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Abstract Background Female nurses with high occupational stress are one of the groups at risk of premenstrual syndrome (PMS). The symptoms of this syndrome may affect the reduction of work efficiency, accuracy in doing work, concentration, and increased absenteeism of nurses and can lead to significant economic losses. This study aimed to determine the predictive role of common PMS symptoms in the clinical performance of nurses in public hospitals in Sanandaj, Iran. Methods The present study was a descriptive-analytical and cross-sectional study. In this study, 318 nurses participated in the census method based on the inclusion criteria. Data collection tools were premenstrual symptom screening questionnaires and nurses’ clinical performance evaluations. Data analysis was done with Spearman’s correlation tests, simple linear regression, multiple regression, t-test, one-way variance analysis, Tukey’s post hoc tests, and LSD using SPSS version 22 statistical software. Results The average PMS score of the participants was 30.8 ± 11.45, which indicates severe PMS. Nurses’ average clinical performance score was 45.78 ± 35.29, indicating an average performance. The findings showed that PMS has a significant inverse correlation with clinical performance and its components. Simple linear regression showed that PMS can predict 26.5% of nurses’ clinical performance variance. Simple regression showed that with an increase of one standard deviation in the PMS score, the nurses’ clinical performance score decreased by 0.517 standard deviations and vice versa. However, by controlling confounding variables, with an increase of one standard deviation in the PMS score, the clinical performance score of nurses will decrease by 0.396 standard deviations and vice versa. Conclusions Paying attention to reducing or controlling PMS symptoms may help improve nurses’ performance. Therefore, hospital and nursing managers can improve the performance and efficiency of their workforce by identifying nurses and other employees suffering from PMS and planning and using different methods to reduce its symptoms.

Abstract Successful entrance into specialty training represents a pivotal stage in the careers of medical officers. Selection for entrance into specialty training programs may encompass criteria including research experience, regional exposure, clinical experience, professional achievements, diversity, equity and inclusion factors, and extracurricular activities. Despite multiple syntheses on the topic, the extent to which these individual criteria predict performance during training and practice remains unclear. The objective of this study are to robustly conclude, through an umbrella review of systematic reviews on the topic, which selection criteria used in the selection process for medical and surgical specialty training applicants best predict clinical performance during and after specialty training.

Background: Many practitioners have questioned whether the construction method of pediatric zirconia crowns impacts the periodontal health and clinical performance of severely decayed primary molars. The objective of this study was to compare the periodontal health and clinical performance of primary molars restored with custom-made zirconia crowns (CZCs) and prefabricated zirconia crowns. Methods: Twenty primary molars indicated for crown restorations were selected from ten patients (5–9 years old) randomly. Each patient received two pediatric zirconia crowns constructed by two different methods: one custom-made and one prefabricated. The primary molars were divided into two groups: Group 1: primary molars received CZCs and Group 2: primary molars received prefabricated zirconia crowns (PZCs). Results: After a 12-month follow-up, there was no statistically significant difference between the periodontal health of primary molars restored with custom-made and prefabricated zirconia crowns. The clinical performance of primary molars restored with CZCs was statistically significantly higher than those restored with PZCs in terms of retention and fracture resistance (P ≤ 0.05). Conclusions: The construction method of pediatric zirconia crowns does not significantly affect the periodontal health of primary molars; however, clinical performance is significantly affected in terms of retention and fracture resistance. Clinical Significance: A CZC is an excellent alternative option, especially for primary molars whose permanent successors still have a long time to erupt. The PZC is a quick and easy restoration, but the technique is sensitive.

Resin composites are the first choice for direct restoration of posterior teeth in the treatment of dental caries. This article reviews factors that influence the clinical performance of composite restorations and the results of clinical trials assessing longevity of posterior resin composite restorations. Materials and method. PubMed, and Web of Science electronic databases were searched for articles investigating the clinical performance of direct resin composite restorations placed in posterior teeth. Results and discussions. Factors with significant influence on longevity of posterior composite restorations include patient-related factors (age, carious risk, periodontal disease, bruxism), dental group, cavity size and volume, cervical margin extension, root-filled teeth, oclusal stress. Conclusions. Dental resin composites are material of choice for use in direct minimal interventions in posterior teeth. For patients without bruxism, in medium size cavities, direct composite resins demonstrate similar clinical performance with amalgam restorations. The clinical performance of restorations depends on a number of factors including variables related to the restored tooth, the materials and techniques employed, the patient’s risks, and professional clinical decisions.

Introduction: To evaluate undergraduate students’ clinical ability to extract teeth, we created a new, coordinated, and quantitative assessment form containing nine items that were required to measure the various skills, using the visual analog scale. Materials and Methods: A pilot study was performed with 30 students, each of whom was rated by three examiners. In addition, 118 students (59 fourth-year and 59 fifth-year) were reviewed halfway through the year and at their final examinations. The assessment form was then used to evaluate students’ abilities for tooth extraction throughout the academic year 2022–2023. Results: High inter-examiner reliability and a significant association of mean scores (p

Nursing Students' Self-Efficacy Levels in Clinical Performance and their Perceptions of the Nursing Process

Lizy Sonia Benjamin,1 Eddieson Pasay-an,2 Petelyne Pangket,3 Aidah Sanad Alqarni,4 Ferdinand Gonzales,4 Lailani Sacgaca,5 Dawlat Ahmed Mahmoud,1 Maysa M Mohsen,4 Yahya Showkan Ali Hamdi,6 Sumathi Robert Shanmugam7 1Department of Medical-Surgical Nursing, College of Nursing, King Khalid University, Abha, Saudi Arabia; 2Department of Nursing Administration, College of Nursing, King Khalid University, Abha, Saudi Arabia; 3Department of Medical Surgical Nursing, University of Hail, Hail City, Saudi Arabia; 4Department of Fundamental of Nursing, College of Nursing, King Khalid University, Abha, Saudi Arabia; 5Department of Nursing, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia; 6Nursing Service, Aseer Central Hospital, Aseer, Saudi Arabia; 7Department of Maternity and Pediatric Nursing, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi ArabiaCorrespondence: Sumathi Robert Shanmugam, Department of Maternity and Pediatric Nursing, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia, Email srshanmugm@pnu.edu.saIntroduction: Nursing students frequently encounter the challenge of balancing their studies with the demanding requirements of hands-on practice and this can greatly affect their mental wellbeing. This study aimed to investigate the impact of sleep and psychological well-being on the academic and clinical performance of nursing students in Saudi Arabia.Methods: This study used a cross-sectional approach with 218 student nurses selected through convenience sampling from King Khalid University, Abha, Saudi Arabia. The sleep quality, psychological wellbeing, academic performance and clinical performance questionnaires were adopted to measure the variables. The Google Forms survey was used to gather the data, which were collected in August through October 2023. t-test and chi-square were used to analyze the data.Results: The sleep quality was higher with good/very good performers (p < 0.001). There was a significant difference with academic performance on positive relations (p < 0.007) and purpose in life (p < 0.004). Additionally, there was a significant difference in autonomy (p < 0.01), environmental mastery (p < 0.026), positive relations (p < 0.001), and purpose in life (p < 0.001) with clinical performance. Among students with good academic performance, those who were older than 25 years of age (p < 0.043) and level 3 students (p < 0.001) were found to have a significant correlation. Furthermore, those who were 25 years of age (p < 0.012) and level 3 students (p < 0.001) were also found to have a significant correlation with clinical performance.Conclusion: The sleep quality, positive relations, purpose in life, autonomy, and environmental mastery are all important factors for academic and clinical success. Moreover, older students and level 3 students may be more likely to have the skills and knowledge necessary to succeed in these areas. Further research exploring factors influencing academic and clinical success must be conducted.Keywords: sleep quality, psychological well-being, academic performance, clinical performance, nursing students, Saudi Arabia

Clinical coaching is one educational intervention that researchers have identified to help students achieve their clinical performance goals. However, in northwest Nigerian nursing schools, coaching services are not available. The current study used a quantitative, quasi-experimental design with pre-post-test approach. Four clinical instructors received training on the coaching package before providing coaching to the study group. Data was collected using clinical checklists before coaching and two months later. The coaching was provided to the study group for six weeks. The study compares nursing students' clinical performance before and after coaching. It also established relationship between academic stress and clinical performance.

