Regular Review Research Articles

Effectiveness and Determinants of Implementing the "Xinjiang Model" for Tuberculosis Prevention and Control: A Quantitative Study.

To analyze the effectiveness of the "Xinjiang Model" for tuberculosis prevention and control in Kashgar Prefecture, Xinjiang, and to explore the determinants of the policy implementation effect. The registration data of pulmonary tuberculosis (PTB) patients in Kashgar Prefecture from 2012 to 2021 were collected to describe the temporal trend of registered incidence. A questionnaire survey was conducted among PTB patients registered and treated in the tuberculosis management information system in Zepu and Shache Counties from January 2022 to July 2023 to collect and analyze "Xinjiang model" determinants of effectiveness. The PTB registered incidence in Kashgar Prefecture showed a significant increasing trend from 2012 to 2018 (APC=18.7%) and a significant decreasing trend from 2018-2021 (APC=-28.8%). Among the Kashgar Prefecture, compared with average registered incidence in 2012-2017, registered incidence in 2021 in Shufu, Maigaiti, and Zepu Counties had a greater decline rate of 58.68%, 57.16%, and 54.02%, respectively, while the registered incidence in 2021 in Shache County increased by 6.32%. According to the comprehensive analysis of the factors affecting the effect of policy implementation, the proportion of PTB patients in Zepu County whose health status has now significantly improved compared with that before treatment was significantly greater than that in Shache County (P<0.05); patients in Shache County were significantly less aware than those in Zepu County of how to take tuberculosis drugs, precautions, adverse reactions, and regular reviews during treatment; the factors that accounted for the greater proportion of heavy treatment burden in both Shache and Zepu Counties were discomfort caused by taking or injecting drugs, accounting for 12.8% and 8.7%, respectively. The "Xinjiang model" can effectively control the epidemic situation of tuberculosis in Kashgar, and the knowledge of tuberculosis treatment, adverse reactions to tuberculosis drugs, and treatment costs were the determinants of the effectiveness of policy implementation.

Improving diversity in phase I oncology clinical trials: A single institution experience at the University of Colorado Cancer Center.

e13687 Background: Despite continued improvements in cancer outcomes, disparities persist between racial, ethnic, and socioeconomic groups. One potential driver is the lack of appropriate representation in clinical trials, including dose-finding studies. We implemented a set of initiatives including patient education, outreach, a Spanish-speaking bicultural clinic, and regular review of enrollment by race and ethnicity. To investigate the impact of these initiatives, we examined phase I clinical trial patient demographics and treatment outcomes before and after the intervention. Methods: We performed a retrospective review of patients enrolled in 2018-2019 (cohort 1[C1], pre- intervention) and 2022-2023 (cohort 2[C2], post-intervention). We collected patient demographics, area deprivation index (ADI), body mass index (BMI), ECOG performance status, and tumor type. Differences between cohorts were evaluated with T-tests, Chi-Square test, or the Fisher Exact test. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Hazard ratios (HR), confidence intervals (CI) and p values were derived using the cox proportional hazards method. A multivariable model for patients with colorectal cancers (CRC) was selected using the Akaike information criterion (AIC). Results: A total of 361 patients (C1 n = 209, C2 n = 152) were included. Overall, 52.4% of patients were female. The most common tumor sites were CRC (18.3%), pancreas (11.9%) and breast (10.8%). Study participants were 85.0% White, 3.3% Asian, 1.4% Black and 9.1% Hispanic, compared to cancer incidence in Colorado of 92.8%, 1.6% and 3.3% and 10.0%, respectively. Following our intervention, there was an increase in language preference other than English from 1.9% (4/209) to 6.6% (10/152) (p = 0.028) and in translated consents from 1.4% (3/209) to 5.9% (9/152) (p = 0.033). There was no statistically significant difference in race, ethnicity, insurance, or tumor type, although there was a non-statistically significant increase in Hispanic patients from 8.1% to 10.5%. Median PFS improved from 1.9 to 2.8 months (HR = 0.72, 95% CI 0.57-0.90, p = 0.003). ECOG 1 v. 0 was associated with inferior OS (HR = 1.35, 95% CI 1.06-1.73, p = 0.017), and BMI ≥18.5 v. &lt;18.5 was associated with superior OS (HR = 0.59, 95% CI 0.37-0.95, p = 0.03). AIC model of CRC (n = 66) revealed that ADI scores of 6-10 were associated with worse PFS and OS (p = 0.022 and p = 0.001, respectively). Conclusions: Our interventions resulted in an increase in accrual of non-English speaking patients, however, there was not yet a statistically significant change in overall race and ethnicity. Our study confirms poorer clinical outcomes for patients with higher ADI scores. Further research and intervention are warranted to mitigate disparities in clinical trial accrual and improve clinical outcomes for disadvantaged patients.

