bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Disparities and the Influence of Culturally Competent Care in Overall Health and Healthcare Utilization among Hispanics in a Southeastern US Community
Authors: Malmin Natasha P. , Owen Shannon , Hoyos Lopez Diana , McKinney Rebecca , Rodríguez Vanessa
Published: October 2024

Introduction: This study sought to assess disparities in health/healthcare utilization for Hispanic immigrant community in Greenville County, SC. The study also assessed the role of culturally competent care perceptions on health/healthcare utilization within this growing community. Methods: Secondary administrative data collected by a large health care system in the county facilitated the assessment of health/healthcare utilization disparities using multivariate regression. Primary purposive surveys collected among Hispanic adults assessed culturally competent care perceptions and health/healthcare utilization. Culturally competent care measures included: (1) provider understanding, (2) provider communication behaviors, (3) provider assurance, and (4) interpreter service access. Results: Health disparities were present, with Hispanic residents having lower overall health and lower routine healthcare seeking behaviors compared to non-Hispanic White residents. Moreover, culturally competent care perceptions influenced overall health and healthcare-seeking behavior within this growing Hispanic community. Hispanic residents who perceived negative communication behaviors, lack of assurance, and increased interpretive service barriers reported lower overall health and lower routine healthcare seeking behaviors. Conclusions: Addressing potential cultural competency barriers may reduce health disparities among underrepresented racial/ethnic communities as they grow and become established in the Southeast, while also improving broader health equity for all communities.
Neurofeedback Reduces P300 Amplitudes to Intensely Emotive Pictures in Depressed Cancer Patients
Authors: Krawutschke Marvin , Teufel Martin , Schmidt Kira , Pasche Saskia , Schweig Theresa , Bialek Anna , Kowalski Axel , Tewes Mitra , Schuler Martin , Schadendorf Dirk , Scherbaum Norbert , Skoda Eva-Maria , Fink Madeleine , Müller Bernhard W.
Published: October 2024

Objective. Electroencephalographic neurofeedback (EEG NF) or its effects on event-related potentials (ERPs) in quantitative EEG have not yet been systematically studied in cancer patients. The aim of this study was to investigate the emotional arousal and valence effects on the event-related P300 in a visual oddball paradigm by an individualized EEG alpha and theta/beta NF intervention in cancer patients and survivors ( N = 18, age between 31 and 73 years). Methods. ERPs to low and high arousal target stimuli with either emotional positive or negative content and depressive state were obtained in cancer patients before and after a five-week NF intervention in a waitlist paradigm, following the consensus on the reporting and experimental design of clinical and cognitive-behavioral NF studies (CRED-nf checklist). Results. Overall, P300 amplitudes decreased significantly ( p < .05) from pre to post therapy. Effects concerning high arousal stimuli with negative and positive valences were on the border to significance. Moreover, patients achieved significant relief of depressive symptoms ( p < .05). Especially younger participants (<55 yrs.) benefited. Conclusions. P300 observations could reflect a therapeutic effect on brain activity level. EEG NF alleviates depressive symptoms in cancer patients. Significance. Based on these findings, further studies are needed to investigate the effects on event-related potentials by NF therapy.
Understanding of Key Considerations for Effective Community Engagement in Genetics and Genomics Research: A Qualitative Study of the Perspectives of Research Ethics Committee Members and National Research Regulators in a low Resource Setting
Authors: Nankya Harriet , Alibu Vincent Pius , Wamala Edward , Matovu Enock , Barugahare John
Published: October 2024

To attain effective community engagement (CE) for genetics and genomics research (GGR) is a challenge. This study aimed to analyzed participants’ perspectives on how to attain effective CE for GGR in Uganda. A cross-sectional qualitative study involving in-depth interviews with twenty research ethics committee members and three national research regulators was conducted. GGR is faced with; low genetic literacy among stakeholders, social implications, cultural attitudes towards GGR, and lack of specific guidelines for CE in GGR. Attaining effective CE in GGR should involve; development of guidelines for GGR streamlining CE; boosting stakeholders’ Knowledge in GGR and CE; engagement beyond sensitization; and consensus decision-making. Overall, attaining effective CE in GGR requires addressing the key aspects unique to GGR.
Improved Health Care Utilization Among Men With Depression Undergoing Inflatable Penile Prosthesis in a U.S. Commercial Population
Authors: Golan Roei , McGovern Alysha M. , Shin Young Eun , Rojanasarot Sirikan , Kohn Taylor , Nackeeran Sirpi , Petrella Francis , Ramasamy Ranjith
Published: October 2024

