Clinical, epidemiological, and care profile of hospitalized patients with retinoblastoma in Brazil

ABSTRACT Purpose: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil. Methods: Using data from the Hospital Cancer Registry of the Instituto Nacional de Câncer, patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0-19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20-75, >75 cases). Results: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1-14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals. Conclusions: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services.

Aprendizagem baseada em projeto e a formação médica: relato de experiência introduzindo questões para o debate interprofissional / Project-based learning and medical education: experience report introducing issues for interprofessional debate / El aprendizaje basado en proyecto y la formación médica: informe de experiencia que introduce cuestiones para el debate interprofesional

A aprendizagem baseada em projeto orientada pelos fundamentos da educação interprofissional é um modelo que pode contribuir para a formação de relacionamentos interpessoais, criatividade, empatia e colaboração na educação médica, por meio de uma colaboração mútua com profissionais de saúde da rede. Muito se fala da efetividade desse método no campo do ensino e aprendizagem médica, mas há a necessidade de incluir a importância do desenvolvimento de habilidades interprofissionais, com equipes colaborativas, em ações extensionistas, diante das necessidades locais no contexto da atenção primária, pensando na melhoria dos resultados de saúde. O objetivo deste trabalho é apresentar um relato de experiência de aprendizagem baseada em projeto de estudantes de Medicina no contexto da Estratégia Saúde da Família. Participaram deste trabalho estudantes do Módulo Integração Ensino, Serviço e Comunidade da Faculdade de Medicina da Universidade Federal dos Vales do Jequitinhonha e Mucuri que executaram, em colaboração com uma equipe interprofissional o projeto sobre a saúde do homem. Como resultado da análise qualitativa do feedback entre os integrantes, observaram-se mudanças no comportamento dos estudantes, com melhorias na comunicação, empatia e nas relações interpessoais, por meio do trabalho colaborativo com a equipe interprofissional. Esta experiência poderá ser adaptada para implementar o ensino e aprendizagem no projeto pedagógico orientado pela educação interprofissional na atenção primária.

Project-based learning guided by the fundamentals of interprofessional education is a model that can contribute to the formation of interpersonal relationships, creativity, empathy and collaboration within medical education, through mutual collaboration with health professionals in the health network. Much has been said about the effectiveness of this method in medical teaching and learning, but there is a need to include the importance of developing interprofessional skills, with collaborative teams, within extension actions, in view of local needs in the context of primary care, thinking about the improved health outcomes. The objective of this work was to present a report of a project-based learning experience of medical students in Family Health Strategy. Students from the Teaching, Service and Community Integration Module of the Faculty of Medicine of Universidade Federal dos Vales do Jequitinhonha e Mucuri participated in this work, executing in collaboration with an interprofessional team a project about men's health. As a result of the qualitative analysis of the feedback among the members, changes in student behavior were observed with improvements in communication, empathy and interpersonal relationships through collaborative work with the interprofessional team. This experience can be adapted to implement teaching and learning in the pedagogical project guided by interprofessional education in primary care.

El aprendizaje basado en proyectos y guiado por los fundamentos de la educación interprofesional es un modelo que puede contribuir a la formación de relaciones interpersonales, creatividad, empatía y colaboración dentro de la educación médica, a través de la colaboración mutua con los profesionales de la salud en la red de salud. Mucho se habla de la efectividad de este método dentro de la enseñanza y el aprendizaje médico, pero es necesario incluir la importancia del desarrollo de habilidades interprofesionales, con equipos colaborativos, dentro de las acciones de extensión, frente a las necesidades locales en el contexto de la atención primaria, pensando sobre los mejores resultados de salud. El objetivo de este trabajo es presentar un informe de experiencia de aprendizaje basado en proyectos de estudiantes de medicina en la Estrategia de Salud Familiar. Participaron en este trabajo estudiantes del Módulo Integración Enseñanza, Servicio y Comunidad de la Facultad de Medicina de la Universidade Federal dos Vales do Jequitinhonha e Mucuri que ejecutaron en colaboración con un equipo interprofesional el proyecto sobre la salud del hombre. Como resultado del análisis cualitativo de la retroalimentación entre los integrantes, se observaron cambios en el comportamiento de los estudiantes con mejoras en la comunicación, la empatía y las relaciones interpersonales a través del trabajo colaborativo con el equipo interprofesional. Esta experiencia puede adaptarse para implementar la enseñanza y el aprendizaje en el proyecto pedagógico guiado por la educación interprofesional en atención primaria.

