bluuebunny/crossref_metadata_2025 huggingface dataset:
The Physical Hospital Environment and Its Effects on Palliative Patients and Their Families: A Qualitative Meta-Synthesis
Authors: Miller Elizabeth M. , Porter Joanne E. , Barbagallo Michael S.
Published: August 2021

Aim:

To review the latest qualitative literature on how the physical hospital environment affects palliative patients and their families.

Background:

People with a life-limiting illness may receive palliative care to improve their quality of life in hospital and may have multiple admissions as their illness progresses. Yet, despite a preference for a death at home, more than half of the dying population will receive end-of-life care in hospital. The physical hospital environment consists of ambiance, aesthetics, and architectural factors, and it is well known that the hospital’s acute wards are not a homely environment. Demand is increasing for the physical environment to be improved to better meet the needs and demands of palliative and end-of-life patients and their families.

Method:

Combining thematic analysis and meta-ethnography methodologies, 12 international qualitative papers were analyzed and synthesized by the three authors.

Results:

Findings resulted in the development of the SSAFeR Place approach that incorporates the concepts that are important to palliative and end-of-life patients and their families by describing an environment within the acute or palliative care units that feels safe, is private, customizable, and accommodates family; is a space to share with others, is homelike in ambiance and aesthetics, and is conducive for reflection. The concepts of identity, belonging, and safety are connected to the notions of home.

Conclusions:

To provide person-centered care and to move the focus toward the palliative approach of comfort and quality of life, attention to room size, layout, aesthetics, and ambiance is needed.
Dental Foundation Training (DFT): does it meet the Francis Report Recommendations?
Authors: Richardson Mark
Published: August 2021

This study evaluates Dental Foundation Training (DFT) in the context of the Francis Report recommendations. Results of questionnaires sent to trainees and educational supervisors involved in DFT highlighted the importance of an educational supervisor as a positive role model, the value of the informal curriculum in developing an organisational culture of professionalism, leadership and ethics, and the developmental benefits of experiential learning. DFT needs to create an optimal learning environment which should promote the benefits of reflection, positive role modelling and active participation by foundation trainees in their professional community and organisational culture. The findings of this study confirm the crucial role DFT plays in the development of safe, ethical and effective practitioners. It also underlines the need for clear and consistent UK wide standards of DFT supported by strong leadership and management, underpinned by skilled, professional educational supervisors, and effectively quality assured.
Professionalism – A Medico-Legal Perspective
Authors: Lewis Kevin
Published: August 2021

This article examines the issue of professionalism in relation to dental practitioners, and how it impacts upon the range of medico-legal challenges they might face. It provides an overview of professionalism in a healthcare context and explores some of the characteristics that different parties would associate with it.

The mismatch between these different perspectives and the relative importance that each party attaches to different aspects of professionalism, can often sit at the heart of complaints and litigation.

The article also questions whether or not traditional professional values and behaviours are still relevant in a modern healthcare environment that is increasingly digital, consumerist and competitive – or conversely in such a fast-changing world, whether the need for a modern professionalism is greater than ever.
Hereditary haemorrhagic telangiectasia: A case report
Authors: Mufti Asfandyar , Sachdeva Muskaan , Maliyar Khalad , Joseph Marissa
Published: August 2021

Background:

Hereditary haemorrhagic telangiectasia is an autosomal dominant genetic disorder characterized by abnormalities in blood vessel formation. The clinical manifestations of patients affected with hereditary haemorrhagic telangiectasia include mucocutaneous telangiectasias and visceral arteriovenous malformations.

Case Summary:

We report the case of a 30-year-old female diagnosed with hereditary haemorrhagic telangiectasia presenting with the classic triad of recurrent epistaxis, mucocutaneous telangiectasias and family history of hereditary haemorrhagic telangiectasia with activin receptor-like kinase 1 mutation. Upon skin examination, she was noted to have telangiectasias under left naris, inner lower lip and surface of the tongue, and a vascular malformation on the right forearm.

Conclusion:

Although the skin involvement and epistaxis may be mild symptoms and signs of hereditary haemorrhagic telangiectasia, timely recognition of these can ensure vigilant monitoring of potential severe complications from cerebral and pulmonary visceral arteriovenous malformations.
The Role of Subjective Construals on Reporting and Reasoning about Social Media Use
Authors: Lee Angela Y. , Katz Roberta , Hancock Jeffrey
Published: August 2021

The ways people estimate and make sense of the time they spend with social media should be influenced by the subjective construals that they draw on to guide their perceptions and behaviors on social media. Through qualitative analysis of 60 interviews, we identify how subjective construals of social media can influence two distinct processes relevant to the study of social media effects. First, we find that the process of estimating and self-reporting time spent on social media is influenced by differences in how people construed “social media” in field-standard questions. Conceptual variability in definitions of “social media,” aggregated time spent across multiple sessions and platforms, and perceived norms about use affected their responses. Second, we find that participants’ reasoning about the role of social media in their lives revolved around two key construals about the valence of its effects (positive vs negative) and their perceived agency relative to social media (being in control vs subject to control). People who felt in control of their use also viewed social media more positively, and those who felt controlled by social media viewed it more negatively. These conceptualizations of the nature and effects of social media use—which we discuss as social media mindsets—were closely tied to behaviors and outcomes. These two findings have fundamental implications not only for survey methodologies in social media research but also for how we conceptualize the relationship between social media use and psychological outcomes.
Becoming a Community-Based Physician Researcher
Authors: Pine Donald
Published: August 2021