Objective In recent years, the infant development and assessment programs have received attention by the health system of Iran. In this regard, the training of examiners for performing the Bayley tests has become one of the needs of the health system. This study aims to design and evaluate the validity and reliability of the Bayley-III examiner clinical performance scale. Materials & Methods In this study, participants were Bayley-III test examiners from medical universities in Iran, who were selected using a purposive sampling method. First, in focused group discussion sessions with 10 Bayley-III test experts, the items of instrument were formulated. Then, to evaluate the face validity, the questionnaire was sent to a panel of expert consisting of 8 Bayley-III experts and examiners and they were asked to rate the items from 1 to 5 in terms of importance. The items with an impact score of less than 1.5 were deleted, and other items were revised, if needed. To evaluate content validity, the questionnaire was sent to 10 Bayley-III test experts, and then the content validity ratio (CVR) and content validity index (CVI) were measured. The items with CVR

The rise of computer-aided design and computer-aided manufacturing (CAD/CAM) and 3D printing technologies in orthodontics has revolutionized the development of customized labial and lingual bracket systems with a variety of materials, which offer potential advantages over traditional orthodontic brackets. To highlight the current state of knowledge regarding the mechanical and clinical properties of CAD/CAM and 3D-printed custom bracket systems, we conducted a comprehensive search across the PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases to identify relevant articles published before April 2024. Mechanical (including fracture toughness, hardness, modulus of elasticity, frictional resistance, slot accuracy, torque transmission, and shear bond strength) and clinical (including treatment efficiency and duration, cost, and comfort) properties were compared between traditional and customized orthodontic bracket systems in the current review. Our findings suggest that customized brackets have the potential to increase bracket slot precision, reduce treatment time, and offer cost-efficiency. However, it is worth noting that the advantages and disadvantages of customized bracket systems vary depending on the bracket material and the manufacturing methods, warranting comprehensively controlled investigations in the future.

Infections caused by mycobacteria, including Mycobacterium tuberculosis complex (MTBC) and non-tuberculous mycobacteria (NTM), are a major public health issue worldwide. An accurate diagnosis of mycobacterial species is a challenge for surveillance and treatment, particularly in high-burden settings usually associated with low- and middle-income countries. In this study, we analyzed the clinical performance of two commercial PCR kits designed for the identification and differentiation of MTBC and NTM, available in a high-burden setting such as Ecuador. A total of 109 mycobacteria isolates were included in the study, 59 of which were previously characterized as M. tuberculosis and the other 59 as NTM. Both kits displayed great clinical performance for the identification of M. tuberculosis, with 100% sensitivity. On the other hand, for NTM, one of the kits displayed a good clinical performance with a sensitivity of 94.9% (CI 95%: 89–100%), while the second kit had a reduced sensitivity of 77.1% (CI 95%: 65–89%). In conclusion, one of the kits is a fast and reliable tool for the identification and discrimination of MTBC and NTM from clinical isolates.

The durability and performance of dental composites are essential for ensuring long-lasting dental restorations. However, there is a lack of a standardized procedure for evaluating the lifespan of dental materials. Our proposal assumed that dental materials should be tested under aggressive aging conditions to accelerate materials’ degradation in vitro and such an approach should simulate prolonged material usage in the oral cavity. A comprehensive examination of the impacts of three aging methodologies on various mechanical properties, including the flexural strength (FS), diametral tensile strength (DTS), hardness (HV), fracture toughness (FT), flexural fatigue limit (FFL), and microstructure of selected dental materials (Resin F, Flow-Art and Arkon), was conducted. The findings revealed that preformed aging results in an average reduction of 30% in the mechanical strength properties of the dental composites when compared to the control. Notably, a strong correlation was identified between FS and FFL post-aging whereas no such relationship was observed between these parameters and FT. This paper highlights the significance of aging tests for new dental composites and recommends a focus on flexural strength and fracture toughness to optimize costs and time efficiency. Furthermore, the establishment of a standardized test for fracture toughness in dental composites is recommended. It is proposed that a minimum flexural strength of more than 32–48 MPa after aging should be maintained. A more extensive analysis of commercially available materials is suggested to refine the proper evaluation methods for composite materials.

Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal (GI) tract. Fecal calprotectin (fCAL) is a noninvasive laboratory test used in the diagnosis and monitoring of IBDs such as Crohn’s disease and ulcerative colitis. The fCAL send-out test that our facility has been offering so far uses an ELISA-based method. In the current study, we sought to validate the performance of a Buhlmann fCAL turbo assay in an automated Abbott Alinity C analyzer (AFCAL) in our core laboratory. Five-day imprecision studies showed good performance for both within-run (5.3%) and between-day (2.5%) measurements. The reportable range was verified as 30–20,000 µg/g. Deming regression and Bland–Altman analysis indicated a strong correlation of r = 0.99 with a low, acceptable bias of 1.8% for AFCAL relative to the predicate Buhlmann fCAL ELISA results. AFCAL’s clinical performance was determined retrospectively in 62 patients with ICD codes for IBD. Overall, the implementation of AFCAL in our routine clinical testing has improved our turnaround time, reduced the cost per test, and significantly increased our clinician satisfaction.

This review article will discuss the origin of resin-based dental composite materials and their adoption as potentially useful adjuncts to the primary material used by most dentists for direct restorations. The evolution of the materials, largely driven by the industry’s response to the needs of dentists, has produced materials that are esthetic, strong, and versatile enough to be used in most areas of the oral cavity to replace or restore missing tooth structures. Significant advancements, such as the transition from chemical to light-curing materials, refinements in reinforcing particles to produce optimum polishing and wear resistance, formulating pastes with altered viscosities to create highly flowable and highly stiff materials, and creating materials with enhanced depth of cure to facilitate placement, will be highlighted. Future advancements will likely reflect the movement away from simply being a biocompatible material to one that is designed to produce some type of beneficial effect upon interaction within the oral environment. These new materials have been called “bioactive” by virtue of their potential effects on bacterial biofilms and their ability to promote mineralization of adjacent tooth structures.

