Daily Care Research Articles

Analysis of radiation oncology integration within general practitioners' daily patient care: a cross-sectional survey in Germany.

General practitioners (GPs) play acrucial role in providing interdisciplinary care for radiation oncology patients. This study aims to understand the specific needs and challenges faced by general practitioners in Germany when treating oncology patients. Acomprehensive web-based questionnaire with 24items was disseminated to GPs in Germany via email using survio.com. The survey collected data on demographics, qualifications, clinical experiences, decision-making involvement, and symptom recognition. It specifically examined post-radiotherapy care and the use of specialized palliative homecare networks (SAPV). Statistical analyses were descriptive. The survey was open from July4 to August9, 2023. Anotable majority of general practitioners displayed confidence in their understanding of cancer-related symptoms, with over half (54.6%) rating their knowledge with 4out of5. This level of self-assessed expertise extended to their capacity to address the needs of cancer patients (53.8%), although 67% express aneed for further education in specifically radiotherapeutic side effects. Satisfaction with SAPV networks was high, and 72.3% of respondents were actively involved in palliative care, compared to only 45.6% in managing radiation therapy. Notable challenges included inadequate communication with specialists, insufficient staffing, and under-recognition of GPs' roles in oncology care. The study highlights aparadox where GPs show high engagement in palliative care but limited involvement in radiation therapy management due to communication gaps and professional development needs. Addressing these disparities through targeted initiatives and fostering acollaborative care model is essential to amplify the important role of GPs, ensuring more integrated and effective patient care.

Comparison of integrated versus parallel continuous renal replacement therapy combined with veno-venous extracorporeal membrane oxygenation in patients with COVID-19 ARDS

IntroductionAcute kidney injury (AKI) is a common complication of acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) in patients receiving extracorporeal membrane oxygenation (ECMO) support, leading to requirement of continuous renal replacement therapy (CRRT) in 70% of ECMO patients. Parallel arrangement of CRRT and ECMO circuits is common in adult patients. However, CRRT may also be integrated directly into the ECMO circuit. This study compares the safety of both approaches.MethodsThis retrospective analysis included 105 patients treated with continuous veno-venous haemodiafiltration and veno-venous ECMO (Cardiohelp©) for COVID-19-induced ARDS between April 2020 and December 2021. Of these, 48 patients received a parallel connected CRRT running independently from ECMO (parallel approach), while in 57 patients, CRRT was integrated into the ECMO circuit (integrated approach) by connecting the CRRT access line to the post-oxygenator port and the CRRT return line to the pre-oxygenator position. Local protocol for risk assessment of this device combination mandated a maximum return line pressure below 250 mmHg in the CRRT system.ResultsAt CRRT initiation, the integrated group had significantly higher median pressures in CRRT lines compared to the parallel approach group (access line 110 mmHg vs. -25 mmHg, return line 170 mmHg vs. 50 mmHg; p < 0.01). However, median transmembrane pressures were similar between both groups (20 mmHg vs. 20 mmHg, p = 0.16). In-hospital mortality (p = 0.99), catheter associated infections (p = 0.47), bacteraemia (p = 0.96), filter clotting (p = 0.58) and unplanned CRRT system changes (p = 0.45) within the first 72 h of CRRT were comparable between both groups. The integrated group exhibited higher rates of bleeding events (37% vs. 23%; p = 0.08). Thromboembolism occurred in four cases in the integrated group, while one pneumothorax was observed in the parallel group. No cases of air embolism, device associated haemolysis or blood leakage was documented.ConclusionsDespite higher pressures in CRRT lines, the integrated approach provided comparable safety to the parallel approach. In case of hygienically challenging settings (such as the COVID-19 pandemic), the minimization of extracorporeal accesses and the streamlining of alarm management are decisive factors in providing intensive care medicine. Therefore, the integrated configuration of CRRT into the ECMO circuit can be advantageous in daily intensive care medicine.