STRESS DETECTION IN IT PROFESSIONALS

The goal of this project is to use image processing and machine learning to recognize stress in IT professionals. The aim is to monitor the mental health of people working in front of computers for long periods of time, control and reduce stress, and provide a better working environment for IT workers. This approach focuses on managing stress and creating a healthy work environment so employees can get the best out of themselves at work. The overall aim of the research is to propose a reliable, simple and accurate search. The main purpose of this study is to analyze and provide information about the stress of employees by estimating the stress of the individual according to the symptoms determined by the care. The main goal of our study is to use effective machine learning and imaging techniques to diagnose stress in IT professionals. Our system is an updated version of the original stress testing method that does not include real-time testing and in-person interviews, but does include real-time measurement and regular employee reviews and controls over time. Keep track of information/stress on body and mind by giving regular questions to check stress treatment. Our system mainly focuses on managing stress and creating a healthy working environment so that employees can make the most of stress during work. Key Words: Face Detection, Facial Emotions, Morphological Processing, Convolutional Neural Network.

The Royal Marsden BRIDgE TRE Transparency Project

BackgroundThe BRIDgE platform is the Royal Marsden’s Trusted Research environment, which aims to transform clinical practice and improve outcomes for patients by enabling data analytics and AI development using real-world cancer data within secure, collaborative, cloud-based workspaces. This project evaluated the BRIDgE website against the new UK Health Data Research UK Transparency Standards, leading to changes to implement the following: Open Access Application form and Guidance (Standard 1), Transparent Access Process and Criteria (Standard 2), Clear website navigation (Standard 3), Consider Target Audience (Standard 4), Regular Review of Website Content (Standard 5), and Transparency of Data Use and Auditing (Standard 6). Our primary aim was to improve the content and sign posting so that patients and researchers would be better informed, resulting in increased website traffic and requests via our Contact Us page. MethodsInformation about the transparency project and the updates to the website were presented to a patient panel for feedback and a leaflet was co-designed with patient representatives. ResultsChanges included a new BRIDgE home page, which was re-designed to make navigation simpler and clearer, improved signposting, so both patients and researchers were aware of the sections meant for their consumption, such as the new Researchers’ Frequently Asked Questions (FAQ) page, which contained detailed instructions on how to request data, the governance workflow and costing structure. Finally, we expanded the Research Projects and Publications page, and added a Case Study from one of the Researchers, detailing their personal experience on the platform. ConclusionsWe anticipate that the impact of this project will be that patients will be more informed about Trusted Research Environments in general and what BRIDgE specifically enables in terms of innovative research and data security, leading to greater assurance for patients that their data is being used securely for their benefit. Researchers will get the benefit of the new FAQ page, which includes a great deal more information than was previously available about the platform, the data access methods, and the governance processes. We envisage that this will lead to more traffic on the site and a greater number of requests for information and workspaces via the Contact Us page. Finally, the patient leaflet will be the first time that patients in our waiting areas will be able to read about research informatics at the Royal Marsden and the work of our data scientists, in paper form. The resources developed using the funding from the transparency project are the revamped BRIDgE website https://www.cancerbrc.org/BRIDgE and (soon to be published) patient leaflet.

A newly designed anatomical plate for the therapy of posterolateral tibial plateau fracture via a supra-fibular-head approach: a retrospective study.

