Strong Recommendations Research Articles

Pediatric Coronavirus Disease 2019 Vaccine Experiences, Practices, and Attitudes in Rural Primary Care Clinicians

ObjectivePediatric coronavirus disease 2019 (COVID-19) vaccination rates remain low in rural areas. A strong clinician recommendation improves vaccine uptake, but the pediatric COVID-19 vaccine recommendation practices of rural primary care clinicians have not been reported. Our objectives were to describe, among rural Colorado pediatric clinicians: 1) recommendation practices for COVID-19 vaccine compared to influenza and school-entry required vaccines, and 2) personal attitudes. MethodsFrom July to October 2023, surveys were distributed to clinicians in rural Colorado identified as pediatric vaccine providers in counties designated as rural through the Colorado Immunization Information System using mail and email. ResultsOf 89 survey respondents, 37% of clinicians strongly recommended COVID-19 vaccines for children 6 months–5 years old, compared to 79% for influenza (P = 0.05) and 92% for school-entry required vaccines (P = 0.04). For children 6–11 and 12–17 years old, 43% and 44% of clinicians strongly recommended COVID-19 vaccines, respectively, compared to 71% and 70% for influenza (P < 0.01), and 91% for school-entry required vaccines (P < 0.01). Forty four percent of clinicians agreed that COVID-19 vaccines are important for pediatric patients. The most common clinician-perceived challenges to discussing pediatric COVID-19 vaccines included a lack of parent interest in more information (76% “somewhat” or “strongly” agree), lack of ability to change parents’ minds (71%), and concerns that the vaccines are too political (40%). ConclusionsMost rural Colorado clinicians do not strongly recommend pediatric COVID-19 vaccines compared to influenza and school-entry required vaccines. Efforts to improve pediatric COVID-19 vaccine uptake should aim to strengthen clinicians’ recommendations of these vaccines.

Development and Update of Guideline-based Quality Indicators in Lung Cancer

Abstract Background In 2022, an update of the German lung cancer guideline, first published in 2010 and revised in 2018, was released. This article aims to show the process of updating, developing, and implementing guideline-based quality indicators (QI) into the certification system for lung cancer centers (LCC). Methods A multidisciplinary and interprofessional working group revised the guideline QIs from 2018 using the strong recommendations of the guideline update, a systematic review for QIs, and the results of the implemented QIs from LCC. Results For 4 out of 8 indicators from the 2018 guideline, the LCC showed an improved implementation of the requirements in the last 3 years (2018–2020). For 3 indicators, the median of the results was constant at a very high level (≥96% or 100%). Only the “adjuvant cisplatin-based chemotherapy” indicator showed declining values between 2018 and 2020. The target values and plausibility limits were well achieved by LCC. After updating the guideline, one QI from 2018 was not included in the new QI set due to the small denominator population. Based on the new strong recommendations, 8 new QIs were defined. From the QI set of the guideline update, 13 of 15 indicators (7 since 2018 and 6 from 2022 on) were adopted into the certification program. Conclusions The guideline recommendations are implemented by LCC at a high level. The process presented confirms the successful implementation of the so-called quality cycle in oncology. The QIs developed by the German Guideline Program in Oncology (GGPO) are adopted by the certification program. The implementation of the QI is measured in LCC, evaluated by the German Cancer Society (DKG), and reflected back to the GGPO. The “real world” data have led to the deletion of one QI and show a high implementation of most QIs in LCC.

2024 Update to the 2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures.

This document describes performance measures for heart failure that are appropriate for public reporting or pay-for-performance programs and is meant to serve as a focused update of the "2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures." The new performance measures are taken from the "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines" and are selected from the strongest recommendations (Class 1 or Class 3). In contrast, quality measures may not have as much evidence base and generally comprise metrics that might be useful for clinicians and health care organizations for quality improvement but are not yet appropriate for public reporting or pay-for-performance programs. New performance measures include optimal blood pressure control in patients with heart failure with preserved ejection fraction, the use of sodium-glucose cotransporter-2 inhibitors for patients with heart failure with reduced ejection fraction, and the use of guideline-directed medical therapy in hospitalized patients. New quality measures include the use of sodium-glucose cotransporter-2 inhibitors in patients with heart failure with mildly reduced and preserved ejection fraction, the optimization of guideline-directed medical therapy prior to intervention for chronic secondary severe mitral regurgitation, continuation of guideline-directed medical therapy for patients with heart failure with improved ejection fraction, identifying both known risks for cardiovascular disease and social determinants of health, patient-centered counseling regarding contraception and pregnancy risks for individuals with cardiomyopathy, and the need for a monoclonal protein screen to exclude light chain amyloidosis when interpreting a bone scintigraphy scan assessing for transthyretin cardiac amyloidosis.

