Years Of Clinical Experience Research Articles

Plagiocephaly and malocclusion

The term plagiocephaly means oblique head. Most skull deformities are a result of intrapartum or utero molding but can be caused by congenital torticollis and after birth due to persistent head position of newborns staying in one head position for a long time and abusive use of strollers, car seats, car seats, swings. Its prevalence is growing fast, in 30 years it passes from 1 in each 300 babies in early nineties to 16 to 48 % in 2020. The aim of this paper is bringing the light to some serious conditions of treatment protocols in individuals with plagiocephaly. The skull deformity causes facial asymmetry that are not treatable by orthopedic or orthodontic intra or extra oral appliances, nor orthognathic surgery. Well, despite the fact that the patient or the tutors have to be notified of the facial asymmetry that persists, functional limitations will be presented. In more than 30 years of clinical experience treating these patients it was never sought the 4 first permanent molars and the 4 canines in the same Angle’s Class. In one side can be seen Class 1, but on the other it will be finding class 2 or class 3, the case reported exemplifies it, and the worst, mastication guidance will have to be very carefully done since, in most cases if it is tried to adjust the inferior and superior dental midline the vertical asymmetry of the occlusal plane (minimum vertical dimension) will worsen. Really there is no unique treatment protocol and it has to be considered case by case. It is time to deepen the knowledge in this area since the prevalence is growing. Based on the case reported, non-treated plagiocephaly can bring serious limitations to malocclusion treatment results. Further studies are necessary to a better understanding of the situation plagiocephaly versus malocclusion.

Physicians' Perspectives on the Impact of Insurance Status on Clinical Decision-Making in Saudi Arabia.

Background The decision-making process in clinical practice depends heavily on collaboration and information sharing. Physicians' decision-making processes are profoundly influenced by the patient's insurance status, which warrants focused investigation. Hence, this study aimed to investigate how physicians perceive the influence of insurance status on treatment options and medical interventions and to explore the extent to which physicians discuss insurance-related considerations with patients during the shared decision-making process. Methodology This was a cross-sectional exploratory study conducted in various healthcare facilities all over Saudi Arabia. The electronic questionnaire was the primary tool for data collection. Data were then coded, entered, and analyzed using both descriptive and inferential statistical methods. Results The study involved 430 physicians, primarily male (n= 230, 53.5%), aged 31-40 years (n= 215, 50%), and mostly non-Saudi (n= 285, 66.3%). Medical officers constituted the majority of the study population (n= 258, 60%), with one to five years of experience (n= 187, 43.5%), and engaged in private practice (n= 230, 70%). Concerning insurance, 287 (66.7%) physicians considered patient's insurance when discussing treatment options, while 318 (74%) physicians discussed the financial implications of different treatment options with the patients. Regarding outcomes, 373 (86.7%) physicians believed that insurance status affected patient outcomes and treatment modalities. Significant factors, such as age between 31 and 40 years (P < 0.001), over 10 years of clinical experience (P = 0.002), engagement in both governmental and private practice (P = 0.012), and being a medical officer (P = 0.005), demonstrated a high impact on the insurance status influencing clinical decision-making. Overall, recognizing the influence of insurance on decision-making is crucial for equitable healthcare. Conclusions More than half of the physicians demonstrated high scores indicating the impact of insurance status on the clinical decision-making process. This impact was influenced by specific physician parameters such as age, experience, specialty, and type of practice. Moreover, the financial situation and insurance status of the patients significantly affected treatment and patient outcomes.

From plan to practice: A qualitative study of public mental health therapists' session-planning practices.

