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In clinical anesthesia and the rescue of critically ill patients, arterial puncture and catheterization are the most commonly chosen ways to establish central arterial access for patients. Invasive arterial puncture and catheterization facilitate the grasp of real-time vital sign information of patients during surgery, which strengthens patient monitoring during surgery and improves safety. However, the traditional method of arterial puncture and cannulation through palpation of the radial artery is often prone to complications related to mechanical injury, such as hemorrhage, hematoma, and accidental perforation of the artery. Studies have shown that ultrasound-guided radial artery puncture and cannulation can shorten the puncture cannulation time, reduce the incidence of complications related to puncture cannulation, and improve the success rate of puncture cannulation. In order to verify it, this paper uses the experimental group and the control group to conduct comparative experiments and uses the neural network method to evaluate the effects of the two methods. As a more mature method of artificial intelligence, BP neural network is widely used in a wide range of applications and has the characteristics of strong generalization ability and fast convergence, so we choose it as the base model. The specific work of this paper is as follows: (1) in-depth study of the relevant theory of BP neural network (BPNN), focusing on the structure of BPNN and the working principle of algorithm; the problems to be solved in the clinical anesthesia effect evaluation have laid a theoretical foundation for the establishment of an improved BPNN evaluation model in the following chapters. (2) introduce the basic principle of genetic neural network, analyze the benefits of combining genetic neural network and BPNN; introduce in detail the process of genetic algorithm to optimize the weights and thresholds of BPNN, and establish a GA-BP evaluation model. The test proves the feasibility and superiority of the model. [ABSTRACT FROM AUTHOR]

Objective. In order to better adapt to clinical applications, this paper proposes a cross-validation decision-making fusion method of Vision Transformer and DenseNet161. Methods. The dataset is the most critical acetic acid image for clinical diagnosis, and the SR areas are processed by a specific method. Then, the Vision Transformer and DenseNet161 models are trained by the fivefold cross-validation method, and the fivefold prediction results corresponding to the two models are fused by different weights. Finally, the five fused results are averaged to obtain the category with the highest probability. Results. The results show that the fusion method in this paper reaches an accuracy rate of 68% for the four classifications of cervical lesions. Conclusions. It is more suitable for clinical environments, effectively reducing the missed detection rate and ensuring the life and health of patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: Quality indicators (QIs) can be used for measuring the quality of actions of healthcare providers. This systematic review gives an overview of such QIs measuring processes of care for chronic kidney disease (CKD), and identifies the QIs that have content, face, operational and/or predictive validity.Methods: PubMed and Embase were searched using a strategy combining the terms "quality of care," "quality indicators" and "chronic kidney disease". Papers were included if they focused on developing, testing or applying QIs for assessing the quality of care in adult patients with CKD not on renal replacement therapy.Results: Two hundred and seventy-three QIs from thirty-one papers were extracted, including QIs on adequate monitoring of kidney function and vascular risk factors, on indicated treatment, drug safety, adherence and referral to a specialist. The QIs that were considered content, face and operational valid focused on monitoring of glomerular filtration rate, albumin-creatinine ratio, lipid levels and blood pressure, the use of non-steroidal anti-inflammatory drugs, nitrofurantoin and biphosphonates in patients with CKD, and QIs on monitoring haemoglobin and treatment with angiotensin-converting-enzyme-inhibitors/angiotensin-receptor-II-blockers in patients with CKD and comorbidities. No QIs were tested for predictive validity. In addition, only two QIs focused on diet and no other QIs focused on lifestyle management.Conclusions: Based on this review, sufficiently validated QIs can be selected for measuring the quality of CKD care. This review provides insight in QIs that need further validation, and in areas of care where QIs are still lacking. [ABSTRACT FROM AUTHOR]

In this paper, the safety of Tripterygium wilfordii polyglycoside (TW) preparation was evaluated by combining literature research and evidence-based evaluation research, so as to provide evidence-based safety information of Tripterygium wilfordii polyglycoside preparation (nephroptosis) for government decision making and clinical application. In this paper, we propose a network structure inspired by the LSTM gate mechanism. All the research methods of the included references are evaluated by internationally recognized evaluation tools or standards. Prevalence was analyzed according to the type of intervention (e.g., time of administration) and route of administration. The results of this experiment provide methods and suggestions for the evaluation of traditional Chinese medicine nephroptosis in the future. [ABSTRACT FROM AUTHOR]

Since the discovery of mesenchymal stem cells (MSCs) in the 1970s, they have been widely used in the treatment of a variety of diseases because of their wide sources, strong differentiation potential, rapid expansion in vitro, low immunogenicity, and so on. At present, most of the related research is on mesoderm-derived MSCs (M-MSCs) such as bone marrow MSCs and adipose-derived MSCs. As a type of MSC, ectoderm-derived MSCs (E-MSCs) have a stronger potential for self-renewal, multidirectional differentiation, and immunomodulation and have more advantages than M-MSCs in some specific conditions. This paper analyzes the relevant research development of E-MSCs compared with that of M-MSCs; summarizes the extraction, discrimination and culture, biological characteristics, and clinical application of E-MSCs; and discusses the application prospects of E-MSCs. This summary provides a theoretical basis for the better application of MSCs from both ectoderm and mesoderm in the future. [ABSTRACT FROM AUTHOR]

The emergence of energy spectrum CT provides greater diagnostic value for clinical practice. Its advantage is that it can provide more functional imaging parameters and accurate image information for clinical practice, which represents a mainstream direction of CT technology development at present. This paper mainly studies the clinical trial of CAMPO Precision128 Max ENERGY spectrum CT combined with multiple parameters to evaluate the benign and malignant pleural effusion. This paper analyzes the principle and key performance parameters of energy spectrum CT imaging, the etiology of pleural effusion, and its conventional diagnostic methods and uses energy spectrum CT to detect the benign and malignant pleural effusion. In this paper, two groups of patients with different types of pleural effusions were scanned by line spectrum chest CT scans, and energy spectrum analysis software was used to measure and calculate the CT values of conventional mixed energy values of ROI of patients with pleural effusions. For the CT value and energy curve slope measurement value of different single energy keV, independent sample t-test was used to analyze and compare the two sets of data, and finally it has been found out that the two sets of data were similar. According to the experimental results, the curves of energy spectrum of the two groups of data are similar in the descending curve of bow-back. The slope of energy spectrum curve in the leakage group was lower than that in the exudate group, showing statistical significance (P < 0.05). The slope of energy spectrum curve K in the malignant pleural effusion group was significantly higher than that in the benign pleural effusion group, and the difference was statistically significant (P < 0.05). The trend of energy spectrum curves of the two is roughly the same, while at the high energy level, part of the energy spectrum curves of the two are overlapped. The above conclusion indicates that energy spectrum CT plays a certain role in the differential diagnosis of pleural effusion. At the same time, energy spectrum CT also provides a noninvasive and rapid examination method for clinical differentiation of pleural effusion, which has certain clinical application value and prospect. [ABSTRACT FROM AUTHOR]

