bluuebunny/crossref_metadata_2025 huggingface dataset:
Women's Group Treatment for Substance Use Disorder
Authors: Epstein Elizabeth E. , McCrady Barbara S.
Published: July 2023

Women’s Group Treatment for Substance Use Disorder: Evidence-Based Cognitive Behavioral Therapy—Therapist Guide is a session-by-session treatment manual for therapists to use in group or individual therapy to treat women with alcohol use disorder (AUD) and other substance use disorders (SUDs) in outpatient or inpatient settings. The manual addresses the unique problems and treatment needs of women with AUD and SUD and is based on scientific evidence accumulated over 25 years. The manual provides step-by-step guidance to deliver each session, sample dialogue, informational handouts, and worksheets, and is designed to be used with the corresponding Client Workbook. This cognitive behavioral motivational enhancement program covers 12 weekly sessions to help women to become abstinent, to prevent relapse to drinking or drug use, and to improve their quality of life. Step-by-step instructions are provided for addressing behaviors around drinking and drug use and for improving general coping skills such as problem-solving, assertiveness training, wellness behaviors, and communication training. Additional female-specific interventions include enhancing clients’ social network support; building healthy, supportive relationships; and alleviating depression, anxiety and trauma symptoms.
Clinical and Group Management Issues in Women’s CBT Group for SUD
Authors: Epstein Elizabeth E. , McCrady Barbara S.
Published: July 2023

This chapter covers clinical and group management issues that are important for therapists to understand. Specific issues discussed in this chapter include handling clients’ ambivalence about change, enhancing clients’ motivation to change, setting goals, and dealing with clients who continue to drink or use drugs. Information is provided about how therapists should deal with comorbid psychological and psychiatric issues such as depression, anxiety, trauma, and suicidality. Other topics covered are physiological symptoms of withdrawal from drugs or alcohol, intimate partner violence, parenting concerns, and how to handle clients who arrive to treatment intoxicated or high. Suggestions are given for managing the group (managing time, managing group members, hybrid coping skills, and supportive group process).
Session 1: Orientation, Daily Monitoring, and Abstinence Plans
Authors: Epstein Elizabeth E. , McCrady Barbara S.
Published: July 2023

Session 1 of the Therapist Guide explains how to deliver the treatment as a closed or open group, and introduces optional graphing to monitor client progress. At the start of the session, the therapist facilitates introductions, distributes client workbooks, reviews treatment requirements, and presents an overview and rationale for the treatment. Psychoeducation is provided about women and substance use and about alcohol and drugs. The therapist presents personalized feedback to each client about her pre-treatment substance use pattern, amounts, normative data, and consequences of use. Daily self-monitoring to identify cravings, triggers, and substance use is introduced. An abstinence plan is developed with each client. In every session, clients learn how to identify high-risk situations likely to occur in the upcoming week and brainstorm strategies to cope without using alcohol or drugs. Informational handouts and practice worksheets are used. Homework is assigned.
Session 4: Enhancing Motivation to Change and Increasing Positive Consequences of Abstinence
Authors: Epstein Elizabeth E. , McCrady Barbara S.
Published: July 2023

Session 4 provides an overview of some motivational interviewing techniques for the therapist. In this session the clients will use a decisional matrix to evaluate the pros and cons of continuing or stopping their drinking or drug use. This is done in a personalized way for each client, with identification of clients’ values as a guide to their own pros and cons. Coping skills are introduced to increase the salience of positive consequences of abstinence and negative consequences of use. The group brainstorms positive alternatives that can replace alcohol/drug use to help make abstinence and recovery rewarding, thus reducing the risk of relapse. As in every session, new skills are taught in a client-centered way and the therapist encourages supportive and constructive interaction and shared wisdom among the group members.
Session 12: Relapse Prevention II, Maintenance Planning
Authors: Epstein Elizabeth E. , McCrady Barbara S.
Published: July 2023

Session 12 provides psychoeducation on slips, relapses, relapse prevention, and long-term maintenance of recovery from alcohol use disorder and substance use disorder. The therapist teaches women how to identify and respond to warning signs of a slip or relapse to alcohol or drug use, and how to handle slips or relapses if they do occur. Clients are helped to develop a relapse contract so they have a plan for relapse prevention and management of slips or relapses. As in every session, women-relevant vignettes and sample worksheets are provided. As in every session, prior skills are carried forward, each client’s abstinence plan is monitored, routine interventions are delivered, and group support is encouraged.
Session 5: Well-Being and Self-Care
Authors: Epstein Elizabeth E. , McCrady Barbara S.
Published: July 2023

Session 5 of the treatment program teaches psychological self-care via exercises that focus on identifying and replacing self-critical shame-based thoughts with self-compassion thoughts. For behavioral self-care habits, clients will learn to identify and track healthy behaviors they want to do more, as well as a more satisfying balance in life by examining their balance between “wants” and “shoulds.” These changes are designed to help clients enjoy sobriety, support and reward abstinence, and eliminate shame-based triggers to drink or use drugs. At the end of the session clients will identify upcoming high-risk situations and develop plans to cope without using alcohol or drugs. The therapist also will review homework for the upcoming week.
Session 6: Identifying Anxiety, Depression, Trauma; Coping with Cravings
Authors: Epstein Elizabeth E. , McCrady Barbara S.
Published: July 2023

