bluuebunny/crossref_metadata_2025 huggingface dataset:
Extracorporeal life support and continuous renal replacement therapy in a patient with Enterovirus A71 associated cardiopulmonary failure: A case report
Authors: Bao Nguyen Trung , Luan Vo Thanh , Liem Bui Thanh , Nhu Vo Hoang Thien , Viet Do Chau , Tung Trinh Huu , Burza Sakib , Thanh Nguyen Tat
Published: January 2024

Rationale:

Hand-foot-mouth disease (HFMD) caused by Enterovirus A71, complicated by cardiopulmonary failure, is associated with a high mortality rate despite intensive treatment. To date, there is a paucity of clinical management data, regarding the use of extracorporeal life support (VA-ECMO) for Enterovirus-A71 associated cardiopulmonary failure reported.

Patient concerns:

The patient in this study presented with severe HFMD complicated by cardiopulmonary failure, polymorphic ventricular tachycardia, and cardiac arrest.

Diagnoses:

Clinical presentations, laboratory data, and polymerase chain reaction (PCR) results from rectal swabs were used to confirm the diagnosis of severe HFMD caused by Enterovirus A71.

Interventions:

The patient was managed with chest compression and an automatic external defibrillator, mechanical ventilation, intravenous immunoglobulin (IVIG), continuous renal replacement therapy (CRRT) and inotrope (milrinone). The patient did not respond to these interventions and subsequently required further management with VA-ECMO.

Outcomes:

The patient achieved a favorable outcomes.

Lessons:

Our study highlights that extracorporeal membrane oxygenation and CRRT can enhance the survival outcomes of patients with severe HFMD with cardiopulmonary failure complications. Furthermore, we propose specific indications for the initiation of VA-ECMO.
Educational effects of and satisfaction with mixed-reality-based major trauma care simulator: A preliminary evaluation
Authors: Lee Han-Dong , Huh Yo , Kim Sora , Baek Ji-Woong , Lee Hojun , Park Sang-Min , Kim Jin-Kak
Published: January 2024

Mixed reality (MR) is a hybrid system that projects virtual elements into reality. MR technology provides immersive learning using various real-world tools. However, studies on educational programs using MR are scarce. This study aimed to investigate the educational effects of and satisfaction with an MR-based trauma decision-making simulator. A total 40 of trainees self-selected to participate in this study. All of them participated in the MR trauma simulator for approximately 30 minutes and conducted voluntary learning without any external help. Declarative knowledge, measured using 20 multiple-choice questions, was assessed before and after MR trauma training. To confirm the educational effect, test scores before and after MR trauma training were compared using a paired t-test. Student satisfaction after training was measured using a ten-item questionnaire rated on a five-point Likert scale. A pretest–posttest comparison yielded a significant increase in declarative knowledge. The percentage of correct answers to multiple choice questions increased (from a mean of 42.3, SD 12.4–54.8, SD 13) after the MR-based trauma assessment and treatment training (P < .001). Of the participants, 79.45% were satisfied with the overall experience of using the MR simulator. This study demonstrated a meaningful educational effect of the MR-based trauma training system even after a short training time.
Prognostic value of circulating tumor cells in patients with recurrent and metastatic colorectal cancer: a systematic review and meta-analysis
Authors: Liu Xia , Lan Hui , Yang Dongmei , Wang Li , Hu Liping
Published: January 2024

Background:

The detection of circulating tumor cells (CTCs) has been employed in prognosticating the likelihood of recurrence and metastasis in colorectal cancer (CRC). Nonetheless, the findings remain enigmatic. This meta-analysis aims to systematically assess the predictive utility of CTCs detection in postoperative recurrence and metastasis among CRC patients.

Methods:

A comprehensive search of PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Cochrane Library was conducted from inception to March 2023. Pooled estimates including sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and summary receiver operating characteristic curve were computed to gauge the predictive value. The QUADAS-2 tool was employed to appraise bias risks in individual studies. The assessment of publication bias in the included literature was performed using Deek’s funnel plot.

Results:

The study encompassed 16 articles and 2037 patients. After synthesizing the pertinent indices, CTCs monitoring demonstrated sensitivity and specificity of 0.71 (95% confidence interval [CI], 0.62–0.79) and 0.71 (95% CI, 0.55–0.83), respectively. The corresponding values for positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 2.4 (95% CI, 1.5–4.0), 0.41 (95% CI, 0.29–0.58), and 6 (95% CI, 3–13). The summary receiver operating characteristic curve yielded an area under the curve of 0.76 (95% CI, 0.72–0.80). Deek’s funnel plot analysis revealed no significant evidence of publication bias (P = .42).

