bluuebunny/crossref_metadata_2025 huggingface dataset:
31: CHALLENGES OF HUMAN RESOURCES MANAGEMENT IN QUALITY IMPROVEMENT BY CLINICAL RISK MANAGEMENT: A QUALITATIVE STUDY ON IRANIAN NURSES' EXPERIENCES
Authors: Farokhzadian Jamileh , Borhani Fariba , Poorchangizi Batool , Nayeri Nahid Dehghan
Published: May 2024

Background and aims:

In recent years serious deficiencies have been identified in the quality of care and patient safety. Clinical risks have created concerns and challenges throughout the healthcare. In 2000, the Institute of Medicine in a report published about 44 000 to 98 000 people die annually as a result of failures in healthcare. After this report hospitals focused on quality improvement using the clinical risk management (CRM) system. This process involves management of human resources, but limitations and shortcomings exist in these resources. The aim of this study was to explore nurses' experiences related to the challenges of human resources management in implementing CRM in the hospitals context.

Methods:

This qualitative study was based on the conventional content analysis of the Lundman and Graneheim approach. The purposive sampling method was used to choose 22 nurses from three hospitals affiliated with the Kerman University of Medical Sciences in southeast of Iran. Data were collected through semi-structured and deep interviews.

Results:

According to the nurses' experiences, human resources management was not suitable, because challenges had created negative perceptions about it. Efficient and competent human resources are effective in achieving the objectives of a CRM system. But, human resource management is accompanied by many challenges. The challenges were described in the following six dimensions: 1) Inadequate productivity, 2) Recession of empowerment, 3) Inappropriate evaluation of performance, 4) Lack of motivation, 5) Personal characteristics and professional competencies, 6) Ethical and professional commitments.

Conclusion:

A suitable context must be provided for nurses by their managers. They must be preparing the infrastructure of human resources management. When the organizational context is improved, nurses will be more satisfied and have a greater tendency to implement and integrate CRM in practice. Therefore, in hospitals, planning for empowerment and improvement of human resources should be placed in a strategic program. Educational programs should be correct, principled, based on the needs of nurses, in line with the purposes of CRM, and continued constantly.
34: COMPARING TWO METHODS OF ENTERAL NUTRITION IN TERMS OF THEIR COMPLICATIONS AND THE TIME NEEDED TO REACH GOAL CALORIE IN PATIENTS HOSPITALIZED IN ICU
Authors: Adineh Mohammad , Fayazi Sedigheh
Published: May 2024

Background and aims:

Nutrition support and noticing the required goal calories in patients having critical conditions are essential aspects of medical care in preventing malnutrition in these patients.

Methods:

This research is a clinical trial which was done on 60 Patients aging between 18 to 65 years old hospitalized in Intensive Care Unit (ICU) of Shiraz's Namazee hospital, South West of Iran, during April to September 2015. Patients were separated randomly into two groups. Enteral nutrition was done with infusion pump for one of the groups and intermittently for the other one. The data was collected for 7 days by a check list regarding enteral nutrition method, complications and the time needed to reach goal calories. Data analysis was done using SPSS-18 software through Chi-square and t-student test.

Results:

The results of this study showed that there was a significant difference of the mean time needed to reach target goal calorie between the continuous and intermittent nutrition methods (P<0.05), so the time was less in continuous infusion method. But, there was no significant difference between the GI complications of the two groups (P>0.05).

Conclusion:

This study showed that continuous enteral nutrition method has better outcomes in Patients hospitalized in ICU than intermittent method.
46: DEVELOPMENT OF EVIDENCE-BASED HEALTH POLICY DOCUMENTS IN DEVELOPING COUNTRIES: A CASE OF IRAN
Authors: Nasab Mohammad Hasan Imani , Seyedin Hesam , Majdzadeh Reza , Yazdizadeh Bahareh , Salehi Masoud
Published: May 2024

Background and aims:

Evidence-based policy documents that are well developed by senior civil servants and are timely available can reduce the barriers to evidence utilization by health policy makers. This study examined the barriers and facilitators in developing evidence-based health policy documents from the perspective of their producers in a developing country.

Methods:

In a qualitative study with a framework analysis approach, we conducted semi-structured interviews using purposive and snowball sampling. A qualitative analysis software (MAXQDA-10) was used to apply the codes and manage the data. This study was theory-based and the results were compared to exploratory studies about the factors influencing evidence-based health policymaking.

Results:

18 codes and three main themes of behavioral, normative, and control beliefs were identified. Factors that influence the development of evidence-based policy documents were identified by the participants: behavioral beliefs included quality of policy documents, use of resources, knowledge and innovation, being time-consuming and contextualization; normative beliefs included policy authorities, policymakers, policy administrators, and co-workers; and control beliefs included recruitment policy, performance management, empowerment, management stability, physical environment, access to evidence, policy making process, and effect of other factors.

