Machine learning applications in healthcare clinical practice and research

Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligence.Among its various applications,it has proven groundbreaking in healthcare as well,both in clinical practice and research.In this editorial,we succinctly introduce ML applications and present a study,featured in the latest issue of the World Journal of Clinical Cases.The authors of this study conducted an analysis using both multiple linear regression(MLR)and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease(NAFLD).Their results implicated age as the most important determining factor in both groups,followed by lactic dehydrogenase,uric acid,forced expiratory volume in one second,and albumin.In addition,for the NAFLD-group,the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure,as compared to plasma calcium and body fat for the NAFLD+group.However,the study's distinctive contribution lies in its adoption of ML methodologies,showcasing their superiority over traditional statistical approaches(herein MLR),thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.

Practice patterns among ophthalmic surgeons in treating concomitant oculoplastic conditions in preoperative period:A questionnaire-based study

BACKGROUND Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure.Some oculoplastic conditions,like nasolacrimal duct obstruction,have been extensively studied,whereas others,like eyelid malposition and thyroid eye disease,have received minimal or no research.AIM To investigate the current practice patterns among ophthalmologists while treating concomitant oculoplastic conditions before any subspecialty ophthalmic intervention.METHODS A cross-sectional survey was disseminated among ophthalmologists all over India.The survey included questions related to pre-operative evaluation,anaesthetic and surgical techniques preferred,post-operative care,the use of adjunctive therapies,and patient follow-up patterns.RESULTS A total of 180 ophthalmologists responded to the survey.Most practitioners(89%)felt that the ROPLAS test was sufficient during pre-operative evaluation before any subspecialty surgery was advised.The most common surgical techniques employed were lacrimal drainage procedures(Dacryocystorhinostomy)(63.3%),eyelid malposition repair(36.9%),and ptosis repair(58.7%).Post-operatively,47.7%of respondents emphasized that at least a 4-week gap should be maintained after lacrimal drainage procedures and eyelid surgeries.Sixty-seven percent of ophthalmologists felt that topical anaesthetic procedures should be preferred while performing ocular surgeries in thyroid eye disease patients.CONCLUSION Approximately 50%of ophthalmologists handle prevalent oculoplastic issues themselves,seeking the expertise of an oculoplastic surgeon under particular conditions.Many ophthalmologists still favor using ROPLAS as a preliminary screening method before proceeding with cataract surgery.Eyelid conditions and thyroid eye disease are not as commonly addressed before subspecialty procedures compared to issues like nasolacrimal duct obstruction and periocular infections.

Importance of etiologies of secondary diabetes:How often do we think off in clinical practice?

The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabetes and emphasizes the necessity for healthcare professionals to recognize these conditions.Failure to do so can result in treatment delays and compromised patient outcomes.The article discusses spe-cific types of diabetes,including maturity onset of diabetes in young,pancreas-related diseases,endocrinopathies,drug-induced diabetes,infections,and con-genital genetic syndromes associated with diabetes mellitus.Case summaries highlight how patients with secondary diabetes,stemming from conditions such as Williams-Beuren syndrome and pituitary adenoma,often exhibit distinct characteristics overlooked in clinical practice.The authors stress the importance of a holistic diagnostic approach and advocate for proactive management through early intervention,including genetic tests and antibody detection.Increased awa-reness and education are crucial for timely identification and proper management,ultimately improving patient well-being.These findings prompt a call to action for healthcare professionals to consider rare causes of secondary diabetes,facili-tating better glycemic control and overall patient care.

Healthcare professionals'knowledge,attitude and practice towards ischemic bowel disease

