Clinical Performance Research Articles

간호대학생의 메타인지, 임상수행능력, 학업 스트레스가 학습성과에 미치는 영향

Objectives The purpose of this study was to determine the effects of metacognition, clinical performance, and academic stress on program outcomes of nursing students. Methods A survey was administered to 105 nursing students in three cities to collect data on metacognition, clin-ical competency, academic stress, and program outcomes scales. The collected data were analyzed using SPSS 26.0 (IBM Corp., Armonk, NY, USA). Stepwise regression analysis was conducted to identify the influencing fac-tors on program outcomes. Results The program outcomes of nursing students was significantly positively correlated with metacognition (r=.72, p<.001) and clinical competency (r=.64, p<.001), and significantly negatively correlated with academic stress (r=.-44, p<.001). Metacognition ( =.44, p<.001), clinical competency (ββ=.30, p<.001), and academic stress (β=-.20, p.=004) were the factors affecting nursing students' program outcomes, and the explanatory power of these variables was 60%. Conclusions In order to achieve program outcomes of nursing students, it is necessary to provide various educa-tional programs to increase metacognition and clinical competency, and it is necessary to regularly check academ-ic stress levels and provide individualized and specific management for students who experience high academic stress.

An Extensible Evaluation Framework Applied to Clinical Text Deidentification Natural Language Processing Tools: Multisystem and Multicorpus Study.

Clinical natural language processing (NLP) researchers need access to directly comparable evaluation results for applications such as text deidentification across a range of corpus types and the means to easily test new systems or corpora within the same framework. Current systems, reported metrics, and the personally identifiable information (PII) categories evaluated are not easily comparable. This study presents an open-source and extensible end-to-end framework for comparing clinical NLP system performance across corpora even when the annotation categories do not align. As a use case for this framework, we use 6 off-the-shelf text deidentification systems (ie, CliniDeID, deid from PhysioNet, MITRE Identity Scrubber Toolkit [MIST], NeuroNER, National Library of Medicine [NLM] Scrubber, and Philter) across 3 standard clinical text corpora for the task (2 of which are publicly available) and 1 private corpus (all in English), with annotation categories that are not directly analogous. The framework is built on shell scripts that can be extended to include new systems, corpora, and performance metrics. We present this open tool, multiple means for aligning PII categories during evaluation, and our initial timing and performance metric findings. Code for running this framework with all settings needed to run all pairs are available via Codeberg and GitHub. From this case study, we found large differences in processing speed between systems. The fastest system (ie, MIST) processed an average of 24.57 (SD 26.23) notes per second, while the slowest (ie, CliniDeID) processed an average of 1.00 notes per second. No system uniformly outperformed the others at identifying PII across corpora and categories. Instead, a rich tapestry of performance trade-offs emerged for PII categories. CliniDeID and Philter prioritize recall over precision (with an average recall 6.9 and 11.2 points higher, respectively, for partially matching spans of text matching any PII category), while the other 4 systems consistently have higher precision (with MIST's precision scoring 20.2 points higher, NLM Scrubber scoring 4.4 points higher, NeuroNER scoring 7.2 points higher, and deid scoring 17.1 points higher). The macroaverage recall across corpora for identifying names, one of the more sensitive PII categories, included deid (48.8%) and MIST (66.9%) at the low end and NeuroNER (84.1%), NLM Scrubber (88.1%), and CliniDeID (95.9%) at the high end. A variety of metrics across categories and corpora are reported with a wider variety (eg, F2-score) available via the tool. NLP systems in general and deidentification systems and corpora in our use case tend to be evaluated in stand-alone research articles that only include a limited set of comparators. We hold that a single evaluation pipeline across multiple systems and corpora allows for more nuanced comparisons. Our open pipeline should reduce barriers to evaluation and system advancement.

Why Are Explainable AI Methods for Prostate Lesion Detection Rated Poorly by Radiologists?

