Careful Review Research Articles

Simplified rules-based tool to facilitate the application of up-to-date management recommendations in cardio-oncology

BackgroundMillions of cancer survivors are at risk of cardiovascular diseases, a leading cause of morbidity and mortality. Tools to potentially facilitate implementation of cardiology guidelines, consensus recommendations, and scientific statements to prevent atherosclerotic cardiovascular disease (ASCVD) and other cardiovascular diseases are limited. Thus, inadequate utilization of cardiovascular medications and imaging is widespread, including significantly lower rates of statin use among cancer survivors for whom statin therapy is indicated.MethodsIn this methodological study, we leveraged published guidelines documents to create a rules-based tool to include guidelines, expert consensus, and medical society scientific statements relevant to point of care cardiovascular disease prevention in the cardiovascular care of cancer survivors. Any overlap, redundancy, or ambiguous recommendations were identified and eliminated across all converted sources of knowledge. The integrity of the tool was assessed with use case examples and review of subsequent care suggestions.ResultsAn initial selection of 10 guidelines, expert consensus, and medical society scientific statements was made for this study. Then 7 were kept owing to overlap and revisions in society recommendations over recent years. Extensive formulae were employed to translate the recommendations of 7 selected guidelines into rules and proposed action measures. Patient suitability and care suggestions were assessed for several use case examples.ConclusionA simple rules-based application was designed to provide a potential format to deliver critical cardiovascular disease best-practice prevention recommendations at the point of care for cancer survivors. A version of this tool may potentially facilitate implementing these guidelines across clinics, payers, and health systems for preventing cardiovascular diseases in cancer survivors.Trial RegistrationClinicalTrials.Gov Identifier: NCT05377320.

Adherence to care and treatment review policy and impact on length of stay

PurposeThe purpose of this clinical audit was to review the adherence to the 2017 care and treatment review policy across two NHS assessment and treatment units. Care and treatment reviews should be offered to people with an intellectual disability and/or autism who are at risk of admission into a mental health hospital.Design/methodology/approachAdmission and discharge data was collected across two assessment and treatment units between January 2019 and December 2022. Adherence to the care and treatment review policy was also reviewed as was length of inpatient stay. A retrospective evaluation was conducted. Triangulation of data was collected via the trusts’ electronic patient record system and NHS analytics team. Descriptive statistics, Mann–Whitney U test and a one-way ANOVA with post hoc tests were used in the analysis.FindingsAn increase in behaviours of challenge and deterioration of mental health were the main reasons for admission. Forty-nine percent (30) of those admitted to the assessment and treatment units accessed a care and treatment review. Care and treatment reviews were more frequently provided for individuals experiencing longer inpatient stays.Originality/valueThere is limited evidence relating to outcomes and impact of care and treatment reviews. Further research is required to explore effectiveness of care and treatment reviews to understand benefits and appropriately prioritise resource.

A physiotherapy-led review of guideline-based care for community-dwelling older people presenting to a metropolitan hospital with accidental falls.

Several guidelines exist to inform best-practice management of community-dwelling fallers. This study aimed to outline a pragmatic approach to developing an audit tool for guideline-based care of falls and provide an overview of current practice. An audit tool to determine compliance with guideline-based care was developed with an allied health and physiotherapy focus, utilising the Australian Commission on Safety and Quality in Health-Care Guidelines for Preventing Falls and Harm from Falls in Older People (2009) and Queensland State Government 'Stay on your Feet' guidelines. A retrospective audit of medical records was completed in July 2020 of community-dwelling people aged 65 years and over with a fall-related emergency department (ED) presentation in a medium-sized metropolitan hospital in Australia. Data were compared between patients admitted to hospital and those discharged home from the ED. Ninety-three patients were included: 68 were discharged home from ED and 25 were admitted to hospital. There was a significant difference in receiving an allied health review (p < .001) between admitted patients (96%) and those who discharged home from ED (68%). The Clinical Frailty Scale was only completed for 23% of patients. Physiotherapy quality-of-care (n = 46 patients) was variable, with poor completion of physical outcome measures (7%) and fall education (4%). However, assessment of mobility was routinely completed (94%), and most patients were referred to an appropriate community service (66%). Adherence to guideline-based care of community-dwelling fallers is inconsistent. Improvements are required in the consistency of risk stratification, comprehensive physical assessment and patient education.

