bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term disability trajectories in relapsing multiple sclerosis patients treated with early intensive or escalation treatment strategies
Authors: Iaffaldano Pietro , Lucisano Giuseppe , Caputo Francesca , Paolicelli Damiano , Patti Francesco , Zaffaroni Mauro , Brescia Morra Vincenzo , Pozzilli Carlo , De Luca Giovanna , Inglese Matilde , Salemi Giuseppe , Maniscalco Giorgia Teresa , Cocco Eleonora , Sola Patrizia , Lus Giacomo , Conte Antonella , Amato Maria Pia , Granella Franco , Gasperini Claudio , Bellantonio Paolo , Totaro Rocco , Rovaris Marco , Salvetti Marco , Torri Clerici Valentina Liliana Adriana , Bergamaschi Roberto , Maimone Davide , Scarpini Elio , Capobianco Marco , Comi Giancarlo , Filippi Massimo , Trojano Maria ,   on behalf of the Italian MS Register
Published: May 2021

Background and aims:

No consensus exists on how aggressively to treat relapsing–remitting multiple sclerosis (RRMS) nor on the timing of the treatment. The objective of this study was to evaluate disability trajectories in RRMS patients treated with an early intensive treatment (EIT) or with a moderate-efficacy treatment followed by escalation to higher-efficacy disease modifying therapy (ESC).

Methods:

RRMS patients with ⩾5-year follow-up and ⩾3 visits after disease modifying therapy (DMT) start were selected from the Italian MS Registry. EIT group included patients who received as first DMT fingolimod, natalizumab, mitoxantrone, alemtuzumab, ocrelizumab, cladribine. ESC group patients received the high efficacy DMT after ⩾1 year of glatiramer acetate, interferons, azathioprine, teriflunomide or dimethylfumarate treatment. Patients were 1:1 propensity score (PS) matched for characteristics at the first DMT. The disability trajectories were evaluated by applying a longitudinal model for repeated measures. The effect of early versus late start of high-efficacy DMT was assessed by the mean annual Expanded Disability Status Scale (EDSS) changes compared with baseline values (delta-EDSS) in EIT and ESC groups.

Results:

The study cohort included 2702 RRMS patients. The PS matching procedure produced 363 pairs, followed for a median (interquartile range) of 8.5 (6.5–11.7) years. Mean annual delta-EDSS values were all significantly ( p < 0.02) higher in the ESC group compared with the EIT group. In particular, the mean delta-EDSS differences between the two groups tended to increase from 0.1 (0.01–0.19, p = 0.03) at 1 year to 0.30 (0.07–0.53, p = 0.009) at 5 years and to 0.67 (0.31–1.03, p = 0.0003) at 10 years.

Conclusion:

Our results indicate that EIT strategy is more effective than ESC strategy in controlling disability progression over time.
Phase I study of pucotenlimab (HX008), an anti-PD-1 antibody, for patients with advanced solid tumors
Authors: Liu Rujiao , Li Wenhua , Meng Yanchun , Gao Shuiping , Zhang Jian , Hu Xichun
Published: May 2021

Background:

Pucotenlimab is a humanized immunoglobulin G4 (IgG4) anti programmed cell death protein 1 (anti-PD-1) monoclonal antibody (mAb) with a S228P hinge mutation and an engineered Fc domain. Preclinical data suggests that pucotenlimab exerts antitumor effects. In this phase I study, which was prospectively registered on www.chinadrugtrials.org.cn (CTR20180125), the safety, maximum tolerated dose, preliminary antitumor activity, pharmacokinetics, and immunogenicity of pucotenlimab were evaluated in patients with advanced solid tumors.

Methods:

Patients with advanced solid tumors refractory to standard therapies were recruited. In a 3+3 dose escalation study, 13 patients received pucotenlimab intravenously every 3 weeks (Q3W) until disease progression or unacceptable toxicity occurred at doses of 1 mg/kg, 3 mg/kg, 10 mg/kg, and 200 mg. 17 additional patients were assigned in the expansion period.

Results:

A total of 30 patients were enrolled. No dose-limiting toxicity was observed. The maximum tolerated dose was not reached. The most common treatment-related adverse events of any grade were proteinuria (40%), fatigue (36.7%), weight loss (26.7%), fever (26.7%), increased aspartate aminotransferase (26.7%), rash (23.3%), and anorexia (20.0%). Partial responses occurred in five patients, with an objective response rate of 16.7%. Pharmacokinetics analysis showed rapid absorption followed by slow terminal elimination, with a mean half-life of 17.1–23.5 days across all dose groups.