Years ago, as a contented community family physician practicing with 4 physician colleagues, I focused on applying medical knowledge to help patients. After a young patient’s death from smoking I became interested in improving our strategy for helping smokers quit. A researcher offered us the opportunity to test a cessation intervention that had been successful in an academic setting. I was concerned that this study would interfere with my patient care duties until I visited a practitioner researcher in Wales. I was inspired and worked with a research professional to build colleague support and carry out this project. After this gratifying experience I had similar experiences working with other research teams. As an ordinary practitioner I had expanded my role to become significantly involved in research. In this role I was working with a team to improve patient care. It was a fundamental change that brought me great satisfaction.
Analysis of Urban Transformation Through the Use of Expanded Research Tools
Authors: Builes-Vélez Ana Elena , Suárez Vásquez Lina María , Correa Velásquez Leonardo , Gutiérrez Aristizábal Diana Carolina
Published: August 2021

In recent years, urban design development has been an important topic in Latin American cities such as Medellín due to the transformation of their urban spaces, along with the new methods used to evaluate the social, morphological, and, in some cases, economic impacts that have been brought about by the urban development projects. When inquiring about the development process and impact of urban studies, and the inhabitants’ relation to a transformed space, it is important to establish the context within which images, drawings, and photographs are analyzed, using graphical approaches triangulated with other research methods to define comparative criteria. In this article, we reflect on the expanded use of various research tools for the analysis of urban transformation, taking with reference the experience lived by a group of researchers in two Latin American cities. From this, it is intended to understand how they work and how they allow us to understand the urban transformation of these cities, the data obtained, and the vision of the researchers.
Is Water-Only Fasting Safe?
Authors: Ogłodek Ewa , Pilis, Prof. Wiesław
Published: August 2021

Background

Water-only fasting (WF) is a practice used to improve and maintain health.

Objective

The aim of the study was to show whether WF performed for 8 days may be a threat to the health and/or life of people undergoing this practice.

Methods

Twelve middle-aged men participated in the study. During the 8-day WF, the subjects ate no food except for drinking mineral water. Before and after WF, all subjects had a series of tests performed, beginning with the level of perceived stress and somatic measurements. The concentrations of creatinine, sodium (Na+), potassium (K+), total calcium (Ca), magnesium (Mg++), urea (U), uric acid (UA) and total protein were determined in this urine and in the serum. For these substances, the values ​​of clearance, renal filtration and fractional excretion were calculated. The osmotic clearance and free water clearance as well as the amount of daily urinary excretion of creatinine, Na+, K+, Ca, Mg++, U and UA were also calculated. Moreover, the concentration of glucose in the serum and the concentration of β-hydroxybutyrate in the plasma were determined. In urine, specific gravity, pH and osmolality were also measured.

Results

After 8 days of WF, the study showed a significant reduction in the level of perceived stress, weight loss, changes in body composition, dehydration, increased ketogenesis, hyperuricemia, decreased serum glucose concentration, and hyponatremia. These changes were accompanied by Na+, K+ and protein sparing, decreased serum Ca and Mg++ concentrations, and reduced daily volume of more acidic urine with elevated specific gravity.

Conclusions

After 8 days of WF, all subjects were found to remain safe and feel the sense of well-being. However, the appearance of the above-mentioned adverse metabolic effects, despite partially effective renal compensations, suggests that the further continuation of fasting intervention by the subjects would be detrimental to their body.
Interpretation of causal relationship between quadriceps tendon Young’s modulus and gait speed by structural equation modeling in patients with severe knee osteoarthritis
Authors: Ebihara Bungo , Mutsuzaki Hirotaka , Fukaya Takashi , Iwai Koichi
Published: August 2021

Purpose:

To clarify the causal relationship between quadriceps tendon stiffness and gait speed in patients with severe knee osteoarthritis (OA) using structural equation modeling.

Methods:

Participants were 36 patients with knee OA (median age, 75.0 [interquartile range, 67.3–76.0] years; Kellgren-Lawrence grade 3 or 4). We measured quadriceps tendon stiffness using Young’s modulus by ShearWave Elastography. Gait speed and kinematics parameters were measured using a motion analysis system. Additional data collected for each patient included age, sex, height, body weight, body mass index, femorotibial angle, knee range of motion, knee extension torque, and pain. We performed structural equation modeling for interpretation of the causal relationship.

Results:

The comparative fit index of the structural equation modeling was 0.990. Quadriceps tendon Young’s modulus was a predictor of maximum knee flexion angle during the swing phase (standardized partial regression coefficients [ β] = –0.67, P < 0.001). Maximum knee flexion angle during the swing phase was a predictor of cadence and step length ( β values 0.35 and 0.55, P = 0.035 and <0.001, respectively). Cadence and step length were predictors of gait speed ( β values 0.50 and 0.63, P < 0.001 and <0.001, respectively).

