bluuebunny/crossref_metadata_2025 huggingface dataset:
Strengthening the role of hospital leadership in infection control (LEAD-IC) – a multimodal educational intervention in German acute care hospitals
Authors: Hansen Sonja , Remschmidt Cornelius , Schröder Christin , Behnke Michael , Gastmeier Petra
Published: October 2023

Background

The effect of leadership support for adherence to infection control and prevention (IPC) measures has been demonstrated. To expand this support, a target group-specific educational study for chief medical officers (CMO) was implemented and its influence on IPC indicators was investigated.

Methods

A controlled cohort study was conducted between 2018 and 2019. The intervention based on an initial workshop, an e-learning course, and a final meeting. Participants’ activities involving IPC management were surveyed. Consumption of alcohol hand rub (AHR) and incidence density of hospital-associated (HA) Clostridioides difficile-associated infections (CDI) were analyzed.

Results

Eight percent of 360 CMOs invited participated in the initial workshop; 70% of those participants registered for the online course. Overall, 43% completed the post-intervention questionnaire, in which 85% of respondents reported increased collaboration with relevant stakeholders. The pre-intervention median AHR consumption was higher in the intervention group than in the control group. Both groups showed an increase (38.6 (interquartile range (IQR) 33.6; 45.0) to 41.9 ml/patient day (PD) (IQR 35.0; 56.6) and 33.4 (IQR 28.3; 40.8) to 35.8 ml/ PD (IQR 31.6; 43.2), respectively). Pre-intervention median HA CDI cases were lower in the intervention group than in the control group. Both groups reported a decrease (0.22 (IQR 0.17; 0.33) to 0.19 cases/1000 PD (IQR 0.15; 0.26) and 0.32 (IQR 0.2; 0.48) to 0.22 cases/1000 PD (IQR 0.11; 0.33), respectively).

Conclusion

Multimodal IPC training of CMOs is worthwhile and can lead to changes in IPC-relevant cooperation in hospitals. IPC training of hospital management should be further intensified.
Newly graduated nurses’ perceptions of their professional role and professional competency: a qualitative focus group study
Authors: Prosen Mirko , Ličen Sabina
Published: October 2023

Background

In recent years, complex and rapidly changing healthcare settings have placed high demands on nursing graduates, who must effectively assume new professional roles with a wide variety of competencies. However, in an ever-altering environment it is impossible to teach students everything. This means that assessing nursing students’ perceptions of their ability to practise their competencies and assume their professional roles is critical for faculty to further develop the nursing education curriculum and to assist healthcare organisations in supporting the transition of graduates. The aim of the study was to explore newly graduated nurses’ perceptions of their new professional role and professional competency associated with this role.

Methods

A qualitative study using the focus group method. The purposive sample included 18 nursing graduates with an average of 29 years, most of whom were female. The average time that had elapsed since graduation was 1.5 years. Four face-to-face focus group interviews were conducted. Thematic analysis was employed to identify themes and subthemes.

Results

Three main themes describing newly graduated nurses’ perceptions were found: (1) significance of the transition period; (2) commitment to the nursing profession; and (3) perceived needs and challenges to professional competency.

Conclusion

The transition from a safe academic environment to turbulent clinical practice is shaped by both graduates’ expectations and reality. The results of the study indicate a high level of commitment to the profession immediately after graduation and point to groups of competencies that need greater emphasis in the nursing curriculum. Although the responsibility for adequately preparing and supporting nursing students for their new professional roles rests with faculty and healthcare organisations, the responsibility for professional development should also lie on the students themselves.
A qualitative evidence synthesis (QES) exploring the barriers and facilitators to screening in emergency departments using the theoretical domains framework
Authors: Barry Louise , Tighe Sylvia Murphy , Griffin Anne , Ryan Damien , O’Connor Margaret , Fitzgerald Christine , Egan Siobhan , Galvin Rose , Meskell Pauline
Published: October 2023

Background

Validated screening tools can be utilised to detect early disease processes and risk factors for disease and adverse outcomes. Consequently, identifying individuals in need of early intervention and targeted assessment can be achieved through the implementation of screening in the ED. Successful implementation can be impacted by a lack of resources and ineffective integration of screening into the clinical workflow. Tailored implementation processes and staff training, which are contextually specific to the ED setting, are facilitators to effective implementation. This review will assist in the identification of barriers and facilitators to screening in the ED using a QES to underpin implementation processes. Healthcare workers engage in screening in the ED routinely. Consequently, this review focused on synthesizing the experience of healthcare workers (HCWs) who are involved in this process. This synthesis is informed by a QES protocol published by the lead author in 2021 (Barry et al., HRB Open Res 3:50, 2021).

Methodology

A comprehensive literature search, inclusive of grey literature sources, was undertaken. Initially, an a priori framework of themes was formed to facilitate the interpretation and organisation of search results. A context specific conceptual model was then formulated using “Best fit” framework synthesis which further assisted in the interpretation of data that was extracted from relevant studies. Dual blind screening of search results was undertaken using RAYYAN as a platform. Thirty studies were identified that met the inclusion criteria. Dual appraisal of full text articles was undertaken using CASP, GRADE CERQual assessed confidence of findings and data extraction was performed by two reviewers collaboratively.

