bluuebunny/crossref_metadata_2025 huggingface dataset:
A smartphone-based support group for alcoholism: Effects of giving and receiving emotional support on coping self-efficacy and risky drinking
Authors: Yoo Woohyun , Shah Dhavan V , Chih Ming-Yuan , Gustafson David H
Published: December 2019

The purpose of this study was to investigate the nature and effects of exchanging emotional support via a smartphone-based support group for patients with alcohol dependence. Of the 349 patients who met the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for alcohol dependence, 153 patients participated in the discussion group within the Addiction-Comprehensive Health Enhancement Support System, a smartphone application aimed at reducing relapse. This was developed to prevent problem drinking by offering individuals in recovery for alcohol dependence automated 24/7 recovery support services and frequent assessment of their symptom status as part of their addiction care. The results showed that receiving emotional support from health care providers improved coping self-efficacy. Giving emotional support and receiving emotional support from health care providers acted as a buffer, protecting patients from the harmful effects of emotional distress on risky drinking. Clinicians and researchers should use the features of smartphone-based support groups to reach out to alcoholic patients in need and encourage them to participate in the exchange of emotional support with others.
Japan’s media fails its watchdog role: Lessons learned and unlearned from the 2011 earthquake and the Fukushima disaster
Authors: Okumura Nobuyuki , Hayashi Kaori , Igarashi Koji , Tanaka Atsushi
Published: December 2019

The Disaster and Media Research Group conducted for the first time, extensive, in-depth interviews with newsroom executives of 14 Japanese mainstream national media outlets (8 newspapers and wire services, and 6 broadcasting networks) on their reflections of Japanese media coverage of the 2011 Great East Japan Earthquake and Tsunami. The Japanese media takes pride in their ability to swiftly communicate news alerts and evacuation announcements. However, they recognized little issue in merely conveying official information from the government and power industry in coverage of the nuclear disaster, rather than demonstrating journalistic effort by seeking alternative sources, particularly for assessing the seriousness of radiation exposure. The main findings from the interviews were that Japanese media (1) are well prepared for broadcasting of immediate reports on seismic scales and tsunami alerts, but less so for assessing the risks of nuclear disaster; (2) share the view that the media’s role is to cooperate with the government to communicate during emergencies, even if this means sacrificing their watchdog role; (3) are steadfast in their belief in traditional platforms while lacking a strategy to adopt the web and smartphone; (4) have little or no interest in collaborative news gathering or journalism sharing; and (5) are negative to the idea of training reporters to specialize in nuclear science, nuclear plant safety measures, or radiation exposure (with the exception of two media interviewed).
Patients’ expectations: is there a typical patient?
Authors: Sayers Mark S , Cunningham Susan J , Newton Tim J
Published: December 2019

Objectives:

To qualitatively explore, and analyse, patients’ expectations before the start of fixed appliance orthodontic treatment and determine whether typologies exist.

Design:

A prospective cross-sectional qualitative study, which involved 13 patients (aged 12–15 years).

Setting:

NHS Hospital Orthodontic Department (UK).

Materials and methods:

In-depth interviews were conducted with patients who consented to participate before the start of fixed appliance orthodontic treatment. The in-depth interview data were transcribed and then managed using a framework approach, followed by associative analysis.

Results:

The in-depth interviews revealed two major themes and associated subthemes which were: first, patients’ expectations about the treatment process and outcome; and second, patients’ expectations of themselves during and after treatment. Three typologies related to patients’ expectations of the orthodontic treatment process were also identified. The first group of participants had minimal expectations of the treatment process, did not anticipate discomfort or pain and did not anticipate that treatment would cause disruption to their daily life. The second group of participants had expectations that treatment would involve arch wire changes, dental extractions and result in some discomfort/pain, which would cause some limited disruption to their daily life (moderate expectations). The third type of participant had expectations of the treatment process involving arch wire changes and dental extractions, and anticipated that the discomfort and pain experienced would significantly affect their daily life (marked expectations).

Conclusions:

These results provide the clinician with information about patient typologies and provide the clinician with some direction when communicating with their patients and managing their expectations before the start of treatment.
The qualitative researcher: the flip side of the research encounter with vulnerable people
Authors: Bashir Nadia
Published: December 2019

Using data from an empirical study involving in-depth interviews with five qualitative researchers, a conceptual lens based on power dynamics and imbalances is applied to explore the researcher: participant encounter, within particular settings and conditions. The research relationship rests on the assumption that the researcher occupies a more powerful position than the participant and the knowledgeable and powerful researcher questions the participant whose position is automatically assumed to shift to that of vulnerable participant. However, this paper seeks to show the flip side, whereby research encounters unfold in such a way that the researcher becomes the ‘vulnerable’. Although acknowledging the privilege and power of the researcher’s position, this article reveals that power is multifaceted and manifests itself in complex ways: as a researcher, fear of being on unfamiliar territory; researcher anxiety about the unpredictability of participants; and researcher feelings of powerlessness to help; and so on – all impacts which are underexplored.
Can External Use of Chinese Herbal Medicine Prevent Cumulative Peripheral Neuropathy Induced by Oxaliplatin? A Systematic Literature Review With Meta-analysis
Authors: Hao Jie , Zhu Xiaoshu , Smith Caroline A. , Bensoussan Alan
Published: December 2019

