Health Services Research Articles

Spatial analysis of malaria cases and Anopheles species in East Java region, Indonesia

Malaria remains a significant public health challenge worldwide, including in Indonesia, particularly in the East Java region. This study aimed to analyse the spatial distribution of malaria cases and Anopheles species that act as vectors in the area. Using an observational design with a cross-sectional approach, data on malaria cases were collected from tiers from the Community Health Centre, District Health Office and Province, all of which were documented on the Ministry of Health's malaria information system for the period 2021–2023. Malaria Vector Distribution Data from the East Java Health Office and the research team directly. Sampling of mosquitoes and larvae was carried out by researchers using a purposive sampling method, which prioritised locations with districts that have a high risk factor for the presence of breeding Anopheles sp., namely, Treggalek District, Malang District and Pacitan District with diverse topography, such as coastal (lagoon), rice fields and hills. The results of the analysis show that the distribution of imported malaria cases in East Java is uneven, with hotspots identified in several areas that have working population mobility from outside the East Java region. The presence of Anopheles species, particularly An. sundaicus and An. maculatus, contributes to their potential as vectors of malaria transmission, with An.sundaicus being more common in coastal areas and An. maculatus in valley and paddy fields. Environmental factors, such as topography of the region, temperature, humidity, and rainfall, influence the variation of Anopheles species. This study emphasises the importance of an ecosystem-based approach to malaria control, as well as the need to improve access to health services and community education. The findings provide important insights for the development of more effective and sustainable health policies in an effort to maintain malaria elimination areas in East Java.

"Caminando y socializando con Happy Older Latinos are Active (HOLA)": Results of a randomized clinical trial to promote health and prevent depression and anxiety in older Latinos.

This study sought to evaluate the feasibility, acceptability, and preliminary efficacy of the Happy Older Latinos are Active (HOLA) health promotion intervention in a group of older Latinos who were at risk for developing major depressive disorder or generalized anxiety disorder. Sixty older Latinos age 60+ with subthreshold depression or anxiety were randomized to receive either HOLA (n = 30) or enhanced psychoeducation through fotonovela control (n = 30). The primary outcomes of interest were feasibility, acceptability, and reduction in depression and anxiety symptom severity. Outcome measures were administered at baseline and at the end of the intervention. Within a year, the enrollment target was met with < 5% of eligible participants refusing randomization. The randomization scheme produced equal numbers of participants randomized to each condition. Four participants (6.7%; HOLA = 1; control = 3) were lost to follow-up, 69% of the HOLA sessions were attended, and participants reported high satisfaction with the intervention. Finally, compared with control, a significant proportion of participants in HOLA experienced a clinically significant reduction in their anxiety symptoms (60% vs. 26.7%). Findings highlight the feasibility, acceptability, and significant impact the HOLA intervention can have in reducing psychological distress because it is responsive, respectful, and specific to the needs of older Latinos. Furthermore, using a community health worker to deliver a health promotion intervention to prevent common mental disorders in older Latinos is an innovative approach for reducing disease burden in a population living with high disparities in accessing and engaging in mental health services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Economic impact of dapagliflozin in the management of chronic kidney disease in Italy: results from a micro-simulation model

Background: Dapagliflozin, approved in the treatment of patients with chronic kidney disease (CKD), has demonstrated attenuation of CKD progression and a reduced risk of cardio-renal outcomes and all-cause mortality (ACM) versus placebo, in addition to standard of care (SoC). The aim of this economic evaluation was to assess the potential medical care cost offsets associated with reduced rates of cardio-renal outcomes in Italy. Methods: A comparative micro-simulation model estimated the outcome-related costs of dapagliflozin plus SoC versus SoC alone over a 3-year horizon based on the DAPA-CKD trial. Incidence rates of end-stage kidney disease (ESKD), hospitalizations for heart failure (hHF), acute kidney injury (AKI) and ACM were estimated for a treated population of 90,564 patients. Associated direct medical costs for non-fatal events (ESKD, hHF and AKI) were calculated using available literature and national tariffs. The analysis was restricted to outcome-associated costs and did not consider the cost of drug treatments and disease management. Results: Patients treated with dapagliflozin plus SoC experienced fewer incident events of ESKD (6,540 vs 9,751), hHF (2,146 vs 4,242), AKI (3,772 vs. 5,271) and ACM (5,780 vs 8,037) per 90,564 treated patients versus those treated with SoC alone. Reductions (–35,6%) in clinical events (ESKD, hHF and AKI) were associated with a 34.4% reduction in total costs (€ 170 million) over 3 years. The clinical effect of dapagliflozin on ESKD management accounted for a € 134.5 million reduction in total costs. Conclusion: Based on the DAPA-CKD trial, dapagliflozin may prevent cardio-renal event incidence with a positive effect upon the Italian National Healthcare Service (NHS). Over three years, we estimated that dapagliflozin can reduce the Italian NHS expenditure associated with the management of ESKD, hHF and AKI events by 34.4% (€ 170 million).

