Standard Tools Research Articles

Nutritional assessment in the HIV-infected older population receiving antiretroviral therapy.

Malnutrition is a pronounced public health issue which often seems underestimated in the older people living with HIV (PLWH) virus infection. PLWH are highly vulnerable to nutritional problems resulting from agingrelated deterioration, disease itself, and adverse effects of antiretroviral therapy (ART). The comprehensive nutritional assessments are necessary to perform routinely in this population to monitor and provide appropriate interventions to reduce comorbid conditions. In this review, we focus on the untoward impacts of malnutrition and nutritional assessments on the morbidity and mortality in the older PLWH. Some predictive factors of nutritional status in this group of patients are discussed. We propose the important components for nutrition assessment tool for older PLWH on ART. Highlighted issue is the need for developing uniform standardized tools for the early diagnosis of malnutrition in this population. Applications of the nutritional assessments, proper nutritional interventions, and regular monitoring of nutritional status in older PLWH liv-ing in every clinical setting may help the patients get better well-being.

SATURN: assessing the feasibility of utilising existing registries for real-world evidence data collection to meet patients, regulatory, health technology assessment and payer requirements

BackgroundSATURN (Systematic Accumulation of Treatment practices and Utilisation, Real world evidence, and Natural history data) for the rare condition osteogenesis imperfecta (OI) has the objective to create a common core dataset by utilising existing, well-established data sources to meet the needs of the various stakeholders (physicians, registry/dataset owners, patients and patient associations, OI community leaders, European [EU] policymakers, regulators, health technology assessments [HTA]s, and healthcare systems including payers). This paper describes the steps taken to assess the feasibility of one existing OI registry (i.e., the Registry of OI [ROI]) as a candidate for SATURN. The same methodology will be applied to other existing OI registries in the future and this same concept could be utilised for other rare disease registries.MethodsThe approach to assessing the feasibility of the ROI registry consisted of three steps: (1) an assessment of the registry characteristics using the Registry Evaluation and Quality Standards Tool (REQueST); (2) a gap analysis comparing SATURN required Core Variables to those being captured in the registry’s Case Report Form (CRF); and (3) a compliance check on the data exchange process following the Title 21 of Code of Federal Regulations (CFR) Part 11/EudraLex Annex 11 Compliance Checklist. The first registry that SATURN has assessed is the ROI database at the Istituto Ortopedico Rizzoli (IOR) in Italy.ResultsThe results from the ROI REQueST have demonstrated satisfactory complete responses in terms of methodology, essential standards, interpretability, and interoperability—readiness for data linkage, data sources, and ethics to meet the needs of data customers. However, the ROI data is from a tertiary referral centre which may limit the ability to understand the full patient journey. The gap analysis has revealed that an exact or logical match between SATURN requested variables and the ROI current variables exists for the following items: patient characteristics, treatment of OI (medical and surgical) and treatment of pain (with the exception of frequency of treatment and reasons for discontinuation), fracture history and bone density. However, data on safety was missing. The compliance check has implied that the ROI implemented appropriate controls for the web-based platform (i.e., Genotype–phenotype Data Integration Platform [GeDI]) that is involved in processing the electronic patient data, and GeDI is a validated/compliant application that follows relevant 21 CFR Part 11/EudraLex Annex 11 regulations.ConclusionsThis robust feasibility process highlights potential limitations and opportunities to develop and to refine the collaboration with the ROI as the SATURN programme moves forward. It also ensures that the existing datasets in the rare condition OI are being maximised to respond to the needs of patients, data customers and decision-makers. This feasibility process has allowed SATURN to build a compliant methodology that aligns with the requirements from the European Medicines Agency (EMA) and HTAs. More data variables will continue to be developed and refined along the way with more registries participating in SATURN. As a result, SATURN will become a meaningful and truly collaborative core dataset, which will also contribute to advancing understanding of OI diagnosis, treatment, and care.

