Careful Evaluation Research Articles

Exploring barriers to mental health service access: a preliminary study among the general Paraguayan population

This study aimed to explore the perception of barriers to accessing mental health services within the general population of Paraguay using the Barriers to Access to Care Evaluation (BACE) scale. The barriers were categorized into three types: attitudinal, instrumental, and stigma-related. The sample comprised 321 participants, the majority of whom were women (82.9%). Among the participants, 62.9% reported experiencing mental ill-health, with the most common disorders being anxiety (37.4%), depression (30.5%), and sleep disorders (20.6%). Of the participants, 157 (48.9%) reported significant attitudinal barriers, which include beliefs and perceptions about mental health treatment, among others; 87 (27.1%) reported significant stigma-related barriers, which involve prejudices and stereotypes associated with mental disorders; and 189 (58.9%) experienced significant instrumental barriers, including financial constraints and limited availability of services. Mental ill-health was significantly associated with all types of barriers. In conclusion, significant barriers to accessing mental health services persist among the Paraguayan population. These barriers must be addressed through evidence-based public policies to improve the quality-of-life of both individuals with mental ill-health and the broader general population.

Predicting ground vibration during rock blasting using relevance vector machine improved with dual kernels and metaheuristic algorithms

The ground vibration caused by rock blasting is an extremely hazardous outcome of the blasting operation. Blasting activity has detrimental effects on both the ecology and the human population living in proximity to the area. Evaluating the magnitude of blasting vibrations requires careful evaluation of the peak particle velocity (PPV) as a fundamental and essential parameter for quantifying vibration velocity. Therefore, this study employs models using the relevance vector machine (RVM) approach for predicting the PPV resulting from quarry blasting. This investigation utilized the conventional and optimized RVM models for the first time in ground vibration prediction. This work compares thirty-three RVM models to choose the most efficient performance model. The following conclusions have been mapped from the outcomes of the several analyses. The performance evaluation of each RVM model demonstrates each model achieved a performance of more than 0.85 during the testing phase, there was a strong correlation observed between the actual ground vibrations and the predicted ones. The analysis of performance metrics (RMSE = 21.2999 mm/s, 16.2272 mm/s, R = 0.9175, PI = 1.59, IOA = 0.8239, IOS = 0.2541), score analysis (= 93), REC curve (= 6.85E−03, close to the actual, i.e., 0), curve fitting (= 1.05 close to best fit, i.e., 1), AD test (= 11.607 close to the actual, i.e., 9.790), Wilcoxon test (= 95%), Uncertainty analysis (WCB = 0.0134), and computational cost (= 0.0180) demonstrate that PSO_DRVM model MD29 outperformed better than other RVM models in the testing phase. This study will help mining and civil engineers and blasting experts to select the best kernel function and its hyperparameters in estimating ground vibration during rock blasting project. In the context of the mining and civil industry, the application of this study offers significant potential for enhancing safety protocols and optimizing operational efficiency.

Seminar Parenting: Peran Ayah dalam Pengasuhan Anak Usia Dini di Desa Tanjunganom, Kecamatan Rowosari, Kabupaten Kendal

The presence of both parents plays a crucial role in the development of early childhood, especially in creating an environment that supports their optimal growth and development. Ideally, fathers and mothers work together in parenting with a balanced division of roles. However, in Indonesia, father involvement is often less than optimal because of the view that the father's main task is to earn a living. This study aims to improve the understanding and knowledge of the community, especially in Tanjunganom Village, about the importance of father involvement in child care. Through seminars and mentoring held by the KKN POSKO 5 UIN Walisongo Semarang team, fathers were given insight into the division of roles, monitoring strategies, and evaluation in child care. The results of this activity showed an increase in knowledge among fathers regarding their role in parenting, as well as their ability to balance time between work and child care. Children who are cared for by actively involved fathers show progress in social, emotional, cognitive, and affective development. In conclusion, father involvement in early childhood care is very important to support children's overall development. Fathers who are active in parenting have a stronger relationship with their children, which ultimately makes children more sensitive to their emotions and environment. Therefore, it is highly recommended for fathers to understand that child care is a shared responsibility between father and mother.

