinical learning situation of student nurse anaesthetists is described as a reflection of different cultures coming together. The operating room environment is a new context to students, and students enter with different clinical background and experiences. There is tension in facilitating student learning due to demands for productivity; supervisors suggest the use of separate operating rooms with a special focus on learning in the future. CONCLUSION Clinical practice facilitates student learning and is a parallel process to routine care. Thus, it requires the cultures of higher education and healthcare organizations to co-exist. This is illustrated with the theme "Contributing to students' future professional roles by bridging the hospital and university cultures". In the operating room, student learning is challenged by a new context and time pressure as shown by subthemes. To overcome challenges and support student learning in the operating room from a supervisors' perspective, interprofessional student teams are suggested as a future approach and need to be further investigated.
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Affiliation(s)
- Jakob Hedlund
- Department of Anaesthesia and Intensive Care, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Hans Hjelmqvist
- Department of Anaesthesia and Intensive Care, Örebro University Hospital, Region Örebro County, Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Arundell F, Sheehan A, Peters K. Strategies used by midwives to enhance knowledge and skill development in midwifery students: an appreciative inquiry study. BMC Nurs 2024; 23:137. [PMID: 38395825 PMCID: PMC10893605 DOI: 10.1186/s12912-024-01784-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Midwifery practice experience for midwifery students is an important component of education to enhance knowledge and skill development. Practicing midwives provide student support in the clinical setting, there is minimal literature relating to strategies midwives use to support students. OBJECTIVE To explore midwifery student experiences of the strategies used by midwives to facilitate knowledge and skill development in the clinical practice setting. METHODS Qualitative approach based on Appreciative Inquiry. The setting is one University in Australia. Participants, thirteen Graduate Diploma in Midwifery students. Individual interviews followed by thematic analysis. RESULTS Data analysis identified six themes, Willingness to share knowledge and develop skills; The positive use of questioning; Moderating support; Teaching through the woman; Learning through problematisation and Providing constructive affirmation. CONCLUSIONS Midwives incorporated varied strategies to support student development in the clinical setting. For an equitable clinical experience, all midwives need support to develop skills and confidence in facilitating student learning.
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Affiliation(s)
- Fiona Arundell
- Western Sydney University, School of Nursing and Midwifery, Building EB LG Room 22, Parramatta South Campus, Locked Bag 1797, NSW 2751, Penrith, Australia.
| | - Athena Sheehan
- Western Sydney University, School of Nursing and Midwifery, Building EB LG Room 22, Parramatta South Campus, Locked Bag 1797, NSW 2751, Penrith, Australia
| | - Kath Peters
- Western Sydney University, School of Nursing and Midwifery, Building 7, G Room 55, Campbelltown Campus, Locked Bag 1797, NSW 2751, Penrith, Australia
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Bashiri FA, Hundallah K, Al-Baradie R, Al-Otaibi A, Ismayl O, AlMalik ME, Muthaffar OY, Futaisi AA, Kurdi D, Tawari AA, AlSowat D, Shafi SA, Ali A, AlHajjar LM, Aldakhil A. Diagnosis and management of infantile epileptic spasms syndrome (IESS) in Gulf Cooperation Council (GCC) countries: Expert consensus statement. Seizure 2024; 117:174-182. [PMID: 38432081 DOI: 10.1016/j.seizure.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
Despite the availability of international recommendations for the management of Infantile Epileptic Spasms Syndrome (IESS), there is a lack of recommendations adapted to the local context of clinical practice of pediatric neurology in the Gulf Cooperation Council (GCC) countries. By an initiative from the Saudi Pediatric Neurology Society (SPNS), a literature review was performed and an expert panel comprised of 13 pediatric neurologists from all GCC countries (Saudi Arabia, Kuwait, Bahrain, Oman, Qatar, and the United Arab Emirates) was subsequently convened to discuss all issues related to the management and diagnosis practices of IESS in the GCC. The overall aim of this consensus document was to develop practical recommendations to support the care of patients with IESS in the GCC and to reflect on how clinical management approaches compare with those adopted internationally.
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Affiliation(s)
- Fahad A Bashiri
- Pediatric Neurology Division, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Khalid Hundallah
- Pediatric Neurology Division, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh 13317, Saudi Arabia.
| | - Raidah Al-Baradie
- Neuroscience Center, King Fahd Specialist Hospital, PO Box 15215, Dammam 314444, Kingdom of Saudi Arabia.
| | - Ali Al-Otaibi
- Pediatric Neurology Division, Department of Neurophysiology, National Neuroscience Institute, King Fahad Medical City, As Sulimaniyah, Riyadh 12231, Saudi Arabia.
| | - Omar Ismayl
- Department of Child Neurology, Sheikh Khalifah Medical City, Al Karamah Street, Abu Dhabi, United Arab Emirates.
| | - Mohamed Elhadi AlMalik
- Department of Pediatric Neurology, Mediclinic Al Jowhara Hospital, Al Ain City, United Arab Emirates.
| | - Osama Y Muthaffar
- Pediatric Neurology Division, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Amna Al Futaisi
- Pediatric Neurology Division, Child Health Department, College of Medicine and Health Sciences, Sultan Qaboos University, P.O.Box 35, P.C 123 Al Khoud, Sultanate of Oman.
| | - Daniah Kurdi
- Pediatric Neurology Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia.
| | - Asmaa Al Tawari
- Pediatric Neurology Division, Department of Pediatrics, Al Sabah Hospital, Ministry of Health, Sabah Health Region, Shuwaikh Industrial, State of Kuwait.
| | - Daad AlSowat
- Pediatric Neurology Division, Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia.
| | - Shatha Al Shafi
- Neurology Division, Epilepsy and EEG Fellowship Program, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh 13317, Saudi Arabia.
| | - Ayman Ali
- Pediatric Neurology Division, Department of Pediatrics, AlSalam Specialist Hospital, Riffa 80278, Bahrain.
| | - Lynn M AlHajjar
- Itkan Health Consulting Group, Al Olaya, Riyadh 12221, Saudi Arabia.
| | - Abdullah Aldakhil
- Itkan Health Consulting Group, Al Olaya, Riyadh 12221, Saudi Arabia.
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Lillekroken D, Kvalvaag HM, Lindeflaten K, Flølo TN, Krogstad K, Hessevaagbakke E. Educating the nurses of tomorrow: exploring first-year nursing students' reflections on a one-week senior peer-mentor supervised inspiration practice in nursing homes. BMC Nurs 2024; 23:132. [PMID: 38378512 PMCID: PMC10877788 DOI: 10.1186/s12912-024-01768-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/28/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Worldwide, the healthcare system stresses a severe deficit of nurses because of elevated levels of work-induced stress, burnout and turnover rates, as well as the ageing of the nursing workforce. The diminishing number of nursing students opting for a career in nursing older people has exacerbated this shortage. A determining factor in the choice of a career within the field of residential care for nursing students is educational institutions offering students learning opportunities with positive learning experiences. Therefore, educational institutions must develop programmes that employ student active learning methods during clinical periods. Although much focus has been given to the development of new educational programs, insufficient consideration has been given to the value of peer mentoring and students' interactions during the clinical placement at nursing homes. The aim of the present study is to explore first-year nursing students' perceptions and experiences with peer mentoring as an educational model during their inspiration practice week at nursing home. METHODS The study employed a qualitative exploratory and descriptive research design. Data collection took place in October 2022 using focus group interviews. A total of 53 students in their first year of the bachelor's programme at the Oslo Metropolitan University participated in eight focus group interviews. The data were analysed following the principles of inductive content analysis. RESULTS The analysis resulted in one main category, 'Being inspired-keep learning and moving forward', representing first-year nursing students' common perceptions of being mentored by third-year students. The main category is supported by two categories: 'Closeness to the mentor' and 'Confidence in mentors' professional knowledge and teaching and supervision methods', which are interpreted as the drivers that enabled first-year students to learn more about nurses' roles and responsibilities in the nursing home. CONCLUSION Mentorship enhances the learning transfer from third-year nursing students over to first-year nursing students by providing them with real-world exposure and guidance from their more experienced peers. This hands-on approach allows them to bridge the gap between theory and practice more effectively, boosting first-year nursing students' confidence and competence in nursing and caring for older people living in nursing homes.
