Common Recommendation Research Articles

Sources and content of advice sought by parents/guardians prior to emergency department attendance.

To describe sources of advice and the recommendations given to parents/guardians prior to attending ED with their child. This was a prospective observational study of patients presenting to two EDs of a multi-centre Victorian Health service in June 2016. Data collection involved surveying all parents/guardians attending paediatric ED during a 1-week period by trained research assistants. We determined the proportion of eligible respondents who sought advice before attending ED, the source of advice, and the type of advice provided. One thousand sixty-nine patients presented to ED over the 1-week period. There were 730 responses to the survey, of which 65% (477/730) had received a total of 620 recommendations prior to ED attendance. Seventy-six per cent (362/477) had received advice from a single source, 19% (90/477) had received advice from 2 sources, and 5% (25/477) from 3 or more sources. The most common sources of advice were general practice consultations (49%), friends/family (13.5%), and NURSE-ON-CALL (11%). Fifty-four per cent (335/620) of the recommendations were to attend ED immediately and 12% (77/620) were to attend if their child was getting worse. Most parents and guardians sought advice from a single source prior to attending an ED. The most common source of advice was consultation with a general practitioner and the most common recommendation was to attend ED immediately, or if their child's condition worsened.

Safety of 3-month flushing interval for prevention of occlusion in totally implantable venous access ports: An analysis focused on intraluminal clots.

This study aimed to assess the safety and feasibility of a 3-month flushing interval for totally implantable venous access ports (TIVAPs), particularly regarding intraluminal clot formation. Between May 2017 and September 2018, we established a single-center cohort of 151 patients who were referred for TIVAP removal and categorized them into three flushing-interval groups: A (⩽1 month), B (1-2 months), and C (2-3 months). Odds ratios (OR) with 95% confidence intervals (CI) were computed using logistic regression to determine the risk of intraluminal clot occurrence. To compare clot lengths among the groups, we employed linear regression. Restricted cubic splines were used to model the flushing interval as a continuous variable. Compared to Group A, Groups B and C had adjusted ORs of 0.82 (0.35-1.92) and 0.78 (0.29-2.11) for intraluminal clot risk. Occlusion was rare (1/151; 0.7%) and successfully treated with mechanical recanalization. Adjusted differences in clot length compared to Group A were 0.01 (-0.85 to 0.87) for Group B and -0.23 (-1.21 to 0.76) for Group C. Spline regression analysis showed no significant association between the flushing interval and clot length (p for trend = 0.84). The incidence and burden of intraluminal clots did not increase significantly within the first 3 months. Occlusion was rare, even in the presence of clots, and was successfully treated. Therefore, a 3-month flushing interval appears to be a safe and practical option, aligning with the common recommendation for surveillance intervals in patients with cancer.

Understanding overfitting in random forest for probability estimation: a visualization and simulation study

BackgroundRandom forests have become popular for clinical risk prediction modeling. In a case study on predicting ovarian malignancy, we observed training AUCs close to 1. Although this suggests overfitting, performance was competitive on test data. We aimed to understand the behavior of random forests for probability estimation by (1) visualizing data space in three real-world case studies and (2) a simulation study.MethodsFor the case studies, multinomial risk estimates were visualized using heatmaps in a 2-dimensional subspace. The simulation study included 48 logistic data-generating mechanisms (DGM), varying the predictor distribution, the number of predictors, the correlation between predictors, the true AUC, and the strength of true predictors. For each DGM, 1000 training datasets of size 200 or 4000 with binary outcomes were simulated, and random forest models were trained with minimum node size 2 or 20 using the ranger R package, resulting in 192 scenarios in total. Model performance was evaluated on large test datasets (N = 100,000).ResultsThe visualizations suggested that the model learned “spikes of probability” around events in the training set. A cluster of events created a bigger peak or plateau (signal), isolated events local peaks (noise). In the simulation study, median training AUCs were between 0.97 and 1 unless there were 4 binary predictors or 16 binary predictors with a minimum node size of 20. The median discrimination loss, i.e., the difference between the median test AUC and the true AUC, was 0.025 (range 0.00 to 0.13). Median training AUCs had Spearman correlations of around 0.70 with discrimination loss. Median test AUCs were higher with higher events per variable, higher minimum node size, and binary predictors. Median training calibration slopes were always above 1 and were not correlated with median test slopes across scenarios (Spearman correlation − 0.11). Median test slopes were higher with higher true AUC, higher minimum node size, and higher sample size.ConclusionsRandom forests learn local probability peaks that often yield near perfect training AUCs without strongly affecting AUCs on test data. When the aim is probability estimation, the simulation results go against the common recommendation to use fully grown trees in random forest models.

