High Usage Rates Research Articles

Optimized medial unicompartmental knee arthroplasty outcome: learning from 20 years of propensity score matched registry data.

Background and purposeUnicompartmental knee arthroplasty (UKA) has increased in use. We investigated changes to UKA revision risk over the last 20 years compared with total knee arthroplasty (TKA), examined external and patient factors for correlation to UKA revision risk, and described the survival probability for current UKA and TKA practice.Patients and methodsAll knee arthroplasties reported to the Danish Knee Arthroplasty Register from 1997 to 2017 were linked to the National Patient Register and the Civil Registration System for comorbidity, emigration, and mortality information. All primary UKA and TKA patients with primary osteoarthritis were included and propensity score matched 4 TKAs to 1 UKA. Revision and mortality were analyzed using competing risk cox regression with a shared gamma frailty component.ResultsThe matched cohort included 48,195 primary knee arthroplasties (9,639 UKAs). From 1997–2001 to 2012–2017 the 3-year hazard ratio decreased from 5.5 (95% CI 2.7–11) to 1.5 (CI 1.2–1.8) due to increased UKA survival. Cementless fixation, a high percentage usage of UKA, and increased surgical volume decreased UKA revision risk, and increased in occurrence parallel to the decreasing revision risks. Current UKA practice using cementless fixation at a high usage unit has a 3-year implant survival of 96% (CI 97–95), 1.1% lower than current TKA practice.InterpretationUKA revision risk has decreased over the last 20 years, nearing that of TKA surgery. High usage rates, surgical volume, and the use of cementless fixation have increased during the study and were associated with decreased UKA revision risks.

Traditional Korean Medicine Usage and Perception: a comparative study between the general population and the disabilities.

ObjectivesThis study is a comparative analysis of the satisfaction and recognition characteristics for traditional Korean medicine (TKM) in people with disabilities and the general population of Korea.MethodsHere, 5,000 subjects were categorized into two groups based on a disability rating using the data from the 2017 National Survey for the Usage of Korean Medicine. The relationships among the sociodemographic characteristics, TKM usage status, recognition of TKM usage, and recognition of the effectiveness of the TKM treatment were analyzed based on the disease. The response reliability was verified using the chi-square test analysis method.ResultsDisabilities corresponded with low rates of high school or higher education (44%, 83.5%) and no jobs (56.9%, 33.5%), mostly the status of the low-income class with a monthly household income of < 1,500 USD (50.9%, 10.5%), poor health conditions (55.2%, 9.8%), high chronic disease prevalence rate (69.0%, 19.9%), high medical care rate (11.2%, 0.5%), and low commercial health insurance subscription rate (44%, 74.2%). Furthermore, people with disabilities visited TKM institutions more often (88.8%, 74.1%) with a high frequency TKM usage rate of ≥ 1-2 times a month (26.2%, 15.3%). They also reported that the cost of using the TKM was very high (14.7%, 8.8%) and that primarily the application of insurance benefits should be improved (52.6%, 47.5%). The treatment effectiveness for diseases was high for musculoskeletal disorders for both people with disabilities and the general population.ConclusionPreferential application of insurance benefits for musculoskeletal diseases must be extended to the TKM treatment as well, as people with disabilities have a high recognition for these conditions with TKM. It is difficult to perform randomized controlled trials on people with disability. Therefore, large-scale observational and cohort studies should be conducted. We hope this study will help establish a suitable TKM policy for people with disabilities.

