Clinical Areas Research Articles

Use of transdermal testosterone in women Poseidon IV group under high complexity assisted reproduction treatment

Poor ovarian reserve (POR) is considered a frequent cause of infertility and is still considered one of the significant challenges in reproductive medicine. Numerous studies have suggested that androgens (dehydroepiandrosterone and testosterone) may play a critical role in follicular development by increasing the number of follicles and, consequently, the number of oocytes, ultimately leading to an increased pregnancy rate. Testosterone is a sex steroid hormone that originates from cholesterol and is considered an obligatory precursor of estradiol biosynthesis. It contributes to greater follicular recruitment, leading to the consideration that exogenous administration could increase the number of recovered oocytes. Methodology A historical, quantitative, observational, longitudinal, retrolective cohort study was carried out in the clinical area of assisted reproduction; 2 groups were formed where all women over 35 with primary or secondary infertility who met the criteria were included. Classification criteria of the POSEIDON IV group (age > 35 years with CFA < 5 follicles and/or AMH < 1.2 ng/mL), during the period from October 2021 to September 2022, the first group of patients had received supplementation with transdermal Testosterone 50mg daily one month before ovarian stimulation, the second group did not receive any treatment before ovarian stimulation. Women with a history of diagnosis of endometriosis, pelvic surgery or oophorectomy were excluded. This study has the approval of the ethics committee of the HISPAREP clinic. Each patient was given an informed consent which they signed before the study. We declare that we have no conflict of interest. The data from the records of all the patients who met the inclusion criteria were collected, including the antral follicle count on the first three days of the menstrual cycle by transvaginal ultrasound one month before ovarian stimulation and after one month of supplementation and without supplementation when starting controlled ovarian stimulation. The number of metaphase II oocytes obtained in each group was also analyzed. Results A total of 20 women were included; 10 underwent controlled ovarian stimulation with prior administration of transdermal testosterone at a dose of 50 mg every 24 hours for one month. The other 10 patients did not receive any supplementation or treatment before ovarian stimulation for highly complex assisted reproduction treatment due to various causes of infertility. The average age of the women was 40.2 ± 2.5 years in the study group and 43.3 ± 2 in the control group; normal weight in 80% of the group with testosterone and 90% without testosterone. The baseline conditions of the patients revealed an average anti-Müllerian hormone (AMH) level of 0.65 ± 0.28 ng/dL in the testosterone group and 0.84 ± 0.49 ng/dL in the non-testosterone group. The infertility factor was ovarian endocrine dysfunction, present in 60% of the testosterone group and 40% of the non-testosterone group; this factor was the predominant cause in both groups. The most common protocol stimulation was with (300/150 U) FSH/LH recombinant (Pergoveris, Merck) and GnRH antagonist (Cetrotide, Merck). The antral follicular count observed by ultrasound in each group after treatment with testosterone was 6.4 ± 2.4, and without testosterone was 6 ± 3.47; p<0.778. Without observing significant differences. The number of metaphase II oocytes obtained (mean ± standard deviation) after testosterone administration was 4.5 ± 2.37 and 1.5 ± 1.62 in participants who did not receive testosterone; p=0.04886, that is p<0.05, so the results were statistically significant in favor of testosterone administration. Conclusions Transdermal testosterone supplementation can be used as an adjuvant in controlled ovarian stimulation treatments in women of the POSEIDON IV group to improve the reproductive prognosis of this group of women. The 50mg dose of transdermal testosterone every 24 hours 1 month prior to the ovarian stimulation in highly complex treatments increases the number of metaphase II oocytes recovered statistically.