Session 6 is the first of two sessions to help clients learn about, identify, and cope with symptoms of anxiety, depression, and trauma, because these are common mental health issues among women. Clients will also learn about the relationship between mood and alcohol/drug use and how they affect each other. Even clients who do not suffer from a full-blown disorder related to depression, anxiety, or trauma can benefit from identifying and understanding types of negative or distressing feelings. Clients will also learn more about what cravings to drink/use drugs are, what they mean, and how to identify them, and will develop strategies to handle cravings without drinking or using drugs. At the end of the session clients will identify upcoming high-risk situations and develop plans to cope without using alcohol or drugs. The therapist also will review homework for the upcoming week.
Session 7: Affect and Mood Management
Authors: Epstein Elizabeth E. , McCrady Barbara S.
Published: July 2023

Session 7 expands on material from Session 6 and teaches clients about the relationship between their “automatic thoughts” and feelings. It lists different types of thoughts that are not usually helpful because they tend to aggravate bad moods; sometimes these types of thoughts are called “thinking errors.” Clients will learn to identify unhelpful thoughts and how these thoughts make them feel, and to cope with these thoughts by challenging and replacing them with more helpful thoughts, or by stepping back and letting them go using acceptance and mindfulness strategies. Clients will recognize and track unhelpful automatic thoughts going forward. They will also learn additional strategies to de-stress and to regulate strong negative emotions. At the end of the session clients will identify upcoming high-risk situations and develop plans to cope without using alcohol or drugs. the therapist also will review homework for the upcoming week.
Can Informal Providers Be Trained to Provide Good Quality Care?
Authors: Shefa Sikder Shegufta
Published: July 2023

Healthcare providers without formal medical qualifications provide care in many rural and resource-denied areas. Although some advocate closing off access to these informal providers due to safety and ethical concerns, this study looks at whether training these informal providers may be one way to improve access to care and the quality of care where few alternatives exist. This randomized controlled trial assessed a program that provided 72 sessions of training over 9 months to informal providers. The study found that training informal providers increased correct case management rates, and the authors posit that this may offer a short-term strategy to improve healthcare outcomes and access.
A Participatory Intervention with Women’s Groups for Reducing Neonatal Mortality and Maternal Depression
Authors: Raithatha Shyamsundar J.
Published: July 2023

The states of Jharkhand and Odisha in India are home to a large percentage of indigenous (Adivasi) population. This population remains underserved, with high rates of unemployment, low literacy, and comparatively poor health indicators. Neonatal mortality still remains a concern, and high rates of maternal depression have been documented. This study shows that a community intervention, the participatory learning and action cycle (PLA), for addressing health problems resulted in a 32% reduction in the odds of neonatal mortality largely by improvements in home–care practices during delivery. This study was included as a result of the staggering reduction in neonatal mortality, and it is possible that the use of this method can be extrapolated to address other health problems at a community level.
A Case Management Strategy for Treating Childhood Pneumonia in a Community Setting?
Authors: Werdenberg Jennifer
Published: July 2023

Acute respiratory infections are one of the commonest causes of childhood mortality globally. This meta-analysis looks at the efficacy of utilizing a case-management strategy to decrease infant and under-5 mortality due to pneumonia. As a result of this intervention, infant mortality overall rate reduction was 15.9% (95% CI 10.6–21.1) deaths/1000 live births, and mortality rate in children under 5 decreased by 36 deaths/1000 live births. Case-management of pneumonia, typically combined with the simultaneous targeting of interventions for other leading causes of childhood mortality, continues to be an important healthy delivery strategy.
Does Home-Based Neonatal Care of Sepsis Improve Neonatal Mortality?
Authors: Lusk Rachel
Published: July 2023

The neonatal mortality rate is significantly higher in developing nations where most neonates are born at home and may not be brought to the hospital for care when ill, either due to traditional beliefs, hesitancy to go to the hospital, or barriers in accessing hospital-level care. In an attempt to bridge this gap, this study looks at the use of community health workers to provide education and home-based neonatal care, including management of sepsis for those who refuse hospital care. As a result, the neonatal mortality rates in rural India were reduced from 59.6 per 1000 live births in the control group to 25.5 in the intervention group by year 3 of the intervention period. This study raises ethical concerns.
Gender Disparity and Heart Diseases in South Africa
Authors: Kole Abhisake
Published: July 2023

Evidence shows a disparity between cardiovascular disease (CVD) and outcomes in men vs. women. Studies from high-income countries (HICs) show that women with CVD were less likely to be prescribed statins or aspirin, and mortality after myocardial infarction is higher in women. This study looked at CVD risk factor distribution by gender, and found that women had a disproportionately higher rate of CVD. Additionally, 55.8% of men had 3 or more risk factors for CVD under control, compared to only 34.2% of women. This chapter was included because it demonstrates that sex is an important social determinant of health globally.
Can Social Interventions Prevent Tuberculosis?
Authors: Tate Erica
Published: July 2023