Aim: This study aimed to determine if participation in a preceptorship programme affected newly hired experienced professional nurses’ self-efficacy in clinical practice and whether their perceived competence was related to respondents’ demographic profiles at a university hospital in Saudi Arabia. Background: Formal preceptorship programmes are initiated with the aim of improving the characteristics related to new workplace adaptations, such as reducing stress and anxiety, improving effective communication, enhancing clinical performance and competencies, and learning new clinical skills. These programmes’ effectiveness in improving nurses’ self-efficacy in clinical practice is seldom measured, especially among newly hired experienced professional nurses. Methods: A quasi-experimental, quantitative pre- and post-test one-group study design with convenient sampling was used. Results: Self-efficacy post-test scores were significantly higher than pre-test scores (p

Background and purpose: The tensions in the emergency department can affect job satisfaction and professional values of nurses working in this department which may influence their clinical performance. The present study investigated the performance of emergency department nurses during cardiopulmonary resuscitation (CPR) and its association with professional value and job satisfaction. Materials and methods: This cross-sectional study was conducted in 10 hospitals affiliated to Mazandaran University of Medical Sciences in 2020-2021. The study samples were 258 nurses in emergency department selected via convenience sampling and quota based on the number of emergency department personnel in every hospital. Data were collected using demographic questionnaire, self-performance checklist in CPR, The Minnesota Satisfaction Questionnaire (MSQ), and The Nurses Professional Values Scale--Revised (NPVS-R). Data analysis was carried out in SPSS V22. Results: The majority of samples (71.7%) were women and the mean age of participants was 31.09±4.7 years. The overall mean scores for professional value, job satisfaction, and nurses' self-performance in CPR were 100.49±14.7, 56.34±12.7, and 30.84±3.0, respectively. Weak direct correlation coefficients were found between nurses' job satisfaction and their performance (r=0.201, P=0.001) and professional values (r=0.339, P=0.001), and also between their professional values and performance (r=0.374, P=0.001). Conclusion: In this study, direct relationships were found between the performance of emergency department nurses in CPR and professional values and job satisfaction. Measures should be taken so that nurses get more familiar with different dimensions of nursing professional values and internalize these values in a wide range of nursing affairs, thereby having higher job satisfaction and clinical performance.

Background: ‘ACROSIS COVID-19 Ag (NPS)’ kit (SG Medical, Seoul, Korea) is a newly developed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen-detection rapid diagnostic test (Ag-RDT) using surface-enhanced Raman scattering (SERS)-based lateral flow immunoassay (LFIA). We evaluated its clinical performance compared with STANDARD Q COVID-19 Ag (SD Biosensor, Suwon, Korea), a previously approved Ag-RDT. Methods: A total of 286 nasopharyngeal swab specimens were collected: 104 positive and 182 negative specimens in SARS-CoV-2 real-time reverse-transcription polymerase-chain-reaction (rRT-PCR). SARS-CoV-2-positive specimens were divided according to the cycle threshold (Ct) value in rRT-PCR. The clinical performance of ACROSIS was compared with that of STANDARD Q. Results: ACROSIS showed significantly higher sensitivity than STANDARD Q (92.3% vs. 85.6%, P = 0.02), especially in specimens with 25 ≤ Ct

Scientific knowledge should be based on evidence. However, some scientific studies can be carried out without sufficient evidence. And these studies may mislead subsequent studies. Ischemia-modified albumin (IMA) is a relatively newly proposed biomarker. It is used not only for myocardial ischemia but also used for other pathological conditions in the body. IMA is commonly measured by albumin cobalt binding (ACB) assay. ACB is a simple colorimetric assay performed in patients’ sera. It is claimed that because of the ischemia or ischemia-reperfusion, the molecular structure of the N-terminus of human serum albumin is changed and therefore it cannot bind metal ions and cobalt ions added into the reaction mixture react with dithiothreitol to give a brown color. The clinical performance of the ACB assay is poor and it has not a strong correlation with other ischemia biomarkers. There are many analytical uncertainties in ACB assay and IMA as well. Despite the uncertainties, the ACB assay is still commonly used for many research studies. Therefore the theory of the ACB assay should be questioned. In this opinion paper, we discussed these uncertainties. In conclusion, there is insufficient evidence for the existence of IMA as a biomarker. The ACB assay essentially measures serum albumin concentration. There are many other interfering factors with the ACB assay. Therefore, the measurement of IMA in any pathological condition is a useless effort.

Abstract Aims Heart failure (HF) remains a major public health problem with increasing prevalence in China. This study evaluated the clinical performance and quality measures for HF management to identify gaps in the standardization of care for patients hospitalized for HF in China. Methods and results Following the results of China‐HF stage I (2012–2015), the second stage of the China‐HF was launched in 2017. Among 113 hospitals with ≥100 cases, the China‐HF Stage II assessed the quality of care measures for HF and compared results with previous data in China and the US‐based Get with The Guidelines‐Heart Failure (GWTG‐HF) registries. In total, 34 938 patients hospitalized with HF were enrolled from January 2017 to October 2020. Echocardiographic left ventricular function and natriuretic peptide test were performed in 93.7% and 93.0% of the cases, respectively. Adherence to standardized guidelines in China‐HF stage II was higher than that in the China‐HF stage I, but generally lower than GWTG‐HF registry with 78.2% of eligible patients was prescribed oral diuretics, 78.7% renin‐angiotensin‐system inhibitors, and 82.2% beta‐blockers. Implantable cardioverter‐defibrillators and cardiac resynchronization devices were implanted in 3.9% and 14.6%, respectively. In contrast, the proportion of eligible patients discharged with spironolactone (87.8%) was higher than GWTG‐HF. The median length of hospitalization was 9 (6, 12) days, and 938 (2.8%) patients died or withdrew from treatment during hospitalization. Conclusions Despite significant improvements in the use of guideline‐recommended testing and therapy, there remain major gaps in quality of care for patients hospitalized for HF in China that are generally larger than gaps observed in the United States.

Objective The in-house developed 70 MHz AMC-4 locoregional hyperthermia system has been in clinical use since 1984. This device was recently commercialized as the Alba 4D (Medlogix®, Rome, Italy), with a similar geometrical 4-waveguide design. At the time of this study a hybrid Alba 4D was installed at our center, which incorporated elements of the AMC-4. This study aims to compare clinical performance of both devices.Methods During one year after clinical acceptance of the hybrid Alba 4D, both devices were used for treatment delivery in patients scheduled for locoregional hyperthermia. Each patient started with the AMC-4, next sessions were allocated to either device. Possible differences between Alba 4D and AMC-4 sessions in power, achieved temperature T0, T10, T50, T90, T100, treatment time and complaints per session, were evaluated using linear mixed models (LMMs) for repeated measures with patient as random effect.Results From March 2018 to April 2019, eleven patients with cervical, pancreatic, vaginal carcinoma and uterine leiomyosarcoma received 27 locoregional hyperthermia sessions with the Alba 4D and 34 sessions with the AMC-4. Median number of sessions per patient was 5 (range 3–13). Treatment results for both devices were not significantly different: T50 was 40.5 ± 1.0 °C vs. 40.8 ± 0.7 °C, applied power was 500 ± 79 W vs. 526 ± 108 W, for the Alba 4D vs. AMC-4, respectively.Conclusion Results of the first patients treated with the hybrid Alba 4D demonstrated comparable clinical performance of the Alba 4D and AMC-4 locoregional hyperthermia systems, and both devices are expected to yield similar favorable clinical results.

Abstract Introduction Simulators in a clinical environment provide a space where students can acquire skills and experience under the supervision of their professors without any worries or inflicting any harm on their patients. The current study aimed to compare the effects of teaching through simulation and the traditional method on nursing students' self-efficacy skills and clinical performance. Method The current study was quasi-experimental and adopted a pre-test & post-test design. The population consisted of 122 students of nursing, out of whom 100 students were selected as the sample. Then, they were randomly divided into an experimental and a control group. A questionnaire assessed the students' self-efficacy skills and clinical performance before and after implementing the instructional programs. The data were analyzed using descriptive and inferential statistical techniques in SPSS 23. Findings The mean of the participants' self-efficacy scores increased significantly after the intervention (from 87.57 to 142.13). Moreover, the mean of the participants' clinical performance increased significantly after the intervention (from 2.16 to 4.57). The findings indicated that simulation teaching significantly affects nursing students' self-efficacy and clinical performance. Conclusion Simulation was recommended as an effective teaching methodology, particularly in nurses' internship wards. In other words, acquiring the essential skills through applying the simulation method is recommended before entering real-world environments.