Conclusion:

This investigation underscores the potential of CTCs detection as a noninvasive modality to efficaciously prognosticate postoperative recurrence and metastasis in CRC.
Evaluation of nurse practitioners’ roles and competencies among rheumatology nurses: Results of a national survey
Authors: Wang Ying , Chen Yanling , Liu Huan , Chen Hong , Liang Yan
Published: January 2024

To investigate nurse practitioners’ roles and competencies among rheumatology nurses in China, an online, cross-sectional survey was conducted between July 7 and 14, 2020 among the national cooperation group of nursing experts on management of rheumatic and immune diseases. A total of 796 valid questionnaires were returned and participants’ mean total scores on the Nurse Practitioners’ Roles and Competencies Scale (NPRCS) was 2.51 (SD = 0.55), indicating a medium level. Medical assistance, leadership reform, and clinical research had low scores in the six dimensions of the NPRCS. Nurse practitioners’ roles and competencies in the area of rheumatology require improvement. Training should focus on medical assistance, leadership reform, and clinical research. The current study can provide a reference for an improved training framework of nursing practitioners in the rheumatology field.
Relationship between the m-FI 11 score and 2-year survival in octogenarians undergoing colorectal cancer resection
Authors: Ari Kaso , Iqbal Muhammad Rafaih , Crane Jasmine , Borucki Joseph , Nunney Ian , Hernon James , Stearns Adam
Published: January 2024

Introduction:

The modified Frailty Index (m-FI) offers a simple scoring tool, predicting short-term outcomes in elderly colorectal cancer (CRC) patients. However, links between m-FI scores and 2-year postoperative mortality in octogenarian CRC resection patients remain underexplored. A streamlined frailty index can aid in preoperative assessments to identify elderly patients who are likely to live longer after curative resection surgery to then tailor postoperative care. Our study aims to assess the association between m-FI scores and 2-year postoperative mortality in elderly CRC surgery patients.

Methods:

A retrospective analysis was conducted on a cohort of consecutive patients aged older than or equal to 80 years who underwent colorectal cancer resection at a tertiary referral centre between 2010 and 2017. The m-FI-11 scores less than or equal to two denoted the non-frail category, whereas m-FI scores equal to or exceeding 3 were categorised as frail. The primary outcome measure was defined as 2-year all-cause mortality.

Results:

A total of 337 patients were studied. The 2-year overall survival rate was 83% with an overall median survival time of 84 months (95% CI: 74–94 months). Patients with m-FI scores less than or equal to 2 had a 2-year survival rate of 85% and a median survival time of 94 months (95% CI: 84–104 months). Conversely, patients with m-FI scores greater than or equal to 3 had a 2-year survival rate of 72% and a median survival time of 69 months (95% CI: 59–79 months). An m-FI score greater than or equal to 3 showed a hazard ratio of 1.73 (95% CI: 0.92–3.26, P=0.092) for 2-year mortality compared to an m-FI score less than or equal to 2.

Conclusion:

Higher m-FI scores significantly correlate with an increased 2-year mortality risk among octogenarian CRC resection patients. This highlights the potential of the m-FI as a preoperative tool for identifying patients likely to survive longer post-surgery. Its integration aids in tailored postoperative care strategies, ensuring efficient recovery to functional baselines in this cohort.
Stroke as an unusual initial presentation of ‘malignant’ middle cerebral artery infarction involvement in systemic lupus erythematosus
Authors: Habes Yousef Mahmoud Nimer , Ahmaro Manar , Dwikat Yasmin , Jobran Afnan W. M. , Abunejma Fawzy Mazen , Abdulrazzak Mohammed
Published: January 2024

Introduction and importance:

SLE, or systemic lupus erythematosus, is a chronic autoimmune condition of uncertain origin characterized by the presence of autoantibodies that target the body’s own antigens.

Case presentation:

A 16-year-old female presented at the emergency room with a right-sided lip droop and subsequently developed symptoms consistent with a malignant hemispheric infarction, including altered consciousness, hemiplegia, and forced gaze deviation. Her laboratory results were within the normal range. However, a brain MRI revealed cerebral edema and a massive infarction in the middle cerebral artery (MCA) region. Subsequently, her serologic profile was indicative of SLE, leading to a later diagnosis.

Clinical discussion:

The patient in this case presented with symptoms suggestive of a stroke. A CT scan showed MCA occlusion, leading to a diagnosis of malignant MCA syndrome. The patient was also diagnosed with systemic lupus erythematosus, which is associated with an increased risk of stroke. Inflammation-induced thrombosis and CNS vasculitis are potential mechanisms linking SLE and stroke.

Conclusion:

This case serves as an example of a sudden and potentially life-threatening presentation of SLE, underscoring the importance of early detection and targeted treatment that can influence the course of the disease.
Spontaneous spinal epidural haematoma following COVID-19 vaccination: a case report
Authors: Rezvani Majid , Sabouri Masih , Aminmansour Bahram , Falahpour Soheil , Sourani Arman , Sharafi Mohammad , Baradaran Mahdavi Sadegh , Foroughi Mina , Nik Khah Roham , Sourani Armin , Veisi Shaahin
Published: January 2024

Introduction:

COVID-19 vaccination side effects are rare but important medical situations. Spine-affecting side effects are amongst the rarest, but exceedingly important. Haemorrhagic spinal manifestations of COVID-19 and its vaccines are less reported with little knowledge about them.

Case presentation:

An 80-year-old male who received his first shot of the COVID-19 vaccine had developed COVID-19 pneumonia, weakness, and sensory problems in his legs followed by sphincter incontinence within 5 days period. MRI showed a spontaneous epidural spinal epidural haematoma (SSEDH) in T10–L1. He underwent laminectomy and haematoma evacuation. One month follow-up showed no clinical improvement.

