Exploring librarians' practices when teaching advanced searching for knowledge synthesis: results from an online survey.

Objective: There is little research available regarding the instructional practices of librarians who support students completing knowledge synthesis projects. This study addresses this research gap by identifying the topics taught, approaches, and resources that academic health sciences librarians employ when teaching students how to conduct comprehensive searches for knowledge synthesis projects in group settings. Methods: This study applies an exploratory-descriptive design using online survey data collection. The final survey instrument included 31 open, closed, and frequency-style questions. Results: The survey received responses from 114 participants, 74 of whom met the target population. Some key results include shared motivations to teach in groups, including student learning and curriculum requirements, as well as popular types of instruction such as single session seminars, and teaching techniques, such as lectures and live demos. Conclusion: This research demonstrates the scope and coverage of librarian-led training in the knowledge synthesis research landscape. Although searching related topics such as Boolean logic were the most frequent, librarians report teaching throughout the review process like methods and reporting. Live demos and lectures were the most reported approaches to teaching, whereas gamification or student-driven learning were used rarely. Our results suggest that librarian's application of formal pedagogical approaches while teaching knowledge synthesis may be under-utilized, as most respondents did not report using any formal instructional framework.

The NICE search filters for treating and managing COVID-19: validation in MEDLINE and Embase (Ovid).

Objective: In this paper we report how the United Kingdom's National Institute for Health and Care Excellence (NICE) search filters for treating and managing COVID-19 were validated for use in MEDLINE (Ovid) and Embase (Ovid). The objective was to achieve at least 98.9% for recall and 64% for precision. Methods: We did two tests of recall to finalize the draft search filters. We updated the data from an earlier peer-reviewed publication for the first recall test. For the second test, we collated a set of systematic reviews from Epistemonikos COVID-19 L.OVE and extracted their primary studies. We calculated precision by screening all the results retrieved by the draft search filters from a targeted sample covering 2020-23. We developed a gold-standard set to validate the search filter by using all articles available from the "Treatment and Management" subject filter in the Cochrane COVID-19 Study Register. Results: In the first recall test, both filters had 99.5% recall. In the second test, recall was 99.7% and 99.8% in MEDLINE and Embase respectively. Precision was 91.1% in a deduplicated sample of records. In validation, we found the MEDLINE filter had recall of 99.86% of the 14,625 records in the gold-standard set. The Embase filter had 99.88% recall of 19,371 records. Conclusion: We have validated search filters to identify records on treating and managing COVID-19. The filters may require subsequent updates, if new SARS-CoV-2 variants of concern or interest are discussed in future literature.

The Role of Lateral Pelvic Lymph Node Dissection in Middle and Lower Rectal Cancer (Stage II or III): A Literature Review.

Lateral lymph node dissection and its inclusion in the treatment of rectal cancer is a controversial issue, with great differences, especially between Eastern and Western countries. Studies try to highlight the superiority of resection of these lymph nodes compared to simple mesorectal resection in terms of local recurrence of the disease, the overall survival of patients, and additional postoperative complications. In this study, the modern literature was reviewed, with the ultimate goal of clarifying the exact importance of lateral lymph node dissection, in terms of oncological outcome in patients with cancer of the middle and lower rectum, by studying the involvement of this lymph node dispersion in terms of local recurrence and overall survival of patients with rectal cancer. This review was carried out using electronic databases, including PubMed, Embase, and MEDLINE, with studies dating back to the last decade. Of the 31 studies that were eventually included in the final review, there is no statistically clear superiority and real benefit from lymph node resection beyond the lymph nodes of the mid-rectum. European guidelines are set against lateral lymph node dissection, except for lymph nodes that show suspicious features on preoperative imaging. In contrast, in Eastern countries, total mesorectal excision (TME) with extensive simultaneous resection of the lateral pelvic lymph nodes (LPLNs) is the protocol followed. Recent studies focus on the subcategory of patients with non-responsive to adjuvant therapy, lateral lymph nodes, in which the ultimate benefit of extensive lymph node dissection is explored. The decision to join the TME procedure for the removal of the LPLNs is a subject of intense research. There are no data on the criteria for determining these lymph nodes as an increased risk of metastatic outbreaks. Despite the great clinical and research interest worldwide nowadays, the resection of LPLNs remains a controversial issue of debate, with intense disagreements according to geographical area, while the existence of additional studies is necessary to come to final conclusions.

