Formal Guidelines Research Articles

An Assessment of the Safety Effects of Roadside Barriers on Reducing Mountainous Crash Injury Severity

Roadside barriers have proven effective in preventing run-off-road accidents that occurred in mountainous areas. Nonetheless, the influence of variables impacting the severity of injuries resulting from collisions involving distinct types of roadside barriers may diverge. This study delves into the factors that influence the severity of driver’s injuries in crashes encompassing three specific varieties of roadside barriers in mountainous regions, namely, W-beam barriers, flexible barriers, and roadside trees. The evolution of these factors over time is examined through the application of a random parameters logit modeling approach with heterogeneity in means and variances (RPLHMVs). By employing injury-severity data from 2016 to 2019 for the mountainous regions of a city in Southwest China, various potential influencing factors encompassing driver-, vehicle-, road-, and environment-specific characteristics are subjected to statistical analysis. The extent of the impact of identified statistically significant factors on driver’s injury severity is assessed through the computation of pseudoelasticities. The findings reveal distinctions in the outcomes of driver’s injury severity contingent upon the type of roadside barrier encountered during vehicle impacts. To illustrate, collisions involving W-beam barriers are more prone to result in severe injuries. Moreover, the influence of variables determining driver’s injury severity displays noteworthy temporal shifts. Notably, the pseudoelasticities of numerous explanatory variables remain temporally consistent for incidents involving flexible or roadside barriers. In contrast, crashes involving W-beam barriers highlight that solely the speeding indicator demonstrates temporally stable pseudoelasticities. The insights garnered from this investigation offer the potential to contribute to the formulation of fresh guidelines for the design and selection of roadside barriers aimed at mitigating the severity of injuries incurred in crashes within mountainous regions.

Surgery for female urethral stricture.

Female urethral stricture (FUS) is a rare entity that causes great morbidity and suffering in those affected. As the available scientific data is sparce, there are no formal guidelines or standard of care for this disease. This is a narrative review of the surgical management for female urethral stricture. The literature review was performed on PubMed. Articles were limited to English, but there was no limitation in terms of date. Management of FUS is divided between endoscopic and open surgical repair. Urethral dilation with or without urethrectomy can be offered as a first-line treatment. However, the rate of success of this procedure remains inferior to open surgical repair, and its efficacy decreases with the number of previous dilations. For distal urethral strictures, distal urethrectomy and advancement meatoplasty may be considered. Vaginal flaps are readily available, easy to harvest, well-vascularized, and allow for a dorsal or ventral orientation urethroplasty. The results of this procedure are promising, but most studies are small and retrospective. Labia flaps are easily accessible, wet, hairless, and elastic. The main limitations with the use of vaginal or labial tissues are co-existing conditions such as lichen sclerosis or vaginal atrophy, which may affect future results. Vaginal and labial graft urethroplasty can be used when it is not possible to mobilize an adequate flap. Stricture-free rates of this technique are variable. In cases of more severe stricture, an augmentation urethroplasty using buccal mucosa graft may be necessary. The techniques used in FUS replicate those for male urethral strictures, where both ventral and dorsal approaches can be utilized. Although there is growing interest in the field, the optimal management of FUS remains to be determined.

Neurological abnormalities among pediatric patients with sickle cell disease in Saudi Arabia: a single-center retrospective study.

Sickle cell disease (SCD) is a common inherited blood disorder characterized by the production of abnormal sickle-shaped red blood cells. SCD can lead to various complications including neurological issues. Early detection and treatment are crucial for preventing these complications. This study aimed to describe the neurological manifestations, radiological findings, and neurological diagnosis related to SCD in Saudi children with the aim of contributing to the formulation of population-based guidelines for screening and treating SCD-related neurological complications. This descriptive retrospective study included pediatric patients aged < 14 years diagnosed with SCD who were regularly followed up at the hematology clinic in KAMC, Jeddah, Saudi Arabia, from January 2008 to January 2022. Demographic and clinical data were collected from the clinical charts of 101 participants. This study included 101 patients with SCD with a mean age of 23 months at diagnosis. Among these, 59% had SCD and high fetal hemoglobin (HbF) levels. Neurological sequelae, including seizures, stroke, and other abnormalities, were observed in 26.7% of patients. There were no significant differences in the onset of neurological issues between the patients with SCD-high HbF and those with other SCD phenotypes. This study highlights the increased risk of brain injury and neurocognitive deficits in children with SCD. The occurrence of neurological sequelae in many patients emphasizes the need for early detection and intervention. Some patients experience neurological complications despite having high HbF levels, suggesting that further interventions are needed. This study has some limitations, including its small sample size and retrospective nature. Early detection and intervention are crucial for neurological complications in patients with SCD. This study emphasizes the need for further research and effective treatment strategies considering the presence of neurological complications despite the presence of high HbF levels. Large-scale studies and population-specific guidelines are warranted for better understanding and management of SCD-related neurological complications in the Saudi population.