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Affiliation(s)
- Daniela Lillekroken
- Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4 St. Olavs plass N, 0130, Oslo, Norway.
| | - Heidi M Kvalvaag
- Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4 St. Olavs plass N, 0130, Oslo, Norway
| | - Katrin Lindeflaten
- Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4 St. Olavs plass N, 0130, Oslo, Norway
| | - Tone Nygaard Flølo
- Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4 St. Olavs plass N, 0130, Oslo, Norway
| | - Kristine Krogstad
- Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4 St. Olavs plass N, 0130, Oslo, Norway
| | - Elisabeth Hessevaagbakke
- Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4 St. Olavs plass N, 0130, Oslo, Norway
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Boaz A, Baeza J, Fraser A, Persson E. 'It depends': what 86 systematic reviews tell us about what strategies to use to support the use of research in clinical practice. Implement Sci 2024; 19:15. [PMID: 38374051 PMCID: PMC10875780 DOI: 10.1186/s13012-024-01337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The gap between research findings and clinical practice is well documented and a range of strategies have been developed to support the implementation of research into clinical practice. The objective of this study was to update and extend two previous reviews of systematic reviews of strategies designed to implement research evidence into clinical practice. METHODS We developed a comprehensive systematic literature search strategy based on the terms used in the previous reviews to identify studies that looked explicitly at interventions designed to turn research evidence into practice. The search was performed in June 2022 in four electronic databases: Medline, Embase, Cochrane and Epistemonikos. We searched from January 2010 up to June 2022 and applied no language restrictions. Two independent reviewers appraised the quality of included studies using a quality assessment checklist. To reduce the risk of bias, papers were excluded following discussion between all members of the team. Data were synthesised using descriptive and narrative techniques to identify themes and patterns linked to intervention strategies, targeted behaviours, study settings and study outcomes. RESULTS We identified 32 reviews conducted between 2010 and 2022. The reviews are mainly of multi-faceted interventions (n = 20) although there are reviews focusing on single strategies (ICT, educational, reminders, local opinion leaders, audit and feedback, social media and toolkits). The majority of reviews report strategies achieving small impacts (normally on processes of care). There is much less evidence that these strategies have shifted patient outcomes. Furthermore, a lot of nuance lies behind these headline findings, and this is increasingly commented upon in the reviews themselves. DISCUSSION Combined with the two previous reviews, 86 systematic reviews of strategies to increase the implementation of research into clinical practice have been identified. We need to shift the emphasis away from isolating individual and multi-faceted interventions to better understanding and building more situated, relational and organisational capability to support the use of research in clinical practice. This will involve drawing on a wider range of research perspectives (including social science) in primary studies and diversifying the types of synthesis undertaken to include approaches such as realist synthesis which facilitate exploration of the context in which strategies are employed.
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Affiliation(s)
- Annette Boaz
- Health and Social Care Workforce Research Unit, The Policy Institute, King's College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE, UK.
| | - Juan Baeza
- King's Business School, King's College London, 30 Aldwych, London, WC2B 4BG, UK
| | - Alec Fraser
- King's Business School, King's College London, 30 Aldwych, London, WC2B 4BG, UK
| | - Erik Persson
- Federal University of Santa Catarina (UFSC), Campus Universitário Reitor João Davi Ferreira Lima, Florianópolis, SC, 88.040-900, Brazil
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Scaramelli E, Roletto A, Bonfitto GR, Fasulo SV, Catania D. How to run successful tutor-training programs for radiographers: A systematic review and considerations for future perspectives. J Med Imaging Radiat Sci 2024:S1939-8654(24)00009-2. [PMID: 38368143 DOI: 10.1016/j.jmir.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Healthcare professions differ from each other, therefore need different approaches in teaching clinical practices. While teaching and learning designs for medical students are widely present on databases, few information is available for radiographers. The aim of this research is to define tools and knowledge needed to develop successful tutor-training programs that can be cross-cutting and inter-disciplinary for radiography profession, taking inspiration from other healthcare professions' programs since the paucity of evidence for radiographers. METHODS A systematic review (PubMed/Embase) was performed according to the PRISMA checklist. Original articles on learning environment related to healthcare practitioners were included. Inclusion criteria comprehended articles covering design and frameworks of peer-assisted-learning (PAL) programs and training-the-trainer (TTT) curricula, skills required to become tutors, tips to install successful tutor-training programs along with benefits for tutors involved. From 1618 retrieved articles, after two selection rounds, 15 articles met the inclusion criteria. RESULTS Out of the 15 articles, none is addressed to radiographers and only 7 % (1/15) to other healthcare professions, opposed to the 93 % (14/15) addressed to medical students. All articles discuss feedback providing, 66 % (10/15) debates which the best behaviour to maintain towards students is to maximize learning, and 46 % (7/15) inform about the importance of briefing and de-briefing activities. An identical percentage (46 %, 7/15) underlines the advantages of tutoring experiences. 11 articles (73 %) enhance that tutors aren't adequately trained to carry out tutoring activities. DISCUSSION Through curricula designed on TTT and PAL programs, radiographers are provided with necessary teachings and frameworks to set up effective training paths. Few institutes promote educational tutor-training courses, even though these are beneficial both for tutors and students, consolidating professionals' knowledge and maximizing students' practical skills. CONCLUSION Offering tutor-training curricula contributes to the development of radiographers as teachers, providing them with guiding principles to improve their formative skills towards future colleagues, therefore optimizing efficacy and effectiveness of programs.
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Affiliation(s)
- Elena Scaramelli
- IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Andrea Roletto
- IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy; Department of Mechanical and Industrial Engineering, Università degli Studi di Brescia, Via Branze 38, 25123 Brescia, Italy.
| | - Giuseppe Roberto Bonfitto
- IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy; Department of Information Engineering, Università degli Studi di Brescia, Via Branze 38, 25123 Brescia, Italy
| | | | - Diego Catania
- IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy; Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
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Nuuyoma V, Muvumwaeni S, Chihururu L. Transcultural nursing: a qualitative analysis of nursing students' experiences in a multicultural context in North-Eastern Namibia. BMC Nurs 2024; 23:123. [PMID: 38360601 PMCID: PMC10870613 DOI: 10.1186/s12912-024-01773-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Culture is a fundamental concept in healthcare settings due to the reason that care provided to patients is holistic and encompasses their perspectives on health, which are greatly influenced by the patients' cultures. To prepare culturally competent nursing graduates, it is important to understand the experiences of students on transcultural nursing during clinical practice. However, there are limited studies that have explored experiences of students on transcultural nursing, specifically those located in multicultural societies. In addition, studies focus on experiences of international students who visit with student - exchange programme. Nevertheless, their experiences of transcultural nursing may differ since they are not residents and have limited exposure to transcultural nursing, and therefore cannot be generalized to undergraduate resident students. This study aimed to explore and describe transcultural nursing experiences of nursing students during clinical practice at an intermediate hospital in north-eastern Namibia. METHODS Descriptive and explorative qualitative designs were used, data were collected via individual interviews from 16 final year nursing students, who were sampled using maximum variation purposive and snowballing sampling. During data collection, an interview guide was used together with audiotape and field notes. Data analysis followed Tesch's eight steps in qualitative coding process. Trustworthiness was ensured using four principles of Lincoln and Guba, Moreover, ethical clearance and permission were granted by research ethics committees from two institutions. FINDINGS Four main themes emerged as findings of the study are: nursing students' exposure to different cultural practices and beliefs; personal feelings experienced by nursing students during transcultural nursing; challenges experienced by students during transcultural nursing; and nursing students coping mechanisms. CONCLUSIONS Nursing students had mixed experiences on transcultural nursing which touch on aspects such as exposure to cultural aspects, personal feelings, challenges, and coping mechanisms. These findings are useful in helping nurse educators, clinical mentors, students, and future researchers to understand experiences of students on transcultural nursing. Consequently, assist in enriching transcultural nursing issues in curricula and for adequate preparation of graduates to become culturally competent when providing nursing care.
