bluuebunny/crossref_metadata_2025 huggingface dataset:
Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report
Authors: Krug Ralf , Volland Julian , Reich Sebastian , Soliman Sebastian , Connert Thomas , Krastl Gabriel
Published: September 2020

Background To report the outcome of guided endodontic treatment (GET) of a case of dentin dysplasia with pulp canal calcification (PCC) and apical periodontitis based on the use of a 3D-printed template designed by merging cone-beam computed tomography (CBCT) and surface scan data.Case presentation A 12-year old female with radicular dentin dysplasia type I (DD-1) presented for endodontic treatment. Radiography revealed PCC in all teeth and apical radiolucency in seven teeth (15, 12, 26, 36, 32, 31 and 46). Tooth 36 had the most acute symptoms and was thus treated first by conventional access cavity preparation and root canal detection. Despite meticulous technique, the distal and mesiolingual canals were perforated. The perforations were immediately repaired with mineral trioxide aggregate, and the decision was made to switch to guided endodontic treatment for the remaining 6 teeth. CBCT and intraoral surface scans were acquired and matched using coDiagnostix planning software (Dental Wings Inc.), the respective drill positions for root canal location were determined, and templates were virtually designed and 3D-printed. The template was positioned on the respective tooth, and a customized drill was used to penetrate the calcified part of the root canal and perform minimally invasive access cavity preparation up to the apical region. All root canals were rapidly and successfully located with the templates. At 1-year follow-up, clear signs of apical healing were present in all treated teeth. Conclusions In patients with dentin dysplasia, conventional endodontic therapy is challenging. GET considerably facilitates the root canal treatment of teeth affected by dentin dysplasia.
Methicillin-resistant Staphylococcus aureus nasal carriage among janitors working in hospital and non-hospital areas: a comparative cross-sectional study
Authors: Abie Seid , Tiruneh Moges , Abebe Wondwossen
Published: September 2020

Background: Nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA) plays a key role in the epidemiology and pathogenesis of both healthcare-associated and community-acquired MRSA infections in various populations. Screening of MRSA nasal colonization is important in the prevention and control of infection and may provide useful information to guide antimicrobial therapy. This study aimed to determine nasal carriage of MRSA, its antimicrobial susceptibility pattern, and associated factors among janitors working in hospital & non-hospital areas at the University of Gondar, Northwest Ethiopia.Methods: A comparative cross-sectional study was carried out in a total of 436 study participants (221 hospital and 215 non-hospital janitors) from January to May 2019. The study participants were sampled using a simple random sampling technique. Data on socio-demographic characteristics and associated factors were collected through face to face interviews using a structured questionnaire. Nasal swabs were collected and inoculated into Mannitol salt agar. MRSA was detected using cefoxitin (30µg) disc and an antibiotic susceptibility test was done using the disc diffusion method. Data were entered and analyzed using SPSS version 20 statistical package. P-value ≤ 0.05 was considered as statistically significant.Results: The overall prevalence of S. aureus was 101/436 (23.2%, [95% CI: 19.3-27.8], of which, 29.4% (65/221) were isolated from hospital and 16.7% (36/215) non-hospital janitors. The prevalence of MRSA was 4.8% (21/436) [95% CI: 3.0-6.9]; of these, 8.1% (18/221) of the isolates were from the hospital and 1.4% (3/215) non-hospital janitors, while methicillin-sensitive S. aureus (MSSA) in hospital & non-hospital janitors were 49 (22.2%) and 31 (14.4%), respectively. Among the MRSA isolates, 52.4% (11/21) were multi-drug resistant. Of these, 42.9% (9/18) were isolated from hospital and 66.7% (2/3) non-hospital janitors. Hence, nasal carriage of MRSA was significantly associated with hospitalization within the preceding year (AOR = 3.15, CI = 1.13-8.71).Conclusion: The present study revealed that high MSSA and MRSA were isolated from the hospital as compared to non-hospital janitors and high rates of antibiotics resistance were recorded in the hospital janitors. Consequently, hospitalizations were significantly associated with MRSA. Accordingly, regular screening of carriers in apparently healthy janitors is required for the prevention of nosocomial infections.
Technology Intervention to Support Caregiving for Alzheimer's Disease (I-CARE): Study Protocol for a Randomized Controlled Pilot Trial
Authors: Braly Tyler , Muriathiri Doris , Brown Janetta C. , Taylor Britain M. , Boustani Malaz A. , Holden Richard J.
Published: September 2020

