Quality Gap Research Articles

Smoking cessation pharmacotherapy use during index hospital admission following cystectomy for bladder cancer: A retrospective cohort study.

To identify gaps in urologic oncology quality and evidence-based smoking cessation care by assessing how often smoking cessation pharmacotherapy (SCP) is given in the inpatient setting following cystectomy. The Premier Healthcare Database (PHD), a deidentified all-payer dataset, was used to generate nationally representative estimates of SCP receipt during hospitalization following cystectomy for patients with bladder cancer who smoke. Regressions were used to model associations between SCP receipt and patient- and hospital-level factors. Of the 21,624 patients who underwent cystectomy for bladder cancer, 3,676 patients (17.0%) were identified as current smokers, representing a weighted estimate of 16,063 admissions. Among these admissions, 27.9% of patients received SCP, the vast majority of which (91.5%) received exclusively nicotine replacement therapy. Rates of SCP receipt varied substantially across hospitals (median: 25.0%, IQR: 20.0-33.3, range: 0.0-60.0). Older age and black race (aOR = 0.59, 95% CI: 0.42-0.82) were associated with lower odds of SCP receipt. Increased patient comorbidity score was associated with higher odds of SCP receipt (aOR = 1.02, 95% CI: 1.01-1.03); specifically, chronic pulmonary disease, alcohol abuse, and depression were independently associated with SCP receipt. Hospital teaching status, bed capacity, and mean annual cystectomy volume were not associated with SCP receipt. SCP receipt was not associated with hospital length of stay nor 90-day readmission or mortality following cystectomy. SCP is infrequently given to patients who smoke during their hospitalization following cystectomy for bladder cancer, representing a gap in quality urologic oncology care and a missed opportunity to effectively intervene with evidence-based treatment.

Empathic communication skills training: Randomized controlled trial to reduce lung cancer stigma in lung cancer care.

TPS12152 Background: Stigma is commonly experienced by people diagnosed with lung cancer and is often triggered during clinical encounters with their oncology care provider (OCP), particularly associated with routine assessment of smoking history. Lung cancer stigma is associated with gaps in quality of care as well as poorer psychological and physical health-related outcomes for patients. The overall objective of this multi-site national clinical trial is to test whether an OCP-facing training intervention in empathic communication skills (ECS) reduces stigma and distress and promotes patient engagement. Our prior pilot work has demonstrated that the ECS intervention is both feasible and efficacious to reduce stigma during clinical encounters. Methods: This NCI-funded multi-site national trial employs a cluster randomized design comparing usual care (waitlist control) with ECS training (intervention). With outreach and site recruitment support provided by GO2 for Lung Cancer and the American Cancer Society, community oncology sites (n = 16) nationwide will be randomized 1:1 to each arm. 9-11 OCPs will be recruited per site with 6 unique patients per OCP enrolled (total 54-66 patients/site). Statistical analysis will evaluate the effect of ECS training on primary OCP outcomes (e.g., empathic skill uptake) and secondary patient-reported outcomes (e.g., psychological distress). The 2.5 hour ECS training is delivered live using a videoconference platform. The didactic content covers knowledge and consequences of stigma on patients with lung cancer and in-depth review of specific ECS strategies. Participants then engage in experiential small-group role-play sessions with trained patient actors, where they are given tailored feedback by trained facilitators and their peers. Eligible sites must have at least 15 OCPs and clinic volume of at least 20 new patients with lung cancer per month. Eligible OCPs (physicians, NPs and PAs) must currently be treating and conducting outpatient clinic consultations with at least 1 patient with lung cancer per week. Eligible patients must be receiving treatment for lung cancer, English and/or Spanish speaking, currently or formerly smoking, and have had no more than 5 prior visits with the participating OCP. Currently, this trial is open to accrual and has 5 sites across the nation completing paperwork for activation. Clinical trial information: NCT05456841 .