Utilizing a HRSA Training Grant to Promote PMHNP Student Resilience: Answering the Call to Enhance Trauma-Informed Teaching and Learning Practices in Nursing Education

Nursing burnout has reached a new level of prevalence among professionals and is rising among nursing students and can impact student success in the classroom and clinical areas. Among advanced practice nurses, psychiatric-mental health nurse practitioners have the least favorable combination of low compassion satisfaction and high secondary traumatic stress, placing them at even greater risk for burnout compared to other specialties. Trauma informed teaching and learning principles can serve to prevent burnout and have a positive impact on learning outcomes. Through these teaching methods, nurse educators have the opportunity to both support students during their nursing education and prepare students for the professional stressors that contribute to burnout. This quality improvement project involved implementation and evaluation of a HRSA funded program to train PMHNP students interested in working in rural and underserved areas. The training intervention included didactic curricular enhancements, a trauma resiliency training and a longitudinal clinical practicum. Qualitative program outcomes indicated that trainees were implementing trauma-informed principles and skills with patients and for self-care during their nursing training and at one year follow-up. The program may offer practical upstream solutions for nurse educators and future studies should explore concepts more formally to develop best practice models.

Strain-Specific Targeting and Destruction of Cells by Prions.

Prion diseases are caused by the disease-specific self-templating infectious conformation of the host-encoded prion protein, PrPSc. Prion strains are operationally defined as a heritable phenotype of disease under controlled conditions. One of the hallmark phenotypes of prion strain diversity is tropism within and between tissues. A defining feature of prion strains is the regional distribution of PrPSc in the CNS. Additionally, in both natural and experimental prion disease, stark differences in the tropism of prions in secondary lymphoreticular system tissues occur. The mechanism underlying prion tropism is unknown; however, several possible hypotheses have been proposed. Clinical target areas are prion strain-specific populations of neurons within the CNS that are susceptible to neurodegeneration following the replication of prions past a toxic threshold. Alternatively, the switch from a replicative to toxic form of PrPSc may drive prion tropism. The normal form of the prion protein, PrPC, is required for prion formation. More recent evidence suggests that it can mediate prion and prion-like disease neurodegeneration. In vitro systems for prion formation have indicated that cellular cofactors contribute to prion formation. Since these cofactors can be strain specific, this has led to the hypothesis that the distribution of prion formation cofactors can influence prion tropism. Overall, there is evidence to support several mechanisms of prion strain tropism; however, a unified theory has yet to emerge.

Developing effective In-Service Education for intensive care nurses: Exploring the views of clinical stakeholders in the Kingdom of Saudi Arabia

BackgroundEvidence-based in-service education (ISE) in the intensive care unit (ICU) is essential to maintaining nurse skill and competence in this complex clinical area. However, there has been limited research that has focused on developing and optimising the specialised training required by ICU nurses working in trauma care. ObjectivesTo explore the perspectives of ICU clinical stakeholders regarding their needs and preferences for ISE to inform the future development and implementation of effective educational interventions. DesignA qualitative, multiple-case study supported by the “Empowering Education” theoretical framework, which emphasises the importance of stakeholder involvement in education development. SettingsAdult ICUs in three major hospitals located in two geographical areas in Saudi Arabia. ParticipantsForty clinical nurses, twelve nurse managers, nine nurse leaders and seven clinical educators participated. MethodsData were collected through semi-structured interviews followed by focus groups. Framework analysis was used for data analysis. FindingsStakeholders wanted ISE and training by subject experts characterised by: (i): relevant educational content; (ii): a range of educational techniques and (iii) flexible delivery and format. Nurses also identified factors that encouraged them to participate in ISE including adequate resources and a supportive work environment, whilst heavy workloads, cost and scheduling issues hindered engagement. ConclusionThis paper highlights the importance of considering staff needs and local context when developing in-service ICU education to support nurses' competence. Further recommendations and a proposed framework to develop future ISE in the ICU are provided. Tweetable abstractThe key to effective in-service education for ICU nurses is understanding stakeholders' needs and motivational drivers, whilst addressing barriers to successful implementation.

Clinical effects and biological mechanisms of exercise on lumbar disc herniation.

Lumbar Disc Herniation (LDH) is a syndrome in which lumbar disc degeneration, rupture of the annulus fibrosus, and herniation of the nucleus pulposus irritate and compress the nerve roots and cauda equina, resulting in the main manifestations of lumbar pain and/or lower extremity pain. There is evidence in various clinical areas that exercise is effective in treating LDH, and exercise intervention for more than 2weeks reduces disease activity in LDH. However, the mechanism of exercise's action in reducing disease activity in LDH is unclear. In this article, we first summarize and highlight the effectiveness of exercise in treating LDH and provide guideline recommendations regarding exercise type, intensity, frequency, and duration. Then, we integrate the existing evidence and propose biological mechanisms for the potential effects of exercise on neuromechanical compression, inflammatory chemical stimuli, and autoimmune responses from the perspective of LDH pathogenesis as an entry point. However, a large body of evidence was obtained from non-LDH populations. Future research needs to investigate further the proposed biological mechanisms of exercise in reducing disease activity in LDH populations. This knowledge will contribute to the basic science and strengthen the scientific basis for prescribing exercise therapy for the routine clinical treatment of LDH.