Psychological interventions for children with emotional and behavioral difficulties aged 5-12 years: An evidence review.

In low- and middle-income countries (LMICs), children and families face a multitude of risk factors for mental health and well-being. These risks are even further exacerbated in humanitarian emergencies. However, access to effective mental health services in such settings is severely limited, leading to a large mental health treatment gap. Middle childhood (5-12 years) is a crucial period for human development during which symptoms of emotional distress often emerge, with one in three mental disorders developing prior to age 14. However, there is little evidence of effective psychological interventions for children in this developmental stage, and suitable for implementation within LMICs and humanitarian emergencies. We conducted this evidence review to inform the development of a new intervention package based on existing best practice for this age group, drawing insights from both global and LMIC resources. Our review synthesizes the findings of 52 intervention studies from LMICs and humanitarian settings; 53 existing systematic reviews and meta-analyses covering both LMICs and high-income countries, and 15 technical guidelines. Overall, there is limited high-quality evidence from which to draw recommendations for this age group; however, some promising intervention approaches were identified for children experiencing externalizing and internalizing symptoms, traumatic stress and a combination of difficulties. Several effective interventions utilize cognitive-behavioral techniques for children, in either group or individual format, and incorporate caregiver skills training into treatment, although the findings are mixed. Most evaluated interventions use specialists as delivery agents and are lengthy, which poses challenges for scale-up in settings where financial and human resources are scarce. These findings will inform the development of new psychological interventions for children in this age group with emotional and behavioral difficulties.

Smart, sustainable, and circular port maintenance: A comprehensive framework and multi-stakeholder approach.

Ports and waterways are key in supporting the waterborne supply chains that form the backbone of global trade. Maintaining adequate water depth is vital for accessibility and safe navigation. Port authorities and contractors are the key players in developing maintenance strategies, and they strive for a mutually beneficial compromise. Port authorities aim to optimize port performance while keeping costs and delays at acceptable levels. Contractors aim to optimize the use of equipment and execution strategies to achieve cost-effectiveness and time efficiency. While minimum cost and duration are common and simple decision criteria, there is growing societal pressure to incorporate smart, sustainable, and circular elements. However, these elements are less straightforward to interpret and there is a lack of a comprehensive framework to quantify smart, circular, and sustainable strategies. This lack of clarity presents significant challenges in balancing traditional and emerging objectives in port maintenance. Our study directly addresses this gap by providing a structured approach to decision-making that integrates these critical but complex elements. As a result, trade-offs on these important issues are harder to achieve reducing the contributions of port authorities and contractors. This study addresses this gap by applying the Frame of Reference (FoR) method to extract objectives and indicators for decision-making from both the port authorities' and contractors' perspectives. We fill in the prescribed elements of the basic FoR template through a systematic literature review (SLR), clarifying to what extent consensus exists on these topics. The SLR revealed 128 articles and identified common strategies, research methods, influential journals, and contributing countries. Projecting these findings onto the basic FoR template showed that the protection of marine ecosystems and sediment management has received considerable attention from researchers while mitigating emissions and adopting smart techniques are emerging subjects in the literature that need further investigations. As a result, this study offers theoretical and managerial insights to improve what can be achieved with smart, circular, and sustainable maintenance strategies, while identifying crucial remaining knowledge gaps.

[Constructing an indexing template for ancient acupuncture medical cases based on knowledge element theory].

