Health Care Research Articles

Saving the Health Care Safety Net: Progress and Opportunities.

The health care safety net provides essential clinical care and social services for low-income, uninsured, and underinsured populations in the United States. Despite these important functions, the health care safety net has experienced recurrent financial instability, growing market pressures, and workforce strain. Payment reform has also introduced unique challenges for safety net providers related to measuring and reaching quality benchmarks. A common theme among these challenges is that many of them result from applying standard health policy approaches to the safety net instead of using safety net-specific approaches. This review describes progress toward strengthening the safety net, key challenges, and opportunities moving forward.

Evaluation of effective strategies in the prevention of chemotherapy induced mucositis among Children

Abstract Background Oral mucositis is a frequent side effect of anticancer treatments. It impairs the patient’s quality of life, aggravate clinical condition, increase the risk of infection and can delay anticancer treatment. Health care workers at the NIBD and BMT Karachi, Pakistan emphasize on oral hygiene to prevent such complications for the patients. Proper oral hygiene protocol can reduce the risk of oral ulcers. In this study we have done the evaluation of oral hygiene. At NIBD and BMT among pediatric population are advice to brush their teeth twice a day, use pyodine/ Chlorhexidine 0.2% mouth wash thrice a day followed by application of anti-fungal jell. Methods A cross-sectional survey was conducted from date 8/5/2020 to 11/5/2020 at children hospital. 73 admitted patients were the study using convenient sampling, team approached eligible patients and informed consent was obtained from parents. A standardized questionnaire was then administered in Urdu (Pakistan’s national language). Results 11% of patients reported that they frequently or always suffered from oral ulcer and use mouth washes for gargles; however 79.5% reported that they rarely or never suffered from oral ulcer and use mouth washes. In contrast, 9.6% patients reported that they rarely or never suffered from oral ulcer and do not use mouth washes, whereas none of the patients who reported that they do not use mouth washes for gargles had suffered from oral ulcer frequently or all the time. 2.7% of the patients experienced oral ulcer frequently or always and brush once in a day, 6.8% experienced oral ulcer frequently or always and brush twice or more in a day and 1.4% don’t brush and suffered from oral ulcer frequently or always. Conversely, 27.4% never or rarely had oral ulcer and brush once in a day, 54.8% never or rarely had oral ulcer and brush twice or more in a day and 6.8% don’t brush and had never or rarely experienced oral ulcer Conclusion The use of proper oral hygiene protocol can decrease the risk of chemotherapy induced mucositis. Majority of the patients at NIBD 02 + 103 understand the importance of oral hygiene after their doctor’s Furthermore oral hygiene can decrease levels of oral mucositis and eventually decrease inpatient admissions, delays in treatments and improving the quality of life.

Roles and experiences of nurses in primary health care during the COVID-19 pandemic: a scoping review

BackgroundNurses form the frontline of the healthcare system’s response to both epidemics and pandemics, and this was especially the case during the novel coronavirus disease (COVID-19) pandemic. Although the influence of COVID-19 on nursing roles has attracted interest, there is no integrated knowledge of nurses’ roles and experiences in primary health care settings during the COVID-19 pandemic. Thus, this study identifies the roles and experiences of nurses in primary health care during the COVID-19 pandemic.MethodsA scoping review study design and the Joanna Briggs Institute methodology were used. The study searched five electronic databases (PubMed, CINAHL, EMBASE, Scopus, and PsychINFO) and included studies published in English from March 2020 to June 2023 that focused on the roles and experiences of nurses (participants) during COVID-19 (concept) in primary health care settings (context).ResultsFourteen articles were selected for review, involving a total of 1,487 nurses as study participants. The various roles undertaken by nurses in primary health care settings were categorized as comprehensive care providers, supporters and empowerers, coordinators and collaborators, information navigators, and change agents. Challenges and strategies are multilevel intrapersonal, interpersonal, organizational, community, and societal issues, but are not mutually exclusive.ConclusionsThe pandemic-induced challenges revealed primary health care nurses’ vital and indispensable roles and resilience. They also fostered a heightened awareness of technological influence on the progression of primary health care in the current milieu. Policymakers and healthcare organizations need to integrate primary health care nurses’ expanding and emerging roles within the scope of practice, ensuring their effective implementation without excessive regulatory constraints. This study emphasizes the importance of developing multilevel interventions to address the support needs of primary health care nurses through a system-based approach. Building a strong infrastructure to support nurses’ self-care, offering continuing professional development opportunities, and securing official government recognition will be essential for enhancing the resilience of primary healthcare nurses in preparation for future, potentially devastating pandemics.