Применение цифровых двойников в здравоохранении

One of the revolutionary steps stimulating the development of innovations in healthcare is the introduction of digital twins. The purpose of the study. The purpose of the presented literature review was to study various data sources on the technology of digital twins in healthcare and the possibility of their application with the introduction of the national standard of the Russian Federation “Digital twins in healthcare”. As a result of the study, a digital twin scheme was formed, digital twins were classified according to criteria. Materials and methods. The literature review was conducted in the Pubmed Web of Science and Elibrary databases in September 2024 using the following terms: “digital twin”, “digital healthcare”, “personalized medicine”. Results. The use of digital twins will improve the quality, accessibility and continuity of medical care, and will create opportunities for the development of personalized medicine. Conclusions. Effective development in the field of digital twins in healthcare is directly related to the issues of their standardization, their creation and use should be carried out in accordance with approved standards and not contradict the norms of ethics in medicine.

The nature, sequence and duration of professional activities of Emergency Medical Service providers: An observational study to evaluate quality of care using the steps in the EMS care process as described by the SPART model

Background The quality of care given by EMS staff is in part monitored by routine review of deployment reports that the providers must complete after each deployment. The assessment consists of determining whether a deployment was performed in a medically correct manner and thus whether the clinical reasoning process was appropriate. The time used during the deployment is also measured, as there are often time limits for performing different parts of the deployment and these must be adhered to. One might question whether measuring the time spent really gives insight into the quality of care, and if it might not be more useful to see how that time was spent. We therefore conceived a study to map the EMS care process and evaluate this process in relation to the time used. Methods We used a focused ethnographic study design. Video recordings of EMS deployments in combination with semi-structured interviews of the EMS providers involved, were thematically analysed. This led to insights into the EMS care process and the embedded clinical reasoning. By categorising the professional activities we identified we were able to define a model that describes in general the EMS care process. We reported the first part of this study in which we developed this so called SPART model in a separate paper. In this second part of the study we determined the execution time within a deployment and measured the frequency of occurrence and the duration of the identified activities. We interpreted the operational content and the time variables both qualitatively and quantitatively. We also determined the distribution of activities over the three deployment operational periods (response, on-scene and transport period). Results Using the SPART model, we gained insight into the different activities’ nature, order, and duration. We could qualitatively judge the effectiveness of the clinical reasoning process, i.e., the quality of care delivered. Generally, the studied cases were followable, and the clinical reasoning process was medically logical. The diagnostic process sometimes continued after the clinical decision, which was not medically logical. Remarkably, this never changed the clinical decision. Although this could negatively affect the quality of care, we found no clinical evidence that this was the case. Conclusion Our findings demonstrated that the quality of care in EMS can be measured by using the SPART model to evaluate EMS deployments. We concluded that qualitative judgment was more important than quantitative evaluation. Interpreting the order of different activities led to the clearest understanding of the clinical reasoning process. It was concluded that knowledge of the exact time used per activity and, in total, had the least impact on understanding the clinical reasoning process.

Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia.

