International Clinical Experience Research Articles

Experience in endoscope choice for neuroendoscopic lavage for intraventricular hemorrhage of prematurity: a systematic review.

Intraventricular hemorrhage (IVH) of prematurity occurs in 20-38% of infants born < 28 weeks gestational age and 15% of infants born in 28-32 weeks gestational age. Treatment has evolved from conservative management and CSF diversion of temporizing and shunting procedures to include strategies aimed at primarily clearing intraventricular blood products. Neuroendoscopic lavage (NEL) aims to decrease the intraventricular blood burden under the same anesthetic as temporizing CSF diversion measures in cases of hydrocephalus from IVH of prematurity. Given the variety of neuroendoscopes, we sought to review the literature and practical considerations to help guide neuroendoscope selection when planning NEL. We conducted a systematic review of the literature on neuroendoscopic lavage in IVH of prematurity to examine data on the choice of neuroendoscope and outcomes regarding shunt rate. We then collected manufacturer data on neuroendoscopic devices, including inflow and outflow mechanisms, working channel specifications, and tools compatible with the working channel. We paired this information with the advantages and disadvantages reported in the literature and observations from the experiences of pediatric neurosurgeons from several institutions to provide a pragmatic evaluation of international clinical experience with each neuroendoscope in NEL. Eight studies were identified; four neuroendoscopes have been used for NEL as reported in the literature. These include the Karl Storz Flexible Neuroendoscope, LOTTA® system, GAAB system, and Aesculap MINOP® system. The LOTTA® and MINOP® systems were similar in setup and instrument options. Positive neuroendoscope features for NEL include increased degrees of visualization, better visualization with the evolution of light and camera sources, the ability to sterilize with autoclave processes, balanced inflow and outflow mechanisms via separate channels, and a working channel. Neuroendoscope disadvantages for NEL may include special sterilization requirements, large outer diameter, and limitations in working channels. A neuroendoscope integrating continuous irrigation, characterized by measured inflow and outflow via separate channels and multiple associated instruments, appears to be the most commonly used technology in the literature. As neuroendoscopes evolve, maximizing clear visualization, adequate inflow, measured outflow, and large enough working channels for paired instrumentation while minimizing the footprint of the outer diameter will be most advantageous when applied for NEL in premature infants.

Correct understanding of the non-surgical management options in the treatment of intermittent exotropia in children

Intermittent exotropia is the commonest type of strabismus, and surgery is the primary treatment. Follow-ups and other non-surgical management options can be used for patients who are younger, less cooperative, with well controlled exotropia, or unwilling to operate. However, there are many misconceptions regarding the treatment, especially the non-surgical treatment of intermittent exotropia in children, due to lack of thorough understanding about the natural course of intermittent exotropia, the timing for surgery, and the suitable candidates, effectiveness, and potential risks of different non-surgical options. This article provide an objective evaluation about the common non-surgical management options of intermittent exotropia based on the international research findings and clinical experience, in order to facilitate the correct understanding and rational use of the non-surgical treatment.

On terminology and topographic classification of the lingual lymph nodes

A review of accumulated international clinical experience and prognostic significance calculations of metastatic involvement of the lingual lymph nodes is given. Anatomical terminology of lingual lymph nodes and its contradictive aspects are discussed. It is shown that metastatic lesions of the lingual lymph nodes posses high prognostic value, therein a topographic anatomic classification of the lingual lymph nodes is needed to increase the efficiency of diagnosis and augmenting of the oncologic treatment results. This classification should be unified to avoid misunderstanding between researchers.

Application of artificially intelligence in various fields

In the past two decades, research into artificial intelligence has resulted in significant improvements in the performance of both production and service systems. Current research indicates that an article presenting a comprehensive literature overview of international research, different theoretical, and clinical experience in the area of artificial intelligence is urgently required. This article presents the current state-of-the-art in ai technologies in an integrated, succinct, and beautifully distilled style in order to demonstrate the experiences gained in the area of artificial intelligence. This article, in particular, gives a comprehensive overview of current breakthroughs in the information systems discipline (AI) and its implementations. The work is aimed for those who are just getting started in the area of artificial intelligence. It also serves to remind experienced researchers of some of the issues they are already familiar with.

Experiences of nurse educators facilitating and teaching in an international setting.

