Process In Clinical Settings Research Articles

The impact of a customized aesthetic prosthetic leg cover on social interaction cues and attitudes in the general UK population: Two experimental studies.

To explore the impact of an aesthetic prosthetic leg cover on attitudes toward individuals with lower-limb amputation and associated social interaction cues among the general UK population. Two novel experimental methodologies. In study 1, participants (n = 188) viewed 1 of 3 images of an individual: (1) wearing a traditional stem prosthetic, (2) wearing an aesthetic leg cover, or (3) as a nonamputee. They then completed an attitude scale and rated the personality of the individual using the 10-item Big Five Inventory. Study 2 (n = 31) used eye tracking and facial expression software to explore gaze and facial arousal when viewing 1 of 9 manipulated videos of the same individual talking about 3 different scenarios. In study 1, the aesthetic leg cover led to significantly higher ratings of agreeableness than stem and nonamputee images and significantly higher ratings of extraversion than the nonamputee image. Attitudes toward an individual with a prosthesis did not significantly differ depending on which image they viewed and were generally positive. In study 2, all participants focused mainly on the individual's face regardless of scenario topic or leg condition, although participants focused more around the leg cover in more active contexts. Customized aesthetic leg covers may help individuals living with amputation to be perceived more positively in social situations. These experimental methodologies could be extended to explore the differential impact of context, functionality, and activity of specific types of customized aesthetic prosthetics and could help inform shared decision-making processes in clinical settings.

Empirical Study on the Relationship Between Quality of Nursing Services and Postoperative Satisfaction of Patients with Acute Appendicitis: Intermediation Based on Information Flows

This study investigated the relationship between nursing care and patient satisfaction, with a specific focus on postoperative satisfaction in patients with acute appendicitis. The shift in China's medical model from a biomedical approach to a biopsychosocial framework emphasizes patient-centered care, with patient satisfaction becoming a key indicator of service quality. The study used a survey-based approach to collect data from 384 patients in hospitals in Guangxi, China. Through statistical analysis, the study explores how the quality of care services, doctor-patient communication processes, and information exchange affect patient satisfaction. The research results show that there is a significant positive correlation between the quality of nursing services and patient satisfaction. In particular, the professional level and effective communication skills of nursing staff significantly improve patient satisfaction. This study provides practical recommendations for enhancing the training process in clinical settings.

IDeRare: a lightweight and extensible open-source phenotype and exome analysis pipeline for germline rare disease diagnosis.

Diagnosing rare diseases is an arduous and challenging process in clinical settings, resulting in the late discovery of novel variants and referral loops. To help clinicians, we built IDeRare pipelines to accelerate phenotype-genotype analysis for patients with suspected rare diseases. IDeRare pipeline is separated into phenotype and genotype parts. The phenotype utilizes our handmade Python library, while the genotype part utilizes command line (bash) and Python script to combine bioinformatics executable and Docker image. We described various implementations of IDeRare phenotype and genotype parts with real-world clinical and exome data using IDeRare, accelerating the terminology conversion process and giving insight on the diagnostic pathway based on disease linkage analysis until exome analysis and HTML-based reporting for clinicians. IDeRare is freely available under the BSD-3 license, obtainable via GitHub. The portability of IDeRare pipeline could be easily implemented for semi-technical users and extensible for advanced users.

Morphometric analysis of the mastoid process using cone beam computed tomography

The sexual dimorphism of the mastoid process, as demonstrated by cone beam computed tomography (CBCT), is not well examined in forensic anthropology or clinical diagnostics. The mastoid region can be precisely imaged in three dimensions using CBCT, which reveals minute anatomical variations between males and females. These characteristics can help forensic professionals identify the sex of unidentified human remains, helping to solve crimes and aid in the search for missing persons. Moreover, recognising sexual dimorphism in the mastoid process in clinical settings can help with precise patient identification and individualised medical treatments, highlighting the important function of CBCT in both the forensic and medical areas.

Application value of miRNA-182 as a biomarker for cancer diagnosis: a systematic review with meta-analysis.