The booming development of 3D virtual technology provides the basis for the innovation of teaching mode of clinical medicine. Integrating 3D virtual technology into the clinical education teaching of medical students can help medical students learn clinical expertise more intuitively, enrich practical experience, improve hands-on ability, and make up for the shortcomings of traditional medical teaching. However, the traditional 3D modeling method has the problems of sparse and insufficient accuracy of output results, which greatly limits the specific application of 3D virtual technology in clinical teaching. Therefore, this paper addresses the shortcomings of previous 3D virtual technology in 3D modeling of organs, introduces deep learning, and then proposes a pyramidal shape perception network with the ability to generate samples on point clouds. Experimental results show that the proposed model not only has a large improvement in accuracy but also shows a high degree of confidence in providing real-time feedback of local image attributes. [ABSTRACT FROM AUTHOR]

Adolescents and children worldwide are threatened by osteosarcoma, a tumor that predominantly affects the long bone epiphysis. Osteosarcoma is the most common and highly malignant bone tumor in youngsters. Early tumor detection is the key to effective treatment of this disease. The discovery of biomarkers and the growing understanding of molecules and their complex interactions have improved the outcome of clinical trials in osteosarcoma. This article describes biomarkers of osteosarcoma with the aim of positively influencing the progress of clinical treatment of osteosarcoma. Femoral bone tumor is a typical condition of osteosarcoma. Due to the wide range of femoral stem types, complexities in the distal femur, and tumors in the rotor part of femur, physicians following the traditional clinical approach face difficulties in removing the lesion and fixing the femur with resection of the tumor segment. In this paper, the effect of small doses of different concentrations of lidocaine anesthesia in patients undergoing lumpectomy for osteosarcoma femoral tumor segments is investigated. A computer-based artificial intelligence method for automated determination of different concentration levels of lidocaine anesthesia and amputation of osteosarcoma femoral tumor segment is proposed. Statistical analysis is carried on the empirical data including intraoperative bleeding, intraoperative and postoperative pain scores, surgical operation time, postoperative complications, patient satisfaction, and local anesthetic dose. The results showed that the patients in the study group had low intraoperative bleeding, short operation time, low postoperative hematoma formation rate, high patient satisfaction, higher dosage of anesthetic solution, and low dosage of lidocaine. Results revealed that mean arterial pressure and heart rate in extubating and intubating were significantly lower in the observation group than in the control group, and a significant difference (P < 0.05) was observed between the two groups. This proves that the proposed algorithm can adequately reduce bleeding, alleviate postoperative pain, shorten operation time, reduce complications, accelerate recovery, and ensure better treatment results. [ABSTRACT FROM AUTHOR]

The paper aims to build a nursing information platform (NIP) for general surgery (GS) patients and explore its clinical application effect based on cloud computing (CC) technology. Specifically, the present work first analyzes and expounds on the characteristics of GS patients, the CC concept, the three-tier service mode of CC, and the cloud data center (CDC). Secondly, based on the principle of the overall system design, the evaluation indexes of medical care end, patient end, family end, and management end are constructed using Visual Studio 2010. Thirdly, the expert evaluation and user evaluation methods are selected to analyze the clinical application effect of the proposed system. Finally, SPSS is used to analyze the effect of the proposed system. The results of the first and second rounds of the expert evaluation show that the authority coefficient of experts is greater than 0.7, which indicates that the degree of expert authority is good. The proposed CC-based GS patient-oriented NIP system is universal. The evaluation results of 20 users have shown 15 doctors and nurses, 14 patients, and 18 family members, who mostly still support applying the proposed CC-based GS patient-oriented NIP system and believe that the system brings convenience and improves work efficiency. In short, more incentives should be taken to build a NIP for GS patients. [ABSTRACT FROM AUTHOR]

Maternity is a special category of population and the criteria for emergency prescreening cannot be directly applied to adults. Therefore, a set of criteria for grading maternal conditions should be established. In this paper, we have combined the semantic analysis technique of BiLSTM-Attention neural network and fuzzy defect risk assessment method, to develop a hybrid approach, to preprocess the text of emergency obstetric prescreening information. Furthermore, we have used word2vec to characterize the word embedding vector and highlight the features related to the degree of defects of emergency obstetric prescreening information through the attention mechanism and obtain the semantic feature vector of the warning information. BiLSTM-Attention neural network has the dual advantages of extracting bidirectional semantic information and giving weight to important judgment information which has effectively improved the semantic understanding accuracy. Experimental tests and application analysis show that the judgment model which is based on proposed method has accurately classified and graded the defects of emergency obstetric prescreening alerts. Additionally, the accuracy and microaverage value are used as evaluation indexes. [ABSTRACT FROM AUTHOR]

This paper presents an in-depth study and analysis of clinical care of patients with hyperthyroidism using wearable medical devices in the context of medical IoT scenarios. According to the use scenario of the gateway and the connectivity of the equipment, the hardware architecture, hardware interfaces, functionality, and performance of the gateway were briefly designed, so as to monitor patients with hyperthyroidism more comprehensively and save labor costs. The gateway can provide access to different devices and adaptation functions to different hardware interfaces and provide hardware support for the subsequent deployment of the proposed new medical communication protocols and related information systems. A medical data convergence information system based on multidevice management and multiprotocol parsing was designed and implemented. The system enables the management and configuration of different medical devices and access to data through the targeted parsing of the underlying medical device communication protocols. The system also provides the automatic adaptation of multiple types of underlying medical device communication protocols and automatic parsing of multiple versions and can provide multiple devices to process fused data streams or device information and data from a single device. The use of event-driven asynchronous communication eliminates the tight dependency on service invocation in the synchronous communication approach. The use of a metadata-based data model structure enables model extensions to accommodate the impact of iterative business requirements on the database structure. Real-time patient physiological data transmission for intraoperative monitoring based on the MQTT protocol and video transmission for intraoperative patient monitoring based on the RTMP protocol were implemented. The development of the intelligent medical monitoring service system was completed, and the system was tested, optimized, and deployed. The functionality and performance of the system were tested, the performance issue of slow query speed was optimized, and the deployment of the project using Docker containers was automated. [ABSTRACT FROM AUTHOR]

Teleorthodontics represents the orthodontic care system involving remote management of orthodontic treatment. Despite skepticism, there are several advantages of including teleorthodontics in the clinical orthodontic practice. In the present review, we discuss the lights and shadows of this new communication healthcare system and its applications in the field of orthodontics that is destined to change the future of our clinical practice. For this purpose, we have provided a point-to-point analysis based on data from the most valuable scientific evidence on this topic. The information and data discussed in the present paper were obtained from the most relevant studies evaluating the performance of teleorthodontics and remote monitoring systems in clinical practice. [ABSTRACT FROM AUTHOR]