Ancient acupuncture medical cases not only possess historical literary value but also hold significant clinical importance. To enhance the utilization of ancient acupuncture medical cases and to guide the excavation of acupuncture theory and its clinical application, this study constructs an indexing template for "Ancient Acupuncture Medical Cases" based on the knowledge element theory and the fine-grained indexing requirements of ancient acupuncture texts. This template includes two levels, 7 categories, 28 knowledge element data, 31 semantic types, and 15 semantic relationships. These element data construct the interconnections of knowledge in ancient acupuncture medical cases, serving as a basis for fine-grained indexing of acupuncture medical case literature.

Exploring Egalitarianism: A Conceptual and Methodological Review of Egalitarianism and Impacts on Positive Intergroup Relations.

Considerable research on intergroup relations emphasizes attitudes, motivations, and emotions that lead to the reduction of prejudice. While factors that actively promote positive intergroup interactions have been emerging, a central theoretical framework has not been formally proposed. To address this gap, we engaged a positive psychology lens to explore how researchers have defined key indicators and consider the positive counterparts of traditional prejudice-reduction models to begin building a new framework of egalitarianism. After scanning 16,840 records that emerged in PsycInfo using keywords "egalitarian", "non-prejudice", and "intergroup", we assessed 158 articles for eligibility. Among the relevant articles (N = 54), we analyzed authors' definitions, methods of measurement, types of processes, and outcomes associated with egalitarian values as they related to intergroup behavior. Overall, there was notable variability in how researchers conceptualized and studied egalitarianism. We discuss the five broad categories of egalitarianism (prejudice reduction, universal orientation, concern for others, positive expression, and low social dominance orientation) and how they relate to positive or negative and approach or avoidant outcomes. Through these findings, we urge scholars to utilize a centralized model for studying egalitarianism in intergroup contexts moving forward.

Dengue epidemic in China before 1978.

Dengue, an acute febrile disease transmitted by Aedes mosquitoes, is caused by the dengue virus (DENV), presenting a formidable challenge to global public health. By examining clues from ancient Chinese books and conducting a comprehensive review, this study elucidates the characteristics of potential dengue epidemics in China prior to 1978. This evidence indicates that China may not have experience dengue epidemics before 1840. During 1840-1949, however, it experienced a noticeable dengue occurrence and prevalence in the 1870s, 1920s, and 1940s. Then from 1949 to 1978, only sporadic reports were accounted. The disparity in the frequency of dengue occurrences across three time periods suggests that the persistent characteristic of dengue epidemics in China primarily arises from imported cases resulting from international exchanges, subsequently leading to local outbreaks influenced by global epidemic trend. This research offers a novel perspective on retrospectively examining the historical trajectory of dengue epidemics and provides valuable insights into exploration of DENV epidemic patterns.

Medical Toxicology vs. Emergency Medicine and Internal Medicine - Are We Really Full of Case Reports?

INTRODUCTION: Case reports are perceived as having diminished value relative to other study designs. It has been said that medical toxicology (MT) is based largely upon case report literature and thought to be unique in this regard. We sought to quantify recent MT publication of case reports compared with top periodicals from emergency medicine (EM) and internal medicine (IM) journals. METHODS: A retrospective review examined 5 years of articles in 6 U.S.-based medical journals-MT (Journal of Medical Toxicology, Clinical Toxicology), EM (Annals of Emergency Medicine, Journal of Emergency Medicine), and IM (JAMA Internal Medicine, New England Journal of Medicine) was performed using on-line resources. Every article in each issue was categorized into Case report vs. Research and Analysis articles vs. Excluded. "Case report" was defined as one (or ≤ 5) individual patients, one patient's data, etc. Total articles per issue were reported after removing Excluded items. RESULTS: Between 2018 and 2022, these 6 periodicals published 522 issues; with 2644 case reports; and 8246 total included articles. Comparison of MT case reports vs. EM revealed a significant difference and odds (Odds Ratio = 1.7, (95% CI: [1.49, 2.03], p < 0.001); MT compared with IM was not significantly different (Odds Ratio = 1.1, (95% CI: [0.96, 1.30], p = 0.150). The percent of case reports increased in the IM and EM journals compared with a relative decrease in the MT journals. Cumulative case report precents were consistently greater in EM and IM than in MT. CONCLUSION: In the past 5 years, MT journals published fewer and had a declining trend of case reports compared with leading EM and IM journals. Future research is needed to determine the effect on MT practice resulting from the diminished body of case report literature.

