Clinical Institutions Research Articles

Pediatric Acute Lung Injury and Sepsis Investigators (PALISI): Evolution of an Investigator-Initiated Research Network.

The Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network originated over 20 years ago to foster research to optimize the care of critically ill infants and children. Over this period, PALISI has seen two major evolutions: formalization of our network infrastructure and a broadening of our clinical research focus. First, the network is unique in that its activities and meetings are funded by subscriptions from members who now comprise a multidisciplinary group of investigators from over 90 PICUs all over the United States (US) and Canada, with collaborations across the globe. In 2020, the network converted into a standalone, nonprofit organizational structure (501c3), making the PALISI Network formally independent of academic and clinical institutions or professional societies. Such an approach allows us to invest in infrastructure and future initiatives with broader opportunities for fund raising. Second, our research investigations have expanded beyond the original focus on sepsis and acute lung injury, to incorporate the whole field of pediatric critical care, for example, efficient liberation from mechanical ventilator support, prudent use of blood products, improved safety of intubation practices, optimal sedation practices and glucose control, and pandemic research on influenza and COVID-19. Our network approach in each field follows, where necessary, the full spectrum of clinical and translational research, including: immunobiology studies for understanding basic pathologic mechanisms; surveys to explore contemporary clinical practice; consensus conferences to establish agreement about literature evidence; observational prevalence and incidence studies to measure scale of a clinical issue or question; case control studies as preliminary best evidence for design of definitive prospective studies; and, randomized controlled trials for informing clinical care. As a research network, PALISI and its related subgroups have published over 350 peer-reviewed publications from 2002 through September 2022.

Isolation, identification and antibiotic resistance profile of thermophilic Campylobacter species from Bovine, Knives and personnel at Jimma Town Abattoir, Ethiopia.

Thermophilic Campylobacter species are common cause of animal and human bacterial diseases with growing resistance to antimicrobials. The aim of this study was to determine the prevalence and antimicrobial susceptibility pattern of Campylobacter species from bovine, knives and personnel in Jimma Town, Ethiopia. Faecal samples and carcasses swabs were collected from cattle systematically selected from the annual plan of Jimma Municipal Abattoir. Personnel hand and knife swabs were collected after slaughtering each selected cattle. A cross-sectional study with systematic sampling method was conducted from October 2019 to September 2020 for the isolation, identification and antimicrobial susceptibility pattern of thermophilic Campylobacter species. Isolation and identification of Campylobacter species were performed according to the techniques recommended by the International Organization for Standardization, and in vitro antibiotic susceptibility testing was screened using the standard agar disc diffusion method as recommended by Clinical and Laboratory Standards Institutions. A total of 684 samples (171 samples from faeces, carcasses, knives and personnel hands, were collected independently). The overall prevalence of thermophilic Campylobacterspecies was 5.6% (38/684). Majority of the isolates were from faecal samples (12.9%, n = 22) followed by carcass swabs(4.1% n = 7), knife swabs(3.5% n = 6) and personnel hand swabs(1.8% n = 3). Isolated and identified species of C.jejuni, C. coli and C. lari accounted for 63.2%, 23.7% and 13.2%, respectively. The isolated Campylobacter species were found to be resistant to Cephalothin (100%), Ampicillin (60.5%), Cefotaxime (60.5%), Chloramphenicol (47.4%) and Tetracycline (42.1%). On the other hand, the isolates were susceptible to Nalidixic acid (86.8%), Ciprofloxacin (86.8%), Sulphamethazole (84.2%), Ceftriaxone (78.9%), Clindamycin (68.4%) and Cefixime (65.8%). 84.2% of the isolates showed multi-drug resistance for three-to-six drug classes. All the C. lari isolates were multidrug resistant. All the three isolated species of Campylobacter were resistant to Cephalothin, and most were multidrug resistant. Isolation of Campylobacter species from faecal, carcass, knife and hand swabs revealed possible risk of contamination and exposure to Campylobacter infection of those who consume raw meat. Therefore, enactment of hygienic practices during the slaughtering process, proper handling and cooking of meat and awareness creation on jurisdictional antibiotic usage are required to avoid Campylobacter infection.

