bluuebunny/crossref_metadata_2025 huggingface dataset:
A Quality Improvement Study on Delirium Awareness Day: In Pursuit of Missed Delirium Diagnoses
Authors: Koca Meltem , Öztürk Yelda , Boğa İlker , Bürkük Suna , Eşme Mert , Akyürek Yasemin , Şimşek Sevgi , Aydın Derya Durmaz , Çiçek Filiz , Karabulut Erdem , Halil Meltem , Cankurtaran Mustafa , Tanrıöver Mine Durusu , Doğu Burcu Balam
Published: August 2022

The current study aimed to screen for delirium in hospitalized older adults and assess the validity of the Turkish version of the 4A's Test (4AT-TR) as a feasible tool to integrate in routine patient care. The point prevalence of delirium according to clinical evaluation in routine practice was detected among all patients aged ≥60 years in 12 pilot wards. Delirium screening was then conducted by two arms: (a) nurses using the 4AT-TR and (b) geriatricians according to
Diagnostic and Statistical Manual of Mental Disorders, 5th edition
(
DSM-5
) criteria. Prevalence of delirium according to clinical impression was 3.3% (
n
= 4), whereas prevalence was 12.4% (
n
= 17) according to
DSM-5
criteria and 13.8% (
n
= 17) according to the 4AT-TR. The 4AT-TR performed by nurses had a sensitivity of 66.6% and specificity of 93.5%. Area under the receiver operating characteristic curve for delirium diagnosis was 0.819 (
p
< 0.001). Most delirium cases remain undetected unless a routine and formal delirium assessment is integrated in hospital care of high-risk patients. The 4AT-TR performed by nurses seems to be a valid tool for determining delirium in hospitalized older adults. [
Journal of Gerontological Nursing, 48
(8), 43–51.]
Interprofessional Education and Older Adults in the Shared Virtual Classroom: Lessons Learned During the COVID-19 Pandemic
Authors: Zhang Wendy J. , Mansour Daniel Z. , Lee Merton , Brandt Nicole J.
Published: August 2022

The current article provides an overview of an interprofessional service-learning course that became virtual in the setting of the coronavirus disease 2019 pandemic. Telehealth video technologies were used to build an intergenerational, virtual classroom and increase engagement of older adults with interdisciplinary health professional students. The virtual classroom involved group health education sessions, individualized Medicare wellness visits, and a clinical huddle. The course addressed the public health need for reliable health information during the early days of the pandemic, social connection, and meeting the educational goals for health care students and older adults in a novel virtual setting. Lessons learned for the interdisciplinary team and for engaging older adults included the need for preparation reading, team building exercises, training videos, and telehealth competency checklists. Beyond the pandemic, adoption of virtual methods enables hybrid approaches to interprofessional education and builds competencies for delivery of telehealth and computer-based visits in professional practice settings. [
Journal of Gerontological Nursing, 48
(8), 52–56.]
Deep reinforcement learning algorithm for solving material emergency dispatching problem
Authors: Jiang Huawei , Guo Tao , Yang Zhen , Zhao Like
Published: August 2022

In order to solve the problem that the scheduling scheme cannot be updated in real time due to the dynamic change of node demand in material emergency dispatching, this article proposes a dynamic attention model based on improved gated recurrent unit. The dynamic codec framework is used to track the change of node demand to update the node information. The improved gated recurrent unit is embedded between codecs to improve the representation ability of the model. By weighted combination of the node information of the previous time, the current time and the initial time, a more representative node embedding is obtained. The results show that compared with the elitism-based immigrants ant colony optimization algorithm, the solution quality of the proposed model was improved by 27.89, 27.94, 28.09 and 28.12% when the problem scale is 10, 20, 50 and 100, respectively, which can effectively deal with the instability caused by the change of node demand, so as to minimize the cost of material distribution.
Assessing the therapeutic response of tumors to hypoxia-targeted prodrugs with an in silico approach
Authors: Yilmaz Defne , Tuzer Mert , Unlu Mehmet Burcin
Published: August 2022

Tumor hypoxia is commonly recognized as a condition stimulating the progress of the aggressive phenotype of tumor cells. Hypoxic tumor cells inhibit the delivery of cytotoxic drugs, causing hypoxic areas to receive insufficient amounts of anticancer agents, which results in adverse treatment responses. Being such an obstruction to conventional therapies for cancer, hypoxia might be considered a target to facilitate the efficacy of treatments in the resistive environment of tumor sites. In this regard, benefiting from prodrugs that selectively target hypoxic regions remains an effective approach. Additionally, combining hypoxia-activated prodrugs (HAPs) with conventional chemotherapeutic drugs has been used as a promising strategy to eradicate hypoxic cells. However, determining the appropriate sequencing and scheduling of the combination therapy is also of great importance in obtaining favorable results in anticancer therapy. Here, benefiting from a modeling approach, we study the efficacy of HAPs in combination with chemotherapeutic drugs on tumor growth and the treatment response. Different treatment schedules have been investigated to see the importance of determining the optimal schedule in combination therapy. The effectiveness of HAPs in varying hypoxic conditions has also been explored in the study. The model provides qualitative conclusions about the treatment response, as the maximal benefit is obtained from combination therapy with greater cell death for highly hypoxic tumors. It has also been observed that the antitumor effects of HAPs show a hypoxia-dependent profile.
The Integration of Classroom and Community Learning in Narrative Accounts of Co-Curricular Service
Authors: Walton Marsha , Baker-Olson Anna , Luckes Hannah , Blaber Isabelle , Walker Erin , Folkes-Lallo Becca , Becton Michele , Thomas Elizabeth
Published: August 2022