Advancing cryptography: a novel hybrid cipher design merging Feistel and SPN structures

In the dynamic field of cryptography, lightweight ciphers play a pivotal role in overcoming resource constraints in modern applications. This paper introduces a lightweight cryptographic algorithm by seamlessly merging the proven characteristics of the Feistel cipher CLEFIA with the advanced substitution-permutation network (SPN) framework of RECTANGLE for key generation. The algorithm incorporates a specially optimized feather S-box, balancing efficiency and security in both CLEFIA and RECTANGLE components. The RECTANGLE key generation, vital for the proposed lightweight technique, enhances overall cryptographic security and efficiency. Meticulous consideration of resource limitations maintains the algorithm's lightweight nature, making it well-suited for applications with restricted computational resources. To validate the efficacy of the lightweight algorithm, extensive evaluation on encrypted data is conducted using National Institute of Standards and Technology (NIST) tools, known for assessing cryptographic algorithm quality. Results reveal a high degree of randomness, indicative of robust resistance against cryptographic attacks. This manuscript provides a comprehensive examination of the lightweight algorithm, emphasizing key attributes, security enhancements, and successful integration of the optimized feather S-box. Rigorous testing, particularly NIST tool-based randomness analysis, offers empirical evidence of the algorithm's resilience against attacks, establishing its suitability for secure data encryption in resource-limited environments.<p> </p>

Need for Data Standardization and Infrastructure of Research Data Management to Promote Using Real-world Data

Real-world data (RWD) have been increasingly used for regulatory decision-making and as a control group for new drug approval applications. RWD is also helpful in understanding information such as risk factors (e.g., pre-existing medical conditions, personal protective equipment, travel, contacts, smoking, and exposure to animals) and vaccination status for the coronavirus disease 2019 (COVID-19). The methodology of utilizing RWD is inconsistent across healthcare institutions. However, there are possible solutions to standardize RWD for clinical data use, which include the use of Clinical Data Interchange Standards Consortium (CDISC) standards, tools, and concepts. This study examines the availability of CDISC and other international standards for the utilization of RWD with concrete examples and presents the potential platform for implementation. We consider the solution currently available to temporarily convert clinical data-warehouse (DWH) data into the Fast Healthcare Interoperability Resources (FHIR) format to comply with the CDISC standard. This approach would allow for converting institution-level standards to national standards as an interim solution until FHIR is supported, mapping national standards to international standards. We believe that the ideal research environment is a data platform that complies with national and international regulations related to RWD applications. Within such a platform, users can share data freely, rather than rely on a specific facility or vendor. Data platform developments are progressing in Japan and globally. In Japan, initiatives to use research data on research data platforms are being conducted. We are experimenting with implementing tools and knowledge shared by CDISC.

Impact of bariatric surgery, lifestyle change, and pharmacotherapy on fertility in men with obesity: a systematic review protocol.

This review will determine whether various health interventions designed to reduce weight (lifestyle change, bariatric surgery, pharmacotherapy) in men with obesity are associated with improved fertility markers. The review will also establish whether the degree of weight loss achieved through these methods is associated with improvement. Current preconception guidelines provide limited information for men with obesity. Small studies implementing lifestyle changes in men are associated with improvement in sperm quality, whereas bariatric surgery has not been associated with improvements in sperm quality. Determining the benefit of different interventions and the relationship to weight lost is necessary to optimize male fertility. The population will be men younger than 50 years with overweight (BMI >25 kg/m 2 ) or obesity (BMI >30 kg/m 2 ). The exposure of interest will be an intervention undertaken to improve health or reduce weight, categorized as lifestyle change, bariatric surgery, or pharmacotherapy. Outcomes will include time to conception, fecundity rate, assisted reproduction outcomes, and semen quality measures. Secondary analysis will determine whether degree of weight loss achieved is associated with degree of improvement. This review will follow the JBI methodology for systematic reviews of etiology and risk. Databases to be searched will include PubMed, Embase (Ovid), Cochrane Central Register of Controlled Trials, Web of Science Core Collection, and Scopus. Articles not published or translated into English will be excluded. Methodological quality will be assessed using the JBI critical appraisal tools. Data will be extracted using a tool developed by the reviewers. Statistical meta-analysis will be performed where possible to synthesize outcomes of similar methods. PROSPERO CRD42022349665.