O43 ADHERENCE OF CLINICIANS TO HYPERTENSION CLINICAL PRACTICE GUIDELINES: A MULTICENTER CROSS SECTIONAL STUDY

Background: Hypertension is the cardiovascular risk factor that accounts for most preventable deaths worldwide. Implementation of clinical practice guidelines (CPG) reduces variability in care and improves outcomes. In Colombia, clinicians’ adherence to recommendations is rarely reported. The aim of this study was to assess the adherence of clinicians to hypertension CPG in out-patient clinics from Bogotá. Methods: we performed a cross-sectional study as part of the baseline measurement of a cluster randomized trial. A panel of experts selected seven prioritized recommendations from the Colombian hypertension CPG. Clinicians from 5 health-care institutions in Bogotá, Colombia, who voluntarily accepted to participate were included. We consulted electronic health-records of a consecutive sample of patients with hypertension treated by the participating clinicians to evaluate the applicability of, and adherence to, selected recommendations. Results: The 37 clinicians included had a mean age of 36.9 years, 54.05% were male, most of them general physicians (83.7%) and the mean clinical experience was 10.5 years. Evaluation of 4872 recommendations by reviewing health-records from 696 patients (67% female, mean age 68.5 years, 51.5% less than 5 years since diagnosis) showed an overall applicability of 21.3% (CI95% 20.1-22.4%) and adherence was 29.1% (CI95% 26.3-37.9%). We identified a significant variation in adherence between recommendations, being highest for treating with combination of antihypertensive medications for stage 2 hypertension (58.7%) and lowest for proteinuria screening (7.8%) (figure 1). Adherence was better in male clinicians (25% vs 32%, p=0.008) and those with more clinical experience (35% for &gt;10 years of experience vs 26% for &lt;10 years of experience, p=0.014). Also, clinicians were more adherent to recommendations related to treatment with moderate certainty of evidence (39.5%), compared to those on screening with high certainty (15.2%). Conclusions: in a sample of physicians practicing in Bogotá, adherence to strong recommendations from the Colombian hypertension CPG varied greatly by clinicians’ sex, clinical experience and the type of recommendations, and was overall poor.

Inadequate Evidence for Acupuncture as an Alternative or Adjunct to Antidepressants/Psychotherapy for Postpartum Depression: A Bayesian Systematic Review and Network Meta-Analysis.

Acupuncture is popular in the treatment of mental illness. This study determined its feasibility and role in managing postpartum depression (PPD) using a network meta-analysis. We systematically searched seven databases up to May 2024 for randomized controlled trials (RCTs) appraising acupuncture's efficacy and safety against waitlist-control, placebo, standard control, or as an add-on treatment. Cochrane criteria were followed. Thirteen studies encompassing 872 participants underwent analysis. Both pairwise and network meta-analysis indicated that acupuncture, psychotherapy, and antidepressants were comparable in clinical efficacy rate and in reducing Hamilton Depression Scale and Edinburgh Postnatal Depression Scalescores. Acupuncture and psychotherapy also effectively mitigated concurrent anxiety symptoms. Combining acupuncture with antidepressants augmented therapeutic efficacy and reduced reported gastrointestinal adverse effects associated with antidepressant use. Acupuncture combined with psychotherapy offered similar benefits with superior safety profile. However, the quality of evidence ranged from very low to low due to significant risks of bias and limited sample sizes. The efficacy of psychotherapy and the combination of acupuncture and psychotherapy might be underestimated, as most RCTs used supportive therapy or individual counseling as positive controls instead of recommended approaches like interpersonal psychotherapy (IPT) or cognitive behavioral therapy (CBT) per PPD guidelines. Current evidence precludes strong recommendations of administering acupuncture in PPD. Rigorous RCTs are essential to validate promising outcomes observed in comparisons between acupuncture, antidepressants, and their combined application. It remains inconclusive whether acupuncture's antidepressive effect is specific or non-specific. Given that psychotherapy is a recommended first-line treatment, investigating the potential efficacy enhancement of combining acupuncture with IPT/CBT is paramount to ascertain the preferred therapeutic approach for PPD.