Although we have evidence that reflection on community service enhances student development outcomes, we have little understanding of the process by which students integrate their academic and community experiences. This study is a part of a larger Participatory Research project, for which we collected 403 narrative accounts of awkward or meaningful experiences written by 123 Bonner Scholars. Members of an interpretive community which included Bonner Scholars examined a subset of these stories pertinent to students’ integration of classroom and community work. We reliably identified several ways in which students talked about course material in their descriptions of their community experiences. Students wrote frequently about applying skills or concepts that they learned in the classroom to their work in the community. In some instances, this integration led to expressions of cultural humility and critical analysis. In contrast, few authors discussed how their community-based learning contributed to the classroom. We identified obstacles to this, and we argue that the types of knowledge and knowledge production privileged in academia inhibits genuine collaboration with our students and colleagues across institutional divisions. We suggest ways in which we might better support integrative student learning, faculty development, and institutional improvement.
Case Experiences With Immigrants on Workforce Training Using Virtual Reality
Authors: Kauppinen Raine , Drake Merja
Published: August 2022

Due to the rapid changes in the labor market, people need to constantly reshape their competencies, resulting in a tremendous need to reskill the workforce. Vocational training has traditionally been the task of educational institutions; however, today some companies also perform their own training. Overall success in establishing an individual's career depends on successful entry into the workforce, and in case of immigrants, entering the workforce is even more demanding. The key question is how educational institutions and companies can cooperate in this area. Immersive environments like virtual reality offer one type of solution. They are increasingly being used in workforce training and changing landscapes in educational institutions and companies. Using case examples, this chapter illustrates how several companies have jointly developed vocational materials with educational institutions and immigrants. The experiences are discussed, and examples of virtual reality training tasks implemented and connecting them to relevant competencies are presented.
SMarketing
Authors: Rosário Albérico Travassos
Published: August 2022

The concept of sales management can be defined as a business activity that is focused on the implementation of sales and management techniques in the sales operations of a company. A new concept has been discussed in sales marketing (SMarketing). An SMarketing strategy intends to align marketing and sales with the objective of obtaining better efficiency and effectiveness in results, through communication. SMarketing can be defined as the possible combinations between commercials and marketing professionals. The concept can be materialized as follows: marketing messages stimulate target customers who are in turn visited by the sales force and/or when the sales force regains contact with potential consumers, impacting them. Research on the subject is scarce and this study intends to carry out a systematic review of bibliometric literature (LRSB) of scientific and/or academic documents indexed in Scopus, in order to further clarify the knowledge and understand the practical implications as well as the lines of future research.
Sales Communication
Authors: Akdoğan Leyla , Durmaz Yakup
Published: August 2022

The development of technology and communications has brought about important changes in the field of marketing as well as in other fields. The fast access to information and presence of an infinite number of products have increased the expectations of customers in terms of quality service. Therefore, selling a product to a customer moves away from a narrow understanding and requires a more complex effort. In such a competitive environment, businesses would want to survive by maximizing their profits. For this reason, in addition to other activities, it is also important for businesses to establish a long-term, quality, and effective communication with customers that will benefit both sides. Sales is a two-way process. The better a salesperson communicates with a customer, the more the sale will be. A successful communication is made by using verbal and non-verbal communication instruments in harmony. This chapter examines the concept of sales, the sales process, the characteristics of sales representatives, the concept of communication, and sales communication.
The Role in Interpersonal Competency on Online vs. Offline Shopping
Authors: Elhaoussine Youssef
Published: August 2022

This research investigates the role of interpersonal competency on online versus offline behavior. Three experiments were conducted, comparing the intention of two groups of participants with high and low levels of interpersonal competencies. The author measured the preferences of online versus offline sources of information, the preferences of online versus offline shopping platforms, and the preferences between highly trusted versus less trusted online platforms, all on bipolar scales specially designed for this research. The results shows that participants with a lower level of interpersonal competencies will indeed prefer online sources of information and retail platforms, and they will also favor more trusted shopping platforms. Based on those results, several marketing implications were drawn.
The Role of Information Technologies to Adapt to a Global Pandemic
Authors: Puaschunder Julia
Published: August 2022

