Effectiveness and Challenges: The Current Situation of Electronic Health Records (EHRs) to Improve Health Care Outcomes

Background. In the Philippines, although software for Electronic Health Records (EHRs) is still new, knowledge about EHRs benefits is increasing.Objective: This study investigated the effectiveness of electronic health records to health care outcomes at selected health facilities in the National Capital Region (NCR) and CALABARZON regions of the Philippines. The effectiveness of the current EHRs in government and private health facilities were determined in terms of quality patient care, patient engagement, support team-based care, workload, and data liquidity; and the challenges facing health providers in the implementation of electronic health records were identified.Methods. The research utilized the descriptive, cross-sectional design. Three hundred seven (N=307) health providers from the medical, nursing, and paramedical departments were the study participants. A three-part adapted questionnaire was the main tool used for data collection. Mean, standard deviation, and Mann-Whitney & Kruskal-Wallis’s tests were utilized for data analysis.Results. The results revealed that in the Philippines, EHRs are moderately effective in improving health care outcomes. EHRs effectiveness is primarily achieved through better access and retrieval of health information. EHRs implementation poses major challenges in the Philippines’ health facilities which are central to socio-economic and organizational factors.Conclusions. The more effective the use of EHR systems, the greater the challenges experienced by care providers and health facilities

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of migraine in adults

Background: This is an updated version of the original Cochrane review published in 2005 on selective serotonin re-uptake inhibitors (SSRIs) for preventing migraine and tension-type headache. The original review has been split in two parts and this review now only regards migraine prevention. Another updated review is under development to cover tension-type headache. Migraine is a common disorder. The chronic forms are associated with disability and have a high economic impact. In view of discoveries about the role of serotonin and other neurotransmitters in pain mechanisms, selective serotonin re-uptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been evaluated for the prevention of migraine. Objectives: To determine the efficacy and tolerability of SSRIs and SNRIs compared to placebo and other active interventions in the prevention of episodic and chronic migraine in adults. Search strategy: For the original review, we searched MEDLINE (1966 to January 2004), EMBASE (1994 to May 2003), the Cochrane Central Register of Controlled Trials (CENTRAL 2003, Issue 4), and Headache Quarterly (1990 to 2003). For this update, we applied a revised search strategy to reflect the broader type of intervention (SSRIs and SNRIs). We searched CENTRAL (2014, Issue 10), MEDLINE (1946 to November 2014), EMBASE (1980 to November 2014), and PsycINFO (1987 to November 2014). We also checked the reference lists of retrieved articles and searched trial registries for ongoing trials. Selection criteria: We included randomised controlled trials comparing SSRIs or SNRIs with any type of control intervention in participants 18 years and older of either sex with migraine. Data collection and analysis: Two authors independently extracted data (migraine frequency, index, intensity, and duration; use of symptomatic/analgesic medication; days off work; quality of life; mood improvement; cost-effectiveness; and adverse events) and assessed the risk of bias of trials. The primary outcome of this updated review is migraine frequency. Main results: The original review included eight studies on migraine. Overall, we now include 11 studies on five SSRIs and one SNRI with a total of 585 participants. Six studies were placebo-controlled, four compared a SSRI or SNRI to amitriptyline, and one was a head-to-head comparison (escitalopram versus venlafaxine). Most studies had methodological or reporting shortcomings (or both): all studies were at unclear risk of selection and reporting bias. Follow-up rarely extended beyond three months. The lack of adequate power of most of the studies is also a major concern. Few studies explored the effect of SSRIs or SNRIs on migraine frequency, the primary endpoint. Two studies with unclear reporting compared SSRIs and SNRIs to placebo, suggesting a lack of evidence for a difference. Two studies compared SSRIs or SNRIs versus amitriptyline and found no evidence for a difference in terms of migraine frequency (standardised mean difference (SMD) 0.04, 95% confidence interval (CI) -0.72 to 0.80; I2 = 72%), or other secondary outcomes such as migraine intensity and duration. SSRIs or SNRIs were generally more tolerable than tricyclics. However, the two groups did not differ in terms of the number of participants who withdrew due to adverse advents or for other reasons (one study, odds ratio (OR) 0.39, 95% CI 0.10 to 1.50 and OR 0.42, 95% CI 0.13 to 1.34). We did not find studies comparing SSRIs or SNRIs with pharmacological treatments other than antidepressants (e.g. antiepileptics and anti-hypertensives)

Detection of SARS-CoV-2 N protein allelic variants by rapid high-throughput CLEIA antigen assay

We report the data obtained using an automated chemiluminescence enzyme immunoassay (CLEIA) for rapid antigen detection of SARS-CoV-2 with a number of variants