Arab healthcare professionals’ knowledge and perception of occupational therapy

BackgroundOccupational therapy (OT) services are not widespread and not well-represented or integrated into many healthcare settings. As a result, OT is not available at many clinical and rehabilitation institutions, which has led to both poor access and reduced knowledge and benefit from OT in many countries worldwide and in the Arab region.ObjectiveTo examine Arab healthcare professionals’ level of knowledge and perception of OT in an attempt to identify what action is required to enhance awareness and promote OT profession.MethodsA descriptive online survey was conducted for healthcare professionals from different disciplines and Arab countries to obtain their knowledge and perceptions of OT.ResultsA total of 281 healthcare professionals completed the survey (57% were male). Of the total, only 96 (34.2%) have had worked with OT before, 144 (51.2%) were uncertain about the main domain of OT, 98 (34.9%) were not fully aware of the diverse OT healthcare work settings and different health conditions handled by OT, and 126 (44.8%) were not sure about the difference between OT and physical therapy (PT). Almost two third of the sample (187; 66.5%) were not satisfied with their knowledge of OT, 195 (69.4%) showed interest in learning further about OT, and 209 (74.4%) agreed that OT plays a vital role in the interdisciplinary rehabilitation team. There were significant associations between the participants’ knowledge of OT and their specialty (p = 0.01) and years of experience (p = 0.02).ConclusionMost Arab healthcare professionals perceive OT as playing a vital role in the interdisciplinary rehabilitation team. However, OT is not clearly understood and healthcare professionals are not well-educated about OT services and benefits. There is an emerging need to educate healthcare professionals on the focus areas of OT practice. Promoting and advocating for OT is key and crucial.

Development and evaluation of an interoperable natural language processing system for identifying pneumonia across clinical settings of care and institutions.

To evaluate the feasibility, accuracy, and interoperability of a natural language processing (NLP) system that extracts diagnostic assertions of pneumonia in different clinical notes and institutions. A rule-based NLP system was designed to identify assertions of pneumonia in 3 types of clinical notes from electronic health records (EHRs): emergency department notes, radiology reports, and discharge summaries. The lexicon and classification logic were tailored for each note type. The system was first developed and evaluated using annotated notes from the Department of Veterans Affairs (VA). Interoperability was assessed using data from the University of Utah (UU). The NLP system was comprised of 782 rules and achieved moderate-to-high performance in all 3 note types in VA (precision/recall/f1: emergency = 88.1/86.0/87.1; radiology = 71.4/96.2/82.0; discharge = 88.3/93.0/90.1). When applied to UU data, performance was maintained in emergency and radiology but decreased in discharge summaries (emergency = 84.7/94.3/89.3; radiology = 79.7/100.0/87.9; discharge = 65.5/92.7/76.8). Customization with 34 additional rules increased performance for all note types (emergency = 89.3/94.3/91.7; radiology = 87.0/100.0/93.1; discharge = 75.0/95.1/83.4). NLP can be used to accurately identify the diagnosis of pneumonia across different clinical settings and institutions. A limited amount of customization to account for differences in lexicon, clinical definition of pneumonia, and EHR structure can achieve high accuracy without substantial modification.

Anterior epistaxis.

<h3>Introduction</h3> Academic-practice partnerships are a promising strategy that could strengthen the promotion and innovation of evidence-based nursing practice (EBNP). However, there is little evidence of how academic and clinical institutions and individuals should collaborate in each process of EBNP and the factors that influence academic-practice partnerships in EBNP. There is a pressing need to explore the extent of the literature on academic-practice partnerships in EBNP, as well as to classify, compare and summarise the results or opinions obtained from various types of literature to identify both existing knowledge and gaps in the research. <h3>Methods and analysis</h3> The scoping review will be conducted following the methodological guidelines provided by the JBI. The scoping review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Seven databases, including the Cochrane Library, PubMed, Web of Science, CINAHL, EMBASE, SCOPUS, Educational Resource Information Center and two Chinese databases (ie, CNKI and WANFANG DATA), will be searched. The grey literature will also be searched using the American Association of Colleges of Nursing, American Nurses Association, Open Grey, Grey Literature Report and the official website of JBI. The literature screening and data extraction will be conducted independently by two researchers. A third researcher will be involved when a consensus is needed. <h3>Ethics and dissemination</h3> Ethics approval is not required. The findings of the scoping review will be disseminated in a conference and a peer-reviewed journal.

