Hospital Practice Research Articles

Developing Informed Consent for Academic Hospital-Based Biobank Modeling: An Experience from Indonesia.

Background: Informed consent (IC) for biobank practice is vital to ensure that sample collection, storage, and utilization are ethical. However, the standard practices in biobanking in upper-middle-income countries such as Indonesia often rely on specific consent, leading to restricted sample use and ethical concerns. This article describes the development of an IC model that meets ethical standards and yet is acceptable for biobanking practice in an Indonesian academic hospital. Method: We conducted a study involving Universitas Gadjah Mada (UGM) Biobank Unit and the UGM Academic Hospital, Yogyakarta, Indonesia, between 2019 and 2021. The IC development process consisted of four stages: (1) conceptualization, (2) preparation, (3) pilot, and (4) evaluation. These activities were part of a more extensive pilot study for an academic hospital-based biobank (Medical Biobank for Research in Indonesia (MBRIO) study). Result: We conceptualized a broad consent model, consisting of an information sheet, comprehension test, agreement sheet, and exit survey. We tested and revised the broad consent document to ensure readability, trained 10 consenting staff (1 surgeon and 9 nurses), and then piloted the IC procedure on 24 patients with elective surgery. The evaluation showed that patients understood the information objectively and subjectively. Consenting staff considered the broad consent model acceptable for the academic hospital setting and suggested improvements to increase the readability of information sheets and have more trained staff for better coordination. Conclusion: The IC development process and model consent are ethically sufficient, acceptable and feasibleto be implemented in academic hospital-based biobanks in Indonesia adjusted to the business processes.

THE COMBINED USE OF SINGLE- AND DUAL-MOBILITY CUPS IN PRIMARY TOTAL HIP ARTHROPLASTY IS SAFE IN A UNIVERSITY HOSPITAL PRACTICE

Dislocation after Total Hip Arthroplasty (THA) is a frequent cause of revision and patients with intrinsic risk factors have been identified. The use of dual mobility (DM) cup has shown great efficiency in preventing dislocation, with questions regarding selective or absolute use. The aim of this study was to compare the outcome of single mobility THA (SM-THA) and DM-THA, when used for selected patients.This retrospective continuous cohort study evaluated 490 patients of whom 275 received SM-THA and 215 received DM-THA. There were 304 primary osteoarthritis (62%), 121 femoral neck fractures (24%) and 65 other indications (14%). The surgical approach was anterior (AA) in 79% and posterior (PA) in 21% of cases. In the DM-THA group, 189 patients (87%) presented at least one dislocation risk factor compared to 128 patients (46%) in the SM-THA group. The primary outcome was revision for all causes, with or without implant removal. Secondary outcomes included length of hospital stay.There was no difference in all cause revision at two years follow up with 9 procedures (3.2%) in SM-THA group and 11 in DM-THA group (5.1%) (p=0.3). There were 3 dislocations in SM-THA group (3 AA) and 3 in DM-THA group (2 PA and 1 AA) (p=0.4).The length of stay was significantly longer in DM-THA group with 7 days (2–12) compared to 4 days (1–7) in SM-THA group (p=0.001).SM-THA and DM-THA are two complementary devices in the management of patients requiring primary THA. SM-THA is a safe option for patients without dislocation risk factors, especially when using AA. The identification of such factors is important to select patients requiring DM-THA and provide reproducible outcomes in a University Hospital practice including various levels of surgeon experience.

Treatment adherence of Covid-19 in students from central Mexico: Contrast of a structural equation model

Treatment adherence is a central axis in the health agenda. In the framework of the SARS CoV-2 pandemic, it is necessary to predict this phenomenon. The objective of the present work was to contrast a model of structural equations. A confirmatory, psychometric and cross-sectional work was carried out with a selection of 100 students, considering their participation in the social service and professional practices in public hospitals in central Mexico. A factorial structure was found that explained 62% of the total variance, suggesting the contrast of the model in other scenarios.

