Medical Standards Research Articles

Spatial Analyses of Crisis Pregnancy Centers and Abortion Facilities in the United States, 2021 (Pre-Dobbs): Cross-Sectional Study

Background Crisis pregnancy centers (CPCs) are religious nonprofit organizations with a primary mission of diverting people from having abortions. One CPC tactic has been to locate near abortion facilities. Despite medical groups’ warnings that CPCs do not adhere to medical and ethical standards and pose risks, government support for CPCs has significantly increased. Objective This study aims to map CPCs, abortion facilities, and geographical areas in the United States into 4 zones based on their proximity to CPCs and abortion facilities. We sought to describe the number and percentage of reproductive-aged women living in each zone and the proximity of CPCs to abortion facilities. Methods Using 2021 data from CPC Map and the Advancing New Standards in Reproductive Health Abortion Facility Database, we determined the ratio of CPCs to abortion facilities. Along with census data, we categorized and mapped US block groups into 4 distinct zones based on locations of block group centroids within 15-mile (1 mile is approximately 1.609 km) radii of CPCs and abortion facilities, namely “no presence,” “CPC only,” “abortion facility only,” and “dual presence.” We calculated the number and percentage of block groups and reproductive-aged (15-49 years) women living in each zone. We calculated driving distances and drive times from abortion facilities to the nearest CPC and mapped abortion facilities with CPCs in close proximity. All analyses were conducted nationally and by region, division, and state. Results Nationally, the ratio of CPCs to abortion facilities was 3.4, and 54.9% (131,410/239,462) of block groups were categorized in the “dual presence” zone, 26.6% (63,679/239,462) as “CPC only,” and 0.8% (63,679/239,462) as “abortion facility only.” Most reproductive-aged women (45,150,110/75,582,028, 59.7%) lived in a “dual presence” zone, 26.1% (19,696,572/75,582,028) in a “CPC only” zone, and 0.8% (625,403/75,582,028) in an “abortion facility only” zone. The number of block groups and women classified as living in each zone varied by region, division, and state. Nationally, the median distance from abortion facilities to the nearest CPC was 2 miles, and the median drive time was 5.5 minutes. Minimum drive times were <1 minute in all but 11 states. The percentages of abortion facilities with a CPC within 0.25, 0.5, 1, and 3 miles were 14.1% (107/757), 22.6% (171/757), 36.1% (273/757), and 66.3% (502/757), respectively. Conclusions The findings suggest that CPCs’ tactic of locating near abortion facilities was largely realized before the 2022 US Supreme Court decision that overturned the federal right to abortion. Research on CPCs’ locations and tactics should continue given the dynamic abortion policy landscape and risks posed by CPCs. Tailored programming to raise awareness about CPCs and help people identify and access safe sources of health care may mitigate harm. Increased regulation of CPCs and government divestment may also mitigate CPC harms.

Replacing the Gallium Oxide Shell with Conductive Ag: Toward a Printable and Recyclable Composite for Highly Stretchable Electronics, Electromagnetic Shielding, and Thermal Interfaces.

Liquid metal (LM)-based composites hold promise for soft electronics due to their high conductivity and fluidic nature. However, the presence of α-Ga2O3 and GaOOH layers around LM droplets impairs conductivity and performance. We tackle this issue by replacing the oxide layer with conductive silver (Ag) using an ultrasonic-assisted galvanic replacement reaction. The Ag-coated nanoparticles form aggregated, porous microparticles that are mixed with styrene-isoprene-styrene (SIS) polymers, resulting in a digitally printable composite with superior electrical conductivity and electromechanical properties compared to conventional fillers. Adding more LM enhances these properties further. The composite achieves EMI shielding effectiveness (SE) exceeding 75 dB in the X-band frequency range, even at 200% strain, meeting stringent military and medical standards. It is applicable in wireless communications and Bluetooth signal blocking and as a thermal interface material (TIM). Additionally, we highlight its recyclability using a biodegradable solvent, underscoring its eco-friendly potential. This composite represents a significant advancement in stretchable electronics and EMI shielding, with implications for wearable and bioelectronic applications.

