bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Service Innovation Orientation and Open Innovation on Innovation Performance of Medium and Small Private Hospitals in India
Authors: Khan Mohammad Jamal , Ahmad Sahrish , Abdul Halim Hasliza , Ahmad Noor Hazlina
Published: August 2022

Previous studies have established the relationship between service innovation orientation, open innovation and innovation performance in context of manufacturing firms. However, studies explore service innovation orientation, open innovation and innovation performance in context of medium and small private hospitals are scarce. The main objective of the study is to investigate the relationship between service innovation orientation, open innovation and innovation performance in medium and small private hospitals in India. A quantitative study using cross-sectional survey method was performed and the data were collected from 173 medium and small private hospitals in three northern states in India using purposive sampling. The findings suggest that there is a positive relationship between service innovation orientation and open innovation. It also shows that there is a positive relationship between open innovation and innovation performance. The findings also reveal that open innovation mediates the relationship between service innovation orientation and innovation performance. The study contributes to the understanding of health practitioners and policymakers about the usefulness of service innovation and open innovation to improve the innovation performance of medium and small private hospitals.
A Scoping Review and Conceptual Framework Examining the Role of Sleep Disturbance in Financial Exploitation in Older Adults
Authors: Armendariz Jessica R. , Han S. Duke , Fung Constance H.
Published: August 2022

Sleep disturbances and financial exploitation have both been linked to impaired cognitive ability, loneliness, and depressed mood in older adults, suggesting a potential role of sleep disturbances in increasing vulnerability to financial exploitation. We sought to identify evidence linking sleep disturbances to financial exploitation. We conducted a systematic search of MEDLINE, PubMed Central, and National Center for Biotechnology Information Bookshelf for relevant published articles on sleep and financial exploitation. Three studies examining both sleep and financial exploitation were identified. None of the studies explored sleep disturbances as a cause of financial exploitation. More work needs to be done to examine the role of sleep disturbances in financial exploitation. We propose a conceptual framework for identifying possible associations among sleep disturbance, biopsychosocial, and decision-related situational factors to guide further exploration of relationships between sleep and financial exploitation.
How to harmonise variations in streetscape skeletons under zoning regulations: Considering their external diseconomies
Authors: Usui Hiroyuki
Published: August 2022

The arrangement of buildings along roads creates one of the most fundamental patterns of three-dimensional streetscape skeletons, primarily defined as a set of building heights and setbacks in a district. Under zoning regulations, building heights and setbacks are indirectly controlled by the building coverage ratio (BCR) and the floor area ratio (FAR). Variations in the BCR result in variations in streetscape skeletons. Moderate complexity of streetscape skeletons is a necessary condition for aesthetic streetscape. Understanding the relationships between variations in the BCR, building heights and setbacks is thus important in order to harmonise streetscape skeletons, smaller variations in building heights, and setbacks, however, this relationship has yet to be theoretically investigated due to the complex relationship between buildings. The objective of this paper is therefore to formulate the relationship between variations in building heights and setbacks as a function of the standard deviation of BCR, and, based on this formulation, to discuss how to indirectly harmonise variations in streetscape skeletons under zoning regulations. This formulation enables us to analytically investigate the relationship between these two functions and the standard deviation of a BCR. An indirect scheme for harmonising variations in streetscape skeletons under zoning regulations is proposed on the basis of this formulation. The external diseconomies of inharmonious streetscape skeletons are quantitatively defined in order to incentivise plot owners to harmonise streetscape skeletons. The optimal building height and setback criteria are computed, which minimises the social cost of inharmonious building heights and building setbacks in a district. This scheme for incentivising plot owners to reduce their social costs is expected to contribute to indirectly harmonising streetscape skeletons.
Palliation of Malignant Dysphagia: Dilation, Stents, Cryoablation or Photodynamic Therapy—A Surgical Perspective
Authors: Rahman Uzma , Okusanya Olugbenga T.
Published: August 2022

Esophageal cancer remains a major cause of morbidity and mortality worldwide, with a low survival rate. Patients with advanced disease most commonly present with dysphagia and weight loss. Treatment is geared toward palliation of symptoms and improved quality of life in these patients. Various treatment modalities are available for these patients, although there is no data demonstrating the superiority of any particular technique. The aim of this chapter is to review these palliative interventions while focusing on endoscopic dilation, stents, cryoablation, and photodynamic therapy.
How I Do It: ESD Versus EMR for EAC
Authors: Thota Prashanthi N. , Sanaka Madhusudhan R.
Published: August 2022

Endoscopic resection has been proven to be safe and effective for staging and treatment of early esophageal cancer. There are 2 main modalities of endoscopic resection: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). EMR entails snare excision of abnormal mucosa and is the most widely used method for resection of visible lesions in the Barrett’s neoplasia. ESD involves dissection in the submucosal plane using electrosurgical knives enabling enbloc removal of lesion irrespective of the size and therefore useful in management of T1a lesions more than 15 mm in size and in cases where EMR is not technically feasible or inadequate. The various steps in performing these 2 techniques are discussed here.
Treatment Options for Patients With Persistent Disease After Initial Endotherapy for Esophageal Neoplasia
Authors: Wong Clarence K. , Joseph Kurian , Turner Simon R.
Published: August 2022