Colorectal cancer is a high death rate cancer until now; from the clinical view, the diagnosis of the tumour region is critical for the doctors. But with data accumulation, this task takes lots of time and labor with large variances between different doctors. With the development of computer vision, detection and segmentation of the colorectal cancer region from CT or MRI image series are a great challenge in the past decades, and there still have great demands on automatic diagnosis. In this paper, we proposed a novel transfer learning protocol, called CST, that is, a union framework for colorectal cancer region detection and segmentation task based on the transformer model, which effectively constructs the cancer region detection and its segmentation jointly. To make a higher detection accuracy, we incorporate an autoencoder-based image-level decision approach that leverages the image-level decision of a cancer slice. We also compared our framework with one-stage and two-stage object detection methods; the results show that our proposed method achieves better results on detection and segmentation tasks. And this proposed framework will give another pathway for colorectal cancer screen by way of artificial intelligence. [ABSTRACT FROM AUTHOR]

Abstract: Problem: The aim of this concept analysis was to clarify failure to rescure as a nurse‐sensitive indicator. Although the concept of failure to rescue as a nurse‐sensitive outcome has appeared in the nursing literature for over a decade, conceptual clarity is needed to address its variable and ambiguous use in health care. Methods: Walker and Avant's eight‐stage method of concept analysis was used to explore the concept of failure to rescue in nursing practice. Twenty‐one papers were retrieved from Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE databases and selected for review and synthesis. Results: Failure to rescue as a nurse‐sensitive indicator was found to be a “failing to rescue” process characterized by a cascade of events, including four key attributes: (1) errors of omission in care, (2) failure to recognize changes in patient condition, (3) failure to communicate changes, and (4) failures in clinical decision making. Conclusions: Nurses have a pivotal role in “failing to rescue” through early recognition, escalation, and intervention of subtle changes signaling complications. Upstream strategies, such as the use of early warning sign indicators, structured communication, and teamwork, shift the discourse from failure to rescue, to processes in nursing practice of good catch events. [ABSTRACT FROM AUTHOR]

The novel coronavirus disease 2019 (COVID-19) is a contagious disease that has caused thousands of deaths and infected millions worldwide. Thus, various technologies that allow for the fast detection of COVID-19 infections with high accuracy can offer healthcare professionals much-needed help. This study is aimed at evaluating the effectiveness of the state-of-the-art pretrained Convolutional Neural Networks (CNNs) on the automatic diagnosis of COVID-19 from chest X-rays (CXRs). The dataset used in the experiments consists of 1200 CXR images from individuals with COVID-19, 1345 CXR images from individuals with viral pneumonia, and 1341 CXR images from healthy individuals. In this paper, the effectiveness of artificial intelligence (AI) in the rapid and precise identification of COVID-19 from CXR images has been explored based on different pretrained deep learning algorithms and fine-tuned to maximise detection accuracy to identify the best algorithms. The results showed that deep learning with X-ray imaging is useful in collecting critical biological markers associated with COVID-19 infections. VGG16 and MobileNet obtained the highest accuracy of 98.28%. However, VGG16 outperformed all other models in COVID-19 detection with an accuracy, F1 score, precision, specificity, and sensitivity of 98.72%, 97.59%, 96.43%, 98.70%, and 98.78%, respectively. The outstanding performance of these pretrained models can significantly improve the speed and accuracy of COVID-19 diagnosis. However, a larger dataset of COVID-19 X-ray images is required for a more accurate and reliable identification of COVID-19 infections when using deep transfer learning. This would be extremely beneficial in this pandemic when the disease burden and the need for preventive measures are in conflict with the currently available resources. [ABSTRACT FROM AUTHOR]

Physical stimulation has been widely used in clinical medicine and healthcare due to its noninvasiveness. The main applications of physical stimulation in the oral cavity include laser, ultrasound, magnetic field, and vibration, which have photothermal, cavitation, magnetocaloric, and mechanical effects, respectively. In addition, the above four stimulations with their unique biological effects, which can play a role at the gene, protein, and cell levels, can provide new methods for the treatment and prevention of common oral diseases. These four physical stimulations have been used as important auxiliary treatment methods in the field of orthodontics, implants, periodontal, dental pulp, maxillofacial surgery, and oral mucosa. This paper systematically describes the application of physical stimulation as a therapeutic method in the field of stomatology to provide guidance for clinicians. In addition, some applications of physical stimulation in specific directions are still at the research stage, and the specific mechanism has not been fully elucidated. To encourage further research on the oral applications of physical stimulation, we elaborate the research results and development history of various physical stimuli in the field of oral health. [ABSTRACT FROM AUTHOR]

Abstract: Diffusion‐weighted MRI is a key diagnostic component of clinical medicine. Radiologists use models of the effects of diffusion weighting to connect the decay of the signal intensity in tissues with macroscopic (diffusion tensor imaging) and microscopic (q‐space imaging) structures. This multi‐scale problem has stimulated the creation of many diffusion models spanning phenomenon in cells, in tissues, and in organs. Such models can be heuristic or based on simulations, stochastic processes, histological structure or physical and physiological constraints. The goal of this paper is to provide an overview of these approaches by considering several different classes of mathematical models (linear, nonlinear, integer, and fractional orders) that can, and have in some cases, been used to fit diffusion attenuation in complex biological tissues, such as brain white and gray matter. The focus here is not on solving the Bloch‐Torrey equation or on fitting curves to data, but on the choices (Gaussian, anomalous, isotropic, anisotropic) one often has to make when beginning the analysis of diffusion data. It is hoped that this presentation, while oversimplified, will be of use to students and to new investigators who seek an introduction to diffusion attenuation model selection and characterization. Examples are given that illustrate the relationship between the functional form of the diffusion decay rate and, in the case of a Stejskal‐Tanner gradient pulse sequence, the expected signal decay. Model limitations are noted and connections to more advanced treatments of diffusion modeling methods are provided. [ABSTRACT FROM AUTHOR]