Deep learning offers significant advancements in the accuracy of prostate identification and classification, underscoring its potential for clinical integration. However, the opacity of deep learning models presents interpretability challenges, critical for their acceptance and utility in medical diagnosis and detection. While explanation methods have been proposed to demystify these models, enhancing their clinical viability, the efficacy and acceptance of these methods in medical tasks are not well documented. This pilot study investigates the effectiveness of deep learning explanation methods in clinical settings and identifies the attributes that radiologists consider crucial for explainability, aiming to direct future enhancements. This study reveals that while explanation methods can improve clinical task performance by up to 20%, their perceived usefulness varies, with some methods being rated poorly. Radiologists prefer explanation methods that are robust against noise, precise, and consistent. These preferences underscore the need for refining explanation methods to align with clinical expectations, emphasizing clarity, accuracy, and reliability. The findings highlight the importance of developing explanation methods that not only improve performance but also are tailored to meet the stringent requirements of clinical practice, thereby facilitating deeper trust and a broader acceptance of deep learning in medical diagnostics.

Effect of milling procedures in CAD-CAM systems on the color changes of CAD-CAM polymethyl methacrylate resin material as interim material

PurposeThis study aimed to investigate the effects of new and used burs on CAD-CAM PMMA resin color changes following thermocycling.Materials and methodsTwenty disk-shaped specimens (10 × 2 mm) were made using a single brand of CAD-CAM polymethyl methacrylate resin (Polident) for the color test. Group N consisted of half of the specimens that were machined using the new tungsten carbide bur set, and Group U consisted of the specimens that were milled using the used bur set (500 machining time). A color test was performed on the specimens both before and after thermocycling. For the statistical analysis, the Kruskal-Wallis and Dunn Pairwise Comparison tests were employed.ResultsThe ∆E* value of specimens (2.057) milled with the used bur was higher than those of specimens milled with the new bur (0.340), but this value is within clinically acceptable limits. After thermocycling, specimens milled with the utilized burs had the greatest L* (93.850) and b* (5.000) values. After thermocycling, statistically significant differences were discovered between Group N and Group U as well as between specimens milled with the utilized bur before and after thermocycling.ConclusionThermocycling process have an effect on the mean ∆E values of specimens milled with the used carbide bur, but these ∆E* values were not statistically significant.Clinical significanceThe color and clinical performance of CAD-CAM restorations may be affected by variations in CAD-CAM milling bur properties, particularly those related to their frequent use.

Zinc and Inflammatory Bowel Disease: From Clinical Study to Animal Experiment.

Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract (GI) with a high incidence rate globally, and IBD patients are often accompanied by zinc deficiency. This review aims to summarize the potential therapeutic value of zinc supplementation in IBD clinical patients and animal models. Zinc supplementation can relieve the severity of IBD especially in patients with zinc deficiency. The clinical severity of IBD were mainly evaluated through some scoring methods involving clinical performance, endoscopic observation, blood biochemistry, and pathologic biopsy. Through conducting animal experiments, it has been found that zinc plays an important role in alleviating clinical symptoms and improving pathological lesions. In both clinical observation and animal experiment of IBD, the therapeutic mechanisms of zinc interventions have been found to be related to immunomodulation, intestinal epithelial repair, and gut microbiota's balance. Furthermore, the antioxidant activity of zinc was clarified in animal experiment. Appropriate zinc supplementation is beneficial for IBD therapy, and the present evidence highlights that alleviating zinc-deficient status can effectively improve the severity of clinical symptoms in IBD patients and animal models.

Systematic Literature Review: The Influence of Compensation on Employee Performance in Beauty Clinics in Indonesia

Today's beauty business is starting to be looked at by many business people in Indonesia. We can see this from the many public figures who have decided to enter this business. Currently, many people labeled crazy rich are also pursuing this business, so it can be said that the beauty business is quite promising. This study aims to determine the effect of compensation on employee performance in several beauty clinics in Indonesia. The research method used is a Systematic Literature Review (SLR) 6 (six). Journal articles with a slice of compensation variables and employee performance in beauty clinics were published between 2017 and 2023 (see attachment). From searching articles through Google Shoolar, research rabbit and publish or perish, only six articles were found that contained the desired variables with the object of research on employees in beauty clinics. Searches with the keywords compensation, employee performance, and beauty clinics produce many journal articles for research purposes other than beauty clinics. From this study, it is known that four out of 6 articles are studied that state that compensation affects performance in beauty clinics. This illustrates that, in general, compensation will positively affect employee performance in beauty clinics.

Update to the essential genomic nursing competencies and outcome indicators.