Conclusions:

Pucotenlimab had an acceptable toxicity profile at doses up to 10 mg/kg and the maximum tolerated dose was not reached. Based on the pharmacokinetics, efficacy, and safety profile, 3 mg/kg Q3W or 200 mg Q3W are optimal for further drug development.
A Conditional Generative Adversarial Network for Synthesis of Continuous Glucose Monitoring Signals
Authors: Cichosz Simon Lebech , Xylander Alexander Arndt Pasgaard
Published: May 2021

This report describes how a Conditional Generative Adversarial Network (CGAN) was used to synthesize realistic continuous glucose monitoring systems (CGM) from healthy individuals and individuals with type 1 diabetes over a range of different HbA1c levels. The results showed that even though the CGAN generated data, did not perfectly reflect real world CGM, many of the important features were captured and reflected in the synthetic signals. It is briefly discussed how heterogenous data sources constitutes a challenge for comparison of predictive CGM models. Therefore 40,000 CGM days were generated by the trained CGAN, equivalent to 940,000 hours of synthetic CGM measurements. These data have been made available in a public database, which can be used as a reference in future studies.
Anemia, sarcopenia, physical activity, and the risk of tuberculosis in the older population: a nationwide cohort study
Authors: Yoo Jung Eun , Kim Dahye , Choi Hayoung , Kang Young Ae , Han Kyungdo , Lee Hyun , Shin Dong Wook
Published: May 2021

Background:

The aim of this study was to investigate whether physical activity, sarcopenia, and anemia are associated an with increased risk of tuberculosis (TB) among the older population.

Methods:

We included 1,245,640 66-year-old subjects who participated in the National Screening Program for Transitional Ages for Koreans from 2009 to 2014. At baseline, we assessed common health problems in the older population, including anemia and sarcopenia. The subjects’ performance in the timed up-and-go (TUG) test was used to predict sarcopenia. The incidence of TB was determined using claims data from the National Health Insurance Service database.

Results:

The median follow-up duration was 6.4 years. There was a significant association between the severity of anemia and TB incidence, with an adjusted hazard ratio (aHR) of 1.28 [95% confidence interval (CI), 1.20–1.36] for mild anemia and 1.69 (95% CI, 1.51–1.88) for moderate to severe anemia. Compared with those who had normal TUG times, participants with slow TUG times (⩾15 s) had a significantly increased risk of TB (aHR 1.19, 95% CI, 1.07–1.33). On the other hand, both irregular (aHR 0.88, 95% CI 0.83–0.93) and regular (aHR 0.84, 95% CI, 0.78–0.92) physical activity reduced the risk of TB. Male sex, lower income, alcohol consumption, smoking, diabetes, and asthma/chronic obstructive pulmonary disease increased the risk of TB.

Conclusion:

The risk of TB among older adults increased with worsening anemia, sarcopenia, and physical inactivity. Physicians should be aware of those modifiable predictors for TB among the older population.
Hemorrhage and venous thromboembolism in critically ill patients with COVID-19
Authors: Qiu Chenyang , Li Tong , Wei Guoqing , Xu Jun , Yu Wenqiao , Wu Ziheng , Li Donglin , He Yangyan , Chen Tianchi , Zhang Jingchen , He Xujian , Hu Jia , Fang Junjun , Zhang Hongkun
Published: May 2021

Objective:

The majority of patients with COVID-19 showed mild symptoms. However, approximately 5% of them were critically ill and require intensive care unit admission for advanced life supports. Patients in the intensive care unit were high risk for venous thromboembolism and hemorrhage due to the immobility and anticoagulants used during advanced life supports. The aim of the study was to report the incidence and treatments of the two complications in such patients.

Method:

Patients with COVID-19 (Group 1) and patients with community-acquired pneumonia (Group 2) that required intensive care unit admission were enrolled in this retrospective study. Their demographics, laboratory results, ultrasound findings and complications such as venous thromboembolism and hemorrhage were collected and compared.

Results:

Thirty-four patients with COVID-19 and 51 patients with community-acquired pneumonia were included. The mean ages were 66 and 63 years in Groups 1 and 2, respectively. Venous thromboembolism was detected in 6 (18%) patients with COVID-19 and 18 (35%) patients with community-acquired pneumonia (P = 0.09). The major type was distal deep venous thrombosis. Twenty-one bleeding events occurred in 12 (35%) patients with COVID-19 and 5 bleeding events occurred in 5 (10%) patients with community-acquired pneumonia, respectively (P = 0.01). Gastrointestinal system was the most common source of bleeding. With the exception of one death due to intracranial bleeding, blood transfusion with or without surgical/endoscopic treatments was able to manage the bleeding in the remaining patients. Multivariable logistic regression showed increasing odds of hemorrhage with extracorporeal membrane oxygenation (odds ratio: 13.9, 95% confidence interval: 4.0–48.1) and COVID-19 (odds ratio: 4.7, 95% confidence interval: 1.2–17.9).

