Practice Settings Research Articles

Data-driven modelling of neurodegenerative disease progression: thinking outside the black box.

Data-driven disease progression models are an emerging set of computational tools that reconstruct disease timelines for long-term chronic diseases, providing unique insights into disease processes and their underlying mechanisms. Such methods combine a priori human knowledge and assumptions with large-scale data processing and parameter estimation to infer long-term disease trajectories from short-term data. In contrast to 'black box' machine learning tools, data-driven disease progression models typically require fewer data and are inherently interpretable, thereby aiding disease understanding in addition to enabling classification, prediction and stratification. In this Review, we place the current landscape of data-driven disease progression models in a general framework and discuss their enhanced utility for constructing a disease timeline compared with wider machine learning tools that construct static disease profiles. We review the insights they have enabled across multiple neurodegenerative diseases, notably Alzheimer disease, for applications such as determining temporal trajectories of disease biomarkers, testing hypotheses about disease mechanisms and uncovering disease subtypes. We outline key areas for technological development and translation to a broader range of neuroscience and non-neuroscience applications. Finally, we discuss potential pathways and barriers to integrating disease progression models into clinical practice and trial settings.

Comparison of Two Strategies for Hypercholesterolemia Detection through Point-of-Care Testing.

Childhood dyslipidemia is a common condition that can lead to atherosclerotic cardiovascular disease in adulthood. It is usually multifactorial. Screening for cholesterol disorders in children varies based on risk factors, with some guidelines recommending cascade screening for children with a clear family history of familial hypercholesterolemia, targeted screening for those with specific risk factors, and universal screening. Point-of-care testing (POCT) cholesterol tests offer potential advantages, including ease of use, portability, increased patient access, low cost, fewer medical or laboratory visits, and instant results. This study aimed to evaluate the effect of POCT cholesterol screening on the diagnosis of hypercholesterolemia in children in a family practice setting. We used a POCT cholesterol analyzer to perform two different (universal and targeted) screening approaches for dyslipidemia in children. We used the NCEP guidelines for the classification of the results. We screened 183 children, 105 in the universal screening group and 78 in the targeted screening group. Eight patients in the targeted screening group had elevated cholesterol levels (p = 0.02). All participants received instant feedback and recommendations. Using a targeted screening approach, POCT could be a practical and effective tool for identifying at-risk children with hypercholesterolemia.

Framework for pediatric robotic surgery program development

Pediatric robotic surgery has seen increasing implementation for its many benefits over the past two decades. As more pediatric surgeons gain exposure to robotic surgery, the interest in utilizing this technology is growing. However, there are no guidelines or existing framework for developing pediatric general surgery robotic programs. Programmatic development can be challenging, requiring institutional support, a minimum 12-month multistep process in partnership with the robot manufacturer, and organization of a local dedicated team. A cornerstone to all program building is collaboration and communication with key stakeholders who are committed to establishing a robotic surgery program. In this manuscript, we detail numerous best practices for implementation, followed by three variations of programmatic development, each drawing lessons from one of three practice settings: (i) A children's hospital in a large medical center associated with an adult hospital, (ii) a free-standing children's hospital, and (iii) a community-based practice. We aim for this article to provide a framework that can serve as a guide for those beginning this process, consolidating the key resources and strategies used to develop a robust pediatric robotic surgery program.

PENGETAHUAN PERAWAT MEMBERIKAN HIGH QUALITY CPR DAN KESIAPSIAGAAN DALAM MANAJEMEN BENCANA DI INSATALASI GAWAT DARURAT DI 4 RUMAH SAKIT DAERAH DI KAB. SEMARANG

Blockage of coronary arteries causes problems in the heart's electrical system, one of them is cardiac arrest occurs suddenly at any time and at anyone. The heart failure caused the supply of food to organs to decrease. As health workers, knowledge of High-QualityPR must be maintained by nurses in dealing with cardiac arrest, and as part of preparedness, nurses carry out their duties when disaster occurs. Objective: This research aims to determine nurses' knowledge of improving High-Quality CPR capabilities in practice settings and in disaster activities. Research method: this research used qualitative descriptive design using the Convenience Sampling Technique, namely sampling taken based on the wishes of the researcher based on convenience, adequacy, and cooperation. Research solution: nurses in carrying out their duties in health services and disaster preparedness must know High-Quality CPR and carry out activities to reduce disasters in patients who experience cardiac arrest problems. Conclusion: This research is expected to confirm in provision High Quality CPR services. Keywords: Cardiac Arrest, High-Quality CPR, Knowledge