Associations have been drawn between social factors such as adequate nutrition and the incidence of tuberculosis (TB) disease progression. The original Papworth experiment analyzed the incidence rates of TB infection, disease, and death in 315 children living in the Papworth Village Settlement during 1918–1935. The Village provided various social interventions such as stable employment, housing, medical supervision, and nutrition during the pre-chemotherapy and pre-Bacillus Clamette Guerin (BCG) era. This study reanalyzed data from the Papworth experiment and shows the importance of social factors, such as housing, nutrition, and access to medical care, in decreasing TB disease and death rates in close contact with household members.
Socioeconomic Status and Heart Disease
Authors: Bradke Amanda
Published: July 2023

The original Whitehall study demonstrated an inverse association between mortality rates and social class by stratifying coronary heart disease (CHD) deaths by employment grade among a cohort of British civil service office workers. Importantly, these differences were only partially explained by well-established heart health risk factors, such as smoking and obesity. Whitehall II thus aimed to investigate additional causes of these observed differences by using a similar, but more contemporary population that included women. The study found an inverse relationship between employment grade and prevalence of angina, EKG evidence of ischemia, and symptoms of chronic bronchitis. Persons in lower-status jobs had worse self-perceived health status with less feeling of control over their health, some increased health-risk behaviors, lower economic status, and worse scores regarding social circumstances at work and social supports. When similar populations were compared, there was no diminishing difference in morbidity over the 20 years between the two studies.
Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa
Authors: Ue Frances
Published: July 2023

Results from another study incidentally showed that mass administration of azithromycin for trachoma (the world’s leading cause of preventable blindness of infectious origin) may reduce childhood mortality. The authors of this study looked to verify this, giving children in the intervention group oral azithromycin twice a year for 2 years. Childhood mortality was 13.5% lower in communities in the azithromycin group than in the placebo group. However, there was also an increase in macrolide-resistant Streptococcus pneumoniae in the azithromycin group. This study was included due to the ethical considerations it raises in performing mass administration of an important drug.
Prevention of HIV
Authors: Wong Lena
Published: July 2023

PrEP (pre-exposure prophylaxis) is the prevention of choice for people at “substantial risk” of HIV infection. This trial not only randomized serodiscordant heterosexual couples to pre-exposure prophylaxis, but also gave all participants HIV-1 testing with counseling, risk-reduction counseling, screening and treatment for sexually transmitted infections, free condoms, and referral for male circumcision and post-exposure prophylaxis according to national policies. This trial found an overall relative reduction in HIV acquisition of 67% with tenofovir disoproxil fumarate (TDF) alone and 75% with tenofovir/emtricitabine (TDF/FTC) compared with placebo. This shows that pre-exposure prophylaxis is an effective way to prevent HIV transmission among heterosexual partners.
When to Start HIV Treatment? A Global Question
Authors: Goldman Robin , Constant Georgery
Published: July 2023

With advances in treatment, human immunodeficiency virus (HIV) can be managed as a chronic disease. However, prior to 2015, there was little data about the timing of starting antiretroviral therapy (ART) for patients with CD4+ counts >500 cells per cubic millimeter. The START trial randomized patients into immediate initiation of ART at diagnosis or deferred initiation of ART until CD4+ counts were less than 350 cells/mm3, or the patient developed an AIDS-defining condition or another condition requiring the initiation of treatment. The primary endpoint of the study was a composite of HIV-related illness, other illness, and mortality. The trial was stopped early based on interim analyses with the conclusion that immediate initiation of antiretroviral combination therapy for persons diagnosed with HIV, regardless of CD4+ count, provided benefits in terms of health outcomes.
Safety and Efficacy of Sulfamethoxazole/Trimethoprim Chemoprophylaxis for Pneumocystis carinii Pneumonia in AIDS
Authors: Shipton Linda
Published: July 2023

The safety and efficacy of sulfamethoxazole and trimethoprim for the prevention of Pneumocystis carinii pneumonia in patients with AIDS were evaluated. Sixty patients with AIDS-associated Kaposi’s sarcoma but no history of other opportunistic infections were included in the study. Antiretroviral therapy was not available at the time of this study. Half received sulfamethoxazole and trimethoprim preventive therapy and another half did not. None of the patients in the sulfamethoxazole and trimethoprim group developed Pneumocystis carinii pneumonia compared to 53% in the control group. While death from opportunistic infections was high in both groups, the mean length of survival was longer and the proportion of patients alive at the end of the study was greater in the trimethoprim and sulfamethoxazole group. Side effects of the trimethoprim and sulfamethoxazole were common.
Impact of Improved Treatment of Sexually Transmitted Diseases on HIV Infection in Rural Tanzania
Authors: Sautter Casey , Shields Ryan , Hakizimana Sadoscar
Published: July 2023

