Specific Health Care Research Articles

Ways to improve the system of prevention and treatment of environmental diseases

International experience, as well as many Russian research works, prove the necessity to concentrate efforts of healthcare professionals and researchers on development of healthcare technologies for diagnosis, prevention and treatment (including health resort treatment and rehabilitation) of so-called environmental diseases caused by unhealthy environments and adverse environmental factors (physical, chemical, biological, social ones). This paper proposes the integration of research areas in environmental medicine into profiles of various research specialties (Occupational Medicine, Ecology, etc.). It is also proposed to transform the healthcare specialty of Doctor of Occupational Medicine into Doctor of Environmental Medicine. Finding ways to improve the system of prevention and treatment of environmental diseases, discussing the issues of further integration of environmental medicine, public health, ecology, occupational medicine, restorative medicine and other biomedical, preventive and clinical disciplines may improve the diagnosis and treatment of human diseases caused by adverse effects of environmental factors, as well as contribute to the development of preventive strategies. The methods of epidemiologic (including prenosologic) diagnostics based on the assessment of functional reserves of the body should play a key role in scientific research with the implementation of its results in the practice of health professionals of various profiles, including environmental occupational pathologists, in order to improve clinical diagnostics and develop personalized treatment and rehabilitation programs for patients exposed to adverse environmental factors.

К вопросу о критериях и показателях оценки организации качества и эффективности диспансерного наблюдения пациентов с психическими расстройствами.

An important area of improving mental health protection of the population is to increase the efficiency of dispensary observation of patients in psychiatric medical organizations, which allows achieving stabilization or improvement of their health, thereby increasing the quality of life of both patients and their relatives. To make the necessary management decisions on the part of the management of medical organizations aimed at improving the quality indicators of the organization and the efficiency of dispensary observation, appropriate information support is necessary. However, there are currently no separately developed criteria for assessing dispensary observation in the framework of primary specialized health care for mental disorders. Purpose of study is to substantiate the basic principles of systematization of criteria and indicators for assessing the organization of quality and efficiency of dispensary observation of patients with mental disorders for the purpose of monitoring and correct assessment of quality with subsequent adoption of adequate management decisions. Materials and methods. To systematize the criteria and indicators for assessing the organization of quality and efficiency of dispensary observation of patients with mental disorders, we used regulatory documents defining the activities of the psychiatric care system of the constituent entity of the Russian Federation, primary accounting and reporting medical forms, and the results of expert assessment. Results. Organizational and methodological approaches to the development and scientific substantiation of indicators for assessing the organization of quality and effectiveness of dispensary observation of patients with mental disorders included work with regulatory documents and analytical indicators used in the work of the OGBUZ «IOPD» and an expert assessment of the indicators of the effectiveness of dispensary observation of patients with mental disorders. The criteria and indicators for assessing the organization of quality and effectiveness of dispensary observation of patients with mental disorders were systematized into three groups, including a number of subgroups, which allows you to correctly assess the activities of the district psychiatrist’s office for dispensary observation of patients with mental disorders. Findings. Thus, the criteria and indicators for assessing the organization of quality and effectiveness of dispensary observation of patients with mental disorders allow you to receive information and make adequate management decisions regarding improving the structural efficiency of the psychiatric service as a whole, determine further actions to link them to regulatory documents and their subsequent digitalization. In general, the proposed methodological approaches make it possible to form an appropriate system of indicators for each hierarchical level of management of the psychiatric service.

