bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the overlapping presentation of irritable bowel syndrome and vulvodynia: a scoping review of the evidence and mechanisms
Authors: Perelmuter Sara , Soogoor Anantha , Maliszewski Katelyn , Grimshaw Alyssa
Published: August 2024

Introduction

Vulvodynia is a complex and multifactorial medical condition characterized by pain in the vulvar area without any identifiable cause. Vulvodynia is underdiagnosed, leading to increased risk of sexual dysfunction and reduced quality of life. Irritable bowel syndrome (IBS) is a gastrointestinal disorder predominantly affecting women. Vulvodynia and IBS frequently co-occur in women, with a 2- to 4-fold increased likelihood of IBS diagnosis in those with vulvodynia. These conditions may share underlying causes, highlighting the need for research to better understand their shared pathophysiology and develop effective therapeutics.

Objective

The aim of this scoping review was to assess the evidence of simultaneous presentation of IBS and vulvodynia.

Methods

A comprehensive search was conducted in 6 databases between inception of database and August 2023: PubMed, Web of Science, Scopus, Science Direct, Google Scholar, and Cochrane Library. Studies included primary research about IBS and vulvodynia in terms of presentation overlap, diagnosis, or treatment. Data were extracted from eligible studies, summarized, and collated.

Results

Of the 306 unique articles identified, 33 were included in the final analysis: 20 cross-sectional studies, 4 case-control studies, 2 case reports, 4 cohort studies, 2 quasi-experimental studies, and 1 randomized trial. Common themes included a high prevalence of overlapping vulvodynia and IBS with a significant diagnostic delay in vulvodynia, mast cell involvement and visceral hypersensitization as common pathophysiology, and the need for a multimodal treatment.

Conclusion

Our review adds to the evidence that there is an association between vulvodynia and IBS. Despite this, research on the underlying molecular mechanisms of this association is scarce, and diagnostic delays persist for vulvodynia. Increasing awareness of the overlap of these conditions will improve screening for vulvodynia in the patient population with IBS, thereby improving the diagnostic delay, and understanding the pathophysiology will enable treatment strategies that address both conditions.
Unveiling the potency of ready-to-use brodifacoum blocks in lesser bandicoot rats: exploring toxicity, blood clotting factors, and organ histology
Authors: Sharma Arshdeep , Singla Neena , Bansal Neelam
Published: August 2024

Background

The present study unveiled the effectiveness of ready-to-use brodifacoum blocks (0.005%) against the prevalent field rat species in southeast Asia, Bandicota bengalensis. Brodifacoum, a more potent second-generation anticoagulant, offers a solution for managing rodents resistant to other anticoagulants of its class.

Methodology

Male and female bandicoot rats caught wild were exposed to brodifacoum for 1, 2, and 3 days in both the no-choice and bi-choice tests. The observations included mortality rates, impact on body weight, food consumption, blood clotting factors, organ weights, and histological changes.

Results

Results indicated 100% mortality within 2–3 days in the no-choice tests, and 50.00%–83.33% mortality in the bi-choice tests within 5 to 8 days. The median lethal feeding periods were determined to be 2.10 and 2.33 days for male and female rats, respectively. Toxicity symptoms included bleeding from the nose, gums, and feet. While no significant effects were observed on body weight or organ weights, food consumption decreased notably in no-choice tests. Additionally, significant increases in prothrombin time and activated partial thromboplastin time were noted 24 h post-treatment in the no-choice tests, with post-treatment international normalized ratios of 9.45–14.20 and 1.52–3.03 in the no-choice and the bi-choice tests, respectively. Histological analysis revealed mild to severe necrotic changes in the liver and kidneys after brodifacoum treatment.

Conclusions

Overall, this study underscores the potential of ready-to-use brodifacoum blocks as an effective tool for rodent population control, offering a viable alternative to other second-generation anticoagulant rodenticides.
GALV-KoRV-related retroviruses in diverse Australian and African rodent species
Authors: Hayward Joshua A , Tian Shuoshuo , Tachedjian Gilda
Published: August 2024

The enigmatic origins and transmission events of the gibbon ape leukemia virus (GALV) and its close relative the koala retrovirus (KoRV) have been a source of enduring debate. Bats and rodents are each proposed as major reservoirs of interspecies transmission, with ongoing efforts to identify additional animal hosts of GALV-KoRV-related retroviruses. In this study, we identified nine rodent species as novel hosts of GALV-KoRV-related retroviruses. Included among these hosts are two African rodents, revealing the first appearance of this clade beyond the Australian and Southeast Asian region. One of these African rodents, Mastomys natalensis, carries an endogenous GALV-KoRV-related retrovirus that is fully intact and potentially still infectious. Our findings support the hypothesis that rodents are the major carriers of GALV-KoRV-related retroviruses.
The European Green Deal: climate action, social impacts and just transition safeguards
Authors: Arabadjieva Kalina , Bogojević Sanja
Published: August 2024

The European Green Deal (EGD) is a growth strategy that seeks to combine climate action with economic stimuli. Climate action, however, inevitably creates winners and losers, at least in the short term. Zooming in on two examples of such actions—the phase-out of coal in Bulgaria and the mining for lithium (necessary for electric vehicle batteries) in Serbia—we point to the significant social implications of the EGD and how these give rise to conflicts that threaten to undermine the economic transformation envisioned for achieving climate neutrality. We show that the remedies put in place by the EU to deal with the social consequences of climate action are too narrow and fragmented and contain almost no legal obligations to promote a socially ‘just transition’ that ‘leaves no-one behind’—the leitmotif of the EGD. We join forces here, as scholars of labour law and environmental law, to identify substantive and procedural legal safeguards that would strengthen the social element of the EU climate agenda and help mitigate some of the emerging conflicts and backlash against climate policies.
Transitional pain services updates and a novel service for the obstetric population
Authors: Blanco Rafael , Ansari Tarek
Published: August 2024

Purpose of review

This paper is an update of the publications on Transitional Pain Services and explores the viability of a dedicated transitional pain service for women.

