Management Advice Research Articles

A Multifaceted Assessment of the Consultation Liaison Psychiatry Service Within a Regional Australian Hospital

Background: Medical and mental health conditions have a reciprocal relationship, with each impacting the other. Consultation–liaison psychiatry (CLP) is a sub-speciality that addresses psychiatric comorbidities in the general hospital system and positively impacts hospital resources through its service aspects of ‘consultation’ and ‘liaison’. This multi-faceted evaluation aims to describe and evaluate the characteristics of a regional CLP service. Methods: Retrospective evaluation of all referrals accepted by CLP between May 2021 and 2022 were reviewed through the hospital’s electronic records. An evaluation tool was designed to assess multiple aspects of care, including the source of referrals, the reasons for referral, patient demographics, how quickly the patient was seen, information on their mental health, and the details and timeframe of CLP involvement. Findings: There were 147 patients included in this study. Doctors were the primary referrers (92%). A total of 94% of patients were reviewed within 24 h of the referral being received. Referral reasons were balanced across diagnostic clarification/review, medication review, and risk review. A large proportion of referrals were aged > 60 years. There was a large proportion of patients who lived rurally, requiring hospital transfer. CLP involvement was primarily required to provide a diagnosis (91% of patients) and provide pharmacological management advice (88%). Conclusions: The CLP service currently operates with limited resources, and without additional support, the sustainability of the service will become increasingly challenged due to population ageing. It is essential that we address this issue to ensure that the community’s needs are met effectively.

Pengaruh Nilai Pelanggan dan Pengalaman Pengunjung Terhadap Loyalitas Pengunjung di Jakabaring Sport City

The sports and recreation sector in Jakabaring Sport City, Palembang, plays an important role in improving the quality of life of the community, but the challenge of maintaining visitor loyalty is a major concern. This research aims to analyze the influence of customer value and visitor experience on loyalty at Jakabaring Sport City. The research method used was quantitative with multiple regression analysis, involving 135 respondents selected by accidental sampling. Data was collected through a questionnaire with a Likert Scale. The results of the analysis show that customer value and visitor experience partially have a significant effect on loyalty. The conclusion of this research is that increasing the value and experience felt by visitors can encourage higher loyalty. The advice for managers is to continue to improve the quality of services and facilities, as well as create interesting experiences. The Palembang City Government is advised to support the development of infrastructure that supports accessibility, while visitors are expected to provide feedback for continuous improvement. This research provides an important contribution for managers in designing effective strategies to attract and retain visitors to Jakabaring Sport City. Keywords: customer value, visitor experience, customer loyalty, satisfaction

Growth Patterns of Small Pelagic Fish in West Africa

Small pelagic fishes play important ecological roles in marine ecosystems, constitute some of the most economically valuable fisheries resources, and play a vital role in West African food security. Often living in upwelling regions, these species appear to have developed mechanisms to cope with environmental variability, such as opportunistic reproductive tactics, enhancing their growth performance, or increasing their egg production by following the more predictable system attributes of seasonal cycles. To test this hypothesis, we investigated size-dependent patterns of the two growth mechanisms (i.e., growth rate) of two West African small pelagic populations (Ethmalosa fimbriata and Sardinella maderensis) in upwelling environments. These results were discussed with other areas in African tropical Atlantic waters. The monthly mean length of both species showed a large variation over the study period. Based on the fish length-frequency data and a coastal upwelling index, we found that the growth peaks of the species tended to occur during the most intense periods of upwelling (March–April). This study showed a significant decrease in size compared with other species found in other regions. It demonstrates how the geographical distribution of the same species, together with location-specific variation in temperature and food, can combine to determine local and regional growth responses in pelagic fish. Changes in growth rate may be an adaptive tactic in response to environmental change, as well as phenotypic plasticity in fish. This knowledge is essential to predict future changes in fish productivity and distribution vs. climate and to provide effective advice for ecosystem-based management.

Is the information provided by large language models valid in educating patients about adolescent idiopathic scoliosis? An evaluation of content, clarity, and empathy : The perspective of the European Spine Study Group.

