Personal Care Research Articles

Practical guidelines of the International Working Group on the Diabetic Foot, European Society for Vascular Surgery, Society for Vascular Surgery on the prevention and management of diabetes-related foot disease 2023

Diabetes‑related foot disease results in a major global burden for patients and the healthcare system. The International Working Group on the Diabetic Foot (IWGDF) has been producing evidence‑based guidelines on the prevention and management of diabetes‑related foot disease since 1999. In 2023, all IWGDF Guidelines have been updated, based on systematic reviews of the literature and formulation of recommendations by multidisciplinary experts from all over the world. In addition, a new guideline on acute Charcot neuro‑osteoarthropathy was created. In this document, the IWGDF Practical Guidelines, we describe the basic principles of prevention, classification and management of diabetes‑related foot disease, based on the seven IWGDF Guidelines. We also describe the organizational levels to successfully prevent and treat diabetes‑related foot disease according to these principles and provide addenda to assist with foot screening. The information in these practical guidelines is aimed at the global community of healthcare professionals who are involved in the care of persons with diabetes. Many studies around the world support our belief that implementing these prevention and management principles is associated with a decrease in the frequency of diabetes‑related lower‑extremity amputations. The burden of foot disease and amputations is increasing at a rapid rate, and comparatively more so in middle to lower income countries. These guidelines also assist in defining standards of prevention and care in the these countries. Authors hope that these updated practical guidelines continue to serve as a reference document to aid healthcare providers in reducing the global burden of diabetes‑related foot disease.

Machine learning models for personalised healthcare on marketable generative-AI with ethical implications

Personalised healthcare, underpinned by a deep understanding of individual patient variability, demands innovative solutions. Machine Learning (ML) models offer a promising avenue to achieve this by facilitating the development of enhanced Digital Twins (DTs). This research proposes a novel framework for creating DTs tailored to individual patients, considering not only physical attributes but also the intricate interplay of social, and biological factors. By capturing this comprehensive patient profile, ML-powered DTs have the potential to revolutionise healthcare by enabling predictive, preventive, and personalised care strategies, ultimately leading to improved patient outcomes and the development of a marketable, trust-worthy product. Current healthcare solutions lack personalisation, often failing to consider individual differences in disease presentation and response to treatment. Traditional DTs in healthcare often adopt a disease-centric or organ-specific approach, thereby restricting their capacity to deliver comprehensive, personalised care. To address this limitation, we propose a holistic Artificial Intelligence (AI) framework centered on ML models. Initially focusing on diabetes, our research aims to enhance diagnosis, treatment, and predictive capabilities through personalised insights, thereby optimising patient outcomes and care management. The benefits identified with our ML model are early disease prevention and risk stratification, optimised treatment planning and therapy selection, enhanced patient-physician communication and shared decision-making, reduced healthcare costs and improved resource allocation. Our models are designed to optimise patient care while prioritising safety and societal benefit. To ensure this, we have conducted a thorough assessment of potential ethical implications. Key challenges identified include data privacy and security, algorithmic bias, diagnostic accuracy, data interoperability and standardisation, integration with existing healthcare systems, ethical management of sensitive patient data, refinement of ML methodologies, addressing legal and ethical AI challenges, and suggesting robust ethical guidelines. A comprehensive evaluation of accuracy, reliability, and associated risks will be conducted prior to full-scale integration into the healthcare ecosystem to establish a robust ethical framework for our research models.

A Study of the Clinical Characteristics of Patients with Low Back Pain at a Single Center in Baghdad

