The National Health Service(NHS)is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom.There are several challenges militating against the...The National Health Service(NHS)is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom.There are several challenges militating against the effective laboratory service delivery in the NHS in England.Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients.They provide the"engine room"of modern medicine with 70%of diagnosis based on the laboratory results generated by them.This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England.Laboratory service delivery in the NHS in England faces numerous daunting challenges;staffing levels in the last few years have become dangerously low,less remunerated,relatively less experienced and predominantly band 5's,multidisciplinary rather than specialty based,associated with working more unsocial hours without adequate recovery time,de-banding of staff,high staff turnaround,profit and cost driven rather than quality.These factors has resulted in burn out,low morale,high sickness absences,increased error rate,poor team spirit,diminished productivity and suboptimal laboratory service delivery.There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix,ensuring adequate remuneralion of laboratory staff,implementing evidenced-based specialty oriented service,determining the root cause/s for the high staff turnover and implementing corrective action,identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.展开更多
The release of the Mid Staffordshire hospital report otherwise called the Francis report once again ignited the debate about the issue of abuse of especially vulnerable patients, while navigating the care pathway as i...The release of the Mid Staffordshire hospital report otherwise called the Francis report once again ignited the debate about the issue of abuse of especially vulnerable patients, while navigating the care pathway as inpatients in hospitals;within the National health service (NHS), England. Once more the official reaction from the NHS directorate is more “standards” to monitor failed standards in patient care. Of interest in the official responses so far, are the unheard voices addressing the issue of healthcare and organizational ethics concerns that need revisiting. This article seeks to revisit practice, systems and care issues leading to incidents of the type of the Staffordshire abuses, and the important but yet unheralded place of organizational and care ethics in helping to curb such abuses from re-occurring.展开更多
Objective: To test the feasibility of a fully paperless system, termed “paperlite” in a UK breast screening service. To demonstrate in NHS practice, how workload and workflow could be improved by moving to a paperle...Objective: To test the feasibility of a fully paperless system, termed “paperlite” in a UK breast screening service. To demonstrate in NHS practice, how workload and workflow could be improved by moving to a paperless system and discovering what impact this has upon the complexity within the service. Setting: Warwickshire, Solihull and Coventry Breast Screening Service in the West Midlands of England. Methods: Quality improvement methodologies were employed, including value stream mapping, task analysis and a time-and-motion study. Results: The screening centred screened approximately 50,000 women per year. If they were to implement a paperless system, the administrative workload would decrease. The time saving per batch of screens, which could be achieved by moving to the paperless system ranged from 19 to 56 minutes (mean = 36 minutes). When calculated by batch the mean time saving per woman screened by moving to the paperless system was 42 seconds. This equates to 583 hours of administrative work per year in a centre screening 50,000 women. Conclusions: The paperless system has many benefits compared to the original system in terms of reductions in waste, time and cost. The simplification and standardisation of the process resulted in fewer tasks and interfaces where errors could occur, hence inadvertently improving patient safety. The limitation of the work is the heavy reliance on technology, live interfacing with computer databases and software stability is necessary for a paperless system to be used in NHS practice.展开更多
Type 2 diabetes mellitus(T2DM)significantly elevates the risk of colorectal cancer(CRC)and complicates its treatment by promoting chemoresistance.Poor glycemic control has been linked to exacerbated CRC progression an...Type 2 diabetes mellitus(T2DM)significantly elevates the risk of colorectal cancer(CRC)and complicates its treatment by promoting chemoresistance.Poor glycemic control has been linked to exacerbated CRC progression and diminished chemotherapy efficacy,impacting patient outcomes through various mechanisms such as oxidative stress,activation of metabolic pathways,and altered protein modifications that hinder apoptosis and enhance tumor survival.Clinical evidence shows that T2DM patients experience higher rates of chemoresistance and reduced disease-free survival and overall survival compared to non-diabetic patients.Specifically,those with poor glycemic control exhibit increased chemo-resistance and poorer survival metrics.Antidiabetic treatments,including metformin,acarbose,and gliclazide,show promise in improving chemotherapy response and glycemic management,potentially enhancing patient outcomes.Addressing this challenge requires a comprehensive,multidisciplinary approach involving oncologists,endocrino-logists,and surgeons to optimize patient care.Integrated strategies that prioritize glycemic control are essential for reducing chemoresistance and improving survival in CRC patients with T2DM.展开更多
