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ResiliDents: Development and Evaluation of Resilience Module in Dental Undergraduate Curriculum
Get PDFIntroduction
The Dental profession is among the most stressful professions. This is a concern as high levels of exhaustion and psychological distress have been recorded even in early years postgraduation. Individuals with greater resilience tend to handle stress better. There are still no agreed frameworks with which to promote resilience in the undergraduate curriculum. This study aimed to inform the educational field on developing and evaluating an eLearning module to promote resilience‐building competencies in dental undergraduate students in Trinity College Dublin (TCD), Ireland.
Methods
A pre‐post evaluation was adopted to investigate the effectiveness of an online educational intervention module on the resilience of dental undergraduate students using the Connor‐Davidson Resilience Scale (CD‐RISC). All students in the latter years of the dental undergraduate programme were recruited as part of their curriculum and opted in for inclusion in the study. Data were analysed using SPSS v.22.
Results
Change in CD‐RISC‐25 mean score from pre to post‐test was positive, increasing from 63.84 (SD = 15.69) to 68.87 (SD = 18.06) by 7.9%; this was not statistically significant. Subscale scores did not change with statistical significance apart from the coping subscale (p < 0.01).
Conclusion
This was the first online eLearning module to be successfully developed with a focus on key topic literature review and engagement of recent graduates to promote development of essential resilience skills in the cohort. Although the results demonstrated no significant changes in outcomes, interventions that enable students to cope and successfully manage stress are needed in the curricula. Further investigation is required to understand the development and retention of such skills in dental undergraduates
Synthetic electrocardiograms for Brugada syndrome: from data generation to expert cardiologists evaluation
Get PDFAims
Synthetic electrocardiograms (ECGs) for inherited cardiac diseases may overcome the issue related to data scarcity for artificial intelligence (AI)-based algorithms. This study aimed to evaluate experienced cardiologists’ ability to differentiate synthetic and real Brugada ECGs.
Methods and results
A total of 2244 ECG instances (50% synthetic generated by a generative adversarial network, 50% real Brugada patients’ ECGs) were evaluated by 7 cardiologists, each with &gt;15 years of experience. All ECGs were standard 12-lead recordings acquired with identical settings (paper speed 25 mm/s, amplitude 10 mm/mV) and randomly assigned without identifying markers. The examination was blinded and conducted in 2 rounds with at least 2 h gap between rounds to assess potential learning effects and intra-rater reliability. Each physician classified the recordings as ‘real’ or ‘synthetic’ without having any additional information. Performance metrics, including accuracy, sensitivity, specificity, and intra-rater reliability (Cohen's Kappa), were analyzed. Brugada syndrome (BrS) specialists’ repeated evaluations were characterized by low accuracy (first round 40%, second round 42%), specificity (first round 22%, second round 26%) and sensitivity (first round 58%, second round 58%). Intra-rater reliability varied widely (Cohen’s Kappa: −0.12 to 0.80).
Conclusion
Synthetic Brugada ECGs cannot be adequately distinguished from real patients’ ECGs by BrS specialists
Healthcare services for low-wage migrant workers: A systematic review
Get PDFLow-wage labour migrants often face health-damaging living and working conditions, but are frequently excluded from healthcare. The othering of migrants, bordering of healthcare and simple oversight and negligence create widening health inequalities for a society’s essential workers. This review aimed to identify the forms and effectiveness of healthcare services designed to make healthcare accessible for migrant workers.
We searched for literature through Medline, Embase, Global Health, Web of Science, and Global Index Medicus (from 1 January 2000 till 9 June 2023), focussing on selected work sectors (domestic work, construction, manufacturing, agriculture, mining). Primary research, reports, and grey literature from 2000 onwards containing descriptions or evaluations of healthcare services exclusively targeting low-wage migrant workers and their families were included. We excluded services focussing only on specific health conditions or disease screening. Quality appraisal was based on tools from the Joanna Briggs Institute. We narratively synthesised service characteristics and effects. This review follows the PRISMA reporting guidelines for systematic reviews and is registered with PROSPERO (XX).
