Caring for depression in the dying is complex and challenging – survey of palliative physicians

Background Depression is prevalent in people with very poor prognoses (days to weeks). Clinical practices and perceptions of palliative physicians towards depression care have not been characterised in this setting. The objective of this study was to characterise current palliative clinicians’ reported practices and perceptions in depression screening, assessment and management in the very poor prognosis setting. Methods In this cross-sectional cohort study, 72 palliative physicians and 32 psychiatrists were recruited from Australian and New Zealand Society of Palliative Medicine and Royal Australian and New Zealand College of Psychiatrists between February and July 2020 using a 23-item anonymous online survey. Results Only palliative physicians results were reported due to poor psychiatry representation. Palliative physicians perceived depression care in this setting to be complex and challenging. 40.0% reported screening for depression. All experienced uncertainty when assessing depression aetiology. Approaches to somatic symptom assessment varied. Physicians were generally less likely to intervene for depression than in the better prognosis setting. Most reported barriers to care included the perceived lack of rapidly effective therapeutic options (77.3%), concerns of patient burden and intolerance (71.2%), and the complexity in diagnostic differentiation (53.0%). 66.7% desired better collaboration between palliative care and psychiatry. Conclusions Palliative physicians perceived depression care in patients with very poor prognoses to be complex and challenging. The lack of screening, variations in assessment approaches, and the reduced likelihood of intervening in comparison to the better prognosis setting necessitate better collaboration between palliative care and psychiatry in service delivery, training and research.

Patients that are having Covid-19 Disease After the First Dose of Covid-Vaccine

There is no effective treatment for the Covid-19 disease that is still impacting the whole world. It considered that vaccines, one of the effective means to prevent infectious diseases, will play a significant role in protecting from the Covid-19 Disease. Vaccinations generals performed before exposure. We aimed to follow the clinical and laboratory progress of patients who got Covid-19 after the first dose of the Covid-19 vaccine and to evaluate the changes that may occur in antibody formation. 13 patients, who received the first dose of COVID 19 vaccine Coronovac as of 14.01.2021 when vaccination started in Adıyaman University Training and Research Hospital/Turkey, who had symptoms after the vaccine and whose real-time PCR found to be positive, were included in the study. After the first dose of the Covid-19 vaccine, 13 patients exam. Three of our patients were female, and 10 of them were male. The average age was 38.8. British variant detected in 4 of our patients; 1 of them was female. Contact times differed between 3 and 5 days. The most common symptoms were muscle-joint pain (53.8), weakness-fatigue (46.2), fever (38.5), and headache (30.8). Three of our patients, being one female, received inpatient treatment. Furthermore, our five patients who checked regarding Sars cov-2 IgG became positive in the first month. No adverse changes in the course of the illness observed in the patients were RT-PCR positive after the first dose of the Covid-19 vaccine. Antibody response detected at the end of the first month. Vaccination is an effective method for taking infectious diseases under control but adhering to personal protective measures still maintains their importance.

Delivering Higher Education in public Health Emergencies

With the general closure of universities and schools in Sierra Leone due to the COVID-19 pandemic, digital learning has become a credible alternative to maintain students in educational, training, and research links. The study responds to three primary questions: 1) What digital learning modalities have shown to be most effective for providing continuity in learning amid temporary or permanent school closures? 2) What digital learning modalities are promising for their use but evidence for their use evidence about them is still lacking? 3) What are the challenges and considerations when planning for and implementing digital learning? The study utilised qualitative research methods: interviews; focus group discussions; qualitative survey; and document reviewing. A stratified sample of 260 participants (161 male and 99 female) was randomly drawn from teachers, education officials and information technology experts. This paper provides snapshots of the different distance learning initiatives and program that have been implemented, including both the promises they offer.

COMPARISON OF SEGMENTATION METHODS USED FOR BONE FRACTURE IMAGES

The usage of computers and software in the biomedical field has been increasing and applications for doctors, clinicians, scientists and other users have been developed in the recent times. Manual, semi-automatic and fully automatic applications developed for bone fracture detection are one of the important studies in this field. Image segmentation, which is one of the image preprocessing steps in bone fracture detection, is an important step to obtain successful results with high accuracy. In this study, Otsu thresholding method, active contour method, k-means method, fuzzy c-mean method, Niblack thresholding method and max min thresholding range (MMTR) method are used on bone images obtained by Karabük University Training and Research Hospital. When any filters are not applied on images to remove noises, the most successful method is obtained by K-means method based on specificity and accuracy as 89,55% and 83,31% respectively. Niblack thresholding method has the highest sensitivity result as 92,45%.

Child Avoidance of Anxiety-Provoking Situations in the Classroom and Teacher Accommodation

This study examined: (1) school-based avoidance among students with problematic anxiety, (2) teachers’ levels of accommodation of avoidant behaviour, and (3) the relation between teacher accommodation and student avoidance and anxiety. Participants included 31 elementary school students with problematic anxiety (mean age = 7.7 years; range 5–11; 58% female; 71% White) and their teachers (mean age = 41.1 years; 100% female; 100% White). Children completed interviews about their anxiety, and teachers reported on students’ avoided situations and completed a questionnaire about their own use of accommodation. Results indicated that the most commonly avoided situations involved individual and group academic performance (e.g., reading aloud in front of class). All teachers engaged in some form of accommodating behaviour more than one day a week (e.g., assisted a student in avoiding things that might make him/her more anxious), and teachers who reported engaging in more accommodating behaviours had students with higher avoidance and anxiety. Findings suggest that additional training and research on teachers’ behaviours that maintain and/or reduce anxiety via reducing accommodating behaviours appears warranted.