REVISÃO CRÍTICA DAS ESTRATÉGIAS DE COMBATE AO SEDENTARISMO INFANTIL CAUSADO PELO USO EXCESSIVO DE TECNOLOGIA: UMA NOVA ABORDAGEM COM BASE NA LITERATURA

Childhood sedentary behavior, driven by excessive technology use, has become a growing concern in the field of children’s health. This study conducts a critical review of current strategies to combat childhood sedentary behavior, identifying the main gaps in existing approaches. Although screen time reduction is a common recommendation, interventions often fail to maintain long-term effectiveness, partly due to a lack of behavioral focus and integration of technology as a tool in promoting physical activity. Based on the literature review, this article proposes a new theoretical model that uses technology proactively, integrating it into gamified physical education programs, real-time monitoring, and family involvement. The suggested model aims to increase children’s adherence to physical activities and ensure the inclusion of low-income populations through strategic partnerships to broaden access to technological devices. The study concludes that integrating technology and health can offer more sustainable and effective solutions to reduce childhood sedentary behavior.

Understanding hospital antimicrobial prescribing decisions and determinants of uptake of new local antimicrobial prescribing guidelines in Laos.

Antimicrobial use in Laos is among the highest in Southeast Asia. The first Lao comprehensive antimicrobial prescribing guidelines have been available since 2021. This study explored the determinants of antibiotic prescribing decisions and how the new prescribing guidelines were being used. In August 2022, in-depth interviews were conducted with 16 Lao prescribers from two hospitals. Participants were questioned about their prescribing behaviours, attitudes to guidelines, how they learned about the guidelines and factors influencing their uptake. The interviews were audio-recorded, transcribed, and translated into English. Thematic analysis of the transcripts was conducted. Lao prescribers considered multiple factors before deciding to prescribe antibiotics to their patients. The most common factor was based on the clinical judgement of the prescribers. Lack of certain antibiotics and turnaround times of laboratory results were the main challenges to prescribing antibiotics appropriately. The majority of participants were satisfied with the guidelines, regarding them as comprehensive, simple and convenient. However, most participants admitted that they did not access the guidelines very often. The main reason was that they could remember the treatment recommendations because they treat similar diseases on a daily basis. Improving antibiotic knowledge was the most common recommendation in order to improve the appropriate use of antibiotics. Raising awareness of the guidelines and promoting their use should also be considered. In addition, heads of the wards, and policy and implementation leaders, should support, monitor and feedback their use to encourage all prescribers to follow the guidelines. Several factors contribute to enhancing appropriate antibiotic prescription. Key factors for improving antibiotic prescription include enhancing prescribers' clinical knowledge, ensuring access to essential antibiotics, and updating guidelines regularly. Health leaders must get involved to promote their use.

