Clinical Advice Research Articles

Analysis of queries to a Swedish drug information centre identifies scientific knowledge gaps

Drug Information Centres (DICs) are providing clinicians with evidence-based support for rational drug treatment. However, knowledge gaps in the literature may hinder DICs from offering optimal guidance. This study examined the extent and nature of these knowledge gaps and their impact on clinical pharmacological advice, using real-world query data from a Swedish regional DIC. Data from 2022 at the Sahlgrenska University Hospital were analysed, focusing on queries outside off-label prescriptions and pharmaceutical aspects. A qualitative text content analysis identified phrases indicating a lack of evidence. Responses were categorized by the presence of these signalling phrases and the presence or absence of knowledge gaps. Among 209 responses, the majority were patient-specific (79%), posed by physicians (95%), and often related to adverse effects (37%). The analysis revealed that 23% of the responses had scientific knowledge gaps, and in 18% of the responses, no clinical pharmacological advice could be provided. Knowledge gaps were particularly associated with queries on adverse effects, long-term medication safety, specific patient cases and comorbidities, drug comparisons, or patient populations with limited literature coverage. This analysis highlights the potential of DICs to identify unmet clinical needs in drug treatment and to promote research for evidence-based, patient-centred drug treatment.

A latent class analysis of co-occurring insomnia and anxiety among Chinese pregnant women

Currently, there remains a paucity of comprehensive evidence concerning the concurrent presence of insomnia and anxiety in pregnant women. This study, employing convenience sampling, enrolled 1049 Chinese pregnant women. Key assessment instruments comprised a three-item Insomnia Symptoms scale, a two-item Generalized Anxiety Disorder Scale, as well as measures of demographic and pregnancy-specific characteristics. The findings revealed that the prevalence of insomnia and anxiety symptoms among the participants was 54.5% and 18.8%, respectively. Considering the heterogeneous patterns of co-occurring insomnia and anxiety, 30% pregnant women experienced high insomnia with moderate anxiety, while 70% pregnant women experienced mild insomnia with mild anxiety. This study found that educational level, trimester, miscarriage history, pregnancy complications and pregnancy-related anemia significantly affected co-occurring insomnia and anxiety in pregnant women. This study provides clinical advice for reducing sleep disorders and anxiety in pregnant women.

Smartphone pregnancy apps: systematic analysis of features, scientific guidance, commercialization, and user perception

BackgroundOver 50% of pregnant women use pregnancy applications (apps). Some app s lack credibility, information accuracy, and evidence-based clinical advice, containing potentially harmful functionality. Previous studies have only conducted a limited analysis of pregnancy app functionalities, expert involvement/evidence-based content, used commercialization techniques, and user perception.MethodsWe used the keyword “pregnancy” to scrape (automatically extract) apps and app information from Apple App Store and Google Play. Unique functionalities were derived from app descriptions and user reviews. App descriptions were screened for evidence-based content and expert involvement, and apps were subsequently analyzed in detail. Apps were opened and searched for used commercialization techniques, such as advertisements or affiliate marketing. Automated text analysis (natural language processing) was used on app reviews to assess users’ perception of evidence-based content/expert involvement and commercialization techniques.ResultsIn total, 495 apps were scraped. 226 remained after applying exclusion criteria. Out of these, 36 represented 97%/88% of the total market share (Apple App Store/Google Play), and were thus considered for review. Overall, 49 distinct functionalities were identified, out of which 6 were previously unreported. Functionalities for fetal kick movement counting were found. All apps are commercial. Only 15 apps mention the involvement of medical experts. 10.3% of two-stars user reviews include commercial topics, and 0.6% of one-/two-/three-/five stars user reviews include references to scientific content accuracy.ConclusionProblematic features and inadequate advice continue to be present in pregnancy apps. App developers should adopt an evidence-based development approach and avoid implementing as many features as possible, potentially at the expense of their quality or over-complication (“feature creep”). Financial incentives, such as grant programs, could support adequate content quality. Caregivers play a key role in pregnant individuals’ decision-making, should be aware of potential dangers, and could guide them to trustworthy apps.