Conclusion:

Most of the cited barriers to the development of evidence-based policy were related to control beliefs, i.e. barriers at the organizational and health system levels. This study identified the factors that influence the development of evidence-based policy documents based on the components of the theory of planned behavior.But in exploratory studies on evidence utilization by health policymakers, the identified factors were only related to control behaviors. This suggests that the theoretical approach may be preferable to the exploratory approach in identifying the barriers and facilitators of a behavior.
50: EFFECT OF LOW-LEVEL LASER THERAPY IN THE TREATMENT OF BURNING MOUTH SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Amirzade-Iranaq Mohammad Hossein , Masoumil S. M. R.
Published: May 2024

Background and aims:

low level laser therapy (LLLT) has been used in the treatment of burning mouth syndrome (BMS) for recent years and the role of intervention has not proven accurately. We conducted a systematic review and meta-analysis to investigate the efficacy of low level laser therapy (LLLT) in the treatment of burning mouth syndrome (BMS).

Methods:

We performed a search on PubMed, Embase, Scopus and Web of Science for relevant studies that met our eligibility criteria. English language restriction included and only randomized clinical trials on humans entered to this study.

Data extraction: 63 Records identified through database searching and also 1 Additional records identified by hand-searching. After removing duplicates and studies not meeting inclusion criteria like case reports and animal studies, at last 9 Full-text articles assessed for eligibility. Quality assessment of this study was executed by using the Critical Appraisal Skills Programme (CASP). Eventually 7 of these studies were selected for meta-analysis by Comprehensive meta-analysis version 2.

Results:

From Total of 9 studies 7 randomized controlled trials (RCTs) studies including BMS patients were selected. Our results shows us LLLT can relieve the sensation of mouth .WMD in visual analog scale (VAS) pain outcome score after treatment was significantly lower in the experimental groups compared with control groups (WMD=−11.42 [95% CI= −16.82, −9.72], I(2) =0%).

Conclusion:

low level laser therapy is an effective therapeutic intervention in reduction of the symptoms of burning mouth syndrome.
57: EVALUATION OF THE CIRCULATING LEVELS OF IL-12 AND IL-33 IN PATIENTS WITH BREAST CANCER: INFLUENCES OF THE TUMOR STAGES AND CYTOKINE GENE POLYMORPHISMS
Authors: Minaee Keyhan , Jafarzadeh Abdolahe , Rostami Maryam , Bonyani Mehdi , Eftekhari Moohamadhassan , Tabrizi Reza
Published: May 2024

Background and aims:

IL-12 as an anti-tumor cytokine and IL-33 a novel identified cytokine with both pro- or anti-tumor activities, play important roles in response against tumor cells. Our aim was to evaluate the IL-12 and IL-33 levels and single nucleotide polymorphisms (SNP) in their genes in patients with breast cancer.

Methods:

Blood samples were collected from 100 patients with breast cancer, and 100 healthy women were controls. The serum IL-12 and IL-33 levels were measured by ELISA. The SNP rs3212227 (in IL-12 gene) and rs1929992 (in IL-33 gene) were determined using PCR-RFLP.

Results:

The IL-12 levels similarly expressed in patients and controls. IL-12 levels in patients at stage I were significantly lower than in the healthy group (P<0.05). IL-33 levels and the IL-33/IL-12 ratio were significantly higher in patients than the control group (P<0.001). The IL-33 levels and IL-33/IL-12 ratio in stage IV patients were significantly higher than other stages and controls (PP<0.001, respectively). There were no significant differences in the frequencies of genotypes in rs3212227 and rs1929992 between patients and the control group. No significant differences were observed between subjects with various genotypes at rs3212227 and rs1929992 with respect to related cytokine levels.

Conclusion:

These results indicate that the diminished IL-12 production may contribute to the tumor establishment. The higher IL-33 levels and IL-33/IL-12 ratio in patients also indicate an imbalance in Th1/Th2 responses that may contribute to tumor development. Thus, correcting the imbalance of Th1/Th2 could be an important strategy for cancer immunotherapy.
66: EXPLORING THE APPLICATION OF EVIDENCE IN THE IRANIAN NURSES' CLINICAL JUDGMENT AND DECISION MAKING: A HYBRID QUALITATIVE STUDY
Authors: Seidi Jamal , Alhani Fatemah , Salsali Mahvash , Kazemnejad Anoushirvan
Published: May 2024

Background and aims:

Clinical judgment is based on data collection, information, interpretation, and deduction due to clinical decision making for election of kind/place and time for an intervention or priority. This process needs to apply appropriate evidences; so this study was conducted in order to explain how to use the evidence of Iranian Nurses' Clinical Judgment and Decision Making.

Methods:

This Qualitative Study was a hybrid content and concept analysis. This study was a part of a research project approved by the National Institute of Health Research that was conducted at Kurdistan University of medical sciences in 2015. Based on purposive sampling, 26 open and semi structure interviews were conducted with 18 participants. Data collection simultaneously analyzing was continued till saturation and emerging themes. In the concept analyzing, literatures including, 12 articles, 2 books, and 1thesis were selected. Then these literatures were reviewed based on thematic analyzing,

Results:

Results of content analysis showed two main themes including; integration of the type of evidence based on situational of practice (for example guidelines in emergency ward) and how to access evidence (for example access by internet). Results of content analysis showed two factors determining the level of evidence used, including normal or urgent clinical conditions, having enough time.

