Quality Of Outcomes Research Articles

Evaluation of visual quality and refractive outcomes of myopia with presbyopia after laser blended vision surgery

Objective: To investigate the postoperative outcomes and visual quality following laser blended vision (LBV) surgery for the correction of myopia with presbyopia. Methods: This is a prospective study. A total of 50 patients (100 eyes) who underwent LBV surgery for myopia with presbyopia at Beijing Tongren Hospital, Capital Medical University, between August 2021 and March 2022 were included. Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), best-corrected distance visual acuity (BCDVA), manifest refraction spherical equivalent (MRSE) were measured preoperatively and at 1, 3, 6, 12, and 24 months postoperatively for the dominant eye, non-dominant eye, and both eyes. Effectiveness Index (EI) and Safety Index (SI) were calculated to evaluate refractive outcomes. Accommodation function and contrast sensitivity were assessed to evaluate functional vision. Objective visual quality was assessed using higher-order aberrations (HOAs) and a dual-channel visual quality analysis system. Subjective visual quality was evaluated using a questionnaire. Results: At 24 months postoperatively, the EI and SI for the dominant eye were 1.04±0.23 and 1.14±0.14, respectively, while for the non-dominant eye, they were 0.85±0.21 and 1.06±0.08, respectively. Although there were statistically significant differences in UNVA between the eyes at 1 and 3 months postoperatively (all P<0.05), no significant differences were observed from 6 months onward (all P>0.05). At 6 months postoperatively, the UNVA for the dominant and non-dominant eyes were 0.07±0.13 and 0.03±0.13, respectively, with no significant difference (P>0.05). MRSE showed no significant differences at any follow-up time points up to 24 months. Accommodation function did not decrease compared to preoperative levels at any postoperative follow-up. Increases in HOAs were primarily due to spherical aberrations, and there were no significant differences in objective visual quality before and after surgery. Contrast sensitivity improved significantly at 24 months postoperatively compared to preoperative levels. At 24 months postoperatively, 11 out of 12 patients reported good visual quality in the questionnaire. Conclusions: LBV surgery gradually achieves good binocular blended vision within 6 months postoperatively and demonstrates good safety, efficacy, and stability at 24 months. It maintains good functional vision and visual quality with high postoperative patient satisfaction.

Current status, challenges, and future career pathways of diploma-prepared nurses from the stakeholders’ perspective: a qualitative study

BackgroundThe global shortage of nurses is a pressing issue affecting healthcare quality and patient outcomes. Nurse turnover is driven by work-related stress, and job dissatisfaction is persistent. In Saudi Arabia, many diploma-prepared nurses need more bridging programs to convert their diplomas into bachelor’s degrees. Educational and organizational issues can limit the provision of quality nursing care. Differences in educational preparation influence nurses’ interpretations of patient safety and their roles within healthcare systems. Addressing the need for more policies and regulations regarding nurse turnover and the retention of diploma-prepared nurses is crucial. Thus, a comprehensive exploration of barriers and incentives for diploma-prepared nurses to complete their Bachelor of Science in Nursing (BSN) can lead to transformative institutional strategies, such as tuition compensation and clinical-academic collaborations. This study aims to fill this gap by understanding the current challenges, future trends, and solutions from stakeholders’ perspectives and developing tailored career pathways for diploma-prepared Nurses from the stakeholders’ perspective. Thus, it contributes to policy development and improved healthcare delivery and fosters a promising future for healthcare.MethodsThis qualitative study employed a thematic analysis and grounded theory methodology as we delved into stakeholders’ perspectives to generate a substantive framework for overcoming obstacles and cultivating tailored career pathways for diploma-prepared nurses. A purposive sampling technique was used to choose participants, ensuring their rich, relevant, and diverse information based on their expertise, experience, and ability to provide valuable insights. Data were collected using one-on-one semi-structured questions for in-depth interviews.ResultsOur findings revealed key concepts that were evident in the data. These concepts formed three main themes and several subthemes essential to understanding the current status of, challenges faced by, and career pathways for diploma-prepared nurses. The three main themes have emerged, and core categories have emerged under each theme accordingly. The results generated a practical framework, offering tangible solutions to overcome challenges and develop career pathways for diploma-prepared nurses.ConclusionsThe findings significantly affect policy development and healthcare delivery improvement. This suggests the need for policies that support diploma-prepared nurses in completing their BSN and the development of tailored career pathways that align with their educational background and career goals and the Kingdom’s 2030 Vision.

