Evidence-based Selection Research Articles

Developing institution-specific admission competency criteria for prospective health sciences students

BackgroundGiven the critical role of health professionals in societal health, the development of robust and effective selection methods is of fundamental concern for educational institutions within the field of health sciences education. Conventionally, admission competencies have been determined by institutional authorities. Developing institution-specific competency criteria enables an admission process that is mission- and value-aware, evidence-based, and strategically adaptable. However, few schools have established their admission competency criteria, although the majority possess their own models of graduation competencies. This study reports the process of developing and validating an institution-specific admission competency model that addresses the need for evidence-based and mission-aligned selection processes that are distinct from standardized models.MethodsThis study was conducted in two phases, using both qualitative and quantitative analyses. Phase I involved constructing an admission competency model through a qualitative approach facilitated by workshops with 17 faculty members and 92 first-year pre-doctoral students of a dental school. Through constant comparative analysis, this phase focused on the extraction and refinement of competencies for entering dental students. In Phase II, a questionnaire developed from the workshops asked respondents to rate the importance of 47 attributes across 10 constructs on a 5-point Likert scale. A total of 301 individuals participated in the survey. Exploratory Factor Analysis (EFA) identified the factor structure, and Confirmatory Factor Analysis (CFA) examined construct validity and assessed the model fit with the data.ResultsThe EFA of the 47 attributes identified 10 factors, and the CFA results indicated a good-to-acceptable level of fit for the ten-factor model. Aligned with the American Association of Medical Colleges Premed competencies, this study identified unique attributes specific to the institution, such as confidence, leadership, and entrepreneurship. These findings highlight the importance of developing tailored competencies reflecting the unique needs of institutions and their fields.ConclusionsThis study demonstrates the feasibility and value of creating institution-specific admission competency models, offering a methodology that aligns with evidence-based mission-driven selection processes. The distinct competencies identified emphasize the need for educational institutions to consider unique institutional and field-specific requirements and move beyond standardized models to enhance the selection of medical students.

Green roof runoff reduction of 84 rain events: Comparing Sedum, life strategy-based vegetation, unvegetated and conventional roofs

Green roofs have emerged as effective stormwater management systems, but understanding the contribution of their various components to hydrological performance is crucial for optimizing their design and implementation. More empirically measured data on the hydrological function of green roof vegetation is needed, especially under realistic low-maintenance, non-irrigated scenarios. Further, targeted, evidence-based plant selection based on ecological theories may improve green roof hydrological performance. Previous research has suggested that, in contrast to monocultures, mixtures of species with complementary traits could optimize provisioning of various ecosystem services. Thus, species mixtures based on their adaptive life strategy using the CSR theory (Competitor, Stress tolerator, and Ruderal) were hypothesized to have better hydrological performance than a Sedum monoculture or bare substrate under natural conditions over multiple seasons. To test this hypothesis, the runoff from thirty 2 m2 green roof modules was measured. The retention and detention performance of different green roof treatments were evaluated for 84 precipitation events of varying rain depth and intensity during snow-free periods. Differences in retention as well as detention between the vegetation treatments varied, but generally increased with increasing rain event volume and the Stress-tolerant treatment generally performed better than bare substrate. On a mean event basis, the mixture of stress-tolerator species demonstrated a 74 % retention rate, while the Bare substrate retained 72 % of the rainfalls. Overall, the green roofs, including bare substrate and vegetated treatments, effectively retained >50 % of the cumulative precipitation depth. In line with previous studies, the Sedum monoculture generally showed worse hydrological performance than other non-succulent vegetation mixtures, despite its relatively high cover and survival. The vegetated treatment with the highest species richness and diversity in life strategies (Mix) did not provide the best vegetation cover, or hydrological performance. Instead, the Stress-tolerant treatment, characterized by the high survival rate of a single graminoid species, consistently demonstrated superior event-based stormwater retention and peak attenuation capabilities.

Modified Balloon Use After Rotational Atherectomy Reduces Major Adverse Cardiovascular Event Rates in Severely Calcified Coronary Lesions: A Systematic Review and Meta-Analysis.