Use of Bayesian probabilistic model approach in common bean varietal recommendation

AbstractRecommendation of new varieties is supported by value for cultivation and use (Valor de Cultivo e Uso [VCU]) trials. For a more reliable recommendation, it is necessary to identify methodologies that make better use of the genotype‐by‐environment interaction (GEI). The methodology proposed by Dias et al. is an alternative to take advantage of the GEI; it considers concepts of Bayesian models and probability methods of adaptation and stability analysis in a single model, classifying the genotypes regarding possible success based on a defined selection intensity. Thus, the aim of the present study was to explore the use of Bayesian probabilistic method for the purpose of recommend common bean (Phaseolus vulgaris L.) varieties. To that end, we used grain yield data from 15 genotypes of common bean evaluated in 42 environments distributed over different crop seasons, years, and locations in regard to VCU trials conducted from 2016 to 2018. Under a predefined selection intensity of 30%, the genotypes with greater marginal probability of superior performance were G01, G14, G07, G11, and G02. The genotypes with greater marginal probability of superior stability were G06, G07, G04, G03, and G12. Considering the joint probability of superior performance and yield stability, the genotypes G07, G14, G01, G11, and G04 stand out. Therefore, the use of the Bayesian probabilistic method showed promise in recommendation of common bean varieties.

Descriptive analysis of recommendations made by county-level overdose fatality review teams in indiana to combat the opioid epidemic

Overdose fatality review teams (OFRTs) are becoming more common across U.S. communities as a means of addressing the overdose epidemic and improving local overdose prevention strategies; however, empirical examinations of the work of OFRTs are lacking. The current study seeks to characterize recommendations for local overdose prevention strategies made by county-level OFRTs across Indiana in order to understand their practices. MethodsA qualitative descriptive content analysis was conducted on recommendations made by 19 county-level OFRTs across Indiana in 2022. ResultsOFRTs generated 1512 recommendations during 2022 based on case reviews of 291 overdose deaths occurring across 19 Indiana counties; of those, 26.8 % (n=405) were specific to the case reviewed, rather than relevant to the broader community, and were not further coded. The remaining 1109 recommendations were coded according to their overall scope, recommendation strategy, and target agency. The most common recommendations addressed substance use more broadly (e.g., improving substance use screening/assessment in healthcare settings), followed by recommendations directly addressing overdose risk (e.g., naloxone distribution, increasing harm reduction programs). Other common recommendations related to mental health, OFRT practices, and addressing social determinants of health. Common recommendation strategies were to implement new services or service improvements. ConclusionResults highlight the extent of further efforts needed to improve overdose prevention and the need for further research and support of OFRTs across the United States.

Activity restriction and risk of adverse pregnancy outcomes

BackgroundActivity restriction is a common recommendation given to patients during pregnancy for various indications, despite lack of definitive data showing improvements in pregnancy outcomes. ObjectiveTo determine if activity restriction (AR) in pregnancy is associated with decreased odds of adverse pregnancy outcomes (APOs). Study designSecondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) prospective cohort. Nulliparous singletons were followed at 8 sites from October 2010–September 2013. Demographic and clinical data were collected at 4 timepoints, and participants were surveyed about AR recommendations at 22w0d-29w6d and delivery. We excluded participants missing data on AR and age. Participants were grouped according to history of AR, and APOs included: gestational hypertension (gHTN), preeclampsia/eclampsia, preterm birth (PTB), and small for gestational age (SGA) neonate. Associations between AR and APOs were examined using uni- and multivariable logistic regression models adjusting for a priori identified APO risk factors. ResultsOf 10,038 nuMoM2b participants, 9,312 met inclusion criteria and 1,386 (14.9%) were recommended AR; participants identifying as Black (aOR 0.81 [95% CI 0.68–0.98]) or Hispanic (aOR 0.73 [95% CI 0.61–0.87]) were less likely to be placed on AR when compared to those identifying as White. Overall, 3,197 (34.3%) experienced at least one APO (717 [51.7%] of participants with AR compared to 2,480 [31.3%] participants without AR). After adjustment for baseline differences, the AR group had increased odds of gHTN (aOR 1.61 [95% CI 1.35–1.92]), preeclampsia/eclampsia (aOR 2.52 [95% CI 2.06–3.09]) and iatrogenic and spontaneous PTB (aOR 2.98 [95% CI 2.41–3.69]), but not delivery of an SGA neonate. ConclusionAR in pregnancy was independently associated with increased odds of hypertensive disorders of pregnancy and PTB, but future prospective work is needed to determine potential causality. Further, participants identifying as Black or Hispanic were significantly less likely to be recommended AR compared to those identifying as White. While AR is not an evidence-based practice, these findings suggest bias may impact which patients receive advice to limit activity in pregnancy.El resumen está disponible en Español al final del artículo.

