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Adolescents with cancer (AWC) in pediatrics may not have adequate opportunities for peer support. This mixed methods study aimed to characterize peer support needs of AWC during or shortly after treatment. Ten AWC with median age 16.5 (range 14-18) years completed a survey and semistructured interview. Three themes were apparent: cancer journey difficulties, current support system, and peer support perspectives. Participants felt incompletely understood by existing supports, lacked connection with other AWC, and craved experiential information. Peer support interventions should be flexible, facilitate various interactions, and include social media. The next step is to implement and evaluate an intervention.

With the implementation of the new heart transplant (HT) allocation system, patients requiring biventricular support systems have the highest priority, a shorter waitlist time, and a higher frequency of HT. However, the short-term and long-term outcomes of such patients are often disputed. Hence, we examined the outcomes of these patients who underwent HT before change in allocation scheme. Additionally, we compared post-HT outcomes of extracorporeal membrane oxygenation (ECMO) with other nondischargeable biventricular (BiVAD) supported patients. We identified adult ECMO or BiVAD supported HT recipients between 2000 and 2018 in the Scientific Registry of Transplant Recipients database. We compared survival with the Kaplan-Meier method. Using overlap propensity score weighting, we constructed Cox proportional hazards regression models to determine the risk-adjusted influence of BiVAD versus ECMO on survival. Of the 730 patients HT recipients; 528 (72.3%) and 202 (27.7%) were bridged with BiVAD and ECMO, respectively. For BiVAD versus ECMO patients, the 30-day, 1-year, 3-year, and 5-year mortality rates were 8.0% versus 14.4%, 16.3% versus 21.3%, 22.4% versus 25.3%, and 26.3% versus 25.7%, respectively. Risk-adjusted post-HT survival of BiVAD and ECMO patients at 30-day (HR 1.24 [95% CI, 0.68-2.27]; P = 0.4863), 1-year (HR 1.29 [95% CI, 0.80-2.09]; P = 0.3009), 3-year (HR 1.27 [95% CI, 0.83-1.94]; P = 0.2801), and 5-year (HR 1.35, 95% CI, 0.90-2.05; P = 0.1501) were similar. Around three-fourth of the ECMO or BiVAD supported patients were alive at 5-years post-HT. The short-term and long-term post-HT survivals of groups were comparable.

BACKGROUND Hospitalization of a newborn infant is stressful for all mothers. Hospitals in Malawi have limited nursing staff and support, so mothers are the primary care providers for their hospitalized infants. Few studies have explored the experience of these mothers as both care providers and mothers. PURPOSE The purpose of this study was to explore the experiences of mothers during the hospitalization of the infant. The goal was to increase knowledge of their primary concerns about the hospital stay. METHODS This was a descriptive qualitative study conducted at Queen Elizabeth Central Hospital in Malawi. Mothers were interviewed prior to their infant's discharge. We used the directed content analysis approach to analyze our data. RESULTS Twenty mothers of preterm or full-term infants were interviewed. The primary concerns were perinatal experiences, the infant's condition and care including breastfeeding, support from family members, and support and care from healthcare providers. Additionally, mothers of preterm infants were concerned about the burdens of kangaroo mother care. IMPLICATION FOR PRACTICE In hospitals that provide limited nursing support to mothers and their infants, it is important to identify a support system for the mother and provide mothers with information on infant care. IMPLICATIONS FOR RESEARCH Future research should identify specific supports and resources in the community and hospital settings that are associated with positive hospital experiences.

Highlights • Thermoplastic masks are widely used in clinical routine on conventional LINACs. • Patient setup is more challenging on MR-LINAC systems. • lOn the MRIdian system, there is no dedicated holder for the anterior receiver coil. • We evaluated the suitability of a customised coil support system for MRgRT. • (MR) image uniformity measurements demonstrated improved image uniformity. • Fixed distancing between the receiver coils and the patient is possible. • This coil support system represents a solution for stable anterior coil placement., Magnetic resonance imaging (MR)-guided online adaptive radiotherapy is a promising technique in the field of radiation oncology providing excellent visualisation of soft-tissues, and allowing for online plan adaptation and tumour tracking. In order to facilitate the accurate dose delivery to the target volume while sparing healthy surrounding normal tissue in the brain or head-and-neck (H&N) region, precise patient immobilisation with good image quality is pertinent. Herein, we present a customised thermoplastic mask holder with an integrated anterior MR receiver coil support system for MR-guided online adaptive radiotherapy in the brain and head-and-neck region. The approved medical product was developed by Innovative Technologie Voelp (IT-V), Innsbruck, Austria. MR image uniformity measurements demonstrated improved image uniformity at the expense of decreased signal-to-noise ratio due to a more defined and larger distance between the anterior receiver coil and the phantom or patient. This integrated coil support system represents a practical solution facilitating stable and reproducible anterior coil placement while maintaining the thermoplastic mask holder functionality, a widely established immobilisation technique.

Purpose of review To summarize elements of cross-sector population health networks to support systems and policy change to achieve equitable access to health services and healthy development opportunities for young children and families, allowing everyone to have a fair and just opportunity to be as healthy as possible. Recent findings The principles and tactics of Equity and Inclusion, Readiness, Joint Planning, Governance, and Data can guide cross-sector networks in effectively supporting communities in addressing health inequities. These principles are not linear or siloed, but rather, they overlap and reinforce each other. The principles require equity and the participation of community members to be central in all aspects of cross-sector network work. Summary By building strong relationships among community partners, cross-sector population health networks can ensure the network is not a short-term, transactional one-time project, but rather, a sustained collaboration through enduring processes and infrastructure. Networks can gain a fuller understanding of the needs and assets of a community through engagement and leadership by community members than they could gather from data and surveys alone. This approach to serving a community by making members equal partners in the effort helps to place equity at the center of a network's focus, as does embedding equity-related decision-making tools and processes into daily operations of the network. If cross-sector networks build resilient, inclusive structures and procedures, they can utilize them to quickly pivot and adjust to emerging needs or respond to crisis.