NAVIGATING SERVICE INNOVATION: INVESTIGATING THE STAGES OF INNOVATION PROCESS IN TELECOMMUNICATION INDUSTRY

This research explored the stages of service innovation within the telecommunications industry, specifically examining PT Telkom Indonesia Datel Temanggung. Using a qualitative approach that included observation and interviews with five employees, the research identified a six-stage process for service innovation: opportunity identification, idea management, concept development, pilot test, launch, and learning. The results highlighted significant challenges faced during the innovation process and emphasized the importance of customer involvement. Additionally, service innovation at PT Telkom had crucial managerial implications, requiring careful evaluation to ensure profitability and customer satisfaction. Managers must navigate the innovation timeline to balance stakeholder impact and avoid employee burnout. Phased rollouts and targeted marketing were recommended strategies to keep customers informed and engaged throughout the innovation process.

Digital Papillary Adenocarcinoma: Uncommon Malignancy of Sweat Glands - Two Rare Cases

Abstract Digital papillary adenocarcinoma (DPA) is a very rare malignant tumor of the sweat glands originally described by Helwig in 1979.It often presents as a solitary painless mass, commonly found on the volar surface of the fingers and toes and the adjacent skin of the palms and soles. Materials and Methods: Two rare cases of DPA in 43- and 48-year-old male patients who presented with swelling finger were included over period of one year study in a tertiary care hospital. Results: Our study had two cases with male patient of age 48 year and 43 year old. Both presented with swelling and a mass lesion left middle finger, past 8 years and nodule in proximal phalangeal region of left index finger for 15 years respectively. On histomorphology and immunohistochemistry both were diagnosed as DPA. Conclusion: DPA is a rare adnexal tumor which generally present for months to years before the patient seeks medical attention. Careful evaluation with early surgical removal and accurate histological diagnosis is must when managing patients with DPA as these can be aggressive and even result in metastasis..

Morphological and molecular data warrant the description of a new species of the genus Scutiger (Anura, Megophryidae) from the Central Himalaya.

Recent phylogenetic studies in Himalayan lazy toads of the genus Scutiger Theobald, 1868 revealed the presence of genetically deeply divergent lineages. The taxonomy of S.nepalensis sensu lato was re-assessed based on museum material considering molecular and morphological data. The results strongly support the recognition of a new species, S.kanjiroba sp. nov. distributed along the Nepalese Kanjiroba massif. It is further shown that S.sikimmensis has an apparently much more restricted distribution range than previously thought. The frequent misidentification of Scutiger across large areas of the Himalaya-Tibet area highlights the significance of careful taxonomic evaluation of collection material and the need for the direct morphological comparison of closely related species when describing new species.

Two Decades of Thyroid Nodule Cytology in Children: Malignancy Risk Assessment at a Tertiary Care Center

Plain Language SummaryPediatric thyroid nodules are less common than those in adults, but they have a higher risk of being cancerous. This study reviews data from the past 20 years at a major healthcare center to understand how often these nodules are malignant in children and how accurate fine-needle aspiration (FNA) biopsies are in diagnosing them. The study analyzed 75 thyroid nodules from 73 children, finding that 62.6% of the nodules were malignant. The FNA biopsy, a key diagnostic tool, was shown to be very accurate, with a sensitivity of 78.38% and a perfect specificity of 100%. This means that FNA is highly reliable for identifying both cancerous and noncancerous nodules in children. One significant finding is that the risk of cancer in thyroid nodules categorized as indeterminate (uncertain) by the Bethesda System is much higher in children than in adults. This suggests that pediatric thyroid nodules behave more aggressively, underscoring the need for careful evaluation and tailored guidelines for children. These results are crucial for medical professionals as they highlight the importance of specialized approaches in managing thyroid nodules in children, ensuring accurate diagnosis and appropriate treatment to avoid overtreatment and unnecessary surgeries.

Esophageal Dysmotility in Multiple System Atrophy: A Retrospective Cross-Sectional Study.