The present situation of the nursing practice environment and its influence on nursing quality in a post-epidemic era: a cross-sectional study

BackgroundNursing Practice Environment is an important index to improve nursing quality and patient outcome. To explore the nursing practice environment in the COVID-19 ward during the period of COVID-19 and its impact on nursing quality to provide reference for setting up supporting nursing team in epidemic area in the future.MethodsA cross-sectional survey was conducted among 251 nurses working in COVID-19 ward in Shanghai, Hainan and Hunan in December 2022 through stratified proportional sampling. Structured questionnaires, including general information questionnaire, professional practice environment scale and nursing quality questionnaire, were used to investigate the patients. Pearson correlation was used to analyze the correlation between nursing practice environment and nursing quality, and multiple linear regression analysis was used to analyze the influencing factors of nursing quality in the COVID-19 ward.ResultsThe professional practice environment scale score was (3.34 ± 0.40), the nursing quality questionnaire score was (9.47 ± 0.81), both at a high level. Single factor analysis showed that nursing quality was related to educational background, physical condition, professional title, grade of the original hospital and composition of nursing staff in supported departments. Nursing quality were positively correlated with each nursing practice environment dimensions (in addition to teamwork). The results of regression analysis showed that the nursing practice environment in the COVID-19 ward had a positive impact on nursing quality.ConclusionsThe nursing practice environment and nursing quality of nurses in the COVID-19ward is generally very high. The education, working hospital level and nursing practice environment of nurses are the important factors influencing nursing quality. The relationship between nursing practice environment (include leadership and autonomy in clinical practice, staff relationships with physicians, control over practice, communication about patients, handling disagreement and conflict, internal work motivation and cultural sensitivity) and nursing quality is positive. It is suggested that the hospital should pay special attention to and improve nursing practice environment in order to improve nursing quality when setting up temporary ward in the future epidemic period of infectious diseases, ensure patient safety.Impact on clinical practiceResearch shows that an active nursing practice environment can improve the quality of care, and nursing managers create and maintain an active practice environment to improve the quality of care and ensure patient safety.

Growth, yield and quality response of Eggplant (Solanum melongena L.) to blended NPSB fertilizer rates and intra-row spacing in Boloso Bombe district, Wolaita zone, South Ethiopia

Eggplant is the most important fruit vegetable crop in many countries, including Ethiopia. In spite of this, its production is hindered by low nutrient availability in soil and suboptimal intra-row spacing. In order to address these issues, a field investigation took place in the Wolaita zone during 2022/23 growing season to evaluate the effects of various concentrations of blended NPSB fertilizer and intra-row spacing on the growth, yield, and quality of eggplants. Five various blended NPSB fertilizer rates (0, 50, 100, 150, and 200 kg ha−1) and three intra-row spacing distances (30, 40, and 50 cm) were used in the investigation, which was designed as a randomized complete block with three replicates. Based on an analysis of variance, it was discovered that the main effects of NPSB fertilizer rates and intra-row spacing significantly (p < 0.01) affected many of parameters, including dry matter content, total soluble solids, fruit number, fruit length, and days to 50 % flowering. Additionally, the interaction effect between NPSB fertilizer and intra-row spacing significantly (p < 0.05) impacted the number of days to first fruit harvest, plant height, leaf area, branch number, leaf number, fruit diameter, fresh fruit yield, marketable fresh fruit yield, unmarketable fresh fruit yield, and total fresh fruit yield. According to the current investigation, the highest marketable fresh fruit yield (121.04 t ha−1) was obtained by 150 kg ha−1 NPSB with 40 cm intra-row spacing. These findings suggest that 150 kg ha−1 of blended NPSB fertilizer with 40 cm distance between plant spacing is optimal for eggplant cultivation in the study area and analogous agro-ecological settings. This optimized approach can effectively support eggplant growers in maximizing both yield and quality outcomes.