We evaluated depression-related health care resource utilization and antidepressant prescription medication utilization among commercially insured men in the United States who underwent inflatable penile prosthesis (IPP) implantation between January 1, 2007 and December 31, 2020, and who received a depression diagnosis in the year preceding the IPP procedure. A total of 11,177 patients received an IPP during the index period, 808 of whom were diagnosed with depression. A statistically significant reduction in overall depression-related health care visits occurred from pre- to post-IPP, decreasing from 4.9 to 3.8, p < .001. In addition, there was a significant reduction in depression-related inpatient visits (0.07 vs. 0.03, p = .02) and office visits (4.25 vs. 3.29, p < .001) from pre- to post-IPP. Of the 678 men who received an antidepressant medication within 1 year prior to their IPP date, 15% stopped antidepressant medication use entirely post-IPP. Among patients with continued antidepressant medication use post-IPP ( n = 574), there was a significant decrease in the number of prescriptions (7.55 vs. 8.09, p < .0001) and refills (7.52 vs. 8.11, p = .0015), with a higher likelihood of discontinuation (17.6% vs. 10.5%, p < .0001) and a lower proportion of days covered (0.79 vs. 0.83, p = .0004) post-IPP compared with pre-IPP. In conclusion, IPP was associated with reduced depression-related health care utilization and antidepressant medication use among recipients. This suggests potential mental health benefits for IPP recipients beyond restoration of erectile function. Comprehensive insurance coverage for IPP, especially for men with depression, may be beneficial to both patients and insurers.
Medicine and Motion: The Link Between Medications and Exercise
Authors: Haag Sarah J. , Damaschke Jeffrey A. , Srivastava Sneha
Published: October 2024

There is abundant evidence about the impact of physical activity on health. Many of the clinical guidelines include physical activity as a strong recommendation in treatment plans to optimize health outcomes; however it is necessary to consider the interaction between medications and physical activity. There are certain medical conditions, including cardiovascular disease, diabetes, pain and urinary incontinence that may directly impact physical activity as well as medications for those conditions can affect how a person can be physically active. Having individualized conversations with patients to determine ways to incorporate physical activity into their lives, taking medications into consideration, may lead to healthier outcomes.
Safety profiles of vancomycin in pediatrics based on China hospital pharmacovigilance system: A retrospective cohort study
Authors: Huang Zhijie , Pan Xiuming , Chen Yao , Chen Weida , Chen Quanyao , Huang Zhiyi , Chen Jiemin , Yang Jianhui , Cai Can
Published: October 2024

The safety of vancomycin in children requires special attention. The evidence from active pharmacovigilance systems about vancomycin-related adverse drug reactions (ADRs) was rare. We aimed to investigate the association between doses of vancomycin and ADRs among children. This retrospective cohort study included a total of 643 inpatient children. Children who received vancomycin were regarded as exposed groups and classified into low-dose, normal-dose, and high-dose groups. Those who did not receive vancomycin and had similar severity of infection were classified into the unexposed group. ADR signal detection was performed by the China Hospital Pharmacovigilance System. Logistic regression analyses were conducted to explore the effect of intravenous vancomycin on ADRs. This study included 156 patients (178 ADR cases) in the exposed group and 487 patients (364 ADR cases) in the unexposed group. The top three reported ADRs were eosinophilia ( n = 75, 48.1%), hemoglobin decreased ( n = 72, 46.2%), and blood bilirubin increased ( n = 13, 8.3%) in the exposed group. Patients in the low-dose, normal-dose, and high-dose groups showed a higher risk of hemoglobin decreased when compared with those in the unexposed group, with the fully adjusted ORs (95% CIs) of 6.91 (3.61, 13.20), 7.80 (3.87, 15.76), and 8.80 (4.08, 19.01), respectively. Besides, compared with patients in the unexposed group, those in the normal-dose and high-dose groups show a significantly higher risk of eosinophilia and blood bilirubin increased, respectively. It is important to monitor eosinophilia, hemoglobin decreased, and blood bilirubin increased in pediatrics receiving vancomycin, especially those receiving normal-dose and high-dose vancomycin.
Evaluation of metaheuristic optimization algorithms applied to path planning
Authors: Sehuveret Hernández Dizahab , García-Muñoz Jorge Alberto , Barranco Gutiérrez Alejandro I
Published: October 2024

The development of autonomous ground vehicles is a topic widely discussed by the international scientific community. Path planning for these robots is an essential element to achieving a satisfactory fulfillment of missions without human intervention. This work adopts and improves the metaheuristic optimization methods harmony search and ant colony optimization, developing strategies based on the enhanced harmony search and improved ant colony optimization to achieve short, collision-free paths for robot movement. A description of the original methods and improvement procedures is presented, and their performance in path planning is compared through simulation. Theoretical results are supported by simulated experiments, which highlight the situations in which each metaheuristic algorithm is preferable and the benefits they bring to the path planning strategy.
The effects of aerobic exercise on cardiometabolic health in postmenopausal females: A systematic review and meta-analysis of randomized controlled trials
Authors: Huynh Eric , Wiley Elise , Noguchi Kenneth S , Fang Hanna , Beauchamp Marla K , MacDonald Maureen J , Tang Ada
Published: October 2024

Background:

After menopause, reductions in ovarian hormones increase the risk of cardiovascular disease. Aerobic exercise training has been shown to reduce cardiovascular risk in older adults, but its effectiveness in postmenopausal females is less definitive.

Objectives:

The objectives of this study were to examine the: (1) effects of aerobic training, and (2) association between aerobic training intensity and cardiometabolic health outcomes in postmenopausal females.

Design:

Systematic review and meta-analysis of randomized controlled trials.

