bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence of Pain and Resiliency on Foot and Ankle Surgery Outcomes
Authors: Hoch Caroline , Pire Jonathan , Scott Daniel J. , Gross Christopher E.
Published: June 2022

Background:

Resilience is the ability to recover after stressful events and has been shown to correlate with surgical outcomes. However, there has been minimal research on the impact of patient resiliency on foot and ankle surgical outcomes. This study aims to determine the predictive value of preoperative resiliency scores on surgical outcomes and investigate how this compares with the predictive value of pain scores.

Methods:

We conducted a retrospective review of adult patients who completed a preoperative Brief Resilience Scale (BRS) and underwent surgery between November 2019 and November 2020 with a fellowship-trained foot and ankle surgeon (N=184). Data included demographics, comorbidities, surgical details, complication and reoperation rates, pre- and postoperative opioid and benzodiazepine use, and additional patient-reported outcome measures (ie, visual analog scale [VAS], Pain Catastrophizing Scale [PCS], Pain Disability Index [PDI], Foot and Ankle Outcome Score [FAOS] pain subscale). Mean follow-up duration was 4.49 (range, 1.10-14.17) months.

Results:

BRS weakly correlated with decreased postoperative benzodiazepine use ( P=.007). PCS magnification ( P=.050) and helplessness ( P=.047) subscales weakly correlated with increased follow-up duration. PDI total score and most subscores significantly correlated with an increase in at least 1 of the following: follow-up duration, or postoperative opioid or benzodiazepine use. Neither the VAS nor FAOS pain subscore correlated with any outcome. PDI total score was the strongest predictor of postoperative opioid (β=0.334) and benzodiazepine (β=0.315) use. Preoperative opioid users had significantly higher PDI total score (user=39.3, nonuser=24.9; P=.012) and subscores (ie, social activity, sexual behavior, self-care, life-support activities).

Conclusion:

BRS is an unreliable tool for predicting outcomes in foot and ankle surgery, as it only weakly correlated with decreased benzodiazepine use. Rather, given the PDI’s strong associations with postoperative measures in this study, physicians should consider the value of preoperative PDI completion when predicting how foot and ankle surgery recipients will fare postoperatively.

Level of Evidence:

Level III, retrospective cohort study.
Comparing the Outcomes of MSA and Fundoplication in Severe GERD
Authors: Wang Mark C. , Silva Jack P. , James Tayler J. , Rodriguez Eddie A. , Cheng Vincent , Putnam Luke R. , Bildzukewicz Nikolai A. , Bell Reginald , Lipham John C.
Published: June 2022

Introduction:

Magnetic sphincter augmentation (MSA) is an effective treatment option for gastroesophageal reflux disease (GERD), with similar outcomes to fundoplication. MSA has yet to be compared to fundoplication specifically in patients with severe GERD. The objective of this study was to compare MSA and fundoplication in patients with severe GERD.

Methods:

A retrospective cohort study was performed of patients with severe GERD (preoperative DeMeester score >50) who underwent MSA or fundoplication at 3 high-volume centers from 2016 to 2019. Nissen and partial fundoplications were included. GERD control was measured by GERD health-related quality of life (GERD-HRQL) scores and discontinuation of acid suppressive medication (ASM). Other outcomes included postoperative gas-bloat symptoms, dysphagia requiring dilation, and esophagitis.

Results:

A total of 122 patients were included: 82 (67%) underwent MSA and 40 (33%) underwent fundoplication (23% Nissen, 77% partial). The groups were similar regarding gender, GERD duration, hiatal hernia size, preoperative GERD-HRQL score, severe esophagitis, and DeMeester score. Median follow-up was 24 [12-34] months. Postoperative GERD-HRQL scores (5 vs 3, P = .36), ASM discontinuation (80% vs 86%, P = .41), gas-bloat symptoms (18% vs 23%, P = .58), dysphagia requiring dilation (19% vs 8%, P = .11), and esophagitis (7% vs 10%, P = .08) were similar between the groups. A subset analysis was performed comparing outcomes of MSA, Nissen fundoplication, and partial fundoplication. No significant differences were found.

Conclusion:

In this cohort of patients with severe GERD, MSA was just as effective as Nissen and partial fundoplication with regards to improved quality of life and side effect profile at 24-month follow-up.
Arthrogenic Muscle Inhibition Following Knee Injury or Surgery: Pathophysiology, Classification, and Treatment
Authors: Sonnery-Cottet Bertrand , Hopper Graeme P. , Gousopoulos Lampros , Vieira Thais Dutra , Thaunat Mathieu , Fayard Jean-Marie , Freychet Benjamin , Ouanezar Hervé , Cavaignac Etienne , Saithna Adnan
Published: June 2022

Background:

Arthrogenic muscle inhibition (AMI), a process in which quadriceps activation failure is caused by neural inhibition, is common following knee injury or surgery. No classifications exist to describe the variable presentations of AMI following knee injury.

Indications:

AMI can result in significant morbidity following knee injury, and it is essential to recognize and treat. It is crucial to identify patients at higher risk of postoperative complications as surgery should be delayed for specific rehabilitation programs. Understanding the pathophysiology of AMI is vital as this can guide therapeutic interventions.