The outbreak of the COVID-19 pandemic has exacerbated the rise of AI, robots, and algorithms in the economy, which is expected to completely disrupt employment patterns. With the advancement of technologies, employment patterns will shift to a polarization between AI's rationality and humanness. Robots and social machines have already replaced people in a variety of jobs. Almost all traditional professions are prospected to be infused with or influenced by AI, algorithms, and robotics in the future. AI and robots offer the luxuries of affordability and democratization of access to services, as they will be—in the long run—commercially more affordable and readily available to serve all humanity. Also, the longevity potential of machines outperforms any human ever having lived. These new technologies also come with the price of overpopulation problems and the potential for misuse and violent action. Just like many other technologies, robots could be misused. This chapter discusses the current trend of digital disruption and its wider societal implications.
Impact of Pediatric Intensive Care Unit Preadmission Huddle on Perceptions of Interprofessional Communication About Patient Safety
Authors: Perkowski Caroline , Eldridge Barbara , Zurca Adrian D. , Demartini Theodore K. M. , Ceneviva Gary D. , Williams Duane , Fang Xinying , Zhou Shouhao , Thomas Neal J. , Krawiec Conrad
Published: August 2022

Background

Preadmission discussions in the study institution’s pediatric intensive care unit are not standardized and admission plans were thought to be disjointed, leading to a perceived lack of organization and preparation for the arrival of a critically ill child.

Objective

To evaluate the impact of a new, formalized preadmission pediatric intensive care unit interdisciplinary huddle on clinician perceptions of interprofessional communication. The hypothesis was that preadmission huddles would improve unit clinicians’ perceptions of interprofessional communication.

Methods

Interprofessional pediatric intensive care unit clinicians (physicians, advanced practice providers, nurses, and respiratory therapists) completed surveys before and 7 months after preadmission interdisciplinary huddle implementation. Huddle compliance and perceptions of interprofessional communication in the unit were evaluated.

Results

Of 265 eligible pediatric intensive care unit admissions, 69 huddles (26.0%) occurred. The postintervention survey revealed increased odds (odds ratio [95% CI]) of responding “strongly agree” or “agree” to questions about the opportunity to “communicate effectively with health care team members” (2.42 [1.10-5.34]), “respond to feedback from health care team members” (2.54 [1.23-5.24]), and “convey knowledge to other health care team members” (2.71 [1.31-5.61]) before an admission.

Discussion

This study introduced a formalized huddle that improved pediatric intensive care unit clinicians’ perceived communication with other health care team members in the preadmission period.

Conclusions

Future studies are needed to determine if this perceived improvement in communication significantly affects health care outcomes of critically ill children or if these results are generalizable to other pediatric intensive care unit settings.
National Nurse Work Environments - October 2021: A Status Report
Authors: Ulrich Beth , Cassidy Linda , Barden Connie , Varn-Davis Natasha , Delgado Sarah A.
Published: August 2022

Background

The health of nurse work environments has been shown to affect both patient and nurse outcomes. In 2005, the American Association of Critical-Care Nurses published the AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence, and a second edition was published in 2016. The American Association of Critical-Care Nurses conducted critical care nurse work environment studies in 2006, 2008, 2013, 2018, and, most recently, October 2021, which was expanded to include registered nurses in all areas of practice.

Objective

To report the results of the October 2021 study with comparisons to previous studies and recommendations for continued improvement and to evaluate the current state of nurse work environments.

Methods

An online survey was used. A total of 9862 registered nurses responded to the survey; 9335 met the study criteria of currently practicing as a registered nurse.

Results

The health of nurse work environments has declined dramatically since the 2018 study. However, as in 2018, evidence of a positive relationship exists between implementation of the American Association of Critical-Care Nurses Healthy Work Environment Standards and the health of nurse work environments, between the health of nurse work environments and job satisfaction, and between job satisfaction and the intent of nurses to leave their current positions or to stay.

Conclusion

It is time for bold, intentional, and relentless efforts to create and sustain healthy work environments that foster excellence in patient care and optimal outcomes for patients, nurses, and other members of the health care team.
Assessing the cognitive component of subjective well-being: Revisiting the satisfaction with life scale with classical test theory and item response theory
Authors: Pretorius Tyrone B. , Padmanabhanunni Anita
Published: August 2022

Life satisfaction is generally regarded as the cognitive component of subjective well-being, as opposed to positive and negative affect, which are regarded as the affective components. This topic has been extensively studied worldwide and has been linked to a variety of outcomes related to the work context as well as psychological well-being. In this study, we examine the psychometric properties of the Satisfaction with Life Scale (SWLS), one of the most widely used measures of life satisfaction, using three different approaches: classical test theory, Rasch analysis and Mokken analysis. Combining these three approaches provides a more comprehensive validation of an instrument. In this study, schoolteachers (n = 355) completed the SWLS, the trait scale of the State-Trait Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, the Beck Hopelessness Scale and the University of California, Los Angeles Loneliness Scale. The three approaches confirmed the reliability, validity and unidimensional nature of the SWLS, thus supporting its continued use as a measure of life satisfaction in the South African context.
Risk factors associated with a high incidence of sexually transmitted infections in Beitbridge, Zimbabwe
Authors: Siziba Anelle , Nunu Wilfred N. , Mudonhi Nicholas , Ndlovu Vuyelwa , Munyai Ofhani , Ndlovu Brighton , Sanganyado Edmond
Published: August 2022

