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Moving is an integral part of everyday life and applies to accessing the workplace, attending a health centre or meeting friends. Determination of the source of sound may be important when a visually impaired person is moving around. This allows to navigate, but also provides important information about potential danger. Sound exercises have been prepared to support the ability to recognize the direction of sound and to learn about the problems associated with it. The research version of the app was prepared covering 12 situations related to three static and nine dynamic sources of sounds. All 10 participants in the exercises had a significant degree of visual impairment. An extended dataset obtained from three subjects without disabilities was also included. As a result, six exercises qualified for the final set of sound exercises, which allow to gain benefits from their implementation. [ABSTRACT FROM AUTHOR]

Conventional cytogenetic analysis is an important tool for the diagnosis of many hematologic disorders (HD). A karyotype is designed as « complex » when several alterations are detected. However, there is no clear consensus on the exact definition of a complex karyotype (CK), and there is a lack of studies that exclusively analyze CK in the literature. Complex karyotypes were analyzed over a period of 12 years at the Jacques Loiselet Center for Medical Genetics and Genomics (CGGM) at Saint Joseph University in Beirut (USJ) in Lebanon. 255 CK were analyzed with their associated chromosomal abnormalities (CA) detected. Out of 255 patients, 59.22% were males with a mean age of 59 years. The most common anomaly associated with CK was hyperdiploidy with a prevalence of 22.41%, which is different from a previously published study. To our knowledge, this represents the largest series of CK, particularly within the Middle East region. This study underscores the critical role of conventional cytogenetics in detecting CK, ultimately contributing to improved management of HD. Further investigations focusing on CK are needed. [ABSTRACT FROM AUTHOR]

Delays or misdiagnoses in detecting pneumoperitoneum can significantly increase mortality and morbidity. We developed and validated a deep learning model designed to identify pneumoperitoneum in computed tomography images. The model is trained on abdominal scans from Far Eastern Memorial Hospital (January 2012–December 2021) and evaluated using a simulated test set (14,039 scans) and a prospective test set (6351 scans) collected from the same center between December 2022 and May 2023. External validation included 480 scans from Cedars-Sinai Medical Center. Overall, the model achieves a sensitivity of 0.81–0.83 and a specificity of 0.97–0.99 across retrospective, prospective, and external validation; sensitivity improves to 0.92–0.98 when cases with a small amount of free air (total volume <10 ml) are excluded. These findings suggest that the model can deliver accurate and consistent predictions for pneumoperitoneum in computed tomography scans with segmented masks, potentially accelerating diagnostic and treatment workflows in emergency care. CT scans are routinely used to diagnose pneumoperitoneum. Here the authors present a deep learning model for detecting pneumoperitoneum in abdominal CT scans, validated on datasets from Taiwan and the US, showing high accuracy and potential to accelerate diagnosis and treatment in emergency care. [ABSTRACT FROM AUTHOR]

Supporting academics' initial development as university teachers is important for improving their ability to contribute to high-quality education and for reducing anxiety and stress around teaching. Focusing on tasks experienced as challenging is considered a key principle for organising effective teacher professional development. To apply this principle in practice, more knowledge is needed about the development of novice university teachers' self-efficacy in their teacher tasks. Therefore, this study aims to investigate phases in the development of novice university teachers' self-efficacy. Data were collected amongst 201 novice university teachers at a Dutch research-intensive university and associated university medical centre, using a questionnaire measuring self-efficacy in different teacher tasks. Polytomous Rasch analyses were performed on novice university teachers' self-efficacy scores, both across and within teacher tasks. Results suggested three developmental phases in novice university teachers' self-efficacy across teacher tasks: (1) development in 'teaching and supporting learning', (2) development in 'assessment and feedback' and 'educational design', (3) development in 'educational leadership and management' and 'educational scholarship and research'. Two or three phases for the development of self-efficacy were found within each of these teacher tasks. These results expand our knowledge of the development of academics' self-efficacy related to specific teacher tasks. They also provide suggestions for how pedagogic training and workplace learning may be shaped in such a way that they focus novice university teachers' learning on teacher tasks that are difficult but not overchallenging. [ABSTRACT FROM AUTHOR]

Background: Transesophageal echocardiography (TEE) is a vital diagnostic tool in clinical practice, particularly in transcatheter interventions where it aids in both pre-operative planning and intra-operative guidance. Traditional TEE probes often require general anesthesia due to patient discomfort. However, the development of miniaturized TEE probes presents a promising alternative, enabling routine examinations and interventions with minimal sedation. This study evaluates the feasibility of performing a complete 2D/4D TEE protocol with the new 4D mini-TEE probe in the echocardiography department and its application in transcatheter interventions. Methods: This is a retrospective study that included 30 consecutive patients from two high-volume European hospitals (Interbalkan Medical Center, Thessaloniki, Greece, and Rennes University, France) that underwent TEE or transcatheter interventions. The new 4D mini-TEE 9VT-D probe (GE Healthcare) was utilized. The quality of the images and the tolerance of the probe were assessed in the cath lab during interventions and in the echocardiography department during routine TEE examinations. Results: Direct comparison of the 4D mini-TEE probe with the standard 6VT-D probe confirmed the excellent image quality of this new pediatric probe. Most of the patients required minimal sedation or local oropharyngeal anesthesia, with satisfactory tolerance reported. Most of the transcatheter procedures did not require general anesthesia and intubation, resulting in shorter procedural time. Both 2D and 4D imaging modalities offered adequate intra-operative guidance for transcatheter procedures. Conclusions: The 4D mini-TEE probe delivers exceptional imaging capabilities for routine examinations and transcatheter interventions without needing sedation. Its use reduces esophageal trauma and the need for general anesthesia, enhancing patient comfort and safety. [ABSTRACT FROM AUTHOR]

Objectives: The increase in the number of arthroplasty surgeries worldwide also leads to an increase in revision surgeries. This study examines the costs of primary and revision arthroplasty treatments in a tertiary university hospital's orthopedics and traumatology clinic. It also explores the impact of revision surgeries on the healthcare system. Methods: Seventy-six patients who had total knee arthroplasty at a university hospital between 01.01.2017 and 30.09.2022 were included in the study. The patients were divided into three groups: primary (n=25), aseptic reasons one-stage revision (n=27), and septic reasons two-stage revisions (n=24). For each patient included in the study, detailed documents regarding medical supplies, anesthesia, operating room, intensive care, consultation, medicine/serum, medical treatment, laboratory, blood and blood products, microbiology, radiology, food, bed, and attendant fees were provided separately by the hospital purchasing and statistics departments. Results: When comparing the costs of primary, one-stage revision, and two-stage revision surgeries, the average costs were 5689 Turkish Lira (₺), 8294.97 ₺, and 40919.67 ₺, respectively. In patients with septic reasons, the group that underwent two-stage revisions had significantly higher costs than the aseptic group in terms of surgery time, hospital stay duration, medication, treatment, surgery, anesthesia, intensive care, laboratory tests, imaging, blood center services, consultations, visits, meal expenses, and invoiced amount (P<0.001). Conclusion: Preventing and treating periprosthetic infections is costly and challenging. We need more research to develop effective protocols and reduce costs. As the number of patients undergoing knee arthroplasty is expected to rise, healthcare systems must ensure the sustainability of public financial resources, especially in public university hospitals. [ABSTRACT FROM AUTHOR]

AbstractAimsMethodsResultsConclusionsAging is an inevitable stage in which in addition to physiological and mental changes, perception and awareness decline, and memory functions gradually deteriorate. The aim of this study was to examine the effects of body awareness on fall-related behaviors and fall risk in geriatric individuals.This cross-sectional study was conducted with 176 individuals over 65 years of age who presented to family health centers. Body awareness (BAQ), fall-related behaviors (FaB) and fall risk (Morse) were examined. Statistical significance was accepted as p < 0.05 in the analyzes.There was a moderate, negative, and statistically significant relationship between the Morse and BAQ scores of the participants (r=-0.576) (p < 0.05). There was a moderate, positive, and statistically significant relationship between the BAQ and FaB scores of the participants (r = 0.235) (p < 0.05).The results showed a significant relationship between body awareness levels and fall-related behaviors and fall risk in geriatric individuals. [ABSTRACT FROM AUTHOR]