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is a distressing condition characterized by persistent or recurrent, unwanted, or intrusive sensations of genital arousal that occur in the absence of subjective feelings of sexual desire that persist for at least 3 months. Despite its negative psychosocial impact, including high levels of suicidal ideation, it is not well known by most health care providers and can easily be misdiagnosed or remain undiagnosed. This paper describes a detailed biopsychosocial regional algorithm for the assessment and management of PGAD/GPD and draws attention to the need for multidisciplinary approaches to its effective management.

Predictors of time to unplanned implanon discontinuation in the first year of application at public hospitals in North Shoa, Central Ethiopia: using acceleration failure time model

IntroductionContraceptive discontinuation has become a widespread issue on a global basis. Implants, of which Implanon is the most popular, are only the second most widely used form of modern contraceptive in Ethiopia. However, Implanon was discontinued at a rate as high as 23.4% in Ethiopia within the first year of use. Therefore, the purpose of this study was to identify the incidence rate and predictors of unplanned discontinuation of Implanon in the first year of application at public hospitals in the North Shoa zone, Central Ethiopia.MethodsA retrospective follow-up study was conducted at public hospitals in the North Shoa zone among women who use Implanon. A total of 429 women who wanted their Implanon removed after insertion were selected as study participants during the data collection period. Data were gathered from the family planning initiation and removal registration books as well as by contacting users directly. A log-rank test was used to assess the significance of observed differences between categorical variable strata. The acceleration failure time model with log-normal distribution was used to fit the survival data.ResultsThe unplanned discontinuation rate Implanon in the first year of insertion was 19.1% with an estimated mean survival time of 10.9 months (95% CI: 10.65, 11.14). Women with an interval period of insertion (AAF = 1.53; 95% CI: 1.06, 2.21), women who chose implanon by themselves (AFF = 1.32; 95% CI: 1.02, 1.71), women who were satisfied with the service (AFF = 1.40; 95% CI: 1.06, 1.83), and women who were given instructions on what to do if they experienced side effects (AFF = 1.85; 95% CI: 1.40, 2.44), had a lower likelihood of discontinuing their implanon in the first year of insertion.ConclusionThe risk of unplanned Implanon discontinuation was found to be high in the study area. Health care providers should pay close attention to clients' needs when delivering family planning services, and the client should ultimately decide whether to use the service. Family planning departments must also engage in early-side effects treatment and reassure clients to lessen discontinuation.

Characteristics of relatives with high expressed emotion and related factors: a study of relatives of people with dementia in China

BackgroundChina has the highest number of people with dementia globally, and the responsibility of caring for people with dementia primarily falls on relatives, who bear heavy caregiving burdens and pressure. Providing care for an individual with dementia is emotionally and physically demanding, particularly due to the frequent manifestation of behavioral and psychological symptoms associated with dementia (BPSD). This underscores the crucial need to comprehend and address caregivers’ emotional expression (EE).AimTo explore the characteristics of relatives with high expressed emotion of people with dementia and related factors in mainland China.MethodsA survey using cross-sectional questionnaires conducted with 165 relatives of individuals with dementia in China.ResultsA significant number of relatives had high EE (n = 61, 39%). The variation in EE, about 37.8%, is explained by seven independent variables. The proportion of psychological distress among relatives in EE variation is 14.5%. (b = 0.387, p < 0.001). Length of care-taking, active coping, and chronic diseases accounted for 6.5% (b = 0.264, p < 0.001), 5.1% (b=-0.239, p = 0.001) and 4.1% (b = 0.211, p = 0.002) of the variance in EE, respectively.ConclusionsChinese health care providers can identify high-risk groups for assistance based on the severity of dementia, age, health status and duration of care. Enhancing coping styles and alleviating emotional distress among relatives could be advantageous in decreasing EE.Clinical evidenceUnderstanding the risk factors for high EE in different cultures can help guide practice on a global scale to improve the quality of life of people with dementia.

Frustrations in Providing Orthopaedic Trauma Care: An OTA Member Survey Study.