Background: Sexually transmitted infections (STIs) are a major public health challenge, particularly in developing countries where the health infrastructure is often poor. Despite having a number of interventions in Beitbridge (such as the 24-h wellness centre), Zimbabwe, the incidence and prevalence of STIs is increasing.Objectives: This study, therefore, aims to assess the risk factors associated with the high incidence of STIs in urban Beitbridge.Method: A case-control study was conducted on 30 respondents who had suffered from STIs (selected from the registers at Beitbridge hospital and followed up) and 90 respondents who had not suffered from STIs (from the community) who resided in Beitbridge for at least 6 months and this excluded all those who were in transit. The factors contributing to the high incidence of STIs were identified using a pretested interviewer-administered semi-structured questionnaire in conjunction with a Likert scale to establish the attitudes and risk behaviours of the respondents on STIs.Results: A significant association was observed between high STI incidences and the nature of occupation (odds ration [OR]: 3.8), area of residence (OR: 2.78), number of sexual partners (OR: 7.56), payment demanded for sex (OR 22), condom use (OR: 3.7), alcohol use (OR: 2.86), and suspicion that partners had other sexual companions (OR: 15.5). Furthermore, a larger proportion of controls were knowledgeable on STIs as compared to the cases who participated in the study.Conclusion: There is a need to develop awareness strategies that foster safe sexual practices, particularly among populations who do not choose abstinence or a single sexual partner lifestyle.
The scope of human creative action: Created co-creators, imago Dei and artificial general intelligence
Authors: Molhoek Braden
Published: August 2022

This article examines the relationship between artificial general intelligence (AGI) and the image of God. After identifying various models that Christian theologians use to classify or define the imago Dei, particular attention will be given to the ‘created co-creator’ model. Scholars have interpreted this model in different ways, based on the nature of human creative action. This action is seen as either subordinate to divine creation action or the human creative action is truly cooperative with divine creative action. Whether AGI would be made in the image of God in these models is then explored, highlighting the differences between humans as sub-creators versus humans as cooperative co-creators. If human creative action is cooperative, then the question arises as to whether AGI can be made in ‘the image of humanity’. Some elements of this image are explored, and then the discussion turns to whether AGI would be made in ‘the image of humanity’, and if so, could AGI still be made in the image of God?Contribution: The argument concludes by pointing to future work using the various models of imago Dei to help inform the relationship between humans and AGI by briefly mentioning two examples.
Troubleshooting obstetric spinal anaesthesia at district hospital level
Authors: Bishop David G. , Le Roux Simon P.D.P.
Published: August 2022

Obstetric spinal anaesthesia is routinely used in South African district hospitals for caesarean sections, providing better maternal and neonatal outcomes than general anaesthesia in appropriate patients. However, practitioners providing anaesthesia in this context are usually generalists who practise anaesthesia infrequently and may be unfamiliar with dealing with complications of spinal anaesthesia or with conversion from spinal to general anaesthesia. This is compounded by challenges with infrastructure, shortages of equipment and sundries and a lack of context-sensitive guidelines and support from specialised anaesthetic services for district hospitals. This continuous professional development (CPD) article aims to provide guidance with respect to several key areas related to obstetric spinal anaesthesia, and to address common concerns and queries. We stress that good clinical practice is essential to avoid predictable, common complications, and hence a thorough preoperative preparation is essential. We further discuss clinical indications for preoperative blood testing, spinal needle choice, the use of isobaric bupivacaine, spinal hypotension, failed or partial spinal block and pain during the caesarean section. Where possible, relevant local and international guidelines are referenced for further reading and guidance, and a link to a presentation of this topic is provided.
Middle ear status – structure, function and pathology: A scoping review on middle ear status of COVID-19 positive patients
Authors: Sebothoma Ben , Khoza-Shangase Katijah
Published: August 2022

Background: The coronavirus disease 2019 (COVID-19) pandemic is the latest public health emergency that has presented challenges globally. Limited evidence exists on the association between COVID-19 and middle ear pathologies, regardless of the respiratory nature of some of the core symptoms.Objective: This scoping review aimed at exploring evidence on the effects of COVID-19 on middle ear functioning as part of symptom mapping and preventive planning for ear and hearing care.Method: Electronic bibliographic databases, including Medline, ProQuest, PubMed, Science Direct, ERIC and Scopus, were searched to identify peer reviewed publications, published in English, between December 2019 and January 2022, related to the effects of COVID-19 on middle ear functioning. The keywords used as MeSH terms included ‘middle ear pathology’, ‘middle ear disorder’, ‘otitis media’, ‘hearing loss’, ‘hearing impairment’, ‘audiology’ and ‘COVID-19’ or ‘coronavirus’.Results: From eight studies that met the inclusion criteria, the findings revealed that middle ear pathologies occur in this population, with the occurrence ranging from 1.15% to 75%. Tympanic membrane structural changes, otitis media and conductive hearing loss (CHL) were commonly reported. The current findings must be interpreted with caution given that most of the studies reviewed had extremely small sample sizes or were case studies or series, thus limiting generalisability.Conclusion: The findings highlight the value of strategic research planning to collate data during pandemics, ensuring that future studies use appropriate and well-designed methodologies. Trends and patterns of middle ear pathologies in this population must also be established to determine the need for periodic monitoring.
Peculiarities in the Pentecostal tradition: Disciplinal and decolonial perspectives in a South African context
Authors: Kgatle Mookgo S.
Published: August 2022

