Diagnostic Phase Research Articles

The current landscape of nutrition care in oesophageal and gastric cancer – insights from the national oesophagogastric nutrition audit (NONA) survey

Specialist nutritional support is important during treatment for oesophagogastric (OG) cancer yet current practice remains unstandardised across the UK. The National Oesophagogastric Nutrition Audit (NONA) aimed to describe the current landscape of OG dietetic services in the UK and Ireland, with a specific focus on resource allocation, barriers to dietetic support, and the provision of support throughout the cancer pathway. Tertiary cancer units, secondary care, and community services across the UK and Ireland were invited to complete a 28-point electronic questionnaire. Team leaders and senior specialist OG dietitians were the target respondents. All data points were peer-reviewed, piloted, and revised by the NONA steering committee before distribution. Data points covered a range of areas related to resources, skill mix, provision of support throughout the cancer pathway, and involvement with national audit and research. Complete responses were received from 50 individual units (tertiary surgical units, n=35 and tertiary oncology units, n=10). Secondary care and community services were underrepresented (n=5). Of the units proving tertiary cancer care, the majority (77%) agreed or strongly agreed they were able to provide adequate nutritional care in the post-operative period. However, confidence dropped significantly in the early diagnostic phase and in the neoadjuvant period, with 52% and 67% of tertiary units disagreeing that they could provide adequate dietetic support during these parts of the cancer pathway, respectively. Inadequate funding, understaffing, and the prioritisation of inpatients were commonly reported barriers. There was significant variation in practice regarding nutritional assessment, service structure, and staffing resource allocation across specialist units. The NONA survey provides a 'real-world' landscape of nutritional care for patients with OG cancer. Lack of funding, resource, and evidence-base may explain the variation seen in services provided across the UK. Further research and consensus is required to help standardise nutritional care, guide service specification, and improve nutritional outcomes for patients with OG cancer.

“They are dealing with people’s lives…”: Diagnostic and post-diagnostic healthcare experiences in primary progressive aphasia

Purpose The healthcare experience is a multifaceted and varied process, particularly for people living with complex conditions such as primary progressive aphasia (PPA). Different experiences influence pathways through the health system, impacting client outcomes. To our knowledge, no previous studies have directly explored the healthcare experiences of people with PPA and their families. This study aimed to explore the experiences of people living with PPA from the perspective of both the person with PPA and their families during diagnostic and post-diagnostic phases, and to identify factors influencing service access and perceptions of quality of care. Method The study followed an Interpretive Phenomenological Analysis (IPA) approach. In-depth, semi-structured interviews were completed with three people with PPA and their primary care partner, and two further care partners of people with PPA. Result Five superordinate themes were identified: characterising the assessment experience, getting a diagnosis, moving beyond the diagnosis, participant interactions with clinicians, and overall service provision. The five superordinate themes comprised 14 subthemes. Conclusion The study provides preliminary insights into the complexity of the PPA healthcare journey, and the need for increased accessibility of information and supports following diagnosis. The findings inform recommendations for improving quality of care and the development of a PPA service framework or care pathway.

Surgery of the colorectal polyps and early stage cancer - Expected standards

Benign polyps and early-stage cancer of the colon and rectum traditionally belong to the territory of endoscopic removal. Even though the quality of endoscopic imaging systems and additional diagnostic methods have undergone a substantial evolution over the past decade, large, sessile and lateral-spreading lesions of the large bowel still represent a significant risk of malignancy. This doubt may be undispellable until the removal of the lesion. Therefore endoscopists need to be highly cautious, and keep a very low threshold to involve an expert surgeon even at the phase of diagnostics, as well as treatment. We summarise state-of-the-art treatment principles of benign polyps and early malignant colorectal cancer. Finally, we propose national quality measures of surgical interventions for colorectal polyps.