Integrating point-of-care diabetes detection with lifestyle counselling in community settings: outcomes from Western Sydney, Australia

IntroductionEarly detection and prevention of type 2 diabetes and its complications are global health priorities. Optimal outcomes depend on individual awareness and proactive self-management of health risks. This study evaluates the effectiveness of a community-based diabetes detection and intervention program in a high-risk area in western Sydney, Australia.Research design and methodsWe collaborated with the Workers Lifestyle Group, Tamil Association Arts and Culture Association, and the National Aboriginal and Islanders Day Observance Committee to implement our program. Participants underwent HbA1C testing via point-of-care blood spot testing. They received personalized feedback, education on diabetes management, and were offered opportunities to enrol in lifestyle modification programs. Participants identified with pre-diabetes (HbA1C 5.7–6.4%) or diabetes (HbA1C > 6.4%) were advised to consult their General Practitioners (GPs). A follow-up questionnaire was distributed 3–8 months post-intervention to evaluate the programs usefulness and relevance and lifestyle changes implemented by the participants.ResultsOver eight months, 510 individuals participated. Of these, 19% had an HbA1C > 6.4%, and 38% had levels between 5.7 and 6.4%. Among those with diabetes, HbA1C levels ranged as follows: 56% <7%; 20% 7-7.9%; 18% 8-8.9%; and 5% >9%. Post intervention survey indicated that the program was well-received, with 62.5% of responses reporting lifestyle changes and 36.3% seeking further advice from their local healthcare providers.ConclusionThe study demonstrates a significant prevalence of pre-diabetes and diabetes in the community, similar to findings from larger-scale hospital and general practice studies. Point-of-care testing combined with personalized education effectively motivated participants toward healthier lifestyle choices and medical consultations. The paper discusses the scalability of this approach for broader population.

Assessing the Efficacy of Medium- and High-Reality Simulators in Normal Labor Management: A Randomized Controlled Trial

IntroductionIn recent years, the use of simulation has become integral to midwifery education. This study systematically examined the effectiveness of high- and medium-reality simulators in the management of normal labor, focusing on their impact on normal delivery skills, student satisfaction, and self-confidence in learning. The evaluation encompassed both laboratory and hospital settings, providing a comprehensive assessment of the simulators' efficacy in enhancing key aspects of midwifery education. Material and methodIn this experimental randomized controlled study, the sample group comprised 102 students enrolled in the midwifery department of a university in Türkiye. These students were randomly assigned to three groups utilizing Research Randomizer (https://www.randomizer.org). The students consisted of a control group (d1 = slide and video presentation, 30 people) and two experimental groups (d2 = medium-reality simulator, 32 people; d3 = high-reality simulator, 33 people). Data were collected by a single observer using various tools, including the Introductory Information Form, the Student Satisfaction and Self-Confidence in Learning Scale, and the Normal Birth Evaluation Form. Pre- and post-test applications were conducted in both laboratory and hospital settings. This study is registered on ClinicalTrials.org with the registration number NCT05999409. FindingsSimulation-based learning did not lead to a significant difference between the groups in terms of students' satisfaction and self-confidence in learning (p > .05). However, it was observed that the utilization of both medium- and high-reality simulations significantly impacted students' normal delivery skills, leading to a statistically significant difference between the groups (p < .05). ConclusionMedium- and high-reality simulation training proved effective in enhancing the normal delivery skills of midwifery students, with a notable positive impact. However, this training did not have a significant influence on student satisfaction and confidence. The findings suggest that incorporating medium- and high-reality simulation training is crucial for midwifery students to be able to improve their skills in hospital practice.

