European Union digital education framework : a quality standard to guide the design of healthcare apps

Digital Education Initiatives and Timely Solutions (DIG-IT) is an Erasmus+ project collaboration between university academics, clinical educators, industry partners, healthcare professionals, and technology experts over 5 European Union (EU) states. The objectives are to create digital educational capacity for academic faculty and mobile learning opportunities for continuing professional healthcare education. The first deliverable of this project was the innovative European Union Digital Education Quality Standards Framework and Toolkit or EU-DEF. This framework can be used to consider all principle and secondary aspects when designing, delivering, and evaluating digital education resources. In this article we explore the framework efficacy in collaboratively developing two open access, mobile healthcare apps, ECG Interpretation for Nurses and Nurse Leadership and Management. We describe the teamwork needed and steps taken during this process, and demonstrate the adaptability, usability, and value of this tool for other online development projects. The EU-DEF is an evidence-based, comprehensive framework that can be used as a starting point for individuals or teams when developing digital educational projects. Considering all variables helps focus the expertise required to produce robust end-products.peer-reviewe

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Fyoozhun [Incorporated]: A business plan

Executive Summary. FYOOZHUN INCORPORATED is a corporation that is formed to answer the ever-changing needs of consumers. It is located at #7 Nottingham St. Hillsborugh Alabang Village, Cupang, Muntinlupa. Fashion is beginning to be expensive and the nine proponents took the challenge of designing, manufacturing, and selling their unique and innovative product, Futwurx sandals. These are sandals with interchangeable straps that can fit your mood and style. It\u27s innovation allows consumers to change the strap designs based on their preferences. This allows the consumer to buy less pairs and be practical, yet be fashionable at the same time. The primary market of this innovative, versatile and practical product is composed of schools and villages located in the Alabang, Parañaque, Muntinlupa and Makati. These are St. Francis of Assisi High School, De La Salle Santiago Zobel School, Assumption College and Merville Village. The total population of the primary market is 359 respondents. Three hundred fifty nine respondents from the above mentioned schools and village were selected through systematic random sampling and were surveyed by requesting them to answer a carefully formulated and pretested questionnaire. Upon completion of the survey, the data gathered were analyzed and interpreted. The market acceptability rate of Futwurx was determined to be 82.21% for the primary target market. Majority (84.1%) of the respondents found the product unique and innovative, with 85.2% willing to buy it. Monthly potential demand was computed to be 229 units. Market share of FYOOZHUN INCORPORATED for Futwurx was 62.88%. Using the time and motion study, the proponents determined that for Futwurx, the assembly line method would be the most effective method of production. The manufacturing process goes as follows: the patterns for the sole and straps are traced and cut on different materials the different cut materials of the insole are bonded by rugby and primer is applied to the rubber sole these are sent to the sub-contractor for buffing and pressing the different cut materials of the straps are swen together and Futwurx is packaged. Within one production day, an average of 36 units of the product can be produced. Maximum output is 57 units while minimum output is 15 units. Cycle time for the production of one unit of Futwurx sandals is approximately 13 minutes, with the percentage of efficiency at 83.62%. Production cost per unit was computed to be P 163.28, while selling price of the product was computed to be P300.00. Break-even analysis showed that FYOOZHUN INCORPORATED needs to sell approximately 12 units of Futwurx, or achieve gross sales of P 3,423.91 per month. to avoid incurring losses. Corporation is the type of business ownership that the proponents have chosen because of its advantages. The corporate name FYOOZHUN INCORPORATED was chosen because the proponents are a fusion of different talents and ideas. The corporation will exist for 10 months. The stockholders and the board of directors are the proponents themselves. Each one of them has duties and responsibilities to perform as well as rules and regulations to follow. The different pre-operation, operation, and post-operation activities are also to be underwent by the proponents during its term of existence. Financial assumptions are specified for the proponents to follow. The proponents will finance the business through the help of their parents. Borrowing from financial institutions is not allowed. The project cost required to finance the first month of operation is P 17,000.00. Budgets were prepared to estimate the amounts of expenses to be incurred by the company. Projected financial statements are also provided to show the expected income from the business and the assets of the corporation. The said business is said to generate an income of P 596,400.00 at the end of its existence. The return on investment is 1,606.79% while the return on equity is 94.41%. This means that the business is very profitable and the proponents are able to utilize their assets effectively. In conclusion, the project is found to be feasible based on the studies made. However, the proponents must still consider factors that might affect the operations of the business in the future such as inflation and economic recession. keeping an open mind and keeping the initiative and determination will surely make the business a successful one

Cardiovascular Efficacy and Safety of Bococizumab in High-Risk Patients

BACKGROUN

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit