Development Of New Guidelines Research Articles

Recommendations to Improve Management of Incidental Pulmonary Nodules in Canada: Expert Panel Consensus.

Introduction: Incidental pulmonary nodules (IPN) are common radiologic findings, yet management of IPNs is inconsistent across Canada. This study aims to improve IPN management based on multidisciplinary expert consensus and provides recommendations to overcome patient and system-level barriers. Methods: A modified Delphi consensus technique was conducted. Multidisciplinary experts with extensive experience in lung nodule management in Canada were recruited to participate in the panel. A survey was administered in 3 rounds, using a 5-point Likert scale to determine the level of agreement (1 = extremely agree, 5 = extremely disagree). Results: Eleven experts agreed to participate in the panel; 10 completed all 3 rounds. Consensus was achieved for 183/217 (84.3%) statements. Panellists agreed that radiology reports should include a standardized summary of findings and follow-up recommendations for all nodule sizes (ie, <6, 6-8, and >8 mm). There was strong consensus regarding the importance of an automated system for patient follow-up and that leadership support for organizational change at the administrative level is of utmost importance in improving IPN management. There was no consensus on the need for standardized national referral pathways, development of new guidelines, or establishing a uniform picture archiving and communication system. Conclusion: Canadian IPN experts agree that improved IPN management should include standardized radiology reporting of IPNs, standardized and automated follow-up of patients with IPNs, guideline adherence and implementation, and leadership support for organizational change. Future research should focus on the implementation and long-term effectiveness of these recommendations in clinical practice.

DOP01 Definitions of histological abnormalities in inflammatory bowel disease: an ECCO position paper

Abstract Background High quality histological examination of ileocolonic biopsies in inflammatory bowel disease (IBD) plays a critical role in optimising clinical management, investigative studies, and clinical trials. The correct assessment of histological features can confirm the diagnosis of IBD, assist with its subclassification (as ulcerative colitis or Crohn’s disease), facilitate the estimation of disease activity and disease extent, and aid the detection of mimics and complication. However, there are surprisingly few universal definitions of each histological abnormalities and the existing definitions are often inconsistent. The main practical concern is that histological scoring schemes, or guidelines on histological diagnosis, include detailed features, and many of these features have, paradoxically, no, or vague definitions. Furthermore, interobserver variability for many histological features in IBD is significantly high, possibly reflecting lack of precision. The aim of this paper is to review and assess any existing histologcal definitions and criteria, selecting the most appropriate where possible, and modifying them or writing new definitions where necessary. Methods The European Crohn's and Colitis Organisation (ECCO) and the project leaders formed a panel of experts in the IBD field, composed of pathologists and gastroenterologists to explore inconsistencies in the definitions of histological abnormalities using the best resources and evidence available. The panel examined existing definitions, peer reviews publications, scoring schemes, guidelines and textbooks. An important contribution was also given by their professional experience and knowledge. Results The literature review process confirmed that most current existing definitions often have no evidence base and vary between sources. The panel of experts developed 40 statements on histological definitions in IBD with accompanying supporting text for each statement. Conclusion The statements represent expert consensus with the support of evidence where available. Further possible development of this process will include attempts to grade histological changes, aiming to improve the consistency of pathological diagnosis, a reduction in currently high rates of interobserver variability, more precision in clinical trial work and research, and to facilitate development of new guidelines and scoring schemes for IBD.

Psychotherapist perceptions of engagement-building behaviours with youth clients across developmental levels.