Discussion:

To our knowledge, this was the first post-vaccination SSEDH and second in haemorrhagic spinal complications following COVID-19 vaccination. Considering the neuropathogenesis pathway of COVID-19 and its vaccines, there are common mechanisms of action that could potentially justify post-vaccination SSEDH such as seen in COVID-19 infection, itself. Early Neurosurgical intervention and better preoperative neurological status could be a beneficial modifier for favourable clinical outcomes.

Conclusion:

SSEDH and COVID-19 vaccine coincidence is a rare clinical event, still no solid association could be scientifically explained. Further studies are required for a reliable pathophysiologic association. Early diagnosis, interdisciplinary medical approach, and faster intervention are the cornerstone of the treatment paradigm.
Thoracoabdominal duplication accompanied by intestinal malrotation: a case report and literature review of a rare congenital anomaly in an infant
Authors: Mashlah Qusai , Al Laham Omar , Odah Bashi Hajar , Sharaf Aldeen Rahaf , Alashi Sami , Abdulkader Mohammd
Published: January 2024

Introduction and importance:

Thoracoabdominal duplication and intestinal malrotation are extremely rare congenital alimentary tract anomalies that can manifest in any segment of the gastrointestinal tract. Still, tubular duplications are an even rarer subset of alimentary tract duplications. Misdiagnosis could occur and this will yield devastating ramifications. Therefore, consideration in the clinical settings is warranted to aid in conducting timely therapeutic interventions.

Case presentation:

In this article, we illustrate the overwhelmingly rare occurrence of thoracoabdominal duplication coexistent with intestinal malrotation in a 7-month-old male whose primary complaint was chronic dyspnoea since birth that progressed to involve cough and fever. Imaging analysis revealed a significant intrathoracic fluid-filled cyst.

Clinical discussion:

The intestinal malrotation was treated through Ladd’s procedure, and surgical excision of the duplicated segments was accomplished. The subsequent analysis of the resected specimens via means of histopathology utilizing Hematoxylin and Eosin dyes established the definitive diagnosis of a foregut duplication cyst.

Conclusion:

Thoracoabdominal duplication is one of the most crucial topics in the field of Paediatric Surgery. It is exceptionally rare in occurrence, and the scarcity of available resources that document and describe this topic is evident in the published literature. The authors must opt to document, study, and broaden awareness regarding this life-threatening pathology so that they can circumvent the resultant complications by means of early detection and the performance of apt surgical interventions. Upon careful review of the available literature, we can state that ours is the first-ever case documented from their country regarding this topic and this co-incidence.
Perceptions of telemedicine among healthcare professionals in rural tertiary care hospitals of rural Sindh, Pakistan: a qualitative study
Authors: Shardha Harsha K. , Kumar Grouve , Sagar  , Kumar Rajesh , Qazi Mansoor A. , Munir Saqib , Tariq Waleed , Maheshwari Payal , Kumar Bhavesh , Tahir Muhammad J. , Shrateh Oadi N. , Ahmed Ali
Published: January 2024

Background:

Telemedicine has proven to be a boon in the field of medical sciences, as it provides a platform for all health-care personnel to assist patients remotely through digital technology advancements. It brings hope to the lower middle-income regions of the world. Thus, the study was conducted to explore the perceptions regarding telemedicine among healthcare professionals (HCP) in rural Sindh, Pakistan.

Methodology:

Overall, 19 in-depth interviews were conducted and this comprised of HCP working in the Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences (PAQSJIMS) and Peoples University of Medical and Health Sciences for Women (PUMHSW) being involved in providing online consultations and practicing telemedicine. The interviews were conducted and audio recorded in Sindhi and Urdu and were later transcribed in to English, coded for themes and sub-themes, and were analyzed using content analysis.

Results:

The opportunities perceived with the use of telemedicine services were reducing nosocomial infections, facilitating the healthcare in remote areas, handling telemedicine tools, application of telemedicine services on the ground and reducing stress. However, inadequate awareness regarding telemedicine, difficulty in physical examination, the need for training, lack of compliance, and concerns regarding accuracy in diagnosis and treatment were identified as the perceived barriers to the use of telemedicine services.

Conclusion:

HCP had perception toward telemedicine as have numerous opportunities favoring implementation as well as various barriers are needed to overcome to promote the usage of telemedicine. Increased awareness, training programs, and technological advancements are key to overcome these challenges.
Vesicular herpes zoster eruption following chronic obstructive pulmonary disease treatment in the emergency department: lessons learnt from immunosuppression
Authors: Shrestha Abhigan Babu , Gupta Pukar , Gurung Nisha , kandel Sudarshan , Upadhyay Mahima , Gurung Amrita , Karki Shailendra , Mokbul Mobin Ibne
Published: January 2024

Background:

Herpes zoster (HZ) is a reactivation of the varicella-zoster virus (VZV) that can occur in people with weakened immune systems. Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that can also impair the immune system.6–8

Case presentation:

The authors present the case of a 65-year-old male with COPD who developed HZ. The patient was initially admitted to the hospital for an acute exacerbation of COPD. After his condition stabilized, he developed vesicular rashes on the medial aspect of his left leg. A skin biopsy confirmed the diagnosis of HZ.

Clinical discussion:

This case report provides further evidence that HZ can be induced in patients who are undergoing treatment for COPD. The authors recommend that COPD patients be vaccinated against HZ to prevent this complication.