Conclusion:

Combined results showed that integrating evidence in clinical judgment and decision making were based on access to evidence; clinical conditions, and time. Guidelines are the best integrated evidence in emergency wards and critical condition. When the guidelines were not available or there was insufficient time, nurses used their own experiences or the expert opinion. Therefore, it is recommended to update the guidelines and localize them for having appropriate integration of evidence.
8: ACADEMIC SELF-EFFICACY AND TEST ANXIETY AMONG STUDENTS OF MEDICAL SCIENCES
Authors: Taheri-Kharameh Zahra
Published: May 2024

Background and aims:

A student's level of self-efficacy and test anxiety directly impacts their academic performance. The aim of study was to determine the relationship between academic self-efficacy and test anxiety among the students of the Qom medical sciences university.

Methods:

In this descriptive and analytical study, 100 students of the Qom University of Medical Sciences were selected via random sampling methods. The students completed the test anxiety and academic self-efficacy Questionnaires. Logistic regression analysis and Pearson correlation coefficient were used for data analysis.

Results:

The score of test anxiety of 48.2% of the students was more than the mean of test anxiety score. Results showed a negative and significant relationship between academic self-efficacy and test anxiety (r=0.21;p=0.04). Multivariate logistic regression analysis showed self-efficacy predicts the test anxiety (OR=0.34, % 95 CI: 0.16–0.74).

Conclusion:

The findings of this study showed that the students with higher self-efficacy experience lower test anxiety. Therefore, the strengthening of this individual feature in students can lead to the better performance of students in the exam situation by decreasing of test anxiety
88: MANAGER'S PERSONALITY TYPE: DOES IT MAKE DIFFERENCE IN THE APPLICATION OF EVIDENCE-BASED PRACTICE APPROACH
Authors: Sokhanvar Mobin , Naderi Bahar , Kakemam Edris , Arab-Zozani Morteza , Mousazadeh Yalda
Published: May 2024

Background and aims:

Managers are responsible for their decisions and organizational performance. Evidence-based practice (EBP) can improve decision effectiveness and secure organization against potential risks. This study was conducted to investigate the relationship between managers personality type and using evidence- based practice approach.

Methods:

This descriptive-analytical study was done in 2015 among managers of Tehran teaching hospitals. Census method was used to sampling and all hospital managers (44 managers) were selected. Standard DISC personality test and researcher-designed questionnaire (about using EBP approach) were used for data collection. Data analyzes were performed through SPSS-V20 software by using One-Way ANOVA and Tukey statistical tests.

Results:

The response rate was 86.4 percent. The 81.6 percent of managers were men and mean age of all participates was 46.7 years. The 57.8 percent of managers had academic education in management. Findings showed that the portion of dominant, influential, steady and conscientious personality types were 36.4, 27.3, 13.6, and 22.7 percent, respectively. The mean of using EBP approach was 3.1 of five point scale. The results of One-Way ANOVA showed that the scores of EBP using were different based on personality types (p<0.05). The Tukey's results determined that the mentioned difference was related to conscientious personality type.

Conclusion:

Managers with conscientious personality type had used EBP approach more than others. Therefore, it can be suggested to conduct similar studies in larger samples and using the results of these studies in recruiting processes particularly for key jobs.
91: NARRATIVE REVIEW OF WOMEN'S HEALTH IN IRAN: CHALLENGES AND SUCCESSES
Authors: Akbari Maryam , Joulaei Hasan
Published: May 2024

Background and aims:

In each society, the health of women in different periods may be endangered by an unequal distribution of resources, facilities, and gender prejudices. The present study evaluated the time trend of Iranian women's health between 1990 and 2013.

Methods:

This narrative review includes an integration and descriptive summary of the existing evidence on trends and criteria of different aspects of women's health from social determinant point of view. The evidence was drawn from peer-reviewed, cross-national or large-scale studies, official sources of the Ministry of Health, reviews, and online scientific databases published between 1990 and 2013.

Results:

The average life expectancy of Iranian women has increased from 44.15 years in 1960 to 75.75 years in 2012; in most deprived provinces of Iran, however, this criterion is about 67.3 years, and in the capital it is 75.8 years. In 2011, 43.37% of DALYS, 36.21% of YLL, and 1.92% of YLD were dedicated to women; these figures were 3.63% lower than they were in 2003. Although a significant reduction has occurred in maternal mortality rate, which dropped from 83 to 23 per 100,000 between 1990 and 2013, there is no equal distribution in maternal mortality across the country as manifested by the unfavorable conditions of border provinces (SD=19.2). The prevalence of HIV/AIDS is an alarming health problem among Iranian females, increasing approximately 546% between 2007 and 2015. As for mental health, depression in women was ranked first among diseases in 2011 compared to a second place ranking in 2003. As regards social health, the delinquency of women has increased in recent years compared to men with women committing more crimes related to drugs and actions against virtue. The annual report of the United Nations for the gender gap index in 2013 ranked Iran as 130 among 136 countries (from 0.622 in 2000 to 0.584 in 2013).

Conclusion:

Generally, over the last three decades, the health indices of Iranian women have grown in aspects of physical, mental, and social health. Remarkable differences can be seen among female health indices based on geographic location and in comparison with men. To promote an improved health status for Iranian women, the root causes of the discrepancies must be identified and a comprehensive national plan must be established.
Scoping review of exposure questionnaires and surveys in interstitial lung disease
Authors: Barnes Hayley , Elmrayed Seham , Barber Christopher Michael , Feary Johanna , Lee Cathryn T , Gandhi Sheiphali , Peters Cheryl E , Salisbury Margaret L , Johannson Kerri A
Published: May 2024

Background

Many interstitial lung diseases (ILDs) have clear causal relationships with environmental and occupational exposures. Exposure identification can assist with diagnosis, understanding disease pathogenesis, prognostication and prevention of disease progression and occurrence in others at risk. Despite the importance of exposure identification in ILD, there is no standardised assessment approach. Many questionnaires are in clinical and research use, yet their utility, applicability, relevance and performance characteristics are unknown.

