Assessment Tool Research Articles

Teaching medical ethics and medical professionalism in Saudi public and private medical schools.

Medical ethics and professionalism are two essential parts of building up the identity of a competent physician. This study was conducted to determine the nature, content, and methods of medical ethics and professionalism education in Saudi public and private medical schools. It also sought to identify the challenges and obstacles in teaching and assessing medical ethics and professionalism and suggest appropriate changes. A cross-sectional study was carried out in Saudi private and public medical schools. To achieve the study's aim, an assessment tool in the form of a novel self-administered questionnaire was developed, piloted, and then used. A representative from each of the 28 Saudi medical schools participated in the study. Twenty-four (82.1%) responding medical schools have no medical ethics department. Most of the medical schools (64.2%) have 25% or less of their faculty staff who teach ethics holding a qualification in medical ethics. Most schools have a specific course for medical ethics and professionalism (85.7% and 57.1%, respectively). Multiple-choice questioning is the most popular assessment method in medical ethics and professionalism courses (89.3% and 60.7%, respectively). The need for more qualified staff and clear guidelines/resources is a significant drawback to the teaching of medical ethics. Therefore, the study recommends developing national guidelines dedicated to the undergraduate teaching curriculum from which courses would be designed to enhance medical ethics and medical professionalism.

Development of Method for the Measurement of Dermal Exposure on a Lifelike Cow Dummy to Assess the Risk of Using a Urease Inhibitor (Atmowell®) to Reduce NH3 Emissions in Cattle Farming

Up to 58% of NH3 emissions can be reduced through the use of the urease inhibitor Atmowell® in cattle farming. Automated manure scraper and drag hose systems should be used to apply urease inhibitors (UIs) to stable floors. Proof of safe use is also needed. A risk assessment of the urease inhibitor PPDA was conducted utilising estimated and calculated exposure data along with established and verified model calculation tools. Risk assessment models can be improved using measured dermal exposure data. The fluorescent dye pyranine and a Tyvek® collector were used to measure exposure. Tyvek® was attached to a lifelike cow dummy. Regarding the drag hose system, two worst-case scenarios were considered: over the cow and passing the cow. Regarding the robot application system, a 0 m frontal scenario was considered. The over the cow scenario exhibited the highest dermal exposure, with 1.5 mg of PPDA/cow per application run. The robot scenario exhibited the smallest amount, with 0.8 mg of PPDA/cow per application run. The risk of using PPDA was already excluded by model calculation tools in a risk assessment. Compared with the estimated and calculated dermal exposure values, the measured dermal exposure levels were reduced by a factor of two to six.

Border Defence Mechanism Using Deep Learning Technique

In response to escalating concerns regarding potential border airstrikes, this paper introduces an advanced deep-learning model that utilizes Convolutional Neural Networks (CNNs) for accurate military aircraft classification. Functioning as a pivotal tool for proactive threat assessment, the system works by distinguishing and categorizing six aircraft types with exceptional accuracy, facilitating real-time analysis, and aiding with the development of responsive counter-attack strategies. The multi-stage process begins with the comprehensive collection of diverse datasets, followed by the extraction of spatial features from images using CNNs. Optimization techniques fine-tune model parameters to ensure optimal performance. This approach significantly strengthens national security by leveraging advanced technology for proactive threat mitigation. Emphasizing this paper’s vital role in enhancing border defence capabilities, it highlights the model’s capacity to navigate evolving security challenges through improved awareness of the environment. The model's ability to adapt to real-world conditions, including variations in lighting, weather, and terrain, demonstrates its practical applicability. For seamless implementation, the deep learning model is deployed using Django and SQLite as a web page providing an efficient and user-friendly interface This sophisticated deep learning model is fundamental in fortifying national security measures against potential threats along border regions.