There are numerous treatment options for esophageal dysplasia and neoplasia. Initial endoscopic therapy is the standard of care for high-risk lesions of the esophagus. However, residual and recurrent disease may be seen after initial endoscopic treatment, and selection of the optimal salvage treatment may be critical in achieving cure. Patients may be high risk for esophagectomy after assessment of risk factors such as age, frailty, and nutritional status. A wide array of salvage endoscopic eradication therapies may also be available, but consideration should be given to the initial endoscopic treatment modality, patient related risk factors, and expertise at the regional center. Chemoradiation may also play a key role in treating high risk patients and should be planned in conjunction with surgery or endoscopic therapy. Multidisciplinary team care improves survival in high-risk patients with high-risk lesions. Consideration should be given to a multidisciplinary approach after the diagnosis of dysplastic and malignant esophageal disease.
How I Teach It: Robotic Assisted Minimally Invasive Esophagectomy (RAMIE)
Authors: Kuckelman John , Marshall M. Blair
Published: August 2022

Robotic surgery has provided an attractive minimally invasive option for esophagectomy. Benefits include magnified 3D visualization, a variety of instruments with 7 degrees of motion that simplify sewing and fine dissection, as well as autonomous control of the operation with the use of 3 robotic arms. We provide a detailed review of how we perform robotic esophagectomies that conclude in the chest. A video demonstrating the crucial steps is provided. Although 3-field robotic assisted minimally invasive esophagectomy (RAMIE) is possible when needed, we will focus here on approaches with anastomosis in the chest.
How I use platelet transfusions
Authors: Stanworth Simon J. , Shah Akshay
Published: August 2022

Platelet transfusions are commonly administered for the prevention or treatment of bleeding in patients with acquired thrombocytopenia across a range of clinical contexts. Recent data, including randomized trials, have highlighted uncertainties in the risk-benefit balance of this therapy, which is the subject of this review. Hemovigilance systems report that platelets are the most frequently implicated component in transfusion reactions. There is considerable variation in platelet count increment after platelet transfusion, and limited evidence of efficacy for clinical outcomes, including prevention of bleeding. Bleeding events commonly occur despite the different policies for platelet transfusion prophylaxis. The underlying mechanisms of harm reported in randomized trials may be related to the role of platelets beyond hemostasis, including mediating inflammation. Research supports the implementation of a restrictive platelet transfusion policy. Research is needed to better understand the impact of platelet donation characteristics on outcomes, and to determine the optimal thresholds for platelet transfusion before invasive procedures or major surgery (eg, laparotomy). Platelet transfusion policies should move toward a risk-adapted approach that does not focus solely on platelet count.
Incidence and impact of anticoagulation-associated abnormal menstrual bleeding in women after venous thromboembolism
Authors: de Jong C.M.M. , Blondon M. , Ay C. , Buchmuller A. , Beyer-Westendorf J. , Biechele J. , Bertoletti L. , Colombo G. , Donadini M.P. , Hendriks S.V. , Jara-Palomares L. , Nopp S. , Ruiz-Artacho P. , Stephan P. , Tromeur C. , Vanassche T. , Westerweel P.E. , Klok F.A.
Published: August 2022

Preliminary data and clinical experience have suggested an increased risk of abnormal uterine bleeding (AUB) in women of reproductive age treated with anticoagulants, but solid data are lacking. The TEAM-VTE study was an international multicenter prospective cohort study in women aged 18 to 50 years diagnosed with acute venous thromboembolism (VTE). Menstrual blood loss was measured by pictorial blood loss assessment charts at baseline for the last menstrual cycle before VTE diagnosis and prospectively for each cycle during 3 to 6 months of follow-up. AUB was defined as an increased score on the pictorial blood loss assessment chart (>100 or >150) or self-reported AUB. AUB-related quality of life (QoL) was assessed at baseline and the end of follow-up using the Menstrual Bleeding Questionnaire. The study was terminated early because of slow recruitment attributable to the COVID-19 pandemic. Of the 98 women, 65 (66%) met at least one of the 3 definitions of AUB during follow-up (95% confidence interval [CI], 57%-75%). AUB occurred in 60% of women (36 of 60) without AUB before VTE diagnosis (new-onset AUB; 95% CI, 47%-71%). Overall, QoL decreased over time, with a mean Menstrual Bleeding Questionnaire score increase of 5.1 points (95% CI, 2.2-7.9), but this decrease in QoL was observed only among women with new-onset AUB. To conclude, 2 of every 3 women who start anticoagulation for acute VTE experience AUB, with a considerable negative impact on QoL. These findings should be a call to action to increase awareness and provide evidence-based strategies to prevent and treat AUB in this setting. This was an academic study registered at www.clinicaltrials.gov as #NCT04748393; no funding was received.
MOSCATO: a supervised approach for analyzing multi-Omic single-Cell data
Authors: Towle-Miller Lorin M. , Miecznikowski Jeffrey C.
Published: August 2022

Background

Advancements in genomic sequencing continually improve personalized medicine, and recent breakthroughs generate multimodal data on a cellular level. We introduce MOSCATO, a technique for selecting features across multimodal single-cell datasets that relate to clinical outcomes. We summarize the single-cell data using tensors and perform regularized tensor regression to return clinically-associated variable sets for each ‘omic’ type.

