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Journal of Primary Health Care Jun 2024Introduction Advanced and extended primary health care practice roles have been developed in Aotearoa New Zealand (NZ) for dietetics, nursing, pharmacy, and...
Introduction Advanced and extended primary health care practice roles have been developed in Aotearoa New Zealand (NZ) for dietetics, nursing, pharmacy, and physiotherapy professions. Advanced musculoskeletal physiotherapy roles in primary health care could address escalating health care costs, challenges to workforce sustainability and inefficient primary/secondary care interfaces. Little is known about how stakeholders perceive the recently introduced Advanced Practice Physiotherapist (APP) scope of practice. Aim This study aimed to explore health professionals' perceptions of the APP scope of practice in NZ and how APPs could influence physiotherapy service delivery for people with musculoskeletal conditions in primary health care. Methods Qualitative, face-to-face, semi-structured interviews were conducted with 15 participants including physiotherapists, general practitioners, medical specialists and Accident Compensation Corporation case managers. Inductive interpretive analysis was undertaken. Results Five themes were identified: perceptions of current musculoskeletal management in primary health care; lack of a career pathway; ways in which APPs might facilitate change and what their role would be; characteristics of an APP; and the implementation of the APP role into practice. Discussion Stakeholders were supportive of the APP scope of practice and thought it has the potential to improve patient pathways, health care delivery and health outcomes for those with musculoskeletal conditions. Stakeholders also thought it would fill an important gap in the physiotherapy clinical career pathway. Successful implementation will require assessment of applicants' personal attributes as well as clinical experience and academic qualifications to ensure all stakeholders have confidence to engage with the service, clear communication, active promotion and specific funding.
Topics: Humans; Primary Health Care; New Zealand; Physical Therapists; Qualitative Research; Attitude of Health Personnel; Male; Female; Scope of Practice; Interviews as Topic; Musculoskeletal Diseases; Adult; Professional Role; Middle Aged; Stakeholder Participation
PubMed: 38941257
DOI: 10.1071/HC24029 -
Journal of Primary Health Care Jun 2024
Substitution of regulated health professionals such as doctors and nurses with unregulated health professionals such as physician assistants gives rise to concerns around patient safety and accountability issues: Yes.
Topics: Humans; Patient Safety; Physician Assistants; Social Responsibility; Physicians; Nurses
PubMed: 38941250
DOI: 10.1071/HC24075 -
Journal of Primary Health Care Jun 2024
Substitution of regulated health professionals, such as doctors and nurses, with unregulated health care workers, such as physician assistants, gives rise to concerns around patient safety and accountability issues: No.
Topics: Humans; Patient Safety; Physician Assistants; Social Responsibility; Physicians; Nurses
PubMed: 38941249
DOI: 10.1071/HC24077 -
JMIR Research Protocols Jun 2024Artificial intelligence (AI) medical devices have the potential to transform existing clinical workflows and ultimately improve patient outcomes. AI medical devices have...
BACKGROUND
Artificial intelligence (AI) medical devices have the potential to transform existing clinical workflows and ultimately improve patient outcomes. AI medical devices have shown potential for a range of clinical tasks such as diagnostics, prognostics, and therapeutic decision-making such as drug dosing. There is, however, an urgent need to ensure that these technologies remain safe for all populations. Recent literature demonstrates the need for rigorous performance error analysis to identify issues such as algorithmic encoding of spurious correlations (eg, protected characteristics) or specific failure modes that may lead to patient harm. Guidelines for reporting on studies that evaluate AI medical devices require the mention of performance error analysis; however, there is still a lack of understanding around how performance errors should be analyzed in clinical studies, and what harms authors should aim to detect and report.
OBJECTIVE
This systematic review will assess the frequency and severity of AI errors and adverse events (AEs) in randomized controlled trials (RCTs) investigating AI medical devices as interventions in clinical settings. The review will also explore how performance errors are analyzed including whether the analysis includes the investigation of subgroup-level outcomes.
METHODS
This systematic review will identify and select RCTs assessing AI medical devices. Search strategies will be deployed in MEDLINE (Ovid), Embase (Ovid), Cochrane CENTRAL, and clinical trial registries to identify relevant papers. RCTs identified in bibliographic databases will be cross-referenced with clinical trial registries. The primary outcomes of interest are the frequency and severity of AI errors, patient harms, and reported AEs. Quality assessment of RCTs will be based on version 2 of the Cochrane risk-of-bias tool (RoB2). Data analysis will include a comparison of error rates and patient harms between study arms, and a meta-analysis of the rates of patient harm in control versus intervention arms will be conducted if appropriate.
RESULTS
The project was registered on PROSPERO in February 2023. Preliminary searches have been completed and the search strategy has been designed in consultation with an information specialist and methodologist. Title and abstract screening started in September 2023. Full-text screening is ongoing and data collection and analysis began in April 2024.