Reliable Autism Spectrum Disorder Diagnosis for Pediatrics Using Machine Learning and Explainable AI.

Background: As the demand for early and accurate diagnosis of autism spectrum disorder (ASD) increases, the integration of machine learning (ML) and explainable artificial intelligence (XAI) is emerging as a critical advancement that promises to revolutionize intervention strategies by improving both accuracy and transparency. Methods: This paper presents a method that combines XAI techniques with a rigorous data-preprocessing pipeline to improve the accuracy and interpretability of ML-based diagnostic tools. Our preprocessing pipeline included outlier removal, missing data handling, and selecting pertinent features based on clinical expert advice. Using R and the caret package (version 6.0.94), we developed and compared several ML algorithms, validated using 10-fold cross-validation and optimized by grid search hyperparameter tuning. XAI techniques were employed to improve model transparency, offering insights into how features contribute to predictions, thereby enhancing clinician trust. Results: Rigorous data-preprocessing improved the models' generalizability and real-world applicability across diverse clinical datasets, ensuring a robust performance. Neural networks and extreme gradient boosting models achieved the best performance in terms of accuracy, precision, and recall. XAI techniques demonstrated that behavioral features significantly influenced model predictions, leading to greater interpretability. Conclusions: This study successfully developed highly precise and interpretable ML models for ASD diagnosis, connecting advanced ML methods with practical clinical application and supporting the adoption of AI-driven diagnostic tools by healthcare professionals. This study's findings contribute to personalized intervention strategies and early diagnostic practices, ultimately improving outcomes and quality of life for individuals with ASD.

Focus on food instead of nutrients improves consumers’ understanding of meals’ nutrition quality

Abstract Background Nowadays, most of the information directed to consumers focuses on nutrients, ignoring the impact of the interactions between different foods, origin or degree of processing. The methodologies currently applied have led consumers to confuse foods with nutrients, meat and fish are often referred to as “proteins”, grains and potatoes are referred to as “carbohydrates, forgetting that these foods are source of other nutrients, such as fat, proteins or fibre. Furthermore, its efficacy is compromised by the difficulties of reading labels among consumers. Objectives This study aimed to evaluate the understanding about food and nutritional information presented in menus to consumers, comparing the nutrient-focused approach (Nutrition Declaration) and the new food-focused approach (infographic - based on the Portuguese food Guide, from previous research). Methods 4 different meals were created, 2 balanced and complete in terms of food and nutrient content and 2 unbalanced and uncomplete. A questionnaire was applied, evaluating the understanding of the balance and healthiness of the meals, using the two approaches (nutrient-focused and food-focused). The order of presentation of the approaches and the meals was randomized for all participants. The questionnaire was distributed online through snowball sampling. Results 221 individuals participated, mostly female (67%), aged 25 to 54 years old. Evaluation of meals (“how balanced” and “how complete” the meal is) using the Nutrition Declaration did not allow to distinguish the quality of meals (Mb = 3,8;Mc=4,0), in opposite the Infographic returned significant differences between M1/M2 (Mb = 4,3;Mc=4,4) and M3/M4 (Mb = 2,5;Mc=2,6) (p < 0.01) allowing consumers to perceive differences between meals. The percentage of consumers that respond “I don’t know” to these questions decreased using the food-focused tool (13% vs 2%). Conclusions The food-focused approach allows for better understanding of meals’ nutritional balance. Key messages • The infographic provides more information about the daily food portions and how different meals and types of food contribute for complying food and nutritional recommendations. • The use of the infographic in menus, recipes, cookbooks and clinical advice may improve better food choices and a healthier lifestyle.

High Prevalence of Tobacco Consumption among Pregnant Women in a Southern European City (Seville): A Challenge for the Health System.

