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The objective of this scoping review was to survey the literature on the use of AI/ML applications in analyzing inpatient EHR data to identify bundles of care (groupings of interventions). If evidence suggested AI/ML models could determine bundles, the review aimed to explore whether implementing these interventions as bundles reduced practice pattern variance and positively impacted patient care outcomes for inpatients with T2DM. Six databases were searched for articles published from January 1, 2000, to January 1, 2024. Nine studies met criteria and were summarized by aims, outcome measures, clinical or practice implications, AI/ML model types, study variables, and AI/ML model outcomes. A variety of AI/ML models were used. Multiple data sources were leveraged to train the models, resulting in varying impacts on practice patterns and outcomes. Studies included aims across 4 thematic areas to address: therapeutic patterns of care, analysis of treatment pathways and their constraints, dashboard development for clinical decision support, and medication optimization and prescription pattern mining. Multiple disparate data sources (i.e., prescription payment data) were leveraged outside of those traditionally available within EHR databases. Notably missing was the use of holistic multidisciplinary data (i.e., nursing and ancillary) to train AI/ML models. AI/ML can assist in identifying the appropriateness of specific interventions to manage diabetic care and support adherence to efficacious treatment pathways if the appropriate data are incorporated into AI/ML design. Additional data sources beyond the EHR are needed to provide more complete data to develop AI/ML models that effectively discern meaningful clinical patterns. Further study is needed to better address nursing care using AI/ML to support effective inpatient diabetes management. Lymphoedema is a chronic condition caused by lymphatic insufficiency. It leads to swelling of the limb/midline region and an increased risk of infection. Lymphoedema is often associated with mental and physical problems limiting quality of life. The first choice of treatment is a conservative treatment, consisting of exercises, skin care, lymph drainage and compression. Reconstructive lymphatic surgery is also often performed, that is, lymphovenous anastomoses, lymph node transfer or a combination. However, robust evidence on the effectiveness of reconstructive lymphatic surgery is missing. Therefore, the objective of this trial is to investigate the added value of reconstructive lymphatic surgery to the conservative treatment in patients with lymphoedema.
A multicentre randomised controlled and pragmatic trial was started in March 2022 in three Belgian university hospitals. 90 patients with arm lymphoedema and 90 patients with leg lymphoedema will be included. All patients are randomised between conservative treatment alone (control group) or conservative treatment with reconstructive lymphatic surgery (intervention group). Assessments are performed at baseline and at 1, 3, 6, 12, 18, 24 and 36 months. The primary outcome is lymphoedema-specific quality of life at 18 months. Key secondary outcomes are limb volume and duration of wearing the compression garment at 18 months. The approach of reconstructive lymphatic surgery is based on presurgical investigations including clinical examination, lymphofluoroscopy, lymphoscintigraphy, lymph MRI or CT angiography (if needed). All patients receive conservative treatment during 36 months, which is applied by the patient’s own physical therapist and by the patient self. From months 7 to 12, the hours a day of wearing the compression garment are gradually decreased.
The study has been approved by the ethical committees of University Hospitals Leuven, Ghent University Hospital and CHU UCL Namur. Results will be disseminated via peer-reviewed journals and presentations.
The femoral head contralateral to the collapsed femoral head requiring total hip arthroplasty (THA) often manifests in the precollapse stage of osteonecrosis of the femoral head (ONFH). It is not yet demonstrated how autologous concentrated bone marrow injection may prevent collapse of the femoral head concurrent with contralateral THA. The primary objective is to evaluate the efficacy of autologous concentrated bone marrow injection for the contralateral, non-collapsed, femoral head in patients with bilateral ONFH, with the ipsilateral collapsed femoral head undergoing THA.
This is a multicentre, prospective, non-randomised, historical-data controlled study. We will recruit patients with ONFH who are scheduled for THA and possess a non-collapsed contralateral femoral head. Autologous bone marrow will be collected using a point-of-care device. After concentration, the bone marrow will be injected into the non-collapsed femoral head following the completion of THA in the contralateral hip. The primary outcome is the percentage of femoral head collapse evaluated by an independent data monitoring committee using plain X-rays in two directions 2 years after autologous concentrated bone marrow injection. Postinjection safety, adverse events, pain and hip function will also be assessed. The patients will be evaluated preoperatively, and at 6 months, 1 year and 2 years postoperatively.