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Affiliation(s)
- Vistolina Nuuyoma
- School of Nursing and Public Health, University of Namibia, Rundu Campus, Rundu, Namibia.
| | - Sitembile Muvumwaeni
- School of Nursing and Public Health, University of Namibia, Rundu Campus, Rundu, Namibia
| | - Leonard Chihururu
- School of Nursing and Public Health, University of Namibia, Rundu Campus, Rundu, Namibia
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Karlsen K, Nygård C, Johansen LG, Gjevjon ER. In situ simulation training strengthened bachelor of nursing students' experienced learning and development process- a qualitative study. BMC Nurs 2024; 23:121. [PMID: 38360599 PMCID: PMC10870516 DOI: 10.1186/s12912-024-01771-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/28/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND In advanced clinical learning labs on campus, high-fidelity simulation has become an essential educational approach in the Bachelor of Nursing Education programme. However, simulation while in clinical placement, in situ, is rarely used in Bachelor of Nursing Education. The aim of the present study was to explore how in situ simulation training at a surgical hospital ward, according to Bachelor of Nursing students, influenced their learning and development process. METHODS A qualitative descriptive study was conducted. Data were collected through individual interviews with a sample of 21 s-year Bachelor of Nursing students who completed 40 in situ simulations during their eight-week clinical placement at a Norwegian University Hospital. Data were analysed using inductive content analysis. RESULTS The data analysis generated six subcategories constituting two descriptive categories: building professional confidence and internalising nursing knowledge. Although the students found in situ simulation stressful and uncomfortable for being assessed by student peers, the teacher and preceptor, the process of managing clinical situations in simulation helped build professional confidence. What the students had learned in the simulation was directly transferable to real clinical situations because they were in the hospital setting. The simulation sessions enabled them to connect theoretical knowledge and clinical skills. They could test their skills in a safe environment, performing procedures that made them aware of how their knowledge could be used in real life. CONCLUSION According to the Bachelor of Nursing students' own experiences, in situ simulation supported the students' learning process, connected theory and practice and contributed to developing confidence in the performance of clinical skills. Including simulation in clinical practice could prove to be an effective way of teaching and learning clinical skills in nursing regarding resources and learning outcomes.
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Affiliation(s)
| | - Carina Nygård
- UiT The Arctic University of Norway, Harstad, Norway
| | | | - Edith Roth Gjevjon
- UiT The Arctic University of Norway, Harstad, Norway.
- Lovisenberg University College, Oslo, Norway.
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Huang BK, Elicker BM, Henry TS, Kallianos KG, Hahn LD, Tang M, Heng F, McCulloch CE, Bhakta NR, Majumdar S, Choi J, Denlinger LC, Fain SB, Hastie AT, Hoffman EA, Israel E, Jarjour NN, Levy BD, Mauger DT, Sumino K, Wenzel SE, Castro M, Woodruff PG, Fahy JV, Sarp FTNSARP. Persistent mucus plugs in proximal airways are consequential for airflow limitation in asthma. JCI Insight 2024; 9:e174124. [PMID: 38127464 DOI: 10.1172/jci.insight.174124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUNDInformation about the size, airway location, and longitudinal behavior of mucus plugs in asthma is needed to understand their role in mechanisms of airflow obstruction and to rationally design muco-active treatments.METHODSCT lung scans from 57 patients with asthma were analyzed to quantify mucus plug size and airway location, and paired CT scans obtained 3 years apart were analyzed to determine plug behavior over time. Radiologist annotations of mucus plugs were incorporated in an image-processing pipeline to generate size and location information that was related to measures of airflow.RESULTSThe length distribution of 778 annotated mucus plugs was multimodal, and a 12 mm length defined short ("stubby", ≤12 mm) and long ("stringy", >12 mm) plug phenotypes. High mucus plug burden was disproportionately attributable to stringy mucus plugs. Mucus plugs localized predominantly to airway generations 6-9, and 47% of plugs in baseline scans persisted in the same airway for 3 years and fluctuated in length and volume. Mucus plugs in larger proximal generations had greater effects on spirometry measures than plugs in smaller distal generations, and a model of airflow that estimates the increased airway resistance attributable to plugs predicted a greater effect for proximal generations and more numerous mucus plugs.CONCLUSIONPersistent mucus plugs in proximal airway generations occur in asthma and demonstrate a stochastic process of formation and resolution over time. Proximal airway mucus plugs are consequential for airflow and are in locations amenable to treatment by inhaled muco-active drugs or bronchoscopy.TRIAL REGISTRATIONClinicaltrials.gov; NCT01718197, NCT01606826, NCT01750411, NCT01761058, NCT01761630, NCT01716494, and NCT01760915.FUNDINGAstraZeneca, Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Sanofi-Genzyme-Regeneron, and TEVA provided financial support for study activities at the Coordinating and Clinical Centers beyond the third year of patient follow-up. These companies had no role in study design or data analysis, and the only restriction on the funds was that they be used to support the SARP initiative.
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Affiliation(s)
- Brendan K Huang
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and
| | - Brett M Elicker
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Travis S Henry
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Kimberly G Kallianos
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Lewis D Hahn
- Department of Radiology, UCSD, San Diego, California, USA
| | - Monica Tang
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and
| | | | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | - Nirav R Bhakta
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Jiwoong Choi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Loren C Denlinger
- Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sean B Fain
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Annette T Hastie
- Department of Internal Medicine, Section for Pulmonary, Critical Care, Allergy and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nizar N Jarjour
- Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Bruce D Levy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dave T Mauger
- Division of Biostatistics and Bioinformatics, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Kaharu Sumino
- Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, USA
| | - Sally E Wenzel
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and
- Cardiovascular Research Institute and
| | - John V Fahy
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and
- Cardiovascular Research Institute and
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Kahriman I, Aksoy B, Kandaz U, Arslan Ü. Investigation of nursing students' emotional states toward challenging situations in clinical practice and metaphorical perceptions of the concept of a nurse. Nurse Educ Pract 2024; 75:103873. [PMID: 38277803 DOI: 10.1016/j.nepr.2024.103873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024]
Abstract
AIM This study aims to determine nursing students' emotions toward the challenging situations they encounter in clinical practice and their metaphorical perceptions of the concept of a nurse. BACKGROUND Challenging situations in clinical practice negatively affect nursing students' perceptions of the nursing profession and their professional learning and development. DESIGN The study is based on quantitative, metaphorical and picture-drawing analysis. METHODS The quantitative and qualitative parts of it were conducted with 200 nursing students attending their first and second years in the 2021-2022 academic year. The Draw a Picture of a Cactus Test was carried out with 30 students in clinical practice. The data were collected using the "Sociodemographic Information Form" and the "Semi-structured Interview Form". Content analysis techniques, descriptive statistics, picture analysis and psychological tests were used to evaluate the data. The study was reported based on Standards for Reporting Qualitative Research (SRQR). RESULTS Nursing students involved in the study produced 37 metaphors related to the "concept of a nurse" and three most expressed ones were "mother, lifeguard and helper." The metaphors produced by nursing students were categorized under six roles: "caregiver, educator, supporter, researcher, administrator and therapeutic/rehabilitator". The pictures drawn by the students about the challenging situations in clinical practice and the expressions they used were associated with self-centeredness (n=21), being attentive (n=19), aggression toward peers (n=13), low motivation (n=11) and need for protection (n=11). Nursing students experienced feelings of loneliness, passivity and anxiety when navigating difficult conditions in clinical practice. CONCLUSIONS Metaphors and picture drawing allow a unique approach to the concept of nursing and nursing students' emotional states toward challenging situations in their clinical practice.
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Affiliation(s)
- Ilknur Kahriman
- Karadeniz Technical University, Faculty of Health Sciences, Department of Child Health and Diseases Nursing, Trabzon, Turkey.
| | - Bahar Aksoy
- Akdeniz University, Kumluca Faculty of Health Sciences, Child Health Nursing Department, Antalya, Turkey; Karadeniz Technical University, Faculty of Health Sciences, Department of Nursing, Trabzon, Turkey.
| | - Ufuk Kandaz
- Karadeniz Technical University, Health Practice Research Center, Department of Child and Adolescent Psychiatry and Diseases, Trabzon, Turkey.
| | - Ümit Arslan
- Trabzon University, Department of Basic Education, Department of Preschool Education, Trabzon, Turkey.
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Wang M, Wu Y, Li G, Lin Q, Zhang W, Liu H, Su J. Articular cartilage repair biomaterials: strategies and applications. Mater Today Bio 2024; 24:100948. [PMID: 38269053 PMCID: PMC10806349 DOI: 10.1016/j.mtbio.2024.100948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/09/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
Articular cartilage injury is a frequent worldwide disease, while effective treatment is urgently needed. Due to lack of blood vessels and nerves, the ability of cartilage to self-repair is limited. Despite the availability of various clinical treatments, unfavorable prognoses and complications remain prevalent. However, the advent of tissue engineering and regenerative medicine has generated considerable interests in using biomaterials for articular cartilage repair. Nevertheless, there remains a notable scarcity of comprehensive reviews that provide an in-depth exploration of the various strategies and applications. Herein, we present an overview of the primary biomaterials and bioactive substances from the tissue engineering perspective to repair articular cartilage. The strategies include regeneration, substitution, and immunization. We comprehensively delineate the influence of mechanically supportive scaffolds on cellular behavior, shedding light on emerging scaffold technologies, including stimuli-responsive smart scaffolds, 3D-printed scaffolds, and cartilage bionic scaffolds. Biologically active substances, including bioactive factors, stem cells, extracellular vesicles (EVs), and cartilage organoids, are elucidated for their roles in regulating the activity of chondrocytes. Furthermore, the composite bioactive scaffolds produced industrially to put into clinical use, are also explicitly presented. This review offers innovative solutions for treating articular cartilage ailments and emphasizes the potential of biomaterials for articular cartilage repair in clinical translation.
