Medical Patients Research Articles

Sleep oscillations and their relations with sleep-dependent memory consolidation in early course psychosis and first-degree relatives

Sleep spindles mediate sleep-dependent memory consolidation, particularly when coupled to neocortical slow oscillations. Schizophrenia is characterized by a deficit in sleep spindles that correlates with reduced overnight memory consolidation. Here, we examined sleep spindle activity, slow oscillation-spindle coupling, and both motor procedural and verbal declarative memory consolidation in early course, minimally medicated psychosis patients and non-psychotic first-degree relatives. Using a four-night experimental procedure, we observed significant deficits in spindle density and amplitude in patients relative to controls that were driven by individuals with schizophrenia. Schizophrenia patients also showed reduced sleep-dependent consolidation of motor procedural memory, which correlated with lower spindle density. Contrary to expectations, there were no group differences in the consolidation of declarative memory on a word pairs task. Nor did the relatives of patients differ in spindle activity or memory consolidation compared with controls, however increased consistency in the timing of SO-spindle coupling were seen in both patients and relatives. Our results extend prior work by demonstrating correlated deficits in sleep spindles and sleep-dependent motor procedural memory consolidation in early course, minimally medicated patients with schizophrenia, but not in first-degree relatives. This is consistent with other work in suggesting that impaired sleep-dependent memory consolidation has some specificity for schizophrenia and is a core feature rather than reflecting the effects of medication or chronicity.

The association between intra-arrest arterial blood pressure and return of spontaneous circulation in out-of-hospital cardiac arrest

BackgroundThe optimal haemodynamic parameter for goal-directed resuscitation in out-of-hospital cardiac arrest (OHCA) remains uncertain. This study aimed to characterise the association between invasive blood pressure (IBP) measurements and return of spontaneous circulation (ROSC) in adult OHCA patients, to identify this parameter. MethodsA retrospective observational study was conducted at East Anglian Air Ambulance (EAAA). Adult (≥18 years) medical OHCA patients attended by EAAA between 01/02/2015 and 01/02/2024, who had arterial IBP measurement during chest compressions were included. The initial, minimum, maximum, average (mean) and Δ (maximum-initial) were calculated for systolic (SBP), diastolic (DBP) and mean arterial (MAP) components of IBP. Logistic regression and receiver operating characteristic curves tested the association between IBP variables and ROSC. ResultsDuring the study period, 4363 OHCA patients were attended and 80 met inclusion criteria. Thirty-four patients (42.5 %) achieved ROSC and 4 (5.0 %) survived to discharge. The maximum, average and Δ DBP; and maximum and average MAP were positively associated with ROSC. Maximum DBP had an AUC of 0.83 (95 % CI 0.74–0.92) with an optimal cut-off of 35 mmHg (sensitivity 94.1 %; specificity 58.7 %) for predicting ROSC. The odds ratio for ROSC was 1.05 (95 % CI 1.03–1.08) for every 1 mmHg increase in maximum DBP. ConclusionsThis study supports the use of arterial DBP as an important haemodynamic parameter for goal-directed resuscitation in adult OHCA. Maximising DBP may increase the chances of ROSC. These data suggest that a DBP threshold of 35 mmHg is optimal for identifying patients who may achieve ROSC with continued resuscitation.

Analysis of prognosis and medical resource utilization in elderly patients with trauma: A retrospective cohort study in one trauma center

Background: Trauma is consistently among the top ten causes of death worldwide. The aging population, constituting 15.21% of adults aged over 65 in Taiwan as of November 2019, has significantly impacted healthcare expenditures. This study aimed to explore the prognosis and resource utilization in patients with geriatric trauma. Methods: This retrospective analysis included ER admissions between January 2015 and December 2017 at a Level I trauma center in southern Taiwan. Of the 5,185 eligible patients, 1,743 were elderly. Comparisons between the age groups assessed medical resource use, patient characteristics, trauma profiles, and management. Outcomes examined included mortality, complications, length of hospital stay, duration of ICU stay, and costs. Results: Elderly patients, predominantly women, exhibit more blunt injuries often resulting from accidental falls. They experienced longer hospital stays and higher medical expenses, as well as increased complication and mortality rates. Mortality predictors included age, GCS score, trauma severity score (≥16), complications, surgery, and initial hypotension. Complications correlated with prolonged length of hospital stay (LOS), early blood transfusion, and mortality, impacting overall expenditure along with trauma severity, ICU days, surgery, and AIS score (≥3). Conclusion: Elderly patients had a longer LOS, higher mortality and complication rates, and higher total medical costs. The required medical expenses for elderly trauma cases were relatively higher than those for younger individuals. Relevant authorities should consider patient age when formulating policies for trauma reimbursement. Based on our findings, healthcare resource utilization can be reduced by decreasing the length of hospital stay and mitigating trauma severity. We recommend collecting more detailed data, extending the study period, and engaging in multicenter collaborations to validate our findings and provide a roadmap for further research. We suggested that interventional studies are needed to test strategies aimed at reducing resource utilization and improving outcomes in elderly trauma patients, which would be valuable.

