bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequency of changed behaviours in residential aged care and common mitigation strategies – A retrospective review of behavioural report logs
Authors: Brimelow Rachel , Beattie Elizabeth , Byrne Gerard , Dissanayaka Nadeeka
Published: September 2022

Background

Changed behaviours in residential aged care facilities (RACF) are frequently reported in the literature. How RACF staff routinely respond to these observed changed behaviours represents a significant gap.

Objective

To analyse the frequency of changed behaviour reported within RACF behavioural report logs and to ascertain how staff typically manage these behaviours.

Methods

Residents (N = 25) with varying levels of cognitive function were recruited from a 160 bed RACF in Queensland, Australia. A retrospective analysis of behavioural report logs was conducted to elucidate prevalence of reported changed behaviours as categorised by RACF staff. Thematic analysis of staff recorded behavioural mitigation strategies was used to categorise staff actions. A case analysis was also conducted to highlight the challenges faced by RACF staff managing persistent acute changed behaviours using identified common mitigation strategies. The STROBE guidelines were followed for reporting.

Results

There were 395 behaviours recorded in a two‐month period. Physical agitation, interfering while wandering, trying to get to inappropriate places, verbal refusal of care, physical aggression, and verbal disruption were most frequently reported by staff. Management strategies included redirection, PRN psychotropic medication, reassurance, routine care practices, offering of beverages, repositioning, and rarely analgesia. A 24‐h case analysis highlighted how staff utilised redirection and multiple doses of a PRN benzodiazepine with limited effectiveness.

Conclusion

This study reveals current mitigation strategies employed by RACF staff in response to acute changed behaviours often associated with dementia. Agitation and wandering are prevalent and are difficult for staff to manage effectively.

Relevance to clinical practice

This study highlights that careful consideration should be taken to avoid overuse of PRN benzodiazepines in management of changed behaviours. Short‐term mitigation strategies, such as redirection, may not be effective if underlying causes such as pain, physiological, mental, emotional, or social needs are not met.

Patient and public contribution

A RACF participated in project design and review.
A rapid molecular identification method for Meloidogyne chitwoodi from potato tubers without using nematode extraction methods
Authors: Uysal Gülsüm , Devran Zübeyir
Published: September 2022

Potato (Solanum tuberosum L.) is one of the major crops for human nutrition. Columbia root‐knot nematode, Meloidogyne chitwoodi Golden et al. (1980), can cause significant decrease in potato yields in the world. The aim of the study was to develop a novel molecular method for the rapid and accurate detection of M. chitwoodi on infested potato tubers. Total DNA from peel and tissues of potato were directly isolated from M. chitwoodi‐infested potato tubers without using any nematode extraction method. Meloidogyne chitwoodi was successfully detected and identified in total DNA isolated using species‐specific primers. Meloidogyne chitwoodi was also successfully identified in DNA isolated from only one necrotic spot in potato. Our results show that this molecular method is quite useful for fast and accurate identification of M. chitwoodi on potato. Based on these results, it seems that useful practical and applicable aspects for direct detection of M. chitwoodi from potato tubers without nematode extraction. The novel technique can be used in quarantine laboratories and potato seed producer companies. To the best of the authors' knowledge, this is the first report to identify M. chitwoodi using a novel molecular method from potato tubers without nematode extraction.
Identifying hiatal hernia with impedance planimetry during esophageal distension testing
Authors: Carlson Dustin A. , Kahrilas Peter J. , Simlote Aditi , Vespa Edoardo , Teitelbaum Ezra , Hungness Eric , Kou Wenjun , Pandolfino John E.
Published: September 2022

Introduction

Functional luminal imaging probe (FLIP) Panometry evaluates the esophageal response to distension involving biomechanics and motility. We have observed that hiatus hernia (HH) is evident during FLIP studies as a separation between the crural diaphragm (CD) and lower esophageal sphincter (LES) like what is seen with high‐resolution manometry (HRM). The aim of this study was to compare FLIP findings to endoscopy and HRM in the detection of HH.

Methods

A total of 100 consecutive patients that completed FLIP during sedated endoscopy and HRM were included. LES‐CD separation was assessed on FLIP and HRM with the presence of HH defined as LES‐CD ≥1 cm. The agreement was evaluated using the kappa (κ) statistic.

Results

Hiatal hernia was detected in 32% of patients on HRM and 44% of patients on FLIP with a substantial agreement between studies (84% agreement;κ = 0.667). On FLIP, a ‘new’ HH (i.e. HH not observed on HRM) occurred in 14 patients and an “enlarged” HH (i.e., LES‐CD ≥2 cm larger than on HRM) occurred in 11 patients. Among patients that also completed, timed barium esophagogram (TBE), delayed esophageal emptying on TBE was more common in patients with new or enlarged HH on FLIP than those without: 7/11 (64%) versus 2/12 (17%);p = 0.017.

Conclusion

FLIP can detect HH with a substantial agreement with HRM, though esophageal distension with FLIP testing appeared to elicit and/or enlarge a HH in an additional 25% of patients. Although this unique response to esophageal distension may represent a mechanism of dysphagia or susceptibility to reflux, additional study is needed to clarify its significance.
Characterizing natural variability of lignin abundance and composition in fine roots across temperate trees: a comparison of analytical methods
Authors: Xia Mengxue , Valverde‐Barrantes Oscar J. , Suseela Vidya , Blackwood Christopher B. , Tharayil Nishanth
Published: September 2022

Lignin is an important root chemical component that is widely used in biogeochemical models to predict root decomposition. Across ecological studies, lignin abundance has been characterized using both proximate and lignin‐specific methods, without much understanding of their comparability. This uncertainty in estimating lignin limits our ability to comprehend the mechanisms regulating root decomposition and to integrate lignin data for large‐scale syntheses.

