bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Uni- and Biplanar External Fixator for Initial and Definitive Complex Foot Trauma
Authors: Pablo Randolino Juan , Gaitán Laura , Slullitel Gastón , Gonzalez Emanuel , Lopez Valeria
Published: August 2024

Background:

Evidence concerning the complex foot trauma, especially its definitive management, is scarce. Soft tissue envelope sequalae are the primary parameters that delay or make internal fixation implausible. Stability conferred by external fixators makes them a reasonable initial treatment choice. Although AO or circular fixators can be applied around the foot, this can involve a learning curve and substantial costs, especially for the circular fixator. There is little evidence as to how well external fixators work as a definite method of fixation in patients where progression to internal fixation cannot be made.

Methods:

We prospectively evaluated 10 adult patients with severe and complex foot trauma who were consecutively treated at our clinic. Initial reduction and stabilization were performed with an external fixator that was initially conceived for distal radius fractures, applied during the initial procedure and mantained throughout the treatment.

Results:

Fracture healing was obtained in all 10 cases, and both internal and external column length was restored. One of the patients developed chronic osteomyelitis. At the 1-year follow-up visit, these patients averaged 45.6 points in the physical and 44.8 points on the mental status sections of the 12-Item Short Form Health Survey (SF-12). The Foot Function Index findings for pain, disability, and daily activities limitations were 33.3, 39, and 41.5, respectively, which suggest moderate residual impairment.

Conclusion:

In this relatively small case series of complex foot trauma, we found that the use of simple external fixation as definitive treatment worked reasonably well.

Level of Evidence:

Level III, prospective cohort study.
App-assisted learning of Chinese characters: Matching parts and radicals in structural templates
Authors: Wang Haoshu , Sun Pengyuan , Chan Daniel KG
Published: August 2024

This study explores the effectiveness of the autonomous practice of Chinese characters through an app. Some 45 participants with no prior Chinese knowledge were trained using character-building tasks in three different modes: (a) teacher-assisted; (b) app-assisted with necessary parts/radicals; (c) app-assisted with extra parts/radicals as distractors. The results of subsequent tests indicated that all three training modes effectively improved reading and writing of Chinese characters. However, the two app-assisted groups demonstrated a more significant improvement in writing accuracy. Besides, participants from the app-assisted group with additional parts/radicals out-performed the other two groups in terms of the accuracy of writing structures and parts/radicals. These findings suggest that incorporating app-assisted exercises, especially those that challenge learners with distractors, can effectively augment traditional learning methods.
Health services interventions to improve the quality of care in rare disease: a scoping review
Authors: Chou Cody , Wiredu Sydney O. , Von Imhof Liesel , Tan Anran , Agarwal Sasha , Lydston Melis , Merker Vanessa L.
Published: August 2024

Background:

Rare diseases are often complex, multisystem disorders requiring specialized, lifelong care. These diseases share significant challenges in healthcare delivery, including diagnostic delays, limited access to specialists, and lack of effective treatments.

Objectives:

To aggregate and critically examine innovative health services interventions for rare diseases, with the goal of identifying potentially scalable strategies to improve care.

Eligibility criteria:

Peer-reviewed original research published in English reporting results of interventions to improve guideline-concordant care, care coordination, and care transitions in rare disease populations. Using Covidence software, two researchers independently screened all texts against preestablished inclusion and exclusion criteria, with conflicts resolved through consensus discussion with a third researcher.

Sources of evidence:

Comprehensive searches were conducted in April 2022 in Ovid MEDLINE, Embase.com, Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov.

Charting methods:

Two researchers independently extracted study characteristics and results from eligible full texts using Covidence software, with any conflicts resolved through consensus discussion with a third researcher.

Results:

Our search identified 2899 articles. After screening for eligibility criteria, 12 articles describing health services interventions in rare diseases were identified. Most studies were conducted in Europe and involved adult participants. Three main intervention targets were identified: (1) increasing patients’ access to multidisciplinary expertise (e.g. using expert panels/tumor boards, integrating additional disciplines into care teams, and creating a hotline for specialist advice); (2) using technology to give point-of-care physicians access to information (e.g. electronic medical record templates/decision-support); and (3) standardizing care through clinical care pathways.

Conclusion:

This review identified several efficacious interventions to improve healthcare delivery for individuals with a single rare disease. Testing these strategies across broader groups of rare disease patients could more efficiently improve healthcare delivery for the rare disease community, facilitating patients’ timely access to treatments, improving their health outcomes, and potentially reducing healthcare costs with economies of scale.
The road toward patient-led research in the GLUT1 Deficiency community: a patient organization perspective
Authors: Ojeda Torres Sandra Stella , Sanchez Chantal Marie , Steele Glenna Spencer
Published: August 2024

