bluuebunny/crossref_metadata_2025 huggingface dataset:
Palliative home parenteral nutrition in patients with ovarian cancer and malignant bowel obstruction: experiences of women and family caregivers.
Authors: Sowerbutts Anne Marie , Lal Simon , Sremanak Jana , Clamp Andrew , Jayson Gordon C. , Teubner Antje , Hardy Lisa , Todd Chris , Raftery Anne-Marie , Sutton Eileen , Morgan Robert D. , Vickers Alexander J. , Burden Sorrel
Published: October 2019

ABSTRACT Background Malnutrition is a problem is advanced cancer, particularly ovarian cancer where malignant bowel obstruction (MBO) is a frequent complication. Parenteral nutrition is the only way these patients can received adequate nutrition and is a principal indication for palliative home parenteral nutrition (HPN). Giving HPN is contentious as it may increase the burden on patients. This study investigates patients’ and family caregivers’ experiences of HPN, alongside nutritional status and survival in patients with ovarian cancer and MBO. Methods This mixed methods study collected data on participant characteristics, clinical details and body composition using computed tomography combined with longitudinal in-depth interviews underpinned by phenomenological principles. The cohort comprised 38 women with ovarian cancer and inoperable MBO admitted (10/2016 to 12/ 2017) to a tertiary referral hospital. Longitudinal interviews (n=57) were carried out with 20 women considered for HPN and 15 of their family caregivers. Results Of the 38 women, 32 received parenteral nutrition (PN) in hospital and 17 were discharged on HPN. Nutritional status was poor with 31 of 33 women who had a CT scan having low muscle mass, although 10 were obese. Median overall survival from admission with MBO for all 38 women was 70 days (range 8 - 506) and for those 17 on HPN was 156 days (range 46 – 506). Women experienced HPN as one facet of their illness, but viewed it as a “lifeline” that allowed them to live outside hospital Nevertheless, HPN treatment came with losses including erosion of normality through an impact on activities of daily living and dealing with the bureaucracy surrounding the process. Family caregivers coped but were often left in an emotionally vulnerable state. Conclusions: Women and family caregivers reported that the inconvenience and disruption caused by HPN was worth the extended time they had at home.
Improving management of glycaemic control in people with T2DM in Primary Care: estimation of the impact on the clinical complications and associated costs
Authors: Mata-Cases Manel , Mahon James , Mauricio Didac , Franch-Nadal Josep , Real Jordi , Hex Nick
Published: October 2019

Aim To estimate the potential benefits in terms of avoided complications and cost reduction if the Spanish health system would encourage the intensification of treatment for better glycaemic control in adults with Type 2 diabetes from the current HbA1c target used in clinical practice of 68 mmol/mol to a target of 53 mmol/mol. Methods The IQVIA Core Diabetes Model (version 9.0) was used to model the impact of these changes in respect of micro- and macrovascular complications and the associated costs. The modelling was based on data derived from the SIDIAP-Q population database from Catalonia, taking a random cohort of 10,000 people with type 2 diabetes and dividing it into sub-groups based on their basal HbA1c. Results The CDM modelling showed that the average cost reduction per person varies depending on basal HbA1c. The model estimates that after 25 years, people with a basal HbA1c between 48 and 58 mmol/mol and >75 mmol/mol show an average cost reduction of €6,027 and €11,966, respectively. Applying the per-person cost reduction to the cohorts of the prevalent population in Spain (1,910,374) the overall estimated cost reduction was €14.7 billion over 25 years. The improvements in outcomes resulted in an estimated reduction of more than 1.2 million complications cumulatively over 25 years, of which more than 550,000 relate to diabetic foot and more than 170,000 related to renal disease. Conclusion Over a 25 year period, Spain could considerably reduce costs and avoid major complications if, on a population level, more ambitious glycaemic control, according to Spanish or EU guidelines, could be achieved among people with type 2 diabetes by reducing the HbA1c threshold for treatment intensification. Although there is a slower trajectory for benefits in earlier years, there is a much more rapid benefit gain between years 5 and 15.
The Effect of Distraction Techniques on Pain and Stress during Labor: A Randomized Controlled Clinical Trial
Authors: Amiri Paria , Mirghafourvand Mojgan , Esmaeilpour Khalil , Kamalifard Mahin , Ivanbagha Reyhaneh
Published: October 2019