The African Pentecostal tradition as a distinct movement within the Protestant tradition is discussed here from disciplinal and decolonial perspectives. The characteristics that inform this distinction are explored to show that Pentecostalism is part of the Protestant tradition but distinct from other streams within this tradition. In addition, the different types and streams that exist within the broader Pentecostal movement such as classical Pentecostalism, African Independent Pentecostalism, Newer Pentecostal and Charismatic Churches and prophetic Pentecostalism are highlighted to demonstrate peculiarities. These distinctions help not to generalise when addressing the challenges and weaknesses of a specific Pentecostal sub-tradition. However, it is these distinctions in Pentecostalism that enable both insiders and outsiders to engage in an interdisciplinary study within theological disciplines and multidisciplinary study between theology and other disciplines. The distinctions in Pentecostalism assist African scholars in thoroughly engaging in decolonial discourses within theological studies in order to highlight challenges and provide solutions.Intradisciplinary and/or interdisciplinary implications: This article demonstrates that the peculiarities in the Pentecostal tradition and sub-traditions in Africa serve as an opportunity for an interdisciplinary, multidisciplinary and transdisciplinary study of theology. In addition, these peculiarities – despite their challenges – are a trigger for the decolonisation of theological education and knowledge systems in South Africa and elsewhere in Africa.
The Prominent Role of miR-942 in Carcinogenesis of Tumors
Authors: Yadegar Negar , Dadashi Zahra , Shams Kimiya , Mohammadi Mahdis , Abyar Mahya , Rafat Milad
Published: August 2022

As a family of short noncoding RNAs, MicroRNAs have been identified as possible biomarkers for cancer discovery and assist in therapy control due to their epigenetic involvement in gene expression and other cellular biological processes. In the present review, the evidence for reaching the clinical effect and the molecular mechanism of miR-942 in various kinds of cancer is amassed. Dysregulation of miR-942 amounts in different kinds of malignancies, as bladder cancer, esophageal squamous cell carcinoma, breast cancer, cervical cancer, gastric cancer, colorectal cancer, Kaposi's sarcoma, melanoma, Hepatocellular carcinoma, nonsmall-cell lung cancer, oral squamous cell carcinoma, osteosarcoma, ovarian cancer, pancreatic ductal adenocarcinoma, renal cell carcinoma, and prostate cancer has stated a considerable increase or decrease in its level indicating its function as oncogene or tumor suppressor. MiR-942 is included in cell proliferation, migration, and invasion through cell cycle pathways, including pathways of transforming growth factor-beta signaling pathways, Wnt pathway, JAK/STAT pathway, PI3K/AKT pathway, apoptosis pathway, hippo signaling pathway, lectin pathway, interferon-gamma signaling, signaling by G-protein coupled receptor, developmental genes, nuclear factor-kappa B pathway, Mesodermal commitment pathway, and T-cell receptor signaling in cancer. An important biomarker, MiR-942 is a potential candidate for prediction in several cancers. The present investigation introduced miR-942 as a prognostic marker for early discovery of tumor progression, metastasis, and development.
Prevalence of erectile dysfunction in Type 2 diabetes mellitus (T2DM) and its predictors among diabetic men
Authors: Parmar Ramkesh S. , Verma Stuti , Neelkamal  , Pathak Vineet K. , Bhadoria Ajeet S.
Published: August 2022

Background:

Diabetes mellitus (DM) is one of the common causes of morbidity and mortality globally. It has also been associated with erectile dysfunction (ED) adding to poor quality of life. The present study aimed to determine the prevalence of ED and its predictors among diabetic men.

Material and Methods:

A hospital-based cross-sectional observational study was conducted at a tertiary care centre including 357 diabetic men recruited over one and half years. ED was identified using International Index of Erectile Function score and independent predictors were identified using multiple logistic regression analysis.

Results:

ED was found in 212 (59.38%) diabetic males. A strong negative correlation was found between potency score and age (r = −0.647), and a moderate negative correlation with duration of DM (r = −0.324), systolic blood pressure (SBP), and diastolic blood pressure. BMI, fasting blood sugar, serum cholesterol, and serum creatinine showed a weak negative correlation with potency score. Serum testosterone level showed a strong positive correlation with potency score. Age, SBP, duration of diabetes, fasting blood sugar, and serum-free testosterone (P < 0.05) were independent predictors of ED.