Experiences of preceptorship in Singapore: A qualitative exploratory study of preceptors’ experience in precepting nursing students during pre-registration of clinical placement in an acute hospital

BackgroundPreceptors play an important role in teaching and guiding nursing students to transit to the role of registered nurses. Nursing students are trained to acquire the skills and knowledge in providing good quality care to patients. However, the preceptors in the clinical area may face challenges in providing care to their patients in addition to their preceptor role. It is vital to explore and gain insights on the preceptorship experience to better understand their challenges and facilitate their preceptorships and the learning experience of the nursing students. AimsThis study explored the preceptors’ experience to understand their challenges and support received in the facilitation of the preceptorship and learning experience of the nursing students in an acute care hospital in Singapore. MethodsSemi-structured interviews were conducted from June to October 2021 with ten registered nurses working in an acute hospital. Thematic analysis was conducted. ResultsThree main themes emerged from the thematic analysis: (1) preceptor-student relationship; (2) barriers and challenges to successful preceptorship; and (3) outcomes of successful preceptorship. ConclusionsThis study provided valuable insights in the experience of the preceptors in Singapore. Recommendation for nursing management and leaders to establish support system in promoting recognition of preceptors, establish dialog sessions between stakeholders. Nursing education to provide support and to review the efficacy of the current preceptorship program to identify correlation with successful precepting experience for both preceptors and nursing students. Despite challenges faced by the preceptors, their experience had been positive and they are committed in precepting the nursing students.

Working hours of full-time hospital physicians in Japan: a cross-sectional nationwide survey

BackgroundThe culture of excessively long overtime work in Japan has not been recently addressed. New legislation on working hours, including a limitation on maximum overtime work for physicians, will be enforced in 2024. This study was performed to elucidate the working conditions of full-time hospital physicians and discuss various policy implications.MethodsA facility survey and a physician survey regarding physicians’ working conditions were conducted in July 2022. The facility survey was sent to all hospitals in Japan, and the physician survey was sent to all physicians working at half of the hospitals. The physicians were asked to report their working hours from 11 to 17 July 2022. In addition to descriptive statistics, a multivariate logistic regression analysis on the factors that lead to long working hours was conducted.ResultsIn total, 11,466 full-time hospital physicians were included in the analysis. Full-time hospital physicians worked 50.1 h per week. They spent 45.6 h (90.9%) at the main hospital and 4.6 h (9.1%) performing side work. They spent 43.8 h (87.5%) on clinical work and 6.3 h (12.5%) on activities outside clinical work, such as research, teaching, and other activities. Neurosurgeons worked the longest hours, followed by surgeons and emergency medicine physicians. In total, 20.4% of physicians were estimated to exceed the annual overtime limit of 960 h, and 3.9% were estimated to exceed the limit of 1860 h. A total of 13.3% and 2.0% exceeded this level only at their primary hospital, after excluding hours performing side work. Logistic regression analysis showed that male, younger age, working at a university hospital, working in clinical areas of practice with long working hours, and undergoing specialty training were associated with long working hours after controlling for other factors.ConclusionsWith the approaching application of overtime regulations to physicians, a certain reduction in working hours has been observed. However, many physicians still work longer hours than the designated upper limit of overtime. Work reform must be further promoted by streamlining work and task-shifting while securing the functions of university hospitals such as research, education, and supporting healthcare in communities.

Anaesthetic subspecialties and sustainable healthcare: anarrative review.