We compared five methods of estimating lignin abundance and composition in fine roots across 34 phylogenetically diverse tree species. We also assessed the feasibility of high‐throughput techniques for fast‐screening of root lignin.

Although acid‐insoluble fraction (AIF) has been used to infer root lignin and decomposition, AIF‐defined lignin content was disconnected from the lignin abundance estimated by techniques that specifically measure lignin‐derived monomers. While lignin‐specific techniques indicated lignin contents of 2–10% (w/w) in roots, AIF‐defined lignin contents were c. 5–10‐fold higher, and their interspecific variation was found to be largely unrelated to that determined using lignin‐specific techniques. High‐throughput pyrolysis–gas chromatography–mass spectrometry, when combined with quantitative modeling, accurately predicted lignin abundance and composition, highlighting its feasibility for quicker assessment of lignin in roots.

We demonstrate that AIF should be interpreted separately from lignin in fine roots as its abundance is unrelated to that of lignin polymers. This study provides the basis for informed decision‐making with respect to lignin methodology in ecology.
Comparative efficacy of finger versus forehead Plethysmographic Variability Index monitoring in pediatric surgical patients
Authors: Fidan Seyfullah , Zengin Seniyye Ülgen , Orhon Meliha , Umuroğlu Tümay
Published: September 2022

Introduction

The Plethysmographic Variability Index can be measured by both finger and forehead probes. Vasoconstriction may jeopardize the reliability of finger PVI measurements in pediatric patients undergoing surgery. However, forehead vasculature exhibits more marked resistance to alterations in the vasomotor tonus.

Objective

Our aim was to compare the Plethysmographic Variability Index measured via finger or forehead probes in mechanically ventilated pediatric surgery patients in terms of their ability to predict fluid responsiveness as well as to determine the best cut‐off values for these two measurements.

Materials and Methods

A total of 50 pediatric patients undergoing minor elective surgery were included after provision of parental consent and ethics committee approval. Perfusion index measured at the finger or forehead and Plethysmographic Variability Index monitoring comprised the primary assessments. Hemodynamic parameters monitored included perfusion index, Plethysmographic Variability Index, and cardiac output. A ≥ 15% increase in cardiac output following passive leg raise maneuver was considered to show fluid responsiveness. Two groups were defined based on fluid responsiveness: Group R (responsive) and Group NR (non‐responsive). Student's t‐test, Mann–Whitney U test, DeLong test, and ROC were used for statistical analysis.

Results

The area under curve for finger and forehead Plethysmographic Variability Index prior to passive leg raise maneuver were 0.699 (p = .011) and 0.847 (p < .001), respectively. The sensitivity for finger and forehead measurements at a cut‐off value of ≤14% was 92.9% and 96.4%, and 45.4% and 72.7%, respectively.

Conclusion

Although forehead and finger Plethysmographic Variability Index monitoring were similarly sensitive in predicting fluid responsiveness in pediatric surgical patients, the former method provided higher specificity. The best cut‐off value for PVI measurements with forehead and finger probes was found to be 14%.
Fairness as comparative desert
Authors: Wu S. Deon
Published: September 2022

One prominent theory of fairness is John Broome's. This article identifies several problems with Broome's theory but defends Broome's claim that fairness requires the proportionate satisfaction of claims. This article also shows how Broome's conception of fairness is compatible with fairness as comparative desert.
Evaluating the effectiveness of labor market interventions on reducing the impacts of the COVID‐19 pandemic
Authors: Elgin Ceyhun , Williams Colin , Öz Yalaman Gamze
Published: September 2022

This paper evaluates whether different labor market policy interventions taken in response to the COVID‐19 pandemic have been effective in reducing its adverse impacts. We construct a database covering 165 countries and 39 labor market interventions grouped into four pillars: stimulating the economy and jobs (pillar 1); supporting enterprises, employment, and incomes (pillar 2); protecting workers (pillar 3); and social dialogue (pillar 4). The results revealed that measures taken under pillars 1, 2, and 3 have reduced the impacts of the pandemic on economic growth; measures under pillar 4 were significantly associated with reducing its impacts on employment and those under pillar 2 with reducing its impacts on working hours.
The impacts of women's land ownership: Evidence from Vietnam
Authors: Nguyen My , Le Kien
Published: September 2022

Women's equal access to and control over economic resources such as land are integral to achieve gender equality and sustainable economic development. This study evaluates the impacts of women's land ownership on various women's and household's outcomes in the context of Vietnam. We discuss the beneficial effects of allowing women to own more land on both women and their families. In particular, there is a positive association between women's land ownership and intra‐household bargaining power in various aspects. In particular, the relationship is the strongest for women's autonomy in decisions regarding their children. It is also easier for land‐holding women to formally access credit and invest in human capital. We further study the favorable effects of women's land ownership on their families in terms of spending and saving behaviors. Finally, women's land ownership also contributes to household social capital. These findings lend support to the passage and implementation of laws intended to grant women equal rights to the ownership and control over land.
The persuasive role of the past: Policy feedback and citizens' acceptance of information communication technologies during the COVID‐19 pandemic in China
Authors: Guo Yue , Zhou Lei , Chen Jidong
Published: September 2022

