Aspects Of Patient Care Research Articles

Healthcare Providers’ Experiences of Psychological Support for People With Cancer in Ardabil, Iran; Acontent Analysis Study

Objectives Psychological support is one of the basic aspects of care for patients with cancer. It has been emphasized in literature and clinical practice for many years. This study aims to explore the experiences and perceptions of healthcare providers in Ardabil, Iran, about psychological support to patients with cancer. Methods The research was conducted using conventional qualitative content analysis in cancer treatment centers in Ardabil, Iran, in 2021. Participants were 19 healthcare providers who were purposefully selected and interviewed to explore their experiences. After transcribing the recorded data, analysis was carried out based on Graneheim and Lundman’s content analysis method. Results Based on the content analysis results, four main themes, including “highlighting positive mental connection with oneself and others”, “positive awareness”, “positive change in the patient’s point of view,” and “strengthening the perceived value” were extracted. These categories reflected the healthcare providers’ efforts to “strengthen the positive mindsets” of patients and showed the formation of psychological support for patients with cancer. Conclusion Strengthening of the positive mentality in patients with cancer is needed for their psychological support, and should be used as a strategic plan in the development of training programs for healthcare providers. It can be an indicator for evaluating psychological support to these patients and be a step towards providing quality care to them. The findings can be useful for designing a tool to measure the status of psychological support for patients with cancer in Iran or assess the care quality and performance of healthcare providers in giving psychological support to these patients.

The Role of Clinical Assessment in the Era of Biomarkers.

Hippocratic Medicine revolved around the three main principles of patient, disease, and physician and promoted the systematic observation of patients, rational reasoning, and interpretation of collected information. Although these remain the cardinal features of clinical assessment today, Medicine has evolved from a more physician-centered to a more patient-centered approach. Clinical assessment allows physicians to encounter, observe, evaluate, and connect with patients. This establishes the patient-physician relationship and facilitates a better understanding of the patient-disease relationship, as the ultimate goal is to diagnose, prognosticate, and treat. Biomarkers are at the core of the more disease-centered approach that is currently revolutionizing Medicine as they provide insight into the underlying disease pathomechanisms and biological changes. Genetic, biochemical, radiographic, and clinical biomarkers are currently used. Here, we define a seven-level theoretical construct for the utility of biomarkers in neurodegenerative diseases. Level 1-3 biomarkers are considered supportive of clinical assessment, capable of detecting susceptibility or risk factors, non-specific neurodegeneration or dysfunction, and/or changes at the individual level which help increase clinical diagnostic accuracy and confidence. Level 4-7 biomarkers have the potential to surpass the utility of clinical assessment through detection of early disease stages and prediction of underlying pathology. In neurodegenerative diseases, biomarkers can potentiate, but cannot substitute, clinical assessment. In this current era, aside from adding to the discovery, evaluation/validation, and implementation of more biomarkers, clinical assessment remains crucial to maintaining the personal, humanistic, and sociocultural aspects of patient care. We would argue that clinical assessment is a custom that should never go obsolete.