Background/Objectives: Calcified coronary lesions require plaque modification techniques for optimal stent apposition, of which rotational atherectomy (RA) is the most commonly used one. Challenging cases require the use of additional dedicated devices (such as modified balloons, MB); however, data available for evidence-based device selection are limited. The aim of this study is to determine the impact of the balloon-based technology used after successful RA treatment on outcomes. Methods: This study was carried out according to the PRISMA guidelines. MEDLINE, CENTRAL and Embase databases were systematically searched for eligible randomized and non-randomized studies. Results: A total of nine studies and 1024 patients were included in the analysis. Patients were treated with RA followed by either plain balloon angioplasty (RA + BA) or modified balloon (RA + MB) treatment prior to stent implantation. There was no significant difference in MACE (major adverse cardiovascular events; OR: 0.53; 95% CI: 0.21-1.34; p = 0.153), all-cause mortality (OR: 0.68; 95% CI: 0.33-1.42; p = 0.265), and target lesion revascularization (OR: 0.64; 95% CI: 0.27-1.55; p = 0.264) between the two groups. However, a sensitivity analysis demonstrated a significant decrease in MACE for patients with severely calcified lesions (OR: 0.42; 95% CI: 0.25-0.70; p = 0.009) in the RA + MB group. The analyses of the safety outcomes of slow flow/no reflow (OR: 0.59; 95% CI: 0.29-1.22; p = 0.128) and coronary artery perforation (OR: 1.18; 95% CI: 0.70-1.99; p = 0.480) showed no difference between the two groups. Conclusions: Our meta-analysis suggests that the benefit of the more invasive RA + MB treatment is statistically significant for severely calcified lesions, but is not associated with additional procedural complications.

Comparative Safety Profiles and Usage Patterns of Iodinated Contrast Media in Medical Imaging.

This study aimed to analyze the usage patterns and hypersensitivity reaction (HSR) profiles of six nonionic iodinated contrast media (ICMs) used in computed tomography (CT) to enhance patient safety and inform evidence-based contrast agent selection. We retrospectively reviewed 248,209 CT scans obtained between January 2020 and December 2022. Six ICMs (iomeprol, iohexol, ioversol, iopromide, iodixanol, and iobitridol) were compared on the basis of their usage rates, HSR incidence, and severity. This study also evaluated the impact of premedication protocol reinforcement and assessed the quarterly HSR rates. Among the 248,209 CT scans, 1603 (0.65%) were associated with HSRs. Most HSRs were mild (86.2%), with moderate (10.9%) and severe (2.9%) reactions being less common. Four ICMs were used as first-line agents and two ICMs were used as second-line agents. The second-line agents, iobitridol and iodixanol, exhibited 7-8 times higher HSR rates compared to the first-line agents. A modified premedication protocol implemented in mid-2022 significantly reduced the incidence of moderate HSRs (p = 0.0075). The quarterly analysis indicated a trend in higher HSR rates in the first quarter and a statistically significant increase in severe HSRs in the third quarter (p = 0.033). These findings highlight the importance of tailored premedication protocols and a 7-8 times higher rate of HSR with second-line agents in contrast-enhanced imaging. Future research should focus on elucidating the mechanisms underlying these variations to further refine contrast agent selection and management strategies.

Gender differences in operational and cognitive abilities.

Gender differences in cognitive and operational abilities have been identified. Yet, their interrelationship remains underexplored. This prevents tailored evidence-based selection, allowing discrimination to persist. Data from a test battery of operational and cognitive tests was analyzed. In total 2,743 aviation pilot candidates' test scores were analyzed. Males had a significantly higher score on mental spatial ability, memory retention, abstract problem solving, multitasking ability (MU), and manual spatial ability (MSA); and females on perceptual speed. Correlations between MU and MSA [difference = 0.269 (95% CI: 0.114; 0.405)] and between MSA and perceptual speed [difference = 0.186 (95% CI: 0.027; 0.332)] were significantly stronger among female applicants. A high MSA score was more predictive of a high score on MU, Perceptual speed, and Memory for female compared with male applicants (p < 0.002 for the MSA score × sex interaction effect in all three cases). Interpretation of test scores in between genders potentially may need to look different for final selection decisions for operational professions, as female test profiles were shown to exhibit greater homogeneity.

