Search

Increasing chronic disease rates in regional Australian communities necessitates innovative models of healthcare. We evaluated the efficacy of an interprofessional chronic disease program, delivered within a regional student-led nursing and allied health clinic in Southern Queensland, Australia. Changes to anthropometric, aerobic fitness and strength, and quality of life outcomes were examined at four time points spanning 16 months: intake, program transition (4 months), 6 and 12 months (post-transition). Our primary aim was to investigate whether the health improvements achieved during the program were sustained at 12 months in a subset of participants who provided complete data. Significant improvements were found in 6 of 11 measures, including the 6-minute walk test, grip strength, and self-reported quality of life across physical and psychosocial dimensions, with these improvements maintained to final review. No significant changes were found in body mass index (BMI), waist circumference, fat mass, or muscle mass. This is the first health clinic in regional Australia to deliver a student-led model of interprofessional and collaborative service to tackle the increasing burden of chronic disease in the community. The cost-effectiveness of this service and other potential clinical and social benefits remain to be investigated. [ABSTRACT FROM AUTHOR]

This article is a primer to reading the primary texts of Jacques Lacan. I argue that there is an experiential dimension to the act of reading Lacanian texts that approximates the transmission of psychoanalysis in a clinical setting. A primary insistence is that Lacanian psychoanalysis has a fundamentally different relationship to knowledge than other therapeutic and theoretical traditions, and that therefore any emphasis on understanding is incongruous with the larger aims of the project. I discuss Lacanian conceptions of frustration and love in order to explore these ideas, before turning to a specific moment in the Lacanian corpus. I conclude by exploring implications for work in the public sector. [ABSTRACT FROM AUTHOR]

Literature shows failure of the outpatient clinic (OC) pathway after emergency department (ED) ultrasound diagnosis of symptomatic cholelithiasis (SC). We hypothesized SC to be more prevalent on final surgical pathology (FSP) in patients who successfully completed OC pathway. This retrospective single-institution chart review compared OC and ED patients with right upper quadrant (RUQ) pain and cholelithiasis whom underwent cholecystectomy. Clinical evaluation was considered positive if RUQ pain >4 h, or + Murphy's sign. Ultrasound was positive if two of these three were present: sonographic Murphy's, wall thickness > 4 mm, or pericholecystic fluid. Results were compared with FSP. Six hundred-seven patients underwent cholecystectomy, 299 OC and 308 ED. OC was more likely to SC (23% versus 4.6%) (P < 0.0001) and ED acute cholecystitis (39.3% versus 4.7%). Chronic cholecystitis was the most common FSP in both OC (72%) and ED (56%) populations, of these, 73% of OC denied pain >4 h versus only 10% of ED (P < 0.001). Median time from evaluation to cholecystectomy was 14 d versus 14 h in the OC and ED respectively (P < 0.0001). While chronic cholecystitis was the most common FSP in both OC and ED, the majority of OC reported RUQ pain <4 h delineating these presentations. Duration of pain should be utilized as algorithm triage. We recommend patients with pain episode <4 h should complete OC algorithm with expedited cholecystectomy within 14 d. [ABSTRACT FROM AUTHOR]

Copyright of Traditional Chinese Drug Research & Clinical Pharmacology is the property of Traditional Chinese Drug Research & Clinical Pharmacology Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Patients with breast pain are usually seen in 'one-stop clinic' (OSC) with breast imaging. In the absence of associated red flag features, the incidence of breast cancer is extremely low. With increase in referrals the OSC capacity is over-stretched. We developed a consultant nurse-led dedicated 'breast pain clinic' in September 2021 without routine breast imaging. After meticulous history and examination, patients obtained detailed counselling and advice regarding breast pain management. If any abnormality was noted then appointment was given for OSC. Aim: To assess the effectiveness of a consultant nurse-led dedicated 'breast pain clinic'. Methods: A prospective study of all consecutive patients seen in 'breast pain clinic' from September 2021 until September 2022. Feedback was sought from all patients. Results: Altogether 429 patients were seen. The mean age was 48.7 years (range 18–86). 87.6% (n = 376) patients required no breast imaging. Only 12.4% (n = 53) patients needed referral to OSC and subsequently 2 patients (0.46%) were diagnosed with breast cancer. Ninety-eight percent of patients felt reassured and 99.2% patients were extremely likely/likely to recommend this service to family and friends. Out of 376 patients who were discharged from breast pain clinic, 12 patients were referred again over a median follow-up period of 15 months, and 2 out of them were diagnosed with breast cancer. Conclusion: A consultant nurse-led 'breast pain clinic' provides service improvement as it eases the pressure on the OSC. Most patients were managed without breast imaging with high level of patient satisfaction and low rereferral rate. [ABSTRACT FROM AUTHOR]

The health industry in Indonesia faces a variety of complex and multidimensional challenges. In the face of fierce competition from hospitals that offer self-contained laboratory services and the development of infrastructure that facilitates access to more well-equipped healthcare facilities, it is important to understand how service quality affects customer satisfaction and loyalty. This study aims to explore the influence of Service Quality on Customer Satisfaction and Customer Loyalty at the X Clinical Laboratory in Pematang Siantar City, as well as to examine the role of customer satisfaction as a mediator. The results show that Service Quality has a significant positive influence on customer satisfaction (coefficient: 0.8825), indicating that an improvement in Service Quality will increase customer satisfaction. Based on these findings, the management of Clinical Laboratory X is advised to implement several strategies to improve service quality, customer satisfaction, and loyalty to remain the top choice. [ABSTRACT FROM AUTHOR]

Adjuvants, materials added to vaccines to enhance the resulting immune response, are important components of vaccination that are many times overlooked. While vaccines always include an antigen to tell the body what to vaccinate to, of equal importance the adjuvant provides the how, a significant factor in producing a complete response. The adjuvant space has been slow to develop with the first use of an adjuvant in a licensed vaccine occurring in the 1930s, and remaining the only adjuvant in licensed vaccines for the next 80 years. However, with vaccination at the forefront of protection against new and complex pathogens, it is important to consider all components when designing an effective vaccine. Here we summarize the adjuvant space in licensed vaccines as well as the novel adjuvant space in clinical trials with a specific focus on the materials utilized and their resulting impact on the immune response. We discuss five major categories of adjuvant materials: aluminum salts, nanoparticles, viral vectors, TLR agonists, and emulsions. For each category, we delve into the current clinical trials space, the impact of these materials on vaccination, as well as some of the ways in which they could be improved. Adjuvants present an exciting opportunity to improve vaccine responses and stability, this review will help inform about the current progress of this space. Translational impact statement: In the aftermath of the COVID‐19 pandemic, vaccines for infectious diseases have come into the spotlight. While antigens have always been an important focus of vaccine design, the adjuvant is a significant tool for enhancing the immune response to the vaccine that has been largely underdeveloped. This article provides a broad review of the history of adjuvants and, the current vaccine adjuvant space, and the progress seen in adjuvants in clinical trials. There is specific emphasis on the material landscape for adjuvants and their resulting mechanism of action. Looking ahead, while the novel vaccine adjuvant space features exciting new technologies and materials, there is still a need for more to meet the protective needs of new and complex pathogens. [ABSTRACT FROM AUTHOR]