Higher education crisis: Academic misconduct with generative AI

AbstractHigher educational institutions (HEIs) are facing a significant challenge in maintaining academic integrity due to the technological integration of generative artificial intelligence (AI). The widespread use of AI tools by college students has resulted in an increase in plagiarism and cheating, highlighting the need for effective implementation of this technology. However, there is a lack of research on the best practices for using AI in academic settings. HEIs must take responsibility for addressing these issues, as the majority of institutions do not have formal guidelines for AI use, leading to confusion among students and instructors. To combat academic misconduct, HEIs should establish clear objectives and policies for the equitable, inclusive, and ethical use of AI. Improving AI literacy among students and faculty is crucial, as it ensures that everyone has equal access to technology, preventing a digital divide. Moreover, proactive education on the ethical use of AI is vital for HEIs to prepare students for the AI‐driven future of education and maintain academic integrity.

Design of the external forced air cooling control strategy for the bulb tubular turbine generator based on multi-objective optimization

The compact internal structure of the bulb tubular turbine generator (BTTG) leads to poor ventilation and heat dissipation capability (VHDC). It will result in high-temperature faults and lead to losses for the hydro-power station, if the staff at the hydropower station fail to promptly regulate the external forced air cooling for effective heat dissipation. Thus, a specific and effective ventilation control strategy (VCS) is of utmost importance for the operation of the BTTG. In this study, the finite element method (FEM) was employed to solve the magnetic-flow-thermal coupled field of a 24-MW BTTG. The distribution characteristics of electromagnetic losses and their impact on the temperature field were revealed. Experimental validation was conducted to verify the effectiveness of the numerical results. The response surface methodology (RSM) was employed to design an experimental plan by building upon this foundation. Integrated with a multiobjective genetic algorithm (MOGA), an optimal relationship between ambient temperature, fan flow rate, and heating components’ temperature was established. This relationship serves as the optimized ventilation control strategy for the BTTG. This research provides a theoretical framework for the formulation of operational guidelines to ensure the safe operation of generators.

Exploring factors for antibiotic over-prescription in children with acute upper respiratory tract infections in Assiut, Egypt: a qualitative study

BackgroundOver-prescription of antibiotics contributes to antibiotic resistance, which is a global health threat. Egypt has alarmingly high rates of antibiotic over-prescription for acute upper respiratory tract infections (URIs) in children. To effectively address this issue, it is important to understand the various factors that influence prescription behaviors. The Teixeira antibiotic prescription behavioral model (TAPBM) offers a comprehensive framework through which these factors can be explored. This qualitative study sought to investigate the perspectives of key stakeholders involved in pediatric healthcare in Egypt, with the primary goal of identifying the underlying determinants that contributed to this problem.MethodsThis qualitative study was conducted in Assiut City, Egypt, between January and March 2023. Purposive sampling was used to select participants, including consultant pediatricians, supervisors of pediatric training programs, and specialists in infection prevention and control. Thirteen semi-structured in-depth interviews (IDIs) were conducted, audio-recorded, and transcribed. Thematic analysis was performed using MAXQDA 2020 software.ResultsTwo main themes emerged from the analysis: intrinsic factors related to physicians, extrinsic factors related to patients, and nonphysician factors. Intrinsic factors encompass personal characteristics and attitudes. Prescribing decisions were influenced by factors such as fear of complications, limited follow-up visits, and competition. Knowledge and education also played a significant role. Moreover, diagnostic uncertainty in distinguishing between bacterial and viral infections posed a challenge. Extrinsic factors included patient and caregiver factors, such as parental expectations and demands for antibiotics, driven by the belief that they produced rapid results. Moreover, patients’ demographic factors, including socioeconomic status and living conditions, affected their prescribing behavior. Health system-related factors, such as the type of healthcare institution and the absence of formal national guidelines, were identified as influential factors. Additionally, this study highlighted the influence of the pharmaceutical industry. The potential impact of the COVID-19 pandemic on antibiotic prescriptions was addressed.ConclusionsThe study highlights the intricate interplay between intrinsic and extrinsic factors that shape antibiotic prescription decisions, underscoring the significance of addressing these factors in mitigating overprescribing.