Model-based meta-analysis of HbA1c reduction across SGLT2 inhibitors using dose adjusted by urinary glucose excretion

This study was aimed to evaluate whether the dose–response relationship of the sodium glucose co-transporter-2 inhibitors (SGLT2is) in patients with type 2 diabetes mellitus (T2DM)—canagliflozin, dapagliflozin, empagliflozin, ipragliflozin, luseogliflozin, and tofogliflozin—can be explained in a unified manner based on their ability to promote urinary glucose excretion (UGE). Information on HbA1c reduction at various doses of each SGLT2i was collected from literatures on randomized controlled trials and was normalized based on the daily UGE data from phase I studies. After normalizing doses, the dose–response relationship of HbA1c reduction of most of SGLT2is was represented by a unified nonlinear mixed-effect model, with the estimated maximum HbA1c (%) reduction (Emax) of 0.796 points, whereas covariate analysis showed that canagliflozin had a 1.33-fold higher Emax than those of the other drugs. Other covariates included baseline HbA1c levels, body weight, disease duration, prior treatment, and renal function. Findings from this study would influence drug selection and adjustment in clinical practice. As with SGLT2is, in cases where the efficacy cannot be easily evaluated but an appropriate pharmacodynamic marker was assessed in early clinical trials, similar approaches for other drug classes can guide strategic and evidence-based dose selection in phase III trials.

Extracorporeal membrane oxygenation as a bridge to lung transplantation: 5-year outcomes and bridge to decision in a large, older cohort

BackgroundExtracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (BTT) has expanded considerably, though evidence-based selection criteria and long-term outcome data are lacking. The purpose of this study was to evaluate whether risk factors often used to exclude patients from ECMO BTT—specifically older age and not yet being listed for transplant—are validated by long-term outcomes.MethodsTo ensure minimum 5-year follow-up, a retrospective cohort study was performed of adult patients actively listed for lung transplantation at a high-volume center and bridged on ECMO between January 2012 and December 2017. Data was collected through January 1, 2023.ResultsAmong 50 patients bridged on ECMO, 25 survived to transplant. Median age at listing was 58 (interquartile range [IQR], 42–65) in the transplanted group and 65 (IQR, 56.5–69) in the deceased group (P = 0.051). One-year, 3-year, and 5-year survival were 88% (22/25), 60% (15/25), and 44% (11/25), respectively, with eight patients still living at the time of review. Median time spent at home during the year post-transplant was 340 days (IQR, 314–355). Older age at listing was a negative predictor of survival on ECMO to transplant (odds ratio 0.92 [95% confidence interval, 0.86–0.99], P = 0.01). Thirteen patients were placed on ECMO prior to being listed and three were listed the same day as ECMO cannulation, with 10/16 transplanted. No significant difference in post-transplant survival was found between patients placed on ECMO prior to listing (n = 10) and those already listed (n = 15) (P = 0.93, log-rank). Serial post-transplant spirometry up to 5 years and surveillance transbronchial biopsy demonstrated good allograft function and low rates of cellular rejection.ConclusionsIn one of the oldest cohorts of ECMO BTT patients described, favorable survival outcomes and allograft function were observed up to 5 years irrespective of whether patients were previously listed or bridged to decision. Despite inherent limitations to this retrospective, single-center study, the data presented support the feasibility of ECMO BTT in older and not previously listed advanced lung disease patients.

