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Introduction: Globally, healthcare organizations have transitioned from paper-based documentation to electronic health records (EHR), including in Saudi Arabia. However, the adoption of EHR at the national level in Saudi Arabia needs more attention. Thus, this study aimed to determine the workflow integration of EHR and associated factors. Objectives: The specific aims were to examine the level of EHR use and workflow integration among nurses, to determine the differences in EHR use and workflow integration based on nurses' demographic characteristics, and to determine the association between the predictive factors and EHR workflow integration. Methods: This is a cross-sectional, correlational descriptive study. The data were collected from 293 nurses using the convenience sampling method. The participating nurses completed a questionnaire that included two measures: the Information System Use Survey and the Workflow Integration Survey (WIS). The data were analyzed using descriptive and multivariate statistics with SPSS software. Results: The nurses had a positive perception of EHR use and workflow. The EHR use scores differed based on workplace (P <.01), education level (P <.05), and area of practice (P <.001). Similarly, the EHR workflow integration scores varied according to workplace (P <.05), education level (P <.05), and area of practice (P <.001). Education level and workplace significantly predicted information system use. Furthermore, education level and information system use significantly predicted the EHR integration into nurses' workflow. Conclusion: The nurses expressed a greater perceived use of EHR regarding the integrated health information system, which was a predictor of EHR integration into nurses' workflow. [ABSTRACT FROM AUTHOR]

The article discusses the developments in brain transplantation and the possible clinical applications of such techniques. Through grafting, cerebellar, cerebral cortical and hippocampal grafts survive and develop organotypic maturation as determined by histological and electrophysiological criteria. The effectiveness of an approach depends on the resolution of several issues relating to the aetiology of the disease itself and to the practcal techniques to be used in human patients.

The article discusses on the clinical aspects on the use of intravenous anesthesia to produce muscular paralysis and as an analgesic in major surgical operations in medical practice. It offers information on the component of the balanced anesthesia and the techniques in the application process of such drugs. It also points out the advantages as well as the advantages on the of the drug towards patients.

The article focuses on the issue regarding the intelligence tests in the selection of medical students with emphasis on A level performance as a criterion for entry. The General Medical Council outlines recommendations of proficiency standard emphasizing clinical skills that are basic and of primary importance of clinical practice.

The article provides an overview of the factors that influenced the management and therapeutic interpretation of Crohn's disease. These involve the importance of measuring the disease activity, mortality rates, surgical involvement and medical therapy. However, surgical resection is still considered as the efficient approach to the complete therapy of this intestine and ileocaecal valve's diseased segment.

The author reflects on the problems that confront clinical experimentation. These problems include the concern with medical ethics and compassionate interest in the individual, the fear of questioning, the fear of litigation, and the sheer greediness of private practitioner. He argues that ethical constraints and other problems on clinical experimentation are just an excuse of muddled thinking and complacency.

In recent years, extracellular vesicles (EVs) have gained significant attention due to their tremendous potential for clinical applications. EVs play a crucial role in various aspects, including tumorigenesis, drug resistance, immune escape, and reconstruction of the tumor microenvironment. Despite the growing interest in EVs, many questions still need to be addressed before they can be practically applied in clinical settings. This paper aims to review EVs' isolation methods, structure research, the roles of EVs in tumorigenesis and their mechanisms in multiple types of tumors, their potential application in drug delivery, and the expectations for their future in clinical research. [ABSTRACT FROM AUTHOR]

Malignant tumors have become a significant public health problem that severely threatens human health. Drug-targeting therapy is essential for tumor therapy, along with surgery and radiotherapy. Of the 378 novel drugs approved over the past five years, those for oncological therapy remains at the top (25%). These drugs are used to treat patients with various cancers by acting on corresponding targets, such as EGFR, JAK, BTK, IDH, and FLT3. This review examines anti-tumor agents approved between 2016 and 2020, classifying them according to indication (such as lung cancer, leukemia, breast cancer, and myeloma). These drugs are reviewed according to their route of administration, first-in-class designation, approval dates, and expedited review categories. Furthermore, this paper summarizes the targets and modes of action of the approved anti-tumor drugs while systematically discussing their synthetic routes for medicinal chemistry or industrial use, which will benefit next-generation drug discovery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Epigenetics is an important mRNA expression regulator. However, how distinct epigenetic factors, such as microRNAs (miRNAs) and promoter methylation, cooperatively regulate mRNA expression is rarely discussed. Recently, apparent miRNA regulation of promoter methylation was identified by bioinformatic analysis; however, it has not yet been experimentally confirmed. If miRNA regulation of other epigenetic factors were identified, it would reveal another layer of epigenetic regulation. In this paper, histone modifications (H3K4me1, H3K4me3, H3K27me3, H3K27ac, H3K9ac, and H2AZ) during mammalian spermatogenesis were studied and the apparent miRNA-target-specific histone modification was investigated by bioinformatic analyses of publicly available datasets. RESULTS: We identified several miRNAs' target genes that are significantly associated with histone modification during mammalian spermatogenesis. MiRNAs that target genes associated with the most significant histone modifications are expressed before or during spermatogenesis; thus the results were convincing. CONCLUSIONS: In this paper, we identified apparent miRNA regulation of histone modifications using a bioinformatics approach. The biological mechanisms of this effect should be further experimentally investigated. [ABSTRACT FROM AUTHOR]