Digital technologies as solutions to China’s aging population: a systematic review of their opportunities and challenges in rural development

IntroductionDifferences exist in the rate of aging between individuals residing in urban and rural areas in China, with rural areas experiencing a more pronounced impact. Smart aging represents a prevalent future trend in this regard, though its development will inevitably face challenges. However, studies focusing on rural areas are scarce. Future models of aging in less developed regions, including rural areas and townships, are expected to integrate and draw inspiration from the smart aging paradigm.MethodsWe present a systematic review of the current application of digital technologies in caring for older people in rural areas. We conducted extracted and screened 26 articles out of 823, sourced from five databases: Web of Science, IEEE Xplore, Engineering Village, PubMed/MEDLINE and CNKI.ResultsThe articles focus on digital technologies that cater to the daily life, medical care, spiritual comfort, and cultural entertainment needs of rural older people. In our review, we focused on four aspects of digital technology: mobile applications (apps), websites and platforms, mobile devices and terminals, and VR technologies or other unspecified technologies.DiscussionWe found that current digital technologies for smart aging have room for improvement in meeting the recreational and mental comfort needs of older adults. Digital technologies are predominantly applied to the smart community/rural and smart healthcare sectors, with limited applications in the smart home sector. Future studies should explore smart-home older adults care services to address digital cognitive barriers faced by older adults.

The Effect of Life Activity Levels of Palliative Care Patients on the Caregivers' Perception of Caregivers Burden.

Objective(s): Studies show the effects of dependent patients' caregivers on the caregiving burden. Knowing the effects of maintenance of movement, especially in life activities, on the factors affecting the caregiving burden is important for the quality of care, ensuring that the caregiver's capacity is preserved. Methods: This descriptive and cross-sectional study research was carried out to determine the effect of life activity levels of palliative care patients on the care burden of caregivers. The number of individuals to be sampled was calculated according to the sample formula with a known population. The sample of the consisted of 108 patients and their caregivers in a district state hospital between June and December 2022. Data were collected using the Barthel Index of Patient Activities of Daily Living (ADL) and Caregiver Burden Scale. Descriptive statistical methods, quantitative data analyses, and correlation analyses were used in the analysis of the data. Results: The average age for patient was 78.13 ± 10.25 and for caregivers was 54.64 ± 13.22 years. Barthel ADL Index score of the patients was 35.05, and 38% of the patients were completely dependent. Caregiver Burden Scale scores was 50.80, and 76.8% of the caregivers had moderate caregiver burden. Patients with increasing age, with diabetes mellitus and dementia diagnosis, not using glasses, or having urinary catheters and gastrostomy tubes had lower activity levels. The caregiver burden of caregivers was higher in those who spent 3 to 4 h for daily patient care, who had sleep problems, who thought that their health deteriorated compared to those who did not. It was determined that as the patients' ability to perform their daily activities decreased, the caregiver burden increased (r = -0.417; P < .01). Conclusions: It might be recommended that nurses can implement the nursing interventions completely and severely dependent patients' caregivers psychological and social support.

Prediction of oral diseases in care dependent older people

BackgroundA large number of older people depend on others for help with their daily personal care, including oral health care. Nursing home and elder-care staff often face challenges identifying older people, who are exposed to or at an increased risk of oral diseases. Thus, the aim of this study was to identify risk factors that non-dental care staff can use to identify older people at risk of oral diseases and poor oral hygiene.MethodsIn this cross-sectional study, the oral health and risk factors for poor oral health were determined for 217 care dependent older people living in two nursing homes and a rehabilitation centre or receiving home care in two Danish municipalities. The outcome variables for oral disease i.e. caries, periodontitis, and gingivitis, and oral hygiene, i.e. plaque and calculus, were assessed using standardised oral examinations. Risk factors for oral diseases and poor oral hygiene were assessed based on a questionnaire concerning (1) background information, (2) health status, (3) social support, (4) oral health behaviours, and (5) self-reported oral health. The associations between oral health and risk factors were investigated using logistic regression analyses.ResultsIn general, older people with different living arrangements had quite similarly distributed risk factors. The oral examinations showed that 54.5% had oral diseases, and 14.8% had poor oral hygiene. Not seeing a dentist regularly was significantly associated with having oral diseases (Odds Ratio, 2.87; CI, 1.53–5.39) and poor oral hygiene (OR, 4.50; CI, 1.83–11.05). A significant association was found between the presence of an oral disease and adversely affected quality of life (OR, 2.65; CI, 1.42–4.95), especially due to challenges eating (OR, 3.76; CI, 1.64–8.60) and/or smiling and showing teeth (OR, 3.64; CI, 1.27–10.42). A significant association was also found between poor oral hygiene and taking psychotropic drugs (OR, 2.61; CI, 1.08–6.30).ConclusionQuestions regarding the use of the dental care system and oral health problems could be used by nondental care staff in conversations with older people to determine their risk of oral diseases and poor oral hygiene.