Performance of high-order Godunov-type methods in simulations of astrophysical low Mach number flows

High-order Godunov methods for gas dynamics have become a standard tool for simulating different classes of astrophysical flows. Their accuracy is mostly determined by the spatial interpolant used to reconstruct the pair of Riemann states at cell interfaces and by the Riemann solver that computes the interface fluxes. In most Godunov-type methods, these two steps can be treated independently, so that many different schemes can in principle be built from the same numerical framework. Because astrophysical simulations often test out the limits of what is feasible with the computational resources available, it is essential to find the scheme that produces the numerical solution with the desired accuracy at the lowest computational cost. However, establishing the best combination of numerical options in a Godunov-type method to be used for simulating a complex hydrodynamic problem is a nontrivial task. In fact, formally more accurate schemes do not always outperform simpler and more diffusive methods, especially if sharp gradients are present in the flow. For this work, we used our fully compressible Seven-League Hydro (SLH) code to test the accuracy of six reconstruction methods and three approximate Riemann solvers on two- and three-dimensional (2D and 3D) problems involving subsonic flows only. We considered Mach numbers in the range from 10−3 to 10−1, which are characteristic of many stellar and geophysical flows. In particular, we considered a well-posed, 2D, Kelvin–Helmholtz instability problem and a 3D turbulent convection zone that excites internal gravity waves in an overlying stable layer. Although the different combinations of numerical methods converge to the same solution with increasing grid resolution for most of the quantities analyzed here, we find that (i) there is a spread of almost four orders of magnitude in computational cost per fixed accuracy between the methods tested in this study, with the most performant method being a combination of a low-dissipation Riemann solver and a sextic reconstruction scheme; (ii) the low-dissipation solver always outperforms conventional Riemann solvers on a fixed grid when the reconstruction scheme is kept the same; (iii) in simulations of turbulent flows, increasing the order of spatial reconstruction reduces the characteristic dissipation length scale achieved on a given grid even if the overall scheme is only second order accurate; (iv) reconstruction methods based on slope-limiting techniques tend to generate artificial, high-frequency acoustic waves during the evolution of the flow; and (v) unlimited reconstruction methods introduce oscillations in the thermal stratification near the convective boundary, where the entropy gradient is steep.

Fiscal Multipliers and Financial Crises

Abstract I study the effects of the U.S. fiscal policy response to the Great Recession, accounting for both standard tools and financial sector interventions. A nonlinear model calibrated to the United States allows me to study the state-dependent effects of different fiscal policies. I combine the model with data on the fiscal policy response to find that the fall in consumption would have been one-third larger in the absence of that response, for a cumulative loss of 7.18%. Transfers and bank recapitalizations yielded the largest fiscal multipliers through new transmission channels that arise from linkages between household and bank balance sheets.

Evaluation and impact of descriptive metadata on academic event management in Ukraine: A quantitative study

Objective. The study aims to understand the impact of descriptive metadata in academic events. It focuses on the need for analytical frameworks that consider the events' characteristics and the interests of the participants. Design/Methodology/Approach. The article focuses on academic event management and metadata quality based on user preferences and feedback. It surveyed Ukrainian organizers and scholars between August and October 2022, analyzing the responses of 1,270 participants using descriptive statistics and qualitative analysis in RStudio. Results/Discussion. The survey showed that most (over 84%) of organizers and academics are dissatisfied with the metadata quality, with a third rating it as very bad. Frequent errors in metadata emphasized the need for better management, including a preference for using identifiers like ORCID and DOI and a preference for open access to information about academic events. Conclusions. The results highlight the importance of developing specialized tools for metadata management and standardization of metadata elements in Ukraine to facilitate organization and participation in academic events at national and international levels. Originality/Value. The study makes an important contribution to understanding descriptive metadata management in academic events in Ukraine, suggesting ways to improve efficiency in this area.

A Cone Beam CT Bronchoscopy Study of the Ultrathin Cryoprobe for Biopsy of Peripheral Lung Lesions.