IVF laboratory management through workflow-based RFID tag witnessing and real-time information entry

BackgroundDual-person inspection in IVF laboratories cannot fully avoid mix-ups or embryo transfer errors, and data transcription or entry is time-consuming and redundant, often leading to delays in completing medical records.MethodsThis study introduced a workflow-based RFID tag witnessing and real-time information entry platform for addressing these challenges. To assess its potential in reducing mix-ups, we conducted a simulation experiment in semen preparation to analyze its error correction rate. Additionally, we evaluated its impact on work efficiency, specifically in operation and data entry. Furthermore, we compared the cycle costs between paper labels and RFID tags. Finally, we retrospectively analyzed clinical outcomes of 20,424 oocyte retrieval cycles and 15,785 frozen embryo transfer cycles, which were divided into paper label and RFID tag groups.ResultsThe study revealed that comparing to paper labels, RFID tag witnessing corrected 100% of tag errors, didn’t affect gamete/embryo operations, and notably shorten the time of entering data, but the cycle cost of RFID tags was significantly higher. However, no significant differences were observed in fertilization, embryo quality, blastocyst rates, clinical pregnancy, and live birth rates between two groups.ConclusionsRFID tag witnessing doesn’t negatively impact gamete/embryo operation, embryo quality and pregnancy outcomes, but it potentially reduces the risk of mix-ups or errors. Despite highly increased cost, integrating RFID tag witnessing with real-time information entry can remarkably decrease the data entry time, substantially improving the work efficiency. This workflow-based management platform also enhances operational safety, ensures medical informational integrity, and boosts embryologist’s confidence.

Taurine, alpha lipoic acid and vitamin B6 ameliorate the reduced developmental competence of immature mouse oocytes exposed to methylglyoxal

Advanced glycation end products (AGEs) are the final products of the Maillard reaction, formed through the interaction of carbohydrates and proteins. Reactive dicarbonyl compounds such as methylglyoxal (MGO) serve as precursors for AGEs formation. Elevated levels of MGO/AGEs are observed in conditions like obesity, polycystic ovarian syndrome (PCOS), and diabetes, negatively impacting oocyte development. Previous studies have shown that hydrogen sulfide, a gasotransmitter with anti-AGEs effects, is produced in a process influenced by vitamin B6. R-α-lipoic acid (ALA) inhibits protein glycation and AGEs formation while stimulating glutathione (GSH) production. Taurine mitigates oxidative stress and acts as an anti-glycation compound, preventing in vitro glycation and AGEs accumulation. This study aimed to explore the ameliorative effects of a micronutrient support (Taurine, ALA and B6: TAB) on mouse oocytes challenged with MGO. Our results indicate that MGO reduces oocyte developmental competence, while TAB supplementation improves maturation, fertilization, and blastocyst formation rates. TAB also restores cell lineage allocation, redox balance and mitigates mitochondrial dysfunction in MGO-challenged oocytes. Furthermore, cumulus cells express key enzymes in the transsulfuration pathway, and TAB enhances their mRNA expression. However, TAB does not rescue MGO-induced damage in denuded oocytes, emphasizing the supportive role of cumulus cells. Overall, these findings suggest that TAB interventions may have significant implications for addressing reproductive dysfunctions associated with elevated MGO/AGEs levels. This study highlights the potential of TAB supplementation in preserving the developmental competence of COCs exposed to MGO stress, providing insights into mitigating the impact of dicarbonyl stress on oocyte quality and reproductive outcomes.

A Novel Approach to Supporting Ambulatory Nursing Professional Development.

Because of the growth of nursing care in ambulatory clinics, nursing education and professional development needs have increased. At one academic medical center, development of a combined centralized-decentralized nursing professional development model addressed the needs of this expansion. Hiring dedicated nursing professional development staff for prioritized education programs improves throughputs and outputs associated with nursing professional development. Implementation of unit-based clinic rounding has improved staff engagement with education, professional development, and quality outcomes. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

Pubic bone osteomyelitis and fistulas after radiation therapy of the pelvic region: patient-reported outcomes and urological management of a rare but serious complication