Glucose transporter type 1 deficiency syndrome (GLUT1 Deficiency) is a rare epileptic encephalopathy first described in 1991. Impaired glucose transport leads to decreased glucose supply to the brain, resulting in an alteration of brain metabolism and function. Clinically, classical GLUT1 Deficiency is characterized by infantile-onset epilepsy, which is often drug resistant, movement disorders, intellectual disability, and speech and language disorders. There is a broad spectrum of symptoms and severity which may change over time. GLUT1 Deficiency is caused by pathogenic variants of the SLC2A1 gene that can be spontaneous or inherited in an autosomal dominant fashion, although a few cases of autosomal recessive transmission have also been reported. There is currently no cure for GLUT1 Deficiency; however, the recommended standard of care treatment is a medically supervised ketogenic dietary therapy, which helps improve some symptoms for some patients. The Glut1 Deficiency Foundation aimed to develop a strategic research plan centered on the needs and priorities of patients using a patient voice survey and gathering input from all stakeholders. The Collective Voices Survey content was developed through virtual focus group discussions and questionnaires with patients and families. We used learnings from our survey and our first scientific conference to assemble our strategic research plan, which we have called our Research Compass. The survey provided clarity and a more comprehensive representation of patient and family experiences. It also sheds light on their priorities for research, ideas around treatment development, and willingness to participate in clinical trials. Learnings from this survey, along with input from other stakeholders, helped us identify some of the research gaps in our disease field. These insights are incorporated into the Research Compass that is now guiding the scientific focus and priorities in our community and ensuring that patients are at the center of this effort.
The use of art as a creative research method to understand psychosocial care needs for children with rare diseases
Authors: Buckle Niamh , O’Neill Amy , Sweeney Alison , McNulty Sandra , Bracken Shirley , Awan Atif , Sinnott Shannon , Gibbs Lisa , Larkin Philip , Kroll Thilo , Somanadhan Suja
Published: August 2024

Background:

Even though a disease might be labelled as ‘rare’, it is estimated that 450 million people globally are affected by rare diseases, and 70% of these conditions are among children. All children have the right to good quality healthcare and to be heard despite the country or state they live in. While children’s drawings are increasingly used in qualitative research to understand children’s experiences and perceptions of illness, few studies in the rare disease field utilize this method.

Objective:

This study examined drawings of children with rare diseases to gain insight into their experience living with their condition.

Design:

A qualitative phenomenological research study was employed to explore and understand children’s and young people’s experiences and perceptions of living with rare diseases through research participants’ artistic expression in drawings and responses to semistructured interview questions.

Methods:

A purposively selected sample of children ( n = 7) attending tertiary paediatric healthcare was invited to participate in a once-off art session facilitated by an art therapist, followed by semi- structured interviews. A practical iterative framework for art-based data analysis was developed to incorporate art interpretations, semi-structured interviews and reflexive analysis.

Results:

As drawing is an open visual medium, a framework was developed to analyse the drawings thematically. The themes that emerged from the drawings were fitting in versus feeling different and supportive relationships. These themes highlight the contradictory experience of living with a rare disease and the role of family and friends in influencing the participants’ experiences.

Conclusion:

Developing an art analysis framework benefitted the thematic analysis of the participants’ drawings. This study concludes that art can help offer opportunities for children to express themselves and for health and social care professionals to understand the impact of rare diseases on their everyday lives.
Delay in seeking treatment and associated factors among women with pelvic organ prolapse in Bale Zone, Southeast Ethiopia: a hospital-based cross-sectional study
Authors: Ejigu Neway , Seyoum Kenbon , Gomora Degefa , Kene Chala , Mengistu Sheleme , Geta Girma , Abdella Mujib , Ayele Alemitu , Admasu Yaregal , Embiale Ayinamaw , Mesfin Telila , Eshetu Derese , Shifera Wondu , Wardofa Tadele , Atlaw Daniel , Sarbecha Negussie , Beressa Girma
Published: August 2024

Background:

Pelvic organ prolapse (POP) is a major reproductive health problem that severely affects women’s quality of life in several ways. Women who suffer from POP silently wait to heal from their problem without seeking care until the disease progressively worsens.

Objective:

The aim of this study was to assess factors associated with delay in seeking treatment among women with POP at public hospitals in Bale Zone, Southeast Ethiopia.

Design:

Facility-based cross-sectional study.

Methods:

A total of 344 study participants were enrolled at public hospitals in Bale Zone, Southeast Ethiopia, from 20 February to 20 May 2023. A consecutive sampling method was used to select the respondents. Data were collected using a pretested interviewer-administered structured questionnaire. Both bivariable and multivariable logistic regressions were used to identify the predictors of the outcome variable. Both the crude odds ratio (COR) and adjusted odds ratio (AOR) along with a 95% confidence interval (CI) were used to estimate the strength of the association between predictors and the response variable.

Results:

This study revealed that out of 333 participants, 76.9% (95% CI: 72.1, 81.4) were delayed in the treatment of POP. The median time of delay for POP treatments was 36 [interquartile range (IQR): 24–96] months. Being a rural resident [adjusted odds ratio (AOR) = 2.02, 95% CI: 1.23, 4.00], autonomous decision-making (AOR = 5.46, 95% CI: 2.30, 10.85), lack of support (AOR = 3.94, 95% CI: 1.64, 9.48), an embarrassment to see male health care providers (AOR = 2.04, 95% CI: 1.09, 3.81), and a lack of knowledge about successful POP treatment (AOR = 2.29, 95% CI: 1.27, 4.14) were significantly associated with delay of treatment for POP.