To determine sources of frustration for surgeons and how they might affect job satisfaction within the orthopaedic trauma community. A 25-question survey regarding potential common causes of frustration, operating room (OR) utilization, and career satisfaction was electronically distributed to the Orthopaedic Trauma Association (OTA) membership. Four hundred seventy-one surgeons participated in the survey (response rate 27.5%). The highest ranked source of frustration was OR turnover time, followed by staff turnover, and OR scheduling. Most reported they were very satisfied with their career (n=240, 51.0%). The top three strategies to increase career satisfaction from most to least effective were increased compensation, case delay reduction, and decreased work hours. The majority of surgeons reported that if their number one frustration was solved, they would feel a higher level of career satisfaction (very satisfied: n=344, 73.1%). Most felt their cases did not start on time (n=273, 58.0%), with the majority of respondents reporting that their cases were delayed on average between 15-60 minutes (n=222, 81.9%). The number one ranked reason for case start delays was OR turnover and case setup, followed by the anesthesia team. Many surgeons within the orthopaedic trauma community reported concern with OR turnover time and staff turnover. Addressing these sources of frustration is crucial to maintaining surgeon well-being and can aid in optimizing delivery of patient care. Future studies should seek out institutions that have successfully addressed these common frustrations and identify potential strategies in order to improve the delivery of orthopaedic trauma care across North America. Level V.

The cornerstones of randomized clinical trials.

Randomized clinical trials (RCTs) are pivotal in medical research, offering critical evidence on the efficacy and safety of treatments. This paper explores the distinct purposes and designs of superiority, non-inferiority, equivalence, and pragmatic trials, each addressing unique research questions. Superiority trials aim to demonstrate a new treatment's effectiveness over existing standards, while non-inferiority and equivalence trials focus on ensuring new treatments are not significantly worse or are similar to existing ones, respectively. Pragmatic trials assess interventions in real-world settings. A fundamental ethical principle in RCTs is clinical equipoise, ensuring unbiased treatment allocation. The CONSORT statement provides guidelines for transparent reporting of RCTs, enhancing the reliability of findings. Key methodological considerations include sample size calculation, randomization, blinding, and the choice between intention-to-treat and per-protocol analyses. Stratified analysis and forest plots further aid in understanding treatment effects across diverse populations. By adhering to these principles, RCTs remain a cornerstone of evidence-based medical practice, advancing patient care and outcomes.

Risk Factors for Emergency Room Visit by Head and Neck Cancer Patients: A Longitudinal Cohort Study in the Korean Healthcare System.

Due to the application of multiple treatment modalities, a substantial proportion of patients with head and neck cancer (HNC) experience one or more emergency room (ER) visits or unplanned hospitalizations during or after treatment. We investigated HNC cases that visited ERs after cancer treatment to identify potential risk factors in the context of the Korean healthcare system. This was a single-center cohort study of HNC patients who underwent cancer treatments at OOOO in 2019 (N = 566). The patients were treated with surgery alone (N = 184), surgery plus adjuvant therapy (N = 138), curative non-surgical treatment (radiation or chemo-radiation) (N = 209), or palliative treatments (N = 35). We followed up cases for up to 3 years, who visited the ER after (or during) cancer treatments and analyzed the main reasons and risk factors for ER visits. The rate of ER visits was 8.0% (N = 45) of patients with HNC (no. of ER visits, N = 70, 12.4%, mean = 1.56, range = 1-4), among which treatment-related ER visits made up 4.6%. Common reasons for ER visits were surgical site or wound problems (31.1% per patient, 22.9% per ER visits), and oral intake or feeding problems (22.2% per patient, 31.4% per ER visit). Tumor subsite (17.9% of treatment-related ER visits in hypopharynx cancer), tumor burden (8.6-12.2% in T2-4 and 6.7% in N+ status), and treatment modalities (surgery with adjuvant chemo-radiation, 19.4%) were identified as significant risk factors for ER visits, while patient age and comorbidities were not. The most common causes for ER visits were wound and feeding problems in HNC patients, and tumor factors and treatment modalities were independent risk factors for ER visits. Adequate planning and management to address these problems could help reduce ER visits and costs and improve patient care.

B-UMCS: Blockchain-enabled Unified Medical Consultancy Service.