Background. Peripheral neurotoxicity caused by oxaliplatin (OXA) chemotherapy is the main limitation preventing continuation of chemotherapy in patients with gastrointestinal cancer. The purpose of this study was to determine the efficacy of external use of Chinese herbal medicine (CHM) on the incidence of cumulative OXA-induced peripheral neurotoxicity (OIPN). Method. Scientific literature databases were searched to identify controlled clinical trials analyzing CHM in OIPN. Clinical studies that included at least 1 relevant primary outcome were analyzed by 2 independent reviewers. Meta-analysis was performed on the software RevMan 5.3. Results. 700 cancer patients of 9 studies were reported, of whom 352 received external CHM and 348 received warm water baths, conventional medicine, or no intervention as controls. Neurotoxicity incidence (Levi grade ≥ 1) was significantly decreased in CHM group, compared with no intervention ( P < .01). The incidence of cumulative neurotoxicity (Levi grade ≥2) was also significantly lower in the CHM group than in all the control groups ( P < .05), and the cumulative neurotoxicity in the CHM group was significantly reduced (Levi grade ≥ 3) in comparision with no intervention ( P < .01). These results were consistent with those of the subgroup analyses for preventing OIPN at each of the chemotherapy treatment cycles. There was no difference in the incidence of adverse events between groups ( P > .05). Conclusion. External use of CHM may be beneficial in preventing the OXA-induced cumulative neurotoxicity. However, given the low quality of the evidence, the results should be interpreted with caution.
Mind the Gate to Improve Comorbid Cognitive Impairments in Epilepsy
Authors: Maguire Jamie
Published: December 2019

[Box: see text]
Twice daily cefazolin is effective for treatment of serious methicillin-sensitive Staphylococcus aureus infection in an outpatient parenteral antimicrobial therapy program
Authors: Birrell Michael T. , Fuller Andrew
Published: December 2019

Background:

The use of cefazolin for infections caused by Staphylococcus aureus has been demonstrated to be effective, and associated with fewer adverse effects compared with anti-staphylocccal penicillins; however, use of cefazolin on outpatient parenteral antimicrobial therapy (OPAT) programs often requires the use of continuous infusions. We report the outcomes of patients with serious infections caused by methicillin-sensitive S. aureus (MSSA) treated using twice daily cefazolin by a large tertiary hospital OPAT program. The aim of this study was to evaluate the safety, efficacy and outcomes after 90 days of follow up for patients with serious infections caused by MSSA treated with twice daily cefazolin by our OPAT program.

Methods:

A retrospective analysis of clinical outcomes of cases treated for a serious infection proven to be caused by MSSA treated with cefazolin monotherapy on the OPAT program at a tertiary hospital between January 2010 and July 2016 (6.5 years). Outcome measures included readmission rate, adverse drug reactions and clinical cure.

Results:

A total of 111 cases of serious MSSA infection were treated with cefazolin in the OPAT service during the study period, including 52 with peripheral or vertebral osteomyelitis and 13 with infective endocarditis; 56 patients had bacteraemia. Median duration of intravenous antibiotic therapy was 41 days, and the median proportion of intravenous therapy administered via OPAT was 69%. Two patients had recurrence of infection within 90 days, but were in the setting of retained prosthetic material. A total of 4% of patients experienced an adverse drug reaction. No cases of antibiotic failure were identified.

Conclusions:

The use of twice daily cefazolin for serious MSSA infection on an OPAT program is safe and effective. Further study is needed to assess for noninferiority to conventional treatment regimes.
Myositis ossificans in the diabetic foot: a review of the literature with an illustrative case series
Authors: Sharma Vivek , Sharma Dhiraj , Dinar Heather , Dhatariya Ketan K
Published: December 2019

Objective

Myositis ossificans is a rare non-neoplastic form of heterotopic ossification most commonly described after trauma or surgery, in the diabetic foot.

Design

We provide a review of the literature including three illustrative cases.

Participants

Individuals presenting to the foot clinic.

Setting

Single centre, tertiary multidisciplinary specialist diabetes foot clinic.

Results

We review the literature surrounding Myositis ossificans, and describe three cases of Myositis ossificans following foot surgery in people with diabetes. All of the imaging was consistent with the descriptions of Myositis ossificans reported elsewhere in large muscle groups. These are the first reports of Myositis ossificans occurring in the feet of people with diabetes.

Conclusions

Myositis ossificans has only very rarely been described in the foot and, as far as we are aware, never in people with diabetes. Given that the prevalence of diabetes is increasing, and the foot problems requiring surgery are also rising, we suggest that clinicians should be more aware of this condition because it may occur more frequently.
Are Standardized Letters of Recommendation in Residency Applications Correlated With Objective Data?
Authors: Tang Alice L , Howard Javier J M , Singh Eshita , Tabangin Meredith E , Wang James C , Myer Charles M , Altaye Mekibib , Rohde Sarah L
Published: December 2019

Objective:

To evaluate whether the standardized letter of recommendation (SLOR), commonly used for medical students applying to otolaryngology residency, correlates with objective data in the application.