Fluctuating voltage levels in power grids necessitate automatic voltage regulators(AVRs)to ensure stability.This study examined the modeling and control of AVR in hydroelectric power plants using model predictive cont...Fluctuating voltage levels in power grids necessitate automatic voltage regulators(AVRs)to ensure stability.This study examined the modeling and control of AVR in hydroelectric power plants using model predictive control(MPC),which utilizes an extensive mathe-matical model of the voltage regulation system to optimize the control actions over a defined prediction horizon.This predictive feature enables MPC to minimize voltage deviations while accounting for operational constraints,thereby improving stability and performance under dynamic conditions.Thefindings were compared with those derived from an optimal proportional integral derivative(PID)con-troller designed using the artificial bee colony(ABC)algorithm.Although the ABC-PID method adjusts the PID parameters based on historical data,it may be difficult to adapt to real-time changes in system dynamics under constraints.Comprehensive simulations assessed both frameworks,emphasizing performance metrics such as disturbance rejection,response to load changes,and resilience to uncertainties.The results show that both MPC and ABC-PID methods effectively achieved accurate voltage regulation;however,MPC excelled in controlling overshoot and settling time—recording 0.0%and 0.25 s,respectively.This demonstrates greater robustness compared to conventional control methods that optimize PID parameters based on performance criteria derived from actual system behavior,which exhibited settling times and overshoots exceeding 0.41 s and 5.0%,respectively.The controllers were implemented using MATLAB/Simulink software,indicating a significant advancement for power plant engineers pursuing state-of-the-art automatic voltage regulations.展开更多
Monogenic diabetes is a heterogeneous disorder characterized by hyperglycemia arising from defects in a single gene.Maturity-onset diabetes of the young(MODY)is the most common type with 14 subtypes,each linked to spe...Monogenic diabetes is a heterogeneous disorder characterized by hyperglycemia arising from defects in a single gene.Maturity-onset diabetes of the young(MODY)is the most common type with 14 subtypes,each linked to specific mutations affecting insulin synthesis,secretion and glucose regulation.Common traits across MODY subtypes include early-onset diabetes,a family history of autosomal dominant diabetes,lack of features of insulin resistance,and absent islet cell autoimmunity.Many cases are misdiagnosed as type 1 and type 2 diabetes mellitus.Biomarkers and scoring systems can help identify candidates for genetic testing.GCK-MODY,a common subtype,manifests as mild hyperglycemia and doesn’t require treatment except during pregnancy.In contrast,mutations in HNF4A,HNF1A,and HNF1B genes lead to progressive beta-cell failure and similar risks of complications as type 2 diabetes mellitus.Neonatal diabetes mellitus(NDM)is a rare form of monogenic diabetes that usually presents within the first six months.Half of the cases are lifelong,while others experience transient remission.Permanent NDM is most commonly due to activating mutations in genes encoding the adenosine triphosphate-sensitive potassium channel(KCNJ11 or ABCC8)and can be transitioned to sulfonylurea after confirmation of diagnosis.Thus,in many cases,monogenic diabetes offers an opportunity to provide precision treatment.The scope has broadened with next-generation sequencing(NGS)technologies,replacing older methods like Sanger sequencing.NGS can be for targeted gene panels,whole-exome sequencing(WES),or whole-genome sequencing.Targeted gene panels offer specific information efficiently,while WES provides comprehensive data but comes with bioinformatic challenges.The surge in testing has also led to an increase in variants of unknown significance(VUS).Deciding whether VUS is disease-causing or benign can be challenging.Computational models,functional studies,and clinical knowledge help to determine pathogenicity.Advances in genetic testing technologies offer hope for improved diagnosis and personalized treatment but also raise concerns about interpretation and ethics.展开更多
Dry eye disease(DED)is a multifactorial disorder that disturbs ocular surface equilibrium,considerably diminishing quality of life.Present therapies only offer symptomatic alleviation.Stem cell treatment,especially me...Dry eye disease(DED)is a multifactorial disorder that disturbs ocular surface equilibrium,considerably diminishing quality of life.Present therapies only offer symptomatic alleviation.Stem cell treatment,especially mesenchymal stem cells(MSCs),has surfaced as a viable approach for tissue regeneration and immunological regulation in DED.Preclinical and early clinical investigations indicate that MSCs can improve lacrimal gland functionality,diminish inflammation,and facilitate corneal regeneration.Nonetheless,obstacles persist in enhancing MSC viability,determining the optimal MSC source,and guaranteeing sustained therapeutic effectiveness.Additional extensive randomized clinical trials are required to confirm the efficacy of MSC-based therapies for severe DED.展开更多
Use of immunomodulating agents to prevent the progression of autoimmuneβ-cell damage leading to type 1 diabetes mellitus(T1DM)is an interesting area for research.These include non-specific anti-inflammatory agents,im...Use of immunomodulating agents to prevent the progression of autoimmuneβ-cell damage leading to type 1 diabetes mellitus(T1DM)is an interesting area for research.These include non-specific anti-inflammatory agents,immunologic vaccination and anti-inflammatory agents targeting specific immune cells or cytokines.Teplizumab is an anti-CD3-molecule that binds to and leads to the disappearance of the CD3/TCR complex and rendering the T cell anergic to its target antigen.Preclinical and clinical trials have demonstrated its efficacy in reducing the decline in serum C-peptide levels and the need for insulin therapy if used early in the disease process of T1DM.The benefits have been apparent as early as six months to as long as seven years after therapy.It has recently been approved by the Food and Drug Administration to delay the onset of clinical(stage 3)type 1 diabetes in children above 8 years of age.In their recent metaanalysis published in the World Journal of Diabetes,Ma et al found that those in the teplizumab treatment group have a greater likelihood of reduction in insulin use,change in C-peptide response,and better glycemic control compared to the control group with a good safety profile.However,all the included randomized control trials have been conducted in high-income countries.High cost of therapy and unknown utility of the molecule in stage 3 disease limit its widespread use.展开更多
