Response Score Research Articles

Evaluating the Healthcare System Responsiveness for COVID-19 Care in Southeast Iran

Background: Health system responsiveness is critical in managing infectious disease epidemics. Objectives: The purpose of this study was to evaluate the responsiveness of the health system during the Coronavirus disease 2019 (COVID-19) pandemic. Methods: A cross-sectional study was conducted among 350 patients who had been discharged from hospitals after recovering from COVID-19 during 2021 - 2022 in Sistan-Baluchistan province, located in the southeastern region of Iran. Data were collected using the World Health Organization health system responsiveness tool through telephone interviews. Descriptive statistics methods were used to determine the responsiveness score. T-tests and one-way analysis of variance were also used to compare the means between groups. Results: The overall score for health system responsiveness was 110.12 ± 13.12, indicating a moderate level of responsiveness. The communication dimension received the highest mean score (30.12 ± 4.73), while the choice of provider dimension had the lowest mean score (5.65 ± 2.37). Significant relationships were found between health system responsiveness and variables such as place of residence (P = 0.01), city of residence (P = 0.001), and household size (P = 0.05). Conclusions: The study identified areas for improvement in health system responsiveness within Sistan-Baluchistan's hospitals during the COVID-19 pandemic. To enhance patient care and strengthen the healthcare system's responsiveness, health policymakers should implement measures such as developing responsiveness guidelines, establishing a dedicated responsiveness unit, and providing training programs for healthcare professionals. Regular evaluation of responsiveness in hospitals is also crucial.

Pharmacological Activation and Transgenic Overexpression of SIRT1 Attenuate Traumatic Optic Neuropathy Induced by Blunt Head Impact.

Resveratrol (RSV) is a nutraceutical compound known for its therapeutic potential in neurodegenerative and metabolic diseases. RSV promotes survival signals in retinal ganglion cells (RGCs) through activation of SIRT1, an NAD+-dependent deacetylase. RSV and SIRT1 reduce RGC loss induced by direct optic nerve injury, but effects in indirect models of traumatic optic neuropathy remain unknown and are examined in this study. An electromagnetic stereotaxic impactor device was used to impart five traumatic skull impacts with an inter-concussion interval of 48 hours to wild type (WT) and SIRT1 knock in (KI) C57BL/6J mice overexpressing the SIRT1 gene. A cohort of WT mice also received intranasal administration of RSV (16mg/kg) throughout the experimental period. Loss of righting reflex (RR), optokinetic response (OKR) scores, and immunolabeled RGC count are determined to assess optic neuropathy in this model of traumatic brain injury (TBI). TBI significantly decreases RGC survival and decreases OKR scores compared with control uninjured mice. Either RSV administration in WT mice, or SIRT1 overexpression in SIRT1 KI mice, significantly increases RGC survival and improves OKR scores. RR time increases after the first few impacts in all groups of mice subjected to TBI, demonstrating that RSV and SIRT1 overexpression are able to attenuate optic neuropathy following similar degrees of TBI. Intranasal RSV is effective in preserving visual function in WT mice following TBI. Constitutive overexpression of SIRT1 recapitulates the neuroprotective effect of RSV. Results support future exploration of RSV as a potential therapy for indirect traumatic optic neuropathy.

Consumers' familiarity with wine increased their acceptance of pasta sauce containing grape pomace.

Grape pomace (GP) is a waste product of the winemaking process and has been proposed as a nutritionally beneficial ingredient, as it contains phenolic compounds, dietary fiber, and antioxidant activity. It can be a polarizing ingredient due to its flavor components. Familiarity has been found to influence consumers' preferences and sensory perception of food. A sensory test was conducted to evaluate the acceptance, sensory perception, and emotional response to pasta sauces containing GP (3% [3GP], 6% [6GP], 9% [9GP] by volume and control without GP addition). The sensory trials included wine consumers (n=44) and nonconsumers of wine (n=58) to determine how consumers' familiarity with the flavor properties of GP influenced their perception of the pasta sauce. Overall, the addition of GP decreased the liking scores of the GP-containing sauces, but the wine consumers' hedonic scores for the control, 3GP, and 9GP were significantly higher than the nonconsumers. Both consumer groups identified that the samples with a higher amount of GP addition were associated with sour, bitter, astringency, grainy, and gritty attributes. However, the wine consumers used more positive emotions to describe their emotional response to the GP-containing samples. The study identified that GP led to off-flavors and textures in the pasta sauces. PRACTICAL APPLICATION: GP is currently a waste product, but it has many nutritional benefits. Consumers are increasingly looking for nutritional benefits from their food. When incorporated into pasta sauces, GP decreased the acceptance of the pasta sauce and negatively impacted the flavor and texture. Familiarity has been found to impact consumer acceptance, and wine consumers had a more positive emotional response and higher hedonic scores in response to the GP-containing pasta sauce than nonconsumers of wine.