Recent findings

We address common pain pathologies establishing referral criteria, pathways, and effective strategies to decrease chronification of pain during pregnancy.

This review highlights the importance establishing transitional pain service models at every institution and in particular in obstetric population as pain is normalized by Society during pregnancy.
Complications of Hardware Removal in Pediatric Orthopaedic Surgery
Authors: Desai Vineet M. , Mahon Scott J. , Pang Amanda , Hauth Lucas , Shah Apurva S. , Anari Jason B.
Published: August 2024

Background:

Hardware removal (HR) is one of the most common surgical procedures in pediatric orthopaedics. Surgeons advocate for HR for a variety of reasons, including to limit peri-implant fracture risk, restore native anatomy for adult reconstruction surgery, permit bone growth and development, and mitigate implant-related pain/irritation. To our knowledge, no recent study has investigated the characteristics and complications of HR in pediatric orthopaedics. The goal of this study is to report the prevalence and complications of hardware removals across all of pediatric orthopaedic surgery.

Methods:

A retrospective case series was conducted of all hardware removals from 2012 to 2023 performed at a single urban tertiary-care children’s hospital. Cases were identified using CPT codes/billing records. Spinal hardware and cases for which hardware was either implanted or explanted at an outside hospital were excluded. Patient demographic and clinical data were recorded. For patients with multiple hardware removals, each case was recorded independently.

Results:

A total of 2585 HR cases for 2176 children met study criteria (57.7% male; mean age 12.3±4.4 y). The median postoperative follow-up time was 1.7 months (interquartile range: 0.6 to 6.9). The most common sites of hardware removal were the femur/knee (32.7%), tibia/fibula/ankle (19.3%), and pelvis/hip (18.5%). The most common complications included sustained, new-onset postoperative pain (2.6%), incomplete hardware removal (1.6%), and perioperative fracture (1.4%). The overall complication rate of hardware removal was 9.5%. Eighty-eight percent of patients who underwent hardware removal for pain experienced pain relief postoperatively. HR >18 months after insertion had a 1.2x higher odds of overall complication (P=0.002) and 3x higher odds of incomplete removal/breakage (P<0.001) than hardware removed 9 to 18 months after insertion.

Conclusions:

The overall complication rate of hardware removal across a large series in the pediatric population was 9.5%. Despite hardware removal being one of the most common and often routine procedures in pediatric orthopaedics, the complication rate is not benign. Surgeons should inform patients and families about the likelihood of success and the risks of incomplete removal during the informed consent process.

Level of Evidence:

IV
Effect of Home-Based Cardiac Telerehabilitation in Patients After Percutaneous Coronary Intervention
Authors: Zheng Yan , Guo Jing , Tian Yun , Qin Shuwen , Liu Xiaoling
Published: August 2024

Low adherence to hospital-based cardiac rehabilitation has been observed in patients after percutaneous coronary intervention. The effectiveness of home-based cardiac telerehabilitation in this setting is unclear. This study aimed to investigate the impact of home-based cardiac telerehabilitation on exercise endurance, disease burden status, cardiac function, and quality of life in patients after percutaneous coronary intervention. A total of 106 patients after percutaneous coronary intervention were randomly assigned to either the intervention group (receiving routine rehabilitation care and home-based cardiac telerehabilitation) or the control group (receiving routine care only), with 53 patients in each group. The 6-minute walking test, anerobic threshold, physical component summary score, mental component summary score, Vo
2max, and left ventricular ejection fraction were measured in both groups before and 3 months after the intervention. Additionally, the Short-Form 12 scale and Family Burden Interview Schedule were used to assess quality of life and disease burden status. The intervention group demonstrated significant improvements in 6-minute walking test, anerobic threshold, Vo
2max, physical component summary score, mental component summary score, Short-Form 12 scale, and Family Burden Interview Schedule scale scores compared with the control group (P<0.05). Results suggest that home-based cardiac telerehabilitation may improve exercise endurance and quality of life and reduce disease burden status in patients after percutaneous coronary intervention.
A review of the addictive potential of pregabalin and gabapentin
Authors: Dalsgaard Helene , Dalhoff Kim Peder , Heerfordt Ida M.
Published: August 2024