Background/Objective: Multiple system atrophy (MSA) is often associated with dysphagia and esophageal dysmotility (ED). However, ED in patients with MSA is poorly understood. To assess the relationship between ED, dysphagia, and other clinical findings in such patients and investigate the details of ED in MSA using high-resolution manometry (HRM). Methods: Patients from The University of Tokyo Hospital with MSA who underwent swallowing examinations, esophagography, and HRM between 2017 and 2022 were enrolled. A retrospective chart review of patients' backgrounds, swallowing function, and esophageal motility was performed. ED was evaluated using the Chicago Classification version 4.0. Results: Seventy-four patients with MSA were identified. The median age was 64 years, 48 patients (65%) were male, and the cerebellar variant type was predominant (69%). Abnormal upper esophageal sphincter (UES) resting pressure was observed in 34 patients (46%) and intraesophageal stasis in 65 (88%). High-severity MSA was a risk factor for developing dysphagia, vocal fold movement impairment, and abnormal UES function (p < 0.05). However, no overt clinical risk factors for ED were identified. Various types of ED were detected using HRM, and ineffective esophageal motility was the most frequent disorder. Conclusions: ED is a common occurrence in patients with MSA. Although a high-severity MSA may be a risk factor for developing dysphagia and vocal fold motion impairment, ED can occur regardless of clinical severity. Since ED is rarely detected based on subjective symptoms, careful evaluation of esophageal motility by esophagography or HRM is warranted in patients with MSA.

Trauma–Sensitive Residential Care: Perspectives of Portuguese Professionals to Spark Change

ABSTRACT Despite global pressure for deinstitutionalization of children in care, and recent legislative changes, Portugal remains a country with very high prevalence of residential care amongst at-risk children. These children were exposed to multiple traumatic events that can disrupt development. Thus, the expansion toward a truly sensitive approach to trauma is valuable, as it aims to increase awareness of its effects and ensure the best empathic care, providing a safe and healthy environment, with consequences also for the wellbeing of residential care staff. The present study aims to characterize the quality of residential care environments in Portugal through the lens of trauma-sensitive care, and to map professionals understanding of main domains, priorities and obstacles to change in this area. The study adopts a mixed method design, reporting on the perceptions of 85 professionals. Main findings show that professionals demonstrate better perceptions regarding physical environment but consider training and supervision as fragile dimensions. Qualitative data bring detail to these views, reinforcing the call for training to all staff and for continuous support to demanding job roles. This exploratory study highlights major aspects that urge to ensure trauma-sensitive residential care – supportive of professionals, to meet the needs of children and youth. Practice Implications The need to invest in training as the cornerstone to gather staff consensus around the importance of trauma-sensitive care and leverage change. The value of supervision in order to strengthen all residential care community. The importance of a shared theoretical background, common to all staff, to ensure secure and restorative relations with children and youth in line with trauma-sensitive care. The added value of the Trauma-Sensitive Care Evaluation Questionnaire for Welfare System as a tool to guide and monitor organizational change and its multilevel impact.

Phosphodiesterase-5 inhibitors and hearing impairment: a disproportionality analysis using the US food and drug administration adverse event reporting system

ABSTRACT Background This study aimed to investigate the association between phosphodiesterase-5 inhibitors (PDE-5i) and hearing impairment adverse events (HIAEs) while providing an overview of the characteristics of drug-related HIAEs. Research design and methods We conducted a detailed pharmacovigilance analysis using data from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database, covering 2004 to 2022. By calculating the reporting odds ratio (ROR) and the information component (IC), we identified signals that indicate the association between PDE-5i use and HIAEs. Results Among the 191,398 reports related to PDE-5i, we identified 2,608 cases of HIAEs. Signals were observed for both PDE-5i monotherapy and polytherapy, indicating combinations of drugs. Avanafil exhibited the strongest signal (ROR: 4.35, 95% CI: 2.56–7.41, IC: 2.09, 95% CI: 0.10–3.51), while vardenafil showed the weakest signal (ROR: 2.69, 95% CI: 2.21–3.28, IC: 1.14, 95% CI: 0.74–2.04). Sildenafil had the highest reported cases (ROR: 3.03, 95% CI: 2.82–3.24, IC: 1.57, 95% CI: 1.34–1.80). Conclusion These findings highlight a significant correlation between PDE-5i use and HIAEs, emphasizing the need for careful evaluation in clinical practice and providing appropriate guidance to patients before initiating treatment.