Therapists must dedicate considerable time to session plan to implement evidence-based practices (EBPs) flexibly and with fidelity. It is unclear whether public mental health settings offer the structural and organizational support for therapists to engage in session planning and, therefore, whether they provide the necessary infrastructure for EBP implementation. In Fall 2022, 18 therapists working in public mental health settings in New York City were recruited through snowball sampling to participate in 90-min semistructured qualitative interviews. Therapists were prompted to review their session-planning practices using a chart-stimulated recall strategy; to describe structural, organizational, and individual barriers and facilitators to session planning; and to generate recommendations to support their session planning. Qualitative data were analyzed using thematic analysis. A diverse group of therapists participated in the study-22% identified as Black; 22% as Asian; and 11% as Hispanic/Latinx. Seventy-eight percent of therapists were social workers; and they had on average 6.18 (SD = 5.70) years of clinical experience. The research team identified four multilevel session-planning barriers and three multilevel session-planning facilitators. Therapists proposed seven multilevel recommendations to support their session planning. Overall, therapists indicated that managing high productivity standards, severe clinical presentations, and clients' social needs often prevent them from having time to plan for sessions. Efforts to implement EBPs in public mental health settings cannot neglect the structural realities faced by agencies, therapists, and clients. Multilevel resources and reforms to support therapists' session planning are necessary. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perspectives of genetic counseling supervisors regarding genetic counseling students' attainment of practice-based competencies in clinical care through remote supervision.

There are limited studies regarding the attainment of the Accreditation Council for Genetic Counseling Practice-Based Competencies by genetic counseling students who complete clinical rotations in an in-person setting versus in a remote setting that incudes telephone and/or video patient encounters. This study explored the perceptions of 17 patient-facing genetic counselors who had served as supervisors for genetic counseling students regarding student attainment of practice-based competencies in in-person compared to remote rotations. Participants were recruited through an American Board of Genetic Counseling eblast and were required to have at least 2 years of clinical experience and experience providing genetic counseling supervision for at least one in-person rotation and one remote rotation. Four focus groups were created comprising genetic counselors from various practice disciplines. Discussion focused on potential differences and similarities in supervisor perceptions of student attainment of each clinical practice-based competency, and whether there were any concerns about students being able to attain each competency in remote rotations. Overall, participants discussed that genetic counseling students' attainment of clinical competencies through remote rotations was comparable to in-person rotations; however, 15 themes were identified illustrating differences reported by participants in how they observed these skills being performed by students in in-person versus remote clinical settings. The findings of this study highlight important considerations when developing a remote rotation, as well as ways in which certain clinical skills may be further enhanced through a combination of both in-person and remote clinical experiences. A noted limitation of remote rotations is that students have less of an opportunity to interact with other providers, and so may require other opportunities for interprofessionalism and to understand their role as part of a larger organization. Further study is required to elucidate differences between telephone and video clinics, as well as potential differences pertaining to various specialty areas of practice.

Exploring Clinical Lessons Learned by Experienced Hospitalists from Diagnostic Errors and Successes.

Diagnostic errors cause significant patient harm. The clinician's ultimate goal is to achieve diagnostic excellence in order to serve patients safely. This can be accomplished by learning from both errors and successes in patient care. However, the extent to which clinicians grow and navigate diagnostic errors and successes in patient care is poorly understood. Clinically experienced hospitalists, who have cared for numerous acutely ill patients, should have great insights from their successes and mistakes to inform others striving for excellence in patient care. To identify and characterize clinical lessons learned by experienced hospitalists from diagnostic errors and successes. A semi-structured interview guide was used to collect qualitative data from hospitalists at five independently administered hospitals in the Mid-Atlantic area from February to June 2022. 12 academic and 12 community-based hospitalists with ≥ 5years of clinical experience. A constructivist qualitative approach was used and "reflexive thematic analysis" of interview transcripts was conducted to identify themes and patterns of meaning across the dataset. Five themes were generated from the data based on clinical lessons learned by hospitalists from diagnostic errors and successes. The ideas included appreciating excellence in clinical reasoning as a core skill, connecting with patients and other members of the health care team to be able to tap into their insights, reflecting on the diagnostic process, committing to growth, and prioritizing self-care. The study identifies key lessons learned from the errors and successes encountered in patient care by clinically experienced hospitalists. These findings may prove helpful for individuals and groups that are authentically committed to moving along the continuum from diagnostic competence towards excellence.