Background: Pain control and the stress associated with labor and delivery are among the most important issues of health care system. Use of distraction techniques during childbirth is reported to reduce pain and stress of labor. However, there is a limited publication that looked on the effect of distraction techniques on labor pain and stress. Thus, the aim of this study was to determine the effect of distraction techniques on labor pain and stress (primary outcomes), fear of childbirth, length of delivery stages, first minute Apgar score and oxytocin consumption (secondary outcomes).
Methods: A randomized controlled clinical trial was conducted on 68 pregnant women. Participants were allocated into two groups (intervention and control groups) by blocked randomization. Participants in the intervention group received distraction techniques in four sessions. Questionnaires of Fear of Childbirth (W-DEQ version A) and PSS once were completed before intervention and again at the 36th week for the W-DEQ and in the active phase for the PSS through interviews. The pain was assessed through VAS during active phase per hour. The length of delivery stages was recorded in the partograph chart. Data were analyzed by independent t-test and ANCOVA .
Results: The mean of perceived stress during labor in the intervention group was significantly less than that of the control group (AMD: -3.2; 95% CI: -0.8 to -6.0; P= 0.01). The mean (SD) of pain intensity during labor was less than in the intervention and control groups compare to the control group (6.2 vs 7.5; P<0.001). There was no significant difference between the two groups in terms of fear of childbirth score (AMD: 5.3; 95% CI: 13.0 to -6.0; P= -2.3). Moreover, there was no statistically significant difference between the two groups in terms of the active phase of labor (P= 0.504), second stage of delivery (P= 0.928), total length of delivery (P= 0.520), Apgar score (P= 1.000) and frequency of oxytocin consumption (P= 0.622).
Conclusion: According to the results, distraction techniques can reduce the pain and stress of labor, but further studies by using the distraction techniques are needed to reach a decisive conclusion .
DNA methylomes and transcriptomes analysis reveal implication of host DNA methylation machinery in BmNPV proliferation in Bombyx mori
Authors: Huang Haoling , Wu Ping , Zhang Shaolun , Shang Qi , Yin Haotong , Hou Qirui , Zhong Jinbo , Guo Xijie
Published: October 2019

Background

Bombyx mori nucleopolyhedrosis virus (BmNPV) is a major pathogen that threatens the sustainability of the sericultural industry. DNA methylation is a widespread gene regulation mode in epigenetics, which plays an important role in host immune response. Until now, little has been known about epigenetic regulation on virus diseases in insects. This study aims to explore the role of DNA methylation in BmNPV proliferation.Results

Inhibiting DNA methyltransferase (DNMT) activity of silkworm can suppress BmNPV replication. The integrated analysis of transcriptomes and DNA methylomes in silkworm midguts infected with or without BmNPV showed that both the expression pattern of transcriptome and DNA methylation pattern are changed significantly upon BmNPV infection. A total of 291 differentially methylated genes (DMGs) were observed in BmNPV infected midguts, among which, 126 genes were hypermethylated and 115 genes were hypomethylated. Significant differences in both mRNA transcript level and DNA methylated levels were found in 26 genes. BS-PCR validated the hypermethylation of BGIBMGA014008 , a structural maintenance of chromosomes protein gene in the BmNPV-infected midgut. In addition, DNMT inhibition reduced the expression of inhibitor of apoptosis family genes, iap1 from BmNPV, Bmiap2, BmSurvivin1 and BmSurvivin2 .Conclusion

Our results indicate that DNA methylation plays positive roles in BmNPV proliferation and loss of DNMT activity could induce the apoptosis of infected cells to suppress BmNPV proliferation. Our results may provide a new idea and research direction for the molecular mechanism on insect-virus interaction.
Incidence Trend of Breast Cancer and its Risk Factors in Women of Eastern Mediterranean Region Countries between 1998 and 2018: A Systematic Review and Meta-Analysis
Authors: Zahedi Razieh , Vardanjani Hossein Molavi , Baneshi Mohammad Reza , Haghdoost Ali Akbar , Afshar Reza Malekpour , Sarabi Roghayeh Ershad , Tavakoli Ftemeh , zolala farzaneh
Published: October 2019

Abstract
Background
This study was conducted to provide evidence on the current status of breast cancer (BC) and its incidence trend in EMR during 1998-2018. Also, this study aimed to investigate the association between the incidence of BC and HDI and some factors related to this index, including total fertility rate (TFR), and obesity, using a meta-analysis.
Method
Data on incidence of BC were collected from various sources, including PubMed, Embase, Web of Science, and WHO, from 1998 to 2018 using systematic review and meta-analysis. Pooled ASR (age standardized rate) was calculated based on study duration and quality of data using a subgroup analysis and random effect meta-analysis.
Results
A total of 76 studies (499 data points) were analyzed. Pooled ASR of BC for EMR was 39.8 per 100 000 person-year (95% confidence interval [CI], 36.01, 43.9) during 2011-2018. ASR of BC had an upward trend in EMR from 2005 to 2018. However, the increasing trend was found to be slightly different in various regions based on quality of data. Moreover, pooled ASR had a significant association with Human Development Index (HDI) [-6.6 (95% CI, -8.9, -4.3)] and obesity [0.1 (95% CI, 0.07, 0.1)].
Conclusion
Pooled ASR of BC in EMR was lower than the global average. Also, the ASR value and its incremental trend have been higher in countries with low-quality data than in other countries of this region in recent years. Data quality or physiological factors, such as increase in obesity rates, could be the reasons for this incremental trend.
Molecular characterization and expression analysis of pitaya (Hylocereus polyrhizus) HpLRR genes in response to Neoscytalidium dimidiatuminfection
Authors: Xu Min , Liu Cheng-Li , Fu Yu , Liao Zhi-Wen , Guo Pan-Yang , Xiong Rui , Cheng Yu , Wei Shuang-Shuang , Huang Jia-Quan , Tang Hua
Published: October 2019

