Managed Care Research Articles

Evaluating the efficacy of tap water and commercial soap for outpatient wound management in simplified wound care

Managing wounds outside of hospital settings can be challenging due to limited knowledge, resources, and financial constraints. This study evaluates the safety and efficacy of using tap water and a commercial soap-based cleanser for wound care in outpatient settings. This prospective study enrolled 15 patients with open or surgical wounds. Participants used a commercial soap containing surfactants (decyl glucoside, sodium C14- 16 olefin sulfate) and tap water to cleanse their wounds. Exclusion criteria included severe systemic illnesses, uncontrolled diabetes, and immunosuppression. We monitored wound healing, infection rates, and complications over a 2-week period. The study examined wounds of various origins: surgical (n=9), traumatic (n=4), and infection-related (n=2). All wounds healed completely within 2 weeks, with no instances of infection, dehiscence, or delayed healing observed. These findings indicate that a straightforward soap-and-water cleansing regimen is both safe and effective for wound management. This study demonstrates that using tap water and commercial soap is a cost-effective and reliable strategy for wound management outside hospital settings. This approach has the potential to simplify wound care practices and reduce barriers to treatment, particularly in resource-limited environments.

The role of digital health in modern pharmacy: A review of emerging trends and patient impacts

The integration of digital health into modern pharmacy practices has revolutionized patient care and medication management, ushering in a new era of convenience, accessibility, and personalized healthcare services. This review provides an insightful review of the evolving role of digital health in pharmacy, focusing on emerging trends and their impacts on patients. Digital health technologies, such as telepharmacy services, mobile health applications, and virtual consultations, have transformed the traditional pharmacy model by bridging geographical barriers and expanding access to healthcare services. Pharmacists can now engage with patients remotely, providing medication counselling, monitoring, and adherence support through digital platforms. These innovations enhance patient convenience, empower individuals to take control of their health, and ultimately improve health outcomes. Furthermore, digital health solutions leverage advanced technologies like artificial intelligence (AI) and data analytics to optimize medication therapy and personalize patient care. AI-driven algorithms analyze patient data to identify trends, predict health outcomes, and optimize medication regimens, leading to more effective treatment plans and reduced medication errors. Moreover, digital health fosters greater collaboration and communication among healthcare providers, enabling seamless coordination of care and improved patient outcomes. Through secure electronic health records and interoperable systems, pharmacists can access comprehensive patient information, facilitating informed decision-making and enhanced patient safety. However, the adoption of digital health in pharmacy also presents challenges, including data privacy concerns, regulatory complexities, and disparities in digital literacy among patients. Addressing these challenges is crucial to ensure the ethical and effective implementation of digital health technologies in pharmacy practice. In conclusion, the integration of digital health into modern pharmacy represents a paradigm shift in patient care delivery, offering unprecedented opportunities to enhance accessibility, efficiency, and quality of care. By embracing emerging digital health trends, pharmacists can revolutionize medication management, improve patient engagement, and ultimately contribute to better health outcomes for individuals and communities.

Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers: The IN-PEACE Randomized Clinical Trial.

