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Introduction: Incidental pulmonary nodules (IPN) are common radiologic findings, yet management of IPNs is inconsistent across Canada. This study aims to improve IPN management based on multidisciplinary expert consensus and provides recommendations to overcome patient and system-level barriers. Methods: A modified Delphi consensus technique was conducted. Multidisciplinary experts with extensive experience in lung nodule management in Canada were recruited to participate in the panel. A survey was administered in 3 rounds, using a 5-point Likert scale to determine the level of agreement (1 = extremely agree, 5 = extremely disagree). Results: Eleven experts agreed to participate in the panel; 10 completed all 3 rounds. Consensus was achieved for 183/217 (84.3%) statements. Panellists agreed that radiology reports should include a standardized summary of findings and follow-up recommendations for all nodule sizes (ie, <6, 6-8, and >8 mm). There was strong consensus regarding the importance of an automated system for patient follow-up and that leadership support for organizational change at the administrative level is of utmost importance in improving IPN management. There was no consensus on the need for standardized national referral pathways, development of new guidelines, or establishing a uniform picture archiving and communication system. Conclusion: Canadian IPN experts agree that improved IPN management should include standardized radiology reporting of IPNs, standardized and automated follow-up of patients with IPNs, guideline adherence and implementation, and leadership support for organizational change. Future research should focus on the implementation and long-term effectiveness of these recommendations in clinical practice. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Design Sample Measure Results Conclusion: Compliance is crucial for patients to control and manage their high blood pressure. This study assesses the compliance levels of hypertensive patients in China and explores the factors influencing compliance.A descriptive, cross‐sectional design was conducted.A total of 371 hypertensive patients were recruited from six County hospitals and 12 township health centers in Zhejiang Province, China.Patient compliance was measured using the Hypertensive Patient Scale (CHPS). Independent‐sample T‐test or variance analysis was applied to analyze CHPS scores by sociodemographic factors, and linear regression was used to explore the significant correlates of the total CHPS score.The total score of CHPS was 50.18 ± 6.12. Among the seven domains, drug treatment and lifestyle had the highest and lowest average scores, 3.59 ± 0.87 and 2.74 ± 0.73, respectively. The total score of CHPS positively associated with age (β = 0.075, p = 0.028), > 7 years of hypertension (β = 1.896, p = 0.022; Ref: < 3 years), and negatively associated with males (β = −2.224, p = 0.001; Ref: female) and rural area (β = −2.008, p = 0.007; Ref: urban area).These findings highlight the importance of related measurements of the local “health‐oriented” healthcare system. Primary health professionals should strengthen their health behavior intervention capacity and improve hypertension management among their patients. [ABSTRACT FROM AUTHOR]

This study investigates the application of discrete event simulation in analyzing patient management and cost dynamics within a hospital system. A simulation that integrates machine learning models, specifically Decision Trees, Random Forests, Support Vector Machines, and Gradient Boosting methods, to predict treatment costs and appointment availability was developed. Conducted over 30 days, the simulation generates synthetic data for training the models. The results are assessed in terms of the total number of patients treated, cumulative costs incurred, and the cost-effectiveness of each predictive model. The findings reveal significant variations in the performance of different machine learning techniques, demonstrating that adopting advanced analytics can substantially improve hospital resource management. This research aims to develop more efficient patient care strategies, contributing to optimizing hospital operations and enhancing patient experiences. [ABSTRACT FROM AUTHOR]

Les troubles somatiques fonctionnels (TSF) sont fréquents et entraînent une détérioration significative de la qualité de vie. Leur origine est multifactorielle et mal comprise, mais leur prise en charge est relativement codifiée. Les traitements médicamenteux sont généralement peu efficaces tandis que les approches psychocorporelles jouent un rôle central, avec trois grands principes : une relation médecin–patient empathique, respectueuse et sincère, une activité physique régulière et graduelle, et une psychothérapie de type thérapie cognitive et comportementale (TCC). L'établissement d'une alliance thérapeutique repose sur la reconnaissance de la véracité et de la pénibilité des symptômes et la délivrance d'un diagnostic positif associé à un modèle explicatif rationnel. Les facteurs d'entretien cognitifs – focalisation attentionnelle et catastrophisme – et comportementaux doivent être recherchés et constituent des cibles thérapeutiques privilégiées. Les patients ont fréquemment des conduites d'évitement, notamment de l'effort physique. Il faut alors les inciter à reprendre une activité physique graduelle, en s'adaptant à leurs possibilités. Celle-ci a fait ses preuves dans l'amélioration de la fatigue, la douleur et la qualité de vie physique et mentale des patients. Parmi les approches psychothérapeutiques, le bénéfice d'une TCC est modeste mais bien démontré. L'association d'une activité physique graduelle et d'une TCC semble complémentaire. D'autres approches comme la méditation de pleine conscience ont un niveau de preuve plus faible. Étant donnée la fréquence des TSF dans la population générale, il semble nécessaire que l'ensemble des médecins soit formé à leur prise en charge. Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly understood, and their management is often inadequately defined. Medications typically show limited effectiveness, while mind–body approaches play a central role, guided by three key principles: establishing an empathetic, respectful, and sincere doctor–patient relationship; promoting regular and gradual physical activity; and implementing cognitive behavioral therapy (CBT). Special attention must be devoted to establishing a trustworthy relationship between the physician and the patient. Recognizing the reality and severity of symptoms and providing a positive diagnosis as well as an explanatory model to account for them rationally are fundamental aspects of patient management. Cognitive and behavioral maintenance factors should be investigated and constitute therapeutic targets. Cognitive factors include focused attention on body functioning and catastrophizing. Patients frequently display avoidance behaviors, particularly in relation to physical exertion, and it is crucial to motivate them to reintroduce gradual physical activity customized to their abilities. This approach has demonstrated efficacy in improving fatigue, pain, and the physical and mental quality of life for patients with FSD. Among psychotherapeutic approaches, the benefit of CBT is well-established. The combination of gradual physical activity and CBT appears to be complementary. Other mind-body approaches such as mindfulness meditation might help although their level of evidence is weaker. Given the prevalence of FSD in the general population, it seems necessary for all physicians to be trained in managing this condition. [ABSTRACT FROM AUTHOR]

To support implementation of integrated behavioral health care (IBHC) models in local settings, providers may benefit from clinical decision-making support. The present analysis examines perspectives on patient characteristics appropriate or inappropriate for, and currently managed within, IBHC at a large medical center to inform recommendations for provider decision-making. Twenty-four participants (n = 13 primary care providers; n = 6 behavioral health providers; n = 5 administrators) in an IBHC setting were interviewed. Thematic analysis was conducted with acceptable interrater reliability (κ = 0.75). Responses indicated behavioral health symptom and patient characteristics that impact perceptions of appropriateness for management in IBHC, with high variability between providers. Many patients with characteristics identified as inappropriate for IBHC were nonetheless currently managed in IBHC. Interactions between patient ability to engage in care and provider ability to manage patient needs guided decisions to refer a patient to IBHC or specialty care. A heuristic representing this dimensional approach to clinical decision-making is presented to suggest provider decision-making guidance informed by both patient and provider ability. [ABSTRACT FROM AUTHOR]