Conclusion:

Prevalence of ED is high in diabetic males. Better blood sugar control and blood pressure control could reduce sexual dysfunction in diabetic men and improve quality of life.
The first consultation with a depressed patient
Authors: Arroll Bruce , Roskvist Rachel , Moir Fiona , Walsh Esther , Louis Deana , Buttrick Lily , Khalil Nada , Mount Vicky , Dowrick Christopher
Published: August 2022

Background:

The first consultation with a depressed patient is important because many patients do not return for subsequent visits. Therefore, the first consultation provides a unique opportunity for diagnosis (if required) and treatment, but there are risks of both under and over-diagnosis.

Aim:

To understand how general practitioners utilize diagnosis when patients present with a new episode of depression.

Method:

We approached a random selection of twenty-one general practitioners (GPs) in Auckland, New Zealand and asked them to participate in a semi-structured telephone interview. The interviews explored “the first consultation for a depressed/distressed patient” were undertaken to theme saturation. Interviews were hand-written and later transcribed.

Results:

We identified three major themes in GPs’ approach to diagnosis. The issue of diagnosis was underpinned by a complex understanding of depression and the GP role. GPs did not always make a formal diagnosis, but the experience of a patient’s distress/depression was understood by drawing on a range of factors and resources. These included time, screening tools, clinician experience, and patient affect. GPs were careful about how they communicated a diagnosis, both in their documentation and in their conversations with patients.

Conclusion:

At an initial appointment, the distressed/depressed patient can present to their GP with various symptoms and differing degrees of distress. GPs draw upon a variety of skills and resources to negotiate these complexities. The value of a diagnosis was questioned and issues such as impairment may be more useful concepts for GPs. This is the first study to report the findings of the first visit.
Barriers facing family physician in primary health care when dealing with emergency cases in Riyadh, Saudi Arabia
Authors: Alruwaili Amjad H. , Alrajeh Maha S. , Al Salem Wasan , Alqudah Ola
Published: August 2022

The scarcity of emergency cases presented to the primary health care centers (PHCCs) makes treating such cases by family physicians more difficult To identify the barriers facing family physicians in PHCCs when facing emergency cases in Riyadh, Saudi Arabia. A cross-sectional descriptive design was deployed in the study among a sample of family physicians. A reliable and valid self-reported questionnaire was used. In addition, an observational sheet was used to investigate the preparedness of PHCCs to deal with emergency situations. The study included 162 PHC physicians. Almost two-thirds of them (65.4%) aged 25–34 years, and 52.5% were females. Middle-aged (25––35 years) physicians (P = 0.030), females (P < 0.001), Saudis (P = 0.027), those attended advanced cardiovascular life support (ACLS) since more than 2 years (P = 0.029), those who had no exposure in working in emergency units (P = 0.029), and less experienced physicians (<1 year) (P = 0.010) showed lower “perceived level of competence in performing emergency skills.” The commonest barrier facing physicians during the management of emergency cases in thePHC was lack of appropriate equipment (76.5%), followed by lack of exposure to emergency cases (62.3%) and lack of time (50.6%). Dealing with emergency cases is considered part of the medical practice in PHCCs. For primary care physicians, the level of training in emergency medicine courses is suboptimal particularly advanced trauma life support (ATLS) courses in Riyadh. Inregards to emergency services at the PHC level in Riyadh, most of the items were available; however, defects were reported in some. Knowing the barriers facing doctors during dealing with emergency cases helps in improving and providing integrated medical care.
Exaggerated hyperkeratosis in a nursing home patient
Authors: Zhu Caroline , Wohltmann Wendi , Krikoriantz Steve , Sasaki Geoffrey
Published: August 2022

Scabies, caused by the mite Sarcoptes scabiei var hominis, is a common infestation that presents with intense itching. Crusted scabies, also known as Norwegian scabies, is a severe variant of classic scabies that is characterized by hyperkeratotic lesions and often manifests in immunosuppressed patients. There is both a high parasitic load and high infectivity with this form of scabies because crusted scabies can look similar to many conditions including psoriasis, eczema, and seborrheic dermatitis, diagnosis can be difficult and is based on both clinical findings and microscopic detection of the scabies mite, eggs, or fecal material (scybala). We describe a case of a 64-year-old female patient diagnosed with crusted scabies.
Prevalence of fall and associated risk factors among the elderly living in a rural area of Kolar
Authors: Bhoomika Venkateshappa , Chandrappa Muninarayana , Reddy Mahendra M.
Published: August 2022

Background:

Falls in elderly persons are one of the leading causes of death. Falls are responsible for 10–15% of all emergency department visits among elderly. The study was conducted to determine the prevalence of falls in rural areas and to assess the various socio-demographic factors associated with falls.

Methodology:

It was a community-based, cross-sectional study conducted in Rural Health Training Centre (RHTC), Devarayanasamudra, Department of Community Medicine, among the elderly persons aged ≥ 60 years. The total sample size was 511, calculated using a previous study using OpenEpi software. The data were collected using a pretested semi-structured questionnaire. The period prevalence of falls was assessed by asking for history of falls in the past 12 months. Chi-square and regression analysis were performed with statistically significant P value defined as less than 0.05.