Enterprise risk management implementation challenges in medical laboratories in Harare, Zimbabwe.

Medical laboratories play crucial roles in healthcare, and effective enterprise risk management (ERM) is necessary to ensure business continuity, patient safety, and quality of care. In medical laboratories, ERM is important for enhancing patient safety, regulatory compliance and accreditation, quality management, business continuity, and cyber security. By following ERM principles and approaches, the medical laboratories can proactively manage their risks, improve patient safety, and maintain a high level of quality and reliability of outcomes. However, implementing ERM in medical laboratories faces unique challenges. This study explored the specific challenges and offers practical solutions for overcoming them to ensure successful ERM implementation in Harare, Zimbabwe. A cross-sectional survey was done through 41 self-administered questionnaires and interviews with medical laboratory staff from the six main medical laboratories in Harare. Data were analyzed using the Statistical Package for Social Sciences version 22. Quantitative data were analyzed using descriptive statistics such as frequencies and percentages. Qualitative data were analyzed using mean scores of Likert scale responses. The main challenges identified in the study included increased workload, staffing, organizational structures, timeliness of information, inadequate information technology support, and insufficient financial support in ERM. These can be addressed by portfolio management of risks, leveraging on cutting edge technology, restructuring to ensure swift responses to issues and redistributing staff workload, and training personnel to avoid burnouts and ensure maximum efficiency. Implementing ERM in medical laboratories requires understanding and addressing these challenges. By following the ERM principles and approaches the medical laboratories can proactively manage their risks, improve patient safety and maintain a high level of quality and reliability of outcomes ERM is still a new approach in the sector and needs further research.

Evaluación de la fiabilidad y legibilidad de las respuestas de los chatbots como recurso de información al paciente para las exploraciones PET-TC más communes

PurposeThis study aimed to evaluate the reliability and readability of responses generated by two popular AI-chatbots, ‘ChatGPT-4.0’ and ‘Google Gemini’, to potential patient questions about PET/CT scans. Materials and methodsThirty potential questions for each of [18F]FDG and [68Ga]Ga-DOTA-SSTR PET/CT, and twenty-nine potential questions for [68Ga]Ga-PSMA PET/CT were asked separately to ChatGPT-4 and Gemini in May 2024. The responses were evaluated for reliability and readability using the modified DISCERN (mDISCERN) scale, Flesch Reading Ease (FRE), Gunning Fog Index (GFI), and Flesch-Kincaid Reading Grade Level (FKRGL). The inter-rater reliability of mDISCERN scores provided by three raters (ChatGPT-4, Gemini, and a nuclear medicine physician) for the responses was assessed. ResultsThe median [min-max] mDISCERN scores reviewed by the physician for responses about FDG, PSMA and DOTA PET/CT scans were 3.5 [2–4], 3 [3–4], 3 [3–4] for ChatPT-4 and 4 [2–5], 4 [2–5], 3.5 [3–5] for Gemini, respectively. The mDISCERN scores assessed using ChatGPT-4 for answers about FDG, PSMA, and DOTA-SSTR PET/CT scans were 3.5 [3–5], 3 [3–4], 3 [2–3] for ChatGPT-4, and 4 [3–5], 4 [3–5], 4 [3–5] for Gemini, respectively. The mDISCERN scores evaluated using Gemini for responses FDG, PSMA, and DOTA-SSTR PET/CTs were 3 [2–4], 2 [2–4], 3 [2–4] for ChatGPT-4, and 3 [2–5], 3 [1–5], 3 [2–5] for Gemini, respectively. The inter-rater reliability correlation coefficient of mDISCERN scores for ChatGPT-4 responses about FDG, PSMA, and DOTA-SSTR PET/CT scans were 0.629 (95% CI = 0,32−0,812), 0.707 (95% CI = 0.458−0.853) and 0.738 (95% CI = 0.519−0.866), respectively (p < 0.001). The correlation coefficient of mDISCERN scores for Gemini responses about FDG, PSMA, and DOTA-SSTR PET/CT scans were 0.824 (95% CI = 0.677−0.910), 0.881 (95% CI = 0.78−0.94) and 0.847 (95% CI = 0.719−0.922), respectively (p < 0.001). The mDISCERN scores assessed by ChatGPT-4, Gemini, and the physician showed that the chatbots' responses about all PET/CT scans had moderate to good statistical agreement according to the inter-rater reliability correlation coefficient (p < 0,001). There was a statistically significant difference in all readability scores (FKRGL, GFI, and FRE) of ChatGPT-4 and Gemini responses about PET/CT scans (p < 0,001). Gemini responses were shorter and had better readability scores than ChatGPT-4 responses. ConclusionThere was an acceptable level of agreement between raters for the mDISCERN score, indicating agreement with the overall reliability of the responses. However, the information provided by AI-chatbots cannot be easily read by the public.

