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Introduction: Since intimacy is a fundamental human need within social relationships, and recognizing that a fear of intimacy correlates with various negative consequences, it becomes crucial to examine the origins and factors that contribute to addressing this issue. This research aimed to investigate the mediating roles of mentalization and integrative self-knowledge in the link between childhood trauma and the fear of intimacy. Methods: Conducted as correlational descriptive research, our study incorporates a total sample of 303 adult women and men participants aged 20 to 50 in Tehran using the convenience sampling method. They completed the Fear of Intimacy Scale (FIS), the Childhood Trauma Questionnaire (CTQ), the Mentalization Scale (MentS), and the Integrative Self-Knowledge Scale (ISK). To analyze the research data at the descriptive level, frequency, percentage, standard deviation, and Pearson's correlation coefficient were used, while path analysis tested our hypotheses in SPSS version 26 and AMOS version 24. Fit indices were used to check the model's fit, and the mediation test was performed using the bootstrapping method. The fit indices revealed an excellent fit of the model with the data (2 = 1.51, 2/df = 1.51, p = 0.219; RMSEA = 0.05; SRMR = 0.02; CFI = 0.99; NFI = 0.99; TLI = 0.99). Results: Results indicate mentalization fully mediates the childhood trauma-fear of intimacy relationship (ß = 0.14, p < 0.01). However, the indirect relationship between childhood trauma and fear of intimacy through integrative self-knowledge was insignificant. The results also showed that the path coefficient from mentalization to fear of intimacy was negative and significant (ß = -0.41, p < 0.001), while the path coefficient from integrative self-knowledge to fear of intimacy was not significant (ß = -0.02, p > 0.05). Discussion: Based on the current findings indicating the complete mediation of mentalization and the insignificance of the mediation of integrative selfknowledge, we can deduce that enhancing the capacity for mentalization holds promise in effectively addressing intimacy-related issues. Overall, the study suggests mentalization effectively predicts the relationship between childhood trauma and fear of intimacy. This, in turn, may mitigate the detrimental effects of challenging childhood experiences on an individual's ability to engage in intimacy and cultivate emotional closeness. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVDs) remain a major global health challenge and a leading cause of mortality, highlighting the need for improved predictive models. We introduce an innovative agent-based dynamic simulation technique that enhances our AI models' capacity to predict CVD progression. This method simulates individual patient responses to various cardiovascular risk factors, improving prediction accuracy and detail. Also, by incorporating an ensemble learning model and interface of web application in the context of CVD prediction, we developed an AI dashboard-based model to enhance the accuracy of disease prediction and provide a user-friendly app. The performance of traditional algorithms was notable, with Ensemble learning and XGBoost achieving accuracies of 91% and 95%, respectively. A significant aspect of our research was the integration of these models into a streamlit-based interface, enhancing user accessibility and experience. The streamlit application achieved a predictive accuracy of 97%, demonstrating the efficacy of combining advanced AI techniques with user-centered web applications in medical prediction scenarios. This 97% confidence level was evaluated by Brier score and calibration curve. The design of the streamlit application facilitates seamless interaction between complex ML models and end-users, including clinicians and patients, supporting its use in real-time clinical settings. While the study offers new insights into AI-driven CVD prediction, we acknowledge limitations such as the dataset size. In our research, we have successfully validated our predictive proposed methodology against an external clinical setting, demonstrating its robustness and accuracy in a real-world fixture. The validation process confirmed the model's efficacy in the early detection of CVDs, reinforcing its potential for integration into clinical workflows to aid in proactive patient care and management. Future research directions include expanding the dataset, exploring additional algorithms, and conducting clinical trials to validate our findings. This research provides a valuable foundation for future studies, aiming to make significant strides against CVDs. [ABSTRACT FROM AUTHOR]

This article discusses the challenges posed by the Mpox outbreak in a clinical setting. The World Health Organization has declared Mpox a public health emergency due to its increased spread and higher fatality rate compared to previous outbreaks. The article highlights the various patterns of skin lesions associated with Mpox, including mucocutaneous involvement and the potential for unaesthetic scars. It also emphasizes the importance of dermoscopy for accurate diagnosis and long-term follow-up to manage the infection effectively. The article concludes by discussing the impact of Mpox on patients' quality of life, particularly in terms of residual scars. [Extracted from the article]

Background: Clinical accompaniment is an activity predominantly supervised by the clinical facilitator to develop the skills of the students. In South Africa, clinical accompaniment aims to develop the skills of the students to equip them in delivering efficient health services to the patients. Previous studies revealed that students experienced challenges and were negatively affected due to inadequate clinical accompaniment in the learning practice. Aim: The aim was to determine the challenges faced by University of KwaZulu-Natal (UKZN) undergraduate nursing students during their clinical accompaniment. Methods: An observational cross-sectional study design, with an analytic component was implemented. Questionnaires were used to collect data. Of the 400 registered nursing students, 245 were undergraduates; of these, 241 consented to participate in this study. Data captured into SPSS Statistics Package V28. ANOVA were used in comparing challenges amongst participants. A p-value less than 0.05 was considered significant. Results: A total of 241 participants responded to the questionnaires, which yielded a response rate of 98.4%. This study comprised first-year (32.4%), second-year (32.8%) and third-year (34.9%) students. There was no remarkable difference in terms of challenges amongst study participants (1st; 2nd; 3rd), p=0.592. Conclusion: This study revealed the challenges faced by undergraduate nursing students during their clinical accompaniment. Contribution: Study results might assist in developing effective guidelines to resolve the challenges encountered by students.

ABSTRACT Clostridium perfringens has emerged as a growing public health concern due to its ability to cause various infections and its increasing resistance to antibiotics. To assess its current epidemiology in clinical settings, we conducted a survey involving 426 healthy individuals and 273 ICU inpatients at a provincial hospital in China. Our findings revealed a high prevalence of C. perfringens in healthy individuals (45.77%, 95% CI: 41.0%–50.6%) and ICU patients (12.82%, 95% CI: 9.1%–17.4%). The identified 220 C. perfringens isolates displayed substantial resistance to erythromycin (57.9%), clindamycin (50.7%), and tetracycline (32.0%), primarily attributed to the presence of erm(Q) (54.4%), lnu(P) (13.8%), tetB(P) (83.6%), and tetA(P) (66.7%). Notably, C. perfringens isolates from this particular hospital demonstrated a high degree of sequence type diversity and phylogenic variation, suggesting that the potential risk of infection primarily arises from the bacteria’s gut colonization rather than clonal transmissions within the clinical environment. This study provides an updated analysis of the current epidemiology of C. perfringens in healthy individuals and ICU patients in China and emphasizes the need to optimize intervention strategies against its public health threat.IMPORTANCEClostridium perfringens is a bacterium of growing public health concern due to its ability to cause infections and its increasing resistance to antibiotics. Understanding its epidemiology in clinical settings is essential for intervention strategies. This study surveyed healthy individuals and ICU inpatients in a provincial hospital in China. It found a high prevalence of C. perfringens, indicating infection risk. The isolates also showed significant antibiotic resistance. Importantly, the study revealed diverse sequence types and phylogenetic variation, suggesting infection risk from intestinal colonization rather than clonal transmission in hospitals. This analysis emphasizes the need to optimize intervention strategies against this public health threat.