Genomic healthcare applications have relevance to all healthcare professionals including nursing, and most evidence-based clinical applications impact the quality and safety of healthcare. To guide nursing genomic competency initiatives, the Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics were established through a process of consensus in 2005. A 2009 update incorporated outcome indicators consisting of specific areas of knowledge and clinical performance indicators, to help support academic integration. Almost 20 years have elapsed since these competencies were first established, yet incorporating the competencies into general and specialty scope and standards of nursing practice is inconsistent, competency integration into curricula is highly uneven, continuing education in genomics for nurses is limited, and the genomic capacity of the nursing workforce remains low. These deficits have persisted despite substantial advances in genomic technology which substantially reduced costs and increased evidence-based clinical applications, including direct to consumer genomic tests, the integration of genomics into evidence-based guidelines, and evidence that genomics impacts the quality and safety of healthcare. The aim of this project was to update and achieve consensus on genomic competencies applicable to all registered nurses. This was a mixed methods study. The update to the competencies was performed based first on a literature review to update the competencies based on the current state of the evidence. Using the updated content, a modified Delphi study was conducted with registered nurse panelists from clinical, academic, and research settings. Once consensus was achieved, the competencies were made available through the American Nurses Association for public comment. Public comments were then reviewed and integrated as needed. The literature review resulted in a transition from genetics to genomics, given the reduction in costs, which resulted in an expansion of the scope of testing in both the germline and somatic contexts. Two Delphi rounds were required to reach consensus prior to the public comment period. Public comments were solicited through the American Nurses Association, and each comment was reviewed by the authors and addressed as indicated. The Essentials of Genomic Nursing: Competencies and Outcome Indicators constitute the minimum competency in genomics required of all registered nurses regardless of the level of academic training, role, or specialty. Evidence-based genomic applications span the entire healthcare continuum and, therefore, are relevant for all registered nurses regardless of academic training, role, practice setting, or clinical expertise. These competencies serve as the guide for the minimum requirements for registered nurse practice as well as guide curricula and continuing education for all registered nurses, including but not limited to administrators, educators, nursing leaders, practicing nurses, and researchers.

Clinical performance and safety of a two-lead cardiac resynchronization therapy system with a floating atrial sensing dipole

Abstract Background The incidence of complications after implantable cardioverter-defibrillator (ICD) and cardiac resynchronisation therapy (CRT-D) implantations is dependent on the number of implanted leads. The majority of CRT-D patients have unimpaired sinus node function and do not require atrial pacing. A two-lead CRT-D system with a floating atrial sensing dipole mounted on the right ventricular lead ((CRT-DX) allows dual chamber tachyarrhythmia detection, and atrio-ventricular sequential pacing with a reduced amount of implanted material. Purpose This study investigated the clinical efficacy and safety of the CRT-DX system. Methods This multicentre, single-arm study observed patients after de novo implantation of a CRT-DX system for 12 months. Patients were eligible for the study when chronotropic competence was proven by heart rates ≥100 bpm during exercise, premature ventricular contractions rate of < 5%/h and absence of atrioventricular block ≥ II. Intraoperatively measured p-wave amplitude of ≥ 1 mV was recommended. The primary safety endpoint was the additional implantation of a right atrial (RA) lead after the initial implantation. As indicators of efficacy, we report the changes in left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) class over the follow-up period. Results Overall, 110 patients were implanted with the complete CRT-DX system. Mean age of study participants was 62 ± 12 years and 77 (70%) were male. The underlying heart disease was non-ischemic in 66 (60%) patients and 103 (93%) had a left bundle branch block. NYHA class was II in 60 (54.5%) and III in 50 (45.5%) patients. ICD placement was performed in 13 (11.8%) patients for the secondary prevention of sudden cardiac death. A total of 104 patients completed the follow-up, 2 patients died, 1 had the system explanted for infection, 2 withdrew consent and 1 was lost to follow-up. The primary endpoint of RA lead implantation was met in 2 (1.8%) participants (Figure 1). One patient required atrial pacing and one patient, who had shown a p-wave amplitude < 1 mV at implantation, lost atrial sensing. The mean RA sensing amplitude remained stable during follow-up (4.6 ± 1.8 mV, 4.9 ± 1.8 mV and 4.6 ± 1.8 mV at 1, 6 and 12 months, respectively; Figure 2). The LVEF improved by 14.7% ± 11.0%, from 26.3% ± 6.9% to 40.8% ± 10.7% (p < 0.00001). Changes in NYHA class were available in 87 patients with 35 (40.2%) improved by one class and 13 (14.9 %) by two classes. Thirty-four (39.1%) had no change and 5 (5.7%) worsened by one class (global p < 0.00001). Conclusion The two-lead CRT-DX system showed a low requirement of subsequent RA lead implantations (1.8%) and stable RA sensing amplitudes. Our results suggest a CRT response similar to that of conventional three-lead CRT-D systems. CRT-DX systems appear to be a feasible alternative for patients with chronotropic competence.Kaplan-Meier curve for primary endpointDaily mean RA sensing amplitude

Computed chest radiography for total body irradiation: image quality and clinical feasibility.