Findings

This is the first known synthesis of qualitative research on HCW’s experiences of screening in the ED. Predominantly, the findings illustrate that staff experience screening in the ED as a complex challenging process. The barriers and facilitators identified can be broadly categorised under preconditions to screen, motivations to screen and knowledge and skills to screen. Competing interests in the ED, environmental stressors such as overcrowding and an organisational culture that resists screening were clear barriers. Adequate resources and tailored education to underpin the screening process were clear facilitators.

Trial registration

PROSPERO: CRD42020188712 05/07/20.
Challenges and achievements in the utilization of the health system among adolescents in a region of Burkina Faso particularly affected by poverty
Authors: Krohn Joshua , Bountogo Mamadou , Ouermi Lucienne , Sie Ali , Baernighausen Till , Harling Guy
Published: October 2023

Objective

Healthcare for adolescents receives little attention in low-income countries globally despite their large population share in these settings, the importance of disease prevention at these ages for later life outcomes and adolescent health needs differing from those of other ages. We therefore examined healthcare need and use among adolescents in rural Burkina Faso to identify reasons for use and gaps in provision and uptake.

Methods

We interviewed 1,644 adolescents aged 12-20 living in rural northwestern Burkina Faso in 2017. Topics included healthcare need and satisfaction with care provided. We calculated response-weighted prevalence of perceived healthcare need and utilization, then conducted multivariable regression to look at predictors of need, realized access and successful utilization based on the Andersen and Aday model.

Results

43.7 [41.2 - 46.0] % of participants perceived need for healthcare at least once in the preceding 12 months - 52.0 [48.1 - 56.0] % of females and 35.6 [32.5 - 39.0] % of males. Of those with perceived need, 92.6 [90.0 - 94.3] % were able to access care and 79.0 [75.6 - 82.0] % obtained successful utilization. Need was most strongly predicted by gender, education and urbanicity, while predictors of successful use included household wealth and female guardian’s educational attainment.

Conclusion

Healthcare utilization among adolescents is low in rural Burkina Faso, but mostly thought of as sufficient with very few individuals reporting need that was not linked to care. Future objective assessment of healthcare need could help identify whether our results reflect a well-functioning system for these adolescents, or one where barriers lead to low awareness of needs or low expectations for service provision.
Modelling the effect of demographic change and healthcare infrastructure on the patient structure in German hospitals – a longitudinal national study based on official hospital statistics
Authors: Schoffer Olaf , Schriefer Dirk , Werblow Andreas , Gottschalk Andrea , Peschel Peter , Liang Linda A. , Karmann Alexander , Klug Stefanie J.
Published: October 2023

Background

Effects of demographic change, such as declining birth rates and increasing individual life expectancy, require health system adjustments offering age- and needs-based care. In addition, healthcare factors can also influence health services demand.

Methods

The official German hospital statistics database with odd-numbered years between 1995 and 2011 was analysed. This is a national comprehensive database of all general hospital inpatient services delivered. Official data from hospital statistics were linked at the district level with demographic and socio-economic data as well as population figures from the official regional statistics. Panel data regression, modelling case numbers per hospital, was performed for 13 diagnosis groups that characterised the patient structure. Socio-demographic variables included age, sex, household income, and healthcare factors included bed capacity, personnel and hospital characteristics.

Results

The median number of annual treatments per hospital increased from 6 015 (5th and 95th percentile [670; 24 812]) in 1995 to 7 817 in 2011 (5th and 95th percentile [301; 33 651]). We developed models characterising the patient structure of health care in Germany, considering both socio-demographic and hospital factors. Demographic factors influenced case numbers across all major diagnosis groups. For example, the age groups 65–74 and 75 + influenced cerebrovascular disease case numbers (p < 0.001). Other important factors included human and material resources of hospitals or the household income of patients. Distinct differences between the models for the individual diagnosis groups were observed.

Conclusions

Hospital planning should not only consider demographic change but also hospital infrastructure and socio-economic factors.
What factors influence a Quality Improvement Collaborative in improving contraceptive services for foreign-born women? A qualitative study in Sweden
Authors: Siösteen-Holmblad Ingrid , Larsson Elin C. , Kilander Helena
Published: October 2023

Background

Improved contraceptive services could reduce the unmet need for contraception and unintended pregnancies globally. This is especially true among foreign-born women in high-income countries, as the health outcomes related to unmet need of contraception disproportionally affect this group. A widely used quality improvement approach to improve health care services is Quality Improvement Collaborative (QIC). However, evidence on to what extent, how and why it is effective and what factors influence a QIC in different healthcare contexts is limited. The purpose of this study was to analyse what factors have influenced a successful QIC intervention that is aimed to improve contraceptive service in postpartum care, mainly targeting foreign-born women in Sweden.

Methods

A qualitative, deductive design was used, guided by the Consolidated Framework for Implementation Research (CFIR). The study triangulated secondary data from four learning seminars as part of the QIC, with primary interview data with four QIC-facilitators. The QIC involved midwives at three maternal health clinics in Stockholm County, Sweden, 2018–2019.

