Clinical Expertise Research Articles

Nurses’ implementation of evidence based practice in nursing process and its associated factors in South Wollo Zone public hospitals, Northeast Ethiopia: a mixed method study

BackgroundEvidence-based practice is clinical decision-making using the best evidence available in the context of individual patients’ preferences and clinical expertise. It is serving as a crucial instrument for the health science disciplines to minimize the theory-practice gap although the level of practice is unknown. Thus, this study aimed to assess nurses’ implementation of evidence-based practice in nursing process and its associated factors in South Wollo Zone Public Hospitals.MethodsAn explanatory sequential mixed method was employed from April 1 to May 29, 2023, among 419 nurses for the quantitative part and 15 others for the qualitative part. The data were collected using structured, pretested, self-administered questionnaires. Simple random and purposive sampling techniques were used to select participants for the quantitative and qualitative studies, respectively. The bivariable analysis was done primarily, and variables with a p-value < 0.25 were further examined using a multivariable logistic regression model to control con-founders. Then, variables having a p-value less than 0.05 with a 95% CI were used to declare significantly associated factors. The key informants were interviewed using pre-made interview guidelines, and then open code software was utilized to conduct a thematic analysis.ResultNurses who had poor implementation of evidence-based practice in the nursing process were 228 [54.42%; 95% CI: (49.8–59.3)]. Similarly, the key informants concluded that the implementation of evidence-based practice in the nursing process was low. Participants who were 31– 40 years old [AOR = 0.61, 95% CI: (0.38–0.99)], 41–50 years [AOR = 0.32, 95% CI: (0.15–0.65)], working at general hospitals [AOR = 3.37, 95% CI: (1.39–8.18)] and comprehensive specialized hospitals [AOR = 7.29, 95% CI: (3.06 − 17.31)], lack of training about evidence-based practice (AOR = 2.50, 95% CI: (1.36–4.56)], and lack of internet access [AOR = 2.46, 95% CI: (1.43–4.23)] were factors associated with poor levels of nurses’ implementation of evidence-based practice in the nursing process. The absence of computers, libraries, and updated guidelines were other factors identified on the quality analysis.ConclusionNurses’ implementation of evidence-based practice in the nursing process was low. Age, working in general hospitals, and comprehensive and specialized hospitals, lack of training, and internet access were factors that had significant associations. Hence, hospital managers should give an attention to internet access and training about utilization of evidence-based practice in nursing process, particularly for those aged above thirty years old.

Orthodontic bracket failure rate after bonding with and without primer – A systematic review and meta-analysis

To compare the difference in failure rates between orthodontic brackets bonded with light-cured primer and those bonded without primer. An electronic search of five databases and additional manual searches were performed until January 2024. Randomized and prospective non-randomized controlled trials directly comparing the bracket failure rate with and without primer. Two authors independently collected study characteristics by extracting outcome data from pre-defined sheets. After evaluating the risk of bias, the odds ratio and 95% confidence intervals (CIs) were calculated with random-effects models. Four studies were evaluated using qualitative and quantitative analysis. The analysis included data from 199 patients (1691 brackets with primer and 1646 brackets without primer). Random effects of pooled meta-analysis demonstrated statistically significant differences in the bracket failure rates (odds ratio=1.50, p=0.010, [95% CI 1.10 to 2.05]). The risk of failure was 1.5 times greater when brackets were bonded without primer. The results should be interpreted in the context of the limited sample size, even though there was a substantial difference in the failure rates of brackets with and without a primer, favouring the use of a primer. Furthermore, the validity of the finding may be limited by potential variables such as patient factors, clinician expertise, and isolation. More extensive research is required to validate these findings (PROSPERO CRD42024593134).

Targeted Development and Validation of Clinical Prediction Models in Secondary Care Settings: Opportunities and Challenges for Electronic Health Record Data.