Conclusion:

A large number of women with POP did not seek health care in this study: Being in rural, autonomous decision-making, a lack of support, an embarrassment to see male health care providers, and a lack of knowledge on successful treatment were associated with treatment delay. Educating women and the community to make them aware that it is a treatable condition and encourage women’s independence in decision-making on health care services in the family will improve their quality of life.
Septic Arthritis of the Temporomandibular Joint in a 6-Year-Old Child: A Case Report
Authors: Nganzeu Claude , Rogol Elizaveta
Published: August 2024

Septic arthritis of the temporomandibular joint (SATMJ) is very rare in the pediatrics population. In children, it can be acquired through trauma or as a complication of acute otitis media or otomastoiditis. Prompt diagnosis and management are crucial for full recovery without complications such as ankylosis or growth disturbance. In this case report, we present a case of a 6 year-old who presented with an acute SATMJ and was successfully treated with surgical and medical intervention.
Hybrid Reconstruction of a Large Traumatic Lower Lip Avulsion Defect Utilizing Cleft Lip Reconstruction Techniques to Optimize Outcomes
Authors: Awad Amanda N. , Kotamarti Vasanth S. , Nguyen Brittany N. , Adetayo Oluwaseun A.
Published: August 2024

Large defects of the lip pose a reconstructive challenge due to the prominent facial location, significant impact on self-image and quality of life, and effects on functional needs such as oral competence, sensation, articulation, and maintenance of normal range of incisal opening. Current lip reconstruction practice follows guidelines based on defect depth and size. Optimal outcomes are achieved with use of local tissues which achieve better color, texture match, and ability to maintain sensation and orbicularis function. However, this is not usually possible in large defects. Cleft repair principles revolve around many of the similar goals of traumatic and oncologic lip reconstruction—to improve function and aesthetics. The authors present a case of a young male who sustained a traumatic lower lip avulsion defect involving greater than 75% of his lower lip. This was fully reconstructed using principles borrowed from cleft lip component repair, thus eliminating the need for a free flap without or without a tendon graft. This approach optimized aesthetic and functional outcomes, while avoiding several of the drawbacks of the classic oral flap reconstruction, especially in a young patient without static rhytids to camouflage reconstructive scars. In the presented technique, the senior author (OAA) successfully designed a modification of the classic Karapandzic repair technique utilizing principles from cleft lip reconstruction to address skin, muscle, and mucosa in separate components. This new modification of a classic technique presented by the authors utilizes principles from cleft lip reconstruction for improved functional and aesthetic outcomes in a single-stage reconstruction. This cross-pollination of principles resulted in the successful modification of traditional techniques leading to improved aesthetics, sensate reconstruction, complete oral competence, good maximal incisal opening and color match, and decreased scar burden.
Management of Coincident Metopic and Unilateral Lambdoid Craniosynostosis, a Rare Entity
Authors: Daly Gwendolyn E. , Ferry Andrew M. , Howell Lori K. , Selden Nathan R. , Wolfswinkel Erik M.
Published: August 2024

Introduction:

Multi-suture craniosynostosis is rare and comprises only 3% to 7% of all craniosynostosis cases. Depending on the sutures involved, there are multiple operative approaches for this disease. In this report, we describe the staged surgical management of a patient who presented with metopic and unilateral lambdoid synostosis with initial posterior cranial vault remodeling followed by fronto-orbital advancement (FOA).

Methods:

At our institution, case reports detailing a single patient are not considered human research by the Institutional Review Board and official approval was not sought. Written consent for inclusion of patient information and images was obtained from the patient’s legally authorized representative.

Results:

A male patient was treated for metopic and right unilateral lambdoid synostosis. Physical examination was notable for trigonocephaly, right sided posterior plagiocephaly, right mastoid bulging, and contralateral parietal bossing. Treatment of his synostotic deformities was delayed and treated in stages. This was achieved with initial posterior vault expansion, to treat his lambdoid synostosis, via a modification to the classic switch cranioplasty at 5 months of age. The patient subsequently underwent fronto-orbital advancement for correction of metopic synostosis at 10 months of age. The posterior cranial vault remodeling procedure permitted sufficient cranial vault expansion to delay fronto-orbital advancement until 10 months of age. Of note, excellent bone fill and union were observed of the posterior bone grafts at the time of scalp flap elevation during this second procedure. His most recent follow up appointment at 11 months status post FOA demonstrated continued deformational correction as well as good bone fill and wound healing.

Conclusions:

Multi-suture craniosynostosis is rare with only a single other report in the literature discussing concurrent metopic and unilateral lambdoid synostosis. A multi-stage approach is the most commonly employed technique and must be tailored to each patients’ unique presentation.
Paramedic occupational violence: A qualitative examination of aggressive behaviour during out-of-hospital care
Authors: Drew Peter , Devenish Scott , Tippett Vivienne
Published: August 2024

