Telehealth-Delivered Program and Accompanying Patients to Enhance the Clinical Condition of Patients Throughout a Liver Transplant: Protocol for a Mixed Methods Study.

BACKGROUND: Liver transplantation (LT) is indicated in patients with severe acute or chronic liver failure for which no other therapy is available. With the increasing number of LTs in recent years, liver centers worldwide must manage their patients according to their clinical situation and the expected waiting time for transplantation. The LT clinic at the Centre hospitalier de l'Université de Montréal (CHUM) is developing a new health care model across the entire continuum of pre-, peri-, and posttransplant care that features patient monitoring by an interdisciplinary team, including an accompanying patient; a digital platform to host a clinical plan; a learning program; and data collection from connected objects. OBJECTIVE: This study aims to (1) evaluate the outcomes following the implementation of a patient platform with connected devices and an accompanying patient, (2) identify implementation barriers and facilitators, (3) describe service outcomes in terms of health outcomes and the rates and nature of contact with the accompanying patient, (4) describe patient outcomes, and (5) assess the intervention's cost-effectiveness. METHODS: Six types of participants will be included in the study: (1) patients who received transplants and reached 1 year after transplantation before September 2023 (historical cohort or control group), (2) patients who will receive an LT between December 2023 and November 2024 (prospective cohort/intervention group), (3) relatives of those patients, (4) accompanying patients who have received an LT and are interested in supporting patients who will receive an LT, (5) health care professionals, and (6) decision makers. To describe the study sample and collect data to achieve all the objectives, a series of validated questionnaires, accompanying patient logbooks, transcripts of interviews and focus groups, and clinical indicators will be collected throughout the study. RESULTS: In total, 5 (steering, education, clinical-technological, nurse prescription, and accompanying patient) working committees have been established for the study. Recruitment of patients is expected to start in November 2023. All questionnaires and technological platforms have been prepared, and the clinicians, stakeholders, and accompanying patient personnel have been recruited. CONCLUSIONS: The implementation of this model in the trajectory of LT recipients at the CHUM may allow for better monitoring and health of patients undergoing transplantation, ultimately reducing the average length of hospital stay and promoting better use of medical resources. In the event of positive results, this model could be transposed to all transplant units at the CHUM and across Quebec (potentially affecting 888 patients per year) but could also be applied more widely to the monitoring of patients with other chronic diseases. The lessons learned from this project will be shared with decision makers and will serve as a model for other initiatives involving accompanying patients, connected objects, or digital platforms. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54440.

Integrating accompanying patients into clinical oncology teams: limiting and facilitating factors.

OBJECTIVES: Since 2018, four establishments in Quebec have been instrumental in implementing the PAROLE-Onco program, which introduced accompanying patients (APs) into healthcare teams to improve cancer patients' experience. APs are patient advisors who have acquired specific experiential knowledge related to living with cancer, using services, and interacting with healthcare professionals. They are therefore in a unique and reliable position to be able to provide emotional, informational, cognitive and navigational support to patients who are dealing with cancer. We aimed to explore APs' perspectives regarding the limiting and facilitating factors in terms of how they are integrated into the clinical oncology teams. METHODS: A qualitative study based on semi-structured interviews and focus groups was conducted with 20 APs at the beginning of their intervention (T1) and, two years later, during a second data collection (T2). Limiting and facilitating factors of APs' integration into clinical teams were analyzed in terms of governance, culture, resources and tools. RESULTS: The limited factors raised by APs to be integrated into clinical teams include the following: confusion about the specific roles played by APs, lifting the egos of certain professionals who feel they are already doing what APs typically do, lack of identification of patient needs, absence of APs in project governance organizational boundaries, and team members' availability. Various communication challenges were also raised, resulting in the program being inadequately promoted among patients. Also mentioned as limiting factors were the lack of time, space and compensation. Creating opportunities for team members to meet with APs, building trust and teaching team members how APs' activities complement theirs were enhancing factors. Other facilitators include APs being involved in decision-making committees, being leaders in promoting the PAROLE-Onco program to patients and clinical team members and creating opportunities to communicate with team members to help enhance their work and provide feedback to improve patient services. Awareness of APs' added value for the team and patients is also a key facilitator. Regarding tools, offering accompanying services by telephone allows both patients and APs to benefit from the flexibility they need. CONCLUSION: Over time, APs were able to identify optimal factors for successful implementation. Recommendations include APs and professionals working in co-construction on organization, leadership, resources and status factors. This could help catalyze a change in culture within health establishments and allow people dealing with cancer to benefit from the experiential knowledge of other patients within their clinical team.