Drug and pesticide usage for sea lice treatment in salmon aquaculture sites in a Canadian province from 2016 to 2019

We used 4 years of publicly available data (2016–2019) on chemical usage at salmon sites with information on production, stocking, locations and environmental conditions to explore patterns of anti-sea lice treatments in a Canadian province. Results show that sequential chemical treatments are prevalent, emamectin benzoate (EMB) with azamethiphos being the most used combination with a decrease in ivermectin usage. Relatively high rates of usage of EMB per fish biomass may point to potential lice resistance patterns with information needed on mechanisms and local populations. Lower or no chemical usage at some sites indicate less sea lice infestations likely influenced by localized site conditions (coves), and a lessened need for medication due to the usage of cleaner fish and possibly other non-chemical methods (not documented in this report). The year/climate influenced chemical input only in sites with higher treatment levels likely due to effects on sea lice growth and reproduction. Observed differences between years are warmer surface temperature in the fall, a higher freshwater input in spring, and stronger wind conditions for 2017 and 2018 with more medication usage for these two years. The lack of significant effect of site distances calculated in zones of influence based on 24 h potential connectivity patterns highlight the need to refine the resolution of hydrodynamic processes.

Blood-feeding patterns of Anopheles vectors of human malaria in Malawi: implications for malaria transmission and effectiveness of LLIN interventions

BackgroundAccess to human hosts by Anopheles mosquitoes is a key determinant of vectorial capacity for malaria, but it can be limited by use of long-lasting insecticidal nets (LLINs). In Malawi, pyrethroid-treated LLINs with and without the synergist piperonyl butoxide (PBO) were distributed to control malaria. This study investigated the blood-feeding patterns of malaria vectors and whether LLINs containing pyrethroid and PBO led to a reduction of human blood feeding than those containing only pyrethroids.MethodsMosquitoes were sampled inside houses from May 2019 through April 2020 by aspiration, pyrethrum spray catch, and light trap methods in two sites. One site (Namanolo, Balaka district) had LLINs containing only pyrethroids whereas the other (Ntaja, Machinga district) had LLINs with both pyrethroids and PBO. Anopheles species, their blood-meal host, and infection with Plasmodium falciparum were determined using PCR methods.ResultsA total of 6585 female Anopheles were sampled in 203 houses. Of these, 633 (9.6%) were blood-fed mosquitoes comprising of 279 (44.1%) Anopheles arabiensis, 103 (16.3%) Anopheles gambiae 212 (33.5), Anopheles funestus, 2 (0.3%), Anopheles parensis and 37 (5.8%) were unidentified Anopheles spp. Blood meal hosts were successfully identified for 85.5% (n = 541) of the blood-fed mosquitoes, of which 436 (81.0%) were human blood meals, 28 (5.2%) were goats, 11 (2.0%) were dogs, 60 (11.1%) were mixed goat-human blood meals, 5 (0.9%) were dog–human, and 1 was a mixed dog-goat. Human blood index (fraction of blood meals that were humans) was significantly higher in Namanolo (0.96) than Ntaja (0.89). Even though human blood index was high, goats were over-selected than humans after accounting for relative abundance of both hosts. The number of infectious Anopheles bites per person-year was 44 in Namanolo and 22 in Ntaja.ConclusionAlthough LLINs with PBO PBO may have reduced human blood feeding, access to humans was extremely high despite high LLIN ownership and usage rates in both sites. This finding could explain persistently high rates of malaria infections in Malawi. However, this study had one village for each net type, thus the observed differences may have been a result of other factors present in each village.