Perspectives on Hearing Aid Cost and Uptake for Prescription and Over-the-Counter Hearing Aid Users.

This study explored user perspectives on the relationship between hearing aid cost and uptake, as well as cost-related recommendations for others with hearing difficulties, in a sample of prescription and over-the-counter (OTC) hearing aid users. A secondary analysis was conducted on a cross-sectional survey using qualitative content analysis to analyze responses related to the cost of hearing aids. The study included a total of 241 adult participants, comprising 179 prescription hearing aid users from the Hearing Tracker website and 62 OTC hearing aid users from the Lexie Hearing U.S. database. Prescription users had a mean age of 66.7 years (SD = 13.2), including 62.0% males, 37.4% females, and 0.6% nonbinary individuals. OTC users had a mean age of 63.0 years (SD = 13.4), with 48.4% males and 51.6% females. Three overarching domains were identified: perceived enablers to hearing aid uptake related to the cost, perceived barriers to hearing aid uptake related to the cost, and recommendations to others with hearing difficulties related to the cost, with 14 categories recognized for prescription users and 12 for OTC users. Both groups identified the high cost of hearing aids and lack of insurance coverage as significant barriers to uptake. Many prescription users reported external support (e.g., financial support and health insurance coverage) as an enabler, while OTC users frequently mentioned the affordability of OTC devices. The most common recommendation among prescription users was to seek professional support, whereas OTC users recommended researching hearing aids before making a purchase. Cost and insurance coverage consistently emerge as primary barriers to hearing aid adoption for both prescription and OTC users. To foster greater accessibility, initiatives should target these financial obstacles. Additional research is warranted on the relationship between hearing aid cost and uptake, especially among OTC users and those seeking financial assistance. https://doi.org/10.23641/asha.26496922.

Reconsidering the Role of Weight Loss in Treatment for Chronic Pain: Knee Osteoarthritis as an Exemplar

Chronic pain is prevalent among individuals with higher body weight and associated with greater impairment. As a result, weight loss is a common recommendation for pain management among those with higher body weight. Body weight is an appealing target because it is modifiable and evidence-based treatments to produce weight loss are well-established. In the last 2 decades, there has been a growing line of scientific work investigating the application of weight loss to individuals with chronic pain. This represents an important step to integrate the conceptualization of pain and body weight and there is preliminary work suggesting treatment effects are enhanced when weight loss treatment is combined with pain coping skills. However, weight loss outcomes are variable and difficult to sustain, and access to evidence-based treatment is limited. These concerns are set against the backdrop of growing public and academic concern about the weight-centric approach to health care that dominates western medicine. This is a timely moment to reconsider the conceptualization of weight and pain, and the role of weight loss in chronic pain treatment. Using osteoarthritis as an exemplar, we review the evidence for and clinical uptake of weight loss as a chronic pain management strategy and conclude with key areas for consideration to advance the scientific understanding of these comorbid conditions and how to optimize pain management for individuals of higher body weight. PerspectiveThis focus article critically considers the role of weight loss in management of chronic pain among individuals of higher body. Using knee osteoarthritis as an exemplar, the evidence and clinical uptake of weight loss for pain management is reviewed. Limitations are considered to guide future research and clinical care.

