bluuebunny/crossref_metadata_2025 huggingface dataset:
Orbital apocrine hidrocystoma. Report of two cases
Authors: Di Marino Matteo , Quaranta Leoni Flavia , Ranazzi Giulio , Quaranta Leoni Francesco M
Published: December 2023

Introduction

We report the clinical features and the management of two cases of orbital hidrocystoma in the setting of an enlarging orbital mass.

Cases description

A 48-year-old man presented with a mass in the right upper medial orbital quadrant, firmly attached to the supraorbital incisure. A 70-year-old man had a well demarcated lesion in the upper lateral orbital quadrant adherent to the lacrimal gland. There was no history of previous orbital trauma. In both cases histopathology confirmed a diagnosis of apocrine hidrocystoma. Following surgery, the first patient complained of mild hypoesthesia in the territory of the supraorbital nerve that resolved spontaneously within 3 weeks. Surgery was uneventful in the other patient. No recurrence was seen during the follow up.

Conclusions

Apocrine hidrocystomas have been rarely described in the orbit, but should be considered in the differential diagnosis of orbital cystic masses. Recurrence is rare following complete surgical excision.
A framework of transmediation
Authors: Peña Ernesto , James Kedrick
Published: December 2023

The concept of transmediation might be one of the most influential intellectual tools for studying, discussing and fostering innovative phenomena across fields of study. One could argue that the term itself is self-explanatory. Etymologically, it suggests a transition (to go across) between different media but the concept of transmediation has been shaped both by the somewhat historically lax definition of media and the disciplines that have adopted the term. And while the looseness of media gives transmediation a potential for interdisciplinarity, the siloed nature of academic disciplines could have, at the same time, hindered such potential. In this paper, we introduce a framework for transmediation based on an analysis of the use and evolution of the concept and our own explorations over the last few years. This framework aims to provide a common language and a set of conceptual prompts to explore the notion of transmediation further.
Interorganizational evaluation capacity building in the public, health and community sectors
Authors: Laubek Charlotte , Bourgeois Isabelle
Published: December 2023

Evaluation capacity building is generally conceptualized as occurring either at the individual or the organizational levels. However, ongoing societal crises require organizations within or across sectors to work together to find solutions to complex problems and to evaluate joint initiatives. Interorganizational evaluation capacity is required to ensure the ongoing conduct and use of evaluations to support interorganizational decision-making and improvement. This exploratory study describes and analyzes four cases of interorganizational evaluation capacity building initiatives in the public, health and community sectors in Canada and Denmark to identify their key dimensions. Preliminary findings highlight the importance of developing individual and organizational evaluation capacity as well as the need to provide stakeholders with interorganizational evaluation training and projects in which they can work together to better learn about each other’s organizations and challenges and find solutions to common problems.
The relationship at the heart of the experience of daughter caregivers of a parent with dementia: An interpretative phenomenological analysis
Authors: Ruyant Belabbas Elena , Manceau Charlotte , Wawrziczny Emilie
Published: December 2023

Background

Parents with dementia require emotional, physical, psychological and financial support from their child caregivers to continue living at home. Daughter caregivers have been shown to be more involved in self-care and household tasks and to experience higher levels of distress than son caregivers.

Objective

The aim of this study was to investigate the experience of daughter caregivers who provide informal care for a parent with dementia living in their own home.

Method

Semi-structured interviews were conducted with 11 daughter caregivers of a parent with Alzheimer’s disease. Interviews were analysed using Interpretative Phenomenological Analysis.

Results

Three axes emerged from the analyses: [1] the before conditions the after: the quality of the previous relationship with the parent with Alzheimer’s disease is a determining factor and allows the identification of three profiles of daughter caregivers: ‘the grateful’, ‘the resentful’ and ‘the ambivalent’, [2] when the relationship protects against the sense of burden: the feeling of being invaded by the caregiving situation is influenced by the quality of the relationship with the parent with Alzheimer’s disease, and [3] alone or almost: the support network is desired when it is absent but kept at arm’s length when it is present.

Discussion

The results underline the importance of assessing the quality of attachment and supporting the relationship with the parent (especially when the relationship prior to the disease was difficult). Daughter caregivers should also be encouraged to delegate tasks and refocus their actions related to their values. Family mediation sessions may be planned to improve the organisation of care and set up an efficient collaboration.
Outcome of Chronic Foot Osteomyelitis Treated With Hyperbaric Oxygen: An Observational Study
Authors: Menekse Serdar
Published: December 2023