P461 Deep learning model for endoscopic differential diagnosis between intestinal lymphoma and Crohn's disease: a multicenter study

Abstract Background Primary and secondary intestinal lymphoma (IL) are a relatively rare cancer, while easily misdiagnosed due to the unclear aetiology and unspecific clinical symptoms. Moreover, the endoscopic features of IL vary depending on pathological types, making it difficult to distinguish from Crohn's disease (CD). This study aims to develop deep learning models based on endoscopic images, facilitating the differential diagnosis of IL and CD. Methods We retrospectively recruited 271 patients with IL and 232 patients with CD from 6 tertiary centres in China. With out-of-focus or poor-bowel-prepared images excluded, we used 1739 IL and 1649 CD images for internal and external validation to build deep learning models. For internal validation, we used five-fold cross-validation with 1517 IL images and 1428 CD images from 5 centres randomly assigned without any patient overlap. 222 IL and 221 CD images from the 6th centre were used for independent external validation to measure the generalization ability of models. Further, we compared the performance of models with that of clinical physicians consisting of 2 junior physicians and 2 endoscopy specialists with more than ten years of clinical experience. We evaluated models using metrics such as accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) and used the kappa statistic to measure the inter-rater reliability between models and clinical physicians. Results We developed multiple convolutional neural network models, including ResNet18, ResNet34, ResNet50, VGG16, VGG19, DenseNet121, Inception v3, and Xception. The top 3 models in the internal validation were Inception v3, Xception, and DenseNet121. Inception v3 showed the best performance (accuracy: 83.1%; AUC: 0.910), while Xception performed better on average (average accuracy: 76.8%; average AUC: 0.834). In the external validation, the top 3 models were Inception v3, DenseNet121, and VGG19. Inception v3 achieved the highest accuracy of 81.9%, while DenseNet121 had the best AUC of 0.903. Compared with clinical physicians, Inception v3 performed better than junior physicians (average accuracy: 67.2%) and showed good agreement with the best endoscopy specialist (kappa: 0.604, p&amp;lt;0.05). Conclusion Convolutional neural network models using endoscopic images were able to differentiate PIL from CD, with better-diagnosing performance than junior physicians, good agreement with specialists, and good generation ability, which were expected to assist clinical physicians lacking experience to differentiate PIL and CD more precisely under endoscope.

Non-biologic immunosuppressive drugs for inflammatory and autoimmune skin diseases.

Non-biologic immunosuppressive drugs, such as azathioprine, dapsone or methotrexate are fundamental treatment options for a wide range of autoimmune and chronic inflammatory skin diseases. Some of these drugs were initially used for malignancies (e.g., azathioprine or methotrexate) or infectious diseases (e.g., hydroxychloroquine or dapsone) but are nowadays mostly used for their immunosuppressive/immunomodulating action. Although dermatologists have years of clinical experience with these drugs, some of the mechanisms of action are not fully understood and are the subject of research. Although these drugs are commonly used, lack of experience or knowledge regarding their safety profiles and management leads to skepticism among physicians. Here, we summarize the mechanism of action and detailed management of adverse effects of the most commonly used immunosuppressive drugs for skin diseases. Furthermore, we discuss the management of these drugs during pregnancy and breastfeeding, as well as their interaction and handling during vaccination.

Enhancing occupational therapy service provision with military veterans through policy reform: Findings from a national survey.

Almost half a million Australians have served with the Australian Defence Force. Given the high prevalence of physical and mental health conditions and complexity of civilian life adjustment after military service, high-quality occupational therapy services are critical. However, there is limited description of occupational therapy service provision to individuals funded by the Australian Department of Veterans' Affairs to inform government policy. The aim of this study was to describe the practice of Australian occupational therapists working with former service members and identify opportunities to enhance practice and policy. A cross-sectional study using an online survey was conducted to collect information from occupational therapists providing services to Department of Veterans' Affairs clients. Frequency analyses were performed to describe quantitative data. Qualitative data were analysed using thematic analysis. No consumer or community involvement occurred. Participants included 123 Australian occupational therapists residing in metropolitan (47%), regional (28%) and rural/remote (23%) areas. Most occupational therapists (69%) had over 15 years of clinical experience and worked in private practice (87%). Common interventions included home modifications, equipment prescription and assistive technology (77%), goal-oriented rehabilitation (16%) and activities of daily living or function assessments and education (13%). Three themes describing practice issues were identified: (1) Service provision as rewarding yet underfunded, (2) Administrative complexity and lack of understanding of the occupational therapy role and (3) Need for specialist professional development opportunities. Australian occupational therapists are providing a range of services to Department of Veterans' Affairs clients although mostly relating to physical conditions. Occupational therapy practice with former Australian Defence Force members should be expanded to meet their diverse and complex needs. Further research and education are needed to support use of specialist knowledge and interventions. Advocacy by peak associations and policy reform are urgently required to ensure sustainable services, particularly in rural areas.