Background This study aimed to evaluate whether the systemic immune-inflammatory index (SII) can be used as a prognostic indicator in COVID-19 patients presenting to the emergency department. Given the high mortality and morbidity associated with COVID-19, identifying reliable prognostic markers is crucial for optimizing patient management. Methods This retrospective observational study included 639 COVID-19 patients admitted to our emergency department between February 1, 2022, and February 1, 2023. Patients' SII was calculated using complete blood count parameters (neutrophil, lymphocyte, and platelet counts). Data on patient outcomes, including intensive care unit (ICU) admission and in-hospital mortality, were analyzed using statistical methods such as receiver operating characteristic (ROC) curve analysis to assess the predictive power of SII, neutrophil-tolymphocyte ratio (NLR), and neutrophil-to-platelet ratio (NPL). Results Among the 639 patients, 136 died during hospitalization. Significant differences in SII, NLR, and NPL were observed between patients admitted to the ICU and those with less severe outcomes. The highest AUC (area under the curve) value was observed for NLR, with a cut-off value of >4.87, predicting mortality with a sensitivity of 72.79% and specificity of 77.73%. SII also demonstrated significant prognostic value with a cutoff of >806.03, predicting mortality with a sensitivity of 75.74% and specificity of 66%. Conclusion SII, NLR, and NPL are effective prognostic indicators in COVID-19 patients, particularly in predicting the need for intensive care and mortality risk. These findings suggest incorporating these markers into routine clinical practice could improve risk stratification and patient outcomes. However, further largescale studies are needed to validate these results and refine the use of these markers in clinical settings. [ABSTRACT FROM AUTHOR]

Objective: Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community‐based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high‐quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). Methods: A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim‐focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub‐coded according to emerging issues. Thematic saturation and co‐occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high‐quality care. Results: Sixty‐five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow‐up, referral, and interventional treatment. Of these, follow‐up was the most relevant step impacting on the delivery of high‐quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot‐spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high‐quality care at several stages of the patient journey, including drug therapy, follow‐up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). Significance: This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient‐centered care with a chronicity perspective. Plain Language Summary: Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non‐specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high‐quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high‐quality care for patients with epilepsy. [ABSTRACT FROM AUTHOR]

Background: Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation has comparable efficacy and safety to the gold standard of radiofrequency ablation in the treatment of symptomatic atrial fibrillation (AF). Initial randomized control trials were performed using Arctic Front Advance Pro™ (AFr) (Medtronic, Dublin, Ireland) CB system. Novel CB systems have recently become available, including the POLARx™ (Px) (Boston Scientific, Marlborough, Massachusetts, USA) system. We aimed to compare PVI using the Px and the AFr CB systems in our patient population in terms of efficacy, safety and procedure characteristics in a routine clinical setting. Methods: We performed a retrospective analysis of our internal AF ablation registry, containing 452 consecutive patients (pts) that underwent first procedure cryo-PVI for symptomatic AF. Primary endpoints were AF recurrence after 3 and 12 months, complication rate, procedure duration, fluoroscopy time and fluoroscopy dose. Secondary endpoints were minimal freeze temperature, time to isolation (TTI) and temperature at TTI for each of the pulmonary veins as well as minimal esophageal temperature during the procedure. Results: The primary efficacy endpoints of AF recurrence after 3 and 12 months were similar between the AFr and the Px systems (25.5% vs 21.3%, p = 0.416 and 22.2% vs 20.6%, p = 0.794, respectively). Complication rates were similar (3.9% vs 6.8%, p = 0.18) between groups and consisted mostly of mild vascular complications. The AFr group showed a significantly shorter procedural duration (68 (55–77) vs 73 (60–80) min, p = 0.002), and lower fluoroscopy dose compared to the Px system. Fluoroscopy times remained similar, however. Minimal freeze temperatures and temperatures at time of isolation were significantly lower in the Px group. However, the time to isolation and minimal procedural esophageal temperature were similar in both groups. Conclusion: PVI using the AFr and the Px systems showed comparable safety and efficacy. Procedural times were longer for the Px system. The Px system showed lower freeze temperature measurements but seemed to have a comparable biological effect. [ABSTRACT FROM AUTHOR]

Minimally Invasive Robotic Surgery (MIRS) has emerged as a transformative approach in surgical practice, offering reduced patient trauma and enhanced precision. However, challenges persist, including the loss of tactile feedback for surgeons. This study explores the application of machine learning algorithms, specifically variational autoencoders, in vibro-acoustic (VA) signal analysis to address this issue. Our comparative analysis evaluates the potential of supervised learning in surgical data analysis, contributing to advancements in surgical technology. Despite achieving an accuracy of 81%, our results indicate opportunities for further refinement, considering the superior accuracies reported in previous studies. This research underscores the importance of innovative approaches in medical data analysis for optimizing patient care in minimally invasive surgery. [ABSTRACT FROM AUTHOR]

Background: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV2, first detected in China in 2019. This disease causes respiratory infections and significantly impacts global health. Purpose: This study aims to analyze the risk factors for mortality in COVID-19 patients at Universitas Airlangga Hospital in 2021. Methods: This observational analytical study uses a case-control design, including 168 samples with 64 cases and 64 controls. Secondary data from patient medical records at Universitas Airlangga Hospital, including age, gender, education, comorbidities, oxygen saturation, and length of stay. Chi-square tests analyzed the data with a 95% confidence level (a=5%). Results: The analysis revealed significant associations between COVID-19 mortality and several factors. Age (p=0.01; OR=3.24; 95%CI=1.57-6.65), gender (p=0.01; OR=2.2; 95%CI=1.17-4.02), education (p=0.00; OR=2.40; 95%CI=1.11-5.40), comorbidities (p=0.08; OR=2.50; 95%CI=1.26-4.91), and oxygen saturation (p=0.00; OR=5.40; 95%CI=117.10-2490.06) were significantly associated with COVID-19 mortality. Oxygen saturation was the most influential factor (p=0.00; OR=901.73; 95%CI=120.75-6733.48) associated with mortality. Conclusion: Age, gender, education, comorbidities, and oxygen saturation significantly affect COVID-19 mortality rates. This study highlights the importance of monitoring and managing these risk factors in managing COVID-19 at Universitas Airlangga Hospital. [ABSTRACT FROM AUTHOR]