BACKGROUND Ischemic bowel disease(IBD)is a critical condition caused by reduced blood flow to the intestines,leading to tissue damage and potentially severe complications.Early recognition and timely management are essential for improving patient outcomes and reducing morbidity and mortality associated with IBD.AIM To evaluate the knowledge,attitude and practice(KAP)of healthcare professionals regarding IBD.METHODS This cross-sectional study was conducted among healthcare professionals in China from November 2023 to December 2023 using a self-designed questionnaire.RESULTS A total of 315 valid questionnaires were analyzed,with 215 participants(68.25%)being female.The mean KAP scores were 17.55±5.35(range:0-24),27.65±2.77(range:8-40),and 18.88±4.23(range:6-30),respectively.Multivariate linear regression analysis revealed the following factors to be independently associated with knowledge:Age 26-35 years(β=2.80,95%CI:0.31-5.30,P=0.028),professional title(β=2.66,95%CI:0.91-4.41,P=0.003),position(β=-3.78,95%CI:-5.45 to-2.11,P<0.001),participation in IBD-related training(β=3.45,95%CI:2.39-4.51,P<0.001),and admission of more than five IBD cases in the past month(β=3.25,95%CI:1.58-4.92,P<0.001).Attitude was independently associated with knowledge(β=0.20,95%CI:0.15-0.26,P<0.001)and being a nurse or nursing supervisor(β=-1.30,95%CI:-2.16 to-0.40,P=0.003).Practice was independently associated with knowledge(β=0.20,95%CI:0.10-0.30,P<0.001)and attitude(β=0.24,95%CI:0.06-0.42,P=0.007).Structural equation modeling demonstrated direct effects of knowledge on attitude(β=0.24,P<0.001)and practice(β=0.26,P<0.001),as well as of attitude on practice(β=0.22,P=0.012).CONCLUSION Healthcare professionals demonstrated adequate knowledge but moderate attitude and inactive practice regarding IBD.Addressing the gaps in attitude and practice through targeted training programs and interventions is essential for improving patient care and outcomes.

Evaluating the impact of virtual reality on reducing restrictive practices in psychiatric wards

This manuscript critically evaluates the randomized controlled trial(RCT)conducted by Phiri et al,which assessed the effectiveness of virtual reality(VR)training for psychiatric staff in reducing restrictive practices(RPs).Specifically,this RCT investigated the impact of VR on the handling of aggressive patients by psychiatric staff compared to traditional training methods.Despite significant reductions in perceived discrimination in the VR group,there were no major improvements in self-efficacy or anxiety levels.The system usability scale rated the VR platform highly,but it did not consistently outperform traditional training methods.Indeed,the study shows the potential for VR to reduce RPs,although fluctuations in RP rates suggest that external factors,such as staff turnover,influenced the outcomes.This manuscript evaluates the study’s methodology,results,and broader implications for mental health training.Additionally,it highlights the need for more comprehensive research to establish VR as a standard tool for psychiatric staff education,focusing on patient care outcomes and real-world applicability.Finally,this study explores future research di-rections,technological improvements,and the potential impact of policies that could enhance the integration of VR in clinical training.

The response of roots and the rhizosphere environment to integrative cultivation practices in paddy rice

Integrative cultivation practices(ICPs)are essential for enhancing cereal yield and resource use efficiency.However,the effects of ICP on the rhizosphere environment and roots of paddy rice are still poorly understood.In this study,four rice varieties were produced in the field.Each variety was treated with six different cultivation techniques,including zero nitrogen application(0 N),local farmers’practice(LFP),nitrogen reduction(NR),and three progressive ICP techniques comprised of enhanced fertilizer N practice and increased plant density(ICP1),a treatment similar to ICP1 but with alternate wetting and moderate drying instead of continuous flooding(ICP2),and the same practices as ICP2 with the application of organic fertilizer(ICP3).The ICPs had greater grain production and nitrogen use efficiency than the other three methods.Root length,dry weight,root diameter,activity of root oxidation,root bleeding rate,zeatin and zeatin riboside compositions,and total organic acids in root exudates were elevated with the introduction of the successive cultivation practices.ICPs enhanced nitrate nitrogen,the activities of urease and invertase,and the diversity of microbes(bacteria)in rhizosphere and non-rhizosphere soil,while reducing the ammonium nitrogen content.The nutrient contents(ammonium nitrogen,total nitrogen,total potassium,total phosphorus,nitrate,and available phosphorus)and urease activity in rhizosphere soil were reduced in all treatments in comparison with the non-rhizosphere soil,but the invertase activity and bacterial diversity were greater.The main root morphology and physiology,and the ammonium nitrogen contents in rhizosphere soil at the primary stages were closely correlated with grain yield and internal nitrogen use efficiency.These findings suggest that the coordinated enhancement of the root system and the environment of the rhizosphere under integrative cultivation approaches may lead to higher rice production.