The principles of environmentally sustainable healthcare as applied to anaesthesia and peri-operative care are well documented. Associated recommendations focus on generic principles that can be applied to all areas of practice. These include reducing the use of inhalational anaesthetic agents and carbon dioxide equivalent emissions of modern peri-operative care. However, four areas of practice have specific patient, surgical and anaesthetic factors that present barriers to the implementation of some of these principles, namely: neuroanaesthesia; obstetric; paediatric; and cardiac anaesthesia. This narrative review describes these factors and synthesises the available evidence to highlight areas of sustainable practice clinicians can address today, as well as posing several unanswered questions for the future. In neuroanaesthesia, improvements can be made by undertaking awake surgery, moving towards more reusables and embracing telemedicine in quaternary services. Obstetric anaesthesia continues to present questions regarding how services can move away from nitrous oxide use or limit its release to the environment. The focus for paediatric anaesthesia is addressing the barriers to total intravenous and regional anaesthesia. For cardiac anaesthesia, a significant emphasis is determining how to focus the substantial resources required on those who will benefit from cardiac interventions, rather than universal implementation. Whilst the landscape of evidence-based sustainable practice is evolving, there remains an urgent need for further original evidence in healthcare sustainability targeting these four clinical areas.

Challenges Faced by University of Limpopo Learner Nurses during Psychiatry Clinical Exposure: A Qualitative Study.

Clinical exposure of learner nurses to psychiatric hospitals is a requirement by the South African Nursing Council. Clinical experience helps learner nurses build cognitive and affective skills, cultural acculturation, and professional identity. The clinical placement also aids nursing learner nurses in making decisions regarding future career paths. The goal of psychiatric nursing practice is to enhance mental and physical health and improve the patient's quality of life and rehabilitation. A qualitative research approach was followed, and a descriptive, explorative, and contextual design was used in this study to explore the challenges faced by University of Limpopo learner nurses during psychiatry clinical exposure. The population included learner nurses from level two to level four who registered for psychiatric nursing science practice. Convenience sampling was adopted. Semi-structured interviews were used to collect data, and the data were analyzed using the Tesch open coding method. Measures to ensure trustworthiness were adhered to, and ethical considerations were observed. The findings of this study indicated that learner nurses go through challenges and discomfort in the form of mental health care users, clinical environment matters, and the attitude of clinical staff in the hospital. Proper preparation of the learner nurses and clinical areas can assist in reducing the challenges that learner nurses go through.

Student satisfaction in clinical area subjects during the COVID-19 pandemic in a medical school

IntroductionCoronavirus SARS-CoV-2 had an impact on health and education, among other subjects. It caused changes in teaching medicine. The objective of the study was to determine student satisfaction in the subjects of the clinical area in a medical school during the coronavirus SARS-CoV-2 pandemic.MethodsThe current study has an observational, descriptive, and cross-sectional design. The sample consisted of 119 students. Inclusion criteria included being a student enrolled in the 2021–2022 semester, between the VI and XII semesters in a medical school.ResultsIt was found that the median age was 21 years; 68 (57.1%) were men. Overall student satisfaction was 67.1%. High student satisfaction was found in the dimension development of professional skills (84.9%), achievement of student expectations (69.7%), and virtual assistance (67.2%) at a medium level of student satisfaction. Flexibility in learning (64.7%), the use of infrastructure and facilities (61.7%), and the use of educational resources (61.3%) were reported.DiscussionThe students were generally satisfied with the dynamic communication of the teachers, especially concerning promoting student participation (79%).

Artificial Intelligence in Clinical and Surgical Gynecology

Clinicians have increasingly been using artificial intelligence (AI) to make decisions and to increase their knowledge in various clinical and surgical gynecological areas. A vast amount of clinical, medical, and biological patient data is processed in fast computer networks using complex algorithms to create mathematical modeling. The development of these mathematical models gives hope of a promising future with their contribution to overcoming the difficulties encountered in the diagnosis, individualization of treatment plans and improving patient outcomes. Virtual AI in clinical gynecology uses pattern recognition to aid diagnosis, plan treatment, and predict outcomes in gynecological malignancies, assisted reproductive techniques, and urogynecology. In gynecological surgery, physical AI combines augmented reality in operations in the form of computer-aided or robotic platforms. However, AI is yet to be fully incorporated into modern medical practice to improve patient outcomes in clinical gynecology.