Building a positive therapeutic relationship is a challenging, yet critical, first step in conducting youth psychotherapy. A number of studies in the youth treatment literature have indicated that a positive therapeutic alliance is related to increased treatment attendance, participation, and outcome. Some research has examined therapist behaviours for engaging therapy clients; however, developmental differences in alliance formation have had limited exploration. The current study surveyed clinicians about their use of specific engagement strategies and the developmental stage of their youth clients. It was hypothesised that participants would differentially rate the importance of different aspects of therapeutic engagement based upon a youth client's developmental stage and that these would correspond with differences in specific engagement strategies. A total of 64 clinicians with experience treating youth completed the study. The participants completed a questionnaire administered online that asked them to rate the importance of developmental differences to forming a therapeutic relationship and provide example client behaviours from their clinical experience for each developmental stage. Results showed clinicians felt the relative importance of collaboration, advocacy, and trustworthiness increased with age. These differences were also evidenced in the specific strategies clinicians endorsed in relation to each engagement factor across developmental stages. This program of research will eventually aid in the development of new guidelines for engaging clients in youth psychotherapy. In addition, the results may be used to enhance psychotherapy training for those working with children and adolescents.

Laparoscopic treatment of ventral hernias: the Italian national guidelines

Primary and incisional ventral hernias are significant public health issues for their prevalence, variability of professional practices, and high costs associated with the treatment In 2019, the Board of Directors of the Italian Society for Endoscopic Surgery (SICE) promoted the development of new guidelines on the laparoscopic treatment of ventral hernias, according to the new national regulation. In 2022, the guideline was accepted by the government agency, and it was published, in Italian, on the SNLG website. Here, we report the adopted methodology and the guideline’s recommendations, as established in its diffusion policy. This guideline is produced according to the methodology indicated by the SNGL and applying the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Fifteen recommendations were produced as a result of 4 PICO questions. The level of recommendation was conditional for 12 of them and conditional to moderate for one. This guideline's strengths include relying on an extensive systematic review of the literature and applying a rigorous GRADE method. It also has several limitations. The literature on the topic is continuously and rapidly evolving; our results are based on findings that need constant re-appraisal. It is focused only on minimally invasive techniques and cannot consider broader issues (e.g., diagnostics, indication for surgery, pre-habilitation).

Train the Trainer for Implementing Treatment Guidelines

Introduction:A collaborative project between Sweden and Kosovo with the aim to develop treatment guidelines for the ambulance services was undertaken. Firstly, relevant guidelines were identified, then translated, and processed to fit with the Kosovan ambulance service system. The next step was to train instructors in becoming proficient in training colleagues to use the guidelines. A train the trainer approach was chosen as it can be seen as grounded in Kolb's experiential learning theory and Crossan et al. organizational learning theory. Those theories describe how individuals learn and how organizations develop.Method:This implementation project supported training of local instructors to become proficient in training colleagues in 13 selected treatment guidelines for the ambulance services using scenario training. Initially, Kosovar instructors received directions from Swedish instructors then they observed the Swedish instructors. After this, they took more responsibility for the training. Seven Swedish instructors instructed eight Kosovar instructors for a week where about 100 Kosovan doctors and nurses were trained in patient assessment and treatment guidelines. The trainees were divided into four parallel groups of 4-5 participants with one Kosovar instructor supported by a Swedish instructor.Results:After the training week, eight instructors from two different ambulance service centers achieved proficiency in training colleagues in using treatment guidelines. Each Kosovar instructor was involved in 30 training occasions.Conclusion:The training resulted in the involved Kosovar ambulance service centers being able to train new colleagues in providing standardized patient assessment and treatment using treatment guidelines. In addition, the trained Kosovar instructors will be able to contribute to the development of new guidelines and revision of established guidelines.Applying a train the trainer approach, theoretically grounded in learning theories, provides a sound basis to achieve systematic change for improving patient safety. Here, the knowledge distribution among practitioners is improved in an inexpensive manner.

Updates in screening for tuberculosis. Review of guidelines

The aim of the study was to evaluate the current guidelines and methodological recommendations on the detection of suspects and methods of diagnosis of tuberculosis in order to identify the need to update them. Material and methodology: a review of the literature consisting in the evaluation of the electronic sources published in PubMed and the HINARI health literature collection, as well as the paper publications, were evaluated. The results were grouped and systematized according to the level of scientific evidence. Results: the development of new guidelines and the updating of those already in use has a major importance for the standardization of TB screening and diagnostic procedures, and the annual review is one of the key principles of the management of the screening actions.

A multi-criteria decision-making (MCDM) approach for data-driven distance learning recommendations.

Distance learning has been adopted as an alternative learning strategy to the face-to-face teaching methodology. It has been largely implemented by many governments worldwide due to the spread of the COVID-19 pandemic and the implication in enforcing lockdown and social distancing. In emergency situations distance learning is referred to as Emergency Remote Teaching (ERT). Due to this dynamic, sudden shift, and scaling demand in distance learning, many challenges have been accentuated. These include technological adoption, student commitments, parent involvement, and teacher extra burden management, changes in the organization methodology, in addition to government development of new guidelines and regulations to assess, manage, and control the outcomes of distance learning. The objective of this paper is to analyze the alternatives of distance learning and discuss how these alternatives reflect on student academic performance and retention in distance learning education. We first, examine how different stakeholders make use of distance learning to achieve the learning objectives. Then, we evaluate various alternatives and criteria that influence distance learning, we study the correlation between them and extract the best alternatives. The model we propose is a multi-criteria decision-making model that assigns various scores of weights to alternatives, then the best-scored alternative is passed through a recommendation model. Finally, our system proposes customized recommendations to students, and teachers which will lead to enhancing student academic performance. We believe that this study will serve the education system and provides valuable insights and understanding of the use of distance learning and its effectiveness.

The complexity of constructing empowerment measuring instruments: a delphi study*

ABSTRACT The value of empowerment as a central concept for social work implies the potential benefits of measurement to understand how this value is materialised in social work. The way in which instruments are developed and constructed impact their quality. With regard to the complexity of measuring empowerment, this article aims to provide insights in experts’ views on the theoretical requirements to measuring empowerment in social work. A Delphi study of 3 rounds was conducted to achieve consensus into the appropriate method of instrument development for empowerment. By retrieving, organising, exchanging and combining opinions and arguments from different experts, this study provides insights into their views on requirements when developing measuring instruments for empowerment. The results show elaborations on substantive requirements and considerations that should be taken into account when developing empowerment measures in social work and that have led to the development of new guidelines. These provide social work and its researchers the opportunity to construct instruments that align with methodological standards, theoretical requirements, and ethical principles.

Early satiety in cancer

<h3>Objectives</h3> Edication management is a process in which medications are selected, procured, delivered, prescribed, reviewed, administered and monitored to assure high-quality patient care and safety. This paper explores clinicians’ attitudes...

Prevention and control of non-communicable diseases in antenatal, intrapartum, and postnatal care: a systematic scoping review of clinical practice guidelines since 2011

BackgroundNon-communicable diseases (NCDs) are a leading cause of maternal mortality and morbidity worldwide. The World Health Organization is developing new recommendations focusing on the management of NCDs for pregnant, intrapartum, and postnatal women. Thus, to support the development of new guidelines and recommendations, we aimed to determine the availability, focus, and scope of recommendations of current guidelines for the management of NCDs during pregnancy, intrapartum, and postnatal period.MethodsPubMed, Global Index Medicus, TRIP, and Guideline International Network databases were searched on 31 May 2021, to identify any NCD-related guidelines published between 2011 and 2021 with no language or country restrictions. Websites of 165 professional organizations were also searched. Characteristics of included guidelines were analyzed, and recommendations were extracted from guidelines of five high-priority NCD conditions (diabetes, chronic hypertension, respiratory conditions, hemoglobinopathies and sickle cell disease, and mental and substance use disorders).ResultsFrom 6026 citations and 165 websites, 405 guidelines were included of which 132 (33%) were pregnancy-specific and 285 (88%) were developed in high-income countries. Among pregnancy-specific guidelines, the most common conditions for which recommendations were provided were gestational diabetes, circulatory diseases, thyroid disorders, and hypertensive disorders of pregnancy. For the five high-priority conditions, 47 guidelines were identified which provided 1834 recommendations, largely focused on antenatal care interventions (62%) such as early detection, screening tools, pharmacological treatment, and lifestyle education. Postnatal recommendations largely covered postnatal clinical assessments, lifestyle education, and breastfeeding. Health system recommendations largely covered multidisciplinary care teams and strengthening referral pathways.ConclusionsThis study provides a robust assessment of currently available guidelines and mapping of recommendations on NCD management within maternal health services, which will inform the scope of the World Health Organization’s future guideline development activities. This study identified a need to develop guidelines that consider NCDs holistically, with an integrated approach to antenatal, intrapartum, and postnatal care, and that are relevant for resource-limited contexts. Any such guidelines should consider what interventions are most essential to improving outcomes for women with NCDs and their newborns, and how variations in quality of NCD-related care can be addressed.