Results

Factors from all five CFIR domains were identified, however, the majority of factors that influenced the QIC were found inside the QIC-setting, in three domains: intervention characteristics, inner setting and process. Outside factors and those related to individuals were less influential. A favourable learning climate, emphasizing co-creation and mutual learning, facilitated reflections among the participating midwives. The application of the QIC was facilitated by adaptability, trialability, and a motivated and skilled project team. Our study further suggests that the QIC was complex because it required a high level of engagement from the midwives and facilitators. Additionally, it was challenging due to unclear roles and objectives in the initial phases.

Conclusions

The application of the CFIR framework identified crucial factors influencing the success of a QIC in contraceptive services in a high-income setting. These factors highlight the importance of establishing a learning climate characterised by co-creation and mutual learning among the participating midwives as well as the facilitators. Furthermore, to invest in planning and formation of the project group during the QIC initiation; and to ensure adaptability and trialability of the improvement activities.
Korean primary health care program for people with disabilities: do they really want home-based primary care?
Authors: Kim Hye-Jin , Lim Jae-Young , Jang Soong-Nang
Published: October 2023

Background

Despite many studies on home-based primary care (HBPC)-related benefits and challenges, little is known about the perspectives of potential target groups of the care and their intention or preference for using it. This study aimed to explore the demand for HBPC from the perspective of people with disabilities (PWDs) and caregivers and identify relevant determinants for that demand.

Methods

Data from the population-based survey conducted in the Gyeonggi Regional Health & Medical Center for People with Disabilities in South Korea were analyzed. Logistic regression analysis was performed to identify relevant determinants for the demand on HBPC.

Results

Overall, 22% of respondents required HBPC, and 34.7% of persons aged ≥ 65 years demanded it. Older adults with disability, homebound status, and a need for assistance with daily living activities were associated with a demand for HBPC. Though having severe disability, only 19.49% of self-reported respondents demanded for HBPC, while 39.57% of proxy-reported respondents demanded for HBPC. Among self-reported group, only marital status was a predictor associated with a demand for HBPC. In contrast, among proxy-reported groups, PWDs with external physical disabilities, or with unmet medical needs due to availability barriers reported a higher demand for HBPC.

Conclusions

The demand for HBPC does not derive from the medical demands of the users themselves, but rather the care deficit by difficulty in getting out of the house or in outpatient care. Beyond an alternative to office-based care, HBPC needs to be considered to solve the care deficit and as well as to deal with PWDs’ medical problems.
The impact of funding models on the integration of Ontario midwives: a qualitative study
Authors: Darling Elizabeth K. , Lemay Sylvie B. , Ejiwunmi ‘Remi , Miller Katherine J. , Sprague Ann E. , D’Souza Rohan
Published: October 2023

Background

Nearly 30 years post legalisation and introduction, midwifery is still not optimally integrated within the health system of Canada’s largest province, Ontario. Funding models have been identified as one of the main barriers.

Methods

Using a constructivist perspective, we conducted a qualitative descriptive study to examine how antepartum, intrapartum, and postpartum funding arrangements in Ontario impact midwifery integration. We conceptualized optimal ‘integration’ as circumstances in which midwives’ knowledge, skills, and model of care are broadly respected and fully utilized, interprofessional collaboration and referral support the best possible care for patients, and midwives feel a sense of belonging within hospitals and the greater health system. We collected data through semi-structured telephone interviews with midwives, obstetricians, family physicians, and nurses. The data was examined using thematic analysis.

Results

We interviewed 20 participants, including 5 obstetricians, 5 family physicians, 5 midwives, 4 nurses, and 1 policy expert. We found that while course-of-care-based midwifery funding is perceived to support high levels of midwifery client satisfaction and excellent clinical outcomes, it lacks flexibility. This limits opportunities for interprofessional collaboration and for midwives to use their knowledge and skills to respond to health system gaps. The physician fee-for-service funding model creates competition for births, has unintended consequences that limit midwives’ scope and access to hospital privileges, and fails to appropriately compensate physician consultants, particularly as midwifery volumes grow. Siloing of midwifery funding from hospital funding further restricts innovative contributions from midwives to respond to community healthcare needs.

Conclusions

Significant policy changes, such as adequate remuneration for consultants, possibly including salary-based physician funding; flexibility to compensate midwives for care beyond the existing course of care model; and a clearly articulated health human resource plan for sexual and reproductive care are needed to improve midwifery integration.
Sociodemographic inequities in unscheduled asthma care visits among public assistance recipients in Japan: additional risk by household composition among workers
Authors: Nishioka Daisuke , Saito Junko , Ueno Keiko , Kondo Naoki
Published: October 2023

Background

Public assistance programs aim to prevent financial poverty by guaranteeing a minimum income for basic needs, including medical care. However, time poverty also matters, especially in the medical care adherence of people with chronic diseases. This study aimed to examine the association between the dual burden of working and household responsibilities, with unscheduled asthma care visits among public assistance recipients in Japan.

Methods

This retrospective cohort study included public assistance recipients from two municipalities. We obtained participants’ sociodemographic data in January 2016 from the public assistance database and identified the incidence of asthma care visits. Participants’ unscheduled asthma visits and the frequency of asthma visits were used as the outcome variables. Unscheduled visits were defined as visits by recipients who did not receive asthma care during the first three months of the observation period. Participants’ age, sex, household composition, and work status were used as explanatory variables. Multiple Poisson regression analyses were performed to calculate the cumulative incidence ratio (IR) with a 95% confidence interval (CI) of unscheduled visits across the explanatory variables. The effect of modification on the work status by household composition was also examined.