Large language models (LLM) have the potential to bridge knowledge gaps in patient education and enrich patient-surgeon interactions. This study evaluated three chatbots for delivering empathetic and precise adolescent idiopathic scoliosis (AIS) related information and management advice. Specifically, we assessed the accuracy, clarity, and relevance of the information provided, aiming to determine the effectiveness of LLMs in addressing common patient queries and enhancing their understanding of AIS. We sourced 20 webpages for the top frequently asked questions (FAQs) about AIS and formulated 10 critical questions based on them. Three advanced LLMs-ChatGPT 3.5, ChatGPT 4.0, and Google Bard-were selected to answer these questions, with responses limited to 200 words. The LLMs' responses were evaluated by a blinded group of experienced deformity surgeons(members of the European Spine Study Group) from seven Europeanspine centers. A pre-established 4-level rating system from excellent to unsatisfactory was used with a further rating for clarity, comprehensiveness, and empathy on the 5-point Likert scale. If not rated 'excellent', the raters were asked to report the reasons for their decision for each question. Lastly, raters were asked for their opinion towards AI in healthcare in general in six questions. The responses among all LLMs were 'excellent' in 26% of responses, with ChatGPT-4.0 leading (39%), followed by Bard (17%). ChatGPT-4.0 was rated superior to Bard and ChatGPT 3.5 (p = 0.003). Discrepancies among raters were significant (p < 0.0001), questioning inter-rater reliability. No substantial differences were noted in answer distribution by question (p = 0.43). The answers on diagnosis (Q2) and causes (Q4) of AIS were top-rated. The most dissatisfaction was seen in the answers regarding definitions (Q1) and long-term results (Q7). Exhaustiveness, clarity, empathy, and length of the answers were positively rated (> 3.0 on 5.0) and did not demonstrate any differences among LLMs. However, GPT-3.5 struggled with language suitability and empathy, while Bard's responses were overly detailed and less empathetic. Overall, raters found that 9% of answers were off-topic and 22% contained clear mistakes. Our study offers crucial insights into the strengths and weaknesses of current LLMs in AIS patient and parent education, highlighting the promise of advancements like ChatGPT-4.oand Gemini alongside the need for continuous improvement in empathy, contextual understanding, and language appropriateness.

Growth, mortality, exploitation, and recruitment patterns of Labeobarbus altianalis (Boulenger, 1900) in River Kuja-Migori, Kenya

The Ripon barbel, Labeobarbus altianalis, a riverine fish found in the Lake Victoria Basin is regarded as species of less concern, but it is vulnerable to overfishing and population decline. This study aimed at determining growth, mortality, exploitation rate, and recruitment patterns of L. altianalis (Boulenger, 1900) in River Kuja-Migori. A total of 1,217 specimens with overall total lengths ranging from 9.5-41.5 cm (mean 28.5 ± 2.7) were collected monthly from January to December 2021. The fish were caught using an electrofisher in wadable areas and monofilament nets in deeper areas. Electronic length frequency analysis (ELEFAN) software in Fish Stock Assessment Tools (FiSAT II) program was used to analyze data. Natural mortality (M) Fishing mortality (F) and total mortality (Z) coefficients were 0.15 year-1, 0.52 year-1 and 0.67 year-1 respectively. The asymptotic length (L∞) was 44.94 cm TL while the instantaneous growth rate (K) was 0.15 year-1. The exploitation rate was 0.44 year-1 and the length-based growth performance index (Ø’) was 3.03. Results indicated that the longevity of L. altianalis was 9 years. Recruitment occurs throughout the year with bimodal annual recruitment peaks coinciding with the two rainy seasons in the region. This study provides important information for developing management advice for the L. altianalis riverine fishery.