Nursing Shortage in Pakistan

The health workforce including Medical, Nursing and Allied Health Professionals is the foundation of any health care system. Investment in the health sector reduces disease burden, improves productivity and ultimately contributes positively in economic growth of the country. Pakistan is generally confronted with dire shortage of qualified health professionals especially the nursing staff that is the backbone of every healthcare systems across the world. Nurses have incredible contribution in assisting the doctors in every aspect of patient care, thus ensuring that individuals receive the best possible care at all stages [1]. The nursing profession continues to face shortages due to a lack of potential educators, high turnover, and inequitable workforce distribution. The nursing staff employed in the hospitals is primarily responsible to provide all kind of nursing care to the admitted patients i.e., monitoring of vital signs, fluid management, and administration of medication in line with the orders of the attending physicians. Nurses are also responsible to monitor the nutrition intake, look after personal hygiene of patients and care of bowels, prevention of bedsores etc., maintain medical record and ensure the ambiance conducive to recovery. Their role therefore, requires essential nursing skills, apart from commitment and vigor. There are however, issues of quality in nursing education, particularly regarding development of proficiency in basic nursing & midwifery skills [2]. Nursing Institutions lack in quality output, due to deficiencies in nursing faculty, infrastructure and professional supervision. It is expedient to remain abreast with contemporary advancements in nursing education and practices to produce competent and skillful nursing workforce for better clinical outcomes. According to the Pakistan Economic Survey 2020-2021, Pakistan had a total of 116,659 registered nurses in 2020 for a population of about 200 million people. In the general wards of Pakistani hospitals, the current nurse-patient ratio is 1: 40, while the Pakistan Nursing Council recommends a nurse-patient ratio of 3:10 [3]. The deficiency in the actual number of nurses rendering services is further aggravated by positions remaining vacant due to shortage of skilled nurses, thus compromising quality of nursing care. This shortage in nursing strength is also worsened by an urge to move overseas particularly the Gulf countries, as large number of nurses opt for employment abroad for better financial incentives [4]. The situation is even worst in the private sector particularly, in the smaller hospitals that end up with hiring semi- qualified and poorly trained or self-trained staff on meager salary and poor employment terms on the pre-text of shortage of qualified nurses. Larger private setups often resort to make shift arrangements by engaging nurses employed in the public hospital for second shift. Such nurses are therefore, required to work for up to 16 hours a day, thus, further compromising quality of care. It is highly recommended to increase the number of nursing training opportunities and slots to overcome this serious shortfall and to ensure availability of sufficient number of nurses in the public as well as private sector to comply with the recommended Nurse: Bed ratio and to fill vacancies as per the sanctioned strength in public hospitals on priority basis. Also to improve the training facilities at Nursing Colleges in terms of qualified faculty and proper infrastructure to improve quality of training of the nursing cadre. Introduction of Continuous Professional Development (CPD) Programs for nurses with mandatory completion of credit hours on regular basis for continually building the skills and improving the quality of nursing and midwifery services can also prove to be a great initiative [5]. Enrolling more male nurses can help provide nursing care at hospitals located in the relatively hard to reach areas.

A Study of Management of Adverse Reaction to Iodinated Contrast Media used in Computed Tomography at UCMS-TH

INTRODUCTION: Iodinated contrast media is used in computed tomography imaging to enhance the visibility of blood vessels and tissues. They have distinct clinical effectiveness and toxicity profiles. Although low osmolar contrast media have made iodinated contrast media safer in recent years, adverse reactions can sometimes occur. The management of adverse reactions to iodinated contrast media is an important aspect of patient care during computed tomography examinations. The purpose of this study was to evaluate the management of adverse reactions to iodinated contrast media during contrast-enhanced computed tomography examinations at Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal. MATERIALS AND METHODS: A prospective, observational study was conducted on 323 patients at Department of Radiodiagnosis and Medical Imaging, Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal, from December 15, 2022 to May 15, 2023. All data was obtained from the Department of Radiodiagnosis and Medical Imaging, as per the study inclusion criteria. The data were analyzed with statistical package for the social sciences version 20. RESULTS: The mean age of study participants was 48.49±19.78 years. There were 34.67% male and 65.33% female patients involved in this study. Universal College of Medical Sciences and Teaching Hospital favoured a more strict approach, to determine the normal renal function and withhold metformin before iodinated contrast media exposure. 36.84% of patients had a history of previous adverse reactions, before undergoing contrast-enhanced computed tomography scans. Following iodinated contrast media administration, 94.74% experienced nausea and vomiting which was followed by mild urticarial (88.54%) and dyspnea (19.81%). Premedication protocol was predominantly implemented with antihistamine, pheniramine (73.1%), and corticosteroid, hydrocortisone (26.9%). Mild urticaria was treated with pheniramine (87.1%), nausea and vomiting was treated with metoclopramide (83.01%), dyspnea was treated by epinephrine, hydrocortisone and oxygen (9.38%). CONCLUSIONS: Universal College of Medical Sciences and Teaching Hospital has established a standard protocol for the management of adverse reactions experienced by patients during iodinated contrast media administration. Premedication with antihistamines and corticosteroids was recommended for highrisk patients.

