Satisfactory Compliance Research Articles

The potential effect of mobile application-based telerehabilitation on physical activity levels in heart failure patients: insights from the intelliot EU project

Abstract Background Regular physical activity is paramount in heart failure (HF) patients and, due to its well-established benefit in quality of life, functional capacity and prognosis, carries a Class I indication in international guidelines. However, satisfactory compliance rates remain suboptimal, which is largely attributable to unavailability or suboptimal utilization of comprehensive cardiac rehabilitation programs. Digital health application-based telerehabilitation, on the other hand, has emerged as a potentially valuable tools in enhancing risk factor control and lifestyle modification rates in this high-risk patient population. Purpose In this study, we aimed to investigate whether the use of a purpose-designed Internet of Things (IoT)-based e-health system could lead to a clinically relevant increase in physical activity in a cohort of patients with HF across the spectrum of left ventricular ejection fraction (LVEF). Methods Nineteen HF patients were enrolled in the study. Subjects' key clinical characteristics are summarized in Picture 1. All subjects were provided with: a) a set of medical devices with wireless connectivity, b) a state-of-the-art smartwatch and c) a latest-generation smartphone, to which a dedicated patient application was installed. The latter was coupled with a web-based platform designed for physician use, forming the patient-physician interface (PFI). On top of standard-of-care verbal and written exercise recommendations, study physicians also prescribed individualized, guideline-directed exercise regimens for each patient via the PFI, which, in turn, delivered to subjects notifications upon detection of deviations (Picture 2). The first month of participation -during which the smartwatch was used as an activity tracker but exercise notifications had not been activated- served as the baseline period; baseline physical activity level in steps per day was then compared to the respective value measured during each of the 5 following months. Results Mean baseline-to-peak increase in daily step count was calculated at 23.34% (-20.33 - 103.63%). A baseline-to-peak increase in physical activity level of at least 20% was observed in 9/19 patients, with 6 more demonstrating a baseline-to-peak increase in the order of magnitude of 15-19.99%. Only 3 patients failed to achieve any increase in daily step count average. However, after the study month in which the peak physical activity value was observed (typically in the 2nd-4th study month), mean daily step count declined to baseline again in all but 2 patients. Conclusions Despite the study's non-randomized design and small sample size, our results suggest that mobile application-based telerehabilitation constitutes a promising approach in HF patients’ care, as it could aid them achieve a clinically relevant increase in physical activity; this effect, however, can be transient, and this highlights the importance of continued physician oversight.Picture 1: Clinical characteristicsPicture 2: Exercise prescription example

Community Mobilisation for Human Sample Collection in Sensitive Communities: Experiences from Granular Mapping of Schistosomiasis and Soil-Transmitted Helminths in Ekiti State, South West, Nigeria

Community mobilisation is a vital process for raising awareness and increasing participation in healthcare interventions, research, and programmes that require human sample collection and mass management. In this report, we present the community mobilisation approach undertaken for the implementation of the operational mapping and assessment of granular schistosomiasis and soil-transmitted helminths in Ekiti State, Nigeria. The mobilisation was conducted in 177 communities/wards of the 16 local government areas. A total of 15,340 urine and stool samples were collected in 34 days. The efficacy and success of the strategy were evaluated through the following three performance metrics: community compliance rate, the participant response rate at the community level, and the overall compliance response rate of the four most sensitive LGAs. Community compliance was 93.7% as sample collection was denied in nine communities and two other communities demanded the return of the collected samples despite our mobilisation effort because of cultural bias and myths that connect the collection of stool and urine samples to ritual activities in the local context. The participant response rate at the community level was 86.7%. Three of the four sensitive LGAs (based on previous assessment programmes) demonstrated satisfactory compliance rates of 100%, while a response rate of 64.0% was computed for one of the LGAs. We believe our approach contributed to effective community mobilisation and awareness and that the developed model has the potential to improve participation rates in large healthcare assessments and intervention programmes.