1943P Updated pan-tumor guidelines for neoadjuvant scoring of pathologic response: A joint SITC and INMC effort

1943P Updated pan-tumor guidelines for neoadjuvant scoring of pathologic response: A joint SITC and INMC effort

775P Association between chemotherapy response score (CRS) and tumour homologous recombination deficiency (tHRD) in women with newly diagnosed FIGO stage IIIC/IV high-grade serous ovarian cancer (HGSOC)

775P Association between chemotherapy response score (CRS) and tumour homologous recombination deficiency (tHRD) in women with newly diagnosed FIGO stage IIIC/IV high-grade serous ovarian cancer (HGSOC)

Evaluation of the Nutritional Knowledge in Relation to Secondary Prevention Among Doctors and Nurses in the Northern of Morocco: A Cross-Sectional Study.

Morocco is a country that has been experiencing an epidemiological and health transition characterized by a change in lifestyle and an increase in mortality for non-communicable diseases (NCDs). The objective of this study is to evaluate the nutritional knowledge in relation to secondary prevention of doctors and nurses working in the hospitaland primary healthcare centersin Morocco.Specific knowledge about nutrition for diabetes, for high blood pressure and high cholesterol, for functional colopathy, for iron deficiency anemia, for vitamin B12 deficiency, for overweight and for hyperuricemia or gout attack were evaluated. Cross-sectional exploratory study carried out between June and December 2022, using a self-administered questionnaire developed on the basis of similar studies and the several standardized nutrition guides. A random cluster survey included 238 nurses and 131 doctors working in health centers and 234 nurses and 54 doctors working in hospitals. Statistical analyses were carried out using SPSS version 21.0 software, the Kolmogorov-Smirnov test, the Mann Whitney test, and Spearmen's correlation. Multiple linear regression analysis was used to explore the most significant sociodemographic variables. Among the seven nutritional content areas assessed in this study, we found that among doctors, the nutrition axis for high blood pressure and high cholesterol had the median correct response score of (0.57 interquartile range (IQR) (0.28, 0.71)). The same for nurse, but with the lower scores ((0.28 IQR (0, 0.43)) , (0.28 IQR (0.07, 0.42)) respectively). Our results do not reveal any statistically significant association of the median of total score of answers of both health professionals (nurses or of doctors) with their gender (p=0.383). However, they were significantly associated with basic training (p<0.001), continuous training (p=0.002), receiving information on nutrition (p=0.018), and their age (p=0.016). In conclusion, this study highlighted the major gaps in the nutritional knowledge of doctors and nurses regarding secondary prevention of NCDs. However, they should undergo continuing nutrition education programs to ensure safe and sound nutritional advice not only to patients but also to the public.Furthermore, policymakers should devote systematic efforts to nutrition education during basic training in medical and nursing schools, which will provide doctors and nurses with adequate training.

