The Role of Blood Testing in Prevention, Diagnosis, and Management of Chronic Diseases: A Review

Blood tests are vital to prevention, diagnosis, and management of chronic diseases. Despite this, it can be challenging to construct a comprehensive view of the clinical importance of blood testing because relevant literature is typically fragmented across different disease areas and patient populations. This lack of collated evidence can also make it difficult for primary care providers to adhere to best practices for blood testing across different diseases and guidelines. Thus, this review article synthesizes the recommendations for, and importance of, blood testing across several common chronic conditions encountered in primary care and internal medicine, including cardiovascular diseases, diabetes mellitus, chronic kidney disease, vitamin D deficiency, iron deficiency, and rheumatoid arthritis. Future research is needed to continue improving chronic disease management through clearer dissemination and awareness of clinical guidelines among providers, and better access to blood testing for patients (e.g., via pre-visit laboratory testing).

Antibody drug conjugates in breast cancer in China: Highlights, challenges, and prospects

Antibody drug conjugates (ADCs) are novel drugs that exert specific cytotoxicity against tumor cells. China approved T-Dxd in May 2023, and their introduction has changed the nation's clinical practice. Although more than 700 ADCs are being investigated worldwide, the challenges that remain in antibody engineering, drug discovery, safety management, resistance, drug selection, and sequencing hinder the further promotion and application of ADCs. Experts in China have discussed the several critical concerns related to clinical practice since 2022. Here, the authors conducted a review of ADCs and then discussed several ADCs explored in China. This study proposes several solutions and strategies to maximize the potential benefit that ADCs can provide to patients with breast cancer.

A Palearctic view of a bat fungal disease

The fungal infection causing white-nose disease in hibernating bats in North America has resulted in dramatic population declines of affected species, since the introduction of the causative agent Pseudogymnoascus destructans. The fungus is native to the Palearctic, where it also infects several bat species, yet rarely causes severe pathology or the death of the host. Pseudogymnoascus destructans infects bats during hibernation by invading and digesting the skin tissue, resulting in the disruption of torpor patterns and consequent emaciation. Relations among pathogen, host, and environment are complex, and individuals, populations, and species respond to the fungal pathogen in different ways. For example, the Nearctic Myotis lucifugus responds to infection by mounting a robust immune response, leading to immunopathology often contributing to mortality. In contrast, the Palearctic M. myotis shows no significant immunological response to infection. This lack of a strong response, resulting from the long coevolution between the hosts and the pathogen in the pathogen's native range, likely contributes to survival in tolerant species. After more than 15 years since the initial introduction of the fungus to North America, some of the affected populations are showing signs of recovery, suggesting that the fungus, hosts, or both are undergoing processes that may eventually lead to coexistence. The suggested or implemented management methods of the disease in North America have encompassed, for example, the use of probiotics and fungicides, vaccinations, and modifying the environmental conditions of the hibernation sites to limit the growth of the pathogen, intensity of infection, or the hosts' responses to it. Based on current knowledge from Eurasia, policy makers and conservation managers should refrain from disrupting the ongoing evolutionary processes and adopt a holistic approach to managing the epizootic.

Hotspot sheep scab management: A community-based regional approach in England

BACKGROUND

Ovine psoroptic mange (sheep scab), caused by an infestation of the mite Psoroptes ovis, leads to clinical disease, economic loss and severely compromised animal welfare. Here, a community-based approach to the management of scab in three high-risk areas of England is described.

METHODS

For each of the 254 farms included in the study, an initial survey of their clinical sheep scab history was followed up by a blood test (ELISA) to detect the presence of antibodies to P. ovis. This facilitated the coordination of treatment across groups of farms in each region. Blood testing was then repeated at the end of the treatment programme.

RESULTS

On the first blood test in 2021/2022, 25.6% (±5.5%) of the flocks were positive for sheep scab. On the second test in 2022/2023, 9% (±3.94%) of the flocks tested were positive, showing a highly statistically significant reduction in prevalence overall, but with strong regional variation.

LIMITATIONS

generating an understanding of the flock-level nature of the blood test and confidence in its detection of scab where clinical signs were not apparent provided ongoing challenges.

CONCLUSIONS

The programme demonstrated that a focused community-based approach can be used to significantly reduce the prevalence of sheep scab in high-risk areas of England. The use of the blood test on all farms allowed the identification of subclinical sheep scab. The programme provides an effective model for sheep scab management on a national scale.

The Impact of mHealth-Based Continuous Care on Disease Knowledge, Treatment Compliance, and Serum Uric Acid Levels in Chinese Patients With Gout: Randomized Controlled Trial

Background

In patients with gout, suboptimal management refers to a lack of disease knowledge, low treatment compliance, and inadequate control of serum uric acid (SUA) levels. Several studies have shown that continuous care is recommended for disease management in patients with gout. However, in China, the continuous care model commonly used for patients with gout requires significant labor and time costs, and its efficiency and coverage remain low. Mobile health (mHealth) may be able to address these issues.

Objective

This study aimed to explore the impact of mHealth-based continuous care on improving gout knowledge and treatment compliance and reducing SUA levels.

Methods

This study was a single-center, single-blind, and parallel-group randomized controlled trial. Participants were recruited at the West China Hospital of Sichuan University in Chengdu, China, between February 2021 and July 2021 and were randomly assigned to the intervention and control groups. The intervention group received continuous care via an mHealth app, which includes modules for health records, 24 weeks of gout-related health education materials, and interactive support. The control group received routine continuous care, including face-to-face health education, paper-based health education materials consistent with the content for the intervention group, and telephone consultations initiated by the patient. Follow-up was conducted at 6 months. Participants' gout knowledge levels and treatment compliance were measured at baseline and the 12th and 24th weeks, and participants' SUA levels were measured at baseline and the 24th week. The intention-to-treat principle and a generalized estimating equation model were used to test the effect of the intervention.

Results

Overall, 258 potential participants underwent eligibility assessments, and 120 were recruited and randomized into the intervention (n=60, 50%) and control (n=60, 50%) groups. Of the 120 participants, 93 (77.5%) completed the 24-week study. The 2 groups had no significant differences in sociodemographic or clinical characteristics, and the baseline measurements were comparable (all P>.05). Compared with the control group, the intervention group exhibited a significant improvement in gout knowledge levels over time (β=0.617, 95% CI 0.104-1.129; P=.02 and β=1.300, 95% CI 0.669-1.931; P<.001 at the 12th and 24th weeks, respectively). There was no significant difference in treatment adherence between the 2 groups at the 12th week (β=1.667, 95% CI -3.283 to 6.617; P=.51), while a statistical difference was observed at the 24th week (β=6.287, 95% CI 1.357-11.216; P=.01). At the 24th week, SUA levels in both the intervention and control groups were below baseline, but there was no significant difference in SUA changes between the 2 groups (P=.43).

Conclusions

Continuous care based on the mHealth app improved knowledge levels and treatment compliance among patients with gout. We suggest incorporating this intervention modality into standard continuous care for patients with gout.

Development and implementation of a strategy for early diagnosis and management of scrub typhus: an emerging public health threat

Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging zoonotic disease in the tropics with considerable morbidity and mortality rates. This disease, which is mostly prevalent in rural areas, remains underdiagnosed and underreported because of the low index of suspicion and non-specific clinical presentation. Limited access to healthcare, diagnostics, and treatment in rural settings further makes it challenging to distinguish it from other febrile illnesses. While easily treatable, improper treatment leads to severe forms of the disease and even death. As there is no existing public health program to address scrub typhus in India, there is an urgent need to design a program and test its effectiveness for control and management of the disease. With this backdrop, this implementation research protocol has been developed for a trial in few of the endemic "pockets" of Odisha, an eastern Indian state that can be scalable to other endemic areas of the country, if found effective. The main goal of the proposed project is to include scrub typhus as a differential diagnosis of fever cases in every tier of the public health system, starting from the community level to the health system, for the early diagnosis among suspected cases and to ensure that individuals receive complete treatment. The current study aimed to describe the protocol of the proposed Scrub Typhus Control Program (STCP) in detail so that it can receive valuable views from peers which can further strengthen the attempt.

The Role of Telepharmacy in the Delivery of Clinical Pharmacy Services Following the COVID-19 Pandemic: A Descriptive Report

Background: Telepharmacy, which utilizes telecommunication technology to provide pharmaceutical care remotely, has gained significance in expanding access to pharmacists, particularly in areas with limited health care facility access. The COVID-19 pandemic, with its restrictions on in-person interactions, underscored the importance of telepharmacy in ensuring continuity of care. Objectives: The objective of this study was to determine the impact of telepharmacy on the delivery of clinical pharmacy services before and after the COVID-19 pandemic. Methods: This study explores the use of telepharmacy in delivering medication therapy management (MTM), chronic disease management (CDM), chronic opioid analgesic therapy (COAT), and transitions of care (TCM) visits. Data from electronic health records (EHRs) was collected to analyze the number referrals, number and type of visits, mode of visits, and locations served using correlations and descriptive statistics. Results: The findings indicate an increase in the number of referrals and visits following the pandemic, with a shift toward telepharmacy visits. The study highlights the convenience and accessibility provided by telepharmacy, resulting in improved patient access to clinical pharmacy services at 1 Midwest health system following the COVID-19 pandemic. Conclusions: The continued use of telepharmacy is important to ensure that patients, especially those in rural locations, have access to health care services and can be a positive factor in growing clinical pharmacy services.