Effectiveness of the AF-EduCare and AF-EduApp approach to improve atrial fibrillation knowledge and risk factor awareness in patients with atrial fibrillation: a randomized controlled trial.

Developing an integrated care pathway for atrial fibrillation (AF) patients is of pivotal importance, given the different treatment strategies. Moreover, knowledge about the condition is an important factor in engaging patients in their care. Patient education formed the core of the integrated AF-EduCare/AF-EduApp approach. The main aim of this manuscript is to report the impact of this approach on AF and risk factor (RF)-related knowledge and self-care awareness. Atrial fibrillation patients (n = 1232) were randomized to standard care (SC) or three educational interventions: in-person, online, or app-based education. Patients in the intervention groups received targeted education based on their responses to the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) and a Self-Care Questionnaire (SCQ) presented at different time points. Patients who received educational follow-up reached a significantly higher knowledge score (in-person: 86.5 ± 13.2%; online: 82.5 ± 19.3%; app: 80.1 ± 15.0%) than the SC group (65.3 ± 16.6%) after 12/18 months (P < 0.001). The knowledge rapidly improved with the first sessions (i.e. 3 months) and remained sustained in all education groups. Patients with RF at baseline showed a slight but significant increase in awareness about their RF through education [e.g. no knowledge of last measured systolic blood pressure compared between education vs. SC: odds ratio of 0.45 (P = 0.012)], a change that was not seen in SC patients. Nevertheless, patients keep under-estimating the presence of their own RFs compared with objective documentation in their medical record (e.g. hypertension). The JAKQ and SCQ are good instruments to provide targeted education to AF patients in daily clinical care. Knowledge level increases clinically significantly, but the impact on awareness about personal risk factors remains unsatisfactory. ClinicalTrials/gov: NCT03707873NCT03788044.

Creatinine Muscle Index as a Novel Muscle Mass Indicator in Patients With Chronic Kidney Disease

ABSTRACTBackgroundThe early detection of muscle loss in patients with chronic kidney disease (CKD) is crucial. The creatinine muscle index (CMI, mg/day/1.73 m2), which is calculated as the product of serum creatinine, is easily available in daily care and estimates the muscle mass. However, the association between CMI and muscle mass has not been fully assessed. We aimed to investigate whether CMI can serve as a predictor of muscle mass in patients with CKD.MethodsThis cross‐sectional study included patients with CKD undergoing kidney biopsy and plain computed tomography (CT) to assess the kidney morphology. Muscle mass was assessed using the psoas muscle index, determined by dividing the cross‐sectional psoas muscle area at the L3 level, measured by manual tracing on pre‐biopsy CT, by the participant's height (cm2/m2).ResultsIn total, 159 participants (84 male [52.8%], mean age 51.7 ± 16 years) were included. CMI was positively correlated with PMI in men (r = 0.37, p &lt; 0.01) and women (r = 0.56, p &lt; 0.01). The prevalence of low muscle mass was 55 (65.5%) in men and 44 (58.7%) in women. The odds ratios (ORs) and 95% confidence intervals (CIs) for low muscle mass were significantly higher in Tertile 1 of CMI than in Tertile 3 in both men and women (OR, 5.37 [95% CI, 1.32–21.8] in men; OR, 7.31 [95% CI, 1.38–38.6] in women) after adjusting for age, body mass index and co‐morbidities (hypertension and diabetes). According to receiver operating characteristics curves, the optimal cut‐off value of CMI for low muscle mass was 1079 mg/day/1.73 m2 (area under the curve 0.69 [95% CI: 0.57–0.81]; sensitivity, 0.78; specificity, 0.62) in men and 693 mg/day/1.73 m2 (area under the curve 0.74 [95%CI: 0.63–0.85]; sensitivity, 0.57; specificity, 0.90) in women.ConclusionsCMI is significantly associated with muscle mass in patients with CKD. Our findings suggest the utility of CMI for screening the muscle mass in this population.