Disclosure of medical errors to patients by medical professionals: a protocol for a qualitative systematic review

IntroductionAlthough the disclosure of medical errors is an integral component of medical ethics, it remains inconsistent in practice worldwide. Despite various explanations of why healthcare professionals reveal their mistakes to...

Priority Setting in Norwegian Municipal and Health Care Services: A Thematic Analysis of Public Consultation Documents

Priority Setting in Norwegian Municipal and Health Care Services: A Thematic Analysis of Public Consultation Documents

From classroom to collaboration: how pre-graduation interprofessional learning shapes health professional graduates’ interactions in practice

ABSTRACT Interprofessional education (IPE) aims to prepare health professional students with the knowledge, attitudes and skills required for collaborative healthcare practice. Although positive outcomes have been documented at the completion of university-based IPE experiences, or longitudinally across health care degrees, the literature is unclear on how university-based IPE influences graduate practice. This study therefore explores how health professional graduates experience interprofessional interactions in practice and how these may be connected to their university-based IPE experiences. Interviews with seven health professional graduates who had participated in an 11-week IPE course as part of their pre-licensure degrees were analyzed using interpretative phenomenological analysis. The participants were able to articulate instances of effective and less effective collaboration from their professional experiences, making sense of these experiences with explicit reference to the themes of role understanding, collaborative working relationships, interprofessional communication, patient-centered care and contextual influences; all ideas introduced in their university-based IPE. They connected their understanding of roles, collaborative working relationships and interprofessional communication explicitly to their prior university-based IPE, identifying these learnings as foundational knowledge. This connection was not as explicit for patient-centered care and contextual issues. These findings highlight the critical importance of IPE in preparing health professionals for high-quality contemporary practice.

Automated Detection of Neurodevelopmental Disorders Using Face-to-Face Mobile Technology Among Typically Developing Greek Children: Randomized Controlled Trial.

Neurodevelopmental disorders (NDs) are characterized by heterogeneity, complexity, and interactions among multiple domains with long-lasting effects in adulthood. Early and accurate identification of children at risk for NDs is crucial for timely intervention, yet many cases remain undiagnosed, leading to missed opportunities for effective interventions. Digital tools can help clinicians assist and identify NDs. The concept of using serious games to enhance health care has gained attention among a growing group of scientists, entrepreneurs, and clinicians. This study aims to explore the core principles of automated mobile detection of NDs in typically developing Greek children, using a serious game developed within the SmartSpeech project, designed to evaluate multiple developmental domains through principal component analysis (PCA). A total of 229 typically developing children aged 4 to 12 years participated in the study. The recruitment process involved open calls through public and private health and educational institutions across Greece. Parents were thoroughly informed about the study's objectives and procedures, and written consent was obtained. Children engaged under the clinician's face-to-face supervision with the serious game "Apsou," which assesses 18 developmental domains, including speech, language, psychomotor, cognitive, psychoemotional, and hearing abilities. Data from the children's interactions were analyzed using PCA to identify key components and underlying principles of ND detection. A sample of 229 typically developing preschoolers and early school-aged children played the Apsou mobile serious game for automated detection of NDs. Performing a PCA, the findings identified 5 main components accounting for about 80% of the data variability that potentially have significant prognostic implications for a safe diagnosis of NDs. Varimax rotation explained 61.44% of the total variance. The results underscore key theoretical principles crucial for the automated detection of NDs. These principles encompass communication skills, speech and language development, vocal processing, cognitive skills and sensory functions, and visual-spatial skills. These components align with the theoretical principles of child development and provide a robust framework for automated ND detection. The study highlights the feasibility and effectiveness of using serious games for early ND detection in children. The identified principal components offer valuable insights into critical developmental domains, paving the way for the development of advanced machine learning applications to support highly accurate predictions and classifications for automated screening, diagnosis, prognosis, or intervention planning in ND clinical decision-making. Future research should focus on validating these findings across diverse populations integrating additional features such as biometric data and longitudinal tracking to enhance the accuracy and reliability of automated detection systems. ClinicalTrials.gov NCT06633874; https://clinicaltrials.gov/study/NCT06633874. RR2-https://doi.org/10.3390/signals4020021.