Peer Support to Promote Surgeon Well-being: The APSA Program Experience

BackgroundPeer support programs have evolved to train physicians to provide outreach and emotional first aid to their colleagues when they experience the inevitable challenge of a serious adverse event, whether or not it is related to a medical error. Most pediatric surgeons have experienced the trauma of a medical error, yet, in a survey of APSA membership, almost half said that no one reached out to them, and few were satisfied with their institution's response to the error. Thus, the APSA Wellness Committee developed an APSA-based peer support program to meet this need. MethodsPeer supporters were nominated by fellow APSA members, and the group was vetted to ensure diversity in demographics, practice setting, and seniority. Formal virtual training was conducted before the program went live in 2020. Trained supporters were surveyed 6 months after the program launched to evaluate their experiences with providing peer support. Results15 referrals were made in the first year, 60 % of which were self-initiated. Most referrals were for distress related to adverse events or toxic work environments (33 % each). While only about 25 % of trained supporters had provided formal support through the APSA program, more than 80 % reported using the skills to support colleagues and trainees within their own institutions. ConclusionOur experience in the first year of the APSA peer support program demonstrates the feasibility of building and maintaining a national program to provide emotional first aid by a professional society to expand the safety net for surgeons who are suffering.

Technology-Assisted Parenting Intervention Plus Therapist Coaching: A Pilot Randomized Trial in a Community Practice Setting

ABSTRACT Disruptive behaviors are the most common clinical presentation in children and adolescents, particularly among disadvantaged youth referred to community mental health clinics (CMHCs). When left unaddressed, disruptive behaviors can increase the risk of adverse mental health outcomes. While parenting interventions are known to be efficacious and efficient treatment approaches, there are many barriers to involvement in such programs, particularly for disadvantaged populations. This pilot randomized controlled trial evaluated a technology-assisted parenting intervention (Parenting Wisely, PW) with therapist coaching compared to treatment as usual (TAU) at a CMHC. Participants included 53 caregiver-adolescent dyads and 13 clinicians recruited from a CMHC. Dyads randomized to PW + therapist coaching received a multi-component intervention that utilized a technology-assisted parenting program alongside therapist coaching sessions. Feasibility/acceptability assessments were conducted and preliminary findings on parenting outcomes and adolescent behavior outcomes were collected at 3- and 6-months post-baseline. Qualitative and quantitative results supported the feasibility and acceptability of the parenting PW + therapist coaching intervention as evidenced by caregiver engagement, therapist adherence, lack of treatment withdrawals, and satisfaction ratings. Exploratory analyses did not show differences between treatment conditions for parenting and adolescent behavioral outcomes. PW + therapist coaching may be better suited for early adolescents, who are at a critical period when disruptive behavior patterns are not yet ingrained, and parents have more authority and opportunity to address family interactions. Next steps for further evaluation include testing the effectiveness, predictors, moderators, and mechanisms of treatment outcomes of PW + therapist coaching as an adjunct to usual care.

Comparison of US Oncologist Rurality by Practice Setting and Patients Served

Studies of the oncology workforce most often classify physician rurality by their practice location, but this could miss the true extent of physicians involved in rural cancer care. To compare a method for identifying oncology physicians involved in rural cancer care that uses the proportion of rural patients served with the standard method based on practice location. This cross-sectional study used retrospective Centers for Medicare & Medicaid Services encounter data on medical oncologists, radiation oncologists, and surgeons treating Medicare beneficiaries diagnosed with breast, colorectal, or lung cancer from January 1 to December 31, 2019. Data were analyzed from May to September 2023. The standard method of classifying oncologist physician rurality based on practice location was compared with a novel method of classification based on proportion of rural patients served. The study included 27 870 oncology physicians (71.3% male), of whom 835 (3.0%) practiced in a rural location. Physicians practicing in a rural location treated a high proportion of rural patients (median, 50.0% [IQR, 16.7%-100%]). When considering the rurality of physicians' patient panels, 5123 physicians (18.4%) whose patient panel included at least 20% rural patients, 3199 (11.5%) with at least 33% rural patients, and 1996 (7.2%) with at least 50% rural patients were identified. Using a physician's patient panel to classify physician rurality revealed a higher number and greater spread of oncology physicians involved in rural cancer care in the US than the standard method, while maintaining high performance (area under the curve, 0.857) and fair concordance (κ, 0.346; 95% CI, 0.323-0.369) with the method based on practice setting. In this cross-sectional study, classifying oncologist rurality by the proportion of rural patients served identified more oncology physicians treating patients living in rural areas than the standard method of practice location and may more accurately capture the rural cancer physician workforce, as many hospitals have historically been located in more urban areas. This new method may be used to improve future studies of rural cancer care delivery.