Care management benefits community-dwelling patients with dementia, but studies include few patients with moderate to severe dementia or from racial and ethnic minority populations, lack palliative care, and seldom reduce health care utilization. To determine whether integrated dementia palliative care reduces dementia symptoms, caregiver depression and distress, and emergency department (ED) visits and hospitalizations compared with usual care in moderate to severe dementia. A randomized clinical trial of community-dwelling patients with moderate to severe dementia and their caregivers enrolled from March 2019 to December 2020 from 2 sites in central Indiana (2-year follow-up completed on January 7, 2023). Electronic health record screening identified patients with dementia; caregivers confirmed eligibility, including dementia stage. The intervention consisted of monthly calls from a trained nurse or social worker and evidence-based protocols to help caregivers manage patients' neuropsychiatric symptoms, caregiver distress, and palliative care issues (eg, advance care planning, symptoms, and hospice) (n = 99). Usual care caregivers received written dementia resource information and patients received care from usual clinicians (n = 102). The primary outcome was Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score (scores range from 0-36, with higher scores indicating worse patient symptoms). Secondary outcomes included Symptom Management in End-of-Life Dementia scores, caregiver depression (Patient Health Questionnaire-8) scores, caregiver distress (NPI-Q distress) scores, and combined ED and hospitalization events. Outcomes were assessed quarterly for 24 months or until patient death. A total of 201 dyads were enrolled (patients were 67.7% female; 43.3% African American; mean [SD] age, 83.6 [7.9] years); 3 dyads withdrew and 83 patients died over the course of the study, with at least 90% of eligible dyads in both groups completing each of the quarterly assessments. For the dementia palliative care vs usual care groups, mean NPI-Q severity scores were 9.92 vs 9.41 at baseline and 9.15 vs 9.39 at 24 months, respectively (between-group difference at 24 months, -0.24 [95% CI, -2.33 to 1.84]). There was no significant difference in the rate of change in NPI-Q severity from baseline between groups over time (P = .87 for the group and time interaction). There were no significant differences in the secondary outcomes, except that there were fewer combined ED and hospitalization events in the dementia palliative care group (mean events/patient, 1.06 in dementia palliative care vs 2.37 in usual care; between-group difference, -1.31 [95% CI, -1.93 to -0.69]; relative risk, 0.45 [95% CI, 0.31 to 0.65]). Among community-dwelling patients with moderate to severe dementia and their caregivers, dementia palliative care, compared with usual care, did not significantly improve patients' neuropsychiatric symptoms through 24 months. ClinicalTrials.gov Identifier: NCT03773757.

Lived experiences of patients with advanced pancreatic cancer on patient-reported outcomes (PROs) management: a qualitative phenomenological study in Southwest China

ObjectivesTo explore the lived experiences of patients with advanced pancreatic cancer enrolled in a patient-reported outcomes (PROs) management programme and to preliminarily understand how PROs management influences various aspects of...

IgE and Eosinophilia in Newly Arrived Refugees in Denmark: A Cross-Sectional Study of Prevalence and Clinical Management in Primary Care

IgE and Eosinophilia in Newly Arrived Refugees in Denmark: A Cross-Sectional Study of Prevalence and Clinical Management in Primary Care

Urology on a changing planet: links between climate change and urological disease.

Urological diseases and their varied forms of management warrant special attention in the setting of climate change. Regarding urological cancers, climate change will probably increase the incidence and severity of cancer diagnoses through exposures to certain environmental risk factors, while simultaneously disrupting cancer care delivery and downstream outcomes. Regarding benign urological diseases, a burgeoning body of work exists on climate-related heat waves, dehydration, urolithiasis, renal injury and infectious and vector-borne diseases. Adding to the potential effect on disease pathogenesis, many patients with urological diseases undergo high-tech, resource-intensive interventions, such as robotic surgery, and entail intensive longitudinal assessments over many years. These features incur a considerable carbon footprint, generate substantial waste, and can introduce vulnerabilities to climate-related weather events. Links exist between planetary health (the health of humans and the natural systems that support our health), climate change and urological disease and urological care providers face many challenges in the era of anthropogenic climate change. The next steps and priorities for research, management, and health care delivery include identification and prioritization of health care delivery strategies to minimize waste and carbon emissions, while supporting climate resilience. Examples include supporting telemedicine, limiting low-value care, and building resilience to minimize impacts of climate-related disasters to prepare for the challenges ahead.

Optimizing Diabetes-in-Pregnancy Outcomes Requires a Care Continuum.

This study aimed to assess the strengths, limitations, opportunities, and threats presented by diabetes-in-pregnancy. We review the improvements in maternal and fetal mortality since the advent of insulin therapy, evaluate current health challenges, and identify opportunities for preventing increased mortality due to diabetes-in-pregnancy. Prior to 1922, women with type 1 diabetes mellitus (T1DM) of childbearing age were discouraged from becoming pregnant as the maternal and fetal/neonatal mortality rates were extremely high. Starvation-level dietary restriction was the only "treatment," with limited success in managing the disease. The discovery of insulin coupled with careful clinical management presented the possibility of successful pregnancies for women with T1dm. Over the course of the next half-century, maternal survival increased from 54 to 97%. However, the gains made in reducing adverse outcomes of diabetes in pregnancy are eroding due to modern challenges. The global obesity epidemic has led to an increase in type 2 and gestational diabetes mellitus (DM). T1DM also is on the rise. Together, the rise in the prevalence of pregestational diabetes has increased the risks for adverse outcomes. Here we review the ongoing challenges as well as opportunities for research to improve outcomes. We suggest that overweight, obesity, and diabetes management must be coupled with preconception counseling and education and must include, in addition to, Ob/Gyns, primary care, nutrition, weight management, and other experts to ensure that those at risk of pregnancy complications due to diabetes have the best possible outcomes. KEY POINTS: · Diabetes in pregnancy is affecting more people.. · The obesity epidemic is fueling an increase in pregestational diabetes.. · Research is needed to reduce inequities in diabetes in pregnancy outcomes.. · Blood glucose control should start prior to pregnancy..

European Society of Cardiology quality indicators for the management of acute coronary syndrome.

Closing the evidence-practice gap for the treatment of acute coronary syndrome (ACS) is central to improving quality of care. Under the European Society of Cardiology (ESC) framework, we aimed to develop updated quality indicators (QIs) for the evaluation of quality of care and outcomes for patients with ACS. A Working Group of experts including members of the ESC Clinical Practice Guidelines Task Force for ACS, Acute CardioVascular Care Association and European Association of Percutaneous Cardiovascular Interventions followed the ESC methodology for QI development. This methodology involved (i) the identification of the domains of ACS care for the diagnosis and management of ACS; (ii) the construction of candidate QIs through a systematic review of the literature; and (iii) the selection of the final set of QIs (using a modified Delphi method). Five domains of care for the diagnosis and management of ACS were identified: (1) structural framework and logistics, (2) in-hospital non-invasive care, (3) invasive strategy and periprocedural management, (4) secondary prevention interventions, and (5) outcomes. In total, 21 main QIs were selected, covering all five domains of care for the diagnosis and management of ACS. This document defines five domains of ACS care, and provides 21 QIs for the diagnosis and management of ACS. The updated ESC QIs for ACS may be used for quality improvement initiatives.

Surgical Outcomes in Unicoronal Synostosis-A 23-Year Experience From a Single Supraregional Craniofacial Unit.

Unicoronal synostosis is a rare condition leading to anterior plagiocephaly with facial scoliosis and deformation of the anterior cranial fossa. Fronto-orbital advancement and remodelling (FOAR) is the standard of care for management, aiming to normalise the brow shape and position while ameliorating the risk of raised intracranial pressure (ICP) throughout childhood. Published long-term surgical outcome data for unicoronal synostosis is lacking. The authors present our series of 151 cases of FOAR for unicoronal synostosis between January 2000 and January 2023. The average age at surgery was 22.7 months, with an average follow-up of 87 months. Ninety-six patients (66.2%) had no comorbidity. Nineteen (13.1%) had named genetic or chromosomal disorders. There was a 33.1% dural tear rate with no related postoperative CSF leak. Ninety-three patients (67.8%) had a blood transfusion with average donor exposure <1. The total early complication rate was 8.6% most commonly infection and wound dehiscence at 3.4% and 2.8%, respectively. The most common late complication was temporal recession in 30 (20.1%) patients and 3 of these patients required revision surgery. None of our patients required investigation for, or treatment of, raised ICP after the primary surgery. There were no life-threatening complications or mortalities. The authors compare our results to a previous publication on trigonocephaly patients and other available published data. The authors present our recommendations, which include support for a supraregionalized service that encompasses high-volume workload and multidisciplinary care.

Regular Use of Oral Nonsteroidal Anti-inflammatory Drugs in a Population of Polish Seniors: Findings from the PolSenior2 Cross-Sectional Survey.