Background:

Standardized letters of recommendation using Likert-type scales for different attributes are commonly used by evaluators because of their high interrater reliability and efficiency in preparation and interpretation. Given that these are subjectively scored, it is unknown how well these correlate with objective data.

Methods:

Applications to the University of Cincinnati otolaryngology residency were evaluated in the academic cycle of 2017-2018. Standardized letters of recommendation were scored to determine whether certain attributes were correlated with objective data (United States Medical Licensing Examination [USMLE] scores and number of presentations/publications) provided in their application. Spearman correlations were used to evaluate the strength of the relationship between the subjective score in certain attributes with objective data.

Results:

There were 217 applications to the University of Cincinnati that contained SLORs. Of these applications, 474 standardized letters were scored in categories of medical knowledge, research, and commitment to academic medicine. Total publications and presentations were weakly correlated with commitment to academic medicine (0.35, P < .0001, n = 369) and with research (0.44, P < .0001, n = 355). Medical knowledge was weakly correlated with Step 1 scores (0.20, P < .0001) and Step 2 scores (0.18, P = .0002).

Conclusions:

Subjective research and commitment to academic medicine rating scores were weakly correlated with greater academic productivity. Similarly, medical knowledge scores were weakly correlated with Step 1/2 scores. Further research may be needed to assess how to interpret SLOR scores in addition to the information available in an otolaryngology application.

Level of Evidence:

4
JagRover
Authors: Bhattacharjee Deborshee
Published: December 2019

The case is about the dilemma faced by Mr. Keith Gregor, MD of JagRover Warehouse Operations when he realizes that the technology which they are using is soon going to get obsolete. Currently, the warehouse operation is supported by SAP Warehouse Management System which is going to get obsolete in few years according to the product roadmap of SAP. SAP has introduced a new product known as the extended warehouse management system which is embedded in their suite for High Performance Analytic Appliance (HANA) product. This would mean changes for the warehouse operations, not only in terms of the product but also changing their current database management system. These changes will have huge cost implications. Mr. Keith Gregor is under the dilemma whether to invest on the new product or look for some other options. Cost and analytical abilities are the two heads which will majorly drive his investment decision.
Kooda Collection Ltd: Systematic Garbage Collection in India
Authors: Dash Sanket Sunand , Yadav Rama Shankar , Gupta Monika , Rathi Poonam
Published: December 2019

Founded by Mr. Rawal, Kooda Collection Ltd. was started in 2010 to collect waste paper from Vadodara. In contrast to the traditional operating model, where there were 4–7 intermediaries between the suppliers (households) and paper mills, Kooda Collection Ltd.’s operating model consists of being the sole intermediary between the suppliers and buyers. The firm had captured 20 percent of the market in Vadodara and was now eyeing expansion opportunities in other cities in Gujarat. Two possible options are Surat and Ahmedabad, both of which have a larger supplier base than Vadodara. Surat and Ahmedabad have large industrial bases and that is another potential source of raw material. Some of the questions on which the firm needs to take a decision are: city selected for expansion, operational challenges, supplier base to be targeted and mode of financing for expansion. The firm also has to decide whether to open a branch in the new city or run it from Vadodara.
Inhibition of the mutated c-KIT kinase in AML1-ETO–positive leukemia cells restores sensitivity to PARP inhibitor
Authors: Nieborowska-Skorska Margaret , Paietta Elisabeth M. , Levine Ross L. , Fernandez Hugo F. , Tallman Martin S. , Litzow Mark R. , Skorski Tomasz
Published: December 2019

Key Points

c-KIT activating mutations cause resistance to PARP inhibitor in AML1-ETO–positive leukemias. c-KIT inhibitor avapritinib downregulates BRCA1/2 and DNA-PK catalytic subunit to restore the sensitivity to PARP inhibitor.
Invasive fungal infections in acute myeloid leukemia treated with venetoclax and hypomethylating agents
Authors: Aldoss Ibrahim , Dadwal Sanjeet , Zhang Jianying , Tegtmeier Bernard , Mei Matthew , Arslan Shukaib , Al Malki Monzr M. , Salhotra Amandeep , Ali Haris , Aribi Ahmed , Sandhu Karamjeet , Khaled Samer , Snyder David , Nakamura Ryotaro , Stein Anthony S. , Forman Stephen J. , Marcucci Guido , Pullarkat Vinod
Published: December 2019

Key Points

The incidence of IFIs during VEN-HMA therapy is low, and the used antifungal prophylaxis approach did not influence the risk of IFIs. The risk of IFIs is higher in nonresponders and those who were treated in the r/r AML setting.
Differential gene expression among three sex types reveals a MALE STERILITY 1 (CpMS1) for sex differentiation in papaya
Authors: Zerpa-Catanho Dessireé , Wai Jennifer , Wang Ming Li , Yu Li’ang , Nguyen Julie , Ming Ray
Published: December 2019

Background

Carica papaya is a trioecious plant species with a genetic sex-determination system defined by sex chromosomes. Under unfavorable environmental conditions male and hermaphrodite exhibit sex-reversal. Previous genomic research revealed few candidate genes for sex differentiation in this species. Nevertheless, more analysis is still needed to identify the mechanism responsible for sex flower organ development in papaya.