For the sake of all those who need dental care in various places, this article presents the rationale for designing and implementing a portable dental unit and finding new and more modern ways to manufacture and evaluate it as well. This device gives priority to durability, portability of the device in different work environments, infection control, and safety. The basic components include, but are not limited to, the air pressure system, the water tank, the Arduino microcontroller to control and manage the pressure, the electrical valves and filters that are subject to international standards, the foot switch, and the device's control panel. The handpiece assembly in this dental unit, which includes the electric motor handle, the triple syringe, the high-speed turbine, and the low-speed turbine, allows for a variety of dental treatments. The effectiveness of the dental unit was confirmed through its experiment by specialists at Al Noor University in May 2023. Dr. Al Qubais Al Assaf, who supervised the examination, confirmed the effectiveness of the unit in delivering water and compressed air, in addition to its successful design, the ease of carrying and transporting the device, and the ease of its installation, in addition to its durability and resistance to aging Infection and protective functions. Dr. Al-Assaf also spoke about the importance of the mobile dental unit to provide dental care in remote areas or in cases where individuals cannot reach scientific clinics. [ABSTRACT FROM AUTHOR]

ckground: The Children Emergency Room (CHER) is a high-volume, fast-paced environment where children present with acute illnesses. With the paradigm shift in educational models towards outcome-based education, teaching and assessment of students must be structured to attain intended learning outcome in every rotation. Objective: This study assessed the relationship between teaching methods and learners’ satisfaction. We also identified challenges to CHER posting and likely solutions. Methods: This is a descriptive cross-sectional study, using a semi-structured anonymous feedback form to elicit perception of learning objectives and adequacy of teaching methods in CHER. Adequacy of participation in emergency care was assessed on a 4-point Likert scale. Bivariate analysis for possible determinants of adequate CHER posting satisfaction on a visual analogue scale (VAS) was done. P-value < 0.05 was considered significant. Results: A total 112 medical students participated in this study; 51.8% of them knew their specific learning objectives on the first day in the unit. The participants’ grand mean score for learning satisfaction in CHER was adequate (2.65±0.24). Their preferred teaching method was Bedside Teaching/ Clerkship (3.01±0.78) but they were dissatisfied with simulations (2.29±0.91) and participation in emergency care (2.19±0.10). Participants in junior posting were more satisfied than those in senior posting (OR =3.45, 95% CI: 1.46- 8.15; p=0.005). A high workload was identified as a challenge. Conclusion: The overall clinical experience of medical student in CHER is satisfactory. Our study however, shows that there is inadequate simulation-based teaching, case presentation and participation in case management by the medical students. Curriculum reforms may be necessary to address these identified gaps and improve clinical experience of medical students in CHER.

Introduction The global pandemic was an emerging challenge that significantly impacted healthcare systems and the delivery of care. Prompt actions and adaptive techniques, such as the virtual clinic, were implemented to ensure the quality and continuity of the care provided. The aim of this quality improvement project was to ensure the smooth implementation and effectiveness of the virtual clinic during the COVID-19 crisis. Methods A specialized team of multidisciplinary healthcare providers was established to systematically ensure the implementation of the virtual clinic within the Department of Oncology. The team used multiple Plan-Do-Study-Act (PDSA) cycles of the quality improvement model to achieve the final goal and facilitate the transition to the virtual clinic. Results A total of 29 weekly virtual clinic sessions were conducted, covering various oncology services. From March to December 2020, 81% of the scheduled patients (3888) responded to virtual clinic calls. Physicians initiated 234 unplanned virtual clinic calls to follow up on a patient’s condition. In addition, 916 medications were shipped to patients as needed. A patient satisfaction survey in May 2020 indicated an overall satisfaction rate of 92% with the virtual clinic process. Staff satisfaction was also high (91%), and 88% of the physicians believed that the virtual clinic would continue beyond the pandemic. Conclusion Implementing the virtual clinic is achievable through following systematic steps and effectively addressing emerging challenges as required. The concept of the virtual clinic was well accepted by patients and staff.

Introduction: Approximately 20% of patients with metastatic spine disease develop symptomatic spinal cord compression, and these patients can present urgently to the emergency department (ED) or, in a more organized fashion, to a clinic. In a cohort of patients undergoing metastatic spine surgery, we sought to (1) determine the rate of ED presentation, (2) identify preoperative and perioperative risk factors associated with ED presentation, and (3) evaluate whether ED vs. clinic presentation impacts long-term outcomes. Methods: A single-institution, multi-surgeon, retrospective cohort study was undertaken of patients undergoing metastatic spinal tumor surgery between 02/2010 and 01/2021. The primary exposure variable was presentation setting, dichotomized to the ED vs. clinic. The primary outcomes were postoperative functional status, measured with the Karnofsky Performance Scale (KPS) and McCormick Scale (MMS), local recurrence (LR), and overall survival (OS). Secondary outcomes included complications and readmissions. Results: A total of 311 patients underwent metastatic spine surgery (51.7% ED vs. 48.3% clinic). Those presenting to the ED had higher rates of smoking (21.7% vs. 16.0%, p = 0.02), were more likely to have 2+ comorbidities (47.2% vs. 32.7%, p = 0.011), and were more likely to have public insurance (43.5% vs. 32.0%, p = 0.043). Preoperative KPS was lower in ED patients (p < 0.001), while the Bilsky score was higher (p = 0.049). ED patients had higher rates of oligometastatic disease (p = 0.049), higher total decompressed levels (p = 0.041), and higher rates of costotransversectomy (p = 0.031) compared to clinic patients. Length of stay was significantly longer for ED patients (7.7 ± 6.1 vs. 6.1 ± 5.8 days, p = 0.020), and they were less likely to be discharged home (52.2% vs. 69.3%, p = 0.025). ED presentation was significantly associated with shorter overall survival (HR =1.53 95% CI = 1.13–2.08, p = 0.006). Conclusions: Of patients undergoing metastatic spine disease, approximately half presented through the ED vs. clinic. ED patients had higher rates of smoking, public insurance, and higher Bilsky score. ED patients also underwent more extensive surgery, had longer LOS, were less likely discharged home, and most importantly, had a shorter overall survival. These results suggest that initial presentation for patients undergoing surgery for metastatic spine disease significantly impacts outcomes, and signs/symptoms of metastatic spine disease should be recognized as soon as possible to prevent ED presentation. [ABSTRACT FROM AUTHOR]

Hydrogels have been used in the clinic since the late 1980s with broad applications in drug delivery, cosmetics, tissue regeneration, among many other areas. The past three decades have witnessed rapid advances in the fields of polymer chemistry, crosslinking approaches, and hydrogel fabrication methods, which have collectively brought many new hydrogel products, either injectable or non‐injectable, to clinical studies. In an article published in 2020 entitled “Hydrogels in the clinic”, we reviewed the clinical landscape and translational challenges of injectable hydrogels. Here, we provide an update on the advances in the field and also extend the scope to include non‐injectable hydrogels. We highlight recently approved hydrogel products, provide an update on the clinical trials of injectable hydrogels, and discuss active clinical trials of topically applied and implantable hydrogels. [ABSTRACT FROM AUTHOR]