Opportunities for Antibiotic Stewardship Interventions in a Pediatric Hospital

Abstract Objective This study's objective was to assess an antibiotic stewardship intervention, compare pediatric antibiotic usage in a non-university hospital (Children's Hospital Traunstein [TS]) with a university hospital (Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich [MUC]), and assess adherence to national guidelines. Methods Antibiotic usage pre- and post-antibiotic stewardship (ABS) intervention was compared, and antibiotic prescriptions over 4 months were prospectively recorded. ABS intervention consisted of weekly teaching sessions, antibiotic pocket cards, and rounds with pediatric infectious disease staff. Medical records were reviewed to describe antibiotic consumption, antibiotic dosages and length of use, and adherence to national guidelines. Pediatric antibiotic usage was compared between hospitals and patient groups. Results After the ABS intervention, the use of second-generation cephalosporins decreased, while penicillin with β-lactamase inhibitors (BLI) increased. Survey of antibiotic prescriptions over the 4 months study period in the non-university hospital showed a high administration rate of second-generation cephalosporins and extended-spectrum penicillins in the non-intensive care units (ICU) wards (48.53 and 38.93 days of therapy [DoT]/1,000 patient days [PD], respectively) and a high rate of third-generation cephalosporins in the ICU ward (110.33 DoT/1,000PD). A high prescriptions rate was seen in the neonatal intensive care unit (NICU) wards (DoT/ length of therapy [LoT] ratio of 2.185). Reserve group antibiotics were only given in the ICU. Adherence to national guidelines was highest in the NICU and pediatric ICU wards. Striking was the relatively high rate of incorrect usage of second-generation cephalosporins. Comparing the pediatric wards of the non-university hospital (TS) and the university hospital (MUC), the prescription ratio was 11.1% (TS) versus 30.6% (MUC), and DoT/1,000PD 198.9 (TS) versus 483.6 (MUC), p = 0.02. ABS intervention changed the choice of described antibiotics, but not the overall frequency. Conclusion Adherence to national guidelines was highest in fields with standardized therapy recommendations, like in the NICU. In MUC, antibiotics, in particular restricted ones, were prescribed more frequently, probably due to higher severity of illness.These data indicate that the usage of antibiotics and adherence to national guidelines show a wide variety, but ABS interventions were effective in changing prescription behavior.

Auditing the Representation of Female Versus Male Athletes in Sports Science and Sports Medicine Research: Evidence-Based Performance Supplements.

Although sports nutrition guidelines promote evidence-based practice, it is unclear whether women have been adequately included in the underpinning research. In view of the high usage rates of performance supplements by female athletes, we conducted a standardised audit of the literature supporting evidence-based products: β-alanine, caffeine, creatine, glycerol, nitrate/beetroot juice and sodium bicarbonate. Within 1826 studies totalling 34,889 participants, just 23% of participants were women, although 34% of studies included at least one woman. Across different supplements, 0–8% of studies investigated women exclusively, while fewer (0–2%) were specifically designed to compare sex-based responses. The annual publication of female-specific studies was ~8 times fewer than those investigating exclusively male cohorts. Interestingly, 15% of the female participants were classified as international/world-class athletes, compared with 7% of men. Most studies investigated performance outcomes but displayed poorer representation of women (16% of participants), whereas health-focussed studies had the greatest proportion of female participants (35%). Only 14% of studies including women attempted to define menstrual status, with only three studies (~0.5%) implementing best practice methodologies to assess menstrual status. New research should target the efficacy of performance supplements in female athletes, and future sports nutrition recommendations should specifically consider how well female athletes have contributed to the evidence-base.

SOCIAL MEDIA AND DIGITAL JUSTICE IN NIGERIA: AN APPRAISAL

In recent times, it has become a common knowledge that there are people who are cut off from the flow of information and further isolated from the pull of discussions made possible by digital media. This study, therefore, sought to examine the perception of Southeast residents towards the issues of digital justice in the media space of the country. This study is anchored on the technological determinism theory which was propounded by Marshall McLuhan in 1964. This study adopted the mixed-method research design which deals with the collection of quantitative and qualitative data. According to the National Bureau of Statistics (2017), the population of the southeast is 21,955,400. The sample size of 384 was arrived at using Wimmer and Dominick Online Sample Size Calculator. For the qualitative aspect of the study (in-depth interview), 10 respondents were purposively sampled. Furthermore, the questionnaire and interview guide were the instruments of data collection. The findings of the study revealed that there was a high rate of social media usage among residents in Southeast, Nigeria. Further analysis of data revealed that, at a mean average of 3.0, respondents agree that there are cases of digital injustice in southeast Nigeria. Findings of the study also indicated that, at a mean average of 3.1, respondents identified inadequate telecommunication services, poor network, and lack of knowledge as challenges affecting the actualization of digital justice in the southeast, Nigeria. The researcher concludes that the actualization of digital justice may not be actualized until the residents are given access to digital infrastructure, quality data networks, cheaper social media-enabled gadgets, and cheaper data services. It is recommended that more effort should be put in place by both government and private telecommunication companies to ensure that everybody is connected to digital media.

