Ulcerative colitis (UC), characterized by its recurrent nature, imposes a significant disease burden and compromises the quality of life. Emerging evidence suggests that achieving clinical remission is not sufficient for long-term remission. In pursuit of a favorable prognosis, mucosal healing (MH) has been defined as the target of therapies in UC. This paradigm shift has given rise to the formulation of diverse endoscopic and histological scoring systems, providing distinct definitions for MH. Endoscopic remission (ER) has been widely employed in clinical practice, but it is susceptible to subjective factors related to endoscopists. And there\'s growing evidence that histological remission (HR) might be associated with a lower risk of disease flares, but the incorporation of HR as a routine therapeutic endpoint remains a debate. The integration of advanced technology has further enriched the definition of deep MH. Up to now, a universal standardized definition for deep MH in clinical practice is currently lacking. This review will focus on the definition of deep MH, from different dimensions, and analyze strengths and limitations, respectively. Subsequent multiple large-scale trials are needed to validate the concept of deep MH, offering valuable insights into potential benefits for UC patients.

UNASSIGNED: While guidelines exist for the diagnosis and management of pediatric celiac disease (CeD), current practices in North America are not well-described. This study aimed to explore current practice patterns to identify gaps and direct future clinical, training and research initiatives.
UNASSIGNED: A 23-item survey designed by the Celiac Disease Special Interest Group was distributed electronically to its members. Questions explored four themes: (1) screening and diagnosis pre and post the coronavirus disease (COVID)-19 pandemic, (2) treatment and monitoring, (3) family screening and transition of care, and (4) CeD focused training.
UNASSIGNED: The survey response rate was 10.8% (278/2552). Most respondents were from the United States (89.9%, n = 250) and Canada (8.6%, n = 24). While endoscopy remained the gold standard, serology-based diagnosis was accepted by 47.5% (132/278). In response to the COVID-19 pandemic, 37.4% of providers changed their diagnostic practice. Barriers to care included: lack of insurance coverage for dietitians, wait times, and lack of CeD focused training. During fellowship 69.1% (192/278) reported no focused CeD training.
UNASSIGNED: Survey results revealed practice variation regarding the diagnosis and management of CeD in North America including a substantial proportion accepting non-biopsy, serology-based diagnosis, which increased during the COVID-19 pandemic. Variations in screening, diagnosis, interval surveillance, and family screening were also identified. Dedicated CeD education in pediatric gastroenterology fellowship may be an opportunity for standardizing practice and advancing research. Future North American guidelines should take current care patterns into consideration and develop new initiatives to improve care of children with CeD.

Upper respiratory tract infections (URTIs) are common in patients of the pediatric age group and often lead to significant morbidity and mortality. Antibiotics such as cefixime have contributed to the management of URTIs, particularly when bacterial etiology is suspected. Several studies have evaluated the effectiveness of cefixime in pediatric URTIs, showing promising results in alleviating symptoms and reducing the duration of illness. Cefixime, a third-generation cephalosporin, exhibits broad-spectrum activity against common pathogens implicated in URTIs, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, which are resistant to hydrolysis by several β-lactamases. Due to its unique three-hour elimination half-life, cefixime allows for twice-daily or, in most cases, once-daily dosage. As a third-generation cephalosporin, cefixime effectively targets the common bacterial pathogens associated with these infections. Its notable efficacy is coupled with a favorable safety profile, making it a preferred choice for pediatricians and family physicians. The safety profiles of cefixime in children have been extensively studied with generally favorable outcomes. Adverse events are typically mild and infrequent, with gastrointestinal disturbances being most commonly reported. Notably, cefixime has a low propensity to induce bacterial resistance, making it a valuable option in the era of increasing antibiotic resistance. Cefixime may serve as a substitute for penicillin and first-generation cephalosporins in cases of acute upper and lower respiratory tract infections, acute otitis media, and acute uncomplicated urinary tract infections. This review aimed to provide a comprehensive outline of the use of cefixime in the treatment of URTIs in the pediatric population, focusing on its efficacy, safety, and overall clinical applications.