IntroductionSince intimacy is a fundamental human need within social relationships, and recognizing that a fear of intimacy correlates with various negative consequences, it becomes crucial to examine the origins and factors that contribute to addressing this issue. This research aimed to investigate the mediating roles of mentalization and integrative self-knowledge in the link between childhood trauma and the fear of intimacy.MethodsConducted as correlational descriptive research, our study incorporates a total sample of 303 adult women and men participants aged 20 to 50 in Tehran using the convenience sampling method. They completed the Fear of Intimacy Scale (FIS), the Childhood Trauma Questionnaire (CTQ), the Mentalization Scale (MentS), and the Integrative Self-Knowledge Scale (ISK). To analyze the research data at the descriptive level, frequency, percentage, standard deviation, and Pearson’s correlation coefficient were used, while path analysis tested our hypotheses in SPSS version 26 and AMOS version 24. Fit indices were used to check the model’s fit, and the mediation test was performed using the bootstrapping method. The fit indices revealed an excellent fit of the model with the data (χ2 = 1.51, χ2/df = 1.51, p = 0.219; RMSEA = 0.05; SRMR = 0.02; CFI = 0.99; NFI = 0.99; TLI = 0.99).ResultsResults indicate mentalization fully mediates the childhood trauma-fear of intimacy relationship (β = 0.14, p 0.05).DiscussionBased on the current findings indicating the complete mediation of mentalization and the insignificance of the mediation of integrative self-knowledge, we can deduce that enhancing the capacity for mentalization holds promise in effectively addressing intimacy-related issues. Overall, the study suggests mentalization effectively predicts the relationship between childhood trauma and fear of intimacy. This, in turn, may mitigate the detrimental effects of challenging childhood experiences on an individual’s ability to engage in intimacy and cultivate emotional closeness.

Since ancient times, date fruit has been used as a staple food because of its high nutritional value and caloric content. With the development of food science and the application of modern instrumentation, we now know that date seeds contain large amounts of dietary fiber, phenols, polyphenols, amino acids, fatty acids, and many vitamins and minerals. Due to the presence of these functional food ingredients, date seeds are used in various applications, including foods such as bread, hot beverages, cosmetics such as hair and skin products, and as feed for culturing aquatic animals. Date seeds have been used in clinical applications, making use of their antioxidant, anti-inflammatory, anti-cancer, anti-diabetic, and antimicrobial properties. There is now growing awareness of the value of date seeds, which were considered a waste product. In this review, we focused on explaining the major biochemical constituents of date seeds and developing these constituents for various applications. We also highlight the expected developments in date seed use for the future.

Abstract Aim The study aimed to explore and describe the barriers affecting Registered Nurses in undertaking clinical teaching in clinical settings. The exploration was based on the experiences of Registered Nurses at a selected teaching hospital in Namibia. The researcher intended to identify strategies that could be used to mitigate the negative effects of barriers to effective clinical teaching. Design A qualitative explorative, descriptive and contextual research design was used. Methods Purposive sampling was used to select 16 participants. Data were collected through in‐depth, semi‐structured interviews, which were audio‐recorded and transcribed verbatim. Data were analysed using thematic analysis. Results Clinical teaching is negatively affected by several barriers that hamper clinical teaching and nursing students' learning outcomes. Seven main themes were identified: (1) participants' understanding of clinical teaching; (2) organizational barriers; (3) patient barriers; (4) Registered Nurse barriers; (5) student barriers; (6) training institution barriers; and (7) strategies to mitigate barriers to clinical teaching. Conclusion The findings revealed that several barriers negatively affect clinical nursing education and hamper the clinical teaching and learning of nursing students. Patient or Public Contribution This study may assist in the development of targeted interventions that address the barriers that hinder clinical teaching at teaching hospitals. Additionally, this study could assist in improving the health care that is provided by nursing students to patients. The findings may assist with improved quality by reducing nursing students' theory‐practice gap and by promoting collaboration between Registered Nurses and nurse educators in clinical settings.

Background: Therapist-guided exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD) is frequently conducted within clinical settings but rarely at places where patients are usually confronted with OCD symptom-provoking situations in daily life (eg, at home). Objective: This study aimed to investigate patients' views on 1 ERP session at home via videoconference and its impact on treatment outcome. Methods: A total of 64 inpatients with OCD received 1 session of therapist-guided videoconference-based ERP at home in adjunction to a multimodal inpatient treatment between 2015 and 2020. Results: Compared with 64 age- and sex-matched controls who received a multimodal inpatient treatment without 1 session of videoconference-based ERP at home, patients who received 1 session of videoconference-based ERP in adjunction to a multimodal inpatient treatment showed stronger reductions in OCD symptom severity from admission to discharge. Before the videoconference-based ERP session, patients reported high rationale credibility and treatment expectancy. After the videoconference-based ERP session, patients reported medium-to-high positive mood as well as depth and smoothness of the session, and they perceived the working alliance as high. Conclusions: Results highlight the importance of administering therapist-guided ERP sessions in patients' natural environment to enhance treatment response in OCD. Videoconference-based ERP as add-on to treatment as usual is, therefore, a promising approach to facilitate the application of ERP in patients' natural environment and foster the generalization of ERP conducted in clinical settings. [ABSTRACT FROM AUTHOR]

Since ancient times, date fruit has been used as a staple food because of its high nutritional value and caloric content. With the development of food science and the application of modern instrumentation, we now know that date seeds contain large amounts of dietary fiber, phenols, polyphenols, amino acids, fatty acids, and many vitamins and minerals. Due to the presence of these functional food ingredients, date seeds are used in various applications, including foods such as bread, hot beverages, cosmetics such as hair and skin products, and as feed for culturing aquatic animals. Date seeds have been used in clinical applications, making use of their antioxidant, anti-inflammatory, anti-cancer, anti-diabetic, and antimicrobial properties. There is now growing awareness of the value of date seeds, which were considered a waste product. In this review, we focused on explaining the major biochemical constituents of date seeds and developing these constituents for various applications. We also highlight the expected developments in date seed use for the future. [ABSTRACT FROM AUTHOR]

Self-regulated learning (SRL) can enhance students' learning process. Students need support to effectively regulate their learning. However, the effect of learning climate on SRL behavior, its ultimate effect on learning and the underlying mechanisms have not yet been established. We explored these relationships using self-determination theory. Nursing students (N = 244) filled in questionnaires about SRL behavior, perceived learning, perceived pedagogical atmosphere and Basic Psychological Needs (BPN) satisfaction after their clinical placement. Structural equation modelling was used to test a model in which perceived pedagogical atmosphere affects SRL behavior and subsequent perceived learning through BPN satisfaction. The tested model had an adequate fit (RMSEA = 0.080, SRMR = 0.051; CFI = 0.972; TLI = 0.950). A positively perceived pedagogical atmosphere contributed to SRL behavior, which was fully explained by BPN satisfaction. SRL partially mediated the contribution of pedagogical atmosphere/BPN to perceived learning. A learning climate that satisfies students' BPN contributes to their SRL behavior. SRL behavior plays a positive but modest role in the relationship between climate and perceived learning. Without a culture that is supportive of learning, implementation of tools to apply SRL behavior may not be effective. Study limitations include reliance on self-report scales and the inclusion of a single discipline. [ABSTRACT FROM AUTHOR]