A review on artificial intelligence for the diagnosis of fractures in facial trauma imaging.

Patients with facial trauma may suffer from injuries such as broken bones, bleeding, swelling, bruising, lacerations, burns, and deformity in the face. Common causes of facial-bone fractures are the results of road accidents, violence, and sports injuries. Surgery is needed if the trauma patient would be deprived of normal functioning or subject to facial deformity based on findings from radiology. Although the image reading by radiologists is useful for evaluating suspected facial fractures, there are certain challenges in human-based diagnostics. Artificial intelligence (AI) is making a quantum leap in radiology, producing significant improvements of reports and workflows. Here, an updated literature review is presented on the impact of AI in facial trauma with a special reference to fracture detection in radiology. The purpose is to gain insights into the current development and demand for future research in facial trauma. This review also discusses limitations to be overcome and current important issues for investigation in order to make AI applications to the trauma more effective and realistic in practical settings. The publications selected for review were based on their clinical significance, journal metrics, and journal indexing.

Practical Considerations for Delandistrogene Moxeparvovec Gene Therapy in Patients With Duchenne Muscular Dystrophy

BackgroundDelandistrogene moxeparvovec is a gene transfer therapy approved in the United States, United Arab Emirates, and Qatar for the treatment of ambulatory patients aged four through five years with a confirmed Duchenne muscular dystrophy (DMD)-causing mutation in the DMD gene. This therapy was developed to address the underlying cause of DMD through targeted skeletal, respiratory, and cardiac muscle expression of delandistrogene moxeparvovec micro-dystrophin, an engineered, functional dystrophin protein. MethodsDrawing on clinical trial experience from Study 101 (NCT03375164), Study 102 (NCT03769116), and ENDEAVOR (Study 103; NCT04626674), we outline practical considerations for delandistrogene moxeparvovec treatment. ResultsBefore infusion, the following are recommended: (1) screen for anti-adeno-associated virus rhesus isolate serotype 74 total binding antibody titers <1:400; (2) assess liver function, platelet count, and troponin-I; (3) ensure patients are up to date with vaccinations and avoid vaccine coadministration with infusion; (4) administer additional corticosteroids starting one day preinfusion (for patients already on corticosteroids); and (5) postpone dosing patients with any infection or acute liver disease until event resolution. Postinfusion, the following are recommended: (1) monitor liver function weekly (three months postinfusion) and, if indicated, continue until results are unremarkable; (2) monitor troponin-I levels weekly (first month postinfusion, continuing if indicated); (3) obtain platelet counts weekly (two weeks postinfusion), continuing if indicated; and (4) maintain the corticosteroid regimen for at least 60 days postinfusion, unless earlier tapering is indicated. ConclusionsAlthough the clinical safety profile of delandistrogene moxeparvovec has been consistent, monitorable, and manageable, these practical considerations may mitigate potential risks in a real-world clinical practice setting.

Impacts of School-Based Outdoor Pedagogical Training Programme on the Teaching Practices of Pre-Primary School Teachers in Oyo State, Nigeria