Free tumbler in Snapchat vs coffee tasting ticket in Instagram: the impact of gift type and message type on B2C gift-giving on different social media platforms

PurposeThis paper aims to examine the differential effects of the type of gift (material vs experiential) offered on Snapchat and Instagram (Study 1) and how the impacts of gift type and message type (informational vs emotional) vary by the two different image-sharing social media platform in a business-to-consumer (B2C) gift-giving context (Study 2).Design/methodology/approachStudy 1 used a two (social media: Snapchat vs Instagram) by two (gift type: material vs experiential) between-subject factorial design, whereas Study 2 used a two (social media: Snapchat vs Instagram) by two (gift type: material vs experiential) by two (message type: informational vs emotional) between-subject factorial design. A series of analyses of covariance was conducted to test the suggested hypotheses.FindingsStudy 1 demonstrated that the promotion of material gifts was more effective on Snapchat than on Instagram, while the promotion of experiential gifts was more effective on Instagram than on Snapchat. Study 2 showed that the impacts of gift type and message type varied by social media platform. The promotion of an experiential gift with an emotional ad appeal was found to be more effective on Instagram than on Snapchat, while the promotion of a material gift using an informational ad appeal was found to be more effective on Snapchat than on Instagram.Research limitations/implicationsThis research used a college student sample for the experiments. However, to extend the generalizability of the results, it is recommended that future experiments be conducted with nonstudent samples. Also, the current research manipulated the two different social media conditions, Snapchat vs Instagram, by enforcing participants to use their social media and then provided experimental stimuli in a different screen from their social media account. If the stimuli were distributed through participants’ real social media account, the external validity of this research could be enhanced. Finally, future research should apply this framework to other countries with different social media platforms to confirm the generalizability of the study’s findings.Practical implicationsThis research can thus contribute to the development of new guidelines for planning social media marketing in the business gift-giving context. By leveraging findings that the fit effect of gift types and advertising appeals differs based on social media platform, practitioners can create a more effective social media plan for their advertising campaigns. Given that copywriting and media plans are among the most important and difficult work in the business of advertising, this study’s findings would assist advertising practitioners in planning and executing the most effective advertising campaigns.Originality/valueThe findings of this study provide valuable insights for the development of effective brand promotion strategies for B2C gift-giving via social media.

Impact of unilateral hearing loss in early development.

The purpose of this review is to provide an update on current literature as it relates to the impact of unilateral hearing loss for the pediatric population. Current studies further corroborate past research findings which reveal the potential consequences of unilateral hearing loss on spatial hearing, language, and neurocognitive functioning. Deficits among children with unilateral hearing loss may parallel those seen in children with bilateral hearing loss, further challenging historic views that hearing in one ear in childhood is sufficient for normal development. The potential deficiencies seen in children with unilateral hearing loss can be subtler than those seen with bilateral hearing loss, but may nonetheless also impact school performance, patient fatigue, parental stress, and quality of life. Early interventions within a sensitive period of development of the central auditory system may circumvent potential barriers in cognitive, academic, and psychosocial development. This review synthesizes the latest research on the impact of unilateral hearing loss in childhood and the role for possible interventions. The summarized information may serve to support the development of new guidelines for the evaluation and treatment of children with unilateral hearing loss.