Interpretable modeling and discovery of key predictors for pneumonia diagnosis in children based on electronic medical records.

BackgroundCommunity-acquired pneumonia is one of the most common infectious diseases in children and is a leading cause of death among children under 5 years of age, resulting in high rates of antibiotic usage and hospitalization. It is of extremely practical significance to make full use of the existing electronic medical records to study pneumonia and to establish automatic diagnosis models for pneumonia.MethodsWe established pneumonia diagnosis models of Bayesian network using a total of 13,448 electronic medical records. We investigated learning network structure and parameter estimation and evaluated different structure learning strategies and various modeling methods. By identifying the key predictors of model, the pneumonia status was analyzed.ResultsThe performance of the proposed Bayesian network was evaluated using a set of 3361 cases with a precision of 0.7861, a recall of 0.9889, and an F1-score of 0.8759. On an independent external validation set containing 4925 cases, Bayesian network achieved a precision of 0.7382, a recall of 0.9947, and an F1-score of 0.8475. Our proposed Bayesian network outperformed all other methods, including CatBoost, XGBoost, LightGBM, logistic regression, and ridge classification.ConclusionThe appropriate feature selection improved the performance of Bayesian networks. The proposed Bayesian network had good generalizability and could be directly applied to clinical research centers. And the key predictors identified by the network demonstrated good clinical interpretability, allowing for a better understanding of pneumonia status and complications. This study had important clinical value and practical significance for the research and diagnosis of pediatric pneumonia.

A design method based on Bayesian decision for routing-based digital microfluidic biochips

With the continuous application and development of the digital microfluidic technology in various fields, many researchers have studied the design of digital microfluidic chips. Module-based chip design methods greatly simplify the design process but waste resources, including through the inadequate use of electrodes within the module and guard cells. To address this problem, a routing-based synthesis method based on a digital microfluidic biochip (DMFB) platform is presented. Routing-based DMFBs ensure a much higher chip utilization factor by removing the virtual modules on the chip and the extra electrodes needed as guard cells. Many previous works focused only on the problems of synthesis completion times, bioassay completion times, and electrode utilization rates. However, the reliability of chips has not been fully studied, and this factor is extremely important because faulty chips affect the test results. Thus, the influence of chip reliability should be fully considered. This paper proposes a design method based on Bayesian decision-making (BBD) for routing-based DMFBs that can fully consider the reliability of chips during the DMFB design process. Simulated experimental results showed that the method can address the reliability problems of chips. The efficiency and convergence performance of the algorithm were very good. The proposed method can achieve an average assay completion time that is shorter than those of the moduleless synthesis (MLS) and modified-MLS (MMLS) methods. The electrode usage rate of the proposed method is better than that of the module-based and improved Dijkstra and improved particle swarm optimization (ID-IPSO) methods.

Precisamos falar sobre uso de Metilfenidato por estudantes de medicina - revisão da literatura

Abstract: Introduction: Studies methylphenidate (MPH) has been used by medical students to increase their mental activity and improve the performance required during undergraduate school, generating concern regarding the risks to their physical and mental health. This scenario indicates the need for specifically aimed measures in medical schools. Objective: To review the literature about the use of MPH without medical indication amongst medical students. Method: A thorough review of the literature published in English, Spanish, and Portuguese, between 2013 and 2019, based on data made available by Pubmed and Scielo, utilizing keywords in the three above languages, along the four stages of the selection process. Results and Discussion: Altogether, 224 articles were found, of which 25 were selected after reading, dealing with the use of MPH or ‘cognition enhancer’ by undergraduate medical students without a doctor’s prescription. The research indicated significant variability in the frequency of consumption, related to the investigated pattern of use, use with or without indication, before or after entering University and country where the study was carried out. The most frequent justification for the use without medical indication was to attain improvement in academic performance. A lack of research with a fair appraisal of the cognition, behavioral and psychic risks involved, among them addiction and the approach of the topic in medical schools, was noted. Conclusion: The high rates of usage of MPH by medical students aiming at cognitive enhancement strengthens the importance of preventative actions in medical schools. The strategies must consider information concerning the risks of use (of MPH) without medical indication; non-pharmacological interventions for performance improvement; sleep hygiene measures organization for adequate study activities; broad discussions about ethical aspects and curricular structure.