Optimized Centroid-Based Clustering of Dense Nearly-square Point Clouds by the Hexagonal Pattern

Abstract An approach to optimize centroid-based clustering of flat objects is suggested, which is practically important for efficiently solving metric facility location problems. In such problems, the task is to find the best warehouse locations to optimally service a given set of consumers. An example is assigning mobiles to base stations of a wireless communication network. We suggest a hexagonal-pattern-based approach to partition flat nodes into clusters quicker than the k-means algorithm and its modifications do. First, a hexagonal cell lattice is applied to nodes to approximately determine centroids of the clusters. Then the centroids are used as initial centroids to start the k-means algorithm. The suggested method is efficient for centroid-based clustering of dense nearly-square point clouds of 0.1 million points and greater by using no fewer than 6 lattice cells along an axis. Compared to k-means, our method is at least 10 % faster and it is about 0.01 to 0.07 % more accurate in regular Euclidean distances. In squared Euclidean distances, the accuracy gain is 0.14 to 0.21 %. Applying a hexagonal cell lattice determines an upper bound of the clustering quality gap.

Abstract 96: When Canada is a Under-Resourced Country: Patient-Oriented Research on Optimizing Rational Decision-Making for Bladder Cancer

Abstract Purpose: To identify gaps between the ideal and current approaches to Non-Muscle Invasive Bladder Cancer (NMIBC) in Canada, and determine what should be done short- and long-term to address those gaps. Methods: Prompted by a patient diagnosed with NMIBC in July 2022, we first searched the global literature for the most-effective preventive, screening, diagnostic, and therapeutic approaches to NMIBC, and also examined sites such as Bladder Cancer Canada and professional societies’ sites for clinical recommendations. We next conducted written and oral interviews with urologists, researchers, primary care physicians, and manufacturers of related interventions to understand and synthesize the literature and determine the best clinical course of action. Results: Our approach produced prompt and free care, of quality ranging from poor to outstanding. It required substantial patient resilience and advocacy, much of which is likely easily remediable, some of which will require policy changes. Care quality gaps of particular concern that were identified included: Conclusion: Treatment of NMIBC in Canada is not currently provided in an optimized or rational fashion. Several improvements that are without meaningful associated cost have been identified that we conclude should be immediately implemented. Other interventions should be considered immediately by policymakers to reduce unnecessary morbidity, mortality, suffering, and other societal costs. Citation Format: Erica Frank. When Canada is a Under-Resourced Country: Patient-Oriented Research on Optimizing Rational Decision-Making for Bladder Cancer [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 96.

E-SERV-EX: A Multi-item Scale for Measuring Customer Expectations from the Online Retail Services

Purpose: The purpose of this article is the scale development, refinement, and psychometric evaluation of the multi-item scale (E-SERV-EX) for assessing the customers’ expectations from the online retail services and exploring the impact of different demographic and behavioral factors on customer’s expectation. Design/Methodology/Approach: It was conclusive research, which is quantitative and cross-sectional in nature. Data were collected through a survey method using a structured questionnaire from 518 respondents, selected through judgmental sampling from Delhi NCT. The primary statistical tools used in the study were exploratory factor analysis, confirmatory factor analysis for scale development, and partial least square-structural equation modelling for hypothesis testing. Findings: The final scale had 31 items divided into nine dimensions. Assurance/trust, efficiency, fulfillment/reliability, responsiveness, security/privacy, web-design, personalization, price aspects, and customer engagement. Scales demonstrated good psychometric properties based on the findings from various reliability and validity tests conducted in this study. Web design was the most crucial factor, and personalization was the least important factor expected. When we speak about demographic factors, males had more expectations than females in individual and overall expectations. With an increase in age and income, customers’ expectations from online retailer services decrease. With the increase in distance from the physical retail outlet, customers’ expectations from online retail service increase. Consumers with more experience in internet usage and online retail usage had higher expectations. Consumers who surf and purchase more from online retailers also expect more. Practical Implications: The e-expectation scale developed in this study will help marketers and retailers better understand e-service quality expectations. Knowing the consumers’ expectations would help the retailers in framing the e-marketing mix and strategies. The expectations scale can be used in policy formulation and web designing. This scale will also help fill GAP 1 (expected service and management’s perceptions of consumer expectations) and GAP 5 (customer expectations and customer perceptions) of the service quality gap model of Parasuraman, Zeithaml, and Berry. Originality/Value: This research paper contributes to the literature by developing, refining, and evaluating a novel multi-item scale, E-SERV-EX, with good psychometric properties for measuring customer expectations from online retail services whereas most of the papers in the past measured the perceptions. E-SERV-EX can be employed by marketers, retailers, and policymakers to develop effective e-marketing strategies, web designs, and policy formulation by understanding consumer expectations. Most importantly, this scale helps fill GAP 1 (expected service and management’s perceptions of consumer expectations) and GAP 5 (customer expectations and customer perceptions) of the service quality gap model proposed by Parasuraman, Zeithaml, and Berry.