Sea Level Rise in Europe: Summary for Policymakers

Abstract. Sea level rise (SLR) is a global concern for low-lying coastal areas, including many European coasts. The European Knowledge Hub on Sea Level Rise (KH-SLR), a collaborative effort by the Joint Programming Initiatives for “Connecting Climate Knowledge for Europe” (JPI Climate) and for “Healthy and Productive Seas and Oceans” (JPI Oceans), has developed the 1st Assessment Report (SLRE1) to address the challenges posed by SLR in Europe. The report's target audience includes national and subnational bodies focused on research and policy advice for coastal management and climate adaptation, as well as European experts who contribute to shaping policy frameworks and collecting information at a pan-European scale. This report, preceded by a series of targeted surveys and workshops with researchers and stakeholders (e.g. coastal decision-makers), has synthesized the current scientific knowledge on SLR drivers, impacts, and policies at local, national, and European basin scales. It provides in-depth and basin-specific analyses on local sea level changes, compared with relevant global assessments of the Intergovernmental Panel on Climate Change (IPCC). In addition, it identified critical knowledge gaps needed to support the development of actionable information. The Summary for Policymakers (SPM) distils the key findings of the SLRE1, presenting information specific to the six European basins: Mediterranean Sea, Black Sea, North Sea, Baltic Sea, Atlantic, and Arctic. The SPM highlights basin-specific trends, vulnerabilities, and potential impacts, while also orienting future requirements.​​​​​​​

ATUAÇÃO DA FISIOTERAPIA NA PREVENÇÃO DO PÉ DIABÉTICO

Physical therapy plays a comprehensive role in diabetic foot prevention by providing education, assessment, exercise, pain management, and footwear advice. This bibliographic review includes studies published from 2015 to 2024, selected through the Medline/PubMed, SciELO and LILACS databases. 31 articles were found and 10 met the inclusion criteria to be used in the results and discussion. The participation of physiotherapy in the prevention of diabetic foot is crucial, as physiotherapists play a fundamental role in promoting health and preventing complications in patients with diabetes.

INTEGRATING ALLIED HEALTH PROFESSIONALS DURING THE ONCOLOGICAL TREATMENT PHASE FOR GLIOBLASTOMA PATIENTS: A CASE STUDY AT A UK CANCER CENTRE

Abstract AIMS Primary brain tumour patients should be offered neurological rehabilitation assessment at diagnosis and every stage of follow With only 5% of glioblastoma patients surviving more than 5 years, specialist management that spans across all phases of the Dietz rehabilitation model is required to optimise function, treatment tolerance and Quality-of-life. At Guy’s cancer centre an Allied health multi-disciplinary team (Physiotherapy, Occupational therapy and Speech and language therapy) work alongside the oncologist-led clinic to support this patient group. METHOD Case history A 54-year-old, male, was diagnosed with right parietal Glioblastoma, WHO grade 4, IDH wildtype, MGMT 5.47% methylated (August 2023) on biopsy only. He underwent chemo/radiotherapy - 60gy/90 fractions with Temozolmide (TMZ) on 3/11/2023 Currently C4 of adjuvant TMZ. Dexamethazone 2mg was discontinued on 29/11/2023, he continues with Keppra 500mg twice daily. RESULTS Dietz Intervention approach in phases: PREVENTATIVE Fatigue management was introduced prior to radiotherapy including a physical activity review, advice on pacing, sleep hygiene and relaxation techniques. Given the patient’s history of shift work and altered sleep patterns, managing risks of treatment-related fatigue was of particular importance. Restorative &amp; Supportive: A targeted and periodised exercise programme was initiated, comprising 1:1 gym based physiotherapy sessions. The aims included enhancing exercise confidence, improve balance, endurance, maintain strength, pain management and weight maintenance during chemo/radiotherapy and adjuvant TMZ. Education was deployed on adjusting activity levels based on chemotherapy cycle and day to day side effects, alongside ongoing fatigue management advice around pacing and sleep hygiene. CONCLUSION Learning and Recommendations Implementing tailored rehabilitation interventions early in the patient’s treatment pathway, enables proactive management to mitigate the impact of treatment-related side effects on their QOL. Based on our experience, early engagement with a dedicated therapy team is recommended to foster strong rapport with both the patient and their caregivers. This facilitates timely rehabilitation planning for optimal outcomes.

The Retrosynthesis Mindset: A Problem-Solving Tool

AbstractRetrosynthesis refers to the process of deconstructing a target molecule step by step until simpler and commercially available synthetic precursors are identified to develop a valid synthetic pathway. As a powerful problem-solving tool, it has gradually been expanded to other fields of chemistry. The application of a ‘retrosynthesis mindset’ can be relevant beyond chemistry, such as in education, research management, and science advice. In this Letter, we discuss the concept of the retrosynthesis mindset and its implications within and beyond chemistry in the hope of highlighting a broader potential and encouraging the adoption of such a mindset to enhance problem solving and strategic planning across disciplines.1 Introduction2 Retrosynthesis Education3 Retrosynthesis Within and Beyond the Lab4 Conclusion

Community breast pain clinics can provide safe, quality care for women presenting with breast pain.