Evaluation of Spiritual Care and Well-Being Levels of Individuals Diagnosed with Lung Cancer in Turkey.

This study aimed to assess the spiritual care needs and spiritual well-being levels of lung cancer patients undergoing chemotherapy (CT). This descriptive cross-sectional study was conducted with 110 patients in the outpatient CT unit of a university hospital. Data were collected using a personal information form, the "Three-Factor Spiritual Well-Being Scale" and the "Spiritual Care Needs Scale." The average age of participants was 62.6 ± 8.0years. Patients with a university or above education level, civil servants, self-employed individuals, those receiving only CT, and those with less than 5 CT cycles had significantly higher spiritual well-being scores (p < 0.05). Spiritual care needs scale scores were significantly higher for married individuals and those receiving only CT (p < 0.05). In conclusion, both spiritual well-being levels and spiritual care needs were observed to be high among lung cancer patients.

A delayed diagnosis of hyperthyroidism in a patient with persistent vomiting in the presence of Chiari type 1 malformation.

To present and discuss an uncommon clinical presentation of hyperthyroidism in a female patient with Chiari type 1 malformation. We explore how her medical history influenced the diagnostic process and ultimately contributed to the delayed diagnosis. In this case study, we discuss an unusual presentation of hyperthyroidism in a 35-year-old female with Chiari type 1 malformation. Initially experiencing headaches, tremors, and dizziness, the patient consulted multiple specialists without a clear diagnosis. Later, she developed recurrent vomiting unrelated to food intake, significant weight loss (12 kg), and muscle weakness, leading to her hospitalization. After six months of clinical evaluation with several specialists (neurologists, neurosurgeons, and gastroenterologists), she was,finally, diagnosed with hyperthyroidism by an Internal Medicine physician in another private clinic. Treatment with thiamazole and propranolol led to the improvement of symptoms progressively. This caseemphasizes the vital role of clinical reasoning, crucial problem-solving, and decision-making processes while addressing cognitive biases in medical specialization. Besides, it highlights the need for internist evaluation in outpatient care to ensure comprehensive assessment and prompt specialist referrals if needed. This case accentuates the importance of internist evaluation for comprehensive care and timely specialist referrals. Recognizing unusual presentations, like thyrotoxic vomiting, and addressing cognitive biases, such as confirmation and anchor biases, are crucial for accurate and prompt diagnosis. This approach enhances diagnostic accuracy, minimizing unnecessary tests and costs, and alleviates patient suffering.

Exploring Scalability of BFT Blockchain Protocols through Network Simulations

Novel Byzantine fault-tolerant (BFT) state machine replication protocols improve scalability for their practical use in distributed ledger technology, where hundreds of replicas must reach consensus. Evaluating the performance of BFT protocol implementations requires careful evaluation. We propose a new methodology using scalable network simulations to predict BFT protocol performance. Our simulation architecture allows for the integration of existing BFT implementations without modification or re-implementation, offering a cost-effective alternative to large-scale cloud experiments. We validate our method by comparing simulation results with real-world cloud deployments, showing that simulations can accurately predict performance at larger scales when network limitations dominate. In our study, we applied this methodology to assess the performance of several “blockchain-generation” BFT protocols, including HotStuff, Kauri, Narwhal &amp; Tusk, and Bullshark, under realistic network conditions (with constrained 25 Mbit/s bandwidth) and induced faults. Kauri emerges as the top performer, achieving 6742 operations per second (op/s) with 128 replicas, outperforming BullShark (2318 op/s) and Tusk (1952 op/s). HotStuff, using secp256k1 and BLS signatures, reaches 494 op/s and 707 op/s, respectively, demonstrating the efficiency of BLS-signature aggregation for saving bandwidth. This study demonstrates that state-of-the-art asynchronous BFT protocols can achieve competitive throughput in large-scale, real-world scenarios.

Pulsed-field- vs. cryoballoon-based pulmonary vein isolation: lessons from repeat procedures.