Results

Robustness was assessed over simulations based on available single-cell simulation methods, and applicability was assessed through an example using CITE-seq data to detect genes associated with leukemia. We find that MOSCATO performs favorably in selecting network features while also shown to be applicable to real multimodal single-cell data.

Conclusions

MOSCATO is a useful analytical technique for supervised feature selection in multimodal single-cell data. The flexibility of our approach enables future extensions on distributional assumptions and covariate adjustments.
Missed opportunities in medical therapy for patients with heart failure in an electronically-identified cohort
Authors: Mukhopadhyay Amrita , Reynolds Harmony R. , Nagler Arielle R. , Phillips Lawrence M. , Horwitz Leora I. , Katz Stuart D. , Blecker Saul
Published: August 2022

Background

National registries reveal significant gaps in medical therapy for patients with heart failure and reduced ejection fraction (HFrEF), but may not accurately (or fully) characterize the population eligible for therapy.

Objective

We developed an automated, electronic health record-based algorithm to identify HFrEF patients eligible for evidence-based therapy, and extracted treatment data to assess gaps in therapy in a large, diverse health system.

Methods

In this cross-sectional study of all NYU Langone Health outpatients with EF ≤ 40% on echocardiogram and an outpatient visit from 3/1/2019 to 2/29/2020, we assessed prescription of the following therapies: beta-blocker (BB), angiotensin converting enzyme inhibitor (ACE-I)/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), and mineralocorticoid receptor antagonist (MRA). Our algorithm accounted for contraindications such as medication allergy, bradycardia, hypotension, renal dysfunction, and hyperkalemia.

Results

We electronically identified 2732 patients meeting inclusion criteria. Among those eligible for each medication class, 84.8% and 79.7% were appropriately prescribed BB and ACE-I/ARB/ARNI, respectively, while only 23.9% and 22.7% were appropriately prescribed MRA and ARNI, respectively. In adjusted models, younger age, cardiology visit and lower EF were associated with increased prescribing of medications. Private insurance and Medicaid were associated with increased prescribing of ARNI (OR = 1.40, 95% CI = 1.02–2.00; and OR = 1.70, 95% CI = 1.07–2.67).

Conclusions

We observed substantial shortfalls in prescribing of MRA and ARNI therapy to ambulatory HFrEF patients. Subspecialty care setting, and Medicaid insurance were associated with higher rates of ARNI prescribing. Further studies are warranted to prospectively evaluate provider- and policy-level interventions to improve prescribing of these evidence-based therapies.
Impact of transient and chronic loneliness on progression and reversion of frailty in community-dwelling older adults: four-year follow-up
Authors: Chu Bin-Lin , Zhang Wen
Published: August 2022

Background

Frailty is a common condition in older adults that is characterized by transitions between frailty states in both directions (progression and reversion) over time. Loneliness has been reported to be associated with the incidence of frailty, but few studies have explored the impact of persistent loneliness over time on frailty. In this study, we aimed to whether and how two different types of loneliness, transient and chronic, were associated with changes in frailty status in older adults.

Methods

The analytic sample contained 2961 adults aged ≥ 60 years who completed interviews for both the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. The logistic regression model was used to examine the relationship between transient and chronic loneliness and progression and reversion of frailty. Demographics (age, sex, education level, marital status, urban–rural residence), living alone, chronic conditions, physical function, and depressive symptoms from the 2011 wave were adjusted.

Results

After four years, 21% of the studied sample reported progression, 20% reported reversion in frailty, 31% reported transient loneliness, and 14% reported chronic loneliness. There was no significant difference in participants who reported transient loneliness (OR = 1.10, 95% CI [0.89,1.37]), or chronic loneliness (OR = 1.14, 95% CI [0.84,1.57]) on the progression of frailty, compared with no report of loneliness. Participants reporting chronic loneliness (OR = 0.68, 95% CI [0.50,0.93]) were less likely to report reversion in their level of frailty compared to participants who did not report loneliness but not transient loneliness (OR = 0.87, 95% CI [0.70,1.08]).

Conclusions

Roughly the same percentage, a fifth, of older Chinese adults progressed or reversed in frailty status without active intervention. Chronic loneliness was related to a lower probability of reversion in the frail group than in the no loneliness group, but not in the transient loneliness group. More attention should be given to older adults with chronic loneliness.
Attitudes toward own aging and cognition among individuals living with and without dementia: findings from the IDEAL programme and the PROTECT study
Authors: Sabatini Serena , Martyr Anthony , Ukoumunne Obioha C. , Ballard Clive , Collins Rachel , Pentecost Claire , Rusted Jennifer M. , Quinn Catherine , Anstey Kaarin J. , Kim Sarang , Corbett Anne , Brooker Helen , Clare Linda
Published: August 2022

Background

It is unclear whether people with dementia (PwD) have more negative attitudes toward own aging (ATOA) than people without dementia and what factors influence ATOA among PwD. We investigated whether PwD have more negative ATOA than individuals without dementia and whether cognition and dementia subtype are associated with ATOA in PwD.

