bluuebunny/crossref_metadata_2025 huggingface dataset:
The Road to Retirement: A Life Course Perspective on Labor Market Trajectories and Retirement Behaviors
Authors: Brydsten Anna , Hasselgren Caroline , Stattin Mikael , Larsson Daniel
Published: September 2023

While a prolonged working life has been mainly feasible for people with the most advantageous working careers, knowledge about the barriers for those with vulnerable occupational paths is still scarce. This study explores the conditions for prolonged working life from a perspective on labor market trajectories. Drawing from a gendered life course perspective and that (dis)advantageous tends to accumulate over time, we investigate the opportunity structure for the most disadvantaged workers and which characteristics of labor market trajectories can explain the decision to work longer. To this end, a Swedish longitudinal survey and register data from the Panel Survey of Ageing and the Elderly (PSAE) were used, following people across a substantial part of their working life. With sequence analysis, we identified 5 trajectories that represent typical labor market trajectories from mid-life until retirement age. Our findings showed that labor market precarity in mid-life remained a key characteristic until the expected retirement age, showing both early signs of early labor market exit and a precarity trap into a prolonged working life. These findings emphasize the need to identify at-risk groups early in their careers and that mid-life interventions are needed to prevent involuntary labor market exits and to ensure a sustainable working life. In particular, the need to protect older workers with turbulent or precarious labor market trajectories against labor market risks and retirement schemes that could inadvertently contribute to increased social and economic inequality in later life.
The intraoperative management of robotic-assisted laparoscopic prostatectomy
Authors: Chiumello Davide , Fratti Isabella , Coppola Silvia
Published: September 2023

Purpose of review

Robotic-assisted laparoscopic radical prostatectomy has become the second most commonly performed robotic surgical procedure worldwide, therefore, anesthesiologists should be aware of the intraoperative pathophysiological consequences. The aim of this narrative review is to report the most recent updates regarding the intraoperative management of anesthesia, ventilation, hemodynamics and central nervous system, during robotic-assisted laparoscopic radical prostatectomy.

Recent findings

Surgical innovations and the advent of new technologies make it imperative to optimize the anesthesia management to provide the most holistic approach possible. In addition, an ageing population with an increasing burden of comorbidities requires multifocal attention to reduce the surgical stress.

Total intravenous anesthesia (TIVA) and balanced general anesthesia are similar in terms of postoperative complications and hospital stay. Reversal of rocuronium is associated with shorter hospital stay and postanesthesia recovery time. Adequate PEEP levels improve oxygenation and driving pressure, and the use of a single recruitment maneuver after the intubation reduces postoperative pulmonary complications. Restrictive intravenous fluid administration minimizes bladder–urethra anastomosis complications and facial edema. TIVA maintains a better autoregulation compared with balanced general anesthesia. Anesthesiologists should be able to optimize the intraoperative management to improve outcomes.
Development, Validation, and Usability of the Chatbot ESTOMABOT to Promote Self-care of People With Intestinal Ostomy
Authors: Morato Jéssica Emanuela Mendes , do Nascimento Jose William Araujo , Roque Geicianfran da Silva Lima , de Souza Rafael Roque , Santos Isabel Cristina Ramos Vieira
Published: September 2023

This study aimed to describe the process of construction, validation, and usability of the chatbot ESTOMABOT to assist in the self-care of patients with intestinal ostomies. Methodological research was conducted in three phases: construction, validation, and usability. The first stage corresponded to the elaboration of a script through a literature review, and the second stage corresponded to face and content validation through a panel of enterostomal therapy nurses. In the third phase, the usability of ESTOMABOT was assessed with the participation of surgical clinic nurses, patients with intestinal elimination ostomies, and information technology professionals, using the System Usability Scale. The ESTOMABOT content reached excellent criteria of adequacy, with percentages of agreement equal to or greater than 90%, which were considered adequate, relevant, and representative. The evaluation of the content validity of the script using the scale content validity index/average proportion method reached a result above 0.90, and the Fleiss κ was excellent (P < .05). The overall usability score of the chatbot was 81.5, demonstrating excellent usability. The script, developed and incorporated into the ESTOMABOT prototype, achieved satisfactory content validity. The usability of the chatbot was considered to be good, thereby increasing the credibility of the instrument.
Ceftriaxone Pharmacokinetics and Pharmacodynamics in 2 Pediatric Patients on Extracorporeal Membrane Oxygenation Therapy
Authors: Cervantes Francisco C. , Mizuno Tomoyuki , Dong Min , Tang Peter , Arbough Trent , Vinks Alexander A. , Kaplan Jennifer M. , Tang Girdwood Sonya C.
Published: September 2023

Background:

Critically ill patients with cardiac or respiratory failure may require extracorporeal membrane oxygenation (ECMO). Antibiotics are frequently administered when the suspected cause of organ failure is an infection. Ceftriaxone, a β-lactam antibiotic, is commonly used in patients who are critically ill. Although studies in adults on ECMO have suggested minimal impact on ceftriaxone pharmacokinetics, limited research exists on ceftriaxone pharmacokinetics/pharmacodynamics (PK/PD) in pediatric ECMO patients. We report the PK profiles and target attainment of 2 pediatric patients on ECMO who received ceftriaxone.

Methods:

Ceftriaxone concentrations were measured in 2 pediatric patients on ECMO using scavenged opportunistic sampling. PK profiles were generated and individual PK parameters were estimated using measured free ceftriaxone concentrations and a published population PK model in children who are critically ill, using Bayesian estimation.