Knowledge, attitudes and practices on postoperative pain management among registered nurses in a private hospital in Selangor-Malaysia

Background: Postoperative pain is an important aspect of patient care. It occurs when there is tissue injury and muscle spasms following surgery. The goal of postoperative pain management is to minimize discomfort and side effects. Poor pain management can result in patient discomfort, complications, slow recovery, and longer hospitalization. Therefore, it is crucial for registered nurses to have a good understanding of postoperative pain assessment tools in order to provide the best pain management for their patients.Purpose: To assess knowledge and attitude related to pain management practices among registered nurses (rn) in postoperative patients. Method: In this study, a descriptive quantitative cross-sectional survey design was used. A questionnaire was administered, consisting of four parts. The first part collected socio-demographic data from Registered Nurses. The second part contained 13 true and false questions to evaluate their knowledge level. The third part consisted of 14 questions to assess the attitudes of Registered Nurses, and the fourth part consisted of 18 questions using a Likert scale to evaluate their practices. The total number of respondents was 108 Registered Nurses. The data obtained were analyzed using IBM Social Packages for the Social Sciences (SPSS) software version 26.Results: The study finding shows that 58.2% of Registered Nurses possess adequate knowledge regarding postoperative pain management, while 41.8% lack sufficient knowledge. These nurses agree that effective analgesia is crucial in postoperative care, with 90.8% recognizing the importance of pain measurement instruments. Providing a clean and comfortable ward with a neatly made bed is the most commonly practiced intervention for pain relief among Registered Nurses. Additionally, the study found a positive correlation between age, years of clinical experience, and pain management practices.Conclusion: According to the findings, there is significant variation in the knowledge, attitude, and practices of registered nurses when it comes to managing postoperative pain. To ensure that patients receive helpful and effective pain management after surgery, it is important for nurses to participate in ongoing professional development activities.

Teleconsultation Perceptions of Medical and Radiation Oncologists in the COVID-19 and Post-COVID-19 Era: A National Survey in the Philippines.

The study reports on the current perception of medical and radiation oncologists regarding teleconsultation in the Philippines. Before the COVID-19 pandemic, the adoption of telemedicine was not widespread. With movement restrictions imposed during the pandemic, physicians were compelled to use telemedicine. It is uncertain whether physicians will still adopt its use in practice in the post-COVID-19 era. This study gives insight into the possible adaptation of this mode of consultation in the future, especially in areas with limited health care resources. We conducted a national survey among medical oncologists and radiation oncologists in the Philippines. A 43-item online survey was developed, validated, and administered to the oncologists. The demographics and data from categorical questions were reported as frequencies and percentages. A total of 142 responses were gathered from 82 medical oncologists and 60 radiation oncologists. There was agreement among participants that, during the pandemic, teleconsultation could be used for the first visit, diagnostic workup request, treatment explanation, follow-up care, and chronic disease management. There was disagreement whether cancer diagnosis disclosure and cancer prognosis revelation could be performed via teleconsultation, and there was agreement that emergency consultation and physical examination would warrant a face-to-face consultation. After the COVID-19 pandemic, 78.7% intend to continue using teleconsultation except for emergency consultations, first visits, physical examination, diagnosis disclosure, and cancer prognosis revelation. Teleconsultation was perceived by oncologists as an acceptable method of providing cancer care during and after the COVID-19 pandemic. Oncologists also intend to use teleconsultation in the post-COVID-19 era in certain aspects of patient care.

Analysis of diabetes attitudes, wishes and needs in Switzerland, the Swiss DAWN2™ Study

Swiss DAWN2™ aimed to evaluate the difficulties and unmet needs of individuals with diabetes and stakeholders, based on the assessments of diabetes care and self-management: the individual burden of disease, the perception of the quality of medical care, and the treatment satisfaction of individuals with diabetes living in the Canton of Bern. The results of the Swiss cohort were analysed and compared with the global DAWN2™ results. 239 adult individuals with diabetes were enrolled in a cross-sectional study at the Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism at the University Hospital of Bern between 2015 and 2017. The participants completed validated online questionnaires regarding health-related quality of life (EQ-5D-3L) and emotional distress (PAID-5), diabetes self-care activities (SDSCA-6), treatment satisfaction (PACIC-DSF), and health-related wellbeing (WHO-5). Eligibility criteria were as follows: participants were aged >18 years, had a diagnosis of diabetes type 1 or 2 since at least 12 months and gave written informed for the participation in the present study. When compared globally, the Swiss cohort reported a higher quality of life (77.28 ± 16.73 vs. 69.3 ± 17.9 EQ-5D-3L score, p <0.001) and lower emotional distress (22.28 ± 20.94 vs. 35.2 ± 24.2 PAID-5 score, p = 0.027). Higher frequencies of self-measurement of blood glucose (6.43 ± 1.68 vs. 3.4 ± 2.8 SDSCA-6 score, p <0.001) and physical activity (4.40 ± 2.04 vs. 3.8 ± 2.7 SDSCA-6 score, p = 0.05) were reported. PACIC-DSF revealed higher satisfaction concerning organisational aspects of patient care (60.3 ± 1.51 vs. 47.3 ± 24.3, p<0.001) and higher health-related well-being as compared to the global score (71.38 ± 23.31 vs. 58 ± 13.8 WHO-5 Well-Being Index, p <0.001). HbA1c >7% correlated to emotional distress (PAID-5, 26.08 ± 23.37 vs. 18.80 ± 17.49, p = 0.024), unfavourable eating habits (4.28 ± 2.22 vs. 4.99 ± 2.15, p = 0.034) and decreased physical activity (3.95 ± 2.16 vs. 4.72 ± 1.92, p = 0.014). Sleeping problems were most commonly reported (35.6%). In total, 28.8% of respondents completed diabetes-related educational programs. In global comparison, Swiss DAWN2™ showed a lower burden of disease and yet a higher level of treatment satisfaction in patients who were treated in Switzerland. Further studies are required to assess the quality of diabetes treatment and unmet needs in patients treated outside of a tertiary care center.