CONCLUSIONS
Evaluations of AI medical devices have shown promising results; however, reporting of studies has been variable. Detection, analysis, and reporting of performance errors and patient harms is vital to robustly assess the safety of AI medical devices in RCTs. Scoping searches have illustrated that the reporting of harms is variable, often with no mention of AEs. The findings of this systematic review will identify the frequency and severity of AI performance errors and patient harms and generate insights into how errors should be analyzed to account for both overall and subgroup performance.
TRIAL REGISTRATION
PROSPERO CRD42023387747; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387747.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
PRR1-10.2196/51614.
Topics: Humans; Randomized Controlled Trials as Topic; Artificial Intelligence; Algorithms; Systematic Reviews as Topic; Patient Harm; Equipment and Supplies; Research Design
PubMed: 38941147
DOI: 10.2196/51614 -
JAMA Health Forum Jun 2024
Topics: Artificial Intelligence; Humans; Patient Safety; Hospitals
PubMed: 38941085
DOI: 10.1001/jamahealthforum.2024.1369 -
Applied Psychophysiology and Biofeedback Jun 2024Effective emergency responses are crucial for preventing coal mine accidents and mitigating injuries. This paper aims to investigate the characteristics of emergency...
Effective emergency responses are crucial for preventing coal mine accidents and mitigating injuries. This paper aims to investigate the characteristics of emergency psychophysiological reactions to coal mine accidents and to explore the potential of key indicators for identifying emergency behavioral patterns. Initially, virtual reality technology facilitated a simulation experiment for emergency escape during coal mine accidents. Subsequently, the characteristics of emergency reactions were analyzed through correlation analysis, hypothesis testing, and analysis of variance. The significant changes in physiological indicators were then taken as input features and fed into the three classifiers of machine learning algorithms. These classifications ultimately led to the identification of behavioral patterns, including agility, defensiveness, panic, and rigidity, that individuals may exhibit during a coal mine accident emergency. The study results revealed an intricate relationship between the mental activities induced by accident stimuli and the resulting physiological changes and behavioral performances. During the virtual reality simulation of a coal mine accident, subjects were observed to experience significant physiological changes in electrodermal activity, heart rate variability, electromyogram, respiration, and skin temperature. The random forest classification model, based on SCR + RANGE + IBI + SDNN + LF/HF, outperformed all other models, achieving accuracies of up to 92%. These findings hold promising implications for early warning systems targeting abnormal psychophysiological and behavioral reactions to emergency accidents, potentially serving as a life-saving measure in perilous situations and fostering the sustainable growth of the coal mining industry.
PubMed: 38940884
DOI: 10.1007/s10484-024-09651-4 -
The Journal of Craniofacial Surgery Jun 2024Management of pediatric facial fractures depends on location and severity, age, and associated injuries. Accurate diagnosis of associated injuries is crucial for...
Management of pediatric facial fractures depends on location and severity, age, and associated injuries. Accurate diagnosis of associated injuries is crucial for effective treatment. This study evaluates the incidence of associated injuries and seeks to determine the influencing factors to provide imaging guidance. A retrospective review of pediatric facial fractures from the American College of Surgeons National Trauma Data Bank from 2017 to 2021 was completed. Associated cervical spine (c-spine), skull fracture, traumatic brain injury (TBI), and intracranial bleeding were evaluated. Demographics, fracture patterns, mechanisms, protective devices, and the Glasgow Coma Scale (GCS) were reviewed. A total of 44,781 pediatric patients with 65,613 facial fractures were identified. Of the total, 5.47% had a c-spine injury, 21.86% had a skull fracture, 18.82% had TBI, and 5.76% had intracranial bleeding. Multiple fractures significantly increased the rate of all associated cranial and c-spine injuries. Single midface fractures had the highest c-spine, TBI, and intracranial bleeding rates. With increasing age, there was a significant increase in c-spine injury and TBI, while there was a decrease in skull fractures. Motor vehicle accidents and GCS <13 were associated with significantly increased rates of all injuries. Among pediatric patients with facial fractures, 5.47% had a c-spine injury, 21.86% had a skull fracture, 18.82% had TBI, and 5.76% had intracranial bleeding. The authors' findings recommend c-spine imaging in older age and cranial imaging in younger patients. Multiple facial fractures, fractures of the midface, decreased GCS, and motor vehicle accidents increase the need for both c-spine and cranial imaging.
PubMed: 38940552
DOI: 10.1097/SCS.0000000000010437 -
Annals of Agricultural and... Jun 2024Due to educational migration to Poland, students from Ukraine and Belarus may experience security to varying degrees. The aim of the study was to check the extent to...
INTRODUCTION AND OBJECTIVE
Due to educational migration to Poland, students from Ukraine and Belarus may experience security to varying degrees. The aim of the study was to check the extent to which people from Ukraine and Belarus studying in Lublin feel safe, taking into account their own life and health. An attempt was also made to establish the relationship between the sense of security and selected features of the surveyed students.