An integrated GIS-MCDM framework for zoning, ranking and sensitivity analysis of municipal landfill sites

ABSTRACT This study introduces a comprehensive Geographic Information System – Multi Criteria Decision-Making (GIS-MCDM) framework to identify and evaluate potential municipal landfill sites in Nashik, India. The approach integrates topographic, geomorphological, environmental, and infrastructure criteria to create thematic raster layers representing suitability for landfill development. Criteria include ground slope, elevation, land use, proximity to water bodies, land value, and infrastructure proximity. The Analytical Hierarchy Process (AHP) was employed to determine the relative weights of these criteria, facilitating the computation of the Landfill Suitability Index (LSI) and the creation of a suitability map. The analysis classified the 480 sq. km study area into five categories, with 6.79% of the area deemed “Very High” suitability. The TOPSIS method ranked 16 potential sites within high-suitability regions, identifying L10 near Adagaon as the most optimal site. Sensitivity analysis confirmed the stability of site rankings under various weight adjustments, providing robust tool for evidence-based landfill site selection.

Insights into undergraduate medical student selection tools: a systematic review and meta-analysis

Evaluating medical school selection tools is vital for evidence-based student selection. With previous reviews revealing knowledge gaps, this meta-analysis offers insights into the effectiveness of these selection tools. A systematic review and meta-analysis were conducted applying the following criteria: peer-reviewed articles available in English, published from 2010 and which include empirical data linking performance in selection tools with assessment and dropout outcomes of undergraduate entry medical programs. Systematic reviews, meta-analyses, general opinion pieces, or commentaries were excluded. Effect sizes (ESs) of the predictability of academic and clinical performance within and by the end of the medicine program were extracted, and the pooled ESs were presented. Sixty-seven out of 2,212 articles were included, which yielded 236 ESs. Previous academic achievement predicted medical program academic performance (Cohen’s d=0.697 in early program; 0.619 in end of program) and clinical exams (0.545 in end of program). Overall aptitude tests predicted academic achievement in both the early and last years (0.550 & 0.371, respectively). Within aptitude tests, verbal reasoning and quantitative reasoning best predicted academic achievement in the early program (0.704 & 0.643, respectively). Neither panel interviews, multiple mini-interviews, nor situational judgement tests (SJT) yielded statistically significant pooled ES. Current evidence suggests that learning outcomes are predicted by previous academic achievement and aptitude tests. The predictive value of SJT and topics such as selection algorithms, features of interview (e.g., content of the questions) and the way the interviewers’ reports are used, warrant further research.

Measuring Temporal Trends and Patterns of Inpatient Antibiotic Use in Northwest China's Hospitals: Data from the Center for Antibacterial Surveillance, 2012-2022.

The challenge of emerging antimicrobial resistance and variation in antibiotic use across provinces in China call for knowledge on antibiotic utilization at the regional level. This study aims to evaluate the long-term trends and patterns of antibiotic usage in Xinjiang Province, the largest provincial-level division located in the northwest of China, aiming to provide evidence in enhancing provincial antimicrobial stewardship (AMS) and developing policy measures to optimize regional antimicrobial use. This was an ecological study with temporal trend analysis on inpatient antibiotic utilization, with antibiotic use data from 92 public hospitals covered by Xinjiang's Center for Antibacterial Surveillance from 2012 to 2022. Antibiotic use was measured by the number of daily defined doses per 100 patient days (DDDs/100 pds). Patterns of antibiotic use were described by Anatomical Therapeutic Chemical (ATC) subgroups and the Access, Watch, Reserve (AWaRe) classification. The Average Annual Percent Change (AAPC) of antibiotic use and the corresponding 95% confidence intervals (CIs) were calculated to describe the trend of antibiotic use over time. Joinpoint regression was performed using the Weighted Bayesian Information Criteria (WBIC) model with a parametric method. A pairwise comparison between secondary and tertiary hospitals was conducted to explore disparities in antibiotic use across hospital levels. The most commonly used antibiotics were also analyzed. The total inpatient antibiotic use in Xinjiang was 27.6 DDDs/100 patient days in 2022, with a significant decreasing trend during 2012-2022 (AAPC, -2.0%; 95% CI, -3.6% to -0.4%). The Watch group antibiotics were the most used AWaRe category, with the Access-to-Watch ratio decreasing significantly from 46.4% to 24.4% (AAPC, -6.8%; 95% CI, -8.4% to -5.1%). No significant difference was found in the trend of total antibiotic use between secondary and tertiary hospitals, but there were disparities across hospital levels in subgroups. Third-generation cephalosporins, second-generation cephalosporins, and fluoroquinolones remained the top three antibiotic class throughout the study period. The number of antibiotics accounting for 90% of the total antibiotic use decreased from 34 antibiotics in 2012 to 18 antibiotics in 2022. The decreasing trend of inpatient antibiotic use in Xinjiang's public hospitals reflects the effects of continuous AMS implementation. Patterns of antibiotic use underscore the need for further efforts on evidence-based antibiotic selection and for analyses on the appropriateness of antibiotic use.