Chronic refractory osteomyelitis of the foot stands as a formidable challenge in medical care, associated with significant morbidity and escalating healthcare costs. Traditional therapeutic approaches, including surgical debridement and systemic antibiotics, often fall short, leaving patients and clinicians in search of more efficacious interventions. Hyperbaric oxygen therapy (HBOT), an innovative therapeutic modality, has recently emerged as a promising adjunct therapy, offering a beacon of hope in this therapeutic conundrum. In this groundbreaking observational study, we meticulously analyzed the experiences of 80 patients suffering from chronic refractory osteomyelitis of the foot. Following surgical debridement and tailored antibiotic therapy, each patient was treated with HBOT at 2.5 atmospheres absolute for 120 min, 5 days a week, spanning an average of 50 days. Our primary endpoints focused on complete eradication of infection, recurrence metrics, and any adverse effects linked to HBOT. Astonishingly, 68 of the 80 patients (85%) achieved a total infection clearance, maintaining this status through a mean follow-up period of 36 months, all without a single report of HBOT-induced complications. Our compelling findings advocate that HBOT, synergized with standard surgical and antibiotic regimens, can revolutionize the treatment landscape for chronic refractory osteomyelitis of the foot. Given these promising preliminary results, there's an imperative need for extensive research to delineate the long-term advantages and to fine-tune HBOT protocols, potentially paving the way for a new therapeutic gold standard.
Acceptability of a Telerehabilitation Biofeedback System Among Stroke Survivors: A Qualitative Analysis
Authors: Donnelly Miranda R. , Phanord Coralie S. , Marin-Pardo Octavio , Jeong Jessica , Bladon Barrisford , Wong Kira , Abdullah Aisha , Liew Sook-Lei
Published: December 2023

Electromyography (EMG) biofeedback delivered via telerehabilitation can increase access to occupational therapy services for stroke survivors with severe impairment, but there is limited research on its acceptability. This study identified factors influencing the acceptability of a complex, muscle biofeedback system (Tele-REINVENT) for upper extremity sensorimotor stroke telerehabilitation among stroke survivors. We conducted interviews with stroke survivors ( n = 4) who used Tele-REINVENT at home for 6 weeks and analyzed the data with reflexive thematic analysis. Biofeedback, customization, gamification, and predictability affected the acceptability of Tele-REINVENT among stroke survivors. Across themes, features and experiences that gave participants agency and control were more acceptable. Our findings contribute to the design and development of at-home EMG biofeedback interventions, which can improve access to advanced occupational therapy treatment options for those who need it most.
Telehealth-Guided Virtual Reality for Recovery of Upper Extremity Function Following Stroke
Authors: Adams Richard J. , Ellington Allison L. , Kuccera Kate A. , Leaman Hannah , Smithson Catherine , Patrie James T.
Published: December 2023

This rater-blinded, randomized control trial (RCT) investigated the effectiveness of a Glove Rehabilitation Application for Stroke Patients (GRASP) virtual reality home exercise program (HEP) for upper extremity (UE) motor recovery following stroke. The GRASP system facilitates the use of the affected UE in simulated instrumental activities of daily living (IADLs). Participants were asked to use the system at home in asynchronous telehealth sessions 4 times per week over 8 weeks. A non-blinded occupational therapist (OT) provided synchronous telehealth visits biweekly. Analysis comparing pre- and post-assessment results for the Fugl-Meyer UE assessment (FMUE) shows a clinically important and statistically significant between-group difference for participants completing the GRASP HEP protocol compared with usual and customary care controls. Statistically significant and clinically important differences were also found in Motor Activity Log (MAL) scores. This evidence provides support for the effectiveness of home-based, IADL-focused, virtual reality therapy with telehealth support.
Telehealth Self-Management Support in Early Stroke Rehabilitation: A Feasibility Randomized Controlled Trial
Authors: Lee Danbi , Fischer Heidi , Yang Bishan , Tingey Jamie L. , Miller McKenzie , Kahlia Faran , Bombardier Charles H.
Published: December 2023

Background:

Skills to manage the chronic effect of stroke are often not sufficiently addressed in early stroke rehabilitation.

Objectives:

The study evaluated the feasibility of conducting a trial testing the efficacy of telehealth self-management support early in stroke recovery.

Methodology:

Process, resources, and scientific feasibility was assessed for a randomized controlled trial comparing the effect of motivational interviewing and a group-based self-management program to treatment-as-usual with first-time stroke patients. Data were analyzed using descriptive statistics, effect sizes, and thematic analysis.

Results:

Fifteen stroke patients were enrolled, and 10 completed the study (intervention n = 6). 100% attendance was achieved with technical support, reminders, and schedule flexibility. Participants were satisfied with the intervention and reported emotional benefits and gain of new insights. Perceived recovery showed moderate effect ( r = 0.54).

Conclusion:

The findings support the feasibility of an efficacy trial as well as the potential benefit of integrating telehealth self-management support early in stroke rehabilitation.
Exploring the link between Multimorbidity and direct healthcare costs in Ireland: A cross-sectional study
Authors: Walsh Sharon , Gillespie Paddy
Published: December 2023

Background

Multimorbidity has emerged as a major challenge facing health services globally, which will place a substantial burden on health systems going forward. This paper seeks to estimate the association between multimorbidity and direct healthcare costs among older people in Ireland from a healthcare system perspective.

Methods

Cross-sectional analysis of data on 8,447 community-dwelling adults aged 50 and over collected between 2009 and 2011 as part of the Irish Longitudinal Study on Ageing. Multivariable generalised linear model regression, employing a log-link and Poisson family distribution, is used to assess the association between self-reported multimorbidity status and direct healthcare costs.