Breast pain is not typically a symptom of breast cancer, yet nationally 20% of 2-week wait (2WW) breast referrals are breast pain alone. The East Midlands Breast Pain Pathway improves patient experience and frees capacity in secondary care diagnostic breast clinics, managing women with breast pain only in a community setting. We report the results of implementation of community breast pain clinics (CBPCs) at sites in Derbyshire (catchment population ~1 million), with 12 months follow-up data. 1036 patients were seen at CBPCs between June 2021 and February 2023. The median patient age was 49 (range 16-88) years. 993 patients (95.8%) were discharged from the clinic with breast pain management advice. 43 (4.2%) patients were referred for further assessment at a 2WW breast diagnostic clinic. Objective family history risk assessment identified 124 patients (12.3%) above population risk of breast cancer, who were offered referral to familial cancer services for ongoing management. Seven patients were diagnosed with breast cancer at or within 12 months of CBPC attendance. Five patients were diagnosed through attending the CBPC, one patient was subsequently referred to 2WW clinic with a new symptom and had a mammographically occult tumour and one was diagnosed following a subsequent routine breast screening invitation. Two of the five patients had a personal history of breast cancer which was a stated exclusion criterion for the CBPC. Breast cancer incidence in women with breast pain only and fulfilling CBPC referral criteria was 4.8/1000, confirming that this population is at low risk of developing breast cancer.Patient service satisfaction was high with 99% (n=1022) 'extremely likely or likely' to recommend the service. The results confirm the pathway is the first to demonstrate women can be safely managed with breast pain alone in a community setting with high levels of patient satisfaction.

Oak declines: Reviewing the evidence for causes, management implications and research gaps

Abstract Oak decline is a complex disorder caused by multiple stressors. Although declines have been observed across Europe since 1700, there is still a lot of uncertainty around the cause, and therefore the appropriate management techniques. Using literature from across European oak ecosystems, this review and perspective discusses the key stressors associated with oak declines in Quercus robur L. and Q. petraea (Matt.) Liebl. in Europe and the newly described acute oak decline breaking out in the United Kingdom (and beyond), with a view to identifying important evidence gaps and management implications. The key factors implicated in oak decline include drought, pests and pathogens. These factors can interact in positive feedback loops to increase stress and decline within oaks. Extreme frost, waterlogging, soil properties, land management, nitrogen pollution, heavy metal pollution, genetic predisposition and mycorrhizal changes could also be involved in decline, but more research is required to understand these. In acute oak decline, necrotic lesions are caused by a bacterial complex of up to three species, and it has been observed that the presence of the wood borer Agrilus biguttatus Fabricius 1776 can amplify the symptoms. Practical implication: The amount that each stressor contributes towards these declines and the ‘tipping points’ are largely unknown and are likely to differ between decline events, sites and even individual trees. This makes management advice provision exceedingly difficult. Historic records show oaks in decline can recover; therefore, allowing trees time and space to recover should be a priority for management practitioners. Future research recommendations for effective management of declining oaks are discussed.

Harvest sustainability assessments need rethinking under climate change: A ringed seal case study from Svalbard, Norway

AbstractThroughout the Arctic, ice‐affiliated marine mammals constitute local subsistence resources but detrimental effects of declines in their sea ice habitats create a need for harvest sustainability assessments in light of climate change. At the same time, empirical data required for thorough population analysis of these species are often sparse at best, as illustrated by the focal species in this study, ringed seals in Svalbard: the last population survey took place two decades ago (2002–2003), demographic data are limited to age, sex, and reproductive status of a small subset of shot individuals, and harvest reporting is patchy and incomplete. Data sparsity is one of the main reasons why potential biological removal (PBR) became a commonly used tool for assessing sustainability of marine mammal harvests. Herein, we calculated PBR for Svalbard ringed seals using both recommended default parameters and population‐specific parameters obtained from an integrated population model (IPM). PBR estimates were highly uncertain, suggesting the number of sustainably harvestable individuals could lie anywhere between 0 and 91, with a substantial chance of any harvest being unsustainable under current environmental conditions and trends. Subsequent population viability analyses (PVAs) further confirmed that the current harvest was likely unsustainable, even in a scenario in which sea ice conditions would not deteriorate (and therefore lower pup survival) further. However, uncertainty in population projections was high, and forecasts thus not ideal for formulating management advice. Better forecasts will require more frequent population surveys and obtaining more knowledge regarding the links between vital rates and environmental conditions, both of which may be facilitated by the adoption of novel technology (e.g., drone monitoring, genetic studies). The modeling framework created in this study can be readily updated with new data as they become available, and can serve as a tool for adaptive management of this and other marine mammal populations.

