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Introduction: Advance care planning (ACP) ensures that patients receive medical care aligned with their values, goals, and preferences, especially regarding end-of-life decisions in serious chronic illnesses. Objective: This project aimed to introduce and promote evidence-based ACP in oncology and palliative care at a midsized hospital near Berlin, Germany, during the COVID-19 pandemic. Methods: This project was guided by the JBI Evidence Implementation Framework and used a mixed methods audit cycle. A baseline audit was conducted using qualitative interviews and workshops with representatives from all the health care disciplines involved in oncology and palliative care at the hospital. The findings were compared with eight best practice recommendations. Targeted strategies aimed at the key stakeholders involved in ACP practice were then implemented. Finally, a semi-quantitative questionnaire was used in a follow-up audit with the same participants as in the baseline audit. Results: The baseline audit revealed a high level of familiarity with the concept of ACP. However, there was a lack of a uniformly accepted definition and understanding of ACP among the health care professionals, leading to a lack of coordination in task distribution. The follow-up audit revealed improvements with regard to education and training in ACP (Criterion 1: 50% to 100%) and organizational support to facilitate ACP conversations (Criterion 3: 87.5% to 100%). Other audit criteria compliance rates remained unchanged. Conclusion: Clinical education and team-based process analysis can facilitate ACP implementation across disciplines in oncology and palliative care facilities. However, the project did not succeed in implementing lasting changes in clinical processes and best practice ACP due to the COVID-19 pandemic. Such an endeavor would demand considerable resources and time, both of which were constrained during the pandemic. [ABSTRACT FROM AUTHOR]

The article discusses the increasing use of the Cochrane Risk of Bias 2 tool (RoB 2) in biomedical systematic reviews. A study of 3880 non-Cochrane systematic reviews published in 2020 found that the RoB 1 tool was used in 57.4% of reviews, while the RoB 2 tool was used in 6.9% of reviews. Another analysis of 1000 non-Cochrane systematic reviews published in 2023/2024 reported that 45% used the RoB 1 tool and 38% used the RoB 2 tool. The authors commend the availability of raw data for transparency and suggest further studies on the adequacy of RoB 2 tool usage in systematic reviews. [Extracted from the article]

Study objectives: The main objectives of this study were to assess the effect of mandibular advancement device (MAD) therapy on the upper airway morphology, as well as the occurence of dental and skeletal side effects following 1-year MAD therapy in patients with mild to moderate obstructive sleep apnea (OSA). Methods: In this study we included 15 patients with mild to moderate OSA treated with MAD therapy. All subjects underwent sleep study and lateral cephalometric radiography at baseline and at 1-year follow-up. Lateral cephalograms were analyzed with respect to relevant variables. Results: MAD therapy reduced apnea-hypopnea index (AHI) from 22.9±5.9 to 9.7±4.5 events/h (P<0.001) after 1-year of therapy. Oral area enclosure (3697.0±372.4 vs. 3381.5±336.4 mm2, P<0.001), superior airway space width (8.9±2.0 vs. 10.0±2.0 mm2, P=0.039), soft palate width (10.9±1.0 vs. 9.8±1.4, P=0.005) and length (45.4±3.8 vs. 43.9±4.2 mm, P=0.033) were significantly larger with the MAD intra-orally. Additionally, the tongue length decreased (84.1±5.3 vs. 80.7±5.9 mm, P=0.002), while the tongue height increased significantly (27.0±2.4 vs. 29.9±2.5 mm, P=0.003) with the MAD intra-orally. There were no significant changes in skeletal and dental cephalometric variables after 1 year of MAD therapy. Conclusions: Our results show significant enlargement of the upper airway dimensions with the MAD intraorally in patients with mild to moderate OSA. Although there were no significant changes in skeletal and dental cephalometric variables after 1 year of MAD therapy, close follow-up during MAD therapy is advisable to prevent potentially relevant occlusal changes. [ABSTRACT FROM AUTHOR]