A new Covid-19 diagnosis strategy using a modified KNN classifier

Covid-19 is a very dangerous disease as a result of the rapid and unprecedented spread of any previous disease. It is truly a crisis that threatens the world since its first appearance in December 2019 until our time. Due to the lack of a vaccine that has proved sufficiently effective so far, the rapid and more accurate diagnosis of this disease is extremely necessary to enable the medical staff to identify infected cases and isolate them from the rest to prevent further loss of life. In this paper, Covid-19 diagnostic strategy (CDS) as a new classification strategy that consists of two basic phases: Feature selection phase (FSP) and diagnosis phase (DP) has been introduced. During the first phase called FSP, the best set of features in laboratory test findings for Covid-19 patients will be selected using enhanced gray wolf optimization (EGWO). EGWO combines both types of selection techniques called wrapper and filter. Accordingly, EGWO includes two stages called filter stage (FS) and wrapper stage (WS). While FS uses many different filter methods, WS uses a wrapper method called binary gray wolf optimization (BGWO). The second phase called DP aims to give fast and more accurate diagnosis using a hybrid diagnosis methodology (HDM) based on the selected features from FSP. In fact, the HDM consists of two phases called weighting patient phase (WP2) and diagnostic patient phase (DP2). WP2 aims to calculate the belonging degree of each patient in the testing dataset to class category using naïve Bayes (NB) as a weight method. On the other hand, K-nearest neighbor (KNN) will be used in DP2 based on the weights of patients in the testing dataset as a new training dataset to give rapid and more accurate detection. The suggested CDS outperforms other strategies according to accuracy, precision, recall (or sensitivity) and F-measure calculations that are equal to 99%, 88%, 90% and 91%, respectively, as showed in experimental results.

Palliative care referral across the disease trajectory in high-grade glioma.

Adults with high-grade glioma (HGG), WHO grade III or IV, have substantial palliative care needs. Our aim was to determine occurrence, timing, and factors associated with palliative care consultation (PCC) in HGG at one large academic institution. HGG patients receiving care between 08/1/2011 and 01/23/2020 were identified retrospectively from a multi-center healthcare system cancer registry. Patients were stratified by any PCC (yes/no), and timing of initial PCC by disease phase: diagnosis (before radiation), during initial treatment (first-line chemotherapy/radiation), second-line treatment(s), or end-of-life (after last chemotherapy). Of 621 HGG patients, 134 (21.58%) received PCC with the vast majority occurring during hospital admission [111 (82.84%)]. Of the 134, 14 (10.45%) were referred during the diagnostic phase; 35 (26.12%) during initial treatment; 20 (14.93%) during second-line treatment; and 65 (48.51%) during end of life. In multivariable logistic regression, only higher Charlson Comorbidity Index was associated with greater odds of PCC [OR 1.3 (95% CI 1.2-1.4), p < 0.01]; but not age or histopathology. Patients who received PCC prior to end of life had longer survival from diagnosis than those referred during end of life [16.5 (8, 24) months vs. 11 (4, 17); p < 0.01]. A minority of HGG patients ever received PCC, which primarily occurred in the inpatient setting, and nearly half during the end-of-life phase. Thus, only about one in ten patients in the entire cohort potentially received the benefits of earlier PCC despite earlier referral having an association with longer survival. Further studies should elucidate barriers and facilitators to early PCC in HGG.

Isolated calcaneal tuberculous osteomyelitis in a 13-year female: a diagnostic dilemma: rare case report and review of literature

Foot and ankle involvement in osteoarticular tuberculosis is uncommon and isolated calcaneal tubercular osteomyelitis of foot bones sparing nearby joints with an osteolytic defect is even more rare. Worsening of the disease can occur over a time involving nearby joints and small bones if diagnostic and therapeutic phase are delayed. We present a retrospective study of osteolytic variety of foot calcaneal bone tuberculosis. We present a case report of 13-year female with isolated osteolytic variety of calcaneal tuberculous osteomyelitis to highlight the clinical, radiological features and management challenges of the condition. Biopsy was done to confirm tissue diagnosis based on Gene Xpert, AFB staining, MGIT culture, and histopathology. Surgical intervention was done in form of debridement and sinus tract removal as a diagnostic and therapeutic purpose to prevent further involvement of a nearby joints and small bone with cystic destruction. Isolated calcaneal tubercular osteomyelitis cases are still found to be seen in our environment though considered a rare. When tuberculous pathology is limited to the isolated calcaneal bone sparing the other joints, the prognosis is better than in osteoarticular disease, as there is less deformity, and hence, less residual pain and disability.