Practical skills in creating and conditions of a modern endoscopy department

Accumulated many years of experience in creating workrooms and functional endoscopy departments. Due to the fact that in our practice there are a lot of different regulatory documents in the field of construction: SNiP, codes of practice, practical design guidelines, as well as medical standards: SanPiN, sanitary rules, guidelines, various recommendations and orders of the Ministry of Health of the Russian Federation, there is a huge resonance on the requirements of these documents for the creation of working conditions for flexible endoscopy of a certain profile in a medical organization. There are no standards for the development of models of a specific profile of endoscopy departments due to its widespread use in various medical practices. The development of a project for a new medical organization does not in any way concern sanitary standards, while newly built modern medical organizations are checked precisely according to sanitary standards and do not in any way concern building codes. Such an imbalance leads us to the harmonization of multi-profile documents, averaging of area requirements, engineering solutions, conditions for linking the operating requirements from the manufacturer of high-tech equipment. The creation of working groups and the development of individual planning solutions allows us to take into account all the nuances for proper operation, work out the equipment according to technical and dimensional characteristics and clearly formulate the requirements for the preparation of endoscopy workrooms.

A Comparative Evaluation of New and Used Dental Explorer Working Tips

Abstract The dental explorer medical device assists multiple functions, including marginal assessment. The working tip quality of this instrument has been previously established as a factor affecting operator judgment. However, little data exists to demonstrate the actual quality of working tips in clinical practice. The purpose of this study is to investigate and quantify if any real, measurable differences of the explorer working tip dimension exist among such instruments currently in service and compare to published medical device industry standards. Twenty new #23 dental explorer instruments from two manufacturers served as controls and sixty-three instruments in circulation at a dental school clinic were observed using light microscopy. The instruments were measured 50 micrometers from the terminus. A one-way analysis of variance (ANOVA) was performed to analyze values among groups. No statistically significant difference between the mean working tip dimension of new instruments was detected between brands. However, statistically significant differences between new and used instruments were detected regardless of brand. The range of values was 92.5–227.5 micrometers with average used instrument tip estimated over 50% wider than the average new instrument. These findings imply that other studies employing a dental explorer may be confounded if the instrument is not measured. Furthermore, the results of this study should serve as a motivating factor toward future research to update quality standards regarding the medical device with a goal of defining acceptable dimensions of the instrument working tip for certain applications in relation to clinical performance and expected outcomes.

The Ethical Standard for End-of-Life Decisions for Unrepresented Patients

There has been increasing awareness of the medical and moral challenges in the care of unrepresented patients: those who cannot make their own medical decisions, do not have any surrogate decision maker, and have not indicated their treatment preferences. Most discussions have focused on procedural questions such as who should make decisions for these patients. An issue that has not gotten enough attention is the ethical standard that should govern medical decision making. I explore the question of which ethical standard provides better justification for end-of-life decisions for unrepresented patients. Two options are considered: the conventional and less demanding best interest standard, and the novel and more demanding medical futility standard. I explain the similarities and differences between these two standards, examine arguments for and against each one, and suggest that the medical futility standard is ethically superior and should replace the established best interest standard.

Research on the Corrosion Resistance and Cytotoxicity of Medical Forged Co-28Cr-6Mo Alloy