UNASSIGNED: The current professional nursing education program adopts various great attention for clinical practice to supply nursing students.
UNASSIGNED: To assess the prevalence and associated factors of stress and coping strategies of nursing students during clinical practice in the school of nursing, Wachemo University, Ethiopia, 2024.
UNASSIGNED: A facility-based cross-sectional design study was conducted between January 1 and 12/2024. The total number of students was 421. Data were collected using the validated tool and entered using Epi-data Version 3.1 and exported to SPSS Version 25 for analysis. Binary logistic regression was done, and variables with a p-value of <.05 were taken into the multivariable analysis. Statistically significant was declared at a p-value of <.05 with AOR and 95% CI.
UNASSIGNED: The prevalence of stress and coping strategies was 58.4% with 95% CI [53.6-62.8] and 52.0% with 95% CI [47.3-56.5] respectively. Male gender, private regular, and instructor guide were significantly associated with stress. Age group 19-24 years, having low grades, living in a university dorm, clinical staff guiding, instructor guiding, and asking unclear issues were significantly associated with coping strategies.
UNASSIGNED: About six in ten nursing students have stress. Being male gender, being a private, living with families, and instructor guide are significantly associated with stress. Therefore, managing gender-related issues, attending regular programs, living in a university dorm, and guiding the students might reduce the burden of stress during clinical practice. About five in ten nursing students have good coping strategies. Being age group of lower years old, having low grades, living in a university dorm, clinical staff guiding, instructor guiding, and asking the instructor about unclear issues were significantly associated with coping strategies. Therefore, improving grades, living in a university dorm, clinical staff and instructor guidance, and asking about unclear issues might enhance coping strategies.

BACKGROUND: Workplace bullying in clinical nurse education significantly threatens students\' well-being and professional development. Despite its prevalence, many incidents go unreported, exacerbating the issue and compromising the quality of care. A significant gap exists in the literature regarding comprehensive mixed-methods systematic reviews on unreported bullying incidents among nursing students. This review aims to address this knowledge gap and propose effective strategies to tackle this pervasive problem.
OBJECTIVE: This mixed-methods systematic review aimed to explore the factors influencing the non-reporting of workplace bullying incidents among nursing students during clinical practice.
METHODS: Mixed-methods systematic review.
METHODS: An extensive literature search was conducted across ten databases, including PubMed, Cochrane, Embase, Web of Science, CINAHL, PsycINFO, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG, from database inception to November 1, 2023. Google Scholar and reference lists of included studies were also searched. Studies were selected based on eligibility criteria regarding population, phenomena of interest, and context. Two researchers independently assessed study quality, with disagreements resolved by a third reviewer. Relevant data were extracted and synthesized using the Joanna Briggs Institute\'s convergent integrated approach, ensuring a comprehensive integration of qualitative and quantitative findings.
RESULTS: Twenty-one studies met the inclusion criteria, comprising six qualitative, twelve quantitative, and three mixed-methods studies. Four integrated themes emerged from nursing students\' perspectives on reasons for not reporting workplace bullying during clinical practice: (i) fear and concerns related to reporting, (ii) concerns about professional image, (iii) barriers and challenges in reporting, and (iv) perceived ineffectiveness of reporting.
CONCLUSIONS: This systematic review provides valuable insights into nursing students\' perspectives on the non-reporting of workplace bullying incidents during clinical practice. Understanding these reasons enables stakeholders to collaboratively develop interventions to create a safer and more supportive environment for nursing students, ultimately enhancing quality care and the well-being of healthcare professionals.

OBJECTIVE: Case-mix adjusted hemodialysis mortality has decreased since 1998. Many factors that influence mortality may have contributed to this trend and these associations may differ by continental region. We studied changes in hemodialysis facility practices over time and their potential role in mediating changes in patient survival.
METHODS: Observational prospective cohort study.
METHODS: Adult hemodialysis patients treated in hemodialysis 500 facilities participating in the Dialysis Outcomes Practice Patterns Study (DOPPS) between 1999 and 2015 in the US, Japan, and 4 four European countries: Germany, Italy, Spain, and UK.
METHODS: Four practice measures at each facility: the percentages of patients with Kt/V>1.2, interdialytic weight gain [IDWG]<5.7%, phosphorus<6 mg/dL, and using AV fistulae.
RESULTS: Patient survival.
METHODS: Mediation analyses, adjusted for case mix, were conducted using 3-year study phase as the exposure and facility practice measures as potential mediators.
RESULTS: In Europe, we observed a 13% improvement in overall case-mix adjusted survival per decade. Trends in facility practice measures, especially Kt/V and phosphorus, explained 10% improvement in case-mix survival per decade, representing 77% (10% explained of 13% improvement) of the observed improvement. In Japan, 73% of the observed 12%/decade improvement in case-mix adjusted survival could be attributed to facility practices, especially Kt/V and IDWG. In the US, 56% of the observed 47%/decade improvement in case-mix adjusted survival could be attributed to facility practices, especially AV fistula use and phosphorus control.
CONCLUSIONS: Unmeasured changes in the characteristics of the patient population over this period may confound the observed associations.
CONCLUSIONS: The improvements in adjusted hemodialysis patient survival in Europe, Japan, and the US from 1999 to 2015 can be largely explained by improvements in specific facility practices. Future changes in patient survival may be responsive to further evolution in the implementation of common clinical practices.