Left ventricular assist devices (LVADs) are increasingly implanted in patients with advanced heart failure. Currently, LVAD care is predominantly concentrated at specialized tertiary care hospitals. However, the increasing workload and logistical burden for implanting centres pose significant challenges to accessing care for individual patients in remote areas. An emerging approach to LVAD patient management is the use of a shared care model (SCM), which facilitates collaboration between implanting centres and local non-implanting hospitals. This scoping review explores and synthesizes the current scientific evidence on the use of SCMs in LVAD care management. Eligible studies were identified in EMBASE, PubMed MEDLINE, Web of Science, Cochrane and Google Scholar. Findings were synthesized in accordance with PRISMA-ScR guidelines. Of the 950 records screened, five articles met the inclusion criteria. Four review articles focused on the proposed benefits and challenges of using SCMs. Main benefits included improved patient satisfaction and continuity of care. Important challenges were initial education of non-implanting centre staff and maintaining competency. One prospective study showed that absence of LVAD-specific care was associated with impaired survival and higher rates of pump thrombosis and LVAD-related infections. The use of SCMs is a promising approach in the long-term management of LVAD patients. However, sufficient evidence about the impact of SCMs on patients and the healthcare system is not currently available. Standardized protocols based on prospective studies are needed to develop safe and effective shared care for LVAD patients. [ABSTRACT FROM AUTHOR]

This case study documents the case of a 27-year-old female who presented with a complaint of left anterolateral thigh numbness, initially diagnosed as meralgia paresthetica with a differential diagnosis of lumbar radiculopathy. Over a span of two weeks, the patient endured emotional trauma and subsequently developed lesions in the area of complaint. The patient was diagnosed at a medical clinic with herpes zoster and was prescribed anti-viral medication which resulted in complete resolution. This case highlights the importance of considering herpes zoster as a differential diagnosis for nerve-related symptoms. Features of lumbar radiculopathy, meralgia paresthetica, varicella zoster and herpes zoster are discussed, as well as the defining characteristics and treatment options. Practitioners must remain vigilant in suspicion of viral infections such as herpes zoster even with lower incidence due to approved vaccines. [ABSTRACT FROM AUTHOR]

Radial artery spasm (RAS) is a common complication associated with transradial access (TRA) for coronary interventions, particularly affecting elderly patients in whom radial access is preferred due to its benefits in reducing bleeding complications, improving clinical outcomes, and lowering long-term costs. This review examines the incidence, prevention, and treatment of RAS. Methods included an online search of PubMed and other databases in early 2024, analyzing meta-analyses, reviews, studies, and case reports. RAS is characterized by a sudden narrowing of the radial artery due to psychological and mechanical factors with incidence reports varying up to 51.3%. Key risk factors include patient characteristics like female sex, age, and small body size as well as procedural factors such as emergency procedures and the use of multiple catheters. Preventive measures include using distal radial access, hydrophilic sheaths, and appropriate catheter sizes. Treatments involve the intraarterial administration of nitroglycerine and verapamil as well as mechanical methods like balloon-assisted tracking. This review underscores the need for standardizing RAS definitions and emphasizes the importance of operator experience and patient management in reducing RAS incidence and improving procedural success. [ABSTRACT FROM AUTHOR]

Introduction: This study analyzed oncologic patient management from initial tumor diagnosis to tumor follow-up in oral and maxillofacial surgery (OMFS) in Germany. Material and methods: A dynamic online questionnaire with a total of 44 questions was used to generate general and specific data regarding oncologic patient management with head and neck malignancies, supportive care, and (pre-) rehabilitation from initial tumor diagnosis to tumor follow-up and head and neck cancer center (HNCC) structures in OMFS in Germany. The questionnaire was sent to 81 OMFS departments affiliated with the German-Austrian-Swiss Working Group for Tumors of the Jaw and Facial Region (DÖSAK) and the German Association of Oral and Maxillofacial Surgery (DGMKG). Data analysis was conducted descriptively. Results: Forty-eight OMFS departments participated (response rate 59.26%), of which 36/48 (75%) were certified HNCC. 28/34 (82.4%) reported subjective improvements in oncologic care, most often interdisciplinary collaboration (21/33, 63.64%) and clinic structure changes (21/34, 61.76%). Nearly all OMFS departments present patients in multidisciplinary tumor boards (45/46, 97.83%) and aim for osseous reconstruction post-tumor resection (43/44, 97.73%). Significant discrepancies regarding the frequency of masticatory-functional dental rehabilitation following osseous reconstruction were observed. Before oncologic therapy, patients are offered various supportive services, mostly psychotherapy and psycho-oncological support (24/26, 92.31%). Post-therapy, speech therapy (43/43, 100%), physiotherapy (40/43, 93.02%), lymphatic drainage, and follow-up rehabilitation (39/43, 90.7%, respectively) are most often offered. 17/43 (39.53%) have oncological nursing staff. 36/40 (90%) manage patients and side effects during adjuvant therapy, while 5/41 (12.2%) provide proprietary palliative care. 36/41 (87.8%) offer counseling to patients and families. Conclusion: Oncologic patient care in OMFS is highly standardized and potentially attributable to many certified HNCCs in Germany. Certain treatment aspects are handled differently, possibly due to institution-specific reasons. Clinical relevance: The high homogeneity in treatment protocols reflects the widespread high and comparable treatment quality of head and neck malignancies in OMFS in Germany. [ABSTRACT FROM AUTHOR]

• Obstructive sleep apnea (OSA) is a frequent in pregnancy that may affect negatively maternal and fetal outcomes. • Limited diagnostic and screening tools restrict the practitioner ability to appropriately manage gestational OSA patients. • Current screening and treatment options are summarized, proposing a clinical approach for managing OSA in pregnancy. • Improved knowledge will allow the practitioner to better counsel toward mitigating the effects of OSA on mother and fetus. Obstructive sleep apnea (OSA) is a frequent condition during pregnancy and its occurrence is increased in obese women. There are growing concerns about both pre-existing OSA and the development of gestational OSA and their effect on maternal pregnancy outcomes, fetal development, and even early childhood. A strong body of research has revealed maternal complications of OSA, but far fewer studies explore its impact on the developing fetus, highlighting an important area of future research. As evidence in both areas mounts about the negative reproductive impact of OSA, studies have emerged that explore the limitations of current diagnostic criteria and screening tools for this disorder in pregnancy which, in turn, limit the practitioner's ability to appropriately refer patients for OSA diagnosis and treatment. This expert review summarizes the current data regarding OSA screening tools in pregnancy, the limitations of these tools, and available OSA treatments and their efficacies. Our objective is to develop recommendations for how to best screen and manage OSA in pregnancy. We conclude that improved understanding of available tools and treatments will allow the obstetric practitioner to better counsel patients and help mitigate the deleterious effects of OSA on mother and fetus. We herein propose a clinical approach for the screening and management of OSA in pregnancy. [ABSTRACT FROM AUTHOR]