Community-based preventive health interventions have been advocated by organizations such as the World Health Organization (WHO) since the 1980s; however, the efficacy of the recommendations had never been studied in randomized controlled trials. This is the first randomized trial to demonstrate an impact of a preventive intervention on HIV incidence in the general population living in areas with high prevalence of STD co-infection. The authors show that protocolized syndromic STD treatment reduced HIV incidence by about 40% in a rural population.
Artesunate versus Quinine for Severe Falciparum Malaria
Authors: Baidya Anurima
Published: July 2023

Plasmodium falciparum is one of the deadliest species of Plasmodium that causes malaria in humans and is responsible for approximately 50% of all malaria infections. This multi-center, open-label, randomized trial determined that parenteral artesunate effectively reduces mortality by 7% compared with quinine (15% vs. 22% for artesunate and quinine, respectively) and should become the treatment of choice for severe P. falciparum malaria cases in adults. The findings from this study underpinned the inclusion of parenteral artesunate as an effective regimen for the treatment of severe malaria globally.
Efficacy of Zinc to Control Diarrhea in Developing Nations
Authors: Keough Colleen
Published: July 2023

Acute diarrhea remains a leading cause of childhood deaths, with up to 2.5 million deaths estimated annually among children below 5 years of age. Zinc likely plays an important role in modulating the host resistance to infectious agents. This double-blind randomized controlled trial conducted in New Delhi, India, demonstrates that in pediatric populations likely to have a high prevalence of zinc deficiency and malnutrition, zinc supplementation during episodes of diarrhea results in a 39% reduction in the mean number of watery stools per day and a 21% reduction in the number of days with watery stools. The number of emesis was same both groups.
Bubble CPAP as a Cost-Effective Technology to Reduce Need for Mechanical Ventilation in Neonates
Authors: Walker Andrea
Published: July 2023

This observational study looks at the introduction of an alternative technique for ventilatory support, bubble CPAP, in a referral hospital in a developing nation. The use of bubble CPAP was associated with a 50% reduction in the need for mechanical ventilation with no difference in mortality. Importantly, bubble CPAP could be initiated and administered by nurses after only 1–2 months of on-the-job training, and the cost of the machine is significantly cheaper, it requires less expertise to administer, and it has fewer risks than mechanical ventilation. This makes bubble CPAP an excellent option for higher-level neonatal care in resource-limited areas.
What Is a Cost-Effective Way to Screen for Cervical Cancer in Resource-Denied Settings?
Authors: Sirna Stephanie
Published: July 2023

As a result of resource-intensive cytology-based cervical cancer screening programs, cervical cancer incidence has decreased substantially in high-income countries, with 85% of cases now occurring in low- and middle-income countries (LMICs). This is largely due to lack of screening and lack of human papillomavirus (HPV) vaccine access. Alternative screening with visual inspection with acetic acid (i.e., vinegar [VIA]) has been utilized as a method to detect and treat cervical dysplasia with fewer visits and resources. This randomized cohort study showed that VIA screening is an effective method to prevent cervical cancer in developing countries, resulting in a 25% reduction in cervical cancer incidence and a 35% reduction in cervical cancer mortality in the intervention group.
Unavailability of Cardiac Catheterization
Authors: Olds Peter
Published: July 2023

Ischemic heart disease is one of the most common causes of mortality across the globe. The standard of care for acute myocardial infarction (MI) is percutaneous coronary intervention (PCI), which remains woefully unavailable to the majority of the population in the Global South due to structural and economic inequities. Hence, the ISIS-2 study, which was done in 1988, remains relevant in locations where PCI is unavailable. This study was done to assess the efficacy of streptokinase and aspirin, alone and in combination, on vascular mortality in patients with acute MI. Streptokinase and aspirin reduced the odds of 5-week mortality by 25% and 23%, respectively, compared with those receiving placebo. The combination of streptokinase and aspirin led to a 42% reduction in the odds of mortality at 5 weeks, compared with those receiving placebo. Hence, in patients who present with acute MI, the combination of streptokinase and aspirin is safe and effective and remains the cornerstone of ST Elevation Myocardial Infarction (STEMI) care in regions where PCI is unavailable.
Do Checklists Improve Surgical Outcomes in Under-Resourced Settings?
Authors: Shah Priyansh , Mohan Monali , Gadgil Anita , Roy Nobhojit
Published: July 2023

Surgery is a vital medical service that can prevent loss of life or limb but is also associated with risk of death and complications—half of which are likely to be avoidable. The World Health Organization (WHO) published guidelines identifying multiple best practices to ensure the safety of surgical patients worldwide. This study performed across 8 hospitals in 8 cities across 5 continents by the Safe Surgery Saves Lives Study Group shows the implementation of the checklist reduced the overall death rate by 47% and complications by 36% after introduction of the checklist. The overall rates of surgical-site infection declined from 6.2% to 3.4% (p <0.001).
Powerful Doctors and Underfunded Public Health
Authors: Navin Mark C. , Attwell Katie
Published: July 2023