Music Therapy Educators’ Perspectives on Practica Community Partnerships

Abstract Music therapy educators are tasked by the American Music Therapy Association with creating practica placements for students. However, open-ended instructions result in many differing structures of placements and no formal guidelines or codifying supports for educators working with community partners. The purpose of this descriptive survey study was to provide an understanding of music therapy educators’ perspectives on successful and challenging elements of community partnerships and evaluative factors educators use when creating, monitoring, or discontinuing practica placements. Of the 139 participants, 100 currently teach or previously taught music therapy, and their quantitative and qualitative responses were included in data analysis. Educators perceived relational elements of partnerships as greater contributors to success than logistical elements. They identified pro-active and consistent communication (23.69%, n = 59), commitment to the partnership (18.07%, n = 45), and partners’ perception of students providing meaningful services (18.07%, n = 45) as necessary to successful partnerships. The most prominent challenging element was partners who did not value or understand music therapy. However, only 2.9% of educators (n = 2) indicated teaching partners about music therapy and its benefits as a part of their processes for establishing and monitoring community partnerships. The recognition that education and advocacy of music therapy play an underlying role in practica relationships can help guide educators toward more successful partnerships. Recommended future research should include perspectives of community partners and students on practica relationships.

P09 Lancashire and South Cumbria Critical Care Network Vancomycin Project

Abstract Background This project was a collaborative piece of work across a critical care network that included specialist advice from colleagues including aseptic/technically trained pharmacists and microbiology to optimize care for critical care patients in Lancashire and South Cumbria. We used several members of our workforce including pharmacists, nursing staff, microbiologists, rotational doctors and consultants to work towards a harmonized guideline. Methods During our initial meeting, we identified that different centres were using different glycopeptides and administering them differently: East Lancashire Hospitals (ELHT)—continuous vancomycin infusion; Blackpool Cardiac and Blackpool General—continuous vancomycin infusion, with no formal guideline in place but adopted from ELHT; Lancashire Teaching Hospitals—intermittent vancomycin infusions; and University Hospitals Morecambe Bay—teicoplanin is glycopeptide of choice. Our consultant microbiologist discussed the use of glycopeptides and what infections they are used for in critical care. The pharmacokinetics of vancomycin and the benefit of using a continuous infusion was also discussed. We decided to undertake a clinical audit of our vancomycin guidelines at ELHT to ensure that we had an evidence base to implement our guideline and provide assurance to the working group. We agreed to reconvene the working group after this audit was completed and after the concerns of colleagues had been addressed. Results and conclusions We presented the results of our audit and highlighted the opportunities harmonizing this guideline would provide. We discussed various scenarios such as stepping up from a ward protocol to a continuous infusion and the different methods of calculating creatinine clearance and if this would influence the first 24 h of the infusion. One comment was concerning the administration of vancomycin and the number of times nurses will be changing bags for patients requiring higher doses, i.e. the majority of patients would usually be on 3 g/day or more depending on concentrations. This would mean changing the bag more than twice a day; as much as there is a therapeutic benefit to continuous vancomycin infusions, considering the max. concentration for peripheral and central lines allows for larger volumes, it would be beneficial (except in fluid restricted cases) to have a slightly larger volume to reduce the number of bag changes and plastic consumption. We considered this comment and discussed it with our aseptic services lead pharmacist. We attended a meeting of the ICS Aseptics Working Party across Lancashire and South Cumbria. WE discussed the proposed guideline and requested that aseptic units across Lancashire and South Cumbria developed worksheets to manufacture 5 g in 600 mL or 10 g in 1.2 L for central use to stop breaking the line when changing a bag and reducing plastic consumption. We also met with critical care practice educators across the network to discuss how we can promote this guideline and ensure nursing staff and prescribers are aware of how to prescribe and administer continuous vancomycin infusions. One of our units noted that they have had a few incidents with incorrect concentrations of vancomycin being made up for patients. We developed an e-learning package to educate our workforce.