Background: Informal caregivers of patients with Alzheimer's disease and related dementias (ADRD) manage a complex spectrum of patient behavioral and psychological symptoms of dementia (BPSD). Mobile health information technologies have quickly become sources for modern social support and chronic disease management. These technologies can improve our understanding of how to care for patients with ADRD and their informal caregivers. A mobile telehealth intervention could help reduce caregiver burden and BPSD. Methods: This is a pilot randomized controlled trial of 60 dyads of patients living with ADRD and their caregivers, to test the feasibility and estimate the effect of the Brain CareNotes (BCN) mobile telehealth system. Participants will be recruited from two health systems. Participants will be randomly assigned to either the BCN intervention arm or usual care comparator. Data will be collected at baseline, 3- and 6-month follow-up. The primary objectives of this trial are to assess feasibility outcomes: (a) recruitment rate; (b) data completion; (c) BCN usability; (d) BCN acceptance; and (e) BCN use, assessed either on an ongoing basis or at 3- and 6-months post-intervention. A secondary objective was to estimate the intervention’s effects on caregiver burden and patient BPSD outcomes at 3 and 6 months, assessed by the Neuropsychiatric Inventory.Discussion: The study will assess the intervention feasibility and effect size of the BCN telehealth system as a potentially scalable and lower-cost solution for addressing the ADRD public health crisis.Trial Registration: Clinical Trials. NCT03119259. Registered 4/18/2017. Clinicaltrials.gov/ct2/show/NCT03119259
[18F]FDG PET/CT for evaluating early response to neoadjuvant chemotherapy in pediatric patients with sarcoma: a prospective single-center trial 
Authors: Polverari Giulia , Ceci Francesco , Passera Roberto , Crane Jacquelyn , Du Lin , Li Gang , Fanti Stefano , Bernthal Nicholas , Eilber Fritz C , Allen-Auerbach Martin , Czernin Johannes , Calais Jeremie , Federman Noah
Published: September 2020

Introduction: This is a prospective, single-center trial in pediatric patients with sarcoma aiming to evaluate [18F]FDG PET/CT as a tool for early response assessment to neoadjuvant chemotherapy (neo-CTX).Methods: Bone or soft tissue sarcoma patients with i) baseline [18F]FDG PET/CT within four weeks prior to the start of neo-CTX (PET1), ii) early interim [18F]FDG PET/CT (six weeks after the start of neo-CTX (PET2), iii) evaluation of neo-CTX response by histology or MRI, and iv) definitive therapy after neo-CTX (surgery or radiation) were included. Semi-quantitative PET parameters (SUVmax, SUVmean, SUVpeak, MTV and TLG) and their changes from PET1 to PET2 (ΔPET) were obtained. The primary endpoint was to evaluate the predictive value of PET1, PET2 and ΔPET parameters for overall survival (OS) and time to progression (TTP). The secondary outcome was to evaluate if [18F]FDG PET/CT can predict the response to neo-CTX assessed by histopathology or MRI. Primary and secondary outcomes were also evaluated in a sub-population of patients with bone involvement only.Results: Thirty-four consecutive patients were enrolled (10 females; 24 males; median age 15.1 years). 17/34 patients (50%) had Osteosarcoma, 13/34 (38%) Ewing Sarcoma, 2/34 (6%) synovial sarcoma and 2/34 (6%) embryonal liver sarcoma. Median follow-up was 39 months (range 16-84). Eight of 34 patients (24%) died, 9/34 (27%) were alive with disease and 17/34 (50%) had no evidence of residual/recurrent disease. Fifteen of 34 (44%) and 19/34 (56%) were responders and non-responders, respectively. PET2-parameters were associated with longer TTP (p <0.02). ΔMTV was associated with tissue response to neo-CTX (p=0.047). None of the PET1, PET2 or ΔPET parameters were associated with OS. Conclusion: [18F]FDG PET/CT performed six weeks after the start of neo-CTX can serve as an early interim biomarker for TTP and pathologic response but not for OS in pediatric patients with sarcoma.
We have the program, what now? Development of an implementation plan to bridge the research-practice gap prevalent in exercise oncology
Authors: Kennedy Mary Ann , Bayes Sara , Newton Robert U. , Zissiadis Yvonne , Spry Nigel A. , Taaffe Dennis R. , Hart Nicolas H. , Davis Michael , Eiszele Aileen , Galvão Daniel A.
Published: September 2020

Background Exercise has emerged as a promising therapy for people with cancer. Novel programs have been developed to translate research into practice; however, implementation barriers have limited their success in part because successful translation of exercise oncology research into practice requires context-specific implementation plans. The aim of this study was to employ the implementation mapping protocol to develop an implementation plan to support programming of a co-located exercise clinic and cancer treatment center.Methods The Implementation Mapping protocol, which consists of five specific iterative tasks, was used. A stakeholder advisory group advised throughout the process.Results A comprehensive needs assessment was used to identify the organization’s general manager as the program adopter; oncologists, center leaders, and various administrative staff as program implementers; and the operations manager as the program maintainer. Twenty performance objectives were identified. The theoretical domains framework was used to identify likely determinants of change, which informed the selection of eight individual implementation strategies across the individual and organizational levels. Finally, an evaluation plan was developed which will be used to measure the success of the implementation plan in the project’s next phase. Conclusion The Implementation Mapping protocol provided a roadmap to guide development of a comprehensive implementation plan that considered all ecological domains, was informed by theory, and demonstrated an extensive understanding of the implementation context. Strong research-practitioner partnerships and effective stakeholder engagement were critical to development of the plan.
Applying SF-6D to measure Health State Utilities among the Middle and Old Aged Patients with Hypertension in China
Authors: Liu Xiaohan , Bai Guannan , Li Hui , Li Shunping
Published: September 2020