Identified studies included 21 healthcare services targeting low-wage migrant workers in six countries (China, Dominican Republic, Italy, Qatar, South Africa, USA) in three sectors (agriculture, manufacturing, domestic work). Services included established medical facilities (e.g., general hospital care, semi-permanent primary healthcare (PHC) services); mobile clinics for PHC; and telehealth services. The healthcare services were provided by governmental, non-governmental, academic, and private actors. Most targeted migrant farmworkers and were primarily located in the United States. Common healthcare barriers were addressed, for example, via free care, outreach, or non-traditional hours. However, service effects on health, access and uptake, patient satisfaction, and acceptability were largely unclear, as only six studies offered some fragmentary evaluative evidence.
Few healthcare services targeting migrant workers have been documented and evaluated, especially in LMICs. Although migrant workers are deemed to be mobile populations, once in the destination location, many are quite immobile when it comes to accessing healthcare. Thus, in the face of persistent exclusion of migrant workers, health systems cannot simply rely on the ability of this vital workforce to seek and use preventative or curative care, but healthcare services must be actively designed to be accessible to this mobile population in order to ensure health as a human right
Foetal Cardiac Function in Early Labour and Intrapartum Outcomes: A Prospective Observational Study
Get PDFObjective
To assess foetal myocardial deformation in normo‐oxygenated foetuses in early labour and its relationship with intrapartum outcomes.
Design
Single centre prospective study.
Setting
Referral tertiary maternity unit.
Population
Uncomplicated singleton term pregnancies in early labour.
Methods
Two‐dimensional (2D) ultrasound clips of the 4‐chamber view of the foetal heart were collected in labour and sent to TomTec software for the offline speckle tracking echocardiography analysis. The left (LV) and right ventricular (RV) myocardial (MyoGLS) and endocardial longitudinal (EndoGLS) strain were evaluated.
Main Outcome Measures
Operative delivery including caesarean or assisted vaginal birth due to suspected intrapartum foetal compromise (IFC) as defined by standard CTG criteria.
Results
In total, 208 cases were included. Operative delivery due to suspected IFC was recorded in 20 (9.6%) cases and was associated with higher LV ejection fraction (EF) (47.4 + 8.2 vs. 40.9 + 12.9%, p = 0.03) and increased RV MyoGLS (−15.9 + 4.0 vs. −12.5 + 4.3%, p < 0.01) and RV EndoGLS (−17.7 + 4.4 vs. −14.3 + 4.7%, p < 0.01) compared to cases not having operative delivery due to suspected IFC. Maternal age (OR 1.138, 95% CI [1.010–1.281], p = 0.03), baseline foetal heart rate at acquisition (OR 1.068, 95% CI [1.007–1.134], p = 0.03) and RV MyoGLS (OR 0.575, 95% CI [0.366–0.903], p = 0.02) were independently associated with the primary outcome.
Conclusions
Increased right ventricular myocardial deformation is associated with operative delivery due to suspected IFC, suggesting an early cardiac response to labour‐related hypoxia
Guidance for conducting and evaluating serological surveys to assess interruption of yaws transmission in the context of an eradication target
Get PDFThis document provides a summary of guidance developed for national programmes on conducting serosurveys to assess yaws transmission status, with the objective of confirming yaws seroprevalence below 1% at each of three serosurveys over a period of 3–10 years after reporting the last case of active yaws in a region. It proposes active testing of children aged 1–5 years through population-based surveys and includes recommendations on survey design, sample size determination, sampling of primary sampling units (PSUs) within an evaluation unit, sampling of households within PSUs, integration with existing public health surveys, and follow-up protocols for positive results. Geospatial analysis and sustained surveillance are recommended for accurate assessment of whether transmission interruption has been achieved
Morbidity in children with major kidney anomalies: a European population-based study
Get PDFKnowledge about the prognosis for children born with congenital anomalies is important for counselling parents after a prenatal diagnosis. Nine population-based European Congenital Anomaly registries provided data on all children born 1995–2014 diagnosed with congenital hydronephrosis, multicystic kidney disease (MCKD), or posterior urethral valves (PUV) and on reference children from the same populations. Data up to 2015 on prescriptions, hospital diagnosis, and surgical procedures up to the 10th birthday were obtained by linkage to prescription and hospital databases. The study included 5624 children diagnosed with congenital hydronephrosis, 1314 with MCKD, and 414 with PUV. Children with hydronephrosis or MCKD were 13 times more likely to have prescriptions for antihypertensives compared to reference children before 10 years of age. Around 3% of children with congenital hydronephrosis or MCKD had a diagnosis of kidney failure at the age of 5 years; however, only 1% had a kidney transplantation by the age of 5 years. For children with PUV, 18.3% had a diagnosis of kidney failure and 5% had a kidney transplantation by the age of 5 years. Conclusion: Children born with congenital hydronephrosis and MCKD generally have a low absolute risk of developing kidney failure. Children with PUV have much higher morbidity, with 1 in 5 (18.3%) being diagnosed with kidney failure before the age of 5 years. It is important to monitor these children closely in early childhood in order to prevent or delay kidney failure
Cardiovascular disease reported as modes of death in the Office for National Statistics mortality data: a retrospective observational study
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A cause of death is a specific disease or injury which directly led to the death whereas a mode of death which is a mechanism such as respiratory failure, cardiac arrest or cardiac failure but does not provide the cause of death. We sought to establish the scale of use of cardiovascular mode and other non-specific codes as causes of death.