Multiple studies focus on the experiences of visiting students from high resource regions that participated in clinical placements in lower resource countries but less focus on the experiences of the educators accompanying students. The purpose of this study was to explore the experiences of educators during an international clinical placement of nursing students in a country in West Africa. We implemented a focussed ethnographic design. We purposively sampled educators who accompanied students on an international clinical placement. Data collection from 2018 to 2019 consisted of in-depth individual interviews. We utilized Roper and Shapira's (2000, 10.4135/9781483328294.) data analysis process, which includes coding keywords, identifying patterns and theorizing. Three themes emerged from the data: rewards in accompanying students, challenges experienced and the need for mentoring and continuous support. Educators found it rewarding to see growth in students, how students developed as global citizens, how students developed critical thinking and problem-solving skills and create lifelong friendships. Educators who accompany nursing students to international clinical placement experience valuable learning and challenging issues. Educators must navigate, support and advance student learning when on an international placement. It is crucial to have adequate institutional support from both the home and host country.

Physical activity and exercise in peritoneal dialysis: International Society for Peritoneal Dialysis and the Global Renal Exercise Network practice recommendations.

Life participation requiring physical activity and physical function is a key patient-reported outcome for people receiving peritoneal dialysis (PD). Clinician guidance is required from multidisciplinary sources regarding exercise and activity advice to address the specific needs of this group. From August 2020 through to June 2021, the Global Renal Exercise Network and the International Society for Peritoneal Dialysis reviewed the published literature and international clinical experience to develop a set of clinical practice points. A set of questions relevant to physical activity and exercise were developed from the perspective of a person receiving PD and were the basis for the practice point development. The GRADE framework was used to evaluate the quality of evidence and to guide clinical practice points. The review of the literature found sparse quality evidence, and thus the clinical practice points are generally based on the expert consensus of people receiving PD, PD exercise expert clinicians and experienced PD exercise researchers. Clinical practice points address timing of exercise and activity (post-catheter insertion, peritoneal space empty or full), the uptake of specific activities (work, sex, swimming, core exercise), potential adverse outcomes related to activity and exercise (exit site care, perspiration, cardiovascular compromise, fatigue, intra-abdominal pressure), the effect of exercise and activity on conditions of interest (mental health, obesity, frailty, low fitness) and exercise nutrition.

Врожденная корь (клинический случай)

В статье представлено обобщение международных практических рекомендаций и зарубежного клинического опыта наблюдения за детьми, рожденными матерями, больными корью, в разные сроки беременности; приведены международные критерии диагноза «врожденная корь». Описан собственный опыт ведения одного из клинических случаев врожденной кори во время вспышки 2017–2018 годов в условиях областной детской клинической больницы.

The Role of Debriefing in a Community Health Study Abroad.

Study abroad experiences offer nursing students the opportunity to develop cultural competence and sensitivity while providing care within the context of a different culture. Debriefing is a strategy that engages students in conversation and active reflection to process emotions, examine personal values, and synthesize knowledge gained from active learning experiences. While debriefing can enhance learning outcomes in study abroad programs, there is currently a paucity of literature that explores its use within the context of study abroad. In this article, we describe a structured debriefing approach we use in an international community health clinical experience. We conclude with a discussion of the lessons we have learned to improve the effectiveness of our debriefing sessions and recommendations for future research.

Current status and further potential of lung donation after circulatory death.

Chronic organ shortage remains the most limiting factor in lung transplantation. To overcome this shortage, a minority of centers have started with efforts to reintroduce donation after circulatory death (DCD). This review aims to evaluate the experimental background, the current international clinical experience, and the further potential and challenges of the different DCD categories. Successful strategies have been implemented to reduce the problems of warm ischemic time, thrombosis after circulatory arrest, and difficulties in organ assessment, which come with DCD donation. From the currently reported results, controlled-DCD lungs are an effective and safe method with good mid-term and even long-term survival outcomes comparable to donation after brain death (DBD). Primary graft dysfunction and onset of chronic allograft dysfunction seem also comparable. Thus, controlled-DCD lungs should be ceased to be treated as marginal and instead be promoted as an equivalent alternative to DBD. A wide implementation of controlled-DCD-lung donation would significantly decrease the mortality on the waiting list. Therefore, further efforts in establishment of legislation and logistics are crucial. With regard to uncontrolled DCD, more data are needed analyzing long-term outcomes. To help with the detailed assessment and improvement of uncontrolled or otherwise questionable grafts after retrieval, ex-vivo lung perfusion is promising.

Virtual Study-Abroad Through Web Conferencing: Sharing Knowledge and Building Cultural Appreciation in Nursing Education and Practice.

