bluuebunny/crossref_metadata_2025 huggingface dataset:
0859 AVAPS to the rescue: A case of severe obstructive sleep apnea with treatment resistant to UPPP and CPAP in a pediatric patient with Prader-Willi syndrome
Authors: Hwig Nauras , Peng Victor , Diaz-Abad Montserrat , Lasso-Pirot Anayansi
Published: May 2022

Introduction

Prader-Willi syndrome (PWS) has a prevalence of 1/10,000 to 1/30000 and is the most common syndromic form of obesity. Prader-Willi syndrome is defined by a multitude of features that develop from early childhood to adolescents, but one of the primary developments is obesity in the setting of hyperphagia during early childhood. Due to the development of obesity, there is a high prevalence of obstructive sleep apnea (OSA) among PWS patients.

Report of Cases: A 6-year-old boy with PWS with a 2-year history of loud snoring underwent polysomnography (PSG) which showed severe OSA with Apnea-Hypopnea Index (AHI, events/h) 133.7. The patient underwent surgical intervention with a combined uvulopalatopharyngoplasty and adenotonsillectomy and a follow up PSG showed a residual AHI of 37. On CPAP titration the AHI improved to 1.2 with CPAP 14 cm H2O and the patient was discharged on home nasal CPAP. Over the next several years, the patient had suboptimal CPAP compliance. At 11 years of age, the patient was admitted to the intensive care unit (ICU) with volume overload –with a normal cardiac workup- and respiratory failure requiring high flow nasal cannula oxygen. Venous blood gas (VBG) showed pH 7.34 and severe hypercapnia with pCO2 73 mmHg c/w obesity hypoventilation syndrome (OHS). The patient was started on CPAP then changed to bilevel PAP ST with supplemental oxygen. Due to persistent hypercapnia in the high 60s noninvasive ventilation (NIV) was switched to Average Volume-assured Pressure Support with auto titrating EPAP (AVAPS-AE) with significant improvement in hypercapnia and overall tolerance. Discharge VBG showed pH 7.35 and PCO2 56 mm Hg. The patient was discharged home, is doing well and has avoided readmission for at least 6 months.

Conclusion

This case highlights the potential for newer modes of noninvasive ventilation with autotitrating EPAP to treat severe OSA with OHS and hypercapnic respiratory failure in patients with PWS and other conditions. With the growing obesity epidemic, rates of treatment failures with CPAP and traditional bilevel PAP therapy may increase and consideration of alternative modes of NIV therapy should be considered.

Support (If Any)
Valerian and postoperative sleep: a retrospective cohort analysis of gynecological, urologic, and general surgical patients
Authors: Winter Anne-Sophie , Haverkamp Christian , Gratzke Christian , Huber Roman , Lederer Ann-Kathrin
Published: May 2022

Study Objectives

Postoperative sleep disturbances appear to be a common complication after surgery being treated with sleep-promoting medication such as valerian, but robust data and evidence of medicinal approaches are lacking.

Methods

We performed a retrospective cohort analysis of all 21 168 urological, gynecological, and general surgical patients of the University Medical Center Freiburg, Germany, who underwent surgery between 2015 and 2020. Target parameters were the usage of sleep-promoting medication to estimate the occurrence of postoperative sleep disturbances as well as the kind of sleep medication with a special focus on herbal medication such as valerian.

Results

Drug-treated sleep disturbances occurred in 15% (n = 3083) of the patients. Valerian was the second most applied drug (n = 814, 26.4%) after classic benzodiazepines (n = 1 138, 36.9%). The majority of patients got valerian as monotherapy. Age, length of stay, and comorbidities were associated with demand for sleep medication in general (p < .001). Valerian monotherapy was more common in women (OR 1.53, 95% CI: 1.33–1.77, p < .001), elderly patients (OR 1.50, 95% CI: 1.29–1.75, p < .001), and patients with prolonged hospital stay (OR 2.23, 95% CI: 1.91–2.61, p < .001).

Conclusions

Valerian plays an important role in the treatment of postoperative sleep disturbances clinically, and it appears to be a promising therapeutic approach especially in women, older and sicker patients, and those with prolonged hospital stay. Further research has to clarify the efficacy of valerian postoperatively.

Clinical trial registration

DRKS00027903, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027903
Trajectories of insomnia symptoms and insufficient sleep duration in early adolescents: associations with school stress
Authors: Bauducco Serena V , Özdemir Metin , Gradisar Michael , Boersma Katja , Bayram-Özdemir Sevgi
Published: May 2022

Study Objectives

We examined how adolescents’ sleep patterns (i.e. insomnia symptoms and sleep duration) change from early- to mid-adolescence and whether adolescents follow different trajectories. Furthermore, we also examined the characteristics of adolescents within different trajectories, with a specific focus on the role of school-related stress.

Methods

We used three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1294; Mage = 13.2 [range: 12–15 years], SD = .42; 46.8% girls). Using established measures, the students reported on their sleep duration, insomnia symptoms, and perceived school-stress (including stress of school performance, peer and teacher relations, attendance, and school-leisure conflict). We used latent class growth analysis (LCGA) to identify adolescents’ sleep trajectories, and the BCH method to describe the characteristics of the adolescents in each trajectory.

