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Objectives: This article aims to systematically review and analyze the outcome of published literature on patient safety and safety culture related to dental schools. It also aims to observe implemented changes in dental school training and curriculum that have improved patient safety and safety culture within institutions. Methods: All studies concerning patient safety and safety culture from the period of January 2010 to May 2020 were included which were specific to dental educational institution settings. The assessment was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) checklist to ascertain that the included studies were specific to the objective of our systematic review. Results: The included studies were assessed for country-wise publication, type of study, and its outcome. Of the 10 studies that met the inclusion criteria, 5 articles were related to patient safety. 2 out of the 5 articles were from the United States of America (USA) 2 were from the United Kingdom (UK), followed by 1 from Mexico. For articles related to safety culture, 3 out of the 5 articles were from Saudi Arabia, and 2 were from the USA. Conclusion: The analysis of the selected review articles suggests that rigorous training should be implemented in inpatient record documentation, incident reporting, and infection control protocols. The authors suggested focused training on patient safety culture and the inclusion of safety culture awareness and training to the dental undergraduate curriculum.

Objectives This article investigates the association between changes in electronic health record (EHR) use during the coronavirus disease 2019 (COVID-19) pandemic on the rate of burnout, stress, posttraumatic stress disorder (PTSD), depression, and anxiety among physician trainees (residents and fellows). Methods A total of 222 (of 1,375, 16.2%) physician trainees from an academic medical center responded to a Web-based survey. We compared the physician trainees who reported that their EHR use increased versus those whose EHR use stayed the same or decreased on outcomes related to depression, anxiety, stress, PTSD, and burnout using univariable and multivariable models. We examined whether self-reported exposure to COVID-19 patients moderated these relationships. Results Physician trainees who reported increased use of EHR had higher burnout (adjusted mean, 1.48 [95% confidence interval [CI] 1.24, 1.71] vs. 1.05 [95% CI 0.93, 1.17]; p = 0.001) and were more likely to exhibit symptoms of PTSD (adjusted mean = 15.09 [95% CI 9.12, 21.05] vs. 9.36 [95% CI 7.38, 11.28]; p = 0.035). Physician trainees reporting increased EHR use outside of work were more likely to experience depression (adjusted mean, 8.37 [95% CI 5.68, 11.05] vs. 5.50 [95% CI 4.28, 6.72]; p = 0.035). Among physician trainees with increased EHR use, those exposed to COVID-19 patients had significantly higher burnout (2.04, p Conclusion Increased EHR use was associated with higher burnout, depression, and PTSD outcomes among physician trainees. Although preliminary, these findings have implications for creating systemic changes to manage the wellness and well-being of trainees.

Background Surgical complications are common among older adults and are potential indicators of poorer long-term outcomes. The authors examined the effects of in-hospital complications on changes in older adults’ self-perceived cognitive function in the year after surgery. Method The authors conducted a prospective longitudinal study with 2,155 older adults (age ≥ 65) undergoing surgery, investigating the association between self-reported, in-hospital complications after surgery and Patient-Reported Outcomes Measurement Information System Applied Cognition-Abilities survey (4 items, cognitive function) at 30 days and 1 year after surgery. Surveys were scored on a continuous scale of 0–100, with higher scores representing better self-perceived cognitive functioning. Patient characteristics including demographics, type of complications, surgery type, pain, and activities of daily living were also collected. Results Having one in-hospital complication was associated with a decrease of 1.79 points (95% confidence interval (CI): −2.78, −0.80), indicating lower self-perceived cognitive functioning at 1 year after surgery; having two or more in-hospital complications was associated with 2.82 point (95% CI: −4.50, −1.15) decrease at 1 year after surgery. Models specific to complication type indicated that respiratory [−3.04, (95% CI: −5.50, −0.57)], neural [−2.11, (95% CI: −3.97, −0.25)], and general complications [−2.39, (95% CI: −3.51, −1.28)] were associated with statistically significant decreases in cognitive function. Discussion Older surgical patients who suffer in-hospital complications show greater decline in self-perceived cognitive function during the ensuing year. Geriatric specialists may be able to intervene in the immediate perioperative period to reduce complications and possibly mitigate cognitive decline among older adults.