The prevalence of prenatal tobacco exposure remains high in many countries, particularly in southern Europe. The aims of this study were to estimate the prevalence of smoking among pregnant women in a southern Spanish city (Seville) and to identify the associated sociodemographic and obstetric characteristics. In a descriptive, cross-sectional study, a random sample of pregnant women who were scheduled to undergo a morphology scan at their public referral hospital in their 20th week of gestation were interviewed in person. At the start of pregnancy, 38.2% of the pregnant women were smokers. In the twentieth week, 19.1% continued to smoke, and the same percentage had quit. The prevalence of smoking in pregnant women was higher among those with a low level of education (60% among pregnant women with no studies and 30.4% in those with primary education) and among those who had had abortions (38.5%). Pregnant smokers with obesity were the least likely to have given up smoking during pregnancy. Women with a lower educational level should be a prime target for cross-sectoral interventions aimed at preventing prenatal tobacco exposure. Implementation of support measures for providing effective clinical advice in preconception and prenatal care regarding healthy lifestyles is particularly needed.

Psychiatrists' views on clozapine prescribing in Ireland.

Despite proven effectiveness in refractory schizophrenia, clozapine remains underutilised, and it is important to understand potential reasons for this. This study's aim was to examine in a National sample of Consultant Psychiatrists their knowledge of, attitudes and perceived barriers to clozapine use. A novel questionnaire was designed and distributed by email to 275 Consultant Psychiatrists in Republic of Ireland. Twenty-eight percent (n = 77) completed the survey, with 55% of respondents practicing for 15 or more years. Clinicians expressed confidence in managing clozapine treatment and side effects and were well aware of clozapine's clinical effectiveness and guideline-based use. A majority indicated insufficient experience managing rechallenge and half expressed insufficient experience managing adverse events. Perceived patient factors were highlighted as barriers with 69% of respondents reporting patients' concern about effectiveness and 50% regarding tolerability. Sixty-four percent (n = 40) indicated that a specialised/tertiary clozapine service would facilitate initiation, with 57% (n = 36) reporting less frequent blood monitoring would aid clozapine prescribing. A majority identified that access to dedicated staff (81%, n = 51) and dedicated day hospital services (84%, n = 53) would facilitate community initiation. Consultants are familiar with clozapine use and related guidelines. Dedicated staff and facilities for clozapine use is one identified structural change to enhance clozapine prescribing in Ireland. Tertiary service or clinical advice service would assist in clozapine rechallenge cases or in managing significant adverse events. More structured patient education regarding clozapine effectiveness and professional development programmes focused on managing side effects and rechallenge may promote clozapine use.

Effect of Health Education on Knowledge and Attitude of Parents towards Paediatric Epilepsy in Egyptian Children

Abstract Background Epilepsy remains one of the most common neurological diseases in the world but seems to be widely misunderstood, especially in low-income countries. Patients with epilepsy can face considerable stigma in society, Parents’ knowledge on care of children greatly influences the health status of a child by reducing the mortality and morbidity rate. Aim of the Work Assess the attitude and knowledge toward paediatric epilepsy amongst parents of paediatric patients with epilepsy and other parents seeking advice in the out-patient clinic, Assess the effect of educational program of home management of seizures on knowledge and practice of parents. Patients and Methods This comparative cross-sectional study included 100 parents of children with epilepsy who follow up in Paediatric neurology clinic, Ain Shams University (Group A) and 300 parents of normal children who sought advice in Paediatric outpatient clinic, Ain Shams University (Group B) in which sociodemographic characteristics were collected and a validated questionnaire was distributed before and after an educational session about epilepsy facts and its first aid. Results The study revealed significant difference between study and control groups in their baseline knowledge about epilepsy, in terms of “epilepsy being an organic disease, rather than a psychiatric illness or an evil spirit” (67.0% vs. 39.8%, P < 0.001) respectively, and management of a child experiencing a seizure where 6% of group A answered “do not know” vs 74.6% of group B, P < 0.001). Regarding attitude towards epilepsy, both groups showed negative attitude towards epilepsy; 78% of group A and 66% of group B agreed that epilepsy is a factor that strongly impair child learning. Similarly, 81% of group A and 65% of group B reported that epilepsy can strongly limit sports and leisure activities. In terms of effect of educational effect, group A showed significant difference in number of correct answers regarding manifestation and first aid measures for a child with seizure before and after education (12% vs 51% P < 0.001 & 45% vs 75% P = 0.009) respectively. Moreover, group B showed significant difference in correct answers for both topics after education (0% vs. 49.2 % P, 0.001 & 0% vs 71.2% P < 0.001). Conclusion Our results highlight the need for educational programs and targeted awareness campaigns, to reduce misconceptions and promote a more supportive environment for individuals with epilepsy.

