Clinical Departments Research Articles

Goals of Morbidity and Mortality meetings in paediatric acute care. A qualitative case study.

Morbidity and Mortality meetings are conducted in varied clinical contexts including paediatrics. Widely cited as an educational or quality improvement tool, the reality is more complex. In this qualitative study, the aim was to explore the perceived goals of the paediatric acute care Morbidity and Morbidity meeting. This study used semi-structured interviews and observation within a qualitative case study methodology. Data were collected in a large paediatric quaternary hospital. Analysis generated themes related to meeting observations and the participant's interpretation of meeting goals. A total of 44 interviews were conducted with 14 nurses, 29 doctors, and 1 allied health professional. Thirty-two meetings in six clinical departments were observed. Two themes were developed: complex and nuanced goals; and tensions and contest between and within goals. Meeting goals to evaluate care, learn, support, adhere, and change and respond were sometimes in competition and had varied interpretations. Morbidity and Mortality meetings in this setting are valued and occupy a complex role which reaches beyond identification of measurable patient safety interventions. Understanding goals more fully can lead to optimised conduct and meaningful measurement of efficacy. The strength in these meetings may be the way they promote an embedded safety culture, and an informed and skilled workforce.

Impact of the organ-system integrated curriculum on the research productivity of a Philippine government medical school: An ARIMA-based bibliometric analysis

The organ-system integrated (OSI) curriculum was pioneered in the country by the U.P. College of Medicine (UPCM) in 2004. Data on its impact on research productivity was lacking. This study aims to describe the trends in research productivity of UPCM in a time series and the impact of OSI implementation on publication trends. Relevant electronic databases (PubMed, Scopus, and WPRIM) were searched from the earliest indexed record until December 2023. The auto-regressive integrated moving average (ARIMA) time series analysis was used to compare the actual and predicted trends during the OSI implementation using the pre-OSI trend. A total of 2,705 articles were included. Acta Medica Philippina is the journal with the highest number of publications (n = 420, 20.24%). Although there is a considerable rise in the number of publications utilizing evidence synthesis and qualitative design, observational studies remain as the most common design (n = 293, 2021-2023 period). The leading clinical departments are Neurosciences and Medicine. The departments of Biochemistry and Clinical Epidemiology take the lead among basic sciences departments. Despite the glaring uptrend in publications concurrent with OSI implementation, the actual trend is not significantly different from the predicted trend (LR chi2(1) = 0.37; Prob > chi2 = 0.5432). The OSI curriculum did not significantly change the trend of productivity. Medical curriculum designers should revisit strategies dedicated for research competencies. It is imperative to include activities for qualitative and mixed-methods designs. Future studies should consider relevant critical events in the time series forecasting models and the scientific outputs in the grey literature.

Evaluating Plasmodium falciparum automatic detection and parasitemia estimation: A comparative study on thin blood smear images.

Malaria is a deadly disease that is transmitted through mosquito bites. Microscopists use a microscope to examine thin blood smears at high magnification (1000x) to identify parasites in red blood cells (RBCs). Estimating parasitemia is essential in determining the severity of the Plasmodium falciparum infection and guiding treatment. However, this process is time-consuming, labor-intensive, and subject to variation, which can directly affect patient outcomes. In this retrospective study, we compared three methods for measuring parasitemia from a collection of anonymized thin blood smears of patients with Plasmodium falciparum obtained from the Clinical Department of Parasitology-Mycology, National Reference Center (NRC) for Malaria in Paris, France. We first analyzed the impact of the number of field images on parasitemia count using our framework, MALARIS, which features a top-classifier convolutional neural network (CNN). Additionally, we studied the variation between different microscopists using two manual techniques to demonstrate the need for a reliable and reproducible automated system. Finally, we included thin blood smear images from an additional 102 patients to compare the performance and correlation of our system with manual microscopy and flow cytometry. Our results showed strong correlations between the three methods, with a coefficient of determination between 0.87 and 0.92.