Rational Use of Monoclonal Antibodies as Therapeutic Treatment in an Oncologic Patient with Long COVID

We present the case of a 76-year-old male patient persistently infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the setting of a stage IIIC cutaneous melanoma and non-Hodgkin’s lymphoma (NHL). Due to the persistent coronavirus disease 19 (COVID-19), all cancer treatments were discontinued. Because of the worsening of his clinical state and the persistence of SARS-CoV-2 positivity for more than six months, the patient was treated with sotrovimab, which was ineffective due to resistance mutations acquired during that time. In order to resume cancer treatment and make the patient free from SARS-CoV-2, an in vitro screening of Evusheld monoclonal antibodies (tixagevumab–cilgavimab) against the viral strains isolated from the subject was performed. The promising results obtained during in vitro testing led to the authorization of the off-label use of Evusheld, which made the patient negative for SARS-CoV-2, thus, allowing him to resume his cancer treatment. This study highlights the Evusheld monoclonal antibodies’ efficacy, not only in prevention but also in successful therapy against prolonged COVID-19. Therefore, testing neutralizing monoclonal antibodies in vitro against SARS-CoV-2 mutants directly isolated from patients could provide useful information for the treatment of people affected by long COVID

ICME international survey on teachers working and learning through collaboration

This article presents preliminary results from a survey commissioned for ICME 13 (2016) focusing on "Teachers Working and Learning Through Collaboration". It takes as a starting point a previous survey, commissioned for ICME 10 in 2004 that focused on Mathematics Teacher Education. The current survey focuses centrally on teachers involved in collaborations, sometimes in formal settings of professional development, but also in a more diverse range of collaborative settings including research initiatives. The roles of teachers involved in the collaboration, survey methods, decisions and limitations are described. While some of the findings to date resonate with those of the earlier survey, other findings highlight characteristics and issues relating to the differing ways in which teachers collaborate, either with other teachers or the various 'others', most notably mathematics teacher educator researchers. The roles and relationships that contribute to learning in such collaborations, as well as theories and methodologies found in survey sources, are a focus of the findings presented here. Studies rarely theorised collaboration, and few of those that did so reported explicitly on how their theoretical frame shaped the design of research methodologies/approaches guiding activities with teachers. One significant outcome has been the difficulty of relating teachers' learning to collaboration within a project, although many initiatives report developments in teaching, teacher learning and students' learning

The route to solve the interplay between inflammation, angiogenesis and anti-cancer immune response

Even though the crucial role played by inflammation in cancer development and progression was first hypothesized by Rudolf Virchow at the beginning of the nineteenth century, only recently inflammation has been recognized as a hallmark of cance

Type I interferons induced by endogenous or exogenous viral infections promote metastasis and relapse of leishmaniasis.

The presence of the endogenous <i>Leishmania</i> RNA virus 1 (LRV1) replicating stably within some parasite species has been associated with the development of more severe forms of leishmaniasis and relapses after drug treatment in humans. Here, we show that the disease-exacerbatory role of LRV1 relies on type I IFN (type I IFNs) production by macrophages and signaling in vivo. Moreover, infecting mice with the LRV1-cured <i>Leishmania guyanensis</i> ( <i>LgyLRV1</i> <sup> <i>-</i> </sup> ) strain of parasites followed by type I IFN treatment increased lesion size and parasite burden, quantitatively reproducing the LRV1-bearing ( <i>LgyLRV1</i> <sup> <i>+</i> </sup> ) infection phenotype. This finding suggested the possibility that exogenous viral infections could likewise increase pathogenicity, which was tested by coinfecting mice with <i>L. guyanensis</i> and lymphocytic choriomeningitis virus (LCMV), or the sand fly-transmitted arbovirus Toscana virus (TOSV). The type I IFN antiviral response increased the pathology of <i>L. guyanensis</i> infection, accompanied by down-regulation of the IFN-γ receptor normally required for antileishmanial control. Further, LCMV coinfection of IFN-γ-deficient mice promoted parasite dissemination to secondary sites, reproducing the <i>LgyLRV1</i> <sup> <i>+</i> </sup> metastatic phenotype. Remarkably, LCMV coinfection of mice that had healed from <i>L. guyanensis</i> infection induced reactivation of disease pathology, overriding the protective adaptive immune response. Our findings establish that type I IFN-dependent responses, arising from endogenous viral elements (dsRNA/LRV1), or exogenous coinfection with IFN-inducing viruses, are able to synergize with New World <i>Leishmania</i> parasites in both primary and relapse infections. Thus, viral infections likely represent a significant risk factor along with parasite and host factors, thereby contributing to the pathological spectrum of human leishmaniasis