UNASSIGNED: The primary aim of undergraduate dental education is to prepare dental students for independent dental practice and to enable them to provide safe and effective dental care. This study aimed to investigate the self-perceived preparedness of senior dental undergraduate students in Turkey.
UNASSIGNED: Purposive sampling was used to recruit final-year dental students from 10 dental institutions offering undergraduate dental programs in Turkey. Student preparedness was assessed using a previously validated dental preparedness assessment scale based on 50 items encompassing core clinical skills, cognitive attributes, and behavioral skills. The research instrument was then translated into Turkish. The R statistical environment for Windows was used for the data analysis.
UNASSIGNED: Responses were provided by 272 students (156 women and 116 men; 57% and 43%, respectively) across 10 different universities. The mean score of the participants was 75.68 with slightly higher scores for men compared to women (77.35 vs. 74.46 respectively). However, independent t-tests showed that the scores did not differ significantly between women and men.
UNASSIGNED: This study evaluated the self-perceived preparedness for dental practice of final-year students from 10 universities in Turkey. Although the results showed several areas of weakness, the scores of self-perceived preparedness of Turkish students were comparable to those reported in Europe and Asia. These findings can be used to inform future curriculum development to support students in consolidating their learning in perceived areas of weakness.

UNASSIGNED: Real-world data on health-related quality of life (HRQoL) in palmoplantar pustulosis (PPP) are scarce and few studies have analysed the generic HRQoL.
UNASSIGNED: To assess HRQoL using the generic EQ-5D instrument and the Dermatology Life Quality Index (DLQI) instrument in PPP compared to plaque psoriasis.
UNASSIGNED: Cross-sectional data from PsoReg, the Swedish National Registry for Systemic Treatment of Psoriasis (2006-2021), were examined. The study included 306 patients with PPP, out of which 22% had concomitant plaque psoriasis (n = 68), and 7041 patients with plaque psoriasis only. EQ-5D and DLQI were compared between patients with PPP and patients with plaque psoriasis, overall and stratified by sex. A subgroup analysis compared outcomes for patients with PPP vs. patients with severe plaque psoriasis (Psoriasis Area and Severity Index ≥10). Multiple regression analyses were performed to control for potential confounders (age, sex, comorbidities, lifestyle factors).
UNASSIGNED: Patients with PPP were to a larger extent female (79% vs. 37%, p < .01) and older (mean [SD] age 59.9 [11.9] vs. 50.7 [16.0] years, p < .01) than patients with plaque psoriasis. EQ-5D values were significantly lower (worse) in patients with PPP (mean [SD] 0.622 [0.309]) compared to patients with plaque psoriasis (mean [SD] 0.715 [0.274]). No significant difference was observed compared to patients with severe plaque psoriasis (p = .237). DLQI was comparable in PPP and plaque psoriasis patients (p = .117). In the regression analyses, PPP only and PPP with plaque psoriasis were associated with lower EQ-5D values of 0.065 (p < .01) and 0.061 points (p < .10) compared to plaque psoriasis patients.
UNASSIGNED: PPP had a substantial negative impact on patients\' generic and dermatology-specific HRQoL. Patients with PPP were worse off in terms of generic HRQoL compared with patients with plaque psoriasis when controlling for the impact of potential confounders.
Real-world data on health-related quality of life in palmoplantar pustulosis (PPP) are scarce and previous studies have been predominantly restricted to the Dermatology Life Quality Index.This study also shows a significant impairment of the generic HRQoL (assessed by the generic EQ-5D instrument) in patients with PPP.Patients with PPP rated their generic HRQoL worse than patients with plaque psoriasis.