Optimizing clinical research in a regional cancer center network: A survey-based approach.

e13560 Background: Conducting clinical research (CR) within regional care networks (RCNs) of comprehensive cancer centers presents unique challenges. This study aimed to identify and address such barriers at Memorial Sloan Kettering Cancer Center's (MSKCC) RCN, encompassing six sites across New York and New Jersey. Methods: A survey was conducted among medical oncologists at the RCN sites (February 2022-February 2023) to assess their perspectives on research-related challenges. The 23-question survey included multiple-choice, open-ended, and ranking questions regarding protocol availability, consenting processes, staffing support, and more. Results: 92/108 (85%) medical oncologists completed the survey, revealing three key challenges: 1. Limited protocol availability: Only 47% of the time was there a suitable trial available in the RCN for patients interested in clinical trials. Notably, 50% of attendings referred over 5 patients out of the RCN to MSKCC Main Campus for trial enrollment. Identified barriers to opening desired protocols (n=23 in total) included closed to accrual, pending amendments, and sponsor approval issues. 2. Inadequate investigator representation: 278 protocols lacked RCN physicians listed as consenting providers hindering potential patient participation. 3. Insufficient research staff including clinical trial nurses and administrative staff. Only 33% were satisfied with the research support, and 67% of physicians identified lack of clinical research support staff as the biggest barrier to accrual. 58% reported delays of more than one week in screening eligible patients due to insufficient support. Following these observations, interventions were implemented. Thirteen of the 23 studies were opened to accrual, all RCN physicians were added to the 278 protocols, and an analysis of staffing needs increased clinical trial nursing and administrative staff. Therapeutic and non-therapeutic accruals in the Department of Medicine rose by 10.5%, and total research visits increased by 21.4% compared to the previous year. Conclusions: This survey-based approach identified and addressed key barriers to CR within MSKCC's RCN, and in turn, increased research activity was noted. These findings offer a potential roadmap for optimizing research in similar networks by enhancing protocol accessibility, addressing staffing needs, and fostering collaboration. Further investigations are ongoing to address challenges in other clinical departments.

Advanced antibacterial materials for the prevention of nosocomial infections

Abstract Nosocomial infections, as the most common adverse event in health care environments, have become an urgent global challenge. It is of great significance in solving nosocomial infections to improve patient survival rates and reduce the economic burden on patients. Antibacterial materials play a crucial role in the prevention and treatment of nosocomial infections. Since traditional antibacterial materials are not sufficient to satisfy the increasing clinical requirements, advanced antibacterial materials are widely developed in biomedical applications and hospital health fields, aiming at achieving more efficient, longer-lasting, and safer antimicrobial effects. This article outlines the construction strategies and mechanisms of advanced antibacterial materials, including bacterial adhesion prevention, release of antibacterial agents, contact-kill materials, and multistrategy-based sterilization. Meanwhile, the latest progress in advanced antibacterial materials in clinical departments and public environments is summarized and explored, including dressings, medical sutures, implants, bone cements, catheters, plastics products, ceramics, and fiber fabrics. Finally, the challenges and future directions for researches and translations of advanced antibacterial materials are discussed, providing comprehensive reference and guidance for the development of medical system and clinical applications.

Evaluation of Primary and Secondary Stability of Endosseous Dental Implants With and Without the Use of Platelet-Rich Fibrin: A Clinical Study.

This clinical study investigates platelet-rich fibrin's (PRF) impact on dental implant stability, addressing global oral health challenges and limitations of traditional methods. Emphasizing osseointegration's pivotal role, the study explores PRF's potential in enhancing implant stability, assessing it through resonance frequency analysis (RFA) and implant stability quotient (ISQ). The hypothesis suggests PRF may improve both primary and secondary stability, aiming to uncover clinical benefits in dental implant procedures Materials and methods: The study involved 24 subjects from the Department of Periodontics outpatient clinics with a meticulously designed methodology. This included a pre-surgical protocol with oral prophylaxis, impressions, and cone-beam computed tomography (CBCT) analysis. PRFpreparation utilized a minimally invasive venipuncture technique. Implant placement followed a two-stage surgical protocol, assessing primary stability with MEGA ISQ (Ostell). Post-surgery, patients received instructions and underwent recall for secondary stability after three months. Clinical parameterssuch as plaque index (PI), gingival index (GI), implant probing pocket depth (IPPD), sulcus bleeding index (SBI), and implant stability (IS)were systematically recorded. Robust statistical analyses, usingIBM SPSS Statistics for Windows v20.0 (IBM Corp., Armonk, USA) software, incorporated Mann-Whitney U and Wilcoxon signed-rank tests for group and within-time point comparisons, with a significance level of p<0.05. This comprehensive study yields nuanced insights into the impact of PRF and implant procedures on key clinical parameters, contributing significantly to the field. This study compared dental implants with and without PRFin 24 patients. Both groups showed significant improvements in the PI, GI, and SBI. The PRF group exhibited higher ISin the third and sixth months, while IPPDwas lower in the PRF group in the sixth month. The findings of the study highlight a positive impact on implant stability contributing to better implant outcomes.