The Role of Nursing Care in the Management of External Ventricular Drains on the Neurosurgical Ward: A Quality Improvement Project

The management of external ventricular drains (EVDs) is a critical aspect of patient care in the intensive care setting. However, nurses on the general floor are not commonly exposed to patients with EVD and therefore lack the necessary knowledge and skills to manage and troubleshoot EVDs effectively. The aim of this study was to evaluate the level of knowledge, comfort, and impact of EVD management among nurses on the floor after the implementation of a quality improvement (QI) tool. This is a cross-sectional study conducted among registered nurses working on the neurosurgical floors of the Montreal Neurological Hospital. Data were collected using a questionnaire based on the plan-do-study-act model. A survey assessing the level of knowledge and comfort with EVD management was conducted before and after the implementation of the QI tool. Seventy-six nurses completed the questionnaire regarding their knowledge and comfort level in EVD management. Results showed that only 42% of the nurses reported feeling "comfortable" whereas 37% reported feeling "uncomfortable" in caring for patients with an EVD. In addition, only 6.5% reported being "comfortable" in troubleshooting a malfunctioning EVD. However, the level of comfort significantly improved after using the QI project. The results of this study highlight the need for continued training and education to support the care of patients with EVDs in the ward setting. The implementation of a QI tool can significantly improve nurses' knowledge and comfort level in EVD management, leading to improved patient outcomes and overall quality of care.

Letter to the Editor Regarding “Differences in Health Care Resource Utilization After Surgery for Metastatic Spinal Column Tumors in Patients with a Concurrent Affective Disorder in the United States”

The management of external ventricular drains (EVDs) is a critical aspect of patient care in the intensive care setting. However, nurses on the general floor are not commonly exposed to patients with EVD and therefore lack the necessary knowledge and skills to manage and troubleshoot EVDs effectively. The aim of this study was to evaluate the level of knowledge, comfort, and impact of EVD management among nurses on the floor after the implementation of a quality improvement (QI) tool.This is a cross-sectional study conducted among registered nurses working on the neurosurgical floors of the Montreal Neurological Hospital. Data were collected using a questionnaire based on the plan-do-study-act model. A survey assessing the level of knowledge and comfort with EVD management was conducted before and after the implementation of the QI tool.Seventy-six nurses completed the questionnaire regarding their knowledge and comfort level in EVD management. Results showed that only 42% of the nurses reported feeling “comfortable” whereas 37% reported feeling “uncomfortable” in caring for patients with an EVD. In addition, only 6.5% reported being “comfortable” in troubleshooting a malfunctioning EVD. However, the level of comfort significantly improved after using the QI project.The results of this study highlight the need for continued training and education to support the care of patients with EVDs in the ward setting. The implementation of a QI tool can significantly improve nurses' knowledge and comfort level in EVD management, leading to improved patient outcomes and overall quality of care.

SARS-CoV-2-Related Adaptation Mechanisms of Rehabilitation Clinics Affecting Patient-Centered Care: Qualitative Study of Online Patient Reports.