Background: Canker disease caused by Neoscytalidium dimidiatum is a devastating disease resulting in a major loss to the pitaya industry. However, resistance proteins in plants play crucial roles to against pathogen infection. Among resistance proteins, the leucine-rich repeat (LRR) proteins are a major family that play crucial roles in plant growth, development, and biotic and abiotic stress responses, especially in disease defence. Results: In the present study, a transcriptomics analysis identified a total of 272 LRR genes, 233 of which had coding sequences (CDSs), in the plant pitaya ( Hylocereus polyrhizus )in response to fungal Neoscytalidium dimidiatum infection. These genes were divided into various subgroups based on specific domains and phylogenetic analysis. Molecular characterization, functional annotation of proteins, and an expression analysis of the LRR genes were conducted. Additionally, four LRR genes (CL445.Contig4_All, Unigene28_All, CL28.Contig2_All, and Unigene2712_All, which were selected because they had the four longest CDSs were further assessed using quantitative reverse transcription PCR (qRT-PCR) at different fungal infection stages in different pitaya species ( Hylocereus polyrhizus and Hylocereus undatus ), in different pitaya tissues, and after treatment with salicylic acid (SA), methyl jasmonate (MeJA), and abscisic acid (ABA) hormones. The associated protein functions and roles in signaling pathways were identified. Conclusions: This study provides a comprehensive overview of the Hp LRR family genes at transcriptional level in pitaya in response to N. dimidiatum infection and provides a basis for further in-depth functional studies.
Forecasting the 2017/2018 seasonal influenza epidemic in England using multiple dynamic transmission models: a Case Study
Authors: Birrell Paul , Zhang Xu-Sheng , Corbella Alice , Leeuwen Edwin van , Panagiotopoulos Nikolaos , Hoschler Katja , Elliot Alex J , McGee Maryia , de Lusignan Simon , Presanis Anne M , Baguelin Marc , Zambon Maria , Charlett André , Pebody Richard G , De Angelis Daniela
Published: October 2019

Background: Since the 2009 A/H1N1 pandemic, the UK has a suite of real-time statistical models utilising enhanced pandemic surveillance data to nowcast and forecast a future pandemic. Their ability to track seasonal influenza and predict heightened winter healthcare burden in the light of high activity in Australia in 2017 was untested. Methods: Four transmission models were used in forecasting the 2017/2018 seasonal influenza epidemic in England: a stratified primary care model using daily, region-specific, counts and virological swab positivity of influenza-like illness consultations in general practice (GP); a strain-specific (SS) model using weekly, national GP ILI and virological data; an intensive care model (ICU) using reports of ICU influenza admissions; a synthesis model that included all data sources. For the first 12 weeks of 2018, each model was applied to the latest data to provide estimates of epidemic parameters and short-term influenza forecasts. The added value of pre-season population susceptibility data was explored. Results: Estimates of disease spread were consistent over time and across models. The combined results provided valuable nowcasts of the state of the epidemic. Short-term predictions of burden on primary and secondary health services were initially highly variable before reaching consensus beyond the observed peaks in activity between weeks 3–4 of 2018. Estimates and predictions varied according to pre-season immunity levels. Conclusions: This exercise successfully applied a range of pandemic models to seasonal influenza. Forecasting early in the season remains challenging but represents a crucially important activity to inform planning. Improved knowledge of pre-existing levels of immunity would be valuable.
Contextual and individual determinants of tooth loss in adults: population-based multilevel study
Authors: Roberto Luana Leal , Silveira Marise Fagundes , De Paula Alfredo Mauricio Batista , Ferreira Efigênia Ferreira , Martins Andréa Maria Eleutério De Barros Lima , Haikal Desirée Sant'Ana
Published: October 2019

Background: Tooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35-44 years of age), in accordance with individual and contextual social characteristics. Methods: This was a multilevel cross-sectional study with data from 8,837 adult participants from the National Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped according to the theoretical model of Watt & Sheiham (2012). Negative Multilevel Hierarchical Binomial Regression was conducted and the Mean Ratio (MR) was estimated. Results: Brazilian adults lost a mean of 7.31 (95% CI 6.9-7.8) teeth. Among the contextual variables, the number of teeth lost was lower among residents of municipalities with higher Municipal Human Development Index (MHDI), and was higher in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who reported pain, who had not used dental services for more than a year and those whose reason for the consultation was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels, higher income and males. Conclusions: The number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.
Comprehensive analysis on phenotype and genetic basis of Chinese Fanconi anemia patients: dismal outcomes call for nationwide studies
Authors: Nie Daijing , Zhang Jing , Wang Fang , Zhang Wei , Liu Lili , Chen Xue , Zhang Yang , Cao Panxiang , Xiong Min , Wang Tong , Wu Ping , Ma Xiaoli , Tian Wenjun , Wang Mangju , Chen Kylan N. , Liu Hongxing
Published: October 2019