Coronavirus Disease 2019 (COVID-19) was first reported in December 2019, in the City of Wuhan, China. Within the span of a few weeks, the disease had spread to other regions of China and eventually to different parts of the world. COVID 19 has affected 221 countries and territories around the world, with a total of 121,290,697 positive cases and 2,682,554 deaths as on March 17, 2021. Accurate disease diagnosis (for the SARS-Cov-2 virus and variants), coupled to patient isolation are currently critical strategies in restricting disease spread. Due to lack of time during this pandemic the diagnostics assays were not adequately validated. Infected individuals at times could potentially be missed by real-time reverse transcription polymerase chain reaction (rRT-PCR) for SARS-CoV-2 tests due to incorrect/inefficient sampling procedure, low limit of detection and epidemiology of the virus. rRT-PCR test results should be interpreted in conjunction with clinical examination and Computed Tomography (CT), particularly in suspected symptomatic individuals or those with epidemiological history of contact with known COVID-19 cases. Considering the above-mentioned constraints, the current scenario demands rapid and point-of-care tests for detection of SARS-CoV-2 in remote locations. To date, there is no reliable commercially available antigen detection kit. The infected subjects reveal low levels of antibodies against SARS-CoV-2 through the early period of infection. In addition, techniques such as, Digital RT-PCR technology and isothermal RNA amplification with electrochemical biosensors are some of the new technologies currently being developed to provide sensitive and specific SARS-Cov-2 antigen detection. The newly reported variant, SARS-CoV-2 VUI 202012/01 may not influence diagnostic outcomes as worldwide most PCR assays use two or more (including RdRp/ E/ N) reliable gene targets, besides S gene.

ObjectiveTo conduct a systematic review and meta-analysis to ascertain the impact of operating room (OR) to intensive care unit (ICU) handoff interventions on process-based and clinical outcomes.MethodWe included all English language, prospective evaluation studies of OR to ICU handoff interventions published as original research articles in peer-reviewed journals. The search was conducted on 11 November 2019 on MEDLINE, CINAHL, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials databases, with no prespecified criteria for the type of comparison or outcome. A meta-analysis of similar outcomes was conducted using a random effects model. Quality was assessed using a modified Downs and Black (D&B) checklist.Results32 studies were included for review. 31 studies were conducted at a single site and 28 studies used an observational study design with a control. Most studies (n=28) evaluated bundled interventions which comprised information transfer/communication checklists and protocols. Meta-analysis showed that the handoff intervention group had statistically significant improvements in time to analgesia dosing (mean difference (MD)=−42.51 min, 95% CI −60.39 to −24.64), fewer information omissions (MD=−2.22, 95% CI −3.68 to –0.77), fewer technical errors (MD=−2.38, 95% CI −4.10 to –0.66) and greater information sharing scores (MD=30.03%, 95% CI 19.67% to 40.40%). Only 15 of the 32 studies scored above 9 points on the modified D&B checklist, indicating a lack of high-quality studies.DiscussionBundled interventions were commonly used to support OR to ICU handoff standardisation. Although the meta-analysis showed significant improvements for a number of clinical and process outcomes, the statistical and clinical heterogeneity must be accounted for when interpreting these findings. Implications for OR to ICU handoff practice and future research are discussed.

OBJECTIVES: To report changes in practice brought about by COVID-19 and the implementation of new guidelines, and to explore factors relating to unscheduled re-presentations for patients discharged from the emergency department (ED). DESIGN: Prospective multicentre national audit over 12 weeks from 6th April 2020. SETTING: UK secondary care ENT departments. PARTICIPANTS: Adult patients with acute epistaxis. MAIN OUTCOME MEASURES: Re-presentation within 10 days for patients discharged from the ED. RESULTS: Eighty three centres from all four UK nations submitted 2631 valid cases. The majority of cases were ED referrals (89.7%, n = 2358/2631). 54.6% were discharged from the ED following ENT review (n = 1267/2322), of whom 19.5% re-presented within 10 days (n = 245/1259) and 6.8% were ultimately admitted (n = 86/1259). 46.7% of patients had a non-dissolvable pack inserted by ED prior to referral to ENT (n = 1099/2355). The discharge rates for ED patients and their subsequent re-presentation rates were as follows: non-dissolvable packs, 29.5% discharged (n = 332/1125), 18.2% re-presented (n = 60/330); dissolvable products, 71.1% discharged (n = 488/686), 21.8% re-presented (n = 106/486); cautery only, 89.2% discharged (n = 247/277), 20.0% re-presented (n = 49/245); and no intranasal intervention, 85.5% discharged (n = 200/234), 15.2% re-presented (n = 30/198). Univariable logistic regression showed that not being packed by ED, antiplatelet medications, failed cautery and recent epistaxis treatment were significant predictors of re-presentation within 10 days. CONCLUSIONS: Management of acute epistaxis was notably affected during the initial peak of the pandemic, with a shift towards reduced admissions. This national audit highlights that many patients who may previously have been admitted to hospital may be safely discharged from the ED following acute epistaxis.