Everyone should have their own midwife: Women’s and staff experiences during the implementation of two midwifery continuity of care models in regional Australia

ProblemMidwifery Continuity of Care (MCoC) remains inaccessible for most Australian women; this is especially true in rural and regional areas. BackgroundStrong evidence demonstrates MCoC models improve experiences for women and their babies and are also shown to improve midwifery workforce wellbeing. However, implementation and upscale remains limited. AimTo explore the views and experiences of implementing MCoC for both staff and women, understanding their experiences, concerns and solutions in a regional context. MethodsQualitative data was collected via focus groups with women and healthcare staff, at six and twelve month post implementation. Data was thematically analysed using Braun and Clarke six step process. FindingsThe findings support that ‘women love it’ and midwives working in the new MCoC model ‘loved their job’. The major concern was that not all women could access the model and disconnected communication was problematic during implementation. ‘Sharing stories’ was a solution to overcoming these issues and promoting the positive impact of MCoC - in particular ways of working and adaption to an all-risk midwifery group practice. DiscussionThis study supports widespread evidence that MCoC is valued by both women and staff. In a regional context it is important to recognise challenges faced during implementation and identifying solutions that other maternity services could consider when implementing MCoC. ConclusionThe study offers strong recommendation for regional areas to consider MGP to maintain safe, quality local maternity services.

Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders.

Literature review with clinical recommendations. To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice.

User expectations and experiences of an assistive robotic arm in amyotrophic lateral sclerosis: a multicenter observational study

ObjectiveRobotic arms are innovative assistive devices for ALS patients with progressive motor deficits of arms and hands. The objective was to explore the patients´ expectations towards a robotic arm system and to assess the actual experiences after the provision of the device.MethodsA prospective observational study was conducted at 9 ALS centers in Germany. ALS-related functional deficits were assessed using the ALS-Functional Rating Scale-revised (ALSFRS-R). Motor deficit of the upper limbs was determined using a subscore of three arm-related items of the ALSFRS-R (items 4–6; range 0–12 points). User expectations before provision (expectation group, n = 85) and user experiences after provision (experience group, n = 14) with the device (JACO Assistive Robotic Device, Kinova, Boisbriand, QC, Canada) were assessed.ResultsIn the total cohort, mean ALSFRS-R subscore for arm function was 1.7 (SD: 2.0, 0–9) demonstrating a severe functional deficit of the upper limbs. In the expectation group (n = 85), the following use cases of the robotic arm have been prioritized: handling objects (89%), close-body movements (88%), pressing buttons (87%), serving drinks (86%), and opening cabinets and doors (85%). In the experience group (n = 14), handling objects (79%), serving drinks (79%), near-body movements (71%), pushing buttons (71%), serving food (64%), and opening doors (64%) were the most frequent used cases. Most patients used the device daily (71.4%, n = 10), and 28.6% (n = 4) several times a week. All patients of the experience group found the device helpful, felt safe while using the device, and were satisfied with its reliability. NPS of the assistive robotic arm revealed 64% "promoters" (strong recommendation), 29% "indifferents" (uncertain recommendation) and 7% "detractors" (no recommendation). Total NPS was + 57 demonstrating strong patient satisfaction.ConclusionsInitiation of procurement with a robotic assistive arm was confined to patients with severe functional deficit of the upper limbs. User experience underlined the wide spectrum of use cases of assistive robotic arms in ALS. The positive user experience together with high satisfaction underscore that robotic arm systems serve as a valuable treatment option in ALS patients with severe motor deficits of the arms.

