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.

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.

BACKGROUND: The impact of missing data on individual continuous glucose monitoring (CGM) data is unknown but can influence clinical decision-making for patients.
OBJECTIVE: We aimed to investigate the consequences of data loss on glucose metrics in individual patient recordings from continuous glucose monitors and assess its implications on clinical decision-making.
METHODS: The CGM data were collected from patients with type 1 and 2 diabetes using the FreeStyle Libre sensor (Abbott Diabetes Care). We selected 7-28 days of 24 hours of continuous data without any missing values from each individual patient. To mimic real-world data loss, missing data ranging from 5% to 50% were introduced into the data set. From this modified data set, clinical metrics including time below range (TBR), TBR level 2 (TBR2), and other common glucose metrics were calculated in the data sets with and that without data loss. Recordings in which glucose metrics deviated relevantly due to data loss, as determined by clinical experts, were defined as expert panel boundary error (εEPB). These errors were expressed as a percentage of the total number of recordings. The errors for the recordings with glucose management indicator <53 mmol/mol were investigated.
RESULTS: A total of 84 patients contributed to 798 recordings over 28 days. With 5%-50% data loss for 7-28 days recordings, the εEPB varied from 0 out of 798 (0.0%) to 147 out of 736 (20.0%) for TBR and 0 out of 612 (0.0%) to 22 out of 408 (5.4%) recordings for TBR2. In the case of 14-day recordings, TBR and TBR2 episodes completely disappeared due to 30% data loss in 2 out of 786 (0.3%) and 32 out of 522 (6.1%) of the cases, respectively. However, the initial values of the disappeared TBR and TBR2 were relatively small (<0.1%). In the recordings with glucose management indicator <53 mmol/mol the εEPB was 9.6% for 14 days with 30% data loss.
CONCLUSIONS: With a maximum of 30% data loss in 14-day CGM recordings, there is minimal impact of missing data on the clinical interpretation of various glucose metrics.
BACKGROUND: ClinicalTrials.gov NCT05584293; https://clinicaltrials.gov/study/NCT05584293.

BACKGROUND: Machine learning (ML) risk prediction models, although much more accurate than traditional statistical methods, are inconvenient to use in clinical practice due to their nontransparency and requirement of a large number of input variables.
OBJECTIVE: We aimed to develop a precise, explainable, and flexible ML model to predict the risk of in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI).
METHODS: This study recruited 18,744 patients enrolled in the 2013 China Acute Myocardial Infarction (CAMI) registry and 12,018 patients from the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective Acute Myocardial Infarction Study. The Extreme Gradient Boosting (XGBoost) model was derived from 9616 patients in the CAMI registry (2014, 89 variables) with 5-fold cross-validation and validated on both the 9125 patients in the CAMI registry (89 variables) and the independent China PEACE cohort (10 variables). The Shapley Additive Explanations (SHAP) approach was employed to interpret the complex relationships embedded in the proposed model.
RESULTS: In the XGBoost model for predicting all-cause in-hospital mortality, the variables with the top 8 most important scores were age, left ventricular ejection fraction, Killip class, heart rate, creatinine, blood glucose, white blood cell count, and use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs). The area under the curve (AUC) on the CAMI validation set was 0.896 (95% CI 0.884-0.909), significantly higher than the previous models. The AUC for the Global Registry of Acute Coronary Events (GRACE) model was 0.809 (95% CI 0.790-0.828), and for the TIMI model, it was 0.782 (95% CI 0.763-0.800). Despite the China PEACE validation set only having 10 available variables, the AUC reached 0.840 (0.829-0.852), showing a substantial improvement to the GRACE (0.762, 95% CI 0.748-0.776) and TIMI (0.789, 95% CI 0.776-0.803) scores. Several novel and nonlinear relationships were discovered between patients\' characteristics and in-hospital mortality, including a U-shape pattern of high-density lipoprotein cholesterol (HDL-C).
CONCLUSIONS: The proposed ML risk prediction model was highly accurate in predicting in-hospital mortality. Its flexible and explainable characteristics make the model convenient to use in clinical practice and could help guide patient management.
BACKGROUND: ClinicalTrials.gov NCT01874691; https://clinicaltrials.gov/study/NCT01874691.