Purpose: Hypertension is a growing public health problem in China; however, little is known about health-related quality of life (HRQoL) especially health state utility (HSU) of patients with hypertension in rural China. This study aimed to examine the HSU as measured by SF-6D and to investigate its associated factors among middle and old aged patients with hypertension in rural China.Methods: Data were collected from twelve villages in Shandong Province in 2016. SF-36 was administrated to measure HRQoL of middle and old aged patients with hypertension and was got to the SF-6D values using Hong Kong’s tariff. Descriptive analyses, such as demographic characteristics, socio-economic status, and utility, were stratified by hypertension classification. Multiple linear regression models were applied to assess the associated factors of HSU.Results: A total of 933(response rate:86.4%) middle and old aged patients (69.1±8.2 years) with hypertension participated in the study. 39.4% of participants were male; 44.2% had stage I hypertension; 26.4% had stage II and above. The mean score of SF-6D utility score was 0.743 (SD: 0.14, range: 0.32-1.00, median: 0.756, Interquartile range:0.634-0.859). Being female (β=-0.046), having two or more comorbidities (2 vs 1 β=-0.066; >3 vs 1 β=-0.098) and the health expenditure higher than 2000 RMB (2000-3999 vs<2000 β=-0.042; 4000-5999 vs<2000 β=-0.046; >6000 vs <2000 β=-0.071) were significantly associated with lower SF-6D overall score; while being farmer (β=0.032), having high household income (10000-14999 vs <5000 β=0.045; ＞15000 vs <5000 β=0.064) and having stage I and above hypertension (stage I vs Normotensive β=0.047; stage II vs Normotensive β=0.079; stage III vs Normotensive β=0.095) were significantly associated with higher SF-6D overall score.Conclusion: SF-6D was capable to measure quality of life middle and old aged patients with hypertension in China. And multiple factors were demonstrated to be significantly associated with quality of life.
Decoding semi-automated title-abstract screening: a retrospective exploration of the review, study, and publication characteristics associated with accurate relevance predictions
Authors: Gates Allison , Gates Michelle , DaRosa Daniel , Elliott Sarah A. , Pillay Jennifer , Rahman Sholeh , Vandermeer Ben , Hartling Lisa
Published: September 2020

Background. We evaluated the benefits and risks of using the Abstrackr machine learning (ML) tool to semi-automate title-abstract screening, and explored whether Abstrackr’s predictions varied by review or study-level characteristics.Methods. For a convenient sample of 16 reviews for which adequate data were available to address our objectives (11 systematic reviews and 5 rapid reviews) we screened a 200-record training set in Abstrackr and downloaded the relevance (relevant or irrelevant) of the remaining records, as predicted by the tool. We retrospectively simulated the liberal-accelerated screening approach. We estimated the time savings and proportion missed compared with dual independent screening. For reviews with pairwise meta-analyses, we evaluated changes to the pooled effects after removing the missed studies. We explored whether the tool’s predictions varied by review and study-level. Results. Using the ML-assisted liberal-accelerated approach, we wrongly excluded 0 to 3 (0 to 14%) records that were included in the final reports, but saved a median (IQR) 26 (9, 42) hours of screening time. One missed study was included in eight pairwise meta-analyses in one systematic review. The pooled effect for just one of those meta-analyses changed considerably (from MD (95% CI) -1.53 (-2.92, -0.15) to -1.17 (-2.70, 0.36)). Of 802 records in the final reports, 87% were correctly predicted as relevant. The correctness of the predictions did not differ by review (systematic or rapid, P=0.37) or intervention type (simple or complex, P=0.47). The predictions were more often correct in reviews with multiple (89%) vs. single (83%) research questions (P=0.01), or that included only trials (95%) vs. multiple designs (86%) (P=0.003). At the study level, trials (91%), mixed methods (100%), and qualitative (93%) studies were more often correctly predicted as relevant compared with observational studies (79%) or reviews (83%) (P=0.0006). Studies at high or unclear (88%) vs. low risk of bias (80%) (P=0.039), and those published more recently (mean (SD) 2008 (7) vs. 2006 (10), P=0.02) were more often correctly predicted as relevant. Conclusion. Our screening approach saved time and may be suitable in conditions where the limited risk of missing relevant records is acceptable. As several of our findings are paradoxical, and require further study to fully understand the tasks to which ML-assisted screening is best suited.
Exploring wealth-related inequalities in maternal and child health coverage in Latin America and the Caribbean
Authors: Colomé-Hidalgo Manuel , Campos Juan Donado , De Miguel Ángel Gil
Published: September 2020

Background. Maternal and child health have shown important advances in the world in recent years. However, national averages indicators hide large inequalities in access and quality of care in population subgroups. We explore socioeconomic inequalities affecting health coverage and interventions in reproductive, maternal, newborn, and child health in Latin America and the Caribbean. Methods. We analyzed representative national surveys from 15 countries conducted between 2001 and 2016. We estimated maternal-child health coverage gaps using the Composite Coverage Index – a weighted average of interventions that include family planning, maternal and newborn care, immunizations, and treatment of sick children. We measured absolute and relative inequality to assess gaps by wealth quintile. Pearson’s correlation coefficient was used to test the association between the coverage gap and population attributable risk. Results. The Composite Coverage Index showed patterns of inequality favoring the wealthiest subgroups. In eight countries the national coverage was higher than the global median (78.4%; 95% CI: 73.1-83.6) and increased significantly as inequality decreased (Pearson r = 0.9; p <0.01). Conclusions. There are substantial inequalities between socioeconomic groups. Reducing inequalities will improve coverage indicators for women and children. Additional health policies, programs, and practices are required to promote equity.
Pooling for SARS-CoV-2 Control in Care Institutions
Authors: Alvargonzalez Jorge J. Cabrera , Cao Sonia Rey , Castro Sonia Pérez , Lamas Lucía Martínez , Calvo Olaia Cores , Piñon Julio Torres , Fresco Jacobo Porteiro , Comesaña Julio Garcia , Garcia Benito Regueiro
Published: September 2020