Amyloidosis is defined as a rare group of 30 protein-folding diseases characterized by the extracellular deposition of a specific soluble precursor protein that aggregates in the form of insoluble fibrils. The gastrointestinal tract (GI) is a common site for amyloid deposits: Among patients with systemic amyloidosis, at least 70% present with gastrointestinal deposition. Rarely, the deposition is exclusively localized in this area, leading to various gastrointestinal symptoms (bleeding, weight loss, etc.). In this case report, we present a rare and unusual form of localized gastrointestinal amyloidosis, diagnosed after a post-mortem examination of an 83-year-old woman who died due to septic shock resulting from post-colonoscopy iatrogenic perforation of the sigma, in a suspected medical liability case. Morphological examination revealed AL amyloid deposits within the muscular wall of the submucosal vessels of the rectum, which caused increased friability of the vessels and ischemic changes in the intestinal mucosa. A renal cell carcinoma (RCC) was found, which might be related to amyloid deposits, as reported by the literature. Amyloid deposits are an unknown and unpredictable pathological substrate that increase the risk of iatrogenic perforation. Analysis of the medical documentation did not reveal any censurable conduct in terms of prescribing the procedure, technical execution, or subsequent management of the patient following the perforation. GI amyloidosis should be part of the risk stratification of patients with rectal bleeding and gastrointestinal symptoms, and awareness is essential to guide subsequent diagnostic and therapeutic approaches and investigate underlying causes. [ABSTRACT FROM AUTHOR]

This research aims to improve the quality of Telkomedika Telkom University Clinic services by developing a mobile application that is tailored to the personality type of patients with conscientiousness. This Mobile Application is designed to fulfill the patient's need for service information through the service information feature and streamline the queuing process through the online reservation feature. Through the use of the DISC personality type approach, this study focuses on the preferences and characteristics of patients to increase satisfaction. Users or patients with this conscientious personality type tend to be meticulous, systematic, and structured. Therefore, a structured interface design and also an easy-to-understand task flow will help users in using the application efficiently. The results of the study show the importance of understanding user preferences in designing applications. Usability Testing on the Telmed 2.0 application prototype resulted in a Single Ease Question (SEQ) score of 6.88, indicating ease of use. In addition, User Acceptance Testing showed that all features worked well, with a score of 91.5 on the System Usability Scale (SUS), indicating an excellent level of ease of use of the application. [ABSTRACT FROM AUTHOR]

Acalvaria is a rare congenital malformation of unknown etiopathogenesis that affects the development of the skull and surrounding muscular structures. There is scant literature regarding the pathophysiology, and no standardized guidelines exist for patient management. Herein, we present a case of acalvaria in a newborn and our multidisciplinary approach from diagnosis to 1 year of age. [ABSTRACT FROM AUTHOR]

Abstract Objective Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community‐based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high‐quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). Methods A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim‐focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub‐coded according to emerging issues. Thematic saturation and co‐occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high‐quality care. Results Sixty‐five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow‐up, referral, and interventional treatment. Of these, follow‐up was the most relevant step impacting on the delivery of high‐quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot‐spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high‐quality care at several stages of the patient journey, including drug therapy, follow‐up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). Significance This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient‐centered care with a chronicity perspective. Plain Language Summary Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non‐specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high‐quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high‐quality care for patients with epilepsy.

Aim of the study: The emergence of the COVID-19 pandemic has catalyzed a paradigm shift in emergency dental care, prompting a reassessment of traditional approaches and the adoption of innovative strategies to address evolving challenges. Introduction: This comprehensive study explores the multifaceted landscape of emergency dental care amidst the COVID-19 pandemic, delving into the integration of tele-dentistry, advancements in point-of-care testing, optimization of aerosol-reducing techniques, enhancements in personal protective equipment (PPE), and the pivotal role of public health preparedness and education. Materials and Methods: Through a meticulous review of existing literature and analysis of pertinent studies, this study elucidates the transformative impact of these innovations on emergency dental care provision. Results: Tele-dentistry has emerged as a valuable tool for remote assessment, initial guidance, and triaging of cases, while advancements in point-of-care testing facilitate rapid and accurate diagnosis of COVID-19 infection in dental settings. Moreover, optimization of aerosol-reducing techniques and advancements in PPE design contribute to minimizing viral transmission risks during emergency procedures. Furthermore, this study underscores the importance of robust public health preparedness and education in fostering a proactive approach to dental emergencies and instilling confidence in patients to seek timely care. Collaborative efforts among dental professionals, researchers, and public health authorities are essential in navigating the complexities of the COVID-19 pandemic and fortifying preparedness for future crises. Conclusion: This study advocates for the continued integration of innovative solutions and adaptive strategies in emergency dental care, guided by a commitment to patient safety, evidence-based practices, and interdisciplinary collaboration. By embracing these advancements, the dental community can navigate the challenges posed by the COVID-19 pandemic and emerge stronger, more resilient, and better equipped to ensure the oral health and well-being of individuals for generations to come.

Abstract Background An increasing number of clinical trials for new therapeutic strategies are underway or being considered for dystrophinopathy. Having detailed data on the natural progression of this condition is crucial for assessing the effectiveness of new drugs. However, there’s a lack of data regarding the long-term data on the natural course and how it’s managed in China. In this study, we offer a comprehensive overview of clinical and molecular findings, as well as treatment outcomes in the Chinese population. Methods Institutional data on all patients with dystrophinopathy from August 2011 to August 2021 were retrospectively reviewed. The data included geographic distribution, age at diagnosis, molecular findings, and treatment options, such as corticosteroids, cardiac interventions, and clinical outcomes. Results In total, 2097 patients with dystrophinopathy, including 1703 cases of Duchenne muscular dystrophy (DMD), 311 cases of Becker muscular dystrophy (BMD), 46 cases of intermediate muscular dystrophy (IMD), and 37 cases categorized as “pending” (individuals with an undetermined phenotype), were registered in the Children’s Hospital of Fudan University database for dystrophinopathy from August 2011 to August 2021. The spectrum of identified variants included exonic deletions (66.6%), exonic duplications (10.7%), nonsense variants (10.3%), splice-site variants (4.5%), small deletions (3.5%), small insertions/duplications (1.8%), and missense variants (0.9%). Four deep intronic variants and two inversion variants were identified. Regarding treatment, glucocorticoids were administered to 54.4% of DMD patients and 39.1% of IMD patients. The median age at loss of ambulation was 2.5 years later in DMD patients who received glucocorticoid treatment. Overall, one cardiac medicine at least was prescribed to 7.4% of DMD patients, 8.3% of IMD patients, and 2.6% of BMD patients. Additionally, ventilator support was required by four DMD patients. Eligibility for exon skipping therapy was found in 55.3% of DMD patients, with 12.9%, 10%, and 9.6% of these patients being eligible for skipping exons 51, 53, and 45, respectively. Conclusions This is one of the largest studies to have evaluated the natural history of dystrophinopathy in China, which is particularly conducive to the recruitment of eligible patients for clinical trials and the provision of real-world data to support drug development.

Recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) is a challenging disease, requiring personalized management by a multidisciplinary team. The aim of this retrospective multicentric study was to characterize real-world healthcare resource use and patient care for R/M HNSCC in Portugal during the first year after diagnosis. A total of 377 patients ineligible for curative treatment were included, mostly male (92.8%), aged 50–69 years (74.5%), with heavy alcohol (72.7%) or smoking habits (89.3%). Oropharynx (33.2%) and oral cavity (28.7%) were primary tumor locations, with lung metastases being the most common (61.4%). Eligible patients for systemic treatment with palliative intent (80.6%) received up to four treatment lines, with varied regimens. Platinum-based combination chemotherapy dominated first-line treatment (>70%), while single-agent chemotherapy and anti-PD1 immunotherapy were prevalent in later lines. Treatment approaches were uniform across disease stages and primary tumor locations but varied geographically. Treated patients received more multidisciplinary support than those who were ineligible. This study provides the first Portuguese real-world description of R/M HNSCC patient characteristics, treatment patterns, and supportive care during the year after diagnosis, highlighting population heterogeneity and aiming to improve patient management.