Assessment of impaired glomerular filtration rate and associated factors in South West Ethiopia: a cross-sectional study

IntroductionCurrently, kidney disease is an increasing major health problem worldwide. It is expected to be the 5th ranked cause of death by 2040. If it is early detected, further complication caused by kidney disease will be minimized. An assessment of impaired glomerular filtration rate (eGFR) has potential aids in early identification and treatment of kidney disease. However, in hospital practice instead of using eGFR, direct measurement of serum creatinine level is used for assessing renal function. Hence, this study is aimed to assess the magnitude and associated factors of impaired glomerular filtration rate among admitted patients in Wolkite University Specialized Teaching Hospital (WKUSTH).ObjectiveTo assess the magnitude and associated factors of impaired glomerular filtration rate in WKUSTH, Ethiopia 2023.MethodInstitutional based cross-sectional study with secondary data was conducted. 338 participants were selected by a convenient sampling technique. Epidata 3.1 version for data entry and SPSS version 20 for data analysis was used. Bivariate analysis was used to screen candidate variables for multivariate analysis. In the multivariate analysis a P-value < 0.05 were considered statistically significant.ResultsThe study enrolled 338 patients admitted to WUSTH. Seventy (20.7%) (95% CI: 16.6–25.4%) of them had impaired eGFR according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and Modification of Diet in Renal Disease (MDRD-4). older age (AOR 3.38, 95% CI; 1.31, 8.71), hypertension (AOR 17.8, 95% CI; 7.75, 41.22), anemia (AOR 2.51, 95% CI; 1.11, 5.83) DM (AOR 11.2, 95% CI; 4.11, 30.73), and high BMI (AOR 7.56, 95% CI; 3.16, 18.08), were independently associated with impaired eGFR.ConclusionsThe magnitude of impaired eGFR was prevalent among adult patients admitted to WKUSTH medical ward with different medical conditions. Old age, Hypertension, Diabetes, high body mass index, and Anemia were significantly associated with impaired eGFR both in CKD-EPI and MDRD-4 equation. Estimation of GFR for all hospitalized adults with known CKD risk factors might help in early detection of CKD and prevent complications.

(Sensor Division Early Career Award) Portable Diagnostics for Cancer Management at Printed Strips

Point-of-care testing (PoC) is revolutionizing the healthcare sector improving patient care in daily hospital practice and allowing reaching even remote areas. In the frame of cancer management, the design and validation of PoC enabling the non-invasive, rapid detection of cancer markers is urgently required to implement liquid biopsy. However, despite substantial advances in sensing technologies, the development, preparation, and use of self-testing devices is still confined to specialist laboratories and users. Decentralized analytical devices will enormously impact daily lives, enabling people to analyze diverse clinical, environmental, and food samples, evaluate them and make predictions to improve quality of life, particularly in remote, resource-scarce areas. In recent years, paper-based analytical tools have attracted a great deal of attention; the well-known properties of paper, such as abundance, affordability, lightness, and biodegradability, combined with features of printed electrochemical sensors, have enabled the development of sustainable devices that drive (bio)sensors beyond the state of the art. Their blindness toward colored/turbid matrices (i.e., blood, soil), their portability, and the capacity of paper to autonomously filter/purge/react with target species make such devices powerful in establishing point-of-need tools for use by non-specialists. Depending on analytical requisites, different types of paper (filter, office) and configurations (1D, 2D, 3D) can be adopted. Focusing on stable blood-based markers with high-specificity, such as miRNAs, is of crucial importance. A wide overview regarding application ranging from DNA to miRNA detection will be provided, with the aim in showing the potentialities of portable electrochemical biosensors for improving society involvement in monitoring circulating nucleic acids associated to diverse conditions, i.e. cancer, Alzheimer’s disease, HIV.

Global Leadership Initiative on Malnutrition criteria using calf and upper arm circumference as phenotypic criteria for assessing muscle mass demonstrate satisfactory validity for diagnosing malnutrition in hospitalized patients: A prospective cohort study.