How can the enforcement of policies in the past influence a society's future adoption of information communication technologies (ICTs)? In this paper, we tackle this question by exploring how past e‐governance policies influence citizens' willingness to use the health QR code, which is a COVID‐19 tracing app widely used in China's pandemic control. Past policies regarding smart‐city development in China involve two aspects: the construction of electronic infrastructure and the applications of specific technologies. Empirical analysis based on a nationwide dataset in China suggests that past policies exhibit persuasive effects and influence citizens' acceptance of the health QR code. Specifically, e‐governance applications in cities significantly enhance citizens' acceptance through the demonstration of their usefulness. However, the construction of e‐governance infrastructure per se does not have the same impact on citizens' acceptance. By connecting citizens' acceptance of new technology with past e‐governance policies, the study illustrates a nuanced policy feedback mechanism through which past policies can substantially reshape public opinion by policy outcomes.
Mental rotation and schizotypal personality traits: A Bayesian approach
Authors: García‐Pérez Ángel , González‐Rodríguez Antonio , Godoy‐Giménez Marta , Sayans‐Jiménez Pablo , Cañadas Fernando , Estévez Ángeles F.
Published: September 2022

People diagnosed with schizophrenia exhibit mental rotation differences, suggesting that clinical levels of positive symptoms, such as psychotic hallucinations, are related to disruptions in their monitoring and manipulation of mental representations. According to the psychosis continuum, findings in people with a high level of schizotypal personality traits are expected to be qualitatively similar, but research concerning this topic is scarce. A spared mental imagery manipulation in this population only could suggest that this ability might be a possible protective factor, or that the emergence of clinical‐level positive symptoms could be paired with disruptions in this capacity. To explore this issue, 205 undergraduate students (122 women) completed a novel mental rotation task identifying the stimulus that was a 90, 180, or 270° rotation of a black circle with colored portions and were assessed with the Schizotypal Personality Questionnaire. Men performed better in most conditions. No relationship was detected between schizotypal personality traits and accuracy in the task. These results do not support that mental imagery manipulation disruptions may be related to schizotypal personality traits in non‐clinical populations. Thus, they might instead be associated with the onset of psychosis disorders as mental representation handling is hindered. However, additional research is required including the general population, as well as those with higher levels of psychotic symptoms and psychosis disorders. Future research could also focus on working memory processes related to mental representation manipulations of different sensory modalities such as auditory mental representations and their relationship with schizotypal personality traits and clinical populations.
Robust skin microrelief depth estimation using a mobile stereo system
Authors: Moon Cho‐I , Lee Onseok , Choi Min‐Hyung
Published: September 2022

Background

The skin surface becomes wrinkled and rough due to various internal and external factors. A three‐dimensional (3D) analysis of the skin is required to improve skin conditions. Stereophotogrammetry, a noninvasive 3D analysis method, is easy to install and use, but most stereo systems have a fixed baseline and scale. Previous stereo systems are not suitable for observing micro‐range skin features. Therefore, we suggest the optimal conditions and methods for the 3D analysis of skin microrelief using a multi‐conditioned stereo system.

Methods

We constructed a nonconvergence model using a mobile device and acquired stereo images under multiscale and multi‐baseline conditions. We extracted 3D information of the skin through our process: preprocessing, skin feature extraction, feature matching, and actual depth mapping. We improved the accuracy of the 3D analysis of the skin by using disparity values instead of disparity maps. We compared and analyzed the performances of six local feature detector and descriptor algorithms. In addition, we suggested depth‐mapping formulas to estimate the actual depth of the skin microrelief.

Results

We confirmed that stereo images with a working distance of 70–75 mm and a baseline of 4–8 mm are effective for the 3D analysis of skin microrelief. In addition, accelerated KAZE exhibited the best performance for features extraction and stereo matching. Finally, the extracted 3D information was converted to the actual depth, and the performance of the 3D analysis was verified.

Conclusion

The proposed system and method that provide texture information are effective for 3D skin disease analysis and evaluation.
Effects of Physical Exercise Training on Cerebral Blood Flow Measurements: A Systematic Review of Human Intervention Studies
Authors: Kleinloog Jordi P.D. , Nijssen Kevin M.R. , Mensink Ronald P. , Joris Peter J.
Published: September 2022