Exhaustive Search of Dietary Intake Biomarkers as Objective Tools for Personalized Nutrimetabolomics and Precision Nutrition Implementation.

To conduct an exhaustive scoping search of existing literature, incorporating diverse bibliographic sources to elucidate the relationships between metabolite biomarkers in human fluids and dietary intake. The search for biomarkers linked to specific dietary food intake holds immense significance for precision health and nutrition research. Using objective methods to track food consumption through metabolites offers a more accurate way to provide dietary advice and prescriptions on healthy dietary patterns by healthcare professionals. An extensive investigation was conducted on biomarkers associated with the consumption of several food groups and consumption patterns. Evidence is integrated from observational studies, systematic reviews, and meta-analyses to achieve precision nutrition and metabolism personalization. Tailored search strategies were applied across databases and gray literature, yielding 158 primary research articles that met strict inclusion criteria. The collected data underwent rigorous analysis using STATA and Python tools. Biomarker-food associations were categorized into 5 groups: cereals and grains, dairy products, protein-rich foods, plant-based foods, and a miscellaneous group. Specific cutoff points (≥3 or ≥4 bibliographic appearances) were established to identify reliable biomarkers indicative of dietary consumption. Key metabolites in plasma, serum, and urine revealed intake from different food groups. For cereals and grains, 3-(3,5-dihydroxyphenyl) propanoic acid glucuronide and 3,5-dihydroxybenzoic acid were significant. Omega-3 fatty acids and specific amino acids showcased dairy and protein foods consumption. Nuts and seafood were linked to hypaphorine and trimethylamine N-oxide. The miscellaneous group featured compounds like theobromine, 7-methylxanthine, caffeine, quinic acid, paraxanthine, and theophylline associated with coffee intake. Data collected from this research demonstrate potential for incorporating precision nutrition into clinical settings and nutritional advice based on accurate estimation of food intake. By customizing dietary recommendations based on individualized metabolic profiles, this approach could significantly improve personalized food consumption health prescriptions and support integrating multiple nutritional data.This article is part of a Nutrition Reviews special collection on Precision Nutrition.

Shifting the Paradigm for Establishing and Maintaining Milk Production in the Setting of Mother/Infant Separation.

Establishing lactation when mother and infant are separated, such as when the neonate is admitted to the neonatal intensive care unit (NICU), is challenging. The most common clinical advice is to express milk eight or more times per day, every 3 hours, around the clock. Sometimes, the first time that parents hear this is after the birth of their baby. This can be overwhelming and sometimes unachievable. A five-step paradigm shift is proposed that refocuses lactation care on providing evidence-based assistance and ongoing clinical education, and assessment beginning prenatally and extending past maternal discharge, to improve outcomes through curated support. Simple guidelines can begin with expressing milk at least five times a day by Day 5 of life (5 × 5), and expressing milk at least once between 0100 and 0500 (overnight pumping). With these measures, neonatal care in the NICU setting can provide personalized and achievable guidance on pumping schedules.