Results

The aim of this study was to identify differentially expressed genes among male, female and hermaphrodite flowers in papaya during early (pre-meiosis) and later (post-meiosis) stages of flower development. RNA-seq was used to evaluate the expression of differentially expressed genes and RT-qPCR was used to verify the results. Putative functions of these genes were analyzed based on their homology with orthologs in other plant species and their expression patterns. We identified a Male Sterility 1 gene (CpMS1) highly up-regulated in male and hermaphrodite flower buds compared to female flower buds, which expresses in small male flower buds (3–8 mm), and that might be playing an important role in male flower organ development due to its homology to MS1 genes previously identified in other plants. This is the first study in which the sex-biased expression of genes related to tapetum development in the anther developmental pathway is being reported in papaya. Besides important transcription factors related to flower organ development and flowering time regulation, we identified differential expression of genes that are known to participate in ABA, ROS and auxin signaling pathways (ABA-8-hydroxylases, AIL5, UPBEAT 1, VAN3-binding protein).

Conclusions

CpMS1was expressed in papaya male and hermaphrodite flowers at early stages, suggesting that this gene might participate in male flower organ development processes, nevertheless, this gene cannot be considered a sex-determination gene. Due to its homology with other plant MS1 proteins and its expression pattern, we hypothesize that this gene participates in anther development processes, like tapetum and pollen development, downstream gender specification. Further gene functional characterization studies in papaya are required to confirm this hypothesis. The role of ABA and ROS signaling pathways in papaya flower development needs to be further explored as well.
Heckman-type selection models to obtain unbiased estimates with missing measures outcome: theoretical considerations and an application to missing birth weight data
Authors: Koné Siaka , Bonfoh Bassirou , Dao Daouda , Koné Inza , Fink Günther
Published: December 2019

Background

In low-income settings, key outcomes such as biomarkers or clinical assessments are often missing for a substantial proportion of the study population. The aim of this study was to assess the extent to which Heckman-type selection models can create unbiased estimates in such settings.

Methods

We introduce the basic Heckman model in a first stage, and then use simulation models to compare the performance of the model to alternative approaches used in the literature for missing outcome data, including complete case analysis (CCA), multiple imputations by chained equations (MICE) and pattern imputation with delta adjustment (PIDA). Last, we use a large population-representative data set on antenatal supplementation (AS) and birth outcomes from Côte d’Ivoire to illustrate the empirical relevance of this method.

Results

All models performed well when data were missing at random. When missingness in the outcome data was related to unobserved determinants of the outcome, large and systematic biases were found for CCA and MICE, while Heckman-style selection models yielded unbiased estimates. Using Heckman-type selection models to correct for missingness in our empirical application, we found supplementation effect sizes that were very close to those reported in the most recent systematic review of clinical AS trials.

Conclusion

Missingness in health outcome can lead to substantial bias. Heckman-selection models can correct for this selection bias and yield unbiased estimates, even when the proportion of missing data is substantial.
Protocol for a prospective, cluster randomized trial to evaluate routine and deferred dialysis initiation (RADDI) in Chinese population
Authors: Zhao Xinju , Wang Pei , Wang Lining , Chen Xiaonong , Huang Wen , Mao Yonghui , Hu Rihong , Cheng Xiaohong , Wang Caili , Wang Li , Zhang Ping , Li Detian , Wang Yuzhu , Ye Wenling , Chen Yuqing , Jia Qiang , Yan Xiaoyan , Zuo Li
Published: December 2019

Background

The timing of when to initiate dialysis for progressive chronic kidney disease (CKD) patients has not been well established. There has been a strong trend for early dialysis initiation for these patients over the past decades. However, the perceived survival advantage of early dialysis has been questioned by a series of recent observational studies. The only randomized controlled trial (RCT) research on this issue found the all-cause mortality, comorbidities, and quality of life showed no difference between early and late dialysis starters. To better understand optimal timing for dialysis initiation, our research will evaluate the efficacy and safety of deferred dialysis initiation in a large Chinese population.

Methods

The trial adopts a multicenter, cluster randomized, single-blind (outcomes assessor), and endpoint-driven design. Eligible participants are 18–80 years old, in stable CKD stages 4–5 (eGFR > 7 ml/min /1.73 m2), and with good heart function (NYHA grade I or II). Participants will be randomized into a routine or deferred dialysis group. The reference eGFR at initiating dialysis for asymptomatic patients is 7 ml/min /1.73 m2 (routine dialysis group) and 5 ml/min/1.73 m2 or less (deferred dialysis group) in each group. The primary endpoint will be the difference of all-cause mortality and acute nonfatal cerebro-cardiovascular events between the two groups. The secondary outcomes include hospitalization rate and other safety indices. The primary and secondary outcomes will be analyzed by appropriate statistical methods.

