Clinical Role Research Articles

Historical aspects of the creation and development of university clinics (literature review)

The study is relevant due to the special role of university clinics in maintaining and strengthening public health, since these medical institutions provide training future doctors, conduct clinical and scientific activities, develop and test advanced treatment methods. A systematic review of the literature sources (original research and reviews) selected using bibliographic and semantic search in the databases MedLine, The Cochrane Library, Global Health, Cyb,erLeninka, RSCI, devoted to the historical aspects of the creation and development of university clinics. The authors studied the specifics of the activities of university clinics, searched for solutions to the problem of improving the efficiency and quality of both medical and educational processes of their life. Despite the fact that university clinics originated in different ways, the main models of their activities are highlighted in the form of a single educational, scientific, and medical complex, which allows training of medical personnel at a qualitatively different level, providing practice-oriented training, as well as the possibility of developing scientific achievements of medical science. The literature data provided by the authors indicate university clinics today to be centers of advanced practical and scientific experience in providing medical care of the population. The study of historical patterns of development of university clinics makes it possible to use the most successful experience of their management in the structure of an educational institution and develop requirements that a university clinic must meet at the present stage to ensure strategic sectoral tasks of the state health system both within the framework of training medical personnel and in ensuring the process of providing medical care of the population in the Russian Federation.

The Sowers of Seeds: A Qualitative Analysis of the Role of Palliative Care Educators in Facilitating Goals-of-Care Conversations and Palliative Care Referrals.

Optimal care for seriously ill and older patients often involves advance care planning (ACP), goals-of-care (GOC) conversations, and specialty palliative care consultation, three sometimes overlapping, yet distinct practices. Insufficient staffing and investment in these areas have limited their availability. We explored the facilitators and barriers to successful implementation of the VIDEO-PCE trial. The intervention aimed to increase patient engagement in ACP, GOC, and by establishing Palliative Care Educators, a new clinical role integrated into existing hospital wards. This qualitative interview study employed a semi-structured interview guide tailored to the interviewee's clinical role. The interviews elicited perceptions of the facilitators and barriers to integration of palliative care educators (PCEs) into existing workflows. We developed deductive codes a priori and inductive codes as we coded interview transcripts. Medical/surgical floor clinical colleagues, palliative care team members, and PCEs from both participating sites were interviewed. Twenty-four individuals were interviewed (12 clinical staff of medical and surgical wards, seven palliative care team members, and five PCEs). Four themes were identified: (1) The work completed by the PCEs provided a foundation for future palliative care involvement; (2) Constituting the new role in practice required revision and creativity; (3) Communication was important to providing continuity of care; and (4) Establishing trust catalyzed the acceptance of the role. The creation and implementation of a new role within existing clinical workflows posed some challenges but were felt to relieve staff from some work burden and allow more patients to engage in ACP and GOC conversations. ClinicalTrials.gov Identifier: NCT04857060.

Diagnostic Splenectomy: Clinical Profile, Role, and Relevance in Diagnosis of Lymphoma

Diagnostic Splenectomy: Clinical Profile, Role, and Relevance in Diagnosis of Lymphoma

IBCL-187 Diagnostic Splenectomy: Clinical Profile, Role, and Relevance in Diagnosis of Lymphoma

IBCL-187 Diagnostic Splenectomy: Clinical Profile, Role, and Relevance in Diagnosis of Lymphoma

The Biological Mechanisms and Clinical Roles of RNA-Binding Proteins in Cardiovascular Diseases.

RNA-binding proteins (RBPs) have pivotal roles in cardiovascular biology, influencing various molecular mechanisms underlying cardiovascular diseases (CVDs). This review explores the significant roles of RBPs, focusing on their regulation of RNA alternative splicing, polyadenylation, and RNA editing, and their impact on CVD pathogenesis. For instance, RBPs are crucial in myocardial injury, contributing to disease progression and repair mechanisms. This review systematically analyzes the roles of RBPs in myocardial injury, arrhythmias, myocardial infarction, and heart failure, revealing intricate interactions that influence disease outcomes. Furthermore, the potential of RBPs as therapeutic targets for cardiovascular dysfunction is explored, highlighting the advances in drug development and clinical research. This review also discusses the emerging role of RBPs as biomarkers for cardiovascular diseases, offering insights into their diagnostic and prognostic potential. Despite significant progress, current research faces several limitations, which are critically examined. Finally, this review identifies the major challenges and outlines future research directions to advance the understanding and application of RBPs in cardiovascular medicine.