Nurses' Adherence to Infection Control Practices in Emergency Departments

Background: Follow-Up on Infection Prevention Measures It is an assortment of techniques intended to keep things free of microbes, Patient protection from diseases necessitates several actions. Preventing and controlling infections is one of the most crucial tasks for nurses. Using hand hygiene with personal protection equipment is a crucial step that can help prevent infections or their repercussions. The safety of patients and maintaining sterility and cleanliness in hospitals are the responsibilities of all nurses working there. Objectives: to evaluate the adherence of emergency department nurses to infection control protocols and recommendations. Methodology: This cross-sectional study selected a nonprobability (purposive) sample of 120 nurses working in emergency departments across three hospitals: Baghdad Teaching Hospital (50%), Al-Kindy Teaching Hospital (35.8%), and Sheik Zaydi Hospital 14.2%. The study was conducted from September 20, 2023, to 30 June 2024. collection tool, which consists of two parts: The first part is the demographic characteristics of the nursing staff (age, gender, level of education, years of experience in the emergency department, and participation in training courses related to infection control measures). Second part: Checklists were utilized for observation. The study instrument's reliability was assessed using the Statistical Package for Social Science Program (IBM SPSS) by applying Cronbach's Alpha. Results: The study finding shows that, based on the data, 66.7% of the respondents reported a fair level of practices about infection control measures. Sociodemographic factors such as qualifications notably impact nurses' practices regarding adherence to infection control practices. CONCLUSIONS: The researcher concluded that the nurses' practices were not at the level required (fair) to fit with the critical and special nature of the emergency department. Recommendations: Standard precautions are the basic level of the infection control process. The participants may possess satisfactory knowledge and compliance levels. However, more training programs and more focus on the standard precautions by educational institutes are needed for nurses to improve their knowledge and compliance with infection-control standard precautions.

Contribution of legal architecture toward strengthening co-management platforms in small-scale fisheries in Sri Lanka

The importance of a robust and supportive legal framework to encourage community involvement in resource management is undeniable. The legal landscape of Sri Lanka's fisheries sector is examined in this paper, with a specific focus on co-management - a collaborative approach involving fishers, government agencies, and other stakeholders for sustainable fisheries management. A systematic review of relevant Acts, Regulations, and other related literature explores how the existing legal framework enables the establishment and function of co-management platforms. The appropriateness and sufficiency of current legal provisions towards implementing "co-management good practices" outlined in the FAO's Assessment Sheet for co-management design and performance and the practical application of legal provisions aimed at promoting co-management are also examined. The Fisheries and Aquatic Resources Act No. 35 of 2013 emerges as the cornerstone legislation supporting co-management. Particularly significant is the provision for establishing Fisheries Management Coordinating Committees within designated Fisheries Management Areas. These Fisheries Coordinating Committees include representatives from village-level Fisheries Management Committees, government bodies, and key stakeholders appointed by the Director General of the Department of Fisheries and Aquatic Resources. This represents a crucial step towards collaborative management of fisheries resources. The analysis reveals satisfactory compliance of existing legal provisions with the FAO's "co-management good practices". However, some deficiencies and practical limitations have been identified. For instance, there is no legal mandate to make Fisheries Management Committees or Fisheries Coordinating Committees compulsory within designated Fisheries Management Areas, nor is there a requirement for regular meetings. While the legal framework generally supports co-management, there is substantial room for improvement. The paper recommends that the government should address legal and administrative challenges that hinder the effective implementation of co-management initiatives.

Compliance of healthcare workers in a psychiatric inpatient ward to infection control practices during the COVID-19 pandemic: a participant observation study supplemented with a self-reported survey

BackgroundAs an emerging infectious disease with a heterogenous and uncertain transmission pattern, coronavirus disease 2019 (COVID-19) has created a catastrophe in healthcare-associated infections (HAIs) and posed a significant challenge to infection control practices (ICPs) in healthcare settings. While the unique characteristics of psychiatric patients and clinical settings may make the implementation of ICPs difficult, evidence is lacking for compliance with ICPs among healthcare workers (HCWs) in a psychiatric setting during the COVID-19 pandemic.MethodsA cross-sectional multi-method study based on participant unobtrusive observation coupled with the completion of a self-administered ICP survey was conducted to assess compliance with ICPs among HCWs in a psychiatric inpatient ward in a regional hospital. An online checklist, called eRub, was used to record the performance of HCWs in hand hygiene (HH) and other essential ICPs. Furthermore, a well-validated questionnaire (i.e., Compliance with Standard Precautions Scale, CSPS) was used to collect the participants’ self-reported ICP compliance for later comparison.ResultsA total of 2,670 ICP opportunities were observed from January to April 2020. The overall compliance rate was 42.6%. HCWs exhibited satisfactory compliance to the wearing of mask (91.2%) and the handling of clinical waste (87.5%); suboptimal compliance to the handling of sharp objects (67.7%) and linen (72.7%); and poor compliance to HH (3.3%), use of gloves (40.9%), use of personal protective equipment (20%), and disinfection of used surface/area (0.4%). The compliance rates of the nurses and support staff to HH were significantly different (χ2 = 123.25, p < 0.001). In the self-reported survey, the overall compliance rate for ICPs was 64.6%.ConclusionThe compliance of HCWs in a psychiatric inpatient ward to ICPs during the COVID-19 pandemic ranged from poor to suboptimal. This result was alarming. Revisions of current ICP guidelines and policies that specifically target barriers in psychiatric settings will be necessary.