Hospitalized individuals present high rates of malnutrition and loss of muscle mass (MM). Imaging techniques for assessing MM are expensive and scarcely available in hospital practice. The Global Leadership Initiative on Malnutrition (GLIM) proposed a framework for malnutrition diagnosis that includes simple measurements to assess MM, such as calf circumference (CC) and mid-upper arm circumference (MUAC). This study aimed to analyze the validity of the GLIM criteria with CC and MUAC for malnutrition diagnosis, using Subjective Global Assessment (SGA) as the reference standard, in inpatients. A prospective cohort study was conducted on 453 inpatient adults in a university hospital. The presence of malnutrition was assessed within 48 h of hospital admission using SGA and GLIM criteria using CC and MUAC as phenotypic criteria for malnutrition diagnosis. Accuracy, agreement tests, and logistic regression analysis adjusted for confounders were performed to test the validity of the GLIM criteria for malnutrition diagnosis. The patients were aged 59 (46-68) years, 51.4% were male, and 67.8% had elective surgery. Compared with SGA, the GLIM criteria using the two MM assessment measures showed good accuracy (area under the curve > 0.80) and substantial agreement (κ > 0.60) for diagnosing malnutrition. The highest sensitivity was obtained with GLIMCC (89%), whereas GLIMMUAC showed high specificity (>90%). Also, malnutrition identified by GLIMCC and GLIMMUAC was significantly associated with prolonged hospitalization and in-hospital death. In the absence of imaging techniques to assess MM, the use of CC and MUAC measurements from the GLIM criteria demonstrated satisfactory validity for diagnosing malnutrition in hospitalized patients.

Exploring strategies promoting interprofessional collaborative practice in spinal cord injury rehabilitation at a private South African hospital group

Background. Implementing an interprofessional collaborative practice (IPCP) in hospitals improves health outcomes, enhances patient safety and reduces length of stay by optimising resource utilisation. Although this approach was desired at a private hospital group in South Africa (SA), the specific strategies for clinical guidelines and capacity management pertaining to spinal cord injury (SCI) patients and the implementation of IPCP were unknown. Objective. To explore strategies for implementing clinical guidelines and capacity management for SCI rehabilitation to promote IPCP in a private hospital group in SA. Method. This exploratory descriptive qualitative study included participants who were selected through purposive sampling. The participants comprised 11 staff from various disciplines and management of the private hospital group, one local and one international expert in IPCP. Three online focus groups (n=13) were conducted, involving three to five participants. The transcriptions were analysed thematically using Braun and Clarke’s framework. Results. Interprofessional communication and tools as well as capacity development were three emergent themes from the data. Strategies pertaining to communication methods, digitisation, visual displays, patient care information, educational information and education of healthcare workers were suggested to promote IPCP. Conclusion. These findings from the emergent themes could assist in implementing and integrating an IPCP approach into the rehabilitation service. Further research assessing the efficacy of implementing the IPCP strategies and digital platform would be beneficial.

Assessment of professional empowerment among midwives in selected LAC: A multisite descriptive study

Objectiveto identify the perception of professional empowerment among midwives in selected Latin American countries (LA). Specifically, this study aimed to compare i) the global level of empowerment among midwives in different LA countries, ii) the scores according to the different dimensions of the scale, and iii) scores according to area the of expertise. DesignA quantitative, observational, analytical, cross-sectional and multisite study using an adaptation of the Perceptions Midwifery Empowerment Scale (PEMS). SettingsClinical, educational and managerial midwifery positions in 5 LA countries belonging to a Latin American Research Network in Midwifery. All the participating countries reported a similar profile regarding type of education, association and regulation procedures. ParticipantsA total of 1127 responses from midwives with different professional backgrounds were included in the study. FindingsA total mean score of 73.28 (74.23–72.03) points was reported. Chile reported the lowest score of empowerment compared to the other countries, while Argentina reported the highest. Midwives' perceptions of empowerment within their area of expertise, primary health care (PHC) was the area of reference, and gynaecology reported a significantly lower score. Midwives working in management were significantly more empowered compared with those in other areas. Midwives who had continuous education and postgraduate studies were the most empowered. Regarding the provision of woman-centred Care, Chile and El Salvador differed significantly from Argentina (reference), while Uruguay reported a significantly higher score in this dimension. Midwives working in hospital wards reported significantly lower scores compared to those working in PHC. Key conclusions and implications for practiceThis study suggests that midwifery programmes in the LA countries would benefit from prioritising professional empowerment, especially in the areas of hospital practice, where midwives' perceptions of empowerment were most limited.