Background Neonatal hypothermia significantly contributes to infant morbidity and mortality in low-resource settings like Malawi. Kangaroo mother care (KMC) is essential but faces challenges in providing continuous thermal support. The Dream Warmer is a neonatal warming device that was developed to complement KMC. We studied its implementation outside a research environment. Methods Using an implementation science approach, we conducted a prospective interventional cohort study in two hospitals and four health centres in Malawi. Through audits and surveys, we assessed the effect of the Dream Warmer on neonatal hypothermia as well as healthcare provider (HCP) and parent attitudes regarding thermoregulation and related issues. Results The Dream Warmer raised no safety concerns and effectively treated hypothermia in 90% of uses. It was positively received by HCPs and parents, who reported it had a favourable effect on the care of small and sick newborns. Challenges identified included a scarcity of water and electricity, lack of availability of the device and HCPs forgetting to prepare it in advance of need or to use it when indicated. Feedback for future training was obtained. The Dream Warmer's strong safety and effectiveness performance is consistent with results from strict research studies. Training materials can be adapted to optimize integration into daily practice and provide educational content for parents. Conclusions The Dream Warmer is a safe and effective device to treat neonatal hypothermia, particularly when KMC is insufficient. We gained an understanding of how to optimize implementation through robust HCP and family education to help combat hypothermia. [ABSTRACT FROM AUTHOR]

The current study aims to examine how toxic management styles can lead to both psychological and physical withdrawal of employees in the healthcare sector. The quantitative approach was used in this research. Preliminary data was collected through online questionnaires from 413 employees working in private and public hospitals and health centers in France. Structural equation modeling was used to test the research hypotheses in the SmartPLS program. The research results indicate a direct positive effect of two styles of toxic leadership (unpredictability and authoritarian leadership) on physical withdrawal behaviors. The results also showed that self-promotion and unpredictability positively affect psychological withdrawal behaviors in hospitals and health centers. The results of the research can be useful for managing health centers to remove the behaviors of toxic leaders from the work environment and protect and support staff so that they can continue carrying out their duties. [ABSTRACT FROM AUTHOR]

Introduction: Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy and is characterized by a higher risk of distant metastasis compared to papillary thyroid cancer. Intraoperative frozen section (IOFS) diagnosis of FTC is challenging due to its limited sensitivity and accuracy, leading to uncertainty in intraoperative surgical decision-making. In response, we developed a predictive model to assess the risk of follicular carcinoma in thyroid nodules identified as suspicious for follicular neoplasm by IOFS. Methods: This model was derived from preoperative clinical and ultrasound data of 493 patients who underwent thyroid surgery at Ningbo Medical Center Lihuili Hospital. It identified five significant predictors of follicular carcinoma: nodule size, thyroglobulin (Tg) level, hypoechogenicity, lobulated or irregular margins, and thick halo. Results: The model demonstrated robust discrimination and calibration, with an area under the curve (AUC) of 0.83 (95% CI: 0.77-0.90) in the training set and 0.78 (95% CI: 0.68-0.88) in the validation set. In addition, it achieved a sensitivity of 81.63% (95% CI: 69.39-91.84) and 68.00% (95% CI: 48.00–4.00), a specificity of 77.42% (95% CI: 72.18-82.66) and 72.51% (95% CI: 65.50-78.96), an accuracy of 78.1% (95% CI: 73.4-82.4) and 71.9% (95% CI: 65.3-78.6), a positive predictive value (PPV) of 41. 67% (95% CI: 35.65-48.84) and 26.79% (95% CI: 19.40-34.33), respectively, and a negative predictive value (NPV) of 95.61% (95% CI: 92.86- 97.99) and 94.07% (95% CI: 90.44-97.08) in the training and validation sets, respectively. Conclusion: The model can accurately rule out FTC in low-risk nodules, thereby providing surgeons with a practical tool to determine the necessary extent of surgical intervention for nodules flagged as suspicious by IOFS. [ABSTRACT FROM AUTHOR]

Electronic waste (e-waste), often dominated by the informal sector, has had adverse effects on recipient developing countries' economies, health and physical environment. Ghana, over the years, has had support from international organisations to manage its e-waste crisis. Until 2016, there was no e-waste specific policy to guide the management of the sector. In 2016, Ghana passed a regulatory policy – Act 917 – to specifically deal with e-waste, supported by other frameworks such as a regulatory instrument (L.I. 2250), a technical guideline for environmentally sound e-waste management and an e-waste-specific policy, which is currently being developed. However, there is dearth of research on how effectively a regulatory policy such as Act 917 can help address an informally dominated sector whose crude recycling approaches have had great environmental and health impacts. Adapting the analytical framework and intervention theory, key stakeholders within the e-waste sector were interviewed on: the effectiveness of the Act, the challenges confronting them and their involvement in the design and implementation processes. The findings showed that stakeholders were represented at various stages of the process. Informal recyclers were provided with training programmes, health centres and an incentive scheme to minimise burning of electrical and electronic equipment. There however exist many challenges to the sound management of the sector, particularly, the lack of end-to-end recycling facilities, registering and formalising the sector and sequencing of the e-waste policy and regulatory framework. The research concludes by recommending areas for future studies. [ABSTRACT FROM AUTHOR]

Objective: To assess whether, and to what extent, performing triplicate measurements can improve accuracy of estimation of fetal weight (EFW) compared to single measurements. Methods: This was a prospective study conducted at a single medical center. A total of 100 term parturients with an anticipated delivery within 72 hours were recruited for EFW measurements. All examinations were done with adherence to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines. EFW was calculated using the Hadlock formula. Triplicate measurements from three different images were obtained for each parameter and the averaged values were used for clinical purposes. EFW calculated using average measurements was compared to EFW calculated using the first measurements. Results: There was a small but significant improvement in EFW when using averaged measurements compared to single measurements (mean improvement 34 ± 105 g, P =.002). Deviance from birthweight in single measurements was significantly higher compared to averaged measurements (median deviance 198 versus 148 g, respectively, P =.005). This difference was more pronounced when assessing the 75th centile (348 versus 282 g, respectively). Conclusions: Using triplicate measurements instead of single measurements when performing EFW confers a small, but statistically significant, improvement to EFW accuracy. Using triplicate measurements for assessing EFW should be thus considered, especially in cases suspected of growth disorders. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Conclusions To evaluate the effectiveness of mindfulness therapy as an adjunct to pharmacological treatment for improving blood pressure (BP) control in hypertensive adult patients at a health center in Lima, Peru.This study employed a quasi‐experimental design with a quantitative and longitudinal cohort approach. The participants included 50 adults who were diagnosed with hypertension and who regularly attended the health center in the Villa El Salvador district of Lima, Peru. The data were collected using three instruments: the Depression Anxiety Stress Scale (DASS 21), validated in Peru; a sociodemographic questionnaire; and a BP recording sheet. The Wilcoxon test was utilized to assess the effectiveness of mindfulness therapy on BP control, while the nonparametric Friedman test was used to evaluate the effectiveness of mindfulness therapy considering confounding factors.Therapy resulted in favorable outcomes for BP control. After eight sessions, the average systolic BP decreased from 122.8 to 115.0 mm Hg (a reduction of 7%), and the average diastolic BP decreased from 78.1 to 69.9 mm Hg (a reduction of 11%).Mindfulness is an effective complementary therapy for controlling BP in hypertensive adults. It also helps reduce confounding factors such as stress, anxiety, and depression. [ABSTRACT FROM AUTHOR]

Objective Data Setting and Design Data Sources and Analytic Sample Principal Findings Conclusions To examine the response of community health center (CHC) quality to quality levels at neighboring CHCs in the presence of non‐price competition.A quasi‐experimental study of US community health centers. Outcome variables were indices that measured overall quality of CHC care. Using patient flow data, we constructed CHC‐specific Hirschman–Herfindahl index (HHI) and competitors' composite quality measure. The plausibly exogenous change in characteristics of “competitors' competitors” was exploited to identify the relationship between competition and quality of care, using a generalized two‐stage least square model with instrumental variables.Using the Health Center Program Uniform Data System (2014–2018), linked with American Community Survey and Medical Expenditure Panel Survey, we analyzed 1098 unique federally funded CHCs in 50 states and District of Columbia which had at least one neighboring CHC and had non‐missing data for 2015–2018 (4226 CHC‐years).Most of CHCs served populations in overlapping geographic markets, with median market concentration decreasing during the study period. A one‐percent increase in competitors' quality was associated with a 0.71‐percent increase in an index CHC's composite quality (p < 0.01), consisting of a 0.59‐percent increase in chronic condition control rates (p < 0.01); a 0.68‐percent increase in the screening and assessment rates (p < 0.01); and a 0.78‐percent increase in medication management rates (p < 0.01). The association was stronger at CHCs serving a smaller proportion of uninsured patients. No significant quality reaction was observed at CHCs with a percentage of uninsured patients larger than the 75th percentile. We observed no significant associations between HHI and quality.Increasing competition does not harm quality of care at CHCs. A CHC appears to improve its quality if its competitors improved quality. The beneficial quality effect was less pronounced in CHCs providing a significant proportion of care to uninsured patients, suggesting lack of incentives faced by these CHCs. [ABSTRACT FROM AUTHOR]