With a focus on building global citizens, a U.S. and Norwegian academic collaborative partnership fostered clinical learning experiences addressing cultural and health care comparisons. High-impact educational practices integrated into international clinical experiences, combined with virtual global learning classrooms, highlighted the Sustainable Development Goals. Given nursing education's requirements, devising innovative strategies expanded global learning in brief but transformative experiences while integrating nontraveling students, especially relevant considering current pandemic-related travel restrictions. We developed an educational experience pairing U.S. students (17 in person; 64 through web conference) and Norwegian students (50 in person; 3 for web conference) in population health experiences, providing required clinical hours and a shared cultural exchange. Integration of nontraveling students in joint virtual global experiences broadened the global learning opportunity for all. This work offers insight into how faculty used a virtual global learning experience as a synergistic tool with traditional study abroad.

Consensus of Chinese experts on clinical detection of molecular markers of colorectal cancer

Colorectal cancer is one of the malignant tumors with the highest morbidity and mortality in China. With the research of precision medicine concept and tumor-related molecular markers, appropriate detection and application of colorectal cancer-related molecular markers has become an important part of current clinical practice. In order to effectively solve the current clinical problems and improve clinicians' understanding and application of molecular markers on colorectal cancer, the Chinese Society of Clinical Oncology(CSCO) Colorectal Cancer Expert Committee organized experts in related fields to write an expert consensus on molecular markers of colorectal cancer based on recent domestic and international clinical trial and clinical experience. The consensus mainly provides guidance on testing specimens, molecular markers and testing methods, and interpretation of testing results. It aims to provide clinicians with standardized clinical reference for diagnosis and treatment, and standard and effective treatment for patients with colorectal cancer.

Mentorship programs for nurse educators accompanying nursing students on international placements to low-middle-income countries: a scoping review protocol.

This scoping review will synthesize literature on mentorship programs for nurse educators who accompany nursing students on international placements to low-middle-income countries. University nursing programs have been increasingly incorporating global health education into their curricula. Nurse educators play a significant role in the provision of international clinical experiences for nursing students by supporting and developing confidence and clinical competence. The contribution of nurse educators can affect a student's decision to remain in the profession, suggesting that providing quality professional development for nurse educators is a worthwhile investment. The challenges that come with this role require the development of a mentorship program for nurse educators who accompany nursing students on international placements to low-middle-income countries. This scoping review will include studies that consider mentorship programs for nurse educators who accompany nursing students on clinical placements in low-middle-income countries. This scoping review will consider experimental and quasi-experimental studies, qualitative studies, text and opinion papers, dissertations, theses, conference reports, and gray literature. Studies published within the previous 40 years will be included as a systematic approach to global education started in the early 1980s. Databases to be searched include MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Sociological Abstracts (ProQuest), and Global Health (Ovid). Following screening, all identified citations will be collated. Titles and abstracts will be screened by two independent reviewers. Potentially relevant studies will be retrieved in full and assessed for inclusion. Data will be extracted by two independent reviewers and presented in diagrammatic or tabular format and accompanied by a narrative summary.

Surgical site infections: guidance for elective surgery during the SARS-CoV-2 pandemic – international recommendations and clinical experience

BackgroundThe COVID-19 pandemic not only had an impact on public life and healthcare facilities in general, but also affected established surgical workflows for elective procedures. The strategy to protect patients and healthcare workers from infection by SARS-CoV-2 in surgical departments has needed step-by-step development. Based on the evaluation of international recommendations and guidelines, as well as personal experiences in a clinical ‘hot spot’ and in a 450-bed surgical clinic, an adapted surgical site infection (SSI) prevention checklist was needed to develop concise instructions, which described roles and responsibilities of healthcare professionals that could be used for wider guidance in pandemic conditions.MethodPublications of COVID-19-related recommendations and guidelines, produced by health authorities and organizations, such as WHO, US-CDC, ECDC, the American College of Surgery and the Robert Koch Institute, were retrieved, assessed and referenced up to 31st January 2020. Additionally, clinical personal experiences in Germany were evaluated and considered.ResultsPart 1 of this guidance summarizes the experience of a tertiary care, surgical centre which utilized redundant hospital buildings for immediate spatial separation in a ‘hot spot’ COVID-19 area. Part 2 outlines the successful screening and isolation strategy in a surgical clinic in a region of Germany with outbreaks in surrounding medical centres. Part 3 provides the synopsis of personal experiences and international recommendations suggested for implementation during the COVID-19 pandemic.ConclusionUnderstanding of COVID-19, and SARS-CoV-2-related epidemiology, is constantly and rapidly changing, requiring continuous adaptation and re-evaluation of recommendations. Established national and local guidelines for continuation of surgical services and prevention of SSI require ongoing scrutiny and focused implementation. This manuscript presents a core facility checklist to support medical institutions to continue their clinical and surgical work during the COVID-19 pandemic.