CMAH Coding Sequence Variants in 15 Non-Domestic Felid Species Related to ABC Blood Group System.

Different blood group systems have been characterized in people and other mammals. In domestic cats, the ABC blood group system plays the most important clinical role and has been investigated extensively-from the phenotype to the molecular genetics. In non-domestic felids, phenotypic ABC blood typing has been performed by different methods to detect the antigens, but the four informative CMAH markers in domestic cats were not able to identify types B and C (AB) in non-domestic cats. In this study, 138 blood samples from 15 non-domestic (wild) felid species were investigated by CMAH exonic sequencing and genotyping for putative variants causing type B or C (AB) and correlation to the respective ABC blood phenotype. A total of 58 CMAH variants were found, including 15 missense and 43 synonymous CMAH variants. One variant (c.635G>C) was concordant with blood type B (and C) in cheetahs and type B in cougars, compared to blood type A in all other felid species (lion, tiger, Canada lynx, snow leopard, clouded leopard, serval, jaguar, fishing cat, Pallas cat, bobcat, black footed cat, leopard, and sand cat). Since cheetahs and cougars belong to the genera puma, it could not be determined if the common CMAH variant is either a marker for type B (or C) or is just common in pumas.

The impact of a clinical academic nurse researcher in critical care: A 1-year service review.

To outline the activity and impact from implementing a clinical academic nurse researcher in a multi-centre critical care unit. A prospective exploratory activity audit informed by the Plan, Do, Study, Act framework. Quantitative data on clinical academic activity, from 1 April 2023 to 31 March 2024, were collected in a Microsoft Excel © [2022, version 16.66.1] spreadsheet. Activity narratives were detailed in qualitative data and the impact categorized. A total of 1500 clinical academic activity hours were logged (accounting for annual leave entitlement and sickness). Of these, 973 h were directly categorized within clinical academic activity. Most frequently undertaken clinical academic activities were academic writing (17.6%), data collection/analysis (9.6%), grant and funding workup (6.8%), Intensive Care Unit service development (6.6%), clinical activity (5.2%) and local level capability and capacity (4.9%) and other supportive tasks such as administration, unscheduled meetings, critical planning time and peer support (38%). Improvements broadly mapped onto five healthcare improvement domains; organizational, process design, data optimization and utilization, evidenced-based practice, and patients/staff impact. Our data indicate system mechanisms afforded by the clinical academic role that have not been explored within the contemporary literature. A nursing clinical academic demonstrates impact across the broad organization whilst increasing the visibility of nursing work and the potential for system resilience. In conclusion, our service review underscores the transformative potential of clinical academics in shaping the future of healthcare. Utilizing their expertise and contributions paves the way for innovation, excellence and sustainability in patient care. This review has provided clarity about clinical academic activity of a nurse researcher during the first year. There is international impact of this work for both clinical academics who may be evaluating such roles and healthcare management developing similar roles locally. No Patient or Public Contribution.

Research priorities for diagnosis, prognosis, and rehabilitation following concussion: results from a national survey of Australian health professionals

Purpose Recently, the Concussion James Lind Alliance Priority Setting Partnership (JLAPSP) (Canada) identified serious research gaps regarding diagnosis, management, and access to effective rehabilitation for concussion/mild traumatic brain injury (mTBI). Our aim was to determine if the same research priorities are important to Australian health professionals working in the concussion/mTBI field. Materials and methods A survey was distributed via professional networks, social media, professional group listservs, a research project noticeboard, and at conferences. It comprised of 25 of the highest ranked concussion research questions from the JLAPSP. We examined how professionals ranked the research questions and analyzed variation in ranking by clinical role and concussion/mTBI work experience. Results Our sample of 187 participants included medical and allied health professionals. Most participants were occupational therapists (22%), physiotherapists (18%), neuropsychologists (17%), and worked in Victoria (47%), New South Whales (18%), or Queensland (15%) in metropolitan areas. Health professionals ranked three research questions highest: identifying methods to predict prolonged recovery; effectiveness of early referral and treatment by a specialized concussion/mTBI team; and implementation studies on upskilling healthcare workers. Conclusions The research priorities identified can guide research efforts to improve the assessment, management, and rehabilitation of individuals with concussion/mTBI in Australia.