Background: Low back pain is a prevalent and consequential problem in contemporary culture. In the early phases of their careers, many athletes who train particularly hard have considerable low back difficulties Aims of study is to enhance understanding and guide best management practices for those with or at risk of low back pain and to identify diverse aspects of clinical and epidemiological factors in Iraqis for low back pain. Patients and methods: A cohort of 440 individuals diagnosed with Low back pain (LBP) from the rheumatology department at Baghdad Teaching Hospital-Medical City in Baghdad province were involved in the current cross-sectional investigation. The sample consisted of 180 men and 260 women, with an average age of 45.7±14.8 years. The research was carried out from 12/October/2023 to 12 /March/2024. Results: All individuals in this study had LBP. The means age was 45 for the group of patients under consideration. 7 ± 14. 8 years. LBP had the highest incidence in the middle-aged (40-59 years 23%) and the lowest was recorded for the aged above 70 years (7. 5%). Females accounted for 59. 1% of the participants. Most of them; a percentage equivalent to 75. 5% were married. Approximately a third or 30% were employed while, 70.9% of the respondents were jobless. 6 % were overweight people and 77 % were non smokers in the study group. The mean age at the first complaint, visit and diagnosis of the disease were 43. 0 ± 14. 0 years (range: 11–75), 43. 3 ± 14. 2 years (range: McGregor observed that 11% to 78% of patients had some degree of in Continuation of Disturbances: Symptoms, defective vision, and 43. 5 ± 14. 2 years (range: 14–78),respectively. Intervertebral disc prolapse was the most frequent diagnosis among the patients with LBP (49. 8%), while infections were the least frequent (0. 2%). In the following aspects of the Oswestry Low Back Pain Disability Scores, majority participated as follows; 44. 3% with fairly severe pain intensity, 42% who require some help with personal care but mostly manage with it, 39. 5% who lift heavy weights but manage light to medium weights, 34. 1% who are prevented from walking more than 100 yards by their pain, 37. 5 The Analyzed Oswestry Low Back Pain Disability Score mean was 22. 22 ± 7. 26. Conclusion: LPB has a higher frequency among the female population

Investigating the pathophysiology and evolution of internal carotid dissection: a fluid-structure interaction simulation study.

Arterial dissection, a condition marked by the tearing of the carotid artery's inner layers, can result in varied clinical outcomes, including progression, stability, or spontaneous regression. Understanding these outcomes' underlying mechanisms is crucial for enhancing patient care, particularly with the increasing use of computer simulations in medical diagnostics and treatment planning. The aim of this study is to utilize computational analysis of blood flow and vascular wall to: (1) understand the pathophysiology of stroke-like episodes in patients with carotid artery dissection; and (2) assess the effectiveness of this method in predicting the evolution of carotid dissection. Utilizing contrast-enhanced magnetic resonance angiography (MRA), we segmented images of the patient's right internal carotid artery. These images were transformed into 3D solids for simulation in Ansys multifisic software, employing a two-way fluid structure interaction (FSI) analysis. Simulations were conducted across two wall conditions (atherosclerotic and normal) and three pressure states (hypotension, normotension, hypertension). The simulations indicated a significant pressure discrepancy between the true and false lumens of the artery. This suggests that flap motion and functional occlusion under hypertensive conditions could be the cause of the clinical episodes. Thrombotic risk and potential for dissection extension were not found to be critical concerns. However, a non-negligible risk of vessel dilation was assessed, aligning with the patient's clinical follow-up data. This study highlights specific hemodynamic parameters that could elucidate carotid artery dissection's mechanisms, offering a potential predictive tool for assessing dissection progression and informing personalized patient care strategies.

Investigation of the Mediator Role of Career Adapt-abilities in the Relationship Between Big Five Factor Personality Traits and Career Distress

Career distress is an important construct for understanding career development in young adults. Revealing the variables associated with this construct has the potential to contribute to the reduction and prevention of career distress. The aim of this study, which was carried out in this direction, is to examine the mediating role of career adapt-abilities in the relationship between career distress and five-factor personality traits of university students. The research was conducted with 369 university students. Big Five Personality Traits Scale, Turkish five‑factor short form of the Career Adapt‑Abilities Scale and Career Distress Scale were used as data collection tools. Data analyzes were performed using Pearson correlation analysis and structural equation modeling method. The findings of the study showed that career adapt-abilities play a full mediator role in the relationship between career distress and extraversion, agreeableness, and conscientiousness personality traits. In addition, career adapt-abilities have a partial mediator role in the relations between career distress and neuroticism and openness to experience personality traits. The results of the study were discussed considering the theoretical basis and previous research. Recommendations for practitioners and researchers are presented.