The Advantages of Using Artificial Intelligence in Urban Planning – A Review of Literature

Urban planning plays a crucial role in shaping communities for the future, analyzing their strengths and weaknesses, and proposing improvement solutions.This systematic literature review process used in this study ensured the inclusion of a wide range of sources, providing a comprehensive overview of the advantages of using artificial intelligence in urban planning. After a careful review of the literature, it is found that artificial intelligence is primarily used to enhance efficiency in urban planning processes, contributing to sustainability. The potential for future challenges has accelerated the adoption of artificial intelligence in urban planning by emphasizing the need for resilient, technology-driven cities. It supports more efficient urban design by automating tasks through generative design software, which subdivides plots and applies housing solutions. Artificial intelligence's role expands to multiple areas within the urban planning obligations of a city, including transportation, environment, waste management, education, healthcare, agriculture, risk management, and security. It guides urban planners by improving analytical models for understanding future physical and social community conditions. Artificial intelligence empowers planners to explore new data collection and analysis methods for predicting urban behavior, saving time and resources. It addresses climate change challenges by supporting transportation, waste management, and water use applications. Artificial intelligence technologies continue to advance, urban planning stands to benefit from increased efficiency, data-driven decision-making, and the creation of more sustainable, resilient cities. Urban planners must adapt themselves by acquiring the necessary skills to ensure successful city planning for the future. Overall, Artificial intelligence is contributing heavily to achieving sustainability by integrating past practices, trends, and new AI-based models.

A case of mistaken identity

Images that demonstrate large and obvious abnormalities sometimes distract the provider from the careful review necessary to make the correct diagnosis. In situations in which the differential diagnosis has a leading diagnosis that is correct almost all time, it is easy to be misled by more obvious possibilities, failing to spend enough time to see the important details, and pursuing therapy that might not result in a good patient outcome. The purpose of this case report is to help readers from making analogous errors in future cases similar to this one.&#x0D; &#x0D; Key words: pleural effusion, endobronchial obstruction, lung cancer, complications, chest tube

Hemolytic disease of the fetus and newborn: rapid review of postnatal care and outcomes

BackgroundAdvances in postnatal care for hemolytic disease of the fetus and newborn (HDFN) have occurred over the past decades, but little is known regarding the frequency of postnatal treatment and the clinical outcomes of affected neonates. Most studies reporting on HDFN originate from high-income countries or relatively large centers, but important differences between centers and countries may exist due to differences in prevalence and available treatment options. We therefore aimed to evaluate the postnatal treatment landscape and clinical outcomes in neonates with Rhesus factor D (Rh(D))- and/or K-mediated HDFN and to provide recommendations for future research.MethodsWe conducted a rapid literature review of case reports and series, observational retrospective and prospective cohort studies, and trials describing pregnancies or children affected by Rh(D)- or K-mediated HDFN published between 2005 and 2021. Information relevant to the treatment of HDFN and clinical outcomes was extracted. Medline, ClinicalTrials.gov and EMBASE were searched for relevant studies by two independent reviewers through title/abstract and full-text screening. Two independent reviewers extracted data and assessed methodological quality of included studies.ResultsForty-three studies reporting postnatal data were included. The median frequency of exchange transfusions was 6.0% [interquartile range (IQR): 0.0–20.0] in K-mediated HDFN and 26.5% [IQR: 18.0–42.9] in Rh(D)-mediated HDFN. The median use of simple red blood cell transfusions in K-mediated HDFN was 50.0% [IQR: 25.0–56.0] and 60.0% [IQR: 20.0–72.0] in Rh(D)-mediated HDFN. Large differences in transfusion rates were found between centers. Neonatal mortality amongst cases treated with intrauterine transfusion(s) was 1.2% [IQR: 0–4.4]. Guidelines and thresholds for exchange transfusions and simple RBC transfusions were reported in 50% of studies.ConclusionMost included studies were from middle- to high-income countries. No studies with a higher level of evidence from centers in low-income countries were available. We noted a shortage and inconsistency in the reporting of relevant data and provide recommendations for future reports. Although large variations between studies was found and information was often missing, analysis showed that the postnatal burden of HDFN, including need for neonatal interventions, remains high.Systematic review registrationPROSPERO 2021 CRD42021234940. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021234940.