Objectives

This scoping review aimed to summarise the available evidence relating to ILD exposure assessment questionnaires, identify research gaps and inform the content for a future single evidence-based ILD questionnaire.

Methods

A scoping review based on Arksey and O’Malley’s methodological framework was conducted. Eligibility criteria: Any questionnaire that elicited exposures specific to ILD was included. A modified COSMIN Risk of Bias Framework was used to assess quality. Sources of evidence: Relevant articles were identified from MEDLINE and EMBASE up to 23 July 2023.

Results

22 exposure questionnaires were identified, including 15 generally pertaining to ILD, along with several disease-specific questionnaires for hypersensitivity pneumonitis (n=4), chronic beryllium disease, sarcoidosis and silicosis (1 questionnaire each). For most questionnaires, quality was low, whereby the methods used to determine exposure inclusion and questionnaire validation were not reported or not performed. Collectively the questionnaires covered 158 unique exposures and at-risk occupations, most commonly birds, mould/water damage, wood dust, asbestos, farming, automotive mechanic and miners. Only five questionnaires also provided free-text fields, and 13 queried qualifiers such as temporality or respiratory protection.

Conclusions

Designing a robust ILD-specific questionnaire should include an evidence-based and relevance-based approach to exposure derivation, with clinicians and patients involved in its development and tested to ensure relevance and feasibility.
13 What works, for whom and in which circumstances when implementing the namaste advanced dementia care programme in the home setting?
Authors: Dalkin Sonia Michelle , Lhussier Monique , Atkinson Joanne , Kendall Nicola , Tolman Sharron
Published: May 2024

Introduction

The Namaste Advanced Demntia Care Programme is a holistic, novel approach based on the five senses, aimed at evoking an emotional response and providing positive ways of communicating with those who have advanced dementia (www.namastecare.com). Namaste has been utilised in care homes internationally (Simard and Volicer, 2010) yet use in the home setting has been scarce. A hospice in the North East of England has implemented Namaste in peoples’ homes through training and matching volunteers to families.

Aim

To begin to understand what works, for whom and in which circumstances when implementing Namaste Care in the home setting.

Methods

A realist evaluation framework was utilised to develop initial programme theories about the use of Namaste in the home setting (Pawson and Tilley, 1997). The theories were developed through three realist focus groups with Namaste volunteers. Data was analysed using context-mechanism-outcome configurations (CMOC). The theories detail if, how and under which circumstances the Namaste Programme works.

Results

Four initial programme theories were developed which were focused around (1) the impact on the person (2) the use of Namaste in the home setting (3) family’s independent use of Namaste (4) the relationships between the person with dementia, the volunteer and the family.

Conclusion

De-hospitalisation is a current policy driver (Foot et al., 2014); this public health approach works towards creating a community of care through engaging the family and community volunteers. The programme theories developed can now be tested in a larger scale study to further demonstrate the impact of Namaste in the home setting.

References

. Foot C, Sonola L, Bennett L, Fitzsimons B, Raleigh V, Gregory S. Managing quality in community health care services.The King’s Fund2014.

. Pawson R, Tilley N.Realistic Evaluation,London Sage.

. Simard J, Volicer L. Effects of Namaste Care on Residents Who Do Not Benefit From Usual Activities.American Journal of Alzheimer’s Disease & Other Dementias2010;25:46–50.
29 Working with dying men in a group setting
Authors: Kravitz Peter
Published: May 2024

This workshop explores working with long-term men’s groups. It will examine the breadth of topics involved and describe the range of skills required by the facilitators.

‘My pain has stabilised – I now have to find a way of living again.’

This presentation follows someone who has always thought of themselves as the hero becoming the one who is being looked after. However gradual this transition may be, to the person experiencing it, it can seem so sudden as to be shocking.

‘In the group anything can come up. It’s people sharing experiences, good or bad, funny or sad. It’s a type of conversation that is hard to get elsewhere.’

These are typical words from one member of the weekly Men’s Group. This presentation will consider what happens when patients with an advanced cancer diagnosis begin to meet regularly in a facilitated single gender setting.

What are the ways back to finding meaning when your life is significantly abbreviated? Shifts occur and this can be challenging to follow in facilitation.

Conversation topics amongst men such as current affairs and sport flow into comparisons of how each person’s pain is treated. A dominant theme is fear of loss of control. Indeed, such issues inevitably arise between group members as well. This may provoke reaction, where a response is what is required.

What happens within the envelope of confidentiality of the group is surprising. In the privacy of a regular group, men here show that courage is a lot more than a wall-off-fear-and-battle-on approach.
32 Improving patient and public involvement in end of life care research
Authors: Seddon Kathy , Murray Alexandra , Buckle Peter
Published: May 2024

Introduction

Members of the Marie Curie (MC) Expert Voices Group (EVG) have all cared for someone at the end of life. Research EVG (REVG) members use this experience to contribute to research. To improve Patient and Public Involvement (PPI) in end of life research they used motivation theory to review case studies of their contributions

Aim(s)

To improve the quality of PPI in end of life care (EOLC) research through consideration of motivation, using REVG case studies.