Data Sources and Methods:

Six electronic databases were searched from inception to July 21, 2023 for aerobic training interventions reporting cardiometabolic outcomes in postmenopausal females. Data were synthesized qualitatively and random-effects meta-analyses and subgroup analyses (light, moderate, and vigorous intensity) were performed. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the certainty of evidence.

Results:

Fifty-nine studies ( n = 4,225; 45–78 years old) were identified, 53 ( n = 3,821) were included in the quantitative analyses. Aerobic training interventions varied in frequency (3–21×/week), intensity, type, time (8–60 min/session), and duration (3–52 weeks). Aerobic training improved systolic blood pressure (mean difference (MD) = −4.41 mmHg, 95% confidence interval (95%CI) [−7.29, −1.52], p = 0.01), resting heart rate (MD = −3.08 bpm, 95%CI [−5.11, −1.05], p < 0.01), body mass index (BMI, MD = −0.65 kg/m2, 95%CI [−0.99, −0.31], p < 0.01), waist circumference (MD = −2.03 cm, 95%CI [−2.65, −1.41], p < 0.01), body fat (MD = −2.57 kg, 95%CI [−3.65, −1.49], p < 0.01), low-density lipoprotein cholesterol (MD = −10.46 mg/dL, 95%CI [−16.31, −4.61], p < 0.01), high-density lipoprotein cholesterol (MD = 3.28 mg/dL, 95%CI [0.20, 6.36], p = 0.04) and cardiorespiratory fitness (standardized MD = 1.38, 95%CI [1.13, 1.64], p < 0.01). There was a very low certainty of evidence for all outcomes. In subgroup analyses, light- and vigorous intensities were beneficial for BMI with no effect for moderate-intensity exercise ( p < 0.01). Light intensity showed a beneficial effect ( p = 0.02) for glucose levels ( p < 0.01) and triglycerides; there was no effect with moderate or vigorous intensities.

Conclusion:

Aerobic training may improve cardiometabolic health outcomes in postmenopausal females. There may be differential effects of exercise intensity on BMI, blood triglycerides, and blood glucose; however, this warrants further investigation.

Registration:

PROSPERO—CRD42022313350
Warlike Heroines and Anglo-German Drama in an Age of Europhobia
Authors: Burdett Sarah
Published: October 2024

The Anglo-German drama, which comes to proliferate in London's patent theatres at the turn of the nineteenth century, renders ubiquitous an arms-bearing heroine whose foreign character and perceived ideological inferences render her a chief object of attack among British Europhobic commentators. Redressing the limited scholarship devoted to this pervasive Anglo-German figure, this essay foregrounds the remarkable extent to which she is implicated in the perceived social and political threats with which the German drama is freighted. The essay uses theatrical commentaries to spotlight three recurring, though not quite harmonious flaws, for which the violent German heroine is contemporaneously berated. Then, analysing performances of Joseph George Holman's The Red-Cross Knights (Haymarket, 1799) and Richard Cumberland's Joanna of Montfaucon (Covent Garden, 1800), the essay illustrates the meticulous methods employed by dramatists to mollify the subversive implications embodied by the Anglo-German Amazon and to uphold supposedly inherent distinctions between male and female conduct, and British and European females, at a moment when the blurring of such gendered and national boundaries portends the social anarchy witnessed across the Channel.
Within-case comparison of the adult and youth justice systems: New directions for a ‘fractured’ penal state?
Authors: Buckley Siobhán , Hamilton Claire
Published: October 2024

Building on recent literature on the importance of local grounded comparison and the ‘fracturing’ of the penal state, this article argues that within-case comparison of the adult and youth justice systems can shed important light on the stark differences that persist in how and why we punish. Using the case of Irish youth justice to illustrate the utility of fracturing the penal state horizontally, as well as vertically, we argue that this provides a helpful lens for making sense of the drivers of penal policy, especially the historical particularities of any penal phenomenon.
The effects of anaesthesia on the cardiovascular, respiratory and nervous systems during inhalational anaesthesia: A case report
Authors: Scott Bevan Michael
Published: October 2024

Our understanding of the effects of anaesthesia is incomplete. Anaesthesia works primarily by causing widespread depression of the central nervous system. This article will consider the anaesthesia provided for a patient undergoing a hysteroscopy, endometrial ablation and biopsy for abnormal uterine bleeding. The relationship between physiology and the effects of anaesthesia is discussed. Several effects of anaesthesia are observed during the case. Relating to the respiratory system, preoxygenation increased end tidal oxygen by 39%, delaying desaturation during apnoea. Propofol had a profound effect on the patient’s respiratory rate by inhibiting the ventilatory drive, resulting in apnoea. The cardiovascular system was affected by tracheal intubation. Stimulation of the sympathetic nervous system caused a 96% increase in heart rate. Induction of anaesthesia resulted in hypotension, treated with the administration of ephedrine, causing vasoconstriction. Modified rapid sequence induction required an increased dose of rocuronium, resulting in an increased duration of action at the neuromuscular junction. The prolonging muscle paralysis required sugammadex as a reversal agent. This case demonstrated the effects of anaesthesia on the respiratory, cardiovascular and nervous systems.
Management of adult mechanically ventilated patients: A UK-wide survey
Authors: Ward James , Terrington Isis , Preston Katie , Smith Alexander , Roe Thomas , Barnes Jonathan , Allen Emma , Lima Sandra , Cusack Rebecca , Grocott Michael P.W. , Dushianthan Ahilanandan ,   the South-coast Peri-operative Audit and Research Collaborative (SPARC)
Published: October 2024

Background:

Mechanical ventilation is a common and often lifesaving intervention that is utilised in intensive care. However, the practices can vary between centres. Through this national survey we aim to gain more information about different strategies adopted across the UK.