Racial and ethnic diversity in global neuroscience clinical trials

BackgroundDespite efforts to increase diversity in neuroscience trials, racial and ethnic minority groups remain underrepresented. Disparities in clinical trial participation could reflect unequal opportunities to participate and may contribute to decreased generalizability of findings and failure to identify important differences in efficacy and safety outcomes. MethodsWe retrospectively reviewed the F. Hoffmann-La Roche database for global, multicenter, neuroscience clinical trials from February 2016 to February 2021 and summarized and stratified race and ethnicity distributions by clinical trial therapeutic area and by country. These data were then compared to national population data for each study's targeted age group (available for studies conducted in the US, Canada, and the UK). The underrepresentation or overrepresentation of each racial and ethnic group was summarized. ResultsThe analysis population included 8015 participants from 47 countries. Globally, 85.6 % of participants were White, 7.1 % were Asian, 1.6 % were Black, 1.3 % were American Indian or Alaska Native, less than 0.1 % were Native Hawaiian or other Pacific Islander, 0.7 % were of multiple races, and 3.6 % were of other/unknown race. White individuals predominated in all but one trial. Black individuals were underrepresented in all trials but one. Asian individuals were overrepresented in approximately 20 % of trials. In the US, 7.3 % of participants were of Hispanic or Latino ethnicity vs 16.4 % of the US population. ConclusionThe findings and learnings from this summary and analysis demonstrate the need for continued awareness and new approaches in designing studies that reflect population diversity.

A national survey of current practice on patients with long term and additional needs in paediatric intensive care units.

Patients with long term and additional needs (LEAP) in paediatric intensive care units (PICUs) are a growing and heterogenous cohort that provide unique challenges to clinicians. Currently no standard approach to define and manage this cohort exists. To analyse bed occupancy, examine current practice, and explore ideas to improve PICU care of patients with long term and additional needs. Patients with LEAP were defined as meeting two or more of the following criteria: length of stay >14 days; life limiting condition; ≥2 failed extubations; hospital stay >1 month prior to PICU admission; likely to require long-term ventilation. An electronic survey was then sent to all UK PICUs, via the UK Paediatric Critical Care Society, to collect quantitative and qualitative data relating to bed occupancy, length of stay, multidisciplinary and family involvement, and areas of possible improvement. Data collection were occurred between 8 February 2022 and 14 March 2022. Quantitative data were analysed using Microsoft Excel 365 and SPSS Statistics version 28.0. Raw data and descriptive statistics were reported, including percentages and median with interquartile range for non-parametric data. Qualitative raw data were examined using thematic analysis. Analysis was undertaken independently by two authors and results assessed for concordance. 70.1% (17/24) PICUs responded. 25% (67/259) of PICU beds were occupied by patients with long term and additional needs. 29% (5/17) of responding units have tailored management plans to this cohort of patient. A further 11% (2/17) have guidelines for children with generic chronic illness. 12% (2/16) of responding units had a designated area and 81% (13/16) of responding units had designated professionals. The majority (68% and 62%) of responding units engaged families and community professionals in multidisciplinary meetings. When asked how the care of long term and additional needs patients might be improved five themes were identified: consistent, streamlined care pathways; designated transitional care units; designated funding and hospital-to-home commissioning; development of roles to facilitate collaboration between hospital and community teams; proactive discharge planning and parallel planning. This survey provides a snapshot of UK practice for a cohort of patients that occupies a considerable proportion (29%) of PICU beds. While only a minority of responding PICUs offer specifically tailored management plans, the majority of units have designated professionals. Opportunities exist to improve PICU care in LEAP patients in areas such as: streamlined care pathways, designated clinical areas, designated funding, and development of defined collaborative roles. Next steps may involve working group convention to develop a consensus definition and share good practice examples.

Assessing the fragility index of randomized controlled trials supporting perioperative care guidelines: A methodological survey protocol.