Discussion

This study protocol represents a large, cluster randomized study evaluating deferred and routine dialysis intervention for an advanced CKD population. The reference eGFR to initiate dialysis for both treatment groups is targeted at less than 7 ml/min/1.73m2. With this design, we aim to eliminate lead-time and survivor bias and avoid selection bias and confounding factors. We acknowledge that the study has limitations. Even so, given the low-targeted eGFR values of both arms, this study still has potential economic, health, and scientific implications. This research is unique in that such a low targeted eGFR value has never been studied in a clinical trial.

Trial registration

The trial has been approved by ClinicalTrials.gov (Trial registration ID NCT02423655). The date of registration was April 22, 2015.
Effects of simultaneous pancreas-kidney transplantation and kidney transplantation alone on the outcome of peripheral vascular diseases
Authors: Sucher Robert , Rademacher Sebastian , Jahn Nora , Brunotte Max , Wagner Tristan , Alvanos Athanasios , Sucher Elisabeth , Seehofer Daniel , Scheuermann Uwe , Hau Hans-Michael
Published: December 2019

Background

The effects of Simultaneous Pancreas Kidney Transplantation (SPKT) on Peripheral Vascular Disease (PVD) warrants additional study and more target focus, since little is known about the mid- and long-term effects on the progression of PVD after transplantation.

Methods

101 SPKT and 26 Kidney Transplantation Alone (KTA) recipients with insulin-dependent diabetes mellitus (IDDM) were retrospectively evaluated with regard to graft and metabolic outcome. Special subgroup analysis was directed towards the development and progression of peripheral vascular complications (PVC) (amputation, ischemic ulceration, lower extremity angioplasty/ bypass surgery) after transplantation.

Results

The 10-year patient survival was significantly higher in the SPKT group (SPKT: 82% versus KTA 40%;P < 0.001). KTA recipients had a higher prevalence of atherosclerotic risk factors, including coronary artery disease (P < 0.001), higher serum triglyceride levels (P = 0.049), higher systolic (P = 0.03) and diastolic (P = 0.02) blood pressure levels. The incidence of PVD before transplantation was comparable between both groups (P = 0.114). Risk factor adjusted multivariate analysis revealed that patients with SPKT had a significant lower amount (32%) of PVCs (32 PVCs in 21 out of 101 SPKT;P < 0.001) when compared to the KTA patients who developed a significant increase in PVCs to 69% of cases (18 PVCs in 11 out of 26 KTA;P < 0.001). In line mean values of HbA1c(P < 0.01) and serum triglycerides (P < 0.01) were significantly lower in patients with SPKT > 8 years after transplantation.

Conclusion

SPKT favorably slows down development and progression of PVD by maintaining a superior metabolic vascular risk profile in patients with IDDM1.
Gender and chronic kidney disease in ankylosing spondylitis: a single-center retrospectively study
Authors: Ye Wenling , Zhuang Jing , Yu Yang , Li Hang , Leng Xiaomei , Qian Jun , Qin Yan , Chen Limeng , Li Xue-mei
Published: December 2019

Background

Ankylosing spondylitis (AS) is a well-known male-predominant inflammatory disease. This study aimed to assess the gender disparity in chronic kidney disease (CKD) in AS patients in China.

Methods

AS patients were retrospectively studied at Peking Union Medical College hospital between January 2002 and June 2018.

Results

Among 616 patients with AS, 154 (25.0%) patients had CKD (age, 41.8 ± 14.2 years; male:female, 3.2:1). Overall, 80 (13.0%) patients had only microscopic hematuria, 62 (10.1%) had proteinuria with or without hematuria, and 33 (5.4%) exhibited a reduced estimated glomerular filtration rate (eGFR, ≤60 mL/min/1.73 m2). Male CKD patients had more frequent proteinuria (p < 0.01), less microscopic hematuria only (p < 0.01), and lower eGFR (p = 0.04) compared with females. CKD was independently associated with hyperuricemia and total cholesterol in females, and with hyperuricemia, hypertension, and serum albumin in males. After follow-up for 1–7 years, five patients required renal replacement therapy including two patients who were already at stage 5 CKD when enrolled and three patients whose creatinine doubled. One patient died in the male group. No patients in the female group showed progression of renal dysfunction.

Conclusions

CKD is a common comorbidity in patients with AS. Male patients are more likely to develop severe manifestations compared with female patients. Hyperuricemia was a strong independent risk factor for CKD in both genders, while hypertension and low serum albumin were risk factors for CKD only in males.
Client perceived quality of the postnatal care provided by public sector specialized care institutions following a normal vaginal delivery in Sri Lanka: a cross sectional study
Authors: Wickramasinghe Sashimali Anuradha , Gunathunga Moraendage Wasantha , Hemachandra Dewabandu Kumarathungalage Nilmini
Published: December 2019

Background

Majority of the maternal and neonatal adverse events take place during the postnatal period. Provision of high-quality care during this period can minimize these events. Assessment of mothers’ perceptions of the quality of care received by them provides valuable feedback to improve the care and ultimately outcomes.