Escala de alerta precoce na identificação de pacientes com risco de deterioração clínica / Early warning scale for identifying patients at risk of clinical deterioration / Escala de alerta temprana en la identificación de pacientes con riesgo de deterioro clínico

Objetivo: avaliar pontuação da National Early Warning Score (NEWS) em relação ao tipo de desfecho e perfil dos pacientes da enfermaria clínica médica de um hospital em Teresina, Piauí, Brasil. Método: estudo quantitativo realizado num hospital público, em Teresina, com 150 prontuários de pacientes internados no setor clínica médica de fevereiro de 2022 a dezembro de 2022, a partir de registros demográficos, clínicos e valores da escala na admissão e desfecho. Resultados: houve associação dos valores da escala com a faixa etária (p=0,029), tempo de internação (p=0,023) e tipo de desfecho (p < 0,001). Alto risco clínico prevaleceu entre pacientes do sexo masculino (13%), na faixa etária de 60 a 94 anos (13%), com permanência de 21 a 57 dias (19,2%) e óbito como desfecho (100%). Conclusão: implementação da referida escala evidenciou ser fundamental para prever agravos clínicos e melhorar qualidade da assistência.

Objective: to evaluate the National Early Warning Score (NEWS) in relation to the type of outcome and profile of patients in the medical clinical ward of a hospital in Teresina, Piauí, Brazil. Method: a quantitative study conducted in a public hospital in Teresina, with 150 medical records of patients admitted to the medical clinic sector from February 2022 to December 2022, based on demographic and clinical records and scale values at admission and outcome. Results: there was an association between the scale values and the age group (p=0.029), length of stay (p=0.023) and type of outcome (p < 0.001). High clinical risk prevailed among male patients (13%), aged between 60 and 94 years (13%), with a stay of 21 to 57 days (19.2%), and death as an outcome (100%). Conclusion: implementation of the aforementioned scale proved to be fundamental for predicting clinical problems and improving care quality.

Objetivo: evaluar el puntaje de la National Early Warning Score (NEWS) con respecto al tipo de desenlace y el perfil de los pacientes de la enfermería clínica médica de un hospital en Teresina, Piauí, Brasil. Método: estudio cuantitativo realizado en un hospital público en Teresina, con 150 historiales médicos de pacientes internados en el sector de clínica médica desde febrero de 2022 hasta diciembre de 2022, a partir de registros demográficos, clínicos y valores de la escala en la admisión y desenlace. Resultados: hubo asociación de los valores de la escala con la edad (p=0,029), tiempo de internación (p=0,023) y tipo de desenlace (p < 0,001). El alto riesgo clínico prevaleció entre los pacientes del sexo masculino (13%), en la franja de edad entre 60 y 94 años (13%), con una estancia de 21 a 57 días (19,2%) y fallecimiento como desenlace (100%). Conclusión: la implementación de dicha escala demostró ser fundamental para prever agravios clínicos y mejorar la calidad de la asistencia.

Fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática / Intervening factors in the management of nursing care for children hospitalized with rheumatic heart disease / Factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática

Objetivo: analisar os fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo descritivo-exploratório com abordagem qualitativa, que utilizou a Teoria Fundamentada em Dados e o Interacionismo Simbólico, respectivamente, como referencial metodológico e teórico. A coleta de dados foi realizada em uma instituição especializada em atendimento cardiológico, no munícipio do Rio de Janeiro. Foram entrevistados 19 profissionais de enfermagem através de um roteiro semiestruturado. Resultado: emergiram os seguintes fatores intervenientes na prática da gerência do cuidado: condição socioeconômica da família, comportamento da criança, condições de trabalho, comunicação ineficaz, educação permanente, trabalho em equipe e experiência profissional. Conclusão: os resultados apontam para a necessidade de proposição de estratégias de ação e interação que facilitem a prática gerencial de cuidado à criança com cardiopatia reumática e sua família face aos fatores intervenientes identificados.