Occupational violence (OV) is an insidious problem for emergency medical services with continued high levels of paramedic exposure despite significant education and resources devoted to mitigation. Though there is considerable data on the epidemiology of the phenomenon, the available evidence on the experiences of paramedics exposed to acts of violence during healthcare is limited. Utilising a generic qualitative approach and a semi-structured interview framework, we examined the perceptions and experiences of 25 Australian paramedics who had been exposed to incidents of patient-initiated violence during out-of-hospital care. A general inductive methodology and a first- and second-cycle coding process assisted in the development of the principal concepts of the patient and the paramedic from the raw data. Subsequently, a further four main themes and 15 secondary themes were developed which characterise the influence of social interaction on the evolution of paramedic OV. The results of this study provide a unique insight into the phenomenon of paramedic OV. As opposed to the rudimentary manifestation of aggression typically endorsed by emergency medical services, aggressive behaviour during healthcare presents as a judicious interaction of dynamic scene management and situational context. The social interactions that occur during healthcare, and the premises which both promote and suppress this connection, were identified to exert significant influence on the evolution of aggressive behaviour. The consequences of these findings challenge traditional violence mitigation strategies which seek to position the patient as both the focal point of initiation and the key to its extenuation.
Status and determinants of healthcare supply chain practices in public health facilities, Northwest Ethiopia: Mixed-method study
Authors: Tefera Bereket Bahiru , Anbessa Gizachew Tilahun
Published: August 2024

Objectives:

This study sought to assess the current state of healthcare supply chain practices and discern the influencing factors from the perspective of healthcare professionals in the West Gojjam Zone, Ethiopia.

Methodology:

This research employed a cross-sectional study design, complemented by qualitative study. Data gathering encompassed self-administered surveys and in-depth face-to-face interviews conducted between 30 April and 30 June 2020. Epi-Data facilitated data entry, while SPSS version 20 conducted subsequent analysis. Multiple linear regression was executed, deeming variables with a p-value less than 0.05 as indicative of a significant association. Thematic analysis was applied to analyze the qualitative data.

Result:

A total of 425 questionnaires were disseminated, with 413 (97.2%) effectively completed and returned. Procurement, after-procurement service, and monitoring and evaluation emerged as areas with suboptimal performance, registering mean values of 2.85, 2.24, and 1.86, respectively. In contrast, storage practices demonstrated relatively superior performance, with a mean value of 3.34. Multiple linear regression analyses unveiled significant correlations between various practices and factors such as training frequency, proficiency of staff in Integrated Pharmaceutical Logistics System (IPLS), managerial support, and proximity to Pharmaceutical Fund and Supply Agency (PFSA). Moreover, impediments to supply chain practices were identified, encompassing limited medication availability at PFSA, budget constraints, tardy reimbursement by the Health Insurance Agency, and a dearth of technicians adept in medical equipment maintenance.

Conclusion:

The implementation status of healthcare supply chain practices within public health facilities was discerned to be inadequate, with several impediments hindering their effective execution.
Prospective Health Impacts of a Universal Basic Income: Evidence from Community Engagement in South Tyneside, United Kingdom
Authors: Howard Neil , Gregory Grace , Johnson Elliott A. , Goodman Cleo , Coates Jonathan , Pickett Kate E. , Johnson Matthew T.
Published: August 2024

Studies have suggested that universal basic income (UBI) has the capacity to have substantial health benefits across the population at national level. Multiple impact pathways have recently been theorized and there are calls for trials to explore these pathways empirically. However, very limited research has taken place at local levels to explore potential context-specific effects, or how these effects could play out in economic, social, and behavioral changes. In order to examine these effects and to think through potential issues and unintended consequences, we brought together citizen engagement groups in Jarrow, South Tyneside, in the northeast of England to explore local people's expectations and positions on the development of UBI policies and pilots prior to their implementation. We found that people's expectations regarding the potential beneficial health impacts of UBI on their communities mapped strongly onto academically theorized impact pathways. They also extended understanding of these pathways in meaningful ways. Our findings add to the literature about UBI and health and provide important insights for the future development of empirical, health focused, UBI research.
Diversity and Team Learning in Intraorganizational Project Teams: The Mediating Role of Shared Leadership
Authors: Kristensen Saeedeh Shafiee , Shafiee Sara
Published: August 2024

This article tested a moderated mediation process to explain the relationships between diversity-based predictors with team learning via shared leadership. Based on data from 183 members of 27 intraorganizational projects teams embedded in a large Danish company as the permanent organization, we show the varying effects of functional and hierarchical power diversity on shared leadership, respectively moderated by transactive memory systems within project teams and the empowering leadership in the permanent organization. Additionally, the psychological safety within the permanent organization strengthens the positive relationship between shared leadership and team learning within project teams. Theoretical and practical implications are discussed.
Intracranial aneurysms in sickle cell disease are associated with hemodynamic stress and anemia
Authors: Wang Yan , Garland Jared S. , Fellah Slim , Reis Martin N. , Parsons Matthew S. , Guilliams Kristin P. , Fields Melanie E. , Mirro Amy E. , Lewis Josiah B. , Ying Chunwei , Cohen Rachel A. , Hulbert Monica L. , King Allison A. , Chen Yasheng , Lee Jin-Moo , An Hongyu , Ford Andria L.
Published: August 2024