The Fragility Index (FI) and the FI family are statistical tools that measure the robustness of randomized controlled trials (RCT) by examining how many patients would need a different outcome to change the statistical significance of the main results of a trial. These tools have recently gained popularity in assessing the robustness or fragility of clinical trials in many clinical areas and analyzing the strength of the trial outcomes underpinning guideline recommendations. However, it has not been applied to perioperative care Clinical Practice Guidelines (CPG). This study aims to survey clinical practice guidelines in anesthesiology to determine the Fragility Index of RCTs supporting the recommendations, and to explore trial characteristics associated with fragility. A methodological survey will be conducted using the targeted population of RCT referenced in the recommendations of the CPG of the North American and European societies from 2012 to 2022. FI will be assessed for statistically significant and non-significant trial results. A Poisson regression analysis will be used to explore factors associated with fragility. This methodological survey aims to estimate the Fragility Index of RCTs supporting perioperative care guidelines published by North American and European societies of anesthesiology between 2012 and 2022. The results of this study will inform the methodological quality of RCTs included in perioperative care guidelines and identify areas for improvement.

A novel approach for safe and automated implementation of far ultraviolet-C light decontamination in clinical areas.

A novel wall-mounted far ultraviolet-C (UV-C) light technology providing automated delivery of far UV-C only when people are not present reduced methicillin-resistant Staphylococcus aureus in a patient room and equipment room. The safety feature that discontinues far UV-C output when people are detected was effective in preventing far UV-C exposure.

Changes in Radiotherapy and Oncology Practices during the Coronavirus Disease-19 Pandemic: A Study of Two Radiotherapy Facilities in Lagos State, Nigeria

Abstract Background: Coronavirus disease (COVID-19) outbreak in 2019 was caused by severe acute respiratory syndrome coronavirus 2 and became a pandemic in 2020, resulting in significant changes in the management of noncommunicable diseases globally including cancer. Globally, the health-care system, including the Nigerian health-care system, experienced agonizing difficulties coping with patient care, thereby transforming health-care delivery worldwide. Aim: This study is aimed at evaluating the changes in radiotherapy and oncology practices during the COVID-19 pandemic in two radiotherapy facilities in Lagos state. Materials and Methods: Using a quantitative nonexperimental design (comparative), data collection was by semistructured questionnaires filled by all medical personnel of oncology centers in Lagos University Teaching Hospital (LUTH) and Eko Hospital in Lagos over 2 months. A total of 65 questionnaires were reviewed. Data obtained were analyzed using SPSS statistics (Social Sciences Statistical Package) Version 26.0., launched in April 2019 in Chicago, USA. Results: The majority of the respondents were aged 31–50 (70.2%) and females (52%), with the majority of the workforce being clinical and radiation oncologists (29.2%) and 38.5% of respondents having 5–10 years of work experience. The oncology centers were operational throughout the pandemic and 67.2% of respondents confirmed that there were no changes in scheduling of new patients, but 89.2% reported a decline in patient attendance in the facility due to fear of contracting COVID-19 infection from the hospital. Implementation of personnel safety and protective measures such as staff screening before each shift, covid 19 infection testing when they exhibited symptoms, routine wearing of masks, face shields, gloves, personal protective equipment gowns, increased sterilization, and social distancing should be adhered to strictly. New operational measures were adopted for patients, which were similar to that of the staff inclusive of telehealth consultations or follow-ups (23.1%) and telehealth for on-treatment visits (16.9%). The incidence of COVID-19 infection patients who came for treatment was 34%, but they were treated at a specific time of the day and a dedicated LINAC machine was devoted to them because our cancer center has 3 LINAC machines. 75.4% of the workforce confirmed a reduction in staffing to curb overcrowding, 13.8% of staff contacted the disease, 10.8% of staff were transferred to other clinical areas, and 36.9% were unavailable due to the impact of the pandemic on the family. Conclusion: A standard protocol has emanated from this study which has been adopted and is being implemented by the two oncology centers as a result of the majority of the respondent’s preference for the Covid 19 induced changes during the pandemic which resulted in the improved and better standard of care for patients, safety for staff, infection control, incorporation of telemedicine, increase in hypofractionation treatment.