Patients Monitoring and Data Management System for Hospitals

This work concerns creating a monitoring system for a smart hospital using Raspberry Pi to measure vital signs. The readings are continually sent to central monitoring units outside the room instead of being beside the patients, to ensure less contacting between the medical staff and patients, also the cloud is used for those who leave the hospital, as the design can track on their medical cases. Data presentation and analysis were accomplished by the LabVIEW program. A Graphical User Interface (GUI) has been created by the Virtual-Instrument (VI) of this program that offer real-time access to monitor patients' measurements. If unhealthy states are detected, the design triggers alerts and sends SMS message to the doctor. furthermore, the clinicians can scan a QR code (which is assigned to each patient individually) to access its real-time measurements. The system also utilizes Electrocardiography (ECG) to detect abnormalities and identify specific heart diseases based on its extracted parameters to encourage patients to seek timely medical attention, while aiding doctors in making well-informed decisions. To evaluate the system's performance, it is tested in the hospital on many patients of different ages and diseases as well. According to the results, the accuracy measurement of SpO2 was about 98.39%, 97.7% for (heart rate) and 98.7% for body temperature. This shows that the system can offer many patients receiving health services from various facilities, and it ensures efficient data management, access control, real-time monitoring, and secure patient information aligning with healthcare standards.

Proteomic Profiling of COVID-19 Patients Sera: Differential Expression with Varying Disease Stage and Potential Biomarkers

Background/Objectives: SARS-CoV-2 is one of the viruses that caused worldwide health issues. This effect is mainly due to the wide range of disease prognoses it can cause. The aim of this study is to determine protein profiles that can be used as potential biomarkers for patients’ stratification, as well as potential targets for drug development. Methods: Eighty peripheral blood samples were collected from heathy as well as SARS-CoV-2 patients admitted at a major tertiary care center in Riyadh, Saudi Arabia. A label-free quantitative mass spectrometry-based proteomic analysis was conducted on the extracted sera. Protein–protein interactions and functional annotations of identified proteins were performed using the STRING. Results: In total, two-hundred-eighty-eight proteins were dysregulated among all four categories. Dysregulated proteins were mainly involved in the network map of SARS-CoV-2, immune responses, complement activation, and lipid transport. Compared to healthy subjects, the most common upregulated protein in all three categories were CRP, LGALS3BP, SAA2, as well as others involved in SARS-CoV-2 pathways such as ZAP70 and IGLL1. Notably, we found fifteen proteins that significantly discriminate between healthy/recovered subjects and moderate/under medication patients, among which are the SERPINA7, HSPD1 and TTC41P proteins. These proteins were also significantly downregulated in under medication versus moderate patients. Conclusions: Our results emphasize the possible association of specific proteins with the SARS-CoV-2 pathogenesis and their potential use as disease biomarkers and drug targets. Our study also gave insights about specific proteins that are likely increased upon infection but are likely restored post recovery.

THE IMPORTANCE OF COMMUNICATION OF MEDICAL RADIOLOGY ENGINEERS AND PATIENTS THROUGH THE LENS OF EMPATHY

Effective communication is essential for the quality of healthcare and patient satisfaction in medical institutions. Empathy as part of emotional intelligence plays a major role in the interaction between healthcare workers and the patient, as it helps to understand patient needs, reduce stress and improve patient experience. This paper analyzes theoretical concepts and practical aspects of empathy in the scope of medical radiology; it examines the challenges and preparations that may arise when communicating and provides guidance on how to improve the connection between medical radiology engineers and patients. Addressing this phenomenon enables the development of strategies to improve communication skills as well as compassion, which can lead to better patient outcomes and contribute to an effective working environment for medical staff.