Needs and expectations of healthcare professionals regarding the topic of alcohology: Results of a survey conducted in France in 2022

ContextAlcohol-related health problems represent a significant public health concern, and it is imperative for the healthcare team to accurately perceive and detect these issues to provide appropriate care. The objective of this survey was to evaluate the knowledge, practices, and educational background of healthcare professionals in the field of alcohol-related health concerns, aiming to identify their information requirements. MethodsThis study employs a cross-sectional descriptive survey methodology, in which data were gathered through a digital questionnaire designed for healthcare professionals (including those in medical, paramedical, and medico-social professions) working in addictology services as well as other relevant services across France and its overseas departments. ResultsA total of 611 questionnaires were deemed usable for analysis. A considerable percentage of participants reported their knowledge and skills to be insufficient or very insufficient, with rates of 33 % and 36 %, respectively. Moreover, a significant proportion of respondents (≈ 28 %) stated that they had received no education in addictology. Our results highlight differences in levels of knowledge and competence among the various healthcare settings, notably with lower reported levels of satisfaction in hospital settings (public and private), private practice, and in Harm Reduction Centers. Furthermore, certain professions reported unsatisfactory levels of skills and knowledge in alcohol-related issues, particularly support staff, pharmacists, expert patients, administrative staff, and social workers. These findings suggest the need to enhance knowledge and skills by tailoring interventions according to the specific healthcare settings and professions. Additionally, the priority themes and channels for disseminating information varied depending on age, region, and professional category. ConclusionThis survey reveals a low level of knowledge, practice, and education in addictology, emphasizing the critical need for training. The importance of training extends not only to the priority topics addressed but also to the channels used for dissemination, all while customizing them to suit the age, professional category, structure, and region of healthcare professionals.

Patient pathways in primary health care – an interview study across various health care personnel in a Canadian and a Norwegian county

BackgroundDue to demographic changes in the Western world governments emphasize the need for viable solutions, e.g. through decentralization of specialist health care services and better coordination within and between health care services. Both Norway and Canada have been through health care reforms and initiatives aiming to improve continuity and coordination of services. Organizational change to primary care in both countries encompasses both team-based service delivery involving allied health professionals, and new blended payment models. The objective of this study was to explore patient pathways in primary healthcare from various health personnel’s perspectives, and across various primary care organizations in Norway and Canada.MethodsThe study had a qualitative design, including interviews with physicians, nurses and managers (n = 19) in primary care, from a county in Norway and a region in Canada. Data were analyzed with a thematic approach, in line with recommendations from Braun & Clarke.ResultsThree themes were identified: 1) Structural challenges, 2) Towards a more specialized primary health care and 3) Dedication could improve continuity. Findings indicate that coordinating health care services was assumed difficult due to different health care levels, funding systems, managements, electronic record systems and organizations. Hospitals were assumed more task oriented, while primary health care services were considered more care oriented, and this challenged the coordination across organizations. Primary care services were perceived to be more and more specialized, also representing a threat for coordination and continuity. Health care personnel in both countries perceived that dedicated personnel for each patient could improve information flow and continuity across services.ConclusionsAchieving continuity and coordination of health care services seems challenging. Integration strategies seem essential for reducing silo thinking and fragmentation of health care services.

Childhood Maltreatment and Revictimization in Young Adulthood: Is Problematic Substance Use a Mediator? A Linked Survey-Register Data Study.

Victims of childhood maltreatment often experience revictimization later in life. However, there is scant knowledge of the explanatory mechanisms that generate this phenomenon. Problematic substance use is a maladaptive coping strategy that may increase the risk of revictimization after maltreatment. We used linear regressions and mediation analyses to investigate the explanatory role of problematic substance use in the association between childhood maltreatment and violent revictimization in young adulthood. We analyzed linked survey-register data on a sample of senior high school graduates in Norway (n = 3,156) who were followed longitudinally until ages 32 to 33 (2021). Ordinary least squares regression analyses showed that childhood maltreatment was associated with both problematic substance use and violent revictimization, adjusted for a wide range of covariates. Moreover, problematic substance use was associated with an increased risk of violent revictimization in young adulthood. Mediation analyses showed that about one eighth (12.0%) of the association between childhood maltreatment and violent revictimization was mediated by problematic substance use. Sensitivity tests indicated that the mediation may be susceptible to unmeasured confounding. Thus, it is unclear whether the mediating role of problematic substance use can be interpreted causally within a counterfactual framework. In conclusion, reducing problematic substance use among victims of childhood maltreatment may mitigate the risk of violent revictimization later in life. Early detection and tailored treatment of problematic substance use could be one way to prevent violent revictimization following childhood maltreatment. Therefore, equitable access to primary and specialized healthcare services is essential, both for victims of maltreatment and individuals with habits of (borderline) problematic substance use. However, the majority of the maltreatment-revictimization pathway (88.0%) is not statistically explained by substance use, which implies that other mechanisms are also at play.