Identifying the essential elements to inform the development of a research agenda for Paramedicine in Ireland: a Delphi Study

BackgroundParamedicine is a dynamic profession which has evolved from a “treat and transport” service into a complex network of health professionals working in a diverse range of clinical roles. Research is challenging in the paramedicine context, and internationally, research capacity and culture has developed slowly. International examples of research agendas and strategies in paramedicine exist, however, research priorities have not previously been identified in Ireland.MethodsThis study was a three round electronic modified Delphi design which aimed to establish the key aspects of the research priorities via end-user consensus. Participants included interested stakeholders involved in prehospital care or research in Ireland. The first round questionnaire consisted of open-ended questions with results coded and developed into themes for the closed-ended questions used in the second and third round questionnaires. A consensus level of 70% was set a priori for second and third rounds.ResultsResearch Priorities that reached consensus included Staff Wellbeing, Education and Professionalism and Acute Medical Conditions. Respondents indicated that these three areas should be a priority in the next 2 years. Education, Staffing and Leadership were imperative Key Resources that required change. Education was a Key Processes change deemed imperative to allow the future research to occur. Outcomes that should be included in the future research strategy were Patient Outcomes, Practitioner Development, Practitioner Wellbeing, Alternate Pathways, Evidence-based Practice and Staff Satisfaction.ConclusionThe results of this study are similar to previously published international studies, with some key differences. There was a greater emphasis on Education and Practitioner Wellbeing with the latter possibly attributed to the timing of the research in relation to the COVID-19 pandemic. The disseminated findings of this study should inform sustainable funding models to aid the development of paramedicine research in Ireland.

Absence of Paneth Cell Metaplasia to Predict Clinical Relapse in Ulcerative Colitis with Endoscopically Quiescent Mucosa.

Paneth cells play multiple roles in maintaining intestinal homeostasis. However, the clinical role of Paneth cell metaplasia (PCM) in ulcerative colitis (UC) remains unclear. We aimed to investigate the relationship between PCM and relapse in patients with UC and compare the usefulness of PCM with other histological indexes, including mucin depletion (MD) and basal plasmacytosis (BP). Patients with UC in clinical remission (CR) who underwent colonoscopy to confirm a Mayo endoscopic subscore (MES) ≦1 with biopsies from the distal colon were enrolled into this retrospective cohort study. Biopsy samples were evaluated for histological findings of PCM, MD, and BP. Clinical relapse was defined as partial Mayo score ≧3 or medication escalation. Multivariate analysis was performed to determine independent predictors of relapse among the three histological findings, MES, and patient background, and relapse prediction models were generated. Eighty-three patients were enrolled in this study (MES 0, n = 47; MES 1, n = 36). The number of PCM cases was significantly higher in patients with prolonged CR than that in those with relapse (p = 0.01). Multivariate analysis showed that the absence of PCM and MD were related to relapse in all the patients. In patients with MES 1, the absence of PCM was the only risk factor significantly and independently associated with relapse (hazard ratio, 4.51 [1.15-17.7]; p = 0.03). The absence of PCM was a histological risk factor for relapse in patients with MES 1, implying a protective role for PCM in remission and a new index for mucosal healing.

Pre-eclampsia update – Advancements in prediction and management of preeclampsia: The clinical role of the PERT test

Preeclampsia, a hypertensive disorder unique to pregnancy, presents significant risks to maternal and fetal health globally. Despite extensive research, its multifactorial aetiology challenges timely diagnosis and effective management2. The Pre-Eclampsia Ratio Test (PERT) emerges as a promising tool for risk prediction, prognosis assessment, and clinical decisionmaking. This essay explores the pathogenesis of preeclampsia, clinical implications of the PERT test, and its potential to revolutionize obstetric care1

AP-2α gene deregulation is associated with renal cell carcinoma patient survival

BackgroundRenal cell carcinoma (RCC), one of the most fatal urologic tumors, accounts for approximately 3% of all adult cancers and exhibits a high metastatic index at diagnosis and a high rate of relapse. Radical or partial nephrectomy is a curative option for nonmetastatic RCCs. Targeted therapy has been shown to improve the survival of patients with metastatic RCCs. However, the underlying cellular and molecular events associated with RCC pathogenesis are not well known.MethodsTo investigate the clinical role of the transcription factor activator protein (AP)-2α in RCC, methylated CpG island recovery assays and microarray analysis were employed. COBRA and RT‒qPCR assays were performed to assess AP-2α expression in RCC.ResultsA negative correlation was noted between AP-2α mRNA expression levels and methylation status. Multivariate analyses showed that AP-2α mRNA was a major risk factor not only for overall and disease-free survival in RCC but also for disease-free survival in clear cell RCC.ConclusionsOur results indicated that AP-2α expression was deregulated in RCC and associated with overall patient survival and disease-free survival. Such findings suggest that AP-2α might play an important role in the pathogenesis of RCC.