Lived experiences of teachers who have undergone attrition in the new normal at a private school

Teacher attrition presents a pressing issue for educational institutions, particularly in the new normal. This study delves into the lived experiences of teachers who faced attrition in a private school in Laguna, Philippines, aiming to understand the reasons behind their decision to leave the profession. Through a qualitative phenomenological approach, specifically, transcendental phenomenology, involving key informant interviews with seven former teachers, recurring themes were identified through thematic analysis. Three major themes emerged: (1) Balancing personal and professional realities, which encompasses managing commitments, coping with job demands, and addressing trauma and mental health challenges; (2) Resources and resilience, highlighting the importance of institutional support, compensation, recognition, and professional growth opportunities; (3) Decision dynamics in navigating attrition, involving personal factors, career aspirations, and reflections on the pandemic's impact. These findings underscore the complexity of challenges teachers face in the new normal. Addressing these challenges necessitates a holistic approach that supports teachers' well-being, provides necessary resources, and acknowledges the multifaceted factors influencing their decisions. By understanding and addressing these dynamics, educational institutions can work towards retaining skilled educators and fostering their growth amidst evolving challenges.

Phthalate Exposure and Pediatric Asthma: A Case Control Study Among Egyptian Children

Background: Phthalates, which are diesters of phthalic acid, are commonly used as plasticizers and additives in various consumer products. Several phthalates have been identified as substances of high concern. Exposure to phthalate esters (PAEs) has been linked to asthma in children, but the specific impacts of PAEs on asthmatic children were not well understood. Objective: The objective of this study was to compare urinary phthalate concentrations in asthmatic and non-asthmatic children and to identify potential sources of exposure as risk factors for asthma. Methods: A case control study was conducted for 100 Egyptian children aged 8-16 years (50 asthmatics and 50 healthy controls). Asthma was identified using GINA guidelines. Socio-demographic and probable risk factors were assessed, in addition to measuring phthalate levels in urine samples using high-performance liquid chromatography. Results and conclusion: Mean urinary Mono-methyl as well as Mono-benzyl levels were highly significant in asthmatic children compared to control group (895.26ng/ mL vs 548.55 ng/mL and 13.5 ng/mL vs 2.07 ng/mL respectively) (p= 0.001). The number of asthmatic children living in houses painted with non-plastic paint was significantly lower (P<0.05) than children living in houses painted with other paints. No association between floor type and asthma was reported. The frequent use of personal care products and plastic painting of walls were identified by multiple logistic regression analysis as the highly significant predictors of asthma in the studied subjects. The declared higher levels of urinary phthalate metabolites (Mono-methyl and Mono-benzyl) in Egyptian asthmatic children may reveal the probable risk of phthalate exposure in triggering bronchial asthma.

Precision medicine activities and opportunities for shaping maternal and neonatal health in Qatar.

Precision Medicine (PM) is a transformative clinical medicine strategy that aims to revolutionize healthcare by leveraging biological information and biomarkers. In the context of maternal and neonatal health, PM enables personalized care from preconception through the postnatal period. Qatar has emerged as a key player in PM research, with dedicated programs driving advancements and translating cutting-edge research into clinical applications. This article delves into neonatal and maternal health in Qatar, emphasizing PM programs and initiatives that have been implemented. It also features noteworthy clinical cases that demonstrate the effectiveness of precision interventions. Furthermore, the article highlights the role of pharmacogenomics in addressing various maternal health conditions. The review further explores potential advancements in the application of PM in maternal and neonatal healthcare in Qatar.

�� ������� ����������Ҳ ����������� Ͳ���ί �������� �����˲

The article highlights the current state of the world market of industrial hemp, presents forecasts for its development, it is stated that the last decade has been characterized by the active development of hemp production in many countries of the world. It is emphasized that this niche plant is called a culture of the 21st century due to a number of advantages that are inherent to it, and also that there are no generalized official statistics on the cultivation of industrial hemp in the world as of 2024. The geography of growing industrial hemp in the world is presented. It is noted that the cultivation of industrial hemp in Ukraine is subject to licensing, the level of the narcotic substance in the varieties that are allowed to grow is the lowest in the world, according to forecasts, the state can become one of the leaders in the production of industrial hemp in the world by 2050. It is highlighted that hemp raw materials are used in the most diverse branches of the economy, in the process of processing different parts of hemp, a wide range of products with high added value can be obtained. A number of other factors that testify to the economic attractiveness of hemp production are also presented, including: short growing season; the possibility of obtaining a significant harvest of biomass even on lands that are unsuitable for other crops; the possibility of cultivation without herbicides; low need for water use; expediency of introduction into crop rotation; the possibility of using all parts of the plant and others. Attention is focused on the multi-vector possibilities of hemp processing; the key factors that encourage the growth of the world market of hemp products are highlighted; the key segments of the global industrial hemp market are highlighted food and beverages, personal care products and paper. Examples of the main areas of hemp processing in Ukraine and the profitability of its cultivation in Ukraine in 2023-2024 are given. It was revealed that the opening of industrial parks, which are aimed exclusively at the cultivation and processing of industrial hemp, is a confirmation of the development of the hemp growing niche in Ukraine. It was concluded that the production of a niche culture of hemp and its processing is accompanied by a high level of economic efficiency