Background: An accurate status determination of breast cancer biomarkers (ER, PR, HER2, Ki67) is crucial for guiding patient management. The “gold standard” for assessing these biomarkers in FFPE tissue is IHC, which faces challenges in standardization and exhibits substantial variability. In this study, we compare the concordance of a new commercial RT-qPCR kit with IHC in determining BC biomarker status. Methods: The performance was evaluated using 634 FFPE specimens, which underwent histological analysis in accordance with standard of care methods. HER2 2+ tumors were referred to ISH testing. An immunoreactive score of ≥2/12 was considered positive for ER/PR and 20% staining was used as a cut-off for Ki67 high/low score. RT-qPCR and results calling were performed according to the manufacturer’s instructions. Results: High concordance with IHC was seen for all markers (93.2% for ER, 87.1% for PR, 93.9% for HER2, 77.9% for Ki67 and 80.1% for proliferative signature (assessed against Ki67 IHC)). Conclusions: By assessing the concordance with the results obtained through IHC, we sought to demonstrate the reliability and utility of the kit for precise BC subtyping. Our findings suggest that the kit provides a highly precise and accurate quantitative assessment of BC biomarkers.

The aim of this study was to estimate the level of empathy among primary care (PC) health professionals and its relationship with their approach to patients at risk due to alcohol consumption. This is an observational, descriptive, and multicenter study that included 80 PHC professionals. The professionals completed a questionnaire comprising socio-occupational questions and inquiries regarding their actions when dealing with patients suspected of risky alcohol consumption. The Jefferson Scale of Empathy was used to measure their level of empathy and was completed by 80 professionals, of whom 57.5% were family physicians, 10% were nurses, and 32.5% were family- and community-medicine residents. The mean age was 39.5 ± 13.1 (SD) (range of 24–65 years) and 71.3% were females. The mean empathy level score was 112.9 ± 11.1 (95% CI: 110.4–115.4; range: 81–132 points). Actions that stood out for their frequency were providing health advice in the general population, offering advice to pregnant women, and recommending abstinence to users of hazardous machinery or motor vehicles. The level of empathy was associated with age (p = 0.029), the health center’s scope (p = 0.044), systematic alcohol exploration (p = 0.034), and follow-ups for patients diagnosed with risky consumption (p = 0.037). The mean score obtained indicated a high level of empathy among professionals. Professionals with greater empathy more frequently conducted systematic screening for risky alcohol consumption.

Abstract Objective Papillary thyroid cancer (PTC) is the most common endocrine malignancy with a steadily increasing incidence. Researches have reported that tumor multifocality occurs in an extensive number of cases. Nevertheless, the clinical characteristics and prognostic value remained controversial. This study was performed to investigate the relationship between multifocal PTC and adverse clinicopathologic features and the prognosis. Methods A systematic review and meta‐analysis were conducted based on three electronic databases up to December 31, 2021. Parameters of interest included five clinical features (extrathyroidal extension, lymphovascular invasion, central lymph node metastasis, lateral lymph node metastasis, distant metastasis) and were pooled into risk ratios (RRs). Time‐to‐event data (recurrence‐free survival and all‐cause mortality) were evaluated using hazard ratios (HRs). Publication bias was examined using funnel plots and Egger's test. Results A total of 23 articles were included according to the inclusion criteria; all of the studies were retrospective cohorts. In comparison with unifocality, multifocality showed an increased risk of extrathyroidal extension (RR 1.38, 95% CI 1.25–1.53), lymphovascular invasion (RR 1.27, 95% CI 1.04–1.55), central lymph node metastasis (RR 1.21, 95% CI 1.12–1.30), lateral lymph node metastasis (RR 1.86, 95% CI 1.62–2.14), and distant metastasis (RR 1.35, 95% CI 1.03–1.76). Multifocal patients were predisposed to postoperative recurrence (HR 1.76, 95% CI 1.50–2.07). The rate of all‐cause mortality did not reach a statistical difference. Level of Evidence 2. Conclusion Multifocal PTC is more aggressive in contrast to unifocal PTC and is accompanied by an increased risk of recurrence. They were usually diagnosed in higher grades and stages. To achieve the maximal benefit, we recommend personalized therapy and close follow‐up for multifocal PTC patients. Further prospective studies will clarify the best‐fitted treatment plans.

Abstract Background According to international guidelines, Human Papillomavirus (HPV) DNA tests represent a valid alternative to Pap Test for primary cervical cancer screening, provided that they guarantee balanced clinical sensitivity and specificity for cervical intraepithelial neoplasia grade 2 or more (CIN2+) lesions. The study aimed to assess whether HPV Selfy (Ulisse BioMed – Trieste, Italy), a full-genotyping HPV DNA test that detects and differentiates 14 high-risk HPV (HR-HPV) types, meets the criteria for primary cervical cancer screening described in the international guidelines, on clinician-collected as well as on self-collected samples. Methods For each participant woman, consecutively referring to Azienda Sanitaria Universitaria Giuliano Isontina (Trieste, Italy) and CRO—National Cancer Institute (Aviano, Italy) for the cervical cancer screening program, the following samples were tested: (a) a clinician-collected cervical specimen, analyzed with the reference test (Hybrid Capture®2 test, HC2) and HPV Selfy; and (b) a self-collected vaginal sample, analyzed with HPV Selfy. Enrolled women were also asked to fulfill a questionnaire about self-sampling acceptability. As required by guidelines, a non-inferiority test was conducted to compare the clinical performance of the test under evaluation with its reference test. Results HPV Selfy clinical sensitivity and specificity resulted non-inferior to those of HC2. By analysis of a total of 889 cervical liquid-based cytology samples from a screening population, of which 98 were from women with CIN2+, HPV Selfy showed relative sensitivity and specificity for CIN2+ of 0.98 and 1.00 respectively (non-inferiority score test: P = 0.01747 and P = 0.00414, respectively); the test reached adequate intra- and inter-laboratory reproducibility. Moreover, we demonstrated that the performance of HPV Selfy on self-collected vaginal samples was non-inferior to the performance obtained on clinician-collected cervical specimen (0.92 relative sensitivity and 0.97 relative specificity). Finally, through HPV Selfy genotyping, we were able to describe HPV types prevalence in the study population. Conclusions HPV Selfy fulfills all the requirements of the international Meijer’s guidelines and has been clinically validated for primary cervical cancer screening purposes. Moreover, HPV Selfy has also been validated for self-sampling according to VALHUDES guidelines. Therefore, at date, HPV Selfy is the only full-genotyping test validated both for screening purposes and for self-sampling. Trial registration ASUGI Trieste n. 16008/2018; CRO Aviano n.17149/2018

Abstract Background The importance of self-regulated learning (SRL) has been broadly recognised by medical education institutions and medical professionals. Self-regulated learning, which is a context-specific process, is affected by personal, contextual and social factors. Although many studies on exploring the factors that influenced SRL and the relationship of between SRL and clinical achievement levels have been carried out in western countries, little is known about the factors associated with self-regulated learning and its relationship with clinical performance among medical students in China. Methods A cross-sectional online survey was distributed to 3rd year clinical medicine students who were in the clinical clerkship stage in a medical college in Wuhan. We used Self-regulated Learning Scale for Undergraduates (SLSU) to measure the self-regulated learning of students and Objective Structured Clinical Examination (OSCE) in the national proficiency test to assess the clinical performance of students. The participation rate was 73.95% (193 students). An independent t-test and analysis of variance were used to analyse the factors associated with self-regulated learning. The relationship between self-regulated learning and clinical performance was analysed with multilinear regression analysis. Results Univariate analysis showed that having a clear career planning and a professional idol, providing full-time teaching clinical teachers in the clerkship department and seeking the help of the surrounding classmates and the guidance of teachers or senior students were significant predictors of self-regulated learning. Multilinear regression analysis has revealed a positive relationship among extrinsic goals (partial r = 0.171), clinical clerkship evaluation (partial r = 0.197) and clinical performance (F = 4.070, p = 0.004). Conclusions Motivation-related personal and social factors related to clinical context could promote the SRL level of medical students in China. Extrinsic goals and clinical clerkship evaluation could facilitate students’ clinical achievements on clinical skills. External support, such as clinical clerkship management, might improve clinical performance on clinical skills in clinical clerkship context.