Pattern of Medical Device Adverse Events in a Tertiary Care Hospital in Northern India: An Ambispective Study.

Knowledge about the pattern of adverse events caused by medical devices (MDs) is limited in India. We aimed to assess the pattern of MD adverse events (MDAEs) in a tertiary hospital in Northern India. This descriptive study was conducted ambispectively at various clinical departments of PGIMER, Chandigarh. We followed the guidelines edged by the Materiovigilance Program of India (MvPI) to conduct this study. The prospective study (PS) was done from January to December 2020, with a concurrent retrospective study (RS) proceeding to 3 years to learn more about the reporting culture, demographics, notification status, risk class of defective devices, and the type of adverse events. We received 224 MDAE in the PS and identified 413 MDAE in the RS. Reporting of adverse events to the national MvPI was negligible in the RS. In the PS, nurses reported the majority of MDAEs (65%), followed by doctors (30%). The occurrence of MDAE was higher in males (PS; 52%, RS; 57%) and age groups between 21 and 30 years (PS; 19.1%, RS; 23.2%) in both studies. MDAEs were frequent in low- to moderate-risk devices (class B: 66%) in the PS, while it was documented only for high-risk devices (class C: 51% and class D: 49%) in the RS. Most of the serious adverse events (SAEs) were reported among moderate to high-risk devices, and an increased frequency of SAE (60.4%) was observed among nonnotified MDs. The overall incidence of near-miss events was 14%. Knowledge of MDAEs and reporting of defective devices to regulatory authorities is essential to prevent further incidence. Adverse events caused by MDs are ubiquitous irrespective of their risk classification, notification status, and patient demographic factors. Accelerated reporting of MDAE by all cadre of healthcare professionals is urgently required to safeguard the health of Indians.

Innovative behaviour profile and its associated factors among nurses in China: a cross-sectional study based on latent profile analysis

ObjectivesThis study aimed to investigate the current status of innovative behaviours among nurses in traditional Chinese medicine (TCM) hospitals using latent profile analysis, identify potential subgroups and their population characteristics...

Organization of clinical pharmacology service in a medical institution

The authors analyzed and described the main stages of organizing the clinical pharmacology service in a medical institution, the rules for organizing the activities of the office of a clinical pharmacologist, the recommended staffing standards for the office of a clinical pharmacologist, the standard of equipment for the office of a clinical pharmacologist, the rules for organizing the activities of the clinical pharmacology department, recommended staffing and equipment standards for the clinical pharmacology department, responsibilities of a clinical pharmacologist, documentation for organizing the clinical pharmacology service, as well as requirements for equipping a pharmacologist’s workplace. The work is of practical importance when organizing a clinical pharmacology service in a medical organization.

Echanges plasmatiques au cours des purpuras thrombotiques thrombocytopéniques

Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially fatal hematological disorder that requires urgent treatment. Once the diagnosis has been made, plasma exchange (PE) must be started immediately and until a response is obtained. Evaluate PE in terms of responses and complications in the treatment of TTP. This was a monocentric, descriptive, retrospective study including patients in whom TTP was diagnosed and treated with plasmapheresis in the clinical hematology department at Aziza Othmana Hospital, between January 2010 and December 2020. Our study included 26 patients. PE was initiated within a median of 1 day. The rhythm of exchanges was daily in 22 patients. Twenty PE-related complications were noted, hypocalcemia being the most frequent (30%). CR was achieved in 15 patients after PE alone. Nine patients were refractory, and six received 2nd-line treatment, with CR achieved in five patients. Relapse was noted in six patients (40%). They were treated by PE and only one patient received rituximab. Four patients had a response. The overall response rate was 69% and overall mortality was 30%. OS at 2 years was 68,3% and RFS was 84,4%. Factors associated with the achievement of CR were the fall in LDH at D5 of treatment (p=0,027,OR=0,59 ;IC 95%[0,32-1,08]) and the daily rhythm of PE (p=0,005, OR=0,35; IC 95%[0,14-0,91]). Our results were comparable to those of the literature, but the rate of refractory disease was higher. Rituximab may enhance our results.

