Practical guide

BACKGROUND: Diagnostic reasoning is a complex cognitive process that requires intuitive, heuristic processing from knowledge and experience, as well as deliberate and reflective thinking. Evidence on interventions to improve diagnostic reasoning is inconsistent, in part because different terms and models are used to guide research. PURPOSE: To present a model of the factors of diagnostic reasoning in Advanced Practice Registered Nurses (APRNs), based on a review of the literature supporting the Metacognitive Diagnostic Reasoning (MDR) Model©...

The COVID-19 pandemic has highlighted the importance of local evidence ecosystems in which academia and practice in the Public Health Service (PHS) are interconnected. However, appropriate organizational structures and well-trained staff are lacking and evidence use in local public health decision-making has to be integrated into training programs in Germany. To address this issue, we developed a framework incorporating a toolbox to conceptualize training programs designed to qualify public health professionals for working at the interface between academia and practice...

BACKGROUND: Professional licensing bodies are valuable sources for tracking the health workforce, as many skilled health-care providers require formal training, registration, and licensure. Regulatory activities in Ethiopia were not effectively implemented due to poor follow-up and gaps in skilled human resources, budget, and information technology infrastructure. OBJECTIVE: The aim of this study was to explore and describe the lived experiences and challenges faced by health care managers in health professionals' licensure practices in Ethiopia...

BACKGROUND: Single nucleotide polymorphisms (SNPs) are inherited genetic variants that can be easily determined in everyday clinical practice using a simple blood or even saliva test. They have the potential to serve as non-invasive biomarkers to predict cancer-specific patient outcomes after resection of pancreatic ductal adenocarcinoma (PDAC). Specifically, two recent analyses led to the identification and validation of three SNPs in the CD44 and CHI3L2 genes (SNPrs187115, SNPrs353630, SNPrs684559) that can be utilised as predictive biomarkers to help select patients who are likely to benefit from pancreatic resection...

Artificial intelligence (AI) algorithms are prone to bias at multiple stages of model development, with potential for exacerbating health disparities. However, bias in imaging AI is a complex topic that encompasses multiple coexisting definitions. Bias may refer to unequal preference to a person or group owing to preexisting attitudes or beliefs, either intentional or unintentional. However, cognitive bias refers to systematic deviation from objective judgment due to reliance on heuristics, and statistical bias refers to differences between true and expected values, commonly manifesting as systematic error in model prediction (ie, a model with output unrepresentative of real-world conditions)...

Polysomnography (PSG) recordings have been widely used for sleep staging in clinics, containing multiple modality signals (i.e., EEG and EOG). Recently, many studies have combined EEG and EOG modalities for sleep staging, since they are the most and the second most powerful modality for sleep staging among PSG recordings, respectively. However, EEG is complex to collect and sensitive to environment noise or other body activities, imbedding its use in clinical practice. Comparatively, EOG is much more easily to be obtained...

PURPOSE: This study aimed to examine the effect of dependent care theory-based post-surgical home care intervention on self-care, symptoms, and caregiver burden in primary brain tumor patients and their caregivers. METHODS: A parallel-group randomized controlled trial was conducted with patients who underwent surgery for a primary brain tumor between March 2019 and January 2020 in a tertiary hospital and with caregivers who cared for them at home. Eligible patients and caregivers were determined by block randomization...

INTRODUCTION: Diffusion tensor imaging (DTI) is a valuable non-invasive imaging modality for mapping white matter tracts and assessing microstructural integrity, and can be used as a "biomarker" in diagnosis, differentiation, and therapeutic monitoring. Although it has gained clinical importance as a marker of neuropathology, limitations in its interpretation underscore the need for caution. METHODS: This review provides an overview of the principles and clinical applicability of DTI...

Although many young people demonstrate resilience and strength, research and clinical evidence highlight an upward trend in mental health concerns among those aged 12 to 25 years. Youth-specific digital mental health interventions (DMHIs) aim to address this trend by providing timely access to mental health support for young people (12-25 years). However, there is a considerable gap in understanding young people user experiences with digital interventions. This review, co-designed with Australia's leading mental health organization Beyond Blue, utilizes a systematic methodology to synthesize evidence on user experience in youth-oriented digital mental health interventions that are fully or partially guided...