Technique Description:

AMI following knee injury can present in a variety of ways including inhibition of the vastus medialis obliquus (VMO) muscle, extension deficits due to hamstring contracture, as well as chronic extension deficits. They also respond differently to conventional treatment modalities and often require longer and specific rehabilitation programs. Therefore, we propose a classification to define these different presentations.

Results:

Grade 0 is a normal VMO contraction. Grade 1a is when VMO contraction is inhibited but activation failure is reversible with simple exercises while Grade 1b requires longer and specific rehabilitation programs. Grade 2a is when VMO contraction is inhibited with an associated extension deficit due to hamstring contracture, but activation failure and loss of range of motion is reversible with simple exercises. However, Grade 2b is refractory to simple exercises, and longer and specific rehabilitation programs are required. Grade 3 is a chronic extension deficit that is irreducible without extensive posterior arthrolysis.

Conclusion:

In conclusion, AMI is a process in which quadriceps activation failure is caused by neural inhibition and is common following knee injury or surgery. Not taking AMI into account preoperatively can result in a very high risk of stiffness postoperatively. We propose a classification for AMI following knee injury or surgery, which describes different presentations and can be used to guide management.
Evaluating the Stability of Type II Genial Tubercle Fracture Repair: A Case Report
Authors: Goodenough Mark , Gersten Joshua , Izzo Steven , Yusupov Yuriy
Published: June 2022

This case explores the management of a type II genial tubercle fracture (GTF) repair and its stability. Few reports describing the surgical correction of this fracture type exist and among the available literature detailing GTF repair, most do not include post-surgical clinical follow-up. The case herein follows the treatment of a 35-year-old male sustaining poly mandibular trauma. Plate fixation, trans-osseous wiring and maxillomandibular fixation (MMF) were used to secure the genial tubercle to a stable mandibular complex. A 6-week closed reduction protocol was implemented for management of a concomitant subcondylar fracture. Although the patient displayed improvements clinically, genial tubercle (GT) displacement was seen radiographically at the completion of treatment. This paper aims to reassess the durability of trans-osseous wiring as a sole means of fracture reduction. Additional studies documenting follow-up evaluations are needed to verify treatment outcomes of this rare fracture pattern.
Cobalt protoporphyrin promotes human keratinocyte migration under hyperglycemic conditions
Authors: Fang Peng-Hsiang , Lai Ying-Ying , Chen Chih-Ling , Wang Hsin-Yu , Chang Ya-Ning , Lin Yung-Chang , Yan Yu-Ting , Lai Cheng-Hung , Cheng Bill
Published: June 2022

Background

Complete healing of diabetic wounds continues to be a clinically unmet need. Although robust therapies such as stem cell therapy and growth factor treatment are clinically applied, these treatments are costly for most diabetic wound patients. Therefore, a cheaper alternative is needed. Cobalt protoporphyrin (CoPP) has recently been demonstrated to promote tissue regeneration. In this study, the therapeutic benefits of CoPP in diabetic wound healing were examined.

Methods

An in vitro wound healing model that mimics re-epithelialization was established to examine the effect of CoPP on the migratory capability of human keratinocytes (HaCaT) in either normal glucose (NG) or high glucose (HG) media, as well as in the presence of either H2O2 or lipopolysaccharide (LPS). At the end of the migration assays, cells were collected and subjected to Western blotting analysis and immunostaining.

Results

HaCaT were found to migrate significantly more slowly in the HG media compared to the NG media. CoPP treatment was found to enhance cell migration in HG media, but was found to decrease cell migration and proliferation when HaCaT were cultured in NG media. CoPP treatment induced high levels of expression of Nrf-2/HO-1 and FoxO1 in HaCaT cultured in either glucose concentration, although the FoxO1 expression was found to be significantly higher in HaCaT that underwent the migration assay in NG media compared to those in HG media. The higher level of FoxO1 expression seen in CoPP-treated HaCaT cultured in NG media resulted in upregulation of CCL20 and downregulation of TGFβ1. In contrast, HaCaT migrated in HG media were found to have high levels of expression of TGFβ1, and low levels of expression of CCL20. Interestingly, in the presence of H2O2, CoPP-pretreated HaCaT cultured in either NG or HG media had similar expression level of Nrf-2/HO-1 and FoxO1 to each other. Moreover, the anti-apoptotic effect of CoPP pretreatment was noticed in HaCaT cultured in either glucose concentration. Additionally, CoPP pretreatment was shown to promote tight junction formation in HaCaT suffering from LPS-induced damage.

Conclusions

CoPP enhances cell migratory capacity under hyperglycemic conditions, and protects cells from oxidative and LPS-induced cellular damage in HG media containing either H2O2 or LPS.
A retrospective autopsy study of 42 cases of stillbirth in Avicenna Research Institute
Authors: Soltanghoraee Haleh , Moradi-Lakeh Maziar , Khalili Narjes , Soltani Azadeh
Published: June 2022

Background

According to the World Health Organization about 2.6 million deaths were reported worldwide in 2015. More than 98% of stillbirths occur in developing countries. At present, the causes of many cases of stillbirth are unknown due to the lack of necessary data and autopsies in Iran. The aim of this study was to investigate the most plausible cause of stillbirth by evaluating clinical records and autopsies.