NEWBORN WITH CONGENITAL SYPHILIS: CASE REPORT

Introduction: Congenital syphilis is caused by the spirochete, Treponema pallidum, which can be transmitted from the infected mother to the fetus by pregnancy. The incidence of congenital syphilis is growing rapidly across the world, with 700 000 to 1.5 million cases reported between 2016 and 2023. Despite the penicillin treatment beeing available, there were 2152 cases reported in 2020 in USA. Differential diagnosis should always consider congenital syphilis as a possible diagnosis in case of clinically unclear conditions and penicillin is still the first-line treatment, irrespective of the stage of the disease.Objective:To show the importance of screening and prevention for congential symphilis in pregnancy.Casepresentation: We report a male newborn GD 37+5/7 born naturally to a mother who was syphilis positive in the second trimester and was treated with penicillin. After delivery, the newborn is admitted to the Clinical Department of Neonatology for lumbar puncture and extensive laboratory workup. Because of the possibility of other organ systems being affected, an extensive ultrasound scan is performed.Conclusion: Although syphilis is not a major public health problem today, the mostserious outcomes of this infection are associated with highly vulnerable groups, such as pregnant women and children. The screening of women for syphilis should become not only a health priority, but also a political priority for every country, and if there is a debate on the spread of this infection, the cure should be available to everyone.Keywords: pregnancy, congenital syphilis, newborn, penicillin

Microbial Pattern of Neonatal Sepsis in the Neonatal Intensive Care Unit of dr. Ramelan Navy Central Hospital.

The morbidity and mortality rates from neonatal sepsis remain high. However, there is limited information about the microbial pattern of neonatal sepsis in Indonesia. Microbial patterns can give an overview of the hygiene of an environment and act as a determinant for choosing definitive antibiotic treatment in neonatal sepsis patients. The organisms that cause neonatal sepsis differ from unit to unit and from time to time within the same unit. This study is aimed at discovering the microbial pattern of neonatal sepsis in the Neonatal Intensive Care Unit (NICU), dr. Ramelan Navy Central Hospital, in 2021-2022. This is a retrospective, cross-sectional study that takes secondary data from the NICU and clinical microbiology department of dr. Ramelan Navy Central Hospital. Data that met the inclusion and exclusion criteria available between January 1, 2021, and December 31, 2022, were collected. Patients whose blood cultures were positive for bacterial growth and diagnosed with sepsis were selected as the study sample. Out of 174 samples, 93 (53.4%) were found positive for bacterial infection and diagnosed as neonatal sepsis. Gram-negative isolates (96.8%) were predominant. Sixty-point-two percent of Klebsiella pneumoniae XDR, 19.4% of Klebsiella pneumoniae ESBL, and 8.6% of Burkholderia cepacia XDR were identified. The gram-positive isolates found in this study were only 3 samples (3.2%). Two-point-one percent of MRSA and 1.1% of Staphylococcus haemolyticus MDR were identified. The most common microorganisms causing neonatal sepsis in our NICU were gram-negative bacteria, particularly Klebsiella pneumoniae XDR. Following the recommended infection control procedures, practicing good hand hygiene, and having access to basic supplies and equipment are important to prevent and reduce the incidence of sepsis.