Understanding Why People Experiencing a Mental Health Crisis Leave the Emergency Department Before Care: AQualitative Interpretive Study.

A number of people experiencing a mental health crisis who present to a hospital emergency department (ED) do not wait (DNW) for assessment or care and leave. This phenomenon is poorly understood and offers an opportunity to enhance quality of care. We sought to understand the characteristics and reasons of those who DNW for assessment or care, and what happens after leaving the ED. We used a semi-structured telephone interview method with open-ended and single choice responses. Participants were recruited from Eastern Health hospitals who had been referred from the ED for specialist mental health care. Respondents (N = 42) tended to be female adults in their 30s, accompanied by another person, and seeking short-term relief and long-term care for a mental health crisis. It became increasingly obvious over time to participants that the cost of waiting was outweighed by the benefit of leaving. A range of factors were identified that took them to this tipping point. Over half reported their condition as having improved and did not seek further care after leaving the ED. Respondents thought a comfortable 'safe place' and communication that conveyed respect and reduced uncertainty while waiting would reduce early leaving. There were challenges in engaging a DNW population. Nonetheless this study offers valuable insights into this phenomenon in an ED setting. Many of the expressed views for reducing DNW appear to be reasonable and achievable.

Development and Validation of Quality Indicators for Pulmonary Arterial Hypertension Management in Japan: A Modified Delphi Consensus Study

Background: Quality indicators (QIs) are used to standardize care and improve outcomes in patients with pulmonary arterial hypertension (PAH). It is important that QIs are validated within specific healthcare contexts. Therefore, this study aimed to validate QIs for PAH management in Japan using a modified Delphi consensus method. Methods: QI candidates were identified from published European QIs and clinical practice guidelines. An expert panel of 11 PAH specialists from diverse Japanese institutions anonymously rated the 36 initial QI candidates in two rounds using a nine-point appropriateness scale. Results: In the first round, 35 QIs received a median score of ≥7 points. A panel discussion was held between rounds to address the single low-scored QI, biomarker modifications, and invasive examinations, resulting in 36 modified QIs. In the second round, all modified QIs received median scores of ≥7 points and were judged to be valid as the final Japanese set of QIs. Conclusions: The findings of this study validated a set of QIs for PAH management tailored to the Japanese healthcare context. These QIs can be used to standardize care, identify areas for improvement, and ultimately enhance outcomes for Japanese patients with PAH.

THE EFFECT OF THE ANESTHETIC NITROUS OXIDE USED IN PEDIATRIC DENTISTRY ON THE REDUCTION OF VITAMIN B12 AND LIVER FUNCTION

The prudent utilization of (N2O/O2) can offer a secure and efficient method to manage dental anxiety in children, adolescents, and individuals with specific healthcare requirements. Application of nitrous oxide for pain and anxiety alleviation in pediatric dentistry patients. One of these optimal methods is to furnish dentists with guidance on the secure and efficient use of nitrous oxide/oxygen (N2O/O2). Analgesia and anxiety alleviation particularly designed for pediatric patients. The recommendations for the use of (N2O/ O2) focus on the objectives, overall factors to consider, situations where it is appropriate, and situations where it should be avoided, for the purpose of managing sedation/anxiety. Before using ( N2O/O2) to treat pediatric patients, several factors should be taken into account. These include the patient’s physical and emotional development, medical and dental history, and the specific dental treatment required. It is also important to consider alternative behavioral guidance options, as well as the credentials and training of the dentist and other dental personnel. The availability of appropriate equipment and facilities, as well as the implementation of management and use monitoring techniques, should also be considered. Additionally, potential harmful effects and consequences, as well as occupational safety, need to be carefully evaluated. The documentation about its utilization is being discussed. The investigation was done on two cohorts of children in public and private clinics. The findings revealed reduced liver function and vitamin B12 levels in children who were exposed to nitrous oxide, as compared to the group of healthy children.