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Affiliation(s)
- Mingkai Wang
- Institute of Translational Medicine, Shanghai University, Shanghai, 200444, China
- Organoid Research Center, Shanghai University, Shanghai, 200444, China
- College of Medicine, Shanghai University, Shanghai, 200444, China
| | - Yan Wu
- Institute of Translational Medicine, Shanghai University, Shanghai, 200444, China
- Organoid Research Center, Shanghai University, Shanghai, 200444, China
| | - Guangfeng Li
- Institute of Translational Medicine, Shanghai University, Shanghai, 200444, China
- Organoid Research Center, Shanghai University, Shanghai, 200444, China
- College of Medicine, Shanghai University, Shanghai, 200444, China
- Department of Orthopedics Trauma, Shanghai Zhongye Hospital, Shanghai, 200941, China
| | - Qiushui Lin
- Department of Spine Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Wencai Zhang
- Department of Orthopedics, The First Affiliated Hospital Jinan University, Guangzhou, 510632, China
| | - Han Liu
- Institute of Translational Medicine, Shanghai University, Shanghai, 200444, China
- Organoid Research Center, Shanghai University, Shanghai, 200444, China
| | - Jiacan Su
- Institute of Translational Medicine, Shanghai University, Shanghai, 200444, China
- Organoid Research Center, Shanghai University, Shanghai, 200444, China
- Department of Orthopedics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
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Simon TA, Suissa S, Boers M, Hochberg MC, Skovron ML, Askling J, Michaud K, Strangfeld A, Pedro S, Frisell T, Meissner Y, Dominique A, Gomez A. Malignancy outcomes in patients with rheumatoid arthritis treated with abatacept and other disease-modifying antirheumatic drugs: Results from a 10-year international post-marketing study. Semin Arthritis Rheum 2024; 64:152240. [PMID: 37500379 DOI: 10.1016/j.semarthrit.2023.152240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/12/2023] [Accepted: 06/25/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To evaluate the risk of malignancy (overall, breast, lung, and lymphoma) in patients with rheumatoid arthritis treated with abatacept, conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs), and other biologic/targeted synthetic (b/ts)DMARDs in clinical practice. METHODS Four international observational data sources were included: ARTIS (Sweden), RABBIT (Germany), FORWARD (USA), and BC (Canada). Crude incidence rates (IRs) per 1000 patient-years of exposure with 95% confidence intervals (CIs) for a malignancy event were calculated; rate ratios (RRs) were estimated and adjusted for demographics, comorbidities, and other potential confounders. RRs were then pooled in a random-effects model. RESULTS Across data sources, mean follow-up for patients treated with abatacept (n = 5182), csDMARDs (n = 73,755), and other b/tsDMARDs (n = 37,195) was 3.0-3.7, 2.9-6.2, and 3.1-4.7 years, respectively. IRs per 1000 patient-years for overall malignancy ranged from 7.6-11.4 (abatacept), 8.6-13.2 (csDMARDs), and 5.0-11.8 (other b/tsDMARDs). IRs ranged from: 0-4.4, 0-3.3, and 0-2.5 (breast cancer); 0.1-2.8, 0-3.7, and 0.2-2.9 (lung cancer); and 0-1.1, 0-0.9, and 0-0.6 (lymphoma), respectively, for the three treatment groups. The numbers of individual cancers (breast, lung, and lymphoma) in some registries were low; RRs were not available. There were a few cases of lymphoma in some of the registries; ARTIS observed an RR of 2.8 (95% CI 1.1-6.8) with abatacept versus csDMARDs. The pooled RRs (95% CIs) for overall malignancy with abatacept were 1.1 (0.8-1.5) versus csDMARDs and 1.0 (0.8-1.3) versus b/tsDMARDs. CONCLUSIONS This international, post-marketing observational safety study did not find any statistically significant increase in the risk of overall malignancies in pooled data in patients treated with abatacept compared with csDMARDs or with other b/tsDMARDs. Assessment of larger populations is needed to further evaluate the risks for individual cancers, especially lymphoma.
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Affiliation(s)
| | | | - Maarten Boers
- Department of Epidemiology & Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marc C Hochberg
- Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA; FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Anja Strangfeld
- Pharmacoepidemiology and Health Services Research, German Rheumatism Research Center, Berlin, Germany; Charité University Medicine, Berlin, Germany
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Thomas Frisell
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Yvette Meissner
- Pharmacoepidemiology and Health Services Research, German Rheumatism Research Center, Berlin, Germany
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Abad-Santos F, Aliño SF, Borobia AM, García-Martín E, Gassó P, Maroñas O, Agúndez JAG. Developments in pharmacogenetics, pharmacogenomics, and personalized medicine. Pharmacol Res 2024; 200:107061. [PMID: 38199278 DOI: 10.1016/j.phrs.2024.107061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/13/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
The development of Pharmacogenetics and Pharmacogenomics in Western Europe is highly relevant in the worldwide scenario. Despite the usually low institutional support, many research groups, composed of basic and clinical researchers, have been actively working for decades in this field. Their contributions made an international impact and paved the way for further studies and pharmacogenomics implementation in clinical practice. In this manuscript, that makes part of the Special Issue entitled Spanish Pharmacology, we present an analysis of the state of the art of Pharmacogenetics and Pharmacogenomics research in Europe, we compare it with the developments in Spain, and we summarize the most salient contributions since 1988 to the present, as well as recent developments in the clinical application of pharmacogenomics knowledge. Finally, we present some considerations on how we could improve translation to clinical practice in this specific scenario.
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Affiliation(s)
- Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), CIBEREHD, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.
| | - Salvador F Aliño
- Gene Therapy and Pharmacogenomics Group, Department of Pharmacology, Faculty of Medicine, Universitat de València, Av. Blasco Ibáñez 15, 46010 Valencia, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, La Paz University Hospital, School of Medicine, Universidad Autónoma de Madrid (UAM), IdiPAZ, Madrid, Spain
| | - Elena García-Martín
- Department of Pharmacology, Universidad de Extremadura, Avda de la Universidad s/n, 10071 Cáceres, Spain
| | - Patricia Gassó
- Basic Clinical Practice Department, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona Clínic Schizophrenia Unit (BCSU), IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Olalla Maroñas
- Public Foundation of Genomic Medicine, Santiago University Hospital, Genomic Medicine group, Pharmacogenetics and Drug Discovery (GenDeM), CIBERER, Santiago Health Research Institute (IDIS), Galicia, Spain
| | - José A G Agúndez
- Universidad de Extremadura. University Institute of Molecular Pathology Biomarkers, Avda de las Ciencias s/n, 10071 Cáceres, Spain.
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Guerra JM, Moreno Weidmann Z, Perrotta L, Sultan A, Anic A, Metzner A, Providencia R, Boveda S, Chun J. Current management of atrial fibrillation in routine practice according to the last ESC guidelines: an EHRA physician survey-how are we dealing with controversial approaches? Europace 2024; 26:euae012. [PMID: 38227804 PMCID: PMC10869216 DOI: 10.1093/europace/euae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024] Open
Abstract
AIMS Although guidelines for the management of atrial fibrillation (AF) are regularly published, many controversial issues remain, limiting their implementation. We aim to describe current clinical practice among European Heart Rhythm Association (EHRA) community according to last guidelines. METHODS AND RESULTS A 30 multiple-choice questionnaire covering the most controversial topics related to AF management was distributed through the EHRA Research Network, National Societies, and social media between January and February 2023. One hundred and eighty-one physicians responded the survey, 61% from university hospitals. Atrial fibrillation screening in high-risk patients is regularly performed by 57%. Only 42% has access to at least one programme aiming at diagnosing/managing comorbidities and lifestyle modifications, with marked heterogeneity between countries. Direct oral anticoagulants are the preferred antithrombotic (97%). Rhythm control is the preferred strategy in most AF phenotypes: symptomatic vs. asymptomatic paroxysmal AF (97% vs. 77%), low vs. high risk for recurrence persistent AF (90% vs. 72%), and permanent AF (20%). I-C drugs and amiodarone are preferred while dronedarone and sotalol barely used. Ablation is the first-line therapy for symptomatic paroxysmal AF (69%) and persistent AF with markers of atrial disease (57%) and is performed independently of symptoms by 15%. In persistent AF, 68% performs only pulmonary vein isolation and 32% also additional lesions. CONCLUSION There is marked heterogeneity in AF management and limited accordance to last guidelines in the EHRA community. Most of the discrepancies are related to the main controversial issues, such as those related to AF screening, management of comorbidities, pharmacological treatment, and ablation strategy.