#1534 Risk of CKD progression taken into account of metabolic changes

Abstract Background and Aims The purpose of this study was to study the relationship between metabolic syndrome and the risk of progression of CKD in a representative sample of patients who were hospitalized in the nephrology department of the 3rd clinic of the Tashkent Medical Academy and in the department of cardiology and interventional cardiology of the Russian National Medical Research and Medical Center. Method In the retrospective part of the study, 1000 case histories of patients with CKD who were inpatient treatment from 2013 to 2019 in the nephrology department of the 3rd clinic of the Tashkent Medical Academy and in the department of cardiology and interventional cardiology of the Russian National Medical Research Center for Medical Sciences were studied. In the prospective part of the study, information on demographic characteristics, including age, gender, education, and profession, was collected during medical visits using a standard questionnaire. Metabolic syndrome was defined according to international guidelines as the presence of three or more of the following risk factors: waist circumference &amp;gt;102 cm in men or &amp;gt;88 cm in women; serum triglyceride level ≥1.70 mmol/L; HDL cholesterol &amp;lt; 1.04 mmol/L in men or &amp;lt; 1.30 mmol/L in women; Blood pressure ≥ 130/85 mm Hg, including achieved; serum glucose level ≥6.11 mmol/L. Metabolic syndrome definition criteria used Results The demographic characteristics of the patients are presented in the table. Mean serum creatinine was similar, but GFR was estimated to be lower among those with metabolic syndrome compared with those without. The percentage of individuals with CKD and elevated serum creatinine was statistically significantly higher among individuals with metabolic syndrome. Low HDL cholesterol, elevated plasma glucose, and abdominal obesity were found to be statistically significantly associated with the risk of developing C5 CKD and elevated serum creatinine. In addition, a significant relationship was observed between the number of metabolic syndrome components and the percentage of CKD C5 or elevated serum creatinine (P &amp;lt; 0.015 and P = 0.02, respectively). In the multivariate model, patients with 1, 2, 3 and 4 or 5 components of the metabolic syndrome had 1.51; 1.50; 2.13 and 2.72 times higher odds of CKD C5 CKD, respectively, compared with individuals without metabolic syndrome components. Overall, patients with metabolic syndrome had a 64% increased odds of CKD compared with a comparison group without metabolic syndrome. Conclusion The present study revealed a positive and significant association between metabolic syndrome and the risk of CKD C5 in those examined. The risk of CKD increased progressively with increasing number of metabolic syndrome components.

#1817 Decrease in hospital-acquired blood stream infection by using automated sensor technology to improve and keep a high level of hand hygiene compliance

Abstract Background and Aims Hospital-acquired infection (HAIs) is a problem for 6-8% of hospitalized patients. HAIs has personal costs, prolongs the hospital stay, increasing the risk of morbidity, mortality, time and staff consuming. Hand hygiene (HH) is essential for preventing infections. World Health Organization (WHO) recommends hand hygiene compliance (HHC) as a key performance indicator. Manual observations of HHC are time consuming and may affect compliance by the physical presence of the observers (Hawthorne effect). There is a need to identify the most effective long-term intervention to improve HHC and reduce HAI. The Danish Ministry of Health have chosen blood stream infections (HA-BSI) as a national indicator for the overall risk of HAIs expecting an incidence of no more than 8 cases per 10,000 patient days. The aim of the present study was to examine the use of an automated sensor technology to improve HHC and prevent HAIs in an inpatient department for nephrology and intern medicine. Nephrology patients have a high number of invasive catheters, which may increases the risk of HAI. Method The study comprised a 2 year cohort with no specific HHC interventions (July 2018-June 2020), a baseline period (February 2020-June 2020) to investigate HHC level by an electronic hand hygiene measuring system (EHHMS) without ongoing HHC interventions followed by a 3 year cohort period (July 2020-June 2023) with various EHHMS-based feedback interventions to staff. Intervention consisted primarily of group feedback and later individual feedback. All caregivers and doctors carried an anonymous Sani ID tag (Sani Nudge, DK) fixed to their nametag throughout the study period. EHHMS-based Sani Sensors were located in designated locations in the clinical department with the purpose of continuously capturing the caregiver patient contact including staff use of liquid alcohol based hand rub (ABHR). In Denmark, the national hygiene guidelines also require that ABHR follow hand wash. Local hygiene mentors regularly presented anonymous group data on boards and in letters to the staff. Soon after there was a demand on individual data, which was then added by individual results forwarded in a personal email every week. HA-BSI was defined as the presence of a pathogen in the blood and the prescription of an appropriate concomitant antimicrobial treatment and classified as hospital-acquired if the patient has been hospitalized for &amp;gt;48 hours. Data were obtained from various electronic health care systems in the hospital. Results We collected HHC data by monitoring 203 caregivers and 50 doctors for a period of 40 months. Caregivers HHC improved after implementation of an electronic hand hygiene measuring system from baseline to group feedback and finally individual feedback (39% vs 50% vs 71%). For doctors, the improvement from baseline to group feedback and finally individual feedback was 30% vs. 32% vs 52%. The overall improvement curve reached a stable plateau after 20 months. An incidence rate of 14 HA-BSI cases per 10,000 patient days during a previous two years control period (95% CI 8.8-21.2) was during the intervention period markedly reduced to 5 HA-BSI cases per 10,000 patient days (95% CI 2.3-9.0). This difference was statistically significant, P = 0.004. Conclusion The use and feedback of the electronic hand hygiene monitoring system improved successfully hand hygiene compliance in the groups of both caregivers, doctors, and furthermore reduced the rate of HA-BSI significantly. We observed a significant stepwise increase in compliance after group feedback data and later after reporting individual data. There continue to be a need to find effective long-term interventions to improve and keep a high level of hand hygiene compliance and a sustained reduction in hospital-acquired bloodstream infection.