Background: China is one of the countries that set the goal to eliminate mother-to-child transmission (EMTCT) of syphilis by a target date. Active screening for syphilis among pregnant women, followed by effective treatment of maternal syphilis, is critical for achieving the goal. The China health authority issued national implementation protocols to guide EMTCT practice in health facilities. Methods: Within a cohort of infants born to mothers infected with syphilis, we obtained the data of regimens used for treatment of maternal syphilis from the National Information System of Prevention of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B, and analysed the physician's treatment behaviour and its associated factors in a public hospital in Suzhou of China. Results: A total of 450 pregnant women who were positive for treponemal or non-treponemal antibody, or had previous infection with syphilis were included into the study for analysis. Of them, 260 (57.8%) were positive for both treponemal and non-treponemal antibodies (syphilis seropositivity), and 353 (78.4%) were treated for syphilis according to the protocol in which 123 (34.8%) were treated with two courses. Non-adherence to treatment recommended by the protocol for maternal syphilis was significantly associated with antenatal visits in the third trimester (AOR 6.65, 95% CI 2.20–20.07, P = 0.001), being positive only for a treponemal test (AOR 5.34, 95% CI 3.07–9.29, P < 0.001) or having a syphilis infection before the pregnancy (AOR 2.05, 95% CI 1.14–3.69, P = 0.017), whereas the uptake of treatment for two treatment courses was associated with attending antenatal care in 2020 or before (AOR 3.49, 95% CI 1.89–6.42, P < 0.001), being positive for treponemal and non-treponemal tests (AOR 5.28, 95% CI 2.78–10.06, P < 0.001) or having non-treponemal antibody titre of ≥1:8 (AOR 3.71, 95% CI 1.77–7.78, P = 0.001). Conclusions: Implementation of the current recommendation to offer a universal treatment for syphilis among all pregnant women who are shown to be positive for a treponemal test alone is challenging in some clinical settings in China. To meet the WHO goals for elimination of congenital syphilis by 2015, the Government of China incorporated a nationwide prevention of mother-to-child transmission program for HIV, syphilis and hepatitis B into the existing maternal and child healthcare system followed by issuing the Protocol for Prevention of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B in 2011, which was updated in 2015 and 2020. This study reported the adherence to the treatment recommendation for maternal syphilis in Suzhou, China. The findings have important implications for updating our knowledge on treatment of maternal syphilis for prevention of mother-to-child transmission of syphilis. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore and describe the barriers affecting Registered Nurses in undertaking clinical teaching in clinical settings. The exploration was based on the experiences of Registered Nurses at a selected teaching hospital in Namibia. The researcher intended to identify strategies that could be used to mitigate the negative effects of barriers to effective clinical teaching. Design: A qualitative explorative, descriptive and contextual research design was used. Methods: Purposive sampling was used to select 16 participants. Data were collected through in‐depth, semi‐structured interviews, which were audio‐recorded and transcribed verbatim. Data were analysed using thematic analysis. Results: Clinical teaching is negatively affected by several barriers that hamper clinical teaching and nursing students' learning outcomes. Seven main themes were identified: (1) participants' understanding of clinical teaching; (2) organizational barriers; (3) patient barriers; (4) Registered Nurse barriers; (5) student barriers; (6) training institution barriers; and (7) strategies to mitigate barriers to clinical teaching. Conclusion: The findings revealed that several barriers negatively affect clinical nursing education and hamper the clinical teaching and learning of nursing students. Patient or Public Contribution: This study may assist in the development of targeted interventions that address the barriers that hinder clinical teaching at teaching hospitals. Additionally, this study could assist in improving the health care that is provided by nursing students to patients. The findings may assist with improved quality by reducing nursing students' theory‐practice gap and by promoting collaboration between Registered Nurses and nurse educators in clinical settings. [ABSTRACT FROM AUTHOR]

Cancer treatment is one of the fundamental challenges in clinical setting, especially in relapsed/refractory malignancies. The novel immunotherapy-based treatments bring new hope in cancer therapy and achieve various treatment successes. One of the distinguished ways of cancer immunotherapy is adoptive cell therapy, which utilizes genetically modified immune cells against cancer cells. Between different methods in ACT, the chimeric antigen receptor T cells have more investigation and introduced a promising way to treat cancer patients. This technology progressed until it introduced six US Food and Drug Administration-approved CAR T cell-based drugs. These drugs act against hematological malignancies appropriately and achieve exciting results, so they have been utilized widely in cell therapy clinics. In this review, we introduce all CAR T cells-approved drugs based on their last data and investigate them from all aspects of pharmacology, side effects, and compressional. Also, the efficacy of drugs, pre- and post-treatment steps, and expected side effects are introduced, and the challenges and new solutions in CAR T cell therapy are in the last speech.

Abstract We investigated parental attachment and prosocial behavior as social protective indicators in adolescents (age 11–17) with symptoms of depression in a clinical setting. Specifically, we tested the moderating effect of these factors on the relation between symptoms of depression and their impairment on daily life. The Development and Well-Being Assessment, as completed by children, mothers, and fathers, was used, and hierarchical multiple regression analyses were conducted for these three perspectives. From the adolescents’ reports, we only found a significant effect of symptoms on impairment, indicating that a higher number of symptoms were related to higher impairment. For the mothers and fathers, a higher score on the adolescents’ prosocial behavior was related to a lower impairment from depression symptoms on the daily life of the adolescent and the family. Only for the mothers did a higher score on prosocial behavior buffer the effect of symptoms on impairment, while a higher parental attachment score was associated with a lower impairment. Further, when examining maternal and paternal attachment separately, only the mothers reported less impairment when perceiving that the adolescent was attached to the father. Paternal attachment even buffered the effect of symptoms on impairment. To conclude, our results indicate that social protective factors, from the parent’s perspective, are likely to have a beneficial effect in clinical practice and should be taken into account when examining impairment scores. Future studies should investigate whether additional protective indicators from the adolescents’ perspective, such as quality of parental attachment or family climate, may have a positive impact on their daily functioning.

Introduction: Reflection is considered an essential element in nurses’ practice with different positive outcomes, we decided to determine the level of nurses’ reflection and then assess the relationship between nurses’ reflection with their self-efficacy and work engagement. Methods: In this cross-sectional study, a total of 240 nurses were selected from seven educational hospitals affiliated with Tabriz University of medical sciences (Iran). The stratified random sampling method was used to select the participants from hospitals. Data were collected through three questionnaires including Groningen Reflection Ability Scale (GRAS), Sherer’s General Self-Efficacy Scale (SGSES), and Utrecht Work Engagement Scale (UWES). Data were analyzed using SPSS version 13. Results: According to the results, the mean (SD) score of nurses’ reflection was calculated as 86.51 (8.17) out of 115. The mean (SD) score of nurses’ self-efficacy was 60.89 (11.11) out of 85. Moreover, the mean (SD) total score of nurses’ work engagement in a possible range of 0 to 6 was 3.39 (1.36). There was a positive and significant relationship between the total reflection score with work engagement and self-efficacy scores. Conclusion: According to the results, nurses working in different units showed different scores of reflection. Moreover, the results of the present study showed that nurses’ reflection is associated with nurses’ work engagement and self-efficacy. Therefore, nurse managers and nurse educators should improve nurses’ skills in reflection and they should support the reflective practice in clinical settings.