Revolution of Medical Review: The Application of Meta-Analysis and Convolutional Neural Network-Natural Language Processing in Classifying the Literature for Head and Neck Cancer Radiotherapy.

This study explored the application of meta-analysis and convolutional neural network-natural language processing (CNN-NLP) technologies in classifying literature concerning radiotherapy for head and neck cancer. It aims to enhance both the efficiency and accuracy of literature reviews. By integrating statistical analysis with deep learning, this research successfully identified key studies related to the probability of normal tissue complications (NTCP) from a vast corpus of literature. This demonstrates the advantages of these technologies in recognizing professional terminology and extracting relevant information. The findings not only improve the quality of literature reviews but also offer new insights for future research on optimizing medical studies through AI technologies. Despite the challenges related to data quality and model generalization, this work provides clear directions for future research.

This study examines how advanced technologies like meta-analysis and machine learning, specifically through Convolutional Neural Networks and Natural Language Processing (CNN-NLP), can revolutionize the way medical researchers review literature on radiotherapy for head and neck cancer. Typically, reviewing vast amounts of medical studies is time-consuming and complex. This paper showcases a method that combines statistical analysis and AI to streamline the process, enhancing the accuracy and efficiency of identifying crucial research. By applying these technologies, the researchers were able to sift through thousands of articles rapidly, pinpointing the most relevant ones without the extensive manual effort usually required. This approach not only speeds up the review process but also improves the quality of the information extracted, making it easier for medical professionals to keep up with the latest findings and apply them effectively in clinical settings. The findings of this study are promising, demonstrating that integrating AI with traditional review methods can significantly aid in managing the ever-growing body of medical literature, potentially leading to better treatment strategies and outcomes for patients suffering from head and neck cancer. Despite some challenges like data quality and the need for extensive computational resources, the study provides a forward path for using AI to enhance medical research and practice.

A bibliometric review of waste management and innovation: Unveiling trends, knowledge structure and emerging research fronts.

The pressing challenges in waste management have motivated this comprehensive study examining prior research and contemporary trends concerning innovation and waste management. A meticulous investigation of 2264 documents (1968-2024) was conducted using bibliometrix R-tool to analyse Scopus and Web of Science databases, offering a holistic global perspective. Heightened societal concern about waste management, driven by soaring waste production from consumption patterns, requires urgent exploration of effective waste elimination and transformation systems. This study provides a comprehensive summary of the topic, delving deeply into its complexities. Through thorough analysis of global trends, it constitutes a significant stride towards identifying effective solutions, offering valuable contributions to both scientific understanding and practical applications. This research pioneers a comprehensive synthesis of innovation and waste management issues, showcasing originality and substantial contributions. The identified collaborative networks expose a lack of transnational cooperation, potentially hindering waste management innovation. Future research around waste management innovation should focus on synergies among competitors within the same industry and across industries to minimize waste and maximize resource utilization, 4.0 technologies, global waste chain impacts and challenges along with solutions for developing countries.

The use of bibliometrics in nursing science: Topics, data sources and contributions to research and practice.