The BRASH syndrome,an acronym for bradycardia,renal failure,atrioventricular(AV)nodal blockade,shock,and hyperkalemia,was first described as a distinct clinical entity in 2016 by Josh Farkas.[1]He proposed a vicious p...The BRASH syndrome,an acronym for bradycardia,renal failure,atrioventricular(AV)nodal blockade,shock,and hyperkalemia,was first described as a distinct clinical entity in 2016 by Josh Farkas.[1]He proposed a vicious pathophysiological cycle driven by the synergy between AV nodal blockade and hyperkalemia.展开更多
Although national transplant organizations share common visions and goals,the creation of a unified global organization remains impractical.Differences in ethnicity,culture,religion,and education shape local practices...Although national transplant organizations share common visions and goals,the creation of a unified global organization remains impractical.Differences in ethnicity,culture,religion,and education shape local practices and infrastructure,making the establishment of a single global entity unfeasible.Even with these social disparities aside,logistical factors such as time and distance between organ procurement and transplantation sites pose significant challenges.While technological advancements have extended organ preservation times,they have yet to support the demands of transcontinental transplantations effectively.This review presents a comparative analysis of the structures,operational frameworks,policies,and legislation governing various transplant organizations around the world.Key differences pertain to the administration of these organizations,trends in organ donation,and organ allocation policies,which reflect the financial,cultural,and religious diversity across different regions.While a global transplant organization may be out of reach,agreeing on best practices for the benefit of patients is essential.展开更多
Introduction In all branches of healthcare,clinicians are seen to be making professional judgements based on objective facts and assessments.However,in our daily lives,we recognise and celebrate individual differences...Introduction In all branches of healthcare,clinicians are seen to be making professional judgements based on objective facts and assessments.However,in our daily lives,we recognise and celebrate individual differences in interests,beliefs and personalities.展开更多
Muscle deconditioning due to hospitalisation is problematic, causing delayed discharges, more nursing, carer, or social service support following discharge, and possible discharge to a care home rather than the patien...Muscle deconditioning due to hospitalisation is problematic, causing delayed discharges, more nursing, carer, or social service support following discharge, and possible discharge to a care home rather than the patient’s own home. Muscle deconditioning is associated with increased mortality, infections, depression, and reductions in patient mobility and ability to engage in their activities of daily living. Preserving muscle strength and function should form part of patients’ rehabilitation plans. Progressive resistance training (PRE) offers the most cost-effective way of preserving muscle strength and function;however, it is not routinely carried out in hospitals. A leg strengthening device (the S-Press) has been developed with the aim of improving access to effective PRE for adults. Using a qualitative approach, thematic analysis of interviews with physiotherapists, patients, and relative carers about their experience of using the S-Press provided insight into integrating PRE into patients’ rehabilitation, what promoted or prevented its use, and the outcomes associated with its use. Four overall themes emerged from the data. “Experience of Users” described that the S-Press was accessible, convenient, time efficient, portable, and manoeuvrable, and it provided an objective measure of progress. “Facilitators” included findings around how the S-Press was easy to use, motivational, and comfortable when in use. “Barriers” comprised the inability of some patients to use the S-Press independently and the identification of obstacles that prevented consistent use. “Impact and Benefits” represented the perceptions of increased leg strength and psychological benefits. The S-Press is beneficial for patients’ rehabilitation by offering PRE that is simple and easy to use, acceptable to both patients and professionals, and can be integrated as part of patients’ rehabilitation plans.展开更多
The World Health Organization declared Sri Lanka a malaria eliminated country in 2016[1-3].At present,the country is in the phase of preventing the re-establishment of malaria[4].However,travelers who contract the dis...The World Health Organization declared Sri Lanka a malaria eliminated country in 2016[1-3].At present,the country is in the phase of preventing the re-establishment of malaria[4].However,travelers who contract the disease overseas in malaria endemic countries continue to present a constant risk of re-establishing malaria in Sri Lanka,where malaria-transmitting mosquitos is prevalent.In this context,robust measures are being implemented in the country to prevent re-establishment of malaria and to stop travelers infected with malaria progressing into severe disease and death.展开更多
Background: Non-radiographic axial spondyloarthritis is a progressive and disabling inflammatory disease affecting young adults, with limited treatment options. TNFi are more efficacious than JAKi and IL1-7i in nr-ax ...Background: Non-radiographic axial spondyloarthritis is a progressive and disabling inflammatory disease affecting young adults, with limited treatment options. TNFi are more efficacious than JAKi and IL1-7i in nr-ax SPA and it has a well-known safety profile over a longer duration. Recently, many IL-17i and JAKi were approved for the treatment of nr-ax SPA;however, data comparing IL1-7i and JAKi in terms of efficacy and safety is lacking. This systematized review aimed to compare the existing efficacy and safety data of JAKi vs IL-17i in the treatment of patients with nr-ax SPA. Methods: A systematic literature search was performed using relevant keywords in many databases. According to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA, 2020), relevant articles were included and evaluated in this review. Efficacy and safety data were collected, analyzed and compared through week 52. The first check was done by the end of week 14 and week 16 for upadacitinib and IL-17i respectively. Results: Data from four RCTs evaluating upadacitinib, secukinumab, ixekizumab, and bimekizumab comprising 1425 patients were analyzed. Overall, a comparable efficacy and safety profile were observed across different treatment arms through week 52;however, non-significant variations were encountered in some outcome measures. The primary endpoint among these RCTs (ASAS40 response rate) was met and it was higher in patients treated with bimekizumab 160 mg sc Q 4 weeks in TNFi non responders (48%) and lowest in ixekizumab 80 mg sc Q 4 weeks treated patients, (35%) (p Conclusion: The above-mentioned three IL-17i and the only one JAKi demonstrated comparable safety and efficacy profiles with some minor variations. A head-to-head trial comparing the effectiveness and safety characteristics of JAKi vs IL-17i may be needed in patients with active nr-ax SpA.展开更多