Leveraging local knowledge to contextualize the opioid epidemic within HEALing Communities Study communities: A Photovoice protocol

Since its inception 30 years ago, Photovoice has gained increasing popularity as a research method and more recently has been incorporated within randomized controlled trial (RCT) designs. Photovoice is a participatory action research method that pairs photography with focus group discussions to record community strengths and concerns, build critical consciousness, and reach policymakers. Adherence of Photovoice implementation to these original tenets of Photovoice varies. This article provides the Photovoice protocol developed by the authors to improve the methodological rigor of Photovoice integration into RCTs and help contextualize the landscape for the HEALing Communities Study (HCS: NCT04111939), a greater than $350 million investment by the National Institute on Drug Abuse along with the Substance Abuse and Mental Health Services Administration to reduce opioid overdose deaths in 67 of the hardest-hit communities in four states (Kentucky, Massachusetts, New York, and Ohio). The product of a cross-state collaboration, this HCS Photovoice protocol provides ethical and methodological tools for incorporating Photovoice into RCT designs to enhance community engagement, communication campaigns, and data-driven decision-making about evidence-based practice selection and implementation.

Identification of genetic markers of resistance to macrolide class antibiotics in Mannheimia haemolytica isolates from a Saskatchewan feedlot.

Mannheimia haemolytica is a major contributor to bovine respiratory disease (BRD), which causes substantial economic losses to the beef industry, and there is an urgent need for rapid and accurate diagnostic tests to provide evidence for treatment decisions and support antimicrobial stewardship. Diagnostic sequencing can provide information about antimicrobial resistance genes in M. haemolytica more rapidly than conventional diagnostics. Realizing the full potential of diagnostic sequencing requires a comprehensive understanding of the genetic markers of antimicrobial resistance. We identified genetic markers of resistance in M. haemolytica to macrolide class antibiotics commonly used for control of BRD. Genome sequences were determined for 99 M. haemolytica isolates with six different susceptibility phenotypes collected over 2 years from a feedlot in Saskatchewan, Canada. Known macrolide resistance genes estT, msr(E), and mph(E) were identified in most resistant isolates within predicted integrative and conjugative elements (ICEs). ICE sequences lacking antibiotic resistance genes were detected in 10 of 47 susceptible isolates. No resistance-associated polymorphisms were detected in ribosomal RNA genes, although previously unreported mutations in the L22 and L23 ribosomal proteins were identified in 12 and 27 resistant isolates, respectively. Pangenome analysis led to the identification of 79 genes associated with resistance to gamithromycin, of which 95% (75 of 79) had no functional annotation. Most of the observed phenotypic resistance was explained by previously identified antibiotic resistance genes, although resistance to the macrolides gamithromycin and tulathromycin was not explained in 39 of 47 isolates, demonstrating the need for continued surveillance for novel determinants of macrolide resistance.IMPORTANCEBovine respiratory disease is the costliest disease of beef cattle in North America and the most common reason for injectable antibiotic use in beef cattle. Metagenomic sequencing offers the potential to make economically significant reductions in turnaround time for diagnostic information for evidence-based selection of antibiotics for use in the feedlot. The success of diagnostic sequencing depends on a comprehensive catalog of antimicrobial resistance genes and other genome features associated with reduced susceptibility. We analyzed the genome sequences of isolates of Mannheimia haemolytica, a major bovine respiratory disease pathogen, and identified both previously known and novel genes associated with reduced susceptibility to macrolide class antimicrobials. These findings reinforce the need for ongoing surveillance for markers of antimicrobial resistance to support improved diagnostics and antimicrobial stewardship.