Unlocking the potential of HHLA2: identifying functional immune infiltrating cells in the tumor microenvironment and predicting clinical outcomes in laryngeal squamous cell carcinoma

BackgroundHHLA2 (human endogenous retrovirus-H long terminal repeat-associating protein 2) represents a recently identified member of the B7 immune checkpoint family, characterized by limited expression in normal tissues but notable overexpression in various cancer types. Nevertheless, the precise function and interaction with immune cells remain poorly understood, particularly in laryngeal squamous cell carcinoma (LSCC). This investigation endeavored to elucidate the biological significance of HHLA2 within the tumor microenvironment of human LSCC tissues and delineate the clinical relevance and functional roles of HHLA2 in LSCC pathogenesis.MethodsThrough multiplexed immunohistochemistry analyses conducted on tissue microarrays sourced from LSCC patients (n = 72), the analysis was executed to assess the expression levels of HHLA2, density and spatial patterns of CD68+HLA-DR+CD163− (M1 macrophages), CTLA-4+CD4+FoxP3+ (CTLA-4+Treg cells), CTLA-4+CD4+FoxP3− (CTLA-4+Tcon cells), exhausted CD8+T cells, and terminally exhausted CD8+T cells in LSCC tissues. Survival analysis was conducted to evaluate the prognostic significance of HHLA2 and these immune checkpoints or immune cell populations, employing COX regression analysis to identify independent prognostic factors.ResultsKaplan–Meier (K–M) survival curves revealed a significant association between HHLA2 expression and overall survival (OS) in LSCC. Elevated levels of HHLA2 were linked to reduced patient survival, indicating its potential as a prognostic marker (HR: 3.230, 95%CI 0.9205–11.34, P = 0.0067). Notably, increased infiltration of CD68+ cells (total macrophages), STING+CD68+HLA-DR+CD163− (STING+M1 macrophages), CTLA-4+CD4+FoxP3+, CTLA-4+CD4+FoxP3−, PD-1+LAG-3+CD8+T cells, and PD-1+LAG-3+TIM-3+CD8+T cells strongly linked to poorer survival outcomes (P < 0.05). A discernible trend was observed between the levels of these immune cell populations, STING+CD68+ (STING+ total macrophages), CD68+HLA-DR+CD163−, STING+CD68+CD163+HLA-DR− (STING+M2 macrophages), PD-1+LAG-3−CD8+T cells, PD-1+TIM-3+CD8+T cells, and PD-1+LAG-3+TIM-3−CD8+T cells and prognosis. Importantly, multivariate COX analysis identified HHLA2 as an independent predictive factor for OS in LSCC patients (HR = 3.86, 95%CI 1.08–13.80, P = 0.038). This underscored the potential of HHLA2 as a critical marker for predicting patient outcomes in LSCC.ConclusionsHHLA2 emerged as a detrimental prognostic biomarker for assessing OS in LSCC patients. Relative to other immune checkpoints, HHLA2 exhibited heightened predictive efficacy for the prognosis of LSCC patients.

Research-related knowledge, understanding and practice in public mental health: the voices of social workers and occupational therapists

IntroductionPrevious studies have explored facilitators and barriers to research conducted by allied health professionals in general medical settings. Since the mental health system is acknowledged to be significantly under-funded and more poorly functioning than general medical services, it is unclear whether the published facilitators and barriers also apply to mental health settings. This study sought to explore the research-related knowledge, understanding and practices of allied mental health clinicians based in a large public mental health service.MethodsA mixed methods study recruited 59 occupational therapists and social workers working in a dedicated metropolitan public mental health service in Melbourne, Australia. Quantitative survey results are reported elsewhere. Semi-structured interviews were conducted with 16 survey responder volunteers. Thematic analysis was conducted on the qualitative survey and interview data.ResultsFour main themes were identified: research must connect with clinical practice; fragments of knowledge; research in practice; and research is not part of my professional identity. The third theme, research in practice, comprised four subthemes: no time for research in clinical roles, missing communication, lack of ownership, and what I need to do research.ConclusionsThis study found that research and research-related activities were not considered part of the mental health social workers and occupational therapists’ professional identities. Dealing with this issue may be instrumental to the realization of these clinicians’ professional peak-body associations’ code of practice and to government mandated practice standards. We provided several strategies to encourage both clinicians and services to view research-related activities as an everyday part of clinical roles. This is especially important if we think of allied health evidence-based practice requiring a reasonable level of research-related skills and/or competencies to appraise, practice, evaluate and adapt their evidence-based practice.