The aim of this investigation was to assess helpful and challenging aspects of electronic health information with respect to clinical workflow and identify a set of characteristics that support patient care processes. We conducted 20 semi-structured interviews at a Veterans Affairs Medical Center, with a fully implemented electronic health record (EHR), and elicited positive and negative examples of how information technology (IT) affects the work of healthcare employees. Responses naturally shed light on information characteristics that aid work processes. We performed a secondary analysis on interview data and inductively identified characteristics of electronic information that support healthcare workflow. Participants provided 199 examples of how electronic information affects workflow. Seventeen characteristics emerged along with four primary domains: trustworthy and reliable; ubiquitous; effectively displayed; and adaptable to work demands. Each characteristic may be used to help evaluate health information technology pre- and post-implementation. Results provide several strategies to improve EHR design and implementation to better support healthcare workflow. [ABSTRACT FROM PUBLISHER]

Cognitive bias is increasingly recognised as an important source of medical error, and is both ubiquitous across clinical practice yet incompletely understood. This increasing awareness of bias has resulted in a surge in clinical and psychological research in the area and development of various 'debiasing strategies'. This paper describes the potential origins of bias based on 'dual process thinking', discusses and illustrates a number of the important biases that occur in clinical practice, and considers potential strategies that might be used to mitigate their effect. [ABSTRACT FROM AUTHOR]

Background: Clinical judgment is declining in new graduate nurses, which affects patient safety and is therefore tested on the Next Generation NCLEX. There is limited research describing barriers and facilitators impacting nursing faculty's experiences teaching clinical judgment. Aims: The purpose of this study was to explore barriers and facilitators affecting undergraduate nursing faculty's clinical judgment teaching methods. Methods: Sixteen qualitative interviews were conducted with full-time nursing faculty at seven universities in the Northeast and Southeast regions of the United States. Results: The findings revealed program, student, and faculty factors affecting clinical judgment teaching methods. Subthemes included time, class size, students' class preparation, critical thinking, task orientation, professional development, and faculty resistance. Conclusion: Minimizing barriers and strengthening facilitators based on participants' practices and previous research can support more effective clinical judgment pedagogy, which has the potential to achieve Next Generation NCLEX success and potentially increase patient safety. [ABSTRACT FROM AUTHOR]

Tailored messages are those that specifically target individuals following an assessment of their unique characteristics. This systematic review assesses the evidence regarding the effectiveness of tailoring within eHealth interventions aimed at chronic disease management. OVID Medline/Embase databases were searched for randomised control trials, controlled clinical, trials, before -after studies, and time series analyses from inception - May 2014. Objectively measured clinical processes/outcomes were considered. Twenty-two papers were eligible for inclusion: 6/22 used fully tailored messaging and 16/22 used partially tailored messages. Two studies isolated tailoring as the active component. The remainder compared intervention with standard care. In all, 12/16 studies measuring clinical processes and 2/6 studies reporting clinical outcomes showed improvements, regardless of target group. Study quality was low and design did not allow for identification of interventions’ active component. Heterogeneity precluded meta-analysis. This review has demonstrated that there is a lack of evidence to suggest that tailoring within an eHealth context confers benefit over non-tailored eHealth interventions. [ABSTRACT FROM AUTHOR]

Vascularized composite allotransplantation (VCA), which can effectively improve quality of life, is a promising therapy for repair and reconstruction after face or body trauma. However, intractable issues are associated with VCA, such as the inevitable multiple immunogenicities of different tissues that cause severe rejection, the limited protocols available for clinical application, and the shortage of donor sources. The existing regimens used to extend the survival of patients receiving VCAs and suppress rejection are generally the lifelong application of immunosuppressive drugs, which have side effects. Consequently, studies aiming at tissue engineering methods for VCA have become a topic. In this review, we summarize the emerging therapeutic strategies for tissue engineering aimed to prolong the survival time of VCA grafts, delay the rejection and promote prevascularization and tissue regeneration to provide new ideas for future research on VCA treatment. [ABSTRACT FROM AUTHOR]

The article reports on the launch of "Japanese Clinical Medicine," a journal published by Libertas Academica Ltd. It states the journal is a broad-scoped journal focusing on human medical clinical research and will accept papers on topics including cardiology, dermatology and oncology. It states the journal will include original research, case reports, reviews and methodologies.