This protocol has been approved by the Certified Committee for Regenerative Medicine of Tokyo Medical and Dental University and Japan’s Ministry of Healthy, Labour and Welfare and will be performed as a class III regenerative medicine protocol, in accordance with Japan’s Act on the Safety of Regenerative Medicine. The results of this study will be submitted to a peer-review journal for publication. The results of this study are expected to provide evidence to support the inclusion of autologous concentrated bone marrow injections in the non-collapsed femoral head in Japan’s national insurance coverage.
jRCTc032200229.
During the preschool years, children depend on adult caregivers to provide opportunities for physical activity (PA). Research has focused on measuring PA in preschool, as well as barriers and facilitators to children’s PA but caregiver perceptions remain largely unknown especially in light of the COVID-19 pandemic. This study aims to understand the value of PA in preschool following the pandemic from three types of adult caregivers, parents of a young child (n=7), preschool teachers (n=7) and preschool administrators (n=7).
In-depth qualitative interviews were conducted to explore the following research questions: (a) how do caregivers describe the importance of PA in preschool postpandemic? (b) how do caregivers support and prioritise PA in preschool postpandemic and what challenges do they face in doing so? and (c) how do caregivers interact with one another to promote PA? Qualitative answers were coded using a codebook developed to answer the research questions of interest.
Parents, teachers and administrators all described valuing PA for preschoolers, but each caregiver type described a different way of promoting it. All the caregivers listed barriers that inhibit their ability to prioritise and promote PA, some heightened postpandemic. Lastly, there were limited caregiver interactions when it came to promoting PA, with the burden largely falling on teachers.
Our findings indicate that one particularly important area for intervention is supporting parents, teachers and preschool administrators in creating a shared understanding of the importance of PA for young children and ways to collaborate to promote it.
Children with sickle cell disease show a significant decrease in bone mineral density, an increase in resting energy expenditure of more than 15%, a decrease in fat and lean mass as well as a significant increase in protein turnover, particularly in bone tissue. This study aims to evaluate the effectiveness of an increase in food intake on bone mineral density and the clinical and biological complications of paediatric sickle cell disease.
The study is designed as an open-label randomised controlled clinical trial conducted in the Paediatrics Unit of the Orléans University Hospital Centre. Participants aged 3–16 years will be randomly divided into two groups: the intervention group will receive oral nutritional supplements (pharmacological nutritional hypercaloric products) while the control group will receive age-appropriate and gender-appropriate nutritional intake during 12 months. Total body less head bone mineral density will be measured at the beginning and the end of the trial. A rigorous nutritional follow-up by weekly 24 hours recall dietary assessment and planned contacts every 6 weeks will be carried out throughout the study. A school absenteeism questionnaire, intended to reflect the patient’s school productivity, will be completed by participants and parents every 3 months. Blood samples of each patient of both groups will be stocked at the beginning and at the end of the trial, for future biological trial. Clinical and biological complications will be regularly monitored.
The protocol has been approved by the French ethics committee (Comité de Protection des Personnes Sud-Ouest et Outre-Mer 2, Toulouse; approval no: 2-20-092 id9534). Children and their parents will give informed consent to participate in the study before taking part. Results will be disseminated through peer-reviewed journals or international academic conferences.
To analyse the process of elaborating social representations about pressure injury preventive measures by the nursing team (nurses and nurse technicians) and how this process relates to preventive practices for hospitalized patients.
Qualitative study, with the application of the theory of social representations in its procedural methodological approach.
The study was carried out in an inpatient clinic of a public hospital in the state of Rondônia, Brazil. Totally, 28 nursing professionals in the medical clinic sectors who had worked directly with patient care for more than 6 months participated. The data were collected between July and September 2021 via in-depth interviews with the application of a semi-structured instrument. Analysis was carried out with the help of ALCESTE software, which performed a lexicographic analysis, and also via thematic analysis. The COREQ guided the presentation of the research report.
The social representations were developed based on the professionals' symbolic beliefs about the visibility/invisibility of the results of applying preventive care. These symbolic constructions mobilized positive and negative feelings among the nursing team, which guided the classification of prevention practices as being of greater or lesser priority among other care activities. There were favourable attitudes among professionals, which included applying prevention measures in their daily routines, and unfavourable attitudes of non-adherence to the institution's protocol for preventing pressure injuries.