Exploring the construction of clinical trial research unionsin China

<p indent="0mm">A clinical trial is a key step in the process of pharmaceutical research and development (R &amp; D). It is a key indicator of the innovative potential of the pharmaceutical industry. ClinicalTrials.gov shows that the average annual growth rate of the total number of clinical trials globally in the past decade (2012–2021) was 20.7%, mainly distributed in Europe and the United States, and the total number of clinical trials registered in China accounted for 6% of the world. According to the statistics of IQVIA Institute for Human Data Science, the global proportion of early-stage R &amp; D pipelines from China-headquartered companies increased from 1% in 2005 to 12% in 2020, which was still far behind that of European and American companies. Among 871 new active substances approved for marketing globally in the past two decades, 522 were for marketing in China, with the high number driven by regulatory acceleration mechanisms from National Medical Products Administration, such as breakthrough and orphan designations and priority reviews. Considering the gap in clinical research strength between China and developed countries such as Europe and the United States, the clinical trial research capacity and level should be improved to assist China in the R &amp; D of innovative drugs. According to the Registration and Information Disclosure Platform for Drug Clinical Studies and the clinical trial institution filing management information platform in China, in the last five years (2017–2021), the average annual growth rates of the total number of new drug clinical trial registration and clinical trial units in China reached 26.9% and 12.6%, respectively. However, clinical trial resources are mainly concentrated in major institutions, municipalities, or provincial capital cities in the eastern and central regions of China, with distributions becoming increasingly polarised. Under the background of China’s new medical reforms, the strategic direction of national political support is to motivate equitable access to high-quality clinical trial resources and cross-regional collaborative development of medical institutions by means of medical unions, national clinical medical research centres, Chinese national major projects for new drug innovation and so on. In the context of this background, clinical trial research unions (CTRUs) have been built in China. A CTRU is defined as a consortium formed by medical institutions, sponsors and third-party service institutions of various levels and functions, led by a national clinical medical research centre or clinical trial medical institutions undertaking major national science and technology projects or supporting projects of national key R &amp; D plans, radiating and driving the improvement of clinical trial research capacity in multiple regions. CTRUs develop a multi-level clinical research centre system and collaborative network by vertically and horizontally combining multi-level medical institutions, sponsors and third-party service institutions. All participants of CTRUs are crucial. The leading clinical trial research medical institution, as the core, is responsible for establishing institutional system standards in CTRUs, designing and leading high-quality multi-centre clinical trials, central ethics and personality training. The major clinical trial research medical institutions are responsible for implementing high-quality, multi-centre, complex and high-risk clinical trials. The other member institutions are responsible for implementing basic clinical trials. The sponsors, contract research organizations (CROs), site management organizations (SMOs) and other enterprises are responsible for funding, supporting and promoting the construction of a clinical trial centre system and collaborative network. The specific construction contents of CTRUs include building a clinical trial research resource sharing platform, homogenising clinical trial quality management, constructing a rapid clinical trial process platform, diversified multi-level and multi-form talent training, information interconnection, deepening strategic cooperation and designing and leading high-level trials. CTRUs have established the selection criteria and assessment exit mechanism and conducted work performance assessments from the dimensions of organisation and implementation, division of labour and cooperation, the connection of clinical trial resources from top to bottom, efficiency and benefit and sustainable development to ensure their good and sustainable development. Through CTRUs, we can achieve high-quality clinical trial resource sharing, improve the clinical trial research capability of member institutions, cultivate high-level skills, such as principal investigators (PIs), sub-investigators, institutional managers and clinical research coordinators (CRCs), and promote the development of clinical trials, economically and with high-quality. Through the trial operation with one member of CTRUs, it was found that the key points should be strengthened in deepening resource sharing, implementing central ethics review, interconnecting information platforms and leading high-quality clinical trials. The construction of CTRUs is an effective means for China’s clinical trial research to solve the current problems and change from a ‘follow-on pattern’ to leading high-level and high-quality international multi-centre trials. However, the construction of CTRUs is a complex systematic project. In addition to performing an excellent job in the top-level design and overall planning, CTRUs’ specific implementation process and measures need to be continuously explored in the practice process.

Correlation between experiences of clinical nurses in the COVID-19 pandemic with learning agility and readiness level for future pandemics.