Cardiomyocyte Reduction of Hybrid/Complex N-Glycosylation in the Adult Causes Heart Failure With Reduced Ejection Fraction in the Absence of Cellular Remodeling.

Heart failure (HF) presents a massive burden to health care with a complex pathophysiology that results in HF with reduced left ventricle ejection fraction (EF) or HF with preserved EF. It has been shown that relatively modest changes in protein glycosylation, an essential posttranslational modification, are associated with clinical presentations of HF. We and others previously showed that such aberrant protein glycosylation in animal models can lead to HF. We develop and characterize a novel, tamoxifen-inducible, cardiomyocyte Mgat1 knockout mouse strain, achieved through deletion of Mgat1, alpha-1,3-mannosyl-glycoproten 2-beta-N-acetlyglucosaminyltransferase, which encodes N-acetylglucosaminyltransferase I. We investigate the role of hybrid/complex N-glycosylation in adult HFrEF pathogenesis at the ion channel, cardiomyocyte, tissue, and gross cardiac level. The data demonstrate successful reduction of N-acetylglucosaminyltransferase I activity and confirm that hybrid/complex N-glycans modulate gating of cardiomyocyte voltage-gated calcium channels. A longitudinal study shows that the tamoxifen-inducible, cardiomyocyte Mgat1 knockout mice present with significantly reduced systolic function by 28 days post induction that progresses into HFrEF by 8 weeks post induction, without significant ventricular dilation or hypertrophy. Further, there was minimal, if any, physiologic or pathophysiologic cardiomyocyte electromechanical remodeling or fibrosis observed before (10-21 days post induction) or after (90-130 days post induction) HFrEF development. The tamoxifen-inducible, cardiomyocyte Mgat1 knockout mouse strain created and characterized here provides a model to describe novel mechanisms and causes responsible for HFrEF onset in the adult, likely occurring primarily through tissue-level reductions in electromechanical activity in the absence of (or at least before) cardiomyocyte remodeling and fibrosis.

Examining Physicians’ Approaches to Treating Relatives in Primary Health Care Centers: Insights from a Qualitative Study

Introduction: Family medicine physicians take care of a diverse population of patients with a variety of acute and chronic diseases. These patients include family, friends, and acquaintances who may ask for direct medical care or help in accessing healthcare products and services within or outside of officially approved procedures. This is ethically challenging due to an ambiguous medical code of ethics, but it is commonly accepted as normal behavior by society. The aim of this study was to explore family medicine physicians’ perspectives regarding the benefits, difficulties, and ethics of responding to medical care requests and/or favors from family, relatives, friends, and acquaintances and to make recommendations. Methods: The study sample consisted of junior and senior family medicine physicians working in primary healthcare centers affiliated with the Ministry of Health in Saudi Arabia. In-depth semi-structured interviews were conducted to collect data. Using social exchange theory, this qualitative study explores how family medicine physicians perceive and handle requests for medical favors from family members and others. Results: Semi-structured interviews were conducted with 19 family medicine physicians (six focus groups) with clinical experience ranging from 3 to 20 years. The data analysis identified three themes: perceived benefits and costs of cultural and social connectedness, shortcomings in patient management and healthcare systems, and recommendations to address challenges between physicians and patients who are relatives. Discussion and Conclusions: This study shows that treating others outside of normal access to healthcare services presents several ethical, moral, and professional challenges. Therefore, policy adaptation requires understanding this intricate dilemma and improving laws, system regulations, and guidelines for physicians and community members to improve access to care, reduce system abuse, empower providers, and enhance community awareness and compliance.