Methods:

All adult intensive care units in the UK were approached to participate. The questionnaire was developed with an electronic survey engine and conducted between 09/11/2023 and 01/04/2024 (Survey Monkey®). The survey included questions on ventilator modes, settings, protocols/pathways, rescue strategies, immediate post-extubation period and follow-up.

Results:

There were 196 responses from 104 hospitals. The most widely adopted start-up ventilation mode was pressure-regulated volume-controlled mode. For acute hypoxaemic respiratory failure (AHRF), most of respondents reported full (39.8%) or partial compliance (58.1%) with the ARDSnet protocol, with PEEP settings being the commonest deviation. Prone positioning (99.0%), followed by recruitment manoeuvres (91.3%) were commonly used rescue measures during AHRF. APRV (55.7%), inhaled (51.3%) and systemic pulmonary vasodilators (44.1%) were also commonly used. Conservative oxygen targets (SaO2 of 88%–92%) were commonly adopted (70.6%). As a care bundle, intermittent ETT cuff pressure monitoring was more common (65.5%) than continuous cuff pressure monitoring (20.0%). Propofol and alfentanil were the most common initial sedative and analgesia (99.5% and 56.9%) respectively. Routine volatile anaesthetic use was rare.

Conclusions:

Our survey has shown significant variation of practice in common but crucial elements of management of patients receiving mechanical ventilation. We hope the results in our survey highlight potential future areas of research.

Collaborators

South-coast Peri-operative Audit and Research Collaborative (SPARC) Severn Trainee Anaesthetic and Critical Care Research group (STAR) Collaborative research in Anaesthesia in the Northeast (CRANE)
Ptyalism gravidarum
Authors: Morton Adam , He Jin-Wen
Published: October 2024

Ptyalism gravidarum, or sialorrhoea, is a highly distressing maternal condition characterised by excess salivation and difficulty swallowing saliva, requiring the affected woman to frequently expectorate. The literature is sparse and somewhat conflicting. There are marked geographical and cultural differences in prevalence. The aetiology is not known, and no trials have been performed with respect to treatment modalities. A review of the available literature is presented, and possible future directions for research are suggested.
Trapeziometacarpal total joint arthroplasty, with or without supervised hand rehabilitation: A quasi-experimental trial
Authors: Bonhof-Jansen Elske EDJ , Brink Sander M , de Jong Tjeerd R , van Uchelen Jeroen H , Bakker Eric WP
Published: October 2024

Introduction

Aim of this study was to determine whether postoperative supervised rehabilitation improves functional outcomes after trapeziometacarpal (TMC) total joint arthroplasty (TJA), compared to education alone.

Method

A quasi-experimental before-after trial included 31 women (≥40 years) per group diagnosed with trapeziometacarpal osteoarthritis who underwent TJA. A cohort ( n = 31) who was given education alone was compared to a cohort ( n = 31) who were subjected to supervised rehabilitation. Primary outcome was the difference in hand function 3 months postoperatively, measured by the Michigan Hand Outcomes Questionnaire (MHOQ). Other outcomes were the MHOQ subscale scores, the active range of motion, strength, time to return to work, satisfaction and complications.

Results

Patients in the education group had a significantly higher median delta MHOQ score when compared to the rehabilitation group at 3 months; 28.5 (20.5-31.3) versus 15.8 (1.9-21.1), ( p = <0.01) and at 12 months 36.6 (26.8 - 47.2) versus 27.4 (14.5 - 33.0), ( p = 0.01). Only the secondary outcomes the MHOQ subscales hand function, ADL and satisfaction revealed significant differences in favor of the education group. The education method reduced the median number of hand therapy sessions with eight visits.

Conclusion

The present study does not show a significant or clinically relevant benefit from supervised rehabilitation in terms of functional outcomes following TJA compared to education alone. Based on this, it seems safe to leave patients unsupervised in their recovery following TJA and to suffice with just education, however further exploration of effectiveness and safety of this intervention is recommend in larger trials.
What have we learnt from the inhibition of IL-6 in RA and what are the clinical opportunities for patient outcomes?
Authors: Taylor Peter C. , Feist Eugen , Pope Janet E. , Nash Peter , Sibilia Jean , Caporali Roberto , Balsa Alejandro
Published: October 2024