The advent of blockchain technology within the healthcare domain has signified a paradigm shift, transitioning from an emerging trend to an essential infrastructure component that ensures decentralization, transparency, integrity, and persistent availability. Despite its potential, the healthcare sector has not fully capitalized on the vast array of benefits blockchain technology offers. Most existing works utilized blockchain technology within a specific healthcare entity's services but not among several healthcare organizations. They notably lack the provision for direct communication and knowledge transfer between doctors from different hospitals. Therefore, this paper introduces a pioneering Blockchain-based Unified Medical Consultancy Service (B-UMCS) that leverages blockchain's robustness to revolutionize telehealth services by (a) alleviating the shortage of medical expertise through facilitating the interconnection of physicians from diverse hospitals and geographical areas onto a consolidated platform, (b) promoting the seamless sharing of medical consultations, electronic health records (EHRs), and expert insights while upholding rigorous security and privacy protocols, (c) integrating the inherent security mechanisms of blockchain with the distributed data storage functionality offered by the Interplanetary File System (IPFS). This work details the B-UMCS's components, interactions, smart contracts, protocols, algorithms, storage and transmission of EHRs, and their corresponding implementations. The evaluations of the proposed B-UMCS reveal that it secures and facilitates the sharing of EHRs and enables healthcare professionals to collaborate and exchange expertise seamlessly across institutional boundaries. They are additionally ensuring that healthcare providers can offer their knowledge in an efficient and scalable manner. Overall, B-UMCS not only addresses the current challenges in healthcare data security and accessibility but also opens new avenues for collaboration and knowledge sharing among healthcare professionals, ultimately contributing to improving patient care quality.

Multi-modal large language models in radiology: principles, applications, and potential.

Large language models (LLMs) and multi-modal large language models (MLLMs) represent the cutting-edge in artificial intelligence. This review provides a comprehensive overview of their capabilities and potential impact on radiology. Unlike most existing literature reviews focusing solely on LLMs, this work examines both LLMs and MLLMs, highlighting their potential to support radiology workflows such as report generation, image interpretation, EHR summarization, differential diagnosis generation, and patient education. By streamlining these tasks, LLMs and MLLMs could reduce radiologist workload, improve diagnostic accuracy, support interdisciplinary collaboration, and ultimately enhance patient care. We also discuss key limitations, such as the limited capacity of current MLLMs to interpret 3D medical images and to integrate information from both image and text data, as well as the lack of effective evaluation methods. Ongoing efforts to address these challenges are introduced.

Principles of Stereotactic Surgery.

Stereotactic procedures are used to manage a diverse set of patients across a variety of clinical contexts. The stereotactic devices and software used in these procedures vary between surgeons, but the fundamental principles that constitute safe and accurate execution do not. The aim of this work is to describe these principles to equip readers with a generalizable knowledge base to execute and understand stereotactic procedures. A combination of a review of the literature and empirical experience from several experienced surgeons led to the creation of this work. Thus, this work is descriptive and qualitative by nature, and the literature is used to support instead of generate the ideas of this framework. The principles detailed in this work are categorized based on 5 clinical domains: imaging, registration, mechanical accuracy, target planning and adjustment, and trajectory planning and adjustment. Illustrations and tables are used throughout to convey the concepts in an efficient manner. Stereotactic procedures are complex, requiring a thorough understanding of each step of the workflow. The concepts described in this work enable functional neurosurgeons with the fundamental knowledge necessary to provide optimal patient care.

Instituto y no hospital. La distintiva organización que Ignacio Chávez concibió para combatir integralmente a las enfermedades del corazón en México. En el octogésimo aniversario del Instituto Nacional de Cardiología.