Results

We found four trajectories for adolescents’ insomnia symptoms; (1) low insomnia (69%), (2) low-increasing (17%, ‘emerging risk-group’), (3) high-decreasing (9%), (4) high-increasing (5%; ‘risk-group’). For sleep duration, we found two trajectories; (1) ~8 h sufficient-decreasing (85%), (2) ~7 h insufficient- decreasing (15%; ‘risk-group’). Adolescents in risk-trajectories were more likely to be girls and consistently reported higher levels of school stress, particularly regarding school performance and attending school.

Conclusions

School stress was prominent among adolescents suffering from persistent sleep problems, especially insomnia, and deserves further attention.
Effect of a direct-fed microbial (10-G Armor) on feedlot performance, carcass characteristics, and prevalence of Salmonella in fed-beef heifers
Authors: Mayer Lauren M , Martens Kevin , Word Alyssa B , Holland Ben P , Lucherk Loni L , Lawrence Ty E , Tennant Travis C
Published: May 2022

Crossbred beef heifers (N = 1,394; initial shrunk body weight [BW] 291 ± 9.9 kg) were used to investigate the efficacy of 10-G Armor (Life Products, Inc., Norfolk, NE; 10-G) upon feedlot performance, carcass characteristics, and fecal and subiliac lymph nodes Salmonella prevalence. Heifers were blocked by day of arrival and allocated to 1 of 20 pens (N = 70 heifers/pen) and assigned one of two treatments (10 pens/treatment): no direct-fed microbial (CON) or 2 g/heifer/d of Lactobacillus acidophilus, Enterococcus faecium, Pediococcus pentosaceus, Lactobacillus brevis and Lactobacillus plantarum, respectively (Life Products, Inc., Norfolk, NE; 10-G). Twenty-four animals were randomly selected from each pen for Salmonella sampling. Recto-anal mucosal swab samples (RAMS) were obtained at initial processing and harvest; subiliac lymph nodes were collected at harvest. In addition, pen surface fecal pats were collected and composited by pen (10 pats per composite, 5 composites per pen) on days 0, 52, 120, and 192. Data were analyzed as a generalized complete block design, and pen served as the experimental unit. No differences were observed in live growth performance metrics (P ≥ 0.55). Yield grade distributions did not differ between treatments (P ≥ 0.62); however, cattle fed 10-G tended (P = 0.06; 14.6% vs. 18.9%) to have fewer USDA Select carcasses and more (P = 0.09; 73.6% vs. 78.0%) USDA Choice carcasses. Cattle fed 10-G tended (P = 0.10; 9.2% vs. 12.3%) to have fewer liver abscesses and had fewer (P = 0.04; 5.3% vs. 8.5%) severe liver abscesses. Salmonella prevalence of RAMS did not differ between treatments at initial processing (P = 0.97; CON = 11.6%, 10-G = 11.5%) or at harvest (P = 0.91; CON = 99.0%, 10-G = 98.6%); however, RAMS differed (P < 0.01) in Salmonella prevalence between the two collection times. Cattle fed 10-G had a lower frequency of Salmonella positive lymph nodes (P = 0.01; CON = 15.8%, 10-G = 7.4%) than CON. However, Salmonella log (mpn/g) of lymph nodes did not differ between treatments at harvest (P = 0.34; CON = 0.73, 10-G = 0.34). These data indicate that cattle fed 10-G have decreased rates of severe liver abscesses without altering live animal performance or carcass characteristics. Supplementation of 10-G significantly reduced the prevalence rate of Salmonella recovered from the subiliac lymph nodes. The factors responsible for the observed difference in the effects of 10-G on Salmonella warrant further investigation
Mitochondrial phosphatidylethanolamine synthesis affects mitochondrial energy metabolism and quiescence entry through attenuation of Snf1/AMPK signaling in yeast
Authors: Miyata Non , Ito Takanori , Nakashima Miyu , Fujii Satoru , Kuge Osamu
Published: May 2022

The Ups2‐Mdm35 complex mediates intramitochondrial phosphatidylserine (PS) transport to facilitate mitochondrial phosphatidylethanolamine (PE) synthesis. In the present study, we found that ups2∆ yeast showed increased mitochondrial ATP production and enhanced quiescence (G0) entry in the post‐diauxic shift phase. Transcriptomic and biochemical analyses revealed that the depletion of Ups2 leads to overactivation of the yeast AMPK homolog Snf1. Inactivation of Snf1 by depletion of an Snf1‐activating kinase, Sak1 canceled the changes in mitochondrial ATP production and quiescence entry observed in ups2∆ cells. Furthermore, among the factors regulated by Snf1, upregulation of pyruvate carboxylase, Pyc1 and downregulation of acetyl‐CoA carboxylase, Acc1, respectively, were sufficient to increase mitochondrial ATP production and quiescence entry. These results suggested that a normal PE synthesis mediated by Ups2‐Mdm35 complex attenuates Snf1/AMPK activity, and that Snf1‐mediated regulation of carbon metabolisms has great impacts on mitochondrial energy metabolism and quiescence entry. We also found that depletion of Ups2 together with the cell‐cycle regulators Whi5 and Whi7, functional orthologs of the Rb1 tumor suppressor, caused a synthetic growth defect in yeast. Similarly, knockdown of PRELID3b, the human homolog of Ups2, decreased the viability of Rb1‐deficient breast cancer cells, suggesting that PRELID3b is a potential target for cancer therapy.
Innovating Health Research Methods, Part I
Authors: Golden Tasha L.
Published: May 2022