Design:
We extracted the mortality statistics recorded between 2013 and 2021 and then selected cardiovascular codes.
Setting:
The Office for National Statistics mortality data.
Participants:
Deceased individuals from England and Wales.
Main outcome measures:
Cause of death.
Results:
Of 4,852,897 deaths, 836,741 (17.2%) had cardiovascular codes. Of these, 103,160 (12.3%) were labelled as modes and 35,784 (4.3%) were non-specific causes. Modes increased from 5862 in 2013 to 14,641 in 2021. Modes included 56,291 (6.7%) as arrhythmia and 46,787 (5.6%) as heart failure. Non-specific included 12,192 (1.46%) myocardial degeneration and 6573 (0.79%) cardiomegaly. Non-specific cardiomyopathies included other cardiomyopathies (207) and cardiomyopathy, unspecified (2984).
Conclusions:
Modes of death are being used in a notable proportion of medical certificates and this is increasing which is worrying and does not provide the underlying cause of the death. It is important that a cause of death is given so that underlying heritable cardiac conditions, such as channelopathy or cardiomyopathy, are identified. This enables referral of blood relatives for cardiological screening and intervention. ICD-11 will help address some of the non-specific causes of death with the inclusion of codes for sudden arrhythmic death syndrome and arrhythmogenic cardiomyopathy. Autopsy is essential to establish a cause of death where only a mode of death can be given without clarification of a causative disease
Intravenous Clarithromycin in Critically Ill Adults: A Population Pharmacokinetic Study
Get PDFBackground: Clarithromycin is a commonly used macrolide antibiotic. Infection is a major source of mortality and morbidity in critical care units. Pharmacokinetics may vary during critical illness and suboptimal antimicrobial exposure has been shown to be associated with treatment failure. The pharmacokinetics of intravenous clarithromycin in critical illness have not previously been described. Methods: Pharmacokinetic, clinical and demographic data were collected from critically ill adults receiving intravenous clarithromycin. Drug concentrations were measured using high-performance liquid chromatography/mass spectrometry. Population pharmacokinetic analysis was performed using NONMEM version 7.5.1. Allometric weight scaling was added, and periods of renal replacement therapy were excluded a priori. Simulations of 10,000 patients were performed to assess pharmacokinetic–pharmacodynamic (PKPD) target attainment. Results: The analysis included 121 samples taken from 19 participants. A two-compartment model was found to provide the best fit. The addition of covariates did not improve model fit. There was no evidence of auto-inhibition in this population. Population parameter estimates of clearance and volume of distribution were lower than previously reported, with high interindividual variability. Simulations suggested reasonable pharmacokinetic–pharmacodynamic (PKPD) target attainment with current dosing regimens for most organisms that clarithromycin is used to treat with known clinical breakpoints. Conclusions: To our knowledge, this is the first study to describe the pharmacokinetics of intravenous clarithromycin in humans. Although our simulations suggest reasonable target attainment, further investigation into appropriate PKPD targets and clinical breakpoints for clarithromycin may enable dosing optimisation in this population
Avoidable hospitalizations for ambulatory care sensitive conditions in children under five years in Ecuador, 2000-2023