Emergency-related inpatient admissions in child and adolescent psychiatry: comparison of clinical characteristics of involuntary and voluntary admissions from a survey in Bavaria, Germany.

Emergency inpatient admissions of children and adolescents are more difficult if the patient is admitted involuntarily and/or the caregivers or custodians of institutional care are absent. The present study aimed to clinically characterize involuntary versus voluntary admissions by examining the reasons for presentation and associated factors. We retrospectively analyzed patients who presented to the emergency department of a hospital for child and adolescent psychiatry in Bavaria, Germany, and were admitted as inpatients for crisis intervention in the 4th quarter of 2014-2018. Reasons for presentation, clinical and sociodemographic characteristics, and type of admission (voluntary versus involuntary) were analyzed for 431 emergency inpatient admissions. A total of 106 (24.6%) patients were involuntarily admitted. In a binominal logistic regression, presentation due to alcohol consumption, deviant social behavior, and psychosocial burden was positively associated, whereas difficulties at school and depression were negatively associated, with the likelihood of involuntary admission. 58.5% of the 123 unaccompanied patients were admitted involuntarily. Reasons for the presentation of unaccompanied and voluntary inpatient admissions were suicidal thoughts, psychosocial burden, and externalized aggression. A substantial number of child and adolescent psychiatric admissions represent emergency admissions. Involuntarily admitted patients and unaccompanied children/adolescents represent a non-negligible proportion of clinical routine and the clinical and legal background factors need to be further clarified in future studies. This study is registered in the German Clinical Trials Register (24 September 2019, DRKS00017689).

The Effects of Accompanying Ryegrass on Bayberry Trees by Change of Soil Property, Rhizosphere Microbial Community Structure, and Metabolites.

As a subtropical and tropical tree, bayberry (Myrica rubra) is an important fruit tree grown commercially in southern China. Interestingly, our studies found that the fruit quality of bayberry with accompanying ryegrass was significantly improved, but its mechanism remains unclear. The aim of this study was to explore the mechanism of accompanying ryegrass on the beneficial effect of the fruit quality of bayberry by measuring the vegetative growth parameters, fruit parameters with economic impact, physical and chemical properties of rhizosphere soil, microbial community structure, and metabolites of the bayberry with/without ryegrass. Notably, the results revealed a significant difference between bayberry trees with and without accompanying ryegrass in fruit quality parameters, soil physical and chemical properties, microbial community structure, and metabolites. Compared with the control without accompanying ryegrass, the planting of ryegrass increased the titratable sugar, vitamin C, and titratable flavonoid contents of bayberry fruits by 2.26%, 28.45%, and 25.00%, respectively, and decreased the titratable acid contents by 9.04%. Furthermore, based on 16S and ITS amplicon sequencing of soil microflora, the accompanying ryegrass caused a 12.47% increment in Acidobacteriota while a 30.04% reduction in Actinobacteria was recorded, respectively, when compared with the bayberry trees without ryegrass. Redundancy discriminant analysis of microbial communities and soil properties indicated that the main variables of the bacterial community included available nitrogen, available phosphorus, exchangeable aluminum, and available kalium, while the main variables of the fungal community included exchangeable aluminum, available phosphorus, available kalium, and pH. In addition, the change in microbial community structure was justified by the high correlation analysis between microorganisms and secondary metabolites. Indeed, GC-MS metabolomics analysis showed that planting ryegrass caused a 3.83%-144.36% increase in 19 metabolites such as 1,3-Dipentyl-heptabarbital and carbonic acid 1, respectively, and a 23.78%-51.79% reduction of 5 metabolites compared to the bayberry trees without the accompanying ryegrass. Overall, the results revealed the significant change caused by the planting of ryegrass in the physical and chemical properties, microbiota, and secondary metabolites of the bayberry rhizosphere soils, which provides a new insight for the ecological improvement of bayberry.

Characterization of microbial ecology, Listeria monocytogenes, and Salmonella sp. on equipment and utensil surfaces in Brazilian poultry, pork, and dairy industries.