Results:

Patient 1, an 11-year-old boy on venovenous ECMO for respiratory failure received 2 doses of 52 mg/kg ceftriaxone 12 hours apart while on ECMO and additional doses every 12 hours off ECMO. On ECMO, ceftriaxone clearance was 13.0 L/h/70 kg compared with 7.6 L/h/70 kg off ECMO, whereas the model-predicted mean clearance in children who are critically ill without ECMO support was 6.54 L/h/70 kg. Patient 2, a 2-year-old boy on venoarterial ECMO due to cardiac arrest received 50 mg/kg ceftriaxone every 12 hours while on ECMO for >7 days. Only clearance while on ECMO could be estimated (9.1 L/h/70 kg). Trough concentrations in both patients were >1 mg/L (the breakpoint for Streptococcus pneumoniae) while on ECMO.

Conclusions:

ECMO increased ceftriaxone clearance above the model-predicted clearances in the 2 pediatric patients studied. Twelve-hour dosing allowed concentrations to remain above the breakpoint for commonly targeted bacteria but not 4 times the breakpoint in one patient, suggesting that precision dosing may be beneficial to ensure target attainment in children on ECMO.
Patients Prefer Ultrasound to Nerve Conduction Studies for the Diagnosis of Carpal Tunnel Syndrome
Authors: Carrozzi Sabrina , Schulz William , Beckwitt Colin H. , Wera Jeffrey , Wasil Karen , Fowler John R.
Published: September 2023

Background:

The net promoter score (NPS) allows analysis of patient satisfaction and preference between treatment and/or diagnostic testing. Electrodiagnostic testing (EDX) and ultrasound (US) are commonly used diagnostic tests for carpal tunnel syndrome. Although EDX is reliable for diagnosing carpal tunnel syndrome (CTS), it can be uncomfortable and inconvenient for patients. We aimed to determine whether patients preferred US or EDX studies for the diagnosis of CTS, using the NPS.

Methods:

Seventy-five patients presenting to the clinic for evaluation of CTS complaints who had EDX were prospectively studied. US evaluation of the median nerve was then completed at time of evaluation. Patient satisfaction was determined by asking, “how likely are you to recommend this procedure to a friend or relative?” for both EDX and US. Patient demographics, comorbidities, CTS-6 questionnaire (CTS-6), and functionality assessed through patient-reported qDASH were also recorded.

Results:

Sixty-five patients were included in the study. Most patients did not have any comorbidities and were nonsmokers. The gender composition was similar, and the average age of the enrolled patients was 58. The NPS for US was significantly higher than EDX (P < 0.0001). Patients with diabetes mellitus rated their EDX experience significantly lower than those without diabetes mellitus.

Conclusions:

Patients are more likely to recommend US instead of EDX in the evaluation of CTS complaints. This allows for shared decision-making between the patient and provider if ordering diagnostic testing for CTS.
Safety and Efficacy of Goniotomy following Failed Surgery for Glaucoma
Authors: Lin Fengbin , Nie Xin , Shi Jiguang , Song Yunhe , Lv Aiguo , Li Xiaoyan , Lu Ping , Zhang Hengli , Jin Ling , Tang Guangxian , Fan Sujie , Weinreb Robert N. , Zhang Xiulan
Published: September 2023

Précis:

Goniotomy (GT) is an alternative surgery for patients with prior failed surgery for glaucoma.

Purpose:

To evaluate the efficacy and safety of GT in patients with prior failed surgery for glaucoma.

Materials and Methods:

A prospective, observational multicentered study was performed for patients who underwent GT with prior single or multiple surgery for glaucoma. Outcome measures included intraocular pressure (IOP) change, best-corrected visual acuity change, ocular hypotensive medication use, and occurrence of adverse events through 12 months. Complete success was defined as a postoperative IOP within 6–18 mmHg and a 20% reduction from baseline without ocular hypotensive medications. Qualified success was the same as the definition of complete success, except for postoperative use of medication. Logistic regression models were used to investigate the potential factors for surgical success.

Results:

A total of 38 eyes of 34 patients were included. Twenty-three eyes had only 1 prior surgery, 13 eyes had 2 prior surgeries, 1 eye had 3 prior surgeries, and 1 eye had 4 prior surgeries. At month 12, there was complete success in 42.1% of the eyes and qualified success in 78.9% of the eyes. Preoperatively, the mean IOP was 29.4±6.9 mmHg and the median number of glaucoma medications used was 3.0 (2.0, 4.0); this decreased to 16.7±3.6 mmHg (43.2% reduction; P<0.001) and 2.0 (0.0, 3.0) (P<0.001) at month 12, respectively. The most common complications included hyphema (13.2%), IOP spike (7.9%), and corneal edema (5.2%). Older age significantly contributed to surgical success.

Conclusions:

GT seems to be a safe and effective procedure for patients with prior failed surgery for glaucoma.
Treatment Outcomes for Juvenile Open Angle Glaucoma in Thailand
Authors: Seresirikachorn Kasem , Thiamthat Warakorn , Annopawong Kornkamol , Wanichwecharungruang Boonsong , Friedman David S. , Vu Daniel M.
Published: September 2023

Précis:

Juvenile open angle glaucoma (JOAG) patients with thick central corneas and negative family history were more likely to undergo surgery, mainly trabeculectomy with half requiring additional surgery within 10 years.