Methods

Data from the IDEAL and PROTECT studies were used to compare ATOA between 1502 PwD (mean (SD) age = 76.3 (8.5)) and 6377 individuals without dementia (mean (SD) age = 66.1 (7.1)). Linear regressions and ANOVA were used.

Results

PwD reported slightly more negative ATOA than people without dementia; this relationship disappeared after controlling for depression and self-rated health. In PwD more positive ATOA showed negligible associations with better general cognition, memory performance, verbal fluency, and visuospatial ability. However, after adjusting for covariates only better visuospatial ability predicted more positive ATOA. Additional analyses showed that before and after controlling for covariates, individuals with poorer self-reported visual acuity have more negative ATOA. Amongst dementia subtypes, people with Parkinson’s disease dementia and dementia with Lewy bodies reported most negative ATOA.

Conclusions

ATOA between PwD and people without dementia do not differ. ATOA in PwD appear to be affected not by cognitive impairment but by other characteristics that vary across dementia subtypes. Among PwD, those with Parkinson’s disease dementia and dementia with Lewy bodies may have higher risk of experiencing negative ATOA due to the motor and visual impairments that they experience.
Impact of antimalarial resistance and COVID-19 pandemic on malaria care among pregnant women in Northern Uganda (ERASE): protocol of a prospective observational study
Authors: Segala Francesco Vladimiro , Di Gennaro Francesco , Ictho Jerry , L’Episcopia Mariangela , Onapa Emmanuel , Marotta Claudia , De Vita Elda , Amone James , Iacobelli Valentina , Ogwang Joseph , Dall’Oglio Giovanni , Ngole Benedict , Murri Rita , Olal Lameck , Fantoni Massimo , Okori Samuel , Putoto Giovanni , Severini Carlo , Lochoro Peter , Saracino Annalisa
Published: August 2022

Background

Uganda accounts for 5% of all malaria cases and deaths reported globally and, in endemic countries, pregnancy is a risk factor for both acquisition of P. falciparum infection and development of severe malaria. In recent years, malaria control has been threatened by COVID-19 pandemic and by the emergence, in Northern Uganda, of both resistance to artemisinin derivatives and to sulfadoxine-pyrimethamine.

Methods

In this facility-based, prospective, observational study, pregnant women will be recruited at antenatal-care visits and followed-up until delivery. Collected data will explore the incidence of asymptomatic parasitemia and malaria-related outcomes, as well as the attitudes towards malaria prevention, administration of intermittent preventive treatment, healthcare seeking behavior and use of insecticide-treated nets. A subpopulation of women diagnosed with malaria will be recruited and their blood samples will be analyzed for detection of genetic markers of resistance to artemisinin derivatives and sulfadoxine-pyrimethamine. Also, to investigate the impact of COVID-19 on malaria care among pregnant women, a retrospective, interrupted-time series will be conducted on at the study sites for the period January 2018 to December 2021.

Discussion

The present study will explore the impact of COVID-19 pandemic on incidence of malaria and malaria-related adverse outcomes, along with the prevalence of resistance to artemisinin derivatives and to sulfadoxine-pyrimethamine. To our knowledge, this is the first study aiming to explore the combined effect of these factors on a cohort of pregnant women.

Trial registration: This study has been registered on the ClinicalTrials.gov public website on 26th April, 2022. ClinicalTrials.gov Identifier: NCT05348746.
The robust UCATR algorithm enhances the specificity and sensitivity to detect the infarct of acute ischaemic stroke within 6 hours of onset via non-contrast computed tomography images
Authors: Yu Jianping , Zhang Zhi , Xue Qingping , He Tao , Luo Chun , Zhuo Kaimin , Yang Qian , Xu Tianzhu , Zhang Jing , Xu Fan
Published: August 2022

Problem background

Early detection of acute ischemic stroke (AIS) may provide patients with benefits against harmful health and financial impacts. The use of non-contrast computed tomography images for early detect of the infarct remains controversial.

Materials & methods

Here, we used the UCATR algorithm to extract the pixel values of the infarct and the corresponding contralateral healthy area as the control surface in each NCCT slice for the whole brain. Magnetic resonance imaging results were used to verify both areas. We found significant pathological changes in the infarct compared with the corresponding contralateral healthy area in each NCCT slice.

Attained results

Our approach validated that NCCT can be used to detect the lesion area in the early stage of AIS.

Conclusions

With obvious advantages such as saving time and the ability to quantify the infarct volume, this approach could help more patients survive the fatal and irreversible pathological process of AIS and improve their quality of life after AIS treatment.
Cost of childbirth in Upper West Region of Ghana: a cross-sectional study
Authors: Dalaba Maxwell A. , Welaga Paul , Immurana Mustapha , Ayanore Martin , Ane Justina , Danchaka Laata L. , Matsubara Chieko
Published: August 2022

Background

Out-of-pocket payment (OOPP) is reported to be a major barrier to seeking maternal health care especially among the poor and can expose households to a risk of catastrophic expenditure and impoverishment.This study examined the OOPPs women made during childbirth in the Upper West region of Ghana.