Case Series Comparing Physical Therapy International Clinical Education Experiences in a Developed and Developing Country and Measuring Against Professional Standards and Guidelines

Background. With a growing vision for globalization and internationalization in higher education, a number of Commission on the Accreditation of Physical Therapy Education (CAPTE)–accredited physical therapist education programs across the United States have begun to routinely place their students at international sites for one of their full-time clinical education experiences in both developed and developing countries. The purpose of this article is to compare and contrast the physical therapy international clinical education experience in both the developed and developing country and compare the experiences to professional standards and guidelines. Case Description. This case series describes the experience of 9 physical therapy students in an 8- to 10-week, full-time, international, clinical education experience. Four were placed in the developed country of Italy, and 5 were placed in the developing country of Belize. All students participated in preclinical preparation and experienced cultural immersion for the 8–10 weeks that they participated in the full-time clinical education experience. Outcomes. Evaluative materials consisted of a student weekly questionnaire, an electronic student journal, a Clinical Site Evaluation Form, and comments/ratings from the student's self-assessment on the American Physical Therapy Association's Clinical Performance Instrument. Analysis of the data demonstrated that the participants were experiencing a depth and breadth of clinical experiences commensurate with CAPTE criteria in both the developed and developing settings. Both settings afforded learning experiences in cross-cultural communication and cultural considerations with the developing country posing more cross-cultural practice challenges than the developed country. Discussion and Conclusions. Comparison of the data with a proposed model and guidelines for optimizing international clinical education experiences demonstrated alignment in both the developed and developing country experiences. Both international clinical education experiences met CAPTE standards and other professional standards and proved to be a broadening experience for the participants.

Consensus for the management of analgesia, sedation and delirium in adults with COVID-19-associated acute respiratory distress syndrome.

ObjectiveTo propose agile strategies for a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for patients with COVID-19-associated acute respiratory distress syndrome, considering the high risk of infection among health workers, the humanitarian treatment that we must provide to patients and the inclusion of patients’ families, in a context lacking specific therapeutic strategies against the virus globally available to date and a potential lack of health resources.MethodsA nonsystematic review of the scientific evidence in the main bibliographic databases was carried out, together with national and international clinical experience and judgment. Finally, a consensus of recommendations was made among the members of the Committee for Analgesia, Sedation and Delirium of the Sociedad Argentina de Terapia Intensiva.ResultsRecommendations were agreed upon, and tools were developed to ensure a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for adult patients with acute respiratory distress syndrome due to COVID-19.DiscussionGiven the new order generated in intensive therapies due to the advancing COVID-19 pandemic, we propose to not leave aside the usual good practices but to adapt them to the particular context generated. Our consensus is supported by scientific evidence and national and international experience and will be an attractive consultation tool in intensive therapies.

Лечение коморбидных пациентов с дислипидемией в реальной клинической практике: возможности питавастатина

This paper summarizes international clinical experience with the next generation of statins, pitavastatin, in dyslipidemias. This medication is effective at a dose of 1–4 mg in most patients (including comorbid patients) compared to other statins. Pitavastatin affects various parameters of the lipid profile (i.e., total cholesterol, high-density, low-density, and very-low-density lipoprotein cholesterol, triglycerides, apolipoproteins) and provides pleotropic effects (plaque stabilization, reduction in the levels of systemic inflammatory markers, antithrombotic and antidiabetic effects etc.). The unique structure of this medication and its metabolism account for the minimal risk of adverse effects (AEs) or drug interactions. Hence, pitavastatin is recommended for elderly and senile patients with senile asthenia, patients receiving multiple therapies or individuals with intolerance to other statins. Pitavastatin is prescribed as monotherapy or along with ezetimibe. Long-term taking is associated with the reduction in the rate of cardiovascular events and minimal AEs. This case report (a 65-year-old woman with dyslipidemia, comorbidities, and high cardiovascular risk) illustrates the efficacy and safety of pitavastatin. KEYWORDS: dyslipidemia, hypercholesterolemia, comorbidity, lipid-lowering therapy, high cardiovascular risk. FOR CITATION: Sedykh D.Yu., Khryachkova O.N., Kashtalap V.V., Barbarash O.L. Treatment for dyslipidemia in comorbid patients in real clinical practice: potentialities of pitavastatin. Russian Medical Inquiry. 2021;5(4):218–224 (in Russ.). DOI: 10.32364/2587-6821- 2021-5-4-218-224.

Co-editors' notes

Co-editors' notes

Diagnosis and treatment pathway for pneumonia in patients with diabetes mellitus: a Chinese experts' consensus

Patients with diabetes mellitus are prone to various infections owing to host immune impairment, especially pneumonia. In China, morbidity of pneumonia in patients with diabetes mellitus is high. And in case of pneumonia, patients with diabetes mellitus were of increased probability of opportunistic infections, low detection rate of pathogens, more severe pneumonia and high mortality, resulting in heavy medical and economic burdens. Therefore, it is urgent for multi-disciplinary experts to explore and formulate standards for diagnosis and treatment of pneumonia in patients with diabetes mellitus to improve the prognosis. Based on domestic and international literatures and clinical experiences of experts in respiratory and critical care medicine, endocrinology, microbiology and clinical pharmacy, a consensus was developed on the diagnosis and treatment of pneumonia in patients with diabetes mellitus.

Prevention of COVID-19-associated Haemostasis Failure in Patient with Stented Coronary Arteries: a Clinical Case

Introduction.In patients with COVID-19, acute pulmonary lesion grows on inflammation and microvascular thrombosis. Thromboinflammation may develop outside alveolar endothelium and affect endothelium of the heart, kidneys, intestine and other vital organs leading to a multiple-organ insufficiency and possible lethal outcomes. Treatment and prevention of SARS-CoV-2 in the Russian Federation should comply with the Interim Methodological Guidelines of the Russian Ministry of Health that support the global mainstream of COVID-19 containment measures and are updated regularly with new evidence on drug effectiveness, including anticoagulants.Materials and methods.We review a clinical case of effective treatment of a COVID19 patient with prior coronary surgery from the perspective of the Interim Methodical Guidelines of different editions and international clinical experience in anticoagulant therapy.Results and discussion.A retrospective analysis of the patient’s treatment demonstrated the efficacy of thromboelastography in rapid assessment of blood hypercoagulation and parnaparin sodium as a drug of choice among low-molecular heparins in a combined setting with dual antiplatelet therapy. Etiotropic therapy rendered to this patient is currently considered less effective.Conclusion.Combination of anticoagulants with antiaggregants is shown effective under high risks of thrombosis and a background COVID-19 infection, if justified clinically. In cases of complicated diff erential diagnosis, selection of optimal management strategy, anticoagulant and/or antiplatelet therapy monitoring, a good practice is to rely on both the available domestic guidelines and latest meta-analyses combined with international clinical experience.

Launch of Master’s program (M.Sc.) in Health Economics and Statistics in Taras Shevchenko National University of Kyiv

Health Economics has now evolved into a complex science that is based on related disciplines, including epidemiology, statistics, psychology, sociology, operations research, and mathematics. Thus, Health Economics is a set of economic and statistical disciplines that serve as the basis for decision-making by healthcare providers and governments. It also includes a set of analytical methods used in the analysis of the healthcare market.&#x0D; Health Economics and Statistics is a modern master’s program with the main objective to prepare statistics specialists who are able to solve complex problems, make appropriate analytical decisions in the field of clinical research and management decisions in the field of public health that involves conducting research and fostering innovation in the face of uncertainty. Studying statistical methods enables students to acquire up-to-date analytical skills applied to clinical research and healthcare management.&#x0D; The objectives of the Master’s program are focused on providing students with the necessary information about international clinical research experience, forming a critical understanding of the pricing process on the healthcare market, as well as the mechanism for reimbursement of medical expenses in the world. In addition, the program will provide students with an understanding of the organization of existing health systems and methods needed to analyze health policies.&#x0D; The advantages of the program are tied to the goals of the acquisition of applied statistical analysis skills, which is an indispensable requirement of high qualification of an analyst in clinical research and public health. This is ensured by: 1) integration of practice with academic training; 2) the opportunity to contribute to the development of one's own potential; 3) expanding the capacity for scientific research; 4) the opportunity to defend a master’s thesis, working on a real project; 5) providing real career perspectives.&#x0D; Thus, the implementation of this program will provide an opportunity to prepare highly qualified specialists – analysts in the field of clinical research and public health. Specialists who are in high demand in the private sector (clinical research market) on the national and international level, in the national, regional and local NGOs and institutions in positions related to the planning, collection, processing, and analysis of clinical and public health data, as well as evaluating the quality of managerial decisions in healthcare. All of this, in turn, will help to ensure the competitiveness of specialists and increase the prestige of the specialty.