Objective: to analyze the factors involved in the management of nursing care for children hospitalized with rheumatic heart disease. Method: this is a descriptive-exploratory study with a qualitative approach, which used Data-Based Theory and Symbolic Interactionism, respectively, as methodological, and theoretical references. Data was collected in an institution specializing in cardiac care in the city of Rio de Janeiro. Nineteen nursing professionals were interviewed using a semi-structured script. Result: the following intervening factors in the practice of care management emerged: the family's socioeconomic status, the child's behavior, working conditions, ineffective communication, continuing education, teamwork, and professional experience. Conclusion: the results point to the need to propose strategies for action and interaction that facilitate management practice in caring for children with rheumatic heart disease and their families, given the intervening factors identified.

Objetivo: analizar los factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio descriptivo-exploratorio con enfoque cualitativo, cuyos marcos metodológico y teórico fueron la Teoría Fundamentada y el Interaccionismo Simbólico, respectivamente. La recolección de datos se realizó en una institución especializada en atención cardiológica, en la ciudad de Río de Janeiro. Fueron entrevistados 19 profesionales de enfermería mediante un cuestionario semiestructurado. Resultado: surgieron los siguientes factores intervinientes en la práctica de la gestión del cuidado: condición socioeconómica de la familia, comportamiento del niño, condiciones de trabajo, comunicación ineficaz, educación continua, trabajo en equipo y experiencia profesional. Conclusión: los resultados indican que es necesario proponer estrategias de acción e interacción que faciliten la práctica de la gestión del cuidado al niño con cardiopatía reumática y a sus familiares, con respecto a los factores intervinientes identificados.

Impact of healthcare system strain on the implementation of ICU sedation practices and encephalopathy burden during the early COVID-19 pandemic.

The COVID-19 pandemic posed unprecedented challenges to healthcare systems worldwide, particularly in managing critically ill patients requiring mechanical ventilation early in the pandemic. Surging patient volumes strained hospital resources and complicated the implementation of standard-of-care intensive care unit (ICU) practices, including sedation management. The objective of this study was to evaluate the impact of an evidence-based ICU sedation bundle during the early COVID-19 pandemic. The bundle was designed by a multi-disciplinary collaborative to reinforce best clinical practices related to ICU sedation. The bundle was implemented prospectively with retrospective analysis of electronic medical record data. The setting was the ICUs of a single-center tertiary hospital. The patients were the ICU patients requiring mechanical ventilation for confirmed COVID-19 between March and June 2020. A learning health collaborative developed a sedation bundle encouraging goal-directed sedation and use of adjunctive strategies to avoid excessive sedative administration. Implementation strategies included structured in-service training, audit and feedback, and continuous improvement. Sedative utilization and clinical outcomes were compared between patients admitted before and after the sedation bundle implementation. Quasi-experimental interrupted time-series analyses of pre and post intervention sedative utilization, hospital length of stay, and number of days free of delirium, coma, or death in 21 days (as a quantitative measure of encephalopathy burden). The analysis used the time duration between start of the COVID-19 wave and ICU admission to identify a "breakpoint" indicating a change in observed trends. A total of 183 patients (age 59.0 ± 15.9 years) were included, with 83 (45%) admitted before the intervention began. Benzodiazepine utilization increased for patients admitted after the bundle implementation, while agents intended to reduce benzodiazepine use showed no greater utilization. No "breakpoint" was identified to suggest the bundle impacted any endpoint measure. However, increasing time between COVID-19 wave start and ICU admission was associated with fewer delirium, coma, and death-free days (ß = - 0.044 [95% CI - 0.085, - 0.003] days/wave day); more days of benzodiazepine infusion (ß = 0.056 [95% CI 0.025, 0.088] days/wave day); and a higher maximum benzodiazepine infusion rate (ß = 0.079 [95% CI 0.037, 0.120] mg/h/wave day). The evidence-based practice bundle did not significantly alter sedation utilization patterns during the first COVID-19 wave. Sedation practices deteriorated and encephalopathy burden increased over time, highlighting that strategies to reinforce clinical practices may be hindered under conditions of extreme healthcare system strain.

Conscientious Objection to Gender-Affirming Surgery: A Cross-Sectional Analysis of Plastic Surgery and Urology Residency Programs.