BACKGROUND The artificial liver support system (ALSS) is an effective treatment method for liver failure, but it requires deep venous intubation and long-term indwelling catheterization. However, the coagulation mechanism disorder of basic liver failure diseases, and deep venous thrombosis (DVT) often occur. AIM To evaluate the risk factors for DVT following use of an ALSS and establish a risk assessment score. METHODS This study was divided into three stages. In the first stage, the risk factors for DVT were screened and the patient data were collected, including ALSS treatment information; biochemical indices; coagulation and hematology indices; complications; procoagulant use therapy status; and a total of 24 indicators. In the second stage, a risk assessment score for DVT after ALSS treatment was developed. In the third stage, the DVT risk assessment score was validated. RESULTS A total of 232 patients with liver failure treated with ALSS were enrolled in the first stage, including 12 with lower limb DVT. Logistic regression analysis showed that age [odds ratio (OR), 1.734; P = 0.01], successful catheterization time (OR, 1.667; P = 0.005), activity status (strict bed rest) (OR, 3.049; P = 0.005), and D-dimer level (≥ 500 ng/mL) (OR, 5.532; P < 0.001) were independent risk factors for DVT. We then established a scoring system for risk factors. In the validation group, a total of 213 patients with liver failure were treated with ALSS, including 14 with lower limb DVT. When the cutoff value of risk assessment was 3, the specificity and sensitivity of the risk assessment score were 88.9% and 85.7%, respectively. CONCLUSION A simple risk assessment scoring system was established for DVT patients with liver failure treated with ALSS and was verified to have good sensitivity and specificity.

Specific Language Impairment (SLI) is a language disorder that delays progress in mastering speech-language skills, and typically occurs in childhood. Most speech-language pathologists commonly use paper-based instruments to diagnose and treat this problem. This article describes the design, implementation, and evaluation of SATEL, an ontology-based system used both in diagnosing this condition and as part of speech therapy for children with SLI. With the help of a Kinect sensor, SATEL is able to recognize and classify pronounced words. The proposed system was designed and evaluated by a team of four speech-language pathologists and 26 children diagnosed with SLI. Results showed an accuracy rate of 94.42% and 97.75% in recognizing syllables and words correctly and incorrectly pronounced in the diagnostic and treatment modules, respectively.

Introduction Lateral radiography of the knee joint is frequently performed; however, the retake rate is high owing to positioning errors. Therefore, in this study, to reduce the required number and time of image retakes, we developed a system that can classify the tilting directions of lateral knee radiographs and evaluated the accuracy of the proposed method. Methods Using our system, the tilting directions of a lateral knee radiographs were classified into four direction categories. The system was developed by training the DCNN based on 50 cases of Raysum images and tested on three types test dataset; ten more cases of Raysum images, one case of flexed knee joint phantom images and 14 rejected knee joint radiographs. To train a deep convolutional neural network (DCNN), we employed Raysum images created via three-dimensional (3D) X-ray computed tomography (CT); 11 520 Raysum images were created from 60 cases of 3D CT data by changing the projection angles. Thereby, we obtained pseudo images attached with correct labels that are essential for training. Results The overall accuracy on each test dataset was 88.5 ± 7.0% (mean ± standard deviation), 81.4 ± 11.2%, and 73.3 ± 9.2%. The larger the tilting degree of the knee joint, the higher the classification accuracy. Conclusion DCNN could classify the tilting directions of a knee joint from lateral knee radiographs. Using Raysum images made it possible to facilitate creating dataset for training DCNN. The possibility was indicated for using support system of lateral knee radiographs. Implications for practice The system may also reduce the burden on patients and increase the work efficiency of radiological technologists.

The aim of this article is to achieve an account of the key surgical points in thyroid and parathyroid surgery that helps the surgeon to achieve safe interventions. A surgery is not enjoyed if the surgeon does not have full knowledge of the applied anatomy of the area to be operated on. In thyroid surgery, having a basic understanding of the embryology of both glands provides great help when it comes to dissection and surgical treatment. The position of the patient and the equipment that we must have before starting the surgical act is essential. Releasing the gland from its support systems: fascia, ligaments and vascular pedicles, effectively and through the correct dissection plane is a key aspect in the proper development of the surgery. The identification of the tubercle of Zuckerkandl indicates the crossroads between the inferior thyroid artery, the superior parathyroid gland and the recurrent nerve. We consider neuromonitoring of the recurrent nerve necessary, because except for the exception of a known non-recurrent recurrent nerve, the complexity in the location of this nerve cannot be determined a priori. The hemostatic instruments that we currently have require their routine use. Thorough knowledge of thyroid surgery makes it easier for the surgeon to perform any surgical treatment of the parathyroid glands. Nuestro objetivo es lograr una descripción de los puntos quirúrgicos clave en la cirugía tiroidea y paratiroidea que ayude al cirujano a conseguir intervenciones seguras. Una cirugía no se disfruta si el cirujano no tiene pleno conocimiento de la anatomía aplicada del área a operar. En la cirugía de tiroides tener un conocimiento básico de la embriología de ambas glándulas aporta una gran ayuda a la hora de la disección y tratamiento quirúrgico. La posición del paciente y el equipo de instrumentos que debemos tener antes de iniciar el acto quirúrgico es fundamental. Desanclar la glándula de sus sistemas de sujeción: fascia, ligamentos y pedículos vasculares, de manera eficaz y por el plano correcto de disección es un aspecto clave en el buen desarrollo de la cirugía. La identificación del tubérculo de Zuckerkandl nos señala la encrucijada entre arteria tiroidea inferior, glándula paratiroides superior y nervio recurrente. Consideramos necesaria la neuromonitorizacion del nervio recurrente, porque salvo en la excepción de un nervio recurrente no recurrente conocido, no se puede determinar a priori la complejidad en la localización de este nervio. Los instrumentos hemostáticos de los que disponemos en la actualidad obligan a su uso rutinario. El minucioso conocimiento de la cirugía de tiroides facilita al cirujano la realización de cualquier tratamiento quirúrgico de las glándulas paratiroides.