PurposeThis study investigated late urinary adverse events (UAEs) in patients who underwent pelvic radiation therapy, with a focus on occurrence, diagnostic characteristics and the impact of subsequent extirpative surgery with the need of urinary diversion on quality of life.MethodsA retrospective analysis of 20 patients after pelvic radiotherapy (2016–2022) was conducted. Data included demographics, perioperative details, oncological parameters, and patient-reported outcomes. Imaging (CT, MRI) was examined for early manifestations of late UAEs.ResultsIn the study cohort, prostate cancer was the primary malignancy in 85% with a mean radiation dose of 84 Gray over 35 days. Time to diagnosis of late UAEs was 4.0 years post-radiation. Radiological assessment demonstrated a progressive increase in typical CT and MRI features of pubic bone osteomyelitis over time. Surgical interventions, mainly cystectomy, were required with variable outcomes in patient-reported post-surgery quality of life.ConclusionDiagnosing and managing late UAEs after pelvic radiation necessitate an understanding of their occurrence, diagnostic features and appropriate management strategies. Early imaging, particularly MRI, is crucial for timely diagnosis and treatment planning. Variable post-surgery quality of life underscores the importance of a multidisciplinary approach in managing late UAEs. The study contributes to understanding these complications and emphasizes their consideration in post-radiation follow-up care.

Intensive Care Unit Sleep Promotion Bundle: Impact on Sleep Quality, Delirium, and Other Patient Outcomes.

High-quality sleep is important for optimal patient recovery. Sleep deprivation during hospitalization may lead to poor patient outcomes. To examine whether implementation of a sleep promotion bundle in the intensive care unit affects rates of delirium and agitation, restraint use, and length of stay. An evidence-based sleep promotion bundle was developed and implemented in 2 intensive care units in a 1025-bed level I trauma teaching hospital. Deidentified data from the electronic health record were obtained for patients hospitalized before and during the intervention. Data included scores on the Confusion Assessment Method for the Intensive Care Unit, Richmond Agitation-Sedation Scale, and Glasgow Coma Scale; restraint use; and hospital and intensive care unit length of stay. A total of 137 patients during the preintervention period and 149 patients during the intervention period were hospitalized in the intensive care units and met inclusion criteria. A 9-percentage-point decrease in the incidence of delirium from before to during the intervention was found, although it was not statistically significant (P = .07). Significant reductions were found in both intensive care unit (P = .04) and hospital (P = .03) length of stay. A significant decrease was found in Richmond Agitation-Sedation Scale high scores for patients requiring mechanical ventilation (P = .03). No significant differences were found in Richmond Agitation-Sedation Scale low scores, Glasgow Coma Scale scores, or restraint use. Critical care nurses are in an optimal position to implement evidence-based sleep promotion measures. Further research on sleep promotion bundles is needed.

Sustainable Building Construction Materials in the United Arab Emirates: A Review

The construction industry, a major player in economic development, is facing increased pressure to address sustainability concerns amidst rapid population growth and urbanization. With global projections indicating a significant rise in building demand by 2050, sustainability has emerged as a crucial focus area and paradigm shift to enhance environmental friendliness, quality, and project outcomes. The UAE, renowned for its vibrant construction industry, offers a unique context for examining the integration of sustainable practices. The use of sustainable construction practices is growing in the UAE, where the built environment plays a key role in economic growth and environmental stewardship. The United Arab Emirates (UAE) aims to foster long-term sustainability while enhancing the standard of living for current and future generations by integrating social, environmental, and economic aspects within construction projects, while also reevaluating conventional sustainable development frameworks and embracing a triple bottom line approach. This research was conducted to explore sustainable construction material usage and evaluation in the United Arab Emirates. The literature was reviewed for sustainable building construction materials across the UAE in the SCOPUS index from 2014 to 2024, as well as the regional regulations concerning the subject. This study evaluated the increasing trend of sustainable construction material research works, as well as the sound regional parameters of sustainable construction materials implemented across the country. Through an exploration of the significance of sustainable construction materials, this research underscores the multifaceted benefits of locally sourced, recyclable, and renewable materials in reducing environmental impacts, fostering economic and social well-being, and improving overall project performance and project management practices. The construction sector’s role in economic development and its substantial environmental impact are discussed in alignment with sustainable construction materials, sustainable construction practices, and the need to enhance environmental sustainability and create healthier built environments. In the realm of sustainable construction materials, project management knowledge areas encompass a range of factors. These include the properties of materials sourced regionally; the incorporation of recycled content; considerations for indoor air quality, energy, and water efficiency parameters; and how these properties relate to project scopes, scheduling constraints, and challenges. Additionally, the availability of resources and competency levels, quality control standards, specifications, communication strategies, and stakeholder involvement play crucial roles. It is important to assess both the positive and negative risks associated with these elements across construction projects.

Process and outcome differences in the care of patients undergoing elective and emergency right hemicolectomy.