AIM: To describe the use of bibliometrics in nursing and assess their contribution to research and practice. DESIGN: A content analysis was conducted of topics, data sources and applications of bibliometrics in nursing research articles. METHODS: The study universe included 129 bibliometric articles on nursing retrieved from Scopus. A content analysis was performed to identify the purposes and topics of the articles, the sources employed to collect the data, the time frames covered, the amounts of records surveyed, and the features of the nursing literature analysed in bibliometric papers. RESULTS: Nursing bibliometric research revolves around six key areas: global descriptions of the nursing literature, literature on specific nursing research topics, nursing education, nursing profession, nursing research using a certain framework or method, and nursing literature published in a country or region. Studies rely on three types of sources to retrieve the surveyed literature: bibliographic databases, sets of disciplinary journals and samples of documents. Bibliometrics can be employed to advance nursing research (identification of research gaps, establishment of research agendas, assessment of methodological approaches, etc.) and practice (identification of professional competences, categorisation of professional tasks, recognition of educational improvements, etc.), suggesting new avenues for researchers who aim to conduct further bibliometric research in the field. Further research is needed to assess the coverage of the nursing literature by new bibliographic data sources and to explore unaddressed topics such as gender imbalance in authorship.

"Ping-pong" in the heart: a case report and literature review.

BACKGROUND: Ball thrombus is rare and life-threatening. The correct diagnosis and timely management are key to improving patient prognosis. Here, we present a case report and literature review of ball thrombus. CASE PRESENTATION: A 75-year-old woman presented to our outpatient clinic because of palpitations and chest distress for 8 months. She was diagnosed mitral stenosis, and transthoracic echocardiography (TTE) showed a round mass attached to the left atrial (LA) wall. Before anesthesia induction, TTE found that the mass has dropped from the LA wall, and was spinning in the LA causing intermittent obstruction of the valve. Anesthesia induction was then carried out under TTE monitoring, and transesophageal echocardiograph found another mass in the LA appendage after intubation. She underwent LA mass removal and mitral valve replacement, and was discharged uneventfully. Histopathology confirmed the diagnosis of thrombus. Our literature review identified 19 cases of ball thrombus between 2015 and 2024. The average age was 54.8 (range 3-88) years. Heart failure was present as the initial symptom in 11 cases, and most patients had mitral valve disease or concomitant with atrial fibrillation. 12 cases received surgery, and 7 received medical treatment only. 2 deaths occurred, one due to the obstruction of left ventricular inflow tract and the other due to the worsening of heart failure. CONCLUSION: Ball thrombus is rare in clinical settings. Urgent thrombectomy should be performed as soon as possible, and echocardiography can be used for real-time monitoring during surgery.

SciScribe: Automating & Contextualizing Literature Reviews in Cardiac Surgery.

OBJECTIVES: The task of writing structured content reviews and guidelines has grown stronger and more complex. We propose to go beyond search tools, toward curation tools, by automating time-consuming and repetitive steps of extracting and organizing information. METHODS: SciScribe is built as an extension of IBM's Deep Search platform, which provides document processing and search capabilities. This platform was used to ingest and search full-content publications from PubMed Central (PMC) and official, structured records from the ClinicalTrials and OpenPayments databases. Author names and NCT numbers, mentioned within the publications, were used to link publications to these official records as context. Search strategies involve traditional keyword-based search as well as natural language question and answering via large language models (LLMs). RESULTS: SciScribe is a web-based tool that helps accelerate literature reviews through key features: 1. Accumulate a personal collection from publication sources, such as PMC or other sources; 2. Incorporate contextual information from external databases into the presented papers, promoting a more informed assessment by readers. 3. Semantic question and answering of a document to quickly assess relevance and hierarchical organization. 4. Semantic question answering for each document within a collection, collated into tables. CONCLUSIONS: Emergent language processing techniques open new avenues to accelerate and enhance the literature review process, for which we have demonstrated a use case implementation within cardiac surgery. SciScribe automates and accelerates this process, mitigates errors associated with repetition and fatigue, as well as contextualizes results by linking relevant external data sources, instantaneously.

Patch Augmentation in Arthroscopic Rotator Cuff Surgery-Review of Current Evidence and Newest Trends.

