Conectar
by Yasutaka Yanagita, Kosuke Ishizuka, Daiki Yokokawa, Kiyoshi Shikino
BackgroundWith the growing volume of medical information, proficiency in utilizing clinical decision support systems (CDSSs) is increasingly important for physicians. Further, research has primarily focused on CDSSs’ accuracy for specific symptoms, diseases, and treatments, but the extent to which CDSSs contribute to the clinical reasoning process and evaluation of their output remains unclear. While Google is not a traditional CDSS, previous studies have evaluated its role as a diagnostic support tool, demonstrating its ability to assist physicians in retrieving relevant medical information and influencing diagnostic decision-making.
ObjectiveThis study aimed to assess whether using Google search can enhance diagnostic accuracy and confidence among medical students, and to evaluate how the interpretation of search results influences their diagnostic confidence.
MethodsForty-eight fifth-year medical students in clinical clerkship at Chiba University Hospital were presented with ten clinical scenarios in text format. Initially, they provided the most likely diagnosis without assistance and recorded their confidence levels. Subsequently, they used Google search to revisit their diagnoses and confidence levels, using a 7-point Likert Scale. Focus group interviews were conducted to discuss changes in confidence, and the interviews were analyzed qualitatively using content analysis. A mixed-methods analysis compared the average number of correct diagnoses and confidence levels before and after using Google search.
ResultsIn total, 470 responses from 48 fifth-year medical students were evaluated after excluding 10 inappropriate responses. Correct diagnoses increased from an average of 63.6% without assistance to 76.2% using Google search (P P Conclusions
This study underscores the value of using Google search in medical education to enhance diagnostic skills and confidence. The improvement in accuracy and confidence among students demonstrates the supportive role of Google search in clinical reasoning and education. This highlights the need for educators to teach discernment in information analysis to ensure optimal use of CDSS in medical training. Proper integration of these tools is crucial for developing future physicians capable of effectively navigating vast amounts of medical data.
Challenges within prehospital emergency care (PEC) have significant implications for the provision of emergency department (ED) care. However, ED overcrowding is a prevalent issue with negative impacts on patient outcomes. It can be attributed to multiple factors, such as non-emergency attendances, inaccessible alternative care service pathways (ACSPs) and inefficiencies in emergency medical service operations. ED overcrowding has prompted healthcare systems worldwide to implement interventions. These include tele-triaging, virtual ED and non-conveyance protocols that primarily aim to reduce demand for ED care and increase the supply of alternative services. However, despite such efforts, there remain unaddressed limitations that prevent PEC interventions from being successfully implemented. Moreover, prior studies and reviews have found mixed results, and that ED overcrowding interventions remain underused. Therefore, there is a need for this qualitative systematic review and meta-synthesis to capture the complexities of implementation challenges and identify enablers required to complement PEC interventions.
This systematic review and meta-synthesis aims to offer a consolidated overview of PEC interventions intended to reduce ED overcrowding. It focuses on presenting international perspectives on the current challenges these interventions face. The enablers presented in this review could also better inform the actions taken by healthcare systems aiming to implement similar interventions.
A comprehensive search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature Complete, PsycINFO, Web of Science and Scopus was conducted to obtain a set of qualitative studies. Following a quality appraisal with the Critical Appraisal Skills Programme tool, data from the included studies were extracted and meta-synthesised.
A final 21 qualitative intervention-based studies were included. Through these studies, four themes were identified: (1) types of PEC interventions to alleviate ED demands and right-site patients, (2) perceived benefits of interventions, (3) challenges in implementing interventions and (4) key enablers for successful implementation of interventions. Our results describe key factors such as the importance of ACSPs and support for PEC healthcare workers in the form of standardised guidelines, as well as education and training.
We further discuss how enablers can integrate into current PEC systems to complement the interventions explored. Discussions are concentrated on several key interventions (tele-triaging, virtual ED and non-conveyance protocols) as they were perceived to hold significant potential in addressing PEC challenges and could be further elevated through various enablers. Overall, we could conclude that each intervention needs to be complemented by enablers to optimise its benefits.
To assess the quality of amoxicillin products in Indonesia’s private market by surveying the range of products available across different areas, followed by product sampling and laboratory testing.