How do different modalities of land use practices impact the environmental features and macroinvertebrates? An assessment of mountain streams from Patagonia, Argentina

Agricultural intensification is a significant process, transforming the land and modifying stream water quality and biodiversity. Land-use practices are associated with substantial changes in vegetation structure, significant inputs of nutrients, erosion, and increased sedimentation, all of which profoundly impact aquatic biota and ecosystem functioning. The effect of different agricultural practices (horticulture, extensive and intensive livestock) on stream water quality was compared in terms of physicochemical features, bacteria, habitat condition, riparian ecosystem, and macroinvertebrate variables in a temperate rural landscape (Patagonia). The main objective was to identify which variables related to land use were determinants in the configuration of biotic communities. Significantly higher values in water temperature, conductivity, nutrients, and bacteria were found at intensively developed sites than at reference ones. The quality of the habitat and the riparian ecosystem had been profoundly modified. A multidimensional scaling analysis revealed that macroinvertebrate assemblages also differed among land use categories, with the variables: total phosphorous, total nitrogen, bacteria (E. coli, mesophilic and total coliforms), water temperature, and oxygen having the highest predictive power. Macroinvertebrate metrics (richness of EPT (Ephemeroptera+Plecoptera+Trichoptera), Plecoptera, shredders and scrapers, and the percentage of scrapers and collectors) proved appropriate bioindicators for discriminating intensive land use impacts and highlighted a trend of biodiversity loss. Plecoptera richness, a taxa group with a high level of endemism, responded significantly to habitat condition degradation. These results confirm that the intensification of land use leads to increased nutrient levels and suppressed aquatic-terrestrial interactions involved in the provision of allochthonous detrital input, shade, and habitat structure for larval stages and adults. The Habitat Condition Index appears to be a useful tool for rapid stream assessment and providing early warnings. Several ecological services are threatened in these Patagonian agroecosystems. Restoring riverbank heterogeneity and improving management practices that ameliorate nutrient and sediment inputs are crucial to enhance biodiversity.

Best practice models of aged-care implemented for First Nations people: a systematic review aligned with the Good Spirit Good Life quality of life principles

BackgroundAged-care programs that are based in First Nations worldviews are believed to translate to improved quality of life for First Nations Elders. First Nations perspectives of health and well-being incorporates social and cultural determinants in addition to traditional Western biomedical approaches. This is exemplified by the Good Spirit Good Life (GSGL) framework, which comprises 12 strength-based factors determined by First Nations Elders as constituting culturally appropriate ageing. Our objective was to conduct a systematic review of existing aged care models of practice to determine the degree of alignment with the GSGL framework. Recommendations of the national Australian Royal Commission into Aged Care Quality and Safety informed this work.MethodsWe conducted a systematic search of academic and grey literature in the PubMed, Scopus, Ovid Embase, and Informit online databases. Inclusion criteria comprised English language, original research describing the implementation of First Nations culturally appropriate aged care models, published before August 2022. Research that was not focused on First Nations Elders’ perspectives or quality of life was excluded. We subsequently identified, systematically assessed, and thematically analyzed 16 articles. We assessed the quality of included articles using the Aboriginal and Torres Strait Islander Quality Assessment Tool (ATSIQAT), and the Joanna Briggs Institute (JBI) critical appraisal tool for qualitative research.ResultsMost studies were of medium to high quality, while demonstrating strong alignment with the 12 GSGL factors. Nine of the included studies detailed whole service Models of care while 7 studies described a single program or service element. Thematic analysis of included studies yielded 9 enablers and barriers to implementing models of care.ConclusionsBest-practice First Nations aged care requires a decolonizing approach. Programs with strong adherence to the 12 GSGL factors are likely to improve Elders’ quality of life.

Immunotherapy Combined With Standard Therapies in Head and Neck Squamous Cell Carcinoma - A Meta-analysis.

Head and neck squamous cell carcinoma (HNSCC) is a deadly disease with a poor prognosis due to late diagnosis and limited treatment options. Immunotherapy (IT) is emerging as a promising approach, especially after the failure of standard of care therapies (STs). The objective of this systematic review and meta-analysis was to evaluate whether the addition of IT to STs improves outcomes for patients with HNSCC, including overall survival (OS), progression-free survival (PFS), and quality of life (QoL). This review employed the Population Intervention Comparison and Outcome (PICO) framework to identify relevant search terms in electronic databases, and also included supplementary hand searches. Six primary research articles were selected using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) flow chart, and were critically appraised. Data extraction from these studies was conducted, and a meta-analysis was performed to aid in the generation of forest plots. The addition of IT to standard anticancer therapies was found to enhance patient outcomes, such as OS, PFS, and QoL. The toxicity profile of IT was acceptable, with minimal treatment-related deaths. The most frequently observed adverse events (AE) were related to the skin, followed by hematological toxicities. Based on our analysis, the addition of IT to STs is a suitable treatment option and is supported by current research. However, further studies are needed to investigate factors that influence treatment effectiveness and to develop optimal therapies. To achieve this, we recommend a comprehensive treatment approach that involves the multidisciplinary team (MDT) and patient assessment tools.