Methods

A cross sectional survey was conducted in specialized institutions of Colombo district, Sri Lanka, to assess the maternal perceptions of the quality of regular postnatal care and its correlations, using an interviewer administered questionnaire. The questionnaire contained 23 items distributed under three main domains: technical and information domain, interpersonal care domain and ward facilities and cleanliness domain. Each item was given a score from 1 to 5 and total scores were calculated for the total questionnaire and for each domain. Descriptive statistics were used to assess the perceptions and multivariate analysis was conducted to assess the significant correlates of positive perceptions.

Results

The median score obtained for the questionnaire was 108, (Inter Quartile Range 96–114). The median scores of the technical care and information domain, interpersonal care domain and ward facilities and cleanliness domain were 43 (IQR 38–45), 33 (IQR 30–35) and 32 (IQR 28–35) respectively. Attending teaching/ specialized hospitals (aOR=1.6, p < 0.001), 20–35 age group (1.8, p = 0.024), and services such as initiation of breast feeding within 1 h of delivery (2.1, p = 0.009), pain relief during episiotomy suturing (2.2, p < 0.001), practicing Kangaroo Mother Care (1.4, p = 0.035), receiving health advices by doctors or midwives (2.1, p < 0.001) were significant correlates of positive perceptions.

Conclusions

Majority of mothers had favourable perceptions of the quality of care received by them. However, the ward facilities and environment domain has obtained lower ratings compared to technical and interpersonal care domains. Several services were significantly associated with favourable perceptions. Authorities should consider these findings when attempting to improve care quality. Further, this assessment should be carried out regularly to obtain more current data.
Nomograms to predict individual prognosis of patients with squamous cell carcinoma of the urinary bladder
Authors: Zhang Guanghao , Li Zhiwei , Song Daoqing , Fang Zhiqing
Published: December 2019

Background

On the basis of some significant clinical parameters, we had an intent to establish nomograms for estimating the prognosis of patients with squamous cell carcinoma of the urinary bladder (SCCB), including overall survival (OS) and cancer-specific survival (CSS).

Methods

The data of 1210 patients diagnosed with SCCB between 2004 and 2014,were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. The Cox proportional hazards regression model was applied to evaluate the association between variables and survival. Nomograms were constructed to predict the OS and CSS of an individual patient based on the Cox model. In the end, the performance of nomograms was internally validated by using calibration curves, concordance index (C-index), and k-fold cross-validation.

Results

Several common indicators were taken into the two nomograms (OS and CSS), including age at diagnosis, marital status, sex, TNM stage, surgical approach, tumor size, and lymph node ratio while the OS nomogram additionally contained race, grade, and chemotherapy. They had an excellent predictive accuracy on 1- and 3- year OS and CSS with C-index of 0.733 (95% confidence interval [CI], 0.717–0.749) for OS and 0.724 (95% CI, 0.707–0.741) for CSS. All calibration curves showed great consistency between actual survival and predictive survival.

Conclusions

The nomograms with improved accuracy and applicability on predicting the survival outcome of patients with SCCB would provide a reliable tool to help clinicians to evaluate the risk of patients and make individual treatment strategies.
Investigating the sociodemographic profile and health-related outcomes of chronically ill homeopathic patients: results from an observational multi-centered study in Bulgaria
Authors: Vankova Desislava , Kapincheva Iskra
Published: December 2019

Background

The Complementary and Alternative Medicine (CAM) field in Europe has been a focus of research developments and public health policy changes for years. However, these processes are still in their infancy phase in Bulgaria. In this paper, homeopathy is the investigated CAM-modality at a Bulgarian context. The aim is threefold: 1) to outline the sociodemographic profile of the chronically ill adult patients (≥18 years old) who choose homeopathic medical treatment (HMT); 2) To identify the patients’ sources and needs of information about homeopathy, and the reasons to use HMT; and 3) to measure health-related outcomes in patients who have visited homeopathic clinics to look for HMT of their chronic conditions.

Methods

A cross-sectional observational multi-centered study (≥18 years old, n = 211) was conducted between June 2016 to Dec. 2017 in Bulgaria. Potentially eligible participants for the study were all chronically ill patients who had been receiving HMT for a year or more and had visited the homeopathic clinics for a follow up within the study period. The EQ-5D-3L instrument was applied with an additional questionnaire on sociodemographic and health related data.

Results, discussion and conclusions

The study results outlined the country specific sociodemographic profile of the chronically ill homeopathic patients in Bulgaria: they are predominantly female, with higher education and at the age groups between 30 and 50.

The EQ-5D-3L version, was applied to measure patients’ health-related quality of life and to promote the use of a standardized generic instrument as a complementary and reliable scientific tool to assess the patient-reported outcomes of the homeopathic patients. Regarding the reasons of choice: the participants choose HMT because it is safe and mild, to avoid excessive antibiotic use, because the conventional treatment was not successful, etc. The study confirms the social demand for more scientific information about homeopathy. Participants stated that the medical universities’ curriculum should keep pace with the modern CAM-developments. A key message is that the future of the successful chronic disease management is in the integration of the conventional and CAM-modalities and these processes should be facilitated through public health regulations, education and research. The presented study is a supportive action in this direction.
Predictors of satisfaction after lumbar disc herniation surgery in elderly
Authors: Hareni Niyaz , Strömqvist Fredrik , Strömqvist Björn , Rosengren Björn E. , Karlsson Magnus K.
Published: December 2019

Background

The aim of this study was to evaluate satisfaction and factors associated with satisfaction in elderly undergoing lumbar disc herniation surgery.