Conclusion:

HZ can develop in COPD patients, mainly using inhaled steroids. Compliance to medication should be monitored, on the other hand zoster vaccination should be provided to prevent it and its foremost complication which includes secondary bacterial infection, post-herpetic neuralgia, scarring, nerve palsy and encephalitis in case with disseminated zoster.
Reconceptualizing Patient Safety Beyond Harm
Authors: Jeffs Lianne , Kuluski Kerry , Flintoft Virginia , MacLaurin Anne , Asselbergs Maaike , Zeng Rui Lin , Bruno Frances , Schonewille Noah , Baker G. Ross
Published: January 2024

Background:

Although patients' and care partners' perspectives on patient safety can guide health care learning and improvements, this information remains underutilized. Efforts to leverage this valuable data require challenging the narrow focus of safety as the absence of harm.

Purpose:

The purpose of this study was to gain a broader insight into how patients and care partners perceive and experience safety.

Methods:

We used a mixed-methods approach that included a literature review and interviews and focus groups with patients, care partners, and health care providers. An emergent coding schema was developed from triangulation of the 2 data sets.

Results:

Two core themes—feeling unsafe and feeling safe—emerged that collectively represent a broader view of safety.

Conclusion:

Knowledge from patients and care partners about feeling unsafe and safe needs to inform efforts to mitigate harm and promote safety, well-being, and positive outcomes and experiences.
Exploring Hospital Transfers for Long-Stay Nursing Home Residents With End-Stage Renal Disease
Authors: Canada Kelli E. , Vogelsmeier Amy A. , Popejoy Lori L. , Powell Kimberly , Brandt Lea , Rantz Marilyn
Published: January 2024

Background:

Nursing home residents with end-stage renal disease (ESRD) are an understudied, yet growing population within nursing homes.

Purpose:

To describe hospital transfers for nursing home residents diagnosed with ESRD and receiving hemodialysis.

Methods:

Data were analyzed for residents with ESRD transferred to the hospital between October 2016 and September 2020 (n = 219). Descriptive statistics, bivariate analyses, logistic regression, and content analysis were used for analysis.

Results:

Clinical factors associated with transfers included abnormal vitals, altered mental state, and pain. Other factors included lack of care planning and advance directives, provider communication, resident/family preferences, missing/refusing dialysis, and facility resources. The odds of an observation/emergency department only visit was 2.02 times larger when transferred from the dialysis clinic.

Conclusions:

Advance care planning and coordinated care between nursing home and dialysis clinics are needed along with proactive planning when residents miss dialysis or experience a condition change at the dialysis clinic.
Comparable Efficacy of Repeated Transcranial Direct Current Stimulation, Cognitive Behavioral Therapy, and Their Combination in Improvement of Cold and Hot Cognitive Functions and Amelioration of Depressive Symptoms
Authors: Nejati Vahid , Nozari Masoumeh , Mirzaian Bahram , Pourshahriar Hosein , Salehinejad Mohammad Ali
Published: January 2024

This study aimed to evaluate the effectiveness of repeated transcranial direct current stimulation (rtDCS), cognitive behavioral therapy (CBT), and their combination (rtDCS-CBT) in the treatment of cognitive dysfunction, social cognition, and depressive symptoms in women diagnosed with major depressive disorder (MDD). A total of 40 female participants with MDD were randomly assigned to one of four groups: rtDCS, CBT, rtDCS-CBT, and a control group. The participants' depressive symptoms, executive functions, and social cognition were assessed at baseline, preintervention, postintervention, and during a 1-month follow-up. The rtDCS group received 10 sessions of anodal dorsolateral and cathodal ventromedial prefrontal cortex (2 mA for 20 minutes). The CBT group received 10 sessions of traditional CBT, whereas the combined group received CBT after the tDCS sessions. The results of the analysis of variance indicated that all intervention groups demonstrated significant improvements in depressive symptoms, cognitive dysfunction, and social cognition compared with the control group (all p < 0.001). Furthermore, the rtDCS-CBT group exhibited significantly greater reductions in depressive symptoms when compared with each intervention alone (all p < 0.001). Notably, working memory improvements were observed only in the rtDCS group (p < 0.001). In conclusion, this study suggests that both CBT and tDCS, either individually or in combination, have a positive therapeutic impact on enhancing executive functions, theory of mind, and depressive symptoms in women with MDD.
Interpersonal Sensitivity as a Mediator of the Effect of Childhood Parenting Quality on Depressive Symptoms
Authors: Morishita Chihiro , Masuya Jiro , Ishii Yoshitaka , Seki Tomoteru , Deguchi Ayaka , Higashiyama Motoki , Ono Miki , Honyashiki Mina , Higashi Shinji , Kusumi Ichiro , Inoue Takeshi
Published: January 2024

The aim of this study was to analyze whether interpersonal sensitivity mediates the effect of qualitative parenting characteristics experienced during childhood on the appraisal of life experiences and depression severity during adulthood in adult community volunteers. A total of 404 Japanese adult volunteers answered the following four self-report questionnaires: Parental Bonding Instrument, Interpersonal Sensitivity Measure, Life Experiences Survey, and Patient Health Questionnaire-9. Structural equation modeling was performed to analyze whether childhood parenting quality increases depressive symptom severity through interpersonal sensitivity, which then affects the appraisal of recent life events. In the two structural equation models, inadequate care and excessive overprotection received during childhood were associated with the negative evaluation of life experiences and depression severity in adulthood through high interpersonal sensitivity. Our findings indicate interpersonal sensitivity as a mediator of the effect of inadequate care and excessive overprotection experienced in childhood on the negative evaluation of life experiences and depression severity in adulthood.
Trend Analysis of Inpatient Medical Adverse Events in Taiwan (2014–2020): Findings From Taiwan Patient Safety Reporting System
Authors: Munkhtogoo Dulmaa , Liu Yueh-Ping , Hung Sheng-Hui , Chan Pi-Tuan , Ku Chih-Hung , Shih Chung-Liang , Wang Pa-Chun
Published: January 2024