Conclusion:

Our results showed a causal relationship between quadriceps tendon stiffness and gait speed in patients with severe knee OA. Quadriceps tendon Young’s modulus can affect gait speed through the maximum knee flexion angle during the swing phase, cadence, and step length. Adding therapeutic intervention to decrease the quadriceps tendon Young’s modulus may lead to increased gait speed.
Sifting Interactional Trust Through Institutions to Manage Trust in Project Teams: An Organizational Change Project
Authors: Farid Parinaz
Published: August 2021

Trust in project teams has been found to lead to positive project outcomes. However, the role of project managers in facilitating development of trust in projects is not well-understood. This article addresses this by exploring mechanisms to facilitate the development of interactional and institutional trust and explicating the interplay between those mechanisms. Drawing on longitudinal data from an organizational change project, findings suggest that to facilitate trust development, project managers must concurrently exercise four practices: preaching, involving, sympathizing, and adhering. Simultaneous and tailored application of the first three practices affects interactional trust; the latter not only fosters institutional trust but is also a necessary filter for the dynamics of interactional trust.
MICA/B antibody induces macrophage-mediated immunity against acute myeloid leukemia
Authors: Alves da Silva Pedro Henrique , Xing Samantha , Kotini Andriana G. , Papapetrou Eirini P. , Song Xiaoyu , Wucherpfennig Kai W. , Mascarenhas John , Ferrari de Andrade Lucas
Published: August 2021

Acute myeloid leukemia (AML) is a clonal hematopoietic stem and progenitor cell malignancy characterized by poor clinical outcomes. Major histocompatibility complex class I polypeptide-related sequence A and B (MICA/B) are stress proteins expressed by cancer cells, and antibody-mediated inhibition of MICA/B shedding represents a novel approach to stimulate immunity against cancers. We found that the MICA/B antibody 7C6 potently inhibits the outgrowth of AML in 2 models in immunocompetent mice. Macrophages were essential for therapeutic efficacy, and 7C6 triggered antibody-dependent phagocytosis of AML cells. Furthermore, we found that romidepsin, a selective histone deacetylase inhibitor, increased MICB messenger RNA in AML cells and enabled subsequent stabilization of the translated protein by 7C6. This drug combination substantially increased surface MICA/B expression in a human AML line, pluripotent stem cell-derived AML blasts and leukemia stem cells, as well as primary cells from 3 untreated patients with AML. Human macrophages phagocytosed AML cells following treatment with 7C6 and romidepsin, and the combination therapy lowered leukemia burden in a humanized model of AML. Therefore, inhibition of MICA/B shedding promotes macrophage-driven immunity against AML via Fc receptor signaling and synergizes with an epigenetic regulator. These results provide the rationale for the clinical testing of this innovative immunotherapeutic approach for the treatment of AML.
Targeting RIOK2 ATPase activity leads to decreased protein synthesis and cell death in acute myeloid leukemia
Authors: Messling Jan-Erik , Agger Karl , Andersen Kasper L. , Kromer Kristina , Kuepper Hanna M. , Lund Anders H. , Helin Kristian
Published: August 2021

Novel therapies for the treatment of acute myeloid leukemia (AML) are urgently needed, because current treatments do not cure most patients with AML. We report a domain-focused, kinome-wide CRISPR-Cas9 screening that identified protein kinase targets for the treatment of AML, which led to the identification of Rio-kinase 2 (RIOK2) as a potential novel target. Loss of RIOK2 led to a decrease in protein synthesis and to ribosomal instability followed by apoptosis in leukemic cells, but not in fibroblasts. Moreover, the ATPase function of RIOK2 was necessary for cell survival. When a small-molecule inhibitor was used, pharmacological inhibition of RIOK2 similarly led to loss of protein synthesis and apoptosis and affected leukemic cell growth in vivo. Our results provide proof of concept for targeting RIOK2 as a potential treatment of patients with AML.
Large scale genomic rearrangements in selected Arabidopsis thaliana T-DNA lines are caused by T-DNA insertion mutagenesis
Authors: Pucker Boas , Kleinbölting Nils , Weisshaar Bernd
Published: August 2021

Background

Experimental proof of gene function assignments in plants is based on mutant analyses. T-DNA insertion lines provided an invaluable resource of mutants and enabled systematic reverse genetics-based investigation of the functions of Arabidopsis thaliana genes during the last decades.

Results

We sequenced the genomes of 14 A. thaliana GABI-Kat T-DNA insertion lines, which eluded flanking sequence tag-based attempts to characterize their insertion loci, with Oxford Nanopore Technologies (ONT) long reads. Complex T-DNA insertions were resolved and 11 previously unknown T-DNA loci identified, resulting in about 2 T-DNA insertions per line and suggesting that this number was previously underestimated. T-DNA mutagenesis caused fusions of chromosomes along with compensating translocations to keep the gene set complete throughout meiosis. Also, an inverted duplication of 800 kbp was detected. About 10 % of GABI-Kat lines might be affected by chromosomal rearrangements, some of which do not involve T-DNA. Local assembly of selected reads was shown to be a computationally effective method to resolve the structure of T-DNA insertion loci. We developed an automated workflow to support investigation of long read data from T-DNA insertion lines. All steps from DNA extraction to assembly of T-DNA loci can be completed within days.