Indoor Air Quality in an Orthopedic Hospital from Romania

Inside hospitals, there is a trend of increasing levels of air pollutants. However, only the indoor air quality in operating theaters is carefully monitored. Therefore, we set the goal of this study to evaluate the indoor air quality in areas of an orthopedics department and to compare the indoor air quality indices that characterize these areas. We used a monitoring system based on the Internet of Things with uRADMonitor model A3 sensors, with which we prospectively measured indoor air quality in the facilities of the orthopedic emergency hospital of Targu Mures in Romania, between 1 February 2023, and 31 January 2024. The primary target pollutants investigated in the emergency room, outpatient room and ward were carbon dioxide (CO2), nitrogen dioxide (NO2), volatile organic compounds (VOCs) and particles with a diameter smaller than 2.5 μm (PM2.5). We compared the effectiveness of the intervention for emergency rooms where air purifiers were working or not. The concentrations of CO2, VOCs and PM2.5 were significantly higher in the emergency room than in the outpatient room or ward. The indoor air quality was worst in winter, when the CO2, NO2 and VOC concentrations were at their highest. Air purifiers can help reduce the concentration of PM2.5 in emergency rooms. Medical staff and patients in orthopedic hospitals, especially in emergency rooms, are frequently exposed to polluted ambient air, which can affect their health. Orthopedic medical practice guidelines should address issues relating to the protection of personnel through the application of measures to improve indoor air quality.

Diagnostic Validity of Clinical Observations for Detecting Physiologic Swallowing Impairment.

A clinical swallow evaluation (CSE) is a noninvasive and indirect assessment of the anatomical and physiological integrity of the swallowing mechanism in a natural setting. A CSE goes beyond a screening, a dichotomized indicator of dysphagia risk, by comprehensively examining the patient's swallowing through gaining sensory and motor information of oral and pharyngeal function. Information obtained from CSEs in combination with medical, social, and environmental patient related factors allow clinicians to make critical decisions about patients' health and quality of life. It is essential that we have assessment tools with rigorous methodological quality to optimize the accuracy of our clinical judgement. The purpose of this study is to investigate the diagnostic validity of clinical observations obtained through the Mann Assessment of Swallowing Ability (MASA) to better inform clinicians regarding the confidence that the items are testing what they are intended to test and reflect indication of true physiologic swallowing impairment and airway invasion. Area Under the ROC Curve (AUC) analyses revealed that the MASA's diagnostic validity showed acceptable accuracy levels for detecting oral impairment and aspiration, and poor accuracy for detecting pharyngeal impairment and penetration. In the cross-validation analysis, the AUC accuracy level for aspiration changed from acceptable to poor, but remained the same for oral impairment, pharyngeal impairment and penetration. In our sample, acceptable levels for detecting aspiration but poor levels for detecting pharyngeal impairment indicate that the MASA does an adequate job of identifying risk but not explaining the nature of impairment. These results support the need for videofluoroscopic imaging to identify the nature and severity of swallowing impairment, guide intervention and provide recommendations for safe and efficient oral intake.

A01 - AHP An Examination of the Opinions of NHS Stakeholders on the Current and Future Role of Physician Associates

Abstract Background Globally, healthcare systems are experiencing problems recruiting and retaining healthcare workers. Like many developed countries, in the UK, shortages are exacerbated by rising healthcare costs and models have had to be developed utilising shorter training periods and a generalized skillset. One of the consequences is the development of intermediate-level practitioners including Physician Associates (PAs). By 2024 over 4,000 PAs were working in the NHS, but their myriad roles has meant that integration has been challenging. This study examines the opinions of NHS stakeholders on the current and future roles of PAs and explores approaches to improve their integration. Method This cross-sectional study at a single NHS Trust gathered views and experiences regarding PAs through a survey of consultant and junior medical staff (JDs), PAs, and patients. Patients who interacted with a PA within four weeks prior to the period of the survey were randomly selected to avoid recall bias. Surveys, initially generated by doctors and a PA, were tailored, validated by experts, and pilot-tested. Distribution was via Microsoft Forms® and ACCURX® and responses were collected electronically with weekly reminders. Data were analysed using Microsoft Excel® and SPSS®, with qualitative analysis used to identify recurring themes. Results Consultants more frequently recognised positive contributions of PAs (p=0.012) although 68.6% noted PA roles were unclear. The PA role had only been explained to 11% of JDs, just 14% fully understood their role and 75% felt PAs might negatively affect their training. Conversely most PAs felt consultants (87.5%) and JDs (81.3%) were aware of their responsibilities. While 62.5% of PAs anticipated career progression, 87.5% were satisfied with training, 56.3% were considering a career change and 75% felt the healthcare climate adversely affected their work. Only 14% of patients fully understood the PA role, but 86% comfortable being seen by them. Conclusion This study highlights the positive contributions of PAs and recognition by stakeholders. Integration however remains challenging with concerns regarding JD training, PA career progression, and job satisfaction. The main hurdles remain unclear compounded by myriad PA roles and surveys reveal significant gaps in understanding among JDs and patients. PAs overestimate understanding of their role and education of stakeholders regarding their PA roles is crucial and must involve PAs, managers, consultants, GMC, and Royal Colleges. Local trusts and consultants must define PA roles, ensure career progression, and support JD training to enhance interprofessional relationships, trust, and the quality of patient care.