“Mind the gap”: An exploratory qualitative study of paramedics’ experiences attending older adults who fall in Western Australia

PurposeTo explore paramedics’ experiences and perspectives about attending and managing older adults who had fallen. ProceduresThis qualitative, exploratory study used a purposive sample of paramedics in Western Australia. Participants had at least one year of clinical experience. Semi-structured interviews were undertaken. Data were analysed via an inductive thematic approach. FindingsFourteen paramedics were interviewed (Median age: 38 years, n = 5 females). The main theme identified that experiences were positive when attending patients with high-acuity medical problems or injuries following falls because binary decision-making (transport vs non-transport) was appropriate. Themes highlighted that decision-making for low-acuity falls attendances was a complex balance between 1) patient context, 2) risk management, 3) paramedic reactions, and 4) the lack of alternate referral pathways available. Experiences could be stressful and frustrating when attending falls call-outs for older adults with no injuries or medical problems. Participants concurred that when transport to hospital was not required there were no available, alternative pathways to refer onwards for appropriate health or social care. ConclusionAttending low-acuity call-outs for falls was often frustrating and required complex decision-making, with gaps in services identified. Further exploration of alternative referral pathways for health care for pre-hospital management of adults who fall is required.

Assessing Diversity and Cultural Competency among Canadian Physiotherapists: A Cross-Sectional Survey Part 1

Purpose: The aims of this study were to describe cultural diversity among physiotherapists, to understand the challenges to the delivery of physiotherapy to equity-seeking communities, and to measure and assess factors associated with cultural competency. Methods: We conducted a cross-sectional survey (57-items) of Canadian physiotherapists that assessed demographics, cultural competency, and challenges in delivery of rehabilitation. We used backwards elimination method to develop our regression models, and cross-validated by estimating shrinkage. Results: Our sample included 808 physiotherapists (Female: 77.8%). Most practitioners identified as White/Caucasian, with Indigenous populations significantly under-represented. Physiotherapists exhibited high scores in cultural awareness and sensitivity (Mean: 6.0/7 [95% CI: 6.0, 6.1]), with lower scores for cultural competency behaviours (Mean: 4.5/7 [4.4, 4.5]). There was a weak association between gender (men), uncertainty regarding the presence of cultural health disparities, race (White/Caucasian), prior diversity, equity, and inclusion (DEI) training, and DEI attitudes ( R2 = 0.17, p &lt; 0.0001) with cultural awareness and sensitivity. There was also weak association between engagement in prior DEI training, cultural awareness and sensitivity scores, increased years of clinical experience and race (White/Caucasian) with culturally competent behavioural scores ( R2 = 0.13, p &lt; 0.0001). Conclusions: The findings suggest the need to improve current educational structures in DEI and promote recruitment of diverse physiotherapists. Clinical Implications: This work may help policy makers and educational institutions in developing initiatives for cultural competence.

Modules From the End-of-Life Nursing Education Consortium: Japan Core Curriculum Necessary for Second- to Fourth-Year Nurses as Assessed by Advanced Practice Registered Nurses.

