Careful Review Research Articles

Spiritual Care and Pregnant Women: A Literature Review

Background: Spiritual care is an intervention based on the client's potential power of faith and spirituality, in order to empower him to use spiritual resources, in order to deal with critical situations, including pregnancy. Physical and mental changes during pregnancy make women mentally vulnerable. The purpose of this study is to review the researches done about the effect of spiritual care on pregnancy stress and anxiety.
 Methods: In this study, to find articles, search databases, Google Scholar; Iran Medex; Magiran; SID and using a combination of Persian keywords Spiritual care, Spirituality, Pregnant women, Childbirth and their English equivalent in databases, Embase, Web of Science, PubMed, Scopus without time limit were searched. From a total of 28 articles obtained after careful review in terms of providing duplicate results, 15 articles were selected and finally 7 articles in terms of inclusion and exclusion criteria in this study were included and reviewed.
 Results: In general, it can be said that the number of studies conducted in recent years focusing on the effect of spirituality on pregnancy and childbirth is limited. The results of studies have shown that spiritual care can reduce stress, anxiety, depression and even increase the quality of life of pregnant women.
 Conclusion: Spirituality can help people to evaluate negative events in a different way, this first creates a sense of control over oneself and the environment, and then reduces anxiety, stress and increases the quality of life.

Do physicians know when to refer patients for genetic testing?

Primary care physicians (PCPs) are commonly approached with concerns involving patient genetics. This is a challenge because most PCPs lack expertise in genetic testing compared to their genetic counselor counterparts. Currently, the recommended best practice is to refer patients for genetic testing based on cancer-related family history questionnaires with a genetic counseling referral to discuss their results and any implications. However, the extent to which PCPs are using these questionnaires for this purpose remains poorly understood. In this cross-sectional study, PCPs were presented with the American Cancer Society's seven recommended family history questions to determine the percentage who consider each to be an indicator for referral to a genetics specialist. Questionnaires were completed by 88 of 260 attending PCPs at a national primary care review conference. The main outcome was the percentage of PCPs who identified each question as a trigger for genetic testing. Secondary outcomes included correlations with years of practice, genetics training, and methods used to obtain patient family history. Only two of the seven questions were considered triggers by most PCPs (range, 76-83%). The remaining five had lower percentages (range, 22-55%). Years of practice did not influence the number of triggers identified (Spearman correlation coefficient test: r = 0.05, p = 0.68). Few PCPs (3.4%) felt they had good to excellent genetics training during residency. Only 44.3% had genetics specialists available for referral. Overall, low percentages of PCPs consider the American Cancer Society questions to be triggers for genetic testing referrals. Furthermore, many do not have a genetics specialist or counselor available for referral. Addressing these concerns may help PCPs understand the basics of genetic testing and use standardized questionnaires to make appropriate referrals to genetic specialists, thereby reducing inappropriate referrals and improving appointment access to this precious resource for those who truly need it.

TSC2 inactivation, low mutation burden and high macrophage infiltration characterise hepatic angiomyolipomas.

Although TSC1 or TSC2 inactivating mutations that lead to mTORC1 hyperactivation have been reported in hepatic angiomyolipomas (hAML), the role of other somatic genetic events that may contribute to hAML development is unknown. There are also limited data regarding the tumour microenvironment (TME) of hAML. The aim of the present study was to identify other somatic events in genomic level and changes in TME that contribute to tumorigenesis in hAML. In this study, we performed exome sequencing in nine sporadic hAML tumours and deep-coverage targeted sequencing for TSC2 in three additional hAML. Immunohistochemistry and multiplex immunofluorescence were carried out for15 proteins to characterise the tumour microenvironment and assess immune cell infiltration. Inactivating somatic variants in TSC2 were identified in 10 of 12 (83%) cases, with a median allele frequency of 13.6%. Five to 18 somatic variants (median number: nine, median allele frequency 21%) not in TSC1 or TSC2 were also identified, mostly of uncertain clinical significance. Copy number changes were rare, but detection wasimpaired by low tumour purity. Immunohistochemistry demonstrated numerous CD68+ macrophages of distinct appearance from Küpffer cells. Multiplex immunofluorescence revealed low numbers of exhausted PD-1+/PD-L1+, FOXP3+ and CD8+ T cells. hAML tumours have consistent inactivating mutations in TSC2 and have a low somatic mutation rate, similar to other TSC-associated tumours. Careful histological review, standard IHC and multiplex immunofluorescence demonstrated marked infiltration by non-neoplastic inflammatory cells, mostly macrophages.