The SARS-CoV-2 pandemic impacted access to inpatient rehabilitation services. At the current state of research, it is unclear to what extent the adaptation of rehabilitation services to infection-protective standards affected patient-centered care in Germany. The aim of this study was to determine the most relevant aspects of patient-centered care for patients in inpatient rehabilitation clinics under early phase pandemic conditions. A deductive-inductive framework analysis of online patient reports posted on a leading German hospital rating website, Klinikbewertungen (Clinic Reviews), was performed. This website is a third-party, patient-centered commercial platform that operates independently of governmental entities. Following a theoretical sampling approach, online reports of rehabilitation stays in two federal states of Germany (Brandenburg and Saarland) uploaded between March 2020 and September 2021 were included. Independent of medical specialty groups, all reports were included. Keywords addressing framework domains were analyzed descriptively. In total, 649 online reports reflecting inpatient rehabilitation services of 31 clinics (Brandenburg, n=23; Saarland, n=8) were analyzed. Keywords addressing the care environment were most frequently reported (59.9%), followed by staff prerequisites (33.0%), patient-centered processes (4.5%), and expected outcomes (2.6%). Qualitative in-depth analysis revealed SARS-CoV-2-related reports to be associated with domains of patient-centered processes and staff prerequisites. Discontinuous communication of infection protection standards was perceived to threaten patient autonomy. This was amplified by a tangible gratification crisis of medical staff. Established and emotional supportive relationships to clinicians and peer groups offered the potential to mitigate the adverse effects of infection protection standards. Patients predominantly reported feedback associated with the care environment. SARS-CoV-2-related reports were strongly affected by increased staff workloads as well as patient-centered processes addressing discontinuous communication and organizationally demanding implementation of infection protection standards, which were perceived to threaten patient autonomy. Peer relationships formed during inpatient rehabilitation had the potential to mitigate these mechanisms.

Can ChatGPT improve communication in hospitals?

Hospitals’ use of communication is a crucial aspect of patient care, yet medical material is often hard to read and understand for patients. Issues related to lack of standardization, use of jargon, reliance on outdated technology, poor coordination between health personnel, and shortage of healthcare workers lead to miscommunication, delays, and errors in patient care. By improving communication, hospitals can improve patient care and outcomes, and perhaps lower costs. This opinion piece compares current communication methods with the use of ChatGPT technology to explore whether ChatGPT can improve the efficiency and accuracy of communication in healthcare settings and, hence, improve patient care. While natural language processing (NLP) tools such as ChatGPT and other artificial-intelligence-generated content (AIGC) have tremendous potential to be very useful in healthcare, they should not be solely used as a substitute for humans and should therefore be used with caution.

Self-powered, light-controlled, bioresorbable platforms for programmed drug delivery

Degradable polymer matrices and porous scaffolds provide powerful mechanisms for passive, sustained release of drugs relevant to the treatment of a broad range of diseases and conditions. Growing interest is in active control of pharmacokinetics tailored to the needs of the patient via programmable engineering platforms that include power sources, delivery mechanisms, communication hardware, and associated electronics, most typically in forms that require surgical extraction after a period of use. Here we report a light-controlled, self-powered technology that bypasses key disadvantages of these systems, in an overall design that is bioresorbable. Programmability relies on the use of an external light source to illuminate an implanted, wavelength-sensitive phototransistor to trigger a short circuit in an electrochemical cell structure that includes a metal gate valve as its anode. Consequent electrochemical corrosion eliminates the gate, thereby opening an underlying reservoir to release a dose of drugs by passive diffusion into surrounding tissue. A wavelength-division multiplexing strategy allows release to be programmed from any one or any arbitrary combination of a collection of reservoirs built into an integrated device. Studies of various bioresorbable electrode materials define the key considerations and guide optimized choices in designs. In vivo demonstrations of programmed release of lidocaine adjacent the sciatic nerves in rat models illustrate the functionality in the context of pain management, an essential aspect of patient care that could benefit from the results presented here.

Invited commentary: Comparison of visual discomfort experienced by surgeons in wireless versus conventional endoscopy in laparoscopic surgery.