Background: Studies with saliva are of immense advantage as the process of it collection from humans is a noninvasive method and can be repeated with least compliance problems. In this study, the levels of lactate dehydrogenase (LDH), amylase, reduced glutathione (GSH), glutathione S-transferase (GST), protein-bound sialic acid (PBSA), lipid peroxidation (LPO) and total antioxidant capacity (TAC) were analysed in the blood and saliva samples of head and neck cancer (HNC) patients and compared it with age-matched healthy controls (N = 30) to explore the usefulness of the parameters as an endpoint biomarkers. Materials and Methods: HNC patients visiting hospital for treatment (n = 31) were the participants of the study; age- and sex-matched healthy controls were included. Levels of LDH, amylase, PBSA, LPO (as malondialdehyde), GSH, GST and TAC were analysed in whole, unstimulated saliva samples. Results: The levels of LDH, amylase, PBSA and LPO were significantly higher, and levels of GSH, GST and TAC were significantly lower in blood and saliva of HNC patients when compared to healthy controls (P < 0.001). There was statistically significant correlation between blood and saliva with regard to the levels of amylase and GSH (P < 0.001). Conclusions: This study demonstrated significant changes in the biochemical parameters of blood and saliva in HNC patients and correlation of salivary GSH and amylase with corresponding levels of blood. Salivary biochemical parameters could serve as sensitive and convenient biomarkers of HNC.

This paper has made a survey on motor imagery EEG signals and different classifiers to analyze them. Resolution for medical images like CT, MRI can be improved using deep sense CNN and improved resolution technology. Drowsiness of a student can be analyzed using deep CNN and it helps in teaching, assessment of the student. The authors have proposed 1D-CNN with 2 layers and 3 layers architecture to classify EEG signal for eyes open and eyes closed conditions. Various activation functions and combinations are tried for 2-layer 1D-CNN. Similarly, various loss models are applied in compile model to check the CNN performance. Simulation is carried out using Python 2.7 and 1D-CNN with 3 layers show better performance as it increases number of training parameters by increasing number of layers in the architecture. Accuracy and kappa coefficient increase whereas hamming loss and logloss decreases by increasing number of layers in CNN architecture.

Background: Dengue fever (DF) is an arboviral disease of public importance with high mortality and morbidity in tropics. The school-going children are at high risk of developing dengue as they are exposed to the vector, female Aedes aegypticus mosquito, during daytime. The paediatric patients may not present with typical symptoms like in adults. Aim: The aim of this study is to study the clinical and laboratory parameters in paediatric patients with emphasis on various haematological ratios. Materials and Methods: This was a retrospective study conducted in the Clinical Microbiology Department of Tertiary Care Hospital in the coastal part of Karnataka, India, to compare the clinichaematological parameters in the paediatric patients diagnosed with DF. The data were retrospectively collected from January 2015 to December 2018 entered into Microsoft excel, and statistical analysis was done by the Student's t-test. P < 0.05 was considered statistically significant. Results: A total of 258 patients were included in the study, with 132 (51.4%) were females and 112 (43.2%) patients belonging to 11–15 years' age group. The most common symptoms were fever (100%), vomiting (36%) and headache (21.6%). The dengue patients had leucopenia, lymphocytosis, monocytosis, thrombocytopenia, increased erythrocyte sedimentation rate and haematocrit were elevated significantly. The aspartate transaminase and serum creatinine were increased. Conclusion: When a patient presents with fever, vomiting, headache, thrombocytopenia and increased haematocrit may be indicator to DF in endemic areas.

