bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Microsurgical Reconstruction Timing on the Risk of Free Flap Loss in Acute Burns: Systematic Review and Meta-Analysis
Authors: Alessandri-Bonetti Mario , Kasmirski Julia A. , Liu Hilary Y. , Corcos Alain C. , Ziembicki Jenny A. , Stofman Guy M. , Egro Francesco M.
Published: August 2024

Background:

Free tissue transfer is usually considered as a last resort in severe burn cases, when skin substitutes and local flaps are not viable options. Prior studies have demonstrated a free flap loss rate ranging from 0% to 44%. The aim of this study is to identify the ideal timing to perform free flap reconstruction in acute burn-related injuries to minimize free flap loss.

Methods:

A systematic review and meta-analysis was performed and reported according to PRISMA guidelines. PubMed, Embase, Web of Science, and Cochrane Library databases were queried. The review protocol was registered on PROSPERO database (CRD42023404478). Three time intervals from day of injury were identified: (1) 0–4 days, (2) 5–21 days, and (3) 22 days–6 weeks. The primary outcome was total free flap loss.

Results:

A total of 17 articles met inclusion criteria. The analysis included 275 free flaps performed in 260 patients (88% men, 12% women) affected by acute burn injuries. The pooled prevalence of free flap failure in the three time intervals (0–4 days, 5–21 days, and 22 days–6 weeks) were 7.32% [95% confidence interval (CI): 2.38%–20.37%], 16.55% (95% CI: 11.35%–23.51%), and 6.74% (95% CI: 3.06%–14.20%), respectively.

Conclusions:

Free flap reconstruction carries a high risk of failure in patients with acute burn. However, timing of the reconstruction appears to influence surgical outcomes. Free flap reconstruction performed between 5 and 21 days from burn injury had a trend toward higher flap loss rates and should be discouraged.
Knot Security 101: A Comprehensive Practical Review to Optimal Knot Configuration, Pulling Direction, Throw Count, and Tail Length
Authors: Bushong Elizabeth E. , Janis Jeffrey E.
Published: August 2024

Background:

Knots are the weakest structural point in a suture line and inevitably weaken almost all suture materials. This practical review critically evaluates the factors, such as suture material properties, gauge, configuration, throw count, and tail length, that affect knot security.

Methods:

A PubMed search between the years 1934 and 2023 identified relevant studies that addressed factors relating to knot security. Studies that investigated knots and sutures solely used in laparoscopic and arthroscopic surgery were excluded. Knot configurations assessed were the Aberdeen, sliding, square, and surgeon’s.

Results:

Eighty-six articles were included in this review article and demonstrated that knot security varies greatly between suture materials and gauge. Knot security also varies by configuration, throw count, conditions, tail length, and stitch type. Throw count differs by knot configuration, with the Aberdeen knot being most secure with three throws and one to two turns compared with three to five throws for surgeon’s and square knots. The optimal tail length was 3 mm.

Conclusions:

This practical review demonstrates that there are significant differences in knot security based on a variety of factors. It is challenging to propose an ideal knot because most studies did not evaluate knot security using a broad variety of suture materials, gauges, and throws for each of the most common knots. Although this review article demonstrated several applicable findings, additional robust studies are needed to simplify proposals.
PARS PLANA VITRECTOMY FOR THE TREATMENT OF VITREOUS AMYLOID IN PATIENTS WITH HEREDITARY TRANSTHYRETIN AMYLOIDOSIS
Authors: Marques João Heitor , Morais Inês , Coelho João , Severo Milton , Menéres Maria João , Beirão João Melo
Published: August 2024

Purpose:

To describe a series of patients with hereditary transthyretin amyloidosis with vitreous amyloid and to study the efficacy and safety of pars plana vitrectomy for its treatment.

Methods:

Retrospective study of 266 patients with hereditary transthyretin amyloidosis because of Val30Met mutation submitted to pars plana vitrectomy for vitreous amyloid, with a minimum of 3-month follow-up. Indications for surgery were disabling myodesopsia or two lines loss in visual acuity. Only the first operated eye was considered for analysis.

Results:

Male patients were operated at younger age (51.0 vs. 53.6, P < 0.001). Best-corrected visual acuity improved from 0.38 to 0.89 (decimal scale, P < 0.001). Preoperative glaucoma was associated with lower gain in visual acuity (P < 0.001). During the follow-up, 69%, 22%, and 1% developed new-onset glaucoma, retinal angiopathy, or retinal detachment, respectively, and 36% required cataract surgery. Pars plana vitrectomy was also required in the fellow eye in 57%. Hereditary transthyretin amyloidosis–related death occurred in 27%, 9.3 (95% confidence interval 8.0 to 10.7) years after pars plana vitrectomy.

Conclusion:

Vitreous opacities are frequently the first symptomatic manifestation of ocular amyloidosis. Moreover, they may be a marker of mortality. Vitrectomy is a safe and effective treatment, but these patients require long-term follow-up to monitor the development or worsening of glaucoma or retinal angiopathy.
Paenibacillus lautus: A new foe in endogenous endophthalmitis
Authors: Joshi Aditi , Rao Chetan , Majumder Parthopratim Dutta , Anand A. R.
Published: August 2024

Purpose:

To discuss the diagnosis and management of a rare case of endogenous endophthalmitis (EE) caused by Paenibacillus lautus mimicking granulomatous uveitis in a child, highlighting the use of 16S rRNA gene amplicon sequencing as an accurate method to identify rare pathogens.