Following increasing inquiries to the Danish Poison Information Centre regarding pregabalin and gabapentin, this review investigates existing literature about the addictive potential of these two drugs, with a focus on publications after 2020. A systematic search of PubMed was conducted to identify studies concerning the recreational use, misuse and withdrawal symptoms associated with pregabalin and gabapentin. Five case studies, three observational studies, and two interviews were included. This review highlights demographical variations in the misuse of the drugs. Notably, a high prevalence of recreational use of pregabalin was observed among adolescents often co-ingested with sedatives, such as opioids and alcohol. Withdrawal symptoms often followed abrupt discontinuation even at recommended doses, underscoring the drugs’ potential for physical dependence. This review adds information to the already existing literature and provides new insights into the misuse and abuse of pregabalin and gabapentin. This review supports the need for further monitoring and better patient education to mitigate the rising misuse.
Pilot Safety Study of a Microfabricated Device for Anterior Stromal Puncture to Treat Corneal Epithelial Disease in the Optical Axis
Authors: Chaum Edward , Kim Dooho Brian , Kane Steven , Swann Forrest B. , Waite Aaron , Wade Lloyd R. , Riemann Christopher D. , Snyder Michael E.
Published: August 2024

Purpose:

Anterior stromal puncture is an inexpensive and widely used technique at the slit lamp to treat recurrent corneal erosions (RCE), common sequelae of corneal abrasions, trauma, and epithelial basement membrane dystrophies (EBMDs). The purpose of this study was to determine safety of a novel anterior stromal micropuncture device (termed a “plexitome”) for use in the optical axis of the cornea.

Methods:

We performed an IRB-approved clinical pilot study on 45 patients with diverse corneal pathologies to determine the safety of the plexitome device and examined corneal healing responses clinically for a minimum of 30 days after treatment. Follow on efficacy data was collected for treated patients with RCE. Micropuncture treatment was performed either through loose epithelial tissue or after debridement using a cotton tip at the slit lamp. After “imprinting,” patients were treated with topical medications including antibiotics, hypertonic saline/ointment, bandage contact lenses, and/or patching according to the treating physician's routine care for the condition.

Results:

Micropuncture using the “plexitome” device did not create visible scars in the corneal stroma of the 45 patients treated and followed for at least 30 days. Photographic evidence of imprinting was seen at in 1 patient at 30 days. There were no significant adverse events associated with treatment.

Conclusions:

Micropuncture of the cornea using the “plexitome” device does not create optically evident anterior stromal scarring after treatment. Micropuncture using the device may be an effective way of treating RCE and other corneal manifestations of EBMD in the optical axis, which is not currently possible using standard anterior stromal puncture methods.
Meta-analysis of qualitative studies on older people’s attitudes toward death in a nursing facility
Authors: Pang Hui , Wang Wenjun , Zhao Fengyi , Cheng Huanhuan
Published: August 2024

An older person’s negative attitude toward death will adversely affect their physical and mental health. To gain an in-depth understanding of the attitudes of older people in nursing institutions when facing death, this article reviewed the literature and followed up with references for providing better end-of-life care to older people in nursing institutions. Older people in nursing institutions have both positive and negative attitudes toward death. Effective nursing interventions should be provided for older people to help them face death positively and make adequate preparations for death.
The effectiveness of HALP score in predicting mortality in non-ST-elevation myocardial infarction patients
Authors: Kiliç Raif , Güzel Tuncay , Aktan Adem , Güzel Hamdullah , Kaya Ahmet Ferhat , Çankaya Yusuf
Published: August 2024

Background:

The HALP score, measured based on hemoglobin, albumin, lymphocyte, and platelet levels, is regarded as a novel scoring system that indicates the status of systemic inflammation and nutritional health. Our study aimed to evaluate the relationship between HALP score and prognosis in non-ST-elevation myocardial infarction (NSTEMI) patients.

Methods

Between 1 January 2020 and 1 January 2022, 568 consecutive patients diagnosed with NSTEMI from a single center were included in the study retrospectively. The patients were divided into two equal groups according to the median HALP cutoff value of 44.05. Patients were followed for at least 1 year from the date of admission.

Results

The average age of the patients was 62.3 ± 10.6 years and 43.7% were female. In-hospital and 1-year mortality were found to be significantly higher in the group with low HALP scores (6.0 vs. 2.1%, P = 0.019 and 22.5 vs. 9.9%, P < 0.001, respectively). In receiver operating characteristic curve analysis, a cutoff level of 34.6 of the HALP score predicted 1-year mortality with 71% sensitivity and 65% specificity (area under the curve: 0.707, 95% confidence interval: 0.651–0.762, P < 0.001). In Kaplan–Meier analysis, higher mortality rates were observed over time in the group with lower HALP scores (log-rank test=16.767, P < 0.001). In Cox regression analysis, the HALP score was found to be an independent predictor of 1-year mortality (odds ratio: 0.969, 95% confidence interval: 0.958–0.981, P < 0.001).

Conclusion

We found that a low HALP score could predict in-hospital and 1-year mortality in patients admitted to the hospital with a diagnosis of NSTEMI.
Management of Chyle Leak in Pediatric Surgical Oncology: A Systematic Review
Authors: Alhayek Nabil , Alwani Abdulkarim , Pio Luca , Abdelhafeez Abdelhafeez H.
Published: August 2024

Introduction:

Chyle leak, a rare complication, arises from damage to primary lymphatic vessels due to congenital factors or medical interventions, leading to conditions such as chylothorax and chylous ascites. Managing chyle leaks is challenging, especially in pediatric surgical oncology, often arising as postoperative complications. Treatment options range from conservative dietary adjustments to surgical interventions, depending on leak severity and patient condition. This systematic review examines the management of chyle leaks in pediatric surgical oncology, emphasizing both conservative and surgical approaches.