Results

For the full sample, 21.20% reported having no chronic conditions, 27.39% had one chronic condition, and 51.40% had multimorbidity. After controlling for a range of socio-demographic and health status variables, we found that relative to those reporting no chronic conditions, one chronic condition was associated with additional average annual costs of €513 (95% CIs: 245, 781), increasing to €1277 (95% CIs: 942, 1612) for those with 6 or more chronic conditions. Relative to those reporting 2 chronic conditions, 4 chronic conditions were associated with additional costs of €411 (95% CIs: 106, 716), 5 chronic conditions with €591 (95% CIs: 214, 969), and 6 or more chronic conditions with additional average costs of €1006 (95% CIs: 641, 1371).

Conclusion

This study finds positive and significant associations between the number of chronic conditions and direct healthcare costs and further highlights the potential economic benefits from preventing the onset and progression of multimorbidity
Association of intradialysis blood sodium level, blood pressure variability, and hydration status with hemodialysis-related headache: a prospective cohort study
Authors: Xiong Yuqin , You Nujia , Liao Ruoxi , Wu Ling , Liu Yao , Ling Ziying , Yu Yang
Published: December 2023

Objective

To identify primary factors contributing to hemodialysis-related headache (HRH) in maintenance hemodialysis (MHD) patients.

Methods

Adult outpatients receiving MHD were prospectively enrolled from a hemodialysis (HD) center of a tertiary hospital in China. Twelve dialysis sessions were successively monitored for each patient. HRH is defined as having at least three headache episodes that begin during HD and resolve within 72 h of HD session completion. Blood gas analysis during headache episodes and body composition analysis after dialysis were conducted. Hour-to-hour vital sign variability during dialysis was assessed using the metric of average real variability (ARV). Multivariable logistic regression analysis was conducted to explore the factors triggering HRH.

Results

A total of 95 Chinese MHD patients were enrolled, with 92 patients (60.9% were males) included in the final analysis. The mean age of the 92 patients was 59.3 ± 17.5 years, and the median dialysis vintage was 27.1 (12–46.2) months. Among them, 12 patients (13%) complained of 42 headache attacks, and eight (8.7%) were diagnosed with HRH. For eight patients with HRH, headache occurred 100.3 ± 69.5 min after the start of dialysis, with a mean VAS score of 4.3 ± 1 points. The quality of headaches was dull (six patients), pulsating (one patient), or stabbing pain (one patient); all the headaches were bilateral, with one having concomitant vomiting. The intradialysis headache duration and the whole headache duration were 98.8 ± 68.1 and 120 (65–217.5) minutes, respectively. Younger age (OR = 0.844, 95% CI 0.719–0.991, p = 0.039), decreased blood sodium level (OR = 0.309 in the range of 133–142 mmol/L, 95% CI 0.111–0.856, p = 0.024), increased ARV of intradialysis systolic blood pressure (OR = 3.067, 95% CI 1.006–9.348, p = 0.049) and ratio of overhydration to dry weight (OR = 1.990, 95% CI 1.033–3.832, p = 0.040) were found to be independent risk factors for HRH.

Conclusions

This study suggested a significant attribution of blood sodium, hydration status and blood pressure variability to HRH.
Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trial
Authors: Xu Fang , Li Yanan , Wang Xupeng , Sun Ran , Zheng Zilei , Zhang Qi , Gao Mingyang , Tao Wei , Zhao Juan , Wang Qiujun
Published: December 2023

Background

Neuroinflammation may be a potential mechanism of postoperative delirium (POD) in geriatric patients, and hypertonic saline (HS) has immunomodulatory properties. The purpose of this study was to investigate whether HS could reduce the incidence of POD in elderly patients and its effect on neutrophil activation and inflammatory cytokine expression.

Methods

We studied the effect of pre-infusion of 4 mL/kg 3% hypertonic saline vs. 4 mL/kg 0.9% normal saline on POD in patients undergoing shoulder arthroscopy in a prospective, randomized, double-blind, controlled trial. Neutrophil surface molecules (CD11b, CD66b and CD64) were analyzed by flow cytometry. Circulating concentrations of inflammatory factors IL-1β, IL-6, TNF-α and neurological damage factor S100β were assessed by enzyme immunoassay. The Confusion Assessment Method-Chinese Revision (CAM-CR) was applied for the assessment of POD 1–3 days after surgery.

Results

The incidence of POD in group H was significantly lower than that in group N (7.14% vs 26.83%, P = 0.036). The expression levels of inflammatory cytokines ( IL-6 and TNF-α) and neutrophil surface markers (CD11b and CD66b) were significantly lower in group H than in group N at 24 h after surgery (P = 0.018, P < 0.001, P < 0.001, P = 0.024). There were no significant differences in postoperative pain, nausea and vomiting, infection, phlebitis, and patients satisfaction between the two groups.

Conclusion

Pre-infusion of HS can reduce the incidence of POD and the immune-inflammatory response.