Older adults represent a growing proportion of the general population. Nonsteroidal anti-inflammatory drugs (NSAIDs) constitute a group of medicines that are both necessary, owing to their anti-inflammatory, analgesic, and cardioprotective abilities, and potentially harmful, owing to their side effects. This study provides a comprehensive analysis of NSAID usage patterns among Polish adults aged 60 years and older. It focused on the regular use (≥ three times per week) of two types of NSAIDs: acetylsalicylic acid (ASA) and non-ASA NSAIDs, examining consumption on the basis of age, sex, educational level, and place of residence. Data were collected from the PolSenior2 study, a national cross-sectional survey of 5987 Polish individuals aged 60-106 years, conducted from 2018 to 2019. The study found that 30.7% [95% confidence interval (CI) 28.8-32.7)]of Polish seniors regularly used NSAIDs, with 26.2% (95% CI 24.5-28.0) regularly using ASA, 6.3% (95% CI 5.3-7.2) regularly using non-ASA NSAIDs, and 1.9% (95% CI 1.4-2.3) reporting regular use of both. An age-related increase in regular NSAID use, including ASA, was observed. Women were more likely than men to use non-ASA NSAIDs regularly, whereas men in the 70-79 age group were more likely to use ASA. A lower level of education was associated with more frequent NSAID use. The findings have implications for healthcare practitioners and policymakers, emphasizing the need for careful management of NSAID use. The study contributes to a more nuanced understanding of NSAID usage and underscores the necessity for tailored healthcare strategies to ensure safe and effective medication use among older adults.

Optimizing Workforce Management in Long-Term Care Through AI and Machine Learning: Enhancing Efficiency and Improving Care Quality

Optimizing Workforce Management in Long-Term Care Through AI and Machine Learning: Enhancing Efficiency and Improving Care Quality

Patient and Health Professional's Perspectives of Periprosthetic Joint Infection: A Systematic Review and Meta-Ethnography.

Background: Periprosthetic joint infection (PJI) is a major challenge for surgical teams and patients following an orthopedic surgical procedure. There is limited understanding on patient and health professional's perception of PJI. The aim of this study was to examine the literature to better understand the perspectives of patients, and those who manage PJI. Methods: Published and unpublished literature databases were systematically searched from inception to June 21, 2024. Qualitative studies reporting the perspectives of living with and managing PJI were included. Data were synthesized using a meta-ethnography approach and the GRADE-CERQual tool. Results: Of the 584 citations identified, 10 studies (n = 91 patients; n = 70 health professionals) met the eligibility criteria and were included. Three themes, all moderate-certainty evidence, were identified from the health professional data, including the following: (1) importance of PJI; (2) impact on health professionals; and (3) support for change. From the patient data, six themes on the basis of moderate-certainty evidence were identified: (1) psychological and social impact; (2) physical impacts; (3) relationship with health professionals; (4) relationship with others; (5) uncertainty over the future; and (6) support for change. A novel line of argument was developed offering third-order constructs, on the basis of first- and second-order themes. Conclusion: PJIs are perceived as devastating by both patients and health professionals. They impact on all aspects of a patient's physical, social and psychological health, each interacting on one another over the course of infection and management. Strategies to improve communication, multidisciplinary management, and personalization of care are advocated by both patients and health professionals to promote better outcomes.

Limitations of District Health Information Software 2 (DHIS2) as a Decision Support Tool for Upazila Health Service Management in Bangladesh

Background: District Health Information Software 2 (DHIS2) is an open source, web-based, health management information system (HMIS) recognized as world's largest HMIS platform, customized for health information system of Bangladesh for decentralized data entry since 2011. Health care managers and employees should be well informed about the health information system for accurate, appropriate, precise, timely, valid information and also interpretation of information which are the basis for policy planning and decision-making at various levels of the organization. The study aimed at exploring the limitations of DHIS2 in decision making process for health service management among the Upazila (Sub district) level health managers of Bangladesh. Methods: The cross sectional study was conducted among the Upazila Health and Family Planning Officers (UH&amp;FPOs) of Bangladesh during the period of January to December 2018. All (482) UH&amp;FPOs of Bangladesh posted as regular, current charge or in-charge were included for the study. Data were collected by a pre-tested semi-structured email-based questionnaire. Results: Response rate was 88.8% (428 out of 482). The mean age of the respondents was 47.08 (±6.33 SD). Mean duration of job experiences as UH&amp;FPO was 1.9 years (±1.635 SD). Regarding limitation, the study revealed that 76.2% (of 424) UH&amp;FPOs think that lack of rrealizing the Importance of DHIS2 by Doctors, Nurses and other Staffs is the most important “Facility Centered Barriers” for using DHIS2 as a decision support tool of Upazila health service management. Beside this 71.2% UH&amp;FPOs think that lack of effective training of the staffs concerned with DHIS2 operation are the second most important barrier. The study also revealed that 59.7% (of 402) UH&amp;FPOs think that absence of the option for automatically displaying the summary reports of various datasets in the respective Upazila dashboard is the most important “Software Centered Barriers” for using DHIS2 as a decision support tool of Upazila health service management beside this 58.5% UH&amp;FPOs think difficulties in identifying the management related data elements from various data sets of DHIS2. Conclusion: So, this study recommends scaling up DHIS2 by redesigning training programs with more focus on the ways of its’ application in the decision making process, create awareness among all categories of health staffs, customization of its contents and more research on this ground. These initiatives will explore several innovative approaches to monitor health indicators by DHIS2, measure and plan health interventions to ensure quality health service and will lead towards achieving Sustainable Development Goal 3 (SDG-3). JOPSOM 2023; 42(2): 43-50