Efflux transporters in drug disposition during pregnancy.

Evidence-based dose selection of drugs in pregnant women has been lacking due to challenges in studying maternal-fetal pharmacokinetics. Hence, many drugs are administered off-label during pregnancy based on data obtained from non-pregnant women. During pregnancy, drug transporters play an important role in drug disposition along with known gestational age-dependent changes in physiology and drug-metabolizing enzymes. In this review, as Dr. Qingcheng Mao's former and current lab members, we summarize the collective contributions of Dr. Mao, who lost his life to cancer, focusing on the role of drug transporters in drug disposition during pregnancy. Dr. Mao and his team initiated their research by characterizing the structure of Breast Cancer Resistance Protein [BCRP, ATP-Binding Cassette (ABC) G2]. Subsequently, they have made significant contributions to the understanding of the role of BCRP and other transporters, particularly P-glycoprotein (P-gp/ABCB1), in the exposure of pregnant women and their fetuses to various drugs, including nitrofurantoin, glyburide, buprenorphine, bupropion, tetrahydrocannabinol, and their metabolites. This review also highlights the gestation- and pregnancy-dependent transporter expression at the blood-brain and blood-placenta barriers in mice. Significance Statement Dr. Qingcheng Mao and his team have made significant contributions to the investigation of the role of efflux transporters, especially P-glycoprotein and breast cancer resistance protein, in maternal-fetal exposure to many xenobiotics: nitrofurantoin, glyburide, buprenorphine, bupropion, tetrahydrocannabinol and their metabolites. Studies of individual compounds and the expression of transporters during gestation and pregnancy have improved the understanding of maternal-fetal pharmacokinetics.

Core outcome Set for Cardio-oncology (COS-CO): development of a set of outcomes for the cardiovascular assessment and monitoring of cancer patients and survivors.

There is an increasing awareness of the evidence-based selection of outcomes to be measured in clinical trials and clinical practice. Currently, there is no core outcome set (COS) for cardio-oncology, which may hinder the (inter)national comparison of the effectiveness of research and the quality of cardio-oncology care. The aim of this study is to develop a standard and pragmatic patient-centred outcome set to assess and monitor cancer patients and survivors at risk of or with cardiovascular diseases. A list of outcome domains was generated through a review of registries and guidelines, and six patient interviews. The project team reviewed and refined the outcome domains prior to starting a two-round Delphi procedure conducted between January-June 2022. The panellists, including healthcare providers and researchers, were invited to rate the importance of the outcomes. 26 experts from 11 countries rated a list of 93 outcomes (round 1) and 63 outcomes (round 2) to gain consensus on a list of outcome measures, and of demographic factors, health status and treatment variables. The final COS includes 15 outcome measures, reflecting four core areas: life impact (n=2), pathophysiological manifestations (n=9), resource use/economic impact (n=1), and mortality/survival (n=3). Next, six demographic factors, 21 health status, three cardiovascular and nine cancer variables were included. This is the first international development of a COS for cardio-oncology. This set aims to facilitate (inter)national comparison in cardio-oncology care, using standardised parameters and meaningful patient-centred outcomes for research and quality of care assessments.

Risk factors for antimicrobial use in Dutch pig farms: A cross-sectional study

BackgroundAntimicrobial use (AMU) has decreased significantly in Dutch pig farms since 2009. However, this decrease has stagnated recently, with relatively high AMU levels persisting mainly among weaners. The aim of this study was to identify farm-level characteristics associated with: i) total AMU and ii) use of specific antimicrobial classes. MethodsIn 2020, cross-sectional data from 154 Dutch pig farms were collected, including information on AMU and farm characteristics. A mixed-effects conditional Random Forest analysis was applied to select the subset of features that was best associated with AMU. ResultsThe main risk factors for total AMU in weaners were vaccination for PRRS in sucklings, being a conventional farm (vs. not), high within-farm density, and early weaning. The main protective factors for total AMU in sows/sucklings were E. coli vaccination in sows and having boars for estrus detection from own production. Regarding antimicrobial class-specific outcomes, several risk factors overlapped for weaners and sows/sucklings, such as farmer's non-tertiary education, not having free-sow systems during lactation, and conventional farming. An additional risk factor for weaners was having fully slatted floors. For fatteners, the main risk factor for total AMU was PRRS vaccination in sucklings. ConclusionsSeveral factors found here to be associated with AMU. Some were known but others were novel, such as farmer's tertiary education, low pig aggression and free-sow systems which were all associated with lower AMU. These factors provide targets for developing tailor-made interventions, as well as an evidence-based selection of features for further causal assessment and mediation analysis.