Although hemodynamic stress plays a key role in aneurysm formation outside of sickle cell disease (SCD), its role is understudied in patients with SCD. We hypothesized that tissue-based markers of hemodynamic stress are associated with aneurysm presence in a prospective SCD cohort. Children and adults with SCD, with and without aneurysms, underwent longitudinal brain magnetic resonance imaging/magnetic resonance angiography (MRA) to assess cerebral blood flow (CBF) and oxygen extraction fraction (OEF). Baseline characteristics were recorded. In the subgroup of adults, stepwise mixed-effect logistic regression examined clinical variables, CBF, and OEF as predictors of aneurysm presence. Cumulative rates of new aneurysm formation were estimated using Kaplan-Meier analyses. Forty-three aneurysms were found in 27 of 155 patients (17%). Most aneurysms were ≤3 mm and in the intracranial internal carotid artery. On univariate analysis, older age (P = .07), lower hemoglobin (P = .002), higher CBF (P = .03), and higher OEF (P = .02) were associated with aneurysm presence. On multivariable analysis, age and CBF remained independently associated with aneurysm presence. Seventy-six patients (49% of enrollment) received follow-up MRAs (median, 3.5 years). No aneurysm grew or ruptured, however, 7 new aneurysms developed in 6 patients. The 3-year cumulative rate of aneurysm formation was 3.5%. In 155 patients with SCD, 17% had intracranial aneurysms. Three-year aneurysm formation rate was 3.5%, although limited by small longitudinal sample size and short follow-up duration. Aneurysm presence was associated with elevated CBF in adults, as a tissue-based marker of cerebral hemodynamic stress. Future studies may examine the predictive role of CBF in aneurysm development in SCD.
How will lung cancer screening and lung nodule management change the diagnostic and surgical lung cancer landscape?
Authors: Hardavella Georgia , Frille Armin , Chalela Roberto , Sreter Katherina B. , Petersen Rene H. , Novoa Nuria , de Koning Harry J.
Published: August 2024

Introduction:

Implementation of lung cancer screening, with its subsequent findings, is anticipated to change the current diagnostic and surgical lung cancer landscape. This review aimed to identify and present the most updated expert opinion and discuss relevant evidence regarding the impact of lung cancer screening and lung nodule management on the diagnostic and surgical landscape of lung cancer, as well as summarise points for clinical practice.

Methods:

This article is based on relevant lectures and talks delivered during the European Society of Thoracic Surgeons–European Respiratory Society Collaborative Course on Thoracic Oncology (February 2023). Original lectures and talks and their relevant references were included. An additional literature search was conducted and peer-reviewed studies in English (December 2022 to June 2023) from the PubMed/Medline databases were evaluated with regards to immediate affinity of the published papers to the original talks presented at the course. An updated literature search was conducted (June 2023 to December 2023) to ensure that updated literature is included within this article.

Results:

Lung cancer screening suspicious findings are expected to increase the number of diagnostic investigations required therefore impacting on current capacity and resources. Healthcare systems already face a shortage of imaging and diagnostic slots and they are also challenged by the shortage of interventional radiologists. Thoracic surgery will be impacted by the wider lung cancer screening implementation with increased volume and earlier stages of lung cancer. Nonsuspicious findings reported at lung cancer screening will need attention and subsequent referrals where required to ensure participants are appropriately diagnosed and managed and that they are not lost within healthcare systems.

Conclusions:

Implementation of lung cancer screening requires appropriate mapping of existing resources and infrastructure to ensure a tailored restructuring strategy to ensure that healthcare systems can meet the new needs.
The awareness of enhanced recovery after surgery (ERAS) cesarean delivery guidelines among anesthesiology and reanimation assistants in Turkey; a questionnaire study
Authors: Dedebagı Zeliha , Özden Eyyüp Sabri , Özcan Mustafa Soner , Solmaz Filiz Alkaya , Kırdemir Pakize
Published: August 2024

Background

To reduce maternal-fetal morbidity and mortality, it is becoming increasingly important for anesthetists to understand and implement enhanced recovery after surgery (ERAS) cesarean delivery guidelines. Our aim was to reveal the knowledge of anesthesia assistants in Turkey about ERAS during cesarean delivery and to increase their awareness of ERAS.

Methods

This descriptive study was conducted in the city of Isparta, Turkey in 2023. The survey, which was approved by the ethics committee, was distributed to participants across Turkey via e-mail and online messages. The survey comprises of a total of 42 questions evaluating perioperative ERAS recommendations.

Results

Of the 404 participants in our survey, 59.9% were associated with university hospitals and 65.8% had completed three or more years of education. A total of 87.9% of the participants were familiar with ERAS; however, only 42.8% had received ERAS training. Although 93.8% of the participants’ institutions performed a cesarean delivery, ERAS recommendations were only implemented at a rate of 48%. This may be due to the absence of an ERAS team, which was identified in our survey at a high rate of 66.6%.

Conclusion

Awareness about ERAS was high among the participants, but the implementation rates of some recommendations were low. The reason for this may be the inability to form a multidisciplinary team and inadequate training of participants. For this purpose, we recommend the formation of a multidisciplinary team for ERAS protocol implementation and increased participant training opportunities.
A systematic review assessing the association of inflammatory markers with kidney dysfunction in people living with HIV on highly active antiretroviral therapy
Authors: Choshi Joel , Hanser Sidney , Mabhida Sihle E. , Mokoena Haskly , Moetlediwa Marakiya T. , Muvhulawa Ndivhuwo , Sekgala Machoene D , Nkambule Bongani B. , Mchiza Zandile J.R. , Ndwandwe Duduzile , Nqebelele Unati , Kengne André P. , Dludla Phiwayinkosi V.
Published: August 2024