Before deploying a clinical prediction model (CPM) in clinical practice, its performance needs to be demonstrated in the population of intended use. This is also called "targeted validation." Many CPMs developed in tertiary settings may be most useful in secondary care, where the patient case mix is broad and practitioners need to triage patients efficiently. However, since structured or rich datasets of sufficient quality from secondary to assess the performance of a CPM are scarce, a validation gap exists that hampers the implementation of CPMs in secondary care settings. In this viewpoint, we highlight the importance of targeted validation and the use of CPMs in secondary care settings and discuss the potential and challenges of using electronic health record (EHR) data to overcome the existing validation gap. The introduction of software applications for text mining of EHRs allows the generation of structured "big" datasets, but the imperfection of EHRs as a research database requires careful validation of data quality. When using EHR data for the development and validation of CPMs, in addition to widely accepted checklists, we propose considering three additional practical steps: (1) involve a local EHR expert (clinician or nurse) in the data extraction process, (2) perform validity checks on the generated datasets, and (3) provide metadata on how variables were constructed from EHRs. These steps help to generate EHR datasets that are statistically powerful, of sufficient quality and replicable, and enable targeted development and validation of CPMs in secondary care settings. This approach can fill a major gap in prediction modeling research and appropriately advance CPMs into clinical practice.

The Effectiveness of Acceptance and Commitment Therapy Method on the Life Expectancy of Patients with Various Diseases in Iran: A Literature Review Study

Context: Acceptance and commitment therapy (ACT) is a cognitive-behavioral psychotherapy method focusing on acceptance and commitment to life values. Objectives: This study aimed to evaluate the effectiveness of the ACT method on the life expectancy (LE) of patients with different diseases. Evidence Acquisition: The present study is a literature review that collects findings from past related studies in the last two decades. For this purpose, the essential and common Medical Subject Headings (MeSH) terms were first identified. Then, the desired MeSH terms were searched in the most reliable and essential international databases, including Google Scholar, Scopus, PubMed, Web of Science, and national databases, including Magiran, SID, Iran doc, etc. First, 265 articles were identified, and then 18 were selected as final studies considering the inclusion and exclusion criteria. Results: The findings of 18 studies were extracted for the present study. Some different types of patients, including those with rheumatoid arthritis, depression, multiple sclerosis, asthma, diabetes, liver transplants, chronic pain, cancer, physical-motor disabilities, drug addiction, and others, were shown to increase LE through the use of the ACT method. The main finding of the present study was that using the ACT method to increase LE in patients with various diseases has a significant effect, which was clearly highlighted in all the selected studies. Conclusions: Based on the findings, ACT is an effective and high-efficiency method in increasing patients' LE. Acceptance and commitment therapy can improve LE, resilience, quality of life, compliance with treatment, and other patient benefits, thus improving the speed of recovery for patients. Therefore, the ACT method, which is a non-pharmacological method, can be used by specialists and clinical psychology experts for different patients.

Automating cancer diagnosis using advanced deep learning techniques for multi-cancer image classification

Cancer detection poses a significant challenge for researchers and clinical experts due to its status as the leading cause of global mortality. Early detection is crucial, but traditional cancer detection methods often rely on invasive procedures and time-consuming analyses, creating a demand for more efficient and accurate solutions. This paper addresses these challenges by utilizing automated cancer detection through AI-based techniques, specifically focusing on deep learning models. Convolutional Neural Networks (CNNs), including DenseNet121, DenseNet201, Xception, InceptionV3, MobileNetV2, NASNetLarge, NASNetMobile, InceptionResNetV2, VGG19, and ResNet152V2, are evaluated on image datasets for seven types of cancer: brain, oral, breast, kidney, Acute Lymphocytic Leukemia, lung and colon, and cervical cancer. Initially, images undergo segmentation techniques, proceeded by contour feature extraction where parameters such as perimeter, area, and epsilon are computed. The models are rigorously evaluated, with DenseNet121 achieving the highest validation accuracy as 99.94%, 0.0017 as loss, and the lowest Root Mean Square Error (RMSE) values as 0.036056 for training and 0.045826 for validation. These results revealed the capability of AI-based techniques in improving cancer detection accuracy, with DenseNet121 emerging as the most effective model in this study.

Defining the urology nurse practitioner in Australia and New Zealand: A Delphi study.