Accumulating US studies indicate gender inequities in youth violence research and responses. Improving youth health thus requires greater understanding of how girls and young women perceive and experience violence, and gathering such data demands research methods that are trauma-informed and assets-based. This mixed-methods study addresses these dual needs. To support gender equity in youth violence research, it incorporated 4 violence surveys and 3 arts-based methods to examine girls' and young women's experiences and perceptions of violence. Then, to advance trauma-informed, assets-based research, it used study findings to generate an assessment of all methods employed. Results are presented in a 2-part article, with Part II (published separately) detailing the arts-based strategies and assessing all methods. Part I (below) conveys findings from all data sources regarding population experiences, needs, and assets related to violence and safety. Girls and young women reported extensive experiences with violence, and mental health was a prominent challenge, likely exacerbated by persisting threats. Participants' priorities included domestic and intimate partner violence, social isolation, and the necessity of action and change. This study confirms the value of mixed-methods, gender-responsive youth violence research, and of providing processes by which youth can share their stories on and in their own terms. It also provides a template for further use of creative practices to improve data; apply trauma-informed, assets-based strategies; and advance health equity.
Law Enforcement Perceptions About Naloxone Training and Its Effects Post-Overdose Reversal
Authors: Dahlem Chin Hwa (Gina) , Granner Josephine , Boyd Carol J.
Published: May 2022

Background

Law enforcement officers (LEOs) often are the first responders to arrive at a scene of an opioid overdose. Thus, equipping LEOs as first responders with naloxone is necessary to prevent overdose deaths and a recommended strategy. However, little is known about how LEOs perceive naloxone training and their feelings after using naloxone to save a life. It is important to understand LEOs' experiences with naloxone so as to develop additional training materials that are relevant to the LEO experience.

Methods

A descriptive exploratory study was conducted to explore the perceptions of LEOs about using naloxone in the field and to identify areas that should be included in future naloxone trainings. Interview data were obtained through face-to-face interviews with LEOs (N = 14) and analyzed using manifest content analysis.

Results

LEOs changed their attitudes and beliefs toward naloxone after receiving training and experiencing a successful resuscitation. The change in attitudes was enhanced after saving a life. However, misconceptions about naloxone and lack of understanding about disease of addiction persisted even after training.

Conclusion

Future naloxone curriculum could benefit from additional lessons on the stigma of addiction, the disease of addiction, misconceptions about the safety of naloxone, strategies for postoverdose responses, and the role naloxone, which might play in a hopeful recovery.
Use of Staging Models for Treatment-Resistant Depression Is Not Helpful in Predicting Nonresponse to Acute Intravenous Ketamine Treatment
Authors: Sakurai Hitoshi , Hoeppner Bettina , Jain Felipe , Foster Simmie , Pedrelli Paola , Mischoulon David , Fava Maurizio , Cusin Cristina
Published: May 2022

Background

Some staging models for treatment-resistant depression (TRD) have been developed in the attempt to predict treatment outcome, in particular with electroconvulsive therapy. However, these models have not been tested in predicting clinical outcome of ketamine treatment. We assessed the relationship between patients' classification with different TRD staging models and subsequent nonresponse to acute intravenous ketamine treatment.

Methods

A sample of 120 patients with TRD who received acute ketamine treatment from October 2018 to November 2020 were included. Intravenous ketamine was administered twice weekly for 3 weeks as acute treatment. Generalized linear models were fitted to examine if staging classification at baseline could predict percent change in the 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16) scale. Potential confounders such as age, sex, and primary diagnosis were included in the models. Other generalized linear models were also fitted with the Bonferroni correction to investigate if other clinical variables of potential relevance could predict percent change in the QIDS-SR16.

Results

No TRD staging model proved accurate in predicting depressive improvement after acute ketamine treatment. Clinical variables such as age (F = 6.68, P = 0.01) and history of neuromodulation therapy (F = 5.12, P = 0.03) were negatively associated with subsequent percent improvement in the QIDS-SR16 with acute ketamine treatment.

Conclusions

The efficacy of acute intravenous ketamine treatment was similar in subjects with higher and lower level of treatment resistance, using definitions based on different TRD staging models. Further exploration of ketamine treatment predictors such as age and neuromodulation therapy is warranted.
Clinical Phenotype of Tardive Dyskinesia in Bipolar Disorder
Authors: Gardea-Resendez Manuel , Taylor-Desir Monica J. , Romo-Nava Francisco , Bond David , Vallender Eric J. , Cuellar-Barboza Alfredo B. , Prieto Miguel L. , Nunez Nicolas , Veldic Marin , Ozerdem Aysegul , Singh Balwinder , Markota Matej , Colby Colin L. , Coombes Brandon J. , Biernacka Joanna M. , McElroy Susan L. , Frye Mark A.
Published: May 2022

Purpose

Recognizing the negative impact that antipsychotic-induced movement disorders have on the quality of life and treatment outcomes in bipolar disorder (BD), this study aimed to assess clinical correlates and antipsychotic use patterns of tardive dyskinesia (TD+) in BD.

