Robina Hospital

DeepSeek is a free and self-hostable large language model (LLM) that recently became the most downloaded app across 156 countries. As early academic literature on ChatGPT was predominantly critical of the model, this mini-review is interested in examining how DeepSeek is being evaluated across academic disciplines. The review analyzes available articles with DeepSeek in the title, abstract, or keywords, using the VADER sentiment analysis library. Due to limitations in comparing sentiment across languages, we excluded Chinese literature in our selection. We found that Computer Science, Engineering, and Medicine are the most prominent fields studying DeepSeek, showing an overall positive sentiment. Notably, Computer Science had the highest mean sentiment and the most positive articles. Other fields of interest included Mathematics, Business, and Environmental Science. While there is substantial academic interest in DeepSeek’s practicality and performance, discussions on its political or ethical implications are limited in academic literature. In contrast to ChatGPT, where all early literature carried a negative sentiment, DeepSeek literature is mainly positive. This study enhances our understanding of DeepSeek’s reception in the scientific community and suggests that further research could explore regional perspectives.

BackgroundUnused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment.MethodsThis was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February–18 March 2017 and 5 January–4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression.ResultsA total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%–31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7–3.3).ConclusionOne-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.

The reuse of enteral tube feeding (ETF) equipment is not recommended due to the risk of microbial contamination and subsequent risk of infection; however, this practice continues in many ambulatory settings. A systematic review of the literature was undertaken to review the evidence underpinning the cleaning and reuse of ETF equipment. Studies that investigated the reuse, decontamination, and/or cleaning of ETF equipment were considered for inclusion. Electronic databases were searched (no limits were placed on date of publication, age, or duration of reuse). Extracted data were assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Ten studies met inclusion criteria: 3 investigated changes to clinical outcomes with extending reuse from 24 to ≤72 hours using water rinses; 5 considered the efficacy of various cleaning methods assessed in laboratory conditions; 2 used a combination of both approaches. Sufficient data to allow GRADE assessment was found only for bottle-type containers. A very low level of evidence supports the cleaning and reuse of rigid and "unspecified" bottle containers; no studies were found to inform the reuse of syringes used for bolus feeding or any equipment used for water infusion or flushes. There is an absence of literature evaluating the safety and clinical outcomes of cleaning and reusing ETF equipment, and research is required to support equipment reuse.

To determine the incidence of hypovitaminosis D in proximal femur fracture (PFF) patients and investigate whether sociodemographic factors or radiographic parameters are associated with vitamin D levels. This is a consecutive case series of South-East Queensland patients presenting with low-energy PFFs. Vitamin D levels and sociodemographic factors (age, sex, postcode, medications and type of residence) were collected from medical records. Radiographic parameters included PFF type and cortical thickness of the femur. A total of 313 patients were included (mean age=79.5years), and 105 (34%) were deficient in vitamin D (<50nmol/L). There was no association between vitamin D levels and sociodemographic factors or radiographic parameters. Eighty-four (84%) of vitamin D-deficient patients were not taking vitamin D supplements. Social and demographic factors are not correlated with vitamin D levels in this cohort. Routine vitamin D supplementation may be indicated in ageing patients although it is not always protective of low-energy fractures.

Evidence-based guidelines assist clinicians in practice, but how the guidelines are implemented is less established. To describe the nurses' implementation of activities recommended in evidence-based guidelines for falls prevention and care of older people with cognitive impairment. Structured observation with a categorical checklist was used. Nursing personnel were recruited from one subacute and two acute wards in two hospitals in one tertiary-level health service in south-eastern Queensland, Australia. The data collection instrument identified 31 activities drawn directly from the evidence-based guidelines, which were categorized into six domains of nursing practice: clinical care, comfort, elimination, mobility, nutrition and hydration, and social engagement. Four-hour observation periods, timed to occur across the morning and evening shifts, were conducted over 2months. Nineteen registered nurses, six enrolled nurses, and 16 assistants in nursing (N=41) were observed for 155hr of observation. There was variability in adherence with specific activities, ranging from 21% to 100% adherence. Three categories with the highest adherence were nutrition and hydration, mobilization safety, and social engagement. The clinical care, comfort, and elimination categories had lower adherence, with lowest adherence in activities of education provision about falls risk, pain assessment, using a clock or calendar to reorient to time and place, and bowel care. Nursing care is delivered within an interdisciplinary team. Therefore, responsibility for the everyday fundamental care activities known to prevent falls in older people with cognitive impairment requires localized negotiation. A practical guide for preventing in-hospital falls in older people with cognitive impairment addressing the interdisciplinary context of practice is required. Interdisciplinary teams should develop strategies to enhance the implementation of pain assessment and prevention of constipation in the context of regularly implemented hydration, nutrition, and mobilization care strategies.

Since 1980, 22 state and federal jurisdictions have adopted sentencing guidelines. Nineteen still have them. No two systems are alike. Experience suggests that any well-designed system requires five core features: a permanent, balanced, independent, and adequately funded sentencing commission; typical-case presumptive sentences and departure criteria; a hybrid sentencing theory that recognizes both retributive and crime control purposes; balance between the competing benefits of rules and discretion; and sentence recommendations informed by resource and demographic impact assessments. Balance is needed in terms of commission composition, between conflicting sentencing purposes, between rules and discretion, and between the influence of the commission, the legislature, and case-level actors. Guidelines proponents disagree about a number of important issues. Some relate to which crimes and sentencing issues should be regulated. Others concern the design details that determine how the system actually works. It is clear, however, that preguidelines regimes of unstructured, highly discretionary sentencing are unacceptable and that commission-drafted guidelines, endorsed by the American Bar Association and the American Law Institute, are the only successful sentencing reform model. In four decades, no competing model of comparable detail and scope has been seriously proposed.