Background: Rotator cuff tears are a common and debilitating condition requiring surgical intervention. Arthroscopic rotator cuff repair is essential for restoring shoulder function and alleviating pain. Tear classification by size and tendon retraction, along with the grade for fatty infiltration, influence postoperative outcomes, with large tears and higher fatty infiltration grades linked to higher retear rates. Managing complex tears is challenging, with failure rates ranging from 20 to 94%. Patch augmentation has emerged as a promising strategy, using biological or synthetic materials to reinforce tendon repairs, enhancing structural integrity and reducing retear risk. Methods: A review of the recent literature from January 2018 to March 2024 was conducted using PubMed/MEDLINE, Embase, and Web of Science. Keywords included "rotator cuff tear", "rotator cuff augmentation", "rotator cuff patch", "tendon augmentation", "massive rotator cuff tear", "patch augmentation", and "grafts". Relevant articles were selected based on their abstracts for a comprehensive review. Results: Initial methods used autograft tissues, but advances in biomaterials have led to standardized, biocompatible synthetic patches. Studies show reduced retear rates with patch augmentation, ranging from 17 to 45%. Conclusions: Patch augmentation reduces the retear rates and improves tendon repair, but complications like immune responses and infections persist. Cost-effectiveness analyses indicate that while initial costs are higher, long-term savings from reduced rehabilitation, revision surgeries, and increased productivity can make patch augmentation economically beneficial.

Gonadal Mosaicism as a Rare Inheritance Pattern in Recessive Genodermatoses: Report of Two Cases with Pseudoxanthoma Elasticum and Literature Review.

Germline mosaicism in autosomal recessive disorders is considered a rare disease mechanism with important consequences for diagnosis and patient counseling. In this report, we present two families with PXE in which paternal germline mosaicism for an ABCC6 whole-gene deletion was observed. The first family further illustrates the clinical challenges in PXE, with a typical PXE retinopathy in an apparently heterozygous carrier parent. A systematic review of the literature on gonadal mosaicism in autosomal recessive genodermatoses revealed 16 additional patients. As in most reported families, segregation analysis data are not mentioned, and this may still be an underrepresentation. Though rare, the possibility of germline mosaicism emphasizes the need for variant verification in parents and sibs of a newly diagnosed proband, as it has significant implications for genetic counseling and management.

When we talk about Big Data, What do we really mean? Toward a more precise definition of Big Data.

Despite the lack of consensus on an official definition of Big Data, research and studies have continued to progress based on this "no consensus" stance over the years. However, the lack of a clear definition and scope for Big Data results in scientific research and communication lacking a common ground. Even with the popular "V" characteristics, Big Data remains elusive. The term is broad and is used differently in research, often referring to entirely different concepts, which is rarely stated explicitly in papers. While many studies and reviews attempt to draw a comprehensive understanding of Big Data, there has been little systematic research on the position and practical implications of the term Big Data in research environments. To address this gap, this paper presents a Systematic Literature Review (SLR) on secondary studies to provide a comprehensive overview of how Big Data is used and understood across different scientific domains. Our objective was to monitor the application of the Big Data concept in science, identify which technologies are prevalent in which fields, and investigate the discrepancies between the theoretical understanding and practical usage of the term. Our study found that various Big Data technologies are being used in different scientific fields, including machine learning algorithms, distributed computing frameworks, and other tools. These manifestations of Big Data can be classified into four major categories: abstract concepts, large datasets, machine learning techniques, and the Big Data ecosystem. This study revealed that despite the general agreement on the "V" characteristics, researchers in different scientific fields have varied implicit understandings of Big Data. These implicit understandings significantly influence the content and discussions of studies involving Big Data, although they are often not explicitly stated. We call for a clearer articulation of the meaning of Big Data in research to facilitate smoother scientific communication.

