bluuebunny/crossref_metadata_2025 huggingface dataset:
Necrosis and Changes in Pigmentation Following Silver Nitrate Application: A Case Report
Authors: AlAfeefi Mariam , Al Numairy Mohammed , Al Dhamin Ammar
Published: July 2024

Silver nitrate has useful antimicrobial and anti-inflammatory effects. However, there are currently no guidelines in place for its use in cauterization and the management of hemostasis. This lack of guidelines has resulted in different approaches being taken in outpatient and healthcare settings, which can lead to a higher risk of adverse effects. The authors present a case that illustrates a classic but exaggerated adverse effect following silver nitrate application.
Clinical Characteristics and Inciting Agents for Pseudoporphyria: The Mayo Clinic Experience, 1996–2020
Authors: Kumar Anagha Bangalore , Asamoah Eucabeth M. , Wetter David A. , Davis Mark Denis P. , Alavi Afsaneh
Published: July 2024

GENERAL PURPOSE

To raise awareness regarding the clinical presentations of patients with pseudoporphyria.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Describe the clinical presentation of pseudoporphyria.

2. Identify the differential diagnoses of blistering lesions on hands and feet.

3. Outline the management options for patients with porphyria.

BACKGROUND

Pseudoporphyria is an uncommon immunobullous disease that is clinically and histopathologically similar to porphyria cutanea tarda but without abnormal porphyrin levels. Limited case reports and case series of pseudoporphyria have been published.

OBJECTIVE

To describe the clinical characteristics and inciting agents for patients with pseudoporphyria.

METHODS

Health records were retrospectively reviewed for patients treated at an integrated multiregional health system from 1996 through 2020. To report results, the authors used descriptive statistics, median (range) for continuous variables, and number (percentage) for categorical data.

RESULTS

In total, 23 patients met the inclusion criteria: 13 men and 10 women. The most common medications causing pseudoporphyria were nonsteroidal anti-inflammatory drugs, the antihypertensive agent hydrochlorothiazide, and retinoids. All patients had blisters and reported photosensitivity. Seven patients (30.4%) also had scarring, and one (4.3%) had milia. All patients had normal porphyrin levels in their serum, urine, and stool. Among patients with remission, symptoms resolved at a median of 2.5 months (range, 1 week to 24 months) after discontinuation of the suspected inciting medication. Four patients, however, had persistent symptoms at a median of 6 months (range, 2–9 months).

CONCLUSION

Because pseudoporphyria is a diagnosis of exclusion, clinicians should familiarize themselves with the presentation and management of this uncommon condition.
Management of Diabetic Foot Ulcers with Two Forefoot Offloading Techniques: Case Series
Authors: Dunlap Leslie J. , Lew Eric , Gallegos Regina , Murdoch Richard , Mulvihill Simone
Published: July 2024

Offloading is a key principle to healing diabetic foot ulcers. Nonremovable knee-high offloading devices are considered the criterion standard for offloading plantar forefoot ulcers. However, patients exhibit a limited tolerance for these devices, which contributes to a lack of use. In this case series describing two patients, the authors share two alternative offloading modalities for the treatment of diabetic plantar forefoot ulcers. One patient was managed using a football offloading dressing, and the other was managed with a modified felted football dressing. The football and modified felted football offloading dressings provide a cost-effective, less time-consuming application and often are a better-tolerated alternative to nonremovable knee-high offloading devices. Clinical findings support further investigation into dressing options tolerated by patients with improved adherence and optimal healing outcomes.
Establishing a Comprehensive Nursing Clinic Using the Case Management Model
Authors: Teng Li , Xiao Yueping , Chen Daijun , Fu Adan , Zou Guizhen , Luo Tian , Hu Huan , Wang Yun
Published: July 2024

OBJECTIVE

To explore the practical effect of the case management model in a comprehensive nursing clinic.

METHODS

Based on the case management model, the authors constructed a comprehensive nursing clinic providing wound care, ostomy care, peripherally inserted central catheter care, drainage tube care, nursing consultations, and home care. They evaluated the practical effect of the comprehensive nursing clinic according to workload, economic benefits, and satisfaction of the medical staff and patients.

RESULTS

Since the inception of the comprehensive nursing clinic, the number of visits has increased by 63.57%, and the satisfaction of patients and medical staff has also improved.

CONCLUSIONS

This comprehensive nursing clinic based on the case management model meets the medical needs of patients, has improved the satisfaction of patients and the medical staff, and enhances the professional sense of value and comprehensive quality of specialized nurses.
Adherence to Self-care and Quality of Life of Patients with Diabetic Foot Ulcers Treated with Low-Level Laser Therapy: An Exploratory Study
Authors: dos Santos Cristiana Maria , de Souza Lima da Silveira Pedro Renan , da Rocha Rebeca Barbosa , da Silva Sousa Fernanda Mello , Fontenele Alves Rayana , Silva Barros Ana Carolina , Saura Cardoso Vinicius
Published: July 2024

OBJECTIVE

To evaluate the quality of life (QoL) of patients with a diabetic foot ulcer undergoing treatment with low-level laser therapy (LLLT) at 904 nm and its association with self-care.

METHODS

In this randomized, exploratory study, participants were divided into the following four groups: control group (CG) with LLLT placebo, LLLT group 1 (LG1) at 10 J/cm2, LLLT group 2 (LG2) at 8 J/cm2, and LLLT group 3 (LG3) at 4 J/cm2. Participants received light therapy (or placebo) twice a week, for a total of 20 sessions. Researchers assessed participants’ QoL using the Short-Form 36 questionnaire.