Utilizing a Poster Project as an Assessment in an Introductory Abstract Algebra Course

ABSTRACT Though posters have been used as a pedagogical tool in a variety of fields, the literature suggests that the use of posters as an educational assessment tool by the mathematics community has been limited. This is unfortunate given the numerous potential benefits of a poster, including the development of oral communication skills and the ability to examine a mathematical topic at a deeper level. We describe the use of a poster project in an introductory abstract algebra course with specific implementation guidance including a schedule of assignments and assessment criteria. We also include reflections on the success of this project over several semesters as well as advice for adapting the project to a remote course. Samples of student posters are available upon request to the authors.

Risk factors for violence in an emergency department: Nurses' perspectives.

Work-related violence remains a significant problem in healthcare settings, including EDs. Violence risk assessment tools have been developed to improve risk mitigation in this setting; however, incorporation of these tools into standard hospital processes remains scarce. This research aimed to explore nurses' perspectives on the Bröset Violence Checklist used in routine violence risk assessment and their recommendations for additional items. Thirty nursing staff who used the Bröset Violence Checklist (BVC) as standard practice for 5 years participated in two focus groups where 23 violence risk factors were presented. Using multiple methods, participants were asked to select and elaborate from a pre-determined list what they considered most useful in violence risk assessment in respect to descriptors and terminology. Quantitative data showed most risk factors presented to the group were considered to be predictive of violence. Ten were regarded as associated with risk, and overt behaviours received the highest votes. The terms 'shouting and demanding' was preferred over 'boisterous', and 'cognitive impairment' over 'confusion'. Patient clinical characteristics and staff perceptions of harm, inability to observe subtle behaviour, imposed restrictions and interventions and environmental conditions and impact were also important considerations. We recommend that violence risk assessment include: history of violence, cognitive impairment, psychotic symptoms, drug and alcohol influence, shouting and demanding, verbal abuse/hostility, impulsivity, agitation, irritability and imposed restrictions and interventions. These violence risk factors fit within the four categories of historical, clinical, behavioural and situational.

Utility of the 3Di short version in the identification and diagnosis of autism in children at the Kenyan coast.

The precise epidemiological burden of autism is unknown because of the limited capacity to identify and diagnose the disorder in resource-constrained settings, related in part to a lack of appropriate standardised assessment tools and health care experts. We assessed the reliability, validity, and diagnostic accuracy of the Developmental Diagnostic Dimensional Interview (3Di) in a rural setting on the Kenyan coast. Using a large community survey of neurodevelopmental disorders (NDDs), we administered the 3Di to 2,110 children aged between 6 years and 9 years who screened positive or negative for any NDD and selected 242 who had specific symptoms suggestive of autism based on parental report and the screening tools for review by a child and adolescent psychiatrist. On the basis of recorded video, a multi-disciplinary team applied the Autism Diagnostic Observation Schedule to establish an autism diagnosis. Internal consistency was used to examine the reliability of the Swahili version of the 3Di, tetrachoric correlations to determine criterion validity, structural equation modelling to evaluate factorial structure and receiver operating characteristic analysis to calculate diagnostic accuracy against Diagnostic Statistical Manual of Mental Disorders (DSM) diagnosis. The reliability coefficients for 3Di were excellent for the entire scale {McDonald's omega (ω) = 0.83 [95% confidence interval (CI) 0.79-0.91]}. A higher-order three-factor DSM-IV-TR model showed an adequate fit with the model, improving greatly after retaining high-loading items and correlated items. A higher-order two-factor DSM-5 model also showed an adequate fit. There were weak to satisfactory criterion validity scores [tetrachoric rho = 0.38 (p = 0.049) and 0.59 (p = 0.014)] and good diagnostic accuracy metrics [area under the curve = 0.75 (95% CI: 0.54-0.96) and 0.61 (95% CI: 0.49-0.73] for 3Di against the DSM criteria. The 3Di had a moderate sensitivity [66.7% (95% CI: 0.22-0.96)] and a good specificity [82.5% (95% CI: 0.74-0.89)], when compared with the DSM-5. However, we observed poor sensitivity [38.9% (95% CI: 0.17-0.64)] and good specificity [83.5% (95% CI: 0.74-0.91)] against DSM-IV-TR. The Swahili version of the 3Di provides information on autism traits, which may be helpful for descriptive research of endophenotypes, for instance. However, for accuracy in newly diagnosed autism, it should be complemented by other tools, e.g., observational clinical judgment using the DSM criteria or assessments such as the Autism Diagnostic Observation Schedule. The construct validity of the Swahili 3Di for some domains, e.g., communication, should be explored in future studies.