OBJECTIVE: Medical conscientious objection is a federally protected right of physicians to refuse participation in medically indicated services or research activities that are incompatible with their ethical, moral, or religious beliefs. Individual provider objections to gender-affirming surgery have been documented, however the prevalence of such objections is unknown. Our study aimed to characterize physician objections to gender-affirming surgery in plastic surgery and urology residencies and to assess related institutional policies. DESIGN, SETTING, PARTICIPANTS: A cross-sectional electronic survey was administered to program leadership of 239 accredited US plastic surgery and urology residencies from February to October 2023. Trainee exposure to gender-affirming surgery, programmatic experience with objections, and presence and content of institutional objection policies were collected. Bivariate analyses were performed to determine associations with objectors. RESULTS: One-hundred and twenty-four plastic surgery (n = 59) and urology (n = 65) residencies completed the survey, representing a 52% response rate. Most programs included didactic training (n = 107, 86%) and direct clinical exposure (n = 98, 79%) to gender-affirming surgery. Few (n = 24, 19%) endorsed existent objection policies. Sixteen programs (13%) experienced objections to gender-affirming surgery by trainees (n = 15), faculty (n = 6), and staff (n = 1). Neither geographic region, exposure to gender-affirming surgery, nor presence of objection policies significantly contributed to programmatic objections. Programs with formal objection policies reported increased confidence in addressing future objection events (p = 0.017). CONCLUSIONS: Objection to gender-affirming surgery is a rare, but plausible occurrence amongst plastic surgery and urology trainees. Residency programs should consider anticipatory policies to protect patients and, when feasible, provide reasonable accommodations for objecting trainees.

Discharge Follow-Up of Patients in Primary Care Does Not Meet Their Care Needs: Results of a Longitudinal Multicentre Study.

Adequate coordination between healthcare levels has been proven to improve clinical indicators, care costs, and user satisfaction. This is more relevant to complex or vulnerable patients, who often require increased care. This study aims to evaluate the differences between hospital discharge follow-up indicators, including number of general practitioners' (GPs) and community nurses' (CNs) consultations, presentiality of consultations, type of first post-discharge consultation, and time between hospital discharge and first consultation. Vulnerable and non-vulnerable patients were compared. A longitudinal retrospective study was carried out in the north of Tenerife on the post-discharge care of patients discharged from the Canary Islands University Hospital (Spanish acronym HUC) between 1 January 2018 and 31 December 2022. The results obtained show deficiencies in the care provided to patients by primary care (PC) after being discharged from the hospital, including delayed first visits, low presentiality of those visits that were less frequent even with increased patient complexity, scarce first home visits to functionally impaired patients and delays in such visits, and a lack of priority visits to patients with increased follow-up needs. Addressing these deficiencies could help those most in need of care to receive PC, thus reducing inequalities and granting equal access to healthcare services in Spain.

Digital Innovation to Grow Quality Care Through an Interprofessional Care Team (DIG IT) Among Underserved Patients With Hypertension.

PURPOSE: The impact of digital health on medically underserved patients is unclear. This study aimed to determine the early impact of a digital innovation to grow quality care through an interprofessional care team (DIG IT) on the blood pressure (BP) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk score of medically underserved patients. METHODS: This was a 3-month, prospective intervention study that included patients aged 40 years or more with BP of 140/90 mmHg or higher who received care from DIG IT from August through December 2021. Sociodemographic and clinical outcomes of DIG IT were compared with historical controls (controls) whose data were randomly extracted by the University of California Data Warehouse and matched 1:1 based on age, ethnicity, and baseline BP of the DIG IT arm. Multiple linear regression was performed to adjust for potential confounding factors. RESULTS: A total of 140 patients (70 DIG IT, 70 controls) were included. Both arms were similar with an average age (SD) of 62.8 (9.7) years. The population was dominated by Latinx (79.3%) persons, with baseline mean BP of 163/81 mmHg, and mean ASCVD risk score of 23.9%. The mean (SD) reduction in systolic BP at 3 months in the DIG IT arm was twice that of the controls (30.8 [17.3] mmHg vs 15.2 [21.2] mmHg; P <.001). The mean (SD) ASCVD risk score reduction in the DIG IT arm was also twice that of the controls (6.4% [7.4%] vs 3.1% [5.1%]; P = .003). CONCLUSIONS: The DIG IT was more effective than controls (receiving usual care). Twofold improvement in the BP readings and ASCVD scores in medically underserved patients were achieved with DIG IT.

Large language model triaging of simulated nephrology patient inbox messages.