Thematic and sentiment analysis of replies to depression help seeking related posts on Sina Weibo

Depression is the most prevalent mental disorder globally, but traditional sources of depression help seeking such as psychiatry are laced with social stigma, resulting in a low worldwide depression professional help seeking rate. In recent years, many with depression have turned to the internet and specifically to social media as an alternative medium to seek help for depression, but the effects of online help have been discovered to be ambiguous. The present study aimed to investigate how depression help seeking related posts are responded to on Chinese social media in terms of two dimensions: themes and sentiments. Employing machine learning statistical techniques including topic modeling and sentiment analysis, this paper assessed the themes and sentiments within 8027 responses to 648 depression help seeking related posts created between October 1, 2018 and June 30, 2024. Topic modeling results reported that four prevalent themes underlie replies to depression help seeking related posts: Sad emotional support, Empathizing, Advising professional help, and Sharing. These prevalent themes all reflected supportive attitudes towards depression help seeking related posts through diverse ways. Sentiment analysis, on the other hand, revealed that still, 18.34% of responses held negative sentiments toward depression help seeking related posts. However, the prevalent sentiment in responses was also discovered to be positive, in line with the results of topic modeling. 78.04% of replies were found to hold positive sentiment, 3.63% of replies were found to hold neutral sentiment, and the mean sentiment score of responses was also positive. The findings of the present study provide insight into how depression help seeking is reacted to in Chinas social media landscape, indicating possible factors that may hinder the effects of seeking help for depression on social media and suggesting the potential need for systems to foster a more supportive online environment towards depression help seeking on Chinese social media.

A comparative study of Appendicitis inflammatory response (AIR) score with Alvarado score in diagnosis of acute appendicitis at KCMC Hospital

Background: Acute appendicitis is an acute inflammation of the appendix, most resulted from obstruction of the lumen of the appendix. It is one of the most common causes of acute abdomen. Although a very common and long-known phenomenon, appendicitis remains a diagnostic challenge for most surgeons. Objective: To compare the validity of Appendicitis Inflammatory Response Score with Alvarado score in diagnosis of acute appendicitis at KCMC Hospital. Methods: A prospective hospital based cross sectional study done over a period of six months (September 2016 to March 2017). Patients were admitted to general surgical ward after the diagnosis of acute appendicitis reached and all parameters included in the AIR score and Alvarado score were prospectively recorded on patients presenting symptoms of acute appendicitis. All removed appendix specimens were sent for histopathological examination. Data was entered and analyzed using statistical package of social sciences version 20. Results: A total of 35 patients enrolled in this study, 57% male, male to female ratio 1.3:1, mean age of 27(14-49) years. 31 patients confirmed histologicaly to have features of acute appendicitis, among these inflamed appendicitis were 51.6%. And advanced appendicitis 48.4% and negative appendicectomy rate was 11.4%. The sensitivity and specificity of both AIR and Alvarado score were 54.4%, 77.4% and 75%, 75%. PPV and NPV were 94.4%, 96% and 17.6%, 30% respectively. Conclusion: From our study we have seen Alvarado score is a better assessment tool that is accurate helping in diagnosis of acute appendicitis. Its high sensitivity and ROC is greater than that of the AIR score. We conclude that AS has outperform AIR score in accuracy in diagnosis of AA.

