-
Journal of the American College of... Jul 2024Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging (MRI), are key components in the evaluation and...
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging (MRI), are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.
Topics: Humans; Emergency Service, Hospital; Child; Diagnostic Imaging; Decision Support Systems, Clinical
PubMed: 38944445
DOI: 10.1016/j.jacr.2024.03.016 -
Nephrology, Dialysis, Transplantation :... Jun 2024Acute kidney injury is common in patients with acute decompensated heart failure. It is more common in patients with acute heart failure who suffer from chronic kidney...
Acute kidney injury is common in patients with acute decompensated heart failure. It is more common in patients with acute heart failure who suffer from chronic kidney disease. Worsening renal function is often defined as a rise in serum creatinine of more than 0.3 milligrams per deciliter (26.5 µmol/L), which by definition, is acute kidney injury stage one. Perhaps the term acute kidney injury is more appropriate than worsening renal function as it is used universally by nephrologists, internists, and other medical practitioners. In health, the heart and the kidney support each other to maintain body's homeostasis. In disease, the heart and the kidney can adversely affect each other's function causing further clinical deterioration. In patients presenting with acute heart failure and fluid overload, therapy with diuretics for decongestion often causes a rise in serum creatinine and acute kidney injury. However, in the longer term the decongestion improves survival and prevents hospital admissions despite rising serum creatinine and acute kidney injury. It is important to realize that renal venous congestion due to increased right sided heart pressures in acute heart failure is a major cause of kidney dysfunction and hence decongestion therapy improves kidney function in the longer term. This review provides a perspective on the acceptable acute kidney injury with decongestion therapy which is associated with improved survival; as opposed to acute kidney injury due to tubular injury related to sepsis or nephrotoxic drugs, which is associated with poor survival.
PubMed: 38944413
DOI: 10.1093/ndt/gfae146 -
The Science of the Total Environment Jun 2024In the last decades, several studies have highlighted the significant impacts of the food sector. Therefore, enhancing sustainability within this sector has become of... (Review)
Review
In the last decades, several studies have highlighted the significant impacts of the food sector. Therefore, enhancing sustainability within this sector has become of paramount importance. A crucial step towards achieving this goal involves the definition and implementation of effective sustainability metric and measurements. In this regard, the adoption of multi-criteria decision analysis (MCDA) methods can be seen as one of the most suitable and promising approach to comprehensively capture the complex and broad-ranging effects of agricultural practices and food supply chains. In such context, a systematic review of the scientific literature on multi-criteria approaches and tools for measuring the sustainability of food supply chains (harvest and post-harvest stages) has been carried out, resulting in the selection and analysis of 42 articles. To delve into the selected articles, three main areas of focus have been identified. The first about MCDA methods and their features, revealing the most adopted methods for sustainability assessments of food supply chains. The second, focusing on the participatory approach, led to the definition of a stakeholder's engagement map, highlighting the typology of stakeholders involved, the reasons of their involvement and engagement methods. Lastly, the third focus is related to the analysis and classification of indicators adopted in each study and the sustainability dimensions to which they refer to. The results of the present review study provide a comprehensive overview of the essential aspects to be considered when developing a MCDA for sustainability assessment in the food sector, serving as a valuable resource for both scholars and practitioners.
PubMed: 38944301
DOI: 10.1016/j.scitotenv.2024.174235 -
Biomedicine & Pharmacotherapy =... Jun 2024The integration of biochips with AI opened up new possibilities and is expected to revolutionize smart healthcare tools within the next five years. The combination of... (Review)
Review
The integration of biochips with AI opened up new possibilities and is expected to revolutionize smart healthcare tools within the next five years. The combination of miniaturized, multi-functional, rapid, high-throughput sample processing and sensing capabilities of biochips, with the computational data processing and predictive power of AI, allows medical professionals to collect and analyze vast amounts of data quickly and efficiently, leading to more accurate and timely diagnoses and prognostic evaluations. Biochips, as smart healthcare devices, offer continuous monitoring of patient symptoms. Integrated virtual assistants have the potential to send predictive feedback to users and healthcare practitioners, paving the way for personalized and predictive medicine. This review explores the current state-of-the-art biochip technologies including gene-chips, organ-on-a-chips, and neural implants, and the diagnostic and therapeutic utility of AI-assisted biochips in medical practices such as cancer, diabetes, infectious diseases, and neurological disorders. Choosing the appropriate AI model for a specific biomedical application, and possible solutions to the current challenges are explored. Surveying advances in machine learning models for biochip functionality, this paper offers a review of biochips for the future of biomedicine, an essential guide for keeping up with trends in healthcare, while inspiring cross-disciplinary collaboration among biomedical engineering, medicine, and machine learning fields.