Assessment of pre-, peri-, and post-surgical practices for elective colorectal patients in a model 4 hospital in Ireland

IntroductionThe ERAS protocol is a set of international guidelines established to expedite patients’ discharge after colorectal surgery. It does this by aiming to prevent postoperative complications early, and return the patient to normal function allowing earlier discharge. Complications such as PONV, DVT, ileus and pain are common after surgery to name a few, and delay discharge. Early treatment and prevention of these complications however is suggested to aid a patients’ return to home at earlier rates than traditional practice.MethodsA prospective chart review and questionnaire was performed on patients undergoing colorectal surgery in UHL in a 6-month period from February to September 2023. Patients were approached on the 3rd day postoperatively and informed about the project. Exclusion criteria included patients who went to HDU or ICU postoperatively.ResultsIn total, 33 patients were recruited. A target of greater than 70% compliance was reached for a variety of the elements of the ERAS protocol such as laparoscopic surgery, preoperative assessments, nutritional drinks, LMWH, oral intake within 24 h of surgery, and intraoperative antiemetics. Unsatisfactory compliance was found with documentation of postoperative antibiotics use of preoperative gabapentin.ConclusionUHL has a satisfactory compliance of over 70% with a large variety of elements of the ERAS protocol. Areas of improvement required include postoperative antibiotic and preoperative gabapentin usage. With the collective effort of the multidisciplinary team, along with education, the ERAS protocol can successfully be applied and implemented in a model 4 hospital in Ireland.

Ensuring radiation safety: Evaluating dose and compliance among medical staff at King Faisal Medical Complex, Saudi Arabia

BackgroundRadiation is an integral part of routine medical practice, but it carries a risk to the health of medical staff. Hence, it should be assessed periodically. The study's goal was to quantify the levels of radiation exposure for medical staff at King Faisal Medical Complex (KFMC), Taif City Saudi Arabia, and to assess their radiation protective procedures in practice. MethodsThe study looked at the thermoluminescence dosimeters (TLDs) records of 50 medical professionals who were exposed to radiation while working at KFMC from 2019 to 2020 in Taif city, Saudi Arabia. In Riyadh, radiation exposure is read from skin TLDs using Harshaw model 6600 plus detectors. The Excel software was utilized to process the obtained data for calculating effective doses. A questionnaire was also distributed to the medical staff to assess their radiation protection procedures. The Statistical Package for Social Sciences (SPSS) program version 23 was used to analyze the obtained data. ResultsThe mean annual effective doses of the medical staff in 2019 and 2020 were determined to be 1.14 mSv and 1.4645 mSv, respectively, with no significant difference in effective doses between males and females in either year. The socio-demographic features of the medical personnel were examined, and the findings revealed that the majority of participants were male radiological technologists. The rate of adherence to radiation protection techniques was 68%, with a normally distributed dispersal. The amount of adherence varied significantly depending on nationality, occupation, and academic qualification. ConclusionAccording to the research, the mean annual effective dosage for medical professionals at KFMC was significantly below the recommended level, indicating satisfactory compliance with the ALARA radiation safety concept.