Methods

A cross-sectional study of 42 stillbirth autopsies in Avicenna Research Institute from 2012 to 2019, was conducted. Data were extracted from a checklist prepared by the project researchers. The checklist contains maternal demographic information, medical history and maternal illness, pregnancy risk factors, placenta and stillbirth information. Collected data were reviewed and classified according to the ReCoDe (Relevant Condition at Death) system.

Results

In the present study, based on ReCoDe classification, related causes of 95.2% of stillbirths were identified and 4.8% were in the unclassified group. The most common causes were:

Fetal causes (64.3%), umbilical cord (14.3%), placenta (7.1%), amniotic fluid (4.8%), maternal medical conditions (2.4%). The causes of about 70% of stillbirth in Iran are unexplained, but in this study, using autopsy results and ReCoDe classification, only 4.8% of stillbirth causes remained unexplained.

Conclusions

In our study, unknown cases were rare after autopsy. But considering the limitations and costs of autopsy, we need to design the guideline to specify cases who need an autopsy.

Fetal autopsy, placental examination and clinical information could reduce the proportion of stillbirths that remain unexplained.
Disempowering women—a mixed methods study exploring informational support about pain persisting after childbirth and its consequences
Authors: Molin Beata , Zwedberg Sofia , Berger Anna-Karin , Sand Anna , Georgsson Susanne
Published: June 2022

Background

Access to information is essential to achieving individual empowerment; meaning the ability to exercise control, manage one’s own condition and make informed decisions. However, studies have shown that information provided to women regarding physiological changes during the postpartum period and postpartum health was inadequate, incorrect, or inconsistent.

Methods

The aim of this study was to explore informational support about pain persisting after childbirth and its consequences. A sequential explanatory mixed methods design was used. In the first, quantitative phase, 1,171 women, who gave birth eight months earlier, completed a self-administered questionnaire. In the second, qualitative phase, 20 women who experienced chronic pain were interviewed. Descriptive statistics and qualitative content analysis were used to analyse the data.

Results

The majority of the women did not receive information about pain persisting after childbirth, or the information was insufficient or incorrect. They did not know when and where to seek help and did not consult health care professionals. In addition, the lack of information had a negative impact on women’s psychological well-being. All women expressed the need to be informed by health care professionals, irrespective of the individual risk of developing chronic pain.

Conclusions

Health services should ensure availability of information to give the women opportunity to achieve empowerment to make good health decisions, increase control over their health and well-being as well as to enhance their self-efficacy. We propose that a booklet or leaflet with relevant information about the risk of developing chronic pain, symptoms and treatment, along with advice about appropriate health care settings should be provided as part of antenatal or postnatal care.
Characteristics and interplay of esophageal microbiota in esophageal squamous cell carcinoma
Authors: Lin Zheng , Rao Wenqing , Xiang Zhisheng , Zeng Qiaoyan , Liu Shuang , Yu Kaili , Zhou Jinsong , Wang Jianwen , Chen Weilin , Chen Yuanmei , Peng Xiane , Hu Zhijian
Published: June 2022

Background

Esophageal microbiota may influence esophageal squamous cell carcinoma (ESCC) pathobiology. Therefore, we investigated the characteristics and interplay of the esophageal microbiota in ESCC.

Methods

We performed 16S ribosomal RNA sequencing on paired esophageal tumor and tumor-adjacent samples obtained from 120 primarily ESCC patients. Analyses were performed using quantitative insights into microbial 2 (QIIME2) and phylogenetic investigation of communities by reconstruction of unobserved states 2 (PICRUSt2). Species found to be associated with ESCC were validated using quantitative PCR.

Results

The microbial diversity and composition of ESCC tumor tissues significantly differed from tumor-adjacent tissues; this variation between subjects beta diversity is mainly explained by regions and sampling seasons. A total of 56 taxa were detected with differential abundance between the two groups, such as R. mucilaginosa, P. endodontalis, N. subflava, H. Pylori, A. Parahaemolyticus, and A. Rhizosphaerae. Quantitative PCR confirmed the enrichment of the species P. endodontalis and the reduction of H. Pylori in tumor-adjacent tissues. Compared with tumor tissue, a denser and more complex association network was formed in tumor-adjacent tissue. The above differential taxa, such as H. Pylori, an unclassified species in the genera Sphingomonas, Haemophilus, Phyllobacterium, and Campylobacter, also participated in both co-occurrence networks but played quite different roles. Most of the differentially abundant taxa in tumor-adjacent tissues were negatively associated with the epidermal growth factor receptor (EGFR), erb-b2 receptor tyrosine kinase 2 (ERBB2), erb-b2 receptor tyrosine kinase 4 (ERBB4), and fibroblast growth factor receptor 1 (FGFR1) signaling pathways, and positively associated with the MET proto-oncogene, receptor tyrosine kinase (MET) and phosphatase and tensin homolog (PTEN) signaling pathways in tumors.

Conclusion

Alterations in the microbial co-occurrence network and functional pathways in ESCC tissues may be involved in carcinogenesis and the maintenance of the local microenvironment for ESCC.
Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study
Authors: Carter Bernie , Saron Holly , Siner Sarah , Preston Jennifer , Peak Matthew , Mehta Fulya , Lane Steven , Lambert Caroline , Jones Dawn , Hughes Hannah , Harris Jane , Evans Leah , Dee Sarah , Eyton-Chong Chin-Kien , Sefton Gerri , Carrol Enitan D.
Published: June 2022

Background

Paediatric early warning systems (PEWS) alert health professionals to signs of a child’s deterioration with the intention of triggering an urgent review and escalating care. They can reduce unplanned critical care transfer, cardiac arrest, and death. Electronic systems may be superior to paper-based systems. The objective of the study was to critically explore the initial experiences and perceptions of health professionals about the acceptability of DETECT e-PEWS, and what factors influence its acceptability.