Systematic Design of a Natural Sciences Collections Digitisation Dashboard

This paper describes the design and build of a pilot Natural Sciences Collections Digitisation Dashboard (CDD). The CDD will become a key service for the Distributed System of Scientific Collections Research Infrastructure (DiSSCo) and aims to improve the discoverability of natural science collections (NSCs) held in European institutions, both digitised and undigitised. Furthermore, it will serve as a dynamic visual assessment tool for strategic decision-making, including the prioritisation of digitisation. The CDD pilot includes high-level information from nine European NSCs, covering the number of objects, taxonomic scope, storage type, chronostratigraphy (Earth Science Collections), geographical region and level of detail in digitisation. This information is structured through a standardised Collection Classification Scheme, which uses high-level categorisation to describe physical natural science collections.

SWAT Model Performance Using Spatially Distributed Saturated Hydraulic Conductivity (Ksat) and Varying-Resolution DEMs

Saturated hydraulic conductivity (Ksat) is a hydrologic flux parameter commonly used to determine water movement through the saturated soil zone. Understanding the influences of land-use-specific Ksat on the model estimation error of water balance components is necessary to advance model predictive certainties and land management practices. An exploratory modeling approach was developed in the physically based Soil and Water Assessment Tool (SWAT) framework to investigate the effects of spatially distributed observed Ksat on local water balance components using three digital elevation model (DEM) resolution scenarios (30 m, 10 m, and 1 m). All three DEM scenarios showed satisfactory model performance during calibration (R2 > 0.74, NSE > 0.72, and PBIAS ≤ ±13%) and validation (R2 > 0.71, NSE > 0.70, and PBIAS ≤ ±6%). Results showed that the 1 m DEM scenario provided more realistic streamflow results (0.315 m3/s) relative to the observed streamflow (0.292 m3/s). Uncertainty analysis indicated that observed Ksat forcings and DEM resolution significantly influence predictions of lateral flow, groundwater flow, and percolation flow. Specifically, the observed Ksat has a more significant impact on model predictive confidence than DEM resolution. Results emphasize the potential uncertainty of using observed Ksat for hydrological modeling and demonstrate the importance of finer-resolution spatial data (i.e., 1 m DEM) applied in smaller watersheds.

Micro-Catchments, Macro Effects: Natural Water Retention Measures in the Kylldal Catchment, Germany

Floods are among the most devastating and financially burdensome natural disasters in Europe. The combined impact of climate change and land use change is expected to exacerbate and intensify the destructive consequences of river floods. In this study, we analysed the effects of wetland restoration on peak and base flows and on water quality in the Kylldal catchment of the Kyll River in the German Middle Mountains using the Soil and Water Assessment Tool+ (SWAT+). Monthly median daily discharge increases varied between 3% and 33% in the studied (micro)catchments. The higher median flow rates show that discharge peaks were attenuated and distributed over a longer period, making both extreme peak flows and low flows less common. Peak flows tended to decrease, with the largest effects between late fall and early spring when peak flow values decreased by up to 18%. The annual maximum peak flows in each of the three micro-catchments decreased by 12–24% on average. The occurrence of daily average flow rates larger than 1 m3 s−1 was up to 45% lower after wetland restoration. Low flows increased by up to 21% and 13% in the summer and fall, respectively, which suggests that drought risk also decreases after wetland restoration. Average nitrogen exports decreased by 38–50% in the project areas and by 20% at the catchment level. Average phosphorus exports decreased by 52–67% in the project areas and by 25% at the catchment level. The study highlights the potential of wetland restoration for improving hydrological services, mitigating flood risks, and enhancing water quality. Restoring and maintaining freshwater ecosystems and their natural sponge functions is crucial for effectively managing water resources and addressing the challenges posed by climate change and land use changes.