Background: There is growing global interest into the attitudes and clinical management of persons who deliberately self-harm. People who self-harm experience many problems and typically have many needs related to management of their psychological wellbeing. A positive attitude amongst general hospital staff should prevail with people who self-harm. The principal purpose was to determine student staff attitudes towards patients who self-harmed from a professional and cultural perspective, which might influence patient treatment following hospital admission. The focus concentrated upon staff knowledge, attitudes and beliefs regarding self-harm. Methods: A cross sectional survey of the hospital staff using a validated questionnaire was carried out. This paper reports on interdisciplinary staff from two large general hospitals in Mysuru, South India (n=773). Results: Findings suggest that within a general hospital setting there is wide variation in staff attitudes and knowledge levels related to self-harm. Whilst there is attitudinal evidence for staff attitudes, this study investigates interprofessional differences in an attempt to progress treatment approaches to a vulnerable societal group. Very few staff had any training in assessment of self harm survivors. Conclusion: There is an urgent need for training general hospital staff in self harm assessment and prevention in south India. The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and opens potential for cross cultural comparison studies. In addition, interventions must focus on current resources and contexts to move the evidence base and approaches to patient care forward. [ABSTRACT FROM AUTHOR]

Background: Surgical site infections (SSI) account for 16% of healthcare associated infections, and are associated with considerable morbidity, mortality and increased costs of care. Ensuring evidence-based practice to prevent SSI is incorporated across the patient�s surgical journey is complex. OneTogether is a quality improvement collaborative of infection prevention and operating department specialists, formed to support the spread and adoption of best practice to prevent SSI. This paper describes the findings of an expert workshop on infection prevention in operating departments. Methods: A total of 84 delegates from 75 hospitals attended the workshop, comprising 46 (55%) theatre nurses operating department practitioners; 16 (19%) infection control practitioners and 22 (26%) other healthcare practitioners.Discussion focused on evidence, policy implementation and barriers to best practice. Responses were synthesised into a narrative review. Results: Delegates reported significant problems in translating evidence-based guidance into everyday practice, lack of local polices and poor compliance. Major barriers were lack of leadership, poorly defined responsibilities, and lack of knowledge/training. Conclusions: This workshop has provided important insights into major challenges in assuring compliance with best practice in relation to the prevention of SSI. The OneTogether partnership aims to support healthcare practitioners to improve the outcomes of patients undergoing surgery by reducing the risk of SSI. [ABSTRACT FROM AUTHOR]

Background: It is known that when crude Pinelliae rhizome and Pinelliae rhizoma preparatum are combined with Aconiti Radix Cocta respectively, the toxicity of the combination varies. However, the component's transformation between different compatibility have remained unclear. Objective: In this paper, a novel approach using rapid resolution liquid chromatography-quadrupole time-of-flight mass spectrometry (RRLC-Q-TOF-MS) coupled with multivariate statistical analysis was established for exploring the influence of processing adjuvants (PAs) on the compatibility of Aconiti Radix Cocta and Pinelliae rhizome. Materials and Methods: In order to obtain information about the representative markers between different groups, an exhaustive study of different protocols based on adding or removing different PAs step by step was carried out and the influence of PAs on compatibility was investigated. Results: It was found that lime can facilitate diester diterpenoid alkaloids with high toxicity in Aconiti Radix Cocta to be converted into low-toxic or non-toxic derivatives. Glycyrrhizae Radix et Rhizoma had no remarkable effect on the process. Conclusion: The established method in this study will be of great significance to process research mechanism and study on traditional Chinese Medicine compatibility and clinical application. [ABSTRACT FROM AUTHOR]

Idiopathic retroperitoneal fibrosis is uncommon enough to be placed low down on a list of differential diagnoses of any problem facing a general surgeon in a district hospital. In this paper, 4 cases of retroperitoneal fibrosis are described, all of whom presented within a 5-year period to the same surgeon; each described a different symptomatology. This paper serves to reiterate the diversity of presenting features in retroperitoneal fibrosis and to demonstrate that this condition may not be as rare as is widely believed. [ABSTRACT FROM AUTHOR]

Over the past decade, different parties in the health care field have developed and disseminated clinical practice guidelines as part of evidence-based medicine. These formal tools based on a scientific evaluation of the research literature purport to tell health care professionals how to practice medicine. Because clinical practice guidelines shift the knowledge base in the health care field through standardization, they remain con troversial within and outside medicine. In this paper, we evaluate the predictive accuracy of four medical professionalization theories-functionalism, Freidson's theory of professional dominance, deprofessionalization theory, and the theory of countervailing powers- to account for (1) the shift from pathophysiology to epidemiology with guidelines, (2) the creation of practice guidelines, and (3) the effects of clinical practice guidelines on the autonomy of health professionals. In light of the mixed predictive record of professionalization theories, we conclude with a need for "evidence-based sociology" and a recalibration of basic premises underlying professionalization theories. [ABSTRACT FROM AUTHOR]

