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OBJECTIVES: In biomedical research, spin is the overinterpretation of findings, and it is a growing concern. To date, the presence of spin has not been evaluated in prognostic model research in oncology, including studies developing and validating models for individualized risk prediction. STUDY DESIGN AND SETTING: We conducted a systematic review, searching MEDLINE and EMBASE for oncology-related studies that developed and validated a prognostic model using machine learning published between 1st January, 2019, and 5th September, 2019. We used existing spin frameworks and described areas of highly suggestive spin practices. RESULTS: We included 62 publications (including 152 developed models; 37 validated models). Reporting was inconsistent between methods and the results in 27% of studies due to additional analysis and selective reporting. Thirty-two studies (out of 36 applicable studies) reported comparisons between developed models in their discussion and predominantly used discrimination measures to support their claims (78%). Thirty-five studies (56%) used an overly strong or leading word in their title, abstract, results, discussion, or conclusion. CONCLUSION: The potential for spin needs to be considered when reading, interpreting, and using studies that developed and validated prognostic models in oncology. Researchers should carefully report their prognostic model research using words that reflect their actual results and strength of evidence. ispartof: JOURNAL OF CLINICAL EPIDEMIOLOGY vol:157 pages:120-133 ispartof: location:United States status: published

Aims Multinomial logistic regression models allow one to predict the risk of a categorical outcome with > 2 categories. When developing such a model, researchers should ensure the number of participants ([Formula: see text]) is appropriate relative to the number of events ([Formula: see text]) and the number of predictor parameters ([Formula: see text]) for each category k. We propose three criteria to determine the minimum n required in light of existing criteria developed for binary outcomes. Proposed criteria The first criterion aims to minimise the model overfitting. The second aims to minimise the difference between the observed and adjusted [Formula: see text] Nagelkerke. The third criterion aims to ensure the overall risk is estimated precisely. For criterion (i), we show the sample size must be based on the anticipated Cox-snell [Formula: see text] of distinct ‘one-to-one’ logistic regression models corresponding to the sub-models of the multinomial logistic regression, rather than on the overall Cox-snell [Formula: see text] of the multinomial logistic regression. Evaluation of criteria We tested the performance of the proposed criteria (i) through a simulation study and found that it resulted in the desired level of overfitting. Criterion (ii) and (iii) were natural extensions from previously proposed criteria for binary outcomes and did not require evaluation through simulation. Summary We illustrated how to implement the sample size criteria through a worked example considering the development of a multinomial risk prediction model for tumour type when presented with an ovarian mass. Code is provided for the simulation and worked example. We will embed our proposed criteria within the pmsampsize R library and Stata modules.

ispartof: ANNALS OF PALLIATIVE MEDICINE vol:11 issue:8 pages:2792-2795 ispartof: location:China status: published

BACKGROUND: Palliative care involves the care for patients with severe and advanced diseases with a focus on quality of life and symptom management. Integration of palliative care with curative and/or chronic care is expected to lead to better results in terms of quality of life and reduced costs. Although initiatives in different countries in Europe choose different structures to integrate care, they face similar challenges when it comes to creating trust and aligning visions, cultures and professional values. This paper sets out to answer the following research question: what roles and attitudes do palliative care professionals need to adopt to further integrate palliative care in Europe? METHODS: As part of the European Union (EU)-funded research project InSup-C (Integrated Supportive and Palliative Care). (2012-2016), 19 semi-structured group interviews with 136 (palliative) care professionals in 5 European countries (Germany, the United Kingdom, Belgium, the Netherlands, Hungary) were conducted. A thematic analysis was conducted. RESULTS: Integration of palliative care calls for diplomatic professionals that can bring a cultural shift: to get palliative care, with its particular focus on the four dimensions (physical, psychological, social, spiritual), integrated into historically established medical procedures and guidelines. This requires (a) to find an entrance (for telling a normative story), and (b) to maintain and deepen relationships (in order to build trust). It means using the appropriate words and sending a univocal team message to patients and being grateful, modest, and aiming for a quiet revolution with curation oriented healthcare professionals. CONCLUSION: Diplomacy appears to be essential to palliative care providers for realizing trust and what can be defined as normative integration between palliative and curative and/or chronic medicine. It requires a practical wisdom about the culture and goals of regular care, as well as keeping a middle road between assimilating with values in regular medicine and standing up for the basic values central to palliative care. ispartof: INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT vol:11 issue:6 pages:786-794 ispartof: location:Iran status: published

The generalizability of predictive algorithms is of key relevance to application in clinical practice. We provide an overview of three types of generalizability, based on existing literature: temporal, geographical, and domain generalizability. These generalizability types are linked to their associated goals, methodology, and stakeholders. ispartof: NPJ DIGITAL MEDICINE vol:6 issue:1 ispartof: location:England status: published

Background: Advance care planning supports patients to reflect on and discuss preferences for future treatment and care. Studies of the impact of advance care planning on healthcare use and healthcare costs are scarce. Aim: To determine the impact on healthcare use and costs of an advance care planning intervention across six European countries. Design: Cluster-randomised trial, registered as ISRCTN63110516, of advance care planning conversations supported by certified facilitators. Setting/participants: Patients with advanced lung or colorectal cancer from 23 hospitals in Belgium, Denmark, Italy, the Netherlands, Slovenia and the UK. Data on healthcare use were collected from hospital medical files during 12 months after inclusion. Results: Patients with a good performance status were underrepresented in the intervention group ( pConclusions: Lower care costs as observed in the intervention group were mainly related to patients’ characteristics. A definite impact of the intervention itself could not be established.

The scientific report presents a study conducted by the Research Center of Socio-Political Monitoring of the School of Public Policy and Management at RANEPA Institute for Social Sciences. The relevance of the study: Preserving and strengthening the health of the population is a priority task for the Russian state. Currently, this problem is acquiring special significance in the context of changes in the social reality associated with a challenging COVID-19 pandemic situation. The purpose of the study is to analyze the behavioral strategies of the population related to maintaining and improving their health. The objectives of the study are related to assessing the degree of influence of the main behavioral factors on the health and social well-being of the citizens, with an assessment of the measures taken by the state to form behavioral strategies of the population aimed at protecting and strengthening their health. The subject of the study is the prevalence of various types of behavioral strategies and their impact on the health status and social well-being of representatives of different socio-demographic groups and strata. Methods: The main source of empirical information was the all-Russian sociological survey of the population, conducted on April 8-19, 2021 using the method of formalized personal interviews at the respondents’ place of residence. 1,500 people aged 18 and over were interviewed in 30 regions of the Russian Federation. Results: The study records an increase in the people’s positive self-perception of their health over the past two decades; at the same time, the respondents are susceptible to a wide range of diseases. There is an increase in demand for qualified medical care in case of illness; however, self-medication remains widespread, which can negatively affect people's health. The people’s actual behavior often does not correspond to their ideas about a healthy lifestyle. Russians do not have a well-developed culture of healthy lifestyles; they lack the habit of daily positive activities to maintain and strengthen their health. In general, the results of the study show insufficiency of the measures taken by the state to create conditions for strengthening the public health. Conclusions. The problems identified show the need to increase the availability of medical care, improve health awareness of the public, expand incentives for self-preservation and health promotion. Scientific novelty. The value of this study lies in obtaining up-to-date information on the priorities of the Russian citizens, their self-preservation behavior in a force majeure situation of an epidemiological crisis and its consequences, which can contribute to promoting managerial decisions in healthcare and social development that are adequate to the needs of the population.&nbsp