Co-Cr-Mo alloy as a human body implant material has a long history, because of its excellent corrosion resistance and biocompatibility, and is widely used in human hip joint materials. Co-Cr-Mo alloy in the human body is often in a passivation state; the formation of dense oxide film on the alloy surface prevents further corrosion of the alloy. The main component of the passivation film is the oxide of Cr, so a layer of oxide film formed by Cr on the surface of Co-Cr-Mo alloy is the reason for its good corrosion resistance. In biocompatibility, cytotoxicity is the first choice and necessary option for biological evaluation, and cytotoxicity can quickly detect the effect of materials on cells in a relatively short time. Therefore, this research conducted a comparative evaluation on the corrosion resistance and biocompatibility of forged Co-Cr-Mo alloys produced in domestic and foreign alloys in line with medical standards. Three simulated human body fluids and Princeton electrochemical station were selected for corrosion resistance experiments, and it was found that the corrosion resistance of four alloys in sodium citrate solution inside and outside China would be reduced. All the alloys exhibit secondary passivation behavior in Hanks solution, which improves the corrosion resistance of the alloys. According to the self-corrosion potential Ecorr analysis, the corrosion resistance of domestic B alloy is the best, while that of foreign R31537 alloy is poor. In the biocompatibility experiment, the biocompatibility of Co-Cr-Mo alloy was evaluated through the measurement of contact Angle and cytotoxicity reaction. The experimental results show that Co-Cr-Mo alloy is a hydrophilic material, and the contact Angle of foreign R31537 alloy is smaller, indicating that the surface of R31537 alloy is more suitable for cell adhesion and spreading. According to the qualitative and quantitative analysis of the cytotoxicity experiment, the toxic reaction grade of domestic A, B and R31537 alloy is grade 1, the toxic reaction grade of C alloy is grade 2, and C alloy has a slight toxic reaction.

RANCANG BANGUN PENDETEKSI DEHIDRASI MANUSIA BERDASARKAN WARNA URINE BERBASIS INTERNET OF THINGS (IOT)

In the current technological era, the Internet of Things (IoT) provides creative fixes for numerous health problems. The purpose of this research is to design and construct a urine color analysis system that uses the Internet of Things to identify human dehydration. Urine color is precisely measured and analyzed by the system using color and pH sensors. Data is then sent over an internet connection to a cloud-based platform.The urine color analysis results will be compared to accepted medical standards as part of the processing of the gathered data to ascertain the user's bodily hydration level. This system has a Blynk app-based user interface that offers proper hydration recommendations and real-time information about the user's level of hydration. It is anticipated that by putting this system in place, users will be able to efficiently check their level of hydration and take precautions to avoid being dehydrated. This research offers a more approachable and cost-effective method of managing one's own health in addition to aiding in the development of Internet of Things-based health technology.

The Role of Hospital By Laws in Providing Legal Protection Against Alleged Medical Malpractice at the Padang Panjang City Regional General Hospital

Hospital By Laws (HBL) is an internal hospital rule designed to provide legal protection to both patients and medical personnel. In the context of Padang Panjang Hospital, HBL should function as a reference in resolving medical disputes and maintaining the quality of health services. Based on the analysis of the situation, HBL has not functioned optimally, especially in dealing with cases of alleged medical malpractice. The purpose of this study was to analyze the role of HBL in providing legal protection against alleged medical malpractice at Padang Panjang Hospital, as well as to find obstacles faced in its implementation. The method used is a sociological juridical approach with primary data obtained through interviews with related parties in the hospital, and secondary data from related legal literature. The results of the study show that many cases of alleged malpractice are resolved informally through mediation, without using strict legal procedures based on HBL. Several cases such as misalignment of surgery, incorrect installation of infusions in infants, and negligence in the installation of Nasogastric Tube (NGT) are examples of the weak implementation of HBL at Padang Panjang Hospital. The main obstacle found in the implementation of HBL is the lack of understanding and awareness from hospitals of the importance of HBL as a legal instrument. Dispute resolution is more often carried out through a family approach without involving the formal rules regulated in the HBL. This shows that there is a gap between existing regulations and practices carried out in the field. The supervision mechanism for the implementation of HBL in hospitals has also not run well, so this rule is not functioning as it should. This study suggests the need to strengthen the implementation of HBL at Padang Panjang Hospital through more intensive socialization to all medical personnel and hospital management as well as training on professional ethics and medical service standards. Supervision is needed to ensure that these rules are properly implemented in resolving medical disputes. Padang Panjang Hospital is expected to improve the quality of its services while providing better legal protection for patients.

Do healthcare professionals work around safety standards, and should we be worried? A scoping review

BackgroundHealthcare staff adapt to challenges faced when delivering healthcare by using workarounds. Sometimes, safety standards, the very things used to routinely mitigate risk in healthcare, are the obstacles that staff...