Results

We identified 2,386 recipients at risk of having unscheduled visits, among which 121 patients (5.1%) had unscheduled visits. The multivariable Poisson regression revealed that the working recipients had a higher incidence of unscheduled visits than the non-working recipients (IR 1.44, 95% CI 1.00–2.07). Among working recipients, the IRs of unscheduled visits were higher among recipients cohabiting with adults (IR 1.90 95% CI 1.00–3.59) and with children (IR 2.35, 95% CI 1.11–4.95) than for recipients living alone. Among non-working recipients, the IRs of unscheduled visits were lower for recipients living with family (IR 0.74, 95% CI 0.41–1.35) and those living with children (IR 0.50, 95% CI 0.20–1.23). A higher frequency in asthma visits was observed among working recipients living with family.

Conclusions

Working adults cohabiting with children are at the greatest risk of unscheduled visits among adults receiving public assistance. To support healthy lifestyles of public assistance recipients, medical care providers and policymakers should pay special attention to the potentially underserved populations.
Main causes of death of free-ranging bats in Turin province (North-Western Italy): gross and histological findings and emergent virus surveillance
Authors: Colombino Elena , Lelli Davide , Canziani Sabrina , Quaranta Giuseppe , Guidetti Cristina , Leopardi Stefania , Robetto Serena , De Benedictis Paola , Orusa Riccardo , Mauthe von Degerfeld Mitzy , Capucchio Maria Teresa
Published: October 2023

Background

Bats are recognized as reservoir species for multiple viruses. However, little is known on bats’ health and mortality. Thus, this study aimed to investigate the main causes of death of bats from Turin province (North-western Italy) and to describe gross and histopathological lesions potentially associated with the presence of selected bat viruses.

Results

A total of 71 bats belonging to 9 different species of the familiesVespertilionidaeandMolossidaewere necropsied and samples of the main organs were submitted to histopathological examination. Also, aliquots of the small intestine, liver, spleen, lung, and brain were collected and submitted to biomolecular investigation for the identification ofCoronaviridae, Poxviridae, Reoviridae(Mammalian orthoreovirus species),Rhabdoviridae(Vaprio ledantevirusandLyssavirusspecies) andKobuvirus. The majority of bats died from traumatic lesions due to unknown trauma or predation (n = 40/71, 56.3%), followed by emaciation (n = 13/71,18.3%). The main observed gross lesions were patagium and skin lesions (n = 23/71, 32.4%), forelimbs fractures (n = 15/71, 21.1%) and gastric distension (n = 10/71,14.1%). Histologically, the main lesions consisted of lymphoplasmacytic pneumonia (n = 24/71, 33.8%), skin/patagium dermatitis (n = 23/71, 32.4%), liver steatosis and hepatitis (n = 12, 16.9%), and white pulp depletion in the spleen (n = 7/71, 9.8%). Regarding emergent bat viruses, onlypoxvirus(n = 2, 2.8%) andorthoreovirus(n = 12/71, 16.9%) were detected in a low percentage of bats.

Conclusions

Trauma is the main lesion observed in bats collected in Turin province (North-western Italy) associated with forelimb fractures and the detected viral positivity rate seems to suggest that they did not represent a threat for human health.
Adherence to national malaria treatment guidelines in private drug outlets: a cross-sectional survey in the malaria-endemic Kisumu County, Kenya
Authors: Odhiambo Fredrick Ouma , O’Meara Wendy P. , Abade Ahmed , Owiny Maurice , Odhiambo Fredrick , Oyugi Elvis O.
Published: October 2023

Background

Malaria prevalence in Kenya is 6%, with a three-fold higher prevalence in western Kenya. Adherence to malaria treatment guidelines improves care for suspected malaria cases and can reduce unnecessary anti-malarial use. Data on adherence to guidelines in retail drug outlets (DOs) is limited, yet approximately 50% of people with fever access treatment first in these outlets. This study assessed adherence to the national malaria treatment guidelines among DOs in a high transmission area of Western Kenya.

Methods

In a cross-sectional survey of DOs in Kisumu Central and Seme sub-counties in 2021, DO staff were interviewed using structured questionnaires to assess outlet characteristics (location, testing services), staff demographics (age, sex, training), and health system context (supervision, inspection). Mystery shoppers (research assistants disguised as clients) observed malaria management practices and recorded observations on a standardized tool. Adherence was defined as dispensing artemether-lumefantrine (AL) to patients with a confirmed positive test, accompanied by appropriate medication counseling. Logistic regression was used to test for association between adherence to guidelines and DO-related factors.