Wastewater System Inflow/Infiltration and Residential Pluvial Flood Damage Mitigation in Canada

Pluvial flooding in urban areas is one of the most significant drivers of disaster loss in Canada. Damages during pluvial flood events are associated with overwhelmed urban drainage (stormwater and wastewater) systems. During the period from 2013 to 2021, Canadian property and casualty insurers reported approximately CAD 2 billion in personal property (residential) pluvial sewer backup claims during flood catastrophes. There has been growing interest in managing pluvial urban flood risk, notably through newly funded national programs focused on climate change adaptation. These programs have included the development of new guidelines and standards focused on managing the underlying factors contributing to urban and basement flooding. Inflow and infiltration (I/I) has received limited attention in the pluvial flood literature, however. Informed by significant engagement with practitioners in Canada, this paper provides a review of the issue of I/I into wastewater systems and its relation to pluvial flooding. The paper will address concerns related to private property engagement in I/I and urban pluvial flood reduction programs. Both improved technical standards and administrative support are needed to ensure that wastewater infrastructure is less susceptible to I/I over its lifecycle.

Guidelines for therapeutic interchange—2022

AbstractThe American College of Clinical Pharmacy (ACCP) Board of Regents charged the 2020 to 2021 Publications Committee to review and revise the 2004 ACCP guideline statement on therapeutic interchange. The committee reviewed previous guidelines and relevant published literature. After development of new guidelines, the committee and Board of Regents voted in support of the updated guideline. The ACCP reaffirms its support of therapeutic interchange. Additional recommendations for appropriate implementation and practice of therapeutic interchange are provided. Therapeutic interchange is an important tool in optimizing patient care, improving access to care, and reducing the cost of medications.

ОСОБЛИВОСТІ ІНТЕРПРЕТАЦІЇ ГЕНДЕРНИХ СТЕРЕОТИПІВ БАЛЕТМЕЙСТЕРАМИ В ТЕМАТИЦІ СУЧАСНИХ ХОРЕОГРАФІЧНИХ ТВОРІВ

Gender relations of young people are an urgent problem of modern society and subject to certain stereotypes. The 21st century is changing stereotypes that have governed gender relations in the society of men and women for many centuries (where historically gender differences have prevailed over individual, qualitative differences in the personality of men and women). The article considers the peculiarities of gender stereotypes of modern Ukrainian and Western European society and analyzes the choreographic works of modern choreographers, which embody different models of gender relations between men and women. The patriarchal, feminist and eclectic models of gender relations of modern youth and the concepts of culturologists and art critics regarding male (masculinity) and female (femininity) manifestations in contemporary choreographic works of Western European choreographers are analyzed. To reveal the influence of gender stereotypes of modern society on the subject of choreographic works of Western European choreographers of the XX-XXI centuries. P. Bausch, M. Graham, A. Duncan, M. Cunningham, M. Morris, A. Preljokazha. To show gender patriarchal stereotypes, which were dominated by the male power over women, which for many centuries were the norm in society and hindered the development of personal individuality, contradict the transformations of gender relations in modern Ukrainian and Western European society. The formation of models of healthy and equal gender stereotypes in modern youth is an important aspect of the development of civilized society. In modern research, gender stereotypes in contemporary choreographic works are almost entirely based on male experience, and historical research in general contains certain patriarchal echoes. The prospect of further research by scientists may be the development of new guidelines for the education of future choreographers on the principles of tolerance, gender interaction, and equal, healthy partnerships.