The Clinical Nurse Practitioner's Essential Role in Early Diagnosis and Management of Multiple Sclerosis in Europe: A Consensus Report.

Timely diagnosis of multiple sclerosis (MS) is a challenge due to factors such as prompt identification of symptoms and consequent delays in hospital visits and treatment initiation. In part to address this challenge, an expert scientific advisory panel of clinical nurse practitioners (CNPs) from different European nations was convened by Viatris on October 25, 2022, in Amsterdam, the Netherlands. This meeting was an interactive discussion to understand the role of clinical nurse practitioners in MS management. The objectives were to (1) understand the current delays in MS diagnosis from the perspective of expert CNPs; (2) determine the role of the CNP in MS management; and (3) identify the opportunities to improve accessibility, foster collaboration among stakeholders, and promote initiatives to educate people with MS. The recommendations of the panel underline the multidimensional role of CNPs in the management of MS at all stages. Health care stakeholders need to work together to achieve better access to treatment regimens and facilitate outcomes in the management of MS through shared decision-making and follow-ups. Further exploration of the role of CNPs in the management of MS, as well as recommendations for early diagnosis, will help both general practitioners and specialists better manage MS care.

Developing the future academic workforce: A descriptive cross-sectional study of the experiences of early career academics from registered health and social care professions

Healthcare academics are generally recruited for their expertise as practitioners, however this may not always convert into expertise in higher education. Investigate experiences of academics who transitioned from clinical roles by: DESIGN: Descriptive cross-sectional survey. 122 survey responses; 103 females, 89.3% UK participants, 65.6% nurses. Average years as clinician was 14.49 (SD 8.44), average age at time of transition was 39.99 (SD 8.28), average length of time in academia was 4.36years (SD 6.51) and most were currently employed as a senior lecturer (36.9%) or lecturer (28.7%). An electronic survey using an amended version of the Career Transition Inventory (CTI), the HEXACO personality trait measure, and open questions for elaboration. Descriptive and inferential statistics were performed on statistical data and open questions were analysed thematically. 73% of participants agreed they felt like a novice again and were overwhelmed in their first year of academia. Most felt they received support from their line manager and the transition was the right decision. Higher levels of extraversion were associated with a positive transition, and those open to new experiences were more likely to feel ready and confident in their career transition. The qualitative data identified four themes: the need to do something different, expectations not reflecting reality, levels of support, and it being a transformative experience. Reasons for transitioning from clinical to academic roles are multifaceted. There is a lack of prior understanding around the complexities of the role, and expectations rarely reflect reality. Academic roles require extensive support and development, and time to transition into the role effectively.

Novel Framework of Financial Hardship in Childhood Cancer: Incorporating Stakeholder Perspectives.

Although financial hardship in childhood cancer contributes to poor outcomes, no standardized tool to assess its impact exists. Existing methods are heterogeneous and designed using high-income country (HIC), adult perspectives. This project aimed to construct a stakeholder-informed conceptual framework of financial hardship in childhood cancer with global relevancy. Group concept mapping, a participatory mixed-methods approach, was used. Participants were parents or caregivers of a child with cancer, childhood cancer survivors, and clinical or nonclinical support personnel, fluent in English, Spanish, or Portuguese. A representative panel established a comprehensive list of relevant items. Participants individually sorted these items into concepts and then rated each item for impact using a four-point Likert scale. Multidimensional scaling and hierarchical cluster analysis identified concepts. Descriptive statistics were calculated for impact ratings. One fourth (21/80) of participants were parents/caregivers or childhood cancer survivors. Participants worked in clinical (44/80), charity/volunteer (27/80), and other nonclinical (13/80) roles. Of the 41 represented countries, 78.0% (32) were low- and middle-income countries (LMICs). Conceptual themes spanned six distinct clusters: medical, nonmedical, assistance and support, treatment impact, family impact, and caregiver impact. These were distinct in composition compared with an existing framework for adult oncology. Caregiver impact (mean, 3.39) and treatment impact (mean, 3.29) were the highest rated clusters, and impact ratings were higher in LMICs compared with HICs. We developed a framework for financial hardship in childhood cancer that reflects the voices of stakeholders, including parents and caregivers, from diverse global contexts. The findings lay a foundation for the development and validation of tools to systematically assess financial hardship in families of children with cancer and inform effective policies and interventions.