Methods

We carried out a cross-sectional study and interviewed women who gave birth between January 2013 and December 2017. Data on socio-demographic characteristics, place of childbirth, as well as direct cost (medical and non-medical) were collected from respondents. The costs of childbirth were estimated from the patient perspective. Logistics regression was used to assess the factors associated with catastrophic payments cost. All analyses were done using STATA 16.0.

Results

Out of the 574 women interviewed, about 71% (406/574) reported OOPPs on their childbirth. The overall average direct medical and non-medical expenditure women made on childbirth was USD 7.5. Cost of drugs (USD 8.0) and informal payments (UDD 5.7) were the main cost drivers for medical and non-medical costs respectively. Women who were enrolled into the National Health Insurance Scheme (NHIS) spent a little less (USD 7.5) than the uninsured women (USD 7.9). Also, household childbirth expenditure increased from primary health facilities level (community-based health planning and services compound = USD7.2; health centre = USD 6.0) to secondary health facilities level (hospital = USD11.0); while home childbirth was USD 4.8. Overall, at a 10% threshold, 21% of the respondents incurred catastrophic health expenditure. Regression analysis showed that place of childbirth and household wealth were statistically significant factors associated with catastrophic payment.

Conclusions

The costs of childbirth were considerably high with a fifth of households spending more than one-tenth of their monthly income on childbirth and therefore faced the risk of catastrophic payments and impoverishment. Given the positive effect of NHIS on cost of childbirth, there is a need to intensify efforts to improve enrolment to reduce direct medical costs as well as sensitization and monitoring to reduce informal payment. Also, the identified factors that influence cost of childbirth should be considered in strategies to reduce cost of childbirth.
The acidic tumor microenvironment enhances PD-L1 expression via activation of STAT3 in MDA-MB-231 breast cancer cells
Authors: Kwon Yong-Jin , Seo Eun-Bi , Jeong Ae Jin , Lee Song-Hee , Noh Kum Hee , Lee Sangsik , Cho Chung-Hyun , Lee Chang-Han , Shin Hyun Mu , Kim Hang-Rae , Moon Hyeong-Gon , Ye Sang-Kyu
Published: August 2022

Tumor acidosis, a common phenomenon in solid cancers such as breast cancer, is caused by the abnormal metabolism of cancer cells. The low pH affects cells surrounding the cancer, and tumor acidosis has been shown to inhibit the activity of immune cells. Despite many previous studies, the immune surveillance mechanisms are not fully understood. We found that the expression of PD-L1 was significantly increased under conditions of extracellular acidosis in MDA-MB-231 cells. We also confirmed that the increased expression of PD-L1 mediated by extracellular acidosis was decreased when the pH was raised to the normal range. Gene set enrichment analysis (GSEA) of public breast cancer patient databases showed that PD-L1 expression was also highly correlated with IL-6/JAK/STAT3 signaling. Surprisingly, the expression of both phospho-tyrosine STAT3 and PD-L1 was significantly increased under conditions of extracellular acidosis, and inhibition of STAT3 did not increase the expression of PD-L1 even under acidic conditions in MDA-MB-231 cells. Based on these results, we suggest that the expression of PD-L1 is increased by tumor acidosis via activation of STAT3 in MDA-MB-231 cells.
GNAS mutation is an unusual cause of primary adrenal insufficiency: a case report
Authors: Tong Yajie , Yue Dongmei , Xin Ying , Zhang Dan
Published: August 2022

Background

Primary adrenal insufficiency in children has non-specific and extensive clinical features, so the diagnosis of its etiology is complex and challenging. Although congenital adrenal hyperplasia is the most common cause, more and more other genetic causes have been identified. GNAS mutation is easily overlooked as a rare cause of primary adrenal insufficiency. Here we firstly report a neonatal case of primary adrenal insufficiency caused by GNAS mutation.

Case presentation

A boy was diagnosed with congenital hypothyroidism 10 days post-partum and treated immediately. He also had persistent hyperkalaemia and hyponatraemia with elevated adrenocorticotropic hormone. At 70 days after birth, he was transferred to our hospital on suspicion of congenital adrenal hyperplasia. Physical examination found no other abnormalities except for growth retardation. Laboratory examination revealed increased aldosterone and normal cortisol, 17-hydroxyprogesterone, and androstenedione levels. Abnormally elevated parathyroid hormone was accompanied by normal blood calcium. Genetic assessment found a de novo, heterozygous c.432 + 1G > A variant in GNAS.