Assessing Rural-Urban Linkages and Their Contribution to Territorial Development: Insights from Zimbabwe’s Small and Medium-Sized Cities

In Sub-Saharan Africa, unprecedented population growth, concomitant with limited industrialisation and job creation, have changed the configurations of rural-urban linkages in recent decades. Indeed, as primate cities do not act as strong engines of growth, territorial dynamics are rapidly being reshaped by renewed flows of people, goods, services and information within and between economic sectors, and between rural and urban areas. Rural densification and the fast expansion of small and medium-sized cities is one manifestation of these changes. As a result of silo thinking about rural and urban in most national strategies, plus the widespread informal economy and limited available statistics in the region, these new rural-urban linkages and their contribution to socioeconomic dynamics remain underexplored. Contributing to fill this gap, the aim of this paper is to present and test a method to assess rural-urban linkages and their possible role in territorial development in southern countries. We use a holistic approach and adopt an original posture, taking rural areas as the point of reference. Our method sets proxy indicators for specific information that is missing on rural-urban linkages. These indicators are then used to build a typology of territories according to potential rural-urban linkages, using a multivariate analysis and clustering. When applied to the case of Zimbabwe, the results reveal three types of districts, which differ in terms of the nature, intensity, direction and potential of rural-urban linkages for territorial development. We discuss the method’s suitability in a diagnostic phase and how it could feed strategic thinking to mainstream rural-urban linkages in territorial development actions.

Stages of renal artery stenosis: a hypothesis based on ultrasound findings: A narrative review

Current ultrasound (US) scanners can directly detect renal artery stenosis (RAS) in which the degree is the same irrespective of heart beat. Frequently, however, blood pressure or renal function is not improved because the stage of RAS is too late. Therefore, RAS should be early detected and thus the radiologists are familiar with US features of early, intermediate, and late RAS. Atherosclerosis is the most common etiology to RAS and begins inflammation from the intima of renal artery. Accordingly, we can hypothesize that there are multi-stages going to the final RAS. At early stage, RAS can be detected on diastolic phase alone. However, at intermediate stage, it begins to be seen on systolic phase and is more severe on diagnostic phase than that at early stage. Finally, at late stage, RAS is seen at the same degree regardless of heart beats because the stenosis is fixed due to fibrosis. The purpose of this review is to introduce a hypothesis on the stages of RAS, to show the renal artery US features of each stage, and to compare US and angiography in terms of RAS detection.

Utility of cardiac bioenzymes in predicting cardiovascular outcomes in SARS-CoV-2.

The relationship between coronavirus disease-19 (COVID-19) and cardiovascular diseases has been an important issue. Therefore, cardiac biomarkers and cardiac imaging have an important place in the diagnostic phase. It is important to know the relationship of biomarkers in COVID-19 so that we can understand the diagnosis of the disease, the predicted course and results after diagnosis.

BENTUK PENGEMBANGAN SDM DI LEMBAGA PENDIDIKAN ISLAM

The existence of human resources in an Islamic Education Institution plays a very important role in realizing the vision, mission, goals and objectives of an Islamic Education Institution. So it requires maximum management, development and empowerment to create a quality Islamic Education Institution. In management science there is study material on forms of HR development for Islamic Education Institutions, which aims to ensure that Islamic Education Institutions carry out their role in improving the quality of education. As we all know, the stages that management goes through in general are POAC (Planning, Organizing, Action, Controlling). So Islamic Education Institutions must have a proven strategy for creating POAC in developing human resources well, including: 1) creating a planning design; 2) the existence of a teaching staff development program; 3) implement the planned program; 4) carry out process evaluation. The process of developing human resources in Islamic Education Institutions has at least four phases, including: 1) Diagnostic Phase; 2) Design Phase; 3) Implementation Phase; 4) Evaluation Phase. The strategies and phases above need to be passed by Islamic Education Institutions with the aim of being able to lead each Islamic Education Institution towards improvement and improvement of superior quality and achievement.