In a previous paper we reported that 10.8% of patients admitted to two large hospitals in Greater London experienced one or more adverse events, of which half were deemed preventable. Here we examine the underlying causes of errors in clinical practice. Rather than identifying specific errors made by individuals, we have looked at possible faults in the organization of care. Adverse events were grouped according to stages in the care process: diagnosis, preoperative assessment and care, operative or invasive procedure (including anaesthesia), ward management, use of drugs and intravenous fluids and discharge from hospital. Less than 20% of preventable adverse events were directly related to surgical operations or invasive procedures ad less than 10% to misdiagnoses. 53% of preventable adverse events occurred in general ward care (including initial assessment and the use of drugs and intravenous fluids) and 18% in care at the time of discharge. Probable contributory factors in these errors included dependence on diagnoses made by inexperienced clinicians, poor records, poor communication between professional carers, inadequate input by consultants into day-to-day care, and lack of detailed assessment of patients before discharge. [ABSTRACT FROM AUTHOR]

The article focuses on the significance of early management of acoustic neuroma in medical practice. It could be noted that the incidence of acoustic neuromas in clinical practice tends to be increasing. In fact, clinicians are constantly encouraged not to miss the acoustic neuromas due to their promising modern imaging techniques for the tumors. However, the results of acoustic neuroma surgery are often not as good as those achieved by the surgeons.

Adoptive cell immunotherapy (ACT) is an innovative promising treatment for tumors. ACT is characterized by the infusion of active anti-tumor immune cells (specific and non-specific) into patients to kill tumor cells either directly or indirectly by stimulating the body's immune system. The patient's (autologous) or a donor's (allogeneic) immune cells are used to improve immune function. Chimeric antigen receptor (CAR) T cells (CAR-T) is a type of ACT that has gained attention. T cells from the peripheral blood are genetically engineered to express CARs that rapidly proliferate and specifically recognize target antigens to exert its anti-tumor effects. Clinical application of CAR-T therapy for hematological tumors has shown good results, but adverse reactions and recurrence limit its applicability. Tumor infiltrating lymphocyte (TIL) therapy is effective for solid tumors. TIL therapy exhibits T cell receptor (TCR) clonality, superior tumor homing ability, and low targeted toxicity, but its successful application is limited to a number of tumors. Regardless, TIL and CAR-T therapies are effective for treating cancer. Additionally, CAR-natural killer (NK), CAR-macrophages (M), and TCR-T therapies are currently being researched. In this review, we highlight the current developments and limitations of several types of ACT. [ABSTRACT FROM AUTHOR]

The literature on coronavirus disease 2019 (COVID-19) treatments, including herbal medicine, has expanded rapidly due to intense global interest. We conducted this scoping review to map the characteristics and assess the quality of systematically conducted reviews of herbal medicine and COVID-19 published during the pandemic era. Electronic databases were searched to identify published systematic reviews and other research synthesis articles relating to herbal medicine vis-a-vis COVID-19 from 2020 to 2022. Forty-eight articles were included. Most were systematic reviews (SR) and/or meta-analyses (MA) on Chinese herbal medicine for clinical treatment during the acute phases of COVID-19 (44%). Regarding adherence to a measurement tool to assess systematic reviews (AMSTAR-2) critical items, only one-third (n=15) reported an a priori protocol, while 21% (n=10) presented a comprehensive literature search strategy. When analysed by type of review, SR/MA (n=23) of clinical interventions had better than the overall average adherence rate in having a pre-registered protocol (87%, n=20) and comprehensive literature search strategy (45%, n=9). Exploratory analysis showed that most articles reported search results from at least two established electronic databases. Risk of bias assessment was performed in almost all SR/MA though there was limited exploration of any potential sources of heterogeneity. Overall, there is a need to improve the methodological design and implementation of systematically conducted reviews of herbal medicine in general to enhance the robustness and reliability of findings, especially given the rapid expansion of literature during unique circumstances such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The article highlights the meeting of the Forum on Lipids in Clinical Medicine that was held in Great Britain. Speaker D. N. Brindley presented a paper on hepatic lipid and lipoprotein metabolism. T. J. Peters of MRC Clinical Research Centre and his group provided an insight into the causes of fatty liver. J. Owen of Royal Free Hospital School discussed the surface composition of plasma lipoproteins.