Background: Efficient triage of patient communications is crucial for timely medical attention and improved care. This study evaluates ChatGPT's accuracy in categorizing nephrology patient inbox messages, assessing its potential in outpatient settings. Methods: One hundred and fifty simulated patient inbox messages were created based on cases typically encountered in everyday practice at a nephrology outpatient clinic. These messages were triaged as non-urgent, urgent, and emergent by two nephrologists. The messages were then submitted to ChatGPT-4 for independent triage into the same categories. The inquiry process was performed twice with a two-week period in between. ChatGPT responses were graded as correct (agreement with physicians), overestimation (higher priority), or underestimation (lower priority). Results: In the first trial, ChatGPT correctly triaged 140 (93%) messages, overestimated the priority of 4 messages (3%), and underestimated the priority of 6 messages (4%). In the second trial, it correctly triaged 140 (93%) messages, overestimated the priority of 9 (6%), and underestimated the priority of 1 (1%). The accuracy did not depend on the urgency level of the message (p = 0.19). The internal agreement of ChatGPT responses was 92% with an intra-rater Kappa score of 0.88. Conclusion: ChatGPT-4 demonstrated high accuracy in triaging nephrology patient messages, highlighting the potential for AI-driven triage systems to enhance operational efficiency and improve patient care in outpatient clinics.

[Impact of primary care nursing discharge follow-up on early hospital readmissions. Observational longitudinal study]. / Impacto del seguimiento al alta de Enfermería en Atención Primaria sobre los reingresos hospitalarios tempranos. Estudio observacional longitudinal.

AIM: To determine the proportion of people who undergo discharge follow-up when indicated. DESIGN: Retrospective longitudinal observational study, with an analytical approach. POPULATION: persons discharged from the Hospital Universitario de la Princesa of any age and sex, with any reason for admission and with an indication for discharge follow-up in Primary Care. Users who did not have an assigned Autonomous Personal Identification Code (CIPA) were excluded. Random sample (n=289). VARIABLES: Discharge follow-up and readmissions (<30 days). Sociodemographic, clinical and discharge follow-up variables were included from the electronic medical records of Primary and Hospital Care. A descriptive analysis of the sociodemographic and clinical characteristics of the study population was conducted. To analyze the association between discharge follow-up and readmissions, a logistic regression model was used. RESULTS: Age 72.4 years (RIQ 60-87). 55.2% of the population were women. Follow-up was conducted in 61.2% of those indicated. According to the logistic regression model performed between early readmission and discharge follow-up, adjusted for all other factors, the group with discharge follow-up had a 66% lower likelihood of hospital readmission (OR 0.34, 95% CI (0.18-0.67)). CONCLUSIONS: These findings suggest that nursing discharge follow-up conducted in primary care reduces the risk of early readmission.

Lessons Pharmacy Practice in India Should Adopt From Advanced Nations: A Review.

In India, pharmacy practice is still at a developing stage with the majority of the graduates taking the industry pathway. Currently, there are only a few pharmacists who have been board-certified by the Board of Pharmacy Specialities (BPS), which is the most established pharmacist board certification program globally. Even though India is the largest global exporter of generic medications, pharmacy practice is yet to gain stronghold within its healthcare scenarios. In this article, we aim to examine the development of pharmacy practice from a global viewpoint and scale down to the recent modern practice, particularly in advanced nations. Furthermore, we assess the ways through which pharmacy practice can be enhanced in India. Notably, with several pharmacy practice graduates completing their studies in India yearly, pharmacy practice is projected to significantly grow in the coming years. Gaining a proper understanding of and embracing advanced clinical pharmacy practices will improve the domain of pharmacy practice among both junior and senior pharmacists. Moreover, enrolling in and receiving international accreditations such as the Board of Pharmacy Specializations (BPS) will validate the practice standards being offered in India as compared to other developed countries, i.e., the US. The main objective of this review is to assess various means through which pharmacy practice can be improved in India.

Knowledge levels of oncology nurses regarding evidence-based practices in the assessment and management of chemotherapy-induced peripheral neuropathy.