COGNITIVE DIAGNOSTIC MODELING ON ASSESSMENT IN HEALTHCARE PROFESSIONS EDUCATION: A RAPID SCOPING REVIEW PROTOCOL

Background: The fast-rising supply of healthcare professional schools imposes improvement on assessment methodologies/strategies as to ensures achievement of sufficient healthcare professional competency, professional’s own health and wellbeing, and patient safety. Ascertain which learner has or has not reached sufficiency in a specific healthcare profession must be determined. Objective: The primary objective of this article is to present the protocol of a rapid scoping review to map the literature regarding the use of Cognitive Diagnostic Modeling (CDM) on assessment in healthcare professions education. Methods: This rapid scoping review protocol is registered on Open Science Framework (OSF) and followed Joanna Brigg Institute’s (JBI) updated manual for scoping reviews, Arksey and O’Malley’s framework and adhered to STructured apprOach to the Reporting In healthcare education of Evidence Synthesis (STORIES) and Best Evidence Medical Education (BEME) guidelines. A systematic and comprehensive search across MEDLINE/PubMed, Embase, Scopus, Web of Science, ERIC, LILACS, MedEdPublish and the grey literature will be conducted without date, language and study design restrictions. This review will include studies on assessment of undergraduate, graduate, and continuing medical and health professions’ education. Study selection and data extraction will be undertaken by two independent authors and synthesized into various strategies as to ensure representation of the state of the art on the use of CMD in assessment of healthcare professional education. Results: This rapid scoping review is anticipated to map CMD applications in healthcare professional education, including for admissions, progress test, assessment, and clinical reasoning. Conclusion: The findings of this rapid scoping review protocol will contribute to ensure relevance and understanding of and gap identification on the use of CDM in assessment of healthcare professions education. Futhermore, they might help academic staff, administration, and researchers in healthcare education.

Variation in general practitioners' follow-up of depressed patients starting antidepressant medication: a register-based cohort study.

Guidelines recommend follow-up within 2 weeks for patients starting medication for depression. Knowledge is lacking about how general practitioners' (GPs) follow-up varies with patients' sociodemographic characteristics. To describe follow-up by GP and specialist in mental healthcare provided to men and women with depression within 3 months of starting drug therapy. Furthermore, to examine whether follow-up varied according to patients' age and education. Registry-based cohort study comprising all patients aged ≥18 years in Norway with a new depression episode in 2014 who started on antidepressants within 12 months from diagnosis. Patients' age and educational level were the exposures. Outcomes were follow-up by GP and/or mental healthcare specialist, and talking therapy with GP, within 90 days of first prescription. Cox proportional hazard models were used to estimate the likelihood of having follow-up contacts. Log binomial regression analysis was performed to explore the likelihood of having talking therapy with a GP. Time to first contact was illustrated by Kaplan-Meier survival curves. The study population comprised 17 000 patients, mean age 45.7 years, 60.6% women. Only 27.8% of the patients were followed up by GP and/or specialist within 2 weeks of the first drug dispensing, 67.1% within 90 days. Older or less educated men and women received less and later contacts than the younger or more highly educated. Differences in age and educational level were associated with follow-up of depressed patients who started medication. This may indicate unwarranted variation in depression care that GPs should consider when prescribing antidepressants.