Method:

A retrospective chart review of the clinical presentation, microbiologic workup—including microscopy, culture, antibiotic susceptibility, and polymerase chain reaction for pathogen DNA of clinical samples—and the clinical management of the case were recorded.

Result:

A 13-year-old boy presented with decreased vision in the right eye for one month. On examination, he had uveitis with hypopyon and complicated cataract. The case underwent an anterior chamber tap followed by vitrectomy and lensectomy. The culture of the vitreous aspirate grew Gram-variable bacilli that could not be identified by conventional microbiological techniques. However, PCR-based sequencing of the 16S rRNA gene was performed, and the bacterium was identified as P. lautus. The patient subsequently developed rhegmatogenous retinal detachment, for which he underwent endo laser photocoagulation and oil tamponade. Four months later, silicone oil was removed, and an intraocular lens was implanted. At six weeks follow-up, the retina remained well attached, and intraocular pressure was maintained.

Conclusion:

P. lautus can cause EE and mimic granulomatous uveitis. Techniques such as 16S rRNA gene sequencing can significantly facilitate aetiological diagnosis in cases where conventional methods fail.
Efficacy and Safety of Antibiotics for the Treatment of Relapsing Fever: A Systematic Review and Network Meta-analysis
Authors: Gao Li , Wu Xinya , Liu Meixiao , Fan Yuxin , Chen Jingjing , Yang Jiaru , Ma Weijie , Zhong Lei , Peng Li , Wu Hanxin , Kong Jing , Li Bingxue , Dong Yan , Ma Weijiang , Liu Aihua , Bao Fukai
Published: August 2024

Relapsing fever is an acute infectious disease caused by a variety of relapsing fever-associated spirochetes, for which no optimal treatment has been developed. The purposes of this study were to compare the efficacy and safety of commonly used antibiotics for the treatment of relapsing fever using a network meta-analysis approach and to explore the advantages of each drug based on the current evidence. This study examined nine published studies involving 1416 patients with relapsing fever treated with penicillin, erythromycin, tetracycline, doxycycline, minocycline or chloramphenicol. The odds ratio (OR) and 95% confidence interval (CI) were used as influence indices for discontinuous data, and the efficacy and safety of drugs were ranked by the surface under the cumulative ranking (SUCRA) curve. The primary outcomes of this study were mortality and cure rates, and the secondary outcomes were the rates of Jarisch-Herxheimer reaction and relapse. Erythromycin (SUCRA, 84.5%) was the most effective antibiotic for reducing mortality, whereas tetracycline was the most effective antibiotic for improving the cure rate (SUCRA, 69.3%) and reducing the relapse rate (SUCRA, 79.7%), and minocycline (SUCRA, 66.4%) was the most effective antibiotic for reducing Jarisch-Herxheimer reactions. In addition, our network meta-analysis showed that tetracycline is superior to penicillin for improving the cure rate (OR, 5.91; 95% CI, 2.21–15.81) and reducing the relapse rate (OR, 0.16; 95% CI, 0.04–0.67).
Clinical characteristics and treatment of psychosis in Parkinson’s disease: A narrative review
Authors: Stamenović Jelena , Živadinović Biljana , Đurić Vanja
Published: August 2024

Parkinson’s disease (PD) is a chronic, progressive, neurodegenerative disorder whose clinical presentation consists of motor and non-motor signs and symptoms. Among the non-motor symptoms, psychosis can occur in the later stages of the disease. Psychosis in PD (PDP) is a common, complex, and significantly disabling disorder associated with poorer quality of life, accelerated cognitive decline, need for hospitalization or institutionalization, and mortality. Hallucinations are a significant symptom of PDP, sporadic at first but more frequent in the later course of the disease, and significantly disrupt daily activities. Appropriate and timely screening of psychotic manifestations is necessary for adequate therapeutic procedures. After the exclusion of comorbid conditions as a possible cause of psychosis, correction of antiparkinsonian therapy may be required, and if necessary, the introduction of antipsychotics. The latest therapeutic recommendations include the use of pimavanserin, if available, otherwise second-generation or atypical antipsychotics. Although PDP has long been recognized as a possible complication in the course of the disease, further clinical studies are needed to fully understand its etiopathogenesis and pathophysiological mechanisms.
TBK1 p.Y153Qfs*9 variant may be associated with young-onset, rapidly progressive amyotrophic lateral sclerosis through a haploinsufficiency mechanism
Authors: Fang Shih-Yu , Tsai Pei-Chien , Jih Kang-Yang , Hsu Fang-Chi , Liao Yi-Chu , Yang Chih-Chao , Lee Yi-Chung
Published: August 2024

Background:

TBK1 variants have been implicated in the pathogenesis of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia spectrum disorder. The current study elucidated the clinical and molecular genetic features of a novel TBK1 variant identified in a patient with young-onset, rapidly progressive ALS.

Methods:

The coding regions of TBK1, SOD1, TARDBP, and FUS were genetically analyzed using Sanger sequencing. Repeat-primed polymerase chain reaction (PCR) was used to survey the GGGGCC repeat in C9ORF72. The study participant underwent a comprehensive clinical evaluation. The functional effects of the TBK1 variant were analyzed through in vitro transfection studies.