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Affiliation(s)
- Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IR SANT PAU, Universitat Autònoma de Barcelona, CIBERCV, Sant Antoni M. Claret 167, 08025 Barcelona, Spain
| | - Zoraida Moreno Weidmann
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IR SANT PAU, Universitat Autònoma de Barcelona, CIBERCV, Sant Antoni M. Claret 167, 08025 Barcelona, Spain
| | - Laura Perrotta
- Arrhythmia Unit, Careggi University Hospital, Florence, Italy
| | - Arian Sultan
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Centre, Split, Croatia
| | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Rui Providencia
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
- Institute of Health Informatics Research, University College London, London, UK
| | - Serge Boveda
- Department of Cardiology, Heart Rhythm Management, Clinique Pasteur, Toulouse, France
- Brussels University VUB, Brussels, Belgium
| | - Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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Matz E, Dutta R, Tsivian M, Terlecki R, Matthews C. The impact of verbal goal setting on operating room turnover time: a randomized trial. Int Urogynecol J 2024; 35:363-367. [PMID: 37962631 DOI: 10.1007/s00192-023-05680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Operating room turnover times are highly variable, with longer times having a significant negative impact on hospital costs, surgeon volume, and satisfaction. The primary aim of this randomized trial was to examine the impact of a verbalized time goal on the likelihood of meeting institutional goals. METHODS This is a prospective, single-blind, randomized study conducted across four operative sites: inpatient main campus and three outpatient centers. Sequential cases for the same surgeon in the same room were randomized to receive a verbal prompt versus usual care, in which no goal setting was verbalized. Multivariate and univariate statistical analyses were performed. RESULTS From July through October 2022, five attending surgeons randomized 88 cases (44 verbal prompt, 44 usual care). Of these, 30 were at the main inpatient hospital. The case mixture included 36% vaginal, 27% endoscopy, 8% open, 10% robotic, and others. Average turnover time was 51.7 and 35.3 min for inpatient and outpatient cases respectively. Overall, only 39.8% of cases hit the institutional turnover time goal. Verbal prompting did not significantly increase the likelihood of achieving the institutional goal (38.4% vs 43.4% p = 0.352) except for in minor surgery (64.0 vs 39.0%, p = 0.0477). A verbal prompt reduced turnover time in major surgery (59.7 vs 47.8 min, p = 0.0445). CONCLUSION Our academic center achieved goal turnover times in only 39.8% of cases. Although verbal prompting did not significantly improve the likelihood of meeting institutional goals in the group as a whole, some subgroups were significantly improved.
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Affiliation(s)
- Ethan Matz
- Department of Urology, University of Texas, Southwestern, 5323 Harry Hines Blvd, MC 9110, Dallas, TX, 75390, USA.
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA.
| | - Rahul Dutta
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
- Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Matvey Tsivian
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
| | - Ryan Terlecki
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
| | - Catherine Matthews
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
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Martínez-Doménech A, Zaragoza-Ninet V, Esteve-Martínez A, García-Rabasco A, Sánchez-Carazo JL, Pérez-Ferriols A. Efficacy and Safety of Dupilumab for the Treatment of Severe Atopic Dermatitis in Clinical Practice: A Single Center Experience. Actas Dermosifiliogr 2024; 115:150-158. [PMID: 37858860 DOI: 10.1016/j.ad.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/09/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Dupilumab is a new targeted therapy for severe atopic dermatitis (AD) with limited real-world evidence. OBJECTIVE Explore our experience with dupilumab for AD in clinical practice at a tertiary care center. MATERIAL AND METHOD Unicentric observational retrospective study including adult and pediatric patients with severe AD receiving dupilumab between December 2017 and December 2021. The Eczema Area and Severity Index (EASI) score, Pruritus Numerical Rating Scale (P-NRS) and Sleep disturbance Numerical Rating Scale (S-NRS) were recovered to assess severity and response. RESULTS Fifty-nine patients received dupilumab: 52, 48, 26 and 13 patients reached 6, 12, 24 and 36 months of treatment, respectively. The EASI-75 response rates were 94.2%, 95.8%, 92.3% and 100% at months 6, 12, 24 and 36. The EASI-90 response rates were 63.5%, 72.9%, 84.6% and 92.3% at months 6, 12, 24 and 36. The EASI <7 response rates were 92.3%, 91.7%, 88.5% and 100% at months 6, 12, 24 and 36. The P-NRS ≥4 reduction rates were 86%, 87.5%, 92.3% and 100% at months 6, 12, 24 and 36. The S-NRS ≥4 reduction rates were 82.7%, 85.4%, 100% and 100% at months 6, 12, 24 and 36. Adverse events were mild and occurred in 20.3% of patients, all of them adults. CONCLUSION Our findings support dupilumab's favorable efficacy and tolerability profile in clinical practice. Dupilumab offers a rapid and sustained response, regardless of combined therapy. Longer follow-ups are still required to adequately assess its performance.
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Affiliation(s)
- A Martínez-Doménech
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - V Zaragoza-Ninet
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain.
| | - A Esteve-Martínez
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - A García-Rabasco
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - J L Sánchez-Carazo
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - A Pérez-Ferriols
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
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Martínez-Doménech A, Zaragoza-Ninet V, Esteve-Martínez A, García-Rabasco A, Sánchez-Carazo JL, Pérez-Ferriols A. Efficacy and Safety of Dupilumab for the Treatment of Severe Atopic Dermatitis in Clinical Practice: A Single Center Experience. Actas Dermosifiliogr 2024; 115:T150-T158. [PMID: 38048951 DOI: 10.1016/j.ad.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/09/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Dupilumab is a new targeted therapy for severe atopic dermatitis (AD) with limited real-world evidence. OBJECTIVE Explore our experience with dupilumab for AD in clinical practice at a tertiary care center. MATERIAL AND METHOD Unicentric observational retrospective study including adult and pediatric patients with severe AD receiving dupilumab between December 2017 and December 2021. The Eczema Area and Severity Index (EASI) score, Pruritus Numerical Rating Scale (P-NRS) and Sleep disturbance Numerical Rating Scale (S-NRS) were recovered to assess severity and response. RESULTS Fifty-nine patients received dupilumab: 52, 48, 26 and 13 patients reached 6, 12, 24 and 36 months of treatment, respectively. The EASI-75 response rates were 94.2%, 95.8%, 92.3% and 100% at months 6, 12, 24 and 36. The EASI-90 response rates were 63.5%, 72.9%, 84.6% and 92.3% at months 6, 12, 24 and 36. The EASI <7 response rates were 92.3%, 91.7%, 88.5% and 100% at months 6, 12, 24 and 36. The P-NRS ≥4 reduction rates were 86%, 87.5%, 92.3% and 100% at months 6, 12, 24 and 36. The S-NRS ≥4 reduction rates were 82.7%, 85.4%, 100% and 100% at months 6, 12, 24 and 36. Adverse events were mild and occurred in 20.3% of patients, all of them adults. CONCLUSION Our findings support dupilumab's favorable efficacy and tolerability profile in clinical practice. Dupilumab offers a rapid and sustained response, regardless of combined therapy. Longer follow-ups are still required to adequately assess its performance.