Objective. After replantation of severed fingers in infants, the utility model patent upper limb restrictive brace-assisted bed rest braking, combined with psychological intervention, can alleviate children's anxiety, so as to reduce the occurrence of vascular crisis. Methods. The study period was from April 2015 to July 2018. In this paper, 30 children with finger injuries in hand surgery in the CIS electronic medical record system of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital were selected as the research objects. Replantation was performed in 30 infants with severed fingers. Among them, 15 cases were applied with the method of aircraft chest arm gypsum splint combined with sedative drug braking and the utility model patented product upper limb restrictive brace fixation-assisted bed rest braking, and the method of psychological intervention was applied at the same time. Results. Among the 15 fingers in the control group, 6 had vascular crisis and 1 in the experimental group. The incidence of vascular crisis in the experimental group was lower, and the difference between the two groups was statistically significant (P < 0.05). The patients were followed up for 9~18 months, with an average of 9.72 ± 1.07 months. In the control group, 15 cases of severed fingers survived, and there were 13 cases of replantation finger necrosis in 2 cases of intractable arterial crisis. In the experimental group, 14 cases of severed fingers survived in 15 cases and there was 1 case of replanted finger necrosis in intractable arterial crisis after operation. There was no significant difference in the survival rate between the two groups (P > 0.05). In addition, the replanted finger function was evaluated. In the control group, 9 cases were excellent, 4 cases were good, and 1 case was fair. In the experimental group, 14 cases were excellent, 1 case was good, and 0 case was fair. The functional evaluation of the experimental group was better than that of the control group, and the difference between the two groups was statistically significant (P < 0.05). Conclusion. For infants after replantation of severed fingers, the application of the utility model patented product upper limb restrictive brace can effectively make up for the insufficient fixation of aircraft chest arm gypsum splint, reduce the occurrence of vascular crisis, and assist children in bed. In addition, the application of psychological intervention can reduce children's postoperative crying and is conducive to children's postoperative recovery. [ABSTRACT FROM AUTHOR]

The introduction of top-down centrally driven solutions to governance of healthcare, at the same time as increasing policy emphasis on greater 'bottom up' patient and public involvement in all aspects of healthcare, has set up complex tensions for policy implementation and healthcare practice. This paper explores the interplay of these agendas in the context of changes in primary healthcare services provided by the National Health Service in England. Specifically, it looks at service user involvement in a qualitative study of the professional response to changes in the governance and incentives in the care of people with long-term conditions. Service users influenced and guided the study at local and national levels. Vignettes of patient stories developed by service users informed in-depth interviews with 56 health and social care professionals engaged in the development of local policies and services for people with complex long-term illness, and themes generated by cross case analysis were validated through service users. The findings presented here focus on four themes about risk and comparison of professionals' and service users' perspectives of the issues: managing risks/consistent support, the risks of letting go/feeling in control, professional identity/helping people to help themselves, and managing expectations/professionals losing out. In this study, service user involvement added value by validating understandings of governance, framing debates to focus on what matters at the point of care and enabling perspective sharing and interaction. We suggest that more collaborative forms of governance in healthcare that take account of service user perspectives and enable interaction with professional groups could help validate processes of quality assurance and provide motivation for continuous quality improvement. We offer a model for 'opening up' collaborative projects to evaluation and critical reflection of the interrelationships between the context, methods and outcomes of service user involvement. [ABSTRACT FROM AUTHOR]

Aim: To describe midwifery students’ practice experience and to explore facilitators and barriers to positive clinical learning experiences. Background: Practice experience is a vital component of every midwifery course. Course dissatisfaction and attrition of midwifery students has been attributed to sub‐optimal practice experiences. Events or actions experienced by midwifery students that trigger dissatisfaction and attrition need to be identified. Evaluation: A meta‐synthesis was based on that developed by Noblit and Hare. Key issues: Students perceive workplaces as poorly prepared for their arrival and subsequent support. Students’ experience in the practice setting is influenced by the existing workplace culture. Workplace culture influences institutional functioning and individuals within the culture. Enculturation of students into the midwifery culture and subsequent learning is affected by the support received. Conclusions: The practice experience of midwifery students was profoundly influenced by workplace culture. Students tended to have polarized accounts of their experience that were predominantly negative. Implications for nursing (midwifery) management: To provide an optimal environment for midwifery students; midwifery managers and individual midwives need to be aware of the facilitators and barriers to midwifery student development in the practice setting. [ABSTRACT FROM AUTHOR]

Extracting retinal vessels accurately is very important for diagnosing some diseases such as diabetes retinopathy, hypertension, and cardiovascular. Clinically, experienced ophthalmologists diagnose these diseases through segmenting retinal vessels manually and analysing its structural feature, such as tortuosity and diameter. However, manual segmentation of retinal vessels is a time-consuming and laborious task with strong subjectivity. The automatic segmentation technology of retinal vessels can not only reduce the burden of ophthalmologists but also effectively solve the problem that is a lack of experienced ophthalmologists in remote areas. Therefore, the automatic segmentation technology of retinal vessels is of great significance for clinical auxiliary diagnosis and treatment of ophthalmic diseases. A method using SegNet is proposed in this paper to improve the accuracy of the retinal vessel segmentation. The performance of the retinal vessel segmentation model with SegNet is evaluated on the three public datasets (DRIVE, STARE, and HRF) and achieved accuracy of 0.9518, 0.9683, and 0.9653, sensitivity of 0.7580, 0.7747, and 0.7070, specificity of 0.9804, 0.9910, and 0.9885, F 1 score of 0.7992, 0.8369, and 0.7918, MCC of 0.7749, 0.8227, and 0.7643, and AUC of 0.9750, 0.9893, and 0.9740, respectively. The experimental results showed that the method proposed in this research presented better results than many classical methods studied and may be expected to have clinical application prospects. [ABSTRACT FROM AUTHOR]

Objective. Intrahepatic cholestasis of pregnancy (ICP) significantly impacts the maternal and fetal safety. Research on the role of clinical pharmacists in guiding drug therapy for this condition remains limited. This study aimed to evaluate the effectiveness of graded pharmaceutical care for women with intrahepatic cholestasis of pregnancy and to provide a theoretical foundation for clinical pharmacist services. Study Design. This study comprises a pre‐and‐post analysis of women with intrahepatic cholestasis of pregnancy (ICP) treated between December 2019 and June 2023 at a tertiary hospital in Jiangsu province. Each group consisted of 102 participants. The control group received standard treatment, while the guardianship group received graded pharmacological care provided by a clinical pharmacist. The effectiveness of pharmacological monitoring by clinical pharmacists was assessed by comparing and analyzing clinical outcome indicators, quality management indicators, safety indicators, and economic factors. Results. The guardianship group exhibited a noteworthy 12.8% reduction in combined adverse pregnancy outcome and more effective management of total prenatal bile acids compared to the control group (16.05 µmol/L vs. 22.85 µmol/L, P < 0.05). The guardianship group displayed superior rationalization of therapeutic drugs and medication duration (P < 0.05). The cost‐benefit analysis revealed a favorable economic impact concerning medication costs but did not indicate economic significance regarding total inpatient costs. Conclusion. The implementation of a graded pharmaceutical care model by a clinical pharmacist holds the potential to enhance outcomes for women experiencing intrahepatic cholestasis during pregnancy, mitigate adverse pregnancy results, optimize the rational utilization of therapeutic medications, and yield positive economic results. [ABSTRACT FROM AUTHOR]