Classification of short and long term mild traumatic brain injury using computerized eye tracking

Accurate, and objective diagnosis of brain injury remains challenging. This study evaluated useability and reliability of computerized eye-tracker assessments (CEAs) designed to assess oculomotor function, visual attention/processing, and selective attention in recent mild traumatic brain injury (mTBI), persistent post-concussion syndrome (PPCS), and controls. Tests included egocentric localisation, fixation-stability, smooth-pursuit, saccades, Stroop, and the vestibulo-ocular reflex (VOR). Thirty-five healthy adults performed the CEA battery twice to assess useability and test–retest reliability. In separate experiments, CEA data from 55 healthy, 20 mTBI, and 40 PPCS adults were used to train a machine learning model to categorize participants into control, mTBI, or PPCS classes. Intraclass correlation coefficients demonstrated moderate (ICC > .50) to excellent (ICC > .98) reliability (p < .05) and satisfactory CEA compliance. Machine learning modelling categorizing participants into groups of control, mTBI, and PPCS performed reasonably (balanced accuracy control: 0.83, mTBI: 0.66, and PPCS: 0.76, AUC-ROC: 0.82). Key outcomes were the VOR (gaze stability), fixation (vertical error), and pursuit (total error, vertical gain, and number of saccades). The CEA battery was reliable and able to differentiate healthy, mTBI, and PPCS patients reasonably well. While promising, the diagnostic model accuracy should be improved with a larger training dataset before use in clinical environments.

A feasibility study using motivational interviewing and a smartphone application to promote physical activity (+Stay-Active) for women with gestational diabetes

BackgroundPhysical activity (PA) interventions have an encouraging role in gestational diabetes mellitus (GDM) management. Digital technologies can potentially be used at scale to support PA. The aim of this study was to assess the feasibility and acceptability of + Stay-Active: a complex intervention which combines motivational interviewing with a smartphone application to promote PA levels in women with GDM.MethodsThis non-randomised feasibility study used a mixed methods approach. Participants were recruited from the GDM antenatal clinic at Oxford University Hospitals. Following baseline assessments (visit 1) including self-reported and device determined PA measurements (wrist worn accelerometer), women participated in an online motivational interview, and then downloaded (visit 2) and used the Stay-Active app (Android or iOS). Women had access to Stay-Active until 36 weeks’ gestation, when acceptability and PA levels were reassessed (visit 3). The primary outcome measures were recruitment and retention rates, participant engagement, and acceptability and fidelity of the intervention. Secondary outcome measures included PA levels, app usage, blood glucose and perinatal outcomes. Descriptive statistics were performed for assessments at study visits. Statistics software package Stata 14 and R were used.ResultsOver the recruitment period (46 weeks), 114 of 285 women met inclusion criteria and 67 (58%) enrolled in the study. Mean recruitment rate of 1.5 participants/clinic with 2.5 women/clinic meeting inclusion criteria. Fifty-six (83%) received the intervention at visit 2 and 53 (79%) completed the study. Compliance to accelerometer measurement protocols were sufficient in 78% of participants (52/67); wearing the device for more than 10 h on 5 or more days at baseline and 61% (41/67) at 36 weeks. There was high engagement with Stay-Active; 82% (55/67) of participants set goals on Stay-Active. Sustained engagement was evident, participants regularly accessed and logged multiples activities on Stay-Active. The intervention was deemed acceptable; 85% of women rated their care was satisfactory or above, supported by written feedback.ConclusionsThis combined intervention was feasible and accepted. Recruitment rates were lower than expected. However, retention rates remained satisfactory and participant compliance with PA measurements and engagement was a high. Future work will explore the intervention’s efficacy to increase PA and impact on clinical outcomes.Trial registrationThe study has received a favourable opinion from South Central—Hampshire B Research Ethics Committee; REC reference: 20/SC/0342. ISRCTN11366562.

Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study.

Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). This study is part of an array of pilots within a European Union funded project, entitled "GATEKEEPER," conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. PRR1-10.2196/52957.

The safety, quality evaluation, and lot release of COVID-19 vaccines imported and used in Nigeria from march 2021 to march 2022

Coronavirus disease (COVID-19) caused by the Severe Acute Respiratory Syndrome Corona 2 Virus (SARS-COV-2 Virus) was a major global health crisis that resulted in severe illness and death around the globe. The swift development of effective vaccines against the disease to mitigate severe illness and death was one of the greatest public health scientific achievements. Most of these vaccines required cold storage and were exported to many developing countries with resource limitations to verify the quality of these products. The National Agency for Food and Drug Administration and Control (NAFDAC) regulates the quality of vaccines imported into Nigeria. This study provides summaries of data collected and QC measures conducted on all the COVID-19 vaccines imported into Nigeria within 2021–2022. Cold-chain parameters and other data requirements for meeting international standards for assessing the quality of vaccines were conducted in ISO17025-accredited laboratories of the Nigerian FDA. QC tests used to assess the safety of the products included tests for sterility, bacterial endotoxin, abnormal toxicity, pH, Physical appearance, extractable volumes, protein tests, and DNA: protein ratios. The products yielded satisfactory compliance, however, there were unsatisfactory sterility and protein test results for two batches of the samples tested. There are additional non-QC regulatory measures employed by NAFDAC to ensure the safety of the COVID-19 vaccines, including supply chain management. Out of ninety-five batches of different COVID-19 vaccines evaluated, 95.5% passed sterility testing. There is a 100% pass of all the vaccines for the Bacteria Endotoxin Test while an 80% pass was observed for the protein content.