Pulsed-field ablation (PFA) is an emerging technology to perform pulmonary vein isolation (PVI). Initial data demonstrated high safety and efficacy. Data on long-term PVI durability and reconduction patterns in comparison to established energy sources for PVI are scarce. We compare findings in repeat ablation procedures after a first PFA to findings in repeat ablation procedures after a first cryoballoon ablation (CBA) based PVI. A total of 550 consecutively enrolled patients underwent PFA or CBA index PVI. Repeat ablations in patients with symptomatic atrial arrhythmia recurrences were analysed. A total of 22/191 (12%) patients after index PFA-PVI and 44/359 (12%) after CBA-PVI underwent repeat ablation. Reconduction of any pulmonary vein (PV) was detected by multipolar spiral mapping catheter at each PV with careful evaluation of PV potentials and by 3D-mapping in 16/22 patients (73%) after PFA-PVI and in 33/44 (75%) after CBA-PVI (P = 1.000). Of 82 initially isolated PVs after PFA-PVI, 31 (38%) were reconducting; of 169 isolated PVs after CBA-PVI, 63 (37%) were reconducting (P = 0.936). Clinical atrial tachycardia occurred similarly in patients after PFA (5/22; 23%) and CBA (7/44; 16%; P = 0.515). Roof lines were set more often after PFA- (8/22; 36%) compared with CBA-PVI (5/44; 11%; P = 0.023). Repeat procedure duration [PFA: 87 (76, 123) min; CBA: 93 (75, 128) min; P = 0.446] was similar and fluoroscopy time [PFA: 11 (9, 14) min; CBA: 11 (8, 14) min; P = 0.739] equal between groups at repeat ablation. During repeat ablation after previous PFA- or CBA-based PVI, electrical PV-reconduction rates and patterns were similar.

INDICADORES DE QUALIDADE EM TERAPIA NUTRICIONAL (IQTN) NA AVALIAÇÃO DO CUIDADO NUTRICIONAL EM UNIDADES HOSPITALARES DO BRASIL: UMA REVISÃO DE LITERATURA

Malnutrition is understood as an imbalance caused by low nutrient intake or increased nutritional needs, in the hospital environment, malnutrition has a direct influence on the clinical course of the patient and is often neglected, resulting in complications such as: infections, delayed healing and prolonged duration of treatment. Hospitalization time. In these cases, nutritional therapy (NT) is used and, along with the implementation, adverse events may prevent the effective implementation of nt. in this context, the use of quality indicators in nutritional therapy (IQTN) are applied, aiming to ensure the effectiveness of daily routines associated with nutritional management. Thus, this work aims to verify the use of the iqtn tool in the evaluation of nutritional care in hospital units in Brazil. the present study is a bibliographical review of the literature, built from scientific articles in the medline database (pubmed), portal periódicos capes and latin american literature in health sciences (lilacs) using the descriptors “Protein-Energy Malnutrition”, “Quality Indicators in Health Care”, “Nutritional Therapy”. Articles that did not correspond to the topic of interest and those published in the last 11 years were excluded. After cataloging, 08 articles were added that demonstrated the implementation of IQTN in the evaluation of nutritional care in services provided in hospitals in Brazil. most studies present indicators in accordance with the proposed goals, but it is worth mentioning that there is a significant prevalence of malnutrition in all the studies selected in this research, however those that have greater adequacy in indices related to nutritional assessment and prescription x calorie and protein infusion has a better prognosis for hospitalized patients. Therefore, the implementation of the IQTN tool becomes necessary in hospital units, as through this method it is possible to assess the compliance of nutritional care in order to minimize risks and intercurrences.

Evaluating Literature Reviews Conducted by Humans Versus ChatGPT: Comparative Study.