Trial registration

Chinese Clinical Trial Registry (14/4/2022, registration number: ChiCTR2200058681.
The effect of fibrinoid necrosis on the clinical features and outcomes of primary IgA nephropathy
Authors: Chen Hongshan , Liu Youxia , Wei Li , Wang He , Zheng Zhenfeng , Yan Tiekun , Jia Junya , Li Dong
Published: December 2023

Background

To explore the clinicopathologic features and outcomes of IgAN patients who presented with fibrinoid necrosis (FN) lesions or not and the effect of immunosuppressive (IS) treatment in IgAN patients with FN lesions as well.

Methods

This was a retrospective cohort study with 665 patients diagnosed with primary IgAN from January 2010 to December 2020 in Tianjin Medical University General Hospital and having detailed baseline and follow-up characteristics. Patients were divided into two groups depending on the appearance of FN lesions. Patients with FN lesions were recruited into Group FN1, while patients who were not found FN lesions in their renal biopsy specimens were recruited into Group FN0. Compare the differences between Group FN0 and Group FN1 in baseline clinicopathologic features, treatment solutions and follow-up data as well. To evaluate the impact of different fractions of FN lesions on baseline characteristics and prognosis of IgAN, we subdivided patients in Group FN1 into 3 groups depending on the FN lesions distribution, Mild Group: 0 < FN% < 1/16; Moderate Group: 1/16 < FN% < 1/10; Severe Group: FN% > 1/10. Furthermore, we compared the differences in baseline clinicopathologic features, treatment solutions and follow-up data among these three groups. Kidney endpoint event was defined as patients went into end-stage kidney disease (ESKD), which estimated glomerular filtration rate (eGFR) < 15 ml/min/1.73 m^2, regularly chronic dialysis over 6 months or received renal transplantation surgery. The kidney composite endpoint was defined by a ≥ 30% reduction in eGFR, double Scr increase than on-set, ESKD, chronic dialysis over 6 months or renal transplantation. Compare the survival from a composite endpoint rate in different groups by Kaplan-Meier survival curve. The univariate and multivariate Cox models were used to establish the basic model for renal outcomes in patients with FN lesions.

Results

(1) A total of 230 patients (34.59%) were found FN lesions in all participants. Patients with FN lesions suffered more severe hematuria than those without. On the hand of pathological characteristic, patients with FN lesions showed higher proportions of M1, E1, C1/C2 and T1/T2 lesions compared with those without FN lesions. (2) The 1-year, 3-year, and 5-year survival of the composite endpoint were lower in the FN1 group than FN0 group. (3) After adjusting for clinicopathological variables, the presence of FN lesions was a significantly independent risk factor for composite endpoint. By using multivariate Cox regression analyses, we also found when the fraction of FN lesions exceeded 10%, the risk of progression into composite endpoint increased 3.927 times.

Conclusion

Fibrinoid necrosis of capillary loops is an independent risk factor of poor renal outcomes. More effective treatment should be considered for those who had FN lesions.
Clinical value of the low-grade inflammation score in aneurysmal subarachnoid hemorrhage
Authors: wang Ling , Chen Ling , Jin Yang , Cao Xiangyang , Xue Liujun , Cheng Qiantao
Published: December 2023

Background and purpose

Multiple inflammatory biomarkers have been shown to predict symptomatic cerebral vasospasm (SCVS) and poor functional outcome in patients with aneurysmal subarachnoid hemorrhage. However, the impact of the low-grade inflammation (LGI) score, which can reflect the synergistic effects of five individual inflammatory biomarkers on SCVS and poor functional outcome on aneurysmal subarachnoid hemorrhage (aSAH), has not yet been well established. The aim of this study was to evaluate the impact of the LGI score on SCVS and poor functional outcome in aSAH patients.

Methods

The LGI score was calculated as the sum of 10 quantiles of each individual inflammatory biomarker. The association of the LGI score with the risk of SCVS and poor functional outcome was analyzed with multivariate logistical regression.

Results

A total of 270 eligible aSAH patients were included in this study: 74 (27.4%) had SCVS, and 79 (29.3%) had poor functional outcomes. After adjusting for confounders, a higher LGI score was revealed to independently predict SCVS (OR, 1.083; 95% CI, 1.011–1.161; P = 0.024) and poor functional outcome (OR, 1.132; 95% CI, 1.023–1.252; P = 0.016), and the second and third tertile group had higher risk of SCVS than lowest tertile group (OR, 2.826; 95% CI, 1.090–7.327; P = 0.033) (OR, 3.243; 95% CI, 1.258–8.358; P = 0.015). The receiver operating characteristic (ROC) curve uncovered the ability of the LGI score to distinguish patients with and without SCVS (area under the curve [AUC] = 0.746; 95% CI, 0.690–0.797; P < 0.001) and poor functional outcomes (area under the curve [AUC] = 0.799; 95% CI, 0.746–0.845; P < 0.001), the predictive value of LGI on SCVS and poor functional outcome is superior than PLT, NLR and WBC, but there was no statistical difference between LGI and CRP for predicting SCVS (P = 0.567) and poor functional outcome (P = 0.171).