Conclusions

Long read sequencing was demonstrated to be an effective way to resolve complex T-DNA insertions and chromosome fusions. Many T-DNA insertions comprise not just a single T-DNA, but complex arrays of multiple T-DNAs. It is becoming obvious that T-DNA insertion alleles must be characterized by exact identification of both T-DNA::genome junctions to generate clear genotype-to-phenotype relations.
Characteristics of viral pneumonia in non-HIV immunocompromised and immunocompetent patients: a retrospective cohort study
Authors: Li Lijuan , Hsu Steven H. , Wang Chunlei , Li Binbin , Sun Lingxiao , Shi Jinying , Ren Yali , Wang Jinxiang , Zhang Xiaoqi , Liu Jiangbo
Published: August 2021

Background

Concerning viral pneumonia, few large-scale comparative studies have been published describing non-HIV immunocompromised and immunocompetent patients, but the epidemiological characteristics of different viruses or underlying diseases in immunocompromised hosts are lacking.

Methods

We retrospectively recruited patients hospitalised with viral pneumonia from six academic hospitals in China between August 2016 and December 2019. We measured the prevalence of comorbidities, coinfections, nosocomial infections, and in-hospital mortalities.

Results

Of the 806 patients, 370 were immunocompromised and 436 were immunocompetent. The disease severity and in-hospital mortality of immunocompromised patients were higher than those of immunocompetent patients. During the influenza season, an increased number of cases of influenza virus (IFV) infection were found in the immunocompromised group, followed by cases of cytomegalovirus (CMV) and respiratory syncytial virus (RSV) infection. During the non-influenza season, CMV was the main virus detected in the immunocompromised group, while RSV, adenovirus (AdV), parainfluenza virus (PIV), and rhinovirus (HRV) were the main viruses detected in the immunocompetent group. Pneumonia caused by Pneumocystis jirovecii (22.4%), Aspergillus spp. (14.1%), and bacteria (13.8%) were the most frequently observed coinfections in immunocompromised patients but not in immunocompetent patients (Aspergillus spp. [10.8%], bacteria [7.1%], and Mycoplasma spp. [5.3%]). CMV infection and infection with two-or-more viruses were associated with a higher in-hospital mortality rate than non-IFV infection. However, patients with IFV and non-IFV infection in immunocompromised patients had similar disease severity and prognosis.

Conclusions

Immunocompromised patients have a high frequency of coinfections, and a higher mortality rate was observed among those infected with CMV and two-or-more viruses. In addition, patients with IFV and non-IFV infection in immunocompromised patients had similar same disease severity and prognosis. The type of viral infection varied with seasons.
Prevalence and risk factors of postpartum depression in the Middle East: a systematic review and meta–analysis
Authors: Alshikh Ahmad Hoda , Alkhatib Asem , Luo Jiayou
Published: August 2021

Background

Postpartum depression (PPD) is a common social health problem that affects not only the mother and newborn, but extends to other family members as well as various aspects of their lives. This systematic review and meta–analysis aims to identify the prevalence and risk factors of postpartum among the women in Middle East countries.

Methods

We searched published articles from Web of Science, EMBASE, PubMed and Cochrane electronic databases to establish study articles. Articles regarding postpartum depression prevalence and associated factors among women in the Middle East were included in this systematic review and meta–analysis. A random–effect model was used for estimation of pooled postpartum depression prevalence with a 95% confidence interval (CI) and forest plot. Presence of heterogeneity was checked by Cochran's (Q) test, and funnel plots and Egger’s statistical tests were used to assess publication bias.

Results

A total of 15 studies were included in this systematic review. The studies were conducted in different countries of the Middle East between 2006 and 2020, nine of the included studies were cross–sectional studies and six were cohort studies. The overall pooled estimate of the prevalence of postpartum depression in the Middle East mothers was very high 27% (95% CI 0.19–0.35). The common risk factors reported based on our review were poor economic, pregnancy associated complications, low education, unplanned pregnancy, housewife, inadequate social support from family members and the feeding by formula. Poor economic and complication during pregnancy presented a significant relationship regarding postpartum depression in meta–analysis.

Conclusions

The prevalence of postpartum depression in the Middle East was higher than other regions of the world. In response to this, we recommend an increase of routine screening for depression during postpartum in this area. Furthermore, it might be necessary to integrate mental health with maternal health care in clinical practice during the postpartum.
TRAIL-coated leukocytes to kill circulating tumor cells in the flowing blood from prostate cancer patients
Authors: Ortiz-Otero Nerymar , Marshall Jocelyn R. , Glenn Antonio , Matloubieh Jubin , Joseph Jean , Sahasrabudhe Deepak M. , Messing Edward M. , King Michael R.
Published: August 2021

Background

Radical surgery is the first line treatment for localized prostate cancer (PC), however, several studies have demonstrated that surgical procedures induce tumor cell mobilization from the primary tumor into the bloodstream.