Objective: The study aimed to determine the level of oncology nurses' knowledge of evidence-based practice for assessing and managing chemotherapy-induced peripheral neuropathy (CIPN). Methods: This study employed a descriptive and cross-sectional research design. It was carried out with oncology nurses who were working at a university hospital in the Western Region of Turkey and who were members of the Oncology Nursing Association. The sample of the study consisted of 96 nurses who met the inclusion criteria. Results: The study sample comprised 94.8% female oncology nurses, 57.3% of whom held an undergraduate degree, and over half (58.5%) of whom were employed as clinical nurses. A majority of nurses (76.0%) indicated that they had not received any training in peripheral neuropathy. 35.4% of the nurses assessed patients receiving neurotoxic chemotherapy for peripheral neuropathy at each visit/each chemotherapy cycle. A total of 43.8% of nurses indicated that they frequently assessed patients for peripheral neuropathy at the conclusion of the treatment protocol. The oncology nurses assessed the patient-reported symptoms of motor neuropathy (58.3%), sensory neuropathy (56.3%), autonomic neuropathy (51.0%), neuropathic pain (55.2%), and co-occurring symptoms (52.1%) on a frequent basis. The nurses reported that they assessed muscle strength (56.3%), gait and balance (58.3%), and quality of life (52.1%) "frequently". In contrast, they assessed deep tendon reflex (41.7%), neurological tests (36.5%), and social activities (46.8%) "rarely". Conclusions: The study findings indicated that oncology nurses require further education and training in evidence-based practices for the assessment and management of CIPN.

Mapping the complexity of task demands during constant observation of patients with complex health behaviors.

Unlicensed patient care assistants (PCAs) are often tasked with providing constant observation (CO) of patients with complex health behaviors. The unique demands of CO are poorly understood, making it challenging to design effective training. Four-component instructional design theory suggests the tasks associated with CO feature non-recurrent challenges, such that effective, simulation-based deliberate practice must reflect real-life variability. This study aimed to elucidate the variety of challenges PCAs encounter during CO of patients with complex health behaviors. We used a qualitative descriptive design and developed a preliminary framework to code interviews. The data collection framework was designed to support creating numerous realistic scenarios to support generalized and transferable learning. From our interviews with 16 participants, we identified 1,066 statements associated with variations in CO tasks. We grouped our findings by two domains, "patient factors" and "environmental contexts." Our results revealed many recurring and non-recurring challenges inherent in CO, requiring a range of skills to maintain patient and staff safety. Instructional design elements may include scenarios incorporating environment and resource assessment, cognitive feedback for non-recurrent tasks, novel methods of self-harm initiated by the patient, and incorporating interdisciplinary staff in which the learner must navigate a complex conversation. This study clarifies the task demands of CO and is useful as a task analysis to guide scenario development for simulation-based experiences. A less systematic approach would risk underrepresenting the difficulties inherent in the task, reinforcing a limited set of behaviors that may not generalize well to the non-recurrent challenges in CO.

Assessment of nurse practitioners' capacity of using the ABC/2 formula for intracranial lesion volume measurement.

BACKGROUND: This study investigates the precision of nurse practitioners (NPs) in measuring intracranial lesion volumes using the ABC/2 method, a simple yet widely used technique in neurosurgical practices. Amidst physician workforce shortages, the role of NPs in clinical practice, including specialized tasks like lesion volume estimation, is gaining importance. METHODS: We conducted a retrospective study involving patients treated for intracranial meningiomas. NPs estimated tumor volumes using the ABC/2 method, which was then compared with automated ABC/2 estimations considered as the gold standard. Statistical analyses, including paired sample t-tests, Bland-Altman analysis, and Intraclass Correlation Coefficient (ICC) analysis, were employed to assess measurement accuracy and consistency. RESULTS: Among the 265 meningioma patients included, NPs measured the average tumor volume as 36.95 ml, generally underestimating it compared to the 39.57 ml average obtained by the automated ABC/2 method. This underestimation, however, was clinically modest, indicated by an average percentage difference of 6.59% and a Cohen's d value of 0.08. Consistency in measurements, assessed using Bland-Altman and ICC analyses, demonstrated a high level of agreement between NPs measurements and the automated method. Additionally, no significant differences in measurement accuracy were observed either among different NPs or across NPs with varying levels of work experience. CONCLUSIONS: Nurse practitioners can effectively employ the ABC/2 method for estimating intracranial lesion volumes with reasonable accuracy and consistency, irrespective of their work experience. This finding is pivotal in enhancing the role of NPs in neurosurgical practices and could be significant in alleviating the strain caused by the global shortage of physicians. Future research may explore extending NPs' roles in other clinical diagnostic and therapeutic tasks.

