OBJECTIVE: This updated version of a systematic review (SR) originally published in 2009 evaluated the effect of smoking on the clinical outcomes achieved with root coverage (RC) procedures in the treatment of gingival recession (GR) defects.
METHODS: This SR includes randomized controlled trials, controlled clinical trials, and case series with a minimum follow-up of 6 months. Eligible studies involved GR defects without interproximal tissue loss submitted to RC procedures, as well as outcome measures from smokers (i.e., those smoking 10 or more cigarettes per day at baseline) and nonsmokers, recorded separately. Three electronic databases were searched up to March 31, 2024. Random effects meta-analyses were conducted thoroughly.
RESULTS: A total of 12 studies reporting on 181 smokers and 162 nonsmokers, submitted to different RC procedures, were included. Half of these trials were originally included in the 2009 SR, whereas the other half (six studies) were included in this update. Nonsmokers experienced greater reductions in GR and gains in clinical attachment level compared to smokers. Pooled estimates comparing smokers and nonsmokers who received coronally advanced flap (CAF) alone and subepithelial connective tissue graft (SCTG) + CAF showed that nonsmokers achieved greater mean root coverage (MRC) in both treatments. Significant differences in MRC of 10.85% (95% CI, 1.92 to 19.77) and 22.04 (95% CI, 14.25 to 29.83), favoring nonsmokers, were identified for CAF and SCTG + CAF, respectively. Similarly, nonsmokers treated with SCTG + CAF displayed superior number of sites exhibiting complete root coverage (CRF) when compared with smokers (risk ratio, 4.12; 95% CI, 1.73 to 9.80).
CONCLUSIONS: Smoking negatively impacts the outcomes of RC procedures, particularly those achieved by SCTG-based procedures.
CONCLUSIONS: Smoking was linked to poorer RC outcomes. These outcomes highlight the critical need to integrate smoking cessation into periodontal treatment plans.

OBJECTIVE: Malignant struma ovarii (MSO) is a rare ovarian tumor characterized by mature thyroid tissue. The diverse symptoms and uncommon nature of MSO can create difficulties in its diagnosis and treatment. This study aimed to analyze data and use machine learning methods to understand the prognostic factors and potential management strategies for MSO.
METHODS: In this retrospective cohort, the Surveillance, Epidemiology, and End Results (SEER) database provided the data used for this study\'s analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using five machine learning algorithms to predict the 5-year survival. A validation method incorporating the area under the curve of the receiver operating characteristic curve was used to validate the accuracy and reliability of the machine learning models. We also investigated the role of multiple therapeutic options using the Kaplan-Meier survival analysis.
RESULTS: The study population comprised 329 patients. Multivariate Cox regression analysis revealed that older age, unmarried status, chemotherapy, and the total number of tumors in patients were poor prognostic factors. Machine learning models revealed that the multilayer perceptron accurately predicted outcomes, followed by the random forest classifier, gradient boosting classifier, K-nearest neighbors, and logistic regression models. The factors that contributed the most were age, marital status, and the total number of tumors in the patients.
CONCLUSIONS: The present study offers a comprehensive approach for the treatment and prognosis assessment of patients with MSO. The machine learning models we have developed serve as a practical, personalized tool to aid in clinical decision-making processes.