In 1936, Ignacio Chávez submitted a proposal to the Mexican government for the creation of a cardiology institute. He had studied in Paris, Berlin, and other European cities in 1926. Upon his return to Mexico, he founded the Cardiology Service at the General Hospital in Mexico City, the first of its kind in the country. The National Institute of Cardiology of Mexico was inaugurated on April 18, 1944, becoming one of the first cardiology institutes in the world. Chávez explained the purpose of this new institute: "We were born with the purpose of studying, researching, and controlling heart diseases." According to him, the institute should be a place where cardiovascular diseases could be addressed comprehensively, combining clinical practice with research and teaching to provide effective knowledge for patient care and scientific advancement. "A health center is for the patient, of course; but something more than that is necessary: a great school for doctors, a great laboratory for researchers, and a social instrument of human help," he said. This vision was summarized in the words: love and science at the service of the heart. Chávez successfully institutionalized cardiology in Mexico. From its inception, the institute became an internationally recognized center, attracting students from various countries. Alfredo de Micheli noted that under Chávez's influence and example, new institutions emerged in the national medical field and expanded onto the international stage. The institute founded by Chávez became a model for similar institutions on other continents and a driving force in the international cardiology movement. Chávez's legacy was a work of love, intelligence, and culture, dedicated to the heart and the care of humanity.

Challenges following CRS and HIPEC surgery in cancer patients with peritoneal metastasis: a comprehensive review of clinical outcomes

Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are a pair of relatively modern therapeutic surgical methods in advanced cancerous patients with peritoneal metastasis (PM). The goal of CRS + HIPEC is treatment or to improve survival outcomes, which are linked to high morbidity side effects and complications, even with their possible advantages. Surgical-related, chemotherapy-related, anesthetic-related, gastrointestinal, organs and systemic complications are the categories into which complications are separated according to frequency, risk factors, and effect on patient outcomes. In this narrative review of the literature, the side effects and complications of HIPEC + CRS in cancer patients with PM are examined. The present knowledge on the incidence, frequency, kinds, and risk factors of acute complications following CRS + HIPEC is summarized in this study. This review emphasizes the need for careful patient selection criteria, precise surgical technique, and thorough intraoperative care to reduce or manage these risks. Moreover, it highlights the need for interdisciplinary collaboration in treating these patients. This study aims to know these complications, improve clinical practice, and guide future studies to increase the safety and efficacy of CRS + HIPEC in treating metastatic colorectal cancer.

How primary and tertiary care services collaborate in urgent care delivery: an evaluation of general practice advice lines

BackgroundTo address the rising demand for urgent care and decrease hospital use, health systems are implementing different strategies to support urgent care patients (i.e. patients who would have typically been treated in hospital) in the community, such as general practitioner (GP) advice lines. The aims of this study were to: identify the support and resources GPs need to manage urgent care patients in the community; assess the need for GP advice lines by primary care services in Australia; and identify the facilitators and barriers to adoption, and strategies to support the sustainability of GP advice lines.MethodsQualitative study involving semi-structured interviews with GPs, hospital-based healthcare providers, consumers, and healthcare management, recruited via existing investigator networks and snowballing approach. The interviews were conducted between February and August 2023. Major themes were identified by an iterative and inductive thematic analysis.ResultsWe interviewed 16 participants (median age 50, IQR 38–59). Based on the aims of the study, three themes emerged: support and resources for GPs; motivation for GP advice lines; and factors influencing the uptake and sustainability of GP advice lines. Participants reported that better communication from hospital services with GPs is critical to ensure continuity of care between tertiary and primary settings. They also noted that GP advice lines can help increase capacity to manage urgent care patients in the community by providing timely decision-support to GPs. However, a reported barrier to the uptake and ongoing use of GP advice lines was the limited hours of the service. To sustain GP advice lines, participants highlighted a need to broaden the scope of the service beyond the pandemic, conduct rigorous evaluation on health outcomes, and further digitise the service so that a tiered level of support could be provided based on risk stratification.ConclusionsThe benefits of GP advice lines are yet to be fully realised. With increasing technology sophistication, there remain opportunities to further digitise and optimise GP advice lines, whilst ensuring better integration within and across primary and tertiary care services. This is however dependent on continued financial and policy support from the government.