Physicians and their professional societies have played an important but often troubling role in the governance of immunization in America. Throughout the 20th century, physician professional organizations often derailed attempts to build a functional American public health system. If such a system had been created, it could have delivered free vaccines and effective health promotion to the public. More recently, the American Medical Association and the American Academy of Pediatrics have called for more coercive mandatory vaccination policies. America’s immunization governance has an unfortunate history of seeking to punish rather than provide, and the political activities of physicians have been a significant driver of that dynamic.
Conclusion
Authors: Navin Mark C. , Attwell Katie
Published: July 2023

America possesses the vaccines it needs to protect the community, but the country’s immunization social order appears to be breaking down. Decreased public trust erodes the potential for vaccination to be a consensus public project, and the decline of liberal democratic government undermines the legitimacy of vaccine mandates. Furthermore, even as voluntary vaccination programs may not achieve sufficiently high vaccination rates to prevent outbreaks, coercive measures will create backfire effects, reduce public trust, and fuel political polarization. In the face of failing governance, America’s public health institutions—and individual Americans—should prepare for a world in which outbreaks of vaccine-preventable diseases are more common. Drawing parallels with the current climate crisis, this chapter lays out a future of adaptation and mitigation for dealing with resurgent vaccine-preventable diseases.
The co-evolution of strong AGN and central galaxies in different environments
Authors: Sampaio V M , Aragón-Salamanca A , Merrifield M R , de Carvalho R R , Zhou S , Ferreras I
Published: July 2023

We exploit a sample of 80 000 Sloan Digital Sky Survey central galaxies to investigate the effect of active galactic nucleus (AGN) feedback on their evolution. We trace the demographics of optically selected AGN (Seyferts) as a function of their internal properties and environment. We find that the preeminence of AGN as the dominant ionizing mechanism increases with stellar mass, overtaking star formation for galaxies with Mstellar ≥ 1010 M⊙. The AGN fraction changes systematically with the galaxies’ star formation activity. Within the blue cloud, this fraction increases as star formation activity declines, reaching a maximum near the green valley (${\sim} 17 \pm 4~{{\ \rm per\ cent}}$), followed by a decrease as the galaxies transition into the red sequence. This systematic trend provides evidence that AGN feedback plays a key role in regulating and suppressing star formation. In general, Seyfert central galaxies achieve an early-type morphology while they still host residual star formation. This suggests that, in all environments, the morphology of Seyfert galaxies evolves from late- to early-type before their star formation is fully quenched. Stellar mass plays an important role in this morphological transformation: while low-mass systems tend to emerge from the green valley with an elliptical morphology (T-Type ∼ −2.5 ± 0.7), their high-mass counterparts maintain a spiral morphology deeper into the red sequence. In high-stellar mass centrals, the fraction of Seyferts increases from early- to late-type galaxies, indicating that AGN feedback may be linked with the morphology and its transformation. Our analysis further suggests that AGN are fuelled by their own host halo gas reservoir, but when in group centrals can also increase their gas reservoir via interactions with satellite galaxies.
Clash of Titans: the impact of cluster mergers in the galaxy cluster red sequence
Authors: Aldás Franklin , Zenteno Alfredo , Gómez Facundo A , Hernandez-Lang Daniel , Carrasco Eleazar R , Vega-Martínez Cristian A , Nilo Castellón J L
Published: July 2023

Merging of galaxy clusters are some of the most energetic events in the Universe, and they provide a unique environment to study galaxy evolution. We use a sample of 84 merging and relaxed SPT galaxy clusters candidates, observed with the Dark Energy Camera in the 0.11 < z < 0.88 redshift range, to build colour–magnitude diagrams to characterize the impact of cluster mergers on the galaxy population. We divided the sample between relaxed and disturbed, and in two redshifts bin at z = 0.55. When comparing the high-z to low-z clusters we find the high-z sample is richer in blue galaxies, independently of the cluster dynamical state. In the high-z bin, we find that disturbed clusters exhibit a larger scatter in the red sequence, with wider distribution and an excess of bluer galaxies compared to relaxed clusters, while in the low-z bin we find a complete agreement between the relaxed and disturbed clusters. Our results support the scenario in which massive cluster halos at z < 0.55 galaxies are quenched as satellites of another structure, i.e. outside the cluster, while at z ≥ 0.55 the quenching is dominated by in situ processes.
Revisiting the mass of open clusters with Gaia data
Authors: Almeida Anderson , Monteiro Hektor , Dias Wilton S
Published: July 2023

The publication of the Gaia catalogue and improvements in methods to determine memberships and fundamental parameters of open clusters has led to major advances in recent years. However, important parameters such as the masses of these objects, although being studied mostly in some isolated cases, have not been addressed in large homogeneous samples based on Gaia data, taking into account details such as binary fractions. Consequently, relevant aspects such as the existence of mass segregation were not adequately studied. Within this context, in this work, we introduce a new method to determine individual stellar masses, including an estimation for the ones in binary systems. This method allows us to study the mass of open clusters, as well as the mass functions of the binary star populations. We validate the method and its efficiency and characterize uncertainties using a grid of synthetic clusters with predetermined parameters. We highlight the application of the method to the Pleiades cluster, showing that the results obtained agree with the current consensus in the literature as well as recent Gaia data. We then applied the procedure to a sample of 773 open clusters with fundamental parameters determined using Gaia Early Data Release 3 data, obtaining their masses. Subsequently, we investigated the relation between the masses and other fundamental parameters of the clusters. Among the results, we found no significant evidence that clusters in our sample lose and segregate mass with age.
Reducing Tubing and Device Misconnections
Authors: Mazzella Dana
Published: July 2023

Purpose:

The aim of this quality improvement (QI) project was to explore prevention strategies to reduce tubing and device misconnections that cause patient harm and death. Practicing evidence-based techniques can improve rates of nursing-sensitive indicators, such as central line–associated bloodstream infections, and increase patient safety.