Dengue fever presents a significant and persistent public health challenge in Sri Lanka.The disease,transmitted by Aedes aegypti and Aedes albopictus mosquitoes,affects individuals across all age groups,with working p...Dengue fever presents a significant and persistent public health challenge in Sri Lanka.The disease,transmitted by Aedes aegypti and Aedes albopictus mosquitoes,affects individuals across all age groups,with working populations and school-aged children at higher risk due to increased outdoor exposure[1].Dengue transmission in Sri Lanka is seasonal with two high transmission waves corresponding with the two monsoon rains every year.The estimated average annual incidence is 175/100000 population,and it was 407.5/100000 in 2023 with a case fatality rate of 0.07%[2].展开更多
The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and...The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and surgeons.The modern robotic curriculum therefore needs to train surgeons of varying experience,gaining access to several robot types,and based in centres around the world.Drawing on this analogy with aviation helps to derive principles for curriculum design,and considers humanemachine interface,non-technical skills,team training,and simulation.The components of the curriculum could be core(cross-platform),platform-specific,specialty-specific,and platform-transitional.Analogous concepts also emerge,including type rating,control as surgery-by-wire,spatio-haptic envelope,and virtual operations.The fourth industrial revolution sets anticipation for progress.展开更多
BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to t...BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to those with native hepatic artery inflow.AIM To investigate the published evidence on the outcomes according to different inflow site for AHCs.METHODS A systematic search was conducted for studies reporting on AHCs in liver transplantation over the last 10 years(January 2014 onwards).Two independent reviewers selected articles,assessed quality,and evaluated bias in the included systematic reviews.The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.The protocol was registered with PROSPERO(CRD42024545810).Review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis statement standards.RESULTS Fourteen studies identified a total of 32486 deceased donor liver transplants,of which 1136(3.5%)required AHCs.The most frequent indications for AHC use included poor arterial flow,intimal dissections,and hepatic artery thrombosis.Among all AHCs,207(18.2%)were supra-coeliac(SC)AHCs,738(65.0%)infrarenal(IR)AHCs,25(2.2%)iliac artery conduits,and 166(14.6%)had unspecified origins.Pooled analysis revealed comparable demographic characteristics.The median follow-up duration ranged from 18 to 52 months.There were no significant differences in early occlusions of AHCs[odds ratio(OR)=0.94(0.48,1.84);P=0.86],late occlusions of AHCs[OR=0.46(0.16,1.32);P=0.15],early allograft dysfunction[OR=0.82(0.46,1.47);P=0.51],biliary complications[OR=1.10(0.69,1.76);P=0.68],post-transplant renal replacement therapy(RRT)requirement[OR=1.12(0.72,1.72);P=0.62],and major surgical complications(Clavien-Dindo>3b)[OR=1.06(0.70,1.61);P=0.79].The median duration for graft occlusion was approximately 142 days,ranging from 13 to 3313 days.One-year graft and patient survival rates for SC conduits were 77%to 81.1%and 80%to 85.1%,respectively.For IR conduits,one-year graft and patient survival rates were 66%to 79.1%and 73%to 88.3%,respectively.Five-year graft and patient survival rates for SC conduits were 53.9%to 67%and 67.8%to 74%,respectively.For IR conduits,five-year graft and patient survival rates were 50%to 56%and 56%to 64.9%,respectively.CONCLUSION Considering these findings,there is no significant difference in early and late outcomes between SC and IR AHCs,although there is a discernible tendency towards higher late occlusion rates in the IR group.展开更多
BACKGROUNDLiving donor kidney transplantation (LDKT) is considered the gold standard fortreating end-stage kidney disease. Previous studies have highlighted the impact ofdonor and recipient demographics in influencing...BACKGROUNDLiving donor kidney transplantation (LDKT) is considered the gold standard fortreating end-stage kidney disease. Previous studies have highlighted the impact ofdonor and recipient demographics in influencing post-transplant outcomes. Webelieve that patient and graft outcomes in a tertiary university hospital setting willhave no difference between pairs of standard criteria vs pairs of extended criteria(EC) donors and recipients in LDKT.AIMTo investigate the outcomes of allocating EC donation (ECD) kidneys to ECrecipients (ECR) in LDKT and compare them to standard and mixed standard andEC pair counterparts.METHODSWe collected data from adult LDKTs conducted between April 2017 and April2022. Donor-recipient pairs were grouped based on criteria as follows: (1) Group1: Standard criteria donor (SCD) to standard criteria recipient (SCR);(2) Group 2:SCD to ECR;(3) Group 3: ECD to SCR;and (4) Group 4: ECD to ECR.RESULTSA total of 149 living donor transplants were analysed over a 5-year period. Graftsurvival, patient survival, and graft function were similar across all four groups.The incidence of common postoperative complications was as follows: (1) Perioperative bleeding (5.6%);(2) Surgical site infection (6.8%);and (3) Incisional hernia (7.4%). No statistically significantdifferences were found in patient or graft outcomes amongst the four groups. Multivariate analysis showed thatgroup 4 recipients might experience inferior 5-year graft function (β = -11.8, P = 0.037) when compared with group1.CONCLUSIONIn LDKT, long-term patient and graft outcomes are comparable amongst different combinations of standard vs ECdonors and recipients. These findings show the primary potential of living donor ECD to ECR kidney transplantationwith satisfying outcomes.展开更多