Purpose:

To assess the characteristics and treatment outcomes of patients with JOAG in Thailand.

Patients and Methods:

This retrospective, multicenter study included all patients diagnosed with JOAG over 12 years from 2 tertiary hospitals in Bangkok, Thailand.

Results:

A total of 200 eyes from 104 patients were included in this study. The mean age of onset was 24.0±10.1 years (range: 5–40 y), with male predominance (60.5%). Over 90% of patients had bilateral JOAG and 25% had a positive family history. Negative family history (adjusted odds ratio=4.59, P=0.02) and thick central corneal thickness were surgical predictors (every 10 µm adjusted odds ratio=1.29, P=0.01). Over 70% of cases needed glaucoma surgery. Trabeculectomy with Mitomycin-C was performed on 131 eyes (65.5%) with a cumulative probability of complete success of 71.0%, 57.8%, 39.2%, and 26.9% and qualified success of 86.3%, 73.6%, 64.8%, and 45.7% at 1, 3, 5, and 10 years, respectively. The mean follow-up after surgery was 94.9 ± 69.8 months (range: 13–153 mo). There were no serious postoperative complications. Myopia and the number of baseline glaucoma medications were significantly associated with surgical failure.

Conclusions:

Trabeculectomy with mitomycin C was the most common primary surgery performed in Thai patients with JOAG, and successfully reduced intraocular pressure without significant complications. Patients with thicker corneas were more likely to undergo surgery. By 10 years, half of the patients required additional surgery and risk factors for failure included myopia and the number of medications.
Association of Maternal Body Mass Index During Early Pregnancy With Offspring Lower Respiratory Infections: A Nationwide Cohort Study
Authors: Li Yang , Xie Qiuling , Huang Heyu , Gissler Mika , Zhang Xi , Lee Priscilla Ming Yi , Svendsen Katrine , Huang Lisu , Li Jiong , Fu Bo
Published: September 2023

Objective:

To assess whether or to what extent maternal obesity during early pregnancy could increase the risk of offspring lower respiratory infections (LRI).

Study design:

This population-based cohort included 688,457 live singleton births born in Denmark between 2004 and 2016. The exposure was maternal body mass index (BMI) during early pregnancy, and the outcome was LRI in offspring. Cox regression models were used to estimate hazard ratios with their 95% confidence intervals (CI) for the association. We also performed subanalysis stratified by the LRI onset age, number of infection episodes before the age of 3, infection pathogens, infection sites, duration of hospital stay due to LRI and allergic constitution of children.

Results:

A total of 64,725 LRIs in offspring were identified during follow-up. Maternal overweight (BMI 25.0–29.9 kg/m2), moderate or severe obesity (BMI 30.0–39.9 kg/m2) and very severe obesity (BMI ≥40 kg/m2) were associated with a 7% (95% CI: 5%–9%), 16% (95% CI: 14%–19%) and 21% (95% CI: 13%–28%) increased risk of LRI in offspring, respectively. Higher maternal BMI was positively associated with earlier onset age, more episodes before the age of 3, and longer hospital stay of LRI in offspring. In addition, allergic constitution of offspring significantly enhanced the effect of maternal BMI on offspring LRI (44% increased risk, 95% CI: 5%–97% for very severe obesity).

Conclusions:

Maternal BMI during early pregnancy might be a risk factor for offspring LRI, especially in children with allergic constitution.
Meropenem Clearance in a Child With End-stage Renal Disease Undergoing Prolonged Intermittent Renal Replacement Therapy: A Case Report and Literature Review
Authors: Shi Hai-Yan , Zhang Wei , Cao Wei , van den Anker John , Chen Xiao-Yu , Zhao Wei
Published: September 2023

Background:

Meropenem is frequently used to treat severe infections in critically ill children. However, pharmacokinetic data on meropenem in children with end-stage renal disease (ESRD) undergoing prolonged intermittent renal replacement therapy (PIRRT) is limited. Our objectives were to evaluate meropenem clearance in a child with ESRD with and without PIRRT, compare the results to previous continuous renal replacement therapy studies in children, toddlers and neonates, and assess whether the currently used dose of meropenem is sufficient.

Case description:

A 5-year-old girl with an estimated glomerular filtration rate of 12.8 mL/min/1.73 m2 was diagnosed with pulmonary infection and treated with 300 mg meropenem once a day. PIRRT was performed for 8 hours every 2 days. We used WinNonlin to evaluate meropenem clearance with and without PIRRT.

Results:

Our case showed that PIRRT increased the clearance of meropenem from 1.39 (1.3) to 2.42 L/h (2.3 mL/kg/min) and caught up 42.6% of the total clearance. This result is in accordance with previous studies in children but slightly less than seen in toddlers and neonates under continuous renal replacement therapy. The current dose of 300 mg once a day is not sufficient to reach the therapeutic target.