Advanced Design and Implementation of a 2-Channel, Multi-Functional Therapeutic Electrical Stimulator

This research introduces the design, implementation, and rigorous evaluation of a novel 2-channel, multi-functional therapeutic electrical stimulator, meticulously engineered to meet the stringent demands of contemporary clinical applications. The device integrates a high-speed R-2R ladder DAC and a sophisticated pulse generator unit, capable of producing twelve essential current waveforms with fully adjustable parameters, including pulse amplitude, pulse duration, and pulse repetitive frequency. The proposed driving stage unit ensures precise voltage-to-current conversion, delivering stable and accurate output currents even under varying load conditions, which effectively simulate the diverse impedance characteristics of human tissue. Extensive testing confirmed the compliance with international medical standards, notably IEC 60601-1, IEC 60601-1-2, and IEC 60601-2-10. The experimental results underscore the device’s consistent operation within prescribed safety and performance thresholds, with all deviations in pulse parameters remaining well below the permissible limits. Furthermore, the proposed electrical stimulator demonstrated exceptional stability across variable load conditions, as evidenced by minimal amplitude errors and high correlation between waveform characteristics. These findings highlight the proposed device’s robustness and its potential as a versatile tool for a wide range of therapeutic applications, including pain management, muscle stimulation, and nerve rehabilitation, thus marking a significant advancement in the field of therapeutic electrical stimulation.

Why Minimally Invasive Techniques Are the Future of Foot Surgery?

Abstract: Minimally invasive surgical techniques have become increasingly prevalent in recent years. The first data on MIS correction of foot deformities dates back to 1940, when the first instrumentation for minimally invasive foot surgery was developed. With the advent of X-ray in the 1960s, both instruments and surgical techniques have been improved. X-ray control is at the heart of this type of surgery. Over the years, the instrumentation and implants used for this type of surgery have undergone rapid development. Nowadays, the question is whether to use open surgery at all for the treatment of foot deformities? The aim of this article is to show the application of minimally invasive techniques for the correction of various orthopeadic diseases of the foot and ankle - benefits, negatives, scope of application and results Materials and Methods: The study included 110 patients who underwent percutaneous (minimally invasive) surgery in the period 2019-2024. Of them, 106 were women aged 13 to 75 years and 4 men aged 45-67 years, and were followed up for a period of 2 years. Results: Clinical, radiological and functional. Conclusions: With MIS surgery, we solve the surgical tasks with minimal trauma to the soft tissues, which leads to much less pain, swelling and faster patient recovery. Overall, we can gain up to 2 months faster recovery. Excellent cosmetic results are also important for most patients. Immediate loading, verticalization and discharge on the same day also meet modern medical standards, which leads to reduced hospital costs.

Assessment of resident physicians satisfaction on residency training in Southwest China:A cross-sectional study

IntroductionChinese Resident Physician Standardized Training has been established to enhance medical training standards and physician capabilities since 2014. Studies indicate high rates of depression and low satisfaction among resident physicians, underscoring the need for surveys to inform policy and enhance their well-being. This study aimed to investigate the satisfaction of resident trainees in southwest China. MethodsA cross-sectional survey was conducted from February 2024 to March 2024 in 5 hospitals from 3 cities in southwest China, using convenience sampling to collect data from residents through a self-administered online questionnaire. The data including demographics, training perspectives, and suggestions was analyzed using SPSS 25.0 with Ordinal Logistic regression to identify factors influencing satisfaction. ResultsThe survey yielded 484 valid responses from 547 collected questionnaires, with an effective rate of 88.48 %. Participants were predominantly first-year residents, female, aged 26–30, and specialized in internal medicine, surgery, general medicine, and medical technology. The majority (78.93 %) expressed overall satisfaction with their residency training, but income satisfaction was lower at 64.05 %. Gender and neutral responses to certain aspects of training as predictors of dissatisfaction, including the training organized by the teaching management department, the training environment, the importance attached to residency training and the program's usefulness for future clinical work. Open-ended feedback from trainees highlighted the need for increased income, improved clinical training, and reduced workload. ConclusionsOur study found 78.93 % of residents satisfied with their training programs. Female residents and those with neutral views or income dissatisfaction were less satisfied. Increasing income, improving clinical training, and reducing workload could further boost satisfaction and program quality.