Objectives We characterize physician workflow in two distinctive emergency departments (ED). Physician practices mediated by electronic health records (EHR) are explored within the context of organizational complexity for the delivery of care. Methods Two urban clinical sites, including an academic teaching ED, were selected. Fourteen physicians were recruited. Overall, 62 hours of direct clinical observations were conducted characterizing clinical activities (EHR use, team communication, and patient care). Data were analyzed using qualitative open-coding techniques and descriptive statistics. Timeline belts were used to represent temporal events. Results At site 1, physicians, engaged in more team communication, followed by direct patient care. Although physicians spent 61% of their clinical time at workstations, only 25% was spent on the EHR, primarily for clinical documentation and review. Site 2 physicians engaged primarily in direct patient care spending 52% of their time at a workstation, and 31% dedicated to EHRs, focused on chart review. At site 1, physicians showed nonlinear complex workflow patterns with a greater frequency of multitasking and interruptions, resulting in workflow fragmentation. In comparison, at site 2, a less complex environment with a unique patient assignment system, resulting in a more linear workflow pattern. Conclusion The nature of the clinical practice and EHR-mediated workflow reflects the ED work practices. Physicians in more complex organizations may be less efficient because of the fragmented workflow. However, these effects can be mitigated by effort distribution through team communication, which affords inherent safety checks.

ObjectiveTo determine whether intraoperative handover of patient care from one anaesthesia clinician to another was associated with an increased risk of adverse postoperative outcomes during paediatric surgeries.Design, setting and participantsA retrospective, population-based cohort study (1 April 2013–1 June 2018) at an academic medical centre.ExposureIntraoperative handover of care between pairs of anaesthesia clinicians from one care provider to another compared with no handover of anaesthesia care.Main outcomes and measuresThe primary outcome was a composite of all-cause mortality and major postoperative morbidity within 30 days after surgery. Secondary outcomes included individual components of the primary outcome and 30-day hospital readmission. Inverse probability of exposure weighting using propensity scores for intraoperative handovers was calculated. Weighted logistic regression was used to determine the association between intraoperative anaesthesia handovers and outcomes.Results78 321 paediatric surgical cases (n=5411 with handovers) were included for analysis. Patients were predominantly male (56.5%) with a median age of 6.56 (IQR: 2.65–12.53) years and a median anaesthesia duration of 76 (IQR: 55–126) min. In the weighted sample, the odds of the primary outcome (OR: 0.92; 95% CI 0.75 to 1.13; p=0.43), any morbidity (OR: 0.93; 95% CI 0.75 to 1.16; p=0.515), all-cause mortality (OR: 0.8; 95% CI 0.37 to 1.73; p=0.565) or 30-day readmission following surgery (OR: 0.99; 95% CI 0.84 to 1.18; p=0.95) did not significantly differ among surgeries with and without handovers.ConclusionsAmong paediatric patients undergoing surgery, intraoperative anaesthesia handovers were not associated with adverse postoperative outcomes, after accounting for relevant covariates. These findings provide a preliminary perspective on the role of intraoperative handovers as a care-neutral event, with implications for improving safety.

Platelet concentrates are derivatives of blood that aid in haemostasis and wound healing after periodontal regenerative procedures. Its ability to act as a natural scaffold of growth factors has gained significance in many surgical procedures. This review article aims to briefly describe the different platelet concentrates used in the field of periodontology.

Background: Family and friends are key providers of care for people living with a long-term neurological condition. Neurological conditions are a significant global contributor to disability and premature death. However, previous research suggests carers often struggle to access appropriate support at end of life. Aims: This review sought to synthesise qualitative studies discussing end-of-life and palliative issues for informal carers supporting people living with neurological conditions. Design: This was a meta-ethnographic synthesis of 38 qualitative studies discussing end-of-life and palliative issues for informal carers supporting people living with long-term neurological conditions. Data Sources: Qualitative articles published after January 2010 in English, addressing carers of people with long-term neurological conditions with regard to palliative care, end of life and/or bereavement. Papers were excluded if it was not possible to separately assess the views of carers. Quality appraisal was not undertaken, but consideration was given to research context. Results: Across the papers, five key themes were identified: the future (un)certainties in the progression of life-limiting neurological conditions; an information paradox of not receiving the right information at the right time; access to support; carers’ roles in decision making around end of life; and maintaining continuity while facing change and disruption in day-to-day living. Conclusions: Given the broad agreement on the challenges faced by carers of people living with long-term neurological conditions, future research should consider opportunities to improve information and support for this group, and the development and evaluation of practical models of service delivery.