Aims and objectivesThe study aimed to determine the impact of clinical nurses' experiences during the COVID‐19 pandemic on their learning agility and readiness for other future pandemics.BackgroundIt is important that nurses have high learning agility so they can successfully adapt their experience to COVID‐19 and other pandemics that may occur in the future. This will positively affect the readiness of nurses to fight against possible future pandemics.DesignThe study is cross‐sectional, descriptive, correlational research.MethodsThe study was carried outby data collection from 383 nurses. Data were collected via online survey using social media. The study methods were followed by the STORBE guidelines.ResultsThe average score of nurses on the Marmara Learning Agility Scale was 4.07 ± .030. The level of readiness of nurses for new pandemics was 96.1%. Positive but weak correlations were found between the effect of nurses' experiences in the COVID‐19 pandemic with their readiness for potential future pandemics and their learning agility.ConclusionsIt was observed that nurses have high learning agility, gained experience during the COVID‐19 pandemic and these experiences affected their readiness for other potential future pandemics.Relevance to clinical practiceHealth institutions to develop learning agility to support career management, manager selection and performance improvement for clinical nurses.

Block-Chain-Based Vaccine Volunteer Records Secure Storage and Service Structure

Accurate and complete vaccine volunteer’s data are one valuable asset for clinical research institutions. Privacy protection and the safe storage of vaccine volunteer’s data are vital concerns during clinical trial services. The advent of block-chain technology fetches an innovative idea to solve this problem. As a hash chain with the features of decentralization, authentication, and resistibility, blockchain-based technology can be used to safely store vaccine volunteer clinical trial data. In this paper, we proposed a safe storage method to control volunteer personal /clinical trial data based on blockchain with storing on cloud. Also, a service structure for sharing data of volunteer’s vaccine clinical trials is defined. Further, volunteer blockchain features are defined and examined. The projected storage and distribution method is independent of any third person and no single person has the complete influence to disturb the processing..

Academic-practice partnerships in evidence-based nursing practice: a scoping review protocol

IntroductionAcademic-practice partnerships are a promising strategy that could strengthen the promotion and innovation of evidence-based nursing practice (EBNP). However, there is little evidence of how academic and clinical institutions and...

Testing an Automated Approach to Identify Variation in Outcomes among Children with Type 1 Diabetes across Multiple Sites.

Efficient methods to obtain and benchmark national data are needed to improve comparative quality assessment for children with type 1 diabetes (T1D). PCORnet is a network of clinical data research networks whose infrastructure includes standardization to a Common Data Model (CDM) incorporating electronic health record (EHR)-derived data across multiple clinical institutions. The study aimed to determine the feasibility of the automated use of EHR data to assess comparative quality for T1D. In two PCORnet networks, PEDSnet and OneFlorida, the study assessed measures of glycemic control, diabetic ketoacidosis admissions, and clinic visits in 2016-2018 among youth 0-20 years of age. The study team developed measure EHR-based specifications, identified institution-specific rates using data stored in the CDM, and assessed agreement with manual chart review. Among 9,740 youth with T1D across 12 institutions, one quarter (26%) had two or more measures of A1c greater than 9% annually (min 5%, max 47%). The median A1c was 8.5% (min site 7.9, max site 10.2). Overall, 4% were hospitalized for diabetic ketoacidosis (min 2%, max 8%). The predictive value of the PCORnet CDM was >75% for all measures and >90% for three measures. Using EHR-derived data to assess comparative quality for T1D is a valid, efficient, and reliable data collection tool for measuring T1D care and outcomes. Wide variations across institutions were observed, and even the best-performing institutions often failed to achieve the American Diabetes Association HbA1C goals (<7.5%).