Reliability of YouTube videos on the management of orthodontic emergencies during COVID-19 pandemic: A quantitative and qualitative analysis.

To assess the content of YouTube videos on the management of orthodontic emergencies during the COVID-19 pandemic. YouTube was systematically searched using the keywords "orthodontic emergency," "orthodontic homecare," "braces emergency," and "braces homecare." The first 100 videos for each keyword were assessed. The upload source, number of views, likes and dislikes, duration, and global quality score were extracted. Home and clinical advice reliability was evaluated using the reliability score (DISCERN) according to the COVID-19 orthodontic emergencies protocol published by the British Orthodontic Society. The majority of the videos were found to be poor quality. Home care advice showed higher reliability than clinical advice. Orthodontic emergency videos uploaded by healthcare professionals had higher reliability. Many types of orthodontic emergencies have received little attention on YouTube, and more useful and reliable educational videos should be uploaded in the event of future pandemics.

114 Prime Time of Life: A multimodal physical activity and health education programme for middle-aged and older adults

Abstract Prime Time of Life is inclusive of people living with clinical conditions and differing fitness and functional abilities. Health screening was conducted preprogramme, and specific clinical exercise advice and support was provided to participants by Dr Diane Cooper, Clinical Exercise Physiologist. Participants completed two 60-minute multimodal (cardiovascular fitness, strength, balance, flexibility) exercise classes per week and were also encouraged to complete additional classes in their purpose built on-demand exercise library. In all 60-minute exercise classes the exercise instructor demonstrated three different options for each exercise to cater for participants who were working at beginner, intermediate and advanced levels of fitness. Participants appreciated the adaptations and progressions that were available for all exercises as it enabled them to work to their ownability and progress and monitor progress throughout the programme. Each week a 20-minute health education workshop relevant to participants was delivered online via Zoom. The workshop was recorded, edited, and uploaded to YouTube to view on-demand. The link for each video was shared with participants weekly via email to support on-demand learning in addition to any other relevant supporting material such as a training diary. The Prime Time of Life programme increased participants upper and lower body strength, aerobic fitness and perceptions of physical and mental health (see chapter 3). This was in addition to increased confidence and feelings of positivity around the participants’ own management of healthy functional ageing (see chapter 3). Participants commented that they really enjoyed the Prime Time of Life programme. It increased their awareness on the importance of multimodal exercise for healthy ageing and that they felt empowered to continue training and improve their health in the long term. Following on from this successful programme a full train the trainer programme has been developed and piloted with 9 Local Sports Partnerships, 20 participants with further plans for upscaling.

Anti-Obesity Medications in Patients With Heart Failure: Current Evidence and Practical Guidance.

Obesity is a significant risk factor for heart failure (HF) development, particularly HF with preserved ejection fraction and as a result, many patients with HF also have obesity. There is growing clinical interest in optimizing strategies for the management of obesity in patients with HF across the spectrums of both ejection fraction and disease severity. The emergence of anti-obesity medications with cardiovascular outcomes benefits, principally glucagon-like peptide-1 receptor agonists, has made it possible to study the impact of anti-obesity medications for patients with baseline cardiovascular conditions, including HF. However, clinical trials data supporting the safety and efficacy of treating obesity in patients with HF is currently limited to patients with HF with preserved ejection fraction, but do confirm safety and weight loss efficacy in this patient population as well as improvements in HF functional status, biomarkers of inflammation and HF stability. Here, we review the current data available surrounding the management of obesity for patients with HF, including the limitations of this evidence and ongoing areas for investigation, summarize the next phase of emerging anti-obesity medications and provide practical clinical advice for the multidisciplinary management of patients with both HF and obesity.

Telemedicine as a counselling tool for nurses in Central Africa.