Antibody‐drug conjugates (ADCs), chemotherapeutic agents conjugated to an antibody to enhance their targeted delivery to tumors, represent a significant advancement in cancer therapy. ADCs combine the precise targeting capabilities of antibodies and the potent cell‐killing effects of chemotherapy, allowing for enhanced cytotoxicity to tumors while minimizing damage to healthy tissues. Here, we provide an overview of the current clinical landscape of ADCs, highlighting 11 U.S. Food and Drug Administration (FDA)‐approved products and discussing over 500 active clinical trials investigating newer ADCs. We also discuss some key challenges associated with the clinical translation of ADCs and highlight emerging strategies to overcome these hurdles. Our discussions will provide useful guidelines for the future development of safer and more effective ADCs for a broader range of indications. [ABSTRACT FROM AUTHOR]

This study aimed to determine the thoughts and expectations of the students who took laboratory animal breeding courses about clinical skill acquisition and their achievements and anxiety levels at the end of the application with a survey study. One hundred thirtyeight students participated in the survey. The questionnaire method was applied to the propositions and questions created using the State-Trait Anxiety Scale and the literature. A statistically significant difference (P<0.05) was found between the students' total scores of opinions and expectations towards the practice before and after the practice course. The total score of opinion and expectation towards the application after the application lesson was found to be higher (P<0.01) than the total score of opinion and expectation towards the application before the application lesson. State anxiety (P<0.05) and trait anxiety total score (P<0.01) were lower after the application lesson than before the application lesson. It was concluded that the applied education made a difference in the students' clinical skill acquisition and positively affected their mood. [ABSTRACT FROM AUTHOR]

The nocebo effect, linked to the belief in the harmfulness of a treatment or a noxa, has been less studied than its opposite, the placebo, but has proven to be equally if not more important than the latter both in clinics and in research. The factors that determine it, the mechanisms that mediate it and the pathological processes that can result are briefly summarized. The implications of nocebo effect in different fields are therefore discussed, as are the main indications for counteracting it. Finally, given that the nocebo effect implies the connection between the cognitive, emotional and behavioral levels, the possibility that it constitutes an interesting study model for a better understanding of the relationships between physical and psychological aspects in both in health and in illness is discussed. [ABSTRACT FROM AUTHOR]

Aim: Contribution to the authorship, including that for case reports, should be appropriately evaluated. I have noticed a scarcity of case reports with clinic doctors listed as coauthors, prompting this investigation. I sought to offer suggestions on the possible reasons for this trend. Methods: I checked case reports published in the Journal of Obstetrics and Gynaecology Research, the Journal of Medical Case Reports, and the BMJ Case Reports. I identified case reports listing a clinic doctor as a coauthor. I consulted eight professors at Jichi Medical University to ascertain whether case reports from their departments included clinic doctors as coauthors and, if not, the reasons. Results: Among 65 case reports from Japanese institutes published in the Journal of Obstetrics and Gynaecology Research, only one paper lists a clinic doctor as a coauthor. Of 100 and 50 papers published in the Journal of Medical Case Reports and BMJ Case Reports, respectively, none listed a clinic doctor as a coauthor. Six out of eight professors admitted to never considering the idea of including clinic doctors as coauthors. Conclusions: The scarcity of case reports with clinic doctors as coauthors extends beyond Japanese obstetrics and gynecology, encompassing various specialties worldwide. Center doctors do not think of the idea that a clinic doctor should be a coauthor. A clinic doctor who transferred the patient should be considered as a candidate coauthor depending on his/her scientific contribution. Such an approach could foster an environment encouraging doctors to contribute to academic writing, regardless of their workplace. [ABSTRACT FROM AUTHOR]

Introduction: More than one in ten people globally live with a mental health illness. Adolescent mental health is a major contributor to that statistic, as 27% of adolescents have one or more mental, emotional, developmental, or behavioral problems. School-based health care clinics can provide mental health services for this age group. Objectives: This project aimed to promote evidence-based practices regarding adolescent mental health screening in schools. Methods: This project used the JBI Evidence Implementation Framework to promote evidence-based practices for adolescent mental health screening in schools. The JBI framework is grounded in an audit and feedback process, along with a structured approach to identifying and managing barriers to compliance with best practices. Five audit criteria representing best practice recommendations were developed. A baseline audit was conducted, followed by the implementation of an improvement strategy. The project was finalized with a follow-up audit to determine any changes in compliance with best practice recommendations. Results: The baseline survey of students revealed a 25% average compliance for audit criteria 1 and 2. The primary barrier to compliance was students' unawareness of the availability of mental health services. The improvement strategy included an educational presentation for students regarding mental health. The follow-up audit revealed an increase in compliance with best practices. Conclusions: The project achieved a 29% increase in compliance with best practices, although only 23% of the students were reached via the improvement strategy. http://links.lww.com/IJEBH/A189 [ABSTRACT FROM AUTHOR]

Aims: To define nurse‐led clinics in primary health care, identify barriers and enablers that influence their successful implementation, and understand what impact they have on patient and population health outcomes. Background: Nurse‐led clinics definitions remain inconsistent. There is limited understanding regarding what enablers and barriers impact successful nurse‐led clinic implementation and their impact on patient health care. Design: Scoping review using narrative synthesis. Methods: PubMed, MEDLINE, Web of Science, Scopus, CINAHL and PsycINFO were searched to identify nurse‐led clinic definitions and models of care between 2000 and 2023. Screening and selection of studies were based on eligibility criteria and methodological quality assessment. Narrative synthesis enabled to communicate the phenomena of interest and follows the PRISMA for Scoping Reviews (PRISMA‐ScR) checklist. Results: Among the 36 identified studies, key principles of what constitutes nurse‐led clinics were articulated providing a robust definition. Nurse‐led clinics are, in most cases, commensurate with standard care, however, they provide more time with patients leading to greater satisfaction. Enablers highlight nurse‐led clinic success is achieved through champions, partners, systems, and clear processes, while barriers encompass key risk points and sustainability considerations. Conclusion: The review highlights several fundamental elements are central to nurse‐led clinic success and are highly recommended when developing interventional nurse‐led strategies. Nurse‐led clinics within primary health care seek to address health care through community driven, health professional and policy supported strategies. Overall, a robust and contemporary definition of nurse‐led care and the clinics in which they operate is provided. Relevance to Clinical Practice: The comprehensive definition, clear mediators of success and the health impact of nurse‐led clinics provide a clear framework to effectively build greater capacity among nursing services within primary health care. This, in addition, highlights the need for good health care policy to ensure sustainability. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Given the prevalence of hematological conditions, surgeries, and trauma incidents, hemostats—therapeutics designed to control and arrest bleeding—are an important tool in patient care. The prophylactic and therapeutic use of hemostats markedly enhances survival rates and improves the overall quality of life of patients suffering from these conditions. Since their inception in the 1960s, hemostats have witnessed remarkable progress in terms of the active ingredients utilized, therapeutic outcomes, demonstrated efficacy, and the storage stability. In this review, we provide a comprehensive analysis of commercially available hemostats approved by the FDA, along with newer investigative hemostats currently in active clinical trials. We delve into the modality of active ingredients, route of administration, formulation type, and disease indications of these approved and investigative hemostats. Further, we analyze the trends observed in the hemostat actives for Hemophilia A and B, concluding with insights into the emerging patterns and noteworthy developments to watch for in this dynamic field. [ABSTRACT FROM AUTHOR]

The article discusses research which evaluated the implementation of an interstitial lung abnormality (ILA) clinic and multidisciplinary discussion. The study characterized ILAs and identified factors associated with the development of interstitial lung disease (ILD) such as socioeconomic status, radiographic progression and inhalational exposures. Data shows results of a review of ILD-focused history and exam by a multidisciplinary committee and diagnostic recommendations for ILA patients.