Rheumatoid arthritis (RA) is an autoimmune disease characterised by persistent inflammation of the synovial joints as well as other tissues and organs. Left untreated, it can lead to joint damage, disability and even increased mortality. The disease is driven by inflammatory cytokines that contribute to the chronic inflammation seen in RA. Interleukin-6 (IL-6) is a key pathological cytokine and a target for treatments aiming to alleviate local and systemic inflammation. Despite advances in understanding RA and the introduction of new treatments, achieving sustained remission remains challenging. This review explores the role of IL-6 in RA pathogenesis, its potential as a treatment target and the significance of personalised medicine in RA management. IL-6 has a dual signalling mechanism, classical and trans-signalling, which influences various intracellular pathways. While several targeted therapies have emerged, no single mechanism-based therapy is universally effective due to the diversity and complexity of the disease. Different approaches to targeting IL-6 have been tested, including biologic blockade of receptors or ligands, and inhibition of IL-6 signalling. IL-6 receptor inhibitors have been validated as RA therapeutics, either alone or in combination with other treatments. Tocilizumab, the first approved IL-6 inhibitor, blocks both soluble and membrane-bound IL-6 receptors, reducing the inflammatory cascade. Clinical trials confirm the efficacy and safety of tocilizumab and its role as a treatment option for patients unresponsive to conventional therapies. The benefits of IL-6 inhibition extend beyond reduced joint inflammation to the amelioration of comorbidities like anaemia, cardiovascular disease, depression and osteoporosis. Tailoring treatment to patients’ profiles and comorbidities is essential for optimal outcomes. A ‘treat-to-profile’ approach, focusing on a holistic view of the patient, could improve personalised medicine strategies. Biosimilars – lower-cost alternatives to biologics – further enhance the accessibility and cost-effectiveness of treatment. IL-6 inhibitors present a valuable treatment option for RA management, particularly for patients with specific comorbidities.
Plasma Radiofrequency Tuboplasty and Cartilage Underlay Myringoplasty for Repairing Chronic Large Perforation with Eustachian Tube Dysfunction
Authors: Lou Zhengcai , Lou Zihan , Lv Tian , Chen Zhengnong
Published: October 2024

Objective

The objective of this study was to compare the outcomes of endoscopic cartilage myringoplasty (ECM) with or without plasma radiofrequency (RF) tuboplasty (PRT) for repairing chronic large perforation with Eustachian tube dysfunction (ETD).

Materials and methods

Chronic large perforations with ETD were randomly divided into receiving ECM or ECM plus PRT. During the 24 months follow-up, the Eustachian tube score (ETS), Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), ET inflammation scale, hearing results, and graft success rate of the patients were analyzed.

Results

A total of 61 subjects were included in the study. Difference of ETS was significant before and after surgery in the ECM + PRT group ( P < .05) but the ECM group was not ( P > .05). Also, significant between-group difference was found regardless of post-24 months ETS and improvement value. Postoperative ETDQ-7 scores were significantly reduced compared with preoperative ETDQ-7 scores in both groups ( P < .05), also, significant between-group difference was found regardless of post-24 months ETDQ-7 scores and improvement value. The graft success rate was 86.7% in the ECM group and 96.8% in the ECM + PRT group at postoperative 24 months ( P > .05). In addition, although the ECM + PRT group showed a better air-bone gap improvement than the ECM group, the difference was not significant (13.01 ± 2.97 vs 10.92 ± 0.69 dB; P > .05). No PRT procedure-related serious adverse events were reported during the follow-up process. No patients developed atelectasis or otitis media with effusion in either group.

Conclusion

ECM combined with low-temperature PRT did not affect the graft success rate but showed a better long-term improvement in ETS and ETDQ-7 than cartilage myringoplasty for the treatment of chronic perforation with ETD. In addition, although PRT showed a better hearing improvement, the difference was not significant between the 2 groups.
The Austrian Political Advertisement Scandal: Patterns of “Journalism for Sale”
Authors: Balluff Paul , Eberl Jakob-Moritz , Oberhänsli Sarina Joy , Bernhard-Harrer Jana , Boomgaarden Hajo G. , Fahr Andreas , Huber Martin
Published: October 2024

Mounting concern surrounds the influence of political actors on journalism, especially as media outlets face increasing financial pressures. These circumstances can give rise to instances of media capture, a mutually corrupting relationship between political actors and media organizations. However, empirical evidence substantiating such mechanisms and their consequences remains limited, particularly in the context of Western democracies. This chapter investigates a recent case in which a former Austrian chancellor allegedly colluded with a tabloid newspaper to receive better news coverage in exchange for increased ad placements by government institutions. We employ automated content analysis to investigate political news articles from seventeen prominent Austrian news outlets spanning 2012–2021 ( n = 222,659). Adopting a difference-in-differences approach, we find a substantial increase in media visibility of the former Austrian chancellor within the news outlet that is alleged to have received bribes, as well as a decrease in favorability for challenger candidates. Although this study does not aim to prove or disprove the involvement of specific political actors or media organizations in unethical or illegal activities, it introduces an innovative method for detecting unusual patterns in media reporting. Findings are discussed in the context of current threats to media independence and underscore the crucial need to protect journalistic integrity and ensure unbiased information for the public.
Reclaiming planetary consciousness
Authors: Rispoli Giulia
Published: October 2024