Background Fanconi anemia (FA) is the most common inherited bone marrow failure (BMF) syndrome with 22 related genes identified. The ALDH2 rs671variant has been proved related to accelerated progression of BMF in FA patients. The phenotype and genetic basis of Chinese FA patients have not been investigated yet.Methods We analyzed the 22 FA-related genes of 63 BMF patients suspected to be FA. Clinical manifestations, morphological and cytogenetic feathers, ALDH2 genotypes, treatment, and outcomes of the definite cases were retrospectively studied.Results 24 patients were confirmed the diagnosis of FA. The median age of BMF onset was 4.5-year old. The number of patients manifested as congenital malformations and growth retardation were 21/24 and 14/24, respectively. BM dysplasia and cytogenetic abnormalities were found in 15/23 and 10/22 patients. All the patients with abnormal karyotype also manifested as BM dysplasia or had evident blasts. Thirty-nine different variants were identified involving seven genes and including twenty-one novel variants. FANCA variants contributed to 58.33% of cases. Ten patients carried ALDH2 -G/A genotype with a significantly younger age of BMF onset ( p =0.024). Within the 22 patients adhering to continuous follow-up, 18 patients underwent hematopoietic stem cell transplantations (HSCTs). During the 33.5 months of follow-up, 8/22 patients died, seven of which were HSCT-related, and one patient who didn’t receive HSCT died from severe infection.Conclusion The phenotypic and genetic spectrum of Chinese FA patients is broad. Bone marrow dysplasia and cytogenetic abnormalities are prevalent and highly consistent. The overall outcome of HSCTs is disappointing. Nationwide multicenter studies are needed for the rarity and adverse outcome of this disease.
Quasimetagenomic source tracking of Listeria monocytogenes from naturally contaminated ice cream
Authors: Ottesen Andrea , Ramachandran Padmini , Chen Yi , Brown Eric , Reed Elizabeth , Strain Errol
Published: October 2019

Background The more quickly bacterial pathogens responsible for foodborne illness outbreaks can be traced to their source, the more illnesses can be prevented and the less unnecessary destruction of food will occur. Whole genome sequencing (WGS) based approaches to source tracking have greatly increased the speed and resolution with which public health response can pinpoint the source of outbreaks. Traditionally, WGS approaches have focused on the culture of an individual isolate before proceeding to DNA extraction and sequencing. For Listeria monocytogenes (Lm), generation of an individual isolate for sequencing typically takes about 6 days. Here we demonstrate that a hybrid, “quasimetagenomic” approach ie; direct sequencing of microbiological enrichment (first step in pathogen detection and recovery) can provide high resolution source tracking sequence data, five days earlier than response that focuses on culture and sequencing of an individual isolate.Methods Naturally contaminated ice cream (from a 2015 outbreak) was enriched to recover Listeria monocytogenes following protocols outlined in the Bacteriological Analytic Manual (BAM). DNA from enriching microbiota was extracted and sequenced at incremental time-points during the first 48 hours of pre-enrichment using the Illumina MiSeq platform (2 by 250), to evaluate genomic coverage of target pathogen, Listeria monocytogenes.Results Quasimetagenomic sequence data acquired from hour 20 were sufficient to discern whether or not Lm strain/s were part of the ongoing outbreak or not. Genomic data from hours 24, 28, 32, 36, 40, 44, and 48 of pre-enrichments all provided identical phylogenetic source tracking utility to the WGS of individual isolates (which require an additional 5 days to culture). Conclusions The speed of this approach (more than twice as fast as current methods) has the potential to reduce the number of illnesses associated with any given outbreak by as many as 75% percent of total cases and additionally, reduce the unnecessary waste of food that has been detained for investigation and due to lengthy response time, could not be deemed safe before spoilage.
Treatment Patterns and Sequences of Pharmacotherapy for Patients Diagnosed with Depression in the United States: 2014 through 2019
Authors: Kern David M. , Cepeda M. Soledad , Defalco Frank , Etropolski Mila
Published: October 2019

Background : Understanding how patients are treated in the real-world is vital to identifying potential gaps in care. We describe the current pharmacologic treatment patterns for the treatment of depression. Methods : Patients with depression were identified from four large national claims databases during 1/1/2014-1/31/2019. Patients had ≥2 diagnoses for depression or an inpatient hospitalization with a diagnosis of depression. Patients were required to have enrollment in the database ≥1 year prior to and three years following their first depression diagnosis. Treatment patterns were captured at the class level and included selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, other antidepressants, anxiolytics, hypnotics/sedatives, and antipsychotics . Treatment patterns were captured during all available follow-up. Results : We identified 269,668 patients diagnosed with depression . The proportion not receiving any pharmacological treatment during follow-up ranged from 31% to 54%. Of the treated, approximately half received ≥2 different classes of therapy, a quarter received ≥3 classes and 10% received 4 or more. SSRIs were the most common first-line treatment; however, many patients received an anxiolytic, hypnotic/sedative, or antipsychotic prior to any antidepressive treatment. Treatment with a combination of classes was relatively uncommon across all treatment lines. Conclusions : Many patients diagnosed with depression go untreated and many others receive a non-antidepressant medication class as their first treatment. More than half of patients received more than one type of treatment class during the study follow up, suggesting that the first treatment received may not be optimal for most patients.
Leucine-rich α2-glycoprotein-1 upregulation in plasma and kidney of patients with lupus nephritis
Authors: Yang Yi , Luo Ran , Cheng Yichun , Liu Tingting , Dai Wei , Li Yueqiang , Ge Shuwang , Xu Gang
Published: October 2019