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Affiliation(s)
- A Martínez-Doménech
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - V Zaragoza-Ninet
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain.
| | - A Esteve-Martínez
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - A García-Rabasco
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - J L Sánchez-Carazo
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - A Pérez-Ferriols
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
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Høium K, Erichsen T, Johannessen LM, Raaheim A, Torbjørnsen A. What characterizes the use of digital technology in bachelor-level practice placements in health programs? Nurse Educ Pract 2024; 75:103883. [PMID: 38266567 DOI: 10.1016/j.nepr.2024.103883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 11/17/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024]
Abstract
AIM The study aimed to investigate what characterizes the use of digital technology in bachelor-level practice placements in health programs. BACKGROUND Practice placement for health students in higher education is complex and suffers from a lack of personnel and scant resources. However, the requirements and expectations of the students in managing an evidence-based practice are increasing. This decade, digital transformation in society and higher education can potentially improve students learning in higher education and practice placement due to increased availability for closer communication and collaboration. DESIGN A systematic review of reviews was conducted based on Joanna Briggs Institute Framework. METHODS Bibliographical databases were searched for studies published between 2010-2022. Out of 4891 screened articles, 15 met eligibility criteria and were included in this review. RESULTS The analysis revealed three main topics that elucidate what characterises the use of digital technology in placements: Leveraging digital solutions for enhanced practical learning; Empowering student learning and confidence in practice placement; and The value of interactive collaboration. CONCLUSIONS The findings show that digital technology used in a structured pedagogical framework may support and enhance students learning in practice placement. However, further work needs to be done to keep up with the rapid development of digital technology in practice placement in health work environments.
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Affiliation(s)
- Kari Høium
- Department of Behavioral Science, Faculty of Health Science, Oslo Metropolitan University, Norway.
| | - Torunn Erichsen
- Department of Nurse Science and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Norway
| | | | | | - Astrid Torbjørnsen
- Department of Nurse Science and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Norway
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Abstract
A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) improves functional bowel symptoms and is a second-line dietary management strategy for the treatment of irritable bowel syndrome (IBS). The diet is complex and involves three stages: restriction, reintroduction and personalisation and clinical effectiveness is achieved with dietitian-led education; however, this is not always available. The aim of this review is to provide an update on the evidence for using the low FODMAP diet, with a focus on the impact of FODMAP restriction and reintroduction considering long-term management of IBS in a clinical setting. Randomised controlled trials have assessed symptom response, quality of life, dietary intake and changes to the gut microbiota during FODMAP restriction. Systematic reviews and meta-analyses consistently report that FODMAP restriction has a better symptom response compared with control diets and a network analysis reports the low FODMAP diet is superior to other dietary treatments for IBS. Research focused on FODMAP reintroduction and personalisation is limited and of lower quality, however common dietary triggers include wheat, onion, garlic, pulses and milk. Dietitian-led delivery of the low FODMAP diet is not always available and alternative education delivery methods, e.g. webinars, apps and leaflets, are available but remove the personalised approach and may be less acceptable to patients and may introduce safety concerns in terms of nutritional adequacy. Predicting response to the low FODMAP diet using symptom severity or a biomarker is of great interest. More evidence on less restrictive approaches and non-dietitian-led education delivery methods are needed.
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Affiliation(s)
- Miranda C E Lomer
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
- Department of Nutritional Sciences, King's College London, Stamford Street, London, UK
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Kwon SJ, Kim Y, Kwak Y. Nursing students' clinical practice education experience during the COVID-19 pandemic: a qualitative study. BMC Nurs 2024; 23:63. [PMID: 38263190 PMCID: PMC10807203 DOI: 10.1186/s12912-024-01730-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Nursing education, including some elements of clinical practice, has largely been conducted online during the coronavirus disease 2019 (COVID-19) pandemic. Numerous studies have examined the experiences of nursing students in academia during the pandemic. However, research on nursing students' clinical practice experiences is limited. This study aimed to analyze nursing students' clinical practice experiences during the COVID-19 pandemic. METHODS This study used a qualitative research design and performed thematic analysis. Participants comprised 13 nursing university students with clinical practice experience at a hospital during the COVID-19 pandemic. Interviews were conducted either online or face-to-face. Data were collected during June‒July 2021. RESULTS Four themes and eight subthemes were generated through thematic analysis. Theme 1 was "Nursing students' anxiety and strict adherence to quarantine practices," with the subthemes of "Fear of infection" and "Protecting themselves." Theme 2 was "Nursing students' belief that their organization is protecting them," with the subthemes of "Strict quarantine rules at hospitals and universities" and "The nursing students regretted the limited scope of practice but felt safe." Theme 3 was "Learning through valuable practice," with the subthemes of "Recognizing the importance of practice" and "Realizing the benefits of practice." Theme 4 was "A sense of duty as a prospective nurse," with the subthemes of "Accepting a sense of duty as a nurse" and "Establishing the expanded role of a nurse." CONCLUSIONS The nursing students recognized the importance of nursing practice during the pandemic and worked harder. A better understanding of the experiences of nursing university students who completed their clinical practice during the COVID-19 pandemic can help nursing professors and managers more effectively train students during times of high stress.
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Affiliation(s)
- Soo Jin Kwon
- Department of Nursing, Ansan University, Ansan, Republic of Korea
| | - Yoonjung Kim
- Faculty of Red Cross College of Nursing, Chung-Ang University, 156-756, Seoul, Republic of Korea.
| | - Yeunhee Kwak
- Faculty of Red Cross College of Nursing, Chung-Ang University, 156-756, Seoul, Republic of Korea
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Shalabi KM, Almurdi MM. Satisfaction and attitudes towards online continuous medical education and its impact on clinical practice among physiotherapists. BMC Med Educ 2024; 24:70. [PMID: 38233905 PMCID: PMC10795308 DOI: 10.1186/s12909-024-05049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND The traditional face-to-face of medical education is gradually being replaced with online education. However, the rate of adoption of online continuing medical education (OCME) as a learning method among practicing clinical physiotherapists (PTs) is unclear. The objectives of this study were to measure the satisfaction with, attitudes towards, and impact of OCME among practicing clinical PTs in Saudi Arabia (SA) and to examine the factors that affect the findings for satisfaction, attitude, and impact towards OCME. METHODS This cross-sectional survey was conducted between October 2021 and January 2022. PTs employed at various medical facilities and specialties in Saudi Arabia completed an online survey to assess satisfaction with, attitudes towards, and impact of OCME. RESULTS Of the 127 participants, 48 were female (37.8%), 44.1% were aged between 24 and 30 years. Overall, 57.5% of the respondents were satisfied with OCME compared with conventional face-to-face education, and 45.7% agreed and 18.1% strongly agreed that OCME was more flexible. Further, 52.8% of the respondents thought that OCME programs could supplement traditional face-to-face education. The majority of the participants (63.8%) agreed that participating in OCME programs increased their knowledge, and 55.1% and 51.2% agreed that attending these programs improved patient outcomes and increased their confidence in patient management, respectively. However, only 38.6% agreed that participating in OCME programs enhanced their clinical expertise. The mean satisfaction, attitude, and impact scores differed significantly according to age group, marital status, number of years of practice, and specialty (p < 0.0001). Multiple regression analysis showed that older age was independently associated with better satisfaction and more positive attitudes and impact. Further, having a specialization also seemed to improve the impact of OCME. CONCLUSION The PTs were satisfied with and had positive attitudes towards OCME, and also found that it had a positive impact on their clinical practice. Thus, existing OCME programs are a good option for expanding the number of PTs proficient in clinical care.
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Affiliation(s)
- Kholood Matouq Shalabi
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Prince Nourah bint Abdulrahman University, P.O.Box 84428, Riyadh 11671, Kingdom of Saudi Arabia
| | - Muneera Mohammed Almurdi
- Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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de Souza S, Williams R, Nikiphorou E. Clinician and patient views on janus kinase inhibitors in the treatment of inflammatory arthritis: a mixed methods study. BMC Rheumatol 2024; 8:1. [PMID: 38229170 DOI: 10.1186/s41927-023-00370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 12/21/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Janus kinase inhibitors (JAKi) are new targeted synthetic disease-modifying antirheumatic drugs (DMARDs) licenced in the UK to treat rheumatoid and psoriatic arthritides. Unlike currently often prescribed biological DMARDs, they target a different part of the inflammatory pathway and are taken orally. The aim of this study was to explore what UK-based rheumatology clinicians and inflammatory arthritis (IA) patients think about the awareness, prescription and use of JAKi; how they compare with biologics; and how the COVID-19 pandemic has affected how JAKi are viewed and prescribed. METHODS Rheumatology clinicians and IA patients completed online surveys and participated in interviews/focus groups between September 2021 and January 2022. Survey data were analysed descriptively, and interview/focus group data underwent an inductive thematic analysis. RESULTS 66.6% of patients had at least some awareness of JAKi, 73.0% from their rheumatology team. Problems getting earlier access to these drugs were raised by some patients, with many being prescribed JAKi after multiple other therapies had failed. 91.5% of clinicians prescribed JAKi in keeping with their local guidelines, with 72.3% prescribing them frequently as a monotherapy. Some clinicians had lingering safety concerns over JAKi use. Despite experiencing side effects and knowing of possible long-term risks, patients felt overall the benefits of JAKi outweighed the risks. 39.3% of patients were 'very satisfied' on JAKi, compared with 25.0% on biologics. Patients on JAKi appreciated their short half-life when it comes to infections, and their convenience as an oral therapy. When JAKi were discontinued in patients, it was predominantly due to inefficacy and non-cardiovascular adverse events. The COVID-19 pandemic resulted in increased prescription of JAKi as an alternative to injections and infusions, primarily to avoid potentially exposing patients to the coronavirus. Some patients believed their JAKi may confer some protection against developing severe COVID-19. CONCLUSION JAKi are an effective treatment option for IA and are liked by patients. The COVID-19 pandemic appears to have impacted their prescription favourably. However, clinicians have safety concerns over JAKi use. Any decision to go on a JAKi should be informed and take into account individual patient risk factors, circumstances and preferences.