Tree: Reducing the use of restrictive practices on psychiatric wards through virtual reality immersive technology training

BACKGROUND Restrictive practices(RPs)are defined by measures linked to physical and chemical restraints to reduce the movement or control behaviours during any emergency.Seclusion is an equal part of RPs intended to isolate and reduce the sensory stimulation to safeguard the patient and those within the vicinity.Using interventions by way of virtual reality(VR)could assist with reducing the need for RPs as it could help reduce anxiety or agitation by way of placing users into realistic and immersive environments.This could also aid staff to and change current RPs.AIM To assess the feasibility and effectiveness of using a VR platform to provide reduction in RP training.METHODS A randomised controlled feasibility study,accompanied by evaluations at 1 month and 6 months,was conducted within inpatient psychiatric wards at Southern Health National Health Service Foundation Trust,United Kingdom.Virti VR scenarios were used on VR headsets to provide training on reducing RPs in 3 inpatient psychiatric wards.Outcome measures included general self-efficacy scale,generalised anxiety disorder assessment 7(GAD-7),Burnout Assessment Tool 12,the Everyday Discrimination Scale,and the Compassionate Engagement and Action Scale.RESULTS Findings revealed statistically significant differences between the VR and treatment as usual groups,in the Everyday Discrimination Scale items Q8 and Q9:P=0.023 and P=0.040 respectively,indicating higher levels of perceived discrimination in the VR group.There were no significant differences between groups in terms of general self-efficacy,generalised anxiety disorder assessment 9,and Burnout Assessment Tool 12 scores.A significant difference was observed within the VR group for compassionate engagement from others(P=0.005)over time.Most respondents recorded System Usability Scale scores above 70,with an average score of 71.79.There was a significant reduction in rates of RPs in the VR group vs treatment as usual group with a fluctuating variability observed in the VR group likely due to external factors not captured in the study.CONCLUSION Ongoing advancement of VR technology enables the possibility of creating scenarios and simulations tailored to healthcare environments that empower staff by providing more comprehensive and effective training for handling situations.

Rural Resilience: A Comprehensive Study on Water Supply, Sanitation, Disease Patterns, and Hygiene Practices in Munshiganj, Bangladesh

This research project investigates the current status of water supply, sanitation, and hygiene practices in Munshiganj District, Bangladesh. Data collection involved a structured questionnaire and a reconnaissance survey. Findings reveal that 30% of individuals rely on surface water (hand-tube wells, rivers, and ponds), prioritized as canal > river > pond, while 70% depend on groundwater (subterranean electric motor, deep tube-well). Drinking water is generally sufficient, with 95% reporting adequacy throughout the year. About 45% use hand tube-well water, 28% use deep tube-well water, and 11% use supply tap water for various purposes. Bathing trends include underground water through electric motor > pond > hand tube-well water > river, while for cooking, the order is underground water through electric motor > pond > hand tube-well water > river. Toilet water supply ranks as supply tap water > hand tube-well water > deep tube-well water. Although sanitation awareness is high, some lack knowledge of good hygiene practices. After defecating, handwashing methods include soap, ash, soil, or water. Children’s waste disposal varies, with some discarding it in open areas. Approximately 40% suffer from diseases like Diarrhoea due to unsafe water, primarily affecting children and elders. Training exists, but a significant portion lacks sanitation education. Dry skin or exposure to cold water may cause temporary irritation. Local government involvement in sanitation efforts is less active compared to non-governmental organizations. Results emphasize the need to enhance community awareness of safe water supplies and sanitation practices. .