Up to 30% of patients with colorectal cancer present as an emergency and have worse outcomes than elective patients. Compared with left-sided cancers, malignancies arising in the right colon are significantly under-researched. We sought to compare cancer care quality and clinical outcomes between emergency and elective presentations of right-sided colon cancer (RCC). This multicentre, retrospective study included all patients who underwent operative management for a RCC, from 1 April 2017 to 31 March 2022. Data were collected from electronic patient records, and host and tumour factors as well as outcomes between emergency and elective cohorts were compared. Overall, 806 patients (median age 72 years) were included. Some 175 patients (22%) presented as an emergency: 140 in obstruction and 35 with tumour perforation, compared with 1 patient with tumour perforation in the elective group (p < 0.001). The emergency group had higher rates of postoperative complications (59.1% vs 20.0%, p < 0.001), increased 90-day mortality (13.7% vs 1.3%, p < 0.001) and a longer hospital stay (5 vs 10 days, p < 0.001). From the emergency cohort only 29.2% of eligible patients received adjuvant chemotherapy and in multivariate regression analysis emergency presentation was associated with a decreased likelihood of receiving adjuvant chemotherapy (odds ratio 0.26 [0.14-0.47], p < 0.001). Both short- and long-term outcomes after emergency presentation of RCC are poor, with inadequate access to subsequent chemotherapy. Strategies addressing emergency presentations of left-sided tumours have moved towards temporisation and elective surgery. Delaying major resectional surgery for optimisation may improve outcomes and access to adjuvant therapies for RCC.

Trifecta outcomes of robotic partial nephrectomy in obese patients: A comparison of body mass index

We analyzed robotic partial nephrectomy (RPN) outcomes in obese patients based on body mass index (BMI) and trifecta achievement. We retrospectively reviewed 296 patients who underwent RPN at Kansai Medical University Hospital between 2014 and 2022. The preoperative clinical data and perioperative outcomes were evaluated. Trifecta achievement (negative surgical margin, no major complications, and no acute kidney injury on postoperative day three) and its relationship to three BMI groups (<25, 25 to <30, and ≥30) were the primary outcome. The correlation between factors in achieving trifecta and BMI was evaluated. Univariate and multivariate analyses assessed variables for achieving the trifecta with logistic regression analysis. C-statistics quantitatively evaluated the prediction accuracy. Among 296 patients, 264 (89.2%) achieved trifecta (BMI categories were <25 [89.9%], 25 to <30 [89.4%], and ≥30 [82.6%]). There was no significant BMI-related difference (p = 0.566). Intraoperative blood loss increased with the BMI (p = 0.034). Multivariate analyses showed preoperative aspects and dimensions used for anatomic (PADUA) score independently predicted trifecta failure (odds ratio 1.71; 95% confidence interval 1.32-2.20; p < 0.001). The C-statistics of the PADUA score increased with increasing BMI. Higher BMI patients had more intraoperative blood loss during RPN. However, RPN remains safe and has acceptable quality and functional outcomes. Since patients with high PADUA scores combined with a high BMI may be at risk of trifecta failure, this should be explained before RPN.

The impact of a digital guideline version on schizophrenia guideline knowledge: results from a multicenter cluster-randomized controlled trial

BackgroundClinical practice guidelines are crucial for enhancing healthcare quality and patient outcomes. Yet, their implementation remains inconsistent across various professions and disciplines. Previous findings on the implementation of the German guideline for schizophrenia (2019) revealed low adherence rates among healthcare professionals. Barriers to guideline adherence are multifaceted, influenced by individual, contextual, and guideline-related factors. This study aims to investigate the effectiveness of a digital guideline version compared to print/PDF formats in enhancing guideline adherence.MethodsA multicenter, cluster-randomized controlled trial was conducted in South Bavaria, Germany, involving psychologists and physicians. Participants were divided into two groups: implementation of the guideline using a digital online version via the MAGICapp platform and the other using the traditional print/PDF version. The study included a baseline assessment and a post-intervention assessment following a 6-month intervention phase. The primary outcome was guideline knowledge, which was assessed using a guideline knowledge questionnaire.ResultsThe study included 217 participants at baseline and 120 at post-intervention. Both groups showed significant improvements in guideline knowledge; however, no notable difference was found between both study groups regarding guideline knowledge at either time points. At baseline, 43.6% in the control group (CG) and 52.5% of the interventional group (IG) met the criterion. There was no significant difference in the primary outcome between the two groups at either time point (T0: Chi2(1) = 1.65, p = 0.199, T1: Chi2(1) = 0.34, p = 0.561). At post-intervention, both groups improved, with 58.2% in the CG and 63.5% in the IG meeting this criterion.ConclusionsWhile the study did not include a control group without any implementation strategy, the overall improvement in guideline knowledge following an implementation strategy, independent of the format, was confirmed. The digital guideline version, while not superior in enhancing knowledge, showed potential benefits in shared decision-making skills. However, familiarity with traditional formats and various barriers to digital application may have influenced these results. The study highlights the importance of tailored implementation strategies, especially for younger healthcare providers.Trial registrationhttps://drks.de/search/de/trial/DRKS00028895