Syntaxin-1a and SNAP-25 expression level is increased in the blood samples of ischemic stroke patients

The interest for the discovery of blood biomarkers for several neurological disorders, including Ischemic Stroke (IS), is growing and their identification in blood samples would be revolutionary allowing a fast and better pathology prediction or outcome and to collect information on patient recovery. The increased permeability of the blood–brain barrier, following a brain infarct, allows the detection of brain proteins in the blood flow. In this work, we analyzed the expression levels of two synaptic proteins Syntaxin (STX)-1a and Synaptosomal Associated Protein, 25 kDa (SNAP-25), in Peripheral Blood Mononuclear Cell (PBMC), serum and in Neuronal Derived Extracellular vesicles (NDEs) of IS patients, age and sex matched healthy control (HC) and younger HC (Y-HC). Interestingly, we identified STX-1a protein in the cytoplasm of PBMC and both STX-1a and SNAP-25 expression levels were significantly augmented in all IS patient’s blood fractions compared to control subjects. In addition, STX-1a blood levels correlated with the IS clinical scales National Institutes of Health Stroke Scale (NIH-SS) and the modified Barthel Index (BI). These results prompted us to speculate that STX-1a and SNAP-25 hematic fluctuations depict the brain damage after an ischemic attack and that their hematic detection could represent a novel and accessible IS biomarkers.

Feasibility, impact, and priority of key strategies to enhance diverse and inclusive training programs in clinical and translational research: A mixed methods study.

Enhancing diversity in the scientific workforce is a long-standing issue. This study uses mixed methods to understand the feasibility, impact, and priority of six key strategies to promote diverse and inclusive training and contextualize the six key strategies across Clinical and Translational Science Awards (CTSAs) Program Institutions. Four breakout sessions were held at the NCATS 2020 CTSA Program annual meeting focused on diversity, equity, and inclusion (DEI) efforts. This paper focuses on the breakout session for Enhancing DEI in Translational Science Training Programs. Data were analyzed using a mixed methods convergent approach. The quantitative strand includes the online polling results. The qualitative strand includes the breakout session and the chat box in response to the training presentation. Across feasibility, impact, and priority questions, prioritizing representation ranked number 1. Building partnerships ranked number 2 in feasibility and priority, while making it personal ranked number 2 for impact. Across each strategy, rankings supported the qualitative data findings in feasibility through shared experiences, impact in the ability to increase DEI, and priority rankings in comparison to the other strategies. No divergence was found across quantitative and qualitative data findings. Findings provide robust support for prioritizing representation as a number one strategy to focus on in training programs. Specifically, this strategy can be operationalized through integration of community representation, diversity advocates, and adopting a holistic approach to recruiting a diverse cadre of scholars into translational science training programs at the national level across CTSAs.

ECG as a risk stratification tool in patients with wearable cardioverter-defibrillator

BackgroundThe wearable cardioverter defibrillator (WCD) is increasingly used in patients at elevated risk for ventricular arrhythmias but not fulfilling the indications for an implantable cardioverter defibrillator (ICD). Currently, there is an insufficient risk prediction of fatal arrhythmias in patients at risk. In this study, we assessed the prognostic role of baseline electrocardiogram (ECG) in WCD patients. MethodsWCD patients from diverse clinical institutions in Germany (n = 227) were retrospectively enrolled and investigated for the incidences of death or ventricular arrhythmias during WCD wearing. In addition, the widely accepted ECG predictors of adverse outcome were analyzed in patients with arrhythmic events. ResultsLife-threatening arrhythmias occurred in 22 (9.7 %) patients, mostly in subjects with ischemic heart disease (15 of 22). There was no difference in baseline left ventricular ejection fraction (LVEF) in subjects with and without arrhythmic events (31.3 ± 7.9 % vs. 32.6 ± 8.3 %; p = 0,24). Patients with arrhythmia exhibited significantly longer QRS duration (109.5 ± 23.1 ms vs. 100.6 ± 22.3 ms, p = 0,04), Tpeak-Tend (Tp-e) (103.1 ± 15.6 ms vs. 93.2 ± 19.2 ms, p = 0,01) and QTc (475.0 ± 60.0 ms vs. 429.6 ± 59.4 ms, p < 0,001) intervals. In contrast, no significant differences were found for incidences of fragmented QRS (27.3 % vs. 24 %, p = 0.79) and inverted/biphasic T-waves (16.6 % vs. 22.7 %, p = 0,55). In multivariate regression analysis both Tp-e (HR 1.03; 95 % CI 1.001–1.057; p = 0.02) and QTc (HR 1.02; 95 % CI 1.006–1.026; p < 0.001) were identified as independent predictors of ventricular arrhythmias.After WCD use, the prophylactic ICD was indicated in 76 patients (33 %) with uneventful clinical course but persistent LVEF ≤35 %. The ECG analysis in these subjects did not reveal any relevant changes in arrhythmogenesis markers. ConclusionsECG repolarization markers Tp-e and QTc are associated with malignant arrhythmias in WCD patients and may be used - in addition to other established risk markers - to identify appropriate patients for ICD implantation.