Methods

The number and temporal fluctuations of circulating tumor cells (CTC), cancer associated fibroblasts (CAF) and CTC cluster present in each blood sample was determined.

Results

The results show that both CTC and CTC cluster levels significantly increased immediately following primary tumor resection, but returned to baseline within 2 weeks post-surgery. In contrast, the CAF level decreased over time. In patients who experienced PC recurrence within months after resection, CTC, CAF, and cluster levels all increased over time. Based on this observation, we tested the efficacy of an experimental TNF-related apoptosis-inducing ligand (TRAIL)-based liposomal therapy ex-vivo to induce apoptosis in CTC in blood. The TRAIL-based therapy killed approximately 75% of single CTCs and CTC in cluster form.

Conclusion

Collectively, these data indicate that CTC cluster and CAF levels can be used as a predictive biomarker for cancer recurrence. Moreover, for the first time, we demonstrate the efficacy of our TRAIL-based liposomal therapy to target and kill prostate CTC in primary patient blood samples, suggesting a potential new adjuvant therapy to use in combination with surgery.
Prediction of the local treatment outcome in patients with oropharyngeal squamous cell carcinoma using deep learning analysis of pretreatment FDG-PET images
Authors: Fujima Noriyuki , Andreu-Arasa V. Carlota , Meibom Sara K. , Mercier Gustavo A. , Truong Minh Tam , Hirata Kenji , Yasuda Koichi , Kano Satoshi , Homma Akihiro , Kudo Kohsuke , Sakai Osamu
Published: August 2021

Background

This study aimed to assess the utility of deep learning analysis using pretreatment FDG-PET images to predict local treatment outcome in oropharyngeal squamous cell carcinoma (OPSCC) patients.

Methods

One hundred fifty-four OPSCC patients who received pretreatment FDG-PET were included and divided into training (n = 102) and test (n = 52) sets. The diagnosis of local failure and local progression-free survival (PFS) rates were obtained from patient medical records. In deep learning analyses, axial and coronal images were assessed by three different architectures (AlexNet, GoogLeNET, and ResNet). In the training set, FDG-PET images were analyzed after the data augmentation process for the diagnostic model creation. A multivariate clinical model was also created using a binomial logistic regression model from a patient’s clinical characteristics. The test data set was subsequently analyzed for confirmation of diagnostic accuracy. Assessment of local PFS rates was also performed.

Results

Training sessions were successfully performed with an accuracy of 74–89%. ROC curve analyses revealed an AUC of 0.61–0.85 by the deep learning model in the test set, whereas it was 0.62 by T-stage, 0.59 by clinical stage, and 0.74 by a multivariate clinical model. The highest AUC (0.85) was obtained with deep learning analysis of ResNet architecture. Cox proportional hazards regression analysis revealed deep learning-based classification by a multivariate clinical model (P < .05), and ResNet (P < .001) was a significant predictor of the treatment outcome. In the Kaplan-Meier analysis, the deep learning-based classification divided the patient’s local PFS rate better than the T-stage, clinical stage, and a multivariate clinical model.

Conclusions

Deep learning-based diagnostic model with FDG-PET images indicated its possibility to predict local treatment outcomes in OPSCCs.
Hope level and associated factors among parents of retinoblastoma patients during COVID-19 pandemic: a cross-sectional study
Authors: Zeng Changjuan , Cao Wenting , Zhao Ting , Li Li , Hou Lili
Published: August 2021

Background

The 2019 coronavirus disease (COVID-19) is a global public health emergency. So far, only a limited number of studies have investigated the impact of the COVID-19 pneumonia pandemic on the mental health of parents having children with cancer. This study investigated the hope, and relevant influencing factors (depression, anxiety, demographic data) among parents whose children had retinoblastoma (RB) during the COVID-19 pandemic.

Methods

A cross-sectional survey and a convenient sampling survey were conducted on 317 parents of RB children admitted to the Ninth People’s Hospital affiliated with Shanghai Jiao Tong University, School of Medicine, and Qilu Children’s Hospital of Shandong University. The survey tools included Demographic Questionnaire, Herth Hope Index (HHI), The Generalized Anxiety Disorder (GAD-7), and the Patient Health Questionnaires (PHQ)-2.

Results

The hope level score of the parents of RB patients was (35.36 ± 4.42), which was at the medium level. The highest dimension of hope score was inner positive readiness and expectancy (12.07 ± 1.57), and the lowest dimension was interconnectedness with self and others (11.50 ± 1.64). The incidence rate of depression and anxiety was 29.97% (95/317) and 41.32% (131/317), respectively. Monoculus or binoculus disease, sleep status, health status, and depression /anxiety had statistically significant effects on the parental hope level (p < 0.05). Multiple linear regression analysis revealed that time since diagnosis, education level, treatment type and depression were independent influencing factors (p < 0.05), accounting for 22.60% of the variation in hope level.

