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Promoting the implementation of clinical decision support systems in primary care: A qualitative exploration of implementing a Fractional exhaled Nitric Oxide (FeNO)-guided decision support system in asthma consultations
Background Clinical decision support systems (CDSSs) can promote adherence to clinical guidelines and improve patient outcomes. Exploring implementation determinants during the development of CDSSs enables intervention optimisation to promote acceptability, perceived appropriateness and fidelity during subsequent implementation. This study sought to explore how clinicians perceive the use of a CDSS which makes recommendations for asthma management based on factors including Fractional exhaled Nitric Oxide testing, and how CDSSs can be designed to promote their implementation. Methods Twenty-three interviews were conducted with clinicians to explore perceptions about the CDSS. Participants included asthma nurses, pharmacists, General Practitioners and respiratory nurse specialists involved in conducting asthma reviews in primary care. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Results Three themes were developed: Appreciating the recommendations of the CDSS, whilst wanting to retain control; Doubt about appropriateness of CDSS recommendations, especially when you can’t see how they were produced; and Potential for the CDSS to increase patients’ trust and adherence to their treatment. Clinicians perceived the CDSS could help them prioritise management options and consider broader factors relating to patients’ asthma symptoms, but it was important to be able to override the recommendation. Lack of transparency over how recommendations were generated and concern about appropriateness of recommendations for specific patients led to uncertainty about adhering to the CDSS. Clinically tailored recommendations were perceived to help reassure patients and/or to support their adherence to asthma management. Conclusions Even small changes to the content of CDSS recommendations, such as explaining how recommendations were generated and showing they are consistent with guidance, may help to overcome barriers to acceptability and perceived appropriateness for clinicians. Focusing on implementation during the development of CDSS interventions is worthwhile to help reduce the evidence-practice gap.
Teledentistry—Dental students’ preparedness and patients’ experiences
Objectives To explore dental students’ preparedness, experiences and confidence levels in utilizing teledentistry (TD) for patient care during the COVID-19 pandemic and to determine the dental needs and experiences of patients receiving treatment from dental students through TD. Methods Two online surveys were administered through Google Forms, incorporating both five-point Likert scales and open-ended questions alone for the student questionnaire. The patient questionnaire, available in English and Mandarin, was distributed during or after teleconsultations. Descriptive statistics were used to summarise the data. Results Out of 125 students, 88% (N = 110) were contacted by 318 patients. Of them, 79.1% reported no telecommunication problems, 91.8% faced no language barriers, and 87.2% encountered no technological barriers. Most students (67.3%) agreed they would need further training in TD. Low confidence levels were observed among 26.3% of students in managing crowns and bridges and among 18.2% of students in managing mucosal conditions. From the patient perspective, 76.4% contacted the students via WhatsApp Messages and 21.0% used the Voice Call mode. About 44.0% of patients enquired about the next available appointment. Their most common concern was tooth pain (15.1%) followed by denture problems (9.1%), chipped fillings (6.6%), and crowns and bridge problems (6.3%). Overall, 82% patients reported effective communication during teleconsultation, 85% were satisfied with the questioning process, and expressed satisfaction with the diagnoses provided. However, 10% of patients chose to ignore their concerns, and 5% sought assistance from medical practitioners. Conclusion Most dental students were confident in addressing patient concerns but recognized the need for additional training for managing complex cases. Both students and patients reported positive experiences with TD, including effective communication and satisfaction. These findings highlight the importance of integrating TD training into dental curricula, addressing technical and privacy concerns, and improving patient education for secure and effective TD use in routine care.
Author Correction: Gut microbiota strain richness is species specific and affects engraftment
An algorithm for equilibrium problems with mixed-type fixed point constraints
In this paper, we introduce a novel class of nonlinear mappings known as ϑ-strictly asymptotically pseudocontractive-type multivalued mapping (ϑ-SAPM) in a Hilbert space domain. In addition, a new method was initiated, and it was shown that this method converges strongly to the solution set of an equilibrium problem (EP) and the set of common fixed points of two finite families of type-one (ϑ-SAPM) and ϑ-strictly pseudocontractive-type multivalued mapping (ϑ-SPM). Moreover, we showed that the classes of mappings considered are independent and also presented a numerical example to illustrate the implementablity of the suggested method. The results obtained improve, generalize and extend several conclusions reported in literature.