Procedural sedation analgesia in prehospital settings: The state of the art

The utilization of analgosedation procedures is progressively becoming more prevalent in conducting a diverse spectrum of procedures necessitated by the patient’s clinical condition. Such procedures may be undertaken by physicians, anaesthesia nurses, and paramedics alike. Due to the broad competencies of employees of the state emergency medical system, it is possible to carry out analgosedation in the prehospital setting. However, performing analgosedation in that situation presents considerable challenges owing to limited familiarity with the patient’s history, available equipment, and environmental conditions at the scene. Hence, prehospital healthcare providers must possess comprehensive knowledge of the procedural capabilities and technical skills associated with analgosedation to mitigate the risk of adverse events. Proficiently executed analgosedation, based on the conscious use of available equipment, medications and the procedure’s capabilities holds significant importance in achieving the desired procedural outcomes and positively impacting the patient’s clinical status. As no formal guidelines in analgosedation for prehospital providers have been developed the authors aimed to summarize current knowledge and skills required to minimize the risk for patients. The authors also aimed to highlight the necessity of responsible and thoughtful training to perform analgosedation in the prehospital setting to develop desirable correct habits and increase situational awareness.

Gendered Disinformation of Female Politicians on Social Media in Kenya: A Case of Migori Republican Council Facebook Page

The increase in information communication technologies (ICTs) has undoubtedly facilitated socio-economic and political progress, granting individuals a platform for expression and engagement. However, this increased connectivity has also given rise to disturbing phenomena such as stalking, abuse, intimidation, and humiliation. While the internet has provided a space for both men and women to voice their opinions, gendered disinformation on social media poses a significant threat to women’s rights across various domains, including politics, social interactions, and psychological well-being. Migori Republican Council (MRC) is the largest Facebook page that provides a forum for debates on the Migori County’s political, social and economic issues. Through a case study and analysis of content of the Facebook page collected through web scraping using rapid miner during the political campaigns for the Kenya’s 2022 General elections in the period spanning January to July 2022.The study revealed a landscape dominated by political debates and campaigns for both male and female politicians. However, campaigns targeting female politicians were marred by gendered slurs, focusing on their physical appearance, marital status, and roles as mothers. This form of gendered disinformation undermines women’s credibility and perpetuates harmful stereotypes, hindering their political participation and representation. To address the negative impact of gendered disinformation, the study advocates for public awareness campaigns to sensitize individuals, bloggers, and Facebook page administrators about the risks associated with harmful content on social media. Additionally, administrators should prioritize the formulation and enforcement of community guidelines that uphold human dignity and prohibit gender-based harassment. Gender training programs for bloggers and the public are essential to empower individuals to recognize and combat gendered disinformation effectively. The bloggers, Facebook administrators and the public should be equipped with digital media and information literacy competencies. Furthermore, the study recommends the development of lexicons for local languages spoken in Migori County to facilitate the identification and elimination of gendered disinformation. This localized approach acknowledges the cultural context and linguistic nuances inherent in combating online disinformation and ensures broader inclusivity in addressing gender-based issues on social media platforms.