Cardiovascular diseases (CVDs) remain a major global health challenge and a leading cause of mortality, highlighting the need for improved predictive models. We introduce an innovative agent-based dynamic simulation technique that enhances our AI models’ capacity to predict CVD progression. This method simulates individual patient responses to various cardiovascular risk factors, improving prediction accuracy and detail. Also, by incorporating an ensemble learning model and interface of web application in the context of CVD prediction, we developed an AI dashboard-based model to enhance the accuracy of disease prediction and provide a user-friendly app. The performance of traditional algorithms was notable, with Ensemble learning and XGBoost achieving accuracies of 91% and 95%, respectively. A significant aspect of our research was the integration of these models into a streamlit-based interface, enhancing user accessibility and experience. The streamlit application achieved a predictive accuracy of 97%, demonstrating the efficacy of combining advanced AI techniques with user-centered web applications in medical prediction scenarios. This 97% confidence level was evaluated by Brier score and calibration curve. The design of the streamlit application facilitates seamless interaction between complex ML models and end-users, including clinicians and patients, supporting its use in real-time clinical settings. While the study offers new insights into AI-driven CVD prediction, we acknowledge limitations such as the dataset size. In our research, we have successfully validated our predictive proposed methodology against an external clinical setting, demonstrating its robustness and accuracy in a real-world fixture. The validation process confirmed the model’s efficacy in the early detection of CVDs, reinforcing its potential for integration into clinical workflows to aid in proactive patient care and management. Future research directions include expanding the dataset, exploring additional algorithms, and conducting clinical trials to validate our findings. This research provides a valuable foundation for future studies, aiming to make significant strides against CVDs.

Abstract Background Spinal manipulative therapy (SMT) is commonly used to treat musculoskeletal conditions, including thoracic spine pain. Applying patient-specific force-time characteristics are believed to be important to improve SMT’s effectiveness. Investigating SMT as part of a multimodal approach is fundamental to account for the complexity of chiropractic clinical practice. Therefore, pragmatic investigations balancing minimal disruptions to the clinical encounter at the same time as ensuring a robust data quality with rigorous protocols are needed. Consequently, preliminary studies are required to assess the study protocol, quality of data recorded and the sustainability of such investigation. Therefore, this study examined the feasibility of investigating SMT force-time characteristics and clinical outcome measures in a clinical setting. Methods In this mixed-methods study, providers recorded thoracic SMT force-time characteristics delivered to patients with thoracic spinal pain during regular clinical encounters. Self-reported clinical outcomes of pain, stiffness, comfort during the SMT (using an electronic visual analogue scale), and global rating of change scale were measured before and after each SMT application. Feasibility was quantitatively assessed for participant recruitment, data collection and data quality. Qualitative data assessed participants’ perceptions on the impact of data collection on patient management and clinical flow. Results Twelve providers (58% female, 27.3 ± 5.0 years old) and twelve patients (58% female, 37.2 ± 14.0 years old) participated in the study. Enrolment rate was greater than 40%, data collection rate was 49% and erroneous data was less than 5%. Participant acceptance was good with both providers and patients reporting positive experience with the study. Conclusions Recording SMT force-time characteristics and self-reported clinical outcome measures during a clinical encounter may be feasible with specific modification to the current protocol. The study protocol did not negatively impact patient management. Specific strategies to optimize the data collection protocol for the development of a large clinical database are being developed.

Background & Aim: The optometrist is often one of the professionals patients consult when they have headaches. The limitations inherent in previous studies on the topic limit the utilization of their findings. Therefore, the aim of conducting the present study was to explore correlations between headache and refractive errors in a clinical setting using extended classification criteria. Methods: The study design was cross-sectional, and sample comprised (headache group = 1062; non-headache group = 1095) participants aged 10–40 years who attended an optometry practice. During case-history taking, participants were classified as headache and non-headache group. Refraction, ocular health examinations, accommodative and vergence tests were performed. Headaches were sub-classified according to the anatomic location such as temporal, frontal, occipital, or diffuse, based on where pain was felt. Results: Temporal and temporo-frontal headaches were most frequent. Participants in the headache group numbered 1062 with mean age 25.1 ± 8.6; females 841 (79.1%) and males 221 (20.8%) while those in the no headache group numbered 1095 with mean age 25.3 ± 8.7; females 648 (59.1%). Low amount spheres and cylinders (p = 0.003) as well as hyperopic, and against-the-rule astigmatism (p = 0.012) and (p = 0.03) respectively were significantly more frequent in the headache group. Conclusion: Temporal headaches were most frequent. Patients with low spheres and cylindrical errors as well as hyperopic and against-the-rule astigmatism were significantly more prone to headaches. This study provides findings, which have not been reported. Findings have implications for clinical practice and highlights the need to compensate for low ametropia. A standard study protocol is recommended.

Background: The Coronavirus 2019 (COVID-19) outbreak rose rapidly and had a strenuous impact on the healthcare systems. As the health system responded to the pandemic, there was a change in the care rendered. Additionally, as more people became infected with the virus, the number of nurses reduced resulting in prolonged working hours and increased burden of care for the remaining few nurses. This study aimed to gain an in-depth understanding of the lived experiences of nurses working in the clinical setting during the COVID-19 pandemic in Ekurhuleni, Gauteng Province. Methods: The study followed a descriptive phenomenological approach. In-depth interviews were conducted face-to-face and telephonically with thirteen professional nurses who were purposively sampled as they had nursed COVID-19 positive patients in a hospital in Ekurhuleni District, Gauteng Province, South Africa. The audio-recorded interviews were transcribed and inductively analysed using descriptive phenomenological analysis with the aid of the ATLASti Version 9 program. Findings: Four themes emerged: (1) Nurse’s social life during COVID-19 pandemic. (2) Challenges in the clinical setting during COVID-19 pandemic. (3) COVID-19 pandemic impact on patient care. (4) Nurse’s future recommendations for pandemic management. Conclusion: The results of this study indicated that professional nurses who nursed COVID-19 patients suffered psychological distress and physical burnout. Having insufficient resources, which included Personal Protective Equipment (PPE) and other equipment exposed the nurses to the possibility of contracting COVID-19. Lack of managerial support worsened poor patient care. Therefore, further studies are needed to improve the procurement of resources and disaster preparedness. Therefore, it is recommended that managerial support which includes offering of professional counselling be done routinely, regular in-service training, and nurses should be involved in decisions affecting patient care. Implications for nursing management: Managerial support to offer professional routine counselling for improvement of mental wellbeing of the nurses and acknowledge nurses’ input.