Background Increased leucine-rich α2-glycoprotein-1 (LRG1) has been observed in various inflammatory and autoimmune diseases. We aimed to explore the expression and role of LRG1 in lupus nephritis (LN).Methods Plasma LRG1 (pLRG1) was measured by enzyme-linked immunosorbent assay in 101 patients with renal biopsy-proven LN and 21 healthy controls (HC). Relationships between pLRG1 and clinical and pathological characteristics were analyzed. The expression of LRG1 in peripheral blood leukocytes and kidney was detected by flow cytometry, immunohistochemistry and immunofluorescence, respectively. Further cell experiments were focused on the role of LRG1.Results We found that LRG1 was expressed in plasma, some peripheral blood leukocytes, proximal tubule and several inflammatory cells. The levels of LRG1 in plasma, peripheral blood leukocytes and kidney were elevated in LN patients as compared to HC. Plasma expression levels of LRG1 correlated positively with renal function and renal disease activity, and reflect specific pathologic lesions in the kidneys of patients with LN. Interleukin-1β and interleukin-6, not tumor necrosis factor-α and interferon γ induced the LRG1 expression in human renal tubular epithelial cell line. Moreover, stimulation of recombinant human LRG1 could inhibit late apoptosis, promote proliferation and regulate expression of inflammatory factors and cytokines.Conclusions Plasma expression levels of LRG1 were associated with renal function, disease activity, and pathology in LN. It might also be involved in renal inflammation, proliferation and apoptosis of endothelial cells. LRG1 might be a potential prognosis novel predictor in LN patients.
Objective evaluation of postoperative changes in real-life activity levels in the postoperative course of lumbar spinal surgery using wearable trackers
Authors: Inoue Masahiro , Orita Sumihis , Inage Kazuhide , Suzuki Miyako , Fujimoto Kazuki , Shiga Yasuhiro , Kanamoto Hirohito , Abe Koki , Kinoshita Hideyuki , Norimoto Masaki , Umimura Tomotaka , Sato Takashi , Sato Masashi , Suzuki Masahiro , Enomoto Keigo , Eguchi Yawara , Akazawa Tsutomu , Aoki Yasuchika , Kawasaki Yohei , Ohtori Seiji
Published: October 2019

Background: Lumbar spinal disease causes disability in daily activities. Operative treatments are aimed at pain relief and rapid return to routine activity. Patient-based outcome measures are used to evaluate pathology and therapeutic effects associated with lumbar spinal disease. However, it remains unknown how much such treatment improves the activity levels.
The purpose of current study was to evaluate the changes in activity levels before and after lumbar spinal surgery using a wearable activity tracker and to compare the relationship between the results and the patient-based outcomes.
Methods: Sixty patients who underwent lumbar surgery were studied. The physical activity of participants was objectively evaluated using a wearable Micro-Motion logger system (Actigraph). We measured the amount of activity before and at 1, 3, 6, and 12 months after the surgery to evaluate postoperative changes. Additionally, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Oswestry Disability Index, Roland-Morris Disability Questionnaire and Visual analog scale were measured as a patient-based outcomes of pain and ADL-related scores and the corresponding relationships with the actual activity levels were evaluated.
Results: The amount of actual activity decreased significantly 1 month after the surgery compared to that during the preoperative period, which then improved after 3 months postoperatively ( p < 0.01). Furthermore, there was a significant improvement 6 months after the surgery compared to that during the preoperative period ( p < 0.05). Moreover, the change in activity amount for each period was strongly correlated, regardless of the period. In contrast, a significant improvement was observed at 1 month after the surgery in almost all items of the patient-based questionnaires ( p < 0.05).
Conclusions: The objective activity tracker demonstrated that lumbar surgery results in the amount of activity decreasing 1 month just after the surgery followed by gradual postoperative recovery within 3 months. In contrast, patient-based outcomes showed improvement in 1 month, which was significantly different from the change in actual activity, indicating the gap between the patient-oriented clinical score and their actual activities.
Short-term and long-term unintended impacts of a pilot reform on Beijing's zero markup drug policy: a propensity score-matched study
Authors: Zeng Jianying , Chen Xiwen , Fu Hongqiao , Lu Ming , Jian Weiyan
Published: October 2019

Background In September 2012, Beijing, the capital of China, selected five tertiary hospitals as pilots to remove the previously allowed 15% markup for drug sales. However, while most research demonstrated the significant decrease in drug sales, the core issue of high health expenditure was not well solved because of the unintended policy impact. This study aimed to empirically evaluate the short-term and long-term unintended impacts on controlling medical expenses of Beijing’s zero markup drug policy from 2012 to 2015.Methods This study extracted 2012-2015 individual-level data from the Beijing Urban Employee Basic Medical Insurance (UEBMI) database and performed a propensity score-matched analysis to evaluate the short-term and long-term impacts on controlling medical expenses. All inpatients in the 5 pilot reform hospitals were selected as the intervention group, while inpatients in other tertiary hospitals were selected as the control group.Results A total of 520,996 inpatients were extracted in this study. For patients in the pilot hospitals, the total expenditures per admission decreased from 17,140.3 yuan in 2012 to 15,430.1 yuan in 2013 and then increased to 16,789.8 yuan in 2015. Expenditure on drugs reduced from 5,811.7 yuan in 2012 to 3,903.4 yuan in 2015. However, a significant substitution effect of medical consumables was first observed in the third quarter of 2014, which undermined the impact of the policy. In the long-term, the intervention group and control group demonstrated the same trend.Conclusion After the zero markup drug policy, expenditure on drugs revealed a continuous decline. However, the decline in total expenditure was weakened by the substitution effect of medical consumables in the long term.
“The Hardest Job You Will Ever Love”: Nurse Recruitment, Retention, and Turnover in the Nurse-Family Partnership Program in British Columbia, Canada
Authors: Campbell Karen A , Borek Natasha Van , Marcellus Lenora , Landy Christine Kurtz , Jack Susan M
Published: October 2019