Cognitive processing therapy (CPT) is a well‐known trauma‐focused treatment that aims to generate more adaptive posttrauma cognitions and emotions. Changes in cognitions are theorized to be the mechanism by which CPT leads to improvement in posttraumatic stress disorder (PTSD) symptoms. The present study aimed to explore associations between changes in PTSD symptom clusters during CPT. We hypothesized that early changes in negative alterations in cognitions and mood (NACM) would correlate with later changes in other symptom clusters. Data were collected from 296 veterans participating a 7‐week PTSD residential treatment program at a U.S. Veterans Affairs medical center. PTSD symptoms were assessed at pretreatment (Week 1), midtreatment (Week 4), and posttreatment (Week 7). Cross‐lagged path analyses demonstrated that pretreatment‐to‐midtreatment improvement in NACM was correlated with midtreatment‐to‐posttreatment improvement in avoidance, β = .52, though this association was bidirectional, suggesting pretreatment‐to‐midtreatment improvements in either cluster may be correlated with midtreatment‐to‐posttreatment improvements. Similarly, pretreatment‐to‐midtreatment improvement in intrusions, β = .40, and arousal, β = .49, were correlated with later improvement in avoidance, suggesting avoidance may improve after improvement in other clusters. Interestingly, pretreatment‐to‐midtreatment arousal improvement was significantly correlated with midtreatment‐to‐posttreatment NACM improvement, β = .27, though the reverse was nonsignificant, whereas a bidirectional association between arousal and intrusions emerged, β = .34, β = .53. Early changes in arousal were correlated with later changes in several other symptom clusters, whereas other clusters demonstrated bidirectional associations. These results may inform understanding of symptom improvement timing across CPT, which may aid in treatment selection and planning. [ABSTRACT FROM AUTHOR]

Importance: While the prevalence and impact of depression have been widely described in sickle cell disease, its relationship with precariousness has never been studied. Objective: This study aimed to describe the prevalence of depression and its relationship with clinical and demographic factors including social precariousness in children with sickle cell disease in French Guiana. Methods: We included children aged 12–18 years with sickle cell disease from the Sickle Cell Reference Center in French Guiana. A simple depression questionnaire "Child depression inventory 2" was proposed and completed by a clinical examination and consultation by a psychologist. Using the known assessment of health inequalities and poverty in health screening centres (EPICES) score, we developed a composite precariousness score that uses five items (each item is scored from 0 to 2). According to the chosen items, precariousness was defined as a score ≥5. Results: The prevalence of depression was 42.5% [95% CI: 31.5–54]. The median age was 15 years [95% CI: 13–17]. The age distribution peaked at 14 years in patients with depression. There were 76% of precarious patients in the depressed group and 18% in the control group (p < 0.0001). In multivariate analysis, genotype SC (OR = 7.66, [1.17; 50.13], p = 0.0338) and precariousness (OR = 15.68, [4.73; 51.94], p < 0.0001) were associated with higher rates of depression. Baseline hemoglobin levels (OR = 0.48, [0.27; 0.88], p = 0.0173) were also associated with lower rates of depression. Conclusions and Relevance: Despite free healthcare, precariousness is an independent risk factor for depression. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusion Premature ventricular contractions (PVCs) are frequently observed with left ventricular (LV) systolic dysfunction, although the prevalence of these associated conditions in the general population remains unknown.We sought to understand the prevalence of frequent PVCs (defined PVCs > 5%) and high burden PVCs (defined PVCs > 10%) and LV systolic dysfunction in patients receiving ambulatory Holter monitors (HM).A prospective multicenter (eight US medical centers) cross‐sectional study collected demographic and PVC burden data from consecutive patients undergoing 24‐h, 48‐h, and 14‐day HM (July 2018–June 2020). Left ventricle ejection fraction (LVEF) data was collected if obtained within 6 months of HM. Four PVC burden groups were analyzed (<1%, 1%–5%, 5.1%–10%, and >10% burden) and stratified by normal LVEF (≥50%) or presence LVEF < 50%.The prevalence of PVC burden of 5.1%–10% and >10% was 4% and 5%, respectively in the population undergoing HM (n = 6529). Age was significantly different between PVC groups (p < .001). In those with LVEF assessment (n = 3713), the prevalence of LVEF < 50% and both LVEF < 50% and PVC > 5% was 16.4% and 4.2%, respectively. The prevalence of PVC > 5% and PVC > 10% in patients with LVEF < 50% was 26% and 16%, respectively. PVC > 5% were more prevalent in older, male, and Caucasians (p < .001). Females had a lower prevalence of PVC > 5% than males (6% vs. 11%; p < .001), but not among those with LVEF < 50% (24% vs. 26%, p = .10).PVC > 5% and PVC > 10% and LVEF < 50% are prevalent in patients undergoing HM. PVC > 5% are associated with older age. Females have a lower prevalence of PVC > 5% than males but similar combined PVC > 5% and LVEF < 50%.ClinicalTrial.gov identifier: NCT03228823. [ABSTRACT FROM AUTHOR]

For decades, iron‐folic acid (IFA) supplements have been provided to pregnant women in Cambodia through antenatal care (ANC) services. However, mounting evidence suggests that multiple micronutrient supplements (MMS) are superior to IFA supplements in achieving positive pregnancy outcomes. The possibility of transitioning from IFA supplements to MMS in government‐run health centres is currently being assessed in Cambodia. A crucial component of this assessment involves identifying factors that can influence adherence to MMS, as low adherence can reduce supplement effectiveness. Consequently, this study aimed to explore the potential barriers and enablers to MMS adherence and identify the strengths and challenges of current ANC services. Data were collected through nine focus group discussions with pregnant women (n = 19), family members (n = 18) and midwives (n = 18) and three in‐depth interviews with maternal and child health chiefs (n = 3) in Cambodia and analysed via content analysis. Factors found to influence MMS adherence included attitudes, perceptions and beliefs about MMS; knowledge related to supplementation; ANC counselling; family influence; physical health; access to ANC; supply of MMS; and supplementation norms. Noted strengths of ANC services were the quality of ANC materials, tailored patient education, midwife–patient relationships and flexibility of provided services. Primary challenges related to poor availability of ANC materials, inadequate midwife training, heavy workload, limited funding and suboptimal physical spaces for delivering ANC services. To effectively promote MMS adherence, strategies must involve pregnant women, family members and community leaders; seek to address knowledge gaps and misconceptions related to MMS; and enhance the availability and accessibility of ANC services. [ABSTRACT FROM AUTHOR]

Left atrial thrombus (LAT) impacts humans greatly and can result in ischemia and necrosis in severe cases. Therefore, health workers appeal to the social community to emphasize the importance of preventive treatment for LAT. This paper proposes an ensemble framework for risk prediction of LAT based on undersampling with replacement (EFRP-UR), addressing the problem of data imbalance. Firstly, in the feature selection process, we adopt the method of separately counting the essential features of data subsets. In view of the characteristics of class imbalance in medical data, we apply our improved undersamling method, "undersampling with replacement", to obtain a number of training subsets, train multiple base-classifiers, and use an iterative method to select the classifiers with better performance for subsequent integration, improving the prediction accuracy of the proposed EFRP-UR. To aim for disease risk prediction, we synthesize the results of different ensemble algorithms in the end to increase the recall rate. Applied to the LAT dataset obtained from the Regional Medical Center, our experimental results prove that the proposed EFRP-UR has improved in accuracy, recall rate and F1 value, compared with any single base-classifier. In addition, if comprehensive data on other diseases exist, EFRP-UR can also be transferred to predict other diseases. [ABSTRACT FROM AUTHOR]