Acute Myocardial Infarction in COVID-19 Patients-A Review of Literature Data and Two-Case Report Series.

Background/Objectives: The newly emergent COVID-19 pandemic involved primarily the respiratory system and had also major cardiovascular system (CVS) implications, revealed by acute myocardial infarction (AMI), arrhythmias, myocardial injury, and thromboembolism. CVS involvement is done through main mechanisms-direct and indirect heart muscle injury, with high mortality rates, worse short-term outcomes, and severe complications. AMI is the echo of myocardial injury (revealed by increases in CK, CK-MB, and troponin serum markers-which are taken into consideration as possible COVID-19 risk stratification markers). When studying myocardial injury, physicians can make use of imaging studies, such as cardiac MRI, transthoracic (or transesophageal) echocardiography, coronary angiography, cardiac computed tomography, and nuclear imaging (which have been used in cases where angiography was not possible), or even endomyocardial biopsy (which is not always available or feasible). Two-case-series presentations: We present the cases of two COVID-19 positive male patients who were admitted into the Clinical Department of Cardiology in "Sfântul Apostol Andrei" Emergency Clinical Hospital of Galați (Romania), who presented with acute cardiac distress symptoms and have been diagnosed with ST elevation AMI. The patients were 82 and 57 years old, respectively, with moderate and severe forms of COVID-19, and were diagnosed with anteroseptal left ventricular AMI and extensive anterior transmural left ventricular AMI (with ventricular fibrillation at presentation), respectively. The first patient was a non-smoker and non-drinker with no associated comorbidities, and was later discharged, while the second one died due to AMI complications. Conclusions: From this two-case series, we extract the following: old age alone is not a significant risk factor for adverse outcomes in COVID-19-related CVS events, and that the cumulative effects of several patient-associated risk factors (be it either for severe forms of COVID-19 and/or acute cardiac injury) will most probably lead to poor patient prognosis (death). At the same time, serum cardiac enzymes, dynamic ECG changes, along with newly developed echocardiographic modifications are indicators for poor prognosis in acute cardiac injury in COVID-19 patients with acute myocardial injury, regardless of the presence of right ventricular dysfunction (due to pulmonary hypertension).

REMOTE CARDIAC DEVICE MANAGEMENT: REAL–WORLD INSIGHTS AND CHALLENGES

Abstract Background telemedicine plays a crucial role in managing patients with Cardiac Implantable Electronic Devices (CIEDs), offering unique technical and clinical benefits. This study explores the characteristics of a real–world population of CIED recipients undergoing entirely remote follow–up. Methods and Results in a prospective evaluation of 808 consecutive CIED patients from two Italian Cardiology Centers (2021–2023), initial on–site assessments were followed by remote evaluations, either scheduled or alert–triggered. The majority received pacemakers (68.8%), with others having Implantable Defibrillators (19.3%) or Implantable Loop Recorders (11.9%). The average age was 75.6±12.6 years, and 42% were female. Most of the patients were retired (83.3%), and 73% required at least one caregiver. The EQ–5D score indicated a lower quality of life (8.9±4.3) compared to the Italian general population. During the observation period (20.6 months), 34.9% of patients were admitted to the hospital, with 50% of cases being cardiovascular–related. Heart failure was the most common cause (13.2%). Device–related issues prompted outpatients’ cardiology clinic Department evaluations in 13.4% of cases. The telemedicine program produced 2780 remote transmissions, with 23% being automatic alerts. In–clinic evaluations were 1313, with a mean duration of 19.2 minutes. Atrial fibrillation (AF) history was prevalent (40.2%), and 719 AF episodes occurred during the observation period. Conclusions Managing CIED patients via telemedicine is feasible but requires structured organization considering patient characteristics and possible outcomes. AF management is crucial, given its high prevalence. Older age and compromised quality of life are significant factors, partly mitigated by the widespread presence of caregivers. Despite remote follow–up, many patients access healthcare structures for cardiovascular reasons, emphasizing the need for distinct pathways for device–related and general care necessities.

Documenting and communicating the contributions of embedded statisticians: Show me the value!