The nursing profession is considered to be at a high risk of workplace stress, workload, and burnout due to the high job demands. The nurses require the appropriate and prompt coping mechanisms to relieve the effects of stress. The nurses have to be emotionally intelligent to overcome the work-related stress to meet the clinical-based duties. But there is a paucity of the effect of emotional intelligence (EI) on the clinical performance of nurses in the literature. Therefore, the role of dimensions of EI in the improvement of clinical performance of nurses was explored in this study.

To determine the relationship between clinical performance and professional self-concept in critical care nurses.

Abstract Background High-fidelity simulators are highly useful in assessing clinical competency; they enable reliable and valid evaluation. Recently, the importance of peer assessment has been highlighted in healthcare education, and studies using peer assessment in healthcare, such as medicine, nursing, dentistry, and pharmacy, have examined the value of peer assessment. This study aimed to analyze inter-rater reliability between peers and instructors and examine differences in scores between peers and instructors in the assessment of high-fidelity-simulation-based clinical performance by medical students. Methods This study analyzed the results of two clinical performance assessments of 34 groups of fifth-year students at Ajou University School of Medicine in 2020. This study utilized a modified Queen’s Simulation Assessment Tool to measure four categories: primary assessment, diagnostic actions, therapeutic actions, and communication. In order to estimate inter-rater reliability, this study calculated the intraclass correlation coefficient and used the Bland and Altman method to analyze agreement between raters. A t-test was conducted to analyze the differences in evaluation scores between colleagues and faculty members. Group differences in assessment scores between peers and instructors were analyzed using the independent t-test. Results Overall inter-rater reliability of clinical performance assessments was high. In addition, there were no significant differences in overall assessment scores between peers and instructors in the areas of primary assessment, diagnostic actions, therapeutic actions, and communication. Conclusions The results indicated that peer assessment can be used as a reliable assessment method compared to instructor assessment when evaluating clinical competency using high-fidelity simulators. Efforts should be made to enable medical students to actively participate in the evaluation process as fellow assessors in high-fidelity-simulation-based assessment of clinical performance in situations similar to real clinical settings.

Objectives: To identify the perception of the impact of the use of the WhatsApp® application in the development of clinical skills in dental students from Colombia, Costa Rica and Peru. Methods: An online questionnaire was applied to 119 students: One hundred and two undergraduate students from Peru (P) and seventeen graduate students from Colombia (C) and Costa Rica (CR). Results: Most of the students perceive that the videos improved their clinic performance, express that sharing videos through the App could complement the theoretical classes, and believe that it promotes the use of information and communications technologies. Conclusions: The students’ perception towards the use of the WhatsApp® application for education purpose is very positive. This disruptive digital technology enabled the meaningful learning of the undergraduate and graduate dental students. Sharing videos through the App can complement traditional lectures and enrich the learning experience.

Alemayehu Sayih Belay, Aychew Kassie Mizan Tepi-University, College of Medicine and Health Science, Department of Nursing, Mizan Aman, EthiopiaCorrespondence: Aychew KassieMizan-Tepi University, College of Health Science, Department of Nursing, P.O. Box: 260, Mizan Aman, EthiopiaTel +251-922460461Email aychewkassie055@gmail.comBackground: Today, one of the most challenging duties of nursing school is achieving clinical practice proficiency. Emotional intelligence correlates with students’ clinical practice performance. Such data are scarce in Southwest Ethiopia. Therefore, this study aimed to examine the relationship between emotional intelligence and clinical performance of undergraduate nursing students during obstetrics and gynecology nursing practice.Methods: A cross-sectional study was employed. All registered 186 fourth-year undergraduate nursing students of Mizan-Tepi University were included in the study. The data were collected using the self-administered structured questionnaires after briefly explaining the objective of the study. The Schutte Self Report Emotional Intelligence Test (SSEIT) was used to collect the data associated with emotional intelligence. Independent t-test, Pearson correlation, linear regression, and ANOVA were computed as appropriate after checking all necessary assumptions and statistical significance was declared at p< 0.05.Results: Emotional intelligence was strongly correlated with clinical practice performance [r (186) =0.767, p< 0.0001]. There was a statistically significant difference in the mean clinical practice performance by sex, where males were performed better [t(186)=3.27, p< 0.0001]. Linear regression analysis showed that emotional intelligence was the only predictor of clinical practice performance (β=0.219, p< 0.0001). In one way ANOVA, the Welch test [FW (3,182) = 218.18, p < 0.0001] and the Brown-Forsythe test [FBF (3,182) = 150.73, p < 0.0001)] revealed that there were statistically significant differences in the mean clinical practice performance among levels of emotional intelligence.Conclusion: This study confirmed that the emotional intelligence of nursing students had significantly affected their clinical performance. This finding poses important questions for the educators responsible for nursing education in both academic and clinical settings. Further investigation is required to assess the factors that increase or decrease EI in nursing students is warranted.Keywords: emotional intelligence, clinical performance, practice, obstetrics and gynecology, nursing, Ethiopia

During the second year of the COVID-19 pandemic, the use of Rapid Diagnosis Antigen Tests (RDAgTs) for SARS-CoV-2 detection has substantially increased as some of the brands available in the market were certified for clinical use by international regulatory agencies. RDAgTs are a fast and cheap tool for SARS-CoV-2 surveillance with great potential to improve testing capacities in middle- and low-income countries compared to the gold standard RT-qPCR. However, as the clinical performance of RDAgTs has been shown to vary greatly between the commercial brands available, evaluation studies are necessary. Moreover, the available evaluation has been done in high-income countries while SARS-CoV-2 transmission is also actively happening in developing countries, many of which are located in tropical latitudes where cross-reactivity with other infectious agents is highly prevalent, which could compromise RDAgT specificity. Moreover, unreported mutations and/or new SARS-CoV-2 variants may compromise RDAgT sensitivity as genomic surveillance is limited in these settings. Here we describe a multicenter and manufacturer‐independent evaluation of the clinical performance and analytical sensitivity of three different RDAgTs brands available in South America from three companies, Rapigen (South Korea), SD-Biosensor (South Korea), and Certest (Spain), compared to the gold standard RT-qPCR. A total number of 1,646 nasopharyngeal swabs from community-dwelling individuals were included in the study, and 379 of them were SARS-CoV-2 positive by RT-qPCR. The overall sensitivity for each RDAgT was 79% (IC95%: 72 - 86.2), 64.2% (IC95%: 56.7 - 71.6), and 45.8% (IC95%: 35.8 - 55.8) for SD-Biosensor, Certest, and Rapigen, respectively. The overall specificity for each RDAgT was 100%, 97.7% (IC95%: 96.8 - 98.6), and 100% for SD-Biosensor, Certest, and Rapigen, respectively. However, the limit of detection (LoD) to achieve a sensitivity over 90% was substantially lower for Certest RDAgT (102 copies/uL) compared to SD-Biosensor (103 copies/uL) or Rapigen (106 copies/uL) RDAgTs, considering that the gold standard RT-qPCR method used in this study has a high sensitivity of 97.7% and low LoD of 5 copies/uL. Additionally, the Certest RDAgT also showed an improved sensitivity up to 79.7% (IC95%: 70.2 – 89.2) for symptomatic individuals. Finally, the slight reduction in specificity for Certest RDAgTs was only associated with one of the laboratories performing this study, pointing out the need for locally assessed evaluation for RDAgTs like this one carried out in Ecuador. In conclusion, two of the three the RDAgTs tested in this study are a fast, cheap, and point of care tool for SARS-CoV-2 surveillance and reliable enough to detect SARS-CoV-2 infectious individuals.