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship betweenCOVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes.

A stackelberg differential game theoretic approach for analyzing coordination strategies in a supply chain with retailer's premium store brand.

The online version contains supplementary material available at 10.1007/s10479-023-05372-9.

What makes a program good? Evidence from short-cycle higher education programs in five developing countries

Short-cycle higher education programs (SCPs) can play a central role in skill development and higher education expansion, yet their quality varies greatly within and among countries. In this paper, we explore the relationship between programs’ practices and inputs (quality determinants) and student academic and labor market outcomes. We design and conduct a novel survey to collect program-level information on quality determinants and average outcomes for Brazil, Colombia, Dominican Republic, Ecuador, and Peru. Categories of quality determinants include training and curriculum, infrastructure, faculty, link with productive sector, costs and funding, and practices on student admission and institutional governance. We also gather administrative student-level data on higher education and formal employment for SCP students in Brazil and Ecuador and match it to survey data. Using machine learning methods, we select the quality determinants that predict outcomes at the program and student levels. We show that specific quality determinants may favor academic and labor market outcomes. Two practices predict improvements in all labor market outcomes in Brazil and Ecuador—teaching numerical competencies and providing job market information—and one practice—teaching numerical competencies—additionally predicts improvements in labor market outcomes for all survey countries. Since quality determinants account for 20–40 percent of the explained variation in student-level outcomes, quality determinants might have a role shrinking program quality gaps. These findings have implications for the design and replication of high-quality SCPs, their regulation, and the development of information systems.

Socio-economic disparities in greenspace quality: insights from the city of Melbourne

PurposeThis paper takes a prudent approach to assessing the quality of greenspace in low- and high socio-economic status (SES) settings. Socio-economic data from deprivation indexes were used to systematically define low- and high-SES suburbs. A Geographical Information System (GIS) observation of greenspaces was used to score spaces according to a scoring criterion contingent on six quality facets. Statistics were then synthesised, producing a Cohen effect score highlighting disparities in each criterion between the two SES groups.Design/methodology/approachAs the phenomena of locational prejudice and meritocratic inequality continue to garner global attention, this paper extrapolates this to a world-renown metropolis, Melbourne. This paper endeavours to provide invaluable insights into the environmental injustice paradigm within greenspace and its respective quality.FindingsConclusive results affirmed a concerning disparity in the quality of greenspace between Melbourne's low- and high-SES settings. Cohen's effect size found that on average, there was a “medium” distinction between the spaces, whilst an individual focus on the quality facets concluded diverse findings.Research limitations/implicationsThe core of study adopted a meticulous virtual assessment to critique the quality of selected greenspaces opposed to an in-person-real world assessment which could garner more nuanced findings.Originality/valueExisting literature on Melbourne has prioritised distribution, proximity and accessibility domains when assessing inequitable greenspace and, consequently, has catalysed a research gap in greenspace quality. This is also one of the first papers to provide insight into the “Plan Melbourne” policy regarding urban regeneration and ameliorating public open spaces.