Historical drivers of HCV Subtypes 1b and 3a in Thailand and 6f in Phetchabun, an HCV endemic area of the country.

The World Health Organization has set a target to eliminate viral hepatitis as a public threat by 2030. In pursuit of this goal, Thailand initiated a hepatitis C virus (HCV) microelimination project targeting Phetchabun province, a well-recognized high-burden HCV endemic area. However, the historical transmission dynamics of HCV in Phetchabun, and in Thailand in general, remain unclear. This study investigates the epidemic histories of HCV in Phetchabun, focusing on Subtypes 1b, 3a, and 6f, and their relationship with HCV in other regions of Thailand, using molecular phylogenetic analyses. Our results reveal nationwide the presence of Subtypes 1b and 3a, while Subtype 6f is mainly confined to Phetchabun. The initial spread of Subtype 1b was inferred to coincide with World War II and the period of suboptimal medical and hygienic standards in Thai blood transfusion services, suggesting a correlation between the two. The early expansion of Subtype 3a was, on the other hand, found to correlate with the epidemic of intravenous drug use in Thailand during the time of Vietnam War. The early expansion of Subtype 6f, in contrast, appears to coincide with the period of severe regional political conflict and social and economic instability. All these findings suggest the complex interplay between social determinants of health and HCV transmission. Post the mid-1990s/early 2000s, all subtypes showed significantly reduced population growth rates, aligning with improvements in blood transfusion safety standards, the nationwide "War on Drugs" policy, and enhanced accessibility to public healthcare and HCV treatments. These combined efforts likely have contributed to curbing the spread of HCV in Thailand. Nevertheless, our analyses reveal that the prevalence of HCV in Thailand remains high overall, emphasizing the need for further research and a nationwide approach to more effectively reduce the HCV burden in Thailand.

An algorithm for drug-resistant epilepsy in Danish national registers.

Patients with drug-resistant epilepsy (DRE) have increased risks of premature death, injuries, psychosocial dysfunction, and a reduced quality of life. Identification of persons with DRE in administrative data can allow for effective large-scale research, and we therefore aimed to construct an algorithm for identification of DRE in Danish nation-wide health registers. We used a previously generated sample of 525 persons with medical record-validated incident epilepsy between 2010-2019, of which 80 (15%) fulfilled International League Against Epilepsy (ILAE) criteria of DRE at the time of the latest contact - this cohort was considered the gold standard. We linked information in the validated cohort to Danish national health registers and constructed register-based algorithms for identification of DRE-cases. The accuracy of each algorithm was validated against the medical record-validated gold standard. We applied the best performing algorithm according to test accuracy (F1 score) to a large cohort with incident epilepsy identified in the Danish National Patient Registry between 1995 and 2013 and performed descriptive and logistic regression analyses to characterize the cohort with DRE as identified by the algorithm. The best performing algorithm in terms of F1 score was defined as 'fillings of prescriptions for ≥ 3 distinct antiseizure medications (ASMs) within 3 years or acute hospital visit with epilepsy/convulsions following fillings of prescriptions for two distinct ASMs' (sensitivity 0.59, specificity 0.93, positive predictive value 0.59, negative predictive value 0.92, area under the receiver operating characteristic curve 0.77, and F1 score 0.595). Applying the algorithm to a register-based cohort of 83,682 individuals with incident epilepsy yielded 8,650 cases (10.3 %) with DRE. In multivariable logistic regression analysis, early onset of epilepsy, focal or generalized epilepsy, somatic co-morbidity, and substance abuse, were independently associated with risk of being classified with DRE. We developed an algorithm for the identification of DRE in Danish national registers, which can be applied for a variety of research questions. We identified early onset of epilepsy, focal or generalized epilepsy, somatic co-morbidity, and substance abuse as risk factors for DRE.