Vaca Muerta: Improved Fracture Width Distribution and Classification of Natural Fracture Widths Based on Outcrops, Cores, and Microresistivity Images Data

Summary Natural fractures in Vaca Muerta are very complex, such that their fracture width distributions cannot be analyzed simply by considering normal, log-normal, or log-log distributions. Natural fractures are commonly classified as macrofractures or microfractures; however, no consistent fracture width is attached to those fractures. In this study, two new approaches are proposed; an improved fracture width distribution and a classification for natural fractures that encompasses all physical widths found in petroleum reservoirs. The method developed in this study first evaluates the distribution of natural fracture widths from outcrops, cores, and microresistivity images of Vaca Muerta shale. An improved fracture width distribution is established through a variable shape distribution (VSD). The model provides a good fit, even if the shape of the distribution deviates from generally accepted distributions. This improves the accuracy of fracture width and intensity prediction, which is useful in generating synthetic production logging tools (PLTs) to estimate productivity from fractured intervals. Subsequently, a consistent classification for natural fractures is introduced to cover all fracture widths found in petroleum reservoirs. Results indicate that fracture widths in Vaca Muerta shale range between 0.0003 mm and 7 mm for outcrops, 0.0003 mm and 2 mm for cores, and 0.01 mm and 2 mm for microresistivity images. The VSD model provides a good fit of fracture widths from the three sources, without truncating any of the data. Truncation of data is usually required when using generally accepted distributions. With this improved distribution, size pattern extrapolation can be performed with greater accuracy. The physical widths can also be translated into hydraulic apertures to generate theoretical PLT. This is useful for estimating relative petroleum production potential from each fractured interval and for identifying future refracturing zones. Additionally, the study gives origin to a consistent classification of fracture widths that has application in Vaca Muerta and other oil and gas reservoirs. Five subclasses are introduced, which are megafractures (&amp;gt; 10 mm), macrofractures (1–10 mm), mesofractures (0.1–1 mm), microfractures (0.01–0.1 mm), and nanofractures (&amp;lt;0.01 mm). A careful review of the literature indicates that there is ambivalence as it is hard to find a clear and precise terminology that encompasses the entire range of fracture widths. The proposed classification eliminates that difficulty. In this paper, for the first time, a consistent fracture width classification is developed that encompasses the whole spectrum of widths found in petroleum reservoirs. It has wide application in Vaca Muerta, where widths, derived from outcrops, cores, and microresistivity image data are matched with a VSD model. Furthermore, the proposed classification can be used in other oil and gas reservoirs, thus eliminating the fracture width ambivalence found many times in the geoscience and petroleum engineering literature.

Clinical characteristics of child and adolescent psychiatric outpatients engaging in fireplay or arson: a case–control study

BackgroundFireplay and arson incidents among children and adolescents have gained attention because of their potentially severe consequences and societal impacts. Understanding the underlying psychiatric characteristics of individuals engaging in fireplay or arson is crucial for early identification and targeted intervention. However, there is a lack of research conducted in clinical psychiatric populations in this context. This study compared the clinical characteristics of child and adolescent psychiatric outpatients who engaged in fireplay or arson with those without such behaviors.MethodsA retrospective case–control study was conducted using data collected from patients who visited the Department of Child and Adolescent Psychiatry at Kohnodai Hospital, National Center for Global Health and Medicine in Japan, between April 2014 and March 2022. Medical records were checked to see if the patient had practically committed behaviors that corresponded to fireplay or arson. The case group was identified using this process. After identifying the case and control groups, sex, diagnosis, antisocial behavior, abuse history, and children-to-parent violence were assessed and compared by careful review of medical records.ResultsThe study identified 64 patients who engaged in fireplay or arson, representing approximately 1.1% of the total 5,587 patients (case group). The median age of the patients’ first fire-related behavior was 13 years (range, 6–18 years). In the case group, 14.1% of the cases involved arson, resulting in substantial damage. Of the remaining 5523 patients, 2268 patients had datasets for the first consultation (control group). The most prevalent diagnosis in the case group was attention-deficit hyperactivity disorder (ADHD), present in 57.8% of the cases. The study revealed a significant association between fire-related behaviors and ADHD as well as antisocial behavior. Gender differences were observed, with boys being more likely to engage in fireplay or arson than girls.ConclusionsThis study suggests that clinicians and mental health professionals should closely consider male sex, ADHD, and antisocial behaviors as potential risk factors for fire-related behaviors. Monitoring the case group for the development of psychiatric disorders, including the use of illegal drugs, is recommended to prevent future arson incidents.