The impact of incorporating waste materials on the mechanical and physical characteristics of tile adhesive materials

Abstract The goal of the investigation is to produce a cement mortar for building units and a high-performance ceramic tile adhesive by using V autoclaved aerated concrete as a partial substitute for cement. The combination consists of sand, crushed limestone, and polymeric additives. The experimental procedures were conducted utilizing contemporary laboratory equipment to facilitate the manufacturing of the product and the subsequent investigation of its characteristics, in accordance with the standards outlined in EN12004 and ASTM C1660. The laboratory tests carried out, which included splitting tensile strength, bonding strength, and open application duration, have demonstrated conformity to the product standards. The raw materials undergo many examinations prior to their utilization in the preparation process. The conducted tests encompassed chemical analysis, X-ray diffraction, and viscosity evaluation. These experiments aimed to ascertain the mixing ratios and determine the optimal quantity of water required for the preparation procedure. A thickness of 3 mm was employed, rendering it very cost-effective and environmentally sustainable due to the utilization of recycled resources. This particular adhesive possesses supplementary characteristics, such as its self-sufficiency on the site, since it is readily used without the need for extra materials, requiring only the addition of the necessary amount of water. Extensive research has been conducted on a range of mix designs and particle sizes for raw materials, together with varying proportions of additives, to determine the optimal ratio that satisfies both criteria and cost considerations. The adhesion strength of the building units was determined to be 7 N/mm2, surpassing the specified value in ASTM C1660. This indicates that the material is deemed successful and meets the required specifications for its application as a mortar for building units, as per the standard stating that an adhesion strength test exceeding 5 N/mm2 is necessary. The evaluation of the characteristics of the material employed as tile adhesive mortar was conducted in accordance with the EN1348 standard, revealing satisfactory compliance with all specified criteria. The application duration of the tile adhesive exceeds 25 min, while its tensile strength surpasses 10 N/mm2, thereby meeting the criteria for classification as a Class A tile adhesive.

Pseudomyopia treated with auricular point sticking combined with periocular needle-embedding therapy and prevention of true myopia: a multicenter randomized controlled trial.

To observe the clinical effect and safety of auricular point sticking combined with periocular needle-embedding therapy for pseudomyopia and prevention of true myopia. A total of 269 children with pseudomyopia were randomized into an observation group (134 cases, 2 cases dropped out) and a control group (135 cases, 5 cases dropped out). In the control group, the healthy education was provided. In the observation group, besides the intervention as the control group, the auricular point sticking was delivered at gan (CO12), pi (CO13), xin (CO15) and yan (LO5) on one ear in each treatment, combined with periocular needle-embedding technique at bilateral Cuanzhu (BL 2), Yuyao (EX-HN 4) and Sibai (ST 2). There were 2 weeks of interval after 4 weeks of treatment. One course of treatment was composed of 6 weeks and 2 courses were required. Separately, before treatment, after 6 and 12 weeks of treatment, and after 12 weeks (the 1st follow-up visit) and 24 weeks (the 2nd follow-up visit) of treatment completion, the spherical equivalent (SE), SE progression, axial length (AL) progression, accommodative amplitude (AMP), the score of the TCM symptom and the general symptom were observed in the two groups. The safety and compliance were evaluated in the two groups. After 6 and 12 weeks of treatment, and in the 1st and 2nd follow-up visits, SE increased when compared with that before treatment in the two groups (P<0.05), and AMP was larger than that before treatment in the observation group (P<0.05). After 12 weeks of treatment, and in the 1st and 2nd follow-up visits, the progression of SE was slower in the observation group compared with that in the control group (P<0.01, P<0.001). After 6 and 12 weeks of treatment, and in the 1st and 2nd follow-up visits, the progression of AL in the observation group was lower than that of the control group (P<0.05, P<0.01, P<0.001); and in the 1st and 2nd follow-up visits, AMP of the observation group was larger when compared with that in the control group (P<0.05, P<0.001). After 6 and 12 weeks of treatment, and in the 1st and 2nd follow-up visits, the total scores of TCM symptom and general symptom were reduced in comparison with those before treatment in the observation group (P<0.05); after 6 and 12 weeks of treatment, the total scores of TCM symptom and general symptom were lower than those before treatment in the control group (P<0.05). In the 1st and 2nd follow-up visits, the difference of the total score of TCM symptom and general symptom in the observation group was larger than that of the control group (P<0.05). In the observation group, compared with the control group, the scores for pale/dark complexion in the 1st and 2nd follow-up visits and that for lassitude in the 2nd follow-up visit were lower (P<0.05), the score for poor concentration after 12 weeks of treatment and that for poor sleep and memory in the 2nd follow-up visit were lower (P<0.05). There were no adverse reactions in the two groups. The compliance was 98.5% in the observation group and was 96.3% in the control group, without statistical difference (P>0.05). On the basis of health education, auricular point sticking combined with periocular needle-embedding therapy can effectively prevent from true myopia, control the increase of SE, delay the growth of AL and improve AMP in children with pseudomyopia. This compound therapeutic regimen can relieve the general symptom and comprehensively prevent from myopia through multiple approaches, with high safety and satisfactory compliance.