Methods:

Our nursing quality management team reviewed internal quality data and found 11 reported misconnections. A literature review was performed to identify recommended prevention strategies that have been used to improve patient outcomes. Recommended strategies included promoting environmental safety, providing adequate education to clinicians on adverse events, performing line tracing and line reconciliation, and reporting all errors in real time.

The nursing quality management team provided education on recommended best practices to prevent misconnection to various stakeholders. Nursing policies and standards of care were revised to include the practice of line tracing and line reconciliation during handoff, admission, transfers, and clinical tests and procedures.

Results:

The nursing quality management team gathered postimplementation data on education and policy changes. Two incidents of misconnection occurred within four months. In their reports, clinicians adopted the language of line tracing and line reconciliation when describing the events and actions performed.

Conclusion:

Implementation of prevention strategies, including adequate education, enabled staff to identify the risk of misconnections and potential adverse events. Clinical staff incorporated line tracing and reconciliation into their practice, improving patient outcomes.
Improving Sickle Cell Disease Care
Authors: Jackson Andrea
Published: July 2023

Research into sickle cell disease (SCD), which disproportionately affects historically underserved ethnic and racial groups, lacks funding and resources. The Centers for Disease Control and Prevention's Sickle Cell Data Collection program is a comprehensive data registry that gathers information about disease prevalence, outcomes, and the type of care patients receive, but it's only currently active in 11 states. This article describes nurses' ethical responsibility to participate in policy work and to advocate for funding for this program, as well as the importance of sharing their perspectives on caring for people who have SCD with legislative representatives.
Compassionate Care for People with Cancer and Opioid Use Disorder
Authors: Jones Katie Fitzgerald , Broglio Kathleen , Ho J. Janet , Rosa William E.
Published: July 2023

Opioid use disorder (OUD) is an important comorbidity to assess and manage in people with cancer. In this article, the authors discuss strategies for safe opioid management in individuals with OUD and cancer-related pain using a composite case example. They highlight core approaches to pain management, including motivational interviewing, harm reduction, and evidence-based treatments, as well as advocacy for person-centered end-of-life care.
Emerging Strategies in 3D Culture Models for Hematological Cancers
Authors: Barozzi Dafne , Scielzo Cristina
Published: July 2023

In vitro cell cultures are fundamental and necessary tools in cancer research and personalized drug discovery. Currently, most cells are cultured using two-dimensional (2D) methods, and drug testing is mainly performed in animal models. However, new and improved methods that implement three-dimensional (3D) cell-culturing techniques provide compelling evidence that more advanced experiments can be performed, yielding valuable new insights. In 3D cell-culture experiments, the cell environment can be manipulated to mimic the complexity and dynamicity of the human tissue microenvironment, possibly leading to more accurate representations of cell-to-cell interactions, tumor biology, and predictions of drug response. The 3D cell cultures can also potentially provide alternative ways to study hematological cancers and are expected to eventually bridge the gap between 2D cell culture and animal models. The present review provides an overview of the complexity of the lymphoid microenvironment and a summary of the currently used 3D models that aim at recreating it for hematological cancer research. We here dissect the differences and challenges between, and potential advantages of, different culture methods and present our vision of the most promising future strategies in the hematological field.
Treatment of chronic migraine with Botox (onabotulinumtoxinA): Development, insights, and impact
Authors: Turkel Catherine C. , Aurora Sheena , Diener Hans-Christoph , Dodick David W. , Lipton Richard B. , Silberstein Stephen D. , Brin Mitchell F.
Published: July 2023

Chronic migraine (CM) is a neurological disease characterized by frequent migraine attacks that prevent affected individuals from performing daily activities of living, significantly diminish quality of life, and increase familial burden. Before onabotulinumtoxinA was approved for CM, there were few treatment options for these seriously disabled patients and none had regulatory approval.

The terminology and recognition of CM evolved in parallel with the onabotulinumtoxinA clinical development program. Because there were no globally accepted classification criteria for CM when onabotulinumtoxinA was in development, the patient populations for the trials conducted by Allergan were determined by the Allergan migraine team in collaboration with headache scientists and clinicians. These trials and collaborations ultimately led to improvements in CM classifications.

In 2010, onabotulinumtoxinA became the first medication and first biologic approved specifically to prevent headaches in patients with CM. Approval was based on 2 similarly designed phase 3, double-blind, randomized, placebo-controlled, multicenter clinical studies. Both studies showed significantly greater improvements in mean change from baseline in headache-day frequency in patients with CM receiving onabotulinumtoxinA compared with those receiving placebo.