Pink tax: Challenges faced by Indonesian women as consumers of personal care products

The phenomenon of pink tax is a gender inequality issue that discriminates women in the purchase of goods or services by producers. The objective of this research is to identify the pink tax phenomenon in Indonesia, encompassing its existence, influencing factors, and the urgency of the related issue. Additionally, this study aims to analyse the role of the government through policies regarding the emergence of the pink tax phenomenon. Policies closely associated with the pink tax include Law Number 8 of 1999 on Consumer Protection, Law Number 5 of 1999 on the Prohibition of Monopoly Practices and Unfair Business Competition, and Law Number 7 of 2014 on Trade. The research methodology employed in this study is qualitative, involving literature review, documentary analysis, and interviews. The findings of this research indicate that the pink tax exists in Indonesia, yet awareness of this issue is not evenly distributed across all layers of society. While some institutions have acknowledged the existence of this problem, there have been no concrete steps taken to reduce or address this gender-based price discrimination. Furthermore, current policies are deemed inadequate in addressing gender-based price discrimination practices and protect women’s consumer. This is attributed to the fact that gender equality elements are not fully encompassed in the existing policies.

EVOLUTION OF ARTIFICIAL INTELLIGENCE IN ANESTHESIA AND ITS PATH FORWARD

Artificial intelligence (AI) has brought a paradigm shift in patient management in the modern healthcare industry. This narrative literature review aims to explore the evolution of AI in the field of anesthesia and discuss its potential path forward. The increased demand for personalized care, smart decision-making tools, precision in practice, and growth in telemedicine, particularly in the realm of perioperative care, has brought AI to the forefront. By examining the existing research and applications of AI in anesthesia, this review seeks to provide insights into the current state of AI technology, its applications, implications for practicing clinicians, and the challenges and limitations that need to be addressed for its successful integration into perioperative care. This review encourages interdisciplinary teamwork between anesthesiologists, technologists, engineers, and technicians to simplify the complexities of AI implementation, address ethical issues, mitigate risks, and ensure safe perioperative care.

Advances in AI-based combination therapies versus standard treatments for heart failure in patients with advanced kidney injury

Background: Recent advancements in AI and Machine Learning (ML) can help manage kidney disease and heart failure by providing predictive analytics and personalized treatment plans, improving diagnostic accuracy, and assisting clinicians in controlling chronic disease symptoms like acute kidney injury (AKI) and Managing Heart Failure (HF). We evaluated AI and ML role in predicting AKI and managing HF patients and it involved analyzing various predictive models and technologies to improve early detection provide personalized treatment, and enhance overall patient outcomes in complex renal and cardiac conditions. Methodology: We conducted our search on databases Scopus, PubMed, and Web of Science. Empirical evidence and state of the art of cutting-edge literature and real-time field research was analyzed. Results: AI advancements in HF management for advanced kidney disease AKI include unsupervised machine learning for risk stratification, reinforcement learning for predictive modeling and dynamic management, and LLMs and chatbots for diagnostic support and patient education. New developments in AI and medical technology are predictive analytics for AKI, automated ultrasound interpretation, AI-enhanced dialysis monitoring, HF risk prediction, remote monitoring, and telehealth integration, and making personal treatment strategies according to patient needs. Innovations like wearable dialysis devices, bioengineered kidney tissues, ECMO, LVADs, TAVR, SGLT2 inhibitors, CRT, and nephroprotective drugs have also improved patient outcomes as these have enabled personalized care and early intervention strategies. Conclusion: It is possible to conclude that AI has revolutionized AKI and HF management. Novel technologies offer precise and adaptive care that strictly addresses individual patient needs.

