4,737 research outputs found

    Enhancing Athletic Participation: Continuous Glucose Monitoring for Pediatric Type 1 Diabetes Athletes

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    The difficulties that children and teenagers with Type 1 Diabetes Mellitus (T1DM) encounter are discussed in this thesis, with a focus on how fear of hypoglycemia (FOH) and actual hypoglycemia associated with this chronic illness affects their ability to engage in physical activities, especially organized sports. A common challenge for children diagnosed with T1DM is meeting the daily recommendation of 60 minutes of daily moderate to vigorous physical activity. The purpose of the proposed study is to evaluate if participation in structured exercise (physical education classes and after-school sports) increases among school-aged children who wear continuous glucose monitors (CGM) when their PE teachers and coaches have been specifically trained to interpret their CGM data and intervene to correct their hypoglycemia. The study will also examine the intervention\u27s effect on the children\u27s FOH and incidence of unsafe blood glucose levels during such structured exercise. Pre and post-intervention FOH will be measured using the Hypoglycemia Fear Survey, which is a validated FOH Questionnaire. Pre and post-intervention blood glucose levels during structured exercise will be measured by CGM. Pre and post-intervention structured exercise participation levels will be measured by the PE teachers and coaches. The ultimate goal of this research is to increase activity and quality of life levels for youth with T1DM

    What is the best time to tweet a journal article? Quasi-randomized controlled trial

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    Introdução: Os usuários das plataformas de mídia social são frequentemente encorajados a agendar suas postagens para aumentar o número de leitores e o engajamento. Nosso objetivo foi descobrir qual é a melhor hora do dia para tuitar um artigo de periódico. Métodos: De janeiro de 2020 a outubro de 2021, 112 artigos de uma revista médica foram postados no Twitter três vezes cada, uma vez em cada idioma: português, espanhol e inglês. Até dois artigos eram postados a cada semana, sendo que cada um dos tuítes em uma semana era postado em uma hora diferente do dia: 06, 09, 12, 15, 18 ou 21:00. Impressões de tuíte e cliques em URL foram os dois desfechos dos modelos bayesianos de regressão binomial negativa multivariada multinível. Resultados: Nenhum par de horas do dia atingiu 95% de probabilidade a posteriori de incluir a melhor hora para tuitar um artigo de periódico, tanto para impressões como para cliques em URL. Os desfechos esperados, a relação entre os desvios padrão e a variabilidade explicada (R²) todos corroboraram que a hora do dia é de pouca importância quando se tuítam artigos de periódicos. Conclusões: Ao contrário do conselho usual e da pesquisa pré-algoritmo, as equipes editoriais não precisam se preocupar em otimizar a hora do dia em que divulgam seu conteúdo no Twitter.Introduction: Social media users are often advised to time their posts to increase readership and engagement. Our objective was to find out which is the best time to tweet a journal article. Methods: From January 2020 to October 2021, 112 articles from a medical journal were posted on Twitter three times each, once in each language: Portuguese, Spanish and English. Up to two articles were posted each week, with each of the week’s tweets being posted in a different hour of the day: 06, 09, 12, 15, 18 or 21:00. Tweet impressions and URL clicks were the two outcomes of the Bayesian multivariate multilevel negative binomial regression models. Results: No pair of times of the day achieved 95% posterior probability of including the best time to tweet a journal article, both for impressions and URL clicks. The expected outcomes, the ratio between standard deviations, and the explained variability (R²) all corroborated that the time of the day is of little consequence when tweeting journal articles. Conclusions: Contrary to popular advice and pre-algorithm research, journal staff need not bother with optimizing the time of the day when they disseminate their content on Twitter

    When Fines Don\u27t Go Far Enough: The Failure of Prison Settlements and Proposals for More Effective Enforcement Methods