The posterolateral tibial plateau fracture is a special type of intra-articular fracture, for which there is no simple, safe, and effective standardized procedure. In this paper, we evaluate the clinical efficacy and the advantages of the treatment of posterolateral tibial plateau fracture by using our designed proximal lateral tibial rim plate for the posterolateral condyle of the tibial plateau via the space above the fibula head. Thirty-eight patients with posterolateral tibial plateau fractures from June 2018 to June 2021 were retrospectively analyzed. CT scans were used to classify the degree of injury in the included patients. All of them were fixed with reduction using an approach above the fibula head combined with a homemade anatomical plate. The regular postoperative review was performed to instruct functional knee exercises. Postoperative complications were observed and follow-up visits were performed to assess the functional outcome. A total of 38 patients with posterolateral tibial plateau fractures, 13 males and 25 females were included in the study. All patients were followed up for 13-26months, with a mean of 15.3months. There were no postoperative complications such as numbness of the limb, knee joint instability, etc. X-ray review showed that the fractures were all healed, and the healing time was 10-16weeks, with an average of 12.1weeks; none of the internal fixation loosening and loss of articular surface occurred during the follow-up period. At the last follow-up, according to the HSS knee function score criteria, the scores were 79-98, with an average of 91.3. The HSS score presented excellent in 34 cases (89%) and good in 4 cases (11%). The Rasmussen score was graded as excellent in 29 cases (76%) and good in 9 cases (24%). In conclusion, The treatment of posterolateral tibial plateau fractures by an approach above the fibula head has the advantages of simplicity and safety, small trauma, and no risk of vascular and nerve injuries, and the anatomical proximal lateral tibial rim plate can play a direct and effective supporting role for the bone fragments of the posterolateral condyle, and the combination of both of them has obvious advantages in the treatment of posterolateral condylar fracture of the tibial plateau, and it is a method worth borrowing and popularizing.

The Challenges and Countermeasures of Entrepreneurial Enterprise Strategic Planning

The main challenges faced by entrepreneurial enterprises in strategic planning include the lack of experience and capabilities of entrepreneurs themselves, affecting the professionalism of strategic decision-making; limitations in resources such as funding and talent, constraining strategic execution; and misjudgment of market conditions and external policy changes, increasing decision-making risks. These challenges seriously impede the effectiveness of strategic implementation for entrepreneurial enterprises. In response, businesses can take three key measures: improving the systematic nature of strategic planning and execution, establishing flexible strategic adjustment mechanisms, and introducing external professional services. Firstly, establishing a scientific and systematic strategic management framework to accurately recognize market trends and proactively control risks. Secondly, setting up regular review mechanisms based on market and policy changes and making strategic adjustments when necessary. Lastly, collaborating with professional organizations to address the lack of experience and perspectives and minimize risks. Through the integrated application of these strategies, entrepreneurial enterprises can ensure the effectiveness of strategic planning and implementation in a complex and ever-changing environment, and gain momentum for sustained growth.

Retirement Planning and Avenues

This study examines the dynamics of retirement planning, focusing on factors influencing individuals' decisions, preferred investment avenues. Through primary data collection via questionnaires, the study identifies major considerations such as family needs, healthcare, and income stability post-retirement. Findings indicate a preference for secured small saving plans over mixed investment options, with a notable lack of awareness about available investment avenues. The study recommends early and consistent savings, diversified investments, and regular review of retirement plans.

Navigating the complex dynamics of anesthesiologists’ professional identity formation in the context of their specialty training program: a phenomenographic perspective

BackgroundA specialty training program is crucial for shaping future specialist doctors, imparting clinical knowledge and skills, and fostering a robust professional identity. This study investigates how anesthesiologists develop their professional identity while navigating unique challenges specific to their specialty. The formation of professional identity in anesthesiology significantly influences doctors’ well-being, teamwork, and ultimately patient care, making it a crucial aspect of anesthesiology education. Utilizing a phenomenographic approach, the research explores the learners’ personal experiences and perspectives of professional identity formation in their specialty training programs, providing valuable insights for enhancing future anesthetic educational programs.MethodThe data for this phenomenographic study were collected through semi-structured interviews with anesthesiology trainees and specialists, guided by open-ended questions. The interviews were conducted at a Swedish university hospital, and participant selection used purposive sampling, providing rich and diverse data for analysis after 15 interviews. Iterative analysis followed the seven-step phenomenographic approach. The research team, comprising qualitative research and anesthesiology education experts, ensured result validity through regular review, discussion, and reflective practices.ResultsThe study reveals three fundamental dimensions: ‘Knowledge of Subject Matter,’ ‘Knowledge of Human Relations,’ and ‘Knowledge of Affect.’ These dimensions offer insights into how anesthesiologists comprehend anesthesiology as a profession, navigate interactions with colleagues and patients, and interpret emotional experiences in anesthesiology practice – all crucial elements in the formation of professional identity. The findings could be synthesized and further described by three conceptions: The Outcome-Driven Learner, the Emerging Collaborator, and the Self-Directed Caregiver.ConclusionThe study uncovers differing learner understandings in the development of anesthesiologists’ professional identity. Varying priorities, values, and role interpretations highlight the shortcomings of a generic, one-size-fits-all educational strategy. By acknowledging and integrating these nuanced learner perspectives, as elucidated in detail in this study, the future of anesthesia education can be improved. This will necessitate a holistic approach, intertwining both natural sciences and humanities studies, focus on tacit knowledge, and flexible teaching strategies, to guarantee thorough professional development, lifelong learning, and resilience.