We strive to increase public (PH) and occupational health (OSH) inter-linkages by building a collaborative framework. Besides Covid-19 pandemic, recent approaches such as Human Exposome and Total Worker Health TM, have led to a shift to improving health of working population and consequently the total population. These health objectives can be best realised through primary care actors in specific contexts. Work, school, home and leisure are the four multi-stakeholder contexts in which health and healthcare (goal-oriented care) objectives needs to be set and defined. PH policy makers need to establish a shared decision-making process involving employees, employers and OSH representatives to set PH goals and align with OSH goals. The policy making process in OSH can serve as a potential way forward, as the decisions and policies are being decided centrally in consultation with social partners and governments. This process can then be mirrored on company level to adopt and implement. ispartof: JOURNAL OF PUBLIC HEALTH POLICY vol:44 issue:1 ispartof: location:England status: Published online

Sağlık sorunlarının çözümüne toplumun katkısı, sağlık sorunlarının erken tanı aşamasında çö züme ulaştırılmasını sağlar; hastalık yönetimini kolaylaştırır, sağlık hizmet sunumunun toplumun bütü nüne ulaşmasına hizmet eder. Toplumun kendi sağlık gereksinimlerinin farkında olması ve sağlık sorunlarının çözümüne katılması, bireyin ve toplumun eğitim düzeyi, sağlık okuryazarlığı ile olduğu kadar toplumda farkındalığını artırmak üzere yapılan girişimlerle de ilgilidir. Topluma dayalı araştır maların yapılması, araştırma sonuçlarının toplumla paylaşılması, sağlık kurumları ve sağlık hizmet su nucularının iş birliği yapması, sağlıkla ilgili mevzuat ve yasalarla ilgili kararların alınması toplumun sağlığın geliştirilmesine aktif katılımını sağlayacak temel girişimlerdir. Aile hekimliği ve birinci basa mak sağlık hizmet sunumu bu temel girişimlerin en etkili olarak sunulacağı hizmet basamağıdır. Ge rekli olan yet-kinlik uzmanlık eğitimi ile edinilebilir. Bu makalede toplumun aile hekimliği uygulamalarına katılımının önemi ve katılımın sağlanmasına yönelik olarak kullanılan yöntemler tartı şılmaktadır. The participation of the community in the solution of the health problems, contributes to early resolution of problems, facilitates disease management, enables the health care to reach the whole community. The awareness of the community about its own health needs and its participation in the solution of health problems are as related to the individual's and the population's education level and health literacy as the attempts to raise the awareness among community. Community based researches, sharing the results with the community, cooperation of health institutions and the health providers, decisions about health related laws and regulations are the essential attempts to reassure the active participation of the community for solving problems. Family medicine and primary health care is the care level where these essential attempts are the most effectively provided. The competencies needed can be acquired by family medicine residency program. In this article, the importance of the participation of the community to the family practice and the methods used forenabling the participation are discussed.

Avrupa aile hekimliği/genel pratisyenlik tanımında (2011), disiplinin temel özelliklerinden biri olan \"birinci basamağın yönetimi’ne göre aile hekimi bireylere açık ve sınırsız erişim sağlar, yaş, cinsiyet veya hiçbir kişinin başka özelliğine göre ayrım gözetmeksizin tüm sağlık sorunları ile ilgilenir.\" Burada bahsedilen açık ve sınırsız erişimin sağlaması için aile hekimleri fiziksel ve finansal ulaşılabilir olmakla birlikte herkesle açık, dürüst ve paylaşımcı iletişim kurmalıdır. Fiziksel olarak ulaşımın zor olduğu bölgelerde gezici sağlık hizmeti vermelidir. Yine bu yerlerde özellikle yaşlı hastalar için tele-sağlık sistemi de hastanın hekime ulaşması için bir yol olabilir. Erişilebilirlik aynı zamanda aile hekimliğinde sürekliliğin sağlanmasının da temel unsurlarındandır. Birçok ülkede mesai saatleri dışında da aile hekimine erişim mevcut olup, acil servise gitmek yerine önemli bir alternatiftir. Ülkemizde ise aile hekimlerinin ulaşılabilirliğinin yalnızca mesai saatleri ile sınırlı olması acil servislerde acil olmayan hasta başvurusundaki fazlalığın nedeni olabilir. According to the "primary care management", which is one of the basic features of the discipline, in the European definition of family medicine/general practitioner (2011) the family physician provides open and unlimited access to individuals, deals with all health problems without discrimination based on age, gender or any other characteristic of any person. In order to provide the open and unrestricted access mentioned here, family physicians should be physically and financially accessible, also should establish open, honest and sharing communication with everyone. They should provide mobile health services in areas where physical access is difficult. In these places, the tele-health system, especially for elderly patients, can be a way for the patient to reach the physician. Accessibility is also one of the basic elements of ensuring continuity in family medicine. In many countries, access to primary care is available outside of working hours, and it is an important alternative to going to the emergency room. In our country, the availability of family physicians is limited to working hours only, which may be the reason for the high number of non-emergency patient applications in emergency services.

The role of feminist theory in health professions education is often ‘ova-looked’. Gender is one cause of healthcare inequalities within contemporary medicine. Shockingly, according to the World Health Organisation, no European member state has achieved full gender equity in regard to health outcomes. Further, contemporary curricula have not evolved to reflect the realities of a diverse society that remains riddled with inequity. This paper outlines the history of feminist theory, and applies it to health professions education research and teaching, in order to advocate for its continued relevance within contemporary healthcare.

Background/aim Several questionnaires have been developed to evaluate the quality of life (QoL) for people living with human immunodeficiency virus (HIV). The aim of this study was to compare Turkish version of the Medical Outcomes Study-HIV Health Survey (MOS-HIV) with Short Form Health Survey (SF-36) in people with HIV. Patients and methods A hundred and 14 patients with HIV were consecutively included. The MOS-HIV and SF-36 questionnaires were applied to all patients at the same day. MOS HIV included 35 items and assessed general health perceptions (GH), physical functioning (PF), social functioning (SF), mental health (MH), bodily pain (P), cognitive functioning, health distress, overall QoL, health transition, role functioning (RF), energy/vitality (EV), physical (Physical health summary score) and mental (MHSS) health summary scores. SF-36 included 36 items and measured eight domains of health concepts including SF, PF, P, RF, GH, role emotional, vitality (V) and MH. Correlation analysis and Bland- Altman plots were used to compare the MOS-HIV and SF-36 questionnaires. Results GH, PF, P, RF, EV, SF, and MH domains of the MOS-HIV were significantly correlated with those of SF 36. The agreement between the tests were 91.2% for PF, 92.1% for RF and pain, 94.7% for GH, 95.6% for EV, 92.1% for SF and 93.9% for MH. Conclusion Turkish version of the MOS HIV showed moderate correlations and agreement with SF 36 suggesting its use as an alternative to SF 36 in assessing QoL in these patients.