OBJECTIVE: To characterize the thematic foci, structure, and evolution of nursing research on clinical reasoning and judgment.
METHODS: Bibliometric analysis.
METHODS: We used a bibliometric method to analyze 1528 articles.
METHODS: We searched the Scopus bibliographic database on January 7, 2024.
RESULTS: Through a keyword co-occurrence analysis, we found the most frequent keywords to be clinical judgment, clinical reasoning, nursing education, simulation, nursing, clinical decision-making, nursing students, nursing assessment, critical thinking, nursing diagnosis, patient safety, nurses, nursing process, clinical competence, and risk assessment. The focal themes, structure, and evolution of nursing research on clinical reasoning and judgment were revealed by keyword mapping, clustering, and time-tracking.
CONCLUSIONS: By assessing key nursing research areas, we extend the current discourse on clinical reasoning and clinical judgment for researchers, educators, and practitioners. Critical challenges must still be met by nursing professionals with regard to their use of clinical reasoning and judgment within their clinical practice. Further knowledge and comprehension of the clinical reasoning process and the development of clinical judgment must be successfully translated from research to nursing education and practice.
UNASSIGNED: This study highlights the nursing knowledge gaps with regard to nurses\' use of clinical reasoning and judgment and encourages nursing educators and professionals to focus on developing nurses\' clinical reasoning and judgment with regard to their patients\' safety.
CONCLUSIONS: In addressing nurses\' use of clinical reasoning and judgment, and with regard to patient safety in particular, this study found that, in certain clinical settings, the use of clinical reasoning and judgment remains a challenge for nursing professionals. This study should thus have an effect on nursing academics\' research choices, on nursing educators\' teaching practices, and on nurses\' clinical practices.
UNASSIGNED: Relevant EQUATOR guidelines have been adhered to by employing recognized bibliometric reporting methods.

BACKGROUND: Clinical decision-making is based on objective and subjective criteria, including healthcare workers impressions and feelings. This research examines the perception and implications of a \'bad feeling\' experienced by healthcare professionals, focusing on its prevalence and characteristics.
METHODS: A cross-sectional paper-based survey was conducted from January to July 2023 at the University Medicine Greifswald and the hospital Sömmerda involving physicians, nurses, medical students and trainees from various specialties. With ethics committee approval, participants were recruited and surveyed at regular clinical events. Data analysis was performed using SPSS® Statistics. The manuscript was written using the Strobe checklist.
RESULTS: Out of 250 questionnaires distributed, 217 were valid for analysis after a 94.9% return rate and subsequent exclusions. Sixty-five per cent of respondents experience the \'bad feeling\' occasionally to frequently. There was a significant positive correlation between the frequency of \'bad feeling\' and work experience. The predominant cause of this feeling was identified as intuition, reported by 79.8% of participants, with 80% finding it often helpful in their clinical judgement. Notably, in 16.1% of cases, the \'bad feeling\' escalated in the further clinical course into an actual emergency. Furthermore, 60% of respondents indicated that this feeling occasionally or often serves as an early indicator of a potential, yet unrecognised, emergency in patient care.
CONCLUSIONS: This study demonstrates the relevance of clinical experience to decision-making. As an expression of this, there is a correlation between the frequency of a \'bad feeling\' and the number of years of experience. It is recommended that the \'bad feeling\' be deliberately acknowledged and reinforced as an early warning signal for emergency situations, given its significant implications for patient safety. Future initiatives could include advanced training and research, as well as tools such as pocket maps, to better equip healthcare professionals in responding to this intuition.

OBJECTIVE: This research examines the effects of artificial intelligence (AI)-based decision support systems (DSS) on the operational processes of nurses in critical care units (CCU) located in Amman, Jordan.
BACKGROUND: The deployment of AI technology within the healthcare sector presents substantial opportunities for transforming patient care, with a particular emphasis on the field of nursing.
METHODS: This paper examines how AI-based DSS affect CCU nursing workflows in Amman, Jordan, using a cross-sectional analysis. A study group of 112 registered nurses was enlisted throughout a research period spanning one month. Data were gathered using surveys that specifically examined several facets of nursing workflows, the employment of AI, encountered problems, and the sufficiency of training.
RESULTS: The findings indicate a varied demographic composition among the participants, with notable instances of AI technology adoption being reported. Nurses have the perception that there are favorable effects on time management, patient monitoring, and clinical decision-making. However, they continue to face persistent hurdles, including insufficient training, concerns regarding data privacy, and technical difficulties.
CONCLUSIONS: The study highlights the significance of thorough training programs and supportive mechanisms to improve nurses\' involvement with AI technologies and maximize their use in critical care environments. Although there are differing degrees of contentment with existing AI systems, there is a general agreement on the necessity of ongoing enhancement and fine-tuning to optimize their efficacy in enhancing patient care results.
UNASSIGNED: This research provides essential knowledge about the intricacies of incorporating AI into nursing practice, highlighting the significance of tackling obstacles to guarantee the ethical and efficient use of AI technology in healthcare.