Background: A frequent caller is defined by The Frequent Caller National Network (FreCaNN) as an adult who makes five or more emergency calls in a month or twelve or more in three months, related to individual episodes of care. However, we believe that when limiting the definition to those who call themselves, one underestimates the impact frequent contacts have on the Emergency Medical Communication Center (EMCC) and the Emergency Medical Services (EMS). Method: We conducted a descriptive retrospective cross-sectional database review of frequent contacts; defined as persons who have ≥ 5 contacts in a month or ≥ 12 contacts in three months. Data were provided from Oslo EMCC, between 1. January 2017 and 31. December 2022. Contrary to the FreCaNN definition, we included all types of contacts and callers, both emergent and non-emergent, regarding patients of all ages. Results: During the study period, 2.149.400 contacts were registered. Of these 129.700 were contacts from frequent callers, where the patients called themselves. When including contacts frequently made on behalf of a patient, we found that 268.723 fit the definition of frequent emergency contacts. When also taking non-emergent contacts into account, a total of 437.361 contacts fit the definition of frequent contacts. Conclusion: When limiting the criteria to only frequent callers, one underestimates the impact persons who have frequent contacts, have on the EMCC and the EMS. We were able to distinguish between three categories—contacts from frequent callers, frequent emergency contacts, and frequent contacts. We believe broadening the definition can benefit both research and audits, when accessing the use of emergency resources to patients with frequent requests for help to the EMCCs. [ABSTRACT FROM AUTHOR]

Introduction: Burkina Faso faces many challenges in the health domain, with no real opportunity for an increase in public health expenditures. In Burkina Faso, as in all low-income countries, health spending efficiency is crucial. The objective of this paper is to assess the efficiency of Advanced Medical Centers (AMCs)—which correspond to district hospitals—in Burkina Faso over the 2017–2020 period and identify the factors that promote—or, on the contrary, limit—the efficiency of these health structures. Method: We first assessed the efficiency level of the 45 AMCs running in the country between 2017 and 2020 using a bootstrap Data Envelopment Analysis (DEA) methodology. Inputs include the number of doctors, nurses, other medical staff, non-medical staff, and beds, while output variables correspond to the number of inpatients, surgeries, outpatients, and inpatient days. In a second step, determinants of AMC's efficiency levels were explored using a double-bootstrap procedure. The roles of AMCs' internal and environmental factors were both considered. Results: We found a mean efficiency score of 0.51 over the study period, indicating that AMCs could have almost doubled their healthcare production without needing additional resources. The size, education level, and health status of the covered population and the density of the healthcare supply in the district appeared to be the driving factors of AMCs' efficiency. Conclusion: Our results indicate that improving the efficiency of AMCs should be a high-level priority for the Burkinabe health policy. Resources could be reallocated across AMCs to increase the overall efficiency of the health system. Key messages: - The efficiency of health spending is of crucial importance in Sub-Saharan Africa, given the important health needs and financial constraints those countries face. - No recent study has investigated the efficiency of Advanced Medical Centers (AMCs), which correspond to district hospitals, in Burkina Faso, although they play a pivotal role in the health system. - The healthcare production of AMCs could have almost doubled over the 2017–2020 period without any increase in the resources used. - Resource reallocation across AMCs based on population size and health needs could be performed to increase the overall efficiency of the health system. [ABSTRACT FROM AUTHOR]

Purpose Case Presentation Results Conclusion To describe the first report of third eyelid cartilage eversion in an adult American Quarter Horse mare.A 22‐year‐old American Quarter Horse mare presented to the University of Missouri Veterinary Health Center Equine Hospital for a 2‐week history of a third eyelid cartilage abnormality of the left eye with no known recent trauma. Complete ophthalmic examination revealed third eyelid cartilage eversion of the left nictitans. The abnormal scrolled cartilage was surgically excised using a handheld cautery unit and submitted for histopathologic evaluation.Histopathologic findings displayed normal third eyelid cartilage, without evidence of neoplasia or inflammation. Mucosal hyperplasia and increased vascularity of the submucosa were observed. The horse healed well after electrocautery excision and normal third eyelid conformation was restored.To the authors' knowledge, this is the first report of an acquired, presumed spontaneous, third eyelid cartilage eversion in a horse. [ABSTRACT FROM AUTHOR]

Diarrhea is a defecation disorder with a frequency of more than three times in 24 hr with watery stools. Based on data from the World Health Organization (WHO), there are 1.7 billion cases of diarrhea that occur globally each year, and in Indonesia, 200 to 400 per 1000 residents each year with 60--80% of cases being children under five years old. Based on data collected by South Cimahi Public Health Center, there were 922 cases of diarrhea in 2022. Diarrhea can be prevented by implementing ODF and Clean and Healthy Life Behavior (PHBS). The Open Defecation Free (ODF) program aims to help people in the area to be free from open defecation. This study aims to understand the relationship between ODF and PHBS behavior with diarrhea incidence of residents in the South Cimahi Health Center area using analytical observation with a cross-sectional study design. A total of 112 residents were selected using a simple random sampling technique. The results showed as many as 56.4% of families who have implemented ODF and have no incidence of diarrhea, and 86.2% of families who have not implemented PHBS with diarrhea. There is a relationship between ODF and PHBS with an incidence of diarrhea (P = 0,00) among residents in the South Cimahi Public Health Center area. [ABSTRACT FROM AUTHOR]

The quality of services of nursing staff in the management of tuberculosis (TB) patients at the Darul Imarah Community Health Center, Aceh Besar Regency due to the limited capacity of human resources in carrying out data collection is not yet known in reality. This research aims to describe (i) the services of nursing staff in treating tuberculosis patients and (ii) the supporting and inhibiting factors for nursing services in treating tuberculosis patients. A descriptive-qualitative approach was used through interviews, documentation, and observation techniques. The results show that to improve the quality of service at the Darul Imarah Community Health Center, Aceh Besar Regency, it is necessary to take steps to improve the quality of nursing staff services for TB patients. [ABSTRACT FROM AUTHOR]

Older adults often experience loss of partnership, illness, and declining health which can contribute to anxiety and depression. This can be a significant public health concern. Senior centers play an important role in providing support and community which may reduce these symptoms. Yoga-Cognitive Behavioral Therapy (Y-CBT) is an innovative approach that specifically targets symptoms of anxiety and depression. Within a group model, Y-CBT integrates cognitive behavioral therapy (CBT) with chair yoga. Y-CBT has demonstrated significant reductions in anxiety and co-occurring depression for adults receiving services at an outpatient behavioral health center. The goal of this study was to evaluate the effectiveness of Y-CBT for older adults attending a senior center setting. Thirty-seven older adults (age 62+) from three senior centers enrolled in the study. After the Y-CBT intervention, anxiety improved (p <.0056) with a large effect size (g = 0.88). Though not significant, depression also improved (g = 0.418), with many participants reporting reduced levels of depression into the minimal or clinically non-significant ranges after, as compared with before the Y-CBT experience. These results indicate that Y-CBT may be a promising approach for the symptoms of anxiety and co-occurring depression which older adults experience. [ABSTRACT FROM AUTHOR]

Background: Oncocytic thyroid carcinoma (OTC) was previously considered a variant of follicular thyroid carcinoma (FTC) but has recently been reclassified as a separate form of thyroid cancer. This study aimed to demonstrate that FTC and OTC are fundamentally distinct entities that can potentially be differentiated preoperatively through cytology and/or molecular testing. Methods: A retrospective chart review of patients diagnosed with FTC and OTC operated upon at two university health centers from January 2016 to September 2023 (n = 3219) was conducted. Molecular testing results were correlated with histopathologic diagnosis. Results: Fifty patients met the inclusion criteria. FTC was identified in 27 (54.0%) patients, and OTC in 23 (46.0%) patients. Patients with OTC were older (61.8 years) than FTC patients (51.2 years) (p = 0.013). Moreover, aggressive tumors were found in 39.1% (9/23) of OTCs compared to 11.1% (3/27) of FTCs (p = 0.021). Amongst Bethesda category III and IV nodules, 17 out of 20 (85.0%) OTC cytology reports demonstrated an oncocytic subtype compared to only 5 out of 24 FTC cytology reports (20.8%) (p = 0.002). On molecular testing, the EIF1AX alteration was exclusively present in OTCs while the PAX8/PPARy and PTEN alterations were exclusively found in FTCs. Copy number alterations (CNAs) were found to be more prevalent in OTC (66.7%) compared to FTC (33.3%), and they were not indicative of tumor aggressiveness. Within the OTC group, all three patients who had a TP53 alteration were diagnosed with aggressive cancer. Lastly, the OTCs exhibited a higher frequency of multiple alterations on molecular testing (66.7%) compared to FTCs (33.3%). Conclusion: To our knowledge, this is the largest study to date comparing the clinical application of abnormalities found on molecular testing for FTC and OTC. It further demonstrates the distinct clinicopathological and molecular characteristics of OTC. [ABSTRACT FROM AUTHOR]