Methods

A descriptive qualitative study (part of The DETECT study) was undertaken February 2020–2021. Single, semi-structured telephone interviews were used. The setting was a tertiary children’s hospital, UK. The participants were health professionals working in study setting and using DETECT e-PEWS. Sampling was undertaken using a mix of convenience and snowballing techniques. Participants represented two user-groups: ‘documenting vital signs’ (D-VS) and ‘responding to vital signs’ (R-VS). Perceptions of clinical utility and acceptability of DETECT e-PEWS were derived from thematic analysis of transcripts.

Results

Fourteen HPs (12 nurses, 2 doctors) participated; seven in D-VS and seven in the R-VS group. Three main themes were identified: complying with DETECT e-PEWS, circumventing DETECT e-PEWS, and disregarding DETECT e-PEWS. Overall clinical utility and acceptability were deemed good for HPs in the D-VS group but there was diversity in perception in the R-VS group (nurses found it more acceptable than doctors). Compliance was better in the D-VS group where use of DETECT e-PEWS was mandated and used more consistently. Some health professionals circumvented DETECT e-PEWS and fell back into old habits. Doctors (R-VS) did not consistently engage with DETECT e-PEWS, which reduced the acceptability of the system, even in those who thought the system brought benefits.

Conclusions

Speed and accuracy of real-time data, automation of triggering alerts and improved situational awareness were key factors that contributed to the acceptability of DETECT e-PEWS. Mandating use of both recording and responding aspects of DETECT e-PEWS is needed to ensure full implementation.
Prevention and control of non-communicable diseases in iran: the case for Investment
Authors: Yousefi Mahmood , Dastan Ilker , Alinezhad Farbod , Ranjbar Mansour , Hamelmann Christoph , Ostovar Afshin , Moghisi Alireza , Mohammadi Sima , Mataria Awad , Hammerich Asmus , Slama Slim , Pourghazian Nasim , Hezaveh Alireza Mahdavi , Valizadeh Behzad , Torabi Parisa , Najmi Mehdi , Moradi Mohammad , Hodjatzadeh Alieh , Keshvari-Shad Fatemeh
Published: June 2022

Background

Non-communicable diseases are imposing a considerable burden on Iran. This study aims to assess the Return on Investment (ROI) for implementation of Non-communicable diseases (NCDs) prevention program in Iran.

Methods

Four disease groups including cardiovascular diseases, diabetes, cancer, and respiratory diseases were included in our ROI analysis. The study followed four steps: 1) Estimating the total economic burden of NCDs using the Cost-of-Illness approach. 2) Estimating the total costs of implementing clinical and preventive interventions using an ingredient based costing at delivering level and a program costing method at central level.3) Calculating health impacts and economic benefits of interventions using the impact measures of avoided incidence, avoided mortality, healthy life years (HLYs) gained, and avoided direct treatment costs. 4) Calculating the ROI for each intervention in 5- and 15- year time horizons.

Results

The total economic burden of NCDs to the Iranian economy was IRR 838.49 trillion per year (2018), which was equivalent to 5% of the country’s annual Gross Domestic Product (GDP). The package of NCD will lead to 549 000 deaths averted and 2 370 000 healthy life years gained over 15 years, and, financially, Iranian economy will gain IRR 542.22 trillion over 15 years. The highest ROI was observed for the package of physical activity interventions, followed by the interventions addressing salt, tobacco package and clinical interventions. Conclusions

NCDs in Iran are causing a surge in health care costs and are contributing to reduced productivity. Those actions to prevent NCDs in Iran, as well as yielding to a notable health impact, are giving a good economic return to the society. This study underscores an essential need for establishment of a national multi-sectorial NCD coordination mechanism to bring together and strengthen existing cross-agency initiatives on NCDs.
A deep convolutional neural network to predict the curve progression of adolescent idiopathic scoliosis: a pilot study
Authors: Yahara Yasuhito , Tamura Manami , Seki Shoji , Kondo Yohan , Makino Hiroto , Watanabe Kenta , Kamei Katsuhiko , Futakawa Hayato , Kawaguchi Yoshiharu
Published: June 2022

Background

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that predominantly occurs in girls. While skeletal growth and maturation influence the development of AIS, accurate prediction of curve progression remains difficult because the prognosis for deformity differs among individuals. The purpose of this study is to develop a new diagnostic platform using a deep convolutional neural network (DCNN) that can predict the risk of scoliosis progression in patients with AIS.

Methods

Fifty-eight patients with AIS (49 females and 9 males; mean age: 12.5 ± 1.4 years) and a Cobb angle between 10 and 25 degrees (mean angle: 18.7 ± 4.5) were divided into two groups: those whose Cobb angle increased by more than 10 degrees within two years (progression group, 28 patients) and those whose Cobb angle changed by less than 5 degrees (non-progression group, 30 patients). The X-ray images of three regions of interest (ROIs) (lung [ROI1], abdomen [ROI2], and total spine [ROI3]), were used as the source data for learning and prediction. Five spine surgeons also predicted the progression of scoliosis by reading the X-rays in a blinded manner.