MATERIAL AND METHODS
The research was conducted using a survey method among 403 students from Ukraine, Belarus and Poland. Eight independent variables were introduced into the analysis of relationships: gender, age, self-assessment of the financial situation, country of origin, place of origin, place of residence during studies, and year of study. The dependency analysis used Wilcoxon and Kruskal-Wallisau tests and CATREG optimal scaling analysis.
RESULTS
The study showed that both Polish and foreign students assessed the level of safety in Poland and during their studies in Lublin as high. They feel safer during the day than after dark. Polish students are more afraid of theft, rape and being hit by a car than students from Belarus and Ukraine, and students from Ukraine are more afraid of verbal abuse. The predictors influencing students' sense of insecurity are, among others, their financial situation and gender.
CONCLUSIONS
The conducted research and analysis of the obtained results suggest that the situation of students from Ukraine and Belarus studying in Lublin, Poland, in terms of safety, is similar to that of Polish students, and even better in some aspects. This result suggests that Lublin is a friendly academic centre for students from across the eastern border of Poland.
Topics: Humans; Poland; Ukraine; Republic of Belarus; Male; Female; Young Adult; Students; Adult; Safety; Surveys and Questionnaires; Adolescent; Eastern European People
PubMed: 38940113
DOI: 10.26444/aaem/189598 -
Annals of Ibadan Postgraduate Medicine Apr 2024The white cerebellum sign (WCS) is a classical but rare radiological finding usually associated with irreversible diffuse hypoxic-ischemic cerebral injury. Very few...
INTRODUCTION
The white cerebellum sign (WCS) is a classical but rare radiological finding usually associated with irreversible diffuse hypoxic-ischemic cerebral injury. Very few cases exist in the literature globally, especially from the West African region, as a potential hallmark of poor prognostic outcome. We describe the white cerebellum sign in a Nigerian pediatric patient, managed for severe head injury.
CASE PRESENTATION
A fourteen-year old boy presented to our emergency department with loss of consciousness following a pedestrian road traffic accident. Physical examination revealed a critically ill boy with fever, hypotension, tachycardia, gasping respiration, GCS 3, bilateral dilated unreactive pupils, absent corneal, gag and oculocephalic reflexes. He was thus diagnosed of severe traumatic brain injury and brainstem dysfunction. He had endotracheal intubation, ventilatory and inotropic support. Cranial computerized tomography scan of the patient showed radiological features in keeping with the WCS. His clinical status remained poor until he suffered a cardiac arrest about twelve hours after admission.
CONCLUSION
WCS has been reported in relation to child abuse, anoxic-ischemic brain injury, inflammatory and metabolic brain disorders and trauma. It is a classical radiological description of diffuse cerebral edema alongside relatively normal cerebellar hemispheres and brainstem. Management of this pathology is symptomatic, and aims to ameliorate the associated raised intracranial pressure, control seizures and prevent cerebral infarction. The index patient, who presented 24 hours after severe head injury with associated early post-traumatic seizures, respiratory failure and brainstem dysfunction, had an unfavourable outcome consistent with previous reports of WCS. We have reported the rare but classical white cerebellum sign. It remains a grave prognosticator of cerebral injury and should be sought for in the neuroimaging of patients with acute brain insults.
PubMed: 38939880
DOI: No ID Found -
Acta Medica Philippina 2024Tibial plateau fractures are due to high energy trauma brought about by axial compression forces and associated varus or valgus component.
INTRODUCTION
Tibial plateau fractures are due to high energy trauma brought about by axial compression forces and associated varus or valgus component.
OBJECTIVE
Patients diagnosed with tibial plateau fractures from January to December 2018 treated with internal vs external fixation will be described according to their Schatzker classification. The study further aims to compare the functional outcomes between the two groups in terms of surgery done.
METHODS
A chart review determined the distribution of demographics. The Modified Rasmussen Score (MRS) was used to determine the clinical and radiographic parameters after taking a new knee radiograph and assessment from the rehabilitation department. The MRS determined the functional outcomes of the said patients. Ethical considerations and proper informed consent were upheld after being reviewed by the hospital's research committee.
RESULTS
Out of 48 patients, 35 underwent internal fixation via open reduction using plates and/or screws, while 13 underwent external fixation using hybrid external fixator. The demographic profile showed mostly males between ages 20 to 49 years old. Most cases were due to vehicular accidents affecting the left lower extremity. In terms of Schatzker classification, the most common was type VI. The computed mean MRS of the internal fixation group was 30.43 while the external fixation group was 30.00, generally showing no significant difference.
CONCLUSION
Surgical intervention of tibial plateau fractures aims for anatomic reduction using internal or external fixation. There was no significant difference on the functional outcome of the two groups despite classifying the respondents according to Schatzker type, hence we can conclude that external fixation be chosen as the treatment of choice for tibial plateau fractures when properly indicated.
PubMed: 38939854
DOI: 10.47895/amp.vi0.6181