Background The Covid-19 pandemic has led to huge disruptions and multi-domain healthcare crisis, with additional impact on children and young people (CYP) affected by Attention Deficit and Hyperactivity Disorder (ADHD). Methods We conducted an online survey and obtained responses from 62 Paediatricians who provide ADHD services for CYP about their experience of Service disruption and adaptations during the first Covid-19 lockdown in the United Kingdom between March and June 2020. The responses were both quantitative and qualitative. Results The Paediatricians reported huge service disruptions such that almost half ceased the assessment of new patients with ADHD, and only 5% were able to offer physical monitoring for most patients. However, all respondents had adopted telemedicine, which allowed them to maintain high levels of non-physical service provision for existing patients. The Paediatricians used risk stratification strategies to determine which patients were more likely to benefit from the limited available face to face appointments for physical monitoring. The Paediatricians demonstrated clinical pragmatism to meet the needs of their patients such as starting medication without physical exam especially if the patient's behaviour was so challenging that it was presenting a crisis at home, and setting aside monthly limits for stimulant medications. Some respondents reported helpful cross-service collaborations to support CYP with ADHD and their families. Conclusion The Covid-19 pandemic has had adverse effect on many CYP with ADHD and caused huge disruption to the ADHD services that support them. As the pandemic continues to cause disruptions to ADHD services, the service adaptations emerging from the literature including some of those identified in this study could be useful to support more stable and sustainable ADHD services, both during and after the pandemic.

Recently, I experienced what care is all about. I became a patient and noticed that my field of expertise, quality of care and patient safety, is not that easy in daily practice. In this Leadership in the Mirror, I reflect on my own experience and describe how four core values of care can hopefully guide the leadership of junior and less junior clinicians. The essay is adapted from the commencement speech I gave in June 2022 at the Faculty of Medicine at KU Leuven University and introduces a new quality framework that highlights the progressions of healthcare towards personalisation of care, with a focus on the whole person as an individual, rather than a restricted view on the patient's disease. ispartof: BMJ LEADER ispartof: location:England status: Published online

The Vitamins and Supplements Market research report is a comprehensive and vital document encompassing business strategies, qualitative and quantitative analysis, and emerging trends of the global Vitamins and Supplements Market. The report offers in-depth research and assessment of the key elements of the global Vitamins and Supplements Market. The research analysts have formulated this report through thorough primary and secondary research with a detailed analysis of the drivers, restraints, challenges, trends, and opportunities to provide a panoramic view of the Vitamins and Supplements Market. Thevitamins and supplements marketsize reached USD 108.4 Billion in 2021 and is expected to register a revenue CAGR of 6.9% during the forecast period. Shift in consumer preferences due to increasing focus on health and prevention and rising prevalence of chronic diseases are some key factors projected to support market revenue growth between 2022 and 2030. Get a sample of the report @https://www.emergenresearch.com/request-sample/1361 In addition, increasing awareness among consumers regarding their health is another factor driving revenue growth of the market. Different types of products are increasingly being used for vitamins and supplements. Food and nutrition sectors have evolved to provide customers with a more tailored experience and make up for dietary loss through supplemental nutrition. In addition, rising prevalence of chronic diseases is another factor increasing demand for vitamins and supplements. The World Health Organization estimates that in 2021, prevalence of chronic diseases was around 57%. This indicates that over 50% of people worldwide have a chronic illness, with cancer, diabetes, and disorders of heart and lungs being the most prevalent. Every day, a range of vitamins, minerals, and nutrients are required to maintain good health and, more significantly, a strong immune system that fights off chronic diseases. Competitive Landscape: Furthermore, the report includes an in-depth analysis of the competitive landscape. The segment covers a comprehensive overview of the company profiles along with product profiles, production capacities, products/services, pricing analysis, profit margins, and manufacturing process developments. The report also covers strategic business measures undertaken by the companies to gain substantial market share. The report provides insightful information about recent mergers and acquisitions, product launches, collaborations, joint ventures, partnerships, agreements, and government deals. Some major companies operating in the global market includeHerbalife International of America, Inc., Archer-Daniels Midland Company, Amway Corporation, Pfizer, Inc., Abbott, Nestle S.A., Nutrition and Biosciences (DuPont de Nemours, Inc.), Bayer AG, Glanbia PLC, and Arkopharma. 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Emergen Research has segmented the vitamins and supplements based on ingredient, form, application, end-users, type, distribution channel, and region: Ingredient Outlook (Revenue, USD Billion, 2019 - 2030) Vitamins Supplements Form Outlook (Revenue, USD Billion, 2019 - 2030) Tablets Capsules Soft Gels Powders Gummies Liquids Application Outlook (Revenue, USD Billion, 2019 - 2030) Immunity Brain/Mental Health Bone & Joint Health Menopause Metabolic Health Beauty Care Digestive & Microbiome Health Others End-Users Outlook (Revenue, USD Billion, 2019 - 2030) Adults Geriatric Pregnant Women Children Infants Type Outlook (Revenue, USD Billion, 2019 - 2030) OTC Prescribed Distribution Channel Outlook (Revenue, USD Billion, 2019 - 2030) Offline Online Emergen Research is Offering Limited Time Discount (Grab a Copy at Discounted Price Now)@https://www.emergenresearch.com/request-discount/1361 Key Benefits For Stakeholders: The report provides an extensive analysis of the current and future trends in the global minimally invasive surgical systems market to elucidate the imminent investment pockets. A detailed analysis of the factors that drive and restrict the growth of the minimally invasive surgical systems market is provided. Extensive analysis of key segments demonstrates the types of energy devices, access equipment, and visualization & documentation systems used in minimally invasive surgeries. A comprehensive analysis of the geographical landscape provides detailed information about various regions across North America, Europe, Asia Pacific, Latin America, and Middle East & Africa. The report offers a competitive landscape of the minimally invasive surgical systems market to assist players to gain insights into the competition scenario. Key companies operating in the market are profiled to provide valuable insights. Regional Outlook ofEd-Tech and Smart ClassroomMarket: North America U.S. Canada Mexico Europe Germany U.K. Italy France BENELUX Rest of Europe Asia Pacific China India Japan South Korea Rest of APAC Latin America Brazil Rest of LATAM Middle East & Africa Saudi Arabia U.A.E. South Africa Rest of MEA Request Customization as per your specific requirement@https://www.emergenresearch.com/request-for-customization/1361 About Us: At Emergen Research, we believe in advancing with technology. We are growing market research and strategy consulting company with an exhaustive knowledge base of cutting-edge and potentially market-disrupting technologies that are predicted to become more prevalent in the coming decade. 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Objectives We involved public and professional stakeholders to assess a novel data interrogation tool, the Neonatal Health Intelligence Tool, for a National Data Asset, the National Neonatal Research Database. Methods We recruited parents, preterm adults, data managers, clinicians, network managers and researchers (trialists and epidemiologists) for consultations demonstrating a prototype tool and semi-structured discussion. A thematic analysis of consultations is reported by stakeholder group. Results We held nine on-line consultations (March–December 2021), with 24 stakeholders: parents (n=8), preterm adults (n=2), data managers (n=3), clinicians (n=3), network managers (n=2), triallists (n=3) and epidemiologists (n=3). We identified four themes from parents/preterm adults: struggling to consume information, Dads and data, bring data to life and yearning for predictions; five themes from data managers/clinicians/network managers: benchmarking, clinical outcomes, transfers and activity, the impact of socioeconomic background and ethnicity, and timeliness of updates and widening availability; and one theme from researchers: interrogating the data. Discussion Other patient and public involvement (PPI) studies have reported that data tools generate concerns; our stakeholders had none. They were unanimously supportive and enthusiastic, citing visualisation as the tool’s greatest strength. Stakeholders had no criticisms; instead, they recognised the tool’s potential and wanted more features. Parents saw the tool as an opportunity to inform themselves without burdening clinicians, while clinicians welcomed an aid to explaining potential outcomes to parents. Conclusion All stakeholder groups recognised the need for the tool, praising its content and format. PPI consultations with all key groups, and their synthesis, illustrated desire for additional uses from it.