Objectives

Medical adverse event (MAE) reporting and management are essential for patient safety campaigns. An epidemiological assessment of MAE trends is crucial for understanding the effectiveness of patient safety improvement efforts. This study analyzed the trends of inpatient MAEs, focusing on MAE incidence and harm severity.

Methods

Longitudinal secondary data (over 2014–2020) on MAEs reported by 18 hospitals were retrieved from the Taiwan Patient-safety Reporting system. The numbers and incidence rates (per 1000 inpatient days) of reported MAEs were calculated. The harm severity levels of six major MAE categories were analyzed. Trend and generalized estimating equation analyses were conducted to investigate changes in MAE patterns.

Results

Trend analyses revealed significant decreasing trends in the number (4763–3107 per year; Jonckheere-Terpstra test = −1.952, P = 0.05) and incidence rates (0.92–0.62 per 1000 inpatient days; β = −0.5017, P = 0.00) of harmful MAEs over 7-year study period. Among the most frequently reported MAEs, tube-related events exhibited the most significant decreasing trend (28%–23.8%; Jonckheere-Terpstra test = −2.854, P = 0.00). The reported numbers, incidence rates, and severity of falls and tube-related events dropped significantly.

Conclusions

By analyzing representative longitudinal MAE data, this study demonstrated the effectiveness of nationwide patient safety improvement campaigns in Taiwan. Our data reveal significant reductions in the reported numbers, incidence rates, and severity of several major MAEs. Specifically, our data indicate significant reductions in the incidence and severity of tube-related events, which can be beneficial for patient safety improvement efforts.
Impact of Repeated Reimbursement Penalties on Hospital Total Quality Scores
Authors: Brewer Alice , Hughes M. Courtney , Patel Kunal N.
Published: January 2024

Objectives

The incidence of hospital-acquired conditions (HACs) is a serious public health issue with implications ranging from patient morbidity and mortality to negative financial impacts on patients and health care systems. Despite substantial efforts to address and reduce HACs, research into the effect of quality improvement programs is inconclusive. This study seeks to better understand the relationship between repeated reimbursement penalties and improvement in HAC quality scores.

Methods

A quantitative comparative analysis of U.S. health care data was conducted. Data on quality outcomes and hospital characteristics were sourced from the Hospital-Acquired Condition Reduction Program from fiscal years 2018 and 2019 and the Centers for Medicare & Medicaid Services Inpatient Prospective Payment System impact files, respectively.

Results

In total, 3123 U.S. hospitals were analyzed to compare differences between total HAC scores of hospitals with and without penalties in consecutive years. Hospitals with repeated penalties had significantly greater improvement in scores (t
497.262 = −13.00, P < 0.001), and the impact was greatest in small hospitals (<100 beds). Repeated penalties had a smaller impact on disproportionate share hospitals (Cohen d = 0.73). Among all hospitals, the effect of repeated penalties was large (Cohen d = 0.75)

Conclusions

This study suggests that repeated penalties can improve quality scores in U.S. hospitals. However, the effect may be exaggerated for smaller hospitals and those that serve patient populations with a relatively higher socioeconomic status. The reason disproportionate share hospitals did not show as much improvement as nondisproportionate hospitals may be because hospitals serving vulnerable populations often have fewer resources.
Structural Competency in Simulation-Based Health Professions Education
Authors: Sagalowsky Selin T. , Woodward Hilary , Agnant Joanne , Bailey Bart , Duncan Ellen , Grad Jennifer , Kessler David O.
Published: January 2024

Summary Statement

Simulation-based health professions educators can advance diversity, equity, and inclusion by cultivating structural competency, which is the trained ability to discern inequity not only at an individual level, but also at organizational, community, and societal levels. This commentary introduces Metzl and Hansen's Five-Step Model for structural competency and discusses its unique applicability to the metacognitive underpinnings of simulation-based health professions education. We offer a pragmatic guide for simulation-based health professions educators to collaboratively design learning objectives, simulation cases, character sketches, and debriefs in which structural competency is a simulation performance domain, alongside patient management, resource usage, leadership, situational awareness, teamwork, and/or communication. Our overall goal is to promote a paradigm shift in which educators are empowered to partner with patients, colleagues, and communities to recognize, learn about, and challenge the factors driving health inequities; a skill that may be applied to a broad range of health professions education within and outside of simulation.
Building Global Partnerships
Authors: Gower Shelley , Mossenson Adam , Ndekezi Jackson Kwizera , Livingston Patricia
Published: January 2024

Introduction

Effective educational initiatives can elevate the quality of patient care globally. Simulation-based education is widely used in high-resource settings, but barriers exist to its widespread use in low-resource settings. Vital Anesthesia Simulation Training (VAST) overcomes these barriers by offering immersive, low-cost portable simulation along with simulation facilitator training. During the COVID-19 pandemic, in-person courses were stopped for more than 2 years. Postpandemic, a 3-day VAST SIMposium was hosted in Rwanda to unite 42 VAST facilitators from 12 widespread countries to introduce new and revised course materials and to rejuvenate dormant skills. The purpose of this study was to explore how the VAST SIMposium influenced perceived development of skills, confidence, and engagement in a community of practice for simulation educators working in low-resource settings.