Academic research productivity relies upon the contribution of statisticians, who are typically clustered in statistics and biostatistics departments, isolated from clinical researchers. Most academic health centres have created consultation hubs or research incubators to make statisticians available for individual collaboration to support the clinical research enterprise. Additionally, some clinical departments within academic health centres have recognized the value in colocating statisticians within their clinical departments to improve availability for collaboration with physicians/researchers. Embedded statisticians encounter the same challenges of isolated statisticians regarding professional support and networking, mentorship and clear role expectations. While for all collaborative statisticians, it is important to effectively communicate value to both collaborators and supervisors, this may be especially problematic for embedded statisticians in clinical departments where their supervisors may not have backgrounds in research or statistics. Previous papers have reported valuable metrics for statisticians, particularly those associated with Biostatistics, Epidemiology and Research Design Cores. There is a knowledge gap regarding metrics tailored to meet the needs of the embedded statistician and clinical supervisors. This paper is a first step towards addressing this important need.In this paper, we explore (1) the critical role of collaborative statisticians and the benefits and challenges of the embedded statistician model, (2) the need for additional metrics specific to embedded statisticians which measure value and (3) how to design a value report. We offer a framework for evaluation of the contributions of the embedded statistician with the following domains: (1) collaboration, (2) research output/productivity, (3) mentoring and (4) education. Metrics that are particularly specific to embedded statisticians and that are not routinely captured include time from project initiation to completion/outcome, time from initial statistical consultation to statistical outcome completion and summary of level of contribution for manuscripts and presentations in addition to author order. We conclude with thoughts on future directions for development of metrics and reporting systems for statisticians embedded in clinical departments.

Retrospective analysis of diagnosis and treatment of tuberculosis in designated medical institutions in China from 2017 to 2022

Objective: To understand the status of tuberculosis diagnosis and treatment capacity and the development and changes of tuberculosis diagnosis and treatment in provincial and municipal designated medical institutions in China from 2017 to 2022, so as to provide a basis for the formulation of relevant policies for the improvement and development of designated medical institutions for tuberculosis and the tuberculosis prevention and treatment service system, and to provide reasonable support for further strengthening the capacity of designated medical institutions for tuberculosis. Methods: This study was initiated and carried out by Beijing Chest Hospital affiliated to Capital Medical University/Clinical Center for Tuberculosis Prevention and Control of China CDC (hereinafter referred to as "Clinical Center") by means of questionnaire survey, and the investigation was carried out from March to November 2023. During this period, the clinical center distributed questionnaires to the hospital member units of "Beijing Tuberculosis Diagnosis and Treatment Technology Innovation Alliance", retrospectively collected their tuberculosis-related diagnosis and treatment data from 2017 to 2022, and used descriptive statistical methods to analyze the number of tuberculosis beds, outpatients and hospitalizations in medical institutions. The results were expressed in absolute numbers (percentages), and three-line tables, bar charts and line charts were drawn to describe the analysis results and changing trends. Results: The 54 medical institutions surveyed in this survey included 21 provincial-level designated medical institutions and 33 prefecture-level designated medical institutions. Most medical institutions have set up clinical departments, auxiliary departments and functional departments to undertake public health tasks of infectious diseases. The tuberculosis laboratory in the hospital has a comprehensive ability and has the detection technology needed for most tuberculosis diagnosis; The number of tuberculosis beds, children's tuberculosis beds and ICU beds all showed an increasing trend from 2017 to 2022. The proportion of tuberculosis beds in the hospital decreased slightly, from 39.31% in 2017 to 34.76% in 2022, showing a slight downward trend. Compared with the hospital surveyed, the number of tuberculosis outpatients in 2019 was 562 029, and the number of outpatients in 2020-2022 was 462 328, 519 630 and 424 069 respectively, which was significantly lower than that in 2019. The number of tuberculosis outpatients in medical institutions decreased significantly from 2020 to 2022. By analyzing the proportion of patients with different types of tuberculosis, the proportion of sensitive tuberculosis outpatients in 2017-2022 decreased from 84.49% in 2017 to 78.05% in 2022, showing a downward trend year by year. The proportion of patients with multidrug-resistant/ rifampin-resistant tuberculosis increased from 2.03% in 2017 to 7.18% in 2022. From 2017 to 2019, the total number of inpatients with tuberculosis showed an upward trend. Compared with 2019, the number of inpatients in 2020, 2021 and 2022 showed a downward trend, and the decline in 2020 was large (down 14.94% compared with 2019). Among the inpatients, the absolute number and proportion of patients with sensitive pulmonary tuberculosis remained relatively stable, and the number and proportion of inpatients with multidrug-resistant/rifampin-resistant pulmonary tuberculosis increased year by year. Conclusions: Most medical institutions have the capacity to carry out routine diagnosis and treatment of tuberculosis, but the public health function needs to be strengthened. The transformation of medical institutions requires proper guidance and adequate support. During 2019-2022, most medical institutions were affected by the COVID-19 epidemic, and their tuberculosis diagnosis and treatment work also changed to varying degrees. During this period, hospitals took various measures to overcome difficulties and tried their best to maintain the normal development of tuberculosis diagnosis and treatment, and the tuberculosis diagnosis and treatment work of various institutions gradually resumed in 2022.