Background: The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU). Methods and materials: This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period. Results: We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%). Conclusion: In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.

Purpose: This study aimed to determine the differences in the levels of physical activity and healthy lifestyle behaviors in elderly individuals living in urban and rural and to examine their relationship with depression. Material and Methods: Individuals who are over >65 years old and residing in the city and rural were included in the study. The Healthy Lifestyle Behaviors Scale-II, the Physical Activity Scale for the Elderly, and the Geriatric Depression Scale-15 were used on the participants. Results: Healthy Lifestyle Behaviors Scale-II scores were not significantly different between the two groups (p=0.430). Physical Activity Scale for the Elderly score in rural (p= 0.001); Geriatric Depression Scale-15 score were statistically higher in the city group (p= 0.01). While the relationship between the Healthy Lifestyle Behaviors Scale-II and Geriatric Depression Scale-15 scores was significant in both groups (p= 0.001 and p= 0.03), the relationship between the Elderly Physical Activity Scale-II and Geriatric Depression Scale-15 scores was significant only in the rural group (p= 0.001). Conclusion: The elderly individuals in rural are more physically active than in the city, and the elderly living in the city have higher depression levels. This current study suggests that the difference in depression scale scores of individuals living in the city center and rural areas may be due to the difference in physical activity scores. The factors affecting depression in the elderly living in cities need to be examined in detail.

Purpose To explore the association between the degree of Chronic illness management and survival rates at 1-, 3-, 5-years post heart transplantation. Methods Exploratory secondary analysis of a cross-sectional, international study (Building Research Initiative Group study). Latent profile analysis was performed to classify 36 heart transplant centers according to the degree of chronic illness management. Results The analysis resulted in 2 classes with 29 centers classified as “low-degree chronic illness management” and 7 centers as “high-degree chronic illness management”. After 1-year posttransplantation, the high-degree chronic illness management class had a significantly greater mean survival rate compared to the low-degree chronic illness management class (88.4% vs 84.2%, p = 0.045) and the difference had a medium effect size (η2 = .06). No difference in survival for the other time points was observed. Patients in high-degree chronic illness management centers had 52% lower odds of moderate to severe drinking (95% confidence interval .30–.78, p = 0.003). No significant associations between degree of chronic illness management and the other recommended health behaviors were observed. Conclusions The findings from this exploratory study offer preliminary insight into a system-level pathway (chronic illness management) for improving outcomes for heart transplant recipients. The signals observed in our data support further investigation into the effectiveness of chronic illness management-based interventions in heart transplant follow-up care.

Background Implementation fidelity assesses the degree to which an intervention is delivered as it should be. Fidelity helps to determine if the outcome(s) of an intervention are attributed to the intervention itself or to a failure of its implementation. Little is known about how fidelity impacts the intended outcome(s) and what elements or moderators can affect the fidelity trajectory over time. We exemplify the meaning of implementation fidelity with INTERCARE, a nurse-led care model that was implemented in eleven Swiss nursing homes (NHs) and showed effectiveness in reducing unplanned hospital transfers. INTERCARE comprises six core elements, including advance care planning and tools to support inter- and interprofessional communication, which were introduced with carefully developed implementation strategies. Methods A mixed-methods convergent/triangulation design was used to investigate the influence of implementation fidelity on unplanned transfers. A fidelity questionnaire measuring the degree of fidelity to INTERCARE’s core components was fielded at four time points in the participating NHs. Two-monthly meetings were conducted with NHs (September 2018-January 2020) and structured notes were used to determine moderators affecting fidelity (e.g., participant responsiveness). We used the fidelity scores and generalized linear mixed models to analyze the quantitative data. The Framework method was used for the qualitative analysis. The quantitative and qualitative findings were integrated using triangulation. Results A higher overall fidelity score showed a decreasing rate of unplanned hospital transfers post-intervention (OR: 0.65 (CI = 0.43–0.99), p = 0.047). A higher fidelity score to advance care planning was associated with lower unplanned transfers (OR = 0.24 (CI 0.13–0.44), p = Conclusion Implementation fidelity is challenging to measure and report, especially in complex interventions, yet is crucial to better understand how such interventions may be tailored for scale-up. This study provides both a detailed description of how fidelity can be measured and which ingredients highly contributed to reducing unplanned NH transfers. Trial registration The INTERCARE study was registered at clinicaltrials.gov Protocol Record NCT03590470.

Purpose: It was aimed to estimate the static and dynamic postural balance performance in adults with different Body Mass Index (BMI) levels. Material and Methods: The study was conducted in Üsküdar Diabetes and Obesity Treatment Center between September and October 2021. Participants were divided into 5 groups according to BMI scores: normal-weight, overweight, 1st degree obese, 2nd degree obese, and 3rd degree obese. In addition, participants' static and dynamic balance performance were assessed by the Limits of Stability (LOS) and modified Clinical Test of Sensory Integration of Balance (m-CTSIB) tests. Results: For LOS parameters, there was a significant difference between groups in reaction time scores only for the backward direction (p

OBJECTIVE: This study aimed to provide an overview of the strategies adopted by hospitals that target effective communication and nonmaterial restoration (i.e., without a financial or material focus) after health care incidents, and to formulate elements in hospital strategies that patients consider essential by analysing how patients have evaluated these strategies. BACKGROUND: In the aftermath of a health care incident, hospitals are tasked with responding to the patients' material and nonmaterial needs, mainly restoration and communication. Currently, an overview of these strategies is lacking. In particular, a gap exists concerning how patients evaluate these strategies. SEARCH STRATEGY AND INCLUSION CRITERIA: To identify studies in this scoping review, and following the methodological framework set out by Arksey and O'Malley, seven subject-relevant electronic databases were used (PubMed, Medline, Embase, CINAHL, PsycARTICLES, PsycINFO and Psychology & Behavioral Sciences Collection). Reference lists of included studies were also checked for relevant studies. Studies were included if published in English, after 2000 and as peer-reviewed articles. MAIN RESULTS AND SYNTHESIS: The search yielded 13,989 hits. The review has a final inclusion of 16 studies. The inclusion led to an analysis of five different hospital strategies: open disclosure processes, communication-and-resolution programmes, complaints procedures, patients-as-partners in learning from health care incidents and subsequent disclosure, and mediation. The analysis showed three main domains that patients considered essential: interpersonal communication, organisation around disclosure and support, and desired outcomes. PATIENT CONTRIBUTION: This scoping review specifically takes the patient perspective in its methodological design and analysis. Studies were included if they contained an evaluation by patients, and the included studies were analysed on the essential elements for patients. ispartof: HEALTH EXPECTATIONS vol:25 issue:1 pages:264-275 ispartof: location:England status: published