Social media plays a crucial role in health information dissemination, yet it also raises concerns about misinformation. This study examines the role of Spanish health centers in promoting influenza vaccination on social networks, particularly X (formerly Twitter), during the 2023–2024 campaign. An observational, retrospective study analyzed the activity of 832 Spanish health centers on X. Data collection focused on the existence of official accounts, follower engagement and the nature of messages posted. Metrics were obtained using X Analytics, and statistical analysis was performed using JAMOVI v2.4 software. Of the 832 centers, 607 had readable X accounts. Collective accounts were more prevalent (351) than individual ones (239). Collective accounts had significantly more followers and posts but showed less engagement compared to individual accounts. The most followed accounts belonged to public entities, like the Community of Madrid and private organizations, such as Sanitas. An analysis of the vaccination campaign revealed that most posts had a political focus with limited health information, resulting in minimal interaction with the public. As a conclusion, the study highlights the fragmented nature of health communication through social networks in Spain. Despite the higher visibility of collective accounts, their engagement with the public is low, often due to the political nature of posts. A unified national strategy is essential for enhancing public health communication, focusing on interactive and relevant content. [ABSTRACT FROM AUTHOR]

In health care centers, monitoring the medical outcomes is desirable to quickly detect performance changes. In recent years, monitoring the surgical process has gained eminence by accounting for patients' health conditions before cardiac surgery where the data is heterogeneous with respect to patients' health conditions. In the current study, we focus on risk-adjusted moving average-exponentially weighted moving average (RAMA-EWMA) control chart to identify the survival time after cardiac surgery. For this purpose, we used two years data set of the cardiac surgery. The performance of the control chart is evaluated by the average run length. Based on the extensive simulation, the average run length properties are computed. It is revealed that the proposed control chart has better shift diagnostic ability than the control chart considers in this study. [ABSTRACT FROM AUTHOR]

Introduction: Limited research has explored immunosuppressant medication adherence over time in pediatric transplant patients, who often struggle with posttransplant regimen adherence, resulting in poor outcomes. Methods: This study investigated the longitudinal growth in immunosuppressive medication levels following transplantation. Medication level variability index (MLVI) scores from tacrolimus blood levels of pediatric organ transplant recipients at a major medical center were analyzed. Linear mixed effect models (LMEM) assessed individual MLVI change trajectories and predictors of growth, exploring both linear and curvilinear growth patterns posttransplant. Results: A sample of 181 patients with at least 4 years of MLVI data were analyzed. Growth curve modeling identified the cubic model as the best fit for the quarterly MLVI values, which significantly decreased within the first 2 years posttransplant before stabilizing. Gender significantly predicted MLVI change, with females showing greater MLVI decreases, while age at transplant did not significantly predict changes. Significant variation in MLVI among individual patients was found in all models. Conclusions: The study demonstrated a significant decrease in MLVI values over time, indicating improved medication adherence in pediatric transplant patients, with females exhibiting more adherent growth patterns than males. Future research should aim to identify pediatric patients at high risk of nonadherence. [ABSTRACT FROM AUTHOR]

Purpose: To describe the Shammas-Cooke formula, an updated no-history (NH) formula for IOL calculation in eyes with prior myopic laser vision correction (M-LVC), and to compare the results with the Shammas PL, Haigis-L, and Barrett True-K NH formulas. Setting: Bascom Palmer Eye Institute (BPEI), The Lennar Foundation Medical Center, University of Miami, Miami, Florida; Dean A. McGee Eye Institute (DMEI), University of Oklahoma, Oklahoma City, Oklahoma; and private practice, Lynwood, California, and St Joseph, Michigan. Design: Retrospective observational study. Methods: We analyzed 2 large series of cataractous eyes with prior M-LVC. The training set (BPEI series of 330 eyes) was used to derive the new corneal power conversion equation to be used in the new Shammas-Cooke formula and the testing set (165 eyes of 165 patients in the DMEI series) to compare the updated formula with 3 other M-LVC NH formulas on the ASCRS calculator: Shammas PL, Haigis-L, and Barrett True-K NH. Results: Mean prediction error was 0.09 ± 0.56 diopters (D), -0.44 ± 0.61 D, -0.47 ± 0.59 D, and -0.18 ± 0.56 D and the mean absolute error was 0.43 D, 0.60 D, 0.61 D, and 0.45 D for the Shammas-Cooke, Shammas PL, Haigis-L, and Barrett True-K NH, respectively. The percentage of eyes within ±0.50 D was 66.7% vs 47.9%, 48.5%, and 65.5%, respectively. Conclusions: The Shammas-Cooke formula performed better than the Shammas PL and Haigis-L (P < .001 for both) and as well as the Barrett True-K NH formula (P = .923). [ABSTRACT FROM AUTHOR]

AIM: To study the efficacy of Mannheim's peritonitis index in predicting the outcome in a patient of peritonitis. OBJECTIVES: Evaluation of Mannheim Peritonitis Index (MPI) score for predicting the morbidity and mortality in patients with peritonitis due to hollow viscus perforation. MATERIALS AND METHODS: Prospective study of 53 patients operated for perforation peritonitis in Oxford Medical College, Bengaluru from October 2020 to August 2022. Mannheim Peritonitis Index score was calculated for each patient. RESULTS: Mean age group was 35.19 ± 12.77. Male predominant with 38 (71.7%) and female were 15 (28.3%) Duration of peritonitis was <24 hours in 25 (47.2%) cases and >24 hours in 28 (52.8%) cases. Peritonitis was localized in 8(15.1%) cases and diffuse in 45(84.9%) cases. Exudate was clear in 7 (13.2%) cases, cloudy and purulent in 43 (81.1%) cases and fecal in 03 (5.7%) cases. MPI score was <21 in 36 (67.92%) cases, 21-29 in 06 (11.32%) cases and >29 in 11 (20.75%) cases. Perforated appendix was 21 (39.62%), peptic ulcer perforation 17 (32.07%) and duodenal perforation was 09 (16.98%) were common causes of perforation peritonitis. Organ failure was present in 12 (22.6%) cases. Malignancy was present in 8 (15.1%) cases. Colonic origin of sepsis was in 16 (30.2%) cases. Mortality was in 5 (9.43%) cases out of which 3 (5.66%) were male and 2 (3.77%) were females. Mannheim Peritonitis Index scores of ≤ 20, 21-29, and ≥ 30 had a mortality of 0%, 0%, and 9.43% respectively. Presence of generalized peritonitis, organ failure at time of admission, type of intra peritoneal exudates carried more significance in predicting the mortality and morbidity in the post op period than other variables. CONCLUSION: Mannheim Peritonitis Index is a simple and specific scoring system for predicting the mortality in patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of the through-and-through wire (TTW) technique for antegrade ureteral Double-J stent placement after failure of either antegrade or retrograde ureteral stent placement. Method: This retrospective study analyzed the medical records of consecutive patients who underwent Double-J stent placement with the TTW technique at Asan Medical Center and Gil Medical Center between January 2016 and February 2023. Patient histories, reasons for employing the TTW technique, TTW pathways, and complications were reviewed. Eight patients were included in the study. The reasons for using the TTW technique were failure to advance a largerdiameter catheter, balloon catheter, or Double-J stent passing over the guidewire beyond the stricture (6/8, 75.0%); failure to negotiate the stricture with a guidewire (1/8, 12.5%); and guidewire passing through a ureteropelvic junction defect (1/8, 12.5%). Results: TTW was applied either between a percutaneous nephrostomy (PCN) and the urethral orifice (n=4), between a PCN and an ileostomy pouch (n=3), or between a left and right PCN (n = 1). Urologic assistance was required for retrograde ureteral cannulation in one male patient (12.5%). Subsequently, balloon dilation and/or Double-J stent placement were performed in all eight patients, resulting in 100% technical success. No major or minor complications occurred. Conclusions: The TTW technique was safe and effective in the undertaking of PCN and antegrade Double-J stent placement in patients for whom either antegrade or retrograde access had failed. [ABSTRACT FROM AUTHOR]