A counterfactual explanation method based on modified group influence function for recommendation

In recent years, recommendation explanation methods have received widespread attention due to their potentials to enhance user experience and streamline transactions. In scenarios where auxiliary information such as text and attributes are lacking, counterfactual explanation has emerged as a crucial technique for explaining recommendations. However, existing counterfactual explanation methods encounter two primary challenges. First, a substantial bias indeed exists in the calculation of the group impact function, leading to the inaccurate predictions as the counterfactual explanation group expands. In addition, the importance of collaborative filtering as a counterfactual explanation is overlooked, which results in lengthy, narrow, and inaccurate explanations. To address such issues, we propose a counterfactual explanation method based on Modified Group Influence Function for recommendation. In particular, via a rigorous formula derivation, we demonstrate that a simple summation of individual influence functions cannot reflect the group impact in recommendations. After that, building upon the improved influence function, we construct the counterfactual groups by iteratively incorporating the individuals from the training samples, which possess the greatest influence on the recommended results, and continuously adjusting the parameters to ensure accuracy. Finally, we expand the scope of searching for counterfactual groups by incorporating the collaborative filtering information from different users. To evaluate the effectiveness of our method, we employ it to explain the recommendations generated by two common recommendation models, i.e., Matrix Factorization and Neural Collaborative Filtering, on two publicly available datasets. The evaluation of the proposed counterfactual explanation method showcases its superior performance in providing counterfactual explanations. In the most significant case, our proposed method achieves a 17% lead in terms of Counterfactual precision compared to the best baseline explanation method.

When common recommendations for cultivating in cold soils inadvertently thaw permafrost

When common recommendations for cultivating in cold soils inadvertently thaw permafrost Melissa Ward Jones, details when common recommendations for cultivating in cold soils inadvertently thaw permafrost, starting with the challenges of cultivating at high latitudes. Cultivating crops within cold soils at high latitudes can be challenging. The growing season is short, with the risk of frosts at each seasonal margin, and overall, both air and soil temperatures limit crop options that can be grown. A common recommendation in cultivating cold soils is the use of seasonal extension techniques, such as greenhouses, high tunnels, low tunnels and various mulches (such as plastic and biodegradable like straw and compost) to artificially heat the soil, and depending on the technique used, the air temperature as well (Stevenson et al., 2014).

Understanding fellow hematology curriculums: Characterizing perspectives and defining opportunities for improvement.

9018 Background: Comprehensive hematology education during fellowship is paramount for providing high-quality care, especially in busy practices. Variability in fellow educational experiences is expected. However, fellowship programs must ensure a well-rounded, equitable educational experience for all fellows to prepare them for practice and board exams in the increasingly dynamic field of hematology. Methods: We administered an e-mail survey to hematology/oncology fellows (n=30) at Mayo (Rochester) to explore inpatient hematology education experiences and the Fellow Hematology Curriculum (FHC) during 2021-2022. Based on results, we designed a fellow-led, consultant-supervised quality improvement (QI) initiative to improve FHC. Responses were in a five-point Likert scale and open-ended format. Results: Twenty fellows completed the survey (66% response rate). Respondents were well distributed (35% PGY4, 25% PGY5, 40% PGY6). Resources most used for self-education were ASH SAP (85%), UpToDate (80%), and NCCN guidelines (50%). 100% of respondents agreed/strongly agreed that the FHC could be improved. 95% agreed/strongly agreed that there is a high degree of variability among consultants regarding engagement in fellows’ education. 45% agreed that education is adequately paired with relevant clinical duties to reinforce key concepts. 25% agreed that FHC had well-defined structure and objectives. In the open-ended responses, a structured curriculum covering a set list of topics paired with the relevant rotation was the most common recommendation by the fellows for improving the FHC and the inpatient hematology educational experience. This prompted a QI initiative to implement a structured, evidence-based curriculum covering essential topics required for hematology practice. Each week of a four-week rotation has a relevant theme (eg, “Marrow Failure week” during the inpatient leukemia service). Fellows selected a topic of interest and created a lecture to be used by all faculty and learners during the relevant rotation (eg, “Aplastic Anemia” during the Marrow Failure). Consultants and pharmacists in respective disease groups reviewed the topics and presentations. These lectures are now provided to fellows and faculty via e-mail prior to relevant rotations. Conclusions: Our survey demonstrated that trainees’ individual educational experiences on inpatient hematology services are widely variable and largely unsatisfying without some form of structured, relevant learning. We identified the need for deliberate, coordinated education as a gap to bridge toward achieving the goal of equitable, comprehensive learning. We intend to perform a post-implementation survey after one year of practicing a structured, relevantly paired FHC. This assessment will be used to make improvements in subsequent iterations of the FHC using the Plan-Do-Study-Act methodology.