BackgroundWorkers and residents in Care Homes are considered at special risk for the acquisition of SARS-CoV-2 infection, due to the infectivity and high mortality rate in the case of residents, compared to other containment areas. The role of presymptomatic people in transmission has been shown to be important and the early detection of these people is critical for the control of new outbreaks. Pooling strategies have proven to preserve SARS-CoV-2 testing resources.The aims of the present study, based in our local experience, were (a) to describe SARS-CoV-2 prevalence in institutionalized people in Galicia (Spain) during the Coronavirus pandemic and (b) to evaluate the expected performance of a pooling strategy using RT-PCR for the next rounds of screening of institutionalized people.MethodsA total of 25,386 Nasopharyngeal swab samples from the total of the residents and workers at Care Homes in Galicia (March to May 2020) were individually tested using RT-PCR. Prevalence and quantification cycle (Cq) value distribution of positives was calculated. Besides, 26 pools of 20 samples and 14 pools of 5 samples were tested using RT-PCR as well (1 positive/pool). Pooling proof of concept was performed in two populations with 1.7% and 2% prevalence.ResultsDistribution of SARS-CoV-2 infection at Care Homes was uneven (0-60%). As the virus circulation global rate was low in our area (3.32%), the number of people at risk of acquiring the infection continues to be very high. In this work, we have successfully demonstrated that pooling of different groups of samples at low prevalence clusters, can be done with a small average delay on Cq values (5 and 2.85 cycles for pools of 20 and 5 samples, respectively). ConclusionsA new screening system with guaranteed protection is required for small clusters, previously covered with individual testing. Our proposal for Care Homes, once prevalence zero is achieved, would include successive rounds of testing using a pooling solution for transmission control preserving testing resources. Scale-up of this method may be of utility to confront larger clusters to avoid the viral circulation and keeping them operative.
Clinical features of patients with hepatic portal venous gas
Authors: Fujii Manato , Yamashita Suguru , Tanaka Mayuko , Tashiro Jo , Takenaka Yoshiharu , Yamasaki Kazuki , Masaki Yukiyoshi
Published: September 2020

Background: Hepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases. However, the factors that would permit accurate identification of bowel ischemia, requiring surgery, in patients with HPVG have not been fully investigated.Methods: Thirty patients that had been diagnosed with HPVG using computed tomography between 2010 and 2019 were allocated to two groups on the basis of clinical and intraoperative findings: those with (Group 1; n=12 [40%]) and without (Group 2; n=18 [60%]) bowel ischemia. Eleven patients underwent emergency surgery, and bowel ischemia was identified in eight of these (73%). Four patients in Group 1 were diagnosed with bowel ischemia, but treated palliatively because of their general condition. We compared the characteristics and outcomes of Groups 1 and 2 and identified possible prognostic factors for bowel ischemia.Results: At admission, patients in Group 1 more commonly showed the peritoneal irritation sign, had lower base excess, higher lactate, and higher C-reactive protein, and more frequently had comorbid intestinal pneumatosis. Of the eight bowel ischemia surgery patients, four (50%) died, mainly because of anastomotic leak following bowel resection and primary anastomosis (3/4, 75%). All except one patient in Group 2, who presented with aspiration pneumonia, responded better to treatment.Conclusions: Earlier identification and grading of bowel ischemia according to the findings at admission should benefit patients with HPVG by reducing the incidence of unnecessary surgery and increasing the use of safer procedures, such as prophylactic stoma placement.
Personal Social Capital and Self-Rated Health among Middle-Aged and Older Adults: A Cross-sectional Study Exploring the Roles of Leisure-Time Physical Activity and Socioeconomic Status
Authors: Kim Youngdeok , Schneider Tim , Faß Eric , Lochbaum Marc
Published: September 2020