Results

None of the 70 DOs assessed had a copy of the guidelines, and 60 (85.7%) were in an urban setting. Staff adhered to the guidelines in 14 (20%) outlets. The odds of adherence were higher among staff who had a bachelor’s degree {odds ratio (OR) 6.0, 95% confidence interval (95% CI) 1.66–21.74}, those trained on malaria rapid diagnostic test (RDT) {OR 4.4, 95% CI 1.29–15.04}, and those who asked about patient’s symptoms {OR 3.6, 95% CI 1.08–12.25}. DOs that had higher odds of adherence included those with functional thermometers {OR 5.3, 95% CI 1.46–19.14}, those recently inspected (within three months) by Pharmacy and Poisons Board (PPB) {OR 9.4, 95% CI 2.55–34.67}, and those with all basic infrastructure {OR 3.9, 95% CI 1.01–15.00}. On logistic regression analysis, recent PPB inspection {adjusted OR (AOR) 4.6, 95% CI 1.03–20.77} and malaria RDT-trained staff (aOR 4.5, 95% CI 1.02–19.84) were independently associated with adherence.

Conclusion

Most outlets didn’t adhere to malaria guidelines. Regular interaction with regulatory bodies could improve adherence. Ministry of Health should enhance private sector engagement and train DOs on RDT use.
Could an optimally fitted categorization of difference between multi-disease score and multi-symptom score be a practical indicator aiding in improving the cost-effectiveness of healthcare delivery for older adults in developing countries?
Authors: Wang Yuhong , Guan Guoying , xue Ying , Zhang Jingyu , Cui Zhe , Han Hui
Published: October 2023

Background

Physio-psycho-socioeconomical health comprehensively declines during aging, the complexity of which is challenging to measure. Among the complexity, multiple chronic disorders continuously cumulated during aging, further aggravating the challenge.

Methods

A population-based survey on Comprehensive Ageing Health Assessment was conducted in older adults (age >  = 60) enrolled from hospital settings and community settings in 13 working centers in six subnational regions in China. Cross-sectional datasets of 8,093 older participants with approximately complete assessment results were collected for the present analysis. Individual’s multi-disease or multi-symptom was respectively scored by summing coexistent multiple diseases or multiple symptoms by respective weighting efficient for Self-Rated Health (SRH). Individual’s age-dependent health decline was further summed of four SRH-weighted scores for daily function (activity of daily life, ADL), physical mobility (an average of three metrics), cognitive function (mini mental state examination, MMSE) and mental being (geriatric depression scale, GDS) plus multi-disease score (MDS) and multi-symptom score (MSS).Multi-disease patten among 18 diseases or multi-symptom pattern among 15 symptoms was latent-clustered in the older adults, the optimal outcome of which was categorized into high, moderate or low aging-associated clusters, respectively. Percentage distribution was compared between overall health decline score and multi-disease pattern cluster or multi-symptom patten cluster. A new variable of difference between MDS and MSS (hereinafter terming DMM) that displayed linear variation with socioeconomic factors was further fitted using multilevel regression analyses by substantial adjustments on individual confounders (level-1) and subnational region variation (level-2).

Results

Consistent gradient distribution was shown between health decline and multimorbidity pattern cluster in the older adults. DMM was found linearly varied with personal education attainment and regional socioeconomic status. Using optimally fitted stratification of DMM (DMM interval = 0.02), an independent U-shaped interrelated tendency was shown between health decline, multi-disease and multi-symptom, which could be well explained by regional disparities in socioeconomic status.

Conclusion

Newly developed metrics for age-dependent health decline and aging-associated multimorbidity patten were preliminarily validated from within. The new variable of optimally fitted categorization of DMM might function as a practical indicator aiding in improving the cost-effectiveness and reduce inequity of healthcare delivery for older adults in developing countries.
Impact of interventions on the quality of life of cancer patients: a systematic review and meta-analysis of longitudinal research
Authors: Nguyen Long Bao , Vu Linh Gia , Le Thanh Thien , Nguyen Xuan Thanh , Dao Nam Gia , Nguyen Duy Cao , Huyen Thi Dang Trang , Vu Thuc Minh Thi , Boyer Laurent , Fond Guillaume , Auquier Pascal , Latkin Carl A. , Zhang Melvyn W.B. , Ho Roger C.M. , Ho Cyrus S.H.
Published: October 2023

The impact of cancer interventions has been conducted in several research due to the significant burden of this non-communicable disease. The interventions that played an important role in the improvement of the patient’s quality of life (QoL) and health-related quality of life (HRQL) can be classified into two main groups: pharmaceutical and non-pharmacological methods. However, studies so far often analyze a specific group of interventions for specific types of cancer. Thus, in this systematic review and meta-analysis, we synthesized the overall impact of cancer interventions on patients’ quality of life in several cancers.

In this research, we followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) to search the longitudinal original research on the Web of Science (WOS) database. After that, the Newcastle-Ottawa Scale (NOS) and Jadad Scale were used to assess the quality of non-randomized control trials and randomized control trials, respectively. Then, the characteristics of the included studies were described in the six main fields table and the random effect model with robust estimation was applied to analyze the impact of interventions on the health utility of patients.