Tooth Shame - An Ethnographic Study of the Choreographies of Tooth Shame in Danish Elderly Care (SSM-D-24-02581)

This study suggests the term tooth shame and explores it as a phenomenon encompassing deep entanglements between emotional experiences, social interactions, and care work practices. Drawing on shame research concerning the body, health, and class, juxtaposed with odontological research on the social implications of oral health issues, it investigates how tooth shame appears in Danish elderly care. In Denmark, oral health is notably impaired among older people depending on professional care, with significant repercussions for general health and social life. The study stems from the Lifelong Oral Health project, which identifies barriers to oral health and examines the potential to improve it in Danish elderly care. It is based on ethnographic fieldwork in nursing homes, home care units, and a rehabilitation center in two Danish municipalities. As self-derogative statements and self-limiting behaviors regarding oral health issues stood out as a general finding in interviews with older people, the focus on tooth shame emerged from this fieldwork. The study contributes to recent shame discussions with a social-material understanding of tooth shame, emphasizing that it is more than an individual feature. It is a collectively distributed phenomenon that expands among people and situations, and that interferes with vital caring practices. The study suggests that tooth shame appears through the performance of tooth shame choreographies, highlighting its implications in a socio-material setting. First, it demonstrates that tooth shame can make older people adapt to oral health issues, for example, by avoiding social interactions, dental care, and oral treatments. Second, it identifies tooth shame as a collectively distributed and expanding phenomenon, as it draws, for example, care workers into sensitive shame situations. Third, it explores how tooth shame interferes with daily dental care practices, professional considerations, and ethical dilemmas within elderly care systems.

Informal care for people with dementia in Europe.

Informal care estimates for use in health-economic models are lacking. We aimed to estimate the association between informal care time and dementia symptoms across Europe. A secondary analysis was performed on 13,529 observations in 5,369 persons from 9 European pooled cohort or trial studies in community-dwelling persons with dementia. A mixed regression model was fitted to time spent on instrumental or basic activities of daily living using disease severity and demographic characteristics. Daily informal care time was 0.5 hours higher in moderate compared to mild and 1.3h higher in severe compared to mild cognitive impairment. Likewise, this was 1.2h and 2.7h for functional disability and 0.3h and 0.6h for behavioral symptoms in the same directions. Estimates can be used in both single- and multi-domain health-economic models for dementia in European settings.

Comparative analysis of the effect of self-assembling peptide P11-4 on enamel erosion: a confocal laser scanning microscopy study.

This study aims to comparatively assess the preventive and protective effects of the self-assembling peptide P11-4 on enamel erosion and evaluate the potential for enamel surface recovery when professional products are combined with home-use dental-care products during the erosive process. Ninety-nine bovine incisors were divided into nine groups: a control group, four groups with the application of professional-products [P11-4 peptide (Curodont-Repair), stannous/Sn2+ containing solution (8% Sn2+), casein-phosphopeptide-amorphous-calcium-phosphate fluoride/CPP-ACPF (MI Varnish), sodium fluoride/NaF (Profluorid)] and four groups with the combination of professional products and home-use daily dental care products [P11-4 peptide (Curodont Repair + Curodont Protect), stannous ions containing agents (8% Sn2++Emofluor Gel Intensive-Care), CPP-ACPF (MI Varnish + MI Paste Plus), NaF (Profluorid + ReminPro)]. Professional products were applied once before a five-day erosive cycle, involving six 2-minute citric-acid exposures per day. In combined-groups, a home-use dental-care product was applied daily at the end of each cycle day. After the cycle, lesion depth and fluorescence were analyzed using confocal-laser-scanning-microscopy, and results were statistically evaluated using paired t-tests, ANOVA, and Tukey's post-hoc tests. The P11-4 group was significantly more effective among the professional-only groups in both parameters (p<0.001). All combined-groups were determined to be statistically more successful than their respective professional-groups in both parameters (p<0.05). Based on lesion depth data, it was observed that the P11-4 and stannous-containing combined-groups showed statistically similar results (p>0.05). In terms of lesion fluorescence data, the P11-4 combined-group was found to be statistically more successful than all other study groups (p<0.05). The self-assembling peptide P11-4 was determined to exhibit the best preventive and protective anti-erosive effect in both professional and combined applications. A positive relationship was observed between the support of professional applications with home-use daily-dental-care products and protection against erosive lesions.