This study aimed to evaluate the level of counting by indicator microorganisms, identify the microbial ecology, detect Listeria monocytogenes and Salmonella sp., and determine the presence of virulence genes and biofilm formation. A total of 480 samples were collected from the surfaces of the equipment and utensils using sterile swabs for the detection of L. monocytogenes and Salmonella sp. and counting mesophilic aerobes, Enterobacteriaceae, Escherichia coli, and Pseudomonas sp. The microbial ecology was evaluated by sequencing the 16S rRNA gene. Genes for virulence and biofilm formation were analyzed and adhesion capacity was evaluated for L. monocytogenes and Salmonella sp. The mesophilic aerobe count was the highest in the dairy processing facility, followed by the pork and poultry slaughterhouses. L. monocytogenes was detected in all facilities, with the highest detection in the pork slaughterhouse, followed by the poultry and dairy facilities. Salmonella sp. was only detected in the dairy. Isolates of L. monocytogenes and Salmonella sp. showed poor adhesion to polystyrene surfaces, virulence genes, and biofilm formation. The frequent contaminants in the slaughterhouses were Pseudomonas, Acinetobacter, and Aeromonas in poultry, Acinetobacter, Pseudomonas, and Brevundimonas in pork, and Pseudomonas, Kocuria, and Staphylococcus in dairy. Our results provide useful information to understand the microbiological risks associated with contamination.

How accompanying ions affect soil heavy metal removal by polyepoxysuccinic acid during washing?

Soil washing with green eluent is an efficient technique to remediate heavy metal contaminated farmland. In addition to eluent, less is known about the roles of accompanying ions on heavy metal removal. We investigated the effects of accompanying ions including Fe3+, Mn2+, Ca2+, Mg2+, Al3+, Si4+ and PO43- on the desorption of Pb2+ and Cd2+ in paddy and arid soils using ethylenediaminetetraacetic acid and polyepoxysuccinic acid as eluents. The release rates of target and accompanying ions showed significant fast and slow reaction stages based on corresponding analysis and kinetic models. In fast reaction stage, Pb2+ and Cd2+ performed geochemical analogy with Ca2+, Mg2+ and PO43-. The release curves of these ions were fitted well with Elovich model, indicating that they released from oxysalt surface into solution via ion exchange, and dissolution of Fe/Mn/Al/Si (hydr)oxides through H+- and ligand-promoted dissolution. In slow reaction stage, Pb2+ and Cd2+ were related to Fe3+, Mn2+, Al3+ and Si4+, which were controlled by intraparticle diffusion process. H+ slowly diffused into interlayer of phyllosilicates to displace target and accompanying ions by ion exchange. Therefore, this research filled the gap of accompanying ions driving the release behavior of heavy metal ions during leaching.

On mathematical modeling of the propagation of a wave ensemble within an individual axon.

The long history of studying the propagation of an action potential has revealed that an electrical signal is accompanied by mechanical and thermal effects. All these effects together generate an ensemble of waves. The consistent models of such a complex phenomenon can be derived by using properly the fundamental physical principles. In this paper, attention is paid to the analysis of concepts of continuum physics that constitute a basis for deriving the mathematical models which describe the emergence and propagation of a wave ensemble in an axon. Such studies are interdisciplinary and based on biology, physics, mathematics, and chemistry. The governing equations for the action potential together with mechanical and thermal effects are derived starting from basics: Maxwell equations, conservation of momentum, Fourier's law, etc., but modified following experimental studies in electrophysiology. Several ideas from continuum physics like external forces and internal variables can also be used in deriving the corresponding models. Some mathematical concepts used in modeling are also briefly described. A brief overview of several mathematical models is presented that allows us to analyze the present ideas of modeling. Most mathematical models deal with the propagation of signals in a healthy axon. Further analysis is needed for better modeling the pathological situations and the explanation of the influence of the structural details like the myelin sheath or the cytoskeleton in the axoplasm. The future possible trends in improving the models are envisaged.

Impact of anti-CGRP monoclonal antibodies on migraine attack accompanying symptoms: A real-world evidence study.