Frequency of occupational health hazards and factors responsible among the waste handlers at the tertiary care hospitals of Karachi.

Hospital waste handlers (HWHs) are in contact with contaminated waste that put them at risk for occupational health hazards. The objective of the study was to determine the frequency of occupational health hazards and identify factors contributing to them among the HWHs at tertiary care hospitals of Karachi. A cross sectional survey was conducted from January 2021 till June 2022 on 417 conveniently selected HWHs of the public and private tertiary care hospitals of the Karachi including three Public sector hospitals (Civil Hospital Karachi, National Institute of Child Health, Jinnah Post Graduate Medical Center) and five private sector hospitals (Sohail University Hospital, Darulsehat Hospital, Kharadar General Hospital, Patel Hospital and Hamdard University Hospital) using a structured questionnaire. Chi Square test was applied to determine the differences in occurrence of different hazardous outcomes (Needle stick injury, Sharp Injury, Eye Symptoms, Skin symptoms, Cough) between different groups of age, gender, type of hospitals and status of being trained in Hospital Waste Management (HWM). Around half of the HWHs (52.6%) labeled the bins of the waste according to their level of hazard. Only 17.9% disinfected the infected waste. The proportion of participants who experienced needle stick and sharp injury in the last six months was 16.3% and 15.8% respectively. Majority of them used disposable gloves (95.7%) and face masks (94.3%). One thirds had access to aprons while only 10.5% had access to protective shoes at their work place. HWHs of private sector were significantly less likely to experience Needle stick injuries, skin symptoms, cough, breathing difficulty and throat burning. The HWM practices in tertiary care hospitals of Karachi is far from being satisfactory. HWHs must be trained and monitored for safe disposal of waste.

Community-engaged artificial intelligence research: A scoping review.

The degree to which artificial intelligence healthcare research is informed by data and stakeholders from community settings has not been previously described. As communities are the principal location of healthcare delivery, engaging them could represent an important opportunity to improve scientific quality. This scoping review systematically maps what is known and unknown about community-engaged artificial intelligence research and identifies opportunities to optimize the generalizability of these applications through involvement of community stakeholders and data throughout model development, validation, and implementation. Embase, PubMed, and MEDLINE databases were searched for articles describing artificial intelligence or machine learning healthcare applications with community involvement in model development, validation, or implementation. Model architecture and performance, the nature of community engagement, and barriers or facilitators to community engagement were reported according to PRISMA extension for Scoping Reviews guidelines. Of approximately 10,880 articles describing artificial intelligence healthcare applications, 21 (0.2%) described community involvement. All articles derived data from community settings, most commonly by leveraging existing datasets and sources that included community subjects, and often bolstered by internet-based data acquisition and subject recruitment. Only one article described inclusion of community stakeholders in designing an application-a natural language processing model that detected cases of likely child abuse with 90% accuracy using harmonized electronic health record notes from both hospital and community practice settings. The primary barrier to including community-derived data was small sample sizes, which may have affected 11 of the 21 studies (53%), introducing substantial risk for overfitting that threatens generalizability. Community engagement in artificial intelligence healthcare application development, validation, or implementation is rare. As healthcare delivery occurs primarily in community settings, investigators should consider engaging community stakeholders in user-centered design, usability, and clinical implementation studies to optimize generalizability.