Abstract Influenza viruses are an important cause of disease in both humans and animals, and their detection and characterization can take weeks. In this study, we sought to compare classical virology techniques with a new rapid microarray method for the detection and characterization of a very diverse, panel of animal, environmental, and human clinical or field specimens that were molecularly positive for influenza A alone (n = 111), influenza B alone (n = 3), both viruses (n = 13), or influenza negative (n = 2) viruses. All influenza virus positive samples in this study were first subtyped by traditional laboratory methods, and later evaluated using the FluChip-8G Insight Assay (InDevR Inc. Boulder, CO) in laboratories at Duke University (USA) or at Duke Kunshan University (China). The FluChip-8G Insight multiplexed assay agreed with classical virologic techniques 59 (54.1%) of 109 influenza A-positive, 3 (100%) of the 3 influenza B-positive, 0 (0%) of 10 both influenza A- and B-positive samples, 75% of 24 environmental samples including those positive for H1, H3, H7, H9, N1, and N9 strains, and 80% of 22 avian influenza samples. It had difficulty with avian N6 types and swine H3 and N2 influenza specimens. The FluChip-8G Insight assay performed well with most human, environmental, and animal samples, but had some difficulty with samples containing multiple viral strains and with specific animal influenza strains. As classical virology methods are often iterative and can take weeks, the FluChip-8G Insight Assay rapid results (time range 8 to 12 h) offers considerable time savings. As the FluChip-8G analysis algorithm is expected to improve over time with addition of new subtypes and sample matrices, the FluChip-8G Insight Assay has considerable promise for rapid characterization of novel influenza viruses affecting humans or animals.

Introduction: The utility of a clinical tool lies in its clinical performance evaluation and describes the relevance and usefulness of that tool in a medical setting. The utility of urodynamic and video-urodynamic studies in the management of specific urodynamic profiles in the diagnosis, treatment, and prognostic approach in neuro-urological patients is the focus of the current review. Methods: For this narrative review, a PubMed® search was performed by cross-referencing the keywords “urodynamics”, “neurogenic bladder”, “utility”, “clinical utility” and “clinical performance” with various terms related to the management of neurogenic lower urinary tract dysfunction. Clinical practice guidelines and landmark reviews from the most renowned experts in the field were also used. Analysis: Assessment of the utility of urodynamic study was performed during the diagnostic, therapeutic and prognostic steps of the neuro-urological patients’ management. We focused on its clinical performance in the identification and evaluation of several unfavorable events, such as neurogenic detrusor overactivity, detrusor-sphincter dyssynergia, elevated detrusor leak point pressure and the presence of vesico-ureteral reflux, which may be indicators for a higher risk for the development of urological comorbidities. Conclusion: Despite the paucity of existing literature assessing the utility of urodynamic study—specifically video-urodynamic study—in neuro-urological patients, it does remain the gold standard to assess lower urinary tract function precisely in this patient category. With regard to its utility, it is associated with high clinical performance at every step of management. The feedback on possible unfavorable events allows for prognostic assessment and may lead us to question current recommendations.

Rapid antigen tests (RATs) are diagnostic tools developed to specifically detect a certain protein of infectious agents (viruses, bacteria, or parasites). RATs are easily accessible due to their rapidity and simplicity. During the COVID-19 pandemic, RATs have been widely used in detecting the presence of the specific SARS-CoV-2 antigen in respiratory samples from suspected individuals. Here, the authors review the application of RATs as detection tools for COVID-19, particularly in Korea, as well as for several other infectious diseases. To address these issues, we present general knowledge on the design of RATs that adopt the lateral flow immunoassay for the detection of the analyte (antigen). The authors then discuss the clinical utilization of the authorized RATs amidst the battle against the COVID-19 pandemic in Korea and their role in comparison with other detection methods. We also discuss the implementation of RATs for other, non-COVID-19 infectious diseases, the challenges that may arise during the application, the limitations of RATs as clinical detection tools, as well as the possible problem solving for those challenges to maximize the performance of RATs and avoiding any misinterpretation of the test result.

The purpose of this observational follow-up clinical study was to observe the quality of posterior composite restorations more than 23 years after application. A total of 22 patients, 13 male and 9 female (mean age 66.1 years, range 50–84), with a total of 42 restorations attended the first and second follow-up examinations. The restorations were examined by one operator using modified FDI criteria. Statistical analysis was performed with the Wilcoxon Mann–Whitney U test and Wilcoxon exact matched-pairs test with a significance level of p = 0.05. Bonferroni–Holm with an adjusted significance level of alpha = 0.05 was applied. With the exception of approximal anatomical form, significantly worse scores were seen for six out of seven criteria at the second follow-up evaluation. There was no significant difference in the first and second follow-up evaluations in the grades of the restorations with regard to having been placed in the maxilla or mandible, as well as for one-surface or multiple-surface restorations. The approximal anatomical form showed significantly worse grades at the second follow-up when having been placed in molars. In conclusion, the study results show that significant differences regarding FDI criteria in posterior composite restorations occur after more than 23 years of service. Further studies with extended follow-up time and at regular and short time intervals are recommended.

Objective: To evaluate the clinical efficacy of direct and indirect composite resin restorations placed in posterior teeth after 2 years. Materials and Methods: A total of 60 teeth were restored with a direct composite resin (BRILLIANT EverGlowTM– Coltene) and an indirect composite resin (CeramageTM– Shofu). All restorations were assessed using the Modified United States Public Health Service criteria at baseline, 3 months, 6 months, 12 months, 18 months, and 24 months after placement. Statistical analysis was performed with Chi-Square test and Cochran's Q test. Results: At the 2-year evaluation, all restorations were retained, with Alpha ratings at 100%. Only two teeth (in the direct restoration group) required endodontic intervention after 18 months due to secondary caries. Surface texture, marginal discoloration, and marginal integrity were predominantly scored as Alpha after 2 years for both groups. Color match was scored as Alpha in 65.4% of direct restorations and 84.4% of indirect restorations. Conclusion: Within the limitations of this study it can be concluded that the clinical performance of the indirect restorations was much improved than that of direct restorations.

Background: Clinical self-efficacy (CSE) plays a pivotal role in safe and quality nursing care delivery. Clinical Belongingness (CB) is a major factor in the clinical practice of nursing students. Objective: This study aimed to assess CSE and CB and their relationship among nursing students. Methods: This descriptive, correlational study was conducted in 2019 in the Faculty of Nursing and Midwifery of Urmia University of Medical Sciences, Urmia, Iran. Participants were 216 eligible 3rd- and 4th-year nursing students. Data were collected using a demographic questionnaire, the Belongingness Scale-Clinical Placement Experience, and the Self-Efficacy in Clinical Performance Questionnaire. The Pearson correlation analysis, the independent-sample t-test, the one-way analysis of variance, and the linear regression analysis were performed for the data analysis. Results: The total mean scores of CSE and CB were, respectively, 134.02 ± 20.62 and 121 ± 16.79, indicating moderate CSE and high CB. CB had significant positive correlation with CSE and was a significant predictor of it (P < 0.05). Conclusion: Nursing students have high CB and moderate CSE, and their CB is a significant positive predictor of their CSE. University authorities are recommended to develop clear strategies to improve nursing students' CSE through improving their CB.