Nurse practitioners with roles in specialty environments face challenges including uncertain role expectations and achieve urology expertise with on-the-job training, mentoring, and independent study. This creates a wide variety of preparation and role descriptions. This study employed Delphi methodology to identify essential components of the urology nurse practitioner (NP) role in Australia and New Zealand, representing an inaugural description of the role. This Delphi study was completed in two rounds. Participants were a nonrandom panel of experts with experience as a full-time urology NP. A definition for the urology NP in Australia and New Zealand is proposed: "The urology nurse practitioner uses critical thinking, complex decision-making, clinical reasoning, advanced assessment skills and clinical expertise, offering acute and chronic care to individuals needing urologic health care, including office-based urology procedures as appropriate. This care is provided in an environment of autonomous practice, with a basis of graduate education and relevant specialty clinical experience, and this practice can extend across health care settings and serve as a model to the wider NP profession." Outpatient urology procedures were ranked highly and deemed integral to the Urology NP role. This may reflect the declining number of urologists and efforts to maintain urology access for local populations. Professional roles of the NP were given less weight by participants. The project offers a contemporary definition of the urology NP role that can be offered to educators and other stakeholders as the role continues to evolve in Australia and New Zealand.

Time–frequency ridge characterisation of sleep stage transitions: Towards improving electroencephalogram annotations using an advanced visualisation technique

Manual sleep stage scoring of polysomnography recordings is an expensive and time-consuming process, further complicated by inconsistent sleep stage agreement among sleep experts (clinicians and sleep technologists). Hence, development of automated sleep scoring algorithms are an emerging topic of interest. Automation typically mimics the clinical decision path by implementing a series of predefined rules, such as the American Academy of Sleep Medicine’s (AASM) scoring manual. Recently, data driven methods have emerged using machine or deep learning. Both manual and automated methods of scoring have known limitations; primarily, unacceptable variation in agreement between different scorers and algorithms. Within the literature, electroencephalogram (EEG) frequency is an important feature considered by both sleep experts and automated approaches for classifying sleep stages.This study presents a novel approach to sleep stage analysis, by developing a methodology to precisely determine the temporal location of sleep stage transitions. The current gold standard fails to identify such transitional changes, which leads to poor inter-scorer reliability. Therefore, development and implementation of such methodologies is a crucial, but overlooked, step in improving the consistency of scoring within sleep studies. In this work, EEG time–frequency ridge analysis was used to characterise the dominant frequency component of EEG signals in time, at the point of sleep stage transition. An in-depth analysis of N3 → N2 and N2 → N3 transitions in the 2018 PhysioNet challenge “You Snooze, You Win” and the Wisconsin Sleep Cohort (WSC) datasets (n = 994, n = 742; approximately 13,888 h of sleep data) showed consistent time–frequency patterns at the point of transition, from one sleep stage to another. This methodology allows simple and ‘interpretable’ features to be generated in future work, to precisely identify the temporal location of sleep stage transitions with the aim of improving inter-scorer reliability.

Facilitating Family Carer Dementia Education: We All Need to Learn.

The importance of family carer dementia education is highlighted in research, practice guidance, and policy. Less attention is paid to how facilitators learn and prepare for their role. This research aimed to explore and describe facilitator learning experiences within a bespoke Scottish Carers' Academy designed around a theory-guided approach called Care Empathia. A healthcare and university partnership ensured integration with services and the fusion of dementia higher education know-how with clinical practice expertise. Nineteen facilitator questionnaires were completed from two Carer Academy hubs; thirteen participated in online focus groups. The questionnaire findings highlighted the learning gained from being a facilitator, observing expert facilitators in action, and listening to the testimonies of family carers. The framework analysis of the focus group data identified six themes, including safe learning approaches, the art of facilitation, emotional work, team learning, and leadership. These findings highlight the importance of facilitator preparation and the advantages of co-delivery models that combine clinical and practice education expertise. Facilitators need to understand how to walk the talk of theory-guided educational models, be open to reciprocity in learning, and be prepared for the emotional work of delivering trauma-informed practical dementia care education to family carers.

A cross-sectional study of evidence-based practice and its determinants among healthcare professionals in Northwest Ethiopia.