Background: Collaboration between parents and professional care providers is an essential part of pediatric palliative care. As children are embedded in family systems and many of the patients are not able to communicate verbally, their parents are the primary interaction partners for palliative care providers. International standards for pediatric palliative care in Europe state that parents should be supported, acknowledged as the primary carers and involved as partners in all care and decisions. Aim: To find out through which care practices pediatric palliative care teams shape collaboration with parents in everyday care. Design: Ethnographic method of participatory observations. Field notes were analyzed using thematic analysis. Setting/participants: Researchers accompanied three pediatric palliative care teams on home visits to eight different families caring for a child with life-limiting conditions. Results: Care practices of palliative care teams were characterized by familiarity, a resource-oriented attitude, empowerment of parents, shared decision-making and support for parents. Palliative care teams not only provided palliative medical treatment for the children, but also developed a trusting care partnership with parents. The teams employed a sensitive and multifaceted communication style in their collaboration with parents. Conclusions: Care practices in pediatric palliative care require time, communication skills, and a high level of psychosocial competence, to develop a trusting, collaborative relationship with parents. This should be taken into consideration when establishing pediatric palliative care structures, preparing guidelines, training staff, and deciding upon appropriate remuneration.

Background Patients at the end-of-life may experience refractory symptoms of which pain, delirium, vomiting and dyspnea are the most frequent. Palliative sedation can be considered a last resort option to alleviate one or more refractory symptoms. There are only a limited number of (qualitative) studies exploring the experiences of relatives of sedated patients and their health care professionals (HCPs). The aims of this study protocol are: 1) to elicit the experiences of bereaved relatives and health care professionals of patients treated with palliative sedation and 2) to explore the understanding of the decision-making process to start palliative sedation across care settings in 5 European countries. Methods This study protocol is part of the larger HORIZON 2020 Palliative Sedation project. Organisational case study methodology will be used to guide the study design. In total, 50 cases will be conducted in five European countries (10 per country). A case involves a semi-structured interview with a relative and an HCP closely involved in the care of a deceased patient who received some type of palliative sedation at the end-of-life. Relatives and health care professionals of deceased patients participating in a linked observational cohort study of sedated patients cared for in hospital wards, palliative care units and hospices will be recruited. The data will be analyzed using a framework analysis approach. The first full case will be analyzed by all researchers after being translated into English using a pre-prepared code book. Afterwards, bimonthly meetings will be organized to coordinate the data analysis. Discussion The study aims to have a better understanding of the experiences of relatives and professional caregivers regarding palliative sedation and this within different settings and countries. Some limitations are: 1) the sensitivity of the topic may deter some relatives from participation, 2) since the data collection and analysis will be performed by at least 5 different researchers in 5 countries, some differences may occur which possibly makes it difficult to compare cases, but using a rigorous methodology will minimize this risk.

Background. Job satisfaction of family physicians (FPs) is vitally important not only for the well-being of physicians but also for the quality of health services. Coordination of care is one of the core dimensions of strong primary care. However, studies focused on the association between care coordination and the job satisfaction of FPs is scarce. Objectives. To explore whether the factors influencing the job satisfaction of FPs differ in countries with different strengths of coordination. Material and methods. Across-sectional study was conducted among FPs in ten European countries which were divided into three groups in terms of care coordination. An online questionnaire was disseminated by e-mail to groups of FPs. Socio-demographic, working conditions and workload features were included as independent variables. Job satisfaction as the outcome variable was measured with one question. The Chi-square test was used for comparative analysis. Results. 278 FPs (72% of the targeted sample size) participated. The job satisfaction of FPs in strong and medium-level care coordination groups was higher than their counterparts in the weak-level care coordination group (p < 0.001). No association was found between the socio-demographics and workload features with job satisfaction. Only the non-existence of a gate-keeping system was associated with the increased job satisfaction of FPs in the medium-level care coordination group (p = 0.01). Conclusions. Primary health care is responsible for the coordination of care within the gigantic healthcare system, and FPs play a role in guiding patients. Studying the association between care coordination and the job satisfaction of FPs might help to build better healthcare systems. The gate-keeping system deserves special attention in this research area.

BACKGROUND: Ecological momentary assessment (EMA) is a scientific self-monitoring method to capture individuals' daily life experiences. Early on, EMA has been suggested to have the potential to improve mental health care. However, it remains unclear if and how EMA should be implemented. This requires an in-depth investigation of how practitioners and researchers view the implementation of EMA. OBJECTIVE: Explore the perspectives of mental health practitioners and EMA researchers on the utility of EMA for mental health care. METHODS: Practitioners (n = 89; psychiatrists, psychologists, psychiatric nurses) and EMA researchers (n = 62) completed a survey about EMA in clinical practice. This survey addressed EMA goals for practitioner and patient, requirements regarding clinical use of EMA, and (dis)advantages of EMA compared to treatment-as-usual. t-Tests were used to determine agreement with each statement and whether practitioners' and researchers' views differed significantly. Linear regression was used to explore predictors of goals and preferences (e.g., EMA experience). RESULTS: Practitioners and researchers considered EMA to be a useful clinical tool for diverse stages of care. They indicated EMA to be most useful for gaining insight into the context specificity of symptoms (55.0 %), whereas receiving alerts when symptoms increase was rated the least useful (11.3 %, alerts is in 95 % of bootstrap iterations between rank 8 and 10). Compared to treatment-as-usual, EMA was considered easier to use (M = 4.87, t = 5.30, p

Substantial interest and investment in clinical artificial intelligence (AI) research has not resulted in widespread translation to deployed AI solutions. Current attention has focused on bias and explainability in AI algorithm development, external validity and model generalisability, and lack of equity and representation in existing data. While of great importance, these considerations also reflect a model-centric approach seen in published clinical AI research, which focuses on optimising architecture and performance of an AI model on best available datasets. However, even robustly built models using state-of-the-art algorithms may fail once tested in realistic environments due to unpredictability of real-world conditions, out-of-dataset scenarios, characteristics of deployment infrastructure, and lack of added value to clinical workflows relative to cost and potential clinical risks. In this perspective, we define a vertically integrated approach to AI development that incorporates early, cross-disciplinary, consideration of impact evaluation, data lifecycles, and AI production, and explore its implementation in two contrasting AI development pipelines: a scalable “AI factory” (Mayo Clinic, Rochester, United States), and an end-to-end cervical cancer screening platform for resource poor settings (Paps AI, Mbarara, Uganda). We provide practical recommendations for implementers, and discuss future challenges and novel approaches (including a decentralised federated architecture being developed in the NHS (AI4VBH, London, UK)). Growth in global clinical AI research continues unabated, and introduction of vertically integrated teams and development practices can increase the translational potential of future clinical AI projects.