In this study titled “A comparison of visual discomfort experienced by surgeons in wireless versus conventional endoscopy in laparoscopic surgery,” Xu et al. present a novel fifth-generation transmission wireless endoscopic system. They evaluated the visual discomfort in a small cohort of single-institution surgeons (n = 20) and compared its degree between conventional and wireless endoscopic laparoscopic surgeries (laparoscopic radical prostatectomy and laparoscopic radical cystectomy). Subjective questionnaires and objective physiological indicators were used to assess this outcome. They found no difference in visual discomfort between these technologies. For decades, the development of new medical and surgical devices has enabled the rise of state-of-the-art minimally invasive surgeries and enhanced the treatment efficiency of diseases. New technologies have affected every aspect of patient care. The introduction of laparoscopic, robotic, and endoscopic surgery in the urological field has allowed surgeons to push treatment boundaries and perform more challenging procedures in a less invasive manner. However, the “minimally invasive” laparoscopic approach is associated with greater perceived discomfort and musculoskeletal pain. [1] Notwithstanding the surgeons' burden associated with the laparoscopic surgery approach, [2] the technique is currently preferred over the open surgery technique for most cases, as it is associated with less pain, less bleeding, and shorter recovery time for patients. [3] In recent years, surgeons' ergonomic awareness has increased. Factors such as exposure and visualization, surgical instrumentation, and posture are key to avoiding musculoskeletal pain and long-term injury. [4] Thus, ergonomic integration and an appropriate operating room environment are paramount to ensure surgical efficiency, safety, and surgeon comfort. [5] The wireless innovative surgical device presented in the study may be comparable to the wired instrument in terms of visual discomfort; however, it may provide other essential benefits such as reduced physical exertion during surgery. Removing the camera wire from the surgical field confers a clear advantage in creating a clean and tidy terrain. The use of wireless devices in the operating room may aid in creating a better environment and improve surgeon ergonomics, ultimately translating into better procedures and outcomes. However, conclusions must be drawn with caution when introducing innovative technologies into the surgical setting. It is not possible to accept a technology of less-than-current standard. The benefits of the proposed instrument must outweigh its limitations to be validated and to eventually expand and change practice. This study did not measure crucial variables such as procedure duration, intraoperative complications, and surgical outcomes. The instrument's weight, battery autonomy, and grasp ergonomy are other important aspects that should be considered. Furthermore, the cost of the wireless device should meet the intersection between the need for improvement and availability of resources in the healthcare system. Today, the dramatic acceleration in the development of surgical instrument technology creates a unique need to rapidly adapt to the latest devices to stay at the forefront and continue moving forward in the field. However, such technologies require validation, and studies must collaborate to build the body of evidence necessary to shift from current practices toward new approaches.

Paramedic To Provider Consultation Challenges in the Emergency Department in Kazakhstan: An Online Survey.

Consultation is an important and necessary aspect of patient care in the emergency department. We prospectively examined difficulties during the consultation process between paramedics and providers in emergency departments in Kazakhstan. The paramedics were interviewed using various platforms and face-to-face meetings. Questionnaires were administered to paramedics to gather feedback on the current consultation process. In our survey, 202 paramedics of ambulance from the cities of Semey, Pavlodar, and Ust-Kamenogorsk, located in the North and East of Kazakhstan took part. Serious barriers to effective consultation were identified during consultations with cardiologists, pediatricians, and traumatologists. Weekends, as well as nighttime, are associated with more consultation difficulties. The most common problems for paramedics are non-attendance of the consultant, refusal of hospitalization by the consultant, and referral to other specialists and departments.More than 40% of the respondents noted the desire to share responsibility for the patient with medical consultants, which indicates uncertainty in their own knowledge due to the limited work experience of the majority of respondents. Barriers that arise during the consultation process of patients with emergency conditions can lead to unfavorable outcomes. Strategies to address these barriers are needed to improve the quality of patient care. This review aims to understand and evaluate the issues that arise during the consultation process.

Impact of COVID-19 pandemic on the diagnosis of patients with skin cancer: a systematic review protocol

IntroductionThe COVID-19 pandemic has changed aspects of patient care in the many scheduled medical activities, restricted access to healthcare facilities, and affected the diagnosis and organisation of patients with other...

Quality performance indicator compliance for the treatment of gastric adenocarcinoma.

Quality performance indicators (QPI) are objective measurements of aspects of patient care that affect clinical outcome. This study investigates the compliance rate to published QPIs of gastric adenocarcinoma (GA) management, in a single institution, to determine areas of strong performance and those requiring improvement. All patients with GA treated from 2010 to 2015, and 2020 to 2021 were included. Electronic data in the form of clinic letters, operation notes, and histology and radiology reports were reviewed with ethics approval. QPI adherence was collected in binary form. QPIs with high compliance rate include preoperative radiological staging and histological diagnosis, subspecialty surgeon training and pathology report documentation. QPIs with low compliance include perioperative chemotherapy (31.6%), postoperative radiological surveillance (32.5%) and minimally invasive approaches to surgical resection (12.5%). QPIs from the systematic review are variably implemented in clinical practice, thus informing on their relevance to real world clinical practice whilst also identifying the areas requiring focus for improvement.