Conclusions

A higher LGI which represents severe low grade inflammation status is associated with SCVS and poor functional outcome at 3 months after aSAH.
Incidence, associated factors, and outcomes of delirium in critically ill children in china: a prospective cohort study
Authors: Lei Lei , Li Yi , Xu Huilin , Zhang Qin , Wu Jiacai , Zhao Shoujv , Zhang Xiaochao , Xu Min , Zhang Shuai
Published: December 2023

Background

Delirium occurs frequently in critically ill children and has been reported in many countries, but delirium is not well-characterized in China. The aim of this study was to represent the incidence of delirium in critically ill children in China, its associated factors, and the influence of delirium on in-hospital outcomes.

Methods

This observational prospective cohort study was set up in a large academic medical center with a 57-bed PICU in southwestern China. Critically ill children who required PICU stays over 24 h and were admitted between November 2019 and February 2022 were included in this study. The Cornell Assessment of Pediatric Delirium was used twice daily for delirium evaluation by bedside nurses, and twenty-four clinical features were collected from medical and nursing records during hospitalization.

Results

The incidence of delirium was 26.0% (n = 410/1576). Multivariate analysis revealed that seven independent risk factors including days of mechanical ventilation and physical restraints, admission diagnosis (neurologic disorder), sleep deprivation, use of benzodiazepines and dexmedetomidine, liver failure/liver dysfunction associated with delirium in critically ill children. One potentially protective factor was the watching television /listening to music/playing with toys. Children with delirium had longer lengths of stay in the PICU (median 11 vs. 10 days, p < 0.001) and hospital (median 18 vs. 15 days, p < 0.001) compared to those without delirium. Additionally, the in-hospital mortality rates were 4.63% and 0.77% in patients with and without delirium (p < 0.05).

Conclusions

Delirium is common in critically ill children in China and related to poor outcomes. Interventional studies are warranted to determine the best practices to reduce delirium exposure in at-risk children.
Income is not an equalizer: health development inequities by ethnoracial backgrounds in California kindergartners
Authors: Perrigo Judith L. , Block E. Piper , Aguilar Efren , Beck Chandler , Halfon Neal
Published: December 2023

Background

Early childhood health development is positively associated with income, but the strength of this relationship with ethnoracial background remains unclear. This study examined the extent of health development inequities among California kindergarteners based on ethnoracial backgrounds and neighborhood-level income.

Methods

This cross-sectional study assessed health development inequities by analyzing neighborhood-level income, ethnoracial background, and health development data for California kindergarteners. Student-level data (n = 106,574) were collected through teacher report between 2010–2020 across 52 school districts and 964 schools. Student addresses were geocoded and linked to American Community Survey neighborhood income levels. Health development was measured using the Early Development Instrument, a population-level measure which includes physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication skills and general knowledge domains. Outcomes included being “on-track” in each domain as well as overall health development.

Results

Using a Generalized Estimation Equation with a log-link function, while accounting for interactions between ethnoracial background, income, and income-squared, we found significant health development inequities by ethnoracial background and neighborhood-level income. Regarding overall health development, as well as the physical, social and emotional domains, Black students had a lower likelihood of being on-track compared to the weighted average across income levels, whereas Asian students surpassed the weighted average. White students exhibited the steepest slope, and at the lowest income levels, their health development scores were akin to their Black and Hispanic/Latino/a low-income counterparts but resembled their Asian counterparts at higher income levels. For the general knowledge and communication domain, white students consistently had the highest likelihood of being on-track, while Hispanic/Latino/a students had the lowest likelihood across all income levels.

Conclusion

This study examines health development inequities among California kindergarteners in diverse communities. Our analysis shows that the relationship between neighborhood-level income and kindergartners’ health development varies by domain and is weaker for students of color. Given the scarcity of population-level data on health development outcomes, these analyses offer valuable insights for identifying ecosystems necessitating support in promoting equitable early childhood health development.
Physiotherapy practice in women’s health: awareness and attitudes of obstetricians and gynecologists in Ghana
Authors: Koranteng Yaa Boatemaa , Adu-Bonsaffoh Kwame , Oppong-Yeboah Bertha
Published: December 2023

Background

Physiotherapy is relatively well integrated into women’s health in many high-income countries (HICs) as compared to low- and middle- countries (LMICs) like Ghana. Suboptimal integration of physiotherapy in modern obstetrics and gynecology especially in low resource settings is partly due to issues related to the awareness and attitudes of referring physicians. This study assessed the awareness and attitude levels towards physiotherapy in women’s health among obstetricians/gynecologists and factors associated with its utilization in Ghana.

Methods

A cross-sectional study was conducted among obstetricians/gynecologists working at a tertiary hospital in Ghana using an “Awareness and Attitude Questionnaire” adapted from a standardized questionnaire. Chi-square test or Fisher exact test was performed and logistic regression was used to assess the association between doctors’ awareness level of physiotherapy’s role in women’s health and years of clinical practice.