USING OF CUPPING TECHNIQUE AS A THERAPEUTIC MODEL IN TREATMENT OF NON-DISCOGENIC LOW BACK PAIN

Background: Cupping therapy is one of the traditional medical technologies practiced for thousands of years. it might have some additional benefits on early rehabilitation for post-stroke complications. Aim of the work: to examine if the use of cupping technique as a therapeutic model in treatment of discogenic low back pain has a significant impact or not. Methodology: 60 Patients divided into two equal groups were participated in this study: Group 1 treated by conventional post-stroke therapy and Group 2 treated by wet cupping in addition to conventional post-stroke therapy. The national institute of health stroke scale (NIHSS) index was sed as patients assessment tool for neurologic deficit evaluation motor functions is assessed by the Fugl-Meyer assessment (FMA) scale, the healing process depended on the bedside swallowing assessment (BSA). For cognitive function, the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) have been used, and any undesirable effect of wet cupping were noted for safety evaluation. Results: Better results have been documented with wet cupping therapy. Statistically significant improvement in pain reduction for both techniques of cupping (dry & wet) when compared to conventional medical therapy without augmentation with cupping therapy. Conclusion:Significant Effect of Hijama (Wet cupping) in post-stroke rehabilitation.

Neutrophil CD64 index as a new early predictive biomarker for infected pancreatic necrosis in acute pancreatitis

ObjectiveInfectious pancreatic necrosis (IPN) is a serious complication of acute pancreatitis, and early recognition and timely intervention are the keys to improving clinical outcomes. The purpose of this study was to investigate the predictive capacity of the neutrophil CD64 index (nCD64 index) on IPN in patients with acute pancreatitisMethodsThis study comprises two independent cohorts: the training cohort consisted of 202 patients from Hunan Provincial People's Hospital, and the validation cohort consisted of 100 patients from Changsha Central Hospital. Peripheral blood samples were collected on the day of admission and on the 3rd, 5th, 7th, and 10th days of hospitalization, and the nCD64 index was detected by flow cytometry. Additionally, relevant clinical characteristics and laboratory biomarkers were collected and analyzed.ResultsWe observed that nCD64 index on admission was significantly higher in the IPN group than Non-IPN group (p < 0.001). In the training cohort, a higher occurrence rate of IPN was observed in the high nCD64 index group compared to the moderate and low nCD64 index group (p < 0.001). Further analysis showed that nCD64 index was significant positive correlated with the incidence rate of IPN (p < 0.001, correlation coefficient = 0.972). Furthermore, logistic regression analysis showed that high expression of the nCD64 index on admission was a risk factor for the occurrence of IPN (OR = 2.971, p = 0.038). We further found that the nCD64 index of IPN patients was significantly higher than the Non-IPN patients on the days 1, 3, and 5 after admission, and the nCD64 index of IPN patients before and after the onset (p < 0.05). At the same time, this study revealed that the nCD64 index on admission showed good predictive efficacy for IPN (AUC = 0.859, sensitivity = 80.8%, specificity = 87.5%), which was comparable to APACHE II score. And this finding was further validated in an independent cohort of 100 participants (AUC = 0.919, Sensitivity = 100.0%, Specificity = 76.6%).ConclusionThis study demonstrated the clinical value of nCD64 index in patients with IPN patients for the first time through two independent cohort studies. The nCD64 index can be used as an early prediction and risk assessment tool for the occurrence of IPN, contributing to the improvement of patient outcomes and efficiency of medical resource allocation.

A Comprehensive Analysis of Beekeeping Risks and Validation of Biosecurity Measures against Major Infectious Diseases in Apis mellifera in Europe

Background/Objectives: In a collaborative effort, FAO, the International Federation of Beekeepers’ Association “Apimondia”, the Appalachian State University, and the Istituto Zooprofilattico Sperimentale del Lazio e Toscana (IZSLT), the FAO Reference Centre for Animal Health and Food Security Discipline Apiculture, health, and biosecurity, designed an online international survey (“Knowledge, Awareness and Practice”-KAP) as a risk assessment tool to validate biosecurity measures able to prevent and control the main honeybee (Apis mellifera subsp.) infectious diseases. Methods: The KAP survey was disseminated through various channels for 14 months (January 2019–March 2020). Beekeepers’ knowledge on nosemosis, American foulbrood (AFB), and European foulbrood (EFB) management was assessed. Beekeepers’ attitudes were investigated by asking them to provide a score called “Acceptance by beekeepers”. Results: Of the 410 respondents, the majority of them (68.3%, n = 252) were from Europe. European beekeepers (n = 252) considered “Highly acceptable” the following practices: removing combs that show signs of dysentery and feeding colonies for nosemosis; the quick identification and management of affected hives for American foulbrood and European foulbrood. Instead, the following practices were considered as not acceptable by beekeepers: for nosemosis, the use of antibiotics and sampling of hive debris for early detection; for American foulbrood and European foulbrood, the shook swarm, the destruction of the whole apiary, as well as their treatment with antibiotics. Conclusion: This study demonstrated the validity of the present “Knowledge, Awareness and Practice” (KAP) survey to validate the best practices for the main infectious honeybee diseases, considering the pragmatic point of view of beekeepers. Sustainable practices for disease control are preferred by the European beekeepers. While having an adequate knowledge base for the early detection of the investigated honeybee diseases, European beekeepers tend to be aware of the health status of their hives, embracing advanced, practice-oriented training. Authors highlight that the selection of practices and their validation should be revised on a regular basis, to be adapted in a timely manner to the current infectious honeybee disease situation, in order to build up a resilient and effective stock of practices.