Method(s)

Review case studies of REVG involvement in EOLC research.

Note factors contributing to participant sense of efficacy.

Explore alignment with participant professed reasons for contributing to research thus draw together key factors promoting successful PPI.

Results

Case Studies of REVG involvement at all stages of research cycles included:

• Reviewing research submissions e.g. Research Centre QQR

• Questionnaire design and wording e.g. Delphi study on advance care planning

• Consensus days e.g. Bereavement consensus days

• Dissemination e.g. Presentations to government. Brain Tumour information sheet

• Impact e.g. Use of case studies for review publications

Factors found to contribute to participant sense of efficacy in these examples included:

• Targeted informative invitations

• Clear jargon free instructions

• Good facilitation drawing out participant experiences

Ensuring alignment with participant’s reasons for action included:

• Opportunities to use all expertise

• Understanding the range of participant goals and planning to allow them to be met

Conclusion(s)

PPI may be more effective if participant motivational needs are understood and planned for.

References

. Bandura, A. (1993). Perceived self-efficacy in cognitive development and functioning. Educational Psychologist, 28, 117–148.

. Csikszentmihalyi, M. (1997b). Finding flow. New York: Basic Books.

. de Charms, R. (1976). Enhancing motivation. New York: Irvington.

. Deci, E. L. (1980). The psychology of self-determination. Lexington MA: D. C. Heath.

. Maslow, A. H. (1968). Towards a psychology of being. New York: Van Nostrand-Rheinhold.

. Yin, R. (1994). Case study research: Design and methods (2nd edn.). Thousand Oaks, CA: Sage Publishing.
44 Marie curie echo network: an innovative practice development initiative
Authors: Cassidy Lyndsay , Heneghan Paula , O’Kane Eamon
Published: May 2024

Introduction

Palliative care is increasingly delivered in the community by health care assistants caring for people in their own homes. To ensure these lone workers are well supported and have access to evidence based education is crucial. Due to the geographical challenges, Marie Curie considered novel ways in which we could reach these workers better.

Marie Curie in Northern Ireland successfully submitted a bid to be part of Project Echo NI. Project Echo is a telementoring programme which uses video-conferencing and is led in Northern Ireland by Northern Ireland Hospice.

Aim

This model aimed to enable community based health care assistants to access education, and increase their knowledge and confidence in caring for people living with a terminal illness.

Methods

Project Echo uses a hub and spoke model, with members of a multi-disciplinary team being at the hub and participants logging in from around Northern Ireland (spokes). Participants generate the topics that they wish to cover in the programme. Evaluation data was collected at 6 time points throughout the programme.

Results

Complete evaluation data will be presented. Positive evaluation results around the technology and method of learning demonstrate how this could be replicated in other areas around the country. Peer learning and access to the multi-disciplinary team were all seen as key in making the programme effective.

Conclusions

Project Echo is an internationally recognised programme, which has been used effectively to deliver a person centred approach to practice development. Marie Curie is now considering other uses for this technology.

References

. Devlin, M. & Mcilfatrick, S. 2010. Providing Palliative and End-of-Life Care in the Community: The Role of the Home Care Worker.International Journal of Palliative Care,16(4), 195–203.

. Herber, O. R. & Johnston, B. M. 2013. The Role of Healthcare Support Workers in Providing Palliative and End-of-Life Care in the Community: A Systematic Literature Review. Health & Social Care in the Community, 21(3), 225–235.
47 The wow consultation
Authors: Laidlaw Sheonad , Carduff Emma
Published: May 2024

Marie Curie Care are in the final stages of implementing an Electronic Patient Records (EPR) and Patient Administration System (PAS), via EmisWeb, enabling the recording of real time patient data on the ward by means of Workstations on Wheels (WOWS). It is hoped that the WOWs will be used at the bedside but health care professionals (HCP) are concerned that this will affect the patient centred care that is the cornerstone of Palliative Care.

Computers are common place in general practice. Studies by Pearce et al (2011, 2008) have been conducted looking at the relationship and interaction between doctor, patient and computer – the third party in the consultation – and show that the doctor-patient relationship changes as each relates to the computer. No research has looked at this relationship in palliative care.

A qualitative study was conducted at the Glasgow hospice using a questionnaire exploring the staff’s feelings about using the WOW in a consultation; their perception of how the patient and their family would feel; how they think that the computer will affect the consultation; and the positives and negatives of using a computer with their patients.

Results show that staff are hesitant and nervous of using WOWs by the bedside, seeing it as a physical barrier to verbal and non-verbal communication, potentially impeding the rapport – and ultimately the relationship - between HCP and patient. Staff see the benefit of using computers to capture patient centred data but not at the expense of their relationship with the patient.