This study aimed to identify the modules of the End-of-Life Nursing Education Consortium-Japan Core Curriculum (ELNEC-J), which are particularly necessary for second- to fourth-year nurses. This cross-sectional study recruited certified nurse specialists in cancer nursing (CNSCNs) endorsed by the Japanese Nursing Association enrolled in Advanced Practice Registered Nurses (APRNs) in Japan. We asked individuals who were active members of the volunteer association of CNSCNs in the Tokai region to participate via email, and we collected data using Google Forms. The participants were asked about their background, including APRN experience and current position. Furthermore, we asked them to select three necessary modules for second- to fourth-year nurses' education from the 10 modules of the ELNEC-J. The study recruited a total of 19 (89%) APRNs (response rate: 100%). Out of them, 14 (73.6%) had more than six years of clinical experience in APRNs, and 12 (63.1%) held managerial positions. Regarding the 10 modules of the ELNEC-J, the responses for the necessary modules were as follows: nursing care at end-of-life 13 (68.4%), pain management 12 (63.2%), symptom management 10 (52.6%), communication 10 (52.6%), and ethical issues in palliative care nursing five (31.6%). According to the perspective of APRNs responsible for palliative care education for incumbent nurses, nursing care at the end of life, pain management, symptom management, and communication are required for second- to fourth-year nurse education.

Psychological Well-Being of Nurses with One to Five Years of Clinical Experience.

Nurses are required to fulfill many roles, including expertise, communication, and leadership and are psychologically vulnerable due to lack of manpower, emotional labor, and shift work. Among them, it is necessary to understand the psychological well-being of new nurses and junior nurses who have a high early resignation rate. The purpose of this study was to investigate psychological well-being of nurses and compare psychological well-being of nurses from the first to the fifth years of clinical experience. Cross-sectional comparative design and purposive sampling method were used. Data were collected from 148 nurses with one to five years of experience working in tertiary care general hospitals. On November 11, 2021, an online link for the structured questionnaire was sent to the group social networking service accounts for nurses. Psychological well-being was assessed using a Korean version of the Scales of Psychological Well-being including autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. The average psychological well-being of nurses was 194.11, with significant differences depending on years of clinical experience (p = .006, F = 3.82) and satisfaction with nursing (p < .001, F = 13.12). It was lowest at 180.08 in the first year, gradually improving, but falling again from the fourth year. Among five subfactors except positive relations with others (p = .389), psychological well-being was related to clinical experiences years using satisfaction with nursing and religion as covariates. This study that compared psychological well-being from the first to the fifth year according to clinical experience revealed the need for optimized intervention for each year. Nursing managers can improve the psychological well-being of nurses through active and appropriate intervention according to the passage of nursing experience.

Assessment of nursing knowledge and practice toward prevention of acquired infections in the emergency department of King Faisal Medical Complex in Taif.

Hospital-acquired infections constitute a significant source of morbidity and mortality for both patients and healthcare professionals. Nursing professionals constitute an integral component of any quality-related program in a hospital, given their oversight and provision of nearly all healthcare services. Nurses' knowledge and attitudes play a significant role in healthcare delivery. Within Saudi Arabia, the prevalence of hospital-acquired infections in hospital settings has prompted a growing emphasis on evaluating nursing knowledge and adherence to practice standards aimed at hospital-acquired infection prevention. This single-center cross-sectional study was conducted at the emergency department of King Faisal Medical Complex, Taif, between October and December 2022, involving 168 nurses. The study utilized a pre-validated structured online questionnaire comprising three sections: demographics, knowledge assessment, and practice evaluation. Knowledge and practice levels were categorized as good, moderate, and poor using quartiles. The study encompassed 168 nurses employed in the emergency department of the hospital, revealing their proficiency in standard practices for preventing hospital-acquired infections. Notably, 63.8% of participants demonstrated a commendable "Good" level of knowledge, while 10.6% exhibited a "Moderate" level and 25.5% manifested a "Poor" level in terms of knowledge. Similarly, concerning practice levels, 56.4% showcased a commendable "Good" practice level, 22.3% maintained a "Moderate" practice level, and 21.3% presented a "Poor" practice level. Chi-square analysis unveiled a significant association between age and knowledge levels (p = 0.000). In addition, age (p = 0.000) and years of clinical experience (p = 0.000) were significantly linked to nurses' practice levels The nurses aged 40-50 years (82%) and those with 10-15 years of clinical experience (83.3%) showed good levels of knowledge and practice, respectively. Overall, most of the nurses demonstrated effective knowledge and compliance with infection prevention practices. Sociodemographic factors such as age and clinical experience exert a notable impact on nurses' knowledge and practices regarding hospital-acquired infections.