Assessment framework for Proof of Concept (PoC) in Industry 4.0 – an interoperability approach

ABSTRACT Large companies have been incessantly pursuing cost reduction, increased performance, and agility in decision-making to meet customers’ demands quickly. This paper presents a framework that allows efficient and agile implementation of Proofs of Concept, based on multicriteria evaluation from interoperability perspectives. The proposed model is based on a three-dimensional structure (cube) characterizing phases related to (i) the creation of a referential model, (ii) the evaluation of organizational maturity (diagnostic phase), and (iii) the proposition of a functional model. One case of an application with a high impact on the supply chain and logistics was used to evaluate the framework.

Promoting HPV vaccination at school: a mixed methods study exploring knowledge, beliefs and attitudes of French school staff

BackgroundHPV vaccine coverage in France remained lower than in most other high-income countries. Within the diagnostic phase of the national PrevHPV program, we carried out a mixed methods study among school staff to assess their knowledge, beliefs and attitudes regarding HPV, HPV vaccine and vaccination in general, and regarding schools’ role in promoting HPV vaccination.MethodsMiddle school nurses, teachers and support staff from four French regions participated between January 2020 and May 2021. We combined: (i) quantitative data from self-administered online questionnaires (n = 301), analysed using descriptive statistics; and (ii) qualitative data from three focus groups (n = 14), thematically analysed.ResultsLess than half of respondents knew that HPV can cause genital warts or oral cancers and only 18% that no antiviral treatment exists. Almost 90% of the respondents knew the existence of the HPV vaccine but some misunderstood why it is recommended before the first sexual relationships and for boys; 56% doubted about its safety, especially because they think there is not enough information on this topic. Schools nurses had greater knowledge than other professionals and claimed that educating pupils about HPV was fully part of their job roles; however, they rarely address this topic due to a lack of knowledge/tools. Professionals (school nurses, teachers and support staff) who participated in the focus groups were unfavourable to offering vaccination at school because of parents’ negative reactions, lack of resources, and perceived uselessness.ConclusionsThese results highlight the need to improve school staff knowledge on HPV. Parents should be involved in intervention promoting HPV vaccination to prevent their potential negative reactions, as feared by school staff. Several barriers should also be addressed before organizing school vaccination programs in France.

Wanneer medicatie opstarten voor gedragsproblemen bij kinderen met een verstandelijke beperking?

When prescribing medication for behavioral problems in children with intellectual disabilities? Factors that determine the prescription of medication for behavioural problems in children with intellectual disabilities. A quantitative research. Background: Behavioral problems are in children (&lt;12 years) with intellectual disabilities, the most common reason for admission with a specialized doctor. The context often demands if there is a need for medication. Clear guidelines for when medication in this specific population is mandatory are lacking. Scope: In this research we explore which factors influence the decision making process of Flemish child- and adolescent psychiatrists before they consider prescribing medication. Methode: Through quantitative semi-structured interviews with Flemish child- and adolescent psychiatrist we gathered data that where analyzed using thematic analysis. Results: The themes that surfaced relate to an estimation if the resilience of the context is still apt or/and the child’s development is safeguarded. If there is no reason for urgency a diagnostic phase is prior. This phase consists of revealing underlying genetic, somatic or psychiatric problems and unachievable expectations regarding intellectual and emotional capacities of the child. These problems should be appropriately addressed if possible. If no underlying problem is identified or if the needed adjustments are unfeasible prescribing medication is taken in to account. Conclusion: We can conclude that the themes that surfaced are more or less in line with the NICE (National Institute for Health and Care Excellence) guideline. This is however a general guideline not specifically targeting children. Using the themes the participants reported we propose a flowchart that could be helpful in the decision-making process when prescribing medication is considered.