References

. Pearce, C, et al. (2011) “The patient and the computer in the primary care consultation”J Am Med Inform Assoc18 (2): 138–142

. Pearce, C, et al. (2008) “Computers in the new consultation: within the first minute”Fam Pract2008 Jun; 25 (3): 202–8
55 The impact of emotional disclosure as a form of therapeutic intervention on health-related outcomes and on the well-being of people with advanced disease: a systematic review
Authors: Kupeli Nuriye , Chatzitheodorou Georgia , Candy Bridget
Published: May 2024

Introduction

Therapeutic emotional disclosure has been associated with positive psychological, physiological and behavioural changes.1In the form of expressive writing it commonly involves writing about a traumatic experience for 15 min over 3–5 consecutive days.2There is evidence that expressive writing in people with cancer may reduce pain and improve energy levels, sleep and psychological symptoms.3It has not been established in a review whether these interventions benefit people with advanced disease.

Aims

To critique and pool the evidence from randomised controlled trials (RCTs) and other comparative studies on the effectiveness of emotional disclosure in adults with advanced disease and to explore the text analysis of participant’s emotional disclosure.

Method

Four databases (Pubmed, CENTRAL, CINAHL, PsycINFO), conference proceedings and a trials register were searched for relevant studies in March 2017. A combination of MeSH and free-text terms on emotional disclosure and end-of-life were used. Key review processes will be undertaken in duplicate. If appropriate meta-analysis will be considered.

Results

The search identified unique 9014 citations. Screening these identified 33 potential relevant studies. Following full text review and contact with authors to clarify their sample population, nine studies on expressive writing met our inclusion criteria. Six were RCTs and three provide text analysis of emotional disclosure responses.

Conclusion

This review is at data extraction phase, it will be completed (as part of an Msc) by September. The findings will provide best evidence on whether a relatively simple intervention can help improve the wellbeing of people with advanced disease.

References

. Pennebaker, J.W., 1997. Writing about emotional experiences as a therapeutic process. Psychological Science, 8(3), pp.162–166.

. Pennebaker, J.W. and Beall, S.K., 1986. Confronting a traumatic event: toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95(3), p.274.

. Merz, E.L., Fox, R.S. and Malcarne, V.L., 2014. Expressive writing interventions in cancer patients: a systematic review. Health Psychology Review, 8(3), pp.339–361.
Modelled impact of virtual fractional flow reserve in patients undergoing coronary angiography (VIRTU-4)
Authors: Ghobrial Mina , Haley Hazel , Gosling Rebecca , Taylor Daniel James , Richardson James , Morgan Kenneth , Barmby David , Iqbal Javaid , Krishnamurthy Arvindra , Singh Rajender , Conway Dwayne , Hall Ian , Adam Zulfiquar , Wheeldon Nigel , Grech Ever D , Storey Robert F , Rothman Alexander , Payne Gillian , Tahir Muhammad Naeem , Smith Simon , Cooke Justin , Hunter Steven , Cartwright Neil , Sadeque Syed , Briffa Norman Paul , Al-Mohammad Abdallah , O’Toole Laurence , Rogers Dominic , Lawford Patricia V , Hose David R , Gunn Julian , Morris Paul D
Published: May 2024

Background

The practical application of ‘virtual’ (computed) fractional flow reserve (vFFR) based on invasive coronary angiogram (ICA) images is unknown. The objective of this cohort study was to investigate the potential of vFFR to guide the management of unselected patients undergoing ICA. The hypothesis was that it changes management in >10% of cases.

Methods

vFFR was computed using the Sheffield VIRTUheart system, at five hospitals in the North of England, on ‘all-comers’ undergoing ICA for non-ST-elevation myocardial infarction acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). The cardiologists’ management plan (optimal medical therapy, percutaneous coronary intervention (PCI), coronary artery bypass surgery or ‘more information required’) and confidence level were recorded after ICA, and again after vFFR disclosure.

Results

517 patients were screened; 320 were recruited: 208 with ACS and 112 with CCS. The median vFFR was 0.82 (0.70–0.91). vFFR disclosure did not change the mean number of significantly stenosed vessels per patient (1.16 (±0.96) visually and 1.18 (±0.92) with vFFR (p=0.79)). A change in intended management following vFFR disclosure occurred in 22% of all patients; in the ACS cohort, there was a 62% increase in the number planned for medical management, and in the CCS cohort, there was a 31% increase in the number planned for PCI. In all patients, vFFR disclosure increased physician confidence from 8 of 10 (7.33–9) to 9 of 10 (8–10) (p<0.001).

Conclusion

The addition of vFFR to ICA changed intended management strategy in 22% of patients, provided a detailed and specific ‘all-in-one’ anatomical and physiological assessment of coronary artery disease, and was accompanied by augmentation of the operator’s confidence in the treatment strategy.
Therapeutic Inducers of Natural Killer cell Killing (ThINKK): preclinical assessment of safety and efficacy in allogeneic hematopoietic stem cell transplant settings
Authors: Poirier Nicolas , Paquin Valérie , Leclerc Séverine , Lisi Véronique , Marmolejo Carolina , Affia Hicham , Cordeiro Paulo , Théorêt Yves , Haddad Elie , Andelfinger Gregor , Lavallée Vincent Philippe , Duval Michel , Herblot Sabine
Published: May 2024

Background

Allogeneic hematopoietic stem cell transplantation (HSCT) remains the standard of care for chemotherapy-refractory leukemia patients, but cure rates are still dismal. To prevent leukemia relapse following HSCT, we aim to improve the early graft-versus-leukemia effect mediated by natural killer (NK) cells. Our approach is based on the adoptive transfer of Therapeutic Inducers of Natural Killer cell Killing (ThINKK). ThINKK are expanded and differentiated from HSC, and exhibit blood plasmacytoid dendritic cell (pDC) features. We previously demonstrated that ThINKK stimulate NK cells and control acute lymphoblastic leukemia (ALL) development in a preclinical mouse model of HSCT for ALL. Here, we assessed the cellular identity of ThINKK and investigated their potential to activate allogeneic T cells. We finally evaluated the effect of immunosuppressive drugs on ThINKK-NK cell interaction.