In myeloablative total body irradiation (TBI), lung shielding
blocks are used to reduce the dose to the lungs and hence decrease the risk of radiation
pneumonitis. Some centers are still using mega-Volt (MV) imaging with dedicated
silver halide-based films during simulation and treatment for lung delineation and
position verification. However, the availability of these films has recently become
an issue. This study examines the clinical performance of a computed radiography
(CR) solution in comparison to radiographic films and potential improvement of image
quality by filtering and post-processing. We compared BaFBrI-based CR
plates to radiographic films. First, images of an aluminum block were analyzed to
assess filter impact on scatter reduction. Secondly, a dedicated image quality phantom
was used to assess signal linearity, signal-to-noise ratio (SNR), contrast and spatial
resolution. Ultimately, a clinical performance study involving two impartial observers
was conducted on an anthropomorphic chest phantom, employing visual grading
analysis (VGA). Various filter materials and positions as well as post-processing were
examined, and the workflow between CR and film was compared. CR
images exhibited high SNR and linearity but demonstrated lower spatial and contrast
resolution when compared to film. However, filtering improved contrast resolution
and SNR, while positioning filters inside the cassette additionally enhanced sharpness.
Image processing improved VGA scores, while additional filtering also resulted in
higher spine visibility scores. CR shortened TBI simulation by over 10 minutes for
one patient, alongside a dose reduction by order of 0.1 Gy. This study
highlights potential advantages of shifting from conventional radiographic film to CR
for TBI. Overall, CR with the incorporation of processing and filtering proves to
be suitable for TBI chest imaging. When compared to radiographic film, CR offers
advantages such as reduced simulation time and dose delivery, re-usability of image
plates and digital workflow integration.

Super resolution deep learning reconstruction for coronary CT angiography: A structured phantom study

PurposeSuper-resolution deep-learning-based reconstruction: SR-DLR is a newly developed and clinically available deep-learning-based image reconstruction method that can improve the spatial resolution of CT images. The image quality of the output from non-linear image reconstructions, such as DLR, is known to vary depending on the structure of the object being scanned, and a simple phantom cannot explicitly evaluate the clinical performance of SR-DLR. This study aims to accurately investigate the quality of the images reconstructed by SR-DLR by utilizing a structured phantom that simulates the human anatomy in coronary CT angiography. MethodsThe structural phantom had ribs and vertebrae made of plaster, a left ventricle filled with dilute contrast medium, a coronary artery with simulated stenosis, and an implanted stent graft. By scanning the structured phantom, we evaluated noise and spatial resolution on the images reconstructed with SR-DLR and conventional reconstructions. ResultsThe spatial resolution of SR-DLR was higher than conventional reconstructions; the 10 % modulation transfer function of hybrid IR (HIR), DLR, and SR-DLR were 0.792-, 0.976-, and 1.379 cycle/mm, respectively. At the same time, image noise was lowest (HIR: 21.1-, DLR: 19.0-, and SR-DLR: 13.1 HU). SR-DLR could accurately assess coronary artery stenosis and the lumen of the implanted stent graft. ConclusionsSR-DLR can obtain CT images with high spatial resolution and lower noise without special CT equipments, and will help diagnose coronary artery disease in CCTA and other CT examinations that require high spatial resolution.