Unintentional poisoning in older Australians: a retrospective audit of New South Wales Poisons Information Centre data

Introduction Poisons information centres provide phone-based risk assessment and management advice on poisonings. Unintentional poisonings are a common reason for consulting a poisons information centre, and older adults are at increased risk of unintentional poisoning and adverse outcomes. We describe patterns of unintentional poisoning in older adults reported to a regional poisons information centre. Methods We conducted a retrospective audit of poisons information centre call records and identified unintentional poisonings involving older adults (≥75 years) over a 12-month period to determine patient demographics and poisoning circumstances (substances, contributing factors, and disposition recommendation). Univariate analyses identified variables associated with hospital referral and multivariate models to identify independent risk factors in home-dwelling older adults. Results We identified 2,757 calls. More exposures occurred in women (62%) and involved therapeutic errors (70.8%). Paracetamol was the most common drug involved (11%), and cardiovascular drugs were the most common drug class (36%). Only 14.3% of the study population was referred to hospital. Independent risk factors for hospital referral in home-dwelling older adults were exposure to cardiovascular, centrally acting and antihyperglycaemics, non-oral route of administration and symptoms at the time of the call. Discussion Unintentional poisoning is not uncommon, and our findings are similar to those in other countries over recent decades. These findings suggest that unintentional poisoning in older adults is inadequately addressed by current medication safety strategies. Our findings indicate the value of timely advice by poisons information centres for preventing potentially unnecessary hospitalizations. Conclusion Further research is needed to identify more effective approaches to medication safety strategies for older adults. Poisons information centre data contribute to pharmacovigilance activities and could inform patient care.

Impact of Online Video Advertisement on Impulsive Buying Tendency with the Mediating Effect of Attitudes (Evidence from University Students in Sri Lanka)

Purpose: TikTok is a growing video-sharing application that allows users to make and share short videos on any topic. At present, young consumer’s impulsive decisions have been increased steadily, due to higher exposure to TikTok on online context. Thus, this research was carried out to examine the factors impacting on impulsive buying tendency of young consumers with a particular focus on attitudes toward online advertisements. Design/methodology/approach: Through a comprehensive survey conducted among 200 undergraduates at University of Ruhuna, data was collected based on a convenient sampling technique. Further, the collected data was analyzed using Smart PLS 4 software. Findings: The findings indicated that informativeness, personalization, and credibility of online video advertisements positively affect attitudes toward online video ads. Additionally, the mediating effect was proved revealing that young consumers make impulsive purchasing decisions based on the attitude formation through informativeness, personalization, and credibility. Originality: Although, the application of Tik Tok is important as a marketing tool, research on the TikTok platform is still scarce and inadequately documented. Implications: The study provides practical advice for marketers and brand managers to focus on improving consumers’ perceptions through the video ad’s informativeness, entertainment, personalization, and credibility to encourage consumers to purchase impulsively.

The impact of restricted grazing systems on the behaviour and welfare of ponies.