Integration of social determinants of health information within the primary care electronic health record: a systematic review of patient perspectives and experiences.

Social determinants of health (SDOH) are the non-medical factors that impact health. Although geographical measures of deprivation are used, individual measures of social risk could identify those most at risk and generate more personalised care and targeted referrals to community resources. We know SDOH are important to health care, but it is not yet known whether their collection via the electronic health record (EHR) is acceptable and useful from the patient perspective. To synthesise relevant literature to explore patient perspectives on integrating information about SDOH into primary care EHRs, and the opportunities and challenges of its implementation in a general practice setting. Systematic review of primary care-based qualitative and mixed-method studies using thematic framework analysis. Key databases were searched for articles reporting patient perspectives of SDOH collection within the primary care EHR. Qualitative and mixed-methods studies written in English were included. A framework analysis was conducted to identify themes. From 14 included studies, the following five main themes were identified: rationale for SDOH screening and the anticipated outcomes; impact of the provider-patient relationship on patient perceptions; data, which included privacy concerns; screening process and referral; and recommendations for future research. Integration of information on SDOH into the EHR appears acceptable to patients. This review has added to the discussion of whether and how to implement SDOH screening and referral programmes into UK primary care systems.

Developing Family Nurse Practitioner Student Competencies: A Two-Part Mental Health-Focused Telehealth Education Activity

Telehealth is becoming a vital option for increasing access to health care. Family Nurse Practitioners (FNPs) are often the primary providers for rural and disadvantaged populations. They may be the first to encounter patients experiencing depression and other psychiatric problems. This article describes a two-part simulated telehealth education initiative to build FNP student competencies in the use of telehealth technology to interview clients with depressive symptoms.In Part 1, students completed didactic modules that introduced them to telehealth concepts. In Part 2, they participated in a simulated telehealth encounter with a standardized patient experiencing depression. Preparation included a review of care of patients with depression and focused content on telehealth etiquette. After the encounter, they received feedback from the standardized patient, debriefed with faculty, and documented their simulated telehealth visit. The activity was evaluated through post-education surveys and a one-time focus group.Students were overwhelmingly positive regarding the relevance of the educational activity to their graduate preparation and future practice. Many shared suggestions for refinement of the activity. Integration into the current curriculum and use of existing resources increased the feasibility, cost-effectiveness, and potential for long-term sustainability of the educational initiative.

Deep Venous Thrombosis as the Clinical Expression of POEMS Syndrome

This case suggests that POEMS syndrome does present with a constellation of signs and symptoms that may lead a clinician to a multitude of other possible diagnoses. Diagnosis is often difficult and delayed. A good history and physical examination as well as a careful review of all workups are paramount in establishing this particular diagnosis. The major criteria of diagnostic for the syndrome are polyradiculoneuropathy, clonal plasma disorder, sclerotic bone lesions, the presence of Castleman disease, and elevated vascular endothelial growth factor. Minor features include organomegaly, extravascular volume overload, endocrinopathy, characteristic skin changes, papilledema, and thrombocytosis. The diagnosis is made with three of the major criteria, two of which must include polyradiculoneuropathy and clonal plasma cell disorder, and at least one of the minor criteria. In this article, we discuss the differential diagnosis and outline the clinical evaluation indicated.

Ijtiḥād in Directing the Complicated Articles in the Principles of Islamic Jurisprudence Ibn Taymiyyah as a case study

This paper aims to study a group of complicated articles in the principles of Islamic jurisprudence that Taqi al-Din Ibn Taymiyyah dealt with and directed, after reviewing his work thoroughly, the selection fell on four articles, which are: Al-Samaniyah’s article on limiting the perceptions of knowledge to the senses, the article of the majority of the scholars of the principles of Islamic Jurisprudence on the scarcity of the overall memorized text, the article of Al-Shāfiʿī and Ahmad regarding the negation of abrogation of the Qur’an for the Sunnah, And Al-ʿAnbari’s article on correcting every Mujtahid (the one giving an independent reasoning). The paper dealt in each article with three issues: its origin, the point of its complication, and Ibn Taymiyyah’s treatment of it. In studying the articles presented, the researcher adopted the critical analytical approach. This paper concluded that: the distinction of al-Taimi’s work due to the wide reading of articles, and a thorough critic in dealing with the articles at the level of authenticating, reviewing and directing, addressing the complicated issues that the scholars are less exposed to, with the investigation of Ibn Taymiyyah's directives to these articles. The study recommended careful reviewing of articles in this field, investigating their issues, and treating them according to the correct approach, giving observations and correcting them according to contemporary studies, and urging for extensive writing in this field according to Ibn Taymiyyah and other critics of the scholars of this discipline.