The Process of Marketisation and Economic Realities in the DPRK

ABSTRACT This article analyses the pattern and degree of marketisation in the DPRK by drawing on sources from within that society. In doing so it creates a point of departure from most conventional analyses of the DPRK economy, which prioritise defector accounts. The conventional view, informed by these accounts, is that jangmadang (quasi-free markets) have been created by ordinary people to meet their basic needs. In this view, ‘marketisation from below’ started when the Public Distribution System broke down due to the collapse of the Soviet Union, upon which the DPRK economy had depended. It is also claimed that as the economy has failed to recover from its prolonged crisis, the State has become dependent upon these markets. However, a careful review of materials produced inside the DPRK indicates that marketisation started ‘from above’ in the early 1980s, with Kim Il Sung’s directives to assuage the chronic shortages of consumer goods. As such, this article contends that marketisation in the DPRK began and has proceeded in accordance with the State’s control and influence. The country’s complete closure of its borders to prevent COVID-19 in the early 2020s confirmed that markets play only a limited role in DPRK society.

2023 IJSPT Orthopedic Summit Research Abstracts.

The International Journal of Sports Physical Therapy is pleased to publish abstracts from the thirteenth Orthopaedic Summit (OSET) taking place in Boston, September 19-23, 2023. The IJSPT hosted the third annual research forum and reception at OSET, sponsored by ATI Physical Therapy and Hyperice. The abstracts presented in the following pages were selected by the OSET Research Committee and editorial staff of the International Journal of Sports Physical Therapy. After careful review, a total of 20 research abstracts were accepted and presented at OSET 2023. Awards for outstanding abstracts were presented on September 22. The 2023 abstracts include contemporary orthopaedic and rehabilitation topics across various research designs. Each abstract presents only a brief summary of a research project / presentation and does not permit full assessment of the scientific rigor with which the work was conducted. While the abstracts offer only preliminary results that may require further refinement and future validation, they do serve an important role in sharing new research ideas and rehabilitation advancements. This sharing of ideas helps to encourage dialogue among researchers, clinicians, and educators that will ultimately contribute to the orthopaedic and rehabilitation body of knowledge. We strongly encourage authors to continue pursuing the publication of their research as a full manuscript. Thank you to all submitting abstracts for consideration. We look forward to another outstanding season of submissions for OSET in 2024. Phil Page PhD, PT, ATC Chuck Thigpen PhD, PT, ATC OSET Research Committee Co-Chairs.

Role of Multidisciplinary Team Meetings in the Diagnosis and Management of Diffuse Parenchymal Lung Diseases in a Tertiary Care Hospital.