Future steps in cardio-oncology—a national multidisciplinary survey among healthcare professionals in the Netherlands

BackgroundThe awareness of cancer therapy–related adverse cardiac effects is fueled by recent literature on cardiotoxicity incidence and detection strategies. Although this influences the sense of urgency, in current practice, cardiotoxicity monitoring and treatment is not structurally performed. With this study, we aimed to evaluate current perspectives on cardio-oncology and to assess needs, ultimately to determine an agenda for improvements in current practice.Material and methodsA national multidisciplinary 36-question survey was conducted. The survey was developed by a multidisciplinary team, theoretically based on an implementation checklist and distributed by email, through cardiology and oncology societies as well as social media.ResultsOne hundred ninety professionals completed the survey, of which 66 were cardiologists, 66 radiation oncologists, and 58 medical oncologists and hematologists. Many professionals were unaware of their specialisms’ cardio-oncology guidelines: 62.1% of cardiologists and 29.3% of the hematologists and medical oncologists respectively. Many cardiologists (N = 46; 69.7%), radiation oncologists (N = 45; 68.2%), and hematologists and medical oncologists (N = 38; 65.5%) expressed that they did not have sufficient knowledge to treat cardio-oncology patients and would either refer a patient or aspire to gain more knowledge on the topic.ConclusionThe field of cardio-oncology is advancing rapidly, with progress in stratification and detection strategies leading to the development of new guidelines and consensus statements. However, the application of these guidelines in current practice appears to be lagging. Professionals express a need for additional training and a practical guideline including risk stratification, monitoring, and treatment strategies. Multidisciplinary discussion and consensus on cardio-oncology care is vital to improve implementation of cardio-oncology guidelines, ultimately to improve cardiac care for oncology patients.

Effect of bupivacaine liposome suspension administered as a cornual nerve block on indicators of pain and distress during and after cautery dehorning in dairy calves

Dehorning is performed on a high percentage of dairies worldwide. Concern about the negative effect of dehorning on animal welfare has contributed to the development of new guidelines that require the use of pain management at the time of disbudding in the United States. However, livestock producers are limited in how to address this requirement due to a lack of (1) approved analgesic drugs, (2) analgesic options that control pain for an extended duration, and (3) analgesic formulations that are practical for producers to administer. The objective of this study was to evaluate the effectiveness of bupivacaine liposome suspension, a novel, long-acting, local anesthetic formulation administered as a nerve block at dehorning, compared with current industry standard analgesic approaches using lidocaine nerve blocks alone or in combination with the nonsteroidal anti-inflammatory drug meloxicam. Fifty male Holstein calves, 10 to 14 wk of age, were enrolled and randomly assigned to 1 of 5 treatment groups before cautery dehorning as follows: (1) bupivacaine liposome suspension block, oral placebo (BUP); (2) lidocaine block, oral placebo (LID); (3) lidocaine block, oral meloxicam (1 mg/kg of body weight; LID + MEL); (4) saline block, oral placebo (CON); and (5) saline block, oral placebo, sham dehorn (SHAM). Biomarkers were collected from 0 to 120 h postdehorning and included infrared thermography, mechanical nociceptive threshold (MNT), pressure mat gait analysis, chute defense and behavior scoring, and blood sampling for serum cortisol and prostaglandin E2 metabolites. Responses were analyzed using repeated measures with calf nested in treatment designated as a random effect, and treatment, time, and their interaction designated as fixed effects. At 2 h postdehorning, the BUP group had a higher MNT compared with the CON group. Furthermore, at 24 h postdehorning, the BUP group had a higher MNT compared with the LID group. Gait distance differed significantly between treatment groups; the CON, LID, and LID + MEL groups had an increased gait distance relative to the SHAM group. The CON group exhibited a higher chute defense behavior score during the dehorning procedure compared with all other treatments. Furthermore, the CON group exhibited more ear flicks than the BUP and LID + MEL groups postdehorning. At 4 h and 24 h after dehorning, the LID + MEL group had a lower average prostaglandin E2 metabolites concentration compared with all other treatment groups. These data showed that administration of bupivacaine liposome suspension as a cornual nerve block at the time of dehorning was as effective at controlling pain as a multimodal approach of lidocaine and meloxicam.