Expression pattern of long non-coding RNAs in treatment-naïve and medicated schizophrenia patients.

Schizophrenia is a disabling mental disorder that affects 1% of people over their lifetime. The etiology and mechanism of schizophrenia are very complex, and many genes are involved in many different signaling pathways in the etiology of this disease. According to recent studies, one of the important mechanisms altered in this disorder is the regulation of immune system and the inflammation mechanism. In the present study, we evaluated the peripheral blood expression pattern of four lncRNAs and three protein-coding genes in the treatment- naïve patients, and medicated patients compared with sex and age-matched controls. In the medicated-patients, expression levels of IFNG, IL18RAP, AC007278.2 were significantly up-regulated (P < 0.05); and the expression level of IFNG-AS1-001 was significantly down-regulated compared to healthy controls (P < 0.05). However, levels of IL18R1, AC007278.3 and IFNG-AS1-003 were not different between these groups. In the treatment-naïve patients, IFNG, IL18R1, IL18RAP, IFNG-AS1-001, AC007278.2, and AC007278.3 were significantly up-regulated compared to controls. On the other hand, IFNG-AS1-003 was significantly down-regulated in the treatment-naïve patients compared to controls. Based on the Spearman correlation matrix, there was a significant correlation between genes in the treatment-naïve patients. We also showed the high sensitivity and specificity of IFNG-AS1-003, IFNG, IL18R1, and AC007278.3 in the identification of treatment-naïve patients from controls. The current study contributes further evidence to the understanding of the role of lncRNAs in the pathogenesis of schizophrenia. Future research is necessary to establish the validity of lncRNAs as peripheral markers for this condition.

Abstract 4126971: Advanced Care Planning in the CCU: What are the Numbers?

Introduction: Advanced care planning (ACP) is an important, though often neglected, part of medicine. It can promote goal-concordant care and improve communication between the medical team and patient. This is especially important in the intensive care unit, where important health decisions are made by patients and families. Previous studies have shown that patients and families are interested in ACP discussions, especially in intensive care units. Studies are limited, however, in analyzing the prevalence of these discussions prior to and during admission to the cardiac intensive care unit (CCU). Methods: This was a retrospective cohort study. Baseline demographics were collected on patients admitted or transferred to the CCU between January 1, 2022- July 1, 2022. The presence of any ACP (documentation including POLST forms, advance directives, or power of attorney forms) filled out prior to and during admission was recorded. Length of stay, outcome of admission, discharge disposition, and baseline comorbidity index using the Charlson Comorbidity Index (CCI) were also recorded. Transplant patients, patients admitted for transplant, and patients who underwent multiple admissions were excluded from the study. Results: Between January and July, 400 patients met criteria for inclusion. The average age was 67, with males accounting for 62% of patients. The average CCI amongst these patients was 6.95. Of the 400 patients, 31 had ACP completed prior to their admission (7.75%). Out of the 369 patients who did not have ACP in place upon admission, 9 had ACP completed during their stay in the CCU (2.44%). There was no difference in CCU hours amongst those who had ACP prior to admission compared to those who did not (p=.9). There was, however, a difference among CCI index: those with ACP prior to admission had an average CCI of 9.94 compared to 6.7 in those without ACP (p&lt;.001). Conclusions: Patients at risk of cardiac-related mortality can benefit from ACP discussions prior to the onset of critical illness; however, only a small fraction of patients admitted to the CCU have proper documentation of this process. Inpatient and outpatient ACP can target at-risk patients to improve both the conversation and documentation of patient values and treatment preferences. Possible interventions to provide this care include physician education, consistent discussion of ACP during rounds, or flagging patients without ACP in the EMR.

Strategies for implementing an electronic patient-reported outcomes-based symptom management program across six cancer centers.