Materials and Methods

Participants with and without TD were included. Clinical variables were compared using t-test and χ2 test. Antipsychotic use patterns in TD+, including number of trials, mean doses, and estimated cumulative exposure, were assessed in a case-only analysis.

Results

The prevalence rate of TD was 5.1%. In comparison to the TD− group (n = 1074), TD+ participants (n = 58) were older, more likely to be female and have type I bipolar illness. There were 60.3% of the TD+ group that continued using antipsychotics at study entry and had a mean cumulative exposure to antipsychotics of 18.2 ± 15.6 years. Average dose, in haloperidol equivalents, was 5.9 ± 3.5 mg and 77.7% of the trials were second-generation antipsychotics.

Conclusions

This study confirms previously identified TD risk factors, such as age, sex, and bipolar subtype in a large BD cohort. Limitations included a cross-sectional design and the lack of tardive illness severity assessment. As atypical antipsychotics continue to be primary mood stabilization treatment, attempting to harmonize large data sets to identify additional biomarkers of tardive risk will optimize individualized care for patients with BD.
Factors Influencing Male Nursing Students' Adaptation to College Life in Korea
Authors: LEE Hwajin , KIM Nam Young , LEE Mikyoung , PARK Hyunyoung
Published: May 2022

Background

Male nursing students face challenges in the nursing profession because of its female-centered nature. In particular, most male students in South Korea must complete military service while in college. Although these kinds of situations may make it difficult for them to adapt to college life, the number of male nursing students is gradually increasing. Therefore, it is important to identify the influencing factors to promote male nursing students' successful adaptation to college life.

Purpose

This study was developed to investigate the relationship between self-efficacy, social support, stress coping, and adaptation to college life among male nursing students in Korea. Factors that influence their adaptation to college life were also analyzed.

Methods

A cross-sectional study was conducted on 217 male nursing students from seven colleges in Korea. Participants completed a questionnaire that was designed to measure self-efficacy, social support, stress coping, and adaptation to college life. Data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, Scheffé test, Pearson's correlation coefficient, and multiple regression.

Results

Male nursing students' self-efficacy, social support, stress coping, and adaptation to college life were shown to all positively correlate with each other. The main factors influencing adaptation to college life were social support, self-efficacy, satisfaction with major, and problem-solving-centered stress coping.

Conclusions

Strategies to enhance social support, self-efficacy, satisfaction with major, and problem-solving-centered stress coping should be developed to improve male nursing students' adaptation to college life.
Doctoral Program Student Recruitment
Authors: Knighten Mary Lynne , Macabasco-O'Connell Aurelia , Gallo Ana-Maria
Published: May 2022

In the context of declining doctoral admissions and scarce resources, a small, private university in southern California serving a diverse student population created an innovative Same Day Admission event for their doctoral nursing programs. In a collaborative effort between the university's doctoral programs and admissions leadership, the complex and lengthy admission process was reduced and the number of applicants increased. A “1-stop shop” concept improved the efficiency of the application and admission process to the Doctor of Nursing Practice and Doctor of Philosophy in Nursing programs. More than triple the number of applicants in one-fifth the amount of time were admitted for the spring and fall 2022 semesters using the Same Day Admission process compared with offering doctoral information sessions, passive inquiries, and a traditional admission process. The applicants praised the efficient, motivating, and energizing process. Feedback from the faculty and staff involved was extremely positive about the collaboration and was used for process improvement purposes. Additional innovations are planned for the future, including the use of applicant narratives for promotion, and current students sharing their lived doctoral program experiences during the Same Day Admission event.
Leading Multisector Partnerships to Address Social Determinants of Health and Advance Health Equity for an Underresourced Heart Failure Patient Population
Authors: Shirey Maria R. , White-Williams Connie
Published: May 2022

Addressing the social determinants of health (SDoH) to advance health equity for persons with heart failure is a complex endeavor. Best results are achieved in partnership with multiple sectors beyond just the health care industry. We describe the evolution of an academic-practice-community partnership addressing the SDoH to advance health equity for a population of underresourced heart failure patients. Using a bundled approach to care delivery within a nurse-led interprofessional collaborative practice model and cultivating multisector partnerships, we initiated a systematic approach to addressing the SDoH within a heart failure clinic in the southeastern United States. Through our SDoH program, our clinic has improved access to care, medications, and food for our patients, thus advancing health equity and reducing hospital readmissions. Our multisector partnerships to address SDoH and advance health equity provide a foundation to improve population health outcomes for underresourced persons with heart failure. An SDoH program such as ours would not have been possible without strong leadership and collaboration of colleagues from multiple disciplines and sectors. In keeping with the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report, we showcase our actions consistent with the report's recommendations.
The Nursing Baccalaureate Dual Enrollment Model
Authors: Landen Jenny , Hernandez Stephen H. A.
Published: May 2022