A cross-sectional survey employing mystery shoppers to purposively sample the widest possible range of amoxicillin products available to patients across different areas in Indonesia.
Licensed and unlicensed medicine outlets in remote, rural and urban areas and online.
Amoxicillin products that are sold to patients as oral solid and dry liquid formulations.
Quality of amoxicillin products, assessed using compendial testing of active pharmaceutical ingredient content and dissolution. Samples that failed any quality test were classified as substandard or out-of-specification (OOS). The raw prevalence of substandard amoxicillin was adjusted based on the national market volume of each product variant.
We surveyed 476 outlets, mostly pharmacies (68.5%), websites (19.7%) and drug stores (10.9%). Among the 120 collected samples, there were 59 distinct products, collectively representing 95% of the estimated market volume for oral solid products and 65% for dry syrups. 12 out of 110 oral solid samples tested OOS (10.9%), as did 3 out of 10 dry syrups (30%). The samples that failed originated from various areas and types of outlets. We found no relation between the price and quality of amoxicillin.
The oral solid amoxicillin products that tested OOS represent an estimated 12.7% of the national market volume. We found no relation between the price and quality of amoxicillin. Combining product-variety sampling with data on market volume presents a promising approach to gain insight into the prevalence of poor-quality medical products using a relatively small sample size.
Adolescent idiopathic scoliosis (AIS) is an acquired deformity that develops in 2–4% of otherwise healthy children during adolescent growth, substantially reducing their quality of life and creating a life-long burden of disease. Despite many years of dedicated research, the cause and mechanism of AIS are still unknown and no effective curative treatments are available for children suffering from this spinal and chest deformity. To date, all etiological studies focused on children with an already established scoliosis. EARLYBIRD aims to uncover the earliest pathoanatomical changes in AIS, by studying longitudinal spinal growth in children at increased risk for scoliosis development with MRI, starting before adolescence.
This prospective observational cohort study will follow two groups: 60 adolescent girls (8–10 years old) who have an older sibling or parent diagnosed with AIS (cohort 1) and 60 adolescents with 22q11.2 deletion syndrome, a genetic microdeletion associated with 50% scoliosis prevalence (cohort 2). Data collection will be completely radiation-free and occur at baseline and yearly during adolescence up to 15 years of age in girls and up to 16 in boys. A comprehensive physical examination, a dedicated spine and chest MRI as well as a standing three-dimensional (3-D) spinal ultrasound will be obtained at each time point. The main parameter will be the longitudinal changes in segmental axial rotation during growth in subjects that do and do not develop AIS. Secondary endpoints are longitudinal changes in 3-D morphology of the bone and intervertebral discs (IVDs) during normal spinal development and during scoliosis development, determining biomarkers for bone growth, implementing radiation-free imaging methods for spinal monitoring in adolescent patients at risk for scoliosis development and use these for spinal skeletal maturity and patient-specific spinal biomechanical analyses.
This protocol has been approved by the Medical Ethics Committee NedMed and is registered on clinicaltrials.gov (NCT05924347). Written informed consent will be obtained from all parents/legal representatives. Key findings will be disseminated via peer-reviewed journals and presentation at conferences. This study is funded by the European Research Council.
This study was conducted to examine the relationship between psychological resilience, ruminative thoughts and spiritual well-being of individuals diagnosed with cancer.
Cancer, which can cause fear, anger and future anxiety in individuals from the moment of diagnosis, is a disease that individuals can associate with death, pain, and suffering.
A descriptive and correlational research design was employed.
The study sample consisted of 382 patients receiving outpatient treatment at an oncology center affiliated with a university hospital in Turkey. Data were collected using the Introductory Information Form, Ruminative Reactions Scale, Psychological Resilience Scale, and FACIT-Sp Spiritual Well-Being Scale. We evaluated the data via descriptive statistics, Pearson correlation, and multiple regression analyses.
The resilience score of the participants was 52.48 ± 6.96, the ruminative reactions score was 44.26 ± 15.11, and the FACIT-Sp total score was 38.97 ± 8.23. In the study, there was a moderate and statistically significant positive relationship between the mean psychological resilience score and the mean scores of FACIT-Sp on the meaning, FACIT-Sp peace, FACIT-Sp faith sub-dimensions, and the total scale of FACIT-Sp (p < 0.05). Also, a moderate and statistically significant negative relationship existed between the mean psychological resilience and the ruminative response scores (p < 0.05).