Influence of silica fume on mechanical property of cemented paste backfill

The cemented paste backfill (CPB) method, which is the most preferred method for tailings storage, is one of the most used methods for the disposal of mine tailings. However, the high rate of cement usage increases the costs. In this study, whether silica fume (SF), which is a pozzolanic material, can be used as a substitute instead of cement was investigated based on mechanical parameters or not. As a result of the experiments, it was determined that SF substituted for portland cement (PC) increased the strength of paste backfill mixtures prepared in a certain cement ratio. In addition, it was determined that SF substitution in CPB increased the durability of mixtures against sulphate attacks as it did in concrete. With the use of SF, savings of up to 20% were achieved in the amount and cost of cement used in CPB. Besides, using it without the pulverizing process required for pozzolanic materials used in other studies had a positive effect in terms of time and cost. Moreover, the use of SF in CPB mixtures resulted in less energy use and less greenhouse gas emissions, and a reduction of environmental pollution caused by SF tailings.

Analysis of Etiology and Risk Factors of Catheter-Associated Urinary Tract Infection in Critically Ill Patients and Research on Corresponding Prevention and Nursing Measures.

Catheter-associated urinary tract infection (CAUTI) is the most common complication in patients with indwelling catheterization. The incidence of CAUTI in my country is still at a relatively high level compared with foreign countries, especially for the ICU, which has a high usage rate of urinary catheters, to focus on prevention and control. This article focuses on studying the risk factors of CAUTI in critically ill patients and discusses targeted preventive care measures. This article investigates and examines the clinical data of CAUTI in critically ill patients. After statistical analysis, the risk factors that affect CAUTI are summarized, so as to derive the cause of CAUTI in order to strengthen clinical care and to further study the prevention, control, and nursing of CAUTI to provide reference. Clinical data shows that the CAUTI infection rate of patients with catheter indwelling ≥7 days is greater than that of patients with catheter indwelling days less than 7 days. The CAUTI infection rate of the patients who change the urine collection bag every day or ≥7 days is greater than that of the patients who change the urine collection bag within 2 to 4 days.

A study on the use of cryptocurrency wallets from a user experience perspective

Recently, the cryptocurrency market has been overgrowing, many investors from the global stock market entered the cryptocurrency business. Users interact and manage their investments and transactions through the cryptocurrency wallet, which is the gateway to buying, selling, sending, receiving, and trading. Studies and statistics show sixfold growth in cryptocurrency wallet accounts over the past 4 years (2017–2020). However, the rate of inactive trading that occurs during the same period causes market sluggishness. This paper examines the reasons behind the high adoption and low usage rate of cryptocurrency wallets, highlighting the factors impacting the utilization of cryptocurrency wallets. We aim to testify the impact of user experience (UX) on the usage level and the impact of trust on wallet usage. We designed a new model to understand the actual users' behavior on using the cryptocurrency wallets. This model combined User Experience Questionnaire (UEQ) with usability to comprehend UX and add trust as a significant construct to understand the impact of user trust in cryptocurrency wallets. The examination was performed with an actual user on an online survey. The data were analyzed using Smart-PLS. The results show good outcomes that contribute to developing and enhancing the implementation of cryptocurrency wallets. Highlighting the importance of UEQ, Usability, and Trust in a blockchain-based application and showed vital signs affecting wallet users. These results could be applied to enhance cryptocurrency wallet utilization and improving the adoption of blockchain applications.