RESULTS

Sixty-two participants were included in the analysis (CG = 18, LG1 = 14, LG2 = 17, LG3 = 13). The LG1 group showed a higher proportion of healing, whereas the CG group showed a lower proportion than the other groups. The LG1 group showed a relationship between physical limitations and blood glucose monitoring, pain and foot care, and general health status (GHS) and foot care. The GL2 group showed a relationship between physical limitations and blood glucose monitoring, vitality and foot care, and GHS and diet.

CONCLUSIONS

Low-level laser therapy had a positive impact on QoL as assessed by the Short-Form 36 questionnaire (functional capacity, vitality, and pain domains), and there was a positive association between QoL and self-care in the LLLT groups (physical limitations, pain, GHS, and vitality domains).
No Difference in Short-Term Surgical Outcomes from Semaglutide Treatment for Type 2 Diabetes Mellitus after Cervical Decompression and Fusion
Authors: Tao Xu , Ranganathan Sruthi , Van Halm-Lutterodt Nicholas , Garcia-Vargas Julia , Wu Andrew , Karnati Janesh , Shankar Sachin , Agyeman Nana , Ashraf Ahmed , Barve Parikshit , Childress Kelly , Adogwa Owoicho
Published: July 2024

Study Design.

Retrospective cohort.

Objective.

To evaluate the impact of semaglutide treatment for Type 2 Diabetes Mellitus (T2DM) on the risk of short-term (<6 months) postoperative complications in patients undergoing primary cervical spine decompression and fusion (CSDF).

Summary of Background Data.

Semaglutide, a GLP-1 receptor agonist, is gaining popularity as a weekly injectable medication for the treatment of T2DM and obesity. Existing research indicates that higher levels of HbA1c and obesity are linked to fewer positive results after undergoing spine surgery, particularly cervical decompression and fusion. Nevertheless, there is a scarcity of publications evaluating the influence of semaglutide therapy on surgical complications, including surgical site infection, wound complications, and reoperation within 6 months, which were aggregated into a composite measure.

Methods.

The PearlDiver Database was queried from January 2010 to December 2021 for patients with a primary diagnosis of T2DM who underwent CSDF for degenerative pathology. Patients with semaglutide treatment within 6 months before index surgery were propensity score-matched to patients without the treatment, employing age, gender, and Charlson comorbidity index (CCI) as matching covariates. A multivariate regression model was used to investigate the impact of semaglutide treatment on postoperative surgical complications.

Results.

The propensity score-matched cohort included 596 patients (semaglutide cohort: 298, control cohort: 298). There were no statistically significant differences between cohorts in the composite measure of postoperative surgical complications following index CSDF (OR 1.26, 95% CI 0.83-1.93, P=0.331). Similarly, both 30-day (OR 0.83, 95% CI 0.49-1.42, P=0.589) and 90-day readmission rate (OR 0.89, 95% CI 0.56-1.42, P=0.724) were similar between both cohorts.

Conclusion.

This study suggests that in patients with T2DM, semaglutide treatment is not associated with higher rates of short-term adverse events after CSDF. The effect of semaglutide use on long-term outcomes remains unknown.
The PROMIS-10 Mental Health T-Score: An Independent Predictor of Recovery for Up to 1 Year After Elective Lumbar Spine Fusion
Authors: Solomito Matthew J. , Kostyun Regina O. , Makanji Heeren
Published: July 2024

Study Design.

Retrospective comparative cohort.

Objective.

Investigate how mental health, as measured by the PROMIS-10 Global Mental Health T-Score (MHT), influences a patient’s recovery up to 1 year after elective lumbar fusion.

Summary of Background data.

Patients with mental health concerns in need of lumbar fusions have increased. Evidence suggests that mental disorders influence a patient’s postoperative recovery; however, there is a paucity of information detailing the association between mental health and outcomes.

Methods.

A total of 351 patients who underwent 1- or 2-level elective lumbar fusion between April 2020 and June 2023 and completed all follow-up evaluations for up to 1 year postfusion were analyzed for this study. Patients were stratified by their MHT score (above average [AA] >50, average [A] 40-50, below average [BA] <40), regardless of mental illness diagnosis. Outcome measures including pain at hospital discharge and 3, 6, and 12 months after fusion, patient satisfaction, and the Oswestry Disability Index (ODI) score at 3, 6, and 12 months after fusion were compared among groups.

Results.

Nearly 20% of patients reported below-average mental health during their preoperative evaluation. After controlling for confounders, findings suggested that patients in the [BA] group reported 2 pain levels higher than the [AA] group at each time point and 1 point higher than the [A] group. Patients in the [BA] group performed worse on the ODI at all-time points compared with the other study groups. Patients in the [AA] group were 3 times more likely to be satisfied with their outcomes compared with the [BA] group.

Conclusion.