Conclusion

During the COVID-19 pandemic, medical staff should formulate targeted intervention measures according to different characteristics of ocular disease, time since diagnosis, treatment type, parental educational level and emotional state in order to improve the level of parental hope.
Born in Brussels screening tool: the development of a screening tool measuring antenatal psychosocial vulnerability
Authors: Amuli Kelly , Decabooter Kim , Talrich Florence , Renders Anne , Beeckman Katrien
Published: August 2021

Background

Antenatal psychosocial vulnerability is a main concern in today’s perinatal health care setting. Undetected psychosocially vulnerable pregnant women and their unborn child are at risk for unfavourable health outcomes such as poor birth outcomes or mental state. In order to detect potential risks and prevent worse outcomes, timely and accurate detection of antenatal psychosocial vulnerability is necessary. Therefore, this paper aims to develop a screening tool ‘the Born in Brussels Screening Tool (ST)’ aimed at detecting antenatal psychosocial vulnerability.

Methods

The Born in Brussels ST was developed based on a literature search of existing screening tools measuring antenatal psychosocial vulnerability. Indicators and items (i.e. questions) were evaluated and selected. The assigned points for the answer options were determined based on a survey sent out to caregivers experienced in antenatal (psychosocial) vulnerability. Further refinement of the tool’s content and the assigned points was based on expert panels’ advice.

Results

The Born in Brussels ST consists of 22 items that focus on 13 indicators: communication, place of birth, residence status, education, occupational status, partner’s occupation, financial situation, housing situation, social support, depression, anxiety, substance use and domestic violence. Based on the 168 caregivers who participated in the survey, assigned points account between 0,5 and 4. Threshold scores of each indicator were associated with adapted care paths.

Conclusion

Generalied and accurate detection of antenatal psychosocial vulnerability is needed. The brief and practical oriented Born in Brussels ST is a first step that can lead to an adequate and adapted care pathway for vulnerable pregnant women.
The impact of phased university reopenings on mitigating the spread of COVID-19: a modeling study
Authors: Rennert Lior , Kalbaugh Corey A. , McMahan Christopher , Shi Lu , Colenda Christopher C.
Published: August 2021

Background

Several American universities have experienced COVID-19 outbreaks, risking the health of their students, employees, and local communities. Such large outbreaks have drained university resources and forced several institutions to shift to remote learning and send students home, further contributing to community disease spread. Many of these outbreaks can be attributed to the large numbers of active infections returning to campus, alongside high-density social events that typically take place at the semester start. In the absence of effective mitigation measures (e.g., high-frequency testing), a phased return of students to campus is a practical intervention to minimize the student population size and density early in the semester, reduce outbreaks, preserve institutional resources, and ultimately help mitigate disease spread in communities.

Methods

We develop dynamic compartmental SARS-CoV-2 transmission models to assess the impact of a phased reopening, in conjunction with pre-arrival testing, on minimizing on-campus outbreaks and preserving university resources (measured by isolation bed capacity). We assumed an on-campus population of N = 7500, 40% of infected students require isolation, 10 day isolation period, pre-arrival testing removes 90% of incoming infections, and that phased reopening returns one-third of the student population to campus each month. We vary the disease reproductive number (Rt) between 1.5 and 3.5 to represent the effectiveness of alternative mitigation strategies throughout the semester.

Results

Compared to pre-arrival testing only or neither intervention, phased reopening with pre-arrival testing reduced peak active infections by 3 and 22% (Rt = 1.5), 22 and 29% (Rt = 2.5), 41 and 45% (Rt = 3.5), and 54 and 58% (improving Rt), respectively. Required isolation bed capacity decreased between 20 and 57% for values of Rt ≥ 2.5.

Conclusion

Unless highly effective mitigation measures are in place, a reopening with pre-arrival testing substantially reduces peak number of active infections throughout the semester and preserves university resources compared to the simultaneous return of all students to campus. Phased reopenings allow institutions to ensure sufficient resources are in place, improve disease mitigation strategies, or if needed, preemptively move online before the return of additional students to campus, thus preventing unnecessary harm to students, institutional faculty and staff, and local communities.
Provider Bias in prescribing opioid analgesics: a study of electronic medical Records at a Hospital Emergency Department
Authors: Keister Lisa A. , Stecher Chad , Aronson Brian , McConnell William , Hustedt Joshua , Moody James W.
Published: August 2021

Background

Physicians do not prescribe opioid analgesics for pain treatment equally across groups, and such disparities may pose significant public health concerns. Although research suggests that institutional constraints and cultural stereotypes influence doctors’ treatment of pain, prior quantitative evidence is mixed. The objective of this secondary analysis is therefore to clarify which institutional constraints and patient demographics bias provider prescribing of opioid analgesics.

Methods

We used electronic medical record data from an emergency department of a large U.S hospital during years 2008–2014. We ran multi-level logistic regression models to estimate factors associated with providing an opioid prescription during a given visit while controlling for ICD-9 diagnosis codes and between-patient heterogeneity.

Results

A total of 180,829 patient visits for 63,513 unique patients were recorded during the period of analysis. Overall, providers were significantly less likely to prescribe opioids to the same individual patient when the visit occurred during higher rates of emergency department crowding, later times of day, earlier in the week, later years in our sample, and when the patient had received fewer previous opioid prescriptions. Across all patients, providers were significantly more likely to prescribe opioids to patients who were middle-aged, white, and married. We found no bias towards women and no interaction effects between race and crowding or between race and sex.