Methods

In the national Swedish register for spinal surgery (SweSpine) we identified 2095 patients aged > 65 years (WHO definition of elderly) whom during 2000–2016 had undergone LDH surgery and had pre- and one-year postoperative data (age, gender, preoperative duration and degree of back- and leg pain, quality of life (SF-36) and one-year satisfaction (dissatisfied, uncertain, satisfied). We utilized a logistic regression model to examine preoperative factors that were independently associated with low and high satisfaction and after LDH surgery.

Results

One year after surgery, 71% of the patients were satisfied, 18% uncertain and 11% dissatisfied. Patients who were satisfied were in comparison to others, younger, had shorter preoperative duration of leg pain, higher SF-36 mental component summary and more leg than back pain (all p < 0.01). Patients who were dissatisfied were compared to others older, had longer preoperative duration of leg pain and lower SF-36 scores (all p < 0.01). 81% of patients with leg pain up to 3 months were satisfied in comparison with 57% of patients with leg pain > 2 years (p < 0.001).

Conclusion

Only one out of ten elderly, is dissatisfied with the outcome of LDH surgery. Age, preoperative duration of leg pain, preoperative SF 36 score, and for satisfaction also dominance of back over leg pain, are in elderly factors associated to good and poor subjective outcome after LDH surgery.
A case report of endorectal displacement of a right ureteral stent following radiochemotherapy and Bevacizumab
Authors: Tognarelli Alessio , Faggioni Lorenzo , Manassero Francesca , Gadducci Angiolo , Selli Cesare
Published: December 2019

Background

The angiogenesis inhibitor monoclonal antibody Bevacizumab is presently the standard treatment for numerous neoplasms but particular toxicities are emerging, such as hypertension, haemorrhage, thromboembolism, gastrointestinal perforation, fistulae, and delayed wound healing. The addition of Bevacizumab to radio and chemotherapy has improved the overall survival rate in patients with metastatic, persistent or recurrent cervical carcinoma. However an increased risk of enteric or urinary fistula formation has been documented, related to hypoxia which is induced by the inhibition of angiogenesis. Moreover, previous pelvic surgery, repeated ureteral stenting and radiation are additional risk factors.

Case presentation

We describe the remarkable case of a right ureteral stent displacement inside the rectum lumen in a patient treated with Bevacizumab for pelvic recurrence of cervical cancer. The patient was referred to our Urology Department with urinary sepsis and bilateral hydronephrosis. Right ureteral stent substitution was planned; at cystoscopy the distal loop of the stent was not visualized inside the bladder. The presence of the distal loop of the right ureteral inside the rectum was clearly demonstrated with a CT scan.

Conclusions

Since Bevacizumab is increasingly used in the treatment of gynaecological neoplasms and indwelling ureteral stents are often required to treat or prevent ureteral compressions, similar cases are likely to be diagnosed and this complication should be considered in the management of advanced pelvic cancers.
Purification of the recombinant green fluorescent protein from tobacco plants using alcohol/salt aqueous two-phase system and hydrophobic interaction chromatography
Authors: Dong Jie , Ding Xiangzhen , Wang Sheng
Published: December 2019

Background

The green fluorescent protein (GFP) has been regarded as a valuable tool and widely applied as a biomarker in medical applications and diagnostics. A cost-efficient upstream expression system and an inexpensive downstream purification process will meet the demands of the GFP protein with high-purity.

Results

The recombinant GFP was transiently expressed in an active form in agoinoculated Nicotiana benthamiana leaves by using Tobacco mosaic virus (TMV) RNA-based overexpression vector (TRBO). The yield of recombinant GFP was up to ~ 60% of total soluble proteins (TSP). Purification of recombinant GFP from the clarified lysate of N. benthaniana leaves was achieved by using an alcohol/salt aqueous two-phase system (ATPS) and following with a further hydrophobic interaction chromatography (HIC). The purification process takes only ~ 4 h and can recover 34.1% of the protein. The purity of purified GFP was more than 95% and there were no changes in its spectroscopic characteristics.

Conclusions

The strategy described here combines the advantages of both the economy and efficiency of plant virus-based expression platform and the simplicity and rapidity of environmentally friendly alcohol/salt ATPS. It has a considerable potential for the development of a cost-efficient alternative for production of recombinant GFP.
Experience obtaining legal abortion in Uruguay: knowledge, attitudes, and stigma among abortion clients
Authors: Makleff Shelly , Labandera Ana , Chiribao Fernanda , Friedman Jennifer , Cardenas Roosbelinda , Sa Eleuthera , Baum Sarah E.
Published: December 2019

Background

The abortion law in Uruguay changed in 2012 to allow first trimester abortion on request. Implementation of the law in Uruguay has been lauded, but barriers to care, including abortion stigma, remain. This study aimed to assess women’s experiences seeking abortion services and related attitudes and knowledge following implementation of the law in Uruguay.