Update of expert recommendations on Wilson’s disease management

Wilson's disease is a rare autosomal recessive hereditary disorder of copper metabolism characterized by excessive copper build up in tissues, including brain and liver. The genetic defect localized at the 13q14 – q21 locus affects the gene for copper transporting protein ATP7B in the liver. This defect can be caused by deletions, insertions or missense mutations, leading to disruption of the copper incorporation into ceruloplasmin and the excretion of excess copper into bile. The disease is characterized by liver damage, neuropsychiatric symptoms, musculoskeletal, hematological and renal clinical signs, the presence of Kayser-Fleischer rings as well as many other possible symptoms, with their manifestation depending on the timeliness of diagnosis, stage and form of the disease, and therapeutic interventions.Organizations investigating the problems of Wilson's disease regularly issue new recommendations as knowledge about the disease expands. Innovative diagnostic and therapeutic procedures are put into practice, and views on the course of the disease features change. The general updates of the latest international recommendations described in this article for their early introduction into practical healthcare relate to diagnostic algorithms, indications and the choice of timing and methods of drug treatment in various groups of patients with Wilson's disease, including a more complete review of neuropsychiatric care, as well as the possible tools for therapy monitoring.

Recommendations for the scope of the Department of Health and Social Care review of licensing in England–the case for redefining the more invasive procedures as ‘surgical’

Non-surgical procedures have been the subject of controversy, in part due to their invasiveness. Professor David Sines from the Joint Council for Cosmetic Practitioners (JCCP) introduces a new non-surgical licensing scheme for England

Three trailblazer councils to pilot MacAlister's ‘families first’ plan

Council leaders share early proposals on delivery of the government's Families First for Children scheme designed to ‘test new ways to reform every part of children's social care’ in response to the Care Review

Review of patient-centered primary care: Getting from good to great.

Reviews the book, Patient-Centered Primary Care: Getting From Good to Great by Alexander Blount (2019). Blount convincingly explains why patient-centered care matters. Blount makes the case for integrated primary care within the milieu of the patient-centered medical home as both the logical future of health care delivery and an ethical imperative. He describes integrated care as a key factor in promoting reciprocity between optimal patient outcomes and reduced physician burnout, articulating a model of integrated care composed of four transformative principles: transparency, empowerment, activation, and mutuality, or the "T.E.A.M. Way." Blount was successful in producing a thorough and frank handbook for patient-centered primary care. Well researched and expertly organized, this book is an informative and accessible book ideal for professionals and practices in the beginning phases of transition, as well as a potent resource for anyone who aims to understand and/or articulate a rationale for patient-centered, integrated primary care-one that we as clinicians and faculty will likely return to repeatedly. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Complete mesogastric excision for gastric cancer: is it the future of gastric cancer surgery?

Gastric cancer remains undoubtedly one of the most common and deadly cancers worldwide. The global incidence shows wide geographic variation with a high prevalence in Asia. Besides that, there are evident differences in epidemiology, histopathology, tumor location, diagnosisand treatment strategy between east and west countries. Gastric cancer represents an aggressive disease, with many factors influencing its development and also recurrence after surgical resection. New knowledge of disease spread and new routes of metastases are now emerging and the 'novel' concept of complete mesogastric excision for gastric cancer is under consideration and debate. This article aims to analyze and highlight this new concept after a careful literature review, offering also a view toward the future.

Delivering the promise: Embedding care experienced young people’s voices into education planning and service design

Educational Psychologists (EPs) play a key role in ‘Keeping the Promise’ by helping to ensure that care experienced children and young people (CECYP) receive all they need to thrive. The Independent Care Review highlighted that transitions can be scary and upsetting for CECYP and Scotland must work to ensure that transitions are limited, relational, planned, and informed. The lived experiences of three care experienced university students in relation to their transition out of high school in Scotland, were explored through semi-structured interviews using the online platform Microsoft Teams. Interpretative Phenomenological Analysis (Smith, 2009) was used to identify themes. The key themes of ‘feeling a lack of control’ and ‘ambitions stuck in the side-lines’ highlighted that damaging stereotypes, organisational pressures, and feeling voiceless, were all barriers to a positive transition out of high school for the participants. The research findings are discussed in relation to the foundation of ‘Voice’, as outlined in The Promise Scotland. Implications for EP practice are discussed both in relation to the transition out of high school and into university for CECYP, but also with a broader lens of embedding CECYP’s views into educational practice.