Monitoring chronic diseases, particularly kidney disorders, in people living with HIV (PLWH) is of paramount importance. Here, a systematic search was conducted across electronic search engine and databases like PubMed, Scopus, and Google Scholar, from date of inception until December 2023, to identify pertinent studies reporting on any association between inflammation and kidney function in PLWH. Only six clinical studies in peer-reviewed journals met the inclusion criteria, involving 1467 participants aged 37 to 51, with approximately 17% being females. The report emphasizes the potential impact of highly active antiretroviral therapy (HAART) on kidney function in PLWH, highlighting the significance of monitoring inflammation markers as indicators of kidney function, even when HAART is effective. Acknowledging study limitations, particularly the scarcity of relevant research, the findings highlight a need for more research to inform on clinical guidance to optimize HIV management, particularly regarding kidney health and HAART regimens. Although very limited studies were evaluated, the study lays an important foundation for future research to uncover the complex relationship between HAART, inflammation markers, and kidney health in PLWH.
Evaluating tuberculosis knowledge and awareness of effective control practices among health care workers in primary- and secondary-level medical institutions in Beijing, China
Authors: Zhang Lijie , Ma Xiaoge , Liu Menghan , Wu Sihui , Li Zhili , Liu Yuhong
Published: August 2024

Objective

Inadequate tuberculosis (TB) knowledge and awareness of proper TB control practices among health care workers (HCWs) may increase the risk of nosocomial TB transmission. This study aimed to assess HCWs’ TB-related knowledge and control practices to guide the development of more effective targeted TB health education and training programs.

Methods

In January 2023 a cross-sectional survey was administered to 323 HCWs employed by five primary health care centers and three secondary comprehensive medical institutions in Beijing, China. Survey data were collected using a standard questionnaire.

Results

Analysis of survey responses revealed TB knowledge and practices awareness rates of 60.4% and 90.6%, respectively. The overall average awareness rate across all 19 TB knowledge- and practice-related questions was 70.0%. Intermediate- and senior-level HCW’s average TB knowledge score was respectively 2.225 and 8.175 times higher than that of primary-level HCWs, while the average TB knowledge score of HCWs in secondary comprehensive medical institutions was 3.052 times higher than that of HCWs in primary health care centers. Higher average TB knowledge score correlated with higher-level professional titles and higher level work units, but higher average TB control practices score correlated with employment at primary health care center rather than secondary comprehensive medical institution. Notably, 13.6% of HCWs had not received TB training during the past three years, while 86.1% expressed willingness to undergo online TB training.

Conclusion

These findings highlight inadequate TB knowledge and awareness of proper TB control practices among HCWs in primary health care centers and secondary comprehensive medical institutions in Beijing, underscoring the urgent need for targeted educational and training initiatives to improve TB awareness and control efforts.
Fibrin-konjac glucomannan-black phosphorus hydrogel scaffolds loaded with nasal ectodermal mesenchymal stem cells accelerated alveolar bone regeneration
Authors: Zou Yin , Mei Xue , Wang Xinhe , Zhang Xuan , Wang Xun , Xiang Wen , Lu Naiyan
Published: August 2024

Background

Effective treatments for the alveolar bone defect remain a major concern in dental therapy. The objectives of this study were to develop a fibrin and konjac glucomannan (KGM) composite hydrogel as scaffolds for the osteogenesis of nasal mucosa-derived ectodermal mesenchymal stem cells (EMSCs) for the regeneration of alveolar bone defect, and to investigate the osteogenesis-accelerating effects of black phosphorus nanoparticles (BPNs) embedded in the hydrogels.

Methods

Primary EMSCs were isolated from rat nasal mucosa and used for the alveolar bone recovery. Fibrin and KGM were prepared in different ratios for osteomimetic hydrogel scaffolds, and the optimal ratio was determined by mechanical properties and biocompatibility analysis. Then, the optimal hydrogels were integrated with BPNs to obtain BPNs/fibrin-KGM hydrogels, and the effects on osteogenic EMSCs in vitro were evaluated. To explore the osteogenesis-enhancing effects of hydrogels in vivo, the BPNs/fibrin-KGM scaffolds combined with EMSCs were implanted to a rat model of alveolar bone defect. Micro-computed tomography (CT), histological examination, real-time quantitative polymerase chain reaction (RT-qPCR) and western blot were conducted to evaluate the bone morphology and expression of osteogenesis-related genes of the bone regeneration.

Results

The addition of KGM improved the mechanical properties and biodegradation characteristics of the fibrin hydrogels. In vitro, the BPNs-containing compound hydrogel was proved to be biocompatible and capable of enhancing the osteogenesis of EMSCs by upregulating the mineralization and the activity of alkaline phosphatase. In vivo, the micro-CT analysis and histological evaluation demonstrated that rats implanted EMSCs-BPNs/fibrin-KGM hydrogels exhibited the best bone reconstruction. And compared to the model group, the expression of osteogenesis genes including osteopontin (Opn,p < 0.0001), osteocalcin (Ocn,p < 0.0001), type collagen (Col ,p < 0.0001), bone morphogenetic protein-2 (Bmp2,p < 0.0001), Smad1 (p = 0.0006), and runt-related transcription factor 2 (Runx2,p < 0.0001) were all significantly upregulated.