Preceptors'experiences in guiding nursing students to use research findings and to implement evidence-based practice

Objective:Evidence-based practices(EBPs)have been taught to students by identifying the best evidence/evidence from research results.However,the experiences of Indonesian nurse preceptors in helping students implement research findings have not been explored thoroughly.This study aimed to explore Indonesian nurse preceptors in guiding nursing students to use research findings.Methods:This study used interpretive phenomenology analysis that involves 9 nurse preceptors from hospitals in West Kalimantan,Indonesia.Semi-structured in-depth interviews were recorded and then transcribed verbatim.Results:Three themes were generated during the analysis:“types of student supervision,”“issues during supervision,”and“the need for research literacy and supervision.”Conclusions:Nurse preceptors need support to supervise the nursing students to use research findings.In addition to upgrading nursing skills,nurse preceptors must receive training in research and its utilization.Developing an appropriate strategy to assist students in using research findings will enhance the promotion of evidence-based nursing practices on a daily basis.

Direct Regeneration of Spent Lithium-Ion Battery Cathodes:From Theoretical Study to Production Practice

Direct regeneration method has been widely concerned by researchers in the field of battery recycling because of its advantages of in situ regeneration,short process and less pollutant emission.In this review,we firstly analyze the primary causes for the failure of three representative battery cathodes(lithium iron phosphate,layered lithium transition metal oxide and lithium cobalt oxide),targeting at illustrating their underlying regeneration mecha-nism and applicability.Efficient stripping of material from the collector to obtain pure cathode material has become a first challenge in recycling,for which we report several pretreatment methods currently available for subsequent regeneration processes.We review and discuss emphatically the research progress of five direct regeneration methods,including solid-state sintering,hydrothermal,eutectic molten salt,electrochemical and chemical lithiation methods.Finally,the application of direct regeneration technology in production practice is introduced,the problems exposed at the early stage of the industrialization of direct regeneration technol-ogy are revealed,and the prospect of future large-scale commercial production is proposed.It is hoped that this review will give readers a comprehensive and basic understanding of direct regeneration methods for used lithium-ion batteries and promote the industrial application of direct regeneration technology.

Water and nitrogen footprint assessment of integrated agronomic practice management in a summer maize cropping system

The footprints of water and nitrogen(WF and NF)provide a comprehensive overview of the type and quantity of water consumption and reactive nitrogen(Nr)loss in crop production.In this study,a field experiment over two years(2019 and 2020)compared three integrated agronomic practice management(IAPM)systems:An improved management system(T2),a high-yield production system(T3),and an integrated soil-crop management system(ISCM)using a local smallholder farmer’s practice system(T1)as control,to investigate the responses of WF,Nr losses,water use efficiency(WUE),and nitrogen use efficiency(NUE)to IAPM.The results showed that IAPM optimized water distribution and promoted water use by summer maize.The evapotranspiration over the whole maize growth period of IAPM increased,but yield increased more,leading to a significant increase in WUE.The WUE of the T2,T3,and ISCM treatments was significantly greater than in the T1 treatment,in 2019 and 2020respectively,by 19.8-21.5,31.8-40.6,and 34.4-44.6%.The lowest WF was found in the ISCM treatment,which was 31.0%lower than that of the T1 treatment.In addition,the ISCM treatment optimized soil total nitrogen(TN)distribution and significantly increased TN in the cultivated layer.Excessive nitrogen fertilizer was applied in treatment T3,producing the highest maize yield,and resulting in the highest Nr losses.In contrast,the ISCM treatment used a reduced nitrogen fertilizer rate,sacrificing grain yield partly,which reduced Nr losses and eventually led to a significant increase in nitrogen use efficiency and nitrogen recovery.The Nr level in the ISCM treatment was34.8%lower than in the T1 treatment while NUE was significantly higher than in the T1 treatment by 56.8-63.1%in2019 and 2020,respectively.Considering yield,WUE,NUE,WF,and NF together,ISCM should be used as a more sustainable and clean system for sustainable production of summer maize.