Objective We utilized a computerized order entry system–integrated function referred to as “void” to identify erroneous orders (ie, a “void” order). Using voided orders, we aimed to (1) identify the nature and characteristics of medication ordering errors, (2) investigate the risk factors associated with medication ordering errors, and (3) explore potential strategies to mitigate these risk factors. Materials and Methods We collected data on voided orders using clinician interviews and surveys within 24 hours of the voided order and using chart reviews. Interviews were informed by the human factors–based SEIPS (Systems Engineering Initiative for Patient Safety) model to characterize the work systems–based risk factors contributing to ordering errors; chart reviews were used to establish whether a voided order was a true medication ordering error and ascertain its impact on patient safety. Results During the 16-month study period (August 25, 2017, to December 31, 2018), 1074 medication orders were voided; 842 voided orders were true medication errors (positive predictive value = 78.3 ± 1.2%). A total of 22% (n = 190) of the medication ordering errors reached the patient, with at least a single administration, without causing patient harm. Interviews were conducted on 355 voided orders (33% response). Errors were not uniquely associated with a single risk factor, but the causal contributors of medication ordering errors were multifactorial, arising from a combination of technological-, cognitive-, environmental-, social-, and organizational-level factors. Conclusions The void function offers a practical, standardized method to create a rich database of medication ordering errors. We highlight implications for utilizing the void function for future research, practice and learning opportunities.

Objective We had three aims 1) understand barriers to perioperative management of anxiety and depression in older surgical patients; 2) identify preferences and requirements for interventions to manage their anxiety and depression; and 3) explore the feasibility of implementing such interventions in perioperative care. Design A qualitative study using semistructured interviews was conducted. Setting Participants were recruited at a large academic medical center. Participants We interviewed older surgical patients and clinicians to characterize their perspectives on management of anxiety and depression symptoms, with emphasis on patient needs, barriers, and potential interventions to address these needs. Measurements We used the Consolidated Framework for Intervention Research to guide the development of interview questions related to intervention implementation feasibility. Thematic analysis was used to analyze interview responses. Results Forty semistructured interviews were conducted. Key barriers for perioperative management of depression and anxiety included fear of surgery, acute pain, postoperative neurocognitive disorders, limited understanding of what to expect regarding surgery and recovery, and overwhelmingly complex medication management. Patients and clinicians suggested that a bundled mental health management intervention targeted for older surgical patient population comprised of behavioral and pharmacologic strategies can help mitigate anxiety and depression symptoms during the perioperative period. Clinicians emphasized the need for a collaborative engagement strategy that includes multiple stakeholders in the design, planning, and implementation of such an intevention. Conclusion New care models need to be developed to integrate mental health care into the current perioperative care practice.

We report a case of a 12-year-old male who initially presented with active systemic lupus erythematosus (SLE) with lupus nephritis and secondary macrophage activation syndrome (MAS). He went on to develop left-sided upper motor neuron (UMN) facial palsy secondary to lupus-related tumefactive demyelination. Tumefactive lesions secondary to demyelination are a very rare manifestation in neuropsychiatric SLE. This child responded to aggressive immunosuppression with steroids and cyclophosphamide.

PURPOSE: Despite considerable research on the barriers to enrollment in cancer therapeutic trials, few studies have elicited barriers from the perspective of community physicians, who provide the majority of cancer care. The purpose of this study was to characterize barriers to and facilitators of cancer therapeutic trials as perceived by oncologists in community practices. METHODS: Twenty semistructured interviews were conducted with oncologists at six community sites affiliated with City of Hope National Medical Center from March to June 2018. Responses were recorded digitally and transcribed. Data were analyzed using qualitative content analysis. RESULTS: Of the 20 participants, 4 (20%) were women, 13 (65%) had > 10 years of practice experience, and 16 (80%) reported that < 5% of their patients were enrolled in a therapeutic trial. Participants identified four system-level barriers: lack of appropriate trials for community-based settings, insufficient infrastructure support, restrictive eligibility criteria, and financial limitations; three physician-level barriers: lack of awareness of available trials, lack of knowledge of trial details, and lack of time; and two patient-level barriers: patient burden and negative beliefs/attitudes toward research. Efforts aimed to increase trial availability, clinical trial support personnel, and physician knowledge were identified as major facilitators. CONCLUSION: Community oncologists face numerous complex, multifaceted barriers to cancer therapeutic trial enrollment. Although expanding clinical research beyond the academic setting allows access to a larger and more diverse patient population, increasing generalizability and relevance of trial findings, there remains a substantial need for new strategies to improve cancer research delivery in the community.