Background Decisions on the management of interstitial lung diseases (ILD) and prognostication require an accurate diagnosis. It has been proposed that multidisciplinary team (MDT) meetings for ILD (ILD-MDT) improve these decisions in challenging cases of ILD. However, most studies in this field have been based on the decisions of individual clinicians and there are few reports on the outcomes of the ILD-MDT approach. We therefore describe the experience of the ILD-MDT meetings at our institution. Methods A single-center retrospective review of the electronic health care records of patients discussed in the ILD-MDT meetings at our institution from February 2016 to January 2021 was performed. At out institution, at each ILD-MDT meeting, the referring pulmonologist presents the clinical history and the results of all relevant investigations including serology, blood gas analyses, lung function tests, bronchoscopy, and bronchoalveolar lavage. A radiologist then describes the imaging including serial computed tomography (CT) scans. When available, the findings on lung biopsy are presented by a pathologist. Subsequent discussions lead to a consensus on the diagnosis and further management. Results The study included 121 patients, comprising 71 (57%) males and 76 nonsmokers (62.8%), with a mean age of 65 years (range: 25-93 years). The average number of comorbidities was 2.4 (range: 0-7). Imaging-based diagnoses were usual interstitial pneumonia (UIP)/chronic hypersensitivity pneumonitis (CHP) in 32 (26%) patients, UIP in 20 (17%) patients, probable UIP in 27 (22%) patients, nonspecific interstitial pneumonia in 11 (9%) patients, and indeterminate interstitial lung abnormalities (ILA) in 10 (8%) patients. The most common consensus clinical diagnosis after an ILD-MDT discussion was chronic hypersensitivity pneumonitis/idiopathic pulmonary fibrosis in 17 patients (14%), followed by idiopathic pulmonary fibrosis and connective tissue disease associated interstitial lung disease in 16 patients (13%), CHP in 11 patients (9.1%), and ILA in 10 patients (8.4%). Only a 42 patients (35%) required surgical lung biopsy for confirmation of the diagnosis. Conclusion This study describes the characteristics of the patients discussed in the ILD-MDT meetings with emphasis on their clinical, radiological, and laboratory data to reach a diagnosis and management plan. The decisions on commencement of antifibrotics or immunosuppressive therapy for patients with various ILDs are also made during these ILD-MDT meetings. This descriptive study could help other health care professionals regarding the structure of their ILD-MDT meetings and with discussions about diagnostic and care decisions for diffused parenchymal lung disease patients.

Acute Myeloid Leukemia with Acute Spinal Cord Compression as the First Feature

Abstract Malignant myeloid sarcoma (chloroma) is a rare extramedullary solid tumor that consists of immature myeloid precursor cells, constantly associated with acute myeloid leukemia (AML). Here, we report the case of a 35-year-old male who developed an acute paraplegia secondary to paraspinal chloroma associated with AML. A careful review of the patient’s history, blood smear, and bone marrow findings will decrease the chance of missing the diagnosis.

Long-Term Outcome in Stroke: The Need of Individualized Follow-Up

Introduction: It is well established that in the long-term, many stroke patients potentially have relevant functional incapacity related to deficits in domains other than motor; the burden of unmet long-term needs likely varies between different types of stroke or different healthcare systems. On the other hand, we can say that the ideal length of follow-up in a specialized consultation after ischemic stroke has not been established. Methods: We evaluated long-term stroke patients who underwent endovascular treatment of anterior circulation in our stroke center and that were classified as “therapeutic success” (modified Rankin scale - mRS &lt;3) at 3 months, to participate in an observational, cross-sectional study. Participants underwent a comprehensive interview and examination using validated standard questionnaires for Portuguese population to assess different life aspects after stroke as Post-Stroke Checklist, EQ-5D-3L scale, mRS, Barthel Index (BI), Burden Scale for Family Caregivers and Hamilton scale. Results: We evaluated 36 patients. The mean age was 67.6 years old (±13,8) and the mean time for the interview was 52,8 (±9,9) months after the stroke. Most patients were independent, with a mean mRS of 1 (ranging from 0–3) and BI 95,4 (70-100). Sixty one percent had a clinically significant deficit in at least one domain. On the Post Stroke Checklist (PSC), 77,8% of participants demonstrated a not good perceived health status. EuroQoL index value was 0.750 (IQR 0.664–1.00). The two major disability parameters identified were in cognition (52,8%) and depression (27,8%). After review of the ongoing care by stroke specialists, in almost 2/3 of the patients, additional measures were proposed: additional etiological investigation (44%), physical or speech rehabilitation (~14%) or changes in pharmacological therapy (~3%). Conclusion: These results highlight the prevalence and importance of non-motor disabilities in long-term stroke patients, even after short-term classification as “therapeutic success”. We also point out that even after more than 3 years of the stroke, additional therapeutic or etiological investigation measures were taken, reinforcing the need for individualized follow-up, without a pre-defined maximum follow-up time in a specialized cerebrovascular pathology consultation.

The impact of wearing facemask on COPD patients: A protocol of a systematic review and meta-analysis.