The effect of a preceptorship programme on newly hired experienced professional nurses’ self-efficacy in nursing clinical competency in Saudi Arabia

AimThis study aimed to determine if participation in a preceptorship programme affected newly hired experienced professional nurses’ self-efficacy in clinical practice and whether their perceived competence was related to respondents’ demographic profiles at a university hospital in Saudi Arabia. BackgroundFormal preceptorship programmes are initiated with the aim of improving the characteristics related to new workplace adaptations, such as reducing stress and anxiety, improving effective communication, enhancing clinical performance and competencies, and learning new clinical skills. These programmes’ effectiveness in improving nurses’ self-efficacy in clinical practice is seldom measured, especially among newly hired experienced professional nurses. MethodsA quasi-experimental, quantitative pre- and post-test one-group study design with convenient sampling was used. ResultsSelf-efficacy post-test scores were significantly higher than pre-test scores (p<0.001). The programme positively influenced the respondents’ self-efficacy scores. As perceived by the respondents, the preceptorship programme had a positive effect and improved their clinical performance in the nursing process. There was no relationship between perceived competence and respondents’ demographic profiles. ConclusionsReporting on self-efficacy in clinical practice may not be the most effective, reliable or accurate measure or evaluation of clinical performance since self-scoring may be affected by existing cultural implications and a strong sense of self-efficacy. The self-scoring results may be followed by qualitative information, like interviews, to determine respondents’ knowledge of the nursing process, direct observation of performance in the clinical area and care outcomes, and confirm if the respondents’ clinical performance matches the obtained results.

Advances in artificial intelligence applications in the field of lung cancer.

Lung cancer remains a leading cause of cancer-related deaths globally, with its incidence steadily rising each year, representing a significant threat to human health. Early detection, diagnosis, and timely treatment play a crucial role in improving survival rates and reducing mortality. In recent years, significant and rapid advancements in artificial intelligence (AI) technology have found successful applications in various clinical areas, especially in the diagnosis and treatment of lung cancer. AI not only improves the efficiency and accuracy of physician diagnosis but also aids in patient treatment and management. This comprehensive review presents an overview of fundamental AI-related algorithms and highlights their clinical applications in lung nodule detection, lung cancer pathology classification, gene mutation prediction, treatment strategies, and prognosis. Additionally, the rapidly advancing field of AI-based three-dimensional (3D) reconstruction in lung cancer surgical resection is discussed. Lastly, the limitations of AI and future prospects are addressed.

Perception of Nursing Students About Effective Clinical Teaching Environments: A Multi-Country Study.

The transition of nursing education from traditional methods to more advanced approaches is crucial for adequately preparing students to deliver competent care in tertiary care centers. Moreover, clinical faculty in nursing plays a key role in guiding nursing students through their clinical training in various healthcare settings. This study aims to describe the perceptions of undergraduate nursing students regarding the effectiveness of the learning environment and clinical teaching in clinical areas across various countries. The study, conducted using a descriptive, cross-sectional research design, gathered data from 215 nursing students using the Clinical Learning Environment Inventory and Clinical Teaching Effectiveness Instrument. Data analysis included frequencies, percentages, mean, standard deviation, t-tests, analysis of variance, and correlation assessments to comprehend the impact of clinical teaching and learning environments. Nursing students' perceptions of the clinical learning environment produced mean scores between 2.03 and 3.38 on a scale from 1 to 4, resulting in an overall mean score of 2.72 across 42 items. This indicates a general satisfaction with their clinical learning experiences. Regarding effective clinical teaching, the mean student responses varied from 3.02 to 3.40 out of a possible 5 points, with a total mean of 3.22. The study revealed notable correlations in the context of effective clinical teaching, particularly with demographic variables and the clinical learning environment. Specifically, a significant correlation with age (r = .177, p = .009) and the clinical learning environment (r = .572, p < .001) was identified. The study concludes that students expressed overall satisfaction with their clinical learning experiences. They recognized the importance of participating in clinical training, fulfilling clinical responsibilities for assigned patients, exerting extra effort for learning, receiving support from preceptors in clinical settings, and being attentive to communications from staff. The collaboration between clinical preceptors and academic nursing lecturers is crucial in providing a positive learning environment for students to complete clinical tasks effectively.

A Survey of Sports Vision Practitioners

The purpose of this study was to survey sports vision practitioners to inform the sports vision community as to the most common practice patterns in this clinical area.