Conclusions

EMSCs/BPNs-containing fibrin-KGM hydrogels accelerated the recovery of the alveolar bone defect in rats by effectively up-regulating the expression of osteogenesis-related genes, promoting the formation and mineralisation of bone matrix.
Implementation of integrated care for type 2 diabetes Mellitus and Periodontitis in Germany: study protocol for a practice-based and cluster-randomized trial
Authors: Hennrich Patrick , Queder Annika , Altiner Attila , Awounvo Sinclair , Dyczmons Jan , Eigendorf Julian , Erdmann Stella , Grobe Thomas , Gutscher Andreas , Herzig Nicole , Jepsen Søren , Kairies-Schwarz Nadja , Kalmus Olivier , Kliemannel Fabian , Santos Sara , Vanella Patrizio , Wensing Michel , Wilm Stefan , Listl Stefan
Published: August 2024

Background

Type 2 Diabetes mellitus (T2DM) and periodontitis share common risk factors and influence one another. However, primary care and oral health care continue to operate separate from each other and fail to synchronize care for patients with T2DM and periodontitis. The purpose of this practice-based trial is to evaluate the implementation of a new integrated care pathway for patients with T2DM and periodontitis. The new approach integrates a screening for T2DM risk in dental care settings in patients with periodontitis, a screening for periodontitis risk in primary care settings in patients with T2DM, and mutual referrals between dentists and primary care physicians.

Methods

Two practice-based studies will be carried out in parallel: (i) In dental care settings: a practice-based, multi-centric, cluster-randomized, controlled trial with a control and an intervention group; (ii) in primary care settings: a practice-based, multi-centric, non-randomized, controlled trial with a synthetic control group calculated from claims data. Following a two-step recruitment approach, 166 dentists and 248 general practitioners will be recruited, who themselves will recruit a total of 3808 patients in their practices. Patient data will be collected at baseline, 12 months, and 24 months after study enrollment. The evaluation comprises: (i) impact evaluation, using a hierarchical linear mixed model; (ii) process evaluation, based on surveys alongside the trials; (iii) economic evaluation. In addition, a Discrete-Choice-Experiment will identify provider’s payment preferences for the new care approach.

Discussion

Upon successful implementation, the intervention will enable health care providers to detect a risk for T2DM and periodontitis in patients at an early stage, thus providing patients an opportunity for timely diagnosis and therapy. Ultimately, this can lead to increased quality of life and reduced health care expenditures. On a methodologic level, the project provides novel insights into a complex intervention on the intersection of general practice and dental care.

Trial registration

The study was prospectively registered at the German Clinical Trials Register (https://drks.de/search/de/trial/DRKS00030587) on 3. July 2023 under ID “DRKS00030587“.
The relationship professional commitment and ethics with patient rights: a cross-sectional descriptive study
Authors: Mohammadnejad Sara , Raiesifar Afsaneh , Karamelahi Zoleikha , Chehreh Razhan
Published: August 2024

Background

Ethical behavior of health workers is an important part of health services. The aim of the present study was to determine the relationship between ethics and professional commitment and its relationship with the level of respect for patient rights in medical students.

Material & methods

A cross-sectional descriptive study was conducted with the participation of nursing, midwifery and emergency medicine students of Ilam University of Medical Sciences. Sampling was done by stratified random method. The data was collected using Demographic, Professional Commitment, Professional ethics and a researcher made questioner on compliance with patient rights questionnaires.

Results

300 students were participated. The results showed that the average score of professional ethics in middle school students is high (64.07 ± 8.01), the average score of professional commitment is also high (64.07 ± 8.01) and the score of respect for patient rights is also high (10.74). ± 83.46) was obtained. The professional ethics score it showed a positive and statistically significant relationship with the patient’s rights compliance score. only professional commitment is related to gender, but the average of all three variables in different age groups and the type of residence (dormitory, private home, etc.) have meaningful statistical difference.

Conclusion

The findings of the study show that the level of ethics and professional commitment and respect for patient rights among nursing, midwifery and emergency medicine students was good. It is hoped that the results of this research will provide a basis for better planning for the development of knowledge and respect for patient rights among students.
Understanding the barriers and facilitators of healthcare services for brain injury and concurrent mental health and substance use issues: a qualitative study
Authors: Grewal Jasleen , Kennedy Cole J. , Mamman Rinni , Biagioni Janelle Breese , Garcia-Barrera Mauricio A. , Schmidt Julia
Published: August 2024

Background

People with acquired brain injury (ABI) may experience concurrent conditions such as, mental health and substance use concerns, that require specialized care. There are services that aim to support people with ABI and these conditions separately; however, little is known about the facilitators and barriers of these services. Therefore, the purpose of this study was to engage stakeholders to investigate the facilitators and barriers of healthcare services for ABI and concurrent issues.

Methods

Semi-structured focus groups were conducted in-person and virtually with people with ABI, caregivers, healthcare professionals, and policy makers during a one-day event in British Columbia, Canada. Manifest content analysis was used with a constructivist perspective to analyze data.