A Community Needs Assessment and Implementation Planning for a Community Exercise Program for Survivors of Stroke: Protocol for a Pilot Hybrid Type I Clinical Effectiveness and Implementation Study.

Physical activity and exercise are important aspects of maintaining health. People with mobility impairments, including survivors of stroke, are less likely to exercise and at greater risk of developing or worsening chronic health conditions. Increasing accessible, desired options for exercise may address the gap in available physical activity programs, provide an opportunity for continued services after rehabilitation, and cultivate social connections for people after stroke and others with mobility impairments. Existing evidence-based community programs for people after stroke target cardiovascular endurance, mobility, walking ability, balance, and education. While much is known about the effectiveness of these programs, it is important to understand the local environment as implementation and sustainment strategies are context-specific. This study protocol aims to evaluate community needs and resources for exercise for adults living with mobility impairments with initial emphasis on survivors of stroke in Richland County, South Carolina. Results will inform a hybrid type I effectiveness and implementation pilot of an evidence-based group exercise program for survivors of stroke. The exploration and preparation phases of the EPIS (Exploration, Preparation, Implementation, and Sustainment) implementation model guide the study. A community needs assessment will evaluate the needs and desires of survivors of stroke through qualitative semistructured interviews with survivors of stroke, rehabilitation professionals, and fitness trainers serving people with mobility impairments. Additional data will be collected from survivors of stroke through a survey. Fitness center sites will be assessed through interviews and the Accessibility Instrument Measuring Fitness and Recreation Environments inventory. Qualitative data will be evaluated using content analysis and supported by mean survey results. Data will be categorized by the community (outer context), potential participants (outer context), and fitness center (inner context) and evaluate needs, resources, barriers, and facilitators. Results will inform evidence-based exercise program selection, adaptations, and specific local implementation strategies to influence success. Pilot outcome measures for participants (clinical effectiveness), process, and program delivery levels will be identified. An implementation logic model for interventions will be created to reflect the design elements for the pilot and their complex interactions. The study was reviewed by the institutional review board and exempt approved on December 19, 2023. The study data collection began in January 2024 and is projected to be completed in June 2024. A total of 17 participants have been interviewed as of manuscript submission. Results are expected to be published in early 2025. Performing a needs assessment before implementing it in the community allows for early identification of complex relationships and preplanning to address problems that cannot be anticipated in controlled effectiveness research. Evaluation and preparation prior to implementation of a community exercise program enhance the potential to be successful, valued, and sustained in the community. DERR1-10.2196/55432.

Molecular Frontiers in Melanoma: Pathogenesis, Diagnosis, and Therapeutic Advances.

Melanoma, a highly aggressive skin cancer, is characterized by rapid progression and high mortality. Recent advances in molecular pathogenesis have shed light on genetic and epigenetic changes that drive melanoma development. This review provides an overview of these developments, focusing on molecular mechanisms in melanoma genesis. It highlights how mutations, particularly in the BRAF, NRAS, c-KIT, and GNAQ/GNA11 genes, affect critical signaling pathways. The evolution of diagnostic techniques, such as genomics, transcriptomics, liquid biopsies, and molecular biomarkers for early detection and prognosis, is also discussed. The therapeutic landscape has transformed with targeted therapies and immunotherapies, improving patient outcomes. This paper examines the efficacy, challenges, and prospects of these treatments, including recent clinical trials and emerging strategies. The potential of novel treatment strategies, including neoantigen vaccines, adoptive cell transfer, microbiome interactions, and nanoparticle-based combination therapy, is explored. These advances emphasize the challenges of therapy resistance and the importance of personalized medicine. This review underlines the necessity for evidence-based therapy selection in managing the increasing global incidence of melanoma.