Conclusion:

Venous thromboembolism and hemorrhage were common in both groups. The predominant type of venous thromboembolism was distal deep venous thrombosis, which presented a low risk of progression. COVID-19 and extracorporeal membrane oxygenation were risk factors for hemorrhage. Blood transfusion with or without surgical/endoscopic treatments was able to manage it in most cases.
Correcting hypokalaemia in a paediatric patient with Bartter syndrome through oral dose of potassium chloride intravenous solution
Authors: Alasfour Salman , Alfailakawi Haya S , Shamsaldeen Yousif A
Published: May 2021

Bartter syndrome is a rare autosomal recessive disorder characterized by hypokalaemia. Hypokalaemia is defined as low serum potassium concentration ˂3.5 mmol/L, which may lead to arrhythmia and death if left untreated. The aim of this case report was to normalize serum potassium concentration without the need for intravenous intervention. A 5-month-old male of 2.7 kg body weight diagnosed with Bartter syndrome was admitted to the general paediatric ward with acute severe hypokalaemia and urinary tract infection. The main challenge was the inability to administer drugs through intravenous route due to compromised body size. Therefore, we shifted the route of administration to the nasogastric tube/oral route. A total of 2 mL of concentrated intravenous potassium chloride (4 mEq potassium) were dissolved in distilled water and administered through nasogastric tube. Serum potassium concentration was rapidly normalized, which culminated in patient discharge. In conclusion, shifting drug administration from intravenous to oral route in a paediatric patient with Bartter syndrome includes numerous advantages such as patient convenience, minimized risk of cannula-induced infection, and reduced nurse workload.
Can the ultrasound suggest the emergency operation of a sliding ovary in a hernia sac?
Authors: Kambouri Katerina , Sotiropoulou Rodoula , Nistikoulis George Petros , Foutzitzi Soultana , Aggelidou Maria , Deftereos Savas
Published: May 2021

In this case, it is described the importance of ultrasound in children with sliding ovaries in inguinal hernias. If the child has no symptoms, an emergency ultrasound could suggest the manner of the operation, scheduled or emergency.
Hair loss in an infant presenting with failure to thrive
Authors: Baidwan Baninder Kaur , Haberman Cara J
Published: May 2021

An 11-month-old male child with a complex past medical history presented for admission due to failure to thrive. He had hair loss throughout his scalp, and his abdomen was distended. There was parental report of hair pulling and hair in his stool. An upper gastrointestinal (GI) radiograph with fluoroscopy was performed and showed a filling defect in the gastric lumen. On endoscopy, he was found to have a gastric bezoar consisting of hair, nail, and food material. The trichobezoar was removed, and he began to tolerate feeds and showed consistent weight gain. There were no recurrence of symptoms 8 months following removal. While inadequate caloric intake is a common reason for failure to thrive, mechanical obstruction from a trichobezoar as a cause is rare and to our knowledge has not been reported in a child this young.
Embedding Music and Music Therapy in Care Pathways for People with Dementia in the 21st Century—a position paper
Authors: Odell-Miller Helen
Published: May 2021

Unique music therapy interventions are discussed from a clinical educational and research perspective, demonstrating a current position on music therapy for people living with dementia and their carers. The position paper, adapted from the keynote lecture given at the workshop “Music Selves and Societies” at Cambridge University in 2018, outlines current research and practice across music and music therapy fields, focussing upon embedding music in daily life and care for people living with dementia. Worldwide, around 50m people have dementia; this is estimated to increase to 75.6m in 2030 and 135.5m in 2050. This results in increased demand for long-term care and a need for heightened awareness and capacity for home care in local settings. Distinctions between interventions delivered by music therapists (direct music therapy) and interventions delivered by musicians or carers arising from training from music therapists (indirect music therapy) are discussed. Political and strategic developments for music and dementia are summarized, highlighting the need for increased training in the field and access to music at all stages of dementia. Case study examples are presented to highlight emerging practices and research; for example, couples attending music therapy groups in a rural community setting (Together in Sound) improved relationships and attitudes for people living with dementia. An international trial investigating reading and music interventions for people living with dementia and their homebased family carers (Homeside) is introduced, alongside practice and research in care homes where music therapy had been found to reduce agitation and improve carers’ well-being. Research shows music therapy interventions address personalized needs linked to daily lived experiences. However, indirect music therapy is needed to reach all who can benefit from music and are living with dementia. It is concluded that high quality, accessible music interventions should be embedded in care, and further research is needed to ascertain best practice.
2019 Novel Coronavirus Vaccination among Post-graduate Residents and Fellows
Authors: Abohelwa Mostafa , Elmassry Mohamed , Abdelmalek John , Payne Drew , Nugent Kenneth
Published: May 2021

Background

Coronavirus-2 (COVID-19) has caused a worldwide pandemic since December 2019. Since then, clinical trials with vaccines have been started and completed, and at present, 3 COVID-19 vaccines have been approved for use in the United States. Healthcare providers were among the first to get vaccinated, but the precise attitudes of healthcare workers toward vaccination are uncertain.

Objective

To understand residents and fellows’ attitudes toward vaccination and record any side effects after vaccination.

Methods

We conducted an anonymous survey that was open from 3-1-2021 to 3-12-2021 using distribution lists from the Graduate Medical Education office on the Lubbock campus of the Texas Tech University Health Sciences Center after getting approval from the Institutional Review Board (L21-088).

Results

Eighty-one residents and fellows (26.6% out of 304) responded to our survey. Among those who responded, 63 (77.8 %) were between 25 and 35 years old, and 41 (50.6%) were males. Seventy-seven (95.1%) received the vaccine (Pfizer-BioNTech), 78 (96.3%) reported that they supported vaccination, and 3 (3.7%) reported that they did not want vaccination. Eight members (9.8%) had tested positive for COVID-19 infection before vaccination, but only 1 (1.23%) had tested positive for COVID-19 antibodies. All residents and fellows reported side effects after the vaccination, including pain at the injection site (77; 100%), local redness (9; 11.6%), local swelling (13; 16.8%), fever (25; 32.5%), fatigue (25; 32.5%), chills (34; 44.1 %), headache (38; 49.4%).