Purpose: The pedagogical potential of outdoor learning in fostering the well-being and holistic development of children have been extensively documented in literature. Most pre-primary school children in Nigeria are however rarely exposed to outdoor learning experiences, owing probably to the inadequacies in knowledge and expertise among pre-primary school teachers. This study developed, implemented and determined the effectiveness of school-based experiential outdoor pedagogical training programme on the teaching practices of pre-primary school teachers in Oyo State, Nigeria.&#x0D; Methodology: The study adopted explanatory sequential design of mixed research methods, where qualitative data supported quantitative findings and provided evidences of the effectiveness of the training programme on outdoor teaching practices. The study used outdoor teaching competencies of the teachers, before and after the training, to provide quantitative evidence as well as interviews to elucidate the perspectives of the teachers on the impact of the training. The participants were (n = 36) pre-primary school teachers who were selected through multi-stage sampling technique across the three Senatorial districts in Oyo State, Nigeria. Experts in outdoor learning in early childhood facilitated the training. The participants were exposed to various critical aspects of their role in facilitating meaningful and enriching outdoor learning experiences for pre-primary children. The participants were engaged in hands-on training with various aspects of effective implementation of the early childhood curriculum in the outdoor environment. Aspects covered included lesson planning, sourcing lesson materials, organization of learning environment, instructional approaches and techniques, assessment and safety management, among others. The study was carried out between September, 2022 and June, 2023.&#x0D; Findings: The study found a variety of improvement in the outdoor teaching practices and learning opportunities for the children. The training showed positive effects on teaching practices and the overall performance of the teachers. The teachers showed increased skillfulness in lesson planning, instructional effectiveness, creativity and innovation in facilitating learning as well as deployment of varieties of teaching methods. The teachers broadly reported positive perspective of the training and believed it was helpful to their teaching practices. In addition, the teachers agreed that the training increased their confidence and expertise to engage children in quality outdoor learning as well as improved children's participation and enthusiasm for learning. Lack of policy support, parental concerns, time and availability of resources were some of the barriers reported by the teachers in the study.&#x0D; Unique Contribution to Theory, Practice and Policy: This study was anchored on experiential theory which emphasized the transformational effect of learning through direct experience, reflection and active experimentation. The findings appeared to lend support to the realms of theory, practice and policy within the domains of early childhood education. It enriched theoretical understanding by offering concrete, real-world applications of outdoor learning concepts, thereby, fostering a deeper comprehension of learning in the practical setting. It also provided pre-primary teachers with practical tools and strategies to effectively implement outdoor learning methodologies, thereby, promoting a more holistic and experiential approach to early childhood education. The study similarly provided a basis for the integration of outdoor pedagogy in the formal educational structure, emphasizing the significance of nature-based education and, suggesting the need for a broader integration of outdoor strategies in the context of educational policy development in Nigeria.

Alone as a drop, together as an ocean: Corporate political activity in cooperatives

Cooperatives are formed by the collective efforts of various actors pursuing common goals, enabling competition with stronger rivals. In Brazil, there is a strong relationship between agricultural cooperatives and politics, with their involvement focused on competing for regulations, information, and access to capital. However, little is known about the effects of this involvement. In this paper, we draw on collective action theory to investigate the individual and collective corporate political activities adopted by Brazilian agricultural cooperatives. Corporate political activity (CPAs) are a subfield of nonmarket strategy (NMS) that addresses actions firms develop outside the market arena to improve their outcomes and achieve competitive advantage. This study focuses on CPAs of Brazilian agricultural cooperatives, which account for over 48% of national agricultural production. We argue that collective CPAs are more effective for these cooperatives, as they enhance their representativeness and legitimacy, facilitating access to capital. To support our argument, we conducted a quantitative study using panel data from 394 Brazilian agricultural cooperatives. The results demonstrate the significance of collective CPA for accessing financing from the Brazilian Development Bank (BNDES) and contributing to collective action theory by offering a political perspective. Moreover, the study enriches CPA literature by identifying two innovative collective CPA tactics: affiliation with central cooperatives and the Organization of Brazilian Cooperatives (OCB). Lastly, the study highlights the importance of cooperation for individual and collective outcomes in practical settings.

Navigating paradoxes of identity and leadership in the age of digital transformation of construction industry: architects’ experiences and perceptions

The ability of architects to adapt to diverse identities and effectively manage the paradoxical challenges posed by digital transformation is critical to their role as innovative leaders in the dynamic digital construction landscape. However, existing research has yet to fully explore the complex experiences of paradoxical leadership and identity adaptation among architects in this context. Addressing this gap, the study aims to explore the types of conflicting identities and paradoxical leadership behaviour experienced by architects in response to the paradoxical challenges inherent to this phenomenon. Employing an interpretive phenomenological approach, the study engaged ten individuals practicing in architectural consultancy practices (ACPs) settings in Malaysia for in-depth, semi-structured interviews and a written account exercise to uncover their experiences. Thematic structural analysis yielded five key themes: “designer and technologist,” “technical-oriented and social-oriented individuals,” “collaborator and independent thinker,” “expert and lifelong learner,” and “reductionist and holistic thinking.” This comprehensive research strategy offers a more in-depth understanding of architects’ experiences and provides novel insights for enhancing leadership and identity development. Additionally, the newly developed paradoxical leadership and identity-based framework can serve as a platform for practitioners to nurture future-ready architects, upskill and reskill the existing workforce, and potentially reduce the industry’s reliance on foreign talent.