Tumoral calcinosis in chronic renal failure: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Tumor calcinosis is a rare and benign disorder characterized by calcified periarticular soft tissue masses. It may be idiopathic or caused by a condition known as hyperphosphatemia. There is still no definitive guideline for treating this disease, with excision being one of the primary treatment modalities. CASE PRESENTATION: 2 patients with a history of longstanding diabetes and dialysis presented with a painless lump on their right buttock, measuring 18 × 30 cm in the right gluteal region. Laboratory examinations showed a high ureum, creatinine, and serum phosphate. A radiograph revealed opacity on the right hip joint, without involvement of the proximal femur bone. A biopsy confirmed the diagnosis of tumor calcinosis. Both patients were treated with calcium carbonate to control their high serum phosphate levels. Both patients showed excellent tumor control without progression. CLINICAL DISCUSSION: Tumoral calcinosis (TC) is an extra-articular benign but aggressive tumor. The precise mechanism of TC remains unknown, which partly explains the lack of established treatment modality. We treat our patients with calcium carbonate to reduce the serum phosphate and treat the tumor without surgery. The treatment yielded a satisfactory clinical result. CONCLUSION: This study showed that a secondary TC may be conservatively treated without any surgical excision if we address the underlying problem. But it may not result in a reduction of the tumor's size.

Current experience and future potential of facilitating access to digital NHS primary care services in England: the Di-Facto mixed-methods study.

Background: Current National Health Service policy in England encourages enhanced digital access in primary care service provision. In this study, we investigate 'digital facilitation' - that range of processes, procedures and personnel which seeks to support National Health Service primary care patients in their uptake and use of online services. Objectives: Identify, characterise and explore the potential benefits and challenges associated with different models of digital facilitation currently in use in general practice which are aimed at improving patient access to online services in general practice in England. Use the resulting intelligence to design a framework for future evaluations of the effectiveness and cost effectiveness of such interventions. Explore how patients with mental health conditions experience digital facilitation and gauge their need for this support. Design: Observational mixed-methods study (literature review, surveys, ethnographic observation and interviews); formal synthesis of findings. Setting: General practice in four regions of England. Participants: Practice survey: 156 staff. Patient survey: 3051 patients. Mental health survey: 756 patients. General practitioner patient survey: 3 million responders. Ethnographic case-studies: 8 practices; interviews with 36 staff, 33 patients and 10 patients with a mental health condition. Stakeholder interviews: 19 participants. Intervention: Digital facilitation as undertaken in general practice. Main outcome measures: Patient and practice staff reported use of, and views of, digital facilitation. Data sources: Surveys, qualitative research; national General Practitioner Patient Survey (2019-22). Review methods: Scoping-review methodology applied to academic and grey literature published 2015-20. Results: While we did find examples of digital facilitation in routine practice, these often involved using passive or reactive modes of support. The context of COVID, and the necessary acceleration (at that time) of the move to a digital-first model of primary care, shaped the way digital facilitation was delivered. There was lack of clarity over where the responsibility for facilitation efforts lay; it was viewed as the responsibility of 'others'. Patients living with mental health conditions had similar needs and experiences regarding digital facilitation to other patients. Limitations: The context of the COVID pandemic placed limitations on the project. Fewer practices responded to the practice survey than anticipated; reconfiguration of general practices to support COVID measures was a key consideration during non-participant observation with social distancing and other measures still in place during fieldwork. Conclusions: Digital facilitation, while not a widely recognised concept, is important in supporting the move to a National Health Service with enhanced digital opportunities and enhanced digital access. General practice staff are allocating resources to provide such efforts in general practices in England. The establishment of clear lines of responsibility, the development of digital tools and platforms that work for patients and practice staff, and investment in staff time and training are needed if digital facilitation is to support the intended digital revolution. Future work: We did not find one single dominant or preferred model of digital facilitation which might reasonably be considered to form the basis of an intervention to be tested. Rather, there is a need to co-develop such an intervention with patients, general practice staff and relevant policy experts. We outline a framework for a future evaluation of such an intervention. Study registration: This study is registered as ResearchRegistry6523 (www.researchregistry.com/browse-the-registry#home/?view_2_search=Di-Facto&view_2_page=1) and PROSPERO CRD42020189019 (www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019). Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128268) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 32. See the NIHR Funding and Awards website for further award information.