Objective: In 2011, Turkey started the nationwide \"Smoking Cessation Treatment Support Program\" via Smoking Cessation Clinics (SCC). This study examined the accessibility of these clinics using Levesque’s framework of access to healthcare services. From the (potential) users’ perspectives, it was aimed to find the challenges they face in accessing these clinics, and it proposed solutions for better implementation. Methods: This study was conducted among 304 smokers who visited four Family Health Centers in a geographically defined area in Istanbul, Turkey, in 2018. Result: In this study, it was found that 74% of smokers wished to quit smoking. Within them, 21% didn’t know of SCCs, and half of them didn’t know what services were provided there. Among those who knew of SCCs, 30% used them to quit smoking. The majority (75.7%) of the SCC users found the medications expensive; 41% didn’t use them, and 64% didn’t re-visit the clinics for follow-ups. Eventually, 4.3% of smokers quit smoking through SCCs. Utilization of these clinics were significantly higher among women (35%) than men (18.6%) (p=0.024). T; and there was no other differences in terms of age, marital status, income, and education level. Conclusion: Smoking cessation programs in Turkey and other countries can be implemented more efficiently if the sufficient number of clinics are opened and are accessible at the local level; more health professionals are trained to practice; the clinics are made more visible; smoking cessation medications are made available constantly; and closer monitoring of service users is ensured. Keywords: Smoking Cessation, Access To Health Care, Health Plan Implementations, Turkey

IntroductionHospital admissions in many countries fell dramatically at the onset of the COVID-19 pandemic. Less is known about how care patterns differed by patient groups. We sought to determine whether areas with higher levels of socioeconomic deprivation or larger ethnic minority populations saw larger falls in emergency and planned admissions in England.MethodsWe conducted a national observational study of hospital care in the English National Health Service (NHS) in 2019–2020. Weekly volumes of elective (planned) and emergency admissions in 2020 compared with 2019 were calculated for each census area. Multiple linear regression analysis was used to estimate the reductions in volumes for areas in different quintiles of socioeconomic deprivation and ethnic minority populations after controlling for national time trends and local area composition.ResultsBetween March and December 2020, there were 35.5% (3.0 million) fewer elective admissions and 22.0% (1.2 million) fewer emergency admissions with a non-COVID-19 primary diagnosis than in 2019. Areas with the largest share of ethnic minority populations experienced a 36.7% (95% CI 24.1% to 49.3%) larger reduction in non-primary COVID-19 emergency admissions compared with those with the smallest. The most deprived areas experienced a 10.1% (95% CI 2.6% to 17.7%) smaller reduction in non-COVID-19 emergency admissions compared with the least deprived. These patterns are not explained by differential prevalence of COVID-19 cases by area.ConclusionsEven in a healthcare system founded on the principle of equal access for equal need, the impact of COVID-19 on NHS hospital care for non-COVID patients has not been spread evenly by ethnicity and deprivation in England. While we cannot conclusively determine the mechanisms behind these differences, they risk exacerbating prepandemic health inequalities.

Purpose The objective of this scientometric analysis was to recognize the top 100 cited articles on 'Male infertility and Antioxidants' and analyze its publication characteristics. Materials and methods The Scopus database was used to retrieve related articles and the top 100 identified based on citation rate. Results The articles were published in 56 journals between 1995 and 2019 with a median (interquartile range) citation score of 17 (5-62). Among the top 100 articles, 69 were clinical studies, which included controlled and blinded (33.33%), prospective (27.54%), randomized-controlled trials (26.09%), uncontrolled (11.59%), and retrospective (1.45%) studies. In addition to conventional semen parameters, advanced sperm function tests such as oxidative stress (51%) and sperm DNA damage (23%) were reported. Pregnancy rate (33%) was found to be the most reported reproductive outcome. Antioxidant therapy was mostly investigated in male cohorts with sperm abnormalities such as asthenozoospermia (28%) and clinical conditions such as idiopathic male infertility (20%), varicocele/varicocelectomy (17%) and general male infertility (16%). Conclusions The most influential publications on antioxidants and male infertility were identified for the first time in the literature. This will serve as a reliable source of information for researchers and clinicians alike.

Qualitative inquiry is increasingly popular in health professions education, and there has been a move to solidify processes of analysis to demystify the practice and increase rigour. Whilst important, being bound too heavily by methodological processes potentially represses the imaginative creativity of qualitative expression and interpretation—traditional cornerstones of the approach. Rigid adherence to analytic steps risks leaving no time or space for moments of ‘wonder’ or emotional responses which facilitate rich engagement. Poetic inquiry, defined as research which uses poetry ‘as, in, [or] for inquiry’, offers ways to encourage creativity and deep engagement with qualitative data within health professions education. Poetic inquiry attends carefully to participant language, can deepen researcher reflexivity, may increase the emotive impact of research, and promotes an efficiency of qualitative expression through the use of ‘razor sharp’ language. This A Qualitative Space paper introduces the approach by outlining how it may be applied to inquiry within health professions education. Approaches to engaging with poetic inquiry are discussed and illustrated using examples from the field’s scholarship. Finally, recommendations for interested researchers on how to engage with poetic inquiry are made, including suggestions as to how to poetize existing qualitative research practices. Supplementary Information The online version of this article (10.1007/s40037-021-00682-9) contains supplementary material, which is available to authorized users.

Background Global spending on health was continuing to rise over the past 20 years. To reduce the growth rates, alleviate information asymmetry, and improve the efficiency of healthcare markets, global health systems have initiated price and quality transparency tools in the hospital industry in the last two decades. Objective The objective of this review is to synthesize whether, to what extent, and how hospital price and quality transparency tools affected 1) the price of healthcare procedures and services, 2) the payments of consumers, and 3) the premium of health insurance plans bonding with hospital networks. Methods A literature search of EMBASE, Web of Science, Econlit, Scopus, Pubmed, CINAHL, and PsychINFO was conducted, from inception to Oct 31, 2021. Reference lists and tracked citations of retrieved articles were hand-searched. Study characteristics were extracted, and included studies were scored through a risk of bias assessment framework. This systematic review was reported according to the PRISMA guidelines and registered in PROSPERO with registration No. CRD42022319070. Results Of 2157 records identified, 18 studies met the inclusion criteria. Near 40 percent of studies focused on hospital quality transparency tools, and more than 90 percent of studies were from the US. Hospital price transparency reduced the price of laboratory and imaging tests except for office-visit services. Hospital quality transparency declined the level or growth rates of healthcare spending, while it adversely and significantly raised the price of healthcare services and consumers’ payment in higher-ranked or rated facilities, which was referred to as the reputation premium in the healthcare industry. Hospital quality transparency not only leveraged private insurers bonding with a higher-rated hospital network to increase premiums, but also induced their anticipated pricing behaviors. Conclusion Hospital price and quality transparency was not effective as expected. Future research should explore the understudied consequences of hospital quality transparency programs, such as the reputation/rating premium and its policy intervention.