Purpose Development of cancer chemotherapy treatment-induced hyperglycemia/ diabetes (secondary diabetes) is a major problem and has never been reported from India. The present study was planned to ascertain this in women undergoing curative chemotherapy for their breast cancer. Materials and Methods This was a retrospective chart-based study and was conducted in a cancer specialty hospital. The information on women who were nondiabetic at the start of the treatment was collected from the files. Details on cancer diagnosis, domicile, body mass index (BMI), type of diet, marital status, number of children, and previous history of diabetes if any were considered. The blood glucose levels before surgery and after the completion of radiotherapy were considered. World Health Organization (WHO) guidelines for diabetes were considered. The data were subjected to frequency and percentage and analyzed using Chi-square test. Association between the demographic details and development of Hyperglycemia or secondary diabetes or prediabetes was done using the Pearson’s correlation analysis. p < 0.05 was considered as statistically significant. Results A total of 474 cases were included in accordance with the inclusion criteria. The results indicated that by the end of the radiation treatment, 24.89% were prediabetic, 10.97% were diabetic after being in prediabetic stage, 8.22% became diabetic without going through a prediabetic stage, and that 55.91% did not develop either prediabetic or diabetic condition. Analysis of development of secondary diabetes and prediabetes with BMI (p < 0.0001) and age (p < 0.024) showed a strong correlation and was significant. Conclusion To the best of the authors’ knowledge, this is the first study from India, and the results indicate that the development of secondary diabetes in women undergoing curative chemotherapy is high. Attempts are underway to ascertain the cause for the development and how it can be mitigated.

Objectives To identify and summarize the existing evidence on the efficacy, effectiveness and safety of biologic therapies used, either as indicated or off-label, in the treatment of FMF. Methods A systematic literature review was conducted using Embase®, MEDLINE®, MEDLINE®-In Process, and Cochrane databases to identify randomized/non-randomized controlled trials (RCTs/non-RCTs) and real-world observational studies of FMF published as full-text articles (2000–September 2017) or conference abstracts (2014–September 2017). Studies with data for ≥1 biologic were included. Studies with Results Of the 3342 retrieved records, 67 publications, yielding 38 unique studies, were included. All studies were published after the year 2010, and the majority (21) were full-text articles. Most studies (33/38) were prospective/retrospective observational; three were double-blind, placebo-controlled RCTs (one each of anakinra, canakinumab and rilonacept); and two were non-RCTs (both canakinumab). Anakinra (26), canakinumab (21) and etanercept (6) were the most frequently used biologics across studies, whereas use of adalimumab, tocilizumab, rilonacept and infliximab was limited (1–2 studies). The available evidence suggested benefits of anakinra and canakinumab in FMF. Conclusion Anti-IL-1 therapies (i.e. anakinra and canakinumab) appear to be effective and safe options in the treatment of overall FMF, including patients with colchicine resistance and FMF-related amyloidosis. There is a need for properly designed prospective or controlled studies to conclude the superiority of one anti-IL-1 therapy over another. Evidence on the use of TNF-α and IL-6 inhibitors is limited, and further research is suggested.

microRNAs (miRNAs) constitute a family of small, non-coding RNA molecules that regulate gene expression and protein expression. microRNAs have influence on a broad range of physiologic and pathologic conditions. They are also considered as promising biomarkers especially when they are secreted extracellularly. In the inflammatory pathways, they dysregulate the molecular processes and contribute to the development of chronic inflammatory diseases including periodontitis. In this review, we provide an overview of miRNA characteristics, biogenesis, mechanisms of action and profiling methods. In addition, the role of miRNAs in the pathobiology of periodontitis, especially those pertaining to the cellular and molecular pathways of inflammation has been considered to enhance our understanding of the pathobiology of periodontitis.

Electroencephalogram (EEG) can track the brain waves which contain the neural activity of the brain. EEG signals help to understand the physiological and functional details and activities of the br...

Nurses in primary care are often the first point of access for those seeking health care, and it is well known that accessing health services can be difficult for some, especially those on a low income. A charity initiative has been developed in a low-income area in England to help such individuals, wherein volunteers help local residents to access local services and support. This study explores the experiences of service users in order to understand their perceptions and feelings about the service, using an instrumental case study method with semi-structured interviews. Qualitative data were collected from six service users and transcribed by the researcher for subsequent thematic analysis. The participants' experiences were characterised by reduced social isolation, reduced emotional distress, improved mobility and transport options, improved confidence and control over life, and effective management of memory issues. Various aspects of advocacy and empowerment were also observed. Further, the coping strategies used by the participants while facing the challenges of social isolation and ageing were highlighted. The findings provide important insight into the support needs of populations on low income, the ways in which they access healthcare and how the volunteer service can best support them.