Missing the Mark: Assessing Dispositions and the Reification of Whiteness in Teacher Preparation

In order to explore whether the WatermarkTM Educator Disposition Assessment (EDA) is an equitable assessment for all teacher candidates regardless of race, this study used a Quantitative Critical Race Theory (QuantCrit) methodological design to analyze a pilot implementation of the assessment representing 650 discreet disposition assessments undertaken in 24 designated courses in five distinct programs of educator preparation at a midsized Midwestern university. Chi-square analysis and descriptive statistics from fall 2019–spring 2020 archival data indicate a statistically significant association between the variable race and the average scores assigned to students in multiple EDA assessments, with marked disadvantages for Black teacher candidates. Through this analysis and a careful and critical review of language embedded in each rubric row, the authors argue that the WatermarkTM EDA advances and reifies a set of normative practices that align with dominant White, middle-class cultural values under the guise of objectivity.

Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with cardiogenic shock despite the lack of evidence from adequately powered randomised clinical trials. Three trials reported so far were underpowered to detect a survival benefit; we therefore conducted an individual patient-based meta-analysis to assess the effect of VA-ECMO on 30-day death rate. Randomised clinical trials comparing early routine use of VA-ECMO versus optimal medical therapy alone in patients presenting with infarct-related cardiogenic shock were identified by searching MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and trial registries until June 12, 2023. Trials were included if at least all-cause death rate 30 days after in-hospital randomisation was reported and trial investigators agreed to collaborate (ie, providing individual patient data). Odds ratios (ORs) as primary outcome measure were pooled using logistic regression models. This study is registered with PROSPERO (CRD42023431258). Four trials (n=567 patients; 284 VA-ECMO, 283 control) were identified and included. Overall, there was no significant reduction of 30-day death rate with the early use of VA-ECMO (OR 0·93; 95% CI 0·66-1·29). Complication rates were higher with VA-ECMO for major bleeding (OR 2·44; 95% CI 1·55-3·84) and peripheral ischaemic vascular complications (OR 3·53; 95% CI 1·70-7·34). Prespecified subgroup analyses were consistent and did not show any benefit for VA-ECMO (pinteraction ≥0·079). VA-ECMO did not reduce 30-day death rate compared with medical therapy alone in patients with infarct-related cardiogenic shock, and an increase in major bleeding and vascular complications was observed. A careful review of the indication for VA-ECMO in this setting is warranted. Foundation Institut für Herzinfarktforschung.

Establishing and sustaining an acute care for elders unit: An incremental journey to success.

Acute Care for Elders (ACE) units reduce hospital-associated delirium, functional decline, and lengths of stay. However, establishing and sustaining such units have proven difficult. There are only 43 ACE units among the >3500 hospitals in the United States. This study describes an iterative quality improvement process, which allowed us to establish and sustain an ACE unit care model in a modern academic hospital. This continuous process was centered on implementing the key principles of the ACE unit model of care: patient-centered care assessments, medical care review, specialized prepared environment, early mobilization, physical therapy, and early planning for discharge to home. Quality of care and patient outcomes data for older adults admitted to our ACE unit includes mortality index (observed/expected) consistently <1 (FY22 = 0.86), 30-day readmission rate of <10% (FY22 9.31%), and length of stay index of ~1 (FY22 1.07). We describe how work on our ACE unit has led to hospital-wide initiatives, including dementia-friendly hospital certification. Our hope is that others can use this process to enhance the dissemination of the ACE unit model of care.

Tension pneumocephalus as a complication of surgical evacuation of chronic subdural hematoma: case report and literature review.

The management of symptomatic chronic subdural hematoma (CSDH) is surgical evacuation and prognosis in most cases is good. Tension pneumocephalus is the presence of air under pressure in the intracranial cavity. A case of tension pneumocephalus developing as a complication of burr hole evacuation of CSDH is illustrated. In this case, tension pneumocephalus was managed by reopening the wound and saline irrigation with a subdural drain placement. Considering this case report and after a careful review of the literature, the physiopathology, diagnosis, and treatment of this complication are highlighted in the article.