Electronic patient-reported outcome (ePRO)-based symptom management improves cancer patients' outcomes. However, implementation of ePROs is challenging, requiring technical resources for integration into clinical systems, substantial buy-in from clinicians and patients, novel workflows to support between-visit symptom management, and institutional investment. The SIMPRO Research Consortium developed eSyM, an electronic health record-integrated, ePRO-based symptom management program for medical oncology and surgery patients and deployed it at six cancer centers between August 2019 and April 2022 in a type II hybrid effectiveness-implementation cluster randomized stepped-wedge study. Sites documented implementation strategies monthly using REDCap, itemized them using the Expert Recommendations for Implementation Change (ERIC) list and mapped their target barriers using the Consolidated Framework for Implementation Research (CFIR) to inform eSyM program enhancement, facilitate inter-consortium knowledge sharing and guide future deployment efforts. We documented 226 implementation strategies: 35 'foundational' strategies were applied consortium-wide by the coordinating center and 191 other strategies were developed by individual sites. We consolidated these 191 site-developed strategies into 64 unique strategies (i.e., removed duplicates) and classified the remainder as either 'universal', consistently used by multiple sites (N = 29), or 'adaptive', used only by individual sites (N = 35). Universal strategies were perceived as having the highest impact; they addressed eSyM clinical preparation, training, engagement of patients/clinicians, and program evaluation. Across all documented SIMPRO strategies, 44 of the 73 ERIC strategies were addressed and all 5 CFIR barriers were addressed. Methodical collection of theory-based implementation strategies fostered the identification of universal, high-impact strategies that facilitated adoption of a novel care-delivery intervention by patients, clinicians, and institutions. Attention to the high-impact strategies identified in this project could support implementation of ePROs as a component of routine cancer care at other institutions. ClinicalTrials.gov. NCT03850912. February 22, 2019. https://clinicaltrials.gov/ct2/show/NCT03850912?term=hassett&draw=2&rank=1.

Abstract 4137205: Management Patterns and Outcomes in the Use of Invasive Mechanical Ventilation for Patients with Cardiogenic Shock

Background: Approximately half of all patients with cardiogenic shock (CS) require invasive mechanical ventilation (IMV). While there have been significant advances in the management of patients requiring IMV based on data primarily derived from medical intensive care patients with respiratory failure, little is known regarding the management and outcomes of IMV in patients with CS. Methods: We conducted an analysis of patients treated for CS who required IMV at an academic safety net hospital from 2017-2023. Indications for IMV, ventilator settings, and medications were obtained from the medical record. The primary outcome was unsuccessful extubation, defined as reintubation within 48 hours of extubation. Results: A total of 110 patients with CS who received IMV were identified. Median age was 60yo; 28% of the cohort was female, 39% of Hispanic ethnicity, and 38% of Black race. Primary reasons for intubation included ongoing cardiac arrest (35%) and hypoxic respiratory failure (34%). Most patients were on minimal ventilator support at 24 hours after intubation (median FiO2 40% [IQR 30-50%], post-end expiratory pressure [PEEP] 5cm H2O [IQR 5-8]). Mechanical circulatory support (MCS) was present in 40% of patients at 24 hours post-intubation. Protocolized spontaneous breathing trials (SBTs) were delayed in 77% of patients, primarily due to hemodynamic instability (88%). Planned or unplanned extubation occurred in 63% of patients after a median of 4.8 days [IQR 2.1-8.0]. Ten percent of patients transferred hospitals while on IMV, while 27% were palliatively extubated or died on IMV. The majority (58%) of patients undergoing non-palliative extubation were on vasoactive medications preceding extubation, with only 2% on MCS. Most patients (58%) were extubated to nasal cannula or room air. A total of 13% of patients experienced unsuccessful extubation. Conclusions: In a cohort of patients with CS requiring IMV, most patients were on minimal ventilator settings within 24 hours yet remained intubated with SBTs delayed due to hemodynamic instability. Rates of failed extubation were comparable to published data from other forms of critical illness. Further work is necessary to determine optimal approaches to ventilator liberation and circulatory support in intubated patients with CS where hemodynamic derangements rather than respiratory insufficiency represent the primary barrier to extubation.

Abstract 4124769: Temporal Changes in Clinical Characteristics and Oucomes of Infective Endcarditis: A Report from JROAD-DPC Study