Results:

We identified a novel frameshift truncating TBK1 variant, c.456_457delGT (p.Y153Qfs*9), in a man with ALS. The disease initially manifested as right hand weakness at the age of 39 years but progressed rapidly, with the revised ALS Functional Rating Scale score declining at an average monthly rate of 1.92 points in the first year after diagnosis. The patient had no cognitive dysfunction. However, Technetium-99m single photon emission tomography indicated hypoperfusion in his bilateral superior and middle frontal cortices. In vitro studies revealed that the p.Y153Qfs*9 variant resulted in a truncated TBK1 protein product, reduced TBK1 protein expression, loss of kinase function, reduced interaction with optineurin, and impaired dimerization.

Conclusion:

The heterozygous TBK1 p.Y153Qfs*9 variant may be associated with young-onset, rapidly progressive ALS through a haploinsufficiency mechanism.
The Nature of Employment in a High Socioeconomic Hardship Community
Authors: Bonney Tessa , Rospenda Kathleen M. , Chaudhry Aeysha , Forst Linda , Conroy Lorraine M. , Holloway Adlaide , Berumen Teresa , Castaneda Dolores , Castaneda Yvette , Gonzalez Sylvia , Hebert-Beirne Jeni
Published: August 2024

Objectives

This cross-sectional survey aimed to examine employment characteristics and their associations with employment precarity in two high socioeconomic hardship Chicago neighborhoods.

Methods

We used a community-based participatory approach to develop and administer a survey to residents who perceived their work situations to be precarious.

Results

A total of 489 residents were surveyed. Responses were skewed toward the most precarious work situations, with the majority of respondents employed outside of a traditional arrangement. Those in the highest precarity category were most likely to identify as Latinx and born outside of the United States. Unstable, low-quality employment conditions were nearly all significantly associated with highest precarity work situations.

Conclusions

Precarious employment is an important predictor of other employment conditions, and characterizing these at a hyperlocal level allows for a nuanced understanding of work as a determinant of health.
Evaluation of Air Consumption Efficiency in Structural Firefighters
Authors: Langford Emily L. , Bergstrom Haley C. , Lanham Sarah N. , Eastman Alyssa Q. , Best Stuart , Ma Xin , Abel Mark G.
Published: August 2024

Objective

This study examines variability in air consumption (AC) between firefighters (FF) working at a standardized pace, evaluates the relationship between air consumption efficiency (ACE) and work economy, identifies parameters associated with ACE, and explores the relationship between ACE and self-paced work rate.

Methods

FF completed randomized trials of an air consumption drill at a standardized pace while breathing through a self-contained breathing apparatus and a gas analyzer. A subsample completed another trial at a self-selected pace.

Results

The average AC variability (±1 standard deviation) was ~3.1 min of cylinder usage (13.7%). AC was positively associated with work economy and numerous physiological and anthropometric outcomes. No relationship was found between ACE and self-paced air consumption drill time.

Conclusions

FF working at higher internal strain demonstrated poorer ACE. Improving metabolic tolerance may extend the self-contained breathing apparatus' functional duration to enhance productivity and safety.
Feasibility of Cryobiopsy Specimen Retrieval Through Standard Guide Sheath for Peripheral Pulmonary Lesions Without Bronchoscope Removal
Authors: Kho Sze Shyang , Tan Shirin Hui , Nyanti Larry Ellee , Chai Chan Sin , Ismail Adam Malik , Tie Siew Teck
Published: August 2024

Background:

Transbronchial cryobiopsy is a promising technique for biopsy of peripheral pulmonary lesions (PPL). However, cryobiopsy specimen retrieval can pose problems due to the risk of bleeding during the blind period when the bronchoscope and cryoprobe are removed en bloc. Artificial airways and prophylactic balloon placement are risk-reducing measures, but the latter is challenging in upper lobe PPL. Specimen retrieval through standard guide sheath (GS) system without the need for bronchoscope removal may now be feasible with the ultrathin cryoprobe.

Methods:

Retrospective review of radial endobronchial ultrasound (rEBUS)-guided transbronchial cryobiopsy for PPL cases in which cryobiopsy specimen was retrieved through the GS over a 6-month period.

Results:

Twenty patients were included with an overall median age of 66.50 (IQR: 53.0 to 76.7). The median procedural time was 30 (IQR: 25.0 to 33.7) minutes. Median target size was 3.20 (IQR: 2.17 to 4.84) cm with 85% of lesions demonstrated “within” rEBUS orientation. Overall technical feasibility was 85% with median cryoactivation of 4.0 (IQR: 3.0 to 4.0) seconds. No specimen was retrieved in 3 patients. The diagnostic yield for forceps and cryobiopsy was 70% and 60%, respectively, and the combined diagnostic yield was 85% (P<0.01 vs. forceps biopsy). Median aggregate size for forceps and cryobiopsy was 8.0 (IQR: 5.3 to 10.0) and 4.5 (IQR: 2.3 to 7.0) mm respectively (P<0.01). No pneumothorax was reported and mild self-limiting bleeding was encountered in 30% of cases.