Stewardship of Prehospital Low Titer O-Positive Whole Blood in a Large Urban Fire-Based EMS System

Introduction: Trauma is the leading cause of death for those aged 1 to 46 years with most fatalities resulting from hemorrhage prior to arrival to hospital. Hemorrhagic shock patients receiving transfusion with 15 minutes experience lower mortality. Prehospital blood transfusion has many legal, fiduciary, and logistical issues. The San Antonio Fire Department participates in a consortium designed to enhance the stewardship of prehospital whole blood. This study aimed to stratify blood usage amongst the field supervisors and special operations units that carry whole blood. Methods: This was a 12-month retrospective analysis of blood usage. Blood tracking forms (used for either blood exchange of transfusion) were cross referenced with city financial records to determine blood usage patterns in the 7th Largest City in the US. We used descriptive statistics, compared usage ratios, and chi-square to compare dichotomized data. Results: A total of 363 whole blood units were obtained and 248 (68.3%) units of whole blood were transfused. EMS field supervisors transfused 74% of whole blood vs. 44% for special operations ambulances (p= <0.001). Response vehicles located in densely populated areas had the highest usage rates. All blood units were either transfused or returned for a zero blood unit wastage for expiration. Conclusion: The information contained within this work can provide other EMS agencies with a basic framework for comparison. The data from the SAFD’s whole blood transfusion rate coupled with the clinical transfusion guideline has provided some insight for prospective agencies considering adopting a whole blood program. EMS systems and municipalities with similar characteristics can project their own whole blood needs and make informed decisions regarding program feasibility and design.

Macroplastic Debris Transfer in Rivers: A Travel Distance Approach

Plastic accumulation in the marine environment is a major concern given the harmful effects and longevity of plastics at sea. Although rivers are likely to significantly contribute to the flux of plastic to marine systems, the behaviour of plastic debris in fluvial systems remains poorly understood and estimates of riverine plastic flux derived from field measurements and modelling efforts are highly uncertain. This paper presents a new probabilistic model of plastic transport in rivers which describes the main processes controlling plastic displacement and which predicts the statistical distribution of travel distances for individual items of buoyant macroplastic debris. Macroplastic transport is controlled by retention in temporary stores (or traps) created by vegetation, bank roughness elements and other obstacles. The behaviour of these traps is represented in the model via a series of Bernoulli trials conducted in a Monte Carlo simulation framework. The model was applied to a tracer experiment in a small 1.1 km river reach. Three replicates were used for calibration and three for validation. For each replicate, 90 closed air-filled polyethylene terephthalate (PET) bottles were introduced at the upstream end of the reach and the location of each bottle was recorded after 24 h. Bottles were chosen as “model” macroplastic litter items given their high usage and littering rate. Travel distances were low. The average and maximum distances travelled over 24 h were 231 m and 1.1 km, respectively. They were also variable. The coefficient of variation of travel distances was 0.94. Spatial patterns were controlled by the location and characteristics of discrete traps. The model was able to describe the observed travel distance distributions reasonably well, suggesting that modelling plastic behaviour in longer reaches and even whole catchments using a stochastic travel distance approach is feasible. The approach has the potential to improve estimates of river plastic flux, although significant knowledge gaps remain (e.g., the rate and location of plastic supply to river systems, the transport behaviours of different types of plastic debris and trap effectiveness in different types of river system, season, and discharge).

P04.22 Tumor treating fields in high-grade glioma patients: A retrospective single-center study