Evaluating the Performance of Vascular Feature Extraction Boosting Algorithm for Peripheral Arterial Disease Detection

A common vascular disease called peripheral arterial disease (PAD) is characterized by constricted or blocked arteries in the legs, which lowers blood flow and raises the risk of consequences including cardiovascular events or amputation of a limb. Timely intervention and management of PAD are contingent upon early identification. Atherosclerosis, or plaque accumulation in the arteries, is the main cause of this illness. Therefore, leg pain, cramping, numbness, weakness, or coolness in the legs are possible signs of PAD, especially when engaging in physical activity. In addition to impairing mobility and quality of life, PAD raises the possibility of consequences like tissue damage, persistent sores, and even limb amputation if treatment is not received. Mixes of dietary adjustments, medication, and, in extreme situations, surgical procedures are used to manage PAD. A nutritious diet, frequent exercise, giving up smoking, and keeping a healthy weight are a few examples of lifestyle changes. It may be necessary to prescribe pharmaceuticals to decrease cholesterol, antiplatelet agents, blood flow improvers, and symptom managers. Procedures like angioplasty, stenting, or bypass surgery may be required in cases when PAD progresses and symptoms are severe to restore blood flow to the affected limbs. To avoid issues and enhance results, PAD must be identified early and managed effectively. As a result, those who are at risk such as those with diabetes, high blood pressure, high cholesterol, or a history of smoking should have screening for PAD regularly. All things considered, PAD is a dangerous illness that needs to be managed proactively to avoid complications and preserve a high standard of living. Through the management of risk factors, adoption of a healthy lifestyle, and adherence to an individualized treatment plan, people with PAD can effectively manage their illness and lower their chance of complications. For long-term treatment and best results, regular monitoring and follow-up with healthcare specialists are necessary. Vascular feature extraction boosting (VFEB), a hybrid algorithm that combines the strength of vascular feature extraction with boosting approaches, is the unique strategy for PAD identification that is present in this study. The VFEB approach makes use of gradient boosting machines (GBMs) to improve classification performance based on these features and convolutional neural networks (CNNs) to extract discriminative features from vascular imaging data. The goal of VFEB is to increase the precision and resilience of PAD detection by combining CNNs for feature extraction with GBMs for classification. Using a dataset of vascular imaging data, we assess the VFEB algorithm’s performance and compare it with other established techniques. The findings show that VFEB performs better than other methods at identifying PAD, providing encouraging opportunities for the early detection and treatment of this crippling vascular ailment. The VFEB system achieves an outstanding accuracy of 99.87%, an F1 Score of 99.64, and MCC 99%. Compared to the conventional methods, VFEB obtains improved accuracy, F1 Score, and MCC by integrating boosting techniques with vascular feature extraction. This study emphasizes the value of utilizing cutting-edge computational tools to improve vascular health outcomes and shows how hybrid algorithms, such as VFEB, may improve PAD identification.

Ageing in China: Comparison of Healthcare Modes for the Elderly Population

Abstract: As China strives to meet the challenges of an ageing population, the need for an effective healthcare system for the elderly is becoming increasingly urgent. The traditional family-centred mode of care, deeply rooted in Chinese filial piety, has become inadequate in the face of modern social change. With a rapid ageing population and a rising incidence of chronic diseases, the demand for healthcare services is expected to grow significantly. This article explores the limitations of the current family-centred mode of ageing care, including the strain placed on families and the lack of adequate healthcare resources, especially in rural areas. The article argues for a shift to a community-based caring mode that provides more comprehensive and sustainable solutions by integrating specialised healthcare services in local communities. Comparing the situation in China to the community healthcare system successfully implemented in Japan, this paper highlights the potential benefits of adopting a similar strategy while taking into account China's unique demographic and regional challenges. Finally, the article argues for a more equitable and efficient healthcare system in China to meet the needs of its rapidly ageing population.

Using Chronic Kidney Disease as a Model Framework to Estimate Healthcare-Related Environmental Impact.