BACKGROUND: Clinical trials on anti-calcitonin gene-related peptide monoclonal antibodies poorly investigated their impact on migraine accompanying symptoms. OBJECTIVE: To evaluate the impact of basal accompanying symptoms on anti-CGRP monoclonal antibodies treatment response and their evolution after six months of treatment in migraine patients. METHODS: Patients with migraine diagnosis seen in the Headache Clinic and treated with erenumab, galcanezumab or fremanezumab were prospectively recruited. They completed a daily eDiary which provided data on headache frequency and the following accompanying symptoms of each day: photophobia, phonophobia, nausea, dizziness, and aura. Patients were classified as responders or non-responders based on 50% or greater reduction in headache days per month at month 6 (≥50% response rate). Accompanying symptoms ratios based on headache days per month were assessed per patient at baseline and after three and six months. Comparisons for basal characteristics, basal accompanying symptoms ratios and their evolution after six months between responders and non-responders were performed. RESULTS: One hundred and fifty-eight patients were included, 44% (69/158) showed ≥50% response rate after six months. A significant reduction in headache days per month in both groups was found at month 6 (-9.4 days/month in ≥50% response rate group; p < 0.001, -2.2 days/month in <50% response rate group; p = 0.004). Additionally, significant decreases in photophobia (-19.5%, p < 0.001), phonophobia (-12.1%, p = 0.010) and aura ratios (-25.1%, p = 0.008) were found in ≥50% response rate group. No statistically significant reductions were found in nausea and dizziness in any group since their reduction was correlated with the decrease in headache days per month. Higher photophobia ratios at baseline were predictive of an increased response between months 3 and 6 (Incidence Risk Ratio = 0.928, p = 0.040). CONCLUSIONS: The days per month with photophobia, phonophobia and aura decreased at a higher rate than headache days per month after six months in the ≥50% response group. Higher photophobia ratios were associated with higher response rates between three and six months. It could indicate an involvement of peripheral CGRP in photophobia as well as a central modulation of migraine through these treatments which mainly act on the periphery.

Parental Accompaniment in Operating Rooms Reduces Child Anxiety.

BACKGROUND: We believe that parental presence before the induction of anesthesia for surgery among children with a cleft palate/lip would be effective in mitigating their preoperative anxiety. OBJECTIVE: We assessed the states of patients with a cleft palate/lip when their parents accompanied them into operating rooms and clarified their and their parents' cognition using a questionnaire. METHODS: Data were collected via nursing observation when patients and their parents entered the operating room. Furthermore, an anonymous questionnaire was administered to patients and parents after the operation regarding their feelings about parental presence in the operating room. RESULTS: In total, nine patients cried when they entered the surgical room. Furthermore, six patients and three parents reported preoperative anxiety. In addition, eight patients agreed that they were satisfied with the presence of their parents before induction. CONCLUSION: Approximately half of the patients cried. However, the presence of parents before the induction of anesthesia was effective in reducing anxiety among most patients and their parents.

Multiple myeloma in a patient with chronic myeloid leukemia: A case report.

Chronic myeloid leukemia (CML), a clonal myeloproliferative disorder of pluripotent hematopoietic stem cells, results from the Philadelphia chromosome (Ph) chromosome. The Ph is from a translocation, t(9;22)(q34q11), that creates a BCR-ABL fusion gene, which is transcribed into proteins with abnormal tyrosine kinase activity, driving the abnormal proliferation of white blood cells. Multiple myeloma (MM) is a proliferation disorder of plasma cells derived from a single clone, which may lead to uncontrolled growth, kidney injury, destructive bone lesions, hypercalcemia and anemia. It is extremely rare that MM and CML should occur in the same patient either synchronously or metachronously. To date, MM accompanied with CML has only been reported in limited studies, and the the cause behind the occurrence of both malignancies together is not understood. With the advent of novel therapies, the survival time in patients with CML and MM has improved. Therefore, the further investigation of the pathophysiology and clinical characteristics of these cases is valuable. The present study reports the case of a 79-year-old male who had been diagnosed with CML and treated with tyrosine kinase inhibitor, and then developed immunoglobulin G-κ MM after 6 years. This report should provide valid raw data for clinical research.

The role and influence of bacteria on the growth of Blastocystis sp. subtype 3.