Results

Sixty-one (61) respondents comprising 7 consultants, 20 senior residents and 34 junior residents, with age median age of 35 years (range: 29–65 years) were recruited. There were more males than females (82% versus 18%) with a mean (SD) duration of practice of (9.41 ± 4.71) years. The participants reported a considerable awareness of physiotherapists’ role in obstetrics (between 72.1% for intrapartum to 91.8% for postnatal) but wide variation in gynecology (from 19.7% in PID to 95. 1% in uterine prolapse). Consultants were more (71.4%) aware of the role of physiotherapy in antenatal care and gynecology while senior residents had more awareness in intrapartum and postnatal care. Junior residents generally showed lowest awareness levels. Duration of clinical practice (≥ 10years) was not significantly associated with doctors’ awareness regarding the importance of physiotherapy in childbirth. There were mixed findings concerning doctors’ attitudes toward physiotherapy: (1) 41% indicated that physiotherapists have been effective in their inter-professional relationship; (2) none of the doctors strongly agreed that physiotherapy may not contribute significantly to the complete well-being of gynecological patients. The main factors influencing utilization of physiotherapy were the perceived notion of non-availability of physiotherapists to cover various wards and physiotherapists not attending ward rounds with doctors to facilitate more education on the scope of physiotherapy practice.

Conclusion

Although obstetricians/gynecologists showed appreciable awareness and attitudes towards physiotherapy, there remains a considerable gap in provider education to ensure optimal utilization of physiotherapy in contemporary obstetrics and gynecology. Further research is recommended to assess implementation challenges associated with regular utilization of physiotherapy services in women’s health in the hospital.
An observer tool to enhance learning of incoming anesthesia residents’ skills during simulation training of central venous catheter insertion: a randomized controlled trial
Authors: Benhamou Dan , Tant Sarah , Gille Benoit , Bornemann Yannis , Ruscio Laura , Kamel Karl , Dunyach Chloé , Jeannin Bénédicte , Bouilliant-linet Maxime , Blanié Antonia
Published: December 2023

Background

Central venous catheter (CVC) insertion using simulation is an essential skill for anesthesiologists. Simulation training is an effective mean to master this skill. Given the large number of residents and the limited duration of training sessions, the active practice time is limited and residents remain observers of their colleagues for much of the session. To improve learning during observation periods, the use of an observer tool (OT) has been advocated but its educational effectiveness is not well defined.

Methods

Incoming anesthesia residents were randomized to use an OT (i.e. procedural skill-based checklist) (OT+) or not (OT-) when observing other residents during a simulation bootcamp. The primary outcome was a composite score (total 60 points) evaluating CVC procedural skills rated immediately after the training. This score covers theoretical knowledge explored by multiple choice questions (MCQs) (/20), perceived improvement in knowledge and skills (/20), perceived impact on future professional life (/10) and satisfaction (/10). Measurements were repeated 1 month later. Residents in each group recorded the number of CVCs placed and their clinical outcomes (attempts, complications) during the first month of their clinical rotation using a logbook.

Results

Immediately after training, the composite score was similar between the two groups: 45.3 ± 4.2 (OT+, n = 49) and 44.4 ± 4.8 (OT-, n = 42) (p = 0.323). Analysis of sub-items also showed no difference. Results at 1 month were not different between groups.

Analysis of the logbook showed no difference between groups. No serious complications were reported.

Conclusions

The use of a procedural task-based OT by incoming anesthesia residents and used during CVC insertion simulation training was not associated with better learning outcomes, neither immediately after the session nor when re-evaluated 1 month later. The training at least once on simulator of all residents could limit the impact of OT. Further studies are necessary to define the place of OT in simulation training.
Essential health services delivery and quality improvement actions under drought and food insecurity emergency in north-east Uganda
Authors: Njuguna Charles , Tola Habteyes Hailu , Maina Benson Ngugi , Magambo Kwikiriza Nicholas , Phoebe Nabunya , Tibananuka Evelyne , Turyashemererwa Florence M. , Rubangakene Moses , Richard Kisubika , Opong George , Richard Ssekitoleko , Opesen Chris , Mateeba Tim , Muyingo Edmond , George Upenytho , Namukose Samalie , Woldemariam Yonas Tegegn
Published: December 2023

Background

Essential health services can be disrupted due to several naturally occurring public health emergencies such as drought, flood, earthquake and outbreak of infectious diseases. However, little evidence exists on the status of essential health services delivery under the effect of drought and food insecurity. North-east Uganda is severely affected by prolonged drought that significantly affected the livelihood of the residents. Therefore, we aimed to determine the current status of essential health services and quality improvement (QI) actions in health facilities in north-east Uganda.

Methods

We used a descriptive cross-sectional study design to assess the availability of essential health service and quality improvement activities in drought and food insecurity affected districts of north-east Uganda. We included a total of 150 health facilities from 15 districts with proportionated multistage sampling method. We interviewed health facilities’ managers and services focal persons using structured questionnaire and observation checklist. We used a descriptive statistic to analyze the data with SPSS version 22.

Results

A few health facilities (8.7%) had mental health specialist. There was also lack of capacity building training on essential health services. Considerable proportion of health facilities had no non-communicable diseases (38.3%), mental health (47.0%), and basic emergency obstetric care (40.3%) services. Stock out of essential medicines were observed in 20% of health facilities. There was lack of supportive supervision, and poor documentation of QI activities.