While the economic and clinical burden of chronic diseases are well documented, their environmental impact remains poorly understood. We developed a framework to estimate the environmental impact of a disease care pathway using chronic kidney disease (CKD) as an example. A life cycle assessment framework was developed for the CKD care pathway and validated by experts. Life cycle stages were characterised for resource utilisation based on a literature review and ecoinvent database inputs, in ten countries. The ReCiPe impact assessment method was used to calculate impacts across multiple environmental dimensions. At CKD stage5, kidney replacement therapies (KRT) have highest impact; emissions ranged between 3.5 and 43.9kg carbon dioxide equivalents (CO2e) per session depending on dialysis modality, and 336-2022kgCO2e for kidney transplant surgery, depending on donor type. Hospitalisations have a substantial environmental impact: a 1-day intensive care stay had highest impact (66.4-143.6kgCO2e), followed by a 1-day hospital stay (28.8-63.9kgCO2e) and an 8-h emergency room visit (14.4-27.5kgCO2e). Patient transport to and from healthcare sites was a key driver of environmental impact for all life cycle stages, representing up to 99.5% of total CO2e emissions. Full care pathways should be analysed alongside specific healthcare processes. Application of this framework enables quantification of the environmental benefits of preventative medicine and effective management of chronic diseases. For CKD, early diagnosis, and proactive management to reduce the need for KRT and hospitalisations could improve patient outcomes and reduce environmental burden.

Evaluating Patient Rights and Agency: An In-depth Examination of Autonomous Decision-Making in AI-Powered Telemedicine

This study examines the adequacy of regulations concerning consent and patient autonomy in AI telemedicine in Ghana. Using the IRAC (Issue, Rule, Analysis, and Conclusion) method, the research analyzes existing Ghanaian healthcare laws and regulations in the context of AI-driven telemedicine. The study finds significant gaps in the current regulatory framework, including a lack of specific provisions for informed consent in AI telemedicine, unclear guidelines on maintaining patient autonomy, and inadequate addressing of liability issues in AI-assisted healthcare. Recommendations include developing specific AI healthcare legislation, updating existing laws to incorporate AI and telemedicine considerations, establishing AI ethics committees, and implementing short-term mitigation strategies such as interpretive guidelines and enhanced disclosure protocols. The study emphasizes the need for a two-pronged approach: long-term regulatory development and immediate implementation of interim measures to protect patient rights and ensure ethical use of AI in telemedicine.

Exploration of Features of Mobile Applications for Medication Adherence in Asia: Narrative Review.

Medication is crucial for managing chronic diseases, yet adherence rates are often suboptimal. With advanced integration of IT and mobile internet into health care, mobile apps present a substantial opportunity for improving adherence by incorporating personalized educational, behavioral, and organizational strategies. However, determining the most effective features and functionalities for these apps within the specific health care context in Asia remains a challenge. We aimed to review the existing literature, focusing on Asian countries, to identify the optimal features of mobile apps that can effectively enhance medication adherence within the unique context of Asian societies. We conducted a narrative review with the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. We identified studies on mobile apps for medication adherence from January 2019 to August 2024 on PubMed and Scopus. Key search terms included "Asia," "chronic disease," "app," "application," "survey," "experiment," "questionnaire," "group," "medical adherence," "medication adherence," "case-control," "cohort study," "randomized controlled trial," "clinical trial," "observational study," "qualitative research," "mixed methods," and "analysis," combined using logical operators "OR" and "AND." The features of mobile apps identified in the studies were evaluated, compared, and summarized based on their disease focuses, developers, target users, features, usability, and use. The study identified 14 mobile apps designed to enhance medication adherence. Of these, 11 were developed by research teams, while 3 were created by commercial companies or hospitals. All the apps incorporated multiple features to support adherence, with reminders being the most common, present in 11 apps. Patient community forums were the least common, appearing in only 1 app. In total, 6 apps provided lifestyle modification functions, offering dietary and exercise recommendations, generating individualized plans, and monitoring progress. In addition, 6 apps featured health data recording and monitoring functions, with 4 allowing users to export and share records with researchers or health care professionals. Many apps included communication features, with 10 enabling feedback from researchers or health care professionals and 7 offering web-based consultation services. Educational content was available in 8 apps, and 7 used motivation strategies to encourage adherence. Six studies showed that mobile apps improved clinical outcomes, such as blood glucose, lipid, and pressure, while reducing adverse events and boosting physical activities. Twelve studies noted positive humanistic effects, including better medication adherence, quality of life, and user satisfaction. This review has identified key components integrated into mobile apps to support medication adherence. However, the lack of government and corporate involvement in their development limits the generalizability of any individual app. Beyond basic reminder functions, features such as multiuser support, feedback mechanisms, web-based consultations, motivational tools, and socialization features hold significant promise for improving medication adherence. Further pragmatic research is necessary to validate the effectiveness of these selected apps in enhancing adherence.