The impact of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response: an action research study

IntroductionHospitals as the main providers of healthcare services play an essential role in the management of disasters and emergencies. Nurses are one of the important and influential elements in increasing the surge capacity of hospitals. Accordingly, the present study aimed to assess the effect of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response.MethodsAll nursing managers employed at Motahari Hospital in Tehran took part in this interventional pre- and post-test action research study. Ultimately, a total of 20 nursing managers were chosen through a census method and underwent training in hospital capacity fluctuations. The Iranian version of the “Hospital Emergency Response Checklist” was used to measure hospital disaster preparedness and response before and after the intervention.ResultsThe overall hospital disaster preparedness and response score was 184 (medium level) before the intervention and 216 (high level) after the intervention. The intervention was effective in improving the dimensions of hospital disaster preparedness, including “command and control”, “triage”, “human resources”, “communication”, “surge capacity”, “logistics and supply”, “safety and security”, and “recovery”, but had not much impact on the “continuity of essential services” component.ConclusionThe research demonstrated that enhancing the disaster preparedness of hospitals can be achieved by training nursing managers using an action research approach. Encouraging their active participation in identifying deficiencies, problems, and weaknesses related to surge capacity, and promoting the adoption and implementation of suitable strategies, can enhance overall hospital disaster preparedness.

Ocrelizumab alters the circulating metabolome in people with relapsing-remitting multiple sclerosis.

Circulating metabolite levels are altered in multiple sclerosis (MS) and are associated with MS severity. However, how metabolic profiles shift following highly efficacious therapies, like ocrelizumab remains unclear. Circulating metabolite levels are altered in multiple sclerosis (MS) and are associated with MS severity. However, how metabolic profiles shift following highly efficacious therapies, like ocrelizumab remains unclear. To assess changes in the circulating metabolome produced by ocrelizumab treatment in people with relapsing-remitting MS (RRMS). Thirty-one individuals with RRMS eligible for beginning treatment with ocrelizumab were recruited and followed with demographic, clinical, quality-of-life, and global metabolomics data collected at each visit. Modules of highly correlated metabolites were identified using the weighted correlation network analysis approach. Changes in each module's eigenmetabolite values and individual metabolites during the study were evaluated using linear mixed-effects models. Patients with a mean age of 40.8 (SD = 10.30) years, and median disease duration of 4.0 (IQR = 8.5) years, were monitored for a median of 3.36 (IQR = 1.43) years. Two out of twelve identified sets of metabolites were altered significantly. The first module mainly contained androgenic and pregnenolone steroids (p-value <0.001, coefficient: -0.10). The second module primarily consisted of several lysophospholipids, arachidonic acid, some endocannabinoids, and monohydroxy fatty acid metabolites (p-value = 0.016, coefficient: -0.12), which its reduction was significantly associated with improvement based on overall disability response score (OR 3.09e-01, 95% CI: 6.83e-02, 9.09e-01, p-value = 3.15E-02). In this longitudinal observational study, using a global untargeted metabolomics approach, we showed significant alteration in circulating metabolome in RRMS patients undergoing ocrelizumab treatment. In particular, we observed a significant reduction in metabolites involved in the lysophospholipid pathway, which was associated with patients' improvement.

Predictive factors of stress response of nursing student repeaters under the background of abolishing the final supplementary examination in China

BackgroundAcademic pressure and frustration stimulation are significant stressors in college students, and response to the prolonged stimuli would cause adverse mental and physical outcomes. However, more is needed to know about the stress response and its predictors among undergraduate nursing students retaking failed course under the background of the abolition of the Final Supplementary Examination in China. This study aimed to investigate the stress response and its predictive factors of nursing student repeaters who are retaking at least one failed course.MethodsA cross-sectional study was conducted, utilizing convenience sampling to recruit 120 nursing student repeaters from four 4-year undergraduate medical universities in China between September 2020 and May 2021. Data collection instruments included a general information questionnaire, a stress response questionnaire, the Connor-Davidson resilience scale, a self-control scale, and a academic self-efficacy questionnaire. The data were analyzed using descriptive statistics, Pearson correlation coefficients, t-tests, analysis of variance (ANOVA), and multiple linear regression.ResultsThe average scores of the total stress response, emotional response, physical response, and behavioral response were 58.07 ± 26.72, 86.97 ± 17.12, 57.69 ± 9.75, 67.16 ± 9.22, respectively. Stress response was predicted by psychological resilience, self-control ability, academic self-efficacy and the number of retaking courses.ConclusionsThe stress response among nursing student repeaters is relatively active. Higher psychological resilience, self-control ability, and academic self-efficacy predict lower levels of stress response. In order to help nursing students with failing and repeating course release their psychological stress and maintain well-being, nursing educators could adopt self-control promotion strategies and emphasize the cultivation of psychological resilience and academic self-efficacy as parts of health promotion programs for this particular student group.