Epilepsy is a widely spread neurological disorder caused due to the abnormal excessive neural activity which can be diagnosed by inspecting the electroencephalography (EEG) signals visually. The manual inspection of EEG signals is subjected to human error and is a tedious process. Further, an accurate diagnosis of generalized and focal epileptic seizures from normal EEG signals is vital for the supervision of pertinent treatment, life advancement of the subjects, and reduction in cost for the subjects. Hence the development of automatic detection of generalized and focal epileptic seizures from normal EEG signals is important. An approach based on tunable-Q wavelet transform (TQWT), entropies, Particle Swarm Optimization (PSO) and Artificial Neural Network (ANN) is proposed in this work for detection of epileptic seizures and its types. Two EEG databases namely, Karunya Institute of Technology and Sciences (KITS) EEG database and Temple University Hospital (TUH) database consisting of normal, generalized and focal EEG signals is used in this work to analyze the performance of the proposed approach. Initially, the EEG signals are decomposed into sub-bands using TQWT and the non-linear features like log energy entropy, Shannon entropy and Stein’s unbiased risk estimate (SURE) entropy is computed from each sub-band. The informative features from the computed feature vectors are selected using PSO and fed into ANN for the classification of EEG signals. The proposed algorithm for KITS database achieved a maximum accuracy of 100% for four experimental cases namely, (i) normal-focal, (ii) normal-generalised, (iii) normal-focal + generalised and (iv) normal-focal-generalised. The TUH database achieved an accuracy of 95.1%, 97.4%, 96.2% and 88.8% for the four experimental cases. The proposed approach is promising and able to discriminate the epileptic seizure types with satisfactory classification performance.

Introduction Few studies have evaluated the impact of delayed diagnosis of axial spondyloarthritis (axSpA) on the overall burden of disease. The objective of this review was to evaluate the available literature on the clinical, economic, and humanistic burden of delayed diagnosis in patients with axSpA. Methods This systematic literature review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the MEDLINE and Embase databases for English-language publications of original research articles (up to July 12, 2018) and conference abstracts (January 1, 2014, to July 12, 2018) reporting studies of adult patients with delayed diagnosis of axSpA associated with clinical, economic, or humanistic burden. Retrieved publications were screened for eligibility by two independent reviewers; discrepancies were resolved by a third independent reviewer. Data were extracted by one reviewer and validated by a second independent reviewer. Results A total of 1391 publications were retrieved, of which 21 met the inclusion criteria and were included in the analysis. Of these, 15 reported data on clinical burden, nine on economic burden, and six on humanistic burden, with eight studies reporting a combination of clinical, economic, and/or humanistic burden. Patients with a delayed diagnosis of axSpA generally had higher disease activity, worse physical function, and more structural damage than those who received an earlier diagnosis. Patients with a delayed diagnosis also had a greater likelihood of work disability and higher direct and indirect healthcare costs than those who received an earlier diagnosis. Delayed diagnosis was associated with a greater likelihood for depression, negative psychological impacts, and worse quality of life. Conclusions Delayed axSpA diagnosis was associated with more functional impairment, higher healthcare costs, and worse quality of life, highlighting the importance of early recognition of axSpA to reduce extensive burden on patients and society. Plain Language Summary Plain language summary available for this article. Electronic Supplementary Material The online version of this article (10.1007/s40744-020-00194-8) contains supplementary material, which is available to authorized users.