A review of clinical practice guidelines on the management of preeclampsia and nursing inspiration

Objectives:To review,evaluate,and synthesize the recommendations of guidelines on preeclampsia(PE)from a nursing perspective.Methods:This is a systematic review of international and national guidelines on PE.Electronic databases and related guideline websites were searched from 2013 to 2023.After systematic retrieval and screening,we used the AGREE II tool to appraise the methodological quality of guidelines that met the eligibility criteria.Then,we analyzed and summarized the recommendations using descriptive analysis and the framework method.Furthermore,we rated the quality of evidence and the strength of the recommendations using the GRADE approach.Results:Ten guidelines were included,among which eight were deemed“clinically useful”and records were extracted.In total,31 recommendations,including 46 items on the nursing management of PE,were summarized from three aspects:1)antenatal care(18 recommendations),including the assessment and regular monitoring of PE,standardized blood pressure(BP)measurement,prevention education for PE,antihypertensive agent monitoring,and magnesium sulfate(MgSO_(4))use;2)intrapartum care(4 recommendations),including childbirth care;3)postpartum care(9 recommendations),including regular nursing monitoring,breastfeeding care and longer-term health counseling.Most of the evidence was rated as“very low”(19/46)or“moderate”(15/46)quality.For the strength of the recommendations,30 items were graded as“strong”and 16 items were rated as“weak”.Conclusions:This study provides professional,evidence-based nursing care resources both for preservice education for nursing staff and health care education for women with PE to help them detect and treat PE in a timely manner.

Research on the development methodology for clinical practice guidelines for organic integration of traditional Chinese medicine and Western medicine

Integrated traditional Chinese medicine(TCM)and Western medicine(WM)is a new medical science grounded in the knowledge bases of both TCM and WM,which then forms a unique modern medical system in China.Integrated TCM and WM has a long history in China,and has made important achievements in the process of clinical diagnosis and treatment.However,the methodological defects in currently published clinical practice guidelines(CPGs)limit its development.The organic integration of TCM and WM is a deeper integration of TCM and WM.To realize the progression of"integration"to"organic integration",a targeted and standardized guideline development methodology is needed.Therefore,the purpose of this study is to establish a standardized development procedure for clinical practice guidelines for the organic integration of TCM and WM to promote the systematic integration of TCM and WM research results into clinical practice guidelines in order to achieve optimal results as the whole is greater than the sum of the parts.

Knowledge, attitudes, and practices regarding Covid-19 and their relationship with Covid-19 booster vaccination status among women with infertility

Objective:To elucidate the relationship among knowledge,attitudes,and practices regarding Covid-19 and their relationship with booster vaccination status among women with infertility.Methods:This questionnaire-based cross-sectional study was performed online and offline among women with infertility who visited an infertility clinic in Jakarta,Indonesia.We assessed the patient’s knowledge,attitudes,and practices regarding Covid-19 and their relationship with booster vaccination status and sociodemographic profile.Results:A total of 178 subjects participated in this study,and most participants(92.6%)had received booster Covid-19 vaccines.From the questionnaire,74.2%had good knowledge,and 99.4%had good attitudes regarding Covid-19;however,only 57.9%of patients had good practices.A weak positive correlation existed between knowledge and attitudes(r=0.11,P=0.13)and a moderate negative correlation between attitudes and practices(r=-0.44,P=0.56).Participants’knowledge about vaccines and infertility was correlated with booster vaccination status(P=0.04).Academic background(P=0.01)and attitudes(P=0.01)were also correlated with booster vaccination status.The significant determinants of hesitance of receiving Covid-19 booster vaccines were high school education or below(OR=0.08,95%CI 0.02-0.36)and poor practices(OR=0.21,95%CI 0.05-0.95).Conclusions:The majority of the participants had received the Covid-19 booster vaccine and had good knowledge and attitudes but poor practices regarding Covid-19.Most participants had poor knowledge about the relationship between infertility and the Covid-19 vaccine.The general population should be more informed and reminded about practices to prevent Covid-19 and the relationship between vaccination and fertility to increase the number of people who receive Covid-19 booster vaccines.