Perspectives on Swedish Regulations for Online Record Access Among Adolescents With Serious Health Issues and Their Parents: Mixed Methods Study.

With the increasing implementation of patient online record access (ORA), various approaches to access to minors' electronic health records have been adopted globally. In Sweden, the current regulatory framework restricts ORA for minors and their guardians when the minor is aged between 13 and 15 years. Families of adolescents with complex health care needs often desire health information to manage their child's care and involve them in their care. However, the perspectives of adolescents with serious health issues and their parents have not been studied. This study aims to qualitatively and quantitatively investigate the perceived benefits and risks of ORA and the awareness of and views on ORA regulations among adolescents with serious health issues and their parents in Sweden. We used a convergent mixed methods (qualitative and quantitative) design, consisting of a survey and semistructured individual interviews with adolescents with serious health issues (aged 13-18 y) and their parents. Participants were recruited via social media and in clinics. Quantitative data were presented descriptively. Interviews were audio recorded, transcribed, and analyzed using inductive thematic content analysis. The survey population included 88 individuals (adolescents: n=31, 35%; parents: n=57, 65%). Interviews were completed by 8 (26%) of the 31 adolescents and 17 (30%) of the 57 parents. The mean age of the surveyed adolescents was 16 (SD 1.458) years, and most of the parents (29/57, 51%) were aged 45 to 54 years. The surveys indicated that most of the parents (51/56, 91%) were critical of the access gap, and most of the adolescents (20/31, 65%) were unaware of the age at which they could gain access. In the interviews, adolescents and parents identified benefits related to ORA that were categorized into 6 themes (empowering adolescents, improved emotional state, enhanced documentation accuracy, improved partnership and communication, supported parental care management, and better prepared for appointments) and risks related to ORA that were categorized into 4 themes (emotional distress and confusion, threatened confidentiality, increased burden, and low usability). Adolescents' and parents' views on ORA regulations were categorized into 3 themes (challenges of the access gap, balancing respect for autonomy and support, and suggested regulatory change). In Sweden, ORA regulations and a lack of available information cause significant inconvenience for adolescents with serious health issues and their parents. Views on access age limits differed, with adolescents expressing their perceived need for independent access, while parents exhibited concerns about adolescents having ORA. The findings indicated the importance of increased education, dialogue, and flexibility to uphold confidential and consistent delivery of adolescent health care. Further exploration is needed to understand the experiences of adolescents and parents in diverse clinical and geographic contexts, as well as the perspectives of pediatric health care professionals on restrictive ORA regulations.

Neural Tube Defects in Eastern Libya: A Five-Year Retrospective Study

Neural tube defects are developmental abnormalities that occur during embryonic neural formation, leading to a range of clinical outcomes. This study investigates the clinical characteristics and prevalence of NTDs in Eastern Libya over five years. A descriptive hospital-based retrospective study was conducted at Aljala Hospital from 2015 to 2019. Data from 214 patients, aged 2 to 120 days, were analyzed. The study assessed clinical presentations, demographic data, timing of surgery, and complications. The most common form of NTD, spina bifida cystica, was the most common type of NTD, with a higher prevalence in males than females. A lack of awareness about folic acid supplementation and limited use of advanced imaging were significant findings. Hydrocephalus was frequently associated with NTDs, and shunt placement occurred predominantly postoperatively. Complications included wound sepsis, CSF leaks, and meningitis. The study emphasizes the need for improved preventive strategies, early antenatal diagnosis, and multidisciplinary care for NTD management in Libya.