We investigated parental attachment and prosocial behavior as social protective indicators in adolescents (age 11–17) with symptoms of depression in a clinical setting. Specifically, we tested the moderating effect of these factors on the relation between symptoms of depression and their impairment on daily life. The Development and Well-Being Assessment, as completed by children, mothers, and fathers, was used, and hierarchical multiple regression analyses were conducted for these three perspectives. From the adolescents' reports we only found a significant effect of symptoms on impairment indicating that a higher number of symptoms were related to higher impairment. For the mothers and fathers, a higher score on the adolescents' prosocial behavior was related to a lower impairment from depression symptoms on the daily life of the adolescent and the family. Only for the mothers did a higher score on prosocial behavior buffered the effect of symptoms on impairment, while a higher parental attachment score was associated with a lower impairment. Further, when examining maternal and paternal attachment separately, we found that, only the mothers, reported less impairment from the symptoms when they perceived that the adolescent was attached to the father, and paternal attachment even buffered the effect of symptoms on impairment. To conclude, our results indicate that social protective factors, from the parent's perspective, are likely to have a beneficial effect in clinical practice and should be taken into account when examining impairment scores. Future studies should investigate whether additional protective indicators from the adolescents' perspective, such as quality of parental attachment or family climate, may have a positive impact on their daily functioning. [ABSTRACT FROM AUTHOR]

Introduction: Reflection is considered an essential element in nurses’ practice with different positive outcomes, we decided to determine the level of nurses’ reflection and then assess the relationship between nurses’ reflection with their self-efficacy and work engagement. Methods: In this cross-sectional study, a total of 240 nurses were selected from seven educational hospitals affiliated with Tabriz University of medical sciences (Iran). The stratified random sampling method was used to select the participants from hospitals. Data were collected through three questionnaires including Groningen Reflection Ability Scale (GRAS), Sherer’s General Self-Efficacy Scale (SGSES), and Utrecht Work Engagement Scale (UWES). Data were analyzed using SPSS version 13. Results: According to the results, the mean (SD) score of nurses’ reflection was calculated as 86.51 (8.17) out of 115. The mean (SD) score of nurses’ self-efficacy was 60.89 (11.11) out of 85. Moreover, the mean (SD) total score of nurses’ work engagement in a possible range of 0 to 6 was 3.39 (1.36). There was a positive and significant relationship between the total reflection score with work engagement and self-efficacy scores. Conclusion: According to the results, nurses working in different units showed different scores of reflection. Moreover, the results of the present study showed that nurses’ reflection is associated with nurses’ work engagement and self-efficacy. Therefore, nurse managers and nurse educators should improve nurses’ skills in reflection and they should support the reflective practice in clinical settings. [ABSTRACT FROM AUTHOR]

This research paper provides a systematic review of the neuropsychology of generalized anxiety disorder (GAD), examining relevant articles' methodologies and subject matter and highlighting key findings. It suggests potential cognitive deficits in GAD patients, such as subtle attention, executive function, and working memory deficiencies. It also discusses neural correlates of GAD, particularly the hyperactivity in the amygdala and insula, and the additional impact of comorbidity with other psychiatric disorders. The paper uses the PRISMA methodology and draws data from the PsycINFO, Scopus, PubMed, and Elsevier databases. Although the reviewed research has contributed to understanding GAD's cognitive and neural mechanisms, further research is required. Additionally, the paper mentions the clinical neuropsychology of GAD, including strategies and treatments, such as cognitive behavioral therapy (CBT), mindfulness, and medication. Lastly, the review identifies the limitations of the existing research and recommends future directions to enhance the understanding of GAD's underlying cognitive and neural mechanisms. The neural underpinnings of GAD encompass heightened activity within the amygdala and insula, which are brain regions implicated in processing adverse emotional reactions. Co-occurring psychiatric disorders, such as major depressive disorder (MDD), can also impact neuropsychological functioning. Additional investigation is warranted to better understand the intricate interplay between GAD, cognitive performance, and underlying neural processes. [ABSTRACT FROM AUTHOR]

Abstract Aim The aim of the study was to examine (1) the perceptions on core competencies of healthcare professionals working at clinical settings in Oman and (2) which demographic characteristics explain the overall core competency. Design A cross‐sectional design. Methods Healthcare Professional Core Competency Instrument, consisting of 11 sub‐scales with 81 items, was distributed to healthcare professionals (n = 1,543; 826 nurses and 717 physicians) who worked at primary, secondary and tertiary healthcare institutions. Descriptive statistics, t‐test, ANOVA and linear regression were used for data analysis. Results Altogether 1,078 healthcare professionals (628 nurses and 450 physicians) responded representing 70% overall response rate. Healthcare professionals perceived their overall core competence as excellent, safety being the highest, and research and evidence‐based practice was the lowest. The multiple linear regression analysis revealed that ethnicity, gender and years of working experience were the characters that explained the overall core competence, where expatriate senior professionals reported higher competency levels compared with counterparts.

An editorial is presented the importance of dedicated supportive research infrastructure in hospital settings to enhance clinical nursing research and evidence-based practice. Topics discussed include the role of interdisciplinary research infrastructure, the engagement of clinical professionals in the research process, and the benefits of a hospital-organized structure in overcoming barriers to conducting clinical research.

In gender transition, psychological and diagnostic assessment is essential for accessing medical treatment and gaining legal recognition. This puts the psychologist in the role of gatekeeper and places the diagnosis at the center of the clinical relationship, despite recent guidelines' depathologizing orientation. This study investigates how trans people approach and prepare for psychological interviews, what they report and what they tend to conceal to optimize the chances of being diagnosed as Gender Dysphoric. Thematic analysis of transcripts of two focus groups involving 13 people brought to light several narrative strategies aimed at assuring the saturation of the clinical criteria needed for the release of the diagnosis, among them the (more or less intentionally) forced adherence to gender binarism in the definition of Self and attempts to hide or affirm aspects of themselves in the clinical encounter. The perception of vexatiousness and imbalance of power in the relationship also emerged as a prominent theme. Between the many implications, the most important relates to the risk that the psychological pathway can be exploited to obtain the diagnosis and, once set up like this, it may lose other functions and meanings. The study can contribute to directing professional practice towards trans people's actual needs to promote health and gender affirmation. [ABSTRACT FROM AUTHOR]

Background: Spinal manipulative therapy (SMT) is commonly used to treat musculoskeletal conditions, including thoracic spine pain. Applying patient-specific force-time characteristics are believed to be important to improve SMT's effectiveness. Investigating SMT as part of a multimodal approach is fundamental to account for the complexity of chiropractic clinical practice. Therefore, pragmatic investigations balancing minimal disruptions to the clinical encounter at the same time as ensuring a robust data quality with rigorous protocols are needed. Consequently, preliminary studies are required to assess the study protocol, quality of data recorded and the sustainability of such investigation. Therefore, this study examined the feasibility of investigating SMT force-time characteristics and clinical outcome measures in a clinical setting. Methods: In this mixed-methods study, providers recorded thoracic SMT force-time characteristics delivered to patients with thoracic spinal pain during regular clinical encounters. Self-reported clinical outcomes of pain, stiffness, comfort during the SMT (using an electronic visual analogue scale), and global rating of change scale were measured before and after each SMT application. Feasibility was quantitatively assessed for participant recruitment, data collection and data quality. Qualitative data assessed participants' perceptions on the impact of data collection on patient management and clinical flow. Results: Twelve providers (58% female, 27.3 ± 5.0 years old) and twelve patients (58% female, 37.2 ± 14.0 years old) participated in the study. Enrolment rate was greater than 40%, data collection rate was 49% and erroneous data was less than 5%. Participant acceptance was good with both providers and patients reporting positive experience with the study. Conclusions: Recording SMT force-time characteristics and self-reported clinical outcome measures during a clinical encounter may be feasible with specific modification to the current protocol. The study protocol did not negatively impact patient management. Specific strategies to optimize the data collection protocol for the development of a large clinical database are being developed. [ABSTRACT FROM AUTHOR]