Stillbirth mortality by Robson ten-group classification system: A cross-sectional registry of 80 663 births from 16 hospital in sub-Saharan Africa.

To assess stillbirth mortality by Robson ten-group classification and the usefulness of this approach for understanding trends. Cross-sectional study. Prospectively collected perinatal e-registry data from 16 hospitals in Benin, Malawi, Tanzania and Uganda. All women aged 13-49 years who gave birth to a live or stillborn baby weighting >1000 g between July 2021 and December 2022. We compared stillbirth risk by Robson ten-group classification, and across countries, and calculated proportional contributions to mortality. Stillbirth mortality, defined as antepartum and intrapartum stillbirths. We included 80 663 babies born to 78 085 women; 3107 were stillborn. Stillbirth mortality by country were: 7.3% (Benin), 1.9% (Malawi), 1.6% (Tanzania) and 4.9% (Uganda). The largest contributor to stillbirths was Robson group 10 (preterm birth, 28.2%) followed by Robson group 3 (multipara with cephalic term singleton in spontaneous labour, 25.0%). The risk of dying was highest in births complicated by malpresentations, such as nullipara breech (11.0%), multipara breech (16.7%) and transverse/oblique lie (17.9%). Our findings indicate that group 10 (preterm birth) and group 3 (multipara with cephalic term singleton in spontaneous labour) each contribute to a quarter of stillbirth mortality. High mortality risk was observed in births complicated by malpresentation, such as transverse lie or breech. The high mortality share of group 3 is unexpected, demanding case-by-case investigation. The high mortality rate observed for Robson groups 6-10 hints for a need to intensify actions to improve labour management, and the categorisation may support the regular review of labour progress.

Prevalence and appropriateness of omeprazole prescription in dogs at a veterinary teaching hospital before and after the publication of the ACVIM consensus statement on the rational administration of gastrointestinal protectants.

Overprescribing of acid suppressants is a common phenomenon in human and small animal patients, leading to potential deleterious gastrointestinal (GI) and non-GI consequences. The impact of consensus statements on veterinary prescribing habits in clinical practice have not been fully evaluated. This study aimed to compare the prescribing habits of the proton pump inhibitor (PPI), omeprazole, in dogs in an academic veterinary teaching hospital before and after the publication of the American College of Veterinary Internal Medicine (ACVIM) consensus statement on rational use of gastrointestinal protectants. Evaluation of the prescribing habits of omeprazole in dogs during the years 2017 and 2021 was retrospectively compared. These years were selected to reflect a 12-month period prior to and following the publication of the consensus statement. One hundred dogs from each year were randomly selected. Dose, frequency of administration, duration of treatment, concurrent prescription of more than one gastroprotectant and indications for prescribing omeprazole were analyzed. A significant increase in the cases that received omeprazole q12h (p < 0.0001) or that underwent a tapering dose after ≥4 week-therapy (p > 0.0001) was detected after the publication of the 2018 ACVIM consensus statement. Considering the indications, there was also a significant increase in the appropriate prescription of omeprazole in the second compared to the first period of study (p < 0.0001). Fifteen of 16 clinicians (94%) involved in the prescription of omeprazole indicated that their reading of the consensus statement had changed their clinical practice regarding PPI administration in dogs. These results support the beneficial impact of the ACVIM consensus statement on the judicious prescribing of omeprazole in an academic veterinary hospital. These results should not be extrapolated to first-opinion veterinary practices, and further efforts should be made to ensure that PPIs are prescribed prudently with a clear indication and regular review of the appropriateness of continued administration to minimize possible risks and adverse drug interactions.