Investigation of probable Salmonella outbreak in the National Cancer Institute, Sri Lanka

Abstract Background An outbreak is the occurrence of case of disease in excess of what would normally be expected in a defined community. Outbreaks in immune compromised population can lead to devastating morbidity and mortality. Infection prevention and control (IPC) team has a pivotal role in both averting and managing outbreaks in health care settings. There were 7 cases of Salmonella spp, isolated from blood and stools since 12th July 2023 up to 11th August. Assuming of a possible outbreak, IPC team decided to investigate in order to find a possible source for the outbreak. Methods As soon as the outbreak was confirmed, immediate relevant control measures were taken after studying the available information. Working case definitions was constructed with clinical criteria and laboratory criteria with restrictions by time, place and person. Different categories of case definitions were used as the diagnosis was uncertain, such as “confirmed”, “probable” and “possible”. Active surveillance was conducted to collect information on additional case. Data collection tool was prepared with demographic information, clinical information and risk factor information. Then more cases were detected and line listing was created to organize important information for the investigation. Epidemic curve was drawn to see the pattern of spread and it was an irregularly jagged curve which interprets as intermittent common source epidemic. Specific control and prevention measures were implemented. Inquiries were made regarding the dietary intake of the patients over the last seven days and it was difficult to find a common source of food item however, all patients have consumed food prepared in the hospital kitchen. Therefore an audit was conducted in the hospital kitchen to identify probable source. Kitchen staff was educated about the food safety measures and personal hygiene. Kitchen staff was screened for Salmonella carrier state in their stool. Quality of the water from the kitchen and wards was checked for fecal contamination. No residual food was available for microbiological testing. Hypothesis was formulated to gather information after discussion with patients and staff. Findings were communicated to all relevant parties including Director and clinicians in the hospital. Salmonella isolates were sent to the Enteric Reference Laboratory, Medical Research Institute, Colombo for serotype identification. Results It was difficult find a common source. There were some malpractices in the kitchen and those were corrected immediately. Water quality in the hospital was satisfactory. Kitchen staff were not colonized with salmonella. However egg supplier to the kitchen was changed recently and eggs were supplied last minute and the eggs were not washed prior to cooking. Three isolates sent to the reference laboratory were identified as Salmonella Weltevreden, one as Salmonella Enteritidis, while the remaining three isolates could not be identified to serotype level with the available resources. Conclusion The exact contributory factor to the outbreak remained elusive. However, numerous food safety issues which can lead to cross contamination during the preparation of food were identified. Consequently, prompt investigation and control measures are essential to prevent further food borne outbreaks.

Anorexia nervosa with comorbid autism spectrum disorder: Optimizing care for youth, caregivers, and health care providers

Anorexia nervosa with comorbid autism spectrum disorder: Optimizing care for youth, caregivers, and health care providers

Self-identity explains better breastfeeding intention of ethnic pregnant mothers of Western Nepal: Extending the theory of planned behavior.

Breastfeeding intention is one of the strongest predictors of breastfeeding behavior and practice. The Theory of Planned Behavior (TPB), with its main construct, behavioral intention, is useful to predict actual behavior. While the literature has examined the implications of other theoretical notions such as self-identity, moral norm, descriptive norm, and socio-demographic variables, their roles remain unclear. Similarly, research on ethnic and low-income mothers is even insufficient. Therefore, given the original TPB constructs, our goal was to examine the role of extra theoretical constructs and specific demographic variables, and observe whether the original model would alter. A cross-sectional analytical study was carried out among 325 pregnant mothers in six purposively selected health care facilities of Kaski and Tanahu districts, using structured pro forma, from December 2018 to November 2019. We developed stepwise multivariate logistic regression from the entered and cleaned data, observed the effects on breastfeeding intention (BFI), and checked against multiple parameters. We interpreted the model with adjusted odds ratios and β coefficients, along with the variance explained. Out of 325 pregnant women, more than half (54.8%) were primiparous, and the mean age was 25.1±5 years. All three theoretical constructs of TPB regressed the BFI significantly, with 10.7%, the breastfeeding attitude dominating (β = 0.734, p = .003), and the other two constructs-perceived breastfeeding control (β = 0.659, p = .011) and breastfeeding subjective norm (β = 0.504, p = .045). Interestingly, breastfeeding self-identity added further variance of 5.2% (β = 0.955, p < .001), followed by income, with 3.2% (β = 0.856, p = .001), both of which also tallied large effect sizes. The model parameters showed consistency and robustness. We discuss the variables of the theoretical and extended model for BFI as well as the arguments for the explained variance. Self-identity is a strong and independent predictor of breastfeeding intention and, therefore, should be considered to better prepare for breastfeeding, especially among ethnic pregnant mothers. The direct and intermediate effects of self-concept and income need further study with more robust designs.