Enhanced Recovery After Craniotomy: Global Practices, Challenges, and Perspectives.

The global demand for hospital care, driven by population growth and medical advances, emphasizes the importance of optimized resource management. Enhanced Recovery After Surgery (ERAS) protocols aim to expedite patient recovery and reduce health care costs without compromising patient safety or satisfaction. Its principles have been adopted in various surgical specialties but have not fully encompassed all areas of neurosurgery, including craniotomy. ERAS for craniotomy has been shown to reduce the length of hospital stay and costs without increasing complications. ERAS protocols may also reduce postoperative nausea and vomiting and perioperative opioid requirements, highlighting their potential to enhance patient outcomes and health care efficiency. Despite these benefits, guidelines, and strategies for ERAS in craniotomy remain limited. This narrative review explores the current global landscape of ERAS for craniotomy, assessing existing literature and highlighting knowledge gaps. Experts from 26 countries with diverse cultural and socioeconomic backgrounds contributed to this review, offering insights about current ERAS protocol applications, implementation challenges, and future perspectives, and providing a comprehensive global overview of ERAS for craniotomy. Representatives from all 6 World Health Organization geographical world areas reported that barriers to the implementation of ERAS for craniotomy include the absence of standardized protocols, provider resistance to change, resource constraints, insufficient education, and research scarcity. This review emphasizes the necessity of tailored ERAS protocols for low and middle-income countries, addressing differences in available resources. Acknowledging limitations in subjectivity and article selection, this review provides a comprehensive overview of ERAS for craniotomy from a global perspective and underscores the need for adaptable ERAS protocols tailored to specific health care systems and countries.

Adult Code Sepsis: A Narrative Review of its Implementation and Impact.

This narrative review explores the implementation and impact of sepsis code protocols, an urgent intervention strategy designed to improve clinical outcomes in patients with sepsis. We examined the degree of implementation, activation criteria, areas of implementation, personnel involved, responses after activation, goals and targets, impact on clinical indicators, and challenges in implementation. The reviewed evidence suggests that sepsis codes can significantly reduce sepsis-related mortality and enhance early administration of treatments. However, variability in activation criteria and inconsistent application present ongoing challenges. The review considers the incorporation of newer scoring systems, such as NEWS and MEWS, and the potential integration of machine learning tools for early sepsis detection. It highlights the importance of tailoring implementation to specific healthcare contexts and the value of ongoing training to optimize sepsis response. Limitations include the ongoing controversy surrounding sepsis definitions and the need for standardized, feasible quality indicators. Future research should focus on standardizing activation criteria, improving protocol adherence, and exploring emerging technologies to enhance early sepsis detection and management. Despite challenges, sepsis codes show promise in improving patient outcomes when implemented thoughtfully and consistently across healthcare settings.

Qualitatively Assessing ChatGPT Responses to Frequently Asked Questions Regarding Sexually Transmitted Diseases.

ChatGPT, a large language model artificial intelligence platform that uses natural language processing, has seen its implementation across a number of sectors, notably in healthcare. However, there remains limited understanding regarding the efficacy of ChatGPT in addressing commonly asked questions on public health subjects. This study aimed to investigate whether ChatGPT could appropriately answer frequently asked questions related to sexually transmitted diseases (STDs). Ten frequently asked questions on STDs were gathered from 25 different government agency websites. The questions were inputted into ChatGPT and subsequent responses were analyzed for accuracy, clarity, and appropriateness using an evidence-based approach on a 4-point grading scale. Of the responses provided by ChatGPT, four were determined to be excellent requiring no clarification and six requiring minimal clarification. No responses were graded as unsatisfactory. Additionally, the responses appropriately emphasized consulting a healthcare specialist. While the majority of responses required minimal clarification, ChatGPT has the potential to be an effective supplementary tool for patient education. Additional research is necessary to explore possible public health strategies that incorporate artificial intelligence to address concerns related to STDs.