Conclusion:

Retrieval of cryoprobe through standard GS appears to be a safe and feasible method that can simplify the transbronchial cryobiopsy procedure and complement forceps biopsy in specific cases.
Curved Spine: The Shape of Spine in Taoist Body Diagrams and Its Influence on Medical Body Diagrams
Authors: ZHANG Xinyue , ZHANG Shujian
Published: August 2024

From the early Taoist diagrams of the human body to the end of the Qing dynasty and the beginning of the Republic of China, Taoists exaggerated and deformed the human spine in a shape-shifting manner. It is likely that medical practitioners were influenced by this style of representation, and there are also numerous diagrams of the human body with the curved spine in the lateral-view diagrams of viscera and Ming Tang Tu (明堂图 Acupuncture and Moxibustion Chart), which constantly show the human torso in an elliptical “egg shape”. No later than the Ming dynasty, medical practitioners began to depict the actual physiological spinal curve of the human body. By the Qing dynasty, the depiction of the spinal curve in medical diagrams of the human figure showed a tendency to part ways with the Taoist freehand style of the previous generation. Although the representation of the curve of the spine was very crude, later medical images of the human body at least gradually straightened the spine and no longer depicted it in a shape-shifting manner. However, the curved spine in Taoist diagrams of the human body continued to exist, and the presentation of the curved spine never changed. This way of depicting its appearance, which is very different from reality, is shaped by Taoism’s special way of perceiving and viewing the body, and may also contain another form of truth.
Integrative Korean medicine treatment for inpatients with osteoarthritis of the knee: An observational study
Authors: Lee Soo Kyeong , Oh Eun Je , Bae Gun Hee , Woo Jae Hyuk , Lee Yoon Jae , Ha In-Hyuk , Kim Ju Yeon , Kim Doori
Published: August 2024

The use of integrative Korean medicine treatment (IKMT) for patients with knee osteoarthritis (OA) has been reported previously; however, to date, no studies have investigated the long-term prognosis of these patients following IKMT for primary knee OA. We aimed to examine the long-term effects of IKMT in patients diagnosed with primary knee OA and receiving IKMT during hospitalization. This retrospective observational study, complemented by a follow-up survey, included patients with primary knee OA who received IKMT during hospitalization across 7 Korean medicine hospitals. The primary outcome was the Numerical Rating Scale knee-pain score, whereas the secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol-5 dimension-5 level questionnaire (EQ-5D-5L), and Patient Global Impression of Change scores. Patients were evaluated at admission, discharge, and during follow-up. Of the 180 included patients, 81 responded to the survey. Compared with the corresponding values at admission, the Numerical Rating Scale score decreased by 2.44 (2.08–2.81) points at discharge and 1.89 (1.5–2.26) points at follow-up. Additionally, compared with their scores at admission, the WOMAC score decreased by 17.20 (13.68–20.71) points at discharge and 25.74 (22.22–29.26) points at follow-up, whereas the EuroQol-5 dimension-5 level questionnaire score improved by ‐0.15 (‐0.18 to ‐0.12) points at discharge and ‐0.12 (‐0.15 to ‐0.09) points at follow-up. The patients expressed high satisfaction with pharmacopuncture (65.4%), acupuncture (54.03%), physical therapy (35.8%), and herbal medicine (34.6%). Regarding Patient Global Impression of Change, 96.30% of the patients reported improvement. IKMT was effective in improving pain, functional disability, and quality of life in patients with primary knee OA. Its effects were maintained throughout the long-term follow-up period, and physical functions continuously improved.
The efficacy of the 5E rehabilitation nursing model combined with mindfulness training on alleviating psychological distress and modulating coping styles in patients with acute myocardial infarction post-PCI: An observation study
Authors: Liu Yan , Sun Aijiao , Hu Xin
Published: August 2024

To explore the influence of the 5E rehabilitation nursing model integrated with mindfulness training on mitigating psychological distress and adjusting coping styles in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). The clinical data of 94 patients with AMI who underwent PCI from August 2020 to January 2022 were retrospectively analyzed. Patients were divided into 2 groups based on different nursing modes. Among them, 47 cases received routine interventions were categorized into the control group, and 47 cases received the 5E rehabilitation nursing model integrated with mindfulness training on the basis of routine interventions were categorized into the study group. After 3 months of intervention, both groups exhibited a significant reduction in Self-Rating Anxiety Scale and Depression Scale scores compared to the pre-intervention period, with the study group demonstrating lower scores than the control group (P < .05). Herth Hope Index scores significantly improved in both groups after intervention, with the study group exhibiting higher scores than the control group (P < .05). After 3 months of interventions, Self-Care Agency scores significantly elevated in both groups, with the study group demonstrating higher scores than the control group (P < .05). WHO Quality of Life-BREF scores significantly improved in both groups, with the study group demonstrating higher scores than the control group (P < .05). The study group exhibited higher compliance and satisfaction levels and lower complication rate compared to the control group (P < .05). Integrating the 5E rehabilitation nursing model with mindfulness training effectively alleviates psychological distress, ameliorates quality of life, and improves satisfaction in AMI patients after PCI.
The effects of gaze stability exercises on balance, gait ability, and fall efficacy in patients with chronic stroke: A 2-week follow-up from a randomized controlled trial
Authors: Cui Zhe , Tang Ying-Ying , Lee Myoung-Ho , Kim Myoung-Kwon
Published: August 2024

Background:

This study aimed to examine the effect of gaze stability exercises on balance, gait ability, and fall efficacy in patients with chronic stroke, as well as to investigate whether any observed effects were maintained 2 weeks later.

Methods:

In this experiment, 30 chronic stroke patients were selected. The patients were randomly divided into 3 groups (10 patients in each group). All patients in the 3 groups performed basic neurodevelopmental treatment. Group 1 performed balance exercises accompanied by gaze stability exercises. Group 2 performed gaze stability exercises, and group 3 performed balance exercises. Each exercise program for 40 minutes 3 times a week for 4 weeks. After the intervention period, the patient’s balance, gait ability, and fall efficacy were measured again. In order to know whether the training effect is maintained, a 2-week follow-up test was conducted after the training.