Diagnosis and management of neuroendocrine prostate cancer

BACKGROUND

Although most patients with prostate cancer (PC) respond to initial androgen deprivation therapy (ADT), castration-resistant disease invariably develops. Progression to treatment-emergent neuroendocrine PC (t-NEPC) represents a unique mechanism of resistance to androgen receptor (AR)-targeted therapy in which lineage plasticity and neuroendocrine differentiation induce a phenotypic switch from an AR-driven adenocarcinoma to an AR-independent NEPC. t-NEPC is characterized by an aggressive clinical course, increased resistance to AR-targeted therapies, and a poor overall prognosis.

METHODS

This review provides an overview of our current knowledge of NEPC, with a focus on the unmet needs, diagnosis, and clinical management of t-NEPC.

RESULTS

Evidence extrapolated from the literature on small cell lung cancer or data from metastatic castration-resistant PC (mCRPC) cohorts enriched for t-NEPC suggests an increased sensitivity to platinum-based chemotherapy. However, optimal strategies for managing t-NEPC have not been established, and prospective clinical trial data are limited. Intertumoral heterogeneity within a given patient, as well as the lack of robust molecular or clinical biomarkers for early detection, often lead to delays in diagnosis and prolonged treatment with suboptimal strategies (i.e., conventional chemohormonal therapies for mCRPC), which may further contribute to poor outcomes.

CONCLUSIONS

Recent advances in genomic and molecular classification of NEPC and the development of novel biomarkers may facilitate an early diagnosis, help to identify promising therapeutic targets, and improve the selection of patients most likely to benefit from NEPC-targeted therapies.

Drug-Resistant Tuberculosis, Georgia, Kazakhstan, Kyrgyzstan, Moldova, and Ukraine, 2017-2022

In 2021, the World Health Organization recommended new extensively drug-resistant (XDR) and pre-XDR tuberculosis (TB) definitions. In a recent cohort of TB patients in Eastern Europe, we show that XDR TB as currently defined is associated with exceptionally poor treatment outcomes, considerably worse than for the former definition (31% vs. 54% treatment success).

Does anticoagulation in combination with immunosuppressive therapy prevent recurrent thrombosis in Behçet's disease?

Vascular involvement in Behçet's disease (BD) occurs in up to 50% of patients. The main mechanism of thrombosis is inflammation. Thus, immunosuppressants (IS) are the mainstay of therapy, and adding anticoagulation (AC) is controversial. In daily practice, we observed that patients who received AC in combination with IS experienced less recurrent thrombosis and decided to investigate our BD patients retrospectively. We hypothesized that adding AC to immunosuppressive therapy may lower the risk of recurrent thrombosis. Treatment at the time of first or recurrent thrombotic events was recorded. Events under the only IS and IS + AC treatments were compared. There were 40 patients (33 males). The most common types of first vascular events were deep vein thrombosis (77.5%) followed by pulmonary embolism (PE) (52.5%). One patient did not receive any treatment. Among the 39 patients, 32 received glucocorticoid and at least one of the azathioprine, or cyclophosphamide, anti-TNF, 5 received monotherapy with azathioprine, 1 received monotherapy with corticosteroid, and the remaining 1 received monotherapy with cyclophosphamide. In total, 22 patients (55%) experienced 27 recurrent venous thromboembolism (VTE) events. Two (7.4%) events while only on AC, 2 (7.4%) events while on AC + IS, and 15 (55.5%) events occurred while on only IS. Eight (19.6%) patients were not receiving any treatment during relapses. The recurrence rate was statistically significantly lower in the IS + AC treatment group compared to IS alone. In conclusion, IS are the mainstay of treatment for BD, and adding AC may help to lower the recurrence risk of thrombotic events.

Patient-Reported Burden of Severe Alopecia Areata: First Results from the Multinational Alopecia Areata Unmet Need Survey

Purpose

Alopecia areata (AA) is an autoimmune disease characterized by hair loss that has significant psychosocial implications. This study aims to describe the patient-reported burden of severe AA, coping mechanism and information needs using data from the multinational AA Patient Satisfaction and Unmet Need Survey.

Patients and Methods

Participants with current or previous ≥50% scalp hair loss (n = 747) were recruited from 11 countries and completed a web-based survey that assessed demographics, clinical characteristics, disease burden and psychosocial impact. Data were stratified according to sex, current age, disease duration and current severity of scalp hair loss.

Results

The mean (SD) age of participants was 43.8 (7.1) years, 55.3% were women, and 63.5% reported AA symptoms within 6 months of diagnosis. Most participants had black or brown hair (88.4%), reported a disease duration of 2 years or more (75.6%) and had current scalp hair loss of ≥50% (87.4%). Severe hair loss also extended to eyebrow (46.9%), eyelash (48.7), beard (61.5%) and body hair (73.2%). Participants commonly reported comorbidities such as anxiety (26.1%), depression (18.1%) and sleep problems (28.1%). The Dermatology Life Quality Index revealed a severe impact on quality of life; 86.2% of participants scored >10. Mental health/mood was significantly affected; 55.8% of participants reported a substantial impact. Long-term effects included decreased self-esteem (32.9%), poor mental health (28.1%) and challenges in day-to-day activities (27.2%). Information needs were centered around treatment expectations, mental health, and available treatment options. More severe symptoms and a greater daily impact were reported by women and those with a longer disease duration.

Conclusion

The study emphasizes the substantial burden, including impaired quality of life and psychological well-being, of severe AA on the lives of surveyed participants. The findings highlight the importance of comprehensive disease management strategies that address both physical and psychosocial aspects of AA.

An updated review on Guillain-Barré syndrome: Challenges in infection prevention and control in low- and middle-income countries

Guillain-Barré syndrome is a rare condition that can be potentially life-threatening. Guillain-Barré syndrome does not have a definitive etiological agent. It is a syndrome that can arise from multiple factors, including various infectious diseases and immunizations. The severity of Guillain-Barré syndrome is exacerbated by these variables, especially in low-income and middle-income countries where healthcare systems are already constrained and struggle to meet the demands of other diseases. The primary aim of our article is to comprehensively examine the life-threatening nature and intensity of Guillain-Barré syndrome by assessing its etiology, progression, and prevalence in low- and middle-income nations while also considering global trends. Furthermore, we proposed the implementation of standard and efficacious treatment and diagnostic resources that are readily accessible and successful in affluent nations and should also be readily accessible in impoverished nations without any unnecessary delay. Our study also emphasized the epidemiological data with molecular epidemiological analysis and the utilization of artificial technology in low- and middle-income nations. The goal was to decrease the incidence of Guillain-Barré syndrome cases and facilitate early detection.

Biosecurity adoption in Québec dairy farms: results from a risk assessment questionnaire analyzed using conventional and unsupervised artificial intelligence methods

This study documents the current state of biosecurity on dairy farms in Québec following the implementation of a mandatory biosecurity risk evaluation that was part of the proAction® accreditation program developed by Dairy Farmers of Canada. Using a cross-sectional design, 3,825 risk assessment questionnaires completed between 2018 and 2021 were extracted from Vigil-Vet database, which is a software utilized by veterinarians for conducting the proAction® risk assessment. Descriptive statistics were used to summarize the practices adopted by dairy producers. Additionally, multiple correspondence analysis was used to explore the association between the diseases of most concern and the adoption of biosecurity practices. Moreover, we used a hierarchical cluster analysis on principal components to identify distinct patterns of biosecurity practices among dairy producers. This analysis enabled the identification of typologies or clusters of farms based on the specific biosecurity practices they currently employ. The results of the descriptive statistics indicated that mastitis was the disease of most concern for most dairy farmers (40%). Moreover, given that only 10% of the 2,237 dairy farmers who acquired animals adhered to quarantine practices, there seems to be a need for improved implementation of biosecurity measures aimed at restricting the introduction of diseases when introducing new animals. Conversely, cleaning stalls and health equipment were adequately addressed by 95% and 86% of dairy producers, respectively. The multiple correspondence analysis indicated no significant association between the disease of most concern and the farm's biosecurity profile, except for respondents who identified digital dermatitis as their disease of most concern. Through the hierarchical cluster analysis, 3 clusters were identified among 3,581 farms: (1) Cluster 1 included farms with good management of sick animals; (2) Cluster 2 included farms with good management of young animals; and (3) Cluster 3 included farms with poor management of sick animals and young animals. Our study makes an important contribution by providing valuable insights into the biosecurity practices currently adopted on Québec dairy farms. It establishes a baseline for assessing progress in biosecurity practices adoption and serves as a reference point for future evaluations. In addition, these findings play a key role in monitoring the effectiveness of interventions aimed at improving biosecurity on dairy farms. By making use of this knowledge, stakeholders can make informed decisions that prioritize animal health, increase productivity, and ensure sustainability of the dairy industry.