Background To guide antibiotic stewardship interventions, understanding for what indications antibiotics are used is essential. Methods In rural Burkina Faso, we measured antibiotic dispensing across all healthcare providers. From October 2021 to February 2022, we surveyed patients in Nanoro district, Burkina Faso, following visits to health centres (3), pharmacies (2), informal medicine vendors (5) and inpatients in health centres. We estimated prevalence of antibiotic use and the proportion of Watch group antibiotics by provider type and by clinical presentation, assessing compliance with WHO's AWaRe Antibiotic Book. We estimated per capita antibiotic use by multiplying prevalence of antibiotic use, mean DDD per adult treatment course, and the rate of healthcare visits per 1000 inhabitants per day, estimated from a prior household survey. Results Outpatient antibiotic use was more frequent after health centre visits (54.8%, of which 16.5% Watch, n  = 1249) than after visits to pharmacies (26.2%, 16.3% Watch, n  = 328) and informal medicine vendors (26.9%, 50.0% Watch, n  = 349). The frequency of antibiotic use was highest for bronchitis (79.9% antibiotic use, of which 12.6% Watch), malaria (31.9%, 23.1% Watch), gastroenteritis (76.0%, 31.7% Watch), rhinopharyngitis (40.4%, 8.3% Watch) and undifferentiated fever (77.0%, 44.8% Watch). Compliance with WHO AWaRe guidance could have averted at least 68.4% of all Watch antibiotic use in outpatients at health centres. Community-wide, 2.9 DDD (95% CI 1.9–3.9) were used per 1000 adult inhabitants per day. Conclusions Most Watch antibiotic use at community level or primary care deviated from WHO guidance. Antibiotic stewardship should focus on key clinical presentations and include primary care and self-medication. [ABSTRACT FROM AUTHOR]

The recent development of pharmacologic therapies for obesity, including the newest agents, glucagon-like peptide 1 receptor agonists, provide more options for treatment and management. Guidelines from the American Gastroenterological Association provide recommendations for the use of these pharmacologic therapies. Here, 2 experts consider how they would discuss lifestyle modifications and pharmacologic therapies with a patient interested in developing a treatment plan for obesity. In 2022, 1 in 8 people in the world were living with obesity, and lifestyle interventions that include diet, exercise, and behavioral modification have been the foundation for management of obesity. Recently, pharmacologic therapies have been developed for management of obesity, the newest of these being glucagon-like peptide 1 receptor agonists. With the development of new pharmacologic options, the American Gastroenterological Association developed a guideline in 2022 to provide evidence-based recommendations for the pharmacologic management of obesity in adults and recommended, for adults with obesity or overweight with weight-related complications who have had an inadequate response to lifestyle interventions, adding pharmacologic agents to lifestyle interventions over continuing lifestyle interventions alone. In this article, 2 experts review the available evidence to answer the following questions: How effective are lifestyle interventions for the treatment of obesity? How effective are pharmacologic interventions for the treatment of obesity? Given these options, how do you engage in a shared decision-making discussion to develop a mutually agreed-on treatment plan? [ABSTRACT FROM AUTHOR]

Embedding counselors in various campus locations has been one strategy to address the student mental health crisis. The aim of this study was to evaluate challenges to implementing the primary care behavioral health (PCBH) model, in which behavioral health counselors (BHCs) are embedded within the college health center, and to explore characteristics associated with differing levels of PCBH fidelity. Seventy-one BHCs working in college health centers completed the online fidelity survey. Most respondent scores denoted moderate or strong fidelity to the PCBH model. Psychologists showed better adherence to autonomous clinical aspects of PCBH while social workers/counselors showed better adherence to collaborative aspects of PCBH. Overall findings suggest fidelity to PCBH by BHCs in college health is driven by independent clinical activity more than interdisciplinary collaboration. Strategies for developing and evaluating a PCBH program that complements the specialty mental health services offered through counseling centers are discussed. [ABSTRACT FROM AUTHOR]

To foster bottom-up innovations, health care organizations are leveraging interdisciplinary frontline innovation teams. These teams include workers across hierarchical levels and professional backgrounds, pooling diverse knowledge sources to develop innovations that improve patient and worker experiences and care quality, equity, and costs. Yet, these frontline innovation teams experience barriers, such as time constraints, being new to innovation, and team-based role hierarchies. We investigated the practices that such teams in federally qualified health centers (FQHCs) used to overcome these barriers. Our 20-month study of two FQHC innovation teams provides one of the first accounts of how practices that sustained worker engagement in innovation and supported their ideas to implementation evolve over time. We also show the varied quantity of engagement practices used at different stages of the innovation process. At a time when FQHCs face pressure to innovate amid staff shortages, our study provides recommendations to support their work. [ABSTRACT FROM AUTHOR]

This research aims to analyze the influence of the knowledge level of JKN-KIS participants, the attitudes of healthcare workers, and the accessibility of health facilities simultaneously on the utilization of health services by JKNKIS participants at community health centers and their networks. The method employed in this study is quantitative, with a minimum sample size of 99 JKN-KIS participants from the work area of Pematang Panggang III.b Health Center in Mesuji Makmur District, Ogan Komering Ilir Regency. This study involves two types of hypothesis testing: the Partial Significance Test (T-test) and the Simultaneous Test (F-test). The data analysis techniques used include descriptive statistical analysis and multiple linear regression analysis. The results indicate that the level of knowledge among JKN-KIS participants does not have a significant impact on the utilization of health services at Pematang Panggang III.b Health Center and its networks. In contrast, the accessibility of health facilities has a positive and significant effect on the health service utilization of JKN-KIS participants. Overall, the knowledge level, attitudes of healthcare workers, and accessibility of health facilities have a positive and significant impact on the utilization of health services at the health center. [ABSTRACT FROM AUTHOR]

Objective: Musculoskeletal diseases are among the most common and costly illnesses across all age groups and various communities, leading to disability, incapacity, early retirement, and job loss. The present study aimed to develop a structural model of quality of life based on resilience with the mediation of perceived stress in women with rheumatoid arthritis. Methods: The research method was descriptive-survey with a structural equation modeling design. The statistical population included women with rheumatoid arthritis in the city of Isfahan. The women with rheumatoid arthritis referred to medical centers in Isfahan had at least one year of disease history. Data were collected using the Varni-Kazisnki and Keller Quality of Life Questionnaire (1996), the Connor-Davidson Resilience Scale, Antonovsky's Sense of Coherence Questionnaire (1993), Cohen, Kamarck, and Mermelstein's Perceived Stress Questionnaire (1983), and the Gratz and Roemer Emotion Regulation Difficulty Scale (2004). Data were analyzed using structural equation modeling and Amos26 software. Findings: The results showed that the direct effect of resilience on the quality of life of patients with rheumatoid arthritis was significant (β = 0.25; P < 0.01). The indirect effect of resilience through the mediation of perceived stress on the quality of life of patients with rheumatoid arthritis was significant (β = 0.16; P < 0.01). Additionally, the total effect of resilience through the mediation of perceived stress on quality of life was significant (β = 0.41; P < 0.01). Conclusion: It can be concluded that the structural model of quality of life based on resilience with the mediation of perceived stress was well-fitted, and perceived stress played a mediating role in the relationship between quality of life and resilience in women with rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Good health is a precondition for socio-political and economic development of any nation. The study aim at assessing the spatial distribution of health care facilities in Adamawa State, Nigeria. The research will be of use to the health sector such as health workers, medical personnel, and international organizations such as UNISEF, UNO, WHO, NGO'S and stakeholders alike. The research employs the use of primary and secondary data. The Research Instrument used is survey questionnaires and Focused Group Discussion alongside Purposive interview. The study population is made up of all the health centers in the 21 Local Governments areas of Adamawa State. The results show the distribution of health facilities across Adamawa State is markedly uneven, reflecting broader patterns of urban-rural disparity. The study recommends that Building of new modern health centers that will cater for the need of the people and the renovation of old ones. Strategic investment in infrastructure, particularly in rural areas, is essential to ensure that health centers are fully functional and accessible all the year-round. [ABSTRACT FROM AUTHOR]