The nursing team's perception of pressure injury prevention is influenced by symbolic, affective, values, and social dimensions. Non-adherence behaviours are attributed to the belief in the invisibility of prevention outcomes, resulting in a reluctance to implement preventive measures.
Understanding the subjective logic that explains the thinking and actions of the nursing team suggests the need to incorporate discussions on beliefs, values, sentiments, and attitudes of nursing professionals into educational programs on pressure injury prevention.
No public contribution.
by Pablo Marino Corrêa Nascimento, Luiz Fernando Rodrigues Junior, Mauro Felippe Felix Mediano, Valéria Gonçalves da Silva, Bernardo Rangel Tura, Fabio César Sousa Nogueira, Gilberto Domont, Adriana Bastos Carvalho, Antônio Carlos Campos de Carvalho, Taís Hanae Kasai-Brunswick, Claudio Tinoco Mesquita, Humberto Villacorta Junior, Helena Cramer Veiga Rey
Sarcopenia, a clinical syndrome primarily associated with reduced muscle mass in the elderly, has a negative impact on quality of life and survival. It can occur secondarily to other diseases such as heart failure (HF), a complex clinical syndrome with high morbidity and mortality. The simultaneous occurrence of these two conditions can worsen the prognosis of their carriers, especially in the most severe cases of HF, as in patients with reduced left ventricular ejection fraction (LVEF). However, due to the heterogeneous diagnostic criteria for sarcopenia, estimates of its prevalence present a wide variation, leading to new criteria having been recently proposed for its diagnosis, emphasizing muscle strength and function rather than skeletal muscle mass. The primary objective of this study is to evaluate the prevalence of sarcopenia and/or dynapenia in individuals with HF with reduced LVEF according to the most recent criteria, and compare the gene and protein expression of those patients with and without sarcopenia. The secondary objectives are to evaluate the association of sarcopenia and/or dynapenia with the risk of clinical events and death, quality of life, cardiorespiratory capacity, ventilatory efficiency, and respiratory muscle strength. The participants will answer questionnaires to evaluate sarcopenia and quality of life, and will undergo the following tests: handgrip strength, gait speed, dual-energy X-ray absorptiometry, respiratory muscle strength, cardiopulmonary exercise, as well as genomic and proteomic analysis, and dosage of N-terminal pro-B-type natriuretic peptide and growth differentiation factor-15. An association between sarcopenia and/or dynapenia with unfavorable clinical evolution is expected to be found, in addition to reduced quality of life, cardiorespiratory capacity, ventilatory efficiency, and respiratory muscle strength.Intimate partner violence (IPV) is a global public health problem. Although both men and women experience IPV, the burden is more on women. To address IPV effectively, it is important to understand the factors that cause IPV including the socioeconomic factors. However, there is an inadequacy of knowledge on how socioeconomic factors at different levels affect IPV. Hence, the objective is to review the individual-level socioeconomic factors associated with IPV victimisation of women and girls.
The search strategy was developed to identify publications from January 2010 to 30 June 2024. The selected electronic databases of PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus and Science Direct will be searched. The eligibility criteria for data collection are based on participants/population (women and girls), exposure (socioeconomic factors) and outcome (IPV). In primary search, the title and abstracts will be screened and reference lists of selected articles will be screened for additional studies. Two researchers will independently screen the articles, and in any disagreements, a third researcher will be consulted. The data will be tabulated to present the study and participant characteristics, comparison descriptors between victims and non-victims, inclusion and exclusion criteria, primary and secondary outcomes data, results, limitations and implications. A quality assessment will be performed on the selected studies to avoid bias. A narrative synthesis will summarise the findings.
Ethical approval was waived because only secondary data are used. The protocol will be published, and the findings will be disseminated via publication in a peer-reviewed journal.
CRD42022373535.
Many studies have explored the food environment to characterise it and understand its role in food practices. Assessment of the organisational food environment can contribute to the development of more effective interventions to promote adequate and healthy eating. However, few instruments and indicators have been developed and validated for assessing this type of setting. The systematisation of those can be useful to support the planning of future assessments and the development of wide-ranging instruments. This study aims to conduct a scoping review to systematise evidence on instruments and indicators for assessing organisational food environments.