Impact of diethyl phthalate on freshwater planarian behaviour, regeneration, and antioxidant defence

Diethyl phthalate (DEP) has been widely used as a plasticiser in various consumer products, including cosmetics, personal care items, and pharmaceuticals, and recent studies reported a higher abundance of this priority phthalate in the aquatic environment. DEP is a potential endocrine disruptor, affecting immune systems in humans and wildlife even at low-level chronic exposure. As concern over phthalates increases globally, regulatory bodies focus more on their environmental impact. However, limited research is available, particularly using model organisms like planarians. Planarians are ideal for toxicological studies and may provide insightful information on pollutants' neurotoxic, developmental, and ecological effects, especially in freshwater environments where planarians play a vital role in ecosystem balance. Therefore, the objective of the current study was to examine the toxicity of DEP using the freshwater Dugesia sp., as an experimental animal. The LC50 for the test organism was calculated using DEP concentrations of 800, 400, 200, 100, and 50 µM, with an estimated LC50 of 357.24 µM. Furthermore, planarians were exposed to sub-lethal DEP concentration (178.62 µM) for one day as well as eight days to evaluate the impact of DEP on planarian locomotion, feeding behaviour, and regeneration ability. At sub-lethal concentration, locomotion and feeding ability were decreased, and regeneration was delayed. Furthermore, neuro-transmittance in planaria was altered by sub-lethal DEP concentration, as indicated by a reduced acetylcholinesterase (AChE) activity. DEP exposure induced oxidative damage in the tested planarians as shown by a marked increase in stress biomarkers, including lipid peroxidation levels and antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT), peroxidase (POX), and glutathione S-transferase (GST). Our study revealed that DEP exposure may prove fatal to freshwater organisms, such as planarians. The observed alterations in behaviour and regeneration ability demonstrate the severity of the effects exerted by DEP as a toxicant in aquatic ecosystems, thereby indicating the need to restrict its usage to protect aquatic environments.

Artificial Intelligence-Powered Technologies For Independent Living Among Older Adults: A Review

Abstract Background The ageing populations in Ireland and around the world has led to an increased focus on technologies that support independent living for older adults. Artificial intelligence (AI) has emerged as a promising solution, with various AI-powered technologies being proposed to assist their daily lives. This review aims to synthesize the findings of studies exploring AI-powered technologies for independent living among older adults. Methods A systematic literature search was conducted using relevant databases, including PubMed, IEEE Xplore, and Google Scholar. The search terms included “artificial intelligence” and “independent living”. Studies published between 2009 and 2023 that investigated AI-powered technologies for independent living among older adults were included in the analysis. Results The included studies investigated various AI-powered technologies including tablets, wearable devices like smartwatches, web portals for carers, Internet of Things (IoT) solutions, user-centered design considerations, the integration of AI with sociology and healthcare, smart home technology, and ambient information systems. The pooled results indicated that AI-powered technologies can improve independent living outcomes for older adults. Benefits included real-time monitoring and health deterioration recognition, fall detection, personalised care, cognitive assistance and reduced isolation. User-centered design approaches and the integration of AI with sociology and healthcare were also found to be essential factors in the successful implementation of these technologies. Conclusion This analysis provides evidence supporting the effectiveness of AI-powered technologies in promoting independent living among older adults. IoT solutions and smart home technology appear to be particularly promising. However, the successful implementation of these technologies requires a multidisciplinary approach, incorporating user-centered design and the integration of AI with sociology and healthcare. Further research is needed to explore the long-term impact of AI-powered technologies on the well-being and autonomy of older adults.

“Everyone has a role in Rehabilitation” - Delivering staff education on rehabilitation skills in a post-acute rehabilitation unit

Abstract Background Due to a combination of disrupted services, it was observed that there was a gap in nursing and HCA knowledge of their crucial role within the rehabilitation process for the patients in an older person's post-acute rehabilitation unit. The purpose of this study was to highlight the importance of delivering nursing and healthcare assistant care (HCA) through the lens of goal specific rehabilitation. Methods A staff education programme was designed covering topics of rehabilitation including interdisciplinary team working, therapy group interventions, role of HCA in rehabilitation, personal care, toileting, continence, pressure areas, manual handling, weight bearing status, pain management, mobility aids, equipment, orthopaedic braces and physical activity recommendations in the older adult. A pre and post knowledge-based questionnaire was completed specific to each topic with maximum score 100% indicating full knowledge of the topic. Handouts and resources were created and provided at each session. Education was facilitated by an OT and PT, on a weekly basis. Participants were given the opportunity to provide feedback on the education session. An analysis of the pre/post questionnaire scores was completed using Microsoft Excel. Results Of the 26 staff (HCA and nurses) on the unit, 23 completed the education. Staff scored an average of 45% on the pre-education questionnaire and 76% on the post-education questionnaire. There was a significant increase in the post education session score (p<0.0001). Participants reported benefited from education session (87% strongly agreed n=20, 13% agreed n=3). Conclusion Peer to peer staff educations within the MDT improved knowledge in core aspects of rehabilitation care. To enhance patient experience and outcome the full MDT should feel part of the rehabilitation programme and be aware of the individuals' goals and their role to achieve the goal. This education initiative was beneficial in reinforcing the rehabilitation ethos of the ward and addressing gaps in ward staff’s knowledge.