Abstract Adjuvants, materials added to vaccines to enhance the resulting immune response, are important components of vaccination that are many times overlooked. While vaccines always include an antigen to tell the body what to vaccinate to, of equal importance the adjuvant provides the how, a significant factor in producing a complete response. The adjuvant space has been slow to develop with the first use of an adjuvant in a licensed vaccine occurring in the 1930s, and remaining the only adjuvant in licensed vaccines for the next 80 years. However, with vaccination at the forefront of protection against new and complex pathogens, it is important to consider all components when designing an effective vaccine. Here we summarize the adjuvant space in licensed vaccines as well as the novel adjuvant space in clinical trials with a specific focus on the materials utilized and their resulting impact on the immune response. We discuss five major categories of adjuvant materials: aluminum salts, nanoparticles, viral vectors, TLR agonists, and emulsions. For each category, we delve into the current clinical trials space, the impact of these materials on vaccination, as well as some of the ways in which they could be improved. Adjuvants present an exciting opportunity to improve vaccine responses and stability, this review will help inform about the current progress of this space. Translational impact statement In the aftermath of the COVID‐19 pandemic, vaccines for infectious diseases have come into the spotlight. While antigens have always been an important focus of vaccine design, the adjuvant is a significant tool for enhancing the immune response to the vaccine that has been largely underdeveloped. This article provides a broad review of the history of adjuvants and, the current vaccine adjuvant space, and the progress seen in adjuvants in clinical trials. There is specific emphasis on the material landscape for adjuvants and their resulting mechanism of action. Looking ahead, while the novel vaccine adjuvant space features exciting new technologies and materials, there is still a need for more to meet the protective needs of new and complex pathogens.

The country has been facing the Covid-19 crisis that has affected the rest of the world in this decade. Numerous approaches and alternatives are implemented by the government to overcome this pandemic either controlled or stopped utterly. In order for the government to succeed, the emphasis on breaking the chain of infection of Covid-19 and the direction of the Movement Control Order (MCO) must be strengthened. Thus, the main goal of this study is to identify the level of patient’s knowledge regarding Covid-19 and Movement Control Order as well as to analyze the relationship between the level of knowledge about Covid-19 and Movement Control Order () among patients who come for treatment at the Kinarut Health clinic. Methodology: This study applies the quantitative research methodology, specifically surveys through questionnaires, whereas the sampling method used is systematic sampling with 200 patients in the Kinarut area. Analysis of instrument evaluation and sampling technique is also discussed in this study. Analysis: The finding showed that the patients' knowledge level about Covid-19 was at a moderate level with a mean value = 3.610, SD = 0.345. The level of knowledge relating to Movement Control Order (MCO) is also at a moderate level with a mean value = 3.610, SP = 0.345. Result: The correlation analysis showed that there is a strong relationship between the level of knowledge about Covid-19 and the level of knowledge of the Movement Control Order, with a correlation value of r = 0.71, p> 0.05. Thus, the results of this analysis show that there is a strong relationship between the variables of the knowledge level of Covid-19 and Movement Control Order in breaking the chain of infection Covid-19, particularly among patients who are living around Kinarut.

Abstract Background An estimated 50% of suspected malaria cases in sub-Saharan Africa first seek care in the private sector, especially in private medicine retail outlets. Quality of care in these outlets is generally unknown but considered poor with many patients not receiving a confirmatory diagnosis or the recommended first-line artemisinin-based combination therapy (ACT). In 2010, a subsidy pilot scheme, the Affordable Medicines Facility malaria, was introduced to crowd out the use of monotherapies in favour of WHO-pre-qualified artemisinin-based combinations (WHO-PQ-ACTs) in the private health sector. The scheme improved the availability, market share, and cost of WHO-PQ-ACTs in countries like Nigeria and Uganda, but in 2018, the subsidies were halted in Nigeria and significantly reduced in Uganda. This paper presents findings from six retail audit surveys conducted from 2014 to 2021 in Nigeria and Uganda to assess whether the impact of subsidies on the price, availability, and market share of artemisinin-based combinations has been sustained after the subsidies were reduced or discontinued. Methods Six independent retail audits were conducted in private medicine retail outlets, including pharmacies, drug shops, and clinics in Nigeria (2016, 2018, 2021), and Uganda (2014, 2019, 2020) to assess the availability, price, and market share of anti-malarials, including WHO-PQ-ACTs and non-WHO-PQ-ACTs, and malaria rapid diagnostic tests (RDTs). Results Between 2016 and 2021, there was a 57% decrease in WHO-PQ-ACT availability in Nigeria and a 9% decrease in Uganda. During the same period, non-WHO-PQ-ACT availability increased in Nigeria by 41% and by 34% in Uganda. The price of WHO-PQ-ACTs increased by 42% in Nigeria to $0.68 and increased in Uganda by 24% to $0.95. The price of non-WHO-PQ-ACTs decreased in Nigeria by 26% to $1.08 and decreased in Uganda by 64% to $1.23. There was a 76% decrease in the market share of WHO-PQ-ACTs in Nigeria and a 17% decrease in Uganda. Malaria RDT availability remained low throughout. Conclusion With the reduction or termination of subsidies for WHO-PQ-ACTs in Uganda and Nigeria, retail prices have increased, and retail prices of non-WHO-PQ-ACTs decreased, likely contributing to a shift of higher availability and increased use of non-WHO-PQ-ACTs.

The Aim of the Study: To describe the clinical and non-clinical characteristics of Gabon footballers in the Haut-Ogooue Polyclinic in Franceville, Gabon, during visits, to assess whether they are not contraceptive to sports. Patients and Methods: A descriptive and analytical cross-sectional study was conducted in the city of Franceville, Gabon, in May 2022. The first and second divisions of footballers were subjected to medical examinations to determine whether they had any contraindications for playing sports, including clinical examinations, rest electrocardiograms (ECG), rest cardiac ultrasounds, chest X-rays, Rick-Dickson and biological checks. Results: The average age of 88 footballers (22–25 years) was 23 years. Blood pressure (BP) is abnormal in 19% of players, and alcohol and tobacco consumption is reported in 70% and 30%, respectively. Exercise adaptation was also closely associated with age (P = 0.00137724; P = 0.008974301), football position (P = 0.009957548; P = 0.006646182) and alcohol consumption (P = 0.000531971). Electrical and biological changes were 16% and 86.79%, respectively. Sinus bradycardia and first-degree atrioventricular block are the most common ECG abnormalities. Metabolic, inflammatory, infectious, electrolyte and anaemia syndromes were found in 22.64%, 24.53%, 19.81%, 7.55% and 12.26%, respectively. Midfielders and defenders have shown the greatest changes in biological parameters. Conclusion: Medical checks are essential to determine if sports are contraindicated, as they can help identify physiological and pathological conditions and improve the monitoring of athletes.