Urbanization factors and the vagaries of the rural health care industry in Nigeria: an analysis of the accessibility of healthcare services by older adults in the Nsukka Local Government Area

This study sought to determine the effects of urbanization on access to healthcare services by older adults in Nsukka Local Government Area. The Nigerian healthcare industry is organized under the three tiers of government: Federal, State and Local governments. As such, most of the healthcare facilities are located in urban areas while majority of older adults reside in different local governments in rural communities where there are a few of the facilities. This has led to poor utilization of medical services by older adults in rural areas. This study adopted a mixed method approach. While questionnaire was used to collect quantitative data, interviews were used to collect qualitative data for the study. Questionnaire survey was used to collect data from 1180 older adults between the ages of 60 years and above from six communities in the study area. Descriptive statistics and Chi square were used to analyze the data while frequency distribution tables and percentages were used to present the results. The research showed that there are inadequate health facilities for the older adults in rural communities in Nsukka LGA. It also found that the older adults suffered challenges arising from lack of medical doctors, nurses, equipments, and drugs for effective healthcare delivery. It is recommended that more efforts should be geared towards providing adequate health facilities and health workers by government at public hospitals in rural communities to increase accessibility and adequate utilization by the older adults.

Ethnic disparities in perceived racism, patient-provider communication and healthcare utilization: Asian Americans

ABSTRACT Background Race is a consequential sociocultural cue in healthcare contexts. Racism is associated with health disparities by influencing patient-provider communication and utilization of healthcare services. Objective This study aimed to investigate how Asian American subgroups differ in their perception of everyday racism, internalized racism, and perceived racism in healthcare settings and whether these perceptions predict their interactions with their health care providers and their utilization of healthcare services. Methods An online survey study was conducted. ANOVA tests were employed to compare the differences in perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system among Filipino (N = 310), Japanese (N = 242), Chinese (N = 287), Asian Indian (N = 304), Korean (N = 199) and Vietnamese (N = 151) participants. Multiple regression analyses assessed whether perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system predicted healthcare service utilization and patient-provider communication among the Asian subgroups sampled. Results There were significant group differences in perceived everyday racism (F = 8.56, p < .001), internalized racism (F = 3.46, p < .01), perceived racism in healthcare (F = 4.57, p < .001). Perceptions of racism and socioeconomic variables were found to predict patient-provider communication and utilization of healthcare services disparately across various Asian subgroups. For instance, the perception of everyday racism was a significant predictor of patient-provider communication for each of the subgroups, excluding the Vietnamese participants. Internalized racism was a significant predictor only for Filipino and Chinese participants. Surprisingly, perceived racism in healthcare was not a predictor for any of the subgroups. Conclusion Findings highlight the complex interplay of sociodemographic factors and perceived racism in shaping patient-provider communication and healthcare service utilization within the Asian American community. Implications are suggested for addressing the unique challenges faced by different Asian American subgroups and for promoting equitable healthcare access and fostering positive patient-provider relationships among the Asian American subgroups.