The MHT was an independent predictor of pain, satisfaction, and ODI scores for up to 1 year post-fusion, while a mental disorder diagnosis was not. An MHT score below 40 may be a risk factor for patients undergoing elective lumbar fusion.
Effects of Yoga on Resilience and Coping With Stress in Adolescents
Authors: Canatan Sinem Dağ , Öksüz Emine
Published: July 2024

This randomized controlled study aimed to determine the effects of yoga on coping with stress in adolescents. The study was conducted in the Famagusta province of Northern Cyprus between September and November 2021. The sample of the study comprised 62 adolescents between the ages of 13 and 16 years, including 30 in the intervention and 32 in the control groups. The descriptive information form, the child and resilience measure (CYRM), and the Kidcope were used for data collection. The intervention group received a 10-week yoga program of 60 minutes twice a week. Pre- and posttest scores were calculated to measure the impact of yoga on resilience and coping with stress. There was a statistically significant difference between the pre- and posttest scores of the yoga intervention group (P < .05). Besides, there was a statistically significant difference between the scores obtained by the intervention and control groups from the CYRM and the subscales of the Kidcope (P < .05). These findings imply that yoga contributes to resilience and coping with stress in adolescents. Based on the findings, we suggest that psychiatric nurses may incorporate yoga to protect the mental health of adolescents.
Health Effects of Tai Chi Qigong Practices and Its Reflections on Nursing Practices
Authors: Kerkez Müjde , Okuyan Canan Birimoglu , Erci Behice
Published: July 2024

This systematic review was conducted to examine the effects of Tai Chi Qigong (TCQi) practices on health and their reflections on nursing practices. A systematic review of randomized controlled trials for TCQi included quantitative English-language studies from 2012 to 2021 using 7 electronic databases (PubMed, CINAHL, Ebrary, Elsevier, Science Direct, Google Scholar, and Scopus). Seven studies were selected to review the effects of TCQi exercise applied by nurses in the presence of symptoms that worsen the general health status of individuals or develop secondary to chronic diseases: sleep disturbance, depression, fatigue symptoms, deterioration in the quality of life, worsening of self-care behaviors, and stress symptoms. Evidence on the use of the TCQi practices is limited, and the proof of its preferability over other integrative methods in care practices by nurses is not at the desired level. Therefore, this systematic review emphasizes further research on the risks and benefits of TCQi practices as with other integrative methods, so that TCQi practices, which are easier to apply than other mind-body practices, can be preferred by nurses.
Progresses Toward Polio Eradication in Asian Countries: Its History and Japan’s Contributions
Authors: Toizumi Michiko , Takamatsu Masamitsu , Toda Kohei , Horikoshi Yuho
Published: July 2024

Japan experienced a large outbreak of wild poliovirus in the 1960s. The government made an exceptional decision to import oral polio vaccines (OPVs) from the Soviet Union and Canada while bypassing the usual approval process for medical products. Mass vaccination and subsequent, routine immunization successfully contained the wild poliovirus; the last case in Japan was reported in 1980. Domestic OPV had been used to sustain Japan’s polio-free state. In 2012, the world’s first inactivated polio vaccine developed from the Sabin vaccine replaced OPVs. Domestic vaccines combined with Sabin-derived inactivated polio vaccine are currently used in Japan. When the World Health Assembly announced the Global Polio Eradication Initiative in 1988, the Japanese government made a commitment to support endemic countries. The Japan International Cooperation Agency supported the establishment of microbiological laboratories, surveillance, distribution of polio vaccines and capacity building. Vaccine-derived poliovirus emerged as a new, international risk in the early 2000s. Vaccine-derived poliovirus was also detected in several Asian countries and required an outbreak response with additional vaccinations and strengthened surveillance. Genetically stable, novel, oral polio vaccine type 2 became available for use in outbreak responses and was used in Indonesia. Japan maintains its commitment to work toward the eradication of the poliovirus.
Stratified health care for low back pain using the STarT Back approach: holy grail or doomed to fail?
Authors: Croft Peter , Hill Jonathan C. , Foster Nadine E. , Dunn Kate M. , van der Windt Danielle A.
Published: July 2024

There have been at least 7 separate randomised controlled trials published between 2011 and 2023 that have examined primary care for nonspecific low back pain informed by the STarT Back approach to stratified care based on risk prediction, compared with care not informed by this approach. The results, across 4 countries, have been contrasting—some demonstrating effectiveness and/or efficiency of this approach, others finding no benefits over comparison interventions. This review considers possible explanations for the differences, particularly whether this is related to poor predictive performance of the STarT Back risk-prediction tool or to variable degrees of success in implementing the whole STarT Back approach (subgrouping and matching treatments to predicted risk of poor outcomes) in different healthcare systems. The review concludes that although there is room for improving and expanding the predictive value of the STarT Back tool, its performance in allocating individuals to their appropriate risk categories cannot alone explain the variation in results of the trials to date. Rather, the learning thus far suggests that challenges in implementing stratified care in clinical practice and in changing professional practice largely explain the contrasting trial results. The review makes recommendations for future research, including greater focus on studying facilitators of implementation of stratified care and developing better treatments for patients with nonspecific low back pain at high risk of poor outcomes.
Frequency of lymph node metastases at different neck levels in patients with oral squamous cell carcinoma: a systematic review and meta-analysis
Authors: Yu Yi-Fu , Cao Lei-Ming , Li Zi-Zhan , Zhong Nian-Nian , Wang Guang-Rui , Xiao Yao , Wu Qiu-Ji , Liu Bing , Bu Lin-Lin
Published: July 2024

Background:

Currently, neck dissection is a standard treatment for the majority of oral squamous cell carcinoma (OSCC) patients. However, the procedure can lead to a series of complications, significantly reducing patient quality of life and even affecting the antitumor immune response in patients undergoing immunotherapy. Therefore, in the era of precision surgery, gaining a deeper understanding of the patterns of lymph node metastasis (LNM) in OSCC is crucial.