Abstract BACKGROUND Tumor-treating fields (TTFields) are a modern anti-mitotic, non-invasive therapy for the treatment of patients with recurrent and newly diagnosed glioblastoma multiforme (GBM). In Europe, Optune® recieved in 2015 the CE certification. TTFields are a low-intensity (1–3 V/cm) approved therapeutic modality using a non-invasive application of intermediate frequency (200 kHz) alternating electric fields through four transducer arrays directly applied to the skin. The EF-14 study has shown that the addition of TTFields to temozolomide chemotherapy in patients with newly diagnosed GBM significantly improved overall survival (OS) and progression-free survival (PFS) without additional adverse events, apart from mild to moderate skin irritations (Stupp et al., JAMA 2017). MATERIAL We retrospectively analyzed data from TTFields-treated patients (2015–2020) that were treated at our department. Patient characteristics such as MGMT promoter methylation status, age, and diagnosis, as well as treatment duration and TTFields therapy usage, were evaluated for this study. RESULTS 29 patients were treated with TTFields therapy between 2015 and 2020 at our hospital. Most patients received TTFields as primary treatment together with temozolomide maintenance therapy. In detail, 48% of patients were diagnosed with newly diagnosed GBM, 41% received TTFields therapy after tumor recurrence and 10% were diagnosed with other high-grade gliomas. In summary, patients could integrate TTFields therapy into their daily life and showed high adherence to the therapy.Particularly, one of our patients (with MGMT-promoter methylation positive) receives TTFields therapy now for almost 1229 days (approx. 41 months) and is still on therapy. Additionally, this patient shows a high usage rate of 86% indicating well integration of the therapy into daily life. CONCLUSION Taken together, our data provided the outcomes of using TTFields together with chemotherapy in the treatment of recurrent and newly diagnosed GBM in our department. Therapy with TTFields has been showing to provide significant clinical benefit for GBM patients.

Effects of a simulation-based nursing process educational program: A mixed-methods study

AimsTo examine the effects of a simulation-based nursing process educational program on nursing students’ confidence in communication and foundational understanding of the nursing process. BackgroundThe nursing process is a core component of patient-centered nursing care that is underpinned by effective communication. However, learning how to engage patients and carry out the distinct steps of the nursing process can be challenging if students are not able to apply knowledge to practice. Simulation-based learning programs can provide an immersive opportunity for students to enhance their understanding of the nursing process as well as improve their communication skills. DesignA mixed methods randomized controlled trial MethodsTwo Fundamentals of Nursing classes were recruited from a university in northern Taiwan. The experimental group (n = 58) engaged with the simulation-based nursing process educational program, which consisted of an online interactive animation and a standardized patient simulation. The control group (n = 49) was assigned a case-study. Confidence in Communication surveys, assignment and examination scores, satisfaction questionnaires and post-simulation reflection logs were used for data collection. Data were analyzed using SPSS 22.0 and qualitative content analysis. ResultsBoth groups showed statistically significant improvement in Confidence in Communication (p < .001). The experimental group performed better on the assignment than the control group (p < .001). No significant difference was seen between either groups’ examination performances. The animation’s high usage rate (mean 5.91 interactions per-user) and the results of the satisfaction questionnaires indicate the program’s positive reception from the experimental group. The following themes emerged: effective communication skills, problem solving, confidence, feeling prepared and novel learning experience. ConclusionThe results demonstrate that the simulation-based nursing process educational program increased students’ self-confidence in communication and non-verbal communication skills as well as foundational understanding of how to carry out the nursing process. The use of interactive simulation-based learning experiences is recommended to improve nursing students’ understanding of how to apply abstract concepts into practice.

Internet-Based HIV Self-Testing Among Men Who Have Sex With Men Through Pre-exposure Prophylaxis: 3-Month Prospective Cohort Analysis From China.