Ceramic soft tissue trimming bur gingival depigmentation: clinical performance and patient experience. A split mouth randomized controlled trial

BackgroundThe ceramic soft tissue trimming bur (CeraTip™) was initially introduced for use in gingivoplasty but has recently been used for gingival depigmentation. The aim of this study is to compare the efficacy of depigmentation between the novel CeraTip™ and the gold-standard surgical scalpel technique.MethodsEight healthy, nonsmokers with moderate to severe gingival hyperpigmentation in both arches were randomly assigned for CeraTip™ depigmentation in one arch as the test group (TG) and scalpel depigmentation in the opposite arch as the control group (CG). Pigmentation indices were used to assess clinical performance. Treatment time, pain level, and esthetic satisfaction were the parameters of patient experience. The assessments were performed at baseline, one week, one month, and three months.ResultsAt all assessment visits, pigmentation intensity represented by the Dummet oral pigmentation index (DOPI), and pigmentation distribution represented by the Hedin melanin index (MI), were significantly lower than those at baseline (p < 0.001) in both groups. When comparing the two groups, Scalpel depigmentation had better initial clinical outcomes, while CeraTip™ had less visible repigmentation, pain scores, treatment time, and greater esthetic satisfaction. However, none of the differences were statistically significant.ConclusionBoth techniques successfully removed gingival hyperpigmentation with comparable clinical performance. The patients preferred CeraTip™ depigmentation.Trial registrationThe study protocol was registered on 11/09/2023 on the www.clinicaltrials.gov database (NCT06031116) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASU-Rec012124).

Impact of high-quality, mixed-domain data on the performance of medical language models.

To optimize the training strategy of large language models for medical applications, focusing on creating clinically relevant systems that efficiently integrate into healthcare settings, while ensuring high standards of accuracy and reliability. We curated a comprehensive collection of high-quality, domain-specific data and used it to train several models, each with different subsets of this data. These models were rigorously evaluated against standard medical benchmarks, such as the USMLE, to measure their performance. Furthermore, for a thorough effectiveness assessment, they were compared with other state-of-the-art medical models of comparable size. The models trained with a mix of high-quality, domain-specific, and general data showed superior performance over those trained on larger, less clinically relevant datasets (P < .001). Our 7-billion-parameter model Med5 scores 60.5% on MedQA, outperforming the previous best of 49.3% from comparable models, and becomes the first of its size to achieve a passing score on the USMLE. Additionally, this model retained its proficiency in general domain tasks, comparable to state-of-the-art general domain models of similar size. Our findings underscore the importance of integrating high-quality, domain-specific data in training large language models for medical purposes. The balanced approach between specialized and general data significantly enhances the model's clinical relevance and performance. This study sets a new standard in medical language models, proving that a strategically trained, smaller model can outperform larger ones in clinical relevance and general proficiency, highlighting the importance of data quality and expert curation in generative artificial intelligence for healthcare applications.

#3022 Rationale and design of the CORDIAL first-in-human clinical trial: a system for sorbent-assisted continuous flow peritoneal dialysis

Abstract Background and Aims Peritoneal dialysis has important disadvantages, including low plasma clearance and a limited technique survival. A new device for sorbent-assisted continuous flow peritoneal dialysis has been designed (Wearable Artificial KIDney, WEAKID) that is based on continuous recirculation (rapid cycling) of peritoneal dialysate via a single-lumen peritoneal catheter with regeneration of dialysate using sorbents. Anticipated benefits are a better plasma clearance a higher mass transfer area coefficient with continuous flow of dialysate and enhanced diffusion due to a higher time-averaged plasma-dialysate concentration gradient with sorbent-based dialysate regeneration, and a prolonged technique survival thanks to lower peritonitis risk (less (dis)connections) and a lower glucose exposure. Method This is a first-in-human, prospective, open-label, non-randomized, single-arm, multicenter study, that will be performed at the University Medical Center Utrecht (Utrecht, The Netherlands), Università degli studi di Modena e Reggio Emilia (Italy), and Instituto de Investigación Hospital Universitario La Paz, Servicio Madrileño de Salud (Spain). We aim to include 12 stable, adult PD patients. In the first week, blood, urine, and dialysate samples will be collected over three separate days to assess the efficacy of the patient's standard PD schedule. The WEAKID system will then be tested in a clinical setting on 6 days over a period of 2 weeks (three consecutive days per week). During the first week, participants will be treated with WEAKID without sorbents for 4h (first day) or 8h (second and third day). The second week, treatment will consist of WEAKID with sorbents for 4h (first day) or 8h (second and third day). This way, exposure to new components of the system is incremental and the effectiveness of continuous recirculation of dialysate and that the added effect of sorbent-based dialysate regeneration can be analyzed separately. Outcomes The primary aim of this first-in-human clinical trial is to evaluate the (short term) clinical safety and performance of WEAKID treatment in a clinical setting. The primary safety objective will be assessed by describing and examining the incidence of: Key secondary objectives include an evaluation of efficacy in terms of plasma clearance, ultrafiltration, net base release, and patient tolerance. Planning Inclusion of the first patient is expected in January 2024, the final inclusion is expected to take place in November 2024.