Materials and methods:

Literature searches were performed on PubMed, Embase, Web of Science, Cochrane Library, WANFANGDATA, and China National Knowledge Infrastructure (CNKI) (inception to 10 April 2024). In addition, a manual searching was conducted in Scopus, Google Scholar, and Education Resources Information Center (ERIC). The authors included observational studies that evaluated the frequency of LNM in OSCC patients. Systematic review and a random effects model meta-analysis were performed.

Results:

The search identified 4694 articles, of which 17 studies included in our study. The authors calculated the frequency of LNM according to the data reported in the articles. Frequency of LNM=number of patients with positive lymph node / number of patients with OSCC. The frequency of LNM was 12% in level I (95% CI: 0.11–0.15, I
2=38.01%), 20% in level II (95% CI: 0.17–0.22, I
2=47.71%), 10% in level III (95% CI: 0.08–0.12, I
2=49.10%), 2% in level IV (95% CI: 0.01–0.03, I
2=27.58%), 1% in level V (95% CI: 0.00–0.01, I
2=11.37%).

Conclusion:

The frequency of LNM is consistent with the ‘cascade theory’ and appears to be no significant difference from different primary sites. The frequency of LNM were low in levels I–III and were very low in level IV–V, which implicated that more conservative treatments may be considered for OSCC in the future. This study will help clinicians better determine the extent of surgery and preserve lymph nodes during neck dissection.
A new pragmatic classification system for thymoma-associated myasthenia gravis: a retrospective cohort study
Authors: Ao Yongqiang , Jiang Jiahao , Miao Junjie , Gao Jian , Yang Xinyu , Zheng Yuansheng , Liang Fei , Wang Shuai , Dong Jihong , Ding Jianyong
Published: July 2024

The management and outcomes of patients with thymoma-associated myasthenia gravis (TAMG) are heterogeneous. Here, the authors propose a novel classification system based on Masaoka stage and Myasthenia Gravis Foundation of America (MGFA) classification, aiming to guide surgical decisions and perioperative management for these patients. Considering both oncological and neurological factors, this novel TAMG classification provides valuable information on outcome stratification and clinical decision-making for TAMG.
Antithrombotic and Antimicrobial Potential of S-Nitroso-1-Adamantanethiol–Impregnated Extracorporeal Circuit
Authors: Lautner-Csorba Orsolya , Gorur Roopa , Major Terry , Wu Jianfeng , Sheet Partha , Hill Joseph , Yu Minzhi , Xi Chuanwu , Bartlett Robert H. , Schwendeman Steven P. , Lautner Gergely , Meyerhoff Mark E.
Published: July 2024

This study presents the utilization of a novel, highly lipophilic nitric oxide (NO) donor molecule, S-nitroso-1-adamantanethiol (SNAT), for developing an NO-emitting polymer surface aimed at preventing thrombus formation and bacterial infection in extracorporeal circuits (ECCs). S-nitroso-1-adamantanethiol, a tertiary nitrosothiol-bearing adamantane species, was synthesized, characterized, and used to impregnate polyvinyl chloride (PVC) tubing for subsequent in vivo evaluation. The impregnation process with SNAT preserved the original mechanical strength of the PVC. In vitro assessments revealed sustained NO release from the SNAT-impregnated PVC tubing (iSNAT), surpassing or matching endothelial NO release levels for up to 42 days. The initial NO release remained stable even after 1 year of storage at −20°C. The compatibility of iSNAT with various sterilization techniques (OPA Plus, hydrogen peroxide, EtO) was tested. Acute in vivo experiments in a rabbit model demonstrated significantly reduced thrombus formation in iSNAT ECCs compared with controls, indicating the feasibility of iSNAT to mitigate coagulation system activation and potentially eliminate the need for systemic anticoagulation. Moreover, iSNAT showed substantial inhibition of microbial biofilm formation, highlighting its dual functionality. These findings underscore the promising utility of iSNAT for long-term ECC applications, offering a multifaceted approach to enhancing biocompatibility and minimizing complications.
Acute diarrhea in the hospitalized immunocompromised patient: what is new on diagnostic and treatment?
Authors: Castillo Almeida Natalia E. , Gomez Carlos A.
Published: July 2024

Purpose of review

This article aims to provide an intuitive framework for diagnosing and managing healthcare-associated diarrhea (HCAD) in the immunocompromised (IC) host.

Recent findings

Our understanding of diarrhea in hospitalized IC patients has significantly evolved. However, the challenge lies in distinguishing between these patients’ numerous causes of diarrhea. The incorporation of gastrointestinal (GI) multiplex polymerase chain reaction (PCR) panels has led to a paradigm shift in our approach to diarrhea. However, using these panels judiciously is of utmost importance, as their misuse can lead to over-testing, overtreatment, and increased hospital costs. We propose a stepwise diagnostic algorithm that ensures diagnostic stewardship, optimal patient care, and resource utilization.