Evidence-based practice (EBP) is the integration of current best evidence with clinical expertise by considering patient preferences and values. Evidence based practice has not been well studied in Ethiopia. Therefore, this study aimed to assess EBP and its determinants among health professionals working at primary public hospitals in the Central Gondar zone, Northwest Ethiopia. A facility-based cross-sectional study was conducted on 422 health professionals. A simple random sampling technique was used to select the study participants. The data were entered into EpiData version 4.6 and exported to SPSS version 25 for analysis. The descriptive, bivariable, and multivariable logistic regression analysis were conducted. Adjusted Odds Ratio (AOR) with 95% confidence intervals and p-value <0.05 were used to assess association of explanatory variables with EBP and declare statistical significance, respectively. About 44.1% (95%CI: 39, 50%) of healthcare professionals had good evidence-based practice. Educational status (AOR: 3.05, CI: 1.07-8.66), spare time (AOR: 1.90, CI: 1.09, 3.31), good knowledge (AOR: 7.95, CI: 4.83, 13.08), good skill (AOR: 2.39: CI: 1.27, 4.53), training (AOR: 2.13, CI: 1.26, 3.58), and internet access (AOR = 2.02: 95% CI: 1.25-3.27) were found to be significant predictors of evidence-based practice. This study revealed that EBP was low compared to national standards. Moreover, having good knowledge and skill about evidence-based practice, being trained, having spare time and internet access and upgrading educational status of health care professionals would enhance good evidence-based practice.

Best Evidence Summary for Management of Older People With Type 2 Diabetes Mellitus Using 'Internet Plus Nursing Services'.

To evaluate and summarise the evidence for the management of older people with Type 2 diabetes mellitus (T2DM) using 'Internet Plus nursing services (IPNS)'. This study was conducted as an evidence summary, adhering strictly to the evidence summary reporting standards established by Fudan University Center for Evidence-based Nursing. We systematically searched for the best available evidence pertaining to the management of older people with T2DM using the IPNS. The literature types encompassed clinical guidelines, expert consensuses, systematic reviews, evidence summaries and original research studies. In order to gather pertinent information, we conducted a comprehensive search across various databases, including UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, the Cochrane Library, PubMed, Web of Science, Yi Maitong Guidelines Network, SinoMed, CNKI, WanFang database, Chinese Biomedical Literature Database and China Science and Technology Journal Database. The search spanned from the inception of each database up to July 2023, ensuring an extensive coverage of relevant resources. After rigorous screening and evaluation, our study ultimately identified 19 articles with high-quality research outcomes. These articles consisted of three guidelines, two expert consensus documents, three systematic reviews and eleven original research studies. Through collaborative and in-depth discussions, we extracted and synthesised 27 pieces of evidence related to the application of the IPNS to enhance the T2DM management for older people. We categorised the evidence into five primary themes: mobile terminal design, team building, health education design, interaction and social support, and information feedback. In designing the IPNS for older people with T2DM, utmost attention should be paid to the intricacies of Internet module development preceded by comprehensive guidance. It is imperative to establish multidisciplinary teams to oversee the curation of patient educational content, ensuring its relevance and effectiveness. Leveraging Internet-based information feedback mechanisms is crucial for fostering peer support, assisting in blood glucose control, enhancing self-management capabilities and ultimately improving overall quality of life. Healthcare professionals are supposed to customise the IPNS for this vulnerable population, taking into account institutional resources and local contextual realities. It is highly recommended that clinical medical personnel worldwide adhere to the evidence-based recommendations for better care of older people with T2DM using the IPNS. No patient or public contribution was incorporated in this study. Our study provides structured ideas for the application of IPNS in T2DM management, provides practicable new ways for IPNS to improve self-management of older people with T2DM, and encourages the provision of Internet-based nursing services based on the needs and characteristics of older people, and jointly solves the challenges of T2DM management in order to enhance the effectiveness of nursing services.

Evaluation of Knowledge, Attitude and Practice of Pharmacists in Tehran Pharmacies regarding Environmental Health Issues to Increase Good Pharmacy Practice

Background: In addition to being the most accessible medical center in the community, the pharmacy is a center for storing and providing medicines and cosmetics that are directly related to people's health. Therefore, observing environmental health issues in the pharmacy, which is managed by the pharmacist, is considered necessary. In this study, considering the direct and high impact of observing various aspects of environmental health on the good pharmacy practice and its value, it has been tried by examining the level of knowledge, attitude and practice of pharmacists in the pharmacies of Tehran city and presenting it, the necessary ground for promotion The environmental health status of pharmacies should be provided. Methods: In this research, standard researcher-made questionnaires were designed and after checking its validity by clinical pharmacists, environmental health and biostatistics experts and its reliability with Cronbach's alpha test, It was completed by the pharmacists of Tehran community pharmacies in the period of April to September 2022, observing ethical points and preserving their identity, in order to show their knowledge, attitude and performance towards environmental health issues in the pharmacy where they operate. Then the obtained data were analyzed in SPSS version 23.0 statistical software. Results: Examination of the data obtained from this study showed that the pharmacists in the study have the appropriate level of knowledge and attitude, but their performance in pharmacies is different. Conclusion: Observation of the results of the study shows that due to the lack of appropriate practical training and the lack of strict rules by regulatory authorities, despite the appropriate level of knowledge of pharmacists, in practice do not consider themselves very obliged to observe health principles.