Chronic obstructive pulmonary disease (COPD) is a common, irreversible but preventable disease characterized by persistent respiratory symptoms. The mortality rate of COPD is predicted to reach 5.4 million by the year 2060. Despite its heavy burden on healthcare expenditure worldwide, only 15% of cases are medically identified. The potential benefits of facemask-wearing for COPD patients remain a topic of debate. We will conduct a systematic review of all randomized trials and non-randomized controlled trials to evaluate the impact of facemasks on COPD patients. Our review will be based on literature obtained through a comprehensive search strategy across multiple electronic databases, including the Cochrane Library, Embase, PubMed, Web of Science, the Chinese Biomedical Database (SinoMed), and China National Knowledge Infrastructure (CNKI), with no restrictions on language or date of publication. Two independent researchers will extract and assess all relevant data using pre-designed data extraction forms. The included studies will be assessed using the Cochrane RoB2 tool and the suggested risk of bias criteria proposed by the Effective Practice and Organization of Care reviews group of the Cochrane collaboration. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We will use Review Manager 5.4 software for statistical analysis. In the context of COVID-19, it is important for COPD patients to wear facemasks. This study aims to conduct a comprehensive and systematic assessment of the impact of facemasks on the physiology and activity of COPD patients. PROSPERO registration number CRD42022326265.

P20 Thoracic outlet obstruction – first presentation of a rheumatological disorder

P20 Thoracic outlet obstruction – first presentation of a rheumatological disorder

Artificial Intelligence and Its Role in the Management of Chronic Medical Conditions: A Systematic Review.

Due to the increased burden of chronic medical conditions in recent years, artificial intelligence (AI) is suggested in the medical field to optimize health care. Physicians could implement these automated problem-solving tools for their benefit, reducing their workload, assisting in diagnostics, and supporting clinical decision-making. These tools are being considered for future medical assistance in real life. A literature review was performed to assess the impact of AI on the patient population with chronic medical conditions, using standardized guidelines. A MeSH strategy was created, and the database was searched for appropriate studies using specific inclusion and exclusion criteria. The online database yielded 93 results from various databases, of which 10 moderate to high-quality studies were selected to be included in our systematic review after removing the duplicates, screening titles, and articles. Of the 10 studies, nine recommended using AI after considering the potential limitations such as privacy protection, medicolegal implications, and psychosocial aspects. Due to its non-fatigable nature, AI was found to be of immense help in image recognition. It was also found to be valuable in various disciplines related to administration, physician burden, and patient adherence. The newer technologies of Chatbots and eHealth applications are of great help when used safely and effectively after proper patient education. After a careful review conducted by our team members, it is safe to conclude that implementing AI in daily clinical practice could potentiate the cognitive ability of physicians and decrease the workload through various automated technologies such as image recognition, speech recognition, and voice recognition due to its unmatchable speed and non-fatigable nature when compared to clinicians. Despite its vast benefits to the medical field, a few limitations could hinder its effective implementation into real-life practice, which requires enormous research and strict regulations to support its role as a physician's aid. However, AI should only be used as a medical support system, in order to improve the primary outcomes such as reducing waiting time, healthcare costs, and workload. AI should not be meant to replace physicians.

Poster ID: 39 How is Paediatric Inpatient Care in Canadian Hospitals Structured to Respond to the Needs of Children with Medical Complexity?

Abstract Background Children with medical complexity (CMC) have diverse medical diagnoses and the following characteristics: multisystem disease, functional limitations, high care needs, and high healthcare utilization. CMC have intensive inpatient resource use with associated high healthcare costs. Best practices and service delivery models to guide inpatient care of CMC are not yet established and likely vary considerably among institutions. Objectives The objective of this study is to describe the availability and organization of resources for CMC during inpatient care across Canadian paediatric hospitals and assess how these services are adapted to the specific needs of CMC. Design/Methods This environmental scan was conducted as a cross-sectional, researcher-administered virtual survey. The instrument was developed based on a literature review of inpatient complex care and consensus among a panel of content experts. The survey was pilot tested with two complex care physicians and one with expertise in questionnaire development. The survey was available in both English and French. Survey participants were identified through snowball sampling within the Canadian Paediatric Inpatient Research Network (PIRN) with the aim of identifying a key informant from each paediatric hospital. Consistent members of the research team administered survey questions to participants via Zoom, and responses were entered into the Qualtrics platform. Quantitative survey responses were analyzed using univariate descriptive analysis. Qualitative responses were categorized and described for comparative purposes. Results Ten interviews were conducted representing ten different paediatric hospitals. Although nine had established complex care programs, only one of these had a specific inpatient care team for CMC. The physician-to-patient and nurse-to-patient ratios were the same for CMC and non-CMC patients. All sites had some form of standardized documentation to support inpatient care of CMC, but each had different elements and purposes. Only two sites had conducted formal evaluation of their inpatient program for CMC. Key informants rated their hospital’s ability to meet the specific inpatient needs of CMC as a 6.5 out of 10 (on average), with a range of 4-8. Conclusion These results suggest a relative lack of inpatient resources directed to CMC, with a high proportion of sites having a complex care program but with few that include a dedicated inpatient team. Further, there is a lack of standardization across the country in terms of documentation and best practices. Key informants perceive room for improvement in inpatient care at their sites. Future studies will identify evidence-based best practices that can be further evaluated and spread.