From the database, 122 longitudinal original research were included in the meta-regression, with most of them having high or fair quality. The European Organization for the research and treatment of cancer scale for quality of life (EORTC-QLQ) was the most used health utility measurement at 65.15%. In the adjusted effect models, the Visual Analogue Scale (VAS) had significant statistics in all models when we compared it with the EQ-5D Scale (p < 0.05) and several types of cancer such as breast, lung, and prostate cancer had significant statistics when comparing with hematological cancer in the model types of cancer (p < 0.01). Moreover, radiotherapy, screening, and a combination of chemotherapy and best supportive care also had significant statistics (p < 0.01) in the model of interventions when compared with radiotherapy applied only. Our research can suggest a vital combination of both pharmaceutical and non-pharmacological interventions to improve the quality of life of some common types of cancer patients.
In vivo characterisation of field pea stem wall thickness using optical coherence tomography
Authors: Fang Qi , Castro-Urrea Felipe A. , Haederle Felix , Sanderson Rowan W. , Silva Dilusha , A. Cowling Wallace , Kennedy Brendan F.
Published: October 2023

Background

Modern field pea breeding faces a significant challenge in selecting lines with strong stems that resist lodging. Traditional methods of assessing stem strength involve destructive mechanical tests on mature stems after natural senescence, such as measuring stem flexion, stem buckling or the thickness of dry stems when compressed, but these measurements may not correspond to the strength of stems in the living plant. Optical coherence tomography (OCT) can be used as a noncontact and nondestructive method to measure stem wall thickness in living plants by acquiring two- or three-dimensional images of living plant tissue.

Results

In this proof-of-principle study, we demonstrated in vivo characterisation of stem wall thickness using OCT, with the measurement corrected for the refractive index of the stem tissue. This in vivo characterisation was achieved through real-time imaging of stems, with an acquisition rate of 13 milliseconds per two-dimensional, cross-sectional OCT image. We also acquired OCT images of excised stems and compared the accuracy of in vivo OCT measurements of stem wall thickness with ex vivo results for 10 plants each of two field pea cultivars, Dunwa and Kaspa. In vivo OCT measurements of stem wall thickness have an average percent error of − 3.1% when compared with ex vivo measurements. Additionally, we performed in vivo measurements of both stem wall thickness and stem width at various internode positions on the two cultivars. The results revealed that Dunwa had a uniform stem wall thickness across different internode positions, while Kaspa had a significantly negative slope of − 0.0198 mm/node. Both cultivars exhibited an increase in stem width along the internode positions; however, Dunwa had a rate of increase of 0.1844 mm/node, which is three times higher than that of Kaspa.

Conclusions

Our study has demonstrated the efficacy of OCT for accurate measurement of the stem wall thickness of live field pea. Moreover, OCT shows that the trends of stem wall thickness and stem width along the internode positions are different for the two cultivars, Dunwa and Kaspa, potentially hinting at differences in their stem strength. This rapid, in vivo imaging method provides a useful tool for characterising physical traits critical in breeding cultivars that are resistant to lodging.
ShinyCore: An R/Shiny program for establishing core collection based on single nucleotide polymorphism data
Authors: Kim Steven , Kim Dong Sub , Moyle Hana , Heo Seong
Published: October 2023

Background

Managing and investigating all available genetic resources are challenging. As an alternative, breeders and researchers use core collection—a representative subset of the entire collection. A good core is characterized by high genetic diversity and low repetitiveness. Among the several available software, GenoCore uses a coverage criterion that does not require computationally expensive distance-based metrics.

Results

ShinyCore is a new method to select a core collection through two phases. The first phase uses the coverage criterion to quickly attain a fixed coverage, and the second phase uses a newly devised score (referred to as the rarity score) to further enhance diversity. It can attain a fixed coverage faster than a currently available algorithm devised for the coverage criterion, so it will benefit users who have big data. ShinyCore attains the minimum coverage specified by a user faster than GenoCore, and it then seeks to add entries with the rarest allele for each marker. Therefore, measures of genetic diversity and distance can be improved.

Conclusion

Although GenoCore is a fast algorithm, its implementation is difficult for those unfamiliar with R, ShinyCore can be easily implemented in Shiny with RStudio and an interactive web applet is available for those who are not familiar with programming languages.
Miserable malalignment syndrome associated knee pain: a case for infra-tubercle tibial de-rotation osteotomy using an external fixator
Authors: Elsheikh Ahmed A. , Cross George W. V. , Wright Jonathan , Goodier William David , Calder Peter
Published: October 2023

Introduction

Miserable malalignment syndrome is a complex torsional lower limb deformity with limited consensus on surgical treatment. We present the outcome of de-rotation of the tibia alone using an external fixator.

Methods

Fifteen patients (22 segments) were operated on between 2012 and 2020; 13 presented with anterior knee pain, and two presented with out-toeing. Gait analysis was done in nine patients, and CT scan rotational profile, including tibial tubercle–trochlear groove distance, femoral version, and tibial torsion, were calculated. Kujala knee pain score and visual analogue pain score (VAS) were recorded. All underwent infra-tubercular osteotomy of the tibia and midshaft osteotmy of the fibula and application of a hexapod circular frame to gradually internally rotate the tibia until the foot aligned with the patella.