A strategic brand development framework for expanding cardiovascular and endocrinology treatments in emerging markets

This paper introduces a conceptual framework for strategic brand development in the pharmaceutical industry, specifically targeting the cardiovascular and endocrinology treatment sectors in emerging markets. The framework explores how stakeholder engagement, market segmentation, and brand positioning can enhance access to critical treatments, addressing growing public health challenges in these regions. Cardiovascular and endocrinological disorders, such as heart disease and diabetes, are rising rapidly in emerging markets due to lifestyle changes, urbanization, and increased life expectancy. Pharmaceutical companies face unique challenges in expanding their market presence in these regions, including varying healthcare infrastructure, economic disparities, and regulatory environments. The proposed framework emphasizes the importance of engaging key stakeholders—such as healthcare professionals, policymakers, and patients—through targeted educational campaigns, partnerships, and advocacy. Effective stakeholder engagement fosters trust and collaboration, which is essential for expanding access to life-saving treatments. In addition, market segmentation is a critical component of this strategy, allowing companies to tailor their marketing efforts to specific demographic groups, economic conditions, and healthcare needs in each region. By identifying the most relevant segments and understanding their unique needs, companies can ensure that their treatments reach the populations most at risk for cardiovascular and endocrinological diseases. Brand positioning is another cornerstone of this framework. By clearly defining and communicating the value of their treatments in terms of efficacy, affordability, and accessibility, pharmaceutical companies can differentiate themselves in increasingly competitive markets. Strategic positioning not only enhances brand visibility but also builds long-term customer loyalty, which is crucial for sustaining market growth in emerging economies. Overall, this conceptual framework provides a roadmap for pharmaceutical companies to strategically develop their brands in the cardiovascular and endocrinology sectors, ultimately contributing to improved public health outcomes in emerging markets.

COVID-19 and COVID-19 Vaccine-Related Skin Ulcerations in the Lower Extremities: A Case Report and Literature Review

Several associations have been made between COVID-19 and vasculitis. Recent data also shows the prevalence and association of de novo vasculitis with either COVID-19 infection or COVID-19 post vaccination. In this article, we present the case of new-onset leukocytoclastic vasculitis, secondary to COVID-19 vaccination, that was complicated by severe infected and nonhealing ulcers in the lower extremities. Case A 53-year-old male patient presented to the dermatology clinics with a three-week history of painful necrotic patches coalescent of the lateral malleolus of the right and left ankles. History goes back to when the patient reported developing pruritic papules two weeks after receiving his second shot of the Pfizer BioNTech COVID-19 vaccine (BNT162b2). Punch biopsy was consistent with leukocytoclastic vasculitis. He was prescribed a four-week course of systemic corticosteroids and antibiotics as per cultures. Vascular assessment confirmed normal peripheral arterial and venous system. Two months later, the patient re-presented with fever and worsening of his lower extremity ulcers. He underwent debridement of his wounds. Intra-operative cultures revealed multidrug resistant bacteria. He required an additional debridement session a few days later and a 14-day course of Piperacillin-Tazobactam. The patient was subsequently discharged on corticosteroids and Azathioprine and followed up in the vascular surgery and rheumatology clinics. At four months follow-up, the patient's wounds were almost completely healed. Conclusion This article highlights a case of severe new-onset COVID-19 vaccine-associated leukocytoclastic vasculitis complicated with infected ulcers that required debridement twice in addition to a prolonged course of antibiotics and immunosuppression therapy. To our knowledge, none of the cases reported in the literature were this severe in nature. In this post-pandemic era, it must remain high on the differential list, and healthcare specialists should maintain a high index of suspicion when evaluating sudden new-onset skin lesions that do not have an immediately apparent etiology.