WTP4.6 Assessment of the Over 75’s undergoing Emergency Laparotomy

Abstract Introduction The National Emergency Laparotomy Audit (NELA) 2019 reported 55% of patients undergoing emergency laparotomies were over 65 years old. 19% had formal frailty assessments and 37% had geriatrician input. Due to the multi-morbid nature of frailty this population carry additional surgical and post-operative risk and may require intensive rehabilitation. NELA and The Centre for Preoperative care recommend patients over 65 should have clinical frailty assessments and be reviewed by an MDT with early Care of the Elderly (COE) input. This audit reviewed use of these recommendations at a large District General Hospital (DGH). Methods We performed an audit on all patients over the age of 75 who had an emergency laparotomy between September 2020 to September 2022. We collected data from their admissions, including clinical frailty scores, AMTS and if COE reviews had occurred. Results We collected data on 57 patients. The average age was 82 (75-96), and the average length of stay was 22 (5-80) days. No patients had either clinical frailty or AMTS scores documented. 16% had a COE review. 16% (9) patients died before 30 days. Conclusion The DGH failed to meet the recommendations for frailty assessment and COE input for patients over 75 having an emergency laparotomy. Suggested improvements may include: a referral pathway to prompt elderly care reviews, or the creation of the “general surgery geriatrician” similar to that of ortho-geriatrician role may be of benefit. Documenting clinical frailty assessments could improve patient outcomes, reduce mortality/morbidity, and provide a more holistic patient approach.

492 Raising the standards: management of acute pancreatitis in a district general hospital

Abstract Introduction Pancreatitis is a common condition seen in General Surgery which may cause significant morbidity and mortality. Current guidelines include fluid resuscitation, ABG and Glasgow-Imrie scoring every 48 hours. The aim of this study is to assess how well the current guidelines are being adhered to at NGH, identify the problems affecting patient care, and plan a sustainable solution. Methods 57 of 102 admissions coded as pancreatitis between Jan-July 2022 fit the inclusion criteria. Information regarding adequate fluid prescription, usage of antibiotics, type of pancreatitis, Glasgow scoring and the type of pancreatitis was collected from patients’ paper and electronic records. Results Average length of stay was 8.3 days. 5 patients (8.8%) were necrotising and 13(22.8%) had concurrent cholecystitis. ABG was done in 14 (24.6%) patients. 17 (29.8%) had a Glasgow-Imrie score planned and 10 (17.5%) had a documented score. 55 (96.5%) patients were fluid resuscitated and all received adequate analgesia. 5 (8.8%) were admitted to ITU, 2 (3.5%) had critical care review. 3/5 (60%) of patients were scored prior to ITU admission. 13 (22.8%) had recurrent pancreatitis and 6 (10.5%) died. Conclusion The current management of pancreatitis at NGH could be improved. Scoring for pancreatitis severity helps early management of patient in need of ITU. We propose creating a pancreatitis pro-forma with scoring to be placed inside every patient's notes with a checklist for pancreatitis management and scoring.

How is entrepreneurial marketing shaped by E-commerce technology: a case study of Chinese pure-play e-retailers

PurposeThe focus of this study is on how online-only retailers, known as pure-play e-retailers, leverage e-commerce platforms to identify and pursue market opportunities. Through the perspective of entrepreneurial marketing, this study aims to explore the influence of e-commerce technologies on the decision-making process of entrepreneurial marketing. This exploration is conducted via a case study of pure-play e-retailers based in China.Design/methodology/approachThis study utilised a qualitative case study methodology to examine the complex processes of entrepreneurial marketing in an online environment. The study gathered detailed insights from both owner-managers and staff members of eight pure-play e-retail businesses. Additionally, the research involved a careful review of the firms' webpages and social media pages. This holistic approach facilitated a comprehensive understanding of their marketing strategies and practices.FindingsThe case study findings indicate that while many core aspects of entrepreneurial marketing remain important, there are distinct factors influencing the entrepreneurial marketing decision-making in the online marketplace. The online EM framework can be visualised as follows: (1) trend-orientated as well as innovative-orientated (2) data-orientated and entrepreneur-orientated (3) innovative-driven customer stimulation (4) orientated towards both platforms and proactiveness.Originality/valueThe paper provides an initial understanding of how digitalisation is enabling and transforming entrepreneurship in companies with high level digitalisation but low level digital development. Building on current entrepreneurial marketing literature, this paper develops an online entrepreneurial marketing framework to enhance understanding of the interaction between e-commerce technology and entrepreneurial marketing decision making.