Conclusions

We report this case to highlight that GNAS mutation is an unusual cause of primary adrenal insufficiency. The combination of primary hypothyroidism and /or pseudohypoparathyroidism will provide diagnostic clues to this condition.
Parental divorce and smoking dependence in Lebanese adolescents: the mediating effect of mental health problems
Authors: Azzi Vanessa , Iskandar Katia , Obeid Sahar , Hallit Souheil
Published: August 2022

Background

Lebanon has the highest prevalence estimates among Middle Eastern countries and Arab women regarding cigarette smoking, with 43% of men and 28% of women involved in such trends. Marital disruption is a tremendous source of irritability and discomfort that may hinder a child's healthy development, creating perturbing distress and increasing disobedience that may exacerbate smoking addiction. Additionally, Lebanese adolescents are inflicted by high emotional and economic instability levels, rendering increased susceptibility to distress and propensity to engage in addictive behavior. This study aims to investigate the association between parental divorce and smoking dependence among Lebanese adolescents, along with exploring the potential mediating effect of mental health disorders of such correlation.

Methods

A total of 1810 adolescents (14 and 17 years) enrolled in this cross-sectional survey-based study (January-May 2019). Linear regressions were conducted to check for variables associated with cigarette and waterpipe dependence. PROCESS v3.4 model 4 was used to check for the mediating effect of mental health disorders between parental divorce and smoking dependence.

Results

Higher suicidal ideation and having divorced parents vs living together were significantly associated with more cigarette and waterpipe dependence. Higher anxiety was significantly associated with more waterpipe dependence. Insomnia and suicidal ideation played a mediating role between parental divorce and cigarette/waterpipe dependence.

Conclusion

Our results consolidate the results found in the literature about the association between parental divorce and smoking addiction and the mediating effect of mental health issues. We do not know still in the divorce itself or factors related to it are incriminated in the higher amount of smoking in those adolescents. Those results should be used to inspire parents about the deleterious effect of divorce on their children to lower their risk of smoking addiction. Further longitudinal studies are needed to better understand the complexity of such associations and to see whether the divorce experience by itself or the factors that accompany it are involved in the increased smoking addiction among adolescents.
Perspectives, perceived self-efficacy, and preparedness of newly qualified physicians’ in practising palliative care—a qualitative study
Authors: Oji Nwabata , Onyeka Tonia , Soyannwo Olaitan , Paal Piret , Elsner Frank
Published: August 2022

Background

Dealing with life-limiting illnesses, death, dying and grief, is uncharted territory for medical graduates. It is a field that is heavily influenced by cultural, religio-spiritual and social factors. This adds complexity to palliative and end-of-life-care, which challenges newly qualified physicians and requires the formation of appropriate knowledge, skills, and attitudes in junior doctors. This study aimed to obtain insight into the perspectives, perceived self-efficacy, and preparedness of newly qualified Nigerian physicians in practising palliative care and identify potential variables influencing them.

Methods

The study was a cross-sectional, multi-centre survey of newly qualified Nigerian physicians, using semi-structured, in-depth qualitative interviews. The data were analysed by applying content-structuring qualitative content analysis.

Results

Forty semi-structured interviews were conducted with medical house officers at two tertiary institutions in Nigeria. The perceived self-efficacy and preparedness of newly qualified Nigerian physicians in practising palliative care were reported to be higher in areas of family involvement, and pain and symptom management than in areas of breaking bad news, prognosis, and diagnosing dying. Major influences on the young physicians’ perceived self-efficacy and preparedness in practising palliative care were socio-economic circumstances of a resource-limited setting and cultural-religious considerations. In addition, the perceived impact of palliative care education and experience was documented.

Conclusions

This study offers valuable insights into the perceived self-efficacy and preparedness of newly qualified physicians and reveals the influence of socio-cultural and socio-economic variables in Nigeria. Evidence of the social, cultural, and religio-spiritual dimensions of palliative care is indispensable for culturally sensitive care. These results could aid in the development of appropriate knowledge, skills, and attitudes in newly qualified physicians through culturally and contextually appropriate palliative care training measures. The results may be applicable to other sub-Saharan African settings and may be used to improve future palliative care education, training, and practice.
NET Rounding: a novel approach to efficient and effective rounds for the modern clinical learning environment
Authors: Chan Shirley J. , Archibald Hannah L. , Conner Stephanie M.
Published: August 2022

Background

Rounds are a foundational practice in patient care and education in the inpatient healthcare environment, but increased demands on inpatient teams have led to dissatisfaction with inefficient, ineffective rounds. In this study, we describe the design, implementation, and evaluation of a novel rounding framework (“NET Rounding”) that provides behaviorally-based strategies to inpatient teams to achieve efficient rounds while preserving patient safety and education.

Methods

NET Rounding consists of nine recommendations divided into three categories: Novel rounding strategies, shared Expectations, and Time management. This framework was introduced as a bundled intervention at a single-site, quaternary-care, academic hospital from March–May 2021. Eighty-three residents and 64 attendings rotated on the inpatient teaching service during the intervention period. Participants were surveyed before, during, and after their rotation about rounding’s contribution to educational value, patient safety, resident duty hour violations and rotation experience. Additionally, rounding duration was recorded daily by team attendings.