Stolen Childhoods: Cape San Child Captives and the Raising of Colonial Subjects in the Nineteenth-Century Cape Colony

Histories of indigenous child captives in settler-colonies remain marginal amid broader inquiries into colonial-era genocides of indigenous peoples. Yet, child transfers played an integral role in the demise of indigenous populations in numerous settler-colonies. Forced child removals occurred alongside the physical annihilation of parent societies and was often an important part of the erosion and eradication of hunter-gatherer peoples and identities. This article aims to set out an analysis of the integral role played by child abductions and transfers in the genocide of the Cape San during the early nineteenth century, with a particular focus on civilian initiative. In the Cape Colony, civilians initiated the practice of capturing and transferring San children to their invasive settler society. San children were considered malleable and better disposed to forced assimilation as labourers. Apprenticeship legislation was eventually introduced in the Cape Colony to regulate indigenous child transfers and to ensure that its worst abuses were minimised, although these ideals were seldom realised. Apprenticeship legislation attempted to catch up with existing practice set in motion by civilians and in effect, colonial authorities played an enabling role by legally legitimising it. The analysis also explores the narrative justifications for San child abduction and transfer employed by European-descended settlers, and contrasts these with contemporary evangelical-humanitarian discourses. Settlers and missionaries adopted different means to incorporate San children into settler society, while agreeing that incorporation was the desired end. Discursively, settlers and missionaries managed to frame their actions as being in the best interests of San children.

Insights into medical students’ perceptions of work culture during the COVID-19 pandemic: a mixed method study

BackgroundThe COVID-19 pandemic brought about profound social changes that affected students worldwide. These changes had both psychological and economic consequences, and also led to the adoption of new teaching methods. It can also have an impact on work culture, which is the collective set of values, norms, and practices within a specific profession, shaping how individuals in that field behave, communicate, and identify with their work. The aim of the study was to examine medical students’ perception of professional culture during the COVID-19 crisis when they voluntarily participated in the healthcare network established, outside of university placements, for the management of COVID patients.MethodsA questionnaire study based on the vignette methodology was conducted among third-year medical students. Drawing from three scenarios in which students were variably engaged in crisis management, it included questions about their perceptions of the medical profession, their motivation, and their sense of belonging to the profession.Results352 students responded to the survey. The pandemic had both a positive and a negative impact on students’ perceptions of the medical profession. Cluster analysis using a k-means algorithm and principal component analysis revealed three clusters of students with different perceptions of the medical profession. The first cluster, which represented the majority of students, corresponded to a relatively positive perception of the profession that was reinforced during the pandemic. In the second cluster, students’ perceptions were reinforced still further, and particular importance was attached to field experience. Students in the third cluster had the most negative perceptions, having been shaken the most by the pandemic, and they attached little importance to field experience.ConclusionsThe analysis highlighted the importance of students being able to adapt and draw on a range of resources during the COVID-19 pandemic. This underscores the need for work cultures that support adaptability and coping. Further research is needed to understand its long-term effects on students’ perceptions of the medical profession and to identify interventions that could support students in the aftermath of this difficult period.

Early Prediction of Poststroke Rehabilitation Outcomes Using Wearable Sensors.