Regional Disparities of Chinese Middle School Students Performance

The development of education in China has witnessed great progress along with 30 years of social reform and the opening up policy, yet the issue of equality in relation to resource distribution has gradually become serious. It can be seen from Chinas results in 2015 and 2018 PISA (OECDs Programme for International Student Assessment), as it chose different regions to participate in the competition. The change in rankings reflects the differences in educational quality among several participating regions (Beijing, Shanghai, Jiangsu, Guangdong, Zhejiang). The study focuses on exploring education development of these regions and aims to take a glance of the regional inequalities in Chinese education. The data collected and comparative study of the development of basic education in these regions in the years of participation revealed that the investment in human, financial, and physical resources had a significant impact on the quality of education. This study divides the five regions into two gradients based on educational inputs and administrative divisions, suggesting possible mechanisms for the occurrence of educational quality gaps across the country, and highlighting the unbalanced distribution in human, financial and material resources.

Health service quality in 2929 facilities in six low-income and middle-income countries: a positive deviance analysis

Primary care is of insufficient quality in many low-income and middle-income countries. Some health facilities perform better than others despite operating in similar contexts, although the factors that characterise best performance are not well known. Existing best-performance analyses are concentrated in high-income countries and focus on hospitals. We used the positive deviance approach to identify the factors that differentiate best from worst primary care performance among health facilities across six low-resource health systems. This positive deviance analysis used nationally representative samples of public and private health facilities from Service Provision Assessments of the Democratic Republic of the Congo, Haiti, Malawi, Nepal, Senegal, and Tanzania. Data were collected starting June 11, 2013, in Malawi and ending Feb 28, 2020, in Senegal. We assessed facility performance through completion of the Good Medical Practice Index (GMPI) of essential clinical actions (eg, taking a thorough history, conducting an adequate physical examination) according to clinical guidelines and measured with direct observations of care. We identified hospitals and clinics in the top decile of performance (defined as best performers) and conducted a quantitative, cross-national positive deviance analysis to compare them with facilities performing below the median (defined as worst performers) and identify facility-level factors that explain the gap between best and worst performance. We identified 132 best-performing and 664 worst-performing hospitals, and 355 best-performing and 1778 worst-performing clinics based on clinical performance across countries. The mean GMPI score was 0·81 (SD 0·07) for the best-performing hospitals and 0·44 (0·09) for the worst-performing hospitals. Among clinics, mean GMPI scores were 0·75 (0·07) for the best performers and 0·34 (0·10) for the worst performers. High-quality governance, management, and community engagement were associated with best performance compared with worst performance. Private facilities out-performed government-owned hospitals and clinics. Our findings suggest that best-performing health facilities are characterised by good management and leaders who can engage staff and community members. Governments should look to best performers to identify scalable practices and conditions for success that can improve primary care quality overall and decrease quality gaps between health facilities. Bill & Melinda Gates Foundation.

Sealing the gaps: enhancing quality control in business school dissertations

PurposeThe purpose of this study is to identify and address significant quality gaps present in business school dissertations in India. Dissertations, an integral and a special component of the overall business school learning process, acquaint students with the practical business world.Design/methodology/approachThe authors benchmarked the dissertation processes of business schools in India against those of reputed business schools in Germany, France, Sweden and Australia. Using a survey questionnaire, the authors checked whether business schools in India followed international processes and, if not, what could be done to adopt such processes. A sample of 367 business schools was studied to obtain reasonable evidence.FindingsThere were major quality issues in the dissertation process across business schools in India. Serious groundwork preparation issues were identified, such as an absence of research proposals. Most business schools also reported that there were no rubrics for dissertation evaluation, resulting in high subjectivity in the evaluation process. Supervisor interactions and control over the progress of the dissertation were also found to be very weak. As a result, the authors conclude that dissertations from business schools in India have major gaps in quality.Originality/valueThis is a novel study that examines the quality assurance of business school dissertations. It highlights major quality concerns surrounding the business school dissertation process and suggests measures to address quality issues. The study’s implications apply to business schools in all developing countries and not just India.