Background Health literacy is a global problem and is particularly relevant when making health care decisions about small children. We analysed how parents of preschool children assess health claims and explored the predictors of their assessment skill. Methods We conducted a survey with questions from the Claim Evaluation Tools (CET) database, part of the Informed Health Choices (IHC) project, in ten paediatric primary care practices of the Split-Dalmatia County Health Center, Split, Croatia, from 1 February to 31 March 2023. Eligible participants were parents accompanying preschool-aged children for check-ups. We also collected data on parents' and children's demographic and health characteristics (including the presence of any chronic illness in the child), visits to paediatric emergency service, hospitalisations, vaccination status, the presence of chronic illness of parents or relatives, and whether parents had to made treatment decisions for themselves and/or their family member. Results Overall, 402 parents of preschool children (median age 35 years (interquartile range (IQR) = 31.0-38.3)) had a median IHC CET test score of 10.0 (IQR = 8.0-11.0) out of 12 questions. The multiple regression analysis showed that female gender, higher level of education, being employed, and having a history of a visit to paediatric emergency service were significant predictors of the test score, explaining 21.9% of the variance. Conclusions Parents of preschool children have a very good ability for critical assessment of health-related statements in a complex health care system and an environment of generally unsatisfactory health literacy. Further studies should explore how parents understand health claims in different geographical, socio-economic and cultural setting, and explore educational interventions to increase critical thinking abilities and informed decision-making, especially among fathers, unemployed parents and those with lower levels of education. [ABSTRACT FROM AUTHOR]

Background: Publishing identifiable patient data in scientific journals may jeopardize patient privacy and confidentiality if best ethical practices are not followed. Current journal practices show considerable diversity in the publication of identifiable patient photographs, and different stakeholders may have different opinions of and practices in publishing patient photographs.Objective: This scoping review aimed to identify existing evidence and map knowledge gaps in medical research on the policies and practices of publishing identifiable photographs in scientific articles.Methods: We performed a comprehensive search of the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL with Full Text, Database of Abstracts of Reviews of Effects, Ovid MEDLINE, and Scopus. The Open Science Framework, PROSPERO, BASE, Google Scholar, OpenGrey, ClinicalTrials.gov, the Campbell Collaboration Library, and Science.gov were also searched.Results: After screening the initial 15,949 titles and abstracts, 98 (0.61%) publications were assessed for eligibility at the full-text level, and 30 (0.19%) publications were included in this review. The studies were published between 1994 and 2020; most had a cross-sectional design and were published in journals covering different medical disciplines. We identified 3 main topics. The first included ethical aspects of the use of facial photographs in publications. In different clinical settings, the consent process was not conducted properly, and health professionals did not recognize the importance of obtaining written patient consent for taking and using patient medical photographs. They often considered verbal consent sufficient or even used the photographs without consent. The second topic included studies that investigated the practices and use of medical photography in publishing. Both patients and doctors asked for confidential storage and maintenance of medical photographs. Patients preferred to be photographed by their physicians using an institutional camera and preferred nonidentifiable medical photographs not only for publication but also in general. Conventional methods of deidentification of facial photographs concealing the eye area were recognized as unsuccessful in protecting patient privacy. The third topic emerged from studies investigating medical photography in journal articles. These studies showed great diversity in publishing practices regarding consent for publication of medical photographs. Journal policies regarding the consent process and consent forms were insufficient, and existing ethical professional guidelines were not fully implemented in actual practices. Patients' photographs from open-access medical journals were found on public web-based platforms.Conclusions: This scoping review showed a diversity of practices in publishing identifiable patient photographs and an unsatisfactory level of knowledge of this issue among different stakeholders despite existing standards. Emerging issues include the availability of patients' photographs from open-access journals or preprints in the digital environment. There is a need to improve standards and processes to obtain proper consent to fully protect the privacy of patients in published articles. [ABSTRACT FROM AUTHOR]

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Aim: The main objective of this study was to investigate the frequency and nature of subjective symptoms and pathological changes of the oral mucosa in Croatian Homeland War invalids. Materials and Methods: A total of 102 disabled Croatian war veterans participated in the study. Based on medical history, data on the presence of subjective symptoms in the oral cavity were collected and a detailed clinical examination was performed. Potentially malignant lesions were biopsied and sent for pathohistological analysis. The study included 88 (86.3%) men and 14 (13.7%) women with a mean age of 54.3 years. In the study sample, 46 respondents (45.1%) reported being smokers, while 56 of them (54.9%) denied the habit of smoking cigarettes daily. Results: Only 33 (32.4%) of the participants reported that a dentist had performed a thorough examination of their oral cavity, and seven of them (6.9%) a general practitioner. The majority of respondents, 77 (75.5%), denied the presence of subjective symptoms in the oral cavity. In-depth clinical examination revealed lesions in 35 (34.3%) participants, and 14 (13.7%) of these were pathological changes representing potentially malignant lesions. Histopathologic findings confirmed the diagnosis of a potentially malignant lesion in ten individuals (four leukoplakia, four erosive lichen planus, and two actinic cheilitis). In the remaining four participants, histopathologic findings indicated moderate dysplasia in two, carcinoma in situ in one, and invasive squamous cell carcinoma in one. Conclusion: Clinical examination revealed 14 potentially malignant changes in the oral mucosa. According to participants, most dentists and general practitioners did not thoroughly examine the entire oral mucosa of their patients. Both physicians and the general population need additional regular education. [ABSTRACT FROM AUTHOR]