Introduction. Increased life expectancy leads to consequent long-term care needs, where informal caregivers may experience overload and strain associated with caregiving, influencing the well-being and health of individuals and eventually leading to an effort to fulfill their role. Within this context, a condition called caregiver role strain has been identified. Objective. To investigate the clinical indicators of the nursing diagnosis caregiver role strain as described in the literature. Materials and Methods. This study is a systematic review of diagnostic accuracy conducted in October 2023, following the recommendations of the Joanna Briggs Institute. The review protocol was registered and approved in the Prospective International Register of Systematic Reviews under registration number CRD42022377411. The QUADAS-2 tool was used to assess the risk of bias and quality of the studies. The databases included SciVerse Scopus (Elsevier), MEDLINE/PubMed (via National Library of Medicine), Latin American and Caribbean Health Sciences Literature (LILACS), CINAHL with Full Text (EBSCO), and PsycINFO (APA), with 48 articles included for quantitative synthesis. Results. Fourteen defining characteristics were identified from the literature, with a predominance of the following indicators: depressive symptoms (45.8%), anxiety (41.6%), physical decline (31.2%), fatigue (22.9%), disturbed sleep pattern (20.8%), emotional disturbance, and irritability (16.6%). The findings suggest that, within the defined circumstances and limitations of the study, examining defining characteristics for the diagnosis caregiver role strain holds potential for advancing scientific knowledge regarding human responses to the challenges experienced by caregivers. Evidence for Practice. The study aligns with clinically relevant indicators crucial for refining and updating the diagnosis, thereby enhancing its level of evidence and clinical accuracy. Simultaneously, it supports addressing the gap in caregiver support and standardized nursing care plans. [ABSTRACT FROM AUTHOR]

Cutaneous neuroendocrine carcinoma (cNEC) is rarely seen in the external ear. In this paper, we newly describe a patient with cNEC in his right external auditory canal, followed by a further discussion on the clinical features, diagnosis, and treatments of cNEC of the external ear. A review of the literature showed that cNEC of the external auditory canal generally presents as asymptomatic and that pathology yields themost confirmative diagnosis. A wide resection with adjuvant radiotherapy and chemotherapy is recommended. The overall prognosis of this condition is poor. [ABSTRACT FROM AUTHOR]

Aim To report a literature study of leadership for learning in clinical practice in the United Kingdom. Background Previous research in the United Kingdom showed that the ward sister was central to creating a positive learning environment for student nurses. Since the 1990s, the ward mentor has emerged as the key to student nurses' learning in the United Kingdom. Methods A literature study of new leadership roles and their influence on student nurse learning (restricted to the United Kingdom) which includes an analysis of ten qualitative interviews with stakeholders in higher education in the United Kingdom undertaken as part of the literature study. Results Learning in clinical placements is led by practice teaching roles such as mentors, clinical practice facilitators and practice educators rather than new leadership roles. However, workforce changes in clinical placements has restricted the opportunities for trained nurses to role model caring activities for student nurses and university based lecturers are increasingly distant from clinical practice. Conclusions and implications for practice Leadership for learning in clinical practice poses three unresolved questions for nurse managers, practitioners and educators - what is nursing, what should student nurses learn and from whom? Implications for nursing management Leadership for student nurse learning has passed to new learning and teaching roles with Trusts and away from nursing managers. This has implications for workforce planning and role modelling within the profession. [ABSTRACT FROM AUTHOR]

This paper uses cloud computing to build and design remote clinical care technology, and the study refines the evaluation approach for the elements and builds an evaluation prototype for the strategy, uses service design theory to improve the design of the service part of the assistive system, summarizes the list of requirements based on system design and service design, and designs a service design prototype. Through design practice, the detailed design of the software interaction interface and the auxiliary product of the care assistance system based on the prototype are investigated. Based on the user perspective, the strategy of meeting user expectations and improving user information literacy is proposed; based on the social network perspective, the strategy of establishing a long-term mechanism for smart medical operation and improving the information interaction network environment is proposed; and based on the system service perspective, the strategy of optimizing the system function design and innovating the service model is proposed. Compared with the traditional written patient handover, the application of MNIS under cloud computing can significantly shorten the handover time of surgical patients, improve the standardized rate of surgical safety verification execution and the qualified rate of nursing documents, while the rate of standardized application of prophylactic antibiotics is also significantly higher than that of the control group. The questionnaire survey of nursing staff in the operating room showed that clinical nursing staff was generally satisfied with the clinical application of MNIS under cloud computing, with an average satisfaction score of 64.5 to 11.3, and an average score of 3.58 to 0.54 for each item. Among them, pre-application training of MNIS, departmental support for MNIS, and its ease of verification in surgical patients were the three main factors favoring the clinical application of MNIS in the operating room with cloud computing, while barriers to wireless network connectivity, inconvenient PDA input, and small screen size were the three main drawbacks affecting its application. The determined clinical evaluation index system of MNIS in the operating room is innovative, which not only includes clinical care indicators but also covers general hardware and software indicators, which can effectively reflect the practical application capability of mobile terminal clinical and user experience feelings, and the evaluation index system is comprehensive. [ABSTRACT FROM AUTHOR]

In recent years, the incidence of thyroid cancer (TC) patients has gradually increased, and it ranks first among all endocrine tumors. TC has no obvious characteristics at the initial stage of onset. Thyroid tumors (TT) have formed when they are discovered, and they are easy to see when they are diagnosed. The disease is confused, so it is necessary to rely on imaging methods for tumor diagnosis. Contrast-enhanced ultrasound (CEUS), as the most commonly used imaging method in current clinical testing, is simple, safe, highly sensitive, can accurately display tumor conditions, and has high clinical value in the judgment of TC tumors. This article uses meta-analysis to select 63 published studies on CEUS to determine benign and malignant (BAM) TT to analyze and explore its clinical application value. This article understands the analysis of BAM TT and its diagnostic methods, clarifies the diagnostic efficiency of CEUS for TT, imaging methods, and imaging characteristics, and uses statistical analysis to analyze its heterogeneity. In this paper, the meta-analysis of CEUS in judging BAM TT is mainly based on references. The sensitivity, specificity, and difference of CEUS in diagnosing BAM TT are analyzed. Real-time elastography (RTE) is the comparison experiment object, and CEUS is used to compare the diagnostic efficiency, pathological results, and diagnostic efficiency of thyroid nodules in CEUS mode. The results of the study show that the nodule with higher diagnostic sensitivity is the echo feature, with a sensitivity of 97.73%, followed by the halo feature, with a sensitivity of 86.36%. In terms of diagnostic specificity, the boundary feature is the most specific. The specificity is 89.47%. In the judgment of BAM tumor nodules, the most obvious difference is the echo feature, which is as high as 14.09, followed by the acoustic halo feature, and the difference is 10.65. [ABSTRACT FROM AUTHOR]