BACKGROUND: Support should be provided to individuals who are ready to be discharged; however, quantitative research is lacking in understanding the challenges of postsurgery lumbar fusion patients' discharge and transition. This article delves into the in-depth experience of lumbar fusion patients with discharge transitions. METHODS: We conducted semistructured individual interviews with 11 patients who had lumbar fusion surgery at one of Korea's most equipped general hospitals. These interviews focused on the patients' discharge transition experiences. The data were analyzed using phenomenological analysis. RESULTS: Lumbar fusion patients' experiences of discharge transition fit into 4 categories: anticipation of surgical transition, the process of transition to discharge, the difficult process of recovery, and recovery strategy. CONCLUSION: To further expedite the discharge process and make better use of cooperative hospital resources, conducting preoperative treatment planning, identifying family and social support systems, and sharing treatment procedures are all required. Furthermore, thorough health information services and step-by-step courses on predicted problems and everyday living after surgery should be considered for postoperative education. It is critical to broadening the scope of preoperative and postoperative education programs, as well as assistance for the social support system, such as the family-based support system and cooperative hospitals.

Особливу актуальність набуває подальший технологічний та організаційний розвиток використання можливостей новітньої екстреної тестової маркерної лабораторної діагностики в удосконаленні організації та наданні екстреної медичної допомоги постраждалим при надзвичайних ситуаціях мирного й воєнного характеру, що обґрунтовує мету дослідження — визначення нагальної потреби забезпечення сучасним діагностичним лабораторним обладнанням цивільних і військових медичних служб. Досліджена та проаналізована вітчизняна й іноземна фахова медична наукова література, нормативно-правова база з організації екстреної медичної допомоги та використання сучасного діагностичного лабораторного обладнання маркерної лабораторної експрес-діагностики point of care технології. Дослідження проводились методами контент-аналізу джерел інформації та узагальнення спостережень. Узагальнення світового досвіду використання різноманітних експрес-тестів маркерної лабораторної діагностики дозволяє дослідити і пов’язати їх з різними станами організму людини, використати в удосконаленні організації та наданні екстреної медичної допомоги постраждалим і пораненим з цивільного населення та військовослужбовців у поліпшенні системи лікувально-евакуаційного забезпечення в дошпитальному і шпитальному періодах.

The COVID-19 pandemic disrupted the usual processes and support systems related to applying to medical school in the United States. The Texas-Wide Premedical Mentoring Program (TPMP) was established to pair medical student mentors in Texas with medical school applicants attending Texas colleges and universities. Our objective was to demonstrate the effect of the TPMP on application preparedness and self-reported mental health outcomes of program participants. A survey was developed to understand the program’s impact on both mentees and mentors. Participants were sent a survey link 3 months after the TPMP launch. In total, 313 participants, comprising 62% premedical student mentees and 38% medical student mentors, completed the survey. Mentees reported a significantly positive effect of the program on anxiety, uncertainty of acceptance, connection to medicine, and making the road to medical school seem less impossible. After participation, mentees felt less alone and reported a positive impact on their perception of the application process. The TPMP positively impacted the mental wellness of both mentees and mentors, and about 80% of mentors felt more fulfilled despite not participating in clinical duties in light of suspensions. In conclusion, program participation was associated with decreasing application knowledge gaps, easing anxiety, and providing alliance for mentees. The TPMP had a similarly positive influence on the mental wellness of mentees and mentors as well as contributed to medical student mentors’ sense of fulfillment.

The new coronavirus infection (COVID-19) has spread to numerous countries around the world since several cases of the disease were first reported in late December 2019 in China. Currently, the WHO strongly recommends infection prevention measures such as wearing masks, hand washing, and frequent disinfection of high-touch surfaces, but there were many arguments against infection prevention policy in March 2020. For example, the WHO did not recommend the use of masks for the healthy general public. In Japan, wearing a mask was required before the habit of wearing a mask was established, which gave additional works of checking whether customer was wearing a mask to the employees. To reduce the workloads of employee and ensure mask-wearing, we started providing the mask-wearing system free of charge on March 5, 2020. We also developed hand washing time estimation and disinfection support system. It is useful to accumulate data on the status of implementation of countermeasures by our application, which leads to gain useful knowledge regarding countermeasures against COVID-19 as well as other infectious diseases. In this paper, we describe the development and introduction impacts of these systems in a pandemic emergencies. In addition, because of the security and privacy issues in running these image analysis applications, we discuss the delivery methods suitable for each service.

Dear Editor,The COVID-19 pandemic has changed the current landscape of grief and loss, creating increased isolation around support systems and normal bereavement rituals. Accessing formalized grief...

AIMS The aim of this study was to develop and test the feasibility of a magnetic resonance imaging (MRI)-based measurement strategy to evaluate the effectiveness of surgical procedures in restoring normal anatomy in all three systems of pelvic floor support and quantify the structural changes induced by prolapse surgery. METHODS Patients underwent clinical examination and stress MRI preoperatively and again 3 months postoperatively. Preoperative and postoperative measures of three MRI-based structural support systems were made: (1) vaginal wall, (2) apical and paravaginal support, and (3) hiatal closure system. Preoperative to postoperative structural changes were calculated and compared to normal values, and bivariate associations were determined. RESULTS The three structural support systems were successfully quantified for both preoperative and postoperative MRIs regardless of operative approaches in all 15 women in the pilot group. Apical support was restored to normal in 11 of 12 patients who underwent an apical suspension procedure and 9 of 14 patients with a posterior repair had normalization of genital hiatus size. Mid-vaginal paravaginal location was elevated an average of 2.5 ± 2.0 cm despite no paravaginal repairs being performed. Paravaginal location improvements were also significantly correlated with apical elevation (r values 0.99-0.87, p

In light of the need for objective mechanism-based diagnostic tools, the current research describes a novel diagnostic support system aimed to differentiate between anxiety and depression disorders in a clinical sample. Eighty-six psychiatric patients with clinical anxiety and/or depression were recruited from a public hospital and assigned to one of the experimental groups: Depression, Anxiety, or Mixed. The control group included 25 participants with no psychiatric diagnosis. Participants performed a battery of six cognitive-behavioral tasks assessing biases of attention, expectancies, memory, interpretation and executive functions. Data were analyzed with a machine-learning (ML) random forest-based algorithm and cross-validation techniques. The model assigned participants to clinical groups based solely on their aggregated cognitive performance. By detecting each group's unique performance pattern and the specific measures contributing to the prediction, the ML algorithm predicted diagnosis classification in two models: (I) anxiety/depression/mixed vs. control (76.81% specificity, 69.66% sensitivity), and (II) anxiety group vs. depression group (80.50% and 66.46% success rates in classifying anxiety and depression, respectively). The findings demonstrate that the cognitive battery can be utilized as a support system for psychiatric diagnosis alongside the clinical interview. This implicit tool, which is not based on self-report, is expected to enable the clinician to achieve increased diagnostic specificity and precision. Further, this tool may increase the confidence of both clinician and patient in the diagnosis by equipping them with an objective assessment tool. Finally, the battery provides a profile of biased cognitions that characterizes the patient, which in turn enables more fine-tuned, individually-tailored therapy.