Background: Personal social capital, which refers to the scope and quality of an individual’s social networks within a community, has received increasing attention as a potential sociological factor associated with better individual health; yet, the mechanism relating social capital to health is still not fully understood. This study examined the associations between social capital and self-rated health while exploring the roles of leisure-time physical activity (LTPA) and socioeconomic status (SES) among middle-aged and older adults.Methods: Cross-sectional data were collected from 662 middle-aged and older adults (Mean age: 58.11±10.59 years old) using the Qualtrics survey panel. Personal Social Capital Scale was used to measure bonding and bridging social capital and the International Physical Activity Questionnaire was used to assess LTPA levels. SES was assessed by education and household income levels. Self-rated health was assessed using a single item, by which the participants were categorized into the two groups, having ‘good’ vs. ‘not good’ self-rated health. A series of univariate and multivariate logistic regression models were established to examine the independent and adjusted associations of social capital with self-rated health and to test mediating and moderating roles of LTPA and SES, respectively.Results: Bonding and bridging social capital were positively associated with self-rated health (Odds ratios = 1.11 and 1.09; P’s <.05, respectively), independent of LTPA that was also significantly associated with greater self-rated health (P-for-linear trends = .007). After adjusting SES, the associations of social capital were significantly attenuated and there was a significant interaction effect by household income (P-for-interaction = .012). Follow-up analyses stratified by household income showed that beneficial associations of social capital with self-rated health were more apparent among the people with low and high levels of household income; yet, LTPA was the stronger predictor of self-rated health among those in the middle class of household income.Conclusions: Findings suggest that both social capital and LTPA are associated with better self-rated health; yet, these associations vary by SES. The health policymakers should address both social capital and PA for enhancing perceived health among aging populations but may need to consider varying SES backgrounds.
Low Rates of All-Cause Revision in Displaced Subcapital Femoral Neck Fractures Treated with Hip Hemiarthroplasty - A Retrospective Review of 4516 Patients from a Single Institute
Authors: Yeung Chi-Yung , Tsai Shang-Wen , Wu Po-Kuei , Chen Cheng-Fong , Chang Ming-Chau , Chen Wei-Ming
Published: September 2020

Background: Femoral neck fracture (FNF) is among the commonest fractures affecting the geriatric population. Hemiarthroplasty (HA) is a standard treatment procedure and has been performed by hip surgeons for decades. Recently, primary total hip replacement has proved advantageous for the treatment of such fractures. The aim of this study is to retrospectively review all causes of failure of all patients who underwent HA in our institute and reevaluated whether HA remains a favourable choice of treatment for patients with displaced FNFs.Methods: A total of 4516 patients underwent HA at our centre from 1998 to 2017. The HA implants included unipolar and bipolar prostheses. Patients diagnosed with displaced FNF, underwent primary HA initially, required second revision procedures, and followed up for a minimum of 36 months were included in this study. Data were collected and comprehensively analysed.Results: In 4516 cases, 99 patients underwent second surgeries. The revision rate was 2.19%. Reasons for failure were acetabular wear (n = 30, 30.3%), femoral stem subsidence (n = 24, 24.2%), periprosthetic fracture (n = 22, 22.2%), infection (n = 16, 16.2%), and recurrent dislocation (n = 7, 7.1%). The mean follow-up period was 78.1 months. The interval between failed HA and revision surgery was 22.8 months.Conclusion: HA has a low revision rate and remains a favourable choice of treatment for patients with displaced FNFs.Levels of Evidence: Level III, Retrospective Cohort Study, Therapeutic Study
Adverse events of video capsule endoscopy over the past two decades: a systematic review and proportion meta-analysis
Authors: Wang Yuan-Chen , Pan Jun , Liu Ya-Wei , Sun Feng-Yuan , Qian Yang-Yang , Jiang Xi , Zou Wen-Bin , Xia Ji , Jiang Bin , Ru Nan , Zhu Jia-Hui , Linghu En-Qiang , Li Zhao-Shen , Liao Zhuan
Published: September 2020

Background: A full spectrum of video capsule endoscopy (VCE) adverse events over the past two decades has not been evaluated. We aimed to determine pooled rates, predictors and temporal-trend of VCE adverse events over the past two decades. Methods: Systematic search of PubMed and EMBASE for English-language publications reporting VCE adverse events (January 1, 2000 to March 31, 2019). Data were extracted independently by two investigators. Pooled VCE adverse event rates were calculated using the random or fixed model as appropriate. Predictors and temporal-trend of each adverse event were performed by meta-regression analyses. Results: In total, 402 studies were identified, including 108,079 VCE procedures. Rate of retention, swallow disorder, aspiration, technical failure, and procedural adverse events were 0.73% (95% confidence interval [CI], 0.59%-0.89%), 0.75% (95% CI, 0.43%-1.13%), 0.00% (95% CI, 0.00%-0.00%), 0.94% (95% CI, 0.65%-1.28%), 0.67% (95% CI, 0.32%-1.10%), respectively; incomplete examination rate of esophagus, stomach, small bowel, and colon were 9.05%, 7.69%, 12.08%, 19.19%, respectively. Patency capsule reduced retention rate by 5.04%, whereas known inflammatory bowel disease increased retention rate by 4.29%. Elder was the risk and protective factor for small bowel incomplete examination (0.30%) and swallow disorder (-0.72%), respectively. Rates of retention and small bowel incomplete examination significantly declined over time (P = .0006 and P < .0001).Conclusions: VCE adverse event rates were generally low, and retention and small bowel incomplete examination rates declined over the past two decades. Patients with known inflammatory bowel disease or elder should be alerted to high risk of retention or small bowel incomplete examination (PROSPERO: CRD42019139595).
Development and Psychometric Testing of a Questionnaire to Assess Nurse’s Perception of Risks during Enteral Nutrition
Authors: Feng Ping , Yang Huili , Xu Lan , Omorogieva Ojo , Lu Xiao-yan , Zhang Hai-ying , Wang Xiao-hua
Published: September 2020