Introduction. Respiratory diseases occupy a leading place in the structure of pathology of childhood. The proportion of influenza and acute respiratory viral infections among all infectious diseases is 90 %. The literature describes gender differences in the immune response to respiratory infections in children, but there is a gap in the description of the cytokine profile in children with influenza depending on gender and age.The aim. To analyze clinical and laboratory parameters as well as cytokine profile parameters in children with influenza.Materials and methods. A single-stage descriptive study was conducted with the participation of 50 children from 1 to 11 years of age with a diagnosis of influenza who were on inpatient treatment at the Irkutsk Regional Infectious Diseases Clinical Hospital from December 2018 to January 2019. The clinical and laboratory features of the course of influenza in children, the duration of treatment were determined. The concentration of cytokines interleukin (IL) 1β, IL-4, IL-6, IL-8, tumor necrosis factor alpha (TNF-α), interferon alpha and gamma (INF-α, INF-γ) in blood plasma was determined by enzyme-linked immunosorbent assay (ELISA) using diagnostic test systems manufactured by Vector-Best (Novosibirsk, Russian Federation) on the analyzer Multiscan EX (Thermo Electron, Germany).The control group consisted of practically healthy children without signs of acute respiratory viral infection (n = 50; mean age 5.3 ± 2.6 years).Results. When comparing clinical and laboratory data and cytokine profile parameters in children with influenza, no gender differences were found. There was a statistically significant increase in the level of pro-inflammatory cytokines IL-1β, IL-6, IL-8, TNF-α, INF-α, as well as CRP, anti-inflammatory cytokine IL-4 in influenza in all age categories, in contrast to the control group (p < 0.05).Conclusion. Influenza in children of different sexes proceeds classically without a statistical difference in clinical and laboratory parameters and in the level of cytokines.

In the event of psychoanalysis, the clinical and the political are necessarily articulated and knotted in praxis, supported in the act by the desire of the analyst. In an inaugural moment of his teaching, Lacan takes up the case of the 'man with fresh brains' after his ego-psychological treatment by Kris and he re-engages psychoanalytic practice on the path determined by desire. [ABSTRACT FROM AUTHOR]

How desire is not simply a life force but an effect of language. We will try to follow its logical and disharmonious path [ABSTRACT FROM AUTHOR]

Background: Long clinic wait times can contribute to treatment delays and decreased patient satisfaction. Veterans are often waiting in the urology clinic for a prolonged period that delays treatments including possible surgical interventions leading to patient dissatisfaction. Purpose: The purpose of this quality improvement project was to decrease the overall procedural wait times in an outpatient urology clinic by implementing a Fast-Track procedural clinic. Methods: The Fast-Track procedural clinic was developed to expedite care for veterans actively under bladder or prostate cancer surveillance, employing lean methodology principles. We also utilized the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) tool to assess patient satisfaction with the newly implemented Fast-Track clinic. Wait times were collected and analyzed by SPSS statistical software to determine the effectiveness of a Fast-Track clinic. Results: The Fast-Track clinic was implemented to veterans presenting to the urology clinic for procedural appointments from June 2021 to December 2021. The usage of a Fast-Track clinic decreased the overall wait times from 131 to 75 minutes within 8 weeks (43% improvement). The OAS CAHPS tool found that 55% of veterans received easy-to-understand instructions pre-Fast-Track implementation, compared with 59% post-Fast-Track implementation (a 4% improvement). Furthermore, 82% of veterans reported that they did not receive written discharge instructions post-Fast-Track implementation compared with 32% pre-Fast-Track implementation. Conclusion: Incorporating a Fast-Track procedural clinic helped minimize wait times, leading to a reduction in procedural wait times and urologic surgical delays. Implications for Nursing: The implications for practice include future studies focusing on other strategies for improving clinic wait times including block schedules and qualitative measures in the urologic and other specialty areas. [ABSTRACT FROM AUTHOR]

Complete care of the patient with upper limb loss mandates a long-term, multifaceted approach. Increased functionality and quality of life require collaborative efforts between the patient's surgeon, prosthetist, hand therapists, mental health professionals, and peers. An individual surgeon may find that initiating and maintaining a practice offering total integrated treatment for upper-extremity amputees is a formidable task, but with specific, actionable recommendations, the process can be demystified. The upper-extremity surgeon must be facile with operative techniques such as targeted muscle reinnervation (TMR), regenerative peripheral nerve interface (RPNI), and soft tissue reconstruction and focus on team recruitment strategy and promotion of the clinic within the community. Consistent communication and team decision-making shape each patient's preoperative and postoperative course. We aim to relay effective interventions at each step of recovery from each clinic member and describe clinic workflow designed to reinforce holistic care. We present a blueprint for creating a functional and comprehensive multidisciplinary center for patients with upper-extremity limb loss for those providers interested in providing care, but who are missing the logistical roadmap for how to do so. [ABSTRACT FROM AUTHOR]

Background/Aim: Lipomas are rare but the most common benign mesenchymal lesions of the gastrointestinal (GI) tract, composed of mature adipose cells. The "piggybacking lipoma" is formed by lipomas with overlying polypoid epithelial lesions, such as sessile serrated lesion, tubular adenoma, or hyperplastic polyp, and the literature on these lesions is limited. In this study, we systematically investigated the clinical, endoscopic, and pathologic characteristics of these unique lipomas. Patients and Methods: This is a single-institution retrospective study of gastrointestinal tract lipomas diagnosed from 2016-2021. Those with concurrent polypoid epithelial or mesenchymal lesions during the same endoscopic episode were included and reviewed in this study, and the lipomas were classified as "piggybacking lipoma" or "non-piggybacking lipoma" depending on whether the concurrent lesion was overlying the lipoma or was at a different location in the intestine. Demographic, clinical, and endoscopic data were obtained from electronic medical records. Results: A total of 100 lipomas with concurrent epithelial or mesenchymal lesions were included in this study. Among them, 21 cases were classified as "piggybacking lipoma" and 79 were classified as "non-piggybacking lipoma". Patients with piggybacking lipomas showed a female predilection, and were more likely to be symptomatic and less likely to exhibit classic endoscopic features of lipoma. Histologically, the piggybacking polyps showed overlying sessile serrated lesions (SSL) (76.2%) and tubular adenoma (TA) (19%), whereas the non-piggybacking group had differing characteristic lesions with TA (57.5%) and SSL (6.0%). Conclusion: Piggybacking lipomas are rare lipomas with overlying polypoid epithelial lesions, most commonly SSL. They present different clinical, endoscopic, and pathologic features compared to non-piggybacking lipomas. [ABSTRACT FROM AUTHOR]

