DISCUSSION: The absence of specific regulations, shortage of healthcare resources, budget constraints, competing health priorities, lack of patient data, and insufficient research incentives discourage orphan drug development and global clinical trial inclusion, resulting in treatment inaccessibility and high costs. The Indian Government introduced the National Policy for Treatment of Rare Diseases (NPRD) to address these challenges. Several initiatives have been introduced to attract stakeholders with government-funded research, grants, incentives, and accelerated regulatory approvals of novel therapies that can ensure timely prevention and treatment of rare diseases. The National RD Registry by the Indian Council of Medical Research (ICMR) aims to provide prevalence data. Innovative approaches are required to improve rare disease management and promote orphan drug research. This will ensure the accessibility and affordability of life-saving therapeutics for India's rare disease patients.
CONCLUSION: An integrated RD management and orphan drug research framework focusing on robust data management, patient-oriented policies to improve the treatment landscape, flexible regulations, strengthening rare disease registry with clinical and diagnostic data, and a favorable research ecosystem to promote indigenous research catering to the Indian population, will improve the treatment landscape and orphan drug research and development in India. This will ensure timely availability of therapeutics at affordable prices.
METHOD: The study utilized data from the National Health and Morbidity Survey (NHMS) 2020, a nationwide cross-sectional survey employing a two-stage stratified random sampling technique to ensure national representativeness. HIV knowledge was assessed using the UNGASS indicators questionnaire, which comprises five questions on HIV prevention and transmission. The data were collected using the computer assisted telephone interviewing (CATI) method. Respondents who did not correctly answer all five questions were considered to have inadequate knowledge about HIV. Descriptive analysis and complex sample logistic regression were performed using SPSS version 28.0.
RESULTS: The survey identified 5,561 eligible respondents, leading to the participation of 3,187 individuals in the second phase of the study, which resulted in a response rate of 57.3%. Our study revealed an overall prevalence of inadequate HIV knowledge at 77.4%, with adolescents aged 13-19 exhibiting the highest prevalence at 86.1%. Multiple logistic regression analysis indicated that respondents with no formal education (aOR 4.34, 95% CI: 0.65, 29.08) were over four times more likely to lack HIV knowledge. Additionally, respondents with only secondary education had an increased risk of 1.79 times. Individuals residing in rural areas were significantly more likely to have inadequate HIV-related knowledge. Furthermore, respondents who worked as unpaid workers, homemakers, or caregivers (aOR 1.71, 95% CI: 1.05, 2.82) showed a higher likelihood of lacking HIV knowledge.
CONCLUSION: Three out of four individuals in the general Malaysian population were found to lack sufficient knowledge about HIV. This underscores the need for targeted interventions in HIV education, particularly in rural areas and among populations with lower educational attainment. Additionally, digital platforms and youth-focused campaigns could be especially effective for reaching adolescents. Policymakers must prioritize inclusive, accessible HIV prevention strategies to address these gaps and reduce transmission rates.
METHODS: Using the Qualtrics XM and WJX platforms, questionnaires were sent online to MAFLD-ICD-11 coding collaborators, authors of papers, and relevant association members.
RESULTS: A total of 890 international experts in various fields from 61 countries responded to the survey. We also achieved full coverage of provincial-level administrative regions in China. 77.1% of respondents agreed that MAFLD should be represented in ICD-11 by updating NAFLD, with no significant regional differences (77.3% in Asia and 76.6% in non-Asia, p = 0.819). Over 80% of respondents agreed or somewhat agreed with the need to assign specific codes for progressive stages of MAFLD (i.e. steatohepatitis) (92.2%), MAFLD combined with comorbidities (84.1%), or MAFLD subtypes (i.e., lean, overweight/obese, and diabetic) (86.1%).
CONCLUSIONS: This global survey by a collaborative panel of clinical, coding, health management and policy experts, indicates agreement that MAFLD should be coded in ICD-11. The data serves as a foundation for corresponding adjustments in the ICD-11 revision.
METHODS: This study is a single-center, single-blinded, prospective randomized clinical study. One hundred twenty patients were randomized into two groups (remifentanil vs dexmedetomidine). Demographic characteristics and clinical outcomes, including level of sedation, vital signs, and patient satisfaction were monitored and recorded.
RESULTS: Group R showed a higher mean observer's assessment of alertness/sedation score (3.9 ± 0.7 vs 3.6 ± 0.8; p = 0.008), mean arterial pressure (92.0 ± 12.0 vs 83.0 ± 13.0 mmHg; p
OBJECTIVE: Although unmet psychosocial needs in young women with breast cancer can negatively impact their quality of life, these needs have not been systematically reviewed. The primary objective of this scoping review was to identify the categories of unmet psychosocial needs among young women with breast cancer. The secondary objective was to examine the relationship between these unmet psychosocial needs and their quality of life.
METHODS: Five electronic databases (MEDLINE from the National Library of Medicine, Cumulative Index of Nursing and Allied Health Literature (CINAHL), SCOPUS, Web of Science WOS, and Google Scholar), as well as reference lists of relevant literature were systematically searched to identify the relevant literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews.