A cross-sectional study to assess medication safety,knowledge,attitude,and practices regarding nutrition and medication among pregnant women

Objective:To assess pregnant women's knowledge,attitude,and practice regarding nutrition and medication usage,analyse the prescribing pattern,and categorize them based on the Food and Drug Administration(FDA)guidelines.Methods:A cross-sectional study was conducted with 264 pregnant women in the obstetrics and gynaecology department of a tertiary care hospital from October 2022 to August 2023.A knowledge,attitude,and practice(KAP)questionnaire was prepared in English language by the researchers and validated by an expert panel consisting of 12 members.The validated questionnaire was then translated into regional languages,Kannada and Malayalam.The reliability of the questionnaire was assessed with test-retest method with a representative sample population of 30 subjects(10 subjects for each language).The subjects'knowledge,attitude,and practice were evaluated using the validated KAP questionnaire.The safety of the medication was assessed using the FDA drug safety classification for pregnancy.Results:The mean scores for nutritional and medication usage knowledge,attitude,and practice were 4.14±1.15,4.50±1.09,and 3.00±1.47,respectively.Among 30 prescribed medications,3 belong to category A(no risk in human studies),8 belong to category B(no risk in animal studies),18 belong to category C(risk cannot be ruled out)and 1 drug is not classified.A significant association was observed between medication knowledge and practice(r=0.159,P=0.010).Conclusions:Most of the study population knows the need to maintain good dietary and medication practices during pregnancy.Counselling pregnant women regarding diet and medication usage is crucial in maternal care.

Intravitreal injection practice patterns among Chinese ophthalmologists

AIM:To describe the practice patterns of intravitreal injections(IVIs)among ophthalmologists in China.METHODS:This was a cross-sectional online survey.Ophthalmologists who had performed accumulated more than 100 injections were contacted by the Brightness Center,a hospital-based national network,to complete an anonymous,24-question,internet-based survey.They were surveyed on practices in injection techniques,pre-,and post-injections procedures.RESULTS:A total of 333 ophthalmologists from 28 provinces/municipalities/autonomous regions responded to the survey(50.68%response rate).The 91.29%of the respondents evaluated systemic risk factors by medical history,electrocardiogram(ECG)and blood test.All the respondents used pre-injection prophylactic antibiotics.Most checked intraocular pressure(IOP,99.1%)and blood pressure(96.1%)before injections.A majority of the respondents performed injections in the operating room(98.8%),wore masks(99.7%),gloves(99.4%)and sterile surgical clothing(96.1%),performed topical anesthetics(97.9%),and applied povidone-iodine(95.8%)pre-injection.The 61.26%of the respondents dilated pupil.About half of the respondents(51.05%)performed bilateral injections in the same setting.Superior temporal quadrant(40.54%)was the most frequent site of injection.Around three quarters used 30-gauge needles.Most respondents(97.9%)measured the site of injection from limbus.More than half(53.45%)performed conjunctiva displacement prior to injection.The 32.43%of the respondents checked IOP post-injection and 87.99%physicians checked hand motion(HM)or counting fingers(CF)after injection,while 36.94%observed optic nerve perfusion.All participants used topical antibiotics post-injections.Most physicians(91.89%)reviewed patients on the following day.CONCLUSION:This study provides a description of the real-world practice patterns in IVIs in China and offers critical information regarding education and training of ophthalmologists and amendment of local society guidelines.

Global systematic review and meta-analysis of knowledge, attitudes, and practices towards dengue fever among the general population

Objective:To determine the global level of knowledge,attitudes,and practices towards dengue fever among the general population.Methods:To complete this systematic review and meta-analysis,a thorough search for pertinent English-language literature was undertaken during the study's extension until October 2023.The search used Google Scholar,Scopus,PubMed/MEDLINE,Science Direct,Web of Science,EMBASE,Springer,and ProQuest.A quality assessment checklist developed using a modified Newcastle-Ottawa Scale for the cross-sectional study was used to evaluate the risk of bias in the included papers.Inverse variance and Cochran Q statistics were employed in the STATA software version 14 to assess study heterogeneity.When there was heterogeneity,the Dersimonian and Liard random-effects models were used.Results:59 Studies totaling 87353 participants were included in this meta-analysis.These investigations included 86278 participants in 55 studies on knowledge,20196 in 33 studies on attitudes,and 74881 in 29 studies on practices.The pooled estimates for sufficient knowledge,positive attitudes,and dengue fever preventive behaviors among the general population were determined as 40.1%(95%CI 33.8%-46.5%),46.8%(95%CI 35.8%-58.9%),and 38.3%(95%CI 28.4%-48.2%),respectively.Europe exhibits the highest knowledge level at 63.5%,and Africa shows the lowest at 20.3%.Positive attitudes are most prevalent in the Eastern Mediterranean(54.1%)and Southeast Asia(53.6%),contrasting sharply with the Americas,where attitudes are notably lower at 9.05%.Regarding preventive behaviors,the Americas demonstrate a prevalence of 12.1%,Southeast Asia at 28.1%,Western Pacific at 49.6%,Eastern Mediterranean at 44.8%,and Africa at 47.4%.Conclusions:Regional disparities about the knowledge,attitude and preventive bahaviors are evident with Europe exhibiting the highest knowledge level while Africa has the lowest.These findings emphasize the importance of targeted public health interventions tailored to regional contexts,highlighting the need for region-specific strategies to enhance dengue-related knowledge and encourage positive attitudes and preventive behaviors.

Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)globally.However,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated.This study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer settings.Methods:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each CPG.We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.Results:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR A.Overall,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous versions.The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current version.In the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)recommendations.Significant variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer types.Conclusion:One-third of the current ESMO CPG recommendations are supported by the highest level of evidence.More well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

AI-Powered Innovations in High-Tech Research and Development: From Theory to Practice

This comparative review explores the dynamic and evolving landscape of artificial intelligence(AI)-powered innovations within high-tech research and development(R&D).It delves into both theoreticalmodels and practical applications across a broad range of industries,including biotechnology,automotive,aerospace,and telecom-munications.By examining critical advancements in AI algorithms,machine learning,deep learning models,simulations,and predictive analytics,the review underscores the transformative role AI has played in advancing theoretical research and shaping cutting-edge technologies.The review integrates both qualitative and quantitative data derived from academic studies,industry reports,and real-world case studies to showcase the tangible impacts of AI on product innovation,process optimization,and strategic decision-making.Notably,it discusses the challenges of integrating AI within complex industrial systems,such as ethical concerns,technical limitations,and the need for regulatory oversight.The findings reveal a mixed landscape where AI has significantly accelerated R&D processes,reduced costs,and enabled more precise simulations and predictions,but also highlighted gaps in knowledge transfer,skills adaptation,and cross-industry standardization.By bridging the gap between AI theory and practice,the review offers insights into the effectiveness,successes,and obstacles faced by organizations as they implement AI-driven solutions.Concluding with a forward-looking perspective,the review identifies emerging trends,future challenges,and promising opportunities inAI-poweredR&D,such as the rise of autonomous systems,AI-driven drug discovery,and sustainable energy solutions.It offers a holistic understanding of how AI is shaping the future of technological innovation and provides actionable insights for researchers,engineers,and policymakers involved in high-tech Research and Development(R&D).

Factors influencing the continuity of evidence-based practice in perioperative airway management for elderly patients with fractures:A qualitative study

BACKGROUND More and more evidence-based practices are emerging,but researchers mostly focus on short-term effects,resulting in evidence-based practices not being applied in the clinic in the long term.In this study,we took the evidence-based practice of perioperative airway management in elderly fracture patients as an example and adopted a descriptive phenomenological approach to understand the influencing factors of its sustainability to provide a reference basis for promoting the continuity of evidence-based practice in the clinic.AIM To explore factors influencing the persistence of evidence-based practice in perioperative airway management in elderly patients with fractures.METHODS This study was qualitative research.Nine nurses who implemented evidencebased practice in the orthopedic ward of a tertiary comprehensive hospital in Shanghai from September 2023 to October 2023 were selected using purposive sampling as research subjects.Semi-structured interviews were conducted with them,and the data were analyzed using the Colaizzi phenomenological analysis method based on the three dimensions and ten factors of the NHS sustainability model.RESULTS Three main themes and ten subthemes were identified:Process aspects(benefits to patients,benefits to nurses,lack of follow-up,complex processes);staff aspects(insufficient human resources,inadequate training and education,lack of leadership support);and organizational environment aspects(inadequate infrastructure,poor patient compliance,poor doctor cooperation).CONCLUSION Human resources,training and education,leadership support,infrastructure,and patient-physician collaboration are important factors influencing the sustainability of evidence-based practice for perioperative airway management in older patients with fractures.