Spatial changes in Royal Malay Town: The Inheritance of ‘Kota’ for Sustainability of Urban Conservation Practices

The continuous degradation of historical urban fabric in traditional towns has hindered efforts to implement sustainable urban conservation practices. Considering the dynamic and complexities of urban areas, which encompass multiple relationships to geographical settings, functional economic and socio-cultural factors, understanding the contextual formation and growth therefore becomes an important consideration in any development project. However, analysing the evolutionary process requires systematic structuring at each hierarchical scale, temporal dimension and level of morphological elements. Thus, posing a significant challenge in extracting the organic growth development of traditional towns. This study attempts to develop a methodological framework for integrated urban morphological analysis that guides the analytical process of spatial changes in Royal Malay town. A case study at Old Town Centre of Kota Bharu, Kelantan was conducted with an emphasis on structuring the case and plan- unit analysis based on diachronic and synchronic comparisons. The findings unveiled the inherent morphogenetic characteristics of Royal Malay towns central to the spatial structure of Kota, which demarcate the fixation line of the growth process and imperative to the functioning system for spatial resilience. This implies that developing a systematic methodological and mapping analysis process aids in providing a clear and responsive strategy in managing rapid spatial transition. This study brings forward the bridging of multidisciplinary knowledge on urban history, geography, design, planning and management to assist in the formulation of comprehensive development guidelines and policies that emphasize an explicit morphological perspective.

Institutionalisation of Electoral Authoritarianism : A Study of The Syria’s Assad Regime

Authoritarianism is a prevalent form of political system in the world where democratic political ideals are limited through advocating strict obedience to a single ruler or group arbitrarily. Electoral authoritarianism is a form that falls between democracy and authoritarianism. They practice authoritarianism behind the institutional façade of representative democracy. The formal structures, guidelines, and practices that make up a political system evolve through a process called institutionalisation. Institutionalisation serves authoritarian regimes' purpose of establishing stability and legitimacy. Establishing long-lasting laws and policies to support the authoritarian government can institutionalise authoritarianism. Electoral authoritarianism became a major form of political system in the post-Cold War era. The institutionalisation of electoral authoritarianism is visible in various countries, especially in West Asia. Syria is the best example, which has a long history of institutionalisation of authoritarian practices. This was most visible during the period of Hafez al Assad in 1970 and continued during his son Bashar Al Assad’s tenure. This institutionalisation is practised by manipulating the country’s constitution, institutions like the army, Judiciary, media, political parties and electoral laws.

Flexible Work Arrangements in the Banking Sector of Bangladesh: A Human Resource Perspective

Whilethe developed nations are applying the flexible work arrangements (FWAs) as an alternative sustainable employee retention strategy, possibility of approaching FWAs in many developing nations, particularly in Bangladesh has remained unexplored. The study aims to investigate the Human Resource (HR) perspectives on whether FWAs are possible in banks in Bangladesh. To explore the state of current and possible potential practices of FWAs, the study conducted 9 (nine) in-depth interviews with HR managers of different categories of banks operating in Bangladesh. This study covered three patterns of bank ownership: private commercial, public commercial, and the bank regulator (central bank). The results of this study revealed that currently banks are informally using FWAs to a limited extent due to a lack of formal regulations and guidelines. The results also revealed that banks are thinking to practice FWAs-namely flex time, flex career, flex place, flex leave and job sharing in near future to match customer demand and to adapt to global banking standards. Additionally, the study disclosed thatthere is an urge to introduce standard regulations on FWAs in the banking sector. Theoretically, this study contributed by raising a new dimension of working arrangements in the banking sector ina developing country context and by underlining the importance of further research on FWAs because the implication of FWAs depends on socio-cultural context. For policy-making purpose, this study has identified the need to reform the existing regulations and to re-examine the organizational culture and human resource management practices of banks in Bangladesh to ensure a healthy work environment for work-life balance.

Implementação de tecnologias em saúde no Brasil: análise de orientações federais para o sistema público de saúde

Abstract This study aimed to identify the regulatory framework and federal guidelines that support the process of implementing health technologies in the Unified Health System (SUS) through analysis of documents and legislation related to the National Health Technology Management Policy, published between 2009 and 2021. The search and selection of documents and subsequent data extraction were carried out. The documents were grouped into three categories: structural regulatory documents, recommendations on evaluation of technologies, and recommendations on clinical guidelines. In 38.8% of the regulatory documents, citations to implementation related mainly to SUS clinical guidelines were identified; however, no document dedicated to guiding implementation actions was identified. Recommendations related to implementations were identified in 27.1% of the reports and 66.1% of the guidelines, although without standardization and, in general, in little detail, focusing on resources and actions needed for making technology available rather than on methods and interventions for its implementation. The results evidence a gap in formal guidelines to guide the implementation process in Brazil, representing an opportunity for the development of models aligned with the reality of the SUS.