Background: Despite advances in medical science and patient care, infective endocarditis (IE) is still a serious and life-threatening disease. Considering the recent shifts in predisposing clinical backgrounds of cardiovascular disease, such as an aging population and increased usage of prosthetic valves and cardiovascular implantable electronic devices, ongoing updates to patient characteristics and outcomes of infective endocarditis (IE) are essential for providing precision diagnoses and effective treatments. Objective: To examine temporal trends in the clinical characteristics and in-hospital occurrence of adverse outcomes of IE. Methods: Observational study of using a nationwide Japanese administrative database (JROAD-DPC), that is operated by the Japanese Circulation Society. IE was identified based on the code of the International Classification of Diseases, Tenth Revision. The study outcomes were in-hospital mortality and IE-compatible complications (heart failure, cerebrovascular episodes, renal failure, and sepsis). Results: Between the years 2016 and 2021, a total of 17,407 IE patients (37.8% female; median age 72 (IQR, 59-81) years) were identified in JROAD-DPC database. The incidence of IE increased from 2.02 per 100,000 population (2,534 cases) in 2016 to 2.59 (3,183 cases) in 2021. The median age of the patients increased from 70 years in 2016 to 73 years in 2021, and patient backgrounds were becoming more complex. Notably, the proportion of patients older than 80 years rose from 25.4% to 30.8%. The in-hospital mortality rate was 14.5%, which significantly increased from 14.1% in 2016 to 15.4% in 2021. Higher age (OR, 1.34; 95% CI, 1.29 to 1.40; &lt;.001), heart failure (OR, 1.37; 95% CI, 1.18 to 1.59; P&lt;.001), cerebrovascular complications (OR, 1.78; 95% CI, 1.59 to 1.99; P&lt;.001), renal failure (OR, 2.36; 95% CI, 2.06 to 2.70; P&lt;.001), and sepsis (OR, 2.79; 95% CI, 2.48 to 3.13; P&lt;.001), were independently associated with increased in-hospital mortality. In contrast, cardiac surgery (OR, 0.47; 95% CI, 0.41 to 0.55; P&lt;.001), and a higher number of total cardiac surgeries (OR, 0.77; 95% CI, 0.65 to 0.92; P&lt;.004) independently predicted a lower in-hospital mortality. Conclusions: The characterization and comprehensive analysis of IE in Japan provide valuable insights into the epidemiology, risk factors, and outcomes of IE, which may inform health service planning and treatment strategies.

Exploring Magnetic and Electrical Brain Stimulation in Parkinsonian Dyskinetic Monkeys.

Parkinson's disease (PD) chronic L-Dopa treatment often triggers motor complications, such as L-Dopa-induced dyskinesias (LID). LID are reported to be associated with abnormal glutamatergic activity between the striatum and primary motor cortex (M1), resulting in M1 hyperactivation. Beneficial noninvasive brain stimulation (NIBS) paradigms were reported to normalize glutamatergic activity. The objective of the present study was thus to set up a NIBS paradigm in parkinsonian monkeys to investigate motor behavior under basal conditions and with L-Dopa treatment-inducing dyskinesias. Motor behavior was investigated in five 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) dyskinetic female Macaca fascicularis monkey models of PD, allowing us to monitor the administration of NIBS and drugs. NIBS used were inhibitory protocols, that is, cathodal transcranial direct current stimulation (c-tDCS) and continuous theta-burst stimulation (cTBS). A procedure of three weeks was developed to progressively acclimate animals to the experimental conditions, equipment and noise of c-tDCS and cTBS before stimulating them with either vehicle or L-Dopa. One session of c-tDCS with L-Dopa yielded no effect, whereas five sessions briefly reduced LID but decreased the duration of L-Dopa anti-PD effects. cTBS alone improved (decreased) parkinsonian scores as compared to sham stimulation or vehicle alone. Two sessions of cTBS with L-Dopa decreased LID without affecting L-Dopa anti-PD effects. This is the first study testing c-tDCS and cTBS on the motor behavior of MPTP dyskinetic monkeys. As compared to medicated patients, MPTP monkeys offer the opportunity to evaluate NIBS after-effects in drug-free and LID conditions, which are critical in the search for new PD treatment.

PUBLIC ANTI-CRISIS MANAGEMENT AND COMMUNICATIONS WHEN PROVIDING EMERGENCY MEDICAL AID IN THE MEDICAL INDUSTRY OF UKRAINE

In this article, the authors focus on several key problems that arise in the process of management and communication in crisis situations related to the provision of emergency medical care. The article examines approaches to managing crisis situations in the sphere of health care of Ukraine in conditions of increased uncertainty and instability. The authors emphasize the importance of effective communication between medical institutions, government structures and the public to ensure prompt response to emergency situations. The article examines various aspects of public crisis management, including planning, organization of resources, and coordination of actions during the provision of emergency medical care. The article analyzes the tools of public management, which allow to minimize various consequences of incoherence of actions between state institutions and medical institutions. Special attention is paid to the importance of prompt decision-making and establishment of communication links between state bodies, medical workers and the population. The possibilities of applying international experience in the field of anti-crisis management and its adaptation to Ukrainian realities are also discussed. The conclusions of the article emphasize the need to reform the health care system in the direction of strengthening its resilience to crises, improving communication mechanisms, and implementing innovative management solutions to increase the effectiveness of providing emergency medical care in emergency situations. The article emphasizes the need for quick decision-making, building effective communication chains between medical staff, patients and other stakeholders. Special attention is paid to the challenges associated with the lack of resources, the limited capabilities of the health care system in the context of crises and the role of leadership in implementing changes. The article also offers recommendations for improving communication processes and management approaches that will contribute to increasing the effectiveness of medical care during emergency situations, particularly in wartime.