Results

There was no preoperative clinical or radiographic evidence for patellar instability, femoral anteversion 30° (21°–54°), and external tibial torsion 50° (37–70). The mean age at surgery was 21 years (12–37) with a mean follow-up of 20 months (9–83). All osteotomies healed, and the frames were removed at a mean of 111 days (80–168). The mean VAS score improved from 8(5–9) to 1(0–4) postoperatively (P < 0.001). The mean Kujala knee pain score increased from 53 (30–75) to 92 (54–100) postoperatively (P < 0.001). The mean preoperative foot progression angle (FPA) was 37° (20°–50°), with 13 postoperatively walking with neutral FPA. One patient walked with symmetrical + 10° and the other with − 5° FPA. All patients reported relief of knee pain and were satisfied with the alignment.

Conclusion

Gradual correction of severe external tibia torsion with a hexapod external fixator and an infra-tubercle tibial osteotomy could provide an optimum method to eliminate knee pain and improve limb alignment in miserable malalignment syndrome.
Symptoms and impacts of familial chylomicronemia syndrome: a qualitative study of the patient experience
Authors: Williams Kate , Tickler Georgina , Valdivielso Pedro , Alonso Jordi , Vera-Llonch Montserrat , Cubells Laia , Acaster Sarah
Published: October 2023

Background

Familial chylomicronemia syndrome (FCS) is a rare, hereditary, metabolic disorder. FCS causes high levels of triglycerides in the blood, which can lead to abdominal pain, xanthomas, and acute pancreatitis (AP). Volanesorsen, along with adherence to a very low-fat diet is used to reduce triglyceride levels in individuals with FCS. We aimed to understand the symptoms of FCS and their impact on health-related quality of life (HRQoL).

Methods

Interviews were conducted with individuals with genetically confirmed FCS in the UK and Spain, some of whom had been treated with volanesorsen. Interview guides were developed with input from a patient advocacy group to explore the symptoms, impacts and management of FCS. Interviews were conducted by telephone and were recorded and transcribed. Data were analyzed using thematic analysis and saturation was recorded.

Results

Seventeen interviews were conducted with individuals with FCS (aged 27–68 years), thirteen of whom were currently/previously treated with volanesorsen. Episodes of AP were the most impactful reported symptom, resulting in severe abdominal pain, nausea, vomiting, fever, bloating and appetite loss. Other symptoms and functional issues included abdominal pain, gastrointestinal symptoms, impaired cognitive function and fatigue. These had an impact on work, social activities, relationships and psychological wellbeing. These symptoms and impacts were illustrated in a conceptual model, including management strategies. The challenges of managing a low-fat diet and experience with volanesorsen were discussed.

Conclusion

Individuals with FCS experience a range of interrelated symptoms and functional limitations which impact their broader HRQoL. Treatments which alleviate symptoms and reduce the incidence of AP episodes have the potential to improve the HRQoL of these individuals.
The RNA methyltransferase METTL16 enhances cholangiocarcinoma growth through PRDM15-mediated FGFR4 expression
Authors: Liu Nianli , Zhang Jinqiang , Chen Weina , Ma Wenbo , Wu Tong
Published: October 2023

Background

RNA N6-Methyladenosine (m6A) modification is implicated in the progression of human cancers including cholangiocarcinoma (CCA). METTL16 is recently identified as a new RNA methyltransferase responsible for m6A modification, although the role of METTL16 in CCA has not yet been examined. The current study aims to investigate the effect and mechanism of the RNA methyltransferase METTL16 in CCA.

Methods

The expression of METTL16 in CCA was examined by analyzing publicly available datasets or by IHC staining on tumor samples. siRNA or CRISPR/Cas9-mediated loss of function studies were performed in vitro and in vivo to investigate the oncogenic role of METTL16 in CCA. MeRIP-Seq was carried out to identify the downstream target of METTL16. ChIP-qPCR, immunoprecipitation, and immunoblots were used to explore the regulation mechanisms for METTL16 expression in CCA.

Results

We observed that the expression of METTL16 was noticeably increased in human CCA tissues. Depletion of METTL16 significantly inhibited CCA cell proliferation and decreased tumor progression. PRDM15 was identified as a key target of METTL16 in CCA cells. Mechanistically, our data showed that METTL16 regulated PRDM15 protein expression via YTHDF1-dependent translation. Accordingly, we observed that restoration of PRDM15 expression could rescue the deficiency of CCA cell proliferation/colony formation induced by METTL16 depletion. Our subsequent analyses revealed that METTL16-PRDM15 signaling regulated the expression of FGFR4 in CCA cells. Specifically, we observed that PRDM15 protein was associated with the FGFR4 promoter to regulate its expression. Furthermore, we showed that the histone acetyltransferase p300 cooperated with the transcription factor YY1 to regulate METTL16 gene expression via histone H3 lysine 27 (H3K27) acetylation in CCA cells.