Conclusions

Most medical trainees have a high interest in COVID-19 vaccination; however, a few reported that they did not want vaccination.
Cognitive and Affective Components of Verbal Self-Concepts and Internal/External Frame of Reference Within the Multidimensional Verbal Domain
Authors: Karimova Könül , Csapó Benő
Published: May 2021

Most researchers have studied students’ academic self-concept within native language and mathematics, indicating the multidimensional nature of academic self-concept. However, there is a shortage of studies that examined the twofold multidimensional structure of verbal self-concept within the internal/external frame of reference (I/E) model of two foreign languages. This study aims to examine affective and cognitive components of English and Russian self-concepts for defining the separation or conflation of these components within the I/E model and evaluate cognitive and affective components across gender. A total of 540 eighth-grade Azeri students participated in this study. Confirmatory factor analysis indicated self-concept structure as twofold multidimensional, distinguishing affective and cognitive components as two different constructs. Study of the I/E model of two language self-concepts showed that Russian achievement correlated with Russian cognitive self-concept and English cognitive self-concept related to English achievement. One general verbal self-concept for different languages may not adequately represent multilingual learners and can produce misleading interpretations. The relationship between the two dimensions of self-concept in two target languages was invariant. The results of this study should encourage researchers to examine subject-specific self-concepts that conceptualize cognitive and affective dimensions of the self-concept and their relationships with achievement.
Failure of States, Fragility of States, and the Prospects of Peace in South Sudan
Authors: Okeke Remi Chukwudi , Idike Adeline Nnenna , Akwara Azalahu Francis , Okorie Cornelius O. , Ibiam Okechukwu E.
Published: May 2021

This article discusses the concepts of failure of states, fragility of states, and the prospects of peace in South Sudan. The article focuses specifically on judicial structural deformities in South Sudan under the qualitative and normative research methodologies, with structural functionalism as theoretical framework. Where preceding works had concentrated their South Sudanese peace-building recommendations on power-sharing mechanisms, this contribution emphasizes a long-term postviolence focus on the building of governance structures. The work recommends that while mediating in liberation struggles, it is critical for the intervening international community to consider the structures on ground, under which an envisaged independent state would thrive, as the prospects of enduring peace in the war-torn South Sudan are more dependent on the creation of such mechanisms than attempting to reconcile the defiant fighters.
Awarding PhD Powers to Polytechnics: An Academic Trap?
Authors: Brás Gonçalo Rodrigues
Published: May 2021

The aim of this article is to understand whether the conditions in Portuguese public polytechnics (PPPs) when studying for a PhD are similar to those in Portuguese public universities (PPUs). Three pillars were analyzed (research, academic staff degree, and precarious rate of academic staff), and to this end, we conducted independent sample t-tests and designed a correlation matrix to shed light on the relationship between the percentage of precarious academic staff and the short-run variables in the environment of PPPs. The main findings reveal differences between PPUs and PPPs, indicating that policymakers failed to ensure that PPPs are competitive vis-a-vis PPUs in this area. Decree-Law No. 65/2018 granting PPPs the right to award doctoral degrees gives rise to a number of risks: a loss of focus in PPPs, the disappearance of the most used system in higher education (binary or dual system), and the absence of higher institutions in Portugal that provide practical training. If this is the path chosen by policymakers and the nature of course programs in PPPs and PPUs are becoming more similar, we strongly recommend that similar conditions should prevail in the two subsystems; this entails greater investment in PPPs and even the possibility of awarding PhD professional degrees in close connection with firms and corporations.
From Print Texts to Online Gaming: The Cross-Cultural History of Wuxia Fictions in Vietnam
Authors: Phan Anh Quang
Published: May 2021

The popularization of online gaming in Vietnam, including PC and mobile gaming, has witnessed the contribution of wuxia fictions as an essential aspect of digital content production. This article shows an attempt in tracing the cultural history of wuxia works in Vietnam. East-West differences have also been taken into consideration as a way to explain reading and playing preferences. By using life course approach along with the concepts of nostalgia and cultural proximity, this study tries to historically portray the wuxia readership in Vietnam and its vestige found in wuxia online games. The findings indicate that wuxia novels serve as a crucial factor representing the literary relationship between the Sinosphere and Vietnam. Its presence has enriched the content of Vietnamese literature, adding a new genre that has been widely accepted by many generations of Vietnamese readers. Because wuxia online games could be seen as the digital continuation of wuxia fictions, the author argues that prior experience drawn from interacting with wuxia novels affects the game selection-making process of players, and gaming companies in Vietnam also acknowledge that and deploy appropriate business strategies.
The Predicament of Europe’s ‘Last Dictator’
Authors: Brel-Fournier Yuliya , Morrison Minion K.C.
Published: May 2021