Aim: This study aims to establish the potential reliability and validity of miRNA-182 as a diagnostic tool in oncology, and hence to contribute to the decision-making process in clinical settings. Materials & methods: To further evaluate the role of miRNA-182 as a cancer biomarker, we conducted a search of the PubMed, Cochrane Library, Wanfang and China National Knowledge Infrastructure databases of existing literature. Conclusion: These results suggest that miRNA-182 could function as a potential molecular marker for cancer detection and diagnosis. The effect of miRNA-182 on tumor development should be further studied to confirm these results and add to the current understanding of its role in cancer.

Applying EBM epistemology and the GRADE system to address practitioners' disagreements in medical malpractice allegations during COVID-19 pandemic.

The GRADE system of clinical recommendations has deontic implications and can discriminate between mandatory, prohibited, and merely permitted medical decisions. The recommendation categories of the GRADE framework map onto deontological imperatives that can lead to a better understanding and management of allegations of imprudence and appropriateness of treatments. Allegations made during the worst phase of COVID-19 pandemic are used as a case study for exploring the deontic implications of GRADE. Conceptual theoretical analysis, case study analysis, and argumentation in defence of hypotheses. Strong GRADE recommendations for or against treatment are justified by high-quality evidence and can be construed as ethical obligations and prohibitions. In contrast, when evidence for benefit or harm is of lower quality, GRADE yields weak, discretionary recommendations. In such grey area cases, the absence of a duty to prescribe or refuse to prescribe a requested treatment is compatible with the privilege of considering unproven but possibly beneficial options in a private setting. This privilege, however, does not extend to healthcare policymakers, who have a duty to promote actions that serve the public and whose recommendations should not be guided by personal or idiosyncratic preferences or values. If there is no prima facie evidence that a proposed treatment is harmful, doctors are not negligent in considering it in shared doctor-patient decision-making. But these clinical decisions under uncertainty do not transfer obligations to health authorities, who are not part of the decision-making process in clinical settings. The clinical decision-making process concerns particulars and is guided by contextual and specific reasons that do not fall within the scope of a general policy. Thus, in the context of a serious epidemic in which patients need and demand treatments, if the body of evidence is still changing and fragile, an attitude of tolerance and connivance may ensure a smoother transition to a more stable phase of progress, both in scientific and clinical medicine.

La Batteria per le Funzioni Esecutive nell'Addiction - BFE-A: un nuovo tool digitalizzato per lo screening neurocognitivo

According to recent neurocognitive models of addictions, a vicious combination of altered executive functions (EF) and dysfunctional reward system represents a main determinant of clinical picture. Executive dysfunctions also have a great impact on worsening addiction disorders as well as on treatment outcomes. Thus, detecting executive dysfunctions with sensitive tools is crucial in order to tailor therapeutic and rehabilitative interventions to patients. We here report the testing of the Battery for Executive Functions in Addiction (BFE-A), a novel battery for EF screening.151 patients with Substance-Use Disorder and 56 health participants completed the seven digitized BFE-A subtests tapping on: learning and memory, working memory, cognitive flexibility, focused attention, attention regulation, and inhibitory control. First-level statistical analyses highlighted lower performance of the clinical sample with respect to healthy participants across all the battery subtests, though verbal memory and focused attention proved to be te most impaired functions. Regression analyses, then, revealed that longer abstinence led to greater memory performance and that a longer history of substance abuse specifically led to less efficient information-processing speed. Findings provide support to the evaluation of the BFE-A as a brief but informative screening battery, potentially complementing the diagnostic process in clinical settings.

Gambaran Karakteristik Penderita Kolelitiasis di Rumah Sakit Umum Daerah Moh. Ansari Saleh Kalimantan Selatan

Cholelithiasis is a component of bile that accumulates, hardens and forms gallstones. The incidence of cholelithiasis is increasing every year. The incidence of cholelithiasis can be caused by various factors such as age, gender, education, weight and clinical manifestations experienced by sufferers. The purpose of this study was to describe the characteristics of cholelithiasis sufferers at Moh. Ansari Saleh, South Kalimantan. This research method uses a observational descriptive research design. The sampling technique used purposive sampling and used secondary data with a total sample of 32. Research show that the characteristics of respondents based on age were mostly 20-50 years old as many as 26 respondents (81.25%), the majority gender was female as many as 18 respondents (56.25%), the majority of respondents were overweight as many as 15 respondents (46 .87%) generally experienced upper right abdominal pain as many as 25 respondents (78.13%). It can be concluded that cholelithiasis occurs in the majority aged 20-50 years, female and overweight. In general, experience pain in the upper right abdomen, heartburn, nausea, vomiting and lack of appetite. The results of this study are expected to be a reference for underdeveloped professions to carry out health programs that refer to promotive and preventive efforts in carrying out nursing care processes in clinical settings.