Compared with the standard cryoprobe, the novel ultrathin 1.1mm cryoprobe (UTCP) has improved ergonomics, shape memory, and flexibility. The performance of UTCP has demonstrated promising results in several small trials. In this single-center, retrospective review, we examine 200 (N=200) consecutive patients referred for cone beam CT bronchoscopic biopsy of peripheral lung lesions. We utilized an extended multimodality approach, including transbronchial needle aspirate, brush, traditional forces biopsies, UTCP biopsies, and BAL. We analyzed tool in lesion, tool touch lesion, center strike rates, and diagnostic yield. We assessed for molecular adequacy and analyzed safety. A total of 222 lesions were biopsied. We achieved a tool in lesion or tool touch lesion confirmation for all biopsy attempts (100%) and a center strike rate of 68%. AQuIRE diagnostic yield was 90%, with 60% malignant, 30% benign lung nodules, and 10% nondiagnostic. UTCP was diagnostic in 3.6 % of peripheral lung lesions biopsies when all other modalities were nondiagnostic; thus, raising our overall diagnostic yield from 86.4% to 90.1%. Our analysis demonstrates superior adequacy for molecular analysis for histologic samples (TBBX or UTCP) versus cytologic samples (FNA) ( P <0.001). Three patients (1.5%) had a pneumothorax, and 1 patient (0.5%) had moderate bleeding. UTCP was diagnostic in 3.6% of peripheral lung lesions when all other modalities were nondiagnostic. In the setting of CBCT guidance, UTCP has a similar safety profile to standard biopsy tools. Future trials are warranted to assess UTCP and its impact on peripheral lung lesion biopsies.

Levels of adherence to treatment, illness perception and acceptance of illness in patients with coronary artery disease - descriptive and correlational study

BackgroundUnderstanding the disease and its acceptance significantly influence adherence to prescribed medications, a critical aspect in managing coronary artery disease (CAD). This study is designed to explore the multifaceted factors influencing medication adherence specifically in CAD patients. Of particular interest is investigating the interconnectedness between medication adherence, the perception of illness, and the level of acceptance of the illness itself among these individuals.MethodsThis cross-sectional study involved 280 confirmed CAD patients who were selected through a convenience sampling method adhering to predefined inclusion criteria. The study was conducted between March and September 2023. Three primary parameters—medication adherence, illness perception, and acceptance of illness—were evaluated using standardized tools: The Morisky Medication Adherence Scale-8, Illness Perception Questionnaire-Brief, and Acceptance of Illness Scale. Statistical analyses using SPSS (version 25) were used to analyze the data.ResultsPatients had moderate illness perception (51.82 ± 7.58) and low acceptance to illness (16.98 ± 4.75), and 61.8 of them adhered to their medication regimen. A positive relationship between acceptance of illness and medication adherence (r = 0.435, p-value < 0.01) was found. Level of education, type of drug and marital status had significantly impact on medication adherence, and gender, level of education, intention to stop drug and marital status were associated with acceptance of illness (p < 0.05).ConclusionThese results underscore the pivotal role of medication adherence in CAD management. Future interventions should target improving illness perception and acceptance of illness among CAD patients to enhance their overall adherence to prescribed medications and ultimately improve disease management.

Reexamining the Dolch Basic Sight Word List: Contemporary Considerations for Culturally Sustaining Approaches to Assess Sight Word Development

ABSTRACT The Dolch Basic Sight Word (DBSW) list has been considered the gold standard tool in schools to determine young readers’ sight word automaticity. It has not changed despite shifts in our lexical and language practices. Assessment tools need to be reexamined for culturally sustaining pedagogical approaches. This study examines how a high-frequency word list constructed from contemporary texts compares to the DBSW list. The study utilized a quantitative corpus linguistic design to construct a new contemporary high-frequency word (CHFW) list using popular American adult texts. Data analysis compared the CHFW list with the original DBSW list using Spearman’s rho for ranked correlation. Texts by authors of color (AoC) were also identified to compare how highly frequent words differed between the CHFW and DBSW lists. Results found correlation between the CHFW and DBSW lists ( ρ = .826) and suggests shifts in lexical and language practices within contemporary written texts. Examining an AoC text, correlation was evident between the DBSW list ( ρ = .800) and CHFW list ( ρ = .790) but displayed less correlation. Findings suggest that using DBSW to assess students’ sight word recognition is an inaccurate reflection of today’s contemporary texts and particularly those texts written by diverse authors.

Development and clinical empirical validation of the chronic critical illness prognosis prediction model.