The dual enrollment model in which universities collaborate with community colleges to provide the prelicensure Bachelor of Science in Nursing (BSN) education has been identified by the National Academy of Medicine as one of 5 viable academic progression models for transforming nursing education. The New Mexico Nursing Education Consortium (NMNEC) is a successful example of the dual enrollment model, which began in 2015 with one partnership. By 2018, 3 universities and 5 community colleges had partnered to offer the BSN jointly with the community college locations. In this retrospective, descriptive study, the 2 program types were compared to assess for differences in demographic and academic characteristics as well as program outcomes for the BSN graduates (n = 1018) from 2015 to 2018. The results of the analysis show that NMNEC has been successful in increasing the total number and diversity of BSN graduates for New Mexico. Importantly, NMNEC serves as an exemplar academic-practice partnership model because the success of the consortium would not have been possible without the involvement of practice partners. The outcomes from this study support academic-practice partnerships as instrumental in developing a better educated and more diverse nursing workforce that will improve patient outcomes and strive for health equity.
Our Nursing Profession at a Crossroads
Authors: Allard Billie Lynn , Conroy Carol A.
Published: May 2022

Nurse navigators, in a role that originally focused on a single health condition and improving specified services for an individual patient, have expanded to include care management and care coordination. As the role evolves, nurse navigators are demonstrating proficiency and achieving success transforming care delivery to improve population health while improving quality outcomes, patient satisfaction, and decreasing cost. One innovative health system's clinical nurse specialist team partnered with primary care providers, ancillary care teams, home care, skilled nursing facilities, community agencies, and partners in public health and schools. Clinical nurse specialists, now called “transitional care nurses (TCNs),” have created an accountable community of health for their high-risk population. By following patients from one setting to the next, TCNs identified opportunities for improvement, created innovative programs to bridge gaps, improved teamwork, and integrated care, resulting in lower cost, high-quality care. Results included 50% reduction in hospitalization for patients with chronic disease, pre- and post-TCN partnership. Patients with diabetes were supported with access to diabetes coaches, which resulted in a 12% reduction in AIC, while patients completing pulmonary rehabilitation programs experienced reduced readmission rates from 24% to 2.7%.
Nursing Leadership at Nation's Leading Public Health System Addressing Health Equity and Social Determinants of Health at the Administrative Level and at the Bedside
Authors: Cineas Natalia , Schwartz Donna Boyle , Patel Kanish
Published: May 2022

New York City Health + Hospitals (NYC H + H) is the largest public health care system in the United States, safeguarding 1.4 million patients annually, caring for 1 in every 6 New Yorkers through 11 essential hospitals, 5 post–acute care facilities, more than 70 community centers, and correctional health services in city jails. The 9600+ nurses and 970+ social workers represent the largest segment of the system's 40 000 employees, charged with delivering essential health care services to the most vulnerable and disadvantaged members of society, regardless of ethnicity, culture, creed, gender, age, sexual orientation, income, immigration, or insurance status. NYC H + H is in the process of reinventing nursing culture with a renewed focus on achieving true nursing excellence, emphasizing professional evidence-based best practices and a compassionate care delivery model, putting nurses in the forefront of all efforts to address the social determinants of health and the devastating consequences of health disparities. Systemwide implementation of foundational transformation is positioning nursing in the vanguard of the system's commitment to equity and diversity in the workplace, recognizing unconscious bias, calling out bigotry, and rooting out systemic racism, all key recommendations in the National Academies, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.
Stakeholders’ Experiences and Perspectives Regarding Care Quality for Women With Breast Cancer
Authors: Abedian Kasgari Kobra , Tavakoli Sany Seyedeh Belin , Mahdizadeh Mehrsadat , Tehrani Hadi , Yazdani Charati Jamshid , Peyman Nooshin
Published: May 2022

Background

The considerable growth in the number of patients with breast cancer leads to substantial pressure on healthcare services; however, the main measures that will evaluate what is important to the key stakeholders in improving the quality of breast cancer care are not well defined.

Objective

This study aimed to synthesize providers’ and patients’ experiences and perspectives regarding barriers and quality breast cancer care in health services.

Methods

PubMed, Scopus, MEDLINE, Web of Knowledge, and the Cochrane Library databases were searched, and articles published in English up to August 2020 were screened. Two reviewers independently screened all articles. Data were obtained directly from different stakeholder groups including patients, health providers, and professionals.

Results

The search strategy identified 21 eligible articles that met inclusion criteria and reported perspectives of 847 health providers and 24 601 patients regarding healthcare quality. Health providers and patients with breast cancer noted information needs, psychosocial support, responsibility for care, and coordination of care as important quality improvement characteristics of the healthcare system.

Conclusion

Shifting to high-quality breast cancer care would likely be a complicated process, and there is a need for the cancer care services to consider important characteristics of quality cancer care as a care priority, that is, to be responsive.

Implication for Practice

Breast cancer survivorship care programs and interventions may need to consider the barriers or common challenges to care noted in this review, especially regarding information sharing and the need for social support and care cooperation.
Cognitive Testing of PAINReportIt-Spanish in Monolingual Hispanic Adults
Authors: Suarez Marie L. , Angulo Rigoberto , Suarez Adam J. , Fullwood Dottington , Allen John , Stern Mariana C. , Flores-Rozas Hernan , Wilkie Diana J.
Published: May 2022

Background

A Spanish language computerized tool would facilitate cancer pain assessment and management for the underserved population of native Spanish speakers who do not speak or lack command of the English language.