Women’s Social Health and Related Factors in Iran: A Systematic Review and Meta-Analysis

Women’s health is the foundation of society’s health and it can be achieved only by addressing all aspects of their health. The aim of this systematic review and meta-analysis is to investigate the prevalence of social health of Iranian women and related factors. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used for reporting; the terms “social health,” “women,” “Iran,” and related keywords were searched in PubMed, Web of Science, Scopus, PsychoInfo, ProQuest and local databases, SID, Magiran, Irandoc, Elmnet, and Noormags up to August 2022. The published English or Persian quantitative primary studies which were conducted in Iran and reported social health or its dimensions among Iranian women were included. The studies were assessed by quality assessment tool for observational cohort and cross-sectional studies developed by National Heart, Lung, and Blood Institute. From the 786 studies retrieved, 22 studies were finally included surveying different groups of women. Age, marital status, education, employment, socioeconomic status, social support, social participation, social trust, social security, communication skills, and self-esteem were the factors affecting women’s social health. Five studies entered meta-analysis and mean score of social health was 98.54 (95% CI: 87.56–109.51) and it was the lowest among women who were the head of households. Since women’s social health has been less considered in the society and research studies, further policies, legislations, and capacity building in mentioned fields are necessary. As social health is an important aspect of health, it is necessary for governments to address the known determinants of women’s social health in order to plan and promote the health of women, family, and finally society.

Telemedicine vs Telephone Consultations and Medication Prescribing Errors Among Referring Physicians

Critically ill children presenting to emergency departments (EDs) in non-children's hospitals are at high risk for experiencing medical errors, including medication errors. Video telemedicine consultations with pediatric specialists have the potential to reduce the risk of medication errors beyond the current standard of care, telephone consultations. To compare the rates of ED physician-related medication errors among critically ill children randomized to receive either video telemedicine or telephone consultations. This cluster randomized, unbalanced crossover trial was conducted at 15 community EDs in northern California between September 2014 and March 2018. Analyses were conducted from May 2022 to January 2023. Participants included acutely ill children younger than 15 years presenting to a participating ED. Participating EDs were randomized to use video telemedicine or telephone for consultations with pediatric critical care physicians according to 1 of 4 unbalanced (3 telemedicine to 1 telephone) crossover treatment assignment sequences. Pharmacists reviewed medical records to document physician-related medication errors using a previously validated instrument. Multilevel logistic regression analyses were performed to create models with the medication order as the unit of analysis and adjusting for age, the log-transformed Revised Pediatric Emergency Assessment Tool score, and hospital study period. A total of 696 patient encounters were included in the trial (mean [SD] age, 4.2 [4.6] years; median [IQR] age, 2.1 [0.5-2.1] years; 304 female [43.7%]), with 537 patient encounters (77.2%) assigned to video telemedicine and 159 patient encounters (22.8%) assigned to telephone. At least 1 physician-related medication error occurred for 87 patients (12.5%), including 20 of 159 patients (12.6%) in the telephone cohort and 67 of 537 patients (12.5%) in the telemedicine cohort. Of the 2414 medication orders, errors occurred in 124 cases (5.1%), including 26 of 513 orders (5.1%) in the telephone cohort and 98 of 1901 orders (5.2%) in the telemedicine cohort. In the multivariable analysis, the adjusted odds ratio of experiencing a medication error among those assigned to telemedicine was 0.86 (95% CI, 0.49-1.52; P = .61). This cluster randomized crossover trial found no statistically significant differences in physician-related medication errors between critically ill children assigned to receive telephone consultations vs video telemedicine consultations. ClinicalTrials.gov Identifier: NCT02877810.