Transanal Minimally Invasive Surgery Versus Endoscopic Submucosal Dissection for Rectal Lesions: A Community Hospital Experience.

Background: To compare tumor margins and surgical outcomes between transanal minimally invasive surgery (TAMIS) and endoscopic submucosal dissection (ESD) for large or malignant rectal adenomatous polyps. Methods: Single institution retrospective analysis of patients who underwent TAMIS or ESD surgery. Results: In total, 30 consecutive patients with similar demographics who underwent either TAMIS (n = 19) or ESD (n = 11) were included. The median (interquartile range, IQR) tumor distances from the anal verge for TAMIS and ESD were 5 cm (3.5-8) and 3 cm (2-4.25) (P = 0.016). Four in TAMIS and two in ESD occupied more than half of the circumference of the bowel lumen. Five (four in situ and one stage 1) in TAMIS and two (one in situ and one stage 1) in ESD were malignant. The median specimen length, width, and height were 3.2 cm, 2.6 cm, and 1.0 cm and 3.5 cm, 2.0 cm, and 0.3 cm for TAMIS and ESD, respectively. There were no statistically significant differences in tumor circumference, malignant ratios, or specimen sizes. Resection margins were involved in two of the ESD, while none of the TAMIS were involved (P = 0.041). The median (IQR) operative time was 72 (62-89) minutes and 120 (90-180) minutes for TAMIS and ESD (P = 0.005). The median (IQR) follow-up time was 3.3 (0.3-11.7) and 0.9 (0.3-15.4) months for TAMIS and ESD. There were no morbidities, no mortalities, or local recurrences among the two groups. Conclusions: Both TAMIS and ESD were found to be feasible and safe in community hospital practice. Operative time was shorter, and there were no involved margins in TAMIS (versus ESD).

Adapting to Change: Exploring the Impact of the COVID-19 Pandemic on Academic Performance in African Students and the Role of Virtual Learning as a Substitute

Many universities and colleges worldwide switched to virtual learning due to the coronavirus pandemic, and classroom course delivery was generally discontinued. The present cross-sectional study aimed to determine the effects of the COVID-19 pandemic on the performance of African students’ academic performance using virtual learning as a substitute. Google Forms was used to collect data. An overall response rate of 97.2% was achieved from 835 participants across 16 African nations. A five-point Likert scale was employed in the questionnaire. Tables, frequencies, and percentages were employed to reveal the study’s findings after using SPSS 21 to analyze the responses. The data revealed that, on average, students in the African region believed that the COVID-19 pandemic had a negative impact on their academic achievement, with a mean score of 3.72. Even though online education allows for self-study, the largest challenge African students had with it was its limitation in enveloping both the theoretical and practical aspects of knowledge impartation (there were no avenues for science or art laboratories, hospital practices, etc.). The idea among students was that exclusively using an online education system would prevent them from achieving intellectual competency. Online education could be improved by making it more engaging, showcasing techniques in real-world situations, and offering concise information.

Three feet under: hāngī and the contemporary adaptation of indigenous culinary techniques

ABSTRACT The sharing of familiar foods is but one of the ways a cultural group identifies itself. But what happens if that cultural group begins to lose touch with, or control of, its food traditions? Worldwide, professional chefs are embracing traditional indigenous cookery techniques and ingredients in their search for national culinary identity. In doing so, the line between ownership and appropriation is becoming an increasingly fine one. Within today’s Māori society, the hāngī is one of the few remaining traditional food preparation techniques still in regular use. Yet the use of its traditional earth oven form is growing more infrequent as less labor-intensive variations grow in popularity and as the technique becomes increasingly incorporated into commercial hospitality practice. Drawing on research that explores the knowledge and personal experiences of seven hāngī practitioners, this paper examines the cultural significance of the hāngī as a traditional indigenous food preparation technique. As the hāngī increasingly crosses over into the commercial realm it questions the fine line between cookery technique and indigenous culinary property as it asks just what makes a hāngī a hāngī?