Implementation of health technologies in Brazil: analysis of federal guidelines for the public health system.

This study aimed to identify the regulatory framework and federal guidelines that support the process of implementing health technologies in the Unified Health System (SUS) through analysis of documents and legislation related to the National Health Technology Management Policy, published between 2009 and 2021. The search and selection of documents and subsequent data extraction were carried out. The documents were grouped into three categories: structural regulatory documents, recommendations on evaluation of technologies, and recommendations on clinical guidelines. In 38.8% of the regulatory documents, citations to implementation related mainly to SUS clinical guidelines were identified; however, no document dedicated to guiding implementation actions was identified. Recommendations related to implementations were identified in 27.1% of the reports and 66.1% of the guidelines, although without standardization and, in general, in little detail, focusing on resources and actions needed for making technology available rather than on methods and interventions for its implementation. The results evidence a gap in formal guidelines to guide the implementation process in Brazil, representing an opportunity for the development of models aligned with the reality of the SUS.

Painful Call About the Under-Reporting of Children's Pain During Humanitarian Crises.

Humanitarian crises often require urgent medical care to people of concern. Such medical aid includes assessing and treating acute medical needs and ongoing chronic health conditions. Among the people of concern there are children, who are often the most vulnerable population in humanitarian contexts because they often lack the experience, independence, and cognitive and verbal skills to deal with the ordeals they are facing. These limitations might prevent identification and diagnosis of pain. The under-diagnosis and under-treated pain by health care providers might be also due to the perceived urgency of more acute or life-threatening medical needs with limited medical equipment and personnel, lack of awareness, or assessment tools in such contexts. Additionally, due to issues of anonymity and lack of formal guidelines, there is a severe lack of standardized registration of children's pain conditions in humanitarian crises. Finally, acute pain is also a predictor of post-traumatic stress disorder, a common outcome in such disasters. We call on health care providers to use standardized scales to assess children's pain intensity, frequency, and duration, and to treat it appropriately. These will not only reduce children's physical suffering but may also prevent subsequent risk of PTSD.

Epilepsy and driving; Impact on the patient and the society

Background &#x0D; Road traffic accidents are a leading cause of morbidity and mortality in Sri Lanka. Although it is a statutory requirement to declare epilepsy before applying for a driving license, the regulations are not well defined.&#x0D; Parallel to the developing transportation infrastructure and the increasing need of driving skills for independence, the impact of epilepsy on driving has become a topic of utmost importance.&#x0D; Methods&#x0D; This is a descriptive observational study. All patients followed up at the National epilepsy center at National hospital of Sri Lanka, who fulfill the international league against epilepsy (ILAE) operational definition of epilepsy were recruited for the study for a period of three months starting from November 2022 to March 2023.&#x0D; Results &#x0D; The study evaluated 142 participants, the majority of whom were males (98%). Only 68 (47.9%) of them were seizure free for more than 2 years. Most of them were on at least two anti-seizure medications. MRI evidence of a lesion was present on 36 (25.4%) participants. 41 (28.9%) of them have faced road traffic accidents as the driver of the vehicle and some have experienced up to 4 road traffic accidents. Out of the 55 road traffic accidents reported by the participants, 13 were due to either development of seizure or aura.&#x0D; Conclusion &#x0D; The advances in transport medicine in many countries have enabled the medically disabled to drive with less restrictive solutions while ensuring road safety. This study highlights the need for formal guidelines on driving with epilepsy, considering the individual medical, financial, and social requirements.