Belarusian citizens elected their first president in 1994. More than 20 years later, in October 2015, the same person triumphantly won the fifth consecutive presidential election. In August 2020, President Lukashenko’s attempt to get re-elected for the sixth time ended in months’ long mass protests against the electoral fraud, unspeakable violence used by the riot police against peaceful protesters and the deepest political crisis in the modern history of Belarus. This article analyzes how and why the first democratically elected Belarusian president attained this long-serving status. It suggests that his political longevity was conditioned by a specific social contract with the society that was sustained for many years. In light of the recent events, it is obvious that the contract is breached with the regime no longer living up to the bargain with the Belarusian people. As a result, the citizens seem unwilling to maintain their obligation for loyalty. We analyze the escalating daily price for maintaining the status quo and conclude considering the possible implications of this broken pact for the future of Belarus.
Sound Localization Bias and Error in Bimodal Listeners Improve Instantaneously When the Device Delay Mismatch Is Reduced
Authors: Angermeier Julian , Hemmert Werner , Zirn Stefan
Published: May 2021

Users of a cochlear implant (CI) in one ear, who are provided with a hearing aid (HA) in the contralateral ear, so-called bimodal listeners, are typically affected by a constant and relatively large interaural time delay offset due to differences in signal processing and differences in stimulation. For HA stimulation, the cochlear travelling wave delay is added to the processing delay, while for CI stimulation, the auditory nerve fibers are stimulated directly. In case of MED-EL CI systems in combination with different HA types, the CI stimulation precedes the acoustic HA stimulation by 3 to 10 ms. A self-designed, battery-powered, portable, and programmable delay line was applied to the CI to reduce the device delay mismatch in nine bimodal listeners. We used an A-B-B-A test design and determined if sound source localization improves when the device delay mismatch is reduced by delaying the CI stimulation by the HA processing delay (τHA). Results revealed that every subject in our group of nine bimodal listeners benefited from the approach. The root-mean-square error of sound localization improved significantly from 52.6° to 37.9°. The signed bias also improved significantly from 25.2° to 10.5°, with positive values indicating a bias toward the CI. Furthermore, two other delay values (τHA –1 ms and τHA +1 ms) were applied, and with the latter value, the signed bias was further reduced in some test subjects. We conclude that sound source localization accuracy in bimodal listeners improves instantaneously and sustainably when the device delay mismatch is reduced.
Adapting Helping Babies Breathe into a Virtual Curriculum: Methods, Results, and Lessons Learned
Authors: Sobelman Celia , Richard Kristen , McQuilkin Patricia , Fahey Nisha
Published: May 2021

Introduction. The Helping Babies Breathe (HBB) curriculum is an established, effective method to combat neonatal mortality. The COVID-19 pandemic has disrupted in-person HBB training sessions worldwide, portending deficits in the dissemination of this important intervention. Methods. A pilot study to compare in-person versus virtual HBB training among US-based pediatric and family medicine residents. Two HBB master trainers condensed the curriculum into an abbreviated course that was offered to 14 learners in-person (n = 6) and virtually via Zoom (n = 8). A standardized 10-item survey was administered before and after the session to measure reported self-efficacy of critical elements of HBB. Difference of difference analysis was performed to detect differences in post vs pre-training results among the 2 groups using STATA MP 15. Results. All learners showed improvement in preparedness, assessment, and skills subcomponents of self-efficacy with no notable differences based on the type of learning medium. At baseline, in-person learners had a 7-point higher self-efficacy score (69.7) in comparison to virtual learners (62.8; P = .26). After training, the confidence score improved significantly; by 14.3 units for in-person learners ( P = .01) and 12.9 for virtual learners ( P = .04). There was no statistically significant difference in improvement between the 2 groups ( P = .67). Furthermore, all learners passed the post-training knowledge assessment. Discussion. Virtual learning of HBB may be an alternative option in the setting of resource and travel limitations. Future work needs to assess possible differences in attainment of assessment skills and retention of the HBB curriculum among virtual learners.
Truth, Deception, and Coercion; Communication Strategies Used by Caregivers of Children with Perinatally Acquired HIV During the Pre-Disclosure and Post-Disclosure Period in Rural Communities in South Africa
Authors: Molokwane Mmathale , Madiba Sphiwe
Published: May 2021

Typically, children with perinatal HIV (PHIV) receive antiretroviral treatment (ART) for a long time prior to receiving disclosure. Communication with children about HIV and treatment is critical for monitoring adherence and retention in care. However, there is a dearth of information on communication between caregivers and their children. This study examines what and how caregivers tell their their children about their illness and medication in the pre-disclosure and post-disclosure period. A qualitative study using semi-structured one-on-one interviews and focus group discussions was conducted with caregivers recruited via purposive sampling from a rural sub-district in South Africa. The interviews were analyzed using thematic analysis. The sample consisted of 38 caregivers, 24 of whom were the children’s biological mothers, 20 had disclosed to the children and 18 had not done so. Caregivers who had disclosed had told their children the truth and named the disease as HIV, but communication about HIV was infrequent and focused on pill taking. Those who had not disclosed had lied, deflected illness-related information, and attributed the children’s ill health to co-morbid conditions. To enforce adherence, most caregivers used coercion and threats of the grave consequences of non-adherence as a communication strategy. Those who had not disclosed used deception, deflecting, and coercion as strategies for coping through the pre-disclosure period. There is a need for healthcare workers to prepare, support, and empower caregivers to develop appropriate responses to children’s questions and to understand the implications of deception on future full disclosure and children’s acceptance of their HIV status.
Serum Lactate: A Predictor of Septic Shock in Childhood Cancers with Febrile Neutropenia
Authors: Suwanpakdee Detchvijitr , Prasertsin Warakorn , Traivaree Chanchai , Rujkijyanont Piya
Published: May 2021