Multi–Scenario Prediction of Land Cover Changes and Habitat Quality Based on the FLUS–InVEST Model in Beijing

As urbanization accelerates worldwide, understanding the impact of urban expansion on habitat quality has become increasingly critical in environmental science research. This study examines the impact of urban expansion on habitat quality in Beijing, forecasting land cover changes and ecological effects by 2030. Using CA–Markov and FLUS models, the research analyzes habitat quality from 2000 to 2030 through the InVEST model, revealing a significant urban land increase of 1316.47 km2 and a consequent habitat quality decline. Predictions for 2030 indicate varying habitat quality outcomes across three scenarios: ecological priority (0.375), natural growth (0.373), and urban development (0.359). We observed that the natural growth scenario forecasts a further decline in habitat quality, primarily due to increased low–value habitat regions. Conversely, the ecological priority scenario projects a notable improvement in habitat quality. To mitigate habitat degradation in Beijing and enhance regional habitat quality and ecological conditions, it is recommended to control urban land cover expansion, adopt effective ecological conservation policies, and systematically carry out national spatial restructuring and ecological restoration. This research provides vital decision–making support for urban planning and ecological conservation, emphasizing the need for comprehensive land cover and ecological strategies in urban development. Additionally, our findings and methodologies are applicable to other rapidly urbanizing cities worldwide. This demonstrates the broader applicability and relevance of our research, providing a framework for sustainable urban planning in diverse global contexts.

Pediatric advanced complex endoscopy team enhances endoscopy quality and provider satisfaction.

Therapeutic endoscopic procedures are increasingly necessary for children. Pediatric gastroenterologist training and experience with endoscopic hemostasis and other complex therapeutic endoscopy procedures are often limited. We evaluated the impact of the implementation of an advanced complex endoscopy (ACE) team, which provides 24/7 inpatient/outpatient back-up endoscopy support. We analyzed hemostasis quality outcomes in the 2 years before implementation of ACE (2018-2020) versus the year following the implementation of ACE (2020-2021). We analyzed pediatric gastroenterology provider satisfaction and perspectives with a survey that was distributed to faculty, fellows, and advanced practice providers 1 month before implementation of ACE and again 12 months following ACE implementation. Endoscopy volume and outcome metrics for hemostasis procedures, including latency to endoscopy, need for reintervention, and administration/diversity of hemostatic therapy, including multimodal therapy, improved in the year following implementation of the ACE (p < 0.05 for each). Survey results demonstrated a positive impact on provider endoscopy experience and high utilization of ACE. Twenty-two percent of providers reported activating ACE in the prior month and 66% in the prior year. Most providers who activated ACE were very satisfied (85%) or satisfied (7.7%). Eighty-three percent noted ACE had a positive impact on inpatients, and 50% noted a positive impact on outpatient endoscopy. Provider anxiety with endoscopy diminished post-ACE implementation (62% vs. 28%). Respondents unanimously found ACE beneficial to patient care (100%). ACE implementation was associated with improved provider perspectives surrounding endoscopy and significant improvement in hemostasis quality parameters, escalation of hemostasis procedure volume, and broadening the range of hemostasis interventions.

Discordant Care and Decision Quality: Patients' Reasons for Not Receiving Their Initial Test of Choice in Colorectal Cancer Screening.