Complications following bilateral simultaneous versus staged total knee arthroplasty in the Japanese population: a propensity-matched case-control study

Although bilateral simultaneous total knee arthroplasty (BSTKA) is an effective treatment for bilateral knee osteoarthritis, safety concerns and lack of precise patient selection criteria persist. This study aimed to determine the differences in perioperative parameters and complication rates between BSTKA and staged TKA in the Japanese population. We retrospectively reviewed 531 patients who underwent BSTKA or staged TKA between 2012 and 2021. Propensity score matching, performed on a 1:1 nearest neighbor basis for age, BMI, diagnosis, ASA score, and age-adjusted Charlson Comorbidity Index, yielded matched cohorts of 94 patients (188 knees) for each group. Outcome measures included operative time, perioperative blood loss, length of hospital stay, and nonmechanical complications after surgery. The BSTKA group had a shorter median operative time and hospital stay (111 min and 16 days) than the staged TKA group (159 min and 33 days) (p < 0.001). Overall complication rates were higher in the BSTKA group than in the staged TKA group (26% vs. 13%, p = 0.026), with anemia requiring transfusion being the most common. Cardiovascular complications were more frequent in the BSTKA group (4.3% vs. 0%, p = 0.043). These findings emphasize the importance of careful patient selection and risk assessment when considering BSTKA.

Student radiographers’ confidence of adapting practice for autistic patients: A qualitative survey on the role of placement experiences

IntroductionHealthcare services can be inaccessible to autistic people without adaptions to clinical practice and the care provided. Therefore, understanding how radiographer education develops students' confidence in adapting care for autistic patients is crucial. This study aimed to explore how placement experience impacts student radiographer confidence in adapting care for autistic patients. MethodsUK final-year student diagnostic and therapeutic radiographers were invited to complete a qualitative online survey. The survey asked for a description of placement experiences; of observing and/or performing the care of autistic patients and how this impacted confidence in caring for autistic patients. The data was thematically analysed. Results43 responses (of 44 received) were included, from which 5 themes emerged. Those who felt placement experiences developed confidence described opportunities to apply theory learnt at university (theme 1) or drew attention to the benefit of prior (external) experience with autistic people (theme 3). However, the balance of power with the supervising radiographer (theme 2), witnessing autistic patients in distress (theme 4), and the heterogeneous nature of autism (theme 5) disrupted students’ development of confidence. ConclusionSeveral participants in this study found clinical placement developed confidence with autistic patients through applying knowledge and providing an opportunity for reflexive learning. However, various obstacles hindered this development, such as witnessing distressed patients, limited experiences with autistic patients and difficulty navigating relationships with radiographers. Implications for practiceTo improve student radiographers’ confidence of providing care for autistic patients, educators should consider methods, e.g., co-produced simulation, to fill potential gaps in their experience. There is also a pressing need for all radiographers to understand their responsibility in educating students and their impact on student wellbeing.

Analysis of Concentrations of Monomethyl Fumarate in Patients with Multiple Sclerosis: Result from Routine Health Care

Dimethyl fumarate is used to treat patients with relapsing-remitting multiple sclerosis. After ingestion, it is rapidly hydrolyzed to the active primary metabolite monomethyl fumarate. The main objective of our study was to analyze serum concentrations of monomethyl fumarate during routine health care in patients with multiple sclerosis treated with a fixed dose of dimethyl fumarate. In the pilot cross-sectional study, data from 42 patients treated with dimethyl fumarate at a dose of 240 mg twice daily were collected. Concentrations of the active metabolite monomethyl fumarate were determined at 1-8 h (median, 3 h) or 10-14 h (median, 13 h) after taking the dose. The relationship between monomethyl fumarate concentrations and absolute lymphocyte count was evaluated. Concentrations of monomethyl fumarate ranged from 2.5-3177.9 μg/L, with most concentrations being undetectable approximately 10 hours after administration. In the 1-8 h (median, 3 h) post-dose subgroup, the concentration/dose ratio ranged widely from 0.04-6.62. The median concentration of monomethyl fumarate in the group with the absolute lymphocyte count <0.8 x 10^9/l was more than four times higher than in the group with the absolute lymphocyte count ≥0.8 x 10^9/l (median 440.1 μg/L versus 98.4 μg/L). The wide interindividual variability in monomethyl fumarate pharmacokinetics could contribute to the differential response to dimethyl fumarate in multiple sclerosis patients. A nonsignificant but noticeable trend was observed in the relationship of higher serum monomethyl fumarate concentrations to absolute lymphocyte counts.