Background: Enteral nutrition (EN) therapy is widely used in clinical practice to provide artificial nutrition to patients, while the incidence of adverse events are relatively highly. In the clinical setting, the occurrence of adverse events is associated with the nurse’s risk perception. Thus, using tool to evaluate nurse’s risk perception of enteral nutrition is necessary. Methods: The draft questionnaire with 37-items was formed by comprehensive literature reviews and semi-structured in-depth interviews with eleven nurses. Two iterations of expert consultations were used to evaluate the content validity, and 4 items were deleted in this phrase. A 33-items questionnaire was used to survey 352 nurses from five tertiary hospitals in China from May to July 2019 with convenience sampling. Content validity, construct validity and known-groups validity were evaluated by content validity index (CVI), exploratory factor analysis, and the comparisons of the different EN risk perception levels of nurses at different working departments and different educational backgrounds, respectively. Reliability was tested by internal consistency, test-retest reliability, and split-half reliability.Results: After the exploratory factor analysis, four items were excluded. Finally, the newly developed questionnaire included 29 items explaining 71.356% of the total variance. It consisted of three factors: Risks of operation (15 items); Risks of EN-related adverse events (11 items), and Risks of EN solution selection (3 items). The CVI of the questionnaire was 0.95 and the CVI of items ranged from 0.875-1.0. The results of known-groups validity showed that the nurses with different educational backgrounds had a statistically significant difference of EN risk perception (z = -3.024, p = 0.002), whereas there was not significantly different between EN risk perception of nurses working in different departments (z = -1.644, p = 0.100). The Cronbach’s α, test-retest reliability, and split-half reliability of the questionnaire were 0.967, 0.818, and 0.815, respectively. Conclusions: The newly developed questionnaire for assessing nurse’s EN risk perception showed good reliability and validity. It can be used as a tool for nursing managers to assess Chinese nurses’ EN risk perception ability, so as to help to reduce the occurrence of adverse events during EN implementation.
The technique of 3D reconstruction combining with biochemistry to build an equivalent formula of indocyanine green (ICG) clearance test to assess the liver reserve function
Authors: Zheng JinLi , Xie Wei , Huang Yang , Zhu Yunfeng , Jiang Li
Published: September 2020

Background: The indocyanine green(ICG) clearance test is the main method of evaluating the liver reserve function before hepatectomy. However, some patients may be allergic to ICG or the equipment of ICG clearance test was lack, leading to be difficult to evaluate liver reserve function. We aim to find an alternative tool to assist the clinicians to evaluate the liver reserve function for those who were allergic to the ICG or lack of equipment before hepatectomy.Methods: We retrospected 300 patients to investigate the risk factors affecting the liver reserve function and to build an equivalent formula to predict ICG 15 minutes retention rate (ICG-R15) value. Results: We found that the independent risk factors affecting ICG clearance test were total bilirubin, albumin, and spleen-to-non-neoplastic liver volume ratio (SNLR). The equivalent formula of the serological index combining with SNLR was: ICG-R15=0.36×TB (umol/L)- 0.78 × ALB(g/L) + 7.783×SNLR + 0.794×PT (s) - 0.016×PLT(/109) - 0.039× ALT (IU/L) + 0.043 × AST (IU/L) + 23.846. The equivalent formula of serum index was: ICG-R152=24.6650.382×TB (umol/L) - 0.799 × ALB(g/L) - 0.025 × PLT(/109) + 0.048 × AST(IU/L) - 0.045 × ALT(IU/L). And the area under the ROC curve (AUC) of predicting ICG-R15≥10% was 0.861 and 0.857, respectively. Conclusion: We found that SNLR was an independent risk factor affecting liver reserve function. Combining with SNLR to evaluate the liver reserve function was better than just basing on serology.
The effect of screening and treatment of Ureaplasma urealyticum infection on semen parameters in asymptomatic leukocytospermia: a case control study
Authors: Zhang Qi-Feng , Zhang Yu-Ji , Wang Sheng , Wei Yu , Li Feng , Feng Ke-Jian
Published: September 2020

Background: Ureaplasma urealyticum (UU) infection, as well as asymptomatic leukocytospermia, whether it has effect on semen parameters and whether it needs screening and treatment is still a confusing and controversial topic for clinicians.Methods: Among 1,530 adult males who visited Guilin People's Hospital due to infertility, 295 were diagnosed with asymptomatic leukocytospermia, and 95 were further screened for UU-positive. 81 UU-positive asymptomatic leukocytospermia patients received 7-day or 14-day treatment plan with doxycycline, and 70 cases were cured. The semen parameters of non-leukocytospermia, leukocytospermia, UU-positive leukocytospermia and UU-negative leukocytospermia groups were compared, and the differences between the two treatment plans and the semen parameters before UU treatment and 1 month after UU-cured were compared.Results: Compared with non-leukocytospermia patients, the sperm concentration, progressive motility (PR), and normal morphology of patients with leukocytospermia decreased, while those with UU-positive leukocytospermia performed more significantly. The PR, total motility, and normal morphology of UU-positive leukocytospermia patients were significantly lower than those of UU-negative leukocytospermia patients (all p<0.001). The UU cure rates of the 7-day and 14-day treatment plan with doxycycline was 84.62% and 89.66% (p=0.738), respectively, and the sperm concentration, PR, total motility, and normal morphology of the cured UU-positive leukocytospermia patients were all increased after 1 month (p=0.001, p=0.022, p=0.004 and p=0.008, respectively).Conclusions: It is significant to screen and treat UU infection in asymptomatic leukocytospermia for improving sperm quality. Where appropriate, the 7-day treatment plan with doxycycline may be a good choice.
EQ-5D-3L health state utility values in transfusion-dependent thalassemia patients in Malaysia : A cross-sectional assessment
Authors: Shafie Asrul Akmal , Chhabra Irwinder Kaur , Wong Jacqueline Hui Yi , Mohammed Noor Syahireen
Published: September 2020