Methods:

This systematic review involved extensive database searches (EMBASE, Web of Science, and PubMed) to identify relevant studies on chyle leak management in the pediatric population. The review included studies from 1982 to 2023 and focused on pediatric and adolescent patients, assessing various treatment approaches and outcomes. Nine articles composed of 163 patients (study population size ranging from 2 to 82 patients). Independent reviewers evaluated the selected studies for inclusion.

Results:

Among 9 articles analyzed, 98.8% of pediatric patients initially received conservative management for chyle leaks, with 11.7% eventually requiring surgical intervention due to persistent leaks (8, 10, and 16 to 22). Neuroblastoma resection is associated with 20% to 40% rate of chyle leak, and the extent of lymphadenectomy has been identified as a risk factor for chyle leak. The study highlighted variability in clinical success rates based on conservative management approaches.

Discussion:

Chyle leak, while rare, presents a complex challenge, especially in pediatric surgical oncology. Various causes and treatment options exist, with a preference for conservative management initially and surgical intervention in specific circumstances. Factors such as leak severity and patient condition guide the choice between approaches. However, the scarcity of comparative data and randomized trials in the pediatric population necessitates further research to establish optimal management strategies for chyle leaks.

Conclusions:

Conservative management of chyle leaks has proven to be the preferred approach in early stages of treatment, whereas surgical management could be the preferred choice in certain situations. Larger prospective studies are needed to further evaluate these results.
A quality improvement project to enhance the knowledge, skills, and attitude of healthcare workers regarding the use of defibrillators
Authors: Gul Fahad , Abid Seemab , Khalid Shafia , Khalid Shahrukh , Shad Iram , Saleem Samar , Qayyum Sardar Noman , Noori Samim
Published: August 2024

Introduction:

Defibrillation is a critical intervention in managing cardiac emergencies, yet healthcare workers (HCWs) preparation for utilizing defibrillators remains inadequate, particularly in low and middle-income countries. This quality improvement project aimed to assess and enhance HCWs’ knowledge, skills, and attitudes toward defibrillator use in the emergency department (ED) through a 1-h defibrillator workshop.

Methodology:

An observational clinical audit was conducted within the ED of a tertiary care hospital. Pre- and post-workshop data were collected from the participants using structured questionnaires for demographics, knowledge assessment (20 multiple-choice questions), skills assessment (10-step checklist), and attitude evaluation (Likert-scale statements). The workshop included theoretical instruction and hands-on practice, with a post-workshop assessment conducted one week later. Data analysis employed descriptive statistics and paired t-tests, while ethical considerations ensured confidentiality and consent.

Results:

The study included 38 participants, demonstrating significant gaps in defibrillator knowledge, skills, and attitudes pre-workshop. Post-workshop assessments revealed a marked improvement in knowledge scores (P<0.05), attitudes (P<0.05), and practical skills (P<0.05). Participants’ confidence and preparation for managing cardiac emergencies notably increased, indicating the workshop’s efficacy in addressing the identified deficiencies.

Conclusion:

The 1-h defibrillator workshop effectively enhanced HCWs’ competence and readiness to utilize ED defibrillators. The observed improvements underscore the importance of targeted educational interventions in bridging knowledge gaps and fostering proactive attitudes toward emergency management. Regular training sessions should be conducted to sustain these enhancements and improve patient outcomes in the ED.
Elevating professional well-being in healthcare
Authors: Carson William , Bates Melissa , Howard John
Published: August 2024

A crosswalk of the NIOSH Impact Wellbeing™ campaign and the ANCC Pathway to Excellence® Framework
Tree-Based Reinforcement Learning for Identifying Optimal Personalized Treatment Decisions for Hand Deformity in Rheumatoid Arthritis
Authors: Yoon Alfred P. , Song Yao , Lin I-Chun F. , Wang Lu , Chung Kevin C.
Published: August 2024

Background:

Silicone metacarpophalangeal (MCP) joint arthroplasty (SMPA) can reconstruct MCP joint deformities in the rheumatoid hand, but patient selection criteria for the procedure remains unclear. The authors used statistical learning to elucidate patient selection criteria that will enhance long-term patient-reported and functional outcomes in patients with severe hand rheumatoid arthritis (RA).

Methods:

This was a secondary analysis of a prospective study of 169 adults with severe hand RA (average combined ulnar deviation and extensor lag at the MCP joint ≥50 degrees, per finger) with 1-year follow-up, conducted at 3 centers in the United States and England from January 1, 2004, to December 31, 2011. Primary outcomes were Michigan Hand Outcomes Questionnaire pain subscore, changes in extensor lag and ulnar deviation, and Arthritis Impact Measurement Scale score. A tree-based reinforcement learning model was used to estimate clinical decision rules for treatment.

Results:

A total of 132 patients (mean ± SD age, 61 ± 9 years; 108 female patients [72%]) were included in the SMPA (n = 50) and non-SMPA (n = 82) cohorts. To minimize ulnar deviation and extensor lag, patients should undergo SMPA. To minimize pain, patients older than 55 years should undergo SMPA. To increase hand-related quality-of-life (QOL), patients with grip strength less than 12 kg should undergo SMPA. Estimations with imputed missing data were similar, aside from a lower grip strength (<8 kg) threshold for hand-related QOL.