Practical Test on the Operation of the Three-Phase Induction Motor under Single-Phasing Fault

Single-phasing is a common problem in the three-phase electrical grid. Despite the fact that the fault occurs in one phasing, the three-phase load is affected, and therefore the load is typically turned off. The three-phase induction motor is the most commonly used in the industry; therefore, this research investigates the behavior of the three-phase induction motor under a single-phasing fault. The main aim of this paper is to answer the question, should the three-phase induction motor be turned off under a single-phasing fault? The problem is investigated theoretically and compared with practical tests to explore the parameters of the induction motor (current, stator temperature, and vibration) that are affected under healthy and single-phasing fault conditions. A practical test machine is built to test the motor behavior under single-phasing faults, where the practical experiment results are compared to those of the simulations. Despite the common recommendation under single-phasing fault is to turn off the induction motors, the preliminary results of this study show that turning off an induction motor under single-phasing can be avoided under certain operating conditions with a simple protection scheme, which is useful in some practical situations.

Standardization of Optimum Grading Sieve Size for Seed Processing in Black Gram [Vigna mungo (L.) Hepper] Varieties

Background: The seeds harvested from the field may not be homogenous in seed size, physical purity and viability in Black gram. Seeds are to be cleaned and graded using seed processing machineries to maintain uniformity of a seed lot. Every variety is having its individuality in seed size. Hence, the common recommendation of 2.8 mm sieve size recommended by Indian Minimum Seed Certification Standards (IMSCS) for grading black gram seeds may not be suitable to recover a maximum quality seeds in all varieties while processing. The present study was carried out to identify a suitable grading sieve size for newly released black gram varieties for getting good quality seeds with better seed recovery during processing. Methods: The study was conducted at Seed Technology Research Unit, Pandit Jawaharlal Nehru College of Agriculture and Research Institute, Karaikal during the year 2020-2023. The experiment was laid out in completely randomized design with four replications. Four newly released black gram varieties viz., ADT 6, VBN 8, VBN 10 and VBN 11 were taken for the study. Specified quantities of unprocessed seeds have been sieved using slotted sieves of three sizes above (3.4 mm, 3.2 mm and 3.0 mm) and two sizes below (2.7 mm and 2.5 mm) the recommended sieve size of 2.8 mm for black gram varieties as per the IMSCS. The seeds retained over each sieves were collected separately and tested for seed quality parameters. Result: The results revealed that the seed recovery percent increased with decrease in sieve size while the seed quality parameters found higher with increase in sieve size.The sieve size of 2.7 mm (slotted) registered the maximum cumulative seed recovery of 87% and 89.9%, respectively in Black gram seeds of cv. ADT 6 and VBN 10 along with required seed standards. However, seeds retained from the sieve size of 3.0 mm (slotted) registered the maximum cumulative seed recovery of 91.2% and 87.5%, respectively in VBN 8 and VBN 11 with requisite seed germination and physical purity as per the IMSCS (75% and 98%). Hence, it is suggested that the sieve size of 2.7 mm may be considered as grading sieve size for seed processing in Black gram seeds of cv. ADT 6 and VBN 10 and 3.0 mm may be used as grading screen (Bottom screen) for VBN 8 and VBN 11 for getting good quality seeds with higher seed germination, physical purity and pure live seeds.