This scoping review was planned according to the methodological framework for scoping reviews proposed by Arksey and O’Malley and subsequently enhanced by Levac et al. For the report of the review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Reviews (PRISMA-ScR) checklist and guidelines will be used. The search will be conducted using PubMed, Embase, Web of Science, PsycINFO, Scopus and Google Scholar databases. The studies to be included were required to have been published in peer-reviewed journals since January 2005. No geographical, population or language restrictions will be applied given the desired breadth of the review. Two researchers will select the articles and extract the data independently. The conceptual model proposed by Castro and Canella will guide the data extraction and analysis. The results will be presented with narrative synthesis for the extracted data accompanying the tabulated and charted results.
This study is based on the analysis of published scientific literature and did not involve patients, medical research, or any type of personal information; therefore, no ethical approval was obtained for this study. The results of this scoping review will be submitted for publication in an international peer-reviewed journal, preferably open access.
To evaluate changes in compassion fatigue (CF), burnout (BO), compassion satisfaction (CS) and fear of COVID-19 among Spanish nurses by comparing two assessment points: before and after the COVID-19 vaccination campaign.
The COVID-19 pandemic has produced a great impact in healthcare worker's professional quality of life, especially among nurses. CF, BO and fear of COVID-19 decisively affect the care provided by nurses and put them at risk for mental health problems, so longitudinal studies are essential.
A repeated cross-sectional design was carried out with a time-lapse of 12 months.
A total of 439 registered nurses in December 2020 and 410 in December 2021 participated in this study through an online survey. Data were collected using the Professional Quality of Life Questionnaire and the Fear of COVID-19 Scale. Occupational and sociodemographic variables were also analysed. This article adheres to the STROBE guidelines for the reporting of observational studies.
The fear of COVID-19 has not been reduced among nurses. The levels of BO remain stable and continue to be high in half of the professionals. CF has been reduced with a small effect size (d = 0.30), while CS has also decreased (d = 0.30). Positive correlations were found in both assessment points between fear of COVID-19 and BO (r = .44, p ≤ .001; r = .41, p ≤ .001) and also between fear of COVID and CF (r = .57, p ≤ .001; r = .50, p ≤ .001). Negative correlations between fear and CS were also found (r = − .16, p = .001; r = − .22, p ≤ .001).
Programmes to reduce fear of COVID-19, BO and CF are needed to improve mental health and to prevent psychological distress among nurses, as well as to increase CS and preserve the productivity and quality of nursing care.
The nurses collaborated by participating in the present study anonymously and disinterestedly.
(1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID-19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects.
Nurses were at increased risk for burnout and low fulfilment prior to the COVID-19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety.
Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non-clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self-report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study.
Both at baseline and across the 5 months, nurses working during the COVID-19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses.
Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention.
Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.
by Akihiro Matsunaga, Naokatsu Ando, Yuko Yamagata, Mari Shimura, Hiroyuki Gatanaga, Shinichi Oka, Yukihito Ishizaka
BackgroundDespite effective antiretroviral therapy, patients with human immunodeficiency virus type-1 (HIV) suffer from a high frequency of malignancies, but related risk factors remain elusive. Here, we focused on blood-circulating viral protein R (Vpr) of HIV, which induces proinflammatory cytokine production and genotoxicity by exogenous functions.
Methods and findingsA total 404 blood samples of HIV patients comprising of 126 patients with malignancies (tumor group) and 278 patients without malignancies (non-tumor group), each of 96 samples was first selected by one-to-one propensity score matching. By a detergent-free enzyme-linked immunosorbent assays (detection limit, 3.9 ng/mL), we detected Vpr at a higher frequency in the matched tumor group (56.3%) than in the matched non-tumor group (39.6%) (P = 0.030), although there was no different distribution of Vpr levels (P = 0.372). We also detected anti-Vpr immunoglobulin (IgG), less frequently in the tumor group compared with the tumor group (22.9% for tumor group vs. 44.8% for non-tumor group, P = 0.002), and the proportion of patients positive for Vpr but negative of anti-Vpr IgG was significantly higher in the tumor group than in the non-tumor group (38.6% vs. 15.6%, respectively, P P P P = 0.010). Finally, multivariate logistic regression analysis suggested a positive link of Vpr with tumor occurrence in HIV patients (P = 0.002).