Conclusions

Providers tend to prescribe fewer opioids during constrained diagnostic situations and undertreat pain for patients from high-risk and marginalized demographic groups. Potential harms resulting from previous treatment decisions may accumulate by informing future treatment decisions.
Emergency admission parameters for predicting in-hospital mortality in patients with acute exacerbations of chronic obstructive pulmonary disease with hypercapnic respiratory failure
Authors: Chen Lan , Chen Lijun , Zheng Han , Wu Sunying , Wang Saibin
Published: August 2021

Background

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common presentation in emergency departments (ED) that can be fatal. This study aimed to develop a mortality risk assessment model for patients presenting to the ED with AECOPD and hypercapnic respiratory failure.

Methods

We analysed 601 participants who were presented to an ED of a tertiary hospital with AECOPD between 2018 and 2020. Patient demographics, vital signs, and altered mental status were assessed on admission; moreover, the initial laboratory findings and major comorbidities were assessed. We used least absolute shrinkage and selection operator (LASSO) regression to identify predictors for establishing a nomogram for in-hospital mortality. Predictive ability was assessed using the area under the receiver operating curve (AUC). A 500 bootstrap method was applied for internal validation; moreover, the model’s clinical utility was evaluated using decision curve analysis (DCA). Additionally, the nomogram was compared with other prognostic models, including CRB65, CURB65, BAP65, and NEWS.

Results

Among the 601 patients, 19 (3.16%) died during hospitalization. LASSO regression analysis identified 7 variables, including respiratory rate, PCO2, lactic acid, blood urea nitrogen, haemoglobin, platelet distribution width, and platelet count. These 7 variables and the variable of concomitant pneumonia were used to establish a predictive model. The nomogram showed good calibration and discrimination for mortality (AUC 0.940; 95% CI 0.895–0.985), which was higher than that of previous models. The DCA showed that our nomogram had clinical utility.

Conclusions

Our nomogram, which is based on clinical variables that can be easily obtained at presentation, showed favourable predictive accuracy for mortality in patients with AECOPD with hypercapnic respiratory failure.
Bone mineral density predictors in long-standing type 1 and type 2 diabetes mellitus
Authors: Bilha Stefana Catalina , Leustean Letitia , Preda Cristina , Branisteanu Dumitru D. , Mihalache Laura , Ungureanu Maria-Christina
Published: August 2021

Background

Despite the increased fracture risk, bone mineral density (BMD) is variable in type 1 (T1D) and type 2 (T2D) diabetes mellitus. We aimed at comparing independent BMD predictors in T1D, T2D and control subjects, respectively.

Methods

Cross-sectional case-control study enrolling 30 T1D, 39 T2D and 69 age, sex and body mass index (BMI) – matched controls that underwent clinical examination, dual-energy X-ray absorptiometry (BMD at the lumbar spine and femoral neck) and serum determination of HbA1c and parameters of calcium and phosphate metabolism.

Results

T2D patients had similar BMD compared to T1D individuals (after adjusting for age, BMI and disease duration) and to matched controls, respectively. In multiple regression analysis, diabetes duration – but not HbA1c- negatively predicted femoral neck BMD in T1D (β= -0.39, p = 0.014), while BMI was a positive predictor for lumbar spine (β = 0.46, p = 0.006) and femoral neck BMD (β = 0.44, p = 0.007) in T2D, besides gender influence. Age negatively predicted BMD in controls, but not in patients with diabetes.

Conclusions

Long-standing diabetes and female gender particularly increase the risk for low bone mass in T1D. An increased body weight partially hinders BMD loss in T2D. The impact of age appears to be surpassed by that of other bone regulating factors in both T1D and T2D patients.
The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women
Authors: Khani Jeihooni Ali , Jormand Hanieh , Harsini Pooyan Afzali
Published: August 2021

Objective

Cervical cancer is considered treatable as long as it is detected early and managed effectively. Pap smear test is a screening tool that plays an important role in the early detection, prevention and can prevent any early cervical cell changes from becoming cancer. This study aims to survey the effect of educational programs based on beliefs, subjective norms, and perceived behavior control on doing the pap-smear test in a sample of Iranian women.

Materials and methods

This experimental interventional study was performed on 300 women admitted to Fasa City, Fars Province, Iran health centers in 2018–2019. A questionnaire consisting of demographic information, knowledge, Health Belief Model, and Theory of Planned Behavior constructs were used to measure on doing of Pap smear test in women before and after 6 months’ educational intervention.

Results

The results revealed that 6 months after the intervention, 108 women (72%) in the experimental group and only 9 women (6%) in the control group received the Pap smear test.