The clinical effectiveness of adhesive agents has been mainly evaluated using class V restorations. Clinical studies evaluating adhesives in combination with posterior composites are scarce and of short-term periods. This paper is aimed to review the current literature on the clinical effectiveness of contemporary adhesives when used to restore posterior teeth (Class I and Class II). To conduct this review, Scopus, PubMed, and Google Scholar databases were used to search for peer-reviewed articles on the clinical performance of adhesive agents in posterior composite restorations. Search terms used included “adhesive agents,” “clinical evaluation,” “composite restorations,” “posterior teeth,” “self-etch adhesives,” “etch -and -rinse adhesives,” and “universal adhesives.” To enrich the results, reference mining of the articles that were identified was used to locate other papers. The process of cross-referencing continued until no new articles were identified. No limits were placed on the year of publication, but only articles in English were considered. The current review found that simplification in the adhesive technique so far seems to affect the clinical performance. There is a relative paucity of evidence relating to the performance of universal adhesive agents in posterior restorations. Further long-term clinical studies are needed to evaluate the clinical performance of adhesive agents.

ABSTRACT The gold standard for confirming bacterial infections is culture-positive, which has a long sample-to-result turnaround time and poor sensitivity for unculturable and fastidious pathogens; therefore, it is hard to guide early, targeted antimicrobial therapy and reduce overuse of broad-spectrum antibiotics. Nanopore targeted sequencing (NTS) is reported to be advantageous in detection speed and range over culture in prior published reports. However, investigation of the clinical performance of NTS is deficient at present. Thus, we assessed the feasibility of NTS for the first time with cohort and systematic comparisons with traditional culture assays and PCR followed by Sanger sequencing. This retrospective study was performed on 472 samples, including 6 specimen types from 436 patients, to evaluate the clinical performance of NTS designed for identifying the microbial composition of various infections. Of these samples, 86.7% were found to be NTS positive, which was significantly higher than culture-positive (26.7%). A total of 425 significant human opportunistic bacteria and fungi detected by NTS were selected to go through validation with PCR followed by Sanger sequencing. The average accuracy rate was 85.2% (maximum 100% created by Cryptococcus neoformans, the last one 66.7% provided by both Staphylococcus haemolyticus and Moraxella osloensis, minimum 0% produced by Burkholderia cepacia). The accuracy rate also varied with sample type; the highest accuracy rate was found in pleural and ascites fluid (95.8%) followed by bronchoalveolar lavage fluid (88.7%), urine (86.8%), and wound secretions (85.0%), while the lowest was present in cerebrospinal fluid (58.8%). NTS had a diagnostic sensitivity of 94.5% and specificity of 31.8%. The positive and negative predictive values of NTS were 79.9% and 66.7%, respectively. For diagnosis of infectious diseases, the sensitivity was greatly increased by 56.7% in NTS compared with culture (94.5% vs 37.8%). Therefore, NTS can accurately detect the causative pathogens in infectious samples, particularly in pleural and ascites fluid, bronchoalveolar lavage fluid, urine, and wound secretions, with a short turnaround time of 8–14 h, and might innovatively contribute to personalizing antibiotic treatments for individuals with standardized protocols in clinical practices. IMPORTANCE Nanopore targeted sequencing (NTS) is reported to be advantageous in detection speed and range over culture in prior published reports. Investigation of the clinical performance of NTS is deficient at present. In our study, cohort and systematic comparisons among three assays (culture, NTS, and Sanger sequencing) were analyzed retrospectively for the first time. We found that NTS undoubtedly has incomparable advantages in accurately detecting the causative pathogens in infectious samples, particularly in pleural and ascites fluid, bronchoalveolar lavage fluid, urine, and wound secretions, with a short turnaround time of 8–14 h. For sterile specimens like blood and cerebrospinal fluid (CSF), the NTS outcomes should be validated using other nucleic acid based detection technology. Overall, NTS might innovatively contribute to guiding early, targeted antimicrobial therapy with lower cost and reduce overuse of broad-spectrum antibiotics.

BackgroundThe measures put in place by health authorities to ensure the professionalism of doctors are important. Hospitals in China have included academic outputs in the promotion criteria to incentive medical clinicians to engage in scientific research so that to improve job performance (JP). However, such practice disproportionally focuses on academic outputs but ignores the force of needs fulfilled brought by intrinsic incentive. This study aims to discuss the realistic problem regarding the promotion mechanism and the potential drivers to clinical JP.MethodsThis study was based on multi-source data collection on clinical performance from electric medical record (EMR), person-environment (P–E) fit from the survey, and academic output from personnel files of ward clinicians (n = 244) of general public hospitals who sought for career progression in Shanghai in 2020. Independent-Sample t-test and chi-square test were used for comparison of two sample means or constituent ratio between promoted and not promoted clinicians. Linear multilevel regression was conducted to examine the relationship between clinical performance and academic outputs and P–E fit.ResultsClinicians who were promoted were more productive in producing academic outputs than those who were not (t = −5.075, p < 0.001). However, there was no difference in clinical performance between the two groups (t = −1.728 to 0.167, p > 0.05). The regression showed that academic outputs were not related to clinical performance, while higher P–E fit was associated with the improvement of various clinical performances.ConclusionThis study shows that P–E fit plays a more important role in facilitating clinical performance than academic performance and highlights the importance of intrinsic motivation of clinicians in achieving clinical performance.

Background: In Korea, laws for many medical technicians were revised in the Enforcement Decree of the Medical Technicians Act (MTA), which was announced on December 2018, whereas those related to dental hygienists remained unchanged. This study aimed to determine the awareness and opinions of dental hygienists regarding MTA.Methods: Dental hygienist were recruited as participants via convenient sampling in Seoul, Gyeonggi-do, and Chungcheong-do; data from 291 self-reported questionnaire responses were used for the final analysis. We investigated the participants’ general characteristics, awareness, and request for the amendment of the MTA. The compliance with the work scope specified in the MTA and level of demand for revision of the MTA were analyzed by independent t-test and one-way analysis of variance. For all statistical analyses, the significance level was set at 0.05.Results: For the 2018 MTA revision, 99 (34.02%) knew that dental treatment assistance and surgery assistance were excluded, whereas 192 (65.98%) did not know. The item “The current medical technician law must be revised” was scored 4.13±0.80 out of 5 points, and significant differences were identified according to the education level, career, and position (p＜0.05). The item “It is necessary to institutionalize the expanded work scope beyond the work scope of dental hygienists specified in the MTA” was scored 4.02±1.04 out of 5 points, and significant differences were identified according to age (p＜0.05).Conclusion: The participants wanted the MTA to be revised to reflect the real-world work performed by dental hygienists in the dental clinical field. The legal system must ensure the legal protection of the work area of the dental hygienist as an oral health professional, and recognize the legal work scope of the dental hygienist.

The importance of biopharmaceutical considerations in pharmaceutical development and drug characterization has been well recognized both by pharmaceutical industry and regulatory authorities as a tool to establish predictive relationships between drug product quality attributes (in vitro data) and its clinical performance (in vivo data). In the present paper, contemporary biopharmaceutics toolkit including in vivo predictive dissolution testing, Biopharmaceutics Classification System, physiologically based pharmacokinetic and biopharmaceutics modeling and simulation, in vitro-in vivo correlation and biowaiver, are reviewed with regards to relevant general principles and applicability. The recently introduced innovative strategy for patient-centric drug development using an integrated systems approach grounded in fundamental biopharmaceutics concepts, clinical insights and therapeutic drug delivery targets, described as Biopharmaceutics Risk Assessment Roadmap (BioRAM) is also presented. Further development in the field will benefit from joint efforts and exchange of knowledge and experiences between pharmaceutical industry and regulatory authorities for the common goal to accelerate development of effective and safe drug products designed in accordance with patients’ needs and expectations.