Early recognition and management are the key elements to prevent febrile neutropenia associated mortality. The prospective observational study aimed to investigate prognostic accuracy of serum lactate to predict septic shock within 48 hours among hemodynamically stable children with febrile neutropenia. In all, 99 pediatric oncology patients who developed febrile neutropenia were enrolled in the study. Clinical information during 48 hours and serum lactate at the time of enrollment were analyzed. Among 99 participating patients, 10 developed septic shock and 4 of those expired. No significant difference was found of patients’ baseline characteristics and basic laboratory parameters between patients with and without septic shock. Serum lactate was significantly elevated among patients developing septic shock ( P-value < .001) and those who expired ( P-value .002). Receiver operating characteristic (ROC) curve was created to identify the best cutoff value for initial serum lactate associated with the development of septic shock within 48 hours. Baseline serum lactate more than 2.5 mmol/L showed the largest area under the ROC curve to predict the septic shock development within 48 hours (ROC area, 0.90; 95% confidence interval [CI], 0.81-0.98), with sensitivity, specificity, negative predictive value, and accuracy of 80.0%, 92.1%, 97.6%, and 90.9%, respectively. Serum lactate level determined early at the time of febrile neutropenia was an effective surrogate marker for developing septic shock within 48 hours among hemodynamically stable, pediatric oncology patients. The level more than 2.5 mmol/L was the best threshold to start preemptive aggressive hemodynamic monitoring and prompt treatment to ensure adequate tissue perfusion.
Implementing Silent Disco Headphones in a Hospital Unit: A Qualitative Study of Feasibility, Acceptance, and Experience Among Patients and Staff
Authors: Hung, PhD, RN Lillian , Dahl, BMT Kevin , Peake Gail , Poljak Luka , Wong Lily , Mann, LLD Jim , Wilkins-Ho, MD Michael , Chaudhury, PhD Habib
Published: May 2021

Introduction

Music is so widely available and inexpensive in the modern world; it is a common option for stress reduction, comfort and enjoyment. Silent disco headphones are used among young people; however, no study has yet investigated whether it is feasible to use these headphones to support mental health and well-being among older people with dementia in hospital settings.

Objective

The study’s main objective is to explore whether music delivered by silent disco headphones was feasible and acceptable to a sample of inpatients staying in an older adult mental health unit of a large urban hospital.

Methods

We employed a video-ethnographic design in data collection, including conversational interviews and observations with video recording among ten patient participants in a hospital unit. A focus group was conducted with ten hospital staff on the unit.

Results

Our analysis identified three themes that represented experiences of patients and staff: (1) perceived usefulness, (2) perceived ease of use, and (3) attitude. Patient participants reported the music delivered by the headphones brought positive benefits. Witnessing the positive effects on patients influenced the staff’s view of how music could be used in the clinical setting to support patients’ well-being.

Conclusions

The music delivered by the silent disco headphones in an older adult mental health unit was found to be an acceptable and feasible intervention for patients. Leadership support is identified as an enabling factor in supporting technology adoption in the clinical setting. The findings can be used to inform practice development and future research.
Experience with a Clinical Audit Requirement for Interns in the Emergency Department
Authors: Windish Ryan , Morel Douglas , Forristal Catherine E
Published: May 2021

Background:

The clinical audit is an important evaluation tool to ensure quality assurance. A clinical audit requirement for interns during their emergency department (ED) term may be a valuable educational activity.

Methods:

The Emergency Audit Initiative (EAI) Program was initiated at Redcliffe Hospital in January 2018. Interns, who were paired with a staff specialist audit mentor, chose a topic of interest and carried out a clinical audit during their 10-week ED term. At the end of term, interns formally presented audit findings in a grand round setting. Interns and staff specialists were surveyed at the end of the intern year regarding aspects of the program. Surveys aimed to assess: (1) value of the program as an educational activity, (2) availability of time and resources to conduct the audit, and (3) perceived impact on practice.

Results:

During the first year of the program, 27 clinical audits were carried out. 16 interns (59%) and 8 staff specialists (57%) responded to the surveys. Interns and staff specialists reported that the audit was a valuable educational experience (88% and 100%). Interns also reported that they had adequate time (94%) and resources (81%) to conduct the audit. Interns and staff specialists however reported only a modest impact on clinical practice because of the audit program.