Objective

Our aim was to identify Spanish-speaking adults’ understanding and interpretation of the PAINReportIt-Spanish items and instructions as well as translation and technical issues.

Methods

In a cross-sectional study, 20 mostly monolingual Spanish-speaking adults engaged in 1.5- to 2-hour, audio-recorded cognitive interviews as they completed the multidimensional PAINReportIt-Spanish. Three bilingual researchers conducted content data analysis.

Results

Sixteen women and 4 men generally understood the translated text, but some had interpretation issues regarding the 0 to 10 number scale and understanding of the pain quality descriptors. Many participants found the program easy to complete, even when they had problems in some areas. Most participants welcomed the opportunity to report pain in their native language and appreciated research to help Hispanics with the management of their pain.

Conclusion

PAINReportIt-Spanish is a valid tool to assess pain in a Spanish-speaking population. Improved orientation to the pain reporting tasks and alternate translations for several problematic/confusing Spanish words require additional study, especially among underrepresented black Hispanics and males.

Implication for Practice

Findings indicate that Spanish-speaking adults (1) easily use a body outline to report their pain location, (2) may use a 0 to 10 scale differently than other individuals, and (3) may have a limited repertoire of pain quality and pattern descriptors.
“I Am Grateful for Every Day I Live”
Authors: Uslu-Sahan Fatma , Er-Korucu Asli , Cekic Yasemin , Simsek Sevgi
Published: May 2022

Background

Considering the life-threatening nature of gynecological cancers, spirituality and religious beliefs may play a key role in the experiences of the patients during the disease process and their coping.

Objective

The aim of this study was to understand the spiritual experiences of Muslim women with gynecological cancer during the disease process.

Methods

A qualitative, phenomenological, and hermeneutic approach was followed in the research. Fourteen women with gynecological cancer in Turkey were interviewed individually. The thematic analysis approach of Braun and Clarke was used to evaluate the data.

Results

The results of the data analysis revealed 3 themes (consisting of 9 subthemes): (1) reaction to cancer: spiritual distress (fear of death, perception of punishment, fear of obscurity and uncertainty, and being a cause of spiritual distress in the family); (2) reaction to cancer: spiritual well-being (accepting whatever may come from Allah, strengthening the faith in Allah); and (3) spiritual resources for coping with cancer (religious practices, hobbies and complementary practices, and family support).

Conclusions

The results of the study shed light on the cases that may cause spiritual distress and improve the spiritual well-being that is experienced by Muslim women with gynecological cancer during the disease process; they also reveal that religion has an effect on the experiences during the cancer process and the coping methods.

Implications for Practice

Healthcare professionals who care for Muslim women with gynecological cancer should plan spiritual care by being aware of the cultural characteristics and religious beliefs of these women and their families.
Narrating Perinatal Obsessive-Compulsive Disorder Through Blogs
Authors: Beck Cheryl Tatano
Published: May 2022

Purpose:

To describe women's experiences of perinatal obsessive-compulsive disorder (OCD) as written in their blogs.

Study Design and Method:

This qualitative descriptive study examined perinatal OCD blogs identified using Google search engine. Krippendorff's thematic content analysis method for qualitative data was used. The unit of analysis included segments of the bloggers' descriptions of their perinatal OCD. Clustering and dendrograms were used to group the data into themes.

Results:

Forty-three different posts from women in the United Kingdom, United States, Australia, and South Africa were analyzed. Five themes were identified that described women's experiences of perinatal OCD as told in their blogs: (1) Starting to tighten its grip during pregnancy, (2) Keeping horrific secrets all to themselves, (3) Tortured with terrifying images and thoughts, (4) Driven to compulsive behaviors to protect their infants, and (5) Long difficult road to recovery but so worth it.

Clinical Implications:

Perinatal OCD is a hidden problem that can have negative consequences for mothers and for their infants and families if not diagnosed or if misdiagnosed. There are effective treatments for OCD, but first nurses and other health care providers need to identify the women who are struggling with this anxiety disorder. During the perinatal period nurses can screen women for OCD. Developing a trusting relationship with pregnant and postpartum women is critical for nurses so that their patients can feel safe enough to share their horrific secret thoughts.
DSM-5 Posttraumatic Stress Disorder Symptoms in Nonclinical Samples of Chinese and Pakistani Trauma-Exposed Adults
Authors: Liu Xu , Wang Li , Hussain Sadiq , Fang Ruojiao , Cao Chengqi , Elhai Jon D.
Published: May 2022