Study objective To explore the social and environmental conditions in emergency departments that contribute to perceived barriers and supports for workplace lactation among individuals working in emergency medicine. Methods Constructivist grounded theory was used by our team to understand the social processes and behaviors associated with workplace lactation for health care professionals working in EDs. A total of 24 interviews of individuals in EDs with recent return-to-work experience after childbirth were performed. The interviews yielded 36 unique experiences (from 21 faculty, 12 trainees, and 3 nurses) because some participants had more than 1 child, in which case all lactation experiences were discussed. Interview transcriptions were coded and analyzed iteratively for the development of themes, per constructivist grounded theory. Results Using constant comparative inductive methods, we describe 3 pervasive themes as they relate to workplace lactation that emerged from the analysis of interview data: (1) emergency medicine culture, (2) workplace lactation policies, and (3) supports for workplace lactation. Conclusion Although formalized workplace lactation policies and other identifiable supports for workplace lactation aid individuals desiring to lactate after returning to work in EDs, many individuals still experience cultural barriers to their desired lactation habits. Policies and individual support systems may continue to fall short of meeting the needs of lactating individuals in emergency medicine unless broader cultural change occurs. Our work offers initial recommendations for shifting the landscape of lactation practices in emergency medicine.

The article refers to resources, problems and challenges of autism diagnosis and support system in Poland. The resources include: the increasing number of specialists, diagnostic and therapeutic centres, well-established course of education for people working with youths, standardised and normalised diagnostic tools. The diagnostic process is not without some areas in need of our focus: the tendency of some specialists to make unauthorised diagnosis, overshadowing; underestimation of comorbidity of ASD with other disorders. The challenges refer to introducing an effective system of monitoring the services provided in form of certification and control in order to prevent their abuse, initiating category of temporary diagnosis; paying more attention on individual’s resources, better cooperation among specialists, teachers and families, developing and unifying diagnostic standards.

Objective Continuous glucose monitoring (CGM) has become increasingly popular among youth with type 1 diabetes (T1D). Used with CGM, remote monitoring (RM) gives caregivers real-time access to patients’ glucose values. Whereas RM may safeguard against hypo- and hyperglycemic events, little is known about how older children and adolescents, who are striving for independence, and their parents view the RM aspect of CGM. The goal of this study was to describe and explore parent and youth perceptions of RM. Methods Youth with T1D and their parents participated separately in semi-structured interviews 2 months after starting CGM. Questions focused on decisions to use and experiences with RM. Results Analysis of 43 parents and 41 youth (13.79 years ± 2.82) interviews revealed four themes, with 10 subthemes. Seven subthemes emerged in parent and youth interviews, and three emerged exclusively in parent interviews. The overarching themes included the impact of RM on (1) peace-of-mind, (2) parental anxiety, (3) communication; and addressed (4) technological limitations that prevented some from using RM. Regardless of youth age, youth and parents found comfort in parental knowledge of glucose values and parental abilities to assist youth (e.g., giving reminders to eat). Whereas RM could lead to conflicts due to excessive communication (e.g., texting), conflicts could be resolved through iterative parent-youth conversations. Conclusion RM may facilitate youth independence by providing a way for them to stay connected to their support system while acquiring developmentally appropriate skills. However, families should have iterative discussions about boundaries to mitigate parental over-involvement.

Tuberculosis (TB) is a global public health problem. Families need to meet healthcare needs during the treatment of TB sufferers. This study aims to identify healthcare needs of families caring for patients with the disease. The cross-sectional study involved 83 families caring for TB patients. The research was conducted at a Primary Healthcare Center in an urban area in West Java. The results revealed that 60.2% of caregivers were 18–40 years old, 60.2% were female, 51.8% were senior high school educated, 43.4% were housewives, 86.7% had an income under the regional minimum wage, and 55.4% had cared for the TB patients for 3–6 months. The families had healthcare needs for emotional support (mean 33.72, SD 4.16); information support (mean 33.28, SD 4.09); instrumental support (mean 32.4, SD 3.73); and appraisal support (mean 28.01, SD 5.93). The greatest support need was how to encourage clients to take treatment completely (Score: 140); TB treatment information (Score: 138); financial support for chest x-ray costs (Score: 114); and how to assess patient behavior in maintaining health (score: 133). Based on the study result, the families need to improve their ability to give appraisal support during the patient's treatment. The identification of families’ healthcare needs in caring for patients with pulmonary TB can provide primary data for developing innovative programs integrated with DOTS programs in healthcare services to improve family support. Abstrak Kebutuhan Perawatan Kesehatan Keluarga yang Merawat Pasien Tuberkulosis. Tuberkulosis (TB) merupakan masalah kesehatan masyarakat global. Keluarga harus memenuhi kebutuhan perawatan kesehatan selama pengobatan pada pasien TB. Penelitian ini bertujuan untuk mengidentifikasi kebutuhan perawatan kesehatan pada keluarga yang merawat pasien TB. P enelitian cross-sectional ini melibatkan responden sebanyak 83 keluarga yang merawat pasien TB. Penelitian ini dilaksanakan di sebuah P uskesmas di Kota Depok , Jawa Barat . Penelitian ini melaporkan sebanyak 60,2% berusia 18 – 40 tahun, 60,2% perempuan, 51,8% lulus sekolah menengah atas, 43,4% ibu rumah tangga, 86,7% pen dapatan di bawah upah minimum regional, 55,4% merawat pasien TB selama 3–6 bulan. Keluarga memiliki kebutuhan perawatan kesehatan untuk dukungan emosional (rerata 33,72, SD 4,16), dukungan informasi (rerata 33,28, SD 4,09), dukungan instrumental (rerata 32,4, SD3,73), dukungan penghargaan (rerata 28,01, SD 5,93). Kebutuhan tertinggi yaitu bagaimana mendorong pasien melakukan pengobatan secara tuntas (140), informasi pengobatan TB (138), dukungan keuangan untuk biaya pemeriksaan rontgen (114), dan bagaimana mengkaji perilaku pasien dalam mempertahankan kesehatan (133). Keluarga membut u hkan peningkatan kapasitas dalam memberikan dukungan penghargaan selama pengobatan pasien. Kebutuhan akan perawatan kesehatan pada keluarga yang merawat pasien TB dapat dijadikan data dasar dalam mengembangkan program inovatif terintegrasi dengan program DOTS di fasilitas layanan kesehatan dalam meningkatkan dukungan pada pasien TB. Kata kunci : keperawatan keluarga, sistem dukungan, Tuberkulosis paru