Diarrhea is a common complication in hospitalized IC patients and is associated with significant morbidity and rare mortality. The advent of new diagnostics, such as GI multiplex PCR panels, holds promise in facilitating the detection of recognized pathogens and may allow for improved outcomes using pathogen-targeted therapy.
Enhancing precision in bone metastasis diagnosis for lobular breast cancer: reassessing the role of 18F-FDG PET/CT
Authors: Usmani Sharjeel , Al Riyami Khulood , Jain Anjali , Alajmi Adil Aljarrah , AlBaimani Khalid , Dumasig Paul , Al Busaidi Asiya , Al Sukati Rashid
Published: July 2024

Purpose

Detection of osseous metastases by imaging can be challenging in patients with invasive lobular breast cancer (ILC). ILC may demonstrate low metabolic rate due to lower tumor cell density, decreased proliferation rate, diffuse infiltration of surrounding tissue, and low level of GLUT-1 expression. The aim of this study is to assess the diagnostic accuracy of 18F-FDG PET/CT in identifying bone metastases in ILC patients.

Material and methods

Out of 52 individuals diagnosed with lobular breast cancer and underwent 18F-FDG PET/CT for evaluation of metastases, 21 patients were included in our study population after applying inclusion and exclusion criteria. The radiological and clinical follow-up of at least 6 months served as the reference standard comparator.

Results

Bone metastases were confirmed in six patients. 18F-FDG PET/CT was true positive in two and false negative in four patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG PET/CT were 33.33, 93.33, 66.67, 77.78, and 76.19%, respectively (95% confidence interval). The tendency of ILC osseous metastases to be more sclerotic explains the low diagnostic accuracy of 18F-FDG PET/CT in detection of bone metastases, making it a less suited method of evaluation.

Conclusion

The results of the present study indicate that 18F-FDG PET/CT has a low diagnostic accuracy in detecting bone metastases in lobular breast cancer and, by inference, new functional modalities can be explored in these patients. The findings contribute valuable insights to optimize the integration of molecular imaging into the diagnostic algorithm for this specific breast cancer subtype.
Pancreatic and Ileal Neuroendocrine Tumors
Authors: Asa Sylvia L. , Mohamed Amr
Published: July 2024

Multiple endocrine neoplasms are a feature of multiple endocrine neoplasia (MEN) syndromes types 1, 2, 4, and 5. However, the ileum is not usually involved in these disorders. We report a series of patients with neuroendocrine tumors (NETs) involving both the pancreas and the ileum. We searched the laboratory information system and personal consultation records of the authors from 2019 to 2023 for patients who had neuroendocrine tumors (NETs) involving both the pancreas and ileum. In a series of 846 patients, we identified 4 patients with pancreatic and ileal NETs, 2 female and 2 male, ages 52 to 75. Two female patients had primary EC cell tumors of the ileum with metastasis to the pancreas that showed expression of CDX2 and serotonin similar to the ileal primary tumors. Two males had primary lesions in the 2 sites with different immunoprofiles; the ileal tumors expressed CDX2 and serotonin and were negative for ARX, whereas the pancreatic tumors expressed ARX, glucagon, and pancreatic polypeptide and were negative for CDX2 and serotonin. In both male patients, the nontumorous pancreas showed preneoplastic changes in the endocrine elements, suggesting germline predisposition to endocrine neoplasia. Testing for known genetic alterations underlying MEN syndromes has not identified a genetic alteration that can be implicated in the development of NETs in both pancreas and ileum. Our series indicates the rare occurrence of NETs in both the pancreas and ileum and emphasizes the importance of using the correct biomarkers to distinguish metastasis from primary neoplasms at the different sites. The rare occurrence of primary ileal and pancreatic NETs may represent a novel MEN syndrome with as yet unknown germline predisposition.
Patient Harm Events and Associated Cost Outcomes Reported to a Patient Safety Organization
Authors: Miller Susanne , Stockwell David C. ,   the Pascal Metrics PSO Collaborative
Published: July 2024

Objectives

The aims of the study were to describe inpatient harm events detected via an automatic electronic trigger system (ETS) and to consider their financial consequences.

Methods

Over a 27-month period, inpatient harm events were identified and documented in 1 healthcare system with 37 acute care facilities. Patients who experienced harm (all harm or preventable harm only) were compared with similar patients who did not. Clinical, financial, and demographic data were used to identify labor-adjusted direct variable costs (DVC) and potential differences in length of stay (LOS) associated with all-harm, preventable-harm, and nonharmed cohorts. Age-adjusted Charlson Comorbidity Index, case mix index, diagnosis-related groups, major diagnostic category, sex, age, location, diagnosis, adverse event category and subcategory, preventability, and harm severity were used to compare cohorts. Total harm events reported via the ETS and the health system’s voluntary event reporting system were compared.

Results

Nearly 93,000 encounters for all-harm (n = 25,665) and nonharmed cohorts (n = 67,217) were compared by random sampling of diagnosis-related group-matched all-harm and nonharmed groups to ensure similar clinical conditions, as measured by Charlson Comorbidity Index and case mix index. Sampling (2 groups, n = 100 and n = 200) showed that increased LOS was associated with harm; yet other clinical comparators were similar across groups. the preventable-harm subcohort had longer LOS (10.7 versus 5.9 days) and higher DVC ($13,442 versus $8024) than the nonharmed cohort. Identification of harm events was nearly 6-fold higher with the ETS than with the voluntary event reporting system.