Flexible ureteroscopy (FURS) has been developed and has become a preferred routine procedure for both diagnosis and treatment of kidney stones and other renal diseases inside the urinary tract. The traditional manual FURS procedure is highly skill-demanding and easily brings about physical fatigue and burnout for surgeons. The improper operational ergonomics and fragile instruments also hinder its further development and patient safety enhancement. A robotic system is presented in this paper to assist the FURS procedure. The system with a master-slave configuration is designed based on the requirement analysis in manual operation. A joint-to-joint mapping strategy and several control strategies are built to realize intuitive and safe operations. Both phantom and animal experiments validate that the robot has significant advantages over manual operations, including the easy-to-use manner, reduced intraoperative time, and improved surgical ergonomics. The proposed robotic system can solve the major drawbacks of manual FURS. The test results demonstrate that the robot has great potential for clinical applications. [ABSTRACT FROM AUTHOR]

Background. Menopause is typically accompanied by significant systemic and oral manifestations, including hormonal changes and increased susceptibility to periodontal disease, which may involve inflammatory biomarkers like aspartate aminotransferase (AST) and osteocalcin in gingival crevicular fluid (GCF). The study is aimed at evaluating the effectiveness of regular inoculation of polyunsaturated fatty acids (PUFAs) as an adjunctive treatment for menopausal women's periodontitis. Methods. Twenty elderly women with chronic periodontitis were split evenly into two groups by random assignment. Patients in group II (the research group) were given soft gelatin capsules containing PUFAs to be consumed directly once daily for 12 months, as opposed to group I (the control group), who received soft gelatin capsules containing some olive oil (placebo). Scaling and root planning (SRP) were used to address periodontal disease in all cases. Results. At baseline, six and twelve months after treatment, clinical indicators and AST and osteocalcin amounts in the GCF were noted. By the conclusion of the research period, all observed clinical measurements had changed significantly and improved. In addition, there had been a significant decrease in AST levels and a nonsignificant decrease in osteocalcin levels in group II compared to group I. Conclusions. Menopausal women with periodontitis who take omega-3 fatty acid supplements in addition to SRP have better oral health. Significant improvements in clinical indicators and a notable decrease in AST levels within the GCF were observed. However, further research with larger cohorts and extended duration is needed to validate these findings and explain potential mechanisms. This trial is registered with NCT06254118. [ABSTRACT FROM AUTHOR]

Objective. To analyze the impact of clinical supervision on the improvement of positivity rates and quality indicators of nursing practice for medical-surgical patients in a private healthcare unit. Methodology. Prospective interventional cohort study with a quantitative approach, to study the effect of supervision on indicators and indices of quality of care. Materials and Method. A quantitative approach through an interventional prospective cohort study and simple random sampling. Results. Of the n = 764 records of audits conducted on the quality of nursing practice that were analyzed, there were higher scores and positivity indices in both services after the implementation of clinical supervision. Conclusion. The practice of clinical supervision allows for the strategic monitoring of teams according to the results of audits on nursing care practices, thus raising the indices of positivity and quality indicators of nursing care practices with a direct impact on the patient. [ABSTRACT FROM AUTHOR]

Optical coherence tomography (OCT) is an optics-based imaging technique, which may be called an "optical biopsy." It can be used to acquire structural information about a tissue at a resolution comparable to histopathology. OCT is based on the principle of low-coherence interferometry where near-infrared (NIR) light is shown on a tissue sample and then cross-sectional images are obtained based on backscattered light and echo time delay. Two main types of OCT are characterized as time-domain OCT (TD-OCT) and Fourier-domain OCT (FD-OCT). The applications of OCT in dentistry can be broadly divided into two groups, i.e., assessment of pathologies and assessment of surfaces and interfaces. Lately, OCT has made its transition from experimental laboratories to mainstream clinical applications. Starting from the short-term training courses, clinicians working in specialities like oral pathology, oral medicine, and oral implantology may find it a useful tool for their practices. It is now clear that OCT will be considered a gold standard diagnostic tool for the detection and characterization of several conditions and lesions of the orofacial region. However, the next challenge will be to incorporate it into the undergraduate and postgraduate curriculum and train dental healthcare staff in the use of these devices. [ABSTRACT FROM AUTHOR]

Objective. Lung cancer is commonly diagnosed and is the leading cause of cancer-related death, morbidity, and burden of disease globally. There is an ongoing need to ensure patients receive optimal evidence-based care and to identify and reduce unwarranted clinical variation to achieve best possible outcomes. The EnRICH program has developed evidence-based clinical quality indicators to measure processes and outcomes of lung cancer care, and a feedback dashboard to report comparative performance data, which highlight variation in both care and outcomes. The aims of this study were to evaluate the acceptability and utility of the quality indicators and feedback dashboard and identify benchmarks for performance monitoring and priorities for future quality improvement interventions to address observed clinical variation. Method. Clinicians from lung cancer multidisciplinary teams (MDTs) at six tertiary clinical sites across regional and metropolitan NSW were invited to participate in evaluation interviews. Interviews were conducted via videoconference and recorded with consent. Data were analysed thematically using framework methods. Results. Thirteen clinicians participated in interviews, with representation from each clinical site and specialty. All participants considered the quality indicators to be clinically meaningful. Three main themes were identified: (i) the importance of timely, local, quality data; (ii) implementable versus nonimplementable clinical practice changes; and (iii) the need for ongoing performance monitoring. Clinicians prioritised two areas of unwarranted clinical variation that could be immediately addressed through easily implementable quality improvement interventions to positively impact patient care: (i) a process to ensure that all stage III patients are discussed by a multidisciplinary team prior to commencing treatment; (ii) a referral pathway to palliative care within eight weeks for patients diagnosed with stage IV disease. The importance of lung cancer nurse specialists for improved care coordination was highlighted. Conclusion. Clinicians would like to continue to receive close-to-real-time quality data for ongoing performance monitoring to identify and address unwarranted clinical variation. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a progressive condition characterized by the gradual deterioration of kidney functions, potentially leading to kidney failure if not promptly diagnosed and treated. Machine learning (ML) algorithms have shown significant promise in disease diagnosis, but in healthcare, clinical data pose challenges: missing values, noisy inputs, and redundant features, affecting early-stage CKD prediction. Thus, this study presents a novel, fully automated machine learning approach to tackle these complexities by incorporating feature selection (FS) and feature space reduction (FSR) techniques, leading to a substantial enhancement of the model's performance. A data balancing technique is also employed during preprocessing to address data imbalance issue that is commonly encountered in clinical contexts. Finally, for reliable CKD classification, an ensemble characteristics-based classifier is encouraged. The effectiveness of our approach is rigorously validated and assessed on multiple datasets, and the clinical relevancy of the strategy is evaluated on the real-world therapeutic data collected from Bangladeshi patients. The study establishes the dominance of adaptive boosting, logistic regression, and passive aggressive ML classifiers with 96.48% accuracy in forecasting unseen therapeutic CKD data, particularly in early-stage cases. Furthermore, the effectiveness of the FSR technique in reducing the prediction time significantly is revealed. The outstanding performance of the proposed model demonstrates its effectiveness in addressing the complexity of healthcare CKD data by incorporating the FS and FSR techniques. This highlights its potential as a promising computer-aided diagnosis tool for doctors, enabling early interventions and improving patient outcomes. [ABSTRACT FROM AUTHOR]