The researchers on a quest to protect the gut from antibiotics
From invention to progress: Energy technology innovation and sustainable development in OECD economies
In the era of Industry 4.0, the advancement in energy technology has taken centre stage to mitigate climate change and promote sustainable development. Ever since the adoption of the United Nations SDGs in 2015, different regions and countries have been moving to achieve these targets by implementing various mechanisms. The OECD is one such region where aggressive funding towards equipment with high energy efficiency and the advancement of technologies for producing and consuming renewable energy are provided to advance towards sustainable development. Given the economic significance of the aforementioned countries, this study evaluates the influence of energy technology innovation on sustainable development in OECD countries. Our research focuses on energy technology innovation, which we measure through the energy technology R&D budget. In addition to energy technology innovation, we consider several other control variables such as state fragility index, financial development and foreign direct investment. In order to achieve the aforementioned goal, we utilize advanced econometric modelling methods of the second generation. These techniques encompass a CSD test, unit root tests, cointegration test, and CS-ARDL model. The result from CS-ARDL suggests that energy technology innovation enhances sustainable development in the short and long run. State fragility is shown to influence sustainable development negatively and significantly. The role of financial development as well as foreign direct investment, is found to be favourable for sustainable development. Based on the outcome, it is recommended that countries of this region significantly increase investment in energy technology, enhance financial development and encourage foreign direct investment along with tackling the fragility of these nations to boost sustainable development.
Scientists use AI to design life-like enzymes from scratch
Prevalence of workplace bullying among medical students: A meta-analysis and systematic review protocol
Workplace bullying is a significant issue impacting various professions, including the healthcare sector. This study presents a meta-analysis aimed at assessing the global prevalence of workplace bullying among medical students and identifying potential influencing factors. Previous research suggests that medical students experience higher rates of bullying compared to senior doctors. However, no worldwide meta-analysis has been conducted on this topic. By utilizing a reliable measurement tool, this study will offer a comprehensive analysis of the prevalence of workplace bullying among medical students. The findings are intended to inform the development of strategies to address this issue and enhance the well-being and professional development of medical students worldwide.
Identifying the spatiotemporal patterns and natural and socioeconomic influencing factors of PM2.5 and O3 pollution in China
To promote collaborative governance of PM2.5 and O3 pollution, understanding their spatiotemporal patterns and determining factors is crucial to control air pollution in China. Using the ground-monitored data encompassing PM2.5 and O3 concentrations in 2019 across 337 Chinese cities, this study explores the spatiotemporal patterns of PM2.5 and O3 concentrations, and then employed the Multi-scale Geographically Weighted Regression (MGWR) model to examine the socioeconomic and natural factors affecting PM2.5 or O3 concentrations. The results show that PM2.5 and O3 concentrations exhibit distinct monthly U-shaped and inverted U-shaped temporal fluctuation patterns across Chinese cities, respectively. Spatially, both pollutants manifest spatial clustering characteristic and a certain degree of bivariate spatial correlation. Elevated PM2.5 concentrations are predominantly concentrated on north and central China, as well as the Xinjiang Autonomous Region, whereas higher O3 concentrations are distributed widely across north, east, and northwest China. The MGWR model outperforms traditional OLS and global spatial regression models, evidenced by its enhanced goodness-of-fit metrics. Specifically, the R2 values for the PM2.5 and O3 MGWR models are notably high, at 0.842 and 0.861, respectively. Socioeconomic and natural factors are found to have multi-scale spatial effects on PM2.5 and O3 concentrations in China. On average, PM2.5 concentrations show positively correlations with population density, the proportion of the added value of secondary industry in GDP, wind speed, relative humidity, and atmospheric pressure, but negatively relationship with per capita GDP, road density, urban greening, air temperature, precipitation, and sunshine duration. In contrast, O3 concentrations are also positively associated with population density, the proportion of the added value of secondary industry in GDP, energy consumption, precipitation, wind speed, atmospheric pressure, and sunshine duration, but negatively correlated with per capita GDP, road density, and air temperature. Our findings offer valuable insights to inform the development of comprehensive air pollution management policies in in developing countries.
Vaccine sceptic RFK Jr is now a powerful force in US science: what will he do?