Equine obesity is a growing concern. Much of the current management advice centres on dietary restrictions, including the removal or limitation of grazing. Little is known about the impact of these approaches on the welfare of the horse. This study investigates the effect of two commonly used grazing systems advocated for the control of weight-the 'strip-grazing' and the 'track' systems-on the behaviour and welfare of outdoor-living ponies. A within-subject cross-over experimental design with four groups of pasture-kept ponies experiencing each system for 4 weeks in a random order. Time budgets and behavioural indicators of welfare were measured using 24-h electronic surveillance, morphometric parameters including weight, body condition score and cresty neck score were measured weekly and activity levels were tracked. The effect of grazing system on movement and behaviour was tested using a general linear model. Ponies moved more [median (IQR) % time spent moving, track: 3.23% (2.08%), strip: 2.02% (0.90%); p = 0.001] and travelled a greater distance [median (IQR) metres/24 h, track: 7013.47 m (1761.49 m), strip: 5331.91 m (494.16 m); p < 0.001] and engaged in less overt agonistic behaviour on the track system compared with the strip system [median (IQR) prevalence per hour; track: 0.14 (0.30), strip: 0.21 (0.37) p = 0.02]. A relatively short time period of exposure to each grazing system. Ponies on strip systems moved less and exhibited increased agonistic interactions compared with the track system, maybe as a result of a perceived reduction in space or concentration of resources, although the accessible areas were matched. These results suggest that there may be physical as well as psychological health benefits to the track system.

Time varying M with starvation mortality in a state-space stock assessment model: Part 2: Atlantic cod (Gadus morhua) on the southern Grand Bank of Newfoundland

State-space models are now a common tool for modeling time-varying ecological phenomena. This extends to state-space stock assessment models (SSAMs), recognized as pivotal components within the evolving landscape of next-generation stock assessment methodologies. Though methods are rapidly evolving, the estimation of time-varying rates of natural mortality (M) remains a challenge, and the sensitivity of stock assessments and management advice to assumed M values underscores the pressing need for improved estimation methods. Using southern Grand Bank (SGB) Atlantic cod as a case study, we introduce a novel approach to estimate time-varying M. We first convert a length-based starvation M index into an age-based index, which we then include in an age-based SSAM to estimate two components of M: starvation M and a remainder component. This produces a new SGB cod SSAM with time-varying total stock M. This model produces a large decrease (68 %) in the size of the model process errors (i.e., their standard deviation) and better fit compared to a model that did not account for time-varying M, indicating that the starvation M index improves our model of stock productivity. By leveraging readily available information on fish body condition and the proportion of fish in really poor condition, the proposed methods offer a valuable solution to the challenges associated with estimating time-varying M. The proposed methods offer a tractable solution to the common struggles associated with quantifying changes in fish productivity, which is crucial for the management of dynamic systems.

Impact of the COVID-19 pandemic on the quality of care for juvenile idiopathic arthritis patients: insights from Thailand

BackgroundThe COVID-19 pandemic has significantly impacted individuals with chronic conditions. This investigation assessed the quality of care provided to pediatric and adolescent patients with juvenile idiopathic arthritis (JIA) during the pandemic in Thailand.MethodsThis cross-sectional analysis enrolled JIA patients aged ≤ 18 years at an academic tertiary care facility from April 2022 to March 2023. Retrospective reviews were performed, complemented by patient and caregiver questionnaires to assess the pandemic’s impact on care quality.ResultsSeventy JIA patients (37 males, 33 females) with a mean age of 13.5 ± 3.1 years were included. A total of 41.4% of the caregivers reported negative impacts on JIA care due to the pandemic and the lockdown, and 31.4% of the patients experienced pandemic-related anxiety. A comparison between the pandemic and prepandemic periods revealed a higher incidence of active disease, although the difference was statistically nonsignificant (37.1% vs 14.2%, p = 0.106). Nonadherence significantly predicted active disease status (adjusted OR 15.04, 95% CI 2.48–91.15, p = 0.03). COVID-19 vaccinations were administered to 85.7% of patients; 52.8% of whom contracted mild COVID-19. Most patients (71.4%) postponed clinic visits; 36% due to lockdowns and 28% due to concerns about COVID-19 exposure in healthcare settings. The majority of patients received telephone JIA management advice from rheumatologists during the lockdown (91.4%).ConclusionsThe COVID-19 pandemic and associated lockdown measures affected the care of JIA patients, impacting both physical and mental health. Nonadherence was a critical factor in disease flare-ups. Telemedicine is indispensable for patient care.

Anti-Obesity Medications in Patients With Heart Failure: Current Evidence and Practical Guidance.