Results:

The results of this study showed that there was a significant improve in balance (overall stability index, limit of stability test, and Berg Balance Scale), gait ability (gait velocity, cadence, step time and step length, Timed Up and Go [TUG] test), and fall efficacy over the different time within the 3 groups. The effect was observed to be maintained in follow-up tests after 2 weeks. In the comparison among 3 groups, the overall stability index, limit of stability test in the balance test and the gait velocity, cadence, step time, step length and Timed Up and Go test in the gait test all showed statistically significant differences, and the other items did not have significant differences. In most of the assessments, group 1 that used balance exercise combined with gaze stability exercise showed a better improvement than the other 2 groups.

Conclusion:

As a result, for stroke patients, gaze stability exercise is an effective arbitration method to improve balance and gait ability and fall efficacy. With balance exercise combined with gaze stability exercise, a greater effect can be seen than with gaze stability exercise or balance exercise alone. Thus, this combination exercise program can be recommended as effective.
Patient education in the digital age: An analysis of quality and readability of online information on rhinoplasty
Authors: Coluk Yonca , Senocak Muhammed Irfan
Published: August 2024

This study aimed to investigate quality and readability of online rhinoplasty information provided on Turkish websites. We searched for the terms “rhinoplasty” (rinoplasti) and “nose job” (burun estetiği) in Turkish using the Google search engine in May 2023. The first 30 sites for each term were included in the evaluation. We used the DISCERN tool to evaluate quality and the Atesman and Cetinkaya-Uzun formulas to assess readability. According to the Atesman formula, the readability scores of all the websites were moderately difficult. According to the Cetinkaya-Uzun formula, the readability scores of websites were at the instructional reading level. The mean total DISCERN score was 2.33 ± 0.60, indicating poor quality. No statistically significant correlations were found between the Atesman or Cetinkaya-Uzun readability scores and the DISCERN scores across all websites (P > .05). Our analysis revealed key areas in which Turkish websites can improve the quality and readability of rhinoplasty information to support decision-making.
Mixed Mode Substantially Increases Hospital Consumer Assessment of Healthcare Providers and Systems Response Rates Relative to Single-Mode Protocols
Authors: Beckett Megan K. , Elliott Marc N. , Hambarsoomian Katrin , Lehrman William G. , Goldstein Elizabeth , Giordano Laura A. , Brown Julie
Published: August 2024

Background:

Low response rates (RRs) can affect hospitals’ data collection costs for patient experience surveys and value-based purchasing eligibility. Most hospitals use single-mode approaches, even though sequential mixed mode (MM) yields higher RRs and perhaps better patient representativeness. Some hospitals may be reluctant to incur MM’s potential additional cost and complexity without knowing how much RRs would increase.

Objective:

The aim of this study was to estimate the differences in RR and patient representation between MM and single-mode approaches and to identify hospital characteristics associated with the largest RR differences from MM of single-mode protocols (mail-only, phone-only).

Research Design:

Patients were randomized within hospitals to one of 3 modes (mail-only, phone-only, MM).

Subjects:

A total of 17,415 patients from the 51 nationally representative US hospitals participating in a randomized HCAHPS mode experiment.

Results:

Mail-only RRs were lowest for ages 18–24 (7%) and highest for ages 65+ (31%–35%). Phone-only RRs were 24% for ages 18–24, increasing to 37%–40% by ages 55+. MM RRs were 28% for ages 18–24, increasing to 50%–60% by ages 65–84. Lower hospital-level mail-only RRs strongly predicted greater gains from MM. For example, a hospital with a 15% mail-only RR has a predicted MM RR >40% (with >25% occurring in telephone follow-up).

Conclusion:

MM increased representation of hard-to-reach (especially young adult) patients and hospital RRs in all mode experiment hospitals, especially in hospitals with low mail-only RRs.
The Mediating Role of Insomnia Severity in the Relationship Between Anxiety Symptoms and Suicidal Ideation
Authors: Berardelli Isabella , Sarubbi Salvatore , Trocchia Maria Anna , Longhini Ludovica , Moschillo Antonella , Rogante Elena , Cifrodelli Mariarosaria , Erbuto Denise , Innamorati Marco , Pompili Maurizio
Published: August 2024

Insomnia and anxiety symptoms are independent clinical variables involved in suicidal ideation in psychiatric inpatients. In this article, we investigated the relationship among insomnia severity, severity of anxiety symptoms, and suicidal ideation in a sample of psychiatric inpatients with severe mental disorders. We used a mediation model considering insomnia severity as the possible mediator of the relationship between anxiety severity and suicidal ideation. We administered the Columbia Suicide Severity Rating Scale, the Insomnia Severity Index, and the Hamilton Anxiety Rating Scale to 116 consecutive inpatients to the psychiatric unit of Sant'Andrea Hospital in Rome. The effect of anxiety symptoms was mediated by insomnia severity; patients who perceive higher anxiety symptoms were more likely to experience higher levels of insomnia and, thus, higher suicidal ideation intensity. Results showed the importance of assessing and treating both insomnia and anxiety in clinical practice.
Manifestations of Paranoid Personality in Workaholic Middle Managers
Authors: Spytska Liana
Published: August 2024