Platelet index ratios in HIV: Emerging biomarkers for immune health and disease management

Human Immunodeficiency Virus (HIV) infection is a global health challenge that requires continuous advancements in diagnostic and prognostic tools. Traditional markers, such as CD4 cell counts and viral load, have played a crucial role in monitoring disease progression and guiding therapeutic interventions. However, emerging research suggests that platelet index ratios may serve as valuable biomarkers in assessing immune health and managing HIV-associated complications. This paper explores the significance of platelet index ratios, including platelet-to-lymphocyte ratio and mean platelet volume-to-lymphocyte ratio, as potential indicators of immune system status in individuals living with HIV. The interplay between platelets, lymphocytes, and their ratios reflects the dynamic nature of the immune response and inflammatory processes during HIV infection. Understanding the role of platelet index ratios in HIV could lead to the development of accessible and cost-effective biomarkers for monitoring immune health. Implementation of these ratios in routine clinical practice may enhance the precision of disease prognosis and guide personalized treatment strategies. Additionally, the exploration of platelet index ratios may pave the way for innovative therapeutic interventions aimed at modulating immune responses in HIV-infected individuals. In conclusion, platelet index ratios represent promising emerging biomarkers for evaluating immune health and managing HIV-related complications. Further research and clinical validation are warranted to establish the utility of these ratios in routine HIV care, potentially revolutionizing the approach to monitoring and improving the health outcomes of individuals living with HIV.

Patient-Centered Chronic Wound Care Mobile Apps: Systematic Identification, Analysis, and Assessment

Background

The prevalence of chronic wounds is predicted to increase within the aging populations in industrialized countries. Patients experience significant distress due to pain, wound secretions, and the resulting immobilization. As the number of wounds continues to rise, their adequate care becomes increasingly costly in terms of health care resources worldwide. eHealth support systems are being increasingly integrated into patient care. However, to date, no systematic analysis of such apps for chronic wounds has been published.

Objective

The aims of this study were to systematically identify and subjectively assess publicly available German- or English-language mobile apps for patients with chronic wounds, with quality assessments performed by both patients and physicians.

Methods

Two reviewers independently conducted a systematic search and assessment of German- or English-language mobile apps for patients with chronic wounds that were available in the Google Play Store and Apple App Store from April 2022 to May 2022. In total, 3 apps met the inclusion and exclusion criteria and were reviewed independently by 10 physicians using the German Mobile App Rating Scale (MARS) and the System Usability Scale (SUS). The app with the highest mean MARS score was subsequently reviewed by 11 patients with chronic wounds using the German user version of the MARS (uMARS) and the SUS. Additionally, Affinity for Technology Interaction (ATI) scale scores were collected from both patients and physicians.

Results

This study assessed mobile apps for patients with chronic wounds that were selected from a pool of 118 identified apps. Of the 73 apps available in both app stores, 10 were patient oriented. After excluding apps with advertisements or costs, 3 apps were evaluated by 10 physicians. Mean MARS scores ranged from 2.64 (SD 0.65) to 3.88 (SD 0.65) out of 5, and mean SUS scores ranged from 50.75 (SD 27) to 80.5 (SD 17.7) out of 100. WUND APP received the highest mean MARS score (mean 3.88, SD 0.65 out of 5) among physicians. Hence, it was subsequently assessed by 11 patients and achieved a similar rating (uMARS score: mean 3.89, SD 0.4 out of 5). Technical affinity, as measured with the ATI scale, was slightly lower in patients (score: mean 3.62, SD 1.35 out of 6) compared to physicians (score: mean 3.88, SD 1.03 out 6).

Conclusions

The quality ratings from physicians and patients were comparable and indicated mediocre app quality. Technical affinity, as assessed by using the ATI scale, was slightly lower for patients. Adequate apps for patients with chronic wounds remain limited, emphasizing the need for improved app development to meet patient needs. The ATI scale proved valuable for assessing technical affinity among different user groups.

Investigation of symptom management and functional state of women who underwent breast cancer surgery

OBJECTIVE

The aim of this study was to investigate the symptom management and the functional status of women who underwent surgery for breast cancer.

METHODS

This cross-sectional descriptive study was conducted in a university hospital surgical oncology clinic. This study was conducted on 80 patients who had undergone breast cancer surgery in the last 5 years in a surgical oncology clinic of a university hospital. Study data were collected using the patient identification form, Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer, and Functional Living Index-Cancer. The data were analyzed with the SPSS program.

RESULTS

The mean total score of Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer was found to be 157.28±36.86, and the mean total score of the Functional Living Index-Cancer was found to be 103.79±18.77. When the correlation between the Functional Living Index-Cancer and Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer scales used in the study was examined, it was determined that there was a positive statistically significant correlation (p<0.05) between the subscale and scale total scores.

CONCLUSION

As a result of the study, it was determined that the self-efficacy and functional status of the patients were poor. Their functional status was also determined to be improved as the symptom self-efficacy levels increased.

Coronavirus disease 2019 pandemic telephone two-week-wait referrals in head and neck cancer - how safe were they?

OBJECTIVE

During the coronavirus disease 2019 pandemic, ENT-UK recommended a move from face-to-face clinics to telephone appointments. This study reviewed the safety of telephone clinics for urgent two-week-wait cancer referrals.

METHODS

Patients consulted in telephone clinics between April and November 2020 were identified from an electronic database. Study patients included those diagnosed with malignant disease at six months. The Head and Neck Cancer Risk Calculator version 2 score, outcome of the initial clinic and final diagnoses were reviewed.

RESULTS

A total of 1062 patients were triaged in clinic; 9.2 per cent (n = 98) were diagnosed with cancer at 6 months. Of these 98 patients, 69 received an urgent face-to-face appointment, 26 underwent urgent scans and 3 had a delayed telephone review. Twenty patients (20.4 per cent) diagnosed with cancer had a low-risk Head and Neck Cancer Risk Calculator score.

CONCLUSION

The late diagnosis rate of 0.28 per cent suggests a small proportion of cancer could have been missed. Telephone clinics, whilst a pragmatic means to maintain patient flow during the pandemic, could result in late diagnoses.

Development and Testing of the Foot Care Scale for Older Japanese Diabetic Patients

We aimed to develop and test the reliability and validity of a foot care self-management assessment tool for older Japanese patients with diabetes. In this cross-sectional observational study, which was carried out according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, additional items were developed and selected to reflect older Japanese patients' needs a thorough investigation with experts in diabetes and geriatrics. A total of 200 older patients with diabetes in a foot care outpatient clinic were included in the study to finalize the scale items and verify the scale's reliability and validity. A factor analysis yielded a 4-factor, 9-item scale. Factors 1 to 4 were "skin condition" (3 items), "nail clipping" (2 items), "attention to wounds" (2 items), and "relationships with others" (2 items). The Cronbach's α coefficients for the 4 factors were .852, .900, .820, and .571, respectively. The overall scale was 0.797, indicating good internal consistency. Spearman's correlation coefficients for each of the 4 factors with the scale's total score showed good stability; all correlations were significant. In Japan's super-aged society, it is important to focus on foot care practices among older adults and to promote good foot care practices among early older adults so that they can practice self-care at home. Therefore, a scale for comprehensively evaluating foot care in elderly patients with diabetes is needed. The Foot Care Scale for Older Diabetics could be useful as a tool for assessing the ability to self-manage foot care in older Japanese patients with diabetes.

Biocontrol Agents of Fusarium Head Blight in Wheat: A Meta-Analytic Approach to Elucidate Their Strengths and Weaknesses

The use of biocontrol agents (BCAs) coping with fungal pathogens causing Fusarium head blight (FHB) is a compelling strategy for disease management, but a better elucidation of their effectiveness is crucial. Meta-analysis is the analysis of the results of multiple studies, which is typically performed to synthesize evidence from many possible sources in a formal probabilistic manner. This meta-analytic study, including 30 pathometric, biometric, physiochemical, genetic, and mycotoxin response variables reported in 56 studies, evidences the BCA effects on FHB in wheat. The effectiveness of BCAs of FHB in wheat in terms of pathogen abundance and disease reductions, biomass and yield conservation, and mycotoxin prevention/control was confirmed. BCAs showed higher efficacy (i) in studies published more recently; (ii) under controlled conditions; (iii) in high susceptible wheat cultivars; (iv) when Fusarium inoculation and BCA treatment did not occur directly on the plant (i.e., at the seed and kernel levels) in terms of disease development and mycotoxin control, and vice versa in terms of biomass conservation; (v) if Fusarium inoculation and BCA treatment occurred by spraying spikes in terms of yield; (vi) at 15 to 21 days post Fusarium inoculation or BCA treatment; and (vii) if they were filamentous fungi. However, BCAs overall were less efficacious than conventional agrochemicals, especially in terms of pathogen abundance and FHB reductions, as well as of mycotoxin prevention/control, although inconsistencies were reported among the investigated moderator variables. This study also highlights the complexity of reaching a good balance among BCA effects, and the need for further research.