Observable, but Not Unobservable Health Numbers are Associated With Self-Reported Health: NHANES 2017-2020

Objective: Present study explored the influence of self-reported health on diff between observable and unobservable health factors. Method: Data obtained through the 2017-2020 pre-pandemic dataset of the National Health and Nutrition Examination Survey (NHANES). A series of analyses of covariance were conducted with self-reported health as the independent variable, and measures of blood pressure, waist-to-hip ratio, fasting glucose and total cholesterol as dependent variables. Family income served as a covariate. Results: Results revealed significant differences in self-reported health and blood pressure, waist-to-hip ratio, and fasting glucose. Individuals who rated their health excellent or very good tended to have better health numbers than those who rated their health as fair or poor. No statistically significant difference was found with self-reported health and cholesterol. Conclusion: It is possible that health numbers that can be observed (or assessed) at home, without a health care professional, may be more aligned with how individuals perceive their own health. Health care professionals may want to further help patients recognize their own health status. The use of wearable technologies may provide added health information resulting in more accurate perception of health. A more accurate perception of a patient’s own health may aid health care professionals in further improving patient care.

Prevalence of Varicose Veins among Nurses in a Tertiary Care Hospital: A Descriptive Study

Abstract Introduction Millions of individuals worldwide spend significant portions of their workdays standing or in static positions, which can pose health risks such as varicose veins. Globally, varicose vein prevalence ranges from 20 to 60%, with women being at two to three times higher risk compared to men. Varicose veins are characterized by dilated, palpable veins with a diameter larger than 3 mm. Nurses face a 16% risk of developing varicose veins, highlighting the importance of health care professionals' well-being for the effective functioning of the health care system. Therefore, this study aimed to provide insights into the prevalence of varicose vein symptoms among nurses. Methods A descriptive prospective study was conducted among 210 nurses with more than 1 year of experience, using purposive sampling. Demographic information and varicose vein symptoms were collected through a self-designed questionnaire. Descriptive statistics were employed for data analysis. Results The study found that 8.6% of nurses were diagnosed with varicose veins. The majority of participants were female (97.6%) with a normal body mass index (86.7%). Prevalent symptoms included worsened leg pain (77.6%), night cramps (62.4%), and throbbing in lower legs (37.6%). Visible spider veins (19.5%) and other symptoms were reported less frequently. Conclusion A lower prevalence of varicose veins among nurses was identified, possibly due to demographic factors of the study population. It is recommended to conduct health education campaigns tailored for health care professionals, particularly nurses, and implement regular health checkups to screen for varicose veins. These proactive measures are essential for promoting occupational health and ensuring the well-being of the nursing workforce.

Benefit-Cost Analyses of Hearing Aids, Over-the-Counter Hearing Devices, and Hearing Care Services.

Limited accessibility to hearing health care threatens healthy aging in place for older adults with hearing loss. A willingness-to-pay (WTP) approach was used to determine benefits and value of prescription advanced digital technology (ADT) hearing aids, over-the-counter (OTC) hearing devices, and rehabilitative services using benefit-cost analyses. This study was a cross-sectional survey with chart review of hearing aid users at two independent audiology practices. Seventy hearing aid users (response rate: 15.6%) provided their WTP for ADT prescription hearing aids, OTC hearing devices, and hearing rehabilitative services. Benefit-cost ratios and net social benefit were calculated using deterministic and exploratory approaches. Point estimates for benefit-cost ratios and net social benefit were derived using bootstrap sampling with replacement (N = 5,000). Median WTP for ADT prescription hearing aids and rehabilitative services were $2,000 and $250, respectively. WTP was lowest for OTC devices (Mdn = $0; maximum = $500). Benefit-cost ratios and net social benefit for ADT prescription hearing aids, OTC devices, and hearing rehabilitative services favored these interventions when out-of-pocket costs remained low. Benefit-cost analyses also produced results favoring prescription ADT hearing aid intervention with costs as high as $1,530 per device. WTP results indicated that all interventions under study have a measurable consumer-perceived benefit. Results of benefit-cost analyses favored the interventions but only when costs were lower than market prices. The benefit-cost analysis results for hearing care services underscore their value when provided as part of a comprehensive rehabilitative plan that may inform future health policy changes.

Suitability of ChatGPT as a Source of Patient Information for Screening Mammography.