Aim: To examine the knowledge of caregivers employed in homes for the elderly and infirm about oral health maintenance of their residents. Materials and Methods: 80 employees of homes for the elderly and infirm from Split and its surroundings participated in this cross-sectional study. The directors of the homes were contacted by e-mail and phone. Caregivers were given a questionnaire that contained general demographic information, questions about oral health maintenance of home residents and caregivers' knowledge of oral health. Results: Total of 73.75% of respondents received training on oral health care as part of their education. 92.5% of the respondents, once or twice a day help residents, who are unable to do it themselves, with oral hygiene, 72.5% of whom also clean their tongues. 73.75% of respondents use antiseptic-soaked gauze when residents have no teeth or in case of limited mouth opening. 6.25% of them do this when residents have sores in their mouths. Only 55% of respondents clean their residents' dentures every day. 52.5% of residents visit dentist when necessary, while only 11.25% visit them regularly. Almost all respondents believe that non-healing sores in the oral cavity can represent potential malignant lesions (95%), as well as that oral health is related to the quality of taste, chewing and swallowing (96.25%). The level of knowledge related to the impact of oral diseases on systemic disorders is satisfactory (75%), while worse results were observed for questions related to comorbidities of the elderly (50%). 65.5% of respondents don't know that acquired pneumonia can be prevented by mechanical cleaning, the use of antiseptics and regular dental care. Conclusion: Most of the caregivers know how to properly perform oral hygiene of their residents, but they don't perform it often enough. Caregivers consider oral health important for general health, but they need additional education on methods to preserve oral health. [ABSTRACT FROM AUTHOR]

Background: Lack of knowledge of systematic reviews (SRs) could prevent individual health care professionals from using SRs as a source of information in their clinical practice or discourage them from participating in such research.Objective: In this randomized controlled trial, we evaluated the effect of a short web-based educational intervention on short-term knowledge of SRs.Methods: Eligible participants were 871 Master's students of university health sciences studies in Croatia; 589 (67.6%) students who agreed to participate in the trial were randomized using a computer program into 2 groups. Intervention group A (294/589, 49.9%) received a short web-based educational intervention about SR methodology, and intervention group B (295/589, 50.1%) was presented with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. The participants' knowledge of SRs was assessed before and after the intervention. The participants could not be blinded because of the nature of the intervention. The primary outcome was the difference in the percentage of correct answers about SR methodology per participant between the groups after the intervention, expressed as relative risk and 95% CI.Results: Results from 162 and 165 participants in the educational intervention and PRISMA checklist groups, respectively, were available for analysis. Most of them (educational intervention group: 130/162, 80.2%; PRISMA checklist group: 131/165, 79.4%) were employed as health care professionals in addition to being health sciences students. After the intervention, the educational intervention group had 23% (relative risk percentage) more correct answers in the postintervention questionnaire than the PRISMA checklist group (relative risk=1.23, 95% CI 1.17-1.29).Conclusions: A short web-based educational intervention about SRs is an effective tool for short-term improvement of knowledge of SRs among health care studies students, most of whom were also employed as health care professionals. Further studies are needed to explore the long-term effects of the tested education.Trial Registration: OSF Registries 10.17605/OSF.IO/RYMVC; https://osf.io/rymvc. [ABSTRACT FROM AUTHOR]

The author discusses the benefits of mentoring in academic medicine. She says that having a mentor is important to having a successful career in academic medicine. She reflects on her relationship with her mentor which was influenced by personal, institutional and social factors of interference. She also emphasizes the benefit she got for having a mentor with uncompromising attitude towards research integrity and fair conduct of the research process.