Compare the use and trend of a telemedicine tool for clinical advice among nurses and other Cameroonian healthcare providers and explore its feasibility and accessibility. A comparative observational descriptive study. The sample includes all telemedicine users who request advice from volunteer medical specialists in Spain on clinical cases through the telemedicine tool "diagnosis assistance" (DA). It consisted of a total of 296 Cameroonian health professionals (59% women), of whom 77 were nurses. The variables in which the trend was explored (2013-2022) were DAs entered by nurses versus other healthcare professionals, compared by primary specialty, comments and documents attached. Feasibility and accessibility were explored through an anonymous survey. There were 2527 DAs between 2013 and 2022, of which nurses introduced 68%. There is an increasing trend in the nurse/other healthcare providers ratio, with significant differences in the chi-square of the linear trend between 2015 and 2022 (χ2 = 395.05; df = 7; p < .001). The probability that a DA was requested by nurses (PR >1) was observed in all years except for 2014, 2018 and 2019. The most tele-counselling requested by nurses was in the specialties of internal medicine, obstetrics and gynaecology, and dermatology. The exchange of comments and attachments was mainly conducted among nurses (74.9% and 50.4%, respectively). The users surveyed considered the tool valuable for diagnosis, applicable, with limitations due to cost, Internet quality or lack of time and effective at reducing hospital referrals. Telemedicine for clinical advice has been used mostly and with increasing tendency by nurses, mainly in internal medicine, gynaecology and dermatology, being a useful and feasible resource that can contribute to improving clinical decision-making by African nurses. The study addressed the problem of the shortage of health professionals in Central Africa and the search for alternatives that facilitate decision-making in this context. Tele-counselling tools through digital platforms that put Spanish specialists in contact with health professionals in Central Africa are mostly used by nurses working in rural health centres with a growing trend in their use. The research allows us to determine that tele-counselling tools constitute a well-accepted resource, which has a positive impact in environments with a shortage of human health resources, favouring the safety of both the nursing professional, through support in decision-making, and the populations to whom they provide care, who benefit from a multidisciplinary approach to their processes. The study has adhered to STROBE guidelines. No Patient or Public Contribution.

Factors Associated with the Practice of Low-Carb and Low-Fat Diets among Participants of the Longitudinal Study of Adult Health (ELSA-Brasil).

In the field of nutrition, both low-carbohydrate (LCD) and low-fat (LFD) diets were initially intended for specific subgroups but are now being embraced by the broader population for various purposes, including aesthetics and overall health. This study aims to assess sociodemographic, health, and lifestyle factors influencing diet choices among public servants in the ELSA-Brasil cohort. Diets were classified as LCD or LFD based on the Brazilian Diabetes Society (<45%) and WHO guidelines (<30%) respectively. A total of 11,294 participants were evaluated (45.3% men; 54.7% women) with a mean age of 52 ± 0.08 years. Having overweight, altered waist circumference, and a history of smoking confers higher chances of adopting an LCD compared to the usual diet, while being over 52 years, non-White race/skin color, in a lower income stratum, and having diagnosis of hypertension and/or diagnosis of diabetes mellitus decrease these chances. Regarding LFDs, belonging to the non-White race/skin color, being over 52 years old, being divorced, and practicing low physical activity decrease the chances of following such a diet compared to the usual diet. In conclusion, factors like age, socioeconomic status, health, and physical activity levels can be the key to understanding why individuals choose restrictive diets beyond clinical advice.

COVID-19 and autoimmune rheumatic disease: behavioural changes adopted by patients amid the pandemic.