The aim of this systematic review was to examine the effects of physical exercise training on cerebral blood flow (CBF), which is a physiological marker of cerebrovascular function. Relationships between training-induced effects on CBF with changes in cognitive performance were also discussed. A systematic search was performed up to July 2022. Forty-five intervention studies with experimental, quasi-experimental, or pre–post designs were included. Sixteen studies (median duration: 14 weeks) investigated effects of physical exercise training on CBF markers using magnetic resonance imaging, 20 studies (median duration: 14 weeks) used transcranial Doppler ultrasound, and eight studies (median duration: 8 weeks) used near-infrared spectroscopy. Studies using magnetic resonance imaging observed consistent increases in CBF in the anterior cingulate cortex and hippocampus, but not in whole-brain CBF. Effects on resting CBF—measured with transcranial Doppler ultrasound and near-infrared spectroscopy—were variable, while middle cerebral artery blood flow velocity increased in some studies following exercise or hypercapnic stimuli. Interestingly, concomitant changes in physical fitness and regional CBF were observed, while a relation between training-induced effects on CBF and cognitive performance was evident. In conclusion, exercise training improved cerebrovascular function because regional CBF was changed. Studies are however still needed to establish whether exercise-induced improvements in CBF are sustained over longer periods of time and underlie the observed beneficial effects on cognitive performance.
Neurons burdened by DNA double-strand breaks incite microglia activation through antiviral-like signaling in neurodegeneration
Authors: Welch Gwyneth M. , Boix Carles A. , Schmauch Eloi , Davila-Velderrain Jose , Victor Matheus B. , Dileep Vishnu , Bozzelli P. Lorenzo , Su Qiao , Cheng Jemmie D. , Lee Audrey , Leary Noelle S. , Pfenning Andreas R. , Kellis Manolis , Tsai Li-Huei
Published: September 2022

DNA double-strand breaks (DSBs) are linked to neurodegeneration and senescence. However, it is not clear how DSB-bearing neurons influence neuroinflammation associated with neurodegeneration. Here, we characterize DSB-bearing neurons from the CK-p25 mouse model of neurodegeneration using single-nucleus, bulk, and spatial transcriptomic techniques. DSB-bearing neurons enter a late-stage DNA damage response marked by nuclear factor κB (NFκB)–activated senescent and antiviral immune pathways. In humans, Alzheimer’s disease pathology is closely associated with immune activation in excitatory neurons. Spatial transcriptomics reveal that regions of CK-p25 brain tissue dense with DSB-bearing neurons harbor signatures of inflammatory microglia, which is ameliorated by NFκB knockdown in neurons. Inhibition of NFκB in DSB-bearing neurons also reduces microglia activation in organotypic mouse brain slice culture. In conclusion, DSBs activate immune pathways in neurons, which in turn adopt a senescence-associated secretory phenotype to elicit microglia activation. These findings highlight a previously unidentified role for neurons in the mechanism of disease-associated neuroinflammation.
The Antagonism between the Murine Gammaherpesvirus Protein Kinase and Global Interferon Regulatory Factor 1 Expression Shapes the Establishment of Chronic Infection
Authors: Jondle C. N. , Sylvester P. A. , Schmalzriedt D. L. , Njoya K. , Tarakanova V. L.
Published: September 2022

Gammaherpesviruses are prevalent pathogens that manipulate physiological B cell differentiation to establish lifelong infection. This manipulation is also involved in gammaherpesvirus-driven B cell lymphomas, as differentiation of latently infected B cells through the germinal center response targets these for transformation.
The Cryptococcus neoformans Flc1 Homologue Controls Calcium Homeostasis and Confers Fungal Pathogenicity in the Infected Hosts
Authors: Stempinski Piotr R. , Goughenour Kristie D. , du Plooy Lukas M. , Alspaugh J. Andrew , Olszewski Michal A. , Kozubowski Lukasz
Published: September 2022

Cryptococcosis is a highly lethal infection with limited drug choices, most of which are highly toxic or complicated by emerging antifungal resistance. There is a great need for new drug targets that are unique to the fungus.
Successful integration of newborn genetic testing into UK routine screening using prospective consent to determine eligibility for clinical trials
Authors: Bendor-Samuel Owen Martyn , Wishlade Tabitha , Willis Louise , Aley Parvinder , Choi Edward , Craik Rachel , Mujadidi Yama , Mounce Ginny , Roseman Fenella , De La Horra Gozalo Arancha , Bland James , Taj Nazia , Smith Ian , Ziegler Anette-Gabriele , Bonifacio Ezio , Winkler Christiane , Haupt Florian , Todd John A , Servais Laurent , Snape Matthew D , Vatish Manu
Published: September 2022

Objective

INGR1D (INvestigating Genetic Risk for type 1 Diabetes) was a type 1 diabetes (T1D) genetic screening study established to identify participants for a primary prevention trial (POInT, Primary Oral Insulin Trial).

Methods

The majority of participants were recruited by research midwives in antenatal clinics from 18 weeks’ gestation. Using the NHS Newborn Bloodspot Screening Programme (NBSP) infrastructure, participants enrolled in INGR1D had an extra sample taken from their day 5 bloodspot card sent for T1D genetic screening. Those at an increased risk of T1D were informed of the result, given education about T1D and the opportunity to take part in POInT.

Results

Between April 2018 and November 2020, 66% of women approached about INGR1D chose to participate. 15 660 babies were enrolled into INGR1D and 14 731 blood samples were processed. Of the processed samples, 157 (1%) had confirmed positive results, indicating an increased risk of T1D, of whom a third (n=49) enrolled into POInT (20 families were unable to participate in POInT due to COVID-19 lockdown restrictions).