BACKGROUND: Empirical use of pharmacogenetic test(PGT) is advocated for many drugs, and resource-rich setting hospitals are using the same commonly. The clinical translation of pharmacogenetic tests in terms of cost and clinical utility is yet to be examined in hospitals of low middle income countries (LMICs). AIM: The present study assessed the clinical utility of PGT by comparing the pharmacogenetically(PGT) guided- versus standard of care(SOC)- warfarin therapy, including the health economics of the two warfarin therapies...

Several cycloreversion reactions of the retro-Diels-Alder type were computationally assessed to understand their quantum tunneling (QT) reactivity. N2 , CO, and other leaving groups were considered based on their strong exothermicity, as it reduces their thermodynamic and kinetic stabilities. Our results indicate that for many of these reactions, it is essential to take into account their QT decomposition rate, which can massively weaken their molecular stability and shorten their half-lives even at deep cryogenic temperatures...

BACKGROUND AND AIMS: Non-invasive tests (NITs) are underutilized for diagnosis and risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD), despite good accuracy. This study aimed to identify challenges and barriers to the use of NITs in clinical practice. METHODS: We conducted a qualitative exploratory study in Germany, Italy, United Kingdom and United States. Phase 1 participants (primary care physicians, hepatologists, diabetologists, researchers, healthcare administrators, payers and patient advocates; n = 29) were interviewed...

Over a decade ago, longitudinal multiomics analysis was pioneered for early disease detection and individually tailored precision health interventions. However, high sample processing costs, expansive multiomics measurements along with complex data analysis have made this approach to precision/personalized medicine impractical. Here we describe in a case report, a more practical approach that uses fewer measurements, annual sampling, and faster decision making. We also show how this approach offers promise to detect an exceedingly rare and potentially fatal condition before it fully manifests...

BACKGROUND OBJECTIVES: The persistent threat of drug resistant malaria demands new cures. Low prevalence of malaria in the Indian state of Kerala compared with other proximal states made us explore if there is any traditional practice in Kerala which may confer protection against malaria. In this context, our attention was drawn to 'Pathimugam' i.e., Ceasalpinia sappan whose heartwood is used to prepare a red aqueous extract which is a uniquely popular drink in Kerala. METHODS: Aqueous and methanolic extracts of various organs of C...

Aqueous zinc-ion batteries (AZIBs) directly using zinc metal anodes are promising candidates for grid-scale energy storage systems due to their intrinsic high theoretical capacity, high safety, and environmental friendliness. However, the uncontrolled dendrite growth and water-triggered side reactions seriously plague its practical application. Herein, a cost-effective and green additive, maltodextrin (MD) is presented, to simultaneously guide the smooth Zn deposition and inhibit the occurrence of water-related side reactions...

Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion...

The flipped classroom is an innovative pedagogy that shifts content delivery outside the classroom, utilizing in-class time for interactive learning. The pre-class and in-class activities in this framework encourage individualized learning and collaborative problem-solving among students, fostering engagement. The Innovative Flipped Learning Instruction Project (IFLIP) conducted faculty development workshops over four years, guiding STEM faculty in integrating flipped teaching (FT) into their courses. The research aimed to assess its impact on pedagogical practices, explore its effectiveness, and provide a framework to implement FT across multiple institutions...

OBJECTIVES: Over the past 2 decades, simulation-based learning has become an essential part of medical training. Simulated clinics have proven to be effective for training medical students. Even so, this learning method presents organizational and financial challenges that limit its dissemination to all medical students, especially since the COVID-19 pandemic. Simulated teleconsultation retains the advantages of interactive simulated clinics while offering concrete solutions to the challenges faced...

This review comprehensively evaluates the impacts of anthropogenic threats on beaked whales (Ziphiidae)-a taxonomic group characterized by cryptic biology, deep dives and remote offshore habitat, which have challenged direct scientific observation. By synthesizing information published in peer-reviewed studies and grey literature, we identified available evidence of impacts across 14 threats for each Ziphiidae species. Threats were assessed based on their pathways of effects on individuals, revealing many gaps in scientific understanding of the risks faced by beaked whales...

INTRODUCTION: Black American Christian church leaders are trusted community members and can be invaluable leaders and planners, listeners, and counselors for Opioid Use Disorder (OUD) sufferers in the opioid overdose crisis disproportionately affecting the Black community. This qualitative study examines the extent to which the knowledge, attitudes, practices, and beliefs of Black American church leaders support medical and harm reduction interventions for people with OUD. METHODS: A semi-structured interview guide was used to conduct in-depth interviews of 30 Black Rhode Island church leaders recruited by convenience and snowball sampling...