Conclusions:

Predicting meropenem clearance in children with ESRD undergoing PIRRT is difficult as clearance will be affected by renal function, PIRRT settings and other factors. Further studies are needed to explore the individual variability of meropenem clearance and optimize the dosing regimen.
Isolated Brain Cysts in Children Afflicted with Congenital Cytomegalovirus
Authors: Barnea-Melamed Shirel , Sever Aviv , Shapira Rootman Mika , Bilavsky Efraim
Published: September 2023

In our clinic, isolated brain cysts identified via early ultrasound are considered as central nervous system involvement in infants with children with congenital cytomegalovirus (cCMV). All infants were diagnosed with caudothalamic or subependymal cysts. When treated according to the cCMV protocol, these patients have an excellent prognosis and no neurological sequelae. Further data on the significance of different cysts in relation to cCMV is warranted.
No Additional Risk of Ampicillin Rash Among Pediatric Liver Transplant Recipients With Concurrent Epstein-Barr Virus Infection
Authors: Tokuda Yusuke , Yamada Masaki , Fukuda Akinari , Shoji Kensuke , Sakamoto Seisuke , Uchida Hajime , Ishiguro Akira , Imadome Ken-Ichi , Kasahara Mureo
Published: September 2023

Background:

Epstein-Barr virus (EBV) infection frequently develops in children undergoing liver transplantation (LT) because of mandated immunosuppressive therapy. There is a risk of ampicillin rash when penicillin derivatives are used in patients with EBV-associated infectious mononucleosis. Hence, the administration of penicillin derivatives may raise concerns about ampicillin rash in patients with high EBV loads. However, no studies confirmed the risk of administering penicillin derivatives to EBV-infected children after LT.

Methods:

This retrospective study was conducted at the largest pediatric transplantation center in Japan. We investigated all pediatric liver transplant recipients who received penicillin derivatives within 2 years of LT between 2014 and 2020. We separated the cohort into EBV-positive and EBV-negative groups to assess the frequency of ampicillin and antibiotic-associated rash.

Results:

Two hundred eighty-six liver transplant recipients were enrolled. There were 111 recipients in the EBV-positive group and 175 recipients in the EBV-negative group. In the EBV-positive group, 49 patients had high EBV DNA loads (≥1000 copies/µg DNA). None of the patients in either group developed ampicillin rash, and the frequency of antibiotic-associated rash did not differ [8/111 (7.2%) vs. 10/175 (5.7%), P = 0.797]. Additional subgroup analysis revealed no difference in the frequency of antibiotic-associated rashes regardless of the presence or absence of high EBV loads.

Conclusions:

In this study, ampicillin rash was not observed, and antibiotic-associated rash was not associated with concurrent EBV infection. Penicillin derivatives can be used safely, even in liver transplant recipients with persistent asymptomatic EBV infection.
Factors Associated With Culture-proven Neonatal Sepsis and Resistance to First-line Antibiotics in Indonesia
Authors: Permana Putu Bagus Dharma , Widodo Agung Dwi Wahyu , Setyaningtyas Arina , Wahyunitisari Manik Retno
Published: September 2023

Background:

Neonatal sepsis is one of the leading causes of neonatal morbidity and mortality in low- and middle-income countries. Blood culture positivity rates and antibiotic resistance pattern of neonatal sepsis differs across various regions. This study aims to identify clinical cofactors associated with blood culture-proven neonatal sepsis and in vitro resistance to first-line antibiotics (ampicillin and gentamicin) from cases originating in a tertiary healthcare center in Surabaya, Indonesia.

Methods:

A retrospective cohort study was conducted from January 2020 to August 2022 by utilizing secondary data collected from standardized electronic medical records. Microbiologic characteristics and associated factors were statistically analyzed using multivariable logistic regression.

Results:

Across 266 neonatal sepsis cases, 46.9% were culture-proven and 79.2% of confirmed sepsis were resistant to first-line antibiotics. The most common isolated pathogen is Klebsiella pneumoniae, followed by coagulase-negative Staphylococci, Acinetobacter baumannii and Enterobacter cloacae. Extremely preterm delivery [adjusted odds ratio (aOR): 5.813; 95% confidence interval (CI): 1.70–19.91] and late-onset sepsis (aOR: 9.165; 95% CI: 5.12–16.40) were associated with culture-proven neonatal sepsis. Increased odds of resistance to first-line antibiotics were identified in extremely preterm (<28 weeks) or very-preterm delivery (28 to <32 weeks) (aOR: 50.80; 95% CI: 1.66–1554.21 and aOR: 45.679; 95% CI: 3.22–647.46, respectively), cesarean section (aOR: 4.149; 95% CI: 1.04–16.53) and an absence of antenatal corticosteroid use (aOR: 0.233; 95% CI: 0.07–0.76).

Conclusions:

The association between clinical cofactors with culture-proven sepsis and antibiotic resistance emphasizes the importance for clinicians to adjust empirical antibiotic regimens based on the local antibiogram and resource availability.
Maternal Mental Health, COVID-19–Related Distress, and Disruptions in Lifestyle Behaviors Among Postpartum Mothers With a Previous Hypertensive Disorder of Pregnancy
Authors: Scott Jewel , Hauspurg Alisse , Davis Esa M. , Bryan Samantha , Catov Janet M.
Published: September 2023

Background

Many perinatal people experienced pandemic-related distress and changes in health behaviors at the onset of the COVID-19 pandemic, but less is known about how the pandemic continued to impact their health.

Objective

The authors of this study examined the influence of pandemic-related distress and maternal mental health on postpartum lifestyle behaviors of mothers with a previous hypertensive disorder of pregnancy.