Exemplarity of the State for the Energy Efficiency of Buildings Institutional - Case of Morocco

Engaged for many years in a strategy to control climate change, Morocco is committed to leverage on sustainable development as a new development model and as a true project for society. This commitment resulted in implementing several reforms targeting the consolidation of a developed economy, improving social conditions, and accelerating positive environmental changes. The public administration developed the Administration Exemplarity Pact (AEP) as a concrete action to lead by example in implementing the National Strategy for Sustainable Development. Developed in accordance with the main stake of the National Strategy of Sustainable Development, its goal is to promote sustainable development governance in our country through several strategic focus areas. This document presents the experience of a Moroccan administration that has implemented the guidelines described in the AEP. The approach and results are detailed and could be used as an example for other Moroccan companies. The first step of the methodology consists of a diagnostic phase to establish the current situation. The second step is related to the strategy to define the approach’s main orientations and the action plan. These key steps allow us to identify areas of improvement and build a roadmap adapted to the current context and constraints. One of the best practices for this approach is to define the main orientations to act by positive contagion on the ecosystem. In conclusion, the AEP axes deployed in a dynamic improvement logic give convincing results. By acting with partners (subcontractors and suppliers), the Moroccan administration can act on the whole value chain and induce an essential change in the Moroccan economic fabric.

Sense of Coherence as a Resource in Promoting Well-Being and Managing Type 1 Diabetes Mellitus: A Pilot Study

When investigating the feelings of caregivers to patients with T1DM, parental stress, anxiety, and depression are found to be most prevalent, especially in the diagnostic phase and in the first months after diagnosis. In this pilot study, we research various significant elements regarding the well-being of mothers with children between 10 and 15 years of age with a chronic condition. The study focuses on a period of at least three years after the child’s diagnosis. The aims of the study are to describe our sample’s levels of satisfaction (SWLS) and subjective happiness (SHS) and to evaluate possible associations. A sample of 40 mothers was offered a series of assessment tools about psychological skills that could play a role in improving mothers’ well-being: the use of specific coping mechanisms (CISS), the methods of narrating the experience of life with a son/daughter with diabetes, the sense of coherence (SOCS 29), health parameters vs. child’s disease (HbA1c, CBCL), and socio-demographic, such as education and work. The most significant associations with respect to subjective happiness are with the sense of coherence, as a unitary value and as distinct factors, and with task-oriented coping. Sense of coherence is also associated with satisfaction.

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

BackgroundSevere trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management.MethodsThe pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation.ResultsThis guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury.ConclusionA multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

Radiographic ratios for classifying furcation anatomy: proposal of a new evaluation method and an intra-rater and inter-rater operator reliability study

ObjectivesEven if it seems to be an important anatomical parameter for tissue regeneration, few studies in literature evaluate the “mean measure” of root divergence. Most of them are linear measurements, which hardly describe the dental furcation conformation in its entirety. It is left to the subjectivity of the operator deciding whether a furcation is convergent or divergent. The goal of this study is to create a visual evaluation method using specific measurements applied on endo-oral X-rays to overcome these problems, giving a conformation of the entire interradicular space and its divergence.Material and methodsA user-friendly software (Paint®, Windows10®) was used to take three different measurements on endo-oral radiographs of upper and lower molars. Three blind operators measured 20 radiographs, to analyze the intra- and inter-operator reproducibility of the measurements. Then, the technique was repeated on 250 radiographic images to identify an average value and define a main conformation of the interradicular space. The ratio of these three measurements allowed to develop a new visual evaluation method of the interradicular space.ResultsIntra and inter-operator reproducibility was statistically confirmed on a sample of 20 anonymous endo-oral radiographs measured by 3 blind operators, indicating that the measurement technique was not operator dependent. Measurement made on 250 X-rays obtained with this technique permitted to subdivide in five groups the conformation of the interradicular space and define a mean value of the interradicular space.ConclusionsA new anatomical evaluation of the interradicular space in its entirety, which could help the clinicians in diagnostic and decisional phase in the therapy of furcated molars, can be obtained.Clinical relevanceA pre-operative evaluation of interradicular space conformation could affect therapy treatment choice.