The problem of paranoid disorders is widespread and difficult to diagnose due to the many mental symptoms that a person often perceives as character traits. Passion for work, the so-called pathological workaholism, harms not only the suffering person but also all the people around them, affecting their quality of life and disrupting social and family ties. The purpose of study was to determine the level of pathological workaholism and its main symptoms. The objectives of the study included interviewing respondents and identifying the correlation between the level of workaholism and mental manifestations, and finding differences in the manifestations of workaholism in men and women. For this purpose, 78 people were examined, including 38 women and 40 men. All participants worked as middle managers in multinational companies. The aim was to identify people with pathological workaholism among the participants using the “Work Addiction Risk Test” questionnaire. Among managers, a high degree of predisposition to workaholism was diagnosed. We found that women have a strong tendency to be fixated on work, and as a result, they have increased rumination anxiety. Regardless of gender, managers who took part in the study showed a pronounced manifestation of paranoid and obsessive-phobic disorders, depression, and asthenic manifestations. Regarding the relationship between neurotic symptoms and a tendency to workaholism, a high correlation was observed (p < 0.05). The results of this study may be useful for specialists to develop means of preventing and effectively treating paranoid workaholism, as a disease that is increasingly having a negative impact on society.
Exploring Effects of Food Shaming on Consumers’ Food-Related Attitudes and Behaviors
Authors: Broome Jessica , Kaplan Hannah , McCullars Jessica , Harris Janet , Rosenbloom Christine
Published: August 2024

Objective

To compare attitudes and behaviors of American adults who have experienced food shaming versus those who have not.

Design

This was an online survey of 2003 US adults, followed by an additional 5 one-on-one in-depth interviews, for a total of 2008. Data were collected between September and November 2022.

Participants

US adults (n = 2008) recruited via commercial research panels.

Main Outcome Measures

Prevalence of food shaming, and attitudes and behaviors among adults who have experienced food shaming versus those who have not.

Analysis

χ
2 and analysis of covariance investigating associations between experience with food shaming and food-related attitudes and behaviors, controlling for body mass index where possible.

Results

Nearly 3 in 10 American adults report that they have experienced food shame. Experiencing food shame correlates with higher guilt and shame, greater likelihood to engage in regimented eating, and more prevalent, as well as negative, emotions around food and imagined interactions with food and nutrition professionals.

Conclusions and Implications

Food shaming is a phenomenon with wide-reaching impacts on attitudes and behaviors. We expect that this innovative study will inform registered dietitian nutritionists and other health professionals to help people develop healthy, sustainable relationships with food.
Medical Coders’ Use of the ICD-10-CM “Unspecified” Codes for Head and Brain Injury in Emergency Department Settings
Authors: Wharton Tracy , Bailey Morgan , Peterson Alexis , Sarmiento Kelly , Bleser Julia A. , Costello Emily Hunt
Published: August 2024

Context

In the emergency department (ED) setting, prioritizing triage and patient care may lead to challenges in capturing detailed documentation necessary for specific International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding in medical records. Consequently, the prevalent use of the “unspecified head injury” code poses concerns about the precision of ED-based administrative billing claims data when analyzed for public health surveillance of nonfatal traumatic brain injuries (TBIs). Understanding the perspective of medical coders can illuminate coding processes and opportunities to enhance coding accuracy for TBI and other head injuries in the ED.

Objective

This evaluation explores medical coders’ perspectives and challenges when assigning ICD-10-CM codes to head injuries in the ED.

Design

This qualitative evaluation utilized a phenomenological approach, which employed semi-structured interviews to understand medical coders’ perspectives, processes, and coding determinations for head injuries in the ED.

Setting

Interviews were conducted using a HIPAA-compliant video-based platform between July 2022 and January 2023.

Participants

Seventeen medical coders with ED coding experience were interviewed. Their backgrounds were diverse, though most had more than 15 years of experience.

Main Outcomes

Four qualitative themes emerged, which highlighted challenges with lack of detailed documentation, defaulting to unspecified codes, time, and productivity pressure, and additional insights into coders’ assumptions and code determination processes.

Results

Medical coders expressed challenges assigning ICD-10-CM codes to the highest level of specificity, citing issues including insufficient documentation by ED providers and terminology variations. Workplace time constraints and pressure for expedited claims also led to defaulting to unspecified codes.

Conclusions

This evaluation highlights the need for improved documentation consistency and detail in ED records to facilitate accurate ICD-10-CM coding. Alleviating time pressures, improving algorithms, and offering specialized training opportunities to medical coders could be helpful steps to improve coding specificity and data accuracy for head injuries in the ED.
Choosing Wisely in Physical Medicine and Rehabilitation
Authors: Neferu Ramona , Fortin Christian , Guo Meiqi , Robinson Lawrence , Bateman Emma A.
Published: August 2024