The impact of immigration and integration policies on immigrant-native labour market hierarchies

ABSTRACT Across European Union (EU) labour markets, immigrant and native populations exhibit disparate labour market outcomes, signifying widespread labour market hierarchies. Despite the considerable investment in migration and integration policies, it remains unclear whether these contribute to or alleviate labour market hierarchies between natives and immigrants. Using a longitudinal model based on individual-level EU LFS and country-level DEMIG POLICY and POLMIG databases, we explore variation in changes of immigration and integration policies across Western EU member states to study how they are linked to labour market hierarchies in terms of unemployment and employment quality gaps between immigrant and native populations. Our findings suggest that designing less restrictive immigration and integration policies could aid in reducing existing labour market disadvantages for immigrants, enabling them to realise their full potential and reduce the immigrant-native labour market hierarchies.

Queering Housing Policy: Questioning Urban Planning Assumptions in Namibian Cities

Heteronormative models of the home have permeated housing policies for decades, only adding to economic and spatial inequalities in a landscape of housing injustices. Half of the urban population in Namibia lives in precarious housing conditions. Cities like Windhoek and Walvis Bay are among the most unequal in the world. Such inequalities translate into significant gaps in housing quality, security, and service provision. These inequalities are acutely felt by LGBTIQ+ populations that already face other forms of exclusion from economic and social life and fundamental human rights. A new National Housing Policy—emphasizing the right to housing—is about to be adopted in Namibia, but would it address the concerns of queer populations? This article asks what it means to engage with Namibia’s new National Housing Policy through the lens of queer decolonial thought. It presents an exploratory study of the questions emerging at the margins of the discussion on the National Housing Policy. The objective was to develop an exploratory research agenda for a queer decolonial perspective on housing in Namibia. In the context of enormous housing shortages, a queer decolonial perspective emphasizes radical inclusion as a principle for housing provision. The exploration of shared queer experiences in accessing housing suggests that the themes of belonging, identity, and safety may support the development of such an agenda. Queer decolonial thought has thus three implications for an agenda of research on housing in Namibia. First, it calls for understanding what community and belonging mean for LGBTIQ+ people. Second, queer decolonial thought poses questions about citizenship, particularly given the shift to a view of the state as creating housing opportunities (through land rights and basic services) and support mechanisms for incremental housing. Queer decolonial thought calls for identifying the multiple ways the state misrecognizes individuals who do not conform to prescribed identities and sexual orientations. Third, queer decolonial thought invites reflection on the constitution of safe spaces in aggressive urban environments and the multiple layers of perceived safety constructed through diverse institutions and public spaces.

Society for Maternal-Fetal Medicine Special Statement: Prophylactic low-dose aspirin for preeclampsia prevention—quality metric and opportunities for quality improvement

Prophylactic low-dose aspirin reduces the rates of preeclampsia, preterm birth, fetal growth restriction, and perinatal death in patients with risk factors for preeclampsia. Despite recommendations from the US Preventive Services Task Force, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine, low-dose aspirin use is reported in <50% of patients with high-risk factors and <25% of patients with >1 moderate-risk factor. These low use rates represent an important "quality gap" and demonstrate the need for quality improvement activities. In this article, we outline the specifications for a process metric to standardize the measurement of the rate of aspirin use. Furthermore, we outline an approach to conducting a quality improvement project to increase the use of aspirin by patients with risk factors for preeclampsia.

Formative evaluation prior to implementation of a brief treatment for posttraumatic stress disorder in primary care