Background Most randomized controlled trials (RCTs) in the academic setting have limited resources for clinical trial management and monitoring. Inefficient conduct of trials was identified as an important source of waste even in well-designed studies. Thoroughly identifying trial-specific risks to enable focussing of monitoring and management efforts on these critical areas during trial conduct may allow for the timely initiation of corrective action and to improve the efficiency of trial conduct. We developed a risk-tailored approach with an initial risk assessment of an individual trial that informs the compilation of monitoring and management procedures in a trial dashboard. Methods We performed a literature review to identify risk indicators and trial monitoring approaches followed by a contextual analysis involving local, national and international stakeholders. Based on this work we developed a risk-tailored management approach with integrated monitoring for RCTs and including a visualizing trial dashboard. We piloted the approach and refined it in an iterative process based on feedback from stakeholders and performed formal user testing with investigators and staff of two clinical trials. Results The developed risk assessment comprises four domains (patient safety and rights, overall trial management, intervention management, trial data). An accompanying manual provides rationales and detailed instructions for the risk assessment. We programmed two trial dashboards tailored to one medical and one surgical RCT to manage identified trial risks based on daily exports of accumulating trial data. We made the code for a generic dashboard available on GitHub that can be adapted to individual trials. Conclusions The presented trial management approach with integrated monitoring enables user-friendly, continuous checking of critical elements of trial conduct to support trial teams in the academic setting. Further work is needed in order to show effectiveness of the dashboard in terms of safe trial conduct and successful completion of clinical trials.

Background Digital health technologies (DHTs), such as electronic health records and prescribing systems, are transforming health care delivery around the world. The quality of information in DHTs is key to the quality and safety of care. We developed a novel clinical information quality (CLIQ) framework to assess the quality of clinical information in DHTs. Objective This study explored clinicians’ perspectives on the relevance, definition, and assessment of information quality dimensions in the CLIQ framework. Methods We used a systematic and iterative eDelphi approach to engage clinicians who had information governance roles or personal interest in information governance; the clinicians were recruited through purposive and snowball sampling techniques. Data were collected using semistructured online questionnaires until consensus was reached on the information quality dimensions in the CLIQ framework. Responses on the relevance of the dimensions were summarized to inform decisions on retention of the dimensions according to prespecified rules. Thematic analysis of the free-text responses was used to revise definitions and the assessment of dimensions. Results Thirty-five clinicians from 10 countries participated in the study, which was concluded after the second round. Consensus was reached on all dimensions and categories in the CLIQ framework: informativeness (accuracy, completeness, interpretability, plausibility, provenance, and relevance), availability (accessibility, portability, security, and timeliness), and usability (conformance, consistency, and maintainability). A new dimension, searchability, was introduced in the availability category to account for the ease of finding needed information in the DHTs. Certain dimensions were renamed, and some definitions were rephrased to improve clarity. Conclusions The CLIQ framework reached a high expert consensus and clarity of language relating to the information quality dimensions. The framework can be used by health care managers and institutions as a pragmatic tool for identifying and forestalling information quality problems that could compromise patient safety and quality of care. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2021-057430

The subject of the study is the improvement of the health care system and social insurance. The main goal of the study is to form a comprehensive healthcare reform agenda aimed at improving the efficiency, quality and accessibility of medical care, introducing innovation and attraction of additional resources. The report presents comprehensive evidence-based approaches to evaluating additional opportunities attracting financial resources to the health care system using sociological methodology of discrete choice. Mechanisms have also been proposed attracting additional funds and formed a portfolio of high-tech medical services that can be financed from the considered sources. In addition, barriers to innovation in healthcare and practical measures to overcome them. The studies carried out are aimed at improving the efficiency of the healthcare system, the availability of advanced medical technologies and attracting additional financial resources for the provision of medical and social assistance

This paper presents the results of an analysis of in-depth interviews with people caring for their elderly relatives. In Russia, as in most other countries, it is the relatives who bear the main burden of caring for the elderly and people with disabilities, which cannot but affect their social and economic status in one way or another. Since 2018 year in Russia, a system of long-term care is being introduced, within which a number of important principles for the organization of social services, including the development of a set of support measures for relatives caring for their loved ones (training schools, day centers, equipment rentals). Person support, employed in related care is extremely important, given that for people of working age age, the main problem is the difficulty of combining the assistance provided and paid work, in connection with which they often have to make a choice in favor of reduction of working hours or complete refusal to work, which affects not only their income, but also complicates the search for a job in the future and reduces the likelihood of returning to the labor market. In addition, this type of long-term care can lead to increase in stress levels, which can potentially lead to a deterioration in physical and mental health. In international studies on the situation caregivers of their relatives and friends with disabilities health opportunities or at older ages, the main finding is that countries where the main type of care for the elderly and disabled is informal home, measures should be implemented, primarily designed to ensure the preservation labor income of caregivers, as well as a decrease in financial, physical and psychological costs of care. An analysis of the interview showed that all respondents showed interest in the long-term care system and its individual elements. At the same time, families that are relatively well-off in social terms are less likely to express the need for additional assistance to their relatives. Partly - because they consider it their duty to take care of their loved one, on the other hand, a certain role is played by the norms accepted in society and deliberately negative attitudes to any institutional form of long-term care outside the family. results this R&D can be used in the interests of the Ministry of Labor and Social protection of the Russian Federation and the social protection authorities of the constituent entities of the Russian Federation for adoption solutions for the development of a long-term care system.

Despite three decades of proven safety and effectiveness of hydroxyurea in modifying sickle cell disease (SCD), its accessibility is limited in Sub-Saharan Africa, which shares 75% of the world's SCD burden. Therefore, it is time to explore the barriers and facilitators for manufacturing and importation of hydroxyurea for SCD in Tanzania. This was qualitative research that employed a case study approach. Purposive sampling followed by an in-depth interview (IDI) using a semi-structured questionnaire aspired by data saturation enabled us to gather data from 10 participants. The study participants were people with more than three years of experience in pharmaceuticals importation, manufacturing, and regulation. The audio-recorded data were verbatim transcribed and analyzed using thematic analysis. Two themes were generated. The first comprised barriers for importation and manufacturing of hydroxyurea with sub-themes such as inadequate awareness of SCD and hydroxyurea, limited market, and investment viability. The second comprised opportunities for importation and manufacturing of hydroxyurea with sub-themes such as awareness of activities performed by medicines regulatory authority and basic knowledge on SCD and hydroxyurea. Inadequate understanding of SCD, hydroxyurea, and orphan drug regulation are major issues that aggravate the concern for limited market and investment viability. Existing opportunities are a starting point towards increasing the availability of hydroxyurea. ispartof: HEALTHCARE vol:10 issue:11 ispartof: location:Switzerland status: published

Eribulin treatment improved overall survival with predictable toxicities in phase 3 trials of patients with previously treated, locally advanced/metastatic breast cancer. This study (NCT02443428) prospectively observed eribulin-treated patients in real-world clinical practice.This observational multicentre registry study enrolled 76 patients with locally advanced/metastatic breast cancer who had ≤2 prior chemotherapeutic regimens for advanced disease. Eribulin was administered at a 1.23 mg/mAEs occurred in 98.7% of patients; 88.2% had eribulin-related AEs. The most common AEs were fatigue (64.5%), alopecia (36.8%), nausea (35.5%) and constipation (30.3%). Serious AEs occurred in 42.1% of patients. The most common grade 3/4 AEs were neutropenia (9.2%), febrile neutropenia (9.2%), dyspnoea (5.3%) and pleural effusion (5.3%). No fatal AEs occurred. Dose reductions occurred in 31.6% of patients, 42.1% experienced dose delays and 9.2% discontinued due to worsening condition. There were complete responses in 2.6% and partial responses in 15.8% of patients. Median time to progression and overall survival were 4.0 and 8.3 months, respectively.Eribulin was well tolerated in real-world clinical practice, comparable to safety and effectiveness reported in other clinical trials.