Abstract Objective This study aimed to analyze the factors influencing glycemic control in patients with type 2 diabetes mellitus (T2DM). Methods Baseline data, encompassing basic information, lifestyle habits, and treatment of 305 T2DM patients from March 2021 to January 2023, were collected and analyzed using SPSS 26.0 software. Results Univariate and multivariate logistic regression analyses identified insulin therapy (OR = 2.233; 95%Cl = 1.013–4.520; P = 0.026) and regular clinic visits (OR = 0.567; 95%Cl = 0.330–0.973; P = 0.040) as independent factors influencing glycemic control. No observed interactions between the two variables were noted. Conclusion History of insulin therapy and regular clinic visits were significantly and independently associated with glycated hemoglobin control in T2DM patients. Tailored interventions based on individual circumstances are recommended to optimize glycemic control.

Background: An increasing number of clinical trials for new therapeutic strategies are underway or being considered for dystrophinopathy. Having detailed data on the natural progression of this condition is crucial for assessing the effectiveness of new drugs. However, there's a lack of data regarding the long-term data on the natural course and how it's managed in China. In this study, we offer a comprehensive overview of clinical and molecular findings, as well as treatment outcomes in the Chinese population. Methods: Institutional data on all patients with dystrophinopathy from August 2011 to August 2021 were retrospectively reviewed. The data included geographic distribution, age at diagnosis, molecular findings, and treatment options, such as corticosteroids, cardiac interventions, and clinical outcomes. Results: In total, 2097 patients with dystrophinopathy, including 1703 cases of Duchenne muscular dystrophy (DMD), 311 cases of Becker muscular dystrophy (BMD), 46 cases of intermediate muscular dystrophy (IMD), and 37 cases categorized as "pending" (individuals with an undetermined phenotype), were registered in the Children's Hospital of Fudan University database for dystrophinopathy from August 2011 to August 2021. The spectrum of identified variants included exonic deletions (66.6%), exonic duplications (10.7%), nonsense variants (10.3%), splice-site variants (4.5%), small deletions (3.5%), small insertions/duplications (1.8%), and missense variants (0.9%). Four deep intronic variants and two inversion variants were identified. Regarding treatment, glucocorticoids were administered to 54.4% of DMD patients and 39.1% of IMD patients. The median age at loss of ambulation was 2.5 years later in DMD patients who received glucocorticoid treatment. Overall, one cardiac medicine at least was prescribed to 7.4% of DMD patients, 8.3% of IMD patients, and 2.6% of BMD patients. Additionally, ventilator support was required by four DMD patients. Eligibility for exon skipping therapy was found in 55.3% of DMD patients, with 12.9%, 10%, and 9.6% of these patients being eligible for skipping exons 51, 53, and 45, respectively. Conclusions: This is one of the largest studies to have evaluated the natural history of dystrophinopathy in China, which is particularly conducive to the recruitment of eligible patients for clinical trials and the provision of real-world data to support drug development. [ABSTRACT FROM AUTHOR]

Recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) is a challenging disease, requiring personalized management by a multidisciplinary team. The aim of this retrospective multicentric study was to characterize real-world healthcare resource use and patient care for R/M HNSCC in Portugal during the first year after diagnosis. A total of 377 patients ineligible for curative treatment were included, mostly male (92.8%), aged 50–69 years (74.5%), with heavy alcohol (72.7%) or smoking habits (89.3%). Oropharynx (33.2%) and oral cavity (28.7%) were primary tumor locations, with lung metastases being the most common (61.4%). Eligible patients for systemic treatment with palliative intent (80.6%) received up to four treatment lines, with varied regimens. Platinum-based combination chemotherapy dominated first-line treatment (>70%), while single-agent chemotherapy and anti-PD1 immunotherapy were prevalent in later lines. Treatment approaches were uniform across disease stages and primary tumor locations but varied geographically. Treated patients received more multidisciplinary support than those who were ineligible. This study provides the first Portuguese real-world description of R/M HNSCC patient characteristics, treatment patterns, and supportive care during the year after diagnosis, highlighting population heterogeneity and aiming to improve patient management. [ABSTRACT FROM AUTHOR]

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Introduction: The aim of this review is to identify common mood concerns in ICD patients and suggest brief psychological screeners essential for early detection and monitoring in patient care. Areas covered: Reliable and valid psychological assessment tools are reviewed, including those specifically designed for ICD patient populations. Expert opinion: Psychological assessment, in combination with cardiologic standard of care, can help overcome many barriers associated with poor implantable cardioverter-defibrillator (ICD) management and related cardiovascular outcomes. Earlier identification and treatment of mood concerns in ICD patients has been shown to improve quality of life (QOL) and patient outcomes. At this time, however, logistical challenges and time restraints, in addition to knowledge of appropriate treatment plans or referral options, remain central barriers to providing integrated, patient-centered care. Ultimately, all cardiology clinics would benefit from a collaborative care team that includes a mental health consultant or in-house psychologists who can provide consultations or referral services. Additionally, all patients that come to the clinics should complete proactive screening measures as routine component of care to assess the presence of mood concerns to improve patient outcomes and aid in treatment planning. [ABSTRACT FROM AUTHOR]

Introduction and aim. Malignant soft tissue tumors exhibiting similar histological and immunohistochemical characteristics to Ewing sarcoma of the bones are referred to as extra-skeletal Ewing sarcoma within the pathology research domain. These tumors fall under the broader classification of Ewing sarcoma family of tumors, which encompasses Ewing sarcoma of the bones, extra-skeletal Ewing sarcoma, and primitive neuroectodermal tumor, the latter demonstrating a more pronounced neural differentiation compared to Ewing sarcoma of the bone. Extra-skeletal Ewing sarcoma stands out as a rare, aggressive, and rapidly growing malignant soft tissue tumor characterized by a notable recurrence rate and a predilection for occurrence in males. The roots of recognizing extra-skeletal Ewing sarcoma trace back to 1975 when Angervall and Enzinger reported the inaugural case. This study aims to underscore the significance of recognizing diverse clinical presentations for precise diagnosis and effective patient care of Extra-skeletal Ewing sarcoma in an elderly patient. Case description. In the context of our pathology research, a noteworthy case involves a 57-year-old female presenting with a mass in the left iliac fossa. The diagnosis, established through a comprehensive approach involving Imaging, histopathological examination, immunohistochemistry, and molecular studies such as fluorescence in situ hybridization, confirms the nature of the tumor as extra-skeletal Ewing sarcoma. This case adds to the understanding and documentation of this distinct variant through a multi-modal investigative process. Conclusion. This case report contributes to the existing literature by shedding light on an atypical presentation of extra-skeletal Ewing sarcoma in an older patient. Understanding the varied clinical manifestations and incorporating advanced diagnostic techniques, such as fluorescence in situ hybridization and immunohistochemistry, is pivotal for accurate diagnosis and optimal patient management. [ABSTRACT FROM AUTHOR]