Dual diagnosis of bipolar disorder and substance use disorder – type of substance used and its impact on treatment adherence and maintenance of abstinence

IntroductionSubstance use disorder is a common comorbidity with bipolar disorder, delaying its diagnosis and making treatment of both disorders more complex and challenging.ObjectivesWe aim to analyze the types of substances used by patients with bipolar disorder and to find if there’s a relationship between the substance used both with treatment adherence and maintenance of abstinence.MethodsWe collected, retrospectively, data from the hospital platform and analyzed it on SPSS Statistics 26, along with a literature review. Our study looks over 3 years, and all patients analyzed have a dual diagnosis of both bipolar disorder and substance use disorder and were hospitalized in the psychiatric ward of a tertiary university hospital.Results There were 2384 hospitalizations in the Coimbra’s University Hospital psychiatric ward, and 88 hospitalizations were coded with a dual diagnosis of bipolar disorder and substance use disorder.Tobacco was the substance more consumed by the patients (53.4%), followed by alcohol (46.6%) and cannabinoids (30.7%). In 18.2% of the patients was identified consumption of cocaine and in 6.8% there was an abuse of opioids. It is important to highlight that 20.5% of the patients used 2 or more substances at the same time.Regarding adherence to treatment for both their bipolar disorder and substance use disorder, in 25% of the patients, there wasn’t a satisfactory compliance with the treatment prescribed.In the group of patients with polydrug use, half of them didn’t comply with the treatment. In the patients consuming only one substance, we found out that 30% of patients who use alcohol didn’t adhere to the treatment, while around 13% of the patients using cannabinoids didn’t comply with the suggested treatment.The relationship between the type of substance used and treatment adherence was statistically significant with a p=0.004 (considering p&lt;0.05).Regarding abstinence from consumption, around 42% of the patients keep using at least one substance. In the group with polydrug use, around 65% of the patients were not abstinent in the last appointments, while in the cannabinoids users’ group around 50% of them were still using the drug. In the group with patients using alcohol, around 43% of them are not abstinent.The relationship between the type of substance used and maintenance of abstinence was found to be statistically significant with a p=0.037 (considering p&lt;0.05).ConclusionsSubstance use disorder can have a huge impact on adherence to treatment, worsening the prognosis of the comorbid bipolar disorder. On the other hand, this dual diagnosis can impact the maintenance of abstinence.Early detection of both diagnosis and simultaneous treatment from an early phase are essential to improve the prognosis of both diseases.Disclosure of InterestNone Declared

Using the DIC Technique in Damage Detection for a Cantilevered Composite Beam

The subject of the article is the use of the Digital Image Correlation (DIC) technique in tests of damage detection in a composite cantilevered beam. Laboratory tests of the beam were conducted using the Q-400 system from Dantec Dynamics GmbH. The research aimed to study the behaviour of the structure under external forces and to analyse the influence of cross-section damage on the displacement field of the beam. The analysed quantities were also the changes in strain fields of the structure. For the laboratory model, the finite element models were prepared, and satisfactory compliance in terms of displacement fields between numerical and laboratory models for undamaged structure was obtained. The research has shown, that it is possible to indicate the approximate location of damage based on the information about changes in the displacement field.