ChatGPT3.5 and ChatGPT4 were released publicly in late November 2022 and March 2023, respectively, and have emerged as convenient sources of patient health education and information, including for screening mammography. ChatGPT4 offers enhanced capabilities; however, it is only available by paid subscription. The purported benefits of ChatGPT for health education need to be objectively evaluated. To assess performance differences, ChatGPT3.5 and GPT4 were used between 13 April and 29 May 2023 to generate breast screening patient information sheets, which were evaluated using the Patient Education Materials Assessment Tool for printed materials (PEMAT-P) and the CDC Clear Communication Index (CDC Index) Score Sheet; and benchmarked against gold standard content in BreastScreen NSW's patient information sheet. Mean scores were reported for comparison. GPT3.5 provided the appropriate tone and currency of information but lacked accuracy, omitting key insights: PEMAT-P understandability 68.0% (SD = 6.56) and actionability 36.7% (SD=20.4); CDC Index 58.8% (SD = 15.3). GPT4 was deemed superior to GPT3.5 but included several key omissions: PEMAT-P understandability 75.0% (SD = 17) and actionability 53.3% (SD = 11.54); CDC Index 66.0% (SD = 4.1). Both ChatGPT versions exhibited poor understandability and actionability and were unclear in their messaging. Those with poor health literacy will not benefit from accessing current versions of ChatGPT and may be further disadvantaged if they do not have access to a paid subscription. ChatGPT is evidenced to be an unreliable and inaccurate source of information concerning breast screening that may undermine participation and risk increased morbidity and mortality from breast cancer. ChatGPT may increase the demand on health care educators to rectify misinformation.

Effect of Nurse-Assisted Early Warning Intervention for Prevention of Venous Thromboembolism Following Cesarean Delivery

Abstract Objective The aim of the study is to assess the role of a nurse-assisted early warning intervention in improving prophylaxis against obstetric venous thromboembolism (VTE) and preventing VTE following cesarean delivery (CD). Methods A prospective cohort study conducted between January 1, 2020, and December 30, 2022, enrolled pregnant women who underwent CD in the obstetric unit of Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital. The patients were assigned to a control group (routine nursing care) or the intervention group (nurse-assisted early warning intervention) depending on whether or not the nurse-assisted early warning intervention had been implemented. The χ 2 test and Student’s t test were used for statistical analysis. The primary outcome was the incidence of systemic VTE following CD, and secondary outcomes were the rates of mechanical or pharmacologic prophylaxis receipts for VTE and the frequency and severity of adverse events related to pharmacologic prophylaxis. Results A total of 27,074 cases were enrolled. The incidence of symptomatic VTE following CD was significantly lower in the intervention group (0.29 per 1000 deliveries) than in the control group (2.4 per 1000 deliveries) (P &lt; 0.001). Significantly more cases received mechanical and pharmacological VTE prophylaxis in the intervention group than in the control group (respectively, 19.8% vs. 12.6% receiving mechanical prophylaxis and 0.9% vs. 0.2% receiving pharmacological prophylaxis). No cases of life-threatening bleeding occurred in either group. Conclusion The application of nurse-assisted early warning intervention may be an effective method for preventing VTE following CD.

Phage Anti-Pycsar Proteins Efficiently Degrade β-Lactam Antibiotics

Metallo-β-lactamases (MBLs) are members of the structurally conserved but functionally diverse MBL-fold superfamily of metallohydrolases. MBLs are a major concern for global health care as they efficiently inactivate β-lactam antibiotics, including the “last-resort” carbapenems, and no clinically suitable inhibitors are currently available. Increasingly, promiscuous β-lactamase activity is also observed in other members of the superfamily, including from viruses, which represents an underexplored reservoir for future pathways to antibiotic resistance. Here, two such MBL-fold enzymes from Bacillus phages, the cyclic mononucleotide-degrading proteins ApycGoe3 and ApycGrass, are shown to degrade β-lactam substrates efficiently in vitro. In particular, ApycGrass displays a distinct preference for carbapenem substrates with a catalytic efficiency that is within one order of magnitude of the clinically relevant MBL NDM-1. Mutagenesis experiments also demonstrate that the loss of a metal-bridging aspartate residue reduces nuclease activity up to 35-fold but improves carbapenemase activity. In addition, we hypothesise that the oligomeric state significantly influences β-lactamase activity by modifying access to the active site pocket. Together, these observations hint at a possible new avenue of resistance via the spread of phage-borne MBL-fold enzymes with β-lactamase activity.