The Hospital Web Quality Multicriteria Analysis Model (HWQ) is constructed, designed, and validated in this research. For this purpose, we examined the web quality analysis models specialized in hospitals and health centers through a literature review and the most current taxonomies to analyze digital media. Based on the benchmarking and walkthrough methods, the analysis model was built and validated by a panel of experts (X = 3.54, CVI = 0.88, Score Σ = 45.58). To test its applicability and reliability, the model was pilot-tested on the websites of the ten public and private hospitals with the best reputation in Spain in 2022, according to the Merco Sanitario ranking. The results showed very similar web structures divided by specific proposals or sections of some centers. In this regard, this study identifies a general communication proposal in hospitals that does not adapt to the guidelines of screen-mediated communication, as well as a lack of personalization and disruptive storytelling ideation. In addition, the work concludes that Spanish hospitals, for the moment, have not opted for formats and technological developments derived from the possibilities of gamified content, 360° immersion, Virtual Reality (V.R), or Augmented Reality (A.R). [ABSTRACT FROM AUTHOR]

Background: Audit is a quality improvement approach used in maternal and newborn health. Our objective was to introduce the practice of standards-based audit at healthcare facility level, and to examine if this would improve quality of care assessed by compliance with standards developed and agreed with healthcare providers. Our focus was on emergency obstetric and newborn care (EmONC). Methods: A multidimensional incomplete stepped-wedge cluster randomised trial with 8 steps was conducted in 44 healthcare facilities in Malawi. A total of 25 standards of care were developed. At each healthcare facility one (health centres) or two (hospitals) standards were audited per cycle with two consecutive audit cycles conducted. Each cycle consisted of five steps: (i) select standard to be audited, (ii) measure compliance with standard (measurement 1), (iii) review findings and identify what changes are required to increase compliance (iv) implement changes, (v) re-measure compliance (measurement 2). Each compliance measurement assessed 25 women. Multilevel mixed effects logistic regression models were used to analyse data for all standards. Results: The crude overall compliance rate rose from 45% in the control phase (measurement 1) to 63% in the intervention phase (measurement 2) (from 51.6% to70.6% at Basic and from 34.5% to 50.8% at Comprehensive EmONC healthcare facilities. When adjusted for standard, facility type, month, and healthcare facility by month, the adjusted OR (95% CI) was 2.80 (1.65, 4.76). Actions taken to improve compliance with standards included improving staff performance of clinical duties and general conduct through re-orientation and staff meetings as well as improved supervision, and, ensuring basic equipment and consumables were available on site (thermometers, rapid diagnostic tests, partograph). Conclusion: The introduction of standards-based audit helped healthcare providers identify problems with service provision, which when addressed, resulted in a measurable and significant improvement in quality of care. Trial registration: ISRCTN registration number: 59931298. [ABSTRACT FROM AUTHOR]

Community participation (CP) and empowerment (CE) have long been viewed internationally as cornerstones of comprehensive primary health care (PHC). Accordingly, policies for new PHC models in Italy, such as the Community Health Centres called "Case della Salute" in 2006 and "Case della Comunità" in 2022, highlight the importance of implementing participatory processes with communities and creating opportunities for CE. This study's objective is to identify the understandings of CP and CE that emerge among practitioners and stakeholders who design participatory approaches in PHC practice and policy in the Emilia-Romagna region in Italy. Nineteen semistructured interviews were conducted with practitioners working on CP and CE processes in these Community Health Centres and with stakeholders involved in research on or the coordination of such processes in the context of these health centres. The data were analysed using qualitative content analysis in light of the following two questions, which emerged inductively from the data: (1) How to support CP and CE processes in practical doing (how do CP/CE)? (2) With which function or aim to support CP and CE (why do CP/CE)? This study shows that the participating practitioners and stakeholders exhibited various understandings of CP and CE in the context of PHC. Four main themes were identified: CP and CE as (a) a variety of forms of dialogue and cooperation, (b) tools for service development, (c) levers for empowerment, collectivism, and democracy and (d) stimuli for institutional change and a new level of professionalism. Moreover, the participants defined "the community" in different ways and often chose specific subgroups within the community to promote CP and CE processes. This study elucidates different perspectives on CP and CE and highlights the opportunities and obstacles for policymaking, research and practice that result from these understandings. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions Macrotrabecular‐massive hepatocellular carcinoma (MTM‐HCC) represents an aggressive subtype of HCC and is associated with poor survival.To investigate the performance of a representation learning‐based feature fusion strategy that employs a multiphase contrast‐enhanced CT (mpCECT)‐based latent feature fusion (MCLFF) model for MTM‐HCC identification.A total of 206 patients (54 MTM HCC, 152 non‐MTM HCC) who underwent preoperative mpCECT with surgically confirmed HCC between July 2017 and December 2022 were retrospectively included from two medical centers. Multiphasic radiomics features were extracted from manually delineated volume of interest (VOI) of all lesions on each mpCECT phase. Representation learning based MCLFF model was built to fuse multiphasic features for MTM HCC prediction, and compared with competing models using other fusion methods. Conventional imaging features and clinical factors were also evaluated and analyzed. Prediction performance was validated by ROC analysis and statistical comparisons on an internal validation and an external testing dataset.Fusion of radiomics features from the arterial phase (AP) and portal venous phase (PAP) using MCLFF demonstrated superior performance in MTM HCC prediction, with a higher AUC of 0.857 compared with all competing models in the internal validation set. Integration of multiple radiological or clinical features further improved the overall performance, with the highest AUCs of 0.857 and 0.836 respectively achieved in the internal validation and external testing set.Multiphasic radiomics features of AP and PVP fused by the MCLFF have demonstrated substantial potential in the accurate prediction of MTM HCC. Clinical factors and Radiological features in mpCECT contribute incremental values to the developed MCLFF strategy. [ABSTRACT FROM AUTHOR]

Background: With the global rise in the elderly population, ensuring geriatric-friendly healthcare services is paramount. This study aimed to assess the current readiness of health facilities in Kampala City, Uganda, to provide geriatric-friendly care services. Methods: We conducted a cross-sectional study in 35 health facilities (HF) including Private for-profit (PFP), Private not-for-profit, and public (government-run) facilities at different levels i.e., Health Centre III, Health Centre IV, and Hospitals, within Kampala City, Uganda. Data was collected using a self-administered health facility assessment tool. Facilities scoring 80–100 were classified as fully ready to offer geriatric-friendly care, 51–79 indicated moderate readiness, and 0–50 indicated low readiness. Results: The overall readiness index (RI) across all facilities was low, 44.09 (SD ± 14.18). The National Referral Hospital (NRH), PFPs, and HFs in Kampala Central had the highest RI of 55.34. 47.63 and 51.09 respectively. The low readiness of HF to provide geriatric-friendly care was due to the low scores in leadership and governance (13.49), financing (19.29), human resource (42.66), and Health Management Information System (47.99) WHO building blocks. HCIVs had a higher readiness index than the other HF levels (Coefficient: 17.40, 95% CI: 4.16 to 30.64, p = 0.012). HFs in Kawempe had a significantly lower RI than those in Makindye and Kampala Central (Coefficient: -13.80, 95% CI: -24.48 to -3.11, p = 0.013). Conclusion: The findings of our study indicate that public and private health facilities in Kampala City are not ready enough to provide geriatric-friendly care services. [ABSTRACT FROM AUTHOR]