ConclusionVpr and IL-6 could be risk factors of HIV-1 associated malignancies, and it would be importance to monitor these molecules for well managing people living with HIV-1.
by Alex Buga, David G. Harper, Teryn N. Sapper, Parker N. Hyde, Brandon Fell, Ryan Dickerson, Justen T. Stoner, Madison L. Kackley, Christopher D. Crabtree, Drew D. Decker, Bradley T. Robinson, Gerald Krystal, Katherine Binzel, Maryam B. Lustberg, Jeff S. Volek
PurposeKetogenic diets may positively influence cancer through pleiotropic mechanisms, but only a few small and short-term studies have addressed feasibility and efficacy in cancer patients. The primary goals of this study were to evaluate the feasibility and the sustained metabolic effects of a personalized well-formulated ketogenic diet (WFKD) designed to achieve consistent blood beta-hydroxybutyrate (βHB) >0.5 mM in women diagnosed with stage IV metastatic breast cancer (MBC) undergoing chemotherapy.
MethodsWomen (n = 20) were enrolled in a six month, two-phase, single-arm WFKD intervention (NCT03535701). Phase I was a highly-supervised, ad libitum, personalized WFKD, where women were provided with ketogenic-appropriate food daily for three months. Phase II transitioned women to a self-administered WFKD with ongoing coaching for an additional three months. Fasting capillary βHB and glucose were collected daily; weight, body composition, plasma insulin, and insulin resistance were collected at baseline, three and six months.
ResultsCapillary βHB indicated women achieved nutritional ketosis (Phase I mean: 0.8 mM (n = 15); Phase II mean: 0.7 mM (n = 9)). Body weight decreased 10% after three months, primarily from body fat. Fasting plasma glucose, plasma insulin, and insulin resistance also decreased significantly after three months (p Conclusions
Women diagnosed with MBC undergoing chemotherapy can safely achieve and maintain nutritional ketosis, while improving body composition and insulin resistance, out to six months.
by Sylwia Bloch, Natalia Lewandowska, Joanna Zwolenkiewicz, Paulina Mach, Aleksandra Łukasiak, Mikołaj Olejniczak, Logan W. Donaldson, Grzegorz Węgrzyn, Bożena Nejman-Faleńczyk
The 24B_1 small non-coding RNA molecule has been identified in Escherichia coli after induction of Shiga toxin-converting bacteriophage Φ24B. In this work, we focused on its direct role during phage and bacterial host development. We observed that in many aspects, this phage sRNA resembles herpesviral microRNAs. Similar to microRNAs, the mature 24B_1 is a short molecule, consisting of just 20 nucleotides. It is generated by cleaving the 80-nt long precursor transcript, and likely it undergoes a multi-step maturation process in which the Hfq protein plays an important role, as confirmed by demonstration of its binding to the 24B_1 precursor, but not to the 24B_1 mature form. Moreover, 24B_1 plays a significant role in maintaining the prophage state and reprogramming the host’s energy metabolism. We proved that overproduction of this molecule causes the opposite physiological effects to the mutant devoid of the 24B_1 gene, and thus, favors the lysogenic pathway. Furthermore, the 24B_1 overrepresentation significantly increases the efficiency of expression of phage genes coding for proteins CI, CII, and CIII which are engaged in the maintenance of the prophage. It seems that through binding to mRNA of the sdhB gene, coding for the succinate dehydrogenase subunit, the 24B_1 alters the central carbon metabolism and causes a drop in the ATP intracellular level. Interestingly, a similar effect, called the Warburg switch, is caused by herpesviral microRNAs and it is observed in cancer cells. The advantage of the Warburg effect is still unclear, however, it was proposed that the metabolism of cancer cells, and all rapidly dividing cells, is adopted to convert nutrients such as glucose and glutamine faster and more efficiently into biomass. The availability of essential building blocks, such as nucleotides, amino acids, and lipids, is crucial for effective cell proliferation which in turn is essential for the prophage and its host to stay in the lysogenic state.To explore and model factors affecting antibiotic prescribing decision-making early in the pandemic.
Semistructured qualitative interview study.
National Health Service (NHS) trusts/health boards in England and Wales.
Clinicians from NHS trusts/health boards in England and Wales.
Individual semistructured interviews were conducted with clinicians in six NHS trusts/health boards in England and Wales as part of the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients study, a wider study that included statistical analysis of procalcitonin (PCT) use in hospitals during the first wave of the pandemic. Thematic analysis was used to identify key factors influencing antibiotic prescribing decisions for patients with COVID-19 pneumonia during the first wave of the pandemic (March to May 2020), including how much influence PCT test results had on these decisions.