Pharmacists’ clinical decision making when responding to a self-medication request for a cough in a developing country

BackgroundSome studies have reported that community pharmacies in developing countries, including Indonesia, provided sub-optimal advice when handling patient's self-medication request for cough. The reasons behind such advice, therefore, need to be investigated. ObjectivesTo describe Indonesian pharmacists’ clinical decision making when handling self-medication cases for a cough. MethodsAn open-ended questionnaire consisting of two cough clinical vignettes (case 1: cough due to asthma worsening and case 2: cough as a symptom of common cold) were developed. Pharmacists were interviewed to provide recommendations and reasons for their recommendations for these scenarios. Content analysis was used to analyse participants’ statements for the two scenarios. The number of participants who provided appropriate recommendations and reasons were then counted. ResultsA total of 245 community pharmacists participated in the study. In the case of cough due to asthma worsening, recommending a product because the product was indicated to help with the symptoms was the most common recommendation and stated reason (40%). Appropriate recommendation (direct medical referral) with appropriate reasoning (indicating warning symptoms and/or making a symptom diagnosis) was provided by 25% participants. In the case of cough as a symptom of common cold, recommending products to help with the symptoms was also the most common recommendation and stated reason (53%). Appropriate recommendations (recommending product) with appropriate reasoning (providing product to treat the symptoms and/or indicating no warning symptoms and/or making a symptom diagnosis) was provided by 81% participants. ConclusionThe ability of Indonesian community pharmacists to provide appropriate recommendations for cough self-medication requests is dependent on whether triage is required. The inability of most community pharmacists to differentiate between major and minor conditions may lead to serious health implications for patients and therefore educational interventions should be undertaken to improve community pharmacists’ differential diagnostic skills for triage.

Dietary Considerations in Cholecystectomy: Investigating the Impact of Various Dietary Factors on Symptoms and Outcomes.

Cholecystectomy is commonly performed to address gallstone diseases, including the development of gallstones, which can lead to symptoms such as nausea, vomiting, and abdominal pain. Bile acids (BAs) produced by the liver are primarily stored and concentrated in the gallbladder (GB). After cholecystectomy, the body's ability to digest lipids isreduced due to the absence of the GB. Post-cholecystectomy syndrome (PCS) can occur when abdominal symptoms manifest after surgery. The purpose of this review is to look at the various effects of different dietary factors on patients undergoing cholecystectomy, how they affect their overall health after surgery, and how they contribute to symptoms of PCS. Some individuals may experience mild discomfort or alterations in bowel patterns, especially after consuming high-fat meals. The findings from the conducted studies suggest that, although dietary changes are a common recommendation, these measures are not sufficiently supported by evidence when it comes to alleviating symptoms and improving outcomes post-cholecystectomy. The studies found that subjects who consumed particular foods, such as processed meat and fried fatty foods, had exacerbated symptoms after cholecystectomy. Further studies are still required to understand the precise food factors that might affect post-surgical symptoms, as well as outcomes, and to develop tailored measures to enhance patient care and long-term prognosis after undergoing cholecystectomy.

Anticancer properties and metabolomic profiling of Shorea roxburghii extracts toward gastrointestinal cancer cell lines