Methods

We interviewed 207 eligible women seeking abortion services at a high-volume public hospital in Montevideo in 2014. We generated univariate frequencies to describe women’s experiences in care. We conducted regression analysis to examine variations in experiences of stigma by women’s age and number of abortions.

Results

Most of the women felt that abortion was a right, were satisfied with the services they received, and agreed with the abortion law. However, 70% found the five-day waiting period unnecessary. Women experienced greater self-judgement than worries about being judged by others. Younger women in the sample (ages 18–21) reported being more worried about judgment than women 22 years or older (1.02 vs. 0.71 on the ILAS sub-scale). One quarter of participants reported feeling judged while obtaining services. Women with more than one abortion had nearly three times the odds of reporting feeling judged.

Conclusions

These findings highlight the need to address abortion stigma even after the law is changed. Some considerations from Uruguay that may be relevant to other jurisdictions reforming abortion laws include: the need for strategies to reduce judgmental behavior from staff and clinicians towards women seeking abortions, including training in counseling skills and empathic communication; addressing stigmatizing attitudes about abortion through community outreach or communications campaigns; mitigating the potential stigma that may be perpetuated through policies to prevent “repeat” abortions; ensuring that younger women and those with more than one abortion feel welcome and are not mistreated during care; and assessing the necessity of a waiting period. The rapid implementation of legal, voluntary abortion services in Uruguay can serve in many ways as an exemplar, and these findings may inform the process of abortion law reform in other countries.
Opportunities and challenges of integrating genetics education about human diversity into public health nurses’ responsibilities in Japan
Authors: Goda Hiromi , Kawasaki Hiromi , Masuoka Yuko , Kohama Natsu , Rahman Md Moshiur
Published: December 2019

Background

Many genetic tests are now available due to evolution by the Human Genome Project. However, the growing use of genetic testing and screening may not only lead to improvements in public health and health promotion, but also trigger grave ethical, legal, and societal concerns. The involvement of community healthcare providers is expected in the future because they have direct contact with the residents through their health programs. The aims of the current study were to clarify how public health nurses perceive the relationship between genetics and professional duties and to identify opportunities and challenges of integrating genetics education into their professional duties.

Methods

In 2017, data were collected through a focus group interview. Content related to the ‘presence or absence of health consultation related to genetic issues as part of actual job duties’ and ‘training for handling genetic-related health consultations’ was extracted. Entire sentences were coded and categorized based on similar semantic content.

Results

Public health nurses had difficulties in recognizing genetic issues in public health activities. In some cases, genetic contents were included in conversation and consultation with the general public. Through the professional education and experiences, public health nurses needed specialized education, post-graduation studies and mentoring about genetics.

Conclusions

Public health nurses whose professional duties do not directly relate to genetics were exposed to genetics-related episodes on a regular basis without their awareness. The provision of accurate information and knowledge related to genetics by public health nurses would also provide an opportunity for clients to be informed about their latent genetic risks. Hence, there is a need for practical resources, the establishment of collaboration networks, and the development of professional organizations for public health nurses.
Transforming community nursing services in the UK; lessons from a participatory evaluation of the implementation of a new community nursing model in East London based on the principles of the Dutch Buurtzorg model
Authors: Lalani Mirza , Fernandes Jane , Fradgley Richard , Ogunsola Caroline , Marshall Martin
Published: December 2019

Background

Buurtzorg, a model of community nursing conceived in the Netherlands, is widely cited as a promising and evidence-based approach to improving the delivery of integrated nursing and social care in community settings. The model is characterised by high levels of patient and staff satisfaction, professional autonomy exercised through self-managing nursing teams, client empowerment and holistic, patient centred care. This study aimed to examine the extent to which some of the principles of the Buurtzorg model could be adapted for community nursing in the United Kingdom.

Methods

A community nursing model based on the Buurtzorg approach was piloted from June 2017–August 2018 with a team of nurses co-located in a single general practice in the Borough of Tower Hamlets, East London, UK. The initiative was evaluated using a participatory methodology known as the Researcher-in-Residence model. Qualitative data were collected using participant observation of meetings and semi-structured interviews with nurse team members, senior managers, patients/carers and other local stakeholders such as General Practitioners (GP) and social workers. A thematic framework analysis of the data was carried out.

Results

Implementation of a community nursing model based on the Buurtzorg approach in East London had mixed success when assessed against its key principles. Patient experience of the service was positive because of the better access, improved continuity of care and longer appointment times in comparison with traditional community nursing provision. The model also provided important learning for developing service integration in community care, in particular, how to form effective collaborations across the care system with other health and social care professionals. However, some of the core features of the Buurtzorg model were difficult to put into practice in the National Health Service (NHS) because of significant cultural and regulatory differences between The Netherlands and the UK, especially the nurses’ ability to exercise professional autonomy.

Conclusions

Whilst many of the principles of the Buurtzorg model are applicable and transferable to the UK, in particular promoting independence among patients, improving patient experience and empowering frontline staff, the successful embedding of these aims as normalised ways of working will require a significant cultural shift at all levels of the NHS.