During the first wave of the pandemic, recommendations to prescribe antibiotics for patients with COVID-19 pneumonia were based on concerns about secondary bacterial infections. However, as clinicians gained more experience with COVID-19, they reported increasing confidence in their ability to distinguish between symptoms and signs caused by SARS-CoV-2 viral infection alone, and secondary bacterial infections. Antibiotic prescribing decisions were influenced by factors such as clinician experience, confidence, senior support, situational factors and organisational influences. A decision-making model was developed.
This study provides insight into the decision-making process around antibiotic prescribing for patients with COVID-19 pneumonia during the first wave of the pandemic. The importance of clinician experience and of senior review of decisions as factors in optimising antibiotic stewardship is highlighted. In addition, situational and organisational factors were identified that could be optimised. The model presented in the study can be used as a tool to aid understanding of the complexity of the decision-making process around antibiotic prescribing and planning antimicrobial stewardship support in the context of a pandemic.
by Douglas C. Smith, Crystal A. Reinhart, Shahana Begum, Janaka Kosgolla, John F. Kelly, Brandon B. Bergman, Marni Basic
Background and aimsTo date, no epidemiological survey has estimated the prevalence of adolescents identifying as being in recovery. This is necessary for planning and identifying the needs of youth with current and remitted substance use disorders. This study estimated the prevalence of recovery status in a large statewide epidemiological survey administered between January and March 2020.
ParticipantsParticipants were high school students in 9th through 12th grades throughout Illinois.
MeasurementsYouth were asked if they were in recovery and if they had resolved problems with substances. Youth who reported recovery and problem resolving dual status (DS), recovery only (RO), and problem resolution only (PRO) were compared to propensity score matched control groups who reported neither status (neither/nor; NN). Outcomes included alcohol use, binge alcohol use, cannabis use, and prescription drug use in the past 30 days.
FindingsPrevalence estimates were 884 (1.4%) for DS, 1546 (2.5%) for PRO, and 1,811 (2.9%) for RO. Relative to propensity matched control samples, all three groups had significantly lower odds of prescription drug use. The PRO group had lower odds of past month cannabis use. There were no significant differences for either alcohol outcome.
ConclusionsPrevalence estimates of youth in recovery are slightly lower than those of adults in recovery, and estimates should be replicated. Youth in recovery and those resolving problems have numerous behavioral health needs, and relative to matched controls, have even odds for past 30-day alcohol use. These findings compel us to further define recovery for adolescents and emerging adults to allow for improving treatments and epidemiological research.
Objetivo: Comprender la relación que establecen profesores, estudiantes y enfermeras asistenciales, entre teoría y práctica del cuidado cultural.
Métodos: Cualitativo, hermenéutico, con enfoque crítico. Se utilizó cuestionario socio demográfico, grupos de discusión y entrevistas episódicas.
Muestra: 34 participantes entre estudiantes, profesores y enfermeros asistenciales.
Resultados: Se identificaron tres temas: 1. Teoría y práctica del cuidado cultural en enfermería: lo aprendido. El cuidado cultural no está formalizado en el currículo, algunos aspectos del cuidado cultural son incluidos en la teoría de los cursos. 2. Práctica y teoría del cuidado cultural en enfermería: lo vivido. Los protocolos rígidos y homogeneizantes de las instituciones de salud fueron los mayores obstáculos para concretar en la práctica el cuidado cultural. 3. Relación entre la teoría y la práctica en Enfermería: lo reconocido. Los profesores reconocen su escasa preparación para formar a los estudiantes en el cuidado cultural.
Conclusiones: Existe una fisura entre la teoría y la práctica en torno al cuidado cultural. Se requiere incluir el cuidado cultural en el currículo y hacerlo congruente con la teoría y la práctica, permitiendo el diálogo de saberes y superando no solo barreras comunicativas, sino actitudinales e institucionales, las cuales se encontraron presentes en el estudio.