Conclusion

The use of prospective consent to perform personalised genetic testing on samples obtained through the routine NBSP represents a novel mechanism for clinical genetic research in the UK and provides a model for further population-based genetic studies in the newborn.
Obstructive and central sleep apnoea in a patient with medically intractable epilepsy
Authors: Schwartz Katherine , Lastra Alejandra C , Balabanov Antoaneta J
Published: September 2022

A woman in her 30s with medically intractable epilepsy and Lennox-Gastaut Syndrome on multiple antiseizure medications and with a deep brain stimulator presented to the epilepsy monitoring unit with increased seizure frequency. She was noted to have periods of apparent apnoea time linked to bursts of epileptiform activity on continuous video EEG monitoring. Once the clinical seizures were controlled, she was discharged to the sleep laboratory. She was noted to have obstructive and central sleep apnoea, which improved with the use of positive airway pressure. Central sleep apnoeas were time linked to electrographic seizures. Ictal central apnoea can easily be overlooked and is likely more common than currently recognised in patients with epilepsy. Ictal central apnoea may be a biomarker for sudden unexpected death in epilepsy.
Cross-sectional nationwide mixed-methods population-based study of living conditions, and identification of sexual and fertility profiles among young women after breast cancer in France: the Candy study protocol
Authors: Assogba Emerline L F , Dumas Agnès , Woronoff Anne-Sophie , Mollévi Caroline , Coutant Charles , Ladoire Sylvain , Desmoulins Isabelle , Dabakuyo-Yonli Tienhan Sandrine
Published: September 2022

Introduction

At the end of the treatment, many young breast cancer (BC) survivors face difficulties related to fertility and sexuality, mainly due to the side effects of treatment. Integrating patient needs into medical decisions is becoming increasingly essential for high quality care. To this end, there is a compelling need to elicit patients’ perspectives through qualitative studies, to understand their experiences and needs in the aftermath of cancer. We aim to: (1) identify clinical, social and economic determinants of sexuality and fertility, and describe other living conditions of young BC survivors in France; and (2) explore young women’s experience after BC in relation to clinical and information needs about fertility preservation and sexual health.

Methods and analysis

This is a mixed-methods, cross-sectional, population-based study. In the quantitative component, women diagnosed with non-metastatic BC between 2009 and 2016 and aged 40 years or younger at diagnosis will be identified through the French network of cancer registries (FRANCIM). Participants will complete self-report questionnaires including standardised measures of sexuality, health-related quality of life (HRQoL), anxiety, depression, social deprivation and social support. Fertility and professional reintegration issues will also be assessed. Sexuality profiles will be identified by ascending hierarchical classification and fertility profiles will be identified by latent class models. Determinants of sexuality, fertility and HRQoL will be identified using a mixed regression model. Subsequently, semistructured interviews will be performed with a sample of 30 women who participated in the quantitative study. Interviews will be recorded, transcribed synthetically and content analysis will be performed, with the aid of NVivo software.

Ethics and dissemination

This study will be performed in accordance with the declaration of Helsinki. The protocol was approved in October 2020 by the Committee for the Protection of Persons North-West III (20.07.16.44445) and by the French national data protection authority (CNIL-MR003 No1989764-v0).

The results of this project will be communicated to the scientific community through publications in international scientific peer-reviewed journals and communications to national and international congresses. Popularised results will also be provided to patient associations. The results of Candy project will also be published on the website of the sponsor,www.cgfl.fr.
Assessment of core teaching competency of health professional educators in Ethiopia: an institution-based cross-sectional study
Authors: Dejene Daniel , Stekelenburg Jelle , Versluis Marco , Ayalew Firew , Molla Yohannes
Published: September 2022

Objectives

Understanding the competency of educators is key to informing faculty development, recruitment and performance monitoring. This study aimed to assess the core teaching competency of nursing, midwifery and biomedical educators, and associated factors in Ethiopia.

Design

An institution-based cross-sectional study was conducted in January 2020 using structured tools adapted from the WHO’s nurse and midwifery educator competency frameworks.

Setting

Two health science colleges and nine student practice sites in Ethiopia.

Participants

All classroom instructors and clinical preceptors of nursing, midwifery and biomedical technician training programmes, and all the graduating class students.

Measures

Overall teaching competency scores, teaching domain competency scores, competency gaps and performance gaps of educators were outcome measures. Past training on teaching skills courses, teaching experiences and sociodemographic characteristics of educators are associated factors.

Results

Most educators were not trained in teaching methods (82%). The teaching competency scores of classroom instructors and clinical preceptors were 61.1% and 52.5%, respectively. Competency gaps were found in using active learning methods, performance assessment, feedback and digital learning. Professional background of classroom instructors had a significant and strong association with their competency score (p=0.004; V=0.507). Age and teaching experience of clinical preceptors had significant associations with their competency score (p=0.023 and p=0.007, respectively) and had strong associations (V=0.280 and 0.323, respectively). Sex of students and their perceptions of how well the educators give education resources had a significant and strong association (p<0.001; V=0.429).

Conclusions

Nursing, midwifery and biomedical educators lacked the competency to undertake important teaching roles, which could contribute to the low quality of education. More attention should be given to strengthening faculty development.
Efficacy and safety of non-pharmacological interventions for neonatal pain: an overview of systematic reviews
Authors: Shen Qiao , Huang Zixuan , Leng Hongyao , Luo Xufei , Zheng Xianlan
Published: September 2022

Objectives

To synthesise current evidence from systematic reviews (SRs) regarding the efficacy and safety of non-pharmacological interventions to prevent and treat pain in newborn infants.

Design

Overview of SRs.

Data sources

We searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang Database, Chinese Science and Technology Periodical Database (VIP) and Google Scholar to identify all relevant SRs published in the last 5 years.

Eligibility criteria for selecting studies

We included SRs that evaluated the efficacy and safety of non-pharmacological interventions for neonatal pain.