Practical aspects of the organization of ethical review of clinical trials in the context of the COVID-19 pandemic

The COVID-19 pandemic has greatly affected all spheres of life, including biomedical research. The ethical regulation of clinical trials has a long history in international and domestic practice. An efficient infrastructure of international and national legislation has been created. At the same time, there are features of the organization of ethical review of clinical trials that arise under the restrictions associated with COVID-19. Healthcare of all countries is faced with the need to develop new approaches caused by the speed of the spread of the disease, its severe consequences for the life and health of people, the excessive burden on the medical worker, not only physical, but also psychological, including those associated with ethical problems. The purpose of this research was to study and analyze the experience of ethical review of clinical trials in the context of the COVID-19 epidemic, its regulatory framework in international and domestic practice. For high-quality and lawful conduct of clinical trials in Russia in the context of the COVID-19 epidemic, appropriate conditions were created, namely, a vertical base: the central ethical committee of the Ministry of Health of the Russian Federation local ethical committees based in clinical institutions and research centers. They are provided with sufficient and high-quality legal support in the form of laws of the Russian Federation, country standards and by-laws. The work of local ethics committees is built in accordance with strict ethical international and domestic standards. Standard operating procedures implemented in local ethics committees provide for all the nuances of situations, including those implemented using modern telecommunication technologies and other end-to-end information technologies. Even if many restrictions are imposed, biomedical research must continue, and accordingly, it must be carried out under the strict control and monitoring of research ethics committees. The article presents an overview of legal sources, an analysis of the main approaches in domestic and foreign literature, taking into account historical retrospective.

A Mixed-Methods Protocol to Identify Best Practices for Implementing Pharmacogenetic Testing in Clinical Settings.

Using a patient’s genetic information to inform medication prescriptions can be clinically effective; however, the practice has not been widely implemented. Health systems need guidance on how to engage with providers to improve pharmacogenetic test utilization. Approaches from the field of implementation science may shed light on the complex factors affecting pharmacogenetic test use in real-world settings and areas to target to improve utilization. This paper presents an approach to studying the application of precision medicine that utilizes mixed qualitative and quantitative methods and implementation science frameworks to understand which factors or combinations consistently account for high versus low utilization of pharmocogenetic testing. This approach involves two phases: (1) collection of qualitative and quantitative data from providers—the cases—at four clinical institutions about their experiences with, and utilization of, pharmacogenetic testing to identify salient factors; and (2) analysis using a Configurational Comparative Method (CCM), using a mathematical algorithm to identify the minimally necessary and sufficient factors that distinguish providers who have higher utilization from those with low utilization. Advantages of this approach are that it can be used for small to moderate sample sizes, and it accounts for conditions found in real-world settings by demonstrating how they coincide to affect utilization.

Development of a tool to analyse what resources are needed to implement a midwife-led care framework- the MIDWIZE conceptual framework

Background: A midwife led care project targeting to decide what to do to achieve the SDG 2030 in maternal and child health, made a project team develop a tool to analyse what health care systems need, to adopt the MIDWIZE Conceptual Framework. The MIDWIZE Conceptual Framework wish to introduce the comprehensive midwifery-managed care provided women in Sweden to other countries, regions, and units where the framework is not fully applied. Methods: In order to determine what resource needs would have to be met to improve midwife led care, a tool was developed using Delphi study technique. Results: Using Delphi study technique together with on-site visits to two Sub-Saharan African countries, members of a project team went to Ethiopia and Uganda, where they visited governments, clinical or educational institutions and together with African leaders developed availability and efficiency of a tool to determine resource needs. Conclusion: If at some future time, a single country, region or unit, might want to use the tool for quality improvement purpose of midwife led care, then the tool might aid in taking the first step to determine what resources might be required and what changes might be recommended as concerns policy at the clinical or educational institution level that are part of already existing health care structures.