Methods

ThINKK cellular identity was explored using single-cell RNA sequencing and flow cytometry. Their T-cell activating potential was investigated by coculture of allogeneic T cells and antigen-presenting cells in the presence or the absence of ThINKK. A preclinical human-to-mouse xenograft model was used to evaluate the impact of ThINKK injections on graft-versus-host disease (GvHD). Finally, the effect of immunosuppressive drugs on ThINKK-induced NK cell cytotoxicity against ALL cells was tested.

Results

The large majority of ThINKK shared the key characteristics of canonical blood pDC, including potent type-I interferon (IFN) production following Toll-like receptor stimulation. A minor subset expressed some, although not all, markers of other dendritic cell populations. Importantly, while ThINKK were not killed by allogeneic T or NK cells, they did not increase T cell proliferation induced by antigen-presenting cells nor worsened GvHD in vivo. Finally, tacrolimus, sirolimus or mycophenolate did not decrease ThINKK-induced NK cell activation and cytotoxicity.

Conclusion

Our results indicate that ThINKK are type I IFN producing cells with low T cell activation capacity. Therefore, ThINKK adoptive immunotherapy is not expected to increase the risk of GvHD after allogeneic HSCT. Furthermore, our data predict that the use of tacrolimus, sirolimus or mycophenolate as anti-GvHD prophylaxis regimen will not decrease ThINKK therapeutic efficacy. Collectively, these preclinical data support the testing of ThINKK immunotherapy in a phase I clinical trial.
0.25% bupivacaine–1% lidocaine vs 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a randomized controlled trial
Authors: Aguilera Germán , Tabilo Camilo , Jara Álvaro , Aliste Julián
Published: May 2024

Introduction

In an effort to shorten onset time, a common practice is to add lidocaine to bupivacaine. In the setting of infraclavicular block, it is unclear what the block characteristics of this practice are compared with bupivacaine alone. We hypothesized that bupivacaine alone increases the duration of motor block, sensory block, and postoperative analgesia while resulting in a slower onset time compared with a bupivacaine and lidocaine mixture.

Methods

40 patients receiving ultrasound-guided infraclavicular brachial plexus block were randomly assigned to receive either 35 mL of 0.25% bupivacaine and 1% lidocaine or 0.5% bupivacaine, both associated with perineural adjuvants (epinephrine 5 µg/mL and dexamethasone 4 mg). After the block was performed, a blinded observer evaluated the success of the block, the onset time, and the incidence of surgical anesthesia. Postoperatively, a blinded observer contacted patients who had successful blocks to inquire about the duration of motor block, sensory block, postoperative analgesia, and the presence of rebound pain.

Results

When comparing patients having bupivacaine alone versus bupivacaine and lidocaine, the mean (SD) motor block duration was 28.4 (5.2) vs 18.9 (3.1) hours, respectively; the mean difference 9.5 hours (95% CI 6.5 to 12.4; p<0.001); the mean (SD) sensory block duration was 29.3 (5.8) vs 18.7 (4.0) hours, respectively; the mean difference 10.6 hours (95% CI 7.1 to 14.0; p<0.001); the mean (SD) postoperative analgesia duration was 38.3 (7.4) vs 24.3 (6.6) hours, respectively; the mean difference 14 hours (95% CI 9.2 to 18.8; p<0.001); and the median (IQR) onset time was 35 (15) vs 20 (10) min, respectively; p<0.001. No other significant differences were detected.

Conclusions

Compared with mixed bupivacaine–lidocaine, 0.5% bupivacaine significantly prolongs sensorimotor block and postoperative analgesia at the expense of a delayed onset time.

Trial registration number

NCT05834023.
Novel intelligent supervised neuro-structures for nonlinear financial crime differential systems
Authors: Syed Farwah Ali , Fang Kwo-Ting , Kiani Adiqa Kausar , Shih Dong-Her , Shoaib Muhammad , Zahoor Raja Muhammad Asif
Published: May 2024

Artificial intelligence (AI)-based applications contribute to monitoring financial transactions and detect fraudulent activity in real-time by analyzing transaction patterns, consumer behavior, and other statistics, making them essential for quickly addressing potential threats in the fight against financial crime dynamics. Leveraging financial crime systems with intelligent supervised neuro-structures exploiting nonlinear autoregressive exogenous networks integrating damped least square (NARX-DLS) optimization methods to achieve an appropriate degree of accuracy and adaptability for the estimation of complex nonlinear financial crime differential systems (NFCDSs). The representative NFCDS for financial crime indicators is expressed as susceptible individuals, financial criminals, individuals under prosecution, imprisoned individuals, and honest individuals. The Adams numerical solver accomplishes the acquisition of synthetic data for the layer structure NARX-DLS algorithm execution to solve NFCDSs for various financial crime parameters, such as recruitment rate, influence rate, conversion rate to honest people, financial criminal prosecution rate per capita, discharge and acquittal rate from prosecutions, percentage of discharge rate from prosecution, transition rate to prison, and freedom rate. A sturdy overlap between the solutions of NARX-DLSs and the reference numerical results of NFCDSs implies that the error value is close to a desirable value of zero. The effectiveness of the NARX-DLSs is evidenced by including a variety of assessment metrics that carefully examine the model’s correctness and efficacy, including mean square error-based convergence arches, adaptive regulating parameters, error distribution, and input-error/cross-correlation analyses.
Porosity and heat transfer analysis of nanofluids due to rotating-stretching disk with Joule heating
Authors: Sultana Uzma , Mushtaq Muhammad , Ahmad Idrees , Muhammad Taseer
Published: May 2024