Conclusion

Essential health service and QI were suboptimal in drought and food insecure emergency affected districts. Human resource deployment (especially mental health specialist), provision of capacity building training, improving non-communicable diseases, mental health and basic emergency obstetric care services are required to improve availability of essential health services. Supporting supply chain management to minimize stock out of medicines, and promoting QI activities are also vital to assure quality of health service in drought and food insecurity affected districts in north-Eastern Uganda.
Correlation of Streptococcus agalactiae concentration on immune system and effective dose of inactivated vaccine for Chitralada 3 strain Nile tilapia (Oreochromis niloticus) in Thailand
Authors: Khunrang Thanakorn , Pooljun Chettupon , Wuthisuthimethavee Suwit
Published: December 2023

The main pathogen in the Nile tilapia (Oreochromis niloticus) culture, Streptococcus agalactiae, causes economic harm. Infected fish’s immune systems worked to eliminate of the infection. This study demonstrated the effect of different bacterial concentrations on tilapia immunity and optimal vaccine concentration to induce immunity in Nile tilapia. The experiment was performed at 102, 104, 106, 108, and 1010 CFU/fish of S. agalactiae compared with the control (PBS) through intraperitoneal injection for 72 h. Fish that survived employed to gather blood, and immune responses were assessed through measures of the survival rate include blood smears, antibody titers, and immunoglobulin gene expression. The vaccine experiment investigated formalin-inactivated S. agalactiae vaccination and administered S. agalactiae injections for 14 days. The statistic revealed a significant difference (p < 0.05) in the 108 and 1010 CFU/fish injections with high survival rates (62.22% and 53.33%, respectively). Immunoglobulin gene expression was highly represented in the 1010 CFU/fish injection; antibody titers were significantly improved from the control group, and antibody levels were high in the 1010 CFU/fish injection. The analysis of blood cell types using the blood smear method revealed a progressive increase in leucocytes, particularly lymphocytes, neutrophils, and monocytes, in the treatment group compared to the control group. Moreover, the erythrocyte/leucocyte ratio decreased significantly in response to the high bacterial injection, indicating an increase in leucocytes. Conversely, the erythrocyte level stayed ed within at the 7.03–9.70 × 102 cell/ml and shown no significant difference (p > 0.05). The lymphocytes were almost two-fold in 1010 CFU/fish compared to 108 CFU/fish. As depicted in the lowest concentration of 106 CFU/fish, the vaccine performance had a high relative percent survival (RPS) at 86.67%. This research suggested that the tilapia infected with high S. agalactiae concentrations did not affect the mortality of the tilapia, and vaccine concentration was effective in 106 CFU/fish.
Recognizing puzzling PD1 + infiltrates in marginal zone lymphoma by integrating clonal and mutational findings: pitfalls in both nodal and transformed splenic cases
Authors: Deng Jili , Cao Youjun , Diao Xinting , Wu Meng , Li Xianghong , Shi Yunfei
Published: December 2023

Background

A marked increase in PD1-positive TFH cells in nodal MZL cases (NMZL) was reported previously and could prompt suspicion for a diagnosis of peripheral T-cell lymphoma (PTCL), especially angioimmunoblastic T-cell lymphoma (AITL).

Case presentation

To demonstrate that the pitfall might exist not only in NMZL but also in transformed splenic MZL (tSMZL), two NMZL cases (70 y/o female with enlarged left cervical lymph node and 75 y/o male with generalized lymphadenopathy) and one case of tSMZL (47 y/o male with nodal and extranodal involvement) with obvious PD1-positive T-cell hyperplasia were described here. Although all their initial diagnoses were prompted to be AITL, they were comprehensively characterized by clinical features, morphologic, immunophenotypic, clonality, and targeted exosome sequencing (TES) findings. Case 1 and Case 2 were NMZL with increased PD1 + T cells in the “peripheral pattern” or “mixed peripheral and central pattern”, and Case 3 was SMZL with abundant PD1-positive T cells in the “nodular pattern” that transformed to tSMZL (DLBCL) with PD1-positive T cells distributed in the “diffuse pattern.” In addition to the monoclonal IG rearrangement and polyclonal TCR rearrangement results, TES demonstrated enriched and recurrent mutations in MZLs and failed to find aberrations described in AITL- or TFH-derived lymphomas.

Conclusions

It is important to realize that this pitfall can also occur in more diagnostically difficult tSMZL cases; the integration of histopathology with clonality and mutation studies is also highlighted.
Family UNited: piloting of a new universal UNODC family skills programme to improve child mental health, resilience and parenting skills in Indonesia and Bangladesh
Authors: Haar Karin , El-Khani Aala , Narotama Narendra , Hussain Amir , Fitri Eva , Badrujaman Aip , Wahyuni Eka , Naheeaan Shah Mohammad , Yassine Ali , Maalouf Wadih
Published: December 2023

Background

Family is one of the most influential social institutions and caregivers act as the main protective factors for children’s mental health and resilience skills. Family skills programmes support caregivers to be better parents and strengthen positive age-specific and age-appropriate family functioning and interactions. We developed a universal, brief and light programme for implementation in low-resource settings, the Family UNited (FU) programme, and conducted a pilot study to show feasibility of implementation, replicability and effectiveness in improving family functioning, child behaviour and resilience.