Purpose: There is a gap of information describing the health state utility values (HSUVs) of Transfusion-dependent Thalassemia (TDT) patients in Malaysia. These values are useful in the assessment of health-related quality of life (HRQoL), economic evaluations and provide guidance to disease management decisions. The objective of this study was to estimate and derive HSUVs associated with the treatment and complications of TDT patients in Malaysia using the EQ-5D-3L instrument.Methods: A cross-sectional survey using the EQ-5D-3L instrument was conducted between May to September 2018 across various public hospitals in Malaysia. Using a multi-stage sampling, patients diagnosed with TDT and receiving iron chelating therapy were sampled. The findings on the EQ-5D-3L survey were converted into utility values using local tariff values. A two-part model was used to examine and derive the HSUVs associated with the treatment and complications of iron overload in TDT.Results: A total of 585 patients were surveyed. The unadjusted mean (SD) EQ-5D-3L utility value for TDT patients were 0.893 (0.167) while mean (SD) EQ VAS score was 81.22 (16.92). Patients who had more than two iron overload complications had a significant decline in HRQoL. Patients who were on oral monotherapy had a higher utility value of 0.9180 compared to other regimen combinations.Conclusion: Lower EQ-5D-3L utility values were associated with patients who developed iron overload complications and were on multiple iron chelating agents. Emphasizing compliance to iron chelating therapy to prevent the development of complications is crucial in the effort to preserve the HRQoL of TDT patients.
The Immediate Effect of COVID-19 Pandemic on Children and Adolescents with Obsessive Compulsive Disorder
Authors: Nissen Judith Becker , Højgaard David , Thomsen Per Hove
Published: September 2020

Background Obsessive compulsive disorder (OCD) is a distressing psychiatric disorder. Traumas may trigger or aggravate OCD symptoms. COVID-19 pandemic has coursed a global crisis and has been associated with onset of psychiatric disorders in adults. Little is known about children/adolescents with OCD. The present study aimed to examine how children/adolescents with OCD react towards COVID-19 crisis. Methods A questionnaire was distributed to two separate groups of children/adolescents. One group was a clinical group newly diagnosed at a specialized OCD clinic. All the children/adolescents had a current close contact to a therapist or doctor. The other group was a survey group identified through the Danish OCD Association. Most of these children/adolescents were diagnosed years ago, and their primary treatment was completed. For the clinical group, data from patient files was available. Results In both groups, but most pronounced in the survey group, participants experienced a worsening of their OCD, anxiety, and depressive symptoms. The aggravation of OCD correlated with the worsening of anxiety, depressive symptoms, and the extent of avoidance behavior. For both groups, OCD aggressive symptoms predicted a significant worsening. Poor baseline insight showed a trend to predict a symptom worsening. The worsening was most pronounced in children with early age of onset and a family history of attention deficit hyperactivity disorder.Conclusions To our knowledge, this is one of the first studies examining the effect of COVID-19 in children/adolescents with OCD. The effect was examined in two separate populations strengthening the findings. The study points towards an influence of the OCD phenotype, baseline insight suggesting a continued vulnerability, and a family history of psychiatric disorders. Trial registration The study is approved by the Danish Data Protection Agency (1-16-02-147-20) registered 1st of April 2020. Oral and written information was given to parents and patients and written consent from patients over 15 years and parents were received.
Risk Factors and Incidence of Suction Loss during Small Incision Lenticule Extraction (SMILE) in 8493 eyes
Authors: Huang Tian-Ze , Shen Ling , Yu Xiao-Ning , Jin Hong-Ying
Published: September 2020

Background: To report the incidence and risk factors of suction loss during small incision lenticule extraction (SMILE).Methods: This retrospective comparative case control study included 8493 eyes of 4261 patients. Patients underwent SMILE surgery between January 2014 and September 2019 were included. Videos of suction loss were reviewed, and the direct causes of suction loss were noted. An independent samples t-test was used for comparisons between the suction loss group and the control group. A binary logistic regression model was used to determine the possible significant risk factors that might increase the likelihood of suction loss during SMILE surgery.Results: Suction loss occurred in 31 (0.37%) eyes of 30 patients; 23 (74.2%) cases occurred in the right eye (the first operative eye) and 8 (25.8%) cases occurred in the left eye. Among the 30 patients, 23 (76.7%) were male and 7 (23.3%) were female. The incidence in the six consecutive years were 0%, 2.13%, 0.34%, 0.24%, 0.22%, and 0.25%. Head and eye movements during surgery caused suction loss in 16 (51.6%) and 15 (48.4%) eyes, respectively. Comparison between the suction loss group and the control group showed that the first operative eye and male gender are at a significantly high risk for suction loss (p < 0.05).Conclusions: The risk factors of suction loss were first operative eye and male gender. Head and eye movements due to patient anxiety are the most common direct causes of suction loss. Surgeon’s experience may help to reduce the incidence of suction loss. Preoperative education and better communication during surgery needs to be emphasized.Trial registration: Retrospectively registered. ChiCTR-ORC-17011040. Registered 1 April 2017. Name of registry: The observation of clinical results after corneal refractive surgery. Data of enrollment of the first participant to the trial: 1 January 2014.
The value of a method to reduce the exposure of the upper respiratory tract for predicting difficult laryngoscopy
Authors: Wu Hao , Hu Dandan , Chen Xu , Zhang Xuebing , Xia Min , Chai Xiaoqing , Wang Sheng , Zhang Wei
Published: September 2020