Description of the etiological factors behind acute moderate and severe malnutrition in children under 5 years hospitalized at two high-complexity referral centers: Case series.

BACKGROUND: Acute malnutrition in children <5 years of age has a direct relationship with medical complications and mortality. We aimed to describe the etiologic factors in children with moderate and severe non-illness-related acute malnutrition who required hospitalization for treatment of malnutrition in two high-complexity hospital centers in Bogotá, Colombia. METHODS: This is a multicenter case series (December 2016 to December 2020) including patients aged 1-59 months with a weight/height indicator less than -2 SD. Electronic health records were reviewed, and demographic (sex, age, city of origin, and socioeconomic status) and clinical data (gestational age at birth, edema, and nutrition status) were collected. Descriptive analysis of information was performed. An exploratory bivariate analysis by diagnostic categories of moderate and severe acute malnutrition vs days of hospitalization was also performed. RESULTS: Forty-five patients were included, 62.2% of whom were male, with a median age of 14 months (Q1-Q3: 7-24). The main etiologic factors of malnutrition were related to problems with total food intake (33.3%), transition in consistency of feeding (31.1%), and breastfeeding technique (22.2%). Only 13.3% had problems related to food insecurity. There were no statistically significant differences between moderate (median: 7 days; Q1-Q3: 5-12) and severe (median: 8 days; Q1-Q3: 5-16) acute malnutrition when compared by days of hospitalization. CONCLUSIONS: The main etiologic factors of malnutrition in our study population were related to problems in the amount of food provided and transition in consistency of complementary feeding.

Clinical information on imaging referrals for suspected or known axial spondyloarthritis: recommendations from the Assessment of Spondyloarthritis International Society (ASAS).

OBJECTIVES: This study aims to establish expert consensus recommendations for clinical information on imaging requests in suspected/known axial spondyloarthritis (axSpA), focusing on enhancing diagnostic clarity and patient care through guidelines. MATERIALS AND METHODS: A specialised task force was formed, comprising 7 radiologists, 11 rheumatologists from the Assessment of Spondyloarthritis International Society (ASAS) and a patient representative. Using the Delphi method, two rounds of surveys were conducted among ASAS members. These surveys aimed to identify critical elements for imaging referrals and to refine these elements for practical application. The task force deliberated on the survey outcomes and proposed a set of recommendations, which were then presented to the ASAS community for a decisive vote. RESULTS: The collaborative effort resulted in a set of six detailed recommendations for clinicians involved in requesting imaging for patients with suspected or known axSpA. These recommendations cover crucial areas, including clinical features indicative of axSpA, clinical features, mechanical factors, past imaging data, potential contraindications for specific imaging modalities or contrast media and detailed reasons for the examination, including differential diagnoses. Garnering support from 73% of voting ASAS members, these recommendations represent a consensus on optimising imaging request protocols in axSpA. CONCLUSION: The ASAS recommendations offer comprehensive guidance for rheumatologists in requesting imaging for axSpA, aiming to standardise requesting practices. By improving the precision and relevance of imaging requests, these guidelines should enhance the clinical impact of radiology reports, facilitate accurate diagnosis and consequently improve the management of patients with axSpA.

Benefits and risks of FDA-approved amyloid-targeting antibodies for treatment of early Alzheimer's disease: Navigating clinician-patient engagement.

The emergence of the United States Food and Drug Administration (FDA)-approved amyloid-targeting therapies for Alzheimer's disease challenges clinicians and healthcare providers with a transformative landscape. Effectively communicating the risks, benefits, burdens, costs, and available support associated with these novel disease-modifying treatments to patients, families, and other healthcare providers is essential but complex. In response, the Alzheimer's Association's Clinical Meaningfulness Workgroup has proposed language surrounding treatment eligibility, benefits, amyloid-related imaging abnormalities (ARIA), apolipoprotein E (APOE) genotyping, and treatment costs, serving as a resource to healthcare professionals in navigating discussions with patients and their families. As the landscape evolves with the approval of new Alzheimer's therapies, this resource stands poised for updates, ensuring its continued relevance in facilitating informed and meaningful patient-provider dialogues. HIGHLIGHTS: Effective communication of risks, benefits, burdens, and costs of FDA-approved amyloid-targeting antibodies is essential to patients, families, and healthcare providers. The Alzheimer's Association's Clinical Meaningfulness Workgroup provides language for physicians and healthcare providers around treatment eligibility, benefits, ARIA, APOE genotyping, and treatment costs. This supplementary resource may be updated as new AD therapies become approved.