OBJECTIVE: To synthesize aged care provider, resident and residents\' family members\' perspectives and experiences of medication administration in aged care facilities; to determine the incidence of medication administration errors, and the impact of medication administration on quality of care and resident-centredness in aged care facilities.
METHODS: A mixed-methods systematic review.
UNASSIGNED: CRD42023426990.
METHODS: The AMED, CINAHL, MEDLINE, EMBASE, EMCARE, PsycINFO, Scopus and Web of Science core collection databases were searched in June 2023.
METHODS: Included studies were independently screened, selected and appraised by two researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was followed, with the Mixed Methods Appraisal Tool was used for critical appraisal. Convergent synthesis of data, thematic synthesis and meta-analysis were performed.
RESULTS: One hundred and twenty-eight studies were included (33 qualitative, 85 quantitative and 10 mixed-methods). Five themes were formulated, including 1) Staffing concerns, 2) The uncertain role of residents, 3) Medication-related decision-making, 4) Use of electronic medication administration records and 5) Medication administration errors. Educational interventions for aged care workers significantly reduced medication administration errors, examined across five studies (OR = 0.37, 95%CI 0.28-0.50, p < .001).
CONCLUSIONS: Medication administration in aged care facilities is challenging and complex on clinical and interpersonal levels. Clinical processes, medication errors and safety remain focal points for practice. However, more active consideration of residents\' autonomy and input by aged care workers and providers is needed to address medication administration\'s interpersonal and psychosocial aspects. New directions for future research should examine the decision-making behind dose form modification, aged care workers\' definitions of medication omission and practical methods to support residents\' and their family members\' engagement during medication administration.
UNASSIGNED: It is important that medication administration in aged care facilities be more clearly acknowledged as both a clinical and interpersonal task. More attention is warranted regarding aged care workers clinical decision-making, particularly concerning dose form modification, covert administration and medication omissions. Resident-centred care approaches that support resident and family engagement around medication administration may improve adherence, satisfaction and quality of care.
CONCLUSIONS: What Problem Did the Study Address? Medication administration in aged care facilities is a complex clinical and interpersonal activity. Still, to date, no attempts have been made to synthesize qualitative and quantitative evidence around this practice. There is a need to establish what evidence exists around the perspectives and experiences of aged care workers, residents and resident\'s family members to understand the challenges, interpersonal opportunities and risks during medication administration. What Were the Main Findings? There is a lack of empirical evidence around resident-centred care approaches to medication administration, and how residents and their families could be enabled to have more input. Dose form modification occurred overtly and covertly as part of medication administration, not just as a method for older adults with swallowing difficulties, but to enforce adherence with prescribed medications. Medication administration errors typically included medication omission as a category of error, despite some omissions stemming from a clear rationale for medication omission and resident input. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The findings of this systematic review contribute to aged care policy and practice regarding medication administration and engagement with older adults. This review presents findings that provide a starting point for aged care workers in regards to professional development and reflection on practice, particularly around clinical decision-making on dose form modification, medication administration errors and the tension on enabling resident input into medication administration. For researchers, this review highlights the need to develop resident-centred care approaches and interventions, and to assess whether these can positively impact medication administration, resident engagement, adherence with prescribed medications and quality of care.
UNASSIGNED: This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021).
UNASSIGNED: No patient or public contribution to this systematic review.

BACKGROUND: The management of Factor XI deficiency is challenged by a variable association between FXI level and bleeding phenotype. Additionally, there is scarce data describing management strategies and their outcomes, specifically bleeding, thrombosis, and other complications.
OBJECTIVE: To evaluate bleeding, thrombosis, and other complications in individuals with severe FXI deficiency seen in our comprehensive haemophilia treatment centre (HTC). Peri-procedural management strategies and the resulting impact on bleeding and other clinically relevant outcomes were reported.
METHODS: Retrospective review of the electronic medical record of adult patients with severe FXI deficiency (< 20% activity) seen at a New York City comprehensive HTC between 2017 and 2022. Procedures, haemostatic management, and outcomes were collected and analysed.
RESULTS: We identified 38 individuals (64%) females with severe FXI deficiency. The mean age was 56 ± 21 years (SD). The median FXI activity level was 3% (IQR: 1-8%). The mean BAT score was 3.1 ± 2.4; (52%) individuals did not have a history of bleeding. A total of 256 surgeries and procedures were performed. There was reduced bleeding with preventative or reactive treatment during procedures. Arterial but not venous thrombotic complications were observed. Plasma was mostly used for procedures associated with higher risk of bleeding and antifibrinolytics for procedures at sites of high fibrinolysis.
CONCLUSIONS: Current management strategies pose a burden of care for these patients and manifested as nonbleeding adverse events and changes in clinical management. These findings highlight the need for novel investigation in predicting and managing bleeding for individuals with severe FXI deficiency.