Optimal Deep Learning Architecture for Automated Segmentation of Cysts in OCT Images Using X-Let Transforms.

The retina is a thin, light-sensitive membrane with a multilayered structure found in the back of the eyeball. There are many types of retinal disorders. The two most prevalent retinal illnesses are Age-Related Macular Degeneration (AMD) and Diabetic Macular Edema (DME). Optical Coherence Tomography (OCT) is a vital retinal imaging technology. X-lets (such as curvelet, DTCWT, contourlet, etc.) have several benefits in image processing and analysis. They can capture both local and non-local features of an image simultaneously. The aim of this paper is to propose an optimal deep learning architecture based on sparse basis functions for the automated segmentation of cystic areas in OCT images. Different X-let transforms were used to produce different network inputs, including curvelet, Dual-Tree Complex Wavelet Transform (DTCWT), circlet, and contourlet. Additionally, three different combinations of these transforms are suggested to achieve more accurate segmentation results. Various metrics, including Dice coefficient, sensitivity, false positive ratio, Jaccard index, and qualitative results, were evaluated to find the optimal networks and combinations of the X-let's sub-bands. The proposed network was tested on both original and noisy datasets. The results show the following facts: (1) contourlet achieves the optimal results between different combinations; (2) the five-channel decomposition using high-pass sub-bands of contourlet transform achieves the best performance; and (3) the five-channel decomposition using high-pass sub-bands formations out-performs the state-of-the-art methods, especially in the noisy dataset. The proposed method has the potential to improve the accuracy and speed of the segmentation process in clinical settings, facilitating the diagnosis and treatment of retinal diseases.

Impact of Emotions on Test of Variables of Attention(TOVA) Performance in a Pediatric Clinical Population: A Retrospective Study.

Continuous Performance Tests, like the Test of Variables of Attention (TOVA), are commonly used to assess attention processes in clinical settings. Although a few previous studies have explored the effects of emotions on the outcome of such tests, the results are scarce and contradictory at times. Through this retrospective study, we aimed to explore the correlation between performance on the TOVA and parent-reported emotional symptoms in youth. We used preexisting datasets of Mood and Feelings Questionnaire, Screen for Child Anxiety Related Disorders, and Vanderbilt Attention-Deficit/Hyperactivity Disorder Diagnostic Rating Scale as well as preexisting results from the TOVA test from 216 patients aged between 8 and 18years. Pearson's correlation coefficients, as well as linear regression models, were computed to examine the association between depressive and anxiety symptoms and the four indices of TOVA (response time variability, response time, commission errors, and omission errors). Additionally, we used generalized estimating equations to determine whether the reported emotional symptoms affect the TOVA outcome differently as the test progresses. Our results showed no significant effect of the reported emotional symptoms on the TOVA results even when controlling for sex or reported inattention and hyperactivity. TOVA results do not seem to be affected by emotional symptoms in youth. This being said, future studies should also explore other factors that can affect the performance on the TOVA, like motor disability, sleepiness, or neurodevelopmental disorders affecting cognitive abilities.

Improving the Practice of Obtaining Informed Consent for Biobanking in Clinical Settings.