Disciplinary vocabulary and mastery of educational objectives in first-grade

BackgroundIn contrast with general academic words, disciplinary academic words have been less studied, in particular their frequency in educational materials and their contribution to educational outcomes in the early grades; therefore, there are no strong scholarly recommendations about teaching these words to young students. A better understanding of the importance of these words for young learners may complement our understanding of vocabulary's role in education and learning, as well as support the development of more effective interventions. AimsTo measure the contribution of children's knowledge of science and social studies disciplinary words to their mastery of educational objectives. SampleOne-hundred-and-seventy-four Chilean first-grade students in 26 schools. MethodsWe identified the general academic and disciplinary vocabulary present in 272 science and social studies materials. Using frequency and pedagogical criteria, we selected a set of science and social studies words, as well as general academic words, and assessed their knowledge in 174 Chilean first graders. Later we administered tests of the children's mastery of educational objectives in the two subjects. Using mixed-effects regression analyses, we examined the contribution of each type of word to mastery of educational goals. ResultsDisciplinary words were frequent in first-grade materials, but only science, not social studies words, had a significant contribution to children's mastery of the educational objectives after controlling for general vocabulary, general academic vocabulary, and working memory. ConclusionsDisciplinary words are frequent, and science words specifically are relevant for first-grade educational objectives. Vocabulary interventions should include both general academic and disciplinary words.

Adherence to Secondary Prevention Measures after Acute Myocardial Infarction and Its Impact on Patient Outcome-A Nationwide Perspective.

Objectives: Secondary prevention is crucial for reducing morbidity and mortality in patients following acute myocardial infraction (MI). However, adherence to cardiac rehabilitation (CR) and pharmacotherapy remains suboptimal despite strong guideline recommendations. This study investigated the adherence to CR, dual antiplatelet therapy (DAPT), and statins following acute MI and evaluated their impact on patient outcomes from a nationwide perspective in Austria. Methods: In this national observational study, all patients diagnosed with acute MI, defined as STEMI or NSTEMI, between April 2011 and August 2015 in Austria were included. Patient characteristics and comorbidities were derived from the Austrian national health insurance system using ICD-10 codes. Adherence to CR, high-intensity statins, and DAPT was assessed based on health insurance records and pharmacy prescription submissions. Cox Regression hazard analysis was used to explore the impact of non-adherence to CR on mortality. Results: Among 16,518 acute MI patients, only 13.4% adhered to the recommended CR programs, which was associated with a significantly lower risk of mortality (adjusted hazard ratio [HR] 0.73; 95% CI: 0.54-0.98; p = 0.036). In contrast, 66.4% of 23,240 patients did not comply with high-intensity statin therapy, correlating with an increased mortality risk (adjusted HR 1.16; 95% CI: 1.06-1.25; p < 0.001). Furthermore, among 22,331 patients analyzed for DAPT adherence, only 29.3% followed the guidelines, yet this adherence was linked to a 21% reduction in mortality over the observation period (adjusted HR 0.79; 95% CI: 0.72-0.88; p < 0.001). Conclusions: This nationwide study reveals alarmingly low adherence to CR and secondary preventive medications among acute MI patients, which is significantly linked to higher mortality rates. Enhanced efforts to promote awareness and adherence are crucial, involving structured referrals and personalized follow-ups to improve patient outcomes. Addressing these gaps through comprehensive healthcare strategies could substantially enhance cardiovascular health.

National Vaccination Coverage Among Adolescents Aged 13-17 Years - National Immunization Survey-Teen, United States, 2023.

Based on safety and efficacy data, vaccinations are the best defense to protect persons and communities from serious vaccine-preventable diseases. The Advisory Committee on Immunization Practices recommends routine vaccination of adolescents aged 11-12 years with three vaccines including tetanus, diphtheria, and acellular pertussis vaccine; quadrivalent meningococcal conjugate vaccine; and human papillomavirus vaccine. CDC analyzed data from the 2023 National Immunization Survey-Teen for 16,658 adolescents aged 13-17 years (born during January 2005-December 2010) to assess vaccination coverage in 2023, recent trends in coverage by birth year, and trends in coverage by eligibility for the Vaccines for Children (VFC) program and birth year. In 2023, coverage with all routine vaccines recommended for adolescents was similar to coverage in 2022. Vaccination coverage among VFC-eligible adolescents was generally stable during the COVID-19 pandemic, except for a decrease in the percentage of VFC-eligible adolescents who were up to date with HPV vaccination by age 13 years among those born in 2010 compared with those born in 2007. Whereas coverage differences were found between VFC-eligible and non-VFC-eligible adolescents before the COVID-19 pandemic, coverage was similar among the most recent birth years in the survey. Providers should make strong recommendations for all routine vaccines and review adolescent vaccination records to verify if adolescents are up to date with all recommended vaccines.