Factors associated with exclusive breastfeeding in " Near Miss " neonates in Brazil.

To assess the association between sociodemographic and perinatal factors and hospital practices to encourage exclusive breastfeeding in near miss neonates in maternity hospitals. This is a prospective cohort of live births from the survey "To be born in Brazil" conducted between 2011 and 2012. The weighted number of newborns who met the neonatal near miss criteria was 832. Exclusive breastfeeding at hospital discharge and 45 days after delivery were dependent variables of the study. The sociodemographic and perinatal factors of the puerperal women and hospital practices to encourage breastfeeding were independent variables. The data were analyzed with Poisson regression and set with p value<0.05. Is exclusive breastfeeding in neonatal near misses associated with factors related to sociodemographic conditions, maternal characteristics and the organization of health services? Data from 498 women and their children were analyzed. Mothers with incomplete primary education were more likely (36%) to have exclusive breastfeeding (RR: 1.36; 95% CI: 1.06-1.74) at discharge. Women who did not offer the breast to the newborn in the joint accommodation (65%) were less likely to be breastfeeding exclusively (RR: 0.65; 95% CI: 0.56-0.75) at discharge. Variables that increased the probability of exclusive breastfeeding after 45 days of delivery were primiparity (RR: 1.36; 95% CI: 1.08-1.69) and having the newborn in the delivery room (RR: 1.90; 95% CI: 1.12-3.24). Exclusive breastfeeding in neonatal near misses was associated with maternal characteristics and important hospital practices, such as being breastfed in the joint accommodation and the newborn being in the mother's lap in the delivery room.

Pharmacokinetics and clinical outcomes of low-dose nivolumab relative to conventional dose in patients with advanced cancer

PurposeNivolumab is approved at various doses, including 3 mg/kg, 240 mg and 480 mg flat doses at various dosing intervals. The concept of low-dose immunotherapy is gaining traction in recent years. However, there is a need to better understand the pharmacokinetics and clinical outcomes at lower doses.MethodsPatients were either administered 40 mg flat dose or 3 mg/kg Q2W/Q3W, depending on affordability as per prevailing hospital practice. All patients were hospitalized on day 1 and pharmacokinetic samples were collected at 0, 0.5, 1.0, 6.0, 24.0, 72.0 h and day 14 following administration of the first dose of nivolumab. Plasma nivolumab levels were measured by ELISA. Patients were followed up for response and toxicity.ResultsTwenty five patients were included in the study. Fourteen received nivolumab at conventional dose (3 mg/kg), while 11 patients received low-dose (40 mg flat). The geometric means of dose normalized Cmax and AUC0-t were comparable between those who received conventional dose and low-dose of nivolumab (0.28 versus 0.23 µg/mL/mg and 0.0014 versus 0.0011 d/mL respectively). Nineteen patients were evaluable for response. ORR among patients who received conventional dose was 5/11 (45.5%) whereas it was 4/9 (44.4%) in the low-dose cohort. All 14 (100%) patients in conventional dosing group and 7/11 patients (63.64%) in low-dose group had treatment emergent adverse events. Grade ≥ 3 toxicities were observed in 4/14 patients in conventional dose group and none in low-dose group.ConclusionLow-dose nivolumab leads to lower exposure in patients as compared with conventional dose, but low-dose was better tolerated, while response rates were comparable to conventional dose.

Survey of nutrition screening practices in pediatric hospitals across the United States.