Conclusions:

Unless there is significant comorbidity that precludes surgery, most patients older than 55 years with severe hand RA will have improved QOL, pain, and function after SMPA. Patients with preserved grip strength may benefit from continued medical management.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
No Clinical Efficacy of Adipose-Derived Regenerative Cells and Lipotransfer in Breast Cancer–Related Lymphedema: A Double-Blind Placebo-Controlled Phase II Trial
Authors: Jørgensen Mads Gustaf , Jensen Charlotte Harken , Hermann Anne Pernille , Andersen Ditte Caroline , Toyserkani Navid Mohamadpour , Sheikh Søren Paludan , Sørensen Jens Ahm
Published: August 2024

Background:

Breast cancer–related lymphedema (BCRL) is a debilitating sequela affecting up to 1 in 3 breast cancer survivors. Treatments are palliative and do not address the underlying lymphatic injury. Recent preclinical and nonrandomized studies have shown promising results using adipose-derived regenerative cells (ADRCs) and lipotransfer in alleviating BCRL through regeneration of lymphatic tissue. However, no randomized controlled trial has been performed in an attempt to eliminate a placebo effect.

Methods:

This randomized, double-blind, placebo-controlled trial included patients with no-option, persistent disabling unilateral BCRL. Patients were randomly assigned in a 1:1 ratio to receive either autologous ADRCs (4.20×107 ± 1.75×107 cells) and 30-cc lipotransfer or placebo (saline) to the axilla. The primary outcome was a change in BCRL volume 1 year after treatment. Secondary outcomes included changes in quality of life, indocyanine green lymphangiography stage, bioimpedance, and safety.

Results:

Eighty patients were included, of whom 39 were allocated to ADRCs and lipotransfer treatment and 41 to placebo treatment. Baseline characteristics were similar in the groups. One year after treatment, no objective improvements were observed in the treatment or placebo groups. In contrast, significant subjective improvements were noted for both the treatment and placebo groups.

Conclusions:

This trial failed to confirm a benefit of ADRCs and lipotransfer in the treatment of BCRL. These nonconfirmatory results suggest that ADRC and lipotransfer should not be recommended for alleviating BCRL. However, the authors cannot exclude that repeated treatments or higher doses of ADRCs or lipotransfer could yield a clinical effect.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.
Defects in Value Associated With Hospital-Acquired Conditions: How Improving Quality Could Save U.S. Healthcare $50 Billion
Authors: Padula William V. , Pronovost Peter J.
Published: August 2024

Hospital-acquired conditions in the United States are considered avoidable complications but remain common statistics reflecting on health system performance and are a leading cause of patient fatality. Currently, over 3.7 million patients experience a hospital-acquired condition in the United States each year, which costs the U.S. healthcare delivery system an excess of $48 billion. Evidence-based clinical practice guidelines for common hospital-acquired conditions (e.g., infections, falls, pressure injuries) to reduce risk to the patient. In each of these instances, preventing the outcome with these guidelines costs less than treating the outcome, in addition to keeping the patient safe from harm. By applying the framework of defects in value to hospital-acquired conditions, we estimate that U.S. health systems could avert this $48 billion in spending on treating harmful hospital-acquired conditions; more so, these systems of care could recuperate over $35 billion after investing proportionally in a system that delivers greater quality by preventing hospital-acquired conditions over treating them. Currently, the Centers for Medicare and Medicaid Services only withholds reimbursements for hospital-acquired conditions and penalizes health systems with high rates of these outcomes. However, payers do not offer any reward-based incentives for hospital-acquired condition prevention. A series of policy and health system solutions, including tracking of hospital-acquired condition rates in electronic health records, identifying centers of excellence at reducing rates of harm with the use of clinical practice guidelines, and rewarding them monetarily for reduced rates could create equal-sided risk and opportunity to engage health systems in improved performance.
Comparing Guidelines to Daily Practice When Screening Older Patients for the Risk of Functional Decline in Hospitals: Outcomes of a Functional Resonance Analysis Method (FRAM) Study
Authors: Meulman Meggie D. , Merten Hanneke , van Munster Barbara , Wagner Cordula
Published: August 2024

Objectives

Dutch hospitals are required to screen older patients for functional decline using 4 indicators: malnutrition, delirium, physical impairment, and falls, to recognize frail older patients promptly. The Functional Resonance Analysis Method was employed to deepen the understanding of work according to the protocols (work-as-imagined [WAI]) in contrast to the realities of daily practice (work-as-done [WAD]).

Methods

Data have been collected from 3 hospitals (2 tertiary and 1 general) and 4 different wards: an internal medicine ward, surgical ward, neurology ward, and a trauma geriatric ward. WAI models were based on national guidelines and hospital protocols. Data on WAD were collected through semistructured interviews with involved nurses (n = 30).