Social factors affecting home-based end-of-life care for patients with cancer and primary caregivers.

This study aimed to explore the social factors of patients and caregivers, including those related to their wishes for home-based end-of-life care that influence its fulfillment. A secondary analysis was conducted using the dataset (home-based end-of-life care N = 625, hospital end-of-life care N = 7603) Comprehensive patient-based survey conducted by The Study on Quality Evaluation of Hospice and Palliative Care by Bereaved Caregivers (J-HOPE 4) and multivariate analysis (multiple logistic regression) to explore the impact of social factors of patients and caregivers on the fulfillment of home-based end-of-life care. The explanatory variables included 11 social factors of patients, such as age and sex, and 18 social factors of primary caregivers. For patients with medical expenses less than 900 USD (OR, 2.05), annual income of fewer than 36,000 USD (OR 0.669), preferences for home care (OR 1.49), preferences to die at home (OR 1.58), wish to die at home (OR 1.52), and lack of patient's financial well-being (OR 0.72) were significant factors associated with home-based end-of-life care. Significant factors relating to caregivers included male caregivers (OR 0.66), poor mental state (OR 0.79), ability to provide daily care (OR 3.02), experience of caring for a deceased family member (OR 0.66), presence of alternative caregivers (OR 0.78), and cohabitation with caregivers (OR 1.47). Patient preferences, social situations, primary caregivers' social situations, and mental states influenced home-based end-of-life care.

Influence of Socio-Demographic Factors on Care Types Received by Elderly People in Irele LGA, Ondo State, Nigeria

This study examines the influence of socio-demographic factors on care types received by elderly people in Irele Local Government Area (LGA), Ondo state, Nigeria. The study employed quantitative technique to elicit data from 100 elderly people through structured questionnaires. The study emphasized the relationship between socio-demographic variables such as age, gender, marital status, education, and occupation on care types received by elderly people including assistance with daily activities, companionship, emotional support, financial, and medical care. The initial evidence from this study showed that there are identified socio-demographic factors (age, education and occupation) with influences on care types received by elderly people. Further results indicate significant interactions between socio-demographic factors like age (p=0.000), education (p=0.017), and occupation (p=0.023), and care types received by elderly people. However, gender (p=0.717) and marital status (p=0.138) of elderly people are insignificantly related to care types received in the study. The findings depict that the care types received by elderly people are influenced by their socio-demographic factors. Moreover, evidences showed that financial support, companionship and medical care are germane care types received by elderly people in this study. Hence, the study recommends that more elderly married females should be urgently considered to benefit from financial support, companionship and medical care within families in Irele Local Government Area of Ondo state and the entire Country.

Understanding Daily Care Experience Preferences Across the Lifespan of Older Adults: Application of Natural Language Processing.