In this commentary, I argue that new concepts and neologisms must reckon with history. The idea of Gaia, to which Gonin et al. refer, is not without its sins, and is in fact at the origin of a controversial tradition that initially gave little weight to the impact of human activities in transforming the biosphere. Politicizing Gaia is not the answer. In my view, it is important to refocus on human agency and strive for common goals to address the crisis of the Anthropocene. What is still missing is a systematic study of the various ways in which a highly differentiated humanity across the globe has conceived itself as a geohistorical force. Pursuing this path helps to provide a historical foundation for the need to build a necessary planetary consciousness.
Assessing the feasibility of the GOTT (Gabapentinoid and Opioid Tapering Toolkit) in a primary care setting in North-East England
Authors: Johnson Lucy , Cole Frances , Kinchin Rebecca , Francis Andrea , Winiarek Konrad , Hampshire Kate , Chazot Paul
Published: October 2024

Objective

To assess the feasibility and possible impacts of implementation of systematic non-pharmacological interventions to reduce the level of prescribing of opioid and gabapentinoid analgesics for chronic non-cancer pain (CNCP), particularly high-dose prescriptions, through a proof-of-concept study in a deprived area (second lowest decile) primary care practice in North-East England.

Participant

Twenty-five primary care staff (clinical and non-clinical) of which 18 clinicians received the intervention.

Intervention used in this study practice known as GOTT (Gabapentinoid and Opioid Toolkit)

All clinicians received an educational skills programme to support patient pain self-management, tailored on the clinicians’ self-assessment of their learning needs, embedding both clinician skill learning and patient self-care resources for rapid access within consultations into a GP clinical management computer system.

Outcome measures

Clinical staff completed questionnaires before and after the GOTT intervention to assess levels of knowledge and confidence in their own skills to support chronic pain self-management across several domains. Prescription data were used to measure changes in opioid and gabapentinoid prescribing at the practice across the 12-month intervention and 30-month follow-up period.

Results

Prescribing of opioid and gabapentinoid/pregabalin decreased substantially in the practice across the intervention period (c. 90% in high-dose opioid [ p = .0118], and 15% gabapentin/pregabalin prescriptions, respectively), over a one-year period during the COVID-19 pandemic. Follow-up analysis showed 100% and c.50% reductions, respectively, in December 2022. The questionnaire data showed an increase in clinician confidence in skills to enable self-management over the intervention period, overall ( p = .044) and, specifically across three of the five domains measured: supporting behavioural change ( p = .028), supporting self-care ( p = .008), and managing difficult consultations ( p = .011).

Conclusion

The GOTT intervention program provided some initial evidence of a proof-of-concept for the implementation of a systematic non-pharmacological pain management skills and resources programme addressing lack of confidence in skills to introduce and support self-management and reduce use of strong opioids and gabapentinoids.
Acute Allograft Rejection in Kidney Transplant Recipients Treated With Immune Checkpoint Inhibitors: An Educational Case Report
Authors: Morrison Steven A. , Vinson Amanda J.
Published: October 2024

Rationale:

Kidney transplant (KT) recipients have an increased risk of malignancy due to chronic immunosuppression. The emerging use of immune checkpoint inhibitors (ICIs) has been a promising development for the treatment of malignancy, but their use adds to the complexity of immunosuppression management for KT recipients. This case report describes 2 cases of acute rejection in KT recipients following ICI initiation and discusses the balance of malignancy treatment with adequate immunosuppression.

Presenting Concerns of Patients:

The first patient is a 44-year-old male KT recipient with a diagnosis of metastatic renal cell carcinoma presenting with acute kidney injury 6 days following initiation of an ICI. The second patient is a 73-year-old male KT recipient with a diagnosis of squamous cell carcinoma presenting with acute kidney injury 2 weeks following initiation of an ICI.

Diagnoses:

Both patients were diagnosed with acute rejection in the setting of reduced immunosuppression and initiation of an ICI.

Interventions:

Both cases received an increased dose of steroid without improvement of graft function. The first patient subsequently underwent a delayed graft nephrectomy due to complications of acute rejection, whereas the second patient did not undergo nephrectomy.

Outcomes:

The first patient experienced complications including perioperative bleeding requiring multiple operations, but ultimately stabilized on hemodialysis and showed a durable response to ICI. The second patient remained dialysis-dependent post-ICI treatment and was readmitted with allograft complications leading to his eventual death.

Teaching Points:

This study underscores the complexity of managing KT recipients diagnosed with malignancy and receiving ICIs. The balance between immunosuppression reduction to treat malignancy and preventing allograft rejection presents a significant challenge. Key considerations include the risk of acute allograft rejection and patient-centered decision-making. These cases highlight the need for further research to develop evidence-based guidelines for managing this patient population. In addition, the patient perspective in this study highlights the importance of careful risk-benefit analysis and the impact of treatment decisions on patient-focused outcomes.
Unsupervised SapBERT-based bi-encoders for medical concept annotation of clinical narratives with SNOMED CT
Authors: Abdulnazar Akhila , Roller Roland , Schulz Stefan , Kreuzthaler Markus
Published: October 2024

Objective

Clinical narratives provide comprehensive patient information. Achieving interoperability involves mapping relevant details to standardized medical vocabularies. Typically, natural language processing divides this task into named entity recognition (NER) and medical concept normalization (MCN). State-of-the-art results require supervised setups with abundant training data. However, the limited availability of annotated data due to sensitivity and time constraints poses challenges. This study addressed the need for unsupervised medical concept annotation (MCA) to overcome these limitations and support the creation of annotated datasets.