Efficacy of daily versus intermittent low glycemic index therapy diet in children with drug-resistant epilepsy: A randomized controlled trial

IntroductionThe predominant reason for the discontinuation of low glycemic index therapy (LGIT) in children with epilepsy is the dietary restrictions imposed therein. This trial intended to compare the efficacy of daily and intermittent LGIT in children with drug-resistant epilepsy (DRE). MethodsThis study was performed between February 2018 and January 2019 to compare the efficacy of daily and intermittent LGIT in children aged 1–15 years with DRE following 24 weeks of dietary therapy. Compliance, the difficulty faced by caregivers, adverse effects, impact on behaviour, and social quotient in both arms were compared. Children in the intermittent LGIT arm received a liberalized diet for two days every week (Saturday and Sunday), which also allowed medium glycemic index foods. Carbohydrate calories were allowed up to 20% of the total caloric requirement in the liberalized diet, as compared to only 10% in standard LGIT. ResultsOut of 132 children randomized (66 in each group), 122 completed 24 weeks follow up. Mean weekly seizure frequency reduction at 24 weeks in the intermittent LGIT group was comparable with that of the daily LGIT group in both intention-to-treat (ITT) and per-protocol analysis (−50.95%± 22.34% vs −47.16%± 23.41%, p=0.36 in ITT and −53.88%±20.54% vs −49.20%±21.87%, p=0.23) in per-protocol analysis for intermittent and daily LGIT group respectively). The proportion with ≥50% reduction in seizure frequency was also comparable between both groups (p=0.73 and 0.56 in ITT and per protocol analysis respectively). The proportion of patients with adverse events and satisfactory compliance rate also had a trend towards favoring intermittent LGIT (p=0.06 and 0.51, respectively), while caregiver difficulty was lower with intermittent LGIT (p=0.001). ConclusionsIntermittent LGIT is comparable to daily LGIT in terms of seizure frequency reduction after 24 weeks of dietary therapy. Trial registrationClinicalTrials.gov (Registration number- NCT03464487, https://clinicaltrials.gov/ct2/show/NCT03464487).

“Miliary lung parenchymal opacities” as presenting feature of metastatic papillary type of thyroid malignancy: It’s not tuberculosis always!

Pulmonary tuberculosis (TB) is the most common cause of mortality and morbidity in South East Asia due to infective causes and tops the list of all infectious etiologies in India. Radiological presentations in pulmonary TB are diverse with the most common in them, which are nodules, consolidation, cavitation, and lung parenchymal destruction with or without collapse and consolidation. In this case report, a 31-year-old female presented with constitutional symptoms with miliary opacities in chest X-ray without microbiological evidence for TB in smear microscopy or nucleic acid amplification tests. She was treated as a case of miliary TB with antituberculosis treatment (ATT) on two occasions in the past 2 years as an “X-ray-positive case” on the basis of symptoms and chest radiology findings. She was never shown any clinical and radiological response in the past 1½ years in spite of satisfactory ATT adherence and compliance. After retrospective analysis of this case at our center, we have documented worsening of radiological findings and chest high-resolution computed tomography conformed miliary nodules and not typical miliary mottling favoring TB. We have noted right thyroid enlargement with a nodule in contrast tomography of neck. Fine-needle aspiration cytology confirmed as papillary carcinoma of the thyroid. We have confirmed this case as miliary metastasis due to primary thyroid malignancy. Miliary metastasis should be considered in cases with atypical radiological and clinical presentations with negative microbiological workup. No empirical ATT should be offered in the era of highly sensitive nucleic acid amplification tests and the term “X-ray-positive with negative microbiological tests” should be phased out.

Tailored therapy guided by genotypic resistance of clarithromycin and levofloxacin detected by polymerase chain reaction in the first-line treatment of Helicobacter pylori infection.