PubMed: 38943990
DOI: 10.1016/j.biopha.2024.116997 -
Physiotherapy Feb 2024Work-related burnout is a significant concern amongst healthcare professionals, including physiotherapists. It can negatively impact on both staff well-being and the... (Review)
Review
BACKGROUND
Work-related burnout is a significant concern amongst healthcare professionals, including physiotherapists. It can negatively impact on both staff well-being and the quality of care delivered to patients.
OBJECTIVES
To estimate the prevalence of burnout among physiotherapists.
DATA SOURCES
PubMed, CINAHL, Web of Science, Embase, Scopus and PsycINFO, from inception to February 1st, 2022.
STUDY SELECTION OR ELIGIBILITY CRITERIA
Studies reporting burnout prevalence among physiotherapists.
DATA EXTRACTION AND DATA SYNTHESIS
Prevalence of burnout. Sub-analyses were performed grouping studies based on countries where surveys were conducted, classified as developed or developing countries. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale.
RESULTS
32 studies were included in the systematic review and 31 in the meta-analysis, enrolling a total of 5984 physiotherapists from 17 countries. Pooled prevalence (95% confidence interval) of burnout was 8% (4-15). Prevalence figures for Maslach Burnout Inventory dimensions were: (i) emotional exhaustion, 27% (21-34) (ii) depersonalization, 23% (15-32) (iii) low personal accomplishment, 25% (15-40). Both overall and single components prevalence was higher, although not significantly, in studies from developing than in developed countries.
LIMITATIONS
Tools used to assess burnout and cut-off scores chosen to identify the burnout prevalence differed across studies.
CONCLUSION AND IMPLICATIONS OF KEY FINDINGS
Prevalence of burnout reported by physiotherapists appears high worldwide, in particular in developing countries, and compares with that reported by nurses and physicians. Substantial heterogeneity in the prevalence of burnout, in its definition and assessment methods across studies, and limited quality of most studies precludes drawing definitive conclusions.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO CRD42022307876 CONTRIBUTION OF THE PAPER.
PubMed: 38943718
DOI: 10.1016/j.physio.2024.01.007 -
The American Journal of Emergency... Jun 2024Boarding time in the Emergency Department (ED) is an area of concern for all patients and potentially more problematic for the hip fracture population. Identifying...
BACKGROUND
Boarding time in the Emergency Department (ED) is an area of concern for all patients and potentially more problematic for the hip fracture population. Identifying patient outcomes impacted by ED boarding and improving emergent care to reduce surgical delay for this patient population is a recognized opportunity. The objective of this study is to examine the impact of ED boarding in relation to patient outcomes in the surgical hip fracture population.
METHODS
This is a retrospective study of hip fracture patients who presented at the ED of a Level 1 trauma center between January 2020 and December 2021. Patients were categorized into four quartiles based on boarding time. Study outcomes-hospital length of stay, time to surgery, visit to ICU post-operative, total blood products, in-hospital complications, discharge disposition, in-hospital mortality, and 30-day readmission-were compared among these four quartiles.
RESULTS
The outcome endpoints were comparable among the four quartiles except for time to surgery. Time to surgery significantly differed among the quartiles, increasing from 20.39 to 29.03 h (p < 0.001) from the first to fourth quartile.
CONCLUSION
In contrast to the existing literature, ED boarding in our study was not associated with adverse outcomes except for time to surgery. By expediting the time to surgery in accordance with established guidelines, adverse outcomes were mitigated even when our patients boarded for a longer duration. System processes including a 24/7 trauma nurse practitioner model, availability of in-house orthopedic surgeons, and timely cardiac evaluation need to be considered in relation to time to surgery, in turn impacting ED boarding and patient outcomes.
PubMed: 38943707
DOI: 10.1016/j.ajem.2024.06.028 -
The Gerontologist Jun 2024This study examined the impact of receiving foundational information about aging on continuing education (CE) interests, preferences, and behaviors of mental health...