Concordance between a person's values and the test or treatment they ultimately receive is widely considered to be an essential outcome for good decision quality. There is little research, however, on why patients receive "discordant" care. A large, randomized trial of decision aids for colorectal cancer (CRC) screening provided an opportunity to assess why some patients received a different test than the one they preferred at an earlier time point. Of 688 patients who participated in the trial, 43 received a different CRC screening test than the one they selected after viewing a decision aid 6 mo prior. These patients answered 2 brief, open-ended questions about the reasons for this discordance. The research team analyzed their answers using qualitative description. Patient responses reflected 6 major categories: barriers or risks of initially favored test, benefits of alternative test, costs or health insurance coverage, discussion with family or friends, provider factors or recommendation, and health issues. Some of the patients' explanations fit well with the informed concordance approach, which infers poor decision quality from the existence of discordant care, since in these cases it appears that the patient's values and preferences were not adequately respected. Other statements suggest that the patient had an informed rationale for changing their mind about which test to undergo. These cases may reflect high-quality decision making, despite the existence of discordance as measured in the trial. This analysis highlights a major challenge to a popular approach for assessing decision quality, the difficulty of normatively assessing the quality of decision making when apparent discordant care has been provided, and the need to assess patient values and preference over time. Value-choice concordance is an accepted measure for assessing decision quality in decision aid trials, but greater exploration of apparently discordant care challenges key assumptions of this method; this study provides evidence that discordance as typically measured may not always reflect low-quality patient decision making.Researchers evaluating decision aids and assessing decision quality should consider the use of qualitative methods to supplement measures of decision quality and consider assessing patient preferences at multiple time points.

Effect of General Surgery Resident Participation in Thoracic Surgery on Oncologic Outcomes: An Observational Cohort Study.

Background: Despite increasing sub-specialization, general surgeons continue to perform oncologic thoracic surgeries. Our objective was to determine whether general surgery resident participation in thoracic surgery affects surgical quality or oncologic outcomes. We hypothesized that patient outcomes with and without resident participation would be similar. Methods: We retrospectively reviewed the electronic health records of patients with stage 0-IV lung cancer undergoing oncologic pulmonary resection at BLINDED FOR REVIEW during an 11-year period (2012-2022). Patients younger than 18years or older than 85years were excluded, as were those who had incomplete follow-up data or were unregistered in our institutional cancer registry. Patients were divided into groups based on whether residents or staff surgeons completed >50% of the critical portions of the operation. We compared 30-day morbidity outcomes, overall survival (OS), and disease-free survival (DFS). Results: Three hundred thirteen patients met inclusion criteria. Demographic and clinical characteristics were similar between groups, as were types of surgical resection and median operative times. A statistical difference was found in the distribution of surgical approach. The odds of morbidity were 65% higher in the Staff group (OR=1.65; 95% CI, 1.007-2.71). Resident participation was not significantly associated with OS or DFS (P =.32 and P =.54, respectively). Discussion: General surgery resident involvement in lung cancer operations is not associated with longer operative times but is associated with a higher likelihood of a thoracotomy. General surgery resident involvement was associated with decreased postoperative morbidity and did not significantly affect OS or DFS.

Application of the blastomere count variations "skip value" in the embryo AI assessment