Conclusions:

Our experience with the EAI program suggests that incorporating a clinical audit requirement into the ED term is possible. Interns and staff specialists reported it to be a beneficial educational and professional development activity.
The Effect of the Educational Environment on the rate of Burnout among Postgraduate Medical Trainees – A Narrative Literature Review
Authors: Grech Marco
Published: May 2021

Background:

Burnout among postgraduate medical trainees is common. It is a syndrome characterised by emotional exhaustion, depersonalisation and reduced personal accomplishment. Burnout is seen as an organisational problem rather than the result of an individual’s ability to cope with the stress at work. The educational environment can play a pivotal role in the prevention of burnout among postgraduate medical trainees. This narrative literature review is aimed at assessing the effect of the educational environment on burnout in postgraduate doctors-in-training.

Methods:

A search of the databases Medline and PscyInfo for articles published between 2015 and 2020 was performed with the key words ‘burnout’ and ‘educational environment’ or ‘clinical learning environment’ or ‘postgraduate medical education’ or ‘learning environment’.

Results:

A total of 27 studies were identified and reviewed by the author. The prevalence of burnout reported varied widely between studies, ranging from 10% to 62%. Many of the factors that contribute to burnout form part of the educational environment, for example, hours worked, mistreatment, harassment and perceptions of injustice. Residency itself is a stressful period wherein trainees have to balance their responsibilities towards their patients with their responsibilities at home, all while furthering their studies and taking on new responsibilities. Interventions to prevent burnout and tackle existing burnout are multiple but very little solid evidence exists to attest to their efficacy. More research is needed to identify the most effective ways to deal with burnout in postgraduate medical trainees.
Rapid Intensive Care Unit Onboarding in Response to a Pandemic
Authors: Alroumi Fahad , Cota Donna , Chinea Jonathan , Ravikumar Nakul , Tiru Bogdan , Pinto-Plata Victor , Tidswell Mark
Published: May 2021

Background:

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, hospital resources have been stretched to their limits. We introduced an innovative course to rapidly on-board a group of non-intensive care unit (ICU) nurse practitioners as they begin to practice working in a critical care setting.

Objective:

To assess whether a brief educational course could improve non-ICU practitioners’ knowledge and comfort in practicing in an intensive care setting.

Methods:

We implemented a multi-strategy blended 12-week curriculum composed of bedside teaching, asynchronous online learning and simulation. The course content was a product of data collected from a targeted needs assessment. The cognitive learning objectives were taught through the online modules. Four simulation sessions were used to teach procedural skills. Bedside teaching simultaneously occurred from critical care faculty during daily rounds. We assessed learning through a pre and post knowledge multiple choice question (MCQ) test. Faculty assessed learners by direct observation and review of clinical documentation. We evaluated learner reaction and comfort in critical practice by comparing pre and post surveys.

Results:

All 7 NPs were satisfied with the course and found the format to work well with their clinical schedules. The course also improved their self-reported comfort in managing critically ill patients in a medical ICU. There was an increase in the mean group score from the pre-to the post-course MCQ (60% vs 73%).

Conclusions:

The COVID-19 Critical Care Course (CCCC) for NPs was implemented in our ICU to better prepare for an anticipated second surge. It focused on delivering practical knowledge and skills as learners cared for critically ill COVID-19 patients. In a short period of time, it engaged participants in active learning and allowed them to feel more confident in applying their education.
Impact of Early Exposure to Simulation Program on Undergraduate Medical Students’ Interest in Urology
Authors: Kimura Tomokazu , Kojo Kosuke , Shiga Masanobu , Chihara Ichiro , Ikeda Atsushi , Kandori Shuya , Kojima Takahiro , Haruta Junji , Nishiyama Hiroyuki
Published: May 2021

Background:

Urological education is as important as surgical training for undergraduates. However, students in undergraduate medical schools have less exposure to urology as their curriculum focuses more on clinical skills, particularly community-based healthcare for a super-aging society. This study aimed to evaluate whether urology-related hands-on training could increase the interest of undergraduate medical students in urology.

Methods:

A 1-day elective program in urological surgery at the University of Tsukuba, particularly in robotic, laparoscopic, and endoscopic surgeries, was offered to 85 fourth-year medical students from 2018 to 2020, prior to their clinical clerkship. The average age of the participants was 22 (range: 21-25) years. We used a scoring system that comprised 1-5 Likert-type items to assess training activity, interest in surgery, and interest in urology before and after the course.

Results:

Before attending the program, the average scores of interest in urology were 3.53 in 2018, 3.15 in 2019, and 3.00 in 2020. The scores in surgery increased after the program; however, this was not significantly different from scores prior to the program. However, the average interest scores in urology were significantly increased to 3.91 ± 0.63 ( P < .05), 3.88 ± 0.58 ( P < .01), and 4.00 ± 0.61 ( P < 0.01) in 2018, 2019, and 2020, respectively. Total likely scores of this program in 2018, 2019, and 2020 were 4.59, 4.76, and 4.88, respectively, indicating a motivation to study surgery and urology during clinical clerkship.