Background: An estimated 50% of suspected malaria cases in sub-Saharan Africa first seek care in the private sector, especially in private medicine retail outlets. Quality of care in these outlets is generally unknown but considered poor with many patients not receiving a confirmatory diagnosis or the recommended first-line artemisinin-based combination therapy (ACT). In 2010, a subsidy pilot scheme, the Affordable Medicines Facility malaria, was introduced to crowd out the use of monotherapies in favour of WHO-pre-qualified artemisinin-based combinations (WHO-PQ-ACTs) in the private health sector. The scheme improved the availability, market share, and cost of WHO-PQ-ACTs in countries like Nigeria and Uganda, but in 2018, the subsidies were halted in Nigeria and significantly reduced in Uganda. This paper presents findings from six retail audit surveys conducted from 2014 to 2021 in Nigeria and Uganda to assess whether the impact of subsidies on the price, availability, and market share of artemisinin-based combinations has been sustained after the subsidies were reduced or discontinued. Methods: Six independent retail audits were conducted in private medicine retail outlets, including pharmacies, drug shops, and clinics in Nigeria (2016, 2018, 2021), and Uganda (2014, 2019, 2020) to assess the availability, price, and market share of anti-malarials, including WHO-PQ-ACTs and non-WHO-PQ-ACTs, and malaria rapid diagnostic tests (RDTs). Results: Between 2016 and 2021, there was a 57% decrease in WHO-PQ-ACT availability in Nigeria and a 9% decrease in Uganda. During the same period, non-WHO-PQ-ACT availability increased in Nigeria by 41% and by 34% in Uganda. The price of WHO-PQ-ACTs increased by 42% in Nigeria to $0.68 and increased in Uganda by 24% to $0.95. The price of non-WHO-PQ-ACTs decreased in Nigeria by 26% to $1.08 and decreased in Uganda by 64% to $1.23. There was a 76% decrease in the market share of WHO-PQ-ACTs in Nigeria and a 17% decrease in Uganda. Malaria RDT availability remained low throughout. Conclusion: With the reduction or termination of subsidies for WHO-PQ-ACTs in Uganda and Nigeria, retail prices have increased, and retail prices of non-WHO-PQ-ACTs decreased, likely contributing to a shift of higher availability and increased use of non-WHO-PQ-ACTs. [ABSTRACT FROM AUTHOR]

Background: The phenomenon of missed care has received increasing interest over the past decade. Previous studies have used a missed care framework to identify missed nursing tasks, although these have primarily been within the acute care environment. The aim of this research was to identify missed care specific to the role of the general practice nurse. Methods: An integrative review method was adopted, using The Mixed Methods Appraisal Tool to assist in a methodological appraisal of both experimental, theoretical, and qualitative studies. Thematic analysis was then used to analyse and present a narrative synthesis of the data. Data sources: CINAHL, SCOPUS, Web of Science and Google Scholar databases were searched between 2011 and 2022 for empirical research that reported missed care and the general practice nurse. Results: Of the 787 papers identified, 10 papers met the inclusion criteria. Three themes identified missed care in relation to primary healthcare nurses: under-staffing and resourcing, communication difficulties, and role confusion. Conclusion: Isolating missed care by general practice nurses was challenging because much of the research failed to separate out general practice nurses from community and primary health care nurses. This challenge was exacerbated by disparity in the way that a general practice nurse is defined and presented in the various databases. While some themes such as those related to communication and understaffing and resourcing demonstrate some parallels with the acute sector, more research is required to identify missed care specific to the general practice nurse. Identifying missed nursing care is an important avenue to achieving improvements in patient care. Predominantly undertaken in the acute sector, there is a need to expand missed care research to the primary healthcare sector. We conducted an integrative review to determine missed care and the general practice nurse. Some commonalities between the primary health and acute sectors were identified such as issues with communication and resource availability. Recent calls for general practice nurses to work to the top of their scope involve a more nuanced understanding of the role, and what is being missed. [ABSTRACT FROM AUTHOR]

Purpose: Utilisation of remote clinics is increasing in healthcare settings worldwide. During the height of the COVID pandemic, our UK-based teaching hospital has trialled telephone assessment for new patients presenting with primary hernias. Selected cases are listed for elective repair of primary hernia direct from telephone clinic assessment. In March 2021, after this process had been in place for 13 months, departmental triage criteria were introduced, allocating patients to initial assessment in Face to Face or Telephone Clinics. Here, we evaluate the effectiveness of telephone assessment, with specific attention to 'Day of Surgery' cancellation. We also assess the effect of our triage criteria on rate of 'Day of Surgery' cancellation. Methods: Departmental diaries were studied retrospectively to identify patients listed for hernia repair between February 2020 and February 2022. Data were obtained from clinic letters, discharge paperwork and operating lists, as well as from management teams. Fishers Exact test was used to compare groups seen either face to face or remotely as well and pre- and post-intervention. Results: 325 patients were listed for hernia repair, 56 after telephone assessment. 6 (11%) of those listed from telephone clinic were cancelled on the day of surgery, compared with 34 (13%) of those seen face to face. With triage criteria in place, listing from telephone clinic increased significantly from 14 to 27%. Overall day of surgery cancellations reduced from 13 to 9%. Rate of day of surgery cancellation in those assessed in telephone clinic reduced from 12 to 9%. Conclusions: There is no significant difference between day of surgery cancellations after face to face or telephone clinic assessment. Triage criteria for telephone assessment appear to increase the numbers being listed after remote clinics. This did not significantly impact the number of day of surgery cancellations. [ABSTRACT FROM AUTHOR]

Access to healthcare in the United States is drastically changing. The governmental response to the coronavirus greatly upended our ways of business. Rationing care damaged trust, instilled hesitancy for treatments and prevention, and functionally introduced medical deserts to poor and rural areas. The response by the practitioners was positive - empowering nurses, physician associates, and pharmacists to perform most patient-facing functions. This paper focuses on community care, primarily by nurse practitioners, where practitioners provide primary care and urgent care near or in existing pharmacies and supermarkets, building on relationships and convenience, thus maximizing patient access and mitigating risks. [ABSTRACT FROM AUTHOR]

Technological advancements of prostheses in recent years, such as haptic feedback, active power, and machine learning for prosthetic control, have opened new doors for improved functioning, satisfaction, and overall quality of life. However, little attention has been paid to ethical considerations surrounding the development and translation of prosthetic technologies into clinical practice. This article, based on current literature, presents perspectives surrounding ethical considerations from the authors' multidisciplinary views as prosthetists (HG, AM, CLM, MGF), as well as combined research experience working directly with people using prostheses (AM, CLM, MGF), wearable technologies for rehabilitation (MGF, BN), machine learning and artificial intelligence (BN, KKQ), and ethics of advanced technologies (KKQ). The target audience for this article includes developers, manufacturers, and researchers of prosthetic devices and related technology. We present several ethical considerations for current advances in prosthetic technology, as well as topics for future research, that may inform product and policy decisions and positively influence the lives of those who can benefit from advances in prosthetic technology. [ABSTRACT FROM AUTHOR]

The covalent attachment of polyethylene glycol (PEG) to therapeutic agents, termed PEGylation, is a well‐established and clinically proven drug delivery approach to improve the pharmacokinetics and pharmacodynamics of drugs. Specifically, PEGylation can improve the parent drug's solubility, extend its circulation time, and reduce its immunogenicity, with minimal undesirable properties. PEGylation technology has been applied to various therapeutic modalities including small molecules, aptamers, peptides, and proteins, leading to over 30 PEGylated drugs currently used in the clinic and many investigational PEGylated agents under clinical trials. Here, we summarize the diverse types of PEGylation strategies, the key advantages of PEGylated therapeutics over their parent drugs, and the broad applications and impacts of PEGylation in clinical settings. A particular focus has been given to the size, topology, and functionalities of PEG molecules utilized in clinically used PEGylated drugs, as well as those under clinical trials. An additional section has been dedicated to analyzing some representative PEGylated drugs that were discontinued at different stages of clinical studies. Finally, we critically discuss the current challenges faced in the development and clinical translation of PEGylated agents. [ABSTRACT FROM AUTHOR]