The safety and effectiveness of onabotulinumtoxinA have been established globally in >5000 patients with CM with or without medication overuse treated in clinical and observational studies. Benefits also include improvements in quality of life, fewer psychiatric comorbidities, and reduced healthcare resource utilization. Across studies, onabotulinumtoxinA was well tolerated; adverse events tended to be mild or moderate in severity and to decline over subsequent treatment cycles.
Changing Landscape of Routine Pediatric Surgery for Rural and Urban Children
Authors: Gadepalli Samir K. , Leraas Harold J. , Flynn-O’Brien Katherine T. , Van Arendonk Kyle J. , Hall Matt , Tracy Elisabeth T. , Ricca Robert L. , Goldin Adam B. , Ehrlich Peter F.
Published: July 2023

Objective:

To describe the changes to routine pediatric surgical care over the past 2 decades for children living in urban and rural environments.

Background:

A knowledge gaps exists regarding trends in the location where routine pediatric surgical care is provided to children from urban and rural environments over time.

Methods:

Children (age 0–18) undergoing 7 common surgeries were identified using State Inpatient Databases (SID, 2002–2017). Rural-Urban Commuting Area codes were used to classify patient and hospital zip codes. Multivariable regression models for distance traveled >60 miles and transfer status were used to compare rural and urban populations, adjusting for year, age, sex, race, and insurance status.

Results:

Among 143,467 children, 13% lived in rural zip codes. The distance traveled for care increased for both rural and urban children for all procedures but significantly more for the rural cohort (eg, 102% vs 30%, P<0.001, cholecystectomy). Transfers also increased for rural children (eg, transfers for appendectomy increased from 1% in 2002 to 23% in 2017, P<0.001). Factors associated with the need to travel >60 miles included year [adjusted odds ratio (aOR)=2.18, 95% CI: 1.94–2.46: 2017 vs 2002], rural residence (aOR=6.55, 95% CI: 6.11–7.01), age less than 5 years (aOR=2.17, 95% CI: 1.92–2.46), and Medicaid insurance (aOR=1.35, 95% CI: 1.26–1.45). Factors associated with transfer included year (aOR=5.77, 95% CI: 5.26–6.33: 2017 vs 2002), rural residence (aOR=1.47, 95% CI: 1.39–1.56), age less than 10 years (aOR=2.34, 95% CI: 2.15–2.54), and Medicaid insurance (aOR=1.49, 95% CI: 1.42–1.46).

Conclusion:

Rural children, younger age, and those on Medicaid disproportionately traveled greater distances and were more frequently transferred for common pediatric surgical procedures.
Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage
Authors: Greijdanus Nynke G. , Wienholts Kiedo , Ubels Sander , Talboom Kevin , Hannink Gerjon , Wolthuis Albert , de Lacy Francisco B. , Lefevre Jérémie H. , Solomon Michael , Frasson Matteo , Rotholtz Nicolas , Denost Quentin , Perez Rodrigo O. , Konishi Tsuyoshi , Panis Yves , Rutegård Martin , Hompes Roel , Rosman Camiel , van Workum Frans , Tanis Pieter J. , de Wilt Johannes H.W. ,   TENTACLE-Rectum Collaborative Group
Published: July 2023

Objective:

This study aimed to develop and validate a prediction model (STOMA-score) for one-year stoma-free survival in rectal cancer (RC) patients with anastomotic leakage (AL).

Background:

AL after RC resection often results in a permanent stoma.

Methods:

This international retrospective cohort study (TENTACLE–Rectum) encompassed 216 participating centres, and included patients who developed AL after RC surgery between 2014-2018. Clinically relevant predictors for one-year stoma-free survival were included in uni- and multivariable logistic regression models. The STOMA-score was developed and internally validated in a cohort of patients operated between 2014-2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models’ performance were evaluated.

Results:

This study included 2499 AL patients; 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA-score: sex, age, ASA-classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal- and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction and reactivation leakage. The STOMA-score showed good discrimination and calibration (c-index 0.71, 95%CI 0.66-0.76).

Conclusion:

The STOMA-score consists of eighteen clinically relevant factors and estimates the individual risk for one-year stoma-free survival in patients with AL after RC surgery, which may improve patient counselling and give guidance when analyzing efficacy of different treatment strategies in future studies.
Outcomes Associated with Esophageal Perforation Management
Authors: Veziant Julie , Boudis Fabio , Lenne Xavier , Bruandet Amelie , Eveno Clarisse , Nuytens Frederiek , Piessen Guillaume
Published: July 2023

Objective:

Evaluate outcomes associated with esophageal perforation (EP) management at a national level and determine predictive factors of 90-day mortality (90dM), failure-to-rescue (FTR) and major morbidity (MM, Clavien-Dindo 3-4).

Background:

EP remains a challenging clinical emergency. Previous population based-studies showed rates of 90dM up to 38.8% but were outdated or small-sized.