Conclusions

The current research results revealed that education based on the combination of the health Belief model and theory of planned behavior might be promoting participation and an increasing rate of receiving Pap smear tests in women.
Nodular malignant melanoma in vulvar skin without pigmentation: a case report
Authors: Nie Jing , Li Yan , Shen Xue , Liu Yan , Shi Haipeng , Lu Yonghong
Published: August 2021

Background

Polypoid nodule growing without apparent pigmentation on the vulvar skin usually reminds us of the diagnostic pitfall, which is commonly and mistakenly diagnosed as other types of tumors. Although there are several manifestations of amelanotic melanoma are known, these malignancies are usually pigmented because they are derived from melanocytes containing melanin. However, amelanotic melanomas are easily misdiagnosed or their diagnoses were commonly delayed due to lack of pigmentation. Therefore, a solitary polypoid nodule is worth noting and further reporting. Particularly, the clinical characteristics and outcomes of the solitary polypoid nodule are rare in Asian patients.

Case presentation

We presented an interesting case of a 33-year-old female with a solitary polypoid nodule without apparent pigmentation on her vulvar skin. Her medical history was unclear, no ulcer was seen in the lesion area, and dermatoscopy was indicated a possible tumorous change, which has caught the attention of clinicians, and then further examined by the pathologist. The final diagnosis was nodular malignant melanoma (NM) (Breslow thickness 9.5mm, Clark level 4).

Conclusions

Hence, though reviewing this case record, the relevant literature and NM-related materials, we suggest that the combination of skin imaging technology and histopathological examination could provide us a better understanding and reduce the possibility of misdiagnosis in clinic practice.
Compliance with medical recommendations depending on the use of artificial intelligence as a diagnostic method
Authors: Soellner Michaela , Koenigstorfer Joerg
Published: August 2021

Background

Advanced analytics, such as artificial intelligence (AI), increasingly gain relevance in medicine. However, patients’ responses to the involvement of AI in the care process remains largely unclear. The study aims to explore whether individuals were more likely to follow a recommendation when a physician used AI in the diagnostic process considering a highly (vs. less) severe disease compared to when the physician did not use AI or when AI fully replaced the physician.

Methods

Participants from the USA (n = 452) were randomly assigned to a hypothetical scenario where they imagined that they received a treatment recommendation after a skin cancer diagnosis (high vs. low severity) from a physician, a physician using AI, or an automated AI tool. They then indicated their intention to follow the recommendation. Regression analyses were used to test hypotheses. Beta coefficients (ß) describe the nature and strength of relationships between predictors and outcome variables; confidence intervals [CI] excluding zero indicate significant mediation effects.

Results

The total effects reveal the inferiority of automated AI (ß = .47, p = .001 vs. physician; ß = .49, p = .001 vs. physician using AI). Two pathways increase intention to follow the recommendation. When a physician performs the assessment (vs. automated AI), the perception that the physician is real and present (a concept called social presence) is high, which increases intention to follow the recommendation (ß = .22, 95% CI [.09; 0.39]). When AI performs the assessment (vs. physician only), perceived innovativeness of the method is high, which increases intention to follow the recommendation (ß = .15, 95% CI [− .28; − .04]). When physicians use AI, social presence does not decrease and perceived innovativeness increases.

Conclusion

Pairing AI with a physician in medical diagnosis and treatment in a hypothetical scenario using topical therapy and oral medication as treatment recommendations leads to a higher intention to follow the recommendation than AI on its own. The findings might help develop practice guidelines for cases where AI involvement benefits outweigh risks, such as using AI in pathology and radiology, to enable augmented human intelligence and inform physicians about diagnoses and treatments.
Pragmatic applications of implementation science frameworks to regulatory science: an assessment of FDA Risk Evaluation and Mitigation Strategies (REMS) (2014–2018)
Authors: Huynh Linda , Toyserkani Gita A. , Morrato Elaine H.
Published: August 2021

Background

A Risk Evaluation and Mitigation Strategy (REMS) is a drug safety program for certain medications with serious safety concerns required by the U.S. Food and Drug Administration (FDA) of manufacturers to implement to help ensure the benefits of the medication outweigh its risks. FDA is encouraging “the research community to develop novel methods for assessing REMS,” conveying the unmet need for a standardized evaluation method of these regulatory-mandated healthcare programs. The objective of this research is to evaluate FDA REMS assessment plans using established implementation science frameworks and identify opportunities for strengthening REMS evaluation.

Methods

A content analysis was conducted of publicly available assessment plans for all REMS programs (N = 23) approved 1/1/2014–12/31/2018 for new drug applications (NDAs) and biologics license applications (BLAs) requiring FDA-mandated Elements to Assure Safe Use (ETASU). Blinded reviewers critically appraised REMS assessment measures (n = 674) using three established implementation science frameworks: RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance); PRECEDE-PROCEED (Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation – Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development); and CFIR (Consolidated Framework for Implementation Research). Framework constructs were mapped to REMS Assessment categories as defined by FDA Guidance for Industry to evaluate congruence.

Results

REMS assessment measures demonstrated strong congruence (> 90% mapping rate) with the evaluative constructs of RE-AIM, PRECEDE-PROCEED, and CFIR. Application of the frameworks revealed that REMS assessment measures heavily emphasize implementation and operations, focus less on health outcomes, and do not evaluate program context and design assumptions.

Conclusions

Implementation science frameworks have utility for evaluating FDA-mandated drug safety programs including the selection of primary measures to determine whether REMS goals are being met and of secondary measures to evaluate contextual factors affecting REMS effectiveness in varying organizational settings.