Results

Hospital protocols were more extensive than national guidelines for all screening indicators. Additional activities mainly comprised specific preventive interventions or follow-up assessments after adequate measurements. Key barriers identified to work according to protocols included time constraints, ambiguity regarding task ownership, nurses’ perceived limitations in applying their clinical expertise due to time constraints, insufficient understanding of freedom-restricted interventions, and the inadequacy of the Delirium Observation Scale Score in patients with neurological and cognitive problems. Performance variability stemmed from timing issues, frequently attributable to time constraints.

Conclusions

The most common reasons for deviating from the protocol are related to time constraints, lack of knowledge, and/or patient-related factors. Also, collaboration among relevant disciplines appears important to ensure good health outcomes. Future research endeavors could shed a light on the follow-up procedures of the screening process and roles of other disciplines, such as physiotherapists.
The anxiety care continuum and its association with viral suppression among persons with HIV
Authors: Zalla Lauren C. , Hutton Heidi E. , Fojo Anthony T. , Falade-Nwulia Oluwaseun O. , Jones Joyce L. , Keruly Jeanne C. , Snow LaQuita N. , Moore Richard D. , Lesko Catherine R.
Published: August 2024

Objective:

It is unclear how often anxiety is diagnosed and treated and whether anxiety treatment is associated with improved viral suppression in persons with HIV. In this study, we characterized the anxiety care continuum and its association with viral suppression in a large urban HIV clinic in the United States.

Design:

Observational cohort study.

Methods:

We described the anxiety care continuum by combining data on self-reported anxiety symptoms, engagement in mental health care, clinical diagnoses and prescriptions from 1967 persons receiving HIV care and treatment in Baltimore, Maryland, from 2014 to 2023. We examined cross-sectional associations with viral suppression. All analyses were stratified by sex and race/ethnicity; a secondary analysis adjusted for age, years in care, and depressive symptoms.

Results:

Nearly one in five patients reported mild-severe symptoms of anxiety but were not currently receiving mental health care or pharmacologic treatment for anxiety; 6% of patients reported anxiety symptoms but were receiving treatment, and 7% had been treated for anxiety that was currently in remission. The prevalence of viral suppression ranged from 87% to 89% across the anxiety care continuum except among patients with untreated moderate-severe anxiety, only 81% of whom were virally suppressed [95% confidence interval (CI): 80, 83]. In adjusted models, untreated moderate-severe anxiety remained associated with viral nonsuppression across demographic groups.

Conclusion:

We observed a robust association between untreated anxiety and viral nonsuppression in a large urban cohort of persons with HIV. Screening for anxiety may identify patients with unmet mental health care needs who face barriers to maintaining viral suppression.
Risk Factors for Rapid Cognitive Decline in Amyloid-Negative Individuals Without Cognitive Impairment or With Early-Stage Cognitive Loss in Screening Tests
Authors: Park Yong-Jin , Choi Joon Young , Lee Kyung-Han , Seo Sang Won , Moon Seung Hwan
Published: August 2024

Purpose

Although rapid cognitive decline (RCD) is an important unfavorable prognostic factor, not much is known about it, especially in amyloid-negative individuals. The purpose of this study was to investigate risk factors for RCD in amyloid-negative individuals.

Patients and Methods

We retrospectively enrolled 741 individuals who were either cognitively unimpaired or had early-stage cognitive ability loss and who underwent 18F-florbetaben (FBB) (n = 402) or 18F-flutemetamol (FMM) (n = 339) PET/CT. Based on visual and semiquantitative (SUV ratio [SUVR]–based) analysis, the following amyloid-negative groups were established: visual-negative FBB (n = 232), visual-negative FMM (n = 161), SUVR-negative FBB (n = 104), and SUVR-negative FMM (n = 101). Univariable and multivariable logistic regression analyses were performed for RCD using 5 SUVRs, 5 cortical thicknesses, and 5 neuropsychological domains and clinico-demographic factors.

Results

In the amyloid-negative groups, a decline in language function was commonly identified as a significant risk factor for RCD (P = 0.0044 in the visual-negative FBB group, P = 0.0487 in the visual-negative FMM group, P = 0.0031 in the SUVR-negative FBB group, and P = 0.0030 in the SUVR-negative FMM group). In addition, declines in frontal/executive function, frontal SUVR, and parietal SUVR; a longer duration of education; and mild cognitive decline in the amyloid-negative groups were also significant risk factors for RCD.

Conclusions

Even in amyloid-negative individuals without cognitive impairment or with early-stage cognitive ability loss, those with decreased language and frontal/executive functions on neuropsychological testing are at risk of progression to RCD.
Circulating Metabolic Markers Identify Patients at Risk for Tumor Recurrence
Authors: Montcusí Blanca , Madrid-Gambin Francisco , Marin Silvia , Mayol Xavier , Pascual Marta , Cascante Marta , Pozo Óscar J. , Pera Miguel
Published: August 2024

Objective:

To investigate the spermidine pathway capability to predict patients at risk for tumor recurrence following colorectal cancer (CRC) surgery.

Background:

Recurrence rates after CRC surgery remain at about 20% despite an optimal technique and adjuvant therapy when necessary. Identification of risk biomarkers of recurrence is an unmet need. The spermidine pathway is indispensable for cell proliferation and differentiation, and is suggested to accelerate tumor spread.

Methods:

This was a prospective cohort study of patients undergoing CRC surgery from 2015 to 2018. Plasma samples were collected before surgery and on postoperative day 4, and the spermidine pathway was assessed through mass spectrometry. Oncological outcomes were registered.