Fracture Risk Assessment Tool (Frax Tool) Scores in Type 2 Diabetes Mellitus Patients in Haji Hospital Medan

Background: Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia resulting from defects in insulin secretion and/or insulin action. Bone fragility in T2DM, which mirrored bone mineral density and bone mass reduction. Classical diagnosis of osteoporosis in T2DM is performed by dual-energy X-ray absorptiometry (DXA) and the risk of fracture can be assessed using the FRAX tool (Fracture Risk Assessment Tool). The purpose of the study was to assess the risk of osteoporosis using FRAX tool calculation (without BMD) in T2DM patients at the endocrine metabolic clinic of Haji Hospital Medan. Method: Descriptive observational with a cross-sectional study approach using primary and secondary data from the medical records of the Endocrine and Metabolic Clinic of Haji Hospital Medan in September-October 2023.Results: Of the 80 respondents with a risk of major osteoporosis, there were 77 respondents (96.3%) with low risk, 3 respondents (3%) with moderate risk, and no respondents with high risk (0%). The FRAX score for the risk of hip fracture received a low risk of 72 respondents (90%). At the same time, the high-risk was 8 respondents (10%).Conclusion: The majority of T2DM patients at Haji Hospital Medan are at low- risk for major osteoporosis and hip fracture

Optimal Global Longitudinal Strain Thresholds for Pediatric Heart Surgery: Insights from a University Hospital.

Congenital heart diseases impact millions annually, with pediatric care lacking suitable risk assessment tools. This research seeks to illuminate the association between the global longitudinal strain (GLS) and the subsequent impact on postoperative outcomes, contributing to a deeper understanding of its predictive value in the pediatric population affected by congenital heart diseases. An observational, analytic, longitudinal, and prospective study was conducted from May 2022 to May 2023, including all patients under 18 undergoing heart surgery with cardiopulmonary bypass (CBP). Patients not classifiable within the Risk Adjustment for Congenital Heart Surgery were excluded. Using transesophageal echocardiography, GLS was measured pre- and post-CPB. Receiver operating characteristic curve analysis determined GLS cut-off points for 30-day mortality risk, using Youden's method for optimal sensitivity and specificity. Bivariate and multivariate analysis identified the relationships between clinical variables. Eighty-nine patients undergoing congenital heart surgery were included. Fifteen deaths occurred. The area under the curve (AUC) for each GLS classification (pre, post, index) demonstrated effective discriminatory capacity (> 0.70) in predicting 30-day mortality. Pre-CBP GLS showed the strongest predictive power (AUC 0.833, IQR: 0.731 - 0.936) with a cut-off point of 12. Values lower than the cut-off point of pre-CPB GLS correlated with increased vasoactive-inotropic Scores and longer mechanical ventilation. GLS measurement is a reproducible method for assessing ventricular function in pediatric heart surgery, showing potential as a prognostic tool. This study marks the initial effort to establish cut-off points for preoperative GLS, postoperative GLS, and the strain index.

Elderly Patients at Risk of Malnutrition Presenting to a Tertiary Hospital in Nepal: A Descriptive Cross-sectional Study

Introduction: The nutritional status of elderly people is crucial for healthy aging, enabling them to maintain productive lives and reduce the progression of chronic diseases. Given that the quality of life tends to decline with age, it becomes particularly crucial for elderly individuals. Therefore, this study was aimed to find out the prevalence of elderly patients at risk of malnutrition in a tertiary hospital. Methods: This descriptive cross-sectional study was conducted among 281 elderly patients in a tertiary hospital from 2 January 2023 to 10 February 2023 after obtaining ethical approval. Non-probability purposive sampling technique was used. A face-to-face interview was conducted using a structured interview schedule with the elderly in the absence of their caregiver using a standard Mini-Nutritional Assessment tool for nutritional status, and WHOQOL_OLD quality of life for the elderly to assess the quality of life. Point estimate at 95% Confidence Interval was calculated.Results: Out of 281 elderly patients enrolled in our study, 164 (58.36%) (52.64-64.16, 95% Confidence Interval) were at risk of malnutrition. Conclusions: The study concluded that older people could be at risk of malnutrition, which could impair their quality of life.