Older adults are a heterogeneous group, and their care experience preferences are likely to be diverse and individualized. Thus, the aim of this study was to identify categories of older adults' care experience preferences and to examine similarities and differences across different age groups. The initial categories of older adults' care experience preferences were identified through a qualitative review of narrative text (n = 3134) in the ADVault data set. A natural language processing (NLP) algorithm was used to automatically and accurately define older adults' care experience preference categories. Descriptive statistics were used to examine similarities and differences in care experience preference categories across different age groups. The overall average performance of NLP algorithms was relatively high (average F-score = 0.88; range: 0.77-0.96). Through a qualitative review of 350 randomly selected texts, a total of 11 categories were identified. The most frequent category was music, followed by photographs, entertainment, family/friends, religion-related, atmosphere, flower/plants, pet, bed/bedding, hobby, and other. After applying the best performing NLP algorithm to each category, older adults' care experience preference categories were music (41.32%), followed by photographs (28.47%), entertainment (13.46%), religion-related (n = 12.69%), pet (12.22%), flower/plants (11.51%), family/friends (8.45%), atmosphere (7.75%), bed/bedding (6.12%), and hobby (5.45%). Young-old and old-old adults had similar care experience preferences with music being the most frequent category while old-old adults had photographs as the most frequent category for their care experience preference. Clinicians must understand the distinct categories of care experience preferences and incorporate them into personalized care planning.

Characterization and Safety Assessment of a Novel Antioxidant Excipient from Sustainable Recovery of Grape Processing Waste Bentonite Designed to Develop a Thermosensitive Buccal Spray for Oral Cavity Wellness.

Nowadays, sustainability efforts focus on extracting natural cosmeceutical ingredients, such as polyphenols, from agri-food waste, for example, black bentonite (BB). The aims of this work were to validate an antioxidant cosmetic ingredient obtained from the waste BB and embed it into an ad hoc designed oromucosal spray intended for oral cavity wellness. Focusing on sustainability, the study tested PEG200, propylene glycol, and their mixtures as unconventional and green extraction solvents, aligned with a waste-to-market approach. The extracts obtained by maceration were characterized through HPLC-DAD and HPLC-MS analyses, DPPH, Bradford, and Folin-Ciocalteu assays. The best P extract was further subjected to OECD-compliant in vitro validation as novel cosmetic raw material and used to prepare a thermosensitive buccal spray for oral daily care. PEG200 enabled the obtainment of a cost-effective polyphenol-rich extract, which was validated as a safe, high value-added cosmetic secondary raw material. The extract was incorporated into a liquid thermosensitive buccal formulation, able to gel once at body temperature and enhance polyphenol accumulation into the oral mucosae even with short contact times. BB is confirmed as a valuable source of polyphenols, and PEG200 represents an effective extraction solvent leading to a novel functional liquid excipient characterized by an OECD-compliant variegate pool of phenols. The buccal spray then proposed represents a valuable, friendly solution for daily oral care, as it is simple to use, as well as the in vitro and ex vivo tests carried out suggested its effectiveness.

Developing a theory of change to guide the design and implementation of a caregiver-centric support service

BackgroundSet against the backdrop of a rapidly ageing population and growing emphasis on the importance of ageing-in-place, family members often assume the role of a caregiver. Navigating through a complex healthcare system while simultaneously juggling the daily care needs of their care-recipients, caregivers often become worn out by the intense caregiver stress and burden, neglecting their own well-being. This translates to adverse health and economic outcomes such as prolonged hospital stays and increased nursing home placement of care-recipients. Seeking to better support caregivers, we developed a theory of change to guide the design and implementation of a caregiver support programme – Project Carer Matters.MethodsWe applied theory of change methodology to explain how the Project’s interventions were hypothesised to lead to their identified short-to-long term goals, drawing on a causal analysis based on available evidence. The theory of change was developed with insights garnered from previous research studies conducted on caregiver stress, stakeholder engagement sessions and multiple dialogues with clinical experts and hospital leaders.ResultsOur final theory of change is the result of the evaluation of the Project in its pilot phase. It is populated with the resources, activities and short-to-long term outcomes that can be attributed or linked to the Project. Multiple meetings and discussion with stakeholders over the pilot prompted frequent practice of the Plan, Do, Study, Act model to refine the ongoing implementation process and the theory of change itself.ConclusionsA theory of change is essential in guiding the design, implementation and evaluation of a complex health care intervention such as Project Carer Matters. The development of the theory of change is a journey and not a resultant product. This journey has also led us to learn that 1) a theory of change needs to be dynamic and ever evolving with time and context, 2) the perspectives of relevant stakeholders need to be included in this process to ensure the feasibility and sustainability of the project in the long run and 3) frequent stakeholder engagements are essential in enabling the implementation team to fine-tune the Project in an effective manner.Trial registrationClinicalTrials.gov, NCT05205135, registered on 24/01/2022.