Background: Comorbidity is the biggest decider in COVID-19 pandemic whether the infected person will develop the severe clinical outcome or not. It is one of the few conclusions that has widespread acceptance. Summary:After analyzing the case fatalities of COVID-19, many patients were found to be having either one of many conditions which are commonly called as comorbidities due to which they cannot made it to survivors list. Also several COVID-19 patients requiring the sophisticated medical attention like ventilators and oxygen support system have any kind of underlying medical condition. Deteriorated immune system is one of the reasons behind slipping into severe symptoms category. Conclusion: It is established that comorbidities are the major influencer in COVID-19 infected patients. More study is needed to further segregate the data on the basis of each comorbidity.

Empirical and numerical methods of design play a vital role in assessing rock mass behaviour quantitativelyand qualitatively for the design of underground structures and support systems. The purpose of this research is to reviewthe techniques used for the management and prevention of failures that occur in rock mass for safe, stable, efficient, andeconomical design of support system for underground structures especially tunnels in diverse rock mass conditions.Failure of tunnels in rocks can occur during construction as well as during service; however, the former is very common.The most challenging task in tunnel construction is the rehabilitation and remedial process of the failed tunnel section.Unfortunately, due to differences in nature, shape, and type of failure, each case needs to be treated discretely andindependently. The risk of failure can be minimized by implementing prior preventive measures, while the success ofrehabilitation is based on better management of rehabilitation work. However, both prevention and rehabilitation needample investigative knowledge that can be learned from case histories. The current work is related to the prevention andmitigation methods of tunnel failure and collapses that occur during the early stages of tunnel designing.

The emergence of mHealth as an alternative access point for care and treatment is lauded by development agencies as ingenious innovation for bridging health care access for teenagers living with HIV/AIDS among detached communities like the islands of Lake Victoria. It is also presumed that mHealth transcends beyond teenagers’ concerns with location and unfriendly hours of operation of health facilities. mHealth is alleged to increase privacy and confidentiality, reduce the cost of service delivery, and loops over retrogressive cultural beliefs and attitudes exhibited by health care providers and caregivers, consequently increasing access to health information, care, and treatment. Specifically, the study sought to determine the technology obsolescence and explore community-based health support systems that facilitate suitable utilization of mHealth by teenagers living with HIV from the island communities of Lake Victoria and its effect on treatment access. To support this study, two philosophies: The theory of Reasoned Action and the Technology Adoption Lifecycle Model were applied. Anchored on cross-sectional study design, stratified sampling identified the psychosocial support groups of teenagers living with HIV. The probit model was applied to the study. With a study population of approximately 409 in Ringiti, Remba, Rusinga, Mfangano, and Mageta Islands, questionnaires were administered to 173 sampled teenagers living with HIV as a unit of analysis, and a control group made up of 30 percent of the sample ascertained effect of mHealth on treatment access. Five focus group discussions and key informant interviews of 10 and 3 were held on each Island. Multiple linear regression analysis was used to estimate the effect of the independent variables on the dependent variable. Further, the results showed that technology obsolescence and community-based health support systems had a significant effect on access to treatment by teenagers living with HIV/AIDS in the Island communities of Lake Victoria. Consequently, this study provides organizations promoting access to access to treatment by teenagers living with HIV/AIDS through mHealth. The study recommended that government and organizations involved in HIV/AIDS related activities should adopt a culture of enhancing mHealth by focusing on technology obsolescence and community-based health support systems. This could go a long way in ensuring there is improved access to treatment by teenagers living with HIV/AIDS in Island communities of Lake Victoria.

Introduction : Children in a foster family have a difficult life situation. This is a challenge for both foster parents and teachers. Cooperation based on shared commitment and understanding gives the child a chance to gain positive life experiences. The acquired knowledge and skills can be a resource that will allow the child to change the (often negative) pattern of life of the biological family they come from. Aim of the study: The aim of the study was understanding how foster parents perceive their cooperation with the school their children attend. Method: The authors applied the interpretive paradigm, the phenomenography method in the study. To collect the data, focus interviews were conducted in three groups of foster parents. In total, 21 parents took part in the study. Results: Foster parents notice the division of responsibility in the process of educating children brought up in their families. Their role is to select an institution, start cooperation, help the child learn and accompany rehabilitation, inform the school staff about the specificity of the child’s functioning, and be the advocate for the child. The role of the staff side, according to parents, is to implement the recommendations of specialists, cooperate with parents, set adequate requirements for the child, and present a friendly attitude towards the child and the foster family. Conclusions: Based on the research results, guidelines for the good cooperation of foster parents with the school were formulated. It is important for teachers to understand the specific situation of not only the child (their life experiences, developmental disorders), but also the foster parent, as well as appreciate their commitment to the child. It would be important to create a support system.

The Central Disaster Psychology Support Group(CDPSG) was launched to provide psychological support(PS) in the case of disasters. Without a systematic psychological response protocol or a clearly stipulated division of responsibilities among related agencies, the existing system added confusion to the delivery of PS. The CDPSG was aimed at building a professional and systematic support system that allows inter-ministerial cooperation, with the Ministry of the Interior and Safety at the center. In this study, a disaster PS system was proposed. Based on the process of psychological change of disaster victims, the proposed system is divided into five phases: on the day of the disaster, within 3 days, within 5 days, within 60 days, and the end phase. Prevention phase, preceding the occurrence of disasters, and continued support phase, following the end phase, were also proposed. Cases of forest fires and infectious diseases were cited as examples. Finally, disaster PS work was classified into (1) cooperative coordination, (2) public relations, (3) counseling, and (4) treatment, and a system of cooperation among ministries was proposed. Further research should focus on laying the legal grounds for such inter-ministerial cooperation, and capture first-hand experience of disasters, as well as the voices of personnel working at the site of disasters.