LEGAL ANALYSIS OF EU ARTIFICIAL INTELLIGENCE ACT (2024): INSIGHTS FROM PERSONAL DATA GOVERNANCE AND HEALTH POLICY

Background: This study correlates the up-to-date ethical, functional and legal evaluations related to the management and governance of artificial intelligence (AI) under European Union (EU) law, particularly impacting the health data sector and medical standards as provided by the Artificial Intelligence Act within the Regulation adopted by the European Council in May 2024. The initial proposal for the management and governance of the AI sector was submitted in April 2021. Three years later, on 13 March 2024, the European Union Artificial Intelligence Act (EU AIA) was adopted by the European Parliament. Subsequently, on 21 May 2024, the Council adopted an innovative legislative framework that harmonises the standards and rules for AI regulation. This framework is set to take effect in May 2026, with the central objective of stimulating and motivating a fair, safe, legal single market that respects the principles of ethics and the fundamental rights of the human person. Methods: The current legal analysis focuses on the European Union’s new institutional governance involving a multistage approach to managing health data, ethical artificial intelligence, generative artificial intelligence and classification of types of AI by considering the degree of risk (e.g. artificial intelligence systems with limited risk and systems with high risk) and medical devices. It outlines the legal framework for AI regulation and governance in the EU by focusing on compliance with the previously adopted legislation in the Medical Devices Regulation (2017) and the In-Vitro Diagnostic Regulation (2017). The paper also examines the application of the newly adopted EU Artificial Intelligence Act in relation to national justice systems, previous EU regulations on medical devices and personal data protection regulation, and its correlation with the European Court of Human Rights jurisprudence. This opens up complex discussions related to judicial reform and access to justice. For this purpose, as a research objective, the legal analysis includes an innovative perspective following an integrative discussion on the latest legal reforms and regulations of the AI sector in Eastern Europe launched in 2024 with a special focus on the latest developments in the EU Candidate Countries namely Ukraine and the Republic of Moldova. Results and conclusions: The present research facilitates the exploration of the real benefits of managing innovative AI systems for medical data, research, and development, as well as within the medical technology industry.

Violation of the procedure established by law for transplantation of human anatomical materials: concepts and types

The article addresses the pressing issue of ensuring legality in the field of transplantation. The current state of healthcare in Ukraine, the need for high-quality medical services, and the necessity of adapting national legislation to international standards prompt a thorough analysis and improvement of the legal regulation of the transplantation of anatomical materials. The main focus of the article is on identifying violations of legislation in the field of transplantation, analyzing their types, and consequences. Various aspects of offenses are examined, including illegal organ trade, violations of the donor consent procedure, and non-compliance with medical ethics and safety standards during transplantation operations. The peculiarities of violations committed by both medical professionals and other related workers in the transplantation of human anatomical materials are revealed. The authors explore the international experience of transplantation regulation and highlight key points that require attention in Ukrainian legislation. The provisions of the Brussels Declaration on the Laws and Customs of War, the Geneva Conventions, and other international documents establishing norms and principles in this field are analyzed. Violations of these norms can have serious consequences for patients’ health and the reputation of medical institutions. The article emphasizes the need to strengthen state control over compliance with legislation in the field of transplantation, improve legal mechanisms of accountability for violations, and create conditions for the effective functioning of the transplantation system in Ukraine. Specifically, the author proposes an original definition of violations of the established order of transplantation of human anatomical materials and provides a classification of violations by areas and forms of activity at each stage of this process. The study aims to form theoretical and practical foundations for ensuring the legality and ethics of the transplantation of anatomical materials in Ukraine, which is an important step in the development of the medical field and the protection of patients’ rights.

Solution to the problem of setting up medical points and road maintenance in mountainous areas based on optimization

Assume there are 100 villages in a mountainous area. To improve the medical standards of the local residents, three medical points need to be established in several villages, and the roads need to be repaired. This paper modifies the Floyd algorithm to derive all the shortest paths between nodes. Based on the Prim algorithm, a minimum spanning tree model is constructed to find the road maintenance method with the lowest cost; a nested greedy algorithm is used to construct an optimization model under multiple variables, effectively solving the problem of setting up medical points and road maintenance in mountainous areas.

Current Status of Outcomes Reported by Patients With Stroke and an Analysis of Influencing Factors: Cross-Sectional Questionnaire Study.