BackgroundSuccessful implementation of evidence-based treatments (EBT) for posttraumatic stress disorder (PTSD) in primary care may address treatment access and quality gaps by providing care in novel and less stigmatized settings. Yet, PTSD treatments are largely unavailable in safety net primary care. We aimed to collect clinician stakeholder data on organizational, attitudinal, and contextual factors relevant to EBT implementation.MethodsOur developmental formative evaluation was guided by the Consolidated Framework for Implementation Research (CFIR), including (a) surveys assessing implementation climate and attitudes towards EBTs and behavioral health integration and (b) semi-structured interviews to identify barriers and facilitators to implementation and need for augmentation. Participants were hospital employees (N = 22), including primary care physicians (n = 6), integrated behavioral health clinicians (n = 8), community wellness advocates (n = 3), and clinic leadership (n = 5). We report frequency and descriptives of survey data and findings from directed content analysis of interviews. We used a concurrent mixed-methods approach, integrating survey and interview data collected simultaneously using a joint display approach. A primary care community advisory board (CAB) helped to refine interview guides and interpret findings.ResultsStakeholders described implementation determinants of the EBT related to the CFIR domains of intervention characteristics (relative advantage, adaptability), outer setting (patient needs and resources), inner setting (networks and communication, relative priority, leadership engagement, available resources), and individuals involved (knowledge and beliefs, cultural considerations). Stakeholders described strong attitudinal support (relative advantage), yet therapist time and capacity restraints are major PTSD treatment implementation barriers (available resources). Changes in hospital management were perceived as potentially allowing for greater access to behavioral health services, including EBTs. Patient engagement barriers such as stigma, mistrust, and care preferences were also noted (patient needs and resources). Recommendations included tailoring the intervention to meet existing workflows (adaptability), system alignment efforts focused on improving detection, referral, and care coordination processes (networks and communication), protecting clinician time for training and consultation (leadership engagement), and embedding a researcher in the practice (available resources).ConclusionsOur evaluation identified key CFIR determinants of implementation of PTSD treatments in safety net integrated primary care settings. Our project also demonstrates that successful implementation necessitates strong stakeholder engagement.

Combining Frameworks to Improve Military Health System Quality and Cybersecurity

Existing conceptual frameworks and commercially available technology could be considered to rapidly operationalize the use of Quality Measures (QM) within military health systems (Costantino et al. 2020). Purchased healthcare as well as digital healthcare services have paved the way for data collection from multiple information systems thus offering stakeholders actionable intelligence to both guide and measure healthcare outcomes. However, the collection of data secondary to Smart Devices, disparate information systems, cloud services, and the Internet of Medical Things (IOMT) is a complication for security experts that also affect clients, stakeholders, organizations, and businesses delivering patient care. We have combined three conceptual frameworks: (1) Donabedian’s Quality Attributes Framework (DQA), (2) The National Academy of Medicine (NAM) framework, and the (3) Healthcare and Public Health (HPH) Cybersecurity Framework (HCF). Each of these frameworks is well-tested, widely accepted, and referenced as the gold standard in delivering quality care (DQA and NAM) and cybersecurity (HCF) for healthcare. Separately, each framework provides long-used analysis, guidance, and application of quality reliable measures of healthcare services. The combined frameworksmay enhance data integrity (collection and standardized safety of data in regard to regulatory compliance). The combined frameworks also support identifying gaps in quality of care, support the prioritization of cost-effective methodologies that predictably improve patient outcomes, and support DHA’s quality measures. Finally, we offer the importance of understanding the components of quality measures in a more precise manner while maintaining information technology (IT) governance compliance.

Pattern, frequency and factors associated with inappropriate high dosing in chronic kidney disease patients at a tertiary care hospital in Pakistan