Results:

Out of 511 elderly persons aged ≥60 years, females accounted for about 54.8% and most of them were of 60–69 years age-group. The majority of the study subjects were illiterates (77.3%), and most of them were married (77.2%). The prevalence of falls in elderly persons was 46.8%. The elderly aged ≥70 years, females, chronic diseases, and use of walking aid were observed to have a statistically significant association with falls (p < 0.005).

Conclusion:

Elderly falls are very common. The primary healthcare providers in rural areas play an important role in prevention of falls in elderly. Caregivers, along with elderly, should be given more detailed health education related to fall prevention.
Foot care knowledge, attitude and practices of diabetic patients
Authors: Alharbi Maha Obaid , Sulaiman Amel Abdalrahim
Published: August 2022

Background:

Among diabetes complications, diabetic foot disease (DFD) is the most common and the most preventable complication. This study aimed to assess the level of knowledge, attitude and practice of foot care among type two diabetes mellitus (DM) patients attending the Diabetic and Endocrine Center at King Fahad Specialist Hospital in Buraydah-Qassim region, Saudi Arabia.

Methods:

A descriptive cross-sectional facility-based study was conducted randomly among type two diabetic patients; respondents were 260 patients. Participants were interviewed using a pretested semi-structured questionnaire.

Results:

Of the total studied patients, 54.2% were males with median age of 58 years. Majority 56.5% of patients had good knowledge and 56.9% had good practices regarding diabetic foot care. The mean knowledge score was 4.0 (±1.86) out of 6. About 39.2% of participants received advice regarding foot care from their physicians. Only 41.5% of the patients examined their feet daily, 41.9% carefully dried between the toes after washing, and 40.8% were walking barefooted at home. About 68.5% of the participants had a history of diabetic foot complications. A significant statistical association was found between the good knowledge and patients’ age, educational level, family monthly income, duration of diabetic illness and having prior knowledge regarding foot care (P-value <0.05). While, good practice of the participants towards the diabetic foot care was found to be statistically associated with the family monthly income and the prior knowledge regarding diabetic foot care (P-value <0.05).

Conclusion:

Our study revealed that more than half of the participants had good knowledge and practices of diabetic foot care. However, the role of physicians and medical staff in annual foot examination and health education is crucial. An awareness program implementation for diabetic foot care is highly needed.
Knowledge and practices of bioethics – Need for periodic assessment and reinstatement for budding family physicians
Authors: Sinha Pooja , Chourey Niraj , Hiremath Ravishekar N. , Ghodke Sandhya , Sharma Atul , Vaswani Pallavi
Published: August 2022

Objective:

The study has been designed to assess the knowledge of ethics amongst young students and professionals, and practices of health care ethics among medical professionals in a government teaching hospital in India.

Methodology:

A cross-sectional study was carried out at one of the teaching hospitals in Southern India with a sample size of 84 among fresh medical graduates, post-graduate trainees, and young consultants with work experience of 6 months to 8 years. The data were collected by means of a structured and validated questionnaire, and the questionnaire was administered before and after a lecture/seminar on ethical principles, and results were analyzed using SPSS software.

Results:

The maximum participants were in the age group of 20 to 24 years with 0–2 years of clinical experience. The basic awareness and practices before the workshop were quite less when compared to after the workshop which showed a very good improvement in the correct responses to the questions. The maximum change seen, reflected in curiosity to learn bioethics. The workshop was an eye-opener for many participants in terms of the Nuremberg Code and its origin. The ethics committee was an alien concept to many participants, and it was reflected in the response postworkshop. The students felt a strong need to discuss ethics and implement them postworkshop. The segment on attitudes in clinical practice showed an impact on autonomy and truth-telling (32% to 50%). The segment on ethical practices reflected a confused audience. The increase in sensitivity to police information, and the concept of error of judgment and negligence were positive. The fact that medical practitioners are legally bound to help accident victims showed a positive response.

Conclusion:

Based on the assessment of pre-and post-workshop, there is a strong need to stress the ethical principles and revision of these ideas from time to time. Workshops and interactive sessions are a good way for periodic assessment and reinstatement of these values in our research and clinical practice. Thus, these should be part of the curriculum across all educational institutions for budding primary care providers and family physicians.
Continuous Positive Airway Pressure (CPAP)—Can this be a boon to tide over ICU crisis in pandemic? A case series
Authors: Tryphena Cherryl B , Panchanathan Ilangovan , Godwin Rajan , Stephenson Sam Jenkins , Davis Kirubakaran , Sahajanandan Raj
Published: August 2022

Introduction:

Coronavirus Disease 19 (COVID-19) disease has caused unusual overload of health care systems all over the world. We describe four severe COVID cases managed by non-intensivist.