Clinical utility of exome sequencing in a pediatric epilepsy cohort.

Exome sequencing (ES) has played an important role in the identification of causative variants for individuals with epilepsy and has proven to be a valuable diagnostic tool. Less is known about its clinical utility once a diagnosis is received. This study systematically reviewed the impact of ES results on clinical decision-making and patient care in a pediatric epilepsy cohort at a tertiary care medical center. Pediatric patients with unexplained epilepsy were referred by their neurologist, and informed consent was obtained through an institutional review board-approved research ES protocol. For patients who received a genetic diagnosis, a retrospective chart review was completed of the probands and their relatives' medical records prior to and after genetic diagnosis. The following outcomes were explored: provider management recommendations, changes in care actually implemented, and anticipatory guidance provided regarding the proband's condition. Fifty-three probands met the inclusion criteria. Genetic diagnosis led to at least one provider recommendation in 41.5% families (22/53). Recommendations were observed in the following categories: medication, screening for non-neurological comorbidities/referrals to specialists, referrals to clinical research/trials, and cascade testing. Anticipatory guidance including information about molecular diagnosis, prognosis, and relevant foundations/advocacy groups was also observed. Results demonstrate the clinical utility of ES for individuals with epilepsy across multiple aspects of patient care, including anti-seizure medication (ASM) selection; screening for non-neurological comorbidities and referrals to appropriate medical specialists; referral to reproductive genetic counseling; and access to research, information, and support resources. To our knowledge, this is the first study to evaluate the clinical utility of ES for a pediatric epilepsy cohort with broad epilepsy phenotypes. This work supports the implementation of ES as part of clinical care in this population.

Inspiring, Recruiting, and Retaining the Health-Care Workforce: What Will it Take?

The U.S. health-care system, the costliest in the world, is facing an exodus of nurses and other healthcare workers. The growth of corporate medicine has contributed to clinician stress and burnout, and has created conditions that have eroded autonomy. Reform is needed that creates cultures in which healthcare providers have agency to make decisions that impact their practice and all aspects of patient care. Massive change is needed to inspire, recruit, and retain the health-care workforce.

Navigating the New Reality: A Review of the Epidemiological, Clinical, and Microbiological Characteristics of Candida auris, with a Focus on Children.

During the past decade, Candida auris emerged across the world, causing nosocomial outbreaks in both pediatric and adult populations, particularly in intensive care settings. We reviewed the epidemiological trends and the clinical and microbiological characteristics of C. auris infection, focusing on the pediatric population. The review is based on 22 studies, which included about 250 pediatric patients with C. auris infection, across multiple countries; neonates and premature babies were the predominant pediatric patient group affected. The most common type of infection reported was bloodstream infection, which was associated with exceptionally high mortality rates. Antifungal treatment varied widely between the patients; this signifies a serious knowledge gap that should be addressed in future research. Advances in molecular diagnostic methods for rapid and accurate identification and for detection of resistance may prove especially valuable in future outbreak situations, as well as the development of investigational antifungals. However, the new reality of a highly resistant and difficult-to-treat pathogen calls for preparedness of all aspects of patient care. This spans from laboratory readiness, to raising awareness among epidemiologists and clinicians for global collaborative efforts to improve patient care and limit the spread of C. auris.

ESPEN guideline on Clinical Nutrition in inflammatory bowel disease

The present guideline is an update and extension of the ESPEN scientific guideline on Clinical Nutrition in Inflammatory Bowel Disease published first in 2017. The guideline has been rearranged according to the ESPEN practical guideline on Clinical Nutrition in Inflammatory Bowel Disease published in 2020. All recommendations have been checked and, if needed, revised based on new literature, before they underwent the ESPEN consensus procedure. Moreover, a new chapter on microbiota modulation as a new option in IBD treatment has been added. The number of recommendations has been increased to 71 recommendations in the guideline update. The guideline is aimed at professionals working in clinical practice, either in hospitals or in outpatient medicine, and treating patients with IBD. General aspects of care in patients with IBD, and specific aspects during active disease and in remission are addressed. All recommendations are equipped with evidence grades, consensus rates, short commentaries and links to cited literature.