Results

90 participants (including 34 people with ABI) provided insights during 15 simultaneous focus groups. Three categories were identified: (1) complexity of ABI, (2) supports, (3) structure of care. Complexity of ABI outlined the ongoing basic needs after ABI and highlighted the need for public awareness of ABI. Supports outlined healthcare professional and community-based supports. Structure of care described people with ABI needing to meet criteria for support, experiences of navigating through the system and necessity of integrated services.

Conclusions

These findings highlight the facilitators and barriers of healthcare services for ABI and concurrent conditions and provide insights into the changes that may be needed. Doing so can improve the accessibility and quality of ABI healthcare services.
Momordica charantia L.-derived exosome-like nanovesicles stabilize p62 expression to ameliorate doxorubicin cardiotoxicity
Authors: Ye Cong , Yan Chen , Bian Si-Jia , Li Xin-Ran , Li Yu , Wang Kai-Xuan , Zhu Yu-Hua , Wang Liang , Wang Ying-Chao , Wang Yi-Yuan , Li Tao-Sheng , Qi Su-Hua , Luo Lan
Published: August 2024

Background

Doxorubicin (DOX) is a first-line chemotherapeutic drug for various malignancies that causes cardiotoxicity. Plant-derived exosome-like nanovesicles (P-ELNs) are growing as novel therapeutic agents. Here, we investigated the protective effects in DOX cardiotoxicity of ELNs from Momordica charantia L. (MC-ELNs), a medicinal plant with antioxidant activity.

Results

We isolated MC-ELNs using ultracentrifugation and characterized them with canonical mammalian extracellular vesicles features. In vivo studies proved that MC-ELNs ameliorated DOX cardiotoxicity with enhanced cardiac function and myocardial structure. In vitro assays revealed that MC-ELNs promoted cell survival, diminished reactive oxygen species, and protected mitochondrial integrity in DOX-treated H9c2 cells. We found that DOX treatment decreased the protein level of p62 through ubiquitin-dependent degradation pathway in H9c2 and NRVM cells. However, MC-ELNs suppressed DOX-induced p62 ubiquitination degradation, and the recovered p62 bound with Keap1 promoting Nrf2 nuclear translocation and the expressions of downstream gene HO-1. Furthermore, both the knockdown of Nrf2 and the inhibition of p62-Keap1 interaction abrogated the cardioprotective effect of MC-ELNs.

Conclusions

Our findings demonstrated the therapeutic beneficials of MC-ELNs via increasing p62 protein stability, shedding light on preventive approaches for DOX cardiotoxicity.
Frontline use of rituximab may prevent ADAMTS13 inhibitor boosting during caplacizumab treatment in patients with iTTP: post hoc analysis of a phase 2/3 study in Japan
Authors: Imada Kazunori , Miyakawa Yoshitaka , Ichikawa Satoshi , Uchiyama Hitoji , Ueda Yasunori , Hashimoto Yasuhiro , Nishimi Masashi , Tsukamoto Masako , Tahara Sayaka , Matsumoto Masanori
Published: August 2024

Background

A recent Phase 2/3 study in Japanese patients showed that caplacizumab was effective in treating immune-mediated thrombotic thrombocytopenic purpura (iTTP), with a low rate of iTTP recurrence. ADAMTS13 activity is monitored weekly during caplacizumab treatment to guide discontinuation of caplacizumab and consequently avoid exacerbations or relapse. The aim of this study was to assess changes in ADAMTS13 activity/inhibitor levels during caplacizumab treatment in this patient population.

Methods

A post hoc analysis of the Phase 2/3 study in Japanese patients was conducted. Patients ≥ 18 years old with confirmed iTTP received 10 mg of caplacizumab daily in conjunction with therapeutic plasma exchange (TPE) and immunosuppression for 30 days post-TPE. Outcomes included time to recovery of ADAMTS13 activity, ADAMTS13 activity level at treatment end, incidence of ADAMTS13 inhibitor re-elevation (ie, inhibitor boosting) during treatment, time to platelet count recovery, number of days of TPE, and safety. Outcomes according to presence of inhibitor boosting were also assessed.

Results

Nineteen patients had confirmed iTTP and were included in this analysis. Median (95% confidence interval) time to recovery of ADAMTS13 activity to ≥ 10%, ≥ 20%, and ≥ 60% was 14.6 (5.9–24.8), 18.5 (5.9–31.8), and 47.5 (18.5–60.9) days, respectively. Median (range) ADAMTS13 activity level at caplacizumab treatment end was 62.0% (29.0–101.0). Nine patients had ADAMTS13 inhibitor boosting. Delayed response of ADAMTS13 activity was observed in patients with inhibitor boosting. The median time to platelet count response and median number of TPE days were shorter in patients with inhibitor boosting compared with patients without inhibitor boosting. Rituximab was administered to almost all patients with inhibitor boosting (88.9%), after completion of TPE. Patients without inhibitor boosting who were treated with rituximab received it prior to completion of TPE. Only one patient experienced a recurrence, which occurred shortly after caplacizumab discontinuation due to an adverse event.

Conclusions

In patients with iTTP, caplacizumab with TPE and immunosuppression may reduce the risk of ADAMTS13 inhibitor boosting if rituximab is administered early in the iTTP treatment period. Early administration of rituximab in addition to caplacizumab may prevent iTTP recurrence with inhibitor boosting.

Trial registration

NCT04074187.