Evaluation of New Frailty at the Front Door Service in a Model 3 Hospital

Abstract Background Frailty at the Front Door (FFD) is a key component of integrated care for frail older persons who attend an Emergency Department (ED). This service was established in a model 3 hospital in 2023. Variable Indicative of Placement (VIP) was used to screen patients aged ≥70 years for frailty. Interdisciplinary assessments and interventions were provided by a Senior Physiotherapist and Senior Occupational Therapist (OT). Methods All assessments by the FFD team from June 2023 to February 2024 inclusive, were included. The variables analysed were age, gender, modified Barthel Index (mBI) score, 4AT score, Clinical Frailty Scale (CFS) score, discharge status, length of stay (LOS), referral pathways and re-presentation within 28 days. Data was analysed in Excel. Results There were 490 assessments over the 9-month period, 217 (44%) male and 273 (56%) female, with a mean age of 80 (SD±7.77) years. The median CFS was 5 (range 2-8) and median mBI was 17 (range 4-20). The 4AT score was ≥4 in 44 (9%) cases (indicating possible delirium and possible cognitive impairment). One hundred and eighty-four (38%) patients were discharged home from ED. Seventy (14%) patients re-presented to ED within 28 days. Acute hospital admission was required for 306 (62%) with a mean LOS of 11 (SD±0.5) days. There were 213 referrals to community services for those patients discharged home. These included Dietetics (36%), Physiotherapy (22.5%), ALONE (18%), Delirium Clinic (9.4%), OT (6%) and others (8.1%). There were 238 referrals to acute services for admitted patients, including Physiotherapy (59%), Dietetics (18.5%), OT (17%) and Speech and Language therapy (5.5%). Conclusion This evolving FFD service is a positive step towards improving older persons’ care in ED. Recognition of frailty in ED leads to early identification of care needs and timely referral to alternative pathways in the community and acute services as appropriate.

Utilizing a Geriatric Emergency Multi-disciplinary Service (GEMS) To Improve Care For Nursing Home (NH) Residents In The Emergency Department (ED)

Abstract Background The GEMS team provides an age attuned service for older adults living with frailty who present to the ED. Under the governance of a Geriatrician older adults living with frailty receive a Comprehensive Geriatric Assessment (CGA) and a collaborative plan of care. NH residents are often the most frail cohort of patients. They can sometimes be referred to the ED with needs that could be managed in the community. Moreover, transfer is associated with a higher risk of mortality (Lemoyne et al. 2019). To address this, all NH residents are classified as priority one by the GEMS Team. Pathways have been developed to the Community Integrated Hub for the Older Person (ICPOP), General Practitioners and Community Palliative Care Teams. The goals is to provide the right care, in the right place and at the right time. Methods Plan, Do, Study, Act (PDSA) Quality Improvement Methodology was utilized. Data was collected on all NH patients presenting to ED and interrogated over a 3-month period. Results 27 patients presented to ED from a nursing home during the collection period. (n=16) 60% of patients were discharged. 89% were living with severe frailty. 100% received a CGA, Advanced Care Planning and family liaison. (n=5) referred to ICPOP. (n=6) referred to Palliative Care through the GP. Conclusion The majority of patients reviewed were living with severe frailty and likely beginning the final journey of their lives. A CGA on presentation to ED ensures the goals of care are aligned with the persons will and preference. Alternative care pathways in the community enabled patients to be discharged back to the nursing home with appropriate follow-up supports. Reference 1. Lemoyne SE, Herbots HH, De Blick D, Remmen R, Monsieurs KG, Van Bogaert P. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC geriatrics. 2019 Dec; 19:1-9.