Blastocystis sp. is an enteric protistan parasite that affects individuals worldwide with gastrointestinal symptoms such as abdominal discomfort, diarrhea, and flatulence. However, its pathogenicity is controversial due to its presence among asymptomatic individuals. Blastocystis sp. subtype 3 (ST3) is the most prevalent subtype among humans that have been associated with irritable bowel syndrome (IBS), Crohn's disease, ulcerative colitis, and colorectal cancer. Axenization of the parasite has been shown to impede its growth thus revealing the importance of accompanying bacteria in ensuring Blastocystis sp. survival. This study aims to identify the influence of accompanying bacteria on the growth of Blastocystis sp. ST3. Blastocystis sp. cultures were treated with Meropenem, Vancomycin, and Amoxicillin-Clavulanic acid (Augmentin). Bacteria-containing supernatant of antibiotic-treated and control cultures were isolated and identified through 16 s rRNA sequencing. Morphological changes of antibiotic-treated Blastocystis sp. ST3 were also observed. The cultures treated with meropenem and augmentin exhibited opposing effects with reduced growth of isolates from symptomatic patients and a significant increase in asymptomatic isolates. Whereas, vancomycin-treated cultures had no difference in the growth of Blastocystis sp. ST3 isolates from symptomatic and asymptomatic patients. Isolates from symptomatic and asymtomatic patients had 6 and 2 distinct bacterial species identified with Proteus mirabilis as the common bacteria among both types of isolates. Morphologically, Blastocystis sp. ST3 cultures exposed to meropenem and augmentin demonstrated an increase in pre-cystic forms. These findings demonstrate the effects of accompanying bacteria on the growth of Blastocystis sp. ST3 that could translate into clinical manifestations observed among Blastocystis sp.-infected patients.

Double Dislocation of the Interphalangeal Joints of the Little Finger.

High-energy traumas may lead to the dislocation of joints with or without fractures. However, simultaneous double dislocation of the proximal and distal interphalangeal joints (PIP and DIP) in fingers shows up rarely. Although it can be inferred as simultaneous dislocation occurring during the same trauma, consecutive events should be taken into consideration. A 29-year-old, right-hand dominant male patient presented to the emergency room with a left little finger deformity after being hit by a ball while playing football. Despite the inability to move the little afteruent to this hyperextension injury, there was mild swelling, ecchymosis, and pain with no trace of laceration or neurovascular injury. PIP and DIP joint dislocations of the left-hand little finger with distal phalanx proximal fracture were detected on the radiograph indicating a stepladder deformity. Closed reduction was achieved by longitudinal traction and applying pressure over the base of the dislocated digit. Afterward, an aluminum finger splint was applied to the little finger in the functional position to prevent further damage. Re-evaluation radiographs revealed a successful reduction of both joints. Immobilization via an aluminum finger splint was recommended for three weeks. Subsequently, range of motion exercises and rehabilitation were started. Three-month follow-up revealed an almost full range of motion in both PIP and DIP joints without stiffness and pain. Although double dislocation seems to present with more painful and swollen fingers than single dislocations, it can also present with mild pain and swelling, as in this case. The little finger is easily exposed to traumas due to the lack of surrounding tissue. Therefore, double dislocation is mostly seen in the little finger. This case report briefly illustrates a rare incidence of double dislocation involving both the PIP and DIP joints of the little finger. Normal range of motion of both joints was reached by early reduction followed by timely rehabilitation.

An exploratory cross-sectional study of the effects of ongoing relationships with accompanying patients on cancer care experience, self-efficacy, and psychological distress.

BACKGROUND: Centre hospitalier de l'Université de Montréal in Canada introduced accompanying patients (APs) into the breast cancer care trajectory. APs are patients who have been treated for breast cancer and have been integrated into the clinical team to expand the services offered to people affected by cancer. This study describes the profiles of the people who received the support and explores whether one-offs vs ongoing encounters with APs influence their experience of care, on self-efficacy in coping with cancer, and on their level of psychological distress. METHODS: An exploratory cross-sectional study was carried out among patients to compare patients who had one encounter with an AP (G1) with those who had had several encounters (G2). Five questionnaires were administered on socio-demographic characteristics, care pathway, evaluation of the support experience, self-efficacy in coping with cancer, and level of psychological distress. Logbooks, completed by the APs, determined the number of encounters. Linear regression models were used to evaluate the associations between the number of encounters, patient characteristics, care pathway, number of topics discussed, self-efficacy measures in coping with cancer, and level of psychological distress. RESULTS: Between April 2020 and December 2021, 60% of 535 patients who were offered support from an AP accepted. Of these, one hundred and twenty-four patients participated in the study. The study aimed to recruit a minimum of 70 patients with the expectation of obtaining at least 50 participants, assuming a response rate of 70%. There were no differences between G1 and G2 in terms of sociodemographic data and care pathways. Statistical differences were found between G1 and G2 for impacts on and the return to daily life (p = 0.000), the return to the work and impacts on professional life (p = 0.044), announcement of a diagnosis to family and friends (p = 0.033), and strategies for living with treatment under the best conditions (p = 0.000). Significant differences were found on the topics of cancer (p = 0.000), genetic testing (p = 0.023), therapeutic options (p = 0.000), fatigue following treatment (p = 0.005), pain and discomfort after treatment or surgery (p = 0.000), potential emotions and their management (p = 0.000) and the decision-making processes (p = 0.011). A significant relationship was found between the two groups for patients' ability to cope with cancer (p = 0.038), and their level of psychological distress at different stages of the care pathway (p = 0.024). CONCLUSIONS: This study shows differences between one-time and ongoing support for cancer patients. It highlights the potential for APs to help patients develop self-efficacy and cope with the challenges of cancer treatment.

