UNASSIGNED: Sacubitril/valsartan (SV) is recommended for patients with heart failure (HF). In addition, a combination of 4 HF medications, including SV, is recommended in patients with HF with reduced ejection fraction (HFrEF). However, evidence on the characteristics of patients who could continue SV and its initiation methods is limited.
UNASSIGNED: To investigate the factors associated with SV continuation and methods of combining HF medications.
UNASSIGNED: This retrospective cohort study included HF patients who initiated with SV at our institution. The endpoint was SV continuation for 6 months after its initiation. Multivariate analysis was used to extract factors associated with SV continuation. The relationship between the methods of combining HF medications (renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, or sodium-glucose cotransporter 2 inhibitors), including the number of HF medications, their combination patterns, and the timing of their initiation, and SV continuation was examined in patients with HFrEF.
UNASSIGNED: Of 186 eligible patients, 68.8% had HFrEF, and 79.0% continued SV for 6 months. Significant factors associated with SV continuation were albumin ≥ 3.5 g/dL (odds ratio, 4.81; 95% confidence interval, 2.19-10.59), body mass index (BMI) ≥ 18.5 kg/m2 (4.17; 1.10-15.85), and systolic blood pressure (SBP) ≥ 110 mmHg (2.66; 1.12-6.28). In patients with HFrEF, the proportion of HF medications not initiated simultaneously with SV was significantly higher in the continuation group than in the discontinuation group (67.3% vs 33.3%, P = 0.002). The number of HF medications and their combination patterns were not significantly associated with SV continuation.
UNASSIGNED: Albumin, BMI, and SBP are useful indicators for selecting patients who are likely to continue SV. In addition, initiating only SV without simultaneously initiating other HF medications in patients with HFrEF may lead to SV continuation.

BACKGROUND: Globally, gastroenteritis (GE) significantly impacts children\'s health and contributes to societal, economic, and health burdens. Previous studies reporting risk factors of GE in children in high-income settings mainly rely on outbreak investigations, which inherently capture only a fractional representation of the overall spectrum of GE occurrences. In addition, there is paucity of comprehensive information pertaining to modifiable risk factors of GE. This scoping review aims to synthesize existing evidence concerning modifiable and behavioural risk factors associated with GE among children in high-income countries.
METHODS: PubMed, Embase, CINAHL, and Scopus were the databases from which articles were retrieved. A descriptive synthesis of the evidence was performed, following the Arksey and O\'Malley scoping studies framework and enhanced by the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist (PRISMA-ScR).
RESULTS: The systematic search identified 13,395 journal articles, which were subsequently screened, and duplicates removed, resulting in 19 articles for inclusion in the review. The majority of these studies (63.2%) employed a case-control design and were predominantly conducted in community settings (68.4%). Factors such as parental literacy, contact with individuals exhibiting gastrointestinal symptoms, and nappy-wearing were identified as significantly associated with childhood GE within domestic environments. Childcare-related variables, including enrolment size, mixing of personnel between child groups, the presence of central cleaning stations, and the implementation of hygiene and disease prevention policies, showed significant association with GE. In addition, the presence of sand pits, paddling pools, and animals in childcare centers correlated with increased incidences of GE among attending children.
CONCLUSIONS: The scoping review reveals a complex and varied research landscape on factors influencing gastroenteritis (GE) for children in high-income countries. The findings suggest that while some variables are closely linked to specific pathogens, others may not be, highlighting variability across GE aetiology. The significant association between various household level and childcare-related factors and childhood GE points to a valuable direction for future research and public health intervention.

BACKGROUND: Empathy is one of the fundamental factors enhancing the therapeutic effects of physician-patient relationships, but there has been no relevant research in China on the pediatric resident physicians\' capacity for empathy or the influencing factors.
METHODS: A mixed-methods study was undertaken. The student version of the Jefferson Scale of Empathy was used to assess 181 postgraduate residents at Shanghai Children\'s Medical Center and Shanghai Children\'s Hospital. Differences in empathy ability among pediatric resident physicians of different genders and specialties were analyzed using independent sample t-tests and Mann-Whitney U tests. A one-way analysis of variance was used to analyze the differences in empathy ability at different educational levels and years of medical residency training. Seven third-year postgraduate pediatric residents from Shanghai Children\'s Medical Center participated in semi-structured interviews exploring the influencing factors. We analyzed the interview transcripts using thematic analysis.
RESULTS: The scale was completed by 154 pediatric residents. No statistically significant differences in empathy were found between educational level, postgraduate year, gender, or specialty. The factors influencing empathy in doctor-patient communication included the person who accompanied the child to see the doctor, how the children cooperated with doctors for medical treatment, the volume of pediatric outpatient and emergency visits, and the physician\'s ability to withstand pressure. All interviewed resident physicians regarded learning empathy as important but rarely spent extra time learning it.
CONCLUSIONS: The evaluation results of resident physicians on changes in empathy after improving clinical abilities vary according to their understanding of empathy, and the work environment has an important impact on pediatricians\' empathy ability. Their empathy score is relatively low, and this requires exploration and intervention.