The evolution of critical care medicine and nursing has aided and enabled the rescue of a large number of patients from numerous life-threatening diseases. However, in many cases, patient health may not be quickly restored, and the long-term prognosis may not be optimistic. In this study, we aimed to develop and validate a prediction model for accurate, precise, and objective identification of the severity of chronic critical illness (CCI) in patients. We used a retrospective case-control and prospective cohort study with no interventions. Patients diagnosed with CCI admitted to the ICU of a large metropolitan public hospital were selected. In the case-control study, 344 patients (case: 172; control:172) were enrolled to develop the prognosis prediction model of chronic critical illness (PPCCI Model); 88 patients (case:44; control: 44) in a prospective cohort study, served as the validation cohort. The discrimination of the model was measured using the area under the curve (AUC) of the receiver operating characteristic curve (ROC). Age, prolonged mechanical ventilation (PMV), sepsis or other severe infections, Glasgow Coma Scale (GCS), mean artery pressure (MAP), heart rate (HR), respiratory rate (RR), oxygenation index (OI), and active bleeding were the nine predictors included in the model. In both cohorts, the PPCCI model outperformed the Acute Physiology And Chronic Health Evaluation II (APACHE II), Modified Early Warning Score (MEWS), and Sequential Organ Failure Assessment (SOFA) in identifying deceased patients with CCI (development cohort: AUC, 0.934; 95%CI, 0.908-0.960; validation cohort: AUC, 0.965; 95% CI, 0.931-0.999). The PPCCI model can provide ICU medical staff with a standardized measurement tool for assessing the condition of patients with CCI, enabling them to allocate ward monitoring resources rationally and communicate with family members.

Markov modeling for cost-effectiveness using federated health data network.

To introduce 2 R-packages that facilitate conducting health economics research on OMOP-based data networks, aiming to standardize and improve the reproducibility, transparency, and transferability of health economic models. We developed the software tools and demonstrated their utility by replicating a UK-based heart failure data analysis across 5 different international databases from Estonia, Spain, Serbia, and the United States. We examined treatment trajectories of 47 163 patients. The overall incremental cost-effectiveness ratio (ICER) for telemonitoring relative to standard of care was 57 472 €/QALY. Country-specific ICERs were 60 312 €/QALY in Estonia, 58 096 €/QALY in Spain, 40 372 €/QALY in Serbia, and 90 893 €/QALY in the US, which surpassed the established willingness-to-pay thresholds. Currently, the cost-effectiveness analysis lacks standard tools, is performed in ad-hoc manner, and relies heavily on published information that might not be specific for local circumstances. Published results often exhibit a narrow focus, central to a single site, and provide only partial decision criteria, limiting their generalizability and comprehensive utility. We created 2 R-packages to pioneer cost-effectiveness analysis in OMOP CDM data networks. The first manages state definitions and database interaction, while the second focuses on Markov model learning and profile synthesis. We demonstrated their utility in a multisite heart failure study, comparing telemonitoring and standard care, finding telemonitoring not cost-effective.

The Synergistic Effects of Preterm Birth and Parent Gender on the Linguistic and Interactive Features of Parent-Infant Conversations.

To investigate the language environments experienced by preterm-born infants, this study compared the linguistic and interactive features of parent-infant conversations involving 2-year-old preterm- and term-born infants. The study also explored how mother-infant and father-infant conversations may be differentially affected by preterm/term birth status. Twenty-two preterm-born (< 37 weeks' gestation) and 25 term-born (≥ 37 weeks' gestation) 2-year-old infants engaged in dyadic mother/father-infant free-play interactions that were transcribed to quantify the linguistic (parental volubility, speech rate, lexical diversity, and morphosyntactic complexity) and interactive (infant/parent responsiveness, turn-taking, and conversational balance) features of parent-infant conversations. Language, cognitive, socioemotional, and executive function skills were assessed via standardized tools. Compared to the term group, the preterm group was characterized by lower maternal speech rate, parental lexical diversity, and parent-infant turn-taking, as well as greater mother-infant conversational balance. The preterm group presented poorer language and executive function skills when compared to the term group. Both similarities and differences exist between the language environments of preterm and term groups. Similarities may be due to the partial developmental catch-up of preterm-born infants (cognitive and socioemotional skills) and parental scaffolding. Differences may partly reflect a parental adaptation to the language and executive function difficulties of preterm-born infants. These findings suggest that researchers/clinicians should appraise the language environment with respect to the unique developmental needs of preterm/term-born infants. Future research directions are provided to advance a more holistic characterization of the language environment and a deeper understanding of the developmental significance of preterm-term differences in such environments. https://doi.org/10.23641/asha.25021931.