Dispatcher-Assisted Cardiopulmonary Resuscitation — Influence on Return of Spontaneous Circulation and Short-Term Survival

The Aim: analysis of the influence of dispatcher assistance during cardiopulmonary resuscitation (CPR) of patients with out-of-hospital cardiac arrest (OHCA) in achieving return of spontaneous circulation (ROSC), better survival at the scene, survival to discharge, and 30-day survival.Materials and methods. This study includes epidemiological data on OHCA collected by the study protocol of the European Resuscitation Council's EuReCa_ONE study during the period October 1, 2014 — December 31, 2019. Statistical analysis was performed using SPSS Statistics v26 and GraphPad Prism v8 software packages.Results. This study included 288 patients with OHCA where CPR was provided by bystander. Dispatcher-assisted CPR (DA-CPR) occurred in 56.9% of those patients and ROSC was achieved in 31.3% of cases. Forty-four patients were hospitalized and 16 of those survived until discharge. There was no influence of dispatcher assistance on ROSC, although it resulted in slightly greater risk of the absence of ROSC (OR=1.063). Higher mortality rate to discharge occurred in DA-CPR group (P=0.013). No statistical significance was observed between DA-CPR and non-DA-CPR groups in terms of death at the scene, and 30-day survival. Dispatcher assistance during the initial CPR in hospitalized OHCA patients was a significant predictor of death outcome during hospitalization (P=0.017, OR=5.500).Conclusions. There is no significant association between the presence/absence of dispatcher assistance and ROSC or 30-day survival rate. In contrast, DA-CPR was non-significantly associated with slightly higher odds for the absence of ROSC. DA-CPR was also associated with lower survival-to-discharge rates in hospitalized OHCA patients. The study findings are the base/ground which highlights the need of implementation of existing and development of new guidelines regarding high-quality professional training of EMS dispatchers as well as basic life support education of general population.

COVID-19 and the cardiovascular system: insights into effects and treatments.

Coronavirus disease 2019 (COVID-19), an acute and highly transmissible infectious disease, has reached a pandemic level since 11 March 2020 and continues to challenge the healthcare system worldwide. The pathogenesis of COVID-19 is a complex process involving mechanisms that suppress the host antiviral and innate immune response, while triggering marked activation of coagulation and hyperinflammation leading to cytokine storm in severe COVID-19. This review summarizes current evidence related to COVID-19-associated cardiovascular severe illness and mortality, which encompasses life-threatening clinical manifestations, including myocardial injury, fulminant myocarditis, cardiac arrhythmia, and ischemic stroke. The onset of hypercoagulable state is consistent with increased venous thromboembolism including deep vein thrombosis and pulmonary embolism. Thromboembolic manifestations include arterial thrombotic events such as stroke, myocardial infarction, and limb ischemia. Several treatment strategies have been investigated to mitigate COVID-19-associated cardiovascular clinical manifestations. The prevalence of thrombo-inflammatory syndrome and subsequent cardiovascular dysfunction prompted the implementation of antithrombotic therapy and strategies targeting major pro-inflammatory cytokines involved in COVID-19 cytokine storm. The development of new guidelines for effective treatment strategies requires concerted efforts to refine our understanding of the mechanisms underlying cardiovascular disease and large-scale clinical trials to reduce the burden of COVID-19 hospitalization and mortality.

Clinician attitude towards safety in medication management: a participatory action research study in an emergency department

ObjectivesEdication management is a process in which medications are selected, procured, delivered, prescribed, reviewed, administered and monitored to assure high-quality patient care and safety. This paper explores clinicians’ attitudes towards...