Impact of an Interprofessional HIV Quality Improvement Team on Patient Care and Resident Learning Opportunities.

Although human immunodeficiency virus (HIV) care is a recommended competency for family medicine training, many programs report a lack of HIV expertise among faculty. After the departure of faculty with HIV care experience, an interprofessional HIV quality improvement team (HIV-QIT) of physicians and pharmacists aimed to maintain on-site HIV care and retain learning opportunities for residents, using process improvement and panel reviews with a remote HIV specialist faculty member. This study reports on a multicycle quality improvement pilot project with pre- and postintervention chart reviews between December 2019 and May 2021. All patients received primary care and HIV-QIT chart reviews on-site. We compared patients with integrated HIV care on-site to those receiving external HIV specialty care. Primary outcomes included virologic suppression, CD4 count ≥200 cells/mm3, and adherence to guideline-recommended HIV care. In cycle 1 (January-June 2020), the HIV-QIT reviewed patient charts and sent guideline-based recommendations to physicians. In cycle 2 (July 2020-May 2021), the HIV-QIT implemented several HIV-specific processes, including decision support updates, note templates, order sets, and reference materials. Sustained process improvements included HIV panel chart audits every 3 to 6 months and subsequent provider education. Of 29 patients, more than half (55%, n=16) received integrated HIV care at the primary care site. We found no significant difference in care quality measures between primary and specialty care. Barriers to care completion included missed or canceled follow-up visits, on-site phlebotomy service closures, and declined HIV services. The HIV-QIT maintained on-site HIV treatment and retained experiential learning opportunities through process improvement and specialist-supported care recommendations to primary care physicians.

The Differences in Accounting Quality between Chinese Companies and American Companies Listed in the United States

This research paper investigates the difference between Chinese listed companies in the US and US companies regarding the quality of accounting information from companies annual reports. After a careful review of literature, researchers decided to apply classic M-score model for information processing and one sample t-test to determine the relationship between accounting quality and the country of the company. There are two hypotheses, and the first one is that the difference between the mean M-score of U.S. listed Chinese companies and the mean M-score of U.S. companies is not significant. The second one is the difference between the mean M-score of U.S. listed Chinese companies, and the mean M-score of U.S. companies is significant. This research result turned out to support the first hypothesis, indicating that the difference between the accounting qualities of the two types of companies is not significant.

‘They feel like another child in care has their back’: An exploration of peer support between looked after children in Scotland

AbstractThe Independent Care Review in Scotland has encouraged a policy shift towards recognizing young people's potential to contribute to their own and others' experiences of care. This paper makes an important contribution to debates around the role of children in the social support systems of others who have experienced loss and trauma. It reports on a research project which explored young people's views on peer support in care and their experiences of it. It highlights the crucial role that ‘peers’ play in looked after children's social support systems at both an individual and systemic level. Friendships, in this context of a social support system based on a shared set of experiences, were regarded as transformative. Barriers to the formation of such social support systems also emerged, for example, limited understanding within the ‘adult’ support system of the significance and benefits of relationships among children. Young people experienced their peer social support systems as overlooked, downplayed or misunderstood by adults. As a result, decisions and actions were often taken which disrupted or, in some cases, destroyed effective social support systems. The paper argues for changes in practice to support the friendships looked after children have whilst in care.