A scenario‐guided strategy for the future management of biological invasions

Future dynamics of biological invasions are highly uncertain because they depend on multiple social–ecological drivers. We used a scenario‐based approach to explore potential management options for invasive species in Europe. During two workshops involving a multidisciplinary team of experts, we developed a management strategy arranged into 19 goals relating to policy, research, public awareness, and biosecurity. We conceived solutions for achieving these goals under different plausible future scenarios, and identified four interrelated recommendations around which any long‐term strategy for managing invasive species can be structured: (1) a European biosecurity regime, (2) a dedicated communication strategy, (3) data standardization and management tools, and (4) a monitoring and assessment system. Finally, we assessed the feasibility of the management strategy and found substantial differences among scenarios. Collectively, our results indicate that it is time for a new strategy for managing biological invasions in Europe, one that is based on a more integrative approach across socioeconomic sectors and countries.

An Updated Review on Probiotic Production and Applications

Microorganisms are ubiquitous and have been exploited for centuries to generate primary and secondary metabolites essential for human welfare and environmental sustainability. Microorganisms occupy a prominent position in the industrial sector due to their unique properties, such as the limited time and space required for their growth and proliferation, as well as their easy manipulation of the genetic material. Among all the microorganisms, probiotics have grabbed the attention of researchers because of their nonpathogenic nature and immersive application in treating digestive ailments and vitamin deficiency, boosting immunity, and detoxifying harmful chemicals. Furthermore, probiotics are widely used to treat various diseases such as constipation, colon cancer, type 2 diabetes mellitus, and obesity, as well as a range of intestinal disorders, including inflammatory bowel disease, among others. The updated information on these diseases and the role of probiotics has not been updated in the past few years. The present review covers updated information on the role of probiotics in these topics. The growth of populations around the globe has attracted the attention of scientists, primarily investigating diverse technologies to meet the gap between probiotic production and demand. With the support of standardized tools and techniques, researchers have explored the potent probiotic strains feasible for industrial production and treating health ailments. In the current review, we have curated the potential information essential for the screening, strain selection, production, and application necessary for probiotic researchers.

Development and State of the Art of Entrepreneurship Education: A Bibliometric Review

Entrepreneurship education (EE) plays a vital role in fostering an entrepreneurial culture and promoting the growth of the small- and medium-sized business sector in a nation. Research on EE has advanced extremely rapidly in the last two decades. These changes are evident not only in the quantity of published works but also in the evolving methods of academic communication, the rise of emerging nations as prominent contributors to EE research, and the shifting areas of focus in study themes. This current study aims to provide a comprehensive picture of these processes based on a big-data-centred bibliometric analysis of a corpus of 3787 articles that appeared in the Web of Science literature database. The bibliographic metadata was analysed using Biblioshiny, CitNetExplorer, and VOSviewer. To understand the most significant development trends, researchers employed the triangulation method, which included scientific mapping and epistemological analysis in addition to standard tools of bibliometric analysis. This has led to the identification of some study needs. First, improving EE methods in secondary school curricula; second, EE in adult education and the practicality of the findings for andragogy; third, EE in least developed countries and its unique challenges; fourth, combining EE with internet-based, innovative training and education approaches like gamification and simulations; fifth, EE’s role and methodological development in societal economic integration; and sixth, women’s unique EE requirements. On top of that, this study provides the basis for policymakers and practitioners to consider incorporating entrepreneurial education programmes, which can help to create a prosperous entrepreneurial ecosystem.