Amid concerns about severe COVID-19 in patients with autoimmune rheumatic disease (AIRD) during the outbreak, it is crucial to explore behavioural changes, whether healthy or unhealthy, arising from this patient population in response to the changing healthcare environment. To investigate COVID-19-driven behavioural changes in patients with AIRD. This observational study invited patients who attended the rheumatology clinic of the Korle Bu Teaching Hospital from 1 August 2020 to 1 July 2021, to respond to a survey questionnaire distributed on the patient's WhatsApp platform. Variables observed were changes in patient behaviour and decision-making related to medication, healthcare service utilisation and clinical advice. Results for 233 patients were analysed in the study, the majority (89.7%) of whom were women. The most significant behavioural changes were a reduction in hydroxychloroquine (HCQ) dosage, adoption of telemedicine for clinical consultation and keen adherence to protective/preventive health measures. Patients also expressed anxiety regarding the risk of contracting COVID-19 (52.5%), infecting their families (66.5%) and losing income (50.2%) due to the pandemic. Women and students were more likely to engage in self-isolation/shielding behaviour. Employed participants practised social distancing more, reduced HCQ dosage and had more fear of losing income. Having mixed connective tissue disease is associated with being anxious about the risk of COVID-19 infection. The COVID-19 pandemic has resulted in behaviour changes among patients with AIRD. Despite the perceived risk, most of these patients continue to adhere to their prescribed medication regimens, especially maintaining the dosage of traditional immunosuppressive agents.

Out-of-hospital birth training, experience and confidence of Australian rural volunteer ambulance officers.

Unplanned out-of-hospital births represent less than 1% of ambulance requests for assistance. However, these call-outs have a high risk of life-threatening complications, which are particularly complex in rural or remote settings with limited accessibility to specialist care support. Many community hospitals no longer provide obstetrics care, so birth parents must travel to larger regional or metropolitan hospitals for assistance. Increased travel time may increase the risk of unplanned out-of-hospital birth and/or complications such as postpartum haemorrhage and neonatal mortality. Rural volunteer ambulance officers (VAOs) are an integral component of Australia's healthcare system, especially in regional and remote areas. Although VAO response to unplanned out-of-hospital births may be considered rare compared to calls to other case types, provision of adequate care is paramount in these potentially high-risk situations. This research investigates Australian rural VAOs' perceptions of their training, experience and confidence regarding unplanned out-of-hospital birth and planned homebirth with obstetric emergencies where ambulance assistance is required. Semi-structured interviews and focus groups were undertaken from late 2021 to mid-2023 via telephone or online videoconference. Sessions were audio-recorded and transcribed verbatim. Data were analysed and coded into themes using Braun and Clarke's six-step process for semantic coding and reflexive thematic analysis. Twenty-eight participants were interviewed from six Australian states and territories, all of whom worked in rural and remote Australia. Ten participants were male, 17 female and one was male-adjacent, with length of VAO experience ranging from 3 months to 29 years. Participants came from seven jurisdictional ambulance services.| Four themes emerged from analysis: (1) Lack of education and exposure to birth resulted in low confidence. Most participants reported significant anxiety attending obstetric call-outs, and explained under-utilisation of specific obstetric and neonatal skills meant skills decay was an issue; (2) limitations were discussed regarding VAO scope of practice and accessing medical equipment specifically required for birthing and neonates that could impact patient care; (3) logistical and communication difficulties were discussed. Long distances to definitive care, potentially limited backup during emergencies and potential unavailability of aeromedical retrieval increased perceived complexity of cases. Telecommunication 'black holes' created a sense of further isolation for VAOs requiring support from senior clinicians; (4) there was a perception that many members of the general public were unaware VAOs often staffed the local ambulance, and expected VAOs to have the same scope of practice as a registered paramedic. Furthermore, VAOs can attend friends and family in an emergency, potentially creating psychological trauma. VAOs report being uncomfortable attending unplanned out-of-hospital births and obstetric emergencies, perceiving they have limited ability to manage complications. Backup from a registered paramedic is dependent on availability, and telecommunications are not always reliable in rural areas for online clinical advice and support. Given the distances to definitive care in regional Australia, this has serious implications for patient safety. Continued VAO education is essential for risk reduction in out-of-hospital births.

Hereditary Amyloidosis: Insights Into a Fibrinogen A Variant Protein.