Perspectives on diagnosis and management of all-cause encephalitis: a European survey of adult infectious diseases healthcare providers.

There is a need to understand current practices, knowledge gaps and training needs of ID physicians regarding encephalitis. A questionnaire was sent to European ID specialists. 201 persons answered. Respondents were involved more often in infectious (64%) than autoimmune encephalitis (7.5%). Respondents reported not feeling comfortable in recognizing (60%), diagnosing (71%), or treating (85%) autoimmune encephalitis. There was a need for the publication of guidelines from the ESCMID for the management of encephalitis (89%). There is heterogeneity in confidence in recognizing, diagnosing, and treating autoimmune encephalitis. European guidelines may be helpful for physicians in daily care.

All-cause and cause-specific mortality in patients with chronic hepatitis B and concurrent steatotic liver disease.

Steatotic liver disease (SLD) is prevalent among patients with chronic hepatitis B (CHB). However, the effects of metabolic dysfunction-associated SLD (MASLD) on the long-term survival of such patients remain unknown. Accordingly, this study investigated the mortality risks in patients with CHB and concurrent SLD. Consecutive patients with CHB and concurrent SLD were retrospectively recruited at National Taiwan University Hospital. MASLD was defined by the presence of cardiometabolic risk factors (CMRF). The cumulative incidences of all-cause and cause-specific mortality were compared. A total of 8,718 patients with CHB and concurrent SLD were included from 2006 to 2021. At baseline, the MASLD group (n=6,562) was older and had a lower proportion of hepatitis B e antigen positivity and lower hepatitis B virus DNA levels compared with the non-MASLD group (n=2,156). After a median follow-up period of 9.1 years, the MASLD group exhibited a higher risk of all-cause mortality compared with the non-MASLD group (adjusted hazard ratio [aHR]: 1.79, 95% confidence interval [CI]: 1.24-2.58, p=0.002). Furthermore, cumulative CMRF dose-dependently elevated the risks of all-cause, liver-related, and cardiovascular mortality (all p<0.05). During the follow-up period, new-onset diabetes mellitus, hypertension, and significant weight gain further increased the risks of all-cause and liver-related mortality (all p<0.05). However, patients with SLD had a lower mortality risk than non-SLD patients after propensity score matching (HR: 0.62, 95% CI: 0.53 - 0.74, p<0.001). Among patients with CHB and SLD, metabolic burden dose-dependently increases the all-cause, liver-related, and cardiovascular mortality risks. Patients with SLD have a lower mortality risk than those without SLD. Identifying these metabolic dysfunctions is crucial for stratifying the level of risk in daily care. Concurrent steatotic liver disease (SLD) is prevalent among patients with chronic hepatitis B (CHB); however, the effects of the associated cardiometabolic risk factors on all-cause and cause-specific mortality remain unknown. This study demonstrated that cumulative metabolic burden dose-dependently increased the risks of all-cause, liver-related, and cardiovascular mortality in patients with CHB and SLD. Moreover, new-onset diabetes mellitus, hypertension, and weight gain during the follow-up period further exacerbated these risks. However, patients with SLD had a lower risk of mortality than those without SLD. Thus, routine screening and monitoring of metabolic dysfunctions constitute a key element of daily care for patients with CHB.

Facilitating an Evidence-Based Quality Improvement Learning Culture in Nursing Teams Through Coaching and Identification of Key Influencing Factors: An Action Research Approach.