The Effect of Monocyte Count on Disease-Free Survival in Esophageal Cancer Patients

Background: Inflammation plays a pivotal role in cancer development and prognosis. Peripheral blood test is a useful parameter in the evaluation of systemic inflammatory response. Previous studies have shown a relationship between monocyte count and prognosis in some solid tumors. The aim of this study was to evaluate the relationship between the monocyte count assessed at diagnosis and disease-free survival and prognosis in patients with esophageal cancer.Materials and Methods: The retrospective study included 145 patients with esophageal cancer who presented to Van Training and Research Hospital Medical Oncology outpatient clinic between January 2015 and September 2020. The effect of monocyte count assessed in the blood samples taken at the time of diagnosis prior to the initiation of the treatment on disease-free survival was investigated.Results: The Receiver Operating Characteristics (ROC) curve analysis determined a cut-off value of 515/μL for the monocyte count assessed at the time of diagnosis. Disease-free survival was 17.3 months (95% CI: 8.4-26.2) in patients with a monocyte count ≥515/μL as opposed to 38.5 months (95% CI: 28. 8-48.1) in patients with a monocyte count <515/μL. Moreover, low monocyte count at diagnosis was associated with significantly higher disease-free survival (p<0.001).Conclusion: It is considered that the proportional distribution of cells in peripheral blood count may reflect the severity of inflammation in the tumor microenvironment. Our findings showed that monocyte count is a prognostic factor affecting disease-free survival in patients with esophageal cancer, regardless of histological subtype.

TRAP sequence; case report

TRAP sequence is a syndrome with poor prognosis seen in monochorionic twin pregnancies at the rate of 1/100. There is an acardiac “nonviable” fetus with multiple anomalies in the TRAP sequence and a pump fetus feeding this fetus through vascular anastomoses in the placenta. Mortality for acardiac twins is 100%. The mortality of the pump twin is around 50%, and death may be generally due to high flow rate heart failure and sometimes prematurity caused by polyhydramnios. Here, we presented an acardiac acephalous type TRAP case that applied to the Obstetrics and Gynecology Clinic of Amasya University Sabuncuoğlu Şerefeddin Training and Research Hospital. The case was 30 years old. The patient had the first pregnancy and reached this pregnancy with the IVF method. She did not have any disease. During the measurement of NT, the fetus of acardiac acephalous type was detected. Laser ablation was performed at the outer center at 18 weeks. All subsequent follow-ups were done by our center. While the patient had 39 weeks and 2 days of pregnancy, the pregnancy was terminated by performing cesarean due to primipara breech arrival.

Evaluation of SARS-CoV-2 vaccination rate among healthcare workers in a tertiary hospital in Mogadishu Somalia: A cross-sectional study

Background The percentage of healthcare workers that are vaccinated against SARS-CoV-2 in Somalia remains unknown. The main purpose of our study is to determine the SARS-CoV-2 vaccination rate among healthcare workers in a tertiary hospital in Mogadishu, Somalia. Methods The design of the study is cross-sectional which was undertaken to assess the vaccination rate of healthcare workers in Mogadishu Somali Turkish Training and Research Hospital from September 1 to September 20, 2021. A total number of 210 healthcare workers have participated in this study. The data were collected using a questionnaire. Results Out of 210 healthcare workers that have enrolled in the study 56.2% (n=118) were males. The mean age of the participants was 28.23 with SD ± 2.9. The most abundant age group in our study was 18-27 years with 53.8% (n=113). According to the participant’s profession, the doctors were the commonest participant with 48.6% (n=102). The SARS-CoV-2 vaccination level of the healthcare workers in Mogadishu Somali Turkish Training and Research Hospital was found to be 20% (n=42). 26.2% of the males that participated in this study were vaccinated against SARS-CoV-2 while only 12% of females were vaccinated. The study found that there is a significant correlation between SARS-CoV-2 vaccination and gender with p value<.05. The study also revealed that there is a negative correlation between age and being vaccination against Covid-19 disease with p value <.01. 30% (n=31) of the doctors, 5.6% (n=4) of nurses, 14.2% (n=14) of radiology technicians, 30.7% (n=4) of anesthesia technicians, and 10% (n=1) of laboratory stuffs were vaccinated against SARS-CoV-2. The reasons for SARS-CoV-2 vaccine hesitancy were fear towards the vaccine complications 58% (n=97), followed by believed that vaccine will not be beneficial, lack of opportunity, no reason, and avoiding for religious or social reasons in 23% (n=39), 8.3% (n=14), 9% (n=15), 1.7% (n=3), respectively. Conclusion We found that only 20% of the healthcare workers in a tertiary hospital in Somalia were vaccinated against SARS-CoV-2 infection. This is an emergency public health situation as it will put the healthcare workers and the patients at risk for developing Covid 19 disease.