Exploration of clinical ethics consultation in Uganda: a case study of Uganda Cancer Institute

IntroductionGlobally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESSs) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence about mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda.MethodsThis phenomenological qualitative study utilized in-depth interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook.ResultsThe study revealed there was no formal committee or mechanism dedicated to resolving ethical dilemmas at the UCI. Instead, ethical dilemmas were addressed in six forums: individual consultations, tumor board meetings, morbidity and mortality meetings (MMMs), core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas.ConclusionThe fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.

A systematic review and meta-analysis of ketamine in pediatric status epilepticus.

Status epilepticus (SE) is a common neurological medical emergency in the pediatric population, with 10%-40% of cases progressing to refractory SE (RSE), requiring treatment with anesthetic infusions. We present a systematic review and meta-analysis of the use of ketamine for the treatment of pediatric SE and its potential advantages over other anesthetic infusions. This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Electronic databases, including PubMed, Cochrane Library, Ovid, Embase, and Google Scholar, were searched with the keywords "pediatrics," "status epilepticus," and "ketamine treatment." Randomized trials, prospective and retrospective cohort studies, and case reports were considered for inclusion. Eighteen publications met the initial inclusion criteria. The 18 publications comprise 11 case reports, one nonconclusive clinical trial, two case series, and four retrospective cohorts. After excluding the case reports because of reporting bias, only the six case series and cohorts were included in the final analysis. There were 172 patients in the six included studies. The weighted age was 9.93 (SD = 10.29) years. The weighted maximum dose was 7.44 (SD = 9.39) mg/kg/h. SE cessation was attained in 51% (95% confidence interval = 43-59) of cases with the addition of ketamine. The heterogeneity was I2 = 0%, t2 = 0, χ2 (5) = 3.39 (p = .64). Pediatric RSE is difficult to treat, resulting in increased morbidity and mortality. Without strong recommendations and evidence regarding preferred agents, this review provides evidence that ketamine may be considered in managing SE in the pediatric population.

An Update on the Independent Plastic Surgery Match (2019-2022): Trends, Predictors, and Program Leaders' Perspectives.

A previous study by the authors noted a decline in independent plastic surgery residency programs and rising applicant participation. This study provides updates on match trends and influential predictors, and gathers program leaders' views on the future of the independent track. Match data (2019-2022) were obtained from the San Francisco match after American Council of Educators in Plastic Surgery approval. Variables influencing match success were analyzed, and program leaders were surveyed about desirable applicant traits and program trajectories. From 2019 to 2022, 243 of 428 applicants matched. Programs and positions declined by 10% and 9.5%, respectively. Applicants rose to 42.3%, but match rates fell from 82% to 56%. Osteopathic graduates doubled, whereas international graduates increased to 53.8%. Successful matches were associated with US allopathic medical school graduates, university-affiliated general surgery residencies, eight or more interviews, United States Medical Licensing Examination scores greater than 230, and high post graduate year (PGY)1-3 American Board of Surgery In-service Training Examination scores (PGY1-64.7%, PGY2-61.2%, PGY3-60.7%; P < 0.05). Of surveyed programs, 55.6% aimed to continue running the independent track in the next year. Conversely, 7.4% planned to discontinue in the next year, 22.2% within 2-5 years, 7.4% within the next decade, and 7.4% were unsure. Although support for the independent plastic surgery track remains, program participation diminishes as applicant interest increases, intensifying match challenges. Increasing number of interviews improves match potential. Program leaders display varied commitments, with looming plans for some programs to discontinue offering this track. Applicant evaluation pivots on strong recommendations, research, and test scores.