Methods

This qualitative study involved in-depth interviews with a purposive sample of 16 VAST SIMposium attendees. Transcripts of audio recordings were analyzed using inductive thematic analysis.

Results

Six themes were identified during data analysis: 1) Diversity with shared passion for medical education; 2) Supportive in-person learning environment; 3) Simulation-based education relevant to low-resource settings; 4) Camaraderie; 5) Building knowledge, skills, and confidence; and 6) Being part of a community of practice.

Conclusion

The SIMposium rejuvenated passion, knowledge, skills, and, most importantly, strengthened global connections and partnerships. These collaborations will benefit areas that are underrepresented in simulation and will ultimately improve patient outcomes. A SIMposium of this format is an efficient and effective way to foster sustainable global dissemination of simulation-based global health education.
Does the injury pattern drive the surgical treatment strategy in multiply injured patients with major fractures?
Authors: Halvachizadeh Sascha , Pfeifer Roman , Duncan James , Klingebiel Felix Karl Ludwig , Kalbas Yannik , Berk Till , Neuhaus Valentin , Pape Hans-Christoph
Published: January 2024

BACKGROUND

The timing of definitive surgery in multiple injured patients remains a topic of debate, and multiple concepts have been described. Although these included injury severity as a criterion to decide on the indications for surgery, none of them considered the influence of injury distributions. We analyzed whether injury distribution is associated with certain surgical strategies and related outcomes in a cohort of patients treated according to principles of early and safe fixation strategies.

METHODS

In this retrospective cohort study, multiple injured patients were included if they were primarily admitted to a Level I trauma center, had an Injury Severity Score of ≥16 points, and required surgical intervention for major injuries and fractures. The primary outcome measure was treatment strategy. The treatment strategy was classified according to the timing of definitive surgery after injury: early total care (ETC, <24 hours), safe definitive surgery (SDS, <48 hours), and damage control (DC, >48 hours). Statistics included univariate and multivariate analyses of mortality and the association of injury distributions and surgical tactics.

RESULTS

Between January 1, 2016, and December 31, 2022, 1,471 patients were included (mean ± SD age, 55.6 ± 20.4 years; mean Injury Severity Score, 23.1 ± 11.4). The group distribution was as follows: ETC, n = 85 (5.8%); SDS, n = 665 (45.2%); and DC, n = 721 (49.0%); mortality was 22.4% in ETC, 16.1% in SDS, and 39.7% in DC. Severe nonlethal abdominal injuries (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.4–3.5) and spinal injuries (OR, 1.6; 95% CI, 1.2–2.2) were associated with ETC, while multiple extremity injuries were associated with SDS (OR, 1.7; 95% CI, 1.4–2.2). Severe traumatic brain injury was associated with DC (OR, 1.3; 95% CI, 1.1–1.4). When a correction for the severity of head, abdominal, spinal, and extremity injuries, as well as differences in the values of admission pathophysiologic parameters were undertaken, the mortality was 30% lower in the SDS group when compared with the DC group (OR, 0.3; 95% CI, 0.2–0.4).

CONCLUSION

Major spinal injuries and certain abdominal injuries, if identified as nonlethal, trigger definitive surgeries in the initial setting. In contrast, severe TBI was associated with delayed fracture care. Patients with major fractures and other injuries were treated by SDS (definitive care, <48 hours) when the pathophysiological response was adequate. The choice of a favorable surgical treatment appears to depend on injury patterns and physiological patient responses.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Evolutionary dynamics of glucose-deprived cancer cells: insights from experimentally informed mathematical modelling
Authors: Almeida Luis , Denis Jérôme Alexandre , Ferrand Nathalie , Lorenzi Tommaso , Prunet Antonin , Sabbah Michéle , Villa Chiara
Published: January 2024

Glucose is a primary energy source for cancer cells. Several lines of evidence support the idea that monocarboxylate transporters, such as MCT1, elicit metabolic reprogramming of cancer cells in glucose-poor environments, allowing them to re-use lactate, a by-product of glucose metabolism, as an alternative energy source with serious consequences for disease progression. We employ a synergistic experimental and mathematical modelling approach to explore the evolutionary processes at the root of cancer cell adaptation to glucose deprivation, with particular focus on the mechanisms underlying the increase in MCT1 expression observed in glucose-deprived aggressive cancer cells. Data from
in vitro
experiments on breast cancer cells are used to inform and calibrate a mathematical model that comprises a partial integro-differential equation for the dynamics of a population of cancer cells structured by the level of MCT1 expression. Analytical and numerical results of this model suggest that environment-induced changes in MCT1 expression mediated by lactate-associated signalling pathways enable a prompt adaptive response of glucose-deprived cancer cells, while fluctuations in MCT1 expression due to epigenetic changes create the substrate for environmental selection to act upon, speeding up the selective sweep underlying cancer cell adaptation to glucose deprivation, and may constitute a long-term bet-hedging mechanism.
The impact of British chemistry and physics upon Japanese science in the late nineteenth century: the Williamson–Sakurai connection at University College London
Authors: Kikuchi Yoshiyuki
Published: January 2024