Choosing Wisely Canada aims to reduce potentially harmful or unnecessary diagnostic investigations and practices in healthcare delivery. A committee of the Canadian Association of Physical Medicine & Rehabilitation surveyed the general membership seeking suggestions on new or revised Physical Medicine & Rehabilitation Choosing Wisely Canada recommendations. Draft recommendations were revised and refined with an emphasis on resource stewardship and alignment with the Choosing Wisely Canada mission. The updated 2023 Choosing Wisely Canada recommendations for physical medicine and rehabilitation are to avoid: (1) investigating and treating asymptomatic bacteriuria in patients with neurogenic bladder; (2) recommending more than a brief period of physical and cognitive rest after mild traumatic brain injury; (3) starting opioid treatment for chronic noncancer pain without exhausting other approaches; (4) ordering diagnostic imaging for low back pain in the absence of red flags; (5) repeating injections without evaluating patients’ responses to them; and (6) recommending carpal tunnel release without first confirming nerve entrapment with electrodiagnostic studies or ultrasonography. We present unique implementation tools to equip practitioners with quality improvement strategies to adopt these recommendations into their practices. Future work will include developing recommendations that consider planetary health co-benefits, creating knowledge translation tools, and assessing the impact of recommendation adoption into clinical practice.
Attitudes and Knowledge of Electroconvulsive Therapy
Authors: Botham Nicola , Sharp Laura , Paterson Helena , Wilson Mia , Martin Daniel , Kelly Stephen , Varveris Daphne , Langan Martin Julie
Published: August 2024

Aims

To explore knowledge and attitudes of medical students before and after exposure to a technology-enhanced learning and teaching (TELT) session about electroconvulsive therapy (ECT).

Background

Adequate knowledge of and attitudes toward ECT is essential for medical students. However, the impact of teaching on knowledge and attitudes is infrequently studied.

Methods

Fourth- and fifth year medical students at the University of Glasgow were provided with an online questionnaire before and after engaging in a remote TELT session, led by a consultant psychiatrist with expertise in ECT. The online teaching session used resources developed by a multidisciplinary team who specialize in ECT. The teaching session lasted around 1 hour. The questionnaire contained 3 sections: baseline demographics, knowledge of ECT, and attitudes toward ECT. Changes in scores were analyzed.

Results

Sixty-seven students completed the teaching session. Response rate to the precourse questionnaire was 68.7% (n = 46), and the postcourse questionnaire was 44.8% (n = 30). Prior to engaging with the learning materials, 9 students reported no knowledge of ECT and a third believed that ECT did not cause a seizure. In general, students who had personal experience of mental illness (friend, relative, or self) had more positive attitudes toward ECT and higher knowledge scores. In general, an increase in knowledge and attitude scores was found in the postcourse questionnaire.

Conclusions

Exposing medical students to a TELT session focused on ECT during their psychiatric placement appeared to improve knowledge and attitudes surrounding ECT.
Modified Electroconvulsive Therapy Normalizes Plasma GNA13 Following Schizophrenic Relapse
Authors: Zhang Hongli , Li Hui , Yu Mei , Yu Minglan , Feng Shuangshuang , Tingting Wang , Yu Yang , Zhang Jin , Liu Kezhi , Tan Youguo , Xiang Bo
Published: August 2024

Objective

GNA13 is an important member of the G protein family, and its coding gene GNA13 has been identified as one of the risk genes for schizophrenia (SCZ). This study aimed to investigate the relationship between GNA13 levels and the clinical symptoms of SCZ following treatment with modified electroconvulsive therapy (MECT).

Methods

This study recruited 82 SCZ patients and 86 healthy controls (HCs). Each SCZ patient received 6 sessions of MECT. The Positive and Negative Syndrome Scale (PANSS) was used to assess SCZ symptom severity. Plasma levels of GNA13 were measured by enzyme-linked immunosorbent assay.

Results

Pretreatment, SCZ patients had a higher GNA13 level than HC (t = 8.199, P < 0.001). MECT reduced the GNA13 level significantly (t = 11.13, P < 0.001) and normalized the difference between SCZ and HC (t = 0.219, P = 0.827). After treatment, the downregulation of GNA13 (ΔGNA13) was negatively correlated with the positive symptoms score reduction rate (ΔP) (r = −0.379, P = 0.027) and positively correlated with the negative score reduction rate (ΔN) (r = 0.480, P = 0.004) in females. In both males and females, the receiver operating characteristic curve revealed that the pretreatment GNA13 level could help differentiate SCZ from HC (male: area under the curve = 0.792, P < 0.001; female: area under the curve = 0.814, P < 0.001).

Conclusion

The reduced expression of GNA13 after MECT may be related to the exhibition of both negative and positive symptoms of SCZ in female patients.
Electroconvulsive Therapy for Psychogenic Polydipsia and Hyponatremia in Chronic Schizophrenia
Authors: Mancini Kathryn , Plimpton Teagan , Lewis Alan S.
Published: August 2024

Compulsive drinking of excessive quantities of water, called psychogenic polydipsia (PP), is a challenging complication of chronic psychotic disorders, which can lead to hyponatremia and downstream morbidity or mortality. Treatments include behavioral modifications such as free water restriction, medications to modify free water excretion, and psychotropic medications to target psychotic symptoms. However, in many cases, these options remain ineffective and/or intolerable, necessitating chronic institutionalization with poor patient quality of life. Here we report the use of an acute course of 8 sessions of bilateral electroconvulsive therapy (ECT) in a 57-year-old man with chronic schizophrenia, PP, and moderate hyponatremia refractory to standard treatments in an inpatient psychiatric setting. Serum sodium normalized and remained stable during and immediately following his ECT course, despite chronic hyponatremia with high variability for months prior to ECT initiation. A literature review found remarkably few reported cases of ECT for PP in chronic schizophrenia, a surprising result given the use of this modality for patients with psychotic illness in many countries. Our findings support future investigation into the clinical utility and mechanism of ECT for PP in this patient population.
COVID-19 and psychiatric disorders among young people: a cross-sectional study
Authors: Prodi Tiziano , Dragogna Filippo , Benatti Beatrice , Varinelli Alberto , Vanzetto Simone , Gianfelice Letizia , Dell’Osso Bernardo
Published: August 2024