Methods

We recruited caregivers with children aged 8–14 years through schools in East Java, Indonesia and Dhaka, Bangladesh to the FU programme. Demographic data, emotional and behavioural difficulties of children, child resilience and parental skills and family adjustment measures were collected from children and caregivers before, 2 and 6 weeks after the intervention. Outcome was assessed through the SDQ (Strengths and Difficulties Questionnaire), PAFAS (Parenting and Family Adjustment Scales) and CYRM-R (Child and Youth Resilience Measure).

Results

We enrolled 29 families in Bangladesh and allocated 37 families to the intervention and 33 to the control group in Indonesia. Overall, there was no effect over time in the control group on any of the PAFAS subscales, whereas significant reductions in scores were found on six of the seven subscales in either country in the intervention group, most prominently in caregivers with higher scores at baseline. We found highly significant reductions in total SDQ scores in the intervention group in both countries, whereas there was no effect over time in the control group in Indonesia. Boys in the intervention group in Indonesia and in Bangladesh seemed to have benefitted significantly on the SDQ as well as the total resilience scale. Overall, on the CYRM-R, particularly children below the 33rd percentile at pre-test benefitted substantially from the programme.

Conclusions

The implementation of a brief family skills programme was seemingly effective and feasible in resource-limited settings and positively improved child mental health, resilience and parenting practices and family adjustment skills. These results suggest the value of such a programme and call for further validation through other methods of impact assessment and outcome evaluation.

Trial registration: Clinical Trial Registration: ISRCTN99645405, retrospectively registered, 22 September, 2022.
Interventions to promote cost-effectiveness in adult intensive care units: consensus statement and considerations for best practice from a multidisciplinary and multinational eDelphi study
Authors: Kansal Amit , Latour Jos M. , See Kay Choong , Rai Sumeet , Cecconi Maurizio , Britto Carl , Conway Morris Andrew , Dominic Savio Raymond , Nadkarni Vinay M. , Rao B. K. , Mishra Rajesh
Published: December 2023

Background

There is limited evidence to guide interventions that promote cost-effectiveness in adult intensive care units (ICU). The aim of this consensus statement is to identify globally applicable interventions for best ICU practice and provide guidance for judicious use of resources.

Methods

A three-round modified online Delphi process, using a web-based platform, sought consensus from 61 multidisciplinary ICU experts (physicians, nurses, allied health, administrators) from 21 countries. Round 1 was qualitative to ascertain opinions on cost-effectiveness criteria based on four key domains of high-value healthcare (foundational elements; infrastructure fundamentals; care delivery priorities; reliability and feedback). Round 2 was qualitative and quantitative, while round 3 was quantitative to reiterate and establish criteria. Both rounds 2 and 3 utilized a five-point Likert scale for voting. Consensus was considered when > 70% of the experts voted for a proposed intervention. Thereafter, the steering committee endorsed interventions that were identified as ‘critical’ by more than 50% of steering committee members. These interventions and experts’ comments were summarized as final considerations for best practice.

Results

At the conclusion of round 3, consensus was obtained on 50 best practice considerations for cost-effectiveness in adult ICU. Finally, the steering committee endorsed 9 ‘critical’ best practice considerations. This included adoption of a multidisciplinary ICU model of care, focus on staff training and competency assessment, ongoing quality audits, thus ensuring high quality of critical care services whether within or outside the four walls of ICUs, implementation of a dynamic staff roster, multidisciplinary approach to implementing end-of-life care, early mobilization and promoting international consensus efforts on the Green ICU concept.

Conclusions

This Delphi study with international experts resulted in 9 consensus statements and best practice considerations promoting cost-effectiveness in adult ICUs. Stakeholders (government bodies, professional societies) must lead the efforts to identify locally applicable specifics while working within these best practice considerations with the available resources.
Expanding the list of sequence-agnostic enzymes for chromatin conformation capture assays with S1 nuclease
Authors: Maria Gridina , Andrey Popov , Artem Shadskiy , Nikita Torgunakov , Andrey Kechin , Evgeny Khrapov , Oxana Ryzhkova , Maxim Filipenko , Veniamin Fishman
Published: December 2023

This study presents a novel approach for mapping global chromatin interactions using S1 nuclease, a sequence-agnostic enzyme. We develop and outline a protocol that leverages S1 nuclease's ability to effectively introduce breaks into both open and closed chromatin regions, allowing for comprehensive profiling of chromatin properties. Our S1 Hi–C method enables the preparation of high-quality Hi–C libraries, marking a significant advancement over previously established DNase I Hi–C protocols. Moreover, S1 nuclease's capability to fragment chromatin to mono-nucleosomes suggests the potential for mapping the three-dimensional organization of the genome at high resolution. This methodology holds promise for an improved understanding of chromatin state-dependent activities and may facilitate the development of new genomic methods.