The Province of Jambi's Madrasah Education Development Strategy: Integrating Contemporary and Conventional Methods

The purpose of this study is to investigate the roles and tactics madrasahs employ in addressing the problems of globalization and curriculum changes, as well as the dynamics of madrasahs in Jambi with an emphasis on social, cultural, and educational changes that take place. With an ethnographic approach, this study employs a qualitative methodology. Because it can give a detailed picture of daily routines, interpersonal relationships, and community culture in madrasahs, this approach was selected. Comprehensive interviews, document analysis, and participant observation were used to gather data. The study's findings demonstrated that proactive curriculum adaptation and sensible management techniques are essential for madrasahs to succeed in surviving and growing in the face of international competition. The parental support system and the role of teachers are the obstacles that must be addressed. To guarantee the caliber of education at madrasahs going forward, it is advised that educators undergo regular review and training

Review of lidocaine plaster prescribing and monitoring in primary care

Abstract Introduction Lidocaine medicated plasters (LMPs) are accepted by the Scottish Medicines Consortium (SMC) for restricted use in post-herpetic neuralgia where first-line therapies are ineffective or intolerable.[1] Subsequently, LMPs are restricted for use in post-herpetic neuralgia within a large NHS board with Ralvo as formulary brand due to cost-effectiveness. Despite this, the spend on LMPs is increasing with the cost per 1000 list size above the national average.[2] Aim To review and improve LMP prescribing and monitoring in a general practice. Methods An audit within a GP practice was undertaken by conducting an EMIS search to extract all patients prescribed LMPs within the previous 6 months from December 2022. A baseline audit was completed to determine compliance against the criteria (standards set as 100%), shown in Table 1. Data were analysed using Microsoft Excel. In the interest of improving audit results, a pharmacist then conducted telephone reviews with a view to stopping LMP if appropriate, reducing prescription quantities and/or switching to Ralvo. Post review, criteria were re-audited to determine the impact. Following this, an education session was conducted. Results The results against the standards are shown in Table 1. The LMP reviews resulted in: therapy stopped (n=2; 8%), therapy reduced (n=7; 26%), therapy continued (n=11; 40%), and therapy removed from repeat (n=7; 26%). Reductions were achieved by reducing the number of patches, cutting patches or increasing the patch-free interval. Some patients continued therapy despite off-license indication due to a significant reduction in pain score and benefit in physical function. Following the audit and review of LMP, an informal general practitioner education session was conducted to promote adherence to formulary and SMC recommendations, aiming to prevent LMP initiation for off-license indications. Impact was not studied. Conclusion There is a lack of compliance with SMC and formulary recommendations with all patients in this study being prescribed LMPs for off-licensed indications. Pharmacy involvement in regular reviews could ensure patients are prescribed the most cost-effective brand and ongoing treatment appropriateness assessed, particularly for off-license indications. The study was implemented in one general practice; therefore, there is scope for extrapolation across the National Health Service board with aims to reduce LMP prescription costs and medication burden. Further work is also required to achieve a change in prescribing habits.

RELATIONSHIP OF QUANTITATIVE CHARACTERISTICS OF THE KIDNEYS WITH ANTHROPOMETRIC AND SOMATOTYPOLOGICAL PARAMETERS OF ADOLESCENT GIRLS IN THE DONETSK REGION

The article presents updated data reflecting the quantitative characteristics of the kidneys in representatives of various somatotypes among adolescent girls in the Donetsk region. Given the high level of morbidity of the urinary system, regular review of echographic patterns of kidney normality is necessary. Determining the features of kidney size depending on the somatotype is an important task of morphology, corresponding to the modern trends of an individual approach in medicine. The information obtained is undoubtedly of value for ultrasound specialists, nephrologists, as well as scientists in theoretical medicine. Materials and Methods: The object of the study was 150 polypositional ultrasound scans of the right and left kidneys of apparently healthy adolescent girls in the Donetsk region (75 subjects). The scans were obtained during a study in B-mode of the gray scale in standard positions (on the back and on the side) using the Radmir device, with a convex sensor. Anthropometric measurements were carried out according to the generally accepted V.V. Bunak’s method. Somatotyping was performed according to the Sheldon's method as modified by Heath and Carter. Calculations were carried out in the Statistica 13 program. Results: the subjects were divided into three groups, according to their specific somatotype. Morphometric ultrasound parameters of the right and left kidneys were obtained. During the statistical analysis, we established distinctive features of the morphometric parameters of the kidneys depending on the somatotypological affiliation of adolescent girls of the Donetsk region. Conclusion: statistically significant differences were found in the quantitative characteristics of the right and left kidneys in representatives of different somatotypes.