The increasing life expectancy of adults with intellectual disabilities has raised new questions and challenges for families. Depending on the severity of their condition, people with intellectual disabilities need support from their families and environment to vary degrees throughout their lives. They depend on their family members, which addiction is a new problem as parents get older, and care will be the responsibility of siblings who are already living independent lives, sometimes geographically far away. Sibling care should be interpreted differently than when it is performed by a parent or a paid carer, it is more emotionally complex, its content and direction are diverse. We know not too much about sibling caregivers, we only have hypothetical answers to the questions based on a small number of studies or research in similar areas. This paper aims to provide an overview of the situation and motivations of adults who care of and take responsibility for their siblings with intellectual disabilities, and of their role and interaction of the various influences that help them understand. Getting to know siblings is necessary in order for the support system of the special education and social policy to adapt properly to the situation of the - unfortunately - barely ‘visible’ population.

BACKGROUND Immune checkpoint inhibitors (ICIs) can lead to immune-related hepatitis (IRH) and severe liver damage, which is life-threatening in the absence of specific treatment. CASE SUMMARY A 75-year-old man was admitted to our hospital complaining of loss of appetite, yellow urine, and abnormal liver function for the past 2 wk. Three months prior to admission, he was treated with two rounds of capecitabine in combination with camrelizumab for lymph node metastasis of esophageal cancer. Although liver function was normal before treatment, abnormal liver function appeared at week 5. Capecitabine and camrelizumab were discontinued. Ursodeoxycholic acid and methylprednisolone 40 mg daily were administered. Liver function continued to deteriorate. Prothrombin time and international normalized ratio were 19 s and 1.8, respectively. The patient was diagnosed with acute liver failure. A pathological analysis of liver biopsy indicated a strongly positive immunohistochemical staining of T8+ cells, thereby suggesting that drug-induced liver injury was related to IRH caused by camrelizumab. Subsequently, we performed sequential dual-molecule plasma adsorption system (DPMAS) treatment with plasma exchange (PE). After two rounds of treatment, the patient's appetite significantly improved, the yellow color of urine reduced, and liver function improved (total bilirubin level decreased) after five rounds of treatment. Liver function normalized 4 wk after discharge. CONCLUSION The use of sequential DPMAS with PE can reduce liver injury and systemic toxic reactions by clearing inflammatory mediators and harmful substances from blood, and regulate immune cell activity, which may be effective in the treatment of severe ICI-induced IRH.

Construction of long tunnels in difficult sites is associated with various risks. Such risks are usually resulted on one hand from the lack of geological and geotechnical studies of the surrounding ground, and on the other hand from the inappropriate support system. On January 1, 2014, the left tube of T1 tunnel located in Constantine (Algeria) collapsed during construction. The collapse incident caused enormous damage and significant economic losses. T1 tunnel is mainly excavated in a formation which consists principally of a poor behaviour altered argillite. Preliminary investigations have shown that the collapse for the most damaged part is due to stress concentration around the tunnel and the low mechanical strength of the preliminary support, which could not support the development of ground pressures. In this paper, two-dimensional numerical modelling using a finite difference calculation code was performed. In order to identify the causes of the collapse incident, the attention is therefore focused on the loads generated within the lining system. The final results are in good agreement with measurements, and also clearly highlight the inefficiency of the adopted support system. In order to resume and get back on the project, necessary appropriate remedies with considerable resources have been implemented and the primary lining rigidity has been improved.

Summary background data Discharge prior to gastrointestinal recovery and use of mobile health technology for remote follow-up may allow for same-day discharge (SDD) after minimally-invasive colectomy within an Enhanced Recovery Pathway (ERP). Objective To investigate the feasibility of SDD protocol with post-discharge follow-up using a mobile phone app in patients undergoing elective minimally-invasive colectomy. Methods Adult patients undergoing elective laparoscopic colectomy or loop ileostomy reversal from 02/2020-11/2020 were screened for eligibility. Patients were eligible if they lived within a 30-minute drive from the hospital, had an adequate support system at home, and owned a smart phone. Patients were discharged from the recovery room on the day of surgery based on set criteria with post-discharge remote follow-up using a mobile application. Feasibility was defined as discharge on the day of surgery without ED visit or readmission within the first 3 days. 30-day complications, ED visits, and readmissions were compared to a non-SDD historical cohort (05/2019-03/2020) also remotely followed-up using the same mobile phone app (standard ERP group). Results A total of 48 patients were recruited to SDD, of which 77% were discharged on the day of surgery without subsequent ED visit in the first 72 hours. There were 11 patients that could not be discharged, including 7 for failure of discharge criteria and 4 for intra-operative complications/concerns. Overall 30-day complications in the SDD group (17%) was similar to the standard ERP group (15%, p=0.813). ED visits (SDD10% vs. standard ERP8%, p=0.664) and readmissions (6% vs. 4%, p=0.681) were also similar. Conclusions and relevance Findings from this study support the feasibility of a SDD protocol in select patients undergoing minimally-invasive colorectal resection. SDD colectomy protocols may represent the next evolution of ERP and postoperative recovery.

International audience; Une étude sur la filière laitière dans la wilaya de Skikda (Algérie) a permis d’analyser la saisonnalité de la production laitière chez 157 exploitations bovines et les implications relatives à la collecte de lait par l’industrie. Les enquêtes ont porté sur les deux systèmes de production (avec terre et hors-sol) en 2016 et 2017 pour évaluer l’importance des contributions des systèmes d’exploitation dans l’approvisionnement des laiteries. Une première analyse en composantes principales a mis en évidence quatre profils de livraison. Une deuxième analyse effectuée sur les vêlages observés dans les troupeaux des exploitations montre une certaine concordance entre la saisonnalité des livraisons de lait et la répartition des vêlages des troupeaux. L’étude a aussi abordé les notions de territoires et de distances parcourues pour les livraisons du lait aux laiteries. Certaines exploitations livraient leur lait à deux laiteries implantées à Skikda qui avaient aussi recours à un approvisionnement en poudre de lait à des prix subventionnés. D’autres livraient leur lait à des centres de collecte de lait implantés dans le bassin laitier et appartenant à deux laiteries industrielles localisées à plus de 250 kilomètres en moyenne dans la wilaya de Bejaia. Ces dernières s’approvisionnaient aussi en poudre de lait mais aux prix libres sur le marché. Elles mettaient en oeuvre des dispositifs d’appui aux éleveurs qui permettaient de diversifier leur approvisionnement afin de lisser les quantités collectées et de compenser la saisonnalité individuelle des fermes. Des dispositifs de concertations pourraient permettre à ces industriels d’accompagner les éleveurs dans des stratégies plus explicites de dé-saisonnement de la production.