We aimed to explore the efficacy and safety of tailored therapy guided by genotypic resistance in the first-line treatment of Helicobacter pylori (H. pylori) infection in treatment-naive patients. Gastric mucosal specimens were taken during gastroscopy, and main mutations of clarithromycin- and levofloxacin-resistant genes were detected by polymerase chain reaction (PCR). Sensitive antibiotics were selected individually for treating H. pylori infection with tailored bismuth-containing quadruple therapy (BQT) consisting of esomeprazole 20 mg twice daily, bismuth potassium citrate 220 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily, or levofloxacin 500 mg once daily, or metronidazole 400 mg four times daily. Safety and patient compliance were assessed 1-3 days after eradication. Treatment outcome was evaluated by urea breath test 4-8 weeks after eradication. One hundred and thirty-two treatment-naive patients with H. pylori infection were included. PCR results suggested resistance rates of 47.7% and 34.9% for clarithromycin and levofloxacin, respectively, and a dual resistance rate of 18.2%. Eradication rates of tailored BQT were 87.1% and 95.8% by intention-to-treat (ITT) analysis and per-protocol (PP) analysis, respectively. There was no statistically significant difference in the efficacy of 7-day clarithromycin-containing, 7-day levofloxacin-containing, and 14-day full-dose metronidazole-containing BQT (ITT analysis: P = 0.488; PP analysis: P = 0.833). The incidence of adverse events was 19.7%, and patient compliance was 97.7%. Tailored BQT guided by genotypic resistance can achieve satisfactory efficacy, safety, and patient compliance in the first-line treatment of H. pylori infection.

Food safety training influence on food service workers’ knowledge and compliance to Malaysia Food Hygiene Regulations 2009

This study was conducted to evaluate the influence of food safety training on the knowledge and compliance of food service workers with Malaysia Food Hygiene Regulations 2009 in Cyberjaya, Selangor, Malaysia. Data were collected from 261 food service workers (108 casual dining restaurant owners and 153 food handlers) through a survey by means of a questionnaire which consisted of questions on business and premises profiles, history of premises inspection and knowledge of food hygiene aspects as outlined in the Malaysia Food Hygiene Regulations 2009. The results showed that there was a significant positive association (p&lt;0.05) between attending food safety training and the level of respondents’ knowledge of Malaysia Food Hygiene Regulations 2009. There was a significant positive association (p&lt;0.05) between respondents’ knowledge and the level of compliance with Malaysia Food Hygiene Regulations 2009 with different food safety training providers. There was also a significant positive association (p&lt;0.05) between respondents’ knowledge and the level of compliance with Malaysia Food Hygiene Regulations 2009 with food safety training sources. In conclusion, over half of the food service workers showed satisfactory food safety knowledge and compliance with Malaysia Food Hygiene Regulations 2009. This study found that there was a significant relationship (p&lt;0.05) between food service workers’ knowledge and compliance with Malaysia Food Hygiene Regulations 2009. A significant relationship (p&lt;0.05) was also found in knowledge and level of compliance with all food safety training factors (food safety training attendance, food safety training providers and food safety training sources) in the Malaysia Food Hygiene Regulations 2009. Hence, hypotheses H1, H2 (H2a, H2b, H2c) were accepted. It is suggested that in related future research, data are collected from a larger sample size and at different locations to gain more comprehensive outcomes.

Adherence to the Clinical Practice Guidelines for the hospital management of patients with decompensated heart failure in a Coronary Care Unit in Colombia

To assess adherence to the recommendations for the diagnosis and management of hospitalized patients with Decompensated Heart Failure issued by the European Society of Cardiology in 2021 at a Coronary Care Unit at a fourth-level hospital in the city of Bogotá. A descriptive cross-sectional study was conducted, including hospitalized patients in the Coronary Care Unit at Hospital San José in Bogotá, with a primary diagnosis of Decompensated Heart Failure, from September 2021 to January 2023. Patient data were collected from medical records. Adherence to the Decompensated Heart Failure guidelines was described in the study. High adherence was observed for laboratory tests and medication prescriptions recommended by the 2021 European Society of Cardiology guidelines. However, there was low adherence to the request for thyroid function tests, troponin, and iron studies. The cause of heart failure and decompensation was adequately recorded. The most common cause of decompensation was acute coronary syndrome. Regarding the hemodynamic profile on admission, the majority presented as Stevenson B. Pharmacological adherence to Class I recommendations showed high compliance in prescribing beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and Angiotensin Receptor-Neprilysin Inhibitors. However, lower adherence was observed for Sodium-glucose co-transporter two inhibitors and Mineralocorticoid receptor antagonists. Variable adherence rates were recorded, emphasizing satisfactory compliance with class I recommendations for certain medications and laboratory tests. It is necessary to improve adherence in the request for paraclinicals, especially in thyroid function tests and ferrokinetic profiles.