Method

We use an unsupervised SapBERT-based bi-encoder model to analyze n-grams from narrative text and measure their similarity to SNOMED CT concepts. At the end, we apply a syntactical re-ranker. For evaluation, we use the semantic tags of SNOMED CT candidates to assess the NER phase and their concept IDs to assess the MCN phase. The approach is evaluated with both English and German narratives.

Result

Without training data, our unsupervised approach achieves an F1 score of 0.765 in English and 0.557 in German for MCN. Evaluation at the semantic tag level reveals that “disorder” has the highest F1 scores, 0.871 and 0.648 on English and German datasets. Furthermore, the MCA approach on the semantic tag “disorder” shows F1 scores of 0.839 and 0.696 in English and 0.685 and 0.437 in German for NER and MCN, respectively.

Conclusion

This unsupervised approach demonstrates potential for initial annotation (pre-labeling) in manual annotation tasks. While promising for certain semantic tags, challenges remain, including false positives, contextual errors, and variability of clinical language, requiring further fine-tuning.
The invisible work of video consultation use in Danish general practice: An ethnographic study
Authors: Lüchau Elle Christine , Olesen Finn , Atherton Helen , Søndergaard Jens , Hvidt Elisabeth Assing
Published: October 2024

Objective

To delineate the characteristics of the work undertaken by general practitioners (GPs) and staff in implementing and utilising video consultation within their situated clinical contexts.

Methods

The data material comprises 33 semi-structured interviews with GPs and staff and 132 hours of ethnographic fieldwork across seven clinics in Denmark. The data collection period spanned from June 2021 to August 2022. Reflexive thematic analysis was employed to analyse the data, drawing inspiration from the concept of invisible work as proposed by Susan Leigh Star and Anselm Strauss.

Results

Four types of invisible work were identified through the analysis: (1) the work of introducing video consultations, (2) the work of stabilising video consultation use, (3) the work of coordinating users and systems, (4) the work of repair as a response to breakdowns.

Conclusions

The video consultation changes the organisational structure and leads to a reconfiguration of professional roles and existing work practices. Moreover, implementing and using video consultations demands articulation, inclusion and affective work by GPs and staff, and this work includes allocating time to coordinate tasks, do workarounds and repair breakdowns.
Role of mobile health applications in prevention and detection of pandemic disease: A population perspective
Authors: Elbilgahy Amal Ahmed , Alenezi Mada Huwaydi , Alruwaili Aseel Hamed , Alhathal Sarah Muteb
Published: October 2024

Background

The Saudi government and the MOH launched six mobile application help in tracking positive cases, get medical consultation from home, and vaccination for coronavirus disease 2019 (COVID-19). Our study was conducted to evaluate the role of mobile health applications in the prevention and detection of pandemic disease from population perspectives.

Methods

A cross-sectional descriptive exploratory research design was utilized in this study. Based on the sample size calculation (described below), we recruited a convenience sample of 462 participants from the Northern Border Region according to the set of inclusion and exclusion criteria: Anyone over 12 years of age, including both genders and both Saudi citizens and non-Saudi citizens, were eligible to participate during the period from March 2022 to the end of July.

Results

In total 462 were participated, and 79.2% of them were females. There was a statistically significant difference between educational level and the overall score of public satisfaction with the ease of use of mobile health applications as well as overall satisfaction with the services provided by mobile health apps during the COVID-19 pandemic. Additionally, there was a statistically significant difference between gender and the role of mobile applications in the prevention of COVID-19 ( p = 0.028).

Conclusion

The study found that most participants agree that the mobile health applications launched by the Saudi government and Ministry of Health have been successful in aiding the anticipation and early detection of COVID-19 cases, as well as facilitating access to healthcare services. Over half of the participants strongly agree that these mobile applications have been very effective and beneficial for their health and have helped save time.
Clinician Awareness of Patient-Reported Health-Related Social Needs: There’s Room for Improvement
Authors: Nederveld Andrea , Bertin Kaitlyn Booske , Dickinson Louise Miriam , Beall Shivani , Nelson Jordan , Glasgow Russell E. , Huebschmann Amy G.
Published: October 2024

Introduction:

People experiencing health-related social needs (HRSNs), such as transportation insecurity, are less likely to undergo preventive health screenings. They are more likely to have worse health outcomes overall, including a higher rate of late-stage cancer diagnoses. If primary care clinicians are aware of HRSNs, they can tailor preventive care, including cancer screening approaches. Accordingly, recent guidelines recommend that clinicians “adjust” care based on HRSNs. This study assessed the level of clinician awareness of patient-reported HRSNs and congruence between clinician perception and patient-reported HRSNs.

Methods:

We surveyed patients aged 50 to 85 years and their clinicians in 3 primary care clinics that routinely screen patients for HRSNs. Patients and clinicians reported the presence/absence of 6 HRSNs, including food, transportation, housing and financial insecurity for medications/healthcare, financial insecurity for utilities, and social isolation. Kappa statistics assessed the concordance of reported HRSNs between patients and clinicians.