With the rapid evolution of artificial intelligence (AI), particularly large language models (LLMs) such as ChatGPT-4 (OpenAI), there is an increasing interest in their potential to assist in scholarly tasks, including conducting literature reviews. However, the efficacy of AI-generated reviews compared with traditional human-led approaches remains underexplored. This study aims to compare the quality of literature reviews conducted by the ChatGPT-4 model with those conducted by human researchers, focusing on the relational dynamics between physicians and patients. We included 2 literature reviews in the study on the same topic, namely, exploring factors affecting relational dynamics between physicians and patients in medicolegal contexts. One review used GPT-4, last updated in September 2021, and the other was conducted by human researchers. The human review involved a comprehensive literature search using medical subject headings and keywords in Ovid MEDLINE, followed by a thematic analysis of the literature to synthesize information from selected articles. The AI-generated review used a new prompt engineering approach, using iterative and sequential prompts to generate results. Comparative analysis was based on qualitative measures such as accuracy, response time, consistency, breadth and depth of knowledge, contextual understanding, and transparency. GPT-4 produced an extensive list of relational factors rapidly. The AI model demonstrated an impressive breadth of knowledge but exhibited limitations in in-depth and contextual understanding, occasionally producing irrelevant or incorrect information. In comparison, human researchers provided a more nuanced and contextually relevant review. The comparative analysis assessed the reviews based on criteria including accuracy, response time, consistency, breadth and depth of knowledge, contextual understanding, and transparency. While GPT-4 showed advantages in response time and breadth of knowledge, human-led reviews excelled in accuracy, depth of knowledge, and contextual understanding. The study suggests that GPT-4, with structured prompt engineering, can be a valuable tool for conducting preliminary literature reviews by providing a broad overview of topics quickly. However, its limitations necessitate careful expert evaluation and refinement, making it an assistant rather than a substitute for human expertise in comprehensive literature reviews. Moreover, this research highlights the potential and limitations of using AI tools like GPT-4 in academic research, particularly in the fields of health services and medical research. It underscores the necessity of combining AI's rapid information retrieval capabilities with human expertise for more accurate and contextually rich scholarly outputs.

Radiological abnormalities of the cervicothoracic vertebrae in Warmblood horses with primary neck-related clinical signs versus controls.

Radiological observations at the cervicothoracic junction in horses with or without related clinical signs have not been comprehensively described. The aim was to evaluate the seventh cervical (C7) to second thoracic (T2) vertebrae in horses with neck-related clinical signs (neck pain and/or stiffness, neck-related forelimb lameness, or general proprioceptive [spinal] ataxia) and control horses. This prospective analytical cross-sectional study included 127 control horses and 96 cases, examined using standardized clinical and radiological protocols. Univariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) to identify factors associated with radiological abnormalities. Severe modeling of the articular processes at C7-T1 was more likely in cases compared with controls, OR, 4.25; CI, 1.04-17.36; P=.04. Cases were more likely to have spondylolisthesis at C7-T1 than controls, OR, 3.61; CI, 1.75-7.44; P<.001. There was a lack of uniformity of disc space width at C6-C7, despite normal alignment of the vertebrae, in five (5.2%) cases and no control horses. Discospondylosis was seen in 9 (9.4%) horses at C7-T1 and 10 of 64 (15.6%) at T1-T2. The sagittal ratio for T1 was smaller for horses with neck-related forelimb lameness (P<.0002), neck pain/ stiffness (P=.04), or neurological cases (P<.001) than controls. The prevalence of radiological abnormalities at C7-T1 and T1-T2 highlights the importance of careful evaluation of the cervicothoracic junction in horses with neck-related signs.

Emergency Department Triage, Transfer Times, and Hospital Mortality of Patients Admitted to the ICU: A Retrospective Replication and Continuation Study.