Fascia Acupuncture System in Veterinary Medicine

The fascia is a network that, permeating the whole organism, envelops the somatic and visceral structures, connecting the parts of the body to each other, determining their shape and offering support. This network organizes, separates and ensures the protection and autonomy of each muscle and viscera and at the same time brings them together in functional units by establishing spatial relationships and allowing communication between them. The band flows according precise paths called myofascial meridians which coincide with the paths of the of Traditional Chinese Medicine (TCM) energy meridians. The importance of this correspondence is both in the diagnostic phase, through the palpation of specific acupoints, and in the integrated therapeutic approach between fascial manipulation and acupuncture. The work introduces an integrated system, called Veterinary Fascia Acupuncture System (VeFAS®) which allows combining the functions of the fascia with the techniques of acupuncture.

Listening to voices from multiple sources: A qualitative text analysis of the emotional experiences of women living with breast cancer in China.

Receiving a breast cancer diagnosis and treatment is both a physical and emotional journey. Previous studies using single-source data have revealed common and culture-specific emotional experiences of patients living with breast cancer. However, few studies have combined such data from multiple sources. Thus, using a variety of data sources, the current study sought to explore the emotional experiences of women in China newly diagnosed, post-operative, or undergoing chemotherapy. We posited that even though women living with breast cancer in China have multiple channels through which they can express these emotional experiences, little variance would be found in their emotional expressivity and the themes they want to express due to cultural inhibitions. Text data from female patients newly diagnosed, post-operative, or undergoing chemotherapy were collected between June 2021 and January 2022 via a Python web crawler, semi-structured interviews, and an expressive writing intervention. Data were transcribed and subjected to thematic analysis. Reporting followed the consolidated criteria for reporting qualitative studies (COREQ) guidelines. Analyses were based on 5,675 Weibo posts and comments published by 448 posters and 1,842 commenters, transcription texts from 17 semi-structured interviews, and 150 expressive writing texts. From this total collection of 461,348 Chinese characters, three major themes emerged: (i) conflicting emotions after diagnosis; (ii) long-term suffering and treatment concerns; and (iii) benefit finding and cognitive reappraisal. Despite gathering information from various sources, we found that distress from body-image disturbances, gender role loss and conflict, and changes in sexuality and fertility, were consistent among this sample of female Chinese patients with breast cancer. However, when women engaged actively in benefit finding and cognitive reappraisal with strong social support, patients were able to find ways to adapt and reported post-traumatic growth. Strong social support was an important facilitator in this growth. These study findings emphasize that healthcare professionals ought to increase cultural sensitivity, provide multiple channels to encourage patients to express their emotions, and incorporate screening for patients' emotional distress at all diagnostic and treatment phases as part of routine nursing care.

Barriers and Facilitators to the Acceptance of eHealth Interventions by Dutch Pediatric Physical Therapists in Times of the COVID-19 Pandemic: A Mixed-Methods Approach.

The COVID-19 pandemic created an urgent need for eHealth as the relevance of infection control and social distancing continues. Evidence describing the acceptability of implementing eHealth into pediatric physical therapy services is limited. To investigate the determinants of eHealth acceptance by Dutch pediatric physical therapists during the COVID-19 pandemic. A mixed-methods approach was used. It included a quantitative exploratory questionnaire of 154 pediatric physical therapists and qualitative in-depth interviews of 16 pediatric physical therapists. The eHealth interventions were beneficial for collaboration between health care professionals and in addition to face-to-face therapy. eHealth interventions were, however, found to be unsuitable especially in the diagnostic phase. Barriers to more extensive application include costs, technical difficulties, and a perceived negative attitude of children. Pediatric physical therapists used eHealth interventions extensively in times of the COVID-19 pandemic. However, the acceptance of eHealth interventions is dependent on the pediatric physical therapist's perception of usefulness in private practice, rehabilitation setting, or clinical hospital.