Challenges in traumatic spinal cord injury care in developing countries - a scoping review.

Objective: To evaluate the leading challenges in developing countries' traumatic spinal cord injury (TSCI) care. Methods: We conducted a systematic search in electronic databases of PubMed, SCOPUS, Web of Science, EMBASE, and Cochrane Library on 16 April 2023. Studies that investigated challenges associated with the management of TSCI in developing countries were eligible for review. We extracted related outcomes and categorized them into four distinct parts: injury prevention, pre-hospital care, in-hospital care, and post-hospital care. Results: We identified 82 articles that met the eligibility criteria including 13 studies on injury prevention, 25 on pre-hospital care, 32 on in-hospital care, and 61 on post-hospital care. Challenges related to post-hospital problems including the personal, financial, and social consequences of patients' disabilities and the deficiencies in empowering people with TSCI were foremost studied. Lack of trained human resources, insufficient public education and delays in care delivery were barriers in the acute and chronic management of TSCI. A well-defined pre-hospital network and standard guidelines for the management of acute neurotrauma are needed. Critical challenges in injury prevention include deficiencies in infrastructure and supportive legislation. Conclusion: Studies focusing on injury prevention and pre-hospital care in TSCI management in developing countries warrant further investigation. It is imperative to develop systematic and evidence-based initiatives that are specifically tailored to the unique circumstances of each country to address these challenges effectively. By understanding the primary obstacles, policymakers and healthcare providers can establish goals for improving education, planning, legislation, and resource allocation.

Primary nursing in the intensive care unit.

Background: Primary nursing (Process Responsible Nursing; PRN) is a nursing organization model, practiced in intensive care units (ICUs), but implementation is challenging. This paper focuses on the qualitative process analysis of the development and implementation of PRN in an ICU at a German university hospital. Aims: Aim was to record the perception of changes in nursing practice due to the introduction of PRN and obtain information on implementation and further optimization perceived by nurses. Method: A qualitative process analysis was done. Data collection took place at three defined times (immediately before implementation and 6 and 12 months after) and each included a focus group interview (FG) and a 5-day ICU ward process analysis (WA) in the form of participant observation. The analysis of FG and WA was carried out according to Kuckartz's content-structuring qualitative content analysis. Findings: The main categories communication, care planning and integration of patients and relatives in care and 13 subcategories with a cross-sectional category could be identified. Positive effects of PRN were found, particularly concerning relatives. The optimization potential included handover, visit appointments, the documentation system and adjustments to the visiting times. Conclusion: The qualitative analysis was able to show changes during the introduction of PRN, e.g. in communication and care planning, but also challenges like visit appointments or the documentation system in nursing practice.

Healthcare-related carbon footprinting-lower impact of a coronary stenting compared to a coronary surgery pathway.

Healthcare is a major generator of greenhouse gases, so consideration of this contribution to climate change needs to be quantified in ways that can inform models of care. Given the availability of activity-based financial data, environmentally-extended input-output (EEIO) analysis can be employed to calculate systemic carbon footprints for healthcare activities, allowing comparison of different patient care pathways. We thus quantified and compared the carbon footprint of two common care pathways for patients with stable coronary artery disease, with similar clinical outcomes: coronary stenting and coronary artery bypass surgery (CABG). Healthcare cost data for these two pathways were disaggregated and the carbon footprint associated with this expenditure was calculated by connecting the flow of money within the economy to the greenhouse gases emitted to support the full range of associated activities. The systemic carbon footprint associated with an average stable patient CABG pathway, at a large tertiary referral hospital in Sydney, Australia in 2021-22, was 11.5 tonnes CO2-e, 4.9 times greater than the 2.4 tonnes CO2-e footprint of an average comparable stenting pathway. These data suggest that a stenting pathway for stable coronary disease should be preferred on environmental grounds and introduces EEIO analysis as a practical tool to assist in health-care related carbon footprinting.