A Magyarországon használatos szűrővizsgálati rendszer nem egységes elvek mentén épül fel a katonai és a polgári egészségügyben. Nincsen csak evidenciaalapú vagykockázatbecslésre hagyatkozó módszer. Egyik szűrési rendszer sem vizsgálta meg, hogy mely betegségek szűrendők az egymáshoz képesti előfordulásuk függvényében. A jelen szűrővizsgálati protokollban szereplő betegségek kimutatása bizonyítottan szükséges, de nem történt vizsgálat arra nézve, hogy biztosan ezek a legfontosabb szűrendő kórképek, illetve a lista frissítésére sincsenek irányelvek. Létrehoztunk egy modellt, amely alapján összehasonlíthatóak a szűrendő betegségek az előfordulási kockázatuk alapján. A modell segítséget nyújthat az egészségügyi rendszerek üzemeltetésében és a szűrővizsgálatok tervezésében.

Introduction: Pre-term neonates have anatomophysiological singularities predisposing them to respiratory complications such as the Acute Respiratory Discomfort Syndrome. Characterized by a deficit in pulmonary surfactant and consequent respiratory failure, increasing the need for invasive and non-invasive ventilatory support. Objective: To analyze the effects of noninvasive ventilation in premature newborns with Acute Respiratory Discomfort Syndrome. Methodology: This is an integrative review in which the following databases were used: SciELO, LILACS, PEDro, MEDLINE and Bireme. The inclusion criteria were studies related to the theme in Portuguese, English and Spanish; complete and published between 2015 and 2020. Results: In the 7 synthesized studies, ventilatory support systems were used: positive airway pressure at two levels: heated, humidified and high-flow nasal cannulas; positive pressure ventilation in the nasal airways; and intermittent positive pressure ventilation. Two studies that used nasal cannulas showed less beneficial effects; and one reported similar outcomes to the others, in addition to causing less nasal damage. Conclusions: The analyzed resources obtained equivalent results, indicating the effectiveness of positive pressure ventilation and intermittent positive pressure during extubation. Highlighting the need for research on the use of high-flow nasal cannulas. Introducción: Los neonatos prematuros tienen singularidades anatomofisiológicas que los predisponen a complicaciones respiratorias como el síndrome de malestar respiratorio agudo. Caracterizado por un déficit de surfactante pulmonar y la consecuente insuficiencia respiratoria, aumentando la necesidad de soporte ventilatorio invasivo y no invasivo. Objetivo: Analizar los efectos de la ventilación no invasiva en recién nacidos prematuros con síndrome de malestar respiratorio agudo. Metodología: Se trata de una revisión integradora en la que se utilizaron las siguientes bases de datos: SciELO, LILACS, PEDro, MEDLINE y Bireme. Los criterios de inclusión fueron estudios relacionados con el tema en portugués, inglés y español; completo y publicado entre 2015 y 2020. Resultados: En los 7 estudios sintetizados se utilizaron sistemas de soporte ventilatorio: presión positiva en la vía aérea a dos niveles: cánulas nasales calentadas, humidificadas y de alto flujo; ventilación con presión positiva en las vías respiratorias nasales y ventilación con presión positiva intermitente. Dos estudios que utilizaron cánulas nasales mostraron efectos menos beneficiosos; y uno informó resultados similares a los demás, además de causar menos daño nasal. Conclusiones: Los recursos analizados obtuvieron resultados equivalentes, indicando la efectividad de la ventilación con presión positiva y la presión positiva intermitente durante la extubación. Destacando la necesidad de investigar el uso de cánulas nasales de alto flujo. Introdução: Neonatos pré-termos apresentam singularidades anatomofisiológicas predispondo-os a complicações respiratórias como a Síndrome do Desconforto Respiratório Aguda. Caracterizada pelo déficit de surfactante pulmonar e consequente insuficiência respiratória, aumentando a necessidade de suporte ventilatório invasivo e não invasivo. Objetivo: Analisar os efeitos da ventilação não invasiva em recém-nascidos prematuros com Síndrome do Desconforto Respiratório Aguda. Metodologia: Trata-se de uma revisão integrativa no qual utilizou-se das bases de dados: SciELO, LILACS, PEDro, MEDLINE e Bireme. Os critérios de inclusão foram estudos relacionados a temática em português, inglês e espanhol; completos e com publicação entre 2015 a 2020. Resultados: Nos 7 estudos sintetizados houve a utilização dos sistemas de suporte ventilatório: pressão positiva em vias aéreas a dois níveis: cânulas nasais aquecidas, umidificadas e de alto fluxo; ventilação de pressão positiva nas vias aéreas nasal, e a ventilação por pressão positiva intermitente nasal. Dois estudos que utilizaram cânulas nasais apontaram efeitos menos benéficos; e um relatou desfechos semelhantes aos demais, além de provocar menor dano nasal. Conclusões: Os recursos analisados obtiveram resultados equivalentes, apontando a eficácia da ventilação por pressão positiva e da pressão positiva intermitente na extubação. Com destaque para a necessidade de pesquisas no uso de cânulas nasais de alto fluxo.

Background Alectinib is approved for the treatment of advanced non-small-cell lung cancer (NSCLC) harboring ALK rearrangements. Although generally well tolerated, alectinib can cause serious or life-threatening side effects. Case Presentation Here, we report a case of a patient with NSCLC with an EML4-ALK fusion and was treated with alectinib but who developed grade 4 hyperbilirubinemia after five months on therapy. Alectinib was discontinued, and an artificial liver support system (ALSS) was used with an impressive decline in bilirubin levels. After two months drug-free, the patient experienced disease progression. Ensartinib was initiated as second-line treatment with a best response of stable disease after three months of therapy with no evidence of hyperbilirubinemia. Conclusion This is the first report of ensartinib treatment after alectinib-induced hyperbilirubinemia which was successfully relieved by ALSS treatment and targeted drug cessation.