A Real Time Delphi Study on the Challenges and Adverse Events to Percutaneous Osseointegrated Implant Integration and Long-Term Fixation in Limb Amputation

Percutaneous Osseointegrated Implants (POI) affix artificial limbs to the body after amputation. Several adverse events challenge mainstream uptake of this technology. This study aims to achieve a consensus regarding “the challenges and adverse events to POI integration and long-term fixation in limb amputation”. We sought a panel of clinical experts divided by profession into surgical, clinical, or clinical academic categories. We used a real time eDelphi method to develop consensus on both the challenges and adverse event items, enabling anonymity, iteration, controlled feedback, and statistical aggregation of group responses. The full panel agreed that the most impactful items are amongst 10 key challenges and eight adverse events. Panellists were in consensus regarding the five most impactful challenges, which were, in decreasing order: patient selection, absence of a multidisciplinary team, design of the implant, soft tissue stability and an experienced surgical team. Panellists considered the five most impactful adverse events, in decreasing order, to be the following: no biological fixation, deep infection, aseptic loosening, no mechanical fixation, and implant breakage. Consensus was obtained on implant breakage and deep infection items. The proportion of consensus from the whole panel across all items was in line with the literature, and we observed an improvement in consensus once the panel was stratified based on job, expertise and implant system.

A machine-learning algorithm to grade heart murmurs and stage preclinical myxomatous mitral valve disease in dogs.

The presence and intensity of heart murmurs are sensitive indicators of several cardiac diseases in dogs, particularly myxomatous mitral valve disease (MMVD), but accurate interpretation requires substantial clinical expertise. Assess if a machine-learning algorithm can be trained to accurately detect and grade heart murmurs in dogs and detect cardiac disease in electronic stethoscope recordings. Dogs (n = 756) with and without cardiac disease attending referral centers in the United Kingdom. All dogs received full physical and echocardiographic examinations by a cardiologist to grade any murmurs and identify cardiac disease. A recurrent neural network algorithm, originally trained for heart murmur detection in humans, was fine-tuned on a subset of the dog data to predict the cardiologist's murmur grade from the audio recordings. The algorithm detected murmurs of any grade with a sensitivity of 87.9% (95% confidence interval [CI], 83.8%-92.1%) and a specificity of 81.7% (95% CI, 72.8%-89.0%). The predicted grade exactly matched the cardiologist's grade in 57.0% of recordings (95% CI, 52.8%-61.0%). The algorithm's prediction of loud or thrilling murmurs effectively differentiated between stage B1 and B2 preclinical MMVD (area under the curve [AUC], 0.861; 95% CI, 0.791-0.922), with a sensitivity of 81.4% (95% CI, 68.3%-93.3%) and a specificity of 73.9% (95% CI, 61.5%-84.9%). A machine-learning algorithm trained on humans can be successfully adapted to grade heart murmurs in dogs caused by common cardiac diseases, and assist in differentiating preclinical MMVD. The model is a promising tool to enable accurate, low-cost screening in primary care.

Challenges in Teledermoscopy Diagnostic Outcome Studies: Scoping Review of Heterogeneous Study Characteristics.