Tips for Transient Perivascular Inflammation of the Carotid Artery Syndrome

BackgroundIdiopathic carotidynia, also known as transient perivascular inflammation of the carotid artery (TIPIC) syndrome, is a rare, self-limited, clinical-radiologic entity. Over the years, the diagnosis of carotidynia has been controversial, but recent pathologic, radiologic, clinical, and laboratory findings support an inflammatory etiology. Case ReportA 61-year-old woman with a history of hypertension, left lower extremity liposarcoma, and right internal jugular port placement 2 weeks prior with initiation of chemotherapy presented to the emergency department with right neck pain and swelling of the lateral neck and lower face for the past 3 days. Computed tomography–neck with IV contrast revealed marked mural thickening of the right common carotid artery, which can be seen with carotidynia (Fay syndrome and TIPIC syndrome) and vasculitis. The patient had elevated inflammatory markers and was treated clinically for carotidynia with ibuprofen, evaluated by vascular surgery, and discharged home. Why Should an Emergency Physician Be Aware of This?The causes of acute neck pain are diverse, ranging from nonemergent to surgically emergent etiologies. As radiologists and emergency physicians, we believe TIPIC syndrome is a rare entity with important clinical impact deserving attention, as it is not typically included in medical training and is usually learned only through years of clinical experience and practice. TIPIC syndrome requires a unique combination of both clinical and radiologic findings to diagnose accurately and appropriately. It is important to be familiar with this diagnosis because treatment is focused on symptomatic relief without the need for invasive procedures. Our goal was to increase awareness of this uncommon diagnosis to improve patient care by preventing unnecessary invasive procedures and aid in timely and accurate diagnosis.

Exploring nurses' awareness and attitudes toward artificial intelligence: Implications for nursing practice.

Worldwide, healthcare systems aim to achieve the best possible quality of care at an affordable cost while ensuring broad access for all populations. The use of artificial intelligence (AI) in healthcare holds promise to address these challenges through the integration of real-world data-driven insights into patient care processes. This study aims to assess nurses' awareness and attitudes toward AI-integrated tools used in clinical practice. A descriptive cross-sectional design captured nurses' responses at three governmental hospitals in Saudi Arabia by using an online questionnaire administered over 4 months. The study involved 220 registered nurses with a minimum of one year of clinical experience, selected through a convenience sampling method. The online survey consisted of three sections: demographic information, an assessment of nurses' AI knowledge, and the general attitudes toward the AI scale. Nurses displayed "moderate" levels of awareness toward AI technology, with 70.9% having basic information about AI and only 58.2% (128 nurses) were considered "aware" of AI as they dealt with one of its healthcare applications. Nurses expressed openness to AI integration (M = 3.51) on one side, but also had some concerns about AI. Nurses expressed conservative attitudes toward AI, with significant differences observed based on gender (χ² = 4.67, p < 0.05). Female nurses exhibited a higher proportion of negative attitudes compared to male nurses. Significant differences were also found based on age (χ² = 9.31, p < 0.05), with younger nurses demonstrating more positive attitudes toward AI compared to their older counterparts. Educational background yields significant differences (χ² = 6.70, p < 0.05), with nurses holding undergraduate degrees exhibiting the highest positive attitudes. However, years of nursing experience did not reveal significant variations in attitudes. Healthcare and nursing administrators need to work on increasing the nurses' awareness of AI applications and emphasize the importance of integrating such technology into the systems in use. Moreover, addressing nurses' concerns about AI's control and discomfort is crucial, especially considering generational differences, with younger nurses often having more positive attitudes toward technology. Change management strategies may help overcome any hindrances.

Relationship Between Clinical Nursing Competence and Work Environment by Career Stage for Nurses with 1-10 Years of Clinical Experience.