Participants' psychological resilience was slightly higher than moderate, their ruminative thoughts were moderate, and their spiritual well-being was high. In addition, there was a relationship between psychological resilience, ruminative reactions, and spiritual well-being.
They may be important for nurses to plan and implement interventions that will reduce patients' ruminative thinking and increase their spiritual well-being and resilience. Therefore, the results obtained in this study may help nursing care be more effective.
The reporting of the results of the study was conducted in accordance with the STROBE guidelines.
To assess HIV testing and status disclosure rates and explore their associated predictors among young adolescents (10–17 years) who received health education through the Orphans and Vulnerable Children programme in Nimule, South Sudan.
A pre–post evaluation study with data collected at baseline (December 2020) and at the endline (December 2022).
The study was conducted in Nimule, a densely populated periurban town characterised by high HIV prevalence and substantial cross-border movement between Uganda and South Sudan, making it a relevant setting for an HIV prevention project.
The primary intervention was HIV risk education delivered through forty peer-led health clubs. Adolescents were screened for HIV risk factors and referred for HIV and other sexually transmitted infection testing at health facilities.
The study included young adolescents aged 10–17 years recruited from HIV-affected households within 17 neighbourhoods in Nimule periurban town. Informed consent was obtained from both caregivers and adolescents.
The primary outcome was self-reported HIV testing and status disclosure. Binary logistic regression was used to assess the association between the study outcome variables and associated sociodemographic factors.
A total of 557 (73.0%) of the 768 enrolled adolescents were surveyed at baseline and endline, including 301 (54.0%) females and 276 (46.0%) males. The median age was 14 years (IQR: 11–16) at baseline and 15 years (IQR: 12–17) at endline.
HIV testing increased from 315 (56.7%) at baseline to 557 (100%). The odds of undisclosed HIV status were 49% lower at endline adjusted OR (aOR) 0.51 (95% CI 0.92, 0.67; p
Male gender and being cared for by siblings or other relatives were strong predictors of lower HIV testing and status disclosure. These findings underscore the importance of targeting efforts towards this category of adolescents in postconflict and resource-limited settings like South Sudan while leveraging peer-led HIV education interventions in conflict-affected settings.
To consolidate and appraise available evidence on the experiences and perceptions of male nurses and male midwives facing discrimination.
Qualitative systematic review. This review was informed by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA).
The Critical Appraisal Skills Program checklist was used to appraise included articles, and extracted data were meta-summarised and meta-synthesised using Sandelowski and Barroso's two-step approach.
PubMed, EMBASE, CINAHL, Scopus, Web of Science, PsycINFO, Cochrane Library, ProQuest (Dissertations and Theses Global) and ClinicalTrials.gov were sourced from the inception to December 2022.
A total of 21 studies were included, involving 283 male nurses and 11 male midwives. Four themes were identified during the meta-synthesis: (1) It's a ‘women's world’, (2) discrimination within and beyond the workplace, (3) stereotypes and labels and (4) the silver lining.
This review offered male nurses' and male midwives' perspectives on discrimination faced in nursing. There is a need to ensure gender equality in the nursing profession by reinforcing the importance and value of employing men in this profession.
Future research should focus on examining the experiences of male nursing students and other healthcare stakeholders to understand discrimination faced by men in nursing from varied geographical and cultural backgrounds. The findings may provide helpful insights for planning supportive interventions, institutional adjustments, legislative changes, educational initiatives and research that benefit male nurses and male midwives.
This qualitative systematic review consolidated and meta-synthesised the available evidence on male nurses' and male midwives' experiences of discrimination. These findings contribute to the understanding of male nurses and male midwives as a gender minority and the need for greater gender equality.
PRISMA.