Results:

A total of 146 patients were included and 24 (16.4%) developed tumor recurrence. Higher levels of preoperative spermidine pathway components (spermidine, spermine, spermidine synthase enzyme, and spermine/arginine balance) were positively associated with recurrence. Surgery promoted a decrease in these pathway elements. The greater the decline was, the lower the risk of recurrence. Preoperative spermidine over the cut-off of 0.198 µM displayed a 4.69-fold higher risk of recurrence. The spermine synthase enzyme behaved in the opposite direction.

Conclusions:

The spermidine pathway is associated with tumor recurrence following CRC surgery and, after confirmation in larger cohorts, could be translated as a risk biomarker of recurrence into clinical practice.
Just because you’re paranoid doesn’t mean they won’t side with the plaintiff: Examining perceptions of liability about AI in radiology
Authors: Bernstein Michael H. , Sheppard Brian , Bruno Michael A. , Lay Parker S. , Baird Grayson L.
Published: August 2024

Background

Artificial Intelligence (AI) will have unintended consequences for radiology. When a radiologist misses an abnormality on an image, their liability may differ according to whether or not AI also missed the abnormality.

Methods

U.S. adults viewed a vignette describing a radiologist being sued for missing a brain bleed (N=652) or cancer (N=682). Participants were randomized to one of five conditions. In four conditions, they were told an AI system was used. Either AI agreed with the radiologist, also failing to find pathology (AI agree) or did find pathology (AI disagree). In the AI agree+FOR condition, AI agreed with the radiologist and an AI false omission rate (FOR) of 1% was presented. In the AI disagree+FDR condition, AI disagreed and an AI false discovery rate (FDR) of 50% was presented. There was also a no AI control condition. Otherwise, vignettes were identical. Participants indicated whether the radiologist met their duty of care as a proxy for whether they would side with defense (radiologist) or plaintiff in trial.

Results

Participants were more likely to side with the plaintiff in the AI disagree vs. AI agree condition (brain bleed: 72.9% vs. 50.0%, p=0.0054; cancer: 78.7% vs. 63.5%, p=0.00365) and in the AI disagree vs. no AI condition (brain bleed: 72.9% vs. 56.3%, p=0.0054; cancer: 78.7% vs. 65.2%, p=0.00895). Participants were less likely to side with the plaintiff when FDR or FOR were provided: AI disagree vs AI disagree+FDR (brain bleed: 72.9% vs. 48.8%, p=0.00005; cancer: 78.7% vs. 73.1%, p=0.1507), and AI agree vs. AI agree+FOR (brain bleed: 50.0% vs. 34.0%, p=0.0044; cancer: 63.5% vs. 56.4%, p=0.1085).

Discussion

Radiologists who failed to find an abnormality are viewed as more culpable when they used an AI system that detected the abnormality. Presenting participants with AI accuracy data decreased perceived liability. These findings have relevance for courtroom proceedings.
IDENTIFICATION OF IMMUNE RESPONSE AND RNA NETWORK OF RHEUMATOID ARTHRITIS AND MOLECULAR DOCKING OFCELASTRUS PANICULATUSAS POTENTIAL THERAPEUTIC AGENT
Authors: Swaminathan Venkataramanan , Arumainathan Jeyvisna
Published: August 2024

Background

Rheumatoid Arthritis (RA) is an acute autoimmune disease leading to critical joint damage and bone destruction, weakening extra-articular organs over time. The pathogenesis of RA is complex and still undiscovered. This study aims to identify immune response, microRNA-hub genes network (miRNA), and drug candidates against RA via bioinformatics analysis.

Methodology

Three Gene Expression Omnibus (GEO) datasets were obtained from the NCBI database and classified into upregulated and downregulated differentially expressed genes (DEGs) using GEO2R tool. Gene enrichment analysis, protein-protein interaction network analysis, top 10 hub genes identification, miRNA-hub genes network analysis, and immune response identification were performed using various bioinformatic tools. Moreover,Celastrus paniculatusphytochemical compounds were retrieved and subjected to autodocking with upregulated and downregulated hub genes that are closely associated with RA. The drug-likeness and PreADMET analysis were performed.

Results

GSE30662, GSE766, GSE72100 datasets revealed 243 upregulated DEGs and 285 downregulated DEGs which exhibited RPS27A, UBB, UBC, UBA52, PSMD4, PSMD1, PSMD7, PSMB7, PSMD8, PSMA7 as top 10 upregulated hub genes and ACTB, TP53, AKT1, GAPDH, CTNNB1, EGFR, TNF, IL6, MYC, ANXA5 as top 10 downregulated hub genes. The miRNA network disclosed hsa-mir-23b-3p, as highly associated with upregulated hub genes whereas hsa-mir-34a-5p and hsa-mir-155-5p with downregulated hub genes. Additionally, immune responses of specific hub genes of RA were revealed while the docking analysis showed oleic acid and zeylasterone as novel drug candidates against RA.