Results

The prediction performance of the DCNN for AIS curve progression showed an accuracy of 69% and an area under the receiver-operating characteristic curve of 0.70 using ROI3 images, whereas the diagnostic performance of the spine surgeons showed inferior at 47%. Transfer learning with a pretrained DCNN contributed to improved prediction accuracy.

Conclusion

Our developed method to predict the risk of scoliosis progression in AIS by using a DCNN could be a valuable tool in decision-making for therapeutic interventions for AIS.
Evaluating the perceived added value of a threefold intervention to improve palliative care for persons experiencing homelessness: a mixed-method study among social service and palliative care professionals
Authors: Klop Hanna T. , de Veer Anke J. E. , Gootjes Jaap R. G. , van de Mheen Dike , van Laere Igor R. , Slockers Marcel T. , Onwuteaka-Philipsen Bregje D.
Published: June 2022

Background

Palliative care for persons experiencing homelessness who reside in social service facilities is often late or lacking. A threefold intervention was implemented to improve palliative care for this population by increasing knowledge and collaboration between social service and palliative care professionals. This consultation service comprised: 1) consultations between social service professionals and palliative care professionals; 2) multidisciplinary meetings involving these professionals; and 3) training of these professionals. This study aims to evaluate the perceived added value of this threefold consultation service in three regions in the Netherlands.

Methods

A mixed-methods evaluation study using structured questionnaires for consultants, requesting consultants, and attendees of multidisciplinary meetings, semi-structured group and individual interviews with social service and palliative care professionals involved, weekly diaries filled out by consultants, and an implementation diary. Qualitative data were analyzed following the principles of thematic analysis. Quantitative data were analyzed descriptively.

Results

Thirty-four consultations, 22 multidisciplinary meetings and 9 training sessions were studied during the implementation period of 21 months. Social service professionals made up the majority of all professionals reached by the intervention. In all regions the intervention was perceived to have added value for collaboration and networks of social service and palliative care professionals (connecting disciplines reciprocally and strengthening collaborations), the competences of especially social service professionals involved (competency in palliative care provision, feeling emotionally supported in complex situations), and the quality and timing of palliative care (more focus on quality of life and dying, advance care planning and looking ahead, and greater awareness of death and palliative care).

Conclusions

The threefold consultation service particularly helps social service professionals connect with palliative care professionals. It helps them to identify palliative care needs in good time and to provide qualitatively better palliative care to persons experiencing homelessness.
Person-centered care content in medicine, occupational therapy, nursing, and physiotherapy education programs
Authors: Wallengren Catarina , Billig Håkan , Björkman Ida , Ekman Inger , Feldthusen Caroline , Lindström Kjellberg Irma , Lundberg Mari
Published: June 2022

Background

Although person-centered care (PCC) ensures high-quality care for patients, studies have shown that it is unevenly applied in clinical practice. The extent to which future health care providers are currently offered education in PCC at their universities is unclear. We aimed to clarify the PCC content offered to students as a basis for their understanding by exploring the PCC content of Swedish national study programs in medicine, nursing, occupational therapy, and physiotherapy.

Methods

Using a qualitative document analysis design, we sampled the steering documents from all higher education institutions (n = 48) with accreditation in medicine (n = 7), nursing (n = 25), occupational therapy (n = 8), or physiotherapy (n = 8) at a single time point. All national study programs (n = 4), local program syllabuses (n = 48), and local course syllabuses (n = 799) were reviewed using a 10-item protocol.

Results

We found no content related to PCC in the steering documents at the national level. At the local level, however, signs of PCC were identified in local program syllabuses and local course syllabuses. Seven of the 48 local program syllabuses (15%) included PCC in their intended learning outcomes. Eight of the 799 local course syllabuses (1%) contained course titles that included the phrase ‘person-centered care,’ and another 101 listed 142 intended learning outcomes referring to PCC. A total of 21 terms connected to PCC were found, and the term ‘person-centered care’ was most commonly used in the nursing programs and least commonly in the medical programs.

Conclusions

There is a broad range in how the national study programs in Sweden have incorporated PCC. The implementation has been driven by a bottom-up strategy. A deliberate and standardized strategy is needed to ensure full implementation of PCC into clinical curricula in higher education.
InspirE5: a participatory, internationally informed framework for health humanities curricula in health professions education
Authors: Carr Sandra E. , Harris Anna , Scott Karen , Ani-Amponsah Mary , Hooker Claire , Phillips Brid , Noya Farah , Mavaddat Nahal , Vuillermin Daniel M. , Reid Steve , Brett-MacLean Pamela
Published: June 2022

Background

Reporting on the effect of health humanities teaching in health professions education courses to facilitate sharing and mutual exchange internationally, and the generation of a more interconnected body of evidence surrounding health humanities curricula is needed. This study asked, what could an internationally informed curriculum and evaluation framework for the implementation of health humanities for health professions education look like?

Methods

The participatory action research approach applied was based on three iterative phases 1. Perspective sharing and collaboration building. 2. Evidence gathering 3. Development of an internationally relevant curriculum and evaluation framework for health humanities. Over 2 years, a series of online meetings, virtual workshops and follow up communications resulted in the production of the curriculum framework.