The prevalence of and factors associated with musculoskeletal (MSK) symptoms in patients with hidradenitis suppurativa (HS) have yet to be elucidated. Given the association between HS and inflammatory comorbidities, understanding the burden of MSK symptoms in patients with HS is crucial for patient-centered care. Our objective was to describe the prevalence of and factors associated with MSK symptoms in patients with HS. A cross-sectional study of 78 consecutive patients recruited between November 2021 and February 2023 with a dermatology-confirmed diagnosis of HS, irrespective of MSK symptoms, was performed. The average age of participants (n=78) was 37 (SD 12.2) years, and the average age at symptom onset was 23 (SD 12.1) years; 54% (n=42) of participants identified as women, and 46% (n=36) as men. The most common comorbidities included depression (n=17, 22%) and preexisting arthritis (n=12, 16%). Approximately 24% (n=18) of participants reported prolonged morning stiffness. In a multivariate regression, depression was significantly associated with morning stiffness (odds ratio [OR] 6.1, 95% CI 1.4-26.1; P=.02), while female sex was significantly associated with arthralgia (OR 19.1, 95% CI 1.6-235.2; P=.02). Every patient with depression reported arthralgia. We highlight the high prevalence of MSK symptoms among patients with HS and note the interplay between depression and MSK symptoms, with each one potentially contributing to the other.

The article considers social, demographic and professional factors determining choice by general practitioners and district therapists of place of employment and their professional motivation. The special questionnaire was developed to be applied in sociological survey. The sampling included general practitioners and district therapists of outpatient medical organizations of the Health Department and the private health care sector of Moscow. The final analysis included 399 questionnaires. It is established that possibility of job combining depends on number of children physician has. The significance of conditions for career growth increases with physician age and availability of adult children. The opportunities for research and education activities are of great value for physicians of private health sector who obtained higher education in Russia and having adult children. The preferred management style of line manager and model of communication with patient are affected by level of workload, working conditions and income level. The preferences regarding type of organizational culture are affected by place of birth. For physicians who graduated from Russian universities, significant factor of non-material incitement is possibility of additional rest. The physicians of older age working in private health sector more often consider career advancement as professional development goal. The factors influencing choice of place of employment and professional motivation in general practitioners and district therapists are summarized. The proposals for attracting, retaining and stimulating physicians are formulated.

UNASSIGNED: Globally, ostomy creation rates are rising. Stomas, while life-saving, pose significant challenges. Nurses are vital in providing care and support to stoma patients. However, ostomy care practice and knowledge among Ethiopian nurses remain understudied. This study aimed to assess these aspects among nurses in Bahir Dar City, Ethiopia, in 2022.
UNASSIGNED: An institutional-based cross-sectional study was conducted in three public hospitals in Bahir Dar City from September 19 to September 30, 2022. A simple random sampling technique was used to select 423 nurses. Binary logistic regression analysis was employed to identify associated factors toward dependent variables by considering p-value <0.05 to be statistically significant.
UNASSIGNED: From the total samples, 382(90.3%) responded to the questionnaire. The overall good knowledge and practice level of nurses regarding ostomy care was 55.2% and 52.1%, respectively. Taking ostomy care training {AOR = 2.44; 95% CI (1.29, 4.61)} and high level of a monthly income of study participants {AOR = 2.90; 95% CI (1.72, 4.91)} had a significant association with knowledge of ostomy care. On the other hand, taking courses on ostomy care {AOR = 1.76; 95% CI (1.06, 2.93)}, receiving training on ostomy care {AOR = 4.15; 95% CI (2.12, 8.09)} and good knowledge level on ostomy care {AOR = 2.13; 95% CI (1.32, 3.45)} were significantly associated with expressed practice of ostomy care.
UNASSIGNED: The study found that only half of nurses exhibit good knowledge and practice in ostomy care. Training and monthly income significantly influence nurses\' knowledge, while practice level is associated with training, course attendance, and knowledge. These findings highlight the importance of targeted training programs and education initiatives to enhance nurses\' competence in ostomy care. It is also crucial to address factors like nurses\' income levels to ensure equitable access to educational resources and opportunities for professional development, thus enhancing their knowledge.

Concrete compressive strength testing is crucial for construction quality control. The traditional methods are both time-consuming and labor-intensive, while machine learning has been proven effective in predicting the compressive strength of concrete. However, current machine learning-based algorithms lack a thorough comparison among various models, and researchers have yet to identify the optimal predictor for concrete compressive strength. In this study, we developed 12 distinct machine learning-based regressors to conduct a thorough comparison and to identify the optimal model. To study the correlation between compressive strength and various factors, we conducted a comprehensive analysis and selected blast furnace slag, superplasticizer, age, cement, and water as the optimized factor subset. Based on this foundation, grid search and fivefold cross-validation were employed to establish the hyperparameters for each model. The results indicate that the Deepforest-based model demonstrates superior performance compared to the 12 models. For a more comprehensive evaluation of the model\'s performance, we compared its performance with state-of-the-art models using the same independent testing dataset. The results demonstrate that our model achieving the highest performance (R2 of 0.91), indicating its accurate prediction capability for concrete compressive strength.