Federated Learning in Dentistry: Chances and Challenges

Building performant and robust artificial intelligence (AI)–based applications for dentistry requires large and high-quality data sets, which usually reside in distributed data silos from multiple sources (e.g., different clinical institutes). Collaborative efforts are limited as privacy constraints forbid direct sharing across the borders of these data silos. Federated learning is a scalable and privacy-preserving framework for collaborative training of AI models without data sharing, where instead the knowledge is exchanged in form of wisdom learned from the data. This article aims at introducing the established concept of federated learning together with chances and challenges to foster collaboration on AI-based applications within the dental research community.

Use of the bibliometric in rare diseases: taking Wilson disease personally

BackgroundBibliometric have been widely applied to the evaluation of academic productivity. However, those of individuals or institutions on a specific disease have not been explored. The aim of the present study is to conduct a bibliometric analysis of particular rare disease and investigate whether those doctors and hospitals with higher index screened by this method specialize in this disease.MethodsA representative rare disease, Wilson disease (WD), was searched on Clarivate Analytics’ Web of Science and Elsevier’s Scopus, which was published in English between 1 January 2001 and 31 December 2020. Clinical authors and medical institutions with the most papers were screened, and their total number of publications and citations, h-index and g-index were computed and then ranked by h-index.ResultsA total of 6856 and 6193 papers and 200 and 160 authors were got from WoS and Scopus, respectively. Scopus provided 160 institutions. The above bibliometric indices were calculated in 100 researchers and 80 institutions, and top 30 authors (Top-30a) and top 20 institutions (Top-20i) of them based on the h-index were listed in the tables. Top-30a came from seven specialties and 13 countries whose median (interquartile range) h-index was 14 (12–19.5) (range 10–28) which was located between associate and full professors in some other disciplines. Top-20i was distributed in 13 countries whose mean ± standard deviation of the h-index was 15 ± 4.9 (range 10–27).ConclusionsThe related specialists and medical institutions of WD screened by specific disease bibliometric analysis are eminent and credible and benefit WD patients to obtain reliable medical treatment. This model may be suitable for other rare diseases.

Reflections on fostering student nurse evidence-based practice competencies via integration of nursing best practice guidelines

Evidence-based nursing practice has been identified as an important nurse competency and standard of practice by nurse regulators and nurse educators in both the United States and Canada, yet little is known about the curricular strategies which foster development of evidence-based competencies in the undergraduate nursing context. Although there are several evidence-based practice models that are being used by nurses, much of the literature reflects evidence-based practice implementation strategies which are focused on nurses already in practice. It remains unclear how evidence-based practice competencies are being taught to undergraduate nursing students. In the Canadian context, the Registered Nurses’ Association of Ontario, promotes the implementation of Nursing Best Practice Guidelines as a viable strategy for implementing evidence-base nursing practice in both the clinical and academic contexts. Clinical and academic institutions that implement best practice guidelines and meet the outcome criteria of the Registered Nurses Association may be designated as a Best Practice Spotlight Organization. In this paper, two of the authors reflect on the curricular strategies they used to integrate Best Practice Guidelines into selected undergraduate nursing courses and the challenges and opportunities that this engendered as part of their university school of nursing’s journey to achieve designation as a Best Practice Spotlight Organization (Academic).

Creating sparser prediction models of treatment outcome in depression: a proof-of-concept study using simultaneous feature selection and hyperparameter tuning

BackgroundPredicting treatment outcome in major depressive disorder (MDD) remains an essential challenge for precision psychiatry. Clinical prediction models (CPMs) based on supervised machine learning have been a promising approach for this endeavor. However, only few CPMs have focused on model sparsity even though sparser models might facilitate the translation into clinical practice and lower the expenses of their application.MethodsIn this study, we developed a predictive modeling pipeline that combines hyperparameter tuning and recursive feature elimination in a nested cross-validation framework. We applied this pipeline to a real-world clinical data set on MDD treatment response and to a second simulated data set using three different classification algorithms. Performance was evaluated by permutation testing and comparison to a reference pipeline without nested feature selection.ResultsAcross all models, the proposed pipeline led to sparser CPMs compared to the reference pipeline. Except for one comparison, the proposed pipeline resulted in equally or more accurate predictions. For MDD treatment response, balanced accuracy scores ranged between 61 and 71% when models were applied to hold-out validation data.ConclusionsThe resulting models might be particularly interesting for clinical applications as they could reduce expenses for clinical institutions and stress for patients.