During the COVID-19 pandemic, a significant rise in mental health issues was observed. Particularly, children and adolescents have shown a higher risk of developing mental disorders than adults. This study aimed to describe the evolving features of the requests for psychiatric emergency interventions during the COVID-19 pandemic in young people. We conducted a cross-sectional study comparing the number, characteristics, and symptoms of people aged between 12 and 18 years old attending one Emergency Department (ED) for psychiatric issues, considering three different periods: T0 (8 March 2019–7 March 2020), T1 (8 March 2020–7 March 2021), and T2 (8 March 2021–7 March 2022). Total admissions were 220: 99 (45%) during T0, 40 (18.1%) for T1, and 81 (36.8%) for T2 (P < 0.001). A significant decrease in the mean age from T0 to T1 was found (P < 0.01). Admissions for psychomotor agitation decreased, while admission due to anxiety disorder and nonsuicidal self-injury raised significantly (P < 0.05), as for first psychiatric presentation (P < 0.01). Regarding substance use, a significant reduction was observed (P < 0.05). The rates of eating disorders (P < 0.001) and early insomnia (P < 0.01) increased from T0. These findings highlight the worsening of psychiatric symptoms in the young population during the COVID-19 pandemic.
Portrait of a UK–Africa Capacity Building Initiative Consortium 2015–2022: the Cameroon, Ghana, South Africa and United Kingdom Materials Initiative (CaGSUMI) for developing materials for solar cells
Authors: Ndifon Peter T. , Awudza Johannes , Revaprasadu Neerish , O'Brien Paul , Lewis David J.
Published: August 2024

The CaGSUMI consortium was funded by the Royal Society–Department for International Development (later the Foreign, Commonwealth & Development Office) on the Africa Capacity Building Initiative programme between the years 2015 and 2022 and involved three Sub-Saharan African universities: Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, University of Yaoundé I, Cameroon, and the University of Zululand, South Africa; and the University of Manchester in the United Kingdom. The project was used to cement an emergent UK–Africa network in the areas of materials chemistry related to renewable energy generation with both thin films and nanomaterials. The consortium’s outputs led to numerous publications of African science in international journals, a number of graduated PhDs who went on to permanent academic positions and prestigious fellowships, the establishment of a capacity-building plan relevant to the chemistry departments in each of the African countries, and the installation of a number of first-in-kind pieces of kit for African laboratories that will keep them on a competitive footing at an international level for the next decade and more.
Creating sustainable capacity for river science in the Congo basin through the CRuHM project
Authors: Bates Paul D. , Tshimanga Raphaël M. , Trigg Mark A. , Carr Andy , Mushi C. A. , Kabuya Pierre M. , Bola Gode , Neal Jeff , Ndomba Preksedis , Mtalo Felix , Hughes Denis
Published: August 2024

In this article, we examine the scientific and sustainable research capacity outcomes of the ‘Congo River: user Hydraulics and Morphology’ or CRuHM project, a six-year effort supported by the Royal Society’s Africa Capacity Building Initiative. This project brought together a consortium of African and UK universities to undertake the first large-scale scientific expeditions to the Congo basin of the modern era in order to better understand the hydraulics and geomorphology of this understudied but globally important river. The river is essential for navigation, irrigation, drinking water and hydroelectric power generation for the 10 basin countries and is critically important for biodiversity and global nutrient, carbon and climatological cycles. This article summarizes the new scientific understanding contributed by the project and the steps taken to ensure a meaningful legacy that would continue long beyond the finite lifetime of available funding. Actions taken to achieve this include establishing a new hydrology research centre at the University of Kinshasa as well as steps to build a wider international community of Congo basin researchers. In this way, we hope to build momentum for future funding initiatives and collaboration.
Mechanistic basis of lineage restriction
Authors: Wu Bohou , Lee Jae Hyun , Foshay Kara M. , Zhang Li , Fernandes Croydon J. , Gao Boyang , Dou Xiaoyang , Zhang Chris Z. , Fan Guoping , Xiao Becky X. , Lahn Bruce T
Published: August 2024

Lineage restriction is the biological phenomenon where cells lose developmental potency during differentiation for all except their adopted lineages. Lineage restriction is foundational to multicellularity as it secures the functional identities of the myriad cell types in the body. As yet, the mechanisms of lineage restriction remain enigmatic. By developing Potency-Seq to systematically map transcriptional potency of genes across the genome, we uncovered a link between the restriction of developmental potency of cells and the occlusion of transcriptional potency of their genomes. We further showed that, strikingly, genes can undergo irreversible occlusion of their transcriptional potency simply by chromatinization into the nucleosomal form with unmodified histones. These findings led to a comprehensive mechanistic account of lineage restriction as driven by gene occlusion. Specifically, naive pluripotent stem cells at the onset of development possess the unique capacity to erase occlusion globally to reset full transcriptional potency of the genome, which in turn establishes full developmental potency of the cells. Such deocclusion capacity is abolished when cells progress from naive to primed pluripotency. From this stage onward, lineage-inappropriate genes can undergo nucleosome-mediated occlusion in an irreversible manner when their cognate transcription factors (TFs) and/or placeholder factors (PFs) no longer exist in cells to protect them. Consequently, the transcriptionally potent portion of the genome shrinks progressively and irreversibly during differentiation, thus permanently restricting the developmental potency of differentiating cells.