Online services are common in the National Health Service. This research looked at 'digital facilitation' in general practices. Digital facilitation is about supporting National Health Service patients in their use of online services. We aimed to understand how much digital facilitation is being used by general practices. We also looked at how digital facilitation happens and if it affects the number of people using online services. We looked at previous research to help us understand what approaches have been used to support patients to use online services. We used surveys to ask staff at general practices what they were already doing, and to ask patients about their experiences. We observed digital facilitation in general practices and spoke to patients and staff to help us understand the benefits and challenges of different approaches. We combined findings from the three stages outlined above to identify key aspects of digital facilitation. All stages of our research included discussions with the project's patient advisory group. We found that digital facilitation is seen as important and has many forms. Most general practices are using passive and reactive types of facilitation. An example of passive facilitation, initiated by the service but not involving direct inter-personal interaction, is the use of text messaging relating to ordering of repeat prescriptions online. An example of reactive facilitation is providing a response to a patient-initiated query regarding online access. There is clear scope to develop a more proactive approach to facilitation that actively engages patients. Our research highlights a lack of clarity over who is responsible for digital facilitation. Different people (patients, staff, policy-makers) often think that the responsibility lies with others. Investment in digital facilitation is needed. Tools and platforms for digital facilitation that meet patients' and general practices' needs should be developed.

Ebstein's Anomaly in a Young Nigerian Lady.

BACKGROUND: Ebstein's anomaly (EA) is a rare congenital heart disease with a wide spectrum of presentation from the womb to adulthood characterized by apical displacement of tricuspid valve leaflets into the right ventricle. This is due to defects in embryological processes of uncertain etiology. CASE SUMMARY: A 28-year-old woman who presented with palpitations from childhood occurring in short paroxysms daily and limiting her from strenuous activities. Physical examination findings revealed a small stature with no associated birth defects. The cardiovascular system revealed tachycardia, a small volume irregular pulse with a split S2 heart sound. ECG showed premature atrial complexes, fragmented QRS with Sodi-Pallares sign, and echocardiographic features in keeping with atrialization of right ventricle with apical displacement of septal leaflet of the tricuspid valve into the right ventricle in keeping with EA. The patient was placed on anti-arrhythmics and anticoagulants. CONCLUSION: The diagnosis of EA in adults is often delayed in low-resource settings for multifaceted reasons. However, medical therapy offers a conservative measure to preserve life while surgical correction is advocated for the majority of cases when picked up early.

CONTEXTE: L'anomalie d'Ebstein (AE) est une cardiopathie congénitale rare caractérisée par le déplacement apical des feuillets de la valve tricuspide dans le ventricule droit. Cette affection se manifeste par un large éventail de symptômes, de la vie fœtale à l'âge adulte, et serait due à des défauts dans les processus embryologiques, bien que son étiologie exacte reste incertaine. RÉSUMÉ DU CAS: Une femme de 28 ans s'est présentée avec des palpitations depuis l'enfance, se produisant en courtes paroxysmes quotidiens et la limitant dans les activités physiques intenses. L'examen physique a révélé une petite stature sans malformations associées. L'évaluation cardiovasculaire a indiqué une tachycardie, un pouls irrégulier de faible volume et un dédoublement du deuxième bruit du cœur (B2). Un ECG a montré des complexes atriaux prématurés, des complexes QRS fragmentés avec un signe de SodiPallares, et des résultats échocardiographiques cohérents avec une atrialisation du ventricule droit et un déplacement apical du feuillet septal de la valve tricuspide, confirmant un diagnostic d'AE. La patiente a été prise en charge avec des antiarythmiques et des anticoagulants. CONCLUSION: Dans les milieux à faibles ressources, le diagnostic de l'AE chez l'adulte est souvent retardé en raison de divers défis. Bien que la prise en charge médicale offre une approche conservatrice pour prolonger la vie, une intervention chirurgicale précoce est recommandée dans la plupart des cas pour obtenir de meilleurs résultats. MOTS-CLÉS: Anomalie d'Ebstein, Rapport de cas, Revue de la littérature.