Conclusions

Patients with preventable harm had increased LOS that was associated with higher DVC per preventable-harm encounter in a large US healthcare system.
Primary Care Quality Improvement Through Patient-Centered Medical Homes and the Impact on Emergency Department Utilization for Children With Autism and Mental Health Disorders
Authors: Huang Li , Saint Onge Jarron M.
Published: July 2024

Background and Objectives:

To address health care spending growth, coordinated care, and patient-centered primary care, most states in the United States have adopted value-based care coordination programs such as patient-centered medical homes (PCMHs). The objective of this study was to understand the relationship between having access to PCMHs and emergency department (ED) utilization for high cost/need children with autism and children with mental health disorders (MHDs).

Methods:

This cross-sectional study included 87 723 children between ages 3 and 17 years in the 2016-2018 National Survey for Children's Health. Multivariate-adjusted logistic regression analyses were used to assess the association between ED and PCMH utilization for children with autism, with MHDs without autism, and others without autism or MHDs. Marginal predictions were used to examine whether PCMH utilization was moderated by health conditions.

Results:

The results showed that children with a PCMH had a 16% reduction in the odds to visit the ED (adjusted odds ratio [aOR] = 0.84; confidence interval [CI], 0.77-0.92; P < .001). When compared with the reference group of children without autism and without MHDs, children with MHDs but without autism had 93% higher odds to visit the ED (aOR = 1.93; CI, 1.75-2.13; P < .001) and children with autism had 35% higher odds to visit the ED (aOR = 1.35; CI, 1.04-1.75; P = .023). Marginal effects results suggested that PCMHs reduced the odds of ED visits the most for children with MHDs without autism and reduced the predicted ED visits from 30.1% to 23.7% (P < .001).

Conclusions:

Primary care quality improvement through access to a PCMH reduced ED visits for children, but the effect varied by autism and MHD conditions. Future PCMH efforts should continue to support children with autism and address unmet needs for children with MHDs with a focus on needed care coordination, family-centered care, and referrals.
Leadership Strategies to Increase Psychological Safety of Nurses: A Longitudinal Study
Authors: Hessler Karen L. , Anderson Gwen , Scannell Mary , McNair Bryan , Becker Maude
Published: July 2024

Background and Objectives:

A work environment where employees feel comfortable taking chances without fear and with sufficient protection from retaliation is psychologically safe. The objective of this study was to investigate the effects of leader training for nurse managers on psychological safety of clinical registered nurses.

Methods:

The study was designed a longitudinal outcomes approach to assess nurse leader intervention (classes on leadership methods and psychological safety) with pre- and post-intervention measurement of nurse psychological safety at each time point.

Results:

The intervention and nurse leader rounding were shown to increase individual psychological safety climate scores of clinical nurses.

Conclusion:

Psychological safety is an important component to consider in a nursing leadership role. Leadership interventions that focus on the tenets of psychological safety and include methods of being present, such as nurse leader rounding, can foster a sense of a psychologically safe environment for clinical registered nurses.
Complexity and Experience Grading to Guide Patient Selection for Minimally Invasive Pancreatoduodenectomy
Authors: Barreto S. George , Strobel Oliver , Salvia Roberto , Marchegiani Giovanni , Wolfgang Christopher L. , Werner Jens , Ferrone Cristina R. , Abu Hilal Mohammed , Boggi Ugo , Butturini Giovanni , Falconi Massimo , Fernandez-Del Castillo Carlos , Friess Helmut , Fusai Giuseppe K. , Halloran Christopher M. , Hogg Melissa , Jang Jin-Young , Kleeff Jorg , Lillemoe Keith D. , Miao Yi , Nagakawa Yuichi , Nakamura Masafumi , Probst Pascal , Satoi Sohei , Siriwardena Ajith K. , Vollmer Charles M. , Zureikat Amer , Zyromski Nicholas J. , Asbun Horacio J. , Dervenis Christos , Neoptolemos John P. , Büchler Markus W. , Hackert Thilo , Besselink Marc G. , Shrikhande Shailesh V. ,   for the International Study Group for Pancreatic Surgery
Published: July 2024

Objective:

To develop a universally accepted complexity and experience grading system to guide the safe implementation of robotic and laparoscopic minimally invasive pancreatoduodenectomy (MIPD).

Background:

Despite the perceived advantages of MIPD, its global adoption has been slow due to the inherent complexity of the procedure and challenges to acquiring surgical experience. Its wider adoption must be undertaken with an emphasis on appropriate patient selection according to adequate surgeon and center experience.

Methods:

The International Study Group for Pancreatic Surgery (ISGPS) developed a complexity and experience grading system to guide patient selection for MIPD based on an evidence-based review and a series of discussions.

Results:

The ISGPS complexity and experience grading system for MIPD is subclassified into patient-related risk factors and provider experience-related variables. The patient-related risk factors include anatomic (main pancreatic and common bile duct diameters), tumor-specific (vascular contact), and conditional (obesity and previous complicated upper abdominal surgery/disease) factors, all incorporated in an A-B-C classification, graded as no, a single, and multiple risk factors. The surgeon and center experience-related variables include surgeon total MIPD experience (cutoffs 40 and 80) and center annual MIPD volume (cutoffs 10 and 30), all also incorporated in an A-B-C classification.