Sociological research methods with a differentiated approachin regional nursing

Background.In the professional audit of the quality of nursing care, sociological research methods are of particular importance in the context of the formation of skills and abilities, with the help of which a set of expert criteria is formed from the general set of practical activities. Taking into account that the selection of qualified elements requires information about the scientific approach, in proportion to the originality of the expert function, it is relevant to identify them more clearly in the examination, which allows correcting the process of training and retraining of personnel. Objective.Toevaluate the sociological research methods of regional nursing on the example of the Orenburg region. Materials and methods.The main criteria for evaluating the activities of medical workers using the Delphi method are presented. The examination performed by the method of sociological and expert survey of average medical workers (n=535), doctors (n=80), heads of medical institutions (n=10) and patients (n=500) allowed us to formulate formalized indicators for evaluating measures to create innovative training and retraining programs for nursing staff. Mathematical "sketches" of the programs are based on factorial/cluster/discriminant analyses. Results. Sociological research methods in regional nursing have sanctioned a set of parameters of the qualities of a specialist in his professional activity in the context of training and retraining of nursing staff. Conclusion. Mathematical prototypes of programmatic training of medical staff created on the basis of sociological research methods in regional nursing contribute to the algorithmization of improvements in the format of the content and quality of training in order to provide competent and competitive specialists for the industry.

Season-dependent characteristics of shock-related injuries in the Arctic zone of the Arkhangelsk region

Relevance. Studying the dynamics of injury rates, injury types and severity, as well as the treatment quality across various country regions, in particular the Arctic, is a prerequisite for managerial, healthcare, and strategic efficiency prior to and during hospital stay, taking into account the climate, geography, social and economic characteristics of every Russian Federation constituent.The objective is to analyse shock-related injuries in the Arctic zone of the Arkhangelsk region to understand season-related injury dynamics.Methods. Retrospective case series description parameters were used to study 140 patients with traumatic shock admitted to the Arkhangelsk Regional Clinical Hospital (ARCH) - a tier 1 trauma center. The analysed medical registration records included patient ambulance record and token (form 114/u), inpatient medical record (form 003/u), surgery logbook (form 008/u), patient radiographs, CT and nuclear MRI reports, as well as laboratory results. The study was conducted in accordance with ethical standards of the Declaration of Helsinki and European Community Directives (8/906 EC) and was approved by the local ethics committee of the Northern State Medical University of the Russian Ministry of Healthcare, Arkhangelsk (protocol no. 02/4-15 dated 04/08/2015). Statistical application package STATA ver.12 was used for statistical data processing.Results and discussion. The research demonstrated that the incidence of shock trauma is 4 times higher in men than in women. The vast majority of the injured are of working age. Seasonal distribution analysis per type of injuries and shock severity, including due to alcohol abuse, was carried out. The number of shock injuries is highest in winter, mainly due to road accidents which constitute 75.6 % of all injuries in winter. Throughout the year, over 50 % of shock injuries are combined injuries, that outperform isolated and multiple injuries in number. In particular, numerous combined injuries occur in winter with a responsible for almost 60 % among all other injuries. The majority the injured with shock-related trauma presented with stage 2 shock (49.3 %), whereas stage 1 and stage 3 shock was diagnosed in 27.9 % and in 21.4 % respectively. In winter, one in four patients with a shock-related injury presented with stage 3 shock. Alcohol-associated shock injuries are more numerous in summer (35.3 %), showing almost the same incidence as road traffic, domestic, and street injuries.Conclusion. The analysis of various types of injuries and season-related incidence of shock injuries in the Arctic territory of the Arkhangelsk region provides evidence to justify preventive measures to reduce the injury rates. Intensified efforts are required to minimise road traffic accidents in winter and combat alcohol abuse responsible for most injuries in summer. Since the vast majority of shock injuries occur in winter, in cold months ambulances must be equipped with local heating facilities, such as evacuation thermal bags with autonomous electric heating, thermal blankets, infusion warmers for blood transfusion and infusion sets.

Impact of Family Mutual Aid System for Personal Medical Insurance Accounts on Paediatric Patients' Outpatient Utilisation Patterns and Costs: a difference-in-differences analysis.