RESULTS: From an initial yield of 2505 articles, 30 articles were included and analyzed. The results identified 13 main domains of unmet psychosocial needs among young women with breast cancer: information needs, psychological needs, physical/symptoms needs, fear of recurrence and spreading, identity-related needs, social needs, sexual needs, social support, financial support, practical needs, spiritual needs, communication-related issues with health care providers, and coping needs. Data were extracted and summarized in a narrative synthesis.
CONCLUSION: Ongoing assessment of informational needs and a clear understanding of the relationship between unmet psychosocial needs and quality of life are essential for healthcare providers to develop robust support systems for young women with breast cancer.
METHODS: This is a randomized clinical trial in a single tertiary centre involving patients with gestational diabetes mellitus (GDM) diagnosed based on NICE guideline on diet modification. The patients are randomized in 1:1 ratio to 4 or 7 points self-monitoring blood glucose. The monitoring was required to be done monthly with ultrasound for fetal growth. Blood was taken at recruitment for measurement of serum HbA1c and fructosamine.
RESULTS: A total of 200 patients were recruited. There were significantly more Malay patients in the 7 points group (88.9% vs 78.2%, p = 0.033). Multiparous patients were significantly more in the 4 points group (82.2% vs 68.7%, p = 0.033). Both groups were similar in clinical characteristics. There was no statistical difference in the neonatal outcome particularly fetal macrosomia and admission to neonatal intensive care unit.
CONCLUSIONS: In patients with GDM on diet modification, self-blood glucose monitoring using either 4 or 7 points resulted in similar maternal and perinatal outcomes. The research was registered under ClinicalTrials.gov (NCT04101396) on 17/9/2019 ( https://register.
CLINICALTRIALS: gov/prs/app/action/SelectProtocol?sid=S00098EN&selectaction=Edit&uid=U0004RD4&ts=2&cx=-qlk1w2 ).
METHODS: The proportion of LMTs was investigated through a cross-sectional study involving all Thai travelers who visited the Thai Travel Clinic before their departure abroad. A prospective study was conducted by enrolling the travelers after the consultation, utilizing two online questionnaires. The first aimed to gather demographic data and categorize participants as either LMTs (if their departure date was ≤14 days) or non-LMTs, while the second assessed travel-related illnesses either upon their return or at the one-month point if their trip exceeded a month.
RESULTS: A quarter (25.5 %) of 310 Thai travelers abroad were classified as LMTs. Both LMTs and non-LMTs showed similar gender distributions with mean ages of 35.8 and 35.7 years old, respectively, but LMTs were more likely to travel for tourism, travel in groups, visit countries within Asia and plan shorter stays abroad. Follow-up studies were conducted from July 2023 to February 2024. 452 departed respondents consisted of 150 LMTs and 302 non-LMTs. Although overall health problems were insignificantly higher in LMTs (32.0 % vs 22.0 %, AOR = 1.469, p = 0.107), gastrointestinal and neurological symptoms (primarily headache and dizziness) were significantly more common among LMTs.
CONCLUSIONS: LMTs represent a significant portion of Thai travelers, posing challenges for travel health specialists in Thailand. Intervention and education efforts may be necessary to address this issue.
DESIGN: A retrospective single-centre study.
METHODS: Data on rapid response team activations from 1 January 2018 to 31 December 2022 were retrieved from electronic medical records at a tertiary hospital in Hangzhou, China. All patients who met the eligibility criteria were included. Multivariable Cox regression analysis was conducted to analyse the data.
RESULTS: Out of 636 patients included, 18.4% (117) experienced a delay, with a median (interquartile range) of 8.5 (12) days from admission to rapid response team activation. Six significant prognostic factors were found to be associated with the higher hazard ratio of rapid response team delay, including call time (05:01 PM and 7:59 AM), emergency admission, a higher Modified Early Warning Score, an admission diagnosis of infection, a comorbidity of respiratory failure/Acute Respiratory Distress Syndrome and the absence of lung infection.
CONCLUSION: The prevalence of rapid response team delays was lower, and the days from admission to rapid response team delay was longer than in previous studies. Healthcare providers are suggested to prioritise the care of high-risk patient groups and provide proactive monitoring to ensure timely identification and management.
IMPLICATIONS FOR PATIENT CARE: Implementing artificial intelligence in continuous monitoring systems for high-risk patients is recommended. The findings help nurses anticipate potential delays in rapid response team activation, enabling better preparedness.
IMPACT: The study highlights the prevalence of rapid response team delays, timing from admission to rapid response team activation and six prognostic factors influencing delays. It could shape patient care and inform future research. Hospital administrators should review staffing, especially during night shifts, to minimise delays. Further qualitative research is needed to explore why nurses may delay rapid response team activation.
REPORTING METHOD: The STROBE checklist was adhered to when reporting this study. 'No patient or public contribution'.