The magnetohydrodynamic (MHD), forced convective, rotating flow of nanofluid is investigated induced by eccentric rotations of a unsteady stretching porous disk and that of the fluid at infinity. The fluid is assumed to be incompressible, viscous, and electrically conductible. The disk and fluid away from the disk rotate about non-coincident axes at the same angular velocity. The forced convection is due to the temperature gradient between the uniform temperatures of the disk and that of the fluid far away from the disk. Consideration of the Joule heating as well as viscous dissipation have been taken into account. Nanofluids based on copper, alumina, and titania have also been assumed. Exact solution has been carried out for the velocity field. Numerical solution, on the other hand, is obtained using Crank–Nicolson algorithm for the temperature profiles. Several physical aspects of the investigation are discussed and explained by means of dimensionless parameters, Prandtl number Pr, Eckert number Ec, porosity parameter S, magnetic parameter [Formula: see text] and unsteady stretching parameter. With increasing nanoparticle volume fraction, the velocity profile is reduced, while the thickness of the boundary layer upsurges. As the unsteady parameter C gets higher values, the velocity profile enhanced whereas the temperature profile gets weaker. Fluid temperature decreases as suction parameter S raises.
Applying reinforcement learning to learn best net to rip and re-route in global routing
Authors: Gandhi Upma , Aghaeekiasaraee Erfan , Sahir  , Mousavi Payam , Bustany Ismail S. K. , Taylor Mathew E. , Behjat Laleh
Published: May 2024

Physical designers typically employ heuristics to solve challenging problems in global routing. However, these heuristic solutions are not adaptable to the ever-changing fabrication demands, and the experience and creativity of designers can limit their effectiveness. Reinforcement learning (RL) is an effective method to tackle sequential optimization problems due to its ability to adapt and learn through trial and error. Hence, RL can create policies that can handle complex tasks. This work presents an RL framework for global routing that incorporates a self-learning model called RL-Ripper. The primary function of RL-Ripper is to identify the best nets that need to be ripped and rerouted in order to decrease the number of total short violations. In this work, we show that the proposed RL-Ripper framework’s approach can reduce the number of short violations for ISPD 2018 benchmarks when compared to the state-of-the-art global router CUGR. Moreover, RL-Ripper reduced the total number of short violations after the first iteration of detailed routing over the baseline while being on par with the wirelength, VIA, and runtime. The proposed framework’s major impact is providing a novel learning-based approach to global routing that can be replicated for newer technologies.
LVMT: An Efficient Authenticated Storage for Blockchain
Authors: Li Chenxing , Beillahi Sidi Mohamed , Yang Guang , Wu Ming , Xu Wei , Long Fan
Published: May 2024

Authenticated storage access is the performance bottleneck of a blockchain, because each access can be amplified to potentially
O
(log
n
) disk I/O operations in the standard Merkle Patricia Trie (MPT) storage structure. In this article, we propose a multi-Layer Versioned Multipoint Trie (LVMT), a novel high-performance blockchain storage with significantly reduced I/O amplifications. LVMT uses the authenticated multipoint evaluation tree vector commitment protocol to update commitment proofs in constant time. LVMT adopts a multi-layer design to support unlimited key–value pairs and stores version numbers instead of value hashes to avoid costly elliptic curve multiplication operations. In our experiment, LVMT outperforms the MPT in real Ethereum traces, delivering read and write operations 6× faster. It also boosts blockchain system execution throughput by up to 2.7×.
Online Cross-modal Hashing With Dynamic Prototype
Authors: Kang Xiao , Liu Xingbo , Xue Wen , Nie Xiushan , Yin Yilong
Published: May 2024

Online cross-modal hashing has received increasing attention due to its efficiency and effectiveness in handling cross-modal streaming data retrieval. Despite the promising performance, these methods mainly focus on the supervised learning paradigm, demanding expensive and laborious work to obtain clean annotated data. Existing unsupervised online hashing methods mostly struggle to construct instructive semantic correlations among data chunks, resulting in the forgetting of accumulated data distribution. To this end, we propose a Dynamic Prototype-based Online Cross-modal Hashing method, called DPOCH. Based on the pre-learned reliable common representations, DPOCH generates prototypes incrementally as sketches of accumulated data and updates them dynamically for adapting streaming data. Thereafter, the prototype-based semantic embedding and similarity graphs are designed to promote stability and generalization of the hashing process, thereby obtaining globally adaptive hash codes and hash functions. Experimental results on benchmarked datasets demonstrate that the proposed DPOCH outperforms state-of-the-art unsupervised online cross-modal hashing methods.