The article analyzes the social and pedagogical conditions of rehabilitation of students with special needs. The attention is focused on the peculiarities of their integration in educational environment and on the support system of these students in Lutsk institute of human development of Open international university of human development “Ukraine”. KEY WORDS: rehabilitation, student with special needs, integration, support model, social adaptation. DOI: http://dx.doi.org/10.15181/tbb.v73i1.1267

For participants of diabetes prevention programs, we consider that it is effective to record vital signs, such as weight and blood pressure, and to receive instruction based on such readings during the follow-up period in order to avoid rebound. Although the Internet is an effective medium for recording data and reporting everyday health status, health support systems that require the use of a PC can place a heavy burden on users, especially elderly users. In this research, we utilized a sensor information web service which is a home network based on ZigBee, and discuss effective implementation of a follow-up system. We explained and demonstrated the proposed system to participants who had completed a diabetes prevention program and administered a questionnaire about their impression of system use. From the questionnaire results, we clarify the considerations and requirements necessary for introducing such a home network system with the elderly. The ultimate purpose of this paper is providing to provide a standard knowledge base system toward a medical prescription capable of dealing with(inconsistencies) and exceptions cases, which will enhance individual healthcare and provide an appropriate prescription. This is accomplished by expanding the capabilities of description logic with defeasible rules, to achieve accurate prescription decision for any patient’s condition(s).

The scientific world witnessed a surge of researches, from all corners of the world, regarding the humanitarian crisis precipitated by COVID-19 pandemic, more specifically its impact on people’s mental health. However, researchers exploring the association between COVID-19 related fear and mental health are yet to understand the conditions through which potential benefits may occur. Many factors could buffer the effects of COVID-19 related fear on mental health; support system is probably the predominant one. Thus, the present study examined the moderating effects of support system in the association between COVID-19 related fear and mental health outcomes – somatic symptoms, generalized anxiety disorder (GAD), and depression. Using a web-based cross-sectional survey, we collected data from 163 volunteers assessed with demographic information, COVID-19 related fear, support system, and mental health outcomes. Hierarchical multiple regression analysis and simple effect tests revealed that high levels of support from family, friends, and significant others might buffer/lessen the psychological sequelae (e.g., somatic symptoms, anxiety, and depression during public health emergencies, such as COVID-19 pandemic. Given the potential for negative mental health outcomes following pandemics, such as COVID-19, efforts to enhance peoples’ support system may be especially important.

We propose a justice-based partnership between employees and family members as a means to create services and support systems for people with intellectual disability, enhancing quality of life indicators. More specifically, we examine the links from mutual intergroup justice to three outcomes reported by family members: satisfaction with the center, service quality delivered by employees, and performance focused on the quality of life of people with intellectual disability. We used data from 111 centers. In each center, a group of family members (n = 845) and a group of employees (n = 914) participated. Multilevel modeling revealed that mutual intergroup justice (between employees and family members) has a positive effect on satisfaction with the center, perceptions of functional and relational service quality, and performance based on quality of life.

The prognosis of Artificial liver support system (ALSS) for hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is hard to be expected, which results in multiple operations of ALSS and excessive consumption of plasma, increase in clinical cost. A total of 375 HBV-ACLF patients receiving ALSS treatment were randomly divided a train set and an independent test set. Logistic regression analysis was conducted and a decision tree was built based on 3-month survival as outcome. The ratio of total bilirubin before and after the first time of ALSS treatment was the most significant prognostic factor, we named it RPTB. Further, a decision tree based on the multivariate logistic regression model using CTP score and the RPTB was built, dividing patients into 3 main groups such as favorable prognosis group, moderate prognosis group and poor prognosis group. A clearly-presented and easily-understood decision tree was built with a good predictive value of prognosis in HBV-related ACLF patients after first-time ALSS treatment. It will help maximal the therapeutic value of ALSS treatment and may play an important role in organ allocation for liver transplantation in the future.

Introduction Hematopoietic stem cell transplant (HSCT) is the definite treatment for acute leukemia but considering HSCT is challenging for the patients. There are many studies that have described the patients’ experience after HSCT but very few studies have reported their experience before going for HSCT and there is no published report in India on patients’ experience before HSCT. Objective We conducted a qualitative study to understand barriers, and support-system while considering HSCT and the chances of getting matched unrelated donor (MUD) for these patients. Materials and Methods The present study was a qualitative study. Demographic details of 514 patients who consented for the study were noted and the patients and their families were interviewed using a semistructured interview booklet before HSCT. The interview sessions were recorded, transcribed verbatim, and analyzed for emerging themes. The study data were analyzed using QDA Miner Lite 4.0 software (Provalis Research, Montreal, Canada). Descriptive statistics such as frequency and percentage were used. The chances of getting a human leukocyte antigen (HLA)-matched donor were also computed by “HLA-matching software.” Results Acute myeloid leukemia (64.01%) was commoner than acute lymphoid leukemia (35.99%) with male: female ratio as 1.98:1. The study showed nine themes as barriers and six themes emerged in regard to the support system for HSCT decision making. The biggest barriers identified among these patients pre-HSCT were related to cost, probability of “success of transplant,” and probable “quality of life.” The family support was the biggest support system variable followed by “treating doctor.” The chances of getting a MUD for these patients were 13.22% and 5.44% in global and Indian data pool, respectively. Conclusion Deciding upon HSCT can be challenging for patients and understanding of barriers and support-system variables among these patients would provide important insights and help design better counseling techniques for such patients of HSCT and future studies in this context.

Jet grouting slabs are widely used in deep excavations owing to their effectiveness for reducing the deflection of the diaphragm wall and the prop forces acting on the struts and improving the basal-heave stability. In this paper, according to case histories in Singapore, a series of finite-element numerical simulations are performed to evaluate the effects of jet grouting slabs on responses to deep braced excavations. On the basis of a parametric sensitivity study, a reasonable thickness of jet grouting slabs is proposed. The effects of the wall depth, wall stiffness, soft-clay thickness, and stiffness on the performance of the jet grouting slabs are assessed by comparing and analyzing a series of simulation results. It is found that the soft-clay thickness significantly affects the wall deflection and basal heave in deep excavation. During the design of support structures, soil profiles should be considered first. The findings of this study provide a reference and guidance for the support system design of similar projects.