BACKGROUND AND OBJECTIVES
This study examined the impact of receiving foundational information about aging on continuing education (CE) interests, preferences, and behaviors of mental health providers.
RESEARCH DESIGN AND METHOD
Participants were practicing licensed professional counselors (LPCs; N = 120) recruited from a random sampling of a state registry. The study employed a three-group randomized controlled design with participants assigned to one of three conditions: an aging-specific reading, an Opioid Use Disorder-specific reading, and a CE requirement-specific reading. As outcomes, participants rated their interest in aging-specific CE and selected to receive an aging-specific CE or Motivational Interviewing-specific CE program.
RESULTS
Perceived competence for working with older adults, assessed before the experimental manipulation, predicted choice and degree of interest in the aging-specific CE across conditions. Participants in the Aging-Reading condition rated a higher interest in aging-specific CE and were marginally more likely to select the aging-specific CE option than those in the other two conditions. Those in the Aging-Reading condition were also more likely to register for and complete an actual CE program focused on any topic.
DISCUSSION AND IMPLICATIONS
Foundational knowledge about aging may increase practitioners' interest and behaviors towards gaining competency for working with older adults, supporting the PEACE model (Levy, 2018) of reducing ageism.
PubMed: 38943477
DOI: 10.1093/geront/gnae085 -
Technology and Health Care : Official... Jun 2024Brain variations are responsible for developmental impairments, including autism spectrum disorder (ASD). EEG signals efficiently detect neurological conditions by...
BACKGROUND
Brain variations are responsible for developmental impairments, including autism spectrum disorder (ASD). EEG signals efficiently detect neurological conditions by revealing crucial information about brain function abnormalities.
OBJECTIVE
This study aims to utilize EEG data collected from both autistic and typically developing children to investigate the potential of a Graph Convolutional Neural Network (GCNN) in predicting ASD based on neurological abnormalities revealed through EEG signals.
METHODS
In this study, EEG data were gathered from eight autistic children and eight typically developing children diagnosed using the Childhood Autism Rating Scale at the Central Institute of Psychiatry, Ranchi. EEG recording was done using a HydroCel GSN with 257 channels, and 71 channels with 10-10 international equivalents were utilized. Electrodes were divided into 12 brain regions. A GCNN was introduced for ASD prediction, preceded by autoregressive and spectral feature extraction.
RESULTS
The anterior-frontal brain region, crucial for cognitive functions like emotion, memory, and social interaction, proved most predictive of ASD, achieving 87.07% accuracy. This underscores the suitability of the GCNN method for EEG-based ASD detection.
CONCLUSION
The detailed dataset collected enhances understanding of the neurological basis of ASD, benefiting healthcare practitioners involved in ASD diagnosis.
PubMed: 38943414
DOI: 10.3233/THC-240550 -
Health Technology Assessment... Jun 2024Gallstone disease is a common gastrointestinal disorder in industrialised societies. The prevalence of gallstones in the adult population is estimated to be... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Gallstone disease is a common gastrointestinal disorder in industrialised societies. The prevalence of gallstones in the adult population is estimated to be approximately 10-15%, and around 80% remain asymptomatic. At present, cholecystectomy is the default option for people with symptomatic gallstone disease.
OBJECTIVES
To assess the clinical and cost-effectiveness of observation/conservative management compared with laparoscopic cholecystectomy for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones in secondary care.
DESIGN
Parallel group, multicentre patient randomised superiority pragmatic trial with up to 24 months follow-up and embedded qualitative research. Within-trial cost-utility and 10-year Markov model analyses. Development of a core outcome set for uncomplicated symptomatic gallstone disease.
SETTING
Secondary care elective settings.
PARTICIPANTS
Adults with symptomatic uncomplicated gallstone disease referred to a secondary care setting were considered for inclusion.
INTERVENTIONS
Participants were randomised 1: 1 at clinic to receive either laparoscopic cholecystectomy or observation/conservative management.
MAIN OUTCOME MEASURES
The primary outcome was quality of life measured by area under the curve over 18 months using the Short Form-36 bodily pain domain. Secondary outcomes included the Otago gallstones' condition-specific questionnaire, Short Form-36 domains (excluding bodily pain), area under the curve over 24 months for Short Form-36 bodily pain domain, persistent symptoms, complications and need for further treatment. No outcomes were blinded to allocation.