The Meiji period between 1868 and 1912, when the introduction of Western science into Japan started in earnest, was also the time when specialization became an increasingly pressing and complex issue in natural science, especially in Victorian Britain where specialization went hand in hand with ‘interconnectedness’ between various fields of study. This article examines the impact of this complicated situation surrounding ‘specialization’ in nineteenth-century British science on Meiji Japan, taking chemistry and physics (natural philosophy) teaching at University College London (UCL) in the 1870s as an example. It reveals how chemistry and physics became interconnected with each other in UCL's science education by the presence of its chemistry professor, Alexander William Williamson (1824–1904), and the impact of this connection on Japanese science with a focus on Williamson's Japanese student, Sakurai Jōji. This paper argues that the interconnectedness of UCL's chemistry and physics significantly affected the disciplinary identity of the Department of Chemistry at the Imperial University of Tokyo through Sakurai.
Applied machine learning techniques for chronic disease treatment default prediction and its potential benefits for patient outcome: A case series study approach
Authors: Owusu-Adjei Michael , Abdul-Salaam Gaddafi , Frimpong Twum , Hayfron-Acquah James Ben
Published: January 2024

In medical diagnosis context, consideration for missing diagnosis and false diagnosis of disease types are important clinical considerations for disease treatment decisions. Effect and impact of disease types especially on others forms the basis for critical clinical decisions. Impact and consequences varies across disease types especially for communicable and non-communicable diseases. Increasing use of predictive techniques owing to high use of connected internet of things devices in healthcare provides sufficient opportunity for potential benefit assessment of predictive modeling impact on disease treatment management. Effective and efficient management of non-communicable diseases such as hypertension is hampered in part by instances of multiple forms of its occurrence in patients leading to treatment management complications. Probing predictive modeling effect and implications for clinical decisions to enhance patient treatment outcome provides important evidence-based justifications for its use in healthcare systems. Effective predictive technique use is significantly dependent on areas of its application and the consequences of error for its use in context.

Author summary

The use of macro average score in class imbalance context is to treat all classes equally regardless of variations in class distributions. Clinical significance as identified in this research work includes the determination of effective and accurate predictive modeling techniques for real-world application context where class distribution variation is a characteristic feature. Identifying various sections of healthcare delivery process ensures effective application of predictive modeling techniques for the required impact on clinical decisions and its effect on patient outcome.
Thoughts and perspectives of metagenome sequencing as a diagnostic tool for infectious disease: an interpretive phenomenological study
Authors: Trivett Hannah , Darby Alistair C. , Oyebode Oyinlola
Published: January 2024

Background

Effective infectious disease diagnostics (IDD) are vital for informing clinical decision-making regarding the treatment and patient management of disease and infections. Conventional clinical methods rely upon culture-dependent techniques, and there has been little shift in the acceptance and integration of culture-independent sequencing methods into routine clinical IDD. This study explored stakeholders’ experiences within IDD, including those working in clinical settings and those conducting research at the forefront of microbial genomics. We aimed to identify factors driving the development and implementation of metagenome sequencing as a routine diagnostic.

Methods

Virtual semi-structured interviews were conducted with purposively selected individuals involved in IDD. The interviews explored the experiences of implementing metagenome sequencing as a diagnostic tool and decisions about which diagnostics are used for identifying bacteria-causing infections. Thematic analysis was used to analyse the data, and an Interpretive Phenomenological approach was used throughout.

Results

Ten individuals were interviewed between July 2021 and October 2021, including Clinical scientists, consultants, and professors in academia. Their experience ranged from no knowledge of metagenome sequencing to an expert understanding of the phenomenon. Five themes emerged: Diagnostic Choice, Infrastructure, Open Data Sharing, COVID-19, and Communication. Participants recognised the need for new diagnostics to be implemented to overcome the limitations of current diagnostic approaches but highlighted the barriers to integrating new diagnostics into clinical settings, such as the impact on clinical decision-making, accreditation, and cost. However, participants felt that lessons could be learnt from using metagenomics in COVID-19 and how other diagnostic platforms have been integrated into clinical settings over the last 20 years.

Conclusions

The study provided clear evidence to address the knowledge gap in current literature and practice for developing and implementing metagenome sequencing as a potential IDD. The knowledge of new and upcoming genomic diagnostic testing is not equally distributed throughout the UK, impacting the understanding and drive to integrate metagenome sequencing into routine clinical diagnostics. Improvements in access to new diagnostics could improve patient treatment and management and positively impact public health.
Indole 3-acetate and response to therapy in borderline resectable or locally advanced pancreatic cancer
Authors: Braadland Peder R. , Farnes Ingvild , Kure Elin H. , Yaqub Sheraz , McCann Adrian , Ueland Per M , Labori Knut Jørgen , Hov Johannes R.
Published: January 2024

Background

Recently, Tintelnotet alreported that a higher concentration of the bacterially produced metabolite indole 3-acetate (3-IAA) in blood was linked to a better response to chemotherapy in people with metastatic pancreatic ductal adenocarcinoma (PDAC). Here, we aimed to extend these observations to people diagnosed with non-metastatic PDAC.