Background: Nurse turnover is a significant issue and complex challenge for all sectors of healthcare and is exacerbated by a global nursing shortage. Nurse-Family Partnership is a community health program for first-time pregnant and parenting girls and young women living in situations of social and economic disadvantage, delivered exclusively by public health nurses and only within a research context in Canada. The aim of this article is to explore and describe factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada.
Methods: Interpretive description was used to guide sampling, data collection and analytic decisions in this qualitative component drawn from the British Columbia Healthy Connections Project mixed methods process evaluation. Semi-structured, individual interviews were conducted with 28 public health nurses who practiced in and then exited Nurse-Family Partnership.
Results: Nurses were motivated to join this program because they wanted to deliver an evidence-based program for vulnerable young mothers that fit with their personal and professional philosophies and offered nurse autonomy. Access to program resources attracted nursing staff, while delivering a program that prioritizes maintaining relationships and emphasizes client successes was a positive work experience. Opportunities for ongoing professional development/ education, strong team connections, and working at full-scope of nursing practice were significant reasons for nurses to remain in Nurse-Family Partnership. Personal circumstances (retirement, family/health needs, relocation, career advancement) were the most frequently cited reasons leading to turnover. Other factors included: involuntary reasons, organizational and program factors, and geographical factors.
Conclusions: Public health organizations that deliver Nurse-Family Partnership may find aspects of job embeddedness theory useful for developing strategies for supporting recruitment and retention and reducing nurse turnover. Hiring nurses who are the right fit for this type of program may be a useful approach to increasing nurse retention. Fostering a culture of connectivity through team development along with supportive and communicative supervision are important factors associated with retention and may decrease turnover. Many involuntary factors were specific to being in a study environment. Program, organizational, and geographical factors affecting nurse turnover are modifiable.
Prediction of patients with a tumor proportion score >50% who do not respond to first-line monotherapy with pembrolizumab
Authors: Morita Mitsunori , Tamiya Motohiro , Fujimoto Daichi , Tamiya Akihiro , Suzuki Hidekazu , Hirano Katsuya , Fukuda Yasushi , Yokoyama Toshihide , Kominami Ryota , Kanazu Masaki , Uchida Junji , Hara Satoshi , Yamashita Syuji , Tomioka Hiromi
Published: October 2019

Background: Pembrolizumab is effective as first-line therapy against advanced non-small cell lung cancer (NSCLC) in patients with programmed death ligand-1 (PD-L1) expression levels ≥50%. However, it is not effective in all patients, and the factors predicting responses among this population remain unknown.
Methods: We retrospectively analyzed patients with NSCLC and a PD-L1 tumor proportion score (TPS) >50%, who received first-line monotherapy with pembrolizumab from February 1, 2017 to April 30, 2018. The study included 11 hospitals, which participated in the Hanshin Oncology clinical Problem Evaluation group (HOPE). We analyzed the differences between responders and non-responders in terms of age, sex, performance status score, degree of progression, histological type, smoking history, expression of PD-L1, use of steroids prior to treatment, metastasis site, and laboratory data.
Results: A total of 205 patients were included in this study. Of those, 108 patients exhibiting complete or partial response were defined as responders. Those exhibiting progressive disease (N=52) were defined as non-responders. In the univariate analysis, Eastern Cooperative Oncology Group performance status score ≥2 (p=0.0832), stage IV disease or recurrence (p=0.0487), PD-L1 TPS 50–89% (p=0.0657), use of steroids prior to the administration of pembrolizumab (p=0.0243), malignant pleural effusion (p=0.0032), and baseline C-reactive protein (CRP) levels >1.0 mg/dL (p=0.0390) were significantly associated with non-response to treatment.
In the multivariate analysis, use of steroids prior to the administration of pembrolizumab (odds ratio [OR]: 5.86; 95% confidence interval [CI]: 1.32–31.8; p=0.0200), malignant pleural effusion (OR: 2.68; 95% CI: 1.15–6.35; p=0.0228), and baseline CRP >1.0 mg/dL (OR: 2.17; 95% CI: 1.03–4.68; p=0.0402) were significantly associated with non-response to treatment.
Conclusion: In real-world patients with NSCLC and a PD-L1 TPS ≥50%, use of steroids prior to treatment, malignant pleural effusion, and baseline CRP levels >1.0mg/dL reduced the effectiveness of first-line monotherapy with pembrolizumab.
The survival impact of concurrent chemotherapy and primary tumor radiotherapy on stage IV squamous non-small-cell lung cancer
Authors: Geng Yichao , Zhang Qiu-Ning , Hu Yin-Xiang , Ma Zhu , Ouyang Wei-Wei , Su Sheng-Fa , Li Qing-Song , Li Hui-qin , Wang Xiaohu , Lu Bing , Liu Ruifeng , Luo Hongtao , Wei Shihong , Wang Lina
Published: October 2019