The purpose of the current study was to examine the latent structure and cross-cultural measurement validity of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) posttraumatic stress disorder (PTSD) symptoms assessed by the PTSD Checklist for DSM-5. Participants comprised trauma-exposed Chinese and Pakistani undergraduate students (N = 495 and N = 186, respectively). Confirmatory factor analysis (CFA) indicated that a seven-factor hybrid model involving intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal factors provided good fit in both samples. This model fit significantly better than three alternative models including the DSM-5 four-factor model and six-factor anhedonia and externalizing behaviors models. The subsequent multigroup CFA showed that the best-fitting hybrid model demonstrated cross-cultural measurement invariance. Our findings provide further empirical support for the seven-factor PTSD hybrid model and its cross-cultural invariance, and have implications for understanding and application of DSM-5's PTSD symptoms.
A Microarray Study on the Expression of ANKRD49 in Lung Squamous Cell Carcinoma and Its Clinicopathologic Significance
Authors: Li Xin-yang , Qin Ke-ru , Liu Yue-hua , Pang Min , Huo Yun-kui , Yu Bao-feng , Wang Hai-long
Published: May 2022

Lung squamous cell carcinoma (LUSC) is associated with poor clinical outcomes and identifying novel biomarkers that are involved in the progression of LUSC is important for prognosis and targeted treatment. Herein, ankyrin repeat domain 49 (ANKRD49) protein in LUSC versus paired noncancerous lung tissues was tested and its clinical significance was evaluated through χ2 test, log-rank test, and Cox proportional hazards model. The results showed the ANKRD49 protein in LUSC was elevated and correlated with the tumor-node-metastasis stage, lymph node metastasis, distal metastasis, and differentiation. Patients with higher ANKRD49 had lower overall survival rate and higher ANKRD49 expression in lung tissues may be used as an independent prognostic marker for LUSC patients.
Projected Impact of Expanded Long-Acting Injectable PrEP Use Among Men Who Have Sex With Men on Local HIV Epidemics
Authors: Balasubramanian Ruchita , Kasaie Parastu , Schnure Melissa , Dowdy David W. , Shah Maunank , Fojo Anthony Todd
Published: May 2022

Background:

Pre-exposure prophylaxis (PrEP) is a key component in helping to reduce HIV incidence in the United States. Long-acting injectable (LAI) PrEP is a new alternative to oral PrEP; its potential to affect local HIV epidemics remains unclear.

Methods:

The Johns Hopkins HIV Economic Epidemiological model (JHEEM) is a dynamic model of HIV transmission in 32 US urban areas. We used JHEEM to project the HIV incidence among men who have sex with men (MSM) from 2020 to 2030 under a range of interventions aimed at increasing PrEP use.

Results:

In the absence of any intervention (ie, current levels of oral PrEP and HIV care engagement), we projected a 19% reduction (95% credible interval, CrI 1% to 36%) in HIV incidence among MSM from 2020 to 2030 across all 32 cities. Adding 10% LAI PrEP uptake (above a base case of all oral PrEP) reduced the incidence by 36% (95% CrI 23% to 50%) by year 2030. This effect varied between cities, ranging from 22% in Atlanta to 51% in San Francisco. At 25% additional LAI PrEP uptake, this incidence reduction increased to 54% (95% CrI 45% to 64%). Reductions in incidence after introducing LAI PrEP were driven primarily by increased uptake and sustained usage rather than increased efficacy.

Conclusions:

LAI PrEP has the potential to substantially reduce HIV incidence among MSM, particularly if it increases PrEP uptake and continued use beyond existing levels. Because potential effects vary by city, the effectiveness of expanding PrEP use is dependent on local dynamics.
High-Resolution Single Tooth MRI With an Inductively Coupled Intraoral Coil—Can MRI Compete With CBCT?
Authors: Hilgenfeld Tim , Saleem Muhammad Abdullah , Schwindling Franz Sebastian , Ludwig Ute , Hövener Jan-Bernd , Bock Michael , Flügge Tabea , Eisenbeiss Anne-Katrin , Nittka Mathias , Mente Johannes , Jende Johann Malte Enno , Heiland Sabine , Bendszus Martin , Juerchott Alexander
Published: May 2022

Objectives

The aims of this study were to quantify T1/T2-relaxation times of the dental pulp, develop a realistic tooth model, and compare image quality between cone-beam computed tomography (CBCT) and high-resolution magnetic resonance imaging (MRI) of single teeth using a wireless inductively coupled intraoral coil.

Methods

T1/T2-relaxometry was performed at 3 T in 10 healthy volunteers (283 teeth) to determine relaxation times of healthy dental pulp and develop a realistic tooth model using extracted human teeth. Eight MRI sequences (DESS, CISS, TrueFISP, FLASH, SPACE, TSE, MSVAT-SPACE, and UTE) were optimized for clinically applicable high-resolution imaging of the dental pulp. In model, image quality of all sequences was assessed quantitatively (contrast-to-noise ratio) and qualitatively (visibility of anatomical structures and extent of susceptibility artifacts using a 5-point scoring scale). Cone-beam computed tomography served as the reference modality for qualitative assessment. Statistical analysis was performed using 2-way analysis of variance, Fisher exact test, and Cohen κ.

Results

In vivo, relaxometry of dental pulps revealed T1/T2 relaxation times at 3 T of 738 ± 100/171 ± 36 milliseconds. For all sequences, an isotropic resolution of (0.21 mm)3 was achieved, with acquisition times ranging from 6:19 to 8:02 minutes. In model, the highest contrast-to-noise ratio values were observed for UTE, followed by TSE and CISS. The best image/artifact quality, however, was found for DESS (mean ± SD: 1.3 ± 0.3/2.2 ± 0.0), FLASH (1.5 ± 0.3/2.4 ± 0.1), and CISS (1.5 ± 0.4/2.5 ± 0.1), at a level comparable to CBCT (1.2 ± 0.3/2.1 ± 0.1).