Background: The current global situation of COVID-19 epidemic is serious. Routine preoperative methods to assess airway such as the interincisor distance(IID), Mallampati classification, and the upper lip bite test(ULBT) have a certain risk of upper respiratory tract exposure and virus spread. The condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and the assessment method does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic.Methods: We enrolled adult patients who underwent general anesthesia and tracheal intubation. The IID, Mallampati test result, ULBT result, and the C-TMD of each patient were evaluated prior to the initiation of anesthesia. The primary outcome were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 , the number of intubation attempts and intubation time.Results: A total of 304 patients were successfully included in the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD ＞1 finger group 46.8±7.3s, compared with the C-TMD ＜1 finger group 50.8±8.6s (p＜0.01).First attempt success rate was higher in the C-TMD ＞1 finger group than in the C-TMD ＜1 finger group (P＜0.01).The correlation between the C-TMD and Cormack-Lehane Level was 0.317(Spearman correlation coefficient, P＜0.001), and the area under the ROC curve was 0.699(P＜0.01). The C-TMD <1 finger width was the most consistent with difficult laryngoscopy (κ=0.485;95%CI: 0.286-0.612) and its OR value was 10.09(95%CI: 4.19-24.28), sensitivity was 0.469(95%CI: 0.325-0.617), specificity was 0.929(95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847(95%CI :0.825-0.865).Conclusion: Compared with the IID , Mallampati classification and ULBT, the C-TMD has higher value in predicting difficult laryngoscopy, which can become a more favorable airway assessment method during the epidemic of COVID-19.Trial registration: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).
Highly Complex Magnetic Microstructures in Hierarchically Phase Separated AlCo(Cr)FeNi High-entropy Alloys
Authors: Lan Qianqian , Kovács András , Caron Jan , Du Hongchu , Song Dongsheng , Soni Vishal , Dasari Sriswaroop , Chaudhary Varun , Ramanujan Raju , Banerjee Rajarshi , Dunin-Borkowski Rafal
Published: September 2020

The hierarchical microstructures of high-entropy alloys (HEAs) can result in highly complex magnetic textures and properties. Here, we use high spatial resolution correlative magnetic, structural and chemical imaging to investigate magnetic textures in phase separated AlCoxCr1 – xFeNi (x = 0.5 and 1) HEAs. The AlCoFeNi HEA, which contains nm-sized A2 precipitates in a B2 matrix, supports large magnetic domains with small-angle magnetization variations. In contrast, the AlCo(Cr)FeNi HEA, which undergoes hierarchical phase separation, contains an unexpected distribution of magnetic vortices within individual A2 precipitates in a weakly ferromagnetic B2 host, in addition to weakly ferromagnetic or nonmagnetic B2 precipitates in large magnetic domains of the A2 phase, as well as Fe-Co-rich inter-phase A2 regions that have strong magnetization. The coercivity is attributed to a complicated magnetization reversal process, which includes the successive reversal of the magnetic vortices. These results provide important insight for the rational design of HEAs with unique and tailored magnetic properties.
A Qualitative Study of Organisational Response to National Quality Standards for 7-Day Services in English Hospitals
Authors: Sutton Elizabeth , Bion Julian , Mannion Russell , Willars Janet , Shaw Elizabeth , Tarrant Carolyn
Published: September 2020

Background National standards are commonly used as an improvement strategy in healthcare, but organisations may respond in diverse and sometimes negative ways to external quality demands. This paper describes how a sample of NHS hospital trusts in England responded to the introduction of national standards for 7-day service (7DS), from an organisational behaviour perspective. Methods We conducted 43 semi-structured interviews with executive/director level and clinical staff, in eight NHS trusts that varied in size, location, and levels of specialist staffing at weekends. We explored approaches to implementing standards locally, and the impact of organisational culture and local context on organisational response. Results Senior staff in the majority of trusts described a focus on hitting targets and achieving compliance with the standards. Compliance-based responses were associated with a hierarchical organisational culture and focus on external performance. In a minority of Trusts senior staff described mobilising commitment-based strategies. In these trusts senior staff reframed the external standards in terms of organisational values, and used co-operative strategies for achieving change. Trusts that took a commitment-based approach tended to be described as having a developmental organisational culture and a history of higher performance across the board. Audit data on 7DS showed improvement against standards for most trusts, but commitment-focused trusts were less likely to demonstrate improvements on the 7DS audit. The ability of trusts to respond to external standards was limited when they were under pressure due to a history of overall poor performance or resource limitations. Conclusions National standards and audit for service-level improvement generate different types of response in different local settings. Approaches to driving improvement nationally need to be accompanied by tailored support for improvement that takes into account local context and organisational culture.