BackgroundPatients with chronic kidney diseases (CKD) are susceptible to the toxic drug effects if given unadjusted doses. Although Pakistan harbors a high burden of CKD patients, there is limited information available on the frequency, pattern and factors associated with unadjusted drug doses among CKD patients.MethodsThis cross-sectional study conducted at Sandeman Provincial Hospital, Quetta included 303 non-dialysis ambulatory CKD patients (glomerular filtration rate < 60 ml/min/1.73m2). The patients’ data were collected through a purpose designed data collection form. The appropriateness of doses was checked against the renal drug handbook-2018, Kidney Disease Improving Global Outcomes guidelines, British National Formulary-2022, and manufacturer leaflets. Data were analysed by SPSS 23 and multiple binary logistic regression analysis was used to assess the factors associated with receiving inappropriate high doses. A p-value < 0.05 was considered statistically significant.ResultsThe patients received a total of 2265 prescription lines, with a median of eight different drugs per patient (interquartile range: 6–9 drugs). A total of 34.5% (783/2265) drugs required dose adjustment. Of these, doses were not adjusted for 56.1% (440) drugs in 162 (53.4%) patients. The most common pharmacological class of drugs requiring dose adjustment were antibiotics (79.1%), followed by antidiabetics (59.2%), diuretics (57.0%), angiotensin converting enzyme inhibitors (56.9%), beta blockers (56.9%), analgesics (56.0%), angiotensin receptor blockers (55.2%), domperidone (53.9%) and antihyperlipidmics (46.1%). Patient’s age of 41–60 (OR = 5.76) and > 60 years (OR = 9.49), hypertension (OR = 2.68), diabetes mellitus (OR = 3.47) and cardiovascular diseases (OR = 2.82) had statistically significant association (p-value < 0.05) with inappropriate high doses.ConclusionThe high frequency of inappropriate high doses suggests an important quality gap in medication dosing for patients with ND-CKD at the study site. Special attention should be paid to the drugs and patients with identified risk factors for receiving inappropriate high doses.

Data-Driven Elucidation of Flavor Chemistry.

Flavor molecules are commonly used in the food industry to enhance product quality and consumer experiences but are associated with potential human health risks, highlighting the need for safer alternatives. To address these health-associated challenges and promote reasonable application, several databases for flavor molecules have been constructed. However, no existing studies have comprehensively summarized these data resources according to quality, focused fields, and potential gaps. Here, we systematically summarized 25 flavor molecule databases published within the last 20 years and revealed that data inaccessibility, untimely updates, and nonstandard flavor descriptions are the main limitations of current studies. We examined the development of computational approaches (e.g., machine learning and molecular simulation) for the identification of novel flavor molecules and discussed their major challenges regarding throughput, model interpretability, and the lack of gold-standard data sets for equitable model evaluation. Additionally, we discussed future strategies for the mining and designing of novel flavor molecules based on multi-omics and artificial intelligence to provide a new foundation for flavor science research.

Epidemiology of critically ill patients in intensive care units in Nepal: a retrospective observational study

Background: Epidemiological data on critically ill patients is crucial for understanding resource utilisation, gaps in quality of care and for supporting surveillance of endemic or emerging diseases. We report the epidemiology of critically ill patients from 17 intensive care units (ICUs) in Nepal using an established and standardised ICU registry. Methods: The ICU registry data is collected prospectively and includes data on case mix, severity, organ support and outcomes. We conducted a retrospective observational study with all adult (≥18 years) critically ill patients admitted to 17 ICUs in Nepal between September 2019 and September 2022. We report on case mix, treatment received, severity of illness, standardised mortality rates (SMR), discharge outcomes and ICU service activity. Descriptive statistics were used to report the findings. Results: Of the 18603 unique admissions, 14% were operative, with 35% emergency surgeries. Patients’ median age was 57 (IQR 40-71) and 59% were male. Hypertension and diabetes were common comorbidities and pneumonia accounted for 26% of all admissions. During the ICU stay, 39% of patients received mechanical ventilation, 29% received vasoactive medication and 10% received renal replacement therapy. The median predicted risk of death was 0.1 (IQR 0.1-0.3) using APACHE II and 0.2 (IQR 0.1-0.4) using eTropICS. The median SMR was 0.7 (IQR 0.5-0.8) and 0.8 (IQR 0.6-1.4) using eTropICS and APACHE II, respectively. Median length of stay was 4 days (IQR 2-7). Eighteen percent died in the ICU; of those alive at discharge, 12% went home, 84% went to another department and 3% went to another hospital. COVID-19 was the most common notifiable disease reported (12% of all admissions). Median ICU turnover was 9% (IQR 6-14) with bed capacity ranging from 43-278. Conclusions: These findings should guide forecasting and service planning to ensure ICUs can optimally care for critically ill patients in Nepal.