Diagnostic Accuracy of DNA-Methylation in Detection of Cervical Dysplasia: Findings from a Population-Based Screening Program

Background: Epigenetic biomarkers in cancer have emerged as promising tools for early detection, prognosis, and treatment response prediction. In cervical cells, hypermethylation of the host and viral HPV-genome increases with the severity of lesions, providing a useful biomarker in the triage of hr-HPV-positive women and during treatment. The present study focuses on evaluating the clinical performance of the FAM19A4/miR124-2 methylation test in a population-based cervical screening program. Methods: Previously collected cervical samples, after bisulfite-converted DNA, were analyzed by PreCursor-M+ kit (distributed by Fujirebio Europe), for DNA methylation. The sensitivity, specificity, and negative/positive predictive values of DNA methylation were compared to histology, colposcopy, the HPV-DNA test, and cytology results. Results: Among the 61-sample set, the specificity of methylation vs. positive histology (≥CIN2) and colposcopy (≥G2) were 87% and 90%, whereas the sensitivity was 50% and 33.3%, respectively. The combination of methylation analysis with standard methods increases diagnostic accuracy. Conclusions: Overall, we found a good specificity of DNA methylation in comparison to currently used techniques. Further larger studies could support the use of FAM19A4/miR124-2 as reliable biomarkers in the prevention of cervical cancer as triage in the screening protocol.

Enhancing clinical skills in pediatric trainees: a comparative study of ChatGPT-assisted and traditional teaching methods

BackgroundAs artificial intelligence (AI) increasingly integrates into medical education, its specific impact on the development of clinical skills among pediatric trainees needs detailed investigation. Pediatric training presents unique challenges which AI tools like ChatGPT may be well-suited to address.ObjectiveThis study evaluates the effectiveness of ChatGPT-assisted instruction versus traditional teaching methods on pediatric trainees’ clinical skills performance.MethodsA cohort of pediatric trainees (n = 77) was randomly assigned to two groups; one underwent ChatGPT-assisted training, while the other received conventional instruction over a period of two weeks. Performance was assessed using theoretical knowledge exams and Mini-Clinical Evaluation Exercises (Mini-CEX), with particular attention to professional conduct, clinical judgment, patient communication, and overall clinical skills. Trainees’ acceptance and satisfaction with the AI-assisted method were evaluated through a structured survey.ResultsBoth groups performed similarly in theoretical exams, indicating no significant difference (p > 0.05). However, the ChatGPT-assisted group showed a statistically significant improvement in Mini-CEX scores (p < 0.05), particularly in patient communication and clinical judgment. The AI-teaching approach received positive feedback from the majority of trainees, highlighting the perceived benefits in interactive learning and skill acquisition.ConclusionChatGPT-assisted instruction did not affect theoretical knowledge acquisition but did enhance practical clinical skills among pediatric trainees. The positive reception of the AI-based method suggests that it has the potential to complement and augment traditional training approaches in pediatric education. These promising results warrant further exploration into the broader applications of AI in medical education scenarios.

A Conceptual Model of Individual Clinical Readiness.