Cluster Zone Leaf Removal Reduces the Rate of Anthracnose (Elsinöe ampelina) Progress and Facilitates Its Control

Anthracnose caused by Elsinöe ampelina is an economically important disease that affects certain hardy and semihardy grapevine cultivars. The control of this disease requires repeated application of fungicides, which has financial and environmental consequences. In this study, leaf removal in the cluster area was studied with a view to facilitating integrated anthracnose management. First, the effect of leaf removal timing (BBCH stage 53 or 71) and intensity (one or both sides of rows) on the progression of anthracnose and on the microclimate was studied in plots planted with Vidal blanc (Vitis vinifera) at two sites in both 2020 and 2021. Overall, at both sites and in both years, anthracnose on leaves was more severe in plots without cluster zone leaf removal. Regardless of the timing of leaf removal, anthracnose severity on leaves and incidence of infected berries at harvest were significantly lower in plots where leaves had been removed on both sides of the rows compared with plots where leaves were removed on one side only. Second, anthracnose management programs with leaf removal, with or without disease risk estimation, were evaluated. All anthracnose management programs including leaf removal in the cluster zone reduced anthracnose development compared with the standard program without leaf removal. Overall mean leaf anthracnose severity, severity at harvest, and anthracnose incidence on clusters at harvest were lower in plots with leaf removal than in the standard program, but the differences between the two treatments were not significant (P > 0.05). More fungicide applications were made in plots managed using the standard programs, specifically 13 applications, compared with plots managed based on assessing the weather-related risk of anthracnose, with 9 and 10 applications made at sites 1 and 2 for the risk-based program, respectively, and 5 and 7 applications made at sites 1 and 2, respectively, when microclimate within the cluster zone was considered. The results of this study clearly show the important role that leaf removal can play in managing grape anthracnose.

Digital health integration for noncommunicable diseases: Comprehensive process mapping for full-life-cycle management

AIM

To create a systematic digital health process mapping framework for full-life-cycle noncommunicable disease management grounded in key stakeholder engagement.

METHODS

A triphasic, qualitative methodology was employed to construct a process mapping framework for digital noncommunicable disease management in Shanghai, China. The first phase involved desk research to examine current guidance and practices. In the second phase, pivotal stakeholders participated in focus group discussions to identify prevalent digital touchpoints across lifetime noncommunicable disease management. In the final phase, the Delphi technique was used to refine the framework based on expert insights and obtain consensus.

RESULTS

We identified 60 digital touchpoints across five essential stages of full-life-cycle noncommunicable disease management. Most experts acknowledged the rationality and feasibility of these touchpoints.

CONCLUSIONS

This study led to the creation of a comprehensive digital health process mapping framework that encompasses the entire life cycle of noncommunicable disease management. The insights gained emphasize the importance of a systemic strategic, person-centered approach over a fragmented, purely technocentric approach. We recommend that healthcare professionals use this framework as a linchpin for efficient disease management and seamless technology incorporation in clinical practice.

Barriers and Facilitators Impacting Disease and Symptom Management Among College Students With Type 1 Diabetes: A Qualitative Study

PURPOSE

This study aimed to explore barriers and facilitators impacting disease and symptom management among college students living with Type 1 Diabetes (T1D).

DESIGN

A qualitative, phenomenological approach using semi-structured, one-on-one interviews.

SETTING

Interviews conducted on Zoom (n = 28) and in-person (n = 3).

PARTICIPANTS

Purposive sample of 31 college students living with T1D for at least 2 years who attended large, 4-year public universities in the Southeastern United States.

METHOD

This study was theoretically informed using the Middle-Range Theory of Self-Care of Chronic Illness Integration of Symptoms to develop interview questions. Interviews were transcribed verbatim and uploaded in NVivo. Data were analyzed thematically using a codebook developed by the research team using the theory as a framework. Trustworthiness was established using an audit trail, memos, and negative case analysis.

RESULTS

Four themes described barriers: diabetes burnout, challenges adjusting to a college lifestyle, difficulty receiving medical supplies, and insurance limitations. Five themes explained facilitators: years of experience managing T1D, tangible support with medical supplies, informational support for disease management, and emotional/technological support for disease and symptom management.

CONCLUSION

Barriers and facilitators in this study should be addressed in future T1D interventions for college students. Findings can also guide healthcare professionals, health promotion practitioners, family, friends, and significant others on how to better support college students as they manage T1D.

Implications of climatic change on sickle cell anemia: A review

Sickle cell anemia (SCA) is a hereditary blood disorder characterized by abnormal hemoglobin, causing red blood cells to assume a sickle shape, leading to various complications. Climate change has emerged as a significant global challenge, influencing environmental conditions worldwide. This paper explores the implications of climatic variations on the prevalence, management, and outcomes of SCA. Climate change affects weather patterns, leading to altered temperatures, increased frequency of extreme weather events, and variations in humidity levels. These changes can have a profound impact on individuals living with SCA. High temperatures exacerbate the symptoms of SCA, potentially triggering painful vaso-occlusive crises due to dehydration and increased blood viscosity. Conversely, cold temperatures may induce vaso-occlusion by causing blood vessels to constrict. Changes in rainfall patterns might also affect water accessibility, which is crucial for maintaining adequate hydration, particularly in regions prone to droughts. The management of SCA is multifaceted, involving regular medical care, hydration, and avoiding triggers that could precipitate a crisis. Adverse weather events and natural disasters can disrupt healthcare infrastructure and access to essential medications and resources for SCA patients, especially in vulnerable communities. To mitigate the implications of climatic change on SCA, interdisciplinary strategies are essential. These strategies may include enhancing healthcare systems' resilience to climate-related disruptions, implementing adaptive measures to address changing environmental conditions, and promoting public awareness and education on managing SCA amidst climate variability. In conclusion, climatic variations pose significant challenges for individuals with SCA, affecting the prevalence, management, and outcomes of the disease.

Investigation of the Impact of Wellinks on the Quality of Life and Clinical Outcomes in Patients With Chronic Obstructive Pulmonary Disease: Interventional Research Study

BACKGROUND

Wellinks is a remote disease management solution that provides novel chronic obstructive pulmonary disease (COPD) care delivery.

OBJECTIVE

This study evaluated the satisfaction, engagement, and clinical outcomes of Wellinks participants. This study also investigated the cadence of health coaching for patients with COPD.

METHODS

A 24-week interventional study was conducted by Wellinks and the COPD Foundation in 2022. Adults with COPD were recruited by the COPD Foundation in the United States and determined to be eligible if they had phone and internet access, owned a smartphone, and were not currently participating in pulmonary rehabilitation. All study participants provided written informed consent. The Wellinks solution included remote health coaching, pulmonary rehabilitation, and group education; participants were provided the Wellinks app and smart spirometry and pulse oximetry devices. Participants were offered 6 coaching sessions in the first 12 weeks. For the second 12-week period, participants either reduced frequency or discontinued coaching; all other components of the Wellinks solution remained unchanged. The COPD Self-Efficacy Scale, Modified Medical Research Council dyspnea scale, pulmonary function, pulse oximetry, and patient-reported healthcare resource utilization were the clinical outcome measures. Nonclinical outcomes included engagement and satisfaction with Wellinks and net promoter score.

RESULTS

In total, 141 adults consented and completed Wellinks onboarding; 84.4% (n=119) of whom remained engaged throughout the 24-week study. Participants had a mean age of 70 (SD 7.8; range 48-88) years, and 55.7% (n=78) were female. Most participants (n=119, 84.4%) completed all 6 coaching sessions during the first 12-week period. Compliance with spirometer and pulse oximeter use was 82.3% and 89.4%, respectively, at week 1 but waned over the study period to 8.5% and 9.2%, respectively, at the end of the study. Participants indicated a high degree of satisfaction with Wellinks, with 95.5% (n=85) and 91% (n=81) of participants indicating that they agreed or strongly agreed that the educational content and health coaching, respectively, were valuable. At the end of the study, the net promoter score was +64 and +55 in the coaching continuation and discontinuation arms, respectively. A significant improvement from baseline to end of the study was observed in the COPD Self-Efficacy Scale total score (P<.001) and domain scores (P<.001 for each domain). In total, 35.1% (n=27) of participants improved by at least 1 category of change on the 5-point Modified Medical Research Council dyspnea scale from baseline to week 24.

CONCLUSIONS

This study confirmed the feasibility of using a remote model of care delivery to support people living with COPD. The insights gained in this study have allowed for further refinement and personalization of the Wellinks care model. Findings related to the combined use of technology and personal care delivery should be considered by others developing remote disease management tools.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05259280; https://clinicaltrials.gov/ct2/show/NCT05259280.