Hepatocellular carcinoma(HCC)remains one of the commonest cancers world-wide with an overall poor prognosis and survival rates.The rising incidence of liver disease,in particular non-alcoholic fatty liver disease,will...Hepatocellular carcinoma(HCC)remains one of the commonest cancers world-wide with an overall poor prognosis and survival rates.The rising incidence of liver disease,in particular non-alcoholic fatty liver disease,will account for a continued increase in the rates of liver cancer.The recurrence of HCC has been reported across the different etiologies of liver disease.Unlike primary HCC,there is no agreed consensus or guidance as to the optimum management of re-current HCC(RHCC).Furthermore,the management of RHCC may prove more challenging compared to primary liver cancer,given the smaller residual liver volume and functions in settings following surgery or transplantation.Various modalities exist for the treatment of primary HCC including resection,liver transplantation,loco-regional and systemic therapies.Nevertheless,the role of such modalities remains unclear in the management of RHCC.In this article,we aim to review the different approaches of the current standards for the mana-gement of RHCC.We will also shed some light on the future perspectives in this field.展开更多
基金Supported by grant(NEI001)from the management of Nelson Biomedical Limited UK
文摘The National Health Service(NHS)is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom.There are several challenges militating against the effective laboratory service delivery in the NHS in England.Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients.They provide the"engine room"of modern medicine with 70%of diagnosis based on the laboratory results generated by them.This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England.Laboratory service delivery in the NHS in England faces numerous daunting challenges;staffing levels in the last few years have become dangerously low,less remunerated,relatively less experienced and predominantly band 5's,multidisciplinary rather than specialty based,associated with working more unsocial hours without adequate recovery time,de-banding of staff,high staff turnaround,profit and cost driven rather than quality.These factors has resulted in burn out,low morale,high sickness absences,increased error rate,poor team spirit,diminished productivity and suboptimal laboratory service delivery.There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix,ensuring adequate remuneralion of laboratory staff,implementing evidenced-based specialty oriented service,determining the root cause/s for the high staff turnover and implementing corrective action,identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.
文摘The release of the Mid Staffordshire hospital report otherwise called the Francis report once again ignited the debate about the issue of abuse of especially vulnerable patients, while navigating the care pathway as inpatients in hospitals;within the National health service (NHS), England. Once more the official reaction from the NHS directorate is more “standards” to monitor failed standards in patient care. Of interest in the official responses so far, are the unheard voices addressing the issue of healthcare and organizational ethics concerns that need revisiting. This article seeks to revisit practice, systems and care issues leading to incidents of the type of the Staffordshire abuses, and the important but yet unheralded place of organizational and care ethics in helping to curb such abuses from re-occurring.
文摘Objective: To test the feasibility of a fully paperless system, termed “paperlite” in a UK breast screening service. To demonstrate in NHS practice, how workload and workflow could be improved by moving to a paperless system and discovering what impact this has upon the complexity within the service. Setting: Warwickshire, Solihull and Coventry Breast Screening Service in the West Midlands of England. Methods: Quality improvement methodologies were employed, including value stream mapping, task analysis and a time-and-motion study. Results: The screening centred screened approximately 50,000 women per year. If they were to implement a paperless system, the administrative workload would decrease. The time saving per batch of screens, which could be achieved by moving to the paperless system ranged from 19 to 56 minutes (mean = 36 minutes). When calculated by batch the mean time saving per woman screened by moving to the paperless system was 42 seconds. This equates to 583 hours of administrative work per year in a centre screening 50,000 women. Conclusions: The paperless system has many benefits compared to the original system in terms of reductions in waste, time and cost. The simplification and standardisation of the process resulted in fewer tasks and interfaces where errors could occur, hence inadvertently improving patient safety. The limitation of the work is the heavy reliance on technology, live interfacing with computer databases and software stability is necessary for a paperless system to be used in NHS practice.
文摘Type 2 diabetes mellitus(T2DM)significantly elevates the risk of colorectal cancer(CRC)and complicates its treatment by promoting chemoresistance.Poor glycemic control has been linked to exacerbated CRC progression and diminished chemotherapy efficacy,impacting patient outcomes through various mechanisms such as oxidative stress,activation of metabolic pathways,and altered protein modifications that hinder apoptosis and enhance tumor survival.Clinical evidence shows that T2DM patients experience higher rates of chemoresistance and reduced disease-free survival and overall survival compared to non-diabetic patients.Specifically,those with poor glycemic control exhibit increased chemo-resistance and poorer survival metrics.Antidiabetic treatments,including metformin,acarbose,and gliclazide,show promise in improving chemotherapy response and glycemic management,potentially enhancing patient outcomes.Addressing this challenge requires a comprehensive,multidisciplinary approach involving oncologists,endocrino-logists,and surgeons to optimize patient care.Integrated strategies that prioritize glycemic control are essential for reducing chemoresistance and improving survival in CRC patients with T2DM.