Results

Following the perspective sharing and evidence gathering, the InspirE5 model of curriculum design and evaluation framework for health humanities in health professions education was developed. Five principal foci shaped the design of the framework. Environment: Learning and political environment surrounding the program. Expectations: Graduate capabilities that are clearly articulated for all, integrated into core curricula and relevant to graduate destinations and associated professional standards. Experience: Learning and teaching experience that supports learners’ achievement of the stated graduate capabilities. Evidence: Assessment of learning (formative and/or summative) with feedback for learners around the development of capabilities. Enhancement: Program evaluation of the students and teachers learning experiences and achievement. In all, 11 Graduate Capabilities for Health Humanities were suggested along with a summary of common core content and guiding principles for assessment of health humanities learning.

Discussion

Concern about objectifying, reductive biomedical approaches to health professions education has led to a growing expansion of health humanities teaching and learning around the world. The InspirE5 curriculum and evaluation framework provides a foundation for a standardised approach to describe or compare health humanities education in different contexts and across a range of health professions courses and may be adapted around the world to progress health humanities education.
The effect of repetition- and scenario-based repetition strategies on anatomy course achievement, classroom engagement and online learning attitude
Authors: Çan Mehmet Ali , Toraman Çetin
Published: June 2022

Anatomy is known to be the oldest and most fundamental branch among medical sciences. That is the reason why it is given at the beginning of medical education to form the basis for other medical sciences. Students who newly begin medical education need to spare plenty of time outside the course hours to study Anatomy which involves different and a lot of terminology. In this study, online repetitions were done outside the class using the repetition (classical presentation) and scenario-based repetition methods and the knowledge levels, course engagement statuses and online learning attitudes of the students were compared quantitatively and qualitatively between the groups.

The study was conducted with 162 medical school year 2 students. These 162 students were randomized to experimental and control groups. The data were obtained with “Anatomy Achievement Test (AAT)”, “Classroom Engagement Inventory (CEI)” and “Medical School Students’ Attitudes Towards Online Learning Scale (MSSATOLS)”. After administering the experimental procedure to the students who were randomized to the experimental and control groups, focus group interviews were held with 16 students from the experimental group, 8 who received the highest scores and 8 who received the lowest scores from the data collecting instruments. The collected research data determined that the affective engagement (AE) and the anatomy achievement test (AAT) performed pre- and post-study were higher in the group in which the scenario-based repetition strategy was applied. AAT pre-test (mean = 27.16) and post-test (mean = 27.15) scores of the repetition group were very close to each other. However, the AAT post-test (mean = 32.33) average of the scenario-based repetition group was above the mean pre-test scores (mean = 26.79) (p < .05). Similarly, the mean AE pre-test (mean = 17.79) and post-test (mean = 17.91) scores of only the repetition group were very close to one another. However, the AE post-test (mean = 19.46) mean score of the scenario-based repetition group was above the mean pre-test score (mean = 17.82) (p < .05). In summary, pre-test and post-test scores changed the anatomy achievement and affective engagement scores, and this change was in favour of experimental group and increasing the post-test scores.

The responses given to the questions in the scales and the impressions obtained from qualitative interviews indicated that the students did not find adequate the lectures given in the form of presentations alone and thought that various methods and primarily scenario-based education should be used as part of anatomy education to be able to establish a good connection with clinical sciences and Anatomy education should be provided not only at the beginning of the medical education but also in the following years.
The impact of the COVID-19 pandemic on a cohort of Labrador retrievers in England
Authors: Woolley Charlotte S. C. , Handel Ian G. , Bronsvoort B. Mark , Schoenebeck Jeffrey J. , Clements Dylan N.
Published: June 2022

Background

The COVID-19 pandemic is likely to have affected the welfare and health of dogs due to surges in adoptions and purchases, changes in the physical and mental health and financial status of dog owners, changes in dogs’ lifestyle and routines and limited access to veterinary care. The aims of this study were to investigate whether COVID-19 restrictions were associated with differences in Labrador retrievers’ lifestyle, routine care, insurance status, illness incidence or veterinary attendance with an illness, who were living in England and enrolled in Dogslife, an owner-based cohort study. Longitudinal questionnaire data from Dogslife that was relevant to the dates between the 23rd of March and the 4th of July 2020, during COVID-19 restrictions in England, were compared to data between the same dates in previous years from 2011 to 2019 using mixed regression models and adjusted chi-squared tests.

Results

Compared with previous years (March 23rd to July 4th, 2010 to 2019), the COVID-19 restrictions study period (March 23rd to July 4th 2020) was associated with owners reporting increases in their dogs’ exercise and worming and decreases in insurance, titbit-feeding and vaccination. Odds of owners reporting that their dogs had an episode of coughing (0.20, 95% CI: 0.04–0.92) and that they took their dogs to a veterinarian with an episode of any illness (0.58, 95% CI: 0.45–0.76) were lower during the COVID-19 restrictions compared to before. During the restrictions period, owners were less likely to report that they took their dogs to a veterinarian with certain other illnesses, compared to before this period.