Inpatient rehabilitation represents a critical setting for stroke treatment, providing intensive, targeted therapy and task-specific practice to minimize a patient's functional deficits and facilitate their reintegration into the community. However, impairment and recovery vary greatly after stroke, making it difficult to predict a patient's future outcomes or response to treatment. In this study, the authors examined the value of early-stage wearable sensor data to predict 3 functional outcomes (ambulation, independence, and risk of falling) at rehabilitation discharge. Fifty-five individuals undergoing inpatient stroke rehabilitation participated in this study. Supervised machine learning classifiers were retrospectively trained to predict discharge outcomes using data collected at hospital admission, including patient information, functional assessment scores, and inertial sensor data from the lower limbs during gait and/or balance tasks. Model performance was compared across different data combinations and was benchmarked against a traditional model trained without sensor data. For patients who were ambulatory at admission, sensor data improved the predictions of ambulation and risk of falling (with weighted F1 scores increasing by 19.6% and 23.4%, respectively) and maintained similar performance for predictions of independence, compared to a benchmark model without sensor data. The best-performing sensor-based models predicted discharge ambulation (community vs household), independence (high vs low), and risk of falling (normal vs high) with accuracies of 84.4%, 68.8%, and 65.9%, respectively. Most misclassifications occurred with admission or discharge scores near the classification boundary. For patients who were nonambulatory at admission, sensor data recorded during simple balance tasks did not offer predictive value over the benchmark models. These findings support the continued investigation of wearable sensors as an accessible, easy-to-use tool to predict the functional recovery after stroke. Accurate, early prediction of poststroke rehabilitation outcomes from wearable sensors would improve our ability to deliver personalized, effective care and discharge planning in the inpatient setting and beyond.

Validation of the Slovene Version of the Stop-Bang Questionnaire in a Primary Practice Setting.

The aim of our study was to validate the Slovene translation of the STOP-BANG (SBQ) questionnaire for use in the primary practice setting. We recruited 158 randomly selected visitors at four primary practice clinics who came to the practice for any reason. Participants completed the Slovene SBQ and underwent type 3 respiratory polygraphy, which was analysed by an experienced somnologist. The SBQ was previously translated in to Slovene and validated for the sleep clinic. Of 158 participants, 153 had valid recordings. The mean age of the participants was 49.5 years (±13.0 years), and 47.7% were male. OSA was identified in 49.0% of the participants. The questionnaire, with a cutoff of ≥3, demonstrated an area under the curve of 0.823 for any OSA (REI≥5), 0.819 for moderate and severe OSA (REI≥15) and 0.847 for severe OSA (REI≥30). Sensitivity was 65.3%, 81.8%, and 90.0%, and specificity was 87.2%, 73.3% and 65.0% for any, moderate to severe and severe OSA, respectively. The Slovene translation of the SBQ is a reliable instrument for OSA risk stratification in the primary practice setting.

Small businesses are not necessarily “small and medium-sized enterprises”

PurposeIn this paper, the authors review the literature on the nature of the small and medium-sized enterprise concept. The review examines the broad diversity of terms and definitions used to describe these kinds of firms in scholarly and practical settings. They relate this examination to the concept of small business for the purpose of comparison, in order to highlight differences and similarities between the concepts.Design/methodology/approachRelevant literature including articles from academia and defining documents from practical settings was identified through a scope literature review. Field data were subsequently collected via questionnaires sent to editors and authors of articles related to the theme. The data were content analyzed and the resulting codes consolidated into dimensions in accordance with the Gioia method. Chi-squared tests were applied to categorical data.FindingsThe use of the composite category “small and medium” was found to be predominant in the labeling of small businesses in scientific articles, including those in journals that specialize in small businesses, with no justifications presented for this, characterizing a widespread and consensual practice between authors and editors. In the defining documents of practical settings, however, the authors observed greater consistency and precision both in the terms used and in the delimiting values for a small business (self-employed, micro business, small business). In the sample of 27 defining documents mentioned in the articles, 25 specifically defined “small business” and 20 defined “micro business,” using indicators such as number of employees and annual turnover. The indicators delimiting values regarding the category of micro business were the same in all the documents analyzed and, regarding the category of small business, many documents used the same delimiting values.Practical implicationsRecognizing the “non-large enterprise” myth will provide a more effective posture for editors and authors to avoid using the term “small and medium,” resulting in greater precision, understanding and knowledge regarding small businesses. A better definition of a small business by academia can help public policymakers and managers of organizations that support small businesses to tailor their actions better according to the different sizes of companies. This will also lead to social gains, given the importance of small businesses in terms of job creation and countries' economies.Originality/valueThe authors identified and described the myth of the “non-large enterprise” among academics, characterized by the dichotomous view of the business universe, composed of “large enterprises” and “non-large enterprises,” the latter group being characterized by the widespread use of the term “small and medium.”