Treatment of illness in the Admiralty Islands was related to the assignment of illness to one of four main categories: (1) interpersonal, soul damage by extra-human agents, (2) interpersonal, cursing within group, (3) interpersonal, sorcery outside of group, and (4) impersonal, organic damage by an immanent impersonal agent. The first two causal assignments persist as explanations for illness with implications for traditional cures in every instance. Three and four vary inversely with one another in priority of resort to native or European curative practices. This paper offers an analysis of factors in the allocation of cases between European (acculturative) and native (counter-acculturative) curative agents. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease (COVID-19) pandemic has challenged palliative end-of-life care for people with dementia. The site of death can be considered as an end-of-life care quality indicator. Most people with dementia prefer to die at nursing or private homes; however, in Japan, they are often hospitalized in psychiatric hospitals for management of neuropsychiatric symptoms. As palliative end-of-life care for older adults with Alzheimer's disease and related dementias has been further challenged by the COVID-19 pandemic, little is known about its effects on the place of death in patients with dementia. Objectives: This study aimed to investigate the shifts in place of death from dementia during the COVID-19 pandemic in Japan. Changes throughout the pandemic were compared between deaths from dementia and from senility. Design: Cross-sectional. Methods: Death certificate data of individuals aged 65 years or older who died in Japan between 1 January 2018, and 31 December 2021, were used to extract the cause and place of death. Differences in place of death between the periods were estimated using multinomial logistic analysis with reference to death in private homes. Results: Deaths from dementia mostly occurred in hospitals (59%), while deaths from senility were most frequent in nursing homes (37%). After adjusting for patient characteristics, the likelihood of hospital deaths significantly increased for patients with dementia during the pandemic. Meanwhile, the likelihood of senility deaths decreased in hospitals but increased in nursing homes during the pandemic. Conclusion: The shift to hospital deaths since the onset of the COVID-19 pandemic was uniquely observed in deaths from dementia. This hospital shift likely involved increased transfers from nursing and private homes to psychiatric hospitals. Further investigation is needed to examine the association between the pandemic-related change in long-term care workforce and palliative care practice in people with dementia. [ABSTRACT FROM AUTHOR]

The study aim was to determine the relationship between a patient's Emergency Severity Index (ESI) score and their or their family's response to the key performance indicator (KPI) question on the post-visit patient and family experience (PFE) survey. Retrospective review of patients presenting to the Pediatric Emergency Department between July 1, 2021, and June 30, 2022, who completed the KPI question on an associated post-visit survey. We performed univariate analyses on all candidate variables; multivariable linear regression identified independent predictors of KPI on the PFE survey. A total of 8136 patients were included in the study. Although ESI score was significantly associated with PFE in univariate analysis, this association was lost in the multivariable model. Independent associations were appreciated with race/ethnicity, time to provider, length of stay, and procedure performance during the visit. Although ESI is not independently associated with PFE in this study, its interaction with factors such as time to provider, length of stay, and procedure performance may be important for emergency department providers creating interventions to impact experience during low acuity visits. [ABSTRACT FROM AUTHOR]

Background: Cefoxitin has shown in vitro activity against Extended-Spectrum β-Lactamase (ESBL) producing Enterobacterales. Outcome data regarding cefoxitin as a carbapenem sparing agent in the management of urinary tract infections (UTI) are scarce. We sought to evaluate the clinical and microbiologic efficacy of cefoxitin as compared to ertapenem. Methods: A retrospective observational study was conducted at our quaternary care institution between May 2015 and March 2019. We identified all patients who received cefoxitin for the treatment of UTI during the study period and used Charlson Comorbidity Index to select a matching cohort from patients who received ertapenem. Primary end points were clinical and microbiological cure. Results: Thirty patients who received cefoxitin were matched with 55 patients who received ertapenem. Clinical cure was marginally in favor of ertapenem: 83.2% in cefoxitin group versus 96.8% in ertapenem group (P =.042). However, 90-day recurrence was in favor of cefoxitin: 13.5% in cefoxitin group versus 34.8% in ertapenem group (P =.045). Microbiologic cure was not significant between the 2 groups with 88.6% success in cefoxitin versus 100% in ertapenem. Additionally, the group difference on 30-day recurrence or relapse rates and the 90-day mortality rate were not clinically significant. Conclusion: Cefoxitin achieved similar microbiologic cure rate when compared to ertapenem for the treatment of UTI caused by ESBL-producing Enterobacterales. No significant differences were found in 30-day recurrence/relapse or mortality rates. Larger randomized controlled trials are required to identify the clinical sittings in which cefoxitin could be used as a carbapenem-sparing agent in the treatment of UTI. [ABSTRACT FROM AUTHOR]

The bone marrow-derived multipotent mesenchymal cells (MSCs) have captured scientific interest due to their multi-purpose features and clinical applications. The operational dimension of MSCs is not limited to the bone marrow reservoir, which exerts bone-building and niche anabolic tasks; they also meet the needs of quenching inflammation and restoring inflamed tissues. Thus, the range of MSC activities extends to conditions such as neurodegenerative diseases, immune disorders and various forms of osteopenia. Steering these cells towards becoming an effective therapeutic tool has become mandatory. Many laboratories have employed distinct strategies to improve the plasticity and secretome of MSCs. We aimed to present how photobiomodulation therapy (PBM-t) can manipulate MSCs to render them an extraordinary anti-inflammatory and osteogenic instrument. Moreover, we discuss the outcomes of different PBM-t protocols on MSCs, concluding with some perplexities and complexities of PBM-t in vivo but encouraging and feasible in vitro solutions. [ABSTRACT FROM AUTHOR]