Conclusions:

Urological hands-on training facilitated interest in urology in medical students prior to their clinical clerkship.
Flourishing as a Measure of Global Well-being in First Year Residents: A Pilot Longitudinal Cohort Study
Authors: Lebares Carter C , Greenberg Anya L , Shui Amy , Boscardin Christy , van der Schaaf Marieke
Published: May 2021

Background:

Physician well-being is critical to optimal learning and performance, yet we remain without validated measures to gauge the efficacy of well-being curricula for trainees. This study evaluates initial evidence of flourishing as a valid measure of global well-being in postgraduate-year-1 residents (PGY-1s), providing a means of assessing well-being intervention efficacy.

Study design:

In this single-site study of PGY-1s participating in Enhanced Stress Resilience Training (ESRT), an online questionnaire of published measures was administered at baseline (T1, just before PGY-1), post-ESRT (T2, 7 weeks later), and at PGY-1 end (T3, 11 months later). The Mental Health Continuum (MHC) was used to assess our primary outcome variable, flourishing, a well-established metric of psychosocial thriving in non-physicians that can be treated continuously or categorically. Correlation between flourishing and both resilience (mindfulness and workplace support) and risk (emotional exhaustion, depersonalization, stress, depressive symptoms, anxiety, and workplace demand) factors was assessed at each time-point and longitudinally.

Results:

Forty-five interns completed the survey at T1, 37 at T2, and 21 at T3; 21 responded at all time points. MHC score was significantly positively correlated with mindfulness (β = 1.47, SE = 0.35, P < .001) and workplace support (β = 2.02, SE = 1.01, P = .05) longitudinally, and at all time points. Flourishing was significantly negatively correlated with depressive symptoms (β = −7.48, SE = 1.68, P < .001), stress (β = −1.28, SE = 0.29, P < .001), and anxiety (β = −1.74, SE = 0.38, P < .001) longitudinally and at all time points, and significantly negatively correlated with emotional exhaustion (β = −2.65, SE = 0.89, P = .003) longitudinally and at T1 (β = −3.36, SE = 1.06, P = .003).

Conclusion:

Flourishing showed appropriate correlation with established resilience and risk factors, thus supporting its concurrent validity as a measure of global well-being in this population. As such, the MHC may provide a simple, meaningful assay of well-being and an effective tool for evaluating the efficacy of well-being interventions. Further validation requires a larger, multi-center study.
Student Perception of Case-based Teaching by Near-Peers and Faculty during the Internal Medicine Clerkship: A Noninferiority Study
Authors: Ahmad Syed E , Farina Gino A , Fornari Alice , Pearlman Ruth Ellen , Friedman Karen , Olvet Doreen M
Published: May 2021

Introduction:

Third-year medical students traditionally receive their didactic or small group teaching sessions from clinical faculty during clerkship rotations. Near-peer teaching is increasingly recognized as an acceptable method for teaching, however most near-peer teaching takes place during the pre-clinical curriculum. We sought to determine if fourth year medical students were noninferior to faculty in facilitating small group discussions during clerkship rotations.

Methods:

Seventy-five third-year medical students participated in a small group session focused on rheumatologic diseases during their internal medicine clerkship rotation. Students were taught by fourth-year medical students who self-selected to participate as near-peer teachers at 1 clinical site (near-peers, N = 36) and by clinical faculty at another site (N = 39). At the end of the session, third-year medical students completed a survey evaluating teacher performance and effectiveness.

Results:

There was no significant difference between the 2 groups on each of the 17 survey items assessing teacher performance, the total teaching performance score, and the teaching effectiveness rating (all P-values >.05). A mean between-group difference of 2% in favor of the near-peers indicated noninferiority of the near-peer teachers compared with faculty teachers on the total teaching performance score. An absolute difference of 14% in favor of the near-peers indicated noninferiority of the near-peer teachers compared with faculty teachers on the teaching effectiveness score. Near-peer teachers reported several benefits, including improving their own medical knowledge and skills as a future educator.

Discussion:

Our data supports the noninferiority of the perceived performance and effectiveness of near-peer teachers compared to faculty teachers in the clerkship setting. Adding near-peer teachers to the clerkship setting is feasible and can be beneficial to all stakeholders.
Biomarkers of ketamine’s antidepressant effect: a clinical review of genetics, functional connectivity, and neurophysiology
Authors: Alario Alexandra A. , Niciu Mark J.
Published: May 2021

Major depressive disorder (MDD) is one of the leading causes of morbidity and all-cause mortality (including suicide) worldwide, and, unfortunately, first-line monoaminergic antidepressants and evidence-based psychotherapies are not effective for all patients. Subanesthetic doses of the N-methyl-D-aspartate receptor antagonists and glutamate modulators ketamine and S-ketamine have rapid and robust antidepressant efficacy in such treatment-resistant depressed patients (TRD). Yet, as with all antidepressant treatments including electroconvulsive therapy (ECT), not all TRD patients adequately respond, and we are presently unable to a priori predict who will respond or not respond to ketamine. Therefore, antidepressant treatment response biomarkers to ketamine have been a major focus of research for over a decade. In this article, we review the evidence in support of treatment response biomarkers, with a particular focus on genetics, functional magnetic resonance imaging, and neurophysiological studies, i.e. electroencephalography and magnetoencephalography. The studies outlined here lay the groundwork for replication and dissemination.