BACKGROUND: Scrub typhus, an acute febrile illness, is one of the emerging and re-emerging infectious diseases in India. This study was undertaken to assess the clinicohematological, treatment, and outcome profile of the patients diagnosed with scrub typhus at the clinical microbiology department of a tertiary care teaching hospital in Coastal Karnataka, India. MATERIALS AND METHODS: This was a retrospective study conducted with patients diagnosed as scrub typhus between January 2014 and December 2017. The demographic, clinical, laboratory, treatment, and outcome profile of these patients were noted and analyzed by Student's t-test. A P < 0.5 was considered statistically significant. RESULTS: A total of 146 patients were included in the study. The males were more infected than females, and people in the age group of 51–60 years were affected the most. Fever (139, 95.2%) was the most common symptom. Eschar was seen in only 52 (34.89%) patients. Anemia, leukocytosis, neutrophilia, lymphocytopenia, eosinophilia, monocytosis, thrombocytopenia, and raised erythrocyte sedimentation rate were statistically significant in scrub patients. The hepatic and renal indicators were also deranged. All patients were treated with doxycycline, and platelet was transfused in 7 (4.8%) patients. Among the seven dead patients, there were significant eosinopenia and deranged renal parameters compared to the survived patients. CONCLUSION: In endemic area, when a middle-aged individual presents with fever and leukocytosis with thrombocytopenia with or without eschar, scrub typhus should be considered as a differential diagnosis and empirical therapy started.

Introduction: The most frequent cause of morbidity in India is cardiovascular diseases (CVDs) complicating chronic kidney disease (CKD). Reports suggest that CKD patients with cardiovascular comorbidities are on multiple drugs, which could potentially lead to drug–drug interactions. This study intends to describe the prevalent trends in prescribing drugs for the haemodialysed CKD patients and attempts to explore the cardiovascular complications and the factors influencing them. Methodology: This observational study was conducted on CKD patients on haemodialysis, presenting to the Dialysis Centre of Father Muller Medical College, Mangalore, Karnataka, India. The study recruited a total of 107 patients from whom data were collected at the first visit and at the end of 6 months. Results: Out of the 107 patients on haemodialysis, 38 cases of cardiovascular comorbidities were noted. Hyperkalaemia was observed in 32.4%, hypokalaemia in 10.5% and normal potassium levels in 56.8% of the patients with cardiovascular comorbidities. Hyperphosphataemia was observed in 65.6%, hypophosphatemia in 0.9% and normal serum phosphate in 33.3% of the patients with anaemia. Conclusions: CVDs are common in CKD patients, and concomitant anaemia and hyperglycaemia tend to complicate the management. In such a background, appropriate care has to be exercised in the treatment of CKD.

As a leading form of preventable visual impairment, it is imperative to assess glaucoma treatment as a function of intraocular pressure (IOP). IOP can spike throughout the day. This necessitates a device that can (1) monitor IOP outside of clinical visits by providing a memory when IOP exceeds a set threshold indicating the possibility for glaucomatous damage to occur; and (2) accurately assess IOP. Both requirements point ultimately towards the development of an implantable device. The Wireless Intraocular Pressure Sensor System (WIPSS) devised by our team uses optical technologies and may assist an overseeing clinician with assessing glaucoma treatment efficacy and avoiding irreversible glaucomatous visual field loss downstream.

Focal epilepsy is a common neurological disorder of the brain. It is symbolized by recurring seizure activities in particular regions of the brain. Electroencephalogram (EEG) signals contain information about the brain activity that can be used to identify areas affected by seizures. For this, however, neurologists have the challenging task to analyze the EEG signal to imply where the source of epilepsy is located. A novel approach to detect regions of focal epilepsy is proposed in this paper. By using an adaptive mixture of independent component analysis as a decomposition algorithm and information about the position of the measuring electrodes, EEG signals are transformed into two-dimensional brain maps that are further altered by a symmetric-weighted scale-invariant local ternary pattern technique. Features from this altered brain map are used as input in a three-layered artificial neural network for classification between epileptic and artifact brain maps. The brain maps classified as artifact are eliminated, and the epileptic components are given as output for doctors to investigate the regions of the brain affected by focal epilepsy. With the proposed methodology, an accuracy of 99.53% to detect epileptic components in EEG signals is reached.

Introduction: Amputation can disturb the quality of life, and it can be worsened when the amputated stump suffers from any dermatoses. It is mandatory for an amputee and the doctor to know about the common dermatoses that an amputated limb can suffer from. The prosthesis should be properly fitting, and hygiene has to be maintained. Case Presentation: A 49-year-old male presented with a warty lesion over the amputated limb. Histopathological examination revealed verrucous hyperplasia, and further examination showed improperly fitted prosthesis. A well-fitted prosthesis with proper padding cured his lesion. Conclusions: The case report highlights how a properly fitted prosthesis corrects the lymphatic flow and thereby reduces complications. It is also important to maintain stump hygiene, as the humid, relatively anaerobic environment inside the prosthesis can trigger the growth of various organisms.