Metabolomics is the laboratory analysis and scientific study of the metabolome—that is, the entire collection of small molecule chemicals in an organism. The metabolome represents the functional state of an organism and provides a multifaceted readout of the aggregate activity of endogenous (cellular) and exogenous (environmental) processes. In this review, we discuss how the integrative and dynamic properties of the metabolome create unique opportunities to study complex pathologies that evolve and oscillate over time, like epilepsy. We explain how the scientific progress and clinical applications of metabolomics remain hampered by biological and technical challenges, and we propose best practices to overcome these challenges so that metabolomics can be used in a rigorous and effective manner to further epilepsy research. [ABSTRACT FROM AUTHOR]

Although there are a number of quality frameworks available for evaluating palliative services, it is necessary to adapt these frameworks to models of care designed for the rural context. The purpose of this paper was to describe the development of a program assessment framework for evaluating a rural palliative supportive service as part of a community-based research project designed to enhance the quality of care for patients and families living with life-limiting chronic illness. A review of key documents from electronic databases and grey literature resulted in the identification of general principles for high-quality palliative care in rural contexts. These principles were then adapted to provide an assessment framework for the evaluation of the rural palliative supportive service. This framework was evaluated and refined using a community-based advisory committee guiding the development of the service. The resulting program assessment framework includes 48 criteria organized under seven themes: embedded within community; palliative care is timely, comprehensive, and continuous; access to palliative care education and experts; effective teamwork and communication; family partnerships; policies and services that support rural capacity and values; and systematic approach for measuring and improving outcomes of care. It is important to identify essential elements for assessing the quality of services designed to improve rural palliative care, taking into account the strengths of rural communities and addressing common challenges. The program assessment framework has potential to increase the likelihood of desired outcomes in palliative care provisions in rural settings and requires further validation. [ABSTRACT FROM AUTHOR]

An EMR system implementation would significantly reduce clinician workload and medical errors while saving the US healthcare system major expense. Yet, compared to other developed nations, the US lags behind. This article examines EMR system efforts, benefits, and barriers, as well as steps needed to move the US closer to a nationwide EMR system. The analysis includes a blueprint for implementation of EMR, industry comparisons to highlight the differences between successful and non-successful EMR ventures, references to costs and benefit information, and identification of root causes. ‘Poka-yokes’ (avoid (yokeru) mistakes (poka)) will be inserted to provide insight into how to systematically overcome challenges. Implementation will require upfront costs including patient privacy that must be addressed early in the development process. Government structure, incentives and mandates are required for nationwide EMR system in the US. [ABSTRACT FROM PUBLISHER]

Diabetic men have benefited in the last 30 years from a significant improvement in total and cardiovascular mortality, whereas diabetic women have had no improvement at all. Moreover, recent research focused on the role of sex hormones in glucose homeostasis, and might account for different pathophysiologic mechanisms in the development of diabetes-related complications. Thus, care of diabetic women is a challenge that requires particular attention. The available data regarding gender-specific care of diabetes mellitus are uneven, rich in some domains but very poor in others, The large prospective trials performed in the last 20 years have assumed that the natural history of diabetes mellitus in men and women, as well as the efficiency of glucose-lowering therapies and management of hyperglycemic-related complications, could be attributable without distinction to men and women. We propose in this paper to analyze the published medical literature according to the specific management of diabetes mellitus in women, and to try ot distinguish some particular features. We found important distinctions between diabetic men and women regarding the patterns of abnormalities of glucose regulations, epidemiology, development of diabetes-related complications, ischemic heart disease, morbidity and mortality, impact of cardiovascular risk factors, development of the metabolic syndrome, depression and osteoporosis, as well as the impact of lifestyle modifications or primary and secondary preventions on cardiovascular risk factors, and finally medical therapeutics. Moreover, special considerations were given to some particular aspects of the medical life in diabetic women, such as the features of gestational diabetes mellitus and the management of pregnancy in pregestational diabetic women, use of contraception, hormone-replacement therapy and polycystic ovary syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Clinical nursing education is an important component of the professional development of nursing students. Key informants such as nursing lecturers, nurse managers and clinical placement coordinators play an essential role in clinical education. Purpose: The purpose of the study was to explore the perspectives of key informants on how the current state of clinical nursing education in Northern Ghana can be improved. Methods: The study used an exploratory qualitative design. Sixteen participants were purposively selected and data were collected through face-to-face individual interviews. Data were analysed using framework analysis. Findings: The study findings indicate that clinical nursing education can be improved by decreasing the overcrowding of students in the clinical setting, decreasing the theory-practice gap and providing relevant material resources in the clinical facilities. Also, nursing education institutions can improve clinical nursing education by equipping the skills laboratories, engaging an adequate number of lecturers, and carrying out clinical accompaniment. Conclusion: There is a need to improve clinical education through collaboration between nursing education institutions and clinical facilities. Effective collaboration will ensure the planning of clinical placement to avoid overcrowding, provision of continuous professional development programmes for preceptors and improvement in clinical supervision. Also, the provision of material resources in skills laboratories and clinical facilities to enhance clinical teaching should be given priority. [ABSTRACT FROM AUTHOR]