Background: Biobanks form key research support infrastructures that ensure the highest sample quality for scientific research. Their activity must align closely and proportionally to the interests of researchers, donors, and society. Informed consent (IC) is a central tool to guarantee the protection of donors' rights and interests. Aim: This study aimed to analyze the challenges of obtaining IC for biobanking in clinical settings and ways to improve this process. Methods: Biobank Bellvitge University Hospital HUB-ICO-IDIBELL in Barcelona received 8671 IC forms between 2017 and 2020. The mistakes that caused IC forms to be rejected by the Biobank were analyzed. In addition, interventions aimed at physicians to improve the IC process were evaluated through a calculation of the relative risk (RR). Finally, physicians who submitted samples to the Biobank, most of whom are involved in research activities, were surveyed about the barriers to collecting IC and how to improve this process. Results: During 2017-2020, 19.6% of IC forms were rejected. The most relevant cause of rejection was the use of outdated IC forms, followed by missing patient information or mistakes having been made by the physician. Evaluation of the rejection rates before and after interventions to improve the IC process suggests significant improvement (27.7% before interventions (January 2017-May 2018) compared to 9.6% after interventions (February-December 2020), RR 0.4 95% CI 0.34-0.47; p < 0.0001). According to the physicians, the most important barrier to collecting IC is the time constraint, and they consider digitalization as a viable solution. Conclusions: Our research offers a view of the less well-understood practical challenges that physicians and biobanks face when collecting IC in clinical settings. It suggests that, despite multiple challenges, continuous monitoring, training, and information programs for physicians are key to optimizing the IC process in clinical settings.

Stretch-Induced Healing of Injured Muscles Is Associated With Myogenesis and Decreased Fibrosis

Background: Alghouth therapeutic stretching exercise has been applied to accelerate the healing of injured skeletal muscles, mechanisms behind the mechanical stretch-induced muscle recovery remain unclear. Purpose: To examine stretch-associated antifibrotic and myogenic responses in injured muscles and to evaluate the feasibility of the ultrasonic Nakagami parametric index (NPI) in assessing muscle morphology during recovery. Study Design: Controlled laboratory study. Methods: Skeletal muscle fibrosis was induced in the right hind legs of 48 rats by making a posterior transverse incision in the gastrocnemius muscle; the left hind legs remained intact as a comparative normal reference. After surgery, the 48 rats were randomly divided into the stretch (S) and control (C) groups. The S group received stretching interventions on the injured hind leg from week 3 to week 7 after surgery, while the C group did not receive stretching throughout the study period. The muscle fibrosis percentage and the ultrasonic NPI were examined sequentially after surgery. Relative expressions of myogenesis-related proteins, including myoblast determination protein 1 (MyoD), myogenin, and embryonic myosin heavy chain (MHCemb), were also evaluated during the follow-up. Results: Mean fibrosis percentages in the injured hind leg were approximately 25% at week 3 in both groups, but they were significantly decreased by approximately 20% from week 4 to the end of the follow-up in the S group only (all, P < .05). Upon injury, the NPI values of injured hind legs in both groups dramatically dropped. Within the S group, stretching increased the NPI values of injured hind legs, which approached those of control hind legs at weeks 6 and 7. The highest MyoD, myogenin, and MHCemb levels were observed at week 6 in both groups. The NPI values corresponded to the MyoD expression in the S group during the follow-up. Conclusion: Stretching induced a decrease in muscle fibrosis and an increase in myogenesis in injured muscles. The NPI values correspond to the myogenesis process. Clinical Relevance: The NPI may be capable of continuously monitoring the injured skeletal muscle morphology during the healing process in clinical settings.

Assessment Strategies Used by Nurse Educators To Evaluate Critical Thinking, Clinical Judgment or Clinical Reasoning In Undergraduate Nursing Students In Clinical Settings: A Scoping Review of The Literature.

Nursing students in Canada are typically enrolled in a four-year bachelor degree program that provides students with the necessary skills and knowledge to enter a highly demanding and challenging workforce. Strong critical thinking, clinical reasoning, and clinical judgment skills are essential skills for safe nursing practice. Therefore, educational institutes and their mentors are mandated to teach and assess these skills. In addition, nursing programs operate under an apprenticeship model, which entails the fulfillment of practical experience during which students are expected to develop and refine their skills in critical thinking, clinical reasoning, and clinical judgment. The purpose of this scoping review of the literature is to assess the available evidence of how higher-level thinking, including critical thinking, clinical reasoning, and clinical judgment are evaluated in undergraduate nursing students in clinical settings. The inclusion criteria consisted of quantitative research articles published in the last 10 years. Search databases accessed included CINAHL Plus (EBSCO), Medline, and PubMed. Seven articles that fit the inclusion criteria became the focus of this scoping review. Four tools to evaluate higher-thinking processes in clinical settings were located and scrutinized: Lasater Clinical Judgment Rubric (LCJR), Script Concordance Testing, and Yoon's Critical Thinking Disposition Instrument. Relevance to practice: The scoping review will provide direction and contextualize future studies that focus on the appraisal of nursing students' critical thinking, clinical reasoning, and clinical judgment in clinical settings.