Conclusions

This study describes a novel METTL16-PRDM15-FGFR4 signaling axis which is crucial for CCA growth and may have important therapeutic implications. We showed that depletion of METTL16 significantly inhibited CCA cell proliferation and decreased tumor progression.
Dominantly inherited micro-satellite instable cancer – the four Lynch syndromes - an EHTG, PLSD position statement
Authors: Møller Pal , Seppälä Toni T. , Ahadova Aysel , Crosbie Emma J. , Holinski-Feder Elke , Scott Rodney , Haupt Saskia , Möslein Gabriela , Winship Ingrid , Broeke Sanne W. Bajwa-ten , Kohut Kelly E. , Ryan Neil , Bauerfeind Peter , Thomas Laura E. , Evans D. Gareth , Aretz Stefan , Sijmons Rolf H. , Half Elizabeth , Heinimann Karl , Horisberger Karoline , Monahan Kevin , Engel Christoph , Cavestro Giulia Martina , Fruscio Robert , Abu-Freha Naim , Zohar Levi , Laghi Luigi , Bertario Lucio , Bonanni Bernardo , Tibiletti Maria Grazia , Lino-Silva Leonardo S. , Vaccaro Carlos , Valle Adriana Della , Rossi Benedito Mauro , da Silva Leandro Apolinário , de Oliveira Nascimento Ivana Lucia , Rossi Norma Teresa , Dębniak Tadeusz , Mecklin Jukka-Pekka , Bernstein Inge , Lindblom Annika , Sunde Lone , Nakken Sigve , Heuveline Vincent , Burn John , Hovig Eivind , Kloor Matthias , Sampson Julian R. , Dominguez-Valentin Mev ,   On behalf of the Prospective Lynch Syndrome Database (www.plsd.eu) and The European Hereditary Tumour Group (www.ehtg.org)
Published: October 2023

The recognition of dominantly inherited micro-satellite instable (MSI) cancers caused by pathogenic variants in one of the four mismatch repair (MMR) genes MSH2, MLH1, MSH6 and PMS2 has modified our understanding of carcinogenesis. Inherited loss of function variants in each of these MMR genes cause four dominantly inherited cancer syndromes with different penetrance and expressivities: the four Lynch syndromes. No person has an “average sex “or a pathogenic variant in an “average Lynch syndrome gene” and results that are not stratified by gene and sex will be valid for no one. Carcinogenesis may be a linear process from increased cellular division to localized cancer to metastasis. In addition, in the Lynch syndromes (LS) we now recognize a dynamic balance between two stochastic processes: MSI producing abnormal cells, and the host’s adaptive immune system’s ability to remove them. The latter may explain why colonoscopy surveillance does not reduce the incidence of colorectal cancer in LS, while it may improve the prognosis. Most early onset colon, endometrial and ovarian cancers in LS are now cured and most cancer related deaths are after subsequent cancers in other organs. Aspirin reduces the incidence of colorectal and other cancers in LS. Immunotherapy increases the host immune system’s capability to destroy MSI cancers. Colonoscopy surveillance, aspirin prevention and immunotherapy represent major steps forward in personalized precision medicine to prevent and cure inherited MSI cancer.
Giardia VSPAS7 protein attenuates Giardia intestinalis-induced host macrophage pyroptosis
Authors: Sun Min , Zhao Zhiteng , Li Ying , Cao Lili , Li Jianhua , Zhang Xichen , Li Xin , Zhang Nan , Cheng Shuqin , Wang Xiaocen , Gong Pengtao
Published: October 2023

Background

The unicellular protozoan parasite Giardia intestinalis, which primarily infects humans and animals such as cattle and sheep, is having a major negative impact on public health. Giardia is able to evade the recognition and elimination of the host immune system because of the trophozoite surface and extracellular vesicles (EVs) covered by variant-specific surface proteins (VSPs). As key proteins for immune evasion, whether VSPs can regulate Giardia-induced pyroptosis and promote Giardia evasion of host immune responses has not been reported.

Methods

To examine the role of Giardia VSPAS7 on Giardia-induced activation of the signaling pathway, secretion of pro-inflammatory cytokines, pyroptosis and the mechanism involved, we constructed the pcDNA3.1-vspas7 expression plasmid and transfected this plasmid into mouse macrophages. Key proteins for pyroptosis, IL-1β secretion and LDH release were detected in pcDNA3.1-vspas7-transfected wild-type (WT) cells and NLRP3-deficient cells by western blot, ELISA and LDH assays, respectively. The interactions of Giardia VSPAS7 and mouse NLRP3 were examined using immunofluorescence assays (IFA), co-immunoprecipitation (Co-IP) and bimolecular fluorescence complementation (BiFC) assays.

Results

VSPAS7 could decrease the levels of phosphorylated-p65 (P-p65), P-IκBα and P-ERK caused by Giardia and reduce the production levels of Giardia-induced pro-inflammatory cytokine IL-6, IL-12 p40 and TNF-α. The results showed that VSPAS7 inhibited Giardia-mediated activation of NF-κB, ERK/MAPK signaling and secretion of pro-inflammatory cytokines. Furthermore, VSPAS7 suppressed Giardia-induced macrophage pyroptosis by reducing GSDMD cleavage, caspase-1 activation, IL-1β secretion and LDH release. We further found that VSPAS7 could interact with mouse NLRP3 directly, and in NLRP3-deficient cells the suppression of Giardia-induced macrophage pyroptosis by VSPAS7 was significantly attenuated.

Conclusions

Overall, VSPAS7 could inhibit Giardia-induced activation of signaling pathways and pyroptosis in host macrophages, allowing Giardia evasion of host immune responses. Studies on Giardia VSP-mediated immune evasion provide an important theoretical basis for in-depth studies on Giardia pathogenicity.

Graphical abstract