Stroke is the leading cause of acquired disability and the second leading cause of death worldwide. Its rate of incidence, disability, mortality, and recurrence is high, and the patients experience various symptoms of discomfort, which not only affect their rehabilitation function but also reduce their ability to perform daily activities and their quality of life. Nowadays, with the improvement of China's medical standards, patients are increasingly attentive to their quality of life and health status. However, diagnostic techniques and effective treatments for patients with stroke are still limited but urgently required. This study aimed to evaluate the quality of life during hospitalization using a stroke patient-reported outcomes (PROs) scale and additionally to recognize potential factors and risk indicators that may impact recurrent events, facilitating early intervention measures. This is a registry-based, retrospective observational cross-sectional study on patients with stroke. A convenient sampling method was used to select various indicators of patients. The Stroke-PRO scale was then used to assess patients' conditions across physical, psychological, social, and therapeutic domains. Multiple linear regression analysis was applied to identify factors influencing stroke PROs, while correlation analysis was conducted to explore the relationship between these outcomes and blood lipid levels. The mean Stroke-PRO score in this study was 4.09 (SD 0.29) points. By multiple linear regression analysis, residence, occupation, physical exercise, Barthel index, Braden scale, National Institutes of Health Stroke Scale scores at admission, and stroke type were the risk factors for reported outcomes of patients with stroke (P<.05). Correlation analysis showed that serum triglyceride, total cholesterol, and low-density lipoprotein were negatively correlated with Stroke-PRO scores in patients with stroke (P<.05), while high-density lipoprotein was positively correlated with patients with stroke (P<.05). The 95% CI was -0.31 to -0.03 for triglyceride, 0.17-0.44 for high-density lipoprotein, -0.29 to -0.01 for cholesterol, -0.30 to -0.02 for low-density lipoprotein, and -0.12 to 0.16 for blood glucose. Patients with stroke have a low level of health, and their reported outcomes need to be improved. Accordingly, nursing staff should pay attention to the quality of life and blood lipid indexes of patients with stroke, actively assess their actual health status, and take early intervention measures to promote their recovery.

Phospholamban Cardiomyopathy Leading to Advanced Heart Failure in an Active Duty Service Member.

A phospholamban mutation is a rare genetic cause of dilated cardiomyopathy (DCM). Our case describes a young service member who presented with advanced heart failure and was found to have a familial DCM from an autosomal dominant phospholamban mutation. He ultimately underwent a successful heart transplant just 23 days after his initial presentation. This case highlights the importance of genetic screening and surveillance for patients with a family history of DCM, and it identifies a gap in medical standards for military accession.

Training and Sustaining: Training and Learning Collaborative Outcomes Across a Statewide Network for Early Autism Diagnosis.

The objective of this study was to describe the development of a primary care professional (PCP) autism diagnosis training model and to report on outcomes related to PCP training and sustained engagement in a longitudinal learning collaborative. We developed Accelerating the Diagnosis of Autism with Primary care Training (ADAPT), a training program to prepare PCPs to develop independent competency in evaluation of autism in children aged 14 to 48 months. ADAPT includes didactic and case-based modules and practice-based coaching delivered by an expert diagnostic specialist; after training, PCPs participate in a longitudinal learning collaborative. Aligned with competency-based medical education standards, measures of autism evaluation knowledge and diagnostic competency are collected. From 2021 to 2023, 13 PCPs completed ADAPT didactic and practicum training to reach competency in independent autism evaluation. Clinicians demonstrated significant improvement in total autism knowledge after didactic training (p = 0.02). Scoring agreement on an autism observational assessment tool between clinicians and expert diagnosticians improved over case observations and practicum evaluations. Similarly, PCPs demonstrated improved evaluation competence, moving on average from Advanced Beginner to Competent Performer as rated by expert diagnosticians. After training, PCPs attended 57% of monthly learning collaborative sessions. Training PCPs to deliver autism evaluations for young children as part of tiered community-based models of care is a promising solution to address access and waitlist challenges. ADAPT is an intensive, standardized PCP training model that results in achievement of independent competency and sustained engagement in autism evaluation. Effectiveness-implementation studies are needed to ensure scalability and sustainability of training models.