Student-run free clinics (SRFC) can solve three problems for Pakistan

Madam, Student-run free clinics are primary care bodies run by medical schools where students provide care under the supervision of senior faculty. SRFCs serve three main purposes in society i.e. undergraduate education, primary care and social justice providing care to the socially deprived. (1) It adds an extra layer of primary care and lessens the burden on secondary and tertiary care hospitals. In the United States, more than 75% of institutions are running SRFCs which provide care in chronic disease management, specialty care, imaging, laboratories, pharmaceuticals, and interdisciplinary services. (2) Care provided at these clinics is at par with other primary health care facilities. (3) They are equally important as a tool of undergraduate medical education (UME) as well as a social justice initiative. Considering Pakistan’s current economic status, SRFCs appear as an option worth trying. These free clinics if reasonably funded, could save thousands of dollars for Pakistan’s healthcare system. Such clinics will help monitor chronically ill patients and will be more cost effective as compare to advanced care units. According to the International Diabetes Federation, Pakistan is ranked third highest in number of diabetic cases. (4) These free clinics can reduce the burden by monitoring and providing necessary care to the diabetic population. Depending on the capabilities of the parent institution, the SRFC can provide care in various other areas as well. The SRFCs can serve as a potentially viable training ground for future doctors. Students from academically advanced years can be assigned different types of work at the clinics. Even first and 2nd-year students can be engaged in history taking and vitals monitoring whereas 3rd and 4th-year students can perform clinical examinations and interpretation of lab reports. Fifth year and interns can work under the direct supervision of senior faculty to prescribe medicine, perform minor procedures and lead other junior colleagues as well. This approach could foster a culture of collegiality, leadership, peer-assisted learning (PAL), and community involvement and at the end of all improve students’ clinical skills and confidence in patient management. Students managing such clinics will also get hands-on experience in running a healthcare setup and dealing with governance and legal issues. Advocacy and social justice in medicine can be encouraged using such initiatives. Students who work at these clinics will be introduced to public health, social work, global health initiatives and the importance of primary health care. ---Continue

Alteration of Blood Parameters in Non-Dialyzed Patients of Chronic Kidney Disease

Chronic kidney disease (CKD) is a serious health problem that can lead to end-stage renal disease. Patients with CKD are usually suffered from anemia, which is one of the major consequences of kidney damage which in turn lead to reduce quality of life, increased risk of cardiovascular disease and cognitive impairment. The study aimed to assess the hematological abnormalities in the CKD patients during pre-dialyzed conditions in EL-Beyda City. The study was included 107 patients who are attended to Nephrology Department in EL-Bayda Medical Center in the period from November 2021 to March 2022. The study was included all CKD stages and were not on dialysis and they were following upped by these centers regularly each month. Data sources were obtained from the personal interview with patients and the records files in Nephrology units. Blood samples were taken in EDTA tube to measure complete blood counts (CBC) include hemoglobin (Hb), hematocrit (HCT), Mean cell volume (MCV), Mean cell hemoglobin (MCH), Mean cell hemoglobin concentration (MCHC), white blood cells (WBC) and platelets count (PLT), as well as renal function tests (blood urea and creatinine). The data were analyzed by Minitab version17. Out of 107 patients were included in this study, 63(58.8%) of patients were females and 44(41.1%) were males, The majority of patients had chronic diseases which could be the contributing cause of CKD; 62% were suffered from hypertension, 40% suffered from diabetes. Anemia was the main abnormality in our study which observed in 49 of participants (45.8%) while the others were non anemic accounting 54% (14.6±0.23). There was a significant difference in the mean of hemoglobin and hematocrit between anemic and non-anemic participants (p- value=0.000). Red cell indices showed normocytic normochromic anemia, thrombocytopenia was noticed in 7 (14%) of patients and leukocytosis was reported in 9 (18%) of them. We can conclude that developing of anemia in CKD patients is associated with poor outcomes and requires a careful management to avoid comorbidities.