文摘Fluctuating voltage levels in power grids necessitate automatic voltage regulators(AVRs)to ensure stability.This study examined the modeling and control of AVR in hydroelectric power plants using model predictive control(MPC),which utilizes an extensive mathe-matical model of the voltage regulation system to optimize the control actions over a defined prediction horizon.This predictive feature enables MPC to minimize voltage deviations while accounting for operational constraints,thereby improving stability and performance under dynamic conditions.Thefindings were compared with those derived from an optimal proportional integral derivative(PID)con-troller designed using the artificial bee colony(ABC)algorithm.Although the ABC-PID method adjusts the PID parameters based on historical data,it may be difficult to adapt to real-time changes in system dynamics under constraints.Comprehensive simulations assessed both frameworks,emphasizing performance metrics such as disturbance rejection,response to load changes,and resilience to uncertainties.The results show that both MPC and ABC-PID methods effectively achieved accurate voltage regulation;however,MPC excelled in controlling overshoot and settling time—recording 0.0%and 0.25 s,respectively.This demonstrates greater robustness compared to conventional control methods that optimize PID parameters based on performance criteria derived from actual system behavior,which exhibited settling times and overshoots exceeding 0.41 s and 5.0%,respectively.The controllers were implemented using MATLAB/Simulink software,indicating a significant advancement for power plant engineers pursuing state-of-the-art automatic voltage regulations.
文摘Monogenic diabetes is a heterogeneous disorder characterized by hyperglycemia arising from defects in a single gene.Maturity-onset diabetes of the young(MODY)is the most common type with 14 subtypes,each linked to specific mutations affecting insulin synthesis,secretion and glucose regulation.Common traits across MODY subtypes include early-onset diabetes,a family history of autosomal dominant diabetes,lack of features of insulin resistance,and absent islet cell autoimmunity.Many cases are misdiagnosed as type 1 and type 2 diabetes mellitus.Biomarkers and scoring systems can help identify candidates for genetic testing.GCK-MODY,a common subtype,manifests as mild hyperglycemia and doesn’t require treatment except during pregnancy.In contrast,mutations in HNF4A,HNF1A,and HNF1B genes lead to progressive beta-cell failure and similar risks of complications as type 2 diabetes mellitus.Neonatal diabetes mellitus(NDM)is a rare form of monogenic diabetes that usually presents within the first six months.Half of the cases are lifelong,while others experience transient remission.Permanent NDM is most commonly due to activating mutations in genes encoding the adenosine triphosphate-sensitive potassium channel(KCNJ11 or ABCC8)and can be transitioned to sulfonylurea after confirmation of diagnosis.Thus,in many cases,monogenic diabetes offers an opportunity to provide precision treatment.The scope has broadened with next-generation sequencing(NGS)technologies,replacing older methods like Sanger sequencing.NGS can be for targeted gene panels,whole-exome sequencing(WES),or whole-genome sequencing.Targeted gene panels offer specific information efficiently,while WES provides comprehensive data but comes with bioinformatic challenges.The surge in testing has also led to an increase in variants of unknown significance(VUS).Deciding whether VUS is disease-causing or benign can be challenging.Computational models,functional studies,and clinical knowledge help to determine pathogenicity.Advances in genetic testing technologies offer hope for improved diagnosis and personalized treatment but also raise concerns about interpretation and ethics.
文摘Dry eye disease(DED)is a multifactorial disorder that disturbs ocular surface equilibrium,considerably diminishing quality of life.Present therapies only offer symptomatic alleviation.Stem cell treatment,especially mesenchymal stem cells(MSCs),has surfaced as a viable approach for tissue regeneration and immunological regulation in DED.Preclinical and early clinical investigations indicate that MSCs can improve lacrimal gland functionality,diminish inflammation,and facilitate corneal regeneration.Nonetheless,obstacles persist in enhancing MSC viability,determining the optimal MSC source,and guaranteeing sustained therapeutic effectiveness.Additional extensive randomized clinical trials are required to confirm the efficacy of MSC-based therapies for severe DED.
文摘Use of immunomodulating agents to prevent the progression of autoimmuneβ-cell damage leading to type 1 diabetes mellitus(T1DM)is an interesting area for research.These include non-specific anti-inflammatory agents,immunologic vaccination and anti-inflammatory agents targeting specific immune cells or cytokines.Teplizumab is an anti-CD3-molecule that binds to and leads to the disappearance of the CD3/TCR complex and rendering the T cell anergic to its target antigen.Preclinical and clinical trials have demonstrated its efficacy in reducing the decline in serum C-peptide levels and the need for insulin therapy if used early in the disease process of T1DM.The benefits have been apparent as early as six months to as long as seven years after therapy.It has recently been approved by the Food and Drug Administration to delay the onset of clinical(stage 3)type 1 diabetes in children above 8 years of age.In their recent metaanalysis published in the World Journal of Diabetes,Ma et al found that those in the teplizumab treatment group have a greater likelihood of reduction in insulin use,change in C-peptide response,and better glycemic control compared to the control group with a good safety profile.However,all the included randomized control trials have been conducted in high-income countries.High cost of therapy and unknown utility of the molecule in stage 3 disease limit its widespread use.