Conclusion

Thus, hsa-mir-23b-3p, hsa-mir-34a-5p, and hsa-mir-155-5p can serve as therapeutic targets of RA while oleic acid and zeylasterone become potential drug candidates against RA.
Next-Day Serum Glial Fibrillary Acidic Protein Levels to Aid Diagnosis of Sport-Related Concussion
Authors: O’Brien William T. , Hickey James W. , Mutimer Steven , Evans Lauren J. , Colman Blake D. , Xie Becca , Giesler Lauren P. , Major Brendan P. , Mitra Biswadev , Spitz Gershon , O’Brien Terence J. , Shultz Sandy R. , McDonald Stuart J.
Published: August 2024

The diagnostic utility of blood glial fibrillary acidic protein (GFAP) in sport-related concussion (SRC) is unclear. This study measured serum GFAP at either 16-24 hours (h), 24-32h, or 36-52h post-SRC in 156 Australian football players and compared levels with 98 control players without SRC. Median GFAP levels were higher in SRC cases at 16-24h (124.7 pg/mL; p<0.001) and 24-32h (96.2 pg/mL; p<0.001) compared to controls (66.0 pg/mL), but not at 36-52h (62.8 pg/mL). GFAP had an area under the curve of 0.83 at 16-24h and 0.72 at 24-32h. Serum GFAP at 16-24h can be a useful aid in SRC diagnosis.
IDENTIFYING PLAUSIBLE RANGES FOR DIFFERENTIAL VACCINE EFFICACY ACROSS HIGH- AND LOW-INCOME SETTINGS: A SYSTEMATIC REVIEW, DESCRIPTIVE META-ANALYSIS, AND ILLUSTRATIVE EVIDENCE ANALYSIS
Authors: Katama Esther Nyadzua , Gallagher Katherine E. , Shah Anoop , Nokes D. James , McAllister David A
Published: August 2024

Background

Randomized clinical trials provide the highest standard of evidence about vaccine efficacy. Modelling exercises such as in evidence synthesis and health economic models where efficacy estimates are combined with other data to obtain effectiveness and cost-effectiveness estimates help inform policy decisions. The main challenge with such sensitivity analyses is in deciding on which assumptions to model.

Purpose

To identify plausible ranges for differential vaccine efficacy across high- and low-income settings.

Data Sources and Study Selection

MEDLINE, EMBASE, clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) were searched for multi-site randomized clinical trials of bacterial and viral vaccines for the period of 01/01/1990 to 31/12/2020. Articles were restricted to those where at least one trial had included a low- or lower-middle-income setting, published in English, and conducted in humans.

Methods

A Bayesian random-effects meta-analysis was used to estimate the difference in vaccine efficacy in high-(high or upper middle) and low-(low or lower middle) income settings. A single hierarchical model that included all trials was used so that the degree to which estimates of vaccine efficacy against different diseases influenced one another was estimated from the observed data.

Results

Across 65 eligible trials (37 high-income, 21 low-income, and 7 both) covering 7 pathogens, only one trial reported efficacy estimates stratified by setting. Trials were similar in terms of design across settings. There was evidence of heterogeneity by vaccine target, typhoid vaccine demonstrated higher vaccine efficacy in low-income settings than in high-income settings but for all other vaccines, the point estimates indicated efficacy was lower in low-income settings; however, all credible intervals crossed the null.

Conclusions

The percentage of trials in low-income settings poorly reflects the burden of disease experienced in low-income settings. While there is evidence of lower vaccine efficacy in low-income settings relative to high-income settings, the credible intervals were very wide. Vaccine efficacy trials should report treatment effects stratified by settings.
Achieving Inclusive Healthcare through Integrating Education and Research with AI and Personalized Curricula
Authors: Bahmani Amir , Cha Kexin , Alavi Arash , Dixit Amit , Ross Antony , Park Ryan , Goncalves Francesca , Ma Shirley , Saxman Paul , Nair Ramesh , Akhavan-Sarraf Ramin , Zhou Xin , Wang Meng , Contrepois Kévin , Than Jennifer Li Pook , Monte Emma , Rodriguez David Jose Florez , Lai Jaslene , Babu Mohan , Tondar Abtin , Rose Sophia Miryam Schüssler-Fiorenza , Akbari Ilya , Zhang Xinyue , Yegnashankaran Kritika , Yracheta Joseph , Dale Kali , Miller Alison Derbenwick , Edmiston Scott , McGhee Eva M , Nebeker Camille , Wu Joseph C. , Kundaje Anshul , Snyder Michael
Published: August 2024

Precision medicine promises significant health benefits but faces challenges such as the need for complex data management and analytics, interdisciplinary collaboration, and education of researchers, healthcare professionals, and participants. Addressing these needs requires the integration of computational experts, engineers, designers, and healthcare professionals to develop user-friendly systems and shared terminologies. The widespread adoption of large language models (LLMs) like GPT-4 and Claude 3 highlights the importance of making complex data accessible to non-specialists. The Stanford Data Ocean (SDO) strives to mitigate these challenges through a scalable, cloud-based platform that supports data management for various data types, advanced research, and personalized learning in precision medicine. SDO provides AI tutors and AI-powered data visualization tools to enhance educational and research outcomes and make data analysis accessible for users from diverse educational backgrounds. By extending engagement and cutting-edge research capabilities globally, SDO particularly benefits economically disadvantaged and historically marginalized communities, fostering interdisciplinary biomedical research and bridging the gap between education and practical application in the biomedical field.