Cognitive preceptorship: An emerging nurse practitioner role transition to practice model.

Transition to practice is difficult for nurse practitioners (NP) pre and post-graduation. At the core of NPs' successful transition to practice is clinical education. There is a lack of theoretical knowledge to guide NPs' transition to practice through preceptorship. The current academic clinical education model and onboarding process in clinical settings require restructuring. Preceptorship is the most important element of NPs' transition to practice; it is in need of restructuring. There is a need for evidence to guide the restructuring of pre and post-graduation NP preceptorship. This paper aims to provide a description and application of the Cognitive Preceptorship Model to the nurse practitioner role transition process. An extensive literature review of NPs' preceptorship during role transition was conducted and the Cognitive Preceptorship Model (CPM) derived from the literature review of other theories and models: the Schlossberg's Transition Theory; Collin's et al. Cognitive Apprenticeship Model;. and Barnes's NP transition attributes. The CPM model's concepts and application to practice are described; included is a description of preceptorship, CPM model origination, as well as CPM model concepts and application. The CPM model's concepts guide the specific application of the preceptorship process to both NP students and novice NPs' transition to practice pre and post-graduation.

Physical and information workflow mapping of vancomycin therapeutic drug management: A single site case study revealing potential gaps in the process.

Vancomycin is one of the most prescribed antibiotics in pediatric intensive care units (PICU) in US hospitals. However, a detailed understanding of workflow and information flow among various stakeholders regarding vancomycin treatment processes in clinical settings is lacking. We conducted direct observations and informant interviews to develop the mapping of key processes and information flow for vancomycin treatment, with an emphasis on therapeutic drug monitoring (TDM) dose adjustment decision-making. A health information technology (HIT) sociotechnical framework was used to identify EHR related safety concerns. A total of 27 vancomycin treatment activities were observed over a 60-h duration including infusion administration, infusion completion, trough concentration blood draw and therapeutic decision making processes. Workflow and information flow mappings revealed (1) deviations between the documented timestamp used for TDM decision making and the actual time the tasks executed and (2) the lack of information flow regarding infusion completion and interruption. Missing features, insufficient usability and lack of integration with workflow and communication in the EHR were deemed safety gaps that may affect the accuracy of therapeutic decisions. Our case study identified gaps in information flow among clinical team members via EHR in TDM processes to provide insights for the improvement of the EHR system for antibiotic treatment purposes. In particular, the potential harm of the missing, uncertain, and inaccurate documented TDM task times warrant further investigations.

Building Culturally Competent Practice with Sexual and Gender Minorities Using Nonviolent Communication

Psychiatric-Mental Health nurses can build cultural competence when caring for clients who are Sexual and Gender Minorities (LGBTQIA+) in the following ways: by learning how health care pathologized core aspects of Sexual and Gender Minorities’ (SGM) identities; by understanding historical and current SGM minority stressors and consequent health disparities and inequities; and by framing health disparities and inequities as forms of cultural violence. To begin building trust among SGMs and health care providers, trust damaged by cultural violence and stigma, nurses can implement the Nonviolent Communication Process in clinical settings.

Barriers and enablers to physical activity participation in patients with venous leg ulcers: a systematic review protocol of qualitative evidence.

The objective of this review is to synthesize available qualitative evidence to provide an overview of the barriers and enablers that influence physical activity participation in patients with venous leg ulcers. Management of venous leg ulcers is a costly and time-consuming process in clinical settings due to the protracted healing process. Physical activity may be a useful adjuvant treatment to improve healing outcomes. However, a low level of physical activity is still observed in patients with venous leg ulcers and the reasons are multifactorial. A comprehensive understanding of the barriers and enablers to physical activity participation from different perspectives is crucial to develop workable interventions and achieve desired healing outcomes. The review will consider qualitative studies that focus on evidence concerning the barriers and enablers influencing physical activity level in adults diagnosed with venous leg ulcers in all settings. Relevant studies will be searched in MEDLINE, CINAHL Plus, PsycINFO, and Emcare databases. Only studies published in English will be considered, with no date limits. Two independent reviewers will perform title and abstract screening and the full text of potential eligible studies will be retrieved and assessed against the inclusion criteria. All eligible studies will be appraised for methodological quality. Qualitative data will be extracted manually by two independent reviewers. A meta-aggregation approach will be used to pool and categorize findings from the included studies. The ConQual approach will be used to grade the final synthesized findings to determine confidence in the analysis findings. PROSPERO CRD42021238579.