Las comunidades educativas tienen el potencial de proyectarse como nichos transformadores de las condiciones de vida a partir de la integración de sus actores en torno a la identificación de las necesidades en salud y la búsqueda de alternativas para resolverlas. En el marco de la maestría en Salud Pública de la Universidad de La Sabana se ha avanzado en estrategias para generar este vínculo, a través del acompañamiento en la formulación de un programa de salud comunitaria en un entorno educativo, basados en la adaptación del modelo Precede-Procede, un método para planear, conducir y evaluar intervenciones de educación para la salud. Teniendo en cuenta lo anterior, el objetivo es reflexionar sobre los aportes del modelo para la formulación de programas de salud comunitaria en entornos educativos, a propósito de la Atención Primaria en Salud (APS) y las políticas de entornos educativos saludables, considerando que son referentes normativos en el territorio colombiano. En síntesis, el modelo Precede-Procede se considera una opción favorable para la formulación de programas de salud en el contexto educativo porque privilegia el enganche y la participación comunitaria; aborda problemáticas contextualizadas y da la posibilidad para que desde edades tempranas se integren estudiantes, además de sus docentes, padres de familia y autoridades administrativas, para consolidar comunidades educativas transformadas en gestoras sociales de su propia salud.
by Timothy R. Elliott, Yu-Yu Hsiao, Kathleen Randolph, Randall J. Urban, Melinda Sheffield-Moore, Richard B. Pyles, Brent E. Masel, Tamara Wexler, Traver J. Wright
Debilitating symptoms of fatigue and accompanying “brain fog” are observed among patients with various chronic health conditions. Unfortunately, an efficient and psychometrically sound instrument to assess these co-occurring symptoms is unavailable. Here, we report the development and initial psychometric properties of the Fatigue and Altered Cognition Scale (the FACs), a measure of self-reported central fatigue and brain fog. Traumatic brain injury (TBI) was chosen to model and develop the FACs due to research team expertise and established links between TBI and the symptom complex. Potential items were generated by researchers and clinicians with experience treating these symptoms, drawing from relevant literature and review of patient responses to measures from past and current TBI studies. The 20 candidate items for the FACs—ten each to assess altered cognition (i.e., brain fog) and central fatigue–were formatted on an electronic visual analogue response scale (eVAS) via an online survey. Demographic information and history of TBI were obtained. A total of 519 participants consented and provided usable data (average age = 40.23 years; 73% female), 204 of whom self-reported a history of TBI (75% reported mild TBI). Internal consistency and reliability values were calculated. Confirmatory factor analysis (CFA) examined the presumed two-factor structure of the FACs and a one-factor solution for comparison. A measurement invariance test of the two latent constructs (altered cognition, fatigue) among participants with and without TBI was conducted. All items demonstrated normal distribution. Cronbach’s alpha coefficients indicated good internal consistency for both factors (α’s = .95). Omega reliability values were favorable (α’s = .95). CFA supported the presumed two-factor model and item loadings which outperformed the one-factor model. Measurement invariance found the two-factor structure was consistent between the two groups. Implications of these findings, study limitations, and potential use of the FACs in clinical research and practice are discussed.by Sona M. Al Younis, Leontios J. Hadjileontiadis, Aamna M. Al Shehhi, Cesare Stefanini, Mohanad Alkhodari, Stergios Soulaidopoulos, Petros Arsenos, Ioannis Doundoulakis, Konstantinos A. Gatzoulis, Konstantinos Tsioufis, Ahsan H. Khandoker
Heart Failure (HF) significantly impacts approximately 26 million people worldwide, causing disruptions in the normal functioning of their hearts. The estimation of left ventricular ejection fraction (LVEF) plays a crucial role in the diagnosis, risk stratification, treatment selection, and monitoring of heart failure. However, achieving a definitive assessment is challenging, necessitating the use of echocardiography. Electrocardiogram (ECG) is a relatively simple, quick to obtain, provides continuous monitoring of patient’s cardiac rhythm, and cost-effective procedure compared to echocardiography. In this study, we compare several regression models (support vector machine (SVM), extreme gradient boosting (XGBOOST), gaussian process regression (GPR) and decision tree) for the estimation of LVEF for three groups of HF patients at hourly intervals using 24-hour ECG recordings. Data from 303 HF patients with preserved, mid-range, or reduced LVEF were obtained from a multicentre cohort (American and Greek). ECG extracted features were used to train the different regression models in one-hour intervals. To enhance the best possible LVEF level estimations, hyperparameters tuning in nested loop approach was implemented (the outer loop divides the data into training and testing sets, while the inner loop further divides the training set into smaller sets for cross-validation). LVEF levels were best estimated using rational quadratic GPR and fine decision tree regression models with an average root mean square error (RMSE) of 3.83% and 3.42%, and correlation coefficients of 0.92 (p
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