Campylobacter spp. are considered the most frequent cause of acute gastroenteritis worldwide. However, outside high-income countries, its burden is poorly understood. Limited published data suggest that Campylobacter prevalence in low- and middle-income countries is high, but their reservoirs and age distribution are different. Culturing Campylobacter is expensive due to laboratory equipment and supplies needed to grow the bacterium (e.g., selective culture media, microaerophilic atmosphere, and a 42°C incubator). These requirements limit the diagnostic capacity of clinical laboratories in many resource-poor regions, leading to significant underdiagnosis and underreporting of isolation of the pathogen. CAMPYAIR, a newly developed selective differential medium, permits Campylobacter isolation without the need for microaerophilic incubation. The medium is supplemented with antibiotics to allow Campylobacter isolation in complex matrices such as human feces. The present study aims to evaluate the ability of the medium to recover Campylobacter from routine clinical samples. A total of 191 human stool samples were used to compare the ability of CAMPYAIR (aerobic incubation) and a commercial Campylobacter medium (CASA, microaerophilic incubation) to recover Campylobacter. All Campylobacter isolates were then identified by MALDI-TOF MS. CAMPYAIR showed sensitivity and specificity values of 87.5% (95% CI 47.4%-99.7%) and 100% (95% CI 98%--100%), respectively. The positive predictive value of CAMPYAIR was 100% and its negative predictive value was 99.5% (95% CI 96.7%-99.9%); Kappa Cohen coefficient was 0.93 (95% CI 0.79-1.0). The high diagnostic performance and low technical requirements of the CAMPYAIR medium could permit Campylobacter culture in countries with limited resources. [ABSTRACT FROM AUTHOR]

Frontline laboratories are adopting culture-independent diagnostic testing (CIDT) such as nucleic acid amplification tests (NAATs) due to numerous advantages over culture-based testing methods. Paradoxically, the viability of pathogens, a crucial factor determining active infections, cannot be confirmed with current NAATs alone. A recent development of viability PCR (vPCR) was introduced to mitigate this limitation associated with real-time PCR (qPCR) by using a DNA-intercalating dye to remove residual and dead cell DNA. This study assessed the applicability of the vPCR assay on diarrheal stools. Eighty-five diarrheal stools confirmed for Salmonellosis were tested via qPCR and vPCR using in-house primers and probe targeting the invA gene. vPCR-negative stools (Ct cut off > 31) were enriched in mannitol selenite broth (MSB) to verify low bacterial loads. vPCR assay showed ~89% sensitivity (qPCR- and vPCR-positive stools: 76/85). vPCR-negative stools (9/85; qPCR-positive: 5; qPCR-negative: 4) were qPCR- and culture-positive post-MSB-enrichment and confirmed the presence of low viable bacterial loads. Random sampling error, low bacterial loads, and receiving stools in batches could contribute to false negatives. This is a pilot study and further investigations are warranted to explore vPCR to assess pathogen viability in a clinical setting, especially when culture-based testing is unavailable. [ABSTRACT FROM AUTHOR]

Abstract Aim This study aims at exploring Saudi newly graduated nurses' perspectives on the facilitators and barriers for successful transition from being a student to being a nurse. Design A phenomenological qualitative methodology was employed. Methods Focus group discussions were carried out among 35 Saudi nurses at one major university hospital in Saudi Arabia. Results Under the theme of barriers to transition three main subthemes emerged, namely “Fear of making medical errors,” “Intense Workload and Expectations,” “Bullying and lack of support,” while under the facilitators of transition the subthemes which emerged were “Supportive preceptor,” “Training workshops,” “Need for transition programs.” This research found that formal and informal techniques for strengthening institutional variables and improving individual factors are critical for new graduate nurses' effective transition into professional responsibilities.

Aim: The aim of the study was to examine (1) the perceptions on core competencies of healthcare professionals working at clinical settings in Oman and (2) which demographic characteristics explain the overall core competency. Design: A cross‐sectional design. Methods: Healthcare Professional Core Competency Instrument, consisting of 11 sub‐scales with 81 items, was distributed to healthcare professionals (n = 1,543; 826 nurses and 717 physicians) who worked at primary, secondary and tertiary healthcare institutions. Descriptive statistics, t‐test, ANOVA and linear regression were used for data analysis. Results: Altogether 1,078 healthcare professionals (628 nurses and 450 physicians) responded representing 70% overall response rate. Healthcare professionals perceived their overall core competence as excellent, safety being the highest, and research and evidence‐based practice was the lowest. The multiple linear regression analysis revealed that ethnicity, gender and years of working experience were the characters that explained the overall core competence, where expatriate senior professionals reported higher competency levels compared with counterparts. [ABSTRACT FROM AUTHOR]

Campylobacter spp. are considered the most frequent cause of acute gastroenteritis worldwide. However, outside high-income countries, its burden is poorly understood. Limited published data suggest that Campylobacter prevalence in low- and middle-income countries is high, but their reservoirs and age distribution are different. Culturing Campylobacter is expensive due to laboratory equipment and supplies needed to grow the bacterium (e.g., selective culture media, microaerophilic atmosphere, and a 42°C incubator). These requirements limit the diagnostic capacity of clinical laboratories in many resource-poor regions, leading to significant underdiagnosis and underreporting of isolation of the pathogen. CAMPYAIR, a newly developed selective differential medium, permits Campylobacter isolation without the need for microaerophilic incubation. The medium is supplemented with antibiotics to allow Campylobacter isolation in complex matrices such as human feces. The present study aims to evaluate the ability of the medium to recover Campylobacter from routine clinical samples. A total of 191 human stool samples were used to compare the ability of CAMPYAIR (aerobic incubation) and a commercial Campylobacter medium (CASA, microaerophilic incubation) to recover Campylobacter. All Campylobacter isolates were then identified by MALDI-TOF MS. CAMPYAIR showed sensitivity and specificity values of 87.5% (95% CI 47.4%–99.7%) and 100% (95% CI 98%–100%), respectively. The positive predictive value of CAMPYAIR was 100% and its negative predictive value was 99.5% (95% CI 96.7%–99.9%); Kappa Cohen coefficient was 0.93 (95% CI 0.79–1.0). The high diagnostic performance and low technical requirements of the CAMPYAIR medium could permit Campylobacter culture in countries with limited resources.