Legal analysis of the merits of electronic transferable records: toward cross-border trade digitalization

Purpose The basis for this study on electronic transferable records (ETRs) in the context of digitalizing cross-border trade is established in this chapter. It illustrates how the growing trend toward paperless trade and technological improvements is changing trade operations. This chapter focuses on the need to look into ETRs because of their capacity to influence business transactions while navigating complex legal issues. The specific goals of the study are outlined, including a review of the advantages, legality, difficulties and best practices of ETRs. This study aims to shed light on the possible advantages and disadvantages of ETRs, the legal framework that controls their use and the best practices for their efficient implementation. This study also seeks to provide informative recommendations for businesses and people that are considering using ETRs. Design/methodology/approach This study explores the evolving world of ETRs and their crucial function in international trade. Multidimensional technique is used to examine the transformative potential of ETRs from a variety of research angles. The research design is based on a comprehensive evaluation of the literature that includes a wide range of reliable sources, including academic papers, business reports and legal documents. The comprehensive retrieval of essential material is ensured through keyword searches in renowned academic databases and industry resources. The qualitative synthesis of secondary sources further enhances this methodology and allows for a complex examination of the implications of ETRs. The case study analysis provides practical information on the benefits, hazards and practical applications of ETRs. Multifaceted aspects are uncovered via a thematic approach and qualitative investigation, including potential advantages, hazards, implementation plans and regulatory frameworks. Findings ETRs offer a range of potential advantages for cross-border trade, encompassing augmented efficiency, reduced costs and heightened security. Nonetheless, their implementation also presents legal challenges and risks, spanning security and privacy concerns, legal ambiguities and technical complexities. Consequently, it is crucial for individuals and businesses to meticulously assess and mitigate these risks through the integration of robust security protocols, staying informed about legal developments and adhering to pertinent regulatory stipulations. In spite of these hurdles, the trajectory of ETR adoption is anticipated to remain on an upward trajectory, driven by increasing recognition of their potential benefits and the concurrent evolution of legal frameworks and technical standards. Research limitations/implications Research limitations included the following: lack of adoption of ETRs internationally; and legal diversity and different legal systems results in different consideration of the ETRs. It makes reaching a unified ETR system more difficult. Practical implications It is necessary to develop clear policies and procedures and establish well-defined policies and procedures governing ETR use. These should encompass security guidelines, data protection measures and adherence to legal mandates. Regular review and updates are imperative. Stay current on legal developments: In light of the continuously evolving legal and regulatory landscape pertaining to ETRs, businesses and individuals must stay abreast of pertinent changes and seek professional counsel when necessary. Collaborate with partners and stakeholders: To ensure harmonization and standardization in ETR deployment, active collaboration with partners, regulators and industry associations is vital. Social implications Enhance awareness and education: Investment in awareness and educational initiatives is crucial. Decision-makers should organize training programs, workshops and seminars to enhance understanding of ETRs’ potential benefits in cross-border trade among stakeholders. Socially, the use of ETR can achieve several political advantages for the society. It minimizes risks of corruption through enhancing tracing and auditing abilities for relevant authorities making it more difficult to engage in corrupt practices. That can promote integrity within government and public procurement system. Originality/value The development of standardized technical frameworks and interoperable platforms for ETRs could enhance their seamless integration into existing trade systems. Additionally, investigating the integration of emerging technologies like blockchain, IoT and AI into ETR ecosystems could unlock innovative solutions to security, authenticity and data management concerns. This study examines how ETRs can radically alter how trade is conducted on a global scale. This paper examines ETRs’ role in improving cross-border trade digitization by examining their advantages, legal difficulties and implementation techniques. The conclusions will aid firms, decision-makers and attorneys in navigating the constantly changing world of trade agreements. The study’s ultimate goal is to offer takeaways that support effective, secure and legally compliant integration of ETRs, ensuring that they operate as a catalyst for improved global trade efficacy and efficiency.