BackgroundRoutine HIV testing accompanied with pre-exposure prophylaxis (PrEP) requires innovative support in a real-world setting.ObjectiveThis study aimed to determine the usage of HIV self-testing (HIVST) kits and their secondary distribution to partners among men who have sex with men (MSM) in China, who use PrEP, in an observational study between 2018 and 2019.MethodsIn 4 major cities in China, we prospectively followed-up MSM from the China Real-world oral PrEP demonstration study, which provides daily or on-demand PrEP for 12 months, to assess the usage and secondary distribution of HIVST on quarterly follow-ups. Half of the PrEP users were randomized to receive 2 HIVSTs per month in addition to quarterly facility-based HIV testing. We evaluated the feasibility of providing HIVST to PrEP users.ResultsWe recruited 939 MSM and randomized 471 to receive HIVST, among whom 235 (49.9%) were daily and 236 (50.1%) were on-demand PrEP users. At baseline, the median age was 29 years, 390 (82.0%) men had at least college-level education, and 119 (25.3%) had never undergone facility-based HIV testing before. Three months after PrEP initiation, 341 (74.5%) men had used the HIVST provided to them and found it very easy to use. Among them, 180 of 341 (52.8%) men had distributed the HIVST kits it to other MSM, and 132 (51.6%) among the 256 men who returned HIVST results reported that used it with their sexual partners at the onset of intercourse. Participants on daily PrEP were more likely to use HIVST (adjusted hazard ratio=1.3, 95% CI 1.0-1.6) and distribute HIVST kits (adjusted hazard ratio=1.3, 95% CI 1.1-1.7) than those using on-demand PrEP.ConclusionsMSM who used PrEP had a high rate of usage and secondary distribution of HIVST kits, especially among those on daily PrEP, which suggested high feasibility and necessity for HIVST after PrEP initiation. Assuming that fourth-generation HIVST kits are available, HIVST may be able to replace facility-based HIV testing to a certain extent.Trial RegistrationChinese Clinical Trial Registry ChiCTR1800020374; https://www.chictr.org.cn/showprojen.aspx?proj=32481International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2019-036231

Implementation of biopsychosocial supported self-management for chronic primary oro-facial pain including temporomandibular disorders: A theory, person and evidence-based approach.

Aims of the study were to: Implement supported self-management for chronic primary oro-facial pain in a clinical setting. Evaluate its impact on consultation rates, pain severity, interference with life and patient experience. Sixty-six patients with chronic primary oro-facial pain received the intervention at a facial pain clinic at Leeds Dental Institute, UK. Brief Pain Inventory (BPI) scores measured pain severity and interference with life before and after the intervention. Process mining outlined patient care pathways. Monthly consultation rates measured 12months before and after the intervention were used to evaluate burden on healthcare services and economic impact. Patient feedback was assessed via Patient and Public involvement discussion groups. Mean BPI scores significantly improved after intervention-from 5.70 (SD 1.89) to 3.78 (SD 2.34) (p<.001); mean pain interference score reduced from 19.95 (SD 9.41) to 12.05 (SD 9.64) (p<.001). Average monthly consultations significantly (p=.001) reduced from 0.42/month before the intervention to 0.16/month after the intervention. Economic assessment showed cost savings of £293 per patient per year. Process mining showed high rates of service usage with 31 patients also attending 51 other specialist services between them. Patient and Public Involvement discussion groups with 5 patients identified that the intervention was a 'constant companion' and should be implemented at the outset in the care pathway. Supported self-management for chronic primary oro-facial pain has a positive impact on health outcomes (physical functioning, pain intensity and patient experience), as well as service usage and healthcare costs when implemented in a secondary care clinical setting. Reconfiguring current care pathways to upscale early implementation of such interventions should be a priority for future testing.

Investigation of University Students’ Smartphone Usage Levels and Effects

Smartphones are among the most used devices. Considering the high rate of usage by university students, these devices' intended usage is a matter of curiosity. The purpose of this study is to determine the smartphones usage duration and purpose of using for university students. The study was carried out with a qualitative design. In the first stage of the study, smartphones' usage duration were obtained from 29 participants via a smartphone application. Considering these data, in the second stage, data were collected from seven participants via semi-structured interview form. Among the study results, it was determined that smartphones and smartphone applications were used extensively. Although this intensive usage causes on students' physical problems, there is no change in use intensity. According to the results, it was determined that the level of use of smartphones for following the educational processes or for improving learning is in the last place. Besides, problems were identified in students' participation in learning processes and focusing on lessons. The most used application types are messaging, social networks, video watching and editing, and game applications. Among the study's suggestions, reducing students' intensively usage and guiding students for using smartphone applications that support learning processes are stated.