Performance Under Fire: Older Adult Cognitive Risks and Protections Under Heat Strain.

Although extreme heat events disproportionately affect older adults and the importance of cognition is known, research examining older adult cognition under heat stress is limited. This study examines the relationship between risk/protective factors and heat strain on older adult cognition, employing a social-ecological model. Retrieved from the 1996-2016 waves of the Health and Retirement Study, our study used older adults aged 50 and older and their spouses residing in the United States. Individual-fixed effects models estimated changes in cognition as measured by fluid and crystallized intelligence scores in response to extreme heat days. This study further estimated interactions of extreme heat with protective/risk factors for cognition (i.e., education, physical activity, social engagement, and genetic risk for Alzheimer's disease). Our results demonstrated that extreme heat days were associated with fluid but not crystallized intelligence scores. Educational attainment, mild physical activity, and social contacts with children moderated this relationship. Furthermore, Alzheimer's disease polygenic scores moderated the correlation between extreme heat days and crystallized intelligence scores. An increasing frequency of extreme heat events and an aging population globally highlight the need for policies and interventions building resiliency in older adults. Actions promoting the protective modifiable behaviors to older adult cognition identified by our study can lead to healthier individuals and communities.

Alkaline phosphatase and liver fibrosis at diagnosis are associated with deep response to ursodeoxycholic acid in primary biliary cholangitis

ObjectivePrimary biliary cholangitis is a chronic and progressive autoimmune liver disease, whose prognosis can be improved by normalizing alkaline phosphatase and bilirubin. While ursodeoxycholic acid (UDCA) is first line standard of care, approximately 40 % of patients exhibit incomplete response. We aimed to identify prognostic markers for deep response to UDCA therapy at presentation. Patient and methodsData from the Brazilian Cholestasis Study Group cohort were analyzed retrospectively. Patients were assessed for deep response, defined as normal alkaline phosphatase and bilirubin, after 1 year of UDCA treatment. Additionally, the performance of the UDCA response score in predicting deep response was evaluated. ResultsA total of 297 patients were analyzed, with 57.2 % achieving an adequate response according to the Toronto criteria, while 22.9 % reached deep response. Cirrhosis (OR 0.460; 95 % CI 0.225–0.942; p = 0.034) and elevated baseline alkaline phosphatase levels (OR 0.629; 95 % CI 0.513–0.770; p < 0.001) were associated with reduced odds of deep response. The UDCA response score exhibited moderate discrimination power (AUROC = 0.769) but lacked calibration. ConclusionsBaseline ALP and liver fibrosis emerge as the most important prognostic factors to predict normalization of alkaline phosphatase and bilirubin after UDCA. The UDCA response score was inadequate for predicting deep response in the Brazilian PBC population.

Hydrogel dressings on neurotrophic keratitis in an experimental animal model.

To investigate the therapeutic effects of hydrogel dressings on neurotrophic keratitis in rats. Male Wistar rats, aged 42-56d, were randomly divided into control, experimental, and treatment groups, each consisting of five rats. The experimental and treatment groups underwent neurotrophic keratitis modeling in both eyes. After successful modeling, biomedical hydrogels formed with polyvinyl alcohol and polyvinyl pyrrolidone were used in treatment group for 7d. Ocular irritation response and keratitis index scores, Schirmer's test, tear film break-up time (BUT), sodium fluorescein staining, and hematoxylin and eosin (HE) staining were used to evaluate the effectiveness of the treatment. The neurotrophic keratitis model was successfully established in rats with severe ophthalmic nerve injury, characterized by keratitis, ocular irritation, reduced tear secretion measured by decreased BUT and Schirmer test values, corneal epithelial loss, and disorganized collagen fibers in the stromal layer. Following treatment with hydrogel dressings, significant improvements were observed in keratitis scores and ocular irritation symptoms in model eyes. Although the recovery of tear secretion, as measured by the Schirmer's test, did not show statistical differences, BUT was significantly prolonged. Fluorescein staining confirmed a reduction in the extent of corneal epithelial loss after treatment. HE staining revealed the restoration of the structural disorder in both the epithelial and stromal layers to a certain extent. Hydrogel dressing reduces ocular surface irritation, improves tear film stability, and promotes the repair and restoration of damaged epithelial cells by maintaining a moist and clean environment on the ocular surface in the rat model.