Background: Corticosteroids (CS) are essential in managing various medical conditions, yet longterm use presents significant risks. Balancing therapeutic benefits with potential hazards requires careful prescription and monitoring. This study evaluates Jordanian physicians' knowledge, experiences, and concerns regarding CS prescriptions, and identifies predictors of both knowledge and fear. Methods: A cross-sectional study was conducted from March to August 2023 using an online survey distributed via social media platforms. Descriptive statistics and linear regression analyses were employed to assess factors influencing physicians' knowledge and fears regarding CS. Results: A total of 171 physicians participated, with a median age of 31 years (IQR=8.0). The majority (86.5%) had prescribed topical (83.1%) and injectable (81.1%) CS formulations. Physicians demonstrated high knowledge (median score: 11/11) but expressed significant concerns (median fear score: 3.5/5), particularly about osteoporosis (73.7%) and hyperglycemia (66.7%). Regression analysis revealed that specialty in rheumatology was significantly associated with higher knowledge scores (p=0.027). Conversely, higher knowledge scores were associated with lower fear scores (p=0.034), while other sociodemographic factors did not significantly impact either knowledge or fears. Conclusion: Jordanian physicians possess substantial knowledge about CS, yet significant concerns remain regarding side effects such as osteoporosis and hyperglycemia. Specialty and knowledge level are key factors influencing both knowledge and fear. These findings highlight the need for targeted educational interventions to address these concerns, improve physician confidence, and enhance patient management outcomes. [ABSTRACT FROM AUTHOR]

Aim: This study aims to perform a comprehensive bibliometric analysis of academic publications on AI applications in vascular surgery, identifying key authors, influential journals, prevalent research themes, and international collaborations, focusing on infrastructure, conceptual structure, and social networks within the field. Material and Methods: The analysis covers 815 documents published from 2020 to 2024, retrieved from the Web of Science Core Collection database. Metrics analyzed include publication growth, citation rates, key contributors, leading journals, prevalent themes, and international collaborations. Results: The research output showed a 15% annual growth rate, peaking in 2023. Despite increasing publications, the average citation rate per article declined. The study identified 5039 contributors with significant international co-authorship. Leading authors included Lareyre F and Raffort J, and the "Journal of Vascular Surgery" was the most influential journal. The USA and China led in contributions, reflecting robust research infrastructure. Key themes include risk assessment, diagnostic methods, and patient management, highlighting AI's role in enhancing diagnostic accuracy, treatment planning, and patient outcomes in vascular surgery. Conclusion: The analysis highlights the rapid growth and collaborative nature of AI research in vascular surgery. Key contributors, influential journals, and emerging themes were identified, emphasizing AI's role in improving diagnostics and patient outcomes. Limitations include the focus on one database and a five-year period, suggesting future research should include more databases and a longer timeframe. Exploring high-impact studies and practical applications will further advance the field. [ABSTRACT FROM AUTHOR]

Aim of the study: The emergence of the COVID-19 pandemic has catalyzed a paradigm shift in emergency dental care, prompting a reassessment of traditional approaches and the adoption of innovative strategies to address evolving challenges. Introduction: This comprehensive study explores the multifaceted landscape of emergency dental care amidst the COVID-19 pandemic, delving into the integration of tele-dentistry, advancements in point-of-care testing, optimization of aerosol-reducing techniques, enhancements in personal protective equipment (PPE), and the pivotal role of public health preparedness and education. Materials and Methods: Through a meticulous review of existing literature and analysis of pertinent studies, this study elucidates the transformative impact of these innovations on emergency dental care provision. Results: Tele-dentistry has emerged as a valuable tool for remote assessment, initial guidance, and triaging of cases, while advancements in point-of-care testing facilitate rapid and accurate diagnosis of COVID-19 infection in dental settings. Moreover, optimization of aerosol-reducing techniques and advancements in PPE design contribute to minimizing viral transmission risks during emergency procedures. Furthermore, this study underscores the importance of robust public health preparedness and education in fostering a proactive approach to dental emergencies and instilling confidence in patients to seek timely care. Collaborative efforts among dental professionals, researchers, and public health authorities are essential in navigating the complexities of the COVID-19 pandemic and fortifying preparedness for future crises. Conclusion: This study advocates for the continued integration of innovative solutions and adaptive strategies in emergency dental care, guided by a commitment to patient safety, evidence-based practices, and interdisciplinary collaboration. By embracing these advancements, the dental community can navigate the challenges posed by the COVID-19 pandemic and emerge stronger, more resilient, and better equipped to ensure the oral health and well-being of individuals for generations to come. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze the factors influencing glycemic control in patients with type 2 diabetes mellitus (T2DM). Methods: Baseline data, encompassing basic information, lifestyle habits, and treatment of 305 T2DM patients from March 2021 to January 2023, were collected and analyzed using SPSS 26.0 software. Results: Univariate and multivariate logistic regression analyses identified insulin therapy (OR = 2.233; 95%Cl = 1.013–4.520; P = 0.026) and regular clinic visits (OR = 0.567; 95%Cl = 0.330–0.973; P = 0.040) as independent factors influencing glycemic control. No observed interactions between the two variables were noted. Conclusion: History of insulin therapy and regular clinic visits were significantly and independently associated with glycated hemoglobin control in T2DM patients. Tailored interventions based on individual circumstances are recommended to optimize glycemic control. [ABSTRACT FROM AUTHOR]

Background: Rare diseases, predominantly caused by genetic factors and often presenting neurological manifestations, are significantly underrepresented in research. This review addresses the urgent need for advanced research in rare neurological diseases (RNDs), which suffer from a data scarcity and diagnostic challenges. Bridging the gap in RND research is the integration of machine learning (ML) and omics technologies, offering potential insights into the genetic and molecular complexities of these conditions. Methods: We employed a structured search strategy, using a combination of machine learning and omics-related keywords, alongside the names and synonyms of 1840 RNDs as identified by Orphanet. Our inclusion criteria were limited to English language articles that utilized specific ML algorithms in the analysis of omics data related to RNDs. We excluded reviews and animal studies, focusing solely on studies with the clear application of ML in omics data to ensure the relevance and specificity of our research corpus. Results: The structured search revealed the growing use of machine learning algorithms for the discovery of biomarkers and diagnosis of rare neurological diseases (RNDs), with a primary focus on genomics and radiomics because genetic factors and imaging techniques play a crucial role in determining the severity of these diseases. With AI, we can improve diagnosis and mutation detection and develop personalized treatment plans. There are, however, several challenges, including small sample sizes, data heterogeneity, model interpretability, and the need for external validation studies. Conclusions: The sparse knowledge of valid biomarkers, disease pathogenesis, and treatments for rare diseases presents a significant challenge for RND research. The integration of omics and machine learning technologies, coupled with collaboration among stakeholders, is essential to develop personalized treatment plans and improve patient outcomes in this critical medical domain. [ABSTRACT FROM AUTHOR]