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    The Eighth Amendment’s Punishments Clause provides the basis on which prisoners may bring suit alleging unconstitutional conditions of confinement. Only a small number of these suits are successful. The suits that do survive typically end in a settlement in which prison authorities agree to address the unconstitutional conditions. However, settlements such as these are easily flouted for two primary reasons: prison authorities are not personally held liable when settlements are broken, and prisoners largely lack the political and practical leverage to self-advocate beyond the courtroom. Because of this, unconstitutional prison conditions may linger for years after prison authorities have agreed to ameliorate them. This is an unacceptable result, and one that is largely shielded from the public eye. This Comment contends that if the United States is to fulfill its promise that “cruel and unusual punishments” will not be inflicted on its prison populations, the judiciary’s methods of enforcing settlements must be expanded beyond the fines it currently employs. This Comment provides a brief grounding in Punishment Clause suits based on select conditions of confinement issues and discusses a real-world example of a prison settlement that went largely ignored for several years. It then proposes three statutory modifications as stronger enforcement methods that the judiciary may employ post-settlement: partial abrogation of qualified immunity, modification of the deliberate indifference standard, and a loosening of the strictures of the Prison Litigation Reform Act. Finally, this Comment also offers a policy solution pre-incarceration: strengthened adherence to the twin prosecutorial duties of protecting the public and imposing alternatives to incarceration

    Mind the implementation gap: a systems analysis of the NHS Long Term Workforce Plan to increase the number of doctors trained in the UK raises many questions

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    BACKGROUND: The National Health Service (NHS) in England is facing a workforce crisis. A new Long Term Workforce Plan (LTWP) seeks to address this, setting out ambitious proposals to expand and reform domestic medical education and training in England. However, there are concerns about their feasibility. SOURCES OF DATA: In September 2023, over 60 individuals representing medical education and training in the UK participated in an exercise run by UK Medical Schools Council by using systems theory to identify risks. AREAS OF AGREEMENT: The UK does need more 'home grown' doctors, but the LTWP has important gaps, including lack of attention to postgraduate training, absence of reference to the need for more educators and capital investment and risk of inadequate clinical placement capacity, particularly in primary care settings. AREAS OF CONTROVERSY: There are unresolved differences in the understanding of a proposed medical apprenticeship model and no scheme has, as yet, been approved by the General Medical Council. Participants were unable to determine who the beneficiaries of this scheme will be (apart from the apprentices themselves). GROWING POINTS: While the LTWP represents a welcome, although overdue, commitment to address the NHS workforce crisis, we identified significant gaps that must be resolved. AREAS TIMELY FOR DEVELOPING RESEARCH: First, the development of the LTWP provides a case study that adds to literature on policymaking in the UK. Second, while we only examined the expansion of medical training, the method could be applied to other parts of the LTWP. Third, a prospective evaluation of its implementation is necessary

    Interventions of Brazil's more doctors program through continuing education for Primary Health Care

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    IntroductionBrazil's More Doctors Program, in its training axis, aims to improve medical training for Primary Health Care through interventions related to the reality of the territory. The research presented here analyzed the interventions implemented by Brazil's More Doctors Program physicians, members of the Family Health Continuing Education Program, and the relationship with Primary Health Care programmatic actions.MethodologyThe research conducted made use of Text and Data Mining and content analysis. In total, 2,159 reports of interventions from 942 final papers were analyzed. The analysis process was composed of the formation of the corpus; exploration of the materials through text mining; and analysis of the results by inference and interpretation.ResultsIt was observed that 57% of the physicians worked in the Northeast Region, which was also the region with the most interventions (66.8%). From the analysis of the bigrams, trigrams, and quadrigrams, four constructs were formed: “women's health,” “child health,” “chronic non-communicable diseases,” and “mental health.” Terms related to improving access, quality of care, teamwork, and reception were also present among the N-grams.DiscussionThe interventions carried out are under the programmatic actions recommended by the Brazilian Ministry of Health for Primary Health Care, also addressing cross-cutting aspects such as Reception, Teamwork, Access Improvement, and Quality of Care, which suggests that the training experience in the Family Health Continuing Education Program reflects on the way these professionals act

    Informing the surgical workforce pathway: how rural community characteristics matter