Background: Prior to the SARS-CoV-2 pandemic, the Xpert® Xpress Flu/RSV assay (GXA) was regularly used, while during the pandemic the Xpert® Xpress SARS-CoV-2/Flu/RSV (plus) assay was developed by Cepheid. In contrast to this new assay, the use of oropharyngeal ESwabs in combination with the Flu/RSV assay is designated as off CE-IVD label use, while these were used frequently in The Netherlands. Aim: To investigate the clinical performance of the GXA using 1,289 ESwab™ oropharyngeal samples for the detection of Influenza A virus, Influenza B virus and respiratory syncytial virus (RSV). Methods: The clinical performance of the GXA was prospectively investigated during the influenza seasons of 2017 and 2018 by testing fresh oropharyngeal samples, collected with ESwab™, contemporaneously with both the GXA and a laboratory developed Flu/RSV real time RT-PCR assay (LDA) (reference method). Results: 1,289 Samples from 1,213 patients (46% men, median age 73 (IQR 62–82)) were tested with both tests. Positive percent agreement (95% CI) was 98% (95%-99%) for Influenza A virus, 92% (88%-95%) for influenza B virus, and 88% (73%-96%) for RSV. Negative percent agreement was ≥ 99% for all three viruses. Ct-values of the GXA were on average higher than the LDA. Conclusion: This study showed a good clinical performance of the GXA in oropharyngeal samples for the detection of Influenza A and B virus. The positive percent agreement of the GXA for the detection of RSV in oropharyngeal samples was somewhat lower and in particular for the detection of RSV-A.

BackgroundThere is conflicting and limited information regarding factors that influence undergraduate nursing students' academic and clinical performance prior to entry to practice.ObjectiveTo identify factors influencing the academic and clinical performance of undergraduate nursing students throughout the course.DesignMixed methods study utilizing a retrospective cohort and a qualitative study.SettingMonash University, Melbourne, Australia.ParticipantsLongitudinal existing data of nursing undergraduate students who commenced in 2017 (n = 176) and 2018 (n = 76), and two focus groups with final year nursing students were analyzed.MethodsRetrospective students' records were used to determine the students' academic and clinical performance using the weighted average mark (WAM) of the theoretical and clinical components of the curriculum, separately. The WAM considered the year level of each unit and was scored out of 100. Multivariate linear regression was used to determine predictor factors of academic and clinical performance. Variables include entry cohort (with no previous nursing qualification vs. diploma of nursing), admission category (domestic vs. international), campus (metropolitan vs. outer metropolitan), and secondary school (year 12) results. Two focus group discussions were conducted and thematically analyzed.ResultsMore than two-thirds of the students were aged 18–20 years and mainly female. Almost 20% of the participants were international students. Students with higher secondary school (year 12) results and studying at the outer metropolitan campus achieved a higher academic performance while international students had significantly lower academic performance compared to domestic students. Students with a previous diploma of enrolled nursing and international students had lower clinical performance. Students identified that a comprehensive orientation, interactive curriculum, formal and informal support structure, and educator qualities influenced their academic and/or clinical performance.ConclusionsA supportive educational environment with an interactive curriculum may enhance students' academic and clinical performance and readiness for practice. Furthermore, targeted interventions for international students, those with lower secondary school (year 12) results, and those with a former diploma of nursing may be required to increase academic and clinical performance.

Due to the questionable durability of dental restorations, there is a need to increase the lifetime of composite restoration. The present study used diethylene glycol monomethacrylate/4,4′-methylenebis(cyclohexyl isocyanate) (DEGMMA/CHMDI), diethylene glycol monomethacrylate/isophorone diisocyanate (DEGMMA/IPDI) monomers, and bis(2,6-diisopropylphenyl)carbodiimide (CHINOX SA-1) as modifiers of a polymer matrix (40 wt% urethane dimethacrylate (UDMA), 40 wt% bisphenol A ethoxylateddimethacrylate (bis-EMA), and 20 wt% triethyleneglycol dimethacrylate (TEGDMA)). Flexural strength (FS), diametral tensile strength (DTS), hardness (HV), sorption, and solubility were determined. To assess hydrolytic stability, the materials were tested before and after two aging methods (I-7500 cycles, 5 °C and 55 °C, water and 7 days, 60 °C, 0.1 M NaOH; II-5 days, 55 °C, water and 7 days, 60 °C, 0.1 M NaOH). The aging protocol resulted in no noticeable change (median values were the same as or higher than the control value) or a decrease in the DTS value from 4 to 28%, and a decrease in the FS value by 2 to 14%. The hardness values after aging were more than 60% lower than those of the controls. The used additives did not improve the initial (control) properties of the composite material. The addition of CHINOX SA-1 improved the hydrolytic stability of composites based on UDMA/bis-EMA/TEGDMA monomers, which could potentially extend the service life of the modified material. Extended studies are needed to confirm the possible use of CHINOX SA-1 as an antihydrolysis agent in dental composites.

Training in healthcare skills can be affected by trainees’ workload when completing a task. Due to cognitive processing demands being negatively correlated to clinical performance, assessing mental workload through objective measures is crucial. This study aimed to investigate task-evoked changes in pupil size as reliable markers of mental workload and clinical performance. A sample of 49 nursing students participated in a cardiac arrest simulation-based practice. Measurements of cognitive demands (NASA-Task Load Index), physiological parameters (blood pressure, oxygen saturation, and heart rate), and pupil responses (minimum, maximum, and difference diameters) throughout revealed statistically significant differences according to performance scores. The analysis of a multiple regression model produced a statistically significant pattern between pupil diameter differences and heart rate, systolic blood pressure, workload, and performance (R2 = 0.280; F (6, 41) = 2.660; p < 0.028; d = 2.042). Findings suggest that pupil variations are promising markers to complement physiological metrics for predicting mental workload and clinical performance in medical practice.

Background: The Early Warning Score (EWS) system has been recommended for early identification tool of deterioration. However, its implementation has not been optimal; one of which is due to the low level of knowledge and understanding of EWS among nurses. Purpose: This study aimed to determine the effects of EWS tutorial simulation on nurses’ knowledge and clinical performance. Methods: This study employed a pretest posttest quasi-experimental design with a control group. Purposive sampling was used to recruit the samples of 42 respondents each in the intervention group and control group. The data were collected using the questionnaires to measure the knowledge and clinical performance, and analyzed using Chi square, Wilcoxon and Mann-Whitney tests. Results: The results showed that there were differences in the pre-test and post-test of knowledge and clinical performance in the intervention group and control group (p

The controversial role of ethics in clinical education and its ability to draw the attention of a large audience is inevitable. The issues and challenges of the COVID-19 pandemic have transformed the clinical education environment. This study was conducted to explore the challenges and ethical requirements of medical sciences education during the COVID-19 pandemic in 2020. The study was qualitative research and the instrument was a semi-structured interview. The participants included faculty members of the basic and clinical Sciences at Iran University of Medical Sciences. After 16 rounds of interviews, theoretical saturation was achieved. Qualitative data were analysed using conventional content analysis, which resulted in 81 preliminary codes and 28 sub-categories. Finally, two themes of "ethical challenges" and "ethical requirements", and 10 categories were achieved. The sub-categories were consisted of "being patient-centred", "social accountability of curriculums", "ethical challenges of the clinical environment", "the poor performance of the clinical faculty members and students", "being justice-centred", "raising awareness", "observing clinical research ethics", "preservation and promotion of mental health", "patient confidentiality", and "respect for individuals". We hope the ethical challenges in medical education that were created due to the emergence of Covid-19 can be reduced and eliminated by defining a framework for ethical requirements.