Blood pressure measurements for diagnosing hypertension in primary care: room for improvement

BackgroundIn the adult population, about 50% have hypertension, a risk factor for cardiovascular disease and subsequent premature death. Little is known about the quality of the methods used to diagnose hypertension in primary care.ObjectivesThe objective was to assess the frequency of use of recognized methods to establish a diagnosis of hypertension, and specifically for OBPM, whether three distinct measurements were taken, and how correctly the blood pressure levels were interpreted.MethodsA retrospective population-based cohort study using electronic medical records of patients aged between 40 and 70 years, who visited their general practitioner (GP) with a new-onset of hypertension in the years 2012, 2016, 2019, and 2020. A visual chart review of the electronic medical records was used to assess the methods employed to diagnose hypertension in a random sample of 500 patients. The blood pressure measurement method was considered complete if three or more valid office blood pressure measurements (OBPM) were performed, or home-based blood pressure measurements (HBPM), the office- based 30-minute method (OBP30), or 24-hour ambulatory blood pressure measurements (24 H-ABPM) were used.ResultsIn all study years, OBPM was the most frequently used method to diagnose new-onset hypertension in patients. The OBP-30 method was used in 0.4% (2012), 4.2% (2016), 10.6% (2019), and 9.8% (2020) of patients respectively, 24 H-ABPM in 16.0%, 22.2%, 17.2%, and 19.0% of patients and HBPM measurements in 5.4%, 8.4%, 7.6%, and 7.8% of patients, respectively. A diagnosis of hypertension based on only one or two office measurements occurred in 85.2% (2012), 87.9% (2016), 94.4% (2019), and 96.8% (2020) of all patients with OBPM. In cases of incomplete measurement and incorrect interpretation, medication was still started in 64% of cases in 2012, 56% (2016), 60% (2019), and 73% (2020).ConclusionOBPM is still the most often used method to diagnose hypertension in primary care. The diagnosis was often incomplete or misinterpreted using incorrect cut-off levels. A small improvement occurred between 2012 and 2016 but no further progress was seen in 2019 or 2020. If hypertension is inappropriately diagnosed, it may result in under treatment or in prolonged, unnecessary treatment of patients. There is room for improvement in the general practice setting.

Within-talker and within-session stability of acoustic characteristics of conversational and clear speaking stylesa).

In speech production research, talkers often perform a speech task several times per recording session with different speaking styles or in different environments. For example, Lombard speech studies typically have talkers speak in several different noise conditions. However, it is unknown to what degree simple repetition of a speech task affects speech acoustic characteristics or whether repetition effects might offset or exaggerate effects of speaking style or environment. The present study assessed speech acoustic changes over four within-session repetitions of a speech production taskset performed with two speaking styles recorded in separate sessions: conversational and clear speech. In each style, ten talkers performed a set of three speech tasks four times. Speaking rate, median fundamental frequency, fundamental frequency range, and mid-frequency spectral energy for read sentences were measured and compared across test blocks both within-session and between the two styles. Results indicate that statistically significant changes can occur from one repetition of a speech task to the next, even with a brief practice set and especially in the conversational style. While these changes were smaller than speaking style differences, these findings support using a complete speech set for training while talkers acclimate to the task and to the laboratory environment.

Implementing a clinical checklist for pregnant patients with opioid use disorder.

Opioid use disorder (OUD) has been increasing in pregnant patients over the past two decades. Best practice guidelines that are available for these patients, must now be implemented by health care teams. Clinical checklists have been used for other complex patient cohorts with good success and are a potentially viable tool for ensuring best practices with this patient population as well. Maine has seen a dramatic increase in the number of pregnant patients with OUD. Many of these patients seemed to "fall through the cracks" in the traditional prenatal care model. The obstetrical care team expressed feeling overwhelmed by the complex care needs of these patients and unsure of how to improve their care. To improve prenatal care delivery for patients with OUD, we implemented an evidence-based clinical checklist. This local, NP-led quality improvement project was done in partnership with a state-led initiative to improve perinatal care for patients with OUD. An evidence-based checklist provided by the state initiative was implemented for prenatal patients with diagnosed OUD. Use of a clinical checklist for patients with OUD increased the rate of several best practices during their prenatal care, including emergency naloxone prescription, tracking prescription monitoring reports, and contraceptive planning. Rates of completed prenatal screening for substance misuse, social determinants of health, and intimate partner violence also increased in our practice overall, as a result of this project. To further improve perinatal care coordination for patients with OUD, we recommend future evaluation of clinical checklists within various practice settings.