Teledermoscopy has demonstrated benefits such as decreased costs and enhanced access to dermatology care for skin cancer detection. However, the heterogeneity among teledermoscopy studies hinders the systematic reviews' synopsis of diagnostic outcomes, impeding trust and adoption in general practice and limiting overall health care benefits. This study aims to improve understanding and standardization of teledermoscopy diagnostic studies, by identifying and categorizing study characteristics contributing to heterogeneity. Subsequently, the variability and consistency of these characteristics were assessed. A review of systematic reviews regarding the diagnostic outcomes of teledermoscopy was performed to discern reported study characteristics contributing to heterogeneity. These characteristics were thematically grouped into 3 domains (population, index test, and reference standard), forming a data extraction framework. A scoping review on teledermoscopy diagnostic outcomes studies was performed, guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Data pertaining to study characteristics from included studies were extracted and analyzed through descriptive content analysis. Systematic reviews' reference lists validated the scoping review query. The literature search yielded 4 systematic reviews, revealing 15 heterogeneous studies across the population, index test, and reference standard domains. The scoping review identified 49 studies, with 27 overlapping with the systematic reviews. Population characteristics varied, with one-third (16/49, 33%) of studies reporting fewer than 100 samples; most studies (41/49, 84%) reported on the type of lesion, and most (20/49, 41%) teledermoscopy consultations took place in secondary care. One-fifth (11/49, 22%) did not describe inclusion or exclusion criteria, or the criteria varied highly. Index test characteristics showed differences in clinical expertise, profession, and training in dermatoscopic photography, and 59% (29/49) did not report on 1 or more index test characteristics. Image quality and clinical information reporting likewise varied. Reference standard characteristics involved teledermatologists' assessment, but 16 studies did not report teledermatologists' experience levels. Most studies (26/49, 53%) used histopathology as a gold standard. The heterogeneity in the population, index tests, and reference standard domains across teledermoscopy diagnostic outcome studies underscores the need for standardized reporting. This hinders the synopsis of teledermoscopy diagnostic outcomes in systematic reviews and limits the integration of research results into practice. Adopting a (tailored) STARD (Standards for Reporting Diagnostic Accuracy Studies) checklist for teledermoscopy diagnostic outcome studies is recommended to enhance the consistency and comparability of outcomes. We suggest performing a Delphi study to gather consensus on the tailored STARD guideline.

How Are We Addressing Axial Psoriatic Arthritis in Clinical Practice?

Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting the musculoskeletal system, skin and nails. In addition to peripheral joints, inflammation of the spine and sacroiliac joints may occur. Yet, research into this axial phenotype has lagged behind partly because of the challenge in its clinical identification with a lack of specific clinical, molecular or imaging biomarkers. In the absence of a validated definition of what constitutes axial PsA (axPsA), guidelines for the management of axial involvement in PsA in clinical practice are scarce. On the basis of a literature review and their clinical expertise, a group of rheumatology experts provide their opinion to aid the diagnosis and management of axial PsA in clinical practice.

Resident Unions: Why Now and Will They Change Medical Education and Health Care?

During the COVID-19 pandemic, resident unions proliferated. While unionization resulted in increased compensation and benefits, the process of union negotiations may have created adversarial relationships between residents and their institutions' leadership, who residents depend on for supervision and the development of clinical expertise. Such adversarial relationships could affect the learning environment, which is critical to the delivery of high-quality care. In this commentary, the authors suggest that academic medical centers should offer residents an authentic seat at the institutional care delivery leadership table, ensuring residents' full participation in key organizational decisions. Doing so represents an alternative to unionization, with its potentially adversarial relationships, while still achieving a key goal of residents-to be included in the decisions that affect them and the care they provide. In this way, residents can use their unique understanding of the institutions' strengths and weaknesses to improve the quality of patient care and the learning environment. Such engagement can also help residents achieve competence in systems-based practice and provide a vital link between institutions and the patients and community they serve through health policy and advocacy activities.

Highly efficient image navigator based 3D whole-heart cardiac MRA at 0.55T.

To develop and evaluate a highly efficient free-breathing and contrast-agent-free three-dimensional (3D) whole-heart Cardiac Magnetic Resonance Angiography (CMRA) sequence at 0.55T. Free-breathing whole-heart CMRA has been previously proposed at 1.5 and 3T. Direct application of this sequence to 0.55T is not possible due to changes in the magnetic properties of the tissues. To enable free-breathing CMRA at 0.55T, pulse sequence design and acquisition parameters of a previously proposed whole-heart CMRA framework are optimized via Bloch simulations. Image navigators (iNAVs) are used to enable nonrigid respiratory motion-correction and 100% respiratory scan efficiency. Patch-based low-rank denoising is employed to accelerate the scan and account for the reduced signal-to-noise ratio at 0.55T. The proposed approach was evaluated on 11 healthy subjects. Image quality was assessed by a clinical expert (1: poor to 5: excellent) for all intrapericardiac structures. Quantitative evaluation was performed by assessing the vessel sharpness of the proximal right coronary artery (RCA). Optimization resulted in an imaging flip angle of , fat saturation flip angle of , and six k-space lines for iNAV encoding. The relevant cardiac structures and main coronary arteries were visible in all subjects, with excellent image quality (mean ) and minimal artifacts (mean ), with RCA vessel sharpness ( ) comparable to previous studies at 1.5T. The proposed approach enables 3D whole-heart CMRA at 0.55T in a 6-min scan ( ), providing excellent image quality, minimal artifacts, and comparable vessel sharpness to previous 1.5T studies. Future work will include the evaluation of the proposed approach in patients with cardiovascular disease.