Interprofessional Staffing Pattern Clusters in U.S. ICUs.

To identify interprofessional staffing pattern clusters used in U.S. ICUs. Latent class analysis. Adult U.S. ICUs. None. None. We used data from a staffing survey that queried respondents (n = 596 ICUs) on provider (intensivist and nonintensivist), nursing, respiratory therapist, and clinical pharmacist availability and roles. We used latent class analysis to identify clusters describing interprofessional staffing patterns and then compared ICU and hospital characteristics across clusters. We identified three clusters as optimal. Most ICUs (54.2%) were in cluster 1 ("higher overall staffing") characterized by a higher likelihood of good provider coverage (both intensivist [onsite 24 hr/d] and nonintensivist [orders placed by ICU team exclusively, presence of advanced practice providers, and physicians-in-training]), nursing leadership (presence of charge nurse, nurse educators, and managers), and bedside nursing support (nurses with registered nursing degrees, fewer patients per nurse, and nursing aide availability). One-third (33.7%) were in cluster 2 ("lower intensivist coverage & nursing leadership, higher bedside nursing support") and 12.1% were in cluster 3 ("higher provider coverage & nursing leadership, lower bedside nursing support"). Clinical pharmacists were more common in cluster 1 (99.4%), but present in greater than 85% of all ICUs; respiratory therapists were nearly universal. Cluster 1 ICUs were larger (median 20 beds vs. 15 and 17 in clusters 2 and 3, respectively; p < 0.001), and in larger (> 250 beds: 80.6% vs. 66.1% and 48.5%; p < 0.001), not-for-profit (75.9% vs. 69.4% and 60.3%; p < 0.001) hospitals. Telemedicine use 24 hr/d was more common in cluster 3 units (71.8% vs. 11.7% and 14.1%; p < 0.001). More than half of U.S. ICUs had higher staffing overall. Others tended to have either higher provider presence and nursing leadership or higher bedside nursing support, but not both.

AB074. Propensity-score matched analysis to evaluate the safety and utility of intraoperative cell-salvaged autologous blood transfusion in metastatic spine tumour surgery.

Blood loss is an important consideration in metastatic spine tumour surgery (MSTS). Allogeneic blood transfusion (ABT) is the current standard of blood replenishment for MSTS despite known complications. Salvaged blood transfusion (SBT) through intraoperative cell salvage addresses the majority of complications related to ABT. However, the use of SBT in MSTS still remains controversial. We aim to conduct a prospective propensity-score (PS) matched analysis to evaluate the long-term clinical outcomes of intraoperative cell salvage (IOCS) in MSTS. Our study included 98 patients who underwent MSTS from 2014-2017. A PS matched cohort was created using the relevant and available predictors of treatment assignment and outcomes of interest. Clinical outcomes consisting of overall survival (OS), as well tumour progression (TP) that was evaluated using RECIST (v1.1) were compared in the matched cohort. Our study had a total of 98 patients with a mean age of 60 years old. A total of 33 patients received SBT. Overall median blood loss was 600 mL [interquartile range (IQR): 300-1,000 mL] and overall median blood transfusion (BT) was 620 mL (IQR: 110-1,600 mL). Group PS matching included 30 patients who received ABT and 28 patients who received SBT. There was also no significant difference between the OS of patients who underwent ABT or SBT (P=0.19). SBT did not show any significant increase in 4-year tumour progression [PS matched hazard ratio (HR) 3.659; 95% confidence interval (CI): 0.346-38.7; P=0.28]. SBT has been shown to have similar clinical outcomes to that of ABT in patients undergoing MSTS, with potential benefits of avoiding complications and costs of ABT. This will be the first long-term PS matched analysis to report on the clinical outcomes of SBT and affirms the clinical role of SBT in MSTS today.

Responding to Patient Deterioration from Simulation to Practice: A Narrative Study of Undergraduate Nursing Students

Responding to Patient Deterioration from Simulation to Practice: A Narrative Study of Undergraduate Nursing Students