Background: cardiovascular diseases, including acute myocardial infarction (AMI) and takotsubo cardiomyopathy (TTC), are significant causes of morbidity and mortality worldwide. Timely differentiation of these conditions is essential for effective patient management and improved outcomes. Methods: We conducted a review focusing on studies that applied artificial intelligence (AI) techniques to differentiate between acute myocardial infarction (AMI) and takotsubo cardiomyopathy (TTC). Inclusion criteria comprised studies utilizing various AI modalities, such as deep learning, ensemble methods, or other machine learning techniques, for discrimination between AMI and TTC. Additionally, studies employing imaging techniques, including echocardiography, cardiac magnetic resonance imaging, and coronary angiography, for cardiac disease diagnosis were considered. Publications included were limited to those available in peer-reviewed journals. Exclusion criteria were applied to studies not relevant to the discrimination between AMI and TTC, lacking detailed methodology or results pertinent to the AI application in cardiac disease diagnosis, not utilizing AI modalities or relying solely on invasive techniques for differentiation between AMI and TTC, and non-English publications. Results: The strengths and limitations of AI-based approaches are critically evaluated, including factors affecting performance, such as reliability and generalizability. The review delves into challenges associated with model interpretability, ethical implications, patient perspectives, and inconsistent image quality due to manual dependency, highlighting the need for further research. Conclusions: This review article highlights the promising advantages of AI technologies in distinguishing AMI from TTC, enabling early diagnosis and personalized treatments. However, extensive validation and real-world implementation are necessary before integrating AI tools into routine clinical practice. It is vital to emphasize that while AI can efficiently assist, it cannot entirely replace physicians. Collaborative efforts among clinicians, researchers, and AI experts are essential to unlock the potential of these transformative technologies fully. [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndrome (ACS) is a severe cardiovascular disease with globally rising incidence and mortality rates. Traditional risk assessment tools are widely used but are limited due to the complexity of the data. Methods: This study introduces a gated Transformer model utilizing machine learning to analyze electronic health records (EHRs) for an enhanced prediction of major adverse cardiovascular events (MACEs) in ACS patients. The model's efficacy was evaluated using metrics such as area under the curve (AUC), precision–recall (PR), and F1-scores. Additionally, a patient management platform was developed to facilitate personalized treatment strategies. Results: Incorporating a gating mechanism substantially improved the Transformer model's performance, especially in identifying true-positive cases. The TabTransformer+Gate model demonstrated an AUC of 0.836, a 14% increase in average precision (AP), and a 6.2% enhancement in accuracy, significantly outperforming other deep learning approaches. The patient management platform enabled healthcare professionals to effectively assess patient risks and tailor treatments, improving patient outcomes and quality of life. Conclusion: The integration of a gating mechanism within the Transformer model markedly increases the accuracy of MACE risk predictions in ACS patients, optimizes personalized treatment, and presents a novel approach for advancing clinical practice and research. [ABSTRACT FROM AUTHOR]

Gastric cancer (GC) is one of the most common types of cancer and is associated with relatively low survival rates. Despite its considerable burden, there is limited guidance for Canadian clinicians on the management of unresectable metastatic GC and gastroesophageal junction cancer (GEJC). Therefore, we aimed to discuss best practices and provide expert recommendations for patient management within the current Canadian unresectable GC and GEJC landscape. A multidisciplinary group of Canadian healthcare practitioners was assembled to develop expert recommendations via a working group. The often-rapid progression of unresectable GC and GEJC and the associated malnutrition have a significant impact on the patient’s quality of life and ability to tolerate treatment. Hence, recommendations include early diagnosis, identification of relevant biomarkers to improve personalized treatment, and relevant support to manage comorbidities. A multidisciplinary approach including early access to registered dietitians, personal support networks, and palliative care services, is needed to optimize possible outcomes for patients. Where possible, patients with unresectable GC and GEJC would benefit from access to clinical trials and innovative treatments.

Introduction: Physiotherapy in the private sector has a great presence and weight in today's health care. Knowing the satisfaction between private health insurance patients and private patients will help to improve quality standards in Physiotherapy treatment, and thus clinical outcomes. Material and method: survey carried out during 2023 in Google forms distributed among private clinics in Galicia between March and August. More than 300 survey responses were obtained with a correct distribution. Results: patients with private health insurance showed lower satisfaction than private patients. Behavioural and organizational aspects were considered. The factors evaluated show a clear difference between the two groups, being more positively valued by patients treated by private Physiotherapy. Conclusion: treatment time, fewer resources, accessibility, communication and patient management should be valued and taken into account in order to offer a higher quality of care in Physiotherapy. Lower satisfaction is related to lower perceived quality and worse clinical outcomes. [ABSTRACT FROM AUTHOR]

Gastric cancer (GC) is one of the most common types of cancer and is associated with relatively low survival rates. Despite its considerable burden, there is limited guidance for Canadian clinicians on the management of unresectable metastatic GC and gastroesophageal junction cancer (GEJC). Therefore, we aimed to discuss best practices and provide expert recommendations for patient management within the current Canadian unresectable GC and GEJC landscape. A multidisciplinary group of Canadian healthcare practitioners was assembled to develop expert recommendations via a working group. The often-rapid progression of unresectable GC and GEJC and the associated malnutrition have a significant impact on the patient's quality of life and ability to tolerate treatment. Hence, recommendations include early diagnosis, identification of relevant biomarkers to improve personalized treatment, and relevant support to manage comorbidities. A multidisciplinary approach including early access to registered dietitians, personal support networks, and palliative care services, is needed to optimize possible outcomes for patients. Where possible, patients with unresectable GC and GEJC would benefit from access to clinical trials and innovative treatments. [ABSTRACT FROM AUTHOR]

Intensive care units have been developed for the purposes of disposal of life threatened patients. The beginnings of intensive care were in surgical "shock" rooms which were used during the time allocated independent intensive care units led by anesthesiologist. The units can be open or closed. In the open units every patient has his doctor that comes when it suits him or to call. In the closed units doctors and nurses constantly work and is responsible for everything that happens in the unit. Working in intensive care is teamwork. Exactly one knows who is responsible for which part. The determination and provision of treatment and rest. Basic control in the ICU is very important to timely detect possible complications of treatment and other issues that can occur as an unfavorable course oftreatment. The nurse should be constantly visit patients, provide a complete care, and observe and notice the changes in patients. The remainder of this paper will show that the indications for the reception of patients, organization of work in the ICU, the demands of nursing care, the type of monitoring that are used, burnout in intensive care and special training of doctors and nurses. [ABSTRACT FROM AUTHOR]