Effect of a multidisciplinary team approach on the management of diabetic foot ulcers on the Central Coast: A review of the Gosford Hospital High-Risk Foot Clinic

This retrospective cohort study aims to assess whether the implementation of a multidisciplinary approach in the Gosford Hospital High-Risk Foot Clinic improved outcomes of diabetic foot ulcers. Ulceration is a common foot complication of diabetes mellitus and greatly increases patient morbidity and mortality. Patients who attended at least one appointment at the Gosford Hospital High-Risk Foot Clinic in 2017 or 2019 were identified through the Gosford Hospital Podiatry department's records. The 2017 and 2019 cohorts were compared on measures of ulcer healing, incidence of amputation, incidence of vascular intervention and surgical debridement, percentage of patients admitted to hospital due to complications and use of systemic antibiotic therapy. Sixty-one patients in 2017 and 59 patients in 2019 met inclusion criteria, and from them, 207 ulcers were included. Between 2017 and 2019, there was a 6.2-week reduction in time to 100% ulcer healing in 2019 (p = 0.021), and 10.1% more ulcers healed within 52 weeks (p = 0.22, 95% confidence interval [CI] [-5.9%, 25.5%]). Whilst there was no significant difference in incidence of patients receiving amputation, there was an increased absolute number of amputations in 2019. Implementation of a multidisciplinary approach at the Gosford Hospital High-Risk Foot Clinic led to improvements in diabetic foot ulcer healing.

Evaluation of Lead-In Direct Oral Anticoagulant Prescribing Practices in Newly Diagnosed Venous Thromboembolism

Various lead-in dosing strategies have been used in clinical practice for venous thromboembolism (VTE), and guidelines do not currently address if the full lead-in dosing duration is necessary after receiving parenteral anticoagulation. This study aims to identify whether full lead-in dosing duration surrounding parenteral anticoagulation affects thrombotic and bleeding outcomes. A single-center, retrospective cohort study was conducted of hospitalized patients diagnosed with VTE and treated with apixaban or rivaroxaban. Patients were grouped depending on duration of lead-in dosing, with the full lead-in dosing group considered as the appropriate duration of the direct oral anticoagulant. The primary outcome was the recurrence of VTE within the index admission to 6 months. Secondary outcomes included major bleeding, clinically relevant minor bleeding, and mortality. Ninety-three patients were prescribed full lead-in dosing, while 99 patients received reduced lead-in dosing. The primary outcome of recurrent VTE was similar between the reduced lead-in group compared to the full lead-in group (3% vs 2%; P = 1.0). Major bleeding within the index admission was significantly higher in the reduced lead-in group: 11 versus 2 (P = .02). There were no significant differences in other secondary outcomes. Full lead-in dosing compared to reduced lead-in dosing duration for VTE had similar rates of thrombotic and mortality events. The higher rate of major bleeding in the reduced lead-in dosing group likely reflects the prescribing practices in less stable patients. This study provides evidence to support reduced lead-in dosing duration in high-risk patients without compromising efficacy outcomes.

Characterizing the Dynamics of Virulence and Fungicide Resistance of Phytophthora capsici in Michigan Vegetable Fields Reveals Loci Associated with Virulence

The oomycete Phytophthora capsici is a destructive pathogen infecting more than 50 plant species and is one of the most serious threats to cucurbit production. Phytophthora blight caused by Phytophthora capsici can affect all plant growth stages, and fungicides and cultural controls are used to limit losses. Dissecting pathogen virulence and fungicide resistance can provide insights into pathogenic mechanisms and inform effective management practices to control P. capsici. In this study, we assessed virulence, mefenoxam sensitivity, and genetic diversity of nine P. capsici populations collected from Cucurbitaceae, Solanaceae, and Fabaceae host families in Michigan from 2002 to 2016. We developed 992 simple sequence repeats (SSRs) in the P. capsici genome and identified 60 SSRs located within or close to RXLR-class (Arginine-any amino acid-Leucine-Arginine) effectors and 29 SSRs within or close to effector CRN (CRinkling and Necrosis) family protein, which represent 62 RXLR and 34 putative CRNs. Population structure analysis shows that mefenoxam resistance was not associated with the year of collection, host type, or location, but there were significant differences in virulence among the populations. Using the general linear model and mixed linear model-based association analyses with all effector-related SSR markers, we identified four SSR markers significantly associated with at least one of the virulence-related parameters. Of these, one (Pce_SC18) was in a predicted CRN effector and had high identity with the putative PhCRN37 effector in the pathogen Plasmopara halstedii, which can be further verified for virulence identification in P. capsici.

Investigations into Economic Returns Resulting from Foliar Fungicides and Application Timing on Management of Tar Spot in Indiana Hybrid Corn

Tar spot, caused by Phyllachora maydis, is the most significant yield-limiting disease of corn (Zea mays L.) in Indiana. Currently, fungicides are an effective management tool for this disease, and partial returns from their use under different disease severity conditions has not previously been studied. Between 2019 and 2021, two separate field experiments were conducted in each year in Indiana to assess the efficacy of nine foliar fungicide products and nine fungicide application timings based on corn growth stages on tar spot symptoms and stromata, canopy greenness, yield, and influence on partial returns. All fungicides evaluated significantly suppressed tar spot development in the canopy and increased canopy greenness over the nontreated control. Additionally, applications of mefentrifluconazole + pyraclostrobin, metconazole + pyraclostrobin, cyproconazole + picoxystrobin at tassel, and propiconazole + benzovindiflupyr + azoxystrobin between the tassel and dough growth stages were the most effective at significantly reducing disease severity, increasing canopy greenness, protecting yield, and offered the greatest partial return. Fungicide products varied in their ability to protect yield under low and high disease severity conditions relative to the nontreated control. Consistently, positive yield increases were observed when disease severity was high, which translated to greater profitability relative to low severity conditions. On average, the yield increases across foliar fungicide products and timed application treatments were 544.6 and 1,020.7 kg/ha greater, and partial returns using a grain value of $0.17/kg were $92.6/ha and $173.5/ha greater, respectively, when high severity conditions occurred. This research demonstrates that foliar fungicides and appropriately timed fungicide applications can profitably be used to manage tar spot in Indiana under high disease severity conditions.

Development of a Standardized Soybean Cyst Nematode Screening Assay in Pennycress and Identification of Resistant Germplasm

The prospect of incorporating pennycress as an oilseed cover crop in the Midwest's corn-soybean rotation system has drawn researcher and farmer attention. The inclusion of pennycress will be beneficial as it provides an excellent soil cover to reduce soil erosion and nutrient leaching while serving as an additional source for oilseed production and income. However, pennycress is an alternative host for soybean cyst nematode (SCN), which is a major biological threat to soybean that needs to be addressed for sustainable pennycress adoption into our current production systems. To develop a standardized SCN resistance screening strategy in pennycress, we tested and optimized five parameters: (i) germination stimulants, (ii) inoculation timing, (iii) inoculation rate, (iv) experimental incubation time, and (v) susceptible checks. The standardized SCN resistance screening protocol includes the following: (i) treating pennycress seeds with gibberellic acid for 24 h, (ii) transplanting seedlings 12 to 15 days after initiating germination and inoculating 10 to 12 days after transplantation, (iii) inoculating at a rate of 1,500 eggs/100 cc soil (1,500 eggs per plant), (iv) processing roots at 30 days after inoculation, and (v) using susceptible pennycress accession Ames 32869 to calculate the female index. The standardized protocol was used to quantify the response of a diverse set of pennycress accessions for response against SCN HG type 1.2.5.7 and HG type 7. While there were no highly resistant pennycress lines identified, 15 were rated as moderately resistant to HG type 1.2.5.7, and eight were rated moderately resistant to HG type 7. The resistant lines identified in this study could be utilized to develop SCN-resistant pennycress cultivars. The study also opens a new avenue for research to understand SCN-pennycress interactions through molecular and genomic studies. This knowledge could aid in the successful inclusion of pennycress as a beneficial cover/oilseed crop in the United States Midwest.[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

Harnessing the Biocontrol Potential of Bradyrhizobium japonicum FCBP-SB-406 to Manage Charcoal Rot of Soybean with Increased Yield Response for the Development of Sustainable Agriculture

Plant growth-promoting bacteria (PGPRs) have the potential to act as biofertilizers and biopesticides. This study was planned to explore indigenously isolated PGPRs as a potential candidate to control charcoal rot that affects various crops including soybean. Among the four different tested species of PGPRs, Bradyrhizobium japonicum (FCBP-SB-406) showed significant potential to enhance growth and control soil borne pathogens such as Macrophomina phaseolina. Bacillus subtilis (FCBP-SB-324) followed next. Bradyrhizobium japonicum (FCBP-SB-406) reduced disease severity up to 81.25% in comparison to the control. The strain showed a strong fertilizing effect as a highly significant increase in biomass and other agronomic parameters was recorded in plants grown in its presence. The same was supported by the Pearson's correlation and principal component analysis. A decrease in disease incidence and severity may be due to the induced resistance imparted by the bacterium. This resulted in significant increments in quantities of defense enzymes, including catalase, peroxidase (PO), polyphenol oxidase (PPO), phenylalanine ammonia lyase (PAL) and superoxide dismutase (SOD). A significant production of proteases, catalases and hydrogen cyanide by B. japonicum (FCBP-SB-406) can also be associated to mycoparasitism. The establishment of PGPRs in treated soils also showed positive effects on soil health. Total metabolite profiling of treated plants in comparison to the control showed the upregulation of many flavonoids, isoflavonoids and amino acids. Many of these compounds have been well reported with antimicrobial activities. Bradyrhizobium japonicum (FCBP-SB-406) can be employed for the production of a potential formulation to support sustainable agriculture by reducing the input of synthetic pesticides and fertilizers.