Conclusions

Dogslife provided a unique opportunity to study prospective questionnaire data from owners already enrolled on a longitudinal cohort study. This approach minimised bias associated with recalling events prior to the pandemic and allowed a wider population of dogs to be studied than is available from primary care data. Distinctive insights into owners’ decision making about their dogs’ healthcare were offered. There are clear implications of the COVID-19 pandemic and associated restrictions for the lifestyle, care and health of dogs.
Evaluating Salmonella pullorum dissemination and shedding patterns and antibody production in infected chickens
Authors: Shen Xuehuai , Zhang Anyun , Gu Ju , Zhao Ruihong , Pan Xiaocheng , Dai Yin , Yin Lei , Zhang Qinghe , Hu Xiaomiao , Wang Hongning , Zhang Danjun
Published: June 2022

Background

Pullorum disease caused by Salmonella pullorum is one of the most important infectious diseases in the poultry industry, responsible for causing substantial economic losses globally. On farms, the traditional method to detect S. pullorum infection mainly involves the collection of feces and sera to test for antigens and antibodies, respectively, but the regularity of Salmonella pullorum dissemination in internal organs and shedding patterns and antibody production in infected chickens remains unclear. Herein we aimed to investigate the dissemination of S. pullorum to different organs and bacterial shedding patterns in the faeces as well as serum antibody production post-infection in chickens of different ages.

Result

In this study, the liver and heart of 2-day-old chickens showed the highest copy numbers of S. pullorum at 6.4 × 106 and 1.9 × 106 copies of DNA target sequences/30 mg, respectively. In case of 10-day-old chickens, the percentage of S. pullorum fecal shedding (0%–40%) and antibody production (0%–56.6%) markedly fluctuated during the entire experiment; furthermore, in case of 42-week-old chickens, the percentage of birds showing S. pullorum shedding in the faeces showed a downward trend (from 63.33% to 6.6% in the oral inoculation group and from 43.3% to 10% in the intraperitoneal injection group), while that of birds showing serum antibody production remained at a high level (38.3% and 80% in the oral inoculation and intraperitoneal injection groups, respectively). We also performed cohabitation experiments, showed that 15% 10-day-old and 3.33% 42-week-old chickens were infected via the horizontal transmission in cohabitation with S. pullorum infected chickens, and revealed a high risk of horizontal transmission of S. pullorum.

Conclusion

This study systematically evaluated the dissemination of S. pullorum in internal organs and bacterial fecal shedding patterns, and antibody production in infected chickens. Collectively, our findings indicate how to effectively screen S. pullorum-negative chickens on livestock farms and should also help in the development of measures to control and eradicate S. pullorum.
Weak cough is associated with increased mortality in COPD patients with scheduled extubation: a two-year follow-up study
Authors: Hong Yueling , Deng Min , Hu Wenhui , Zhang Rui , Jiang Lei , Bai Linfu , Duan Jun
Published: June 2022

Background

Cough strength is associated with short-term outcome in patients with scheduled extubation who successfully complete a spontaneous breathing trial (SBT). However, the long-term outcome is unclear.

Methods

This was a prospective observational study performed in a respiratory ICU of a teaching hospital. COPD patients who successfully completed a SBT were candidates. We enrolled the case who assessed the cough strength by cough peak flow (CPF) or semiquantitative cough strength score (SCSS, ranging from 0 = weak to 5 = strong). Patients were followed up to two years by phone every 3 months.

Results

A total of 215 patients were enrolled in current study. Among them, CPF and SCSS were measured in 214 and 208 cases, respectively. Strong cough was associated with a 16% decrease in the risk of two-year mortality (adjusted hazard ratio [HR] 0.84, 95%CI: 0.78–0.91) per 10 L/min increment of CPF. When it was tested by SCSS, decrease in the risk of two-year mortality per unit increment was 27% (adjusted HR 0.73, 95%CI: 0.62–0.86). Similar results were confirmed in the discharged patients. In all patients, the two-year mortality was 75%, 53%, and 38% in patients with CPF < 60, 60–90, and > 90 L/min; and 85%, 70%, and 40% in patients with SCSS of 0–1, 2–3, and 4–5, respectively. Similar trend was found among the discharged patients whether it was assessed by CPF or SCSS.

Conclusions

In COPD patients, weak cough is associated with increased two-year mortality after a scheduled extubation. It provides objective information to caregivers to improve decision-making process during hospitalization and after discharge.
Association of dietary patterns with blood uric acid concentration and hyperuricemia in northern Chinese adults
Authors: Zhou Meiqi , Huang Xin , Li Ruiqiang , Zhang Zechen , Zhang Limin , Gao Xian , Yang Hui , Ma Yuxia
Published: June 2022

Background

Studies have shown that a direct association exists between the diet and blood uric acid concentrations. However, works on the association of dietary patterns with blood uric acid concentrations and hyperuricemia remain limited. 

Objective

This study aims to evaluate the association of dietary patterns with blood uric acid concentrations and hyperuricemia.

Methods

The relationship between dietary patterns and hyperuricemia was explored through a nutritional epidemiological survey in China (n = 4855). Three statistical methods, including principal component analysis, reduced rank regression (RRR), and partial least squares regression, were used to extract dietary patterns. General linear regression and logistic regression analyses were utilized to explore the relationship of dietary patterns with blood uric acid concentrations and hyperuricemia.