Amyloidosis are a group of diseases in which soluble proteins aggregate and deposit in fibrillar conformation extracellularly in tissues. The effectiveness of therapeutic strategies depends on the specific protein involved, being crucial to accurately determine its nature. Moreover, following the diagnosis, the search for the mutation within relatives allows the clinical advice. Here we report the precise diagnosis and explored the possible reasons of the structural pathogenicity for a renal amyloidosis related to a fibrinogen Aα-chain variant. Whole-exome sequencing and GATK calling pipeline were leveraged to characterize the protein variant present in a patient with kidney failure. Bioinformatics strategies were applied to suggest potential explanations of the variants aggregation. Our pipeline allowed the identification of a single-point variant of fibrinogen Aα-chain, which opened the possibility of curative transplantation. In silico structural analysis suggested that the pathogenicity of the variant may be attributed to a heightened susceptibility to yield a peptide prone to deposit as an oligomer with a β-sheet structure. Exploiting the comprehensive coverage of whole-genome sequencing, we managed to fill a vacant stage in the diagnosis of hereditary amyloidosis and to stimulate the advancement in biomedicine.

Torture victims' perspective on dental treatment: "Every sign you make, every move you take" - A qualitative study.

Torture victims struggling with post-traumatic stress often experience elements in the dental treatment situation that may trigger trauma-related reactions. The aim of the study was to explore intervention strategies that will enable dental health workers to adapt dental treatment to the needs of torture survivors. Exploratory interviews were conducted with 10 torture-exposed resettled refugees with dental treatment experience in Norway. The data was analyzed using qualitative content analysis, which suggested that to minimize trauma-reactions, dental personnel should focus on creating a safe therapeutic space and strengthening the patient's sense of control. Four main categories of clinical advice were proposed: (i) Acquire knowledge about psychology, consequences of torture, cultural differences, trauma-informed care, and the patients' individual needs; (ii) Recognize the trigger-potential of busyness or delays; (iii) Avoid surprises, such as sudden moves or actions and explore triggers individually, but make sure not to evoke images of interrogation, and; (iv) Provide overview both with respect to visibility in the clinical room, and to predictability regarding the dental treatment. Although undergoing dental treatment may be challenging for torture-exposed individuals, it is possible to reduce the predicaments considerably by making feasible adaptions to the treatment and adopting a trauma-informed approach.

Twenty Years in EUCAST Anti-Fungal Susceptibility Testing: Progress & Remaining Challenges.

Since its inception in 2002, the EUCAST Antifungal Susceptibility Testing Subcommittee (AFST) has developed and refined susceptibility testing methods for yeast, moulds and dermatophytes, and established epidemiological cut-off values and breakpoints for antifungals. For yeast, three challenges have been addressed. Interpretation of trailing growth in fluconazole susceptibility testing, which has been proven without impact on efficacy if below the 50% endpoint. Variability in rezafungin MIC testing due to laboratory conditions, which has been solved by the addition of Tween 20 to the growth medium in E.Def 7.4. And third, interpretation of MICs for rare yeast with no breakpoints, where recommendations have been established for MIC-based clinical advice. For moulds, refinements include the validation of spectrophotometer reading for A. fumigatus to facilitate objective MIC determination, and for dermatophytes the establishment of a microdilution method with automated reading and a selective medium to minimise the risk of contaminations. Recent initiatives involve development and validation of agar-based screening assays for detection of potential azole and echinocandin resistance in A. fumigatus and Aspergillus species, respectively, and of terbinafine resistance in Trichophyton species. Moreover, the development of a EUCAST guidance document for molecular resistance testing represents an advancement, particularly for identifying target gene alterations associated with resistance. In summary, EUCAST AFST continues to play a pivotal role in standardizing AFST and facilitating accurate interpretation of susceptibility data for clinical decision-making. Adoption of EUCAST breakpoints for commercial test methods, however, requires thorough validation to ensure concordance with EUCAST reference testing species-specific MIC distributions.