To explore how coaching can facilitate the development of an Evidence-Based Quality Improvement (EBQI) learning culture within nursing teams in hospital and community care settings. This study also explores the specific contextual factors that influence effective outcomes. Action research. Nine teams, including 254 nurses were selected from four hospitals and two community care organisations to participate in the development of an EBQI-learning culture under the guidance of internal and external coaches. Data were gathered from 27 focus groups with 56 unique participants (of whom 31 participated multiple times) and six individual interviews with three external coaches. Transcripts of all interviews were subjected to abductive thematic analysis. To promote an EBQI learning culture in nursing teams, it is essential that internal coaches effectively guide their team members. The internal coaches in this study focused on enhancing readiness for EBQI by providing support, encouraging involvement and motivating team members. They deepened innovation competencies including assessing daily care, implementing well-structured changes in care practices and embedding small steps in the change process in daily routines. It was found that barriers and facilitators within the team's context can influence the development of EBQI-learning culture and therefore need to be considered when seeking to make changes. The presence of external coaches served as a valuable resource and a motivator in supporting internal coaches to apply and improve their coaching skills. To stimulate the development of an EBQI-learning culture, internal coaches need to focus on team readiness to work with EBQI. Priority needs to be given to enhancing the care change competencies of team members. Barriers to change must also be addressed. Internal coaches require external support and motivation to continually develop coaching skills. The Standards for Reporting Qualitative Research. No patient or public contribution.

Comparative analysis of pharmacists’ knowledge and perception on the utilization of precision medicine to reduce antimicrobial resistance in Lebanon and Greece

Pharmacogenomics and precision medicine are promising new tools in the fight against antimicrobial resistance by providing personalized treatment approaches based on an individual genetic makeup. Pharmacists, equipped with appropriate education and tools, can play a significant role in integrating pharmacogenomics and precision medicine into clinical practice and lead the rational use of pharmacogenomics in daily patient care. Improving patient outcomes in primary healthcare settings is the ultimate output. To date, there has been a lack of assessment and comparison of the knowledge and perceptions of pharmacists across different countries. A self-administered questionnaire was sent to 223 participants from Greece and Lebanon. Results showed that 96% and 68% of the pharmacists in both countries were familiar with the terminology of antimicrobial resistance and precision medicine. A deeper investigation showed gaps concerning the profound understanding of antimicrobial resistance from the one health perspective and the preventive measures. Knowledge of pharmacogenomics, its tests, and the value of precision medicine was low in both groups, with more pronounced deficiencies in the Lebanese group. Additionally, pharmacists didn’t perceive their current role in implementing pharmacogenomics and precision medicine in the combat against antimicrobial resistance, but they expressed openness to future involvement in this area. This research can serve as a foundational tool to establish or adjust policies to allocate resources and support both systems and people to enhance precision medicine implementation in low-to-middle-income countries. Furthermore, it highlights the importance of leveraging the experiences and knowledge of high-income countries to effectively address the challenge of antimicrobial resistance.

29. CLINICAL FEATURES AND DAILY ACTIVITY DEPENDENCE IN STROKE PATIENTS: A BARTHEL INDEX-BASED STUDY AT HA TINH REHABILITATION HOSPITAL IN 2024

Aims: Stroke is a leading cause of disability worldwide, significantly affecting patients' ability to perform daily activities. In Vietnam, stroke survivors often face prolonged dependence on others for daily care. This study aimed to describe the clinical characteristics and assess the level of dependence in daily activities among stroke patients at Ha Tinh Rehabilitation Hospital. Methods: A descriptive cross-sectional study was conducted on 117 stroke patients undergoing rehabilitation at Ha Tinh Rehabilitation Hospital from March to September 2024. Patients were assessed using the Barthel Index, which measures independence in 10 basic activities of daily living. Data were collected through medical record reviews, patient observations, and interviews. Statistical analysis was performed using SPSS 25.0, with chi-square tests for differences between proportions. Results: The average Barthel Index score was 50.44 ± 32.42, indicating moderate dependence. Only 16.2% of patients were fully independent, while 49.6% were completely dependent. Factors such as age, educational level, social support, smoking, and clinical conditions like aphasia and dysphagia were significantly associated with levels of independence (p &lt; 0.05). Conclusion: The majority of stroke patients at Ha Tinh Rehabilitation Hospital demonstrated a high level of dependence in daily activities. Interventions targeting social support, lifestyle changes, and early rehabilitation may enhance patient independence and improve outcomes.