BACKGROUND: The purpose of this study is to identify the factors affecting neovascular age-related macular degeneration (nAMD) disease stability after brolucizumab treatment.
METHODS: We retrospectively analyzed the medical records of 31 patients (31 eyes) with recalcitrant nAMD who were switched to brolucizumab after conventional anti-vascular endothelial growth factor (VEGF) treatment. We divided patients into two groups by treatment extension (TE) period: group 1 with TE < 12 weeks (N = 16) and group 2 with TE ≥ 12 weeks (N = 15). We compared outcomes between the groups at 2, 4, 8, and 12 weeks, including morphological characteristics of choroidal neovascularization (CNV). Logistic regression analysis identified factors associated with TE ≥ 12 weeks.
RESULTS: Group 2 had a significantly greater proportion of patients with dry macula (subretinal and intraretinal fluids absent) than group 1 (60 vs. 12.5%) at 2 weeks (P < 0.05). Best-corrected visual acuity (BCVA) and subfoveal choroidal thickness (SFCT) did not differ significantly between groups at all timepoints. Central subfield retinal thickness (CST) was significantly lower in group 2 at 2 (237.1 vs. 280.8 μm; P < 0.05), 4 (224.0 vs. 262.9 μm; P < 0.05), and 8 weeks (216.8 vs. 331.1 μm; P < 0.05). Group 2 had less vessel area (0.63 vs. 1.27 mm2; P < 0.05) and total vessel length (0.22 vs. 0.42 mm; P < 0.05). Choriocapillaris flow deficit (CCFd) was significantly lower in group 2 (42.7 vs. 48.2%; P < 0.05). Dry macula at 2 weeks (odds ratio [OR] = 8.3; P < 0.05) and a lower CCFd (OR = 0.73; P < 0.05) were associated with TE ≥ 12 weeks.
CONCLUSIONS: Early fluid-free status after switching to brolucizumab and choriocapillary function around CNV were prognostic factors for disease stability in nAMD refractory to anti-VEGF treatment.

UNASSIGNED: Acute kidney injury (AKI) is common among hospitalised patients and can lead to significant morbidity or mortality if not properly managed. Renal ultrasound (RUS) is often requested in the initial workup of AKI to rule out obstructive uropathy despite pre-renal aetiologies being implicated in most cases, especially in patients without risk factors for obstruction.
UNASSIGNED: Determine the utility of RUS in detecting bilateral hydronephrosis in the context of AKI, and identify risk factors that can be used to stratify patients to better guide patient management.
UNASSIGNED: Adults who underwent RUS for AKI between January 2019 and December 2021 were reviewed. Renal ultrasound studies that identified bilateral hydronephrosis and the patient characteristics associated with these studies were recorded.
UNASSIGNED: Seven hundred and fifty-eight RUS reports were included. Bilateral hydronephrosis was diagnosed in 43 patients (5.7%). Of these 43 patients, 39 (90.7%) had at least one risk factor for urinary tract obstruction. Bilateral hydronephrosis was only diagnosed in 4 (9.3%) patients without any risk factor for obstruction. The risk factors with the highest odds for being diagnosed with bilateral hydronephrosis included a history of previous ureteric stenting or nephrostomy tube insertion (OR 10.37), previous bilateral hydronephrosis (OR 14.56), or multiple risk factors (OR 23.06).
UNASSIGNED: Renal ultrasound has limited utility in the evaluation of AKI in low-risk patients.
UNASSIGNED: These risk factors can be used to assign patients to high- or low-risk categories to better guide management and reduce the number of unnecessary studies performed while still identifying clinically significant disease.

UNASSIGNED: The aim of this systematic review was to (1) estimate the prevalence of adhering to the MSE guidelines (at least 2 times/days a week) among adults; and (2) synthesize evidence on the correlates of adhering to the MSE guidelines.
UNASSIGNED: Five electronic databases were searched (March 2022), with a total of 30 observational studies consisting of 2,629,508 participants meeting the eligibility criteria. A meta-analysis was conducted to pool the prevalence of adhering to the MSE guidelines using the results of 21 eligible studies (study aim 1); and data reporting correlates of adhering to the MSE guidelines using 12 eligible studies were synthesized and categorized based on the Socioecological Model Framework (study aim 2).
UNASSIGNED: Overall, 22.8 % (95%CI: 18.18 % ─ 27.77 %) of adults adhered to the MSE guidelines, and 23 potential correlates at five levels were examined. Five variables (i.e., sex, age, education level, socioeconomic status) at the sociodemographic level and two variables (i.e., body mass index, self-rated health) at the physical related level were identified as consistent correlates, but displaying weak to moderate association strengths.
UNASSIGNED: Less than a quarter of adults meet the MSE guidelines and multidimensional correlates are associated with the adherence to the guidelines, particularly sociodemographic correlates (e.g., sex, age, and educational level). Findings highlight the need to further promote the importance of engaging in MSE among adults and investing effective interventions that not only provide opportunities for MSE for adults, but also facilitate the development of skills and confidence to engage in MSE.