Introduction: The pre-round meeting is an interprofessional gathering conducted in conjunction with the ward round in many hospitals. Here, nurses, doctors and eventually allied health clinicians discuss clinical issues before attending to the patients. This study focused on the learning aspects of the pre-round meeting, and it is, to our knowledge, the first study to explore the impact of pre-round meetings on learning in a clinical setting. Objectives: To improve our understanding of the impact pre-round meetings has on clinical learning among the nurses and doctors who attend them. Method: A qualitative study. Focus group interviews were conducted. Participants comprised of 9 doctors and 13 nurses from two different hospitals in Norway. The participants represented both surgical and non-surgical departments. Results: This study showed that the pre-round meeting is an arena with a high learning potential. Learning takes place in the discussion that arises when different professions meet. Both nurses and doctors emphasized that the pre-round meeting is both a conscious learning arena and an arena where learning is a by-product. Several factors interfered with the utilization of its learning potential. Conclusion: The pre-round meeting is an arena with high learning potential. However various factors can influence this potential. The study highlights the importance of being aware of the learning potential in the pre-round meeting, to achieve higher-level learning objectives. A collaborative environment, continuity, competence, and availability of the staff and structured pre-round meetings are essential elements for achieving higher-level learning objectives. [ABSTRACT FROM AUTHOR]

Objectives: To assess screening quality metrics and to describe mortality rates eight years after redesign of breast cancer screening and diagnosis pathways, and the introduction of digital breast tomosynthesis. Setting: Breast Unit of the Toledo Health Area in the region of Castilla-La Mancha (Spain). Methods: We recorded screening metrics and mortality data following the introduction of digital breast tomosynthesis in 2011 for screening and diagnosis pathways. We then compared the mortality between Toledo Health Area and the rest of Castilla-La Mancha, where digital breast tomosynthesis is not available. Results: All screening quality metrics improved following the introduction of digital breast tomosynthesis. The cancer detection rate significantly increased from 2.3 (95% confidence interval (CI): 1.9–3.6) to 4.5 per 1000 women (95% CI: 3.2–5.2) on average between the periods 2005–2009 and 2015–2018, while the recall rate significantly decreased from 7.0% (95% CI: 6.8%–8.2%) to 2.6% (95% CI: 2.0%–3.6%). Comparing breast cancer mortality rates for 2014–2018 in the Toledo Health Area with the rest of Castilla-La Mancha, which had similar cancer treatment access and management protocols but without digital breast tomosynthesis, the crude mortality rate was 17.79 (95% CI: 15.38 -20.19) vs. 24.76 per 100,000 (95% CI: 26.12–23.39), respectively. The cumulative risk of death was also significantly lower for the Toledo Health Area than for Castilla-La Mancha. Conclusion: The introduction of digital breast tomosynthesis improved screening quality indicators. Breast cancer mortality simultaneously decreased with respect to the rest of Castilla-La Mancha. Further research is needed to assess the long-term results, and the role that the redesign may have played in reducing mortality. [ABSTRACT FROM AUTHOR]

Introduction: HealthPathways is a clinical information portal developed in New Zealand that enables general practitioners to manage and refer their patients in a local context. We analyzed specialist outpatient appointment costs in Mackay, Queensland before and after HealthPathways implementation. Methods: We retrospectively examined specialist outpatient costs for patients referred by Mackay general practitioners for conditions with varying levels of HealthPathways implementation. Ranked from most clinical pathways available to none, chronic diabetes, cardiology, respiratory, and urology visits from January to March 2015, pre-pathways, and January to March 2017, post-pathways, were assessed. Monte Carlo simulation was used to estimate cost changes. Per-visit costs were multiplied by visit numbers to estimate policy impact. Results: The mean cost per visit increased from $220 to $305 for diabetes and $270 to $323 for respiratory, and decreased from $296 to $257 for cardiology and $444 to $293 for urology. The policy impact for each disease group over 3 months after accounting for visit numbers was a likely saving of $30 360 for diabetes and $10 270 for cardiology, and a likely cost increase of $24 449 for respiratory and $20 536 for urology. Conclusions: We observed that conditions with more comprehensive clinical pathways cost Mackay HHS substantially less following implementation. Costs for low and no pathway implementation referrals increased slightly over the same period. [ABSTRACT FROM AUTHOR]