Improving Environmental Sustainability of Operating Theatres: A Systematic Review of Staff Attitudes, Barriers, and Enablers.

To understand views of staff in relation to attitudes, enablers, and barriers to implementation of environmentally sustainable surgery in operating theatres. This will ultimately help in the goal of successfully implementing more sustainable theatres. Global healthcare sectors are responsible for 4.4% of greenhouse gas emissions. Surgical operating theatres are resource intensive areas and improvements will be important to meet Net-Zero carbon emissions within healthcare. Three databases were searched (Web of Science, Ovid and PubMed), last check January 2024. We included original manuscripts evaluating staff views regarding sustainable operating theatres. The Mixed Methods Appraisal Tool was used for quality appraisal and data analysed using thematic synthesis. 2933 articles were screened and 14 fulfilled inclusion criteria, using qualitative (1), quantitative (2), and mixed methods (11). Studies were undertaken in a variety of clinical (Department of Anaesthesia, Surgery, Otolaryngology, Obstetrics & Gynaecology and Ophthalmology) and geographical settings (Australia, Canada, France, Germany, New Zealand, USA, UK & Ireland,). Across studies there was a lack of evidence exploring enablers to implementation, but barriers mainly related to the following themes: education and awareness, leadership, resistance to change, facilities and equipment, time, and incentive. This systematic review identified attitudes and barriers perceived by clinicians towards improving environmental sustainability within operating theatres, which may inform future strategy towards sustainable surgery. Most studies used a survey-design, whereas use of interviews may provide deeper insights. Future work should be extended to wider stakeholders influencing operating theatres. Additionally, implementation studies should be carried out to examine whether barriers do change in practice. This systematic review identified attitudes and barriers perceived by clinicians towards improving environmental sustainability within operating theatres, which may inform future strategy towards sustainable surgery. Most studies used a survey-design, whereas use of interviews may provide deeper insights. Future work should be extended to wider stakeholders influencing operating theatres. Additionally, implementation studies should be carried out to examine whether barriers do change in practice.

Building a robust pharmacy research program: Reflections from a large healthcare system not affiliated with a college of pharmacy

AbstractProfessional standards for academic health care system pharmacy departments and clinical pharmacists advocate for research and scholarly activities. Developing and sustaining a research program in a clinical pharmacy department is challenging. Over the span of a decade, a robust pharmacy research program was developed in an academic medical center not affiliated with a college of pharmacy. The aim of this manuscript is to provide a framework suitable for scaling research in pharmacy departments within an academic medical center. Objectives to accomplish the aim includes describing the structure and evolution of the clinical pharmacy department research program, listing measurable outputs and achievements of the pharmacists and the program and describing the barriers encountered and solutions that were enacted to overcome them. Elements critical to building and sustaining a research program in the pharmacy department included long‐term commitment from within the department, a departmental research infrastructure, support from institutional leadership, research funding from the institution, and a growth mindset in accordance with company initiatives to support evolving research needs. A research curriculum was developed for pharmacy residents and pharmacists, created electronic tools for research proposal scientific reviews and allocation of funds, and established departmental research career development awards that allowed for protected time to pursue research and professional development. Over the first 10 years of the program, publication rates grew more than three‐fold, faculty appointments and promotions increased approximately five‐fold, and pharmacist investigators obtained extramural federal funding. Further offsetting clinical workload relative to dedicated research time remains a challenge. The experience and success at this academic medical center suggest it is feasible to develop a robust, sustainable clinical pharmacy department research program.