Get PDFAvoidable hospitalizations due to ambulatory care sensitive conditions (ACSC) are an indirect indicator of primary health care quality and effectiveness of care coordination. This study aims to analyze the proportion and trends of hospital discharges for ACSCs (2000-2023) among children under five years, project rates through 2026, and compare standardized rates across cantons. We conducted an ecologic time-series analysis using Ecuador’s national hospital discharge data for 20 ACSCs, as defined by the Pan-American Health Organization. Annual percentage changes were estimated using Joinpoint regression, and forecasts were generated with the Prophet package in R. Standardized morbidity ratios (SMRs) were used to compare rates across 221 cantons, based on Ecuador’s population from the 2001, 2010, and 2022 censuses. Between 2000 and 2023, ACSCs accounted for 26.6% of all hospital discharges. The overall average of annual percent change increased by 2%, and by 6.8%, 6.4%, and 4.2% for respiratory diseases, urinary and skin infections, respectively. Gastrointestinal diseases declined by 1.9% annually. Significant changes in ACSC trends were observed during the following periods: 2000-2007; 2018-2021; and 2021-2023. No significant change occurred from 2008 to 2018. Projections indicated that ACSCs may still represent 20.3% of hospital discharges by 2026. Moreover, 5.4% of cantons consistently exceeded expected SMRs across all three census years analyzed. The rising ACSC rates during the early 2000s, marked by economic structural adjustment and limited public healthcare investment, contrasts with the decline observed during the COVID-19 pandemic. These findings underscore the need to strengthen primary care and public health planning
Causes of HIV-related CNS infection in Cameroon, Malawi, and Tanzania: epidemiological findings from the DREAMM HIV-related CNS implementation study
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CNS infections cause approximately a third of HIV-related deaths. The Driving Reduced AIDS-Associated Meningo-encephalitis Mortality DREAMM study aimed to prospectively diagnose the aetiology of HIV-related CNS infection in five public hospitals in Cameroon, Malawi, and Tanzania.
Methods
DREAMM was a multicentre, hybrid type-2 implementation science project. Adults (aged ≥18 years) presenting with a first episode of suspected CNS infection, who were HIV seropositive or willing to have an HIV test, were eligible for recruitment. Following implementation of the DREAMM model of care, we measured the prevalence of cryptococcal meningitis, tuberculous meningitis, bacterial meningitis, and cerebral toxoplasmosis and did a χ2 test to assess whether prevalence differed between countries. We also reported disease-specific mortality and Toxoplasma gondii seroprevalence.
Findings
Of 356 participants with suspected CNS infection analysed at baseline, 269 (76%) were diagnosed as having a CNS infection. Of these, 202 (75%) had a confirmed diagnosis. Between Cameroon, Malawi, and Tanzania, the prevalence of the four main types of CNS infection differed (cryptococcal meningitis p=0·0014, bacterial meningitis p=0·0043, CNS tuberculosis p<0·0001, and toxoplasmosis p<0·0001). Cryptococcal meningitis (148 [55%] of 269) was the leading cause overall. The next most common causes were CNS tuberculosis in Tanzania (29 [29%] of 99) and bacterial meningitis in Malawi (15 [19%] of 80). In Cameroon, cerebral toxoplasmosis (39 [43%] of 90) was the leading cause followed by cryptococcal meningitis (36 [40%] of 90). For cryptococcal meningitis, all-cause 2-week mortality was 23% (34 of 147) and all-cause 10-week mortality was 45% (66 of 146).
Interpretation
Within the study population, the aetiology of HIV-related CNS infection varied substantially between Malawi, Cameroon, and Tanzania. Additional prospective epidemiological data are needed to inform HIV programmes. 2-week cryptococcal meningitis mortality outcomes were similar to those of clinical trials. However, new interventions are urgently needed to sustain mortality reductions following hospital discharge.
Funding
European and Developing Countries Clinical Trials Partnership and French Agency for Research on AIDS and Viral Hepatitis.
Translations
For the French and Portuguese translations of the abstract see Supplementary Materials section
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