Objective: To explore the correlation between blastomere count variations "skip value" which extracted from by time-lapse technology (TLT) combined with artificial intelligence (AI) and morphological features of in vitro fertilization (IVF) embryo, and to test its feasibility in clinical applications. Methods: This study was a diagnostic experiment (AI reassessment of embryo transferred patients), a total of 6 545 embryos from 1 226 patients who underwent IVF at the Women and Children's Hospital of Chongqing Medical University from December 2020 to December 2021 were retrospectively analyzed, of which 2 869 embryos were attempted to cultured to blastocyst stage by TLT. The embryo dynamic map (EDM) was drawn by Embryo Viewer, a TLT recording software, based on embryo developmental kinetics. The self-developed AI embryo evaluation software identified and recorded the number of cleavages in real time during embryonic development, and compared with the EDM, the correlation between the skip value formed by the change of cleavage sphere counts and the outcomes of the embryos was analyzed. The correlation among skip value, morphological score of embryo, implantation rate and live birth rate were performed by Spearman and step-up logistic regression. The receiver operating characteristic (ROC) curve was selected for reporting there relationship of skip value and morphology. Finally, predicting power of skip value for implantation and live birth rate were performed by ROC analysis. Results: The total skip values extracted from the blastomere count of embryos (72 hours post-fertilization) were negatively correlated with abnormal cleavage, blastocyst formation rate, day 3 (D3)-cell score, uneven size and fragmentation (the β values were -0.268, -0.116, -0.213, -0.159 and -0.222, respectively; all P<0.001); positively correlated with D3-cell number (β=0.034; P<0.001); negatively correlated with blastocyst formation rate and implantation rate (OR=0.97, 95%CI: 0.93-0.99, P=0.034; OR=0.96, 95%CI: 0.93-0.98, P=0.044). The power of predicting implantation were similar between the order selection of skip values and traditional morphology criteria [area under curve (AUC): 0.679 vs 0.620]. Live birth rate were negatively correlated with female age (OR=0.91, 95%CI: 0.88-0.93; P<0.001), D3 general score (OR=0.77, 95%CI: 0.59-0.99; P=0.045) and order selection of skip values (OR=0.98, 95%CI: 0.96-0.99; P=0.038), while positively correlated with retrieved oocyte number and endometrial thickness in embryo transferred (OR=1.08, 95%CI:1.05-1.11, P<0.001; OR=1.09, 95%CI:1.06-0.12, P<0.001, respectively) from multivariate regression analysis, and the power of predicting live birth was 0.666 for AUC. Conclusions: The skip value and its order form is a systematic quantification of embryo development, correlated with embryo developmental quality and clinical outcome. It could be an addition parameter for embryo culture and selection.

Music-Based Interventions for Symptom Management in Critically Ill, Mechanically Ventilated Adults: A Scoping Review of the Literature.

Background: Patients in intensive care units experience high symptom burden during mechanical ventilation (MV). Pharmacologic symptom management is associated with side effects and increased morbidity. Music-based interventions (MBIs) have been associated with reductions in both anxiety in MV adults and pain for critically ill adults, yet their use for the management of other burdensome symptoms has not been evaluated. The purpose of this scoping review is to map the state of evidence for the use of prerecorded music listening MBIs for symptom management in MV adults. Methods: A systematic search of the literature was conducted across four electronic databases (PubMed, EMBASE, CINAHL, and Web of Science) for experimental designed studies that measured the efficacy of MBIs for the management of physical and psychological symptoms including anxiety, sedation/agitation, dyspnea, distress, delirium, sleep, stress, fear, loneliness, or depression in critically ill, MV adults between January 1, 1998, and April 18, 2023. Results: A total of 643 abstracts and 29 clinical trials were included. Overall, the risk of bias, assessed using the Evidence Project tool, was moderate. MBIs were mostly delivered with headphones using music selected either by investigators or from a limited selection. MBIs were associated with reduced pain, agitation, dyspnea, distress and anxiety, and improved tolerance of MV and sedative weaning. Outcomes of delirium were mixed. No studies explored sleep disturbances, fear, or loneliness. Conclusions: Use of MBIs improved symptom experience for critically ill adults during MV. Future studies employing unrestricted patient-preferred music selections and exploring outcomes of sleep quality, psychological distress, and delirium are needed in this highly symptomatic patient population.

Spatial Computing Opportunities in Biomedical Decision Support: The Atlas-EHR Vision

We consider the problem of reducing the time that healthcare professionals need to understand the patient’s medical history through the next generation of biomedical decision support. This problem is societally important because it has the potential to improve healthcare quality and patient outcomes. However, navigating electronic health records is challenging due to high patient-doctor ratios, potentially long medical histories, urgency of treatment for some medical conditions, and patient variability. The current electronic health record systems provide only a longitudinal view of patient medical history, which is time-consuming to browse, and doctors often need to engage nurses, residents, and others for initial analysis. To overcome this limitation, we envision an alternative spatial representation of patient histories (e.g., electronic health records (EHRs)) and other biomedical data in the form of Atlas-EHR. Just like Google Maps, which allows a global, national, regional, and local view, Atlas-EHR can start with an overview of the patient’s anatomy and history before drilling down to spatially anatomical subsystems, their individual components, or subcomponents. Atlas-EHR presents a compelling opportunity for spatial computing since healthcare is almost a fifth of the US economy. However, traditional spatial computing designed for geographic use cases (e.g. navigation, land survey, mapping) faces many hurdles in the biomedical domain. This paper presents several open research questions under this theme in five broad areas of spatial computing.