Results

Thirty-two residents (38.5%) and 45 attendings (70%) completed post-intervention surveys. Rounding duration was recorded on 529/626 rounding days (80.6%) and resulted in achieving efficient rounds on 412/529 days (77.9%). Residents reported improvement in perceived patient safety (54 to 84%, p = 0.0131) and educational value of rounds (38 to 69%, p = 0.0213) due to NET Rounding; no change was observed amongst attendings in these areas (79 to 84% and 70 to 80%, p = 0.7083 and 0.4237, respectively). Overall, 29/32 residents (91%) and 33/45 attendings (73%) reported a positive impact on rotation experience.

Conclusions

NET Rounding enabled inpatient teaching teams to complete rounds more efficiently while preserving patient safety and education.
Identifying and adapting interventions to reduce documentation burden and improve nurses’ efficiency in using electronic health record systems (The IDEA Study): protocol for a mixed methods study
Authors: Strudwick Gillian , Jeffs Lianne , Kemp Jessica , Sequeira Lydia , Lo Brian , Shen Nelson , Paterson Petroiya , Coombe Noelle , Yang Lily , Ronald Kara , Wang Wei , Pagliaroli Sonia , Tajirian Tania , Ling Sara , Jankowicz Damian
Published: August 2022

Background

Although EHR systems have become a critical part of clinical care, nurses are experiencing a growing burden due to documentation requirements, taking time away from other important clinical activities. There is a need to address the inefficiencies and challenges that nurses face when documenting in and using EHRs. The objective of this study is to engage nurses in generating ideas on how organizations can support and optimize nurses’ experiences with their EHR systems, thereby improving efficiency and reducing EHR-related burden. This work will ensure the identified solutions are grounded in nurses’ perspectives and experiences and will address their specific EHR-related needs.

Methods

This mixed methods study will consist of three phases. Phase 1 will evaluate the accuracy of the EHR system’s analytics platform in capturing how nurses utilize the system in real-time for tasks such as documentation, chart review, and medication reconciliation. Phase 2 consists of a retrospective analysis of the nursing-specific analytics platform and focus groups with nurses to understand and contextualize their usage patterns. These focus groups will also be used to identify areas for improvement in the utilization of the EHR. Phase 3 will include focus groups with nurses to generate and adapt potential interventions to address the areas for improvement and assess the perceived relevance, feasibility, and impact of the potential interventions.

Discussion

This work will generate insights on addressing nurses’ EHR-related burden and burnout. By understanding and contextualizing inefficiencies and current practices, opportunities to improve EHR systems for nursing professional practice will be identified. The study findings will inform the co-design and implementation of interventions that will support adoption and impact. Future work will include the evaluation of the developed interventions, and research on scaling and disseminating the interventions for use in different organizations, EHR systems, and jurisdictions in Canada.
COVID-19 and hospital management costs: the Italian experience
Authors: Foglia Emanuela , Ferrario Lucrezia , Schettini Fabrizio , Pagani M. Beatrice , Dalla Bona Martina , Porazzi Emanuele
Published: August 2022

Background

This article investigates the hospital costs related to the management of COVID-19 positive patients, requiring a hospitalization (from the positivity confirmation to discharge, including rehabilitation activities).

Methods

A time-driven activity-based costing analysis, grounding on administrative and accounting flows provided by the management control, was implemented to define costs related to the hospital management of COVID-19 positive patients, according to real-word data, derived from six public Italian Hospitals, in 2020.

Results

Results reported that the higher the complexity of care, the higher the hospitalization cost per day (low-complexity = €475.86; medium-complexity = €700.20; high-complexity = €1,401.65). Focusing on the entire clinical pathway, the overall resources absorption, with the inclusion of rehabilitation costs, ranged from 6,198.02€ to 32,141.20€, dependent from the patient’s clinical condition.

Conclusions

Data could represent the baseline cost for COVID-19 hospital management, thus being useful for the further development of proper reimbursement tariffs devoted to hospitalized infected patients.
Local assessment of the immunohistochemical expression of Foxp3+ regulatory T lymphocytes in the different pathological forms associated with bovine paratuberculosis
Authors: Zapico David , Espinosa José , Fernández Miguel , Criado Miguel , Arteche-Villasol Noive , Pérez Valentín
Published: August 2022

Background

Mycobacterium avium subsp. paratuberculosis infected animals show a variety of granulomatous lesions, from focal forms with well-demarcated granulomas restricted to the gut-associated lymphoid tissue (GALT), that are seen in the initial phases or latency stages, to a diffuse granulomatous enteritis, with abundant (multibacillary) or scant (paucibacillary) bacteria, seen in clinical stages. Factors that determine the response to the infection, responsible for the occurrence of the different types of lesion, are still not fully determined. It has been seen that regulatory T cells (Treg) play an important role in various diseases where they act on the limitation of the immunopathology associated with the immune response. In the case of paratuberculosis (PTB) the role of Treg lymphocytes in the immunity against Map is far away to be completely understood; therefore, several studies addressing this subject have appeared recently. The aim of this work was to assess, by immunohistochemical methods, the presence of Foxp3+ T lymphocytes in intestinal samples with different types of lesions seen in cows with PTB.