Depression’s double-edged impact on body mass index. A hidden catalyst for non-communicable diseases in South Africa’s aging population in long-term care facilities
Introduction The global population of older people, who have a high prevalence of non-communicable diseases, is on an upward trajectory, notably in South Africa. The expansion of this demographic will further strain an already overwhelmed healthcare system, primarily taxed by infectious diseases in younger populations. Physical activity has been shown to effectively reduce risk factors for non-communicable diseases in older people. Objective To investigate the associations between depression, body mass index (BMI) and physical activity and its complex interplay on non-communicable diseases in older people residing in South African long-term care facilities. Method We conducted a cross-sectional study on 396 participants residing in South African rural and urban long-term care facilities to analyse BMI, waist-hip ratio, physical activity and depression levels. The Geriatric Depression Scale and the International Physical Activity Questionnaire was used to evaluate depression and physical activity respectively. Results The sample had a mean BMI of 27.53 kg/m2 (95% CI [26.99, 28.07], SD = 5.49), with an obesity prevalence of 31.82%. Additionally, 35.10% of participants exhibited some degree of depressive symptoms. In an ordinal regression model BMI was a significant predictor (B = .10, p = .007) for increases in depression. Conversely in a linear regression model, depression (B = -2.01, p = .004) and physical activity (B = -.001, p = .008) were predictors for decreases in BMI. Conclusion The relationship between depression and BMI in older people is complex, with depression often leading to both weight loss and, conversely, increased BMI contributing to a higher risk of depression. Physical activity serves as a critical intervention, helping to reduce both BMI and depressive symptoms among older people residing in long-term care facilities. This underscores the importance of integrating PA programs into care strategies to improve overall health and well-being in this population.
Quantum-computing technology that makes qubits from atoms wins mega investment
Correction: Predicting sport fish mercury contamination in heavily managed reservoirs: Implications for human and ecological health
Daily briefing: A simple blood test could diagnose pancreatic cancer early
Breaking up clusters of circulating tumour cells to halt cancer spread
Meta-analysis reveals global variations in plant diversity effects on productivity
Hydrochemical evolution and formation mechanism of groundwater affected by human activities in Zhangxuan basin, northwest of Yanshan mountains, China
The Zhangxuan Basin serves as an ecological barrier and water conservation area for Beijing, the capital of China. Clarifying the hydrochemical evolution of groundwater in this region is essential for the effective management of groundwater resources and the protection of ecological security. In this study, based on data regarding chemistry and level of shallow groundwater from 2016 to 2022, hydrogeochemical analysis methods and geostatistical techniques were applied to investigate the hydrochemical evolution and genesis mechanisms of groundwater under the influence of human activities. The results showed that: (1) From 2016 to 2022, the groundwater remained predominantly characterized by Ca2+ and HCO3-, with the primary hydrochemical type unchanged as HCO3-Ca·Mg. (2) From 2016 to 2022, an overall decreasing trend in hydrochemical components was observed, alongside an increase in HCO3-Na type groundwater. Spatially, along the direction of groundwater flow, a general trend of increasing hydrochemical components was noted, with a significant rise in HCO3-Na type groundwater. (3) The spatiotemporal distribution and evolution of hydrochemistry were influenced by water-rock interactions, lithological characteristics, groundwater flow patterns, and human activities. Along the groundwater flow direction, lithological particles became finer, enhancing forward cation exchange and leaching, with the dissolution of silicate and carbonate minerals intensifying. In localized areas, the hydrochemical components were influenced by the extraction of groundwater source areas and the discharge of industrial waste.
Biomarkers to predict or measure steroid resistance in idiopathic nephrotic syndrome: A systematic review
In this systematic review we have sought to summarise the current knowledge concerning biomarkers that can distinguish between steroid-resistant nephrotic syndrome and steroid-sensitive nephrotic syndrome. Additionally, we aim to select biomarkers that have the best evidence-base and should be prioritised for further research. Pub med and web of science databases were searched using “steroid resistant nephrotic syndrome AND biomarker”. Papers published between 01/01/2012 and 10/05/2022 were included. Papers that did not compare steroid resistant and steroid sensitive nephrotic syndrome, did not report sensitivity/specificity or area under curve and reviews/letters were excluded. The selected papers were then assessed for bias using the QUADAS-2 tool. The source of the biomarker, cut off, sensitivity/specificity, area under curve and sample size were all extracted. Quality assessment was performed using the BIOCROSS tool. 17 studies were included, comprising 15 case-control studies and 2 cross-sectional studies. Given the rarity of nephrotic syndrome and difficulty in recruiting large cohorts, case-control studies were accepted despite their limitations. We present a range of candidate biomarkers along with scores relating to the quality of the original publications and the risk of bias to inform future investigations. None of the selected papers stated whether the authors were blinded to the patient’s disease when assessing the index test in the cohort. Highlighting a key problem in the field that needs to be addressed. These candidate biomarkers must now be tested with much larger sample sizes. Using new biobanks such as the one built by the NURTuRE-INS team will be very helpful in this regard.