A Nationwide Chronic Disease Management Solution via Clinical Decision Support Services: Software Development and Real-Life Implementation Report

BACKGROUND

The increasing population of older adults has led to a rise in the demand for health care services, with chronic diseases being a major burden. Person-centered integrated care is required to address these challenges; hence, the Turkish Ministry of Health has initiated strategies to implement an integrated health care model for chronic disease management. We aim to present the design, development, nationwide implementation, and initial performance results of the national Disease Management Platform (DMP).

OBJECTIVE

This paper's objective is to present the design decisions taken and technical solutions provided to ensure successful nationwide implementation by addressing several challenges, including interoperability with existing IT systems, integration with clinical workflow, enabling transition of care, ease of use by health care professionals, scalability, high performance, and adaptability.

METHODS

The DMP is implemented as an integrated care solution that heavily uses clinical decision support services to coordinate effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines and, hence, to increase the quality of health care delivery. The DMP is designed and implemented to be easily integrated with the existing regional and national health IT systems via conformance to international health IT standards, such as Health Level Seven Fast Healthcare Interoperability Resources. A repeatable cocreation strategy has been used to design and develop new disease modules to ensure extensibility while ensuring ease of use and seamless integration into the regular clinical workflow during patient encounters. The DMP is horizontally scalable in case of high load to ensure high performance.

RESULTS

As of September 2023, the DMP has been used by 25,568 health professionals to perform 73,715,269 encounters for 16,058,904 unique citizens. It has been used to screen and monitor chronic diseases such as obesity, cardiovascular risk, diabetes, and hypertension, resulting in the diagnosis of 3,545,573 patients with obesity, 534,423 patients with high cardiovascular risk, 490,346 patients with diabetes, and 144,768 patients with hypertension.

CONCLUSIONS

It has been demonstrated that the platform can scale horizontally and efficiently provides services to thousands of family medicine practitioners without performance problems. The system seamlessly interoperates with existing health IT solutions and runs as a part of the clinical workflow of physicians at the point of care. By automatically accessing and processing patient data from various sources to provide personalized care plan guidance, it maximizes the effect of evidence-based decision support services by seamless integration with point-of-care electronic health record systems. As the system is built on international code systems and standards, adaptation and deployment to additional regional and national settings become easily possible. The nationwide DMP as an integrated care solution has been operational since January 2020, coordinating effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines.

The current situation of hereditary angioedema patients in Germany: results of an online survey

Introduction

Hereditary angioedema (HAE) is a rare hereditary disease with an estimated prevalence of approximately 1 in 50,000.

Methods

An online survey was performed between January and June 2021 on a total of 99 HAE patients (with 92 of them aged 15 years and older and 7 of them being parents of patients under the age of 15 years). They were asked about their current situation, with a focus on the disease.

Results

The survey results show that HAE has a strong influence on the patients' quality of life. In particular, the anxiety and uncertainty of not knowing when a swelling attack will occur is considered burdensome by the patients. In addition, there can be physical problems during an attack (depending on its severity) that severely burden and limit patients in their everyday lives. Only one-third of the patients surveyed stated that no or only very minor physical limitations occurred during their most recent swelling attack. Almost three-quarters of all patients receive regular treatment at an HAE center. The patients are mostly satisfied with the therapy and particularly with long-term prophylactics (LTPs). When an LTP was used, the frequency and severity of the swelling attacks, and their duration, were significantly lower and/or shorter than when no LTP was used.

Discussion

Despite the high level of satisfaction with their current medication, 62% of patients expressed a strong/very strong interest in an oral LTP. In the group of patients already using an LTP, 74% reported a strong/very strong interest in an oral medication for long-term prophylaxis. The simplicity and minimal time involved in LTP use are considered beneficial to patients' quality of life.

The Role of Systemic Family Psychotherapy in Glycemic Control for Children with Type 1 Diabetes

(1) Background: Family factors play an important role in the management of diabetes, establishing a relationship between conflicts and non-adherence to therapy. High values of HbA1c are involved in specific complications of the disease (retinopathy, nephropathy, neuropathy, ketoacidosis). This study aimed to determine the role of systemic family psychotherapeutic interventions in increasing the quality of parent-child/adolescent relationships and in optimizing the child's glycemic control. (2) Methods: In this prospective observational study, 64 parents of children and adolescents with type 1 diabetes were evaluated regarding their relationship with their children, using the Child-Parent Relationship Scale-Short Form (CPRS-short form). The children were divided into three groups: one participated for 6 months in systemic family psychotherapy with children and their parents (FT), the second group participated in individual psychotherapy (IT), and the control group (CG) received no intervention. HbA1c values were recorded before and after the interventions. (3) Results: HbA1c means decreased significantly after the family psychotherapy program. The scores on closeness in the family therapy group increased significantly, and the scores on conflict decreased significantly after the intervention, compared with IT and CG. (4) Conclusions: Systemic family psychotherapy produces better results in disease management and in strengthening parent-child relationships.

Evaluation of nurse practitioners' roles and competencies among rheumatology nurses: Results of a national survey

To investigate nurse practitioners' roles and competencies among rheumatology nurses in China, an online, cross-sectional survey was conducted between July 7 and 14, 2020 among the national cooperation group of nursing experts on management of rheumatic and immune diseases. A total of 796 valid questionnaires were returned and participants' mean total scores on the Nurse Practitioners' Roles and Competencies Scale (NPRCS) was 2.51 (SD = 0.55), indicating a medium level. Medical assistance, leadership reform, and clinical research had low scores in the six dimensions of the NPRCS. Nurse practitioners' roles and competencies in the area of rheumatology require improvement. Training should focus on medical assistance, leadership reform, and clinical research. The current study can provide a reference for an improved training framework of nursing practitioners in the rheumatology field.

Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease

Historically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference.

Updates in the Management of Congenital Melanocytic Nevi

Congenital melanocytic nevi (CMN) carry an increased risk of melanoma and may be disfiguring, and consensus regarding treatment recommendations is lacking. While clinical monitoring is the standard of care, many caregivers are interested in its removal to prevent psychosocial burden or to decrease risk. Although melanoma can occur regardless of CMN removal, there are a variety of treatments that may offer improved cosmesis or local symptom control, including surgical excision, laser therapy, and other superficially destructive techniques. Regardless of the selected management, these patients are monitored for ongoing melanoma risk. An extensive discussion with families regarding the risks and benefits of observation versus active intervention is essential. To facilitate these discussions, we herein summarize current CMN management strategies and considerations.

Healthcare resource utilization, costs and treatment associated with myasthenia gravis exacerbations among patients with myasthenia gravis in the USA: a retrospective analysis of claims data

Aim: There are limited data on the clinical and economic burden of exacerbations in patients with myasthenia gravis (MG). We assessed patient clinical characteristics, treatments and healthcare resource utilization (HCRU) associated with MG exacerbation. Patients & methods: This was a retrospective analysis of adult patients with MG identified by commercial, Medicare or Medicaid insurance claims from the IBM® MarketScan® database. Eligible patients had two or more MG diagnosis codes, without evidence of exacerbation or crisis in the baseline period (12 months prior to index [first eligible MG diagnosis]). Clinical characteristics were evaluated at baseline and 12 weeks before each exacerbation. Number of exacerbations, MG treatments and HCRU costs associated with exacerbation were described during a 2-year follow-up period. Results: Among 9352 prevalent MG patients, 34.4% (n = 3218) experienced ≥1 exacerbation after index: commercial, 53.0% (n = 1706); Medicare, 39.4% (n = 1269); and Medicaid, 7.6% (n = 243). During follow-up, the mean (standard deviation) number of exacerbations per commercial and Medicare patient was 3.7 (7.0) and 2.7 (4.1), respectively. At least two exacerbations were experienced by approximately half of commercial and Medicare patients with ≥1 exacerbation. Mean total MG-related healthcare costs per exacerbation ranged from $26,078 to $51,120, and from $19,903 to $49,967 for commercial and Medicare patients, respectively. AChEI use decreased in patients with multiple exacerbations, while intravenous immunoglobulin use increased with multiple exacerbations. Conclusion: Despite utilization of current treatments for MG, MG exacerbations are associated with a high clinical and economic burden in both commercial and Medicare patients. Additional treatment options and improved disease management may help to reduce exacerbations and disease burden.

Social and health care top managers' perceptions and aims of strategic work ability management in the midst of change

BACKGROUND

Existing research has mostly focused on themes related to returning to or staying at work and studied organizations' operational rather than strategic level actions to support work ability. Top managers' understanding of work ability management (WAM) may influence how work ability support processes are implemented in organizations.