RESULTS
Between August 2016 and November 2019, 434 participants were randomised (217 in each group) from 20 United Kingdom centres. By 24 months, 64 (29.5%) in the observation/conservative management group and 153 (70.5%) in the laparoscopic cholecystectomy group had received surgery, median time to surgery of 9.0 months (interquartile range, 5.6-15.0) and 4.7 months (interquartile range 2.6-7.9), respectively. At 18 months, the mean Short Form-36 norm-based bodily pain score was 49.4 (standard deviation 11.7) in the observation/conservative management group and 50.4 (standard deviation 11.6) in the laparoscopic cholecystectomy group. The mean area under the curve over 18 months was 46.8 for both groups with no difference: mean difference -0.0, 95% confidence interval (-1.7 to 1.7); -value 0.996; = 203 observation/conservative, = 205 cholecystectomy. There was no evidence of differences in quality of life, complications or need for further treatment at up to 24 months follow-up. Condition-specific quality of life at 24 months favoured cholecystectomy: mean difference 9.0, 95% confidence interval (4.1 to 14.0), < 0.001 with a similar pattern for the persistent symptoms score. Within-trial cost-utility analysis found observation/conservative management over 24 months was less costly than cholecystectomy (mean difference -£1033). A non-significant quality-adjusted life-year difference of -0.019 favouring cholecystectomy resulted in an incremental cost-effectiveness ratio of £55,235. The Markov model continued to favour observation/conservative management, but some scenarios reversed the findings due to uncertainties in longer-term quality of life. The core outcome set included 11 critically important outcomes from both patients and healthcare professionals.
CONCLUSIONS
The results suggested that in the short term (up to 24 months) observation/conservative management may be a cost-effective use of National Health Service resources in selected patients, but subsequent surgeries in the randomised groups and differences in quality of life beyond 24 months could reverse this finding. Future research should focus on longer-term follow-up data and identification of the cohort of patients that should be routinely offered surgery.
TRIAL REGISTRATION
This trial is registered as ISRCTN55215960.
FUNDING
This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/192/71) and is published in full in ; Vol. 28, No. 26. See the NIHR Funding and Awards website for further award information.
Topics: Humans; Gallstones; Cholecystectomy, Laparoscopic; Cost-Benefit Analysis; Male; Female; Middle Aged; Quality of Life; Quality-Adjusted Life Years; Conservative Treatment; Adult; Technology Assessment, Biomedical; Aged; United Kingdom; Markov Chains
PubMed: 38943314
DOI: 10.3310/MNBY3104 -
Journal of Medical Imaging and... Jun 2024There is a lack of evidence about the experiences of radiographers providing care to people living with dementia (PLWD). This study explored the perceptions and...
INTRODUCTION
There is a lack of evidence about the experiences of radiographers providing care to people living with dementia (PLWD). This study explored the perceptions and experiences of radiography practitioners when delivering person-centred dementia care (PCDC) in both diagnostic imaging and radiotherapy departments.
METHODS
A two-phase qualitative multi-method study was conducted. For phase 1, fifteen diagnostic and two therapeutic radiography practitioners from across the UK participated with online focus group discussions. For phase 2, four key stakeholders involved with the development of the UK Society of College of Radiographers Caring for People with Dementia practice guidelines for diagnostic and therapeutic radiography practitioners took part with individual semi-structured interviews.
RESULTS
Participants from both phases identified enablers and barriers to providing person-centred care to individuals living with dementia. Three themes were identified that were linked to (1) Time and workload pressures in delivering person-centred dementia care, (2) Workplace practice and norms, and (3) Areas for improvement in delivering person-centred dementia care.
DISCUSSION
Delivering PCDC can be challenging in practice. This is often due to workplace cultures where time and resources linked to productivity and waiting lists are the norms and impact on the delivery of PCDC. Leaders and managers of departments were thought to not always value a culture of PCDC but were seen as key influencers in supporting change and impact in delivering PCDC. Radiography practitioners were not always aware that a patient had dementia prior to their attendance in the department making it difficult to prepare ahead of appointments. Care partners were identified as having the potential to help alleviate some challenges radiographers faced. Findings also suggest a need for more education and training linked to dementia awareness. Further research is warranted in this area.
PubMed: 38943280
DOI: 10.1016/j.jmir.2024.101441