Methods

Between September 2021 and March 2022, 82 postpartum (19.2 ± 5.5 months) mothers with a hypertensive disorder of pregnancy completed measures of pandemic-related distress and pandemic-related disruption in lifestyle behaviors from the Coronavirus Perinatal Experiences Impact Survey. A Patient Health Questionnaire-9 score ≥ 10 and a score ≥ 3 on the Breslau scale indicated significant depressive and posttraumatic stress disorder (PTSD) symptoms, respectively.

Results

Twenty-two (27.2%) and 30 (36.6%) participants had significant depressive or PTSD symptoms, respectively. In models adjusted for education, income, parity, delivery prepandemic or peripandemic, intervention group, and prepregnancy mental health history, both PTSD symptoms (B= 0.229,P= .029) and pandemic-related distress (B= 0.492,P< .001) associated with greater disruption in health behaviors. Depressive symptoms did not associate with greater disruption in health behaviors (B= 0.169,P= .135).

Conclusion

Monitoring PTSD symptoms may be vital in supporting mothers with hypertensive disorders of pregnancy in making lifestyle changes to prevent cardiovascular disease.
Protein C and protein S deficiencies are associated with increased risk of deep vein thrombosis in pregnant women using oral contraceptives
Authors: Elfaki Elyasa M. , Algarni Abdulrahman , Yousif Tagwa Yousif Elsayed , Hamza Alneil , Abdalhabib Ezeldine K. , Elzein Husham O. , Habiballah Eldaw M. , Ahmed Osama A.B. , Osman Hussam Ali , Kumar Praveen , Babker Asaad M.A. , Alfeel Ayman H. , Saboor Muhammad
Published: September 2023

Background

Oral contraceptives are commonly taken by women and are known to increase the risk of venous thromboembolism (VTE).

Objective

The aim of this study was to investigate the association between oral contraceptive use and natural anticoagulants, that is, protein C (PC), protein S (PS), and antithrombin in pregnant women with deep vein thrombosis (DVT).

Materials and methods

This case–control study was conducted on 330 pregnant women, that is, cases 165 (who used oral contraceptives) and controls 165 (who did not use oral contraceptives). The levels of PC, PS, and antithrombin were measured and compared between the two groups. The use of different types of oral contraceptives and their association with DVT and PC and PS were also analyzed.

Results

The study found that women with DVT had significantly lower levels of PC and PS compared with controls (P < 0.001). However, no significant difference was found in the levels of AT. Among the different types of oral contraceptives, first-generation progestin pills including Ethynodiol Diacetate, Norethindrone Acetate, Norethynodrel, and second-generation oral contraceptives (Lynestrenol, Levonorgestrel and Norgestrel) were not found to be associated with lower levels of PC and AT while Desogestrel, Norgestimate, and Gestodene (third-generation) were associated with lower levels of PS.

Conclusion

This study suggests that the use of contraceptives, particularly those containing Desogestrel, Norgestimate, and Gestodene, may be associated with a higher risk of thrombosis because of the associated lower levels of PS. Monitoring anticoagulant levels is crucial in preventing DVT in this population.
Patient satisfaction with nursing care in Iran: a systematic review and meta-analysis
Authors: Hosseini Seyed Javad , Sadeghi Tahereh , Heydari Abbas
Published: September 2023

Introduction:

Patient satisfaction (PS) with nursing care is considered one of the most important predictors of satisfaction with hospital services. The current research was conducted to determine the level of PS with nursing care provided in hospitals in Iran.

Methods:

A comprehensive systematic search was conducted in various international electronic databases, such as PubMed, Scopus, Web of Science, and Persian electronic databases such as Iranmedex, and the Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as ‘Patient satisfaction’, ‘Satisfaction’, ‘Nursing care’, and ‘Nurse’ from the earliest to 27 January 2023. The risk of bias was assessed using the Joanna Briggs Institute (JBI) scale, and the analysis was performed in Stata software version 14. Subgroup and sensitivity analyses were performed to clarify the source of heterogeneity.

Results:

The results showed that the overall PS with nursing care in different hospitals was 0.83 (95% CI: 0.79–0.86). The proportions of complete satisfaction, partial satisfaction, and dissatisfaction were 0.38 (95% CI: 0.23–0.53), 0.45 (95% CI: 0.34–0.55), and 0.17 (95% CI: 0.12–0.21), respectively.

Conclusion:

However, overall satisfaction was seen in four out of five patients admitted to hospitals in Iran, complete satisfaction with nursing care was 38%. Future studies should identify the effective factors related to PS with nursing care.
Adoption of minimally invasive mitral valve surgery: single-centre implementation experience in Vietnam
Authors: Thuan Phan Quang , Chuong Pham Tran Viet , Dinh Nguyen Hoang
Published: September 2023

The adoption of minimally invasive mitral valve surgery (MIMVS) has become a prominent trend in mitral valve procedures. This article emphasizes that the success of the MIMVS program relies not only on effective teamwork but also on comprehensive hospital support and a clearly defined training strategy. Additionally, targeted marketing initiatives that highlight the value of the heart valve centre are crucial for sustaining the program’s success and attracting a consistent patient flow. The implementation of these strategies requires diligent execution, consistent maintenance, and continuous improvement to ensure the triumph of the MIMVS program. This article aims to share our experience in implementing MIMVS at our centre, providing valuable insights for centres that have yet to adopt this approach or have low adoption rates. While acknowledging that sharing our centre’s experience cannot guarantee success in all centres, customizing the implementation by selecting appropriate features and access points is vital. Each centre may encounter unique challenges, and tailoring the strategy to address specific needs will enhance the effectiveness of the MIMVS program.
Addressing Opportunities and Barriers in Telehealth Neurologic Physical Therapy: Strategies to Advance Practice
Authors: Perron Aimee E. , Garg Hina , Gallagher Sarah , Kennedy Brittany , Oxborough Sara , Schultz Emily , Thielman Gregory , Zhang Qing
Published: September 2023