Force readiness is a priority among senior leaders across all branches of the Department of Defense. Units that do not achieve readiness benchmarks are considered non-deployable until the unit achieves the requisite benchmarks. Because military units are made up of individuals, the unit cannot be ready if the individuals within the unit are not ready. For medical personnel, this refers to one's ability to competently provide patient care in a deployed setting or their individual clinical readiness (ICR). A review of the literature found no conceptual model of ICR. Other potential concepts, such as individual medical readiness, were identified but used inconsistently. Therefore, the purpose of this article is to define ICR and propose a conceptual model to inform future efforts to achieve ICR and facilitate future study of the concept. Model development occurred using a 3-step theoretical model synthesis process. The process included specification of key concepts, identification of related factors and relationships, and organizing them into an integrated network of ideas. ICR is the clinically oriented service members' (COSM) ability to meet the demands of the militarily relevant, assigned clinical mission. ICR leads to one's "individual clinical performance," a key concept distinct from ICR. To understand ICR, one must account for "individual characteristics," as well as one's "education," "training," and "exposure." ICR and individual clinical performance are influenced by the "quality of exposure" and the "patient care environment." One's "individual clinical performance" also reciprocally influences the patient care environment, as well as the "team's clinical performance." These factors (individual clinical performance, team clinical performance, and the patient care environment) influence "patient outcomes." In the proposed model, patient outcomes are an indirect result of ICR and its antecedents (personal characteristics, education, training, and exposure); one's individual clinical performance may not be consistent with their ICR. Patient outcomes are also influenced by the "patient environment" (external to the health care environment) and "patient characteristics"; these elements of the model do not influence ICR or individual clinical performance. Force readiness is a Department of Defense priority. In order for military units to be deployment ready, so too must their personnel be deployment ready. For COSMs, this includes one's ability to competently provide patient care in a deployed setting or their ICR. This article defines ICR, as well as identifies another key concept and other factors associated with ICR. The proposed model is a tool for military medical leaders to communicate with and influence non-medical military leaders in the Department of Defense. Future research is needed to further refine the proposed model, determine the strength of the proposed relationships, and identify interventions to improve ICR.

Smartphone Use in the Management of Neurological Emergencies: A Simulation-Based Study.

Smartphone use in medicine is nearly universal despite a dearth of research assessing utility in clinical performance. We sought to identify and define smartphone use during simulated neuroemergencies. In this retrospective review of a prospective observational single-center simulation-based study, participants ranging from subinterns to attending physicians and stratified by training level (novice, intermediate, and advanced) managed a variety of neurological emergencies. The primary outcome was frequency and purpose of smartphone use. Secondary outcomes included success rate of smartphone use and performance (measured by completion of critical tasks) of participants who used smartphones versus those who did not. In subgroup analyses we compared outcomes across participants by level of training using t-tests and χ2 statistics. One hundred and three participants completed 245 simulation scenarios. Smartphones were used in 109 (45%) simulations. Of participants using smartphones, 102 participants looked up medication doses, 52 participants looked up management guidelines, 11 participants looked up hospital protocols, and 13 participants used smartphones for assistance with an examination scale. Participants found the correct answer 73% of the time using smartphones. There was an association between participant level and smartphone use with intermediate participants being more likely to use their smartphones than novice or advanced participants, 53% versus 29% and 26%, respectively (p < 0.05). Of the intermediate participants, those who used smartphones did not perform better during the simulation scenario than participants who did not use smartphones (smartphone users' mean score [standard deviation] = 12.3 [2.9] vs. nonsmartphone users' mean score [standard deviation] = 12.9 (2.7), p = 0.85). Participants commonly used smartphones in simulated neuroemergencies but use didn't confer improved clinical performance. Less experienced participants were the most likely to use smartphones and less likely to arrive at correct conclusions, and thus are the most likely to benefit from an evidence-based smartphone application for neuroemergencies.

Strategic Use of Biodegradable Temporizing Matrix (BTM) in Wound Healing: A Case Series in Asian Patients.

Skin and soft tissue reconstruction has long been based on the reconstructive ladder. However, a skin substitute has become popular due to its predictable outcomes, without donor-site morbidity. The biodegradable temporizing matrix (BTM; NovoSorb, PolyNovo Ltd., Port Melbourne, Australia) is a synthetic skin substitute that has recently gained its clinical application. Compared with those of other dermal templates, the clinical efficacy and performance of the BTM are not well established, especially among the Asian population. This study aims to share our experience and strategy of using BTM in various wound conditions. The data of patients who underwent skin and soft tissue reconstruction with BTM at a single institution between January 2022 and December 2023 were reviewed. The patient demographics, wound characteristics, surgical details, secondary procedures, and complications were recorded and analyzed. Postoperative 6-month photographs were collected and independently evaluated by two plastic surgeons and two wound care center nurses using the Manchester Scar Scale (MSS). This study included 37 patients, consisting of 22 males and 15 females with a mean age of 51.8 years (range, 18-86 years old). The wound etiologies included trauma (67.6%), necrotizing soft tissue infection (16.2%), burns (10.8%), toe gangrene (2.7%), and scar excision (2.7%). The average wound area covered by BTM was 50.6 ± 47.6 cm2. Among the patients, eight received concomitant flap surgery and BTM implantation, 20 (54.1%) underwent subsequent split-thickness skin grafts (STSG), and 17 had small wounds (mean: 21.6 cm2) healed by secondary intention. Infection was the most common complication, affecting six patients (n = 6 [16.2%]), five of whom were treated conservatively, and only one required debridement. Thirty-three patients (89.2%) had good BTM take, and only four had BTM failure, requiring further reconstruction. At the last follow-up, 35 out of the 37 patients (94.6%) achieved successful wound closure, and the total MSS score was 10.44 ± 2.94, indicating a satisfactory scar condition. The patients who underwent BTM grafting without STSG had better scar scores than those who received STSG (8.71 ± 2.60 vs. 11.18 ± 2.84, p = 0.039). In conclusion, the BTM is effective and feasible in treating various wounds, with relatively low complication rates, and it can thus be considered as an alternative for skin and soft tissue reconstruction. When combined with adipofasical flap reconstruction, it achieves a more comprehensive anatomical restoration.