Conclusions:

This ISGPS complexity and experience grading system for robotic and laparoscopic MIPD may enable surgeons to optimally select patients after duly considering specific risk factors known to influence the complexity of the procedure. This grading system will likely allow for a thoughtful and stepwise implementation of MIPD and facilitate a fair comparison of outcomes between centers and countries.
Keys to successful clinical audit and feedback: essential steps to making impactful improvements in patient care
Authors: Delaforce Alana , Moore Diana
Published: July 2024

Up to 40% of care provided to patients is either wasteful or harmful. The practice of audit and feedback can help identify where care can be improved. However, such audits must be executed in a systematic way that engages with clinicians to maximize the impact of feedback, ultimately improving patient outcomes. Currently, audit training is not integrated into formal education pathways and clinicians need guidance to support them in this activity. This paper explores contemporary research, with the aim of providing practical advice for recommendations to maximize the impact of audit and feedback.

Spanish abstract:

http://links.lww.com/IJEBH/A239
Fisher–KPP-type models of biological invasion: open source computational tools, key concepts and analysis
Authors: Simpson Matthew J. , McCue Scott W.
Published: July 2024

This review provides open-access computational tools that support a range of mathematical approaches to analyse three related scalar reaction–diffusion models used to study biological invasion. Starting with the classic Fisher–Kolomogorov (Fisher–KPP) model, we illustrate how computational methods can be used to explore time-dependent partial differential equation (PDE) solutions in parallel with phase plane and regular perturbation techniques to explore invading travelling wave solutions moving with dimensionless speedc≥2. To overcome the lack of a well-defined sharp front in solutions of the Fisher–KPP model, we also review two alternative modelling approaches. The first is the Porous–Fisher model where the linear diffusion term is replaced with a degenerate nonlinear diffusion term. Using phase plane and regular perturbation methods, we explore the distinction between sharp- and smooth-fronted invading travelling waves that move with dimensionless speedc≥1/2. The second alternative approach is to reformulate the Fisher–KPP model as a moving boundary problem on0<x<L(t), leading to the Fisher–Stefan model with sharp-fronted travelling wave solutions arising from a PDE model with a linear diffusion term. Time-dependent PDE solutions and phase plane methods show that travelling wave solutions of the Fisher–Stefan model can describe both biological invasion(c>0)and biological recession(c<0). Open source Julia code to replicate all computational results in this review is available on GitHub; we encourage researchers to use this code directly or to adapt the code as required for more complicated models.
The web of conflict-related interactions in Colombia: exploring causal linkages between ecological and social variables by the qualitative loop analysis
Authors: Bodini Antonio , Vivian Jenny , Vargas Juan , Clerici Nicola , Scotti Marco
Published: July 2024

In Colombia, the long-lasting internal conflict heavily shaped the socio-ecological context and imposed relationships that persisted after the peace agreement was signed in 2016. One question of interest is whether policies or interventions conceived to attain desirable goals for the post-conflict society may be effective or, rather, if the constraints imposed by the conflict scenario might produce unintended effects, either on the environmental or the social side. To explore this issue, we envisaged the socio-ecological system as a parsimonious set of characteristic ecological and social variables within the conflict-related framework and reconstructed their interactions, exploiting elicitation-based information and the literature. We visualized the resulting interactive networks as signed digraphs. Applying the qualitative technique of loop analysis combined with numerical simulations, we predicted the response of the system to policies as drivers of change, such as subsidized credit to capital-intensive activities or policies that increase small farming competitiveness and access to markets. Highlighting causal linkages reveals that the persistence of conflict factors may produce unexpected interdependencies between licit and illicit activities and that, only in a few cases, the persistence of these mechanisms allows synergies between desirable goals.

This article is part of the theme issue ‘Connected interactions: enriching food web research by spatial and social interactions’.
From nets to networks: tools for deciphering phytoplankton metabolic interactions within communities and their global significance
Authors: Nef Charlotte , Pierella Karlusich Juan José , Bowler Chris
Published: July 2024

Our oceans are populated with a wide diversity of planktonic organisms that form complex dynamic communities at the base of marine trophic networks. Within such communities are phytoplankton, unicellular photosynthetic taxa that provide an estimated half of global primary production and support biogeochemical cycles, along with other essential ecosystem services. One of the major challenges for microbial ecologists has been to try to make sense of this complexity. While phytoplankton distributions can be well explained by abiotic factors such as temperature and nutrient availability, there is increasing evidence that their ecological roles are tightly linked to their metabolic interactions with other plankton members through complex mechanisms (e.g. competition and symbiosis). Therefore, unravelling phytoplankton metabolic interactions is the key for inferring their dependency on, or antagonism with, other taxa and better integrating them into the context of carbon and nutrient fluxes in marine trophic networks. In this review, we attempt to summarize the current knowledge brought by ecophysiology, organismal imaging,
in silico
predictions and co-occurrence networks using 'omics data, highlighting successful combinations of approaches that may be helpful for future investigations of phytoplankton metabolic interactions within their complex communities.