Conclusions

Optimized MRI protocols using an intraoral coil at 3 T can achieve an image quality comparable to reference modality CBCT within clinically applicable acquisition times. Overall, DESS revealed the best results, followed by FLASH and CISS.
New analgesics in cancer pain
Authors: Farrer Elizabeth , Dickman Andrew
Published: May 2022

Purpose of review

Cancer pain continues to be a significant problem despite the range of analgesic and adjuvant medications available. The purpose of this review is to explore the most recent developments in the management of cancer pain.

Recent findings

Tapentadol, launched in the United Kingdom in May 2011, represents the last new analgesic entity with a novel mode of action to enter clinical practice for moderate-to-severe pain. Recent evidence describes the benefit of duloxetine for cancer-related neuropathic pain, and parecoxib by continuous subcutaneous infusion for refractory cancer pain. There is interest in the role of cannabinoids in cancer pain management but much of the evidence to date is in chronic noncancer pain. Conflicting evidence complicates the role that biased opioid agonism may offer in terms of alternative analgesics in the future.

There is development of new drugs with clinical utility on the horizon but a need for high-quality, randomized controlled trials specifically assessing efficacy and tolerability in cancer pain.
Noninvasive respiratory supports for the relief of terminal breathlessness
Authors: Inglis Joshua M. , Furst Chloe , Foreman Linda
Published: May 2022

Purpose of review

Breathlessness is a common symptom in patients with respiratory failure in the terminal phase of their illness. Noninvasive methods of oxygen delivery are frequently used in the palliative setting. We review the evidence supporting noninvasive respiratory supports for the relief of terminal breathlessness in those with life-limiting illnesses.

Recent findings

There is limited evidence to support the use of supplemental oxygen for patients without hypoxia. It is unclear whether the symptomatic benefit of oxygen therapy relates to the oxygen delivery and/or airflow across the nasal mucosa. Early trials suggest that high-flow nasal cannula (HFNC) oxygen therapy improves breathlessness at rest and on exertion for patients with cancer. Noninvasive ventilation (NIV) also appears to improve breathlessness in the palliative setting; however, potential harms include facial pressure injuries, claustrophobia and anxiety. Goals of care should be explicitly discussed and frequently reviewed given that these interventions have the potential for harm and can be challenging to withdraw.

HFNC oxygen therapy and NIV appear to reduce breathlessness in the palliative setting. Further high-quality trials are needed to confirm the symptomatic benefits of noninvasive respiratory supports on breathlessness for patients with cancer.
Cancer pain during an epidemic and a pandemic
Authors: Paice Judith A.
Published: May 2022

Purpose of review

As our global population ages, cancer has become more prevalent. Thankfully, oncologic treatments are highly effective, leading to significantly improved rates of long-term survival. However, many of these therapies are associated with persistent pain syndromes. Clinicians caring for people with cancer must understand how the influence of the current epidemic of opioid misuse and the coronavirus disease 2019 (COVID-19) pandemic have complicated cancer pain management. Creative solutions can emerge from this knowledge.

Recent findings

Persistent pain due to cancer and its treatment can be managed through multimodal care, although efforts to mitigate the opioid misuse epidemic have created challenges in access to appropriate treatment. Isolation measures associated with the COVID-19 pandemic have limited access to nonpharmacologic therapies, such as physical therapy, and have exacerbated mental health disorders, including anxiety and depression.

Cancer pain treatment requires more nuanced assessment and treatment decisions as patients live longer. Societal factors multiply existing challenges to cancer pain relief. Research is needed to support safe and effective therapies.
The pain conductor: brainstem modulation in acute and chronic pain
Authors: Crawford Lewis S. , Boorman Damien C. , Keay Kevin A. , Henderson Luke A.
Published: May 2022

Purpose of review

It is well established in experimental settings that brainstem circuits powerfully modulate the multidimensional experience of pain. This review summarizes current understanding of the roles of brainstem nuclei in modulating the intensity of pain, and how these circuits might be recruited therapeutically for pain relief in chronic and palliative settings.

Recent findings

The development of ultra-high field magnetic resonance imaging and more robust statistical analyses has led to a more integrated understanding of brainstem function during pain. It is clear that a number of brainstem nuclei and their overlapping pathways are recruited to either enhance or inhibit incoming nociceptive signals. This review reflects on early preclinical research, which identified in detail brainstem analgesic function, putting into context contemporary investigations in humans that have identified the role of specific brainstem circuits in modulating pain, their contribution to pain chronicity, and even the alleviation of palliative comorbidities.

The brainstem is an integral component of the circuitry underpinning pain perception. Enhanced understanding of its circuitry in experimental studies in humans has, in recent years, increased the possibility for better optimized pain-relief strategies and the identification of vulnerabilities to postsurgical pain problems. When integrated into the clinical landscape, these experimental findings of brainstem modulation of pain signalling have the potential to contribute to the optimization of pain management and patient care from acute, to chronic, to palliative states.