Impact of a shorter university week on academic performance and study–life balance of dental students

ABSTRACT Background: The 4-day workweek is gaining traction as a credible and effective alternative to conventional 5-day workweek. We aimed to investigate the impact of a 4-day workweek on dental students’ academic performance and study–life balance. Methods: A total of 284 dental students participated in answering an electronic questionnaire. The response scores, mean values, and standard deviations were calculated. Internal consistency and associations between the scores were tested. Differences in responses between preclinical and clinical year students were evaluated. SPSS was used for data analysis, with a significance set at P &lt; 0.05. Results: A total of 246 students reported satisfactory experiences with the new 4-day university week. The majority preferred to continue with the short-week scheme. There were no statistically significant differences between preclinical- and clinical-level scores. A total of 73.3% of the students reported an increase in patient treatment and clinical procedures compared to the previous year with a 5-day schedule. Most students were satisfied with their weekly workload. They reported a significant improvement in clinical performance with the new weekly plan. Introducing a 4-day university week helped 76% of students reduce the cost of attending college. Conclusion: The introduction of the 4-day study week at the College of Dental Medicine was welcomed by students across all years of the program due to the improved academic achievement and clinical training opportunities it provided. They were also satisfied with the longer weekend, as it helped them relieve stress, prepare better for examinations, and spend more time with their family and friends.

Post-market surveillance of six COVID-19 point-of-care tests using pre-Omicron and Omicron SARS-CoV-2 variants.

Post-market surveillance of test performance is a critical function of public health agencies and clinical researchers that ensures tests maintaining diagnostic characteristics following their regulatory approval. Changes in product quality, manufacturing processes over time, or the evolution of new variants may impact product performance. During the COVID-19 pandemic, a plethora of point-of-care tests (POCTs) was released onto the Canadian market. This study evaluated the performance characteristics of several of the most widely distributed POCTs in Canada, including four rapid antigen tests (Abbott Panbio, BTNX Rapid Response, SD Biosensor, and Quidel QuickVue) and two molecular tests (Abbott ID NOW and Lucira Check IT). All tests were challenged with 149 SARS-CoV-2 clinical positives, including multiple variants up to and including Omicron XBB.1.5, as well as 29 clinical negatives. Results were stratified based on whether the isolate was Omicron or pre-Omicron as well as by reverse transcriptase quantitative PCR Ct value. The test performance of each POCT was consistent with the manufacturers' claims and showed no significant decline in clinical performance against any of the variants tested. These findings provide continued confidence in the results of these POCTs as they continue to be used to support decentralized COVID-19 testing. This work demonstrates the essential role of post-market surveillance in ensuring reliability in diagnostic tools.IMPORTANCEPost-market surveillance of diagnostic test performance is critical to ensure their reliability after regulatory approval. This is especially critical in the context of the COVID-19 pandemic as the use of point-of-care tests (POCTs) became widespread. Our study focused on four rapid antigen tests (Abbott Panbio, BTNX Rapid Response, SD Biosensor, and Quidel QuickVue) and two molecular tests (Abbott ID NOW and Lucira Check IT) that were widely distributed across Canada, assessing their performance using many SARS-CoV-2 variants, including up to Omicron subvariant XBB.1.5. Overall, we found no significant difference in performance against any variant, reinforcing confidence in their use. As concerns in test efficacy have been raised by news outlets, particularly regarding the BTNX Rapid Response, this work is even more timely and crucial. Our research offers insights into the performance of widely used COVID-19 POCTs but also highlights the necessity for post-market surveillance.