This article is part of the theme issue ‘Connected interactions: enriching food web research by spatial and social interactions’.
PROBIOTIC POTENTIAL OF RIBOFLAVIN-OVERPRODUCING Bacillus subtilis ACU-I163MR AND ACU-I11MR, ISOLATED FROM FERMENTED AFRICAN LOCUST BEANS
Authors: Awotundun Theresa Abimbola , Olanbiwoninu Afolake Atinuke
Published: July 2024

Riboflavin (Vitamin B2) is a water-soluble compound that plays an important role in multiple cellular functions. This study evaluates the probiotic potential of riboflavin-overproducing Bacillus subtilis strains isolated from fermented African locust beans. After strain improvement, Bacillus subtilis ACU-I11MR and ACU-I163MR were selected due to their higher riboflavin production (0.01905±0.0005 mg/L to 0.0259±0.0077 mg/L and 0.0195±0.0054 mg/L to 0.0267±0.0013 mg/L, respectively). Their safety was confirmed through haemolytic assay, antibiotic susceptibility tests, and the absence of gelatinase and biogenic amine activity. Probiotic potential was assessed via in vitro assays including resistance to low pH, bile salts, phenol, temperature, and NaCl; auto-aggregation; cell hydrophobicity; biofilm formation; antibacterial activity; enzyme and exopolysaccharides production. Both strains were non-haemolytic, negative for gelatinase and biogenic amine activity. They showed significant viability at pH 2 (survival 85.05; 87.09%), 1% bile salts (survival 88.82; 87.64%), and 0.5% phenol (survival 48.80; 59.52%) respectively. ACU-I11MR was susceptible to 9 out of 12 antibiotics, while ACU-I163MR was 100% susceptible. The strains demonstrated strong cell surface adhesion and auto-aggregation, and inhibited several pathogenic bacteria. They produce amylase, protease, and exopolysaccharide, and thrived under various temperature and NaCl conditions. Bacillus subtilis ACU-I163MR, showing superior probiotic potential, could be a promising candidate for developing riboflavin-enriched Bacillus-fermented functional foods.
Taklimakanibacter deserti gen. nov., sp. nov. and Taklimakanibacter lacteus sp. nov., isolated from desert soil
Authors: He Huan-Huan , Feng Chu-Ying , Wang Dong , Zheng Zhuo-Huan , Li Shuai , Xu Zi-Xin , Lu Chun-Yan , Lian Wen-Hui , Dong Lei , Li Wen-Jun
Published: July 2024

Two Gram-stain-negative, aerobic, milk-white coloured, non-motile, short rod-shaped bacteria, designated as strains SYSU D60010T and SYSU D60012T, were isolated from sand samples collected from the Taklimakan Desert of Xinjiang Province in China. Both strains were positive for oxidase, catalase and nitrate reduction, but negative for amylase, H2S production, hydrolysis of gelatin and cellulase. Strains SYSU D60010T and SYSU D60012T grew well at 28 °C, at pH 7 and had the same NaCl tolerance range of 0–1 % (w/v). The major fatty acids (>5 %) of strains SYSU D60010T and SYSU D60012T were summed feature 8 (C18 : 1
 ω7c and/or C18 : 1
 ω6c), iso-C19 : 0 cyclo ω8c, C16 : 0 and iso-C18 : 1 2-OH. Q-10 was the only respiratory ubiquinone. Strains SYSU D60010T and SYSU D60012T showed high 16S rRNA gene sequence similarities to Aestuariivirga litoralis SYSU M10001T (94.2 and 94.1 %), Rhodoligotrophos jinshengii BUT-3T (92.0 and 91.9 %) and Rhodoligotrophos appendicifer 120-1T (91.8 and 91.7 %), and the genomes were 7.4 and 5.8 Mbp in size with DNA G+C contents of 62.8 and 63.0 mol%, respectively. Phylogenetic, phenotypic and chemotaxonomic characteristics indicated that these two strains represent a novel genus and two novel species within the family Aestuariivirgaceae. We propose the name Taklimakanibacter deserti gen. nov., sp. nov. for strain SYSU D60010T, representing the type strain of this species (=KCTC 52783T =NBRC 113344T) and Taklimakanibacter lacteus gen. nov., sp. nov. for strain SYSU D60012T, representing the type strain of this species (=KCTC 52785T=NBRC 113128T).
The hidden RNA viruses in Blattodea (cockroaches and termites)
Authors: Wu Haoming , Li Wenxin , Fan Jingyan , Jiang Shengsheng , Li Jiaxin , Hu Peng , Yu Zejun , Li Yang , Pang Rui , Wu Huan
Published: July 2024

The insect order Blattodea (cockroaches and termites) has drawn substantial research attention for their dietary habits and lifestyle of living with or around humans. In the present study, we focused on the discovery of RNA viruses hidden in Blattodea insects using the publicly available RNA sequencing datasets. Overall, 136 distinctive RNA viruses were identified from 36 Blattodea species, of which more than 70 % were most closely related to the invertebrate-associated viral groups within Picornavirales, Sobelivirales, Bunyaviricetes, Jingchuvirales, Durnavirales, Lispiviridae, Orthomyxoviridae, Permutotetraviridae, Flaviviridae and Muvirales. Several viruses were associated with pathogens of vertebrates (Paramyxoviridae), plants (Tymovirales), protozoa (Totiviridae), fungi (Narnaviridae) and bacteria (Norzivirales). Collectively, 93 complete or near-complete viral genomes were retrieved from the datasets, and several viruses appeared to have remarkable temporal and spatial distributions. Interestingly, the newly identified Periplaneta americana dicistrovirus displayed a remarkable distinct bicistronic genome arrangement from the well-recognized dicistroviruses with the translocated structural and non-structural polyprotein encoding open reading frames over the genome. These results significantly enhance our knowledge of RNA virosphere in Blattodea insects, and the novel genome architectures in dicistroviruses and other RNA viruses may break our stereotypes in the understanding of the genomic evolution and the emergence of potential novel viral species.