Autism in Turkey: demographics, behavior problems, and accompanying medical conditions in a sample of Turkish youth with autism spectrum disorder.

Autism spectrum disorder (ASD) is an etiologically heterogeneous neurodevelopmental condition that eludes a single explanation or cure. Epidemiological studies reveal risk factors, relevant comorbidities, and behavioral correlates to reach a better understanding of ASD. To contribute such data from an understudied ASD population, this paper presents epidemiological data from a Turkish sample of individuals with ASD (n = 911, 748 boys (82.1%) and 163 girls (17.9%) between 1 and 18 years of age). Average age at diagnosis was 31.06 ± 11.88 months, and the male-to-female ratio was 4.6:1. Three in 4 individuals with ASD had obsessive behaviors, and 1 in 4 had allergic conditions, inappropriate sexual behaviors, self-harming behaviors, and harmful behaviors towards others. One in 3 received a dietary treatment for at least 3 months; almost half received vitamin supplements; the majority (70%) did not experience constipation; and 2 in 3 were picky eaters. This paper presents data on the age of diagnosis, gender ratios, accompanying behaviors, and dietary interventions in Turkish individuals with ASD, which are topics of current research interest about ASD. Such data from non-Western populations may supplement epidemiological knowledge gained from Western populations to help reach a more comprehensive understanding of this condition with many unknowns.

Repercusión de la espiritualidad en el afrontamiento de la vida y de la muerte. Estudio desde la perspectiva de los profesionales de enfermería / The influence of spirituality at the beginning and at the end of life. Study from the perspective of nursing professiona

La espiritualidad es la dimensión humana que guía al hombre en la reflexión de su propia existencia,para intentar descubrir el por qué y para qué vive. Esta búsqueda de sentido es todavía más frecuente enaquellos que sufren una enfermedad avanzada e incurable. Habitualmente, sin embargo, esta necesidadno es reconocida por el enfermo, lo cual dificulta su detección y manejo en la atención y cuidado diario porparte de los profesionales sanitarios. Éstos, para poder establecer una relación de ayuda efectiva, debencontemplar también esta dimensión espiritual dentro del concepto de atención integral que se ofrece atodos los pacientes, sobre todo a los que se encuentran en una fase avanzada de la enfermedad. Con estetrabajo hemos intentado, por un lado, conocer la opinión de Enfermeras y TCAE sobre la espiritualidad através de una encuesta de diseño propio. Por otro, hemos querido descubrir cuál es la repercusión espiri-tual que esta experiencia de sufrimiento del paciente tiene sobre los profesionales, así como si el cultivode la espiritualidad de estos, expresada de diferente manera, puede tener efectos positivos también enaquellos. Para ello se han seleccionado profesionales sanitarios de una unidad de oncología que viven dia-riamente el impacto del sufrimiento y la muerte de sus pacientes.(AU)

Spirituality is the human dimension that helps human beings to reflect about their own existence, totry to answer to questions like: what are we living for? This search of meaning is still more pronounced inthose who suffer an advanced and incurable disease. This clear need is nevertheless not always acknowl-edge by the patient, making it difficult to detect and manage it in the daily care by healthcare profes-sionals. In an effort to establish an effective therapeutic relationship, they have to keep in mind also thisspiritual dimension, already integrated in the concept of comprehensive care and usually offered to allpatients, especially in those who are at the end of life. With this work we have tried, on the one hand, toknow the opinion of nurses and TCAE about spirituality through a self-design survey. On the other hand,we wanted to know how this suffering experience may impact on the professionals, as well as if the devel-opment of their own spirituality, differently expressed, may have positive effects on the patients. To thisend, healthcare professionals have been selected from an oncology unit, those who day by day are facingthe impact of suffering and death of their patients.(AU)

Accompanying patients in clinical oncology teams: Reported activities and perceived effects.