Copyright of Harran University Journal of the Faculty of Veterinary Medicine / Harran Üniversitesi Veteriner Fakültesi Dergisi is the property of Harran University, Faculty of Veterinary Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Today, many young men who have sex with men (YMSM) with a new HIV infection were diagnosed and successfully linked to HIV services. Studies on their health behaviors while living with HIV and their attitude toward the HIV clinic are scarce. We characterized common health behaviors of YMSM and assessed their perspective towards the existing HIV services. We collected data from a self-administered questionnaire and in-depth interviews (IDI) using a mixed-method cross-sectional study design. A hundred YMSM, aged 18–24, who attended the HIV clinic were enrolled. Their median age was 23 years (interquartile range, IQR 21–24). Eighty-four (84%) were gay men. Their common health behaviors included 15 (15%) being current smokers and 30 (30%) using alcohol regularly. Sixty-four (64%) reported > 95% antiretroviral treatment adherence, while 32 (32%) self-reported adherence at 80–95%. Fifty-three (53%) reported 100% condom use, while 30 (30%) reported using a condom in > 80% of their sexual activities. From the questionnaire respondents, individual characteristics of providers were the most critical factor affecting participants' willingness to attend HIV services. From the IDI, social disclosure of HIV status was their primary concern, with the presence of self- and anticipating HIV-related stigma issues. In summary, YMSM living with HIV who regularly attended the HIV clinic had a low frequency of health risk behaviors. Most did not socially disclose their serostatus but could manage their health. They were generally satisfied with patient-friendly services while calling to protect their confidentiality and privacy. [ABSTRACT FROM AUTHOR]

The Aim of the Study: To describe the clinical and non-clinical characteristics of Gabon footballers in the Haut-Ogooue Polyclinic in Franceville, Gabon, during visits, to assess whether they are not contraceptive to sports. Patients and Methods: A descriptive and analytical cross-sectional study was conducted in the city of Franceville, Gabon, in May 2022. The first and second divisions of footballers were subjected to medical examinations to determine whether they had any contraindications for playing sports, including clinical examinations, rest electrocardiograms (ECG), rest cardiac ultrasounds, chest X-rays, Rick-Dickson and biological checks. Results: The average age of 88 footballers (22–25 years) was 23 years. Blood pressure (BP) is abnormal in 19% of players, and alcohol and tobacco consumption is reported in 70% and 30%, respectively. Exercise adaptation was also closely associated with age (P = 0.00137724; P = 0.008974301), football position (P = 0.009957548; P = 0.006646182) and alcohol consumption (P = 0.000531971). Electrical and biological changes were 16% and 86.79%, respectively. Sinus bradycardia and first-degree atrioventricular block are the most common ECG abnormalities. Metabolic, inflammatory, infectious, electrolyte and anaemia syndromes were found in 22.64%, 24.53%, 19.81%, 7.55% and 12.26%, respectively. Midfielders and defenders have shown the greatest changes in biological parameters. Conclusion: Medical checks are essential to determine if sports are contraindicated, as they can help identify physiological and pathological conditions and improve the monitoring of athletes. [ABSTRACT FROM AUTHOR]

Background: The South African National Department of Health introduced the ideal clinic realisation and maintenance (ICRM) programme in response to primary health care (PHC) services and to lay a strong foundation for the National Health Insurance implementation. The progress report 2015–2016 on the implementation of this programme indicated that achieving the 50% target in selected vital areas such as staffing, resource allocation, and utilisation was not achieved. Aim: The study aimed to explore and describe nurses’ experiences regarding the ideal clinic project (ICP) implementation. Setting: The study was conducted in 18 PHC clinics in eThekwini district, KwaZulu-Natal. Methods: An exploratory descriptive, contextual qualitative design was employed guided by Donabedian’s structure, process, and outcomes model. Data were collected using semi-structured interviews with 24 nurses between 15 September and 25 October 2020 following receipt of ethics and analysed using Tesch’s open coding approach. Results: The three themes that emerged included structural limitations, processes involved in running the clinic, and support offered to the PHC clinics. These were highlighted as challenges experienced by nurses during the implementation of an ICP. Conclusion: Nurses’ negative experiences and perceptions made it difficult for them to accomplish the ICP standards. Contribution: The findings from the study highlighted critical actions by the health care institution management which if instituted, could facilitate improved implementation of the ICP and achievement of the 50% target in selected vital areas.

Introduction: Medical centers, as complex technical-social systems, are exposed to the risk of fire incidents. This study analyzes the causes and contributing factors of the fire accident at Sina Mehr Clinic to prevent similar accidents, resulting in 19 deaths and 14 injuries. Material and Methods: The causes and contributing factors for accidents in medical centers are found through studies related to laws and regulations, official accident reports, expert reports of regulatory bodies, interviews with experts, and review of past studies, extraction, and categorization. Accident analysis methods included AcciMap and STAMP. Finally, experts’ opinions were used to confirm and strengthen the findings. Results: The most critical root and hierarchical causes of the weakness of medical center management in the field of safety, dangerous conditions, fire accidents, and emergency response are the issuance of a legal building completion permit for a building that violates national building regulations and the issuance of a legal permit for a medical institution for a building with residential use, as well as the insufficiency of supervision by government and public institutions with horizontal relationships with each other and vertical relationships with universities of medical sciences, labor offices, and firefighting organizations, as the direct supervisors of medical centers. Conclusion: The AcciMap and STAMP findings indicate that the priority is to amend the regulations for the establishment, operation, and activity of medical centers with an emphasis on safety regulations, as well as the frequency and shortening of feedback loops such as inquiring about the building completion permit from the municipality, announcing the establishment of a medical center to other governmental and public supervisory authorities, and the reporting of unsafe cases directly by supervisors to the Ministry of Health. Legal authorities are the most crucial cycle in the resilience of fire incidents and their consequences in medical centers.