Background: Ancient schwannoma is a rare subtype of schwannoma characterized by an extended duration of development and distinctive degenerative changes. These changes encompass relative loss of Antoni type A areas, perivascular hyalinization, hemorrhage, cystic necrosis, calcification, and the presence of atypical nuclei that can mimic sarcomatous pleomorphism. These histologic features often lead to diagnostic challenges, with ancient schwannomas frequently being misdiagnosed as malignant tumors. Objectives: This study aims to provide a comprehensive evaluation of the histomorphological spectrum observed in ancient schwannoma. Methods: A retrospective analysis was conducted on 248 schwannoma cases received at our tertiary health centre, spanning the years 2017 to 2023. Among these cases, 25 were identified as ancient schwannoma. Extensive examination of degenerative changes was performed using hematoxylin and eosin-stained paraffin-embedded tissue sections under light microscopy. Results: Patient ages ranged from 22 to 82 years, with a nearly equal distribution between genders (12 females and 13 males). Tumors were located in various anatomical sites including the forearm, brain, abdomen, retroperitoneum, intradural space, lumbar region, and pelvis. Tumor dimensions varied from 1.5 to 11 cm. Histologically, most cases exhibited nuclear atypia, cystic changes, hemorrhage, and siderophages, along with perivascular hyalinization, myxoid change, calcification, and xanthomatous change. Immunohistochemistry confirmed the neural origin of these tumors. Conclusion: Recognition of the diverse spectrum of secondary changes, coupled with the presence of focal areas showing paucicellular and cellular spindle cell arrangements, is crucial for the accurate diagnosis of ancient schwannoma. This study underscores the importance of histomorphological evaluation in distinguishing these benign tumors from malignant counterparts, thereby guiding appropriate clinical management strategies. [ABSTRACT FROM AUTHOR]

Background: Hypertension is one of the most prevalent chronic diseases in the United States and can increase a person's risk of stroke and other cardiovascular complications. Yet only 1 in 4 people with high blood pressure in the United States have their blood pressure managed. To improve hypertension control, we supported 9 health centers in Texas with the implementation of the Healthy Heart Ambassador Blood Pressure Self-Monitoring (HHA) Program. Methods: We provided health center training using the HHA Program Facilitation Training Guide, recorded barriers to implementing the HHA program, and employed strategies to overcome those barriers. Results: There were 68 staff members from the health centers trained to deliver the HHA program. Three health centers successfully implemented all three major components of HHA, three were able to implement two components, two adopted two components, and one withdrew due to insufficient capacity. Capability, technology infrastructure, and motivation were among the barriers most referenced. Conclusion: Clinic non-physician team members delivering the HHA program will need training and ongoing technical assistance to overcome implementation barriers. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Method Results Conclusion Trial Registration Poly‐l‐lactic acid (PLLA‐SCA; Sculptra) was approved in 1999 in Europe and 2004 in United States as a collagen biostimulator. It is a freeze‐dried preparation containing 150 mg PLLA‐SCA per vial and, since approval, has been recommended to be reconstituted 72 h before treatment, which can hinder its use in clinical practice. In 2021, the manufacturer authorized the reconstitution of PLLA‐SCA immediately before use.To evaluate adverse events in patients treated with immediately reconstituted PLLA‐SCA on the face, body, and scars.This was a retrospective analysis of medical records of patients treated with immediately reconstituted PLLA‐SCA for aesthetic purposes from January 1, 2021, to December 31, 2021, at two medical centers.A total of 274 treatment sessions were conducted on 167 patients (ranging from 1 to 5 sessions per patient). Of these, 228 sessions (151 patients) targeted the face, 39 sessions (22 patients) addressed the body, and 7 sessions (5 patients) focused on scars. The mean final concentration of PLLA‐SCA was 15.30 mg/mL for the face, 8.35 mg/mL for the body, and 10.53 mg/mL for scars. The majority of injections were administered with a blunt cannula (face: 87.3%, body: 100%, scars: 57%), and in 6 out of 7 scar treatments, PLLA‐SCA was additionally applied topically after fractional treatment. One patient developed a PLLA‐SCA nodule 30 days after facial treatment, which resolved after two saline injections. The most common adverse events were bruising (face: 6.57%, body: 7.69%) and mild pain (face: 3.07%). No events required further intervention.This study reports an adverse event profile with immediately reconstituted PLLA‐SCA, used on the face, body, and scars, similar to that reported with PLLA‐SCA reconstituted 72 h prior to use.This was a retrospective study of medical records at two medical centers, and trial registration was not required. [ABSTRACT FROM AUTHOR]

A health crisis can affect the attitude towards healthcare seeking of the population. During the COVID-19 pandemic, two situations arose: people either sought care out of caution and vigilance, or because of the fear of contracting the virus and the health restrictions, they did not consult the healthcare facilities. This paper aims to analyze the effects of a health crisis such as COVID-19 on the use of healthcare in Madagascar. Two diseases, diarrhoea and fever, are considered. Fever is a common symptom of COVID-19, and diarrhoea is one of the causes of morbidity in Madagascar and a less common symptom of the pandemic. Data from the Multiple Indicator Cluster Survey in 2018 and the Rapid Survey on the Socio-Economic Impact of COVID-19 in Madagascar in 2020 are used. Considering the same individuals surveyed in 2018 and 2020, after verification of the endogeneity, the absence of it is raised. Probit models without instrumental variables are used. During the pandemic, in the case of diarrhoea, faced with the fear of a pandemic, people have sought other alternatives, such as Community Health Workers (CHWs), which is considered less risky than health centres (0.33; p-value = 0.05). In the case of fever, people out of caution, prefer to consult health centres rather than self-medicate (− 1.86; p-value = 0.00). People's behaviour differs according to the symptoms of their illness, diarrhoea being less well-known and less frequent as a symptom of COVID-19 than fever. [ABSTRACT FROM AUTHOR]

Background: Reactive case detection (RCD) aims to reduce malaria transmission stemming from asymptomatic carriers. Symptomatic individuals diagnosed with malaria at a health centre are followed to their households, where members of the index case and neighbouring households are tested and treated for malaria. An RCD programme was tested in the Ashanti region of Ghana in order to study diagnostic accuracy in the hospital and household settings, assess the prevalence of subclinical infections and possible clustering in index case households, and identify operational challenges for future RCD programmes. Currently, transmission in this region is high, but reactive interventions might become an option once transmission is reduced. Methods: 264 febrile individuals were enrolled at the Mankranso Government Hospital and tested for malaria using rapid diagnostic tests (RDT). From the pool of RDT-positive febrile index cases, 14 successful RCD follow-ups were conducted, and 233 individuals were enrolled from the index case, neighbour, and control households. The sensitivity of diagnostic tools for clinical and subclinical cases was compared, including RDT, expert microscopy by World Health Organization-certified microscopists, field microscopy, and qPCR. Results: Poor diagnosis and low receptivity to RCD-style follow-ups were major limitations to a successful and effective RCD programme. Field microscopy detected only 49% of clinical infections compared to RDT. 54% of individuals did not agree to a follow-up, and 66% of attempted follow-ups failed. The system effectiveness of RCD, calculated as the product of correctly diagnosed index cases, successful follow-ups, and proportion of asymptomatic infections detected by RDT, was very low at 4.0%. Conclusions: Due to low system effectiveness and the endemic nature of the disease setting in which asymptomatic prevalence is high and infections are not clustered around index case households, RCD is currently not a feasible option for malaria control in this region. The operational challenges identified through this study may help inform future reactive intervention programme designs once transmission is reduced. [ABSTRACT FROM AUTHOR]

The herpes simplex viruses consist of the strains, HSV-1 and HSV-2, which are prevalent worldwide and lack a definitive cure. We aimed to explore the specific characteristics of HSV 1 and 2 infections, such as differences between gender assigned at birth, age at infection, site of infection, comorbidities, and effect of pregnancy, through a data analysis. Between 2011 and 2018, the Israeli Central Virology Laboratory diagnosed 9189 samples using multiplexed real-time PCR. In addition, we extracted all of the medical data for 287 females hospitalized at the Sheba Medical Center with HSV-1 (161) or HSV-2 (126) genital infections. HSV-2 was almost absent in the orofacial samples from both genders, while in other lesion sites, HSV-2 was significantly more abundant in females than in males (p < 0.05,). HSV-2 was initially detected at puberty. In the hospitalized females' malignancies, both HSV-1 and HSV-2 were found with a non-significant difference. Simultaneously, pregnancies were more common in females who were HSV-2-positive compared with those who were HSV-1-positive (27.8% vs. 12.4%, respectively, p < 0.01). Primary infections occur more with HSV-1 than with HSV-2 (15.6% vs. 3.2%, respectively). Our findings demonstrate that genital HSV-2 infection episodes are more frequent during pregnancy, suggesting that pregnancy may serve as a risk factor for HSV-2 reactivation or infection. [ABSTRACT FROM AUTHOR]