Methods

Intestinal samples of twenty cows showing the different pathological forms of PTB were evaluated: uninfected controls (n = 5), focal lesions (n = 5), diffuse paucibacillary (n = 5) and diffuse multibacillary (n = 5) forms. Foxp3+ lymphocyte distribution was assessed by differential cell count in intestinal lamina propria (LP), gut-associated lymphoid tissue (GALT) and mesenteric lymph node (MLN).

Results

A significant increase in the number of Foxp3+ T cells was observed in infected animals with respect to control group, regardless of the type of lesion. However, when the different categories of lesion were analyzed independently, all individuals with PTB lesions showed an increase in the amount of Foxp3+ T lymphocytes compared to the control group but this increase was only significant in cows with focal lesions and, to a lesser extent, in animals with diffuse paucibacillary forms. The former showed the highest numbers, significantly different from those found in cows with diffuse lesions, where no differences were noted between the two forms. No specific distribution pattern was observed within the granulomatous lesions in any of the groups.

Conclusions

The increase of Foxp3+ T cells in focal forms, that have been associated with latency or resistance to infection, suggest an anti-inflammatory action of these cells at these stages, helping to prevent exacerbation of the inflammatory response, as occurs in diffuse forms, responsible for the appearance of clinical signs.
Targeting KRAS mutant cancers: from druggable therapy to drug resistance
Authors: Zhu Chunxiao , Guan Xiaoqing , Zhang Xinuo , Luan Xin , Song Zhengbo , Cheng Xiangdong , Zhang Weidong , Qin Jiang-Jiang
Published: August 2022

Kirsten Rat Sarcoma Viral Oncogene Homolog (KRAS) is the most frequently mutated oncogene, occurring in a variety of tumor types. Targeting KRAS mutations with drugs is challenging because KRAS is considered undruggable due to the lack of classic drug binding sites. Over the past 40 years, great efforts have been made to explore routes for indirect targeting of KRAS mutant cancers, including KRAS expression, processing, upstream regulators, or downstream effectors. With the advent of KRAS (G12C) inhibitors, KRAS mutations are now druggable. Despite such inhibitors showing remarkable clinical responses, resistance to monotherapy of KRAS inhibitors is eventually developed. Significant progress has been made in understanding the mechanisms of drug resistance to KRAS-mutant inhibitors. Here we review the most recent advances in therapeutic approaches and resistance mechanisms targeting KRAS mutations and discuss opportunities for combination therapy.
Role of adipose tissue-derived cytokines in the progression of inflammatory breast cancer in patients with obesity
Authors: Ibrahim Aya Saber , El-Shinawi Mohamed , Sabet Salwa , Ibrahim Sherif Abdelaziz , Mohamed Mona Mostafa
Published: August 2022

Background

Inflammatory breast cancer (IBC) represents a deadly aggressive phenotype of breast cancer (BC) with a unique clinicopathological presentation and low survival rate. In fact, obesity represents an important risk factor for BC. Although several studies have identified different cellular-derived and molecular factors involved in IBC progression, the role of adipocytes remains unclear. Cancer-associated adipose tissue (CAAT) expresses a variety of adipokines, which contribute to tumorigenesis and the regulation of cancer stem cell (CSC). This research investigated the potential effect of the secretome of CAAT explants from patients with BC on the progression and metastasis of the disease.

Methods

This study established an ex-vivo culture of CAAT excised from IBC (n = 13) vs. non-IBC (n = 31) patients with obesity and profiled their secretome using a cytokine antibody array. Furthermore, the quantitative PCR (qPCR) methodology was used to validate the levels of predominant cytokines at the transcript level after culture in a medium conditioned by CAAT. Moreover, the impact of the CAAT secretome on the expression of epithelial-mesenchymal transition (EMT) and cells with stem cell (CSC) markers was studied in the non-IBC MDA-MB-231 and the IBC SUM-149 cell lines. The statistical differences between variables were evaluated using the chi-squared test and unpaired a Student’s t-test.

Results

The results of cytokine array profiling revealed an overall significantly higher level of a panel of 28 cytokines secreted by the CAAT ex-vivo culture from IBC patients with obesity compared to those with non-IBC. Of note, interleukin-6 (IL-6), interleukin-8 (IL-8), and monocyte chemo-attractant protein 1 (MCP-1) were the major adipokines secreted by the CAAT IBC patients with obesity. Moreover, the qPCR results indicated a significant upregulation of the IL-6, IL-8, and MCP-1 mRNAs in CAAT ex-vivo culture of patients with IBC vs. those with non-IBC. Intriguingly, a qPCR data analysis showed that the CAAT secretome secretions from patients with non-IBC downregulated the mRNA levels of the CD24 CSC marker and of the epithelial marker E-cadherin in the non-IBC cell line. By contrast, E-cadherin was upregulated in the SUM-149 cell.

Conclusions

This study identified the overexpression of IL-6, IL-8, and MCP-1 as prognostic markers of CAAT from patients with IBC but not from those with non-IBC ; moreover, their upregulation might be associated with IBC aggressiveness via the regulation of CSC and EMT markers. This study proposed that targeting IL-6, IL-8, and MCP-1 may represent a therapeutic option that should be considered in the treatment of patients with IBC.