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    Introduction: Rural areas worldwide face a general surgeon shortage, limiting rural populations' access to surgical care. While individual and practice-related factors have been well-studied in the US, we need a better understanding of the role of community characteristics in surgeons' location choices. This study aimed to understand the deeper meanings surgeons associated with community characteristics in order to inform efforts spanning the rural surgeon workforce pathway, from early educational exposures, and undergraduate and graduate medical education, to recruitment and retention. Methods: We conducted a qualitative, descriptive interview study with general surgeons in the Midwestern US about the role and meaning of community characteristics, exploring their backgrounds, education, practice location choices, and future plans. We focused on rural surgeons and used an urban comparison group. We used convenience and snowball sampling, then conducted interviews in-person and via phone, and digitally recorded and professionally transcribed them. We coded inductively and continued collecting data until reaching code saturation. We used thematic network analysis to organize codes and draw conclusions. Results: A total of 37 general surgeons (22 rural and 15 urban) participated. Interviews totaled over 52 hours. Three global themes described how rural surgeons associated different, often deeper, meanings with certain community characteristics compared to their urban colleagues: physical environment symbolism, health resources' relationship to scope of practice, and implications of intense role overlap (professional and personal roles). All interviewees spoke to all three themes, but the meanings they found differed importantly between urban and rural surgeons. Physical landscapes and community infrastructure were representative of autonomy and freedom for rural surgeons. They also shared how facilities, equipment, staff, staff education, and surgical partners combined to create different scopes of practice than their urban counterparts experienced. Often, rural surgeons found these resources dictated when they needed to transfer patients to higher-acuity facilities. Rural surgeons experienced role overlap intensely, as they cared for patients who were also friends and neighbors. Conclusion: Rural surgeons associated different meanings with certain community characteristics than their urban counterparts. As they work with prospective rural surgeons, educators and rural communities should highlight how health resources can translate into desired scopes of practice. They also should share with trainees the realities of role overlap, both how intense and stressful it can be but also how gratifying. Educators should include the rural social context in medical and surgical education, looking for even more opportunities to collaborate with rural communities to provide learners with firsthand experiences of rural environments, resources, and role overlap

    Combining the hospital frailty risk score with the Charlson and Elixhauser multimorbidity indices to identify older patients at risk of poor outcomes in acute care

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    Objective: The Hospital Frailty Risk Score (HFRS) can be applied to medico-administrative datasets to determine the risks of 30-day mortality and long length of stay (LOS) in hospitalized older patients. The objective of this study was to compare the HFRS with Charlson and Elixhauser comorbidity indices, used separately or combined. Design: A retrospective analysis of the French medical information database. The HFRS, Charlson index, and Elixhauser index were calculated for each patient based on the index stay and hospitalizations over the preceding 2 years. Different constructions of the HFRS were considered based on overlapping diagnostic codes with either Charlson or Elixhauser indices. We used mixed logistic regression models to investigate the association between outcomes, different constructions of HFRS, and associations with comorbidity indices. Setting: 743 hospitals in France. Participants: All patients aged 75 years or older hospitalized as an emergency in 2017 (n=1,042,234). Main outcome measures: 30-day inpatient mortality and LOS >10 days. Results: The HFRS, Charlson, and Elixhauser indices were comparably associated with an increased risk of 30-day inpatient mortality and long LOS. The combined model with the highest c-statistic was obtained when associating the HFRS with standard adjustment and Charlson for 30-day inpatient mortality (adjusted c-statistics: HFRS=0.654; HFRS + Charlson = 0.676) and with Elixhauser for long LOS (adjusted c-statistics: HFRS= 0.672; HFRS + Elixhauser =0.698). Conclusions: Combining comorbidity indices and HFRS may improve discrimination for predicting long LOS in hospitalized older people, but adds little to Charlson’s 30-day inpatient mortality risk

    Survival impact and safety of intrathoracic and abdominopelvic cytoreductive surgery in advanced ovarian cancer: a systematic review and meta-analysis

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    PurposeAchieving no residual disease is essential for increasing overall survival (OS) and progression-free survival (PFS) in ovarian cancer patients. However, the survival benefit of achieving no residual disease during both intrathoracic and abdominopelvic cytoreductive surgery is still unclear. This meta-analysis aimed to assess the survival benefit and safety of intrathoracic and abdominopelvic cytoreductive surgery in advanced ovarian cancer patients.MethodsWe systematically searched for studies in online databases, including PubMed, Embase, and Web of Science. We used Q statistics and I-squared statistics to evaluate heterogeneity, sensitivity analysis to test the origin of heterogeneity, and Egger’s and Begg’s tests to evaluate publication bias.ResultsWe included 4 retrospective cohort studies, including 490 patients, for analysis; these studies were assessed as high-quality studies. The combined hazard ratio (HR) with 95% confidence interval (CI) for OS was 1.92 (95% CI 1.38-2.68), while the combined HR for PFS was 1.91 (95% CI 1.47-2.49). Only 19 patients in the four studies reported major complications, and 4 of these complications were surgery related.ConclusionThe maximal extent of cytoreduction in the intrathoracic and abdominopelvic tract improves survival outcomes, including OS and PFS, in advanced ovarian cancer patients with acceptable complications.Systematic Review RegistrationPROSPERO, identifier CRD4202346809