Methods:

Data from patients admitted to hospitals with EP were extracted from the French medico-administrative database (2012-2021). Etiology, management strategies, short and long-term outcomes were analyzed. A cut-off value of the annual EP management caseload affecting FTR was determined using the Chi Squared Automatic Interaction Detector method. Random effects logistic regression model was performed to assess independent predictors of 90dM, FTR and MM.

Results:

Among 4765 patients with EP, 90dM and FTR rates were 28.0% and 19.4%. Both remained stable during the study period. EP was spontaneous in 68.2%, due to esophageal cancer in 19.7%, iatrogenic post-endoscopy in 7.3% and due to foreign body ingestion in 4.7%. Primary management consisted in surgery (n=1447,30.4%), endoscopy (n=590,12.4%), isolated drainage (n=336,7.0%) and conservative management (n=2392,50.2%). After multivariate analysis, besides age and comorbidity, esophageal cancer was predictive of both 90dM and FTR. An annual threshold of ≥8 EP managed annually was associated with reduced 90dM and FTR rate. In France, only some university hospitals fulfilled this condition. Furthermore, primary surgery was associated with a lower 90dDM and FTR rate despite an increase in MM.

Conclusion:

We provide evidence for the referral of EP to high-volume centers with multidisciplinary expertise. Surgery remains an effective treatment of EP.
Evaluation of the accuracy of a multi-infection screening test based on a multiplex immunoassay targeting imported diseases common in migrant populations
Authors: Aguilar Ruth , Cruz Angeline , Jiménez Alfons , Almuedo Alex , Roca Saumell Carme , Gigante Lopez Marina , Gasch Oriol , Falcó Gemma , Jiménez-Lozano Ana , Martínez-Perez Angela , Sanchez-Collado Consol , Tedesco Andrea , Carlos López Manuel , Jesús Pinazo María , Leonel Thais , Bisoffi Zeno , Färnert Anna , Dobaño Carlota , Requena-Méndez Ana
Published: July 2023

Background

In this study we have evaluated the performance of a novel multiplex serological assay with a panel of 8 antigens able to simultaneously detect IgG to HIV, chronic hepatitis B (HBV) and C (HCV), Chagas disease, strongyloidiasis and schistosomiasis as a screening tool for imported diseases in migrants.

Methods

Six panels of 40 well-characterized, anonymized serum samples from individuals with the respective confirmed infections (n=240) were used as positive controls to assess the sensitivity of the multiplex assay. One panel of 40 sera from non-infected subjects were used to estimate the seropositivity cutoffs for each infection, and 32 additional non-infected sera were used as negative controls to estimate the sensitivity and specificity for each serology. The multi-infection screening test was validated in a prospective cohort of 48 migrants from endemic areas to assess assay performance.

The sensitivity of the Luminex assay was calculated as the proportion of positive test results over all positive samples by the primary reference test. The specificity was calculated using 32 negative samples. Uncertainty was quantified with 95% confidence intervals (CI) using receiver operating characteristic analyses.

Results

The sensitivity /specificity were 100%/100% for HIV (p41 antigen), 97.5%/100% (AUC:0.99,[95%CI: 0.96-1.00]) for HBV (core antigen), 100%/100% (AUC:1.00,[95%CI 1.00-1.00]) for HCV (core antigen), 92.5%/90.6%,(AUC:0.96,[95%CI 0.91-1.00]) for strongyloidiasis (31-kDa recombinant antigen (NIE)), 97.5%/100%,(AUC:0.97,[95%CI 0.93-1]) for schistosomiasis (combined serpinSchistosoma mansoniandS.haematobiumantigens) and 92.5%/96.9%,(AUC: 0.96,[95%CI 0.92-1.00]) for Chagas disease ([T.cruzikinetoplastid membrane protein-11 (KMP11)]).

In the migrant cohort, antibody response to KMP11 correctly identified 14/14(100%) individuals with Chagas disease, whereas HBV-core antigen and NIE-Strongyloides correctly identified 91.7% and 86.4% individuals with chronic hepatitis B and strongyloidiasis respectively.

Conclusions

We have developed a new 8-plex Luminex assay that is robust and accurate, and could facilitate the implementation of screening programmes for imported diseases in migrant populations.
A control engineering perspective on the advantages of efference copies
Authors: Campbell Benjamin P. , Lin Huai-Ti , Krapp Holger G.
Published: July 2023

Biological systems have evolved to perform high-speed voluntary movements whilst maintaining robustness and stability. This paper examines a control architecture based on the principles of efference copies found in insect sensorimotor control which we call the fully-separable-degrees-of-freedom (FSDoF) controller. Within a control engineering framework, we benchmark the advantages of this control architecture against two common engineering control schemes: a pure feedback (PFB) controller and a Smith predictor (SP). Our study identifies three advantages of the FSDoF for biology. It is advantageous in controlling systems with sensor delays, and it can effectively handle noise. Thirdly, it allows biological sensors to increase their operating range. We evaluate the robustness of the FSDoF controller and show that it achieves improved performance with equal stability margins and robustness. Finally, we discuss variations of the FSDoF which theoretically provide the same performance.