暂无摘要。

UNASSIGNED: Given the strikingly high diagnostic error rate in hospitals, and the recent development of Large Language Models (LLMs), we set out to measure the diagnostic sensitivity of two popular LLMs: GPT-4 and PaLM2. Small-scale studies to evaluate the diagnostic ability of LLMs have shown promising results, with GPT-4 demonstrating high accuracy in diagnosing test cases. However, larger evaluations on real electronic patient data are needed to provide more reliable estimates.
UNASSIGNED: To fill this gap in the literature, we used a deidentified Electronic Health Record (EHR) data set of about 300,000 patients admitted to the Beth Israel Deaconess Medical Center in Boston. This data set contained blood, imaging, microbiology and vital sign information as well as the patients\' medical diagnostic codes. Based on the available EHR data, doctors curated a set of diagnoses for each patient, which we will refer to as ground truth diagnoses. We then designed carefully-written prompts to get patient diagnostic predictions from the LLMs and compared this to the ground truth diagnoses in a random sample of 1000 patients.
UNASSIGNED: Based on the proportion of correctly predicted ground truth diagnoses, we estimated the diagnostic hit rate of GPT-4 to be 93.9%. PaLM2 achieved 84.7% on the same data set. On these 1000 randomly selected EHRs, GPT-4 correctly identified 1116 unique diagnoses.
UNASSIGNED: The results suggest that artificial intelligence (AI) has the potential when working alongside clinicians to reduce cognitive errors which lead to hundreds of thousands of misdiagnoses every year. However, human oversight of AI remains essential: LLMs cannot replace clinicians, especially when it comes to human understanding and empathy. Furthermore, a significant number of challenges in incorporating AI into health care exist, including ethical, liability and regulatory barriers.

BACKGROUND: Strict patient isolation in hospital is associated with adverse health outcomes. However, there is a lack of high-quality evidence for effective interventions to improve safety and quality of care for these patients.
OBJECTIVE: To identify patient reported areas for improvement in the care of patients in hospital isolation and to determine the feasibility of collecting patient reported outcomes using validated tools.
METHODS: Design An exploratory mixed methods study. Setting A major metropolitan teaching hospital in Melbourne, Australia. Participants Patients in hospital isolation for transmissible infections. Data collection Data were collected by (1) phone interviews with patients in isolation and (2) seven validated measurement tools to assess cognition, loneliness, nutritional status, quality of life, anxiety and depression and physical activity. Data were collected between September and December 2021. Data analysis Interviews were transcribed and analysed using thematic analysis. Quantitative data were analysed descriptively including participant characteristics and outcome data.
RESULTS: Participants identified areas for improvement including activities to decrease boredom, more contact with staff to mitigate loneliness and increase comfort care, and formalised communication about clinical treatment and discharge plan. Patients with gastrointestinal symptoms were happier to be alone. There were operational challenges within the health service including delays and miscommunication. Only 70% of the participants completed all questionnaires.
CONCLUSIONS: This study identified areas for improvement in care of patients in isolation and demonstrated that collecting patient reported outcomes using validated tools was feasible. The results of this research will inform development of an intervention to manage adverse effects.
UNASSIGNED: Patients in hospital isolation require additional consideration to ensure that their needs are met to avoid adverse outcomes. The patient experience and comfort can be negatively affected when fundamental care is lacking.
UNASSIGNED: EQUATOR guidelines for Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS).
UNASSIGNED: Thirteen patients in hospital isolation agreed to participate in this study, sharing their experiences through interviews and assessment.