INTRODUCTION: Since 2018, four establishments in Quebec, Canada, have decided to implement the PAROLE-Onco programme, which introduced accompanying patients (APs) in healthcare teams to improve the experience of cancer patients. APs are patient advisors who have had a cancer treatment experience and who conduct consultations to complement the service offered by providing emotional, informational and educational support to patients undergoing treatments (e.g., radiotherapy, chemotherapy, surgery), mostly for breast cancer. We aimed to explore the evolution of APs' perspectives regarding their activities within the clinical oncology teams as well as the perceived effects of their intervention with patients, the clinical team and themselves. METHODS: A qualitative study based on semistructured interviews and focus groups was conducted with APs at the beginning of their intervention (T1) and 2 years afterwards (T2). The themes discussed were APs' activities and the perceived effects of their interventions on themselves, on the patients and on the clinical team. RESULTS: In total, 20 APs were interviewed. In T2, APs' activities shifted from listening and sharing experiences to empowering patients by helping them become partners in their care and felt generally more integrated into the clinical team. APs help patients feel understood and supported, alleviate stress and become partners in the care they receive. They also alleviate the clinical team's workload by offering a complementary service through emotional support, which, according to them, helps patients feel calmer and more prepared for their appointments with healthcare professionals. They communicate additional information about their patients' health journey, which makes the appointment more efficient for healthcare professionals. When APs accompany patients, they feel as if they can make a difference in patients' lives. Their activities are perceived by some as an opportunity to give back but also as a way of giving meaning to their own experience, in turn serving as a learning experience. CONCLUSION: By mobilizing their experiential knowledge, APs provide emotional, informational, cognitive and navigational support, which allows patients to be more empowered in their care and which complements professionals' scientific knowledge, thereby helping to refine their sensitivity to the patients' experiences. PATIENT OR PUBLIC CONTRIBUTION: Two patient-researchers have contributed to the study design, the conduct of the study, the data analysis and interpretation, as well as in the preparation and writing of this manuscript.

La madre acompañante en los servicios pediátricos, ejemplo del pensamiento humanista de Fidel / The Accompanying Mother in Pediatric Services, An Example of Fidel's Humanist Thought

Introducción: El desarrollo de la pediatría en Villa Clara tiene una rica historia e importantes contribuciones de grandes personalidades. Una de ellas, fue la incorporación de la madre acompañante en los servicios pediátricos, controversial decisión inicialmente no bien comprendida, que se desarrolló en la provincia en 1968. Objetivo: Explicar el surgimiento de la madre acompañante en los servicios pediátricos de Villa Clara. Métodos: Para analizar el objeto de estudio se realizó una investigación histórica durante el año 2019 mediante el método teórico, que se sustenta en la interacción de lo histórico y lo lógico desde las dimensiones temporal y espacial; y el empírico, consistente en la revisión de fuentes primarias (análisis documental) y secundarias (incluido entrevistas con informantes clave), seguidos por la triangulación metodológica para arribar a consideraciones integradoras. Resultados: Se identificaron destacadas figuras de la especialidad de Pediatría en Villa Clara, y su contribución a la incorporación de la madre acompañante en los hospitales pediátricos. Conclusiones: Los servicios pediátricos de Villa Clara fueron pioneros en la incorporación del modelo de la madre acompañante y su generalización contó con el apoyo del líder histórico de la Revolución, Fidel Castro Ruz(AU)

Introduction: The development of pediatrics in Villa Clara has a rich history and important contributions from great personalities. One of them was the incorporation of the accompanying mother in the pediatric services, a controversial decision initially not well understood, which was developed in the province in 1968. Objective: To explain the emergence of the accompanying mother modality in the pediatric services of Villa Clara. Methods: To analyze the object of study, a historical research was carried out during 2019 using the theoretical method, which is based on the interaction of the historical and the logical from the temporal and spatial dimensions; and the empirical one, consisting in the review of primary sources (documentary analysis) and secondary sources (including interviews with key informants), followed by methodological triangulation to arrive at integrative considerations. Results: Outstanding figures of the specialty of Pediatrics in Villa Clara were identified, and their contribution to the incorporation of the accompanying mother modality in pediatric hospitals. Conclusions: The pediatric services of Villa Clara were pioneers in the incorporation of the accompanying mother model and its generalization had the support of the historical leader of the Revolution, Fidel Castro Ruz(AU)

Risk and protective factors related to immediate postpartum depression in a baby-friendly hospital of Taiwan.