Clinical nursing competence includes ethics, cooperation with other professionals, and management, in addition to nursing abilities and responding per situation. Therefore, it may vary depending on one's experience and the work environment. However, there is a lack of studies exploring the competence for different experience levels. Therefore, this study aimed to clarify the association between clinical nursing competence and the work environment by experience groups. Anonymous self-administered questionnaire surveys were conducted on 717 nurses in regional core hospitals from December 2017 to March 2018. Clinical nursing competence was measured using the Clinical Nursing Competence Self-Assessment Scale (CNCSS). Association of CNCSS with experience and work environment was examined. Responses from 231 nurses with 1-10 years of experience were analyzed. Compared with those in the 2-year experience group, those in the 3-5- and 6-10-year experience groups assessed their "planned development of nursing care" and "assessment of care" competencies to be higher. Additionally, compared with those in the 2-year experience group, those in the 6-10-year experience group assessed their "clinical judgment" and "care coordination" competencies to be higher. Nurses with 1 year of experience showed significant positive correlations between clinical nursing competence and "good interpersonal relationship," "clarity about the organization's vision," and "ease of taking time off"; and those with 6-10 years of experience showed significant positive correlations between clinical nursing competence and "support from superiors and senior coworkers" and "established and easily accessible support system for taking time off for childcare and caregiving." The relationship between clinical nursing competence and the work environment differed according to years of experience. Interventions to improve clinical nursing competence should be developed for each experience group considering the associations.

Assessment of Cardiopulmonary Resuscitation Knowledge Among Physicians in the Pediatrics Department of an Urban Tertiary Referral Hospital in Ethiopia: A Cross‐Sectional Study

Background: Early recognition of cardiac arrest and prompt start of cardiopulmonary resuscitation (CPR) boost survival rates and reduce postarrest consequences. Little information is available about the fundamental CPR knowledge of healthcare workers who work with children in Ethiopia.Methods: All physicians, regardless of seniority, participated in this cross‐sectional survey from June to August 2022. They received a structured survey that was modified from the American Heart Association (AHA) Basic Life Support (BLS) test which was made up of 10 questions about participants’ job experience and 25 multiple‐choice CPR knowledge questions. Data analysis was done using a multinomial logistic regression test with a p value of 0.05.Result: One hundred sixty‐eight doctors with various levels of seniority participated in this study. The participants included a male‐to‐female ratio of 1.3:1, a median age of 28 years, 92 (57.9%) male participants, and 124 (78%) participants with less than 5 years of clinical experience. Ninety‐seven participants, or 61%, had scored less than 75% whereas 13 (8.2%), participants, had good knowledge that is scoring above 75%. Participants who had training in CPR within the previous year showed significantly higher levels of knowledge than those who hadn’t. Even though 90% of the participants claimed to have CPR knowledge, the majority of participants were found not to have below 75%.Conclusion: The study concludes that while many doctors believe they have adequate CPR knowledge, actual knowledge levels are insufficient. Staff should undergo regular certification and assessments to ensure they retain their resuscitation knowledge. This ongoing evaluation is crucial for maintaining high standards of care and preparedness in emergencies.

7‐methylxanthine for myopia control in Denmark – Clinical results 2003–2023

In 2009, the Danish Medicines Agency authorized the use of pharmacy‐compounded 7‐methylxanthine (7‐MX) tablets for treatment of progressive myopia in children. 7‐MX has since been prescribed to more than 1200 individuals with no reports of adverse effects. A high compliance rate has demonstrated that the concept of using an oral pharmaceutical to control myopia progression is feasible. Analysis with the use of linear mixed models of longitudinal data from 711 children aged 7–14 years and with less than 10 diopters (D) of myopia at baseline has shown that myopia progression and axial eye growth is linearly associated with the average daily dose of 7‐MX taken during the observation period. Linear regression of data from 350 children aged 7–10 years at baseline who completed 3 years of follow‐up suggest that the absolute reduction of myopia progression and axial growth over 3 years associated with taking 400 mg three times daily is approximately 1.2 D and 0.35 mm, regardless of baseline myopia. Linear regression of data from 157 children aged 7–10 years at baseline who completed 5 years of follow‐up suggest that the absolute reduction of myopia progression and axial growth over 5 years associated with taking 400 mg three times daily is approximately 1.8 D and 0.62 mm.Thus, the efficacy of 7‐MX does not seem to decrease with duration of treatment. Negative eye growth (eye shortening) of 0.05 mm or more in children taking an average daily dose of 640 mg or more occurs in 1% of children aged 6–9, 3% of children aged 10–13, and 8% of children aged 14–15 at baseline. The largest eye shortening found was in a 6‐year‐old child with an initial myopia of −7.125/−7.75 diopters (D) and axial length of 26.07/26.29 mm who took an average dose of 1152 mg 7‐MX per day. After 1 year, the myopia was reduced to −5.5/−5.75 D and the axial length reduced to 25.77/25.94 mm. 7‐MX does not seem to induce thickening of the choroid and may therefore work by another mechanism than other myopia control interventions. Preliminary data suggest that the effects of 7‐MX and other myopia control methods are additive. In conclusion, based on 20 years of clinical experience in Denmark, 7‐MX shows promise as a non‐toxic, side‐effect free, oral myopia control pharmaceutical, suitable for use as a supplement when myopia progression cannot be completely arrested by monotherapy with low‐dose atropine or an optical device.