Proceedings of a membrane update symposium: advancements, scientific insights, and future trends for dialysis membranes for enhanced clinical outcomes in end stage kidney disease patients.

From September 6 - 8 2022, the Life/2022 Membrane Symposium was held in Frankfurt, Germany, and transmitted live to a worldwide internet audience. The event was part of the Life/Nephrology Campus initiative, a continuous educational platform for the nephrology community to expand knowledge and share expertise on contemporary topics in chronic kidney disease. We describe recent questions and advances in the field, and we underline challenges in the care of dialysis patients and opportunities for integration of new findings into clinical practice to improve patient outcomes in end stage kidney disease patients. Most patients with kidney failure are on maintenance hemodialysis (MHD). The scientific program of the symposium was developed around topics about the role, functional determinants, technical aspects, limitations, and clinical implications of membranes presently in use. International experts with clinical or technical expertise as well as scientific recognition within the nephrology community were asked to prepare their presentations based on their own experiences, perceptions, opinions, and sources of information. The symposium devoted a major portion to discussing novel approaches for improving membranes and treatment quality, including updates on innovative concepts that may could potentially transform the landscape of kidney replacement therapy for chronic kidney disease patients in the future. The intent was to provide insights into current attention points for healthcare professionals new to the field of MHD, and to test a unique forum for continuing medical education integrating physician and patient experiences to promote changes in clinical practice. Furthermore, the symposium premiered a specifically developed mixed reality holographic 3D model to demonstrate recent dialyzer innovation diminishing protein fouling on membrane surfaces. As a continuous online educational platform for scientific exchange, this Life/2022 event provided online learning opportunities with on-demand content, with all symposium lectures freely available on nephrologycampus.com.

Clinical and economic impact of pharmacist interventions to identify drug-related problems in multidisciplinary cancer care: a prospective trial.

The prescription of antitumor drugs has often been associated with drug-related problems. Pretherapeutic multidisciplinary risk assessment programs including pharmaceutical care have been established to secure the initiation of injectable and oral antitumor therapies. This prospective cross-sectional double-center study evaluated the clinical and economic impact of the pharmacist in detecting drug-related problems in patients initiating antitumor therapies. Following pharmaceutical consultations, pharmaceutical interventions were validated by a multidisciplinary team. A committee of independent clinical experts assessed the potential clinical impact of drug-drug interactions. The association of clinical variables with pharmaceutical interventions was tested using a multivariate logistic regression model. Pharmacist cost of the program was assessed by valuing pharmacists' time at their salaries and compared with potentially avoided costs. Four hundred thirty-eight patients with solid tumors were included: 62% males, mean age of 65 ± 13 years, and average of 6 medications. Half of the patients required at least one pharmaceutical intervention and independent factors associated with pharmaceutical interventions were the number of medications (5-9 vs <5: OR = 2.91 [95% CI 1.82-4.65], P < .001) and the type of antitumor treatment (immunotherapy vs intravenous chemotherapy: OR = 0.35 [95% CI 0.18-0.68], P = .002). One hundred seventy-four out of 266 pharmaceutical interventions (130 patients) involved clinically significant drug-drug interactions. Pharmacist costs were estimated to range between €4899 and €6125. Average costs were estimated at €11.4-14.3 per patient. Avoided hospitalization costs were estimated to be €180 633. Clinical pharmacists contribute to the cost-effective reduction of drug-related problems in pre-therapeutic assessment programs for patients with cancer.

Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning

ObjectiveDefine a best practice guide for managing people with patellofemoral pain (PFP).MethodsA mixed-methods convergent segregated synthesis of meta-analysed data with a thematic analysis of semistructured interviews and focus groups. Agreement...