Advances in Personalized Medicine and Genomics for Diabetes Type-2 Management Towards Precision Health

Background: Conventional approaches for diabetes type-2 management generally fail to consider genetic and environmental variations for each patient. But new developments in personalized medicine and genetics are changing our understanding and approaches for type-2 treatment. Objective: To explore the effectiveness of a personalized medicine and genomic based interventions for glycemic level, medication compliance and complications in patients with diabetes type-2 compared to usual care. Methodology: A Randomized Controlled Trial (RCT) study was performed on total n=400 patients with type 2 diabetes. Patients were randomly assigned to two groups; the intervention group was treated according to genomic profile while the control group was treated in a routine manner. Glycemic control (HbA1c), treatment compliance, and the rate of complications during September 2023 till June 2024 were considered as primary indicators. An independent sample t-test and a chi-square test were used to analyse the results with the help of the SPSS version 27.0. p≤0.05 was considered statistically significant. Results: Those patients who were given individualized management had improved mean HbA1c level by 1 percent as compared to the initial level. 2% compared to 0.6% in the standard care group(p<0.01). Patients in the personalized care group had an 85% compliance to recommended treatment as opposed to the standard care group with only 65% (p<0.001). Also, the number of complications was much fewer in the personalized care group (10%) as compared to the standard care group (20%); (p= 0.02). Conclusion: Personalized medicine and genomics-based interventions offer substantial benefits in the management of Type 2 diabetes, leading to better blood sugar control, higher treatment adherence, and fewer complications. These findings suggest that integrating genomics into diabetes care could improve health outcomes for patients.

Updates on Caries Risk Assessment-A Literature Review.

This narrative review aims to provide an update on caries risk assessment (CRA) and the available CRA tools. CRA can be used to monitor the status of oral care, as well as for documentation and research purposes. Caries risk is determined by the interplay of risk and protective factors. Common risk factors include suboptimal oral hygiene practices, previous caries experience, low plaque acidity, frequent snacking, cariogenic diet, enamel defects, reduced salivary flow, polypharmacy, and radiotherapy experience. Caries risk can be reduced through some preventive measures, such as the use of fluoride, gum chewing, dental sealants. The CRA process can be categorized as single or multifactor tools. Single-factor CRA tools include diet analysis questionnaires, cariogenic bacteria testing and saliva testing kits, whereas multifactor CRA tools encompass Caries Management by Risk Assessment (CAMBRA), Cariogram, and PreViser. Some CRA tools may quantify risk and protective factors to compute caries risk. Additionally, they can generate visual and educational presentations that foster success in oral care. Clinicians consider CRA beneficial for developing personalized care plans. However, the literature fails to reflect this and reveals limited studies supporting its use as evidence-based practice for caries management.

Malnutrition Management in Older Adults Referred to Integrated Care Program for Older People (ICPOP) Service

Abstract Background Older adults are at increased risk of malnutrition, and it is estimated that 70,000 Irish people over 65 years old are malnourished or at risk of malnutrition. The ICPOP service provides access to community-based treatment for eligible older people for a period of up to 6 weeks. The aim of this study is to review the nutrition care provided by our ICPOP service and identify current gaps. Methods Data was collected by retrospective chart review of 80 patients who received dietetic input from June to December 2023; from two ICPOP teams, with 0.5 WTE dietitians per team. Demographic data, supplement usage, intervention provided, and discharge destination were recorded. Malnutrition screening tool (MST) and Mini Nutritional Assessment – Short Form (MNA®-SF) were used to assess nutritional status. Results The charts of 80 patients referred to ICPOP dietitians were reviewed. Patients’ mean age was 83 years old (range: 65-97yrs). 55 (68%) patients were malnourished or at risk of malnutrition. 30 (37.5%) patients were taking oral nutrition supplements (ONS) to meet their dietary requirements. Personalised dietetic intervention was provided to all patients. 44 (55%) patients required more than one dietetic review and 87.5% of initial dietitian assessments were domiciliary visits. At the end of the 6 weeks of intervention, 25 (31%) patients required follow-up dietetic care, however, for 6 (24%), who required ongoing dietetic care, and no community dietetic service was available. Conclusion Malnutrition is common in older adults referred to the ICPOP service, and the continuation of care is crucial for treating malnutrition as a chronic condition. However, current limitations in available dietetic services may affect malnutrition management and should be considered in older person care pathways. Therefore, additional investments in community dietetic services in our area, are required to ensure the successful management of malnutrition.