OBJECTIVE

To find out how top managers define WAM, what the aims of WAM were and whether the aims were on a strategic level.

METHODS

Altogether 28 semi-structured interviews among Finnish social and health care top managers were conducted during the years 2019-2021 and analyzed inductively using qualitative thematic analysis.

RESULTS

Top managers' definition of WAM was mainly multidimensional. Two main aims were identified, i.e., to support work ability 1) at the individual and 2) at the organizational level. The aims of the former were to anticipate the decrease of health and functional capacity, to support workers already decrease in these, to develop competence, and to manage the effects of changes on work ability. The aims at the organizational level were to improve labor availability and personnel retention, to ensure the flow of work, and to increase trust and create shared values. Top managers described the aims as being at a strategic level, but this was not yet realized in their organizations because the actions were reactive rather than proactive.

CONCLUSION

Top managers' multidimensional perception of WAM, emphasizing proactive actions, and strategic level aims are crucial and require the commitment of the top managers for strategic WAM, especially during constant changes.

Transmission and Management of Pathogenic Agrobacterium tumefaciens and Rhodococcus fascians in Select Ornamentals

Pathogenic Agrobacterium tumefaciens and Rhodococcus fascians are phytobacteria that induce crown gall and leafy gall disease, respectively, resulting in undesirable growth abnormalities. When present in nurseries, plants infected by either bacterium are destroyed, resulting in substantial losses for growers, especially those producing plants valued for their ornamental attributes. There are many unanswered questions regarding pathogen transmission on tools used to take cuttings for propagation and whether products used for bacterial disease control are effective. We investigated the ability to transmit pathogenic A. tumefaciens and R. fascians on secateurs and the efficacy of registered control products against both bacteria in vitro and in vivo. Experimental plants used were Rosa × hybrida, Leucanthemum × superbum, and Chrysanthemum × grandiflorum for A. tumefaciens and Petunia × hybrida and Oenothera 'Siskiyou' with R. fascians. In separate experiments, we found secateurs could convey both bacteria in numbers sufficient to initiate disease in a host-dependent manner and that bacteria could be recovered from secateurs after a single cut through an infected stem. In in vivo assays, none of six products tested against A. tumefaciens prevented crown gall disease, although several products appeared promising in in vitro trials. Likewise, four compounds trialed against R. fascians failed to prevent disease. Sanitation and clean planting material remain the primary means of disease management.

Non-Motor Symptom Management: Insights into Adherence to Treatment Guidelines in Parkinson's Disease Patients

Background

Non-motor symptoms (NMS) reduce quality of life in Parkinson's disease (PD) patients, who experience three times more NMS than individuals without PD. While there are international and national NMS treatment guidelines, their implication in clinical practice remains unclear.

Objective

This study aimed to investigate the adherence to pharmacological NMS treatment guidelines in patients with mild to moderately severe PD.

Methods

220 PD patients with ≥1 NMS based on the Non-Motor Symptom Questionnaire and a Hoehn and Yahr stage ≤4 were randomly selected from the Swedish Parkinson registry and screened for inclusion. NMS were evaluated using the International Parkinson and Movement Disorder Society-Non-Motor Rating Scale (MDS-NMS), Parkinson's Disease Sleep Scale 2, Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale. Treatment was compared with Swedish national guidelines and international guidelines from the MDS Evidence-Based Medicine Committee.

Results

Among 165 included patients, the median number of NMS was 14, and in median 7 symptoms were estimated to require treatment. The most common NMS requiring treatment were pain (69%) and urinary problems (56%). Treatment of depression and constipation demonstrated the highest adherence to guidelines (79% and 77%), while dysphagia and excessive daytime sleepiness exhibited the lowest adherence (0% and 4%). On average, only 32% of NMS were treated in accordance with guidelines.

Conclusions

Adherence to pharmacological guidelines for NMS in patients with mild to severe PD was low. This study highlights the need for improved evaluation and treatment of NMS to enhance symptom management and quality of life among PD patients.

Fungicide Use Patterns in Select United States Wine Grape Production Regions

Wine grape production (Vitis sp.) in the United States requires fungicide inputs for disease control. Currently, there is limited data available on vineyard fungicide use patterns. This information is important in developing tailored recommendations for disease management and fungicide stewardship. In this paper, we summarize the wine grape vineyard fungicide use patterns from four major regions: Napa and Sonoma valleys (California), Willamette Valley (Oregon), Columbia Valley (Washington), and several smaller regions east of the Mississippi River in years 2009 to 2020. We learned that the average in-season total fungicide applications ranged regionally from 5.6 to 8. The most commonly applied Fungicide Resistance Action Committee (FRAC) codes in spray programs were FRAC 3, 13, and M02 across all regions, with some variation to the top four groups in each region. Most applications were made on 14-day intervals; however, shorter intervals (7-day) were favored early season, and longer intervals (21-day) were favored late season. Tank-mixing multiple active ingredients was common east of the Mississippi River during all stages of grape development; this action was typically favored during the bloom period in other regions. In a subset of records that participated in FRAC 11 fungicide resistance testing, the average number of FRAC 11 applications after testing was reduced to either no applications or one application in Napa and Sonoma valleys. This survey provides regionally specific data related to fungicide stewardship practices that could be a focus for future stewardship messaging and fungicide resistance selection training, including total product use (selection events), spray intervals (selection pressure), and tank mixing (selection management).[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

A meta-analysis on the effect of telemedicine on the management of attention deficit and hyperactivity disorder in children and adolescents

INTRODUCTION

This study aims to report the effect sizes of telemedicine treatments on the symptom domains of paediatric ADHD.

METHODS

In this systematic review and meta-analysis, electronic databases, i.e. PubMed, Scopus, Web of Science and Embase, were searched for articles published up to December 2020. The inclusion criteria were as follows: children or adolescents diagnosed for ADHD or other hyperkinetic disorders; randomized controlled trials (RCTs); efficacy established with parents and teachers or self-rating scales at least for one of the following domains: inattention, cognitive function, hyperactivity, hyperactivity/impulsivity or oppositional behaviours. The risk of bias was assessed using the Cochrane risk of bias tool for RCTs.

RESULTS

From 310 records reduced to 228 after removing duplicates, overall 12 studies were fulfilled our inclusion criteria. They consisted of 708 participants (358 with telemedicine intervention and 350 controls). The telemedicine interventions varied from computerized training programmes with phone calls to videoconferencing programmes, virtual reality classrooms or games. The most applicable method consisted of computerized training programmes with phone calls. Pooling results of all studies with available data on each subscale showed a significant effect of telemedicine on inattention/cognitive function (standardized mean difference (SMD) = 0.26, 95% CI: 0.16, 0.36), hyperactivity/impulsivity (SMD = 0.29, 95% CI: 0.06, 0.52), and oppositional behaviours (SMD = 0.72, 95% CI: 0.24, 1.20) subscales in ADHD. Almost all studies had an overall unclear risk of bias. The source of outcome assessment (parents, teachers or self-report questionnaire) was addressed as a potential confounding factor. In almost all symptom domains, the satisfaction from the treatment was higher in parents than in teachers.

CONCLUSIONS

The clinical effects of telemedicine on the treatment of ADHD showed a small effect size for inattention/cognitive function, hyperactivity/impulsivity and oppositional behaviours.

Exploring Disease Management Experiences of Individuals with Type 2 Diabetes During the COVID-19 Pandemic: A Qualitative Study

The aim of this study was to investigate the impact of COVID-19 infection on disease management among individuals with type 2 diabetes and to explore their perspectives on COVID-19. This descriptive qualitative study included patients with diabetes, with a sample of 15 patients meeting the study criteria. The data were analyzed using code groups, which were then further categorized into main themes and subthemes. The main themes were: initial contact with the SARS-CoV-2 that is associated with COVID-19 illness changes in diabetes self-management behaviors; attempt at maintaining diabetes selfmanagement behaviors; and problems with accessing diabetes care. The study findings revealed several significant insights. Individuals with diabetes exhibited a fear of contracting SARS-CoV-2, which led to reduced levels of exercise and difficulties in managing blood sugar levels and insulin adjustments. Moreover, due to anxiety about COVID-19 infection, they postponed health check-ups, resulting in experiencing diabetes-related complications.