Data extraction and synthesis

Two reviewers independently extracted the data, assessed the methodological quality using a Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and graded the evidence quality with the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results

A total of 29 SRs were included in this overview, of which 28 focused on procedural pain and only 1 focused on postoperative pain. Based on AMSTAR 2, seven reviews were found to be of ‘high quality‘, eight of ‘moderate quality’, five of ‘low quality’ and nine of ‘critically low quality’. The GRADE results suggested that facilitated tucking, kangaroo care, sweet solutions, familiar odour or combined non-pharmacological interventions, such as a combination of sucrose and non-nutritive sucking, were effective and safe in reducing pain from medical procedures in neonates. However, sucrose alone was less effective than local anaesthesia or a combination of the two during circumcision.

Conclusions

Facilitated tucking, small volumes of sweet solutions, kangaroo care and familiar odour were recommended. Scientific implementation strategies should be developed to promote the clinical use of these effective non-pharmacological interventions. Meanwhile, further rigorous trials and SRs are needed to identify the best non-pharmacological approaches for pain from common surgery and illnesses in neonates.

PROSPERO registration number

CRD42021292583.
Understanding of empathetic communication in acute hospital settings: a scoping review
Authors: Haribhai-Thompson Jaquille , McBride-Henry Karen , Hales Caz , Rook Helen
Published: September 2022

Objective

Empathy and empathy education have been reviewed a number of times through systematic reviews and meta-analyses; however, the topic of ‘empathetic communication’ remains poorly understood when considering engaging in hospital-based research. Therefore, this scoping review aimed to explore the existing literature concerning empathetic communication in hospital settings and to evaluate the definitions presented.

Design

Scoping review.

Data sources

Systematic searches of the PubMed, CINAHL, Cochrane, PsycINFO, and PsycArticles databases were conducted.

Study selection

All English studies in which empathetic communication in hospital settings were explored. The search terms used included empathy, communication, hospital settings, providers, and consumers.

Data extraction

Data were assessed through the use of a pre-set analysis tool.

Results

After conducting the searches, 419 articles were identified, of which 26 were included in this review. No single article specifically defined the term ‘empathetic communication’; however, 33 unique definitions of ‘empathy’ were identified, of which 23 considered communication to be a component of empathy. There was a considerable lack of consistency between the empathy definitions, with some classifying communication in empathy as an ability and others classifying it as a dynamic process.

Conclusion

Future and contextually focused research is needed to develop a consistent and clear definition of empathetic communication and empathy within a hospital setting to better build positive healthcare cultures.

Practice implications

Inconsistencies between definitions of empathy in empathetic communication research could reduce the efficacy of future research gains and impact the translation of research findings into clinical practice.
Role of healthcare cost accounting in pricing and reimbursement in low-income and middle-income countries: a scoping review
Authors: Guinness Lorna , Ghosh Srobana , Mehndiratta Abha , Shah Hiral A
Published: September 2022

Objectives

Progress towards universal health coverage (UHC) requires evidence-based policy including good quality cost data systems. Establishing these systems can be complex, resource-intensive and take time. This study synthesises evidence on the experiences of low-income and middle-income countries (LMICs) in the institutionalisation of cost data systems to derive lessons for the technical process of price-setting in the context of UHC.

Design

A scoping review and narrative synthesis of publicly available information.

Data sources

PubMed, MEDLINE, EconLit, the Web of Science and grey literature searched from January 2000 to April 2021.

Eligibility criteria

English-language papers published since 2000 that identified and/or described development of and/or methods used to estimate or inform national tariffs for hospital reimbursement in LMICs. Papers were screened by two independent reviewers.

Data extraction and synthesis

Extraction was performed by one reviewer and checked by the second reviewer on: the method and outputs of cost data collection; commentary on the use of cost data; description of the technical process of tariff setting; and strengths and challenges of the approach. Evidence was summarised using narrative review.

Results

Thirty of 484 papers identified were eligible. Fourteen papers reported on primary cost data collection; 18 papers explained how cost evidence informs tariff-setting. Experience was focused in Asia (n=22) with countries at different stages of developing cost systems. Experiences on cost accounting tend to showcase country costing experiences, methods and implementation. There is little documentation how data have been incorporated into decision making and price setting. Where cost information or cost systems have been used, there is improved transparency in decision making alongside increased efficiency.

Conclusions

There are widely used and accepted methods for generating cost information. Countries need to build sustainable cost systems appropriate to their settings and budgets and adopt transparent processes and methodologies for translating costs into prices.
Correlation of triglyceride–glucose index and dyslipidaemia with premature coronary heart diseases and multivessel disease: a cross-sectional study in Tianjin, China
Authors: Wei Ao , Liu Jingjing , Wang Le , Zheng Senshuang , Cong Hongliang
Published: September 2022

Objectives

Over the past decade, the incidence and global burden of coronary heart disease (CHD) have increased in the young population. We aimed to identify patient characteristics and risk factors for premature CHD, including single-vessel disease (SVD) and multivessel disease (MVD).

Design

Retrospective, cross-sectional study.

Setting

Demographic and clinical data of patients with CHD were collected from the patient medical records of a tertiary hospital in Tianjin, China, between 2014 and 2017.

Participants

A total of 2846 patients were enrolled in the study.