Effect of blended NPS fertilizer and cattle manure on soil property and hot pepper productivity in Jabi Tehnan Ethiopia

Hot pepper is one of the most important spice vegetable crops in Ethiopia and is widely cultivated for dry pod production. However, its productivity is low in Ethiopia due to degraded soil fertility and an unbalanced nutrient supply in the soil. An experiment was conducted to evaluate the effect of NPS fertilizer and cattle manure (CM) on soil chemical properties and hot pepper dry pod yield under irrigation in Jabi Tehnan. This experiment was arranged in factorial combinations of four NPS fertilizer (0, 100, 200, and 300 kg ha−1) and four CM (0, 5, 10, and 15 t ha−1) levels in a randomized complete block design with three replicates. Soil chemical properties, hot pepper phenology, growth, yield, and yield-related traits were recorded and analyzed using SAS software version 9.4. The main and interaction effects of NPS and CM fertilizers had a significant effect on soil chemical properties, hot pepper phenology, growth, yield, and yield-related traits. The combination of NPS fertilizer and CM significantly increased soil chemical properties and hot pepper traits. However, soil chemical properties and hot pepper yield traits showed a somewhat decreasing trend as the combination levels of two fertilizers further increased. The highest marketable (2.90 t ha−1) and total dry pod yield (2.99 t ha−1) were produced at the combination of 200 kg NPS ha−1 and 15 t CM ha−1. However, the partial budget analysis showed that the combination of 200 kg NPS ha−1 and 10 t CM ha−1 had the highest net benefit with an acceptable MRR and can be recommended for profitable hot pepper dry pod production in the study area. However, the experiment was limited to a single location and variety; it should be repeated at multiple locations over the seasons to make a strong recommendation.

The Ravaging Effects of Online Gambling on The Social Functioning of Male Breadwinners In African Families

This systematic review examines the ravaging effects of online gambling on the social functioning of male breadwinners in African families. Online gambling negatively impacts the social functioning of male breadwinners in African families. The researcher realized that online gambling among male African breadwinners leads to habitual neglect of the family and deterioration in socialization. As a result, the way African families function socially is often changed negatively by the male gambler's behaviour. Additionally, because these men are seen as the heads of the families and superiors in their communities, families are further burdened as they fear confronting the situation. The researcher adopted the PRISMA methods for this paper. Based on their excellent reputation and strong recommendations, the researcher used the following scientific search databases to gather data for this study: Google Scholar; Taylor and Francis; Scopus, ScienceDirect, and ResearchGate. The researcher gathered 23 peer-reviewed journal articles, published between 2011 and 2024, and verified them after screening to ensure the study's eminence. Online gambling is growing daily across the globe, particularly in African continents. Some families rely on online gambling for survival due to the poverty rate and high unemployment among African communities. Male breadwinners are opting for online gambling to support their families financially despite its addictive nature and lack of monitoring in many parts of Africa. Because online gambling is so addictive, some male breadwinners find that they spend less time with their families, being more focused on gaming. This study is pivotal as it creates awareness in African continents about the ravaging effects of online gambling among male breadwinners. This study can be further expanded by focusing on African continents, especially in South Africa, where online gaming has been recorded as high in the past few years among males.

European Network for Optimization of Veterinary Antimicrobial Therapy (ENOVAT) guidelines for antimicrobial use in canine acute diarrhoea

Acute diarrhoea is a common presentation in dogs, and a common reason for antimicrobial prescription and nutraceutical use. This evidence-based guideline provides recommendations for antimicrobial and probiotic treatment of canine acute diarrhoea (CAD). A multidisciplinary panel developed the recommendations by adhering to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The opinions of stakeholders (general veterinary practitioners and dog owners) were collected and incorporated to ensure the applicability of this guideline. Four strong recommendations informed by high certainty evidence, and three conditional recommendations informed by very low or low certainty evidence, were drafted by the panel, along with an ungraded section on diagnostic work-up of dogs with acute diarrhoea. The ENOVAT guidelines initiative encourages national or regional guideline makers to use the evidence presented in this document, and the supporting systematic review, to draft national or local guidance documents.