UNASSIGNED: Obstructive sleep apnea (OSA) is a highly prevalent sleep-disordered breathing. It is associated with adverse co-morbidities, being the most scientific evidence of cardiovascular (CV) disease. Currently, OSA is measured through the apnea-hypopnea index (AHI), the total number of respiratory events per hour of sleep. However, different studies have questioned its utility in OSA management, highlighting the need to search for new parameters that better reflect the heterogeneity of the disease. Hypoxic burden (HB) has emerged as a novel biomarker that informs about the frequency, duration and depth of the desaturation related to the respiratory events. We conducted a systematic review in order to find publications about the heterogeneity of OSA measured by HB and its associations with future disease.
UNASSIGNED: Systematic review was conducted using PubMed and Web of Science. The terms \"sleep apne\" and \"hypoxic burden\" were used to look for publications from the date of inception to August 15, 2023. Inclusion criteria: articles in English published in peer-reviewed journals. Exclusion criteria: (1) not available publications; (2) duplicated articles; (3) letters, editorials, and congress communications; (4) articles not including information about HB as a specific biomarker of OSA.
UNASSIGNED: 33 studies were included. The results were classified in 2 main sections: (1) HB implication in the CV sphere: HB showed to be a better predictor of CV risk in OSA patients than traditional measures such as AHI with possible clinical management implication in OSA. (2) HB response to OSA treatment: pharmacological and nonpharmacological treatments have demonstrated to be effective in improving hypoxia measured through the HB.
UNASSIGNED: HB could be a better and more effective parameter than traditional measurements in terms of diagnosis, risk prediction and therapeutic decisions in patients with OSA. This measure could be incorporated in sleep units and could play a role in OSA management, driving the clinic to a more personalized medicine.

UNASSIGNED: ICD-11 implementation will start in early 2022 in WHO member countries, including Russia. This process should be preceded not only by the official translation and wide distribution of ICD-11 statistical classification and diagnostic guidelines but also by clinicians\' training. For recent years ICD-11 development and innovations in the diagnosis of mental disorders were in the focus of attention of mental health professionals in all over the world.
UNASSIGNED: This online survey aimed to identify the current views of the Russian psychiatric community on the upcoming implementation of ICD-11.
UNASSIGNED: A survey was composed in a Google form and circulated through the website of the Russian Society of Psychiatrists and other professional networks. Statistical and narrative analysis was provided. The sample was represented by 148 psychiatrists working in inpatient or outpatient clinical settings.
UNASSIGNED: Expectations for the classification of mental disorders reported by the respondents were wider than the current purpose of ICD-10. In general, the Russian psychiatrists expressed their interests to forthcoming ICD-11 implementation. Positive attitudes to ICD-11 innovations were associated with the familiarity with the ICD-11 draft. Conservative or negative views were related to longer years of clinical experience. Early carrier psychiatrists were more practically oriented than \'old school\' clinicians.
UNASSIGNED: This survey may help to promote the ICD-11 by focusing on its advantages for clinical practice and develop targeted training programs.
UNASSIGNED: Ожидается, что внедрение МКБ-11 начнется с 2022 года в странах-членах ВОЗ, включая Россию. Этот процесс предполагает не только официальный перевод статистической классификации и диагностических указаниях МКБ-11, но и соответствующую подготовку клиницистов. В последние годы разработка МКБ-11 и нововведения для диагностики психических расстройств находились в центре внимания специалистов в области психического здоровья во всем мире.
UNASSIGNED: Данный онлайн-опрос был проведен с целью выявления ожиданий и установок представителей российского психиатрического сообщества в преддверии внедрения МКБ-11.
UNASSIGNED: Опрос был составлен в Google форме и распространен через сайт Российского общества психиатров и другие профессиональные сети. Был проведен статистический и нарративный анализ ответов респондентов. Выборка была представлена 148 психиатрами, работающими в стационарных или амбулаторных клинических условиях.
UNASSIGNED: Ожидания в отношении классификации психических расстройств, о которых сообщили респонденты, были шире, чем те цели, для которых они используют МКБ-10 в своей повседневной практике. В целом российские психиатры выразили свою заинтересованность новой версией МКБ-11. Позитивное отношение к нововведениям МКБ-11 было связано со степенью осведомленности с данным проектом. Консервативные взгляды или негативное отношение были чаще типичны для специалистов с более длительным клиническим опытом. Психиатры, начинающие свою профессиональную карьеру, были более ориентированы на практическое использование новой версии МКБ, чем клиницисты \"старой школы\".
UNASSIGNED: Результаты опроса, отражающие распространенные мнения и взгляды отечественных клиницистов, могут быть полезны для продвижения МКБ-11. Прежде всего потребуется широкое ознакомление профессионального психиатрического сообщества с новыми указаниями данной классификации для диагностики психических расстройств, и привлечение внимания к ее преимуществам для применения в клинической практике. Важное значение имеет также разработка целевых обучающих программ с учетом разной степени готовности к вводимым изменениям.