Feedback in clinical settings: Nursing students' perceptions at the district hospital in the southern part of Namibia.

BackgroundFeedback was the backbone of educational interventions in clinical settings. However, it was generally misunderstood and demanding to convey out effectively. Nursing students were not confident and did not feel free to practise clinical skills during practical placements because of the nature of the feedback they received whilst in these placements. Moreover, they experienced feedback as a barrier to completing practical workbooks.ObjectiveThe purpose of this article was to report on a qualitative study, which explored nursing students’ perceptions of the feedback they received in clinical settings, at a district hospital.MethodThis study was conducted at a district hospital located in southern Namibia. An explorative qualitative design with an interpretivist perspective was followed. A total of 11 nursing students from two training institutions were recruited by purposive sampling and were interviewed individually. All interviews were audio recorded with a digital voice recorder followed by verbatim transcriptions, with the participants’ permission. Thereafter, data were analysed manually by qualitative content analysis.ResultsThemes that emerged as findings of this study are feedback is perceived as a teaching and learning process in clinical settings; participants perceived the different nature of feedback in clinical settings; participants perceived personal and interpersonal implications of feedback and there were strategies to improve feedback in clinical settings.ConclusionNursing students appreciated the feedback they received in clinical settings, despite the challenges related to group feedback and the emotional reactions it provoked. Nursing students should be prepared to be more receptive to the feedback conveyed in clinical settings.

Is skin disinfection before subcutaneous injection necessary? The reasoning of Certified Nurses in Infection Control in Japan.

Nurses continue to disinfect the skin before administering subcutaneous injections as a standard process in clinical settings; despite evidence that disinfection is not necessary. To implement evidence-based practice, it is critical to explore why this gap between "evidence" and "practice" exists. This study aimed to describe the reasons offered by Certified Nurses in Infection Control (CNIC) in Japan for performing skin disinfection before subcutaneous injection. Adopting an inductive qualitative design, interviews were conducted with 10 CNIC in 2013. According to the participants, skin disinfection before subcutaneous injection: (a) was common practice; (b) may have been beneficial if it was omitted; (c) adhered to hospital norms; (d) prevented persistent suspicion of infection; (e) had no detrimental effect; (f) was an ingrained custom; and (g) involved a tacit approval for not disinfecting in home care settings. The themes (c) and (g) were cited as the main reasons affecting decision-making. The CNIC administered injections following skin disinfection in hospitals in accordance with hospital norms. On the contrary, outside the hospital, they administered subcutaneous injections without skin disinfection. All themes except (b) and (g) reflect the barriers and resistance to omitting skin disinfection, while (g) shows that it is already partly implemented in home care settings. It is necessary to create a guideline for skin disinfection before subcutaneous injection that considers the quality of life of patients at home, their physical conditions, and the surrounding environment at the time of injection, in addition to the guidelines applicable in hospitals.

DeepSleep convolutional neural network allows accurate and fast detection of sleep arousal

Sleep arousals are transient periods of wakefulness punctuated into sleep. Excessive sleep arousals are associated with symptoms such as sympathetic activation, non-restorative sleep, and daytime sleepiness. Currently, sleep arousals are mainly annotated by human experts through looking at 30-second epochs (recorded pages) manually, which requires considerable time and effort. Here we present a deep learning approach for automatically segmenting sleep arousal regions based on polysomnographic recordings. Leveraging a specific architecture that ‘translates’ input polysomnographic signals to sleep arousal labels, this algorithm ranked first in the “You Snooze, You Win” PhysioNet Challenge. We created an augmentation strategy by randomly swapping similar physiological channels, which notably improved the prediction accuracy. Our algorithm enables fast and accurate delineation of sleep arousal events at the speed of 10 seconds per sleep recording. This computational tool would greatly empower the scoring process in clinical settings and accelerate studies on the impact of arousals.