Introduction: There are concerns with rising rates of antimicrobial resistance (AMR) across countries with appreciable impact on morbidity, mortality and costs. Amongst low- and middle-income countries, a key driver of AMR is the excessive use of antibiotics in ambulatory care, with a critical area being the appreciable selling of antibiotics without a prescription often driven by patient demand and limited knowledge. There is currently conflicting evidence in South Africa regarding this practice. Consequently, there is a need to explore these critical issues amongst patients, especially in more rural areas of South Africa. A pilot study was undertaken to address this. Methods: A two-step descriptive approach was undertaken. This involved two questionnaires amongst patients exiting chain and independent community pharmacies followed by cognitive interviews. Results: Overall, 21 patients were approached for an interview, including 11 for Part 1 of the questionnaire with 3 declining, and 10 for Part 2, with 2 declining. Subsequently 8 patients completed each part of the questionnaire.. On average, it took 2 min 13 s to complete both parts. 3 of the 5 patients being dispensed an antibiotic were dispensed one without a prescription, with all 3 patients exiting from independent pharmacies. Key reasons for self-purchasing included money and convenience. There was mixed knowledge regarding antibiotics and AMR amongst the 8 patients interviewed with Part 2. Overall, there was a satisfactory understanding of the Part 1 questions, although some modifications were suggested. Some participants had difficulty with fully understanding the questions in Part 2, with a number of suggestions made to improve this for the main study. Conclusion: There were concerns with the extent of purchasing antibiotics without a prescription in this pilot study as well as the knowledge of patients regarding antibiotics and AMR. Both areas need addressing and will be explored further in the main study. [ABSTRACT FROM AUTHOR]

Introduction: The Fundamental Critical Care Support Course (FCCS) is a standardized multidisciplinary program designed to educate participants on the basics of identification and management of patients with critical illness. Our objective was to evaluate the effect of FCCS participation on confidence in the assessment and management of critically ill patients and attitudes towards multidisciplinary education and interprofessional care in a multidisciplinary group of participants. Methods: Participants enrolled in the FCCS course from May 2018 to November 2019 were solicited to participate in a series of surveys evaluating their course experience and confidence in critical care. Attitudes towards multidisciplinary education and interprofessional care were evaluated using the Student Perceptions of Interprofessional Clinical Education-Revised Instrument version 2 (SPICE-R2) tool. A prospective pre- and post-design with a self-report survey including retrospective pre-training assessment and a 3-month follow-up was conducted. Statistical analysis was performed using descriptive statics and non-parametric methods. Results: 321 (97.9%) of the course participants enrolled in the study and completed the confidence survey and SPICE-R2 tool pre-course. Nurses (113, 35.4%) and physicians (110, 34.4%) made up the largest groups of participants, although physician assistants and paramedics were also well represented. Confidence in recognition and management of critical illness significantly improved across all studied domains after course completion, with the mean total confidence score improving from 32.96 pre-course to 41.10 post-course, P < 0.001. Attitudes towards multidisciplinary education and interprofessional care also improved (mean score 41.37 pre-course vs 42.71 post-course, P < 0.001), although pre-course numbers were higher than expected which limited the significance to only certain domains. Discussion: In a multidisciplinary group, completion of FCCS training led to increased confidence in all aspects of critical illness measured. A modest increase in attitudes regarding multidisciplinary education and interprofessional care was also demonstrated. Further study is needed to assess whether this increased confidence translates to improvements in patient care and outcomes. [ABSTRACT FROM AUTHOR]

Objective: Breast cancer clinical stage and nodal status are the most clinically significant drivers of patient management, in combination with other pathological biomarkers, such as estrogen receptor (ER), progesterone receptor or human epidermal growth factor receptor 2 (HER2) receptor status and tumor grade. Accurate prediction of such parameters can help avoid unnecessary intervention, including unnecessary surgery. The objective was to investigate the role of magnetic resonance imaging (MRI) radiomics for yielding virtual prognostic biomarkers (ER, HER2 expression, tumor grade, molecular subtype, and T-stage). Materials and Methods: Patients with primary invasive breast cancer who underwent dynamic contrast-enhanced (DCE) breast MRI between July 2013 and July 2016 in a single center were retrospectively reviewed. Age, N-stage, grade, ER and HER2 status, and Ki-67 (%) were recorded. DCE images were segmented and Haralick texture features were extracted. The Bootstrap Lasso feature selection method was used to select a small subset of optimal texture features. Classification of the performance of the final model was assessed with the area under the receiver operating characteristic curve (AUC). Results: Median age of patients (n = 209) was 49 (21-79) years. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the model for differentiating N0 vs N1-N3 was: 71%, 79%, 76%, 74%, 75% [AUC = 0.78 (95% confidence interval (CI) 0.72-0.85)], N0-N1 vs N2-N3 was 81%, 59%, 24%, 95%, 62% [AUC = 0.74 (95% CI 0.63-0.85)], distinguishing HER2(+) from HER2(-) was 79%, 48%, 34%, 87%, 56% [AUC = 0.64 (95% CI 0.54-0.73)], high nuclear grade (grade 2-3) vs low grade (grades 1) was 56%, 88%, 96%, 29%, 61% [AUC = 0.71 (95% CI 0.63-0.80)]; and for ER (+) vs ER(-) status the [AUC=0.67 (95% CI 0.59-0.76)]. Radiomics performance in distinguishing triple-negative vs other molecular subtypes was [0.60 (95% CI 0.49-0.71)], and Luminal A [0.66 (95% CI 0.56-0.76)]. Conclusion: Quantitative radiomics using MRI contrast texture shows promise in identifying aggressive high grade, node positive triple negative breast cancer, and correlated well with higher nuclear grades, higher T-stages, and N-positive stages. [ABSTRACT FROM AUTHOR]

Introduction: Clinical manifestations of cranial nerve palsies are of great importance, and surgeons should consider them before planning surgical protocol. Materials and Methods: This retrospective study was conducted on preoperative hospital records of 598 Iranian patients with different types of extraocular muscle palsy, including third (90 patients), fourth (501 patients), and fifth (7 patients) nerve palsy at Farabi Hospital, Tehran Province, Iran. Results: In terms of fourth nerve palsy, the mean spherical equivalent (SE) in the right and left eye was 0.23±1.51 and 0.19±1.45 diopter, respectively. Also, the mean angle of vertical deviation was 15.54±8.85 Δ at near and 15.66±8.93 Δ at far. In patients with third nerve palsy, the mean SE in the right and left eye was -0.02±2.08 and 0.08±1.95 diopter, respectively. Also, the mean angle of vertical deviation was 17.8±17.4 Δ at near and 17.8±17.5 Δ at far. In terms of six nerve palsy, the mean SE in the right and left eye was -1.27±3.37 and -1.08±2.52 diopter, respectively. Also, the mean angle of esotropia was 32.4±7.7 Δ at near and 33±6.7 Δ at far. The frequency of amblyopia in patients with third, fourth, and sixth nerve palsies was 21 patients (23.3%), 70(14%), and 4(57.1%), respectively. Conclusion: The clinical characteristics of patients with different types of EOM palsy are remarkably different, which can be attributed to the different properties of these kinds of deviations. [ABSTRACT FROM AUTHOR]