Early Cognitive Function after Deep Sedation Using Different Anesthetic Agents in Pediatric Patients: A Prospective, Randomized Controlled Trial.

Background and Objectives: The impact of anesthetic agents on memory and cognitive function following general anesthesia is of great interest, particularly regarding their effects on the developing pediatric brain. While numerous studies have examined the relationship between anesthetic drugs and brain function, research focusing on early cognitive function following sedation remains limited. Materials and Methods: This study was a prospective, randomized controlled trial involving 148 pediatric patients scheduled for hematological procedures, specifically bone marrow aspiration (BMA) and intrathecal chemotherapy (ITC). Patients were divided into two groups based on the primary anesthetic used: the inhalational sedation group (IHG), in which sevoflurane was used, and the intravenous sedation group (IVG), which received propofol infusion. Apart from the main anesthetic agent, all sedation methods were consistent across both groups. A cognitive function test administered before sedation involved memorizing four distinct images, each associated with a different number. Then, the patients were asked to identify the omitted image upon awakening in the recovery room. Herein, this pre- vs. post-sedation test is called the early recognition assessment (ERA) tool. The primary outcome was the correct response rate after sedation for the two groups. Secondary outcomes included the sedation score, the behavior response score, and the correct response rates according to the number of sedation procedures. Results: This study included 130 patients in the final analysis, with 74 originally assigned to each group. The initial cognitive assessment revealed no significant difference in performance between the anesthetic agents. In addition, no differences were observed in the rates of correct responses or post-sedation scores after repeated procedures. However, the IVG demonstrated higher behavior response scores compared to the IHG. Conclusions: There were no significant differences in the rates of correct responses using the ERA tool between the two groups, irrespective of the number of sedation procedures performed. While some differences were noted in preoperative, intraoperative, and post-anesthesia care, these did not significantly impact the cognitive outcomes measured.

Australian adaptation and external validation of Commissioning for Quality in Rheumatoid Arthritis-RA-Patient Reported Experience Measure (CQRA-RA-PREM).

To evaluate the reliability and validity of an adapted Commissioning for Quality in Rheumatoid Arthritis-RA-Patient-Reported Experience Measure (CQRA-RA-PREM) for assessing care experience in an Australian rheumatology outpatient cohort. Individual patient interviews were performed to check the language and completion time of the CQRA-RA-PREM before modification. Australian Rheumatology Association Database (ARAD) participants completed the CQRA-PREM-Australian version (CQRA-PREM-AU) (22 items, 5 domains), disease activity measure (RAPID-3, BASDAI) and Assessment of Quality of Life (AQOL-6D) index. Exploratory factor analysis (EFA) assessed item correlation. Cronbach's α assessed internal consistency. Individual patient interviews (n = 8, 62% male, mean age 50 years, mean disease duration 4.5 years) informed CQRA-RA-PREM modification. The ARAD survey response rate was 707/1124 (63%); 459 (65%) RA, 134 (19%) PsA, 114 (16%) AS; 67% female, mean age 62 years, mean disease duration 22 years. The median instrument completion time was 299 s (interquartile range 284-414). Scoring of responses allowed an averaged overall score. EFA extracted five factors: all items loading similarly onto factor 1, indicating validity of the overall score. The CQRA-PREM-AU score correlated with the AQOL-6D score (ρ = 0.23, P < 0.01); partial correlation with disease activity was not significant (ρ = 0.03, P = 0.45), indicating divergent validity. Reliability was comparable across disease subgroups (Cronbach's α >0.94). The mean overall score did not differ by disease subgroup [4.1 (s.d. 0.6, P = 0.73) and there was no floor/ceiling effect. CQRA-PREM-AU is a valid and reliable instrument to measure self-reported care experience in Australian rheumatology patients and may be interpreted as an average overall numerical score.