A Brief Review on Essential Medicine

The World Health Organization (WHO) initially released its list in 1977, marking the beginning of the Essential Medicine Concept, a significant advancement in medical treatment. One of the most cost-effective aspects of modern healthcare is the appropriate use of vital medications. From expert judgement to evidence-based selection, the selection process has developed. In 1996, the first Indian list was published. Particularly in the public sector and in low- and lower middle-income countries, Essential Medicine Policies (EMLs) have had an impact on the provision of medications and led to a higher availability of essential vs non-essential medicines. Even yet, fair access is not guaranteed by the accessibility of necessary medications, particularly in the public sector.

A Data Mining Study for Analysis of Acupoint Selection and Combinations in Acupuncture Treatment of Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is the most prevalent upper limb compressive neuropathy. A considerable number of clinical trials and meta-analyses have provided evidence supporting the effectiveness of acupuncture in treating CTS. Nevertheless, the ideal choice of acupoints remains ambiguous. A data mining analysis was conducted with the objective of determining the most effective acupoint combinations and selection for CTS. A search was conducted across seven Chinese and English electronic bibliographic databases spanning from their inception to March 2023. Selected were clinical trials that evaluated the efficacy of acupuncture therapy for CTS, with or without randomised controlled methods. Data extraction mainly included acupoint prescriptions. Information such as first author, study design and study setting were also extracted. The principal outcomes comprised the clinical manifestations linked to CTS. Statistical descriptions were generated using Excel 2019. The analysis of association rules was conducted using SPSS Modeler 18.0. Using SPSS Statistics 26.0, exploratory factor analysis and cluster analysis were conducted. 142 trials (including 86 RCTs and 56 non RCTs) were identified, and 193 groups of effective prescriptions involving 68 acupoints were extracted. The most frequently used acupoints were Da-ling (PC7), Nei-guan (PC6), He-gu (LI4), Wai-guan (TE5), and Yang-xi (LI5). The most frequently used meridians were the pericardial meridian and the large intestine meridian. The majority of special acupoints used were Five-shu points and Yuan-source points, with acupoints on the upper limbs being the most frequently used. The core acupoint groups were analyzed and 11 groups of association rules, 8 factors, and 5 effective cluster groups were obtained. The evidence-based acupoint selection and combinations of acupuncture therapy for carpal tunnel syndrome were provided by the findings of this study.

Multiple case study of processes used by hospitals to select performance indicators: do they align with best practices?

Several health policy institutes recommend reducing the number of indicators monitored by hospitals to better focus on indicators most relevant to local contexts. To determine which indicators are the most appropriate to eliminate, one must understand how indicator selection processes are undertaken. This study classifies hospital indicator selection processes and analyzes how they align with practices outlined in the 5-P Indicator Selection Process Framework. This qualitative, multiple case study examined indicator selection processes used by four large acute care hospitals in Ontario, Canada. Data were collected through 13 semistructured interviews and document analysis. A thematic analysis compared processes to the 5-P Indicator Selection Process Framework. Two types of hospital indicator selection processes were identified. Hospitals deployed most elements found within the 5-P Indicator Selection Process Framework including setting clear aims, having governance structures, considering indicators required by health agencies, and categorizing indicators into strategic themes. Framework elements largely absent included: adopting evidence-based selection criteria; incorporating finance and human resources indicators; considering if indicators measure structures, processes, or outcomes; and engaging a broader set of end users in the selection process. Hospitals have difficulty in balancing how to monitor government-mandated indicators with indicators more relevant to local operations. Hospitals often do not involve frontline managers in indicator selection processes. Not engaging frontline managers in selecting indicators may risk hospitals only choosing government-mandated indicators that are not reflective of frontline operations or valued by those managers accountable for improving unit-level performance.