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Affiliation(s)
- Savia de Souza
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, London, SE5 9RJ, UK.
| | - Ruth Williams
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, London, SE5 9RJ, UK
| | - Elena Nikiphorou
- Rheumatology Department, King's College Hospital, London, SE5 9RS, UK
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Verkuyl M, Violato E, Harder N, Southam T, Lavoie-Tremblay M, Goldsworthy S, Ellis W, Campbell SH, Atack L. Virtual simulation in healthcare education: a multi-professional, pan-Canadian evaluation. Adv Simul (Lond) 2024; 9:3. [PMID: 38200615 PMCID: PMC10782638 DOI: 10.1186/s41077-023-00276-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND As we experience a shortage of healthcare providers in Canada, it has become increasingly challenging for healthcare educators to secure quality clinical placements. We evaluated the impact of virtual simulations created for the virtual work-integrated learning (Virtu-WIL) program, a pan-Canadian project designed to develop, test, and offer virtual simulations to enrich healthcare clinical education in Canada. Evaluation was important since the virtual simulations are freely available through creative commons licensing, to the global healthcare community. METHODS Students self-reported their experiences with the virtual simulations and the impact on their readiness for practice using a survey that included validated subscales. Open-ended items were included to provide insight into the students' experiences. RESULTS The evaluation included 1715 Nursing, Paramedicine and Medical Laboratory students enrolled in the Virtu-WIL program from 18 post-secondary universities, colleges, and institutions. Results showed most students found the virtual simulations engaging helped them learn and prepare for clinical practice. A key finding was that it is not sufficient to simply add virtual simulations to curriculum, careful planning and applying simulation pedagogy are essential. CONCLUSION Virtual simulation experiences are increasingly being used in healthcare education. Results from this rigorous, large-scale evaluation identified ways to enhance the quality of these experiences to increase learning and to potentially decrease the number of hours healthcare students need in clinical practice to meet professional competencies. Further research is needed regarding many aspects of virtual simulations and, in particular, curriculum integration and the timing or sequencing of virtual simulations to best prepare students for practice.
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Affiliation(s)
- Margaret Verkuyl
- School of Community and Health Studies, Centennial College, P.O. Box 631, Station A, Toronto, Ontario, M1K 5E9, Canada.
| | - Efrem Violato
- Centre for Advanced Medical Simulation, Northern Alberta Institute of Technology, 11762 - 106 Street, Edmonton, Alberta, T5G 2R1, Canada
| | - Nicole Harder
- College of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Theresa Southam
- Teaching and Learning Centre, Selkirk College, 301 Frank Beinder Way, Castlegar, British Columbia, V1N 4L3, Canada
| | - Mélanie Lavoie-Tremblay
- Faculty of Nursing, University of Montreal, Pavillon Marguerite-d'Youville, 2375, chemin de la Côte Sainte-Catherine, Bureau 2089, Montréal, QC, H3T 1A8, Canada
| | - Sandra Goldsworthy
- School of Nursing and Midwifery, Mount Royal University, 4925, Mount Royal Gate SW, Calgary, Alberta, T3E 6K6, Canada
| | - Wendy Ellis
- Sally Horsfall Eaton School of Nursing, George Brown College, 51 Dockside Drive, Toronto, Ontario, M5A 1B6, Canada
| | - Suzanne H Campbell
- School of Nursing, The University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
| | - Lynda Atack
- School of Community and Health Studies, Centennial College, P.O. Box 631, Station A, Toronto, Ontario, M1K 5E9, Canada
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Hao Y, Li J, Dan L, Wu X, Xiao X, Yang H, Zhou R, Li B, Wang F, Du Q. Chinese medicine as a therapeutic option for pulmonary fibrosis: Clinical efficacies and underlying mechanisms. J Ethnopharmacol 2024; 318:116836. [PMID: 37406748 DOI: 10.1016/j.jep.2023.116836] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
ETHNIC PHARMACOLOGICAL RELEVANCE Pulmonary fibrosis (PF) is a fibrotic interstitial lung disease caused by continuous damage and excessive repair of alveolar epithelial cells, the pathogenesis of which is not fully understood. At present, the incidence of PF has increased significantly around the world. The therapeutic arsenals against PF are relatively limited, with often poor efficacy and many adverse effects. As a conventional and effective therapeutic strategy, traditional Chinese medicine (TCM) has been widely applied in treating lung fibrosis for thousands of years in China. Due to the multi-ingredient, multi-target characteristics, Chinese medicines possess promising clinical benefits for PF treatment. AIM OF THIS REVIEW This review aims to systematically analyze the clinical efficacy of Chinese medicine on PF, and further summarize the relevant mechanisms of Chinese medicine treating PF in preclinical studies, in order to provide a comprehensive insight into the beneficial effects of Chinese medicines on PF. METHODS Eight major Chinese and English databases were searched from database inception up to October 2022, and all randomized clinical trials (RCTs) investigating the effects of Chinese medicine intervention on effectiveness and safety in the treatment of PF patients were included. Subsequently, preclinical studies related to the treatment of PF in Chinese medicine, including Chinese medicine compounds, Chinese herbal materials and extracts, and Chinese herbal formulas (CHFs) were searched through PubMed and Web of science to summarize the related mechanisms of Chinese medicine against PF. RESULTS A total of 56 studies with 4019 patients were included by searching the relevant databases. Total clinical efficacy, pulmonary function, blood gas analysis, lung high resolution CT (HRCT), 6 min walk test (6-MWT), St George's Respiratory Questionnaire (SGRQ) scores, clinical symptom scores, TCM syndrome scores and other outcome indicators related to PF were analyzed. Besides, numerous preclinical studies have shown that many Chinese medicine compounds, Chinese herbal materials and extracts, and CHFs play a preventive and therapeutic role in PF by reducing oxidative stress, ameliorating inflammation, inhibiting epithelial-mesenchymal transition and myofibroblasts activation, and regulating autophagy and apoptosis. CONCLUSION Chinese medicines show potential as supplements or substitutes for treating PF. And studies on Chinese medicines will provide a new approach to better management of PF.
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Affiliation(s)
- Yanwei Hao
- Department of Geriatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Jiaxin Li
- Department of Geriatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Lijuan Dan
- Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Xuanyu Wu
- Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Xiang Xiao
- Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Han Yang
- Department of Geriatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Rui Zhou
- Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Bin Li
- Department of Geriatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China.
| | - Fei Wang
- Department of Geriatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China.
| | - Quanyu Du
- Department of Endocrinology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China.