Background: Reflection increases meta-cognitive capacities, promotes student-instructor relationships, overcomes the theory-practice gap, and enriches learning. This study aims at exploring nursing students’ perspectives on the facilitators of reflective practices in the clinical setting. Methods: Semi-structured interviews were conducted among 21 Saudi nursing students at one major university in Saudi Arabia. Results: Two major themes were prevalent upon thematic analysis, namely, “Personal Drivers of Reflection” which consisted of “Motivation to Learn”, “Desire to develop”, “Ethical Regard”, and “Responsibility towards patients” and “External Drivers of Reflection” which consisted of “Patient characteristics”, “Case complexity”, and “Competent Instructors”. Conclusion: As per the results of the study, nursing students perceived that they underwent reflection as a response to personal motivational and external educational aspects. According to the findings, instructors should assist students through clinical reflection, with a special focus on their interactions and motivation.

Background: Those who suffer from eating disorders often experience serious impairment in quality of life and the majority never receive treatment. Treatment availability may be increased by implementing methods that demand less resources and are more easy accessible such as internet-based treatments, but knowledge about their effects is still insufficient. The study evaluated effects of two types of internet-based cognitive behavioral therapy and a structured day patient program, the latter being a standard treatment at an eating disorder clinic at the time for the study. Methods: 150 participants with bulimic eating disorders randomized to two types of internet based treatments (one pure online treatment and one based on a self-help guide in book-format) or an intensive 16-week day patient program. The number of participants that started treatment was 120 of which 98 in internet treatment and 22 in the day program. Outcome assessments were carried out at baseline, post treatment, and at one-year follow-up. Results: All treatments were associated with significantly improved eating disorder pathology, self-image, and clinical impairment. Although the day program generally showed larger effects, only one significant difference found was in diagnostic remission post treatment; 51 % of the participant was in remission in internet treatment and 88 % in the day program. At one-year follow-up, participants in the internet treatments had continued to improve, whereas in the day patient program the effect sustained. Internet treatment had a 36 % drop out rate, there were no dropouts found in the day program. Conclusions: All treatments were comparable in effect at follow-up, suggesting that internet treatment is a conceivable alternative to standard treatment. Internet treatment in a book-based format was also equally effective as a pure online format. Internet delivered cognitive behavioral treatment forms can make important contributions to achieve increased access to treatment for patients with bulimic eating disorders. Future research and clinical implications for internet delivered treatments in eating disorder services are discussed. Clinical trial registration: ISRCTN registry https://www.isrctn.com/ISRCTN44999017. The study was registered retrospectively.

Purpose: This study aimed to asses the prevalence and consequences of bullying, and explored these issues experienced by nursing students. Patients and methods: This study used a descriptive survey. A convenience sample of 248 undergraduate nursing student from level 4 to 8 from a selected university in Riyadh, Saudi Arabia. An adapted online questionnaire the Student Experience of Bullying during Clinical Placement (SEBDCP) was used. Results: There are 51% of the respondents who experienced bullying either in the academic or clinical setting. The top sources of the bullying were the friends of the nursing students (60%). Majority of the students, which are (54%) had their academic achievement affected negatively and (49%) considered leaving nursing. Conclusion: Nursing students actually experience bullying both in the academic and clinical settings by their peers and other health care professionals. Bullying is a phenomenon among nursing students that is not appropriately addressed and prioritized by authorities in both academic and clinical settings. Students remain silent and vulnerable to bullying. [ABSTRACT FROM AUTHOR]

Aim: This study aims at exploring Saudi newly graduated nurses' perspectives on the facilitators and barriers for successful transition from being a student to being a nurse. Design: A phenomenological qualitative methodology was employed. Methods: Focus group discussions were carried out among 35 Saudi nurses at one major university hospital in Saudi Arabia. Results: Under the theme of barriers to transition three main subthemes emerged, namely "Fear of making medical errors," "Intense Workload and Expectations," "Bullying and lack of support," while under the facilitators of transition the subthemes which emerged were "Supportive preceptor," "Training workshops," "Need for transition programs." This research found that formal and informal techniques for strengthening institutional variables and improving individual factors are critical for new graduate nurses' effective transition into professional responsibilities. [ABSTRACT FROM AUTHOR]

Background: Inpatient violence in clinical and forensic settings is still an ongoing challenge to organizations and practitioners. Existing risk assessment instruments show only moderate benefits in clinical practice, are time consuming, and seem to scarcely generalize across different populations. In the last years, machine learning (ML) models have been applied in the study of risk factors for aggressive episodes. The objective of this systematic review is to investigate the potential of ML for identifying risk of violence in clinical and forensic populations. Methods: Following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a systematic review on the use of ML techniques in predicting risk of violence of psychiatric patients in clinical and forensic settings was performed. A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Risk of bias and applicability assessment was performed using Prediction model Risk Of Bias ASsessment Tool (PROBAST). Results: We identified 182 potentially eligible studies from 2,259 records, and 8 papers were included in this systematic review. A wide variability in the experimental settings and characteristics of the enrolled samples emerged across studies, which probably represented the major cause for the absence of shared common predictors of violence found by the models learned. Nonetheless, a general trend toward a better performance of ML methods compared to structured violence risk assessment instruments in predicting risk of violent episodes emerged, with three out of eight studies with an AUC above 0.80. However, because of the varied experimental protocols, and heterogeneity in study populations, caution is needed when trying to quantitatively compare (e.g., in terms of AUC) and derive general conclusions from these approaches. Another limitation is represented by the overall quality of the included studies that suffer from objective limitations, difficult to overcome, such as the common use of retrospective data Conclusion: Despite these limitations, ML models represent a promising approach in shedding light on predictive factors of violent episodes in clinical and forensic settings. Further research and more investments are required, preferably in large and prospective groups, to boost the application of ML models in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract Background Solitary pulmonary nodule (SPN) is a common finding in routine clinical practice when performing chest imaging tests. The vast majority of these nodules are benign, and only a small proportion are malignant. The application of predictive models of nodule malignancy in routine clinical practice would help to achieve better diagnostic management of SPN. The present systematic review was carried out with the purpose of critically assessing studies aimed at developing predictive models of solitary pulmonary nodule (SPN) malignancy from SPN incidentally detected in routine clinical practice. Methods We performed a search of available scientific literature until October 2020 in Pubmed, SCOPUS and Cochrane Central databases. The inclusion criteria were observational studies carried out in low-risk population from 35 years old onwards aimed at constructing predictive models of malignancy of pulmonary solitary nodule detected incidentally in routine clinical practice. Studies had to be published in peer-reviewed journals, either in Spanish, Portuguese or English. Exclusion criteria were non-human studies, or predictive models based in high-risk populations, or models based on computational approaches. Exclusion criteria were non-human studies, or predictive models based in high-risk populations, or models based on computational approaches (such as radiomics). We used The Transparent Reporting of a multivariable Prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement, to describe the type of predictive model included in each study, and The Prediction model Risk Of Bias ASsessment Tool (PROBAST) to evaluate the quality of the selected articles. Results A total of 186 references were retrieved, and after applying the exclusion/inclusion criteria, 15 articles remained for the final review. All studies analysed clinical and radiological variables. The most frequent independent predictors of SPN malignancy were, in order of frequency, age, diameter, spiculated edge, calcification and smoking history. Variables such as race, SPN growth rate, emphysema, fibrosis, apical scarring and exposure to asbestos, uranium and radon were not analysed by the majority of the studies. All studies were classified as high risk of bias due to inadequate study designs, selection bias, insufficient population follow-up and lack of external validation, compromising their applicability for clinical practice. Conclusions The studies included have been shown to have methodological weaknesses compromising the clinical applicability of the evaluated SPN malignancy predictive models and their potential influence on clinical decision-making for the SPN diagnostic management. Systematic review registration PROSPERO CRD42020161559