Madrasah Diniyah and Ma'had Al-Jami'ah-Based Religious Moderation Policy in State Islamic University in Indonesia

This article seeks to elaborate the ma’had al-jami’ah-based religious moderation policy at UIN Sayyid Ali Rahmatullah Tulungagung. This issue is interesting because religious moderation is a government policy that must be implemented by government institutions, including Islamic religious universities. The problem is that there are no nationally formal technical-operational guidelines for implementation so each tertiary institution has an interpretation for making policies to strengthen religious moderation by their respective contexts and considerations. The current study used in this article is qualitative with data mining techniques through interviews, observation, and documentation. The data that has been obtained is then analyzed using the Miles, Huberman, and Saldańa model which divides the stages of data analysis into data condensation, data presentation, and conclusion. This article argues that UIN Sayyid Ali Rahmatullah made interesting policies for religious moderation in the form of madrasah diniyah and ma’had al-jami’ah learning policies. Madrasah diniyah and ma’had al-jami’ah are designed not only as an activity to provide religious knowledge to students but also as a strategy for internalizing religious moderation and prevention of radicalism ideology.

Illness perception, self-esteem and self-care management of patients on continuous ambulatory peritoneal dialysis: A cross-sectional study from a Tertiary Care Hospital in South India

Background: Chronic diseases are those conditions that last for more than a year requiring ongoing medical attention and crippling the activities of daily living. End-stage kidney disease invites significant psychosocial stressors and demands routine adaptation. It cha­llenges the patient with a constant fear of death, draining them physically and mentally, making them depen­dent on the healthcare team and having to follow complicated pharmacological regimes with dietary limitations. Objective: The study was intended to assess illness perception, self-esteem, and self-care management of patients on continuous ambulatory peritoneal dialysis. Methodology: Using quantitative approach, a descriptive study was undertaken for a period of six weeks in Peritoneal Dialysis unit of the Artificial Kidney Lab (AK Lab) of Christian Medical College, Vellore. A total of 63 patients were selected using total enumeration sampling technique. Data was collected using self-administered questionnaires namely Brief Illness Perception Questionnaire (B–IPQ), Current thoughts scale and Questionnaire on self-care management. Results: Most of the subject’s illness perception were moderately (42.86%) and severely affected (41.27%). On the whole, the subjects had higher self-esteem (mean = 71.49); however, the appearance self-esteem was rather low (19.67). All subjects had adequate self-care management. Conclusion: Patients undergoing CAPD perceive their illness as a threat and they have low appearance self-esteem. On the basis of this finding, formulation of guidelines for psychological management of these patients would help them to develop coping skills.

Medical Student Experiences and Perceptions of ChatGPT and Artificial Intelligence: Cross-Sectional Study.

Artificial intelligence (AI) has the potential to revolutionize the way medicine is learned, taught, and practiced, and medical education must prepare learners for these inevitable changes. Academic medicine has, however, been slow to embrace recent AI advances. Since its launch in November 2022, ChatGPT has emerged as a fast and user-friendly large language model that can assist health care professionals, medical educators, students, trainees, and patients. While many studies focus on the technology's capabilities, potential, and risks, there is a gap in studying the perspective of end users. The aim of this study was to gauge the experiences and perspectives of graduating medical students on ChatGPT and AI in their training and future careers. A cross-sectional web-based survey of recently graduated medical students was conducted in an international academic medical center between May 5, 2023, and June 13, 2023. Descriptive statistics were used to tabulate variable frequencies. Of 325 applicants to the residency programs, 265 completed the survey (an 81.5% response rate). The vast majority of respondents denied using ChatGPT in medical school, with 20.4% (n=54) using it to help complete written assessments and only 9.4% using the technology in their clinical work (n=25). More students planned to use it during residency, primarily for exploring new medical topics and research (n=168, 63.4%) and exam preparation (n=151, 57%). Male students were significantly more likely to believe that AI will improve diagnostic accuracy (n=47, 51.7% vs n=69, 39.7%; P=.001), reduce medical error (n=53, 58.2% vs n=71, 40.8%; P=.002), and improve patient care (n=60, 65.9% vs n=95, 54.6%; P=.007). Previous experience with AI was significantly associated with positive AI perception in terms of improving patient care, decreasing medical errors and misdiagnoses, and increasing the accuracy of diagnoses (P=.001, P<.001, P=.008, respectively). The surveyed medical students had minimal formal and informal experience with AI tools and limited perceptions of the potential uses of AI in health care but had overall positive views of ChatGPT and AI and were optimistic about the future of AI in medical education and health care. Structured curricula and formal policies and guidelines are needed to adequately prepare medical learners for the forthcoming integration of AI in medicine.