Cancer hallmark genes and proteins orchestrate and drive carcinogenesis to a large extent, therefore, it is important to study these features in different cancer types to understand the process of tumorigenesis and discover measurable indicators. We performed a pan-cancer analysis to map differentially interacting hallmarks of cancer proteins (DIHCP). The TCGA transcriptome data associated with 12 common cancers were analyzed and the differential interactome algorithm was applied to determine DIHCPs and DIHCP-centric modules (i.e., DIHCPs and their interacting partners) that exhibit significant changes in their interaction patterns between the tumor and control phenotypes. The diagnostic and prognostic capabilities of the identified modules were assessed to determine the ability of the modules to function as system biomarkers. In addition, the druggability of the prognostic and diagnostic DIHCPs was investigated. As a result, we found a total of 30 DIHCP-centric modules that showed high diagnostic or prognostic performance in any of the 12 cancer types. Furthermore, from the 16 DIHCP-centric modules examined, 29% of these were druggable. Our study presents candidate systems’ biomarkers that may be valuable for understanding the process of tumorigenesis and improving personalized treatment strategies for various cancers, with a focus on their ten hallmark characteristics.

The global digital health market is worth approximately 300 billion USD1 and is predicted to grow by up to 25% this year. Consequently, medical professionals are increasingly required to use digital technologies such as telehealth platforms, AI-driven clinical decision-making tools, digitally enabled surgical tools, mHealth technologies, or electronic health care records (EHR), as part of care delivery. These technologies hold clear benefits for enabling more efficient, modern care delivery however there are significant challenges to implementation, including when and how to use them, how to enable an accurate medical diagnosis in a virtual environment, interpretation and relevance of novel data points from digital devices, the potential for automation bias, appropriate utilisation of and engagement with digital disease management platforms and continuity of care in a digital world. Several of these issues have become apparent through the pandemic due to the hasty deployment of novel technologies as ‘bolt-on’ solutions to address standalone challenges in healthcare delivery, without consideration of the broader healthcare architecture. The majority of practicing clinicians are not sufficiently trained in how to safely integrate digital health technologies into the clinical workflow before encountering such technologies in practice. The introduction of digital health technologies may therefore represent a risk for medical error and subsequent malpractice liability. Medical malpractice is frequently defined as a physician’s failure to comply with customary medical practice,2 however the application of this standard in the context of digital health is challenging. What are the accepted norms for history and examination during a telehealth consult? How should these be documented on electronic systems? When is it safe to offer digital first solutions for disease management? What is the custom for clinicians to ensure continuity of care? If there is a medical error, should the error be attributed to the clinician or the artificial intelligence-based clinical decision-making system? In this article we identify and discuss technology specific risks for malpractice liability arising from the rapidly growing use of digital health technologies.

SS-18 TIP 2 DIYABETES MELLITUS HASTALARINDA 25-(OH) D VITAMINI DÜZEYI MIKROALBÜMINÜRI VE DIYABETIN SEYRI ILE ILIŞKILI MIDIR? ZEYNEB İREM YÜKSEL SALDUZ, ACLAN ÖZDER BEZMIALEM TIP FAKÜLTESI AILE HEKIMLIĞI ANABILIM DALI Amaç: 25-(OH) D vitamini (VD) eksikliği birçok çalışmada Tip 2 Diyabetes Mellitusun (Tip 2 DM) ortaya çıkan komplikas yonları için önemli bir risk faktörü olarak tanımlanmıştır (1,2). Çalışmamızın amacı VD düzeyleri ile Tip 2 DM seyrinde ortaya çıkan albuminüri seviyesi arasındaki ilişkinin değerlendirilmesidir. Gereç-Yöntem: Çalışma kesitsel, tek merkezli, retrospektif olarak planlandı. Temmuz 2019-Aralık 2019 tarihleri arasında Bezmialem Tıp Fakültesi Hastanesi Aile Hekimliği polikliniğine ayaktan başvuran Tip 2 DM hastalarının sosyodemografik ve laboratuvar verileri elektronik hasta sisteminden tarandı. 148 hasta çalışmaya alındı. Hastalar VD düzeylerine göre ikiye ayrıldı. 25-(OH) D vitamini 20 ng/mL’ nin altında olanlar VD eksikliği olan grup; grup 1, 25-(OH) D vitamini 20 ng/mL’ nin üzerinde olanlar VD eksikliği olmayan grup; grup 2 olarak sınıflandırıldı. Hastaların Glukoz, Üre, Kreatinin, Kan üre azotu (BUN), Glomeruler filtrasyon hızı (GFR), Alanin aminotransferaz (ALT), Aspartat aminotransferaz (AST), LDL koles terol (LDL-C), HDL kolesterol (HDL-C), Trigliserid (TG), Total kolesterol, HbA1c ve hemogram parametre değerleri olarak Lökosit sayısı (WBC), Eritrosit sayısı (RBC), Trombosit sayısı (PLT), Hemoglobin (Hgb), Hematokrit (Hct), Nötrofil mutlak sayısı (Neut), Lenfosit mutlak sayısı (Lymph), Ortalama eritrosit hacmi (MCV), Ortalama trombosit hacmi (MPV), Vitamin B 12 (Vit B12), Ferritin, Tiroid stimülan hormon (TSH), 25-(OH) D vitamini, mikroalbüminüri düzeyi grup 1 ve grup 2 arasında karşılaştırıldı. Vitamin D seviyeleri ve albüminüri arasındaki ilişki incelendi. Bulgular: Çalışmaya 148 hasta dahil edildi. Hastaların yaş ortalaması 56,58±9,76 idi. 70 hasta erkek, 78 hasta kadındı. Tüm hastaların VD ortalaması 22,80±17,84 ve HbA1c ortalaması 7,56±1,65 bulundu. D vitamini 20 ng/mL’ nin altında 76, üzerinde 72 hastamız vardı. D vitamini 20 ng/mL’ nin altındaki grup 1 hastalarımızda; LDL-C, Total Kol, HbA1c, Lenfosit sayısı, mikroalbuminüri düzeyi anlamlı derecede yüksek bulundu. (p