Constructing Applied Knowledge in Nursing Students: A Learning Experience Centered on Evidence-Based Practice

Background: Evidence-based practice must be promoted in nursing education to provide quality care. For this, teaching practices that promote its development must be considered. Aim: The aim of this study was to explore a learning experience centered on evidence-based practice through cooperative learning in an online discussion forum with nursing students. Methods: We employed a descriptive qualitative study with the participation of 137 nursing students. A teaching intervention based on cooperative teamwork through an online forum is proposed. The students, through a question, must manage information to provide a reasoned answer. The interactions in the forums were analyzed through qualitative content analysis. Results: Two themes and eight categories emerged: Critical Analysis of the Literature (Computer Literacy, Reliability of the data sources, Level of evidence according to the article design, and Relevance of the research) and Clinical Practice (Patient’s perspective, Professional experience, Quality of care, and Usefulness of EBP). Conclusions: The use of interactive teaching methodologies (cooperative learning and online discussion forums) facilitates the construction of knowledge applied to clinical practice. Students perceive EBP as necessary and useful for optimal care management, and the forums allow for the development of key competencies, such as autonomous learning, teamwork, and critical thinking.

Differences between private and public primary health care centers and differences between men and women in antihypertensive care and cardiovascular prevention in all patients with hypertension treated in primary care in Stockholm County, Sweden

AimsTo study differences in cardiovascular prevention and hypertension management in primary care in men and women, with comparisons between public and privately operated primary health care (PHC).MethodsWe used register data from Region Stockholm on collected prescribed medication and registered diagnoses, to identify patients aged 30 years and above with hypertension. Age-adjusted logistic regression was used to calculate odds ratios (ORs) with 99% confidence intervals (99% CIs) using public PHC centers as referents.ResultsIn total, 119,267 patients with a registered hypertension diagnosis at their primary care center were included; 58,239 men and 61,028 women. In terms of co-morbidities and medications, there were some differences between privately and publicly run PHC: registered diagnosis of dementia, which was higher at private PHC, age-adjusted OR 1.80 (1.24–2.69). For lifestyle counseling, privately run PHC had a higher rate of registered counseling for tobacco 1.17 (1.06–1.29), physical activity 1.13 (1.06–1.17), unhealthy diet 1.08 (1.04–1.13), and counseling according to highest prioritized level of advice stated by national guidelines 1.14 (1.09–1.18). Differences in comorbidities between men and women were found, with higher frequencies of coronary heart disease, congestive heart failure, atrial fibrillation, stroke, diabetes, and gout among men. Regarding antihypertensive treatment, women received less treatment of calcium channel blockers and ACE inhibitors, but more of angiotensin receptor blockers.ConclusionsThese findings highlight the need for targeted preventive efforts in PHC, especially for male patients, to address disparities in cardiovascular health outcomes. Small differences in preventive measures between public and privately run PHC suggest generally consistent care across healthcare ownership models.

Intracellular dark endothelial spots detected using specular microscopy are associated with graft failure after Descemet's membrane endothelial keratoplasty.

To investigate the correlation between intracellular dark endothelial spots (IDESs) detected by specular microscopy and the incidence of graft failure after Descemet's membrane endothelial keratoplasty (DMEK). We reviewed 100 consecutive DMEK patients performed by a single surgeon at two centres between January 2015 and July 2022. Central corneal thickness was evaluated using anterior segment optical coherence tomography (SS-1000; Tomey, Aichi, Japan), and endothelial cell density was measured using specular microscopy. Kaplan-Meier estimates and Cox regression models were used to evaluate graft failure and associated risk factors. Of the 97 eyes included, 9 experienced graft failure within the follow-up period (52.9 ± 23.9 months). IDES presence significantly correlated with decreased endothelial cell density and higher graft failure rates (hazard ratio = 4.68, 95% confidence interval = [0.96, 22.7], P = 0.034). IDESs represent a significant risk factor for graft failure post-DMEK. Careful postoperative management is imperative to minimise this risk.