No patient or public contribution.
by Moses Kelly Kumwenda, Madalo Mukoka, Elena Reipold-Ivanova, Owen Mhango, Yasmin Dunkley, Florence Abok, Euphemia Sibanda, Constancia Watadzaushe, Elizabeth L. Corbett, Augustine Talumba Choko
Simple and easy to use kits for SARS-Cov-2 self-testing during epidemic waves are needed to optimize diagnostic capacity in low- and middle-income countries. SARS-Cov-2 self-testing kits are available, but application of these novel diagnostic technologies is less understood in low and middle-income contexts. We investigated the ability to understand and perform instructions for use (IFUs) for STANDARD Q COVID-19 Ag Test (SD Biosensor) and Panbio COVID-19 Ag Rapid Test Device (Abbott Rapid Diagnostics) for anterior nares (AN) nasal self-sampling and self-testing for COVID-19 in rural and urban Malawi. Qualitative research methods using iterative cognitive interview approach was used to investigate the ability of healthcare providers and lay community members to understand and perform a COVID-19 self-sample or self-test using the manufacturer’s instructions for use. A total of 120 iterative cognitive interviews were done with healthcare providers and lay community members for self-sampling (N = 76) and self-testing (N = 44). Cognitive interviews began with the manufacturers version of instructions for use followed by subsequent iterations to refine problematic instructions. Structured interview guide and an observation checklist were used to collect data which was then coded inductively. A framework analysis approach was used to synthesize qualitative data. Study participants were generally proficient at performing a COVID-19 self-sampling and self-testing using the two COVID-19 Rapid Testing Devices. Several of design and content problems within manufacturer’s instructions for use made their contextual application sub-optimal. Overall, participants experienced difficulties because of the omission of essential elements within instructions, use of short texts/phrase or lack of a word instruction, the lack of labels on where to open the package; the inconsistencies between word instructions within the instructions for use and the physical contents of the test package; the inability to digest and apply certain technical concepts and the lack of clarity in the phrasing of some text instructions. As expected, healthcare providers experienced fewer problems compared to lay community members. The refinement of these instructions greatly improved comprehension among lay community members. Self-sampling and self-testing for COVID-19 can be performed lay community members with fidelity in a scaled context if the manufacturer’s instructions for use have been refined and tailored to the context. In the current study, we have used the study findings to map the optimisation process of manufacturer’s IFU’S for self-testing RDT’s intended for low literacy contexts including Malawi.by Krzysztof Kusy, Jan Matysiak, Zenon J. Kokot, Monika Ciekot-Sołtysiak, Agnieszka Klupczyńska-Gabryszak, Ewa Anna Zarębska, Szymon Plewa, Paweł Dereziński, Jacek Zieliński
Circulating blood is an important plasma free amino acids (PFAAs) reservoir and a pivotal link between metabolic pathways. No comparisons are available between athletes with opposite training adaptations that include a broader spectrum of both proteinogenic and non-proteinogenic amino acids, and that take into account skeletal muscle mass. We hypothesized that the levels of the exercise-induced PFAAs concentration are related to the type of training-related metabolic adaptation. We compared highly trained endurance athletes (n = 11) and sprinters (n = 10) aged 20‒35 years who performed incremental exercise until exhaustion. Venous blood was collected before and during the test and 30-min recovery (12 samples). Forty-two PFAAs were assayed using LC-ESI-MS/MS technique. Skeletal muscle mass was estimated using dual X-ray absorptiometry method. Glutamine and alanine were dominant PFAAs throughout the whole exercise and recovery period (~350‒650 μmol∙L-1). Total, combined proteinogenic, non-essential, and non-proteinogenic PFAAs levels were significantly higher in endurance athletes than sprinters (ANOVA group effects: p = 0.007, η2 = 0.321; p = 0.011, η2 = 0.294; p = 0.003, η2 = 0.376; p = 0.001, η2 = 0.471, respectively). The exercise response was more pronounced in endurance athletes, especially for non-proteinogenic PFAAs (ANOVA interaction effect: p = 0.038, η2 = 0.123). Significant between-group differences were observed for 19 of 33 PFAAs detected, including 4 essential, 7 non-essential, and 8 non-proteinogenic ones. We demonstrated that the PFAAs response to incremental aerobic exercise is associated with the type of training-related metabolic adaptation. A greater turnover and availability of circulating PFAAs for skeletal muscles and other body tissues is observed in endurance- than in sprint-trained individuals. Non-proteinogenic PFAAs, despite low concentrations, also respond to exercise loads, indicating their important, though less understood role in exercise metabolism. Our study provides additional insight into the exercise-induced physiological response of PFAAs, and may also provide a rationale in discussions regarding dietary amino acid requirements in high-performance athletes with respect to sports specialization.
FreshRSS 