Background and Purpose:

Since the COVID-19 pandemic, the use and implementation of telehealth has expanded, with implementation moving ahead of best practice recommendations due to necessity. Telehealth has improved access and care coordination for patients with various neurologic conditions; however, information regarding therapeutic intensity, safety, and appropriateness is lacking. In 2021, the Academy of Neurologic Physical Therapy formed a Telehealth Taskforce to provide clinical and educational resources for its members and the neurologic physical therapy (PT) community. The purpose of this special interest article is to provide consensus-driven best practice resources developed by the Taskforce and describe the process of creating these resources to assist with telehealth implementation in neurologic PT practice, advocate for continued utilization, and shine light on opportunities for future research.

Summary of Key Points:

In this special interest article, we describe the process, challenges, and opportunities of developing and disseminating resources to educate, train, and support telehealth implementation in neurologic clinical practice. Four key strategies to facilitate telehealth implementation emerged: (1) increase knowledge of resources related to telehealth and mobile applications; (2) develop and disseminate evidence-based and consensus-based best practice recommendations for telehealth in neurologic PT; (3) provide future recommendations for integrating telehealth in PT, education, research, and clinical practice; and (4) encourage advocacy for inclusion of telehealth within the PT community. We explain the need to continue research and provide recommendations to expand telehealth research in neurologic clinical practice.

Recommendations for Clinical Practice:

This article highlights the potential and future of telehealth in neurologic PT practice. Our recommendations provide current clinical tools and resources for telehealth implementation following a knowledge-to-action framework and suggest areas for future research.

Video Abstract available for more insights from the authors (see the Video, the Supplemental Digital Content, available at: http://links.lww.com/JNPT/A447).
Orthosis use and ambulation in adults with myelomeningocele after orthotic management from childhood
Authors: Eriksson Marie , Bartonek Åsa
Published: September 2023

Background:

Orthotic devices are required for walking in many individuals with myelomeningocele. Evidence concerning orthosis use is sparse, partly because of heterogeneity among groups and different definitions of the neurological level.

Objectives:

The objective of this study was to investigate ambulation regarding orthosis use and satisfaction with orthoses after intense orthotic management during childhood.

Study Design:

The study design is a retrospective follow-up with a cross-sectional study at adult age.

Methods:

Participants comprised 59 persons born in 1985 or later. Ambulation was categorized as community (Ca), household (Ha), nonfunctional (N-f), and nonambulation (N-a) groups. Orthosis use was registered at approximately 5 (Age5) and 12 (Age12) years of age and in adulthood (AdultAge). Satisfaction with orthoses was evaluated at AdultAge.

Results:

At Age5, Age12, and AdultAge, orthoses were used by 100%, 98%, and 78% of participants, respectively. Ambulation deteriorated between Age5 and Age12 in 17% of participants and between Age12 and AdultAge in 46%. At AdultAge, 63% maintained their ambulatory function; and muscle function and hip and knee flexion contractures were strongly correlated with ambulation. The ambulation groups did not differ regarding satisfaction with device or services, except in 2 single items where the Ha group differed in ratings from the N-f and N-a groups.

Conclusion:

The high frequency of orthosis use and similar satisfaction in all ambulation groups emphasize that early planning and follow-up of orthosis treatment during growth are important for mobility in adulthood. Our results also underline the importance of a close assessment of each individual's condition.
Using In Situ Simulation to Identify Latent Safety Threats in Emergency Medicine
Authors: Grace Margaret A. , O'Malley Roisin
Published: September 2023

Summary Statement

This review aimed to explore existing literature on the use of in situ simulation to identify latent safety threats in emergency medicine. Studies were required to take place in a clinically active emergency department and have either a primary or secondary aim of identifying latent safety threats. A total of 2921 articles were retrieved through database searches and a total of 15 were deemed to meet the inclusion criteria.

Latent safety threats were detected by a variety of methods including documentation during debrief/discussion (66%), during the simulation itself (33%), participant surveys (20%), and video analysis (20%). Using a multimodality approach with input from observers and participants from different professional backgrounds yielded the highest number of threats per simulation case (43 per case). Equipment was the most commonly reported threat (83%), followed by teamwork/communication (67%). Some studies did not report on mitigation of identified risks; formal processes should be implemented for the management of latent safety threats identified by in situ simulation. Future research should focus on translational outcomes to further strengthen the position of in situ simulation in emergency medicine.
Impact of Umbilicus-Symphysis Pubis Distance on Technical Difficulties in Transabdominal Preperitoneal Hernia Repair (TAPP)
Authors: Arici Sinan
Published: September 2023

Introduction:

Laparoscopic inguinal hernia repair has gained popularity due to its advantages over open procedures. However, technical challenges and anatomical variations can affect surgical outcomes. The umbilicus-symphysis pubis (USP) distance has been identified as a potential factor impacting laparoscopic operations. This study aims to investigate the association between USP distance, technical difficulties, and operative time in the transabdominal preperitoneal (TAPP) surgery.