Cases and Outcome:

We had four unvaccinated cases with acute onset influenza like illness with signs of respiratory failure. Apart from general and COVID-specific measures, we started Continuous Positive Airway Pressure (CPAP) trial for these patients. All these patients were weaned off CPAP and were discharged once they recovered.

Discussion:

Limitation of bed numbers in ICU has caused unforeseen stress upon the system to manage sudden increase of severe acute respiratory distress syndrome during COVID pandemics. Studies have shown non-invasive ventilation (NIV) and high frequency nasal cannula (HFNC) have improved patient outcomes. But managing NIV and HFNC is resource intensive in terms of manpower and equipment. We have found that patients with severe COVID disease can be managed safely using CPAP in secondary care with minimal training of non-intensivist healthcare workers in a cost-effective and efficient way of treating severe COVID who are unlikely to worsen.

Conclusion:

With the imminent third COVID wave looming, it is high time to strengthen our existing primary and secondary health care system by these novel methods to reduce the burden of our tertiary care.
A retrospective study to find out the correlation between NAFLD, diabetes, and obesity in Indian patients
Authors: Saran Mohit , Sharma Jugal Kishore , Ranjan Aastha , Deka Saurav , Sabharwal Mudit , Palukari Srivani , Chandolia Betina
Published: August 2022

Background:

Nonalcoholic fatty liver disease (NAFLD) is present in the body with metabolic disorders such as Type 2 diabetes mellitus (T2DM), obesity, and cardiovascular disease. However, no significant evidence has been found till date exhibiting their association epidemiologically in Indian patients.

Objective:

To assess the association among NAFLD, T2DM, and obesity, and to validate the scoring system with grades of fatty liver (severity of liver disease) estimated by ultrasound vs. NAFLD fibrosis score, BARD score, and aspartate aminotransferase to platelet ratio index (APRI) score.

Methodology:

A retrospective, observational study was conducted out in patients with NAFLD (n = 316) where diagnosis and grades of fatty liver were established via ultrasound reports. The patients were divided into two groups, Group A (n = 114, NAFLD with T2DM) and Group B (n = 202, NAFLD without T2DM). R 4.0.0 was used for statistical analysis.

Results:

The mean age (in years) of the patients was 54.08 ± 10.78 in Group A and 48.10 ± 15.36 in Group B. The mean BMI in Group A was found to be slightly higher as compared to Group B, 27.49 ± 4.94 and 26.56 ± 4.68, respectively, and the difference was found to be statistically significant (p-value <0.05). The overall predictive ability of the NAFLD scoring system matched that to ultrasonography liver grading fibrosis report for approximately 53% of patients. The BARD scoring system was found to be matched with ultrasonography reported Grade 1 fatty liver (198/316). In the case of the APRI scoring system, the association was not observed with ultrasonography reports in any grades of fatty liver.

Conclusion:

Body mass index might be an independent risk factor for NAFLD. NAFLD fibrosis score appears to be a reliable non-invasive tool to determine the severity of liver fibrosis in NAFLD patients. BARD score may predict Grade 1 liver fibrosis. However, APRI scores do not correlate with imaging evidence of fibrosis like NAFLD and BARD scores.
Development and implementation of optimized chest CT protocol in COVID-19
Authors: Pandya Radhika H. , Shinde Mayur Kiran , Patel Viral B. , Phatak Ajay Gajanan , Pandya Himanshu V.
Published: August 2022

Background:

Several studies have justified use of chest computed tomography (CT) in diagnosis, evaluation of severity, treatment response, and complications of coronavirus disease 2019 (COVID-19) pneumonia. Increased utilization of CT in patients with known or suspected COVID-19 pneumonia has resulted in concerns of overuse, lack of protocol optimization, and radiation exposure.

Aims:

The study was conducted to develop and implement optimized protocol for chest CT for reducing radiation dose in adult patients suspected or diagnosed to have COVID-19 infection. Setting and Design: The study was conducted in the department of radiology of a rural tertiary care teaching hospital in western India. Clinical audit was used as a tool to impart and assess the impact of optimized chest CT protocol.

Methods and Material:

The pre-intervention audit included radiation dosimetry data, number of phases and length of scan of 50 adult patients, undergoing non-contrast chest CT scans in March 2021. A brief educational intervention outlining the parameters of optimized protocol was conducted on April 1, 2021.The post-intervention audit consisted of two cycles for 109 and 67 chest CT scans in the months April and May 2021.

Results:

The optimized protocol was found clinically adequate with a good inter-rater reliability. The compliance to the optimized protocol was weak in audit cycle 2, which improved significantly in audit cycle 3 after reinforcement. The mean (SD) per scan Computed Tomography Dose Index-Volume (CTDI-vol) reduced significantly across audit cycles [22.06 (12. 31) Vs. 10.58 (7.58) Vs. 4.51 (2.90) milli Gray, respectively, P < 0.001]. Similar findings were noted for Dose Length Product (DLP).

Conclusion:

Clinical audit of chest CT protocol and resultant radiation doses provided adequate feedback for dose optimization. A simple educational intervention helped achieve dose optimization.