Results

After adjusting for potential confounding factors, the score for the plant-based dietary pattern was found to be negatively correlated with blood uric acid levels (β =  − 3.225) and that for the animal dietary pattern was discovered to be directly correlated with blood uric acid levels (β = 3.645). The participants in the highest quartile of plant-based dietary pattern scores were at a low risk of hyperuricemia (OR = 0.699; 95% CI: 0.561–0.870,P < 0.05), whereas those in the highest quartile of animal dietary pattern scores were at a high risk of hyperuricemia (OR = 1.401; 95% CI: 1.129–1.739,P < 0.05). The participants in the third quartile of scores for the RRR dietary pattern, which was characterized by the relatively high intake of poultry, sugary beverages, and animal organs and the low intake of desserts and snacks, had a significantly higher risk of hyperuricemia than those in the first quartile of scores for the RRR dietary pattern (OR = 1.421; 95% CI: 1.146–1.763,P < 0.05).

Conclusions

Our research indicated that plant-based dietary pattern analyzed by PCA was negatively associated with blood uric acid concentrations, while animal-based dietary pattern was directly associated with blood uric acid concentrations. The RRR dietary pattern may have the potential to induce elevations in blood uric acid concentrations.
Diagnostic performance of endoscopic ultrasound-guided tissue acquisition by EUS-FNA versus EUS-FNB for solid pancreatic mass without ROSE: a retrospective study
Authors: Wong Thanawin , Pattarapuntakul Tanawat , Netinatsunton Nisa , Ovartlarnporn Bancha , Sottisuporn Jaksin , Chamroonkul Naichaya , Sripongpun Pimsiri , Jandee Sawangpong , Kaewdech Apichat , Attasaranya Siriboon , Piratvisuth Teerha
Published: June 2022

Background

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is an established diagnostic procedure for solid pancreatic mass. However, the diagnostic yield between fine-needle aspiration (FNA) and fine-needle biopsy (FNB) remains unclear. We aimed to evaluate and compare the diagnostic yields between FNA and FNB using conventional FNA and Franseen needles of the same size 22-gauge needle, in patients with solid pancreatic mass who underwent EUS-TA without rapid onsite cytopathology evaluation (ROSE).

Methods

All cases of EUS-TA by FNA or FNB for solid pancreatic mass between January 2017 and October 2020 in a single-centre university hospital were retrospectively reviewed. All procedures were performed without an onsite cytologist. Before the endoscopist finished the procedure, macroscopic onsite evaluation (MOSE) was confirmed. The diagnostic yield and the average number of needle passes between FNB and FNA were then compared.

Results

A total of 151 patients (FNA, n = 77; FNB, n = 74) with solid pancreatic mass detected by cross-sectional imaging underwent EUS-TA. The mean age was 62.3 ± 12.8 years, with 88 (58.3%) males. Age, sex, mass location, tumour size and disease stage from imaging were not significantly different between the two groups. The diagnostic performance was higher in EUS-FNB (94.6%) than in EUS-FNA (89.6%). The mean number of needle passes was clearly fewer in FNB than in FNA (2.8 vs. 3.8, p < 0.001). The total procedure time was shorter in FNB (34.7 min) than in FNA (41 min). The adverse event rate between FNB and FNA was not significantly different.

Conclusions

The diagnostic yield of solid pancreatic mass was higher in FNB using the Franseen needle than in FNA using the conventional FNA needle in a centre where ROSE is unavailable, without serious adverse event. In addition, FNB had fewer needle passes and shorter total procedure time.
Single-cell transcriptomics reveals immune dysregulation mediated by IL-17A in initiation of chronic lung injuries upon real-ambient particulate matter exposure
Authors: Zhang Rui , Chen Shen , Chen Liping , Ye Lizhu , Jiang Yue , Peng Hui , Guo Zhanyu , Li Miao , Jiang Xinhang , Guo Ping , Yu Dianke , Zhang Rong , Niu Yujie , Zhuang Yuan , Aschner Michael , Zheng Yuxin , Li Daochuan , Chen Wen
Published: June 2022

Background

Long-term exposure to fine particulate matter (PM2.5) increases susceptibility to chronic respiratory diseases, including inflammation and interstitial fibrosis. However, the regulatory mechanisms by which the immune response mediates the initiation of pulmonary fibrosis has yet to be fully characterized. This study aimed to illustrate the interplay between different cell clusters and key pathways in triggering chronic lung injuries in mice following PM exposure.

Results

Six-week-old C57BL/6J male mice were exposed to PM or filtered air for 16 weeks in a real-ambient PM exposure system in Shijiazhuang, China. The transcriptional profiles of whole lung cells following sub-chronic PM exposure were characterized by analysis of single-cell transcriptomics. The IL-17A knockout (IL-17A−/−) mouse model was utilized to determine whether the IL-17 signaling pathway mediated immune dysregulation in PM-induced chronic lung injuries. After 16-week PM exposure, chronic lung injuries with excessive collagen deposition and increased fibroblasts, neutrophils, and monocytes were noted concurrent with a decreased number of major classes of immune cells. Single-cell analysis showed that activation of the IL-17 signaling pathway was involved in the progression of pulmonary fibrosis upon sub-chronic PM exposure. Depletion of IL-17A led to significant decline in chronic lung injuries, which was mainly triggered by reduced recruitment of myeloid-derived suppressor cells (MDSCs) and downregulation of TGF-β.

Conclusion

These novel findings demonstrate that immunosuppression via the IL-17A pathway plays a critical role in the initiation of chronic lung injuries upon sub-chronic PM exposure.