BackgroundGastrointestinal cancer (GIC) ranks as the highest cause of cancer-related deaths globally. GIC patients are often diagnosed at advanced stages, limiting effective treatment options. Chemotherapy, the common GIC recommendation, has significant disadvantages such as toxicity and adverse effects. Natural products contain substances with diverse pharmacological characteristics that promise for use in cancer therapeutics. In this study, the flower of renowned Asian medicinal plant, Shorea roxburghii was collected and extracted to investigate its phytochemical contents, antioxidant, and anticancer properties on GIC cells.MethodsThe phytochemical contents of Shorea roxburghii extract were assessed using suitable methods. Phenolic content was determined through the Folin-Ciocalteu method, while flavonoids were quantified using the aluminum chloride (AlCl3) method. Antioxidant activity was evaluated using the FRAP and DPPH assays. Cytotoxicity was assessed in GIC cell lines via the MTT assay. Additionally, intracellular ROS levels and apoptosis were examined through flow cytometry techniques. The correlation between GIC cell viability and phytochemicals, 1H-NMR analysis was conducted.ResultsAmong the four different solvent extracts, ethyl acetate extract had the highest phenolic and flavonoid contents. Water extract exhibited the strongest reducing power and DPPH scavenging activity following by ethyl acetate. Interestingly, ethyl acetate extract demonstrated the highest inhibitory activity against three GIC cell lines (KKU-213B, HepG2, AGS) with IC50 values of 91.60 µg/ml, 39.38 µg/ml, and 35.59 µg/ml, while showing less toxicity to normal fibroblast cells. Ethyl acetate extract induced reactive oxygen species and apoptosis in GIC cell lines by downregulating anti-apoptotic protein Bcl-2. Metabolic profiling-based screening revealed a positive association between reduced GIC cell viability and phytochemicals like cinnamic acid and its derivatives, ferulic acid and coumaric acid.ConclusionsThis study highlights the potential of natural compounds in Shorea roxburghii in the development of more effective and safer anticancer agents as options for GIC as well as shedding light on new avenues for cancer treatment.

Understanding hospital antimicrobial prescribing decisions and determinants of uptake of new local antimicrobial prescribing guidelines in the Laos

Background Antimicrobial use in the Laos is among the highest in the Southeast Asia region. The first Lao comprehensive antimicrobial prescribing guidelines have been available since 2021. This study explored the determinants of antibiotic prescribing decisions and how the new prescribing guidelines were being used. Methods In August 2022, in-depth interviews were conducted with 16 Lao prescribers from two hospitals. Participants were questioned about their prescribing behaviours, attitudes to guidelines, how they learned about the guidelines and factors influencing their uptake. The interviews were audio-recorded, transcribed, and translated into English. Thematic analysis of the transcripts was conducted. Results Lao prescribers considered multiple factors before deciding to prescribe antibiotics to their patients. The most common factor was based on the clinical judgement of the prescribers. Lack of certain antibiotics and turnaround times of laboratory results were the main challenges to prescribing antibiotics appropriately. The majority of participants were satisfied with the guidelines, regarding them as comprehensive, simple and convenient. However, most participants admitted that they did not access the guidelines very often. The main reason was that they could remember the treatment recommendations because they treat similar diseases on a daily basis. Improving antibiotic knowledge was the most common recommendation in order to improve the appropriate use of antibiotics. Raising awareness of the guidelines and promoting their use should also be considered. In addition, heads of the wards, and policy and implementation leaders, should support, monitor and feedback their use to encourage all prescribers to follow the guidelines. Conclusions Several factors contribute to enhancing appropriate antibiotic prescription. Key factors for improving antibiotic prescription include enhancing prescribers' clinical knowledge, ensuring access to essential antibiotics, utilizing point-of-care diagnostics while waiting for culture and susceptibility testing results, and updating guidelines regularly. Health leaders must get involved to promote their use.

Feasibility of a Physical Activity Index in Clinical Practice: Perspectives of Providers and Cancer Patients

In Brief Physical activity is a common clinical recommendation for cancer survivors, yet the use of clinical tools to counsel patients is understudied. We developed an integrated Physical Activity Index to assist with this task. The purpose of this project was to conduct interviews to assess the feasibility and clinical utility of the Physical Activity Index from both provider and patient perspectives. Our findings indicate that a Physical Activity Index may be a useful tool to facilitate productive patient-provider communication about physical activity goals.