Mediating Effect of Self-Efficacy in Pain Management between Knowledge and Attitude of Pain toward Pain Management Practice among Nurses in Indonesia

Nurses' knowledge and attitudes significantly influence pain management practices. Higher levels of self-efficacy in pain management are associated with improved pain. This study explored the relationships between nurses’ knowledge and attitudes toward pain, self-efficacy in pain management, and actual pain management practices. This study employed a cross-sectional study which conducted at Sultan Agung Islamic Hospital, Indonesia, involving 249 nurses selected based on predefined criteria. Participants responded to an online survey encompassing demographic queries and standardized tools, namely the Knowledge and Attitude Survey Regarding Pain (KASRP-IDN), the Pain Management Self-Efficacy Questionnaire (PMSEQ-IDN), and the Nurse Behavior Questionnaire in Pain Management (NBQ-P). Mediation analysis was further conducted using the PROCESS add-on to discern the mediating effect of self-efficacy in pain management between knowledge and attitude of pain toward pain management practice among nurses. The study showed significant positive relationships among Knowledge and Attitude Survey Regarding Pain (KASRP), Pain Management Self-Efficacy (PMSE), and Pain Management Practice. However, the mediation analysis depicted that self-efficacy exerted a relatively modest mediating effect between KASRP and pain management practice (K2=0.17, CI= 0.05-0.27). The findings manifest the positive associations between knowledge-attitude regarding pain, self-efficacy in pain management, and pain management practices among nurses. In the future, in-service programs related to pain management should increase the nurses’ knowledge and attitude and enhance their confidence, resulting in actual practice in pain management. However, the mediation effect of self-efficacy is modest, indicating the plausible existence of other contributory variables or factors warranting further exploration and elucidation.

Correlation between Pre-Operative Myocardial Fibrosis and Early Post CABG Dysrhythmia

Background: Cardiac magnetic resonance (CMR) imaging combines the assessment of both the functional and structural aspects of the heart in order to identify the existence, timing, and intensity of ischemic heart disease by analyzing the function of the myocardium and the movement of the heart wall. This study aimed to investigate whether preoperative myocardial fibrosis, measured by CMR imaging, may be used to predict the incidence of rhythm disturbances in the early postoperative phase after coronary artery bypass grafting (CABG) surgery.&#x0D; Methods: Two groups of 92 patients who had CABG procedures performed were studied in this retrospective observational single site cohort study: There were 43 patients in Group A who had atrial or ventricular arrhythmia, and 49 patients in Group B who did not.&#x0D; Results: There was no correlation between arrhythmia and non-arrhythmia group and age, sex, body mass index, risk factor, CMR timing before surgery, cross clamp time, bypass time, left ventricular end-diastolic volume index (LV EDVI), LV end-systolic volume index (ESVI), stroke volume index (SVI), LV ejection fraction (EF) and territory of scar and were positive correlation between both groups and scar (P &lt;0.001). Scar% was an independent predictor of occurrence of rhythm disturbance (P=0.002) while LV EDVI, LV EF, LV ESVI, SVI, and presence of scar were not. Group A had a statistically significantly lower LV-EF% and lower LV-SVI compared to Group B. Group A had a higher scar percentage compared with group B and this was statistically significant (P &lt;0.001). Rhythm disturbance occurred more often in patients with a scar percentage &gt;14.8% {P=0.0002 and area under ROC curve (AUC)=0.708}.&#x0D; Conclusions: CMR has evolved as a gold standard non-invasive imaging tool in cardiovascular medicine. Preoperative CMR imaging may be a promising tool for predicting postoperative cardiac arrhythmia after CABG. Our study showed that preoperative myocardial scarring &gt;14.8%, as determined by CMR imaging, was predictive of early postoperative arrhythmia in patients undergoing CABG.

Respiratory extracorporeal membrane oxygenation : From rescue therapy to standard tool for treatment of acute respiratory distress syndrome?

The use of extracorporeal membrane oxygenation (ECMO) for patients with acute respiratory distress syndrome (ARDS) has increased substantially. With modern trials supporting its efficacy, ECMO has become an important tool in the management of severe ARDS. The objectives of this paper are to discuss ECMO physiology and configurations used for patients with ARDS, review evidence supporting the use of ECMO for ARDS, and discuss aspects of management during ECMO. Current evidence supports the use of ECMO, combined with an ultra-lung-protective approach to mechanical ventilation, in patients with ARDS who have refractory hypoxemia or hypercapnia with severe respiratory acidosis. Furthermore, data suggest that center volume and experience are important factors in the care of patients receiving ECMO. The use of extracorporeal technologies in expanded patient populations and the optimal management of patients during ECMO remain areas of investigation. This article is freely available.