This study aimed to provide new insights into the impact of emergency department (ED) to ICU time on hospital mortality, stratifying patients by academic and nonacademic teaching (NACT) hospitals, and considering Acute Physiology and Chronic Health Evaluation (APACHE)-IV probability and ED-triage scores. We conducted a retrospective cohort study (2009-2020) using data from the Dutch National Intensive Care Evaluation registry. Patients directly admitted from the ED to the ICU were included from four academic and eight NACT hospitals. Odds ratios (ORs) for mortality associated with ED-to-ICU time were estimated using multivariable regression, both crude and after adjusting for and stratifying by APACHE-IV probability and ED-triage scores. None. A total of 28,455 patients were included. The median ED-to-ICU time was 1.9 hours (interquartile range, 1.2-3.1 hr). No overall association was observed between ED-to-ICU time and hospital mortality after adjusting for APACHE-IV probability (p = 0.36). For patients with an APACHE-IV probability greater than 55.4% (highest quintile) and an ED-to-ICU time greater than 3.4 hours the adjusted OR (ORsadjApache) was 1.24 (95% CI, 1.00-1.54; p < 0.05) as compared with the reference category (< 1.1 hr). In the academic hospitals, the ORsadjApache for ED-to-ICU times of 1.6-2.3, 2.3-3.4, and greater than 3.4 hours were 1.21 (1.01-1.46), 1.21 (1.00-1.46), and 1.34 (1.10-1.64), respectively. In NACT hospitals, no association was observed (p = 0.07). Subsequently, ORs were adjusted for ED-triage score (ORsadjED). In the academic hospitals the ORsadjED for ED-to-ICU times greater than 3.4 hours was 0.98 (0.81-1.19), no overall association was observed (p = 0.08). In NACT hospitals, all time-ascending quintiles had ORsadjED values of less than 1.0 (p < 0.01). In patients with the highest APACHE-IV probability at academic hospitals, a prolonged ED-to-ICU time was associated with increased hospital mortality. We found no significant or consistent unfavorable association in lower APACHE-IV probability groups and NACT hospitals. The association between longer ED-to-ICU time and higher mortality was not found after adjustment and stratification for ED-triage score.

Adoption of self-measured blood pressure monitoring in underserved communities: Program evaluation in primary care.

Self-measured blood pressure (SMBP) monitoring is crucial for hypertension management, yet its adoption, particularly among disadvantaged populations, remains low. 'Love Your Heart' is a quality improvement program providing free standard SMBP devices to hypertensive patients, aiming to enhance adoption and assess its impact on blood pressure control. This study evaluates the 'Love Your Heart' program's implementation success through assessing adoption rates and exploring changes in systolic blood pressure (SBP) among participants. We aim to understand factors influencing adoption and potential benefits of SMBP monitoring in a diverse, socially disadvantaged patient population. We retrospectively evaluated the 'Love Your Heart' program using electronic health records (EHR) at a primary care site in Chicago. Adult patients with hypertension were enroled in the 6-month program, which included education sessions and free SMBP devices. Adoption was measured by participation in program components, and changes in SBP were analysed based on adoption status. Statistical analyses were conducted using SAS software, adhering to STROBE reporting guidelines. Of 621 eligible patients, 104 participated, with 83 included in the evaluation. Despite all participants receiving free SMBP devices, adoption rates were modest, with only 7% sharing readings with the care team. However, patients who received device instructions demonstrated greater decreases in SBP compared to those who did not. Although not statistically significant, clinically meaningful decreases in SBP were observed among adopters. The 'Love Your Heart' program highlights the challenges of promoting SMBP monitoring among disadvantaged patient populations. While providing free devices addresses access barriers, low reporting to the care team suggests the need for further support mechanisms. Future research should explore strategies to enhance SMBP adoption and integration into clinical care, particularly in settings lacking automated data transmission systems.

Clinical decision making in prostate cancer care—evaluation of EAU-guidelines use and novel decision support software

Keeping up to date with the latest clinical advances in prostate cancer can be challenging. We investigated the impact of guideline use on quality of treatment decisions as well as the impact of a novel, CE-certified clinical decision support tool (Siemens AIPC software) on the amount of time clinicians spend on decision-making in a multicenter setting. Ten urologists assessed ten clinical cases (screening and localized prostate cancer) in three settings: without support, using a digital version of the EAU guidelines, and with the AIPC tool, resulting in 300 clinical decisions. Comparison involved time spent, decision correct- and completeness. Using AIPC compared to digital guidelines led to a significant reduction of expenditure of time at a per case level (3.57 min and 0:14 min, p < 0.01) and for overall time per urologist (39.45 min and 02:20 min, p < 0.01). Decision options without guidelines support, online guideline usage and usage of AIPC were complete in 61%, 80% and 100%, respectively (p < 0.01). Decision making without guidelines support, online guideline usage and usage of AIPC was correct including all options in 28%, 66% and 100%, respectively (p < 0.01).Clinical decision support systems have the potential to reduces decision-making time and to enhance decision quality.