文摘The BRASH syndrome,an acronym for bradycardia,renal failure,atrioventricular(AV)nodal blockade,shock,and hyperkalemia,was first described as a distinct clinical entity in 2016 by Josh Farkas.[1]He proposed a vicious pathophysiological cycle driven by the synergy between AV nodal blockade and hyperkalemia.
文摘Although national transplant organizations share common visions and goals,the creation of a unified global organization remains impractical.Differences in ethnicity,culture,religion,and education shape local practices and infrastructure,making the establishment of a single global entity unfeasible.Even with these social disparities aside,logistical factors such as time and distance between organ procurement and transplantation sites pose significant challenges.While technological advancements have extended organ preservation times,they have yet to support the demands of transcontinental transplantations effectively.This review presents a comparative analysis of the structures,operational frameworks,policies,and legislation governing various transplant organizations around the world.Key differences pertain to the administration of these organizations,trends in organ donation,and organ allocation policies,which reflect the financial,cultural,and religious diversity across different regions.While a global transplant organization may be out of reach,agreeing on best practices for the benefit of patients is essential.
文摘Introduction In all branches of healthcare,clinicians are seen to be making professional judgements based on objective facts and assessments.However,in our daily lives,we recognise and celebrate individual differences in interests,beliefs and personalities.
文摘Muscle deconditioning due to hospitalisation is problematic, causing delayed discharges, more nursing, carer, or social service support following discharge, and possible discharge to a care home rather than the patient’s own home. Muscle deconditioning is associated with increased mortality, infections, depression, and reductions in patient mobility and ability to engage in their activities of daily living. Preserving muscle strength and function should form part of patients’ rehabilitation plans. Progressive resistance training (PRE) offers the most cost-effective way of preserving muscle strength and function;however, it is not routinely carried out in hospitals. A leg strengthening device (the S-Press) has been developed with the aim of improving access to effective PRE for adults. Using a qualitative approach, thematic analysis of interviews with physiotherapists, patients, and relative carers about their experience of using the S-Press provided insight into integrating PRE into patients’ rehabilitation, what promoted or prevented its use, and the outcomes associated with its use. Four overall themes emerged from the data. “Experience of Users” described that the S-Press was accessible, convenient, time efficient, portable, and manoeuvrable, and it provided an objective measure of progress. “Facilitators” included findings around how the S-Press was easy to use, motivational, and comfortable when in use. “Barriers” comprised the inability of some patients to use the S-Press independently and the identification of obstacles that prevented consistent use. “Impact and Benefits” represented the perceptions of increased leg strength and psychological benefits. The S-Press is beneficial for patients’ rehabilitation by offering PRE that is simple and easy to use, acceptable to both patients and professionals, and can be integrated as part of patients’ rehabilitation plans.
文摘The World Health Organization declared Sri Lanka a malaria eliminated country in 2016[1-3].At present,the country is in the phase of preventing the re-establishment of malaria[4].However,travelers who contract the disease overseas in malaria endemic countries continue to present a constant risk of re-establishing malaria in Sri Lanka,where malaria-transmitting mosquitos is prevalent.In this context,robust measures are being implemented in the country to prevent re-establishment of malaria and to stop travelers infected with malaria progressing into severe disease and death.
文摘Background: Non-radiographic axial spondyloarthritis is a progressive and disabling inflammatory disease affecting young adults, with limited treatment options. TNFi are more efficacious than JAKi and IL1-7i in nr-ax SPA and it has a well-known safety profile over a longer duration. Recently, many IL-17i and JAKi were approved for the treatment of nr-ax SPA;however, data comparing IL1-7i and JAKi in terms of efficacy and safety is lacking. This systematized review aimed to compare the existing efficacy and safety data of JAKi vs IL-17i in the treatment of patients with nr-ax SPA. Methods: A systematic literature search was performed using relevant keywords in many databases. According to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA, 2020), relevant articles were included and evaluated in this review. Efficacy and safety data were collected, analyzed and compared through week 52. The first check was done by the end of week 14 and week 16 for upadacitinib and IL-17i respectively. Results: Data from four RCTs evaluating upadacitinib, secukinumab, ixekizumab, and bimekizumab comprising 1425 patients were analyzed. Overall, a comparable efficacy and safety profile were observed across different treatment arms through week 52;however, non-significant variations were encountered in some outcome measures. The primary endpoint among these RCTs (ASAS40 response rate) was met and it was higher in patients treated with bimekizumab 160 mg sc Q 4 weeks in TNFi non responders (48%) and lowest in ixekizumab 80 mg sc Q 4 weeks treated patients, (35%) (p Conclusion: The above-mentioned three IL-17i and the only one JAKi demonstrated comparable safety and efficacy profiles with some minor variations. A head-to-head trial comparing the effectiveness and safety characteristics of JAKi vs IL-17i may be needed in patients with active nr-ax SpA.
文摘Dengue fever presents a significant and persistent public health challenge in Sri Lanka.The disease,transmitted by Aedes aegypti and Aedes albopictus mosquitoes,affects individuals across all age groups,with working populations and school-aged children at higher risk due to increased outdoor exposure[1].Dengue transmission in Sri Lanka is seasonal with two high transmission waves corresponding with the two monsoon rains every year.The estimated average annual incidence is 175/100000 population,and it was 407.5/100000 in 2023 with a case fatality rate of 0.07%[2].