Mental health training for physicians supervising resident physicians: a cluster randomised controlled trial.

To evaluate an online training program for physician supervisors with the aim of promoting a mentally healthy workplace by improving their use of both responsive and preventive mental health support strategies. Cluster randomised, waitlist-controlled trial. Royal Australasian College of Physicians fellows who were supervising at least one resident physician in any of the 31 primary health networks in Australia and 20 district health boards in New Zealand (health network clusters). A brief online skills-based mental health training program, comprising twelve modules grouped into three topics: common mental illnesses; helping trainees you are concerned about (responsive strategies); and minimising mental health risks at work (preventive strategies). Change between baseline and the 3-month assessment in self-reported recommended supervisor behaviours; differences between intervention and control groups in recommended behaviour scores three weeks, three months, and six months after the program. Ninety physicians from 20 health network clusters were allocated to the intervention group, 88 physicians from 22 clusters to the control group. Intervention group participants reported greater positive change in behaviour across the study period than those in the control group (mixed model repeated measures analysis, group × time interaction: P < 0.001). The mean change in self-reported supervisory behaviour score was higher for the intervention than the control group at the 3-week (mean difference in score, 1.6; 95% confidence interval [CI], 0.8-2.4), 3-month (0.9; 95% CI, 0.2-1.6), and 6-month assessments (1.9; 95% CI, 1.1-2.7). The mean change in self-reported responsive behaviour score was also greater for the intervention group at the 3-week (mean difference, 2.3; 95% CI, 1.5-3.1), 3-month (1.0; 95% CI, 0.2-1.9), and 6-month assessments (2.0; 95% CI, 1.1-2.9); differences in the mean change in preventive behaviour scores were statistically significant at the 3-week (mean difference, 1.1; 95% CI, 0.1-2.2) and 6-month assessments (1.8; 95% CI, 0.8-2.8), but not the 3-month assessment (0.8; 95% CI, -0.1 to 1.7). Brief online mental health training for senior physicians can lead to changes in their self-reported behaviour for supporting the mental health needs of resident physicians. Whether this leads to better mental health for resident physicians should be investigated. Australian New Zealand Clinical Trials Registry, ACTRN12619001496101 (prospective).

Mind the gap—What is the appropriate time interval between sequential dentine stimuli to elicit a dentine hypersensitivity pain response in clinical studies?

ObjectivesTo determine the time interval required for a tooth diagnosed with DH to recover from a stimulus (cold air-blast/tactile) and respond with a similar elicited pain response to a repeat stimulus. MethodsA single-centre, non-randomised, clinical study in healthy adult volunteers. Eligible participants with ≥1 tooth with either a qualifying Schiff score ≥2 following cold air-blast or tactile Yeaple score of ≤20 g were allocated to tactile or air-blast group. Following primary stimulation, the designated tooth was restimulated 10, 5, 2 min and immediately after initial pain cessation. Pain was recorded with participant VAS and investigator Schiff for air-blast. Results40 participants completed the study per group. There was a significant difference in VAS scores for tactile 4 delay intervals (p < 0.001) but not air-blast stimulus, and a significant difference in mean change in VAS score from immediate to two-minute delay between stimuli (8.0 tactile vs 0.8 air-blast, p = 0.011). VAS scores in response to either stimulus showed very wide variation between participants, but changes over delay intervals within participants were relatively slight. There was a significant progressive decrease in mean Schiff score with shortening delay intervals from 10 min (2.38) to stimulation immediately after pain cessation (2.15), p = 0.018. ConclusionsThe findings suggest healthy teeth recover after DH stimulation more quickly following an air-blast than tactile stimulus, with around 2 min allowing recovery from both. Many factors including habituation and pain measurement subjectivity need to be considered. It would be prudent for future studies to use of ≥3 min delays. Clinical significanceNo clinical study has attempted to determine the appropriate interval between successive stimuli in DH patients. The results will impact directly on the conduct of DH trials. These findings suggest the interval could be reduced to around 2-min, but the current standard of 5-min is sufficiently long to give valid results.