The aim of this paper is to provide a thorough summary of published studies that have assessed the efficacy of adjunctive therapies used in addition to cervical cerclage as a preventive measure for preterm birth. We limited our paper to patients treated with cerclage plus an additional prophylactic therapy compared to a reference group of women with cerclage alone. The specific adjunctive therapies included in this systematic review are progesterone, reinforcing or second cerclage placement, tocolytics, antibiotics, bedrest, and pessary. We searched PubMed and Cochrane databases without date criteria with restriction to English language and human studies and performed additional bibliographic review of selected articles and identified 305 total studies for review. Of those, only 12 studies compared the use of an adjunctive therapy with cerclage to a reference group of cerclage alone. None of the 12 were prospective randomized clinical trials. No comparative studies were identified addressing the issues of antibiotics, bedrest, or pessary as adjunctive treatments to cerclage. None of the 12 studies included in this paper demonstrated a clear benefit of any adjunctive therapy used in addition to cerclage over and above cerclage used alone; however, few studies with small numbers limited the strength of the conclusions. [ABSTRACT FROM AUTHOR]

The ever increasing death of patients affected by various types of fatal cancers is of concern worldwide. Curative attempts by radiation/chemotherapy and surgery are often a failure in the long run. Moreover, adverse side effects of such treatments burden the patients with painful survival at the last phase of their life. The failure of early diagnosis is one of the root causes of the problem. Intensive research activities are being pursued in reputed laboratories across the globe to find superior diagnostics and therapeutics. Over the last decade, a number of publications have highlighted RNA interference based silencing of cancer-related gene expression as a promising technology to tackle the aforesaid problems. Superparamagnetic iron oxide nanoparticles (SPIONs) are reported to be excellent vehicles for short-interfering RNA (siRNA). The SPION-siRNA conjugate is biocompatible, stable, and amenable to specific targeting and can cross the blood brain barrier. The issues related to their synthesis, surface properties, delivery, tracking, imaging in relevance to cancer diagnostic and therapeutic, and so forth demand an extensive review, and we have addressed these aspects in this paper. The future prospects of the technology have also been traced. [ABSTRACT FROM AUTHOR]

The prevalence and severity of tooth wear is increasing in industrialised nations. Yet, there is no high-level evidence to support or refute any therapeutic intervention. In the absence of such evidence, many currently prevailing management strategies for tooth wear may be failing in their duty of care to first and foremost improve the oral health of patients with this disease. This paper promotes biologically sound approaches to the management of tooth wear on the basis of current best evidence of the aetiology and clinical features of this disease. The relative risks and benefits of the varying approaches to managing tooth wear are discussed with reference to long-term follow-up studies. Using reference to ethical standards such as "The Daughter Test", this paper presents case reports of patients with moderate-to-severe levels of tooth wear managed in line with these biologically sound principles. [ABSTRACT FROM AUTHOR]

Histoid leprosy, an uncommon variant of lepromatous leprosy, develops usually as relapse in lepromatous patients who are on dapsone monotherapy, but uncommonly arises de novo. This rare form of the disease, with unique clinical and histopathological features, may pose a diagnostic challenge even to astute clinicians. We report the case that occurred de novo in an elderly who presented with small to large lesions all over the body. A fresh focus on histoid leprosy is the primary objective of this paper, especially in the context of the postglobal leprosy elimination era. [ABSTRACT FROM AUTHOR]

Mcsherry R., pearce P., Grimwood K. & Mcsherry W. (2012) Journal of Nursing Management 20, 7-19 The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care Aim The aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs. Background The challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing. Key issues Excellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice. Conclusions Creating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations. Implications for nursing management The importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing. [ABSTRACT FROM AUTHOR]

Despite advances in conventional treatment modalities for malignant brain tumors-surgery, radiotherapy, and chemotherapy- the prognosis for patients with high-grade astrocytic tumor remains dismal. The highly heterogeneous and diffuse nature of astrocytic tumors calls for the development of novel therapies. Advances in genomic and proteomic research indicate that treatment of brain tumor patients can be increasingly personalized according to the characteristics of the targeted tumor and its environment. Consequently, during the last two decades, a novel class of investigative drug candidates for the treatment of central nervous system neoplasia has emerged: recombinant fusion protein conjugates armed with cytotoxic agents targeting tumor-specific antigens. The clinical applicability of the tumor-antigen-directed cytotoxic proteins as a safe and viable therapy for brain tumors is being investigated. Thus far, results fromongoing clinical trials are encouraging, as disease stabilization and patient survival prolongation have been observed in at least 109 cases. This paper summarizes the major findings pertaining to treatment with the different antiglioma cytotoxins at the preclinical and clinical stages. [ABSTRACT FROM AUTHOR]

Background: Delirious mania (DM) as a clinical entity is well described, yet is often unrecognized in clinical practice. While most often misdiagnosed as acute psychotic episodes of organic delirium, these patients meet the criteria for mania with attendant delirium and pose therapeutic challenges. In addition to the case presentation, this paper also discusses the available literature on DM. Case Presentation. A 29-year-old man with DM was treated with a combination of electroconvulsive therapy (ECT), divalproex 2000 mg/day, loxapine 100 mg/day, and lorazepam 4 mg/day. He demonstrated clinically significant improvement by day 10, which persisted through the twelve-month follow-up period. Conclusions. DM is a severe psychiatric syndrome which should be accurately diagnosed. Patients with DM should be treated aggressively, especially with ECT. Lack of recognition of DM can lead to serious morbidity or fatal outcomes. Though the concept of DM is well established, recent psychiatric literature does not make a mention of this life threatening yet treatable condition. We propose that there is a dire need to keep this concept alive. [ABSTRACT FROM AUTHOR]

The application of biotechnology in aquaculture has enabled the development and improvement of a wide range of immunodiagnostic and molecular technologies, and reagents and commercial kits have become more generally available. Recently, method development has increased exponentially as techniques used for clinical and veterinary medicine are adapted and optimized for use in aquaculture. Careful consideration needs to be given to selecting which rapid diagnostic methods to take forward and apply in aquaculture - pathogen detection methods need to be robust yet sensitive, and in many cases, capable of detecting a high degree of heterogeneity. There are numerous innovative techniques that may fulfil these criteria and provide valuable diagnostic tools. It is also important, however, that useful diagnostic methods already developed are standardized and fully validated, and that new technologies do not supercede these just because they are novel methods. The cost, speed, specificity and sensitivity of assays are all extremely important to end-users. This paper looks at some of the opportunities and challenges for the development of rapid diagnostics for aquaculture. [ABSTRACT FROM AUTHOR]