Patients and methods

We measured circulating 3-IAA in samples from a prospective population-based cohort of 124 individuals with borderline resectable or locally advanced PDAC who later underwent primary chemotherapy. The majority (61%) of the individuals were treated with FOLFIRINOX. We used univariable and multivariable Cox proportional hazards regression to estimate the association between pre-treatment 3-IAA and overall survival.

Results

The median serum 3-IAA concentration before chemotherapy was 290 (interquartile range 203–417) ng/mL. The unadjusted hazard ratio (HR) for pre-treatment log2(3-IAA) was 0.93, 95% confidence interval (CI) [0.74–1.16], p=0.52. When adjusting for age, ECOG, CA19-9 and tumor classification, the HR for log2(3-IAA) was 0.87, 95% CI [0.68–1.12], p=0.28.

Conclusions

Our findings suggest that the potentiating effect of 3-IAA observed in metastatic PDAC may not translate to borderline resectable or locally advanced PDAC. We recommend additional clinical validation of 3-IAA’s predictive value before implementation attempts in human studies are initiated.
Seroprevalence and Risk Factors of Chikungunya in Ethiopia: A Systematic Review and Meta-Analysis
Authors: Dagnaw Gashaw Getaneh , Gessese Abebe Tesfaye , Kinde Mebrie Zemene , Bitew Abebe Belete , Dejene Haileyesus , Desalegn Bereket , Abey Solomon Lulie
Published: January 2024

The recurrence of Chikungunya virus poses a significant public health concern, given its association with numerous epidemic episodes in Africa, Asia, and India. Since the virus was first detected in Ethiopia in 2016, the disease has been identified in different parts of the country, emphasizing the need for up-to-date epidemiological data on the status of Chikungunya in Ethiopia. We conducted a systematic review and meta-analysis using online published articles between 2016 and 2023 from PubMed, Scopus, and Google Scholar databases. The PRISMA guideline was thoroughly followed and registered in the Prospective Register of Systematic Reviews (PROSPERO). A set of keywords like ‘Chikungunya,’ ‘Chikungunya Virus,’ ‘Chikungunya Fever,’ ‘Prevalence,’ ‘Seroprevalence,’ “Risk Factor”, “Potential Factors”, and ‘Ethiopia’ were used in the search engines. A total of five articles met the eligibility criteria and were included for data extraction. Meta-analysis was performed using STATA 17 software. The pooled seroprevalence of Chikungunya in Ethiopia was 12.35%. The highest prevalence was reported in Southern Nations, Nationalities, and Peoples’ Region (SNNPR) at 43.6%, while the lowest seroprevalence was in Dire Dawa, at approximately 12%. Factors such as occupation, education, age, and sex contributed to prevalence variation. Subgroup meta-analysis showed heterogeneity across the types of studies employed. No indications of publication bias or small-study effects were found in the Begg’s test and Egger’s test. The findings will help us to understand the trend of Chikungunya in Ethiopia. The findings recommend proactive monitoring or active surveillance of viral diseases and the rigorous enforcement of health systems, as well as One Health measures in Ethiopia, to improve human public health.
Blood-based screening for HPV-associated cancers
Authors: Das Dipon , Hirayama Shun , Aye Ling , Bryan Michael E. , Naegele Saskia , Zhao Brian , Efthymiou Vasileios , Mendel Julia , Fisch Adam S. , Kröller Lea , Michels Birgitta E. , Waterboer Tim , Richmon Jeremy D. , Adalsteinsson Viktor , Lawrence Michael S. , Crowson Matthew G. , Iafrate A. John , Faden Daniel L.
Published: January 2024

Background

HPV-associated oropharyngeal cancer (HPV+OPSCC) is the most common HPV-associated cancer in the United States yet unlike cervical cancer lacks a screening test. HPV+OPSCCs are presumed to start developing 10-15 years prior to clinical diagnosis. Circulating tumor HPV DNA (ctHPVDNA) is a sensitive and specific biomarker for HPV+OPSCC. Taken together, blood-based screening for HPV+OPSCC may be feasible years prior to diagnosis.

Methods

We developed an HPV whole genome sequencing assay, HPV-DeepSeek, with 99% sensitivity and specificity at clinical diagnosis. 28 plasma samples from HPV+OPSCC patients collected 1.3-10.8 years prior to diagnosis along with 1:1 age and gender-matched controls were run on HPV-DeepSeek and an HPV serology assay.

Results

22/28 (79%) of cases and 0/28 controls screened positive for HPV+OPSCC with 100% detection within four years of diagnosis and a maximum lead time of 7.8 years. We next applied a machine learning model classifying 27/28 cases (96%) with 100% detection within 10 years. Plasma-based PIK3CA gene mutations, viral genome integration events and HPV serology were used to orthogonally validate cancer detection with 68% (19/28) of the cohort having multiple cancer signals detected. Molecular fingerprinting of HPV genomes was performed across patients demonstrating that each viral genome was unique, ruling out contamination. In patients with tumor blocks from diagnosis (15/28), molecular fingerprinting was performed within patients confirming the same viral genome across time.

Conclusions

We demonstrate accurate blood-based detection of HPV-associated cancers with lead times up to 10 years before clinical cancer diagnosis and in doing so, highlight the enormous potential of ctDNA-based cancer screening.