Results:

Across 237 paired patient-clinician surveys, mean patient age was 65 years, and 62% and 13% of patients were female and Latinx/Hispanic, respectively. Concordance between clinician- and patient-reported HRSNs varied by HRSN, with the lowest agreement for food insecurity (kappa = .08; 95% CI: 0.00, 0.17; P = .01) and highest agreement for transportation insecurity (kappa = .39; 95% CI: 0.18, 0.59; P < .001). The other HRSNs assessed were housing insecurity (kappa = .30; 95% CI: 0.05, 0.55; P < .001), social isolation (kappa = .24; 95% CI: 0.03, 0.45; P < .001), financial insecurity for utilities (kappa = .21; 95% CI: −0.02, 0.45; P < .001), and financial insecurity for healthcare/medications (kappa = .12; 95% CI: −0.02, 0.27; P < .001). In particular, discrepancies were noted in food insecurity prevalence: patient-reported food insecurity was 29% whereas clinician-reported food insecurity was only 3%.

Discussion:

Clinician awareness of patients’ social needs was only modest to fair, and varied by specific HRSN. In order to adjust care for HRSNs, clinics need processes for increased sharing of patient-reported HRSNs screening information with the entire clinical team. Future research should explore options for sharing HRSN data across teams and evaluate whether better HRSN data-sharing impacts outcomes.
A Diagnostic Dilemma: A Case of Angiosarcoma Presenting as Splenomegaly and Pathologic Fracture
Authors: Gilman Elizabeth A. , Ressler Steven W. , Fasolino John P. , Graham Rondell P. , Croghan Ivana T. , Hurt Ryan T.
Published: October 2024

Background:

Angiosarcomas are rare tumors that can be difficult to diagnose due to subtle changes in the vascular endothelium. When there is evidence to suggest malignancy, such as a pathologic fracture, further investigation is needed, and a high suspicion for angiosarcoma needs to be present so that appropriate immunohistochemical stains are utilized on biopsied tissue. In situations where such suspicion is high and prior biopsies have been negative, performance of splenectomy, can be both diagnostic and therapeutic when splenomegaly is present.

Case Report:

This is a case of a 52-year-old woman with splenomegaly, initially attributed to infection, in the setting of upper respiratory symptoms and thrombocytopenia. Three months later, however, she presented with back pain. Imaging showed lytic bone lesions with pathologic vertebral fracture and numerous liver lesions that were too small to characterize further. Initial biopsies of the liver and bone did not reveal a pathologic process. Several months later, still without a unifying diagnosis, she presented to our institution. MRI of the brain was done for neurologic concerns and showed pathologic enhancement in the calvarium. A PET scan showed diffuse avidity of the skeleton and spleen. After discussing the case with a hematologist, splenectomy was performed for both diagnostic and therapeutic purposes. Angiosarcoma was identified in the spleen and in a PET-directed bone biopsy. With a definitive diagnosis, she returned home and subsequently elected to pursue hospice care.

Conclusion:

When there is a high clinical suspicion for malignant angiosarcoma, a multidisciplinary approach is necessary to direct both tissue acquisition and necessary histochemical staining.
A Service Evaluation of More Than 27 000 Adults Referred to a Community Weight Management Program: 24-Month Outcomes
Authors: Toon Josef , Bennett Sarah-Elizabeth , Lavin Jacquie , Pallister Carolyn , Avery Amanda
Published: October 2024

Background:

Obesity has a significant impact on healthcare resources with limited accessible support available through the NHS. This service evaluation determines 24-month efficacy of referral to an open-group behavioral program by BMI category and socioeconomic status.

Methods:

This retrospective, longitudinal study examined weight outcomes of adults living in England referred by healthcare professionals to Slimming World during 2016 who recorded at least 1 weight change. Primary outcome was % weight change at 3, 6, 12, and 24 months. Socioeconomic status was measured using the Index of Multiple Deprivation (IMD). Data from a post-referral questionnaire investigated self-reported changes in dietary and activity behaviors.

Results:

Twenty-seven thousand five hundred sixty (15.6% male) records were analyzed. Mean (SD) age and BMI on joining were 48.6 (14.80) years and 37.1 (6.31) kg/m2; 91.7% had a BMI > 30 kg/m2. Mean (SD) % weight change was −5.6 (3.79), −7.1 (5.71), −7.5 (6.88), and −7.3 (6.88) at 3, 6, 12, and 24-months, respectively. At 24- months, differences in weight loss between BMI category were significant, ranging from 0.29% (35-<40 vs 40+) to 1.33% (25-<30 vs 40+). For IMD quintile only comparisons against Q1 and Q2 were significant, ranging between 0.36% (Q2 vs Q3) to 0.94% (Q1 vs Q5). Five thousand eight hundred sixty-two (21.2%) completed the post-referral questionnaire. There were no BMI category effects on dietary behaviors but changes in physical activity behaviors were lower within the higher categories albeit effect sizes were small (all ges < 0.001). IMD quintile influenced changes for sugary drinks, watching TV and avoiding moderate activity although effect sizes were small (all ges < 0.01).

Conclusion:

Following 12-week referral to a commercial weight management organization, a mean weight loss of over 7% was reported at 24-months. Adults with higher BMIs and a greater level of deprivation can benefit from the practical support offered as part of the referral, supporting weight loss and weight loss maintenance albeit with some inequality.