P065 Patient-initiated follow up in rheumatoid arthritis: a systematic review and meta-analysis

Abstract Background/Aims Inflammatory arthritides including rheumatoid arthritis (RA) typically require lifelong outpatient care. Patient-initiated follow up (PIFU) has been employed to alleviate burdens on over-stretched rheumatology clinics, aiming to eliminate unnecessary clinic visits and reduce waiting times. There is a paucity of robust data to establish whether clinical outcomes differ under PIFU compared to clinician-mandated follow up. We examined the effect of PIFU on key outcomes in patients with inflammatory arthritis. Methods We searched MEDLINE, Embase, PsycInfo and CENTRAL for randomised controlled trials comparing PIFU (and similar patient-directed strategies) with clinician-mandated follow up in patients with inflammatory arthritis. Publications were screened in accordance with PRISMA guidelines and included based on pre-specified criteria. Risk of bias was assessed using the Cochrane ROB2 tool. Outcome measures analysed were disease activity, serum C-reactive protein, disability, service use and satisfaction with care. Standardised mean differences (SMD) were used to account for variable use of outcome measures between papers. Results Six studies were included with a total of 1,059 patients, all of whom had RA, followed up for between one and six years. Two trials were conducted in Denmark, two in the UK and one each in Sweden and the Netherlands. Two involved two sites; four were single centre. Three studies were deemed to be at high risk of bias, two at moderate risk and one at low risk. The data demonstrated a reduced burden of clinic visits for patients under PIFU (all studies; SMD -0.56, [95% CI -0.85 to -0.28]) equivalent to a reduction in approximately one clinic visit for every two patients over the course of the study period. This was balanced by an increased number of telephone consultations (4 studies, 817 patients; SMD 0.40 [0.13 to 0.66]) equating to an extra consultation per 2.5 patients under PIFU. Non-significant trends were seen towards higher patient satisfaction (all studies; SMD 0.28 [-0.12 to 0.68]) for patients under PIFU. However, there were also trends towards higher CRP (three studies, 490 patients; SMD 0.22 [-0.08, 0.52]) and DAS28 score (4 studies, 658 patients; SMD 0.08[-0.20, 0.36]. No significant difference was seen in patient-reported disability. There was substantial statistical heterogeneity between studies. Conclusion PIFU is associated with a reduction in outpatient clinic appointments but increased numbers of telephone consultations, while maintaining patient satisfaction. Current data do not exclude the possibility of inferior long-term clinical outcomes for patients receiving PIFU. Transition to PIFU risks reducing services’ capacity to assess and modify clinically important parameters (e.g. cardiovascular risk) through regular scheduled review. These studies highlight the challenges in conducting meaningful trials on this question due to the heterogeneity of interventions and outcomes and the already-widespread use of some aspects of PIFU in routine care. Disclosure E. Alveyn: Other; Educational support from UCB. R. Crowder: None. M. Perry: None. S. Norton: None. J. Galloway: Honoraria; from AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB.

A REVIEW OF DATA-DRIVEN DECISION MAKING IN ENGINEERING MANAGEMENT

This research review article explores the transformative impact of data-driven decision-making (DDDM) across various sectors, highlighting the integration of advanced analytics to enhance organizational efficiency, innovation, and strategic planning. Despite the potential benefits, the adoption of DDDM poses significant challenges, including data quality issues, integration complexities, and the need for a cultural shift towards valuing data analytics. Through a comprehensive analysis of recent research and case studies, this article synthesizes key findings, emerging trends, and future research areas in DDDM. It provides practical recommendations for practitioners aiming to implement and optimize DDDM processes, emphasizing the importance of fostering a data-driven culture, investing in robust data infrastructure, and ensuring the ethical use of data. Additionally, the article offers suggestions for continuous improvement and adaptation to technological advancements, advocating for regular strategy reviews, monitoring emerging trends, and fostering innovation. By addressing these challenges and leveraging the outlined recommendations, organizations can unlock the full potential of DDDM, driving significant advancements in efficiency, competitiveness, and strategic decision-making in the digital age.&#x0D; Keywords: Data-driven Decision Making, Engineering Management, Machine Learning, Big Data, Advanced Analytics, Organizational Efficiency, Data Quality and Infrastructure, Technological Advancements.

Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population.

Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures. Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016. Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003. The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients.

A retrospective study of paraganglioma of the urinary bladder and literature review.

To review and summarize the characteristics and therapy of paraganglioma of the urinary bladder (PUB). Patients who underwent the operation in Peking Union Medical College Hospital between January 2012 and December 2021 were reviewed for this retrospective study. A total of 29 patients, comprising 9 (31%) men and 20 (69%) women, were included. The main manifestations were hypertension, palpitation, and micturition syncope. Eight patients had an increased 24-h urinary catecholamine, and seven of them had increased norepinephrine. Normetanephrine in seven patients was increased. Six of 18 metaiodobenzylguanidine and 8 of 22 octreotide scans were positive. In total, 15 cases underwent laparoscopic partial cystectomy and 14 underwent transurethral resection of bladder tumor. In all patients, the immunohistochemical index of Melan-A, AE1/AE3, and α-inhibin were negative, and chromogranin A, S-100, and succinate dehydrogenase were positive. The Ki-67 of 28/29 cases was under 5%, and 1 case with a Ki-67 of 20% was diagnosed with malignant PUB. A total of 27 patients had a regular follow-up, 2 patients were lost during the follow-up, 3 patients had a recurrence, and 1 of these patients died within 1 year of surgery. The symptoms all disappeared or were relieved after the surgery. The transurethral surgery approach fits PUB tumors with a size <3 cm or that protrudes into the bladder and can significantly reduce the postoperative hospital stay. Early detection and treatment are effective, and regular review is necessary after the surgery.

Implementation of a Program for Appendicitis MRI in a Pediatric Hospital.

MRI is increasingly used as an alternate to CT for the evaluation of suspected appendicitis in pediatric patients presenting to the emergency department (ED) with abdominal pain, when further imaging is needed after an initial ultrasound examination. The available literature shows a similar diagnostic performance of MRI and CT in this setting. At the authors' institution, to evaluate for appendicitis in children in the ED, MRI is performed using a rapid three-sequence free-breathing protocol without IV contrast media. Implementation of an MRI program for appendicitis in children involves multiple steps, including determination of imaging resource availability, collaboration with other services to develop imaging pathways, widespread educational efforts, and regular quality review. Such programs can face numerous practice-specific challenges, such as those involving scanner capacity, costs, and buy-in of impacted groups. Nonetheless, through careful consideration of these factors, MRI can be used to positively impact the care of children presenting to the ED with suspected appendicitis. This Clinical Perspective aims to provide guidance on the development of a program for appendicitis MRI in children, drawing on one institution's experience while highlighting the advantages of MRI and practical strategies for overcoming potential barriers.

Influence of disease course and comprehensive management on blood glucose level in children and adolescents with type 2 diabetes mellitus.

The aim of the present study was to evaluate the status of glycemic control, and assess the effects of the disease course and comprehensive management measures on the blood glucose level in children and adolescents with type 2 diabetes mellitus. The study collected the clinical data of type 2 diabetes patients in Beijing Children's Hospital from January 2015 to September 2020. Patients were grouped based on the disease course to compare their glycated hemoglobin (HbA1c) level, islet β-cell function, insulin resistance and comprehensive management measures. Of the 170 participants, the median disease course was 2.0 years (interquartile range [IQR] 1.0-4.0 years). The baseline HbA1c was 11.2% (IQR 9.2-12.4%). According to the grouping by the disease course, the median HbA1c was the lowest (5.7% [IQR 5.3-6.1%]) in the half-year course group and the highest in the 4-year course group (9.0 [IQR 6.8%-11.3%]). Compared with the group with a disease duration <2 years, patients in the >4 years group had a lower proportion of patients with HbA1c <7% (29.2% vs 66.2%), a lower homeostasis model assessment of β-cell function, and a lower proportion with a controlled diet, moderate-intensity exercise, regular follow up and no drug treatment. We deemed HbA1c as the dependent variable, and found that disease duration, homeostasis model assessment of β-cell function at follow up, continuous moderate-intensity exercise, regular review and treatment regimen were significant influencing factors for glycemic control. Children and adolescents with type 2 diabetes and a prolonged disease course showed poor glycemic control and decreased islet β-cell function. A good lifestyle, especially moderate-intensity exercise, can help such cases better control their blood glucose level.