Nutrition screening on admission is critically important to systematically identify patients with undernutrition given the known relationship with deleterious clinical outcomes. Limited data exist regarding optimal processes and criteria for pediatric nutrition screening. Therefore, we sought to characterize nutrition screening practices in pediatric hospitals. A total of 365 inpatient pediatric hospitals in the United States were identified, eligible, and contacted. Eligible hospitals included general pediatric hospitals, adult hospitals with pediatric units, and specialty pediatric hospitals. One respondent at each eligible hospital was asked to complete a 33-question survey of admission nutrition screening practices. Of 268 survey respondents, 37% represented pediatric units in adult hospitals, 35% general pediatric hospitals, and 28% pediatric specialty or psychiatric hospitals. A total of 98.5% endorsed the existence of a screening process on admission. Anthropometrics (eg, body mass index z score, 84%) and nutrition status (eg, change in intake, 67%) were the most common screening criteria applied. A nutrition screening instrument was used in 37% of institutions, and only 31% of institutions reported using pediatric-specific screening instruments. Pediatric units within adult hospitals were 1.38 times more likely to use a screening instrument validated in any population. Barriers to nutrition screening included the lack of a standard screening procedure and insufficient staff to conduct screening. Fifty-four percent of respondents reported a desire to change their hospital's nutrition screening process. Most pediatric hospitals screen for nutrition risk on admission. However, methods and criteria varied widely across pediatric hospitals, highlighting the importance of standardized best practices.

Sustainable sojourns: Fostering sustainable hospitality practices to meet UN-SDGs.

This research discusses the significance of environmental transformational leadership (ENTL) in the creation of energy-saving sustainable behaviors (EESB) among employees in the tourism and hospitality sector of China. The method is consequently a quantitative analysis, where the mediating effect of green intrinsic motivation (GNIM) and green passion (GRP), and the moderating role of green altruism (GNA) are examined to understand their influence on the relationship between ENTL and EESB. The data were gathered from multiple hotels in major Chinese cities, with the use of a structured questionnaire. The study shows that ENTL has significant effect on EESB, with GNIM and GRP serving as mediating factors. In addition, GNA was shown to have been able to boost the effects that ENTL has on these mediators. The findings are indicative of the vital role of leadership in promoting responsible practices within the tourism and hospitality sector, and towards the attainment of the UN Sustainable Development Goals. This research not only fills the gaps in the existing literature that primarily focuses on developed economies but also provides policy makers and business leaders with practical solutions for enhancing the sustainability in emerging economies.

Current Status of Hospitalist Practice and Factors Influencing Job Satisfaction in Korea.

Although the roles and responsibilities of hospitalists have grown considerably in recent years, research on the current job status and satisfaction levels of Korean hospitalists is lacking. We investigate the present state of Korean hospitalists and the factors influencing their job satisfaction 6 years after the pilot program's launch. This cross-sectional analysis was based on an online survey conducted from January 30 to February 18, 2023. Korean hospitalists (N = 303) MAIN MEASURES: The survey encompassed participant demographics, hospital information, education, clinical practice, research involvement, and job satisfaction. We employed multiple logistic regression analyses to identify determinants of satisfaction as a hospitalist. The analysis was based on 79 hospitalists' responses (response rate 26%). Respondents had a median age of 39 years; approximately half were male internal medicine specialists, possessing over 3 years of hospitalist experience. Most respondents were interested in clinical work (94.4%), with only 21.5% interested in research and evidence-based medicine. Over two-thirds indicated that non-clinical duties occupied less than 20% of their time. Overall, job satisfaction among hospitalists averaged 51.9%. Notably, the availability of a research mentor was significantly associated with job satisfaction (P = .011). While hospitalists with more than 3 years of experience, more hospitalists per facility, and autonomy were associated with increased job satisfaction, these associations were not statistically significant. Furthermore, there was no association between night shift work, work type, or work hours and job satisfaction. Although Korean hospitalists primarily focus on clinical practice, our study underscores the positive impact of mentorship from research mentors on job satisfaction, supported by comprehensive univariate and multivariate analyses. These findings signal a progressive transformation in the role of Korean hospitalists, as they increasingly engage in research alongside patient care.