Methods:

A retrospective analysis was conducted on 122 patients who underwent elective TAPP surgery. USP distance was measured, and surgical data were collected. Statistical analysis was performed to evaluate the relationship between USP distance and operative time.

Results:

Among the patients, 80 underwent unilateral hernia repair, and 42 underwent bilateral hernia repair. In unilateral repair, USP distance did not significantly affect operative time. However, in bilateral repair, there was a significant association between USP distance and operation time prolongation (P=0.039).

Discussion:

TAPP surgery presents challenges due to limited visualization and anatomical variations. Factors like USP distance can impact surgical outcomes. A shorter distance increases complexity, while a longer distance facilitates smoother procedures. Surgeons should consider USP distance during surgical planning to optimize outcomes.

Conclusion:

The study findings indicate that USP distance is associated with prolonged operative time in TAPP bilateral hernia repair. Surgeons, especially those in the learning phase, can benefit from considering this relationship to optimize surgical outcomes and resource allocation. Further research is needed to validate these findings and explore additional factors influencing operative time in hernia repair surgeries.
Development of Self-made Gestures as an Adaptive Strategy for Communication in an Individual With Childhood Apraxia of Speech
Authors: Funayama Michitaka , Nakajima Asuka
Published: September 2023

Individuals with childhood apraxia of speech often exhibit greater difficulty with expressive language than with receptive language. As a result, they may benefit from alternative modes of communication. Here, we present a patient with childhood apraxia of speech who used pointing as a means of communication at age 2¼ years and self-made gestures at age 3½, when he had severe difficulties speaking in spite of probable normal comprehension abilities. His original gestures included not only word-level expressions, but also sentence-length ones. For example, when expressing “I am going to bed,” he pointed his index finger at himself (meaning I) and then put both his hands together near his ear (sleep). When trying to convey the meaning of “I enjoyed the meal and am leaving,” he covered his mouth with his right hand (delicious), then joined both of his hands in front of himself (finish) and finally waved his hands (goodbye). These original gestures and pointing peaked at the age of 4 and then subsided and completely disappeared by the age of 7, when he was able to make himself understood to some extent with spoken words. The present case demonstrates an adaptive strategy for communication that might be an inherent competence for human beings.
Comparative Risk of Type 2 Diabetes after Gastrectomy and Endoscopic Resection for Gastric Cancer: A Nationwide Cohort Study
Authors: Kwon Yeongkeun , Kwon Jin-Won , Kim Jiyun , Kim Dohyang , Hwang Jinseub , Ha Jane , Park Shin-Hoo , Park Sungsoo
Published: September 2023

Background:

Patients with gastric cancer (GC) experience two characteristic treatment modalities (gastrectomy or endoscopic resection), which may induce heterogeneity in the risk of post-cancer treatment type 2 diabetes (T2D). We investigated differences in the risk of T2D development in GC survivors according to the two treatment methods.

Study design:

This retrospective nationwide population-based cohort study included 14,646 patients with GC who underwent gastrectomy (n=12,918) and endoscopic resection (n=1,728). We enrolled patients who survived for ≥5 years post gastrectomy or endoscopic resection, no history of diabetes, and had not received adjuvant chemotherapy. The T2D risk was evaluated using Cox regression for the gastrectomy group compared to that for the endoscopic resection group. Given the competing risks of incident T2D and death, a competing risk regression was performed.

Results:

After a median follow-up duration of 8.1 years, the incidence rates of T2D in the endoscopic resection group and gastrectomy group were 7.58 and 6.98 per 1000 person-years, respectively. Patients undergoing gastrectomy showed a significantly higher risk of developing T2D than patients undergoing endoscopic resection (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.18–1.58; P<0.0001). In subgroup analyses, gastrectomy was associated with increased T2D risk in female patients (HR, 1.72; 95% CI, 1.22–2.43; P=0.030 for interaction).

Conclusion:

Among GC survivors, patients undergoing gastrectomy showed a 37% increased risk of T2D development compared to patients undergoing endoscopic resection. Subgroup analyses showed that T2D risk increased by up to 72% in female patients. These results provide insights for establishing screening and preventive strategies for GC survivors to prevent T2D according to different treatment modalities.
Third dose COVID-19 mRNA vaccine enhances IgG4 isotype switching and recognition of Omicron subvariants by memory B cells after mRNA but not adenovirus priming
Authors: Hartley Gemma E. , Fryer Holly A. , Gill Paul A. , Boo Irene , Bornheimer Scott J. , Hogarth P. Mark , Drummer Heidi E. , O’Hehir Robyn E. , Edwards Emily S.J. , van Zelm Menno C.
Published: September 2023

Background

Booster vaccinations are recommended to improve protection against severe disease from SARS-CoV-2 infection. With primary vaccinations involving various adenoviral vector and mRNA-based formulations, it remains unclear if these differentially affect the immune response to booster doses. We here examined the effects of homologous (mRNA/mRNA) and heterologous (adenoviral vector/mRNA) vaccination on antibody and memory B cell (Bmem) responses against ancestral and Omicron subvariants.

Methods

Healthy adults who received primary BNT162b2 (mRNA) (n=18) or ChAdOx1 (vector) (n=25) vaccination were sampled 1-month and 6-months after their 2nd and 3rd dose (homologous or heterologous) vaccination. Recombinant spike receptor-binding domain (RBD) proteins from ancestral, Omicron BA.2 and BA.5 variants were produced for ELISA-based serology, and tetramerized for immunophenotyping of RBD-specific Bmem.