The importance of the development of extracorporeal life support simulation centres for improving skills and knowledge during the COVID-19 pandemic.

Despite increasing implementation of sophisticated and logistically challenging techniques to support patients in life-threatening conditions in the last years, there were no devoted education centres, especially in coronavirus pandemic. To assess the value of gaining evidence-based knowledge and improving the skills of physicians by means of simulation techniques in the safe use of extracorporeal technologies to support patients in the life-threatening conditions. In 2019, the National Education Centre for Artificial Life Support and Patient Safety and the frame program of the course of "Artificial Life Support with ECMO". was created. In years 2019-2023, we managed to organise 34 such courses for 405 physicians, which were additionally endorsed by ELSO (Extracorporeal Life Support Organisation). The physicians' cognitive, behavioural, and technical skills were evaluated before and after the courses. The participants' gender was well balanced (54% men and 46% women). Most of them (mainly at the age between 31-40 years) presented more than 5 years of clinical experience, predominantly in anaesthesiology and intensive care (63%). Of note, 54% of them had no experience with ECMO application. In all detailed aspects of cognitive, behavioural, and technical assessment and knowledge scores, significant improvement was observed after the course. The development of a simulation-based education centre was found to be an invaluable achievement that enabled not only successful standardised training and testing of novel or previously accepted procedures, but also the upgrading of technical skills, even in the challenging COVID-19 pandemic period.

Analysis of questionnaire survey to determine worldwide trends in prescriptions of biologics for the treatment of unresponsive chronic urticaria

BackgroundChronic spontaneous urticaria (CSU) is a common condition treated by allergist/immunologists, but the only FDA-approved biologic medication, omalizumab, may be underutilized globally. ObjectiveThis study was performed to determine the global prescription of omalizumab for treatment of CSU by allergists/immunologists. MethodsAnonymous questionnaire surveys were distributed online to World Allergy Organization (WAO) members worldwide. Categorical data were analyzed for descriptive analysis using one-way frequency tabulation in SAS 9.4. ResultsThere were 348 respondents (43 missing data); Average age 51 (range 28–90); M/F 48%/52%. 58% had > 15 years of clinical experience and 10% < 5; 42% worked in private clinics, 36% public hospitals, 24% academia, 18% private hospitals, and 4% in community practice. Eighty-two percent (82%) prescribed omalizumab for CSU patients and use of omalizumab was highest among young practitioners. The most significant barriers were cost (63%) and restricted formulary (24%). Drug safety (63%) and chances of adverse events (47%) were the most significant factors deciding treatment. Twenty-two percent (22%) reported 80–100% of CSU patients were complete responders to omalizumab; 34% preferred increasing frequency (q 2-weeks), and 18% preferred increasing dose (600 mg q 4-weeks) for partial or non-responders. UAS7, UCT, and CU-QoL were used to assess CSU by 55%, 29%, and 25% of respondents, respectively. Autoimmune thyroid disease (62%), thyroid abnormality (43%) and allergic rhinitis (35%) were the most frequent comorbidities reported. ConclusionsMost clinicians favored omalizumab over other potential treatments due to safety. Although younger clinicians were more likely to prescribe omalizumab, cost and formulary access were major barriers. Only 22% of respondents reported 80% or greater of their patients had complete response to omalizumab, indicating the need for novel CSU therapies.