Introduction: Medical associations and medicolegal bodies are urging for increased chaperone use by physicians during intimate physical examinations in clinical practice (such as breast or pelvic examinations). However, widespread chaperone use is limited by factors such as staff availability and financial considerations. Presently, there is a scarcity of information available regarding the cost of hiring a dedicated chaperone. This study investigates the cost of hiring a chaperone and its financial implications for a physician\'s clinical practice. Materials and Methods: Using data from the Government of Canada website, the range of salary rates for clinic staff who can act as a chaperone in Canada was analyzed. The cost of hiring a chaperone was estimated to be in the range between the cost of hiring a minimum-wage worker and a nurse (the highest-paid hired medical office staff). Obstetrics and Gynecology as well as Plastic Surgery urban community practices were consulted regarding the costs of operating a clinic. Results: The approximate annual income for a minimum-wage worker in Canada is $29,250 CAD. Registered nurses earn on average $72,783.75 CAD per year. The cost of operating a private clinic practice with one staff member in Canada is on average $102,500 CAD per year. Thus, hiring an additional full-time chaperone could increase clinic expenses by approximately 49% per year, bringing the clinic cost to approximately $153,517 CAD per year. For part-time employment, the annual cost of hiring a chaperone is approximately $10,203 CAD for each day/week of employment. Conclusion: In terms of financial considerations, hiring a chaperone can increase clinic expenses by approximately one-and-a-half times. The findings of this study provide an important reference for physicians and may assist with the decision to employ chaperones in clinical practice.
Introduction: Les associations médiales et les institutions médico-légales encouragent fortement le recours à un chaperon lors d’examen physique intime par des médecins en pratique clinique (dans le cas, par exemple, d’examen pelvien ou mammaire). Cependant, le recours généralisé à un chaperon est limité par des facteurs tels que la disponibilité du personnel et des considérations financières. On ne dispose actuellement que de peu d’information sur le coût de l’embauche d’un chaperon dédié. Cette étude porte sur le coût d’un tel recrutement et sur ses implications financières pour la pratique clinique d’un médecin. Matériels et Méthodes: Utilisant des données d’un site Web du gouvernement du Canada, nous avons analysé l’éventail des salaires du personnel d’une clinique pouvant servir de chaperon au Canada. Le coût du recrutement d’un chaperon a été évalué comme se situant entre celui d’une embauche au salaire minimum et celui d’une infirmière (l’emploi le mieux payé parmi le personnel médical d’une clinique). Les cliniques communautaires urbaines d’obstétrique et de gynécologie, ainsi que les cliniques de chirurgie plastique ont été consultées pour ce qui concerne les coûts de fonctionnement des cliniques. Résultats: Le revenu annuel moyen approximatif d’un travailleur au salaire minimum au Canada est de 29 250 dollars canadiens. Les infirmières autorisées gagnent en moyenne 72 783,75 dollars canadiens par an. Le coût de fonctionnement d’une clinique privée ne comptant qu’un(e) employé(e) au Canada est en moyenne de 102 500 dollars canadiens par an. Par conséquent, l’embauche d’un chaperon à temps plein augmenterait les dépenses de la clinique d’environ 49 % par an, soit un total approximatif de 153 517 dollars canadiens par an. Dans le cas d’une embauche à temps partiel, le coût annuel d’un chaperon serait d’environ 10 203 dollars canadiens pour chaque jour/semaine d’emploi. Conclusion: En termes de considérations financières, l’embauche d’un chaperon peut multiplier les dépenses de la clinique par 1,5. Les constatations de cette étude fournissent une référence importante aux médecins et peut les aider dans leur décision d’embaucher des chaperons en pratique clinique.

OBJECTIVE: To understand how pre-registration student nurses experience moral distress and refine the concept in this population.
BACKGROUND: The experience of moral distress has positive and negative effects for health professionals and negatively impacts on patient care. Moral distress is a fluid concept which permits the experience to be varied among different populations. Despite empirical research, a concept analysis has not been performed in the student nurse population.
METHODS: Electronic databases were searched via Ebsco Host Complete and included Cinahl, Medline, APA Psych in March 2024. Search terms included \'Moral Distress\' AND \'Student\', \'Moral Distress\' and \'Baccalaureate.\' Search limits included articles between 2014 and 2024, English Language. Twenty-five papers were included in the review and consisted of eight quantitative studies, 11 qualitative studies, three mixed methods studies and three literature/systematic reviews.
METHODS: An integrated mixed research synthesis (Sandelowski, Voils, Barroso 2006) was conducted and organized into Walker, Avant\'s (2005) framework of antecedents, attributes and consequences. Braun and Clarkes (2006) thematic analysis was then used to generate themes from the literature.
RESULTS: Antecedents emerged as students having moral sensitivity, they recognize unethical circumstances. Attributes identified roots of moral distress. These roots include poor patient care, harm to the patient and unsafe care. Students experience of morally reprehensible events is exacerbated by the disempowerment they experience as being \'just a student\'. Student nurses who do not exhibit moral courage and do not oppose immoral practices do so due to internal constraints which transpire as fear of conflict, withdrawal of learning opportunities, and fear of disruption to learning. This is influenced by their registered nurse supervisor relationship. Consequences of moral distress identify negative feelings, coping mechanisms and positive effects.
CONCLUSIONS: The attributes of moral distress in the student nurse population have distinctive features which should be considered by nurse educators and in empirical research.
UNASSIGNED: None, as this is a concept analysis that contributes to theory development and is not empirical research.