Results

Dose 3 boosters significantly increased ancestral RBD-specific plasma IgG and Bmem in both cohorts. Up to 80% of ancestral RBD-specific Bmem expressed IgG1+. IgG4+Bmem were detectable after primary mRNA vaccination, and expanded significantly to 5-20% after dose 3, whereas heterologous boosting did not elicit IgG4+Bmem. Recognition of Omicron BA.2 and BA.5 by ancestral RBD-specific plasma IgG increased from 20% to 60% after the 3rd dose in both cohorts. Reactivity of ancestral RBD-specific Bmem to Omicron BA.2 and BA.5 increased following a homologous booster from 40% to 60%, but not after a heterologous booster.

Conclusion

A 3rd mRNA dose generates similarly robust serological and Bmem responses in homologous and heterologous vaccination groups. The expansion of IgG4+Bmem after mRNA priming might result from the unique vaccine formulation or dosing schedule affecting the Bmem response duration and antibody maturation.
Poultry Ownership in Urban Kenya is Associated with Increased Fecal Contamination in Household Soil
Authors: Chan Elana M. G. , Swarthout Jenna M. , Chieng Benard , Araka Sylvie , Mboya John , Imali Christine , Harris Angela R. , Njenga Sammy M. , Pickering Amy J.
Published: September 2023

Animal feces can contain zoonotic enteropathogens capable of causing human diarrheal disease. Limited knowledge exists on domestic animal management in low-income urban settlements. We leveraged survey data and environmental samples collected from 120 urban Kenyan households to understand poultry husbandry practices and assess if household poultry ownership was associated withEscherichia colicontamination in stored water and soil. Fifty-five percent (n = 66) of households were in poultry-owning compounds, and 59.1% (n = 39) of these households reported poultry entering the household quarters. Among these 39 households, 53.9% (n = 21) kept poultry in the sleeping quarters of under-5 children. Household poultry ownership (49.2%, n = 59) was associated with increasedE. coliconcentrations in soil but not withE. coliprevalence in stored water. Poultry husbandry in urban settings may promote zoonotic disease transmission, and household soil may be an important transmission pathway for poultry-associated fecal contamination.
Generation and assessment of cytokine-induced killer cells for the treatment of colorectal cancer liver metastases
Authors: Ying Li Celine Man , Tomita Yoko , Dhakal Bimala , Tin Teresa , Li Runhao , Wright Josephine A , Vrbanac Laura , Woods Susan L , Drew Paul , Price Timothy , Smith Eric , Maddern Guy J , Fenix Kevin
Published: September 2023

Colorectal cancer (CRC) is the second leading cause of cancer-related death worldwide. Cytokine-induced killer (CIK) cells are an adoptive immunotherapy reported to have strong anti-tumour activity across a range of cancers. They are a heterogeneous mix of lymphoid cells generated by culturing human peripheral blood mononuclear cells (PBMCs) with cytokines and monoclonal antibodiesin vitro. We compared CIK cells from healthy donors and donors with CRC liver metastases, generated in RPMI supplemented with 10% fetal bovine serum (FBS) or three different serum-free media. CIK cells generated in serum free medium X-VIVO 15 were comparable to those from RPMI medium with 10% FBS in terms of the number and percentages of the main subsets of cells in the CIK culture, and the intracellular levels of granzyme B and perforin, and the pro-inflammatory cytokines IL-2, IFN-γ and TNF-α. There was no significant difference in cytotoxicity against CRC cell lines grown in 2D cultures or as spheroids, and against autologous patient-derived tumour organoids. CIK cells from patients with CRC liver metastases grown in X-VIVO 15 media were similar to those from healthy donors in each of the measures. Donor attributes such as age, sex, or prior chemotherapy exposure had no significant impact on CIK cell numbers or function. These results support further investigations into the therapeutic application of autologous CIK cells in the management of patients with CRC liver metastases.
Preclinical exploration of the DNA Damage Response pathway using the interactive neuroblastoma cell line explorer CLEAN
Authors: Gabre Jonatan L. , Merseburger Peter , Claeys Arne , Siaw Joachim , Bekaert Sarah-Lee , Speleman Frank , Hallberg Bengt , Palmer Ruth H. , Van den Eynden Jimmy
Published: September 2023

Neuroblastoma (NB) is the most common cancer in infancy with an urgent need for more efficient targeted therapies. The development of novel (combinatorial) treatment strategies relies on extensive explorations of signaling perturbations in neuroblastoma cell lines, using RNA-Seq or other high throughput technologies (e.g., phosphoproteomics). This typically requires dedicated bioinformatics support, which is not always available. Additionally, while data from published studies are highly valuable and raw data (e.g., fastq files) are nowadays released in public repositories, data processing is time-consuming and again difficult without bioinformatics support. To facilitate NB research, more user-friendly and immediately accessible platforms are needed to explore newly generated as well as existing high throughput data. To make this possible, we developed an interactive data centralization and visualization web application, called CLEAN (the Cell Line Explorer web Application of Neuroblastoma data;https://ccgg.ugent.be/shiny/clean/). By focusing on the regulation of the DNA damage response, a therapeutic target of major interest in neuroblastoma, we demonstrate how CLEAN can be used to gain novel mechanistic insights and identify putative drug targets in neuroblastoma.