Primary and secondary outcome measures

Premature CHD, which is the primary outcome, was defined as men<45 years and women<55 years. MVD, which is the secondary outcome, was defined as at least two vessels with ≥50% stenosis. Logistic regression models were applied to analyse the characteristics and risk factors of premature CHD and MVD.

Results

Most of the characteristics between patients with premature and mature CHD were not statistically significant. A significantly higher dyslipidaemia prevalence was found in female patients with premature CHD (OR=1.412, 95% CI: 1.029 to 1.936). In the crude model, instead of premature SVD, premature (OR=2.065, 95% CI: 1.426 to 2.991) or mature (OR=1.837, 95% CI: 1.104 to 3.056) MVD was more common in female patients with the highest triglyceride–glucose (TyG) index quartile than those with the lowest TyG index quartile. In male patients, the same trend was observed for mature MVD (OR=2.272, 95% CI: 1.312 to 3.937). The significance of the TyG index was not revealed in multivariate analyses; however, hypertension, diabetes, obesity, smoking, old myocardial infarction and lipoprotein (a) showed a positive association with MVD.

Conclusions

Dyslipidaemia should be considered as an effective factor for the prediction and prevention of premature CHD in women. The TyG index can be a simple auxiliary indicator that can be used in population-based cardiovascular disease screening for the early identification of vascular disease severity.
Predefibrillation end-tidal CO2and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study
Authors: Kwong Jonathan L , Drennan Ian R , Turner Linda , Cheskes Sheldon
Published: September 2022

Background

Predefibrillation end-tidal CO2(ETCO2) may predict defibrillation success and could guide defibrillation timing in ventricular fibrillation (VF) cardiac arrest. This relationship has only been studied using advanced airways. Our aim was to evaluate this relationship using both basic (bag–valve–mask (BVM)) and advanced airways (supraglottic airways and endotracheal tubes).

Methods

Prehospital patient records and defibrillator files were abstracted for patients with out-of-hospital cardiac arrest in Ontario, Canada, with initial VF cardiac rhythms between 1 January 2018, and 31 December 2019. Analyses assessed the relationship between each predefibrillation ETCO2reading and defibrillation outcomes at the subsequent 2 min pulse check (ie, VF, asystole, pulseless electrical activity (PEA) or return of spontaneous circulation (ROSC)), accounting for airway types used during resuscitation. Multivariable logistic regression evaluated the association between the first documented predefibrillation ETCO2and postshock VF termination or ROSC.

Results

Of 269 cases abstracted, 153 had predefibrillation ETCO2measurements and were included in the study. Among these cases, 904 shocks were delivered and 44.4% (n=401) had predefibrillation ETCO2measured. The first ETCO2reading was more often from BVM (n=134) than advanced airways (n=19). ETCO2readings were lower when measured through BVM versus advanced airways (30.5 mm Hg (4.06 kPa) (±14.4 mm Hg (1.92 kPa)) vs 42.1 mm Hg (5.61 kPa) (±22.5 mm Hg (3.00 kPa)),adjANOVA p<0.01). Of all shocks with ETCO2reading (n=401), no difference in preshock ETCO2was found for subsequent shocks that resulted in persistent VF (32.2 mm Hg (4.29 kPa) (±15.8 mm Hg (2.11 kPa))), PEA (32.8 mm Hg (4.37 kPa) (±17.1 mm Hg (2.30 kPa))), asystole (32.4 mm Hg (4.32 kPa) (±20.6 mm Hg (2.75 kPa))) or ROSC (32.5 mm Hg (4.33 kPa) (±15.3 mm Hg (2.04 kPa))), analysis of variance p=0.99. In the multivariate analysis using the initial predefibrillation ETCO2, there was no association with VF termination on the subsequent shock (adjusted OR (adjOR) 0.99, 95% CI 0.97 to 1.02, p=0.57) or ROSC (adjOR 1.00, 95% CI 0.97 to 1.03, p=0.94) when evaluated as a continuous or categorical variable.

Conclusion

Predefibrillation ETCO2measurement is not associated with VF termination or ROSC when basic and advanced airways are included in the analysis. The role of predefibrillation ETCO2requires careful consideration of the type of airway used during resuscitation.
Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response
Authors: Adams Alex , Gupta Vipin , Mohsen Waled , Chapman Thomas P , Subhaharan Deloshaan , Kakkadasam Ramaswamy Pradeep , Kumar Sudheer , Kedia Saurabh , McGregor Colleen GC , Ambrose Tim , George Bruce D , Palmer Rebecca , Brain Oliver , Walsh Alissa , Ahuja Vineet , Travis Simon P L , Satsangi Jack
Published: September 2022

Objectives

We aimed to determine whether changes in acute severe colitis (ASC) management have translated to improved outcomes and to develop a simple model predicting steroid non-response on admission.

Design

Outcomes of 131 adult ASC admissions (117 patients) in Oxford, UK between 2015 and 2019 were compared with data from 1992 to 1993. All patients received standard treatment with intravenous corticosteroids and endoscopic disease activity scoring (Ulcerative Colitis Endoscopic Index of Severity (UCEIS)). Steroid non-response was defined as receiving medical rescue therapy or surgery. A predictive model developed in the Oxford cohort was validated in Australia and India (Gold Coast University Hospital 2015–2020, n=110; All India Institute of Medical Sciences, New Delhi 2018–2020, n=62).