Objective: To analyse the impact of survival with three-dimensional radiotherapy for stage IV squamous non-small cell lung cancer (NSCLC). Methods: Data for 629 eligible patients who received three-dimensional radiotherapy between 2002 and 2016 were retrospectively analyzed.161 of 183 cases were included pre-protocol. Patients received platinum-doublet chemotherapy with concurrent irradiation of the primary tumour. Primary endpoints were overall survival (OS) and progress-free survival (PFS). Results: Of 161 patients, the 1-, 2-, 3- and 5-year OS rates and median survival time (MST) were 45.7%, 14.1%, 11.2%, 2.2% and 11months, respectively. Using contrastive analysis PTV dose ≥63 Gy and <63 Gy, the 1-, 2-,3- and 5-year overall survival (OS) rates and median survival time (MST)were 48.9% vs 43.3%, 21.8% vs 8.2%, 18.4% vs 4.4%, 5.1% vs 0%, and 12 months vs 11months ( χ 2 = 7.222, P=0.007). Contrastive analysis patients received radical concurrent chemoradiation therapy, and the 1-, 2-, 3- and 5-year overall survival (OS) rates and median survival time (MST) were 54.3% vs. 37.2%, 27.2% vs. 7.5%, 24.9% vs. 4.8%, 8.3% vs. 0%, and 14 months vs. 10 months ( χ 2 = 13.180, P=0.000). Multivariate analysis showed that PTV ≥63 Gy was an independent favourable factor for survival. Conclusion: Concurrent chemotherapy and three-dimensional radiotherapy to the primary tumour in stage IV squamous NSCLC could prolong survival, and with increasing intensity of comprehensive treatment, OS gradually improved. PTV ≥63 Gy is the independent prognostic factors for OS.
[Key Words] Stage IV; Squamous non-small cell lung cancer (NSCLC); Concurrent chemoradiotherapy; Overall survival
Determinants of an Evidence-Based Practice Environment: An Interpretive Description
Authors: Duff Jed , Cullen Laura , Hanrahan Kirsten , Steelman Victoria
Published: October 2019

Background Despite the available research to inform nursing practice many patients still fail to receive care that is evidence-based. A number of evidence-based practice (EBP) models have been developed to guide nurses through the steps in the process, yet these models have not been uniformly adopted or consistently used. The original purpose of this research was to gather perspectives and experiences of nurses using the Iowa Model of EBP to help inform its introduction into other practice settings. As a deeper understanding was gained the emphasis of the study shifted towards understanding the determinants of the EBP environment.Method The study was conducted in a 800 bed comprehensive academic medical centre with a 25 year history of using the Iowa Model of EBP. Semi-structured in-depth interviews were conducted with twelve nurses from various roles to ascertain their perspectives and experiences of using the model. The interview transcripts were reviewed alongside relevant published literature and internal documents in a process of synthesising, theorising, and conceptualising. Data were collected during the first four months of 2019.Results The determinants of the local EBP environment were clustered into four themes: 1) The importance of a shared model to guide staff through the EBP process; 2) Support for EBP in the form of education, hands-on training, and knowledge infrastructure; 3) Active team facilitation by direct care nurses, nurse managers, nurses specialists, and nurse scientists; and 4) A culture and leadership that encourages EBP.Conclusion Introducing an EBP model is an important first step for an organisation to improve consistent and reliable evidence-based care; to be most effective, this should be done in conjunction with efforts to optimise the EBP environment.
The Relationship between Course Experience and Academic Engagement in Medical Students: a descriptive-correlational study
Authors: Haghgoo Amin , Asady Hadi , Armoon Bahram , Bayat Amir-Hossein
Published: October 2019

Background One of the essential activities in improving the quality and effectiveness of teaching is to pay attention to the course experience (CE) and academic engagement (AE) of students in their academic process. The aim of this study was to determine the relationship between CE and AE among Iranian nursing students.Methods This is a descriptive-correlational study. The present study was carried out on 124 anesthesia and operating room nursing students who were selected using simple random sampling in the year 2017. The research tools included standard demographic, CE, and AE questionnaires. Data analysis was carried out using descriptive tests, independent t-test, and Pearson correlation in SPSS ver. 24.Results The results of Pearson correlation analysis on the relationship between the subscales of CE, including good teaching, clear goals, appropriate assessment, appropriate workload, independence, and generic skills with AE showed a statistically significant relationship between all remaining subscales, except for the proper workload sub-scale (P=0.234).Conclusions The results of this study showed a significant positive correlation between the CE and AE. Therefore, steps can be taken to improve the quality of the educational system using active and student-centered teaching methods.
Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study
Authors: Chen Yao , Hu Yanyan , Zhang Jin , Shen Yue , Huang Junling , Yin Jun , Wang Ping , Fan Ying , Wang Jianli , Lu Su , Yang Yilin , Yan Lei , Li Keyong , Song Zhenju , Tong Chaoyang , Du Shilin
Published: October 2019

Background : Secondary infection has a higher incidence in septic patients and affects clinical outcomes. This study aims to investigate the clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis.

Methods : A four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between January, 2014 and January, 2018. Clinical data were acquired from medical records. CD14 + monocyte human leukocyte antigen-D related (HLA-DR) expression and serum cytokines levels were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA) respectively.