    How can intersectoral collaboration and action help improve the education, recruitment, and retention of the health and care workforce? A scoping review

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    Inadequate numbers, maldistribution, attrition, and inadequate skill‐mix are widespread health and care workforce (HCWF) challenges. Intersectoral—inclusive of different government sectors, non‐state actors, and the private sector—collaboration and action are foundational to the development of a responsive and sustainable HCWF. This review presents evidence on how to work across sectors to educate, recruit, and retain a sustainable HCWF, highlighting examples of the benefits and challenges of intersectoral collaboration. We carried out a scoping review of scientific and grey literature with inclusion criteria around intersectoral governance and mechanisms for the HCWF. A framework analysis to identify and collate factors linked to the education, recruitment, and retention of the HCWF was carried out. Fifty‐six documents were included. We identified a wide array of recommendations for intersectoral activity to support the education, recruitment, and retention of the HCWF. For HCWF education: formalise intersectoral decision‐making bodies; align HCWF education with population health needs; expand training capacity; engage and regulate private sector training; seek international training opportunities and support; and innovate in training by leveraging digital technologies. For HCWF recruitment: ensure there is intersectoral clarity and cooperation; ensure bilateral agreements are ethical; carry out data‐informed recruitment; and learn from COVID‐19 about mobilising the domestic workforce. For HCWF retention: innovate around available staff, especially where staff are scarce; improve working and employment conditions; and engage the private sector. Political will and commensurate investment must underscore any intersectoral collaboration for the HCWF

    First do no harm overlooked: Analysis of COVID-19 clinical guidance for maternal and newborn care from 101 countries shows breastfeeding widely undermined

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    BackgroundIn March 2020, the World Health Organization (WHO) published clinical guidance for the care of newborns of mothers with COVID-19. Weighing the available evidence on SARS-CoV-2 infection against the well-established harms of maternal-infant separation, the WHO recommended maternal-infant proximity and breastfeeding even in the presence of maternal infection. Since then, the WHO’s approach has been validated by further research. However, early in the pandemic there was poor global alignment with the WHO recommendations.MethodsWe assessed guidance documents collected in November and December 2020 from 101 countries and two regional agencies on the care of newborns of mothers with COVID-19 for alignment with the WHO recommendations. Recommendations considered were: (1) skin-to-skin contact; (2) early initiation of breastfeeding; (3) rooming-in; (4) direct breastfeeding; (5) provision of expressed breastmilk; (6) provision of donor human milk; (7) wet nursing; (8) provision of breastmilk substitutes; (9) relactation; (10) psychological support for separated mothers; and (11) psychological support for separated infants.ResultsIn less than one-quarter of country guidance were the three key breastfeeding facilitation practices of skin-to-skin contact, rooming-in, and direct breastfeeding recommended. Donor human milk was recommended in under one-quarter of guidance. Psychological support for mothers separated from their infants was recommended in 38%. Few countries recommended relactation, wet nursing, or psychological support for infants separated from mothers. In three-quarters of country guidance, expressed breastmilk for infants unable to directly breastfeed was recommended. The WHO and the United Kingdom’s Royal College of Obstetricians and Gynecologists were each cited by half of country guidance documents with the United States Centers for Disease Control and Prevention directly or indirectly cited by 40%.ConclusionDespite the WHO recommendations, many COVID-19 maternal and newborn care guidelines failed to recommend skin-to-skin contact, rooming-in, and breastfeeding as the standard of care. Irregular guidance updates and the discordant, but influential, guidance from the United States Centers for Disease Control may have been contributory. It appeared that once recommendations were made for separation or against breastfeeding they were difficult to reverse. In the absence of quality evidence on necessity, recommendations against breastfeeding should not be made in disease epidemics
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