This study explores the effect of the transformation of paediatric healthcare through the implementation of the Family Mutual Aid System (FMAS) for personal medical insurance accounts, among paediatric patients at a children's hospital (Hospital A in Shanghai, China). We conducted a cohort study in the endocrinology department of Hospital A from August 2021 to July 2023 to assess the impact of the FMAS enrolment on patients' annual outpatient visits, annual outpatient expenditures, and the allocation of these costs among the Basic Medical Insurance Pooling Fund and patients' out-of-pocket (OOP) expenses, with a further subdivision into online and offline consultations. Analysis employed a weighted Difference-in-Differences approach within a fixed-effects model following Propensity Score Matching. The study encompassed 10,975 paediatric patients, divided into those enrolled in the FMAS (observation group) and those not (control group). Enrolment in FMAS was associated with a statistically significant increase in annual outpatient visits by an average of 1.107, predominantly attributed to an uptick in offline consultations. Additionally, there was a substantial 38.9% rise in annual outpatient costs. Detailed analysis revealed a 52.5% increase in costs covered by the medical insurance pooling fund, while patients' OOP expenses decreased by an average of 69.2%. These findings highlight the beneficial effects of FMAS enrolment on healthcare service utilization and risk-sharing mechanisms of medical insurance.

Exploring the career aspirations of pre-registration trainee and qualified pharmacy technicians in NHS Birmingham and Solihull using a self-administered questionnaire

Abstract Introduction The NHS Long-Term Workforce Plan (LTWP) recommends expanding the number of pharmacy technicians to support transformation across the pharmacy workforce.1 Birmingham and Solihull Pharmacy Faculty (BSPF) undertook workforce planning, identifying challenges around recruitment and retention. Aim To identify the career aspirations of pre-registration trainee pharmacy technicians (PTPTs) and pharmacy technicians (PTs) to improve recruitment and retention and inform the BSol pharmacy workforce strategy. Method A self-administered online questionnaire (Microsoft Forms) was developed and piloted before emailing to PTPTs and PTs via the BSPF members to all sectors during November to December 2023. Themes included career aspirations (and support required to achieve these), views on career progression and pathways (and skill utilisation), training received, opinions on cross-sector working, retention and concerns post qualification. An excel spreadsheet of downloaded responses were analysed using descriptive statistics. Ethical approval was not required. Results PTPTs: Responses received were 29 (45%) out of 64 ICS PTPTs from all sectors. The majority, 20 (69%) were from secondary care, two (7%) worked cross-sector. Twenty (69%) were women, with seventeen (27%) aged 25 years and above on entering training. Post qualification, 21 (72%) preferred secondary care; role expectations included medication histories, accuracy checking and patient facing work. Post qualification concerns were autonomy, responsibility, utilising skills and changing sector. PTs: Responses received were 62 (13%) out of 477 ICS PTs from all sectors. The majority, 21 (34%) were from secondary care, six (10%) worked cross-sector. Fifty (81%) were women, length of experience varied with 16 (26%) working for 25 years or more. Common themes PTs identified limited career progression (clinical and leadership), feeling undervalued, work-related stress and salary as factors for leaving the profession. PTPTs and PTs identified location, continuity, familiarity, and progression as reasons for retention. Seventeen (27%) PTs said their skills were underutilised, 25 (40%) stated lack of opportunities affected progression. Only 17 (27%) said their organisation had a career pathway. Twenty (69%) PTPTs expected post-qualification training, but 17 (27%) PTs had received no training in the last three years (or gave no reply). Educational, clinical and leadership roles were common career aspirations for both PTPTs and PTs, facilitators being training opportunities, encouragement from seniors, cross-sector experience and creation of career pathways. Nineteen (66%) PTPTs and 46 (74%) PTs desired cross-sector working. All PTPTs were unfamiliar with other pharmacy sectors, 12 (41%) wanted shadowing opportunities. Discussion / Conclusion The study informs the BSol pharmacy workforce strategy to include: cross/multi-sector working, increase novel ‘top-of-license’ roles and develop career pathways for PTs, to support the NHS LTWP. PTPTs results suggest systems should recruit from an audience wider than schools and colleges, to explore this, the BSPF have funded a BSol PT fellowship. The BSPF are providing shadowing opportunities and the promotion of different pharmacy sectors in colleges. This study provides an insight into career aspirations to improve recruitment and retention of BSol pharmacy technicians. Study limitations include; participants are from BSol and/or the Midlands only, self-selected and small numbers (few from community pharmacy), with PTPTs at colleges only, thus results are not generalisable and risk bias. Reference 1. NHS England (2019). The NHS Long Term Plan. Available at: www.longtermplan.nhs.uk/publications/nhs-long-term-plan (accessed 31st May 2024). NHS Improvement (2019).