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Yasaka T, Ohbe H, Igarashi A, Yamamoto-Mitani N, Yasunaga H. Impact of the health policy for interdisciplinary collaborative rehabilitation practices in intensive care units: A difference-in-differences analysis in Japan. Intensive Crit Care Nurs 2024; 83:103625. [PMID: 38198928 DOI: 10.1016/j.iccn.2024.103625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/02/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Early rehabilitation in intensive care units (ICUs) may be beneficial but is not routinely performed for adults with critical illness. In April 2018, the Japanese government introduced a health policy to provide financial incentives to hospitals that met the requirements of interdisciplinary collaboration and had teams specialized in ICU rehabilitation practices. OBJECTIVES The present study aimed to investigate whether the health policy is associated with improved clinical practices of ICU rehabilitation. METHODS Using a nationwide administrative inpatient database and hospital statistics data from Japan, we identified hospitals that admitted adult patients to the ICU within two days of hospital admission from April 2016 to March 2019. Using hospital-level propensity score matching, we created matched cohorts of 101,203 patients from 108 intervention hospitals that introduced the health policy, and 106,703 patients from 108 control hospitals that did not. We then conducted patient-level difference-in-differences analyses to examine changes in the percentage of patients from the intervention and control hospitals, who underwent early ICU rehabilitation within two days of ICU admission before and after the implementation of the health policy. RESULTS In the intervention group, patients undergoing early ICU rehabilitation increased from 10% and 36% after the policy implementation. In the control group, it increased from 11% to 13%. The difference-in-difference in the percentage of patients who underwent early ICU rehabilitation between the two groups was 24% (95% confidence interval, 19%-29%). CONCLUSIONS Early ICU rehabilitation can be facilitated by financial incentives for hospitals that engage in interdisciplinary collaboration with specialist teams. IMPLICATIONS FOR CLINICAL PRACTICE Our Findings are relevant for hospital administrators, professional organizations, and policymakers in other nations considering strategies to support the additional deployment burdens of early ICU rehabilitation. Future studies need to explore the long-term effects and sustainability of the observed improvements in ICU rehabilitation practices.
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Affiliation(s)
- Taisuke Yasaka
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 1130033, Japan; Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 1130033, Japan.
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan; Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ayumi Igarashi
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 1130033, Japan; Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 1130033, Japan
| | - Noriko Yamamoto-Mitani
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 1130033, Japan; Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 1130033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
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Bredal K, Frandsen LT, Terkelsen JH, Nielsen MH, Melgaard D, Krarup AL. There is a long way from current clinical practice in Denmark compared to recent published English guideline on management of children with eosinophilic oesophagitis. BMC Pediatr 2024; 24:24. [PMID: 38191332 PMCID: PMC10773032 DOI: 10.1186/s12887-023-04483-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND A low incidence of eosinophilic esophagitis (EoE) in children in the North Denmark Region (NDR) were measured in 2007-2017. Few of the children diagnosed before 2017 were treated to remission suggesting a lack of awareness. While there currently are no guidelines for treating EoE in Denmark, a new English guideline was published in 2022 renewing focus on the disease. OBJECTIVE The aim of this study was to measure the difference of current Danish clinical practice for treatment and follow-up of EoE children in the NDR with the new English guideline from the British Society of Gastroenterology (BSG) and the British Society of Pediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN). METHODS This retrospective, register-based DanEoE cohort study included 31 children diagnosed with EoE between 2007 and 2021 in NDR. Medical records were reviewed and information about treatment and follow-up were collected. RESULTS In 32% of the children with EoE in the NDR, first-line treatment corresponded with the new English guideline. One in 6 children were never started on any treatment even though treatment always is recommended. Histologic evaluation within 12 weeks as recommended was performed in 13% of the children. CONCLUSIONS In Denmark focus on improving EoE treatment and follow-up for children is needed, as there is a significant difference between current clinical practice and the recommendations in the new English guideline.
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Affiliation(s)
- Kasper Bredal
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
| | - Line Tegtmeier Frandsen
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, Aalborg, DK-9000, Denmark
| | - Jacob Holmen Terkelsen
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
| | - Martin Hollænder Nielsen
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
| | - Dorte Melgaard
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, Aalborg, DK-9000, Denmark
| | - Anne Lund Krarup
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark.
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, Aalborg, DK-9000, Denmark.
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Couturier JL, Kimber M, Ford C, Coelho JS, Dimitropoulos G, Kurji A, Boman J, Isserlin L, Bond J, Soroka C, Dominic A, Boachie A, McVey G, Norris M, Obeid N, Pilon D, Spettigue W, Findlay S, Geller J, Grewal S, Gusella J, Jericho M, Johnson N, Katzman D, Chan N, Grande C, Nicula M, Clause-Walford D, Leclerc A, Loewen R, Loewen T, Steinegger C, Waite E, Webb C, Brouwers M. A study protocol for implementing Canadian Practice Guidelines for Treating Children and Adolescents with Eating Disorders. Implement Sci Commun 2024; 5:5. [PMID: 38183084 PMCID: PMC10768347 DOI: 10.1186/s43058-023-00538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake. METHODS Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8-10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups. DISCUSSION Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies.
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Affiliation(s)
- Jennifer L Couturier
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
| | - Melissa Kimber
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sheri Findlay
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Josie Geller
- University of British Columbia, Vancouver, Canada
| | - Seena Grewal
- University of British Columbia, Vancouver, Canada
| | | | | | - Natasha Johnson
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | | | | | - Maria Nicula
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Drew Clause-Walford
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | | | | | | | | | - Cheryl Webb
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
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Thomson-Casey C, McIntyre E, Rogers K, Adams J. Practice recommendations and referrals, perceptions of efficacy and risk, and self-rated knowledge regarding complementary medicine: a survey of Australian psychologists. BMC Complement Med Ther 2024; 24:13. [PMID: 38166841 PMCID: PMC10759583 DOI: 10.1186/s12906-023-04288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Many people with mental health problems use a range of complementary medicine (CM), including over the counter products, practices, and utilise the services of CM practitioners. Psychologists are likely to consult with clients using CM, in some form, as part of their broader mental health care. The aim of this research was to determine the number of types of CM products, practices, and practitioners are recommended and/or referred by Australian psychologists as part of their clinical practice, as well as explore the relationship between psychologists' perspectives on the risk and relevance of engaging with CM in psychology. METHODS Survey data was collected from psychologists in clinical practice who self-selected to participate in the study via an online 79-item questionnaire exploring core aspects of CM engagement in psychology clinical practice. RESULTS Amongst the 201 psychologists, 5% reported not recommending any type of CM, with 63% recommending four or more types of CM. Further, 25% had not referred to a CM practitioner, while 33% had referred to four or more types of CM practitioner. Psychologists are recommending and referring to CM even when they perceive their knowledge of CM to be poor, and that engaging with CM was a risk. CONCLUSION This study provides insights into psychologist perceptions of CM within psychology practice and how these perceptions are associated with rates of recommending and referring to CM as part of their clinical practice. These findings may inform the development of CM relevant education and guidelines for psychologists.
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Affiliation(s)
- Carrie Thomson-Casey
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
- Faculty of Health, Southern Cross University, Gold Coast, Australia.
| | - Erica McIntyre
- Institute for Sustainable Futures, University of Technology Sydney, Sydney, Australia
| | - Kris Rogers
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jon Adams
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Petitpain A, Brabant-Thery J, Patin C, Ott L, Basirat A. Status of prosody in the practices of speech-language pathologists in France: A survey on theoretical and clinical dimensions. J Commun Disord 2024; 107:106404. [PMID: 38266444 DOI: 10.1016/j.jcomdis.2023.106404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/28/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE Many populations in the scope of speech and language pathologists (SLPs) are at risk of prosodic disorders that can impact communicative ability. While a few studies have examined the importance of prosody in the clinical practice of English-speaking SLPs, there is a lack of similar research in non-English-speaking countries. The current study aimed to establish an overview of the situation in France and to determine factors that might be associated with assessing and treating prosody. METHOD We collected data about the theoretical and clinical dimensions related to prosody from SLPs in France using an online survey. RESULTS One hundred and twenty-eight valid responses were analyzed. Results suggest that both emotional and linguistic prosodies are examined by SLPs. Some aspects of prosody seem to be mastered better than others. While they are aware of the major prosodic difficulties in various pathologies and their negative impact, most SLPs in France rarely or never assess prosody. They feel more uncomfortable with it than with other speech-language domains and often do not consider it as a therapeutic target. Importantly, the perception of prosody as a therapeutic tool is associated with the frequency of assessing and addressing prosodic impairment. CONCLUSIONS Further studies should focus on identifying the factors that could improve practices and developing comprehensive assessment tools and evidence-based intervention methods in French. Providing better training in prosody and setting up more collaborations between SLPs and researchers in linguistics and psycholinguistics would be keys in developing this field.
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Affiliation(s)
- Aline Petitpain
- Department of Speech and Language Therapy, Faculty of Medicine, UFR3S, F-59000 Lille, France
| | - Juliette Brabant-Thery
- Department of Speech and Language Therapy, Faculty of Medicine, UFR3S, F-59000 Lille, France; Department of Neurology, Roger Salengro Hospital, CHU Lille, F-59000 Lille, France
| | - Cédric Patin
- Univ. Lille, CNRS, UMR 8163 - STL -Savoirs, Textes, Langage, F-59000 Lille, France
| | - Laurent Ott
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Anahita Basirat
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.
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