Results

In the 2015–2019 Oxford cohort, 15% required colectomy during admission vs 29% in 1992–1993 (p=0.033), while 71 (54%) patients received medical rescue therapy (27% ciclosporin, 27% anti-tumour necrosis factor, compared with 27% ciclosporin in 1992–1993 (p=0.0015). Admission C reactive protein (CRP) (false discovery rate, p=0.00066), albumin (0.0066) and UCEIS scores (0.015) predicted steroid non-response. A four-point model was developed involving CRP of ≥100 mg/L (one point), albumin of ≤25 g/L (one point), and UCEIS score of ≥4 (1 point) or ≥7 (2 points). Patients scoring 0, 1, 2, 3 and 4 in the validation cohorts had steroid response rates of 100, 75.0%, 54.9%, 18.2% and 0%, respectively. Scoring of ≥3 was 84% (95% CI 0.70 to 0.98) predictive of steroid failure (OR 11.9, 95% CI 10.8 to 13.0). Colectomy rates in the validation cohorts were were 8%–11%.

Conclusions

Emergency colectomy rates for ASC have halved in 25 years to 8%–15% worldwide. Patients who will not respond to corticosteroids are readily identified on admission and may be prioritised for early intensification of therapy.
Spinal cord lesions and brain grey matter atrophy independently predict clinical worsening in definite multiple sclerosis: a 5-year, multicentre study
Authors: Rocca Maria A , Valsasina Paola , Meani Alessandro , Gobbi Claudio , Zecca Chiara , Barkhof Frederik , Schoonheim Menno M , Strijbis Eva M , Vrenken Hugo , Gallo Antonio , Bisecco Alvino , Ciccarelli Olga , Yiannakas Marios , Rovira Alex , Sastre-Garriga Jaume , Palace Jacqueline , Matthews Lucy , Gass Achim , Eisele Philipp , Lukas Carsten , Bellenberg Barbara , Margoni Monica , Preziosa Paolo , Filippi Massimo
Published: September 2022

Objectives

To evaluate the combined contribution of brain and cervical cord damage in predicting 5-year clinical worsening in a multicentre cohort of definite multiple sclerosis (MS) patients.

Methods

Baseline 3.0T brain and cervical cord T2-weighted and three-dimensional T1-weighted MRI was acquired in 367 patients with MS (326 relapse-onset and 41 progressive-onset) and 179 healthy controls. Expanded Disability Status Scale (EDSS) score was obtained at baseline and after a median follow-up of 5.1 years (IQR=4.8–5.2). At follow-up, patients were classified as clinically stable/worsened according to EDSS changes. Generalised linear mixed models identified predictors of clinical worsening, evolution to secondary progressive (SP) MS and reaching EDSS=3.0, 4.0 and 6.0 milestones at 5 years.

Results

At follow-up, 120/367 (33%) patients with MS worsened clinically; 36/256 (14%) patients with relapsing–remitting evolved to SPMS. Baseline predictors of EDSS worsening were progressive-onset versus relapse-onset MS (standardised beta (β)=0.97), higher EDSS (β=0.41), higher cord lesion number (β=0.41), lower normalised cortical volume (β=−0.15) and lower cord area (β=−0.28) (C-index=0.81). Older age (β=0.86), higher EDSS (β=1.40) and cord lesion number (β=0.87) independently predicted SPMS conversion (C-index=0.91). Predictors of reaching EDSS=3.0 after 5 years were higher baseline EDSS (β=1.49), cord lesion number (β=1.02) and lower normalised cortical volume (β=−0.56) (C-index=0.88). Baseline age (β=0.30), higher EDSS (β=2.03), higher cord lesion number (β=0.66) and lower cord area (β=−0.41) predicted EDSS=4.0 (C-index=0.92). Finally, higher baseline EDSS (β=1.87) and cord lesion number (β=0.54) predicted EDSS=6.0 (C-index=0.91).

Conclusions

Spinal cord damage and, to a lesser extent, cortical volume loss helped predicting worse 5-year clinical outcomes in MS.
Relationship between obstructive sleep apnoea syndrome and silent brain infarction
Authors: Nacafaliyev Vusal , Ortan Pınar , Sayin Sevgi Sidika
Published: September 2022

Background

The relationship between obstructive sleep apnea syndrome (OSAS) and ischaemic stroke is less known.

Objectives

This study aimed to investigate the relationship between OSAS and silent brain infarcts (SBI).

Methods

Patients who applied to our clinic with the complaint of snoring, respiratory arrest during sleep, that underwent polysomnography were included. All patients were undergone cranial magnetic resonance imaging to detect SBI.

Results

SBI was found in 176 (51.5%) of 270 patients in the group with OSAS and 94 (34.8%) patients without OSAS. The patients were evaluated according to their Apnea–Hypopnea Index(AHI) ratio, and those with were found to be significant in terms of SBI. SBI was detected in 56.56% in the moderate and severe (AHI ˃15) stage group and 39.94% in the normal and mild (AHI ≤15) OSAS group (p=0.009).

Conclusions

SBI was found to be significantly higher in patients with moderate and severe stage OSAS compared to the normal and mild OSAS group. Desaturations during sleep may influence the formation of these infarcts. Therefore, this study reported that patients with moderate and severe sleep apnea syndrome may have a higher risk of developing ischaemic cerebrovascular disease and that the treatment of these patients should be planned in this respect.