Systemic sclerosis- (SSc-) related vasculopathy, as manifested by Raynaud's Phenomenon (RP) and digital ulcers (DUs), is associated with significant impairment of the quality of life and morbidity. The current vasoactive approach for SSc-RP, although employing vasodilators, is entirely off-label. PDE-5 inhibitors improve peripheral circulation, are well tolerated, and are widely used for various forms of constrictive vasculopathies. This class of medications has become one of the first lines of treatment of SSc-RP and SSc-DUs among rheumatologists that routinely treat SSc patients. Due to the lack of robust randomized clinical trials of PDE-5 inhibitors in SSc-RP/DUs, the PDE-5 inhibitors have not been FDA approved for these particular indications, which constitutes a significant barrier to prescribing this category of drugs. This paper reviews the current state of evidence-based knowledge in SSc-related vasculopathy and the use of PDE-5 inhibitors. [ABSTRACT FROM AUTHOR]

With the improvement in survival from childhood cancer, late effects of therapy are becoming more apparent. Cardiac disease, one of these late effects, has a significant impact on the life of survivors of childhood cancers. Most survivors are followed by primary care doctors and adult subspecialists after they have graduated from pediatric centers. Since much of the cardiac toxicity of therapy occurs years off of therapy, it is important for these physicians to be aware of how to monitor survivors for the development of cardiac toxicities. In this paper we will discuss the incidence of cardiac disease during treatment and in survivors, what treatment modalities contribute to its development and modalities utilized to screen for cardiac disease. Recommendations for posttherapy monitoring will be emphasized. [ABSTRACT FROM AUTHOR]

Proton MR spectroscopy of the mammary gland area is used to be considered in the realm of basic research, but as a result of the advances in MR techniques, it is now being performed in ordinary clinical practice. It is particularly noteworthy that useful clinical data are now being accumulated with 1.5T MR units, which are the standard units.We think that, at this point, it is very important to systematically review the techniques, clinical applications, and future prospects of protonMR spectroscopy. We have performed proton MR spectroscopy with a 1.5T MR unit in over 3000 cases at our hospital. In this paper, we will comment on the current status of proton MR spectroscopy of the breast, primarily in regard to differentiation between benign and malignant lesions and prediction of the efficacy of chemotherapy while describing the data obtained at our hospital. [ABSTRACT FROM AUTHOR]

PURPOSE. This paper aims to clarify the concept of social capital within a health context using Rodgers's (2000 ) Evolutionary Method. SOURCE. Published literature. CONCLUSIONS. The analysis demonstrates that social capital is the intangible assets, including trust, networks, and social norms of reciprocity, possessed by a society within a specific culture. When a unit (individual or a family) increases its sense of community or quality of community participation, this could increase its social capital. The result of this analysis provides a guide for further conceptual and empirical research and clinical practice. [ABSTRACT FROM AUTHOR]

When characterizing a small renal mass (SRM), the main question to be answered is whether the mass represents a surgical or nonsurgical lesion or, in some cases, if followup studies are a reasonable option. Is this a task for a urologist or a radiologist? It is obvious that in the increasing clinical scenario where this decision has to be made, both specialists ought to work together. This paper will focus on the principles, indications, and limitations of ultrasound, CT, and MRI to characterize an SRM in 2008 with a detailed review of relevant literature. Special emphasis has been placed on aspects regarding the bidirectional information between radiologists and urologists needed to achieve the best radiological approach to an SRM. [ABSTRACT FROM AUTHOR]

The understanding and management of Peyronie's disease (PD) has improved but elucidating the exact etiology of the disease has yet to be achieved. In this paper, we review the historical and clinical aspects of PD. We focus on the evolution of surgical management for PD and review recent published articles that compare popular surgical techniques such as plication and plaque incision with vein graft. These two techniques have been reported to be equivalent with respect to patient satisfaction; however, each technique has its own advantages and disadvantages. [ABSTRACT FROM AUTHOR]

PURPOSE. This paper aims to describe existing community nursing practices and to explore factors that are associated with the transition of clinical practice from acute care settings to community care settings. METHOD. This qualitative case study assessment described existing community nurse practices and explored factors that were associated with the transition to community practice from acute care settings. The 48 participants in this case study were registered nurses who were working in community care nursing during the interview process. CONCLUSIONS. The results of this investigation revealed themes derived from data collection, including autonomy, client and family, education, and community as nursing work. This study indicated that making the transition to community-based nursing includes conceptual as well as emotional adjustments. Community nursing practice was seen by the participants as nursing that captures a holistic approach incorporating multiple dimensions from psychological, sociological, economic, and physical to spiritual aspects that provides services in interaction between the community nurse, the client, and the family. The findings indicate a need for additional supportive preparation strategies incorporated into nursing orientation and continuing education programs. Future research investigating agency culture and socialization would provide a more definitive survey of perceptions and competencies needed for role. [ABSTRACT FROM AUTHOR]

This paper concerns the ethics of human neuromodulation using transcranial magnetic stimulation (TMS). We examine the challenges of modulating the brain with TMS through the research ethics lens and in clinical medicine for treating frank pathology, primarily in psychiatric diseases. We also consider contemporary issues raised in the neuroethics literature about managing unexpected findings, and relate these to TMS and to other frontier neurotechnology that is becoming openly available in the public domain. We argue that safety and informed consent are of paramount importance for TMS, but that personal values and sociocultural factors must also be considered when examining the promise of this technology and applications that ought to be highlighted for extra precautions. [ABSTRACT FROM AUTHOR]

Background and objective: Measuring and assessing the quality of health care services is an issue of high international importance. Providing data can be reliably extracted, making use of the electronic patient record (EPR) could help practitioners fulfil clinical governance obligations and ultimately improve the quality of patient care. The objective of this paper is to describe (i) the process used to apply a series of clinical indicators for preventable drug-related morbidity (PDRM) in the EPR, (ii) problems encountered and (iii) our attempts to resolve them. Method: The PDRM indicators were applied retrospectively in the EPR of all patients aged 18 years and over in nine general practices using the Morbidity Information and Query Export Syntax (MIQUEST) computer software programme. Results: Issues identified as requiring attention when attempting to extract data from the EPR include considering the ranges to be used for age and biochemical test results, accuracy of diagnosis and drug coding, the level of complexity of the information needed, and how best to manipulate the resulting data. Practical difficulties encountered were ensuring the query coding schemes were sufficiently robust and comprehensive to secure reliable data extraction, the number of MIQUEST queries required to express each indicator, the time-consuming nature of the stages involved in the data manipulation process. Discussion: Despite some practical difficulties, we have successfully used MIQUEST to identify potential preventable drug-related morbidities from the EPR. The quality of information that can be extracted from the EPR is obviously limited by the accuracy and completeness of the data on the system and the ability of the enquirer to reliably extract and manipulate that data. Conclusion: Although some of the problems encountered were specific to the MIQUEST software, many, including considering appropriate ranges for age and biochemical test results and paying careful attention to the reliability of drug and diagnosis coding, are relevant whenever data are extracted from the EPR for any purpose. [ABSTRACT FROM AUTHOR]