文摘The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and surgeons.The modern robotic curriculum therefore needs to train surgeons of varying experience,gaining access to several robot types,and based in centres around the world.Drawing on this analogy with aviation helps to derive principles for curriculum design,and considers humanemachine interface,non-technical skills,team training,and simulation.The components of the curriculum could be core(cross-platform),platform-specific,specialty-specific,and platform-transitional.Analogous concepts also emerge,including type rating,control as surgery-by-wire,spatio-haptic envelope,and virtual operations.The fourth industrial revolution sets anticipation for progress.
文摘BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to those with native hepatic artery inflow.AIM To investigate the published evidence on the outcomes according to different inflow site for AHCs.METHODS A systematic search was conducted for studies reporting on AHCs in liver transplantation over the last 10 years(January 2014 onwards).Two independent reviewers selected articles,assessed quality,and evaluated bias in the included systematic reviews.The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.The protocol was registered with PROSPERO(CRD42024545810).Review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis statement standards.RESULTS Fourteen studies identified a total of 32486 deceased donor liver transplants,of which 1136(3.5%)required AHCs.The most frequent indications for AHC use included poor arterial flow,intimal dissections,and hepatic artery thrombosis.Among all AHCs,207(18.2%)were supra-coeliac(SC)AHCs,738(65.0%)infrarenal(IR)AHCs,25(2.2%)iliac artery conduits,and 166(14.6%)had unspecified origins.Pooled analysis revealed comparable demographic characteristics.The median follow-up duration ranged from 18 to 52 months.There were no significant differences in early occlusions of AHCs[odds ratio(OR)=0.94(0.48,1.84);P=0.86],late occlusions of AHCs[OR=0.46(0.16,1.32);P=0.15],early allograft dysfunction[OR=0.82(0.46,1.47);P=0.51],biliary complications[OR=1.10(0.69,1.76);P=0.68],post-transplant renal replacement therapy(RRT)requirement[OR=1.12(0.72,1.72);P=0.62],and major surgical complications(Clavien-Dindo>3b)[OR=1.06(0.70,1.61);P=0.79].The median duration for graft occlusion was approximately 142 days,ranging from 13 to 3313 days.One-year graft and patient survival rates for SC conduits were 77%to 81.1%and 80%to 85.1%,respectively.For IR conduits,one-year graft and patient survival rates were 66%to 79.1%and 73%to 88.3%,respectively.Five-year graft and patient survival rates for SC conduits were 53.9%to 67%and 67.8%to 74%,respectively.For IR conduits,five-year graft and patient survival rates were 50%to 56%and 56%to 64.9%,respectively.CONCLUSION Considering these findings,there is no significant difference in early and late outcomes between SC and IR AHCs,although there is a discernible tendency towards higher late occlusion rates in the IR group.
文摘BACKGROUNDLiving donor kidney transplantation (LDKT) is considered the gold standard fortreating end-stage kidney disease. Previous studies have highlighted the impact ofdonor and recipient demographics in influencing post-transplant outcomes. Webelieve that patient and graft outcomes in a tertiary university hospital setting willhave no difference between pairs of standard criteria vs pairs of extended criteria(EC) donors and recipients in LDKT.AIMTo investigate the outcomes of allocating EC donation (ECD) kidneys to ECrecipients (ECR) in LDKT and compare them to standard and mixed standard andEC pair counterparts.METHODSWe collected data from adult LDKTs conducted between April 2017 and April2022. Donor-recipient pairs were grouped based on criteria as follows: (1) Group1: Standard criteria donor (SCD) to standard criteria recipient (SCR);(2) Group 2:SCD to ECR;(3) Group 3: ECD to SCR;and (4) Group 4: ECD to ECR.RESULTSA total of 149 living donor transplants were analysed over a 5-year period. Graftsurvival, patient survival, and graft function were similar across all four groups.The incidence of common postoperative complications was as follows: (1) Perioperative bleeding (5.6%);(2) Surgical site infection (6.8%);and (3) Incisional hernia (7.4%). No statistically significantdifferences were found in patient or graft outcomes amongst the four groups. Multivariate analysis showed thatgroup 4 recipients might experience inferior 5-year graft function (β = -11.8, P = 0.037) when compared with group1.CONCLUSIONIn LDKT, long-term patient and graft outcomes are comparable amongst different combinations of standard vs ECdonors and recipients. These findings show the primary potential of living donor ECD to ECR kidney transplantationwith satisfying outcomes.
文摘Hepatocellular carcinoma(HCC)remains one of the commonest cancers world-wide with an overall poor prognosis and survival rates.The rising incidence of liver disease,in particular non-alcoholic fatty liver disease,will account for a continued increase in the rates of liver cancer.The recurrence of HCC has been reported across the different etiologies of liver disease.Unlike primary HCC,there is no agreed consensus or guidance as to the optimum management of re-current HCC(RHCC).Furthermore,the management of RHCC may prove more challenging compared to primary liver cancer,given the smaller residual liver volume and functions in settings following surgery or transplantation.Various modalities exist for the treatment of primary HCC including resection,liver transplantation,loco-regional and systemic therapies.Nevertheless,the role of such modalities remains unclear in the management of RHCC.In this article,we aim to review the different approaches of the current standards for the mana-gement of RHCC.We will also shed some light on the future perspectives in this field.