OBJECTIVE: Postpartum depression (PPD) can occur in women soon after childbirth. The aim of this study was to investigate the risk and protective factors for immediate PPD in a baby-friendly hospital. MATERIALS AND METHODS: This cross-sectional study of singleton term pregnancies was performed at MacKay Memorial Hospital in Taiwan from January to September 2019. The enrolled women completed the Edinburgh Postnatal Depression Scale (EPDS) within 48 h after childbirth. Maternal characteristics, pregnancy and delivery factors, maternal comorbidities, supportive and childbirth factors, and neonatal outcomes were investigated. RESULTS: Of the 1197 enrolled women, 1104 (92.23%) were at low risk (EPDS score ≤9), 66 (5.51%) were at moderate risk (EPDS score 10 to 12), and 27 (2.26%) were at high risk (EPDS score ≥13) of PPD. Significant independent risk factors for immediate PPD included the number of miscarriages (adjusted odds ratio (aOR) 1.33, 95% confidence interval (CI) 1.03-1.72, p = 0.031) and intermediate care nursery (ICN) or neonatal intensive care unit (NICU) admission (aOR 2.29, 95% CI 1.13-4.64, p = 0.022). Significant independent protective factors included planned pregnancy (aOR 0.51, 95% CI 0.28-0.92, p = 0.026), husband accompanying his wife (aOR 0.41, 95% CI 0.22-0.75, p = 0.004), early mother and newborn skin-to-skin contact (aOR 0.44, 95% CI 0.24-0.84, p = 0.012), and breastfeeding (aOR 0.23, 95% CI 0.08-0.71, p = 0.010). CONCLUSION: The number of miscarriages and ICN or NICU admission were independent risk factors for immediate PPD. Planned pregnancy, husband accompanying his wife, early skin-to-skin contact, and breastfeeding were independent protective factors for immediate PPD. Health care providers should pay attention to the risk factors and promote the protective factors into hospital policies to prevent the consequences of PPD.

Interstitial Fluid Flows along Perivascular and Adventitial Clearances around Neurovascular Bundles.

This study reports new phenomena of the interstitial fluid (ISF) microflow along perivascular and adventitial clearances (PAC) around neurovascular bundles. The fluorescent tracing was used to observe the ISF flow along the PAC of neurovascular bundles in 8-10 week old BALB/c mice. The new results include: (1) the topologic structure of the PAC around the neurovascular bundles is revealed; (2) the heart-orientated ISF flow along the PAC is observed; (3) the double-belt ISF flow along the venous adventitial clearance of the PAC is recorded; (4) the waterfall-like ISF flow induced by the small branching vessel or torn fascia along the PAC is discovered. Based on the above new phenomena, this paper approached the following objectives: (1) the kinematic laws of the ISF flow along the PAC around neurovascular bundles are set up; (2) the applicability of the hypothesis on the PAC and its subspaces by numerical simulations are examined. The findings of this paper not only enriched the image of the ISF flow through the body but also explained the kernel structure of the ISF flow (i.e., the PAC). It helps to lay the foundation for the kinematics and dynamics of the ISF flow along the PAC around neurovascular bundles.

Newly Designed and Experimental Test of the Sediment Trap for Horizontal Transport Flux.

The transport processes of marine suspended sediments are important to the material cycle and the shaping of seafloor topography. Existing sediment monitoring methods are limited in their use under high concentration conditions, and are not effective in monitoring and capturing sediment in 3D directions, and there is an inability to accurately explain sediment transport processes. To infer the transport process of suspended sediments, this study proposed a time-series vector in situ observation device. An accompanying time-series analytic method was developed for sediment transport fluxes. The correlation between the internal and external flow velocities of the capture tube was established through indoor tests, and then the applicability of the device was verified by the correlation between the theoretical capture quality and the actual capture quality, and the analytic formula of the flux was refined. The proposed observation technique can be used for in situ long-term observation and sampling of marine suspended sediments under conventional and even extreme sea conditions, achieving accurate time-series suspended sediment capture and high-resolution transport flux analysis. The technique thus provides a more effective means for scientific research into the dynamics of seafloor sedimentation, the mechanisms of ocean carbon sinks, and the processes of the carbon cycle.