Adopting a systems engineering approach to a feasibility study of a sidings development at the Midsomer Norton railway station

It is planned to reopen Midsomer Norton railway station, which is a station on the Somerset &amp; Dorset Heritage Railway Line, to traffic. As a first step, Midsomer Norton will be a terminus, and it is proposed to build sidings and a depot for the trains that terminate there. However, a ground investigation is essential before commencing construction of the sidings and the depot, as this is a vital part of any civil engineering process. The behaviour of the ground must be known in order for a structure to be supported by it; therefore, data from the ground investigation are used as reference for any kind of structure development. This study covers a site investigation that includes a desk study, walkover survey, sampling and laboratory testing in order to ascertain the feasibility of a suitable design. Moisture content testing, liquid limit and plastic limit tests, standard compaction testing, shear vane tests, and triaxial compression tests were carried out to determine the soil characteristics and to analyse the soil behaviour. A strong recommendation was made to follow a systems engineering approach in the construction phase, as well as in the design stage. The dependability of the system is ensured by the good use of V – process of systems engineering.

Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Understanding and Setting Treatment Expectations for Patients With Metastatic Spine Tumors.

Literature review with clinical recommendation. A concise curation of the latest spine literature exploring the relationship between expectations and satisfaction for patients with metastatic spinal disease (MSD). Deliver recommendations to practicing clinicians regarding interpretation and utilisation of this evidence. The latest spine literature in the topic of factors affecting the expectations of patients with MSD was reviewed and clinical recommendations were formulated. Recommendations are graded as strong or Conditional. 5 articles were selected. Article 1: risk factors for the development of dissatisfaction from a cohort of 362 MSD patients. Strong recommendation to incorporate risk factor assessment when considering treatment. Article 2: systematic review assessing the relationship between pre-operative patient expectations and subsequent satisfaction in allied disciplines. Conditional recommendation to optimize patient expectation to positively modify patient satisfaction. Article 3: qualitative study of how clinicians, from different specialties, counsel patients with MSD pre-treatment. Strong recommendation to use a multidisciplinary approach. Article 4 qualitative study of how MSD patients experience their pre-treatment counselling and how that affected their appreciation of treatment success. Conditional recommendation to furnish patients with tailored, expected outcomes in the context of systemic progression. Article 5 Design and validation of a pre-treatment questionnaire specific to MSD. A conditional recommendation to incorporate this questionnaire in clinical and research MSD practice. Patients with MSD are approaching end of life care and high levels of treatment satisfaction are crucial at this juncture. The role of expectation management and comprehensive counselling is critical.

Quantifying Stated Preferences for Meningococcal Vaccines Among Adolescents/Young Adults and Parents of Adolescents in the United States: A Discrete Choice Experiment.

Invasive meningococcal disease (IMD) is a severe and life-threatening disease. In the United States (US), vaccine coverage with MenACWY and MenB meningococcal vaccines is suboptimal among adolescents/young adults aged 16-23years. A combined meningococcal vaccine (MenABCWY) could increase convenience (e.g., fewer injections) and improve coverage. The objective was to quantify preferences for hypothetical meningococcal vaccine profiles among adolescents/young adults and parents. An online discrete choice experiment was conducted among 16- to 23-year-olds, and parents of 16- to 18-year-olds. Attributes (3×4) and levels (1×2) were based on the literature and focus groups. Participants made ten pair-wise forced trade-off choices, systematically varied using a D-optimal design. Random parameter logit quantified the relative importance of vaccination attributes and estimated the trade-offs. Differences in preferences by subgroups were assessed. Totals of 300 adolescents and young adults (median age 20years) and 300 parents (median age 46years) completed the survey. Overall, 89.6% of 16- to 23-year-olds and 69.1% of parents preferred a simplified hypothetical meningococcal vaccination profile, e.g., with fewer injections (3 vs. 4) and fewer healthcare provider (HCP) visits (2-3 vs. 4). Having HCP advice and clear Centers for Disease Control and Prevention recommendations impacted vaccination choice, with both groups reporting high trust in HCP information (83.3% among 16- to 23-year-olds; 98.7% among parents). Barriers to vaccination included lack of HCP advice or awareness of meningococcal vaccines, and income level and out-of-pocket costs for parents. Adolescents/young adults and parents demonstrated a significant preference for a meningococcal vaccine that is more convenient (such as combined MenABCWY). Parents' vaccination preferences differed by income level and out-of-pocket costs, suggesting financial barriers to vaccination may exist which could result in IMD prevention inequalities. Findings from this study provide important information to support patient-facing informed policy discussions. A simplified vaccination schedule and strong recommendation could help improve vaccine uptake, schedule compliance, disease prevention, and reduce inequalities in IMD risk and prevention. A graphical abstract is available with this article.