Conventional disease-modifying antirheumatic drugs (DMARDs) have been used in the management of rheumatoid arthritis for a long time. Whereas methotrexate (MTX) is the anchor drug, leflunomide, hydroxychloroquine and sulfasalazine are used along with MTX either in combination or sequentially. Together these four drugs are the most commonly used DMARDs. They are also used in combination with biological DMARDs (bDMARDs) to enhance their efficacy and MTX in particular to reduce antibodies against anti-tumour necrosis factor. Despite their widespread use, concerns regarding their safety especially when used long-term hinder their optimum use in clinical medicine. In this narrative review we have critically appraised the available literature regarding the safety of these four DMARDs when used long-term. [ABSTRACT FROM AUTHOR]

The article focuses on the development of drugs for the treatment of mental diseases. It has been speculated that since diagnosis is not always clearly distinguished, physicians and pharmaceutical manufacturers may not be sure if they are designing new treatments for old diseases when diseases are only being redesigned to fit available treatments. It is important to differentiate treatment from diagnosis since better diagnosis implies differentiated treatments.

This article presents a review of data in literature about the pathogenesis of idiopathic hypercalciuria (IH). A variety of hypotheses concerning the pathogenesis of the disorder have been proposed, including the hyperabsorption of calcium by the intestine. IH was divided into three clinical classes, labeled resorptive hypercalciuria, absorptive hypercalciuria and renal hypercalciuria.

The article offers information on the centennial of professor William Osler's Gulstonian Lectures in 1885. The lectures were delivered when Osler was recently appointed Professor of Clinical Medicine at the University of Pennsylvania. It was stated that the lectures were, as Osler himself realized, not revolutionary in either content or intention.

Human health biobanks are forms of research infrastructure that supply biospecimens and associated data to researchers, and therefore juxtapose the activities of clinical care and biomedical research. The discipline of biobanking has existed for over 20 years and is supported by several international professional societies and dedicated academic journals. However, despite both rising research demand for human biospecimens, and the growth of biobanking as an academic discipline, many individual biobanks continue to experience sustainability challenges. This commentary will summarize how the COVID-19 pandemic is creating new challenges and opportunities for both the health biobanking sector and the supporting discipline of biobanking. While the challenges for biobanks may be numerous and acute, there are opportunities for both individual biobanks and the discipline of biobanking to embrace change such that biobanks can continue to support and drive biomedical research. We will therefore describe numerous practical steps that individual biobanks and/or the discipline of biobanking can take to survive and possibly thrive in response to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

β-thalassemia is an inherited blood disorder in which the body cannot produce hemoglobin normally. Since patients with this condition receive blood transfusions regularly, iron builds up primarily in organs such as the heart, liver and endocrine glands. Accumulation of iron in the organs necessitates chelation therapy. These patients must visit the hospital frequently to assess and follow up on their health condition. Physician intervention is required after each regular assessment to adjust the treatment. Lifelong healthcare support using a web-based expert system with a quick response code is designed for β-thalassemia management in order to deliver benefits to patients, physicians, and other healthcare providers. The aim of this study is to implement a web-based expert system for β-thalassemia management in order to provide treatment recommendations and support the lifelong healthcare of patients. The system provides patient-related details, such as medical history, medicines, and appointments, in real-time. It has been also tested in real-life cases and shown to enhance β-thalassemia management. [ABSTRACT FROM AUTHOR]

One measure of research productivity within the University of Kansas Cancer Center (KU Cancer Center) is peer-reviewed publications. Considerable effort goes into searching, capturing, reviewing, storing, and reporting cancer-relevant publications. Traditionally, the method of gathering relevant information to the publications is done manually. This manuscript describes the efforts to transition KU Cancer Center's publication gathering process from a heavily manual to a more automated and efficient process. To achieve this transition in the most customized and cost-effective manner, a homegrown, automated system was developed using open source API among other software. When comparing the automated and the manual processes over several years of data, publication search and retrieval time dropped from an average of 59 h to 35 min, which would amount to a cost savings of several thousand dollars per year. The development and adoption of an automated publications search process can offer research centers great potential for less-error prone results with a savings in time and cost. [ABSTRACT FROM AUTHOR]

Guillain-Barré syndrome (GBS) is characterized by acute and symmetric flaccid paraparesis and areflexia. Involvement of the central nervous system has been infrequently reported. In the current issue of Clinical Medicine: Case reports, an unusual case of GBS with asymmetric muscle weakness was reported. Corticomotoneuronal dysfunction was invoked as a possible cause for this neurological finding. Reversible blockade of voltage gated Na+ channels resulting in conduction failure may be a possible pathophysiological mechanism. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at the meeting of Forum on Lipids in Clinical Medicine on May 19, 1987 is presented. The meeting aims to consider the effects that lipids may have on thrombotic episodes which may lead in the development of atheroscleriosis and later to myocardial infarction. Among the speakers include S. Moncada of Wellcome Laboratories and T. A. B. Sanders of King's College.