Obesity is a significant risk factor for heart failure (HF) development, particularly HF with preserved ejection fraction and as a result, many patients with HF also have obesity. There is growing clinical interest in optimizing strategies for the management of obesity in patients with HF across the spectrums of both ejection fraction and disease severity. The emergence of anti-obesity medications with cardiovascular outcomes benefits, principally glucagon-like peptide-1 receptor agonists, has made it possible to study the impact of anti-obesity medications for patients with baseline cardiovascular conditions, including HF. However, clinical trials data supporting the safety and efficacy of treating obesity in patients with HF is currently limited to patients with HF with preserved ejection fraction, but do confirm safety and weight loss efficacy in this patient population as well as improvements in HF functional status, biomarkers of inflammation and HF stability. Here, we review the current data available surrounding the management of obesity for patients with HF, including the limitations of this evidence and ongoing areas for investigation, summarize the next phase of emerging anti-obesity medications and provide practical clinical advice for the multidisciplinary management of patients with both HF and obesity.

A Tool Integrated into the Electronic Health Record to Guide Proper Decision-Making Regarding Peri-Endoscopic Anticoagulant Management: A Retrospective Cohort Study.

Background-Anticoagulants, such as vitamin-K antagonists (VKA) and direct oral anticoagulants (DOAC), are widely used among patients who undergo endoscopic procedures. To balance between bleeding and thromboembolic risks, careful decisions must be made about whether and for how long anticoagulants have to be stopped peri-endoscopically and if bridging is necessary. We created a tool in the electronic health records system (EHR) HIX (Microsoft) for invasive procedures to aid this decision-making. By selecting the anticoagulant indication or thrombo-embolic risk and the bleeding risk of the procedure, the tool automatically generates advice for periprocedural anticoagulant management. Objectives-This study assesses whether the tool is used properly peri-endoscopically. Secondly, it examines how many bleeding and thromboembolic events have occurred since the implementation of the tool. Methods-This retrospective study included all orders placed for endoscopies for patients using VKA or DOAC between 2018 and 2021. Results-In total, 986 endoscopies were included for analysis. In 89%, the tool was used correctly; the main error was selecting the wrong bleeding risk (7.5%). The cumulative incidence for moderate or severe bleeding events for DOAC and VKA was 2 (0.5%) and 0, respectively. The cumulative incidence of thromboembolic events for DOAC and VKA was 1 (0.2%) for each. Conclusions-This study evaluates the use of an EHR-integrated decision-making tool to aid peri-endoscopic anticoagulant management. By analysing the usage of the tool, we formulated several suggestions to improve the tool. Although this study is not a comparative one, we can conclude that the thromboembolic and major bleeding risks were low.

Decadal changes in the Sea of Marmara indicate degraded ecosystem conditions and unsustainable fisheries

Globally, all marine ecosystems are under pressure by anthropogenic stressors. However, semi-enclosed seas are at a greater risk of degradation due to their limited connectivity to open seas. This leads to a greater accumulation of pollutants and abrupt regime shifts triggered by unsustainable exploitation of living resources, as ecosystems exhibit low degrees of redundancy and more frequent large-scale episodic events such as harmful algal blooms. The Sea of Marmara is a semi-enclosed marine region that has been subjected to various anthropogenic stressors since the 1990s. Recently, local and governmental authorities have employed basin-wide ecosystem management plans to control and manage point and nonpoint (diffuse) sources of pollutants. However, the management of fisheries in relation to the dynamics of the Sea of Marmara food web has attracted less attention from policymakers, even though fisheries exploitation is one of the most significant anthropogenic pressures. In this study, we capitalized on a previous static ecosystem model of the Sea of Marmara by revising and extending it to simulate the changes between 1990 and 2020. We delineated the temporal dynamics and regime shifts in the food web in terms of ecosystem structure and function by using ecological indicators and developed quantitative management advice for its fisheries. The results showed that the ecosystem has experienced three regimes since 1990, with regime shifts occurring with the onset of the 2000s and the mid 2010s. The first regime exhibited high diversity and material cycling, the second regime was characterized by low diversity and increased impact of fisheries, and the third regime culminated in a fished-down food web state. The analysis of fishery dynamics showed that the majority of harvested species were overexploited. We suggest that the implementation of quotas for exploited species should be considered an immediate solution to the unsustainable exploitation of fish stocks and can help restore ecosystem conditions.