Change in health-related quality of life at early follow-up in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

Symptoms associated with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) impact patient's health-related quality of life (HRQoL). Studies on change and if a minimal clinically important difference (MCID) in HRQoL is reached within a year after diagnosis are lacking. The aim was to investigate the change in HRQoL as well as the proportion of patients that reached MCID at an early postdiagnosis visit. The study included adult patients from the Swedish PAH & CTEPH registry, diagnosed 2008-2021, with Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) at time of diagnosis and a follow-up. Data were analyzed as total population and dichotomized for sex, age (<65 vs. ≥65 years), time of diagnosis (≤2015 vs. >2015) and pulmonary hypertension (PH) subgroups. Data reported as median, interquartile range (IQR), and proportions (%). There were 151 patients (PAH = 119, CTEPH = 32) with an available CAMPHOR score at diagnosis and follow-up. CAMPHOR total sum was 31 (IQR: 21-43) and 25 (14-36); (p < 0.001) at diagnosis and follow-up, respectively. At follow-up, 56% had reached MCID in total sum, while for domains activity, symptoms, and QoL 27%, 33%, and 39% reached MCID, respectively. These results were independent of PH subgroup, diagnosis before or after 2015 and sex. Age below 65 years was related to improvements in activity and worsening of symptoms. In conclusion on a group level, improvements in CAMPHOR total sum as well as all domains were seen in the first year after diagnosis, however, only slightly more than half of the patients reached MCID for CAMPHOR total sum.

Cercospora leaf spot disease of sugar beet

Leaf spot disease caused by Cercospora beticola Sacc. is the most damaging foliar disease threatening sugar beet production worldwide. The wide spread of disease incurs a reduction of yield and economic losses. The in-depth knowledge of disease epidemiology and virulence factor of pathogen is crucial and basic for preventing fungal disease. The integrated control strategies are needed for an efficient and sustainable disease management. The rotation of fungicides and crop could reduce the initial inoculum and delay the emergence of resistant pathogens. Spraying fungicides under the guide of forecasting models and molecular detecting techniques may hinder the onset of disease prevalence. The resistant varieties of sugar beet to cercospora leaf spot could be obtained by combining classical and molecular breeding methods. More effective approaches are supposed to develop for prevention and control for fungal disease of sugar beet.

Design of a Dyadic Digital Health Module for Chronic Disease Shared Care: Development Study

BACKGROUND

The COVID-19 pandemic forced the spread of digital health tools to address limited clinical resources for chronic health management. It also illuminated a population of older patients requiring an informal caregiver (IC) to access this care due to accessibility, technological literacy, or English proficiency concerns. For patients with heart failure (HF), this rapid transition exacerbated the demand on ICs and pushed Canadians toward a dyadic care model where patients and ICs comanage care. Our previous work identified an opportunity to improve this dyadic HF experience through a shared model of dyadic digital health. We call this alternative model of care "Caretown for Medly," which empowers ICs to concurrently expand patients' self-care abilities while acknowledging ICs' eagerness to provide greater support.

OBJECTIVE

We present the systematic design and development of the Caretown for Medly dyadic management module. While HF is the outlined use case, we outline our design methodology and report on 6 core disease-invariant features applied to dyadic shared care for HF management. This work lays the foundation for future usability assessments of Caretown for Medly.

METHODS

We conducted a qualitative, human-centered design study based on 25 semistructured interviews with self-identified ICs of loved ones living with HF. Interviews underwent thematic content analysis by 2 coders independently for themes derived deductively (eg, based on the interview guide) and inductively refined. To build the Caretown for Medly model, we (1) leveraged the Knowledge to Action (KTA) framework to translate knowledge into action and (2) borrowed Google Sprint's ability to quickly "solve big problems and test new ideas," which has been effective in the medical and digital health spaces. Specifically, we blended these 2 concepts into a new framework called the "KTA Sprint."

RESULTS

We identified 6 core disease-invariant features to support ICs in care dyads to provide more effective care while capitalizing on dyadic care's synergistic benefits. Features were designed for customizability to suit the patient's condition, informed by stakeholder analysis, corroborated with literature, and vetted through user needs assessments. These features include (1) live reports to enhance data sharing and facilitate appropriate IC support, (2) care cards to enhance guidance on the caregiving role, (3) direct messaging to dissolve the disconnect across the circle of care, (4) medication wallet to improve guidance on managing complex medication regimens, (5) medical events timeline to improve and consolidate management and organization, and (6) caregiver resources to provide disease-specific education and support their self-care.

CONCLUSIONS

These disease-invariant features were designed to address ICs' needs in supporting their care partner. We anticipate that the implementation of these features will empower a shared model of care for chronic disease management through digital health and will improve outcomes for care dyads.

Evaluation of Amisulbrom Products for the Management of Clubroot of Canola (Brassica napus)

Clubroot, caused by Plasmodiophora brassicae, is an important disease of canola (Brassica napus). Amisulbrom, a quinone inside inhibitor (QiI), was evaluated for its effectiveness in clubroot management in Alberta, Canada. Resting spores of P. brassicae were treated in vitro with 0, 0.01, 0.1, 1, and 10% (w/v) amisulbrom to determine its effect on spore germination and viability. Amisulbrom inhibited resting spore germination by up to 79% and reduced viable spores by 31% relative to the control. Applications of a liquid solution (AL1000, 1000 g active ingredient (ai) ha-1) and granular formulations (AF700, 700 g ai ha-1; AF1000, 1000 g ai ha-1; AF1500, 1500 g ai ha-1) of amisulbrom were tested on the canola cultivars '45H31' (clubroot-susceptible) and 'CS2000' (moderately resistant) under greenhouse conditions and in field experiments in 2019 and 2020. In the greenhouse, the treatments were evaluated at inoculum concentrations of 1 × 105 or 1 × 107 resting spores g-1 soil. A trend of decreasing clubroot severity with an increasing amisulbrom rate was observed. At the lower spore concentration, treatment with AF1500 resulted in a clubroot disease severity index (DSI) <20% for both cultivars, while the lowest DSI under both low and high spore concentrations was obtained with AL1000. The field results indicated a significant reduction in DSI, with varied effects of rates and liquid vs. granular formulations. The greatest reductions (up to 58.3%) in DSI were obtained with AF1500 and AL1000 in 2020. These findings suggest that amisulbrom holds promise as part of an integrated clubroot management approach.

A Mobile Health App for Facilitating Disease Management in Children With Atopic Dermatitis: Feasibility and Impact Study

BACKGROUND

Inadequate control of atopic dermatitis (AD) increases the frequency of exacerbations and reduces the quality of life. Mobile health apps provide information and communication technology and may increase treatment adherence and facilitate disease management at home. The mobile health app, Atopic App, designed for patients and their caregivers, and the associated web-based patient education program, Atopic School, provide an opportunity for improving patients' and caregivers' engagement and adherence to the management of AD.

OBJECTIVE

This noninterventional, observational study aimed to explore the feasibility and potential impact on the management of AD in children by caregivers using the Atopic App mobile health app.

METHODS

The patient-oriented eczema measure (POEM) and numerical rating scale for the grading of pruritus were used as severity scores (scale range: 0-28). The artificial intelligence model of the app was used to assess the severity of AD based on the eczema area and severity index approach. The deidentified data enabled the analysis of the severity of AD, treatment plan history, potential triggers of flare-ups, usage of available features of the app, and the impact of patient education.

RESULTS

During a 12-month period, of the 1223 users who installed the app, 910 (74.4%) registered users were caregivers of children with AD. The web-based Atopic School course was accessed by 266 (29.2%) caregivers of children with AD, 134 (50.4%) of whom completed the course. Usage of the app was significantly more frequent among those who completed the Atopic School program than among those who did not access or did not complete the course (P<.001). Users who completed a second POEM 21 to 27 days apart exhibited a significant improvement of AD severity based on the POEM score (P<.001), with an average improvement of 3.86 (SD 6.85) points. The artificial intelligence severity score and itching score were highly correlated with the POEM score (r=0.35 and r=0.52, respectively).

CONCLUSIONS

The Atopic App provides valuable real-world data on the epidemiology, severity dynamics, treatment patterns, and exacerbation-trigger correlations in patients with AD. The significant reduction in the POEM score among users of the Atopic App indicates a potential impact of this tool on health care engagement by caregivers of children with AD.

Drug Therapies for Diabetes

The treatment of type 2 diabetes (T2D) necessitates a multifaceted approach that combines behavioral and pharmacological interventions to mitigate complications and sustain a high quality of life. Treatment encompasses the management of glucose levels, weight, cardiovascular risk factors, comorbidities, and associated complications through medication and lifestyle adjustments. Metformin, a standard in diabetes management, continues to serve as the primary, first-line oral treatment across all age groups due to its efficacy, versatility in combination therapy, and cost-effectiveness. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) offer notable benefits for HbA1c and weight reduction, with significant cardiovascular benefits. Sodium-glucose cotransporter inhibitors (SGLT-2i) lower glucose levels independently of insulin while conferring notable benefits for cardiovascular, renal, and heart-failure outcomes. Combined therapies emphasizing early and sustained glycemic control are promising options for diabetes management. As insulin therapy remains pivotal, metformin and non-insulin agents such as GLP-1 RA and SGLT-2i offer compelling options. Notably, exciting novel treatments like the dual GLP-1/ glucose-dependent insulinotropic polypeptide (GIP) agonist show promise for substantially reducing glycated hemoglobin and body weight. This comprehensive review highlights the evolving landscape of pharmacotherapy in diabetes, the drugs currently available for treating diabetes, their effectiveness and efficacy, the impact on target organs, and side effects. This work also provides insights that can support the customization of treatment strategies.