Aim. The purpose of the research is to find out the role of clinical and immunological parameters in predicting the effectiveness of additional immunotropic therapy in oxygen-dependent patients with the coronavirus disease COVID-19. Material and methods. 79 oxygen-dependent patients with COVID-19 were examined, who received additional therapy with tocilizumab according to current protocols. The patients were divided into groups: I group – 39 patients who recovered; group II – 40 patients with a fatal outcome of the disease. The content of ferritin (Monobind Inc., USA), interleukin (IL) IL-2 (Elabscience, USA), IL-6 (Invitrogen, Austria), monocyte chemotactic protein-1 (MCP-1) (Elabscience, USA) was determined in the blood serum of patients and persons of the control group by the method of immunoenzymatic analysis. Statistical processing of the obtained data was carried out in the program Statistica 13 for Windows (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. Threshold levels of immunological parameters at different stages of observation, which have prognostic value regarding the risk of a fatal outcome of COVID-19, have been established. After 5 days of tocilizumab administration, the preservation of the indicator of the absolute number of blood lymphocytes ≤1.2 × 109/l (AUC = 0.631, p = 0.039), CRP level >67.5 mg/l (AUC = 0.670, p = 0.020), IL-2 >309.45 pg/ml (AUC = 0.761, p = 0.013), IL-6 >4.66 pg/ml (AUC = 0.871, p < 0.001) indicated a high probability of developing a fatal outcome of the disease in patients with COVID-19. The analysis of the diagnostic significance of ferritin showed the informativeness of the level of its increase as at the time of the start of observation >548.02 ng/ml (AUC = 0.718, p = 0.004) and after 5 days the application of additional immunotropic therapy >443.55 ng/ml (AUC = 0.736, p = 0.026). It has been proven that, in addition to immunological parameters, when assessing the probability of a fatal outcome of COVID-19, such clinical parameters as the presence of febrile fever at the time of the appearance of oxygen dependence (p < 0.05) and the duration of oxygen dependence at the time of additional immunotropic therapy with tocilizumab are informative (p < 0.05). Under the conditions of additional immunotropic therapy with tocilizumab more than 4 days after the onset of oxygen dependence, the probability of ineffectiveness of the specified additional treatment was significant (AUC = 0.756, p < 0.001). Conclusions. The dynamics of immunological parameters in oxygen-dependent patients with COVID-19 during additional immunotropic therapy with tocilizumab has certain features with different treatment results. When predicting the probable risk of a fatal outcome of the disease, clinical parameters are informative, namely the appearance of febrile fever during the development of oxygen dependence and the duration of oxygen dependence until the moment of tocilizumab administration, and immunological parameters, namely the level of the absolute content of lymphocytes, ferritin, CRP, IL-2, IL-6 in the blood.

Introduction. The work highlights the problematic issues of diagnosis and treatment of toxocariasis infection in people in Ukraine, which become even more acute and urgent due to the migration of the population and animals, and the destruction of the country's infrastructure as a result of the war unleashed by Russia. The aim of the study. Improvement of aspects of clinical, laboratory and instrumental diagnostics, as well as treatment of VML in humans Materials and methods. A literature research of the state of the problem of primary and differential diagnosis of the migrating larva in Ukraine and the world has been conducted. 2 clinical cases of diagnosis and treatment of migrating larva in are described. Results. The article describes two clinical cases of visceral migrating larva. The differences of these cases, in addition to the migrating formations in the lungs, were the asymptomatic course, the absence of eosinophilia, and the simultaneous determination of blood class G antibodies by ELISA to Toxocar and human roundworm (A. lumbricoide), which persisted even after treatment. Patients at the stage of diagnosis were examined in an oncology hospital, were consulted by thoracic surgeons and oncologists to exclude lung cancer. Both women were immunocompetent, one patient had a history of cervical cancer. From the epidemiological anamnesis, both women kept cats, and one of them, during chemotherapy for the treatment of a tumor, had a propensity for carnivorous raw-eating. Before prescribing systemic antiparasitic chemotherapy, the patients were examined by an ophthalmologist to exclude parasitic chorioretinitis. The patients were prescribed a 20-day course of albendazal 800 mg/day in two doses. Support therapy consisted of a 5-day course of prednisolone at a dose of 30 mg/day orally in two doses, which started one day before the appointment of albendazole. A control CT scan of the lungs after therapy did not reveal any formations, fibrosis, or calcifications. Discussion. This case proves that tocoscarosis in humans is a multidisciplinary medical and social problem. Conclusions were made on the need to restore the national registration of the disease, adopt national consensuses on treatment and diagnosis, and implement into clinical practice modern methods of verification of specific antibodies to nematodes based on immunoblotting. Conclusions. The registration of cases of VML and T. in the system of control and prevention of infectious diseases in Ukraine should be resumed. It is expedient to introduce specific studies on nematodes in clinical laboratory practice.

Abstract Introduction Older carers or ‘care partners’ of older people experiencing care needs often provide essential support, at times while neglecting their own health and well‐being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well‐being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. Methods Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus‐based summaries, arriving at a preferred service model. Findings This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well‐being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. Public Contribution This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions.

Abstract Objective Delivering effective secondary preventive and integrated care has the potential to break the revolving-door phenomenon of frequent readmissions in patients with advanced chronic liver disease. To address this, we launched the Care Coordination of Liver Disease (CCoLD) pilot, a novel nurse-led cirrhosis clinic in Western Sydney. Methods and analysis Following an index presentation to Blacktown or Mount Druitt hospitals (BMDH), patients (n = 89, matched by age, sex, and MELD-NA) were consecutively either followed up by the CCoLD clinical nurse consultant (intervention cohort) or received standard care (control cohort). Controlled evaluation of the impact of the nurse-led clinic was carried out for a 3-month period including readmission rates, survival, and cost effectiveness. Results The inaugural nurse-led clinic led to improvement in patient-level outcomes including a reduction in unplanned liver-related readmissions (2.08% for intervention cohort vs 12.2% for control cohort, p

Aim. To analyze a case of severe COVID-19 and influenza co-infection in a 48-year-old female patient. Materials and methods. The clinical course, specifics of diagnosis and therapy of the 48-year-old patient S., who was treated for severe co-infection of COVID-19 and influenza at Municipal non-profit Enterprise “Regional Infectious Clinical Hospital” Zaporizhzhіa Regional Council from 29.01.2023 to 17.02.2023, were analyzed. The diagnosis of COVID-19 was confirmed by the detection of SARS-CoV-2 Ag in nasopharyngeal swabs by the immunochromatographic method, and the diagnosis of influenza – by the influenza A viral RNA detection by the polymerase chain reaction method. Current regulatory documents were used when examining and treating the patient. Results. It has been recognized that the unvaccinated 48-year-old female patient was at a risk group due to comorbid pathology (stage 2 hypertension, type 2 diabetes mellitus, grade 2 obesity) developed a severe course of COVID-19 and influenza type A co-infection. The course of co-infection was complicated by severe acute respiratory distress syndrome already on the 6th day of the disease. The diagnosis of COVID-19 was confirmed by a rapid SARS-CoV-2 antigen test. Treatment for COVID-19 was started immediately with the use of remdesivir, dexamethasone, and anticoagulants. However, despite the patient was given the treatment, his condition worsened due to the rapid progression of acute respiratory failure. The presence of clear clinical and laboratory signs of “cytokine storm” required the use of tocilizumab on the 7th day of the disease. Oseltamivir was commenced after receiving laboratory confirmation of influenza A by the PCR method on the 8th day of the disease. A complete etiologic interpretation of the diagnosis made it possible to prescribe a combination antiviral treatment which coupled with the timely additional initiation of tocilizumab, allowed obtaining certain positive dynamics after only five days of treatment with further improvement of the patient’s condition. Conclusions. Our clinical observation has demonstrated the severe course of COVID-19 and influenza co-infection in the unvaccinated high-risk 48-year-old female patient due to the presence of comorbid pathology. The complete etiologic interpretation of the co-infection has made it possible to prescribe the combination antiviral treatment, which coupled with the additional correction of the immunotropic treatment has enabled to obtain the positive dynamics after only 5 days with further improvement of the patient’s condition