Results: A total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 40, 31%). Urinary and deep venous catheterization increased the risk of secondary infection. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital stay owing to secondary infection was 4.63 ± 1.87 days. Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival analysis and Log-rank test revealed that secondary infection group had worse survival between day 15 and day 90.

Conclusions : Urinary and deep venous catheterization increased the risk of secondary infection, in which underlying immunosuppression might also play a role. Secondary infection affected the prognosis of septic patients and prolonged in-hospital length of stay.
Predictors of catheter-related bladder discomfort after gynaecological surgery
Authors: Li Shuying , Song Liping , Ma Yushan , Lin Xuemei
Published: October 2019

Background: Urinary catheterization is universally used during surgery, and the incidence of postoperative catheter-related bladder discomfort (CRBD) is very high during recovery. We conducted this study to identify the incidence and predictors of postoperative CRBD after gynaecological surgery in the post-anesthesia care unit (PACU). Methods: This was a prospective observational study. Patients undergoing gynaecological surgery under general anesthesia with intra-operative urinary catheterization were enrolled. We collected the clinical data, incidence and severity of CRBD, and postoperative pain for the patients. Predictive factors of CRBD were analysed by univariate and multivariate analysis. Results: A total of 407 patients were included in this study. The incidence of CRBD after gynaecological surgery was 64.6% (mild CRBD: 22.8%; moderate CRBD: 34.2%; and severe CRBD: 7.6%). Univariate analysis showed that age, type of surgery, type of laparoscopic surgery, additional analgesics, and postoperative pain were influencing factors for CRBD. Based on multivariate logistic regression analysis, age ≥50 years, uterus-related laparoscopic surgery, and lack of additional analgesics were independent predictors of moderate or severe CRBD. Conclusions: This observational study revealed that the incidence of CRBD after gynaecological surgery in PACU was very high and it was a very distressing experience for patients. We suggested that drug prophylaxis should be used to the patients with high risk of CRBD in gynaecological surgery.
Efficacy and safety of tetramethylpyrazine phosphate on pulmonary hypertension: study protocol for a randomized controlled study
Authors: Wang Jian , Chen Yuqin , He Wenjun , Ouyang Haiping , Liu Chunli , Hong Cheng , Wang Tao , Yang Kai , Lu Wenju
Published: October 2019

Introduction Tetramethylpyrazine (TMP), one of the active ingredients from the traditional Chinese herbal medicine Rhizoma Chuanxiong (Chuanxiong), has been clinically used for the prevention and treatment on cardiovascular diseases. The benefits of TMP are largely attributed to its anti-oxidize and vasodilative activities. However, the efficacy of TMP in the treatment of pulmonary hypertension(PH) is unknown, in this study, we hypothesized that TMP treatment has a therapeutic effect on PH patients.
In vitro synergistic potentials of novel antibacterial combination therapies against Salmonella Typhimurium and Escherichia coli
Authors: Author) Md. Akil Hossain(Former Corresponding , Park Hae-Chul , Lee Kwang-jick , Park Sung-Won , Park Seung-Chun , Author) JeongWoo Kang(New Corresponding
Published: October 2019

Background: Bacteria have remarkable abilities to acquire resistance against antibiotics by several mechanisms. New strategies are needed to block the development of resistance and to prolong the life of traditional antibiotics. This study aimed to increase the efficacy of existing antibiotics by combining them with the opportunistic phenolic compound gallic acid (GA) and its derivatives. Fractional inhibitory concentration (FIC) indexes of phenolic compound-antibiotic combinations against Salmonella enterica serovar Typhimurium ( S. Typhimurium) and Escherichia coli ( E. coli ) were determined. Based on the FIC index values and clinical importance, 3 combinations were selected to evaluate their effects on the virulence factors of these bacteria. The in vitro cytotoxicity of GA and hamamelitannin in human (Hep G2) and Rattus norvegicus (IEC-6) cell lines were evaluated.
Results: Phenolic compounds demonstrated considerable antibacterial effects as the minimum inhibitory concentrations (MICs) of epigallocatechin, GA and hamamelitannin found against different strains were (512–1024), (256–1024) and (512–2048) μg/mL, respectively. The FIC indexes of the combined antibacterials against these strains were 0.281–1.016. The time-kill assays and ultrastructural morphology showed that the GA-ceftiofur combination, and hamamelitannin-erythromycin and GA-ampicillin combinations more efficiently inhibited the growth of S. Typhimurium and E. coli , respectively, compared to the individual antibiotics. Biofilm viability and the swimming and swarming motilities of S. Typhimurium in the presence of GA-ceftiofur and E. coli in the presence of the hamamelitannin-erythromycin and GA-ampicillin combinations were more competently inhibited than individual antimicrobials. The inhibitory concentrations 50% (IC 50 ) of GA and hamamelitannin in Hep G2 cells were 1427.34 μM and 2024.97 μM, and in IEC-6 cells were 564.55 μM and 988.54 μM, respectively.
Conclusions: We can conclude that these antibacterial combinations can be potential medications to treat S. Typhimurium and E. coli infections. Further study to confirm this effect in in vivo system and to determine the precise mechanism of action should be undertaken to establish these combinations as medications.