BackgroundInpatient violence in clinical and forensic settings is still an ongoing challenge to organizations and practitioners. Existing risk assessment instruments show only moderate benefits in clinical practice, are time consuming, and seem to scarcely generalize across different populations. In the last years, machine learning (ML) models have been applied in the study of risk factors for aggressive episodes. The objective of this systematic review is to investigate the potential of ML for identifying risk of violence in clinical and forensic populations.MethodsFollowing Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a systematic review on the use of ML techniques in predicting risk of violence of psychiatric patients in clinical and forensic settings was performed. A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Risk of bias and applicability assessment was performed using Prediction model Risk Of Bias ASsessment Tool (PROBAST).ResultsWe identified 182 potentially eligible studies from 2,259 records, and 8 papers were included in this systematic review. A wide variability in the experimental settings and characteristics of the enrolled samples emerged across studies, which probably represented the major cause for the absence of shared common predictors of violence found by the models learned. Nonetheless, a general trend toward a better performance of ML methods compared to structured violence risk assessment instruments in predicting risk of violent episodes emerged, with three out of eight studies with an AUC above 0.80. However, because of the varied experimental protocols, and heterogeneity in study populations, caution is needed when trying to quantitatively compare (e.g., in terms of AUC) and derive general conclusions from these approaches. Another limitation is represented by the overall quality of the included studies that suffer from objective limitations, difficult to overcome, such as the common use of retrospective data.ConclusionDespite these limitations, ML models represent a promising approach in shedding light on predictive factors of violent episodes in clinical and forensic settings. Further research and more investments are required, preferably in large and prospective groups, to boost the application of ML models in clinical practice.Systematic review registration[www.crd.york.ac.uk/prospero/], identifier [CRD42022310410].

Introduction: Student in a maternity nursing program must be engaged in practical training and they must be well prepared and directed along the way to becoming qualified professionals. Objective: The study aimed to investigate the effect of progressive muscle relaxation exercise on anxiety among male nursing students undergoing maternity clinical training. Methods: A quasi-experimental, pre-post study was conducted on nursing at Arab American University Palestine. The sample of the study consisted of 48 male nursing students enrolled in the maternity nursing course. They were selected through convenience sampling. This study was conducted on one group of male nursing students that received Jacobson's progressive muscle relaxation exercise for five consecutive days per week. The S-anxiety scale (STAI Form Y-1) was applied to collect data before and after the intervention. Results: The magnitude of anxiety reduction after the progressive muscle relaxation exercise was greater than before (t (47) = 21.2, p <.05). Conclusion: The current study's findings indicated the influence of progressive muscle relaxation on maternity clinical setting anxiety reduction among male nursing students. [ABSTRACT FROM AUTHOR]

Objective. Continuous wireless monitoring outside the post-anesthesia or intensive care units may enable early detection of patient deterioration, but good accuracy of measurements is required. We aimed to assess the agreement between vital signs recorded by standard and novel wireless devices in postoperative patients. Approach. In 20 patients admitted to the post-anesthesia care unit, we compared heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), and systolic and diastolic blood pressure (SBP and DBP) as paired data. The primary outcome measure was the agreement between standard wired and wireless monitoring, assessed by mean bias and 95% limits of agreement (LoA). LoA was considered acceptable for HR and PR, if within ±5 beats min−1 (bpm), while RR, SpO2, and BP were deemed acceptable if within ±3 breaths min−1 (brpm), ±3%-points, and ±10 mmHg, respectively. Main results. The mean bias between standard versus wireless monitoring was −0.85 bpm (LoA −6.2 to 4.5 bpm) for HR, −1.3 mmHg (LoA −19 to 17 mmHg) for standard versus wireless SBP, 2.9 mmHg (LoA −17 to 22) for standard versus wireless DBP, and 1.7% (LoA −1.4 mmHg to 4.8 mmHg) for SpO2, comparing standard versus wireless monitoring. The mean bias of arterial blood gas analysis versus wireless SpO2 measurements was 0.02% (LoA −0.02% to 0.06%), while the mean bias of direct observation of RR compared to wireless measurements was 0.0 brpm (LoA −2.6 brpm to 2.6 brpm). 80% of all values compared were within predefined clinical limits. Significance. The agreement between wired and wireless HR, RR, and PR recordings in postoperative patients was acceptable, whereas the agreement for SpO2 recordings (standard versus wireless) was borderline. Standard wired and wireless BP measurements may be used interchangeably in the clinical setting. [ABSTRACT FROM AUTHOR]

Objective: A recent academic-government partnership demonstrated the feasibility of utilizing Emergency Departments (ED) as a primary site for subject enrollment in clinical trials and achieved high rates of recruitment in two U.S. EDs. Given the ongoing need to test new therapeutics for influenza and other emerging infections, we sought to describe the historical rates of participant recruitment into influenza Phase III therapeutic RCTs in various clinical venues, including EDs.Study Design: A cross-sectional study was performed of influenza therapeutic Phase III RCTs published in PubMed, Embase, Scopus, and Clinicaltrials.gov from January 2000 to June 2019.Main Outcome: To estimate the weighted-average number of influenza-positive participants enrolled per site per season in influenza therapeutic RCT conducted in clinical settings, and to describe basic trial site characteristics.Results: 47 (0.7%) of 7008 articles were included for review of which 43 of 47 (91%) included information regarding enrollment sites; of these, 2 (5%) recruited exclusively from EDs with the remainder recruiting from mixed clinical settings (inpatient, outpatient, and ED). The median enrollment per study was 326 (IQR: 110, 502.5) with a median of 11 sites per study (IQR: 2, 59.5). Included studies reported a median of 201 (IQR: 74, 344.5) confirmed influenza-positive participants per study. The pooled number of participants enrolled per site per season was 11 (95% CI: 10, 12). The pooled enrollment numbers per clinical site after excluding the two 'ED only recruitment' studies were less [10.7 (95% CI: 9.9, 11.6)] than the pooled enrollment numbers per clinical site for the two 'ED only recruitment' studies [89.5 (95% CI 89.2-89.27)].Conclusion and Relevance: Published RCTs evaluating influenza therapeutics in clinical settings recruit participants from multiple sites but enroll relatively few participants, per site, per season. The few ED-based studies reported recruited more subjects per site per season. Untapped opportunities likely exist for EDs to participate and/or lead therapeutic RCTs for influenza or other emerging respiratory pathogens. [ABSTRACT FROM AUTHOR]